bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 18895: Utility of Remote Monitoring Using a Mobile Phone in Patients with Heart Failure: the REMOTE-HF-1 Study
Authors: Stahlberg Marcus , Govind Satish C , Orr Nicole M , Gopal Aasha S , Lachmann Justine S , Bhagirath R , Ramesh S S , Lund Lars H , Braunschweig Frieder
Published: July 2021

Objective:
To investigate the clinical feasibility (technical feasibility and patient-/clinician adherence) of remote telemonitoring, using a mobile phone, in an international and diverse HF population.

Methods:
HF patients from five centers in the USA, India and Sweden were equipped with a blood pressure apparatus, digital weight scale and a mobile phone device with custom made software for remote telemonitoring (Vitalbeat®). Patients were asked to record and transmit daily information on body weight, blood pressure and pulse rate as well as symptoms and adherence to medical therapy for 90 days. The primary endpoint, for assessment of general feasibility was defined as % of days with a combination of successful data transmission from patients and data read by clinicians. Acceptable clinical feasibility was a priori set as ≥ 66% of days meeting the primary endpoint. A survey was used to assess patients’ opinions about the remote monitoring system. Data was analyzed according to Intention to treat.

Results:
46 HF patients were included (India=20, USA=13, Sweden=13; 59±16yrs; 84% male; NYHA-class 2.4±0.8) and followed for a total of 4410 days. The primary endpoint occurred in 3178 days (77%) and 34/46 patients (74%) exceeded the cut-off ≥ 66% of days meeting endpoint criteria. In the majority of patients (n=28; 61 %) the primary endpoint was met ≥ 90% of the days, and in 6 patients (13%) 66-89% of the days.Twelve patients (26%) opted to drop out of the study prematurely or were hospitalized for HF related causes. Compared to patients with acceptable clinical feasibility (≥ 66%), patients with less than acceptable feasibility (< 66%) were older (72±12 vs. 56±15 yrs, p=0.003) and more likely to be followed at a center in USA or Sweden (p=0.02 vs. Indian centers). The monitoring system was described as user friendly by 91 % of patients.

Conclusion:
This study shows that remote telemonitoring using a mobile phone is clinically feasible in an international and diverse heart failure population. However, monitoring was less feasible in elderly patients and depended on the geographic location. Further studies are warranted to assess whether clinical feasibility can improve with improved software/hardware design and/or patient selection.
Abstract 18938: Prognostically Important Myocardial Infarctions are Markedly Underreported in Patients Undergoing Percutaneous Coronary Intervention: Insights from CHAMPION PHOENIX
Authors: Mahaffey Kenneth W , Bhatt Deepak L , Stone Gregg W , Gibson C. Michael , Steg P. Gabriel , Hamm Christian W , Wilson Matthew D , Mangum Stacey , Leonardi Sergio , Price Matthew J , Liu Tiepu , Skerjanec Simona , Prats Jayne , White Harvey D , Harrington Robert A
Published: July 2021

Objectives:
In the CHAMPION PHOENIX trial, cangrelor was shown to reduce the primary composite endpoint of death, myocardial infarction (MI), ischemia driven revascularization, or stent thrombosis at 48 hours. We explored the effect of cangrelor on MI including different types of MI and the impact of event adjudication.

Methods:
A central clinical events committee (CEC) systematically identified and adjudicated MI events using pre-defined MI criteria. 30-day death was modeled using baseline characteristics including PCI related MIs.

Results:
Overall, 10,942 patients were included in the primary analyses; 462 patients had at least one MI at 48 hours reported by the CEC (207 [3.8 %] cangrelor; 255 [4.7 %] clopidogrel; OR 0.80; 95% CI [0.67, 0.97];
P
= 0.022), and 143 patients had at least one MI at 48 hours reported by the site investigators (60 [1.1%] cangrelor; 83 [1.5%] clopidogrel; OR 0.72; 95% CI [0.52, 1.01];
P
= 0.053). The Table shows the MI types reported by the CEC, the site investigator reported MIs and treatment comparisons. Of the 462 MIs reported by the CEC, 92 (19.9%) were also reported by site investigators, and 370 (80.1%) were not (170 in cangrelor group, 200 in clopidogrel group). Of the 143 MI events reported by the Site Investigators, CEC reported an MI in 92 (64.3%). CEC reported MI events were independently predictive of 30 day mortality OR 3.48; 95% CI (2.00 - 6.03).

Conclusions:
In patients with ACS undergoing PCI, CEC procedures identified three times as many MIs as the site investigators reported. Site investigators under-report MIs related to percutaneous coronary intervention. MIs reported by the CEC were independently associated with worse 30-day death. The overall efficacy of cangrelor was similar on MIs reported by the site investigators or the CEC.
Abstract 18947: What Can We Learn from Serial Echocardiographic Evaluation of the Aorta in Tetralogy of Fallot?
Authors: Lewis Matthew J , Ginns Jonathan , Rosenbaum Marlon
Published: July 2021

Introduction:
Guidelines for management of aortic root (AoR) dilation with known aortopathies recommend surgical repair when the AoR exceeds 5 cm. Patients with tetralogy of Fallot (TOF) may have an associated aortopathy, though aortic dissection is rare. No guidelines exist regarding timing of surgical intervention. We hypothesized that the rate of AoR dilation in adults with repaired TOF would be low and that an AoR > 5 cm would be associated with standard risk factors.

Methods:
We performed a retrospective study of all adult TOF patients who underwent a transthoracic echocardiogram (TTE) at our Center. Clinical variables and AoR dimension at the sinus of Valsalva were determined. AoR size was treated as an absolute value and as an observed-to-expected ratio based on standard nomograms.

Results:
266 patients met inclusion criteria. On initial TTE, 91 (34%) patients had an AoR > 4.0 cm, 9 (3%) patients had an AoR > 5.0 cm, and 28 patients (11%) had an observed-to expected AoR > 1.5. Male gender, hypertension, and TOF repair at >5 years-old were associated with an AoR > 5.0 cm while only TOF repair at >5 years-old was associated with an observed-to-expected AoR > 1.5. 4 patients had aortic valve (AV) surgery. One patient with an AoR of 5.8 cm had an aortic dissection following pulmonary valve replacement.

206 patients (77%) had serial TTEs. Mean age at first echo was 35.5 years. Mean time between studies was 5.5 years, and 106 patients had a >5 year latency between TTEs. The mean rate of change for all patients was +0.4 mm/year. 72 patients (35%) had an increase in AoR size. 25 patients (12%) had an increase in AoR size ≥0.5cm. Only time >5 years between TTEs was significantly associated with an increase in AoR ≥0.5 cm (p = 0.014). There was no significant association with either rate of AoR increase or AoR increase ≥0.5 cm and gender, hypertension, degree of AR, AV surgery, right-sided arch, AoR> 5cm, time of repair, or prior pregnancy.

Conclusions:
In our cohort of adult patients, AoR dilatation >5.0 cm was uncommon and associated with male gender, hypertension and late repair. The rate of AoR dilation was slow and without clear risk factor. In patients with severe AoR dilation, further study is required to identify significant risk factors for aortic events.
Abstract 18949: Post-Extrasystolic T-Wave Change Predicts Mortality in Survivors of Myocardial Infarction
Authors: Schmidt Georg , Sinnecker Daniel , Müller Alexander , Dommasch Michael , Malik Marek , Barthel Petra
Published: July 2021

Background:
The T-wave of the first normal beat after a ventricular premature complex (VPC) often differs in shape in terms of a change in the T-wave amplitude or in the direction of the T-wave vector. The phenomenon of post-extrasystolic T-wave change (PEST) was first reported by White in 1915 and confirmed in many clinical and experimental studies. However, PEST has not led to a meaningful clinical application. In this study, we tested whether PEST provides prognostic information in contemporarily treated post-MI patients.

Methods and Results:
941 consecutive patients (mean age 61 years, 19% female) presenting with acute MI were enrolled between May 2000 and March 2005. All patients underwent 30-minute recordings of high resolution ECG (1.6 kHz sampling of orthogonal XYZ leads). 224 patients showed VPCs during the 30-minutes. We quantified PEST by two variables (1) change in T-wave area and (2) change in the angle of the T-wave vector in each case compared to the average of three T-waves before and after the first post-extrasysolic beat. PEST was defined as ratio TPEST/T±3 area <1 and ratio TPEST/T±3 angle ≥ 5°. PEST was present in 63 of the 224 patients. Primary endpoint was total mortality during a follow-up period of five years. Uni- and multivariable analyses were performed with traditional risk stratifiers like LVEF ≤ 35%, GRACE score ≥ 120 points and VPC count ≥ 5 per 30 minutes.

During the follow-up, 26 of the patients died. PEST shows the strongest association with mortality in the univariable analysis followed by GRACE score, frequent VPCs and reduced LVEF In the multivariable analysis only PEST and GRACE score were independent predictors of mortality (see table).

Conclusions:
PEST is significantly associated with mortality in survivors of an acute myocardial infarction, and is independent of standard risk predictors. We assume that PEST might becaused by abnormal transmural gradients in action potential duration.
Abstract 18978: Lysine Acetylation of Pyruvate Dehydrogenase Reduces Enzymatic Activity and Contributes to Impaired Substrate Metabolism in the Failing Myocardium
Authors: Zhang Xiaokan , Ji Ruiping , Liao Xianghai , Deng Lily Y , Castillero Estibaliz , Givens Raymond , George Isaac , Schulze P. Christian
Published: July 2021

Introduction:
Many heart failure (HF) associated non-histone proteins are modified by post-translational lysine acetylation which regulates protein activity and affects cardiac function.

Hypothesis:
We hypothesized that acetylation of mitochondrial proteins involved in cardiac metabolism mediate metabolic changes in the failing myocardium. We focused on pyruvate dehydrogenase (PDH) which converts pyruvate, the end-product of glycolysis, to acetyl-CoA, a substrate of the citric acid cycle.

Methods:
Human myocardial tissue from HF patients, failing rodent myocardium after transverse aortic constriction (TAC) induced pressure-overload HF and human cardiomyocyte-like AC16 cells were used. Western Blot, immunoprecipitation assays and mass spectrometry were performed to analyze protein expression and acetylation levels.

Results:
In our studies, we observed a significant increase in overall cardiac protein acetylation in both HF patients (5.8-fold, p<0.05) and in TAC mice (1.8-fold) versus controls. Interestingly, these changes are correlated with a 72% decrease in mitochondrial deacetylase SirT3 expression. The sirtuin inhibitor nicotinamide (NAM) was used to induce mitochondrial protein acetylation. In AC16 cells, NAM treatment leads to a 1.4-fold increase in PDH acetylation level and a 26% decrease in PDH activity was observed (p<0.01). Interestingly, immunoprecipitation assays showed that several PDH associated proteins are also acetylated in response to NAM treatment. Human proteomic mass spectrometry screening confirmed increased PDH acetylation in failing human myocardium compared to control samples. Furthermore, PDH expression is reduced by 47% in failing human myocardium compared to controls (p<0.01). Finally, PDH activity was found to be decreased by 56% (p<0.01) in human failing myocardium compared to controls.

Conclusions:
Together, our data suggest that increased acetylation of PDH due to reduced SirT3 expression in HF contributes to altered mitochondrial substrate metabolism and is associated with cardiac dysfunction. These findings suggest a novel role for acetylation of PDH in the failing myocardium.
Abstract 18989: Periprocedural Heparin Requirement in Patients Undergoing Atrial Fibrillation Ablation Stratified by Different Baseline Anticoagulation Regimens: Evidence for a Prothrombotic State With Interrupted Dabigatran
Authors: Benhayon Daniel , Santangeli Pasquale , Zado Erica , Ryan John , Callans David , Marchlinski Francis
Published: July 2021

Introduction:
Thromboembolic (TE) and bleeding complications represent the most common adverse events during atrial fibrillation (AF) ablation. In order to prevent TE, unfractionated heparin (UFH) is recommended throughout the procedure, with a target ACT of 350-400 sec.

In this study we compared periprocedural heparin requirements during different pre-procedure anticoagulation regimens and the potential clinical implications.

Methods:
We retrospectively analyzed every case of AF ablation performed at our institution over the last 2 years, including only first time ablations, and collected the amount of UFH per kilogram needed to achieve the target ACT.

The groups were compared based on the periprocedural anticoagulation strategy (warfarin vs. dabigatran vs. rivaroxaban), and the number of doses held before the procedure.

Patients on warfarin were all on uninterrupted warfarin, but for comparison we further subdivided this group into INR tertiles, based on INR at time of procedure.

Results:
We included 584 patients. Of those 391 (67%) were on warfarin, 162 (28%) were receiving dabigatran and 31 (5%) rivaroxaban. Baseline characteristics were not significantly different

between the groups, including procedural duration and baseline creatinine. 54.1% had paroxysmal AF and 5.3% had a prior TIA/stroke.

Patients that held ≥2 doses of dabigatran needed significantly more UFH-per-kilogram-per-procedure, as compared to patients on warfarin with INR <1.5. (15% more; p=0.029). See figure.

No differences were observed between those on warfarin with INR ≤1.5 and those holding ≥2 doses rivaroxaban (p=0.56).

No significant differences were observed in the rate of bleeding or TE complications between groups (P=0.18).

Conclusions:
Interrupted dabigatran is associated with significantly increased need for UFH compared to those functionally off warfarin, which may suggest a slight rebound procoagulant effect due to dabigatran interruption.
Abstract 19005: Staying Connected: a CVD Risk Intervention for Young Black Women
Authors: Eastwood Jo-Ann , Moser Debra K , Alshurafa Nabil , Doering Lynn V , Watson Karol , Sarrafzadeh Majid
Published: July 2021

Fifty thousand Black women, disproportionately affected by cardiovascular disease (CVD), die annually; 49% of Black women ≥ 20 years have CVD. Implementing proactive risk reduction is essential. The purpose of this community - based pilot was to test the feasibility of a program combining self-care education with wireless individualized feedback via a unique smartphone designed to appeal specifically to young Black women (YBW).

Methods:
Using church-based recruitment, 49 YBW (aged 25-45 years, 60% single) were randomized to treatment (TX) and control groups by church site. The TX group participated in 4 interactive self-care classes on CVD risk reduction. Each participant set individualized goals. Risk factor profiles (waist circumference (WC), BP, lipid panel by Cholestech [Alere]), medical and reproductive history and a battery of psychosocial instruments were assessed prior to classes and 6 months later. Participants were given smartphones with embedded accelerometers and WANDA-CVD, an application that delivered prompts and messages specifically for this pilot. For activity monitoring, phones were worn on the hip during waking hours. Participants obtained and transmitted BP measurements wirelessly via the phone. Changes over time were measured with paired t-tests and linear regression controlling for age and weight. Effect sizes were calculated using Cohen’s D.

Results:
In risk factor profiles, significant differences favoring the TX group occurred in DBP, WC, and TC/HDL ratio; similar changes in triglycerides yielded a medium-large effect size (Table). TX participants had greater drops in stress, anxiety, and better adherence to heart healthy habits.

Conclusion:
These interim pilot data validate the feasibility of a combined education/wireless monitoring-feedback program in YBW. Further testing in a large randomized trial is warranted to determine long-term effects on behavior change and cardiac risk profiles in this high risk population.
Abstract 19023: Is there a Correlation Between Bleeding Risk Score and Platelet Aggregability?
Authors: Arantes Flavia B , Furtado Remo H , Barbosa Carlos J , Franci André , Menezes Fernando R , Falcao Talia D , Nakashima Carlos A , Baracioli Luciano M , Ramires Jose A , Nicolau Jose C
Published: July 2021

Background:
Clinically relevant bleeding in ACS patients is strongly associated with mortality, with an HR similar to that of stent thrombosis. Although recent data have suggested that on-treatment platelet reactivity after PCI is an independent predictor of bleeding events, this correlation is not as clearly established as for HPR and stent thrombosis, with very few conflicting publications in the literature. The main objective of the present analysis was to evaluate the relationship between platelet reactivity and bleeding risk score in ACS patients submitted to PCI.

Methods:
In a prospective way, we assessed platelet aggregability using VerifyNow P2Y12® assay from 131 ACS patients submitted to PCI, at their discharge from the Coronary Care Unit. All patients were on DAPT with aspirin 100mg + clopidogrel 75mg daily. Low platelet reactivity (LPR) was defined as VerifyNow <85 P2Y12 Reaction Units (PRU). The ACUITY/HORIZONS-AMI bleeding risk score was used to assess the population’s bleeding risk.

Results:
The mean age of the population was 64 years. Low platelet reactivity was observed in 25 patients (19%). There was no significant difference between LPR and no-LPR groups in relation to the mean bleeding risk score (14,6±7,7 PRU vs 15,3±6,9 PRU respectively, p=0.453). By linear regression, a very poor correlation was detected between VerifyNow P2Y12® values and bleeding score risk values (figure 1). By multivariable analysis, only hypertension (OR 0,23; 95% CI 0.093 to 0.73, p=0.01) and previous PCI (OR 2,9; 95% CI 1.05 to 8,2, p=0.04) correlated independently with LPR.

Conclusion:
In post-PCI ACS patients, there is no correlation between platelet aggregability and bleeding risk score. Although the latter is an important toll to minimize bleeding complications, more data is necessary to assess the role of platelet aggregability in the decision making process of this population.
Abstract 19059: Thermodilution-derived Coronary Blood Flow Pattern Immediately After Coronary Intervention as a Predictor of Long-term Clinical Outcomes in Patients With ST-segment Elevation Myocardial Infarction
Authors: Fukunaga Masashi , Fujii Kenichi , Nishimura Machiko , Horimatsu Tetsuo , Saita Ten , Sumiyoshi Akinori , Tamaru Hiroto , Miki Kojiro , Imanaka Takahiro , Masuyama Tohru
Published: July 2021

Background:
We reported that coronary blood flow (CBF) can be evaluated by analyzing thermodilution curve that is measured with a single pressure sensor/thermistor-tipped guidewire in the cardiac catheterization laboratory during percutaneous coronary intervention (PCI). Bimodal shape of thermodilution curve was associated with microvascular damage and predictors of left ventricular functional recovery after ST-segment elevation myocardial infarction (STEMI). However it is unknown whether the bimodal shape of thermodilution curve predicts mortality and re-hospitalization for heart failure in long term period for patients experiencing STEMI.

Methods:
Between September 2009 and August 2012, 97 consecutive patients with a first STEMI were prospectively enrolled in this study. Using a pressure sensor/thermistor-tipped guidewire, CBF pattern was assessed from the thermodilution-curves after successful PCI at maximum hyperemia. CBF pattern was classified into 3 groups according to the shape of thermodilution curve: a narrow unimodal (a rapid fall and rise of temperature-time curves) (n=47), a wide unimodal (a gradual fall and rise of temperature-time curves) (n=33), or bimodal (two populations with valley deeper than 20% of peak temperature drop) (n=17). Major adverse cardiac events (MACE) were defined as cardiac death and/or heart failure re-hospitalization within this study period.

Results:
Median follow-up period was 2.4 years. Although patients in the narrow-unimodal group and the wide unimodal group had a significantly lower incidence of MACE, patients in bimodal group had a higher risk of MACE during this study period (71, 15, 21%, p<0.001). Multivariate analysis revealed that bimodal shape of the thermodilution-curve was the only independent predictor of MACE after STEMI (hazard ratio, 8.38; 95% confidence interval, 2.13-33.00; P=0.0023).

Conclusions:
A bimodal shape of the thermodilution curve is associated with the poor long-term clinical outcomes. This easily assessable coronary flow pattern is useful in clinical risk stratification for STEMI patients in the cardiac catheterization laboratory immediately after PCI.
Abstract 19082: Cardiac Events and Mortality During Admissions for Delivery in Women with Congenital Heart Disease
Authors: Hayward Robert M , Foster Elyse , Tseng Zian H
Published: July 2021

Background:
Labor, delivery, and the postpartum period are a time of increased arrhythmia and congestive heart failure (CHF) incidence. With improvements in the treatment of congenital heart disease (CHD), more women are reaching childbearing age and may be at increased risk for cardiac events and mortality during pregnancy and delivery.

Methods:
The Healthcare Cost and Utilization Project was used to identify admissions for vaginal and cesarean delivery in California hospitals between 1/1/2005 and 12/31/2011. We compared length of stay, in-hospital mortality, incident CHF, cardiac arrest, and incident arrhythmias for women without CHD to women with non-complex CHD (NC-CHD) and complex CHD (C-CHD).

Results:
We identified 2,720,980 deliveries resulting in 2,770,382 live births (74% of live births in the state over this period), which included 3,218 women with NC-CHD and 248 women with C-CHD. History of CHF was more common in women with CHD (8.1% for C-CHD, 2.6% for NC-CHD, and 0.08% for women without CHD, p<0.00005 for NC-CHD compared to no CHD and for C-CHD compared to no CHD). Those with CHD were more likely to undergo cesarean section (Table 1). Length of stay was significantly longer in women with CHD (2.6 ± 2.3 days for women without CHD, 3.4 ± 10.2 days for women with NC-CHD and 5.0 ± 13.3 days for women with C-CHD). In-hospital mortality was not significantly higher in women with CHD (Table 1). Incident heart failure, arrhythmias, and cardiac arrest were uncommon in all groups (Table 1).

Conclusions:
In this study of 2.7 million women admitted to California hospitals for delivery, women with CHD were more likely to undergo cesarean section and had longer length of stay. Despite more frequent history of CHF in women with CHD, incident CHF and arrhythmias were rare during hospitalization. In-hospital mortality and cardiac arrest were not higher in CHD patients. These results suggest that in pregnant women with CHD, cardiac events and mortality at the time delivery are uncommon.
Abstract 19088: Independent Association of Lipoprotein Sub-fractions by Ion Mobility Analysis with Anthropometric and Ectopic Visceral fat on Cardiac CT Examinations in a High risk Population: The Baptist Employee Healthy Heart Study (BEHHS)
Authors: Oni Ebenezer T , Aneni Ehimen C , Veledar Emir , Roberson Lara , Nagi Gagandeep , Shaharyar Sameer , Jamal Omar , Ali Shozab S , Guzman Henry , Malik Rehan , Aziz Mohammad , Cury Ricardo , Fialkow Jonathan , Ozner Michael , Agatston Arthur S , Post Janisse , Feldman Theodore , Nasir Khurram
Published: July 2021

Introduction:
Visceral adiposity is associated with increased CVD risk. Ectopic fat deposition is linked with lipotoxicity, metabolic derangement, insulin resistance, and atherosclerosis. The lipoprotein(LP) subclasses are established risk markers for CVD mortality. We evaluated for the association of ectopic visceral fat measures [pericardial (PCF), Epicardial (EPC)], traditional adiposity measures [waist: hip ratio (WHR), Body Mass index (BMI), waist circumference (WC)] and the LP subclasses.

Methods:
The Baptist Employee Healthy Heart Study (BEHHS) an ongoing study examines the effect of web based interventions on reducing CVD risk in subjects with metabolic syndrome and type II diabetes mellitus. We measured PCF and EPC adipose tissue volumes from the 16-slice multi-detector computed tomography (MDCT) (GE AWW 3D Workstation). Cardio IQ™ Ion Mobility LP fractionation was utilized for advanced lipid subclass measurement resulting in direct quantification of particles in each LP sub-class fraction.

Results:
The population had 182 participants, 74% women, 49% Hispanic, mean age of 52 ± 9 years. The median PCF volume was 130 (97-166) cc, EPC volume 112(78-265) cc, mean WC 105±15 cm, BMI 34±6 kg/m2 ,WHR was 0.94 (SD 0.09). There was no correlation between BMI, and WC with any of the LP. WHR was significantly correlated with LDL particle size LDL large (A), , IDL small, and HDL large, see table 1. These associations were not significant in multivariate regression analysis. On the other hand PCF and ECP were significantly correlated with a wide spectrum of the LPs. After an adjusted robust regression, they remained significantly associated with IDL(large), LDL(total), VLDL(small), VLDL(medium) and VLDL(large).

Conclusion:
This demonstrates association between the ectopic adiposity and LP subclasses compared to traditional obesity measures. Further follow-up is needed to assess the interplay of lifestyle intervention in improving cardiometabolic profile
Abstract 19120: Preoperative Symptoms Predict Improvement in Health-related Quality of Life After Surgery for Severe Aortic Stenosis, While Preoperative Echocardiographic Parameters Do Not
Authors: Auensen Andreas , Hussain Amjad , Rognstad Maja , Rognstad Maja , Aakhus Svend , Aakhus Svend , Beitnes Jan Otto , Gullestad Lars , Pettersen Kjell
Published: July 2021

Introduction:
Symptoms and echocardiographic assessment of the heart and the aortic valve are key factors in the pre-operative decision-making process in patients with severe aortic stenosis (AS). Improved survival and HRQoL are primary goals after surgical aortic valve replacement (SAVR). In this study, we report changes in HRQoL one year after SAVR and study the association between symptoms, echocardiographic measures, and change in HRQoL.

Methods:
In a prospective cohort study of 480 patients with severe AS, 327 patients have been to follow-up at one year, and of these 276 patients have had SAVR. Mean age was 74 years, and 40 % (111) were female. HRQoL was measured using Short-Form 36 (SF-36). Response rate was > 90%. Patients` answers on type (fatigue, dyspnea, chest pain or dizziness) - and frequency (last week) of cardinal AS-symptoms were used to create three patient groups based on estimated total symptom load. We used valve area, mean pressure gradient, cardiac output, ejection fraction, and estimated systolic pulmonary artery pressure as echocardiographic measures of heart function and AS characteristics.

Results:
Mean valve area was 0.7 cm2, mean pressure gradient was 53 mmHg, mean maximum valve velocity 4.5 m/s, mean estimated systolic pulmonary artery pressure 36 mmHg, cardiac output 5,2 m/s, and 89 % had normal ejection fraction.

There was a statistically significant improvement in HRQoL one year after SAVR in six of the eight SF-36 scales. Physical Functioning: (mean pre-operative - mean post-operative score) 61 - 72 p < 0.001, Role-physical Functioning: 52 - 62 p < 0.001, Bodily Pain: 65 - 74 p < 0.001, General Health: 58 - 71 p < 0.001, Vitality: 48 - 56 p < 0.001, Social Functioning: 78 - 81 p = 0.2, Role-emotional Functioning: 77 - 80 p = 0.2, Mental Health: 77 - 80 p = 0.02. There was no association between the echocardiographic parameters and change in HRQoL.

Conclusions:
There was a substantial gain in HRQoL after SAVR. Despite their importance in the pre-operative assessment, echocardiographic measures did not predict change in HRQoL. After SAVR, patients with more symptoms experience the greatest yield in HRQoL, and amount of AS-symptoms is a strong predictor of intermediate HRQoL.
Abstract 19155: Pulsatile Load is a More Important Determinant of Peak Fiber Stress than Valve Area in Aortic Stenosis
Authors: Zamani Payman , Konda Prasad , Akers Scott , Vadde Neetha , Dunde Anjaneyulu , Bhuva Rushik , Peddireddy Shivapriya , Panchal Vandan , Ferrari Victor , Segers Patrick , Chirinos Julio A
Published: July 2021

Background:
In aortic stenosis (AS), the valve imparts an additional hemodynamic burden on the LV in proportion to the degree of valve narrowing. Yet the relative contributions of valve stenosis and arterial load on LV fiber stress are unknown. Furthermore, it has recently been shown that end-systolic measurements of wall stress are unrepresentative of the time-resolved wall stress patterns. Yet, time-resolved LV fiber stress has never been assessed in AS.

Hypothesis:
Arterial load is an important determinant of time-resolved wall stress in AS.

Methods:
We assessed time-resolved LV geometry (using SSFP cine MRI), aortic flow (using phase-contrast MRI) and central aortic pressure (using carotid tonometry) among 40 patients with AS (16 mild, 20 moderate, and 4 severe AS). Arterial load parameters were determined using pressure-flow analyses, including systemic vascular resistance, characteristic impedance of the aorta (Zc), total arterial compliance (pulse-pressure method, TAC), and the amplitudes of the backward (Pb) and forward (Pf) waves. We computed time-resolved ejection-phase myocardial fiber stress using the Arts method.

Results:
Peak fiber stress occurred at 94.4 msec into systole and was significantly greater than end-systolic fiber stress (847±265 vs. 361±149 kdynes/cm2, P<0.0001). After adjusting for cardiac output, AVA, and end-diastolic mass and volume, Pb, TAC, and SVR were all associated with peak and end-systolic fiber stress (Table). Interestingly, while AVA was associated with peak stress, it was not associated with end-systolic stress in any model.

Conclusion:
Peak fiber stress occurs early in systole in AS, demonstrating the importance of time-resolved fiber stress assessments. Our findings demonstrate important contributions from the arterial system to LV fiber stress in AS, including resistive load and various measured of pulsatile arterial load.
Abstract 19159: Assessment of Myocardial Viability After Acute Myocardial Infarction: A Head-to-head Comparison of the Perfusable Tissue Index by PET and Delayed Contrast-enhanced CMR
Authors: Timmer Stefan A , Teunissen Paul F , Danad Ibrahim , Robbers Laurens F , Raijmakers Pieter , Beek Aernout M , van Rossum Albert C , Lammertsma Adriaan A , van Royen Niels , Knaapen Paul
Published: July 2021

Introduction:
Early recognition of viable myocardium is of great clinical importance after acute myocardial infarction (AMI). Delayed contrast-enhanced magnetic resonance imaging (DCE-CMR) has been validated extensively for the detection of viability. An alternative method for detecting viability is the perfusable tissue index (PTI), a positron emission tomography (PET) derived parameter, which is inversely related to the extent of myocardial scar (nonperfusable tissue).

Aims:
To investigate the predictive value of PTI on recovery of LV function after percutaneous coronary intervention (PCI) for AMI.

Methods:
Twenty-six patients with AMI successfully treated by PCI were included. Subjects were examined one week and three months after AMI with [15O]H2O PET and DCE-CMR to assess PTI, regional function and scar. Viability was defined as recovery of systolic wall thickening (SWT) ≥ 3.0 mm at follow-up.

Results:
A total of 396 segments were available for serial analysis. At baseline, 166 segments were dysfunctional, of which 125 (75%) exhibited significant DCE and were located in the myocardial territory supplied by the culprit-artery. Fourty-nine of these dysfunctional segments showed full recovery during follow-up (viable), whereas 76 segments remained dysfunctional (nonviable). Baseline PTI of viable segments was 0.94 ± 0.07 and was significantly higher compared to nonviable segments (0.80 ± 0.11, p = 0.01). The optimal cut-off value for the PTI was 0.85 with a sensitivity of 92% and specificity of 71%, and an area under the curve (AUC) of 0.88. In comparison, a cut-off value of 40% for the extent of DCE resulted in a sensitivity of 75% and a specificity of 65%, and an AUC of 0.75 (p = 0.02 vs PTI).

Conclusions:
This study shows that assessment of myocardial viability shortly after reperfused AMI is feasible with PET, and that the PTI is a good prognostic indicator for recovery of contractile function when compared to DCE-CMR.
Abstract 19169: Anakinra - A Promising New Therapy for Idiopathic Recurrent Pericarditis
Authors: Jain Sonia , Thongprayoon Charat , Espinosa Raul E , Hayes Sharonne N , Klarich Kyle W , Anavekar Nandan S , Moder Kevin G , Oh Jae K , Matteson Eric L
Published: July 2021

BACKGROUND:
Idiopathic recurrent pericarditis (IRP) is a debilitating condition that can be recalcitrant to conventional therapy. Some patients develop steroid dependency with the attendant risks of systemic side effects and increased future recurrence. Anakinra is a recombinant human interleukin-1 receptor antagonist that reduces systemic inflammatory responses. The aim of this study was to evaluate the therapeutic role of anakinra in IRP.

Methods:
We retrospectively studied consenting patients with treatment refractory IRP who received anakinra, between January 2009 and November 2013. The primary end points were symptom resolution and steroid discontinuation.

Results:
Nine patients were followed for a median of 16.8 (IQR 1.3-24) months. Study subjects were predominantly female (7 [78%]) with a median age of 53 (IQR 38 - 58) years. All 9 patients had failed maximum tolerated doses of NSAIDs, colchicine and prednisone (median dose 20 mg [IQR 15 - 22.5]). Primary symptom was chest pain in 9 (100%), with concurrent dyspnea in 5 (56%) patients. Symptom duration prior to anakinra initiation was 24 (IQR 13 - 71) months. Indication for anakinra was steroid sparing agent in 7 (78%) and symptom control in 2 (22%) patients. The dosage was 100 mg once daily via subcutaneous injection. Baseline LVEF was 62% (IQR 59% - 67%). Echocardiographic findings include pericardial effusion in 3 (33%), pericardial thickening in 6 (67%), and constrictive physiology in 4 (44%). Pericardial enhancement on cardiac MRI was seen in 7 (78%) patients. All 9 patients (100%) had symptom improvement with complete resolution in 8 (89%) and partial resolution in 1 (11%) patient. At last follow up, all 9 (100%) patients had discontinued NSAIDs and colchicine, 5 (56%) patients discontinued and 4 (44%) had reduced prednisone dosage. All patients remained on anakinra at the end of follow up. The only reported side effect was transient injection site reaction in 4 (44%) patients. In 2 (22%) patients, attempted anakinra weaning was unsuccessful due to symptomatic flare after 6 weeks.

Conclusion:
Anakinra is an effective alternative agent for the management of steroid dependent IRP. It provides remarkable symptomatic amelioration, limits steroid dependency, and is associated with minimal side effects.
Abstract 19179: Prognostic Value of Combined Coronary Computed Tomography Angiography and Positron Emission Tomography Perfusion Imaging in Patients With Suspected Coronary Artery Disease
Authors: Maaniitty Teemu , Soukka Iida , Saraste Antti , Uusitalo Valtteri , Ukkonen Heikki , Kajander Sami , Mäki Maija , Bax Jeroen , Knuuti Juhani
Published: July 2021

Objectives:
Hybrid imaging using coronary computed tomography angiography (CTA) and positron emission tomography (PET) perfusion imaging accurately detects functionally significant coronary artery disease (CAD), but its optimal clinical use remains unknown. We studied the prognostic significance of strategy utilizing sequential CTA for exclusion of CAD followed by PET perfusion imaging for evaluating functional significance of any suspected obstructive lesions with a hybrid PET-CT device in symptomatic patients with suspected intermediate probability of CAD.

Methods:
We identified a cohort of 864 consecutive patients undergone hybrid PET-CT for the detection of suspected CAD. All patients had CTA and based on CTA findings, haemodynamic significance of any suspected stenoses was evaluated by PET perfusion imaging using H
2
15
O during adenosine-induced stress. Major adverse cardiac events (MACE) including death, myocardial infarction (MI) and unstable angina pectoris (UAP), were collected from the national healthcare statistics.

Results:
After exclusion of 97 patients undergone early (< 6 months) revascularization, 767 patients with age of 61 ± 10 years (41% males) were followed-up for a median time of 2.5 years. During the follow-up 6 deaths, 5 MIs and 3 UAPs occurred. In 462 patients, obstructive CAD was excluded based on CTA alone and the remaining patients with suspected stenoses (n=305, 39.8%) underwent PET perfusion imaging. In patients with normal or non-obstructive CTA annual incidence of MACE was only 0.16%, whereas in patients with suspected stenosis based on CTA it was 1.36% (p<0.05 vs. no stenosis). In patients with suspected obstructive lesion based on CTA, patients with normal PET perfusion had significantly lower event rate than patients with ischemia (0.54 vs. 2.78%, p<0.05).

Conclusion:
In patients with suspected obstructive CAD PET perfusion imaging after CT angiography is able to accurately identify those patients with high risk of future MACE. Sequential use of CTA and PET perfusion imaging appears powerful and safe strategy for targeting therapeutic procedures in high risk individuals.
Abstract 19195: Pulmonary Artery Pulsatility Index Predicts Right Ventricular Failure Following LVAD Surgery
Authors: Morine Kevin J , Kiernan Michael S , Pham Duc T , Denofrio David , Kapur Navin K
Published: July 2021

Introduction:
Identification of pre-operative right ventricular dysfunction may improve patient selection for isolated LVAD surgery. The pulmonary artery pulsatility index (PaPi) is a recently described hemodynamic metric. We evaluated baseline PaPi as a predictor of post-operative right ventricular failure (RVF) following LVAD surgery.

Methods:
We conducted a retrospective review of 132 consecutive LVAD implantations at our hospital. Demographic, clinical, hemodynamic and echocardiographic data were evaluated for their association with the development of RVF. RVF was defined as need for RVAD or inotrope dependence for greater than 14 days. PaPi was calculated as [(systolic pulmonary artery pressure-diastolic pulmonary artery pressure)/right atrial (RA) pressure]. Univariate analysis was performed to identify baseline predictors of RVF. Multivariate logistic regression was used to adjust for baseline RA pressure.

Results:
RVF occurred in 31 of 132 patients (23%); all cases were due to prolonged inotropes. PaPi was lower among patients with RVF compared to those without (no RVF: mean 2.75± SD1.17 vs RVF: 1.38±0.46, P<0.0001). RA pressure, RA to pulmonary capillary wedge pressure ratio (RA/PCWP) and RV stroke work index (RVSWI) were also associated with RVF. Previously identified markers of RV function including mean pulmonary artery pressure and qualitative RV dysfunction by 2D echo were not associated with RVF. Comparison of the area under the curve from receiver operator characteristic curve analysis demonstrated that a PaPi<1.85 was most predictive of RVF (Figure). PaPi remained an independent predictor of RVF after adjusting for RA pressure in a multivariate model.

Conclusions:
PaPi is a routinely available and easily calculated hemodynamic variable associated with RVF following LVAD surgery superior to established markers. Further evaluation of PaPi as part of a risk prediction model to guide clinical decision making may be warranted.
Abstract 19236: Effect of Continuous Flow Left Ventricular Assist Device on Diastolic Pulmonary Artery Pressure-to-Pulmonary Capillary Wedge Pressure Gradient in End Stage Heart Failure Patients with Pulmonary Hypertension
Authors: Thenappan Thenappan , Cogswell Rebecca , Kamdar Forum , Holley Christopher , Harvey Laura , Colvin-Adams Monica , Eckman Peter , Adatya Sirtaz , John Ranjit , Liao Ken , Pritzker Marc R
Published: July 2021

Background:
Continuous flow left ventricular assist devices (LVAD) reduces transpulmonary gradient (TPG) and pulmonary vascular resistance (PVR) in end-stage HF patients with pulmonary venous hypertension (PVH). However, TPG and PVR are flow dependent and may not reflect intrinsic pulmonary vascular remodeling. Diastolic pulmonary artery pressure-to-pulmonary capillary wedge pressure gradient (DPG) has been shown to more accurately reflect pulmonary vascular remodeling.

Objective:
We sought to evaluate the effect of LVAD on DPG in end-stage HF patients with PVH (mPAP > 25 mm Hg and PCWP > 15 mm Hg).

Methods:
We retrospectively reviewed clinical and hemodynamic data on 116 end-stage HF patients with PVH who underwent LVAD implantation and analyzed changes in DPG between pre- and first post-LVAD right heart catheterization (RHC).

Results:
The mean age was 55 ± 14 years and 78% were males. Of the 116 patients, 83 patients had pre-LVAD DPG 7 mm Hg (Combined post-and pre-capillary PVH). The median duration between the pre-and post-LVAD RHC was 147 (IQR: 106-302) days. Table below compares pre-and post-LVAD hemodynamics. In patients with combined post-and pre-capillary PVH, LVAD therapy significantly decreased DPG (9 ± 4 vs. 6 ± 6; P<0.001). However, 42% of these patients did not lower DPG to <7 mmHg with LVAD therapy (non-responders). On multivariate regression, higher pre-LVAD DPG was the only independent factor associated with non-responders. Pre-LVAD DPG >8 mm Hg had 77% sensitivity and 88% specificity for identifying non-responders (AUC 0.82).

Conclusion:
Although DPG decreased after LVAD therapy, it remained significantly elevated (>7mm Hg) in a subset of patients with combined post-and pre-capillary PVH. DPG >8 mm Hg is significantly associated with non-response to LVAD therapy. Additional studies are warranted to assess the impact of these findings on outcomes.
Abstract 19239: Patient Outcomes and Quality of Life 15 years or more after the Ross Operation in Adults
Authors: Ibrahim Michael , Torii Ryo , El-Hamamsy Ismail , Mittal Tarun , Gaer Julien , Takkenberg Johanna J , Yacoub Magdi H
Published: July 2021

Introduction:
The Ross operation provides a living aortic valve substitute with very good results in the medium term. There is continuing concern about its durability in adults.

Methods:
We reviewed a series of patients operated on (by a single surgeon) and prospectively followed up at our centre who underwent the Ross operation at least 15 years before.

Results:
Among 84 patients (69 male, median age at operation 37.5 (range 19.8 - 64.4)), there were 1 early and 4 late deaths. Actuarial survival was 94.9% (55 patients at risk (PAR)) at 15 years and 87.6% (10 PAR) at 19 years, compared to 95.6% at 15 years and 92.7% at 19 years for an age and sex matched UK population. Actuarial freedom from aortic or pulmonary reoperation was 89% (51 PAR) at 15 years and 72.1% at 19 years (10 PAR). Serial echocardiographic follow-up demonstrates stable aortic root dimensions over time without ventricular dilatation. Figure 1 shows the degree of aortic regurgitation over time, which has not increased in the large majority of patients. We assessed quality of life using the Short Form-36 point questionnaire which was 50·7 [median score, 2014, IQR 43.4-59.7] vs 51·0 [2009, IQR 45·9-56·1], non-significant). This compares favourably with previously published quality of life scores in patients with prosthetic valves. Of note, our oldest patient (a female aged 64 at operation), is now 80 years old with maintained valve and ventricular function, and leading an active life.

Conclusions:
It is concluded that the Ross operation provides a durable aortic valve and root substitute with good quality of life for periods of up to twenty years.
Abstract 19298: Is the Seasonal Variation in Acute Aortic Dissection Occurrence Associated with Flu Activity?
Authors: Sandhu Harleen K , Charlton-Ouw Kristofer M , Leake Samuel S , Azizzadeh Ali , Nguyen Tom C , Estrera Anthony L , Safi Hazim J , Miller Charles C
Published: July 2021

Introduction:
Numerous reports have described seasonal patterns of acute aortic dissection (AAD), but reasons for such patterns are unknown. Correlations between cardiovascular morbidity and seasonal influenza have also been described.

Methods:
We compared monthly admissions for AADs at our institution to the US seasonal influenza activity based on US Centers for Disease Control statistics over 13 years. Seasonal variation was modeled by autoregressive integrated moving average (ARIMA) analysis, and multivariate effects of season and influenza activity on aortic dissection admissions were assessed by response surface regression.

Results:
From January 2001 to December 2013, we treated 869 patients with AAD (398 type A, 442 typical type B, 29 type B variants). Admissions for AAD were identified as highest during the months of November to March (high period-HP). For type A AAD, 3.1 cases per month were admitted during HP, compared to 2.1 cases per month for the remainder of the year (p<0.002). Type B AADs averaged 3.2 cases/month during the HP compared to 2.9 cases/month for the remainder of the year (p=0.40). Influenza activity averaged 2.6% during HP compared to 1.1% in the remaining months (p<0.0001). ARIMA models for AAD over the entire 156 month observation period showed statistically significant seasonality (p<0.0001), and smoothed spline plots showed type A dissection and flu activity moving cyclically and generally in synchrony throughout the period (fig 1). Response surface regression demonstrated significant effects of flu activity (p<0.034) and month of the year (p<0.048) on the rate of AAD occurrence at our center.

Conclusion:
Presentation of AAD to our center and seasonal influenza activity in the US were both elevated during the HP, and were significantly correlated. Type A AAD significantly correlated with season or flu activity while Type B did not. Seasonal flu vaccination among high risk patients may be appropriate