bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 2142: Diagnostic and Prognostic Value of Augmented ST-Segment Elevation at Exercise Testing in Patients with Brugada Syndrome
Authors: Makimoto Hisaki , Nakagawa Eiichiro , Takaki Hiroshi , Yamagata Kenichiro , Kawata Hiro , Okamura Hideo , Noda Takashi , Satomi Kazuhiro , Suyama Kazuhiro , Kurita Takashi , Aihara Naohiko , Kamakura Shiro , Shimizu Wataru
Published: July 2021

Background
: It has been reported that ST-segment elevation was augmented at early recovery phase or at peak exercise during exercise testing in some patients with Brugada syndrome (BrS), but its diagnostic and prognostic value has not fully been clarified.

Methods
: Treadmill exercise testing (TMT) was conducted in 93 patients (pts) with BrS (22 documented VF, 31 syncope alone, and 40 asymptomatic; 91 males, 46±14 years) and 22 healthy control subjects (20 males, 48±14 years, 11 with incomplete right bundle branch block (RBBB) and 4 with complete RBBB).

Results
: The augmentation of ST-segment elevation ≥0.05mV in V1-V3 leads compared with that before exercise was observed at early recovery phase (1– 4 minutes at recovery phase) in 32 BrS pts (34%, Group1), at peak exercise in 8 BrS pts (9%, Group 2), but not in either the remaining 53 BrS pts (57%, Group 3) or 22 control subjects. There were no significant differences among the 3 BrS groups in the baseline clinical (age, gender, family history of sudden death,
SCN5A
mutation), electrocardiographic (PR, QRS duration, QTc interval and ST amplitude), and electrophysiologic (AH, HV interval, and VF induction) variables except for the positive ratio of signal averaged ECG (87%, 48%, 63%; P= 0.001). No significant difference was observed in the proportion of previous cardiac events (VF/syncope/asymptomatic; 6/12/14, 0/3/5, 16/16/21, respectively for Group 1, 2, and 3). During 76.0, 74.8, and 52.0 months follow-up, VF occurred in 12/32 (38%) pts of Group1, 0/8 (0 %) pts of Group2, and 10/53 (19%) pts of Group3. Augmentation of ST-segment elevation at early recovery phase was a significant and an independent predictor for subsequent VF occurrence (12/32 (38%) in Group1 vs. 10/61 (16%) in Group2 and 3; hazard ratio [HR]= 1.68; P=0.014), especially in 31 pts with a history of syncope alone (6/12 (50%) in Group1 vs. 1/19 (5%) in Group2 and 3; HR=3.44; P=0.004).

Conclusions
: Our data suggest that augmentation of ST-segment elevation at early recovery phase during exercise testing can be a predictor of poor prognosis in patients with Brugada syndrome, especially in those with a history of syncope alone.
Abstract 2157: Racial Differences in Hospitalizations for Atrial Fibrillation in the United States
Authors: Tabereaux Paul B , Brown Todd M , Osorio Jose , Kay G. N , Bravada Dawn M
Published: July 2021

Introduction:
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the United States; however a paucity of population-based data about nonwhite individuals exist. The objectives of this study were to compare hospitalizations among Whites and African Americans (AA) and to determine whether race is an independent predictor of hospitalization for AF in the United States.

Methods:
Data was obtained from the National Hospital Discharge Survey (years 1996 –2005) and included hospitalizations with a principal diagnosis of AF for patients aged ≥18 yrs and race designated as either White or AA. Codes from the
International Classification of Diseases
-9th revision were used to define AF (427.31), hypertension (401– 405), ischemic heart disease (410 – 414), diabetes mellitus (250), heart failure (425,428) and valvular heart disease (424). Multivariable analysis with logistic regression was used to identify factors that were independently associated with AF hospitalizations

Results:
Among 297,962,043 hospitalizations between 1996 –2005, 3,676,787 (1.2%) had a principal diagnosis of AF. Among the hospitalizations for AF, white race was more common than AA race (2,393,659/186,904,962 of whites (1.3% of white’s hospitalized) and 209,788/33,972,665 of African Americans (0.6% of AA’s hospitalized), p<0.0001). After adjusting for the most common risk factors for AF (age, sex, hypertension, ischemic heart disease, diabetes mellitus, heart failure and valvular heart disease) AA race was independently associated with a decreased odds of hospitalizations for AF (Table 1

: adjusted OR=0.49, 95%CI 0.46 – 0.51).

Conclusions:
After adjusting for the most common risk factors for AF, the odds of hospitalization for AF in AA’s remained half that of whites. Race may be a novel and unaccounted risk factor for atrial fibrillation.
Abstract 2163: Single-site Left Ventricular Apex And Left Ventricular Septal Pacing For Long Term Maintenance Of Cardiac Contractility
Authors: Mills Robert W , Mulligan Larry J , van Hunnik Arne , Kuiper Marion , Lampert Anniek , Skadsberg Nick D , van Wijk Frank , Cornelussen Richard , Prinzen Frits W
Published: July 2021

Objective:
Conventional right ventricular (RV) apex pacing is associated with asynchronous activation and reduced left ventricular (LV) pump function. Previous studies have shown acute hemodynamic benefits over RV apex pacing by LV septal or LV apex pacing. We investigated whether this improvement translates into a long-term benefit and how acute LV function during single site LV pacing compares to biventricular pacing.

Methods:
After AV-nodal ablation, mongrel dogs were randomized to receive 16 weeks of VDD pacing at the RV apex (n = 7), LV apex (n = 7), or LV mid-septum (n = 8; trans-ventricular septal approach). LV contractility (dP/dt
max
/P
instantaneous
) was measured during normal ventricular conduction from atrial pacing (AP) and during ventricular pacing 1–3 hours and 16 weeks after implant. At 16 weeks, contractility was also measured after an acute switch from the implant site (IS) to the non-implanted apex (both for LV septal group) and to RV apex + LV lateral (BiV) pacing.

Results:
While acute and chronic RV apex pacing significantly reduced contractility (Figure a

; mean ± SD, *p<0.05 contrasted to 1), LV pacing maintained contractility near AP levels. After 16 weeks of RV apex pacing, switching to LV apex pacing (but not BiV pacing) increased contractility (Figure b

). After 16 weeks of LV pacing, switching to RV apex pacing decreased contractility. Collectively, acute LV apex pacing enhanced contractility over acute BiV (p<.001).

Conclusions:
Chronic LV apex and LV mid-septal pacing maintain contractility near normal levels, and at a higher level than RV apex pacing. Acutely, LV apex pacing improves contractility compared to BiV pacing.
Abstract 2197: The Multi-System Effect of Exercise Training During Prolonged Bed Rest Deconditioning: An Integrated Approach to Countermeasure Development for the Heart, Lungs, Muscle and Bones
Authors: Hastings Jeffrey , Pacini Eric , Krainski Felix , Shibata Shigeki , Jain Manish , Snell Peter , Fu Qi , Palmer Michael D , Creson Daniel , Levine Benjamin D
Published: July 2021

We propose to prevent the cardiac atrophy and orthostatic intolerance associated with prolonged bed rest using rowing ergometry/resistance training with aggressive volume loading on the day of testing. We hypothesize that prevention of cardiac atrophy will forestall cardiovascular deconditioning, leading to preserved exercise capacity and orthostatic tolerance. Twenty-four healthy subjects, ages 20 –55, were enrolled with 8 randomized to training (EX), 8 with training and volume loading (VOL), and 8 as sedentary (SED) controls. Testing included maximal upright exercise, orthostatic tolerance via graded lower body negative pressure (LBNP), cardiac MRI, as well as invasive cardiac pressure-volume measurements, performed at baseline and at the end of 5 weeks of 6° head down bedrest. Upright exercise capacity was preserved with training as measured by peak workrate and VO2max (EX/VOL: pre 195±46W, 34±7 ml/kg/min; post 202±42W, 33±4 ml/kg/min) but deteriorated in SED group (pre 171±55W, 34±8 ml/kg/min; post 145±51W, 27±7 ml/kg/min). MRI derived mass (% change: +6.3±9.9% EX/VOL vs. −5.5±3.7% SED) was increased by training. Exercise training appears to preserve LV chamber compliance (stiffness constants: EX/VOL: pre= 0.035±0.021, post = 0.036±0.029; SED: pre= 0.020±0.011, post = 0.028±0.007). Training also preserves hemodynamic variables measured at −40mmHg of LBNP, including stroke volume (EX: pre 44±12; post 38±9 ml, VOL: pre 49±30; post 45±29 ml, SED: pre 35±5; post 24±8 ml ). These preliminary data support our hypothesis that an optimized training program consisting of dynamic and resistance exercise can prevent part of the multisystem atrophy and orthostatic intolerance associated with prolonged bed rest. This defines a specific countermeasure that is practical, safe, and effective against the cardiovascular, muscle and bone deconditioning associated with prolonged bed rest. This information is relevant not only for astronauts exposed to long duration spaceflight, but also for patients with chronic reductions in physical activity, and those with disease processes that alter cardiac stiffness such as obesity, hypertension, heart failure or ischemic heart disease, plus normal aging and osteoporosis.

This research has received full or partial funding support from the American Heart Association, AHA South Central Affiliate (Arkansas, New Mexico, Oklahoma & Texas).
Abstract 2273: Comparison of Drug-Eluting Stents and Coronary Artery Bypass Surgery for the Treatment of Multivessel Coronary Disease
Authors: Li Yan , Xu Bo , Zheng Zhe , Li Wei , Zhang Shiju , Gao Runlin , Hu Shengshou
Published: July 2021

Background:
Numerous studies have compared the outcomes of coronary artery bypass grafting (CABG) surgery and coronary stenting for the treatment of multivessel coronary disease. In 2003 drug-eluting stents was introduced with the hope of reducing restenosis. However, limited information exists on the comparison of drug-eluting stents and CABG surgery, and it is also unclear how the long-term outcomes of drug-eluting stents compares with that of CABG surgery.

Methods:
We identified 3720 consecutive patients with multivessel disease who underwent isolated CABG surgery or received drug-eluting stents between April 1, 2004, and December 31, 2005, and we compared safety (total mortality, myocardial infarction) and efficacy (target-vessel revascularization) during a 2-year follow-up. These outcomes were compared after adjustment for differences in baseline risk factors among the patients. We also compared the average total costs per patient at the end of the initial hospitalization and of 1 year follow-up.

Results:
Patients who underwent CABG (n=1886) were older and had more comorbidities than patients who received drug-eluting stents (n=1834). Patients undergoing CABG had significantly lower 2-year rates of target-vessel revascularization (1.39% versus 13.1%). The treatment with a drug-eluting stents was associated with higher rates of total mortality [adjusted hazard ratio (HR) 1.623, 95%CI 1.069 to 2.466], and myocardial infarction. (adjusted HR 1.647, 95%CI 1.147 to 2.442). For the initial hospitalization, the average total costs per patient were similar ($8035 for CABG; $8007 for drug-eluting stents). However, total follow-up costs at 1 year remained lower for CABG ($672 vs $1086) compared with treatment with drug-eluting stents.

Conclusions:
For patients with multivessel disease, CABG continues to be associated with lower rates of total mortality, myocardial infarction and target-vessel revascularization than does drug-eluting stents. CABG is also likely a cost-saving strategy for patients with multivessel disease.
Abstract 2308: Conventional Aortic Valve Replacement in Very Elderly Patients
Authors: Lawrie Gerald M , Earle Elizabeth A , Earle Nan R
Published: July 2021

Suboptimal early and late results of percutaneous AVR have been justified by its use in patients claimed to be at high risk for conventional surgery, particularly the very elderly. We performed an analysis to identify which risk factors in conventional AVR patients are most predictive of mortality and to quantify those risk factors in order to provide a realistic baseline for comparison. We analyzed the outcome of surgery in 1168 patients operated on over a 31 year period on one service. Of those patients, 50 suffered perioperative mortality. Of those, 54% (27/50) were male vs. 62% (699/1118) who did not suffer perioperative mortality and 32% (16/50) vs 22% (242/1118) were >76 yrs old; 21% (9/43) vs. 25% (241/982) had diabetes, and 9.3% (9/43) vs. 5.5 (54/982) had bacterial endocarditis (all p=NS); 22% (11/50) vs. 11% (122/1118) had a prior MI (p=0.0152); 26% (13/50) vs 11% (118/1118) had a prior CAB (p=0.0007); 46% (23/49) vs 29% (322/1118) had a concurrent CAB (p=0.0063); mean EF of 44.50±18.26 vs. 53.33±13.90 (p<0.0001); and mean replacement valve size of 20.69±2.14 vs. 21.75±2.46 (p=0.0031). Logistic regression analysis identified prior CAB (odds ratio (OR) 1.65. p<0.01), concurrent CAB (OR 1.63, p<0.01), bacterial endocarditis (OR 1.85, p<0.05) and replacement valve size (OR 0.81, p<0.01 – larger size is protective) as predictors of perioperative mortality. Age was not a predictor of perioperative mortality. Cox regression analysis for factors predictive of overall mortality identified age (relative risk (RR)1.046, 4.6%/yr, p<0.0001) preop EF (RR 0.982, decrease risk of 1.8%/1% increase EF, p<0.0001), diabetes (RR 1.254, p=0.0031, 25% increase risk with diabetes), and replacement valve size (RR 0.889, p=0.0004, 11.1% decreased risk/mm valve size.) These data suggest that even in high-risk patients, perioperative mortality is relatively low and is not predicted by age alone; therefore conventional surgery should be seriously considered in almost all patients. Age is only one of several risk factors which should be evaluated.
Abstract 2309: Intra-Valve Hemorrhage is Associated with Increased Inflammation, Neovascularization and Calcification in Patients with Severe Aortic Stenosis
Authors: Moreno Pedro R , Astudillo Luis M , Zias Elias , Purushothaman Kothandaraman , Purushothaman Meerarani , Adams David H , Lento Patrick , Fallon John T , Fuster Valentin
Published: July 2021

Intra-plaque hemorrhage is a manifestation of inflammation and neovascularization in atherosclerosis that may also play a role in severe calcific aortic stenosis (AS). This study tested the hypothesis that intra-valve hemorrhage (IVH) will have increased inflammation and neovascularization in severe AS. From Jan-Dec 2006, 94 patients underwent surgery for AS. Tissue specimens from all 94 valves were evaluated (H&E stain). IVH was defined as erythrocyte extravasation mostly located in severely calcified areas, as shown in Figure

. Seven specimens displayed IVH. Of the remaining 87 specimens without IVH, 44 served as controls. Immunohistochemistry was performed to quantify macrophage/T cell infiltration (CD-68+CD-3), and neovessel content (CD-34). Calcification (graded on a scale from 1 to 4) was also perfomed. IVH patients were younger (59 ± 12 versus 69 ± 9;
P<
0.05). Gender, risk factors, coronary disease, aortic valve area, gradient, and ejection fraction were similar in both groups. Macrophage/T cell content was increased in IVH when compared to controls (59 ± 22 versus 28 ± 22;
P<
0.05). Neovascularization was also increased in IVH when compared to controls (32 ± 6 versus 23 ± 10;
P<
0.05). Finally, calcification score was also increased in IVH when compared to controls (3.9 ± 0.4 versus 3 ± 0.9;
P<
0.01). IVH is associated with younger age, increased inflammation, neovascularization, and calcification in severe AS. These results suggest that IVH may play a role in the pathobiology of severe AS, accelerating the process of inflammation and calcification, which may trigger symptoms at a younger age.
Abstract 2317: Nociceptive Stimulation: A Novel Cardioprotective Strategy
Authors: Ren Xiaoping , Fan Guo-Chang , Kadeer Nijiati , Kranias Evangelia G , Jones W.Keith
Published: July 2021

Recent studies show that electro-stimulation from upper extremities or spinal cord elicits cardioprotective effects against I/R injury. In previous studies, we have identified a novel cardioprotective phenomenon that occurs subsequent to remote trauma (abdominal skin incision), termed RPCT. The purpose of this study was to determine whether an abdominal nociceptive stimulation (ANS), either by electrical or by chemical stimulation of remote peripheral sensory nerves along the same area of skin incision can produce cardioprotection similar to that of RPCT against MI. An
in vivo
mouse I/R model was used. ANS was performed 15 minutes prior to I/R or at the beginning of reperfusion with the needles placed along the line of abdominal incision. Infarct size was used to evaluate the results of I/R injury (45 min coronary occlusion, 24h reperfusion) with or without prior ANS treatments. Histological, immunochemical, cellular and functional studies were performed at appropriate timepoints. The results of demonstrate that both pre and post-conditioning produce an 85% reduction in infarct size (6.3 ± 2.2
vs.
52.6 ± 2.8 in preconditioning,
P <
0.01; 10.6 ± 3.1
vs
. 60.2 ± 3.8 in post-conditioning,
P <
0.01, n = 6). Hematoxylin and Eosin staining showed that there was decreased infiltration after ANS compared to sham. We further show that ANS-preconditioning reduces apoptosis as evidenced by TUNEL staining and DNA fragmentation and reduces post-ischemic ventricular dysfunction. In conclusion, our results support 1) ANS is as protective as early phase of RPCT and 2) ANS elicited pre- and post-conditioning provides cardioprotection against myocardial infarction and dysfunction, at least in part, by reducing cardiomyocyte apoptosis after I/R. These results may suggest a novel therapeutic strategy for cardioprotection against I/R injury and have important implications for surgical patients at risk for myocardial infarction.
Abstract 2370: LDL Independent Reduction In Cardiovascular Morbidity And Mortality With Rosuvastatin In Heart Failure Patients With A Raised C-reactive Protein: A Retrospective Analysis Of The Controlled Rosuvastatin Multinational Trial In Heart Failure (CORONA)
Authors: McMurray John , Kjekshus John , Hjalmarson Ake , Wedel Hans , Dunselman Peter , Waagstein Finn
Published: July 2021

Objective: The anti-inflammatory action of statins may contribute to the clinical benefits of these drugs. Heart failure (HF) is an inflammatory state in which the usual epidemiologic relationship between cholesterol and cardiovascular outcomes is reversed, representing an excellent disease model in which to test the statin anti-inflammatory hypothesis.

Methods: We carried out a retrospective subgroup analysis of CORONA, which randomized 5011 patients with low ejection fraction HF of ischemic etiology to placebo or rosuvastatin 10 mg daily. We examined the effect of rosuvastatin according to baseline plasma high-sensitivity C-reactive protein concentration (hs-CRP) with patients divided into two groups: < 2 mg/L (779 placebo/777 rosuvastatin) versus >/= 2 mg/L (1694 placebo/1711 rosuvastatin). Results (table

): Baseline LDL was the same in the two hsCRP groups (approx. 138 mg/dL) and was reduced equally by 45% in each group with rosuvastatin. In patients with a hsCRP >/= 2 mg/L, rosuvastatin treatment was associated with nominally statistically significant reductions in the primary outcome (cardiovascular death, myocardial infarction or stroke), all cause mortality and the pre-specified coronary endpoint (sudden death, fatal or nonfatal myocardial infarction, PCI or CABG, ventricular defibrillation by an ICD, resuscitation after cardiac arrest or hospitalization for unstable angina). Importantly, rosuvastatin also reduced the secondary outcome of HF hospitalizations: hsCRP < 2.0 mg/L 267 placebo/264 rosuvastatin (p n.s.); hsCRP >/= 2.0 mg/L 1015 placebo/827 rosuvastatin (p = 0.0044)

Conclusions: Our findings in patients with HF support and extend previous retrospective analyses in patients with acute and stable coronary heart disease and add more evidence that the anti-inflammatory action of statins may be clinically important, not just in reducing atherosclerotic events but also HF hospitalizations.
Abstract 2402: Matrix Metalloproteinases and their Tissue Inhibitors in Cardiac Amyloidosis: Relationship to Structural and Functional Changes and to Light Chain Amyloid Deposition in the Heart
Authors: Ramamurthy Sujata , Biolo Andreia , Connors Lawreen H , O’Hara Carl J , Meier-Ewert Hans K , Hoo Pamela T Soo , Sawyer Douglas B , Seldin David S , Sam Flora
Published: July 2021

Cardiac amyloidosis is characterized by amyloid infiltration resulting in extracellular matrix disruption. Systemic deposition of immunoglobulin light chain (LC) fibrils (AL or “primary”) amyloidosis can lead to cardiac amyloidosis with heart failure. AL cardiomyopathy (AL-CMP) has an accelerated clinical course and a worse prognosis compared to non-LC cardiac amyloidoses. We therefore tested the hypothesis that determinants of proteolytic activity of the extracellular matrix, the matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs), would have distinct patterns and contribute to the pathogenesis of AL-CMP. We studied 40 patients with systemic amyloidosis: 10 AL-CMP patients, 20 patients with non-LC cardiac amyloidosis: i.e. amyloidosis associated with either wild-type transthyretin (TTR), senile systemic amyloidois (SSA) or a mutant TTR (ATTR), and 10 patients with AL amyloidosis without cardiac involvement. Plasma MMP-2, MMP-9, TIMP-1, TIMP-2 and TIMP-4, brain natriuretic peptide (BNP) values and echocardiographic parameters were determined. AL-CMP and non-LC groups had similar degrees of increased left ventricular wall thickness (LVWT) and mass index (LVMI). However, BNP, MMP-9 and TIMP-1 levels were distinctly elevated and accompanied by marked diastolic dysfunction in the AL-CMP group
vs.
no or minimal increases in the non-LC group. BNP, MMPs and TIMPs were not associated with the degree of LVWT but were to each other and to measures of diastolic dysfunction. Immunostaining of human endomyocardial biopsies showed diffuse expression of MMP-9 and TIMP-1 in AL-CMP and limited expression in non-LC hearts. Despite comparable LVWT and LVMI with non-LC cardiac amyloidosis, AL-CMP patients have higher BNP, MMP-9 and TIMP-1, which correlated with diastolic dysfunction. These findings suggest a relationship between LC and extracellular matrix proteolytic activation that may play an important role in the functional and clinical manifestations of AL-CMP.
Abstract 2457: Predictors of Resistant Hypertension in an Eight Year Follow-Up Study of an Unselected Sample of Adult Male Population in Italy
Authors: Barbato Antonio , Galletti Ferruccio , D’Elia Lanfranco , Ippolito Renato , Iacone Roberto , Venezia Antonella , Cappuccio Francesco Paolo , Siani Alfonso , Barba Gianvincenzo , Strazzullo Pasquale
Published: July 2021

Background: The determinants of resistant hypertension (RH), defined as a blood pressure (BP) persistently above goal in spite of the concurrent use of 3 antihypertensive agents of different classes, remain largely unknown. We investigated the predictors of RH in 799 participants at the Olivetti Heart Study (OHS), mean age 51.5 yrs (SD±7.2) after an average follow-up period of 8 yrs.

Methods: All participants attending the basal (1994 –95) and final (2002– 04) examination of the Olivetti Heart Study. A complete database including anthropometric, biochemical and ECG data was available for the analysis.

Results: Among the 799 participants not affected by RH at basal examination, 497 (62.2%) were normotensive and 302 (37.8%) hypertensive. After 8 years, overall 29 subjects (3.6%) developed RH. Age, BMI, waist circumference, BP, Cornell Index, serum total cholesterol and uric acid, urinary fractional sodium excretion (FENa), a marker of dietary sodium intake, and albuminuria (ALB) were significantly higher (p<0.05) in participants who developed RH compared with the others. Using a logistic regression model, after adjustment for basal antihypertensive treatment, microalbuminuria (Odds Ratio; C.I 95%: 3.2;1.1– 9.3), proteinuria (12.2; 1.9 –76.5), systolic BP (2.1;1.4 –3.3) and FENA (1.4; 1.1–1.7) remained the only independent predictors of RH.

Conclusions: Our results indicate that an early marker of organ damage (albuminuria), an elevated dietary sodium intake and a higher basal BP level were independent predictors of the development of RH in this sample of adult male population.
Abstract 2508: Different Early Changes of Coronary Plaque Composition according to Plaque Stability following Statin Initiation in Acute Coronary Syndromes: Classification and Analysis with IntraVascular UltraSound-Virtual Histology
Authors: Lee Sang Gon , Shin Eun Seok , Kim Shin Jae , Hwang Dae Sung , Kim Sang Hyun
Published: July 2021

Previous trials using intravascular ultrasound(IVUS) have demonstrated that the lipid lowering therapy with statin decrease plaque volume and increase plaque echogenecity in patients with coronary artery disease. The aim of this study was to demonstrate the early effect of statin on plaque composition by IVUS-Virtual Histology(VH) during half a year after coronary event. Thirty six patients with ACS were prospectively enrolled. One target segment was determined in a non-PCI site (>5 mm proximal or distal to the PCI site) with a reproducible index side branch or from the ostium of target vessel. We classified and analyzed the target plaques into two types according to plaque stability: thin-cap fibroatheroma (TCFA, n=10); and non TCFA(n=26) In 6 months after statin therapy, no change was demonstrated in mean percentage of the lipid core(16.9 ± 8.5% to 16.2 ± 10.1%, p=0.67), whereas plaque volume and LDL-cholesterol level were significantly reduced. There was a significant reduction of lipid core percentage in the TCFA type (21.1 ± 7.6 % to 10.9 ± 5.8 %, p= 0.001), but not in the non-TCFA type. The percentage change in lipid core showed a significant relation with the change in high-sensitivity C-reactive protein(r=0.4, p=0.03). Changes in LDL cholesterol and lipid core demonstrated no significant associations. A clear reduction of lipid core was observed only in the TCFA type which suggest that the changes of plaque composition following statin therapy might occur earlier in vulnerable plaque than stable plaque and appears related to their anti-inflammatory effects.
Abstract 2524: Long-Term (4 year) Outcome following Drug Eluting Stent Implantation versus Coronary Artery By-pass Surgery in Unprotected Left Main Coronary artery Lesions
Authors: Chieffo Alaide , Magni Valeria , Maisano Francesco , Ielasi Alfonso , Latib Azeem , Montorfano Matteo , Carlino Mauro , Sangiorgi Giuseppe M , Ferri Luca , Bassanelli Giorgio , Ferrari Angela , Godino Cosmo , Alfieri Ottavio , Colombo Antonio
Published: July 2021

One-year outcome following drug-eluting stent (DES) implantation versus coronary artery by-pass grafting (CABG) in unprotected LMCA lesions have been previously reported from our center.

Methods and results Two hundred forty-nine consecutive patients with an unprotected LMCA stenosis electively treated (107 with PCI and DES implantation and 142 with CABG) in our Center, between March 2002 and July 2004, were analysed. Hierarchical study end points were occurrence at 4 years of: death; death and/or myocardial infarction (MI); death, MI and/or stroke; target vessel revascularization (TVR, defined as any revascularization in left coronary system); and major cardiac cerebrovascular events (MACCE). A propensity analysis was performed to adjust for baseline differences between the two cohorts. At 4 year-clinical follow-up, no difference was found between PCI and CABG in the occurrence of death (respectively 12.0% vs. 14.1%; unadjusted odds ratio- OR=0.845; 95% confidence interval-CI=0.365 to 1.890; P=0.80; adjusted OR=0.652; 95% CI=0.254 to 1.620; P=0.42). At adjusted analysis, PCI group showed a trend toward a lower occurrence of the composite endpoint of death and myocardial infarction (13.0% vs. 19.7%; adjusted OR=0.461; 95% CI=0.180 to 1.088; P=0.08). PCI was associated with a lower rate of the composite endpoint of death, MI and/or stroke (respectively 14.0% vs. 22.5%; unadjusted OR=0.519; 95% CI=0.238to 1.071; P=0.07; adjusted OR=0.431; 95% CI=0.175 to 0.971; P=0.04). Indeed, CABG was correlated to lower TVR (8.4% vs. 28% ; unadjusted OR= 5.018; 95% CI= 1.990-23.8; p=0.0001; adjusted OR= 5.928; 95% CI= 1.933 – 38.0; p= 0.0003). No difference was detected in the occurrence of MACCE ( in PCI 36.4% vs. 28.1% in CABG, unadjusted OR=1.409; 95% CI=0.798 to 2.509 P=0.259; adjusted OR=1.438; 95% CI=0.754 to 2.766; P=0.3007).

Conclusions At 4 year-clinical follow-up, in this single-center experience, there was still no difference in the occurrence of MACCE between elective PCI with DES implantation and CABG in LMCA lesions. There was an advantage of PCI in the composite endpoint of death, MI and/or stroke, while a benefit in the need for reintervention was still found in CABG. :
Abstract 2547: Impact of Tissue characteristics of Coronary Plaque on Distal Embolization after Stent Deployment Evaluated by Integrated Backscatter Intravascular Ultrasound
Authors: Okubo Munenori , Kawasaki Masanori , Ishihara Yoshiyuki , Kubota Tomoki , Yamaki Takahiko , Ojio Shinsuke , Horibe Eisyun , Nishigaki Kazuhiko , Saio Masanao , Fujiwara Hisayoshi , Minatoguchi Shinya
Published: July 2021

Background:
It is well known that coronary plaques that show backward attenuation of ultrasound signal (AT) often cause distal flow disturbance during percutaneous coronary intervention (PCI). However, tissue characteristics of such plaques have not been precisely investigated. We previously developed an Integrated Backscatter Intravascular Ultrasound (IB-IVUS) for tissue characterization of coronary plaques. The aim of this study is to clarify the relationship among tissue components of coronary plaques, AT and distal embolization after stent deployment by use of IB-IVUS.

Methods:
In the pathological study, images were acquired from 221 segments of 18 coronary arteries from 13 cadavers obtained at autopsy. Twenty-three segments that showed AT (10%) were enrolled in this study. A total of 47 regions of interest (ROI) on histological images were compared with IB-IVUS color coded maps. Micro calcifications and cholesterol clefts were evaluated by von Kossa, Masson Trichrome and Hematoxylin-Eosin staining. Percentage of cholesterol clefts area (area of cholesterol cleft/area of ROI) and micro calcification area were calculated by a personal computer. In the clinical study, fourteen lesions which underwent elective stent deployment were enrolled. We evaluated the degrees of distal embolization by measuring serum troponin I (TnI) level before and after PCI and compared with IB-IVUS parameters. We defined the area of AT as the area where IB value is -6dB less than lipid pool.

Results:
In the pathological study, the attenuation of IB values of cholesterol cleft and micro calcification were3.58 ± 1.56 dB/0.1 mm and 3.51 ± 1.74 dB/0.1 mm, respectively. As the % cholesterol cleft area and % micro calcification area increased, the attenuation of IB values increased (r = 0.59 and 0.62, P < 0.001 and 0.001, respectively). Elevation of serum TnI have strong correlation to AT volume at the target lesions compared to the % lipid volume (lipid volume/plaque volume) (r = 0.92 and 0.56, P < 0.001 and 0.001, respectively).

Conclusion:
This is the first demonstration of the relationship among the attenuation of IB values, tissue component and distal embolizaion after PCI. This study provides new clinical insights to prevent and predict distal flow disturbance during PCI.
Abstract 2564: No Late and no Very Late Stent Thrombosis with a Drug-Eluting Stent of the Second Generation: 2 Years Results from the Randomized NOBORI-I Trial
Authors: Silber Sigmund , Chevallier Bernard , Serruys Patricl , Garcia E. , Maranon Gregorio , Suryapranata Harry , Klinieken Isala
Published: July 2021

Background: Late (after 30 days to 1 year) and very late (after 1 year) stent thrombosis is a continuous concern for drug-eluting stents (DES) of the first generation. These stents are characterized by their durable polymer and a ,,360 degree“ elution of the antiproliferative drug not only into the vessel wall, but also into the blood stream. Therefore, the second generation Nobori stent was developed with a biodegradable polymer and a drug elution restricted only to the vessel wall (abluminal coating). The drug, Biolimus A9, is a potent antiproliferative and antiinflammatory Limus derivative.

Methods: The NOBORI-I trial was a prospective randomized study designed to compare the Nobori stent with the Taxus stent (2:1) in pats with single de-novo native coronary lesions, a vessel diameter of 2.5–3.5 mm and a lesion length below 25 mm. Predilatation was required. The primary endpoint was in-stent late lumen loss (LL) at 9 months. The study was designed as a noninferiority trial. 363 pats were enrolled in 29 sites in Europe, Asia and Australia. Clopidogrel (in addition to ASA) was recommended for at least 6 months.

Results: With an in-stent LL of 0.12 mm in the Nobori and 0.33 mm in the Taxus group (p <0.001) the primary endpoint was reached, with a significant result also for superiority. The results for late and very late stent thrombosis are depicted in the table

. Dual antiplatelet therapy was present at one year in 52% of the pats in the Nobori and in 55% of the pats in the Taxus group. After 2 years, it was maintained in 25% of the Nobori and in 20% of the Taxus pats.

Conclusions: As compared to a DES of the first generation with a durable polymer and circumferential drug release, the second generation Nobori stent with its biodegradable polymer and a drug-elution restricted to the vessel wall seems to be safer. Due to the limited power of this study regarding safety, higher number of patients are needed to corrobarate these promising findings.
Abstract 2567: Late Catch-Up Recovery from Endothelial Vasomotor Dysfunction in Infarct-Related Coronary Artery Treated with Sirolimus-Eluting Stent in Patients with Acute Myocardial Infarction
Authors: Obata Jyun-Ei , Kitta Yoshinobu , Kodama Yasushi , Nakamura Takamitsu , Kawabata Ken-ichi , Sano Keita , Hirano Mitsumasa , Saito Yukio , Nakamura Kazuto , Kugiyama Kiyotaka
Published: July 2021

Myocardial ischemia-reperfusion causes endothelial injury in the infarct-related coronary artery. We have previously shown that sirolimus-eluting stent (SES) implantation can aggravate endothelium-dependent vasomotor dysfunction in infarct-related coronary arteries. This study examined effects of SES implantation on duration of reperfusion-induced endothelial dysfunction in infarct-related coronary arteries. This study enrolled 44 patients with a first acute myocardial infarction (AMI) due to occlusion of the left anterior descending coronary artery (LAD) and successful reperfusion therapy using SESs (n = 22) or bare metal stents (BMS, n = 22). Vasomotor function of LAD in response to acetylcholine (ACh) was repeated 2 weeks, 6 months, and 9 months after AMI. Patients with either residual stenosis or in-stent restenosis in LAD were not included in this study. The vasomotor function was also assessed in 20 control subjects for comparison with that in AMI patients. The SES and BMS groups were similar in terms of AMI-related variables including peak CK levels and 2 week LVEF. At 2 weeks after AMI, SES-treated LAD had greater impairment of epicardial dilation and less blood flow increase in response to ACh than BMS-treated LAD (diameter response; 12% vs. 34% of controls, blood flow response; 23% vs. 76% of controls, at 10 μg/min of ACh, respectively). In BMS-treated LAD, the responses of epicardial diameter and blood flow to ACh had recovered to levels similar to those of controls at 6 months (diameter response; 94% of controls, blood flow response; 92% of controls), and the responses showed no further improvement from 6 to 9 months. In SES-treated LAD, the responses were improved but remained lowered compared with BMS-treated LAD at 6 months (diameter response; 58% of controls, blood flow response; 74% of controls). However, the responses in SES-treated LAD at 9 months showed further improvement to levels near to those of BMS-treated LAD or controls (diameter response; 79% of controls, blood flow response; 88% of controls). Although incomplete, the adverse effects of SES on endothelium-dependent vasomotor function in infarct-related coronary arteries were restored through late catch-up recovery after stent implantation.
Abstract 2601: Staged Left Ventricular Recruitment in Patients with Hypoplastic Left Heart Disease and Borderline Left Ventricle
Authors: Emani Sitaram M , Tworetzky Wayne , McElhinney Doff B , Schroeder Brian , Zurakowski David , Bacha Emile , Pigula Frank A , Marx Gerald R , del Nido Pedro J
Published: July 2021

Although hypoplastic left heart (LH) disease occurs as a spectrum, the initial management in neonates with hypoplastic LH syndrome and a borderline left ventricle (LV) is dichotomous: single ventricle palliation (SVP) or biventricular (BiV) repair. Once SVP is pursued, rarely are attempts made to salvage the LH or achieve subsequent BiV conversion. Staged LV recruitment may be achieved in selected patients following SVP by a surgical strategy consisting of relief of inflow and outflow tract obstructions, resection of endocardial fibroelastosis (EFE), and promotion of flow through the LV. All patients with hypoplastic LH and borderline LV (LV end diastolic volume [LVEDV] z scores between −5 and −0.5) who underwent stage 1 procedure between 1995 and 2007 were retrospectively analyzed. Patients with ventricular septal defects and valvular atresia were excluded. Those who underwent LV recruitment (Group 1, n=27) were compared to those who did not (Group 2, n=30). LV recruitment consisted of one or more procedures for EFE resection (27/27), mitral (MV) valvuloplasty (16/27), aortic (AoV) valvulo-plasty (21/27), atrial septal defect restriction (13/27), and augmentation of pulmonary blood flow (12/27). Predictors of increase in LVEDV were determined by multivariable analysis. Mean initial z scores for LVEDV, AoV, and MV for the entire cohort were −2.8 ± 1.2, −2.9 ± 1.0, and −2.0 ± 1.3 respectively, with no significant differences between groups. Stage 1 mortality was 2/27 in Group 1 and 2/30 in Group 2. LVEDV, AoV, and MV z scores increased significantly over time in Group 1, whereas they declined in Group 2 (slope of LVEDV z score regression = 0.76/yr vs. −0.06/yr,
P
<0.001), with restriction of the atrial septum at any stage being the strongest independent predictor of increase in LVEDV (
P
<0.001). To date, BiV conversion has been achieved in 5/27 Group 1 patients and none in Group 2 (
P
=0.015). In patients with borderline LH disease who undergo a stage I procedure during the neonatal period, it is possible to increase LH dimensions using a strategy of AoV and MV valvuloplasty, EFE resection, and modulation of LV filling. In a subset of patients, this strategy has allowed establishment of biventricular circulation.
Abstract 2603: Predictors of Coronary Artery Visualization in Kawasaki Disease in the Pediatric Heart Network (PHN) Multi-Center Study
Authors: Margossian Renee , Lu Minmin , Minich L. L , Bradley Timothy , Cohen Meryl S , Li Jennifer S , Printz Beth F , Shirali Girish , Newburger Jane W , Colan Steven D
Published: July 2021

Background:
Echocardiography is the imaging modality of choice for evaluation of coronary artery (CA) abnormalities in Kawasaki disease (KD). Single center series have established high specificity and sensitivity for abnormality detection.

Objective:
To determine visualization rates of CAs across clinical centers and factors associated with success.

Methods:
Subjects enrolled in an 8 center PHN prospective, randomized trial of pulse steroids in primary treatment of KD underwent standardized echo evaluation at diagnosis and at 1 and 5 weeks later. All studies were interpreted by local centers and at a core laboratory (lab) which provided training and feedback over the study period. Imaging rates were calculated for each tertile of study time (9 month blocks). We explored univariate and multivariate predictors of CA visualization.

Results:
The core lab evaluated 587 echoes from 199 patients over 27 months. Left main, proximal/distal left anterior descending (LAD) and proximal right CAs were verified as visualized by the core lab in 91–98% of studies, but less often for the distal right (65%), circumflex (86%) and posterior descending (PD) (54%) CA segments. Visualization rates for 2 of the 3 less successfully imaged segments improved with time (p<.05). Weight and BSA did not impact success. In multivariate analysis, local center, CA segment and time from study start to echo were independent predictors of visualization (all p<.001). For CA segments for which % visualization varied by center, higher % visualization was associated with larger center volume (p=.001). Use of routine sedation was also associated with higher % visualization: distal LAD odds ratio (OR) 2.32 (95% CI 1.2, 4.49; p = 0.13), distal right OR 9.09 (95% CI 5.38, 15.35; p<.001), circumflex OR 2.94 (95% CI 1.61, 5.38; p<.001), PD OR 2.77 (95% CI 1.7, 4.53; p<.001). Moderate agreement between local and core lab readings (ICC 0.55– 0.70) was present for all CA segments except the PD (ICC 0.38).

Conclusion:
Successful visualization of CAs in KD is associated with the specific CA segment being evaluated, and is influenced by center volume and sedation use. Increased visualization rates over time suggest a learning curve and underscore the value of core lab oversight in pediatric multi-center trials.
Abstract 2608: Alterations In Biomechnical Properties of Ascending Aorta in Marfan Syndrome by Real-time 2-D Ultrasound Speckle Tracking Imaging
Authors: Wu Jin , Xie Mingxing , Zheng Minjuan , Ge Xinyi , Kendall Kathy , Jefferies John Lynn , Towbin Jeffrey , Pignatelli Ricardo , Ayres Nancy , Ge Shuping
Published: July 2021

Background

: Thoracic aortic aneurysm and dissection (TAAD) is the leading cause of death in patients with Marfan syndrome (MFS) and other aortic disease (AD). The natural history of AD aries significantly. The size of the aorta alone does not always predict the risks of complications, such as catastrophic TAAD.

Objectives

: We sought to develop an ultrasound technique to quantitatively measure deformation of the ascending aorta (Ao) using a real-time 2-D ultrasound speckle tracking imaging (USTI) technique to investigate:

alterations in biomechanical properties of AAo in MFS, and

early and sensitive markers for TAAD for MFS.

Methods:

A total of 40 patients (MFS: n=18, age=11.4 ± 6.2 years, versus Control: n = 22, age=10.2 ± 4.3, p = 0.46) were prospectively enrolled. Real-time 2-D echocardiography was performed. The dimension of the AAo root (at the level of aortic annulus, sinus of Valsalva (SOV), sino-tubular junction and ascending aorta) was tracked and measured continuously in the cardiac cycle to derive the maximal and minimal systolic and diastolic dimensions using USTI (Philips Medical Systems). These measurements were used to yield dimensions, strain (deformation), strain rate (rate of deformation), distensibility, stiffness index and elastic modulus.

Results:

The results were summarized in Table 1

. Compared with controls, the MFS group had significantly enlarged dimension of the AAo root (P<0.0001). In addition, the biomechanical properties were significantly altered, suggestive of reduced deformation, distensibility, elasticity and increased stiffness of the AAo root.

Conclusions:
This study demonstrated the feasibility of quantitative measurement of the biomechanical properties of the AAo in MFS using USTI. We have also shown significant deterioration of the biomechanical properties in MFS.

Table 1.

Biomechanical properties of AAO in MFS
Abstract 2615: Multiple Accessory Pathways in Pediatric Patients with Structural Heart Disease
Authors: Zachariah Justin P , Triedman John K , Berul Charles I , Cecchin Frank , Alexander Mark E , Mahajan Tarun , Walsh Edward P
Published: July 2021

Pts with structural heart disease (SHD) such as Ebstein’s and certain cardiomyopathies often have multiple accessory pathways (AP’s) at mapping procedures. The goals of this study were to determine the incidence of multiple AP’s (multAP) in a large pediatric cohort undergoing electrophysiology study, contrasting pts with and without SHD, and to measure the influence of multAP on ablation outcomes.

Methods: Data from all patients (n=1089) undergoing catheter mapping and/or ablation for AP’s at Children’s Hospital Boston from 1990 through 2006 were reviewed. The AP locations were divided into segments along the septum(S), tricuspid(TV) and mitral (MV) valves. The presence of multAP was defined as two or more APs with distinct conduction characteristics mapped at least 1 cm apart. Acute ablation success was defined as elimination of all AP conduction. Recurrence was defined as return of conduction in any one or more AP’s. A total of 1229 APs (36% concealed AP) were mapped in 1089 patients (aged 12.9 ± 4yrs) with locations along TV in 18%, S in 39%, and MV in 43%. Ablation attempts (n=1306) were successful in 94% overall (92% TV, 92% S, and 97% MV), with 8% recurrence rate. A subgroup of 111 pts (10%) had multAP, involving 250 distinct APs. MultAP were significantly more common (p<0.001) among SHD pts (25%) than those without SHD (8%). Ebstein’s, AV discordance, and cardiomyopathy accounted for 28/30 (93%) of SHD pts with multAP. Ebstein’s(OR 8.7,p<0.001) and myopathic pts(OR13.3, p<0.001) were more likely to have multAP. AP locations in SHD pts shifted toward TV, driven by Ebstein’s pts. Acute ablation success did not differ between multAP and a solitary AP (91% vs. 94%, p= n.s.), though recurrence rate was higher for multAP (19% vs. 8%, p<0.001). Acute success was lower in SHD compared to those without SHD (85% vs. 95%, p<0.01), and recurrence was higher (17% vs. 8%, p<0.05). MultAP can be found in 10% of pediatric patients, and are far more common in SHD compared to those with normal hearts. Both the presence of multAP and SHD can negatively influence ablation outcomes.