bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17528: Delayed Rocovery in Peripartum Cardiomyopathy: An Indication for Long-Term Follow-Up and Sustained Therapy
Authors: Biteker Murat , İlhan Erkan , Duman Dursun , Can Mehmet M , Tekkeşin Ahmet
Published: April 2024

Background:
Persistence of left ventricle systolic dysfunction after 6 months of diagnosis is believed to be a marker of an irreversible cardiomyopathy and worse survival in peripartum cardiomyopathy (PPCM). We sought to determine the length of time required for recovery of left ventricle systolic function (LVSF) in patients with PPCM.

Methods:
Forty-two consecutive women with PPCM treated at two tertiary hospitals in Turkey were enrolled in this prospective study over a 5-year period. The minimum required time of follow-up for inclusion was 30 months (range 30-65 months). Clinical evaluation, B-type natriuretic peptide (BNP) and C-reactive protein (CRP) concentrations, and transthoracic echocardiography were evaluated at baseline, every 3 months during the first year, and every 6 months thereafter. Rapid recovery is defined as resolution of heart failure symptoms or signs and normalization of LVSF at 6 months post-diagnosis. Delayed recovery is defined if the length of time required for recovery of LVSF was longer than 6 months. Persistent left ventricular dysfunction (PLVD) is defined as an ejection fraction of less than 50 % at the end of follow-up.

Results:
Twenty patients (47.6%) recovered completely, 10 died (23.8%), and 12 (28.6%) were left with PLVD. Average time to complete recovery was 19.3 months after initial diagnosis (3-42 months). Rapid recovery is observed only in 6 patients (30%) whereas delayed recovery is observed in 14 out of 20 patients (%70) (Figure). Persistent elevation of plasma BNP and CRP above the cut-off values at 3th month is predictive of delayed recovery.

Conclusions:
Full recovery of LVSF in PPCM patients often requires longer than 6 months. Persistent elevation of plasma CRP and BNP above the cut-off values portends a slower response.
Abstract 17545: Effect of Long-Term Circulatory Support on Arterial Wall: Comparison of Histological Findings in Pulsatile and Continuous Flow Blood Pump Recipients
Authors: Potapov Evgenij V , Stepanenko Alexander , Rezaei Sajjad , Morawietz Lars , Lehmkuhl Hans B , Weng Yuguo , Pasic Miralem , Krabatsch Thomas , Hetzer Roland
Published: April 2024

Background.
Continuous flow (CF) ventricular assist devices (VAD) are an established option for treatment of end-stage heart failure. However, the impact of long-term continuous flow with lack of peripheral arterial wall motions on blood pressure regulation and end-organ arterial wall sclerosis, especially in the case of long-term support (over 3 years), remains unclear.

Methods:
Samples of arterial wall (liver, kidney, coronary and cerebral arteries) from a total of 33 autopsies of VAD recipients treated between September 2000 and July 2009 were examined for perivascular infiltrate index, intravascular infiltrate index, wall thickness, thrombosis, entdothelial cell swelling, vessel wall necrosis and perivascular fibrosis. In ten patients (group P) pulsatile devices, and in 23 patients CF devices had been inserted (group CF). The pathologist was blinded to the group distribution. Additionally, clinical course and follow-up data were retrospectively analyzed.

Results:
Median duration of support in group P was 432 days (range 177-1588 days) and in group CF 351 days (range 182-942 days). There were no differences in doses of ACE-inhibitors, beta-blockers, aldactone and diuretics. During follow-up amiodaron was more often used in the CF group than the P group (61% vs. 10%, p=0.009). Throughout the follow-up period mean arterial pressure did not differ between recipients of the two pump types. Diastolic blood pressure in CF device recipients was lower after 3 months of support only (figure). Histological studies did not recognize any relevant differences in arterial wall characteristics between the two groups.

Conclusion:
Chronic mechanical circulatory support for up to 4 years with CF devices does not adversely influence arterial wall properties of the end-organ vasculature.
Abstract 17550: PPAR-δ Activation Induces Angiomyogenesis Through the Potentiation of Endothelial Progenitor Cell Paracrine Network
Authors: Kim Hack-Lyoung , Han Jung-Ku , Choi Young-Eun , Jeon Ki-Hyun , Lee Hyun-Sook , Kwon Yoo-Wook , Cho Hyun-Jai , Kang Hyun-Jae , Oh Byung-Hee , Park Young-Bae , Kim Hyo-Soo
Published: April 2024

Background
Endothelial progenitor cells (EPCs) paracrine network has been known to play a key role in neovascularization. We focused on skeletal muscle regeneration as well as new vessel formation by EPCs and their modulation by PPAR-δ.

Methods and Results
GW501516
, a PPAR-δ agonist enhanced MMP-9 mRNA expression, protein excretion and enzyme activity among several paracrine factors in EPCs. MMP-9 in conditioned media (CM) from
GW501516
treated EPCs degraded IGFBP-3 in Western blot. The CM treatment phosphorylated IGF-1 receptor (R) in HUVECs, enhancing BrdU incorporation, Matrigel tube formation and migration. It also induced proliferation of C2C12 myoblast cells and protected them from hypoxia. Systemic treatment of
GW501516
in mice increased MMP-9 expression in EPCs and degraded IGFBP-3 in serum Western. In mice which received bone marrow transplantation (BMT) from WT mice, continuous infusion of
GW501516
phosphorylated IGF-1R in ECs and skeletal muscle. It increased capillary density and regenerating myotubes with central nuclei, and decreased muscle fibrosis in MT stain. IF for Ki67 and TUNEL stain demonstrated the
in vivo
proliferation and protection from apoptosis of ECs and skeletal muscle cells by GW501516. Limb perfusion recovery was also enhanced in LDPI. BMT from MMP-9 KO mice or IGFBP-3 systemic infusion abolished these effects. Intramuscular injection of
ex vivo
GW501516
treated EPCs to ischemic limbs showed the same effects. But EPCs from MMP-9 KO mice reversed the results. In skin punch wound model,
GW501516
systemic administration enhanced wound healing with increased angiogenesis in WT mice, not in MMP-9 KO mice.

Conclusion
EPC paracrine network through MMP-9 mediated IGF-1 signaling pathway is important in angiomyogenesis, and is potentiated by PPAR-δ activation. Our results suggest PPAR-δ agonist as a good candidate drug for patients with peripheral vascular diseases who need angiomyogenesis for recovery.
Abstract 17582: Encouraging Neurodevelopmental Outcomes in Children with Hypoplastic Left Heart Syndrome at Five Years of Age
Authors: Brosig Cheryl , Mussatto Kathleen , Hoffman George , Hoffmann Raymond G , Dasgupta Mahua , Ghanayem Nancy
Published: April 2024

Introduction:
Patients with hypoplastic left heart syndrome (HLHS) have neurodevelopmental (ND) problems, some of which can be linked to perioperative risk factors. We hypothesized that children with HLHS would perform worse than test norms on ND outcome measures at early school age.

Methods:
English-speaking patients with HLHS at 4-6 years of age were eligible to participate. 44/72 (61%) patients agreed to participate, 37 completed ND testing before close of the study. Three patients were excluded from analyses due to late stroke. Mean age at testing was 5 years (range 4 to 6 years). ND testing included intelligence, visual motor integration, motor skills, memory, and language skills. Parents and teachers completed measures of behavior and attention problems. Patient scores and parent/teacher ratings were converted to z scores and compared to test norms. Scores are displayed in Figure 1 as multidimensional deviations from the test norm at z=0. Higher scores on child measures represent better outcomes, whereas higher scores on parent/teacher rating scales indicate more problems.

Results:
The average ND performance of the tested cohort fell within one standard deviation from test norms for all measures. Children with HLHS performed significantly lower than test norms on measures of visual-motor integration, fine motor skills, memory, and word structure (z=-.42 to -.54). On parent and teacher completed measures, children with HLHS scored higher than test norms on attention problems (z=.40 to .62).

Conclusion:
ND outcome for preschool aged survivors of staged palliation for HLHS in the modern era is encouraging. Although overall ND performance was normal, the cohort showed relative weakness in attention and executive functioning. Ongoing developmental monitoring of these children is recommended to guide interventions that may improve individual outcomes, and to assess the impact of changes in clinical management strategies on functional outcomes.
Abstract 176: A Randomized, Double-Blind Multicenter Trial Comparing Vasopressin and Adrenaline in Patients with Cardiac Arrest at the Emergency Department (Preadmission Intravenous Vasopressin, Adrenaline Outcome Trial [PIVOT])
Authors: Ong Marcus E , Tiah Ling , Leong Benjamin S , Tan Elaine C , Ong Victor Y , Tan Elizabeth A , Poh Bee Yen , Pek Pin Pin , Chen Yuming
Published: April 2024

Aims
Recently, vasopressin has been used in cardiac arrest patients. In human studies on vasopressin, clinical trials have produced conflicting results. We aimed to compare vasopressin and adrenaline in the treatment of cardiac arrest at the Emergency Department (ED).

Methods
This was a randomised, double-blind, multi-centre, parallel-design clinical trial involving four hospitals. All cardiac arrest patients (confirmed by the absence of pulse, unresponsiveness and apnea) aged above 16 were eligible (age 21 and above for one hospital). The exclusion criteria were traumatic cardiac arrest or contraindicated cardio-pulmonary resuscitation (CPR). Eligible patients were randomly assigned to receive adrenaline (1 mg) or vasopressin (40 IU) in the ED. The primary outcome was survival to hospital discharge (defined as patient discharged alive or survival to 30 days post arrest).

Results
We recruited 727 eligible patients (adrenaline= 353; vasopressin= 374) whose baseline characteristics in both groups were comparable. After adjustment for race, medical history, bystander CPR and prior adrenaline given, more patients survived to hospital admission with vasopressin (22•2%) than adrenaline (16•7%) (p=0•047, RR=1•43, 95% CI=1•02- 2•04). No significant differences were noted for return of spontaneous circulation. Eight patients (2•3%) from the adrenaline and 11 (2•9%) from the vasopressin group survived to hospital discharge. After adjusting for race, medical history, bystander CPR and previous adrenaline given, there was no significant difference (p=0•274, RR= 1•72, 95% CI=0•65 -4•51). Post hoc analysis suggested improved outcomes for vasopressin in patients with prolonged arrest times.

Conclusion
Vasopressin seems to improve survival to admission in patients with prolonged cardiac arrest but not long term survival. Further studies on the effect of vasopressin on patients with prolonged arrest are needed. (ClinicalTrials.gov number,
NCT00358579
)
Abstract 17686: Syndecan-4 Proteoliposomes Enhance FGF-2 Induced Proliferation, Migration and Neovascularization of Ischemic Muscle
Authors: Das Subhamoy , Jang Eugene , Albadawi Hassan , Watkins Michael T , Edelman Elazer R , Baker Aaron B
Published: April 2024

Objectives:
Inducing angiogenesis for the treatment of ischemia is an appealing therapeutic strategy for patients in whom traditional treatment modalities cannot be performed or are ineffective. While therapeutic angiogenesis holds great promise for treating patients with ischemia, none of the current methods has found success in clinical trials.

Methods:
Here, we developed a novel method for improving the biological activity of FGF-2 by co-delivering the growth factor with a liposomally embedded co-receptor, syndecan-4. We compared this method of growth factor delivery to FGF-2 alone in in-vitro experiments using a wound healing assay of cell migration, thymidine incorporation for proliferation and a tube formation assay for angiogenic differentiation. We also created hind limb ischemia in rats through femoral artery ligation. Following induction of ischemia, we delivered FGF-2, control or FGF-2 and syndecan-4 proteoliposomes to the rats using an osmotic pump and measure revascularization by Laser Doppler imaging, microCT and histological analysis.

Results:
Syndecan-4 proteoliposomes significantly increased endothelial cell growth, migration and tube formation. In-vivo treatment of rats with hind limb ischemia demonstrated increased revascularization in response to FGF-2 with co-delivery of syndecan-4 proteoliposomes. Laser Doppler imaging (A) showed that syndecan-4 proteoliposomes lead to a nearly complete resolution of ischemia by 7 days whereas FGF-2 alone did not resolve the ischemia by 16 days of treatment (B). This result was confirmed by histological analysis (C) and microCT based arterial reconstruction.

Conclusion:
Taken together, these results support that liposomal delivery of syndecan-4 is an effective means to improving the therapeutic potential of using growth factors to achieve therapeutic neovascularization of ischemic tissue.
Abstract 17695: Transsulfuration Pathway is Essential for Fasting-Induced Cardioprotection Against Ischemic/Reperfusion Injury
Authors: Nakano Shintaro , Ishii Isao , Akahoshi Noriyuki , Tamaki Kayoko , Komiyama Nobuyuki , Nishimura Shigeyuki , Shinmura Ken
Published: April 2024

:
Hydrogen sulfide (H
2
S), a gaseous mediator that is endogenously produced by two transsulfuration enzymes, cystathionine β-synthase (CBS) and cystathionine gamma-lyase (CTH), is known to act against myocardial ischemia/reperfusion (I/R) injury. However, the roles of the transsulfuration that is also essential for cysteine/glutathione biosynthesis remain to be clarified. We investigated the role of transsulfuration pathway in myocardial I/R injury and fasting-induced cardioprotection using mice lacking CBS (CBS
-/-
) or CTH (CTH
-/-
).

:
Ad libitum (AL) fed wild-type mice (Wt), CBS
-/-
and CTH
-/-
displayed no alteration in basal cardiac functions when evaluated by echocardiography. The Langendorff experiment, in which isolated perfused hearts were subjected to 25-min global ischemia followed by 60-min reperfusion, revealed a similar degree of I/R injury among AL-fed 3 strains. However, “2-day-fasting” induced much better LV functional recovery after I/R in Wt but not in CBS
-/-
and CTH
-/-
( Figure ). Fasting failed to reduce total LDH release into the perfusate even in Wt. In Wt, fasting upregulated CBS mRNA expression in the heart. Heart glutathione contents were comparable indistinguishable between Wt and CTH
-/-
in either AL
-
fed or fasting condition.

:
These results demonstrate that fasting attenuates myocardial stunning (reversible change) but not myocardial infarction (irreversible damage) and strongly suggest the involvement of H
2
S generated by CBS / CTH in fasting-induced cardioprotection. Further investigation is required to assess the role of homocysteinemia on fasting-induced cardioprotection since both CBS
-/-
and CTH
-/-
exhibit hyperhomocysteinemia.
Abstract 17696: Characteristics and Outcome of Percutanous Transluminal Angioplasty in Smokers
Authors: Rha Seung Woon , Elnagar Amro , Choi Byoung Geol , Im Sung Il , Kim Sun Won , Na Jin Oh , Han Seong Woo , Choi Cheol Ung , Lim Hong Euy , Kim Jin Won , Kim Eung Ju , Park Chang Gyu , Seo Hong Seog , Oh Dong Joo
Published: April 2024

Background:
Smoking is a known risk factor for peripheral vascular disease (PVD).The aim of this study to determine characteristics and outcome of percutanous transluminal angioplasty (PTA) in smokers.

Methods:
A total 187 patients (pts) with 350 lesions who underwent PTA were enrolled. Pts were divided into 2 groups (non smokers: n=127 pts, smokers: n=60 pts)

Results:
baseline characteristics were similar except that smokers had more males (95% vs. 68.5 %, p<0.001), alcoholic (51.7% vs.14.2%, p<0.001), dyslipidemic (21.7% vs. 11%.p=0.053).While non smokers were more hypertensive (73.2% vs.56.7%, p=0.024). Non smokers had significant higher Rutherford grade & category, other clinical presentations were similar between 2 groups. Smokers had more ostial & longer lesions, while non smokers had more De novo lesions. However procedural & 1 year clinical outcomes were similar between the 2 groups. (table 1).

Conclusions:
In our study, despite longer & ostial lesions in smokers, procedural &1 year clinical outcomes were similar between the 2 groups.
Abstract 17704: The Association of Tooth Scaling and Decreased Cardiovascular Disease -A Nationwide Population-Based Study
Authors: Chen Zu-Yin , Leu Hsin-Bang
Published: April 2024

Background:
Poor oral hygiene has been associated with increased risk for cardiovascular disease frequent tooth brushing has been reported to decrease the risk for CVD recently. However, the association between preventive dentistry and cardiovascular risk reduction remained undetermined. The aim of this study is investigate the effect of mouth scaling on cardiovascular disease and stroke risk, using a nationwide, population-based study and a retrospective cohort design.

Methods:
51108 adult subjects without previous history of stroke or myocardial infarction (MI) who had received full or partial mouth scaling at least once were rerolled from the Taiwan National Health insurance. Another 51512 age-, gender-, and cormobidities-matched subjects without history of stroke or MI and did not receive mouth scaling comprised the comparison control. Cox proportional hazard regressions were performed as a means of comparing the cardiovascular events rate between these two cohorts.

Results:
During an average follow-up period of 7 years, a total of 102,620 patients were enrolled, of which 51,108 patients who had ever received tooth mouth scaling had lower incidence of acute MI and stroke when compared to the control group (0.55% vs. 0.44%, p=0,013 and 2.57% vs. 2.27%, p=0.002, respectively). The log-rank test and Kaplan-Meier survival analysis showed that patients with tooth scaling have significantly higher AMI- free and higher stroke-free survival rates (
p
=0.027 and p= 0.04 respectively). Cox proportional hazard regression model analysis showed that tooth scaling was the independent factor associated with less risk of developing future MI (Hazard Ratio, HR, 0.76, 95% CI, 0.60-0.96;
p
=0.021) and stroke (HR 0.87, 95% CI, 0.78-0.96;
p
=0.007). Furthermore, the frequency of tooth scaling correlated with the risk reduction of MI with HR of 0.76 (95% CI, 0.60-0.96;
p
=0.021) and HR of 0.87 (95% CI, 0.71-1.07;
p=
0.188), comparing often and occasional with never tooth scaling, respectively; stroke with HR 0.87, (95% CI, 0.78-0.96;
p
=0.007) and HR of 0.91 (95% CI, 0.83-1.00;
p
=0.045), comparing often and occasional with never tooth scaling, respectively.

Conclusions:
Tooth scaling was associated with decreased risk for cardiovascular risk and stroke.
Abstract 17709: Central Coronary Venous Troponin Concentrations as a Guide to the Identification of the Culprit Vessel in Multivessel Coronary Artery Disease
Authors: Cramer Gilbert E , Gehlmann Helmut , Aengevaeren Wim R , Dieker Hendrik-Jan , Keuper Wessel , Suryapranata Harry , Verheugt Freek W , Brouwer Marc A
Published: April 2024

Background:
In patients with non ST elevation acute coronary syndromes (NSTE ACS) culprit vessel identification remains a challenge. Notably, in the FAME trial routine multivessel stenting was not superior to FFR-guided revascularization. We hypothesized that a culprit stenosis in the LAD can be identified because troponin concentrations assessed in the great cardiac vein (GCV) would be higher than elsewhere in the coronary venous tree. In addition, in case of a RCX/RCA culprit we expected the concentration to be higher elsewhere in the coronary venous tree.

Methods:
we studied 36 consecutive patients with NSTE ACS who underwent early coronary angiography. In case of normal coronary arteries or a total occlusion a patient was excluded. Right sided catheterization and cannulation of the coronary sinus was performed. The catheter was introduced in the GCV with subsequent blood sampling. This procedure was repeated at the orifice of posterolateral vein and the middle cardiac vein. The culprit was assessed by a blinded committee using ECG, echo and coronary angiography.

Results:
As proof of concept 12 patients with single vessel disease were studied. All 5 with a LAD culprit had the highest troponin concentration in the GCV. In 6/7 patients with a non-LAD culprit the highest concentration was measured distally from the GCV in the coronary venous tree. As a pilot validation set, performed in multivessel disease patients with a definite culprit, the distinction LAD/non-LAD was correct in 14/15. In 9 patients in whom the culprit was unclear, the GCV concentration was highest in two.

Conclusion:
Despite careful study by a blinded committee, the culprit vessel can not be identified with certainty in ~25% of patients with NSTE ACS using conventional information. Assessment of the troponin concentration in the great cardiac vein can reliably distinguish between LAD and non-LAD culprits. Additional studies will address the diagnostic accuracy with regard to RCX and RCA culprits.
Abstract 17892: Network-Driven Integrative Genomics Analysis of the Cardiogram Gwas Reveals Key Drivers and Subnetworks of Coronary Artery Disease
Authors: Yang Xia , Huan Tianxiao , Maouche Seraya , Zhu Jun , Zhang Bin , Preuss Michael , Erdmann Jeanette , Nelson Christopher P , Snell Kym I , Segrè Ayellet V , McPherson Ruth , Quertermous Thomas , Samani Nilesh J , Schunkert Heribert , Assimes Themistocles L ,   Coronary ARtery DIsease Genome wide Replication and Meta-analysis (CARDIoGRAM) consortium
Published: April 2024

Objective:
The molecular mechanisms underlying most CAD susceptibility loci remain unclear and a large proportion of the heritability of CAD remains unexplained. We hypothesize that genetic variation with both strong and subtle effects drives gene subnetworks that affect risk of CAD.

Methods:
We surveyed CAD related molecular interactions by integrating CARDIoGRAM GWAS associations, expression SNPs (eSNPs), and gene networks constructed from 6 tissues of orthogonal mouse and human studies. We first mapped eSNPs to 12 established CAD gene sets or expression signatures from the literature (positive controls) and 2652 coexpression network modules to derive corresponding eSNP sets. We assessed the degree of enrichment for low p value associations with CAD within each eSNP set using Fisher's exact and Kolmogorov-Smirnov (KS) tests. We screened coexpression modules in the Wellcome Trust case control cohort and took 18 forward for testing in all of CARDIoGRAM. Enriched eSNP sets were in turn integrated with tissue-specific Bayesian networks and a protein-protein interaction (PPI) network to identify central network nodes driving these CAD-related gene sets (key drivers or KDs). Top KDs were then used as seeds to derive subnetworks linking KDs.

Results:
We found 11 of 12 positive control gene sets and 12 of 18 coexpression network modules to be significantly enriched for eSNPs with low p values (Bonferroni-corrected p<0.05 for both tests). We identified both tissue-specific KDs and KDs common to multiple tissues and found them to be enriched for CAD-related biological processes such as circulation, inflammatory response, and coagulation. The top KDs across tissues are IL1RN, EGR2, NCF2, and LDLR, and the tissue-specific KDs include LPL and APOE from liver, ALOX5AP and ACE from kidney, F7 and ANAX2 from adipose, BACH1 and FER1L3 from blood, and CD36 and PPARG from the PPI network. We found KDs to be highly connected in the networks. We derived representative subnetworks of the top KDs (21 known and 27 novel).

Conclusions:
Our network-driven integrative analysis not only identified known and novel CAD risk genes but also defined a network structure that sheds light on the molecular interactions of CAD risk genes within, between and across tissues.
Abstract 17913: Linear Relationship Between Seattle Heart Failure Model Predicted Mortality and Hospitalizations in Patients with Chronic Heart Failure
Authors: Moorman Alec J , Ponikowski Piotr , Anker Stefan D , Torre-Amione Guillermo , Young James B , Levy Wayne C
Published: April 2024

Background
Acute heart failure (HF) is a common and costly reason for hospitalization worldwide. We assessed the relationship between Seattle Heart Failure Model-D (SHFM-D) predicted mortality, total hospital days per year and discrete hospitalizations per year using data from the international Advanced Chronic Heart Failure Clinical Assessment of Immune Modulation Therapy (ACCLAIM) trial. We hypothesized a linear relationship between SHFM-D predicted mortality and annual hospitalizations and days hospitalized.

Methods
and Results 2407 chronic HF subjects with a total of 1023 all-cause hospitalizations and 430 HF hospitalizations were grouped by SHFM-D score. There was a linear relationship between SHFM-D estimated mortality and all-cause and HF hospitalizations per year, and all-cause and HF hospital days per year. For each 10% increase in SHFM-D predicted mortality, there were approximately 8 additional all-cause hospital days per year and 5 additional HF hospital days per year (Figure 1), and 0.7 additional all-cause hospitalizations per year and 0.5 additional HF hospitalizations per year (Figure 2). The SHFM-D score also predicted the primary and secondary ACCLAIM endpoints: composite of death or cardiovascular hospitalization (AUC 0.63, 95% CI 0.61-0.66, p < 0.001), death or worsening heart failure hospitalization (AUC 0.69, 95% CI 0.66-0.71, p < 0.001), and all-cause death (AUC 0.73, 95% CI 0.69-76, p < 0.001).

Conclusions
In the ACCLAIM cohort of patients with chronic systolic HF, there is a linear relationship between SHFM-D predicted mortality and annual hospitalizations and total days hospitalized.
Abstract 17914: C-Reactive Protein and Sleep Apnea Symptoms in World Trade Center Responders
Authors: Fishman Miriam L , Iyengar Rupa L , Sawit Simonette T , Maceda Cynara , O'Boyle Jacqueline , Dweck Jessica , Moline Jacqueline , McLaughlin Mary Ann
Published: April 2024

Background
Obstructive sleep apnea (OSA) is particularly prevalent in patients with cardiovascular disease (CVD). OSA is not an isolated sleep disturbance: the extent of its role as a causative agent in development and progression of CVD is under investigation. The hypoxemic stress that occurs during apneas leads to systemic inflammation and studies have shown correlations in the severity of OSA and the elevation of high-sensitivity C-reactive protein (CRP). We seek to characterize the association of CRP and patients at risk for OSA as assessed by the Berlin Questionnaire (BQ) and hypothesize that a positive relationship might improve diagnosis of OSA.

Methods
We evaluated 1,976 participants in the Law Enforcement Cardiac Screening Program, a subset of the World Trade Center Medical Monitoring and Treatment Program. Abnormal CRP is defined as CRP >/= 2 mg/L. Subjects with a positive response in 2 of the 3 categories from the Berlin Questionnaire are considered to be at high risk for OSA. We used chi-squared test and multivariate binary logistic regression in SPSS 19.0 to analyze the relationship between CRP and risk for OSA.

Results
Mean age is 46.77 ± 5.38 years and mean CRP is 3.26 ± 6.29. CRP >/= 2 was significantly related to high risk for OSA,
p
= 0.001. When adjusted for age, gender, and family history of coronary artery disease, CRP >/= 2 and risk for OSA are still significantly correlated (
p
< 0.001).

Conclusion
CRP >/= 2 is associated with being at high risk for OSA. This association may trigger more practitioners to screen their patients with high CRP values for OSA. The presence of a positive inflammatory marker with its implications for systemic disease may encourage patients to undergo the time-consuming diagnosis of and to be adherent to the cumbersome treatment of OSA, potentially resulting in improvement of their cardiovascular health, an exciting area for further research.

Funding Source: NY Fraternal Order of Police, via Office of the NY Attorney General Charity Fund.
Abstract 18015: Short and Long-Term Outcome of Impedance-Guided Preemptive Therapy Provided to Prevent Heart Failure in the Course of Acute Myocardial Infarction
Authors: Shochat Michael , Shotan Avraham , Kazatsker Mark , Levy Yaniv , Asif Aya , Blondheim David , Meisel Simgha
Published: April 2024

Background
Patients sustaining acute myocardial infarction (AMI) frequently develop acute heart failure (AHF) during hospitalization. Currently, treatment is initiated after the appearance of signs of lung fluid overload. Ongoing monitoring of the status of lung fluid content (LFC) may enable the prediction of impending AHF.

Aims
We sought to find out whether non-invasive lung impedance (LI) guided preemptive treatment of AMI patients improves clinical outcomes.

Methods
LI was determined by new noninvasive method. We have shown that a decrease of 12-14% from normal LI value reflects the transition from interstitial to alveolar edema. In the present study we prospectively randomized 213 patients (2:1 ratio) admitted for first AMI with no history of chronic heart failure (CHF) or signs of heart failure at admission and whose LI decreased by >12% to conventional therapy or LI-guided preemptive treatment.

Results
142 patients were treated conventionally (Gr1) and 71 preemptively according to LI (Gr2). Groups were well matched. All Gr1 patients developed AHF. Treatment was begun only at symptom onset. In Gr2 LI-guided preemptive treatment was initiated at the asymptomatic stage of evolving AHF and halted its progression in 89% of patients. Unadjusted analysis has shown that hospital stay, 1-year re-hospitalization rate after discharge, 6-year occurrence of new CHF and survival rate were better in Gr2 patients (p<0. 001). Adjustment for age, LVEF, maximal CK, diabetes, hypertension, hyperlipidemia, smoking, level of creatinine and hemoglobin at admission have shown that LI-guided preemptive treatment was associated with better clinical outcome. Length of hospital stay (OR=5.28, CI: 3.10-8.09, p<0.0001), 1-year re-hospitalization rate (OR=3.62, CI:2.16-6.06, p<0.001), 6-years occurrence of new CHF (OR=3.41, CI:1.26-7.47, p=0.002) and 6-years mortality (OR=3.19, CI:1.13-9.01, p=0.028) were lower in Gr2 than in Gr1. The major factors influencing clinical outcome were age, diabetes mellitus, LVEF <30% and maximal CK (>2216 mg/dl) (p<0.001).

Conclusion
s LI-guided preemptive therapy prevents the occurrence of AHF in 89% of patients, and decreases hospital stay, recurrent admissions, evolution to CHF and mortality during follow-up.
Abstract 18041: The Impact of Bystander CPR on Defibrillation-Survival curve in Out-of-hospital Cardiac Arrest From All-Japan Utstein Registry Data
Authors: Yonemoto Naohiro , Yokoyama Hiroyuki , Nagao Ken , Kimura Takeshi , Nonogi Hiroshi ,   JCS-ReSS group
Published: April 2024

[Background]
The study objective was the effect of time to chain of survival from out-of-hospital cardiac arrest. Several studies had the effects of them on survival from sudden cardiac arrest. These studies were estimated from medium sample size before guideline 2005.

[Method]
We used All-Japan Utstein Registry of the Fire and Disaster Management Agency with a prospective, population based, involving consecutive patients with an out-of cardiac arrest with witness with layperson, over 18 years, from April 1, 2006 to December 31 2009. The primary outcome measure was survival and good neurological outcome; CPC 1 or 2. We evaluated the effect and described the relationship of intervals from collapse to defibrillator with or without bystander CPR for the outcome.

[Results]
19993 adults were included in the analysis. The medium time to bystander CPR was 2 minutes. The medium time to defibrillation was 12 minutes (Figure). Adjusted odds ratio of the average effect of interval from collapse to bystander CPR per a minute was 1.09 and 95% Confidence Intervals (CI) 1.07 to 1.11. Adjusted odds ratio of the average effect of interval from collapse to defibrillator with bystander CPR per a minute was 1.11 and 95%CI 1.10 to 1.12. Adjusted odds ratio of the average effect of interval from collapse to defibrillator without bystander CPR per a minute was 1.12 and 95%CI 1.11 to 1.14. The effect of time to defibrillator with bystander CPR was better outcome than the effect of time to defibrillator without bystander CPR.

[Conclusions]
Proportion of survival with good neurological outcome cardiac arrest differently decreased with time that defibrillation with or without bystander CPR was delayed. Bystander CPR before defibrillation showed better neurological outcome and gained about 5 minutes to obtain the same proportion of the survival without bystander CPR. Our results suggest the effect of times to the chain of survival from nationwide large population data.
Abstract 18057: Impact of Elevated Peripheral Chemosensitivity on Spontaneous Baroreflex Function in Chronic Heart Failure Patients with Cardiorenal Anaemia Syndrome
Authors: Despas Fabien , Franchitto Nicolas , Galinier Michel , Senard Jean-Michel , Pathak Atul
Published: April 2024

Objective
Cardiorenal anaemia syndrome is known to increase mortality and morbidity in patients with CHF. The role of the sympathetic nervous system and related-reflexes in the pathophysiology remains unknown.

Design and Methods
The prospective study was conducted at the Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France. We studied 15 patients with CRA syndrome (age: 66.5 ± 3.1 years; mean BMI: 24.12 ± 0.9 kg/m
2
) and 15 control patients with CHF alone matched for age, gender distribution, type of cardiomyopathy, left ventricular ejection fraction (LVEF) and BMI. We compared sympathetic nerve activity (MSNA), sympathetic baroreflex function (assessed by the slope of the relationship between muscle sympathetic nerve activity (MSNA) and diastolic blood pressure) and its modulation by peripheral chemoreflex, in both groups.

Results
Baseline MSNA was significantly elevated in CHF patients with CRA syndrome compared with patients with CHF alone (83.1 ± 4.6 versus 64.9 ± 2.9 bursts/100 heart beats;
P
<0.01) and sympathetic baroreflex function impaired (2.69 ± 0.44 versus 5.25 ± 0.60 %/mmHg;
P
<0.01). In comparaison with control, chemoreflex deactivation with administration of 100% oxygen led to a significant decrease in muscle sympathetic nerve activity and an increase in arterial baroreflex sensitivity in patients with CRA syndrome.

Conclusion
CRA syndrome is associated with elevated sympathetic activity mediated by both baroreflex impairment and tonic activation of peripheral chemoreflex. The latter, through direct interaction with sympathetic baroreflex function subsequently contributes to further activation of the SNS tone. Altogether, mechanisms described in this study could partly explain how CRAS contributes to the progression of CHF and increases morbidity and mortality in these patients.
Abstract 18064: Prognostic Risk Index for One Year Morbimortality in Hospitalized Patients with Peripheral Artery Disease
Authors: Bura Alessandra , Pros Nicolas , Cambou Jean-Pierre , Aboyans Victor , Constans Joël , Lacroix Philippe
Published: April 2024

Background.
Risk stratification in peripheral arterial disease (PAD) may provide the basis for optimal management strategies in patients. This study aimed to develop a prognostic risk index for one-year morbimortality, in patients with severe PAD.

Methods and results.
Factors associated with morbimortality (total mortality, non-fatal MI or non-fatal stroke) were determined using data from the prospective, multicentre COPART register, including consecutive patients hospitalized for PAD in 3 university hospitals in Southwestern France. A risk score was constructed in a derivation cohort using the beta regression coefficient obtained in the final model of a descending step-by-step logistic regression analysis. The score was then tested on a validation cohort. We analyzed the data of 1,157 patients at hospital discharge: 640 in the derivation cohort and 517 in the validation cohort. At one year, morbimortality rate were respectively 19.2% and 20.3%. The index included the following factors (weight points): age ≥75<85 (+2), ≥85 years (+3); previous history of myocardial infarction (+1); eGFR according to MDRD equation ≤30 (+1.5), >30≤60 ml/min
-1
1.73m
-2
(+1); ankle-brachial index <0.3 (+2), ≥0.3<0.5 (+1.5) and >1.3 (+2); CRP ≥69mg/l (+2); association of statins, antiplatelet agents, renin-angiotensin system inhibitors (-1.5). Morbimortality rates increased significantly with the risk index in the derivation cohort: low risk (≤0 point): 2%; medium (>0≤2): 12.8%; high (>2<4.5): 23%; very high (≥4.5): 42.2%. The prognostic risk index appeared to be discriminating in both cohorts (C-statistic 0.76 and 0.74). Calibration was satisfying, no significant differences were found between the observed and calculated morbimortality rates in the validation cohort, using our prognostic risk index (Hosmer-Lemeshow χ2 p= 0.65).

Conclusions.
This prognostic risk index is a tool for risk stratification in patients with PAD and may be helpful for patient counselling and medical decision making.
Abstract 18067: Targeting Mitochondrial DNA to Reduce Consequences of Oxidative Stress: Role in the Prevention of the Diabetic Cardiomyopathy
Authors: Guarini Giacinta , Kolz Christopher L , Pung Yuh F , Ohanyan Vahagn A , Yin Liya , Bratz Ian N , Marzilli Mario , Chilian William M
Published: April 2024

Mitochondrial dysfunction and increased oxidative stress are hallmarks of diabetic cardiomyopathy, a condition characterized by increased risk of heart failure, independent of coronary atherosclerosis. Mitochondria not only are the major site of energy production, but also generate reactive oxygen species (ROS), and metabolic signals that produce coronary metabolic vasodilation (coupling of flow to metabolism). Accordingly, we hypothesized that elevations in mitochondrial ROS in obesity and diabetes produce oxidative mitochondrial DNA (mtDNA) injury (fragmentation); thus by repairing mtDNA fragmentation, we would restore coronary metabolic dilation. To test this hypothesis, we studied Zucker fatty obese rats (ZOF), lean littermates (ZL), and ZOF in which mtDNA fragmentation was repaired by administration of a cell permeable recombinant protein containing endonucleaseIII and a mitochondrial localization sequence (mt-tat-ENDOIII), which repairs fragmented mtDNA and restores mitochondrial functions. ZOF were treated daily for 3 days (1 µg/g body weight of mt-tat-ENDOIII). ZOF and ZL rats treated with vehicle were positive and negative controls, respectively. The product of mean arterial pressure and heart rate was used as a surrogate of cardiac work (CW). Myocardial blood flow (MBF) was measured by contrast echocardiography under baseline conditions (hexamethonium) and during NE infusion (i.v. norepinephrine, NE) to increase CW. During metabolic stress, ZOF showed coronary insufficiency compared to ZL (P<0.05). Importantly, coronary metabolic dilation in ZOF was restored by the administration of mt-tat-ENDOIII versus ZL (P=NS). We conclude that mitochondrial dysfunction participates to decrease the efficiency of the coronary metabolic regulation in diabetes. By preventing mt-DNA damage, adequate coronary metabolic dilatation can be restored; this could be a therapeutic approach for the prevention of diabetic cardiomyopathy.
Abstract 18068: Everolimus- versus Sirolimus-Eluting Stents for the Treatment of Patients with Unprotected Left Main Coronary Artery Disease (Results from EXCELLENT Registry)
Authors: Park Kyung Woo , Lim Woo-Hyun , Ahn Hyo-Suk , Kang Si-Hyuck , Lee Sang Eun , Yang Han-Mo , Lee Hae-Young , Kang Hyun-Jae , Koo Bon-Kwon , Cho Young-Seok , Yeon Tae-Jin , Chae In-ho , Chung Woo-Young , Kim Sang-Hyun , Kim Hyo-Soo , Oh Byng-Hee , Park Young-Bae
Published: April 2024

Background:
Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) has become a reasonable alternative to coronary artery bypass graft in the treatment of unprotected left main coronary artery disease. However, the results of 2
nd
generation DES in the treatment of these lesions are unknown. The objective of this study was to compare the efficacy and safety of stenting with everolimus-eluting stent (EES) compared with sirolimus-eluting stent (SES) for the treatment of left main disease in the “real world” setting.

Methods:
In the Efficacy of Xience/promus versus Cypher in rEducing Late Loss after stENTing (EXCELLENT) registry, a total of 5161 patients were enrolled from 29 centers in Korea between January 2006 and May 2010. Of these, 241 patients with symptomatic left main coronary artery disease undergoing PCI were analyzed; 139 patient implanted with EES and 102 with SES. We evaluated the rate of all-cause death, cardiac death, myocardial infarction, ischemia-driven target lesion revascularization (TLR) and stent thrombosis. The primary end point of this study was major adverse cardiac events (MACE, composite of death, myocardial infarction, and ischemia-driven TLR) at 1 year.

Results:
Baseline characteristics are similar between the two groups. At 1 year, the cumulative incidence of MACE was 8.6% in the EES and 10.8% in the SES group (p = 0.697). There were no differences in the rate of hard end point (death and myocardial infarction) (5.0% vs. 4.9%, p = 0.909) between the two groups. However, the rate of TLR was numerically lower in the EES group compared with the SES group (3.6% vs. 5.9%), although statically insignificant (p = 0.470). One patient in the EES group (0.7%) and one patient in the SES group (1.0%) experienced stent thrombosis (p = 0.823).

Conclusion:
Implantation of either EES or SES for the treatment of unprotected left main disease is effective and safe. Both stents showed comparable 1-year clinical results regarding MACE and hard endpoint.
Abstract 18272: Impact of Body Mass Index and Gender on Left Atrial Size and the Presence of Atrial Fibrillation
Authors: Gruberg Luis , Parikh Puja B , Malhotra Aditi , Kort Smadar
Published: April 2024

Background:
Atrial fibrillation (AF) is frequently observed in overweight and obese adults. There is limited data on whether increased body mass index (BMI) is independently associated with left atrial (LA) enlargement or the presence of AF. We sought to evaluate the impact of BMI on LA size and presence of AF and to assess whether it is gender specific.

Methods:
We reviewed 1,200 consecutive transthoracic echocardiograms performed at a tertiary care medical center. A total of 701 tests were excluded due to significant mitral valve disease or incomplete LA assessment. LA measurements obtained included A-P diameter from parasternal long axis view, LA area (LAA) and volume (LAV) from apical 2- and 4-chamber views and indexed LA volume to body surface area (LAVI). Patients were divided into three groups according to BMI: normal BMI between 18.5 and 24.9, overweight with a BMI between 25 and 30 and obese with a BMI greater than 30.

Results:
Among 499 patients included in this analysis, 259 (51.9%) were female and 240 (48.1%) were male. Of these, 151 (30.1%) had normal BMI, 181 (36.3%) were overweight and 167 (33.5%) were obese. Obese patients were younger, hypertensive, diabetic, and had larger LA diameter, LAA, and LAV, but similar LAVI. Using multivariate analysis, BMI and gender were both found to be independently associated with LA diameter (p<0.001 for both) and LAA (p<0.001 for both) but not LAVI or the presence of AF. Predictors of LA diameter in men and women included age, BMI, and right ventricular systolic pressure (RVSP). Left ventricular ejection fraction (LVEF) was an independent predictor of LA diameter and LAA in women but not men. Predictors of AF included LAVI (OR 1.046, 95%CI 1.023-1.070) in men and LAA (OR 1.227, 95%CI 1.130-1.333) and age (per year) (OR 1.041, 95%CI 1.008-1.075) in women.

Conclusions:
BMI and gender are independent predictors of LA diameter and LAA but not of LAVI or AF. However, LAVI is an independent predictor of AF in men, whereas LAA and age are independent predictors of AF in women.
Abstract 18300: Development of the Minnesota Stroke Needs Assessment for Survivor and Caregivers
Authors: Lindquist Ruth , Zwygart-Stauffacher Mary , Watanuki Shige , Hadidi Niloufar , Savik Kay
Published: April 2024

The Minnesota Stroke Needs Assessment (MSNA) was an initiative to determine the needs of survivors and caregivers after stroke. The purpose of this abstract is to describe the development of the MSNA surveys to assess and compare the needs of stroke survivors and caregivers. A preliminary list of needs was generated from a literature review and further refined with the aid of input from focus groups of survivors and caregivers. Two survey of needs were constructed, pretested, pilot tested, refined and then administered to survivors and caregivers who rated each need as none, somewhat and great. Factor analysis was performed to identify domains of need. Eighty-two items were factor analyzed with a sample of 281 survivors, and 95 items factor analyzed with a sample of 223 caregivers (age = 63, SD = 14, female = 70%) using the principal components method. For the survivors (age = 70, SD = 14, male = 52%, years since stroke = 3, SD = 3.2), 6 factors, retaining 51 items, which accounted for 54% of the total variance were extracted including disease specific information, health care information, psychological, physical services, and work/role. For the caregivers, 6 factors, retaining 66 items, which accounted for 56% of the total variance were extracted including physical needs, emotional needs, stress management, healthcare information, service/economic/work needs and recreational needs. The identified factors for both groups agreed to a large extent with broad areas of needs identified by the focus groups. Assessment of the original tools with the information provided by the factor analyses will allow refining and shortening of subsequent versions without the loss of any important domain of need. The shorter versions could be useful in assessing the needs of survivors and their caregivers in clinical settings.