bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 2911: T-182C Polymorphism in the Norepinephrine Transporter Gene (SLC6A2) and Risk of Cardiovascular Events in Patients with Dilated Cardiomyopathy: Association of the T allele with a Reduced Risk for Cardiovascular Events
Authors: NAGAI TAKAYUKI , Ogimoto Akiyoshi , Nishimura Kazuhisa , Kurata Akira , Suzuki Jun , Ohtsuka Tomoaki , Okayama Hideki , Miki Tetsuro , Higaki Jitsuo
Published: July 2021

Backgrounds:
The increase in sympathetic activity is one of the hallmarks of the chronic heart failure and has been shown to have an important impact on survival in patients with dilated cardiomyopathy (DCM). Norepinephrine transporter (NET) recaptures as much as 90% of released norepinephrine in the heart, making it a critical mediator of norepinephrine inactivation and presynaptic catecholamine homeostasis. Recently, the polymorphism of
NET T-182C
was reported to be associated with the improvement of left ventricular systolic function by beta-blockers in patients with DCM. However, the association between the incidence of cardiovascular events and the NET polymorphism in patients DCM has not been understood. The purpose of this study was to evaluate the effect of this polymorphism on the incidence of cardiovascular events in patients with DCM.

Methods:
Eighty-three genetically unrelated patients with nonfamilial DCM (64 males, mean age at initial clinical evaluation 59 ± 14 years) were enrolled in this study. An adverse cardiovascular event was defined as cardiac death or hospitalization for cardiac reasons. The time to the first adverse cardiovascular event was analyzed by the Kaplan-Meier method. The TaqMan polymerase chain reaction method was used for the determination of genotypes of the
NET T-182C
gene (SLC6A2) (rs#2242446).

Results:
The distribution of the
NET T-182C
genotypes (T/T, T/C, and C/C) was 43%, 45%, and 12%, respectively. The
NET T-182C
T allele frequency was 0.63. During a mean follow-up period of 45 months, 20 cardiovascular events had occurred. Eight patients died from cardiac cause (1 from pump failure and 7 from sudden cardiac death) and there were 12 hospitalizations for new onset or worsening of heart failure symptoms. The cardiovascular event rate of the patients carrying the T allele (T/T and T/C genotype, n = 73) was significantly lower than that of the patients not carrying the T allele (C/C genotype, n = 10) (p = 0.03).

Conclusion:
Our data suggested that the T allele of the
NET T-182C
gene may be a protective factor against cardiovascular events in patients with DCM.
Abstract 404: Catheter Based Delivery of scAAV6 Leads to High Level, Global Gene Transfer to the Canine Heart Superior to scAAV8, scAAV9, and ssAAV9
Authors: Bish Lawrence , Sleeper Meg , Brainard Benjamin , Cole Steven , Russell Nicholas , Withnall Elanor , Arndt Jason , Davison Ellen , Sanmiguel Julio , Gao Guangping , Wilson James , Sweeney H L
Published: July 2021

Background:
Heart disease is the leading cause of morbidity and mortality, and its prevalence continues to rise. As a result, novel therapies are needed. Adeno-associated virus (AAV) mediated gene transfer may be an effective strategy since the low immunogenicity of AAV favors persistent transgene expression. In addition, the recently developed self-complementary AAV (scAAV) vectors have demonstrated higher expression than traditional, single stranded AAV (ssAAV) vectors. The goal of this study was to compare cardiac gene transfer efficiency of four AAV vectors using non-invasive, catheter based delivery in the dog.

Methods:
Four AAV vectors expressing GFP under control of the CB promoter were evaluated in this study–ssAAV9, scAAV9, scAAV8, scAAV6 –so that comparison could be made between ss and sc vectors as well as among serotypes 9, 8, and 6. Dogs (5–10kg, n=4 per group) underwent cardiac catheterization with introduction of an injection catheter into the LV under fluoroscopy. The interventricular septum (IVS) and LV free wall (LVFW) were targeted from base to apex with 40 injections of 250 ul. The total viral dose was either 2x10
13
gc/kg (ss) or 5x10
11
gc/kg (sc). At 7–10 days post-injection, hearts were explanted and divided into four equal sections from base to apex. GFP expression was quantified in four representative areas from IVS and LVFW in each section. TaqMan PCR was used to track biodistribution.

Results:
GFP expression in the scAAV6 group was approximately 10-fold higher than in the scAAV8 and scAAV9 groups, and GFP expression in the scAAV9 group was approximately 10-fold higher than in the ssAAV9 group, both in terms of total positive cells and total fluorescence (p<0.01). Biodistribution studies revealed that vector genome copies were at least 10 times more abundant in the heart than in any other organ for scAAV6 (p≤0.05).

Conclusion:
scAAV is superior to ssAAV for cardiac gene transfer, and AAV6 has a higher cardiac tropism than AAV8 and AAV9 in the canine. Catheter based delivery of scAAV6 is a safe, effective method for achieving high level, global cardiac gene transfer to the LV. scAAV6 has great potential for transferring therapeutic transgenes to the failing canine heart and may be the vector of choice for clinical trials of cardiac gene transfer.
Abstract 2938: Decrease in Endocardial Radial Strain Precedes Global Left Ventricular Dysfunction in Patients With Hypertension.
Authors: Nishimura Kazuhisa , Okayama Hideki , Saito Makoto , Yoshii Toyofumi , Inoue Katsuji , Hiasa Go , Sumimoto Takumi , Kurata Akira , Suzuki Jun , Ogimoto Akiyoshi , Ohtsuka Tomoaki , Higaki Jitsuo
Published: July 2021

Background: Recent studies have reported that endocardial radial strain was approximately two fold greater than epicardial strain in normal subjects. Hypertension is a major cause of myocardial dysfunction and heart failure, but the difference between endocardial and epicardial radial strain in patients with hypertension is unknown. Two-dimensional speckle tracking echocardiography is a novel echocardiographic method that enables angle-independent assessment. Aim: The aim of this study was to evaluate the difference between radial strain in endocardial and epicardial segments in hypertensive patients.

Method: This study enrolled 37 patients with hypertension (H group, age 63±12years, 24men) and 17 sex- and age-matched normal subjects (N group, age 61±7 years, 9 men). Conventional echocardiography was performed by a Vivid 7 dimension (GE). Endocardial and epicardial radial strains were calculated from the left ventricular (LV) short axis view at the papillary muscle level using custom software (EchoPAC (GE)).

Results: There were no significant differences in LV diastolic dimension (47±5 mm vs. 48±4 mm), LV systolic dimension (29±4 mm vs. 29±4 mm), LV ejection fraction (65±9% vs. 67±6%) and fractional shortening (38±5% vs. 39±5%) between the H and N group. LV mass index (LVMI) in the H group was significantly greater than in the N group (109±33g/m2 vs. 90±22g/m2, P<0.05). Global radial strain including endocardium and epicardium were not significantly different between the H and N group (59±20% vs. 62±17%). However, endocardial radial strain in the H group was significantly less than in the N group (48±24% vs. 62±15%, P=0.03), whereas there was no significant difference in epicardial radial strain between the two groups (38±16% vs. 28±10%). The ratio of endocardial to epicardial radial strain (Endo/Epi ratio) in the H group was significantly smaller than in the N group (1.5±1.1 vs. 2.4±1.1, P<0.01). There were significant correlations between End/Epi ratio and LVMI (r=-0.33, P<0.05), and relative wall thickness (r=-0.43, P<0.01).

Conclusion: A decrease in endocardial radial strain precedes global LV dysfunction in patients with hypertension.
Abstract 2941: Combined Assessment of Coronary Artery Stenosis and Myocardial Ischemia by Rest-Dipyridamole Stress Multidetector Computed Tomography
Authors: Carrascosa Patricia M , Capuñay Carlos , Carrascosa Jorge , Deviggiano Alejandro , Goldsmit Alejandro , Bettinotti Marcelo , Garcia Mario J
Published: July 2021

Introduction: MDCT coronary angiography has been evolving as a noninvasive method for the assessment of coronary artery disease (CAD). More recently, It has been demonstrated that MDCT identifies reduced contrast enhancement in ischemic and/or scarred myocardial segments.

Objective: to determine the ability of rest-stress multidetector computed tomography (RS-MDCT) to detect myocardial ischemia and to assess the relationship between MDCT myocardial perfusion abnormalities and coronary artery stenosis.

Methods: Forty seven patients underwent stress/rest 99mTc sestamibi SPECT and RS-MDCT, using a 16-row detector scanner (Philips Brilliance-16). Myocardial segments were classified by SPECT as normal, ischemic or scarred. SPECT results were then compared with MDCT regional myocardial contrast enhancement. The results of MDCT coronary angiography were also analyzed in 20 patients who underwent invasive catheterization.

Results: The presence of a reduction in contrast enhancement at rest by MDCT identified scar by SPECT with 96% sensitivity and 98% specificity. A stress-induced reduction in contrast enhancement by MDCT identified ischemia by SPECT with 77% sensitivity and 99% specificity. The segment-based sensitivity and specificity for the detection of significant stenosis by MDCT were 92% and 98%, respectively.

Conclusion: Our results showed that a rest-dipyridamole stress MDCT protocol can identify the presence of myocardial ischemia as well as the severity of coronary artery stenosis in patients with suspected coronary artery disease.
Abstract 2958: Perindopril Reduces Large Artery Stiffness and Left Ventricular Outflow Tract Diameter in Patients with Marfan syndrome
Authors: Ahimastos Anna A , Aggarwal Anuradha , D’Orsa Kellie , Formosa Melissa , White Anthony , Savarirayan Ravi , Dart Anthony , Kingwell Bronwyn
Published: July 2021

Introduction:
Aortic stiffness is elevated in Marfan syndrome (MFS) contributing to aortic dilatation and rupture, the major cause of premature death in this population. Excessive signalling by the transforming growth factor-β(TGFβ) plays a crucial role in the development of aortic dilatation.

Hypothesis:
Given the known beneficial effects of angiotensin converting enzyme (ACE) inhibitors on arterial stiffness, we hypothesised that perindopril therapy would reduce aortic stiffness and attenuate aortic dilatation in MFS patients, possibly through effects on TGFβ signalling.

Methods:
17 MFS patients (aged 33 ± 5) on standard β-blocker therapy were randomised to also receive perindopril (8mg od, n=10) or placebo (n=7) for 24 weeks in a double blind study. Indices of arterial stiffness were assessed globally via systemic arterial compliance (SAC) and augmentation index (AIx), and regionally via central (PWVc) and peripheral (PWVp) pulse wave velocity. Left ventricular outflow tract (LVOT) diameter was assessed via a transthoracic echocardiogram. Venous blood samples were analysed for latent and active TGFβ levels using ELISA.

Results:
Perindopril reduced arterial stiffness as indicated by increased SAC (perindopril 62 ± 11% vs placebo -4.30 ± 1%, p<0.0001), reduced AIx (perindopril -23.50 ± 3% vs placebo 3 ± 1%, p<0.0001), reduced PWVc (perindopril -21 ± 2% vs placebo 5 ± 2%, p<0.0001) and PWVp (perindopril -20 ± 2% vs placebo 2 ± 1%, p<0.0001). In addition, perindopril significantly reduced LVOT diameter (perindopril -2.8 ± 0.4mm vs placebo 1.1 ± 0.3mm, p<0.0001). While perindopril marginally reduced mean arterial blood pressure (perindopril -1.3 ± 0.2mmHg vs placebo 0.2 ± 0.5mmHg, p=0.004), importantly, the observed changes in both stiffness (p=0.001– 0.006) and LVOT diameter (p<0.001) remained significant when mean blood pressure was included as a covariate. Finally, perindopril reduced latent TGFβ levels by -14.0 ± 4.5ng/ml when compared to placebo (2.0 ± 2.3ng/ml, p=0.01), and active TGFβ levels by -4 ± 1ng/ml (placebo 3 ± 1 ng/ml, p=0.02).

Conclusions:
In conclusion, ACE inhibition reduces aortic stiffness and LVOT diameter in MFS patients possibly through attenuation of TGFβsignalling, and may potentially protect against aortic rupture.
Abstract 2981: Long Term (3 Years) Outcome in Patients with Unprotected Left Main Coronary Artery Stenosis Treated with Drug-Eluting Stent Implantation
Authors: Chieffo Alaide , Rogacka Renata , Magni Valeria , Airoldi Flavio , Cosgrave John , Ferraro Massimo , Montorfano Matteo , Michev Iassen , Romagnoli Enrico , Godino Cosmo , Colombo Antonio
Published: July 2021

Background:
The long-term safety and efficacy of drug-eluting stent (DES) implantation in the treatment of unprotected left main coronary artery (LMCA) stenosis is still a matter of debate. Some concerns have been recently raised regarding the risk of late stent thrombosis

Methods:
All consecutive patients (pts) who had sirolimus (SES, Cypher, Cordis, Johnson and Johnson Company, Warren, NJ) or paclitaxel-eluting stent (PES, Taxus, Boston Scientific, Natick, MA) electively implanted in de novo lesions on LMCA between March 2002 and June 2004 were analyzed.

Results:
A total of 107 pts were treated: 52 with PES and 55 with SES. Twenty (18.3%) patients were diabetics, 34 (31.8%) unstable angina, mean age 63.8±10.3 years, EF 52.0±10.4. High mortality risk scores (Euroscore >6) were present in 34 (31.7%) of the patients. Eighty-seven (81.3%) patients had distal left main lesions: 77 bifurcations and 10 trifurcations. Both branches were stented in 64 (73.6%) pts: crush technique was performed in 38 (59.4%) of them. Reference vessel diameter was 3.3±0.68mm. Procedural success was achieved in all pts. During hospitalization 10 (9.3%) patients had CK-MB elevation ≥ 5 ULN. None of the patient had Q wave myocardial infarction (MI), died or had CABG. At 1206±347 days clinical follow-up, 11 (10%) patients died, 8 (7.4%) of them were adjudicated as cardiac deaths according to ARC definition. Five of the cardiac deaths could be considered as possible late stent thrombosis. Only 1 had a definite late stent thrombosis (in the left anterior descending artery with MI treated with re-PCI at 3 months while on dual antiplatelet therapy). TVR (defined as any revascularization in left coronary system) occurred in 26 (24.2%) patients and 19 (17%) TLR (defined as any revascularization in the stented segment): 21 had a re-PCI and 5 CABG. Angiographic follow-up performed in 94 (87.8%) pts showed restenosis in 16 pts (17%); all restenosis occurred in pts with treatment of distal left main and were focal.

Conclusions
Treatment of LMCA stenosis with DES appears safe with favorable and improved clinical results maintained at long term clinical follow-up..
Abstract 2985: Impact of PCI in Patients with Recent Onset Severe Angina or Stabilized ACS Treated with Optimal Medical Therapy: a COURAGE Trial High Risk Subset
Authors: Maron David J , Spertus John A , Mancini G.B. John , Hartigan Pamela M , Dada Marcin , Teo Koon K , O’Rourke Robert A , Weintraub William S , Boden William E
Published: July 2021

Background:
The COURAGE trial randomized 2,287 patients with stable coronary artery disease (CAD) to optimal medical therapy (OMT) with or without percutaneous coronary intervention (PCI). Eligibility criteria allowed entry of patients with recent onset, severe angina and recently stabilized acute coronary syndromes (ACS). We hypothesized that patients with recent onset, severe angina or recently stabilized ACS had higher risk for death or MI, and that this risk was reduced by PCI.

Methods:
High risk was defined as Canadian Cardiovascular Society class III angina with first onset of symptoms ≤ 2 months prior to enrollment, recently stabilized class IV angina, or recently stabilized ACS not treated with PCI. Persistent class IV angina patients were excluded. Patients were permitted to undergo revascularization during the trial as clinically indicated for unremitting angina or ACS. The chi square test was used for between group comparisons.

Results:
At baseline, 12% of COURAGE patients were classified as high risk. Within each treatment arm, high risk patients were more likely to suffer death or MI than non-high risk patients (OMT group, 26% vs. 17%, P=0.006; PCI group 24% vs. 18%, P=0.06). There was no significant difference between treatment arms for major cardiovascular events in patients at high risk (see Table

). As observed in the entire COURAGE cohort, revascularization was more frequent in high risk patients randomized to OMT compared with PCI (42% vs. 30%, P=0.04). Outcomes in High Risk Patients Randomized to OMT Alone or OMT + PCI

Conclusions:
The addition of PCI to OMT as an initial management strategy did not reduce death, MI or other major cardiovascular events in this high risk subset of COURAGE patients with recent onset severe angina or stabilized ACS.
Abstract 2986: Did Early Hazard of PCI Offset Late Benefit in the Occluded Artery Trial (OAT)?
Authors: Buller Christopher E , Rankin James M , Renkin Jean , Carere Ronald G , Dzavik Vladimir , Ruzyllo Witold , Forman Sandra A , Buszman Pawel E , Mancini G. B. John , Abreu Pedro F , Lamas Gervasio A , Hochman Judith S
Published: July 2021

Background:
The Occluded Artery Trial (OAT) showed no reduction in death, MI or class IV CHF with routine PCI in occluded infarct-related coronary arteries in stable patients identified up to 28 days post MI. PCI of non-acute coronary occlusions can be complex and hazardous. We report the magnitude and nature of PCI-related early hazard in OAT and its contribution to overall trial results.

Methods:
All 1101 PCI and 1100 medical therapy (MED) assigned patients were examined by intention-to-treat. Pre-specified events (death, MI, class III or IV HF) and procedural complications during the first 48 hours after OAT enrollment (including at least 24 hours post protocol-driven PCI) were analyzed, and the OAT primary composite outcome (death, adjudicated MI, or new class IV HF) was examined at 5 and 30 days, and 60 months.

Results:
Events or complications within 48 hours of enrollment occurred in 55 PCI patients (5.0%) versus 29 MED patients (2.6%) (p=0.01). PCI patients experienced more class III or IV HF events (5 vs. 2), coronary perforation (4 vs. 1), ventricular arrhythmias (6 vs. 2), CNS complications (3 vs. 2), major hemorrhage (8 vs. 1), and vascular complications (5 vs. 1). Cardiac rupture occurred in 4 patients; 2 in each arm. Events/complications were deemed PCI-related by sites in 35 of 55 patients, and by central review in 30 of 55. Attribution by sites and central review were generally concordant and indicate that the observed events excess was causally related to PCI procedures.

Conclusion:
While there was no excess mortality in the PCI-treated group, events and complications during the first 48 hours were significantly more common in OAT patients assigned PCI than in those assigned MED. This early procedural hazard, however, was small in magnitude and was not followed by convergence of event rates through 60 months. We conclude the absence of net benefit for routine PCI in OAT cannot be explained by early hazard offsetting late benefit.

Primary Outcome Life Table Event Rates: 48 hrs, 5 and 30 days, and 60 months
Abstract 2992: Percutaneous Coronary Intervention With Drug Eluting Stents Versus Left Internal Mammary Artery Grafting For Patients With Isolated Lesion In The Proximal Segment Of Left Anterior Desceding Coronary Artery, Suffering From Chronic Stable Angina.
Authors: Vaina Sophia , Toutouzas Konstantinos , Patsa Chrysoula , Tsiamis Eleftherios , Stefanadi Elli , Chlorogiannis Ioannis , Spanos Anastasios , Illiopoulos Dimitrios , Panagiotou Mathaios , Vavouranakis Manolis , Pattakos Eustratios , Stefanadis Christodoulos
Published: July 2021

Introduction:
Coronary artery bypass grafting (CABG) with left internal mammary artery (LIMA) and percutaneous transluminal coronary angioplasty (PCI) with drug eluting stent (DES) implantation are both effective to treat ischemic heart disease. In the current study we evaluated the long term results of the two methods in patients (pts) with isolated proximal left anterior descending artery lesion (pLAD), suffering from chronic stable angina (CSA).

Methods:
We included 280 pts, 170 with DES implantation and 110 with LIMA grafting. Primary end points were the occurrence of major adverse cardiac events (MACE), defined as: Death, myocardial infarction and target vessel revascularization (TVR). Secondary end-points included the length of hospitalization, in-hospital complications and the recurrence of chest pain. Pts were followed-up clinically.

Results:
Mean follow-up period was two years (midrange, one to three years). MACE was 5.29% in the DES group and 2.72% in the surgical group (p=0.37). TVR was 3.52% after PCI and 0% after CABG (p=0.08). The event-free survival curve was similar between the two groups (Figure

). More in-hospital complications were observed in the surgical group compared with the PCI group (16.36% vs. 1.17%, respectively, p=0.01). Recurrent angina was 4.11% in the DES group and 6.36% in CABG group (p = 0.41).

Conclusions
: In the current study the two procedures had similar long-term results, even though the surgical approach was associated with increased in-hospital complications and longer hospitalization. Therefore, both revascularization modalities can be used to treat pLAD lesions in pts with CSA.
Abstract 3005: Surgical Treatment of Severe Right Ventricular Cardiomyopathy
Authors: Chachques Juan , Lavergne Thomas , Frank Robert , Hidden-Lucet Francoise , Fontaine Guy , Hebert Jean-Louis , Lecarpentier Yves , Ciobotaru Vlad , Carpentier Alain , Fabiani Jean-Noel
Published: July 2021

Objective:
Chronically depressed right ventricular (RV) function presents an unresolved therapeutic challenge. Despite recent advances in medical and surgical therapies, prognosis remains poor and patient’s quality of life and mortality are frequently unacceptable. The aim of this work is to present the surgical technique and long-term results of RV dynamic cardiomyoplasty applied in patients with RV failure due to isolated RV cardiomyopathies.

Methods:
Twelve consecutive patients (8 males, 4 females), mean age 37±9 years, were enrolled. All pts had predominant RV dysfunction, associated with tricuspid regurgitation in 11 cases. Etiology of RV failure was arrhythmogenic cardiomyopathy (8 cases), Uhl’s disease (2 cases) and ischemic (2 cases). Patients were in preoperative NYHA FC III. Mean pre-operative EF measured by isotopic technique, was 20 ± 4.2 % for the RV and 37 ± 8 % for the LV. Right ventricular dynamic cardiomyoplasty consists in wrapping the RV free wall with the left Latissimus Dorsi Muscle (LDM) flap. The distal part of the LDM is fixed to the diaphragm and then electrostimulated in synchrony with cardiac function. Eleven patients required associated tricuspid valve surgery (10 annuloplasty rings and 1 valve replacement). In 6 pts an ICD was implanted prior to surgery.

Results:
Nine patients are alive (mean follow-up: 10 ± 3.5 years), seven in NYHA functional class I and two in class II. Three deaths occurred: one patient died postoperatively due to infection, one patient died at day 45 due to gastroenteric complication and one patient died at year 7 due to stroke, while in functional class II. At long term follow-up, mean RVEF is 32 ± 6 % and LVEF is 51 ± 9 %.

Conclusions:
The results of this long-term study demonstrate hemodynamic and functional improvements following RV cardiomyoplasty with no long-term malignant arrhythmias and RV dysfunction related deaths. The effects of RV cardiomyoplasty can be related to chronic systolic compression and diastolic dilatation restriction (positive remodeling), which may reduce tension and excitability of myocardial fibers. This study suggests that cardiomyoplasty is a safe alternative or long-term bridge to heart transplantation in these patients with relatively preserved LV function.
Abstract 3012: Impact of Thromboaspiration during Primary PCI on Microvascular Damage and Infarct Size: Acute and Long term ce-MRI Evaluation.
Authors: Sardella Gennaro , Mancone Massimo , Scardala Raffaele , De Luca Leonardo , Ducci Chiara Bucciarelli , Di Roma Angelo , Carbone Iacopo , Fedele Francesco
Published: July 2021

Background: In patients with ST-elevatrion myocardial infarction (STEMI), impairment of microcirculatory function is a negative independent predictor of myocardial function recovery. Compared with conventional stenting, thrombectomy during primary percutaneous coronary intervention (PCI) seems to improve the parameters of myocardial tissue perfusion. We sought to evaluate the impact of thromboaspiration on procedural outcomes and microascualr damage and infarct size by contrast enhanced-MRI (ce-MRI) as compared to conventional primary PCI.

Methods:We randomized 75 patients (mean age 64.3±10.2, 55 male) referred to our Hospital with a STEMI (<9 hours from symptoms onset) and an occlusive thrombus at basal angiography, to thromboaspiration with a manual device (Export ®-Medtronic (n=38) (group 1)) and standard PCI (n=37) (group 2). 3 days after procedure and 3 months later a ce-MRI was performed to assess the microvascular damage (as hypoenhancement (HO)) and infarct size (as hyperenhancement(HR)) in the 2 groups. The primary end points were the angiographic result in terms of the TIMI ≥ II flow , MBG ≥ 2 and ST-segment resolution (STr)≥ 70% post-stenting and the microvascular damage (grams/g) and infarct size (grams/g) evaluated by ce-MRI.

Results: No differences on baseline, clinical and angiographic preprocedural findings were observed between the two groups. After trombectomy, a TIMI II flow was present in in 38.6 vs 19.6% (p=0.054) and TIMI III was 30.7 vs 72.5% (for group 1 and 2, respectively, p<0.001). Postprocedural MBG ≥2 was 70,3% vs 28,7% (p<0.001) and 90′ ST-segment resolution was 80% vs 37.5% (for group 1 and 2, respectively, p<0.001). Ce-MRI showed an HO of 4.04±5.87g at 3 days vs 0.12±0.4g at 3 months (p= 0.04) in group 1, and 3.7±5.04 vs 2.7±2.3 (3 d and 3 m. respectively)(p=ns) in group 2. At 3 days HR was 17.39±15.6g vs 11.01±8.07g at 3 months in group 1 (p=0.04) and 14.02±7.5g vs 13.6±12.7g ( 3 d. and 3 m. respectively) (p=ns) in group 2.

Conclusion:Compared with conventional stenting, a pretreatment with thrombectomy during primary PCI, improves epicardial flow and procedural outcomes. The long term ce-MRI evaluation suggests a reduction in microvascular damage and infarct size compared with the acute evaluation in the thrombectomy group.
Abstract 3014: Microvascular Obstruction by Cardiac Magnetic Resonance is a Stronger Predictor of Outcomes than left Ventricular Ejection Fraction or End-Systolic Volume Index after Primary Coronary Intervention
Authors: Noguchi Teruo , Yamada Naoaki , Kawamura Atushi , Otsuka Yoritaka , Nonogi Hiroshi , Goto Yoichi
Published: July 2021

Backgroud:
Left ventricular (LV) end-systolic volume index (ESVI) and ejection fraction (EF) are predictor of long-term mortality following an acute myocardial infarction(AMI). However, interpretation of these parameters within 1 week of AMI is difficult due to myocardial stunning. We sought to correlate size of microvascular obstruction (MO), EF, and ESVI determined by cardiac magnetic resonance (CMR) to major cardiovascular events (MACE) after primary coronary intervention for ST-elevation MI (STEMI).

Methods:
CMR was performed in 94 consecutive STEMI patients within 1 week following AMI. The following indexes were calculated: size of MO/LV mass, infarct mass, EF, and ESVI. Patients were divided into two groups according to the size of MO: large MO group (MO/LV ≥ 0.1) and small MO group (MO/LV < 0.1). A three-year clinical follow-up was recorded. Univariate and multivariate analyses were applied to identify predictors of MACE.

Results:
The mean LVEF and ESVI were 43 ± 13% and 49 ± 15 ml. The mean infarct mass was significantly greater in large MO group than that in small MO group (28 ± 15g vs. 19 ± 10g p<0.01). Survival without MACE was significantly lower in patients with large MO group in comparison to those with small MO group (log-rank p<0.001). Large MO (1.98 [95% CI 1.2–2.0], p=0.001), EF (0.91 [0.90 – 0.97], p=0.007), and ESVI (1.04 [1.01–1.06], p=0.01) were the only independent predictors of MACE. However, Large MO was a strongest predictor of MACE by multivariate analysis.

Conclusions:
EF, ESVI, and size of MO predict the future cardiac events. Size of MO measured by CMR, which is independent of stunning, was stronger predictors of MACE than either of the other two parameters.
Abstract 3018: Sedation of Elderly Patients Undergoing Coronary Arteriography Does Not Result in Adverse Outcomes and Improves Postprocedural Care
Authors: Ashraf M. Javed , Vallurupalli Neelima , Cook James R , Schweiger Marc J , Bellantonio Sandra , Studley Jill
Published: July 2021

Background:
Elderly patients are undergoing invasive cardiac diagnostic procedures more frequently. Preprocedural sedation is often prescribed, intraprocedural medications administered, and appropriate concern raised regarding post procedure delirium and adverse consequences in the elderly. The objective of this prospective randomized study was to investigate the effect of premeditation on new onset delirium and procedural care.

Methods:
Patients ≤ 70 years old and scheduled for elective cardiac catheterization were screened for enrollment. All patients underwent a mini mental status exam (MMSE) and delirium assessment using confusion assessment method (CAM) prior to the procedure and repeated at 4 hours and prior to discharge or the next morning. Patients were randomly assigned to receive either diphenhydramine and diazepam (25 mg / 5 mg po) or no premedication. Patient cooperation during the procedure and ease of post-procedure management by nursing staff was measured using Visual Analog Scale (VAS). The degree of alertness was assessed immediately on arrival to the floor, at one and two hours using Observer’s Assessment of Alertness/Sedation Scale (OAA/S).

Results:
Total of 93 patients enrolled in the study, of which 47 patients received premedication prior to the procedure. The mean age was 77 ± 4.2 years, 56% were male. The baseline mean MMES was similar in each group (27.6± 1.4 in premedication group versus 28.17±1.4 in patients without premedication). Patients with premedication were less alert immediately and at one hour after arrival on the floor (p<0.01), but no patient in either group developed delirium after the procedure as measured by CAM. The ease of procedure was greater, pain medication requirement lower and nursing reported an improvement with patient management after the procedure in the premedicated group (all p<0.05).

Conclusion
: Premedication did not cause delirium or confusion in elderly patients undergoing cardiac catheterization. The reduced pain medication requirement, perceived procedural ease and post procedure management favors premedication in elderly patients under going cardiac catheterization.
Abstract 3022: Symptoms After Stenting are Unrelated to Symptoms Before or During Stenting
Authors: Zimmerman Deborah K , Blankenship James C , Skelding Kimberly A
Published: July 2021

Background
: Despite successful PCI, many patients (pts) with chronic chest pain continue to experience pain. The etiology of this is not clear.

Objective:
To determine whether characteristics of pre-PCI symptoms or intra-PCI symptoms predict relief of symptoms after PCI. We hypothesized that compared to pts with atypical angina, more pts with typical angina pre-PCI would have symptoms reproduced by PCI and would have relief of these symptoms after successful PCI.

Methods:
We studied 98 consecutive pts with chronic chest pain in whom PCI provided complete revascularization. Pts were excluded if they had unsuccessful PCI, or prior myocardial infarction or wall motion abnormalities in (or collaterals to) the territory undergoing PCI. During PCI, the first balloon (or stent) inflation was prolonged until 3 minutes or until the pt experienced any discomfort. Pts were asked at the time to characterize intra-PCI symptoms. At phone interview 1 month later, pts were queried regarding chest pain. Patients were divided into groups based on pre-PCI symptoms being typical versus atypical for angina versus mixed, and on whether symptoms during PCI did or did not reproduce pre-PCI symptoms

Results:
Pts presented with unstable angina (25%), chronic outpatient angina (65%), and positive stress tests for ischemia (63%). All target vessels were successfully treated with PCI. At 1 month followup there were no deaths, myocardial infarction, or recurrent PCI. Patients with typical angina more frequently had reproduction of symptoms during PCI (76%) compared to those with atypical symptoms (43%) or patients with mixed symptoms (64%, p = 0.009). However, pain at 1 month after PCI did not correlate with pre-PCI symptoms (typical 26%, atypical 26%, mixed 40%, p = NS). Also, reproduction of pre-PCI symptoms during PCI was similar in patients with pain 1 month later (50%) compared to those without pain 1 month later (65%, p = .24).

Conclusions:
Chronic typical angina symptoms are more often reproduced during PCI than are atypical symptoms. However, typical and atypical symptom pts are equally likely to have relief of symptoms after complete revascularization. Reproduction of pre-PCI symptoms during PCI does not predict their relief after PCI.
Abstract 3027: The Pocket Protector Study: Use of D-Stat
®
Flowable Hemostat in Pulse Generator Pectoral Pockets Reduces the Rate of Clinically Relevant Hematomas
Authors: Slotwiner David , Alder Stuart , Fuenzalida Charles , McCowan Ronald , McPherson Craig , Mela Theofanie , Merliss Andrew , Mobarek Sameh , Nayak Hemal , Shoukfeh Fawwah
Published: July 2021

Background
: Patients who are anti-coagulated following pulse generator implantation have a 20% risk of hematoma development in the pre-pectoral pocket. In general, hematomas are correlated with patient discomfort & pain, lead to increased risk of infections, & may require surgical drainage leading to longer hospitalization.

Objectives
: This investigation was conducted to evaluate safety & effectiveness associated with use of D-Stat
®
Flowable Hemostat following implantation of a pulse generator compared to standard of care. Safety endpoint evaluated the incidence of major study-related adverse events & effectiveness endpoint evaluated the incidence rate of clinically significant hematomas. Clinically relevant hematoma was defined as alteration in the standard of care.

Methods
: Two hundred sixty nine anticoagulated patients were enrolled at ten sites & followed through 8 weeks post-procedure. Patients undergoing implantation were randomized to either D-Stat Flowable Hemostat or standard of care.

Results
: No statistical differences were observed in the baseline demographics between treatment groups. The D-Stat Flowable group presented with 65.4% males compared to 71.4% in the control group. Mean age was 73.3 years in the D-Stat Flowable group vs 72.2 years in the control group. Pulse generator distribution between the study groups was 54.4% pacemakers & 45.5% ICDs in the D-Stat Flowable group vs 54.9% pacemakers & 45.1% ICDs in the control group. The safety of the D-Stat Flowable was successfully demonstrated as the incidence rate of major complications experienced in both groups (D-Stat Flowable: 21.3%; Control: 27.8%) was equivalent (p value 0.0008). The effectiveness of D-Stat Flowable was successfully demonstrated as the overall rate of clinically relevant hematomas experienced in the D-Stat Flowable group (11.8%) was significantly less than that of the control group (22.6%) (p-value 0.0231).

Conclusions
: The findings from this investigation demonstrate the use of D-Stat Flowable within the pre-pectoral pocket in anti-coagulated patient population undergoing placement of a pulse generator is safe and effective. Use of D-Stat Flowable resulted in a 48% reduction in the rate of clinically relevant hematomas in the target population.
Abstract 3034: Ramipril Retards Development Of Aortic Valve Stenosis In a Rabbit Model: Role of thioredoxin interacting protein
Authors: Ngo Doan T , Stafford Irene , Wuttke Ronald D , Weedon Helen , Smith Malcolm D , Kelly Darren J , Sverdlov Aaron L , Kennedy Jennifer A , Horowitz John D
Published: July 2021

Background:
The prevalence of aortic stenosis (AS) has steadily increased over the past 10 years with little improvement in development of therapeutic interventions. We have previously demonstrated that AS develops within 8 weeks in rabbits treated with vitamin D
2
(vit D
2
25,000IU/4 days weekly), and is associated with biochemical and physiological evidence of induction of endothelial dysfunction. We now conduct an investigation in this model of the effects of the ACE inhibitor ramipril on development of AS, extent of endothelial dysfunction and valvular thioredoxin-interacting protein (Txnip), an important regulator of cellular redox balance.

Methods:
Male New Zealand White rabbits were treated with vit D
2
alone (n=10) or vit D
2
/ramipril (ramipril about 0.5 mg/kg/day; n=12). Six untreated rabbits served as a normal comparator group. AS development was assessed by echocardiography with measurement of transvalvular velocity ratio (AVv/LVOTv), aortic valve area (AVA), and aortic valve backscatter scores (AV
BS
). The extent of endothelial dysfunction, was assessed by plasma asymmetric dimethylarginine (ADMA) concentrations and responsiveness to acetylcholine (ACh) in phenylephrine pre-contracted aortic rings. Positive immunostaining for Txnip was quantified by computer-assisted image analysis. .

Results: (
mean ±SEM) Echocardiographic data indicated increased AVv/LVOTv, decreased AVA and increased AV
BS
in the vit D
2
treated rabbits over 8 weeks .Vit D
2
/ramipril attenuated AVv/LVOTv (p<0.05) and AVA (p<0.05, 2-way ANOVA for both); with borderline decreases in AV
BS
(17.8 ± 2.1dB vs 11.9 ± 2.4 dB, p=0.08). ADMA concentrations were decreased (p<0.01, 2-way ANOVA) in the Vit D
2
/ramipril group and vascular response to ACh and AV
BS
were inversely correlated (r
2
= 0.9, p<0.0001). Valve Txnip was diminished for vit D
2
/ramipril (0.44±0.03 % total area,) vs vit D
2
(0.89±0.18 %), p=0.03.

Conclusion:
In this model of AS, ramipril significantly retarded progression of AS and ameliorated endothelial dysfunction. Furthermore, ramipril reversed vit D
2
-induced increases in valvular Txnip, implying an improvement of intracellular antioxidant status. These data add to the rationale for formal clinical evaluation of ACE inhibitor effects in AS.
Abstract 3036: Is the Sympathetic Nervous System, Renin-angiotensin System and Cytokines Activated in Asymptomatic Patients with Chronic Organic Mitral Regurgitation and Normal Left Ventricular Functional Reserve?
Authors: Pu Min , Davidson William , Fan Xiaoxue , Demers Lawrence
Published: July 2021

Activation of the sympathetic nervous system, reninangiotensin system and cytokines has been observed in patients (pts) with congestive heart failure associated with chronic mitral regurgitation (MR). In order to further understand the pathophysiology of chronic MR, it is important to know whether these neurohormonal systems are activated in pts with chronic MR and normal LV function.

Methods:
Twenty pts with chronic MR were studied. All the pts had mitral valve prolapse and moderately severe or severe MR with a mean regurgitant orifice area of 0.42 ± 0.05 cm
2
. Mean exercise capacity on the Bruce protocol was 12 ± 3 Mets. LV diameters and LVEF were measured at rest and immediately post exercise by echocardiography. Normal LV function was defined as resting LV ejection fraction (LVEF) of > 60 % with normal LV systolic functional reserve (increased LVEF of ≥ 5% post exercise). Plasma norepinephrine (NP), renin activity (RA) and tumor necrosis factor-alpha (TNF-α) were measured in pts with MR and 13 normal subjects without MR.

Results:
LV end-diastolic diameter (5.4 ± 0.5 cm vs. 4.5 ± 0.5 cm, p<0.01) and end-systolic diameter (3.6 ± 0.6 cm vs. 2.6 ± 0.5 cm, p<0.01) were significantly larger in pts with MR than the normal subjects. Resting LVEF was similar in two groups (MR: 65 ± 4% vs. normal: 59 ± 6%, p>0.05). There were no significant differences in plasma NP, RA and TNF-α between the MR and normal groups (Table

). NP, RA and TNF-α were not significantly associated with exercise capacity, LV end-diastolic and systolic diameters and pre- and post-exercise LVEF (all p> 0.05).

Conclusion:
Unlike pts with LV dysfunction and MR, neurohormones are not significantly activated in asymptomatic pts with chronic MR and normal LV systolic functional reserve. Therefore, elevation of the neurohormonal levels and/or reduced LV functional reserve may indicate LV function impairment and prompt early surgical and/or medical intervention.
Abstract 3054: Comparison of Transforming Growth Factor-β1 Expression in Aortic Wall of Thoracic Aortic Aneurysm Versus Dissection
Authors: Yang Shouguo , Cui Guanggen , Beygui Ramin , Esmailian Fardad , Ardehali Abbas , Tang Jianping , Plunkett Mark , Laks Hillel , Sen Luyi
Published: July 2021

Background
The underlying mechanism of thoracic aortic aneurysm (TAA) and dissection(TAD) was undetermined, and one controversy lies in whether they represent the different dvelopement period of the same disorder or totally diferent diseases. This study is in aim to compare the expression and distribution of Transforming Growth Factors(TGF) β1 in the aortic wall of TAA versus TAD patients.

Method
Aortic specimens were obtained from patients underwent to aortic procedures for TAA (n=38) and TAD (n=20) at UCLA , and control aorta (CN) from organ donnor (n=20). Double immunofluorescent stainning of TGF-β1 and α-smooth muscle actin were performed with paraffin embeded slides for all aortic samples and semiquantified by fluorescent intensity analysis. Histopathologic examination were performed with HE, Verhoeff van-Gieson and Masson’s trichrome stain.

Results
TAA and TAD patients exhibited an up-regulation of TGF-β1 to 120.3% and 109.6% compared with CN separately (P<0.05), with TAA higher than TAD (P<0.05). TGF-β1 distributed unevenly across aortic wall with the highest levels expression in tunica media, followed by intima then adventitia. In intima, TGF-β1 was expressed at the same level for TAD as CN, but was increased to 115.2% for TAA compared to CN (P<0.05). In media, TGF-β1 increased by 127.2% in TAA and 116.1% in TAD compared to CN (P<0.01), with TAA being higher than TAD (P<0.05). In adventitia, TGF- β1 was up-regulated to 119.6% and 116.7% for TAA and TAD compared to CN (P<0.05). Nucleus density analysis showed cellular plasia in adventitia of TAA and TAD than CN (P<0.05 ), while TAD patients demonstrated a higher nucleus density than TAA in intima and adventitia (P<0.05). α-actin was increased in media of TAA and TAD to 164.5% and 120% than CN (P<0.01 and P<0.05). Attenuated and interrupted elastin and mild to severe cystic medial degeneration were characteristic histopathologic finding in 29 (76.3%) TAA and 17(85%) TAD patients.

Conclusions
TGF- β1 expression was up-regulated in aortic wall of TAA and TAD compared to CN. The significant higher levels of TGF- β1 in intima and media in TAA versus TAD patients implicated a probable positive effect of TGF- β1 to maintain aortic wall integrity, and/or greater comsamption of TGF- β1 in the aortic dissection.
Abstract 3059: Role of End Diastolic Volume on cardiac function induced changes by Surgical Ventricular Restoration
Authors: Di Donato Marisa , Fantini Fabio , Castelvecchio Serenella , Bussadori Claudio , Giacomazzi Francesca , Quarenghi Matteo , Menicanti Lorenzo
Published: July 2021

Background. LV-End diastolic volume (EDV) following surgical ventricular restoration (SVR) is highly dependent on surgical induced changes in ventricular chamber.

Aim. To investigate the role of pre and post-operative EDV on SVR induced changes in cardiac function.

Methods. We analyzed 298 patients submitted to SVR following an anterior MI. All had an echo study pre and post-operatively. SVR was conducted on arrested heart using an endoventricular sizing.

Results. Post-op EDV was directly related to pre-op EDV, r=0.63; P<.001.The larger pre-op EDV the greater surgical volume reduction (average −32%) and the greater EF improvement. At a certain range of EDV (150 –200 ml) either pre or post surgery EF does not differ significantly (34±7% and 34±7%, ns), confirming the central role of EDV.

Conclusions. EF improvement was relatively greater in patients with greater pre-op EDV and greater surgical reduction, although the absolute values of post-op EF are mainly linked to post-op EDV. Our results underline the need for a correct pre-op estimate of EDV reduction in each single patient.

Tab. 1
Abstract 3073: The Impact of Baseline Mitral Regurgitation on 1-Year Clinical Outcomes in Patients Undergoing Cardiac Resynchronization Therapy
Authors: Ando Kenji , Soga Yoshimitsu , shirai Shinichi , Sakai Koyu , Goya Masahiko , Iwabuchi Masashi , Yokoi Hiroyoshi , Yasumoto Hitoshi , Nosaka Hideyuki , Nobuyoshi Masakiyo
Published: July 2021

Background: The impact of mitral regurgitation (MR) on long-term clinical outcomes in patients (pts) undergoing cardiac resynchronization therapy (CRT) is not well established.

Methods: We investigated 110 pts received CRT (age 71+/−10years, NYHA class 3.1+/−0.5, LVEF 26+/−7%, LVEDD 61+/−7mm, pre QRS duration 178+/−29ms) and divided into two groups, 40 pts with baseline MR grade 0 –1 (less MR group) and 70 pts with baseline MR grade 2– 4 (severe MR group). 1-year clinical data were obtained.

Results: Baseline clinical and echocardiographic characteristics were similar between two groups without baseline MR grade (0.9+/−0.3 in less MR group vs.2.2+/−0.5 in severe MR group, p<0.0001). At 1-year follow up, NYHA functional class was significantly better in less MR group than severe MR group (1.9+/−0.8 vs.2.4+/−0.6, p=0.0004). Event free survival rate from heart failure hospitalization (HFH) was significantly higher in less MR group compared to severe MR group (93% vs.75% at 1 year, Log-rank p=0.037) and event free survival rate from combined death and HFH was also significantly higher in less MR group (87% vs.69% at 1 year, Log-rank p=0.039).

Conclusion: Pts with severe baseline MR had worse clinical outcomes even if received CRT compared to less MR pts.