bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 18045: Stem Cell Impregnated Nanofiber Stent Sleeve for Intravascular Paracrine Factor Production
Authors: Hwang Chao-Wei , Johnston Peter V , Xia Zhiyong , Bogdan Virginia , Tomaselli Gordon F , Weiss Robert G , Gerstenblith Gary
Published: July 2021

Background:
Results of stem cell studies for cardiomyopathy and peripheral artery disease are promising, but benefits remain modest in part due to cell washout and immune attack. Evidence suggests that many stem cell effects are paracrine-mediated, wherein secreted factors activate intrinsic repair. We now describe a stem cell impregnated nanofiber (NF) stent sleeve in which a biodegradable NF sleeve is electrospun around a stent and impregnated with a large number of stem cells. The porous sleeve nanostructure prevents cell washout and immune attack, and allows sustained local production and secretion of stem cell paracrine factors.

Methods:
NF stent sleeves are created by electrospinning poly-lactic-co-glycolic acid (PLGA) co-polymer onto expanded stents. Sleeves are impregnated with stem cells in a 1.2 mL solution of 3.2x10
6
mesenchymal stem cells (MSCs). Sleeve nanostructure was examined by electron microscopy. MSC adhesion and viability in the sleeve were assessed on days 1 and 8 using a fluorescent cell viability assay. VEGF and HGF secretion was quantified by ELISA over 7 days. Biological activity of sleeves with MSCs was determined by HUVEC tubule formation on day 8 and compared to sleeves without MSCs.

Results:
Stent sleeves consist of randomly oriented NFs (A) uniformly covering the stent (B) onto which MSCs readily attached. MSCs proliferated normally, remained CD90+ and CD44+, and were confluent on day 8 (C,D) with more than 90% viability. VEGF and HGF (E,F) continued to be secreted, and sleeves with MSCs induced HUVECs to organize into tubules to a 3.1±0.7 fold greater extent than control. NF sleeves can be crimped onto angioplasty balloons and delivered via 8F catheters.

Conclusion:
Our results demonstrate the engineering feasibility of a stem cell impregnated NF stent sleeve, and pave the way for animal studies to assess the efficacy of local paracrine factor production and delivery to treat cardiomyopathy and peripheral artery disease.
Abstract 18060: TRAIL Promotes Angiogenesis and Ischemia-Induced Neovascularisation via NOX4, H2O2 and Nitric Oxide-Dependent Mechanisms
Authors: Di Bartolo Belinda A , Cartland Sian P , Prado-Lourenco Leonel , Azahri Nor Saadah M , Thai Thuan , Yeung Amanda , Thomas Shane R , Kavurma Mary M
Published: July 2021

Background:
Angiogenesis and neovascularization are essential processes that follow ischemia insults. Tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) not only induces endothelial cell (EC) death and inhibits angiogenesis, but also promotes EC migration, invasion and proliferation
in vitro
. These seemingly opposite effects make its role in angiogenesis
in vivo
unclear. Using TRAIL
-/-
and wild-type mice, we sought to determine the role of TRAIL in angiogenesis and neovascularisation. We also sought mechanisms
in vitro
.

Methods and Results:
Reduced vascularisation assessed by real-time
in vivo
3D Vevo ultrasound imaging and CD31 staining was observed in TRAIL
-/-
mice 28 d after hindlimb ischemia. Moreover, reduced capillary formation and increased apoptosis was evident in TRAIL
-/-
muscles even at 3 d after ischemic surgery. We have previously shown that fibroblast growth factor-2 (FGF-2), a potent angiogenic factor, regulates TRAIL gene expression in vascular smooth muscle cells. Indeed, FGF-2 also regulates TRAIL expression in ECs, and FGF-2-inducible proliferation, migration and tubule formation was inhibited with siRNA targeting TRAIL. Notably, both FGF-2 and TRAIL significantly increased NOX4 expression. TRAIL-inducible angiogenic activity in ECs was inhibited with siRNAs targeting NOX4, and consistent with these, NOX4 mRNA was reduced in 3 d ischemic hindlimbs of TRAIL
-/-
mice. TRAIL stimulated intracellular H
2
O
2
levels in ECs, and TRAIL-inducible proliferation, migration and tubule formation was inhibited with not only PEG-catalase, a H
2
O
2
scavenger, but also blocked with L-NAME, a nitric oxide synthase inhibitor.

Conclusions:
This is the first demonstration showing that TRAIL promotes angiogenesis
in vivo
. We show for the first time that the TRAIL stimulates NOX4 expression to mediate nitric oxide-dependent angiogenic effects. This has significant therapeutic implications such that TRAIL may improve the angiogenic response to ischemia and increase perfusion recovery in patients with CVD and diabetes.
Abstract 18067: Maladaptive Aortic Properties after the Norwood Procedure: an Angiographic Analysis of the Pediatric Heart Network Single Ventricle Reconstruction Trial
Authors: Plummer Sarah T , Hornik Christoph P , Baker Hamilton , Fleming Gregory A , Foerster Susan , Ferguson Eric , Glatz Andrew , Hirsch Russel , Jacobs Jeffrey P , Lee Kyong-Jin , Lewis Alan , Li Jennifer S , Martin Mary H , Porras Diego , Radtke Wolfgang A , Rhodes John F , Vincent Julie A , Zampi Jeffrey D , Hill Kevin D
Published: July 2021

Objectives:
Aortic arch reconstruction in patients with single ventricle lesions may predispose to circulatory inefficiency and maladaptive physiology leading to increased myocardial workload. We sought to describe potentially maladaptive aortic anatomy and physiology, risk factors, and impact on right ventricle (RV) function in patients with single RV lesions after Norwood.

Methods:
Pre-stage II angiograms for subjects from the Single Ventricle Reconstruction (SVR) Trial were compared to 50 single left ventricle controls with no prior arch reconstruction. Arch geometry was defined as normal, crenel (elongated), or gothic (angular). Aortic index (ascending /descending aorta diameter) and distensibility index (systolic aortic area - diastolic area) / (diastolic area x pulse pressure) were calculated. Univariable tests were used for comparisons, and Spearman’s rho was used for correlation.

Results:
Interpretable angiograms were available for 326/389 (84%) SVR subjects. Table 1 summarizes findings. Age at catheterization was similar for SVR subjects and controls. SVR subjects more often demonstrated abnormally elongated (crenel) arch geometry with dilated ascending and transverse aortae tapering to a small isthmus. Distensibility was reduced in both the ascending and descending aorta. Risk factors for ascending aortic dilation (aortic index ≥ 2.5) included native aortic stenosis (OR = 2.2 [95% CI: 1.2, 3.8] vs. aortic atresia) and receipt of a RV-pulmonary artery shunt (OR = 2.6 [1.47, 4.5] vs. Blalock-Taussig shunt). There was no association between reduced distensibility and any demographic, anatomic, or reported surgical factors. Aortic dilation and reduced distensibility did not correlate with RV function at 14-month echocardiogram (p=0.5).

Conclusions:
After Norwood single RV surgery, the reconstructed aorta demonstrates abnormal anatomy and physiology. Further study is needed to evaluate the longer-term impact of these findings.
Abstract 18070: Disparities in Advanced Heart Failure Therapy
Authors: Murad Khalil , Roy Samit S , Harcourt Nonye , Colvin Monica
Published: July 2021

Background and Objective:
Disparities in healthcare delivery are increasingly recognized. In this study, we explored disparities based on gender, race, age, region, and hospital type, in receiving advanced heart failure therapies (AHFT) defined as mechanical circulatory support (MCS) and heart transplantation (HT).

Methods:
Using data from the Nationwide Inpatient Sample (NIS), the largest all-payer inpatient health care database in the United States, we identified all hospitalizations between 2005-2011 for patients 18-85 years old, with the diagnosis of congestive heart failure, cardiomyopathy, or cardiogenic shock, and with no known contraindications to AHFT. Multivariate logistic regression analysis was used to determine the likelihood of receiving AHFT based on gender (men versus women), race (White versus Black, Hispanic, or others), age (≤50 versus 51-70 or ≥71 years old), hospital type (teaching versus non teaching), and geographic region (West versus Northeast, Mid-west, or South).

Results:
A total of 3,789,875 hospitalizations met our inclusion criteria, of which 3,769 (0.1%) patients received AHFT: 1,923 (51.0%) received MCS and 1,846 (49.0%) received HT. The following were associated with lower likelihood of receiving AHFT (table 1): female gender, non-white race, older age, non-teaching hospital, and Midwest, Northeast or South geographical region.

Conclusion:
Gender, race, age and regional disparities exist in the delivery of AHFT therapy. As the population of patients with end-stage heart failure continues to grow, effective public health research and policies are needed to identify the sources of disparities and to ensure equity in delivering AHFT.
Abstract 18139: Myocardial Fibrosis Quantified by Cardiovascular Magnetic Resonance is Associated with Histology and Graft Function After Pediatric Heart Transplantation
Authors: Feingold Brian , Salgado Cláudia M , Reyes-Múgica Miguel , Drant Stacey , Miller Susan A , Kellman Peter , Schelbert Erik B , Wong Timothy C
Published: July 2021

Background:
Late survival after pediatric heart transplantation (HTx) remains poor. Many late deaths are due to “graft failure,” typically in the presence of vasculopathy and diffuse myocardial fibrosis (DMF) - a process associated with ventricular remodeling and heart failure (HF). Cardiovascular magnetic resonance (CMR)-derived extracellular volume (ECV) is a validated measure of DMF in the absence of edema or infiltrative disease, and predicts outcomes of HF and mortality in adults. We hypothesize that ECV is a meaningful biomarker of graft dysfunction following pediatric HTx.

Objective:
To test the association of ECV with histologic myocardial fibrosis after pediatric HTx. We also explored associations of ECV with hemodynamic, echocardiographic, and serum measures of graft function.

Methods:
We prospectively enrolled consecutive HTx recipients who were ≥13 years old and ≥9 months post HTx for ECV quantification at the time of surveillance endomyocardial biopsy (EMB). Fibrosis was quantified on EMB by automated image analysis after picrosirius staining and digital scanning. CMR measures of blood and myocardial T1 from basal and mid short axis slices, along with contemporaneous hematocrit, quantified ECV.

Results:
Nineteen pts (12 male) underwent CMR at a mean age of 18.4 ± 2.8 yrs (range 14.9 - 24.4 yrs) and a mean time after HTx of 10.4 ± 6.6 yrs (1.0 - 20.7 yrs). Four pts were excluded from analysis due to acute rejection (ISHLT grade ≥2R) on concurrent EMB (n=2) or poor quality imaging (n=2). Mean ECV was 27.1 ± 3.8 (20.9 - 32.1). Late gadolinium enhancement was observed in 1 pt. ECV showed moderate correlations with histologic myocardial fibrosis (r=0.61; p=0.02) and serum b-type natriuretic peptide (r=0.66; p=0.008). There was a trend to correlation with pulmonary capillary wedge pressure (r=0.51; p=0.06). We found no associations of ECV with systolic or diastolic function, time after HTx, or graft age.

Conclusions:
We demonstrate a novel association of ECV with histologic myocardial fibrosis and serum and hemodynamic markers of HF after pediatric HTx. Given prior observations of myocardial fibrosis in chronic graft failure, these findings suggest that ECV may be a relevant, noninvasive marker of graft dysfunction and a potential therapeutic target.
Abstract 18144: Mobile Phone Text Messaging Improves Antihypertensive Drug Adherence in the Community
Authors: Varleta Paola , Akel Carlos , Acevedo Monica , Salinas Claudia , Pino Javier , Garcia Ana , Echegoyen Carolina , Rodriguez Daniel , Hernandez Hilda , Cofré Pedro
Published: July 2021

Introduction:
Hypertension is a major public health concern and the leading cause of cardiovascular disease worldwide. Prevalence of adequate blood pressure control is low and it is mainly associated to poor antihypertensive drug adherence. We hypothesized that education through mobile phone text messaging (SMS) would improve antihypertensive drug adherence in hypertensive patients followed in a primary care setting.

Methods:
Recently diagnosed hypertensive patients receiving antihypertensive drug treatment for less than 6 months were randomised to receive SMS related to improve drug adherence and to follow a healthy life style or no messages. Exclusion criteria were history of stroke, heart failure, myocardial infarction and hemodialysis. Patients were recruited from 12 different primary care clinics in Santiago, Chile, where free antihypertensive drug therapy was provided. All patients signed an informed consent after which a survey was performed. Compliance was assessed using Morinsky- Green-Levine Questionnaire.Text messages were sent every 12± 2 days. After a 6-month follow-up, a new survey was applied. An Ordinary Least Squares regression model was used to analyse the net difference between the two groups.

Results:
A total of 314 subjects were recruited, mean age 60 ±10 years, 35% male, 67% with low or medium educational level (≤12 years). Mean drug pill number was 2.1 per day and the mean time of drug prescription was 4±1 months; 150 subjects were randomised to text messages. No statistical difference between the control and the intervention groups in regards to gender, age, educational level, blood pressure and baseline compliance was found. Eleven patients were lost of follow-up. Adherence in the control group decreased from to 59,7 % at baseline to 51,7% ( p<0,05) at 6 months. By contrast, in the intervention group, it increased from 50,9 % to 62,7 % ( p<0,05). The absolute difference in mean adherence rate between the two groups was 19,8 % (Standard error: 0.081, p: 0.015).

Conclusion:
This study shows that education through SMS in patients with recently prescribed antihypertensive drugs improved adherence to treatment. SMS could become a good and easy- to- use intervention tool to overcome low adherence to drug treatments in the community.
Abstract 18192: Aortic Stenosis: The Effect of Spectral Broadening in the Left Ventricular Outflow Tract on Stroke Volume and Calculated Aortic Valve Area
Authors: Thaden Jeremy J , Tsang Michael Y , Ito Saki , Pislaru Sorin V , Nkomo Vuyisile T , Suri Rakesh M , Foley Thomas A , Williamson Eric E , Oh Jae K
Published: July 2021

Introduction:
Accurate stroke volume (SV) calculation is critical for calculating aortic valve area by echocardiography. 2D-Doppler estimation of SV (SV
2D
) assumes uniform blood flow velocities through the left ventricular outflow tract (LVOT). Non-uniform flow through the LVOT, appreciated as spectral broadening of the LVOT Doppler signal, could result in inaccurate SV calculation.

Hypothesis:
Increased spectral broadening in the LVOT will result in overestimation of SV by the SV
2D
method compared to 3D volumetric assessment of SV (SV
3D
).

Methods:
Fifty-one consecutive patients with aortic stenosis underwent comprehensive 2D-TTE and assessment of SV
3D
. Patients with ≥ moderate mitral or aortic regurgitation were excluded. An LVOT pulse-wave Doppler signal with > 0.4 m/s difference between outer and inner edge of velocity spectral display (at time of peak velocity) was considered non-uniform flow (i.e., spectral broadening).

Results:
Spectral broadening was present in 33% of the cohort. These patients were commonly female with smaller ventricles and higher ejection fraction. Spectral broadening was associated with a significant overestimation of SV on Doppler-based measurements (101±20 ml vs 78±15 mL, SV
2D
vs SV
3D
, respectively; r=0.83, p<0.0001); such differences were not seen in patients with uniform flow velocities (82±15 vs 79±14 mL, r=0.83, p=0.03). Patient characteristics by spectral broadening are shown in table 1.

Conclusion:
In aortic stenosis patients with non-uniform flow, Doppler-based methods overestimated SV by 29.5% on average (maximum 64%) when compared to 3D methods. This results in a proportional increase in calculated valve area despite a similar mean gradient between groups. Substituting SV
3D
resulted in similar SV, valve area, and mean gradient between uniform and non-uniform groups. When spectral broadening >0.40 cm/s is present, 3D volumetric assessment of SV should be considered for accurate estimation of aortic valve area.
Abstract 18207: Role of Coronary Angiography with Successful Percutaneous Coronary Intervention in Patients with Out-of-Hospital Cardiac Arrest without ST-Segment Elevation Myocardial Infarction
Authors: Sandoval Yader , Miranda David F , Goldsmith Steven R , Bart Bradley A , Smith Stephen W , Bachour Fouad A
Published: July 2021

Background:
Emerging data have supported a strategy of earlier access to cardiac catheterization in patients with out-of-hospital cardiac arrest (OHCA). However, there are as yet no randomized controlled trials (RCT) addressing the issue, and the impact of percutaneous coronary intervention (PCI) on outcome is unclear in the absence of STEMI. We report here the characteristics and outcomes of patients with OHCA without STEMI undergoing coronary angiography (CA) with PCI vs. no PCI, in contrast to patients not undergoing CA.

Methods:
Single center, retrospective study of 195 patients with OHCA without STEMI between July 2007 and April 2014. Patients were categorized into CA vs. no CA (control), and among those undergoing CA we compared those treated with PCI vs. no PCI. Mortality was assessed along with key relevant clinical and angiographic variables in each group (Table).

Results:
195 cases with OHCA without STEMI were reviewed, among which 102 (52%) did not undergo CA. 93 (48%) patients underwent CA, of which 21 (23%) underwent PCI, whereas 72 (77%) did not require PCI. Acute culprit lesion was identified in only 19 out of 93 (20.4%) Inpatient mortality was similar in those undergoing PCI vs. no PCI (19% vs. 14%, p=0.56). Patients that did not undergo CA had a significantly worse mortality, in comparison to patients undergoing CA (p<0.001).

Conclusions:
In this series of consecutive patients with OHCA without STEMI, culprit lesions were uncommon when CA was performed. Overall outcomes in patients receiving CA were better than in those not receiving CA, likely reflecting referral bias based on disease severity. However, successful PCI in patients with obstructive CAD and culprit lesions was not associated with improved inpatient survival. These findings emphasize the need for RCTs to guide the need for CA and/or PCI in these patients.
Abstract 18233: Implantable Loop Recorder Monitoring is Useful in Detecting a High Incidence of Previously Unrecognized Atrial Fibrillation in Hemodialysis Patients. Preliminary Data From the Monitoring in Dialysis (MiD) Study
Authors: Koplan Bruce A , Tombul Selcuk A , Tumlin James A , Charytan David M
Published: July 2021

Introduction:
Patients with end stage renal disease have a high incidence of stroke and studies have shown that even short durations of atrial fibrillation (AFib) in this population increase stroke risk.

Hypothesis:
Implantable loop recorder monitoring will provide useful information to guide stroke risk reduction by detecting and quantifying AFib in hemodialysis (HD) pts.

Methods:
MiD is a prospective multi-center study to characterize arrhythmias in maintenance HD pts with an implantable loop recorder (ILR) over a 12mo period. The ILR device used detects AFib episodes based on incoherence in adjacent R-R intervals, with previous validation against simultaneous Holter monitoring showing 92% sensitivity and 80% positive predictive value for AFib episodes lasting ≥6 minutes.

Results:
Follow-up is available for 45 pts [mean follow-up 6.4mo (0.6-12.0mo), mean age 56yrs (27-76yrs), 36% female]. 1294 AFib episodes ≥6 minutes were detected in 19/45 pts (42%), occurring at a mean rate of 13.7 (95% CI 6.1-30.9) events per patient month in these 19 pts. Minimum total duration of AFib in these 19 pts was 20 minutes with 13/19 pts (68%) having > 100 minutes and 8/19 pts (42%) having >20 hours of ILR-detected Afib during follow-up. Only 5/19 pts (26%) with Afib episodes ≥6 minutes had any prior history of Afib and 13/19 pts (68%) were not on anticoagulation (AC) at study entry. There were also 2 pts with Afib episodes ≥6 minutes with a prior CVA or TIA who had not previously been diagnosed with Afib and were not on AC at study entry. All 19 pts (100%) with Afib episodes ≥6 minutes had CHADS
2
scores ≥1 and 15/19 pts (79%) had CHADS
2
scores ≥2, including 12/13 pts (92%) not on AC. ILR surveillance thus identified 12/45 pts (27%) in the cohort who were not on AC at enrollment with the potential to derive significant stroke risk reduction with AC.

Conclusions:
Afib is common and often undiagnosed in HD pts with 42% of MiD patients having at least one sustained episode (≥6 minutes) and only 11% of these patients having any prior history. ILR surveillance has value in identifying patients at risk for stroke in whom anticoagulation may be beneficial. With improvement in ILR technology with respect to size and wireless capability, clinicians should have a low tolerance to evaluate HD patients for Afib.
Abstract 18256: Impact of Chronic Kidney Disease Staging on Coronary Atherosclerotic Plaque Change of Non-culprit Lesions after Culprit Percutaneous Coronary Intervention
Authors: Kashiyama Kuninobu , Sonoda Shinjo , Takami Hirohito , Anai Reo , Muraoka Yoshitaka , Tsuda Yuki , Araki Masaru , Otsuji Yutaka
Published: July 2021

Introduction:
Renal dysfunction is associated with increased coronary plaque burden, which may cause future coronary events. However, little is known about the impact of chronic kidney disease (CKD) staging on coronary atherosclerotic plaque change of non-culprit lesions (NCL) under standard medical therapy after culprit percutaneous coronary intervention (PCI). We investigated serial coronary plaque change of NCL in patients with different stages of CKD using integrated backscatter intravascular ultrasound (IB-IVUS).

Methods:
We investigated 113 NCL in 113 patients undergoing both IVUS-guided PCI and follow-up IVUS examination. Patients were divided into 4 groups according to baseline CKD stage: CKD-1, n=18; CKD-2, n=43; CKD-3, n=29; and CKD 4-5, n=24. Volumetric IVUS analyses were performed at proximal NCL in de novo target vessels post PCI and at 8-month follow-up. We compared serial changes of plaque burden and composition among groups under standard medical therapy including statins.

Results:
Baseline patient characteristics showed age was significantly older, diabetic patients were more in CKD-3 than the other groups, but otherwise there was no significant difference among groups. Plaque volume at baseline was greater in CKD 4-5 than the other groups. (p =0.009). At follow-up, plaque volume increased in CKD-3 (+ 4.6 mm3, p <0.001) and CKD 4-5 (+ 9.8 mm3, p <0.001), but decreased in CKD-1 (- 5.4 mm3, p =0.002) and CKD-2 (- 3.2 mm3, p=0.001). Serial plaque volume change was correlated with eGFR. (Y= - 0.2X +11.4, p<0.0001). IB-IVUS analysis showed that lipid plaque increased in CKD-3 (+ 4.6 mm3, p <0.001) and CKD 4-5 (+ 5.4 mm3, p <0.001), but significantly decreased in CKD-2 (- 2.7 mm3, p <0.05) at follow-up. Fibrotic plaque also increased in CKD 4-5 (+ 3.4 mm3, p <0.001), whereas it decreased in CKD-1 (- 3.3 mm3, p <0.05). Multivariate models revealed CKD staging is an independent predictor of plaque progression.

Conclusions:
Despite standard medical therapy after culprit PCI, late stages of CKD were associated with coronary plaque progression characterized by greater lipid and fibrotic plaque volumes in NCL. Strict risk management should be required to prevent subsequent coronary events in those patients.
Abstract 18274: Comparative Effectiveness of Stacked versus Single Shock Therapy for In-Hospital Cardiac Arrest: Insights from the Get With the Guidelines-Resuscitation Registry
Authors: Bradley Steven M , Liu Wenhui , Grunwald Gary K , Chan Paul S , Nallamothu Brahmajee K , Sasson Comilla , Varosy Paul D , Anderson Monique L , Schneider Preston M , Ho P. Michael
Published: July 2021

Background:
Among patients with cardiac arrest due to ventricular tachycardia or ventricular fibrillation (VT/VF), guidelines emphasize single shock protocols to minimize interruptions in chest compressions that may impair patient outcomes. The adoption and impact of single shock protocols on survival of in-hospital VT/VF arrest is unknown.

Methods:
In the Get With The Guidelines - Resuscitation multicenter observational registry, we identified 4,114 adults with in-hospital cardiac arrest due to VT/VF between 2004 and 2012, an immediate post-shock rhythm of VT/VF following the initial defibrillation attempt, and a second defibrillation attempt within 3 minutes of the first shock. The time interval in minutes from the initial shock to second shock was used to define stacked shock (time interval of 0 to 1 minute) and single shock protocols (time interval of 2 to 3 minutes). We first evaluated temporal trends in the use of stacked versus single shock protocols. We then used hierarchical regression adjusting for patient arrest characteristics and comorbidities while accounting for clustered observations by hospital to determine the association between stacked versus single shocks for VT/VF and survival to discharge. For this analysis, we restricted our cohort to the 2,984 (72.5%) patients with VT/VFarrest occurring at one of 150 hospitals with the use of both stacked and single shock approaches and at least 10 events during the study period.

Results:
The proportion of patients receiving a single shock protocol for VT/VF following an initial defibrillation attempt doubled from 25% in 2004 to more than 50% in 2012. Compared with patients treated with stacked shocks, treatment with single shocks was associated with a lower risk-adjusted survival to discharge (odds ratio 0.81, 95% confidence interval 0.68 to 0.98, P=0.03).

Conclusion:
Among adults with in-hospital VT/VFarrest, use of single shocks has increased since 2004 in accordance with guideline recommendations. However, compared with stacked shocks, single shocks for VT/VF was associated with decreased odds of survival to discharge. These observational findings suggest further investigation is needed to define the optimal defibrillation strategy for management of in-hospital VT/VF arrest.
Abstract 18295: Racial and Insurance Disparities in Atrial Fibrillation Ablation
Authors: Patel Nileshkumar J , Deshmukh Abhishek , Patel Achint , Patel Neil , Thakkar Badal , Arora Shilpkumar , Patel Nilay , Panchal Vinaykumar , Badheka Apurva O , Kowalski Marcin , Paydak Hakan , Viles Gonzalez Juan F , Myerburg Robert J , Mitrani Raul D
Published: July 2021

Objective:
To identify possible racial and/or health insurance disparities with respect to ablation procedures for atrial fibrillation (AF).

Method:
Using the Nationwide Inpatient Sample (2000-2011), we identified adult patients (pts) admitted with principle diagnosis of AF by ICD 9 code 427.31 who had catheter ablation (ICD 9 code - 37.34). We stratified patients by race (White, Black, Hispanic, and other minority racial groups), insurance status, age, gender, type of hospital, and type of hospital admission. A hierarchical mixed effect multivariate model was created to identify independent predictors of AF ablation.

Results:
Among 4,547,144 patients hospitalized with AF during the study period, 201,447(4.43%) underwent ablation procedures. In absolute numbers, the majority of the ablations were performed in Whites (65.7%) and patients with Medicare (66.7%) or private insurance (24.7%). After adjusting for confounding factors, the proportions of Black pts (compare to White), and Medicare, Medicaid, and Uninsured pts (compare to private insurance), receiving ablation therapy were lower (see table). Odds of having ablation were lower in older and female patients and higher in teaching hospitals and after elective admissions (p<0.001 for all comparisions). Similar racial and insurance disparities were observed over the time course of the study.

Conclusion:
We identified lower rates of AF ablation among black pts even after correction of other factors such as insurance. Ablation rates were also lower among patients without private insurance. These trends persisted during the study period of 2000-2011.
Abstract 18309: Integration of Quantitative Measures of Stenosis Severity With Morphologic Atherosclerotic Plaque Characteristics Improves Discrimination of Coronary Lesions that Cause Ischemia: Results from a Prospective Multicenter International Trial
Authors: Park Hyung-Bok , Ryo Nakazato , Heo Ran , Cho Iksung , Gransar Heidi , Chang Hyuk-Jae , Min James K
Published: July 2021

Background:
Beyond stenosis severity, coronary computed tomographic angiography (CCTA) enables morphologic evaluation of atherosclerotic plaque characteristics (APCs), including aggregate plaque volume, positive arterial remodeling (PR), low attenuation plaque (LAP) and spotty calcification (SC), features associated with global myocardial ischemia and acute coronary syndromes. We determined whether the combination of stenosis severity plus APCs would improve the discrimination of coronary lesions that cause ischemia.

Method:
252 patients from 17 centers in 5 countries [mean age 63 years, 71% males] underwent CCTA and invasive angiography, with invasive fractional flow reserve (FFR) performed for 407 coronary lesions. Stenosis severity was determined by luminal diameter reduction (%DS). Aggregate plaque volume (APV) was defined as the plaque volume from ostium to distal end of the lesion, with APV percent (%APV) defined as APV divided by total vessel volume. Other APCs by CCTA were defined as: (1) PR, lesion diameter/reference diameter >1.10; (2) LAP, any voxel <30 HU; and (3) SC, nodular calcified plaque <3 mm. Lesion ischemia was defined by invasive FFR ≤0.8, which was employed as the reference standard.

Results:
Coronary stenosis severity and APCs demonstrated good discrimination for lesion ischemia: %DS, (Area under the receiver operating characteristics curve [AUC] of 0.72 (95% CI 0.68-0.77), APV (AUC 0.69, 95% CI 0.64-0.73), and %APV (0.75, 98% CI 0.70-0.79). Over %DS alone, the addition of %APV improved the discrimination of lesion-specific ischemia (0.79, 95% CI 0.75-0.83, p<0.001), with further improvement with increasing APC number (0.86, 95% CI 0.82-0.89, p<0.001) [Figure].

Conclusion:
In this prospective multicenter international study, the combination of quantitative measures of stenosis severity with morphologic features of atherosclerotic plaque by CCTA resulted in improved discrimination of coronary lesion-specific ischemia.
Abstract 18343: Antisynthetase Syndrome-Associated Myocarditis
Authors: Sharma Kavita , Orbai Ana-Maria , Desai Dipan , Cingolani Oscar H , Halushka Marc K , Christopher-Stine Lisa , Mammen Andrew L , Wu Katherine C , Zakaria Sammy
Published: July 2021

Background:
The antisynthetase (AS) syndrome is characterized by fever, non-erosive arthritis, inflammatory myopathy, interstitial lung disease, cutaneous involvement, and antibody specificity. Cardiac involvement is extremely rare; we present one of two cases of AS syndrome-associated myocarditis from our institution.

Clinical Case:
A 51 year old woman with history of inflammatory arthritis and hypothyroidism presented with 6 months of increasing fatigue, bilateral proximal muscle weakness, leg edema, dyspnea, and orthopnea. Physical examination revealed a Caucasian woman, markedly dyspneic while speaking, with signs of acute decompensated heart failure (HF) including elevated jugular venous pulse, bilateral rales, S3 gallop, and massive peripheral edema with bilateral proximal upper and lower extremity weakness.

Diagnostic Testing:
Her muscle weakness was concerning for myopathy along with new HF symptoms. Laboratory studies revealed elevations of serum creatine kinase, aldolase, and cardiac troponin I. Thyroid stimulating hormone and free T4 were consistent with subclinical hypothyroidism. MRI and electromyography of the lower extremities and skeletal muscle biopsy were consistent with myositis. Anti-Jo1 antibody was positive, confirming the diagnosis of AS syndrome. Electrocardiogram showed sinus rhythm and low-voltages in all leads. Echocardiography showed severely depressed biventricular function, left ventricular (LV) ejection fraction of 10-15%, normal LV cavity size and wall thickness. Cardiac MRI and endomyocardial biopsy revealed active myocarditis. She received pulse dose corticosteroid therapy, intravenous furosemide, inotropic therapy, and hemofiltration therapy for renal failure. She was discharged home on intravenous dobutamine palliative therapy. Two months later, she presented in cardiogenic shock, failed intensive medical therapy, and died after a cardiac arrest.

Conclusions:
AS syndrome is a rare entity not typically associated with cardiac involvement. We report one of only two known cases of AS syndrome-associated myocarditis, to our knowledge. Based on these observations, we suggest that myocarditis be considered and evaluated for in patients with AS syndrome presenting with HF.
Abstract 18375: Urinary Liver Fatty-acid Binding Protein Within 24 Hours from Contrast Media Exposure May Predict Acute Kidney Injury
Authors: Komatsu Sei , Takahashi Satoru , Kodama Kazuhisa
Published: July 2021

Introduction:
Contrast-induced acute kidney injury (CI-AKI) is one of major complication of contrast medium exposure. However, few biological markers the day after contrast media exposure rapidly predict CI-AKI. Urinary liver fatty-acid binding protein (L-FABP), as a novel marker of renal ischemia and stress, has been reported to elevate in CI-AKI.

Hypothesis:
We tested the hypothesis that L-FABP within 24 hours from contrast media procedure predicted CI-AKI.

Methods:
A total of 160 patients who underwent invasive catheterization or coronary CT angiography were examined the study. Urinary liver fatty-acid binding protein within a day after the procedure was measured. Serum creatinine level within 72 hours were compared to baseline. CI-AKI was defined as laboratory increase of serum creatinine value =25% or >=0.5mg/dl from baseline at 72 hours.

Results:
Estimated glomerular filtration rate of all patients averaged 69±24 ml/min/1.73m2. L-FABP level averaged 11.9±27μg /gCr. On receiver operating characteristics (ROC) analysis, cut-off value was 14.3μg /gCr and the area under the curve (AUC) was 0.739 (95 % CI: 0.576-0.902, P = 0.01). Negative predictive value for predicting CI-AKI was 0.99.

Conclusions:
L-FABP within 24 hours from contrast media procedure may predict CI-AKI with quite high negative predictive value.
Abstract 18388: Albuminuria Determines Event-Free Survival in Atherosclerotic Renal-Artery Stenosis
Authors: He Wencan , Evans Kaleigh L , Ren Kaili , Folt David A , Brewster Pamela S , Murphy Timothy P , Cutlip Donald E , Dworkin Lance D , Shapiro Joseph I , Henrich William , Cooper Christopher J , Steffes Michael , Jaff Michael R
Published: July 2021

Introduction:
Stenosis severity and revascularization may have little relation to outcomes in patients with atherosclerotic renal artery stenosis (ARAS). Albuminuria is a direct indicator of glomerular injury and kidney health. The effect of albuminuria on survival in people with ARAS is not well characterized.

Hypothesis:
Proteinuria predicts clinical events in people with ARAS.

Methods:
The Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) clinical trial is a prospective trial of individuals with ARAS. Patients were followed to a maximum of 8 years. Urine albumin and creatinine were measured at a single core lab and the ratio was log transformed (LUACR). The composite endpoint included: cardiovascular (CV) or renal mortality, myocardial infarction (MI), stroke, chronic heart failure (CHF), progressive renal insufficiency (PRI), and renal replacement therapy (RRT). Utilizing receiver operating characteristic (ROC) curves, we developed 3 cutoff points for the LUACR using three methods: Youden’s, closest to the top-left point and the sample median. In order to verify the cutoff point we randomly divided the sample into a training set and a verification set of equal size. Cross verification was applied and the simulation was repeated 5000 times. The analyses are controlled by age, gender, cystatin-c, and systolic blood pressure.

Results:
Cross verification shows that Youden’s method gives the highest specificity and accuracy. It yields an optimal cutoff point of LUACR=3.83 (UACR is exp(3.83)=46.06). Subjects with values above this threshold, in the verification sample, had higher rates of the composite event rate (50% vs. 27%), PRI (27% vs. 13%), and CHF (16% vs. 5%), all p<0.001; CV death (13% vs. 7%), and all-cause mortality (14% vs. 7%), both p<0.01.

Conclusions:
Albuminuria powerfully predicts adverse cardiovascular and renal events, including all-cause mortality, in people with ARAS.
Abstract 18400: Distinct Endothelial Function in Patients With Chronic Total Occlusion With Preserved Myocardial Viability
Authors: Arima Yuichiro , Hokimoto Seiji , Tayama Shinji , Iwashita Satomi , Akasaka Tomonori , Tabata Noriaki , Sakamoto Kenji , Tsujita Kenichi , Yamamoto Eiichiro , Tanaka Tomoko , Kojima Sunao , Kaikita Koichi , Ogawa Hisao
Published: July 2021

Backgrounds:
Coronary collateral vessels work as a detour and ameliorate ischemic myocardial damage. Induction or enhancement of the collateral growth is a novel therapeutic strategy for the ischemic heart disease, however their mechanisms are almost unknown. Patients with chronic total occlusion (CTO) who keep the intact myocardium maintain rich collateral sources, which perfuse the area of the occluded artery. We tried to assess the characteristics of patients with CTO compared with non-occlusive patients with ischemic heart disease and those with old myocardial infarction (OMI).

Methods:
Consecutive 264 patients from January 2010 to February 2014 were enrolled this study. First we assessed the myocardial viability using summed rest score (SRS) of thallium perfusion scintigraphy and divided into OMI patients (SRS greater than or equal to 4, OMI group, n=99) and the others with almost normal myocardial viabilities (n=165). Next we divided into CTO group (n=51) and Stenosis group (n=114) from the coronary angiographic findings. We also measured their peripheral endothelial function by reactive hyperemia peripheral arterial tonometry index (RHI).

Results:
There were no significant differences between CTO group and Stenosis group in clinical characteristics. Ln-RHI was lowest in the OMI group (OMI 0.53±0.21), furthermore, CTO group showed higher endothelial function than Stenosis group (CTO 0.71±0.21 vs Stenosis 0.63±0.23, p<0.05). Multivariate logistic regression analysis identified high Ln-RHI as an independent factor associated with the presence of CTO (OR 2.523, 95% CI 1.119-5.687, p<0.05) among preserved myocardial patients. Other factors did not show the statistical significance.

Conclusion:
Patient with CTO showed paradoxically high Ln-RHI values in spite of the existence of the total occlusion vessel. Enhanced endothelial function might promote the collateral vessel growth and protect myocardium from the irreversible damage.
Abstract 18402: Impact of Obesity on Outcomes After Percutaneous Coronary Intervention in Japanese Population: Obesity Paradox with High Waist Circumference but Not High BMI
Authors: Sakamoto Kenji , Hokimoto Seiji , Oshima Shuichi , Nakao Koichi , Fujimoto Kazuteru , Miyao Yuji , Shimomura Hideki , Tsunoda Ryusuke , Maruyama Hideki , Hirose Toyoki , Tsujita Kenichi , Arima Yuichiro , Akasaka Tomonori , Tabata Noriaki , Komura Naohiro , Yamanaga Kenshi , Miyazaki Takashi , Ishii Masanobu , Kojima Sunao , Kaikita Koichi , Nakamura Sunao , Ogawa Hisao
Published: July 2021

Introduction:
Although the counterintuitive association between obesity and mortality has been termed the obesity paradox, the evaluation of obesity was inconsistent, and evidence for an obesity paradox among past studies has been also less consistent.

Hypothesis:
This inconsistency may be due, in part, to a discrepancy between central obesity, estimated by waist circumference (WC), and body mass index (BMI) as patterns of adiposity.

Methods:
To elucidate the impact of obesity, 2817 subjects with both WC and BMI data were enrolled from the data of Kumamoto Intervention Conference Study (KICS), a multicenter registry, enrolling consecutive patients undergoing PCI in 15 centers from August 2008 to March 2011 in Japan. Subjects were stratified according to patterns of adiposity (WC or BMI), utilizing NCEP-ATPIII criteria and WHO classification.

Results:
Subjects’ mean age was 69.8 years, and 28% were female. There were 68 deaths during 12-month follow up. Although obesity defined by WC (ObWC) was associated with lower mortality compared with non-obesity (no-ObWC, p=0.013), no difference was shown between obesity, defined by BMI (ObBMI), and non-obesity (no-ObBMI) (p=0.201). When dividing into 4 categories based on high/low of WC and BMI, subjects with high WC and high BMI had the lowest mortality (1.6%) compared to other 3 categories (high WC low BMI; 1.7%, low WC high BMI; 2.4%, or low WC and low BMI; 3.1%). Kaplan-Meier analysis for all cause mortality showed a significant difference between ObWC and no-ObWC (Log Rank p=0.010), but comparable in BMI (ObOMI vs no-ObBMI, p=0.295). This discrepancy was also observed in the analysis for cardiac death (Figure). In multivariate analysis, in addition to age and CKD, ObWC was an independent predictor for the low mortality (OR; 0.582, 95% CI; 0.342-0.991, p=0.046).

Conclusions:
In Japanese patients with known CAD who undergo PCI, central obesity but not BMI is associated with the paradoxical protective effect of obesity.
Abstract 18443: Impact of Left Ventricular Hypertrophy on Impaired Coronary Microvascular Dysfunction Determined by Direct Single-Wire Pressure and Flow Velocity Measurement
Authors: Tsujita Kenichi , Yamanaga Kenshi , Komura Naohiro , Sakamoto Kenji , Miyazaki Takashi , Ishii Masanobu , Tabata Noriaki , Akasaka Tomonori , Akasaka Tomonori , Arima Yuichiro , Ono Takamichi , Kojima Sunao , Tayama Shinji , Kaikita Koichi , Hokimoto Seiji , Yamabe Hiroshige , Nakamura Sunao , Ogawa Hisao
Published: July 2021

Introduction:
Coronary microvascular (MV) dysfunction can be sustained by several pathogenic mechanisms (e.g. functional, structural and extravascular alterations). On the other hand, structural abnormalities (an adverse remodeling of intramural coronary arterioles consisting of vessel wall thickening mainly due to hypertrophy of smooth muscle cells and increased collagen deposition in the tunica media) responsible for coronary MV dysfunction have been consistently documented in patients with hypertrophic cardiomyopathy (HCM) and in those with pathologic left ventricular hypertrophy (LVH). However, there has been no technique that enables direct measurement of coronary MV dysfunction
in vivo
.

Methods:
According to transthoracic echocardiographic data, patients without coronary obstruction (>50% diameter) on angiography were divided into 2 groups; LVH (n=17) and non-LVH (n=24). LVH was defined either interventricular septal thickness (IVST) or posterior wall thickness (PWT) thicker >11mm. To evaluate directly coronary MV dysfunction, a velocity-based index of hyperemic MV resistance (hMR) was measured using a dual-sensor (Doppler velocity and pressure)-equipped guidewire, and the guidewire-derived hemodynamic parameters were compared.

Results:
There were no differences in clinical demographics between the groups except for more common male gender and HCM in LVH group. Although fractional flow reserve was comparable between the 2 groups, coronary flow reserve was significantly impaired (1.96±0.79 vs. 2.55±0.89, p=0.04), and hMR was significantly elevated (2.09±0.79 vs. 1.60±0.50, p=0.04) in LVH group compared with non-LVH group. Older age, worse estimated glomerular filtration rate, and LVH were significantly associated with MV dysfunction (≥median value of hMR [1.7]) in univariate analysis, and left ventricular mass index tended to predict MV dysfunction in multivariate logistic regression analysis (OR, 1.03; 95% CI, 1.00-1.06; p=0.10).

Conclusions:
Compared with non-LVH patients, MV function was impaired in patients with LVH.
In vivo
assessment of hMR was a promising index of MV dysfunction in patients without epicardial obstruction to elucidate the pathophysiologic mechanisms underlying coronary MV dysfunction.
Abstract 18460: Asymmetric Septal Hypertrophy as a Prognostic Indicator During Progression of Aortic Valve Stenosis
Authors: Einarsen Eigir , Cramariuc Dana , Lonnebakken Mai Tone , Boman Kurt , Gohlke-Bärwolf Christa , Chambers John B , Gerdts Eva
Published: July 2021

Objective:
Asymmetric septal hypertrophy (ASH) in patients with severe aortic stenosis (AS) has been associated with increased perioperative morbidity and mortality in smaller studies with severe aortic stenosis (AS). This association has not been tested in a large, longitudinal study.

Methods:
Clinical, echocardiographic and outcome data from 1730 patients with asymptomatic AS, participated in the Simvastatin Ezetimibe in Aortic Stenosis study (SEAS), a randomized placebo controlled study evaluating the effect of lipid lowering medications on progression of AS, were used. ASH was considered present if interventricular septal/posterior wall thickness ratio exceeded 1.5. The association of ASH with rate of major cardiovascular (CV) events was tested in time-dependent cox-regression analysis.

Results:
During a median of 4.3 years follow-up, ASH developed in 17.0 % of patients, and was associated with higher left ventricular mass (LVM) and body mass index (BMI) compared to non-ASH patients (all p<0.05). In time-varying Cox regression analysis, ASH predicted a 50% greater incidence of ischemic CV events (ICE), a 63% greater incidence in the need for coronary artery bypass grafting (CABG) at the time of aortic valve replacement, and a 2-fold higher incidence of hospitalization for heart failure due to progression of AS (CHFAS) independent of important confounders (all p<0.05) (Table).

Conclusions:
Development of ASH during progression of AS was a strong predictor of major CV events in patients participating in the SEAS-study.

Table:
Results are presented as Hazard ratio (95% Confidence Interval).