bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 10367: Levels of Oral Inflammation-- not Salivary or Serum Biomarkers-- Predict Worse Functional Status in Hospitalized Patients With Heart Failure
Authors: Dekker Rebecca L , Lennie Terry A , Moser Debra K , Miller Craig S , Ebersole Jeffrey L , Chung Misook L , Campbell Charles L , Bailey Alison , Tovar Elizabeth G
Published: April 2024

Introduction:
Serum levels of B-type natriuretic peptide (BNP), C-reactive protein (CRP), interleukin-6 (IL-6) and IL-10 are predictors of poor prognosis in patients with heart failure (HF). These biomarkers are detectable in saliva after myocardial infarction; however, they have not been evaluated in patients with HF.

Purpose:
To describe correlations and agreement between salivary and serum BNP, CRP, IL-6 and IL-10, and determine whether they predict worse NYHA functional class in patients with HF, after controlling for visible levels of oral inflammation.

Methods:
In this cross-sectional investigation, serum and whole saliva samples were collected from 75 hospitalized patients with HF [57 ± 12 years, 43% female, NYHA Class I (4%), II (43%), and III (53%)] and analyzed using Biosite Triage (BNP) and a Luminex IS100. Levels of oral inflammation were rated by trained research nurses as good, fair, or poor. Spearman’s rho and the Bland Altman method were used to determine salivary-serum correlations and agreement. Logistic regression was used to determine whether each biomarker was a predictor of worse NYHA functional class, controlling for age, gender, and oral inflammation.

Results:
Median biomarker concentrations were: BNP [serum 361 pg/mL (25th% = 151, 75th% = 777); saliva 9 (4, 29)], CRP [serum 13 ng/mL (6.9, 29.9); saliva 25.6 (5, 51)], IL-6 [serum 19.3 pg/mL (9.1, 38.6); saliva 10.5 (3.7, 28.2)] and IL-10 [serum 64.1 pg/mL (36.2, 135.5); saliva 4.7 (0.1, 20.3)]. There was a strong correlation for serum-salivary CRP (rs = 0.594, p < .001), moderate correlation for serum-salivary IL-6 (rs = 0.288, p = .037), and no correlations between serum-salivary BNP and IL-10. The Bland Altman test showed good serum-salivary agreement for all biomarkers, but as serum concentrations rose, salivary measures underestimated serum levels. In logistic regressions, none of the biomarkers predicted NYHA functional class, but oral inflammation was a predictor of worse functional class in 6 of 8 regression models.

Conclusions:
Salivary CRP and IL-6 correlated with serum measures; however, only oral inflammation- not biomarkers- predicted worse functional class. Prospective studies are needed to explore the relationship between oral health and outcomes in patients with HF.
Abstract 10855: Impact of Race/Ethnicity, Sex, and Socio-Economic Status on the Risk for Heart Failure Readmission: The Importance of Context
Authors: Ponce Sonia , Dodendorf Diane , Butler Deondrea , Martinez Melissa , Cox Bart , Laskey Warren
Published: April 2024

Background:
Though Hispanics (H) have higher heart failure (HF)-related readmission rates compared to non-Hispanics (NH), their in-hospital mortality is reported as lower. Social determinants of health (e.g. educational attainment, annual income and geographic location) are associated with health outcomes regardless of ethnicity. The state of New Mexico has a large Hispanic community accounting for 47% of the population and is one of the poorest states in the country with low literacy levels. These factors make New Mexico a unique venue to assess health outcomes and the impact of ethnicity, sex, and social factors.

Methods:
We analyzed data from 1608 consecutive patients discharged from the University of New Mexico Hospital between 2010-2014 with a principle diagnosis of heart failure. We explored the associations between race/ethnicity, age, sex, level of poverty, education level, and distance from hospital and risk for 30 day readmission using univariable and multivariable statistical analysis.

Results:
Mean age on admission was 63.0 ± 14.1. Men represented 58.4% and 48.8% of the sample population were H. The overall 30 day readmission rate (30dRR) was 13.4%. 30dRR for H was 17.5% compared to 9.6% of NH (p>0.00); for females, regardless of race/ethnicity, 30dRR was 16.7% compared to 10.9% for males (p=0.001). All selected socioeconomic variables were significantly associated with 30dRR on univariable analysis. However, on multivariable analysis only H ethnicity, sex, poverty level and distance from hospital were associated with readmission. Poverty level was strongly associated with higher 30dRR (OR 2.8; 95% CI 1.58-5.19; p>0.001). Living furthest from hospital was associated with lower readmission rate (OR 0.5; 95% CI 0.3-0.8; p>0.007). The rates of clinical characteristics (e.g., diabetes, hypertension, etc.) were similar between groups and did not associate with 30dRR.

Conclusion:
In this unique, less ethnically and socio-economically diverse environment where poverty rates are high and education attainment is low, Hispanic ethnicity, female sex, and living in poverty is associated with higher risk for 30dRR in patients with HF.
Abstract 10948: Patient-reported Quality of Life is a Predictor of Outcomes After Left Ventricular Assist Device Compared to Medical Therapy - Results From the ROADMAP Study
Authors: Stehlik Josef , Haas Donald C , Estep Jerry D , Selzman Craig H , Rogers Joseph G , Milano Carmelo A , Horstmanshof Douglas A , Long James W , Bruckner Brian , Moazami Nader , Shah Keyur B , Kasirajan Vigneshwar , Morris Rohinton , Thomas Jerome M , Drucker David W , Lanfear David E , Brewer Robert J , Aranda Juan M , Klodell Charles T , Chuang Joyce , Farrar David J , Starling Randall C ,   for the ROADMAP Investigators
Published: April 2024

Introduction:
The ROADMAP study examined outcomes in subjects with non-inotrope dependent advanced heart failure (n-HF) selected for either left ventricular assist device (LVAD) or optimal medical management (OMM). At 12 months, more LVAD subjects achieved the composite endpoint of survival and ≥75m improvement in 6-minute walk distance (6MWD), while all-cause mortality was similar in the 2 groups. This suggests the focus in decision-making should be on health related quality of life (HRQoL).

Aim:
The aim of this study was to identify predictors of favorable outcome in n-HF patients treated with LVAD or OMM.

Methods:
We analyzed ROADMAP study data from 200 n-HF pts receiving LVAD or OMM. HRQoL was assessed with the EQ-5D visual analog scale (VAS) that ranged from 0 (worst) to 100 (best) health status.

Results:
At baseline, both LVAD and OMM group had markedly impaired exertional capacity and HRQoL (Table 1). We found that baseline VAS was a powerful predictor of the utility of LVAD therapy. Subjects with VAS<60 at baseline were more likely to achieve a positive outcome at 12 months (defined as survival with ≥75m 6MWD increase or survival with HRQoL VAS≥60) with LVAD compared to OMM (Table 1) thus favoring LVAD for these patients. No significant difference between treatments was seen for those with VAS≥60 at baseline (Table 1), supporting continued OMM. Similar results were seen when the examined outcome was survival as treated on original therapy (Figure 1).

Conclusions:
Patients with poor baseline QoL benefit the most from LVAD therapy compared to continued OMM. HRQoL assessed by EQ5D VAS provides valuable information that can aid in identification of suitable candidates for LVAD therapy.
Abstract 10979: ACE-inhibitor or ARB Therapy Reduces the Risk for GI Bleeding in LVAD Patients
Authors: Houston Brian A , Vaishnav Joban , Schneider Andrea L , Miller P. E , Faridi Kamil , Shah Ashish , Sciortino Chris , Stevens Gerin R , Tedford Ryan J , Judge Daniel , Rouf Rosanne , Russell Stuart D
Published: April 2024

Introduction:
Gastrointestinal bleeding (GIB) due to arteriovenous malformations (AVMs) is a major source of morbidity for patients supported with left ventricular assist devices (LVADs). Recent studies implicate angiogenesis mediated by vascular endothelial growth factor (VEGF) in AVM formation. Transforming growth factor-β is biochemically upstream of VEGF and is up-regulated after LVAD implantation. Angiotensin converting enzyme inhibitors (ACE-inhibitors) and angiotensin receptor blockers (ARBs) inhibit TGF-β.

Hypothesis:
ACE-inhibitor/ARB therapy will be independently associated with a reduced risk of GIB overall and GIB due to AVMs in LVAD patients.

Methods:
We reviewed the records of all patients aged 18 years or older receiving a continuous flow LVAD (HeartMate II or Heartware) at Johns Hopkins Hospital from 1/2004 to 9/2013 (n=186). We excluded patients for whom follow-up records were not available (n=3), those supported with a LVAD for less than 100 contiguous days (n=51), and those missing covariates included in statistical models (n=8), leaving 124 patients included for analyses. Cox proportional hazards models adjusted for demographic, cardiovascular, and laboratory variables were used to assess the association of ACE-inhibitor/ARB therapy with GIB.

Results:
Mean age of patients was 52 years and 75% were male. Ninety-seven patients received ACE-inhibitor and/or ARB therapy during LVAD support. Thirty-six patients (29%) had at least one GIB after discharge from their LVAD implantation; 15 of these 36 episodes (42%) were due to confirmed AVMs. Among ACE/ARB patients, 24% had a post-discharge GIB (23/97) versus 48% (13/27) of non-ACE/ARB patients. Fully adjusted Cox proportional hazards model demonstrated that ACE-inhibitor/ARB therapy was independently associated with a reduced risk of GIB after hospital discharge (HR 0.37, 95% CI 0.17-0.81, p=0.012) with suggestion of reduced risk of GIB due to AVMs (HR 0.32, 95% CI 0.10-1.06, p=0.06).

Conclusions:
ACE-inhibitor and ARBs are independently associated with a reduced risk of GIB in LVAD patients and should be considered for all LVAD patients without contraindications. Possible biologic mechanisms of this observation remain unexplored and warrant further investigation.
Abstract 11004: Prediction of Clinical Outcome in Patients With Aortic Stenosis by Left Ventricular Mechanical Dispersion
Authors: Klaeboe Lars G
Published: April 2024

Introduction:
There is a need for new parameters to improve risk stratification and assess outcome in patients with aortic stenosis (AS). Left ventricular (LV) mechanical dispersion by strain echocardiography reflects heterogeneous myocardial contraction and is a novel marker of sudden cardiac death in structural and primary electrical heart disease. We hypothesized that mechanical dispersion provides valuable prognostic information in patients with AS, and that mechanical dispersion can be used as a clinical tool for risk stratification in these patients

Methods:
We included 55 patients (56% women,75±9 years) with moderate to severe AS. Global longitudinal strain (GLS) was assessed by speckle tracking echocardiography from a 16 LV segments model. Mechanical dispersion was calculated as standard deviation of time from Q/R on ECG to peak strain in 16 LV segments.

Results:
Average aortic valve area was 0.7±0.2 cm2. Most patients had LV septal hypertrophy (12±2 mm) and preserved LV ejection fraction (EF) (57±10%). Aortic valve replacement (AVR) was performed in 37 (67%) patients. During 38±14 months follow-up, 15(27%) patients died (no 30-day mortality after AVR). LV ejection fraction (EF) and GLS were similar in the survival and non-survival group (58±9% vs. 54±13%, p=0.16, and -17.0±3.4% vs. -16.7±4.0%, p=0.78, respectively). Mechanical dispersion was the only echocardiographic parameter that differed between survivors and non-survivors (56±18ms vs. 69±19ms, p=0.02). C-statistics for mechanical dispersion showed an AUC of 0.70 (0.55-0.86) and a value of > 67 ms indicated worse survival (log rank < 0.01) (Fig.1)

Conclusions:
LV mechanical dispersion was significantly higher in the AS non-survivors. Increased mechanical dispersion may be an additional risk marker and could give valuable prognostic information in patients with AS and preserved LVEF.
Abstract 11011: Long-Term Outcomes of Definitive Surgical Repair for Congenitally Corrected Transposition of the Great Arteries
Authors: Nakamoto Yuki , Park In-Sam , Takahashi Yukihiro
Published: April 2024

Background:
Congenitally corrected transposition of the great arteries (ccTGA) is characterized by atrioventricular and ventriculoarterial discordance. The indications, timing, and type of repair vary according to the morphology of the heart, the clinical status of the patient, and the patient’s age. Optimal surgical management of patients with ccTGA remains controversial.

Methods:
The medical records of all patients with ccTGA who underwent definitive repairs between 1977 and 2013 were retrospectively reviewed. The surgical procedures comprised a physiologic repair in 45 patients, anatomic repair (double switch operation) in 14 patients, and a Fontan-type repair in 12 patients.

Results:
The Kaplan-Meier survival at 20 years was similar (75.7% in physiologic repair vs. 83.3% in anatomic repair). However, patients with significant TR showed a worse survival rate than those of the other groups (20 year survival without TVR 96.3%, but only 58.6% with TVR). The freedom from reoperation at 10 years was 78.3% in physiologic repair vs. 66.7% in anatomic repair. The freedom from pacemaker implantation at 10 years was 93.0% in physiologic repair vs. 64.3% in anatomic repair. 14 patients underwent a Fontan-type repair without mortality or heart block.

Conclusions:
No differences were observed between long-term survival rates of patients who underwent physiologic versus anatomic repair. The poorest outcome was seen in patients who required tricuspid valve replacement. Performing an anatomic repair should be considered for patients with significant TR. The best outcome was seen in the patients undergoing the Fontan procedure. However, various complications late after Fontan procedure remain a concern.
Abstract 11100: Difference in Clinical Characteristics, Left Atrial Reverse Remodeling and Functional Outcomes After Mitral Valve Replacement in Patients With Low-Gradient Very Severe Mitral Stenosis
Authors: Cho In-Jeong , Hong Geu-Ru , Shim Chi Young , Chang Hyuk-Jae , Ha Jong-Won , Chung Namsik
Published: April 2024

Introduction:
The discrepancy between planimetered mitral valve area (MVA) and mean diastolic pressure gradient (MDPG) has not been studied extensively in patients with mitral stenosis (MS).

Hypothesis:
The purpose of the current study was to investigate the difference in characteristics and outcomes after mitral valve replacement (MVR) between low and high MDPG groups in very severe MS patients.

Methods:
This study evaluated 140 patients who received isolated MVR due to very severe MS (planimetered MVA ≤ 1.0 cm2) and performed follow-up echocardiography at least 12 months after MVR. Patients were divided into two groups according to preoperative MDPG (Low-gradient, < 10 mmHg; High-gradient, ≥ 10 mm Hg). Strain and strain rate analysis was performed using speckle tracking echocardiography before MVR in 56 patients.

Results:
There were 82 patients in low-gradient group and 58 patients in high-gradient group. The low-gradient group was older and demonstrated higher prevalence of female gender, diabetes mellitus, and atrial fibrillation (all p <0.05). When comparing the low-gradient and high-gradient groups, the left atrial volume index was larger (LAVI, 105.1 ± 51.9 ml/m2 vs. 87.8 ± 42.9 ml/m2, p < 0.001) and strain rate during isovolumic relaxation was lower (0.17 ± 0.08 s-1 vs. 0.29 ± 0.09 s-1, p < 0.001) in low-gradient group. After MVR, the percentage in LAVI reduction after MVR was significantly smaller in low-gradient group (-29.9 ± 15.1% vs. -43.5 ± 16.4%, p < 0.001). Persistent symptoms after MVR was more common in the low-gradient group compared to the high-gradient group (p = 0.004), even though preoperative functional class was similar between the groups.

Conclusions:
Low-gradient very severe MS was common in the population of high prevalence in diastolic dysfunction, such as the elderly, women, diabetes mellitus, and atrial fibrillation, was associated with impaired myocardial isovolumic relaxation, and demonstrated unfavorable left atrial reverse remodeling and a greater risk of persistent symptoms after MVR. These data might suggest the importance of concurrent management of diastolic dysfunction in low-gradient very severe MS.
Abstract 11125: Increasing Stimulus Strength of Coronary Sinus Pacing Improved Left Ventricular Mechanical Dyssynchrony and Contractile Function in Patients With Reduced Ejection Fraction
Authors: Tatsumi Kazuhiro , Tanaka Hidekazu , Matsumoto Kensuke , Kumiko Dokuni , Hatani Yutaka , Hatazawa Keiko , Matsuzoe Hiroaki , Ooka Junichi , Sano Hiroyuki , Shimoura Hiroyuki , Sawa Takuma , Motoji Yoshiki , Mochizuki Yasuhide , Ryo Keiko , Fukuzawa Koji , Hirata Ken-ichi
Published: April 2024

Introduction:
Increasing stimulus strength of left ventricular (LV) coronary sinus pacing decreases QRS duration and inter-ventricular conduction time.

Hypothesis:
Increasing stimulus strength of LV coronary sinus pacing improves LV mechanical dyssynchrony and myocardial function.

Methods:
We studied 36 patients with 6±4 months after cardiac resynchronization therapy (LV ejection fraction: 39±11%). The LV pacing lead was positioned in lateral or posterolateral coronary sinus vein. We measured standard deviation (SD) of time to negative peak circumferential strain (time-CircS) in 6 segments and peak global circumferential strain value (CircS) using two-dimensional speckle-tracking echocardiography to evaluate LV mechanical dyssynchrony and myocardial contractile function, respectively. Low (1.3±0.6V), clinical (2.6±1.0V), and high (7.3±1.1V) voltage conditions of LV coronary sinus pacing were performed under right ventricular pacing-off.

Results:
SD of time-CircS and global CircS under high voltage LV coronary sinus pacing was significantly better than those under low and clinical voltage (78±38 vs. 90±48 and 92±43msec, p=0.014 and 0.016; 5.7±3.4 vs. 5.4±3.3 and 5.4±3.4%, p=0.007 and 0.003). Moreover, global CircS significantly correlated with SD of time-CircS (r= -0.54, p<0.001, n=108).

Conclusions:
Increasing stimulus strength of LV coronary sinus pacing improved LV mechanical dyssynchrony and LV contractile function, leading clinical implication for better management of heart failure patients with cardiac resynchronization therapy.
Abstract 11592: Lipid Droplet Associated Hydrolase (LDAH) Enhances Triacylglycerol Accumulation by Antagonizing Adipose Triglyceride Lipase (ATGL)
Authors: Goo Younghwa , Son Sehee , Paul Antoni
Published: April 2024

Lipid droplets (LDs) are lipid storage depots as well as metabolically dynamic organelles. LD-associated hydrolase (LDAH) is a newly identified protein that is highly expressed in liver and adipose tissues, where triacylglycerol (TAG) is the main form of lipid stored in LDs. However, to date the role of LDAH in TAG metabolism has not been reported. In this study we show that upon oleic acid loading LDAH translocalizes from the endoplasmic reticulum (ER) to the LD surface, and increases the size of LDs by promoting fusion in a tubulin-dependent fashion. LDAH overexpression in HEK 293 cells increased the net TAG content, while LDAH knockdown decreased TAG levels. Mutations in two predicted acyltransferase motifs aiming to assess if changes in TAG content is due to LDAH’s direct enzymatic activity did not affect TAG levels. However, an LDAH splicing variant missing 90 amino acid at C-terminus also localized to LDs, but failed to increase both LD fusion and TAG levels. Consistent with the increase in LD size and area, LDAH increased the level of Perilipin3, a major LD associated protein in HEK293 cells, but decreased the level of adipose triglyceride lipase (ATGL) that regulates rate-limiting step of TAG hydrolysis. ATGL ubiquitination, which ultimately leads to protein degradation, was higher in LDAH-overexpressing cells, and treatment with MG132 to block the activity of the 26S proteasome complex attenuated the reduction in ATGL. Coexpression of ATGL with LDAH reduced LDAH-mediated increase in LD size, total area of LDs, and TAG content. Alternatively, LDAH delayed TAG hydrolysis by ATGL upon treatment with β-adrenergic agonists. In conclusion, the data support a role of LDAH in facilitating LD growth and TAG accumulation, and uncover a mutually antagonistic interaction between LDAH and the catabolic enzyme ATGL.
Abstract 11666: Targeted Delivery of Rat iPS-Endothelial Cells Overexpressing Neutrophil IL8-RA/RB or Macrophage CCR2/CCR5 Receptors Inhibits Neointima Formation in Balloon Injured Rat Carotid Artery
Authors: Giordano Samantha , Xing Dongqi , Hage Fadi G , Townes Tim M , Sun Chiao-Wang , Wu Li-Chen , Oparil Suzanne , Chen Yiu-Fai
Published: April 2024

Introduction:
Interleukin 8 Receptors A and B (IL8RA and IL8RB) and C-C chemokine receptors 2 and 5 (CCR2 and CCR5) found on neutrophil and macrophage membranes respectively, modulate leukocyte chemotaxis after vascular injury. We have generated targeted cell therapy using adenoviral vectors that contain full length IL8RA, IL8RB, CCR2 and CCR5 cDNAs and green fluorescent protein. Transduced endothelial cells differentiated from rat induced pluripotent stem cells (RiPS-ECs) overexpressing these receptors provides support for autologous targeted cell therapy. We hypothesize that transfusion of RiPS-EC overexpressing IL8RA/B (RiPS-IL8RA/B-ECs), CCR2/5 (RiPS-CCR2/5-ECs) or both IL8RA/B and CCR2/5 (RiPS-IL8RA/B+CCR2/5-EC) into rats with balloon injury of the carotid artery will target to the area of injury, decrease the inflammatory response, and inhibit neointima formation. We will further determine the individual contribution of neutrophils and macrophage in the acute vascular injury response.

Methods:
12 wk old male Sprague-Dawley rats received balloon injury of the right carotid artery and were immediately administered i.v. transfusion of 1) saline vehicle, 2)1.5x106 RiPS-Null-ECs; 3)1.5x106 RiPS-IL8RA/B-ECs, 4) 1.5x106 RiPS-CCR2/5-ECs, 6)1.5x106 RiPS-IL8RA/B+CCR2/5-ECs. One group of rats was sacrificed 24 hr post injury and cell transfusion and infiltration of neutrophils and monocytes/macrophages and pro-inflammatory cytokine levels were measured. A second group of rats was sacrificed 2 wks post injury for measurement of neointima formation.

Results:
RiPS-ECs equipped with the IL8RA/B or CCR2/5 homing device mimic the behavior of leukocytes and target to the injured arteries and inhibited neointima formation after endoluminal injury. Conclusions: These findings indicate a novel treatment for vascular injury using targeted cell therapy against both neutrophils and macrophages.
Abstract 11676: Importance of Longitudinal Dyssynchrony in Low Flow Low Gradient Severe Aortic Stenosis Patients Undergoing Dobutamine Stress Echocardiography. A Multicenter Study (on behalf of the HAVEC group)
Authors: Cavalcante Joao L , Delgado-Montero Antonia , Dahou Abdelaziz , Caballero Luis , Rijal Shasank , Gorcsan III John , Monin Jean-Luc , Pibarot Philippe , Lancellotti Patrizio
Published: April 2024

Introduction:
Patients with reduced left ventricular ejection fraction (LVEF), low-flow low-gradient aortic stenosis (LFLG AS) represent a challenging cohort with high morbidity and mortality. Low-dose dobutamine stress echocardiogram (DSE) is recommended for assessment of flow reserve (FR, defined as ≥ 20% increase in stroke volume) which is prognostically important.

Hypothesis:
Presence of longitudinal dyssynchrony (LD) is independently associated with no FR during DSE.

Methods:
185 LFLG AS patients from 4 different institutions who underwent DSE between 1997 through 2013 were studied. Baseline LD, transverse dyssynchrony and strain analysis were performed using vendor-independent 2D CPA TomTec software using DICOM images from apical 2 and 4-chamber and feasible in 97% of patients (N=179). Multivariate logistic regression analysis of predictors of no FR was performed.

Results:
The mean age was 74 ± 9 yrs; LVEF 30 ± 10%; indexed AV area 0.44 ± 0.1 cm2/m2; mean AV gradient 24 ± 7 mmHg; mean QRS width 126 ± 32 msec and 28% of the cohort had a QRS width ≥ 130 msec. LD, pre-defined as maximum opposite wall delay ≥ 130 msec, was present in 83% (149/179) of study cohort, whereas FR on DSE was present in 54%. Coronary artery disease was more common in those without FR. Although baseline LVEF was not different according to FR status (p=0.23), greater LV stroke volume index (p=0.001) and longitudinal strain (p=0.004) were seen in those without FR. LD was more prevalent in patients without FR (90% vs 77%, p=0.02). On multivariate analysis (Figure 1), presence of LD (HR=4.58, p=0.01) was an independent predictor of no FR despite several adjustments.

Conclusions:
LD is very prevalent in patients with LFLG AS undergoing DSE. Quantification of LD provides important insights as LD is independently associated with no FR. Whether LD improves after valvular intervention and whether its correction confers a better prognosis to these patients remains to be studied.
Abstract 11712: A First Look at Potential Linguistic or Cultural Factors Regarding Bystander CPR Education and Performance in Arab-Americans in Southeastern Michigan
Authors: Shams Ali , Swor Robert
Published: April 2024

Introduction:
Cultural and community specific barriers were identified as reasons for low bystander CPR/AED rates in minorities. No literature exists that explores this issue in the Arab American population, a large ethnic community in the state.

Methods:
We performed a cross sectional survey of clients receiving services from ACCESS (Arab Community Center for Economic & Social Services), the largest Arabic nonprofit organization in Michigan, during a 3 month period. The survey was presented verbally or in writing in English/Arabic. The questions were regarding demographics, CPR/AED knowledge, barriers to CPR training, and how best to inform and train respondents. A 5 point Likert scale was used and descriptive statistics are presented.

Results:
Of 434 potential respondents, 192(44.3%) completed the survey. Respondents were majority female (58%), adult (mean age 37) and first generation immigrant (73.9%). They were low income (66% < $30K/year) and well educated (65% > H.S. education). They were predominantly Muslims (81%), 23.8% lacked English proficiency, and 42% completed the survey in Arabic.

About a third (30.4%) had prior CPR training. The vast majority (83.8%) support public CPR education and performance, with 63.1% believing they are currently capable of understanding and implementing CPR instructions given over the phone. Perceived barriers to CPR performance are listed in Table 1.

The most common barrier to learning CPR was availability of nearby CPR courses (17.4%). Respondents identified the Internet as their preferred source of information and community centers as their preferred site for CPR training.

Conclusions:
Members of the Arabic community are aware of the importance of bystander CPR/AED and are willing to learn and perform CPR. Language and female chest exposure are two specific issues to address when designing community specific CPR/AED program. Internet and community center based initiative were preferred sites for educational programs.
Abstract 11727: Anti-Inflammatory Treatment With Colchicine in Acute Myocardial Infarction: A Randomized Study
Authors: Giannopoulos Georgios , Deftereos Spyridon , Angelidis Christos , Alexopoulos Nikolaos , Lekakis John , Stefanadis Christodoulos
Published: April 2024

Background:
Inflammatory processes have been identified as key mediators of the deleterious effects of ischemia/reperfusion in ST-elevation myocardial infarction (STEMI). Colchicine is a substance with potent anti-inflammatory properties, suitable for safe use in patients with cardiovascular disease. The purpose of this study was to test the hypothesis that a short course of colchicine treatment could lead to reduced infarct size.

Methods:
Patients presenting with STEMI 12 hours or less from pain onset (treated with primary percutaneous coronary intervention) were randomized to colchicine or placebo for 9 days. The primary outcome parameter was the area under the curve of creatine kinase-MB (CK-MB) concentration. A subset of patients underwent cardiac magnetic resonance imaging (MRI) with late gadolinium enhancement (LGE) 6-9 days after the index STEMI.

Results:
151 patients were included (60 in the MRI substudy). The area under the CK-MB curve was 3144 [IQR 1754-6940] ng.h.ml
-1
in the colchicine group as compared to 6184 [IQR 4456-6980] ng.h.ml
-1
in controls (p<0.001). Indexed MRI-LGE-defined infarct size was 18.3 [IQR 7.6-29.9] ml/1.73 m
2
in the colchicine group versus 23.2 [18.5-33.4] ml/1.73 m
2
in controls (p=0.019). The relative infarct size (as a proportion to left ventricular myocardial volume) was 13.0 [IQR 8.0-25.3]% and 19.8 [IQR 13.7-29.8]%, respectively (p=0.034). Maximal neutrophil count was 7543 [IQR 6549-10118] /μL in the colchicine group versus 8922 [IQR 7880-10307] /μL in controls (p=0.008). It was significantly associated with relative and absolute MRI-LGE infarct size, as well as with the area under the CK-MB curve (p=0.001).

Conclusion:
These results suggest a potential benefit of colchicine in STEMI, but further clinical trials are necessary to draw secure conclusions, especially considering the fact that the present study was not powered to assess clinical endpoints.
Abstract 11905: Loss of Adrenergic and Adenosine Regulation of Extradyadic L-type Calcium Channels in Rat Atrial Myocytes in Heart Failure
Authors: Glukhov Alexey V , Balycheva Marina , Sanchez-Alonso Jose , Bhogal Navneet , Diakonov Ivan , Mazzola Marta , Faggian Giuseppe , Gorelik Julia
Published: April 2024

It has recently become evident that discrete clusters of L-type Ca2+ channels (LTCCs) exist along the cardiomyocyte sarcolemma in association with distinct membrane structures. Such microdomain-specific localization impact channel function and regulation by a variety of neurohormonal pathways, including adrenergic and adenosine. Disruption in their subcellular targeting may contribute to the pathophysiology of cardiac diseases, including heart failure (HF). We used Ca2+ imaging and super-resolution scanning patch clamp to examine microdomain-specific regulation of LTCCs in atrial myocytes isolated from control and 16-weeks post-MI HF rats. In control, β1 adrenergic receptors (β1ARs) stimulation (ISO 100 nM and β2AR antagonist ICI 50 nM) enhanced spontaneous Ca2+ release events while the following adenosine A1 receptors (AdoA1Rs) stimulation (2'-MeCCPA 200 nM) abolished β1ARs effects. Non-localized β1ARs stimulation (ISO 2 μM and ICI 50 nM in external solution) activated single LTCCs in both t-tubules and on the crest of sarcolemma, increasing LTCC occurrence and enhancing their open probability and amplitude. Local AdoA1R stimulation through the pipette (10 μM) on β1ARs-pretreated cells completely abolished β1ARs effects. In HF, both β1ARs and AdoA1R effects on LTCCs were preserved in t-tubules and lost on the crest. Similar, the effect of β1AR stimulation on spontaneous Ca2+ release events was significantly reduced in HF (28% vs 134% in HF vs control, P<0.01) and the anti-adrenergic effect of AdoA1R was lost (8% vs 84% in HF vs control, P<0.01), despite up-regulation of β1 and AdoA1Rs mRNA. No changes in caveolae density were observed in HF (4.6±0.4 caveolae/μm vs 3.7±0.5 caveolae/μm for HF vs control, P=0.167). Our findings provide the first direct evidence for microdomain-specific remodeling of LTCC regulation by adrenergic and adenosine receptors in HF which could be linked to local disruption in the interactions between LTCCs and their cellular microenvironment. This extends beyond the classical concept of electrical remodeling, stressing the involvement of alteration of spatial compartmentation of ion channels and receptors in addition to classical concepts of changes in protein expression and post-translational modifications.
Abstract 11932: Timing of Hormone Replacement Therapy and Coronary Artery Calcium: The Multi Ethnic Study of Atherosclerosis
Authors: Nezarat Negin , Luo Yanting , Li Dong , Brumback Lyndia , Khurram Nasir , Khazai Bahram , Honoris Lily , Budoff Matthew
Published: April 2024

Introduction:
Cardiovascular disease is a leading cause of mortality in post-menopausal women. Although hormone replacement therapy (HRT) is not recommended for prevention of coronary artery disease, recent evidence suggests the timing of HRT may derive different effects on atherosclerosis formation.

Hypothesis:
We hypothesize that women who are given HRT closer to the onset of menopause will have less coronary artery calcium (CAC).

Method:
Study participants were 3,174 women from the Multi-Ethnic Study of Atherosclerosis (MESA). Women who had not yet started menopause, had started menopause but not yet started HRT, had started HRT before menopause, or did not report age of menopause and/or starting HRT were excluded. To evaluate the association between presence of CAC and timing of HRT, we used logistic regression with presence of CAC as the response and with timing of HRT as a continuous linear predictor. We also used predefined categories of the timing of HRT as a predictor.

Result:
Among the 1396 participants who had gone through or were going through menopause and started HRT post-menopause, the prevalence of CAC was 42%, the mean of CAC was 77 (221) Agatston units, and the median was 0 (0-34).The odds of having CAC was 1.06 (95% CI: 1.04, 1.08; p<0.001) times higher for starting HRT 1 year later post-menopause. The odds ratio was 1.03 (1.01, 1.04; p=0.008; N=1358) after adjustment for traditional cardiovascular risk factors, 1.02 (1.00, 1.05; p=0.02; N=1336) after further adjustment for duration of HRT, and 1.01 (0.99, 1.04; p=0.3; N=839) after further adjustment for type of HRT. The mean difference in CAC associated with starting HRT 1 year later post-menopause was 5.1 Agatston units (3.0, 7.2; P<0.0001); the mean difference was smaller and not significantly different from 0 after adjustment for other risk factors.

Conclusion:
While this study does not provide evidence that the timing of HRT post-menopause is associated with the amount of CAC, it does provide evidence that starting HRT earlier post menopause is associated with lower odds of CAC.
Abstract 11938: Long-term Population-based Outcomes of Novel Oral Anticoagulants Compared to Warfarin Among Long-term Anticoagulated Patients: A Propensity Matched Analysis
Authors: Jacobs Victoria , May Heidi T , Bair Tami L , Anderson Jeffrey L , Crandall Brian G , Cutler Michael , Day John D , Mallender Charles D , Osborn Jeffrey S , Stevens Scott M , Weiss J P , Woller Scott C , Bunch T J
Published: April 2024

Introduction:
Novel oral anticoagulants (NOACs) have been used in clinical practice in the US for the last 4 years. While NOACs may be an attractive alternative to warfarin among many patients, long-term outcomes of use of these medications are unknown. We performed a propensity matched analysis of long-term outcomes among patients taking a NOAC or warfarin.

Hypothesis:
NOACs will be superior to warfarin for the reduction of long-term outcomes.

Methods:
Patients receiving long-term anticoagulation between June 2010 and December 2014 for thromboembolism prevention with either warfarin or a single NOAC were matched 1:1 by index date (± 6 months) and propensity score (±0.01). Multivariable Cox hazard regression was performed to determine the risk of death, stroke/TIA, major bleed, and bleed by the anticoagulant therapy received.

Results:
Patients studied included: apixaban: 590, dabigatran: 583, rivaroxaban: 1, 454. A total of 5,254 patients were studied (2,627 per group). Average age was 72.4±10.9 and 59.0% were male. The majority of patients were receiving long-term anticoagulation for AF management (warfarin: 96.5% vs. NOAC: 92.7%, p<0.0001). Rivaroxaban (n=1,454 [55.3%]) was the most commonly used NOAC, (apixaban=590 [22.5%], dabigatran=583 [22.2%]). History of stroke/TIA and prior bleed were similar between the groups, yet more NOAC patients formally had major bleeding (9.2% vs. 6.8%, p=0.002). The use of NOACs compared to warfarin were associated with a reduced risk of long-term adverse outcomes [Figure, death (p=0.09), stroke/TIA (p<0.0001), major bleed (p<0.0001), and bleed (p=0.14)]. No significant outcome variance was noted in NOAC type comparison.

Conclusions:
Our community-based results are support better long-term efficacy and safety of NOACs compared to warfarin, and are in agreement with the shorter-term results of previous clinical trials.
Abstract 11969: Effects of Definition of Defibrillation Success on Predictability of Ventricular Fibrillation Waveform Analysis
Authors: Li Yongqin , Gong Yushun , He Mi , Quan Weilun
Published: April 2024

Introduction:
Quantitative analysis of ventricular fibrillation (VF) waveform has the potential to optimize the timing of defibrillation by predicting defibrillation outcome. However, there is no consensus on the definition of defibrillation success in out-of-hospital settings. In the present study, we used a registry data of out-of-hospital cardiac arrest (OHCA) to investigate the effects of different definitions of defibrillation success on the predictability of amplitude spectrum area (AMSA).

Methods:
A total of 581 shocks from 264 OHCA patients with VF as the first recorded rhythm were included in this study.We determined the presence of VF, asystole or organized rhythm 120 seconds after shock delivery as the final outcome. In order to identify how different definitions of defibrillation success affect the predictive value of AMSA, we used 3 different definitions that were previously described in the literatures. (1) Termination of VF: A successful shock is defined as no presence of VF for 5 seconds or longer. (2) Return of organized electrical activity (ROEA): A successful shock is defined by an organized rhythm observed for at least 5 seconds after delivery of the shock. (3) Return of a potentially perfusing rhythm: An organized rhythm is restored with a heart rate greater than 40 beats/min, commencing within 60 seconds after shock delivery.

Results:
A total of 153 cases (26.3%) had an final outcome of organized rhythm. The defibrillation success rates were 72.1%, 49.2% and 27.0% when the 3 different definitions were used. The area under the receiver-operating-characteristic curve was 0.563 for termination of VF, 0.706 for organized rhythm, and 0.814 for return of potentially perfusing rhythm (p<0.001).

Conclusion:
AMSA’s ability to predict shock success varied strongly depending on which definition of shock success was used. Termination of VF may be a good measure of defibrillation efficacy for new onset of VF, while return of a potentially perfusing rhythm is clinically more relevant as a definition for defibrillation success in OHCA. AMSA had the highest predictive value when used with the outcome of potentially perfusing rhythm. This supports the assumption that AMSA is, at least to some extent, a measure of myocardial viability.
Abstract 11970: Sirtuin1 is a Key Regulator of Enhanced Therapeutic Potential in Juvenile Skeletal Myoblast Sheet Therapy for Treating Heart Failure
Authors: Ozawa Hideto , Miyagawa Shigeru , Fukushima Satsuki , Harada Akima , Ito Emiko , Saito Atsuhiro , Ueno Takayoshi , Toda Koichi , Kuratani Toru , Sawa Yoshiki
Published: April 2024

Introduction:
Transplantation of autologous somatic tissue-derived stem cells into the heart has been shown to be therapeutically effective for heart failure in adult, though efficacy of this treatment for pediatric patients are poorly established. It is known that juvenile cell behave differently from adult one, associated with expression of aging-related factors such as sirtuin family.

Hypothesis:
Sirtuin 1 expression is a key regulator of differential therapeutic potentials between juvenile and adult skeletal cells (SCs) for treating heart failure.

Methods and Results:
Sirtuin 1 knock down (SIRT1-KD) was induced by RNA interference in primary SCs from Lewis rat. The SIRT1-KD SCs showed a longer doubling time, associated with lower expression of VEGF, HGF, and SDF-1, compared to the primary SCs in vitro. Cell-sheets generated by SIRT1-KD SCs or primary SCs were transplanted over the heart surface of the syngeneic Lewis rat that was subjected to left coronary artery (LCA) ligation 2 weeks prior to the treatment (n=5 each). As a result, recovery of ejection fraction was significantly less prominent in the SIRT1-KD group (31.6%) than the primary group (46.9%), in association with degree of histological ventricular remodeling, such as %fibrosis, myocyte size, or capillary density. Subsequently, autologous SC cell-sheet were cardiac-transplanted in 2-month-old juvenile and 20-30 month-old adult mini-pigs that were subjected to ischemia-reperfusion in the LCA territory (n=5 each). The juvenile porcine SCs displayed significantly shorter doubling time and greater Ki67-positivity, in association with up-regulated SIRT1, HIF-1α, HGF, and SDF-1, in vitro. At 2 months after the transplantation, recovery of EF was more prominent in the juvenile group (23.6% to 49.8%) than the adult group (28.8% to 36.2%). Moreover, regional wall motion (%strain) of the infarct-border area more prominently recovered in the juvenile group (-3.6% to -16.1%) than the adult group (-3.3% to -5.4%).

Conclusions:
Juvenile SCs exhibited an enhanced therapeutic potential in association with upregulated expression of SIRT1 as compared to the adult SCs, suggesting that autologous cell-sheet transplantation may be therapeutically more effective for pediatric cardiomyopathy.
Abstract 11979: Noninvasive Evaluation of the Feature of Hypertensive Heart Failure using One-beat Real-time Three-dimensional Speckle Tracking Echocardiography With High Volume Rates
Authors: Kawasaki Masanori , Tanaka Ryuhei , Minatoguchi Shingo , Sato Hidemaro , Nagata Kijun , Sawada Shigeki , Ishiguro Maya , Yoshizane Takashi , Goto Yoshiaki , Iwama Makoto , Hirose Takeshi , Ono Koji , Arai Masazumi , Noda Toshiyuki , Watanabe Sachiro , Minatoguchi Shinya
Published: April 2024

Background:
Left ventricular (LV) properties in hypertension (HTN) could be deteriorated by pressure overload that causes LV hypertrophy (LVH) resulting in hypertensive heart failure (HHF). However, transition from HTN to HHF and the feature of HHF have not been noninvasively examined.

Methods:
We examined 31 controls (age 69±9), 47 HTN without LVH: LVH (-) (age 70±9), 47 HTN with LVH: LVH (+) (age 69±6) and 37 HHF patients (age 71±11) by 3-dimensional speckle tracking echocardiography with volume rate of 70-80vps (3D-STE). LV contractility and relaxation were assessed by radial strain rate (SR) at systole (SR-S) and isovolumic relaxation (SR-IVR). LV torsion was measured by 3D-STE. Pulmonary capillary wedge pressure (PCWP) was calculated as 10.8 - 12.4 x log (left atrial active emptying function / left atrial minimum volume index) as we reported. Tau was estimated as isovolumic relaxation time / (ln 0.9 x systolic blood pressure - ln PCWP). LV stress was calculated as LV radius x pressure / thickness. LV stiffness was estimated as diastolic stress / strain.

Results:
LV SR-S and SR-IVR in HHF decreased (SR-S; control: 2.5±0.8, LVH (-): 2.6±0.6, LVH (+): 2.5±0.7, HHF: 1.9±0.4* s-1. SR-IVR; -0.8±0.5, -0.7±0.4, -0.7±0.4*, -0.5±0.4* s-1, *p<0.05 vs control). LV ejection fraction (EF) in HHF decreased (66±9, 69±6, 67±11, 51±14* %) associated with reduced torsion (1.4±0.2, 1.4±0.3, 1.5±0.3, 1.2±0.2* °/cm) and increased systolic stress. Tau was prolonged even in LVH (-) (29±12, 41±14*, 47±14*, 65±19*, msec). LV stiffness increased in LVH (+) and HHF (0.5±0.2, 0.6±0.4, 0.6±0.3*, 1.5±1.2*) associated with elevated PCWP (7±2, 8±4, 9±4*, 15±5* mmHg) and diastolic stress (16±5, 19±12, 21±12, 32±13* dynes/cm2). On multivariate logistic analysis, ePCWP was the parameter that showed the strongest independent factor associated with HHF. Using 11mmHg as a cutoff value, sensitivity and specificity to predict HHF in the HTN group was 83 and 81%.

Conclusion:
Noninvasive 3D-STE examination revealed that LV contractility and relaxation were decreased in HHF and that HHF had more reduced EF, prolonged Tau and increased stiffness associated with reduced torsion, increased systolic and diastolic stress and PCWP. PCWP was an independent determinant of HHF in echo parameters.
Abstract 11988: Waist Circumference and Systolic Blood Pressure Are Predictors of Left Ventricular Hypertrophy in Healthy Individuals
Authors: Manaka Yuka , Sekiguchi Haruki , Takano Mayu , Kimura Makiko , Takahashi Yufuko , Tatsumi Fujio , Watanabe Eri , Shimamoto Ken , Kawana Masatoshi
Published: April 2024

Introduction:
Left ventricular hypertrophy (LVH) is considered to be a cause of heart failure. Previous studies indicated that patients with metabolic syndrome (MetS) and obesity might be at risk for cardiovascular disease (CVD). However, little is known about which MetS factors contribute to the development of LVH in healthy adults.

Hypothesis:
The aim of this study was to identify factors related to CVD and major organ dysfunction that could act as predictors of LVH based on thorough medical examinations of healthy subjects.

Methods:
A total of 1056 participants without diabetes mellitus, systolic dysfunction, chronic kidney disease, or other heart diseases underwent a thorough physical examination including transthoracic echocardiography. LV mass index (LVMI) ≥ 51 g/m2.7 was considered LVH. Single and multiple logistic regression analyses of LVMI and cardiovascular risk factors, including MetS factors and indicators of major organ dysfunction, were performed. Obese subjects (WC ≥ 85 cm in males and ≥ 90 cm in females) and non-obese subjects were also analyzed separately.

Results:
A total of 980 adults (age 62.8 ± 12.7 y, male 573) were analyzed, and LVH was observed in 21.5% of subjects (n = 211, male 155). Overall, 33.0% (43 of 434) of obese subjects had LVH. LVH was correlated with age, systolic blood pressure (SBP), diastolic BP, estimated glomerular filtration rate, total bilirubin, fasting blood sugar, HbA1c, and WC. Multiple logistic regression analysis indicated that age, high SBP (≥130 mmHg) and WC were independent predictors of LVMI (odds ratios 1.05, 1.99, 3.03; 95% confidence intervals 1.01-1.06, 1.42-2.79, 2.16-4.25, respectively, P<0.01). In obese subjects, aging, WC, and high SBP were independent predictors of LVMI, but WC was not an independent predictor of LVMI in non-obese subjects. Moreover, the average WC was significantly higher in both males and females in obese (47.7 ± 13.5, 47.9 ± 14.1 g/m2.7) than in non-obese subjects (41.1 ± 10.3, 37.8 ± 10.1 g/m2.7).

Conclusions:
WC and SBP are independent risk factors for LHV in healthy individuals and, therefore, might be useful for predicting cardiovascular disease during routine physical checkups.