bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 2404: ECG Estimate Of Ischemic Acuteness and Time from Pain Onset for Predicting Myocardial Salvage in Patients Undergoing Primary Percutaneous Coronary Intervention
Authors: Engblom Henrik , Heden Bo , Hedstrom Erik , Wagner Galen , Arheden Håkan
Published: July 2021

Background:
The potential for salvage of jeopardized myocardium during coronary occlusion decreases as the duration of persistent ischemia is prolonged. Thus, it is important to be able to assess the acuteness of ischemia as a patient presents with signs of acute coronary syndrome. The aim of this study was to compare ECG estimate of ischemic acuteness and time from pain onset for predicting myocardial salvage in patients with first-time myocardial infarction (MI).

Methods:
Thirteen patients with acutely revascularized first-time MI were studied. All patients had 99mTc tetrofosmin injected and an ECG recorded prior to the PCI. TIMI III flow was obtained in all patients. Single photon emission computed tomography (SPECT) was undertaken within 3 hours of the PCI to assess the myocardium at risk (MaR). Delayed contrast-enhanced magnetic resonance imaging (DE-MRI) was performed 1 week after admission for assessment of infarct size (IS) and infarct transmurality (IT). A salvage index was calculated as (MaR-IS)/MaR. The acuteness of ischemia was estimated both from patient history and from the Anderson-Wilkins (AW) acuteness score of the pre-PCI ECG.

Results:
The figure

shows the relationship between time of symptom onset and salvage index (A) and IT (C) as well as the relationship between AW acuteness score and salvage index (B) and IT (D). The time of symptom onset did not correlate with salvage index or IT. The AW acuteness score, however, showed a significant relationship with both salvage index and IT.

Conclusions:
The initial ECG changes are superior to time from symptom onset to PCI for predicting myocardial salvage and IT in patients undergoing PCI of first-time MI.
Abstract 2441: A Controlled Randomized Trial of Biatrial Ablation for Curing Long-lasting Permanent Atrial Fibrillation (The Decomplex Trial)
Authors: Augello Giuseppe , Santinelli Vincenzo , Cuko Amarild , Gugliotta Filippo , Vicedomini Gabriele , Frigoli Enrico , Torchio Silvia Del , Crisa Simonetta , Sala Simone , Mazzone Patrizio , Pappone Carlo
Published: July 2021

Background:
patients with long-lasting permanent atrial fibrillation (AF) are often destined to remain in AF life-long. In this cohort outcomes of ablation techniques are disappointing, with 20 –74% success rate and 30 –50% repeat procedure. The adjunctive clinical benefit of targeting multiple right and left atrial (LA) sites beyond the pulmonary vein (PV)-LA junction with the aim of achieving acute AF termination has not been prospectively evaluated in a randomized study.

Methods and results:
60 patients with permanent atrial fibrillation of more than 1 year duration, with early recurrence after electrical cardioversion and medical therapy with one or more antiarrhythmic agents were enrolled (mean age 59±10, mean AF duration 60 months, mean LA dimension 44±7 mm, left ventricular EF >40% in all) and randomized to standard circumferential PV ablation (CPVA, control group, N=30) or an extended CPVA schema targeting also inferior LA, atrial septum, LA appendage, coronary sinus and right atrium (test group, N=30). In the test group the procedural endpoint was sinus rhythm (SR) restoration by radiofrequency energy; at each step average cycle length was measured and ablation was stopped if patient gained SR. In the control group the standard CPVA technique was applied. All patient transmitted daily transtelephonic ECG strips whereas at 3, 6 and 12 months an echocardiogram and a 48 hour Holter was obtained. Antiarrhythmic drug therapy was continued for 3 months after ablation in both group (blanking period in which patients were allowed to undergo electrical cardioversion). AF terminated in 5% and 55% of control and test subjects; mean procedure duration was 66 and 88 minutes in the 2 groups; No significant complications occurred in both groups. After a mean follow-up of 4 months, 67% of control patients were sinus as compared with 83% in the test group (p<0.05). 2 and 2 patient undergoing a repeat procedure for recurrent AF for AF (N=2) and AT (N=2). Acute AF termination was the strongest endpoint of SR maitainance (p<0.01)

Conclusion:
Preliminary data show that a modified CPVA ablation strategy in patients with permanent AF is associated with acute AF termination in 55% of patients and achieves medium term restoration and maintenance of sinus rhythm in 83% of patients.
Abstract 2471: Contemporary Results of Isolated Aortic Valve Replacement in High-Risk Patients in the Context of Emerging Percutaneous Approaches
Authors: Voisine Pierre , Mohammadi Siamak , Rodés-Cabau Josep , Mathieu Patrick , Perron Jean , Doyle Daniel , Baillot Richard , Charbonneau Éric , Dumont Éric , Dagenais François
Published: July 2021

Percutaneous aortic valve replacement (AVR) is emerging as an alternative therapeutic approach for high-risk surgical patients, but criteria for patient selection are not clearly established. We sought to evaluate the perioperative and mid-term outcomes in a contemporary cohort of high-risk patients undergoing isolated AVR. Between 1997 and 2006, 855 consecutive patients underwent isolated AVR at our institution. High-risk patients (n=162, 19%) were defined by a preoperative Parsonnet score ≥ 30 or Euroscore ≥ 9. The remaining 693 patients (81%) composed the control group for comparison of perioperative mortality and mid-term freedom from all-cause and cardiac-related mortality. Mean follow up was 2.9±2.1 years. Perioperative mortality was 8.6% in the high-risk and 2.9% in the control group (p=0.0007), lower than that predicted by both scores (p<0.05). Freedom from all-cause mortality at 1 and 5 years were 94% and 82% for the control group and 87% and 65% for high-risk patients (p<0.0001). Freedom from cardiac-related mortality was also higher in the control (96% at 1 year, 91% at 5 years) than the high-risk (89% and 82%, p=0.0003) group. When considering patients who survived the 3-month perioperative period (537 in control, 114 in high-risk group), freedom from all-cause mortality was still higher in the former group at 1 and 5 years (99% vs 99% and 85% vs 75%, respectively, p=0.005), but freedom from cardiac-related mortality was not different (99% vs 100% and 94% vs 92%, respectively, p=0.3). By multivariate analysis, chronic renal failure, emergent procedures and reoperations were identified as independent predictors of mortality in high-risk patients. Contemporary perioperative mortality for isolated AVR in high-risk patients is lower than predicted by the Parsonnet score and Euroscore. Five-year survival in these patients is acceptable, and survivors of the operation experience the same cardiac-related survival benefit as those with standard perioperative risk. The perioperative survival benefit of percutaneous approaches for high-risk patients undergoing AVR remains to be demonstrated and, if present, should be weighed against mid-term outcome benefits of conventional surgical AVR.
Abstract 2481: Myocardial Viability Determined by Myocardial Contrast Echocardiography is Superior to
99m
Technetium Sestamibi Single Photon Emission Computed Tomography in Predicting Hard Cardiac Events Following Acute Myocardial Infarction
Authors: Dwivedi Girish , Janardhanan Rajesh , Hayat Sajad A , Swinburn Jonathan A , Senior Roxy
Published: July 2021

Introduction: The extent of residual myocardial viability (MV) following acute myocardial infarction (AMI) is an important determinant of outcome.
99m
technetium sestamibi single photon emission computed tomography (SPECT) is widely used to assess MV following AMI.

Hypothesis: We hypothesised that myocardial contrast echocardiography (MCE) which has a better spatial and temporal resolution compared to SPECT will be superior for predicting outcome following AMI.

Methods: Accordingly, 99 patients who underwent simultaneous resting low-power MCE & nitrate enhanced SPECT 7 days after AMI were followed up for cardiac death (CD) and AMI. Both SPECT (0=normal;1=mild reduction ;2=moderate reduction;3=severe reduction;4=absent tracer uptake) & MCE perfusion (1=normal;2=reduced;3=absent) were scored on a 16 segment left ventricular (LV) model. Contrast perfusion index (CPI) on MCE and SPECT perfusion index (SPI), both measures of MV, were calculated by adding the respective scores in the 16 LV segments divided by 16.

Results: Ninety five patients were available for the follow up (mean 46 months). There were 15 (16%) events (8 CDs & 7 AMIs). Area under the receiver operator characteristic curves for predicting CD and CD or AMI with MCE (0.82 and 0.80 respectively) were higher compared to SPECT (0.76 and 0.74 respectively). Amongst the clinical, biochemical, echocardiographic and SPECT markers of prognosis, only independent predictors of cardiac death and cardiac death or AMI were age and MV determined by MCE (p=0.01 & p=0.002 respectively).

Conclusion: MV determined by resting MCE is superior to nitrate enhanced SPECT for the prediction of hard cardiac events following AMI.
Abstract 2487: Torsional and Reverse Rotational Mechanics of the Left Ventricular Apex Is Abnormal in Patients with Type 2 Diabetes Mellitus Independent of Presence of Hypertension, Left Ventricular Hypertrophy, Elevated Filling Pressures and Left Atrial Volume
Authors: Zhao Wei , Li Peng , Hong Geu-Ru , Liu Shizhen , Houle Helene , Pedrizzetti Gianni , Tonti Goivanni , Narula Jagat , Vannan Mani A
Published: July 2021

Background :
Diastolic dysfunction (DD) is common in patients with Type 2 DM even in the absence of HTN and LVH. We tested whether apical rotational mechanics offered any additional insights into DD in DM over conventional echo-Doppler measures.

Methods:
We studied
4 groups
:

12 normals
(wall thickness-WT 0.9±0.1cm);

17 patients with DM
(WT 1.0±0.1cm, HbA1c 7±1%, BP 128±4/68±5 mmHg);

16 patients with DM
+HTN (WT 0.9±0.1cm, HbA1c 7±1%, BP 134±23/72±18 mmHg); and

20 patients with DM+HTN+LVH
(WT 1.4±0.2cm, HbA1c 7±4%, BP 135±13/76±9mmHg).

All patients had normal LVEF and mitral E/A ratio. SAX of the LV apex and base were obtained. Velocity Vector Imaging (Siemens, CA) was used to measure:

Longitudinal myocardial velocity (LMV, cm/sec) and strain (LS,%);

Apical rotation velocity (ARV, cm/sec)and reverse rotation velocity(ARRV, cm/sec);

Apical rotation (AR, degree) and LV torsion-LVTOR (degree/cm, and

Circumferential (CS,%) and Radial strains (RS,%).

Results:
Figure

shows LVTOR and % reduction in ARRV data.
All other data will be presented.
Thus, LV torsion is increased in DM alone or DM+HTN (-LVH) groups. But ARRV is reduced by ~ 20% in these groups even with relatively normal E/E’ ratio and LAVI. In the DM+HTN+LVH group, E/E’ and LAVI are increased and apical rotational mechanics resemble the same spectrum as the above groups but are more severe (~25% reduction in ARRV). Thus, reduction in ARRV is a marker of early DD in DM even in the absence of LVH .

Conclusions:
Apical rotational mechanics is more sensitive than conventional echo-Doppler measures to identify myocardial DD in type 2 DM even in the presence of normal E/A ratio, LAVI and LVEF, and in the absence of HTN and/or LVH.
Abstract 2494: Beneficial Actions of Co-Targeting Particulate and Soluble Guanylate Cyclase Dependent cGMP Pools in Experimental Heart Failure
Authors: Boerrigter Guido , Costello-Boerrigter Lisa C , Lapp Harald , Stasch Johannes-Peter , Burnett John C
Published: July 2021

Background:
B-type natriuretic peptide (BNP) signals via particulate guanylyl cyclase (pGC) and cyclic guanosine monophosphate (cGMP). In heart failure (HF), BNP reduces cardiac filling pressures and in selected patients augments sodium excretion and glomerular filtration rate (GFR). Studies have established that pGC and soluble guanylyl cyclase (sGC), the main target of nitric oxide (NO), can be compartmentalized with both enzymes affecting distinct intracellular cGMP pools, resulting in different biological actions. Importantly, sGC may be oxidized in disease states like HF making it unresponsive to NO and nitrovasodilators. BAY 58 –2667 (BAY) is a novel NO and heme independent sGC activator that preferentially stimulates oxidized sGC. We hypothesized that adding direct sGC stimulation with BAY to pGC activation with BNP in HF would enhance vasodilation and cardiac unloading without attenuating the distinct renal actions of BNP.

Methods:
Severe HF was induced by tachypacing in 13 dogs. On day 11, cardiorenal function was assessed in an acute study under anesthesia at baseline and with intravenous BNP (50 ng/kg/min) alone or in combination with BAY (0.3 ug/kg/min).

Results:
BNP significantly increased urine flow (UV), urinary sodium excretion (UNaV), GFR, renal blood flow (RBF) and systemic vascular resistance (SVR) and decreased cardiac output (CO), mean arterial pressure (MAP), right atrial pressure (RAP) and pulmonary capillary wedge pressure (PCWP). Despite a greater decrease in MAP compared to BNP, BAY+BNP resulted in similar increases in UNaV, UV and GFR. Dual pGC and sGC stimulation resulted in greater decreases in SVR, RAP and PCWP together with an augmentation of CO compared to BNP alone.

Conclusion:
Particulate GC activation with BNP in experimental HF enhances renal function and leads to renal but not systemic vasodilation. Addition of the sGC stimulator BAY provides systemic vasodilation, greater cardiac unloading, and augmented CO. Despite a larger decrease in MAP, additional sGC stimulation does not impair the renal actions observed with pGC stimulation alone. These findings support coactivation of sGC with BAY and pGC with BNP as a novel and beneficial therapeutic strategy in HF to optimize activation of distinct GC enzymes and cGMP.
Abstract 2516: Primary Aldosteronism And Inappropriateness Of Left Ventricular Mass
Authors: Muiesan Maria Lorenza , Salvetti Massimo , Paini Anna , Rosei Claudia Agabiti , Monteduro Cristina , Galbassini Gloria , Belotti Eugenia , Aggiusti Carlo , Micheletti Linda , Paderno Valentina , Rosei Enrico Agabiti
Published: July 2021

Background:
The calculation of values of left ventricular mass (LVM) exceeding individual needs to compensate haemodynamic load (inappropriate LVM) can identify patients with high CV risk (de Simone J. Hypertens 2001, Muiesan Hypertens 2007). However, a substantial percentage of LVM variance remains unexplained, even when the influence of cardiac workload, of the body size and gender are taken into account. It is possibile that other factors, non hemodynamic (genetic) or neurohumoral (renin-angiotensin-aldosterone system) may explain the individual LVM.

Aim of this study
to evaluate the prevalence of inappropriate LVM (iLVM) in patients with primary aldosteronism (PA).

Methods
94 PA (51 with adrenal hyperplasia and 43 with adrenal adenoma), (age 49 ± 11 years, 41 F) and in 94 essential hypertensives (EHT) matched for age and sex, underwent echocardiography. The appropriateness of LVM to cardiac workload was calculated by the ratio of observed LVM to the value predicted for an individual gender, height, and stroke work at rest, from a reference population (de Simone et al, 1998). All subjects underwent laboratory examinations, including PRA and plasma aldosterone, and clinic and 24 hours blood pressure measurement.

Results
No significant differences were observed for clinic and 24 hours BP, clinic and 24 hours heart rate, glucose and lipids between PA and EHT. The prevalence of traditionally defined LV hypertrophy (LVMI ≥ 47 g/m
2.7
in F and 50g/m
2.7
in M) was greater in PA patients than in EHT (48 vs 19 % chi
2
= 0.02). In patients without LVH, the prevalence of iLVM (> 128% of predicted) was also greater in patients with PA than in EHT controls, (14 % vs 2.5 %, chi
2
p = 0.012). Among PA those with iLVM had a higher BMI, increased uric acid, lower midwall fractional shortening, and prolonged isovolumic relaxation time (p < 0.05 at least). In all patients a small, albeit statistically significant, correlation was observed between the Aldosterone/PRA levels and the ratio of observed/predicted LVM (r = 0.18, p < 0.02).

Conclusions:
In patients with PA the prevalence of iLVM is increased, even in the absence of traditionally defined LVH. The increase in aldosterone levels could contribute to the increase of LV mass exceeding the amount needed to compensate hemodynamic load.
Abstract 2517: Presence of Auto-antibody against Angiotensin II Receptor in Pregnant Women and Its Potential Role in the Development of Preeclampsia
Authors: Yang Xiaoli , Liu Huirong , Peng Wang , Zhang Jie , Yan Li , Wu Ye , Wu Xiangdong , Goldstein Barry , Ma Xin L
Published: July 2021

Preeclampsia is a serious pathologic complication during pregnancy but its pathogenesis remains unclear. We recently demonstrated that production of auto-antibody against angio-tensin (AGN) II type I receptor (AT1-AA) causes hypertension in experimental animals. Current study determined whether AT1-AA is present in pregnant women and if so, to investigate its potential role in the development of preeclampsia. Blood samples were collected from 35 pregnant women (preeclampsia=18, control=17) and AT1-AA was detected. To determine the potential mechanisms by which AT1-AA may contribute to the development of preeclampsia, vasoconstrictive effects of purified AT1-AA was determined in isolated rat arteriae cerebri media and its pro-apoptotic and cytotoxic effect was determined in cultured HUVEC. Compared with the normal pregnant women (week 37 to 39), sera levels of AT1-AA were markedly increased in preeclamptic patients (0.27±0.03 μmol/L vs. 0.023±0.017 μmol/L, P<0.01). In isolated resistant vascular rings, AT1-AA at pathologically relevant concentrations (0.1 to 0.5 μmol/L) caused significant vasoconstriction (P<0.01) which was completely blocked by losartan, an AT1-receptor antagonist. These results demonstrated that the AT1-AA causes vascular constriction though activation of AT1-receptor. Moreover,
in vitro
incubation of HUVEC with AT1-AA (0.5 μmol/L, 48 hours) resulted in significant caspase activation (caspase-3 and caspase-8: 0.69±0.14 and 3.54±0.24 nmol/h/mg protein with AT1-AA vs. 0.02±0.02 and 0.95±.28 nmol/h/mg protein with normal sera, P<0.01) and a >2-fold increase in LDH release (P<0.01). The pro-apoptotic and cytotoxic effect of AT1-AA was almost identical with that seen in AGN II-treated HUVEC. Collectively, current study demonstrated that AT1-AA is markedly increased in preeclamptic patients. More importantly, purified AT1-AA not only has a direct vasoconstrictive effect which increases blood pressure, but also causes significant endothelial cell death that indirectly contributes to the development of hypertension. These results suggest that production of AT1-AA is a novel risk factor in pregnant women and this auto-antibody may play a causative role in the development of preeclampsia.
Abstract 2534: Real-time Endobronchial Ultrasound Is A Safe Alternative To Angio-CT In The Diagnosis Of Central Pulmonary Embolism
Authors: Aumiller Josef , Schleucher Norbert , Krasnik Mark , Herth Felix , Eberhardt Ralf , Heidelberg Thoraxklinik
Published: July 2021

Introduction:
Life threatening central pulmonary embolism (PE) is defined as thrombotic occlusion of the main pulmonary trunk or of main or lobar pulmonary artery. These vessels accompany the trachea, the main and lobar bronchi at a distance of less than 5 mm. Chest CT enhanced with iv contrast (Angio-CT) has become the gold standard to evaluate suspected, central PE. Here we report imaging of central PE using real-time endobronchial ultrasound (rtEBUS).

Hypothesis:
rtEBUS is equivalent to Angio-CT in diagnosing central PE.
Methods:
In 20 consecutive patients we compared the visualization of central PE by rtEBUS versus Angio-CT using an Olympus ultrasonic bronchoscope BFUC 160F.

Results:
PE was discovered fortuitously via rtEBUS in 7 patients, who were submitted for rtEBUS for hilar and mediastinal lymph nodes in staging of lung cancer. In all 7 patients PE was verified by Angio-CT. In 12 patients with primary documented PE by Angio-CT we were able to visualize all central pulmonary emboli by rtEBUS. Two additional patients were explored for PE by rtEBUS as initial diagnostic procedure because of massive obesity and renal failure. The first diagnosis was confirmed by autopsy, the second by Angio-CT after 4 days with normalized renal function. In all patients we could visualize the pulmonary trunk, both main pulmonary arteries and the lobar arteries at a length of 10 mm by rtEBUS. Duration of the rtEBUS procedure was 5 +/-2 minutes. There were no rtEBUS related complications. All central PE were confirmed by Angio-CT, demonstrating a valid congruence.

Conclusions:
This is the first study to demonstrate that rtEBUS of central pulmonary arteries is a reliable and safe tool for the diagnosis of central PE. Especially in patients with renal impairment, anaphylaxis to intravenous contrast, pregnancy, cardiogenic shock or signs of acute right ventricular failure rt EBUS may be a valuable alternative to Angio-CT.
Abstract 2544: Pulmonary Venous Anatomy Predicts Recurrent Arrhythmia after Pulmonary Vein Antrum Isolation for Atrial Fibrillation
Authors: Jacob Ron , Patel Dimpi , Lieber Michael , Williams Michelle , Natale Andrea , Sola Srikanth
Published: July 2021

Background:
Pulmonary Vein Antrum Isolation (PVAI) is being used with increasing frequency for the treatment of atrial fibrillation. Multi-detector computed tomography (MDCT) can be used to evaluate the complex anatomy of the left atrium and pulmonary veins to facilitate PVAI. We hypothesized that pulmonary vein anatomy, as determined by MDCT, would predict recurrent atrial fibrillation after PVAI.

Methods:
We evaluated consecutive patients scheduled for PVAI who underwent a CT examination of the pulmonary veins on a Philips Brilliance 64 or Siemens Sensation-64 slice MDCT scanner < 3 months prior to a PVAI procedure. The number and ostial area of all pulmonary veins, indexed to body surface area, were determined by 2 independent blinded observers. Transtelephonic monitoring was performed for the first 3– 6 months after the PVAI procedure. Patients were followed at 3, 6, and 12 months with a 12-lead EKG and 48-hour Holter monitor.

Results:
A total of 113 patients (mean age 58±10 years; 73% male) were enrolled and followed for 12 months. A total of 445 pulmonary vein ostia were analyzed; 26% of patients had left sided pulmonary veins with a shared common ostium. The remaining patients had 2 separate left sided pulmonary veins. At the end of the 12-month follow-up, patients with two left sided pulmonary veins had a significantly increased risk of recurrent arrhythmia (34.3%) after PVAI than patients with a common left pulmonary vein (7.7%; p=0.009; OR 4.45). There was no relationship between the number of right sided pulmonary veins or total pulmonary vein ostial size and recurrent arrhythmia (582 cm
2
/m
2
in patients with recurrence vs 505 cm
2
/m
2
without recurrence (P= 0.14).

Conclusion:
In patients undergoing PVAI for atrial fibrillation, the presence of two left sided pulmonary veins, as determined by MDCT, is associated with an increased risk of recurrent arrhythmia at 12 months compared with patients who have a single common left pulmonary vein.
Abstract 2569: Tissue Doppler Imaging In The Evaluation Of Infarcted Segmental Myocardial Function In Stemi Reperfused Patients: Correlation With Myocardial Blush Grade.
Authors: Inches Elena , Mancone Massimo , Sardella Gennaro , Scardala Raffaele , Colantonio Riccardo , Brasolin Bruno , Caira Carmen , Fedele Francesco
Published: July 2021

Background: The myocardial blush grade (MBG) during primary-PCI predicts long-term recovery of left ventricular function. Tissue Doppler imaging (TDI) quantitatively assess regional myocardial function by measuring systolic strain (SS). No data are available on the correlation between MBG and the infarcted segmental systolic function by TDI in STEMIpts.

Methods: We evaluated 40 STEMI pts, divided in four groups (MBG 0; MBG 1; MBG 2; MBG 3) 10 pts for each goup. Primary PCI was performed according to current standard guidelines. Coronary angiograms were analyzed off-line by two expert interventional cardiologists in a blinded manner. MBG were estimated visually. Sixteen-segments model was applied and regional myocardial function was evaluated, immediately after primary PCI, by measuring SS by TDI . Only SS value in infarcted segments was correlated with the MBG.

Results: No significative difference was observed between groups except for family history of CAD that was higher in MBG 2 group. Mean ejection fraction (39,1 ± 8,8%) and mean symptoms to balloon time(4.3 ± 1.6 h ) was similar in the population. 136 infarcted segments were studied by TDI. A significant direct correlation between the MBG and the SS (r=0.79; p<0.005) (Fig.1

). We also observed a significative difference (p<0.005) between mean SS in pts with MBG ≤0 –1 (7.6 ± 2.4%) and in pts with MBG≥2–3(22.6 ± 5.2).

Conclusions: Abnormal values of SS was observed in infarcted segments. The significant correlation observed between the MBG and SS may demonstrate that MBG represent an important predictive index not only of good reperfusion but also of rapid segmental function recovery; similarly an evaluation of SS after primary PCI could be useful to evaluate if primary percutaneus reperfusion has been effective or not.
Abstract 2601: Increased TLR-4+ Monocytes in Thrombi from the Site of Coronary Occlusion in Acute Coronary Syndromes - a Role for Innate Immunity in Acute Coronary Syndrome
Authors: Neidhart Michel , Wyss Christophe , Altwegg Lukas , Yonekawa Keiko , Eberli Franz , Corti Roberto , Roffi Marco , Kucher Nils , Lüscher Thomas , Gay steffen , Maier Willibald
Published: July 2021

Objective:
To evaluate and compare the expression of Toll-like receptors 2 and 4 (TLR-2 and -4) in thrombi obtained at the site of coronary occlusion of patients with acute coronary syndrome (ACS) with their expression in peripheral blood (PBL) of the same patients and healthy controls.

Methods:
Thrombi were mechanically disrupted, treated with actilyse for 12 hours in RPMI + 10% FCS. The amount of erythrocytes was reduced by isotonic lysis. Peripheral blood from the same patients (n = 14) and from age- and sex-matched healthy controls (n = 10) were treated in the same manner. Adherent cells were detached by Accutase and mixed with the non-adhering cells. CD14+ and CD66b+ (FITC) cells were stained for TLR-2 and TLR-4 (PE) and analysed by flow cytometry.

Results:
TLR-4 was detected in the thrombi by immunohistochemistry. The proportion of TLR-4+ cells was markedly increased in the monocyte gate of cells isolated from the thrombus, in comparison to peripheral blood cells from the same patient or healthy controls. Most importantly, the expression of TLR-4, measured as the mean fluorescence intensity, was significantly elevated on CD14+ monocytes of the thrombus, compared to peripheral blood CD14+ cells from the same patient or healthy controls (Figure 1

). No such differences could be found for expression of TLR 2, TLR 3 or TLR 9.

Conclusion:
Thrombi of patients with ACS contain an increased proportion of TLR-4+ monocytes. Thus, our results suggest that activation of innate immunity through TLR-4 is involved in ACS. This may be a part of a link between induction of heat shock proteins and thrombosis.
Abstract 2641: Plasma Von Willebrand Factor and ADAMTS13 Concentrations in Atrial Fibrillation
Authors: Uemura Takashi , Kaikita Koichi , Yamabe Hiroshige , Matsukawa Masakazu , Soejima Kenji , Tanaka Yasuaki , Morihisa Kenji , Ogawa Hisao
Published: July 2021

Background
: Von Willebrand factor (VWF) is released from damaged endothelium, and has a role in platelet aggregation through a receptor on the platelet surface. A metalloprotease that cleaves VWF multimers has been identified, namely, ADAMTS13. We recently reported that the serial changes in plasma VWF and ADAMTS13 antigen levels in patients with acute myocardial infarction (AMI), and that the VWF/ADAMTS13 ratio was a useful prognostic indicator of long-term thrombotic events after AMI. Although previous studies have shown raised plasma VWF in patients with atrial fibrillation (AF), little is known about the role of ADAMTS13 in the pathogenesis of AF. In the present study, we examined the relation between VWF and ADAMTS13 in AF patients.

Methods and Results
: We measured the plasma VWF and ADAMTS13 antigen levels by ELISA in 45 AF patients and 49 control subjects, and also performed echocardiography to examine the relations between these markers and left atrial or ventricular functions. The plasma VWF antigen levels were significantly higher in AF patients compared with controls (2017±749 vs. 1504±497 mU/ml, P=0.0002). In contrast, the plasma ADAMTS13 antigen levels were significantly lower in AF patients compared with controls (825±181 vs. 911±193 mU/ml, P=0.03). The VWF/ADAMTS13 ratio was significantly higher in AF patients compared with controls (2.59±1.20 vs. 1.75±0.76, P<0.0001). The number of patients who received aspirin and warfarin was significantly higher in AF group than control subjects, however, those medical therapy did not affect the VWF and ADAMTS13 antigen levels. There was significant positive correlation between VWF antigen levels and the left atrial dimension (n=128, r=0.228, P=0.0095). Furthermore, there was significant negative correlation between VWF antigen levels and the left atrial appendage peak flow velocity measured by transesophageal echocardiography (n=23, r=-0.611, p=0.0015).

Conclusions
: These findings suggest that the balance between VWF and ADAMTS13 levels may play an important role in the intra-atrial thrombus formation in AF patients. The present results would open a new therapeutic target for prevention of thromboembolic complications in AF.
Abstract 2648: Transient Atrial Fibrillation Within the First Month After Dual Chamber Pacemaker Implantation
Authors: Mittal Suneet , Stein Kenneth , Christman Shelly A , Merkel Stacia , Meyer Timothy E , Gilliam F. Roosevelt
Published: July 2021

Background: Following pacemaker (PPM) implant, atrial fibrillation (AF) is often diagnosed for the first time based on detection of stored atrial high rate episodes (AHRE). However, there are no prospective data regarding the time course of developing AF following dual chamber PPM implantation.

Methods: We evaluated data from the Silent Atrial Fibrillation Detection with Stored EGMs (SAFE) registry, which was a multi-center, prospective registry of patients undergoing dual chamber PPM implant.
No patient had prior history of AF
. Device interrogations were performed at 2-week, 3-, 6-, and 12-months post-implantation. An AHRE was defined as an atrial rate ≥ 180 bpm lasting ≥ 5 minutes.

Results: 1488 patients (55% male, 74 ± 12 years) underwent PPM implantation. During the first month, 47 (3.7%) patients were diagnosed with AF for the first time. In 33 (70%) of these 47 patients, AF lasted between 5 and 60 minutes. Overall, the mean duration of AF was 133 ± 276 minutes (range: 5.4 minutes – 22.9 hours). A majority (81%) of these early episodes occurred within the first 15 days of implant. Twenty-four (51%) of these 47 patients did not have AF beyond this first month. Patients who did and did not have AF beyond the first month were similar with respect to baseline demographics, the use of active versus passive atrial leads, duration of first AF event, and time to first AF episode (Table

).

Conclusions: In the SAFE registry, nearly 4% of patients with no history of AF exhibited AF in the first 30 days after PPM implant, with a majority occurring within the first 15 days post-implant. However, half of these patients failed to have another AHRE after the first month. These ``transient” episodes of AF may represent proarrhythmia from atrial lead insertion, de novo AF, or simply first-detection AF that was previously silent. Long-term follow-up studies are needed to determine the clinical significance of these transient episodes.

SAFE: Demographics Among Patients with AF within 30 Days of Implant
Abstract 2673: Myoblast Transplantation Improves Cardiac Function Whether the Cells are Implanted Early or Late After Coronary Ligation
Authors: Farahmand Patrick , Weisel Richard D , Menasche Philippe , Li Ren-Ke
Published: July 2021

Background:
The inability of skeletal myoblasts to transdifferentiate into cardiomyocytes supports the hypothesis that their beneficial effects on cardiac function after a myocardial infarction (MI) are mediated by paracrine effects. In order to explore the role of the timing of cell therapy on the resultant angiogenesis and matrix remodeling, we compared the effects of myoblast transplantation early or late after MI.

Methods:
MI was generated in Lewis rats by coronary artery ligation. Skeletal myoblasts (5X10
6
) or control media were injected into the scar and border zone either 5 days (early; n=33) or 30 days (late; n=29) after ligation. Function was assessed by echocardiography before transplantation (Tx), and 14 and 30 days thereafter. Invasive hemodynamics were measured with a Millar catheter at 30 days after Tx, following which explanted hearts were processed to assess LV volumes (computerized planimetry), fibrillar collagen (confocal microscopy), and myoblast engraftment, angiogenesis and extra-cellular matrix characteristics (immunohistochemistry).

Results:
Load-independent indices of left ventricular (LV) function (Emax, preload recruitable stroke work) were significantly increased in myoblast recipients compared with controls regardless of whether cells were implanted early (p=0.003, p=0.03, respectively) or late (p=0.003, p=0.0007, respectively) after MI. Changes in fractional shortening (by echocardiography) followed a similar pattern. These changes were associated with a significant reduction in LV volume (p=0.04, p=0.01 for early and late Tx groups vs. controls, respectively), and an increase in angiogenesis (p=0.02) whether the myoblasts were injected early or late after MI. The length and width of collagen fibers both in the scar and remote myocardium were also significantly increased (p<0.001) regardless of the timing of myoblast injection.

Conclusions:
The data suggest that myoblast transplantation improved cardiac function whether cells were injected early or late after MI. In each case, functional recovery was associated with enhanced angiogenesis, favourable effects on extracellular matrix remodeling, and improved LV geometry, supporting the paracrine hypothesis for myoblast transplantation.
Abstract 2680: Tight Heart Rate Control Reduces Secondary Adverse Events in Patients with Type B Acute Aortic Dissection
Authors: Kodama Kazuhisa , Nishigami Kazuhiro , Sawamura Tadashi , Nakao Koichi , Honda Takashi
Published: July 2021

Background

: Although type B aortic dissection (AD) has been treated with beta-blocker to lower the arterial blood pressure (BP), there has been little evidences about reduction in heart rate (HR). We assessed whether tight HR control improved the outcome of medical treatment in patients with AD.

Methods and Results

: From 1997 to 2005, consecutive 223 patients with AD medically treated and controlled to lower BP under 120 mmHg were enrolled. Based on the average HR at 3, 5, and 7 days after the onset, patients were divided to tight HR (<60 bpm) control group (39 patients; mean HR of 56 .8bpm) and conventional HR (equal or more than 60 bpm) control group (184 patients; mean HR of 71.6 bpm). We compared the frequency of aortic events including aortic rupture, recurrent dissection, and aortic expansion of more than 5mm, and surgical requirement between two groups. During a median follow-up of 33.3 months, aortic rupture, recurrent dissection, pathological aortic expansion, and aortic surgery occurred in 3, 14, 43, and 30 patients respectively. Reductions in aortic events and surgical requirement were observed in tight HR control group (10.3% and 2.6%) compared to conventional HR control group (28.3% and 15.8%) (Odds ratio: 0.29 and 0.14. C.I.:0.10 to 0.90 and 0.02 to 1.07, p<0.01.). Kaplan-Meier curves of aortic event and surgical requirement free rates were shown in figure 1 and 2

.

Conclusions

: The present study demonstrated that tight heart rate control improved the outcome of medical treatment in patients with AD.
Abstract 2691: Independent Relation Of Aortic Stiffness With Subclinical Left Ventricular Myocardial Dysfunction In Patients With Cardiovascular Risk Factors
Authors: Malshi Emona , Morizzo Carmela , Guerra Elena , Kozakova Michaela , Florescu Maria , Vinereanu Dragos , Palombo Carlo
Published: July 2021

Introduction: increasing evidence suggests a major role of arterial stiffness in determining transition towards heart failure in patients with cardiovascular (CV) risk factors. An increased LV mass resulting from augmented LV impedance associated with aortic stiffness may partly account for this finding.

Aim of the study: to investigate the possible association of aortic stiffness with LV geometry, mass (LVM) and load-independent indices of myocardial function in patients with CV risk factors.

Materials and methods: 129 subjects were studied, 47 healthy controls (27 males, mean age 45.6 Â± 11 years) and 82 patients with at least one major CV risk factor, and without clinical CV disease or evidence of inducible myocardial ischemia (49 males, mean age 45.5 Â± 17 years). LV mass, geometry, systolic pump function, diastolic filling and intrinsic myocardial performance were assessed by a comprehensive echocardiographic study (Aloka SSD-5500, Japan) including 2-D targeted M-mode and apical 4-chamber view of the LV, transmitral Doppler, and Tissue Doppler Imaging (TDI). LV myocardial longitudinal velocities were studied at medial mitral annulus and interventricular septum (IVS) level. Carotid-femoral pulse wave velocity (PWV), an index of aortic stiffness, was measured by the foot-to-foot method (Complior, Artech, Paris).

Results: in the overall population, PWV correlated (p<0.01) directly with LVM (r=0.410) and inversely with transmitral E/A ratio (r=- 0.528), Em/Am ratio at mitral annulus (r=-0.603) and interventricular septal level (r=-0.497). No significant relations were found with indices of LV systolic function (both chamber and myocardial). In a stepwise regression analysis model (age, CF-PWV, diastolic blood pressure, LVM) only age and CF-PWV entered as independent determinants of TDI Em/Am (squared r value: 0.55, p<0.01).

Conclusion: in a population including normal subjects and patients with risk factors and free of CV disease, an increased aortic stiffness is associated with subclinical impairment of LV myocardial diastolic function independently of LV mass and blood pressure.
Abstract 2700: Reduced Ejection Fraction is Associated with Poor Outcomes in Adults with Left Ventricular Noncompaction Syndrome
Authors: Stanton Christopher M , Brady Peter A , Hodge David O , Asirvatham Samuel J , Bruce Charles J , Friedman Paul A
Published: July 2021

Introduction

Left ventricular non-compaction (LVNC) is a rare cardiomyopathy thought to result from intrauterine arrest of myocardial compaction which has been associated with and increased risk of sudden cardiac death (SCD). However, appropriate identification of at-risk individuals and risk-stratification is lacking, particularly in patients diagnosed during adulthood. We sought to identify high-risk patients wtih LVNC in order to guide therapy.

Hypothesis

That patients with decreased left ventricular ejection fraction (LVEF) would have worse outcomes than those with preserved left ventricular function.

Methods

We reviewed outcomes in all patients diagnosed with LVNC at Mayo Clinic between 2001 through 2006. Data were prospectively entered into a centralized database and retrospectively analyzed. Mortality was compared to age and sex matched population rates.

Results

A total of 80 patients were diagnosed with LVNC during this interval. After exclusion of pediatric patients (n = 21), 59 adult patients (62% male; age 46 ± 19 years, range 18–83) were analyzed. There were 4 deaths in this group (none due to stroke, mortality 18% at 2 years) during follow-up (mean 13.0 ± 13.5 months, range 0–52). Overall survival of patients with LVNC was worse than age and sex matched controls (Minnesota population p < 0.001). This was also noted in patients with LVEF > 35% (n = 35, p = 0.02). Overall LVEF was 41 ± 16% but was lower in patients who died compared to survivors (26 ± 10% vs. 42 ± 15%; Hazard ratio = 2.0 for a decrease in ejection fraction of 10%, p = 0.12). There were no deaths in patients with LVEF > 50% (n = 17).

Conclusion

Survival of adults with LVNC is worse than expected for age and sex. A decrease in ejection fraction is associated with increased risk of death in this population. These data suggest that patients diagnosed with LVNC and reduced LVEF may benefit from ICD implantation, whereas patients with a normal LVEF may be observed.
Abstract 2716: What are the Current ICD Implant Patterns Since Expansion of Primary Indications and Support for Cardiac Resynchronization therapy? Data from a Large Multicenter Prospective Registry
Authors: Goldman Dan , Epstein Andrew , Deering Thomas , Greenberg Steven , Shafiroff Jeff
Published: July 2021

With the publication of MADIT II in 2002 and SCD-HeFT in 2004, primary device implant indications have expanded; and with the COMPANION trial in 2005 supporting the benefit of biventricular devices, the number of ICD implants has increased further. Since these trials, data on implant patterns in a large group of patients from multiple centers has not been reported. The Advancements in ICD Therapy (ACT) prospective implant registry is a non-consecutive patient study developed to track such a group undergoing device implantation. Data on device and lead performance, arrhythmic events and mortality are tracked.

Methods:
Over a 19 month period from November 2004.to June, 2006, 5454 devices were implanted at 286 centers in 38 states in the United States. Patients where enrolled within 2 weeks of implant. Patients are being followed for a period of 2 years at 6 month intervals with device interrogations performed at each visit. Primary prevention patients are those who met MADIT II, SCD-HeFT or DEFINITE criteria as well as those with inheritable conditions.

Results:
Of the 5,454 patients, 402 had generator replacements and are excluded from this report. There where 464 device upgrades. Of the 4578 evaluable patients undergoing first implantation, 3,629 (79.3%) were for a primary prevention indication, and 20.7% for a secondary prevention indication. Biventricular devices were implanted in 1,905 patients (37.7% of total) with 135 of these being device upgrades. Male patients constitute 75.3% (n = 3,806) of the implant group and the median age at enrollment was 67 years. Median patient ejection fraction was 16%, (Interquartile Range 11% to 21%), with 88.6% having ejection fractions ≤ 35%, reflecting a fairly ill cohort.

Conclusions:

In a current large, multicenter ICD implant registry, the overwhelming majority of patients underwent ICD implantation for a primary prevention indication.

Cardiac resynchronization therapy devices were implanted in approximately one third of the patients

Even with expanded indications for implantation, this is a patient cohort with apparent advanced disease states evidenced by their low ejection fractions.
Abstract 2791: Silent Brain Infarction Predicts Cardiovascular Events And Mortality In Long-term Hemodialysis Patients
Authors: Aoyama Toru , Ishii Hideki , Takahashi Hiroshi , Toriyama Takanobu , Aoyama Toru , Takeshita Kyosuke , Matsubara Tatsuaki , Murohara Toyoaki
Published: July 2021

Background:
The cardiovascular (CV) events and mortality are significantly higher in hemodialysis (HD) patents compared to the general population. Although it is of clinical concern to predict the occurrence of CV events in long-term HD patients, more powerful predictor has under exploration. We investigated as to whether silent brain infarction (SBI) would be a predictable factor for future CV events and mortality in a large cohort of patients with long-term HD patients.

Methods:
After cranial magnetic resonance imaging to detect SBI, 202 long-term HD patients (7.1 ± 5.9 years) without symptomatic stroke were prospectively followed up until the incident of CV events (stroke, cardiac events, and death). We analyzed the prognostic role of SBI in CV events with the Kaplan-Meier method and Cox proportional hazards analysis.

Results:
The prevalence of SBI was quite higher compared to the previous reports (71.8% in all the patients). In overall patients, 60 patients suffered from CV disease (31 for coronary artery disease, 7 for congestive heart failure, 14 for symptomatic stroke) and 29 patients died (16 for CV death) during a follow up period (mean= 23 ± 13 months). In subgroup analysis regarding the presence of SBI, CV event-free survival rate for 4 years was significantly lower in the patients with SBI compared to those without SBI (54.6% vs. 86.7%, p=0.0003). CV and overall mortality were also significantly higher in SBI patients compared with No-SBI patients (CV mortality; 20.5 % vs. 4.3 %, overall mortality; 29.0% vs. 9.1% p< 0.01, respectively). Cox proportional hazards models showed that the presence of SBI was a significant predictor of cerebrovascular and CV events and CV and overall mortality even after adjustment for other CV risk factors listed on the Table

.

Conclusion:
SBI detected with MRI would be powerful predictor of CV events and mortality in long-term HD patients.

Hazard ratio (HR) of SBI for future events and mortality
Abstract 2803: Multiple Biomarkers For The Prediction Of Cardiac Events In Chronic Heart Failure Patients
Authors: Niizeki Takeshi , Takeishi Yasuchika , Koyama Yo , Kitahara Tatsuro , Suzuki Satoshi , Kubota Isao
Published: July 2021

Backgrounds:
Chronic heart failure (CHF) still represents the major cause of death and hospitalization. Although there is substantial interest in the use of newer biomarkers to identify CHF patients (risk assessment and prevention for cardiac events) recently, few investigations have evaluated the incremental usefulness of combination of multiple biomarkers. Measurement of several biomarkers simultaneously could enhance risk stratification. We therefore evaluated the usefulness of 7 known biomarkers for predicting cardiac events.

Methods and Results:
We analyzed 7 biomarkers (BNP, uric acid, Na, hemoglobin, creatinine, creatinine clearance, high sensitive CRP) which are known as established prognostic markers for CHF in consecutive 399 CHF patients. When there was an abnormal value, we scored it for one point to calculate multimarker score. Patients were categorized tertiles according to multimarker score. Patients with the high tertile were older and had more severe NYHA class and lower ejection fraction than those with low and intermediate tertiles. There were 135 cardiac events including cardiac deaths and readmissions for worsening CHF during follow-up period. A Cox proportional hazard model showed that patients with high tertile were associated with the highest risk of cardiac events compared with other two tertiles (Figure A

). Kaplan-Meier analysis revealed that tertile analysis effectively risk stratified CHF patients for cardiac events (Figure B

).

Conclusions:
These findings suggest that the combination of the multi-biomarkers could potentially improve the risk stratification of CHF patiens for the prediction of cardiac events.