bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 2092: Heart Failure Patients with Diabetes Have More Comorbidities and Self Care Problems
Authors: Dunbar Sandra B , Heo Seongkum , Pressler Susan J , Song Eun K , Moser Debra K , Lennie Terry A
Published: July 2021

Background
: Approximately 30 – 47% of heart failure (HF) patients have diabetes mellitus (DM) which is associated with increased risk for rehospitalization and death. Little data exist on psychological factors, physical symptoms, and comorbidities that could affect self care and outcomes in this population.

Purpose
: To compare HF patients with and without diabetes on demographic, clinical and psychosocial factors associated with self-care and outcomes.

Methods
: Participants (N = 212, 61 ±11 years old, 62% male, 25% African-American, 62% NYHA functional class III/IV, 37% with DM) from a larger study on nutrition and Body Mass Index (BMI) in HF completed clinical assessments, interviews and questionnaires. Variables and measures were: comorbidities; psychosocial factors of anxiety (Brief Symptom Inventory), depressive symptoms (Beck Depression Inventory-II), and social support (Perceived Social Support Scale); frequency and severity of HF symptoms (Symptom Status Questionnaire); and outcomes of functional status (Duke Activity Status Index; DASI ) and quality of life (MLHFQ). Hospitalizations after 12 months were obtained from medical record review and patient/family interview in a subset. Data were analyzed by t-tests, Chi-Square and nonparametric statistics.

Results
: Patients with DM were older (63 ± 9 vs 60±12 years, p=.02), had higher BMI (32 ± 6.4 vs 29.4 ± 6.7 kg/m
2
, p=.003), and a greater proportion had coronary artery disease, stroke, and renal dysfunction (p=.01) than those without DM. Thirty-seven percent were receiving insulin therapy. Although no differences in psychosocial factors were found, those with DM reported greater symptom severity (13.7 ±6.7 vs 10.7 ± 6.9 p=.003), and exhibited lower DASI scores (11.4 ± 10.8 vs 15.8 ± 13, p=.001), and MLHFQ scores (45.1 ± 22 vs 38.5 ± 23, p=.04) as well as more total hospitalizations at 12 months (1.5 ± 2.8 vs .55 ± 1.1 p=.04, n=122) than those without DM.

Conclusion
: HF patients with concomitant DM are at risk for more complex self care regimens due to increased comorbidities and symptom severity, and reduced functional status and quality of life with increased hospitalizations. These data may be useful in designing a comorbidity model of self management interventions to improve outcomes.
Abstract 2095: Health Policy: Can an Open Access Model for Intravenous Diuretics in an Outpatient Heart Failure Disease Management Program Reduce Hospital Costs?
Authors: Steen Dylan L , Reed Valerie , Roxas Gwendolyn , Fonseca Maria , Lopez Barbara , Hebert Kathy
Published: July 2021

Background: Heart failure (HF) is the most frequent discharge diagnosis for patients older than 65 and one of the most expensive diseases to treat for CMS. Patients with early symptoms of decompensated HF may need access to IV diuretics when oral medications used in a sliding scale dosage are no longer effective. Indigent patients without access to a private physician are at particular risk of having to use the emergency room (ER) for this reason. This model results in more costs and potential admissions. We sought to reduce ER use and improve quality of care and service to indigent patients followed in a Heart Failure Disease Management Program (HFDMP).

Methods: Grant funding was procured to provide free furosemide IVP, potassium and metolazone for patients enrolled in a HFDMP at Jackson Memorial Hospital. The HFDM program consist of intense patient education using DVD’s in both English and Spanish, written material, log books for weight, activity, blood pressure and diuretic use. Patients are instructed to weight daily and add an additional oral dose of furosemide at home for weight gain of greater than 2 pounds. For weight gain of greater than 5 pounds unresponsive to oral therapy, patients were given access to the clinic without an appointment for “walk-in” IVP furosemide, potassium and metolazone.

Results: 173 new patients were enrolled into program in 3 months (10/07 through 12/31/07). Of these, 115 visits for IVP furosemide were recorded from 54 patients. 16 patients used it multiple times (range 2–11). Average ER cost for all CHF patient seen and discharged after diuresis at JMH is $25,692. Therefore, an estimated cost savings of 115 avoidable ER visits is $2,954,586. In the last three quarters of 2007, of all CHF patients seen in the ER, 96.6% are admitted. The average inpatient cost for a primary diagnosis of CHF was $26,404.05 (LOS 5.25 days). The average for a CHF patient seen and discharged from the ER was $5,295 (LOS <48hrs). All monetary values are Billed Charges.

Conclusion: An open access IVP furosemide program is cost effective alternative to ER and inpatient treatment for CHF patients requiring diuresis.
Abstract 2096: Women’s Perception of Lifetime Risk for Having an Acute Myocardial Infarction
Authors: Parkosewich Janet A. , Chyun Deborah , Bradley Elizabeth H. , Funk Marjorie
Published: July 2021

CHD claims the lives of more women than any other disease, yet few women perceive that they are at risk for this serious health condition. Public education campaigns have been implemented to heighten women’s awareness of CHD. The aim of this study was to determine factors associated with the perception of one’s lifetime risk for AMI in women residing in an area in which great effort was made to educate the public about women and CHD. This longitudinally-repeated, cross-sectional study involved five annual random-digit dialing surveys conducted before (2001) and after (2002 – 2005) implementing a local women and CHD public education campaign. The mean age in this sample of 1,470 women was 54 ± 8 years and the majority were White (91%), with >high school education (67%). Only 45% perceived that they were at risk for AMI, yet 84% had one or more cardiac risk factors. Logistic regression analysis, adjusted for demographic characteristics; CHD risk factors, sources of information, and knowledge; lifestyle behaviors; and survey year, revealed that the perception of lifetime AMI risk increases with every additional risk factor (OR = 1.77; 95% CI = 1.60, 1.95), knowing other women with an AMI (OR = 1.76; 95% CI = 1.40, 2.22), having discussed heart-health concerns with physician (OR = 1.42; 95% CI = 1.02, 1.98), knowledge of AMI signs common in women (OR = 1.39; 95% CI = 1.10, 1.74), and receipt of primary care from an internal medicine or family practice physician (OR = 1.36; 95% CI = 1.02, 1.81). Public education campaigns alone may not be the most effective means of increasing women’s perception of their lifetime risk of AMI. These results underscore the importance of gender-specific, individualized CHD education. Women personalize their risk for AMI when the sources of information are valued human resources, such as healthcare professionals and women who have had an AMI.
Abstract 2126: Therapeutic Evaluation of Corticosteroid Therapy for Ventricular Tachycardia Associated with Cardiac Sarcoidosis -Application of High Resolution Electrocardiography-
Authors: Yodogawa Kenji , Seino Yoshihiko , Ono Norihiko , Ibuki Chikao , Ohara Toshihiko , Kobayashi Yoshinori , Katoh Takao , Mizuno Kyoichi
Published: July 2021

Background
The outcome of cardiac sarcoidosis (CS) is sometimes fatal. Ventricular tachycardia (VT) is one of the common causes of sudden death in CS patients. In patients with definite diagnosis of CS, corticosteroid therapy should be the absolute indication. However, little is known about the effectiveness for VT. Further, there is no established method for therapeutic evaluation in CS. Thus, we investigated whether or not VT is suppressed following corticosteroid therapy and the utility of Signal Averaged Electrocardiography (SAECG) for therapeutic assessment in CS patients with VT.

Methods
Fifteen histological proved CS patients presenting with sustained or non-sustained VT were investigated. All of these patients were treated with predonisolone 30mg to 10mg/day, and assessed before and after corticosteroid therapy. All patients underwent SAECG in which the filtered QRS duration (f-QRS), the root mean square voltage of the terminal 40 ms (RMS
40
) in the filtered QRS complex and the duration of low-amplitude signals < 40μV (LAS
40
) in the terminal filtered QRS complex were measured. The presence of VT was assessed by Holter monitoring.

Results
VT was suppressed in 6 patients {VT (−) group} and the remaining 9 patients were not {VT (+) group}. Accumulation of gallium-67 was detected more frequently in VT (−) group than in VT (+) group (66.7% vs. 11.1%, p<0.05). Left ventricular ejection fraction (LVEF) was significantly higher in VT (−) group than that of VT (−) group (54.1+/−20.1 vs 32.8+/−11.7 p<0.05). In VT (−) group, f-QRS and LAS
40
were significantly decreased and RMS
40
was significantly increased compared with those before corticosteroid therapy (f-QRS: 136.3+/−30.6msec vs 116.8+/−25.4msec, p<0.05 LAS
40
: 68.2+/−24.0msec vs 47.8+/−22.9msec, p<0.05 RMS
40
: 7.2+/−3.3 msec vs 13.3+/−7.6msec, p<0.05). However, SAECG parameters did not change significantly in VT (+) group.

Conclusions
In the early and viable stage of the disease, corticosteroid therapy was effective for VT in CS. Reversible conduction abnormality detected by SAECG might reflect reversible arrhythmogenic substrate for the occurrence of VT. SAECG is useful for therapeutic evaluation of CS patients with VT.
Abstract 2140: Infrequent Need for Pacing Following Implantable Cardioverter-Defibrillator Shocks: Analysis of the Sudden Cardiac Death in Heart Failure Trial
Authors: Prutkin Jordan M , Poole Jeanne E , Johnson George , Anderson Jill , Mark Daniel B , Lee Kerry L , Bardy Gust H
Published: July 2021

Background: Implantable cardioverter-defibrillators (ICD) are routinely programmed to pace after a shock to prevent possible asystole. In those with no prior history of bradycardia, there is little data regarding the prevalence and characteristics of those who use post-shock pacing (PSP).

Methods: We analyzed the occurrence of pacing within the first nine beats after the first successful ICD shock for ventricular tachycardia (VT) or ventricular fibrillation (VF) in the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). All ICDs were single lead with the first PSP delivered at 1400msec and all subsequent stimuli delivered at 1200msec. We excluded patients with pacing during pre-shock rhythms and those who had pacing rates different than the protocol default rate of 50bpm (1200 msec).

Results: There were 2521 patients enrolled in SCD-HeFT, of which 811 received an ICD. A total of 153 shock events were examined; 36 (23.5%) had at least one of the first nine beats paced post-shock, though only 4 (2.5%) had greater than 4 out of the 9 beats paced. No subjects needed pacing for all nine beats and only 8 (5.2%) paced for greater than 5 seconds. There were no differences in age, gender, etiology of cardiomyopathy, or NYHA class between those with PSP or not. The prevailing heart rate pre-shock was predictive of PSP; the mean cycle length of the baseline rhythm pre-shock was longer (slower rate) for those who used PSP (735 ± 228msec vs. 624 ± 158msec, P=0.001). More often, VF (vs. VT) was the rhythm shocked in those using PSP (P=0.015). A trend also was seen toward increased frequency of PSP in those receiving 30J shocks (16 of 49) versus ≤20J shocks (20 of 104, P=0.068).

Conclusion: Patients infrequently require multiple paced beats post-shock for VT or VF. Patients using PSP have a slower baseline heart rate and are more likely to have VF as the shocked rhythm. While 1 or 2 paced beats out of the first nine occurred occasionally, these patients also had rapid return of their native rhythm for which the hemodynamic contribution of 1 or 2 paced beats is unclear. These data suggest that for most patients receiving a primary prevention ICD programmed for shock-only therapy, the need for PSP is limited. PSP use may reflect convention and the assumption that minor post-shock pauses are detrimental.
Abstract 2141: Lead Extraction in Pediatric and Congenital Heart Disease Patients
Authors: Atallah Joseph , Berul Charles I , Alexander Mark E , Triedman John K , Walsh Edward P , Cecchin Frank
Published: July 2021

Background: Transvenous pacemaker and defibrillator device implant is a rapidly growing practice in pediatric and young adult congenital heart disease. The need for lead extraction is an associated eventuality in certain patients. Although several techniques have emerged in the past few years, the safety and efficacy of lead extraction in the pediatric population remains unknown. We report our experience with lead extraction using simple traction or complex extraction methods.

Methods: Retrospective cohort study of all patients having undergone a lead extraction at Children’s Hospital Boston from 2002 to 2008. Lead extraction was defined as simple if only traction was required and complex if it required the use of an interlocking stylet.

Results: A total of 114 patients underwent 124 lead extraction procedures with a total of 172 extraction attempts. The average age was 17.1 (2.47– 48.23) years at lead implant and 23.0 (6 –52.7) years at lead extraction. Congenital heart disease was present in 57.3% (71/124) of patients. Extraction by simple traction was achieved for 51 leads (mean lead age=3.1 years), while the remaining 121 leads required complex extraction (mean lead age=7.5 years), of which 32 were abandoned. Of the remaining leads 83/89 (93%) were extracted successfully. Only 2/55 (4%) leads >7.5 years of age could be extracted with simple traction. However, 63/99 (64%) leads >1 and <7.5 years of age were a complex extraction. Multivariable logistic regression analysis showed that a younger lead age (OR=0.7, 95% CI 0.6 – 0.9, P<0.01), silicone-type of lead insulation (OR=7.6, 95% CI 1.6 –36.7, P=0.01) and a lead in the atrial position (OR=3.0, 95% CI 1.1– 8.7, P=0.05) were independent predictors of a simple extraction. There was only one major complication consisting of right atrial perforation and tamponade that was controlled with surgical exploration. There was no mortality related to lead extraction procedures.

Conclusion: The majority of leads implanted in pediatric and young adult patients with congenital heart disease can be extracted successfully. Though certain lead characteristics correlated with a simple extraction procedure, the majority of leads >1 year of age will require a complex extraction technique.
Abstract 2147: Utility of Multichannel Holter ECG Recording at the Third Intercostal Space to Diagnose A Type 1 Brugada ECG; Comparison with Repeated 12-Lead ECGs
Authors: Shimeno Kenji , Takagi Masahiko , Maeda Keiko , Tatsumi Hiroaki , Doi Atsushi , Yoshiyama Minoru
Published: July 2021

The detection of a type 1 Brugada ECG is essential for diagnosis and risk stratification in Brugada syndrome. In this study, we evaluated the detection rate of a type 1 ECG on the multichannel Holter ECG, compared with the 12-lead ECGs recorded repeatedly. We enrolled consecutive 60 patients who had eventually exhibited a diagnostic type 1 ECG in the presence or absence of Na+ channel blockers at either standard or the third intercostal position. All patients underwent 12-lead ECGs recorded at both standard and the third intercostal position at least 5 times between 0 p.m and 2 p.m (4L-ECGs, 3L-ECGs, respectively). The 24-hour Holter ECG was performed in all patients, using a 12-lead Holter recording system. The precordial electrodes were attached at the standard position of V1, V2, V5, V6 and the third intercostal space of V1 and V2 (V1
IC3
, V2
IC3
, respectively). The leads V1 and V2, and V1
IC3
and V2
IC3
on the Holter ECG were expressed as 4L-Holter and 3L-Holter, respectively. The diagnostic type 1 ECG on the Holter ECG was defined as a presence of a coved-type ST-segment elevation >0.2mV over continuous 60 seconds at least one lead. We evaluated the detection rate of the type 1 ECG in 4L-ECGs, 3L-ECGs, 4L-Holter and 3L-Holter, and compared them among the 4 different recording methods. Among 60 patients, the patients showing the type 1 ECG on 4L-ECGs, 3L-ECGs, 4L-Holter and 3L-Holter were 15 (25%), 26 (43.3%), 23 (38.3%) and 33 patients (55%), respectively. The detection rate in 3L-ECGs and 3L-Holter was significantly larger than that in 4L-ECGs (p=0.03, p<0.001, respectively). Additionally, in 8 (23.5%) out of 34 patients with drug-induced type 1 ECG at standard and/or the third intercostal position, a spontaneous type 1 ECG was detected in 3L-Holter. Although the detection rate of a type 1 ECG in 3L-Holter was not significantly different with that in 3L-ECGs, the 3L-Holter was the most sensitive to detect a type 1 ECG among the 4 recording methods. In patients with Brugada type ECG, the Holter ECG recorded in the right precordial leads at the third intercostal space is more sensitive method to detect a diagnostic type 1 ECG than repeated 12-lead ECGs or the Holter ECG at standard position.
Abstract 2156: Left Atrial Fibrosis Impacts Left Ventricular Ejection Fraction in Patients with Atrial Fibrillation
Authors: Akoum Nazem W , Oakes Robert S , Adjei-Poku Yaw , Kuppahally Suman , Segerson Nathan M , Fish Eric N , Rao Swati N , Burgon Nathan S , Kholmovski Eugene G , DiBella Edward V , MacLeod Rob S , Marrouche Nassir F
Published: July 2021

Background.
The extent of left atrial (LA) wall fibrosis detected by delayed enhancement MRI (DE-MRI) appears to be correlated with advanced atrial fibrillation (AF). However, the effect of LA fibrosis on left ventricular function (LVEF) is not well understood. We report the relationship between left atrial fibrosis and LVEF in patients with AF.

Methods.
Sixty-seven patients underwent DE-MRI and 2-dimensional trans-thoracic echocardiography prior to ablation for AF. Three dimensional segmentation of the LA was performed and the extent of fibrosis was quantified using a semi-automated algorithm. Patients were assigned to one of three groups based on the degree of LA fibrosis; 1) mild enhancement where the fibrosis < 15% of the LA wall, 2) moderate enhancement where fibrosis > 15% and < 35%, and extensive where fibrosis > 35% of the LA wall. LVEF was determined both prior to and 3 months following pulmonary vein antrum isolation with posterior wall and septal debulking.

Results.
The average pre-ablation LVEF among patients with mild fibrosis was 53.2% ± 9.9% (n = 41), 52.3% ± 7.4% (n = 19) among patients with moderate fibrosis and 42.1% ± 9.9% (n = 7) among those with extensive enhancement (p = 0.01,one way ANOVA). The difference remains significant after controlling for patient age, gender, hypertension, MI, AF type, mitral valve regurgitation, CAD and the presence of non-AF related CHF. Following ablation, all groups had an increase in the LVEF. The greatest increase occurred among patients in the extensive group. On average, this group experienced an overall improvement of 10.8% ± 14.1%. Patients in the mild enhancement group had an average improvement of 3.3% ± 11.1% and those in the moderate group had an average improvement of 3.8% ± 5.6%. The post-ablation LVEF among patients with mild fibrosis was 56.6% ± 8.3%, 56.2% ± 6.4% among patients with moderate fibrosis and 53.0% ± 15.4% among patients with extensive fibrosis.

Conclusion.
From our preliminary experience with DE-MRI fibrosis detection, patients with extensive LA fibrosis appear to have depressed LV function pre-ablation. This group of patients seems to experience a large improvement (~11%) in LV function post-ablation compared to patients with less LA fibrosis.
Abstract 2161: Left Atrium Reverse Remodeling After Pulmonary Vein Isolation. Will It Be a Predictor for Non-recurrence of Atrial Fibrillation?
Authors: Ishikawa kiyotake , Yoshida Yukihiko , Morita Sumio , Furusawa Kenji , Kanemura Noriyoshi , Yoshida Luke , Hashimoto Tousei , Yamamoto Takashi , Aoyama Yutaka , Takigawa Masateru , Inoue Natsuo , Tatematsu Yasushi , Nanasato Mamoru , Hirayama Haruo
Published: July 2021

Background: Left atrium (LA) dilation plays an important role in development and persistence of atrial fibrillation (AF). Some cases show structural reverse remodeling of LA after catheter ablation of AF. The aim of this study was to assess the clinical significance of LA reverse remodeling.

Method and Results: Echocardiographic data before and after ablation was obtained in 173 cases who underwent pulmonary vein isolation from January 2006 to April 2008 (74.0% men, 61.0±11 years old; paroxysmal AF 114, persistent AF 34, permanent AF 25). Mean atrial diameter before ablation was 39.0±6.1mm (paroxysmal 37.7±5.6mm, persistent 40.7±5.3mm, and permanent 43.0±6.8mm) and LA reverse remodeling was defined as 10% decrement of LA transverse diameter. Half of the cases were taking anti-arrhythmic drugs after ablation, and AF recurrence occurred in 16.8% (29/173) during mean follow up period of 8.5±6.3 months. Reverse remodeling of LA was seen in 34.1% (59/173) and AF recurrence rate in this group was 11.9% (7/59), whereas 19.3% (22/114) without reverse remodeling (P=0.29). However, limited in patients with LA diameter over 40mm (44.5%; 77/173), 3.2% (1/31) of AF recurrence was seen in those with reverse remodeling, while 21.7% (10/46) without reverse remodeling (P=0.04). LA reverse remodeling was observed significantly frequent in patients without history of hypertension(41.5% without hypertension vs 25.6% with hypertension, P=0.036).

Conclusion: LA reverse remodeling after catheter ablation of AF in dilated LA patient is a simple and useful predictor for non-recurrence of AF. Hypertension could be a disturbance for LA reverse remodeling.
Abstract 2168: Efficient Detection of Atrial Fibrillation and Congestive Heart Failure in Single-Lead Devices
Authors: Moorman Randall , Xiao Yuping , Lake Douglas
Published: July 2021

Patients receiving primary prevention single lead ICDs are at risk for atrial fibrillation (AF) and congestive heart failure (CHF). No such device reports AF burden, and only a single CHF measure, trans-thoracic impedance, is available. Entropy measures that count the number of matching RR intervals have promise, as AF is random (high entropy) and CHF is often marked by reduced heart rate variability (RR intervals with many matches) and ectopic beats (few matches). We designed entropy-based measures to detect AF (high entropy) and CHF (mixture of RR intervals with many and with few matches). For real-world implementation, we used only 12 RR intervals, and calculated the result every 30 minutes in 24-hour Holter monitor records from the MIT-BIH databases. The Figure

shows distinction among AF, NSR and CHF records using HR and S.D. (panel A) or the new entropy-based measures. Panel A shows poor diagnostic performance of conventional measures. In Panel B, the y-axis, COSEn, is the coefficient of sample entropy. The AF records all have higher values, and the ROC area is 1.00. The x-axis is a measure of template match counts. It distinguishes between normals and CHF patients with ROC area 0.92. With only 12 RR intervals every 30 minutes, entropy calculations allow for efficient detection of AF and CHF. We propose that single lead devices can be employed as monitors in the primary prevention population, where risk of AF and CHF is high.
Abstract 2170: Unipolar Pace Mapping With the Medtronic SelectSecure 3830 Lead System can Accurately Locate the HIS Bundle for Permanent HIS Bundle Pacing
Authors: Tung Stanley , Rajagopalan Kesava , Affolter Jonathan , Chakrabarti Santabhanu , Davenport Lynn
Published: July 2021

Introduction:
Permanent HIS Bundle pacing (HBP) is one of the most physiological ventricular pacing strategies available. Its wide spread adoption is limited due to challenges in HIS mapping, and requires femoral EP mapping to guide lead placement. We investigate whether unipolar pace mapping (PM) using the lead alone is a viable technique to locate the HB for lead deployment.

Methods:
Patients indicated for ventricular pacing were approached for HBP. An active fixation lead (SelectSecure®3830, Medtronic) inserted through its deflectable sheath was advanced to the right atrium via left pectoral approach.The cathode tip was positioned just outside the tip of the sheath. Unipolar PM was applied at 5V/0.5ms along the tricuspid septal annulus in anterior posterior direction. At the location with 12/12 ECG match to intrinsic QRS, and with pace to QRS delay >30ms, the lead was fixed. Unipolar sensing for HB electrogram was performed with the Medtronic 2090 analyzer (unfiltered, variable gain, sweep speed 50mm/sec). HBP implant thresholds, HB lead implant and fluoroscopy times, intrinsic and paced HV intervals, pre and post QRS and PR intervals were collected. Paired Student
t
-test was used for analysis.

Results:
22 patients (16 male, mean age 69 yrs) underwent HBP. 19 patients had successful HBP, with 3 patients having para-Hisian septal pacing. The mean HBP implants threshold, HB lead implant and fluoroscopy times were 1.67±44V/0.6ms, 43±26min, and 13±12min respectively. The mean intrinsic and paced HV intervals were 60 and 44 ms respectively. After HBP, the QRS duration decreased from 160±44 to 132±43ms (p<0.01). HBP corrected one RBBB, one LBBB, and three right ventricular apical pacing complexes to normal (<120ms) and accounted for the shorter post HBP mean QRS duration. 8 patients presented with PR intervals ≥200msec and had their PR interval narrowed from a mean of 326±141 to 174±21ms (p<0.05).

Conclusions:
Unipolar PM of the His bundle using the Medtronic SelectSecure® lead system alone can accurately locate the HB for HBP with acceptable implant time and pacing thresholds. HBP also has the potential value of AVN and ventricular electrical resynchronization benefit. More data with longer-term follow up are needed before considering wide spread adoption.
Abstract 2207: Value of Ventricular Stiffness Index and Ventricular-Arterial Interaction in Predicting Exercise Capacity in Patients with Nonischemic Dilated Cardiomyopathy
Authors: Choi Eui-Young , Kim Sung-Ai , Rhee Sang Jae , Her Ae Young , Shim Chi Young , Ha Jong-Won
Published: July 2021

Increased ventricular stiffness and afterload are major contributors to the pathogenesis of heart failure. We sought to investigate whether dilated cardiomyopathy (DCM) patients have distinct ventricular elastance or ventricular-arterial interaction compared to hypertensive patients or healthy controls and they can be used to predict exercise capacity. Twenty-five patients with DCM, 25 age- and gender-matched hypertensive patients, and 25 healthy controls underwent a symptom-limited graded supine bicycle exercise echo after a comprehensive resting echo-Doppler evaluation. Left ventricular (LV) diastolic elastance (Ed, early mitral inflow to anuular velocity/stroke volume), ventricular-vascular coupling index (VVI, Ea/Ees) based on arterial elastance index (Ea, end-systolic pressure/stroke volume) to LV end-systolic elastance index (Ees, peak LV outflow tract velocity to acceleration time) and hemodynamic parameters were measured during exercise test. DCM patients had lower Ees, and higher Ed and VVI with blunted response of Ees and Ea to peak exercise than hypertensive patients or controls. In DCM patients, resting Ees correlated with contractile reserve to low grade exercise (Δsystolic mitral annular velocity to 25W. r=0.561, p=0.004) with close relationship between Ed and VVI (r=0.525, p=0.007 at rest; r=0.510, p=0.047 at 25W exercise). Resting Ed (β=−0.597, p=0.003), VVI (β=−0.523, p=0.010), and total stiffness index (Ed x VVI, β=−0.647, p=0.001) correlated with exercise duration independent of age and gender. Total stiffness index could reliably predict the impaired exercise capacity (<400 sec, 69% sensitivity and 70% specificity). DCM patients have distinct Ed and VVI, which have mutual relationship and predictive power of exercise capacity.
Abstract 2233: Comparison of Anatomical and Dynamic CT-derived Parameters between Scar, Border Zone and Healthy Myocardium in Patients Undergoing Ischemic VT Ablation
Authors: Tian Jing , Smith Mark F , Turgeman Aharon , Abbo Aharon , Bruce Patricia , Hood Robert , Peters Robert , Saba Magdi , Shorofsky Stephen , Dickfeld Timm M
Published: July 2021

Background:
Image integration in commerically available 3D mapping systems is currently only used for surface reconstruction of the blood pool/endocardial interface and does not provide any additional information about the myocardial scar substrate. Anatomic and dynamic data is available from high-resolution CT scans that could potentially identify scar and border zone and facilitate ventricular tachycardia ablations.

Methods:
Ten patients with ischemic cardiomypathy underwent contrast-enhanced cardiac CT prior to VT ablation. End-systole wall thickness (ESWT), end-diastole wall thickness (EDWS), wall thickening (WT) and wall motion (WM) were extracted from phase-specific, high-resolution CT. Using a 17 segment model CT criteria were compared with endocardial voltages using the standard clinical criteria of normal (<1.5mV) or abnormal myocardium (<1.5mV) as well as scar (<0.5mV) and border zone (0.5–1.5mV). As proof-of-concept, endo/epicardial surfaces were reconstructed from the CT datasets and co-registered in a 3D mapping system to guide intra-procedural voltage mapping.

Results:
50% of segments were homogenous, containing only voltages of one of the predefined voltage groups, and used for further analysis (26 abnormal/34 normal segments). EDWT, ESWT, WT and WM were 5.8±0.4mm, 5.7±0.6mm, 0±4% and 1.0±0.3mm for abnormal and 8.1±0.5mm, 10.9±0.7mm, 35.7±6.6% and 2.7±0.6mm for healthy segments, respectively. All four parameters differed significantly (P<0.05) between healthy and abnormal segments. In subgroup analyses, EDWT, ESWT, WT and WM were 6.8±1.4mm, 7.0±2.1, 0±14% and 1.3±1.1mm for scar and 4.0±1.0m, 3.7±1.2mm, 0±11%mm and 0.0±0.0mm for border zone segments. All parameters differed significantly between scar and healthy (P<0.05), border zone and healthy (P<0.05) segments respectively. Registration of endo/epicardial surfaces allowed the intraprocedural assessment of wall thickness and correctly predicted areas of abnormal endocardial voltage.

Conclusions:
CT derived anatomic and dynamic parameters showed significant differences between voltage-defined normal and abnormal myocardium. Representation of such parameters such as wall thickness may facilitate the intraprocedural substrate characterization.
Abstract 2234: Value of Multi-Detector Computed Tomography Evaluation of Myocardial Perfusion in the Assessment of Ischemic Heart Disease: Comparison with Nuclear Perfusion Imaging
Authors: Kachenoura Nadjia , Lodato Joseph A , Gaspar Tamar , Bardo Dianna M , Newby Barbara , Gips Sarah , Peled Nathan , Lang Roberto M , Mor-Avi Victor
Published: July 2021

While CT coronary angiography (CTCA) is gaining acceptance as a diagnostic technique, MDCT derived myocardial perfusion has not been validated against an accepted reference standard. We sought to develop a technique for quantitative assessment of myocardial perfusion from MDCT images, and investigate the diagnostic value of resting MDCT perfusion in comparison with SPECT myocardial perfusion imaging (MPI). We studied 98 consecutive patients undergoing CTCA who also had MPI. 20 patients with normal MPI were used as controls. MDCT perfusion was measured in 16 segments in terms of x-ray attenuation. Abnormal resting perfusion was detected by comparison against normal values obtained in the control group. Accuracy of detection was determined against resting MPI on a segment, vascular territory and patient basis. To determine the causes of resting perfusion defects detected by MDCT but not confirmed by resting MPI, stress MPI data were used. Perfusion abnormalities were detected by resting MPI in 36/78 patients in 58 vascular territories. MDCT detected these abnormalities in 31/36 patients (sensitivity 0.86). Abnormalities found in additional 28/78 patients were not confirmed by resting MPI (specificity 0.33). However, 23 of these 28 apparently false positive resting MDCT perfusion tests (82%) were associated with abnormal stress MPI. In the majority of these 23 patients (16 or 70%), the quality of MDCT images was optimal, while in the remaining 5/28 patients with resting MDCT perfusion abnormalities that were not confirmed by stress MPI, 4 (80%) had suboptimal images. Resting MDCT can accurately detect perfusion abnormalities in agreement with resting MPI. Moreover, the majority of abnormalities not confirmed by resting MPI were associated with stress-induced ischemia. Therefore, myocardial perfusion assessment, even at rest, is a potentially valuable addition to MDCT tools for noninvasive evaluation of coronary artery disease without additional radiation or contrast load, which promises not only to improve the diagnostic accuracy of cardiac CT, but is also likely to prove as a cost-effective, single-stop alternative to costly serial testing.
Abstract 2237: Rapid T1w Molecular Imaging of Atherosclerotic Angiogenesis with Colloidal Iron Oxide Nanoparticle
Authors: Caruthers Shelton D , Senpan Angana , Pan Dipanjan , Williams Todd A , Allen John S , Scott Michael J , Gaffney Patrick J , Wickline Samuel A , Lanza Gregory M
Published: July 2021

Introduction
: MR molecular imaging and anti-angiogenic treatment with integrin-targeted nanoparticles offer an attractive nanomedicine tool against atherosclerosis.

Objective:
The objective was to synthesize targeted colloidal iron oxide nanoparticles (CION), which allow high-resolution T1
w
images within 2hrs of injection without T2* artifacts or latent blood pool interference.

Method:
Oleate-coated magnetite nanoparticles were suspended in vegetable oil and emulsified with phospholipid surfactants. With MR (1.5T & 3T), CION (140 –160 nm) were characterized in solution, on fibrin clot phantoms and targeted to angiogenesis
in vivo
. Blood pool signal was measured over time following IV injection of CION.

Result:
CION r1 ionic and particulate relaxivities were 1.1±0.1 mmol[Fe]
−1
s
−1
and 18466±1739 mmol[CION]
−1
s
−1
at 1.5T and 0.7±0.06 mmol[Fe]
−1
s
−1
and 10966±1062 mmol[CION]
−1
s
−1
at 3T. CION targeted to fibrin clots produced marked T1w signal enhancement (SNR=26) versus control clots (SNR=10). T2-weighted images of the bound agent was notable for signal dropout. In atherosclerotic rabbits, the T1 & T2* effects on blood signal (
i.e.
, background interference) were resolved in < 1hr.
In vivo
T1w molecular imaging of the atherosclerotic neovasculature 2h post-injection, was analyzed with a semiautomatic algorithm and demonstrated the potential of T1w neovascular imaging.

Conclusion:
Targeted CION are a new class of vascular constrained T1w molecular imaging agent with potential for detection and characterization of ruptured plaque and atherosclerotic neovasculature, which overcome the temporal and spatial imaging challenges of previous iron oxide agents.
Abstract 2295: Current Outcomes of Simultaneous Carotid Endarterectomy and Coronary Artery Bypass in North America
Authors: Prasad Sunil M , Li Shuang , O’Brien Sean M , Rankin J. S , Gammie James S , Puskas John D , Shahian David M , Chedrawy Edgar G , Massad Malek G
Published: July 2021

OBJECTIVE: Management of patients with concomitant carotid and coronary artery disease has been controversial. Divergent strategies have been employed, including simultaneous carotid endarterectomy and coronary bypass (SCC) versus various staged procedures. While no strict comparison group is available, this study defines current outcomes of SCC, as compared qualitatively to two reference categories.

METHODS: Utilizing the STS database from 2003 to 2007, patients having SCC were compared to cerebrovascular disease patients undergoing coronary bypass with prior carotid endarterectomy (Ref Gp I), and those with carotid Doppler stenosis >75% and no carotid intervention (Ref Gp II). Logistic regression analysis adjusted for differences in baseline characteristics, and operative mortality (OM) and a composite of neurological complications (NC) were assessed.

RESULTS: Of 747,932 patients undergoing isolated CABG with/without CEA, 108,271 (14.4 %) had cerebrovascular disease. In this group, 5,732 (5.3%) underwent SCC. The SCC group had more males and less severe coronary disease (both p<0.001). After statistical adjustment for all baseline differences, SCC had clinically and statistically higher OM and NC as compared to any of the reference groups (TABLE

).

CONCLUSION: Although no proper control group exists for comparison, SCC as recently performed in North America carries a high risk, as compared to any of the reference groups. Suboptimal results associated with the SCC strategy suggest a need for quality improvement and research on the optimal management of patients with simultaneous carotid and coronary disease.
Abstract 2312: High Prevalence of Novel Amyloid Protein Deposition in Surgically Removed Heart Valves
Authors: Kristen Arnt V , Winter Bettina , Helmke Burkhard M , Schnabel Philipp A , Hardt Stefan , Koch Achim , Sack Falk-Udo , Katus Hugo A , Dengler Thomas J
Published: July 2021

Amyloid deposition has been described in degenerative cardiac valve failure, but the prevalence, pathophysiology, and clinical indicators have not been clarified yet. Extensive histological analysis of 150 consecutive, surgically resected heart valve specimens (aortic n = 119, mitral n ± 31; 67.4 ± 1.0 years) was performed. Amyloid deposition was graded semi-quantitatively and classified by specific antisera identifying the most common amyloid proteins. Histological findings were correlated with clinical data. 119 patients had aortic valve disease: aortic stenosis (AS; 100/119; 84%), aortic regurgitation (19/119; 16%); 31 patients had mitral valve disease: mitral stenosis (7/31; 22.6%), mitral regurgitation (24/3177.4%). Amyloid was found in 83/150 (55.3%) specimens with the highest prevalence in aortic stenosis (74/100; 74%), intermediate in mitral stenosis (n = 2/7; 28.6%) and mitral regurgitation (n = 7/24; 29.2%), and lowest in aortic regurgitation (2/19; 10.5%). Moderate to severe amyloid deposition was almost exclusively found in aortic stenosis. Similarily coarse polymorphic amyloid deposits by morphologic analysis were most abundant in aortic stenosis (n = 35/100; 35%). Filamentous cloudy amyloid patterns occurred with the same frequency in aortic stenosis (n = 29/100; 29%). A combination of both was only found in aortic stenosis (n = 7/100; 7%). By immunohistochemical staining none of the most common amyloid proteins was identified. Some of the specimens were weakly stained by the apolipoprotein-AI antibody, more markedly adjacent to the amyloid fibrils. Amyloid deposition in aortic stenosis depended on hyperlipidemia, echocardiographic valvular thickening, and - by trend - on the presence of coronary artery disease, and obesity. Dystrophic valvular amyloidosis appears to represent an underestimated local manifestation of progressive destruction and scarring with diverse deposition pattern predominantly affecting stenotic aortic valves. It appears to depend on risk factors for atheroinflammatory processes and high shear-stress hemodynamic. The underlying protein structure has to be clarified in further studies.
Abstract 2331: BRCA1 Limits Inflammation Induced Apoptosis And Improves Endothelial Function: A Novel Role Of DNA Repair Genes In Vascular Homeostasis
Authors: Singh Krishna K , Shukla Praphulla C , Lovren Fina , Pan Yi , Jurasz Paul , Quan Adrian , Teoh Hwee , Errett Lee , Verma Subodh
Published: July 2021

INTRODUCTION:
Endothelial cell apoptosis, in response to inflammatory, ischemic and hypoxic stressors, has been identified as an essential target for therapies aimed at improving graft patency. BRCA1 is a tumor suppressor gene which functions primarily to promote DNA repair, and afford protection against various genotoxic stimuli, including immunosuppressant and chemotherapeutic regimens often employed post-transplantation. We hypothesized that BRCA1 is a novel target to limit inflammation-induced endothelial cell apoptosis and to restore endothelial function.

METHODS AND RESULTS:
In the first series of studies, we used a gain-of-function approach by adenoviral BRCA1 overexpression in human umbilical vein endothelial cells (HUVECs). Ad-BRCA1-expressing HUVECs exhibited profound protection against TNFα (20 ng/ml)-induced apoptosis, as assessed by flow cytometry, DNA laddering, COMET assay and cleaved procaspase 3 (P < 0.01). This response was mediated by complete prevention of TNFα-induced increases in endothelial ROS production (P < 0.001, vs. Ad-BRCA1). Furthermore, Ad-BRCA1 overexpression prevented TNFα-induced reduction in key indices of endothelial function, namely capillary-like tube formation (P < 0.01) and cell migration (P < 0.01). The protective effects of BRCA1 were not mediated by changes in total or phosphorylated p53 (P = 0.1) but were associated with a significant 6-fold upregulation in eNOS (P < 0.05). A loss-of-function strategy with BRCA1 gene silencing reversed the effects on endothelial apoptosis, ROS production and eNOS phosporylation.

CONCLUSIONS:
BRCA1 protects endothelial cells against inflammation-induced apoptosis, through a mechanism that involves up-regulation of eNOS and reduced ROS production, and is a novel candidate gene to limit aberrant vascular remodeling. These data also suggest that patients with BRCA1 mutations or cancer syndromes may be at an exaggerated risk of native and transplant atherosclerosis and graft dysfunction, particularly in the setting of DNA damaging immunosuppressants.
Abstract 2361: Bone Marrow Dysfunction In Chronic Heart Failure Patients Contributes To Impaired Erythropoiesis
Authors: Westenbrink B.D. , Voors Adriaan A , Vos Annet , van der Harst Pim , Vellenga Edo , de Boer Rudolf A. , van Veldhuisen Dirk J , van Gilst Wiek H
Published: July 2021

Background:
We hypothesised that anemia in chronic heart failure (CHF) patients is caused by bone marrow dysfunction.

Methods:
Bone marrow was harvested during cardiac surgery from 17 patients with CHF (LVEF 32 ± 1.8 %) and 17 age matched control patients with normal cardiac function (LVEF ≥ 55%). Early hematopoietic progenitor cells (CD34
+
) and committed erythroid cells (CD71
bright
), apoptosis (Annexin-V
+
/DAPI
+
) and EPO-receptor (EPO-R) density were quantified by FACS. Erythroid and myeloid colony formation of isolated CD34
+
cells was assessed in methylcellulose containing incrementing doses of erythropoietin (EPO) or myeloid cytokines. After 14 days Burst Forming Units Erythroid (BFU-E) or granulocyte and monocyte colonies were quantified.

Results:
Patients with CHF had lower hemoglobin levels and 35% of CHF patients had anemia. The numbers of CD34
+
and CD71
bright
cells were 2 fold lower in CHF patients (P < 0.05). Throughout the EPO dose-response range, CD34+ cells of CHF patients produced a 3-fold lower number of BFU-E colonies than controls (figure 1

, P < 0.02). Concomittantly, myeloid colony formation was 2 fold lower in CHF patients as well (P < 0.05). This was associated with markedly increased apoptosis (P < 0.01), but equivalent EPO-receptor expression. Lower BFU-E numbers were independently associated with higher NTproBNP levels (R = − 0.5, P = 0.03). However, BFU-E formation was comparable in anemic and non-anemic CHF patients (P = 0.8).

Conclusions
: General bone marrow dysfunction in CHF patients contributes to impaired erythropoiesis. Although this might render patients more susceptible to anemia, it does not exclusively explain its occurrence.

Impaired erythropoiesis in heart failure patients
Abstract 2400: Late Gadolinium Enhancement on MRI is a Prognostic Marker of Poor Survival in Light Chain Amyloidosis: Results from Long-Term Follow Up
Authors: Migrino Raymond Q , Bright Megan , Pajewski Nicholas , Truran Seth , Gutterman David D , Hari Parameswaran
Published: July 2021

Light chain amyloidosis (AL) is a rare disease associated with poor survival especially in the presence of cardiac involvement. Late gadolinium enhancement (LGE) on cardiac MRI was recently shown to correspond to cardiac amyloid deposition but the long term prognostic implication of this finding has not been established. The aim is to compare long-term survival between AL subjects with and without LGE. 25 biopsy-proven AL subjects (12 females, 61 ± 3 years) underwent cardiac MRI while undergoing workup for AL. Survival status was followed 24 ± 10 months post-MRI and compared between LGE positive and negative subjects. LGE was present in 19 (76%) AL subjects. 13 (52%) were in Heart Failure (HF) Class I with 7 (28%), 2 (8%) and 3 (12%) in Class II, III, IV respectively. LVEF was 65 ± 18% in LGE positive and 69 ± 12% LGE negative patients (p = 0.6). On follow up 10/19 LGE positive and 0/6 LGE negative patients died (log rank p = 0.03). LGE and initial presenting HF class (log rank p = 0.001) were associated with poor survival (see figure

). There was no significant association between LGE and initial presenting HF class (Fisher’s exact p = 0.4). This is the first long-term study demonstrating the prognostic significance of LGE in AL amyloidosis. Although small sample size precludes modeling the independent prognostic value of LGE, the lack of strong association with HF class and the presence of LGE in HF Class I subjects suggest additional utility of LGE in assessing the prognosis of AL subjects.
Abstract 2474: Rho-Kinase Inhibition Improves Endothelium-Dependent Vasodilation during Hyperinsulinemia in Patients with Metabolic Syndrome
Authors: Schinzari Francesca , Tesauro Manfredi , Rovella Valentina , Veneziani Augusto , Mores Nadia , Melina Domenico , Cardillo Carmine
Published: July 2021

Impaired insulin-mediated vasodilation in the skeletal muscle may be involved in the development of hypertension in patients with metabolic syndrome (MetS) and contribute to insulin resistance by diminishing the glucose uptake. Rho-kinase, an effector of the small G protein Rho A, plays an important role in hypertension and is reported to interfere with insulin signaling through serine phosphorylation of insulin receptor substrate-1 in blood vessels. We therefore examined the role of Rho-kinase in the pathophysiology of impaired vascular reactivity in patients with MetS by evaluating the effect of Rho-kinase inhibition on NO-dependent vasodilation during hyperinsulinemia. Forearm blood flow (FBF) responses to acetylcholine (ACh), a stimulus for endothelial release of NO, and sodium nitroprusside (SNP), an exogenous NO donor, were assessed during insulin administration (0.1 mU/Kg/min) using the forearm perfusion technique in patients with MetS (n=10) and matched controls (n=10). Patients with MetS were then randomized to intra-arterial infusion of either fasudil (inhibitor of Rho-kinase, 200 μg/min) or placebo and reactivity to ACh and SNP was reassessed. During hyperinsulinemia, vasodilator responses to both ACh and SNP were blunted in patients with MetS (both P>0.001 vs. controls). In patients who received fasudil, its administration did not change unstimulated FBF (P=0.75 vs. insulin alone); the vasodilator response to ACh, however, was significantly enhanced by fasudil (P=0.009 vs. insulin alone), while the response to SNP was not significantly changed (P=0.56). In patients with MetS who received placebo, vascular reactivity to both ACh and SNP was not different than before (both P>0.05). In conclusion, Rho-kinase inhibition during hyperinsulinemia improves endothelium-dependent vasodilator responsiveness in patients with MetS. This suggests that, under those conditions, intravascular activation of Rho-kinase is involved in the pathophysiology of endothelial dysfunction and may constitute a critical mediator linking metabolic and hemodynamic abnormalities in insulin resistance. As a consequence, targeting Rho-kinase might beneficially impact both vascular function and insulin sensitivity in patients with MetS.