bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4683: Risk Stratification in Hypertrophic Cardiomyopathy: Evidence that Syncope is a Marker for Sudden Death
Authors: Spirito Paolo , Autore Camillo , Rapezzi Claudio , Bernabo Paola , Badagliacca Robert , Maron Martin S , Bongioanni Sergio , Coccolo Fabio , Estes N. A , Barilla Caterina S , Biagini Elena , Quarta Giovanni , Conte Maria R , Bruzzi Paolo , Maron Barry J
Published: July 2021

Risk stratification and identification of those patients with hypertrophic cardiomyopathy (HCM) at the highest risk for sudden death is a major issue for patient management, given the effective option of the implantable defibrillator in this disease. For example, the prognostic significance of syncope has not been investigated systematically in large HCM cohorts, and therefore treatment strategies related to this symptom have been based largely on intuition and experience. We assessed the relationship between syncope and sudden death in 1511 consecutive HCM patients. Unexplained (n=153) or neurally-mediated (n=52) syncope occurred in 205 (14%) of patients. Over a 5.6±5.2 year follow-up, 74 patients died suddenly. Relative risk of sudden death was 1.78 (95% CI 0.88 –3.51; p=0.08) in patients with unexplained syncope, and 0.91 (95% CI 0.00 –3.83; p=1.0) in those with neurally-mediated syncope, compared to patients without syncope. However, the time interval between unexplained syncope and initial patient evaluation proved to have a strong impact on sudden death risk. Patients with recent syncope (≤6 months from initial evaluation) showed a 5-fold increase in risk compared to patients without syncope (adjusted HR=4.89; CI 2.19 –10.94; p=0.006), a relationship maintained throughout all age groups (<18, 18 –39 and ≥40 years). Conversely, adult patients (18 –39 and ≥40 years) with remote syncope (>6 months from evaluation) showed no increase in sudden death rate (4.8; 95% CI 0.1–26.7 and 3.2; 95% CI 0.1–17.8 per 1000 person-years, respectively), compared to patients of similar age without syncope (11.8; 95% CI 7.6 –17.6 and 5.7%; 95% CI 3.8 – 8.3 per 1000 person-years). Left ventricular outflow obstruction was not associated with sudden death risk (p=0.29). In this large HCM cohort, unexplained syncope proved to be a risk factor for sudden death. In addition, the temporal proximity of syncopal events to patient evaluation is of clinical relevance. Recent unexplained syncope is associated with an increased risk for sudden death in all age groups, while remote syncopal events do not convey increased risk to adult patients.
Abstract 4684: Differences in Baseline Features and Long Term Follow-Up Post-Transcatheter Closure in Patients with Secundum Atrial Septal Defect - A Cohort Study
Authors: Yong Gerald , Khairy Paul , de Guise Pierre , Ibrahim Reda
Published: July 2021

Patients with atrial septal defects (ASD) may develop pulmonary arterial hypertension (PAH). We aimed to explore predictors of PAH and characterize the evolution of pulmonary arterial systolic pressures (PASP) after transcatheter ASD closure. A cohort study was performed on 215 consecutive patients who underwent attempted transcatheter ASD closure, of which 194 were successful. Patients were classified into 4 groups based on PAH severity derived from baseline echocardiographic PASP estimates: no PAH (<40mmHg; Group I, n=107), mild PAH (40 –50mmHg; Group 2, n=62), moderate PAH (50 – 60mmHg; Group 3, n=27), and severe PAH (≥60mmHg; Group 4, n=19). Follow-up echocardiography was performed at a median of 10 months (IQR 3, 25 months). Independent predictors of moderate or severe baseline PAH were older age (OR 1.10 per year, p<0.0001), larger ASD size (OR 1.13 per mm, p=0.0052), female gender (OR 3.9, p=0.0313) and moderate or severe tricuspid regurgitation (OR 3.6, p=0.0043). Post closure, baseline PAH severity was associated with a greater likelihood of a ≥5mmHg reduction in PASP (33.7%, 73.9%, 79.2%, 100.0%, in Groups 1 to 4, p <0.0001) and larger reduction in PASP (median reduction 0, 8, 17, 22 mmHg in Groups 1 to 4, p<0.0001). However, likelihood of normalization of PASP (<40mmHg) was inversely correlated with baseline PAH severity (90.2%, 71.7%, 66.7%, 23.5% for Groups 1 to 4, p<0.0001). Higher baseline PASP (OR 1.20 per mmHg, p<0.0001), younger age (OR 0.97, p=0.0202), and smaller body surface area (OR 0.13 per m
2
, p=0.0210) independently predicted a ≥5mmHg reduction in PASP. Among patients with moderate or severe baseline PAH, normalization of PASP occurred in 48.8%, and was independently predicted by a lower baseline PASP (OR 0.91 per mmHg, p=0.0418) and absence of moderate or severe tricuspid regurgitation preceding ASD closure (OR 0.139, p=0.0420). In patients with ASD, severity of PAH is modulated by age, gender, defect size, and presence of moderate or severe tricuspid regurgitation. Patients with moderate or severe PAH benefit from a substantial reduction in PASP post-transcatheter ASD closure, but PASP remains elevated in a sizeable proportion of patients, warranting close long-term follow-up.
Abstract 4692: Impact of Pressure Recovery on Diagnosis of Severe Aortic Stenosis in Asymptomatic Patients. (A SEAS Substudy)
Authors: Bahlmann Edda , Cramariuc Dana , Gerdts Eva , Gohlke-Baerwolf Christa , Nienaber Chritoph , Kuck Karl Heinz , Ray Simon
Published: July 2021

Background:
Downstream pressure recovery (PR) in the aorta affects transvalvular pressure gradient measurement and calculation of aortic valve area by continuity equation in patients with aortic stenosis (AS).

Methods:
To assess the clinical importance of PR on evaluation of severity of AS, echocardiographic data in 1562 patients with asymptomatic aortic stenosis (mean age 67 ± 10, 39% women, 51% hypertensive) recruited in the Simvastatin Ezitimibe in Aortic Stenosis (SEAS) study was used. The inner diameter of the ascending aorta was measured at annulus and at sinutubular junction. The aortic valve area (AVAI) was calculated from annular diameter and velocity time integrals from sub- and transaortic flow by Doppler. PR and PR corrected AVAI assessed as energy loss index (ELI) were calculated by previously published equations. Severe aortic stenosis was defined as AVAI <0.60cm
2
/m
2
and ELI <0.55cm
2
/m
2
, respectively. Patients were grouped into tertiles of peak transaortic Doppler velocity (<2.79, 2.79 –3.32, ≥3.33 m/sec, respectively).

Results:
In the total study population, PR ranged from 1.22–16.75 mmHg (mean 5.9±2.3), AVAI from 0.20 –1.85 cm
2
/m
2
(mean 0.67±0.22) and ELI from 0.22–5.94 cm
2
/m
2
(mean 0.89±0.45). PR increased significantly with severity of AS (Table 1

). Both AVAI and ELI decreased with increasing peak transaortic velocity, and the overestimation of AS severity by using unadjusted AVA was largest in the lowest tertile (Table 1

).

Conclusion:
Severity of AS is often overestimated in milder degrees of asymptomatic AS if correction for pressure recovery is not performed. Adjustment of AVA for the effect of energy loss should be performed routinely, and this may be especially important for accuracy of severity assessment in patients with relatively low transvalvular velocities.

Table 1
Abstract 4698: Myocardial Radial Strain Rate Indicates Prognostic Significance in Asymptomatic Patients with Chronic Severe Aortic Regurgitation
Authors: Onishi Tetsuari , Kawai Hiroya , Furuki Maky , Fukuda Yuko , Okada Mariko , Norisada Kazuko , Tatsumi Kazuhiro , Okita Yutaka , Hirata Ken-ichi
Published: July 2021

(Purpose)
The purpose of this study was to investigate the prognostic value of myocardial systolic strain rate (Ssr) in the initial evaluation in asymptomatic patients with chronic severe aortic regurgitation (AR).

(Methods)
We studied 50 patients with severe AR and moderately dilated left ventricle (LV) who did not present with the operative indication in the initial evaluation. During an average of 24 months follow-up period, 15 patients underwent surgical corrections (group S) and remaining 35 did not require them (group M). In the initial echocardiographic examination, we obtained end-diastolic and end-systolic LV dimensions, radius to thickness ratio (R/T) and end-systolic wall stress (WS) from M-mode echocardiograms, and end-diastolic and end-systolic LV volume indices (EDVI and ESVI), LV ejection fraction (EF) using the modified Simpson’s method, and radial Ssr on the LV posterior wall using tissue Doppler imaging. We used a student t-test for 2 group comparison and the receiver-operating characteristic curve (ROC) to search for a predictor from parameters.

(Results)
There was no significant difference in EF, R/T, and WS between two groups in the initial evaluation. However, EDVI and ESVI in group S were significantly larger and Ssr in group S was significantly smaller than those in group M. In ROC analysis, we identified the area under the curve of Ssr was greater than that of the other variables. Kaplan-Meier analysis according to the cutoff value (Ssr 2.4/s) determined by analysis of ROC demonstrated a significantly lower operation-free rate in patients with Ssr < 2.4/s than in those with Ssr ≥ 2.4/s (p < 0.001).

(Conclusions)
Myocardial systolic strain rate is a valuable predictor for the progression of disease, and may be helpful for the risk assessment in the serial evaluation of asymptomatic patients with chronic AR.
Abstract 4706: Perfusion Stress Echocardiography with Perflubutane Polymer Microspheres Provides Incremental Predictive Value for Coronary Artery Disease Over Clinical Risk Factors
Authors: Memisoglu Asli , Wittes Janet , Iskandrian Ami E , Kaul Sanjiv , Porter Thomas R , Senior Roxy , Monaghan Mark J , Udelson James E , Walovitch Richard C , Picard Michael H
Published: July 2021

Introduction
RAMP (Realtime Assessment of Myocardial Perfusion Imaging) 1 and 2 showed that coronary artery disease (CAD) diagnosis with perfusion stress echocardiography (PSE) and perflubutane polymer microspheres in chest pain patients is as accurate as SPECT perfusion imaging.

Hypothesis
PSE provides incremental predictive value over clinical risk factors and ECG for CAD presence.

Methods
RAMP analysis population (n=488; mean age 62 years) included chest pain patients who underwent PSE (real-time and triggered) and gated
99m
Tc SPECT at rest and with dipyridamole stress and had known CAD status by angiography (≥70% stenosis). Severe CAD was defined as >40% left ventricular mass at risk of infarction (jeopardy score). Independent blinded readers (6 PSE, 4 SPECT) interpreted images for the presence of defects (wall motion and/or perfusion). Majority PSE and SPECT assessment was evaluated for CAD association using logistic regression. Covariates included resting ECG and risk factors: age, gender, smoking, diabetes, hypertension, and angina type (typical or unstable).

Results
Three hundred (61%) patients had CAD. In multivariate analyses adjusted for known clinical risk factors and ECG, positive PSE and SPECT were significant predictors of CAD (odds ratio (95% CI)=5.7 (3.7–8.7) and 3.6 (2.4–5.4)), respectively. PSE and SPECT added incremental value for prediction of CAD in multivariate models already including clinical factors and ECG (Table 1

). Among patients with severe CAD (n=80), clinical factors and ECG predicted only 68% CAD prevalence compared to 83% and 79% predicted by clinical factors, ECG and either positive PSE or SPECT, respectively (p<0.001).

Conclusion
PSE with perflubutane polymer microspheres significantly increases the probability of correct CAD diagnosis in stable chest pain patients beyond the probability established by risk factors, symptoms and ECG. Table 1

: Incremental Predictive Value of ECG, PSE and SPECT over Clinical Factors
Abstract 4726: How Reliable is Left Atrial Volume in Estimating Left Atrial Pressure in Advanced Heart Failure Patients? Three-Dimensional Echocardiographic and Catheterization Studies
Authors: Evangelista Antonietta , Mukherjee Jayanta , Ordway Linda , Scali Maria Chiara , Caselli Stefano , Torromeo Concetta , Gaudio Carlo , DeCastro Stefano , DeNofrio David , Nesser H. Joachim , Kuvin Jeffrey T , Patel Ayan R , Pandian Natesa G
Published: July 2021

Previous work has suggested that left atrial (LA) size reflects LA pressure but direct correlative studies of pressure and volume are scant. Furthermore, evaluation of LA size has typically been based on 1-dimensional measures or 2D echo-derived LA area or volume. The aim of this study was to explore whether 3D LA volume could accurately indicate LA pressure in advanced heart failure (HF) patients, in whom filling pressure estimation is clinically relevant. We studied 32 patients with advanced HF both with 3D echo (3DE) performed simultaneously or close to the time of pulmonary capillary wedge pressure (PCWP) measurement by cardiac catheterization. From full volume 3D data sets of the left heart, maximum LA volume (MaxLAV) and minimum LA volume (MinLAV), and volumes indexed to body surface area (MaxMAVI and MinLAVI) were calculated. Mean PCWP was obtained from standard invasive recordings.

Results: The mean LVEF was 23±8. The MaxLAV was 101±38 ml with a range of 34 to 173. MaxLAVI was 50±16 ml/m2 with a range of 19 to 81. MinLAV was 76±37 with a range of 19 to 145. MinLAVI was 38±16 ml/m2, with a range of 12 to 72. The PCWP (mm Hg) was 21±8 with a range of 2 to 34. The correlation between PCWP, and MaxLAV, MaxLAVI, MinLAV and MinLAVI were respectively r=0.193, p=0.28; r=0.25, p=0.16; r=0.24, p=0.17; and r=0.31, p=0.08. Within the group, there were some patients with normal or low PCW but with larger LA volumes (>median) while some patients with high filling pressures did not necessarily have higher LA volumes.

Conclusion: In advanced HF patients, maximum or minimum LA volumes do not correlate with PCWP. LA remodeling and depletion of LA volume reserve in these patients is most likely responsible for the lack of correlation. Thus, in advanced HF patients, LA volume cannot be used to assess left heart filling pressure.
Abstract 4734: Echodynamography is a Novel Useful Technique in Assessing Inertia Force of Late Systolic Aortic Flow and Left Ventricular Early Diastolic Function
Authors: Wakami Kazuaki , Ohte Nobuyuki , Kato Chika , Asada Kaoru , Goto Toshihiko , Fukuta Hidekatsu , Ito Tatsuya , Mukai Seiji , Suzuki Syogo , Kimura Genjiro
Published: July 2021

We previously reported that the inertia force (IF) of the blood flowing out of left ventricle (LV) during late systolic phase produces greater LV elastic recoil force and brings faster LV relaxation. Echodynamography (ALOKA) is a novel technique that enables us to obtain the flow velocity vector from conventional color Doppler velocity data on the range of interest at any phase of cardiac cycle without angle dependency. We investigated whether the flow velocity vector obtained at LV outflow tract (LVOT) in late systole had a relation with IF and invasively obtained LV relaxation parameters.

Method:
Study subjects were consecutive 26 patients who underwent diagnostic cardiac catheterization and conventional color Doppler imaging on the same day. Color Doppler image was acquired in the apical 3-chamber view. The analyses for flow velocity vector were performed offline using an echo image analyzer. The late systolic velocity of the blood flowing was obtained as an average value of the L
VOT
(V
LVOT
−late systole). LV pressure was obtained using a catheter-tipped micromanometer. From the recorded pressure waves, first derivative of LV pressure (dP/dt) and a time constant τ of LV pressure decay during isovolumic relaxation were calculated. From LV pressure-dP/dt relationships (phase loop), IF was determined.

Results:
A significant positive correlation was observed between the V
LVOT
-late systole and IF (r=0.75, p<0.0001). The V
LVOT
-late systole also had significant correlations both with peak negative dP/dt (r=0.49, p<0.05) and the time constant τ (r=−0.70, p<0.0001).

Conclusion:
This study indicates that the V
LVOT
-late systole, which may be a noninvasive substitute for IF, has significant correlations with the parameters of LV relaxation. Echodynamography is a new useful technique to estimate LV early diastolic function.
Abstract 4781: Rate of Progression and Functional Significance of Aortic Valve and Root Calcification Up To 8 Years Following Total Aortic Root Replacement Using a Homograft Versus Freestyle Prosthesis: Results From a Prospective Randomized Trial
Authors: El-Hamamsy Ismail , Zaki Mohamed , Stevens Louis M , Clark Lucy , Rubens Michael , Yacoub Magdi H
Published: July 2021

Introduction - Aortic root calcification is a major limitation following root replacement. The aims of this analysis were to compare the rate of progression of root calcification between homografts and xenografts (Medtronic Freestyle) up to 8 years postoperatively and to determine its functional significance.

Methods - Between 1997 and 2003, 161 patients were prospectively randomized to undergo homograft (Group H) or Freestyle (Group F) total aortic root replacement. Of those, 99 patients underwent a total of 248 electron beam computed tomography (EBCT) studies at 0.5, 1, 1.5, 2, 3 and 8 years (n=17 patients at 8 years). Aortic root calcium scores were calculated using Agatston scores.

Results - Mean calcium scores in Group H at 1, 2, 3 and 8 years were 550±95, 1026±160, 1440±256 and 3876±604 Hounsfield Units (HU), versus 397±84, 556±125, 683 ±151 and 2518±495 HU in Group F. Mixed effects models show higher calcium scores in Group H at 1, 2 and 3 years, with a trend at 8 years (p=0.11). Group H presents a significantly more rapid early rate of progression (slope from 0 to 3 years; p=0.02) and progress similarly to Group F thereafter (slope from 3 to 8 years; p=0.3) (Figure 1

). Echocardiographic evaluation of patients at 8 years showed no correlation between EBCT scores and aortic valve dysfunction.

Conclusion - Homograft roots have a higher propensity to calcifiy than Freestyle prostheses, which follows a time-dependent progression marked by rapid early calcification. Despite the high calcium scores, no correlation with prosthetic valve function was identified at 8 years.
Abstract 4827: Role of Left Ventricular Dyssynchrony in Functional Mitral Regurgitation in Patients with Dilated Cardiomyopathy: A Comparison Study with Geometric Parameters of Mitral Apparatus Estimated with 3d Echocardiography
Authors: Choi Woonggil , Kim Soohyun , Woo Seongill , Kim Deahyuk , Park Keumsoo , Lee Woohyung , Kwan June
Published: July 2021

Objective: Functional mitral regurgitation (FMR) occurs commonly in patients with dilated cardiomyopathy (DCM). The aim of this study was to compare the roles of Left Ventricle(LV) dyssynchrony and geometric parameters of mitral apparatus as determinants of FMR in patients with DCM.

Methods: Fourteen DCM patients without FMR and 15 DCM patients with FMR (ERO = 0.11 ± 0.029 cm
2
) were enrolled. Effective regurgitant orifice (ERO) area and tissue Doppler-derived dyssynchrony index (DI: the standard deviation of time to peak myocardial systolic contraction of eight segments) were measured. The estimated DIs were corrected by the cycle length (CL) of each patient (cDI (%) = DI/CL*100). Using real-time 3D echocardiogrphy, mitral tenting area (MVT) and the degrees of displacement of anterior (APMD) and posterior (PPMD) papillary muscles were estimated. All geometric measurements were corrected (c) by the height of each patient.

Results: There was no significant (p > 0.05) difference in LV Ejection Fraction and cLVEDV between two patient groups. cDI, cMVT, cAPMD and cPPMD significantly (p < 0.05) increased in the patient with FMR comparing with those in patients without FMR. cDI (r = 0.42), cMVT (r = 0.74), cAPMD (r = 0.63) and cPPMD (r = 0.64) showed significant (p < 0.05) correlations with ERO. cMVT was found to the strongest independent predictor of ERO with multivariate regression analysis, whereas cDI did not enter into the model.

Conclusions: The degree of MV tenting rather than LV dyssynchrony was found to be the main determinant of FMR in DCM. However LV dyssynchrony also has a minor independent association with FMR.
Abstract 4831: The A2B Adenosine Receptor Contributes to Post-Infarction Heart Failure
Authors: Maas Jason E , Koupenova Milka , Ravid Katya , Auchampach John A
Published: July 2021

Recent studies have been directed at understanding the role of the A
2B
receptor in regulating cardioprotection, coronary blood flow, fibroblast function, and inflammation. Unlike the other adenosine receptor subtypes, the A
2B
receptor is emerging as a promoter of inflammation in chronic diseases such as asthma and conditions associated with tissue fibrosis. In this study, we used A
2B
receptor gene “knock-out” (A
2B
−/−
) mice to test the role of the A
2B
receptor in infarction-induced heart failure and cardiac remodeling. A
2B
−/−
mice or wild-type (WT) littermates were subjected to permanent ligation of the left coronary artery or sham surgery. Cardiac morphology and function were assessed at 4 and 8 weeks after surgery by echocardiography. At the end of the study, systemic arterial and left ventricular pressures were obtained, after which the hearts were removed and histologically assessed for infarct size and fibrosis. WT hearts experienced significant left ventricular dilation and reduced systolic (fractional area shortening, myocardial performance index, and +dP/dt
max
) and diastolic (end-diastolic pressure [EDP] elevated from 3.2 ± 0.8 mmHg in sham mice to 8.8 ± 1.5 mmHg in infarcted mice and tau was prolonged from 11.6 ± 1.7 ms to 22.3 ± 2.0 ms) function at 8 weeks after coronary artery ligation. Compared to WT mice, there were no significant differences in measures of post-infarction systolic function in A
2B
−/−
mice. However, EDP and tau were significantly improved (2.5 ± 1.5 mmHg and 17 ± 1.4 ms, respectively) and were not worsened compared to sham-operated A
2B
−/−
mice (2.7 ± 2.1 mmHg and 14.5 ± 1.8 ms, respectively). Moreover, interstitial fibrosis was elevated in the non-infarcted myocardium of WT mice subjected to coronary ligation, but not in A
2B
−/−
mice. Importantly, infarct size (WT = 39 ± 2% of the left ventricle; A
2B
−/−
= 43 ± 3%) and systemic blood pressure were not significantly different between WT and A
2B
−/−
mice. The data suggest that absence of the A
2B
receptor results in preservation of diastolic function and decreased development of reactive fibrosis following myocardial infarction. These findings support the concept that adenosine signaling via the A
2B
receptor contributes to post-infarction heart failure and adverse cardiac remodeling.

This research has received full or partial funding support from the American Heart Association, AHA National Center.
Abstract 4863: Rhythm Versus Rate Control Strategies In Heart Failure Patients With Atrial Fibrillation: Impact On Lv Function And Functional Status: Echocardiographic Insights From Af-chf
Authors: Henrard Valerie , Gisbert Alessandro , Roy Denis , Tardif Jean-Claude , Talajic Mario , Thibault Bernard , Racine Normand , White Michel , Guerra Peter G , Ducharme Anique
Published: July 2021

Background:
In heart failure patients, the recently published AF-CHF (Atrial Fibrillation in Congestive Heart Failure) trial did not demonstrate the superiority of a rhythm control (RhyC) over a rate control (RaC) strategy in terms of cardiovascular mortality. Nevertheless, the deleterious hemodynamic effects of AF can lead to further decrease in LV function and symptoms progression. This AF-CHF echocardiographic sub-study was designed to compare the effects of the two treatment strategies (RhyC and RaC) on LV ejection fraction (LVEF), chamber dimensions and volumes, valvular regurgitation, functional status and exercise tolerance.

Methods:
59 patients (29 RhyC:30 RaC) enrolled in AF-CHF were prospectively followed in this echocardiography study, with a standardized exam at baseline and 12 months. The primary endpoint was the change in LVEF.

Results: (Table 1

)

Mean LVEF at baseline was severely depressed (RhyC:27.0±4.9% and RaC:27.6±7.4%, p=0.73), with significant improvement at follow-up for both groups. Other echocardiographic parameters were unchanged at follow-up, including changes in LV and LA volumes and valvular regurgitation. Clinically, mean six-minute walked distance increased significantly in both groups as did NYHA class without any additional benefit for the rhythm control strategy (both p=NS).

Conclusion:
In patients with HF and AF, improvements in LVEF and functional status are observed at 12 months without any additional benefit of rhythm control over a rate control strategy.
Abstract 4889: Long-term Changes Of Left Ventricular (lv) Structure And Function After Adrenalectomy Or Medical Treatment For Primary Aldosteronism
Authors: Rossi Gian Paolo , Cesari Maurizio , Seccia Maria Teresa , Pitter Gisella , Pessina Achille Cesare
Published: July 2021

Objectives:
to evaluate the structural and functional LV outcome of surgically or medically treated patients with documented primary aldosteronism (PA).

Methods:
after a cross-sectional Doppler echocardiography assessment of LV wall thickness and dimensions and transmitral LV filling flow velocity indexes, 55 PA patients entered a prospective follow-up study lasting 6.4 years (range: 4.5 to 8 years) after adrenalectomy (n=41) or medical treatment (n=14). The diagnosis of aldosterone producing adenoma (APA) and idiopathic hyperaldosteronism (IHA) was based on adrenal vein sampling, pathology, and on follow-up data.

Results:
by the PAPY Study criteria 47 patients had APA and 8 IHA. Excess LV hypertrophy (LVH) and concentric remodelling rate was observed at baseline in both groups; atrial contribution to LF filling (ACLVF) was higher in the 14 (6 APA and 8 IHA) medically treated than in the 41 adrenalectomized patients. At follow-up blood pressure (p<0.001) and the rate of LVH decreased (p<0.001): LV mass index (MI) fell (from 115±22 to 106±18 in adrenalectomized patients and from, 118±26 to 103±21 in medically treated patients). This LVMI reduction and an increase of relative wall thickness (from 0.43±0.07 to 0.46±0.06 in adrenalectomized patients and from 0.41±0.06 to 0.45±0.05 in medically treated patients) attained statistical significance only in the former. By contrast, the reduction of ACLVF was significant only in the latter (p=0.002), thus indicating a normalization of the LV diastolic filling indexes (but only in the medically-treated patients which showed an impaired diastolic function at baseline).

Conclusion:
1) Both treatments reduce BP, LV mass index and the prevalence of LVH; 2) With a similar fall of blood pressure and despite a greater reduction of antihypertensive drugs, these changes were more prominent in adrenalectomized patients; 3) An improvement of LV diastolic filling occurs also in the medically-treated PA patients when it is altered at baseline.
Abstract 4913: Difference of not only Magnitude but also Heterogeneity of Neointimal Coverage between Drug-Eluting Stent and Bare Metal Stent in Acute Myocardial Infarction
Authors: Nishino Masami , Yoshimura Takahiro , Lee Yasuharu , Nakamura Daisuke , Nakatani Shinpei , Hara Masahiko , Hashimoto Akihito , Yamagami Kiyoshi , Taniike Masayuki , Kato Hiroyasu , Egami Yasuyuki , Shutta Ryu , Yamaguchi Hitoshi , Tanouchi Jun , Yamada Yoshio
Published: July 2021

Drug-eluting stent (DES) achieved significant reduced restenosis, however the safety of efficacy of DES in acute myocardial infarction (AMI) are still controversial. In this study, we compared angioscopic parameters between DES and bare metal stent (BMS) in patients with AMI. Eighty-seven consecutive patients who received DES or BMS for AMI were enrolled. At 6-month after AMI, coronary angiography was performed in all patients. We performed coronay angioscope (CAS) if the patients did not show significant in-stent restenosis (>50% stenosis). Using CAS, we evaluated the maximum and minimum grade of neointimal coverage within one stent using the following CAS score: 0: stent struts were exposed similary to right implantaiton, 1: stent were covered by very thin neointima, 2: struts were embedded but visible and 3: struts were fully embedded and invisible. We adopted minimium grade as the magnitude of neointimal coverage and calculated heterogeneity score as the following formula: (maximum grade) − (minimum grade). We compared CAS parameters including magnitude and heterogeneity score of neointimal coverage, visible thrombi and plaque color (white or yellow) aroud stent, and serum parameters including low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, hemoglobin A1c and high sensitive C-reactive protein (hs-CRP). Restnosis rate of DES (n=56) was significantly lower than that of BMS (n=31): 9% vs. 29%, p=0.03. In patients without restenosis, DES group revealed lower magnitude and higher heterogeneity score as compared to BMS group while there were no significant differences of the other parameters between the two groups (table

). Not only lower magnitude but also more heterogeneous propery of neointimal coverage were shown in DES as compared to in BMS at 6-month after AMI. These findings may be correlated with future cardiac evetns while restenosis rate is lower in DES than in BMS.
Abstract 4950: Infection with Enterovirus Produces Myocarditis in a Non-Human Primate Model
Authors: Halnon Nancy , Cammock Cheryl , Singletary Morgan , Blanchard James , Skoczylas Jill , Krogstad Paul
Published: July 2021

Introduction:
We performed a pilot study to establish a non-human primate model of enteroviral infection and myocarditis.

Methods:
Juvenile cynomolgus monkeys were inoculated via oral (n=1) or intravenous (n=8) routes with a cloned Coxsackievirus B3 (CVB-3) or a CVB-3 /Enterovirus 86 strain (CVB-MCH) isolated from a clinical specimen from a patient with fatal myocarditis. Clinical and echocardiographic assessment was performed at baseline and at days 3, 7, 14, and 28. CVB-3 neutralizing antibody titers were measured. Viral RNA was detected by RT-PCR and culture of plasma and cardiac tissue. Animals were sacrificed at 14 or 28 days and myocardium examined for viral pathology.

Results:
Infection was achieved by both routes with both CVB-3 strains. Viremia was detected in 6/9, resolving after day 3. All (9/9) generated neutralizing antibody. Two animals infected with 10
7
infectious units (IU) of CVB-3 became moribund and were sacrificed at day 11 and day 14. Subsequent animals received 10
6
IU of CVB-3 and appeared well until sacrificed at day 14 (n=3) or day 28 (n=1). Three infected with 10
6
IU CVB-MCH also appeared well until sacrificed at day 28. Normal ejection fraction was maintained, but four animals had minor wall motion abnormalities. Serum troponin remained normal. Virus was present in myocardium in 5/5 tested. Multiple areas of focal cardiac injury were present in all animals and included lymphocytic or eosinophilic myocarditis (n=6), focal inflammation (n= 3), myocytolysis (n=2), ischemic foci (n=4), contraction band necrosis (n=2), and hypertrophy (n=3). Active myocarditis was present in 4/5 animals at day 14 and 2/4 at day 28.

Conclusions:
We were able to consistently establish infection with CVB-3 in cynomolgus monkeys resulting in clinically apparent or sub clinical disease, including myocarditis or cardiac injury persisting at 28 days. Despite adequate immune responses to clear viremia, virus persisted in the myocardium. The presence of myocyte hypertrophy and injury at 28 days in this model may provide a basis for experiments aimed at modulating immune or virus induced cardiomyopathy.
Abstract 5577: Short-Term Outcomes of STEMI and NSTEMI in Patients with Chronic Kidney Disease: A Report from the National Cardiovascular Data ACTION Registry
Authors: Fox Caroline S , Muntner Paul , Chen Anita Y , Alexander Karen P , Roe Matthew T , Saucedo Jorge F , Wiviott Stephen D
Published: July 2021

Chronic kidney disease (CKD) is a risk factor for myocardial infarction (MI) and death. However, the relationship between severity of CKD and contemporary hospital-based management and outcomes across the spectrum of MI (STEMI and NSTEMI) has not been well-documented. The study population was drawn from the ACTION Registry, a nation-wide sample of STEMI (n=19,481) and NSTEMI (n=30,462) patients admitted to 274 hospitals in the United States between January 1 and December 31, 2007. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation and categorized as ≥60, 30 to <60, 15 to <30 and eGFR<15 mL/min/1.73m
2
or dialysis. Use of acute (first 24 hours) therapies and early (first 48 hours) cardiac catheterization as well as in-hospital major bleeds, and death were compared across CKD stages in models adjusted for demographics, CVD history and prior procedures, and risk factors. Overall, 30.5% and 42.9% of patients with STEMI and NSTEMI, respectively, had CKD Stage III or greater (eGFR<60 ml/min/1.73m
2
or dialysis). Regardless of MI type, patients with CKD were less likely to receive acute evidence-based therapies including aspirin, beta-blockers or clopidogrel or to undergo early invasive care and were more likely to experience a major bleed or death (Table

). There were 1030 deaths among those presenting with STEMI, and 1223 among those with NSTEMI. There was a greater relative increase in death for patients with STEMI with advancing CKD stage than was seen in NSTEMI (P interaction <0.0001 for each stage). A large proportion of patients presenting with STEMI or NSTEMI have CKD. Further efforts to address treatment gaps in the management of MI in the presence of CKD are needed to improve outcomes in this high-risk population.

Table-

Multivariable adjusted odds ratios and 95% confidence intervals of outcomes based on CKD stage
Abstract 5578: The Effect of Age and Estimated Glomerular Filtration Rate on In-Hospital Mortality Following Percutaneous Coronary Intervention for Acute Myocardial Infarction: A Report from the National Cardiovascular Data Registry
Authors: Cardarelli Francesca , Bellasi Antonio , Rojas-Campos Enrique , Ou Fang-Shu , Shaw Leslee J , Veledar Emir , Roe Matthew T , Morris Douglas , Klein Lloyd W , Raggi Paolo
Published: July 2021

To assess the effect of estimated glomerular filtration rate (eGFR) on in-hospital mortality in young (<65 year-old), old (65– 84 year-old) and very old (≥ 85 year-old) patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Chronic kidney disease is associated with worse survival post-PCI in a variety of patient subsets. Similarly, advancing age has been associated with a worse outcome after PCI. Whether risk of death after PCI is different in various age and eGFR groups is not well known. We analyzed data collected by the National Cardiovascular Data Registry (NCDR) between February 04 and March 07 from 631 US hospitals on 169,826 PCIs performed for AMI. In a risk adjusted logistic model we estimated the odds ratio associated with different eGFR levels on in-hospital death among each age group. Younger patients had fewer comorbidities, higher eGFR, less frequent multivessel disease, higher PCI success rate and lower crude mortality than old and very old patients (p<0.0001 for all comparisons). However, the odds ratio of in-hospital death was greater (OR: 7.58, CI: 6.18 –9.29) for a young patient with eGFR<30 ml/min/1.73m
2
than for an old (OR: 4.75, CI: 4.14 – 5.45) or very old patient (OR: 3.50, CI: 2.50 – 4.89) with the same degree of renal insufficiency compared to similar age patients with eGFR≥60 ml/min/1.73m
2
(Figure

). While the impact of renal impairment is substantial in all age groups, severe reduction in eGFR is a worse prognostic factor for younger than older patients.
Abstract 5579: Myocardial Infarction, Clinical Characteristics and Prognosis across Five Renal Function Stages - Data from the Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA)
Authors: Szummer Karolina , Lundman Pia , Jacobson Stefan , Schön Staffan , Lindbäck Johan , Stenestrand Ulf , Wallentin Lars , Jernberg Tomas
Published: July 2021

Assess clinical characteristics, presentation and prognosis following a myocardial infarction (MI) at different degrees of renal insufficiency. Nearly all consecutive patients in Sweden with MI treated at a coronary care unit between 2003–2006 and who had either known creatinine or received dialysis (n=58496, 90.4% of entire cohort) were followed. Glomerular filtration rate (eGFR) was estimated with the Modification of Diet in Renal Disease formula and staged according to the National Kidney Foundation definition. Cox regression analysis adjusting for 30 variables including baseline characteristics, symptoms on admission, ECG-pattern, reperfusion therapy and discharge medication was used to assess mortality with eGFR both as a continuous and categorical variable. Patients with declining renal function differed by being older and having more comorbidites such as diabetes, hypertension and prior MI. Fewer patients with kidney failure presented with chest pain compared to those with normal eGFR≥90 ml/min/m2 (66.2% versus 90.2%). They had a non-ST-elevation MI more often (67.7% versus 55.7%) and clinical heart failure (45.0% versus 10.7%) on admission. Overall, at 30 days and 1 year, 8.5% and 16.4% patients had died. After adjustment, 30-day and 1-year mortality was significantly higher in those with more advanced renal insufficiency (Table

). For every 10 ml decrease in eGFR 30-day mortality increased by 3.1% (95% CI 1.00 –1.06, p=0.025), whereas 1-year mortality increased exponentially. Patients with renal insufficiency differ in presentation pattern for a MI. Although 30-day mortality increases linearly with worsening renal function, 1-year mortality differs by increasing exponentially, leading to extremely high mortality rates in those with severe renal insufficiency. Research into disease mechanisms and advances in therapies are needed to enhance outcome.

Mortality following a MI across renal function groups
Abstract 5603: Oral Dosing of PRT060128, a Novel Direct-acting, Reversible P2Y
12
Antagonist Overcomes High Platelet Reactivity in Patients Non-responsive to Clopidogrel Therapy
Authors: Gurbel Paul A , Conley Pamela B , Andre Patrick , Stephens Gillian , Gretler Daniel D , Jurek Marzena M , Bliden Kevin P , Antonino Mark J , Singla Anand , Suarez Thomas , Tantry Udaya S
Published: July 2021

Introduction:
The ADP receptor P2Y
12
plays a central role in platelet function. Clopidogrel therapy is associated with various limitations including irreversible inhibition, a delayed antiplatelet effect, wide response variability, and non-responsiveness that has been linked to adverse ischemic event occurrence. We report the first pharmacodynamic study of a single oral dose of PRT060128 (PRT128), a novel, direct-acting reversible P2Y
12
inhibitor in patients with high platelet reactivity while on maintenance dose clopidogrel therapy(75mg/d) and aspirin.

Methods:
Previously stented patients (n=27) on maintenance aspirin and clopidogrel therapy were screened for high platelet reactivity (HPR) defined as upper tertile 5μ M ADP-induced aggregation (>43%) based on prior studies conducted at our Center; 7/27 had HPR and were treated with a single oral dose (60 mg) of PRT128. Platelet function was assessed at baseline, 4 hours, 6 hours, and 24 hours post-dosing by light transmittance aggregometry (LTA) stimulated by 5μ M, 20 μ M ADP, and 4μ g/ml collagen; Thrombelastography PlateletMapping (MA
ADP
), Accumetrics P2Y12 assay (PRU), platelet reactivity ratio (%) by vasodilator stimulated phosphoprotein phosphorylation (VASP), and Perfusion Chamber Assay (PCA).

Results:
Results shown in the Table

represent means ± standard deviation for the 7 patients at each time point.

Conclusion:
Based on results using multiple pharmacodynamic assays, PRT060128 is a potent rapid-acting inhibitor of P2Y
12
that overcomes high platelet reactivity in patients non-responsive to clopidogrel therapy. The pharmacodynamic properties of this novel P2Y
12
antagonist warrant future large scale investigations to determine clinical efficacy.
Abstract 5657: Esophageal Temperature Monitoring during Balloon Cryoablation of the Pulmonary Veins
Authors: Ahmed Humera , Neuzil Petr , d’Avila Andre , Laragy Margaret , Mares Karel , Brugge William R , Forcione David G , Ruskin Jeremy N , Reddy Vivek Y
Published: July 2021

Introduction:
Atrial-esophageal fistula is a feared complication of atrial fibrillation (AF) ablation. There have been no reported instances after ablation with the Cryoballoon catheter, which is believed to be associated with a relatively low risk of thromboembolism and PV stenosis, and no risk of atrial perforation. Yet, given the high frequency of subclinical esophageal ulceration reported with radiofrequency energy, we sought to determine the effect of cryoenergy on the esophagus.

Methods:
Catheter ablation was performed using the cryoballoon in 50 pts with paroxysmal AF (Age: 56±10 years, 29 male/21 female, LVEF: 67±6%, LA size 40±5mm). A temperature probe was used to monitor LET; however,
LET changes did not guide therapy
. Post-procedural endoscopy was systematically performed on the last 25 consecutive pts.

Results:
Significant (>1°C) LET drops were observed in 48 (96%) patients (5±3 per patient). The greatest mean LET drop was observed in the LIPV (3.5°C), followed by the RIPV (2.7°C), LSPV (2.1°C) and RSPV (0.9°C). The LET nadir (13.8°C) was observed in the RIPV. Esophageal ulceration was observed in 4/25 (16%) pts; all were asymptomatic and prescribed proton pump inhibitors. Follow-up EGDs at one month revealed complete resolution of ulceration. No patient or procedural characteristics (age, history of GERD, LA size, LVEF, pre-procedural TEE) predicted ulceration. A significant correlation was found between the incidence of esophageal ulceration and

LET nadir,

number of LETs <30°C, and

cumulative LET drop (

Figure

).

Conclusion:
Esophageal ulceration can occur after balloon cryoablation; however, in no instances did this progress to fistula formation.
Abstract 5676: Elevated Oxidative Stress is Associated with Ventricular Fibrillation Episode in Patients with Brugada Syndrome without SCN5A Mutation
Authors: Tanaka Masamichi , Ohgou Keiko , Nakagawa Koji , Tada Takeshi , Murakami Masato , Hiramatsu Shigeki , Miura Daiji , Miura Aya , Nishii Nobuhiro , Nagase Satoshi , Morita Hiroshi , Nakamura Kazufumi , Oka Takefumi , Ohe Tohru , Kusano Kengo
Published: July 2021

Background;
Brugada Syndrome (BS) is a disease known to cause ventricular fibrillation (VF) with structurally normal heart. Gene mutation (i.e. SCN5A) has been proposed to be related to the development of BS and VF. However, the pathophysiological mechanism associated with VF development without SCN5A mutation has not been studied yet. Oxidative stress is a common disorder that is related to many heart diseases. We have previously demonstrated that oxidative stress is closely linked to the arrhythmic development. Accordingly, we examined 4-hydroxy-2-nonenal (HNE) modified protein, which is a common mediator of oxidative stress in the myocardium, and VF episodes in patients with BS.

Methods;
We collected sixty-eight BS patients that underwent right ventricular endomyocardial biopsy (66 males, 2 female; mean age 49.0±11.6 years old). VF was documented in 11 and SCN5A mutation was detected in 14 patients. Biopsy samples were processed for histology [Masson’s trichrome staining for fibrosis, immuno staining for CD45, CD68, and HNE modified protein]. All results from histology were compared with VF episodes. We also performed the analysis in VF patients with (n=14) or without SCN5A mutations (n=54).

Results:
HNE positive area was significantly larger in VF patients [VF(+): 16.3±10.5, VF(−): 9.3±5.7%: P=0.029]. All other parameters (fibrosis area, CD45, and CD68) were not different between the groups. In multivariable analysis, HNE positive area was most important risk factor of VF development in patients without SCN5A mutation (P=0.004).

Conclusions
; These data suggested that oxidative stress is associated with VF development in BS patients, especially in patients without SCN5A mutation.
Abstract 5678: Fast-Fast Form of Atypical AV Nodal Reentrant Tachycardia: Incidence, Electrophysiological Characteristics and Results of Catheter Ablation
Authors: Otomo Kiyoshi , Nagata Yasutoshi , Tachiguchi Hiroshi , Uno Kikuya , Fujiwara Hideomi , Iesaka Yoshito
Published: July 2021

Both the typical (slow-fast (S/F)) and atypical (slow-slow (S/S) and fast-slow (F/S)) forms of the AV nodal reentrant tachycardias (AVNRT) are usually amenable to the classical slow pathway (SP) ablation at the inferoseptal atrial region. However, rare cases of unusual forms AVNRT do not involve an SP in the tachycardia circuits (TC), and they are resistant to the classical SP ablation. The characteristics of the atypical AVNRTs not involving an SP in the TCs remain to be elucidated. A total of 1252 AVNRTs induced during the electrophysiological study in 950 cases were analyzed. Both the anterograde and retrograde limbs of the TC were classified into the fast pathway (FP) or SP according to the A-H (AHI) and H-A intervals (HAI) during the tachycardia; the anterograde FP: AHI of <220 ms, anterograde SP: AHI of ≥220 ms, retrograde FP: HAI of <120 ms, and retrograde SP: HAI of ≥120 ms. Accordingly, each tachycardia was classified into one of the S/F, S/S, F/S and
fast-fast (F
/
F) forms
. There were 998 S/F forms (79.7%), 119 S/S forms (9.5%), 129 F/S forms (10.3%) and 6
F
/
F forms
(0.5%). The
F
/
F forms
were induced by atrial or ventricular extrastimulation without an associated jump-up in the AHI and HAI, and they were characterized by a shorter tachycardia cycle length (260±55 ms), short AHI (153±39 ms) and HAI (107±19 ms) during the tachycardia, earliest retrograde atrial activation (ERAA) at the right superoseptum (n=2) or midseptum (n=4), and 2nd degree AV block without a tachycardia interruption. The retrograde atrial activation sequence during the
F
/
F forms
was identical to that during ventricular pacing. The tachycardias could be entrained from the RV, and they resumed with a V-A-V sequence after the cessation of the entrainment pacing. The classical SP ablation at the right inferoseptal region was unsuccessful in all 6 cases with the
F
/
F forms
. The successful ablation was achieved at the right superoseptum (n=2) or midseptum (n=4) without creating AV block in all 6 cases. The
F
/
F forms
of atypical AVNRT not involving a classical SP in the TC were observed in 0.5% of all AVNRT cases. The results of this study suggested that the TC was smaller and confined to the superior part of the AV nodal area in this extremely rare form of AVNRT.