bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 646: Epicardial Ablation Of Ventricular Tachycardia - A Single Centre Experience
Authors: Schmidt Boris , Chun KR Julian , Koektuerk Buelent , Ouyang Feifan , Kuck Karl-Heinz
Published: July 2021

Background:
Radiofrequency current ablation (RFA) of ventricular tachycardia (VT) focuses on endocardial (endo) substrates. However, if endo RFA fails, an epi approach is a potential treatment option. We report a single centre experience of epi VT ablation.

Patients and Methods:
Between 06/2005 and 02/2008 42 pts (14 female, mean age 49 ± 18 years) underwent electroanatomical endo and epi mapping and ablation for intractable VT, syncope or VT storm with multiple ICD discharges. Pts with normal heart (n=7), ischemic cardiomyopathy (ICM; n=8), NICM (n=11), ARVD (n=8), LV-aneurysm (n=7) or sarcoidosis (n=1) were studied. Mean LV ejection fraction was 45±12%. 20/42 had had at least 1 previous ablation attempt for VT (range 1– 4 ablations). Acute success was defined as non-inducibility of the previously inducible VT. Chronic success was defined as recurrence of any VT.

Results:
Acute procedural success rate was 79% (30/38). In 4 pts VTs were not inducible during EPS. In 28/42 pts endo mapping revealed no pathologic potentials. In 23/38 pts and 7/38 the succesful RFC ablation site was epi and endo, respectively. In 9/38 pts endo ablation failed and VT could only be ablated from epi. Further 7/38 pts needed both endo and epi ablation. In In 4/8 failed ablations epi RFC ablation was impossible due to failed access to target site (adhesions; n=2), close vicinity of a coronary artery (n=1) or the phrenic nerve (n=1). Procedure duration was 263±97 min. Unfortunately, 1 pt died due to perforation of RV and 1 pt had severe hepatic bleeding after epi puncture. One pt died in cardiogenic shock 1 d after the procedure. In 2 pts a sterile pericarditis occurred which resolved without any further intervention. After a median follow-up of 293 days (1–929 days) 53% of pts were alive and free from any VT.

Conclusion:
In pts with failed endo RFC ablation for VT due to different etiologies epi RFC ablation was acutely successful in 61% of pts with a moderate chronic success rate. However, major complications occured in approximately 5% of pts. Epi mapping should be considered if endo pathologic potentials are absent or if endo ablation failed.
Abstract 651: An in Vitro Model to Test Possible Adverse Effects of Electrical Devices on ICD Function
Authors: Friedman Madeleine T , MacVeigh Theodore J , Friedman Peter L
Published: July 2021

Devices such as capsules swallowed to perform video endoscopy (VE-CAP) or cell phones equipped with Bluetooth® (BLUE) emit electrical signals which could have adverse effects on implantable cardiac defibrillators (ICDs). We sought to study whether signals from VE-CAP or BLUE could cause spurious inhibition of ventricular pacing (VP
i
) or spurious detection of ventricular fibrillation (VF
d
) in an in vitro model. A Medtronic D154ATG single chamber ICD was attached to a Medtronic 6948 lead and placed in a saline bath. The ICD was programmed to perform VVI pacing at 60 beats per minute (bpm) and to detect ventricular fibrillation as rates in excess of 188 bpm, with sensitivity programmed at 0.15 mV. ICD therapies were programmed off. A VE-CAP was placed in the saline bath 1 cm. and 6 cm. from the lead tip (LEAD) and then 1 cm. and 6 cm. from the ICD pulse generator (CAN). Marker channels recorded by wireless telemetry from the ICD were used to determine whether the VE-CAP caused interaction (+) or no interaction (−). BLUE was tested in similar fashion. Radiofrequency (RF) electocautery from a Bovie, which is known to result in VP
i
and VF
d
, was applied to the saline bath 1 and 6 cm from the lead and 1 and 6 cm from the pulse generator as a control. The results were as follows: ICD lead tips in the right ventricular apex overlie the diaphragm and are often within 1 cm of the transverse colon. However, even at this distance, interaction between a VE-CAP and an ICD resulting in VP
i
or VF
d
is unlikely to occur. Capsule video endoscopy in patients with ICDs should be safe, even in patients who are pacemaker dependent. Similarly, BLUE is unlikely to cause VP
i
or VF
d,
and should be safe in such patients.
Abstract 681: Characteristics of Atherosclerotic Plaque Burden in Patients With and Without Acute Coronary Syndrome Presenting With Acute Chest Pain to the Emergency Department
Authors: Bamberg Fabian , Ferecik Maros , Truong Quynh , Rogers Ian , Shapiro Michael , Brady Thomas J , Nagurney John T , Hoffmann Udo
Published: July 2021

Background:
Coronary computed tomography (CT) may improve the early triage of patients with acute chest pain in the emergency department (ED). The aim of this study was to compare the presence and extent of coronary atherosclerotic plaque as detected by coronary CT in patients with and without acute coronary syndromes (ACS).

Methods:
The study was designed as a prospective, observational cohort study in patients with acute chest pain but negative cardiac biomarkers and no diagnostic ECG changes, admitted to rule out myocardial ischemia. All patients underwent coronary CT prior to hospital admission. The presence of coronary plaque was treated as a dichotomous outcome, and the extent of CAD was defined as number of (1) coronary segments with plaque, or (2) major coronary arteries with plaque detected by MDCT as assessed by two independent observers. The clinical outcome (ACS) was adjudicated by a review committee using established AHA criteria; subjects with history of CAD (stent placement, bypass) were excluded.

Results
: Among 368 patients with acute chest pain (mean age 53±12 years, 61% male) 31 patients were determined to have ACS (8%). None of the 183 subjects without plaque (50%) had an ACS. Among the remaining 185 subjects (mean age 58.0±11.5 years, 68% male) in whom coronary plaque was detected, patients with ACS had a significantly more plaque (7.2±3.7 vs. 4.2±3.4, p<0.0001 segments) as compared to subjects without ACS. Similar results were seen for calcified plaque and non-calcified plaque (6.5±3.7 vs. 3.6±3.5 segments, p<0.0001; and 3.6±3.2 vs. 1.8±2.2 segments, p<0.0001, respectively). In addition, the rate of ACS increased with the number of major coronary arteries with plaque (1-vessel: 6.8%, 2-vessels: 10.6%, 3 vessels: 30.8%, and 4-vessels: 25%; p<0.01). In contrast, the ratio of non-calcified to calcified plaque was not different between patients with and without ACS (0.68±0.6 vs. 0.54±0.72, p=0.31).

Conclusions:
The extent of coronary plaque differs between subjects with and without ACS among patients presenting with acute chest pain. Detailed assessment of the extent and composition of coronary plaque may be helpful to assess risk of ACS among patients with acute chest pain but inconclusive initial ED evaluation.
Abstract 688: Risk of Radiation Induced Cancer from Cardiac CT in a Real-Life Clinical Patient Population
Authors: Huda Walter , Schoepf U. Joseph , Abro Joseph , Ravenel James G , Costello Philip , Frey Donald
Published: July 2021

Previous studies on lifetime cancer risks from radiation at cardiac CT are based on extrapolation of data unrelated to medical imaging and on presumptive scan protocols but not on actual patient cohorts. We aimed to determine the realistic risk of radiation induced cancer based on a real-life clinical patient population undergoing cardiac CT. We studied 104 consecutive patients undergoing 64-slice cardiac CT (Siemens). Data were obtained on patient demographics (sex, age, weight) as well as CT technique (kV, mAs, scan length, DLP) which were used to determine median values and the 10th and 90th percentiles. Organ dose estimates were obtained using the ImPACT dosimetry spreadsheet. Organ doses were converted into patient lifetime risk of developing radiation induced fatal and non-fatal cancer using the BEIR VII approach. Patient cancer risks were adjusted taking into account patient sex, age and weight, the latter being an often neglected factor influencing radiation risk. The majority of patients (62%) were males, with a median patient age of 59 years (41–72) and a median weight of 92 kg (69–116). All scans were performed at 120 kV, and the median DLP was 1124 mGy-cm (940–1500). In normal sized patients, the organs receiving the highest radiation doses were the lung (76 mGy) and the female breasts (92 mGy). The average patient lifetime risk for developing a radiation induced cancer was 0.12%, of which 90% would be fatal. Approximately 85% of the radiation risk arises from the irradiation of the lung. Patients with an age and weight at the 10th percentile, who receive a DLP at the 90th percentile would have a cancer risk double the average value. In a typical clinical population undergoing cardiac CT patients are predominantly male, heavier set, and in their 5th–7th decade of life. In such a patient population the realistic risk of radiation induced cancer from cardiac CT is 0.12%, with the risk to the most sensitive patients being about twice this value. Thus, in a real-life clinical patient cohort the realistic risk of radiation induced cancer from cardiac CT is substantially lower than previously reported for general populations. Appropriate patient selection and indication remain the most important means for radiation protection.
Abstract 693: Right Ventricular Dilation in Patients with Mild and Moderate Heart Failure: Implications in Morbidity and Mortality
Authors: Bourantas Christos V , Loh Huan P , Rigby Alan S , Bragadeesh Thanjuvar , Lukaschuk Elena I , Garg Scot , Tweddel Ann C , Alamgir Farqad M , Nikitin Nikolay P , Clark Andrew L , Cleland John G
Published: July 2021

Objectives:
To investigate the prognostic impact of right ventricular (RV) morphology in patients with mild and moderate heart failure.

Methods:
80 normal subjects and 401 consecutive patients with left ventricular (LV) ejection fraction (EF)< 45%, on optimal treatment, underwent cardiac magnetic resonance imaging (C-MRI). The LV and the RV borders were detected from the short axis contiguous slices and drawn manually. Body surface area was used to index (I) the LV and RV mass (M) and volumes (V) measured at end-diastole (ED) and end-systole (ES). The indexed volumes were then used to calculate the LV and RV EF. RV dilatation was defined as mean RVESVI+2*SD in normal subjects.

Results:
21 patients had incomplete data and excluded from the analysis. The median age for the remaining patients was 71 years and 86% were men. 77% had ischaemic heart disease and 78% had NYHA I/II breathlessness. The median LVEF was 33% and the RVEF 43%. 286 (75%) patients had normal and 94 (25%) dilated RV. Patients with RV dilation were more often male (92% vs. 84%, p=0.036), had lower systolic blood pressure (120mmHg vs. 129mmHg, p=0.003), and were more likely to have NYHA breathlessness III/IV (30% vs. 18%, p=0.006). Patients with normal RV had higher LVEF (34% vs. 31%, p=0.015), smaller LVEDVI (115ml/m
2
vs. 137ml/m
2
, p<0.0001) and LVESVI (77ml/m
2
vs. 92ml/m
2
, p<0.0001) and were more likely to tolerate β-blockers (91% vs. 74%, p=0.002). Patients were followed up for 45±22months. During that time, there were no significant differences between the two groups regarding the reasons for admissions and the time that they spent to the hospital. Within that time 108 patients died [35 (37%) with dilated and 69 (24%) with normal RV; log-rank=8.404, p=0.004]. In multivariable Cox regression model, including 15 variables only increasing RVESVI (HR: 1.009, 95%CI: 1.000–1.017; p=0.043), the presence of ischaemic heart disease (HR: 2.186, 95%CI: 1.049–4.557; p=0.037) and the presence of peripheral vascular disease (HR: 1.674, 95%CI: 1.036–2.705; p=0.037) were independent predictors of mortality but not LVESVI.

Conclusions:
RV dilation is a common finding in patients with mild and moderate heart failure and is associated with worse prognosis.
Abstract 710: Pioglitazone Treatment Reduces Epicardial Fat in Patients with Type 2 Diabetes Mellitus and Improves Left Ventricular Diastolic Function
Authors: Nagai Hiroyuki , Ito Hiroshi , Iwakura Katsuomi , Okamura Atsunori , Koyama Yasushi , Date Motoo , Higuchi Yoshiharu , Inoue Koichi , Kimura Ryusuke , Toyoshima Yuko , Imai Michio , Ozawa Makito , Ito Norihisa , Okazaki Yukinori , Shibuya Masahiko , Suenaga Hidetaka , Kubota Asuka , Fujii Kenshi
Published: July 2021

Visceral obesity is recognized as a risk factor for cardiovascular events and for diastolic dysfunction. Epicardial fat pad (EFP) is visceral adipose tissue, contains pro-inflammatory substances, and directly attached to epicardial coronary artery. It sometimes infiltrates into cardiac muscle, that may impair diastolic performance. Pioglitazone can reduce the abdominal visceral fat, that is associated with improvement of insulin sensitivity. In this study, we investigated whether pioglitazone can reduce EFP and can improve diastolic function in patients with type 2 diabetes mellitus (DM). Study population consisted of 97 DM patients. All patients underwent echocardiographic examination before and a mean of 9.1 months after pioglitazone. We measured end-systolic thickness of echo free space in front of the free wall of right ventricle to measure EFP. To assess LV diastolic performance, we measured early peak mitral annulus velocity (e′, cm/s) with tissue Doppler. HbA1c decreased (8.1 vs. 7.0%, p=0.0009), trigliceride decreased (179 vs. 135 mg/dl, p=0.0009), and HDL-cholesterol increased (49 vs. 52 mg/dl, p=0.003). Although there was no difference in body weight, EFP thickness significantly decreased (6.3 vs. 5.0mm, p<0.0001) after pioglitazone. Patients were divided into two groups based on EFP thickness at baseline (median value = 6 mm). The percent reduction in EFP is greater in thicker EFP group (≥ 6.0 mm)than in thinner EFP group (<6.0mm) (24 vs. 12 %). Although e′ velocity was comparable before and after pioglitazone in the thinner EFP group, it significantly increased in the thicker EFP group (5.7 vs. 6.7 cm/s, p=0.003). Pioglitazone treatment reduces EFP associated with an improvement in glucose control and in lipid profile among patients with DM. In patients with thicker EFP, the reduction of EFP was greater, that is associated with the better improvement in LV diastolic performance.
Abstract 711: Diagnosis of Acute Myocardial Ischemia by Speckle Tacking Echocardiography -A Comparative Animal Study-
Authors: Ebihara Aya , Takenaka Katsu , Kimura Koichi , Uno Kansei , Fuju Katsuhito , Iwata Hiroshi , Yatomi Yutaka , Sata Masataka , Nagai Ryozo
Published: July 2021

Since the subendocardium is known to be more vulnerable to ischemia than the subepicardium, indexes of subendocardial function are expected to be more sensitive than indexes of whole LV wall. The aim of our study is to compare the diagnostic values of systolic and diastolic indexes measured by 2D speckle tracking echocardiography in an animal experiment. The proximal left circumflex coronary artery was balloon-occluded for 3 minutes in 14 pigs. LV short-axis view was recorded at rest and 30 minutes after release of the occlusion by transthoracic 2D echocardiography except for one pig with ventricular fibrillation. Peak circumferential and radial strain (CR, RS), peak systolic and diastolic strain rate (CSR-S′ and CSR-E′), time from QRS to peak CS and RS, time from QRS to E′, and the incidence of post-systolic shortening (PSS) were measured in the subendocardium of the LV posterior wall. ROC curve analysis of these indexes was done for the diagnosis of acute myocardial ischemia followed by reperfusion. Only 5 indexes showed significant change before and after the occlusion. ROC curve revealed that CSR-E′ had the highest predictive value for detecting the ischemic memory, followed by peak CS, and CSR-S′. Peak early diastolic circumferential strain rate of the subendocardium was the most powerful index for diagnosing ischemic memory after acute coronary occlusion.

Table.

Results of meaurement (mean±SD)
Abstract 815: Recovery of Heart Function in Women with Severe Heart Failure from Peripartum Cardiomyopathy in Haiti
Authors: Fett James D , Sannon Herriot , Thélisma Emmeline , Sprunger Therese L , Suresh Venkita
Published: July 2021

Peripartum cardiomyopathy (PPCM) is a form of heart failure from dilated cardiomyopathy with one of the greatest potentials for eventual full systolic function recovery. Traditional concepts of PPCM have held that if recovery did not occur by the six-month post-diagnosis mark, it would be unlikely to happen. This report shows that improvement and eventual full recovery may occur long after that initial period. PPCM patients have been identified from the Hôpital Albert Schweitzer PPCM Registry, Deschapelles, Haiti, from 2000 to 2008. All patients fully met diagnostic criteria for PPCM, which include onset of heart failure during the last month of pregnancy up to 5 months postpartum, absence of previous heart disease or other cause of heart failure, and echocardiographic criteria for systolic dysfunction. Recovery was defined as left ventricular (LV) ejection fraction (EF) greater than 50 percent. Echocardiography was carried out at initial diagnosis and at 6-month intervals, with a minimum of 24 months follow-up required for inclusion. Standard treatment included diuretics (lasix) and ACE-inhibitors (captopril), as determined by economic factors, which also excluded the routine use of beta-blockade. Thirty-two out of 116 (27.6 %) PPCM patients fully recovered LV systolic function. Mean follow-up was 35 months. The shortest time to recovery was 3 months and the longest time to recovery was 48 months. The number and cumulative percentage of recovery is shown in the following table

:

Table:

Length of time required for recovery of left ventricular function in 32 Haitian PPCM patients, 2000–2008:
Likelihood of recovery did not correlate with age (17–47 years), parity (1–10) or LV EF at diagnosis (12 to 40 %). Complete recovery of LV systolic function in PPCM often occurs after the first 6 to 12 months following diagnosis. It is important to continue treatment and follow-up sufficiently long to assure and document maximum benefit
Abstract 816: Low-Amplitude, High Frequency Electrical Stimulation of the Infarct Region Decreases Matrix Metalloproteinase Abundance and Increases Levels of Tissue Inhibitors of the Metalloproteinases and Collagen Content
Authors: Mukherjee Rupak , Rivers William T , Plyler Rebecca A , Beck Christy , Chang Eileen I , Matthews Robert G , Koval Christine N , Ruddy Jean Marie , Spinale Francis G
Published: July 2021

Discordant alterations in the balance between matrix metalloproteinases (MMP) and endogenous MMP inhibitors (TIMPs) within a myocardial infarct (MI) contribute to alterations in LV geometry and ultrastructure, which lead to LV wall thinning at the MI region. While systemic pharmacological approaches can globally alter LV remodeling post-MI, a targeted regional approachto modify MMP/TIMP balance and MI structure has not been explored. We tested the hypothesis that application of localized high frequency stimulation (LHFS) using low amplitude electrical pulses within a formed MI scar would alter MMP/TIMP levels and prevent MI thinning. A uniform and discrete MI was surgically induced in pigs (n=17). At 3 wks post-MI, pigs were randomized for LHFS (n=7, electrical stimulation at 240 bpm, using 0.8V, 0.05ms pulses at the center of the MI region) or unstimulated (UNSTIM, n=10). At 4 wks post-MI, LV wall thickness (echo), and stiffness (piezoelectric crystals with LV preload reduction) were measured. MMP-2, MMP-9, TIMP-1 (zymography or immunoblotting) levels, and fibrillar collagen content (COLL, histology) in the remote and MI regions were determined and normalized to values in LV samples obtained from non-MI pigs (n=5, 100%). LV wall thickness at the MI region was higher with LHFS than UNSTIM (0.89±0.07 vs 0.67±0.08 cm, p<0.05). With LHFS, MMP-2 levels were lower, and TIMP-1 and COLL levels higher than UNSTIM values in the MI region (TABLE

). Myocardial stiffness in the MI region was higher with LHFS than UNSTIM (14.70±2.08 vs 9.11±1.24, respectively, p<0.05). These findings, for the first time, demonstrate that sub-threshold electrical stimulation of the MI region altered MMP/TIMP balance and collagen content, which directly affected LV wall thickness and stiffness. Thus, LHFS may represent a novel, selective means to favorably modify MI scar remodeling and attenuate the progressive LV wall thinning that occurs post-MI.
Abstract 827: High Serum Level of Neopterin Is a Risk Factor of Patients with Heart Failure
Authors: Sasaki Toshiki , Takeishi Yasuchika , Shishido Tetsuro , Watanabe Tetsu , Nltobe Joji , Miyamoto Takuya , Miyashita Takehiko , Nishiyama Satoshi , Kubota Isao
Published: July 2021

Neopterin is produced by activated monocytes/macrophages, and serum neopterin concentrations reflect the level of oxidative stress. We assessed the hypothesis that serum neopterin is a risk factor for heart failure and predicts adverse clinical outcomes in patients with heart failure. Serum neopterin concentration was measured in 198 patients with heart failure and 62 control subjects by a competitive enzyme-linked immunosorbent assay. Patients were prospectively followed during a median follow-up period of 745 days with end points of cardiac death or re-hospitalization due to progressive heart failure. Serum concentration of neopterin was significantly higher in New York Heart Association (NYHA) Class III/IV patients than in NYHA class I/II patients (P < .001). From the receiver operating characteristic (ROC) curve analysis, the cut-off value of serum neopterin level was determined as 10 nmol/L. Kaplan-Meier analysis clearly demonstrated that the high neopterin group had a significantly higher incidence of cardiac events than occurred in the low neopterin group (P < .0001). Patients were divided into 4 groups based on the serum neopterin levels, the highest 4th quartile was associated with the highest risk of cardiac events (11.1-fold compared with 1st quartile). In the multivariate Cox analysis, serum neopterin concentration was an independent risk factor for cardiac events (hazard ratio 1.70, 95% confidence interval 1.16–2.50, P = 0.0068). Serum neopterin concentration is an independent prognostic factor for heart failure, and may be useful for risk stratification of patients with heart failure.
Abstract 830: Transcardiac Increase in Norepinephrine and Prognosis in Patients with Chronic Heart Failure
Authors: Nishiyama Keizo , Tsutamoto Takayoshi , Kawahara Chiho , Yamaji Masayuki , Tanaka Toshinari , Yamamoto Takashi , Fujii Masanori , Horie Minoru
Published: July 2021

Abnormal cardiac sympathetic nerve activity (CSA) plays an important role in the pathophysiology of CHF. However, no previous study has compared the transcardiac gradient of norepinephrine (NE) and the prognosis of patients with chronic heart failure (CHF). To evaluate the prognostic role of the transcardiac gradient of NE in patients with CHF. We measured hemodynamic parameters and plasma levels of NE, brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) in the aortic root (AO) and coronary sinus (CS) in 356 consecutive patients with CHF. During a median follow-up of 3.5 years, 40 patients died. Transcardiac gradients of BNP (273±276 vs. 472±433 pg/mL, p<0.0001), NT-proBNP (417±700 vs. 928±1093 pg/mL, p<0.0001) and NE (114±160 vs. 473±992 pg/mL, p<0.0001) were significantly higher in non-survivors than survivors. After adjustment for clinical variables associated with CHF including hemodynamics and neurohumoral factors, the transcardiac gradient of NE (p<0.0001) and plasma log NT-proBNP (p<0.0001) were independent prognostic predictors. Among 67 patients in whom
123
I- metaiodobenzylguanidine (MIBG) could be performed, transcardiac increase in NE (ΔNE) was correlated with the washout rate (r=0.398, p=0.0009) and was a superior predictor of mortality than MIBG parameters. Patients were divided into four groups based on the cut-off levels for ΔNE and plasma NT-proBNP, and Kaplan-Meier survival curves were constructed (Figure

). The transcardiac increase in NE, as a biomarker of CSA, is an independent and useful prognostic predictor for evaluating the prognosis of CHF patients.
Abstract 854: Long-term Effects of Telmisartan, an Angiotensin II Receptor Blocker in Hypertensive Patients with Chronic Kidney Disease
Authors: Watanabe Hideki , Nakagawa Kunio , Kakihana Masaaki
Published: July 2021

Hypertension and Chronic Kidney Disease (CKD) is known as a major risk factor for cardiovascular disease (CVD). This study was designed to investigate endothelial function and long-term outcome of telmisartan, angiotensin II receptor blocker, in hypertensive patients with CKD. Seventy one untreated hypertensive patients with CKD (stage 3 or 4) were randomized to receive telmisartan (
Telmisartan group
, n=35) or amlodipine (
Amlodipine group
, n=36). Flow-mediated dilatation (FMD) and nitroglycerin-induced dilatation (NID) of brachial artery were measured by using ultrasound system. Pulse wave velocity (PWV) was measured by using oscilometric technique. We also measured high sensitivity C-reactive peptide (hsCRP) and thiobarbituric acid reactive substance (TBARS) as indexes of inflammation and oxidative stress. The primary outcome was death from CVD, or hospitalization for CVD during a follow-up period 4.2 to 4.7 years (median, 4.4 years). Blood pressure was significantly decreased in the both groups, and there was no difference between two groups at baseline and during study. FMD was significantly increased, and PWV, hsCRP, and TBARS were significantly decreased in the both groups after the treatment. However, these improvements were much better in the telmisartan group as compared with the amlodipine group. The 4.4-year cumulative primary-event rates were 12.6% in the telmisartan group and 37.4% in the amlodipine group (p=0.012 by long-lank test). Telmisartan improves not only endothelial function, PWV, hsCRP, or TBARS, but also long-term cardiovascular outcome in hypertensive patients with CKD.
Abstract 898: Can Angiography With Synchrotron Radiation And A High Sensitivity Receiver Make Lower Doses Of Contrast Medium Possible?
Authors: Konishi Taisuke , Matsushita Shonosuke , Hyodo Kazuyuki , Sugimori Haruhiko , Tokunaga Chiho , Enomoto Yoshiharu , Kanemoto Shinya , Watanabe Yutaka , Hiramatsu Yuji , Sakakibara Yuzuru
Published: July 2021

Introduction: Contrast-induced nephropathy (CIN) is a serious complication associated with angiography and interventional angioplasty. Increased doses of contrast medium are a major risk factor of CIN. It was assumed that the occurrence of CIN could be decreased by reducing the dose of contrast medium. We investigated the effects of a new high resolution and high contrast angiographic system on the application of diluted contrast medium.

Method: Contrast medium was diluted to 32% (a stock solution), 24%, 16%, 12%, 8%, and 4%. Angiography of the hindlimb in rats using a synchrotron radiation and HARP receiver were performed with each concentration of contrast medium (n=5, respectively). The characteristics of synchrotron radiation are high photon density (10,000 times that of conventional X-rays) and straightness of the beam, which lead to high resolution (26 micrometer/pixel). A HARP Receiver is a high sensitivity image capturing system, which was developed by NHK Sci & Tech Res Lab (Tokyo, Japan). It is about 100 times more sensitive than conventional CCD cameras. Each angiographic image was evaluated by 256 grayscale intensity using graphic software NIH Image. The availability of each image as angiography was determined by the judgment of 5 independent cardiologists respectively.

Results: In 256 grayscale, the minimum visible contrast distance for identifying vessels was 10. The value of each image in different concentrations of contrast medium was as follows: 4%: 14+/−12, 8%: 22+/−10, 12%: 23+/−18, 16%: 25+/−11, 24%: 28+/−11, 32%: 40+/−10. Vessels are identified from 4% to 32%. Availability as angiography was confirmed from 8% to 32% by common assent.

Conclusions: The angiographic system using synchrotron radiation and a HARP receiver was able to take angiographic images with as low as 8% contrast medium. This may lead to beneficial effects in patients who cannot undergo sufficient angiography and interventional angioplasty due to renal dysfunction.
Abstract 901: Impact of Microvascular Dysfunction on Long-Term Cardiovascular Events after Primary Coronary Intervention for Acute Myocardial Infarction in Patients Achieving TIMI Grade 3 Reperfusion
Authors: Tamita Koichi , Yamamuro Atsushi , Kaji Syuichiro , Katayama Minako , Tani Tomoko , Kinoshita Makoto , Ehara Natsuhiko , Kitai Takeshi , Yamane Takashi , Furukawa Yutaka , Akasaka Takashi
Published: July 2021

It has been reported that even if TIMI 3 flow is achieved in epicardial coronary arteries after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI), microvascular dysfunction results in insufficient reperfusion. Recent studies have shown that microvascular injury can be assessed from coronary flow velocity (CFV) pattern. The aim of this prospective study was to examine whether the CFV pattern predicts the long-term cardiovascular outcomes in AMI patients who achieved TIMI grade 3 reperfusion. The study population consisted of 161 consecutive patients with a first anterior AMI successfully treated with primary PCI (≤50% residual stenosis with TIMI grade 3). We examined the CFV pattern immediately after PCI using a Doppler guidewire. We defined microvascular dysfunction as a diastolic deceleration time ≤600 ms and the presence of systolic flow reversal. Patients were divided into two groups: those without microvascular dysfunction (n=126; group 1) and those with micriovascular dysfunction (n=35; group 2). We evaluated the association between the microvascular dysfunction and the long-term major adverse cardiovascular event (MACE) rates. The Kaplan-Meier survival curves showed that group 2 was poorer than group 1 in prognosis (p=0.0014). Risk-adjusted data by multivariate analysis showed that the microvascular dysfunction was the strongest predictor for long-term MACE (hazard ratio: 3.37; 95% CI, 1.59–7.15; p=0.0015). The CFV pattern immediately after PCI is an accurate predictor of the long-term cardiovascular outcomes in patients with AMI who achieved TIMI grade 3 reperfusion.
Abstract 956: Cholesterol Crystals Cause Endothelial Damage and Impair Vasoreactivity
Authors: Gadeela Nitesh , Rubinstein Jack , Vedre Ameeth , Huang Ruiping , Abela Andrew J , Abela George
Published: July 2021

Background
Cholesterol has been shown to expand when crystallizing and then be released into the circulation following plaque rupture. We hypothesized that flow of sharp ended crystals in arteries could damage the intimal surface and decrease normal vasoreactivity.

Methods
Bilateral carotid arteries from seven NZW rabbits were placed in a dual perfusion chamber, preconstricted with nor-epinephrine (NE) and then challenged with acetylcholine (ACH) for endothelial reactivity and nitroprusside (SN) to evaluate for smooth muscle reactivity. Both arteries served as their own control and perfused with warm buffered saline solution (PBS). This was followed with PBS and cholesterol crystals (100–500 μm long) and then subjected to the same pharmacological challenge. Diameters were continually recorded and digitally measured at five sites in each artery and averaged. The intimal surface was then examined by scanning electron microscopy for cholesterol crystals and intimal damage.

Results
The vasoconstrictor and vasodilatory response to ACH -but not SN- was significantly decreased after crystals were infused in comparison to initial control measurements (Figure 1

). On microscopic evaluation the intima infused with crystals demonstrated numerous sites of surface tears with evidence of cholesterol crystals perforating and embedding in the surface compared to normal controls.

Conclusion
Cholesterol crystals damaged endothelium and decreased vasoreactivity. The lack of significant change in response to SN suggests that this was due to intimal injury. These data have important clinical implications regarding impaired vasoreactivity during acute cardiovascular events.
Abstract 1100: A Novel Hybrid Of On-Pump Beating Heart Coronary Artery Bypass Grafting Results Produces Significant Myocardial Injury Compared to Conventional Cardioplegic Arrest
Authors: Pegg Tammy J , Francis Jane , Karamitsos Theodoros , Maunsell Zoe , Yu Ly-Mee , Neubauer Stefan , Taggart David , Selvanayagam Joseph B
Published: July 2021

Beating heart coronary artery bypass grafting (CABG) improves early post-operative cardiac function in patients with at least moderate ventricular function but its effects in patients with significantly impaired ventricular function is uncertain. We compared a novel hybrid technique of on-pump beating heart (ONBEAT) to conventional cardioplegic arrest (ONSTOP) in CABG patients with impaired ventricular function using cardiac magnetic resonance (CMR) and biochemical markers. In a single centre randomized trial, 50 patients with impaired ventricular function undergoing CABG were randomly assigned to ONBEAT or ONSTOP. Patients underwent CMR assessment for function and delayed hyperenhancement (HE) for irreversible injury pre-operatively and early post operatively; in addition serum was taken for cTn I and CKMB (0,1,6,24,48 and 120 hours) after surgery. Forty-five patients completed surgery with follow up imaging. Pre-operative characteristics were well matched except for a higher incidence of renal impairment in ONBEAT patients (glomerular filtration rate 58 versus 68 ml.min−1, p=0.02). Mean ± SD cardiac index (CI): ONBEAT 2.85±0.53 and ONSTOP 2.62±0.59L.min−1.m−2. After surgery both groups sustained minor changes to CI (4% reduction ONBEAT, p = 0.43 versus 1% increase ONSTOP, p = 0.97) without significant inter-group difference. The incidence of new HE was significantly higher in the ONBEAT group (p = 0.04) with 6/17 patients (35%) sustaining 8.2 ± 5.2 g of new HE each compared with 2/23 patients (9%) in the ONSTOP group each with 9.8 ± 9.0 g of new HE, p = 0.86. Furthermore serum markers of myocardial injury were higher in ONBEAT patients; median AUC for Troponin I 461[226 – 1141]μg/L versus 160[98 – 357]μg/L, p=0.002 and CKMB 862[499 – 1768]ng/mL versus 549[447–704]ng/mL p=0.004. The incidence of new irreversible myocardial injury was significantly higher in ONBEAT patients, although there was no effect on global cardiac function. Inadequate coronary perfusion in patients with severe proximal coronary disease and low cardiac output may render distal coronary territories ischemic in the absence of formal myocardial protection.
Abstract 1134: Active Adaptation of the Tethered Mitral Valve: Insights into a Compensatory Mechanism for Ischemic Mitral Regurgitation
Authors: Dal-Bianco Jacob P , Aikawa Elena , Bischoff Joyce , Guerrero J L , Handschumacher Mark D , Sullivan Suzanne , Johnson Benjamin , Titus James S , Iwamoto Yoshiko , Wylie-Sears Jill , Carpentier Alain , Levine Robert A
Published: July 2021

Background:
In patients with myocardial infarction (MI) or left ventricular (LV) dilatation, mitral regurgitation (MR) is frequently induced by leaflet tethering imposed by displaced papillary muscles (PMs), and doubles mortality. Despite this, little is known about mitral valve (MV) tissue biology and its potential to compensate for LV remodeling, which has not yet been studied prospectively. We tested the hypothesis that MV area increases over time with mechanical stretch induced by PM displacement, and as a consequence of cell activation and matrix production as opposed to passive stretching.

Methods:
Under cardiopulmonary bypass, the PM tips in 6 adult sheep were retracted apically short of producing MR to replicate tethering without confounding MI or turbulence. Diastolic MV leaflet area (without systolic stretch) was quantified by a new validated 3D echo algorithm at baseline and after 61±6 days, and MV tissue collected for histology (H&E, Masson) and fluorescent cell sorting at sacrifice. Data were compared with 6 unstretched sheep MVs.

Results:
Total diastolic MV leaflet area increased by 2.4±1.3cm2 (17±10%) from 14.3±1.9cm2 to 16.7±1.9cm2 (p<0.01) with maintained stretch, without significant change in unstretched valves despite sham open-heart surgery. Stretched MVs were 2.8 times thicker than normal (1.18±0.43 vs 0.42±0.14mm, p<0.01) due to increased spongiosa layer. Endothelial cells (CD31+) also expressing alpha-smooth muscle actin (α-SMA) were significantly more common by cell sorting in tethered versus normal leaflets (41±19% vs 9±5%, p=0.02), indicating endothelial-mesenchymal transdifferentiation (EMT); α-SMA+ positive cells indicating activation/EMT appeared in the high-stress atrial layer, penetrating into the valve interstitium, with increased collagen deposition, all absent normally.

Conclusion:
Mechanical stresses imposed by PM tethering increase MV leaflet area and matrix thickness, with cellular changes suggestive of reactivated embryonic valve development pathways. These findings support the concept of an actively adapting MV; understanding adaptive mechanisms can potentially provide therapeutic opportunities to augment MV area and reduce ischemic MR.
Abstract 1144: Complete Revascularization of Patients Undergoing Multivessel PCI is an Independent Predictor of Improved Long-Term Survival
Authors: Lehmann Ralf , Held Laura , Hobler Carola , Baier Gregor , Fichtlscherer Stephan , Schaechinger Volker , Zeiher Andreas M , Spyridopoulos Ioakim
Published: July 2021

The prognostic relevance of completeness of revascularization (CR) in patients with coronary multivessel disease (MV-CAD) has so far only been established for surgical treatment strategies. Therefore we investigated the prognostic impact of CR in patients with CAD undergoing multivessel PCI (MV-PCI). Long-term survival was assesed in 679 consecutive patients (pts), who underwent MV-PCI. 47% were treated for acute myocardial infarction. We adapted two common definitions of CR from the CABG trials for our study population: ARTS -successful treatment of all relevant lesions; BARI - no residual stenosis in the LAD. CR according to the ARTS definition was achieved in 73% of the stable patients as compared to only 61% in acute pts. CR (BARI) was achieved in 95% of all pts. Patients with CR demonstrated a better long-term survival (see figure

). Using a multivariable cox regression analysis, procedural factors such as left main PCI, number of diseased vessels, number of treated lesions, number of stents, total stent length, and acuity of underlying CAD did not predict survival. Independent predictors (p<0.05) of long-term mortality were age (> 60y HR 2.36), reduced LVEF (LVEF<40% HR 3.44), female gender (HR 1.67), chronic renal failure (creatinine > 200 mmol/l HR 2.68), elevated CRP (HR 2.09) as well as CR (ARTS; HR 0.46). An open LAD after procedure and PCI on at least one additional vessel (BARI) did not independently predict improved survival. Achievement of CR of all segments is associated with improved survival after PCI in pts with multivessel disease, regardless of the indication for PCI (acute MI or stable CAD).
Abstract 2015: Effect of Early Intensive Statin Therapy on Regression of Coronary Atherosclerosis in Patients with Acute Coronary Syndrome: The Multi-Center Randomized Trial Evaluated by Volumetric Intravascular Ultrasound Comparing Pitavastatin versus Atorvastatin (JAPAN-ACS study)
Authors: Kimura Takeshi , Hiro Takafumi , Morimoto Takeshi , Miyauchi Katsumi , Nakagawa Yoshihisa , Yamagishi Masakazu , Ozaki Yukio , Kimura Kazuo , Saito Satoshi , Yamaguchi Tetsu , Daida Hiroyuki , Matsuzaki Masunori
Published: July 2021

A prior single center study reported that early lipid-lowering therapy with atorvastatin 20 mg/day in patients (pts) with acute coronary syndrome (ACS) significantly reduced coronary plaque volume (PV) of the non-culprit site by intravascular ultrasound (IVUS) evaluation. Effect of statins other than atorvastatin on PV has not been evaluated yet in the setting of ACS. A prospective, randomized open-label parallel group study with blinded endpoint evaluation was perfomed at 33 centers in Japan. Pts with ACS undergoing IVUS-guided percutaneous coronary intervention (PCI) were randomly assigned to receive either 4 mg/day of pitavastatin or 20 mg/day of atorvastatin within 72 hours after PCI. The primary endpoint was the percentage change in non-culprit coronary PV by IVUS from baseline to 8 –12 months follow-up. The study was powered to evaluate non-inferiority of pitavastatin to atorvastatin. Between November 2005 and October 2006, 307 pts (pitavastatin group 153 pts and atorvastatin group 154 pts) were enrolled; 252 pts (82%) had IVUS image qualified for evaluation both at baseline and at follow-up. Low-density lipoprotein cholesterol (LDL-C) decreased from 130.9±33.3mg/dL at baseline to 81.1±23.4mg/dL at 8 –12 months follow-up (p= 0.001) in the pitavastatin group and from 133.8±31.4mg/dL to 84.1±27.4mg/dL (p= 0.001) in the atorvastatin group. PV decreased from 49.8±28.8mm
3
to 41.6±25.0mm
3
(p= 0.001) in the pitavastatin group and from 63.9±33.9mm
3
to 53.3±31.7mm
3
(p= 0.001) in the atorvastatin group. Mean percentage change in PV was −16.9±13.9% and −18.1±14.2% (p=0.5) in the pitavastatin and atorvastatin group, respectively. Upper limit of the 95% confidence interval of the mean difference in percentage change in PV between the two groups (1.11% (−2.27 to 4.48)) did not exceed the pre-defined non-inferiority margin of 5%. There was no significant correlation between percent change in plaque volume and LDL-C at baseline or at follow-up. Early intensive statin therapy with 4mg/day of pitavastatin or 20mg/day of atorvastatin in Japanese patients with ACS resulted in remarkable regression of coronary PV. The effect of pitavastatin 4mg/day on coronary PV was similar to that of atorvastatin 20mg/day.
Abstract 2016: Levosimendan Infusion in Patients with Myocardial Infarction and High Systemic Vascular Resistance
Authors: Tsagalou Eleftheria P , Anastasiou-Nana Maria , Ntalianis Argyrios , Lazaris Nikolaos , Bonios Michail , Kaldara Elisavet , Tseliou Eleni , Katsaros Fotis , Nanas John
Published: July 2021

Background: Levosimendan, a novel inodilator, has been shown to improve hemodynamic function in patients with decompensated heart failure with preserved arterial blood pressure. Data on its use in patients with cardiogenic shock are scarce. The present series describes the 24-h hemodynamic effects of levosimendan as add-on therapy in patients with cardiogenic shock.

Methods: Levosimendan was administered for 24 hours (dose ranging from 0.05 to 0.2μg/kg/min), in addition to catecholamines, in 25 patients who suffered from cardiogenic shock after acute myocardial infarction. Hemodynamic measurements were performed at baseline (prior to levosimendan infusion) and at 24 hours after initiation of levosimendan.

Results: Hemodynamic improvement was evident only in patients (Group 1, n=13) with increased systematic vascular resistance (SVR>18Wood). Levosimendan administration increased the cardiac index ( 2.1±0.4 l/min/m2 from 1.5±0.3l/min/m2, p=0.002) and cardiac power (0.645±0.179W from 0.462±0.164W, p=0.022) and decreased SVR (21±6.7Wood from 23±5Wood, p=0.001) and pulmonary cappillary wedge pressure (16±11mmHg from 23±5mmHg, p=0.059). On the other hand, patients with low systemic vascular resistance (SVR<19Wood)) (Group B, n=12 ) did not have hemodynamic improvement with levosimendan administration.

Conclusions: Levosimendan infusion added to catecholamines in patients with cardiogenic shock after myocardial infarction exerts hemodynamic benefit only in the subgroup of patients with high SVR.
Abstract 2122: ECG Quantification of Myocardial Scar in Cardiomyopathy Patients with or without Conduction Defects: Correlation with Cardiac Magnetic Resonance and Arrhythmogenesis
Authors: Strauss David G , Selvester Ronald H , Lima João A , Arheden Håkan , Miller Julie M , Gerstenblith Gary , Marbán Eduardo , Weiss Robert G , Tomaselli Gordon F , Wagner Galen S , Wu Katherine C
Published: July 2021

Background
: Myocardial scarring from infarction (MI) or nonischemic fibrosis forms an arrhythmogenic substrate. The Selvester QRS-score estimates MI size by quantifying changes in Q-, R- and S-wave durations, amplitudes and morphologies from the 12-lead electrocardiogram (ECG). It provides 32 possible points with each point reflecting scarring of 3% of the left ventricle (LV). Although QRS scoring has been extensively validated for estimating MI scar size in the absence of ECG confounders, it has not been validated in patients with left ventricular hypertrophy (LVH), fascicular/bundle branch blocks or nonischemic scar. We assessed the hypotheses that

QRS-scores (modified for each conduction type) correctly identify and quantify both ischemic and nonischemic scar as compared to the reference standard of Cardiac Magnetic Resonance - Late Gadolinium Enhancement (CMR-LGE) and

QRS-estimated scar size is associated with inducible sustained monomorphic ventricular tachycardia (MVT) during electrophysiologic (EP) testing.

Methods and Results:
A prospective 162 patient cohort with LV dysfunction (95 ischemic, 67 nonischemic) received 12-lead ECG and CMR-LGE before defibrillator (ICD) implantation for primary prevention of sudden cardiac death. QRS-scores correctly diagnosed CMR-scar presence with receiver operating characteristics (ROC) area under the curve (AUC)=0.91 and correlation for scar quantification of r=0.74, p<0.0001, for all patients. Performance within the LVH, bundle branch/fascicular block and nonischemic subgroups ranged from AUC 0.81– 0.94, r=0.60 – 0.80, p<0.001 for all. Of the 137 patients undergoing EP or device testing, 37/82 (45%) of ischemic and 7/55 (13%) of nonischemic patients had inducible MVT. For each 3 QRS point increase (9% LV scarring), the odds ratio for inducing MVT was 2.2 [95% CI: 1.5–3.2, p<0.001] for all patients; 1.7 [1.0 –2.7, p=0.04)] for ischemics; and 2.2 [1.0 –5.0, p=0.05] for nonischemics.

Conclusions
: Compared to CMR, QRS-scores identify and quantify MI and nonischemic scar despite ECG confounders. Higher QRS-estimated scar size is associated with increased arrhythmogenic potential and warrants further study as a risk-stratifying tool for patients with left ventricular dysfunction.
Abstract 2123: ECG Markers to Predict Cardiovascular Death: Heart Rate Variability, Deceleration Capacity and Morphologic Variability in Non-ST-Elevation ACS from the MERLIN-TIMI 36 Trial
Authors: Syed Zeeshan , Scirica Benjamin M , Morrow David A , Mohanavelu Satishkumar , Stultz Collin M , Guttag John V
Published: July 2021

Background
: ECG parameters such as heart rate variability (HRV), deceleration capacity (DC) and morphologic variability (MV) may help identify patients at high risk post-ACS. These techniques measure specific aspects of cardiac health. HRV studies sympathovagal modulation of heart rate, DC extends heart rate turbulence by measuring acceleration-deceleration patterns, and MV quantifies variability in the shape of the ECG signal associated with myocardial instability. We assessed the relationship among HRV, DC and MV, and cardiovascular (CV) death after NSTEACS.

Methods
: HRV, DC and MV were calculated in 2164 placebo patients in the MERLIN-TIMI 36 trial using 24 hour Holter ECG after randomization. For each measure, patients were split into high and low risk groups (cutpoints chosen from literature: HRV LF/HF=1.2 [33.5%], DC<2.5 ms [9.7%], MV LF/HF=3.7 [11.6%]). Mean clinical follow-up was 1 year.

Results
: Each ECG variable was associated with CV mortality when included alone in the multivariate model with the TIMI risk score (TRS) at 30 days (HR 2.8 p=0.008 for HRV, HR 4.5 p<0.001 for DC and HR 5.1 p<0.001 for MV) and at 1 year (HR 2.9 p<0.001 for HRV, HR 2.8 p<0.001 for DC and HR 2.4 p<0.001 for MV). There was a stepwise increase in the risk of CV death at 1 year according to the number of abnormal ECG parameters, even after adjusting for the TRS.

Conclusions
: HRV, DC and MV are significantly associated with CV death both in the short and medium term following NSTEACS. Patients with multiple ECG abnormalities are at highest risk. These ECG parameters may provide complementary information to better risk-stratify patients following ACS.