bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 2135: Correlation between Resting Heart Rate and Defibrillation Energy Threshold in Patients Undergoing Implantable Cardioverter Defibrillator Device Implantation
Authors: Anousheh Ramtin , Krummen David E , Sawhney Navinder S , Chen Wei Chung , Tone Linda , Feld Gregory K
Published: July 2021

To investigate the association between resting heart rate (HR) and defibrillation threshold (DFT) in patients (pts) undergoing ICD implantation. DFT testing is usually considered standard of care during ICD implantation. However, the risk factors for high DFTs remain ill defined and the extent of testing required at implant has not been well defined. Baseline HR has been associated with higher DFTs in prior studies. We studied 128 pts undergoing ICD implantation. Baseline HR and DFTs were determined. HR was determined using ECGs obtained in the resting position on the day of ICD implantation. DFT testing was done during ICD implantation. We excluded 13 pts who were on amiodarone. The baseline characteristics of pts in the study are shown below in the table

below (values in parenthesis represents standard error of the mean): First, a multivariate analysis of the association between baseline HR and DFT was performed, adjusting for left ventricular ejection fraction (LVEF), gender, body surface area (BSA) and beta blocker therapy. For every 10 beat increase in heart rate, DFT increased by 1 joule (p=0.02). Gender and beta blocker therapy did not effect this association. Second, pts were dichotomized based on DFTs to low (<15 joules) and high (≥15 joules). Mean resting HR was significantly higher among pts with high DFT (79 bpm) compared to those with low DFT (70 bpm) after adjusting for LVEF and BSA (p=0.01). Baseline resting HR is a risk factor for high DFT and may help define a higher risk pt population undergoing DFT testing.
Abstract 2198: Left Ventricular Asynchrony Contributes to Symptoms in Patients with Hypertrophic Cardiomyopathy
Authors: Maras Dejan , Chung Robin , Duncan Alison M , Thorp Christine , Li Wei , Henein Michael Y
Published: July 2021

Objective:
Hypertrophic cadiomyopathy (HCM) results in exertional symptoms due to limited cardiac output that improve after removal of the left ventricular outflow tract (LVOT) obstruction. We aimed to assess the effect of pharmacological stress on LV asynchrony in a group of patients with HCM limited by exertional breathlessness.

Methods:
We studied 17 normal controls (aged 58 ± 12 years) and 37 HCM patients (aged 54 ± 15 years, 13 female) with septal thickness >15 mm using Doppler echocardiography, at rest and at peak dobutamine stress. Stress end points were symptoms, >20 mmHg drop in systolic blood pressure, arrhythmia, or maximum dobutamine infusion of 40μcg/kg/min. Ventricular asynchrony was assessed by total isovolumic time and Tei index.

Results:
At rest: LVOT velocity was raised in HCM patients compared to normals (2.0 ± 0.9 v 1.0 ± 2.4, p<0.001, respectively). Total isovolumic time was not significantly different between HCM and normals (10.6 ± 4.4 v 12 ± 2 s/min, respectively), and Tei index was not significantly different between HCM and normals (0.6 ± 0.1 v 0.54 ± 0.2, p=NS, respectively). At peak stress: LVOT velocities increased in HCM compared to normals (4.3 ± 1.7 v 1.7 ± 1.0 m/s, p<0.005, respectively) due to systolic anterior movement of the mitral valve. Total IVT decreased in both HCM and normals (6.3 ± 5.2 v 5 ± 2 s/min,p<0.005, compared to resting values, respectively) as did Tei index (0.24 ± 0.04 v 0.23 ± 0.06, p<0.01, respectively). Total LV filling time decreased in HCM but increased in normals (HCM rest v stress: 29.6 ± 4.5 v 27.5 ± 4.5 s/min, p< 0.05; normals rest v stress 28 ± 4 v 33 ± 3 s/min, p<0.005). QRS duration increased with stress in HCM patients (rest v stress: 103 ± 28 v 110 ± 26 ms, p<0.01), but decreased in normals (rest v stress. 91 ± 9 v 87 ± 8 ms, p=NS).

Conclusion:
Stress results in LV outflow tract obstruction in HCM patients, resulting in known pathophysiological consequences– mitral regurgitation and raised left atrial pressure. In addition, increased ventricular asynchrony compromises filling time. The historical benefit from DDD pacing in this condition may be explained on the basis of LV resynchronisation rather than simply drop in outflow tract gradient.
Abstract 2199: Left Ventricular Diastolic Function Impacts Age Based Differences in Exercise Capacity
Authors: Grewal Jasmine , McCully Robert B , Lam Carolyn S , Kane Garvan C , Pellikka Patricia A
Published: July 2021

Limited information exists regarding the echocardiographic and clinical predictors of exercise capacity and their effects on exercise with advancing age or by sex. We hypothesized that LV diastolic function (DF) impacts exercise capacity to a greater degree with advancing age. This was a prospective cohort study of consecutive patients undergoing routine exercise echocardiography with the Bruce protocol (n=2955). DF assessments at rest and exercise were performed. Those with echocardiographic exercise-induced ischemia and significant valvular disease were excluded. Univariate and multivariate analyses were conducted to determine the strongest echocardiographic and clinical predictors of exercise capacity (METs). Results were reported as unstandardized β coefficient (Standard Error) as outlined beside each variable. Age and sex interactions of these predictors with exercise capacity were determined. The strongest independent multivariate predictors of exercise capacity were female vs. male sex [−1.98 (0.07), p<0.0001], body mass index >30 kg/m
2
[−1.24 (0.08), p<0.0001], age per 10 year increment [−0.85 (0.01), p<0.0001], mild resting diastolic dysfunction vs. normal [−0.70 (0.10), p<0.0001], and moderate/severe resting diastolic dysfunction vs. normal [−1.3 (0.13), p<0.0001]. LV filling pressures measured by a resting E/e’ ≥ 15 [−0.42 (0.14), p=0.004] or exercise E/e’≥ 15 [−0.31 (0.14), p<0.0001] similarly predicted a reduction in exercise capacity, each in separate multivariate analyses. The impact of impaired relaxation and left ventricular filling pressures on exercise capacity increased with advancing age (p<0.001 and p=0.02 respectively), and was most marked after age 50. These predictors had a similar negative effect on exercise capacity among men and women (p=NS). In conclusion, in this large population referred for exercise echocardiography and not limited by ischemia, resting DF and resting/exercise LV filling pressures independently predicted exercise capacity. The increasingly potent effect of impaired relaxation and exercise LV filling pressures with advancing age suggest that DF plays an important role in the development of exercise intolerance in the elderly.
Abstract 2209: Velocity Vector Imaging in Evaluation of Subclinical Right Ventricular Dysfunction in Obstructive Sleep Apnea Patients without Systemic and Pulmonary Arterial Hypertension
Authors: Tugcu Aylin , Yildirimturk Ozlem , Tayyareci Yelda , Demiroglu I C , Aytekin Saide
Published: July 2021

To evaluate regional right ventricular (RV) myocardial velocity, strain and strain rate alterations in newly diagnosed obstructive sleep apnea (OSA) patients without systemic and pulmonary arterial hypertension and to correlate OSA severity to RV dysfunction using Velocity Vector Imaging (VVI). The OSA group consisted of 27 obese patients who were found to have moderate-to-severe OSA, and the control group of 26 age and body mass index-matched healthy subjects who were found not to have OSA on their first polysomnographic testing. All subjects underwent 24-hour ambulatory blood pressure monitoring and conventional echocardiography to exclude systemic and pulmonary arterial hypertension. Peak systolic myocardial velocities, strain and strain rates were determined at the basal and mid segments of RV free wall by VVI. Systemic and pulmonary artery pressures were within normal limits in both groups. Peak systolic myocardial velocities, strain and strain rates were significantly impaired in patients with OSA compared to controls (Table 1

). The apnea hypopnea index (AHI) correlated strongly with all indices obtained by VVI (basal velocity: r=−0.563, p<0.001; basal strain: r=−0.587, p<0.001;basal strain rate: r=−0.372, p<0.006, mid velocity: r=−0.559, p<0.001, mid strain: r=−0.689, p<0.001;mid strain rate: r=−0.658, p<0.001). The structural consequences of OSA in the RV is influenced by the severity of AHI. These effects occur independently from obesity and systemic hypertension. VVI can accurately recognize and quantify abnormalities of RV function in these subgroup of patients.

Table 1
Abstract 2211: Left Ventricular Stroke Volume Values Measured by 2- D Echocardiographic Volumetric and Doppler-Based Methods Cannot be Used Interchangeably
Authors: Barasch Eddy , Han Jing , Petillo Florentina , Passick Michael , Reichek Nathaniel
Published: July 2021

The values of left ventricular stroke volume (SV) measured by Doppler and 2-D echo are frequently reported as if they were interchangeable. No systematic evaluation of the agreement between these methods has been done. To determine the agreement, correlation and reproducibility of SV values measured by 2-D echo and Doppler methods. 107 healthy subjects (mean age 59 ± 14 yrs, 59 % females), had comprehensive echocardiographic evaluation. 2-D LV volumes (2D) were measured by the biplane Simpson’s method. For Doppler, the product of the area of the LV outflow tract (LVOT) x LVOT time velocity integral (TVI), and the area of aortic annulus (AA), and the product of aortic cusp separation (ACS) x aortic TVI were used. Mixed model analysis of variance was performed and Bland Altman agreement limits, Pearson correlation and within-subject coefficient of variation and intraclass correlation coefficient were determined. The mean SV (ml/beat) measured by 2-D and Doppler methods using LVOT, AA and ACS area were: 64 ± 18, 65 ± 15, 76±14, 70 ± 16, respectively. No differences were found between LVOT and 2-D (p = 0.99), borderline between LVOT and ACS (p = 0.051) and significant differences were found between all the other methods. The within-subject coefficient of variation was 19.3% and the intraclass correlation coefficient =0.71, for all the methods indicating good reproducibility. Bland Altman 95% agreement limits for LVOT vs. 2-D were −38.0 and 38.6 ml/beat. The correlation coefficients for all 4 methods are given below. 1. In healthy subjects, although no significant differences were found between mean SV values measured by 2-D and Doppler LVOT methods, the correlation was weak and the agreement limits were large. 2. There was a modest correlation between the Doppler methods and between AA, ACS and 2-D, but the mean SV values were significantly different. 3. SV values measured by these 4 methods cannot be used interchangeably.
Abstract 2221: Long-Term Administration of Thiazolidinedione Provides Multiple Ultrasonic Manifested Antiatherosclerotic Effects Independent of Diabetic Improvement for Type-2 Diabetics Receiving Angiotensin-II Receptor Blocker
Authors: Murakami Tatsuaki , Misawa Katsushi
Published: July 2021

Background:
Insulin resistance and type-2 diabetes mellitus are thought to be highly involved in complex atherothrombogenic processes, but the long-term effects of insulin sensitizing agents remain partially clarified. We assessed hypothesis that long-term use of thiazolidinedione, an insulin sensitizer, pleiotropically inhibits atherosclerotic progression in patients treated with angiotensin-II receptor blocker, one of the best possible antiatherosclerotic therapies.

Methods:
Thirty-two type-2 diabetic patients treated with angiotensin-II receptor blocker were randomized to group-T where they received troglitazone (400mg/day) or pioglitazone (30mg/ day), or to group-C where they continued therapy without thiazolidinedione for more than 2 years. We quantified flow-mediated dilation of brachial artery after 5 minutes forearm occlusion (FMD), dilation of brachial artery after sublingual administration of nitroglycerin (TNG), and intima-media thickness of common carotid artery (IMT) using high-resolution ultrasonography. Changes in FMD, TNG, and IMT were compared between the 2 groups.

Results:
Group-T (n=16) manifested improvements in diabetic variables while group-C showed no improvement. FMD (%) increased after medication in group-T (p<0.01) but remained unchanged in group-C (p=0.86). TNG (%) remained unchanged in both groups. IMT (mm) decreased in group-T (p=0.03) but remained unchanged in group-C (p=0.12). Changes of FMD or IMT in group-T did not correlate to those of HbA1c (FMD: r=0.21, p=0.70, IMT: r=0.22, p=0.62).

Conclusion:
These results indicate long-term therapy with thiazolidinedione in diabetic patients receiving angiotensin-II receptor blocker additionally improves endothelial function, and reduces arterial wall thickness independent of reversal for diabetic status, which may have novel potential benefit for management of atherosclerosis in type-2 diabetics treated with standard antiatherosclerotic therapies.
Abstract 2252: Hemodynamic and Functional Assessment of Mechanical Aortic Valves Using Combined Echocardiography and Multidetector Computed Tomography
Authors: LaBounty Troy , Agarwal Prachi P , Chughtai Aamer , Kazerooni Ella A , Wizauer Eric , Bach David S
Published: July 2021

Introduction: Transthoracic echocardiography (TTE) can evaluate hemodynamics of mechanical aortic valve replacements (AVR), but may not be able to discriminate causes of suspected valve malfunction.

Hypothesis: Combined TTE and multidetector computed tomography (MDCT) may enhance hemodynamic and functional evaluation of AVR.

Methods: Retrospective assessment of 41 consecutive patients with AVR (27 bi-leaflet, 14 tilting-disc) and both TTE and 64-slice ECG-gated MDCT. Two cardiologists (TTE) and two radiologists (MDCT) independently, blindly evaluated studies. TTE measured cardiac index (CI), mean pressure gradient (MPG), effective orifice area (EOA), aortic insufficiency (AI), and sinotubular area (STA). Energy loss coefficient (ELCo) (correcting EOA for pressure recovery) was calculated: ELCo = (STA*EOA)/(STA-EOA). MDCT measured opening angles (OA), geometrical orifice area (GOA), and STA. Patients with elevated MPG (>15 mm Hg) were assessed for low EOA, low OA (>20° below specification), patient-prosthesis mismatch (PPM) (EOA/body surface area <0.85 cm
2
/m
2
), high CI (>4.0 L/min/m
2
), and AI.

Results: There was excellent correlation but a significant difference between the EOA and ELCo (r=0.97, p<0.001; 2.2 ± 0.8 vs. 3.1 ± 1.5 cm
2
, p<0.001). GOA was larger than and only moderately correlated with EOA (r=0.61, p<0.001; 3.6 ± 0.9 vs. 2.2 ± 0.8 cm
2
, p<0.001), with a smaller difference between GOA and ELCo (r=0.55, p<0.001; 3.6 ± 0.9 vs. 3.1 ± 1.5 cm
2
, p<0.001). Elevated MPG was observed in 16 patients, with a low EOA in 2 of these patients. Additional potential etiologies of elevated MPG included PPM in 8 patients and high CI in 4 patients; no patient had a low OA or > mild AI. Either PPM or high CI could be attributed to 12 of 16 patients with elevated gradients, while these were observed 7 of 27 patients with normal gradients (p=0.004).

Conclusion: MDCT is additive to the hemodynamic assessment from TTE, allowing for complete assessment of mechanical AVR hemodynamics and function, including detection of prosthesis OA, and enhances correction for pressure recovery using ELCo. Among patients with elevated gradient on TTE, MDCT allows further assessment to distinguish abnormal prosthesis function from other etiologies including PPM and pressure recovery.
Abstract 2254: Can Left Atrium Predict Survival After an Acute Coronary Syndrome?
Authors: Teixeira Rogerio , Lourenco Carolina , Antonio Natalia , Baptista Rui , Jorge Elisabete , Monteiro Silvia , Monteiro Pedro , Freitas Mario , Providencia Luis A
Published: July 2021

Echocardiography is a crucial tool for the management of the acute coronary syndrome (ACS) patients. To evaluate if left atrium (LA) diameter as a prognostic index in ACS patients. 886 consecutive patients admitted for ACS in a single coronary care unit, between May 2004 and December 2006, and who had echocardiography assessment during admission. Left atrium (LA) diameter was defined by M-Mode paraesternal long axis view. A one-year clinical follow up targeting all-cause mortality was performed. Median age of the population was 66.6±12.2 years, 71.0% were male, and 57.4% were admitted for a non-ST elevation ACS. The area under the operating curve for the LA as a predictor of one year all cause mortality was 0.65 and a cut off of 46 mm had a sensitivity of 67.5% and a specificity of 70.9% for this endpoint. After stratifying the population for this cutoff value of LA diameter, we concluded that patients with a LA diameter ≥ 44mm were older (69.6±11.2 vs 65.3±13.0 years), had a more frequent previous history of, diabetes, dyslipidemia, atrial fibrillation, and a higher body mass index. These patients were more often admitted for an invasive strategy (41.8 vs 32.3% p=0.005), but had a similar coronary anatomy and a similar chance for a complete percutaneous revascularization (49.0 vs 53.0, p=0.37). They had a lower left ventricular ejection fraction (49.6±11.8 vs 52.6±9.6%, p<0.001) higher ventricular dimensions, and presented more often on higher Killip-Kendal classes. There were no associations between LA diameter and LDL cholesterol, admission glycaemia or renal function. In-hospital mortality was similar for both groups (0.3 vs 0.0%, p=0.15), but patients with a LA diameter ≥ 46mm had a one-year survival significantly lower (86.6% vs 94.0%, log rank p < 0.001). This result persisted after an adjusted analysis on a Cox regression model (HR 1.69, 95%CI 1.02 – 2.80 for LA diameter ≥ 44) that included age, gender, diabetes, body mass index and treatment strategy during admission. In our population this simple echocardiographyc parameter was associated with a higher risk profile and worse prognosis on the medium term, and therefore LA diameter should also be included in the global risk assessment of ACS patients.
Abstract 2272: Three Year Survival of Drug-Eluting Stents versus Coronary Artery Surgery in Multivessel Coronary Disease
Authors: Malenka David J , Langner Craig W , Robb John F , Dacey Lawrence J , Kellett Mirle A , Quinn Reed D , Silver M. Theodore , Lee Peter N Ver , Clough Robert A , Hearne Micheal J , Westbrook Benjamin M , Watkins Matthew W , Leavitt Bruce J , O’Connor Gerald T
Published: July 2021

Background.
Several studies have compared survival following bare metal stenting (BMS) to coronary artery bypass grafting (CABG). Less is known about how survival following drug eluting stenting (DES), which compared to BMS has a lower risk of repeat revascularization and better survival, compare to CABG.

Methods.
From our Northern New England percutaneous intervention (PCI) and CABG registries we identified nonemergent multivessel disease patients who received a DES (n=2520) or underwent CABG (n=2626) in 2004 –2006 and compared 3-year survival through 2007. We adjusted for differences in baseline patient characteristics using Cox proportional-hazards models and propensity matching.

Results.
CABG patients had more diabetes, peripheral vascular disease, 3 vessel disease, and more complete revascularization. There was an increased early risk of death through 45 days that was higher for CABG than DES (Figure

). Following this early risk, the survival curves were linear, with a higher annual mortality rate for DES (4.1%/year) than for CABG (2.2%/year). The adjusted survival at 3 years for CABG (90.9%) was better that for DES (87.6%, p<0.01). This finding was robust for all patient subgroups and after propensity matching.

Conclusion
. For patients with multivessel disease, survival at 3 years is better following CABG than DES, though the initial risk is higher with CABG.
Abstract 2284: Long-Term Outcomes of Percutaneous Mitral Balloon Valvuloplasty Versus Open Heart Surgery
Authors: Song Jae-Kwan , Kim Mi-Jeong , Yun Sung-Cheol , Choo Suk Jung , Song Jong-Min , Song Hyun , Kang Duk-Hyun , Chung Cheol Hyun , Park Duk Woo , Lee Seung Whan , Kim Young-Hak , Lee Cheol Whan , Hong Myeong-Ki , Kim Jae-Joong , Lee Jae Won , Park Seong-Wook , Park Seung-Jung
Published: July 2021

Late functional deterioration after percutaneous mitral valvuloplasty (PMV) has raised the issue of comparing long-term outcomes between PMV and open-heart surgery (OHS). The study evaluated 402 patients who underwent PMV and 159 patients who underwent OHS between January 1, 1995, and December 31, 2000. The rates of cardiovascular death or repeated intervention (redo-PMV or OHS) were determined over a median follow-up of 109 months (mean±SD 106±27). The therapeutic effects on adverse outcomes were estimated using Cox’s proportional hazards model adjusting differences in the severity of illness before intervention, and the effects of the cardiac rhythm and echocardiographic score were also tested. The observed (unadjusted) event-free survival rate was similar for both groups, and the hazard ratio for the clinical events after PMV as compared with after OHS was 1.510 (95% confidence interval [CI], 0.914 –2.496, p=0.1079). However, the adjusted hazard ratio was 3.729 (95% CI, 1.963–7.082, p<0.0001), showing a higher event-free survival rate in the OHS group. The adjusted hazard ratios after PMV as compared with after OHS in patients with echocardiographic scores ≥8 and atrial fibrillation were 5.348 (95% CI, 2.504 –11.422, p<0.001) and 3.440 (95% CI, 1.805– 6.555, p=0.0002), respectively, whereas the hazard ratios in patients with echocardiographic scores <8 and normal sinus rhythm did not show differences. OHS was associated with a higher adjusted rate of long-term event-free survival than PMV. Patients with high echocardiographic scores or atrial fibrillation showed better outcomes after OHS.
Abstract 2301: Frail Elderly Patients at Increased Risk for Mortality and Prolonged Institutional Care After Cardiac Surgery
Authors: Lee Dana H , Martin Billie Jean , Yip Alexandra M , Buth Karen J , Hirsch Gregory M
Published: July 2021

Patients referred for cardiac surgery are increasingly older, but chronological age does not always capture biological age. This study assessed frailty, as a functional parameter of biological age, as a predictor of mortality or prolonged institutional care. Functional measures of frailty and clinical preoperative data were collected for all cardiac surgery patients at a single center (2004 –2007). Based on the Katz Index of Activities of Daily Living, frailty was defined as any impairment in feeding, bathing, dressing, transferring, toileting, continence, or ambulation, or dementia. The impact of frailty on in-hospital mortality or institutional discharge (other hospital or nursing facility) was assessed with multivariate logistic regression. The interaction of frailty and age was examined, with non-frail patients age<70 as the referent group.

Results:
Of 3096 patients, 133 (4.3%) were frail. Frail patients were older, more likely to be female, have COPD, CHF, EF<40%, recent MI, pre-operative renal failure, cerebrovascular disease, greater acuity, and more complex operations (p<0.05). Frail patients experienced higher rates of mortality, sepsis, delirium, post-operative renal failure, and transfusion (p<0.001). A greater proportion of frail patients than non-frail patients (49% vs. 9%) were discharged to a setting other than home. In the risk-adjusted models, frailty was an independent predictor of mortality (OR 1.8, 95% CI 1.0 –3.2) or institutional discharge (OR 6.4, 95% CI 4.1–9.9). Furthermore, frail elderly (age≥70) patients had greater risk of institutional discharge (OR 22.7, CI 12.4 – 41.7) than frail younger patients (OR 6.5, CI 3.4 –12.5) or non-frail elderly patients (OR 3.5, CI 2.6 – 4.6). Similarly, frail elderly patients had greater risk of mortality (OR 4.0, CI 1.9 – 8.1) than frail younger patients (OR 1.9, CI 0.8 – 4.7) or non-frail elderly patients (OR 2.4, CI 1.7–3.5). Frailty was an independent predictor of in-hospital mortality and prolonged institutional care. Frailty combined with older age further discriminated those at highest risk. Special consideration should be given to the management of frail elderly patients who have surgical cardiac disease.
Abstract 2303: The Short-term Benefits of Off-pump Coronary Artery Bypass for Diabetes Patients Disappears in the Long Run
Authors: Yuan Xin , Zhe Zheng , Hu Shengshou
Published: July 2021

Numerous studies revealed the adverse impacts of diabetes on the outcomes of coronary artery bypass grafting (CABG). However, the disparities of impacts of different surgical techniques on the prognosis of diabetes and non-diabetes patients were still unknown. The objective of this study was to evaluate the possible beneficial effects of off-pump CABG (OPCAB) on the immediate as well as long term postoperative outcomes. From 1999 to 2005, 5550 consecutive patients underwent isolated conventional CABG (cCABG) or OPCAB in our institute. All patients have finished a 3-year follow up. In-hospital MACE includes cardiac death, stroke and myocardial infarction. As for MACE in the follow-up, the definition was the combination of cardiac death, stroke, myocardial infarction and revascularization. These data were prospectively collected and retrospectively reviewed. After risk adjustment, diabetes patients in cCABG group had an OR of 1.385 (p<0.001) for immediate mortality and 1.291 (p<0.010) for immediate MACE comparing with non-diabetes patients receiving cCABG. On the contrary, no significant differences were found when comparisons between diabetes and non-diabetes patients undergoing OPCAB were carried out, indicating beneficial effects of OPCAB for diabetes patients in short terms. However, while the risk-adjusted HR of diabetes patients for long-term mortality and for long-term MACE in cCABG group were 1.130 (p=0.003) and 1.781 (p=0.001) respective, those in OPCAB group were 1.082 (p=0.077) and 1.038 (p<0.001). These results suggested that although the beneficial effects of OPCAB for diabetes patients in terms of mortality still remained, those in terms of long-term MACE disappeared. Although reductions of differences of in-hospital adverse outcomes between diabetes and non-diabetes patients undergoing OPCABG were seen, these beneficial effects were mitigated in the long run.
Abstract 2305: Determinants of Outcomes Following Mitral Valve Surgery in Patients with Severe Organic Mitral Regurgitation and No or Mild Symptoms
Authors: Magne Julien , Mathieu Patrick , Dagenais François , Charbonneau Eric , Dumesnil Jean G , Pibarot Philippe
Published: July 2021

The optimal timing of mitral valve surgery in patients with severe organic mitral regurgitation (OMR) and no or mild symptoms is highly controversial. The aim of this study was thus to determine the preoperative predictors of mortality following mitral valve surgery in patients with severe OMR and no or mild symptoms. Preoperative and operative data of 324 patients (65% of male, mean age: 65±13 years) with severe OMR and no/mild symptoms (NYHA class I and II) who underwent mitral valve surgery between 1992 and 2007 were prospectively collected in a computerized database. Mitral valve repair (MVRp) was performed in 132 (41%) and mitral valve replacement (MVR) in 187 (59%) patients. Operative mortality was low for both procedures (whole cohort: n=9, 2.7%; MVRp: n=2, 1.5%; MVR: n=7, 3.7%; p=0.34) but was significantly higher in the patients (n=167, 56%) with impaired preoperative left ventricular ejection fraction (LVEF) (<60%) (5.3% vs. 1.2%, p=0.04). Long-term survival was 93±2% at 5 years and 87±3% at 10 years. Patients with LVEF<60% had significantly reduced long-term survival compared to patients with normal LVEF (5-year: 89±4% vs. 95±5%, 10-year: 80±6% vs. 88±4%, p=0.049). Multivariate analysis identified age (Hazard-ratio [HR]= 1.03, 95% confidence interval (CI): 1–1.08, p=0.02), heart failure (HR= 1.9, 95%CI: 1.3–3, p= 0.0018), and LVEF (HR= 1.04, 95%CI: 1.01–1.07, p=0.0253) as independent predictors of long-term mortality. Furthermore, MVR was not associated with worse long-term survival on both univariate (p=0.83) and multivariate (p=0.98) analysis. Performing mitral valve surgery is safe in patients with severe OMR and no or mild symptoms. Impaired LVEF is associated with increased short- and long-term mortality, suggesting that these patients should be promptly operated before the onset of LV dysfunction.
Abstract 2325: Endothelial Progenitor Cells Are Decreased In the Blood And In The Graft Of Heart Transplant Patients With Microvasculopathy
Authors: Osto Elena , Tona Francesco , Fadini Gianpaolo , Castellani Chiara , Baesso Ileana , Gambino Antonio , Agostini Carlo , Tarantini Giuseppe , Vinci Annalisa , Avogaro Angelo , Caforio Alida L , Gerosa Gino , Thiene Gaetano , Angelini Annalisa , Iliceto Sabino
Published: July 2021

We assessed the relationship between peripheral blood progenitor cells (PCs), their incorporation into allografts and coronary microvascular function in heart transplant (HT) patients.

Methods
: PCs were determined by flow cytometry on the basis of the surface expression of CD34, CD133, and KDR antigens: CD34
+
, CD133
+
, CD34
+
CD133
+
, CD34
+
KDR
+
, CD133
+
KDR
+
, and CD34
+
CD133
+
KDR
+
. Biopsies at 2 different time points were examined. Immunoistochemistry for stem cells marker c-Kit, endothelial progenitor cells VEGFR-2, and CD34 was performed in serial sections in the all biopsies. Cells positive for each marker was counted in all biopsy area-section and the number obtained was corrected by area-section. Coronary flow velocity in the anterior descending coronary artery was detected at rest and during i.v. adenosine by transthoracic echocardiography. Coronary flow reserve (CFR) was the ratio of hyperaemic diastolic mean velocity (DMV) to resting DMV. CFR < 2 was considered abnormal. CFR was measured in 29 pts (24 M, age at HT 50 ± 12 years) and was abnormal in 6 (group A) and normal in 23 (group B).

Results
: CFR was lower in group A (1.5 ± 0.1 vs 3.3 ± 0.8, p < 0.0001). CD34
+
KDR
+
, CD133
+
KDR
+
, and CD34
+
CD133
+
KDR
+
cell count were lower in group A (p < 0.05) (Figure

). Endothelial progenitor cells VEGFR-2 on biopsies tended to be lower in group A (p < 0.06) and are related with circulating CD133
+
KDR
+
, and CD34
+
CD133
+
KDR
+
(r = 0.752, p = 0.003 and r = 0.513, p = 0.052, respectively).

Conclusion
: Endothelial progenitor cells are decreased in the blood and in the graft of HT patients with microvasculopathy. Mobilization and engraftment of PCs in HT may be involved in the pathogenesis of allograft vasculopathy.
Abstract 2362: High Serum Erythropoietin Level is Associated with Poor Prognosis in Heart Failure Patients with Systolic Dysfunction but not with Preserved Systolic Function
Authors: Matsumoto Mika , Tsujino Takeshi , Lee-Kawabata Masaaki , Naito Yoshiro , Ezumi Akira , Nakao Shinji , Goda Akiko , Yoshida Chikako , Akahori Kunihiro , Sakoda Tsuyoshi , Ohyanagi Mitsumasa , Masuyama Tohru
Published: July 2021

Introduction: It is known that serum levels of erythropoietin (EPO) are elevated in patients with chronic heart failure (CHF) and correlate with the severity of CHF. Serum EPO levels have been examined in stable CHF patients with LV systolic dysfunction (LVSDF) but not in patients with preserved LV ejection fraction (PLVEF). Moreover, the data about EPO are also lacking in acute decompensated HF (ADHF) patients.

Hypothesis: Serum EPO levels may be different between patients with LVSDF and with PLVEF, and between patients in an acute decompensated state and in a stable, compensated state.

Methods: We studied 52 patients who were admitted to our hospital with ADHF (NYHA functional class of III or IV). There were 22 females, and mean age was 73 years. They were divided into 2 groups: LVSDF (LV ejection fraction (EF) < 45%, n = 37) and PLVEF (LVEF ≥ 45%, n = 15). Serum EPO, hemoglobin (Hb) and plasma brain natriuretic peptide (BNP) levels were measured on admission and after treatment. The estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease Study equation.

Results: On admission, serum EPO levels were higher in the LVSDF than in the PLVEF groups (84 ± 12 vs. 55 ± 9 mU/ml, p < 0.05). After treatment, NYHA functional classes equally improved to I or II, and serum EPO and plasma BNP levels decreased in both groups (LVSDF: 31 ± 5 vs. 84 ± 12 mU/ml, p < 0.05; 526 ± 82 vs. 1134 ± 163 pg/ml, p < 0.05; PLVEF: 24 ± 4 vs. 55 ± 9 mU/ml, p < 0.05; 240 ± 53 vs. 523 ± 87 pg/ml, p < 0.05). The Hb levels and eGFR were not different between the groups on admission. When plasma BNP levels were matched between the 2 groups, the same tendency was observed in the levels of EPO. The higher EPO levels (> 50 mU/ml) in ADHF were associated with higher incidence of cardiac death or HF hospitalizations (log-rank test, p < 0.05) only in the LVSDF group.

Conclusions: Serum EPO levels were higher in patients with LVSDF than in those with PLVEF in ADHF. Elevated serum EPO levels were associated with a poor prognosis in the LVSDF group, but not in the PLVEF group. Serum EPO levels may be useful prognostic value only in HF patients with LVSDF.
Abstract 2364: Chronic Heart Failure Leads to an Expanded Plasma Volume and Pseudoanemia, but Does Not Lead to a Reduction in the Body’s Red Cell Mass
Authors: Adlbrecht Christopher , Kommata Spyridoula , Hülsmann Martin , Szekeres Thomas , Bieglmayer Christian , Strunk Guido , Stoiser Brigitte , Karanikas Georgios , Berger Rudolf , Mörtl Deddo , Kletter Kurt , Maurer Gerald , Lang Irene M , Pacher Richard
Published: July 2021

Chronic heart failure (CHF) is frequently associated with a decreased hemoglobin level. Although in some patients renal anemia may develop, the mechanisms underlying the decrease in hemoglobin in isolated CHF remain largely unknown. We explored robust determinants of anemia including red cell mass as well as related markers and the plasma volume in patients with CHF without renal dysfunction based on non-cardiac reasons. One-hundred consecutive CHF patients were enrolled. The total red cell volume (RCV) was determined by a 51Cr assay. Furthermore, serum ferritin, erythropoietin, hepcidin, and renal function parameters were assessed. The influence of each factor on hemoglobin concentrations was determined in a multiple regression model. Mean hemoglobin concentrations were 11.7 ± 0.8mg/dL in anemic CHF patients and 14.4 ± 1.2mg/dL in non-anemic patients (p < 0.001). However, the RCV was not reduced (1659.3 ± 517.6mL versus 1826.4 ± 641.3mL, p = 0.194). There was no severe deficiency of iron or erythropoietin detectable in CHF patients but corrected reticulocytes were lower in anemic patients (35.1 ± 15.7G/L versus 50.3 ± 19.2G/L, p = 0.001). We found that plasma volume levels were significantly higher in anemic CHF patients, suggesting the presence of pseudoanemia (70.0 ± 2.4% versus 65.0 ± 4.0%, p < 0.001). Correspondingly, plasma volume was the best predictor of hemoglobin concentrations in the regression model applied (B = − 0.651, p < 0.001, R
2
= 0.769). Hemodilution appears to be the most potent factor for the development of low hemoglobin levels in patients with a broad spectrum of severity of heart failure. Our data support an additional independent, but minor influence of iron deficiency on lower than normal hemoglobin concentrations in CHF patients. The study results support not administering erythropoiesis stimulating agents to unselected CHF patients with lower than normal hemoglobin levels.
Abstract 2381: Socioeconomic Status is Associated with Increased Morbidity in Patients Enrolled in a Dedicated Heart Failure Program
Authors: Luu Jane T , Gans Christopher P , Mesgarzadeh Paymon , Stamos Thomas , Kao John A
Published: July 2021

Despite continued advances in medicine, the NIH has reported that differences in the incidence, prevalence, and burden of diseases persist between socioeconomic classes. Heart failure (HF) is the leading cause of hospitalizations in all patients over the age of 65. The effect of socioeconomic disparities on this major cause of morbidity has not been well studied. A retrospective analysis was performed on 500 patients with heart failure followed in the University of Illinois-Chicago heart failure clinic from 1/1/2000 –1/1/2008. Patients were stratified by household income and education level by correlating patient zip codes with the 2000 U.S. Census Data. The primary endpoint was admission for HF exacerbation. In patients with established HF, patients living in areas with lower median household incomes were significantly more likely to have a HF exacerbation (P = 0.006), as well as an increase in total exacerbations (P = 0.005) through an average follow up period of 5.2 years. The same trend was observed when areas were stratified according to the percentage of population with bachelor’s degrees. Overall, baseline characteristics were similar between groups. Significant differences by household income and education level were found in hypertension, presence of coronary artery disease and medication use (Tables 1

and 2

). Despite uniform treatment according to ACC/AHA guidelines, socioeconomic disparities were associated with increased morbidity in patients established in a dedicated heart failure program. Further studies are needed to address these disparities.

Heart Failure Outcomes by Median Household Income

Heart Failure Outcomes by Education
Abstract 2392: Effects of Combination Therapy with ACE and ARB in patients with Acute Decompensated Heart Failure or MI: A Meta-analysis
Authors: Jalandhara Nishant , Arora Rohit , Khosla Sandeep , Adigopula Sashikanth , Bhuriya Rohitkumar , Balamuthusamy Saravanan
Published: July 2021

Angiotensin converting enzyme (ACE) therapy reduces mortality and morbidity from cardiovascular causes in patients with vascular diseases or high risk diabetes without heart failure. The role of combination therapy with ACE and angiotensin II receptor blockers (ARB) is not precisely known. We have assessed the effect of combination therapy with ACE and ARB in patients with heart failure or myocardial infarction. Large randomized control trials that included heart failure or myocardial infarction patients in which ACE and ARB were used in combination and compared with ACE therapy alone were included for the meta-analysis. Systematic review of literature was performed in MEDLINE and OVID search engines. Chi-square test was used to assess inter-study heterogeneity. The effect of combination therapy was assessed by calculating Odds ratio using Revmans software. Results were computed using 95% CI and were considered significant with double sided alpha error < 0.05. Four trials (N = 29,732) fulfilled the inclusion criteria for the study. There was a significant benefit towards use of combination therapy using ACE and ARB in reducing the need for hospitalization for heart failure 0.89 [0.83, 0.95] (P = 0.0004). Although combination therapy had no benefit over ACE use for death due to cardiovascular cause and heart failure 0.96 [0.91, 1.01] (P = 0.15). Combination therapy is not inferior for mortality secondary to cardiovascular cause and heart failure. Although the combination therapy is shown to reduce hospitalization secondary to heart failure. There are more side effects with the use of combination therapy and should be used with caution.
Abstract 2395: Treatment of Nocturnal Cheyne - Stokes - Respiration by Adaptive Servoventilation Improves Sleep Disordered Breathing and Cardiopulmonary Function in Patients with Chronic Heart Failure
Authors: Oldenburg Olaf , Bitter Thomas , Schmidt Anke , Wellmann Birgit , Lehmann Roman , Prinz Christian , Langer Christoph , Horstkotte Dieter
Published: July 2021

Cheyne - Stokes respiration (CSR) is common in patients (pts) with chronic heart failure (CHF) and accompanied by an impaired prognosis. Nocturnal adaptive servoventilation (ASV) was recently introduced to treat CSR in CHF. Aim of this study was the investigation of long-term ASV effects on CSR and CHF parameters. In 41 pts with CHF treated according to current guidelines (39 male; 64.8 ± 10years, NYHA ≥ II, LV-EF ≤ 40%) cardiorespiratory polygraphy (PG), cardiopulmonary exercise (CPX) testing and echocardiography was performed before and after 11.6 ± 5.9 months (median 10.3 months) of ASV treatment (AutoSet CS
™
2, ResMed). In our cohort, mean duration of ASV usage during night was 6:25 ± 1:08 h, while the device was used in 82 ± 21% of possible nights. Apnea-hypopnea-index and apnea-index were reduced from 38.2 ± 11/h to 5.5 ± 7/h and 24.2 ± 14/h to 2.5 ± 5/h, respectively (both p < 0.001). Minimum oxygen saturation rose from 81.4 ± 4.9% to 85.6 ± 4.3% (p < 0.001) while mean oxygen desaturation was reduced from 6.8 ± 2.5% to 4.6 ± 1.8% (p < 0.001). Peak oxygen consumption (VO
2
) during CPX testing increased from 15.2 ± 3.7ml/kg/min to 17.1 ± 4.7ml/kg/min and predicted peak VO
2
from 60.1 ± 13% to 68.5 ± 18% (both p < 0.05). Left ventricular ejection fraction increased from 29.9 ± 6.6% to 33.3 ± 10.6% (p < 0.05). In selected and compliant pts with CHF and CSR, addition of nocturnal ASV therapy to standard heart failure therapy is able to abolish CSR and improve cardiac function. Whether this improvement in SDB and CHF parameters is accompanied with an improvement in CHF prognosis is not yet known.
Abstract 2398: Polymorphisms of Angiotensin Converting Enzyme and Endothelial Nitric Oxide Synthase Genes Act Synergistically to Increase the Risk of Cardiovascular Events in Patients with Hypertrophic Cardiomyopathy
Authors: Ogimoto Akiyoshi , Okayama Hideki , Ohtsuka Tomoaki , Suzuki Jun , Inoue Katsuji , Nishimura Kazuhisa , Nagai Takayuki , Shigematsu Yuji , Hamada Mareomi , Higaki Jitsuo
Published: July 2021

Background:
Patients with hypertrophic cardiomyopathy (HCM) have a small left ventricular cavity size due to hypertrophy. Therefore, reduction of venous return and intravascular volume in patients with HCM leads to low cardiac output and hypotension. We reported that the angiotensin converting enzyme insertion/insertion (ACE I/I) genotype, which leads to inhibitory renin-angiotensin system, is a significant risk factor for cardiovascular events (CE) in patients with HCM. Recently, the endothelial nitric oxide synthase (eNOS) gene polymorphism (Glu298Asp), which plays an important role in the modulation of cardiovascular physiology, is reported to be associated with heart diseases.

Methods and Results:
Genotyping at these loci was performed in 150 patients with HCM. This study design was a nested case-control study. The cardiovascular events were defined as cardiac death and hospitalization for stroke or congestive heart failure. Patients were divided into two groups: group A of 44 patients (29%) with one or more history of the cardiovascular events and group B of 106 patients (71%) without history of the cardiovascular events. Logistic-regression methods were used to determine the potential effect of each genotype and the interaction between them on the risk of CE. The odds ratio for cardiovascular events among persons who had ACE I/I genotype as compared with those with the other ACE genotypes was 2.5 (P < 0.01). In a dominant Asp allele model of the eNOS gene polymorphism, there was a significant difference in genotypes between the two groups (p < 0.01). In addition, there was a marked increase in the risk of CE among persons who were homozygous for both genotypes (ACE I/I and eNOS 298Glu/Glu) (odds ratio, 2.7, P < 0.01).

Conclusion:
The ACE I/I and eNOS 298Glu/Glu act synergistically to increase the risk of CE in patients with HCM. Genotyping at these two loci may be a useful approach for identification of persons with HCM at risk for CE.
Abstract 2401: Endothelial Dysfunction and Oxidative Stress in Human Coronary Microvasculature Following Acute Exposure to AL Amyloid Light Chains: New Mechanism of Amyloid Injury
Authors: Migrino Raymond Q , Hari Parameswaran , Bright Megan , Phillips Shane , Truran Seth , Wittenburg April , Wang Jingli , Gutterman David D
Published: July 2021

Light chain amyloidosis (AL), a plasma cell dyscrasia, is often fatal in patients with heart failure yet the mechanism of injury is unknown. We hypothesize that AL light chains (LC) acutely cause endothelial dysfunction in coronary arterioles. The aims are to measure endothelium-dependent and independent dilation and reactive oxygen species (ROS) in human coronary arterioles exposed to LC from AL subjects. Urine LC was isolated from 3 AL subjects by dialysis and lyophilization. Separately, 15 coronary arterioles were isolated from discarded atrial tissue from 12 non-AL subjects without significant vascular disease or diabetes undergoing open heart surgery (8 males, 70 ± 11 years). Arterioles were pressure-mounted and vessel diameter measured by videomicroscopy. Post-preconstriction with endothelin-1, vessels were exposed to vehicle and sequential doses of bradykinin (endothelium-mediated,10
−10
to 10
−6
M) then papaverine (endothelium-independent, 10
−4
M) were given and dilation was measured. Dilator response was again measured after 20 μg/mL of LC. Coronary arterioles were separately exposed to vehicle and LC and mitochondrial superoxide (MitoSox Red) and hydrogen peroxide (dichlorofluoroscein) were measured by fluorescence microscopy. see figure. Brief exposure to AL amyloid light chains impairs endothelium-dependent coronary vasodilation. This is associated with increased ROS production. This is the first human study demonstrating endothelial dysfunction in coronary microvasculature caused by AL LC. The vascular dysfunction and oxidative stress may be an important mechanism in the pathophysiology of this fatal disease.
Abstract 2403: Inspiratory Muscle Training Decreases Central and Peripheral Sympathetic Activity Improves Reflex Vasodilatory Blood Flow in Patients with Chronic Heart Failure
Authors: Mello Priscila , Guerra Grazia , Dall’ago Pedro , Borille Suellen , Rondom Maria U , Negrao Carlos E , Mostarda Cristiano , Irigoyen Maria Claudia , Krieger Eduardo M , Consolim-Colombo Fernanda
Published: July 2021

Background: Inspiratory muscle training (IMT) improves functional capacity of patients with CHF but the mechanisms of this effect are unknown.

Objective: We tested the hypothesis that IMT could decrease sympathetic activity and improve the reflex muscle vasodilatory response during exercise in patients (CHF) and inspiratory muscle weakness.

Methods: Six patients with CHF and inspiratory muscle weakness (maximal inspiratory pressure <70% of predicted) NYHA Class II–III, EF <35%, peak VO(2) < 20 ml/kg/min, were submitted to a IMT during 12 weeks (30 minute breathing with an inspiratory resistance of 30% of maximal inspiratory pressure). Muscle sympathetic nerve activity (MSNA) was recorded by microneurography, LF (sympathetic) and HF (parasympathetic) components of the heart rate variability and LF/HF ratio were assessed by the use of power spectral analysis of RR interval. Forearm blood flow (FBF) was measured by venous occlusion plethysmography at baseline and during hand grip (HG) manouver. Paired student t-test was used to analyze the impact of IMT in this population.

Results: Compared to baseline, IMT significantly (p < 0,05) caused: an increase in inspiratory muscle force by 130%; a 15% reduction in MSNA (40 ± 1 vs 33 ± 1 bursts/min); an increase in forearm blood flow (0.8+/−0.1 mL/min/100 g) during HG manouver; a decrease in LF% (59 ± 5 vs 39 ± 3 U); an increase in HF% (40 ± 5 vs 61 ± 3 U); a decrease in LF/HF ratio (1,74 vs 0,66).

Conclusions:
Twelve weeks of Inspiratory muscle training in patients with CHF and inspiratory muscle weakness promoted a significant improvement in cardiovascular parameters, such as increase in limb blood flow, cardiac autonomic balance and baroreflex sensitivity, associated with a decrease in peripheral sympathetic activity.