bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 690: Variability and Predictors of Patient Radiation Dose with Dual Source Cardiac CT: Implications for Future Algorithms to Reduce Patient Radiation Dose
Authors: Blankstein Ron , Pale Rodrigo , Nasir Khurram , Shah Amar B , Bezerra Hiram , Bolen Michael , Gupta Rajiv , Mamuya Wilfred S , Abbara Suhny , Brady Thomas J , Cury Ricardo C
Published: July 2021

Intro
: DSCT provides improved temporal resolution due to the simultaneous use of two x-ray sources & detectors. Although use of two sources may increase radiation, the DSCT offers key mechanisms to reduce dose (i.e. pitch adaptation, tube current modulation (TCM) & prospective triggering). Thus, our aim was to assess the patient radiation exposure associated with DSCT and identify variations based on the use of different scan related parameters.

Methods
: Prospective study of a single tertiary medical center where radiation and image quality related data was collected on 304 consecutive patients (pts) presenting for clinical CCT examination. Effective radiation dose was calculated by multiplying the dose-length product × (k=.017 mSv/mGy/cm). Image quality was rated on a subjective IQ score [1=poor to 4=excellent], as well as contrast (CNR) and signal-to-noise (SNR) ratios. Adjusted means of increased radiation dose were calculated based on linear regression models.

Results:
Among 304 consecutive studies (mean age 56.4, BMI 29.4 kg/m
2
, 37% Female), 60% were performed for coronary evaluation, 8% for CABG, 18% for pulmonary veins and 11% for aortic disease. The average radiation dose was 13.5±9.2mSv [range 0.5–55.5 mSv]. TABLE

provides unadjusted and adjusted mean radiation dose for parameters which had a significant univariate association with radiation dose. Independent predictors of lower radiation included low kV, use of TCM, higher pitch, smaller scan length, and regular heart rhythm. Selected use of various TCM algorithms & low KV resulted in no significant difference in IQ, CNR, or SNR.

Conclusions
: DSCT is associated with a wide range of patient radiation exposure. The variability in dose is due to both controllable parameters (i.e. use of TCM, low kV, scan length) as well as parameters that cannot be altered (i.e. irregular rhythm). These results suggest that individualizing scan protocols may result in lower radiation dose without compromising image quality.

Table:

Cardiac DSCT Parameters Affecting Patient Radiation Dose
Abstract 695: Significant Hypertrophy and Reduced Systolic Function Predict Intramyocardial Fibrosis in Patients with Hypertrophic Cardiomyopathy Undergoing Cardiac Magnetic Resonance Imaging
Authors: Rubinshtein Ronen , Glockner James F , Gersh Bernard J , Araoz Philip A , Ackerman Michael J , Tajik A J , Ommen Steve R
Published: July 2021

Background:
Contrast enhanced magnetic resonance imaging (CE-MRI) is a useful tool to define cardiac morphology, systolic function, and the presence of late gadolinium enhancement (LGE). In patients (pts) with hypertrophic cardiomyopathy (HCM), LGE may represent intra-myocardial fibrosis. We explored the association between left ventricular (LV) morphology and function to the presence and amount of LGE in pts with HCM.

Methods:
424 HCM pts (age = 55 ± 16 years, 41% females), without prior history of septal ablation/myectomy, underwent CE-MRI (GE 1.5T) during a 6-year period. LV volumes, diameter, ejection fraction (EF), septal shape and thickness, and the presence of obstructive physiology were assessed from standard steady state free precession pulse sequences. The presence and amount of LGE were traced from a dynamic post contrast inversion recovery pulse sequence. Morphologic and functional findings were then compared with presence and amount of LGE.

Results:
Over half of the pts [239/424 (56%)] had LGE, most commonly localizing to RV insertion points [174/239 pts, (73%)]. The extent of LGE ranged from 0.4–65% of LV mass. Univariate (morphologic) predictors of LGE were: reverse curve septal shape [OR = 7.8, (95% CI, 3.9–15.6)], septal thickness ≥ 16 mm (OR = 4.5, 2.4–8.2), LV mass ≥ 150 grams (OR = 2.6, 1.7–3.8)], LVEF<50% (OR = 4.6, 1.3–16), and presence of obstructive physiology (OR = 1.8, 1.02–3). The percentage of LV mass involved with LGE increased with higher LV mass, increased septal wall thickness, and decreasing LVEF (Spearman rank = 0.2– 0.4, p<0.0001 for all). Multivariate analysis (adjusting for all morphologic and functional parameters) showed that septal thickness ≥ 16mm (p = 0.0001), LV mass ≥ 150 grams (p = 0.01) and LVEF < 50% (p = 0.02) were independent predictors of LGE on CE-MRI.

Conclusions:
LGE, as determined by CE-MRI, was seen in over half of the patients with HCM. Decreased LVEF, increased septal thickness, and increased LV mass were associated with the presence of LGE. The clinical and prognostic impact of these morphological features warrants further investigation.
Abstract 705: The Difference in Left Ventricular Twisting Behavior Between Patients With Hypertensive Heart Disease and Hypertrophic Cardiomyopathy
Authors: Nishimura Kazuhisa , Okayama Hideki , Saito Makoto , Inoue Katsuji , Yoshii Toyofumi , Hiasa Go , Sumimoto Takumi , Suzuki Jun , Ogimoto Akiyoshi , Ohtsuka Tomoaki , Funada Junichi , Higaki jitsuo
Published: July 2021

(Background) Left ventricular (LV) untwisting behavior is a novel index of LV diastolic function since it is a powerful determinant of LV diastolic suction. The LV of patients with hypertrophic cardiomyopathy (HCM) and hypertensive heart disease (HHD) has diastolic dysfunction despite normal systolic function. However, the role of untwisting behavior in HCM and HHD in the pathophysiology of diastolic dysfunction is unknown. The aim of this study was to investigate the difference of LV twisting behavior between patients with HCM and HHD.

(Methods) Forty-four patients with HCM (mean age, 63+/−15 y, 34 males), 30 patients with HHD (mean age, 62+/−12 y, 20 males), and 20 age and sex-matched control subjects were evaluated. After a standard echocardiographic examination, LV twist and twisting velocity profiles from apical and basal short-axis images were analyzed using two-dimensional speckle tracking imaging. All temporal parameters were normalized by R-R intervals.

(Results) LV diastolic and systolic dimensions, and ejection fraction were not significantly different among the groups. LV mass index and early diastolic mitral annular velocity were not significantly different between the HCM and HHD groups. The peak torsion in the HCM and HHD groups was significantly greater than that in the control group (Table

). The peak untwisting velocity in the HCM group was comparable to that in the control group. However, when the peak untwisting velocity was corrected by peak torsion, the value in the HCM group was significantly decreased compared with that in the HHD and control groups. The time to peak untwisting velocity from aortic valve closure in the HCM group was significantly longer than that in the HHD and control groups.

(Conclusion) These results suggest that enhanced peak torsion in HCM might compensate for untwisting behavior, but this mechanism fails to fully compensate for untwisting behavior compared with HHD.

Left ventricular twisting behavior
Abstract 750: Short-Term Postoperative Amiodarone Use Decreases the Incidence of Atrial Fibrillation in Patients Undergoing Cardiac Surgery
Authors: Cook James R , Mandanis Christos , Rousou John A , Stoenescu Mathias L , Deaton David W , Flack Joseph E , Engelman Daniel T
Published: July 2021

Introduction:
Atrial fibrillation (AF) is common after cardiac surgery and related to postoperative complications and length of stay (LOS). We studied the effect of postoperative use of amiodarone (amio) on the incidence of AF, neurologic and pulmonary events, as well as LOS in 694 patients (pts) with no history of AF, who underwent cardiac surgery at one institution.

Methods:
During calendar year 2007, 694 consecutive pts were evaluated. From July through December, 311 pts (amio group) received 150 mg intravenous amiodarone bolus at the end of surgery, followed by 400 mg orally twice a day for 7 days, and 200 mg orally daily for 7 more days. If AF developed before oral amiodarone could be started, pts received additional 150 mg drug boluses. Outcomes were compared against a control group of 307 pts who underwent cardiac surgery at the same institution during the first 6 months of 2007. AF was defined as any episode of atrial fibrillation requiring treatment.

Results:
The mean patient age was 67±12 yrs, 33% were female and 90% received postoperative beta-blocker. AF occurred in 29% of the cohort, and was significantly reduced from 34% in the control group to 24% in the amio group (p<0.004). The reduction in AF was consistent for patients undergoing CABG and/or valve surgery. There was no increase in ventilator time (median 13 hrs) or pulmonary complications in the amio group. Neurologic events were low (4%) and equal in both groups as was the need for postoperative pacemaker therapy (4%). The median LOS was 10 days and not affected by amio treatment.

Conclusions:
Short-term use of amiodarone postoperatively decreases the incidence of AF in patients treated with beta-blocker after cardiac surgery. No increase in adverse events was identified nor influence on LOS. Thus, amiodarone treatment postoperatively appears safe and effective.
Abstract 752: Outcomes of More Than 100 Patients with Type A Aortic Intramural Hematoma: A Single Center Experience
Authors: Song Jae-kwan , Yim Ji Hye , Kim Sung Sik , Kim Sung-Hwan , Yi Myung-Zoon , Song Jong-Min , Kang Duk-Hyun
Published: July 2021

Data regarding the outcome of type A aortic intramural hematoma (AIH) are based on relatively small numbers of the subjects and controversial opinions for treatment option are available. We evaluated 357 patients with type A acute aortic syndrome (AAS) managed in our center between April 1993 and March 2008 to delineate clinical features, management, and outcomes of acute AIH by comparing these patients with those with classic aortic dissection (AD). One hundred one (28.3%) patients had AIH with higher mean age (65±10 versus 56±14 years, p<.001) and higher prevalence of hypertension (67.3% versus 52.3%, p<.001) compared with 256 patients with AD. Emergent surgery was done in 208 patients (81.3%) with AD and 16 (15.8%) with AIH (p<.001). Eight five (84.2%) patients with AIH received initial medical treatment and among them 25 patients (29.4%) underwent timed surgery during admission due to various reasons including development of AD (n=10) and increase of hematoma thickness (n=7). Overall in-hospital mortality was lower in AIH (7.9% versus 17.2%, p=0.025) and markedly lower mortality was observed in patients without emergent surgery (7.1% versus 63.3%, p<.001). The 30-month cumulative survival rates according to the treatment options were not different in AIH group, whereas significant difference was observed in AD group. AIH comprised significant proportion of type A AAS and showed different clinical features and more favorable response to medical treatment compared to classic AD. Contrary to AD, survival benefit of emergent surgery could not be confirmed in AIH.
Abstract 755: Ten-year Survival in Patients with Type A Aortic Intramural Hematoma
Authors: Kitai Takeshi , Kaji Shuichiro , Kim Kite , An Yoshimori , Yamane Takafumi , Ehara Natsuhiko , Katayama Minako , Kinoshita Makoto , Kobori Atsushi , Tamita Koichi , Yamamuro Atsushi , Tani Tomoko , Morioka Shigefumi , Furukawa Yutaka
Published: July 2021

Recent studies have demonstrated that short and mid-term prognosis of type A acute aortic intramural hematoma (IMH) is remarkably better than classic aortic dissection (AD). The distinctive pathology of IMH from classic AD may account for such difference. However, it is uncertain if the prognosis of IMH remains favorable during long-term (ten-year) follow-up. The purpose of this study was to clarify the long-term prognosis of type A IMH. A total of 432 patients with acute aortic syndrome were admitted to our institution from 1989 to 2006. Of these patients, there were 42 patients with type A IMH and 201 patients with classic type A AD. In-hospital and long-term outcomes of the 42 patients with type A IMH were evaluated. Mean age of the patients was 66±10 at baseline and 25 patients were female. Mean follow-up period was 7.6 years. Emergent surgical repair was performed in 11 patients due to complication including cardiac tamponade, aortic regurgitation and aortic dilatation; while 31 patients were treated with initial medical therapy. Nine patients who demonstrated progression to AD or increase in size of hematoma underwent surgical repair except for 2 patients who refused surgery and died of aortic rupture. In-hospital mortality rate of all 42 IMH patients was 4%. There were 3 late deaths and the causes of death were pneumonia, renal failure, and heart failure. The actuarial survival rates were 95, 95 and 87% at 1, 5 and 10 years. Medical treatment alone was not enough to manage all type A IMH patients and almost a half of the patients needed surgical intervention. However, type A IMH patients who were treated medically with surgical repair in cases with complications have favorable long-term (ten-year) prognosis.
Abstract 809: Greater Fluid Retention is Associated with Increased Cardiovascular Mortality in Different Groups of CKD Patients on Hemodialysis
Authors: Kalantar-Zadeh Kamyar , Regidor Deborah L , Kovesdy Csaba P , Bunnapradist Suphamai , Van Wyck David , Horwich Tamara B , Fonarow Gregg C
Published: July 2021

Patients with chronic kidney disease (CKD) who undergo hemodialysis (HD) treatment have striking similarities to heart failure (HF) patients, in that both populations retain fluid frequently, have excessively high mortality, and exhibit an obesity paradox. We hypothesized that in HD patients greater interdialytic fluid retention is associated with poor cardiovascular (CV) survival. We examined the 2-year (7/01– 6/03) mortality in 34,003 MHD patients across the United States, who had an average weight gain of at least 0.5 kg above their end-dialysis dry weight by the time the subsequent HD treatment started. The 3-month average interdialytic weight gain was dichotomized into two categories of 0.5 to 2.0 kg (reference) and >=2.0 kg. After multivariate adjustment for demographics (case-mix) and laboratory surrogates of malnutrition and inflammation, higher weight gain >=2.0 kg was significantly associated with increased death risk in most subgroups of patients particularly among Blacks (death hazard ratio [HD] and 95% confidence interval [CI]: 1.10 [1.01–1.20]), non-diabetics (1.07 [1.01–1.14]), those with 3 to 6 months on dialysis (1.23 [1.14–1.33]) and between 6 months and 2 years on dialysis (1.20 [1.09–1.33]), and those with albumin >3.8 g/dL (1.08 [1.01–1.18]) (see Figure

): In MHD patients greater fluid retention of 2 kg or higher between two consecutive HD treatment sessions appears associated with higher death risk particularly among Blacks, non-diabetics, those with less than 2 years of HD treatment, and those with better nutritional status. The mechanisms by which fluid retention influences survival in HD may be similar to HF patients and warrants further research.

This research has received full or partial funding support from the American Heart Association, AHA Western States Affiliate (California, Nevada & Utah).
Abstract 822: Change in Regional Strain after Cardiac Resynchronization Therapy
Authors: Miyazaki Chinami , Lin Grace , Redfield Margaret M , Espinosa Raul E , Bruce Charles J , Miller Fletcher A , Oh Jae K
Published: July 2021

Background:
Cardiac resynchronization therapy (CRT) improves global systolic function in left ventricle. However, the impact of CRT on regional myocardial function is less clear. The aim of this study, therefore, is to evaluate regional changes in myocardial strain after CRT.

Methods:
Speckle tracking echocardiography (STE) was performed in 91 patients before and 6 month after CRT. Peak longitudinal strain was measured in 18 segments at base, mid and apex in three apical views. Left ventricular end-systolic volume (ESV) was measured by biplane Simpson’s method and reverse remodeling was defined as 10 % reduction in ESV at 6 month after CRT.

Results:
Peak strain improved in basal and mid segments of medial walls (basal inferoseptal, anteroseptal and inferior segments, p<0.05, mid inferoseptal and inferior segments: p<0.01) in entire group after CRT, with a greater degree of improvement in CRT responders than in nonresponders (Figure

). There was no significant improvement in free wall strain, with significant reduction in basal inferolateral segment after CRT (P=0.047) in entire group. Nonresponders had significant reduction in strain at the mid anterolateral segment (P=0.004) (Figure

). Strain of the apical segments also did not improve.

Conclusions:
CRT induces reverse remodeling by enhancing regional myocardial function in the septum, but suppresses the function in the free wall. Lack of reverse remodeling after CRT was characterized by the reduced function in lateral segments without improvement in septal function..
Abstract 828: Serum Midkine Predicts Cardiac Events in Chronic Heart Failure Patients
Authors: Kitahara Tatsuro , Takeishi Yasuchika , Shishido Tetsuro , Watanabe Tetsu , Nitoube Joji , Miyamoto Takuya , Miyashita Takehiko , Nishiyama Satoshi , Kubota Isao
Published: July 2021

Midkine (MK), a heparin-binding growth factor, has various functions such as migration of inflammatory cell and anti-apoptotic effect. Invasion of inflammatory cells and cardiomyocyte apoptosis are involved in development and progression of heart failure (HF). However, relationship between MK and HF has not been previously examined. Therefore, we examined clinical significance of serum MK levels to determine the prognosis of HF patients. Serum levels of MK were measured at admission in 216 consecutive patients hospitalized for chronic HF and 60 control subjects. Patients were prospectively followed during a median follow-up period of 658 days with the end points of cardiac death and progressive HF requiring re-hospitalization. Serum concentrations of MK were significantly higher in patients with HF than in controls and increased as NYHA functional class rose (fig 1

). There were 74 cardiac events, including 30 cardiac deaths and 44 re-hospitalization for HF during follow-up period. Patients with cardiac events had significantly higher concentrations of MK than those without cardiac events (539 ± 57 pg/ml vs. 331 ± 17 pg/ml, P < 0.01). Patients were divided into 4 groups based on midkine levels. Risk of cardiac events increased as MK levels rose (fig 2

). In addition, the Cox multivariate hazard analysis showed that MK was an independent predictor of cardiac events (hazard ratio 1.280, 95% CI 1.027–1.578, P<0.05). Serum MK level is increased in HF patients, and MK is a novel marker for risk stratifying chronic HF patients.

Figure 1.

Serum Midkine Levels in Study Population

Figure 2.

Quartile Analysis of Serum Midkine Levels and Relative Risk for All Cardiac Events
Abstract 837: A Novel -1364A/C Aquaporin 5 Gene Promoter Polymorphism Influences the Regulation of the Renin-Angiotensin-Aldosterone System in Young Healthy Men and Individuals with Coronary Artery Disease
Authors: Adamzik Michael , Frey Ulrich , Schmieder Roland , Heusch Gerd , Peters Juergen , Siffert Winfried
Published: July 2021

Background:
The family of aquaporin water channels contributes to water and salt homeostasis. AQP5 is an ubiquitously expressed exocrine-type water channel. Functional single nucleotide polymorphisms in
AQP5
which alter gene transcription have not yet been described. We, therefore, sequenced the human
AQP5
promoter to detect novel sequence variants which could impact upon AQP5 expression and contribute to the phenotypic variability of the renin-angiotensin-aldosterone system (RAAS).

Method and Results
: Sequencing of the whole
AQP5
promoter revealed a novel -1364A/C polymorphism. Substitution of C for A was associated with increased transcription factor binding as tested by electrophoretic mobility shift assay, but significantly reduced transcriptional activation of the
AQP5
gene by cAMP and serum. The C allele was associated with significantly decreased mRNA in human heart and with decreased protein expression in erythrocyte membranes. Finally, we investigated the phenotypic variability of the RAAS in two different independent study cohorts. First, we studied the phenotypic variability of the RAAS in 103 young (26 ± 3 years) healthy males under an increased salt diet. Increasing dietary salt intake decreased plasma angiotensin II by 25% in AC/CC genotypes but only by 2% in AA genotypes (p=0.012), and decreased serum aldosterone by 34% in subjects with AC/CC genotypes but only by 19% in the AA genotypes (p =0.005). Both genotypes had increased blood pressure under salt diet (p<0.01), which was significantly more pronounced in AA genotypes (p =0.029). Second, we investigated associations with the phenotypic variability of the RAAS in 96 old patients (68 ± 10 years) with coronary artery disease scheduled for coronary artery bypass grafting. ADH plasma concentrations did not differ between genotypes. However, aldosteron serum concentrations were 2-fold (p<0.001) and angiotensin II plasma concentrations were 4-fold higher in AA genotypes in comparison to the AC/CC genotypes.

Conclusion:
A novel single nucleotide polymorphism in the
AQP5
gene promoter evokes an alteration of both AQP5 expression in different in vitro systems and cells, and the regulation of the Renin-Angiotensin-Aldosterone System.
Abstract 842: Potential Role of MicroRNAs in the Pathogenesis of Diabetic Cardiomyopathy
Authors: Karakikes Ioannis , Feber Andrew , Godfrey Tony E , Hajjar Roger J , Lebeche Djamel
Published: July 2021

Cardiac dysfunction is a common and important manifestation of diabetes mellitus and accounts for much of the increased mortality in diabetic patients. Recent studies have uncovered key roles for a family of newly discovered small non-coding regulatory RNA molecules, known as microRNAs (miRNAs), in the control of diverse aspects of cardiac function and dysfunction. However, it remains to be shown whether the expression of miRNAs is altered in the heart in response to diabetes and accounts for the pathogenesis of the disease. We have determined the expression profile of miRNAs in the heart of a rat model of type 2 diabetes using a custom Affymetrix microarray platform in order to gain a better understanding of their possible involvement in diabetic cardiomyopathy. We Identified 17 miRNAs that are differentially regulated during diabetic cardiomyopathy, suggesting that they might function as modulators of this condition. Interestingly, most of the identified miRNAs were similarly dysregulated in type 2 diabetic failing human hearts. Since type 2 diabetes is associated with insulin resistance, we further investigated the functional significance of these miRNAs by over-expression using synthetic miRNA mimics
in vitro
. Overexpression of a single miRNA (mir-152), which was up-regulated in diabetic cardiomyopathy, inhibited insulin-stimulated glucose uptake and induced cardiac hypertrophy in rat neonatal myocytes. Additionally, mir-152 significantly increased the Phospholamban/Serca2a ratio, suggesting abnormal calcium handling. Our results suggest that specific miRNAs play important roles in myocardial dysfunction associated with insulin resistance and may provide novel therapeutic approaches for the management of diabetes-induced cardiomyopathy.
Abstract 846: Patient Willingness to Participate in Genetic Research After a Myocardial Infarction
Authors: Lanfear David E , Jones Philip G , Cresci Sharon , Tang Fengming , Rathore Saif S , Spertus John A
Published: July 2021

To achieve ‘Personalized Medicine’, identifying genetic associations with outcomes is essential. However, not all patients invited to participate in such studies agree. While existing data suggests race, gender, and education may influence this decision, correlates of patient willingness to participate in genetic studies remain incompletely understood. We assessed correlates of patient participation in the genetic substudy of TRIUMPH, a prospective myocardial infarction registry ongoing at 26 US hospitals. Patients enrolled in the first wave (4/05–12/06, N=1854) were analyzed. Factors examined included sociodemographics, financial status, social support, medical literacy, health status, depressive symptoms (PHQ-9, higher scores indicate greater depression) and 26 clinical variables. Predictors of participation were identified using hierarchical logistic regression adjusting for hospital. Variation in consent rates across hospitals was quantified by the median odds ratio (MOR), which compares the odds of consent between two randomly selected patients with identical covariates chosen from different hospitals. Most subjects consented to donation and storage of their genetic material (1,513, 81.6%). Participation rates varied greatly by site, ranging from 50% to 100%. After adjustment for possible confounding by patient factors, the MOR for hospitals was 4.5. Clinical characteristics were not associated with participation in univariate analysis (all p>0.1). In multivariable analysis adjusted for hospital, the only significant predictors of consent were greater depressive symptoms (OR 1.41 per +5 PHQ points, 95% CI 1.19–1.67, p<0.0001), and gender (OR 1.54 for males, 95% CI 1.16–2.04, p=0.0027). Roughly 80% of subjects enrolled in our study consented to genetic analysis. The strongest overall factor associated with participation was hospital. While we cannot rule out confounding by unmeasured characteristics, this suggests that variation in the way information is presented, or other site-specific factors, strongly influence patient participation in genetic studies.

This research has received full or partial funding support from the American Heart Association, AHA Midwest Affiliate (Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, South Dakota & Wisconsin).
Abstract 913: Persistent High Risk of Death and Myocardial Infarction in Patients with Peripheral Arterial Disease Undergoing PCI: Results from the NHLBI Dynamic Registry
Authors: Saya Shoaib , Banerjee Subhash , Selzer Faith , Abbott J D , Naidu Srihari S , Wilensky Robert L , Faxon David P , Jacobs Alice K , Holper Elizabeth M
Published: July 2021

Patients with peripheral arterial disease (PAD) undergoing PCI are at high risk for adverse cardiovascular events in follow up. Trends over time in outcomes with advances in PCI and medical therapy are unknown. We evaluated 866 patients with PAD in the NHLBI Dynamic Registry undergoing PCI according to treatment eras: the early bare metal stent (BMS) era (Wave 1: ‘97–’98, n=180), the BMS era (Waves 2 and 3; ’99 and ’01–’02; n=339), and the drug-eluting stent (DES) era (Waves 4 and 5:’04 and ‘06; n=347). We compared in-hospital and 1-year outcomes by recruitment era. In-hospital CABG rates were significantly lower in the later eras (3.9%, 0.9%, 0.6%, early BMS, BMS, and DES eras respectively, p=0.005), and an increasing percentage of patients were discharged on asprin, beta blockers, statins, and ticlopidine or clopidogrel (all p<0.001). The cumulative 1-year adverse event rates are seen in the table

. Comparison cumulative 1-year event rates in patients without PAD in the early BMS era (n=2323), BMS era (n=3803) and DES era (n=3915) of death were 4.2%, 4.4%, and 4.0% (p=0.76); of MI were 5.3%, 5.0%, and 4.4% (p=0.19), and repeat revasculatization were 21.5%, 15.9%, and 11.4% (p<0.001). The 1-year adjusted hazard ratios (HR) of adverse events in patients with PAD using the early BMS era as the reference are as follows: Death: BMS era HR=0.84 (95% CI 0.46–1.55, p=0.58) and DES era HR=1.35 (95% CI 0.71–2.56, p=0.36); MI: BMS era HR=0.89 (95% CI 0.48–1.66, p=0.72) and DES era HR=1.02 (95% CI 0.55–1.87, p=0.95); and Repeat Revascularization: BMS era HR=0.63 (95% CI 0.41– 0.97, p=0.04) and DES era HR=0.46 (95% CI 0.29–0.73, p=001).
Abstract 950: Should We Measure Intima Media Thickness In Patients With Peripheral Arterial Disease?
Authors: Espinola-Klein Christine , Rupprecht Hans J , Bickel Christoph , Lackner Karl , Savvidis Savvas , Munzel Thomas , Blankenberg Stefan
Published: July 2021

Background:
Carotid intima-media thickness (IMT) is a marker of early atherosclerosis. Patients with peripheral arterial disease (PAD) have advanced atherosclerosis and a high cardiovascular event rate. The aim of this study was to evaluate, whether measurement of carotid IMT adds prognostic information in PAD patients.

Methods:
We included 165 patients (mean age 64.5 ± 9 years, 71.5% men) with PAD. In all patients IMT was measured at both common carotid arteries and the mean IMT was used for further evaluation. Carotid IMT of more than 0.9 mm was defined as thickened. After a median follow-up of 6.5 years in total 33 patients (20%) died from cardiovascular causes.

Results:
Mean IMT was 0.75 ± 0.19 mm and in 30 patients (18.2%) an IMT ≥ 0.9 mm could be detected. Cardiovascular mortality was significantly higher in patients with PAD and IMT ≥ 0.9 mm than in patients with IMT ≥ 0.9 mm (IMT ≥ 0.9 mm = 40.0 % versus IMT < 0.9 mm = 15.6 %; P=0.002, figure

). In a fully adjusted Cox regression analysis (adjusted for age, sex, diabetes, hypertension, high density lipoprotein cholesterol, smoking, body mass index and acute coronary syndrome) a carotid IMT ≥ 0.9 mm could not be identified as an independent predictor for cardiovascular death (Hazard Ratio (95% Confidence Interval) = 2.0 (0.9 – 4.2), P=0.09).

Conclusion:
Patients with PAD and a carotid IMT ≥ 0.9 mm had a higher cardiovascular mortality than patients with normal IMT. But an increased carotid IMT could not be identified as independent predictor for cardiovascular mortality. Therefore it should be discussed whether IMT measurement adds prognostic impact in patients with PAD.

Survival in Accordance to Carotid IMT
Abstract 986: Hematomas of at Least 5 Cm and Outcomes in Patients Undergoing Elective Percutaneous Coronary Intervention: Insights From The STEEPLE Trial
Authors: White Harvey , Montalescot Gilles , Gallo Richard , Steinhubl Steven
Published: July 2021

Background:
In patients undergoing percutaneous coronary intervention (PCI), bleeding has a significant impact on outcomes including 1-year mortality. There is no uniform definition of bleeding and hematomas ≥ 5 cm at the femoral puncture are considered major bleeding events in some trials. In the STEEPLE trial groin hematomas ≥ 5 cm (excluding retroperitoneal bleeds) were classified as minor bleeds. This subanalysis of the STEEPLE trial assessed the impact of hematomas on patient outcomes and 1-year mortality.

Methods:
In STEEPLE, 3528 patients undergoing elective PCI received intravenous enoxaparin (enox; 0.5 or 0.75 mg/kg) or unfractionated heparin (UFH). Bleeding sites and size of haematomas were collected. The 30-day outcomes and 1-year mortality of patients with a hematoma ≥ 5 cm were compared to outcomes in patients with no major or minor bleeding.

Results:
Data on hematomas were available for 3342 patients. Of these, 103 patients (29, 33, 41 in enox 0.5, 0.75 and UFH groups, respectively) had a hematoma ≥ 5 cm; none required transfusion. The 30-day mortality rate, non-fatal myocardial infarction (MI), or urgent target-vessel revascularization (UTVR) were similar between patients with a hematoma ≥ 5 cm and those with no bleeding. All-cause mortality was similar in both groups (Table

).

Conclusion:
The presence of hematomas ≥ 5 cm had no effect on the 30-day ischemic outcomes and 1-year mortality in patients undergoing elective PCI in the STEEPLE trial. Beyond patient discomfort, hematomas ≥ 5 cm were not associated with need for transfusions, and had no effect on prognosis in this analysis. It remains to be determined how to use them in bleeding classifications.
Abstract 1081: Correcting the Underestimation of Absolute Myocardial Blood Flow by Magnetic Resonance Perfusion Imaging
Authors: Lee Daniel C , Johnson Nils P , O’Hara Kelly , Harris Kathleen R
Published: July 2021

Noninvasive assessment of absolute myocardial blood flow is important for evaluation of microvascular function and serial changes in perfusion. Absolute flow can be calculated from magnetic resonance (MR) perfusion studies, but a nonlinear relationship between signal intensity (SI) and gadolinium concentration ([Gd]) in the myocardium may cause underestimation. When the relationship between SI and [Gd] was mapped in chronically instrumented dogs, this was linear in the left ventricular (LV) bloodpool for a 0.005 mmol/kg Gd-DTPA minibolus but nonlinear in the myocardium for a 0.05 mmol/kg bolus. 14 dual-bolus MR first-pass perfusion studies were performed at rest and during vasodilation with variable degrees of left circumflex coronary artery stenosis. Absolute flow by Fermi function deconvolution of MR SI-time curves underestimated microsphere flow by nearly 50% (y = 0.52x + 0.07, r2 = 0.61). When the myocardial and LV SI-[Gd] relationships were used as calibration curves to convert SI values to [Gd], deconvolution of [Gd]-time curves yielded accurate myocardial flow values (y = 0.93x + 0.05, r2 = 0.68). As seen in the figure

, absolute flow measured in endo-, mid-, and epicardial layers progressively decreased from epi- to endocardium in the stenotic zone, (p = 0.0004) while flow did not vary across the myocardial wall in the normal zone (p = 0.72). Correcting the curvilinear myocardial signal response to gadolinium improves the accuracy of absolute myocardial flow quantification by MR perfusion imaging. The high spatial resolution enables measurement of transmural flow differences caused by impaired vasodilator reserve.

This research has received full or partial funding support from the American Heart Association, AHA National Center.
Abstract 1135: Statin Pharmacogenetics: Identification of Genetic Variants that Predict Response to Atorvastatin and Pravastatin
Authors: Mega Jessica L , Morrow David A , Brown Alison , Cannon Christopher P , Sabatine Marc S
Published: July 2021

Background
: LDL cholesterol (LDL-C) reduction in response to statins varies widely, with many patients not reaching target goals. We hypothesized that polymorphisms in LDL-C metabolism and statin pharmacokinetic genes would be associated with magnitude of LDL-C reduction with statin therapy.

Methods
: 49 tagging and candidate polymorphisms were selected in 9 genes and their associations with statin efficacy were tested in 1507 post-ACS subjects randomized to atorvastatin 80 mg/d or pravastatin 40 mg/d.

Results
: Two variants in
APOE
(rs7412 and
rs429358
) were significantly associated with baseline LDL-C (P=7.9×10 −9 and P=0.0032) and determine the isoforms ϵ2, ϵ3, and ϵ4 of apolipoprotein E. After adjustment for baseline LDL-C and clinical features, the percent reduction in LDL-C from baseline to day 30 was greatest in ϵ2 carriers, intermediate in ϵ3/ϵ3 individuals, and least in ϵ4 carriers with atorvastatin (P
trend
=0.00039) and pravastatin (P
trend
=0.00038), (Fig

, Top). The percent of subjects achieving an LDL-C of ≤70 mg/dl was higher for ϵ2 carriers than ϵ4 carriers (atorvastatin P
trend
=0.00037 and pravastatin P
trend
=0.0084) (Fig

, Bottom). The HR for CV death, MI, or stroke over 2 yrs for ϵ2 carriers vs ϵ3/ϵ3 individuals was 0.78 (95% CI 0.40 – 1.51).

Conclusion
: Evaluating genetic variants in 9 genes, we found that carriers of
APOE
ϵ2 versus ϵ4 had significantly lower baseline LDL-C, greater LDL-C reduction with atorvastatin or pravastatin, and more frequently achieved a goal of LDL-C ≤70 mg/dl. These findings add to the understanding of the genetic mechanisms that influence statin efficacy and suggest that common variants, such as the ones in
APOE
, may help tailor treatments.
Abstract 2003: The Characteristics of Non-Culprit Coronary Plaques in Patients with Acute Coronary Syndrome: Noninvasive Assessment by 64-Slice Computed Tomography
Authors: Ando Hirohiko , Amano Tetsuya , Uetani Tadayuki , Nanki Michio , Marui Nobuyuki , Kato Masataka , Kato Bunichi , Yoshida Tomohiro , Yokoi Kiminobu , Kumagai Soichiro , Kunimura Ayako , Ishii Hideki , Matsubara Tatsuaki , Hotta Nigishi , Murohara Toyoaki
Published: July 2021

Some invasive imaging modalities such as intravascular ultrasound and angioscopy have shown the vulnerability of non-culprit plaques in patients with acute coronary syndrome (ACS). Recently multi-slice CT (MSCT) has been used to assess the characteristics of coronary plaque and the major advantage of MSCT is that it can evaluate all coronary plaques noninvasively. The purposes of this study are to assess coronary plaques noninvasively by MSCT and compare the differences of plaque composition between culprit and non-culprit lesions in patients with ACS and stable lesions in the patients with stable angina pectoris (SAP). 64-slice CT was performed in 27 patients with ACS and 33 patients with SAP before percutaneous coronary intervention. According to CT value, we defined plaque components as soft plaque (SP <50 HU), fibrous plaque (50 HU <FP <150 HU) and calcified plaque (CP >500 HU). In all obstructive lesions, we evaluated plaque characteristics by calculating the volume of SP, FP and CP. On the basis of clinical presentation, electrocardiogram and angiographic appearance, coronary lesions in the patients with ACS are divided into culprit or non-culprit lesions. Coronary lesions in the patients with SAP are defined as stable lesions. We analyzed 89 lesions with excellent image quality. Culprit lesions (n=19) and non-culprit lesions (n=25) had significantly larger volumetric percentage of SP and higher remodeling index compared to stable lesions (n=40) (34.4% vs. 29.3% vs. 21.0%, p<0.0001 and 1.061 vs. 1.061 vs. 0.971, p=0.01, respectively). But there was no significant difference in plaque composition between culprit lesions and non-culprit lesions. We assessed coronary plaques noninvasively by MSCT and found that non-culprit lesions in the patients with ACS, as well as culprit lesions, had significantly larger volumetric percentage of SP and higher remodeling index compared to stable lesions in the patients with SAP, supporting the concept of multiple vulnerable plaques in patients with ACS.
Abstract 2004: Usefulness of Coronary CT Angiography in the Early Triage of Patients with Acute Chest Pain
Authors: Hoffmann Udo , Bamberg Fabian , Chae Claudia U , Rogers Ian S , Seneviratne Sujith K , Truong Quynh S , Cury Ricardo S , Abbara Sunhy , Shapiro Michael , Moloo Jamaluddin , Butler Javed , Ferencik Maros , Brown David F , Udelson James E , Achenbach Stephan , Brady Thomas J , Nagurney John T
Published: July 2021

Background:

Early triage of patients with acute chest pain in the emergency department (ED) may be improved by rapid noninvasive assessment of coronary artery disease (CAD) by coronary computed tomography angiography (CTA). We sought to determine the usefulness of coronary CTA for the early triage of patients with acute chest pain but an inconclusive initial ED evaluation.

Methods:

Single center, double-blinded observational cohort study in the ED of a large tertiary academic hospital enrolling 368 consecutive patients with acute chest pain and inconclusive initial ED evaluation (normal initial troponin and an initial ECG without evidence of myocardial ischemia) who were awaiting hospital admission between May 2005 and May 2007. All patients underwent 64-slice contrast-enhanced coronary CTA prior to hospital admission with caregivers and patients blinded to the results of the examination. Diagnostic accuracy and discriminatory power of coronary CTA findings (coronary plaque and stenosis [>50% luminal narrowing]) for acute coronary syndrome (ACS) during index hospitalization and major adverse cardiac events (MACE) during 6- month follow-up.

Results:

Among 368 patients (mean age 53±12 years, 61% male) 31 (8%) developed ACS but no MACE occurred during follow-up. Fifty percent (n=183) of the study population had neither plaque nor stenosis, a finding which had 100% negative predictive value (95% confidence interval [CI]: 98 to 100%) for ACS. In adjusted analysis, the extent of coronary plaque and presence of stenosis were associated with an increased risk for ACS (OR: 1.28, 95% CI: 1.14 to 1.43 and OR: 11.69, 95% CI: 4.4 to 31.0; respectively). Coronary CT findings (no CAD, plaque but no stenosis, and stenosis) discriminated patients at low, intermediate, or high risk of ACS (OR: 8.65, 95% CI: 3.69 to 20.26; AUC: 0.91).

Conclusion

: Half of the patients with acute chest pain and low to intermediate likelihood of ACS have no CAD and may be safely discharged directly from the ED. Coronary CT has excellent discriminatory power in defining patient risk for ACS.
Abstract 2046: Hypercapnic Resuscitation Improves Survival and Neurological Outcomes by Nitric Oxide Synthase-Mediated Enhancement of Brain Perfusion
Authors: Chang Wei-Tien , Gan Lay-San , Chien Chiang-Ting , Huang Chien-Hua , Chen Huei-Wen , Chien Kuo-Liong , Hsu Chiung-Yuan , Tsai Min-Shan , Cheng Hsiao-Ju , Chen Shyr-Chyr , Lee Yuan-Teh , Chen Wen-Jone
Published: July 2021

Neurological injury is one of the major causes of morbidity and mortality following cardiac arrest and cardiopulmonary resuscitation (CPR). Brain perfusion is usually compromised in the post-resuscitation phase, which inevitably lengthens the ischemic insult of the brain. Hypercapnia has been reported to cause cerebral vasodilatation. We therefore sought to study the potentials of hypercapnic resuscitation in improving the brain perfusion as well as survival and neurological prognoses. Using an established rat model of asphyxial cardiac arrest (6 min) and CPR, we employed hypercapnic (5% CO
2
, 95% O
2
) ventilation during CPR and the first 2 h post-resuscitation, and compared the brain perfusion with normocapnia (5% N
2
, 95% O
2
) control. The blood pressure was continuously monitored, with arterial blood sampled regularly for gas analysis. The tissue perfusion of the brain was measured by OxyLyte 2000E perfusion sensor. In a subgroup the survival and neurological outcomes were monitored up to 3 days. TdT-mediated dUTP nick-ends labeling (TUNEL) stain and Bax/Bcl2 of the brain were assessed as indicators of apoptotic cell death. The PaCO
2
was significantly higher (
P
<0.001) and pH significantly lower (
P
<0.001) in hypercapnia group during the first 2 h post-resuscitation. No difference was noted in PaO
2
or blood pressure. In normocapnia control, the brain perfusion was significantly reduced in the first 30 min post-resuscitation. Hypercapnic ventilation enhanced brain perfusion during this period (
P
<0.05). The survival and neurological outcomes were also improved (LogRank
P
<0.05), which was consistent with the decrease in TUNEL stain and Bax/Bcl2. If nitric oxide (NO) synthase inhibitor
N
ω
-nitro-L-arginine methyl ester (L-NAME, 10 mg/kg) was cotreated with hypercapnia, the increased brain perfusion and reduced TUNEL and Bax/Bcl2 were reversed. The improved survival and neurological outcomes were also abrogated. Hypercapnic ventilation during CPR and early post-resuscitation phase improves brain perfusion and hence survival and neurological outcomes. This is in part mediated by NO synthase-related vasodilatation.
Abstract 2057: Effects Of Levosimendan On Microcirculation In Patients With Cardiogenic Shock
Authors: Wimmer Roland , Janusch Matthias , Lemm Henning , Winkler Matthias , Prondzinsky Roland , Russ Martin , Werdan Karl , Buerke Michael
Published: July 2021

Introduction: Cardiogenic shock is characterized by low cardiac output and reduced perfusion pressure with subsequent disturbance of microcirculation. OPS vessel microscopy (orthogonal polarized spectral imaging) is a new method to visualize microcirculation.

Methods: In this study 20 Patients with severe cardiogenic shock caused by a myocardial infarction were followed three days after PCI. Group 1 got the conventional catecholamine treatment (norepinephrine and/or dobutamine), and Group 2 received in addition to this common therapy the calcium sensitizer Levosimendan (Simdax®). Five areas in the oral vestibule were recorded and averaged each 24 hours for three days. Data were transferred on a PC and analysed: The average of diameters, of flow and the cell blood velocity (CBV) were recorded. In this way the effects of Levosimendan on microcirculation were observed.

Results: An increase of the microcirculatory parameters was observed together with a progressing heart index (HI = 2.4 l/min/m2 on day 1 to HI = 3.5 l/min/m2 on day 3): the averaged vessel diameters went up significantly, also the average flow (p<0.028). In patients treated with Levosimendan microcirculation showed 24 hour infusion an increase in vessel diameters after Levosimendan (27.6 μm to 37.1 μm; p=0.013) as well as an improved flow (387x10 –9ml/s to 1049x10 –9ml/s; p=0.047). CBV also augmented in tendency (480 μm/s to 737 μm/s; p=0.054). Compared to conventionally treated patients, we observed a higher vessel diameter in the Levosimendan treated patients(27,37 μm vs. 34,65 μm; p=0,039)

Conclusion: Our data may suggest a benefit for the organ perfusion under Levosimendan treatment. OPS technology could become a new tool to follow shock patients on the intensive care unit in order to analyze therapeutic drug effects on microcirculation.
Abstract 2120: Circulating Markers of Myocyte Injury Predict First Recurrence of Atrial Fibrillation. Data from the GISSI-Atrial Fibrillation Trial
Authors: Masson Serge , Pirelli Salvatore , Pulitano Giancarlo , Carbonieri Emanuele , Gulizia Michele , Vago Tarcisio , Barlera Simona , Maggioni Aldo P , Franzosi Maria Grazia , Disertori Marcello , Latini Roberto
Published: July 2021

Whether circulating biomarkers may help in predicting long-term maintenance of sinus rhythm in patients with atrial fibrillation (AF) is still debated. We evaluated the prognostic role of two markers of cardiomyocyte injury in patients with a history of recent AF. Baseline plasma concentrations of NT-proBNP and cardiac troponin T (high sensitive, for evaluation purposes only) were measured (Elecsys 2010, Roche Diagnostics) in 382 patients diagnosed with symptomatic AF having additional underlying cardiovascular diseases/comorbidities, enrolled in 36 centers participating to GISSI-AF, a prospective randomized study. The association between these markers, clinical characteristics and outcome (adjudicated primary endpoint: time to first recurrence of AF) was tested by univariate and multivariable Cox models. Baseline concentrations of NT-proBNP and hsTnT were 191 [95–363] pg/mL (median [Q1–Q3]) and 0.008 [0.006 – 0.013] ng/mL in these patients with a history of AF (62.8% males, 46.1% aged > 70 y, 11% with either HF or depressed LVEF, 13.1% diabetics, 33.3% with SBP >140 mmHg ). Both markers were elevated in older patients (>70 y), those with HF and/or LVEF<0.40 or with creatinine >1 mg/dL. Above median concentrations of hsTnT (HR [95%CI] adjusted for gender 1.35 [1.02–1.78], p=0.038) and NT-proBNP (1.34 [1.01–1.78], p=0.040) were associated with higher risk of experiencing a first recurrence of AF (203 patients, 53.1%). Even small elevations of circulating markers of cardiomyocyte death (troponin) and stretch (natriuretic peptide) may be useful for the prediction of recurrence of AF in patients with a history of recent AF.