bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11640: Increased Fitness Modifies the Obesity Paradox by Body Composition Even in Individuals With Low Cardio-Respiratory Fitness
Authors: Kachur Sergey , De Schutter Alban , Lavie Carl , Dinshaw Homeyar , Jahangir Eiman , Milani Richard
Published: April 2024

Introduction:
An association of obesity and increased survival has been shown in stable coronary heart disease (CHD) patients, especially in individuals with low cardiorespiratory fitness (CRF). We aimed to examine the impact of fitness improvement on this paradoxical relationship.

Hypothesis:
Increasing fitness after cardiac rehabilitation will change the nature of the obesity paradox by body composition even in a population with low baseline cardiorespiratory fitness.

Methods:
588 subjects with stable CHD referred for cardiac rehabilitation with CRF (<17 cc/kg/min peak oxygen consumption [VO2]) where stratified based on their degree of improvement in CRF. Mortality from the cohort was analyzed with respect to body mass index (BMI), body fat (BF), and lean mass index (LMI).

Results:
In all subjects, higher BMI, BF, and LMI were associated with significant protective effects after adjusting for age, gender, left ventricular ejection fraction, and baseline VO2 (HR 0.5 p = 0.01; HR = 0.60 p = 0.006; HR 0.20 p < 0.001, respectively). In a subgroup that comprised the top 50
th
percentile of VO2 improvement, obesity by BMI and BF was no longer associated with improved survival (HR 0.75 p = 0.4 for BMI and HR 0.83 p = 0.6 for BF, Figure 1), but increased lean mass continued to be protective (HR 0.2 p < 0.001).

Conclusions:
Persons with low baseline CRF who have significant improvement in absolute VO2 continue to have survival benefits from increased LMI but not from increased BF and BMI. The obesity paradox by BF may be limited to those individuals with low CRF that fail to improve after CR.
Abstract 11644: Differentiating Hypertrophic Cardiomyopathy From Hypertensive Left Ventricular Hypertrophy Using Quantitative Layer-specific Speckle-tracking Echocardiography
Authors: Sun Jing Ping , Ni Xianda , Xu Tingyan , Hu Junli , Yang Xing Sheng , Wang Shaochun , Yan Bryan P
Published: April 2024

Background:
The distinction of mild to moderate hypertrophic cardiomyopathy (HCM) from hypertensive left ventricular hypertrophy (HLVH) may be difficult. The aim of this study was to determine the value of a novel multi-layer transthoracic echocardiography in differential diagnosis between HCM and HLVH.

Methods:
Sixty eight patients with HCM and preserved LV ejection fraction (82% male, 50±14 years; LVEF 64±8%); age and sex matched with 68 HLVH (56 male; 50±13 years, LVEF 64±8%) and 68 controls (56 male,50±13 years; LVEF 65±6%) underwent STE (GE Vivid-E9). Quantitative layer-specific longitudinal (LS), circumferential (CS) endocardium, mid-myocardium, and epicardium strain as well as radial strain (RS) assessed by 2-dimensional strain echocardiography. Ratios of endo- to epicardium (end/epi) strain were calculated.

Results:
The absolute value of LS on all layers of hypertrophic segments (Fig. showing LS was normal only in normal thickness of posterior and apical wall) were significantly less but the ratio of end/epi strain and RS were significantly greater in HCM than in HLVH and control group (p< 0.0001 for all, Table). The LS measurements of all LV segments was less but endocardial CS was greater in HLVH than control and HCM; LV global LS and CS was significantly less in HCM patients than HLVH and controls.

Conclusions:
Regional variations of strain and higher ratio of end-/epi-myocardial strain can be used to differentiate diagnosis between HCM and HLVH. The higher value of endo-circumferential strain of patients with HLVH and radial strain of patients with HCM might be the complemental mechanism to reserve the normal LVEF.
Abstract 11650: Association of Macrophage Inflammation Biomarkers With Progression of Subclinical Carotid Atherosclerosis in HIV-infected Women and Men
Authors: Hanna David B , Lin Juan , Post Wendy S , Xue Xiaonan , Anastos Kathryn , Cohen Mardge H , Gange Stephen J , Heath Sonya L , Lazar Jason M , Liu Chenglong , Mack Wendy J , Ofotokun Igho , Tien Phyllis C , Hodis Howard N , Landay Alan L , Kingsley Lawrence A , Tracy Russell P , Kaplan Robert C
Published: April 2024

Introduction:
Monocytes and monocyte-derived macrophages promote atherosclerosis through inflammation and vascular remodeling. We suspect that this is especially true in chronic HIV infection due to increased inflammation. We hypothesized that 4 serum macrophage inflammation markers, soluble (s)CD163, sCD14, galectin-3 binding protein (Gal-3BP), and galectin-3 (Gal-3), are associated with progression of subclinical carotid artery atherosclerosis even after adjustment for the systemic inflammation markers C-reactive protein (CRP) and interleukin-6 (IL-6).

Methods:
We examined 778 women (74% HIV+) in the Women’s Interagency HIV Study and 503 men (65% HIV+) in the Multicenter AIDS Cohort Study who underwent repeated B-mode carotid artery ultrasound imaging in 2004–2013. Baseline marker levels were determined from previously frozen serum specimens. We assessed the association of each marker with new plaque formation (focal IMT >1.5 mm) over a median 7 years, adjusting for demographic, behavioral, and cardiometabolic risk factors, and levels of high sensitivity CRP and IL-6.

Results:
Levels of each marker were significantly higher in HIV+ compared with HIV- individuals. Presence of focal plaque increased from 8 to 15% in women and 25 to 34% in men over 7 years. After adjustment for risk factors plus hsCRP and IL-6, each standard deviation (SD) of sCD14 was associated with a 21% increased risk of new plaque formation (RR 1.21, 95% CI 1.05-1.41), and this pattern was consistent in women and men. sCD163 was marginally associated with increased risk in men (RR 1.24 per SD, 95% CI 0.97-1.59) but not women (RR 0.96, 95% CI 0.75-1.23). Gal-3BP and Gal-3 were not associated with new plaque formation, nor was IL-6. Among men, the association of sCD163 with plaque formation was most pronounced among HIV+ with CD4+ counts <200 cells/uL. Among women, the association between sCD163 and plaque formation was greatest among HIV/HCV co-infected individuals.

Conclusions:
Higher sCD14 and sCD163 levels were associated with new carotid artery plaque formation over 7 years in the context of HIV infection. Monocyte activation may play a disproportionately strong role in the development of atherosclerosis among HIV+ compared with HIV- individuals.
Abstract 11651: Cost-effectiveness of Screening for Atrial Fibrillation in Primary Care With a Hand-held, Single-lead ECG Device in the Netherlands
Authors: Jacobs Maartje , Kaasenbrood Femke , Postma Maarten , Van Hulst Marinus , Tieleman Robert
Published: April 2024

Introduction:
Atrial fibrillation (AF) is the most common arrhythmia and prevalence increases with age. Patients with AF have a high risk of stroke and screening for AF is recommended in all people aged 65 years or older to identify patients eligible for stroke prevention. A hand-held, single-lead ECG device can be used for systematic screening in the population at risk. The objective of this study is to estimate the cost-effectiveness of screening for atrial fibrillation in primary care with the MyDiagnostick® during seasonal influenza vaccination in the Netherlands.

Methods:
Life-time costs and effects of a single screening session for AF detection were assessed from a societal perspective with a decision analytic model consisting of a straightforward decision tree and a joining Markov model. The decision model simulated all patients aged 65 years and over attending the seasonal influenza vaccination in the Netherlands. Event probabilities were derived from clinical trials. Sensitivity analyses were performed to assess the impact of important model assumptions as well as determining the relative effect of individual parameters.

Results:
Screening for AF with the MyDiagnostick® in all patients older than 65 years that attend seasonal influenza vaccination in the Netherlands would decrease the overall costs by є1,364 and increase the quality-adjusted life years (QALYs) by 0.45 QALYs per patient. Early detection of AF would prevent strokes and leads to beneficial health-effects with subsequent cost savings. This screening method would have an estimated probability of 99.9% for being cost-effective at a conservative willingness-to-pay of є20,000/QALY gained.

Conclusions:
Screening for AF in primary care with a hand-held, single-lead ECG during seasonal influenza vaccination is very likely to be cost saving for identifying new cases of AF in the Dutch population aged 65 years and over. Active screening for AF with a single-lead, hand-held ECG device during seasonal influenza vaccination should be implemented in primary care.
Abstract 11672: Incidence of Implantation of Implantable Cardioverter Defibrillators Within 90 Days in Patients Surviving Non-Myocardial Infarction Out-of-hospital Cardiac Arrest in Denmark Between 2001-2012
Authors: Winther-Jensen Matilde , Kjaergaard Jesper , Flensted Lassen Jens , Kober Lars , Torp-Pedersen Christian , Moller Hansen Steen , Lippert Freddy K , Frischknecht Christensen Erika , Hassager Christian
Published: April 2024

Introduction:
For patients surviving out-of-hospital cardiac arrest (OHCA) with a shockable rhythm, implantable cardioverter defibrillator (ICD) is recommended unless the arrest was caused by a reversible condition (acute myocardial infarction (AMI)). Yet, other factors may also influence decision to implant ICD.

Aim:
To determine factors associated with implantation of ICD in patients surviving non-AMI OHCA in a nationwide registry covering all OHCAs in Denmark.

Methods:
We identified 36,950 OHCAs between 2001-2012, 1,933 of whom were without prior ICD, ≥ 18 years, not diagnosed with AMI and surviving until discharge. 1,732 had no ischemic heart disease (IHD) diagnosis, 201 had chronic IHD diagnosis ≤ two days post OHCA. Multiple logistic regression was used to identify factors associated with ICD implantation ≤ 90 days post OHCA.

Results:
In patients with no IHD, the incidence of ICD implantation increased over time (OR: 1.07 per year, CI: 1.03-1.1, p=0.001, fig 1). Witnessed arrest, bystander defibrillation and cardiac etiology were associated with higher odds of ICD (OR
witnessed
: 2.2, CI: 1.6-3.0, p<0.001, OR
defibrillation
: 2.9, CI: 1.6-5.2, p<0.001, OR
etiology
: 16, CI: 5.7-45, p<0.001), and non-shockable rhythm was associated with lower odds of ICD (OR: 0.2, CI: 0.1-0.3 p<0.001). Age ≥ 80 years was associated with lower odds of ICD in patients without IHD (OR: 0.2, CI: 0.1-0.3, p<0.001) as well as patients with IHD (OR: 0.1, CI: 0.01-0.5, p<0.01). In patients with IHD, top income tertile, Charlson comorbidity index (CCI) 1 and witnessed arrest were associated with higher odds of ICD (OR
top income
: 9.7, CI: 1.6-58.6, p=0.01, OR
CCI1
: 5.3, CI: 1.7-17, p<0.01, OR
witnessed
: 3.4, CI: 1.1-10, p=0.04).

Conclusion:
ICD implantation rates increased over the study period in non-IHD patients, but not in patients with IHD. ICD implantation was less likely in patients ≥ 80 years. High income and low comorbidity burden was associated with higher odds in patients with IHD.
Abstract 11673: Neuroprotective Mechanisms of Mefenamic Acid in an
in vitro
Model of Stroke
Authors: Khansari Parto S , Shaligram Sonali S , Rahimian Roshanak , Halliwell Robert F
Published: April 2024

Introduction:
Fenamates are classical non-steroidal anti-inflammatory drugs but they are also modulators of GABA
A
receptors, activators of potassium channels and antagonists of non-selective cation channels. Previous data from our lab has demonstrated that the fenamate, mefenamic acid (MFA), has neuroprotective effects both
in vitro
and
in vivo
.

Hypothesis:
We hypothesized that the neuroprotective actions of mefenamic acid result from its diverse pharmacological properties. To test this hypothesis, we have investigated four pharmacological properties of MFA, namely cyclooxygenase (COX) inhibition, GABA
A
receptor modulation, potassium channel activation and reactive oxygen species (ROS) inhibition against glutamate neurotoxicity
in vitro
.

Methods:
Neurotoxicity was induced by exposure of embryonic rodent hippocampal neurons, 9 days in vitro, to 10 mins of Na-glutamate (5μM). 24 hours after exposure to Na-glutamate, cell death was quantified by measuring the levels of lactate dehydrogenase (LDH) in the media using a CytoTox-96 non-radioactive assay kit. Generation of ROS was measured using Carboxy-H2DCFDA dye.

Results:
MFA and the non-fenamate COX inhibitors, ibuprofen, indomethacin and Na-salicylate were examined against glutamate neurotoxicity at 10 or 100μM. Cell death was significantly (p<0.01) reduced by 79%, (100μM) and 65% (100μM) by MFA and Na-salicylate, respectively, but not with ibuprofen and indomethacin. Generation of ROS was also decreased significantly when treated with MFA at 30μM and 100μM by 38% and 36% (p<0.05) respectively.The effects of co-application of MFA with either picrotoxin (a GABA
A
channel blocker) or bicuculline (a competitive GABA
A
receptor antagonist) or TEA (a K
+
channel blocker) were examined. Co-application of MFA (100μM) with picrotoxin (100μM), bicuculline (10μM) or TEA (30mM) all reduced cell death but neuroprotection was not significant.

Conclusion:
Collectively, these data suggest that COX inhibition and reduction of ROS generation significantly contribute to the neuroprotective actions of MFA against glutamate neurotoxicity. GABA modulation and potassium channel inhibition of MFA may also contribute but they are not the primary mechanism of its neuroprotective actions.
Abstract 11678: Tricuspid Valve Repair Versus Replacement for Very Severe Functional Tricuspid Regurgitation
Authors: Kang Duk-Hyun , Jang Jeong Yoon , Heo Ran , Lee Sahmin , Song Jong-Min , Choi Kee-Joon , Song Jae-Kwan , Lee Jae-Won , Zo Joo-Hee
Published: April 2024

Introduction:
The optimal decision regarding whether to repair or replace the tricuspid valve (TV) remains controversial in patients with very severe functional tricuspid regurgitation (TR).

Objectives:
We sought to compare clinical outcomes of TV repair versus replacement for very severe TR associated with severe TV tethering.

Methods:
We included 96 consecutive patients (20 men, 58±11 years of age) who had both severe tethering of TV and very severe functional TR, and consequently underwent TV surgery during left-sided valve surgery. TV repair was performed on 79 patients (repair group), whereas 17 patients underwent TV replacement (replacement group). The primary end-point of the study was defined as the composite of operative mortality, cardiac death, repeat TV surgery and hospitalization due to congestive heart failure during follow-up.

Results:
The two groups had similar baseline clinical, echocardiographic and operative characteristics, but operative mortality was significantly higher in the replacement group than in the repair group (P=0.008). During a median follow-up of 87 months, 19 (24%) patients in the repair group and 8 (47%) in the replacement group attained the composite end point, and the estimated 10-year event-free survival rate was significantly higher in the repair group (75 ± 6%) than in the replacement group (43 ± 2%) (P = 0.019). TV replacement was independently associated with end points in the Cox proportional hazards analysis after adjustment with propensity score (hazard ratio, 4.033; 95% CI, 1.470 to 11.071; P=0.007).

Conclusions:
Compared with TV repair, replacement was associated with higher operative mortality and worse long-term clinical outcomes in patients with very severe functional TR. Repair should be the preferred surgical option even for severe TR associated with more advanced tethering and right ventricular dilatation.
Abstract 11740: Role of Physical Fitness in Statin Induced Type II Diabetes Mellitus
Authors: Narayan Puneet , Faselis Charles , Kumar Anubhav , Nylen Eric , Tsimploulis Apostolos , Blackman Mark , Pittaras Andreas , Doumas Michael , Kokkinos Peter
Published: April 2024

Introduction:
Several studies have now shown statin use predisposes to the development of type II diabetes mellitus (DM). We evaluated high risk Veterans to identify factors influencing the incidence of statin induced DM,

Methods:
Non-diabetic patients (n= 5143; age: 58.9±10.9 yrs), completed a routine exercise tolerance testing at Washington DC and Palo Alto Veterans Affairs Medical Centers at baseline. All had a normal exercise response. We established five fitness categories based on age-stratified quintiles of peak metabolic equivalents (MET) achieved: Least-fit (4.5±1.1 METs; n= 1007); Low-Fit (6.2±1.1 METs; n=1159); Moderately-Fit (7.3±1.2 METs; n=1061); Fit (8.4±1.1 METs; n=1073) and Highly-Fit (11.0±2.3 METs; n=843). Multivariable Cox models were used to estimate hazard ratios (HR) and 95% confidence intervals [CI] for incidence of DM across fitness categories. The model was adjusted for age, BMI, gender, race, resting blood pressure, hypertension, smoking status and medications. The Least-fit category was the referent.

Results:
During a follow-up of 10.01 years after initiation of statin therapy, 1110 patients developed DM (21.5 events per 1000 person years of follow-up). The association between fitness status and incidence of DM was inverse and graded. The risk was 8% lower for each 1-MET increase in exercise capacity (HR=0.92, CI: 0.89-0.94). When considering fitness categories, DM risk was similar for individuals in the three lowest fitness categories. However, the risk was 22% lower (HR=0.78; CI: 0.64-0.94) for fit individuals (peak exercise capacity: 8.4±1.1 METs) and 42% lower for those in the highest fitness category (peak exercise capacity: 11.0±2.3 METs; HR= 0.58; CI: 0.46-0.73).

Conclusions:
High levels of physical fitness were protective against development of statin induced type II DM in this high risk Veteran population.
Abstract 11870: The -174 G>C Interleukin-6 Gene Polymorphism is Associated With Angiographic Progression of Non-culprit Coronary Plaques in a Mid-term Period
Authors: Anousakis-Vlachochristou Nikolaos , Klettas Dimitrios , Melidis Konstantinos , Azilazian Zeta , Asimomiti Maria , Karanasos Antonios , Spanos Anastasios , Tsiamis Eleftherios , Toutouzas Konstantinos , Nihoyannopoulos Petros , Tousoulis Dimitris
Published: April 2024

Hypothesis:
Inflammation is the key process underlying the course of CAD. Interleukin-6 (IL-6) is an upstream key regulator of inflammation. Single nucleotide polymorphisms (SNPs) of inflammatory genes, reportedly influence the outcomes of CAD patients. We sought to evaluate the impact of -174 G>C IL-6 SNP in patients with established CAD.

Methods:
We examined previous angiographies of patients with a PCI history, who were prospectively re-investigated for stable/unstable angina after >12 months. We defined progression of CAD by qCA as the emergence of a new culprit lesion. We genotyped patients to their Mendelian randomization group of -174 G>C IL-6 SNP (rs1800795). The probability for CAD progression was evaluated with the Kaplan-Meier and Cox model analysis including age, hypertension, family history, dyslipidemia and diabetes.

Results:
A total of 157 patients were included with a median follow-up time of 48 months. Genotype distribution was: GG: 30, CC: 55, GC: 72, C variant: 58%, frequencies were in Hardy-Weinberg equilibrium: χ
2
=0.54, p=0.46. Baseline characteristics were evenly distributed. Serum levels of IL-6 differed significantly: CC 5.58±2.52, GG 2.73±1.08, GC 4.04±1.86 mg/L, p<0.001. At 48 months, carriers of IL-6 C allele had 52.8% cumulative probability for progression vs 13.3% G allele, p=0.005. Results were confirmed in multivariate analysis: C allele HR: 5.09, 95% CI (1.55, 16.7), p=0.007, family history HR: 2.46, 95% CI (1.43, 4.23), p=0.001, dyslipidemia HR: 1.47, 95% CI (1.02, 2.11), p=0.041.

Conclusions:
Patients with established CAD, carrying the -174 C allele of IL-6 gene, had increased risk for progression of non-culprit plaques in a 4-year period. C allele significantly contributed to CAD progression along with family history and dyslipidemia.
Abstract 11882: Reduced N-type Calcium Channels in Ventricular Vagal Neurons and Ventricular Arrhythmogenesis
Authors: Zhang Dongze , Tu Huiyin , Zheng Hong , Muelleman Robert L , Li Yu-long
Published: April 2024

Attenuated cardiac vagal activity is linked to ventricular arrhythmogenesis, and is associated with mortality in patients with chronic heart failure (CHF). However, the sites and mechanisms responsible for decreased cardiac vagal activity are still poorly understood. Our previous studies showed that expression of N-type Ca
++
channel α-subunits (Ca
v
2.2-α) and N-type Ca
++
currents were reduced in intracardiac ganglion neurons from coronary artery ligation-induced CHF rats. Rat intracardiac ganglia are divided into the atrioventricular ganglion (AVG) and sinoatrial ganglion. Ventricular myocardium only receives projection of neuronal terminals from the AVG. Here, we tested the hypothesis that reducing N-type Ca
++
channels in AVG neurons contributes to ventricular arrhythmogenesis. Lentiviral Ca
v
2.2-α shRNA (2 μl, 1x10
6
pfu/ml) or scrambled shRNA was
in-vivo
transfected into rat AVG neurons. Non-transfected sham rats served as control. Using real-time single-cell PCR and reverse-phase protein array, we found that
in-vivo
transfection of Ca
v
2.2-α shRNA decreased expression of Ca
v
2.2-α mRNA and protein in rat AVG neurons. The results from whole-cell patch clamp recording showed that Ca
v
2.2-α shRNA reduced N-type Ca
++
currents and cell excitability in AVG neurons. The data obtained from telemetry ECG recording demonstrated that 83% (5 out of 6) of conscious rats with Ca
v
2.2-α shRNA transfection had premature ventricular contraction (p<0.05 vs. 0% of non-transfected sham rats or scrambled shRNA transfected rats). Additionally, an index of susceptibility to ventricular arrhythmias, inducibility of ventricular arrhythmias evoked by programmed electrical stimulation is higher in rats with Ca
v
2.2-α shRNA transfection (1.8 ± 0.3 ventricular arrhythmia score), compared to non-transfected sham rats and scrambled shRNA transfected rats (0 ventricular arrhythmia score, p<0.05 vs. these two groups). From these results, we conclude that reduced N-type Ca
++
channels in AVG neurons cause vagal neuronal dysfunction, which is a trigger to initiate ventricular arrhythmias. These results suggest that reduced N-type Ca
++
channels in AVG neurons might be involved in ventricular arrhythmogenesis and sudden cardiac death in the CHF state.
Abstract 11884: MRI and ICDs or Pacemakers After Magnsafe
Authors: Mason Steve , Tonkin Allison , Osborn Jeffrey S , Ethington Jon-David , Anderson Jeffrey L , Dhar Ritesh , Bunch T J , Lappé Donald L , Le Viet T , Knowlton Kirk U
Published: April 2024

Introduction:
The MagnaSafe registry was a prospective study that examined cardiac implantable electronic devices (CIED) parameter changes when exposed to non-thoracic MRI scanning. This registry data showed that MRI scans in patients with a CIED can be performed safely. Ongoing real-word data that encompasses newer CIED technologies are required to further understand outcomes of non-MRI conditional CIED parameters after exposure to 1.5 Tesla extra-thoracic MRI. These data are especially pertinent as the REPLACE trial showed a 4% (without leads) and 15% (with leads) risk of major complications with upgrade to a MRI conditional device.

Methods:
We prospectively examined 152 patients with either a pacemaker or ICD who underwent MR imaging between 2-12-2014 date and 3-15-2016 dates using a General Electric 1.5 Tesla model Optima MR450w scanner. Ambient temperature was set at 19
°
C. Pacing modes during MRI were 0D0 for intrinsic rates >40 and D00 for rates ≤40. All patients were cleared prior to scan by both Radiology and Cardiology per our in-house developed standard protocol with pre- and post-MRI CIED interrogation. Primary outcomes were death, generator or lead failure. Secondary outcomes were a battery voltage loss of >0.04 V, decrease in P wave voltage of >50% and R wave voltage of >25%, a threshold increase of >0.5 V, and an impedance change of >50 Ω.

Results:
181 scans were performed in 50(28%) patients with pacemakers and 131(72%) patients with ICDs. A summary of vendor and device type is listed. No patients experienced a primary or secondary outcome, regardless of whether the device was MRI-conditional. By design, each patients underwent a post MRI device interrogation there were no parameter changes seen or device complications.

Conclusions:
Real-world ongoing device surveillance at Intermountain Medical Center using the MagnaSafe registry approach and endpoint to demonstrate that 1.5 Tesla extra-thoracic MRI scanning is safe in patients with all forms of CIED, regardless of whether the device was MRI conditional.. This data extend to newer Bi-V technologies and lead designs as well as subcutaneous ICDs. This data continue to support that clinically-indicated MRI tests need not be withheld in patients with CIEDs.
Abstract 11888: Mechanical Circulatory Support Increases Return of Spontaneous Circulation in Patients Receiving Mechanical Chest Compressions for Cardiac Arrest in the Cardiac Catheterization Laboratory
Authors: Venturini Joseph M , Retzer Elizabeth , Estrada J Raider , Friant Janet , Beiser David , Edelson Dana , Paul Jonathan , Blair John , Nathan Sandeep , Shah Atman P
Published: April 2024

Introduction:
In the cardiac catheterization laboratory (CCL), use of a mechanical chest compression (MCC) device allows acute cardiac life support (ACLS) and percutaneous interventions to occur simultaneously. Use of MCC in the CCL ensures adequate chest compressions without relying on manual compression providers. This is especially important in the context of recent studies that have shown that therapies offered in the CCL increase survival in patients with cardiac arrest. Furthermore, mechanical circulatory support (MCS) has been shown to improve outcomes of patients with cardiac arrest, but it is not known whether emergent, percutaneous MCS initiation provides clinical efficacy in patients undergoing MCC-assisted ACLS in the CCL.

Methods:
We performed a retrospective analysis of patients who received MCC-assisted ACLS in the CCL at our institution between April 2014 and February 2016. Baseline characteristics, resuscitation characteristics, and clinical outcomes were compared between patients who were treated with MCS and those who were not. Unpaired two-sample t-tests were used to compare continuous variables. Fisher’s exact test was used to compare categorical variables.

Results:
Thirty-one patients received MCC-assisted ACLS in the CCL. Twenty-two patients (71%) were treated with MCS (14 external cardiac life support (ECLS), 3 Impella, 5 intra-aortic balloon pump (IABP)). Patients who received MCS were significantly more likely to achieve return of spontaneous circulation (ROSC) than those who did not receive MCS (95% v 22%, p = 0.00). Thirty-day survival was more common in the group receiving MCS (Table 1). The majority of patients who received MCS suffered cardiac arrest either outside the hospital or in the emergency department.

Conclusions:
The addition of percutaneous MCS to MCC-assisted ACLS increased the rate of ROSC. These findings support the use of emergent percutaneous MCS during MCC-assisted ACLS in the CCL.
Abstract 11893: The Impact of Statin Therapy on Survival Following Inpatient Cardiac Arrest
Authors: Khoury Abdulla Rami , Abbas Amr E
Published: April 2024

Introduction:
Over 200,000 hospitalized patients suffer cardiac arrest annually with a high morbidity and mortality following cardiopulmonary resuscitation (CPR). The aim of this study was to examine factors associated with survival post CPR in hospitalized patients.

Hypothesis:
Pre-arrest statin therapy is associated with improved survival.

Methods:
A retrospective analysis of consecutive hospitalized patients that underwent CPR between 4/2012 to 12/2013 at Beaumont Hospital. Patients with CPR perioperatively, in the setting of trauma, during pregnancy and postpartum were excluded, also patients or their surrogates who elected palliative care/hospice were excluded. Univariable and a step-down logistic regression multivariable analysis were performed.

Results:
Of 124 patients included in the study, 80 patients died, whereas 44 patients survived. Pre-arrest clinical factors and CPR characteristics associated with survival on univariable analysis were: History of PCI in 36.4% of survivors compared to 16.5% of those who did not survive (p=0.013). Hyperlipidemia was more common in survivors (68.2% versus 32.5%, p=0.001), as well as being on statins (76.7% versus 43%, p=0.0004). Those who did not survive were more likely to have active cancer (16.3% versus 2.3%, p=0.018), less likely to have a shockable rhythm (7.9% versus 27.9%, p=0.003), and more likely to have CPR ≥ 15 minutes (82.4% versus 19.5%, p<0.0001). On multivariable analysis, CPR duration and statin therapy were the only factors associated with survival. Those who did not survive were more likely to have CPR
≥
15 minutes (Adjusted OR 18.08, 95% CI 6.5-50.5, p<0.001) and less likely to be on statin therapy before cardiac arrest ( Adjusted OR 0.29, 95% CI : 0.10-0.83 p= 0.021) with C-Statistic of 0.86.

Conclusion:
This study suggests that being on statin therapy is associated with high likelihood of survival following CPR. Further studies are needed to confirm this finding.
Abstract 11909: Migraine Headaches and Cardiovascular Outcomes in Women With Symptoms and Signs of Ischemic Heart Disease: Results of an Extended follow-up From the Women’s Ischemia Syndrome Evaluation
Authors: Rambarat Cecil A , Elgendy Islam Y , Johnson B. Delia , Pepine Carl J , Bairey Merz C Noel , Bittner Vera A , Reis Steven E , Thompson Diane V , Ahmed Bina
Published: April 2024

Introduction:
Data regarding the association between migraine headaches (MH) and cardiovascular (CV) events in women have been inconsistent. The aim of this study was to determine the long-term risk of CV events among women with and without MH who were evaluated for suspected ischemic heart disease (IHD) in the Women’s Ischemia Syndrome Evaluation (WISE) Study.

Methods:
Women reporting a history of MH were identified from the WISE cohort. Extended follow-up data were available for a median follow-up of 6 years. Cox proportional adjusted hazard ratios (HR) were constructed for time to first adverse CV event (CV death, non-fatal myocardial infarction [MI], heart failure hospitalization, or non-fatal stroke) among women with and without MH. Additionally, HR were determined for each event separately, as well as, all-cause death, angina hospitalization, death or MI, and CV death or MI.

Results:
Data on self reported MH were available on 917 women. A total of 224 (24.4%) reported a history of MH. Compared to those who did not report a history of migraines, women with a history of MH had an increased adjusted* risk of CV events (HR 1.83 CI 1.22-2.75, p=0.004) at a median follow up of 6-years. This result was mainly due to an increase in the risk of stroke (HR 2.33 CI 1.16-4.68, p=0.018) (Table 1).

Conclusion:
Among women being evaluated for IHD, those who reported a history of MH had an increased risk of future CV event. This finding was primarily driven by the more than 2-fold increased risk of stroke.
Abstract 11925: Differences in End-of-Life Preferences and Planning by Prognosis in Patients Hospitalized With Acute Decompensated Heart Failure
Authors: Young Kathleen A , Strand Jacob J , Redfield Margaret M , Dunlay Shannon M
Published: April 2024

Introduction:
In patients with heart failure, preferences for end-of-life (EOL) care and involvement in advance care planning can vary over their illness trajectory. The aim of this study was to compare EOL preferences by prognosis, assessed using the validated Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) risk score, in patients hospitalized with acute decompensated heart failure (ADHF).

Hypothesis:
EOL preferences and planning vary by prognosis.

Methods:
Between January 2014 and January 2016, Southeastern Minnesota residents hospitalized with ADHF at Mayo Clinic hospitals in Rochester, MN were prospectively recruited into an observational cohort study. Information on EOL preferences and advance care planning were assessed by patient questionnaire. MAGGIC risk scores and associated 1-year mortality estimates were calculated using patient characteristics at the time of hospital admission and stratified by quartile. The associations of EOL preferences/ planning and prognosis were examined using two sample t-tests and linear regression.

Results:
Among 400 patients (mean age 77.7 years, 46% female), predicted 1-year mortality ranged from 3.9-72.5% (median 22.5%). Patients with higher estimated mortality (worse prognosis) more often elected Do Not Resuscitate (DNR) status (p=0.001) and more often had an advanced directive (p<0.001, Table). No other differences in EOL preferences or planning by prognosis were observed.

Conclusions:
In community patients hospitalized with ADHF, resuscitation preferences and rates of completion of advance care planning documents varied with prognosis, though patient-clinician EOL discussions and awareness and attitudes about EOL options did not.
Abstract 11979: Relationship between the QT Interval and Outcome in Low-Flow Low-Gradient Aortic Stenosis With Low LVEF
Authors: Dahou Abdellaziz , Toubal Oumhani , Clavel Marie-Annick , Beaudoin Jonathan , Magne Julien , Mathieu Patrick , Philippon François , Dumesnil Jean G , Puri Rishi , Ribeiro Henrique B , Larose Éric , Rodés-Cabau Josep , Pibarot Philippe
Published: April 2024

Background:
The QT interval has been shown to be associated with cardiovascular events. There is no data available on the association between the QT interval and left ventricular (LV) function and on its impact on prognosis in patients with low LV ejection fraction (LVEF), low-flow, low-gradient (LF-LG) aortic stenosis (AS). The objectives of this study were to examine the relationship between the corrected QT interval (QTc) and LV function and outcome in patients with LF-LG AS and low LVEF.

Methods:
Ninety-three patients (73±10 years; 74% men) with LF-LG AS (i.e. mean gradient [MG] <40 mmHg and indexed aortic valve area [AVAi] ≤0.6 cm2/m2) and reduced LVEF (≤40%) were prospectively included in this analysis and 63 (68%) of them underwent aortic valve replacement (AVR) within 3 months following inclusion. QTc was calculated with the Bazett formula. Prolonged QTc was defined as QTc> 450 ms in men and >470 ms in women. The severity of AS was assessed by the projected AVA (AVAproj) at normal flow rate. LV global longitudinal strain (GLS) was measured by 2D speckle tracking and expressed in absolute value
Abstract 11981: Can Preoperative Intensive Carotid And Intracranial Artery Screening Reduce Perioperative Strokes in Cardiovascular Surgery?
Authors: Imasaka Ken-ichi , Tayama Eiki , Tomita Yukihiro
Published: April 2024

Introduction:
The occurrence of stroke is a concern in patients undergoing cardiac surgery (CS) concomitant with carotid and/or intracranial artery disease (CIAD). Although the 2011 American Heart Association guidelines recommend screening only selected patients referred for elective CS, the clinical utility of CIAD screening is poorly understood.

Objectives:
To evaluate the effectiveness of CIAD screening for patients undergoing elective CS.

Methods:
Between February 2004 and December 2014, 1095 of 1134 patients (97%) underwent routine CIAD screening before CS at our institute. CS included coronary artery bypass grafting (CABG) in 378 (34%) patients, CABG + valve surgery in 151 (13%), valve surgery in 480 (42%), aortic surgery without brain protection in 43 (4%), and others in 82 (7%). Patients were divided as follows: those who underwent CS before (n=500) and those after (n=634) the introduction of intensive screening (IS) in January 2009. Preoperative screening had undergone transition in 2009, from the evaluation of carotid atherosclerosis alone to that of carotid and intracranial atherosclerosis. Moreover, patients detected with ≥moderate stenosis on IS underwent single-photon emission computed tomography (SPECT) with acetazolamide (ACZ). CIAD was classified based on the degree of stenosis as mild (0%-49% stenosis: n=836 [before/after: 370/466]), moderate (50%-69%: n=118 [56/62]), or severe (70%-100%: n=141 [36/105]).

Results:
One of 166 (0.6%) patients with ≥moderate stenosis undergoing SPECT with ACZ was diagnosed with impaired cerebral autoregulation and underwent prophylactic superficial temporal artery to middle cerebral artery anastomosis 1 month before CABG. Subsequently, the patient underwent CABG without experiencing postoperative stroke. The introduction of IS significantly reduced the prevalence of perioperative stroke (2.8% vs. 0.9%, P=0.03) and permanent neurological dysfunction (2.4% vs. 0.5%, P=0.01). Additionally, prevalence of intraoperative stroke decreased significantly after the introduction of IS (1.4% vs. 0.2%, P=0.03).

Conclusions:
Incidence of perioperative stroke decreased following the introduction of IS. Therefore, IS might help identify patients at risk of perioperative stroke.
Abstract 12008: Comprehensive Bivariate Meta-Analysis of Hypertension Trials With Heart Failure as an Outcome
Authors: Kostis William J , Cheng Jerry Q , Dobrzynski Jeanne M , Garg Aakash , Kostis John B
Published: April 2024

Introduction:
In meta-analyses, odds ratios (OR) are considered more meaningful to summarize data of multiple trials while absolute risk reduction (ARR) is more relevant to specific clinical questions. We developed a novel bivariate random effects meta-analysis method for simultaneous evaluation of ORs and ARRs.

Methods:
Using this method, we analyzed the efficacy of different classes of antihypertensive therapy in preventing heart failure (HF) in 54 randomized clinical trials not requiring diabetes as an inclusion criterion (331,728 patients, 12,969 events), including SPRINT and HOPE-3.

Results:
The expected relationship between OR and ARR for a given baseline risk was observed. Diuretics were superior to all other medications, both with respect to ARR and OR (ARR 14.6 per thousand, 95% CI 7.3-22.0; OR 0.52, CI 0.38-0.70). Intensive therapy (ARR 5.1, CI -1.9-12.1; OR 0.72, CI 0.46-1.11) was the second best, followed by ACEIs (ARR 4.9, CI 0.1-9.6; OR 0.81, CI 0.69-0.95), ARBs (ARR 4.4, CI -0.3-8.5; OR 0.90, CI 0.81-0.99), and DHPs (ARR 1.0, CI -3.4-5.4; OR 0.89, CI 0.86-1.16). Verapamil was associated with a trend toward increased absolute risk (ARR 2.3, CI -0.1-4.8; OR 1.17, CI 0.99-1.37). Multiple metaregression identified the magnitude of the difference between the blood pressure lowering from baseline in the active and control groups as the only significant association (p<0.04) of the benefit in preventing HF. The effects on all-cause and cardiovascular mortality were consonant with the above with the exception of verapamil, where the adverse effect was attenuated when cardiovascular and all-cause death were considered.

Conclusions:
This new bivariate meta-analysis method combining ARR and OR is useful in clinical decision making, using ARR for specific clinical questions, OR to summarize studies. Based on information from all available studies, diuretics are the superior medication for the prevention of HF in hypertensive patients from both points of view.
Abstract 12009: A Prospective Randomized Placebo-Controlled Crossover Trial of Flecainide for Catecholaminergic Polymorphic Ventricular Tachycardia
Authors: Kannankeril Prince J , Moore Jeremy P , Cerrone Marina , Priori Silvia G , Kertesz Naomi J , Ro Pam , Batra Anjan S , Kaufman Elizabeth S , Fairbrother David L , Saarel Elizabeth V , Etherdige Susan P , Kanter Ronald J , Carboni Michael P , Dzurik Matthew V , Fountain Darlene , Chen Heidi , Ely E W , Roden Dan M , Knollmann Bjorn C
Published: April 2024

Introduction:
Randomized clinical trials (RCTs), the gold standard to evaluate new therapies, have not been performed in Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT). Up to 30% of CPVT patients have recurrent symptoms or cardiac events despite standard therapy with beta-blockers. In a mouse model flecainide was found to directly target the molecular defect in CPVT and in retrospective clinical studies patients had improved ventricular ectopy during exercise with flecainide added to beta-blockers.

Hypothesis:
Flecainide + beta-blocker is superior to beta-blocker alone in CPVT.

Methods:
CPVT patients were enrolled in a single blind placebo-controlled crossover RCT of flecainide added to beta-blocker. Subjects underwent a baseline exercise (Ex) test on maximally-tolerated beta-blocker dose which continued throughout the trial, then were randomized to flecainide or placebo for 3 months, followed by Ex testing. After a 1 week washout, subjects crossed over to placebo or flecainide for 3 months, followed by Ex testing. The primary endpoint of ventricular ectopy during Ex was compared between beta-blocker + flecainide vs. beta-blocker + placebo. Ex tests were scored on an ordinal scale of worst ventricular arrhythmia observed (0 = no ectopy, 1 = isolated PVC’s, 2 = bigeminy, 3 = couplets, 4 = nonsustained VT).

Results:
A total of 13 subjects (7 males) at 10 centers were randomized. Median age was 16 years and baseline Ex test score was 3 (IQR 1-3.5). Ventricular ectopy during Ex was significantly reduced by flecainide (P<0.01, see Figure); there was no difference between baseline and placebo Ex score (P=0.7). Overall adverse events and serious adverse events did not differ between flecainide and placebo.

Conclusions:
This placebo-controlled RCT demonstrates that flecainide + beta-blocker is superior to beta-blocker alone in reducing exercise-induced ventricular arrhythmias in CPVT.
Abstract 12025: Higher Lactate Oxygen Index Rather than Artery Lactate Indicate Poor 24h-survival After Resuscitation in a Porcine Model of Prolonged Cardiac Arrest
Authors: Zhai Xiaozhu , Yang Zhengfei , Jiang Longyuan , Wen Cai , Zheng Houzhen , Yu Tao , Peberdy Mary A , Ornato Joseph P , Tang Wanchun
Published: April 2024

Introduction:
Increases in arterial lactate concentration (ALac) and cerebral lactate oxygen index (LOI) are documented indicators of poor prognosis in critically ill patients. In the present study, we investigated the changes of ALac and LOI after successful cardiopulmonary resuscitation (CPR) in a porcine model of prolonged cardiac arrest (CA).

Hypothesis:
Lactate oxygen index serves as a more sensitive indicator of post resuscitation survival than arterial lactate.

Methods:
Twelve male domestic pigs weighing 40 ± 3kg were studied. Ventricular fibrillation was electrically induced and untreated for 10 min. All animals were successfully resuscitated. Blood gas samples were obtained from the internal jugular vein and abdominal descending aorta at baseline (BL), 30 min and 120 min after resuscitation (PR). LOI was calculated based on the arterial (CaO
2
) and jugular venous oxygen (CjO
2
) content: CaO
2
= (1.34 х Hb х SaO
2
) + (0.003 х paO
2
), CjO
2
= (1.34 х Hb х SjO
2
) + (0.003 х pjO
2
), LOI = -(arterial lactate-jugular vein lactate)/(CaO
2
-CjO
2
).

Results:
Five animals died in <24 h after initial resuscitation and the other seven survived > 24 h. The level of ALac in all animals increased significantly at PR30 and returned to BL at PR120. No significant differences in ALac were observed between survivors and non-survivors. LOI was increased in all animals after resuscitation when compared with BL. We observed significantly higher LOI levels at PR30 and PR120 in non-survivors vs. survivors.

Conclusions:
Higher LOI levels after resuscitation indicate poor 24 h survival in a pig model of prolonged CA.
Abstract 12028: Deranged Renal Functions Improve After Enhanced External Counter Pulsation Therapy in Patients With Chronic Ischemic Heart Disease
Authors: Mittal Sanjay , Jain Vivek , Bansal Manish , Kasliwal Ravi R , Trehan Naresh
Published: April 2024

Introduction:
Renal dysfunction frequently occurs in patients with coronary artery disease (CAD) significantly limiting their therapeutic options. Enhanced External Counter Pulsation (EECP) therapy improves symptomatic status and cardiac function in patients with CAD; however it’s impact on concomitant renal dysfunction is not well understood.

Hypothesis:
EECP therapy could improve renal function by improving LV systolic function and subsequently the renal perfusion.

Methods:
Patients with CAD referred to our EECP lab having baseline calculated glomerular filtration rate (GFR) less than 60ml/min were included in the study. All patients were subjected to 35 EECP sessions of one hour each. A thorough clinical evaluation, echocardiography, 6 min hall walk test and renal function test were done at the baseline and after completion of therapy. GFR was calculated with the help of MDRD (Modification of Diet in Renal Disease) formula. Statistical comparisons were made in renal parameters before and after EECP therapy.

Results:
Seventy four patients with GFR <60ml/min, mean age 64.5+/-8.7 yrs, 63(92%) males, completed 35 sessions of EECP therapy. Significant improvement was noted in left ventricular ejection fraction (LVEF) (34.8+/-12.4 to 38.8+/-12.3%, P<0.0001), functional class and 6 min hall walk distance (263.4+/-147.8 meters to 403.1+/-96.2 meters, P<0.0001) from baseline to post EECP therapy. GFR increased significantly from 39.5+/-15.1 ml/min at baseline to 46.5 +/- 21.9 ml/min after EECP. The improvement in GFR was more pronounced in the subgroup of 51 patients having baseline LVEF <40%, where 61% patients showed increase in GFR (from mean 40.6+/-14.8 to 48.1 +/- 20.1 ml/min, p= 0.003) after EECP. Blood urea and creatinine also significantly decreased in this group after EECP therapy.

Conclusions:
Deranged renal function, including reduced GFR, improve significantly after EECP therapy in patients with CAD, especially in those having baseline low LVEF. This beneficial effect of EECP is likely to be due to improvement in renal perfusion secondary to better LV function. Accordingly, EECP could be a potential therapeutic option for stabilizing ischemic heart failure patients with deranged renal function, prior to cardiac interventions.