bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 2927: Long QT Syndrome as a Cause of Stillbirths
Authors: Crotti Lia , Insolia Roberto , Ghidoni Alice , Antonazzo Patrizio , Facchinetti Fabio , Cetin Irene , Schwartz Peter J
Published: July 2021

Background
: Stillbirths (intrauterine fetal deaths occurring after the 22
th
week of gestation) notably contribute to perinatal mortality. Among them, 25–50% of cases remain unexplained after thorough investigation. We recently demonstrated that 10% of Sudden Infant Death Syndrome (SIDS) cases carry functionally relevant genetic variants in Long QT Syndrome (LQTS) genes. We previously hypothesized that severe forms of LQTS could contribute to mortality not only shortly after birth but also before. Accordingly, we are now screening LQTS genes in unexplained stillbirths.

Materials and Methods
: We receive DNA from an ongoing Italian multicenter study on rigorously defined ``unexplained stillbirths”. DNA is extracted from placenta or umbilical cord. Through DHPLC and sequence analysis we screen the main LQTS genes:
KCNQ1, KCNH2, SCN5A, KCNE1
and
KCNE2.
Any amino-acid substitution identified in the samples is checked in a control population of 122 Caucasian controls. Here, we report the preliminary data on the first 17 cases (gestational age of death: 23–38 weeks).

Results
: A total of 3 missense mutations have been identified in 3 of 17 stillbirths (18%). Two were on
SCN5A
and one on
KCNH2
. The two mutations on
SCN5A
(V1951L; P2006A) have been previously associated to SIDS and shown to increase the late sodium current. The mutation on
KCNH2
is a novel genetic variant absent in 244 reference alleles and never described in any control populations. We are currently performing the electrophysiological cellular studies to define its functional effect.

Conclusions
: The initial data from this ongoing study already indicate that a yet to be defined but potentially significant number of currently unexplained intrauterine fetal deaths might be caused by ion channel diseases such as LQTS. The completion of our study will soon provide a reliable quantification of this contribution. There are potentially important implications for the affected families, ranging from prevention of recurrences to identification of other affected family members and to possible prevention of SIDS or later sudden deaths in subsequent siblings.
Abstract 2931: Raised Blood Pressure Modifies the Association between Alcohol Intake and the Progression of Arterial stiffness: An 6 years’ observational study
Authors: Tomiyama Hirofumi , Matsumoto Chisa , Yamada Jiko , Yoshida Masanobu , Shiina Kazuki , Yamashina Akira
Published: July 2021

Objectives:
The J-shaped association between alcohol intake and cardiovascular events has been reported. Increased arterial stiffness is a cardiovascular risk, and raised blood pressure (RBP) (≥130/85 mmHg) is associated with a progressive increase of arterial stiffness. The present prospective study was conducted to examine the association between alcohol intake and the progression of arterial stiffness, and also clarify whether RBP modify this association over a period of 6 years.

Methods
: The brachial-ankle PWV was measured and alcohol intake was interviewed on three occasions, at an interval of 3 years, in Japanese male subjects without RBP (n=955) and those with RBP (n=601) (age, 40±8 years, 1279 men and 287 women).

Results:
According to the results of the interviews on three occasions, the subjects were categorized according to their daily alcohol intake into three groups {non-drinker group (Non), light-moderate (LiMo) and heavy (Heav) alcohol intake groups}. In subjects without RBP, the increase of the PWV during 6 years’ follow-up was lower in the LiMo group than in the Non group, even after adjusting changes in atherosclerotic risk factors (p<0.05); however, no such attenuation was observed in the subjects with RBP. On the other hands, in subjects with RBP, the increase of the PWV during 6 years’ follow-up was higher in the Heav group than in other two groups (Figure

).

Conclusion
: Light-moderate alcohol intake may have a vasculo-protective effect against structural arterial stiffening in subjects without RBP. In the presence of RBP, however, this protective effect is blunted and heavy alcohol intake seems to be rather harmful in middle-aged subjects.
Abstract 2944: 64-Slice Computed Tomography Coronary Angiography in Patients with High, Intermediate or Low Pre-test Probability of Significant Coronary Artery Disease
Authors: Meijboom Willem B , van Mieghem Carlos A , Mollet Nico R , Pugliese Francesca , Weustink Annick C , van Pelt Niels , Krestin Gabriel P , de Feyter Pim J
Published: July 2021

Objectives

We assessed the usefulness of 64-slice CT coronary angiography (CTCA) to detect or rule out coronary artery disease (CAD) in patients with various estimated pre-test probabilities of CAD.

Background

The pre-test probability of the presence of CAD may impact on the diagnostic performance of CTCA.

Methods

64-slice CTCA (Siemens Sensation 64, Germany) was performed in 254 symptomatic patients. Patients with heart rates ≥65 bpm received beta-blockers before CTCA. The pre-test probability for significant CAD was estimated by type of chest discomfort, age, gender, traditional risk factors and defined as high (≥71%), intermediate (31–70%) and low (≤ 30%). Significant CAD was defined as the presence of at least one ≥ 50% coronary stenosis on quantitative coronary angiography which was the standard of reference. No coronary segments were excluded from analysis.

Results

The estimated pre-test probability of CAD in the high (N:105), intermediate (N:83) and low (N:66) group was 87%, 53% and 13%, respectively. The diagnostic performance of the CT scan was different in the three subgroups. The estimated post-test probability of the presence of significant CAD after a negative CT scan was 17%, 0%, and 0%, and after a positive CT scan 96%, 88% and 68%.

Conclusions

CTCA is useful in symptomatic patients with a low or intermediate estimated pre-test probability of having significant CAD, and a negative CT-scan reliably rules out the presence of significant CAD. CTCA does not provide additional relevant diagnostic information in symptomatic patients with a high estimated pre-test probability of CAD.
Abstract 2951: Estimation of Perfusion with
13
N-Ammonia Retention Underestimates the Frequency and Extent of Hibernating Myocardium when Compared to Quantification of Absolute Myocardial Blood Flow
Authors: Luisi Andrew J , Heavey Brendan M , Canty John M , deKemp Robert A , Fallavollita James A
Published: July 2021

Background:
Viable dysfunctional myocardium can be classified as chronically stunned (normal resting perfusion) or hibernating (reduced resting flow). While
13
N-ammonia (NH
3
) retention (late uptake) is typically used to estimate perfusion, the frequency and extent of hibernating myocardium (HM) may differ when quantification of dynamically-acquired absolute myocardial blood flow (MBF) is performed.

Methods:
Patients with stable ischemic cardiomyopathy (n = 25, EF 32 ± 2%, NYHA Class 2.1 ± 0.7) who were candidates for an ICD for the primary prevention of sudden death underwent imaging with NH
3
and insulin-clamp
18
F-2-deoxyglucose (FDG). Segmental perfusion (17 segment LV model, % peak segment) was assessed by both retention (20 minute summed image) and absolute MBF using a 3-compartment model (ml/min/g). Normal segments were defined as perfusion ≤ 80% peak segment. Segments with <50% peak segment FDG uptake were defined as scar. The remaining segments were considered HM if FDG/perfusion ratio was ≥ 1.2.

Results:
Of the 425 total segments, only 15 (3.5%) were considered HM when NH
3
retention was used to assess perfusion. In contrast, the number of HM segments increased markedly with quantification of absolute MBF (159 or 37%, p<0.001 vs. retention), with a commensurate reduction in the number of normally-perfused segments.

Conclusions:
The estimation of perfusion with NH
3
retention significantly overestimates MBF (Figure

) and hence underestimates the frequency and extent of HM. While the differentiation of chronically stunned from HM may not influence the decision for revascularization, the distinction may be important if HM is an independent risk factor for sudden death.
Abstract 2970: Mechanism of Increased Susceptibility of Youth to Sudden Death with Chest Wall Impact (Commotio Cordis)
Authors: Madias Christopher , Dau Nathan , Maron Barry J , Estes N.A. Mark , Bir Cynthia , Mark Link S
Published: July 2021

Background. Commotio cordis (CC), sudden cardiac death secondary to blunt, innocent-appearing chest wall blows in sports and other daily activities, is being reported with increasing frequency. Children and adolescents are most at-risk for this phenomenon. In an experimental animal model, it has been shown that ventricular fibrillation (VF) can be induced with a baseball blow to the chest wall during the vulnerable period of repolarization. We hypothesized that in this model, larger subjects would require higher impact velocities to induce VF.

Methods. Under general anesthesia, 41 juvenile swine (16 to 55 kg) were placed prone in a sling and received chest wall blows at 30 to 60 mph with a lacrosse ball aimed directly over the cardiac silhouette. Impacts were timed to occur during the vulnerable period for VF (10 –30 ms prior to the T-wave peak). Animals were divided into 4 groups based on weight (16 to 25kg, 26 to 35kg, 36 to 45kg, and 46 to 55kg) and the frequency of VF was analyzed.

Results. In 419 impacts, the smallest animals (16 to 25kg) were most vulnerable to VF and incidence of VF decreased incrementally as animal size increased. Impacts at 30 mph only induced VF in the smallest animals. In the largest animals (46 to 55kg), VF was only induced at impacts of 60 mph (figure

).

Conclusion. Impact velocity and subject size are important variables in the generation of CC. In this animal model, smaller animals are more vulnerable to generation of VF across a wider range of impact velocities. These data might underlie the higher vulnerability to CC that has been observed in children and young adults and has implications for the prevention of CC with chest wall protectors.
Abstract 2971: Managed Ventricular Pacing In Pediatric Patients And Patients With Congenital Heart Disease
Authors: Kaltman Jonathan R , Ro Pamela , Zimmerman Frank , Moak Jeffrey P , Epstein Michael , Zeltser Ilana J , Buck Karen , Shah Maully J , Vetter Victoria L , Tanel Ronn E
Published: July 2021

Introduction:
Ventricular dyssynchrony induced by ventricular pacing (VP) may predispose patients (pts) to congestive heart failure. The detrimental effects of VP are directly related to the cumulative percentage of VP (Cum%VP). Managed ventricular pacing (MVP, Medtronic) is a novel pacing algorithm developed to minimize unnecessary VP by uncoupling atrial pacing from VP. The use, efficacy, and safety of MVP in pediatrics pts and pts with congenital heart disease (CHD) have not been described.

Methods:
A multicenter review evaluated all pediatric pts < 22 years old and older pts with CHD that had an implanted device using an MVP algorithm. Primary outcome variables were Cum%VP and adverse events. A subgroup analysis evaluated pts that had a DDD/R pacemaker prior to MVP device with similar low pacing rate and compared Cum%VP before and after initiation of MVP, using Wilcoxon signed-rank test.

Results:
62 patients from 6 centers were included for the review (see table

). Mean age at MVP device implant was 21.5 ± 9.6 years (range 7–51). 63% of pts had CHD. With MVP device, mean Cum%VP was 4.3 ± 14.6% (range 0 – 83.7). By pacing indication, Cum%VP was 2.9 ± 6.5% in pts with sinus node dysfunction (n = 24), 34.8 ± 41.3% in pts with atrioventricular (AV) block (n = 5), and 0.6 ± 1.0% in pts with an ICD (n = 33). 11 patients were eligible for subgroup analysis. With DDD/R pacing, mean low rate was 64 ppm and mean paced/sensed AV intervals were 251 and 241 ms. With MVP, mean low rate was 63 ppm and mean paced/sensed AV intervals were 193 and 166 ms. Compared to DDD/R, Cum%VP significantly decreased with MVP (67.1 ± 29.4 vs. 9.2 ± 24.8%; p < 0.005). One MVP-related adverse event occurred: a pt with intermittent AV block had symptoms with nonconducted atrial beats and was reprogrammed to DDD.

Conclusions:
MVP can be used safely and can significantly reduce unnecessary ventricular pacing in pediatric pts and pts with CHD. MVP should be considered when choosing a pacing mode for this pt population.
Abstract 2973: Effects Of Cardiac Resynchronization Therapy On The Mitochondrial Proteome In A Canine Model Of Heart Failure
Authors: Agnetti Giulio , Elliott Steven T , Kane Lesley A , Yung Christina , Chakir Khalid , Samantapudi Daya , Guarnieri Carlo , Caldarera Claudio M , Kass David A , Van Eyk Jennifer E
Published: July 2021

Cardiac resynchronization therapy (CRT) is a procedure used in the clinics to ameliorate the symptoms associated with heart failure-induced conduction disturbances and ventricular dyssynchrony. The molecular modifications underlying the beneficial effects of CRT have not been completely clarified. Recent investigations suggest that CRT may reduce apoptosis of cardiac myocytes. Mitochondria are likely to be major players in this benign transition due to their role in both energy production and apoptosis regulation. Therefore the proteome of cardiac mitochondria was investigated in a canine model for heart failure alternatively submitted to CRT.

Methods and results: Mitochondria-enriched fractions obtained from sections of the left ventricular free wall of dyssynchrony-induced heart failure (DHF) dogs alternatively submitted to CRT were analyzed through two-dimensional gel electrophoreisis (2DE). Roughly 1200 protein spots were visualized on the 2D gels after silver staining. Software-assisted differential display analysis indicated that the density of almost 50 protein spots was significantly changed upon CRT. These spots were selected and identified through mass spectrometry. Among other changes six forms of ATP synthase beta subunit were decreased 2- to 3-fold (0.0001≤p≤0.047), as well as four forms of cytochrome C (2-fold decrease, 0.002≤p≤0.047). The existence of multiple forms of a protein suggests for the presence of post-translational modifications (PTM). Therefore the phosphorylation (a common PTM) status of mitochondrial proteome was also monitored by combining the differential-in-gel electrophoresis (DIGE) technology with alkaline phosphatase teatment. ATP synthase beta subunit was differently phosphorylated in CRT samples comparing to DHF as indicated by the change in its isoelectric point upon treatment with alkaline phosphatase.

Conclusions: The proteomic investigation of mitochondria revealed a previously unseen presence of PTM mechanisms at the mitochondria level in heart failure and CRT. Phosphorylation mechanisms in the mitochondria may play a prominent role in modulating cardiac function, as observed for the beneficial effects of CRT.
Abstract 2991: Percutaneous Vs Surgical Revascularization For Multi-vessel Coronary Artery Disease: A Single Center 10 Year Follow-up Of Sos Trial Patients.
Authors: Buszman Pawel E , Wiernek Szymon , Szymanski Radoslaw , Bialkowska Bozena , Buszman Piotr P , Tendera Michal
Published: July 2021

Aim:
The aim of the study was to evaluate PCI and CABG long-term results in patients with multivessel disease during 8–10 years observation based on the CCS scale, vital status and left ventricular ejection fraction (LVEF).

Materials and methods:
The analysis involved 100 patients, who were randomized to SOS study (PCI-49; CABG-51) in 1997–2000 in the Silesian Heart Center, Katowice, Poland. There was no difference between both groups according to the basic demographic and angiographic data. The average time of observation was 8,4 ± 0,85 years. Echocardiography was performed four times in each patient: before and after the procedure, 3–4 years later and last time 8–10 years after the procedure. Stenocardia was assessed in accordance with the CCS classification.

Results:
During nearly 10 years follow-up there was 9 deaths in the PCI group (18%, 4 cardiac -8%) and 8 deaths in the CABG group (16%, 4 cardiac, 8%) (F-Cox-test: p=ns for all cause mortality and cardiac death). LVEF and intensification of stenocardia estimated based on CCS classification were not statistically different between both groups at the end of observation. However, in PCI group LVEF increased significantly (p=0,03), while in CABG group it was unchanged. In both groups improvement of symptoms after revascularization was maintained during the follow-up (Wilcoxon test: p<0.001) but it was achieved with repeat revascularization, which was more frequent in PCI group (30 vs 6%, p=0.003).

Conclusions:
Long-term results demonstrate that both methods of the myocardial revascularization are equal in terms of long-term survival, release of angina and preservation of left ventricular systolic function.
Abstract 3002: Left Ventricular Diameter Predicts Recovery in Acute Cardiomyopathy: Results of the IMAC 2 Trial
Authors: Starling Randall C , Cooper Leslie T , Dec G W , Boehmer John , Liu Peter , Pauly Daniel , Gorscan John , Tanabe Masaki , Kip Kevin , McNamara Dennis M
Published: July 2021

Introduction :
The incidence of spontaneous clinical improvement in acute cardiomyopathy (ACM) patients treated with evidence based medical therapy is unknown. We hypothesized that pts without LV dilatation at presentation would have the greatest potential for recovery of ejection fraction (EF).

Methods:
A multi-center NHLBI sponsored trial, Intervention in Myocarditis and Acute Cardiomyopathy II (IMAC 2) was designed to study the clinical course of ACM and the mechanisms associated with outcomes. A clinical, echocardiography, and genetics core lab are established.

Results:
15 centers have enrolled 215 pts, mean age 45 ± 14 yrs, 34% female, NYHA class I–IV% 18/54/21/7, baseline EF 0.25 ± 0.09. Therapy included 80% beta blockers and 92% ACE or ARB treated. All patients enrolled had symptoms for ≤ 6 mos and were diagnosed with acute, idiopathic cardiomyopathy or myocarditis. Baseline and 6 mo echoes in 140 pts reviewed by the core lab demonstrated increased ejection fraction (EF): 0.25 ± 0.09 to 0.40 ± 0.11 p<0.001; mean increase 0.15 ± 0.10. Recovery in EF from baseline to 6 mos was related to LVEDD at baseline as shown in the Figure

. Kaplan Meier survival n=207 at 1 and 2 years 96% and 94% and transplant free survival at 1 and 2 yrs 92% and 91%.

Conclusions:
Results of IMAC 2 reveal a marked spontaneous improvement in EF over 6 months, greatest in those with non-dilated LVEDD at baseline, and excellent overall survival in ACM pts treated with evidence based therapies.
Abstract 3008: Intracoronary Compared with Intravenous Bolus Abciximab Application in Patients with ST-Elevation Myocardial Infarction Undergoing Primary Coronary Intervention The randomized Leipzig Immediate PercutaneouS Coronary Intervention Abciximab i.v. versus i.c. in ST-Elevation Myocardial Infarction Trial (LIPSIAbciximab-STEMI)
Authors: Thiele Holger , Schindler Kathrin , Friedenberger Josef , Eitel Ingo , Fürnau Georg , Grebe Eigk , Kivelitz Dietmr , Schuler Gerhard
Published: July 2021

Background
Abciximab reduces major adverse cardiac events in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI). Intracoronary bolus application of abciximab results in high local drug concentrations and may be more effective than standard intravenous bolus application for reduction of infarct size, no-reflow and improvement in perfusion.

Methods
Patients undergoing primary PCI were randomized to either intracoronary (n=77) or intravenous (n=77) bolus administration of abciximab with subsequent 12 hour intravenous infusion. Primary endpoint was infarct size and extent of microvascular obstruction assessed by delayed enhancement magnetic resonance. Secondary endpoints were ST-resolution at 90 minutes, Thrombolysis in Myocardial Infarction (TIMI)-flow and perfusion grade post PCI, and the occurrence of major adverse cardiac events within 30 days.

Results
The primary endpoint infarct size could be reduced by absolute 7% (17.7% i.c. versus 24.7% i.v., p=0.005). Similarly, the extent of microvascular obstruction was significantly smaller in i.c. patients in comparison to i.v. patients (p=0.02). Myocardial perfusion measured as early ST-segment resolution was significantly improved in i.c. patients with an absolute ST-resolution of 76±23% versus 64±31% (p=0.009). The TIMI flow after PCI was not different between treatment groups (p=0.51), but there was a trend towards an improved perfusion grade (p=0.12). There was a trend towards a higher major adverse cardiac event rate after intravenous versus intracoronary abciximab application (15.6% versus 5.2%, p=0.06; relative risk 3.00; 95% confidence intervals 0.94 –10.80).

Conclusions:
Intracoronary bolus administration of abciximab is superior to standard intravenous treatment with respect to infarct size, extent of microvascular obstruction, and perfusion in primary PCI. An adequately powered trial for major adverse cardiac event reduction is warranted.
Abstract 3030: Differential Regulation of Valvular Interstitial Cell Dysfunction by Extracellular Matrix Components
Authors: Rodriguez Karien J , Masters Kristyn S
Published: July 2021

Calcification is the leading cause of bioprosthetic and native aortic valve failure, but relatively little is known regarding the factors that contribute to the progression of valvular calcification. Because extracellular matrix (ECM) disarray is often observed in explanted diseased valves, we have investigated the role of individual ECM components in the in vitro calcification of valvular interstitial cells (VICs). The transformation of VICs to an osteoblast-like phenotype was quantified in VICs cultured on different types of ECM coatings. The results show that the number and size of calcific nodules formed in VIC cultures, as well as the expression of mineralization markers alkaline phosphatase (ALP) and CBFa1, were highly dependent upon the composition of the culture surface. In fact, VICs cultured on certain ECM components, namely collagen (Coll) and fibronectin (FN), were resistant to calcification, even upon treatment with potent mineralization-inducing growth factors, such as transforming growth factor beta1 (TGFb1). Meanwhile, VIC cultures on fibrin (FB), laminin, and heparin not only had a high number of calcified nodules (p<0.001 vs. Coll, FN), but also elevated levels of ALP and CBFa1 (p<0.02), and the number of nodules on these ‘pro-calcific’ coatings significantly increased upon treatment with exogenous TGFb1 (p<0.05). To explain the ECM-dependence of calcification, the endogenous production of a pro-mineralization factor (TGFb1) was assessed in VICs on anti-calcific (Coll) and pro-calcific (FB) substrates. Quantification of TGFb1 mRNA revealed that VICs on Coll surfaces expressed a significantly lower amount of TGFb1 mRNA than VICs on FB (p<0.01). Furthermore, treatment with a neutralizing antibody to TGFb1 decreased TGFb1 mRNA expression by VICs on Coll in comparison to VICs on FB or polystyrene controls (p<0.02). Thus, we have discovered a strong correlation between VIC calcification and ECM composition. Our findings show that the ECM plays an important role in controlling TGFb1 expression and subsequent calcification of VICs, which may significantly impact the design of biomaterials for valve tissue engineering, understanding of valvular disease, and the development of preventative treatments for valve calcification.
Abstract 3035: Decrease Of Aortic Valve Area In A Hypercholesterolemic Rabbit Model Is Reversed By Short-term ApoAI-treatment
Authors: Speidl Walter S , Ibanez Borja , Santos-Gallego Carlos G , Garcia Mario J , Fuster Valentin , Goldman Martin E , Badimon Juan J
Published: July 2021

Background. Aortic valve stenosis (AVS) is the second most common indication for heart surgery. Althoug recent observations linked AVS and atherosclerosis, medical treatment of AVS is limited. ApoAI-Milano (ApoAI-M) is a mutant form of ApoAI. We have recently shown that ApoAI-M rapidly regressed established atherosclerotic lesions in a hypercholesteremic rabbit model. The aim of this study was to test whether hypercholestermia decreases AVA in rabbits and whether this can be reversed by short-term ApoAI-M-treatment.

Methods. We used transthoracic echocardiography (Philips HD 11 XE echograph with a 12-MHz phased-array probe) to compare AVA, as determined by continuity equation, of 14 white New Zeeland rabbits, fed with atherogenic diet (0.2 % of cholesterol) for nine month, with 6 healthy controls. The hypercholesterolemic animals were then randomized into ApoAI-M (ETC-216; Pfizer): 2 injections (75mg/Kg) in 4 days, or placebo. Six days after the last dose, we assessed aortic valve morphology by echocardiography and histopathology.

Results. Hypercholesteremic diet resulted in a markedly reduced AVA compared to controls (0.17±0.02cm2 vs. 0.21±0.03cm2, p<0.01). ApoAI-M treatment increased AVA by 27 % (p<0.05) whereas placebo had no effect, resulting in significantly higher AVA in treated rabbits (0.22±0.03cm2 vs 0.16±0.02cm2, p<0.005). Histopathologic cross-examination showed markedly reduced thickness of aortic valve leaflets in ApoAI-M-treated rabbits.

Conclusion. We show that reduction of AVA can be induced experimentally in hypercholesterolemic rabbits and can be investigated by transthoracic echocardiography. In addition, this study provides for the first time evidence that AVA can be increased pharmacologically, namely by treatment with ApoAI-M.
Abstract 3037: Long-Term Positive Left Ventricular Remodeling After Correction of Severe Organic Mitral Regurgitation: A Pilot Cardiovascular Magnetic Resonance Study
Authors: Haffajee Jessica A , Hauser Thomas H , de la Torre Ralph , Manning Warren J , Gelfand Eli V
Published: July 2021

Background
: One of the goals of referring patients with chronic severe organic mitral regurgitation (MR) for corrective mitral valve surgery (MVR) is preservation of postoperative global left ventricular (LV) systolic function. Using cardiovascular magnetic resonance (CMR) methods, we have previously reported an intermediate decline in postoperative LV ejection fraction (LVEF). We hypothesized that years following successful surgical correction, there would be evidence of ongoing positive ventricular remodeling with improvement in systolic function and used quantitative CMR to prospectively test this hypothesis.

Methods
: Fourteen patients (50% female, 55 +/− 11.3 yrs) underwent elective MVR for severe organic MR. Quantitative CMR was performed preoperatively and at median times of 3 months and 27 months following MVR.

Results
: See Table

. At 3 mo, postoperative LVEF declined by 27% (p<0.001) but recovered to preoperative values at 27 mo (p=NS vs. pre, p<0.001 vs. 3 mo). Twelve (86%) of 14 patients had normal LVEF 27 mo after MVR. LV end diastolic volume index (LVEDVI) declined by 32% at 3 mo (p<0.001) and by an additional 9% at 27 mo (p<0.001 vs. pre, p<0.019 vs. 3mo), with 12 (86%) of 14 patients achieving normal volumes. LV mass index (LVMI) declined by 22% at 3 mo (p<0.001) with a further decline of 17% at 27 mo (p<0.001 vs. pre, p<0.001 vs. 3 mo). All patients had normal LVMI at long-term follow-up.

Conclusions
: In this prospective pilot study, we demonstrate ongoing positive LV remodeling beyond the intermediate postoperative period. These changes likely reflect normalization of cardiac hemodynamics following correction of MR with decreases in ventricular volumes and mass as well as preservation of systolic function.

Comparison of LV parameters preoperatively, at 3 mo, and at 27 mo following MVR
Abstract 3046: Protective Effect Of Preoperative Angiotensin Converting Enzyme Inhibitors On Renal Outcome Following Coronary Artery Bypass Graft Surgery. A Propensity Score-adjusted Analysis
Authors: Benedetto Umberto , Refice Simone , Roscitano Antonino , Capuano Fabio , Simon Caterina , Comito Cosimo , Di Nucci Gian Domenico , Angeloni Emiliano , Sinatra Riccardo
Published: July 2021

Introduction: A large number of patients undergoing coronary artery bypass graft (CABG) surgery are treated with angiotensin converting enzyme (ACE) inhibitors before the operation. Since ACE inhibitors decrease glomerular perfusion pressure, it is still believed that their withdrawal before surgery on cardiopulmonary bypass may reduce postoperative renal adverse events. However, no previous study has attempted to address this issue. We aimed to evaluate the impact of preoperative ACE inhibitors on renal outcome in patients undergoing on pump CABG surgery using a risk adjusted approach.

Methods and Results: A propensity score-based analysis of 531 patients undergoing elective isolated CABG surgery on cardiopulmonary bypass. Patients with preoperative end-stage renal failure requiring dialysis were excluded. Of those 531 patients, 204 were treated with ACE inhibitors before the operation and 327 were not treated with ACE inhibitors. Renal adverse outcome following surgery was defined as 20% decrease in creatinine clearance from preoperative or post-operative mechanical renal support. After adjusting for propensity score and covariates, multivariate analysis showed that preoperative ACE inhibitors had a protective effect against renal adverse outcome following CABG surgery (odds ratio [OR], 0.8; 95% confidence interval [CI],0.5 to 0.9;
P
<0.01). Other independent predictors of adverse renal outcome were age (OR 1.17 per 1 years; 95% CI 1.01 to 1.39;
P
<0.001), female sex (OR 0.72; 95% CI 0.51 to 0.93;
P
<0.001); left ventricular ejection fraction less than 0.30 (OR 2.12; 95% CI 1.92 to 2.85;
P
<0.01); pre-operative creatinine clearance (OR 1.23 per 10ml/min decrease; 95% CI 1.01 to 1.31;
P
<0.001); diabetes (OR 1.80; 95% CI 1.25 to 2.24;
P
<0.01); aortic cross clamp time (OR 1.31 per 10 min increase; 95% CI 1.11 to 1.61;
P
<0.01). Operative mortality was not statistically different between groups (2.4% versus 4.0% in patients with and without preoperative ACE inhibitors;
P
=0.45)

Conclusions: Preoperative ACE inhibitors are associated with better renal outcome in patients undergoing on pump CABG surgery. No clinical evidences support ACE inhibitors withdrawal before surgery
Abstract 3048: A Prospective Randomized Trial of Blood B-type Natriuretic Peptide Levels Informing Management after Elective Coronary Artery Bypass Grafting
Authors: Deliri Hamid , Davis Elaine , Hager Casey S , Welch Christine A , Malik Firasat S , McCullough Peter A , Wagner Galen S , Carter William H
Published: July 2021

Background:
Measuring B-type natriuretic peptide (BNP) levels is valuable in diagnosis, risk stratification, and management of patients with congestive heart failure.

Hypothesis:
Knowledge of peri-operative levels of BNP by physicians in patients undergoing elective coronary artery bypass grafting (CABG) influences care processes and clinical outcomes.

Methods:
Patients undergoing CABG between the ages of 18 –79, with left ventricular ejection fraction (LVEF) ≥ 40%, serum creatinine ≤ 2.0 mg/dl, and without a history of myocardial infarction within six months or a history of atrial fibrillation (AF) at any time were eligible for this prospective randomized trial. Of 150 patients recruited, 75 were randomized to BNP-informed group with levels obtained immediately before surgery, 12, and 72 hours post-operatively. The remaining 75 patients were in a control group and had no routine BNP measurements. Cardiovascular surgeons and cardiologists were presented the BNP results and encouraged to integrate them into clinical decision making. Clinical outcomes were pre-specified as initial hours of post-operative ventilation, re-intubation, weight change from baseline, creatinine change from baseline, occurrence of post-operative AF, post-operative hospital length-of-stay, in-hospital mortality, and re-admission during the first 30 days after discharge.

Results:
Both groups were similar in age, BMI, LVEF, pump time, use of intra-aortic balloon pump or inotropes, and prophylactic beta-clocker or amiodarone. The mean BNP values were 63.7±91.4, 131.3±103.4, 315.6±238.4 pg/ml at baseline, 12 and 72 hours after CABG. The rates of post-operative AF were 5/75 (6.7%) and 15/75 (20.0%), in the BNP-informed and control groups, respectively, p=0.02. The median surgery-to-discharge length-of-stays were 5.8±1.8 days and 6.6± 2.5 days respectively, in the BNP-informed and control groups, p = 0.04. There was no difference between the groups in regards to other pre-specified outcomes.

Conclusion:
Provision of peri-operative BNP values to cardiothoracic surgeons and cardiologists caring for patients after CABG reduces the occurrence of post-operative AF, and shortens the post-operative length-of-stay.
Abstract 3049: Clinical Outcomes after Urgent Coronary Artery Bypass Surgery in Patients on Clopidogrel: Are the Risks Tangible or Anecdotal?
Authors: Singh Steve K , Nesher Nachum , Desai Nimesh D , Elmistekawy Elsyed , Moussa Fuad , Christakis George T , Goldman Bernard S , Cohen Gideon N , Laflamme Claude , Callum Jeannie , Fremes Stephen E
Published: July 2021

PURPOSE

: Clopidogrel is indicated in acute and chronic coronary syndromes and often administered prior to angiography. These patients are often sent subsequently for coronary artery bypass grafting (CABG) surgery, where potential increase in bleeding risk must be balanced with risk of ongoing ischemia if CABG delayed. This study aimed to test the hypothesis that patients undergoing urgent CABG who received clopidogrel, versus those who did not, have worse bleeding outcomes and early mortality.

METHODS

: We reviewed 451 consecutive patients (04/2005–12/2006) who underwent urgent CABG at our institution: 262 never received clopidogrel pre-CABG, 189 received clopidogrel <5 days prior. The latter all received intraoperative antifibrinolytics. The primary endpoint was in-hospital death, massive transfusion (>10U PRBC) or massive blood loss (>2L chest-tube loss/24 hrs).

RESULTS

: Patient characteristics were comparable between groups. Prior MI (71% vs 46%), NYHA class 3– 4 (94% vs 81%) and prior PCI (22% vs 13%) were higher in the clopidogrel group (p<0.05). Cross-clamp time was statistically higher in the clopidogrel group (97±30 vs 90±28 min, p=0.02); cardiopulmonary bypass and total operative times were similar. There was no difference in the primary endpoint of in-hospital death or massive bleeding indices (clopidogrel: 7% vs no clopidogrel: 6%, p=0.9). Death, bleeding indices, renal failure, post-op MI and stroke, were no different even after adjusting for the date of stopping clopidogrel pre-CABG. Chart audit showed bleeding as a significant contributor to cause of deaths, was no different in either cohort. After multivariable regression analysis, clopidogrel or the duration it was stopped pre-CABG, were not predictors of outcomes (death, MI, stroke or chest reopening for bleeding). Significant independent predictors of the primary endpoint included pre-op renal dysfunction, peripheral vascular disease and pre-op hemoglobin.

CONCLUSION

: Clopidogrel, or the time it was stopped prior to CABG, was not a risk factor for in-hospital death, massive bleeding, or other poor early outcomes in patients undergoing urgent CABG. Practice measures such as the use of antifibrinolytic agents may ameliorate the adverse effects of clopidogrel.
Abstract 3056: Ischemia on Presentation Stratifies Mortality Risk in Surgery for Acute Type A Dissection
Authors: Augoustides John G , Geirsson Arnar , Szeto Wilson Y , Walsh Lisa , Cornelius Brittany , Pochettino Alberto , Bavaria Joseph E
Published: July 2021

Introduction: The mortality risk of surgery for acute type A dissection (ATAD) depends on the clinical presentation in published risk models. The identified risk factors predominantly relate to preoperative ischemia whether generalized due to systemic hypotension and/or regional due to aortic branch occlusion. A focus on preoperative ischemia might further clarify mortality risk after surgery for ATAD.

Hypothesis: Ischemia, whether generalized (due to systemic hypotension) and/or regional (due to local arterial malperfusion), stratifies mortality risk after operative repair of ATAD.

Methods: With IRB approval, all patients undergoing operative repair of ATAD (January 1993 – December 2004) were studied. Perioperative data of interest were abstracted from the medical records and archived electronically. The standardized operative protocol included aortic arch repair with deep hypothermic circulatory arrest and retrograde cerebral perfusion. Statistical significance was defined as a probability value of < 0.05.

Results: The study cohort = 221. Average age was 61.6 ± 15.2 years. The cohort was divided into 2 groups: ischemia 42.1% (93/221) and no ischemia 57.9% (128/221). The ischemia subgroup was further divided as follows: generalized 36.6% (34/93); regional 41.9% (39/93); both 21.5% (20/93). Thirty-day mortality was 12.7% (28/221)): 85.7% (24/28) of all deaths were in the ischemic subgroup (p<.05). Mortality was 8.3 fold higher in the presence of ischemia: ischemia 25.8% (24/93) versus no ischemia 3.1% (4/128) (p<.05). The mortality in ischemia subgroups was as follows: generalized 17.6% (6/34); regional 25.6% (10/39); and, both 40% (8/20). All intraoperative deaths occurred in the ischemia group [17.8%(5/28) of all deaths]. Causes of death were grouped as follows: neurological 7/28 (25%: all in ischemia group); cardiac 7/28 (25%: 6/7 in ischemia group); bleeding 3/28 (10.7%: all in ischemia group); multisytem organ failure 11/28 (39.3%: 8/11 in ischemia group).

Conclusions: Preoperative ischemia is the major risk for mortality after operative repair for ATAD. Perioperative interventions to minimize ischemia and optimize organ protection should reduce the high mortality in the subgroup with ischemia on presentation.
Abstract 3066: Left Atrial Asynchrony Before And After Electrical Cardioversion: Mechanical Resynchronization And Improvement Of Atrial Function After One Month Of Synus Rhythm
Authors: Rondano Elisa , Dell’Era Gabriele , Piccinino Cristina , De Luca Giuseppe , Bellomo Giorgio , Marino Paolo N
Published: July 2021

Background: Dispersed conduction due to atrial fibrillation (AF) is linked to cavity remodelling and loss of filling and emptying properties. Cardioversion (CV) should remodulate function through recovery of atrial mechanical synchronism (AMS). Purpose: To assess if conversion of AF to sinus rhythm (SR) is associated with improvement of AMS, 101 patients (pts) with AF, age 70±8 yrs, with or without (n=5) structural heart disease were echoed 1 week before electrical CV (all pts) and 1 month later only in case of SR maintenance (n=53).

Methods: Atrial volume was calculated from anteroposterior diameter and area according to the formula: 4.2
*
diameter/ 2
*
area/2. 2D strain (speckle tracking technique) was used to estimate peak and standard deviation (SD) of the time-to-peak (% of R-R’ interval) of the deformation of 6 segments arbitrarily identified along the septum, the roof and the lateral wall of the atrial cavity, as imaged in a 4-chamber view. BNP was also measured 1 week before in all pts and 1 month after CV, if SR was maintained.

Results: There was a significant decrement in atrial volume after SR was restored (from 59.6 ±20.4 ml/m
2
[59.5±19.7 ml/m
2
for all pts] to 52.8±21.3 ml/m
2
; p=0.002) together with an increase in mean peak strain (from 9.6±4.9% [9.7±4.8% for all pts] to 15.9±7.0%, p<0.001). There was no change in time-to-peak of individual strains before and after CV (from 52.3±12.7% [52.2±12.0% for all pts] to 50.4±11.3%; p=NS), but SD significantly decreased (from 19.1±7.6% [20.2±8.1% for all pts] to 15.6±7.4%; p=0.015) suggesting improved AMS. Also BNP decreased significantly (from 128±99 pg/ml [118±87 pg/ml for all pts] to 87±90 pg/m; p<0.001) and its change corresponded to the reduction in atrial volume (P=0.016). A logistic regression analysis identified SD as the only predictor of maintenance of SR post CV (p=0.076), with a 1.5 increment, per 10 SD reduction, in the chance of maintaining SR at 1 month. Duration of AF, atrial volume, peak strain, BNP and ventricular EF did not exert any effect on SR persistence.

Conclusion: In AF patients that maintain SR 1 month after CV

AMS is significantly decreased and this improvement favourably modulates atrial strain, volume and dismission of BNP,

the extent of AMS pre-CV can predict maintenance of SR at 1 month.
Abstract 3072: Beneficial Effects of Cardiac Resynchronization Therapy in Patients with Class Two Heart Failure
Authors: Ellison Kristin E , Mikaelian Brad J , Hoth Karin F , Devecchi Fausto G , Poppas Athena , Kirk Malcolm M , Buxton Alfred E
Published: July 2021

Cardiac resynchronization therapy (CRT) improves heart failure (HF) symptoms in patients (pts) with EF <35%, QRS >120ms, and NYHA class 3 and 4 HF. The aim of this study was to compare the effects of CRT in pts with EF <35%, QRS >130, and class 2 vs 3/4 HF. We enrolled 25 patients. All received ECGs, transthoracic echocardiograms, 6 minute walk tests, and Minnesota quality of life questionnaires pre-op and three months post-op. Fourteen pts were class 2, 10 patients were class 3, and 1 class 4. Ischemic cardiomyopathy accounted for 7 out of the 14 class 2 pts and 5 out of the 11 class 3/4 pts. As a group, all patients had a significant increase in 6 minute walk (1150 vs 1249, p=0.02), increase in EF (30% vs 39%, p<0.01), decreased QRS duration (162 vs 143, p=0.001), and improved quality of life scores (31.1 vs 21.7, p=0.03), comparing pre and post-op measurements. There was no significant difference in response of class 2 versus class 3/4 pts (see table

). Nonischemic pts had greater response than ischemic pts. Class 2 HF pts reported greater improvement in mental health than class 3 and 4. Younger patients reported greater functional improvement, while pts with higher BMI reported less physical benefit. Summary: Pts with NYHA class 2 symptoms derive similar hemodynamic benefit from CRT as pts with class 3/4 symptoms and may derive greater mental health benefits than class 3/4 pts.

Comparison of Pre and Post-Implant Parameters Between Class 2 and 3/4 Patients
Abstract 3078: Myocardial Collagen Metabolism In Failing Hearts Before And During Cardiac Resynchronization Therapy
Authors: Umar Soban , Bax Jeroen J , Klok Margreet , Hessel Marleen H , Adel Brigit den , Bleeker Gabe B , Henneman Maureen M , Atsma Douwe E , van der Wall EE , Schalij MJ , van der Laarse Arnoud
Published: July 2021

Objective
Cardiac resynchronization therapy (CRT) has proven efficacy in improving left ventricular ejection fraction (LVEF), LV diastolic function, NYHA functional class and outcome in patients with congestive heart failure (CHF), although a substantial number of patients respond poorly to CRT. We investigated whether myocardial collagen metabolism of patients with CHF is implicated in good or poor response to CRT.

Methods
We analyzed collagen synthesis and degradation by measuring the concentrations of aminoterminal propeptides of type I and type III collagen (PINP and PIIINP, resp.) and carboxyterminal telopeptide of type I collagen (ICTP), respectively, in serum of 64 patients with CHF before and 6 months after start of CRT. Patients had NYHA class III–IV, LVEF ≤35%, and QRS duration >120 ms.

Results
In 46 patients, CRT resulted in >10% reduction of LV end-systolic volume (LVESV), referred to as responders, whereas in 18 patients LVESV did not change upon CRT or even increased, referred to as non-responders. Responders demonstrated an increase of serum PINP and PIIINP upon CRT, from 32.9±2.2 to 46.7±4.0 μg/L (p<0.001) and from 4.59±0.24 to 5.13±0.36 μg/L (p<0.05), respectively, whereas serum PINP and PIIINP of non-responders did not change upon CRT (from 41.8±4.3 to 43.8±6.2 μg/L and from 4.03±0.45 to 4.28±0.31 μg/L, resp.). Responders had higher serum levels of ICTP at baseline and at 6 months follow-up (from 3.38±0.54 to 3.12±0.48 μg/L) than non-responders at both time points (from 1.96±0.37 to 1.92±0.38 μg/L), although these differences were not statistically significant.

Conclusion
Compared to future non-responders to CRT, future responders demonstrate relatively low levels of markers of collagen synthesis and relatively high levels of markers of collagen degradation at baseline. Unlike non-responders, responders show an increase in collagen synthesis in the first 6 months of CRT.
Abstract 3091: Prediction of Major Adverse Cardiac Events in Patients Presenting With Chest Pain In Outpatient Clinic By Adenosine Stress Magnetic Resonance
Authors: Chan Wing Sze , Luk Ching Hon , Tse Hung Fat
Published: July 2021

Background: This study was designed to determine the diagnostic value of adenosine cardiac magnetic resonance (CMR) in low to moderate total number cardiac risk factor (TLCRF) patients presenting with chest pain in outpatient clinic. We hypothesized that adenosine CMR has a high negative predictive value in development of CAD or future adverse cardiac events.

Methods: Adenosine stress CMR was performed on 315 pts who presented initially to outpatient clinics with chest pain. Ten patients confirmed to have previous myocardial infarction defined by delay CMR were excluded. Three patients were excluded due to suboptimal image quality. Patients were followed up during outpatient visits or contacted through telephone interview to determine the incidence of significant CAD defined as coronary artery stenosis >50% on angiography, new myocardial infarction (MI), or cardiovascular death.

Results: Totally 302 patients (M: F = 242:60; mean age= 58±12; mean baseline TLCRF= 2.5 ± 1) underwent rest and adenosine stress CMR. With a follow up period of 29 ± 6 months, there were 32 adverse event (30 patients underwent coronary percutaneous angioplasty due to unstable angina and 2 new MI) and 3 cardiovascular deaths. Adenosine perfusion abnormalities had 100% sensitivity and 89% specificity in detecting subsequent CAD and the most accurate component of the CMR examination in predicting events. Despite TLCRF and abnormal CMR can significantly predicting the prognostic outcome (p=0.04 Vs p=0.001 respectively), multivariate analysis showed that the abnormal CMR was the strongest predictor of the event rate (adjusted hazard ratio 1.45 per 10% increase, p=0.02). Three patients with normal adenosine study had a subsequent diagnosis of CAD and underwent successful angioplasty.

Conclusions: Among the low to moderate cardiac risk patients who presented with chest pain in outpatient clinics, adenosine CMR examination has a high sensitivity and specificity in predicting the future development of significant CAD. It implies the potential application of CMR in CAD screening in general population.