bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 5808: Assessment of Aortic Bioprostheses is Feasible Applying Cardiovascular Magnetic Resonance - In Vivo and In Vitro Studies
Authors: von Knobelsdorff Florian , Wassmuth Ralf , Rudolph Andre , Greiser Andreas , Dieringer Mathias , Bohl Steffen , Buschmann Eva E , Abel-Aty Hassan , Dietz Rainer , Schulz-Menger Jeanette
Published: July 2021

Orifice area is decisive to assess bioprosthetic performance after aortic valve replacement. However, standard calculation by transthoracic echocardiography (TTE) is often limited. This is the first series testing cardiovascular magnetic resonance (CMR) to quantify the orifice area of bioprostheses. Prosthetic orifice visualization was performed in a clinical 1.5T MR system (Siemens Magnetom Avanto) within a stack of prosthesis parallel steady state free precession cines (slice thickness 5mm, no gap). Orifice quantification was done manually by planimetry. In vivo, we compared the orifice area obtained by CMR with TTE (continuity equation) prospectively in 56 patients with aortic bioprostheses (40 stented, 16 stentless). In a subgroup of 23 patients also transesophageal echocardiography (planimetry; TEE) was applied. In vitro, we studied four different bioprostheses in a CMR-compatible pulsatile flow model under standardized conditions. In vivo, CMR planimetry was feasible in 52 patients (92.9%). Atrial fibrillation with rapid heart rate, inability to sustain breath holds and flow-artifacts rendered image-quality non-diagnostic in 3 patients. Three patients had insufficient transthoracic acoustic windows. Correlations of CMR with TTE (n=50; r=0.85; p<0.001) and CMR with TEE (n=21; r=0.97; p<0.001) were highly significant, both for stentless and stented bioprostheses. In Bland-Altman analysis, mean difference between CMR and TTE was −0.06±0.24cm
2
, between CMR and TEE 0.03±0.12cm
2
. In vitro, mean orifice areas obtained by CMR planimetry were 1.60±0.04cm
2
for Hancock 25, 1.59±0.01cm
2
for Perimount 23, 1.29±0.07cm
2
for Perimount 21 and 1.56±0.04cm
2
for Mitroflow 25. The assessment of bioprostheses by CMR is technically feasible and provides orifice areas with close correlation to echocardiography. Thus, CMR is an important non-invasive tool to assess bioprostheses in selected patients. The flow model allows for establishing CMR specific reference orifice areas for various valve types and comparing their hydrodynamic performance under standardized conditions. The concepts and information presented in this abstract are based on research and are not commercially available.
Abstract 6145: Low Fetuin-A Concentrations Predict the Progression of Aortic Valve Calcification in Non-Dialyzed Patients
Authors: Koos Ralf , Brandenburg Vincent , Mahnken Andreas Horst , Mühlenbruch Georg , Stanzel Sven , Kelm Malte , Kühl Harald Peter
Published: July 2021

Human fetuin-A (alpha
2
-Heremans Schmid glycoprotein) has been identified as the most potent circulating inhibitor of vascular and soft-tissue calcification. We aimed to investigate the relationship between the serum fetuin-A level and the progression of aortic valve calcification (AVC) assessed by retrospectively ECG-gated Multislice Spiral Computed Tomography (MSCT) in patients with calcific aortic valve disease. A prospective study in 77 non-dialyzed patients (mean age 70 ± 8 years) with echocardiographically proven aortic valve disease was performed. In all patients serum fetuin-A levels were measured by nephelometry (BNII, Dade Behring Holding, Liederbach, Germany) using a polyclonal rabbit anti-human antibody against fetuin-A. For quantification of AVC all patients underwent 16-slice MSCT (Sensation 16, Siemens, Forchheim, Germany with scan parameters as follows: 420ms tube rotation time, 12× 0.75mm collimation, tube voltage 120KV). After a mean follow-up of 12.6 ± 1.4 months a second non-enhanced MSCT examination for quantification of AVC was performed. Images were reconstructed at 60% of the RR interval. AVC was assessed using Agatston AVC score. In multifactorial analysis of covariance including fetuin-A levels, baseline AVC score, the covariables sex, age, body mass index, C-reactive protein, glomerular filtration rate, serum lipids, diabetes, smoking status and hypertension, only fetuin-A levels revealed a significant effect on the progression of AVC (p<0.001). Post-hoc analysis demonstrated that patients with baseline fetuin-A levels lower than the median of the cohort (0.72g/l) showed a significantly higher increase of AVC scores (34.6 ± 31.4%, n=39) than patients with fetuin-A levels larger than the median (10.0 ± 11.2%, p<0.001) despite comparable baseline AVC scores. Vice versa, patients with progressive AVC > 10% (n=48, 62%) had lower fetuin-A serum levels at baseline than non-progressors (n=29, 38%; 0.66±0.13g/L versus 0.82±0.11 g/L, p<0.001). The present study suggests that low fetuin-A serum levels indicating systemic calcification inhibitor deficiency were associated with increased progression of AVC independently of the renal function.
Abstract 6181: ST Segment Resolution and Pathological Findings of Aspirated Materials in Patients with ST Elevation Acute Myocardial Infarction
Authors: Suzuki Asami , Kakuta Tsunekazu , Yonetsu Taishi , Lee Tetsumin , Iwamoto Taro , Kawaguchi Naohiko
Published: July 2021

Early resolution of ST-segment elevation (STR) is a potent predictor of better clinical outcome after PCI in ST elevation acute myocardial infarction (STEMI). The aim of this study was to determine the association of aspirated materials and serial change of ST elevation. We studied 150 consecutive STEMI patients with assessable ECG recording, in whom standard PCI was performed with the adjunctive use of aspiration thrombectomy. STR(+) was defined as more than 50% resolution of ST-segment elevation at 60min after PCI. Aspirated materials were pathologically classified into thrombus only group (fresh, lytic, or organized) or thrombus and atheroma complex group, and compared between STR(+) and STR(−). TIMI flow grade, IVUS findings after aspiration(ruptured plaque, calcification, thrombus and echo signal attenuation), area under the curve (AUC) of CK-MB release, and pathological findings were also compared between the two groups. Seventy-six patients (50.6%) showed STR and 74 patients didn’t. RCA culprit lesion was significantly more frequent in STR(+)(P<0.05). There was no significant difference in other patient characteristics or IVUS findings in the present cohort. AUC of CK-MB was lower in STR(+)(p=0.02). TIMI 3 flow was more frequently achieved in STR(+)(p<0.05). Fresh thrombus was more frequent in STR(+)(p<0.05), whereas atheromatous component and lytic or organized thrombus were frequently observed in STR(−)(p<0.05). Culprit lesions in STEMI, when atheroma and thrombus complex with lytic or organized thrombus was aspirated, caused more myocardial damage and less frequent STR.
Abstract 6189: Stent Fracture does not Affect Long Term Patency in the Femoro-popliteal Artery: Four Years Experience
Authors: Iida Osamu , Nanto Shinsuke , Uematsu Masaaki , Morozumi Takakazu , Watanabe Tetsuya , Awata Masaki , Onishi Toshinari , Sera Fusako , Minamiguchi Hitoshi , Yano Masamichi , Ikeoka Kuniyasu , Okamoto Shin , Tanaka Nobuaki , Yasui Haruyo , ishihara Takayuki , Dohi Tomoharu , Nagata Seiki
Published: July 2021

[Background] Stent fracture in the femoro-popiteal (FP) artery has been related to poor long term patency. However, time course of patency with and without stent fracture beyond 2 years has not been explored.

[Methods] We studied consecutive 334 FP lesions that received provisional stenting with metallic or nitinol stents (Luminexx, Bard: 90 lesions and Smart, Cordis: 243 lesions). Stent fracture was determined by X-ray with multiple projections. Patency was either assessed by Duplex ultrasonography as peak systolic velocity ratio > 2.5 or by angiography (% diameter stenosis > 50%).

[Results] Stent fracture occurred in 19% (55/334) lesions and restenosis rate at mean follow up (16+/−12 months) was 20% (67/334). Primary patency with or without stent fracture was 83% with fracture versus 68% without fracture at 1 year, p=0.03; 75% versus 60% at 2 years, p=0.04; 68% versus. 60% at 3 years, p=0.05; 63% versus 60% at 4 years, p=0.06.

[Conclusion] Stent fracture affected the patency during the first 2 years, but unlikely affected the patency beyond 4 years.
Abstract 1195: A Genomic Signature of Atherosclerosis among Individuals with Low Framingham Risk Score: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Huang Chiang-Ching , Liu kiang , Rajamannan Nalini , Du Pan , Lin Simon , Burke Gregory , Shea Steven , Szklo Moyses , Watson Karol , Johnson Craig , Lloyd-Jones Donald
Published: July 2021

Background
: The Framingham risk score (FRS) predicts low 10-year risks for the majority of women, even in the face of substantial burden of subclinical atherosclerosis (SA). However, many individuals predicted to be at low risk will still experience cardiovascular disease (CVD) events in the short term. We hypothesized that gene expression signatures in peripheral blood leukocytes (PBLs) could improve risk stratification among low-risk individuals, by identifying those with significant SA burden.

Methods
: We performed a case-control study of gene expression profiles among healthy women with low FRS (<10%) and no diabetes; we selected 49 cases with subclinical atherosclerosis (SA; defined as coronary artery calcification (CAC) >100 and carotid intima-media thickness (IMT) >1.0) and 72 age and race matched controls with CAC=0 and carotid IMT <0.65 from the MESA cohort. Microarray data were generated from Illumina BeadArray chips. Multiple cross-validation and gene ontology/pathway analysis were used to construct a classification model and identify genetic pathways involved in atherosclerosis.

Results
: A total of 2,462 genes with coefficient of variation >0.03 were used for data analysis. A gene signature composed of 40 to 60 genes in a support vector machine classification model was associated with an odds ratio of 3.5 for SA (p=0.002), resulting in a 71% specificity and 59% sensitivity for SA. For the 251 most differentially expressed genes (p = 10
−8
~ 0.0004, false discovery rate (FDR) <0.2%) between those with and without SA, Ingenuity Pathway Analysis and Panther gene ontology analysis revealed this set of genes is enriched in innate immune function (p<10
−7
). Notably, the majority of the top 30 genes (p<10
−6
, FDR<10
−6
) were involved in toll-like receptor (TLR) signaling and hypoxia signaling.

Conclusion
: The results of functional genomic analysis suggest the activation of innate immune system through TLR signaling is associated with high burden of SA that can be detected in PBLs of healthy women predicted to be at low risk for CVD events. Our findings merit validation in a larger cohort.
Abstract 1197: Migration Related Differences in Blood Iron Availability Among Resident Compared With Migrant South Asians are Related to Indices of Atherogenesis
Authors: Patel Jeetesh V , Vyas Avni , Cruickshank John K , Gunarathne Ashan , Chackathayil Julia , Bhatnagar Deepak , Mackness Michael I , Lip Gregory Y , Hughes Elizabeth A , Durrington Paul N
Published: July 2021

Introduction.
The global burden of coronary heart disease is estimated to be the highest on the Indian subcontinent. The pathophysiology of this increased risk is unclear, and its magnitude increases with migration from India to Britain. We sought to measure the impact of migration and nutritional transition on haematological parameters amongst South Asians, and their relation to indices of atherogenesis - oxidised low density lipoprotein (oxLDL) and paraoxonase activity (on HDL).

Methods.
We studied oxidised LDL and the antioxidant enzyme, paraoxonase (PON1), blood count profiles, dietary intake and iron biochemistry in 230 migrant Indian Gujaratis living in Britain, and 305 of their contemporaries (age and gender matched) still living in villages of origin in India.

Results.
Haemoglobin levels were associated with established CHD risk factors (including blood pressure, serum cholesterol, and 10 yr CHD risk score) irrespective of site and gender (P<0.001), and highest amongst migrants (P<0.001). Amongst women, migration related differences included a greater red blood cell volume in migrants, and was associated with greater levels of oxidised LDL compared to rural contemporaries (P<0.001). Metabolic and dietary indices of iron were associated with levels of haemoglobin and in turn with oxidised LDL (partial correlation coefficient = 0.18, p<0.001) and paraoxonase activity (0.28, p<0.001), adjusting for the effects of gender and site.

Conclusion.
Levels of haemoglobin are associated with CHD risk factors and direct indices of atherosclerosis in our culturally matched population of rural and migrant Indians. Accelerated erythropoiesis or higher iron levels may underline an increased susceptibility for the oxidative modification of LDL in this ethnic group.
Abstract 1244: Lipid Goals among Patients with Diabetes or the Metabolic Syndrome: The Lipid Treatment Assessment Project (L-TAP) 2
Authors: Jukema J W , Blumenthal Roger S , Santos Raul D , Waters David D , Messig Michael , Tarasenko Lisa
Published: July 2021

Background:
Achievement of lipid targets is particularly important in individuals with diabetes mellitus (DM) and the metabolic syndrome (MS) because their cardiovascular (CV) risk is high. This analysis of the L-TAP 2 population compared goal attainment by DM status and number of MS components.

Methods:
In L-TAP 2, patients aged ≥20 years with dyslipidemia on stable lipid lowering therapy were assessed at investigation sites in 9 countries (US, Spain, Canada, Netherlands, Korea, France, Taiwan, Mexico, and Brazil) between September 2006 and April 2007. Lipid levels were determined once in each patient at time of enrollment. Achievement of LDL-C success (according to National Cholesterol Education Program Adult Treatment Panel III guidelines), triglycerides (TG) goals (<150 mg/dL), and HDL-C success (>40 mg/dL in men or >50 mg/dL in women) was compared using logistic regression by DM status and number of MS components (BMI ≥30 kg/m
2
, TG ≥150 mg/dL, HDL-C <40 mg/dL in men or <50 mg/dL in women, blood pressure ≥130/≥85 mm Hg, fasting glucose ≥110 mg/dL). Lipid and CRP levels were compared by DM status using ANOVA.

Results:
A total of 9955 patients were evaluated. Patients with DM, compared with those without DM, had significantly lower achievement of LDL-C success (67% vs 75%), TG goals (55% vs 64%), and HDL-C success (62% vs 75%;
P
<0.0001 for all comparisons). However, significantly more DM patients had LDL-C <70 mg/dL (28% vs 16%;
P
<0.0001). As the number of MS components increased, success rates significantly decreased for both LDL-C (81%, 75%, 71%, 69%, 69%, and 69% for 0, 1, 2, 3, 4, and 5 MS components respectively;
P
<0.0001) and HDL-C (91%, 74%, 50%, and 24% for 1, 2, 3, and 4 MS components respectively;
P
<0.0001). Patients with DM, compared with those without DM, had significantly higher CRP levels (1.86 vs 1.52 mg/L), significantly lower total cholesterol (175 vs 188 mg/dL), LDL-C (91 vs 104 mg/dL), HDL-C (49 vs 54 mg/dL), and non-HDL-C (125 vs 134 mg/dL), and higher TG (177 vs 155 mg/dL;
P
<0.0001 for all comparisons).

Conclusions:
This analysis indicates that despite their increased CV risk, patients with DM remain undertreated. Furthermore, as the number of MS components increases, lipid goal success rates decrease.
Abstract 1245: The Mortality Rate from Cardiovascular Disease is more than Five Times Higher in Individuals with Diabetes Mellitus who have the Hp 2–2 Genotype as Compared to Individuals with Diabetes Mellitus who do not have the Hp 2–2 Genotype
Authors: Milman Uzi , Blum Shany , Shapira Chen , Levy Andrew
Published: July 2021

Objective: To determine if the Haptoglobin (Hp) genotype can predict the risk of death from cardiovascular disease in individuals with Diabetes Mellitus (DM) in a prospective community based longitudinal study. Background: The Hp gene is polymorphic in man with two classes of alleles denoted 1 and 2. Retrospective analysis of 5 longitudinal studies has demonstrated that the Hp genotype is a major determinant of the risk of incident CVD in DM individuals. Specifically, individuals with the Hp 2–2 genotype and DM were found to have a 2–5 fold increased risk of CVD as compared to Hp 1–1 or Hp 2–1 DM individuals.

Method: 2241 individuals with DM ≥55 years of age from 47 primary health care clinics were Hp genotyped and followed prospectively for three years for incident myocardial infarction, stroke and death (all cause and cardiovascular). All aspects of the medical care of individuals in the cohort were left to the discretion of the patient’s physician.

Results: The cohort consisted of 708 individuals with the Hp 2–2 genotype and 1533 individuals with the Hp 1–1 or 2–1 genotype. At baseline there were no significant differences between individuals with and without the Hp 2–2 genotype in their DM characteristics (HbA1c, duration) or in the prevalence of cardiovascular disease (25% in both groups). During the nearly 3 year period of follow up total mortality was increased in individuals with the Hp 2–2 genotype (2.5% vs 1.8%, HR 0.68, CI 0.35–1.25, p=0.2 by log rank). These differences in overall mortality were the result of a greater than 5 fold increase in CV death in Hp 2–2 individuals (1.1% vs 0.2%, HR 0.15, CI 0.038 – 0.44, p=0.001 by log rank). The incidence of non fatal MI was increased by over 50% in the Hp 2–2 group (3.9% vs. 2.5%, p=0.068). These differences were unaffected by adjustment for DM characteristics and conventional cardiovascular risk factors.

Conclusions. DM individuals with the Hp 2–2 genotype are at a dramatically increased risk of death due to cardiovascular disease. Pharmacogenomic treatment strategies targeted to this high risk population may provide considerable public health and economic benefit.
Abstract 1254: Development of a Risk Score for Incident Atrial Fibrillation in the Community; the Framingham Heart Study
Authors: Schnabel Renate B , Sullivan Lisa M , Levy Daniel , Pencina Michael J , Massaro Joseph M , D’Agostino Ralph B , Newton-Cheh Christopher , Magnani Jared W , Tadros Thomas M , Kannel William B , Wang Thomas J , Ellinor Patrick T , Wolf Philip A , Vasan Ramachandran S , Benjamin Emelia J
Published: July 2021

Atrial fibrillation (AF) contributes to increased morbidity and mortality. An easily applicable AF risk score for incidence of AF in the community is unavailable. We examined 8044 person-exams among subjects who were 46 –95 years of age and attended routine Framingham Heart Study (FHS) exams (n=4764 individuals; mean age 61 years, 55% women). Multivariable Cox regression related clinical data to 10-year AF incidence (n=457). Secondary analyses incorporated routine echo data (n=7156, 445 events) for left atrial size, left ventricular wall thickness, and fractional shortening. Age, sex, body mass index, significant murmur, systolic blood pressure, hypertension treatment, PR interval, and heart failure were associated with incident AF (C-statistic 0.78; 95% CI 0.76 – 0.80; p<0.05). Predicted 10-year risks of AF were similar to observed risks (calibration Chi
2
statistic=4.16; p=0.90). In a later FHS sample, additional incorporation of echo variables slightly increased the C-statistic from 0.78 (0.75– 0.80) to 0.79 (95% CI 0.77– 0.82), p=0.005. Reclassification by echo variables was only modest (integrated discrimination improvement of 0.021; p=0.003). We provide a point score (and excel spreadsheet) for incident AF. The figure

displays AF risk by selected risk factor levels. The FHS AF risk profile stratifies individuals in the community, and may provide a framework to evaluate new biological or genetic markers for AF risk prediction. Further studies are needed to validate the risk score in other populations.

Predicted 10-Year Risk of AF by Risk Factors & Sex
Abstract 3108: Clinical Characteristics of Left Ventricular Systolic Dysfunction without Heart Failure in Community-Based Elderly Individuals: The Cardiovascular Health Study
Authors: Pandhi Jay , Kop Willem J , Gottdiener John S
Published: July 2021

Left ventricular systolic dysfunction without heart failure (HF), also known as asymptomatic left ventricular systolic dysfunction (ALVSD), is at least as prevalent in the general population as left ventricular systolic dysfunction with heart failure (HF-LVSD). However, the clinical characteristics of ALVSD have not been well defined in an elderly population. Our aim is to evaluate the clinical features of elderly community-based individuals with ALVSD. The Cardiovascular Health Study is a multicenter cohort study designed to assess cardiovascular risk factors and outcomes in a population 65 years and older. This study quantifies baseline demographic variables and cardiovascular risk factors in participants with ALVSD. Comparisons were made with two reference groups: individuals with HF-LVSD, and those with normal left ventricular systolic function without HF (NL-LVSF). ALVSD was present in 385 of 5152 participants (7.5%) at baseline, whereas HF-LVSD was present in 84 participants (1.6%). Among those with ALVSD, 251 (65.2%) had borderline ejection fraction (EF) (45–54%), and 134 (34.8%) had impaired EF (< 45%). ALVSD was associated with elevated cardiovascular risk factors and comorbidities compared to NL-LVSF but lower than those in individuals with HF-LVSD (see table

). Among participants with ALVSD, impaired EF was associated with male sex and higher prevalence of coronary disease and LVH compared with borderline LV function. ALVSD is more common than HF-LVSD in community-dwelling elderly individuals. Furthermore, it is characterized by more cardiac risk factors and comorbidities than those with NL-LVSF, but less than those with HF-LVSD. The severity of systolic dysfunction is associated with comorbid cardiovascular risk factors. ALVSD may identify an important group of individuals at high risk for heart failure and cardiovascular mortality.

Comparison of Clinical Characteristics Between ALVSD, NL-LVSF, and HF-LVSD
Abstract 3132: Paraoxonase-1 Activity Is not Independently Related with the Risk of Future Coronary Artery Disease
Authors: Birjmohun Rakesh S , Vergeer Menno , Stroes Erik S , Tanck Michael W , Wareham Nicholas J , Luben Robert , Sandhu Manjinder S , Kastelein John J , Khaw Kay-Tee , Boekholdt S M
Published: July 2021

Background
Paraoxonase-1 (PON1) is a potent antioxidant enzyme bound to high-density lipoprotein (HDL). Its activity, but not its concentration, is controlled by the PON1 Q192R polymorphism. PON1 is considered to protect against atherogenesis, but it is unclear whether this relation is independent of its carrier, HDL.

Objective
To evaluate the predictive value of PON1 for coronary artery disease (CAD) we assessed PON1 activity and genotype (Q192R polymorphism) in a large cohort.

Methods and results
We performed a case-control study nested in the prospective EPIC-Norfolk cohort. Cases (n = 1138) were apparently healthy men and women aged 45–79 years who developed fatal or nonfatal CAD during a mean follow-up of 6 years. Controls (n=2237) were matched by age and sex. Serum PON1 activity was lower in cases vs. controls (59.9 ± 44.6 U/L vs. 63.4 ± 46.7 U/L, p=0.020) and correlated with HDL cholesterol (r= 0.16, p<0.0001). Whereas the PON1 Q192R polymorphism strongly controlled PON1 activity (QQ: 27 ± 9, QR: 87 ± 27 and RR 152 ± 44 U/L), it was not related to the risk of future CAD (Odds Ratio [OR] per R allele 0.98 [0.84–1.15], p=0.84). Using conditional logistic regression, quartiles of PON1 activity showed a modest inverse relation with CAD risk (OR for the highest vs. the lowest quartile 0.77 [0.63– 0.95], p=0.013; p for trend over quartiles 0.064). PON1 activity adjusted for Q192R genotype - a proxy for PON1 concentration -correlated better with HDL cholesterol (r=0.29, p<0.0001) and strongly predicted CAD risk (OR for the highest versus the lowest quartile 0.72 (0.58 – 0.91), p for trend over quartiles = 0.005). However, this relation was abolished after adjustment for HDL related parameters (HDL particle number, HDL cholesterol, HDL size and apolipoprotein A-I; OR for highest vs. lowest quartile 0.87 [0.66 –1.16], p for trend over quartiles = 0.13).

Conclusion
In the largest prospective study to date, we show that PON1 activity inversely relates to CAD risk, but not independently of HDL, presumably due to its close association with the HDL particle. Since the Q192R polymorphism profoundly affects lifelong PON1 activity, our inability to demonstrate a relation between the Q192R polymorphism and CAD risk suggests that PON1 activity is not a causal factor in atherogenesis.
Abstract 3151: Inflammatory Markers and Risk of Coronary Heart Disease in Relation to the Apob/Apoa-i Ratio in Healthy Men and Women; The Epic-Norfolk Population Study
Authors: Rana Jamal S , Arsenault Benoit J , Stroes Erik S , Côté Mélanie , Després Jean-Pierre , Kastelein John J , Wareham Nicholas J , Boekholdt Matthijs , Khaw Kay-Tee
Published: July 2021

Studies have shown that individuals with an elevated apoB/apoA-I ratio are at increased risk for CHD. Presence of higher levels of inflammatory markers is also associated with increased CHD risk. The respective contributions of the apoB/apoA-I ratio and inflammatory markers to CHD risk are unknown. The apoB/apoA-I ratio and the plasma concentrations of an extensive panel of inflammatory markers including CRP, adiponectin, fibrinogen, myeloperoxidase, secretory phospholipase A2 (sPLA2) as well as lipoprotein-associated phospholipase A2 (Lp-PLA2) activity were measured in a prospective case-control study of 844 cases and 1762 matched controls (1651 men and 955 women) aged between 45–79 years who participated to the EPIC-Norfolk prospective population study. In both sexes, compared to participants in bottom apoB/apoA-I ratio tertile, participants in the top tertile had the highest levels of CRP (4.4 [3.7–5.0] vs. 2.8 [2.4 –3.2] mg/dL, p<0.001 in men and 4.1 [3.4 – 4.8] vs. 3.1 [2.6 –3.6] mg/dL, p=0.03 in women), fibrinogen (3.2 [3.1–3.2] vs. 2.9 [2.8 –2.9] g/L, p<0.001 in men and 3.2 [3.1–3.2] vs. 3.0 [2.9 –3.1] g/L, p<0.001 in women) and the highest Lp-PLA2 activity (60.7 [59.3– 62.1] vs. 47.3 [46.0 – 48.6] nmol/min/mL, p<0.001 in men and 55.6 [53.8 –57.4] vs. 41.5 [40.2– 42.8] nmol/min/mL, p<0.001 in women) and the lowest adiponectin levels (7.9 [7.6 – 8.3] vs. 10.2 [9.7–10.6] μg/mL, p<0.001 in men and 11.3 [12.7–13.5] vs. 15.5 [14.6 –16.1] μg/mL, p<0.001). Myeloperoxidase and sPLA2 levels did not differ in apoB/apoA-I ratio tertiles. Compared to men in the bottom apoB/apoA-I ratio tertile and only 0 or 1 inflammatory markers in the top tertile (bottom for adiponectin), men in the top apoB/apoA-I ratio tertile had odds ratio (OR) for future CHD of 1.7 [95%CI 1.1–2.5], whereas those with 4, 5 or 6 inflammatory markers in the top tertile had an OR of 2.1 [1.4 –3.1] for future CHD. Among women, these OR for future CHD were of 1.7 [1.05–2.9] and 2.2 [1.2–3.9]. Men and women with an elevated apoB/apoA-I ratio also exhibited increased levels of inflammatory markers. The presence of additional elevated levels of multiple inflammatory markers was associated with an elevated CHD risk independent of higher levels of apoB/apoA-I ratio.
Abstract 3173: Have Door-to-Balloon Times Improved After Initiation of the D2B Alliance? An Analysis of the Get-with-the-Guidelines Registry
Authors: Nallamothu Brahmajee K , Krumholz Harlan M , Peterson Eric D , Pan Wendy , Masoudi Frederick A , Bradley Elizabeth H , Stern Amy , Janicke David , Hernandez Adrian , Cannon Christopher , Fonarow Gregg C
Published: July 2021

In an effort to improve DTB times, the D2B Alliance enrolled ~900 PCI hospitals across the U.S. in a large quality improvement initiative. We compared changes in DTB times for hospitals in the GWTG Registry that enrolled in the D2B Alliance with those that did not. We used data on DTB times from Jul 06 to Mar 08 to allow for 1 quarter of baseline data prior to the D2B Alliance launch and 1 year of follow-up data. We limited our analysis to STEMI patients undergoing primary PCI and excluded transfer-in cases. DTB times were defined from hospital arrival to first device. We evaluated the % of patients treated within 90 minutes using GEE models to examine trends over time, with interaction terms added to assess the specific effect of the D2B Alliance. 5801 patients at 167 hospitals - 98 in the D2B Alliance and 69 that were not - were included. No significant differences were noted in age, gender, race, prior CAD and rates of compliance with composite AMI performance measures between patients at D2B Alliance and non-D2B Alliance hospitals; however, more D2B Alliance hospitals had on-site cardiac surgery (89% vs. 74%). At baseline 54.6% and 53.1% of patients at D2B Alliance and non-D2B Alliance hospitals were treated within 90 minutes, respectively; these numbers increased to 75.3% and 71.6% (both p<0.001) by the end of the study period (Figure

). However, no significant differences were noted in rate of change between D2B Alliance and non-D2B Alliance hospitals. The proportion of STEMI patients treated within 90 minutes improved since initiation of the D2B Alliance. Among GWTG hospitals, this improvement was not limited to facilities that directly participated.
Abstract 3207: Ratio of Microparticles To Endothelial Progenitor Cells Is Increased In A Diabetic Population
Authors: Curtis Anne M , Zhang Lifeng , Medenilla Elizabeth , Gui Ming , Wilkinson Patrick F , Hu Erding , Giri Jay , Doraiswamy Vijay , Gunda Sampath , Burgert Mark , Edelberg Jay M , Mohler Emile R
Published: July 2021

Diabetes Mellitus (DM) is strongly associated with a high incidence of cardiovascular disease (CVD) although often individuals show no symptoms or signs of disease. Therefore, quantitative measures are needed to distinguish those diabetic patients at higher risk for CV events. Cell derived microparticles (MPs), submicron membrane vesicles released from activated cells, and endothelial progenitor cells (EPCs) are mediators of cellular damage and endothelial reparative capacity respectively. Both are emerging biomarkers of vascular health and have been assessed individually in diabetic populations. To extend on this, we examined whether the relationship of MPs to EPCs could be used as a potential index of vascular pathology. Plasma samples were collected from patients with early-stage (ES, Diagnosis<1yr, n=11, 51±4yrs, 7.2±0.5% HbA1c) and long-term (LT, Diagnosis>5yrs, n=21, 64±3yrs, 7.1±0.3% HbA1c) with type 2 DM and compared to age related healthy volunteers (H, n=18, 57±3yrs, 5.3±0.7% HbA1c). EPCs positive for CD133
+
/CD34
+
and MP subtypes, AnnexinV
+
(AnnV
+
), platelets (CD41
+
), monocytes (CD14
+
) and endothelial (CD144
+
) were measured by flow cytometry. Pro-coagulant microparticles and quantification of soluble proteins was measured using ELISA based methods. A significant relationship was found between MPs and EPCs which correlated with disease duration (H vs. ES vs. LT). Significant changes of pro-coagulant MPs (
P
=0.02) and AnnV
+
MPs (
P
=0.02) were noted. Of particular interest, the ratio of CD144
+
MPs/EPC increased dramatically (
P
=0.009) followed by ratios of AnnV
+
(
P
=0.01), CD41
+
(
P
=0.01) and CD14
+
(
P
=0.03) MPs/EPCs. These indices of compromised vascular function were highest in the LT group despite intensive statin therapy (LDL mg/dL, 109±8 in H, vs. 80±7 in LT,
P
=0.01). Of note, the ratio of endothelial MPs/endothelial progenitor cells (CD144
+
MPs/EPCs) was more informative than CRP and a range of inflammatory mediators. This is the first report of a relationship of MPs and EPCs in DM. This ratio provides a quantitative measurement of both pro-coagulant and endothelial injury and can identify DM patients with potentially increased risk of CV disease.
Abstract 3223: Dietary Pattern, Metabolic Syndrome and Left Ventricular Systolic Dysfunction - The Multi-Ethnic Study of Atherosclerosis
Authors: Liu Longjian , Nettleton Jennifer A , Bertoni Alain G , Bluemke David A , Lima Joao A , Szklo Moyses
Published: July 2021

Little is known about the association between dietary patterns and left ventricular (LV) function. We assessed the hypothesis that dietary patterns may influence LV function via pathways related to metabolic dysfunction. With a cross-sectional study design, using reduced rank regression (RRR), dietary patterns that maximally explained variation in metabolic syndrome (MetSyn) components (waist circumference, serum triglycerides, fasting glucose, HDL cholesterol, SBP, and DBP) were identified. We used magnetic resonance imaging to assess LV ejection fraction (LVEF), LV mass, and stroke volume. LV mass and stroke volume were adjusted for body surface area (m
2
). Insulin resistance (IR) was estimated using HOMA-IR method. A total of 4574 (M: 2173, F: 2401) White, African American, Hispanic and Chinese adults aged 45– 84 and free of clinical cardiovascular disease were included in these analyses. After adjusting for age, sex, and race/ethnicity, scores on the primary dietary pattern (RRR1) were positively correlated with intake of added fats, processed meats, and cheeses, and negatively correlated with vegetable, soy, wine, green/black tea, and fish intake. With adjustment for demographics, lifestyle factors, and anti-hypertensive drug use, means for LV mass increased across quintiles of RRR1 scores, and means for LVEF and stroke volume decreased across quintiles of RRR1 scores. Multiple linear regression analyses indicated that each one unit increase in RRR1 score (i.e. toward high-fat food intake) was associated with 0.32 g/m
2
(95%CI: 0.05–0.69 g/m
2
) increase in LV mass, and with 0.26 % (−0.44 ~ − 0.08 %) and 0.28 ml/m
2
(−0.52~ −0.05, ml/m
2
) decreases in LVEF and stroke volume, respectively. The associations remained significant after adjustment for IR alone, but were not significant after adjustment for all MetSyn components. A dietary pattern characterized by high intakes of added fats, meats, and cheese and low intakes of vegetables, soy and fish, as indicative of variation in MetSyn components, was significantly associated with unfavorable LV function. The result supports the hypothesis that the influence of dietary pattern on LV function may be through a pathway related to metabolic dysfunction.
Abstract 3230: Elevated Glucose and Mortality in Patients Hospitalized with Heart Failure
Authors: Kosiborod Mikhail , Inzucchi Silvio , Spertus John A , Wang Yongfei , Masoudi Frederick A , Havranek Edward P , Krumholz Harlan M
Published: July 2021

Background:
While some professional societies recommend target-driven blood glucose (BG) control for all hospitalized patients, the association between elevated BG and adverse outcomes has not been well established in patients hospitalized with heart failure (HF).

Methods:
We evaluated a nationally representative cohort of 50,532 patients hospitalized with HF between 04/1998 – 06/2001. Admission BG was analyzed as a categorical variable (≤110, >110 –140, >140 –170, >170 –200, >200 mg/dL), and in 10 mg/dL increments. The association between BG and all-cause mortality over 30 days and 1 year was analyzed using Cox regression, both in the entire cohort and in patients with and without diabetes (DM).

Results:
After multivariable adjustment, there was no significant relationship between BG and 30-day mortality (for BG >110 to 140, >140 to 170, >170 to 200, and >200, hazard ratios and 95% confidence intervals were: 1.09 (0.98 –1.22), 1.27 (1.11–1.45), 1.16 (0.98–1.37), 1.00 (0.87–1.15) respectively vs. BG ≤110, P for linear trend 0.53). Results were similar for 1-year mortality, and did not differ between patients with and without DM (P values for DM*BG interaction 0.11 and 0.55 for 30-day and 1-year mortality respectively). A lack of association between BG and mortality over 30-days and 1-year was also observed when BG was analyzed in 10mg/dL increments (Figure

).

Conclusions:
We found no significant association between BG and mortality in a large cohort of hospitalized HF patients. While the impact of BG lowering on outcomes cannot be determined based on this study, our findings do not support resource-intensive interventions for BG monitoring and management in this patient group.
Abstract 3237: The Economic Impact of Same-Day Discharge after Transradial Percutaneous Coronary Intervention and a Single Bolus of Abciximab; an Analysis from the EASY Trial
Authors: Rinfret Stéphane , Kennedy Wendy , Lachaine Jean , Lemay Anne , Rodés-Cabau Josep , Bertrand Olivier F
Published: July 2021

Background:

In patients presenting with an acute coronary syndrome, same-day home discharge (SDD) after an uncomplicated transradial percutaneous coronary intervention (PCI) performed under a single bolus of abciximab was found clinically non-inferior to the usual overnight hospitalization (OH) and an abciximab bolus followed by a 12h infusion.

Objective:

To estimate post-PCI health resources cost of trial subjects, and, using cost-minimization, immediate and short-term economic impact of same-day home discharge.

Method:

A total of 1005 patients were randomized to either the SDD group (n =504) or the OH (n = 501). As randomization was post-procedure, and PCI resource use showed minimal and non-significant differences, a post-PCI cost analysis was conducted. A hospital-based perspective was used. Detailed per patient information of healthcare resources used immediately post-PCI up to hospital discharge were prospectively collected. Costs were estimated based on 2006 Laval Hospital unit prices, and 2006 costs from the Centre Hospitalier de l’université de Montréal (CHUM) hospital costing system (direct and indirect costs). In addition, patient-reported resources for a period of 30 days post-discharge were examined.

Results:

Per hour post-PCI hospital costs were estimated as $113, based on average 2006 cost for all patients hospitalized for angioplasty plus stent (DRG 112) at the CHUM ($5716), net of estimated PCI-related cost ($1131), and divided by average post PCI length-of-stay of subjects. SDD patients stayed an average of 8.9 hours (95%CI from 8.2 to 9.5) post-PCI, compared to 26.5 hours (25.2–27.8) for OH patients. Mean estimated post-PCI hospital costs (including abciximab infusion when used, other medications, nursing time, meals, etc..) were $1004 ($929–$1079) in the SDD group versus $3117 ($2975–$3260) in the OH group, saving, on average, $2113 per patient (p<0.001). Within 30 days of discharge, only 50 patients were rehospitalized, 29 after SD discharge and 21 after OH (p=0.26).

Conclusion:

Same-day home discharge after an uncomplicated transradial PCI and a single bolus of abciximab resulted in a 68% relative saving in post PCI costs. In our trial, SDD of 504 patients saved over 1 million dollars to the hospital.
Abstract 3239: Risk of Stroke after New-Onset Atrial Fibrillation versus Chronic AF in Patients Undergoing Coronary Artery Bypass Surgery
Authors: Yeo Khung Keong , Li Zhongmin , Katz Scott , Douketis James , Danielsen Beate , White Richard H
Published: July 2021

Background: Among patients undergoing isolated coronary artery bypass graft surgery (CABG), the risk of post-operative stroke has not been compared between patients with chronic atrial fibrillation (AF) versus patients with hospital-acquired new-onset AF (new-AF).

Methods: Using linked hospital discharge data together with comprehensive clinical data from the California CABG outcomes reporting program, we conducted a retrospective cohort study of all patients undergoing isolated CABG in California between years 2003–2006. Using hospital discharge data, chronic AF was defined as ICD-9-CM =427.31 present at time of admission and during a previous hospitalization. New-AF was defined as a first-ever code for AF that was not present at the time of admission. The risk of stroke < 30 days after surgery, defined using specific ICD-9-CM codes, was analyzed using logistic regression, with adjustment for 15 clinically important stroke risk factors. As a sensitivity analysis, we developed a propensity model for new-AF, and analyzed the risk of stroke after hospital discharge but within 30 days of surgery.

Results: Among 61,031 cases, 2081 (3.4%) had chronic AF; 9858 (17%) had new-AF; the 30-day incidence of stroke was 1222 (2.0%). Compared to patients with no-AF, the adjusted risk of stroke in patients with chronic AF was odds ratio (OR) = 1.2 (CI: 0.9 –1.5), whereas for new-AF, it was OR= 1.7 (CI: 1.5–1.9), c-statistic = 0.73. Using the propensity analysis, the risk of stroke after hospital discharge associated with new-AF versus no-AF was similar across quintiles of the risk score (OR range=1.7–1.8).

Conclusion: After adjusting for stroke risk factors, patients who developed AF during hospitalization for CABG had an approximately 70% higher risk of stroke within 30 days compared to patients without AF, whereas the risk of stroke in patients with chronic AF was not significantly increased. Interventions that reduce the incidence of new-AF after CABG surgery may reduce the incidence of subsequent stroke.
Abstract 3277: Sustained Benefits in Vascular Function through Flavanol-Containing Cocoa in Medicated Diabetic Patients: A Double-Masked, Randomized, Controlled Trial
Authors: Balzer Jan , Rassaf Tienush , Heiss Christian , Kleinbongard Petra , Lauer Thomas , Merx Marc , Heussen Nicole , Gross Heidrun , Keen Carl , Schroeter Hagen , Kelm Malte
Published: July 2021

Purpose
Epidemiological investigations revealed an inverse correlation between the dietary intake of flavanols, the mortality of cardiovascular disease, and the incidence of diabetes. Controlled trials evaluating longer-term effects of flavanol-containing cocoa on endothelial function in diabetic patients are missing. This study was designed to test feasibility and efficacy of a dietary intervention based on daily intake of flavanol-containing cocoa for improving vascular function of medicated diabetic patients.

Methods
In a feasibility study with 10 diabetic patients, we assessed vascular function as flow-mediated dilation (FMD) of the brachial artery, plasma levels of flavanol metabolites, and tolerability following an acute, single-dose ingestion of cocoa, containing increasing concentrations of flavanols (75,371,963mg). In a subsequent efficacy study, changes in vascular function in 41 medicated diabetics were assessed following a 30-day, thrice-daily dietary intervention with either flavanol-rich cocoa (321mg flavanols per dose) or a nutrient-matched control (25mg flavanols per dose). Both studies were undertaken in a randomized, double-masked fashion.

Results
A single ingestion of flavanol-containing cocoa was dose-dependently associated with significant acute increases in circulating flavanols and FMD (at 2h: from 3.7±0.2% to 5.5±0.4%, p<0.001). A 30-day, thrice-daily consumption of flavanol-containing cocoa increased baseline FMD by 30% (p<0.0001), while acute increases of FMD upon ingestion of flavanol-containing cocoa continued to be manifest throughout the study. Treatment was well tolerated without evidence of tachyphylaxia. Endothelium-independent responses, blood pressure, heart rate, and glycemic control were unaffected.

Conclusions
Our study clearly establishes improvements of endothelial function after regular consumption of flavanol-containing cocoa in patients with type 2 diabetes, highlighting the potential of flavanol-containing diets, and underscoring the potential health care benefit for reducing the risk of cardiovascular events in diabetic patients.
Abstract 5008: Lifestyle Practices in Adults 65 Years and Older and 7-Year Follow-up Mortality: The Chicago Heart Association Detection Project in Industry Study (CHA)
Authors: Vu Thanh Huyen T , Garside Daniel B , Daviglus Martha L
Published: July 2021

Background and Objective
: Prospective data on combined effects of lifestyle practices (smoking, heavy drinking, and physical inactivity) in older age on mortality are limited. We examine the combined impact of lifestyle behaviors in adults 65 years and older on CVD, non-CVD, cancer, and all-cause mortality after 7 years of follow-up.

Methods
: In 1996, a health survey was mailed to all surviving participants, ages 65–102, from the Chicago Heart Association Detection Project in Industry Study. The response rate was 60% and the sample included 4,200 male and 3,288 female respondents. Unhealthy lifestyle (un-HL) practices were classified into three groups as having
two or more
,
one
, or
none
of the following three un-HL factors (current smoking or stopped smoking only within the past 10 years; heavy drinking ->15 g/day for women or >30 g/day for men; and infrequent exercise). Vital status was ascertained through 2003 via the National Death Index.

Results
: With adjustment for age, race, education, marital status, living arrangement, and BMI, the hazards of CVD, non-CVD, cancer, and all-cause mortality were highest among men and women who had
two or more
un-HL factors and lowest among those who had healthy lifestyle. For example, in men, compared to those with
none
un-HL factors, the hazard ratios (95%CIs) of all-cause death for those with
two or more
and
one
un-HL factors were 2.10 (1.73–2.46) and 1.56 (1.36–1.77), respectively. Associations were attenuated somewhat but remained strongly significant with further adjustment for comorbidities (see table

).

Conclusion
: Having no unhealthy lifestyle factors in older age is associated with a lower risk for CVD, non-CVD, cancer, and all-cause death. These results should encourage healthy lifestyle practices in elderly people to decrease mortality and promote longevity.

Adjusted* Hazard Ratios (95% CIs) for CVD, Non-CVD, Cancer, and All-Cause Death by Number of Unhealthy Lifestyle Factors in 1996 and Gender
Abstract 5016: Growth-Differentiation Factor-15 is an Independent Predictor of Cardiovascular Events and Mortality in Patients with Stable Coronary Artery Disease
Authors: Kempf Tibor , Sinning Jan-Malte , Quint Anja , Bickel Christoph , Sinning Christoph , Wild Philipp S , Schnabel Renate , Lubos Edith , Rupprecht Hans J , Münzel Thomas , Drexler Helmut , Blankenberg Stefan , Wollert Kai C
Published: July 2021

Circulating levels of the TGF β-related cytokine, growth-differentiation factor-15 (GDF-15), provide independent prognostic information in patients with unstable coronary artery disease (CAD). To explore the prognostic utility of GDF-15 in patients with stable CAD, we analyzed the relation of GDF-15 to mortality and cardiovascular (CV) events in the AtheroGene registry which enrolled consecutive patients with stable angina and at least one stenosis >30% in a larger coronary artery. Patients were followed for a median of 3.6 years. Serum samples for measurement of GDF-15 along with other biomarkers were available from 1352 patients. Two pre-specified cutoff points (1200 and 1800 ng/L) were used to identify different risk groups. 55.9%, 26.4%, and 17.7% of the patients presented with GDF-15 values <1200 ng/L, between 1200 and 1800 ng/L, and >1800 ng/L, respectively. Increasing levels of GDF-15 were related to age (P<0.001), hypertension (P=0.01), diabetes mellitus (P<0.001), low HDL cholesterol (P<0.001), and the extent of CAD (P=0.001). Moreover, significant relations to hsCRP, troponin T, NT-proBNP, and reduced renal function (GFR) were observed (all P<0.001). Increasing levels of GDF-15 were associated with an increased risk of all-cause mortality (P<0.001, log-rank test), CV mortality (P<0.001), and CV events (P<0.001). Receiver operating curve analyses confirmed GDF-15 as a strong marker of 2-year adverse outcomes (area under the curve for all-cause mortality, 0.79; CV mortality, 0.81; CV events, 0.70). By multiple Cox regression analysis, GDF-15 emerged as an independent predictor of all-cause mortality (HR 2.1 per one standard deviation of lnGDF-15 [95% CI 1.6 –2.8], P<0.001), CV mortality (HR 2.2 [95% CI 1.5–3.3], P<0.001), and CV events (HR 1.7 [95% CI 1.3–2.4], P=0.001) after adjustment for baseline characteristics, clinical variables, LDL/HDL ratio, hsCRP, troponin T, NT-proBNP, and GFR. Patients with a GDF-15 level above 1800 ng/L had a highly elevated risk of CV mortality even in the fully adjusted model (HR 5.2 [95% CI 1.6 –16.1], P=0.005). These data identify GDF-15 as a powerful and independent biomarker of mortality and CV events in patients with stable CAD.