bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 1077: Non-Invasive MRI Assessment of Coronary Endothelial-Dependent Vasoreactivity
Authors: Hays Allison G , Hirsch Glenn A , Kelle Sebastian , Gerstenblith Gary , Stuber Matthias , Weiss Robert G
Published: July 2021

Endothelial-dependent coronary artery vasoreactivity is an important indicator of vascular function and is traditionally measured invasively. We hypothesized that coronary vasoreactivity can be measured non-invasively and abnormal function detected using high-field MRI. We studied 16 healthy adults (mean age ± SD 41.1±14.1 years, seven men) and eight patients with coronary artery disease (CAD, mean age 56.6±11.3, two men). To measure endothelial-dependent vasoreactivity, 3T coronary MRI was performed before and during continuous isometric hand-grip exercise, a known endothelial-dependent stressor. Cross-sectional coronary artery area and peak diastolic coronary flow velocities were quantified. In healthy adults, coronary arteries significantly dilated and increased in flow velocity with stress (baseline vs. stress area: 13.0±3.0 vs.14.9±4.1mm2, p<0.001; and velocity: 23.4±7.7 vs. 31.2±11.2 cm/s, p<0.0001). In CAD patients, the coronary arteries did not dilate (baseline vs. stress area: 18.4±5.2 vs. 17.5±4.5mm2, p=0.11) and decreased in flow velocity with stress (24.2±9.2 vs. 20.6±5.9cm/s, p=0.04). Relative changes are shown in Figure 1

. We provide first evidence that MRI and isometric handgrip exercise, an established endothelial-dependent stressor, non-invasively detects significant changes in two common indices of coronary endothelial vasoreactivity: coronary artery area and flow velocity. This novel technique demonstrates physiologic coronary artery vasodilation and increased flow velocity in healthy subjects in response to handgrip stress, and their pathologic absence in patients with CAD.

Figure 1.

Percent change in coronary artery area and peak diastolic coronary flow velocity from baseline to stress (isometric handgrip exercise) in healthy adults (n=16) and CAD patients (n=8). (*,† p<0.0001 healthy vs. CAD)
Abstract 1079: Modulation of Atherosclerotic Plaque Characteristics by Minocycline: An Evaluation by Molecular Imaging of Matrix Metalloprotainase (MMP) Expression
Authors: Ohshima Satoru , Fujimoto Shinichiro , Nakagami Hironori , Haider Nezam , Zhou Jun , Osako Mariana K , Fujimoto Ai , Zhu Jie , Narula Navneet , Murohara Toyoaki , Petrov Artiom , Morishita Ryuichiro , Narula Jagat
Published: July 2021

MMP activation in atherosclerotic lesions plays an important role in plaque progression and vulnerability, and is a potential target for plaque stabilization. We evaluated the effectiveness of minocycline (MC) in modulation of plaque characteristics using molecular imaging of MMP expression, compared with fluvastatin (FS). 38 NZW rabbits with experimental atherosclerotic lesions were subjected to in vivo micro SPECT/CT imaging for the assessment of MMP activity using 99mTc-labeled broad spectrum MMP inhibitor (MPI). Atherosclerotic lesions were produced by balloon deendotheliazation of abdominal aorta, and high cholesterol diet for 4 months. Of these, 7 received low dose MC (1.5mg/kg), 7 high dose MC (3mg/kg, N=7), 6 FS (1mg/kg), and 6 combination of low dose MC and FS (MC+FS) in the fourth month, 12 received no intervention (Rx-control). 8 unmanipulated normal chow-fed rabbits were used as disease controls (Dz-control). After
in vivo
imaging, aortas were explanted for %ID/g MPI uptake, histological characterization, and MMP activity assays. Parallel
in vitro
studies were performed for the effect of MC and FS on NF-κB, VCAM-1 and MMP-9 expression from cultured TNF-α-stimulated smooth muscle cells and macrophages. Target accumulation of MPI was best visualized in atherosclerotic aorta in Rx-control atherosclerotic rabbits. % ID/g MPI in Rx-control (.10±.04%) was significantly higher than Dz-control (.016±.004%), MC-low (.081±.02%) and high (.045±.01%) dose, FS (.056±.011%), and MC+FS (.049±.005%) rabbits, and showed a significant correlation with histologically and biochemically-verified MMP-2, -9 activity. MC-treated plaques showed marked reduction in inflammation and increase in smooth muscle content.
In vitro
cell culture confirmed that NF-κB and VCAM-1 expression in activated VSMC were reduced by MC, and that MMP-9 expression in activated macrophage was also inhibited by MC. The present study demonstrates that MC is equally effective as FS in modulation of plaque characteristics, and that molecular imaging can characterize various biologic processes
in vivo
and allows for the study of the efficacy of targeted interventions.
Abstract 1098: Effect of Hypercholesterolemia on Myocardial Necrosis and Apoptosis in Response to Ischemia Reperfusion Injury
Authors: Osipov Robert M , Bianchi Cesario , Feng Jun , Liu Yuhong , Clements Richard T , Sodha Neel , Sellke Frank W
Published: July 2021

OBJECTIVE: Myocardial ischemia-reperfusion(I/R) injury often results in necrosis and apoptosis and may lead to cardiac dysfunction or death. This study investigates impact of hypercholesterolemia in the setting of I/R injury on myocardium.

METHODS: The mid-left anterior descending coronary artery in normocholesterolemic (NCn=7) and hypercholesterolemic (HCn=7) Yucatan males were occluded for 60 min, followed by reperfusion for 120 min. Hemodynamic values were recorded. Monastryl blue/TTC staining was utilized to assess the area-at-risk (AAR) and necrosis. The expression of Bcl2, apoptosis inducing factor (AIF), total & cleaved caspase3, total & cleaved PARP, bad, BNIP3, Akt and phospho-Akt measured. The TUNEL staining utilized to assess the magnitude of apoptosis.

RESULTS: Hemodynamic values of MAP (p<0.01), DLVP (p<0.01), +dP/pt (p<0.01), and −dP/pt (p<0.01) were increased 1.2 fold in HC. In HC longitudinal and horizontal segmental shortening in the AAR decreased by 49% vs. 26% (p<0.01) and 68% vs. 48% (p<0.01) at the end. The AAR was similar in both groups (36% vs. 34%, p=0.61) whereas infarct size increased 45% in HC (42% vs. 61%, p=0.01). The expression of anti-apoptotic Bcl2 decreased 2.3-fold (p<0.01) whereas pro-apoptotic PARP and BNIP3 increased 2.8-fold (p<0.01) and 1.9 fold (p<0.01) respectively in HC. Ischemia decreased Akt expression 1.6-folds (p<0.01) and phospho-Akt 1.5 fold (p<0.01) in HC, whereas increased phospho-Akt 1.9 fold (p<0.01) in NC. In HC the TUNEL+ cells increased 3.8 fold (p=0.03) in the AAR.

CONCLUSIONS: This study demonstrated that hypercholesterolemia have positive ionotropic effect on myocardial function, increase infarct size in AAR, mediate pro-apoptosis and attenuate survival pathway after I/R injury.
Abstract 1120: Chest Pain and Dyspnea in a Pregnant Woman with a Prosthetic Valve
Authors: Ahmed Jameel , Philippides George , Klein Michael
Published: July 2021

A 31 year old pregnant female at nine weeks gestation presented with a complaint of recurrent chest pain and dyspnea. The patient had undergone aortic valve replacement with a bileaflet mechanical valve at 25 years of age. Most recently, she had been anti-coagulated with low-molecular weight heparin. The patient had missed two doses of enoxaparin over the prior week. Physical examination was notable for muffled, but audible mechanical valve sounds with an early peaking, systolic murmur over the right sternal border. Transthoracic echocardiogram revealed an elevated mean trans-aortic gradient of 38 mm Hg. Of note, echocardiogram at an outside hospital six days earlier had revealed normal gradients. Trans-esophageal echocardiography was performed, which revealed a poorly mobile posterior leaflet without large thrombus, and confirmed elevated gradients. Fluoroscopy of the aortic prosthesis also revealed a fixed posterior leaflet. A presumptive diagnosis of prosthetic valve obstruction (PVO) due to prosthetic valve thrombosis (PVT) was made. After discussion with the patient, intravenous tissue plasminogen activator was administered. Fluoroscopy the following day revealed both aortic valve leaflets to be fully mobile and transthoracic echocardiogram demonstrated normal trans-aortic gradients. Patient was anti-coagulated with enoxaparin until twelve weeks gestation and with coumadin for the duration of her pregnancy. At 37 weeks, a healthy, baby boy was delivered. PVO can be caused by thrombus, pannus formation or endocarditis. PVT is the most common etiology, with an annual rate of 0.5 to 8%. An increase in clotting factors during pregnancy results in a physiologic hypercoagulable state and higher rates of thromboembolic complications. Management options of PVT include surgery or intravenous thrombolytic therapy. Trans-esophageal echocardiography can be used to help guide management. This case illustrates the difficulties in the diagnosis and management of a relatively uncommon condition (prosthetic valve thrombosis) in a common patient (pregnant female). In conjunction with the clinical history and physical examination, various imaging modalities were utilized to arrive at a likely diagnosis and formulate a management plan.
Abstract 1147: Drug Eluting Stents Do Not Delay Early Endothelialization But Show Distinct Differences In Endothelial Function
Authors: Van Der Giessen Willem J , Sorop Oana , Krabbendam-Peters Ilona , Onuma Yoshinobu , van Beusekom Heleen M
Published: July 2021

Late stent thrombosis and impaired endothelium dependent vasodilation in Cypher and Taxus are often attributed to delayed re-endothelialization. Data to support this hypothesis is scarce and the functional status of endothelium within these drug eluting stents is unknown. We compared 3 DES (Paclitaxel; Sirolimus (-limus via mTOR) and Tacrolimus (-limus via calcineurin)) to BMS in swine coronary arteries with respect to early endothelialization (%EC) at 5 days and function as assessed by immunocytochemistry for eNOS and vWF expression at 28 days (semiquantitative score) and in vitro vasoreactivity at 5 and 28 days.

Results. There were no significant differences in %EC between DES and BMS at 5 days (Anova, p=0.7). While vWF expression was similar for all DES, PES showed diminished eNOS expression at 28 days. Microvascular function showed no overt impairment distal to both DES in EC-dependent dilation to bradykinin at 5 and 28 days. However, eNOS blockade by L-NAME uncovered a strongly depressed NO production in both DES at 5 days which recovered at 28 days.

Conclusion. DES show no differences in re-endothelialization as compared to BMS. In vitro data showed that both DES induced a temporary reduction in NO production. However, only Paclitaxel showed a prolonged reduction in eNOS expression at 28 days.

planimetry of endothelial presence and function
Abstract 1158: Sudden Death in Children with Cardiomyopathy: Long Term Follow-Up from a National Population-Based Study of Childhood Cardiomyopathy
Authors: Bharucha Tara , Davis Andrew M , Turner Christian , Justo Robert , Robertson Terry , Ramsay Jim , Daubeney Piers E , Nugent Alan W , King Ingrid , Weintraub Robert G
Published: July 2021

Introduction
Better data regarding the incidence and risk factors for sudden cardiac death (SCD) in children with cardiomyopathy (CM) is critical in defining appropriate primary prevention strategies.

Methods
The National Australian Childhood Cardiomyopathy Study is a prospective cohort study, including
all
children in Australia with primary CM diagnosed at 0 – 10 years of age, between 1987–1997. SCD was defined as sudden and unexpected death in children who were not hospitalized and not in congestive heart failure at the time of death. Nine subjects with sudden death as presenting symptom were excluded. Indexed echocardiographic measurements at latest follow-up were compared between subjects with SCD and survivors.

Results
Study criteria were met by 291 children. Mean duration of follow-up was 9.2 years. The incidence of sudden death relative to each CM type, for all cases and as a proportion of deaths, is shown in the Table

: Incidence of SCD by CM type. SCD incidence was significantly associated with CM type, for all cases (
p
= 0.006) and when only those subjects who died were considered (
p
= 0.005), with LVNC and RCM having up to 4 times the risk of other CM types. Children with familial DCM had a significantly higher rate of SCD than subjects with non-familial CM (12% vs 3%;
p
= 0.028), however, familial CM was not a risk factor in other CM types. DCM SCD subjects had larger LVEDd Z score than survivors (median 5.53 vs 1.16;
p
<0.0001) and lower FS Z score (median −9.23 vs −0.51;
p
= 0.0025). HCM SCD subjects had thicker LVPW dimension Z scores than survivors (median 4.63 vs 1.18;
p
= 0.007). Twelve subjects (2 DCM, 8 HCM and 2 LVNC) underwent ICD implantation (8/12 for primary prevention).

Conclusions:
This population based study defines new risk factors for sudden death in children with CM. RCM is well known to have a high incidence of SCD. In addition, children with LVNC and those with DCM who have severe dilatation, systolic dysfunction or familial DCM are at increased risk of sudden death.
Abstract 2013: Long Term Clinical Prognosis of Provocation Positive Variant Angina
Authors: lee Hyun jong , Choi Jin ho , Park Ji han , Choi Soo Hee , Gwon Hyeon-Cheol , Song Young Bin , Hahn Joo-Yong , Doh Joon-Hyung , Lee Sung yoon , Kim Myeng gon , Choi Seung Hyuk , Lee Sang Hoon
Published: July 2021

Background Although coronary vasospasm provocation test is widely performed in daily clinical practice, data regarding the long term prognosis of variant angina is still limited.

Methods We retrospectively investigated clinical consequence of 1,736 patients who underwent elective diagnostic coronary angiography and vasospasm provocation test for the evaluation of chest pain from Sep 1994 to Dec 2006. Variant angina was defined by decrease of anterograde coronary flow less than TIMI 2, or new development of severe coronary stenosis (diameter stenosis > 90%) accompanied by typical angina pain and corresponding EKG change provoked by ergonovine intracoronary infusion, followed by nitroglycerin infusion and resolution of vasospasm. Patients who developed spontaneous spasm without provocation or underwent revascularization were excluded.

Results Provocation test was positive in 723 patients and negative in 1,013 patients. Median follow-up period was 1452 days (interquartile range: 711 − 2606), which was not different between two groups. 5-year all major adverse cardiac event (MACE)-free, death-free, and revascularization-free survival was significantly lower in positive provocation group compared to negative group (90.0% versus 95.4%, 92.9% versus 95.7%, 96.8% versus 99.6%, p<0.05 by log-rank test), and cardiac death-free survival was marginally lower in positive provocation group (96.9% versus 98.7%, p=0.051). Although positive provocation group showed higher incidence of smoking, diabetes, hypertension, and significantly fixed stenosis in major coronary arteries (frequency: 19.4% versus 8.2%), multivariate analysis using Cox proportional hazard model revealed that positive provocation test is still an independent predictor of MACE (p<0.001).

Conclusion Our result shows that positive provocation test might be associated with adverse outcome in chest pain patients. It suggests that long term medical care should be provided for patients with positive provocation test.
Abstract 2014: Additive Cilostazol to Dual Antiplatelet Therapy Achieves Greater Inhibition of Platelet Aggregation Compared With High Maintenance-Dose Clopidogrel in Patients With Acute Myocardial Infarction
Authors: Jeong Young-Hoon , Choi Bong-Ryong , Kim In-Suk , Kwak Choong Hwan , Hwang Jin-Yong , Lee Seung-Whan , Park Seong-Wook
Published: July 2021

Objectives
The aim of study was to compare platelet inhibition by additive cilostazol to dual antiplatelet therapy (triple antiplatelet therapy) and high maintenance-dose (MD) clopidogrel 150mg/d in patients with acute myocardial infarction (AMI).

Methods
AMI patients undergoing successful stenting (n =90) were randomly assigned to 1 of 3 MD regimens: Standard group, clopidogrel 75 mg/d; High MD group, clopidogrel 150 mg/d; Triple group, additive cilostazol 100 mg twice daily. Platelet functions were evaluated before discharge and 30 days after discharge. Percent inhibition (PI) and a rate of poor responder to clopidogrel were assessed, based on maximal and late platelet aggregation (Agg
max
and Agg
late
).

Results
Baseline platelet measures were similar in 3 groups. There was more potent and consistent PI by Triple group in all platelet measures. PI of 5 uM ADP-induced Agg
max
was 3.5% in Standard group, 22.6% in High MD group, and 44.1% in Triple group (p < 0.001). In addition, PI of 5 uM ADP-induced Agg
late
was 12.3%, 31.5%, and 65.0% in each group, respectively (p < 0.001). Similar results were demonstrated when 20 uM ADP and 6 ug/ml collagen were used. In terms of poor response to clopidogrel (5 and 20 uM ADP-induced Agg
max
> 50%), fewer patients in triple group (4.3% and 23.3%) met a criteria than those in standard group (23.3% and 73.3%) and high MD group (16.7% and 60.0%) at 30 days (p = 0.028 and < 0.001, respectively). All parameter between Triple and High MD groups were significantly different.

Conclusions
Triple antiplatelet therapy achieves greater platelet inhibition and lesser rate of poor response to clopidogrel compared with high MD clopidogrel in AMI patients.
Abstract 2026: Incidence, Predictors and Outcome of Upper Gastrointestinal Bleeding in Patients with Acute Coronary Syndromes
Authors: Shalev Aryeh , Fich Alexander , Gilutz Harel , Cafri Carlos , Novack Victor , Ilia Reuben , Zahger Doron
Published: July 2021

Purpose:
The broad utilization of revascularization and antithrombotic drugs has improved outcome of patients with acute coronary syndromes (ACS). Nevertheless, these strategies are associated with a substantial risk of bleeding, which is associated in turn with increased mortality. Most bleeding episodes are related to arterial punctures. The characteristics and outcome of patients who develop upper gastrointestinal bleeding (UGIB) in this setting have received little attention.

Methods:
Using computerized databases we identified all patients admitted to our center between 10/96 and 11/07 for an ACS who developed UGIB during their hospital stay. For each case 3 control cases matched for age, gender, and ACS subtype were randomly selected. Multiple baseline characteristics, as well as antithrombotic agents, revascularization strategy, endoscopy reports and 30-day mortality were recorded.

Results:
7240 ACS patients were admitted to our ICCU during the study period, of whom 64 (0.9%) developed UGIB. There were no significant differences between groups in the prevalence of diabetes and other risk factors, revascularization strategy, or the use of proton pump inhibitors or H2-blockers. Patients who bled suffered more from renal impairment and LV dysfunction and were more frequently treated with thienopyridines (89% vs. 68%, p=0.002) and GPIIb/IIIa receptor blockers (39% vs. 24%, p=0.03), but were treated equally with aspirin (100% vs. 96%, p=0.2). The combination of unfractionated heparin (UFH) with either GP IIb/IIIa receptor blockers or enoxaparin was also associated with UGIB (30% vs. 7%, p=0.001 and 36% vs. 18%, p=0.005, respectively). Patients who developed UGIB had a substantially higher 30-day mortality rate (33% vs. 6%, p<0.001). Among patients for whom endoscopy was available (35 patients of 64) the source of bleeding was similarly distributed between the esophagus, stomach and duodenum. Gastritis and duodenitis were the most common findings.

Conclusions:
UGIB in patients with ACS is associated with very high mortality. Patients who bled tended to have a greater degree of cardiac and renal dysfunction. The use of combined anti-platelet therapy, especially in conjunction with UFH is a strong risk factor for this serious complication.
Abstract 2049: Fluid Resuscitation with Na+/h+ Exchanger Inhibitor Improves Cardiovascular and Metabolic Function in a Pig Model of Uncontrolled Hemorrhagic Shock
Authors: Wu Dongmei , Dai Hui , Qi Jiansong , Abraham William
Published: July 2021

Uncontrolled hemorrhage remains a leading cause of traumatic death. The aim of this study was to evaluate the effects of Na+/H+ exchanger (NHE) inhibition on enhancing fluid resuscitation outcomes in traumatic hemorrhagic shock, and to investigate the mechanisms related to NHE inhibitor -induced protection and recovery from hemorrhagic shock. Tibia fractures with soft tissue injury were induced in 12 anesthetized instrumented male pigs. The animals underwent hemorrhage of 25ml/kg for 20min, followed by a 4mm abdominal aortic tear with surgical repair after 30minutes. Animals then underwent initial fluid resuscitation with either 15ml/kg Hextend (n=6) or 3mg/kg BIIB513 +15ml/kg Hextend (n=6). Resuscitation occurred over 40 minutes. A second resuscitation was given 4 hours later. Studies were terminated at 6 hours. All animals survived the entire experiment. In both groups
,
hemorrhage resulted in similar impaired myocardial performance, and severe hemodynamic and metabolic alterations. Compared to resuscitation with Hextend alone, the addition of BIIB513, improved the hemodynamic response to fluid resuscitation showing a 23% increase in mean blood pressure and a 31% increase in blood oxygen content, as well as preventing metabolic acidosis during early resuscitation. Echocardiography analysis showed that NHE-1 inhibition with BIIB513 attenuated the hemorrhage induced myocardial hypercontracture and resulted in a significant 77% increase in stroke index. NHE-1 inhibition also reduced plasma levels of myocardial troponin-I by 88%, attenuated myeloperoxidase activity in the liver by 46%, and improved organ function. Consistent with this was the finding that nuclear factor (NF)-κB phosphorylation, nuclear translocation, and NF-κB DNA binding activity in the liver was attenuated in Hextend + BIIB513 treated animals, compared to Hextend only treated animals. The present study shows that the response to fluid resuscitation after traumatic hemorrhage is improved by the addition of the NHE-1 inhibitor BIIB513. That BIIB513 treatment attenuates NF-κB activation and neutrophil infiltration suggests that this improvement may be related to the reduction in tissue inflammatory injury.

This research has received full or partial funding support from the American Heart Association, AHA National Center.
Abstract 2052: A Rapid Cooling of The Brain Using Percutaneous Cardiopulmonary Bypass Significantly Improves Neurological Function in Patients with Out-of-Hospital Cardiogenic Cardiac Arrest
Authors: Kano Hitoshi , Satou Tomoyuki , Yamazaki Kei , Saitou Tomoyo , Endou Akio , Shimojima Hidekazu , Takauji Shuuhei , Akita Masahide , Nakayama Hiroshi , Matsui Toshihisa , Okada Masaki , Makise Hiroshi , Nakagawa Yuuta , Makino Takao , Iwakiri Naoki , Fukuda Hiroyuki , Katou Noriyoshi , Togashi Masaki , Yoshida Tetsunori
Published: July 2021

Objectives:
Neurological recovery in patients (pts) with out-of-hospital cardiogenic cardiac arrest (OHCCA) is affected by the cerebral circulatory collapse time from the cardiac arrest to the return of spontaneous circulation. According to recent studies, the cerebral circulatory collapse time is estimated to be 30 min. or less in order to successfully recover neurologically. In addition, percutaneous cardiopulmonary bypass (PCPB) is a powerful tool for rescuing the pts with OHCCA refractory to advanced cardiovascular life support (ACLS), and we have been positively performing cardiopulmonary cerebral resuscitation and rapidly cooling of the brain using PCPB. In this treatment, the cerebral circulatory collapse time is the duration from cardiac arrest to the start of PCPB, we discovered the fact that there are many neurologically successful cases of recovery even though the cerebral circulatory collapse time has exceeded 30 min. In the present study, we investigated the neurological prognosis in relation to the cerebral circulatory collapse time.

Methods:
From January 2006 to April 2008, 77 consecutive pts with OHCCA, who have been treated with brain hypothermia at 34 degree C were included. 77 pts were divided into two groups. Brain hypothermia (BH) groups (n=34) were treated with only brain hypothermia after the return of spontaneous circulation, and PCPB groups (n=33) were treated with hypothermia using PCPB against refractory to ACLS. The relation between the cerebral circulatory collapse time and the neurological prognosis were assessed.

Results:
The cerebral circulatory collapse time were from 8 min. to 78 min. in the BH groups, whereas it lasted from 22 min. to 91 min. in PCPB groups. In BH groups, the cases with the favorite neurological outcome were 23 cases (67.6%) and the average collapse time was 19.2 min. (8 to 35 min.) In contrast, in the PCPB groups, the successful neurological cases were 15 cases (45.5%), the average collapse time was 43.6 min (22 to 60 min.) In the cases who received PCPB, there were cases of neurologically successful prognoses even though the cerebral circulatory collapse time was long.

Conclusions:
These results suggest that a rapid cooling of the brain using PCPB permits a cerebral circulatory collapse time.
Abstract 2054: Neuron-specific Enolase as a Prognostic Parameter in Patients Treated with Mild Hypothermia After Cardiopulmonary Resuscitation for Out-of-hospital Cardiac Arrest
Authors: Schneider R. , Stumpf C. , Yilmaz A. , Wasmeier G.H. , Schlundt C. , Garlichs C. , Daniel W.G. , Achenbach S.
Published: July 2021

Background: Overall prognosis in comatose survivors of Cardiopulmonary resuscitation is poor and the degree of hypoxic brain damage is usually the most important prognostic factor. Elevation of the neuron-specific enolase (NSE) as measured with 72 hours after admission has been identified as a predictor of neurologic outcome, and a threshold level of 33 ng/ml has been proposed as a highly specific cut-off value, above which neurologic outcome will be unfavourable. Therapeutic hypothermia is a new concept to improve neurologic outcome in patients after resuscitation, and the prognostic relevance of elevated NSE levels in patients treated by hypothermia has not yet been assessed.

Methods: Mild therapeutic hypothermia (33–34°C) was applied via an intravenous cooling catheter for 24 hours in 38 consecutive patients admitted after successful on-site resuscitation following out-of-hospital cardiac arrest (28 male, 10 female, age 38 – 83 years, mean age 64.4±12.7 years). 72 hours after admission, NSE level was measured. Clinical and neurologic outcome was assessed at 1 and 4 weeks.

Results: Out of 38 patients, 4 patients died within the first 72 hours. In 2 additional patients, NSE measurement was impossible because of haemolytic serum. NSE levels displayed a wide range (9.8 ng/ml − 720 ng/ml). Of the 32 patients available for analysis, 17 patients suffered severe ischemic brain damage or died during the further course (NSE 11.0 –720 ng/ml, mean 150.4±185.9 ng/ml). 15 patients recovered and had favourable neurologic outcome (NSE 9.8 – 47.9 ng/ml, mean 21.1±11.9 ng/ml). Using the recommended threshold value of 33 ng/ml, the sensitivity for ischemic brain damage was 76.5%, specificity was 80.0%, and the positive predictive value was 81.3%.

Conclusions: Based on prior experience in patients without therapeutic hypothermia, a cut-off level of 33 ng/ml has been recommended as a highly specific threshold above which neurologic outcome in patients resuscitated for out-of-hospital cardiac arrest will be poor. Our data demonstrate, however, that favourable outcome can be achieved even for higher NSE levels in patients who are treated with therapeutic hypothermia. Thus, the prognostic value of NSE in these patients must be reconsidered.
Abstract 2058: Expression of Brain MMP9 in a Rat Model of Cardiopulmonary Resuscitation Treated with SB-3CT
Authors: He Zhijie , Wang Tong , Huang Zitong , Zou Zijun , Chen Xiaotong
Published: July 2021

Over-expression of matrix metalloproteinase 9(MPP 9) in brain could degrade extracellular matrix, destroy the structure of microvascular basal membrane and vascular wall, take part in neural- inflammatory response in a rat model of cardiopulmonary resuscitation (CPR). SB-3CT is a antagonist of MPP 9. SB-3CT can inhibit over-expression of MPP 9 and reduce impairment of brain in a rat model of CPR. One hundred and twenty rats were randomly divided into 3 groups: the sham-operated group, the resuscitation control group and the resuscitation treatment group with SB-3CT. The rats were executed and the brains were taken out at 0h, 3h, 9h, 24h and 48h. The expression of MMP 9 in brain was detected. Water content and Evans blue content in brain tissue were observed. The expression of MMP 9 (Table 1

), water content and Evans blue content in the resuscitation control group was obviously higher than the sham-operated group at 0h, 3h, 9h, 24h and 48h. The expression of MMP 9, water content and Evans blue content in the resuscitation treatment group was similar to the resuscitation control group at different time, but the level was lower than the resuscitation control group(p<0.05). SB-3CT as a specific antagonist of MMP9, could decrease the expression of MMP9 and decrease cerebral edema in a rat model of CPR, and it may be a useful traetment method for cerebral ischemia/reperfusion injury after CPR.

Table 1

Expression of brain MMP 9 after resuscitation in a rat model of CPR
Abstract 2084: Measurement of Health Outcomes After Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Graft (CABG): Better Physical Features with PCI vs. Quality of Life with CABG
Authors: Seki Satomi , Motomura Noboru , Kinugawa Koichiro , Ono Minoru , Yao Atsushi , Kato Naoko , Ito Naomi , kazuma Keiko
Published: July 2021

Objectives:
There remains a controversy as to which is a better treatment for multi-vessel coronary artery disease (CAD): percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Although the mortality and morbidities in those patients have been frequently evaluated, only a few studies reported on their health outcomes. The purpose of this study is to measure and compare the health outcomes in these patients in the Japanese population by using a disease-specific scale.

Methods:
A total of 354 patients were recruited from a university hospital in Tokyo. A cross-sectional postal survey was conducted by mailing self-administered questionnaires that measured health outcomes, and 331 patients (93.5%) responded. The selected disease-specific scale was the Japanese version of the Seattle Angina Questionnaire (SAQ-J). The score of each domain in the SAQ-J was set between 0 and 100. The higher the score, the better the outcome. Analysis of variance was used to analyze the data.

Results:
Non-PCI and non-CABG responders and those with incomplete responses were eliminated from the study, and data from 131 patients (PCI = 55, CABG = 76) were analyzed. The mean ages for PCI and CABG were 67.9 ± 9.5 and 69.6 ± 9.7 (mean ± SD), and the number of males was 46 (83.6%) and 68 (89.5%), respectively. The average interval between the procedure and the survey was 6.5 ± 8.0 and 7.6 ± 7.4 years, respectively. The number of 3-vessel CAD patients in PCI and CABG groups were 20 (36.4%) and 58 (76.3%)(P < 0.001). In terms of health outcomes after PCI and CABG, the PCI group had a significantly better score than the CABG group under the physical limitation domain of the SAQ-J (79.2 ± 19.7 vs. 71.5 ± 22.0; P = 0.005). On the other hand, the CABG group had a significantly better score in the quality of life (QOL) domain (70.9 ± 23.0 vs. 79.4 ± 18.1; P = 0.025). There was no significant difference between PCI and CABG in terms of anginal stability, anginal frequency, and treatment satisfaction.

Conclusions:
This is the first study to compare the health outcomes with PCI and CABG by using a disease specific scale in Japanese patients. The patients with CABG had a better QOL outcome than those with PCI. On the other hand, they were more likely to have physical limitations than the PCI group.
Abstract 2086: Community-Dwelling African-American Beliefs Associated with Adherence to Antihypertensive Medications: A Matter of Life and Death
Authors: Lewis Lisa M
Published: July 2021

Medication adherence is low among hypertensive patients regardless of ethnic background. However, African-American prevalence is higher when compared to Caucasian-Americans.

Recognizing African-American perspectives about their adherence to antihypertensive medications is necessary for the development of successful interventions aimed at improving adherence to prescribed regimens. Thus, the purpose of this qualitative study was to explore community-dwelling hypertensive African-American beliefs regarding adherence to antihypertensive medications. A community and academic partnership was formed to conduct three focus groups with 40 participants at two community centers in a Northeastern urban city. Each focus group was recorded and transcribed verbatim. We analyzed the focus group data using thematic analysis. Participants had a mean age of 57 years, were mostly female (n=27), high school graduates (n=14), unemployed (n=27), and earned an annual income of $20, 000 or less (n=18). In addition, they had a mean hypertension diagnosis of 8 years with most participants reporting adherence to their antihypertensive medication regimens (n=26). Study participants described salient beliefs regarding their adherence to antihypertensive medications. Data analysis revealed an overarching theme of “it’s a matter of life and death” in which study participants were able to articulate the health benefits associated with adhering to their medications but also described the difficulties associated with adherence in relation to their social contexts. Participants identified three major difficulties associated with the remaining adherent to their antihypertensive medications. The difficulties included: (a) negotiating their limited resources, (b) negotiating their neighborhood violence, and (c) negotiating their feelings of mistrust of doctors. Although these results cannot be generalized, they do provide significant insight into the contextual factors associated with the lives of some community-dwelling hypertensive African-Americans. These findings are important because they can be used to tailor interventions to increase medication adherence in hypertensive African-Americans.
Abstract 2090: Health Related Quality of Life Outcomes of Therapeutic Life Style Modification Program for Women with Metabolic Syndrome
Authors: Oh Eui Geum , Kim Soo Hyun , Bang So Yeon , Hyun Sa Saeng , Jeon Yong Kwan , Im Jee Aee , Lee Mi Kyung , Lee Jung Eun , Chu Sang Hui
Published: July 2021

Background:
The metabolic syndrome (MetS), with associated increased CHD risk, is highly prevalent among postmenopausal women in Korea. Although therapeutic lifestyle modification (TLM) has been recommended as a cornerstone therapy, studies investigating the effects of TLM on health related quality of life (HRQOL) are limited.

Purpose
: This study was to evaluate HRQOL outcomes of a six-month TLM in Korean women with Mets.

Methods:
A randomized controlled design was used. Fifty four women (mean age of 63.2 y) with Mets were recruited from community health centers and randomly assigned to the intervention (N=31) or control (N=23) groups. The subjects in the intervention group participated in a supervised weekly TLM session for six months. The TLM program was consisted of health monitoring, education, aerobic exercise (40-min/session, 200 Kcal/day), and a low calorie diet with low carbohydrate (≈1300Kcal/d). Those in the control group received a booklet about MetS and were instructed to maintain their usual diet and activities. HRQOL was measured using the MOS SF-36 at before, during (month 3), completion (month 6), and after completion of the TLM program (month 12). Mixed-model repeated measures ANCOVA was used to evaluate HRQOL outcomes.

Results
: There were significant group by time interactions for general health (
P
= .043) and vitality (
P
= .012). Both general health (mean 23-point change) and vitality scores (mean 16-point change) greatly improved in the treatment group over 6 months of TLM, compared with control group. However, the improvement of the general health and vitality in the experimental group was not sustained at month 12. There were significant treatment main effects (all
P <
.05) for the remaining SF-36 subscale scores.

Conclusion
: A systematic TLM program may be effective strategy for improving HRQOL in postmenopausal women with MetS.
Abstract 2097: National Survey of Cardiologists’ Perceptions of Continuous ST-segment Monitoring
Authors: Sandau Kristin E , Sendelbach Sue , Frederickson Joel , Doran Karen
Published: July 2021

Continuous ST-segment (cST-seg) monitoring has been shown to help identify early and transient cardiac ischemia. American Heart Association and American Association of Critical Care Nurses recommend its use among specific patient populations. Investigators examined factors associated with cardiologists’ reported benefits, barriers, and perceptions of usefulness for cST-seg monitoring. A random sample (n=200) within a national pool of 4,985 cardiologists registered with the vendor Epocrates® was electronically surveyed. Cardiologists agreed/ strongly agreed that benefits of cST-seg monitoring included
early identification of potential ischemia
(83.5%), and
early identification of reocclusion after PCI
(74%)
or fibrinolytics
(72.5%). Cardiologists agreed/strongly agreed that barriers included
false positive alarm for ischemia
(61.5%);
lack of understanding of this technology by nursing staff
(56.5%);
extra phone calls based on inaccurate monitoring
(48%);
lack of understanding of this technology by other physicians
(47%); and
extra cost/ treatment due to false positive alarms
(43%). Cardiologists agreed/strongly agreed that cST-seg monitoring
identifies patients who need further tests
(69%) and
is clinically useful in detecting transient myocardial ischemia
(65%). The primary factor associated with higher benefits, clinical usefulness, and past use of cST-seg monitoring by cardiologists was whether or not their hospitals had a standard of practice for using cST-seg monitoring. The secondary factor was awareness of published consensus guidelines for cST-seg monitoring. Findings may indicate that when cardiologists are given the opportunity to work with a hospital that provides guidelines and experience in cST-seg monitoring, they may be more likely to appreciate its benefits and clinical utility. Clinical leaders should initiate multi-disciplinary efforts to review the level of evidence for possible incorporation of cST-seg monitoring into their hospitals’ standards of practice. Findings will help direct further research and interdisciplinary education in appropriate use of technology by critical care nurses and cardiologists.
Abstract 2125: P Wave Morphology Is a Predictor of Poor Cardiac Outcome and Death in MADIT II Patients
Authors: Holmqvist Fredrik , Platonov Pyotr G , McNitt Scott , Polonsky Slava , Carlson Jonas , Zareba Wojciech , Moss Arthur J
Published: July 2021

The objective of the present study was to non-invasively analyse atrial electrophysiology to identify markers associated with increased risk of mortality and deterioration of heart failure in a high-risk population with advanced CHF and a history of acute myocardial infarction. Patients included in MADIT II with sinus rhythm at baseline were studied (n=802). Unfiltered and bandpass filtered signal-averaged P waves were analyzed to determine orthogonal P wave morphology, P wave duration and RMS20. The association between P wave parameters and data on the clinical course and cardiac events during a mean follow-up of 20 months was analyzed. P wave duration was 139±23 ms and the RMS20 was 1.9±1.1 μV. None of these parameters were significantly associated with poor cardiac outcome. Differences in P wave morphology were independently predictive of non-sudden cardiac death (HR 2.66; 95% CI 1.41–5.04, P=0.0027). In addition, in univariate analyses differences in P wave morphology were found to be associated with an increased risk of all-cause mortality (HR 1.35; 95%CI 1.01–1.81, P=0.042) and cardiac death (HR 1.54; 95%CI 1.10 –2.16, P=0.011) (figure

) In the present study the value of analyzing the P wave morphology in patients with previous myocardial infarction and CHF is demonstrated. Changes in P wave morphology were shown to be independently predictive of increased risk of non-sudden cardiac death. Furthermore, statistically significant associations between P wave morphology changes and all-cause mortality, cardiac death and CHF hospitalization was demonstrated.
Abstract 2137: Relationship between Duration of Basal QRS Complex and Effectiveness of Antitachycardia Pacing in Implantable Cardioverter-Defibrillator Patients
Authors: Jimenez-Candil Javier , Moriñigo Jose , Olgado Maria Ruiz , Ledesma Claudio , Martín-Luengo Cándido
Published: July 2021

In re-entrant Monomorphic Ventricular Tachycardias (MVT), the ability of Antitachycardia Pacing (APT) to terminate the arrhythmia depends on the presence of an excitable gap (EG) and on the capability of the impulses to penetrate this EG. The main limiting factor for penetrating the EG is the distance and the obstacles between pacing site and circuit. Therefore, the duration of basal QRS complex (QRSd), as marker of left ventricle size, fibrosis and/or necrosis, could be related to the efficacy of ATP. Our aim is to determine the relationship between QRSd and the effectiveness of ATP in terminating MVT. In this prospective study we included 200 ICD patients with substrate for presenting MVT (LVEF: 31±11; pacing site: right ventricular apex). Detection and ATP therapies for MVT were programmed as follows: a) Fast-MVT : Cycle Length (CL): 250 –320 ms; 1 burst of 5 pulses at 84 % of CL, and: b) Slow MVT: CL > 320 ms; 3 bursts of 15 pulses at 91%. QRSd was determined on the surface ECG (50 mm/s) inmediatly before the device implant. During a follow-up of 602±368 days, 546 MVT (CL: 329±35 ms; fast MVT: 41 %; QRSd: 111±25 ms) were recorded in 64 patients. Overall success rate of APT was: 87%. MVT terminated with ATP were associated with QRSd values significantly lower: 109±24 vs. 121±29 (p<0.001). After classifying the events into 3 groups according to the QRSd tertiles (≤100, 101–119, ≥120 ms), the frequency of successful ATP (S-ATP) was higher in the first tertile: 96% vs. 80% (Odds Ratio: 5.8; 95% Confidence Interval: 2.9- 11.6; p<0.001). In a multivariate analysis which included LVEF, aetiology, indication, functional class, CL of MVT, beta-blocker therapy (mgs/day) and left ventricle end-diastolic diameter, QRSd (ms) remained as an independent predictor of S-ATP: Odds Ratio: 0.96 (95% Confidence Interval: 0.94 – 0.97; p<0.001). Patients with lower values of QRSd presented higher rates of S-ATP (mean±standard deviation): 98±4 (QRSd≤100) vs. 81±26 (QRSd: 101–120) vs. 72±40 (QRSd>120); p=0.01 (ANOVA). Among ICD patients, the duration of QRS complex is related to the effectiveness of ATP: for each ms of QRSd the adjusted probability of ATP terminating the episode decreases 4 points. Patients with QRSd≤100 ms have significantly higher rates of S-ATP.
Abstract 2143: Clinical Impact of the Hot-Bath Test in Patients with Brugada Syndrome
Authors: Mori Aiko , Kusano Kengo , Nagase Satoshi , Nakamura Kazufumi , Morita Hiroshi , Ohe Tohru
Published: July 2021

Background: Hot-bath related sudden death is sometimes observed and it is well known that fever aggravates ventricular arrhythmias in Brugada syndrome. Accordingly we examined the ECG changes during Hot-bath to identify high risk Brugada patients.

Methods: Total 31 Brugada patients [clinically documented ventricular fibrillation (VF) in 12] were examined. Waterproof Holter-ECGs (modified-NASA: the point at a maximum ST-elevation) during Hot-bath were recorded and compared with ECGs during sodium channel blocker (pilsicainide) administration. We also compared ECG changes with the clinical characteristics (SCN5A mutation, family history of sudden death and syncopal episode).

Results: Taking Hot-bath rose body temperature from 36.4±0.4°C to 38.1±1.8°C and increased ST-level significantly (0.17±0.15 to 0.31±0.25mV, P=0.0001). One patient developed VF (figure) during Hot-bath in whom ST-level was more elevated than that during pilsicainide administration. In accordance with ST-level change during Hot-bath and pilsicainide administration, we divided into two groups. Group 1 (n=11): ST-level was more elevated during Hot-bath than pilsicainide administration, and Group 2 (n=20): ST-level was less elevated during Hot-bath than pilsicainide administration. Family history of sudden death was more observed in Group1 (46%) than Group 2 (10%, P=0.02), but other parameters were not different between the groups.

Conclusion: Hot-bath aggravates ST-elevation in Brugada patients. Hot-Bath test would be useful to identify high risk Brugada patients.
Abstract 2148: Abnormal T Wave Alternans Could Provide Additional Risk Stratification in Patients with Prolonged QRS Duration
Authors: Mine Takanao , Kanemori Tetsuzou , Nakamura Hiroaki , Masuyama Tohru , Ohyanagi Mitsumasa
Published: July 2021

QT dispersion, signal averaged electrocardiogram (SAECG) and T wave alternans (TWA) have been found to be increased susceptibility to life-threatening arrhythmias or cardiac death

(LTA/CD). Patients with heart diseases often present prolonged QRS duration (p-QRSd), however the risk stratification in patients with p-QRSd still remains. We investigated whether QT dispersion, SAECG and TWA would provide additional risk stratification in patients with p-QRSd. We studied 52 patients (47 males, mean age 66±9 yrs) with QRS duration ≥ 120ms (34 RBBB type and 18 LBBB type) who had heart diseases (45 coronary artery disease and 7 dilated cardiomyopaty). QT dispersion was measured from standard 12-lead ECG. The filtered QRS duration (f-QRS) and root mean square voltage of the terminal 40ms of the QRS complex (RMS40) were obtained by SAECG. TWA was measured with the CH 2000. TWA was considered positive when the alternans with alternans voltage ≥ 1.9μV and alternance ratio ≥ 3 was sustained ≥ 1 minute in vector magnitude, X, Y, Z, V4 or two precordal leads at heart rate ≤ 110bpm. TWA was classified negative when the alternans wasn’t presented at heart rate ≤ 110bpm and considered indeterminate if the record didn’t meet either positively or negatively. Abnormal TWA was defined as positive or indeterminate. An abnormal TWA test was present in 56% (23 patients had negative TWA, 11 had indeterminate and 18 had positive). During the follow-up periods (69±41 months), 15 patients had life-threatening arrhythmias (n=12) and/or cardiac death (n=7). Univariate analysis revealed left ventricular ejection fraction (LVEF), RMS40 and abnormal TWA (n=29) as significant variables, however there was no significant difference in LTA/CD rate between BBB types, and no associations between QT dispersion and LTA/CD. On logistic regression analysis, only LVEF (p=0.02) and abnormal TWA (p=0.02, odds ratio 9.803 [95%CI 1.430 to 67.207]) were independently associated with LTA/CD. Abnormal T wave alternans could provide additional risk stratification in patients with prolonged QRS duration.