bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 1732: Three-dimensional Left Atrial And Oesophagus Reconstruction Using Cardiac C-arm Computed Tomography For Ablation Of Atrial Fibrillation: Preliminary Experience
Authors: Noelker Georg , Marschang Harald , Gutleben Klaus , Ritscher Guido , Schmidt Martin , Sinha Anil M , Rittger Harald , Marrouche Nassir F , Brachmann Johannes
Published: July 2021

Objectives: Threedimensional imaging has been widely adopted as a standard component of the AF ablation procedure. We tested the feasibility of the new 3D imaging system (DYNA-CT) using the C-arm to reconstruct the left atrium and the oesophagus and compared it to the established CT-scan imaging modality.

Methods and results: We included 14 consecutive patients (7 female, mean age 54 +/− 12) presenting for PVAI in the study. Prior to the ablation procedure (<24 hours) a 64 slice CT-scan was used to reconstruct the left atrium and oesophagus in all study patients. Immediately before performing the transseptal puncture a rotational angiography (RTA) was performed with a delay of 4.5 to 8.5 seconds after administration 84 ml of contrast media into the pulmonary artery via a standard 6F pigtail catheter with a flow rate of 15ml/s. The pigtail catheter was flushed immediately after contrast media (CM) administration in inspiration breath hold. In 12 patients 80 ml of barium based CM was administered orally immediately before RTA to contrast the ESO. The acquired CT and RTA left atrial and oesophagus reconstructed images were compared using the Leonardo software (Fig. 1

). Table 1

demonstrates results of comparison between CT and RTA data.

Conclusions: From our initial experience DYNA-CT seems to provide a feasible and reliable left atrial and oesophagus images to help mapping and navigation during the PVAI.

Table 1:

Anatomical structures demonstrated using the 2 imaging modalities
Abstract 1757: A 35-Year-Old Female with Anterior ST Segment Elevation and Cardiogenic Shock
Authors: Bonaca Marc , Morrow David , Ho Carolyn
Published: July 2021

A 35 year-old female with history of spontaneous pneumothorax presented with acute onset chest pain. She was hypotensive and tachycardic. Exam revealed tall stature, distended neck veins, and diffuse crackles. CXR showed pulmonary edema, no pneuomothorax and normal cardiac and mediastinal silhouettes. Electrocardiogram showed antero-lateral ST elevation. The patient was intubated and stabilized. Transthoracic echocardiogram showed anterior wall motion abnormality, no pericardial effusion, a normal aortic root with no obvious dissection or aortic insufficiency. CT angiogram of the chest showed no aortic dissection. As no dissection was identified she was taken for cardiac catheterization for acute MI. Angiography revealed a patent right coronary and an occluded left-main. The left-main was successfully treated with angioplasty and stenting. Subsequent TEE revealed an aortic intramural hematoma adjacent to the left-main ostium. Repeat CT angiography revealed non-flow limiting dissections of the left subclavian, the superficial mesenteric, and the left internal carotid arteries. Her body habitus and presentation suggested a malignant connective tissue disorder. Family history included maternal fatal aortic rupture at age 40 and sudden death of her maternal grandfather at age 45 of unknown etiology. In addition to Marfan Syndrome, her aortic dissection without aortic dilation suggested a possible TGF-B receptor mutation (Loeys-Dietz syndrome). Genetic testing revealed a novel Fibrillin-1 mutation at intron 40. The location at the splice acceptor site of the intron/exon boundary was likely to be pathogenic. Her daughter has tall stature and normal aortic root and is undergoing mutation confirmation testing. The phenotypic characteristics of patients with Marfan and related syndromes may vary and are associated with important morbidity and mortality. Basic science and clinical translational studies have advanced our understanding of disease pathogenesis and our approach to patient care. Genetic testing offers potential for definitive identification of family members at risk. Illumination of the role of TGF-beta signaling in the pathobiology of these syndromes has led to new possibilities in treatment and diagnosis.
Abstract 1758: 3 Acute Coronary Syndromes, 5 Stents and 8 Antithrombotics in 12 Days in a 59-Year-Old Woman
Authors: O’Donoghue Michelle , Maree Andrew O , Garasic Joseph M , Sabatine Marc S
Published: July 2021

A 59-year-old female with a history of hypertension and hyperlipidemia presented with a two day history of escalating chest pain. Her ECG revealed evolving T wave changes in leads V1–V3; troponin levels were undetectable. She was treated with aspirin 325mg and unfractionated heparin for unstable angina. Cardiac catheterization demonstrated high-grade stenoses in the proximal and mid left anterior descending artery. Two bare metal stents were deployed and she was given a 600mg loading dose of clopidogrel. She was discharged to home on hospital day 3 on a regimen that included aspirin 325mg and clopidogrel 75mg daily. Two days after discharge, the patient returned to the ED with substernal chest pain and anterior ST-segment elevations on ECG. Emergent coronary angiography demonstrated occlusive thrombus within the proximal stent. Intravascular ultrasound (IVUS) confirmed adequate stent deployment without edge dissection. Following thrombectomy, two additional bare metal stents were inserted and all stents post-dilated at high-pressure. She reported full medication compliance. She was empirically reloaded with 300mg of clopidogrel and her dose increased to 150mg daily. A hypercoagulability workup was negative. Two days after her second hospital discharge, the patient returned with chest pain and anterior ST-segment elevations on ECG. Emergent angiography confirmed recurrent stent thrombosis. Repeat IVUS showed that the stents were fully expanded and well apposed without evidence of mechanical complication. Following thrombectomy, an additional bare metal stent was inserted. She was empirically started on heparin and continued on clopidogrel 150mg daily. Following discontinuation of peri-procedural eptifibatide, platelet response to aspirin and clopidogrel were assessed with the VerifyNow™ (Accumetrics, San Diego, CA) assay. She demonstrated an appropriate response to aspirin but was found to have 0–3% platelet inhibition to clopidogrel on successive testing. Her clopidogrel was replaced with ticlopidine and coumadin. Repeat platelet testing demonstrated modest platelet inhibition (17%) with ticlopidine. Cilostazol was added as a third antiplatelet agent and her coumadin was discontinued. She has had no subsequent cardiac events.
Abstract 1768: Magnetic Resonance Imaging Reveals Novel Phenotypic Expression of Desmosomal Mutation in First-Degree Relatives of Patients with Arrhythmogenic Right Ventricular Dysplasia (ARVD). Prevalence and Clinical Significance in Patients Evaluated For ARVD.
Authors: Tandri Harikrishna , Dalal Darshan , Jain Aditya , Judge Daniel P , Abraham Theodore , James Cynthia , Daya Samanthapudi K , Tichnell Crystal , Russell Stuart , Calkins Hugh , Bluemke David A
Published: July 2021

Background: In this report we present the prevalence and significance of a novel MRI abnormality that we identified in desmosomal mutation positive asymptomatic relatives of arrhythmogenic right ventricular dysplasia (ARVD) patients.

Methods: MRI of 38 first-degree relatives was analyzed for abnormalities blinded to the mutation status. Focal crinkling of the right ventricle (accordion sign) was observed in 15/25 mutation positive vs. 0/13 mutation negative patients. The presence of this finding was sought in 207 patients evaluated for ARVD blinded to clinical history and was correlated with electrophysiologic findings.

Results: Mean age of the population was 32±16, 61% had a family history of ARVD. Based on non-invasive testing the 207 patients were classified into 4 groups 1) 106 normal, 2) 57 Idiopathic ventricular tachycardia (VT), 3) 33 probable ARVD, 4) 11 definite ARVD. A family history of ARVD was present in 74%, 0%, 67% and 36% respectively. 43 patients had the “accordion sign” and the prevalence in the four groups was 10%, 5%, 70% and 100% respectively. The abnormality was seen in the sub-tricuspid region in 62%, outflow tract in 30% in both regions in 8%. After excluding group 4, 48% of patients with the accordion sign had T wave inversion’s beyond V1 compared with 7% of those without the sign (p<0.001). During electrophysiologic testing, reentrant VT could be induced in 44% (7/16) of patients with accordion sign compared to 2% (1/48) without the sign (p<0.01).

Conclusion: Focal crinkling of the RV termed “Accordion sign” may represent an early manifestation of ARVD that correlates with mutation positive status and predicts inducibility of ventricular arrhythmias.
Abstract 1801: The Benefit of an Early Invasive Strategy in Women Versus Men with Non-ST-Elevation Acute Coronary Syndromes: A Collaborative Meta-Analysis of Randomized Trials
Authors: O’Donoghue Michelle , Sabatine Marc S , Boden William E , Braunwald Eugene , Cannon Christopher P , Clayton Tim C , de Winter Robbert J , Fox Keith A , Lagerqvist Bo , McCullough Peter A , Murphy Sabina A , Spacek Rudolf , Swahn Eva , Wallentin Lars , Windhausen Fons
Published: July 2021

Background:
Although an early invasive strategy (INV) is frequently used in patients with non-ST-elevation acute coronary syndromes (NSTEACS), some trials have shown this strategy to be associated with worse outcomes in women. We conducted a collaborative meta-analysis of randomized trials of INV vs. conservative strategy (CONS) stratified by gender and biomarker (CK-MB or troponin) elevation.

Methods
: The principal investigators for each trial provided data on the incidence of death (D), non-fatal MI (MI) and rehospitalization with ACS by gender & biomarker elevation through long-term follow-up. Odds ratios from each trial were combined using a random-effects model with weighting based on inverse variance.

Results:
Data were combined across 8 trials (3075 women, 7074 men). The OR for D/MI/ACS for INV vs. CONS was 0.83 in women (95% CI 0.68–1.01) and 0.75 in men (95% CI 0.58 – 0.98) with no significant heterogeneity between genders (P=0.54). In women, the benefit of INV tended to be greater in those with elevated biomarkers (OR 0.73, 0.58 – 0.92), compared with those without (OR 0.99, 0.67–1.47) (P interaction=0.19). In contrast, men benefited from INV irrespective of biomarker status (OR 0.78, 0.57–1.07 and OR 0.75, 0.58 – 0.98, P interaction=0.85). For patients in the INV arms, women were more frequently found to have no significant coronary artery disease (stenosis diameter <50%) at angiography than were men (27% vs 8%, P<0.001).

Conclusions:
In patients with NSTEACS, an INV strategy reduces the composite of death, MI or rehospitalization with ACS to a similar extent in both women and men. Elevated biomarkers of necrosis may help identify women who benefit most from an INV strategy.

Death, Non-fatal MI or Rehospitalization with ACS*
Abstract 293: Comprehensive Genetic Analysis of the Platelet Activating Factor Acetylhydrolase Gene and Cardiovascular Disease in Case/Control and Family Datasets
Authors: Sutton Beth S , Crosslin David R , Shah Svati H , Nelson Sarah C , Bassil Anthony C , Hale A B , Haynes Carol , Goldschmidt-Clermont Pascal J , Vance Jeffery M , Kraus William E , Gregory Simon G , Hauser Elizabeth R
Published: July 2021

Platelet Activating Factor Acetylhydrolase (PAFAH) is a potent pro- and anti-inflammatory molecule that has been implicated in multiple inflammatory disease processes, including cardiovascular disease. The goal of this study was to investigate the genetic effects of PAFAH in two large, independent coronary artery disease (CAD) datasets (CATHGEN and GENECARD) to better elucidate its genetic role in CAD. Using a haplotype tagging (ht) approach, 19 htSNPs were genotyped in CATHGEN case/control samples (cases = 807 and controls = 267) and in the GENECARD Family Study (n= 1,101 families, 2,954 individuals). Single SNP analysis using logistic regression was performed on all CATHGEN subjects, resulting in nine SNPs showing significant association in all CATHGEN subjects (P-values ranged 0.0004 – 0.02). CATHGEN cases were further stratified into subgroups based on age of CAD onset (AOO) and severity of disease; 600 young affecteds (YA, AOO<56) and 207 old affected (OA, AOO >56) to provide a consistent validation set for the early onset CAD GENECARD Family study. After stratification of subjects based on AOO, the OA subgroup remained the most associated, with 14 SNPs significantly associated (P-value ranged 0.0001– 0.02). Logistic regression analysis of the GENECARD probands resulted in similar association to that seen in the YA CATHGEN cases (P-values ranged 0.002– 0.05). Of the 19 SNPs genotyped, three SNPs (I198T, A379V, and R92H) were nonsynonymous coding changes. Interestingly, rs1051931 (A379V) and rs1805017 (R92H) constituted the most significantly associated SNPs, even after Bonferroni correction and appear to represent independent associations (r
2
= 0.09). Haplotype analysis was also performed on all 19 SNPs using a two-SNP sliding window approach, resulting in significant association in 161 of 171 haplotypic combinations. In summary, PAFAH represents an important, potentially functional candidate in the pathophysiology of CAD based on numerous associations using two independent data sets and multiple statistical approaches. Functional studies are warranted to evaluate the functional consequences of R92H and A379V polymorphisms.
Abstract 1843: Centrifugal Organization and Rate Step-Down: A Novel Method for Identification of Potential Drivers in Human Atrial Fibrillation
Authors: Krummen David E , Bullinga John R , Narayan Sanjiv M
Published: July 2021

Introduction:
Drivers have been shown in animal models of AF as regions where fibrillation rate and organization step-down to surrounding regions. However, sites of interest in human AF have typically been identified by high AF rate alone or by complex fractionated atrial electrograms (CFAE), which may explain the suboptimal ablation success at these sites.

Hypothesis:
We hypothesized that a potential driver of human AF should exhibit high rate and organization with ‘local control’, i.e. centrifugal step-down to neighboring sites.

Methods:
In 17 patients (age 63±9 y; 9 persistent) prior to AF ablation, we analyzed AF rate and organization
simultaneously
between 64 left atrial (LA) basket electrodes and electrodes in pulmonary veins (PV), coronary sinus (CS) and right atrium. At each electrode, we spectrally measured AF cycle length (CL) and organization (PAR), and visually quantified fractionation for 8.192 second AF epochs.

Results:
We analyzed 6687 electrode-epochs. Sites of rapid AF were ubiquitous, but met criteria for a single driver in only 7 patients. Unlike sites of rapid AF rate alone which were often mixed with sites of both high and low rate,
potential drivers
showed an organized and step-wise fall in rate and organization with distance from that site (p=0.005) in persistent and paroxysmal AF. In persistent AF, CL rose from 138±25 ms at driver sites (n=5) to 194±10 ms at neighbors (p<0.05) and organization fell in a parallel organized fashion with distance (p<0.05). Drivers lay at CS and LA roof but not PVs. In paroxysmal AF, 4 of 6 drivers lay near or within PVs. Notably, only one third of drivers were at or adjacent to regions showing fractionation (CFAE).

Conclusions:
Simultaneous multi-site analysis identified a potential AF driver with local control of AF rate and organization in 41% of patients, lying within or near PVs in paroxysmal but not persistent AF, and relating inconsistently to electrogram fractionation. Future work should identify multiple co-existing drivers, and determine if ablating such sites improves outcome.
Abstract 1847: Prognostic Impact Of Previous Percutaneous Coronary Interventions On Coronary Artery Bypass Graft Surgery: A Multicentric Analysis FromThe German Federal State North-Rhine-Westphalia
Authors: Massoudy Parwis , Thielmann Matthias , Lehmann Nils , Marr Anja , Kleikamp Georg , Maleszka Ariane , Zittermann Armin , Körfer Reiner , Radu Miriam , Krian Arno , Litmathe Jens , Gams Emmeran , Sezer Ömer , Scheld Hans , Schiller Wolfgang , Welz Armin , Dohmen Guido , Autschbach Rüdiger , Slottosch Ingo , Wahlers Thorsten , Neuhäuser Markus , Remagen Rhein Ahr Campus , Jöckel Karl-Heinz , Jakob Heinz
Published: July 2021

Background:

We have previously shown that multiple prior percutaneous coronary intervention (PCI) procedures adversely affect outcome after subsequent coronary artery bypass grafting (CABG). We were now interested to investigate this effect on a multicentric basis.

Methods:

Eight cardiac surgical centers from the German Federal State of North-Rhine-Westphalia provided outcome data of 37140 consecutive patients having undergone isolated first-time CABG between 01/2000 and 12/2005. Twenty-two patient characteristics and outcome variables, which are part of a collection of data claimed by the national medical quality-control commission, were retrieved from the individual databases. Three groups of patients were analyzed for overall in-hospital mortality and major adverse cardiac events (MACE): Patients without a previous PCI procedure, patients with 1 previous PCI procedure and patients with ≥2 previous PCI procedures before surgery. Unadjusted univariable and risk-adjusted multivariable logistic regression analysis were applied. Computed propensity-score matching was performed based on 15 patient major risk factors to correct for and minimize selection bias.

Results:

A total of 10.3% of patients had 1 previous PCI procedure, and 3.7% of patients had ≥2 previous PCI procedures. Risk-adjusted multivariable logistic regression analysis of ≥2 previous PCI significantly correlated with in-hospital mortality (odds ratio [OR], 2.0; confidence interval [CI], 1.4–3.0;
P
<0.0005) and MACE (OR, 1.5; CI, 1.2–1.9;
P
<0.0013). After propensity score matching, conditional logistic regression analysis confirmed the results of adjusted analysis. A history of ≥2 previous PCI procedures was significantly associated with in-hospital mortality (OR, 1.9; CI, 1.3–2.7;
P
=0.0016) and MACE (OR, 1.5; CI, 1.2–1.9;
P
=0.0019).

Conclusions:

This large multicentric trial supports earlier results of our single-center analysis, multiple previous PCI procedures significantly increased the event of in-hospital mortality and MACE after subsequent CABG.
Abstract 1855: Transmural Myocardial Repair with Engineered Heart Tissue Grafts
Authors: Biermann Daniel , Didié Michael , Karikkineth Bijoy Chandapillai , Lange Claudia , Eschenhagen Thomas , Zimmermann Wolfram H
Published: July 2021

Engineered Heart Tissue (EHT) can be utilized to partially repair infarcted myocardium in rats. Here, we investigated the feasibility of EHT-grafts as transmural wall replacement in a heterotopic transplantation model.

Methods:
EHTs (diameter: 15 mm, thickness: 1– 4 mm) were generated from 12.5 ×10
6
neonatal rat heart cells, collagen type I, and matrigel. Similarly, non-contractile constructs were generated from rat cardiac fibroblasts (FB) and mesenchymal stem cells (MSC). Grafts were surgically inserted into large transmural defects (diameter: 6 mm) in the left ventricle of explanted donor hearts. Subsequently, “treated” hearts were transplanted into weight-matched (308±12 g; n=14), immune suppressed (cyclosporine, azathioprine, prednisolone) Wistar rats in heterotopic position. All transmural defects were also covered with an aortic patch to prevent bleeding from the ventricles. Sham surgeries included aortic patch implantations only. Heterotopic hearts were harvested after 28 days and subjected to morphological analyses by confocal laser scanning microscopy (CLSM).

Results:
Heart transplant weight at the time of implantation was 1.1±0.02 g (n=14). Heterotopic heart weight increased substantially in Sham (2.4±0.3 g, n=3) and FB-graft (2.1±0.1 g, n=3) animals, whereas MSC- (1.7±0.2 g, n=4) and EHT-graft (1.3±0.1 g, n=4; p<0.05 vs. Sham) animals showed a smaller or no increase in weight, respectively. EHT grafts remained contractile throughout the observation period. CLSM revealed that EHT-grafts established oriented muscle bundles (actin and actinin staining) inside the transmural defects and were strongly vascularized (CD31 and smooth muscle actin staining; lectin labeling) leading to partial reconstitution of the myocardial continuity. This was not observed in animals with FB- and MSC-grafts. However, MSC-grafts, but not FB-grafts, contained newly formed vessels with a markedly larger diameter than observed in EHT-grafts (21±6 vs. 5±0.7 μm; p<0.05).

Conclusion:
EHTs can be utilized as myocardial tissue grafts to reconstruct and prevent pathological enlargement of the left ventricle. This study constitutes a first step to establish a novel transmural myocardial repair technology involving fully bioengineered heart muscle.
Abstract 1874: Circumferential and Radial Left Ventricular Mechanics in Elderly Canines with Hypertensive Heart Disease
Authors: Korinek Josef , Shapiro Brian P , Lam Carolyn S , Meyer Donna M , Redfield Margaret M
Published: July 2021

Introduction:
Cross-sectional studies in patient with hypertensive heart disease (HHD) and heart failure with normal ejection fraction (HFnlEF) suggested impairment of longitudinal myocardial mechanics as assessed by tissue Doppler imaging. It has been suggested that enhanced circumferential, and/or radial LV mechanics or LV remodeling compensates for depression in longitudinal function and thus, preserves EF in HHD or HFnlEF.

Hypothesis
: We hypothesized that if longitudinal performance is depressed, whether due to increased afterload or to intrinsic myocardial dysfunction, circumferential and radial LV mechanics would also be effected. To test this hypothesis, we used an aged canine model of hypertension.

Methods:
Elderly dogs (n=22) underwent bilateral renal wrapping to induce hypertension. 2D echocardiography (mid-short axis views) was performed before and 8 weeks after renal wrapping; peak radial (PR) and peak circumferential (PC) regional strains were measured by speckle tracking averaging data from 6 segments. Ejection fraction (EF), LV mass index (LVMI), systolic blood pressure (SBP), and circumferential wall stress (CWS) were assessed as well.

Results
: See table

. PR correlated with PC (r=0.65), EF (r=0.67), LWMI (r=0.71) and CWS (r=0.58) (p<0.005 for all). PC correlated also with EF (r=0.60), LWMI (r=0.49) and CWS (r=0.48) (p<0.01 for all). The relationship between EF and CWS (r
2
=0.64, p<0.001) was modified by the addition of either PC (r
2
=0.74, p for PC =0.005) or PR strain(r
2
=0.69, p for PR =0.04).

Conclusions
: These data show that development of hypertension with LV hypertrophy does not enhance but impairs circumferential and radial LV mechanics as assessed with strain imaging, and that like EF, circumferential and radial strain are related to afterload (wall stress). However, both confer additional information regarding contractility. Conclusions regarding myocardial function based on strain imaging must account for its load dependence.
Abstract 1878: Improved Detection of Viable Myocardium by a Novel Strain Doppler Measure in Patients with Acute Myocardial Infarction
Authors: Vartdal Trond , Pettersen Eirik , Helle-Valle Thomas , Lyseggen Erik , Smith Hans-Jørgen , Andersen Kai , Smiseth Otto A , Edvardsen Thor
Published: July 2021

BACKGROUND: Detection of viable myocardium is vital for treatment strategy during acute myocardial infarction (AMI). The aim was to study if strain Doppler echocardiography (SDE) prior to reperfusion therapy could predict viable myocardium in AMI as determined by cardiac magnetic resonance imaging (CMR).

METHODS: Twenty-five patients (58 ± 12 years, 7 women) with AMI who underwent percutaneous coronary intervention (PCI) were examined by SDE immediately prior to PCI. End-systolic longitudinal strain and duration of systolic lengthening was analyzed in 16 left ventricular segments. CMR was performed 11 ± 4 months after reperfusion therapy. Scars exceeding 50% of the segment was considered non-viable.

RESULTS: Duration of systolic lengthening in non-viable myocardial segments was 249 ± 135 ms compared to 39 ± 86 ms in viable segments (p<0.0001), with a direct relationship to scar transmurality (r=0.89, p<0.0001). A duration of systolic lengthening longer than 67.3% (~2/3) of systole (Figure

) detected non-viable myocardium by a sensitivity of 90% and a specificity of 93%. Strain demonstrated end-systolic shortening (−15 ± 6%) in viable segments in contrast to lengthening in non-viable segments (3 ± 4%, p<0.0001). End-systolic strain correlated also with the scar transmurality (r=0.71, p<0.0001).

CONCLUSION: SDE performed before reperfusion therapy in AMI can identify viable myocardium. Duration of systolic lengthening which is a novel parameter might prove to be a superior measure for predicting recovery of myocardial function.
Abstract 1895: ICD And CRT-D Therapy In The Elderly; High Rates Of Use And Little Data
Authors: Epstein Andrew , Kay G N , Plumb Vance , Shafiroff Jeff , Syed Zaffer A
Published: July 2021

Introduction:
in primary and secondary prevention (PP and SP)randomized controlled trials (RCTs) of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT-D)devices, the median age of enrolled patients (pts) was approximately 64 years(yrs). The purpose of this study is to describe: actual prescribing practice of ICD and CRT-D therapy in the elderly, given their under-representation in these studies.

Methods:
The ACT Registry is a prospective database that includes over 5,000 pts with an ICD or CRT-D implanted for standard indications. They are herein reported stratified by age ≥ 70 and ≥ 80 yrs old, indication (PP vs SP), device type, and then by device type for each indication.

Results
: Of 4,560 pts with age recorded, 41% (n= 1,867) of those undergoing initial implantation were ≥ 70 yrs, and 12% (n=546) were ≥ 80 yrs old. For those ≥ 70–79 yrs old (n=1,321), 82% had a PP indication. For those ≥ 80 yrs old (n=546), 79.5% had a PP indication. The distribution of’ CRT-D, dual chamber (DC) ICDs and single chamber (SC) ICDs was 33.1%, 40.7%, and 26.2% respectively for pts 70–79 yrs old. For pts ≥ 80 yrs old, a similar distribution was observed: 32.8%, 40.7% and 26.6%, respectively. For PP pts 70–79 yrs old (n=1,083), the distribution of CRT-D, DC, and SC devices was 37.5%, 37.2%, and 25.3%, respectively. For PP pts ≥ 80, yrs (n=434), the distribution of CRT-D, DC, and SC devices was 37.1%, 36.2%, and 26.7%, respectively. Among SP pts 70–79 (n=238), the distribution of CRT-D, DC and SC devices was 13%, 56.7%, and 30.3% respectively. Among SP pts ≥ 80 (n=112), the distribution of CRT-D, DC and SC devices was 16.1%, 58.0% and 25.9% respectively. For PP pts ≥ 80 yrs receiving a CRT-D, 36% had a QRS duration > 120 ms, 41% were NYHA Class III-IV, and 20.4% met both criteria.

Conclusions:

Although relatively few elderly pts were included in RCTs on which current practice is based, over 40% of new devices are implanted in pts ≥ 70, and over 10% in pts ≥ 80 yrs.

Despite a PP ICD indication in 80% of elderly pts, only ~ 25% receive SC devices.

Of elderly pts receiving a CRT-D, < 40% have a QRS duration or NYHA Class meeting usual accepted implant criteria.

These data indicate that study of device efficacy and selection in the elderly in needed.
Abstract 1932: Bleeding and Vascular Complications Following Percutaneous Coronary Intervention can be Reduced with Multiple Practice Changes
Authors: Robb John F , Sharma Arvind K , Malenka David J , Piper Winthrop D , Conley Sheila M , Freidman Bruce J , Hettleman Bruce D , Jayne John E , Niles Nathaniel W , Thompson Craig A , Kaplan Aaron V
Published: July 2021

Background
: Bleeding (BC) and vascular complications (VC) remain an important cause of post-PCI morbidity and mortality that are potentially avoidable. We implemented a series of practice changes to reduce the risk of BC and VC and hypothesized they would be significantly associated with a decreased risk of these adverse events.

Method
s: Data were prospectively collected on 5916 consecutive patient admissions comprising 6019 PCIs from 1/2002–9/2006 at the Dartmouth-Hitchcock Medical Center. During that time period practice changes included routine fluoroscopy-guided femoral puncture, routine femoral angiography, selective use of closure devices, increased use of bivalirudin, decreased use of IIb/IIIa inhibitors, use of a dedicated recovery unit. Logistic regression was used to examine the relationship between changing practices, BC, and VC, controlling for case-mix, with results reported as adjusted odds ratios (OR) with 95% confidence intervals.

Results:
Between 2002 and 2006 BC rates decreased from 5.95% to 4.42% (p=0.006) and VC rates from 0.47% to 0.09% (p=0.070). The risk of BC decreased significantly with the use of bivalirudin, femoral angiography, suture-mediated closure, and use of a recovery unit (Table

). VC decreased significantly with the use of closure devices.

Conclusions:
Procedural and process changes made in the care of patients undergoing PCI were significantly associated with decreasing the risk of BC and VC.

Adjusted * Odds Ratios for Bleeding and Vascular Complications: Treatment and Process Variables
Abstract 1936: Cornell Product Left Ventricular Hypertrophy In Electrocardiogram Is A Strong Predictor Of Stroke In Community-dwelling Japanese Normotensives
Authors: Ishikawa Joji , Ishikawa Shizukiyo , Kayaba Kazunori , Shimada Kazuyuki , Kario Kazuomi
Published: July 2021

Background
: Incidence of stroke is higher than ischemic heart disease in Japanese. Left ventricular hypertrophy (LVH) is associated with an increased risk for stroke among hypertensives. We evaluated the risk of LVH among normotensives (SBP/DBP<120/80 mmHg) subjects.

Methods:
In a Japanese general population, 10755 subjects who were undertaken electrocardiogram and measured BP at baseline were evaluated Cornell product (CP) and Sokolow-Lyon (SL) voltage as markers of LVH (CP≥2440 mm ms and SL voltage>35 mm). Follow-up was performed for 10 years and incidence of stroke was evaluated.

Results:
Prevalence of CP-LVH were 2.7% for normotensives, 5.2 % for prehypertensives, 11.0 % for hypertensives, and that of SL-LVH were 8.6%, 11.4%, and 22.5%, respectively. In overall subjects, CP-LVH and SL-LVH were independent predictors of stroke [CP-LVH: hazard risk (HR) 1.65, 95% confidence interval (CI) 1.22–2.25, SL-LVH: HR 1.30, 95%CI 1.02–1.65] after adjustment for confounding factors. In Cox regression analysis in each stage of hypertension, hazard ratios of stroke in subjects with CP-LVH were higher among normotensives (HR 8.28, 95%CI 3.72–18.41) than among prehypertensives (HR 1.56, 95%CI 0.67–3.63) and hypertensives (HR 1.48, 95%CI 1.02–2.13) (Figure

), although that in subjects with SL-LVH were not significant (normotensives: HR 1.54, 95%CI 0.70–3.40, prehypertensives: HR 1.29, 95%CI 0.72–2.32, hypertensives: HR 1.21, 95%CI 0.90–1.62).

Conclusion:
The ECG-LVH independently predicted future stroke in a Japanese general population. The specificity of the Cornell product-LVH is higher than that of Sokolow-Lyon-LVH especially among normotensive subjects <120/80 mmHg.
Abstract 1940: Coagulation Activity is Increased in the Left Atrium of Patients with Paroxysmal Atrial Fibrillation
Authors: Motoki Hirohiko , Tomita Takeshi , Aizawa Kazunori , Kasai Hiroki , Izawa Atsushi , Kumazaki Setsuo , Tsutsui Hiroshi , Koyama Jun , Ikeda Uichi
Published: July 2021

Background: Measurements of plasma markers which reflect thrombin activity (thrombin-antithrombin III complex; TAT), active fibrinolysis (plasmin-alpha 2-plasmin inhibitor complex; PIC), and platelet activity (platelet factor 4; PF4) are useful in identifying patients with various cardiovascular disorders at high risk of thromboembolism. In this study, we investigated the hemostatic status of the left atrium in patients with paroxysmal atrial fibrillation (pAF).

Methods: Patients with pAF (n=10) and chronic AF (cAF) (n=10), and control subjects without AF (n=10) were enrolled in this study. TAT, PIC, and PF4 levels were determined in specimens of blood obtained from the left atrium of AF patients who were undergoing catheter ablation. The blood specimens were also obtained from the left ventricle of control subjects.

Results: Levels of PIC and PF4 did not differ significantly among 3 groups, whereas TAT levels in the left atrium of pAF and cAF patients were significantly higher than those in the left ventricle of control subjects (pAF: 29±19ng/ml, cAF: 28±19ng/ml, control: 3.1±3.0ng/ml, p<0.01).

Conclusion: We demonstrated for the first time that coagulation system is activated in the left atrium of pAF patients as well as cAF patients. This result suggests that even in a non-paroxysmal period, pAF patients are at high risk of thromboembolism, and anticoagulation therapy is indicated in those patients.
Abstract 305: Tumor Necrosis Factor-α p75 Receptor, Satellite-Cell Survival, Activation and Muscle Regeneration
Authors: Goukassian David A , Tkebuchava Tengiz , Bord Evelyn , Silver Marcy , Curry Cynthia , Mehta Shanu , Gilbert Hui-ya , Sasi Sharath , Qin Gangjian , Kishore Raj , Losordo Douglas
Published: July 2021

Aging is a risk factor for ischemic diseases. TNF-α, a pro-inflammatory cytokine, is expressed in ischemic tissues and is known to modulate angiogenesis. Little is known about the role of TNF-α receptors (TNFR1/p55 and TNFR2/p75) in angiogenic signaling and muscle regeneration. We studied neovascularization in the hind limb ischemia (HLI) model in young and old TNFR2/p75 knockout (p75KO) and wild type (WT) age-matched controls. Between days 7–10 post-HL surgery 100% of old p75KOs experienced auto-amputation of the operated limbs, whereas none of the age-matched WT mice exhibited HL necrosis. Poor blood flow recovery in p75KOs was associated with decreased capillary density and significant reduction in the expression of VEGF mRNA transcripts in ischemic tissue. Compared to presurgery, on days 1–10 post-HL surgery there was 6–10-fold increase in the number of satellite-cells (embrionic NCAM staining) in WT mice, whereas in p75KOs after day 1 through day 10 satellite cells were not detecable. Indeed, p75KO tissue showed increased and prolonged (via day 10) inflammation - neutrophil (MPO-1) and macrophage (F/480) infiltration. Transplantation of WT/GFP (+) BM mononuclear cells into γ-irradiated p75KOs one month prior to HL surgery prevented limb loss, suggesting that ischemia-induced neovascularization and mobilization of BM-derived cells is mediated, at least in part, via TNFR2/p75 expressed in BM-derived cells. In the same BM transplantation model we evaluated the rate of proliferation (Ki67 + cells) of resident GFP (−) vs BM-derived GFP (+) cells. We found that in both WT and p75KO ischemic tissue Ki67 (+) cells almost exclusively were GFP (+), indicating that only BM-derived cells proliferate in the ischemic tissue. Interestingly, Ki67/GFP (+) cells started to appear in WT tissue by day 3 through day 21, whereas in p75KO tissue first proliferative activity was detected on day 28, suggesting extremely delayed recovery and regenaration in p75KO tissue. Our study suggests that, signaling through p75 receptor is required for collateral vessel development in ischemia-induced neovascularization as well as plays a critical role in muscle regeneration and suggest a potential gene target, which could be used to improve the repair of ischemic tissue in adults.
Abstract 1975: Detection Of Left Ventricular Thrombus With Cardiac Magnetic Resonance Imaging In Patients With Acute St-segment Elevation Myocardial Infarction (stemi)
Authors: Eitel Ingo , Schindler Kathrin , Friedenberger Josef , Fuernau Georg , Schuler Gerhard , Kivelitz Dietmar , Thiele Holger
Published: July 2021

Introduction
Previously published studies showed differences regarding the prevalence of intraventricular thrombi in patients with acute myocardial infarction (MI) (4–56%). Until now there are no exact results about the occurrence of left ventricular thrombi in acute STEMI. Recognition of LV thrombus is important because the related risk of systemic embolization is high.

Methods
To investigate the extent of myocardial infarction we examined 225 consecutive patients undergoing primary percutaneous coronar intervention (PCI) in acute STEMI within 12 h after symptom onset by cardiac magnetic resonance imaging within 2– 4 days. Routinely all patients were examined with transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE). All images were analyzed for the presence of intraventricular thrombi.

Results
In 18 patients (8.0%) we detected left ventricular thrombi, but none of these were seen in TTE or TEE. In two cases an intraventricular thrombus was detected by TEE and TTE, but in the subsequently performed MRI no thrombus was found. In all cases the left ventricular thrombi could be detected in the late enhancement sequence, 8 (44.4%) of them were missed in the cine SSFP sequences. Left ventricular thrombi were more frequently diagnosed in patients with moderate to severe impairment of the left ventricular systolic function (13/18 [72,2%]). Remarkable was also that 14 (77.8%) of the 18 patients with left ventricular thrombus in MRI had an anterior MI, whereas only 2 (11.1%) had an inferior MI, 1 (5,6%) a septal MI and 1 patient (5,6%) a lateral MI.

Conclusion
In our study TEE and TTE missed left ventricular thrombi in all 18 patients as compared to MRI. There were two false-positive results in TEE and TTE as compared to MRI. Patients with impaired left ventricular function and acute anterior MI have a higher risk of developing left ventricular thrombi than in other infarct-locations. Therefore it could be potentially important to screen in particular high-risk patients (with anterior MI and impaired left ventricular function) with cardiac magnetic resonance imaging to exclude left ventricular thrombi and to lower the risk of embolic events. In particular late enhancement sequences are suitable to detect intraventricular thrombi.
Abstract 1982: In Vivo Virtual Histology Intravascular Ultrasound Correlates of Risk Factors for Sudden Coronary Death in Men: Results from the Prospective, Global, Multi-center VH-IVUS Registry
Authors: Missel Eduardo , Mintz Gary S , Carlier Stephane G , Qian Jie , Shan Shoujie , Castellanos Celia , Kaple Ryan K , Dangas George , Mehran Roxana , Moses Jeffrey W , Stone Gregg W , Leon Martin B
Published: July 2021

Background:
Histopathological data shows that cigarette smoking and a total-cholesterol-to-high-density-lipoprotein ratio (TC/HDL) >5 are associated to sudden coronary death (SCD) in men. We hypothesized a relationship between virtual histology intravascular ultrasound (VH-IVUS) findings and these risk factors.

Methods and Results:
We performed whole pullback VH-IVUS analyses in a consecutive series of 473 male pts and measured the four basic VH-IVUS coronary plaque components - fibrous (FI), fibro-fatty (FF), dense calcium (DC) and necrotic core (NC) - as well as calculated a NC/DC ratio. Pts age was 61±11years, with 27% current smokers and 69% with a lipid disorder. Among VH-IVUS parameters, the NC/DC ratio was the only parameter related both to the TC/HDL ratio (r=0.18, p=0.0008) and LDL-C levels (r=0.17, p=0.002); it had a negative correlation with HDL-C levels (r=0.11, p=0.03), and was significantly higher for smokers [median: 1.98 (1.35, 3.18)] vs. non-smokers [median: 1.70 (1.23, 2.53), p=0.006]. A NC/DC value >3 was the threshold that best identified smokers with a TC/HDL>5 (odds ratio 3.0, p=0.0001). ROC curves showed superiority of the NC/DC ratio (A
2
: 0.64, p<0.0001) over %DC (A
2
: 0.58, p=0.006) or %NC (A
2
: 0.51, p=0.43) as isolate parameters to identify pts with a risk profile for SCD (Figure

).

Conclusions:
In diseased coronary segments the ratio of necrotic core to calcification detected by VH-IVUS is related to previously-published pathologic risk factors for SCD.
Abstract 1984: Histopathologic Validation of Virtual Histology Intravascular Ultrasound Analysis of Peri-calcific Necrotic Core Area
Authors: Kim Sang-Wook , Mintz Gary S , Lee Wang-Soo , Kim Hyoung-Joong , Lee Tae-Jin , Hong Young-Joon , Lee Sung-Yun , Lee Seong-Woo , Woo Hye-Jong , Lee Kwang-Je , Kim Tae-Ho , Kim Chee-Jeong , Weissman Neil J , Ryu Wang-Seong
Published: July 2021

The effect of calcium-associated acoustic shadowing on Virtual Histology intravascular ultrasound (VH-IVUS) plaque component analysis is unknown.

Methods.
We harvested 87 coronary arteries from 30 autopsied specimens. IVUS imaging was performed 50mm from the LMCA ostium. We then selected 10 calcified segments for comparative VH-IVUS vs pathologic comparisons.

Results.
Pt age was 46±8.9yrs and 90% were males. VH-IVUS analysis of the calcified plaque showed 11±3.8% necrotic core, 8±1.9% fibrofatty plaque, 69±9.9% fibrotic plaque, and 10±6.6% dense calcium. Dense calcium was correlated with the size of the necrotic core (r=0.774, p=0.009). Three coronary arteries with moderate to severe calcium were examined histopathologically. VH-IVUS analysis showed fibrotic tissue behind the calcium, but histopathology showed an acellular sclerotic area (dense collagenous tissue) just beneath the calcium with a relatively well-preserved vascular smooth muscle layer. Within the necrotic core, VH-IVUS showed prominent red necrotic core area combined with calcium; however, histopathology showed empty space of decalcification surrounded by just collagenous tissue with outer smooth muscle actin positive cell layer. More importantly, no active inflammation was present around calcium.

Conclusion.
VH-IVUS necrotic core surrounding areas of dense calcium correlated with dense collagenous tissue histopathologically. It is important not to overinterpret VH IVUS studies of dense calcium with prominent necrotic core. More precise classification/validation for necrotic core is necessary.
Abstract 2002: Dual Mechanism of Blood Flow Augmentation to the Brain using an Impedance Threshold Device in a Pediatric Model of Cardiac Arrest
Authors: Alexander Carly , Yannopoulos Demetris , Aufderheide Tom , McKnite Scott , Matsuura Tim , Metzger Anja , Lurie Keith
Published: July 2021

Background: During cardiac arrest use of an impedance threshold device (ITD) increases circulation and the chances for survival. The ITD has not been systematically evaluated during conventional CPR in a pediatric animal model. We hypothesized that the ITD increases blood flow to the brain by lowering intrathoracic pressure during the CPR decompression phase thus

enhancing venous return to the right heart and forward flow with the subsequent compression and

maintaining or lowering diastolic intracranial pressure (ICP) thus reducing resistance to forward flow. In this manner ITD use was hypothesized to mimic the ‘gasping reflex’ during CPR.

Methods: In the first study 9 female propofol anesthetized piglets (10–12 kg) were subjected to 6 min of untreated ventricular fibrillation, 6 min of conventional CPR (ventilation rate 10 bpm), then 6 min of CPR with an active ITD (resistance of −10 cm H20). A second study was similar except that a sham ITD was used in 8 piglets.

Results: After 2 min of active ITD treatment, decompression phase airway pressures (surrogate for intrathoracic pressure) (mmHg) decreased from −0.5 ± 0.2 to −2.6 ± 0.5 (mean ± SEM, p < 0.001) and common carotid blood flow (mL/min) increased by 65% (59.2 ± 16.7 to 91.1± 27.9, p = 0.02). In the sham group, airway pressures were unchanged and carotid blood flow decreased from 39 ± 2.5 to 38.8 ± 4.3 (p = 0.47). ICP decreased more rapidly in time and to a greater degree in 6/9 piglets when comparing ITD use to measurements preceding its application, contributing to an increase in cerebral perfusion (CePP) (mmHg) in 5/9 active ITD piglets, while in the sham group, CePPs remained the same or decreased in 8/8 piglets (p = 0.03). Coronary perfusion pressures (CPP) (mmHg) increased in 5/9 piglets after 2 min of the active ITD and remained the same or decreased in 8/8 piglets treated with the sham device (p = 0.03). Return of spontaneous circulation was achieved with a single shock in 4/9 active ITD piglets and 1/8 sham ITD piglets (p = 0.29).

Conclusions: Use of an active ITD during CPR in piglets significantly increased carotid blood flow and CPPs. The ITD also lowered ICP during the decompression phase, similar to the mechanism of the ‘last gasp’, thereby reducing resistance to forward blood flow to the brain.
Abstract 2026: Atrial Fibrillation Predicts Ventricular Arrhythmogenicity In Heart Failure
Authors: Lemola Kristina , Khan Razi , Nattel Stanley , Lemola Sakari , Guerra Peter G , Macle Laurent , Dubuc Marc , Talajic Mario , Popescu Elena , Mansour Fadi , Dumont Frederic , Katsouras Grigorios , Thibault Bernard , Gagne Pierre , Roy Denis , Khairy Paul
Published: July 2021

Background:
Atrial fibrillation (AF) is associated with appropriate ICD discharges in patients with primary prevention indications. We explored potential effect modifiers impacting on ventricular arrhythmogenic risk associated with AF.

Methods and Results:
A retrospective cohort study was conducted on 215 consecutive patients with ICDs for primary prevention having a left ventricular ejection fraction (LVEF) < <26>35% and followed for 1.3±0.7 years. Mean age was 61.0±0.7 years and 17% were women. Cox regression models were explored in subgroups of patients stratified by demographic parameters, prior medical and surgical history, physical exam features, laboratory findings, and results of diagnostic tests. Appropriate ICD discharges were received by 10% of patients. AF was associated with a 3.5 fold increased risk [95% CI (1,5, 8.1), P=0.005]. Effect modifiers for the relationship between AF and appropriate ICD discharges included QRS duration and QTc. In patients with a QRS>130 msec (N=93), 6 of 33 (18%) patients with AF received appropriate ICD discharges versus 2 of 60 (3%) without AF (P=0.03). In this subgroup, AF was associated with a hazard ratio of 5.1 (P=0.049). Among individuals with a QTc >440 msec (N=93), 6 of 32 (19%) AF patients received appropriate ICD discharges versus 1 of 61 (2%) without AF (P=0.01). AF was associated with a hazard ratio of 10.3 (P=0.031). Five of 28 patients (18%) with both prolonged QRS and QTc duration (N=77) that also having AF received appropriate ICD discharges compared to 0 of 49 of patients without AF (P=0.005). After adjusting for medical therapy, AF independently predicted appropriate ICD discharges in subgroups with and without QRS and QTc increase.

Conclusion:
AF portends increased risk for ventricular tachyarrhythmias in patients with heart failure, particularly when associated with conduction and/or repolarization abnormalities. This finding may reflect common depolarization and repolarization defects associated with the arrhythmic milieu contributing to AF and ventricular arrhythmias, or adverse consequences of AF on the complex neurohumoral/electrophysiological substrate underlying ventricular arrhythmogenesis in heart failure.