bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 8886: Seasonal Variation of Atrial Fibrillation Hospitalizations
Authors: Deshmukh Abhishek , Kumar Gagan , Pant Sadip , Badheka Apurva , Dabhadkar Kaustubh , Tuliani Tushar , Shenoy Maithili , Paydak Hakan , Mehta Jawahar L
Published: April 2024

Introduction:
Atrial Fibrillation (AF) hospitalization has emerged as an important clinical end point to assess outcomes of AF. There has been an interest in seasonal variation of cardiovascular hospitalizations.We assessed seasonal variation in hospitalizations for AF from a large national hospitalization database in the past decade.

Methods:
The Nationwide Inpatient Sample database was used to estimate the annual number of hospitalizations with AF from 2000-2008.Identification of AF related hospitalizations was based on the designation of the International Classification of Diseases (9th Edition) Clinical Modification (ICD-9-CM) diagnosis code 427.31 (AF) as the principal discharge diagnosis. The frequency of hospitalization for each month cumulative over 8 years was calculated and divided by number of days in that month to obtain the mean hospitalizations per day for each month. All calculations were carried out using the weighted estimates approximating nationwide population estimates

Results:
An estimated 2909423 hospitalizations with primary diagnosis of AF occurred in the United States from the beginning of the calendar year 2000 to the end of the calendar year 2008. The number of hospitalizations per day in each month is shown in Figure 1.The number of hospitalization was maximum in the winter months and minimum in summer months. Specifically, the mean number of hospitalization each day (averaged over 8 years) was least in July (7532). There was a rising trend from July to February. The average number of hospitalization was highest in February (8260); thereafter, the hospitalization rate dropped to a nadir in July.

Conclusion:
We identified for the first time in United States an impressive pattern of seasonal variation in hospitalizations for AF.Further efforts must be made to identify triggers and methods to prevent AF hospitalizations and reduce its burden on health care system.
Abstract 8894: Comparison of More Than 3 Years Clinical Outcomes Between Drug-eluting Stent and Bypass Surgery for Unprotected Left Main Coronary Artery Disease: A Meta Analysis of Randomised and Risk Adjusted Studies
Authors: Wang Dongxue , Zhou Chenghui , Liu Hong , Xie Shuang , Liu Yuqing , Li Yishi
Published: April 2024

Backgrounds:
Previous data from meta analysis have reported controversial the short and midterm clinical outcomes between drug-eluting stent (DES) and coronary bypass surgery graft (CABG) for paitents with unprotected left main coronary artery disease (ULMCD). However, the long-term outcomes remain unknown.

Methods:
A systemic research was carried out in Pubmed, Embase, Cochrane library and scientific sessions of AHA, ACC and ESC (up to April 2012). All randomised and nonrandomised studies after >=3 years of follow-up comparing DES and CABG in ULMCD were included. In order to control the potential confoundings in observational studies, risk adjusted hazard ratio (HR) or odds ratio (OR) by propensity score matching or Cox regresson method was abstracted.

Results:
10 eligible studies (2 randomised, 8 nonrandomised) wth 6782 subjects were identified and selected. Mortality, death/MI/stroke and target vessel revascularizaton(TVR) were focused. Pooled analysis revealed that there was no statistical significant difference between DES and CABG in mortality (OR=0.92, 95% confidential interval [CI]: 0.65 to 1.31, P=0.646, heterogeniety test: 0.0%; Fig 1) and death/MI/stroke (OR=1.03, 95% CI: 0.75 to 1.42, P=0.841, heterogeniety test: 0.0%).However, compared with CABG, DES had a significant increased incidence of TVR(OR=3.45, 95% CI: 2.38 to 4.99, P<0.00001, heterogeniety test: 0.0%). No evidence of significant publication bias was observed in mortality (Begg’s test, P=0.245; Egger’s test, P=0.518). Sensitivity analysis of mortality excluding each included study at one time revealed that most individual study was consisted with the direction and size of the overall effect ( all P>0.1).

Conclusions:
Based on the available evidence, after long-term follow up, the mortality and composite outcome are similar between DES and CABG in patients with ULMCD, however, incidence of TVR is still high in DES comparing with CABG.
Abstract 8895: Clinical Outcomes of Mutation Carriers in Pulmonary Arterial Hypertension in Children
Authors: Chida Ayako , Shintani Masaki , Yagi Hisato , Fujiwara Maya , Kojima Yasuko , Sato Hiroki , Imamura Shinichiro , Nakayama Tomotaka , Ishiwata Takahiro , Furutani Yoshiyuki , Inai Kei , Saji Tsutomu , Matsuoka Rumiko , Nonoyama Shigeaki , Nakanishi Toshio
Published: April 2024

Background:
In heritable pulmonary arterial hypertension (HPAH) and idiopathic pulmonary arterial hypertension (IPAH), mutations have previously been described in genes for the bone morphogenetic protein receptor type 2 (
BMPR2
) and the activin receptor-like kinase 1 (
ALK1
). It is, however, not known, especially in childhood, how these mutations relate to the clinical characteristics.

Methods:
Sixty four childhood patients whose onset of IPAH/HPAH was under 16 years old were selected. Mutations were monitored by direct sequencing and multiplex ligation-dependent probe amplification in
BMPR2, ALK1, endoglin, SMAD1, SMAD2, SMAD3, SMAD4, SMAD5, SMAD6, SMAD7, SMAD8
,
BMPR1A
and
BMPR1B
genes. One
SMAD8
mutation carrier and 2
BMPR1B
mutation carriers were excluded from the present analysis because of minority of cases. Functional characteristics, hemodynamic parameters, and clinical outcomes were compared among
BMPR2
mutation group,
ALK1
mutation group, and noncarrier group.

Results:
Among these 61 childhood IPAH/HPAH patients, 18 had
BMPR2
mutation and 7 had
ALK1
mutation. At the time of diagnosis, age, WHO functional class, mean pulmonary artery pressure, pulmonary resistance, serum brain natriuretic peptide level, and 6-minute walking distance were similar among 3 groups. Medications including bosentan and sildenafil were also similar among 3 groups. Among 61 patients, 5-year and 10-year survival were 77% and 74%, respectively. Despite targeted therapy, 5-year survival in the
BMPR2
mutation group (55%) was lowest among these 3 groups. The 5-year survival in the
ALK1
mutation group (64%) tended to be lower than that in the noncarrier group (91%). Intravenous epoprostenol therapy strongly ameliorated the WHO functional class in all groups. Especially in the
ALK1
mutation group, pulmonary vasodilator therapies were not effective except for intravenous epoprostenol.

Conclusions:
Prognosis of IPAH/HPAH in children with
BMPR2
and
ALK1
mutation is poor. Aggressive treatment including intravenous epoprostenol may be warranted in those children.
Abstract 8930: Acute and Long-term Outcome of the Magnetic Navigation System for Ablation of Arrhythmias in a Large Series of Patients
Authors: Akca Ferdi , Bauernfeind Tamas , Schwagten Bruno , De Groot Natasja M , Jordaens Luc , Szili-Torok Tamas
Published: April 2024

Objective:
Evaluate safety and efficacy of Magnetic Navigation System (MNS) in a large series of patients during long-term follow up. Background: MNS has the potential for improving safety and efficacy based on atraumatic catheter design and superior navigation capabilities.

Methods:
In this prospective registry, 1.266 consecutive patients underwent ablation. Patients were divided into two age- and sex-matched groups. Ablations were performed either using MNS (group MNS, 457) or conventional manual ablation (group MAN, 809). Following parameters were analyzed: acute success rate, fluoroscopy time, procedure time, complications (major: pericardial tamponade, permanent atrioventricular (AV) block, stroke, pulmonary embolism, major bleeding, death; minor: minor bleeding, temporary AV block). Recurrence rate was assessed during an average follow up of 24±14 months. Subgroup analysis was performed for the following groups: isthmus dependent and atypical atrial flutter, atrial tachycardia, AV nodal re-entrant tachycardia, circus movement tachycardia, atrial fibrillation and ventricular tachycardia (VT).

Results:
MNS was equally effective as MAN in acute success rate for overall groups (91,5% vs. 91,5%, p=ns). MNS was more successful for VTs (85,5% vs. 67,1%, p=0.006) and AVRT (96,3% vs. 88,4%, p=0.05). In the MNS group less fluoroscopy was used for AVNRT (12±7 vs. 27±19, p<0.001) and VT (26±19 vs. 48±29, p<0.001), however, longer fluoroscopy times were registered for AF (58±19 vs. 47±25, p<0.001). Procedure times for the overall group were longer in the MNS group (191±92 vs. 173±77 min, p=0.003). During follow up no differences in recurrence were observed between MNS and MAN for the overall population and the subgroups. MNS was associated with less major complications (1,1% vs. 3,7%, p=0.004). The total numbers of complications were lower in group MNS (5,0% vs. 9,8%, p=0.002).

Conclusions:
Our data suggest that the use of MNS improves safety without compromising efficiency of ablations. MNS is more effective than manual ablation for VTs and AVRTs.
Abstract 8952: ST-Segment Depression in Lead aVR Predicts In-Hospital Adverse Outcomes in Patients With Inferior Wall Acute Myocardial Infarction
Authors: Kosuge Masami , Ebina Toshiaki , Hibi Kiyoshi , Iwahashi Noriaki , Tsukahara Kengo , Maejima Nobuhiko , Endo Mitsuaki , Morita Satoshi , Umemura Satoshi , Kimura Kazuo
Published: April 2024

Introduction:
During inferior wall acute myocardial infarction (IWMI), lead aVR is frequently ignored. However, ST-segment depression in lead aVR (ST↓aVR) during IWMI might represent a reciprocal change in response to an opposite vector resulting from ST-segment elevation in the apical region, suggesting a larger area at risk.

Hypothesis:
We assessed the hypothesis that ST↓aVR can provide important prognostic information in patients with reperfused IWMI.

Methods:
We studied 268 patients with a first IWMI who had TIMI 3 flow of the right coronary artery or left circumflex coronary artery after fibrinolysis or primary percutaneous coronary intervention within 6 h after symptom onset. Patients were divided into the 3 groups according to the degree of ST↓aVR on admission ECG: G-A, 122 patients with no ST↓aVR; G-B, 95 patients with ST↓aVR ≤1.0 mm; and G-C, 51 patients with ST↓aVR >1.0 mm. The perfusion territory of the culprit artery was assessed on the basis of the angiographic distribution score. Impaired myocardial reperfusion was defined as myocardial blush grade 0/1 on the final angiogram.

Results:
There were no differences in age, coronary risk factors, time to admission, reperfusion therapy, culprit artery, or final TIMI flow grade among the 3 groups. In G-A, G-B, and G-C, the sum of ST-segment elevation in leads II, III, aVF and V5-6 on admission ECG was 4±4, 9±5, and 17±7 mm (p<0.01); the angiographic distribution score was 0.5±0.2, 0.6±0.2, and 0.7±0.1 (p<0.01); peak creatine kinase level was 2225±1515, 3150±1792, and 4911±2238 mU/ml (p<0.01); and the frequencies of impaired myocardial reperfusion was 4%, 18%, and 71% (p<0.01); the combined outcome of in-hospital death, reinfarction, or congestive heart failure was 2%, 7%, and 14% (p<0.01), respectively. Multivariate analysis showed that as compared with no ST↓aVR, the odds ratios (95% CI) for in-hospital adverse events associated with ST↓aVR ≤1.0 mm and ST↓aVR >1.0 mm were 1.49 (0.64-3.39; p=0.15) and 2.01 (1.18-4.51; p<0.05), respectively.

Conclusions:
In patients with reperfused IWMI, greater ST↓aVR on admission ECG is associated with a larger area at risk, impaired myocardial reperfusion, and a larger infarct size. ST↓aVR >1.0 mm is an independent predictor of in-hospital adverse outcomes.
Abstract 9035: Epigenetic Modifications are Associated with Ascending Thoracic Aneurysm Formation in Patients with Bicuspid Aortic Valve
Authors: Shah Asad A , Feng Sheng , Krupp Deidre , Haynes Carol , Grass Elizabeth , Lin Shu S , Hauser Elizabeth R , Kraus William E , Gregory Simon G , Shah Svati H , Hughes G. Chad
Published: April 2024

Objective:
Bicuspid aortic valve (BAV) disease predisposes to early and more frequent ascending thoracic aortic aneurysm formation, but the mechanisms underlying this aortopathy remain incompletely characterized. The objective of this study was to identify genes predisposing to ascending aneurysm formation in patients with BAV aortopathy using a multipronged molecular approach.

Methods:
Ascending aortic aneurysm tissue samples were collected at the time of ascending aortic replacement in subjects with bicuspid (N=16) and trileaflet (N=16) aortic valves. All patients in the trileaflet valve group had degenerative aneurysms and those with connective tissue disorders were excluded. Using the aortic tissue samples, genome-wide DNA methylation status was determined using Illumina 450K methylation chips. Gene expression was determined using Illumina Whole-Genome DASL arrays. Gene methylation and expression were compared between bicuspid and trileaflet groups using Wilcoxon Rank Sum tests.

Results:
Twenty-six genes were differentially methylated between the bicuspid and trileaflet groups, and six of these genes also had significantly different gene expression between groups. Protein tyrosine phosphatase, non-receptor type 22 (
PTPN22
) was strongly hypermethylated (beta: bicuspid 0.68 vs. trileaflet 0.55, P=4x10
-5
) and had a resultant highly significant decrease in gene expression (log 2 gene expression intensity: bicuspid 5.1 vs. trileaflet 7.9, P=2x10
-5
).

Conclusions:
In patients with ascending thoracic aortic aneurysms, there exist differential DNA methylation and gene expression signatures between those with BAV aortopathy versus acquired degenerative aneurysms and trileaflet aortic valves. The strongest finding was for
PTPN22
, a gene involved in T-cell receptor signaling and associated with various autoimmune disorders. These differences may highlight novel mechanisms of aneurysm development in the BAV population, potentially serving as biomarkers and/or pharmacologic targets.
Abstract 9118: Inhibition Of Interleukin-1 Activity By Anakinra Improves Endothelial, Coronary And Aortic Function In Patients With CAD And Coexistent Rheumatoid Arthritis By Reducing Apoptosis And Oxidative Stress
Authors: Ikonomidis Ignatios , Tzortzis Stavros , Andreadou Ioanna , Pavlidis George , Katseli Chrysoula , Katsimbri Pelagia , Paraskevaidis Ioannis , Parissis John , Anastasiou-Nana Maria , Lekakis John
Published: April 2024

Background:
Interleukin-1 mediates atherogenesis and coronary vasoreactivity. Anakinra, a human recombinant interleukin-1a receptor antagonist, is used forthe treatment of rheumatoid arthritis (RA) and shows favourable effects onendothelial and arterial function in RA patients. We investigated the effects of anakinra on coronary endothelial and arterial function in CAD patients with coexistent RA.

Methods:
Forty patients with chronic CAD and RA were randomized to receive a single injection of anakinra (100mg s.c.) or placebo and after 48 hours the alternative treatment in a double-blind trial and 23 age and sex matched subjects with similar risk factors served as controls. At baseline and 3 hours after treatment we assessed a) coronary flow reserve (CFR) of the LAD using Doppler echocardiography, b) aortic strain (AS), c) flow mediated endothelial dependent dilation of the brachial artery (FMD) by ultrasonography d) soluble Fas, Fas ligand, nitrotyrosine (NT) and protein carbonyls (PC) serum levels. All controls had no clinical history for CAD and a negative for ischaemia treadmill exercise test.

Results:
Patients had impaired FMD, CFR and AS compared to controls(p<0.001). At baseline, NT was related with AS and FMD (r=-0.401 andr=-0.386),while Fas and FasL with CFR (r=-0.450 and r=-0.362) (p<0.05). After 3 hours of anakinra treatment, there was an improvement in FMD, CFR and AS compared to placebo, reaching values similar to those in controls (FMD: 5.1±2.3%, vs.13.9±3.5% vs. 8.1±3.6%, p=0.006, CFR: 2.1±0.7 vs. 3.0±1.1 vs.3.4±0.7, p<0.001, AS: 4.4±2.3% vs. 9.6±3.6% vs. 8.0±2.8 %, p=0.003). Furthermore, there were a decrease in NT (median 6.66 vs. 6.15 nM/L), PC (0.131vs. 0.091 nmol/mg protein), Fas (51.8 vs. 49.3 pg/ml) and FasL levels (47.6 vs. 40.95 pg/ml) after anakinra (p<0.05). No significant changes were observed after placebo.

Conclusion:
IL-1 inhibition improves endothelial function and consequently, coronary and aortic wall function, probably through reduction of nitrooxidative stress and apoptosis.
Abstract 9230: Arrhythmias After the Fontan Operation; Which is Superior: Intracardiac Lateral Tunnel or Extracardiac Conduit? An International Multicenter Study of 1271 Patients
Authors: Balaji Seshadri , Bradley David J , Etheridge Susan P , Law Ian H , Singh Anoop K , Gajewski Kelly K , Singh Harinder R , Batra Anjan S , Tsao Sabrina , Tisma-Dupanovic Svjetlana , Tateno Shigeru , Takamuro Motoki , Nakajima Hiromichi , Sanatani Shubayan , Roos-Hesselink Jolien W , Shah Maully
Published: April 2024

Background:
Arrhythmias, both brady and tachyarrhythmias, are common after the Fontan operation for single ventricle. By avoiding surgery near the sinus node, reducing pressure overload of the right atrium (RA), and decreasing RA scarring, the extracardiac conduit (ECC) is thought to be less arrhythmogenic than the intracardiac lateral tunnel (ILT). Evidence of such superiority is, however, lacking or inconclusive.

Methods:
An international multi-center retrospective study of 1271 patients was performed comparing early and late bradyarrhythmia (defined as need for pacing) and tachyarrhythmia (defined as needing any acute or chronic anti-arrhythmic therapy) between 669 ECC and 602 ILT patients. Age at Fontan was ILT 2.8 +/- 2.2 vs ECC 3.5 +/- 2.2 (p<0.0001).

Results:
In the early post-operative period, bradyarrhythmias requiring pacing were noted in 83 (11%) ECC patients vs 24 (4%) ILT patients (p < 0.0001) and tachyarrhythmias were noted in 53 (8%) ECC patients vs 32 (5%) ILT (p=ns). At follow-up (FU) (ECC 4.8+/- 4 years Vs ILT 8.9 +/- 5.4, mean +/- SD p<0.0001)), bradyarrhythmias were seen in 39 (6%) ECC vs 62 (10%) ILT (P <0.003) and tachyarrhythmias in 23 (3%) ECC vs 58 (10%) ILT (p< 0.0001). However, when length of FU was factored in, the incidence of brady and tachyarrhythmias did not differ between the 2 groups (p=ns).

Conclusions:
ECC has a higher incidence of early bradyarrhythmias. When length of FU is accounted for, late arrhythmia burden is similar between the two groups. Overall, the ECC does not appear to be less arrhythmogenic than the ILT. Therefore, the decision of which type of Fontan to perform may best be based upon individual patient anatomy, hemodynamic factors and surgeon preference rather than on a desired decrease in arrhythmia burden from the ECC.
Abstract 9237: An Adaptor Protein Afadin Regulates Lymphatic Vessel Development by Modulating RhoA Activation
Authors: Takeuchi Keisuke , Majima Takashi , Miyoshi Jun , Ogita Hisakazu
Published: April 2024

Afadin is an intracellular binding partner of nectins, the cell-cell adhesion molecules; it plays important roles in the formation of cell-cell junctions. Afadin knockout mice show early embryonic lethality, therefore little is known about the function of afadin in organ development. To elucidate the role of afadin in the vascular system in vivo, we generated endothelial cell-specific afadin-null mice by the Cre-LoxP system. These afadin conditional knockout (cKO) mice were almost embryonically lethal as a result of severe subcutaneous edema. Defects in the lymphatic vessels of the skin were observed, although the abnormality in the blood vessels was not detected. We also found that severe disruption of the VE-cadherin-mediated cell-cell junctions occurred only in lymphatic endothelial cells, but not in blood endothelial cells. Since depletion of afadin did not affect the ability of differentiation and proliferation of lymphatic endothelial cells, the disruption of cell-cell junctions in the lymphatic vessels is considered to be the primary reason to cause the embryonic lethality in afadin cKO mice. We further investigated the molecular mechanism by which the phenotype in afadin cKO was specifically observed in the lymphatic vessels in the in vitro assays using blood and lymphatic microvascular endothelial cells (BMVECs and LMVECs). Knockdown of afadin caused the elongated shapes and cell-cell junction disruption in LMVECs, but not BMVECs. In afadin-knockdown LMVECs, enhanced F-actin bundles were formed at the cell periphery and the activation of RhoA was strongly increased in comparison with afadin-knockdown BMVECs. Given that the excessive RhoA activation can induce the force to shrink the cells, these results indicate that afadin has different effects on blood and lymphatic endothelial cells by controlling the activation of RhoA, which critically regulates the development of mouse embryos.
Abstract 9252: Global Longitudinal Strain And Left Atrial Volume Index Predict Appropriate Implantable Cardioverter Defibrillator Therapy In Hypertrophic Cardiomyopathy Patients
Authors: Debonnaire Philippe J , Thijssen Joep , Leong Darryl P , Joyce Emer M , Bax Jeroen J , Schalij Martin J , Atsma Douwe E , Delgado Victoria , Ajmone Marsan Nina
Published: April 2024

Introduction:
Accurate predictors of appropriate implantable cardioverter defibrillator (ICD) therapy in hypertrophic cardiomyopathy (HCM) patients have not yet been identified.

Hypothesis:
Left ventricular global longitudinal strain (GLS) and indexed left atrial volume (LAVI), indices of systolic and diastolic ventricular function respectively, may be predictive for appropriate ICD therapy in HCM patients.

Methods:
LAVI and 2-dimensional speckle tracking-derived GLS were assessed in 92 HCM patients undergoing ICD implantation. Appropriate ICD therapy was defined as occurrence of antitachycardia-pacing/shock for ventricular tachycardia/fibrillation.

Results:
Appropriate ICD therapy occurred in 21 (23%) patients during a median follow-up of 4.2 (1.6-7.8) years. Both LAVI and GLS showed higher accuracy for appropriate ICD therapy prediction compared to the presence of ≥1 conventional sudden cardiac death risk factor(s) [area under the ROC curve 0.76 (95%CI:0.65-0.87) and 0.65 (95%CI:0.54-0.77) versus 0.52 (95%CI: 0.43-0.58) respectively, p<0.001]. In particular, the presence of LAVI ≥34 mL/m
2
or GLS ≥-14% predicted appropriate ICD therapy with 100% sensitivity. Equally important, the presence of LAVI <34 mL/m
2
and GLS <-14% showed a negative predictive value of 100%. Moreover, using these cut-off values, multivariate analysis revealed both LAVI (p=0.03) and GLS (p=0.04), but not the presence of any conventional sudden cardiac death risk factor, as independent predictors of appropriate ICD therapy. Likelihood ratio test (p<0.001) and integrated discrimination improvement index (0.19, p<0.001) showed that LAVI and GLS were of incremental value over conventional sudden cardiac death risk factor(s) to predict appropriate ICD therapy. In addition, net reclassification improvement of 0.45 indicated substantial and adequate reclassification of patients into low probability for appropriate ICD therapy including GLS and LAVI in the risk stratification model (p=0.005).

Conclusion:
GLS and LAVI accurately predict appropriate ICD therapy in a high-risk HCM population. In addition to conventional sudden cardiac death risk factors, both parameters may be useful to optimize criteria and timing for ICD implantation in these patients.
Abstract 9254: Race Differences in Ventricular Remodeling Among College Football Players: Implications for a Cardiovascular Screening Program
Authors: Peter Shanon , Haddad Francois , Hulme Olivia , Gomari Armaghan , Myers Jonathan , Froelicher Vic , Ashley Euan
Published: April 2024

Objective:
Intensive athletic training is associated with increased cardiac ventricular mass and volume. We sought to investigate the hypothesis that African American (AA) football players remodel with a greater mass-to-volume (M:V) ratio than their Caucasian counterparts. We also sought to compare diastolic and systolic function between the two groups. We finally examined the correlation between precordial ECG voltage and M:V ratio.

Methods:
All entering Stanford Division I football players (81 Caucasian and 39 AA) over a 5 year period underwent cardiovascular screening with history, physical exam, ECG and focused echocardiogram. Comparison of remodeling and functional indices plus ECG voltage parameters was performed using Student’s t-test and multivariable logistic regression analysis adjusted for body size, resting blood pressure and field position.

Results:
Compared with their Caucasian counterparts, AA football players had on average higher LV mass index (77 ± 11 vs. 71±11 g/m
2
, p=0.009), higher relative wall thickness (0.31 ± 0.04 vs. 0.24 ± 0.20, p<0.001) and higher mass to volume ratio (1.18 ± 0.16 vs. 1.06 ± 0.09 g/mL, p< 0.001). AA football players had lower early diastolic tissue Doppler velocity (18 ± 2 vs. 19 ± 2 cm/s, p=0.043). There were no significant differences in systolic indices of LV ejection fraction or velocity of circumferential shortening. AA players showed significantly greater precordial voltage on QRS spatial vector magnitude score consisting of |V2-S| + |V5-R| (31.9 vs. 27.0 mV, p = 0.002). There were no significant relationships between M:V and net voltage.

Conclusion:
College footballers of African ancestry exhibit more physiologic concentric ventricular remodeling, lower early diastolic annular velocities and increased ventricular voltage when compared to Caucasian FP. These findings may be important in deriving race specific indices of ventricular remodeling for use in screening college athletes.
Abstract 93: A Percutaneous Left Ventricular Assist Device Improves Survival in a Porcine Model of Cardiac Arrest and Resuscitation
Authors: Derwall Matthias , Ebeling Andreas , Föhr Philipp , Brücken Anne , Nix Christoph , Fries Michael
Published: April 2024

Introduction: Manual chest compressions usually result in 20-30% of normal vital organ blood flow. Hence, improving circulation during cardiopulmonary resuscitation (CPR) may increase the number of successfully resuscitated patients.

Hypothesis: Optimizing intra- and post-CPR hemodynamics by using a percutaneous intravascular left-ventricular-assist device (LVAD) instead of chest compressions increases the rate of return of spontaneous circulation (ROSC).

Methods: Seven pigs were instrumented with an LVAD (Impella 2.5, Abiomed, Danvers, MA) and a pulmonary artery catheter to measure mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), mean pulmonary artery pressure (MPAP) and pulmonary capillary wedge pressure (PCWCP). Data from previous experiments (Derwall et al. Shock 2010) using conventional CPR with a piston driven chest compressor served as control (n=8).

In both groups CA was electrically induced and left untreated for 10 minutes before CPR was attempted, either by activating the LVAD at the highest possible flow, or performing chest compressions at a rate of 100/min. After two injections of 1mg adrenaline and a total of 6 minutes CPR, defibrillation was attempted. Hemodynamic values were recorded for 120 minutes before animals were weaned from the respirator.

Results: On average, the LVAD delivered 1.3 ± 0.1 L/min during CPR (34 % of baseline CO) resulting in an increase in MAP from 18 ± 10 mmHg after 10 minutes of CA to 35 ± 2 mmHg before defibrillation (see Figure ; * indicates p<0.05 for MAP at 10 vs. 16 min). MAP, HR, MPAP and PCWP did not differ before CA or after 120 minutes following CPR. While all animals (n=7) in the LVAD group presented with ROSC following CPR, only 50% (n=4) of the animals in the chest compressions group could be successfully resuscitated (p=0.035).

Conclusion: Using a percutaneous LVAD instead of conventional chest compressions did not significantly alter post-CPR hemodynamics, but improved the rate of ROSC in this model.
Abstract 9304: Chain Length and Saturation of Primary Dietary Fats Mediate Impaired or Preserved Triglyceride Dynamics and Contractility in Decompensated Hearts
Authors: Lahey Ryan , Lewandowski E. Douglas
Published: April 2024

Oxidation of long chain fatty acids (LCFA) provides approximately 70% of ATP in the heart. Alternatively, LCFAs incorporate into the endogenous lipid pool as triacylglyceride (TAG). The dynamic process of TAG turnover, a source of LCFA for beta-oxidation and nuclear receptor activation, is reduced in cardiac hypertrophy. The current study tested the hypothesis that LCFA storage kinetics are influenced by acyl chain composition by comparing incorporation of two major plasma LCFAs, palmitate (16-carbon, saturated) and oleate (18-carbon, monounsaturated), into the TAG pool of sham operated control (SHAM) and hypertrophied (HYP) rat hearts. Isolated hearts were perfused with buffer containing 5 mM glucose, 1 mM lactate and 0.4 mM of either 13C-palmitate or 13C-oleate. Sequential 13C NMR of intact hearts and endpoint LC/MS enabled quantitation of TAG dynamics. With palmitate, HYP hearts contained 48% less TAG vs SHAM (P<0.01), while oleate maintained similar TAG in HYP and SHAM. LCFA incorporation into TAG displayed two distinct kinetic components: a saturable exponential, reflecting LCFA uptake, and a linear component, reflecting TAG turnover. Time contants of the exponential uptake phase reflected similar rates of uptake of either LCFA in SHAM and HYP. However, HYP displayed reduced TAG turnover with palmitate (HYP: 46.7 +/- 12.2 nmol/gdw/min, SHAM: 84.3 +/- 4.9; P<0.01), while oleate supported similarly elevated turnover in both groups (HYP: 140.4 +/- 11.2 nmol/gdw/min, SHAM: 143.9 +/- 15.6). Work output (rate-pressure-product) was reduced simlarly in HYP with either LCFA. In contrast, oleate supported greater contractility than palmitate in HYP for both +dP/dt (25%) and -dP/dt (23%) (P<0.05), despite no differences in the contribution of either LCFA to beta-oxidation. These data demsontrate the influence of FA composition on TAG turnover in both normal and hypertrophied myocardium, with oleate being more readily incorporated into TAG than palmitate. The findings link reduced TAG turnover rates to impaired dP/dt which can be mediated by LCFA species. Furthermore, oleate confers improved lipid content and storage dynamics in comparison to palmitate in the setting of pressure-overload hypertrophy, which are linked to cardiac contractility.
Abstract 9363: Intervention for Re-coarctation in the Single Ventricle Reconstruction Trial: Incidence, Risk and Outcomes
Authors: Hill Kevin D , Rhodes John F , Aiyagari Ranjit , Baker G. H , Bergersen Lisa , Chai Paul J , Fleming Gregory A , Fudge J. C , Gillespie Matthew J , Gray Robert G , Hirsch Russel , Lee Kyong-Jin , Li Jennifer S , Ohye Richard G , Oster Matthew E , Pasquali Sara K , Pelech Andrew M , Radtke Wolfgang A , Takao Cheryl M , Vincent Julie A , Hornik Christoph P
Published: April 2024

Objectives: To determine the incidence of re-coarctation (re-CoA), risk factors and outcomes in patients with single right ventricle lesions after Norwood.

Methods: The cohort included subjects randomized to right ventricle-pulmonary artery shunt (RVPAS) or modified Blalock Taussig shunt (MBTS) in the Single Ventricle Reconstruction (SVR) Trial. Re-CoA was defined by intervention, either catheter-based or surgical. Univariate analysis and multivariable Cox proportional hazard models were performed adjusting for center.

Results: Of the 549 SVR subjects, 97 (18%) underwent 137 interventions (92 balloon aortoplasty; 45 surgical) for re-CoA. Intervention typically occurred at pre-stage II catheterization (n=71, 52%) or at stage II surgery (n=44, 32%). Median age and catheterization gradient at first intervention were 4.9 months (range: 1.1-10.5) and 17 mm Hg (range: 0-60) respectively. Center intervention rates varied from 0-50%. In multivariable analysis, re-CoA was not associated with assigned shunt type, but was associated with actual shunt type received (HR 2.0 for RVPAS vs. MBTS, p=0.02), and Norwood discharge peak echo-Doppler arch gradient (HR 1.07 per 1 mm Hg, p<0.01). No other demographic, anatomic or surgical variables predicted intervention. Subjects with re-CoA demonstrated comorbidities at pre-stage II evaluation including higher pulmonary arterial pressures (15.4 ± 3.0 vs. 14.5 ± 3.5 mm Hg; p=0.05), higher pulmonary vascular resistance (2.6 ± 1.6 vs. 2.0 ± 1.0 WU x m²; p=0.04) and increased echocardiographic volumes (end-diastolic volume: 28.0 ± 7.4 vs. 24.9 ± 8.2 ml; p=0.01). There was no difference in 12-month post-randomization transplant-free survival for those with and without re-CoA (83% vs. 86%; p=0.5).

Conclusions: Intervention for re-CoA was common and varied by center. The association with receipt of an RVPAS may be due to intra-operative cross-over because of arch anatomy that prohibited use of a MBTS. Those undergoing intervention demonstrated ventricular dilation and worsened hemodynamics prior to stage II surgery. Although intervention was not associated with increased 1-year transplant/mortality, further evaluation is warranted to evaluate effects of morbidity of re-CoA.
Abstract 9431: Heart Failure Induces Significant Changes in the Nuclear Pore Complex of Human Cardiomyocytes
Authors: Rivera Miguel , Tarazon Estefania , Rosello Esther , Molina Micaela , Salvador Antonio , Sanchez Lazaro Ignacio , Martinez Dolz Luis , Almenar Luis , Montero Anastasio , Gonzalez Juanatey Jose Ramon , Lago Francisca , Azorin Inmaculada , Portoles Manuel
Published: April 2024

Introduction:
We have recently reported alterations in different transporters that orchestrate the nucleocytoplasmic transport, such as increased importin and exportin levels in patients diagnosed with heart failure (HF). We hypothesized whether we could also find alterations in the nuclear pore complex (NPC) structure, the gateway connecting the nucleoplasm and cytoplasm. Therefore, we quantified several representative proteins that compose the different parts of NPCs, named nucleoporins (Nup), in this syndrome.

Methods:
A total of 90 human heart samples from ischemic (ICM, n=45) and dilated (DCM, n=36) patients undergoing heart transplant and control donors (CNT, n=9), were analyzed (nuclear-cytoplasmic fractionation) by Western-blotting. Subcellular distribution of proteins was analyzed by immunocytochemistry, fluorescence and electron microscopy.

Results:
When we compared nucleoporin protein levels according to etiology, ICM showed significant higher levels of linker Nup93 (42%, p<0.0001), FG Nup153 (139%, p<0.01) and transmembrane ring Nup NDC1 (65%, p<0.0001) than those of the CNT group. Furthermore, DCM also showed significant differences for Nup93 (88%, p<0.0001), Nup153 (157%, p<0.01) and NCD1 (41%, p<0.0001). However, the nucleoporins Nup155, Nup160 and translocated promoter region (TPR) did not show significant differences. Furthermore, subcellular distribution of nucleoporins was not altered in pathological hearts, although we observed an increase in the fluorescence intensity in ICM and DCM samples of those Nup with high protein levels.

Conclusions:
This study shows alterations in specific proteins that compose NPC, overall those that are directly exposed to cargo undergoing transport (Nup93 and Nup153) and those that surround the core (NDC1), in hearts from patients with ICM and DCM. These changes could be accompanied by modifications in the functional dynamics through NPC and therefore our findings may be the basis for a new approach to HF management.
Abstract 9449: Dynamic Left Ventricular Dyssynchrony Assessed by Three Dimensional Speckle-Tracking Area Strain during Dobutamine Stress Has a Negative Impact on Cardiovascular Events in Patients with Idiopathic Dilated Cardiomyopathy
Authors: Matsumoto Kensuke , Tanaka Hidekazu , Tatsumi Kazuhiro , Sawa Takuma , Mochizuki Yasuhide , Motoji Yoshiki , Imanishi Junichi , Miyoshi Tatsuya , Hiraishi Mana , Kaneko Akihiro , Tsuji Takayuki , Ryo Keiko , Fukuda Yuko , Kawai Hiroya , Hirata Ken-ichi
Published: April 2024

Background:
Left ventricular (LV) dyssynchrony is not a stable phenomenon, but rather, changes dynamically with changes in hemodynamic conditions. Since the prognostic impact of dynamic dyssynchrony has not yet been elucidated, our objective was to investigate, by using novel three-dimensional (3-D) speckle-tracking area strain, the clinical impact of dynamic dyssynchrony on patients with idiopathic dilated cardiomyopathy (DCM).

Methods:
Forty-eight DCM patients with ejection fractions of 33±9% (all <45%) were prospectively recruited, and 3-D speckle-tracking area strain was used to measure both contractile reserve and changes in dyssynchrony during dobutamine stress (20μ g/kg/min). The standard deviation of time-to-peak area strain from 16 LV segments was adopted as the LV dyssynchrony index. Event-free survival was then tracked over a 12-month period.

Results:
A ≥6.94% increase in the dyssynchrony index during dobutamine stress (Δdyssynchrony index) was the best predictor of cardiovascular events with 90% sensitivity and 82% specificity. Multivariate Cox analysis indicated that not only the absence of contractile reserve ([[Unable to Display Character: ∆]]global area strain ≤3.89%, p=0.03), but also the presence of dynamic dyssynchrony ([[Unable to Display Character: ∆]]LV dyssynchrony ≥6.94%, p=0.04) was an independent predictors of cardiovascular events. Patients with dynamic dyssynchrony had a significantly poorer prognosis than those without (log rank p<0.001). Importantly, absence of dynamic dyssynchrony and presence of contractile reserve during dobutamine stress were associated with the most favorable outcome (100%), whereas the reverse condition was associated with the worst outcome (20%, p<0.001).

Conclusions:
Dynamic dyssynchrony during dobutamine stress constitutes a potential predictor of cardiovascular events in patients with DCM, while assessment of dynamic dyssynchrony in combination with contractile reserve may further improve prognostic risk stratification.
Abstract 9633: Human Blood and Cardiac Stem Cells Synergize to Enhance Cardiac Repair When Co-transplanted Into Ischemic Myocardium
Authors: Davis Darryl R , Latham Nicholas , Ye Bin , Lam Bu-Khanh , Kuraitis Drew , Ruel Marc , Suuronen Erik J , Stewart Duncan J
Published: April 2024

Blood-derived circulatory angiogenic cells (CACs) and resident cardiac stem cells (CSCs) have both been shown to improve cardiac function after myocardial infarction (MI). However, whether one cell type is superior has long been an area of speculation with no head-to-head trial. In this study, we compared the effect of human CACs and CSCs, alone or in combination, on myocardial function in an immunodeficient mouse model of MI. Methods and Results- CACs and CSCs were cultured from left atrial appendages and blood samples obtained from patients undergoing clinically-indicated heart surgery. In hypoxic culture conditions designed to mirror ischemic myocardium, protein arrays demonstrated that CACs expressed a broader cytokine profile than CSCs (36 vs. 5, respectively; p<0.05) with 3 cytokines in common. Co-culture of CACs and CSCs further enhanced the production of stromal cell derived factor-1α and vascular endothelial growth factor (p<0.05). Conditioned media promoted equivalent vascular networks and endothelial progenitors recruitment with superior effects using co-cultured conditioned media (p<0.05 vs. single cell cultures). Intramyocardial injection of CACs or CSCs alone improved left ventricular ejection fraction (LVEF) when injected one week after MI (p<0.05 vs. vehicle (PBS) or normal human dermal fibroblasts (NHDF); Figure). Co-transplantation of CACs and CSCs together improved LVEF to a greater extent than either stem cell therapy alone (p<0.05 vs. CAC or CSC injection alone). Conclusions- CACs and CSCs provide unique paracrine repertoires with equivalent effects on angiogenesis, stem cell migration and myocardial repair. Combination therapy with both cell types synergistically improves post infarct myocardial function greater than either therapy alone. This synergy is likely mediated by the complimentary paracrine signatures that promote revascularization and the growth of new myocardium.
Abstract 9658: Concomitant Maze Procedure Reduces Adverse Clinical Events in Patients with Left Ventricular Dysfunction Undergoing Open Cardiac Surgery
Authors: Kim Joon Bum , Jung Sung-Ho , Choo Suk Jung , Chung Cheol Hyun , Lee Jae Won
Published: April 2024

Background:
Clinical benefits of concomitant maze procedure can be offset by surgical risks added by the procedure especially in patients with left ventricular (LV) dysfunction undergoing open heart surgery.

Methods:
Between January 1999 and March 2011, a total of 139 patients (mean age 52.7±12.3 years, 54 females) with valvular atrial fibrillation (AF) and a LV ejection fraction (EF) of 40% or less underwent open heart surgery with (n=77) or without (n=62) the concomitant maze procedure. We compared primary adverse outcomes (death; composite of death, thromboembolic events, or congestive heart failure [CHF]) during a median follow-up period of 66.9 months (inter-quartile range, 27.8-105.5 months).

Results:
Primary outcomes occurred in 41 patients including 36 deaths, 7 thromboembolic events and 8 hospitalizations due to CHF. After adjustment for baseline risk profiles, patients who had undergone the maze procedure were at similar risks of death (hazard ratio, 0.48; 95% confidence interval, 0.17-1.35;
P
=0.17) but a significantly lower risk of the composite adverse outcomes (hazard ratio, 0.34; 95% confidence interval, 0.14-0.83;
P
=0.017) compared with those who did not undergo the maze procedure (Figure). For 23 propensity-score matched pairs, the combination of the maze procedure resulted in decreased LV systolic (
P
=0.013) and diastolic (
P
=0.041) dimensions, and increased LV EF (56.2±7.9% vs. 49.9±11.9%,
P
=0.010) compared with cardiac surgery alone on echocardiographic assessments performed at a median of 62.8 months (inter-quartile range, 26.5-119.0 months) after surgery. At the end of follow-up, patients who had undergone the maze procedure had superior New York Heart Association functional status than those who did not (
P
=0.008).

Conclusion:
Adding the maze procedure in patients with valvular AF and LV dysfunction reduced adverse outcomes, and improved LV systolic function and functional status as compared with cardiac surgery alone.
Abstract 9735: Endothelial Vasomotor Function in the Brachial Artery is Associated with Long-term Cardiovascular Events in Patients after Implantation of Drug Eluting-Stent
Authors: Kitta Yoshinobu , Nakamura Takamitsu , Uematsu Manabu , Sugamata Wataru , Deyama Juntaro , Fujioka Daisuke , Saito Yukio , Kawabata Ken-ichi , Obata Jun-ei , Kugiyama Kiyotaka
Published: April 2024

Endothelial dysfunctionin systemic arteries is a predictor of long-term coronary events. Although drug eluting-stent (DES) implantation aggravates coronary artery endothelial vasomotor dysfunction, it remains unclear endothelial dysfunction in systemic arteries provides prognostic information in coronary artery disease (CAD) patients after implantation of DES. Thus, we examined whether endothelial dysfunction may predict future cardiovascular events in CAD patients after implantation of DES.

Methods:
This study included 231 consecutive patients with newly diagnosed CAD who had elective and successful PCI with DES in de novo lesions of native coronary arteries. Measurement of FMD (expressed as percent dilation from baseline brachial artery diameter) during reactive hyperemia was performed by high-resolution ultrasound at entry (before PCI) and after 6months. All patients had individualized, optimized therapies including medications and recommended life style changes to reduce risk factors for CAD according to AHA guidelines. Patients were prospectively followed up until the occurrence of 1 of the following events: cardiovascular death, recurrent or refractory angina pectoris, nonfatal myocardial infarction, and ischemic stroke. The impairment of FMD was defined as < 5.5% (mean minus 1SD of FMD in 100 age- and sex-matched normal subjects in our hospital).

Results:
Impaired FMD (<5.5%) was in 86 (37%) patients after 6months. During a follow-up period of 30 ± 0.8 months, events occurred in 19 patients of the 86 patients with impaired FMD after 6months. Using multivariate Cox hazards analysis, impaired FMD after 6months was a predictor of future cardiovascular events that was independent of impaired FMD at entry, use of medications, age, and traditional CAD risk factors (odds ratio 2.9, 95%CI 1.3 - 6.2, p < 0.01)

Conclusions:
Endothelial dysfunction in the brachial artery represents an adverse outcome in CAD patients after implantation of DES. Measurement of FMD may be useful for risk stratification in CAD patients after implantation of DES.
Abstract 9749: Predictors of Missed Reduction of LV Mass in Unselected Hypertensive Members of the Strong Heart Study
Authors: de Simone Giovanni , Devereux Richard B , Izzo Raffaele , Roman Mary J , Lee Elisa T , Howard Barbara V
Published: April 2024

Background:
Clinical trials indicate that reduction of hypertensive LV mass is a reachable objective during antihypertensive management. Whether similar results can be achieved in usual clinical contexts also in unselected population-based samples is unclear.

Methods:
Among 1133 hypertensive participants of the 4
th
Strong Heart Study (SHS) exam, 862 (76%, 490 women or 57%) underwent a repeated echocardiogram after 4 yrs (5
th
SHS exam) and were analyzed. Variations of at least 5% of the initial values of both systolic blood pressure (SBP) and LV mass index (LVMi) were categorized for analysis.

Results:
Compared with the 4
th
exam, SBP decreased in 41% of participants, increased in 31% and was unchanged in 28%. LV hypertrophy (LVH) was found in 31% at the 4
th
-exam (n=265) and in 37% at the 5
th
exam (n=312). LVMi did not change from 4
th
to 5
th
exam, but in men there was a more significant trend to increase (from 42.0±8.9 to 43.8±9.3 g/m
2.7
) than in women (from 45.3±10.5 to 45.8±11.4 g/m
2.7
, p<0.004 between genders). Percent (%) change of LVMi was positively related to % change of SBP (r=0.18) and followup SBP (r=0.19, both p<0.0001). Participants who decreased LVMi had initial higher LVMi, HDL-cholesterol and uric acid (UA), with lower heart rate, BMI, waist-to-hip ratio (WHR) and urinary albumin/creatinine ratio (UACR, all 0.05<p<0.0001). Lack of decrese in LVMi was not related to any class of meds used at the time of the 4
th
exam (diuretics, ACE-i, ARB, Ca
++
channel blockers, other vasodilators, β-blockers). In hierarchical logistic regression, adjusting for older age (p<0.02), sex, initial LVMi and field center, lack of decrease in LVMi was independently associated with initially higher BMI (p<0.0001), WHR (p=0.05), UACR (p<0.001), UA (p<0.004) and to the % change of SBP (p<0.005), without additional independent contribution of glucose status (including diabetes), initial SBP and classes of antihypertensive meds.

Conclusions:
These results suggest that antihypertensive management does not effectively decrease LV mass in unselected population-based hypertensive subjects. The lack of effect is associated with poor BP control, is predicted by older age, initial central obesity, kidney damage, and is not affected by type of initial antihypertensive therapy.