bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17400: Catecholamine Release Triggered by Epicardial Absolute Refractory Period Stimulation Augments Global Left Ventricular Function
Authors: Ito Bruce R , Covell James W , Curtis Guy P
Published: March 2022

Background:
Biventricular epicardial (Epi) pacing can augment left ventricular (LV) function in heart failure. We postulated that these beneficial effects could involve catecholamine release from local autonomic nerve activation. This hypothesis was tested by applying Epi pacing stimuli during the muscle’s absolute refractory period (ARP) thereby activating intrinsic nerves without altering activation sequence.

Methods:
Anesthetized farm pigs (n=5) were instrumented with a LV high-fidelity pressure transducer, left atrial and LV Epi pacing electrodes, and sonomicrometer segment length (SL) gauges placed proximal and distal to the LV stimulation site. A small catheter was placed into the great cardiac vein adjacent to the LV pacing site for blood sampling. During atrial pacing at constant rate, 3 electrical pulses (0.8ms, 2-3x threshold volts) were applied to the LV Epi electrodes during the ARP. An experimental run consisted of baseline measurements, with 10 minutes of stimulation followed by 5 minutes of recovery repeated 3 times before and with ß- receptor blockade (BB, metoprolol, 5 mg). Coronary venous blood was sampled at baseline and at 5 and 10 minutes of stimulation for norepinephrine analysis (NE by ELISA).

Results:
ARP stimulation produced a significant increase in coronary venous NE levels (p< 0.01) accompanied by a significant 10-15% increase in LV dP/dt max (p< 0.01). Segment length vs. LV pressure loop area proximal to the stimulus site was significantly decreased (29.8 ± 10.9 mmHg*mm) compared to baseline (92.6 ± 8.2 mmHg*mm) but was unchanged at the distal site. BB abolished the changes in segment function and blocked the increase in LV dP/dt despite continued NE release.

Conclusion:
These results demonstrate that ARP EPI pacing induces NE release and augments global LV function. This effect may contribute to the beneficial effect of biventricular Epi pacing in some patients with heart failure.
Abstract 17417: ABCC6 Deficiency Promotes Atherosclerosis
Authors: Brampton Christopher , Chen Li-Hsieh , Apana Ailea , Leftheriotis Georges , Martin Ludovic , McCurdy Sara , Boisvert William A , Le Saux Olivier
Published: March 2022

Introduction:
Vascular calcification is associated with aging and common conditions such as hypercholesterolemia and certain genetic disorders. A molecular pathway inhibiting ectopic calcification is initiated by ABCC6, a membrane transporter primarily expressed in liver. ABCC6 facilitates the cellular efflux of ATP from hepatocytes, which is rapidly converted into pyrophosphate (PPi) in the liver vasculature. ABCC6 is responsible for the majority of the PPi release from the liver, and ~60% of plasma PPi in both in humans and mice. As PPi is a major inhibitor of calcification, mutations in ABCC6 underlie the currently incurable calcification disorder pseudoxanthoma elasticum (PXE), some cases of generalized arterial calcification of infancy (GACI). Hypothesis: Multiple lines of evidence have suggested a pathological synergy between ABCC6 and hyperlipidemia.

Methods:
We examined crosses between Abcc6-/- and Ldlr-/- mice and serum samples from human PXE patients. Three mouse genotypes were generated Ldlr-/-, Ldlr-/-xAbcc6-/- and Ldlr-/- xAbcc6+/-.

Results:
When subjected to a high fat diet, mice with reduced or no Abcc6 expression displayed a 2-fold increase of atherosclerotic plaque area (p=0.0001). Interestingly, atherosclerotic plaque was also found in Abcc6-deficient mice fed a normal diet but not in control Ldlr-/- animals. Aortic calcification was not significantly affected by Abcc6 expression except in Ldlr-/-xAbcc6-/- mice fed regular chow (p=0.0001). We observed an increased proliferation of smooth muscle cells of but no increase in monocyte-macrophage infiltration in the plaque of Ldlr-/-xAbcc6-/- mice. Importantly, we determined that the cholesterol efflux from isolated macrophages towards HDL (mediated by ABCG1) was significantly decreased (-28%, p=0.006) in Ldlr-/-xAbcc6-/- mice while the efflux towards ApoA1 (mediated by ABCA1) was unchanged. The analysis of high-density lipoprotein (HDL) and low-density lipoprotein (LDL) fractions in these mice showed altered profiles similar to those found with human PXE plasma samples. Conclusions: Our results indicated that, in addition to being an important inhibitor of vascular calcification, ABCC6 inhibits atherogenesis by modulating reverse cholesterol transport.
Abstract 17436: Ten-year Clinical Outcomes After the First Sirolimus-eluting Stent Implantation: Impact of In-stent Restenosis Lesion
Authors: Miura Katsuya , Kadota Kazushige , Ohya Masanobu , Shimada Takenobu , Amano Hidewo , Izawa Yu , Hyodo Yusuke , Otsuru Suguru , Hasegawa Daiji , Habara Seiji , Tada Takeshi , Tanaka Hiroyuki , Fuku Yasushi , Goto Tsuyoshi , Mitsudo Kazuaki
Published: March 2022

Background:
Little is known about the clinical follow-up after sirolimus-eluting stent (SES) implantation and about the effect of SES implantation in in-stent restenosis (ISR) lesion more than five years. We aimed to compare clinical outcomes up to 10 years after SES implantation in de novo lesion and ISR lesion.

Methods:
A series of 392 patients underwent the first SES implantation between November 2002 and December 2004, whose clinical outcomes were investigated. There were 253 patients for de novo lesion and 139 patients for ISR lesion. We evaluated the outcomes from the SES implantation to five years and beyond five years. Clinical information was obtained either from a review of the hospital records or by telephone interviews with the patients, family members, or primary care physicians.

Results:
Mean follow up period was 10.0 years. Cumulative incidence of major cardiac events (MACE) and target-lesion revascularization in ISR group were significantly higher than that in de novo group through 10 years (56.1% vs. 38.7%; p = 0.01, and 41.3% vs. 20.6%; p = 0.004, respectively) and the difference of the MACE and TLR rate in two groups increased in this period. Cumulative incidence of myocardial infarction (MI) and stent thrombosis (ST) between 2 groups were not significantly different (13.0% vs. 7.9%; p = 0.1, and 5.0% vs. 2.4%; p = 0.15, respectively).

Conclusion:
The incidence of MACE and TLR after the SES implantation in ISR lesion was significantly higher than that in de novo lesion and the difference of the TLR rate between in two lesions became more clear through 10 years, although the incidence of MI and ST had no significant difference in 2 groups.
Abstract 17437: Do Patients With Uncomplicated Non-ST Segment Acute Coronary Syndromes Require Admission to Critical Care Units?
Authors: van Diepen Sean , Lin Meng , Bakal Jeffrey A , McAlister Finlay A , Kaul Padma , Katz Jason N , Fordynce Chritopher B , Southern Danielle A , Graham Michelle M , Wilton Stephen B , Newby L K , Granger Christopher B , Ezekowitz Justin A
Published: March 2022

Background:
Clinical practice guidelines recommend admitting patients with stable non-ST segment elevation acute coronary syndrome (NSTE ACS) to telemetry units, yet up to two thirds of patients are admitted to critical care units (CCU). The outcomes of patients with stable NSTE ACS initially admitted to a CCU versus a cardiology ward with telemetry have not yet been described.

Methods:
We used a population-based dataset of 7,869 patients hospitalized with NSTE ACS admitted to hospitals in Alberta, Canada between April 1, 2007 and Mar 31, 2013 and excluded patients (n=589) who received CCU procedures or therapies on the day of admission. We compared outcomes among patients initially admitted to a CCU (n=5141) with those admitted to cardiology telemetry wards (n=2728).

Results:
Patients admitted to cardiology telemetry wards were older (median 69 vs 65 years, p<0.001), and more likely to be female (37.2% vs 32.1%, p<0.001) and have a history of prior myocardial infarction (14.3% vs 11.5%, p<0.001). Patients admitted directly to cardiology telemetry wards had similar hospital stays (6.2 vs 5.7 days, p=0.29), fewer cardiac procedures (39.1% vs 45.8%, p<0.001) and higher mean Charleston scores (1.3 vs 1.0, p<0.001) compared with patients initially admitted to CCUs. There were no differences in the frequency of cardiac arrest (0.7% vs 0.9%, p=0.51), in-hospital mortality (1.3% vs 1.2%, adjusted odds ratio (aOR) 1.57; 95% CI, 0.98 to 2.52), 30-day all-cause mortality (1.6% vs 1.5%, aOR 1.50; 95% CI 0.82 to 2.75), or 30-day all-cause post-discharge readmission (10.6% vs 10.8%, aOR 1.07; 95% CI 0.90 to 1.28) between cardiology telemetry ward and CCU patients. Results were similar across low, intermediate, and high risk NSTE ACS Charleston subgroups and in patients with non-ST segment myocardial infarction or unstable angina.

Conclusions:
No differences in clinically important outcomes were observed between patients with NSTE ACS initially admitted to wards or CCUs. These findings suggest that stable NSTE ACS can be managed appropriately in telemetry wards and present an opportunity to reduce hospital costs and critical care capacity strain.
Abstract 17470: The Effectiveness of Ethanol Infusion in the Vein of Marshall for Bidirectional Mitral Isthmus Block in Unsuccessful Cases With Conventional Ablation
Authors: Hirai Kaeko , Fujimoto Hajime , Naito Masaki , Yano Hiroki , Kosugi Takaaki , Hashimoto Yukihiro , Isojima Takuya , Suzuki Megumi , Iwama Hajime , Nakai Takehito , Doi Naofumi
Published: March 2022

2015 AHA Effectiveness of Ethanol Infusion in the Vein of Marshall for Bidirectional Mitral Isthmus Block in Unsuccessful Cases with Conventional Ablation

[Introduction]
Treatment of mitral isthmus dependent atrial tachycardia (AT) requires bidirectional mitral isthmus (MI) block. It is usually difficult to achieve bidirectional MI block by endocardial linear ablation. When MI block is incomplete, additional ablation inside the coronary sinus (CS) is often required. The vein of Marshall (VOM) is located in the epicardial aspect of MI. The purpose of this study is to determine whether complete bidirectional MI block is obtained by ethanol infusion in the VOM in cases with incomplete MI block by conventional ablation.

[Method]
This study consisted of 38 consecutive patients who underwent conventional ablation to obtain bidirectional MI block from October 2013 to September 2014.

[Results]
In 24 patients (63%), bidirectional MI block was achieved by conventional ablation. In 11 patients (29%) of the other 14 patients, the CS venogram was performed to assess the presence or absence of the VOM. The VOM was imaged in 9 patients (24%), into which 100% ethanol was injected (2ml, 2-3times). After ethanol infusion in the VOM, bidirectional MI block was obtained in all cases (Figure).

[Conclusion]
Ethanol infusion in the VOM is an effective treatment in cases with incomplete MI block by conventional ablation.
Abstract 17474: The Real World Prevalence of Cerebrovascular Disease Findings by Computed Tomography or Magnetic Resonance Imaging in Patients With Coronary Artery Disease
Authors: Hokimoto Seiji , Tabata Noriaki , Akasaka Tomonori , Sakamoto Kenji , Yamamoto Eiichiro , Tsujita Kenichi , Yamamuro Megumi , Kaikita Koichi , Kojima Sunao , Ogawa Hisao
Published: March 2022

Background:
Patients with coronary artery disease (CAD) are often complicated with cerebrovascular disease (CVD). Although there are many reports on the relation between stroke with symptomatic signs and CAD, there are few studies on CVD findings obtained from imaging examination irrespective of neurological signs. The aim was to examine the prevalence of CVD findings and clinical outcome in CAD patients.

Methods:
In 1091 consecutive CAD patients (772 males, mean age 70.1±10.3) who required percutaneous coronary intervention (PCI), we examined the CVD findings by computed tomography (CT) or magnetic resonance imaging (MRI) of brain before PCI. Patients were classified into 4 CVD findings and non-CVD: 1) microbleeds (G1), 2) lacunar infarction (G2), 3) non-lacunar infarction more severe than lacunar infarction (G3), 4) old cerebral bleeding (G4), and 5) non-CVD findings (G0). Acute conditions of CVD were excluded. Clinical endpoints were cardiovascular death, myocardial infarction (MI), stroke, unstable angina (UA) and urgent revascularization.

Results:
The number of CVD from cerebral imaging was 324 (29.7%) and there were 26 (2.4%), 125 (11.5%), 144 (13.2%), 29 (2.6%) and 767 (70.3%) in G1, G2, G3, G4 and G0, respectively. Patients with CVD findings had a high incidence of left main trunk or multi-vessels diseases, peripheral artery disease, chronic kidney disease and high age and high pulse wave velocity. Cardiovascular event rate was significantly higher in patients with CVD findings than in patients with non-CVD findings (9.6% vs. 4.7%, P=0.002). Details in clinical outcome were as follows: cardiovascular death (G1, G2, G3, G4, and G0; 0%, 0.8%, 2.8%, 3.4% and 0.9%, respectively), MI (0%, 0.8%, 0.7%, 3.4% and 0.5%), stroke (0%, 4.0%, 1.4%, 3.4%, and 0.7%), UA (3.8%, 4.0%, 4.2%, 6.9%, and 2.5%), revascularization (3.8%, 0.8%, 2.2%, 3.4% and 0.7%), respectively. Multiple regression analysis identified CVD findings as a predictor of clinical events (OR, 2.06; 95%CI, 1.18-3.60; P=0.001).

Conclusions:
There was high incidence of MRI or CT findings of brain irrespective or with or without neurological signs in CAD patients. We should also pay attention to asymptomatic patients with microbleeds or lacunar infarction irrespective of overt previous stroke.
Abstract 17521: Safety and Efficacy of Centhaquin as a Novel Resuscitative Agent for Hypovolemic Shock
Authors: Goyal Ashish O , Lavhale Manish S , Gulati Anil
Published: March 2022

Centhaquin (PMZ-2010) is a cardiovascular active agent (0.01 to 0.05 mg/kg) which has been shown to have resuscitative effect in a (1) rat model of fixed pressure blood loss, (2) rabbit model of uncontrolled bleeding with trauma, and (3) pig model of massive blood loss. PMZ-2010 produced a decrease in heart rate and vascular resistance; however, it increased mean arterial pressure by increasing cardiac output. We embarked on studies to develop PMZ-2010 as a resuscitative agent for hypovolemic shock. Toxicological studies were carried out and intravenous injection of PMZ-2010 in mice, rats and rabbits showed LD50 >100 mg/kg, 79.43 mg/kg and 9.55 mg/kg, respectively. The No Observed Adverse Effect Level (N.O.A.E.L.) of PMZ-2010 determined after repeated (28 days) intravenous injections of different doses in mice, rats and rabbits was found to be 1.0 mg/kg. A 14 day repeated dose toxicity study of PMZ-2010 (0.01, 0.10 and 1.0 mg/kg, iv) in canine model (beagle dog) was conducted and there were no clinical symptoms of toxicity in low and middle whereas in high dose (1.0 mg/kg) temporary sluggishness, shivering and salivation was observed, while biochemical profile was normal in all groups. We conducted a single center randomized, double-blind, placebo-controlled, single and multiple-ascending dose phase I study in healthy male subjects to evaluate the safety of PMZ-2010 (NCT02408731). The study population comprised 6 cohorts of 4 subjects each, which were randomized so that 3 subjects received the active drug and 1 subject received placebo. For single ascending dose cohorts, the initial dose of PMZ-2010 was 0.005 mg/kg, iv infusion. Based on the safety and tolerability of the administered dose, subsequent escalation of doses 0.01, 0.05 0.10 and 0.15 mg/kg was performed and maximum tolerated dose (MTD) was found to be 0.10 mg/kg. For multiple-ascending dose cohorts, the initial dose/day of PMZ-2010 was equal to maximum tolerated dose (MTD) 0.10 mg/kg (3 X 0.033 mg/kg/day) for 2 days. Subsequent escalation of dose was done up to 2 times MTD 0.20 mg/kg (3 X 0.067 mg/kg/day) for 2 days. It is concluded that MTD of PMZ-2010 in humans is 0.10 mg/kg and can be safely used for its resuscitative effect. (Mr. Tajuddin and Dr. D. Chilkoti are acknowledged for assisting in clinical studies).
Abstract 17560: Characteristics Associated With Symptom Diary Use in Patients With Heart Failure
Authors: Park Linda G , Dracup Kathleen , Whooley Mary A , Moser Debra K , Pelter Michele M , Biddle Martha , Clark Robyn A , Howie-Esquivel Jill
Published: March 2022

Introduction:
Health care providers regularly counsel heart failure (HF) patients to monitor symptoms and weight changes daily in order to detect and quickly treat HF exacerbations. We found diary use is associated with higher survival rates in chronic HF patients; however, the factors related to diary use are unknown. Therefore, the aim of this study was to determine the factors associated with diary use.

Methods:
We conducted a secondary analysis of a 3-arm randomized controlled trial among rural HF patients with two intervention groups (Fluid Watchers LITE and PLUS) and usual care. The two intervention groups were asked to use daily diaries for 2 years to track weight, HF symptoms, and response to symptom changes. The intervention groups received education on HF self-care and a script to call their health care provider; however, the 2 groups varied on the number of follow-up phone calls received. Patient groups were categorized by duration of adherence to diary use: None, Low (1-3 months), Medium (4-12 months), and High (13-24 months). Multivariable ordinal logistic regression using step-wise forward selection was conducted to determine factors that were associated with diary use.

Results:
Patients were 66 ± 13 years old, 58% were male, and 50% had systolic HF with 67% (N=264/393) of patients who completed diaries. After controlling for age, depression, and death in the multivariable logistic ordinal regression, depression (OR, 0.95; 95% CI, 0.92-0.98; P=0.002) and sedentary lifestyle (OR, 0.61; 95% CI, 0.42-0.89; P=.01) were associated with less diary use. In contrast, older age (OR, 1.59; 95% CI, 1.07-2.3; P=.02) and HF self-care (OR, 1.03; 95% CI, 1.01-1.06; P=.01) were associated with more diary use.

Conclusions:
Since diary use is associated with higher survival rates in HF patients, it is important to recognize that depression and sedentary lifestyle were negatively associated with diary use whereas older age and HF self-care were positively associated with diary use. Addressing modifiable psychosocial factors may have meaningful impact on improving survival in this vulnerable population of HF patients who suffer from frequent rehospitalizations and early death related to their disease.
Abstract 17679: Automating Cardiopulmonary Resuscitation Quality Data Abstraction for Entire Episodes of Cardiac Arrest Resuscitation
Authors: Lin Steve , Turgulov Anuar , Taher Ahmed , Buick Jason E , Byers Adam , Drennan Ian R , Morrison Laurie J
Published: March 2022

Introduction:
Research and quality assessment of cardiopulmonary resuscitation (CPR) quality has traditionally been limited to the first five minutes of resuscitation due to significant costs in both time and personnel from manual data abstraction. Manual CPR quality data abstraction of entire episodes of resuscitation may be too resource-intensive for many emergency medical service (EMS) agencies and hospitals. Moreover, the first five minutes of CPR are also different in many aspects compared to later time periods during cardiac arrest resuscitation, which represents significant knowledge gaps since the majority of resuscitations go beyond five minutes.

Methods:
We developed a software program to facilitate and help automate data abstraction from electronic defibrillator files for entire resuscitation episodes. Internal validation of the software program was performed on 50 randomly selected out-of-hospital cardiac arrest cases with resuscitation durations up to 60 minutes. CPR quality data variables were abstracted as minute averages, which included ventilation rate, CPR compression rate, depth, fraction, and end-tidal CO2. CPR quality data variables were manually abstracted independently by two trained data abstractors and automatically by the software program. Error rates and the time needed for data abstraction were measured.

Results:
A total of 9826 data points were abstracted. Manual data abstraction resulted in a total of six errors (0.06%) compared to zero errors by the software program. The mean time ± SD needed for data abstraction was 20.3 ± 2.7 minutes manually and 5.3 ± 1.4 minutes using the software program (p=0.003).

Conclusion:
Our data abstraction software was 100% accurate in abstracting CPR quality data for complete cardiac arrest resuscitation episodes. It significantly reduced the time and resources required to abstract CPR quality data, and will allow EMS agencies and hospitals to evaluate their CPR quality in a cost-effective manner. The development of this software will enable future studies to efficiently evaluate CPR quality during entire resuscitation episodes, including its impact on patient outcomes during prolonged cardiac arrests.
Abstract 17719: A New Termination-of-resuscitation Rule for Out-of-hospital Cardiac Arrest in the Japanese Population
Authors: Hashiba Katsutaka , Tahara Yoshio , Kimura Kazuo , Yasuda Satoshi , Yonemoto Naohiro , Nonogi Hiroshi , Saku Keijirou , Nagao Ken
Published: March 2022

Background:
Termination of resuscitation (TOR) rules for out-of-hospital cardiac arrest (OHCA) have been constructed for better utilization of hospital healthcare resources and increasing the availability of care for other patients. However, TOR rules in the prehospital settings are not legally implemented in Japan. Thus, almost all OHCA patients are transported to the hospital, regardless to the possibility of successful resuscitation.

Objective:
To validate the TOR-ALS rule in the Japanese population and to establish a new TOR rule for terminating ongoing resuscitation just after hospital arrival.

Methods:
The Fire and Disaster Management Agency (FDMA) of Japan developed a nationwide database of a prospective population-based cohort using an Utstein-style template for OHCA patients since January 2005. Data from January 2005 to December 2012 of this database was used for the current analysis. We constructed a new TOR rule consisting of 5 factors (no-witness, no-ROSC, asystole for the initial rhythm, no-defibrillation, age). Positive predictive value(PPV), negative predictive value(NPV), sensitivity, specificity and receiver operating characteristic(ROC) curve to predict Cerebral Performance Category(CPC) 3 to 5 at one-month for the TOR-ALS rule (no-witness, no-bystander, no-return of spontaneous circulation (ROSC), no-defibrillation before hospital arrival) and the new rule.

Results:
In the database, 925,288 patients were documented for the study period. Adult patients 18 years or older with OHCA without external causes of arrest were included, resulting in 708,933(77%) patients in the present analysis. Values were as followed for the TOR-ALS rule, PPV99.88%, NPV3.27%, sensitivity31.41%, specificity98.39%, Area Under Curve(AUC)-ROC0.649, and for the new rule, PPV99.96%, NPV3.40%, sensitivity33.45%, specificity99.40%, AUC-ROC0.664.

Conclusion:
The new TOR rule has a higher PPV and specificity to predict unfavorable outcome of OHCA in a Japanese population. Validation is required to prove the clinical utility of the rule.
Abstract 17740: Effects of High Intensity Interval Training on Blood Pressure and Endothelial Function in Prehypertensive and Hypertensive Patients
Authors: Heo Jung Ho , Jo Eun-Ah , Cho Kyunng-Im , Yu Ga-in
Published: March 2022

Introduction:
Recently, several studies have shown that high-intensity interval training (HIT) is superior to continuous moderate-intensity exercise (CME) for improvement on endothelial in patients with cardiovascular disease. However, little is known about its effects on changes in blood pressure, especially in hypertensive patients.

Hypothesis:
To compare the effects of HIT and CME on changes in blood pressure reduction and endothelial function in pre- and hypertensive patients..

Methods:
Seventeen pre- and hypertensive patients, aged 52.1±7.6, participated in this study, tapered off their medications, if necessary, and were randomized to either HIT (n=9) or CME (n=8) group. HIT was composed of 5 sets of 3 min exercise at 80% HRR, and each interval was separated by 3 min recovery at 40% HRR. CME was composed of 35 min exercise at 60% HRR. Both groups were designed to use same energy expenditure, and performed exercise 5 days per week for 4 weeks. Endothelial function was determined by assessing endothelial progenitor cells (EPCs) using flow cytometry and flow mediated dilation (FMD) using ultrasonography. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured at rest and during exercise at 60% HRR by using automatic blood pressure monitor

Results:
: SBP at rest were significantly decreased in both groups, but these changes were not different between groups. DBP at rest and during exercise was significantly decreased in HIT, but not in CME. However, SBP during exercise was significantly decreased in CME, but not in HIT. EPCs and FMD were significantly increased in HIT, but not in CME.

Conclusions:
The results of this study suggest that HIT and CME equally have beneficial effects on blood pressure reduction in pre- and hypertensive patients. However, HIT may improve endothelial function better than CME. Therefore, HIT can be an effective rehabilitation programs for hypertensive patients.
Abstract 17752: Does a Three-month “Blanking Period” Also Exist After the Second Session of Atrial Fibrillation Ablation?
Authors: Fujimoto Yuhi , Hayashi Meiso , Oka Eiichiro , Hagiwara Kanako , Takahashi Kenta , Tsuboi Ippei , Yodogawa Kenji , Iwasaki Yu-ki , Miyauchi Yasushi , Shimizu Wataru
Published: March 2022

Background:
The concept of a blanking period within three months after the first session of radiofrequency (RF) catheter ablation for atrial fibrillation (AF) is widely accepted, but it remains unclear whether this phenomenon is also observed after the second session. We tried to examine the presence of a post second session blanking period, and the factors related to this phenomenon.

Methods:
Among 549 consecutive patients who underwent an initial AF ablation, 134 (96 males, 63 ± 10 years) received a second ablation procedure, and were followed for 634 ± 421 days thereafter. The patient clinical background, laboratory data, ablation procedures during the second session, and arrhythmia recurrences defined as any episodes of atrial tachyarrhythmias lasting ≥30 seconds were analyzed. Arrhythmia recurrences were classified into two categories: those seen within and after the first three months post ablation, which were defined as early period recurrences (EPRs), and late period recurrences (LPRs), respectively.

Results:
EPRs and LPRs developed in 28 (21%) and 25 (19%) patients, respectively. Although an EPR was an independent predictor of an LPR (hazard ratio, 8.17; 95% confidence interval 2.97-22.48), 13 of the 28 patients with EPRs (46%) did not experience LPRs, supporting the concept of a blanking period. Compared to the patients with both EPRs and LPRs, those who experienced only EPRs had a higher left ventricular ejection fraction (LVEF) (63.1 ± 2.3 vs. 71.3 ± 1.5%, P=0.006) and lower serum brain natriuretic peptide (BNP) level before the ablation session (169 ± 47 vs. 55 ± 12 pg/ml, P=0.015). There were no significant differences in the clinical background, left atrial diameter, amount of RF energy delivered, ablation procedures, and serum C-reactive protein (CRP) concentration after the session between these two groups.

Conclusion:
A three-month blanking period was also recognized after the second session of AF ablation. This phenomenon was related to the better patient cardiac function indicated by the LVEF and serum BNP, but was not associated with other clinical and laboratory parameters, including CRP, and ablation procedures.
Abstract 17766: PET Imaging With 68Ga-DOTATATE Can Detect High-risk Carotid and Coronary Atherosclerotic Lesions
Authors: Tarkin Jason M , Joshi Francis R , Evans Nicholas R , Groves Ashley M , Gopalan Deepa , Manavaki Roie , Kirkpatrick Patrick J , Coughlin Patrick A , Hayes Paul , Buscombe John R , Fryer Tim D , Bennett Martin R , Davenport Anthony P , Warburton Elizabeth A , Rudd James H
Published: March 2022

Introduction:
Up-regulation of somatostatin receptor subtype-2 (SST2) has been observed on the cell surface of activated macrophages, where it can potentially be exploited as a molecular imaging target to identify high-risk plaque.

Hypothesis:
We tested the hypothesis that SST2 vascular PET imaging with 68Ga-DOTATATE can reveal high-risk plaque in patients with atherosclerosis, and compared with 18F-FDG.

Methods:
Prospective sequential 68Ga-DOTATATE and 18F-FDG PET imaging plus CT angiography was performed in 39 patients with atherosclerosis.

Results:
A total of 36 carotid arteries and 40 coronary plaques were analyzed. Mean age 69.5 ± 9.5 yrs, 76.9% male. Median (IQR) 68Ga-DOTATATE TBRmax was significantly higher in recently symptomatic carotid arteries compared to: 1) the contralateral side [p=0.0013], 2) stable carotid plaques [p<0.0001] and 3) normal carotid arteries [p<0.0001] Figs A and B. 18F-FDG TBRmax was also higher on the symptomatic side [1.60 (1.44-1.88) vs. 1.56 (1.31-1.78), p=0.0024]. Unlike 18F-FDG, myocardial 68Ga-DOTATATE binding was sufficiently low to allow coronary artery analysis in all patients. Culprit coronary plaques imaged 33 (21-62) days post-ACS had higher 68Ga-DOTATATE TBRmax compared to both stable stented plaques [p = 0.04] and stable calcific plaques [p <0.0001]; however the highest signal occurred in relation to soft lipid-rich plaques.

Conclusion:
Measuring vascular inflammation with SST2 PET is feasible and differentiates high and low risk lesions. High target specificity, low myocardial binding and generator production offer potential advantages of 68Ga-DOTATATE over 18F-FDG and other tracers for imaging atherosclerosis.
Abstract 17815: The Effects of Nanoparticle-mediated PPARγ Agonist Delivery on Plaque Stabilization: A Multichannel High-resolution Intravital Imaging Analysis
Authors: Choi Jah Yeon , Ryu Jiheun , Song Joon Woo , Kim Ji Bak , Oh Dong Joo , Gweon DaeGab , Yoo Hongki , Park Kyeongsoon , Kim Jin Won
Published: March 2022

Introduction:
Plaque inflammation is associated with fibrous cap destabilization and rupture.

Hypothesis:
We hypothesized that the specific delivery of a novel PPARγ agonist, lobeglitazone, to inflamed plaques via nanoparticle (NP) targeting mannose receptors on macrophages could reduce inflammation in atheromata and thus, tested it using serial optical intravital molecular imaging.

Methods and Results:
A novel near-infrared fluorescence (NIRF) probe was fabricated by chemically conjugating thiolated glycol chitosan with mannose-PEG, and NIRF dye Cy5.5 (ext/emi 675/694 nm) for imaging. Lobeglitazone was incorporated into NIRF-NP targeting macrophage mannose receptors (MMR). In vitro, MMR-NIRF-NP was selectively uptaken by RAW264.7 cells, and NIRF signals were estimated to be 10-fold over control group (p<0.01). In ELISA and immunoblot analysis, lobeglitazone-incorporated MMR-NIRF-NP significantly decreased inflammatory cytokines. To assess the therapeutic effects in vivo, macrophage activity in the carotid plaques of apoE-/- mice were serially imaged using a customized multichannel intravital fluorescence microscope (IVFM) under mechanical carotid stabilization. After baseline imaging, lobeglitazone-loaded MMR-NIRF-NPs were intravenously injected (7 mg/kg, twice weekly) and plaque NIRF signals were compared with p.o. treated group and controls. Four weeks later, IVFM at the same plaques revealed that macrophage signals much more decreased in lobeglitazone-loaded NP treated mice compared to those at baseline, and controls (P<0.05). FM and immunostainings corroborated the in vivo findings.

Conclusions:
Lobeglitazone-incorporated MMR-NIRF-NP was able to selectively target and image atheroma macrophages, and effectively reduce plaque inflammation as assessed by intravital optical imaging. NP-mediated lobeglitazone delivery could be a promising therapeutic strategy for high-risk plaque stabilization.
Abstract 17817: The Incidence and Mortality Risk of Acute Thoracic Aortic Dissection: Results From a Nationwide Population-based Study
Authors: Melvinsdottir Inga H , Lund Sigrun H , Agnarsson Bjarni A , Sigvaldason Kristinn , Gudbjartsson Tomas , Geirsson Arnar
Published: March 2022

Introduction:
Acute thoracic aortic dissection is a potentially lethal disease associated with high morbidity, however, contemporary data on incidence and mortality risk are lacking. Utilizing a nationwide data comprising the Icelandic population we aimed to determine the incidence, mortality and the time-dependent mortality risk of acute thoracic aortic dissection.

Methods:
Data was retrospectively collected using hospital discharge registries in Iceland from 1992-2013 as well as autopsy database from Medical Examiner Office. To capture all cases diagnostic codes for dissection (ICD-9: 441.1 and ICD-10: I71.0) were queried as well as for aortic aneurysm and arterial dissection. Total of 1811 charts were reviewed resulting in 153 confirmed diagnoses of acute thoracic aortic dissection. Demographics, medical history, risk factors and clinical symptoms were collected for all patients. Incidence was calculated using age and gender specific information provided by National Statistics Iceland.

Results:
Age and gender-adjusted incidence of acute thoracic aortic dissection was 2.5/100,000/year and no significant change in incidence was observed. The mean age was 66.9±13.6 years, 61% (94/153) were males and 66% (101/153) were Stanford type A. Of all patients diagnosed with dissection 18% (27/153) died prior to hospital arrival while the risk of death for all patients that arrived alive to a hospital was 21% (27/126) within 24 hours and 45% (57/126) at 30 days. Predictors for short-term mortality included female sex, renal disease and family history of dissection. The overall 10-year survival was 39% of which negative predictors included age, coronary artery disease, renal disease, peripheral vascular disease and family history of dissection. During the course of the study the 30-day mortality rate decreased by 0.96/year, (95% CI: 0.92- 0.99) and the 10-year survival improved significantly (p=0.04).

Conclusions:
Acute thoracic aortic dissection is uncommon but a lethal condition where two thirds of patients die within 30 days of the index event. The incidence remained constant but a decline in short-term mortality and increased long-term survival was observed indicating improved overall outcome in patients diagnosed with this complex condition.
Abstract 17855: Prognostic Impact of Coronary Revascularization in Acute Coronary Syndrome Patients With Cardiogenic Shock
Authors: Sakamoto Kazuo , Matoba Tetsuya , Mohri Masahiro , Tanaka Nobuhiro , Hokama Yohei , Fukutomi Motoki , Hashiba Katsutaka , Fukuhara Rei , Ueki Yasushi , Suwa Satoru , Matsuura Hirohide , Tachibana Eizo , Yonemoto Naohiro , Nagao Ken ,   JCS Shock Registry Scientific Committee
Published: March 2022

Background:
Randomized trials have shown that coronary revascularization benefits patients with acute coronary syndrome (ACS). Furthermore, recent studies reported that revascularization could improve the outcome even in high-risk patients. We investigated the prognostic impact of revascularization and the factors that abandon the invasive strategy in patients with ACS complicated with cardiogenic shock.

Methods and results:
The Japanese Circulation Society Cardiovascular Shock registry (JCS-Shock registry) was a prospective, observational, multi-center, cohort study. Between May, 2012 and June, 2014, a total of 980 patients with cardiovascular shock were enrolled from 82 centers in Japan. We assessed the prognostic impact of coronary revascularization in ACS patients in JCS-Shock registry. The primary endpoint was all cause mortality at 30 days after administration.

Among 495 subjects with ACS (ST-segment elevation acute myocardial infarction (STEMI) 408, Non-ST-segment elevation ACS (NSTEACS) 87), emergent coronary angiography was carried out in 448 (90.9%) subjects and any revascularization (percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)) was performed in 411 (83.0%) subjects.

Thirty-day mortality in subjects treated with PCI and/or CABG (Revasc group) was 29.8% and neither PCI nor CABG (Non-Revasc group) was 51.2% (n=84, 17.0%) (P=0.0015 by Chi-square test), suggesting a beneficial effect of revascularization. Baseline characteristics of subgroups in Revasc or Non-Revasc were significantly different in age (71.0 vs. 76.5, P<0.0037), female gender (23.2% vs. 40.5%, P=0.0016), previous PCI (66.7% vs. 39.1%, P<0.0276), STEACS (86.8% vs. 60.7%, P<0.0001).

Conclusions:
In the JCS Shock registry that observed contemporary emergency cardiovascular care in Japan, 30-day mortality of ACS complicated with cardiogenic shock was lower in patients underwent coronary revascularization compared with patients without any revascularization. Revascularization was less performed in elderly, female, patients without previous PCI and NSTEACS patients, associated with unfavorable outcomes. We may reconsider the therapeutic strategy to benefit patients by coronary revascularization.
Abstract 17889: A Randomized Controlled Trial of Moderate Glucose Control After Complex Pediatric Cardiac Surgery
Authors: Wang Xu , Li Shoujun , Li Xia , Ma Kai , Yang Juxian , Zeng Min , Li Shengli , Duan Leilei
Published: March 2022

Introduction:
Infants and children after cardiac surgery may develop hyper- or hypoglycemia, associating with higher nosocomial infection or neurological morbidities.

Hypothesis:
The hypothesis of this perspective randomized control study is moderate glucose control may improve clinical outcomes.

Methods:
We randomly assigned children(≤3 years of age) who were admitted to the pediatric cardiac intensive care unit (PICU) after cardiopulmonary bypass surgery into either moderate glucose control group (target blood glucose: 110-143mg per deciliter) or conventional glucose control group (target level below 200mg per deciliter). The primary outcome was the rate of nosocomial infection in PICU. Second outcomes include hospital mortality, duration of mechanical ventilation and PICU stay, and a composite morbidity variable included events of requiring extracorporeal membrane oxygenation, delayed sternal closure, dialysis-dependent renal failure and hypoglycemia.

Results:
A total of 593 patients underwent randomization: 293 to moderate glucose control group and 300 to conventional glucose control group. The baseline data were balanced between these two groups. Mean 72 hours time-weighted blood glucose average was lower in the moderate control group than in the conventional group (129.9±22.1 mg per deciliter vs. 138.8±28.6 mg per deciliter, p<0.001). Although no statistically significance reached, there is a trend that nosocomial infection occurred less in moderate glucose group (17 (5.80%) vs. 29 (9.67%), P=0.054). Duration of mechanical ventilation was shorter in the moderate control group (18 (range, 4-300) hours vs 22 (range 3-771) hours, p=0.046). Hypoglycaemia (blood glucose ≤65mg per deciliter) which occurred in 7(2.39%) patients in the moderate group versus 8 (2.67%) in the conventional group, was statistically similar between groups. Other secondary outcomes did not differ significantly between groups.

Conclusions:
With moderate glucose control, although the major clinical outcomes did not change, this randomized control study showed shorter ventilation time after pediatric cardiac surgery, substantially benefit for patients with complex congenital cardiac anomalies.
Abstract 17956: Stratification of Cardiac Electrophysiologic Phenotypes via Systematic Auditory Electrophysiology Evaluation
Authors: Kapur Sunil , MacRae Calum A
Published: March 2022

It is well appreciated that overlap exists between cardiac and auditory electrophysiology, notably the classic example of Jervell Lange Neilson syndrome. We aimed to investigate if further insights into cardiac electrophysiology could be derived via auditory electrophysiology evaluation. We performed a retrospective chart review in the Partners Healthcare system from January 2001- May 2015 for patients who underwent at least 23 hours of a Holter recording as well as an auditory hearing evaluation. 55 patients were identified. Indications for auditory evaluation included patient complaint of hearing loss, symptomatic tinnitus and pre-neurosurgical evaluation. Indications for Holter recordings included complaint of palpitations and heart rate monitoring. Of the 55 patients, 26 (47%) had at least mild sensorineural defect in at least one ear while 28 (51%) had at least mild conductive defect in at least one ear. All auditory evaluations were interpreted by a clinical audiologist. Patients with sensorineural hearing defects had an increased percentage of total (summed atrial and ventricular) ectopic beats when compared to those without any hearing defects as well as those with conductive hearing defects (3.7% versus 0.3% versus 0.5% respectively, p<0.05). The 9 patients (16%) with bilateral sensorineural loss had significant increase in atrial ectopy as a percent of total beats when compared to the 46 patients without bilateral sensorineural hearing loss (6.1% versus 1.1%, p<0.05). Patients with bilateral sensorineural hearing defects had an increased prevalence of atrial fibrillation when compared to those without sensorineural hearing loss (44% vs 14%). In conclusion, a retrospective analysis of a small population of patients having undergone clinical auditory evaluation and Holter monitoring suggests that patients with bilateral sensorineural defects have increased atrial arrhythmias over controls. This finding serves as a hypothesis generating observation regarding the ability of non-cardiac electrophysiologic findings to characterize arrhythmic propensity. These observations further suggest that extracardiac electrophysiologic determinants exist that may be leveraged to better stratify arrhythmic risk.
Abstract 17966: Circadian Variation of Intracoronary Thrombus Aspiration Efficacy in Patients With St-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
Authors: Fournier Stephane , Hugelshofer Sarah , Degrauwe Sophie , P. Marques-Vidal Pedro , Radovanovic Dragana , Erne Paul , Eeckhout Eric , Muller Olivier , Iglesias Juan-F.
Published: March 2022

Introduction:
The clinical benefit of intracoronary thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) in patients with STEMI remains controversial. Different studies have suggested a circadian variation of myocardial infarction size (IS) among patients with STEMI depending on the time of the day at symptom onset.

Hypothesis:
Clinical efficacy of manual TA varies according to circadian rhythms.

Methods:
We analyzed data from a large, nationwide, prospective, multicenter registry of patients admitted with ACS in Switzerland (AMIS). Patients undergoing primary PCI for STEMI with (TA+) or without (TA-) manual TA within 12 hours of symptom onset were included. We divided 24 hours into 4 time groups based on the time of symptom onset: group 1 (00:00-05:59), group 2 (06:00-11:59), group 3 (12:00-17:59) and group 4 (18:00-23:59). The primary endpoint was in-hospital all-cause mortality.

Results:
Between 2008 and 2014, a total of 3,648 patients (TA+, n=1,800; TA-, n=1,848) were included. In-hospital death of any cause occurred in 3.8% of the patients in the TA+ group, as compared with 3.7% in the TA- group (p=0.44). In-hospital mortality was not statistically different between the 4 time groups in TA+ and TA- patients (2.1%, 4.6%, 2.9% and 5.1% respectively in TA+ group, p=0.082 and 3.1%, 3.0%, 5.6% and 2.9% respectively in TA- group, p=0.098). We observed a circadian variation of myocardial IS in patients undergoing TA with larger myocardial IS occurring during the night period (group 1: 2,833±2,304 U/l; group 2: 2,449±2,336 U/l; group 3: 2,542±2,114 U/l; group 4: 2,995±2,424 U/l, p=0.001). Of note, there was a statistically significant net benefit of manual TA in terms of myocardial salvage in patients with symptom onset between 06:00 and 18:00 (groups 1 vs. 2: p<0.001; groups 1 vs. 3: p<0.05; groups 4 vs. 2: p<0.001; groups 4 vs. 3: p <0.05).

Conclusion:
In a real-world registry of patients with STEMI, intracoronary TA during primary PCI was not associated with improved in-hospital all-cause mortality, independently of the time of symptom onset. However, our results suggest a circadian variation of the efficacy of manual TA with a significant reduction of myocardial IS in patients with symptom onset between 06:00 and 18:00.
Abstract 17995: NT-proBNP Predicts Myocardial Damage and Correlates With Stem Cell Mobilization in Patients With ST-Eelevation Myocardial Infarction
Authors: Asfour Ahmed , Leung Steve , Mathbout Mohammad F , Klyachkin Yuri M , Abdel-Latif Ahmed , Ziada Khaled
Published: March 2022

Introduction:
N-Terminal prohormone of brain natriuretic peptide (NT-proBNP) is released from cardiomyocytes during injury. However, the relationship between plasma levels, extent of myocardial damage and its correlation with bone marrow stem cell (BMSC) mobilization are poorly understood.

Methods:
Plasma levels of NT-proBNP (pg/ml), troponin I (ng/ml) and CK (IU/L) were assessed in 76 patients with ST-elevation myocardial infarction (STEMI) at baseline (time of successful primary percutaneous intervention) then at 6, 12, 24, and 48-hour intervals. Levels of circulating Lin-/CD45- cells that are positive for CXCR4, CD34 and CD133 (BMSCs) were examined at the same time points using flow cytometry. Echocardiography and cardiac MRI (CMR) were performed prior to hospital discharge for assessment of cardiac function and scar size. Extent of myocardial damage was quantified using peak biomarker levels and gadolinium enhancement on CMR.

Results:
Patients characteristics were consistent with the typical demographics for STEMI population (Panel A). Plasma levels of NT-proBNP increased steadily following STEMI to peak at 24 hours (Panel B). Peak NT-proBNP levels correlated positively with indices of myocardial damage such as peak troponin I (r=0.6, P<0.001), peak CK (r=0.3, P=0.04) and late gadolinium enhancement on CMR examination (r=0.54, P=0.02) (Panels C-E). NT-proBNP levels correlated negatively with left ventricular ejection fraction and volume on echocardiography and CMR. There was strong correlation between peak NT-proBNP levels and peak numbers of circulating BMSCs such as Lin-/CD45-/CXCR4+ BMSCs (r=0.6, P<0.001) (Panel F).

Conclusion:
Peak levels of NT-proBNP following STEMI are predictive of the extent of myocardial damage quantified by cardiac biomarkers or CMR. NT-proBNP levels are also associated with the extent of BMSC release, raising the possibility that it has a role in initiating the myocardial reparative process following STEMI.