bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 2152: Close Bidirectional Relationship Between Chronic Kidney Disease and Atrial Fibrillation: The Niigata Preventive Medicine Study
Authors: Watanabe Hiroshi , Watanabe Toru , Sasaki Shigeru , Nagai Kojiro , Aizawa Yoshifusa
Published: July 2021

Atrial fibrillation (AF) and chronic kidney disease share risk factors including obesity, hypertension, diabetes, and the metabolic syndrome as well as pathophysiologic mechanisms including persistent inflammation and oxidative stress. We tested the hypothesis here that two conditions are risk factors for each other. This is a prospective community-based observational cohort study based upon an annual health check-up in Niigata prefecture, Japan. We studied the association of kidney dysfunction with new-onset AF and the association of AF with development of kidney disease in 235,818 subjects (mean age, 60.9 ± 11.7 years). Development of kidney dysfunction was defined by an elevation of serum creatinine level (≥1.4 mg/dL for men, ≥1.2 mg/dL for women) or an GFR reduction (<60 ml/min/1.73 m
2
) in subjects without baseline kidney dysfunction.
Kidney disease as risk of AF
During a follow-up of 5.9 ± 2.4 years, AF developed in 2,947 subjects (1.3%). Baseline serum creatinine and GFR were associated with risk of subsequent AF (adjusted hazard ratios, HRs [95% confidence interval, CI], 1.09 [1.02–1.17] for serum creatinine [1 mg/dL increment] and 1.02 [1.00 –1.03] for GFR [10 ml/min/1.73 m
2
decline]). The HRs for AF increased inversely with GFR: 1.32 (95% CI, 1.08 –1.62) for GFR 30 –59 ml/min/1.73 m
2
and 1.57 (95% CI, 0.89 –2.77) for GFR <30 ml/min/1.73 m
2
. The effect of chronic kidney disease on risk of new-onset AF was significant after eliminating subjects with treated hypertension or diabetes.
AF as risk of kidney disease
During a 5.9 year follow-up, 7,791 subjects (4.0%) developed kidney dysfunction and 11,307 subjects (5.8%) developed proteinuria. Baseline AF was associated with development of kidney dysfunction (HRs [95% CI], 1.84 [1.30 –2.61] for serum creatinine-based model and 1.77 [1.50 –2.10] for GFR-based model) and proteinuria (HR [95% CI], 2.20 [1.92–2.52]). The association remained significant in subjects without treated hypertension and diabetes. Kidney dysfunction increased the risk of new-onset of AF and AF increased risk of development of kidney disease. This finding supports the concept that the two conditions share common abnormal molecular signaling pathways contributing to their pathogenesis.
Abstract 2155: Plasma Adiponectin Levels in Patients with Atrial Fibrillation
Authors: Shimano Masayuki , Shibata Rei , Tsuji Yukiomi , Ouchi Noriyuki , Inden Yasuya , Murohara Toyoaki
Published: July 2021

The occurrence and development of atrial fibrillation (AF) are associated with changes in electrical properties and cardiac structure, known as electrical and structural atrial remodeling. AF characterized by atrial remodeling also occurs with obesity-related conditions. Adiponectin, an adipose tissue-derived hormone, exerts beneficial effects on the heart in various pathological conditions. These observations led us to speculate that adiponectin levels affect the development and prevalence of AF. Here, we investigated a potential association between circulating adiponectin levels and atrial remodeling in patients with AF. We measured plasma adiponectin levels, serum carboxy-terminal telopeptide of collagen type I (CITP) levels, as a collagen type I degradation marker, and serum type III procollagen-N-peptide (PIIINP) levels, as a collagen type III synthesis marker in consecutive 414 patients; 225 paroxysmal AF, 81 persistent AF and 108 paroxysmal supra-ventricular tachycardia without AF history (control) patients, who admitted for scheduled radiofrequency catheter ablation. Plasma adiponectin levels were significantly higher in patients with persistent AF compared to paroxysmal AF and control patients (p<0.05). Serum CITP levels, but not serum PIIINP levels, were also higher in patients with persistent AF compared to paroxysmal AF and control patients (p<0.05). In addition, a positive correlation was observed between adiponectin levels and CITP levels (r=0.39, p<0.005) or the P wave duration (r=−0.31, p<0.05) in patients with persistent AF. High plasma adiponectin levels are associated with the presence of persistent AF, which is accompanied by increased CITP levels. Hyperadiponectinemia might also attenuate atrial conduction disturbance. Thus, measurement of plasma adiponectin could be useful for assessment of AF.
Abstract 2171: The Rechargeable ICD: A new Application for a Well-Known Technology: Results of a Long-term Animal Study.
Authors: Niehaus Michael , Goerler Heidi , Detsch Daniel , Klein Gunnar
Published: July 2021

Current ICD-systems use a non rechargeable dry battery as energy source. Thus, the life span of these systems is limited by the capacity of their battery. Therefore, this project deals with the development of a device (rechargeable ICD - rICD) being recharged transcutaneously by a magnetic field.

Method:
A prototype of this rICD consisting of an 4
th
generation ICD housing containing a lithium polymer rechargeable battery, a charging coil for receiving the transmitted energy, integrated circuits for charging controls and a new telemetry system. These devices were tested in a long-term animal study in 10 Merino sheep (age 2±0.5 years, weight 54±9 kg) over a period of 1 year. By means of the telemetry system, the rICD was controlled. State of charge, LiIon voltage, charging current and temperature of LiIon battery, electronics and rICD housing were monitored continuously. Under general anaesthesia (ITN), the prototypes were implanted on the lateral neck of the sheep. The implantation of the devices, positions of charging coils and telemetry antennas as well as the implantation depths were documented by means of x-ray. All animals underwent monthly follow-ups with full charge-discharge cycles. At last, the animals were euthanatized and the ICD pockets were excised and analyzed microscopically.

Results:
Implantations were successful in all animals. Mean implantation depth was 2.2±0.6 cm. Monthly follow-up measurements showed that neither the tissue exposed to the electromagnetic field nor the device itself nor the LiIon battery presented with significant heating. Mean charging current was 34±11 mA. Thus, efficient charging of the LiIon battery was possible. One animal presented with a pocket infection. Other tissue alterations of the ICD-pockets have not been observed.

Conclusion:
The transcutaneous wireless energy transfer for rechargeable ICDs has been shown to be reliable, stable and effective in a long-term animal study.
Abstract 2194: Age and Double Product Reserve-Adjusted Modification of the Duke Treadmill Score Nomogram
Authors: Rafie Amir H Sadrzadeh , Dewey Frederick E , Sungar Gannon W , Ashley Euan A , Hadley David , Myers Jonathan , Froelicher Victor F
Published: July 2021

The Duke Treadmill Score (DTS) is an established clinical tool for risk stratification from exercise testing. We aimed to determine if age and other variables could improve the prognostic power of the DTS and if so, to modify the DTS nomogram. From a total of 1959 patients referred for exercise testing at the Palo Alto VA Medical Center from 1997 to 2006, we studied 1759 male veterans (mean ± SD age, 57±12 years) free of heart failure. Double product (DP) was calculated by multiplying systolic BP and HR; variables and their products were subtracted to obtain the differences between rest and maximal exercise (reserve) and recovery. Cox survival analysis was performed for 157 all-cause and 53 (34%) cardiovascular deaths (CVD) during a follow-up of 5 years. Of all the hemodynamic measurements, DP reserve was the strongest predictor of CVD (Wald Z-score, −3.84; P<0.00001) after adjustment for potential confounders. When the components of DTS were entered in the Cox hazard model with DP reserve and age, only DP reserve and age were chosen (P<0.00001). Using the Cox coefficients, a score of [Age - DTS - 3 x (DP reserve/1000)] yielded AUC of 0.84 compared to 0.76 for the DTS. Using this equation, a nomogram was constructed by adding age and DP reserve to the original DTS nomogram. The point at which the modified DTS line intersects the line drawn from the Age - DTS line to the corresponding value for DP reserve/1000 indicates average annual CVD. We propose an age and DP reserve adjusted DTS nomogram that improves the prognostic estimates of average annual CVD over the DTS alone. This nomogram requires external validation and extension to women.
Abstract 2195: Significant Relation of Arterial Stiffening to Hyperventilatory Response to Exercise in Patients with Coronary Artery Disease
Authors: Enko Kenki , Sakuragi Satoru , Kusano Kengo
Published: July 2021

Exercise intolerance is a common feature of patients with coronary artery disease (CAD). Enhanced ventilatory response is determinants of exercise capacity and marker of a poor prognosis irrespective of LV systolic function. Pulse wave velocity (PWV), which is a reliable marker of arterial stiffness, modulates left ventricular (LV) function and is related to exercise capacity in CAD patients; however, the relationship of PWV to ventilatory response to exercise in CAD patients has not been fully elucidated. In this study, we examined PWV and cardiopulmonary exercise testing (CPX) in CAD patients and evaluated the relationship between PWV and ventilatory response to exercise. We studied 81 CAD patients (69±8yo, 64men). All subjects underwent symptom limited CPX. Ventilatory response to exercise was determined by VE/VCO
2
slope. We also measured PWV using an automated device (form ABI/PWV, Colin, Japan) prior to CPX. LV function was assessed by echocardiogram. In univariate analysis, PWV was related to VE/VCO
2
slope (r=0.34, p<0.01). PWV was also associated with exercise time (r=−0.22, p<0.05), time to ST depression (r=−0.32, p<0.01) and peak VO
2
(r=−0.44, p<0.01). The relationship between PWV and VE/VCO
2
was still significant after adjustment for age, sex and blood pressure. Patients with high PWV (over 1800cm/sec, n=29) had higher BNP (140±214 vs 59±66 pg/ml, p<0.05) and lower E/A ratio (0.7±0.2 vs. 0.9±0.3, p<0.05) than those with low PWV (under 1800cm/sec, n=52). In exercise testing, patients with high PWV had higher VE/VCO
2
slope (30.9±2.6 vs. 29.0±3.4, p<0.01), shorter time to ST depression than patients with low PWV (352±79 vs. 403±59 sec, p<0.01), whereas severity of CAD, defined as number of diseased vessels, was comparable between the two groups. Arterial stiffening is associated with enhanced ventilatory response to exercise in CAD patients. Diastolic dysfunction and lowered threshold of myocardial ischemia associated with arterial stiffening are probably involved in the hyperventilatory response to exercise in CAD patients.
Abstract 2243:
In Vivo
3D MR Angiography Reveals Accelerated Collateral Vessel Growth in CD73
−/−
Mice after Hindlimb Ischemia
Authors: Flögel Ulrich , Böring Yang C , Jacoby Christoph , Schrader Jürgen
Published: July 2021

Adenosine is a potent stimulator of angiogenesis, however, its role in arteriogenesis is not yet known. To address this issue we induced severe hindlimb ischemia in a mouse mutant lacking CD73 (ecto-5′-nucleotidase) which shows enhanced monocyte adhesion to the endothelium, considered to be an important initial trigger for arteriogenesis. For serial comparison of blood flow recovery and direct visualization of newly developed collateral vessels in wild-type (WT) and CD73
−/−
mice we established a high resolution 3D MR angiography (MRA) protocol. MRA images (field of view 2.56x2.56x1.92 cm
3
, matrix 256x256x192, voxel size 1 nl) of murine hindlimbs were recorded at 9.4 T within a reasonable acquisition time of approximately 30 min and were subsequently segmented and quantified using in-house-developed software. Collateral flow was detected as early as 3 d after ligation reaching a transient maximum 7 d after occlusion. At this time the extent of collateralization in the ischemic area was substantially enlarged in CD73
−/−
mice (+70% vs. WT, p<0.05, n=6). The improved blood supply was also reflected in a faster recovery of hindlimb muscle energetics in the mutant compared with WT controls as assessed by
31
P MR spectroscopy
in vivo
. Histology confirmed the enhanced development of collaterals in CD73
−/−
mice. In conclusion, our protocol allows the quantitative assessment of growing collateral vessels in mice. We found that lack of CD73-derived adenosine promotes arteriogenesis. Fig. 1

: MRA from hindlimbs of CD73
−/−
mice 7 d after ligation of the femoral artery. Newly developed collateral vessels are colored in green. Insert shows the typical “corkscrew morphology” of the collaterals.
Abstract 2245: Interventional Electrophysiology Studies And Ablation Therapy Under Real Time MRI Guidance - Early Detection Of Complications
Authors: Ritter Oliver , Nordbeck Peter , Fidler Florian , Warmuth Marcus , Hiller Karl-Heinz , Nahrendorf Matthias , Maxfield Michelle , Wurtz Sabine , Geistert Wolfgang , Broscheit Jens , Jakob Peter M , Bauer Wolfgang R
Published: July 2021

Background:
Cardiac magnetic resonance imaging (MRI) offers 3D real time imaging with unsurpassed soft tissue contrast without X-ray exposure. However, electrophysiological (EP) examinations of patients with rhythm disorders and ablation procedures are still not possible in the MRI environment. To minimize safety concerns and imaging artifacts, we aimed at developing a setup including catheters for interventional EP based on carbon technology.

Methods and Results:
The setup, which includes a steerable carbon catheter, was tested for safety, image distortion, pacing and sensing properties, and feasibility of ablation at 1.5 Tesla. MR imaging was performed in two different 1.5-T whole-body scanners. To assess unintentional heating of the catheters by radio frequency (RF) pulses of the MR scanner
in vitro
, a fluoroptic thermometry system was used to record heating at the catheter tip.
In vivo
tests for pacing and sensing properties and ablation therapy were performed in eight pigs. There was no significant heating of the carbon catheters while using short, repetitive RF pulses from the MR system. Since there was no image distortion when using the carbon catheters, exact targeting of the lesion sites was possible. During imaging, pacing of
in vivo
pig hearts and sensing the intra cardiac electrogram was possible without any artifacts. Several RF-ablation procedures, including AV node modulation were performed successfully in the scanner. Potential complications during ablation such as perforation of the RV free wall could be monitored in real time as well.

Conclusion:
Here we describe a newly developed EP technology for interventional electrophysiology based on carbon catheters. These catheters are suitable for electrophysiological diagnostic and ablation procedures. Their feasibility was demonstrated by performing safety EP studies and ablation therapy with carbon catheters in the MRI environment.
Abstract 2246: Coronary Arterial Positive Remodeling Detected by MRI: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Miao Cuilian , Chen Shaoguang , Macedo Robson , Lai Shenghan , Liu Kiang , Li Debiao , Wasserman Bruce A , Vogel-Clausen Jens , Lima Joao A , Bluemke David A
Published: July 2021

The purpose of this study was to determine the ability of magnetic resonance imaging (MRI) to detect early changes of coronary atherosclerotic remodeling. Positive remodeling is associated with plaque vulnerability and rupture. 179 subjects (90 men, age 61±9 yrs) free of clinical cardiovascular disease underwent cross-sectional coronary wall MRI using a black blood technique. Outer contour area (“vessel size”), lumen area, and mean vessel wall thickness were obtained. Linear regression was used to determine the correlations of mean wall thickness with outer contour area or lumen area before and after adjustment for body size parameters. The outer contour area increased with increasing mean wall thickness (p<0.0001). Lumen area also increased, but at a smaller rate than outer contour area (p<0.0001). When men and women were examined separately (Figure

), the relationships continued to be significant (P<0.0001 and 0.05 respectively) with no differences in these relationships between men and women. When vessel size was normalized by LV size or body mass index, the relationships remained significant, and the relative slopes were similar to that in the non-normalized model. The positive correlations between outer contour area and vessel wall thickness remained significant for each coronary bed (right, left main, left anterior descending) individually.
Abstract 2250: Is Atrial Fibrillation in Hypertrophic Cardiomyopathy Due to Left Atrial Structural Remodeling as Determined by Speckle-Derived Atrial Strain Imaging?
Authors: Shan Ying , Lin Grace , Yuasa Toshinori , Miller Fletcher A , Ommen Steve R , Brady Peter A
Published: July 2021

Background: Atrial fibrillation (AF) is common in HCM yet the mechanisms are poorly understood but are likely secondary to either the consequences of left atrial structural remodeling (LASR) or myopathy, or triggers arising from pulmonary and other thoracic veins. The presence and severity of LASR as characterized by left atrial strain (LA ϵ), and its relationship to AF in HCM, has not been determined. Therefore, we measured LA ϵ and strain rate (SR) in Pts with HCM both with (AF+) and without (AF−) prior AF and compared these measures to those in age and gender matched controls without HCM or AF.

Methods: Two-dimensional speckle-derived LA longitudinal peak ϵ, SR during systole (SR
S
), early (SR
E
) and late diastole (SR
A
) were measured at the basal and mid portions of the lateral, septal, and posterior LA walls using Vector Velocity Imaging during sinus rhythm and were averaged.

Results: Mean age of Pts in each of the matched groups was 56 ± 2 years (16 males; 59%). Significant left ventricular outflow tract obstruction was present in all Pts with HCM. Diastolic dysfunction was similar in both HCM groups and worse when compared to controls. Peak LA
3
, SR
S
, SR
E
, and SR
A
for each group is shown (table 1

). HCM was associated with significantly lower LA ϵ and SR compared to controls. Although LA size was increased in Pts with HCM when compared to controls there was no correlation between LA size and ϵ or SR (p>0.05 for all). No differences in LA ϵ and SR were found between AF+ versus AF− Pts.

Conclusion: HCM is associated with LASR as determined by decreased LA ϵ and SR. However, LA ϵ and SR were similar in AF+ versus AF− Pts suggesting that the occurrence of AF in HCM is not due to LASR alone.

Table 1.

Left Atrial Strain and Strain Rate in Hypertrophic Cardiomyopathy
Abstract 2275: The Association of Cardiac Catheterization Timing, Contrast Media Amount, and Preoperative Renal Function with Post Cardiac Surgery Acute Renal Failure and Mortality
Authors: Medalion Benjamin , Cohen Hilit , Assali Abid , Snir Eitan , Sharoni Erez , Biderman Philip , Kornowski Ran , Porat Eyal
Published: July 2021

Background

The effect of cardiac catheterization timing, contrast media dose, and preoperative renal function on post cardiac surgery acute renal failure (ARF) prevalence is unclear.

Methods and Results

Data of 395 consecutive patients who underwent CABG were prospectively collected. Glomerular filtration rate (eGFR) was estimated by the CockcroftGault equation. Patients were divided into 3 groups according to the time between cardiac catheterization and surgery (Group I:≤1 day, Group II:>1 and ≤5 days, Group III:>5 days). Patients who underwent salvage operation, or were on dialysis before surgery were excluded. Multivariable analysis was used to identify risk factors for ARF (defined as 25% decrease from baseline of eGFR, and eGFR≤60ml/min on postoperative day 3). propensity score analysis was used to adjust differences in preoperative characteristics between groups. ARF developed in 13% of patients. Hospital mortality was 3.3% and was higher in patients who developed ARF (21%) vs those that did not (0.6%, p<0.001). Multivariable analysis identified operation within 24 hours of catheterization (OR=4), and eGFR<60ml/min up to 5 days from catheterization (OR=2.5) as independent predictors of ARF (p<0.05). The use of more than 1.4 ml/kg of contrast media in patients with eGFR<60ml/min predicted ARF as well (OR=5, p<0.001). Older age, lower weight, and lower preoperative hemoglobin levels were also associated with ARF.

Conclusions

Whenever possible, cardiac surgery should be delayed for at least 24 hours (preferably 5 days) from catheterization, especially in patients with low eGFR, and in those who received high dose of contrast media.
Abstract 2280: Three Hundred Consecutive Cases of Multi-Vessel Small Thoracotomy (MVST) Coronary Artery Bypass Grafting
Authors: McGinn Joseph T , Reddy Vijaysimha , Lapierre Harry , Ruel Marc
Published: July 2021

Background:
Multi-Vessel Small Thoracotomy (MVST) is a new coronary operation that does not require special infrastructure and is potentially available to all cardiac surgeons. It aims at approaching the minimal invasiveness of percutaneous coronary interventions (PCI) while giving patients the durability of surgical revascularization. We examined the feasibility and safety of MVST in the first large series of this operation to date.

Methods and Results:
All myocardial territories can be accessed via a 4 – 6cm left 5th intercostal (IC) thoracotomy. An endothoracic apical retractor and epicardial stabilizer are introduced through the subxyphoid and left 7th IC spaces, respectively. The procedure is performed off-pump. The left internal thoracic artery (LITA) is used to graft the left anterior descending (LAD), and radial artery or saphenous vein segments are used to graft the lateral and inferior myocardial territories. Proximal anastomoses are performed from the LITA as a T-graft or directly on the aorta. In the first 300 consecutive MVSTs at our 2 centers, mean age was 61.9±10.7y and 97 patients were female (32%). Diabetes was prevalent in 94 (31%) and previous PCI in 69 (23%). The average number of grafts was 2.1±0.8; 104 patients (34%) had total arterial grafting, and 7 (2.3%) underwent MVST as a hybrid revascularization strategy. There were 12 conversions to sternotomy (4.0%), 7 patients requiring CPB assistance (2.3%), and 3 reinterventions for bleeding (1.0%). Perioperative mortality was 2 patients (0.7%). Respiratory failure occurred in 22 patients (5.3%), atrial fibrillation in 52 (17%), and the median length of stay was 4 days. No stroke or deep wound infection occurred. At a mean follow-up of 19.2±9.4 months, 9 patients (3.0%) had required postoperative coronary interventions, 7 of which were for issues with LITA T-grafts. Only 2 graft failures occurred in the 128 patients with proximal anastomoses onto the aorta (P=0.1 vs. LITA T-grafts).

Conclusions:
MVST is feasible, safe, and associated with excellent procedural and short-term outcomes. The avoidance of T-grafts from the LITA may optimize long-term patency. The MVST procedure has the potential to make multi-vessel minimally invasive coronary surgery safe, effective, and diffusible.
Abstract 2298: Impact of Preopeartive Anemia on Long-term Outcomes Following Isolated Coronary Artery Bypass Surgery
Authors: Li Yan , Zheng Zhe , Zhang Shiju , Wang Xianqiang , Gao Huawei , Hu Shengshou
Published: July 2021

Background:
The prognostic and clinical value of preopeartive anemia in patients undergoing cardiac surgery has recently been recognized. However, very limited information exists on the impact of preopeartive anemia on long-term outcomes following coronary artery bypass graft (CABG) surgery. This study aimed at examining the degree to which preopeartive anemia affects long-term outcomes after isolated CABG surgery.

Methods:
A unicenter study was conducted on 5488 consecutive survivors of isolated CABG between January 1999 and December 2005. Preopeartive anemia was defined according to the World Health Organization definition (hemoglobin < 13g/dL for male; hemoglobin < 12g/dL for female). Long-term outcomes of interest were total mortality, myocardial infarction (MI), repeated revascularization, and major adverse cardiac events (MACEs=total mortality or MI or repeated revascularization). These outcomes were compared after adjustment for differences in baseline risk factors among the patients.

Results:
1437 (26.2%) patients had preoperative anemia. After a mean follow-up of 43.3±18.3 months, preoperative anemia was found to be an independent risk factor for total mortality (hazard ration [HR]: 1.490; 95% CI: 1.074 to 2.067; p=0.017), MI (HR: 1.595; 95% CI: 1.028 to 2.474; p=0.037) and MACEs (HR: 1.363; 95% CI: 1.059 to 1.755; p=0.016). We also found that aspirins and beta-blockers were underused in patients with anemia during follow-up.

Conclusions:
Preopeartive anemia has a strong negative impact on long-term outcomes following isolated CABG. Our data also suggest that the incorporation of preoperative anemia into the risk assessments of long-term outcomes after CABG is recommended. Future intense and systematic studies are needed to help ensure high-quality cardiac care of patients with anemia.
Abstract 2311: The Complete Supraannular Concept - In-vivo Hemodynamics of Bovine and Porcine Aortic Bioprostheses
Authors: Ruzicka Daniel J , Eichinger Walter B , Hettich Ina M , Hutter Andrea , Bleiziffer Sabine , Badiu Catalin C , Bauernschmitt Robert , Lange Ruediger
Published: July 2021

Complete supraannular placement of an aortic bioprosthesis is one approach to optimize the hemodynamic result of an aortic valve replacement. It is achieved with the combination of a special valve design and the supraannular sewing technique with non-everted mattress sutures. We evaluated five bioprostheses designed for complete supraannular placement to assess potential hemodynamic differences due to other factors (e.g. valve material) than implantation position. In 336 patients (mean age 72.0 ± 7.1 years; 143 females) hemodynamics including mean pressure gradients (MPG), effective orifice areas (EOA), and indices (EOAi) and incidence of patient-prosthesis-mismatch (PPM) were evaluated 6 months postoperatively. Annulus diameter was measured intraoperatively. Patients received the CE Perimount Magna (Magna n = 169), Medtronic Mosaic (Mosaic n = 46), Mosaic Ultra (Ultra n = 17), SJM Epic Supra (n = 46) and the Sorin Soprano (Soprano n = 58). MPG, EOA and EOA
i
for all patients divided by annulus size groups are presented in table 1

. Severe PPM was observed more frequently in patients with the Mosaic (12/46; 26.1%) and Ultra (3/17; 17.6%) prostheses. Complete supraannular placement cannot prevent high pressure gradients or patient-prosthesis-mismatch thoroughly, but the choice of a bovine prosthesis can optimize hemodynamic performance.
Abstract 2320: Long Acting Erectile Dysfunction Drug Tadalafil Limits Myocardial Ischemia/Reperfusion Injury and Preserves Left Ventricular Function through Protein Kinase G Dependent Pathway
Authors: Salloum Fadi N , Ockaili Ramzi A , Abbate Antonio , Hoke Nicholas N , Chau Vinh Q , Lall Sumeet , Kukreja Rakesh C
Published: July 2021

Tadalafil (TAD) is a novel long acting inhibitor of phosphodiesterase-5, which enhances erectile function in men through accumulation of cGMP in the corpus cavernosum. Since cGMP-dependent protein kinase (PKG) signaling plays a key role in cardioprotection, we hypothesized that TAD would limit myocardial infarction (MI) following ischemia/reperfusion (I/R) through a mechanism involving PKG. Additionally, we contemplated that TAD would preserve left ventricular (LV) function following 30 min ischemia and 24 hr reperfusion. TAD (1 mg/kg, ip) or 10% DMSO (vehicle) was administered in ICR mice 1 hr prior to 30 min of regional ischemia by coronary artery occlusion followed by 24 hr reperfusion. In another subset of mice, KT5823 (KT), a specific PKG inhibitor (1 mg/kg, ip), was administered 10 min before TAD or 10% DMSO. Infarct size was measured at the end of reperfusion using TTC and LV function was assessed using transthoracic echocardiography. Infarct size was reduced in TAD-treated mice as compared to controls. KT abolished TAD-induced protection and KT alone had no effect on infarct size in controls (Figure

). All groups did not present with significant LV dilatation at 24 hr post infarction. However, TAD preserved fractional shortening (FS:31 ± 1.5%) as compared to control mice (FS: 22 ± 4.8%, P ± 0.05). Baseline FS was 44 ± 1.7%. KT abrogated the preservation of LV function with TAD by a marked decline in FS to 17 ± 1%. TAD is a powerful cardioprotective agent which limits MI and preserves LV function through activating PKG. Therefore, this drug may be a useful therapeutic modality to suppress I/R injury in patients with cardiovascular disease.
Abstract 2321: Reactive Oxygen Species-Induced Activation of 5′AMP-Activated Protein Kinase Mediates Cardioprotection Against Ischemia and Reperfusion Injury
Authors: Onderwater Geert , Hamdani Nazha , Vreden M. Jumoke A , Steenhuisen Jeroen , Eringa Etto C , Stienen Ger J , Loer Stephan A , Bouwman R. Arthur , Lamberts Regis R
Published: July 2021

The myocardium possesses intrinsic protective mechanisms against ischemia and reperfusion injury (I/R). 5′AMP-activated protein kinase (AMPK) is known as regulator of cellular energy status and is reduced during diabetes mellitus. Recently, AMPK is also implicated in ischemic preconditioning leading to cardioprotection against I/R. We hypothesize that AMPK is involved in anesthetic-induced cardioprotection and that this AMPK activation is evoked by production of reactive oxygen species (ROS). Isolated Langendorff-perfused rat hearts were subjected to 35 minutes of global ischemia followed by 120 minutes of reperfusion. Hearts were divided into 2 groups: a Control group and a Sevo group receiving three times 5-minute episodes of 2.5 vol% sevoflurane before I/R. AMPK phosphorylation was determined with Western Blot analysis. Cardioprotection was assessed as recovery of left ventricular pressure after I/R and as infarct size using triphenyltetrazolium chloride staining. In the Control group, I/R resulted in a twofold increase in phosphorylation levels of AMPK (Control 1.0 ± 0.1 vs. Control-I/R: 2.3 ± 0.1 a.u., n = 4, p < 0.05). Sevoflurane preconditioning did not immediately, prior to ischemia, affect the AMPK phosphorylation (Sevo 0.9 ± 0.2 vs. Control 1.0 ± 0.2, n = 6), but doubled the increase in AMPK phosphorylation to control after ischemia (Sevo-I: 2.0 ± 0.5 (vs. Control-I), n = 6, p < 0.05), as well as after I/R (Sevo-I/R: 2.1 ± 0.3 vs. (Control-I/R), n = 6, p < 0.05). The AMPK-inhibitor compound C (1 and 10 μM) reduced the increase in AMPK phosphorylation and abolished the cardioprotection derived from functional recovery and infarct size. In addition, the ROS-scavenger n-(2-mercaptopropionyl)-glycine (MPG, 1mM) also reduced the sevoflurane-mediated increase in AMPK phosphorylation and completely prevented cardioprotection. These results demonstrate for the first time a direct link between AMPK activation and the production of ROS in cardioprotection. We conclude that anesthetic-induced AMPK activation protects the heart against I/R and relies on production of ROS, which might be especially important in the context of impaired cardioprotection in the diabetic myocardium.
Abstract 2379: Use of Hospice and Acute Care in Heart Failure vs. Cancer at End-of-Life
Authors: Setoguchi Soko , Glynn Robert J , Flavell Carol N , Levin Raisa , Stevenson Lynne W
Published: July 2021

Advances in heart failure (HF) have prolonged survival but more patients (pts) die from HF than from any type of cancer. Quality of care improvement for HF has focused largely on initiation of life-saving treatments. Pts dying of HF were less likely to be supported by hospice and more likely to die in hospitals than pts with terminal cancer. Two end-of-life cohorts (HF and cancer) were identified using Medicare data. The HF cohort consisted of pts with 2 HF hospitalizations before cardiac death. The cancer cohort had registry-defined solid-organ cancer and death attributed to cancer. We assessed hospice use, ER visit, and acute hospitalization during 30 days prior to death and deaths in hospitals. Time trend and predictors of hospice use were also assessed. Among 7,930 HF pts with median age 82, 78% female and 5% black, 20% were referred to hospice compared to 51% in 7,565 cancer patients. The mean duration of hospice prior to death was longer with heart failure (68 for HF and 15 days for cancer). A modest rise in hospice use over time was parallel in the two groups. Acute care prior to death was higher for HF than cancer pts. (59 vs. 40% for ER visit and 62 vs. 45% for hospitalizations). More HF pts died in acute care hospitals than cancer pts (37 vs. 21%). Younger age, male gender, black race and dialysis therapy were associated with lower use of hospice in multivariate analyses. Although hospice use is increasing slowly over time, the contribution of hospice remains lower in HF, and more HF deaths occur in acute care settings. Further studies are needed to assess indications for hospice and acute care services in HF patients at the end of life.
Abstract 2390: Düsseldorfer-ABCD Trial (Autologous Bone Marrow Cells in Dilated Cardiomyopathy)
Authors: Schannwell Christiana M , Yousef Muhammad , Basalyk Carmen M , Zeus Tobias , Brehm Michael , Köstering Matthias , Strauer Bodo-Eckehard
Published: July 2021

Heart failure is a dangerous disease with an increasing frequency. Although conventional drug therapy may delay remodeling, there is no basic therapeutic regime available for preventing or even reversing this process. Several preclinical as well as clinical trials have shown that transplantation of autologous bone marrow cells improved cardiac function after myocardial infarction and chronic heart disease (CAD). We investigated the effects of intracoronary (ic) autologous stem cell transplantation (STX) at patients with non-ischemic dilated cardiomyopathy (DCM).

Methods: A total of 10 patients with DCM were included in this study (group I). The control group also consists of 10 age and sex-matched patients with comparable ejection fraction (group II). CAD and myocarditis were excluded. All patients of group I received an ic autologous STX with mononuclear cells. Cell transplantation was performed via the ic administration route. All cells were infused directly into the dominant coronary vessel. To achieve a maximal ischemic stimulus all patients received Dobutamine intravenously and Dipipyridamol by ic application. All 20 patients were re-investigated after 3 months.

Results: Three months after ic STX, the global left ventricular ejection fraction increased in patients from 18 ± 1 up to 26 ± 3% (p < 0.01). In parallel the physical ability (functional capacity) rose from 25 to 75 watt (p < 0.01). In addition, we found an improvement of maximum oxygen uptake under stress from 1236 ± 217 up to 1473 ± 198 ml/min (p < 0.01). Furthermore we documented a reduction of arrythmia. An unchanged or even impaired left ventricular function was not observed in any patient of group I. In the control group (group II) no significant changes were documented. No side effects of ic autologous STX were found, particularly no arrythmias, no heart insufficiency, no dyspnoea and no palpitations.

Conclusion: These results show that transplantation of autologous bone marrow cells, as well as the ic approach, represents a novel and effective therapeutic procedure for the therapy of DCM. For this method of therapy, no ethical problems exist, and no side effects were observed. However, further experimental studies and controlled prospective clinical trials have to follow.
Abstract 2404: Sympathetic Cardiorenal Interaction Becomes Exaggerated When Cardiac and Renal Functions Are Both Deteriorated
Authors: Oda Yoshitaka , Joho Shuji , Hirai Tadakazu , Asanoi Hidetsugu , Inoue Hiroshi
Published: July 2021

The pathophysiology of the cardiorenal interaction remains poorly understood. We tested the hypothesis that renal insufficiency (RI) and cardiac dysfunction would contribute to the elevated sympathetic activity in patients with heart failure. In 79 patients with heart failure (ejection fraction (EF) < 0.45), the resting muscle nerve sympathetic activity (MSNA), plasma norepinephrine (NE), brain natriuretic peptide (BNP) were determined. Estimated glomerular filtration rates (eGFR) less than 60ml/min/1.73m
2
measured by simplified Modification of Diet in Renal Disease equation for Japanese was used to identify RI. Although NE and BNP were comparable between RI group (n = 30, eGFR 45 ± 10) and no RI group (n = 49, eGFR 76 ± 10), MSNA was higher in RI group (burst rate, 54 ± 14 versus 46 ± 14 bursts/minute, p < 0.05; burst incidence, 77 ± 19 versus 68 ± 18 bursts/100beats, p < 0.05). For patients with preserved EF (≥ 0.30), MSNA was similar between those with and without RI, while for patients with low EF (< 0.30), MSNA was significantly higher in those with RI than in those without RI (burst rate, 62 ± 10 versus 49 ± 15 bursts/minute, p < 0.01; burst incidence, 88 ± 12 versus 68 ± 18 bursts/ 100beats, p < 0.01). The difference of MSNA between patients with low EF and with preserved EF was significantly greater in RI group than in no RI group (interaction, p < 0.05). These findings suggest that sympathetic cardiorenal interaction might become exaggerated when cardiac and renal functions are both deteriorated.
Abstract 2415: Long-Term Baroreflex Activation Therapy Increases the Threshold for the Induction of Lethal Ventricular Arrhythmias in Dogs with Chronic Advanced Heart Failure
Authors: Wang Mengjun , Zaca Valerio , Jiang Alice , Ilsar Itamar , Ebinger Matthew , Sabbah Michael B , Dye Kattlin , Schuger Claudio , Sabbah Hani N
Published: July 2021

Heart failure (HF) is associated with a high incidence of ventricular tachycardia (VT) and fibrillation (VF). Patients with HF in whom these lethal arrhythmias can be induced by electrophysiological (EP) testing carry a high risk of sudden cardiac death. We showed that chronic electrical carotid baroreflex activation therapy (BAT) with the Rheos® System (CVRx, Inc.) improves LV function, attenuates LV remodeling and restores autonomic sympathetic-parasympathetic balance in dogs with HF. This study examined the effects of long-term therapy with BAT on the induction of VT or VF in dogs with coronary microembolization-induced HF (LV ejection fraction ~20%). Eleven dogs with HF underwent EP testing at baseline prior to therapy and after 3 and 6 months of therapy with BAT and again 6 weeks after withdrawal of BAT therapy (n = 7) or no therapy at all (Control, n = 4). Programmed ventricular stimulation was performed from the right ventricular apex and included delivery of up to 4 extrastimuli at progressively shorter coupling intervals (in steps of 10 msec). The extrastimuli were delivered following 8 ventricular paced beats with a drive cycle length between 600 and 200 msec. If a sustained monomorphic VT or VF could not be induced, isoproterenol infusion was initiated to increase the sinus rate by ~30% and the EP stimulation protocol was repeated. At baseline, a sustained VT or VF was induced in all 11 dogs (100%). After 3 and 6 months of follow-up, all Control dogs (100%) were induced into sustained VT or VF. After 3 months of BAT, only 3 of 7 dogs (43%) were induced into sustained VT or VF. After 6 months of BAT, only 2 of 7 dogs (29%) were induced into sustained VT or VF. Finally after withdrawal of BAT therapy, all dogs (100%) were again induced into systained VT or VF. In addition to improving LV function and attenuating LV remodeling, long-term monotherapy with BAT markedly increases the threshold for lethal ventricular arrhythmias in dogs with chronic HF. This is a marked improvement over inducibility of lethal arrhythmias seen in historical untreated controls. This benefit of BAT supports the continued exploration of this device as a therapeutic modality for treating patients with chronic HF and increased risk of sudden cardiac death.
Abstract 2418: Complement Deposition in Endomyocardial Biopsy Is Predictive of Antibody-Mediated Rejection in Cardiac Transplantation
Authors: Sokos George G , Rodriguez E R , Tan Carmela D , Pidwell Diane J , Mullens Wilfried , Haire Christina J , Taylor David O , Starling Randall C
Published: July 2021

Controversy exists regarding the criteria used for the diagnosis of Antibody-mediated rejection (AMR) and a consensus has not been reached regarding the most appropriate criteria for the diagnosis. Recent data have suggested the use of Immunohistochemistry for the presence of C4d as being adequate for the diagnosis but has not been uniformly accepted. The added utility of C3d staining in addition to C4d is unknown.

METHODS:
We evaluated endomyocardial biopsies from consecutive patients collected over a 14 month period. Biopsies were screened for the presence of complement deposition, specifically C4d and C3d. Electronic medical records were reviewed retrospectively for the clinical data and the diagnosis of clinically relevant AMR.

RESULTS:
A total of 1511 endomyocardial biopsies were performed on 330 consecutive patients. Eighteen patients were found to have evidence of C4d complement staining and 18 patients with both C4d and C3d staining. Mortality was significantly higher (28% vs 0%, p < 0.05) in the patients with both C4d and C3d staining compared to C4d alone. Patients with both C4d and C3d received more treatment (corticosteroids, plasmapheresis), were hospitalized more frequently, and illness was associated with frank hemodynamic compromise including reduced EF and cardiac index (Table 1

).

CONCLUSION:
Complement deposition with both C4d and C3d on endomyocardial biopsy is more commonly associated with reduced EF, hemodynamic compromise, and mortality. C4d alone, although common, is often not associated with morbidity. Statregies for the management and follow up of AMR should be a priority for research.

TABLE 1:

Clinical Outcomes
Abstract 2419: Left Ventricle Function Preservation by a Novel Synthetic Hydrogel Injection in Myocardial Infarction Rabbit
Authors: Li Xiaoyan , Jliang Xuejun , Wang Tao , Lin Taol , Huang Congxin , Jiang Hong
Published: July 2021

Myocardial infarction and the subsequent heart failure remain among the world’s prominent health challenges. Other studies have demonstrated that bio-derived materials improve cardiac function after implantation for angiogenic potential. In this study, we hypothesized that injection of biomaterials into infarcted myocardium can preserve left ventricle (LV) function through its prevention of paradoxical systolic bulging. Infarction was induced in rabbit myocardium by coronary artery ligation. In sham-operated rabbits (n = 5), a suture was tied loosely around the left anterior descending coronary artery without ligating it. 7 dayslater, 100μl α-cyclodextrin (CD) solution and 100μl poly (ethylene glycol)-b-polycaprolactone-(dodecanedioic acid)-polycaprolactone-poly (ethylene glycol)(MPEG-PCL-MPEG) solution (n = 7) was injected simultaneously through Duploject applicator into the infarcted myocardium. Solid hydrogel matrix formed by linear MPEG-PCL-MPEG polymer threading into the cavities of the α-cyclodextrin after mixing. Injection of phosphate buffered saline (PBS) served as controls (n = 7). 28 days after the treatments, histological analysis indicated that injection of hydrogel prevented scar expansion and wall thinning compared with group (
P
< 0.05) without more microvessel density in infarcted myocardium (
P
= 0.70).By echocardiography, LV ejection fraction was significantly greater in the hydrogel group (56.09 ± 8.42%) than the control group (37.26 ± 6.36%,
P
= 0.001). The LV end-diastolic and end-systolic diameters were 2.07 ± 0.33 cm and 1.74 ± 0.30cm in the control group, respectively. Smaller LV end-diastolic diameter (1.61 ± 0.26cm,
P
= 0.005) and smaller end-systolic diameter (1.17 ± 0.23cm,
P
= 0.001) were found in the hydrogel group. These results suggest that α-CD/MPEG-PCL-MPEG hydrogel injection could serve structural and mechanical support of an injured LV replacing some of the functions of the damaged ECM and thus prevented paradoxical motion serves, which may eventually lead to LV remodeling and dilation prevention. Our study should initiate further experimental and clinical studies exploring potential approaches to the treatment of postinfarction heart failure.
Abstract 2425: Absence of Auto-Antibodies against Cardiac Troponin I Predicts Improvement of Left Ventricular Function after Acute Myocardial Infarction
Authors: Leuschner Florian , Li Jin , Göser Stefan , Reinhardt Lars , Öttl Renate , Bride Peter , Zehelein Jörg , Pfitzer Gabriele , Remppis Andrew , Giannitsis Evangelos , Katus Hugo A , Kaya Ziya
Published: July 2021

Application of antibodies against cardiac troponin I (cTnI-Ab) can induce dilation and dysfunction of the heart in mice. Recently, we demonstrated that immunization with cTnI induces inflammation and fibrosis in myocardium of mice. Others have shown that autoanti-bodies to cTnI are present in patients with acute coronary syndrome. But little is known about the clinical relevance of detected cTnI-Ab. First, anti-cTnI and anti-cTnT antibody titers were measured in sera from 272 patients with dilated- (DCM) and 185 with ischemic- (ICM) cardiomyopathy. Secondly, 108 patients with acute myocardial infarction (AMI) were included for a follow-up study. Heart characteristics were determined by magnetic resonance imaging 4 days and 6 –9 months after AMI. Altogether, in 7,0% of patients with DCM and in 9,2% with ICM an anti-cTnI IgG antibody titer ≥1:160 was measured. In contrast, only in 1,7% of patients with DCM and in 0,5% with ICM an anti-cTnT IgG antibody titer ≥1:160 was detected. Ten out of 108 patients included in the follow-up study were tested positive for cTnI-Ab with IgG Ab titers ≥1:160. TnI-Ab negative patients showed a significant increase in LVEF and stroke volume 6 –9 months after AMI. In contrast, there was no significant increase in LVEF and stroke volume in TnI-Ab positive patients. We demonstrate for the first time that the prevalence of cTnI-Abs in patients with AMI has an impact on the improvement of the LVEF over a study period of 6 –9 months.
Abstract 2431: Global Strain with Speckle Tracking Method is Next Generation Index of Left Ventricular Systolic Function
Authors: Kanzaki Hideaki , Amaki Makoto , Hasegawa Takuya , Ohara Takahiro , Hashimura Kazuhiko , Kitakaze Masafumi
Published: July 2021

Background.

Myocardial strain is an index of regional function, whereas global left ventricular (LV) systolic function is generally assessed with ejection fraction (EF). Recent development of speckle tracking analysis software allows angle-independent and less time-consuming measurement of whole LV strain. Our objective was to assess whether the method is useful as another index of global LV systolic function.

Methods.

In 54 patients (LVEF 36±19%, 7–72%), digital gray-scales cine-loops were acquired from the apical 4-, 2-chamber, and long-axis views (GE Vivid7). After defining a region of interest (ROI) by tracing the LV endocardial border with several points at each view, a bull’s eye map was automatically constructed based on longitudinal strain and an averaged value of systolic peak strain was easily determined (EchoPAC Dimension AFI, GE). The strain value multiplied by −1 was used as global strain. Nineteen of the 54 patients underwent dobutamine stress and global strain value was calculated at baseline and during administration of 10 μg/kg/min.

Results.

Figure at left shows a bull’s eye strain map in a case of anterior myocardial infarction with regional dyskinetic wall motion. The blue area indicates the dyskinetic region. Despite of low dose, dobutamine increased global strain value (from 15.3 ± 5.3 to 17.1 ± 6.0,
P
<0.001) as well as LVEF. Figure at right shows global strain value was well correlated with LVEF (
r
=0.917,
P
<0.001).

Conclusion.

Global strain is a new index which reflects the location, severity and extent of myocardial damage in addition to global LV systolic function.