bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17328: Ultrasmall Supraparamagnetic Particles of Iron Oxide-enhanced Magnetic Resonance Imaging in the Assessment of Cellular Inflammation after Myocardial Infarction
Authors: Stirrat Colin G , Alam Shirjel R , MacGillivray Tom J , Dweck Marc R , Henriksen Peter A , Newby David E , Semple Scott
Published: July 2021

Introduction:
Excessive inflammation after myocardial infarction (MI) can be detrimental to the recovery of cardiac function. Ultrasmall superparamagnetic particles of iron oxide (USPIO)-enhanced magnetic resonance imaging (MRI) can detect myocardial cellular inflammation after MI. We aimed to determine the time course and duration of USPIO-enhancement following acute MI.

Methods:
Twenty-one patients with acute MI were studied in the 3-month period following acute MI. Repeated T2*-weighted 3T MRI was performed throughout and 24 h after USPIO (ferumoxytol, 4 mg/kg) administration at 4±3, 12±2, 21±4 and 90±9 days. Myocardial regions of interest (ROIs) were drawn and categorised into infarct and non-infarct regions by the presence or absence of late gadolinium enhancement (LGE). R2* values within ROIs were determined to assess the time course and duration of uptake and clearance of USPIO.

Results:
Following single-dose USPIO administration 2-7 days after acute MI, USPIO uptake is demonstrable at 24 h (p<0.0001) and is cleared within 4-8 days (Figure 1a). Increased USPIO uptake is seen in the infarct region at days 2-7 (p<0.0001), and days 10-14 (p<0.05) compared to non-infarcted myocardium (Figure 1b).

Conclusions:
For the first time, we have shown USPIO-enhanced MRI can detect and quantify infarct-related cellular inflammation in the first 2 weeks following acute MI.
Abstract 17383: Total Left Ventricular Unloading with Impella® during Ischemia Reperfusion Minimizes Infarct Size, Preserves Left Ventricular Function and Prevents Chronic Heart Failure
Authors: Kakaino Takamoro , Saku Keita , Arimura Takahiro , Akashi Takuya , Nishizaki Akiko , Oga Yasuhiro , Ikeda Masataka , Kishi Takuya , Ide Tomomi , Sunagawa Kenji
Published: July 2021

Background:
Despite marked advances of revascularization, acute myocardial infarction (MI) remains a major cause of chronic heart failure (CHF). Since excessive oxygen demand relative to supply is the fundamental mechanism of ischemia, we previously demonstrated, using a conventional left ventricular assist device (VAD), that total left ventricular (LV) unloading markedly reduced the MI size in ischemia reperfusion (IR) model through minimizing the myocardial oxygen consumption in acute experiment. The purpose of this investigation was to examine if the transvascular VAD, Impella®, could totally unload LV during IR and preserve LV function in chronic phase.

Methods:
We allocated 15 dogs into 3 groups, Sham (n=4), IR (n=6) and IR+Impella® (n=5). In IR and IR+Impella®, we ligated the left anterior descending artery for 180min through a left thoracotomy and then reperfused. In IR+Impella®, we introduced Impella® through the left subclavian artery from 60 min after the beginning of ischemia to 90 min after reperfusion. We then assessed LV function and MI size 4 weeks after IR injury.

Results:
Under Impella® support, LV pressure was much lower than arterial pressure indicating total LV unloading. In comparison with IR, Impella® significantly improved LV ejection fraction (2D-echo, Fig) (Sham 64±2.8, IR 48±3.1, IR+Impella® 64±1.2%, p=0.0007), lowered LVEDP (Sham 5.9±1.1, IR 16±3.7, IR+Impella® 4.3±0.87mmHg, p<0.05) and increased end-systolic elastance (sonomicrometric volumetry) (Sham 11±3.1, IR 5.7±1.5, IR+Impella® 12±1.6 mmHg/ml, p<0.05). Furthermore, Impella markedly reduced MI size (%LV circumferential area, IR 18±9.2, IR+Impella® 2.1±0.76%, p=0.0044, Fig) and decreased NT-proBNP (Sham 1004±462, IR 3385±677, IR+Impella® 1463±217pg/ml).

Conclusions:
Total LV unloading during IR with Impella® strikingly reduces MI size and preserves LV function in chronic phase. Impella® is a powerful tool in the management of acute MI in preventing CHF.
Abstract 17392: Bilateral Blood Pressure Measurement: a Simple Way to Reduce Diagnostic Delay in Acute Type a Aortic Dissection
Authors: Iafrancesco Mauro , Mascaro Jorge , Abdelaziz Mahmoud , Bhudia Sunil , Rahman Ishtiaq A , Bryan Alan J , Modi Amit P , Tsang Geoffrey , Pirone Francesco , Lewis Michael E , Doukas George , Ritchie Andrew J , Bose Amal K , Dark John H , Peng Ed W , Goodwin Andrew , Bhakhri Kunal , Roberts Neil , Siddiqui Hajira , Wendler Olaf , Loubani Mahmoud , Bashir Mohamad , Harrington Deborah , Oo Aung Y , Ibe Robert , Chukwuemeka Andrew , Ranasinghe Aaron M ,   United Kingdom Trainees Cardiothoracic Rsch Collaborative
Published: July 2021

Introduction:
Despite rapid presentation, the majority of patients with acute type A aortic dissection (ATAAD) have significant delays to diagnosis and surgical treatment.

Hypothesis:
We set out to investigate factors associated with diagnostic delay in ATAAD in the UK.

Methods:
As part of a UK-wide national audit, patients admitted to their institution with a known diagnosis of ATAAD between January 2009 and July 2011 were identified. Using a standardised questionnaire, retrospective data was collected on presentational symptoms, time, potential differential diagnoses, time to operative intervention and outcomes.

Results:
A total of 14 centres submitted data on a total of 239 patients. At presentation 91.6% were symptomatic and the majority (74.5%) presented to non-surgical centres. Bilateral upper limb blood pressures were recorded in 48.4% and of these 56.3% had a >20mmHg difference in blood pressure. The median [IQR] time between symptom onset and admission was 2 hours (h) [1.2-4.9], between admission and diagnosis 4.5 [2.3-18.3] h and between symptoms to operation was 14.8 [9.1-32.8] h. Diagnosis delay was greater than 3 h in 63% of patients and than 12 h in 33%. Surgical in-hospital mortality was 22.5%. In only 155 (64.9%) patients ATAAD was included in the differential diagnosis at initial presentation. Non-consideration of ATAAD was significantly higher in patients presenting without pain (52% vs. 29%, p: 0.039) and in whom only unilateral BP measurement was taken (43% vs. 13%, p <0.0001) and significantly lower in whom a 20 mmHg difference in BP between arms was found (26% vs. 6%, p <0.013). Measurement of unilateral BP was significantly associated with a delay in diagnosis of greater than 3 h (72% vs. 52%, p: 0.043) and greater than 12 h (47% vs. 14%, p<0.0001). Non-consideration of ATAAD resulted in administration of heparin and/or antiplatelets in 21% of patients.

Conclusions:
There are still significant delays in diagnosis and management of ATAAD. These are in part related to non-consideration of the potential diagnosis. Measurement of bilateral BP is a simple intervention and may reduce non-consideration of the diagnosis by revealing patients with a pulse deficit and increasing the index of suspicion to aid in the diagnosis of ATAAD.
Abstract 174: Remote Ischemic Preconditioning Improves Digital Vascular Endothelial Function and Enhances Circulating Nitric Oxide Formation in Healthy Volunteers
Authors: Tao Jun , Tong Xinzhu
Published: July 2021

Background:
Remote ischemic preconditioning (RIPC) induced by brief episodes of ischemia of the limb protects against organ damage by ischemia-reperfusion. It has been reported that RIPC improves endothelial function of the forearm in normal subjects and patients with coronary artery disease. However, the digital vascular endothelial response to RIPC has not been determined in healthy volunteers.

Methods:
This study was performed to examine effect of RIPC on fingertip digital vascular endothelial function by using endothelial pulse amplitude tonometry (EndoPAT) device and alteration in circulating nitric oxide(NO) level in peripheral blood. Ten healthy adult subjects (5 men, 5 women, mean age 25.2 years) had 3 cycles of 5 min ischemia alternating with 5 min reperfusion of the forearm. Another 10 healthy volunteers (6 men, 4 women, mean age 26.2 years) were used as the control group of sham and the cuff was inflated for 3 times at 10 mmHg for 5 minutes with 5-minute intervals. Fingertip digital vascular endothelial function of the ipsilateral arm was measured prior to first ischemia, 3h and 6h after the last episode of ischemia. Blood samples were taken from the contralateral arm prior to first ischemia, 3h and 6h after the last episode of ischemia.

Results:
Fingertip digital vascular endothelial function was significantly increase in 3h and 6h after the last RIPC intervention compared with the baseline condition(p<0.05). In parallel the RIPC stimulus increased circulating NO formation(p<0.05). There is a close association between finger vascular endothelial function and NO formation(p<0.05).

Conclusion:
The present findings demonstrate for the first time that transient RIPC contributes to improvement of digital vascular endothelial function and increase in circulating NO production in healthy volunteers. Our data provide a novel evidence to support that RIPC might gain even wider application not only in disease but also in health.
Abstract 17448: A Novel Technique for Respiratory Motion Correction in Rapid Left Ventricular Myocardial T1 Mapping and Quantitative Analysis of Myocardial Fibrosis
Authors: Kawaji Keigo , Marino Marco , Tanaka Akiko , Tarroni Giacomo , Ota Takeyoshi , Lang Roberto M , Patel Amit R
Published: July 2021

Introduction:
Quantitative myocardial T1 mapping is increasingly being used to measure myocardial fibrosis, but this approach requires effective breath-holds during MRI. Respiratory artifacts from poor breath-holds result in motion-corrupted pixels and measurement error. We developed and tested the feasibility of an approach that applies motion correction (MC) followed by semi-automated segmentation to obtain motion-free T1 maps of the LV.

Methods:
Modified Look-Locker Inversion Recovery (MOLLI) data was acquired on 1.5T MRI scanner, where the endo- and epicardial borders were semi-automatically detected using noise characteristics of myocardial tissue [1,2] and followed by fully automated partitioning into AHA-defined segments [1]. Affine motion correction was then applied to each segment to generate MC-T1 maps of the heart. This approach was tested on 24 slices (12 before contrast injection [PRE]; 12 post [POST], 96x2 ROI segments) from 4 swine with no LV abnormality. The same segmented ROIs on T1 maps without MC were also assessed for comparison.

Results:
The standard deviation of T1 within each ROI became significantly lower after MC: [MC vs non-MC: 94 ± 37 vs 114 ± 51 ms (PRE, p<0.00005); 66 ± 51 vs 89 ± 67 ms (POST, p<0.0005)], suggesting less motion blurring and possibly less error in T1 measurements within each generated ROI (fig). Significant changes were observed in POST T1 values (446 ± 66 vs 435 ± 89ms; p < 0.0005), yielding an average increase of 2.6 ± 1.6% per segment. The inferior (+3.9%) and inferiolateral segments (+4.5%) yielded the most change, corresponding to regions with most motion across MOLLI images as assessed visually. PRE T1 changes were also significant (998 ± 94 vs 1008 ± 114 ms; p < 0.05).

Conclusions:
Our new semi-automated and motion-corrected T1 map assessment shows promise to improve the accuracy of T1 measurements but needs further validation in a larger dataset. This technique may become useful for objective evaluation of myocardial fibrosis.
Abstract 17481: MicroRNAs Mediate the Protective Effect of Angiotensin Converting Enzyme Inhibition (ACEi) on the Heart in Rat Model of Acute Kidney Injury
Authors: Rana Indrajeet , Velkoska Elena , Burrell Louise M , Charchar Fadi J
Published: July 2021

Introduction:
Cardiovascular complications are common in patients with kidney disease. MicroRNAs play an important role in regulating cell death pathways and cardiac hypertrophy but it is not known whether cardiac microRNAs contribute to cardio-renal cross talk. microRNA-1 and microRNA-133 are associated with cardiac fibrosis and apoptosis after myocardial infarction, whilst microRNA-212/132 is associated with cardiac hypertrophy.

Aim:
Using a rat model we investigated whether acute kidney injury leads to changes in cardiac microRNAs (1,133,212 and 132) and their gene targets. We also tested the effect of treatment with the angiotensin converting enzyme inhibitor (ACEi) ramipril on these cardiac microRNAs.

Methods:
Heart tissues were collected from rats 10 days after subtotal nephrectomy (STNx) surgery, where one kidney was removed and the other partially ligated (n=9), from sham animals (n=9), and from STNx rats treated with ramipril (n=9). RNA was extracted from the left ventricle and quantitative real time PCR was used to measure microRNA and their target gene expression levels.

Results:
In rats with renal injury, there was a significant increase in left ventricular hypertrophy (P<0.05 vs sham). There was also a significant increase in expression of cardiac microRNA-212 (2 fold, P<0.05 vs Sham) and microRNA-132 (3 fold, P<0.05 vs Sham). Ramipril treatment in STNx rats attenuated the increase in microRNA-212 and caused a significant increase in expression of microRNA-133 (P<0.001 vs Sham, P<0.001 vs STNx+Veh) and microRNA-1 (P<0.01 vs Sham, P<0.01 vs STNx+Veh). Renal injury induced left ventricular hypertrophy was attenuated in ramipril treated STNx rats (P<0.001 vs STNx+Veh). We also found altered expression of caspase 9, fibronectin 1, collagen 1A1 and forkhead box O3, all known for their involvement in the regulation of apoptosis, fibrosis and hypertrophy in cardiac cells, whilst being targets for the above microRNAs.

Conclusions:
The involvement of microRNAs in cardiac pathologies associated with kidney injury is a novel finding of our study. Our finding suggests an involvement of microRNA-1, microRNA-133 and microRNA-212/132 in the cardioprotective action of ACE inhibition in acute kidney injury.
Abstract 175: Vasopressin Maintains Robust Organ Blood Flow During Resuscitation from Hemorrhagic Shock
Authors: Gazmuri Raúl J , Whitehouse Herbert K , Baetiong Alvin , Whittinghill Karla , Radhakrishnan Jeejabai
Published: July 2021

Background:
We have reported beneficial hemodynamic and survival effects of vasopressin (VP) infusion in swine models of hemorrhagic shock (HS), and attributed the effects to increases in peripheral vascular resistance. However, VP may also exert a minor effect on venous return. In the present study we used fluorescent microspheres to measure the effects of VP on blood flow to organs of interest during HS produced by liver laceration (LL).

Methods:
Forty male domestic pigs (32.3 to 40.3 kg) had their left lateral liver lobe lacerated with a sharpened steel, X-shaped 5 cm blade clamp. Thirty-two pigs received a second LL in the same lobe 7.5 minutes later and 24 pigs received a third LL in the left medial lobe at 15 minutes from the first LL. Pigs were randomized 1:1 to receive an infusion of VP (0.04 U/kg•min-1) or vehicle intraosseously starting 7 minutes after the first LL until the end of the experiment (240 min). Microspheres were injected into the left ventricle at baseline (BL) and during HS at times shown in the Table.

Results:
At 60 minutes of HS, VP infusion was associated with higher aortic blood pressure and lower cardiac index (both NS) along with overall reductions in blood flow to various organs (Table) coincident with a statistically significant reduction in heart rate (157±43 vs 184±29 min-1; p≤0.05). At 120 and 180 minutes of HS, the heart rate was only mildly reduced (NS). The aortic pressures remained high but without a reduction in cardiac index. Organ blood flows were all comparable or higher with VP than in control pigs attaining statistical significance for renal cortical blood flow.

Conclusion:
Contrary to the expected hemodynamic effects of VP redistributing blood flow away from “non-vital organs,” we observed a robust hemodynamic effect that adequately perfused vital and “non-vital” organs during HS without deterioration over time. Early and sustained VP infusion could represent a highly effective intervention for hemodynamic stabilization during severe HS.
Abstract 17584: Pulmonary Artery Systolic Pressure Independently Predicts All-Cause Mortality in Patients with Coronary Artery Disease Irrespective of a Diagnosis of Heart Failure
Authors: Ghasemzadeh Nima , Alanbari Raghda , Hayek Salim , Awad Mosab , Khayata Mohamed , Alzaraneh Bushra , Al Kassem Hatem , Smith Graham , Kumar Saket , Saon Md , Zheng Shuai , Yadalam Adithya K , Dhammaputri Christella , Tabba Aisha , Butler Javed , Sperling Laurence S , Quyyumi Arshed A
Published: July 2021

Background:
Elevated pulmonary artery systolic pressure (PASP) is associated with a worse outcome in heart failure (HF), but the prognostic role of PASP in patients with coronary artery disease (CAD) remains unknown.

Methods:
863 patients with known or suspected CAD (age: 64±13 years, 62% male) enrolled in the Emory Cardiovascular Biobank were followed for a median 455 days for all-cause death. Transthoracic echocardiographic parameters included measurement of left ventricular ejection fraction (LVEF, range: 5-80%) and diastolic function parameters. Youden’s index from the receiver operating curve analysis was used to determine the best discriminatory cutoff for PASP (cutoff=43 mmHg). Cox regression was performed to determine independent predictors of mortality.

Results:
88 (10%) subjects died during follow-up. PASP correlated with left ventricular ejection fraction (LVEF, N=644, r=-0.20, p<0.0001), C-reactive protein (CRP, N=539, r=0.12, p=0.004), and mitral valve inflow E/A ratio (N=359, r=0.32, p<0.0001), mitral valve deceleration time (N=260, r=-0.16, p=0.007),and left atrial size (LAs, N=694, r=0.25, p<0.0001). High PASP predicted incident mortality in a model adjusted for age, gender, diabetes, hypertension, dyslipidemia, smoking, glomerular filtration rate, CRP, heart failure, Gensini angiographic severity score, as well as aspirin, statin, beta-blocker, and angiotensin converting enzyme-inhibitor use (HR: 3.3, p=0.000001). The association of PASP with death was independent of LVEF (HR=3.2, p=0.00002). Thus, high PASP also predicted mortality in subjects with LVEF>50% and no history of HF (HR: 4.7, p=0.004). In separate models, this association was also independent of LAs and E/A.

Conclusion:
High PASP >43 mmHg is an independent predictor of mortality in patients with CAD even in those with preserved LVEF without HF. Whether high PASP predicts future development of HF and hospitalization for HF exacerbation needs to be investigated.
Abstract 17620: Does Doppler E/e’ Ratio Reliably Estimate Diastolic Filling Pressures in Stress Cardiomyopathy?: A Validation Study in Apical and non-Apical Phenotypes
Authors: Iskandar Aline , Aurigemma Gerard P , Fitzgibbons Timothy P , Ahmed Mohammed , Tighe Dennis
Published: July 2021

BACKGROUND:
We have recently shown that mean LV end diastolic pressure (LVEDP) is commonly elevated in apical ("Tako-tsubo") stress cardiomyopathy (SCM) and likely contributes to heart failure in this syndrome. The assessment of diastolic filling pressures by use of E/e’ ratio (early diastolic transmitral E to tissue Doppler e') has been applied to many forms of heart disease, but has not been validated in SCM, and has not been studied in the apical sparing variant.

METHODS:
We identified 62 patients with SCM, 43 patients with apical/Tako-tsubo SCM and 19 patients with apical sparing (basal and midventricular) variant of SCM, who underwent measurement of E/e', using the average of lateral and septal e’ (cm/s), within 48 hours of direct invasive measurement of LVEDP (mm Hg).

RESULTS:
LVEDP was significantly higher in apical sparing SCM compared to apical SCM (28 ± 6 mmHg vs. 22 ± 7 mmHg, p<0.002). LVEDP directly correlated with E/e’ ratio in apical SCM (r = 0.64, p < 0.0001, Figure 1). When individual data were examined, we found that of the apical SCM group, 3 pts had normal LVEDP and were correctly identified with normal E/e’ ratio (< 8). All apical SCM patients with elevated LVEDP (16 mm Hg or greater) had E/e’ > 8, and fifteen of these had E/e’ ratio > 15.

By contrast, all apical sparing SCM had elevated LVEDP. In this group, E/e’ did not predict LVEDP: the overall correlation between E/e’ and LVEDP (r = 0.27, p = 0.26, Figure 2) was poor. When individual data were examined, 5 patients with elevated LVEDP had normal E/e’ and, of the remaining 14 patients with elevated LVEDP, only 1 patient had E/e’ >15.

CONCLUSION:
Our results demonstrate:

1.

Elevated LVEDP is found among 95% of SCM, regardless of the phenotype.

2.

Unexpectedly, apical sparing SCM appears to have worse impairment of diastolic function and higher LVEDP than apical variant SCM

3.

E/e’ ratio reliably predicts LVEDP in pts with apical variant SCM; by contrast, this index underestimates LVEDP among patients with apical sparing SCM.
Abstract 17806: The Prognostic Importance of Frequent Premature Atrial Contractions Following Ischemic Cerebrovascular Events
Authors: Keaney John J , Akijian Layan , Mulholland Doug , Hannon Niamh , Ní Chróinín Danielle M , Horgan Gillian , McGorrian Catherine , Blake Gavin , Mahon Niall G , Kyne Lorraine , Duggan Joseph , Murphy Sean , Kelly Peter J
Published: July 2021

Background:
Following ischemic cerebrovascular accident (CVA) or transient ischemic attack (TIA) aggressive risk factor modification is undertaken to reduce the risk of recurrent events. Holter monitoring is advocated to facilitate the detection and treatment of Atrial Fibrillation (AF). Frequent Premature Atrial Contractions (PACs) are associated with the development of AF, but to date it is unknown whether the burden of PACs on Holters is of any prognostic importance following CVA/TIA.

Objective:
PACs on Holter monitoring may be a marker for recurrent cerebrovascular events post CVA/TIA.

Methods:
Retrospective analysis was performed on Holters of patients with CVA/TIA enrolled in a prior population based stroke study. Frequent PACs were defined as a rate of PACs ≥ 100 per 24 hours. The primary endpoint was recurrent CVA or TIA.

Results:
84 cases (61.0% male) were reviewed. Mean age was 69.7 ± 12.4 years. Mean time to follow-up was 2514.6 ± 91.2 days. The average number of PACs in the frequent group (Hi-PAC, 21 patients) was 1610.8 ± 4541.4 compared with 21.8 ± 27.6 in those with less than 100 PACs (Lo-PAC, 63 patients). There was no statistically significant difference in age, gender, hypertension or diabetes between the two groups. On follow-up there were 20 recurrent events and 33 patients died. In the Hi-PAC group there were 8 (38.1%) recurrent events, and 16 (76.2%) patients died versus 12 (18.8%) and 17 (26.6%) respectively in Lo-PAC group. On Cox regression analysis the Hazard ratio (HR) for recurrent events was 2.75 (95% confidence interval (CI) 1.08 to 7.01). Kaplan Meier curves revealed a statistically significant difference in recurrance rates between the two groups (p < 0.05). There was also a statistically significant difference in overall mortality on Kaplan Meier survival analysis (p < 0.001), and with a hazard ratio on Cox regression analysis of 3.47 (95% CI 1.74 [[Unable to Display Character: –]] 6.91). There was no significant difference in incidence of MI or AF.

Conclusion:
Frequent PACs on Holter monitor represent a significant risk factor for both recurrent events and mortality following CVA/TIA. Further prospective studies should be performed to assess whether these patients may benefit from more aggressive anticoagulation, similar to those with AF.
Abstract 17930: Indices of Adiposity and Subclinical Cardiovascular Disease: the Jackson Heart Study(JHS)
Authors: Ogunsua Adedotun A , Akinkuolie Akintunde O , Ayodele Olulade A , Liu Jiankang , Hickson DeMarc , Taylor Herman A , Gona Philimon , Goldberg Robert , Clark Cheryl
Published: July 2021

Background:
Evidence that indices of adiposity, which better account for central obesity, outperform body mass index (BMI) in discriminating presence versus absence of cardiovascular disease (CVD) are largely derived from Caucasian populations with limited and inconsistent findings in African Americans (AA). Characterization of the optimal measure of adiposity for improving CVD risk prediction and stratification in AAs is needed.

Aim:
We cross-sectionally evaluated the performance of BMI, waist circumference (WC), % body fat (%BF), waist to height ratio (WHtR), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) in predicting the presence of subclinical CVD as defined by coronary artery calcification (CAC) and abdominal aorta calcification (AAC) in the JHS, a cohort of AAs.

Methods:
2,253 participants (66% female, mean age: 55 years) with no prior CVD were studied. VAT, SAT, CAC and AAC were determined using CT scan, %BF was assessed with bioelectric impedance and other adiposity indices were measured using standard protocols. Logistic regression models were constructed and c statistic from receiver operating characteristic curve was used to assess the utility of each adiposity index in predicting CAC and AAC.

Results:
Prevalence of CAC and AAC were 43% and 63% respectively. In univariate analyses with CAC as outcome, c statistic for VAT, WHtR, WC, %BF, SAT and BMI ranged from 0.60-0.51 in decreasing order, and were statistically significantly higher when compared with BMI, except SAT and %BF. Similar results were noted for AAC. However, none of the indices improved risk discrimination beyond traditional CVD risk factors (Table).

Conclusion:
VAT had the highest discrimination capacity for subclinical CVD followed by WHtR and WC. These results suggest that though other adiposity measures performed slightly better than BMI, none of the measures contributed significantly to discriminating subclinical CVD beyond the traditional CVD risk factors.
Abstract 18017: Validations for the Reliability of a Dedicated 3-Dimensional Speckle Tracking Imaging System for Right Ventricular Function Analysis
Authors: Atsumi Akiko , Seo Yoshihiro , Nakamura Akihiro , Ishizu Tomoko , Enomoto Yoshiharu , Okazaki Tomoya , Abe Yasuhiko , Aonuma Kazutaka
Published: July 2021

Background:
Three-dimensional (3D) imaging has the potential to evaluate right ventricular (RV) function accurately because of its complex geometry. We have developed a dedicated 3D-speckle tracking imaging (STI) system for the right ventricle, and performed validation studies to assess the reliability of 3D-STI derived deformation data.

Methods:
In 9 anesthetized sheep, RV full volume data sets for 3D-STI were obtained using a 3D echocardiography system (Toshiba Medical Systems) simultaneously with sonomicrometry data at the baseline and during pulmonary artery (PA) banding at moderate and severe levels, and propranolol infusion. In 7 RV segments (basal and mid anterior, basal and mid lateral, basal and mid inferior, and outflow), area change ratio (ACR), longitudinal strain (LS), and circumferential strain (CS) were calculated with prototype 3D-STI software (Figures) and compared with those by sonomicrometry.

Results:
ACR by 3D-STI strongly correlated with sonomicrometry data (Y=0.78X-5.0, R=0.83, p<0.001). LS and CS also showed significant correlations between the modalities (LS; Y=0.78X-1.8, R=0.79, CS; Y=0.62X-2.9, R=0.77, p<0.001). In segmental analysis, all deformation data showed significant correlations in each segment. During PA banding, PA pressure increased at a moderate (48.4±8.4mmHg) and a severe level (53.9±8.5mmHg mmHg) compared to the baseline (22.5±4.6mmHg). In contrast, 3D-STI data had graded decreases at the baseline, moderate and severe levels (ACR; -32.5±8.3, -24.2±10.0, -16.1±10.9%, p<0.001, LS; -16.0±6.2, -9.5±6.8, -5.1±7.7%, p<0.001, CS; -16.3±5.4, -12.6±7.6, -9.3±7.3%, p=0.003). During propranolol infusion, RV dP/dt was significantly decreased compared to the baseline (807±287 vs. 535±199 mmHg/s, p=0.01), and 3D-STI data also reduced (ACR; -23.3±7.7, LS; -10.4±5.8, CS; -11.5±5.4, p<0.05 vs. baseline).

Conclusions:
The newly developed 3D-STI system is a reliable modality for RV function analysis.
Abstract 18081: Inverse Changes in Atrial Size During Obstructive Apnea
Authors: Pressman Gregg S , Cepeda-Valery Beatriz , Seetha Rammohan Harish R , Moldovan Raul , Orban Marek , Horrow Jay , Samuel Solomon P
Published: July 2021

Introduction:
Obstructive sleep apnea (OSA) is characterized by large swings in intrathoracic pressure. These pressure changes create an afterload burden on the left ventricle and presumably affect venous return to the right heart, and pooling of blood in the lungs. To better understand cardiac dynamics during OSA we used real time 2-D echocardiography to compare left (LA) and right atrial (RA) areas at baseline and during a series of gasping inspiratory efforts against an occluded airway.

Hypothesis:
Significant changes in atrial area will occur during inspiratory effort, with an inverse relationship between the two atria.

Methods:
Each of 14 healthy male subjects <30 years, trained in the Mueller Maneuver (MM), made 5 to 6 maximal gasping efforts to simulate naturally occurring OSA. Concomitant echocardiographic loops were acquired using the apical 4 chamber view.

Results:
Average baseline (end-systolic) atrial area was 16.6 ± 0.837 cm2 (100 beats; mean ± pooled SD) for the LA and 16.3 ± 0.931 cm2 for the RA. During the MM average LA area was 16.7 ± 1.29 cm2 (252 beats) and average RA area was 15.4 ± 1.69 cm2. For left and right separately, variance in atrial area during the MM exceeded that at baseline (p<0.0001, F-test). During the MM, LA variance increased to 2.38-fold that of baseline, RA variance to 3.30-fold. Further, there was an inverse relationship between LA and RA area during the MM (graph). Visual inspection of digitized loops revealed a sudden decrease in LA area with inspiratory effort.

Conclusions:
Performance of the MM as a series of gasping efforts (designed to mimic natural OSA) produced marked and mutually inverse variation in LA and RA area as compared with baseline. LA area decreased abruptly with onset of negative inspiratory pressure. Such changes, repeated hundreds of times per night, have the potential to alter atrial structure and function. These data may help explain the strong association between obstructive sleep apnea and atrial fibrillation.
Abstract 18120: The Relationship Between Estimated Total Ischemic Time and Hospital Survival in Patients Suffering From Out of Hospital Cardiac Arrest
Authors: Gunter Ryan , Banuelos Rosa , Doshi Pratik B
Published: July 2021

Introduction:
The incidence of out of hospital cardiac arrest (OHCA) in the U.S. is approximately 400,000 patients per year. Despite quality improvement efforts, overall survival after cardiac arrest remains poor, suggesting that there are other factors at play. One such variable is total ischemic time. This analysis was performed to determine the role of total ischemic time in hospital survival after OHCA.

Methods:
The OHCA records were queried from the cardiac arrest registry maintained by Houston Fire department from 2007-2012.Association between outcome and predictor variables was assessed using logistic regression. The outcome variable is defined as survival and discharge from the hospital. Our predictor variable of interest was Estimated Total Ischemic Time, which was calculated as the difference between time of Return of Spontaneous Circulation (ROSC) and Fire Rescue Dispatch time. The Hosmer-Lemeshow Goodness of Fit test grouped by ten showed that the null (the model) should not be rejected (p = 0.8678). The final model includes Estimated Total Ischemic Time, age divided into categories by decade, presence of a shockable rhythm, and presence of a witness to the cardiac arrest.

Results:
The database consisted of 9,074 OHCA cases, of which 446 were included in the final analysis. According to our model, the data suggests there is a decrease in probability of survival as estimated total ischemic time increases. The odds of survival and discharge from the hospital of an OHCA patient with an estimated total ischemic time of 2 minutes is 0.956 (95%CI 0.936 - 0.977) times the odds of a patient whose estimated total ischemic time was 1 minute.

Conclusion:
Estimated Total Ischemic Time is a significant contributor to the probability of survival, however it is not the only one. This model exemplifies just one example of the importance of adjusting for both prehospital and hospital care in clinical decision-making and healthcare quality improvement.
Abstract 18153: Abnormal Dynamic Myocardial Response to Exercise Despite Normal Resting Ejection Fraction in Childhood Cancer Survivors Treated With Anthracyclines
Authors: Chen Ching Kit - , Cifra Barbara , Slorach Cameron , Manlhiot Cedric , McCrindle Brian W , Dragulescu Andreea , Friedberg Mark K , Redington Andrew N , Nathan Paul C , Mertens Luc
Published: July 2021

Introduction:
There are limited data on myocardial systolic & diastolic response to exercise in pediatric cancer survivors treated with anthracycline. We used exercise echocardiography to evaluate ventricular systolic and diastolic reserve in these patients.

Methods:
50 children (age 14.4±2.4 years) who had received anthracycline treatment with median dose 178mg/m
2
(range 60-450) underwent stepwise exercise echocardiography at 9.3±2.9 years after end of therapy, and compared with 50 normal controls. All subjects had normal resting LVEF. Peak systolic (s’) & early diastolic (e’) myocardial velocities in the LV & RV lateral wall, & basal septum were measured at rest & during exercise using color TDI. Measurements of myocardial isovolumic acceleration (IVA) at incremental heart rates (HR) were used to study force-frequency relationships (FFR).

Results:
At rest, LV systolic parameters were preserved in patients; septal e’ was significantly lower compared to controls (10.4±1.9cm/s vs 11.4±1.9cm/s;
p
=0.009). At peak exercise, LV & RV lateral wall, & basal septal e’ velocities were lower in patients (17.4±3.8cm/s vs 19.6±3.1cm/s,
p
=0.002; 21.5±1.6cm/s vs 22.3±1.9cm/s,
p
=0.02; & 16.3±2.4cm/s vs 18.7±2.7cm/s,
p
<0.001; respectively) & the slopes of change with increasing HR were significantly lower in patients for LV lateral e’ [EST (SE): +0.68 (0.08) vs +0.85 (0.05) cm/s per 10 bpm;
p
<0.001], RV lateral e’ [+1.47 (0.05) vs 1.69 (0.06) cm/s per 10 bpm;
p
<0.001] & basal septum e’ [+0.50 (0.05) vs 0.58 (0.05) cm/s per 10 bpm;
p
=0.001]. During exercise, peak contractile force developed by patients was significantly lower (LV IVA 5.12±1.85m/s
2
vs 6.75±3.28m/s
2
;
p
=0.004). FFR analysis showed reduced rate-contractility trajectory in patients [+0.202 (0.008) vs +0.217 (0.008) natural log m/s
2
per 10 bpm;
p
=0.001].

Conclusions:
Long-term survivors of anthracycline-treated pediatric cancer have reduced systolic & diastolic myocardial reserve in response to exercise.
Abstract 18216: Epigenetic Up-regulation of α-smooth Muscle Actin Expression and Cell Aggregation in Human Aortic Valve Interstitial Cells Promotes Calcific Nodule Formation
Authors: Song Rui , Fullerton David A. , Ao Lihua , Zhao Kesen , Meng Xianzhong
Published: July 2021

Older people are at risk of calcific aortic valve disease. Aortic valve interstitial cells (AVICs) play an important role in nodular calcification in aortic valve leaflets. AVICs in human aortic valves consist of fibroblasts and myofibroblasts that express α-smooth muscle actin (α-SMA). We have observed that AVICs of diseased aortic valves have greater osteogenic activities. However, molecular mechanism underlying AVIC formation of calcification nodules is not well understood. We hypothesized that an epigenetic mechanism promotes AVIC calcification nodule formation through induction of α-SMA expression and cell aggregation.

Methods and Results:
MiRNA profiles in AVICs from normal and diseased human aortic valves were analyzed by miRNA array and real-time qPCR. Diseased AVICs displayed higher levels of miR-486. Immunoblotting and immunofluorescence staining revealed that diseased AVICs had higher levels of α-SMA and α-SMA fibers. Inhibition of miR-486 by lentiviral-delivered miR-486 antagomir in diseased AVICs suppressed α-SMA expression and cell aggregation, resulting in reduced calcification nodule formation. Conversely, lentiviral-delivered miR-486 mimic in normal AVICs induced α-SMA expression and cell aggregation, leading to exacerbated calcification nodule formation. Stimulation of normal AVICs with pro-osteogenic mediators TGF-β1 and BMP-2 up-regulated miR-486 levels. MiR-486 antagomir reduced α-SMA expression, cell aggregation and calcification nodule formation in cells exposed to TGF-β1 or BMP-2. Further, miR-486 mimic induced AKT phosphorylation. Inhibition of AKT decreased α-SMA expression and cell aggregation induced by miR-486 mimic in normal AVICs. Knockdown of α-SMA suppressed cell aggregation and calcification nodule formation.

Conclusions:
The pro-osteogenic phenotype of AVICs of diseased aortic valves is associated with up-regulated levels of miR-486 and α-SMA. MiR-486 modulates the AKT pathway to up-regulate α-SMA expression and cell aggregation that are required for calcification nodule formation. These novel findings indicate that miR-486 contributes to the mechanism underlying aortic valve calcification and appears to be a therapeutic target for suppression of valvular osteogenic activity.
Abstract 18262: Molecular Genetics of Familial Hypercholesterolemia in Israel Revisited
Authors: Durst Ronen , Ibe Uche Ken , Meiner Vardiella Meiner , Shpitzen Shoshi , Schurr Dani , Eliav Osnat , Futema Marta Futema , Whittall Ros , Humphries Steve E , Leitersdorf Eran
Published: July 2021

Background:
In 1996, the first summary of molecular genetics of familial hypercholesterolemia (FH) in Israel was published (Reshef A, Hum Gen, 1996). Since then, new technology for mutation screening became available making genetic diagnosis easier more accurate, and more comprehensive. We performed systematic mutation screening of index cases of 68 pedigrees to reanalyze the profile of mutations among Israeli FH patients.

Methods and results:
In 68 individuals the entire coding region, promoter and intron-exon junctions of the
LDLR
and part of exon 26 of the
APOB
gene were screened for variants using High Resolution Melting, with Sanger sequencing of any identified melt shifts. Mutations of the
LDLR
gene were found in twenty-three patients (34% of the total) with seventeen different mutations . The most common mutation was p.(V827I) (47% of the detected mutations), not previously reported in Refech et al but reported to occur in patients from Russia. Three variants, two in exon 4 and one in the promoter region were not reported before; p.(C121S), p.(E140A) and c.-191 C>A. One patient carried the common
APOB
p.(R3527Q) mutation. 70% of the cohort were negative for an
LDLR
or
APOB
mutation. It was hypothesized that FH can be caused by an accumulation of LDL-C raising alleles each having a small contributive effect (Talmud et al., 2013). Using this published gene score method derived from twelve common LDL-C raising SNPs in eleven genes, the mean polygene score was significantly higher (p=0.03) among mutation negative Israeli FH patients compared with a European control population.

Conclusion:
We identified mutations in 30% of a new Israeli FH cohort. In these we found 3 novel
LDLR
mutations. The high prevalence of p.(V827I) likely reflects the change in demographics of the Israeli population since 1996 . In the remaining mutation free cohort, there is likely to be a polygenic cause of their elevated LDL-C and FH diagnosis. These data can help design a future strategy for early screening for FH in our population.
Abstract 18272: The Increasing Proportion of Acute Myocardial Infarction Represented by the Uninsured: a Growing Financial Burden in the United States
Authors: Doran Bethany , Guo Yu , Xu Jinfeng , Bangalore Sripal
Published: July 2021

Introduction:
Under the provisions of the Affordable Care Act, insurance coverage will markedly increase with the Congressional Budgetary Office estimating the number of insured to increase by approximately 13 million in 2014 and 25 million in 2016. However, approximately 31 million non-elderly US citizens are expected to remain without health insurance in 2016. Acute myocardial infarction (AMI) remains a source of significant morbidity and mortality, as well as cost to society. No prior studies have examined temporal rates of uninsured among patients presenting with an AMI using a nationally representative database.

Hypothesis:
We tested the hypothesis that the proportion of uninsured individuals with AMI and cost of uninsured to society will vary by year.

Methods:
We used the Nationwide Inpatient Sample (NIS), which contains estimates from approximately 8 million hospital visits and information related to number of discharges, aggregate charges, and principal diagnoses of all patients discharged in the US. We calculated the percentage of acute myocardial infarction by insurance status, and the sum of all charges of hospital stays in the US adjusted for inflation.

Results:
The cost to society due to acute myocardial infarction in the uninsured increased substantially from 1997 to 2012, with total cost in 1997 of $852,596,272 and $3,446,893,954 in 2012 after adjustment for inflation. In addition, although rates of AMI decreased in the general population (from 268.6/100,000 individuals in 1997 to 193.8/100,000 individuals in 2012), the proportion of individuals with AMI who were uninsured increased (from 3.83% in 1997 to 7.37% in 2012).

Conclusions:
The proportion of those experiencing AMI who are uninsured is rising, as is cost to society. It remains to be seen what the effects of expanding health insurance will have on the rate of AMI as well as proportion of AMI represented by the uninsured.
Abstract 18297: Clinical and Prognostic Utility of Cardiac Magnetic Resonance Imaging in Multiple Myeloma Patients With Suspected Amyloidosis
Authors: Bhatti Sabha , Watts Evan , Syed Fahd , Hakeem Abdul
Published: July 2021

Background:
Upto 30% of patients with multiple myeloma have AL amyloidosis and cardiac involvement is associated with worse outcomes in these patients. Traditional screening modalities including EKG, echocardiography and biomarkers have limited value. The aim of this study was to evaluate the role of “screening” cardiac MRI in a large multiple myeloma population at a large specialized referral center.

Methods & Results:
164 consecutive patients with multiple myeloma who underwent cardiac MRI between 6/2005 and 10/2011 were enrolled in this study. Primary endpoint was all cause death. Clinical, EKG, echocardiographic, biomarker and MRI predictors for death were analyzed. Mean age of population was 63+10 years, 40% females and 16% African Americans. 30% of the population had MRI evidence of cardiac involvement. There were 26 patients who had biopsy proven systemic amyloidosis, of whom 62% showed cardiac involvement on MRI. 81% patients with confirmed cardiac amyloidosis on endomyocardial biopsy had typical MR pattern of cardiac involvement. During a median follow up period of 702 days (mean 1019 (950) days), there were 59 deaths (36%). Amyloid pattern on cardiac MRI (OR 2.19), elevated BNP and increased LV wall thickness on MRI were significant predictors of mortality . (All p<0.05)

Conclusions:
This is the largest study to date evaluating the role of cardiac MRI in multiple myeloma patients with suspected cardiac amyloidosis. Cardiac MRI is a clinically robust tool for risk stratification of this subset of patients.
Abstract 184: Consideration of the Patient’s Age Is Important to Predict the Need for Massive Transfusion in Patients with Severe Blunt Trauma
Authors: Ogura Takayuki , Fujizuka Kenji , Nakano Minoru , Nakamura Mitsunobu
Published: July 2021

Back Ground:
The aging of society is progressing rapidly, and the aging of the trauma patient has also progressed over time. Age-related physiologic or anatomic loss of organ function, muscle atrophy, osteoporosis, and reduction in the average amount of subcutaneous tissue may lead to more serious effects of a traumatic injury. The aim of this study is to investigate the effect of patient’s age in the need for massive transfusion.

Material and Methods:
This study was conducted at a single institution, all patients in this study experienced blunt traumatic injuries. Patients with out-of-hospital cardiac arrest or isolated head trauma were excluded. We reviewed data from severely injured trauma patients admitted between Jan. 2008 and Mar. 2012. The following parameters were evaluated: age, sex, systolic blood pressure (SBP), heart rate (HR), Glasgow Coma Scale (GCS), results of the Focused Assessment with Sonography for Trauma (FAST), unstable pelvic fracture, femoral fracture, serum lactate, base excess, hemoglobin level (Hb), platelet count (Plt), prothrombin time (PT), antithrombotic agents, active outer bleeding, and Injury Severity Score (ISS). Massive transfusion was defined as the transfusion of 10 or more units of packed red blood cells, within 24 hours of the time of injury. We compared the parameters in patients who underwent massive transfusion (the MT group) with those who did not (the non-MT group), and independent contributed variables were detected by multiple logistic regression analysis.

Results:
232 patients were included. Age, positive FAST, serum lactate, active outer bleeding, the presence of unstable pelvic fracture, and ISS in the MT group were all significantly greater than in the non-MT group. SBP, GCS, Hb, Plt, and PT were significantly less in the MT group than in the non-MT group. Age (p=0.02), SBP (p<0.01), positive FAST (p<0.01), the presence of unstable pelvic fracture (p<0.01), PT (p=0.01), and ISS (p<0.01) were independent contributed variables for massive transfusion.

Conclusion:
Elderly blunt trauma patient tended to be transfused massively, and consideration of the patient’s age is important to predict the need for massive transfusion in severe blunt trauma patients.