bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 9883: Comparison of Magnetic Resonance Imaging Findings in Non-ST-Segment Elevation versus ST-Segment Elevation Myocardial Infarction Patients Undergoing Early Invasive Intervention
Authors: Song Young Bin , Xu Jianqiang , Hahn Joo-Yong , Gwon Hyeon-Cheol , Chang Sung-A , Choi Seung-Hyuk , Choi Jin-Ho , Lee Sang Hoon
Published: April 2024

Background
To define causes and pathophysiological mechanisms underlying differences in clinical outcomes, we compared the findings of contrast-enhanced magnetic resonance imaging (CE-MRI) between patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) who received early invasive intervention.

Methods
In 168 patients undergoing early invasive intervention for STEMI (n=113) and NSTEMI (n=55), CE-MRI was performed a median of 6 days after the index event. Infarct size was measured on delayed-enhancement imaging and area at risk (AAR) was quantified on T2-weighted images.

Results
The median infarct size was significantly smaller in the NSTEMI group than in the STEMI group (10.7% [5.6-18.1] versus 19.2% [10.3-30.7],
P
<0.001). Although there was a trend of greater myocardial salvage index ([AAR - infarct size] × 100/ AAR) in the NSTEMI group than the STEMI group (48.2 [30.4-66.8] versus 40.5 [24.8-53.5],
P
=0.056), myocardial salvage index was similar between the groups in patients with anterior infarction (39.6 [20.0-54.9] versus 35.5 [23.2-53.4],
P
=0.96). The NSTEMI group also had a significantly lower extent of microvascular obstruction and smaller number of segments with >75% of infarct transmurality relative to the STEMI group (0% [0-0.6] versus 0.9% [0-2.3],
P
<0.001 and 3.0±2.3 versus 4.6±2.9,
P
=0.001, respectively). Myocardial hemorrhage was detected less frequently in the NSTEMI group than the STEMI group (22.6% versus 43.8%,
P
=0.029). In multivariate analysis, baseline Thrombolysis In Myocardial Infarction flow grade 3 and hemorrhagic infarction were closely associated with ST-segment elevation (OR 0.32, 95% CI 0.13-0.81,
P
=0.017; OR 5.66, 95% CI 1.77-18.12,
P
=0.003, respectively).

Conclusions
In vivo pathophysiological differences revealed by CE-MRI assessment include more favorable infarct size, AAR, myocardial salvage and reperfusion injury in patients with NSTEMI than in those with STEMI undergoing early invasive intervention.
Abstract 9899: Wnt11-Pretreated Bone Marrow Mesenchymal Stem Cells Induce Superior Cardiac Repair After a Reperfused Myocardial Infarction
Authors: Cheng Guangming , Xuan Yu-Ting , Quinn Carrie M , Sanganalmath Santosh K , Girgis Magdy , Wang Ou-Li , Zhu Yanqing , Yang Yanjuan , Flaherty Michael P , Lietzau-Mourer Shelley , Zuba-Surma Ewa K , Vincent Robert J , Xu Dong , Davani Arash , Dawn Buddhadeb
Published: April 2024

Wnt11, a member of the evolutionarily conserved Wnt family of glycoproteins, plays important roles in cellular migration, proliferation, and differentiation during embryogenesis. However, the impact of Wnt11 signaling in cardiac repair after an acute myocardial infarction (MI) remains largely unknown. Based on the ability of Wnt11 to induce cardiomyogenic differentiation in adult cells, we hypothesized that pretreatment of bone marrow mesenchymal stem cells (MSCs) with Wnt11 would improve the outcomes of infarct repair. In vitro, Wnt11 pretreatment upregulated the expression of antiapoptotic and angiogenic molecules in MSCs. Wnt11 also increased the expression of Nkx2.5 (Figure), a marker of cardiac commitment. To test the efficacy of Wnt11 pretreatment on MSC-induced cardiac repair in vivo, MSCs were cultured in presence of Wnt11-secreting 293 cells (on an insert) for 5 days and transplanted intramyocardially after a reperfused MI. Age-matched male wild-type (C57BL/6J) mice underwent a 30-min coronary occlusion followed by reperfusion, and 48 h later received intramyocardial injection of vehicle, untreated MSCs (1 million in 30 microL), or Wnt11-pretreated MSCs (1 million in 30 microL). Echocardiography was performed 4 d prior to coronary occlusion/reperfusion (BSL1) and at 48 h (BSL2), 21 d, and 35 d after cell injection. After 35 d, compared with mice that received vehicle or untreated MSCs, mice injected with Wnt11-pretreated MSCs exhibited greater LV ejection fraction (Figure) and smaller LV end-diastolic volume, indicating that Wnt11 pretreatment transforms MSCs into superior vehicles of infarct repair. We conclude that intramyocardial transplantation of Wnt11-pretreated MSCs after a reperfused MI results in improved myocardial repair. These results underscore that pretreatment with Wnt11 may potentially enhance the outcomes of therapeutic infarct repair in humans.
Abstract 9948: Serum Total Bilirubin Levels Predict Amputation Events in Type 2 Diabetic Mellitus
Authors: Chan Kim H , Stocker Roland , Sullivan David , Rajamani Kushwin , Ng Martin , O'Connell Rachel , Keech Anthony
Published: April 2024

Objectives:
Bilirubin is well known for its antioxidant and anti-inflammatory properties, and may protect against vascular disease. It has previously been demonstrated that higher serum bilirubin levels were associated with reduced peripheral arterial disease (PAD) prevalence. However, the relationship between bilirubin and lower limb amputation, a consequence of PAD, is currently unknown. We hypothesized that bilirubin protects against amputation events in type 2 diabetic patients with PAD.

Methods:
The relationship between baseline serum total bilirubin level and amputation events was analyzed in 9795 type 2 diabetic patients from the FIELD (Fenofibrate Intervention and Event Lowering in Diabetes) study in a pre-specified subsidiary analysis. Lower limb amputation was adjudicated blinded to treatment allocation. Relevant clinical and biochemical data were available for analyses. Bilirubin was analyzed continuously using Cox regression techniques.

Results:
Serum bilirubin level was significantly inversely associated with lower limb amputation rate. When bilirubin was analyzed continuously, patients with lower bilirubin levels had an increased risk of amputation compared with patients with higher bilirubin levels (HR 1.38 per 5 µmol/L decrease in bilirubin, 95% CI 1.07-1.79, p=0.013). The same association persisted after adjustment for baseline variables including age, sex, height, smoking status, alcohol intake, GGT, ALT, HbA1c, and history of hypertension, hypercholesterolemia, previous PAD, prior revascularization, amputation, ulcer, neuropathy, renal dysfunction and diabetic retinopathy (p=0.032), as well as treatment allocation (placebo vs. fenofibrate).

Conclusion:
Our results identify a highly significant inverse relationship between serum bilirubin level and lower limb amputation rate. Our data is consistent with the hypothesis that bilirubin plays a protective role against amputation in the setting of type 2 diabetes.
Abstract 9969: Are Men or Women More Likely to Call 911 During an Acute Coronary Syndrome (ACS)?
Authors: Newman Jonathan , Muntner Paul , Chang Melinda J , Ye Siqin , Perez Sarah , Shimbo Daichi , Davidson Karina W
Published: April 2024

Introduction
: Many patients with ACS fail to call 911. Several studies have identified gender differences in 911 use during an ACS. It may be that general health seeking behaviors impact differently on men and women, which may manifest as an increase in 911 calls. If present, the effect of general health seeking on gender differences in 911 use would be expected for both unstable angina (UA) and myocardial infarction (MI). To examine the effect of increased general health seeking behaviors, participants were stratified as either UA or MI in our examination of the association between gender and 911 use at ACS presentation.

Methods
: Participants were hospitalized patients with an ACS (
N
=
476) enrolled in a prospective cohort study. Demographic, psychosocial and clinical factors were assessed within 7 days of enrollment via clinical interview or chart review. Calling 911 was determined by self-report and verified through a random selection of 20% of medical charts.

Results
: Of the 476 participants, 292 (61.3%) had UA and 184 (38.7%) had an MI. Women and men with UA were equally likely to call 911 (14.9% vs. 12.6%,
P
= 0.59). In contrast, women with an MI were much more likely to call 911 than men (56.7% vs. 28.2%,
P
< 0.001). In a multivariable model adjusted for socio-demographic factors (age, race/ethnicity, public health insurance status, health insurance (within 2 years), high school education and martial status) and history of MI, women remained significantly more likely than men to call 911 during an MI (Prevalence Ratio 2.03; 95% C.I. 1.39 - 2.98,
P
< 0.001), Table.

Conclusion:
Our study shows that women with an MI are two times as likely than men to call 911, independent of possible socio-demographic explanatory factors. Women with UA did not differ from men in calling 911. Our findings suggest that gender differences in calling 911 are unlikely to be related to either health seeking behaviors or socio-demographic factors.
Abstract 9975: Midwall Late Gadolinium Enhancement Predicts Mortality in Non-Ischemic Dilated Cardiomyopathy
Authors: Gulati Ankur , Khwaja Jahanzaib , Guha Kaushik , Raza Sadaf , Morarji Kishen , Ismail Tevfik , Di Pietro Elisa , Secchi Francesco , Brown Tristan , Davendralingham Natasha , Banya Winston , Daryani Yousef , Jabbour Andrew , Pennell Dudley , Prasad Sanjay
Published: April 2024

Introduction:
Small studies with composite endpoints show that midwall late gadolinium enhancement (LGE) predicts short term adverse prognosis in dilated cardiomyopathy (DCM). We hypothesized that midwall LGE is an independent predictor of mortality over a long follow-up period.

Methods:
Consecutive patients with DCM referred for CMR between 2002-2008 were prospectively enrolled. The diagnosis of DCM was made using clinical, CMR and coronary angiographic findings. Patients with ischemic heart disease, primary valvar disease and infiltrative CM were excluded. LGE-CMR at 1.5T (Siemens Sonata or Avanto, Germany) was performed in 2 phase-encoding directions. The presence of midwall LGE was determined by a specialist blinded to all outcome data. The primary endpoint was all-cause mortality. The secondary endpoint was a composite of cardiovascular (CV) mortality or cardiac transplantation.

Results:
Two hundred and thirty patients (157 male, mean age 50 yrs, mean LVEF 35%) were followed up for a median duration of 44 months. Midwall LGE was identified in 87 (38%) patients. No patient was lost to follow-up. There were 33 deaths (26 CV deaths, 7 non-cardiac) and 7 patients underwent cardiac transplantation. Kaplan-Meier analysis demonstrated a significant association between the presence of midwall LGE and both the primary (p=0.02, Fig.1) and secondary (p=0.003) endpoints. Midwall LGE remained a significant independent predictor of all-cause mortality (HR 2.2, 95% CI 1.1 to 4.7; p=0.035) and CV mortality/transplantation (HR 2.8, 95% CI 1.3 to 6.0; p=0.007) on stepwise Cox regression multivariable analysis allowing for conventional outcome predictors.

Conclusions:
Midwall LGE is a significant independent predictor of both all-cause mortality and CV mortality/transplantation in DCM. Detection of midwall LGE by CMR represents an important and novel marker for the risk stratification of DCM patients.
Abstract 18234: Body Mass Index and Body Mass Index Z Score Trajectories from Birth to Adolescence
Authors: Yoshinaga Masao , Ninomiya Yumiko , Tanaka Yuji , Tanoue Kazuyuki , Nuruki Norihito , Sonoda Masahiro , Takahashi Hideto , shinomiya Masaki , Miyazaki Ayumi
Published: April 2024

Background:
There are 3 critical periods for developing obesity during childhood: the fetal period; a period of adiposity rebound between 4-6 years; and during adolescence. The approach of latent class growth ascertains the most interpretable set of classes. The resulting categorical latent variable represents the groups of homogenous individuals within the class to which they belong.

Aim:
We hypothesized that the early infantile period is another critical period at risk for developing obesity in adolescents using latent class growth models based on longitudinal height and weight data.

Methods:
The study cohort included 913 healthy adolescent volunteers (396 males and 517 females) aged 15-18 years in Japan. Complete data sets for height and weight at birth, 1.5, 3, 6, 9 and 12 years of age, as well as at present, were obtained. Body mass index (BMI) and age- and sex-specific BMI Z scores were used as measures of obesity. Adiposity rebound was defined as the point of minimal BMI during infancy. Three-group latent class growth models were used in the present study.

Results:
The BMI trajectories showed that individuals who consistently increased in BMI during infancy, i.e., they showed no adiposity rebound, were at the highest risk for adolescent obesity in both sexes. The Z score trajectories revealed that male subjects who were born with high Z scores and whose scores remained at high levels, as well as those who were born with low Z scores and whose scores had a sharp increase from birth to 1.5 years, were at risk for developing obesity. Female subjects who were born with relatively high Z scores and whose scores had a sharp increase from birth to 1.5 years were at risk. A representative figure is shown as Fig 1.

Conclusion:
These data suggest that the early infantile period is important for preventing further development of obesity. Further more detailed studies are required to identify individuals and the exact timing of the critical periods during early infancy to prevent later obesity.
Abstract 18242: Left Ventricular Non-Compaction on Cardiac Magnetic Resonance Imaging is prevalent in patients with Myotonic Dystrophy
Authors: Choudhary Preeti , Nandakumar Ramasami , Grieve Stuart , Broadhurst Paul , Dean John C , Puranik Rajesh , Celermajer David S , Hillis Graham
Published: April 2024

Aims:
Myotonic dystrophy (MD) is an autosomal dominant neuromuscular disorder characterised by myotonia, skeletal muscle weakness and multi-system disease. Patients with MD are at high risk of premature cardiovascular death related primarily to arrhythmias, conduction abnormalities and dilated cardiomyopathy. Cardiac magnetic resonance imaging (cMR) is the optimal modality to detect early abnormalities of left ventricular (LV) structure and function. There are, however, few data exploring the prevalence of cMR abnormalities in this setting. The aim of the current study is therefore, to address this.

Methods:
Forty patients with MD and 41 age and gender matched controls underwent clinical evaluation, standard 12 lead EKGs, 24 hour Holter monitoring, echocardiography and cMR. Cardiac MR scans were analysed by blinded two observers.

Results:
There was a significantly higher prevalence of compaction abnormalities in patients with MD (non-compaction [NC] in 34% in MD vs. 12% in controls; p=0.02). LV function, however, was similar in MD patients and controls, (MD mean EF = 58 standard deviation [SD] 7% vs. mean 59 SD 6% in controls, p = 0.4). PR interval and QRS durations were also significantly prolonged in patients with MD (mean MD PR interval = 186 SD 29 ms vs. 155 SD 24 ms, mean MD QRS duration = 100 ms SD 12ms vs. 88 ms SD 9 ms in controls; p <0.001 for both). There was no significant difference in QTc in MD patients compared to controls (MD mean QTc = 410 SD 10 ms. vs. 409 SD 15 ms. in controls p=0.51). Among patients with myotonic dystrophy, there were no significant differences in the PR, QRS durations and the QTc between patients with normal compaction and NC (p=0.87). No other Holter parameters correlated with NC.

Conclusion:
LV non-compaction is common in patients with MD and has not been well characterised previously. Non-compaction in patients with MD is not associated with conduction abnormalities within this cohort. The clinical relevance of these findings require further study.
Abstract 18247: In Vitro Perfused Human Capillaries
Authors: Moya Monica L , Hsu Yu-Hsiang , Hughes Christopher C , Lee Abraham P , George Steven C
Published: April 2024

Understanding the function and structure of the microcirculation is key to improving our understanding of pathophysiological process in many areas of cardiovascular disease including myocardial infraction and hypertension. Many of the techniques used to investigate the microcirculation include costly clinical human observations, in vivo animal studies, which require extrapolation of results to human, or in vitro models that lack the dynamic feature of perfusion. We have developed an in vitro model system of microtissues with perfused, living, dynamic human capillaries. In this work we demonstrate the ability to develop capillaries under two different pressure distributions and we assess features of the in vitro formed capillaries including permeability and shear rate. Our device consist of a PDMS casing consisting of two microfluidic channels on either side of 12 diamond shaped chambers containing stromal cells co-seeded with endothelial cells in a fibrin matrix. In both designs, formation of perfused vessels was encouraged by both mechnical and chemical stimuli. Finite element simulations demonstrate the ability to control the pressure distribution (Fig 1a & 1b) and subsequent interstitial flows within the two designs. Varying or equal transverse pressure drops across each tissue chamber were created by either decreasing or increasing the pressure at the pores (Figure 1c & 1d). Within 2-3 weeks of culture, a network of vessels (diameter=15-50µm) was observed (Fig 1e) in both designs. Perfusion of the vessels was confirmed at day 21 by perfusing FITC-dextran through the vessels by convection. The vessels were impermeable to 70 and 150 kDa FITC-dextran (Fig 1f). Microspheres tracked as they moved through the vessels revealed fluid velocities ranging from 0-4,000 µm/s at various locations along the vessel.
Abstract 18267: Coronary Risk Factors and Prevalence and Severity of Coronary Atherosclerosis in the Young
Authors: Otaki Yuka , Gransar Heidi , Dey Damini , Lin Fay , Cheng Victor , Achenbach Stephan , Al-Mallah Mouaz , Matthew Budoff , Cademartiri Filippo , Callister Tracy Q , Chang Hyuk-Jae , Chinnaiyan Kavitha , Chow Benjamin , Delago Augustin , Hadamitzky Martin , Hauesleiter Joerg , Kaufmann Philippo , Maeffei Erica , Shaw LesLee , Berman Daniel , Feuchtner Gurdun , Dunning Allison , Villines Todd , Min James K
Published: April 2024

Purpose.
We examined the relationship between coronary risk factors (RF) and prevalence and severity of coronary atherosclerosis in young individuals undergoing coronary CT angiography (CCTA).

Methods.
Of 27125 patients undergoing CCTA, 1635 young (50%stenosis), and presences of calcified plaque (CP) and non-calcified plaque (NCP).

Results.
Among 1635 subjects (70% men, age 38±6 years), 6% had diabetes (DM), 31% had hypertension (HTN), 37% had dyslipidemia (CHOL), 21% had smoking (SM) and 33% had family history (FH) of CAD. Among all young individuals, any CAD, obs CAD, CP and NCP were observed in 19%, 4%, 5%, and 8%, respectively. Compared to women, men demonstrated higher rates of any CAD (21% vs 12% P<0.001), CP (6% vs 3% P=0.01), and NCP (9% vs 5% P=0.008), although no difference was observed for rates of obs CAD (5% vs. 4% P=NS). Any CAD, obs CAD, and NCP were higher for young individuals with DM, HTN, CHOL, SM or FH of CAD; while only DM and CHOL were associated with CP (Table). In multivariable analysis adjusting for sex and RFs, male sex was the strongest predictor for any CAD (Odds Ratio [OR] 1.95, 95% Confidence Interval [CI] 1.43-2.66, P<0.001), CP (OR 1.46, 95%CI 1.08-1.98, P=0.014) and NCP (OR 1.33, 95%CI 1.06-1.67, P=0.014); while FH of CAD was the strongest predictor for obs CAD (OR 2.71, 95% CI 1.65-4.45, P3 RFs manifesting a significant increase in any CAD (P<0.001 for trend); obs CAD (P<0.001 for trend); NCP (P<0.001 for trend) and CP (P=0.008 for trend).

Conclusions.
CAD is present in 1 in 5 young individuals, with sex and coronary RFs associated with increasing presence and severity of CAD.
Abstract 18314: Fragmented QRS on a 12-lead ECG: A Predictor of Major Arrhythmic Events and Sudden Cardiac Death in Patients with Hypertrophic Cardiomyopathy; Long-term Follow-up Study
Authors: Kang KI-Woon , Hwang Hye Jin
Published: April 2024

INTRODUCTION
Fragmented QRS (fQRS) on a 12-lead electrocardiogram (ECG) is associated with major arrhythmic events (MAEs) included sudden cardiac death (SCD). However, Limited data was still shown in patients with hypertrophic cardiomyopathy (HCM).

METHODS
fQRS included various RSRpatterns (QRS duration < 120ms), such as ≥1 R prime or notching of the R wave or S wave present on at least two contiguous leads of those representing anterior (V1-V5), lateral (I, aVL, V6), or inferior (II, III, aVF) myocardial segments on a 12-lead electrocardiogram (ECG). In the 454 (71% male, age 62±11 years, mean follow-up duration 10±1 years) patients with diagnosed HCM using echocardiography. We divided into two groups; fQRS and non-fQRS group at the time of diagnosis. MAEs (sustained VT or non-sustained VT on ambulatory 24-hr holter monitoring) including SCD were retrospectively reviewed.

RESULTS
fQRS was found (87/203, 42.8%) and predominantly located in inferior lead, the patients were divided into two groups: Heart rate, PR interval, QRS duration and QTc interval were similar in both groups. MAEs including SCD [14 (31.1%) vs. 2 (2.2%)] were higher in the fQRS group compared with the non-fQRS group (mean follow-up duration, 7.1±2.2 years). Multivariate Cox regression analysis revealed that fQRS was an independent significant predictor for MAE including SCD [hazard ratio 11.09 (confidence interval 2.40-51.09), p=0.002]. A Kaplan-Meier survival analysis revealed that fQRS group was significantly associated with lower MAE-free survival rate compared to non-fQRS group (P=0.004).

CONCLUSION
The fQRS complex is an independent predictor of MAEs including SCD in patients with HCM on long-term follow-up.
Abstract 18321: Impact of Single Catheter Ablation of Atrial Fibrillation on Appropriate and Inappropriate Implantable Cardioverter Defibrillator Therapies in Patients with Cardiomyopathy
Authors: Kosiuk Jerzej , Nedios Sotirios , Darma Angeliki , Rolf Sascha , Arya Arash , Piorkowski Christopher , Gaspar Thomas , Sommer Philipp , Hindricks Gerhard , Bollmann Andreas
Published: April 2024

Background:
Atrial fibrillation (AF) is associated with frequent appropriate and inappropriate ICD therapies. Catheter ablation of AF has been shown to reduce AF burden and improve left ventricular function in heart failure patients but the impact on ICD therapies has not been studied. Here, we tested the hypothesis that AF ablation reduces ICD therapies in patients with cardiomyopathies.

Methods:
In 73 consecutive patients (mean age 59 ± 10 years, 85 % male) with previously implanted ICD due to ischemic (n=30) or dilated cardiomyopathy (n=43) undergoing AF catheter ablation, the frequency of appropriate and inappropriate ICD therapies before and after AF ablation were compared.

Results:
During mean follow-up of 3.3 ± 3 years prior to AF ablation, 4.5 ± 14.7 therapies per patient-year were delivered as opposed to 1.5 ± 10.9 in period of 1.1 ± 0.9 years after ablation. Therefore, catheter ablation of AF reduced the frequency of all ICD therapies by a factor of 3 (p=.002). Both, inappropriate therapies decreased from 2.7 ± 10.9 to 1.4 ± 10.9 per patient-year (p=.02) and appropriate therapies decreased from 1.7 ± 10.9 to 0.1 ± 0.9 per patient-year (p=.028). While heart failure medication and use of antiarrhythmic drugs was comparable during entire follow-up period, left ventricular ejection fraction (LVEF) was significantly improved from 36 ± 11 to 42 ± 13% (p=.004) after AF ablation.

Conclusions:
In patients with ischemic or dilated cardiomyopathy, catheter ablation of AF reduces inappropriate and appropriate ICD therapies and improves LVEF.
Abstract 18351: Prevalence, Clinical Significance and Relevance to Screening of Electrocardiographic Abnormalities in Hypertrophic Cardiomyopathy
Versus
Athlete's Heart
Authors: Calore Chiara , Melacini Paola , Pelliccia Antonio , Cinzia Cianfrocca , Schiavon Maurizio , Fernando M Di Paolo , Francesca Bovolato , Filippo M Quattrini , Basso Cristina , Thiene Gateano , Iliceto Sabino , Corrado Domenico
Published: April 2024

Background:
Hypertrophic cardiomyopathy is often in the differential diagnosis with athlete’s heart due to the partial overlap of ECG and echocardiographic abnormalities. This study assessed the prevalence, clinical significance and relevance to athletic screening of ECG abnormalities in hypertrophic cardiomyopathy (HCM) patients versus highly trained athletes.

Methods:
We compared the ECG tracings of 247 HCM patients (73% males, mean age 39±14 years) with those of 133 highly trained athletes with augmented left ventricular (LV) mass (87% males, mean age 27±6 years), with the same age range (15-65 years) Based on the ECG findings, HCM patients and athletes were grouped as normal ECG (Group 1), isolated increase of QRS voltage (Group 2) and abnormal ECG showing ≥1 non-voltage criteria, including atrial enlargement, QRS left axis deviation, ST-segment or T-wave abnormalities, pathologic Q waves, and complete bundle branch block, regardless of QRS amplitude (Group 3).

Results:
Group 1 ECG was found in 11/247 (4%) HCM patients vs 69/133 (52%) athletes (P<0.001); Group 2 ECG in 6 (2%) vs 53 (40%) (P<0.001) and Group 3 ECG in 230 (93%) vs 11 (8%) (P<0.001). Compared with HCM patients from Group 3, those from Group 1 and 2 had a lower maximal LV wall thickness (16±2 and 18±3 mm vs 21±5 mm; P=0.01) and a lower rate of either defibrillator implants (0 vs 17%) or major arrhythmic events (0 vs 6%) during a follow-up of 8±6 years. Combined voltage and non-voltage ECG abnormalities (Group 2 and 3) showed a sensitivity of 96% and a specificity of 52% for HCM, whereas non-voltage criteria alone (Group 3) increased the specificity to 92% (P<0.001) and reduced the sensitivity to 93% (P=0.35).

Conclusions:
The ECG abnormalities of HCM and athlete’s heart overlap marginally. Unlike athletes, among HCM patients the ECG pattern of isolated increase of QRS voltages is uncommon and associated with a mild phenotype similarly to normal ECG. Interpreting as normal an isolated increase of QRS voltages almost doubles the ECG specificity, without significantly reducing sensitivity for HCM.
Abstract 18354: Cardiac Magnetic Resonance Allows Noninvasive and Accurate Monitoring of Serial Changes in Pulmonary Vascular Resistance and the Acute Vasodilator Response in Chronic Pulmonary Hypertension
Authors: GarcÍa-Álvarez Ana , Fernández-Friera Leticia , GarcÍa-Ruiz Jose Manuel , Nuño-Ayala Mario , Pereda Daniel , Fernández-Jiménez Rodrigo , Guzmán Gabriela , Sanz-Rosa David , GarcÍa-Prieto Jaime , Mirelis Jesus G , Pizarro Gonzalo , Fuster ValentÍn , Ibañez Borja
Published: April 2024

Background:
Monitoring pulmonary vascular resistance (PVR) during the follow-up of patients with pulmonary hypertension (PH) and the acute vasodilator response require invasive right heart catheterization. A noninvasive method would be valuable. Hypothesis: Cardiac magnetic resonance (CMR) allows noninvasive monitoring of PVR and the acute vasodilator response.

Methods:
Two experimental models of chronic PH were developed in pigs. A precapillary PH model was induced by repeated pulmonary embolization with microspheres (n=8). A postcapillary PH model was generated with surgical banding of the main pulmonary vein (n=10). At baseline and every month, animals were evaluated by CMR (pulmonary artery mean flow velocity [PAvel] from phase-contrast images) with simultaneous invasive quantification of PVR using a CMR-compatible Swan-Ganz catheter (N=60 pairs of measurements). Generalized estimating equations analysis was used to correlate repeated measurements of PVR and PAvel. Additionally, correlation between acute changes in PAvel and PVR induced by pulmonary embolization (n=10) or vasodilator administration (n=10) inside the magnet was assessed using Spearman correlation.

Results:
Both models generated chronic PH (mPAP=30.8±4.8 and 54.5±12.8, pre and postcapillary respectively) with typical changes on pathology. CMR-model based on PAvel strongly correlated with serial measurements of PVR in both precapillary (r=0.86, p<0.01) and postcapillary (r=0.97, p<0.01, examples in figure A) models. Additionally, acute changes in PAvel were strongly correlated with the increase in PVR induced by acute embolization (r=-0.98, p<0.001, figure B) or the fall in PVR produced by vasodilator testing (r=-0.89, p<0.001, figure C).

Conclusions:
CMR allows noninvasive and accurate monitoring of acute and chronic changes in PVR and the acute vasodilator response in a broad spectrum of PH. This may be very valuable for the evaluation and follow-up of patients with PH.
Abstract 18357: Outcomes and Quality of Anticoagulant Control in Patients Newly Diagnosed with Non-valvular Atrial Fibrillation: Insights from the Worldwide GARFIELD Registry
Authors: Mantovani Lorenzo , Mueller Iris , Bassand Jean-Pierre , Fitzmaurice David , Goldhaber Samuel , Goto Shinya , Haas Sylvia , Turpie Alexander G , Verheugt Freek W , Rushton-Smith Sophie , Kakkar Ajay , for the GARFIELD Investigators
Published: April 2024

Background:
Prevalence of atrial fibrillation (AF) is increasing due to an aging population. Most AF patients require long-term anticoagulant treatment to prevent stroke. Consequences of insufficient or excessive anticoagulation with vitamin K antagonists (VKAs) can be serious. Time within therapeutic INR range (TTR) evaluates the efficacy and quality of INR control. It remains unclear whether better anticoagulation control (TTR >60%) is associated with lower thrombotic and bleeding events in real-world clinical practice. Hypothesis: The incidence of thrombotic and bleeding events in anticoagulated AF patients treated with VKAs is increased when INR is not well controlled (TTR <60%).

Methods:
Patients were recruited at 543 sites selected at random in accordance with nationally defined AF care settings. A total of 10,609 patients newly diagnosed with non-valvular AF and with ≥1 additional investigator-determined stroke risk factor were recruited consecutively between Dec 2009 and Oct 2011. TTR was calculated by percentage of INR recordings in target range.

Results:
In 6047 patients treated with VKAs, 3952 had INR recordings available at the time of this analysis. TTR was >60% in 1660 (42.0%) of these patients. A total of 55,257 INR measurements were recorded. Event rates and monitoring frequency in relation to quality of INR control are shown in the Table. Mean length of follow-up was 15.2 (SD 6.9) months. Patients with INR not well controlled were more likely to have a stroke/TIA, a major bleed, an ICH and death than patients with INR well controlled.

Conclusions:
These observational data support the findings of randomized clinical trials, by indicating that INR control is instrumental in determining adverse event rates in patients treated with VKAs, but are not consistent with the post-hoc comparisons of novel OACs with warfarin. Table: Event rates and INR recordings in relation to TTR.
Abstract 18370: Role and Potential Impact of TEE in Detecting Markers of Thromboembolism in Non Valvular Atrial Fibrillation Patients with a CHADS2 score = 0?
Authors: Ederhy Stéphane , Lang Sylvie , Boyer-Chatenet Louise , Haddour Nabila , Meuleman Catherine , Fleury Guillaume , Adavane Saroumadi , Di Angelantonio Emanuele , Boccara Franck , Cohen Ariel
Published: April 2024

Background:
Transesophageal echocardiography (TEE) parameters (left atrial appendage, LAA thrombus or spontaneous echocardiographic contrast (SEC), aortic atheroma (AAA) are powerful markers of thromboembolism (TE) in non-valvular atrial fibrillation (NVAF) patients. However, the prevalence and potential impact of these abnormalities have not been evaluated in patients at very low risk of TE. We evaluated TEE-detected LASEC, thrombus and AAA in AF patients referred for cardioversion and analyzed the subgroup of patients with a CHADS
2
score=0.

Methods:
Among 763 consecutive patients hospitalized for NVAF, prior to cardioversion, TEE was systematically performed within 24h after admission; 205 patients had a CHADS
2
score=0. The following parameters were described: presence and severity of LASEC, LA thrombus, aortic atheroma (AAA).

Results:
Mean age was 54.5 ± 13.5 years. AF was paroxysmal in 101 patients (49.3%), persistent in 82 (40.0%) and permanent in 22 (10.7%). Transthoracic echocardiography showed LVEF<40% in 12 (5.9%) and median of mean LA area was 18 (15-23) cm
2
. LA thrombus was found in 1 patient (0.5%), LASEC in 60 (29.3%), classified as mild in 43 (21.0%), moderate in 14 (6.8%) and severe in 3 (1.5%). AAA was present in 6 patients (2.9%). The table compares some baseline characteristics in patients with (LAASEC/thrombus or aortic atheroma ≥ 4 mm) or without TEE abnormalities, defined as an endpoint. In the multivariate analysis, age (OR, 1.04, 95% CI 1.01-1.07), non paroxysmal AF (OR, 3.23, 95% CI 1.54-6.78) and LA area (OR, 1.08, 95% CI 1.02-1.16) were predictors of TEE-detected LASEC/thrombus or aortic atheroma.

Conclusions:
TEE prior to cardioversion in NVAF found TEE-detected risk markers of thromboembolism (LASEC/thrombus or aortic atheroma) in one third of patients with a CHADS
2
score = 0.
Abstract 18372: Differences in Quantitative Assessment of Myocardial Scar and Gray Zone by Delayed Enhanced Cardiac Magnetic Resonance Imaging Using Established Gray Zone Protocols
Authors: Mesubi Olurotimi , Ego-Osuala Kelechi , Jeudy Jean , Etienne-Mesubi Martine , Ament Dawn , Vincent See , Saliaris Anastasios , Shorofsky Steve , Dickfeld Timm-Michael
Published: April 2024

Background:
Delayed enhanced cardiac magnetic resonance imaging (DE-CMRI) is the gold standard for scar evaluation. Heterogeneous areas in the scar, known as ‘gray zone’ (GZ), may serve as arrhythmogenic substrate. Various signal intensity (SI) thresholds have been described and validated for GZ and infarct core definition. Little is known about the effect of these protocols on the presence and amount of GZ and infarct core. We aimed to compare 3 previously described methods.

Methods:
Postprocessing analysis of good quality DE-CMRI images was performed in 14 patients with ischemic (12) or non-ischemic (2) cardiomyopathy and no implanted cardiac devices. Myocardial scar was defined as core and GZ using the following SI thresholds. The core was defined as >50% of maximal SI (MSI) in the hyperenhanced area for the full width at half-maximum (FWHM) and ‘modified-FWHM’ (or ‘Roes’) methods and >3SD of mean SI of remote myocardium for the n-standard deviation (NSD) method. GZ was defined as > peak SI of remote myocardium to 50% of MSI (FWHM), between ≥ 35% -50% of MSI (Roes) and 2-3SD of mean SI of remote myocardium (NSD).

Results:
All patients had evidence of scar on DE-CMRI. The GZ mass was significantly different for the 3 methods with 46±38 g vs. 15±6 g vs. 17±7 g for FWHM, NSD and Roes respectively (p = 0.01). There was no difference in GZ mass between the NSD and Roes (p = 0.12). Infarct core mass was similar for FWHM and Roes (22±13 g) but significantly higher with NSD (63±36 g, p < 0.01). There was a difference in total myocardial scar (core + GZ) with 68±40 g vs. 78±40 g vs. 39±19 g for FWHM, NSD and Roes respectively (p < 0.01). The GZ extent (% of scar that was GZ) also varied significantly for the 3 methods, 62±22% vs. 22±10% vs. 45±11% for FWHM, NSD and Roes respectively (p < 0.01). A strong correlation was shown between GZ mass and total myocardial scar (r = 0.94, p < 0.01 for FWHM, r = 0.74, p < 0.01 for NSD and r = 0.84, p < 0.01 for Roes).

Conclusion:
Considerable variability exists among the current methods for MRI scar quantification of GZ and scar core. There is a 3-fold increase in GZ mass quantified by the FWHM method compared to the NSD and Roes methods. Infarct core and total myocardial scar mass also differ using these methods. Further evaluation of the most accurate quantification method is needed.
Abstract 18374: Secretoneurin Gene Therapy Improves Hindlimb and Cardiac Ischemia in Apo E -/- mice Without Influencing Systemic Atherosclerosis
Authors: Theurl Markus , Albrecht-Schgoer Karin , Schgoer Wilfried , Lener Daniela , Demetz Egon , Pachinger Otmar , Tancevski Ivan , Kirchmair Rudolf
Published: April 2024

Background:
Hypercholesterolemia (HC) is a major risk factor for the development of cardiovascular diseases and associated with reduced neovascularization in response to ischemia. Recent studies showed up-regulation of secretoneurin (SN) by hypoxia and reported induction of angio-, arterio- and vasculogenesis in the hindlimb ischemia (HLI) model. The aim of this study is to evaluate the therapeutic effect of SN in a condition associated with impaired vascular response.

Methods/Results:
SN stimulated capillary tube formation, proliferation and activation of ERK1/2 and Akt in

umbilical vein endothelial and coronary artery endothelial cells (CAEC) in the presence of 50 microg/ml oxidized LDL (oxLDL) comparable to VEGF (rel. capillary tube formation CAEC: SN 1.56±0.05 vs. VEGF 1.63±0.09, n=4, P<0.01 vs ctr). To assess a therapeutic effect of SN
in-vivo
Apo E -/- mice set on western diet underwent HLI by ligation of the femoral artery or myocardial infarction (MI) by ligation of the left anterior descending artery. SN-plasmid (p-SN) or control-plasmid (p-ctr) was injected in the ischemic adductor muscle or the infarct border zone. In the HLI-model SN-therapy increased capillary (capillaries/HPF 200x: p-SN 354.6±14 vs. p-ctr 204.8±8.6; P<0.001) and arteriole (arterioles/HPF 200x: p-SN 5.6±0.52 vs. p-ctr 3.1±0.24; P<0.001) density and improved limb perfusion, assessed by laser Doppler perfusion imaging (rel. LDPI ratio ischemic/non ischemic limb day 28: p-SN 0.78±0.04 vs. p-ctr 0.64±0.02; n=10; P<0.05). Interestingly, SN didn’t induce recruitment of endothelial progenitor cells to ischemic muscle in Apo E -/- mice (% lin
-
sca
+
flk
+
c-kit
+
cells: p-SN 1.72±0.3 vs. p-ctr 1.65±0.3, n=5, n.s.) In the MI-model cardiac parameters were significantly improved by SN-therapy (ejection fraction % 49.2±4.3 vs. 34.1±2.8, P<0.01; left ventricular end diastolic diameter mm 3.2±0.2 vs. 3.8±0.3, P<0.05; n=13). Aortic plaque area wasn’t affected by SN (Sudan IV staining % plaque area: p-SN 15.6±0.8 vs. p-ctr 15.2±2, n=5, n.s.)

Conclusion:
SN-therapy induces angiogenesis in-vitro and in-vivo without affecting vasculogenesis or atherosclerosis in HC and therefore represents a promising therapeutic strategy to reduce tissue ischemia in atherosclerotic diseases.
Abstract 184: Acre ST-Segment Elevation Myocardial Infarction (STEMI) Registry (ASTEMIR): Interval Times Since Symptoms and Reperfusion Success
Authors: Timerman Sergio , Gonzalez Maria Margarita Castro , Neves Sebastiao V , Ramires Jose A , Holanda Rejane M S , Kalil Filho Roberto
Published: April 2024

Proposal: STEMI treatment and its impact on outcomes are highly dependent on time since symptoms onset. We aimed to evaluate the time intervals between symptoms onset, emergency unit admission, electrocardiogram (EKG) and treatment or transfer to treatment thrombolytic therapy(TT) capable unit and their relation to reperfusion success in the public health system (SUS) of ACRE, Rio Branco, Brazil.

Method: The ASTEMIR(Jan 2010-Dec 2011) is the first Brazilian prospective TT registry to include community-based emergency units and general hospitals patients, with a more reliable record of the AMI care reality. It included consecutive STEMI admitted to 3 general hospitals and 8 community-based emergency units.

Results: 189 patients (61±12y, 54% males), with high prevalence of hypertension (71%), diabetes (33%) and previous AMI (13%). On admission, 81% had typical chest pain and 37% Killip class≥II. Half of the patients received TT with tenecteplase (median ambulance--to-needle 104min, IQR 87-207) or door-to-needle 289min, IQR 234-437 reperfusion. The general pain-to-admission time was 155min (76-324) and admission-to-EKG,162min (90-393). Both, pain-to-admission and admission-to-EKG were lower in the reperfusion group (110 vs 205 min,p=0.002, and 155 vs 220min,p=0.001,respectively).

Conclusion: Pain-to-admission and admission-to-EKG times are related to reperfusion success. Regardless of this, the interval times observed in Acre, Rio Branco are close to the ideal recommended by the guidelines. Improvements in population awareness for readily identificationof AMI and health professional education for higher suspicion of STEMI could meliorate this reality in Acre.
Abstract 18404: Current Status of Clinical Background of Hemodialysis Patients with Atrial Fibrillation in Japan: From the Fushimi Af Registry
Authors: Akao Masaharu , Chun Yeong-Hwa , Wada Hiromichi , Esato Masahiro , Hashimoto Tetsuo , Abe Mitsuru , Hasegawa Koji , Tsuji Hikari , Furuke Keizo , The Fushimi AF Registry Investigators
Published: April 2024

Background:
Atrial fibrillation (AF) increases the risks of stroke and death, and the prevalence of AF is increasing significantly. Despite the remarkable effect of warfarin against embolic stroke, the use of warfarin in hemodialysis patients is controversial (or contraindicant), because of the high risk of bleeding in this patient population. The Fushimi AF Registry, a community-based prospective survey, was designed to enroll all of the AF patients living in Fushimi-ku, Kyoto, which is a typical urban district of Japan with a population of 283,000; rough estimate of 2,200 AF patients. The purpose of the study is to investigate the real-world current status of clinical backgrounds of Japanese AF patients, and to follow the clinical outcome in a long term. At present, we have enrolled 3,020 patients from March 2011 to March 2012.

Methods and Results:
We compared the clinical backgrounds of AF patients between those with hemodialysis (HD; n=87) and without it (NHD; n=2,933). Although the mean age was comparable between the two groups (HD vs. non-HD: 72.7 vs. 74.2; NS), HD group showed significantly higher rates of various co-morbidities (heart failure 40.2% vs. 27.9%; hypertension 80.5% vs. 60.5%; diabetes mellitus 55.2% vs. 23.3%). The rates of atherosclerotic vascular diseases were much higher in HD group (coronary artery disease 42.5% vs. 15.2%; myocardial infarction 21.8% vs. 6.4%; peripheral artery disease 19.5% vs. 4.4%), whereas the rate of stroke was comparable (21.9% vs. 19.4%; NS). HD group had higher risk profiles (CHADS2 score 2.72 vs. 2.07; p<0.01), but received lower warfarin use (40.2% vs. 51.0 %; p=0.05). The rate of major bleeding was modestly higher in HD group (3.4% vs. 1.5%; p=0.15), but was much lower than previously reported (10-50%).

Conclusion:
The Fushimi AF registry represents the clinical profile of real-world Japanese AF patients. Hemodialysis patients with AF have higher risk profiles, but receive lower warfarin treatment for stroke prevention. The bleeding risk may be lower than reported under careful management, and therefore the use of warfarin could be considered in patients with particularly high risk for stroke in a case-by-case basis.
Abstract 18425: Total Aortic Volume as a Predictor of Aortic Complications in Marfan Syndrome
Authors: den Hartog Alexander , Franken Romy , Zwinderman Aeilco , Marquering Henk , Mulder Barbara , Groenink Maarten
Published: April 2024

Background:
Mortality and morbidity in Marfan syndrome, an autosomal dominant systemic connective tissue disorder, is mainly determined by aortic complications (development of aortic aneurysm and subsequent dissection). Dissection of the descending aorta usually occurs at relatively normal aortic diameters and is therefore difficult to predict. The aim of this study was to assess total aortic volume as a predictor for aortic complications in Marfan syndrome.

Methods:
In 96 adult MFS patients a Gadolinium enhanced 3D MRI of the aorta was performed. Total aortic volume (aortic valve - aortic bifurcation) measurement was performed with 3D vessel analysis software (3mensio vascular, 3mensio medical imaging BV, Bilthoven, the Netherlands). Aortic complications (aortic dissection and aortic surgery) during 3 years follow-up were collected from patients’ medical charts.

Results:
In the Marfan patients (68 % male), 22% with a history of prophylactic aortic root repair, mean age 36 ± 12 years , mean body surface area (BSA) 2.06 ± 0.24 m2) a mean aortic volume of 114 ± 25ml/m2 was calculated. Aortic complications during 3 year follow-up occurred in 17 Patients. Prophylactic aortic root replacement was performed in 13 patients (14%). Descending aortic dissection occurred in 4 patients, all after previous aortic root replacement and without aortic dilatation in the dissected parts. Mean aortic volume in patients who underwent aortic surgery during the follow-up was significantly higher as compared to the uncomplicated patients (127 ± 22 ml/m2 vs 107 ± 23 ml/m2 p = 0.006). Mean aortic volume in patients with descending aortic dissection was significantly higher as compared to the uncomplicated patients (138 ± 32 ml/m2 vs 107 ± 23 ml/m2 p = 0.012). Regression analysis revealed that total aortic volume corrected for BSA may serve as a predictor for aortic root replacement and as a predictor for descending aortic dissection (OR 1.034 95 % CI 1.008 - 1.061 p = 0,011 and OR 1.042 95 % CI 1.004 - 1. 081 p= 0.028 respectively).

Conclusion:
Aortic volumes may predict aortic events in Marfan syndrome.
Abstract 18448: Partial Blockade of Inwardly Rectifying K
+
Current Enhances Electrotonic Interactions and Destabilizes Spiral Wave Reentry
Authors: Kushiyama Yasunori , Honjo Haruo , Niwa Ryoko , Takanari Hiroki , Yamazaki Masatoshi , Takemoto Yoshio , Sakuma Ichiro , Kodama Itsuo , Kamiya Kaichiro
Published: April 2024

Introduction:
Spiral wave (SW) reentry is a principal mechanism for the maintenance of tachyarrhythmias, such as ventricular tachycardia/fibrillation (VT/VF). We have recently reported that partial blockade of the inward rectifier K
+
current (I
K1
) destabilizes the rotation center of SWs without enhancement of wavefront-tail interaction in the arm, in favor of their termination (ESC 2012), but underling mechanisms remain to be clarified. We hypothesized that alteration in electrotonic influence due to decreased membrane conductance plays a role in destabilization of the SW rotation center.

Methods:
A 2-dimensional ventricular muscle layer was prepared in Langendorff-perfused rabbit hearts, and optical action potential signals were recorded from the epicardial surface of the left ventricle. The dynamics of SW reentry were analyzed during VT induced by modified cross-field stimulation. The space constant (
λ
) was estimated by a decay of electrotonic depolarization induced by injection of subthreshold cathodal current.

Results:
Partial blockade of I
K1
by 50 µM Ba
2+
significantly increased theλ: e.g., the value in a direction across the fiber orientation (λ
T
) increased from 0.82±0.19 mm in control to 1.27±0.33 mm after 50 µM Ba
2+
(n=5, P<0.05, Figure A). SW reentry under control condition rotated around a short line of block (FBL, 4.2±1.4 mm, n=12). In contrast, SW reentry induced after 50 µM Ba
2+
was destabilized: the FBL was significantly prolonged (11.7±3.2 mm, n=12, P<0.05) and, in 6/12 hearts, showed a prominent change in its shape with a cycle of a few rotations, resulting from intermittent conduction block near the rotation center (Figure B).

Conclusions:
These results suggest that partial I
K1
blockade enhances electrotonic interactions, which could contribute to destabilization of SW reentry.