bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4497: Non-Selective NSAIDs Increase Incidence of Peri-Procedural Infarct and Prolong Hospital Stay after Percutaneous Coronary Interventions
Authors: Alimohammad Rizwan , Westergaard Sara , Torosoff Mikhail
Published: July 2021

Non-steroidal anti-inflammatory drugs (NSAIDs) increase risk of CV events. We sought to evaluate hospital outcomes associated with NSAID therapy in patients undergoing percutaneous coronary interventions (PCI). Data on NSAID use in single institution treated, consecutive PCI patients (treatment period 2004 –2006, rofecoxib-treated subjects excluded) was merged with NY State Angioplasty Registry database, and studied with ANOVA, chi-square, Kaplan-Meier, and logistic regression analyses. Of 2933 ASA-treated PCI patients (29% females) only 78 (2.7%) were treated with non-selective (ns) NSAIDs and 15 (0.5%) with Celecoxib. Most commonly used ns-NSAIDs were Ibuprofen (n=47) and Ketorolac (n=16). Most common indications for NSAIDs were musculoskeletal pain (35%) or “non-cardiac” chest pain (9%). NSAID-treated patients were younger (56+/−12 in ns-NSAID, 60+/−12 in Celecoxib, and 62+/−12 years old in “no NSAID” groups; p<0.001). More NSAID-treated patients had a history of myocardial infarction (p<0.001) or reduced ejection fraction (p=0.008). NSAIDs treatment did not affect post-PCI in-hospital mortality (p=0.769). However, post-procedural myocardial infarction (MI) was more common in ns-NSAID-treated patients (5% in ns-NSAID, 0% in Celecoxib, and 1% in “no NSAID” groups, p=0.002), odds ratio 5.4 (95%CI of 1.9 –15.9, p=0.002). Post-procedural length of stay in survivors was also significantly longer in the ns-NSAID group (3.9+/− 3.4 days), as compared to Celecoxib (1.1+/− 0.3 days) or “no NSAID” groups (2.2 +/−3.3 days; p<0.001). Ns-NSAID treatment remained predictive of prolonged hospital stay (p=0.011) after adjustment for age (p=0.033), ejection fraction (p<0.001), and history of previous (p<0.001) or post-procedural MI (p=0.001). We observed an increased incidence of peri-procedural MI and longer post-PCI length-of-stay in patients treated with non-selective NSAIDs, but not with Celecoxib. Poor outcomes in ns-NSAIDs treated PCI patients may be due to attenuation of aspirin’s anti-platelet effects by ns-NSAIDs. Pending results of the randomized trials, providers should limit use on non-selective NSAIDs in patients with coronary artery disease undergoing PCI.
Abstract 4505: Presentation To Non-PCI Center Is Major Modifiable Factor Associated With Delayed Door-to-balloon Time In HORIZONS-AMI
Authors: Blankenship James C , Scott Thomas D , Skelding Kimberly A , Berger Peter B , Parise Helen , Brodie Bruce R , Witzenberger Bernard , Gaugliumi Giulio , Peruga Jan Z , Lansky Alexandra J , Mehran Roxana , Stone Gregg W
Published: July 2021

Introduction: Many pts with STEMI receive reperfusion later than recommended by current guidelines. Hypothesis: Factors associated with delayed door-to-balloon times (D2B) can identified; some may be modifiable.

Methods: In the HORIZONS-AMI study, 3602 pts within 12 hours of onset of STEMI undergoing primary PCI were prospectively enrolled. Times were recorded for onset of symptoms, arrival at PCI center, arrival in catheterization laboratory, and first balloon inflation. Pts transferred from a non-PCI center to a PCI center were considered separately from pts presenting initially to a PCI center. Logistic regression using 29 demographic/historic variables and 6 pre-PCI adverse events (arrhythmias, CPR, hypotension, respiratory failure) identified factors associated with (1) first door-to-balloon time > 90 minutes, and (2) for each time interval, the highest quintile.

Results: Complete time data was available for 2639 pts. Of 1848 pts presenting directly to a PCI center, 55% had D2B < 90 minutes. Of 781 pts transferred from a non-PCI center to a PCI center, 12% had D2B< 90 minutes. Presentation to a non-PCI center was the strongest predictor of D2B > 90 minutes (OR 9.1 compared to presentation to a PCI center, p < .0001). Other predictors of D2B > 90 minutes included history of congestive heart failure (OR 2.1, p = 0.0133), diabetes (OR 1.45, p = 0.002), prior MI (OR 1.43, p = 0.046), and baseline diuretic use (OR 1.36, p = 0.042), but not pre-PCI adverse events. Demographic factors correlated only weakly with delays in milestones between presentation and balloon inflation. Median D2B was similar for US (91 minutes) versus non-US pts (101 minutes, p = NS). After arrival at the cath lab, balloon inflation was delayed 1 hour (p < 0.001) in pts with prior CABG compared to pts without prior CABG.

Conclusions: In HORIZONS-AMI, D2B < 90 minutes was achieved in only one half of pts presenting to a PCI center and one tenth of pts presenting to a non-PCI center. The only potentially modifiable factor observed in this study was presentation to a non-PCI center. This data highlights the need for ambulance triage of pts with chest pain to bypass non-interventional centers and deliver pts directly to primary PCI centers of excellence.
Abstract 4511: Left Ventricular Diastolic Dysfunction Occurs Following Percutaneous ASD Closure: An Effect of Ventricular-Arterial Compliance Mismatch?
Authors: White Paul , Hoole Stephen , Kharbanda Rajesh , Lee Evelyn , Shapiro Leonard
Published: July 2021

Percutaneous ASD closure can result in hemodynamic compromise and pulmonary edema immediately after closure, particularly in older adults. We hypothesized that the percutaneous Amplatzer® septal occluder (ASO) device would influence LV diastolic function. Eighteen adult patients (6 male, 41±20 years) undergoing elective ASO device implantation for secundum ASD closure (Qp:Qs >1.5) under general anaesthetic had LV (18 patients) and RV (11 patients) conductance catheter assessment. Load dependent (time constant of diastolic relaxation (Tau)) and independent (end-diastolic pressure volume relationship (EDPVR), effective arterial elastance (Ea) and ventricular-arterial (V-A) coupling (Ees/Ea)) indices were measured before and after closure. Following closure of the ASD with an ASO device (8 –34mm), LV Tau increased (msec: 47.7(8.2) vs. 51.4(9.6), p<0.05) and there was a trend to increased LV EDPVR (1.1 (0.7) vs. 1.4 (1.1), p=0.19). The Ea increased significantly (mmHg/ml: 8.6 (5.8) vs. 10.8 (6.3), p=0.01) and V-A coupling deteriorated (Ees/Ea 0.61 (0.59) vs. 0.37 (0.18), p=0.09). RV hemodynamics remained constant. Percutaneous ASD closure causes an immediate deterioration in LV diastolic function, as a result of altered V-A coupling due to an increase in Ea. This could explain why patients develop pulmonary edema after ASD closure. Correcting Ea offers a potential therapeutic target to prevent diastolic dysfunction following ASO implantation.
Abstract 4513: Efficacy And Safety Of Percutaneous Patent Foramen Ovale Closure In Patients With Thrombophilia
Authors: Rengifo-Moreno Pablo , Cruz-Gonzalez Ignacio , Cubeddu Roberto J , Sanchez-Ledezma Maria , Ning Mingming , Mcnamara Maryellen , Buonanno Ferdinando , Inglessis-Azuaje Ignacio , Demirjian Zareh , Palacios Igor F
Published: July 2021

Background:
The presence of a patent foramen ovale (PFO) is associated with higher rates of cryptogenic stroke. In patients with hypercoagulable states, the incidence of recurrent cerebral ischemic events may be greatly increased if a PFO is present. Percutaneous PFO closure is an alternative therapeutic approach for patients with both conditions who are not candidates for long-term anticoagulation, or have developed recurrent neurological events despite medical therapy.

Methods:
Between January 1995 to February 2007, 424 consecutive patients with PFO and cryptogenic stroke underwent percutaneous PFO closure. Of these, we identified 112 (26%) patients with a hypercoagulable disorder. We compared the safety and long-term outcome of percutaneous PFO closure in these two groups of patients.

Results:
Patients with thrombophilia were older (51.7±13 vs 48.3±14 years, p = 0.025), yet no different regarding baseline demographics or echocardiographic characteristics. Percutaneous PFO closure was successful in all the patients. There were no differences in the type of device used (Amplatzer: 53.6 vs 50%, Cardioseal 39.3 vs 41.7%, Sideris 7.1 vs 8.3%; p= 0.78). At median follow-up of 14.3 months (interquartile range: 6.1–31.4 months) there rate of stroke/TIA was similar for both groups (1.7 vs 1.6%, log rank test p = 0.35). At follow-up echocardiography, the rate of complete PFO closure was greater in the thrombophilic patients (97.3 vs 91.7%, p=0.04).

Conclusions:
Percutaneous PFO closure is safe and effective in preventing recurrent ischemic cerebral events in patients with thrombophilia.
Abstract 4514: Postoperative AV Block and Pacemaker Implantation after Transcatheter Aortic Valve Implantation
Authors: Bleiziffer Sabine , Ruge Hendrik , Horer Jurgen , Mazzitelli Domenico , Schreiber Christian , Hutter Andrea , Brockmann Gernot , Bauernschmitt Robert , Lange Ruediger
Published: July 2021

High grade AV block and consecutive pacemaker (PM) implantation are frequent complications following transcatheter aortic valve implantation (TAVI). We aimed to identify risk factors predicting these complications. For logistic regression analysis, we included 85 patients (mean age 81±7y, EuroScore 24±15%) who underwent TAVI (n=73 transfemoral, n=2 via subclavian artery, n=10 transapical) between June 2007 and May 2008 and who had no previously implanted PM. Of those, 22 (26%) developed postoperative AV block with the need of PM implantation. PM implantation had to be performed more frequently in patients with pathological preoperative ECG findings, such as AV block °I (33% PM implantation) or bundle branch block (39% PM implantation) vs normal ECG (20% PM implantation, n.s.), and in patients receiving a CoreValve (28% PM implantation) vs an Edwards Sapien prosthesis (10% PM implantation, n.s.). Stepwise logistic regression analysis revealed the occurrence of a transient AV block > °I during the TAVI procedure (52% PM implantation) as the only significant independent factor predicting later PM implantation (OR 8.98, CI 2.69 –29.98, p<0.001), while gender, age, EuroScore, prosthesis type and dimensions, annulus diameter and preoperative ECG findings had no significant influence. Patients who experience a transient AV block > °I during TAVI procedures should carefully be monitored postoperatively, as there is a 9fold increased risk of developing high grade AV block with the indication for a PM implantation.
Abstract 4531: Statin Use Is Associated with Decreased Mortality in Persons with Peripheral Arterial Disease
Authors: Vidula Himabindu , Tian Lu , Liu Kiang , McDermott Mary M
Published: July 2021

We determined whether statin use was associated with lower all-cause and cardiovascular disease (CVD) mortality in persons with lower extremity peripheral arterial disease (PAD). We also determined whether favorable associations of statin use with mortality were stronger in persons with higher C-reactive protein (CRP) compared to those with lower CRP levels. Participants were 681 men and women with PAD from the Walking and Leg Circulation Study (WALCS) and WALCS II prospective cohort studies. Participants were identified from non-invasive vascular laboratories in Chicago. Participants attended a baseline visit and annual visits for a mean follow-up of 3.7 years. Statin use was determined at baseline and each annual visit. Outcome measures were all-cause and CVD mortality. Time dependent Cox regression analyses were used to evaluate associations of statin use and mortality. Analyses were also repeated separately in participants with baseline CRP values above vs. below the median for the cohort. Analyses were adjusted for age, sex, race, comorbid conditions, ankle brachial index, total cholesterol, high density lipoprotein cholesterol, and other confounders. One hundred fifty five (23%) persons died during follow-up. Two hundred ninety (43%) persons were on a statin at baseline. At baseline, median CRP level was 2.6 mg/L. Statin use was associated with significantly lower all-cause mortality (hazard ratio, 0.52 [95% CI, 0.31 to 0.88], P = 0.014) and CVD mortality (hazard ratio, 0.41 [95% CI, 0.17 to 0.99], P = 0.048) as compared to statin non-use. In persons with CRP >2.6 mg/L, statin use was associated with a significantly lower risk of all-cause mortality (hazard ratio, 0.44 [95% CI, 0.23 to 0.88], P = 0.019, interaction term P = 0.67) and CVD mortality (hazard ratio, 0.20 [95% CI, 0.06 to 0.65], P = 0.0075, interaction term P = 0.39). However, in persons with CRP < 2.6 mg/L, statin use was not associated with lower mortality. Among persons with PAD, statin use is associated with significantly lower all-cause and CVD mortality at mean follow-up of 3.7 years. This finding is largely attributable to favorable associations of statin use with lower mortality among PAD patients with elevated baseline CRP levels.
Abstract 4532: Benefits of Strength Training and Supervised Treadmill Exercise on Walking Performance for Persons with Peripheral Arterial Disease with and without Intermittent Claudication Symptoms
Authors: McDermott Mary M , Dyer Alan , Liu Kiang , Guralnik Jack M , Ades Philip , Ferrucci Luigi , Nelson Miriam , Llyod-Jones Donald , Pearce William H , Van Horn Linda , Criqui Michael H
Published: July 2021

Most men and women with lower extremity peripheral arterial disease (PAD) do not have classic symptoms of intermittent claudication (IC). We assessed the ability of supervised treadmill walking exercise and lower extremity resistance training to improve walking performance, quality of life, and brachial arterial flow-mediated dilation (FMD) in PAD persons with and without symptoms of IC. The study design was a randomized controlled clinical trial. One-hundred fifty participants with ankle brachial index (ABI) < 0.95 were randomized to one of three arms for 6 months: a) supervised treadmill exercise; b) supervised lower extremity resistance training; c) control condition. Outcomes were six-month change in the six-minute walk test, maximal treadmill walking performance, brachial arterial FMD, and the quality-of-life outcome measures of the Walking Impairment Questionnaire (WIQ) scores and the Short-Form 36 Physical Functioning score. The average age of study participants was 70.6 + 10.3, the average ABI was 0.60 + 0.20, and 52% were women. One hundred thirty-six (91%) participants completed follow-up. Results are shown in the Table

. Findings were similar when analyses were restricted to participants without IC. This study demonstrates, for the first time, that both aerobic and resistance exercise interventions improve treadmill walking performance and WIQ scores in PAD persons with and without classic symptoms of IC. Supervised treadmill exercise additionally improves six-minute walk performance and brachial arterial FMD in PAD participants with and without IC.

TABLE.

Change in outcomes at six month follow-up by group assignment.
Abstract 4535: Therapeutic Angiogenesis by Mononuclear Cell Implantation for Critical Digit Ischemia of Patients with Connective Tissue Diseases
Authors: Takahashi Masafumi , Ishigatsubo Yoshiaki , Fujimoto Kazuteru , Miyamoto Masaaki , Minota Seiji , Horie Takashi , Aizawa Yoshifusa , Amano Jun , Murohara Toyoaki , Matsubara Hiroaki , Ikeda Uichi
Published: July 2021

Systemic sclerosis (SSc or scleroderma) is an autoimmune connective tissue disease characterized by diffuse fibrosis, degenerative changes, and microvascular abnormalities. The vasculopathy mainly affects small arteries and capillaries and causes insufficient blood flow, which leads to clinical manifestations, such as Raynaud’s syndrome, fingertip ulcers, and gangrene. Recently, implantation of bone marrow-derived mononuclear cells (MNCs) has been successfully used for therapeutic neovascularization in Buerger’s disease that is thought to be an “autoimmune” vasculitis. The purpose of this study is to determine the efficacy of autologous MNC implantation into the ischemic digits of patients with connective tissue diseases. This study was performed as a prospective, non-randamized, and multicenter clinical trial. Thirty-four patients (19 SSc, 5 SLE, 2 CREST, 2 MCTD, 4 APS, 2 PN) who had painful ischemic digits with skin ulcers were enrolled in this study. Autologous MNCs obtained from bone marrow or peripheral blood were implanted into the ischemic digits. Ischemic pain and ulcers improved remarkably after MNC implantation. In particular, SSc patients showed dramatic improvement of these parameters (18 of 19 patients, 94.7%). In patients with other types of connective tissue diseases, pain and ulcers improved in 12 of 15 patients (80.0%). No serious adverse event was observed. These results demonstrate that implantation of autologous MNCs from bone marrow or peripheral blood into ischemic digits is feasible, safe and effective for improvement of pain and skin ulcers in patients with connective tissue diseases including SSc. Thus, larger, randomized and controlled trials for this cell therapy in patients with connective tissue diseases will be warranted.
Abstract 4553: Pre-Operative Brain Injury in Newborn Infants with Transposition of the Great Arteries Occurs at Similar Rates to other Complex Congenital Heart Disease, and is not Related to Balloon Atrial Septostomy
Authors: Gunn Julia , Shekerdemian Lara , Hunt Rod , Coleman Lee , Hope Ayton , Whelan Laura-Clare , Kean Michael , Beca John
Published: July 2021

Introduction:
Brain injury (BI) in the form of white matter injury (WMI) or ischaemic stroke, seen on magnetic resonance imaging (MRI), is common in neonates with congenital heart disease (CHD). It has previously been suggested that balloon atrial septostomy (BAS) may be an independent risk factor for pre-operative BI in neonates with transposition of the great arteries (TGA).

Hypothesis
: We hypothesised that: 1. The incidence of BI is similar in neonates with TGA and other severe CHD 2. The risk of pre-operative BI is not increased by BAS

Methods:
Neonates with TGA, hypoplastic left heart syndrome (HLHS) or pulmonary atresia (PA) were enrolled in a prospective study of BI related to CHD. Pre-operative brain MRI was performed in all patients. In those with TGA who underwent BAS, MRI occurred after septostomy. T1, T2 and diffusion-weighted images were obtained in axial and coronal planes. Scans were reviewed by blinded assessors, and were classified according to WMI (punctate lesions) or ischaemic stroke. Fisher’s Exact Test was used to compare rates of WMI and stroke in each patient group.

Results:
Sixty-six neonates (mean weight 3.4±0.5kg) were studied, of whom 44 had TGA, 13 had HLHS and 9 had PA. The median age at MRI was 7 days (range 1–31). Thirty-five of the neonates with TGA underwent BAS a median of 1 day (1–21) followed by MRI 7 days (2–12) later. BI was present in 17 (26%) patients. The table

shows the incidence of BI in the sub-groups. Two neonates with a stroke also had WMI.

Table

showing MRI abnormalities in patient sub-groups.

Neonates with TGA were not at increased risk of pre-operative BI compared with those with HLHS or PA (p=1.0). BAS did not increase the risk of pre-operative BI in neonates with TGA (p=1.0).

Conclusions:
Pre-operative BI occurs at a similar rate in neonates with TGA and other severe CHD. The risk of pre-operative BI in neonates with TGA is not increased by BAS.
Abstract 4569: What is the Best Operation for Transposition of the Great Arteries with Left Ventricular Outflow Tract Obstruction?: Midterm results
Authors: Emani Sitaram M , Beroukhim Rebecca , Zurakowski David , Pigula Frank A , del Nido Pedro J , Geva Tal , Bacha Emile
Published: July 2021

Transposition of the great arteries (TGA) with left ventricular outflow tract obstruction (LVOTO) may be treated with arterial switch operation (ASO) with or without LVOT intervention, aortic translocation, or Rastelli operation. We evaluated mid-term results of repair for TGA/LVOTO at our institution. Patients diagnosed with TGA/LVOTO at Children’s Hospital Boston from 1995 to 2007 who underwent repair were retrospectively reviewed. LVOTO was defined as pulmonary valve (PV) z-score < −2.0 or LVOT gradient > 15 mmHg in the presence of anatomic subvalvar stenosis. Preoperative morphology of the LVOT and PV were recorded. Kaplan-Meier freedom from LVOT reintervention was compared between groups and risk factors were determined by logistic regression. 88 patients with TGA/LVOTO were repaired. Ventricular septal defect was present in 78 (89%). Patients with lower PV z-scores at presentation were more likely to undergo Rastelli or aortic translocation as opposed to ASO ± LVOT intervention. At median follow up of 2.7 years (range 8 mo to 11 yrs), all patients were alive. Patients undergoing Rastelli were more likely to require surgical reintervention for LVOTO compared to the other groups (
P
=0.015, log-rank=10.49). Patients undergoing ASO alone had a higher rate of LVOT reintervention than those who had concomitant LVOT intervention (
P
=NS). In those undergoing Rastelli, a higher PV z-score was a predictor of LVOT reintervention (odds ratio = 4.0,
P
=0.012). TGA patients with severe LVOTO who undergo Rastelli repair have a high rate of LVOT reintervention. Higher preoperative PV z-score is a risk factor for reintervention in this group. Patients with mild/moderate LVOTO undergoing ASO alone may have an increased risk of LVOT reintervention.
Abstract 4576: Validation and Clinical Outcome of Less Invasive Goal-Directed Hemodynamic Management by the Transpulmonary Thermodilution in Patients after Subarachnoid Hemorrhage
Authors: Mutoh Tatsushi , Kazumata Ken , Ishikawa Tatsuya , Terasaka Shunsuke , Yasui Nobuyuki
Published: July 2021

Assessment of cardiac output (CO) and intravascular volume is of high importance for adequate cerebral perfusion and oxygen delivery in patients suffering from cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH), but is often precluded by the invasiveness and complexity of a pulmonary artery catheter (PAC) placement. We sought to evaluate the utility of less invasive goal-directed volumetric and hemodynamic monitoring by advanced transpul-monary thermodilution (PiCCO
™
, Pulsion, Germany) utilizing only central venous and peripheral arterial catheters compared with standard circulatory management after SAH. One-hundred fourteen patients with SAH treated within 24 hours of ictus were investigated. Validation of transpulmonary dilution-derived intermittent and calibrated continuous CO (TPCO and PCCO) and cardiac preload (GEDV, global end-diastolic volume) were compared with PAC-derived reference CO (PACO), pulmonary capillary wedge pressure (PCWP), or central venous pressure (CVP) in 14 patients diagnosed with vasospasm. In a subsequent prospective trial of 100 cases, the clinical course and outcome of this method (n=53) was compared to those of CVP or PCWP and PACO guided conventional therapy (n=47), after the establishment of each fluid protocol for treatment of vasospasm (triple-H therapy). TPCO and PCCO (indexed to the BSA) showed excellent correlation (
r
= .91 and .86) and small bias (+0.07 and +0.24 L/min/m
2
) with a low percentage error (10.2 and 12.4%), when compared to PACO. The relationship between GEDV and stroke volume in response to defined volume loading was stronger (
r
= .71) than that between CVP or PCWP and stroke volume (
r
= .16 and .26). Frequency of cardiopulmonary complications (0 vs 10%) and vasospasm-related cerebral infarction (9 vs 17%), amount of daily fluid intake (4,210±968 vs 5,681±1,019 mL), and length of ICU stay (14±2 vs 17±2 days) were significantly reduced (p<0.05) in the transpulmonary themodilution group. Transpulmonary thermodilution enables clinically acceptable monitoring in patients following SAH. Goal-directed therapy guided by the volumetric and hemodynamic parameters with this method has a potential advantage over conventional methods.
Abstract 4590: Safety and Efficacy of Prolonged Use of Unfractionated Heparin After Percuatneous Coronary Intervention: A Meta-Analysis
Authors: Singh Param P , Singh Sarabjeet , Molnar Janos , Arora Rohit
Published: July 2021

The current guidelines for percutaneous coronary intervention (PCI) do not address the prolonged post-procedural use of unfractionated heparin (UFH) to prevent acute occlusion. However, recently published small studies have yielded mixed results, leaving the question unanswered. Hence a meta-analysis was performed to evaluate safety and efficacy of prolonged use of UFH after PCI. A systematic review of literature revealed 7 studies (Juergens et al, Rabah et al, Garachemani et al, Pizzulli et al, Freidman et al, Tanajura et al and Ellis et al) involving 2412 patients. End points analyzed were ischemic complications (acute closure, myocardial infarction and repeat revascularization) and major vascular complications (hematoma, arterio-venous fistula, pseudo-aneurysm and retroperitoneal bleed). Since the studies were homogenous for outcomes, combined relative risks (RR) across all the studies and the 95% confidence intervals were computed using the Mantel-Haenszel fixed-effect model. A two-sided alpha error < 0.05 was considered to be statistically significant. There were no significant differences in patient demographics between both groups. Compared with placebo the risk of major vascular complication was significantly higher in patients getting post-procedural UFH for prolonged hours (RR: 2.24, CI: 1.68 – 3.48; p=0.001). However, the risk of ischemic complications was similar in both groups (RR: 0.95, CI: 0.46 – 1.96; p=0.89). The meta-analysis suggests that prolonged use of UFH after PCI may result in increased major vascular complications, even though the incidence of ischemic complications may not decrease.
Abstract 4605: Increased Body Mass Index is Protective against Low Bone Mineral Density in Patients with Heart Failure
Authors: Abshire Demetrius A , Moser Debra K , Clasey Jody L , Chung Misook L , Pressler Susan J , Dunbar Sandra B , Heo Seongkum , Lennie Terry A
Published: July 2021

Patients with heart failure (HF) may be at greater risk for decreased bone mineral density (BMD) than similarly-aged healthy adults due to limited activity and medications. Being overweight or obese may protect against decreased BMD due to greater weight bearing and hormonal differences. However, these assumptions have never been tested. The purposes were to

compare BMD between patients with HF and similarly-aged healthy adults,

compare BMD among normal weight, overweight, and obese patients with HF, and

determine whether body mass index (BMI) is a predictor of BMD in patients with HF.

A total of 119 patients with HF (preserved or non-preserved systolic function, age = 61 ± 12 yrs, 61% NYHA Class III/IV) and 58 community-dwelling older adults free of cardiovascular disease (age = 70 ± 7 yrs) underwent total body dual-energy x-ray absorptiometry scans. Bone mineral density Z-scores (matched for sex, age, weight, and ethnicity) were compared between patients with HF and healthy elders. Patients with HF were divided into four BMI categories to compare differences in total body BMD by BMI. Multiple linear regression was used to test whether BMI predicted BMD in patients with HF after controlling for age, sex, and NYHA class. Patients with HF had lower total body area BMD Z-scores (0.32 ± 1.20) than the healthy elders (0.88 ± 1.30,
p
= 0.005). Within the HF group, those with a BMI <25 kg/m
2
had lower total body BMD (1.13 ± 0.13 g/cm
2
) compared to those with BMIs of 25–29.9 kg/m
2+
(1.24 ± 0.13 g/cm
2
,
p
= 0.002), 30 –34 kg/m
2+
(1.23 ± 0.12 g/cm
2
,
p
= 0.019), and >34 kg/m
2
(1.26 ± 0.13 g/cm
2
,
p <
0.001). In the multiple linear regression, BMI was a significant predictor of BMD in patients with HF (β= 0.337,
p <
0.001), explaining an additional 11% of the variance beyond age, sex, and NYHA class (R
2
= 0.40,
p
<0.001). These results suggest that while HF is associated with decreased BMD, being overweight or obese may be protective against low BMD. This may be another example of better outcomes in overweight and obese patients with HF.

This research has received full or partial funding support from the American Heart Association, AHA Great Rivers Affiliate (Delaware, Kentucky, Ohio, Pennsylvania & West Virginia).
Abstract 4606: Appetite Ratings on Single-item Visual Analog Scale Identify Patients with Heart Failure at Risk for Malnutrition
Authors: Lennie Terry A , Heo Seongkum , Pressler Susan J , Dunbar Sandra B , Chung Misook L , Song Eun Kyoung , Moser Debra K
Published: July 2021

Background
: Patients with heart failure (HF) are at risk for malnutrition due to multiple factors. A simple, clinically feasible tool to identify risk for malnutrition is needed. Visual analog scales have been used in studies on appetite but it is unknown whether an appetite scale can be used to identify patients with HF at risk for malnutrition.

Purpose
: To determine whether differences in kcal and protein intake could be identified in patients with HF grouped by their appetite rating.

Method
: A total of 137 patients (63% male, 60 ± 12 years, 56% NYHA class III/IV, ejection fraction (39 ± 14%) were recruited from outpatient HF clinics in the Midwest and South. Patients provided detailed 4-day food diaries that were reviewed by a registered dietitian to verify serving sizes and preparation methods and to obtain missing information. Patients were also asked to rate their appetite over the 4 days of diet recording on a 10 mm visual analog with anchors of “no appetite” and “extremely good appetite” Diaries were analyzed by Nutrition Data Systems software. Three series of between-group comparisons of kcal and protein (total and referenced to kg body weight) were made by t-tests using 4 mm (below midpoint), 5 mm (mid-point), and 6 mm (above mid-point) cut-points.

Results
: Significant differences in kcal and protein intake were identified between groups using the 6 mm cut point. A total of 36% of the patients had low appetite ratings (<6mm). Patients with low appetite ratings consumed 20% fewer total kcals (1555 vs. 1936 kcal, p = .001) and 23% fewer kcal/kg (18 vs. 22 kcal, p = .005) than those with high ratings. The low appetite group also consumed 24% less protein than the high appetite group (62 g vs. 82 g, p = .001). The .71 g/kg protein intake of the low appetite group was below the recommended .8 g/kg protein intake for adults. In contrast, the .91 g/kg protein intake of the high appetite group was above the recommended level.

Conclusion
: Patients with lower appetite ratings had kcal and protein intakes below recommended levels while those with high appetite ratings had adequate intake. These results provide evidence that rating appetite on a visual analog scale may be a simple tool that could be used clinically to identify patients with HF at risk for malnutrition.

This research has received full or partial funding support from the American Heart Association, AHA Great Rivers Affiliate (Delaware, Kentucky, Ohio, Pennsylvania & West Virginia).
Abstract 4607: Lycopene Intake Predicts Event-Free Survival in Patients with Heart Failure
Authors: Biddle Martha J , Heo Seongkum , Song Eun Kyeung , Lennie Terry A , Dunbar Sandi , Pressler Susan J , Kim JinShil , Moser Debra K
Published: July 2021

Background: Higher intake of the dietary carotenoid lycopene may be beneficial for heart disease. A main source of lycopene is processed tomato products, which are high in sodium. Increased dietary sodium intake is a primary reason for heart failure (HF) exacerbation and may counter the positive effects of lycopene.

Purpose: To determine whether lycopene intake stratified by sodium intake predicts event-free survival.

Methods: Detailed 4-day food diaries were kept by 149 HF pts (age 60 ± 12, 38% female). A registered dietitian reviewed the diaries with pt to verify serving sizes and preparation methods. Nutrient analysis was performed using Nutrition Data System software
™
. Pts were stratified into 2 groups by sodium intake based on the median of 2913 mg. Outcomes were then compared in these strata by 2 groups of lycopene intake formed by the median intake of the sample (2624 mcg). Kaplan Meier and Cox regression survival techniques were used to detect differences in event-free survival (survival free of HF or cardiac hospitalization) between lycopene groups in the 2 sodium strata.

Results: High lycopene compared to low lycopene intake was associated with greater event free survival. (p=.012, figure

). This finding held in both sodium strata, although the best event-free survival was in the high lycopene group with the low sodium intake (p=.019). High lycopene intake was a predictor of event-free survival after controlling for age, gender, NYHA and EF (p=.014).

Conclusion: These findings suggest the naturally occurring antioxidant lycopene has the potential for substantial impact on event free survival rates in HF pts, but its positive effect is attenuated by high sodium intake.
Abstract 4626: Optimal Dose of Adv-hHCN4 Creates Stable and Long-lasting Biopacing Activity in Cultured Ventricular Cardiomyocytes
Authors: Xiao Yong-Fu , Nikolskaya Alena , Zeng Lepeng , Qiu Xiaohong , Jaye Deborah A. , Sharma Vinod , Sigg Daniel C.
Published: July 2021

Purpose: Hyperpolarization-activated cyclic nucleotide-gated (HCN) genes have been successfully used as a strategy for recreating cardiac biological pacemakers in animal models. However, optimal dose of HCN and toxicity from HCN overexpression have not been investigated. Therefore, we assessed the effects of various titers of adenoviral human HCN4-GFP vector (Adv-hHCN4) on cardiomyocytes.

Methods: Neonatal rat ventricular myocytes (NRVMs) were isolated, selected and cultured on microelectrode arrays to assess their automaticities. Morphology and apoptosis with and without HCN or Ca
2+
channel inhibitor were also assessed.

Results: Beating rates significantly increased in NRVMs after hHCN4 infection (Fig. 1

). For example, the rates were gradually increased to 235±11 beat/min on day 7 after hHCN4 infection with 1×10
5
PFU/array. In contrast, control cells showed low rates. NRVMs with ≥10
6
PFU/array Adv-hHCN4 reached faster rates early and subsequently stopped beating (Fig. 1

). In addition, myocytes with ≥10
6
PFU/array Adv-hHCN4 underwent significant apoptosis (>50%) which potentially resulted from hHCN4 overexpression and was blocked by the HCN channel blocker Cs
+
(1 mM), but not by the Ca
2+
channel inhibitor nifedipine. In addition, myocytes infected with ≥10
6
PFU/array Adv-GFP maintained normal morphology and rate. Our data demonstrate that hHCN4 transfer significantly and dose-dependently increased beating rates of NRVMs. However, overexpression of HCN could cause apoptosis. Therefore, an optimal dose of HCN gene is important for reducing toxicity and creating stable and long-lasting biopacing activity in cardiomyocytes in vitro, and probably also in vivo.

Figure 1.

Effects of hHCN4 infection on automaticities of neonatal rat ventricular myocytes. Each data point represents an averaged beating rate (mean ± SE) from 8 to 10 arrays. Various titers (1×10
5
to 1×10
7
PFU/500,000 cells per array) of Adv-Hhcn4 (expect control) were added to the arrays after measurements on day 0 (see the arrow)
Abstract 4669: Does Long-QT Syndrome Involve the Sinus Node?
Authors: Shusterman Vladimir , Nemec Jan , Buncova Marie , Winter Bruce , Shen Win-Kuang , Ackerman Michael J
Published: July 2021

Background:
The hallmark of Long QT Syndrome (LQTS) is a prolongation of the ventricular electrical action potential caused by mutations involving key cardiac ion channels on the surface membrane of ventricular myocytes. Different mutations are associated with specific modes of arrhythmia initiation and distinct changes in cardiac rhythm prior to these events. We hypothesized that some LQTS-causing mutations might involve the sinus node, leading to aberrations in cardiac rhythm. To test this hypothesis, we examined the features of cardiac rhythm in 23 genotyped patients with LQTS and 14 matched controls (C) using Holter ECG data (6hrs).

Methods:
QRS-complexes were identified using custom software and verified by an experienced ECG reader; series of sinus beats were extracted and gaps in time series were linearly interpolated. The mean, max, and min heart rate (HR), the time (SD, SDNN, SDANN, RMSSD, pNN50) and frequency-domain (Total (TP), Very low (VLF), Low (LF), High (HF) frequency powers, and LF/HF) indices of heart rate variability (HRV) were calculated in each 5-min interval and over the entire recording. The short-long-short irregularity was examined using the novel multiscale rhythmogenetic analysis (MRA), which quantifies changes in the HRV indices during the transition from one time-scale window to another.

Results:
The maximum heart rate was slower in LQTS than in C (101±13 and 119±19bpm, p=0.001). The high-frequency power (HF) was lower in LQTS than in C (80±76 and 113±58ms
2
, p<0.05). However, the short-term irregularity (quantified by the difference in RMSSD between the 75ms and 2000ms time scales) was 4 times greater in LQTS compared to C (p=0.003). Inclusion or exclusion of two patents who were on β-blockers did not change the results.

Conclusions:
LQTS is associated with specific changes in cardiac rhythm, including:

diminished acceleration capacity,

decreased high-frequency power, and

enhanced short-long-short irregularity.

This suggests that LQTS involves channel modifications in the sinus node, which might contribute to arrhythmogenesis. Rhythm characterization in genetic sub-types of LQTS might improve arrhythmia risk stratification in this heterogeneous patient population.
Abstract 4680: Rapid Growth in Hospitalizations for Adults with Congenital Heart Disease in the United States
Authors: Opotowsky Alexander R , Siddiqi Omar , Webb Gary D
Published: July 2021

Background: Adults with congenital heart disease (ACHD) constitute a growing population due to advances in pediatric care and diagnostic testing. This study aimed to better define the growth in ACHD hospitalizations and to provide data on the cost of hospitalization for these patients.

Methods: We utilized data from the 1998 –2005 Nationwide Inpatient Survey, the largest all-payer nationally representative hospital discharge database, to analyze trends in ACHD hospitalizations. We included all patients over 17 years of age with Clinical Classification Software diagnostic code 213 (Cardiac and Circulatory Anomalies). National estimates of hospitalizations and hospital charges by year for ACHD diagnoses were calculated, as were equivalent estimates for specific subsets of patients.

Results: The number of ACHD hospitalizations increased 67% between 1998 and 2005, from 53,212 to 88,610 per year. Over this period, the annual number of admissions increased for both simple (44,781 to 75,911) and complex diagnoses (8,431 to 12,699)(Table

). Patients 55 years or older made up approximately 51% of all ACHD patients, and 40% of those with complex disease. Rates of hospitalization increased similarly for patients under and over 55 years old among all diagnostic categories. Inpatient mortality decreased from 2.6+/−0.2% to 1.7+/−0.1% for simple diagnoses, and 4.4+/−0.5% to 3.7+/−0.4% for complex diagnoses. Mean hospital charges per hospitalization increased 66% from $21,485 to $35,565, and the estimated total national charges for these hospitalizations increased from $1.1 billion to $3.1 billion in 2005 (all in 1998 dollars). In 1998, admissions for ACHD accounted for 0.31% of estimated total national charges for hospitalizations of patients 18 years or older, as compared with 0.47% in 2005.

Conclusions: There has been a striking increase in hospitalizations for ACHD, and the cost of these admissions is rising out of proportion to overall hospital costs.

Number of Adult Congenital Heart Disease Admissions per Year
Abstract 4694: Prognostic Value of the Contractile Reserve on Exercise Echocardiography in Asymptomatic Aortic Stenosis
Authors: Hachicha Zeineb , Dumesnil Jean G , Bergeron Sébastien , Arsenault Marie , Pibarot Philippe
Published: July 2021

Abnormal exercise test defined as the occurence of exercise limiting symptoms or of blood pressure drop, is useful to predict clinical events in asymptomatic patients with aortic stenosis (AS). Whether exercise stress echocardiographic data, especially the response of LV systolic function to exertion, have an added predictive value is unclear. to determine if the behaviour of LV systolic function during exercise test can predict maximum exercise capacity and clinical outcomes in patients with asymptomatic AS. 48 patients with asymptomatic AS (aortic peak velocity: 3.4 ±0.7 m/s) and preserved LV ejection fraction (≥50%) were assessed by echocardiography at rest and during a maximum ramp semi-supine bicycle exercise test. 18 (38%) patients had an abnormal exercise test (occurrence of exercise limiting symptom: angina: 1, severe dyspnea: 14; drop in systolic blood pressure: 1; ventricular arrhythmias: 2). Compared to patients with normal test, these patients had smaller LV end-diastolic volumes (87±15 vs 100±21, p=0.02), smaller indexed aortic valve area at peak stress (0.52±0.18 vs 0.63±0.15, p=0.02) and smaller increase in LVEF during exercise (ΔLVEF: 6±4% vs 11±6%, p=0.008). Absent or limited contractile reserve defined as ΔLVEF <10% was observed in 66% of patients with abnormal test vs 33% in those with normal test, p=0.02. The most important predictors of an abnormal exercise test were an AVA at peak stress<1cm
2
(p=0.03; NPV=91%, PPV=62%) and ΔLVEF <10% (p=0.016, NPV=83%, PPV=54%). At a mean follow up of 14±6 months, 4 patients developed cardiac symptoms and 9 were referred for AVR. At one year, the event (AVR or symptom)-free survival was markedly lower in patient with abnormal vs normal test (65±11% vs 96±3%, p≤0.001) and in patients with ΔLVEF <10% vs ΔLVEF ≥10% (70±9 % vs 96±4%, p=0.03). An abnormal test was associated with 3.6-fold (p=0.0003) and ΔLVEF <10% with a 1.9-fold (p=0.04) increase in the risk of cardiac events. Exercise-limiting symptoms, fall in blood pressure or ventricular arrhythmias as well as no or minimal increase in LVEF during exercise predicts the onset of symptoms and need for AVR. Stress exercise echocardiography may be helpful to improve risk stratification in asymptomatic AS.
Abstract 4705: Detection of Significant Left Anterior Descending Coronary Artery Disease in Pacemaker Dependent Patients Utilizing Real Time Perfusion Imaging During Dobutamine Stress Echocardiography
Authors: Koneru Jayanthi , Dodla Saritha , Xie Feng , O’Leary Edward , Porter Thomas R
Published: July 2021

Non-invasive methods of detecting left anterior descending (LAD) coronary artery disease (CAD) in patients who are pacemaker dependent (PD) are limited because of right ventricular (RV)-pacing induced left ventricular wall thickening (WT) abnormalities involving the septum and apex. Real time perfusion echocardiography (RTPE) analyzes myocardial blood flow (MBF) changes with high resolution (<2 mm) during intravenous (IV) infusions of ultrasound contrast, and can potentially identify whether significant LAD is present in PD patients during dobutamine stress (DS). 54 consecutive PD patients who were being evaluated for CAD using DS echocardiography with RTPE were identified. Dobutamine was infused to 30 u/kg/min, but had to be combined with incremental RV pacing to achieve 85% predicted maximum heart rate. Perfusion and WT in the septum and apex were assessed at rest and at peak DS. MBF in the LAD territory was considered abnormal if a >4 second delay in contrast replenishment occurred during a continuous 3% Definity infusion at rest, or >2 second delay at peak DS. Quantitative coronary angiography (QCA) was performed to assess for significant CAD (>50% diameter stenosis considered significant). Outcomes were analyzed by examining coronary events (death, non-fatal myocardial infarction, or need for coronary revascularization) at a median follow-up of 20 months post DS. WT abnormalities in the septum and apex due to RV pacing were noted in 43 of the patients (80%), while the remaining patients exhibited normal WT. Of those with pacing-induced WT abnormalities, 25 (58%) had a MBF abnormality at peak stress, while 18 (42%) had normal myocardial contrast enhancement. Overall, the positive predictive value (PPV) of abnormal MBF by RTPE for the detection of LAD CAD in PD patients was 85%. Patients with a MBF abnormality in the LAD territory by RTPE had a coronary event rate of 17 % at follow up, while patients with normal MBF responses during DS had no events at follow up (negative predictive value 100%). RTPE is helpful in detecting CAD in the LAD territory of patients who are PD. A normal MBF response predicts an excellent cardiac outcome, irrespective of WT responses.
Abstract 4708: Rapid Resolution of ST Segment Elevation and Recovery of Function in Acute Myocardial Infarction Treated with Low Dose Intravenous Thrombolytics, Transthoracic Ultrasound, and Intravenous Microbubbles
Authors: Xie Feng , Lof John , Dodla Saritha , Zutshi Reena , Porter Thomas R
Published: July 2021

Rapid non-invasive methods of recanalizing acutely thrombosed coronary arteries and restoring microcirculatory flow are needed. Failure of ST segment elevation to resolve on the 12 lead electrocardiogram is a marker of microvascular no reflow, and occurs in over 30% of acute myocardial infarctions treated with primary percutaneous interventions. Transthoracic ultrasound (TTU) and intravenous (IV) microbubbles (MB) have the potential to increase epicardial recanalization (RC) when used with low dose thrombolytic therapy (TT). We hypothesized that this therapy may also dissolve microvascular thrombi, and thus improve microvascular recovery during treatment of an acute coronary thrombosis. In 45 closed chest pigs, acute left anterior descending (LAD) thromotic occlusions were created, followed by randomized treatment to either a) IV low dose TT alone (50,000 u/kg recombinant urokinase; n=15), or b) IV low dose TT combined with IV lipid encapsulated MB (ImaRx Therapeutics, Inc) and TTU (1.5 MHz diagnostic transducer using 1.9 MI therapeutic impulses applied only when low MI imaging detected MB within the affected risk area; n=30). Resolution of ST segment elevation as well as wall thickening (WT) within the central portion of the risk area were analyzed in pigs that had epicardial RC versus those that did not exhibit RC in the IV MB treated groups. Epicardial RC occurred within 60 minutes in 15 pigs (50%) treated with IV MB and TTU (p< 0.01 compared to IV TT alone;Table

). Significant >50% ST segment resolution occurred in over 90% of pigs with epicardial RC treated with TT and MB, but also in six of 15 pigs that did not have RC. In these six pigs, WT within the risk area increased similar to the pigs which had epicardial RC (Table

). Diagnostic TTU and IV microbubbles improve microvascular perfusion even if epicardial RC is not achieved, leading to rapid recovery of function. Both epicardial and microvascular reflow can be achieved with this technique.

ST segment and WT Changes Before and Following Treatment