bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 1832: Location of Making Type 1 Electrocardiogram in Brugada Syndrome: Comparison between Lead Position and Anatomical Location of Right Ventricular Outflow Tract
Authors: Nagase Satoshi , Hiramatsu Shigeki , Nishii Nobuhiro , Murakami Masato , Tada Takeshi , Miyaji Kohei , Oka Takefumi , Nakamura Kazufumi , Kusano Kengo , Ohe Tohru
Published: July 2021

Introduction:
Recording type 1 ECG in right precordial leads in the presence or absence of a sodium channel blocker is a diagnostic criterion in Brugada syndrome (BrS). It was also suggested that right ventricular outflow tract (RVOT) is the arrhythmogenic substrate in BrS. However, we occasionally observed type 1 ECG only in the third intercostal space (3ics), not standard fourth intercostal space (4ics). Accordingly, we examined the relationship between the position of ECG leads manifesting type 1 and anatomical location of RVOT under fluoroscopic image.

Methods:
Total 33 BrS patients were examined in this study. All patients had more than one of the following: documented ventricular fibrillation (VF), several episodes of syncope, a family history of sudden death, SCN5A mutation or inducibility of VF by programmed electrical stimulation. Anatomical location of the RVOT was determined under fluoroscopic image with right ventriculography. ECG was also recorded at the 3ics in leads V1 and V2 in addition to the standard V1 and V2 at the 4ics with fluoroscopically visible electrodes. A pure sodium channel blocker, pilsicainide, was administered in all patients without manifesting type 1 ECG under baseline conditions. Relationships between anatomical location and the position of ECG leads manifesting type 1 were examined in all patients.

Results:
Type 1 ECG was recorded in all patients with pilsicainide administration. The location of RVOT corresponded with lead V1 and V2 at the 4ics in 5 patients and at the 3ics in 28 patients. In 4 out of 5 patients (80.0%) corresponding RVOT with 4ics, type 1 ECG was recorded at the 4ics. However, in 24 out of 28 patients (85.7%) corresponding RVOT with 3ics, type 1 ECG was recorded only at the 3ics. Furthermore, in 7 out of 12 symptomatic patients (58.3%) with documented VF or syncope, type 1 ECG was not recorded at the 4ics, however, could be detected at the 3ics without pilsicainide administration. The location of RVOT was not different between symptomatic and asymptomatic patients.

Conclusions:
Type 1 ECG is predominantly caused at the RVOT, and the relationship between the position of ECG lead and the RVOT is variable. Recording ECG at the 3ics in addition to the standard 4ics in the right precordial leads is convincing in diagnosis of BrS.
Abstract 1846: Coronary Artery Bypass Surgery is superior to Percutaneous Coronary Intervention With Drug-Eluting Stents for Unprotected Left Main Coronary Artery Disease
Authors: Sunagawa Gengo , Komiya Tatsuhiko , Tamura Nobushige , Kobayashi Taira , Furukawa Tomokuni , Matsushita Akihito , Murashita Takashi , Kanno Kazuyoshi , Hayashi Sachiko , Watanabe Shun , Sakaguchi Genichi
Published: July 2021

(Introduction)
Improvements in results of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) have been extending their use in patients with unprotected left main coronary artery (ULMCA) disease.

(Hypothesis)
We assessed the hypothesis that coronary artery bypass grafting (CABG) would be superior to PCI with DES in patients with ULMCA.

(Methods)
From January 2004 to March 2006, 114 patients underwent CABG (emergency: 42 cases), and 136 patients underwent PCI with DES (emergency: 9 cases) for ULMCA disease. In CABG, 91 patients had off-pump surgery. In PCI, all patients had sirolimus-eluting stent implantation. The mean follow-up was 621±291 days in CABG and 455±216 days in PCI. Survival, major adverse cardiac events (MACE), and target lesion revascularization (TLR) were analyzed by the Kaplan-Meier method.

(Results)
Preoperative characteristics and risk factors were compatible between the groups except for EuroSCORE (8.0±3.5 in CABG and 5.0±3.0 in PCI, p<0.0001). Thirty-day mortality was 3.5% (elective cases 0%) in CABG and 0% in PCI. Survival rate at 2 years was 94.2% in CABG and 90.2% in PCI (p=0.25). Survival rate at 2 years excluding emergent cases was 98.2% in CABG and 91.2% in PCI (p<0.05)(Figure

). MACE-free rate at 2 years was 93.5% in CABG and 59.7% in PCI (p<0.0001). Freedom from TLR was 98.0% in CABG and 58.8% in PCI (p<0.0001). During the follow-up period, there were 2 late deaths in CABG and 11 late deaths (including 5 sudden deaths) in PCI.

(Conclusions)
CABG was superior to PCI with DES in terms of long-term outcomes including survival, MACE-free, and TLR. DES carried higher risk for sudden death which might be associated with stent thrombosis.

Survival curve in elective cases
Abstract 1849: Comparison of Coronary Artery Bypass Surgery and Percutaneous Coronary Intervention for the Treatment of Unprotected Left Main Coronary Disease in Octogenarians
Authors: DeBlois Jonathan , Voisine Pierre , Bertrand Olivier F , Mohammadi Siamak , Barbeau Gerald , Rousseau Melanie , Larose Eric , Dagneais François , Mathieu Patrick , Perron Jean , Gleeton Onil , Déry Jean-Pierre , Baillot Richard , Proulx Guy , Roy Louis , Noël Bernard , Doyle Daniel , DeLarochellière Robert , Rodés-Cabau Josep
Published: July 2021

Background:
Very little data exists regarding percutaneous coronary intervention (PCI) as an alternative to coronary artery bypass graft (CABG) for the treatment of unprotected left main disease (LMD) in octogenarians, and no studies to date have compared CABG and PCI for the treatment of LMD in this population. The objectives of our study were to compare the acute and midterm follow-up results of PCI and CABG for the treatment of significant LMD in octogenarians.

Methods:
A total of 163 consecutive patients ≥80 years old diagnosed with LMD have undergone coronary revascularization in our center between 2002 and 2006. One hundred and one patients underwent CABG and 62 patients had PCI (non-surgical candidates: 30%, very high surgical risk patients: 61%, patient refusal of CABG: 9%). All complications occurring within the first 30 days following the procedure were recorded, and major adverse cardiovascular events -MACCE- (cardiac death, myocardial infarction, cerebrovascular event, revascularization) were evaluated at follow-up.

Results:
Patients who underwent PCI were older (85 ± 3 yrs vs. 82 ± 2 yrs, p<0.0001), presented more frequently with an acute coronary syndrome (92% vs. 50%, p<0.0001), and had a higher EuroSCORE (9.5 ± 2.7 vs. 8.5 ± 2.5, p=0.01). Drug-eluting stents were used in 48% of PCI patients. There were no significant differences in the incidence of MACCE at 30 days between groups (CABG: 28%, PCI: 19%, p=0.22), but the CABG group was associated with a higher rate of atrial fibrillation (48% vs. 14%, p<0.0001) and acute renal failure (17% vs. 6%, p=0.05). The incidence of MACCE occurring between 30 days and 24 ± 17 months follow-up was higher in the PCI group (32% vs. 13%, p=0.005), but the cumulative incidence of MACCE was similar in both groups (CABG 39% vs. PCI 44%, p=0.53).

Conclusions:
PCI was associated with a 30-day cardiac event rate similar to that of CABG for the treatment of unprotected LMD in octogenarians. Surgical patients experienced fewer cardiac events during the follow-up period, but the cardiovascular event-free survival rate was similar between groups at 2-year follow-up. Further randomized studies with longer-term follow-up comparing both revascularization strategies in this high risk coronary population are warranted.
Abstract 1852: The Association Between Perioperative Complications, Intermediate Survival and Use of Aprotinin During Isolated Coronary Bypass Grafting Surgery
Authors: Ad Niv , Speir Alan M , Harrison Michelle , Hunt Sharon L , Barnett Scott D
Published: July 2021

Introduction:
Aprotinin during CABG has been linked to increased rates of perioperative complications and increased long-term mortality. We report our results for the association of CABG, aprotinin use and intermediate survival.

Methods:
Subjects were 1,679 isolated CABG, on-pump, cases with no prior hx of renal failure or dialysis between 2001 and 2002. Aprotinin pts were additionally propensity matched to non-aprotinin pts to control for pt acuity. Increased EuroSCORE (E) indicates increased pt acuity.

Results:
Aprotinin pts (n=817) presented as older (63.7 vs. 61.2, p=0.05), increased E (6.5 vs. 4.1, p=0.05), and urgent operative status (61.7% vs. 41.6%, p=0.05). This group experienced greater rates of perioperative prolonged ventilation (8.7%% vs. 4.8%, p=0.01), acute renal failure (4.3% vs. 2.0%, p=0.01), 30d mortality (2.2% vs. 1.0%, p=0.06) and signif. decreased unmatched 5-year survival (86.1%, vs. 92.8%, p=0.001). Aprotinin use was not signif. assoc. with increased intermediate mortality (HR: 1.26; 95% CI: 0.66–2.41) but cases with high E (6+) were (HR: 5.47; 95% CI: 2.98–10.08). Moderate E was not signif. assoc. with mortality (HR: 1.75; 95% CI: 0.91–3.35) nor was any aprotinin-E interaction term (HR: 1.00; 95% CI: 0.93–1.08). After matching, controls were signif. less at risk of mortality at 5 years, (91.3% vs. 88.1%, p=0.05; Figure 1

).

Conclusions:
Our results suggest that pts with aprotinin experienced higher rates of perioperative complications; however, the pts in this group were generally at higher risk for adverse outcome. Aprotinin use may convey an increased risk of intermediate mortality, but after matching, mortality estimates are greatly reduced.
Abstract 1856: Transplantation of Bone-marrow Mononuclear Cells into the Infarcted Heart has Favorable Engraftment Compared to Mesenchymal Stem Cells, Skeletal Myoblasts and Fibroblasts
Authors: van der Bogt Koen E , Sheikh Ahmad Y , Schrepfer Sonja , Hoyt Grant , Cao Feng , Ransohoff Katie , Contag Christopher H , Robbins Robert C , Wu Joseph C
Published: July 2021

Introduction:
A comparative analysis of the efficacy of different cell candidates for the treatment of heart disease remains to be described. This study aimed to evaluate the therapeutic efficacy of 4 cell types in a murine model of myocardial infarction.

Methods:
Bone-marrow cells (MN), mesenchymal cells (MSC), skeletal myoblasts (SkMb) and fibroblasts (Fibro) were isolated from male L2G transgenic mice (FVB background) that express firefly luciferase (Fluc) and green fluorescence protein (GFP). Cells were characterized by flow cytometry, bioluminescence imaging (BLI), and luminometry. Female FVB mice (n=60) underwent LAD ligation and were randomized into 5 groups to intramyocardially receive one cell type (5 × 10
5
) or PBS. Cell survival was measured
in vivo
by BLI and
ex vivo
by TaqMan PCR at week 6. Cardiac function was assessed by echocardiography and invasive hemodynamic measurements at week 6.

Results:
Fluc expression correlated with cell number in all groups (r
2
>0.93).
In vivo
BLI revealed donor cell death of MSC, SkMb, and Fibro within 3 weeks after transplantation. By contrast, cardiac signal was still present after 6 weeks in the MN group, as confirmed by PCR (p<0.01). Echocardiography showed significant preservation of fractional shortening in the MN group compared to controls (p<0.05). Measurements of left ventricular end-systolic/diastolic volume revealed the least amount of ventricular dilatation occurred in the MN group (p<0.05).

Conclusion:
This is the first study to directly compare a variety of cell candidates for myocardial therapy and indicates that MN exhibit a favorable survival pattern, which translates into preservation of cardiac function.
Abstract 1873: Initial Experience with Real-Time Three-Dimensional Transesophageal Echocardiography in Patients Undergoing Transcatheter Atrial Septal Defect Closure
Authors: Passeri Jonathan J , Inglessis Ignacio , Palacios Igor F , Picard Michael H
Published: July 2021

Background:
Transcatheter closure of atrial septal defects (ASD) is performed with intracardiac or transesophageal echocardiography (TEE) guidance. ASDs often have an elliptical shape and 2D imaging may underestimate the maximum diameter. Three-dimensional (3D) TEE using reconstructed gated acquisitions in multiple planes is a time-consuming process limited by motion artifact, making it impractical for intra-procedural use. Recently, a matrix array TEE capable of real-time 3D (RT3D) imaging has been developed (Philips Medical Systems).

Methods:
Two-dimensional, Doppler and RT3D TEE images were acquired in 5 patients undergoing ASD closure. Device selection was based on the maximum diameter of the ASD measured by 2D imaging. RT3D images were analyzed using commercially available software (QLab, Philips). The maximum diameter was measured and compared to 2D.

Results:
The mean maximum diameter was 1.6 ± 0.8 cm using 2D imaging and 2.0 ± 1.1 cm using RT3D images (p=0.16). In the 3 patients with ASDs >2 cm, the maximum diameter was 2.2 ± 0.1 cm by 2D imaging compared to 2.8 ± 0.3 cm by RT3D imaging (p=0.02), an underestimate of 20.7 ± 12.2 %. In the remaining 2 patients with ASDs <1.2 cm, there was good agreement between 2D and 3D measurements. In the 2 patients with the largest discrepancy between 2D and 3D measurements, the initial device selected was retrieved prior to catheter release, due to significant residual shunting or instability along the septum, requiring placement of a larger device.

Conclusion:
RT3D TEE during transcatheter ASD closure is feasible and may improve defect sizing and device selection during transcatheter ASD closure.
Abstract 1879: Global Lv Strain Is An Accurate Measure For Scar Extent After Myocardial Infarct. A Comparison Of Longitudinal, Circumferential And Radial Strain Measurements
Authors: Vartdal Trond , Gjesdal Ola , Helle-Valle Thomas , Lunde Ketil , Hopp Einar , Smith Hans-Jørgen , Ihlen Halfdan , Edvardsen Thor
Published: July 2021

Purpose: Recent progress by speckle tracking echocardiography (STE) provides the opportunity to assess left ventricular (LV) function in 3 dimensions. We studied LV longitudinal, circumferential and radial strain and calculated which strain parameter that correlated best to myocardial scar mass in patients with chronic ischemic heart disease.

Methods: 40 patients (aged 58 ± 10 years, 9 women) were studied 8.5 ± 5.4 months after a first myocardial infarction. LV infarct mass was estimated by late enhancement MRI and compared to global LV strain. Global LV strain is calculated by averaging all segmental peak systolic strain values by STE in a 16 segment model. Longitudinal strain was assessed from 3 apical views, and circumferential- and radial strain from 3 short axis slices (apical, mid and basal).

Results: In average, 7.9 ± 4.1 segments and a total of 34 ± 27g were infarcted. Transmural infarct (≥50% transmural) was found in 25 patients. All global strains correlated significantly with infarct mass (figure

). In a ROC analysis, longitudinal strain was superior to identify substantial (≥30g) myocardial infarcts (sensitivity = 0.80, specificity = 0.85). Circumferential strain was best to identify minor (≥5g) myocardial infarcts (sensitivity = 0.82, specificity = 0.86).

Conclusion: Assessment of strain in all 3 major dimensions reflects decreased LV function due to ischemic myocardium. Global longitudinal- and circumferential- strains are excellent markers to identify patients with myocardial infarct.

Figure:

Correlation plots
Abstract 1905: Quantification Of Macrophages In Atherosclerotic Plaques Of Rabbits Using The Novel Specific Ct Contrast Agent N1177: A Comparison With 18f-fdg Uptake On Pet-ct And Histology
Authors: Hyafil Fabien , Rudd James H , Cornily Jean-Christophe , Rafique Ash , Feldman Laurent J , Machac Josef , Fuster Valentin , Fayad Zahi A
Published: July 2021

Introduction.
N1177 is a novel computed tomography (CT) contrast agent taken up by macrophages.

Purpose.
We tested if the enhancement detected on CT in aortic wall of rabbits 2 hours after injection of N1177 correlates with metabolic activity measured with 18F-FDG uptake on positron emission tomography (PET)-CT and macrophage area on histology.

Methods.
Atherosclerotic plaques were induced in the aorta of 7 New-Zealand White rabbits by a repeated balloon injury (4 weeks apart) and 4 months of hyperlipemic diet. Three non-injured rabbits fed a chow diet were used as controls. A CT of the aorta (n=10) was acquired in each rabbit before and 2 hours after intravenous injection of N1177 (250 mg iodine/kg). One week later, the same rabbits were imaged on a PET-CT 3 hours after injection of 1 mCi/kg of 18F-FDG. Enhancement of the aortic wall after injection of N1177 was compared to the SUV on PET-CT, and to macrophage area on immunohistochemistry (anti-RAM-11 antibody) of corresponding sections.

Results.
A significant higher enhancement was measured on N1177-enhanced CT in the aortic wall of atherosclerotic compared to control rabbits (mean increase of 10.0 ± 5.2 Hounsfield Units vs. 2.0 ± 2.1 HU, respectively; p<0.05). We found a strong correlation between the enhancement of the aortic wall measured on N1177-enhanced CT (Fig

.: before (A) and 2 hours after (B) injection of N1177) and

FDG uptake on PET-CT (Fig. C

; r=0.61, p<0.001),

macrophage area on immunohistology (Fig. D

; r=0.63, p<0.001).

Conclusion.
Enhancement detected in the aortic wall of rabbits with N1177-enhanced CT correlated with intense metabolic activity measured with 18-F-FDG on PET-CT and with macrophage area on histology.
Abstract 1910: Monitoring of Inflammatory Processes By In Vivo 19F Magnetic Resonance Imaging
Authors: Flögel Ulrich , Ding Zhaoping , Hardung Hendrik , Jander Sebastion , Reichwein Gaby , Jacoby Christoph , Schubert Rolf , Schrader Jürgen
Published: July 2021

This study was aimed at developing a new approach for
in vivo
detection of inflammation by
19
F magnetic resonance imaging (MRI) using biochemically inert emulsified perfluorocarbons (PFCs). PFCs have been clinically used as blood substitutes and are known to be phagocytized by the reticuloendothelial system. Local inflammation was provoked in two murine models of acute cardiac and cerebral ischemia, respectively, followed by intravenous injection of PFCs. A typical example of anatomically matching
1
H and
19
F images obtained at 9.4 Tesla 4 days after myocardial infarction is shown below. The
1
H image (left) clearly shows the presence of ventricular dilatation and wall thinning within the infarcted area (I), and in the corresponding
19
F image (middle) a signal pattern matched in shape of the free left ventricular wall. Merging of these images (right) confirms the localization of PFCs within the anterior, lateral, and posterior wall. In all animals (n=8) studied,
19
F signal was also detected in the adjacent chest tissue, where thoracotomy for infarction was performed (T). No background signal from other tissue was observed. Repetitive MRI revealed in both injury models a time-dependent infiltration of injected PFCs into infarcted areas, and histology demonstrated a colocalization of PFCs with cells of the monocyte-macrophage system. Using rhodamine-labelled PFCs, circulating monocytes/macrophages were identified to be the main cell fraction taking up injected PFCs. In conclusion, PFCs can serve as positive contrast agent for detection of inflammatory processes by MRI, permitting high spatial resolution and an excellent degree of specificity due to lack of any
19
F background.
Abstract 1924: Longterm Outcome Of Pediatric Patients With Discrete Subaortic Stenosis
Authors: Drolet Christian , Miro Joaquim , Côté Jean-Marc , Gardin Letizia , Rohlicek Charles V
Published: July 2021

INTRODUCTION: We previously reported the clinical outcomes of a large pediatric cohort with discrete subaortic stenosis (SubAS)
1
. While patients with more significant left ventricular outflow tract obstruction (LVOTO) at diagnosis progressed rapidly others with mild LVOTO at presentation showed little progression of obstruction or aortic insufficiency (AI). A limitation of our previous study was a relatively short follow-up period.

OBJECTIVE: To extend the follow-up of our previously described cohort with SubAS.

METHODS: Information was gathered retrospectively on 71 previously identified patients diagnosed with SubAS from 1985–1998.

RESULTS: Current data was available on 61/71 patients. At diagnosis the average age was 5.2±0.5 years (mean±SEM), peak LVOT Doppler gradient (Echograd) was 30±3 mmHg, and AI (all mild) was present in 25%. At last assessment the average age was 15.7±0.4 years. Twenty patients were followed only medically and were last reassessed 9.2±1.0 years after diagnosis at 15.8±0.7 years of age. The mean Echograd was unchanged from diagnosis (19±2 vs. 19±3 mmHg). The incidence of AI on echocardiography (all mild) increased from 5% to 55% although none was detectable by auscultation. Forty-one patients underwent surgery 3.0±0.5 years after diagnosis at 7.4±0.6 years of age. The Echograd at diagnosis was 35±3 and increased to 61±6 mmHg pre-operatively. Ten patients were re-operated 5.7±0.7 years after the first surgery and 2 patients had a second re-operation. The last follow up of the operated patients occurred at 15.7±0.6 years of age. At that time the Echograd was 16±3 mmHg and the incidence of AI by echocardiography had increased to 98% (36 mild & 3 moderate) but was evident on auscultation in only 25%.

CONCLUSIONS: This study represents the largest and longest contemporary follow-up of pediatric patients with discrete SubAS. Our results indicate that some patients with SubAS show significant LVOTO at diagnosis and subsequent progression. Surgery in these patients provides good relief of LVOTO but does not eliminate AI. The one third of patients presenting with mild LVOTO and AI show little progression through childhood and adolescence. We suggest that the latter can be safely followed medically. 1) Rohlicek et al. Heart 82:708;1999
Abstract 1926: The Incidence, Predictors, and Outcome of Delayed Stent Fracture After Successful Implantation of Sirolimus-Eluting Stents
Authors: Umeda Hisashi , Gochi Tomoko , Iwase Mitsunori , Ishiki Ryoji , Izawa Hideo , Toyama Junji , Murohara Toyoaki
Published: July 2021

Background:

Recently, stent fracture (SF) of sirolimus-eluting stents (SES) has been shown to be associated with an increased risk of restenosis after SES implantation. We sought to assess the incidence, predictors, and clinical outcome of SF after implantation of SES.

Methods:

A consecutive series of 430 lesions of 382 patients treated with SES followed by coronary angiography at 6 to 9 months were analyzed. SF was defined as complete transverse liner separation or single or multiple stent strut fracture.

Results:

At follow up, SF occurred in 33 of 430 lesions (7.7%), and 32 of 382 patients (8.4%). In 23 of 33 lesions (69.7%), SF was found in a single point, whereas SF occurred in 2 or more points per lesion in 10 lesions (30.3%). Minimal lumen diameter was significantly smaller in patients with SF (2.11±0.64 mm vs. 2.52±0.60 mm,
P
<0.001), presumably due to greater late lumen loss (0.36±0.57 mm vs. 0.08±0.50 mm,
P
=0.005). Consequently, in-stent restenosis in lesions with SF was observed more frequently than non-SF lesions (15.2% vs. 4.0%,
P
=0.004). At 450 days, however, the cumulative rate of major adverse cardiac events (death, myocardial infarction, or target lesion revascularization) was similar in patients with and without SF (9.1% vs. 7.1%,
P
=0.722). Multivariable predictors of SF were shown in Figure

.

Conclusions:

The occurrence of SF 6 to 9 months after implantation of SES in consecutive “real-world” patients was relatively common, which did not lead to an increased risk of adverse cardiac events at 450 days. Total stent length, the reduction in the lesion angle by stenting, and lesions located on the right coronary artery were identified as predictors of SF after implantation of SES.
Abstract 1941: Level and Value of Circulating Endothelial Progenitor Cells in Patients after Acute Ischemic Stroke
Authors: Hon-Kan Yip
Published: July 2021

Background and Purpose

Endothelial progenitor cells (EPCs) migrate from bone marrow to systemic circulation in response to tissue ischemia where they differentiate into mature endothelial cells for in situ angiogenesis. This study tested the hypothesis that the level of circulating EPCs is substantially increased and predictive of prognostic outcomes after acute ischemic stroke.

Methods

The level of circulating EPCs [staining markers: CD31/CD34 (E
1
), CD62E/CD34 (E
2
) and KDR/CD34 (E
3
)] was examined using flow cytometry at 48 h after acute ischemic stroke in 138 consecutive patients. The EPC level was also evaluated once in twenty healthy volunteers and in forty at-risk controls.

Results

Level of circulating EPCs (E
1–3
) was significantly higher in ischemic stroke patients than in at-risk control subjects (
p
<0.05). Additionally, EPC (E
1–3
) level was significantly lower in patients with severe neurological impairment [defined as a score ≥12 on the National Institute of Health Stroke Scale (NIHSS)] than in patients with less severe impairment (NIHSS < score 12) at 48 h after ischemic stroke (
p
<0.0001). Moreover, the EPC (E
3
) level was strongly correlated with improved NIHSS ≥ 4 on day 21 after ischemic stroke (
p
=0.0004). Furthermore, low circulating EPC level was independently predictive of severe neurological impairment (NIHSS ≥ 12) at 48 h (E
1–3
) and combined major adverse clinical outcomes (defined as recurrent ischemic stroke, any cause of death, or NIHSS of ≥ 12) on day 90 (E
1
) following ischemic stroke (
p
<0.001).

Conclusions

Level of circulating EPCs is independently predictive of prognosis after ischemic stroke.
Abstract 1949: The Protein Kinase MAP4K4 Is Activated in Failing Human Hearts and Mediates Cardiomyocyte Apoptosis in Experimental Models, in vitro and in vivo
Authors: Xie Min , Zhang Dou , Wang Sam C , Sano Motoaki , Wang XiaoZhen , Pocius Jennifer S , Taffet George E , Michael Lloyd H , Entman Mark L , Mann Douglas L , Tan Tse-Hua , Schneider Michael D
Published: July 2021

Mitogen-activated protein kinases (MAPKs) have been implicated in cardiac muscle hypertrophy, apoptosis, and heart failure, but relatively little is known of the proximal MAP4Ks that might couple cardiac stress signals to downstream effector kinases. Previously we have shown that epitope-tagged MAP4K4 (hematopoietic progenitor kinase/germinal center kinase-like kinase, HGK) was activated by diverse apoptotic signals in cultured cardiomyocytes and transgenic mouse hearts. Here, we report results for the activation of MAP4K4 in the hearts of patients undergoing therapeutic transplantation, and for the functional consequences of disrupting endogenous MAP4K4 by RNA interference. Compared with 10 control donor hearts obtained at overlapping ages, MAP4K4 activity increased in all subjects with dilated (4.5-fold; N = 13), hypertrophic (4-fold; N = 5), ischemic (2.5-fold; N = 6) and adriamycin-induced cardiomyopathy (3-fold, N = 2; p < 0.001 for all four groups). Activity of the MAP4K4 target, TGFbeta-activated kinase-1 (TAK1/MAP3K7), and the executioner caspase, caspase-3, increased concordantly in all subjects. In mouse myocardium, each of four biological signals for cardiomyocyte apoptosis induced the kinase activity of MAP4K4: biomechanical stress, ischemia/reperfusion injury, and gain-of-function mutations for TNFalpha and Gq. Analogous results were seen in cultured cardiomyocytes, using oxidative stress, ceramide and the cardiotoxic anti-cancer drug doxorubicin. Transgenic expression of MAP4K4 in myocardium produced little or no baseline phenotype, but markedly sensitized the myocardium to apoptosis caused by Gq. In culture, we proved that MAP4K4 induces apoptosis via TAK1, JNK, and the mitochondrial death pathway. As predicted, ceramide-induced and hydrogen peroxide-induced apoptosis was suppressed using RNA interference to silence expression of MAP4K4. Thus, MAP4K4 is activated in response to many specific cardiac death signals, and mediates cardiac apoptosis in vitro and in vivo. The prevalent activation of MAP4K4 in failing human hearts and the pro-death actions of the kinase suggest that MAP4K4 is a possible therapeutic target in the treatment of apoptotic cardiomyopathies.
Abstract 1954: Activation of Endothelial Cells in Conduit Veins of Dogs With Heart Failure and Veins of Normal Dogs Following Vascular Stretch by Acute Volume Loading
Authors: Colombo Paolo , Rastogi Sharad , Onat Duygu , Zaca Valerio , Sabbah Hani N
Published: July 2021

Background:
Endothelial dysfunction is an independent predictor of poor prognosis in patients with heart failure (HF). Using a novel approach of endovascular endothelial cell (EC) sampling, we previously showed that ECs collected from conduit veins using J-wires are activated in patients with HF as evidenced by increased expression of pro-inflammatory genes including inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2). The underlying cause(s) of this endothelial activation and dysfunction is not known. In this study, we tested the hypothesis that the HF state itself and the vascular strain associated with congestion can both account for these findings.

Methods:
We studied 6 normal (NL) dogs (LV ejection fraction >50%, central venous pressure (CVP) ~ 8 mmHg) and 6 dogs with HF (ejection fraction ~ 30%, CVP ~9 mmHg) produced by intracoronary microembolizations. This model of HF manifests the disease syndrome in the absence of other co-morbid conditions often present in patients with CHF. NL dogs were studied at baseline and 1 hr after rapid fluid load (500 ml Dextran-40) resulting in CVP>20 mmHg. ECs were scraped from jugular veins. mRNA was analyzed by RT-PCR and quantified in densitometric units (du).

Results:
Data are shown in the table

. Endothelial iNOS and COX-2 were increased in HF dogs compared to NL. Tissue necrosis factor (TNF)-α, early growth response gene (EGR-1), receptor for advanced glycation end products (RAGE) and glutathione peroxidase (GPx) were also up-regulated in HF. In NL dogs, fluid load increased iNOS, COX-2, TNF-α, Egr-1, RAGE and GPx to levels that approached those of HF.

Conclusions:
The HF state itself, in the absence of other co-morbid conditions, and vascular stretch are both sufficient to activate venous ECs in dogs in a manner consistent with that seen in patients with HF. As such, molecular measures of EC dysfunction may potentially serve as “biomarkers” of severity of HF and possibly of impending decompensation.
Abstract 1957: The Carboxyterminal Telopeptide of Procollagen type I and Procollagen type III Aminoterminal Peptide (PIIINP) are Strong Predictors of Cardiovascular Morbidity and Mortality in the Elderly; The Cardiovascular Health Study
Authors: Barasch Eddy , Gottdiener John S
Published: July 2021

Background:
The fibrillar myocardial extracellular matrix is mainly composed of type I and III fibrillar collagen and their turnover are reflected in the serum level of carboxyl-terminal propeptide type I (PIP) and procollagen type III aminoterminal peptide (PIIINP). The prognostic value of these biomarkers in elderly individuals with heart failure (HF) or other cardiovascular disease (CVD) and in healthy subjects is largely unknown.

Aim:
To determine the predictive value of PIP, its degradation metabolite, carboxyterminal telopeptide of procollagen type I (CTIP), and PIIINP serum level for the incident CV morbidity and mortality in a nested case control study of community-dwelling elderly individuals enrolled in the Cardiovascular Health Study (CHS).

Methods:
In 880 participants (ppts) enrolled in the CHS (mean age 77 ± 6 yrs, 52 % males, 79 % white), 310 with HF, 287 controls (no HF but other CVD) and 283 healthy ppts, serum levels of PIIINP, PIP and CTIP were measured by radioimmunoassay. The number of incident CV disease and death were recorded. Wilcoxon rank sum test, Kruskal-Wallis test, and Cox proportional hazards regression were used as appropriate.

Results:
Age, gender and race and fully adjusted analyses are presented in the table

:

Conclusions:

In this large elderly cohort, there is a strong association between CTIP, PIIINP and incident CVD and death.

Elevated CTIP level increases the risk of death more than 50% and of symptomatic PVD by almost two-fold.

Whereas PIIINP has a lower predictive power than CTIP, PIP was not associated with incident CVD or death.

Serum CTIP and PIIINP have a good prognostic value for both incident CVD and death in elderly individuals with or without known CV disease.
Abstract 1961: Multi-Modality Comparison of Volumetric Quantification of Right Ventricular Volumes Using a Novel Semi-Automated Border Detection Software
Authors: Sugeng Lissa , Weinert Lynn , Niel Johannes , Steringer-Mascherbauer Regina , Hyca Martin , Bartolles Rolf , Schummers Georg , Mor-Avi Victor , Lang Roberto M , Nesser Hans-Joachim
Published: July 2021

Background.
Right ventricular volumes (RVV) and ejection fraction (RVEF) measurements are challenging due to the complex shape of the right ventricle (RV). Current methods are tedious and have limited ability to take into account the base of the RV and right ventricular outflow tract. Novel semi-automated border detection software, RV analysis (RVA) was recently developed (TomTec) to overcome these limitations. Our goal was to determine whether there are inter-modality differences between real-time 3D echocardiographic (RT3DE), cardiac computed tomography (CCT) and cardiac magnetic resonance (CMR) data using the same RVA.

Methods.
We acquired transthoracic RT3DE images of the RV (Philips iE33 w/X4 probe) from the apical window using a full-volume mode in 12 patients referred for CMR imaging (1.5T Siemens scanner) and CCT (Toshiba) on the same day. CMR and CCT images were obtained in a stack of short-axis slices from RV base to apex, four-chamber and coronal views, and reformatted to obtain Cartesian volume data. All three types of images were analyzed to obtain end-systolic and end-diastolic volumes (ESV, EDV) and EF using RV analysis software (RVA). RT3DE and CCT were compared to CMR values as the reference standard, using linear regression and Bland-Altman analyses.

Results.
Analysis of RT3DE, CCT and CMR data were feasible in all patients. RT3DE and CCT RVV and RVEF correlated well with CMR (Table). CCT overestimated RVV whereas RT3DE underestimated RVV. Both CCT and RT3DE slightly underestimated RVEF compared to CMR.

Conclusion.
This new technique for volumetric RV surface detection applied to RT3DE and CCT data provides accurate RVV and RVEF measurements in agreement with CMR.
Abstract 1979: Association of Renal Dysfunction, Myocardial Fibrosis and Survival in Patients with Severe Left Ventricular Dysfunction: A Delayed Hyperenhancement MRI Study
Authors: Halley Carmel M , Kwon Deborah H , Carrigan Thomas P , Setser Randolph , Schoenhagen Paul , Starling Randall , Flamm Scott D , Desai Milind Y
Published: July 2021

Background:
Both renal dysfunction and severe left ventricular (LV) systolic dysfunction lead to reduced survival. Delayed hyperenhancement magnetic resonance imaging (DHE-MRI) accurately detects myocardial fibrosis (scar), seen commonly in patients with severe left ventricular (LV) dysfunction. We sought to determine the association of myocardial scar and renal dysfunction on survival in patients with severe LV dysfunction.

Methods:
We studied 176 consecutive patients (61 ± 13 years, 73 % men) with severe LV systolic dysfunction (mean ejection fraction (24 ± 8 %) who underwent DHE-MRI (Siemens 1.5 T scanner, Erlangen, Germany) from 2005–6. Myocardial scar was determined visually on DHE-MR images, using custom software (Siemens Research), and defined as intensity >2 standard deviation above viable myocardium. Clinical and laboratory information, along with all-cause mortality, were recorded. Glomerular filtration rate (GFR, ml/min/1.73 m
2
) was calculated using the following formula: 186 × (serum creatinine
−1.154
) × (age
−0.203
) × 1.212 (if black) × 0.742 (if female). We divided patients into 4 groups:

GFR > 60, no scar (n = 28)

GFR > 60 with scar (n = 85)

GFR ≤ 60, no scar (n = 9) and

GFR ≤ 60 with scar (n = 53).

Results:
There were 24 deaths in the group and 14 patients (65 %) had myocardial scar. Mean GFR was 70 ± 29 and 62 (35 %) patients had at-least moderate renal dysfunction (GFR < 60). Frequency of myocardial scar was higher in patients with GFR ≤ 60 vs. those with GFR > 60 (92 % vs. 79 %, p = 0.02). On multiple regression (including GFR, myocardial scar, coronary artery disease, hypertension, diabetes and coronary bypass), GFR and myocardial scar were associated with mortality (both p value < 0.05, overall model p value < 0.001). There were no deaths in group 1, 7 in group 2, 3 in group 3 and 14 in group 4 (p < 0.001). One year survival was significantly worse for groups 2, 3 and 4, compared to group 1 (log rank p value < 0.001).

Conclusion:
Renal dysfunction is associated with a higher frequency of myocardial fibrosis in patients with severe LV dysfunction. Presence of renal dysfunction, myocardial fibrosis or both is associated with worse survival in such patients. The mechanistic association between renal dysfunction and myocardial fibrosis needs to be further defined.
Abstract 1985: Increased Plaque Mass, but not Relative Plaque Composition, Distinguishes Culprit Coronary Artery Lesions in Patients with Acute Coronary Syndrome: A Lesion Analysis by Intravascular Ultrasound Histology
Authors: Frutkin Andrew , Mehta Sameer K , McCrary Justin R , House John , Marso Steven P
Published: July 2021

INTRODUCTION

Intravascular ultrasound Virtual Histology (IVUS-VH) uses radiofrequency analysis to measure coronary artery plaque geometry and classify plaque components into one of four categories: fibrous, fibrofatty, necrotic or calcified. We hypothesized that patients with acute coronary artery syndrome (ACS) would have atherosclerotic plaque geometry and composition that differs from patients with stable, obstructive coronary artery disease.

METHODS

In a crossectional study we used IVUS-VH to image 38 culprit lesions of 28 ACS patients and 104 lesions of 71 non-ACS patients prior to intervention. In both ACS and non-ACS patients, culprit lesions were defined as the site of percutaneous coronary intervention with at least 3 contiguous frames of > 40% percent plaque burden (100 × [external elastic membrane (EEM ) area − lumen area]/EEM area ) and a neointimal thickness > 600 um subtending an arc of > 10% vessel circumference. Plaque geometry and composition were measured with IVUS-VH software (pcVH v.2.2, Volcano Corp). A remodeling index was calculated as the ratio of the EEM area at the frame of the minimal lumen area to the EEM area of a reference frame (within 10 mm of MLA).

RESULTS

Lesions of ACS patients were longer and had greater plaque volume than non-ACS patients (Table

). The proportions of IVUS-derived plaque components were similar in both ACS and non-ACS culprit lesions (Table

).

CONCLUSION

Culprit coronary artery lesions in ACS patients have greater plaque mass than in non-ACS patients, but relative plaque composition is similar between these patient populations. Measurements of atherosclerotic plaque mass may discriminate better than plaque composition as to which patients with severe, obstructive coronary artery disease are at greatest risk of coronary artery thrombosis. Longitudinal studies using IVUS-VH will best resolve which IVUS-VH measurements of plaque geometry and composition have greatest predictive value.
Abstract 1997: Reduced Door-to-Balloon Time in ST Elevation Myocardial Infarction as a Consequence of Formalized Data Analysis and Feedback
Authors: Keating Friederike K , Ahlersmann Dorothe , Hilgers Reinhard , Duwald Holger , Nitsche Rolf , Von Knobelsdorff Georg , Moeller Karsten , Scholz Karl H
Published: July 2021

Background
: Formalized data feedback is one strategy proposed to reduce treatment time in ST elevation myocardial infarction (STEMI). We prospectively evaluated the effect of systematic data analysis and feedback on door-to-balloon time and on components of treatment time in a German semirural hospital network.

Methods
: Consecutive patients presenting with STEMI over a one-year period (2006) were enrolled (n=114). The 3-hospital network included one hospital with primary percutaneous coronary intervention (PCI) capacity. Protocols were in place to ensure prompt transfer of patients with STEMI to the PCI center and to minimize time to treatment. They included obtaining and transmitting pre-hospital 12-lead ECGs, bypassing non-PCI hospitals, and bypassing the emergency room with direct transfer to the cardiac catheterization laboratory (CCL) when feasible. No changes were made to these treatment protocols during the study period. On a quarterly basis, data on time to treatment and its components, from initial patient contact to balloon inflation, were collected, presented to, and discussed with staff involved in the initial evaluation, transfer, and treatment of the patients. Comparisons between quarters were made with the Gehan and Pearson χ
2
tests.

Results
: The longest transport distance was 29 miles, and the longest transport time was 47 minutes. Mean (median) door-to-balloon times decreased from 63 (54) minutes during the first quarter to 47 (35), 37 (31), and 36 (26) minutes during the next 3 quarters (p<0.0001). Significant reductions were observed in the time between arrival at the PCI center and arrival in the CCL (p<0.02), and in the time from arrival in the CCL to balloon inflation (p<0.01). There was a nonsignificant increase in the proportion of patients with a transmitted 12-lead ECG (p=0.12). By contrast, the proportion of patients who bypassed the emergency room increased markedly (from 23% during the first quarter to 76% during the 4
th
quarter, p= 0.0023).

Conclusion
: Formalized data feedback can lead to a marked reduction in door-to-balloon times for STEMI. This is in part due to changes in pre-hospital decision making (bypassing the emergency room).
Abstract 1998: Short- and Long-Term Effects of Abciximab in Patients Undergoing Primary Stenting for Acute Myocardial Infarction: Meta-Analysis of Randomized Trials
Authors: Vasu Sujethra , Stone Gregg W , Brown David L
Published: July 2021

Background:
Both short- and long-term benefits of abciximab therapy in primary angioplasty for acute myocardial infarction (AMI) have been reported. However, primary stenting is the preferred treatment of AMI and conflicting data exists on the effect of abciximab therapy on outcomes following primary stent treatment of AMI. We therefore performed a meta-analysis of all randomized trials of abciximab in primary stenting for AMI for which there was short-term (30-day) and long-term (≥ 1 year) follow-up.

Methods:
We searched the MEDLINE and Cochrane databases using the following key words: stent, acute myocardial infarction, abciximab and randomized trial. Four studies (ISAR-2, ADMIRAL, CADILLAC and ACE) were included in this analysis. The incidence of the individual end points of death, reinfarction and target vessel revascularization (TVR) at 30 days and at long-term follow-up was extracted. Follow-up data was available at 1 year for ACE and CADILLAC, at 3 years for ADMIRAL and 5 years for ISAR-2. A random effects model was used to calculate the combined odds ratio (OR) of reinfarction, TVR and mortality associated with the use of abciximab.

Results:
The 4 trials enrolled 2137 patients of whom 1074 were randomized to abciximab and 1063 to placebo. Long-term follow up was available for 2107 patients, 1064 in the abciximab group and 1043 in the control group. At 30 days, abciximab resulted in a significant reduction in the odds of TVR (OR 0.45, 95% CI, 0.27–0.75, P=0.003) and a non-significant reduction in the odds of reinfarction (OR 0.43, 95% CI, 0.18–1.0, P=0.06) but no reduction in 30-day mortality (OR 0.78, 95% CI, 0.47–1.2, P=0.34). During long-term follow up, abciximab treatment resulted in a non-significant reduction in the risk of TVR (OR 0.77, 95% CI 0.58–1.0, P=0.06) but no reduction in reinfarction (OR 0.58, 95% CI, 0.3–1.1, P=0.12) or mortality (OR 0.90, 95% CI, 0.48–1.6, P=0.74).

Conclusions:
Abciximab resulted in a significant reduction in TVR at 30 days that diminished over time. We were unable to demonstrate a significant reduction in reinfarction or mortality at 30 days or at 1–5 years. These results suggest the need for an appropriately powered clinical trial to define the role of abciximab during primary stenting for AMI.
Abstract 1999: Percutaneous Coronary Intervention with Off-site Cardiac Surgery Backup for Acute Myocardial Infarction as a Strategy to Reduce Door-to-Balloon Time.
Authors: Umans Victor A , Peels Hans O , de Swart Hans , Hautvast Raymond
Published: July 2021

We sought to determine whether primary percutaneous coronary intervention (PCI) for patients admitted with an acute ST-segment elevation myocardial infarction (STEMI) can be performed more rapidly and with comparable outcomes in a community hospital vs. a tertiary center with cardiac surgery. We started the first PCI with off-site surgery program in the Netherlands in 2002 and report the results of 639 consecutive pts. In the safety phase, 199 patients presenting with STEMI were randomly assigned to treatment at our off-site center vs a more distant cardiac surgery center. In the confirmation phase, 440 consecutive patients were treated in the off-site hospital. Safety and efficacy endpoints were the rate of angiographically successful PCI procedure (diameter stenosis <50% and TIMI 3 flow) in the absence of major adverse cardiac and cerebrovascular events (MACCE) at 30 days. The randomization phase showed a significant decrease of 37 minutes in door-to-balloon time (p<0.001) with comparable procedural and clinical success (91% TIMI-3 flow in both groups). In the confirmation phase, the 30-day MACCE-free rate was 95%. None of the 639 patients in the study required emergency surgery for failed primary PCI. Time to treatment with primary PCI can be significantly reduced when treating patients in a community hospital setting with off-site cardiac surgery backup as compared with transport for PCI to a referral center with on-site surgery. PCI at hospitals with off-site cardiac surgery backup can be considered as one of the needed strategies to improve access to primary PCI for a larger segment of the population basis, and can be delivered with a very favorable safety profile.