bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P382: Continued Thienopyridine Use at Six Months After PCI is Not Associated with Better Outcomes in End-Stage Renal Disease Requiring Dialysis
Authors: Chang Tara I , Montez-Rath Maria , Solomon Matthew D , Shen Jenny , Winkelmayer Wolfgang C
Published: July 2021

Introduction:
While coronary disease is common in end-stage renal disease, there are few studies of thienopyridine use after PCI in this population. Guidelines recommend 1 to 12 months of thienopyridine use depending on stent type, but are based on patients without advanced kidney disease. However, patients on dialysis often have more severe coronary disease and higher risks of bleeding. We hypothesized that in patients on dialysis undergoing PCI with stenting: 1) most will discontinue thienopyridines prior to 1 year; 2) discontinuation of thienopyridines prior to 6 months post-PCI will associate with higher risks of death or MI, but a lower risk of bleeding.

Methods:
Using the US Renal Data System, we identified patients on dialysis with Medicare Parts A+B+D (with low-income subsidy) who had PCI with stenting between 7/07 and 12/09. Thienopyridine discontinuation was defined as >30-day gap in supply. We performed a landmark analysis, selecting patients who were event-free at 6 months after PCI, and categorized them as having discontinued thienopyridines or not at that point. We propensity-matched patients for discontinued vs. continued use and fit Cox models to examine death, death or MI, and hospitalized bleeding.

Results:
We identified 4686 patients, 66% of whom received a drug-eluting stent [DES]. At 90-days, 78% of DES and 65% of bare metal stent (BMS) patients used a thienopyridine; this proportion fell to 64% and 48% at 6 months, and 42% and 29% at 1 year. Overall rates of death and MI were high (Table). In the matched cohorts, patients who discontinued thienopyridine use prior to 6 months (vs. continued use) had no significant differences in long-term outcomes (Table).

Conclusions:
In patients on dialysis who undergo PCI with stenting, most use thienopyridines for <1 year. Continued thienopyridine use at 6 months was not associated with a significant benefit or with higher bleeding risk. Our study highlights the need for future trials to determine the optimal duration of thienopyridine use after PCI in this high-risk population.
Abstract P399: Development of a Claims-Based Algorithm to Identify a Coronary Heart Disease Free Population in Medicare
Authors: Kent Shia T , Safford Monika M , Zhao Hong , Levitan Emily B , Curtis Jeff R , Kilgore Meredith L , Muntner Paul
Published: July 2021

Introduction:
There is increasing interest in using claims data to study risk for incident coronary heart disease (CHD). However, claims-based algorithms for identifying a population without a history of CHD are not well established.

Objective:
To develop a claims-based algorithm for identifying a population without previous myocardial infarction (MI) or coronary revascularization.

Methods:
The REasons for Geographic and Racial Differences in Stroke (REGARDS) study is a national cohort that included a baseline study visit in 2003-2007. Participants linked to Medicare claims were used to identify cohorts with continuous 6 month, 1 year, 2 year, or 3 year coverage prior to the REGARDS baseline (“look-back” periods). History of CHD at baseline was defined as a self-report of a previous MI or cardiac revascularization. We examined Medicare claims prior to baseline to identify evidence of CHD. Approaches used fixed-window look-back periods (e.g., claims within a 1 year window prior to baseline) and all available look-back (e.g. requiring a minimum of 1 year of Medicare coverage, but using all claims available prior to baseline). Among those without CHD claims in Medicare, we calculated the percent who self-reported CHD for the different look-back periods.

Results:
There were 8,104 participants with 6 months of look-back and no CHD claims. Requiring 1, 2 or 3 year look back periods reduced the number of participants by 1,001 (5%), 2,237 (16%) and 3,157 (26%), respectively. Using fixed-window look-back periods, the percent without CHD claims who self-reported CHD was lower with longer look-back periods (Table). Requiring 6 months of look-back and using all available claims resulted in a lower percent self-reporting CHD than any fixed-window look-back period. The percent self-reporting CHD was only modestly lower when requiring longer all available look-back periods.

Conclusion:
We found that a 6 month minimum look-back period is adequate for identifying a CHD-free population in Medicare when all available claims data are used.
Abstract P406: Trend of Salt Consumption in Italy from 2009 to 2012
Authors: Donfrancesco Chiara , Strazzullo Pasquale , Galeone Daniela , Palmieri Luigi , Lo Noce Cinzia , Ippolito Renato , Russo Ornella , Vanuzzo Diego , Giampaoli Simona
Published: July 2021

Background:
Strategies aiming at reducing dietary sodium are being implemented in many countries based on evidence-based knowledge supporting their cost-effectiveness for reduction of cardiovascular and other chronic diseases. From 2009 to 2011 a Preventive Program of the Italian Ministry of Health has been implemented in Italy including the agreement with bread makers’ associations for the gradual reduction of the salt content in bread, public information campaigns, and the evaluation of population current dietary sodium intakes. This analyses aim to monitor dietary intake of sodium and potassium in representative samples of the Italian adult population before and after the Preventive Program.

Methods:
Data from random samples of persons aged 35-79 years and resident in Italian central regions were collected from October 2009 to September 2010 (299 men and 280 women) and from April to July 2012 (205 men and 210 women). Determinations of sodium and potassium were assessed in a centralized laboratory. Information on the consumption of high salt content food were collected through a questionnaire. Comparisons between mean levels and prevalences were performed using t-test and chi-squared test respectively.

Results:
In men, mean level of sodium chloride per day resulted 185 mmol (95% confidence interval: 177-193 mmol) in 2009-2010 samples and 161 mmol (152-169 mmol) in 2012 samples (p<0.0001). In women, mean level of sodium chloride per day resulted 144 mmol (138-151 mmol) and 125 mmol (117-132 mmol) respectively (p=0.0001). Among men, sodium chloride excretion was higher than 85 mmol (the WHO recommended upper level for sodium intake) in 97% in 2009-2010 samples and 91% in 2012 samples (p=0.0026); among women in 86% and 73% respectively (p=0.0002). Among men, 23% have declared in 2009- 2010 to eat bread without salt often, while 40% in 2012 (p<0.0001); in women 22% and 39% respectively (p=0.0001). No statistically significant differences were found between mean levels of potassium between samples collected in 2009- 2010 and samples of 2012.

Conclusions:
Presented data show that average daily sodium intake in central Italy is still largely higher than that recommended but a significant improvement of mean level of sodium intake and consumption of bread without salt resulted. This results fully justify and encourage the preventive initiatives for reduction of sodium intake and its monitoring in the general population.
Abstract P417: Trans Fatty Acids in Serum are not Associated with Weight Gain in School-age Children
Authors: Baylin Ana , Perng Wei , Mora-Plazas Mercedes , Marin Constanza , Villamor Eduardo
Published: July 2021

Introduction:
Childhood obesity is an independent predictor of later life obesity and cardiovascular disease risk. Yet, the biological processes that underlie excess weight gain among children are not well understood. There is some evidence that long-term intake of trans fatty acids may be associated with weight gain in animal and human studies. Higher intake of fast foods, which are rich in trans fatty acids, has been linked to overweight status among school-age children. However, the specific effects of trans fatty acids are unknown.

Hypothesis:
We hypothesized that trans fatty acids will be associated with faster weight gain during school years.

Methods:
We quantified trans fatty acids by gas-liquid chromatography in serum samples of 668 children aged 5-12 y at the time of recruitment into an ongoing cohort study carried out in Bogota (Colombia) since 2006. Serum levels of 16:1, 18:1, 18:2 and total trans fatty acids were used as biomarkers of intake. Anthropometric characteristics were measured periodically for a median of 30 months. BMI-for-age Z-scores (BAZ) were calculated with the use of the World Health Organization reference. We estimated mean change in BAZ over follow-up according to quartiles of each trans fatty acid at baseline using mixed effects regression models with restricted cubic splines.

Results:
Mean ± SD 16:1, 18:1, 18:2, and total trans fatty acids, as % of total serum fatty acids, were 0.21 ± 0.06, 0.86 ± 0.36, 0.92 ± 0.27, and 1.99 ± 0.59, respectively. None of them were associated with change in BAZ after adjusting for sex, baseline age, and socioeconomic status. Analyses stratified by sex yielded similar null results.

Conclusions:
Biomarkers of trans fatty acid intake were not associated with weight gain in school-age children. It is possible that there is not enough variability in the range of intake for this population to detect associations. Alternatively, the potential harmful effects of trans fatty acids may not become apparent until adulthood after long-term cumulative exposure.
Abstract P429: Parallel Processes of Sedentary Behavior and Cardiometabolic Risk Factors in Obese Adolescents
Authors: Carlson Jordan , Norman Gregory , Kolodziejczyk Julia , Patrick Kevin
Published: July 2021

Introduction:
Sedentary time has been negatively associated with cardiometabolic health in adults. These associations are less clear in youth, may differ by sedentary measurement method, and rarely have been investigated longitudinally.

Hypothesis:
Greater accelerometer measured sedentary time and reported screen time will be associated with poorer status on cardiometabolic risk factors at baseline and longitudinally.

Methods:
Obese (BMI ≥ 95th percentile for age and gender) 11-13 year olds were enrolled in a primary care weight loss trial. Half were girls and 82% were Hispanic. Of the 106 participants enrolled, 73 completed baseline and 12-month assessments. Assessments occurred in the clinic and included a fasting blood draw. Table 1 lists the risk factor variables.

The first dependent variable was reported screen time (television and computer/video games). The second was total sedentary time, calculated from waist-worn Actigraph accelerometers as percent of wear time with counts < 100 per 60-second epoch.

Mplus software was used to fit latent growth parallel processes models, with the intercept of the biomarker regressed on the sedentary time intercept (cross-sectional association), and the slope of the biomarker regressed on the sedentary time slope (longitudinal association). Models were adjusted for potential confounders. Full information maximum likelihood estimation was used to account for missing data.

Results:
Participants reported 3.2 (SD = 2.0) screen time hours. Associations between screen time and risk factors are presented in Table 1.

Total sedentary time (M = 61±11% of wear time) was positively associated with BMI (β = .22; p < .05) at baseline but not with other risk factors. Total sedentary time was not associated with risk factors longitudinally.

Conclusion:
Changes in screen time but not total sedentary time were associated with cardiometabolic risk factors, specifically BMI, blood glucose, LDL, AST, and ALT. Associations were independent of physical activity and psychosocial diet variables.
Abstract P431: The Effect of Ten Days of Reduced Physical Activity (rPA) on Markers of Vascular Function
Authors: Witkowski Sarah , Tassinari Kara , Guhanarayan Gayatru
Published: July 2021

Flow-mediated dilation (FMD) is an early marker of cardiovascular disease. Circulating angiogenic cells (CAC) are hypothesized to support endothelial health and repair and have been related to Framingham risk score. Both FMD and CAC have been investigated as early biomarkers of vascular dysfunction and are related to physical activity. Low physical activity is a risk factor for cardiovascular disease however, the effect of a short-term reduction in physical activity on FMD and CACs is unclear.

Purpose:
To use a novel, objectively monitored model of rPA wherein participants maintain energy balance to evaluate changes in a physiological and cellular marker of vascular function.

Hypothesis:
rPA will result in lower FMD and CAC compared with baseline.

Methods:
Physical activity was measured via Actigraph GT3X before and during 10 days of rPA in healthy trained men (n=6). Baseline caloric intake was assessed and participants were instructed to reduce their intake to match the reduction in energy expenditure during rPA. FMD was assessed via duplex ultrasound of the brachial artery. Artery diameter and shear rate were analyzed with FMD Studio software (Quipu, Pisa). Data for baseline shear rate, baseline vessel diameter, peak shear rate, peak vessel diameter, absolute FMD, relative FMD, area under the curve (AUC), and normalized FMD were calculated for each subject. CAC colony forming units (CFU-EC) were measured before and after rPA. Paired T-tests were used to determine differences between variables before and after rPA.

Results:
Actigraph data revealed increased sedentary time (656 ± 42 to 758 ± 36 min/day, p=0.02) and decreased moderate to vigorous physical activity with rPA (MVPA, 87 ± 16 to 59 ± 9, p=0.03). Weight did not change with rPA. There was a 60 ± 27% increase in baseline shear rate (p=0.03) and a 22 ± 5% decrease in peak shear rate with rPA (p=0.003). We also found a 39% decrease in CAC with rPA (21 ± 5 to 14 ± 6, p=0.03).

Conclusion:
Our preliminary data show that short-term rPA results in significant changes in shear stress and CACs, two markers of vascular function. Future research should explore the independent influence of changes in physical activity and sedentary behavior on vascular function.
Abstract P442: Apparently Healthy Fit Asymptomatic Adults Are Not Immune To Sub-clinical Atherosclerosis
Authors: Scales Robert , Cornella Kathryn A , Vardhini Mohan , Akalan Cengiz , Wu Qing , Halli Susan , Hurst Robert T
Published: July 2021

Evidence suggests that cardiovascular (CV) fitness below the 20
th
percentile for age and gender is associated with increased cardiac death and all cause mortality. This study assessed the association between CV fitness and sub-clinical atherosclerosis (SCA) in a self-selected group of participants in a cardiology-based prevention program. The study involved a single visit observation of participants. 240 apparently healthy asymptomatic adults <65 years (69% male) received a maximal graded exercise stress test and a carotid intima-media thickness (CIMT) evaluation with B-mode ultrasound. CV fitness was classified based on age-gender norms (very poor=1-19
th
, poor=20-39
th
, fair=40-59
th
, good=60-79
th
, excellent/superior=80-100
th
percentile). CIMT was used to define CV health based on age-gender-race norms. SCA was considered present when there was non-occlusive carotid artery plaque (>1.5mm and >50% of the surrounding intima-media) or CIMT >75
th
percentile. Anyone with a prior history of clinically apparent atherosclerosis or diabetes was excluded from the study. The mean age of participants was 50 yrs (SD= 8.7). 113 participants (47%) had excellent/superior CV fitness. 41 (17%) were classified good, 36 (15%) fair, 20 (8%) poor and 30 (12%) very poor. 69 (61%) participants with excellent/superior CV fitness had advanced atherosclerosis (plaque=43%; n=49 or CIMT >75
th
percentile=l7%; n=20). In the good classification there were 26 (64%) with plaque (49%; n=20) or CIMT >75
th
percentile (15%; n=6). There were 23 (63%) in the fair classification with plaque (44%; n=16) or CIMT >75
th
percentile (19%; n=7), 11 (55%) in the poor classification with plaque (45%; n=9) or CIMT >75
th
percentile (10%; n=2) and 17 (56%) in the very poor classification with plaque (53%; n=16) or CIMT >75
th
percentile (3%; n=1). 58 (24%) of the total number of participants were classified with superior CV fitness (95-100
th
percentile); of which 36 (62%) had SCA (plaque=45%; n=26 or CIMT >75
th
percentile=17%; n=10). In this self-selected population, CIMT testing detected evidence of SCA across all age-gender fitness classifications, which included very fit individuals. Further investigation is needed to identify other factors that may be associated with increased CV risk in apparently healthy fit asymptomatic adults.
Abstract P443: Move for Health: Pedometer Based Assessment for Physical Activity among Resident Physicians at a Busy New York City Hospital
Authors: Supariwala Azhar A , Agarwal Shivkumar , Pai Poonam , Sangli Swathi , Thammaiah Yathin , Duttuluri Manideep , Parvanetni Swathi , Dukkipati Sai Sreenija , Paladugu Keerthana , Cohen Randy , Uretsky Seth , Rozanski Alan
Published: July 2021

Background:
Regular physical activity (PA) improves mental health and decreases the incidence of coronary heart disease. Current guidelines recommend >10,000 steps/day (s/d) as an appropriate PA target. We studied the self-perception of PA among the physicians and compared it with an objective measure using a pedometer.

Methods:
85 internal medicine physicians,91% residents (age: 30±3.8 yrs; 57% Male) were enrolled in this study. Demographic and international physical activity questionnaire (IPAQ) were obtained. Participants were instructed to wear an Omron HJ-720 pedometer all day except during sleep to record average s/d over a 7 day period. The pedometer steps were not made visible to the participants. Physicians were stratified according to sedentary lifestyle [SL] (7500 s/d).

Results:
Mean daily steps were 6521 ± 2524 s/d. Only 8(9.4%) participants reached the recommended target of >10,000 s/d. Mean daily steps at work (6AM to 5PM) were 4420±2242 s/d, which constituted 68% ± 24% of their daily PA. There were 26 (31%) subjects in the SL group (3551 ±1075 s/d), 27 (32%) LA group (6340 ± 819 s/d) and 32 (38%) in SA group (9086 ± 1243 s/d). Step count did not correlate with age, gender, BMI, foreign or American medical graduate, PGY status, or type of rotation (floors,ICU, electives). At the time of enrollment, 56% of physicians stated that they achieve “enough” PA. According to the IPAQ, 61% of physicians were in the high PA group. However, these PA levels did not correlate with objective pedometer measurements. SA group had higher work time PA (p<0.001). All groups maintained the week day PA during the weekends.

Conclusion:
Despite the perception of being PA, most physicians in our study did not achieve the recommended daily steps/day. “Walking at work” is not enough to reach recommended PA targets. Future research is needed for successful strategies to create awareness and improve PA among physicians.
Abstract P454: The Predictors of Non-adherence of Regular Physical Activity After Coronary Revascularization
Authors: gucuk ipek esra , Acar Burak , Burak Cengiz , Bayraktar Fatih , Kara Meryem , Ozcan Cetin Elif H , Cetin Mehmet S , Guray Umit , Guray Yesim
Published: July 2021

Background:
Coronary heart disease the leading cause of mortality worldwide and regular physical activity is a comprehensive management strategy for these patients. We investigated the parameters that influence regular physical activity in patients with a history of coronary revascularization.

Methods:
We included outpatients who had a history of coronary revascularization at least 6 months prior to enrollment. A questionnaire was filled out with each patient to collect the data of engagement in regular physical activity, demographics, clinical characteristics, and dietary adherence.

Results:
We enrolled 202 consecutive outpatients (age 61.3±11.2 years, 73% males). The median duration after revascularization was 60 months. One hundred and 4 (51%) patients had previous percutaneous coronary intervention, 67 (33%) patients had coronary by-pass graft surgery, and 31 (15%) patients had both of the revascularization procedures. Of all, 46 (23%) patients were engaging in regular physical activity with a median of 2 days per week. Patients were classified into two subgroups according to their physical activity habits. There was no significant difference in age, comorbid conditions or revascularization type between subgroups. In the univariate regression analysis, absence of regular physical activity was associated with female gender, low education level, unemployment, low household income, implantation of bare metal stent (vs. drug eluted stent) and absence of regular follow-up visits. Stepwise multivariate regression analysis concluded that low education level (p=0.01, OR=3.26, 95%CI: 1.31 -8.11), and absence of regular follow-up visits (p=0.04, OR=2.95, 95%CI: 1.01-8.61) were independent predictors of non-adherence of regular physical activity in study subjects.

Conclusion:
Regular physical activity rates were lower in outpatients with a history of previous coronary revascularization. Education level and regular follow-up visits could influence physical activity adherence in these patients.
Abstract 110: The Association Between the Timing of Epinephrine (Adrenalin) Administration and Survival from Out-of-Hospital Ventricular Fibrillation Arrest
Authors: Ewy Gordon A , Bobrow Bentley J , Chikani Vatsal , Sanders Arthur B , Otto Charles W , Zuercher Mathias , Spaite Daniel , Kern Karl B
Published: July 2021

Introduction:
The benefit of epinephrine administration by emergency medical services providers (EMS) during resuscitation of patients with out-of-hospital-cardiac arrest (OHCA) is controversial. To address the association of the timing of epinephrine administration and outcome, we accessed the Save Hearts in Arizona Register and Educational (SHARE) program registry, and analyzed the time between 9-1-1 dispatches, the first dose of epinephrine and survival to hospital discharge.

Methods:
A retrospective analysis of prospectively collected statewide OHCA data using the SHARE database between October 2004 and December 2013.

Results:
There were 2,213 OHCA with a shockable initial rhythm who received epinephrine by EMS. Logistic regression was performed adjusted for age, gender, witnessed, bystander CPR, arrival time (dispatch to scene), and dispatch to defibrillation time, year, and method of ventilation. Of these, 396 (17.8%) survived to discharge. The times from dispatch to first epinephrine administration were analyzed. Survival progressively decreased with longer time intervals of epinephrine administration: Survival, < 9 min (99/398) 24.8%, 9-13 min (216/1,058) 20.4% and >13 min (81/757) 10.7%. The Adjusted odds ratio for decreased survival for the group receiving epinephrine after 13 minutes was 2.32 (95% CI 1.5-3.4) (p<0.0001). The neurological CPC Scores of the 242 survivors was also related to time delay of epinephrine administration: CPC 1 or 2 were; < 9 min 69 (17.3%), 9-13 min 132 (12.4%), >13 min 47 (6.2%). Survival was significantly less in those receiving epinephrine >13 min after EMS arrival (Chi Square p<0.0001).

Conclusion:
In this retrospective database analysis, epinephrine administered by EMS to patients with OHCA and a shockable rhythm in <13 min from dispatch was associated with significant improvement in survival compared to epinephrine administered >13 min after dispatch.
Abstract 11005: Influence of High-Degree Atrioventricular Block on 30-Day Clinical Outcome Following Acute Myocardial Infarction in the Drug-Eluting Stent Era: Results From Nation-Wide Registry of Acute Myocardial Infarction
Authors: Kim Hack-Lyoung , Kim Sang-Hyun , Seo Jae-Bin , Chung Woo-Young , Zo Joo-Hee , Kim Myung-A , Park Kyung-Woo , Koo Bon-Kwon , Kim Hyo-Soo , Chae In-Ho , Choi Dong-Ju , Cho Myeong-Chan , Kim Young-Jo , Kim Ju Han , Ahn Youngkeun , Jeong Myung Ho
Published: July 2021

Introduction:
This study was conducted to investigate the prognostic value of high-degree atrioventricular block (HDAVB) among patients with acute myocardial infarction (AMI) treated with DES.

Methods:
A total of 13,862 patients with AMI, registered in the nation-wide AMI database between January 2005 and June 2013, were analyzed. Second- (Mobitz type I or II) and third-degree atrioventricular block (AVB) were considered as HDAVB in this study. Thirty-day major adverse cardiac events (MACE) including all causes of death, recurrent myocardial infarction, and revascularization were evaluated.

Results:
Percutaneous coronary intervention with implantation of DES was performed in 89.8% of the patients. HDAVB occurred in 378 patients (2.7%). Thirty-day MACE occurred in 1,144 patients (8.2%). Patients with HDAVB showed worse clinical parameters at initial admission, and the presence of HDAVB was associated with 30-day MACE in univariate analyses. However, the prognostic impact of HDAVB was not significant after adjustment of potential confounders (p = 0.489). Among patients with HDAVB, patients with a culprit in the left anterior descending (LAD) coronary artery had worse clinical outcomes than those of patients with a culprit in the left circumflex or right coronary artery. LAD culprit was a significant risk factor for 30-day MACE even after controlling for confounders (odds ratio, 5.28; 95% confidence interval, 1.22-22.81; p = 0.026).

Conclusions:
Despite differences in clinical parameters at the initial admission, HDAVB was not an independent risk factor for 30-day MACE in adjusted analyses. However, a LAD culprit was an independent risk factor for 30-day MACE among patients with HDAVB.
Abstract 11069: Alogliptin, a Dipeptidyl Peptidase-4 Inhibitor Improves Ventricular Tachypacing-Induced Atrial Fibrillation in a Rabbit Model
Authors: Yamamoto Toshihiko , Shimano Masayuki , Inden Yasuya , Yoshida Naoki , Ishikawa Shinji , Okumura Satoshi , Kato Hiroyuki , Yanagisawa Satoshi , Nagao Tomoyuki , Ito Tadahiro , Mizutani Yoshiaki , Tsuji Yukiomi , Hirai Makoto , Murohara Toyoaki
Published: July 2021

Introduction:
Dipeptidyl peptidase-4 (DPP-4) inhibitors, prescribed for type 2 diabetes mellitus, are recently reported to have cardioprotective effects via improving ventricular function. However, the role of DPP-4 inhibition in atrial remodeling, especially arrhythmogenic substrate, remains unclear. Therefore, we investigated the effects of a DPP-4 inhibitor, alogliptin, on atrial fibrillation (AF) caused by ventricular tachypacing (VTP) in a rabbit model.

Methods:
New Zealand white rabbits (male, 2.8-3.1kg) were exposed to VTP (380-400 ppm) for 3 weeks using an implanted right ventricular pacemaker and fed/treated with or without alogliptin (20mg/kg/day). Three weeks later, rabbits were assessed by echocardiography, electrophysiological study and atrial histological analysis (Masson-trichrome staining for fibrosis and anti-CD31 immunofluorescence staining for capillary density). Moreover, expression of atrial angiogenic factors were determined by Western blot.

Results:
AF was induced by atrial burst pacing in electrophysiological study. VTP rabbits exhibited a prolongation of AF duration, while alogliptin treatment attenuated it (8.8±2.3 seconds vs 2.4±0.3 seconds, p<0.05). Alogliptin also reduced the extent of atrial fibrosis in response to VTP (10.8%±1.0% vs 6.6%±1.1%, p<0.05). In addition, VTP rabbits treated with alogliptin displayed a 1.6-fold increase in capillary density of the left atrial myocardium compared with those without treatment. Western blot analysis indicated that the phosphorylation ratio of eNOS in arrhythmic left atrium was twice higher in alogliptin-treated rabbits compared with control. However, in echocardiography, rabbits treated with alogliptin did not show improvement in left atrial enlargement and left ventricular systolic dysfunction caused by VTP.

Conclusions:
Alogliptin disrupted the process of AF promotion caused by the accumulation of fibrotic atrial tissue through augmenting atrial angiogenesis and improving endothelial function. Our findings suggest that DPP-4 inhibitors may be useful for the prevention of VTP-induced AF.
Abstract 11084: Coronary Artery Bypass Graft Surgery in Elderly Patients With Multivessel Coronary Artery Disease is Associated with Better Outcomes
Authors: Posenau John T , Wojdyla Daniel M , Shaw Linda K , Alexander Karen P , Ohman E. M , Patel Manesh R , Smith Peter K , Rao Sunil V
Published: July 2021

Introduction:
The appropriate revascularization strategy for elderly patients with multivessel CAD is unclear.

Hypothesis:
We hypothesized that the rate of death, MI, and revascularization would be lower in elderly patients with multivessel CAD who receive revascularization with CABG.

Methods:
We used the Duke Databank for Cardiovascular Disease from 10/01/2003 through 06/30/2013 to identify patients ≥ 75 years old with multivessel disease, and treatment with PCI or CABG within 30 days of index catheterization. Exclusions included STEMI, left main disease, and significant valvular disease. The primary outcome was a composite of all-cause death, MI, and coronary revascularization through latest follow-up. The outcomes were examined across initial revascularization therapies including bare metal stents, drug-eluting stents, and CABG. Unadjusted estimates were assessed with Kaplan-Meier time-to-event methods. Multivariable Cox proportional hazards modeling was used to assess adjusted relationships with outcome.

Results:
We identified 763 patients who met criteria (BMS n=202, DES n=411, CABG n=150). The median age was 79 years and the median follow up time was 6.28 years. Unadjusted primary outcome rates per 100 patient-years of follow up were 22.41% for BMS, 16.97% for DES, and 12.39% for CABG. After adjustment, both BMS and DES were associated with a higher risk of the primary outcome. BMS versus CABG HR=1.58 (1.15-2.19, p=0.01). DES versus CABG HR=1.45 (1.08-1.95, p=0.01). The adjusted event rate for PCI with DES versus BMS was not significant, HR=0.92 (0.71-1.19, p=0.51).

Conclusions:
In this retrospective single center analysis of 763 elderly patients with multivessel coronary disease, CABG was associated with a significantly lower rate of death, MI, and revascularization when compared with initial revascularization with bare metal or drug-eluting stents. This may reflect selection of healthier patients taken for bypass surgery.
Abstract 111: Analysis of Successful Resuscitation for an Emergency in School Demonstrates Contribution of Teachers and Proposes Issue for Location of Automated External Defibrillator
Authors: Komori Akiko , Ayusawa Mamoru , Kato Masataka , Chou Ami , Watanabe Hirofumi , Abe Yuriko , Jinbo Shino , Kamiyama Hiroshi , Sumitomo Naokata , Takahashi Shori
Published: July 2021

BACKGROUND:
Considerable numbers of cardiac emergencies have been resuscitated without neurological sequel by public action of resuscitation and defibrillation. Since resuscitated cases are increasing also in Japanese schools, it is necessary to investigate factors for successful resuscitation.

METHODS:
Students resuscitated with AED were picked up from all issues in Mutual Aid Insurance System for Schools from 2005 to 2011. A total of 128 students were listed and classified to victims and survivors. Victims consisted of 62 cases that died or had brain sequel, and survivors consisted of 66 cases that recovered without sequel. Demography, causative disease, AED user, and the location of resuscitation in both groups were compared.

RESULTS:
Number of enrolled cases increased from 4 to 35 annually. School grade distribution is similar between two groups. Male to female ratio was 4.6 in victims and 2.1 in survivors (p=0.07). The most causative disease was cardiomyopathy (HCM) (22.6%) in victims, and ventricular fibrillation (VF) (28.8%) in survivors. They are the second in each other group. The third was congenital disease (8.1%) in victims, and long QT syndrome (LQT) in survivors (10.6%). In survivors, 6 cases were previously implanted ICD and 11 cases were implanted ICD after resuscitation and returned to school. Ambulance crew operated AED in 35.8% and 12.2% cases, and schoolteachers did in 64.2% and 87.8% of victims and survivors, respectively. Rate of successful resuscitation was significantly higher in cases operated by schoolteachers than that by ambulance crew (p<0.01). Concerning location of resuscitation, 62.9% of victims and 71.2% of survivors were resuscitated at athletic field or gymnasium. Prevalence of resuscitation at swimming pool in victims was 2/62(3.2%) and was significantly less than that in survivors, which was 9/66(13.6%) (p<0.05). Prevalence at classroom was 6/62(9.7%) in victims was significantly more than that in survivors, which was 1/66(1.5%) (p<0.05).

CONCLUSIONS:
AED operation by teachers improve prognosis of cardiac emergencies in Japanese schools. AED should be placed near athletic field, gymnasium, pool, and ideally on the way to school for possible student.
Abstract 11107: Efficacy and Safety of Intensive Statin Therapy for Hypercholesterolemic Patients With Bioprosthetic Aortic Valve Replacement for Aortic Valve Stenosis
Authors: Morimoto Yoshihisa , Sugimoto Takaki , Arase Hiroki
Published: July 2021

Objectives:
Intensive rather than standard statin therapy has been proven to be superior in improving cardiovascular outcome, whereas the effects of intensive statin therapy on inflammation and lipoprotein biomarkers are not well defined. The purpose of this study was to validate the efficacy of intensive statin therapy for hypercholesterolemic patients with bioprosthetic aortic valve replacement for aortic valve stenosis.

Methods:
In this study, we performed a single-center, randomized, single-blind clinical trial. A total of 30 hypercholesterolemic patients with bioprosthetic aortic valve replacement were enrolled and randomly divided into two groups [intensive-dose rosuvastatin therapy (target LDL-C level: 70 mg/dl) and standard-dose rosuvastatin therapy (target LDL-C level: 120 mg/dl). Evaluation variables, including changes in serum lipid profile, aortic valve area, and E/e’ representing left ventricular diastolic function, from baseline to years 1 and 2, were used to compare the benefits of these two statin therapies.

Results:
At baseline, there were no differences between the two groups, including in LDL-C level (intensive 121+/-27 vs. standard 118+/-31, n.s.), aortic valve area (intensive 1.58+/-0.47 vs. standard 1.54+/-0.42, n.s.), and E/e’ (intensive 19+/-20 vs. standard 20+/-10, n.s.). After 2 years of treatment, improvements of LDL-C level (intensive 75+/-11 vs. standard 95+/-10, p<0.001), aortic valve area (intensive 1.63+/-0.24 vs. standard 1.43+/-0.32, n.s.), and E/e’ (intensive 16+/-6 vs. standard 23+/-8, p<0.05) were all better in the intensive group.

Conclusions:
Compared with standard statin therapy, long-term intensive-dose statin appears to be safe and lowered the LDL-C level significantly, further improved left ventricular diastolic function, and preserved bioprosthetic aortic valve.
Abstract 11154: Predictors of Improvement of Left Ventricular Diastolic Function After Transcatheter Aortic Valve Replacement in Severe Aortic Stenosis With Preserved Left Ventricular Systolic Function: A Serial Echocardiographic Study
Authors: Utsunomiya Hiroto , Mihara Hirotsugu , Itabashi Yuji , Berdejo Javier , Matsuoka Ken , Siegel Robert J , Mohammad Kashif , Al-Jilaihawi Hasanian , Makkar Raj R , Shiota Takahiro
Published: July 2021

Background:
Improvement of left ventricular (LV) diastolic function (DF) after transcatheter aortic valve replacement (TAVR) is not fully elucidated. The present serial transthoracic echocardiography study aimed to investigate the long-term clinical and hemodynamic impact of DF improvement after TAVR and to identify its predictors.

Methods:
We retrospectively reviewed echocardiographic and clinical data before and after TAVR in 98 patients with severe aortic stenosis (AS) and preserved LV systolic function. Mitral annular displacement was measured as the maximal distance of lateral annular motion during systole in apical 4-chamber view. DF was classified as grade 0 to 3 based on the recommendations of the American Society of Echocardiography. DF improvement was defined as ≥1 grade improvement at the 1-year follow-up.

Results:
Fifty-nine patients (60%) showed DF improvement. At baseline, patients with the improvement had a less severity of AS (valve area index, 0.37 ± 0.09 vs. 0.32 ± 0.08 cm2/m2) than those with no improvement. Despite similar baseline and changes in LV ejection fraction and mass index, the improvement group shows better recovery of functional status, stroke volume index, and E/e’ (Fig.1-3), as well as plasma brain natriuretic peptide level (median, 264 to 110 vs. 267 to 252 pg/ml, p = 0.017). When adjusting for age, demographic variables, valve area and change in mass index, absence of coronary artery disease (p = 0.03), mitral annular displacement (p < 0.001), and right ventricular end-diastolic diameter (p = 0.02) were independently associated with DF improvement. A mitral annular displacement >11.9 mm had a sensitivity of 83% and a specificity of 72% for prediction of DF improvement (Fig.4).

Conclusion:
DF improvement is often observed after TAVR and when present may be accompanied by more favorable clinical and hemodynamic changes. Mitral annular displacement, but not AS severity or degree of mass regression, predicts DF improvement after TAVR.
Abstract 11155: Impact of Serum Calcium Levels on Mortality of Patients With Heart Failure and Chronic Kidney Disease
Authors: Miura Shunsuke , Yoshihisa Akiomi , Nodera Minoru , Sato Akihiko , Takiguchi Mai , Shimizu Takeshi , Nakamura Yuichi , Yamauchi Hiroyuki , Owada Takashi , Abe Satoshi , Suzuki Satoshi , Oikawa Masayoshi , Kobayashi Atsushi , Yamaki Takayoshi , Sugimoto Koichi , Kunii Hiroyuki , Nakazato Kazuhiko , Suzuki Hitoshi , Saitoh Shu-ichi , Takeishi Yasuchika
Published: July 2021

Background:
Chronic kidney disease-mineral and bone disorders (CKD-MBD) are associated with vascular calcification and abnormal electrolyte that lead to cardiovascular disease and mortality. CKD-MBD are identified by imbalances in serum calcium (Ca), phosphate, and parathyroid hormone (PTH). Although, the relation of phosphate and PTH to prognosis of HF patients has been reported, prognostic impact of Ca on patients with heart failure (HF) and CKD remains unclear.

Methods and Results:
Consecutive 191 patients admitted for HF and CKD (estimated GFR < 60 ml/min/1.73 m
2
) were divided into 3 groups based on levels of corrected Ca: low Ca (Ca < 8.4 mg/dl, n = 32), normal Ca (8.4 ≤ Ca <10.0, n = 149), and high Ca (10.0 ≤ Ca, n = 10) groups. We compared echocardiographic findings and levels of hemoglobin, BNP, troponin T, CRP, estimated GFR, intact PTH, phosphate, zinc (Zn), and magnesium (Mg) among the three groups. Furthermore, we prospectively followed cardiac, non-cardiac, and all-cause mortality. The low Ca group, as compared to normal and high Ca groups, had lower levels of hemoglobin and Zn (hemoglobin: 11.2 vs. 12.4, 13.0 g/dl, P < 0.001; Zn: 58.1 vs. 70.1, 71.0 mg/dl, P = 0.003). Age, body mass index, BNP, troponin T, CRP, estimated GFR, intact PTH, phosphate, Mg, and left ventricular ejection fraction were similar among the three groups. Importantly, cardiac mortality (log-rank P = 0.003) and all-cause mortality (P < 0.001), but not non-cardiac mortality, were higher in low Ca group than in normal and high Ca groups in HF and CKD patients. In the multivariate Cox proportional hazard analyses, hypocalcemia was an independent predictor of cardiac (HR 2.34, P = 0.007) and all-cause mortality (HR 1.89, P = 0.027) in HF and CKD patients.

Conclusions:
Hypocalcemia was an independent predictor of cardiac and all-cause mortality in HF and CKD patients. Thus, taking appropriate management to control CKD-MBD balance may improve the prognosis of patients with HF and CKD.
Abstract 11187: Atrial Fibrillation in Women With Acute Myocardial Infarction: Insights From a 20-Years Registry in Qatar (1991-2010)
Authors: Salam Amar M , AlBinali Hajar , Singh Rajvir , Al-Qahtani Awad , Asaad Nidal , Al-Suwaidi Jassim
Published: July 2021

Objectives:
There is very scarce data on women with atrial fibrillation (AF) in the setting of acute myocardial infarction (AMI). The aim of this study was to compare women and men with AF during hospitalization with AMI in a real-world population.

Methods:
Retrospective analysis of all patients hospitalized with AMI and AF in Qatar from 1991 through 2010 was made. Patients were divided into two groups according to gender. Clinical characteristics, management and outcomes were analyzed.

Results:
During the 20-years period, 12871 patients were hospitalized with AMI; 1611 women and 11260 men. Of these 227 patients developed AF during hospitalization; 69 women (4.3%) and 158 men (1.4%), p <0.05. Women with AF were 6 years older and had significantly higher rates of hypertension (72.5% vs. 44.3%), diabetes mellitus (66.7% vs. 43%), dyslipidemia (18.8% vs. 7.6%) and chronic renal impairment (8.7% vs. 7%) compared to men [all P=0.001]. Non ST-elevation AMI was the commonest underlying type of AMI in both sexes and it was more common in women compared to men (81.2% vs. 67.7%, P= 0.04). Women with AF had significantly longer hospital stay compared to men (8.5 days versus 6 days, p=0.02) whereas in-hospital mortality and stroke rates were comparable between the two groups [table].

Conclusions:
We report significant risk profiles differences and a higher prevalence of AF following AMI in women. Further studies are warranted to further explore and confirm this observation in larger registries.
Abstract 11228: The Endothelial Nitric Oxide Synthase Gene -786T/C Polymorphism is a Significant Predictive Factor for Myocardial Lactate Production During Acetylcholine-Provoked Coronary Spasm
Authors: Kaikita Koichi , Sato Koji , Nakayama Masafumi , Tsujita Kenichi , Kojima Sunao , Hokimoto Seiji , Ogawa Hisao
Published: July 2021

Myocardial lactate production (MLP) in the coronary circulation is a supporting diagnostic marker useful in the evaluation of coronary spasm-induced myocardial ischemia during acetylcholine (ACh)-provocation test. We previously found a -786T/C polymorphism in the 5’-flanking region of the endothelial nitric oxide synthase (eNOS) gene and reported that this polymorphism is strongly associated with coronary spasm. However, there is no report showing the relation between MLP induced by ACh-provocation test and eNOS gene -786T/C polymorphism in the large study population. We examined 712 consecutive patients who underwent myocardial lactate measurement during ACh-provocation test and agreed with genetic screening test of eNOS gene -786T/C polymorphism between January 1991 and December 2010. ACh-provoked MLP was observed in 252 out of 712 patients included in the present analysis [252 MLP-positive and 460 MLP-negative patients]. MLP-positive patients were more likely to be female, diabetic, non-smokers, had epicardial, multivessel and diffuse spasm pattern, with eNOS-786T/C polymorphism (60% vs. 44%, p<0.001, 25% vs. 19%, p=0.047, 61% vs. 46%, p<0.001, 83% vs. 36%, p<0.001, 37% vs. 11%, p<0.001, 39% vs. 12%, p<0.001, and 23% vs. 15%, p=0.011, respectively). Multiple logistic regression analysis identified female gender, epicardial spasm and -786T/C polymorphism to correlate with the MLP-positive finding (OR: 0.327; 95% CI: 0.226-0.475; p<0.001, OR: 10.137; 95% CI: 6.767-15.187; p<0.001, and OR: 1.621; 95% CI: 1.025-2.564; p= 0.039). In the analysis of patients with epicardial coronary spasm, Kaplan-Meier survival curve showed no difference in 5-year survival rates free from major adverse cardiac events between MLP-positive and MLP-negative patients with epicardial coronary spasm (p=NS). In conclusion, multiple predictors including female gender and eNOS gene -786T/C polymorphism were the significant predictors for the MLP induced by ACh-provocation test, highlighting the close relation between the genetic factors and ACh-induced myocardial ischemia in Japanese patients with coronary vasospastic angina.
Abstract 11236: Prevalence and Risk Factors of Catheterization-Related Cerebral Infarction: Evaluation at Diffusion-Weighted Magnetic Resonance Imaging
Authors: Morita Yusuke , Kato Takao , Funasako Moritoshi , Nakane Eisaku , Miyamoto Shoichi , Izumi Toshiaki , Haruna Tetsuya , Inoko Moriaki
Published: July 2021

Introduction:
Due to improvements of catheter design and approach, catheterization-related cerebral infarctions are expected to decrease, whereas this may be counterbalanced by increased risk profile of patients who undergo catheterization.

Aims:
The aim of this study is to examine the prevalence and risk factors of symptomatic and asymptomatic catheterization-related cerebral infarctions in the contemporary era, using diffusion-weighted magnetic resonance imaging (MRI).

Methods and Results:
We retrospectively analyzed 84 patients who underwent 1237 diagnostic and interventional catheterization procedures conducted within 2010 and 2011 in our hospital and who obtained the MRI within 14 days after catheterization. Among these, 10 patients developed a neurological event underwent MRI for suspected cerebral infarction (group A), whereas 74 patients were asymptomatic and underwent MRI for various reasons (group B); 52% of patients for the assessment before coronary bypass or surgery of aortic valve, 19% for the systemic vascular assessment for atherosclerotic diseases, and 28% for other reasons. The MRI revealed a fresh cerebral infarction in 5 patients in group A and 22 patients (29.7%) in group B. In patients with infarct lesions, more number of catheters were used (p=0.01), the intravascular procedure was longer (mean ± SEM, 17.1 ± 1.7 minutes vs. 22.7 ± 2.4 minutes, p=0.06), and the mean age tended to be higher (mean ± SEM, 74.1 ± 1.67 vs. 70.4 ± 1.1, p=0.07). The features of infarction were as follows: 62.9% of patients had multiple lesions and relatively small lesions in asymptomatic patients compared to those in symptomatic patients.

Conclusions:
Symptomatic cerebral infarction occurred after 5 of 1237 (0.4%) procedures. However, the rate of asymptomatic catheterization-related cerebral infarctions detected using diffusion-weighted MRI remains high in high-risk patients or candidates for cardiac surgery, when the rate is compared to that reported by previous studies conducted around 10 years ago. More number of catheters used and longer procedure time were associated with cerebral infarction in present study and careful procedural planning is warranted.