bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 1564: Does Location of the Second Internal Thoracic Artery Graft Influence Outcome?
Authors: Stockins Aleck , Sabik Joseph F , Houghtaling Penny L , Blackstone Eugene H , Lytle Bruce W
Published: July 2021

Objectives:
To determine whether location of the second internal thoracic artery (ITA) graft used for bilateral ITA grafting affects mortality and morbidity of patients with 3-system coronary artery disease, and to identify factors associated with location of the second ITA.

Methods:
From 1/1972 to 6/2006, 3,611 patients with 3-system coronary artery disease underwent bilateral ITA grafting with one ITA to the left anterior descending (LAD) system and the second to either the circumflex (LCx; n=2,926) or right coronary artery (RCA; n=685) system. Follow-up was 9.2±7.2 years. Propensity score methodology was used to obtain risk-adjusted outcome comparisons between patients with the second ITA to the LCx vs RCA.

Results:
In-hospital mortality (0.34% vs 0.58%;
P
=.4), stroke (0.96% vs 0.88%;
P
=.8), myocardial infarction (1.3% vs 0.73%;
P
=.2), renal failure (0.44% vs 0.29%;
P
=.6), respiratory insufficiency (3.5% vs 3.8%;
P
=.7), and reoperation for bleeding (3.4% vs 3.2%;
P
=.8) were similar in patients who received the second ITA to the LCx or RCA, and remained similar after propensity score adjustment. Late survival was also similar (Fig

.). Despite this, there has been a gradual decline in ITA to RCA grafting, particularly in the presence of severe LCx disease, but more use in women and in patients without RCA occlusion or distal stenoses.

Conclusions:
Contrary to prevailing wisdom that the second ITA graft should be anastomosed to the next most important left-sided coronary artery in 3-system disease, the second ITA graft may be placed to either the LCx or RCA system with similar early and late outcomes.
Abstract 1574: Inhibition Of Extracellular Ca
2+
Influx And Rho Kinase Mediate Hypoxic Dilation Of Human Mammary Artery
Authors: Venkataramana Vijay , Muhammad Arshad , Wolin Michael S , Gupte Sachin A
Published: July 2021

Objective
: Systemic artery dilates in response to decrease in Po
2
, to maintain blood supply to stressed organ. However, the mechanism of hypoxic dilation is still unknown and the effect of hypoxia on human systemic arteries is infrequently studied. Since the internal mammary artery (IMA), a routinely used bypass conduit, is often exposed to low Po
2
that evokes vasospasm and leads to hypo-perfusion of myocardium in peri- and post-operative conditions, we initiated this study to elucidate the mechanism of hypoxic dilation in IMA.

Methods & Results
: The distal IMA was collected during a CABG surgery in a blinded-fashion and 2–3 mm rings were used in the isometric tone study. The IMA rings pre-contracted with either KCl (30 mM; n=7), a depolarizing agent, or phenylephrine (PE: 10 μM; n=7), a α-adrenergic agonist, relaxed to 34 ± 12% and 10±7%, respectively, of the steady-state pre-hypoxic contraction, in a time-dependent manner by decreasing Po
2
from 140 to 30 torr. The initiation of hypoxic dilation was mediated by opening of K
+
channels, because IMA pre-contracted with PE relaxed (P=0.027) to 74±12% of the steady-state pre-hypoxic contraction @ 3 minutes by hypoxia and tetraethylammonium acetate (TEA; 10 mM), a K
+
channel blocker, suppressed (P=0.059) relaxation (97.4±1.6% @ 3 minutes). More interestingly pretreatment of IMA with Y-27362 (10 μM), a Rho kinase inhibitor, shifted Ca
2+
sensitivity to the right, since [Ca
2+
]
o
required to induce 50% contraction of IMA by KCl (30 mM) was shifted from 0.3±0.1 mM (control) to 1.1±0.1 mM (Y-27362), and decreased (P=0.043) hypoxic dilation (Y-27362+KCl: 74±14%; n=5
versus
KCl: 34±12%; n=7; @ 3 minutes). Hypoxia also shifted Ca
2+
sensitivity and suppressed (P<0.005) steady-state contraction (Normoxia: 4.3±0.1g
versus
Hypoxia: 1.2±0.6g) evoked by 1.5 mM [Ca
2+
]
o
.

Conclusion
: Our results, therefore, demonstrate that inhibition of extracellular Ca
2+
influx and Rho kinase plays a major role in hypoxic dilation of human artery and we propose that response of IMA conduits to hypoxia could be compromised in hypertension and diabetes in which the Ca
2+
handling and Rho kinase is modulated, leading to hypo-perfusion of myocardium in hypertensive/diabetic patients undergoing CABG surgery.

(Supported by AHA Grant #0435070N)
Abstract 1589: Pulmonary Hypertension Is Associated With Regional Right Ventricular Systolic Dysfunction And Dyssynchrony: Strain and Strain Rate Assessment Using Velocity Vector Imaging Technique.
Authors: Meng Hong , Villarraga Hector R , Lee PuWai , Aijaz Shah A , Kittipovanonth Maytinee , Seward James B , Chandrasekaran Krishnaswamy
Published: July 2021

Background: Strain and strain rate has been shown to identify subtle contraction abnormalities of left ventricle.

Objectives: We hypothesized that S and SR derived from velocity vector imaging (VVI) will allow early identification of global and regional RV systolic function in patients with pulmonary hypertension (PHT) compared to conventional echo parameters.

Methods: 96 patients, 35 normal RV Systolic Pressure (RVSP < 30 mmHg) and 61 with PHT, {24 mild-moderate (RVSP > 60 mmHg) and 37 severe (RVSP < 60 mmHg)} underwent echo-Doppler assessment of RV. Apical 4 chamber images at end expiration were used for RV lateral wall (LW) and ventricular septal (VS) segment analysis for systolic tangential velocity (Ta V), S and SR. In addition RV end systolic and diastolic area, RV fractional area change (RV FAC), RV performance index (RIMP) and tricuspid annulus systolic excursion were measured.

Results: Peak S, systolic SR and Ta V at the basal, mid and apical segments of the RV LW and VS were depressed in patients with PHT compared with controls, Table 1

, P 0.001. Similarly, significant decrease in RIMP was seen in patients with PHT compared to controls, p <0.001. Significant correlation (p<0.001, r >0.6) was noted between the 2D FAC and S, SR. The time to peak systolic S indexed to end diastolic area (EDA) is significantly prolonged, p<0.01 in all segments in patients with PHT indicating dyssynchrony.

Conclusion: S and SR allows assesment of Regional RV systolic function otherwise difficult to assess from conventional echo-Doppler technique. PHTN is associated with not only regional RV systolic dysfunction but also with dyssynchrony. Thus, this new tool can offer new insights in the functioning of right ventricular global and regional function.

mean±SD of strain
Abstract 1602: Strain-derived and Tissue velocity-derived Dyssynchrony Indexes for Prediction of Reverse Remodeling with Cardiac Resynchronization Therapy
Authors: Miyazaki Chinami , Redfield Margaret M , Espinosa Raul E , Bruce Charles J , Hayes David L , Miller Fletcher A , Oh Jae K
Published: July 2021

Background
: Dyssynchrony indexes derived from time to peak systolic velocity and time to peak strain have been reported to predict left ventricular reverse remodeling (RR) after cardiac resynchronization therapy (CRT). The predictive characteristics of these indices have not been validated in a variety of clinical settings. Our objective was to determine the predictive value of strain and tissue velocity derived dyssynchrony indices for RR or clinical response to CRT in a prospective single-center CRT registry.

Methods
: Prospective registry of all heart failure patients (pts) undergoing CRT with echo before and 3 and 6 months after CRT. Color -coded tissue Doppler imaging in 12 segments was used to calculate the standard deviation of time to peak strain (Tϵ-SD) and time to peak systolic velocity (Tv-SD). RR was defined as a decrease in end systolic volume (ESV; biplane Simpson’s method) ≥15%. Indices were assessed with receiver-operating characteristics (ROC) analysis and the area under the curve (AUC) calculated in all pts and excluding those with atrial fibrillation at implant.

Results
: To date, of the first 87 patients, 4 died (classified as non-responder); 83 pts had 3 and 59 pts had 6 month echocardiography follow-up. Tϵ-SD (93%) and Tv-SD (98%) were feasible in most pts. RR occurred in 42 pts (51%) at 3 month and 32 patients (54%) at 6 month follow-up. See table

. Tϵ-SD was superior to Tv-SD for prediction of RR in all pts and in those without atrial fibrillation. Findings were similar regardless of ischemic (68% of patients) or non-ischemic etiology. Neither baseline Tϵ-SD nor Tv-SD correlated with the improvement in clinical response measured by the change in six minute walk distance or peak VO
2
at 3 or 6 month after CRT (data not shown).

Conclusions
: In this single center experience, mechanical dyssynchrony measured by strain imaging but not tissue velocity imaging was predictive of RR. Neither index predicted clinical response.
Abstract 1608: Posterior Shift of the Anterior Papillary Muscle is a Determinant of Improvement after Cardiac Resynchronization Therapy
Authors: Hara Tetsuya , Yamashiro Kohei , Okajima Katsunori , Kajiya Teishi
Published: July 2021

Background
: Cardiac resynchronization therapy (CRT) can improve heart failure symptoms and decrease mitral regurgitation (MR). Improved coordinated timing of mechanical activation of papillary muscle was reported to be a contributor to reduction of MR after CRT.

Purpose
: We tested the hypothesis that the anatomical location of anterior papillary muscle (A-PM) affects improvement of MR and other parameters after CRT.

Methods
: Twenty-three patients (age 69.8 ± 8.2 years, left ventricular ejection fraction (LVEF) 29.4 ± 6.9%, 16 male, 20 non-ischemic dilated cardiomyopathy, 3 previous myocardial infarcion) underwent both CRT and multi-detector computed tomography (MDCT) were studied. We measured the angle between the anterior edge of the left ventricular free wall and A-PM (Ang. PM) in cross sectional images of left ventricle obtained by MDCT. Patients were divided into 2 groups; 13 patients with severe A-PM displacement (Ang.PM >100 degree) and 10 patients with Ang.PM <100 degree. In both groups, parameters obtained by echocardiography, NYHA functional class, and brain natriuretic peptide before and 6 months after CRT were analyzed.

Results
: Mean Ang.PM was 106 ± 12.2 degree. LVEF and NYHA functional class were significantly improved after 6 months of CRT in both groups (p < 0.05, respectively). However, significant decreases of the proportion of grade 2– 4 MR, left ventricular end-systolic and end-diastolic dimensions, and brain natriuretic peptide level after 6 months of CRT were observed only in patients with severe A-PM dislocation (p = 0.02, p = 0.04, p = 0.03 respectively).

Conclusion
: Posterior shift of A-PM may have a potential to predict improvement after CRT.
Abstract 1609: Infarct size and Transmurality as Predict Response to Cardiac Resynchronization Therapy in Patients with Ischemic Cardiomyopathy
Authors: Foley Paul W , Chalil Shajil , Khadjooi Kayvan , Smith Russell E , Frenneaux Michael P , Leyva Francisco
Published: July 2021

Aim:
To determine whether myocardial scarring, quantified using late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR), predicts response to cardiac resynchronisation therapy (CRT).

Methods and results:
45 patients with ischemic cardiomyopathy [age 67.1 ± 10.4 yrs (mean ± SD)] underwent assessment of 6-min walking distance (6MWD) and quality of life (QoL) before and after CRT. Scar size (% left ventricular mass), location and transmurality were assessed prior to CRT using LGE-CMR. Responders (survival for 1 year with no heart failure hospitalizations, and improvement by ≥1 NYHA classes or ≥25% 6-MWD) had a higher LVEF (p=0.048), smaller (<33%) scars (p=0.009) and fewer scars with ≥51% transmurality (p=0.002). Scar size correlated negatively with change in 6MWD (r=−0.54, p<0.001) and positively with changes in QoL scores (r=0.35, p=0.028). Responder rates in patients with <33 % scar were higher than in those with ≥33% scar (82% vs 35%, p<0.01). Responder rates in patients with scar transmurality <51% were higher than in those with ≥51% (89% vs 46%, p<0.01). Amongst patients with posterolateral scars, a transmurality ≥51% was associated with a particularly poor response rate (23%), compared to scars with <51% transmurality (88%, p<0.001). In multivariate analyses, both scar size (p=0.022) and transmurality (p=0.004) emerged as predictors of response. In patients with posterolateral scars, pacing outside the scar was associated with a better responder rate than pacing over the scar (86% vs 33%, p=0.004).

Conclusions:
In patients with ischemic cardiomyopathy, a scar size ≥33%, a transmurality ≥51% and pacing over a posterolateral scar are associated with a suboptimal response to CRT.
Abstract 1614: Sequential Analysis of Immunosuppressive Therapy in Autoreactive Myocarditis - Sequential Analysis from ESETCID
Authors: Maisch Bernhard , Pankuweit Sabine , Koelsch Susanne , Hufnagel Guenther , Funck Reinhard , Grimm Wolfram , Sattler Alexander
Published: July 2021

In the European Study on Epidemiology and Treatment of Cardiac Inflammatory Disease (ESETCID) pts with autoreactive (virus-negative) myocarditis (AM) and an ejection fraction <45% were randomised for 6 months of treatment with azathioprin (2mg/kg BW/day for 1 m and 0.85mg/kg BW/day for 5 m) + prednisolone (1.25mg/kg BW/ for 1 m and 0.3mg/kg BW/day for 5 m) or placebo on top of their heart failure treatment and followed-up for up to 8 years.

Patients: 3149 pts with dilated cardiomyopathy were screened, 103 pts (mean age 47± 9 years, 81 male, 22 female) with AM and an EF 14 infiltrating cells/mm
2
), persistence of viral or bacterial genomes for Parvo B19, coxsackie-, influenza-, adeno-, cytomegalo-, HHV 6, EBV, chlamydia and borrelia were excluded from the analysis. 56 pts (45 m) with AM were treated with verum, 47 pts ( 38m) with placebo. MACE are defined as cardiac death, heart transplantation, ICD implantation or hospitalisation for cardiac decompensation. Time to MACE is given in days to the event.

Results: Inflammation was eradicated in 63% in the treatment group, but it also vanished spontaneously in 40% in the placebo arm(p<0,05). After 12 months the Kaplan Mayer MACE curves began to diverge. At 4 years freedom from MACE was 50% in the verum and 40% in the placebo group. Respective data at 8 years were 40% and 20% freedom from MACE. NYHA-association class and Minnesota Heart Failure Score improved in treatment and placebo arms to a similar extend. Ejection fraction by echo and radioventriculography improved in both arms with a trend for immunosuppression(IS). Independent from IS pts with no inflammation in the follow-up biopsy (n=45) showed a better NYHA-class (p<0,05), ejection fraction and superior long term freedom from MACE than those with persistent inflammation..

Conclusion: Immunosuppression is superior to conventional heart failure treatment in the acute eradication of the inflammatory infiltrate iDCM patients and bears better long-term prognosis.

Results
Abstract 1632: Coronary Calcification Relates to Bone Metabolism and CD4+ T-Cell Activation
Authors: Soejima Hirofumi , Fukunaga Takashi , Oe Yoko , Fukushima Ryuichiro , Ogawa Hisao
Published: July 2021

Background: Osteopontin (OPN) facilitates bone resorption by enhancing the binding of osteoclast to hydroxyapatite. OPN is expressed in both the intima and the medial layers when arterial calcification is present. OPN is the most abundant molecule secreted by activated T-cells. We previously demonstrated that CD4+ T-cells play an important role in acute coronary syndrome and coronary artery disease (CAD). Osteoprotegerin (OPG) is associated with the progression of vascular calcification in diabetic patients or in patients on long term hemodialysis. Either an intravenous injection of recombinant OPG protein or the transgenic overexpression of OPG has been shown to reverse osteoporosis and prevent vascular calcification. Collagen Type I constitutes the most substantive proportion of the matrix protein of bone. Analysis of a Collagen Type I breakdown product, a Cross-linked N-terminal Telopeptide of Type I Collagen (NTX), has been used to estimate rates of bone degradation. We therefore investigated whether these markers (OPN, OPG, NTX) reflected coronary calcification as detected by multislice computed tomography (MSCT) in patients with CAD and assessed the association these markers with CD4+ T-cell activation.

Methods and Results: We measured serum OPN, OPG, and NTX levels of 76 consecutive patients who received MSCT. The frequency of OPN producing CD4+ T-cells was determined with flow cytometry. Coronary calcification was present in 41 of the 76 patients. Serum OPN, OPG, and NTX levels were all significantly higher in patients with coronary calcification than in those without. Multiple logistic regression analysis revealed that age >70 years, hypertension and serum OPN level >630 ng/ml were determinants of coronary calcification independent of other coronary risk factors. The frequency of osteopontin producing CD4+ T-cells was higher in patients with coronary calcification and it was negatively correlated with serum OPG levels.

Conclusions: The presence of coronary calcification is reflected better by an osteoporosis facilitating factor (OPN) than by an osteoporosis inhibiting factor (OPG) or by a marker of the bone degradation rate (NTX). Assessment of bone metabolism could be useful for clinical determinations of coronary heart disease.
Abstract 1656: Prognosis After Ventricular Fibrillation During First Myocardial Infarction
Authors: De Jong Jonas S , Marsman Roos F , Henriques José P , Wilde Arthur A , Dekker Lukas R
Published: July 2021

Introduction
: Based on data from the thrombolysis era high mortality rates are ascribed to survivors of primary ventricular fibrillation, i.e. VF within the first 48 hours of acute myocardial infarction (AMI). However, current guidelines do not advice ICD implantation if left ventricular function recovers well. We present new data from a large dataset of primary VF survivors treated with percutaneous coronary intervention (PCI).

Methods
: Multi-center case-control study with prospective follow-up. Consecutive patients with a first AMI and VF prior to PCI (cases,
n
=372) were compared with patients with a first AMI without VF (controls,
n
=305). Primary endpoint is survival > 30 days.

Results
: Median follow up duration was 3.34 years for cases and 3.69 years for controls (
p
= 0.015). VF occurred at a mean of 65 minutes after onset of chest pain and occurred out of hospital in 42.3%, in the ambulance in 23.4% and after hospital admission in 32.7% of cases. Median time to PCI was 160 mins in cases vs 180 mins in controls. All cause mortality > 30 days was 5.9% for cases and 8.2% for controls. Cox regression analysis showed that survival was not influenced by VF. During follow-up 25 cases received an ICD against 3 in controls. Even if all ICD wearers were presumed dead, VF did not reach significance as a predictor for survival. Significant predictors for improved survival were: younger age (
p
=0.013) and time to PCI (
p
=0.027).

Conclusion
: VF during AMI does not predict survival in those who survive the first month. These VF survivors have an excellent prognosis with or without an ICD. This study underlines that primary VF by itself does not constitute an indication for ICD implantation.
Abstract 1657: Prophylactic Implantation Of Cardioverter Defibrillators In Patients With Severe Cardiac Amyloidosis
Authors: Kristen Arnt V , Dengler Thomas J , Hegenbart Ute , Schonland Stefan O , Sack Falk-Udo , Voss Frederick , Becker Rüdiger , Katus Hugo A , Bauer Alexander
Published: July 2021

Objectives:
Benefit of prophylactic implantation of a cardioverter defibrillator (ICD) in patients with cardiac light-chain amyloidosis (CA) was assessed.

Background:
CA carries a high risk for sudden cardiac death (SCD).

Methods:
Implantation of ICD was performed in 19 patients with histologically proven CA because of a high risk for SCD. These 19 patients were compared to historical controls of CA without ICD. Survival was defined as absence of death or heart transplantation. Definition of high risk for SCD was based on heart failure (NYHA ≥II), a history of unexplained syncope, interventricular septal thickness ≥15mm (IVS), left ventricular ejection fraction ≤45% (LVEF), ventricular premature contractions Lown ≥IVa, serum level of troponin T ≥0.03 μg/l (TnT) and/or a N-terminal-proBNP level ≥3500 ng/l.

Results:
Patients had NYHA class ≥II (n=17; 89%), syncopes (n=9; 47%), IVS ≥15mm (n=17; 89%), LVEF ≤45% (n=5; 26%), Lown ≥IVa (n=15; 79%), TnT >0.03 μg/l (n=9; 47%), and NT-proBNP ≥3500 ng/l (n=12; 63%). There were no severe perioperative complications. During a median follow-up of 380 days 2 patients with sustained ventricular tachyarrhythmias were successfully treated by the ICD. There were 9 deaths from electromechanical dissociation (n=5), heart transplantation (n=2) or non-cardiac causes (n=2). Survival of ICD patients did not differ from matched controls. Non-survivors had higher NT-proBNP plasma levels (7576±1571 ng/l) than survivors (4036±737 ng/l, p<0.05).

Conclusions:
ICD implantation in high-risk patients with CA is feasible, but while selected patients may benefit from an ICD, routine prophylactic implantation is not recommended. More specific predictors of SCD need to be identified.
Abstract 1664: Impact of Ischemic Burden and Revascularization on Outcomes among Patients Receiving Drug Therapy Versus an Implantable Cardioverter Defibrillator in MUSTT: Evidence for Ischemia Induced Proarrhythmia
Authors: Crandall Mark A , Bunch Thomas J , Munger Thomas M , Hafley Gail , Lee Kerry L , Buxton Alfred E , Packer Douglas L
Published: July 2021

Background.
ICD implantation for primary prevention of sudden death in patients with ischemic cardiomyopathy and left ventricular dysfunction is well established. However debate exists between the relationship between ischemia and the proarrhythmic state. Persistent ischemia may counter antiarrhythmic (AA) drug and/or device efficacy. Furthermore, the extent to which revascularization mitigates this influence of ischemia on efficacy is unknown.

Methods
. 704 patients enrolled in the MUSTT trial were studied. Ischemia was determined by the presence of angina within 6 weeks of enrollment and ≥ 2 reversible thallium defects. Revascularization was characterized as CABG or PTCA within 1 year of enrollment or the use of thrombolytics with the sentinal myocardial infarction (MI). We compared groups who were randomized to background medical treatment (BG Rx) verses those who were randomized to AA drug therapy in addition to EP testing (EP AARx).

Results
. 507 (81%) patients had ≤2 vessel CAD, whereas the remaining 19% had 3 vessel disease. 268 patients reported angina within 6 weeks of study enrollment. Thallium imaging revealed 0–1 defects in 458 (65%) and ≥2 in another 246 (35%). Those with ≥ 2 defects on Thallium and angina within 6 weeks of device implant had a significantly lower 5-year freedom from mortality in the EP AARx and BG Rx cohorts (Table

). Patients with EP AARx had an 8% lower mortality than those with BG Rx therapy alone if they received thrombolytics. However, if they did not receive thrombolytics, their mortality rate was 5% higher than the BG Rx group.

Conclusion
. Outcomes are worse in patients on antiarrhythmic therapy with ischemic factors compared to those on background therapy alone, particularly in the setting of recent angina. A proarrhythmic effect from antiarrhythmic drug therapy in patients with ischemia may underlie the higher mortality. ICD therapy mitigates the negative long-term effect of ischemia on mortality in those treated with AA therapy.

Five Year Freedom from Mortality
Abstract 1667: Early Childhood Mental Development After Transfusion-free Cardiac Surgery On Cardiopulmonary Bypass: A Multi-institutional Study
Authors: Ukai Tomohiko , Adachi Takenori , Numaguchi Atsusi , Fukumi Daichi , Yasuda Toshiaki , Hasegawa Hiroki , Yokote Jyun , Kado Miwako , Nagashima Masami , Maeda Masanobu
Published: July 2021

Background:
The use of blood products is often necessary to prime the extracorporeal circuits for pediatric cardiac surgical patients. The use of blood products carries serious risks both in the acute and long-term aspects of patient care. However, excessive hemodilution during cardiopulmonary bypass (CPB) is associated with decreased oxygen carrying capacity, edema, and organ dysfunction. Especially, whether brain dysfunction after transfusion-free cardiac surgery on CPB occurred is unknown.

Objective:
This study aims to investigate whether excessive hemodilution affects child’s mental development.

Methods:
We studied 143 infants (24.2 +/− 15.8 months, 5 months ~ 3 years of age) had performed surgical closure of ventricular septal defect (VSD) in less than 12 months (4.8 +/− 2.6 months) of age in 7 children’s hospitals. Questionnaires mailed to the parents included the Tsumori-Inage Infant Developmental Scale estimating subjects’ behavioral developmental level as Developmental Quotients (DQ). The infants were divided into 3 groups; transfusion-free (Group A, n=52), transfusion during CPB (Group B, n=24) and transfusion after CPB (Group C, n=66).

Results:
Lower DQ was found for Group A (94.7 +/− 11.6) than Group B (103.5 +/− 16.0, p=0.008) and Group C (101.7 +/− 17.9, p=0.016). No correlation was found between DQ and minimum hemoglobin level during CPB (min-Hb) in Group A. The DQ was likely to be lower in the infants with below 6 g/dl (93.0 +/− 13.0) than with over 6 g/dl (98.7 +/− 8.3. p=0.10) of min-Hb.

Conclusions:
The results suggest that the infants after transfusion-free surgery of VSD on CPB delay in the mental development in their early childhood. Maintaining minimum hemoglobin level over 6 g/dl during CPB seems to prevent the mental development from delay.
Abstract 1672: Glomerular Insufficiency, An Early Marker Of Renal Dysfunction In Patients With A Fontan Circulation.
Authors: Koh Hui Beng , Stedman Brian , Rogerson Mary , Veldtman Gruschen
Published: July 2021

Introduction
: Fontan circulations have high central venous pressures and low dynamic cardiac output, risk factors for depressed renal perfusion.

Objectives
: Hypothesizing subclinical renal dysfunction, we sought to characterize renal pathophysiology and cardio-renal interaction in this group.

Method:
17 Fontan patients were tested for early morning urine cystatin C, alpha-1-microglobulin (A
1
M), retinol binding protein (RBP), protein:creatinine and albumin:creatinine ratio; serum cystatin C (S.Cys-C) and creatinine; echocardiography including Tissue Doppler (TDI); and renal Doppler.

Results
: 6 (mean age 22.8 ± 5.0years) of 17 patients (mean age 23.5 ± 4.2years) had subclinical renal dysfunction, mean S.Cys-C-derived glomerular filtration rate (GFR
S.Cys-C
) 77.31 ± 7.82ml/min/1.73m
2
, vs. 114.21 ± 36.38ml/min/1.73m
2
in the remainder. Whilst GFR
S.Cys-C
correlated highly with 2-D visual assessment of systemic ventricular function (correlation=0.618; p=0.014) this was not the case for any TDI parameters. Tubular function indices (urine cystatin C, RBP and A
1
M) were normal. Glomerular function indices were abnormal for S.Cys-C, with mean 1.04 ± 0.06mg/L, range 0.97–1.11mg/L; (normal range:0.53–0.95mg/L). Gross morphological renal abnormalities included 3 abnormal bipolar sizes in both right (mean 9.13 ± 0.49cm) and left (mean 9.38 ± 0.66cm) kidneys (normal range>10cm), 6 and 5 abnormal renal cortical thicknesses in right (mean 11.61 ± 1.27mm) and left (mean 12.31 ± 0.92mm) kidneys respectively (normal range>13mm) and 1 mild scarring of the right kidney. Abnormal resistive indices were present in the right kidney of 3 patients (mean 0.79 ± 0.01, range 0.78–0.80), and in the left kidney of 2 patients (mean 0.83 ± 0.02, range 0.81–0.84). Patients with abnormal resistive indices (>0.77) had lower arterial saturations (mean 88.67 ± 2.08%, range 87–91% vs. mean 94.77 ± 2.46%, range 90–97% in those without) and higher haematocrit (mean 0.49 ± 0.01L/L, range 0.48–0.49L/L vs. mean 0.46 ± 0.03L/L, range 0.42–0.52L/L in those without).

Conclusion
: Fontan patients often have subclinical renal dysfunction mainly due to glomerular insufficiency. Ventricular function, cyanosis and polycythemia appear to be important drivers for renal dysfunction.
Abstract 1707: Analysis Of Extracellular Matrix Remodeling On Endomyocardial Biopsies From Patients With Inflammatory Cardiomyopathy
Authors: Lettau Olga , Rutschow Susanne , Jaeger Sebastian , Kuehl Uwe , Puhl Kerstin , Noutsias Michael , Schultheiss Heinz P , Pauschinger Matthias
Published: July 2021

Introduction: The biopsy based analyse, with histological, immunohistological and molecular biological analysis of myocardial tissues, represents the only possible tool to investigate the basement of inflammatory cardiomyopathy. Since development of this disease assume involvement of extracellular matrix remodelling, the analyze of this process were aimed in this article.

Methods and results: Endomyocardial biopsies from patient with inflammatory cardiomyopathy (n=170) were analysed by RT-PCR, Furthermore, histological, immunohistological and biochemical methods (ELISA) were used to estimate the matrix proteins amount in myocardial tissues (n=36). All results were obtained by comparison of patient groups regarding to left ventricular ejection fraction (LVEF), EF>60 versus EF<30. EF<30 group featured significaly increased inflammation cells per surface area: CD3 (p<0.001), CD11a (p<0.02), CD45 (p<0.02), Mac1 (p<0.02) and HLA (p<0.01). The gene expression revealed an increased transcripts number of IL-2 (p<0.01), IL-5 (p<0.01), IL-6 (p<0.02), INF beta (p<0.039), Collagen type I (p<0.001), III (p<0.0014) and IV (p<0.0004) as well Laminin (p<0.001). On the protein level ICTP (p<0.04), MMP9 (p<0.04) and TIMP I (p<0.01) were significaly increased in this group in comparison with EF>60 group. The escalating number of active CD3 cells correlated positively with BNP (ρ=0.624, p<0.0091), adhesion cell number ICAM (ρ=0.682, p<0.01) and VCAM (ρ=0.475, p<0.01) and with uPA (ρ =0.265, p<0.013), as well as with increased quantity of collagen type III per section area (ρ=0.632, p<0.01). The expanded abundance of type I collagen products was clearly dependent of the expression of collagen I gene (ρ=0.575, p<0.002) and uPA (ρ=0.544, p<0.004). Precise correlation between the amount of MMP 9 protein and downward EV values (ρ=− 0.4133, p<0.0073) was also observed in the patient group with EF<30.

Conclusion: Myocardial inflammation lead to an imbalance in the MMP/TIMP system with development of myocardial fibrosis with significant correlation to LV-dysfunction. Extracellular matrix remodeling with an imbalance in the MMP/TIMP system plays an important role in the development of left ventricular dysfunction in inflammatory heart disease
Abstract 1715: Necrotic Core and its Ratio to Dense Calcium are Predictors of High-risk Non-ST-Elevation Acute Coronary Syndromes: Results from the Prospective, Multi-center, Global VH-IVUS Registry
Authors: Missel Eduardo , Mintz Gary S , Carlier Stephane G , Qian Jie , Shan Shoujie , Castellanos Celia , Kaple Ryan K , Dangas George , Mehran Roxana , Moses Jeffrey W , Stone Gregg W , Leon Martin B
Published: July 2021

Background:
Increased CK-MB levels and ST-segment depression are predictors of a worse prognosis in the setting of acute coronary syndromes (ACS). We hypothesized a relationship between virtual histology intravascular ultrasound (VH-IVUS) findings and these prognostic factors.

Methods and Results:
We performed whole vessel VH-IVUS measurements in a consecutive series of 225 pts presenting with non ST-elevation (NSTE) ACS on admission; the four basic VH-IVUS coronary plaque components - fibrous (FI), fibro-fatty (FF), dense calcium (DC) and necrotic core (NC) - were measured and the NC/DC ratio calculated. Pts age was 62 ± 11 years with 72% males and 23% diabetics. Among VH-IVUS parameters, only the NC/DC ratio had a positive association to CK-MB levels (r=0.21, p=0.03); it was also significantly higher for ST-depression vs. non-ST-depression ACS (1.97±0.37 vs. 1.58±0.31, p=0.02). A NC/DC value ≥2 was the threshold that best separated high-risk NSTE ACS pts from those with neither abnormal CK-MB nor abnormal ECG findings (odds ratio 3.8, p=0.01), and a %NC ≥6 best enhanced the predictive value of the NC/DC ratio (odds ratio 3.1, p=0.04). Pts with both NC/DC value ≥2 and %NC ≥6 had significantly higher LDL-C (132.46±49.80 vs. 100.28±36.46, p=0.001) and more myocardial injury when compared to pts with no predictors (p=0.002, Figure

).

Conclusions:
Using VH-IVUS analysis, we identified parameters that were positively associated to a high-risk ACS presentation. Our results
in-vivo
reinforce previous histopathological findings that both a larger necrotic core content and less quantitative calcium are substrates for plaque vulnerability.
Abstract 1717: Post-Procedural Incomplete Stent Apposition after Implantation of Everolimus-Eluting or Paclitaxel-Eluting Stents: Insights from the Randomized SPIRIT III Trial
Authors: Yamasaki Masao , Ako Junya , Tsujino Ichizo , Sakurai Ryota , Waseda Katsuhisa , Hasegawa Takao , Shimohama Takao , Honda Yasuhiro , Lansky Alexandra J , Sudhir Krishnankutty , Stone Gregg W , Fitzgerald Peter J
Published: July 2021

Background
: We investigated the morphometric changes of post-procedural incomplete stent apposition (ISA) after implantation of Everolimus-eluting cobalt-chromium alloy XIENCE™ V stents (EES) and Paclitaxel-eluting Taxus
™
stents (PES).

Methods
: Data were obtained from the SPIRIT III trial (2:1 randomized, multicenter trial comparing EES to PES in de novo native coronary artery lesions). Serial IVUS imaging was performed post-intervention and at 8 months follow-up. ISA was defined as separation of at least 1 stent strut from the vessel wall with evidence of blood speckle behind the strut. The following parameters were obtained from the IVUS analysis:

ISA area at the maximum ISA (max ISA) site, ISA angle (angle of the ISA arc at the max ISA site), ISA depth (length between the stent strut and the vessel wall at the max ISA site), and ISA length (longitudinal length of the ISA);

vessel, stent, lumen, peri-stent plaque, and neointimal hyperplasia area at the ISA site.

Results
: At baseline, there were 34 ISA sites in 29 EES (18 at the proximal edge, 9 at the distal edge, and 7 within the stent body), and 16 ISA sites in 11 PES (4 at the proximal edge, 5 at the distal edge, and 7 within the stent body). ISA area, angle, depth, and length decreased between post-procedure and follow-up period in both groups (Table

). Vessel and peri-stent plaque area increased in PES, whereas no changes were observed in EES. There was no difference in the incidence of either persistent or resolved ISA between the 2 groups (p=0.32). Neither stent thrombosis nor in-stent restenosis occurred in the patients with post-procedural ISA over a period of 12 months.

Conclusion
: This IVUS analysis suggests different vessel responses at the site of post-procedural ISA between EES and PES, but no clinical consequences. Longer term follow-up with larger cohorts is warranted to further validate the clinical implications of ISA with drug-eluting stents.
Abstract 1733: Complete Ablation of Typical Atrial Flutter in Patients with Corrected Congenital Heart Defects: “Non-Traditional” Access to the Surgically Excluded Cavotricuspid Isthmus
Authors: Yaman Malek M El , Asirvatham Samuel J , Packer Douglas L , Porter Co-burn J
Published: July 2021

Background:
Although multiple macroreentrant atrial flutters are seen in postoperative patients with congenital heart disease, cavotricuspid isthmus (CVTI) dependent flutter remains a fairly common arrhythmia in this group. When a Fontan or atrial switch (Mustard/Senning) type of procedure is performed, a portion of the CVTI is excluded from catheter access obtainable via a systemic venous route. We evaluated different techniques to access this excluded portion and completely ablate CVTI dependent flutter.

Methods/Results:
Between 1990 and 2007, 140 patients with surgically corrected congenital heart disease underwent an ablation procedure at our institution. Their records were reviewed to identify those with prior Fontan or atrial switch procedure who had documented CVTI dependent flutter requiring ablation. Data collected included methods of catheter access, circuits observed or induced, the location and number of ablation lines, immediate and long-term success, and complications.

Results:
Sixteen patients were identified (14, Fontan; 2, Mustard). In 12/16 (75%) patients bidirectional block of CVTI dependent flutter could not be achieved by right atrial (venous approach) ablation alone. In 7 of those, the excluded portion of the CVTI was targeted for ablation. This was accomplished by a retrograde transaortic approach via an interventricular communication then through the right atrioventricular valve (5 patients). Another retrograde transaortic approach was used with the catheter crossing the left atrioventricular valve then an atrial septal communication (one patient). A third approach involved an antegrade transconduit puncture (one patient). In all 7 patients, successful ablation of CVTI dependent flutter with bidirectional block was achieved. Post-procedure, one patient had temporary AV block requiring pacemaker placement. Follow-up was available on 4/7 patients (3 to 22 months, mean 10 months) with no documented recurrence of their CVTI dependent flutter.

Conclusion:
Even when surgical procedures exclude a portion of the CVTI, complete ablation for typical atrial flutter with resulting bidirectional block can be achieved via “non-traditional” approaches targeting the surgically excluded arrhythmogenic tissue.
Abstract 1744: Adenylate-Cyclase VI Transforms Ventricular Cardiomyocytes Into Biological Pacemaker Cells
Authors: Ruhparwar Arjang , Kallenbach Klaus , Klein Gunnar , Makoui Mahyar E , Bara Christoph , Sigg Daniel C , Haverich Axel , Karck Matthias , Niehaus Michael
Published: July 2021

Background-

Genetic therapy of arrhythmic disorders of the heart has been subject of extensive studies. Cyclic AMP (cAMP) is generated in response to β-adrenergic receptor stimulation and also binds to HCN channels, where it regulates spontaneous rhythmic activity in the heart. Aim of this study was to demonstrate whether in-vivo adenoviral gene transfer of Adenylate-Cyclase type VI (AC
VI
) can create biological pacemaker activity in a porcine atrioventricular node (AV-node) block model.

Methods and Results-

Adenovirus encoding either AC VI or β-Galactosidase (lacZ) gene were injected into the lateral wall of the left ventricle of adult pigs via anterolateral thoracotomy at a dose of 10
10
virus particles each. After 12 days, the AV-node was ablated and three-dimensional electrophysiological cardiac mapping was performed using the Ensite™ electro-anatomical system. After rapid ventricular pacing and administration of Isoprenalin all animals of the AC-VI group exhibited an escape rhythm originating from the area of the left ventricular injection site at a rate of 100 ± 7 beats/minute (n = 5), while the escape rhythms in the control group (n = 4) originated from the right ventricle. Western blot analysis of the injection sites revealed a significantly higher expression of AC-VI in the respective group as compared to the control group.

Conclusions-

Our study demonstrates that AC-VI gene transfer may be a novel method to create a biological pacemaker
Abstract 1772: Electrocardiographic Unrecognized Myocardial Infarction Risk Stratification: Quantitated SPECT Infarct Size Predicts Mortality Independent of Clinical and Exercise Test Variables
Authors: Ammar Khawaja , Miller Todd D , Hodge David O , Rodeheffer Richard J , Gibbons Raymond J
Published: July 2021

Background
: Unrecognized myocardial infarction (UMI), as diagnosed by surveillance electrocardiography (ECG), has the same poor prognosis as recognized (RMI), independent of ejection fraction or ischemia. The value of post UMI risk stratification by infarct size is unknown.

Methods
: The study group consisted of 5430 patients who underwent 2 day stress (exercise n = 191, pharmacologic n = 155) and rest Tc-99m sestamibi SPECT studies. UMI was diagnosed if ECG showed Q wave MI in the absence of history of MI. SPECT infarct size was quantitated based on a 60% of peak counts threshold method and was expressed as a percentage of the left ventricle (% LV). The association between infarct size and mortality was adjusted for clinical and exercise test prognostic scoring systems.

Results
: The population consisted of 346 UMI, 628 RMI, and 4456 patients without MI (No MI). Compared to No MI, mortality risk was increased in UMI (RR 1.7, 95% CI 1.6–1.9;
p
< 0.001) and RMI (RR 1.6, 95% CI 1.4–1.9;
p
< 0.001) patients. In the UMI group, infarct size was significantly associated with mortality (
p
< 0.001), which persisted after adjustment for Mayo prognostic score alone (available in all patients) (
p
< 0.001) and for Mayo prognostic score, Framingham risk score, and Duke treadmill score (data available in 137 patients) (
p
< 0.001). For every 10% LV increase in infarct size, mortality risk increased 30% (RR = 1.3, 95% CI 1.2–1.5) (see figure

).

Conclusions:
In patients with UMI, larger quantitated SPECT infarct size predicts increased mortality independent of clinical and exercise test prognostic scoring systems. This finding supports the use of infarct size imaging for risk stratification of UMI patients.
Abstract 1775: Prognostic Value of Exercise and Dobutamine Positron Emission Tomography
Authors: Al Shammeri Owayed , Beanlands Rob , Ruddy Terrence , deKemp Robert , Chow Benjamin
Published: July 2021

Introduction
Positron emission tomography (PET) is commonly performed using vasodilator stress, but exercise and dobutamine stress is available to patients with contraindications to vasodilators. Vasodilator PET appears to have prognostic value, however the prognostic value of PET using stressors which induce myocardial ischemia have not been well evaluated.

Hypothesis
To evaluate the prognostic value of myocardial demand ischemia induced by treadmill exercise and dobutamine PET.

Methods
124 patients (mean age = 61.29 ± 10.73 years; 87 men) had treadmill exercise or dobutamine Rb-82 or N-13 ammonia PET. Images were assessed qualitatively using a 17-segment model and a semi-quantitative visual score (five-point scale) to calculate the summed stress score (SSS). Images were categorized as normal (SSS<4), abnormal (SSS ≥ 4) or inconclusive (SSS< 4 and suboptimal treadmill exercise or dobutamine stress). Follow-up was performed to ascertain outcomes (cardiac death, nonfatal MI and/or late revascularization.

Results
Of the 124 patients, 46 (37.1%) had a normal PET, 15 (12.1%) had an inconclusive study, and 63 (50.1%) had an abnormal PET (mean follow up 2.8 ± 1.4 years). There were no deaths or non-fatal MI but 1 late revascularization (annual event rate = 1.7%) in the group with a normal PET. Abnormal PET MPI group had 15 cardiac events (1 cardiac death, 4 nonfatal MI, and 10 late revascularization) with an annual event rate of 13.0% (p = 0.002).

Conclusions
Though small, this study suggests that myocardial PET perfusion defects resulting from demand ischemia induced by treadmill exercise and dobutamine stress may have prognostic value.
Abstract 1822: Impact on Anxiety of an Education and Counseling Intervention Designed to Decrease Treatment Seeking Delay in Response to Acute Coronary Syndrome (ACS) Symptoms
Authors: Moser Debra K , McKinley Sharon , Riegel Barbara , Doering Lynn V , Meischke Hendrika , Pelter Michele , Dracup Kathleen
Published: July 2021

Background:
Patient delay in seeking treatment for ACS symptoms remains a substantial problem with most people delaying more than 2 hours before they seek treatment. Thus, it is vital to test interventions to improve this behavior, but at the same time it is essential that such interventions not increase anxiety. Given that these interventions seek to decrease patient denial of the seriousness of symptoms, it is possible that they may increase anxiety.

Purpose:
To determine the impact on anxiety of an individual face-to-face education and counseling intervention designed to decrease patient delay in seeking treatment for ACS symptoms.

Methods:
This was a multicenter randomized (intervention vs. usual care) controlled trial of the intervention in which anxiety data were collected (using the Multiple Affect Adjective Checklist) at baseline, 3-months and 12-months after the intervention. A total of 3522 patients with confirmed coronary artery disease (CAD) who were at risk for ACS were enrolled; data from 2597 patients with complete anxiety data at all three time points are included here. There were no differences in patients completing all three time points and those who did not. The intervention consisted of a 45 minute education and counseling session, reinforced by a phone call one month later in which the social, cognitive and emotional responses to ACS symptoms were discussed as were barriers to early treatment seeking. Repeated measures ANCOVA was used to compare anxiety levels across time between the groups controlling for age and gender.

Results:
There were significant differences in anxiety by group (p = 0.014). Anxiety level was stable in patients in the control group, but decreased by 10% at 3 months in the intervention group and remained at this reduced level at 12 months.

Conclusion:
An intervention designed to reduce patient delay in seeking treatment for ACS symptoms did not increase anxiety, but rather was associated with a reduction in anxiety. Interventions in which CAD patients directly confront the possibility of an acute cardiac event do not cause anxiety if they provide patients with appropriate strategies for managing symptoms.
Abstract 1829: Circadian Changes in ST-RR and QT-RR Relationships During Daily Life of Patients with Brugada Syndrome
Authors: Mizumaki Koichi , Fujiki Akira , Nishida Kunihiro , Tsuneda Takayuki , Sakamoto Tamotsu , Iwamoto Jotaro , Inoue Hiroshi
Published: July 2021

In patients with Brugada syndrome, abnormal rate-dependent repolarization dynamics has been proposed as a modulating factor of arrhythmogenesis. In the present study, we assessed the hypothesis that circadian changes in both ST-RR and QT-RR relationship could relate to occurrence of ventricular fibrillation (VF) in daily life of patients with Brugada syndrome.

Methods:
Thirty-five male patients with Brugada syndrome who had the type I ST elevation were categorized into 14 symptomatic (with documented VF or syncope) and 21 asymptomatic groups. Unipolar V
2
and V
5
leads digital Holter ECG was recorded, and ST level in V
2
and QT interval in V
5
were automatically measured. Both ST-RR and QT-RR relationships were evaluated by means of ST-RR and QT-RR linear regression lines according to four 6-hour periods. In all 14 symptomatic patients, the time of spontaneous episodes of VF were investigated from the implantable cardioverter defibrillator stored data.

Results:
In symptomatic patients, ST-RR slope was highest during 18:00–24:00 and was lowest during 0:00 – 6:00; however, these circadian changes were blunted in asymptomatic patients. ST-RR intercept was not different between the 2 groups and didn’t show distinct circadian changes in both groups. The QT-RR slope was always lower, except during 6:00–12:00, in symptomatic patients than in asymptomatic patients. Circadian changes in QT-RR relationship were not evident in both groups. QT-RR intercept was not different between the 2 groups and didn’t show distinct circadian changes in both groups. Nineteen (59%) of total 32 episodes of spontaneous VF of 14 symptomatic patients occurred between 18:00 and 24:00, and 9 episodes (28%), between 0:00 and 6:00. VF seldom occurred during the daytime.

Conclusions:
In symptomatic patients with Brugada syndrome, a combination of augmentation of ST elevation with inhibited prolongation of QT interval during bradycardia could relate to an occurrence of VF in the late evening.

Circadian Changes in ST-RR and QT-RR Slopes