bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14705: Utility of Late Gadolinium Enhancement to Predict Response to Cardiac Resynchronization Therapy: A Meta-analysis
Authors: Edmiston Marissa , Vallakati Ajay , Aneja Ashish
Published: July 2021

Introduction:
Late gadolinium enhancement on cardiac magnetic resonance imaging (LGE-CMR) has been shown to predict adverse cardiovascular outcomes, especially ventricular arrhythmic events.

Hypothesis:
A few studies, limited by small sample size, have examined the relationship between myocardial scar and cardiac resynchronization therapy (CRT) response. We performed a meta-analysis to determine whether scar identified on LGE predicts response to CRT in cardiomyopathy.

Methods:
We searched PubMed and Embase for clinical trials reporting CRT response based on scar determined by LGE -CMR. Primary outcome was defined as improvement in NYHA class or echocardiographic parameters (not limited to but including dP/dT, radial strain and reduction of LV end systolic volume). Random effects model was used to pool the data across the studies.

Results:
After screening 1876 articles, we identified 14 clinical trials that met inclusion criteria. A total of 984 patients were included in the analysis. There was no significant heterogeneity across the studies (I
2
=30%, p= 0.13). Presence of scar on LGE-CMR decreased CRT response by 39% (RR: 0.61 (95% CI 0.53 - 0.71; p<0.001). Exclusion sensitivity analysis did not change the effect size. Pooled analysis of studies reporting only ischemic cardiomyopathy revealed that any myocardial scar reduced CRT response by 38% (RR: 0.62 (0.44 - 0.86; p=0.004).

Conclusions:
The presence of any myocardial scar detected by LGE predicts sub-optimal response to CRT in cardiomyopathy. This shows that identification of scar using LGE- CMR can be used as an important risk stratification tool for CRT response.
Abstract 14731: Glyc A, a Novel Marker of Inflammation, Predicts Cardiovascular Events in HIV-Positive Patients: Results of SMART Study
Authors: Duprez Daniel , Neuhaus Jacqueline , Otvos James , Neaton James D , Lundgren Jens D
Published: July 2021

Background:
Cardiovascular disease (CVD) is increasing in HIV-infected patients. Glyc A is a novel nuclear magnetic resonance (NMR) spectroscopy signal in plasma arising from the glycosylation of circulating acute phase proteins. The acute phase proteins have been independently associated with CVD in HIV patients, but the association of Glyc A and CVD has not been studied. We aimed to quantify the risk of CVD associated with Glyc A at baseline in HIV-positive patients enrolled in the Strategies for Management of Anti-Retroviral Therapy (SMART) study.

Methods:
In a nested case-control study, Glyc A was measured using NMR at baseline in 246 HIV positive patients [median age, interquartile range (IQR): 49 (44,56) years, 81 % male], who experienced a CVD event (defined as coronary heart disease (CHD), myocardial infarction, coronary artery disease requiring revascularization, atherosclerotic non-CHD (stroke and peripheral arterial disease), congestive heart failure and CVD or unwitnessed death) over an average of 2.8 years of follow-up and 472 matched controls. Odds ratios (ORs) associated with baseline levels of Glyc A for CVD were estimated using conditional logistic regression unadjusted and after adjustment for BMI, race, HIV-RNA and antiretroviral therapy status, smoking, prior CVD, diabetes, total/high-density lipoprotein cholesterol ratio, use of blood pressure and lipid-lowering drugs, hepatitis co-infection, CD4+ and major baseline ECG abnormalities.

Results:
At baseline median Glyc A (IQR) was 383 (333, 442) μmol/L in patients who developed a CVD event and 368 (322, 419) μmol/L in controls (P < 0.001 for difference). The unadjusted OR for CVD (highest versus lowest quartile) was 2.18 (with 95% confidence interval (CI) 1.38-3.44, P < 0.001). After adjustment for baseline covariates and CVD risk factors, OR was 2.20 (95% CI, 1.29-3.76, P = 0.004).

Conclusion:
Higher levels of Glyc A are associated with increased risk of CVD in HIV patients after considering established CVD risk factors.
Abstract 14785: Oral Administration of Eicosapentaenoic Acid Ameliorates Anti-inflammatory Functions of High-Density Lipoprotein in Dyslipidemic Patients
Authors: Tanaka Nobuaki , Ishida Tatsuro , Nagao Manabu , Mori Takeshige , Monguchi Tomoko , Sasaki Maki , Mori Kenta , Kondo Kensuke , Nakajima Hideto , Honjo Tomoyuki , Toh Ryuji , Hirata Ken-ichi
Published: July 2021

Objective:
Previous studies have reported that inflammation converts high-density lipoprotein (HDL) to dysfunctional form lacking its anti-inflammatory properties. However, little is known about pharmacological therapy to improve HDL function. It has been recently postulated that fatty acid component in HDL-phospholipids modulates HDL functions. We investigated the effect of oral administration of high dose eicosapentaenoic acid (EPA) on HDL functions.

Methods:
Patients with dyslipidemia were treated with 1800 mg/day EPA for 4 weeks, and HDL fractions were isolated by ultracentrifuge before and after the EPA treatment. HDL functions were evaluated by multiple in vitro cell-based assays.

Results:
The EPA treatment did not affect the quantity in the serum lipid profile including serum cholesterol, triglyceride and apolipoprotein levels, but significantly increased EPA concentrations both in the serum and HDL fraction. The EPA/arachidonic acid ratio in the HDL was in proportion to that in the serum, suggesting that EPA was incorporated in HDL particles. The HDL after EPA treatment possessed high activity of paraoxonase-1, an HDL-associated anti-oxidative enzyme, compared to HDL before EPA treatment. In addition, the EPA-rich HDL significantly improved endothelial cell migration, and markedly inhibited cytokine-induced expression of vascular cell adhesion molecule-1 in human umbilical vein endothelial cells, compared to HDL before the EPA treatment. Moreover, the EPA-rich HDL had high capacity of cholesterol efflux capacity from macrophages.

Conclusion:
Administration of high dose EPA improves anti-inflammatory, anti-oxidative, and cholesterol efflux capacity of HDL in dyslipidemic patients. Thus, EPA may transform “dysfunctional HDL” to “functional”, in patients with coronary risk factors.
Abstract 14799: Home Blood Pressure Range and 24-hr Ambulatory Blood Pressure Control: The Japan Morning Surge Home Blood Pressure (J-HOP) Study-ABPM Substudy
Authors: Taki Mizuri , Hoshide Satoshi , Eguchi Kazuo , Yano Yuichiro , Kario Kazuomi
Published: July 2021

Background:
Measures of home and ambulatory blood pressure monitoring (HBPM and ABPM) are crucial to evaluate BP control status in hypertensive patients. HBPM is widely used in clinical practice, but ABPM is used less frequently. Few studies have examined the threshold of home BP, suggesting well controlled BP in 24-hour BP, daytime BP, and nighttime BP .

Methods:
We analyzed data from the Japan Morning Surge Home Blood Pressure (J-HOP) Study, which included 1,439 patients with at least one cardiovascular risk factor (mean age 64.6 years, 47.8% men, 82.3% used antihypertensive medications). Both HBPM (three measures each in the morning and evening over 14 days, using the same semiautomatic HBP device with data memory and 24-hr ABPM were performed in all patients).

Results:
Of 355 patients with home systolic BP (HSBP) <125mmHg, 78.9%, 76.9%, and 81.4% were classified as having well-controlled 24-hr SBP (<130mmHg), daytime SBP (<135mmHg), and nighttime SBP (<120mmHg), respectively). In contrast, of 656 subjects with HSBP ≥135 mmHg, 67.5% were classified as having uncontrolled 24-hr SBP (≥130mm Hg). Of 428 patients with HSBP between 125mmHg and 134mmHg, only 54.9% were classified as having well-controlled 24-hr SBP.

Conclusions:
Among patients with high cardiovascular risk, nearly 80% of those with home systolic BP <125mmHg were well-controlled for 24-hr SBP including nighttime systolic BP, whereas nearly 70% of those with >135mmHg were uncontrolled for 24-hr systolic BP. The patients with HBP at 125-134mmHg require ABPM for the evaluation of their 24-hr BP control status.
Abstract 14803: Use of Real-Time Transesophageal Echocardiography to Improve Safety of Lead Extraction
Authors: Oestreich Brett , Ahlgren Bryan , Tompkins Christine , Varosy Paul , Seres Tamas , Aleong Ryan
Published: July 2021

Background:
Transvenous lead extraction (TLE) carries a small but measurable risk of serious adverse events. Few studies have examined the potential benefit of continuous monitoring with transesophageal echocardiography (TEE) during this procedure.

Objective:
Evaluate the utility of TEE during TLE involving both conventional and laser lead removal.

Methods:
TEE was performed in 100 consecutive patients undergoing TLE. All patients underwent TLE in the operating room with general anesthesia and continuous TEE monitoring.

TLE was attempted for 193 leads in 100 patients. Eighty patients required laser lead extraction (80%). Indications for extraction were device endocarditis (28), lead fracture (28), recalled lead (21), pocket infection (17), and other (6).

Results:
Sixty-seven patients were male and the average age was 56.96 +- 17.01 years. The average length since lead implant was 78±55.19 (1.4-274.43) months. Complete success occurred in 181 leads (94%), partial success in 4 leads (2%), and failure in 8 leads (4%). Major complications included right ventricle laceration (1) and right atrium/superior vena cava laceration (2) which resulted in detection and localization within 1-2 minutes and prompt surgical repair. Premature termination and unnecessary surgery were prevented in 4 patients with hypotension but no intracardiac abnormalities seen on TEE (Figure 1). There was one upper gastrointestinal bleed from the TEE probe (1). In-hospital mortality was 0%.

Conclusion:
In total the clinical management was changed in 7 patients (7%) based on real-time TEE monitoring helping to decrease the TLE related mortality and premature termination of the procedure.

Figure 1

Monitoring with real time TEE prevented premature termination of cases with severe hypotension showing RV obstruction due to invagination of the free wall.

RA: right atrium; RV: right ventricle.
Abstract 14815: Impact of Fluctuations in Glucose Levels on Vascular Endothelial Dysfunction in Non Diabetes Mellitus (DM) Patients with Coronary Artery Disease (CAD)
Authors: Akasaka Tomonori , Hokimoto Seiji , Tabata Noriaki , Sakamoto Kenji , Tsujita Kenichi , Kojima Sunao , Kaikita Koichi , Ogawa Hisao
Published: July 2021

Background:
Fluctuations in glucose levels give rise to inflammation and endothelial dysfunction by increasing oxidative stress. Mean amplitude of glycemic excursions (MAGE) is commonly used as a degree of fluctuations in glucose levels, and plays a significant role in vascular endothelial dysfunction in patient with diabetes mellitus (DM). Vascular endothelial dysfunction is associated with cardiovascular event risk. Thus, we examined the impact of MAGE on vascular endothelial dysfunction and clinical outcomes in non DM patients with CAD.

Methods:
We analyzed 22 non DM patients with CAD following percutaneous coronary intervention (PCI) during 12 months follow up, and assessed the relationship among MAGE, the level of high-sensitivity CRP (hs-CRP), and reactive hyperemia index (RHI) measured from RH-PAT (reactive hyperemia peripheral arterial tonometry). Cardiovascular events were cardiovascular death, myocardial infarction, stroke, unstable angina,and revascularization.

Results:
In clinical characteristics of total patients, age, HbA1c, average of blood glucose for 24 hour, and MAGE were 73ys, 5.93%, 121.5mg/dl, and 55.5mg/dl. MAGE correlated with hs-CRP (r=0.610; P=0.004) and RHI (r=–0.485; P=0.047), but not correlated with HbA1c, LDL cholesterol, HDL cholesterol, triglyceride, and systolic blood pressures. In short, high glycemic excursions (high MAGE) is associated with high inflammation (high hs-CRP) and vascular endothelial dysfunction (low RHI). When patients were classified into MAGE<60mg/dl (normal glycemic excursions) and MAGE>60mg/dl (high glycemic excursions), group of MAGE>60mg/dl were significant higher in hs-CRP (0.251±0.301 vs 0.072±0.067mg/dl, P=0.048) and lower in RHI (0.392±0.193 vs 0.834±0.316, P=0.008) than group of MAGE<60mg/dl. Multivariate analysis for vascular endothelial dysfunction identified MAGE as a predictive factor (OR13.3, 95%RI 1.069-166.4, P=0.044). Moreover, MAGE was an independent predictive factor for cardiovascular events (OR11.0, 95%RI 1.42-85.20, P=0.022)

Conclusions:
Fluctuations in glucose levels are associated with inflammation, endothelial dysfunction, and cardiovascular events risk in non DM patients with CAD.
Abstract 14854: A Prognostic Study of the J wave Patterns on the Resting Electrocardiogram in Ambulatory Patients
Authors: Pargaonkar Vedant S , Perez Marco V , Jindal Akash , Froelicher Victor F
Published: July 2021

Introduction:
The prognostic value of J waves and terminal QRS slurs remains controversial. Population studies have demonstrated differing results, with some suggesting that J waves and slurs are associated with cardiovascular death (CVD).

Hypothesis:
We tested the hypothesis that J waves or terminal QRS slurs on the electrocardiogram (ECG) were associated with cardiovascular death.

Methods:
Resting digitized 12-lead ECGs from 20,661 ambulatory individuals at the VA Palo Alto Health Care System were visually coded using computer display. Using ≥ 0.1 mV as the amplitude criteria, J-waves were measured at the top of the upward deflection and QRS slurs at the top of the conduction delay on the QRS down-stroke in at least two contiguous leads. Multivariate Cox hazard regression analyses were used to study the associations between J waves, terminal QRS slurs, ST segment slope and CVD.

Results:
Of the 20,661 subjects, 90% were male (43 ± 8 years of age) and 10% were female (40 ± 10 years of age); 16% were African-American and 7% were Hispanic. Over a median follow-up of 17 years, there were 859 cardiac deaths. A total of 4219 (20%) ECGs had J waves and/or slurs present in the inferior and/or lateral territories: 3318 (16%) ECGs had J waves and/or slurs only in inferior leads (II, III, aVF), 1701 (8%) only in lateral leads (V4-6, I, aVL) and 1198 (6%) in both inferior and lateral leads. None of the J wave/terminal QRS slur patterns were associated with higher rates of cardiovascular mortality (Figure). The subset of ECGs with J wave/terminal QRS slur patterns that also had downward ST slopes were also not associated with CVD.

Conclusion:
We found no association between higher rates of CVD and any pattern of J waves/terminal QRS slurs, with or without downward ST slope. While previous studies have shown that J waves and terminal QRS slurs are present at higher rates in patients with idiopathic ventricular fibrillation, we did not find them to be predictive of CVD in long-term follow up of a clinical cohort.
Abstract 14877: Native T1-based Cardiovascular Magnetic Resonance for Characterizing Chronic Myocardial Infarctions: Proof-of-Concept Study in Canines
Authors: Kali Avinash , Cokic Ivan , Tang Richard L , Yang Hsin J , Sharif Behzad , Marbán Eduardo , Li Debiao , Berman Daniel S , Dharmakumar Rohan
Published: July 2021

Introduction:
Gadolinium infusion required for Late Gadolinium Enhancement (LGE) Cardiovascular Magnetic Resonance (CMR) imaging is contraindicated in nearly 20% of myocardial infarction (MI) patients due to chronic end-stage kidney disease.

Hypothesis:
Using a canine model of MI, we investigated whether native T1 mapping at 3T could be an alternative to LGE CMR for characterizing chronic MIs (CMIs).

Methods:
Canines (n=29) were subjected to ischemia-reperfusion injury. Native T1 maps, native T2 maps and LGE images were acquired at 7 days (acute, AMI) and 4 months (CMI) post-MI at 1.5T and 3T. Infarct location, size and transmurality, measured using Mean + 5 Standard Deviations criterion, were compared between T1 maps and LGE images. Native T2 maps were used to examine the resolution of edema between AMI and CMI. Following the CMR studies, animals were euthanized and ex-vivo histology was performed.

Results:
T1 maps and LGE images were not different for measuring infarct size (p=0.61) and transmurality (p=0.81) in CMI at 3T. In AMI at 3T, T1 maps overestimated both infarct size (p=0.007) and transmurality (p=0.007) relative to LGE images. At 1.5T, T1 maps underestimated both infarct size and transmurality relative to LGE images in both AMI and CMI (p<0.001 for all cases). Relative to the remote territories, T1 of the infarcted myocardium was elevated in AMI (3T: p<0.001; 1.5T: p<0.001) and CMI (3T: p<0.001; 1.5T: p=0.037). T2 of the infarcted myocardium was elevated in AMI (p<0.001 at both 3T and 1.5T), but not in CMI (3T: p=0.19, 1.5T: p=0.55) indicating that myocardial edema resolved by 4 months post-MI. Masson’s trichrome staining showed extensive replacement fibrosis within CMIs. Sensitivity and specificity of T1 maps to detect CMI were 95% and 97% respectively at 3T, and 58% and 78% respectively at 1.5T.

Conclusions:
Native T1 mapping at 3T can characterize CMIs with high diagnostic accuracy. T1 elongations in CMI appear to arise predominantly from replacement fibrosis.
Abstract 14878: Relationship of Serum Erythropoietin Level to Clinical Outcome in Acute Heart Failure Patients without Anemia
Authors: Homma Takehiro , Nagai Toshiyuki , Sugano Yasuo , Yamane Takafumi , Shibata Tatsuhiro , Nakamura Kenji , Iwakami Naotsugu , Chinen Daigo , Asaumi Yasuhide , Aiba Takeshi , Noguchi Teruo , Kusano Kengo , Ishihara Masaharu , Ogawa Hisao , Yasuda Satoshi , Anzai Toshihisa
Published: July 2021

BACKGROUND:
Elevation of serum erythropoietin (EPO) level is frequently observed in heart failure (HF) patients, and higher serum EPO level has been reported to be associated with worse clinical outcome in chronic HF. However, serum EPO level was highly influenced by the presence of anemia and its prognostic significance in acute HF (AHF) patients without anemia remains unknown.

METHODS:
We examined 320 consecutive AHF patients who admitted to our institution between January 2013 and January 2014 from prospective registry. Patients who had anemia defined as a hemoglobin concentration < 13g/dl (males) and <12 g/dl (females) based on the WHO criteria, acute coronary syndrome and without complete data-set at admission were excluded. Finally, 92 patients were divided into two groups according to higher serum EPO level (above 25.7 mIU/ml, the median) or lower serum EPO level (below 25.7 mIU/ml) at admission. Adverse events were defined as worsening HF and death within 90 days after admission.

RESULTS:
Adverse events were occurred in 10 patients (11 %). Higher EPO group had significantly higher incidence of adverse events compared with lower EPO group (19.6% vs 10.9%, P<0.01, Figure). Patients with higher EPO level had higher serum creatinine and plasma brain natriuretic peptide (BNP) levels on admission than those without. There were no significant differences between the two groups in terms of age, gender, oxygen saturation, NYHA class, cardiovascular medications, left ventricular ejection fraction (LVEF), reticulocyte count on admission. Multivariate logistic regression analyses showed that higher serum EPO level (OR 10.6, 95% CI 1.7-204.9, P<0.01) was an independent determinant for adverse events within 90 days after admission, among variables including age, gender, LVEF, serum creatinine, hemoglobin and plasma BNP levels on admission.

CONCLUSIONS:
Higher serum EPO level might be a predictor for worse short-term clinical outcome in AHF patients without anemia.
Abstract 149: Zoniporide Combined with α-Methylnorepinephrine Promotes Greater Hemodynamic Stability than Either Agent Alone During Chest Compression in Rats
Authors: Lamoureux Lorissa , Whitehouse Herbert K , Radhakrishnan Jeejabai , Gazmuri Raúl J
Published: July 2021

Background:
We have reported in animal models of cardiac arrest that sodium hydrogen exchanger-1 (NHE-1) inhibition - by attenuating reperfusion injury - helps preserve left ventricular distensibility yielding higher forward blood flows during chest compression. Others have reported that α-methylnorepinephrine (α-MNE) - a selective peripheral α2-adrenoreceptor agonist - is superior to epinephrine given its lack of β-agonist effect that intensifies myocardial ischemia. We examined in a rat model of VF the effects of combining the NHE-1 inhibitor zoniporide (ZNP) with α-MNE during CPR, expecting to elicit a vasopressor effect (α-MNE) that is better maintained over time because of ZNP.

Methods:
VF was electrically induced in 32 male retired breeder Sprague-Dawley rats and left untreated for 8 minutes. Chest compression was then initiated, gradually increasing the depth of compression (maximum 17 mm) to attain an aortic diastolic pressure of 28 mmHg by the end of minute 2, maintaining such level for the remaining 6 minutes of chest compression, time at which defibrillation was attempted. The rats were randomized 1:1:1:1 to receive a 3 mg/kg bolus of ZNP or 0.9% NaCl before starting chest compression and a 100 μg/kg bolus of α-MNE or its vehicle at minute 2 of chest compression with the investigators blind to the assignment.

Results:
The ratio between the aortic diastolic pressure and depth of compression (Figure) was higher - as expected - in rats that received α-MNE(+) given its vasopressor effect. The effect, however, was not maintained and declined over time; but to a significantly lesser degree in rats that also received ZNP; i.e., α-MNE(+)/ZNP(+) group.

Conclusions:
The findings support a favorable interaction between α-MNE and ZNP; the first prompting needed peripheral vasoconstriction - likely with less concomitant myocardial injury - and the latter preserving left ventricular distensibility, which combined enhance the hemodynamic efficacy of chest compression.
Abstract 14905: Combined Assessment of Serum Neutrophil Gelatinase-Associated Lipocalin and N-Terminal Pro-B-Type Natriuretic Peptide Levels on Admission Improves the Prediction of Mortality in Patients Hospitalized to Coronary Care Units
Authors: Okuyama Ryunosuke , Ishii Junnichi , Kawai Hideki , Muramatsu Takashi , Naruse Hiroyuki , Motoyama Sadako , Matsui Sigeru , Izawa Hideo , Ozaki Yukio
Published: July 2021

Background:
Neutrophil gelatinase-associated lipocalin (NGAL) is best known clinically as a novel and early marker of acute kidney injury. Renal dysfunction portends significant risk in patients admitted to coronary care units (CCUs). Thus, a sensitive marker of renal injury might also help to risk stratify patients hospitalized to CCUs. We prospectively investigated the prognostic value of a combination of serum NGAL and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels on admission for mortality in patients hospitalized to CCUs.

Methods:
We measured serum NGAL and NT-proBNP levels on admission in 974 consecutive patients hospitalized to CCUs. Among these patients, heart failure was present in 55%, and acute coronary syndrome in 40%.

Results:
Serum NGAL levels significantly correlated with NT-proBNP levels (r = 0.37, p <0.0001) and estimated glomerular filtration rate (r = -0.68, p < 0.0001). During a mean follow-up period of 829 days after admission, there were 178 (18%) all-cause deaths including 145 cardiovascular deaths. Comparably, patients who died were older (median, 78 vs. 72 yrs, p < 0.0001), had higher levels of NGAL (102 vs. 55 ng/ml, p < 0.0001), NT-proBNP (4043 vs. 1250 pg/ml, p < 0.0001), D-dimer (2.6 vs. 1.1 μg/ml, p < 0.0001), and high-sensitive C-reactive protein (6.0 vs.2.0 mg/l, p < 0.0001), and displayed lower values of left ventricular ejection fraction (39 vs. 50 %, p < 0.0001) and estimated glomerular filtration rate (43 vs. 65 ml/min/1.73m
2
, p < 0.0001) than those who did not. In multivariate Cox regression analysis including 11 clinical and biochemical variables, tertiles of NGAL (p = 0.02) and NT-proBNP (p = 0.02) was independently associated with all-cause deaths. The combination of NGAL and NT-proBNP tertiles were associated with increased all-cause mortality rates (
Figure
).

Conclusion:
The combined assessment of NGAL and NT-proBNP levels on admission may be useful for evaluating the risk of mortality in patients admitted to CCUs.
Abstract 14957: Investigation of Myocardial Birefringence using Polarization-Sensitive Optical Coherence Tomography in a Mouse Model of Myocardial Infarction
Authors: Jang Sun-Joo , Park Tae Jin , Oh Wang-Yuhl
Published: July 2021

Introduction:
Although several imaging modalities have been utilized to characterize myocardium, the birefringence of myocardium has not been spotlighted. The polarization-sensitive optical coherence tomography (PS-OCT) is a novel imaging method for the characterization of tissue birefringence.

Hypothesis:
The birefringence of infarcted myocardium would be different from non-infarcted myocardium. We examined the myocardial birefringence in a mouse coronary artery ligation model using PS-OCT.

Methods:
Male C57B/6 mice (20-30g) underwent thoracotomy and the ligation of left anterior descending artery. At post-myocardial infarction (post-MI) 3 hours or on post-MI day 28, the left anterior wall of the mice was imaged with PS-OCT in vivo and ex vivo. The local phase retardation for tissue birefringence, the local principal axis directional uniformity for tissue orientation, and the degree of polarization uniformity were demonstrated and compared with collagen fiber staining (picrosirius red). For PS-OCT system, wavelength-swept laser with 140 nm bandwidth (center wavelength = 1,280 nm) and 120 kHz A-line rate was used.

Results:
The endocardial border could be detected by high birefringence of myocardium. There was no difference in the birefringence between systole and diastole. The infarcted anterior wall showed dyskinesia or hypokinesia. The systolic wall thickening was lower in the infarcted wall compared to the normal anterior wall. At post-MI 3 hours, there was no significant change in myocardial birefringence. On day 28, the infarcted myocardium with scar tissue showed low level of local birefringence with irregular tissue orientation compared to the normal myocardium. The 3D reconstructed images were used to differentiate transmural or subendocardial MI.

Conclusions:
Our study demonstrated that the PS-OCT would be helpful for the evaluation of myocardial function and tissue characterization in myocardial infarction.
Abstract 14976: Impact of the Duration of Dual Antiplatelet Therapy in Patients with Peripheral Arterial Occlusive Disease After Percutaneous Transluminal Angioplasty on Clinical Outcomes
Authors: Cho Sungsoo , Ko Young-Guk , Shin Dong-Ho , Kim Jung-Sun , Kim Byeong-Keuk , Choi Donghoon , Hong Myung-Ki , Jang Yangsoo
Published: July 2021

Introduction:
Limited data from clinical trials investigating dual antiplatelet therapy (DAPT) in patients with peripheral arterial occlusive disease (PAOD), suggested its potential for a reduction in cardiovascular events. However, the optimal duration of DAPT in patients with symptomatic PAOD after percutaneous transluminal angioplasty (PTA) has not been clearly established. The aim of this study was to determine the optimal duration of DAPT in patients with symptomatic PAOD after PTA.

Hypothesis:
Longer duration of DAPT is associated with better clinical outcomes in patients with symptomatic PAOD after PTA.

Methods:
From May 2011 to August 2012, 249 patients with 264 lesions treated with PTA were divided into two groups based on the duration of DAPT [aspirin plus clopidogrel, < 6-month DAPT (n= 120) vs. ≥ 6-month DAPT (n = 129)]. Propensity score-matching analysis was used to adjust for baseline characteristics between two groups.

Results:
The median follow-up duration was 22.0 ± 8.2 months. In Cox proportional hazard analysis, ≥ 6-month DAPT group was found to be associated with lower rates of MACE (myocardial infarction, stroke, death, and target lesion revascularization; hazard ration [HR]: 2.22; 95% confidence interval [CI]: 1.13-4.35, p = 0.021), and rehospitalization (unstable angina, transient ischemic attack, amputation, and other lesions PTA; HR: 2.29; 95% CI: 1.04-5.01, p = 0.039). Nevertheless, there was no significant association between duration of DAPT and bleeding.

Conclusions:
DAPT longer than 6 months was associated with lower rates of MACE and rehospitalization in patients with symptomatic PAOD after PTA.
Abstract 15001: Fusion of Echocardiographic Hemodynamic Data and Computed Tomographic Anatomical Data of the Aortic Valve Determine Severity of Low-Gradient Aortic Stenosis with Preserved Ejection Fraction
Authors: Kamperidis Vasileios , van Rosendael Philippe J , Katsanos Spyridon , van der Kley Frank , Regeer Madelien , Al Amri Ibtihal , Sianos Georgios , Ajmone Marsan Nina , Bax Jeroen J , Delgado Victoria
Published: July 2021

Introduction:
Severe aortic stenosis with preserved left ventricular ejection fraction is classified into 4 groups, according to flow and gradient, with still debatable underlying pathophysiology.

Hypothesis:
The use of multi-detector computed tomography (MDCT) and Doppler echocardiography refines the differential characteristics and true severity of each aortic stenosis group.

Methods:
Patients with severe aortic stenosis [aortic valve area index (AVAi) <0.6cm2/m2] and ejection fraction ≥50% (n=191, age 80±7 years, 48.2% male) with echocardiography and MDCT prior to transcatheter aortic valve replacement were included. Patients were classified into 4 groups based on stroke volume index (≤35 or >35 ml/m2) and mean pressure gradient (≤40 or >40mmHg): 1. Normal-flow, high-gradient, 2. Low-flow, high-gradient, 3. Normal-flow, low-gradient, 4. Low-flow, low-gradient. Aortic valve calcium was evaluated on MDCT. Fusion AVAi was estimated by continuity equation using Doppler hemodynamics and MDCT left ventricular outflow tract (LVOT) area.

Results:
AVAi and LVOT area index were both significantly different among the 4 groups when evaluated by echocardiography. On MDCT, although LVOT area index was comparable among groups, fusion AVAi remained significantly different (Figure): normal-flow, low-gradient had the largest area (0.62±0.11cm2/m2), resulting in reclassification into moderate stenosis in 52% of these patients, while low-flow, low-gradient group had comparable fusion AVAi to normal-flow, high-gradient group. Aortic valve calcium load was largest among patients with high-gradient (median 3412AU for normal-flow and 3181AU for low-flow) and was comparable between patients with low-gradient (2143AU for normal-flow and 2310AU for low-flow).

Conclusion:
MDCT refines the hemodynamic characterization of low gradient AS patients by providing more accurate AVAi estimation and calcium load.
Abstract 15164: Healthy Lifestyle and Heart Rate Variability in the General Population
Authors: Aeschbacher Stefanie , Bossard Matthias , Schoen Tobias , Risch Martin , Risch Lorenz , Conen David
Published: July 2021

Background:
The combined influence of lifestyle factors such as smoking, diet or obesity on heart rate variability (HRV), a measure of autonomic function, is not well studied. We therefore assessed the relationship of a healthy lifestyle score with 24-hour HRV in the general population.

Methods:
A population-based cohort of healthy individuals aged 25-41 years without prevalent cardiovascular disease was investigated. 24-hour electrocardiography (ECG) was performed with a validated device. All ECG studies were systematically post-processed, and the standard deviation of all normal RR Intervals (SDNN) used as a marker of HRV. Body mass index (BMI) was calculated as body weight (kg) divided by height (meters) squared. Unhealthy lifestyle habits were summed to a lifestyle score with a scale from 0=healthy to 6=unhealthy. One point was given for smoking cigarettes in the past, consuming <5 portions of fruits or vegetables per day, vigorous physical activity <180 minutes per week and a BMI of 25-30kg/m2; two points were given to current smokers and individuals with a BMI ≥30kg/m2.

Results:
2140 participants (median age: 37 years, 47% men) were included in this analysis. Mean SDNN values among men and women were 76 and 66ms (p<0.0001), respectively. Main results are shown in the table. Because of a strong sex by lifestyle score interaction (p<0.0001), sex-specific results were evaluated. Most participants had a score between 2 and 3 (Table). In sex-specific multivariable linear regression analysis with SDNN as the outcome variable we found a β (95% confidence interval (CI)) of -4.73 (-5.64; -3.82), p<0.0001 among men and -2.15 (-2.90; -1.40), p<0.0001 among women.

Conclusion:
Healthy lifestyle was strongly associated with greater HRV in this large sample of young adults, particularly among men. Our findings provide one potential explanation how a healthy lifestyle may lead to better cardiovascular outcomes.
Abstract 15174: Higher Plasma Osmolality as an Independent Determinant of In-hospital Worsening Renal Function in Acute Decompensated Heart Failure
Authors: Motokawa Tetsufumi , Nagai Toshiyuki , Sugano Yasuo , Yamane Takafumi , Shibata Tatsuhiro , Nakamura Kenji , Iwakami Naotsugu , Chinen Daigo , Asaumi Yasuhide , Aiba Takeshi , Noguchi Teruo , Ishihara Masaharu , Kusano Kengo , Ogawa Hisao , Yasuda Satoshi , Anzai Toshihisa
Published: July 2021

Backgrounds:
Previous studies showed that worsening renal function (WRF) was associated with poor clinical outcome in acute decompensated heart failure (ADHF) patients. Hyperosmolarity is known to cause direct renal cell injury and decreases in renal blood flow and glomerular filtration rate. In ADHF setting, the plasma osmolality can be changed dramatically. However, the prognostic significance of plasma osmolality for the development of WRF in ADHF patients is unclear.

Methods:
We examined 320 consecutive ADHF patients who admitted to our institution between January 2013 and January 2014 from prospective registry. Patients who had acute coronary syndrome and without complete data-set at admission were excluded. Finally, 303 patients were divided into two groups according to lower plasma osmolality (below 297 mOsm/kg H2O, the cut-off value based on ROC analysis) or higher plasma osmolality (above 297 mOsm/kg H2O) at admission. WRF was defined as ≥ 0.3 mg/dl increase in serum creatinine from baseline to discharge.

Results:
During follow-up period (median 21 days, interquartile range 14-29), WRF was occurred in 58 patients (19.6 %). Patients with higher plasma osmolality had significantly higher incidence of WRF compared with those without (32.3% vs 13.6%, P<0.01). Higher plasma osmolality was associated with more use of diuretics, higher serum creatinine level and lower hemoglobin level. There were no significant differences between the two groups in terms of age, sex, body mass index, NYHA functional class, left ventricular ejection fraction (LVEF), blood pressure, etiology of HF, cardiovascular medications other than diuretics, plasma brain natriuretic peptide (BNP) level on admission. Multivariate logistic regression analyses showed that higher plasma osmolality (OR 2.00, 95% CI 1.00-3.98, P=0.049), as well as lower hemoglobin (OR 1.22, 95% CI 1.04-1.42, P=0.012), was an independent determinant of WRF, although other variables including age, sex, serum creatinine level and use of diuretics on admission were not.

Conclusions:
In patients with ADHF, higher plasma osmolality on admission was an independent predictor of in-hospital WRF, suggesting the measurement of plasma osmolality might be useful for identifying patients at risk for WRF.
Abstract 15252: Segmental Myocardial Perfusion Improves after Repeated Intramyocardial Cell Injection
Authors: Mann Imke , Rodrigo Sander F , van Ramshorst Jan , Beeres Saskia L , Zwaginga Jaap J , Al Younis Imad , Bax Jeroen J , Fibbe Wim E , Schalij Martin , Atsma Douwe E
Published: July 2021

Introduction:
We previously demonstrated that intramyocardial bone marrow mononuclear cell (MNC) injection improves segmental myocardial perfusion. This study was designed to evaluate in patients with recurrent refractory angina the effect of repeated injection on segmental myocardial perfusion.

Methods:
Twenty-one patients with recurrent refractory angina pectoris, who received 100x10^6 autologous MNC intramyocardially using the NOGA-system for a second time, were enrolled. Single-photon emission computed tomography was performed at baseline and 3 months after both injection procedures. The myocardium was divided into 17 segments and in both stress and rest images, segmental tracer activity was categorized on a 4-point scale. (1=>75%; 2=50%-74%; 3=25%-49%; 4=<25%) Segments demonstrating increased perfusion of at least 1 point in stress or rest perfusion were categorized as improved.

Results:
The second injection procedure was 4.6 ± 2.5 years after the first. In total, 139 segments were injected for the first time during either of the procedures, of which 80(58%) segments improved. Repeated injection in the same segment was performed in 45 segments. Of these segments, 18(40%) improved, less than after a first injection (P=0.030). Repeatedly injected segments can be subdivided in 29 previously responding segments (improved after the first injection) and 16 previously non-responding segments (not improved after the first injection). Of the responding segments, 13(45%) segments improved after repeated injection and of the non-responding segments, 5(31%) segments improved. This difference was not significant (P=.476).

Conclusions:
Segmental myocardial perfusion can improve after repeated intramyocardial MNC injection independently of the effect of the first injection, but the first injection is more effective.
Abstract 15272: Wnt11 Delivered in Mesenchymal Stem Cell-Derived Media Promotes Angiogenesis Through Non-canonical Wnt-PKC-JNK Pathway
Authors: Wang Jingcai , Yu Bin , Gong Min , Liu Honghai , Wang Yigang , Millard Ronald W. , Xu Meifeng
Published: July 2021

Background:
Wnt11 is involved in many developmental and cellular processes. We have previously reported that Wnt11 overexpressing (MSC
Wnt11
) significantly improved cardiac function and increased angiogenesis. Here, we aimed to elucidate how Wnt11 delivered by MSC increase blood vessel formation.

Methods and Results:
An acute myocardial infarction (MI) model in SD rats was developed by ligation of the left anterior descending (LAD) coronary artery. Conditioned medium (CdM) collected from MSC
Wnt11
(CdM
Wnt11
) was injected immediately into the ischemic border area. Rats treated with CdM
Wnt11
showed a significantly improved cardiac function. Furthermore, CdM
Wnt11
increased blood vessel density and regional blood flow in ischemic myocardium. Fluorescent immunostaining showed that both vWF-positive single endothelial cell numbers and microvessel numbers were significantly increased in CdM
Wnt11
treated myocardium.
In vitro
studies showed that CdM
Wnt11
significantly increased number and length of capillary-like structure (CLS) formation and promoted human umbilical vein endothelial cells (HUVECs) migration. These results were confirmed by directly treating HUVECs with recombinant Wnt11 proteins (5μg/ml) or over-expressing Wnt11 in HUVECs (H
Wnt11
). However, these effects could be abolished by using a Wnt11 neutralizing antibody. Immunostaining and Western blotting results revealed upregulation of p-pan-PKC and p-JNK in H
Wnt11
. Real-time PCR analysis indicated that the expression of novel PKCs including PKCδ, PKCε, PKCη, and PKCθ was significantly upregulated in H
Wnt11
. Moreover, the effect of Wnt11 on CLT formation and HUVECs migration were abrogated when the JNK inhibitor SP600125 at 5 μM and the PKC inhibitor Calphostin-C at 0.1 μM were added to the culture system.

Conclusion:
Our data suggests, for the first time, that Wnt11 in MSC-derived media improved cardiac function and promoted angiogenesis in ischemic myocardium. The effect of Wnt11 in angiogenesis is mediated by novel PKCs, with JNK as its downstream mediator.
Abstract 15345: Prevalence of Abnormal Preparticipation Screening H&Ps in Collegiate Athletes as Compared to Focused Screening Echocardiography
Authors: Modaff Daniel , Hegde Sheila , Helwig Dennis , Bell Nancy , Rahko Peter
Published: July 2021

Introduction:
For all competitive athletes, the American Heart Association preparticipation screening (AHA PPS) guidelines recommend a 12 element focused history and physical. Evaluation of an abnormal PPS finding is left to the clinician’s discretion. The correlation between an abnormal PPS finding and structural heart disease is not well documented. A murmur on physical exam is classically used as a tool to identify a multitude of structural heart abnormalities. We propose that the current AHA PPS and specifically, a murmur detected on exam, correlate poorly with true echocardiographic abnormalities in the collegiate athlete population.

Methods:
A PPS modeled after the AHA guidelines was conducted on all incoming athletes at a single university from 2007 to 2013. All athletes independently underwent a focused screening echo the same day of the exam. PPS examiners were blinded to results of the screening echoes. Data from both screening exams were compared. We report the prevalence of abnormal H&P findings and its relation to structural abnormalities found on focused echo screening.

Results:
There were 2472 athletes screened. At least one positive PPS element was noted in 655 (26.5%) athletes. Of this group, 24 (3.7%) had an abnormal focused echo. The PPS was normal in 1817 (73.5%) athletes but an abnormal echo was found in 19 of these athletes, indicating 44.2% of all abnormal echoes (N=43) had a negative PPS. Of the athletes with abnormal echo findings, 23 had structural abnormalities classically associated with a murmur. Only four of these athletes had an actual murmur on exam. In total, a murmur was detected in 36 athletes. By echocardiography, 25 (69.4%) had no structural abnormalities, thereby rendering the murmur benign. A murmur consistent with a minor structural abnormality was found in 7 (19.4%) athletes, and a murmur consistent with a significant structural abnormality was found in 4 (11.1%) athletes.

Conclusions:
The AHA PPS and specifically, a murmur on exam, do not reliably detect the presence of structural heart disease. An abnormal PPS is rarely associated with structural heart disease and an immediate focused echo can rapidly determine this and eliminate the need for further cardiac evaluation.
Abstract 15360: Prolonged P Wave Duration is Not Associated With New Onset Atrial Fibrillation During 10-year Follow-up After First-ever Ischemic Stroke in Lund Stroke Register
Authors: Baturova Maria A , Lindgren Arne , Carlson Jonas , Shubik Yuri V , Olsson Bertil , Platonov Pyotr G
Published: July 2021

Introduction:
Prolonged P-wave duration (PWD) is associated with paroxysmal atrial fibrillation (AF), which might be underdiagnosed in ischemic stroke patients, in whom it might be pivotal for initiation of secondary prevention oral anticoagulation therapy. We aimed to assess whether PWD predicts new-onset AF during 10-year follow-up in ischemic stroke patients compared to control subjects enrolled in the Lund Stroke Register (LSR).

Methods:
Study sample comprised of 227 first-ever ischemic stroke patients without AF (mean age 72±12 y, 92 female) and 1:1 age- and gender- matched control subjects without stroke and AF enrolled in LSR from Mar 2001 to Feb 2002. The date of new-onset AF during follow-up was assessed by the date of first AF ECG in the regional ECG database and by record linkage with the Swedish National Patient Register. The available standard snapshot 12-lead sinus rhythm ECGs at baseline were retrieved from electronic database and digitally processed.

Results:
Patients with ischemic stroke compared to controls more often had hypertension (57% vs 31%), diabetes (15% vs 7%) and vascular diseases (42% vs 13%, all p < 0.005). New-onset AF was detected in 39 (17%) stroke patients and in 30 (13%) controls, p=0.296. In the multivariate Cox regression analysis, new onset AF in the stroke group was associated with age>65 years (HR=3.78, 95%CI 1.32-10.85, p=0.013) and hypertension (HR=2.42, 95%CI 1.09-5.40, p=0.030), but not with PWD. On the contrary, PWD>120 ms was the only independent predictor of new onset AF in the control group after adjustment for age and cardiovascular risk factors (HR=3.36, 95%CI 1.41-8.01, p=0.006, Figure 1).

Conclusions:
Prolonged P-wave duration is the strongest predictor of AF incidence during 10-year follow-up in stroke-free population. However, in ischemic stroke patients the developing of AF is more likely associated with more advanced cardiovascular comorbidities than with electrical abnormalities in the heart.
Abstract 15440: Dynamics of Adipocyte and Endothelial Progenitor Cell Pools in Expanding Adipose Tissue
Authors: Holden Candice R , Wysoczynski Marcin , Sansbury Brian , Hellmann Jason , Zafar Nagma , Gibb Andrew , Spite Matthew , Bhatnagar Aruni , Hill Bradford
Published: July 2021

Objective:
Obesity is a major risk factor for the development of several chronic diseases including type 2 diabetes and cardiovascular disease. Proper fat storage in white adipose tissue (WAT) is required to maintain insulin sensitivity and to preserve (cardio)vascular health. We hypothesize that endothelial and adipocyte progenitor cell populations (EPCs and APCs, respectively) must be appropriately balanced for physiological, as opposed to pathological, remodeling of WAT.

Methods and Results:
To determine the impact of nutrient excess on stem/progenitor cells in epididymal WAT, male C57BL/6J mice were placed on a high fat diet (HFD; 60% fat) for 12 weeks and changes in WAT stem cell populations were measured in the stromal vascular fraction by flow cytometry. Although the APC (CD24+/CD29+/Sca+/CD14-/CD45-) population, which has the capacity to differentiate into adipocytes both
in vitro
and
in vivo
, was not significantly changed with diet, Flk+/Sca+ EPCs were diminished, promoting a 4-fold decrease in the EPC/APC ratio (p <0.05, n = 6/group). To determine whether this deficit may be due to poor stem cell recruitment, mice were irradiated, and the bone marrow was repopulated with GFP+ donor marrow. The transplanted mice were then placed on a low fat diet (LFD; 10% fat) or HFD for 12 weeks, and WAT progenitor cells were again measured. Greater than 95% of the putative APCs in the WAT of HF-fed mice were GFP+ (p<0.0001, n=7-8/group), indicating a bone marrow-derived origin. Unexpectedly, less than 1% of the EPCs were GFP+ (p<0.001, n=7-8/group), which suggests that EPCs present in WAT are not derived from bone marrow in adult mice. Confocal analysis of WAT from HF-fed, bone marrow-transplanted mice showed little evidence of significant APC differentiation into triglyceride-laden adipocytes, suggesting that conditions associated with nutrient excess may impair the ability of the adipose organ to store fat properly.

Conclusions:
These results demonstrate that putative APCs, and not EPCs, in epididymal WAT are derived from bone marrow. Furthermore, our data suggest that conditions of nutrient excess promote an imbalance in EPCs and APCs, the stoichiometry of which may be critical for the development of new adipocytes and for proper storage of fat.