bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13379: The Prognostic Value of Pulse Oximetry Plethysmographic Waveform During CPR
Authors: Xu Jun , Li Chen , Zhu Huadong , Yu Xuezhong
Published: July 2021

Introduction:
A facile, early predictor of the outcome of resuscitation is needed. Pulse oximetry, which noninvasively detects the blood flow of peripheral tissue, has achieved widespread clinical use. We noticed that the better the quality of CPR was, the better the appearance of pulse oximetry plethysmographic waveform (POP) was. Hypothesis: We assessed the hypothesis that the amplitude of POP (Amp) and the area under the curve of POP (AUC) could be utilised as a tool to predict the outcome of resuscitation.

Methods:
617 cardiac arrest patients from 14 hospital in 10 cities were enrolled in the study and retrospectively assigned to two groups: ROSC group and non-ROSC group. Estimation of prognosis of cardiac arrested patients through the analysis of change of POP parameters during CPR.

Results:
POP parameters in chest compressions stage [Amp (111.0 (66.0,210.5) vs 41.0 (23.0,119.8)) PVA, AUC (3243.5±30.8 vs 2334.0 (1827.0,3229.0)) PVPG (Figure 1)] and PETCO2 [(23.1±4.0 vs 13.0(8.0,23.0)) mmHg (Figure 2)] were statistically different between ROSC group and non-ROSC group (P < 0.01). Cut-off values for ROSC in CPR patients were shown in Table 1. Conclusions: In conclusion, POP parameters could help predict the prognosis of the patients during CPR. The prognostic value of POP parameters was non inferiority to PETCO2, and this method was noninvasive, safe, economy.
Abstract 13409: Left Ventricular Remodeling and Function Following Aortic Valve Replacement for Low-Flow, Low-Gradient Aortic Stenosis With Preserved Ejection Fraction-Results From the TOPAS Study
Authors: Dahou Abdellaziz , Clavel Marie-Annick , Dumesnil Jean G , Capoulade Romain , Ribeiro Henrique B , Senechal Mario , O’Connor Kim , Rodés-Cabau Josep , Pibarot Philippe
Published: July 2021

Background:
Aortic valve replacement (AVR) is recommended (IIa) in symptomatic patients with paradoxical low-flow, low-gradient aortic stenosis (PLF-LG AS). This entity is characterized by pronounced LV concentric remodeling with impaired LV filling and reduced LV longitudinal systolic function and stroke volume despite preserved LV ejection fraction (p-EF). However, there is lack of data about the evolution of LV geometry and function following AVR in these patients.

Methods:
We prospectively enrolled thirty-two patients (age=71±12 years; 59% men) with PLF-LG AS (SVi<35 mL/m2, mean gradient<40 mmHg, indexed aortic valve area [AVA] 50%) who underwent AVR within 3 months following inclusion. Stroke volume was measured in the LV outflow tract by pulsed-wave Doppler and indexed for body surface area (SVi). Global left ventricular longitudinal strain (GLS) was measured by 2D speckle tracking.

Results:
Following AVR, mean gradient decreased (15±8 mmHg post vs. 30±7 pre AVR) and AVA increased significantly (1.40±0.31 vs. 0.70±0.12 cm2) (all p<0.0001). AVR was associated with a positive LV remodeling with an increase in LV end-diastolic diameter (46±4 vs. 44±4 vs mm; p=0.0027) and volume (99±21 vs. 89±20 ml, p=0.003) and a decrease in relative wall thickness (0.46±0.06 vs. 0.58±0.11; p=0.0004) and LV mass (175±37 vs. 207±44 g; p=0.002). SVi increased significantly from baseline to 1 year (36±7 vs. 31±3 ml/m2; p=0.0002), whereas LVEF remained unchanged (63±6 vs 63±7; p=NS). SVi increased significantly in the subset of patients with mild to moderate DD at baseline (all p<0.05) but not in those with severe DD (p=NS). GLS also increased significantly from baseline to 1 year (17±4 vs. 14.5±4%; p=0.03). There was a significant correlation between post-AVR increase in GLS and increase in SVi (r=0.52; p=0.02).

Conclusion:
The findings of this study demonstrate that in patients with PLF-LG AS and p-EF, AVR is associated with an increase in LV stroke volume which is mainly due to positive LV remodeling and improvement in LV longitudinal systolic function. Our results provide further support to the ACC/AHA recommendations with regard to indication of AVR in these patients.
Abstract 13435: Deranged Intra-Cardiac Blood Flow Components and Kinetic Energy in Dilated Cardiomyopathy Are an Additional Marker of Disease Severity and Correlate With Established Markers of Prognosis
Authors: Stoll Victoria , Hess Aaron , Levelt Eylem , Eriksson Jonatan , Dyverfeldt Petter , Ebbers Tino , Myerson Saul , Carlhäll Carl-Johan , Neubauer Stefan
Published: July 2021

Introduction:
Heart failure (HF) due to dilated cardiomyopathy (DCM) is a complex syndrome in which numerous cellular, mechanical and flow processes/interactions become deranged. Insights into derangement of left ventricular intra-cardiac flow patterns and kinetic energy (KE) are now afforded by the use of 4D flow CMR. Previous studies have found derangements of intra-ventricular flow components and KE within DCM patients compared to healthy volunteers.

Hypothesis:
We hypothesised that increasing derangement in 4D flow measures would relate to: 1) decreased mechanical cardiac function, as assessed by myocardial strain, 2) increased levels of biochemical remodelling markers and 3) worsening patient symptoms and functional capacity.

Methods:
26 idiopathic DCM patients (69% male, mean age 55±2 yr, LVEF 35±2%) and 10 controls (70% male, mean age 57±4yr, LVEF 68±1.2%) were assessed with 3T CMR.

Results:
The LV volume was divided into 4 functional components; direct flow (DF), delayed ejection flow (DEF), retained inflow (RI) and residual volume (RV). Compared to controls DCM’s had significantly decreased DF (11±1% vs 38±2%) and increased RV (51±2% vs 31±1%) (fig a). The KE at end diastole differed significantly for all flow components between groups (fig b).

Circumferential strain was significantly impaired in DCM’s vs controls (-9.9±0.8% vs -19.7±0.5%, p<0.0001). DF KE correlated positively to the 6 minute walk test (6MWT) and strain, and negatively to the Minnesota HF questionnaire and BNP (fig c).

Conclusions:
DCM patients demonstrated less efficient blood flow patterns and deranged KE profiles. The greater the derangement of flow parameters from normal, the worse the myocardial strain, BNP, 6MWT and patient symptoms. This study suggests that flow parameter derangements are novel biomarkers of disease severity in DCM, correlating with established markers of prognosis such as BNP and 6MWT and may become useful in monitoring novel therapies and predicting prognosis.
Abstract 13454: The Impact of Prior Stroke on the Outcome of Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement
Authors: Didier Romain , Koifman Edward , Kiramijyan Sarkis , Negi Smita , Escarcega Ricardo , Baker Nevin , Jiaxing Gai , Torguson Rebecca , Okubagzi Petros , Ben-Dor Itsik , Satler Lowell , Pichard Augusto , Waksman Ron
Published: July 2021

Introduction:
Prior stroke has been identified as an independent correlate for post-procedure cerebrovascular events (CVE) in aortic stenosis (AS) patients undergoing surgical aortic valve replacement (SAVR). The present study aimed to evaluate the impact of prior cerebrovascular events on outcome in AS patients undergoing TAVR.

Methods:
Patients with severe AS undergoing TAVR between May 2007-March 2015 were included and categorized to patients with and without prior CVE defined as stroke and transit ischemic attack. Baseline, procedural characteristics, in-hospital outcomes, 1-month and 1-year mortality were compared, in accordance with the VARC-2 consensus.

Results:
A cohort of 662 consecutive patients with severe AS undergoing TAVR was included in the analysis. Of these, 120 patients had prior CVE, and 542 without. Balloon expandable valve was used in 70.7% and self-expandable valve in 29.3% of the patients. Trans-femoral access was used in 78% (571), and pre-TAVR balloon aortic valvuloplasty was performed in 87% (574). Patients with prior CVE had a higher mean STS score compared to those without prior CVE (10.1% versus 8.8%, respectively; p=0,006) and demonstrated higher rates of atherosclerotic disease involving the coronary, peripheral and carotid arteries. In-hospital minor stroke occurred more often in patients with prior CVE vs. those without CVE (3.3% vs. 0.7%; p=0.04). However, similar mortality rates were recorded at 1, 6, and 12 months (figure 1), and there were no significant differences in major stroke, bleeding, or post-procedure hospital stay between both groups.

Conclusions:
Prior history of CVE infers a higher risk for in-hospital minor stroke, yet no impact on other outcomes post TAVR. Patients with and without a history of prior CVE with severe aortic stenosis will similarly benefit from TAVR. Therefore, a history of CVE should not be considered an exclusion criterion.
Abstract 13476: Association of HLA-DRB3*01:01 With Heparin-Induced Thrombocytopenia
Authors: Karnes Jason H , Denny Joshua C , Cronin Robert M , Shaffer Christian M , Mosley Jonathan D , Mallal Simon A , Phillips Elizabeth J , Roden Dan M
Published: July 2021

Introduction:
Variation in the human leukocyte antigen (HLA) region is now used clinically to prevent immune-mediated adverse drug reactions. Heparin-induced thrombocytopenia (HIT) is an unpredictable, life-threatening, immune-mediated reaction to heparin treatment. Previous studies have implicated
HLA-DR
variants in HIT, but HLA alleles which predispose patients to HIT have not been identified.

Hypothesis:
Our hypothesis is that sequenced HLA alleles are associated with HIT.

Methods:
We identified HIT cases and heparin-exposed controls in an electronic medical record coupled to a DNA biobank. Cases were defined based on HIT antibody results, HIT risk scoring (4Ts score), and serotonin release assay results. Controls were matched to cases based on age, gender, and type of heparin exposure (unfractionated versus low molecular weight heparin). We performed high resolution, four-digit HLA sequencing for
HLA-A, HLA-B, HLA-C, HLA-DR, HLA-DP,
and
HLA-DQ
using long-read 454 FLX sequencing. We tested association of sequenced HLA alleles using conditional univariate logistic regression in a dominant model. Analysis was restricted to individuals with European ancestry and HLA alleles with a frequency greater than 0.01 (n=101). P values were corrected using a Bonferroni correction for 101 sequenced HLA alleles (alpha=4.95x10
-4
).

Results:
We identified 77 HIT cases and 345 matched controls. No statistical differences were observed between cases and controls for baseline characteristics. The
HLA-DRB3*01:01
allele was significantly associated with HIT (odds ratio 3.55, p=1.09x10
-4
). No other alleles showed a significant association with HIT.

Conclusions:
We implicate the
HLA-DRB3*01:01
allele as a risk factor for HIT. This allele represents a biologically plausible candidate for HIT, considering the previous literature implicating
HLA-DR
variation in HIT, the central role of
HLA-DR
in T cell-dependent antibody production, and the importance of T cells in HIT pathogenesis. Validation of
HLA-DRB3*01:01
as a predictor of HIT pathogenesis would lead to preventive genotyping to reduce the risk of HIT.
Abstract 13551: Invasive Hemodynamic Assessment of Cardiac Output State After MitraClip Therapy
Authors: Bednar Frantisek , Kocka Viktor , Budesinsky Tomas , Linkova Hana , Tousek Petr
Published: July 2021

Introduction:
MitraClip therapy has become a therapeutic alternative for high surgical risk patients with symptomatic mitral regurgitation (MR). There are limited data about early and no data about later hemodynamic consequences after MR correction and about the impact of elimination of regurgitant flow on cardiac output state .

Methods:
We studied invasive hemodynamic parameters before operation (conscious non-sedated patients, T1), immediately after MitraClip implantation (still under general anaesthesia, T2) and on day 1 (late) after procedure (conscious, extubated patients, T3) using right heart cathetrization.

Results:
Of 25 MitraClip patients (72% male; mean age 70y) with functional MR, in 20 were performed invasive measurements in all time points. MitraClip implantation resulted in an increase in cardiac index (CI) from 1.8±0.5 (T1) to 2.4±0.5(T2) and to 3.2±0.5 L/min/m2 (T3), in a decrease in systemic vascular resistance index (SVRI) from 3759±847 (T1) to 2508±551 (T2) and to 1679±360 dyn.s.cm-5/m2 (T3), in a decreese in pulmonary capillary wedge pressure (PCWP) from 17±5 (T1) to 13±5(T2) and to 10±4mmHg(T3), in a decrease in pulmonary vascular resistance index (PVRI) from 598±362 (T1) to 532±260 (T2) and to 363±184 dyn.s.cm-5/m2 (T3), (all p<0.05).

Conclusion:
MR reduction after successful MitraClip implantation significantly increases CI immediately (27%) and late (75%) and leads to concomitant decrease in SVRI, PVRI and PCWP immediately (33%, 11% and 25%) and late (55%, 39% and 41%) after procedure. No patients showed worsening of cardiac output state immediately (T2) and late (T3) after MR correction.
Abstract 13578: 12-Lead Electrocardiograms Can Be Reconstructed Using the 3 Electrodes of a Subcutaneous Implantable Cardioverter Defibrillator
Authors: Cronbach Peter L , Wilson David G , Greenhut Saul E , Stegemann Berthold , Panfilo Daniele , Morgan John M
Published: July 2021

Background:
Data from reduced lead ECG configurations can be transformed to reconstruct a 12-lead ECG. The sensing electrodes of a subcutaneous ICD (S-ICD) could provide a suitable basis for such a system. Reconstruction of a 12-lead ECG from conventional S-ICD vectors has not previously been demonstrated.

Hypothesis:
A 12-lead ECG signal can be accurately derived from S-ICD electrode vectors.

Methods:
Participants with ICDs (N=61) underwent 3 minute ECGs with electrodes in the standard S-ICD and 12-lead positions. Participants were randomised to either a training (N=31) or validation (N=30) group. Two participants and one further lead were subsequently excluded from the validation group due to technical faults.

The transformation was a linear combination of the 2 independent S-ICD vectors to each of the 8 independent leads of the 12-lead ECG, with coefficients selected that minimized the root mean square error (RMSE) between recorded and derived ECGs when applied to the training group. The transformation was then applied to the validation group and agreement between the recorded and derived lead pairs was measured by Pearson correlation coefficient (r) and normalised RMSE (NRMSE).

Results:
In total, 335 lead pairs were compared (figure1). Distribution of r and NRMSE were skewed. Mean r = 0.731 (SE 0.021), Median r = 0.903 (SE 0.015). NRMSE Mean = 0.227 (SE 0.011) Median = 0.167 (SE 0.008). 252/335 (75.2%) of all pairs had an r > 0.7 (indicating very strong positive correlation).

Figure 1:
Example 12-lead ECG, recorded (blue line) and derived (red line). Participant randomly selected from top 20% by mean Pearson correlation coefficient.

Conclusions:
We have demonstrated reconstruction of a 12-lead ECG from S-ICD vectors. The agreement between derived and measured signals was generally excellent and comparable with other widely accepted reduced lead systems. If perfected, the ability to generate 12-lead data from an S-ICD could help clinicians to localise and treat arrhythmias.
Abstract 13606: Platelet Activation is Less Enhanced in the New Balloon Expandable Edwards Sapien 3 Valve Compared to Its Predecessor Model (Edwards Sapien XT)
Authors: Fateh-Moghadam Suzanne , Voesch Sabrina , Geisler Tobias , Gawaz Meinrad , Bocksch Wolfgang
Published: July 2021

Aim of the study:
Stroke and thromboembolic events after transfemoral aortic valve replacement (TAVR) continue to be a problem. The aim of our study was to compare platelet aggregation (Agg) and platelet activation (PA) observed with two different catheter valves, the ESV-XT and the newer ESV-3 valve in patients (pts) undergoing TAVR on dual antiplatelet therapy (DAPT).

Methods and results:
174 pts with severe aortic stenosis and high surgical risk underwent successfully TAVR (60 ESV-XT; 114 ESV-3). Platelet Agg and PA (CD62P expression) were evaluated before and for the following 3 days after TAVR under DAPT. Platelet Agg was inhibited to the same extent in both valve types and there was no significant difference in platelet drop between both valve types between day 0 and day 3 [ESV-XT versus ESV-3: median (25th-75th percentile): platelet count (x 1000 ): 55 (42-74) versus 61(42-93), p=0.280].

However there was an enhanced CD62P expression directly after TAVR with the ESV-XT compared to the ESV-3 [CD62P (MIF): 7.4 (6.8-8.6) versus 6.6 (6-7.9), p=0.014 ]. Surface expression of platelet CD62P was associated with the occurrence of residual aortic regurgitation (AR) and was significantly higher in pts with residual AR [ CD62P (Mild AR) versus CD 62 P (no or trace AR): 7.9 (7.3-9.1) versus 7.1 (6.4 -8.0), p < 0.001)].

Conclusion:
Although platelet inhibition was similar in both valve types, platelet activation was significantly enhanced in pts with the ESV-XT compared to the ESV-3 valve and was associated to the amount of residual AR which was significantly reduced by ESV-3, which may have implications for thromboischemic events following TAVR procedure.
Abstract 13654: Gemcabene Monotherapy and in Combination With Atorvastatin Lowers High Sensitivity C-Reactive Protein (hsCRP) in a Phase 2 Clinical Trial
Authors: Stein Evan A , Bakker-Arkenma Rebecca , McShane Margaret M , Sooch Mina P , Bisgaier Charles L
Published: July 2021

Background:
It is well established that inflammation plays a key role the progression of atherosclerosis and that serum high sensitivity c-reactive protein (hsCRP), may be a good marker of the degree of underlying vascular inflammation. Thus hsCRP has been recognized as a predictor of cardiovascular risk and lipid lowering drugs, such as statins, which also result in a reduction of hsCRP may be more likely to reduce cardiovascular events. Gemcabene is an inhibitor of hepatic cholesterol, triglyceride, and apoC-III synthesis resulting in decreased assembly of VLDL and enhances the systemic clearance of VLDL and its subsequently production of remodeled lipoproteins including LDL.

Study Design and Results:
In an 8-week double blind randomized, placebo-controlled, dose-ranging, efficacy and safety Phase 2 study, gemcabene 300, 600 and 900 mg/day administered as monotherapy or in combination with atorvastatin 10, 20 and 80 mg/day resulted in a significant and dose dependent reduction of LDL-C (Study 4141001). A secondary objective of this study was to evaluate the modulation of hsCRP by gemcabene. Of 277 patients randomized, 250 (90%) completed the study. Baseline mean LDL-C was 174.7mg/dL, and median hsCRP = 2.5 mg/L. The median % reduction in hsCRP with Gemcabene 300, 600 and 900 mg monotherapy was 25.8%, 41.5% and 35.3% respectively compared with 9.4% for placebo. The rank-transformed data showed significant difference favoring gemcabene over placebo in the 600 and 900 mg groups (p=0.0070 and p =0.0018, respectively). Co-administration of 300, 600, and 900 mg gemcabene with atorvastatin aggregated over the dose range showed decreases in hsCRP beyond atorvastatin monotherapy (which ranged from 27-41%) by an additional 16% (p=0.0237), 23% (p=0.0017) and 28% (p=0.0001), respectively.

Conclusions:
Gemcabene significantly lowered hsCRP alone and on top of statins in hypercholesterolemic patients.
Abstract 13688: Patients With Autoimmune Disease: Not a Contraindication for Heart Transplantation
Authors: Yabuno Jamie , Patel Jignesh , Kittleson Michelle , Luu Minh , Liou Frank , Siddiqui Saira , Chang David H , Czer Lawrence , Hamilton Michele , Kobashigawa Jon A
Published: July 2021

Introduction:
Autoimmune diseases such as lupus, scleroderma, sarcoidosis, and psoriasis are associated with an increased immune response through autoantibody formation.There has been concern that this up-regulation of the immune system may increase the risk of rejection after heart transplantation. Therefore, we evaluated our patients with autoimmune diseases who subsequently underwent heart transplantation at our institution.

Methods:
Between 2009 and 2013 we assessed 26 patients who had a concomitant history of autoimmune disease prior to heart transplantation. Autoimmune diseases included psoriasis (5), Grave’s disease (5), sarcoidosis (5), CREST syndrome (2), Hashimoto thyroiditis (1), dermatomyositis (1), ulcerative colitis (1), systemic lupus erythematosus (1), multiple sclerosis (1), antiphospholipid syndrome (1), polymyalgia rheumatic (1), celiac disease (1), and ANCA vasculitis (1). These patients were compared to a control group of patients who did not have pre-transplant autoimmune disease (n=363).

Results:
Patients with pre-transplant autoimmune disease did not have any significant difference in 1- year survival, 1-year actuarial freedom from any treated rejection, 1-year actuarial freedom from treated cellular rejection, 1- year actuarial freedom from treated antibody- mediated rejection, and 1-year actuarial freedom from biopsy negative rejection (see table).

Conclusions:
Pre-transplant autoimmune diseases do not appear to affect post-transplant outcomes. Therefore, preexisting autoimmune disease is not a contraindication to proceed with heart transplant.
Abstract 13689: Right Ventricular Edema and Pericardial Effusion in Pulmonary Hypertension: Role of Lymphatics
Authors: Colvin Kelley L , Lohani Ozus , Yeager Michael E
Published: July 2021

Introduction:
Pulmonary hypertension (PH), regardless of etiology, is characterized by right ventricular remodeling and eventual failure. Pericardial effusion in the setting of PH is a serious and important clinical problem that portends a grim prognosis. Unfortunately, there are few mechanistic data available to explain its pathogenesis.

Hypothesis:
We hypothesized that the RV lymphatic vasculature and function would be decreased in PH associated with pericardial effusion.

Methods:
We examined human RV tissue from patients with PH and from rat models of PH with and without pericardial effusion and RV failure. We evaluated the extent of lymphatic vasculature, the presence of myocardial edema, and degree of pericardial effusion using invasive (immunoblot, immunohistology, RV wet/dry ratios) and non-invasive techniques (MRI, echocardiography, intravital imaging). To investigate whether neo-lymphangiogenesis affected RV function in PH, we treated rats with exogenous recombinant vascular endothelial growth factor C (VEGFC) before and during the development of PH.

Results:
We found decreased prox1+/podoplanin+ lymphatic vessels in RVs, but not left ventricles, from PH compared to either controls or to individuals with PH that lacked RV failure. The extent of lymphatic vasculature inversely correlated with the presence of myocardial edema, pericardial effusion, and positively correlated with cardiac output. In addition, the presence of increased interstitial fluid preceded development of RV fibrosis and was associated with increased numbers of tcf21+ RV fibroblasts. We found that administration of VEGFC induced a neo-lymphangiogenic response in RVs of rats, reduced myocardial edema, and promoted significant improvement in RV function.

Conclusions:
Decreased lymphatic vasculature and function likely contribute to myocardial edema and pericardial effusion in severe PH with RV failure. Augmentation of RV neo-lymphangiogenesis in rat models of PH greatly attenuated the edema, effusion, and fibrosis compared to vehicle controls. Collectively, these data raise the possibility that therapies to promote RV lymphangiogenesis and function may have important therapeutic benefit by reducing the high mortality of pericardial effusion in PH.
Abstract 13707: Psychometric Testing of the Self-Care of Chronic Angina Index (SCCAI)
Authors: Dickson Victoria , Lee Christopher , Yehle Karen , Faulkner Ken , Mola Ana , Riegel Barbara
Published: July 2021

Coronary heart disease (CHD) requires a significant amount of self-care conceptualized as a process of treatment adherence (self-care maintenance) and symptom response (self-care management).Yet, there are no instruments that measure self-care in this population. Purpose: To test the psychometric properties of the Self-Care of Chronic Angina Index (SCCAI).

Methods:
A sample of 392 adults with CHD (e.g., history of MI, angina) completed the SCCAI and the General Adherence Scale (GAS). Multidimensional factor analysis was used to identify item structure. Factor determinacy scores (FDS) were computed for multidimensional scales. Cronbach’s alpha and FDS were computed for unidimensional scales. Validity was tested using correlations to test associations between observed domains of self-care and adherence (GAS).

Results:
62% of the sample was male; mean age 61.4±9.6 years; mean duration of CHD 7±10 years. A multidimensional self-care maintenance factor entailed “consultative behaviors” (keep appointments, take aspirin and medicines as prescribed, check blood pressure, use medication reminder system, and avoid smoking/smokers) and “autonomous behaviors” (exercise, ask for low sodium foods, eat fruits/vegetables, and try to lose weight) (FDS = 0.83). A multidimensional self-care management factor entailed “immediate recognition and response” (recognize symptoms, reduce activity and take nitroglycerine) and “delayed response” (call doctor, take aspirin and evaluate treatment effectiveness) (FDS = 0.74). A unidimensional confidence factor captured patients’ self-efficacy in following treatment advice, and recognizing, evaluating and treating symptoms (α=0.84, FDS = 0.91). Consultative (r=0.89) and autonomous (r=0.82) behaviors, immediate recognition and response (r=0.86), delayed response behaviors (0.79) and confidence (r=0.27) were associated with adherence (all p<0.001).

Conclusion:
The findings support the conceptual basis of self-care in patients with CHD as a process of maintenance, i.e. consultative and autonomous behaviors, and management, with symptom awareness and response. The SCCAI confidence scale as a measure of self-efficacy can be used to identify behaviors to target in future interventions.
Abstract 13721: The Monitoring of rSO2 Value During CPR is Useful for High-Quality CPR
Authors: Ogawa Yoshihito , Shiozaki Tadahiko , Hirose Tomoya , Ohnishi Mitsuo , Tajima Goro , Nishimura Tetsuro , Kishi Masashi , Ogura Hiroshi , Shimazu Takeshi
Published: July 2021

[Background]
Recently, the patients with out-of-hospital cardiac arrest are increasing. It is very important to do chest compression continuously for the return of spontaneous circulation (ROSC). But we can not but stop chest compression during checking pulse every few minutes. We reported that Regional cerebral Oxygen Saturation (rSO2) value was not elevated by manual chest compression and mechanical chest compression increased a little rSO2 value on CPR without ROSC and rSO2 value became a good parameter of ROSC in single center study.

[Purpose]
The purpose of this study is to evaluate clinical utility of rSO2 value during CPR in multicenter study.

[Method]
Retrospectively, we considered the rSO2 value of the out-of -hospital cardiac arrest patients from December 2012 to December 2014 in multicenter. During CPR, rSO2 were recorded continuously from the forehead of the patients by TOS-OR (Japan). CPR for patients with OHCA was performed according to the JRC-guidelines 2010.

[Result]
252 patients with OHCA were included in this study. The rSO2 value on arrival, during CPR and ROSC were 44.4±8.9%, 45.4±9.7%, 58.6±9.2%. In ROSC, with rSO2 cutoff value of 52.7%, the specificity and sensitivity were 80% and 79%, respectively. The negative predict value was 99.2%, respectively. It means little possible to ROSC, if the rSO2 value is less than 52.7%. So, it may be possible to reduce the frequency of checking pulse during CPR.

[Conclusion]
The monitoring of rSO2 value could reduce the frequency of checking pulse during CPR and do chest compression continuously.
Abstract 13748: Predictors of Yellow Neointima After Stent Implantation in the Superficial Femoral Artery
Authors: Tsujimura Takuya , Ishihara Takayuki , Iida Osamu , Okamoto Shin , Nanto Kiyonori , Shiraki Tatsuya , Fujita Masashi , Masuda Masaharu , Kanda Takashi , Sunaga Akihiro , Okuno Shota , Matsuda Yasuhiro , Yanaka Koji , Ohashi Takuya , Uematsu Masaaki
Published: July 2021

Background:
Neoatherosclerosis is known to occur after coronary stenting, but whether it occurs following stenting in the superficial femoral artery (SFA) remains unknown.

Methods:
This study comprised angioscopic evaluations of 149 stents implanted in the 102 SFA lesions from 92 patients from April 2012 to September 2014. Complete neointimal coverage (defined as struts fully embedded and invisible) was found in 87 stents in the 67 native lesions from the 61 patients. We compared characteristics between the cases with (23 stents, 26%) and without yellow neointima (YN) at the site of complete neointimal coverage, and evaluated the predictors of YN.

Results:
Median follow-up duration was significantly longer in the YN(+) than YN(-) group (370 [interquartile range: 282-884] days vs. 350 [95-394] days, P<0.001), while patient characteristics, medication use, rate of drug-eluting stent and bare-metal stent use (48% vs. 50%, P=1.0), and lesion and procedural characteristics were similar between them. Low-density lipoprotein cholesterol (LDL-C) level at intervention was higher in the YN(+) than YN(-) group (109±25 mg/dL vs. 97±25 mg/dL, P=0.049). At angioscopic follow-up, LDL and total cholesterol (TC) levels were higher in the YN(+) than YN(-) group (109±27 mg/dL vs. 97±25 mg/dL, P= 0.046; and 188±33 mg/dL vs. 172±34 mg/dL, P=0.048, respectively).

Conclusions:
YN was associated with the degree of dyslipidemia, suggesting the presence of neoatherosclerosis in the SFA following stenting.
Abstract 13789: Developing Xeno-Free Human Induced Pluripotent Stem Cell-Derived Cardiac Construct for Regeneration Therapy Using a Rat Myocardial Infarction Model
Authors: Shiozaki Motoko , Miyagawa Shigeru , Fukushima Satsuki , Minami Itsunari , Domae Keitaro , Yajima Shin , Ito Emiko , Aiba Kazuhiro , Asada Takashi , Nakatsuji Norio , Sawa Yoshiki
Published: July 2021

Background:
Use of induced pluripotent stem cells (hiPSC) is promising to establish cardiac regenerative medicine in clinical arena; however, safety is concerned by regulatory scientific view, including use of xeno-biological materials for production of the graft. We have explored synthetic small molecules, KY, instead of standard xeno-materials to induce cardiomyogenic differentiation, such as BMP4, Activin A or insulin. We herein studied therapeutic efficacy of hiPSC-derived cardiomyocytes (CMs) generated by xeno-free condition on chronic myocardial infarction (MI) in rat.

Methods:
Lentivirus vector carrying Oct3/4, Sox2 and Klf4 was transfected in human dermal fibroblasts to establish hiPSC cell-line. KY was added to the hiPSCs, which displayed 80±10%-positivity in cardiac-troponin T. Scaffold-free cardiac graft was produced by hiPSC-CMs that were cultured in thermoresponsive dishes, and transplanted over the cardiac surface of athymic nude rats that were subjected to left coronary artery ligation 2 weeks prior to the treatment, or sham operation was performed.

Results:
Echocardiographically, ejection fraction recovered after the treatment in the hiPSC-CM group (48±4% at baseline, 55±4% at 1 week, 55±4% at 2 weeks, and 56±3% at 4 weeks), whereas the sham group showed gradual reduction in ejection fraction (46±5% at baseline, 42±5% at 1 week, 38±4% at 2 weeks, and 34±6% at 4 weeks). Immunohistochemistry showed that cardiac-troponin T and human nuclear antigen double positive-hiPSC-CMs were present in the lateral cardiac surface in the hiPSC-CM hearts. In the hiPSC-CM group, collagen fibers significantly decreased in the infarct-border and remote areas (p<0.01 and p<0.01, respectively). CD31-positve capillary number in the infarct-border area was significantly greater in the hiPSC-CM group (p<0.01) than the sham group.

Conclusion:
Transplantation of scaffold-free human iPSC-CMs grafts produced by xeno-free synthetic small molecules was effective on rat chronic MI heart, warranting further studies to optimize production of iPSC-based artificial cardiac graft for cardiac regeneration therapy.
Abstract 13871: Heart Transplant Recipients Enjoy Higher Health-related Quality of Life than Left Ventricular Assist Device Recipients
Authors: Saito Shunsuke , Toda Koichi , Nakamura Teruya , Miyagawa Shigeru , Yoshikawa Yasushi , Fukushima Satsuki , Yoshioka Daisuke , Kubota Kaori , Ueno Takayoshi , Kuratani Toru , Sawa Yoshiki
Published: July 2021

Introduction:
The aim of this study was to evaluate and compare health-related quality of life (HRQoL) in patients waiting for heart transplantation (HTx) on inotropic support or on left ventricular assist device (LVAD) support and in patients after HTx.

Methods:
A prospective, comparative design was used to characterize changes over time in HRQoL (SF-36) in patients waiting for HTx on inotropic support (Group-Ino: n = 12) or on LVAD support (Group-LVAD: n = 16) and in patients after HTx (Group:HTx: n = 19).

Results:
LVAD or HTx free survivals at 1 and 2 years of Group-Ino, Group-LVAD, and Group-HTx were 44% and 33%, 100% and 82%, and 100% and 100%, respectively. Actuarial survivals at 1 and 5 year of the 3 groups were 100% and 89%, 100% and 100%, and 100% and 100%, respectively. The patients on inotropic support stayed hospitalized all through the waiting time, while 31% of patients on LVAD support went back to work or school, and 63% of patients did so after HTx. The SF-36 psychosocial component scores were unexpectedly high in all the 3 groups: 47.9±10.3 in Group-Ino, 51.4±12.5 in Group-LVAD, and 54.5±7.6 in Group-HTx (norm-based scoring, differences not significant among the 3 groups). On the other hand, the SF-36 physical component score was significantly higher in Group-HTx (45.7±11.7) than in Group-Ino (3.9±11.7, p < 0.01) and in Group-LVAD (25.2±18.9, p < 0.01). The changes of treatment status resulted in significant increase in the SF-36 physical component scores: Ino --> LVAD: 16.7±17.2 points, Ino --> HTx: 46.3±12.5 points, LVAD --> HTx: 19.6±28.2 points.

Conclusion:
Although the survival after LVAD implantation was as good as that after HTx, HRQoL in HTx recipients was significantly higher than that in LVAD recipients.
Abstract 13874: Poor Quality of Warfarin Therapy is Associated With Elevated Risk Of Myocardial Infarction in Patients With Atrial Fibrillation. Results From the FinWAF Registry With 54568 Patients
Authors: Raatikainen Pekka , Niiranen Jussi , Korhonen Pasi , Mehtälä Juha , Khanfir Houssem , Lassila Riitta , Lehto Mika
Published: July 2021

Background:
A bulk of data indicates that atrial fibrillation (AF) has serious adverse prognostic implications among patients with myocardial infarction (MI). However, the impact of the quality of vitamin K antagonist (VKA) therapy on the incidence of MI among patients with AF is largely unknown.

Patients and Methods:
We evaluated the association between the quality of VKA therapy (time in therapeutic range, TTR) and risk of MI in a cohort of 54568 patients using warfarin for AF (FinWAF). In the FinWAF database information from several Finnish nationwide registries are linked through the civil registration number of the patients.

Results:
The number, crude rate and adjusted hazard ratio (HR) of MI among patients with AF and various TTR levels are presented in Table 1. The risk of MI was significantly higher among patients with TTR<50% than in the reference population (TTR=60-70). In contrast, patients with TTR>80 were less likely to have MI during the mean follow-up of 2.4 years (SD 1.7, range 0.0-5.0). Moreover, the risk of MI was clearly higher among those with previous MI (HR 7.0. 95% confidence limits 6.4-7.8).

Conclusions:
Our data demonstrated an indirect relationship between TTR values and incidence of MI in patients with AF. This novel finding emphasize the importance of high-quality warfarin management not only with regards to stroke but also to the risk of MI.
Abstract 13929: Pulmonary Artery Diameter Index Predicts the Complications of Balloon Pulmonary Angioplasty
Authors: Sugimoto Koichi , Nakazato Kazuhiko , Yoshihisa Akiomi , Sakamoto Nobuo , Yamaki Takayoshi , Kunii Hiroyuki , Takeishi Yasuchika
Published: July 2021

Backgrounds:
Balloon pulmonary angioplasty (BPA) has been an attractive strategy as a new treatment for peripheral type chronic thromboembolic pulmonary hypertension (CTEPH). However, BPA occasionally causes fatal complications such as hemorrhagic pulmonary edema, and asymptomatic mild lung injury detected on computed tomography (CT) image is not rare. Pathogenesis of lung injury after BPA has been considered to be a direct vascular injury due to guide wire or balloon, cytokine release at the time of reperfusion, and vulnerability of peripheral pulmonary vascular wall. However, predictive factors of lung injury have not been established.

The pulmonary artery expansion of the central portion is frequently observed in patients with advanced pulmonary hypertension and the pulmonary artery diameter can be measured easily and accurately by CT.

Therefore, we focused on the pulmonary artery diameter and investigated the association between complications after BPA.

Methods:
The subject consisted of 16 CTEPH patients diagnosed by right heart catheterization and pulmonary arteriography who underwent BPA (2 males, 14 females, age 60.5 ± 11 years. Initial hemodynamic indices of study subjects were mean pulmonary artery pressure (mPAP) 48.8±12.8 mmHg, cardiac output (CO) 3.62±1.07 L/min, and pulmonary vascular resistance (PVR) 11.6±8.15 WoodUnits. Patients were divided into two groups: group N (no symptoms or signs of any complications, n=9) and group C (symptoms such as hemoptysis or lung infiltration on CT image without symptoms, n=7). We measured pulmonary artery diameter on CT at the transition from the main trunk to the right pulmonary artery and corrected by body surface area. We defined this as the pulmonary diameter index.

Results:
CO was lower in group C than in group N, but there was no difference in mPAP, PVR, BNP, and the use of pulmonary vasodilators between two groups. Pulmonary artery diameter index in group C was significantly higher than that in group N (21.95 ± 5.89 vs. 14.22 ± 2.41 mm/m
2
, P<0.01). ROC curve indicated 85.7% sensitivity and 88.9% specificity using cut-off value of 18.0 to predict the complications after BPA.

Conclusions:
Our study suggested that pulmonary artery diameter index would be a novel predictor of the complications after BPA.
Abstract 13930: Culprit Lesion in Patients With ST-elevation Myocardial Infarction is Severely Narrowed With Large Plaque Burden: A Combined Intravascular Ultrasound and Optical Coherence Tomography Study
Authors: Higuma Takumi , Soeda Tsunenari , Yamada Masahiro , Yokoyama Hiroaki , Izumiyama Kei , Nishizaki Fumie , Lee Jay , Minami Yoshiyasu , Ong Daniel S. , Lee Hang , Okumura Ken , Jang Ik-Kyung
Published: July 2021

Background:
There have been controversies on the degree of stenosis of the culprit lesion in patients with ST-elevation myocardial infarction (STEMI). In the past it was thought the culprit lesion for STEMI had only mild to moderate stenosis. However, recent studies suggested that in fact the degree of the luminal narrowing might be severe at the culprit site.

Aim:
The aim of the current study was to investigate the severity and the detailed morphologic characteristics of the culprit lesion in patients with STEMI using intravascular ultrasound (IVUS) and optical coherence tomography (OCT).

Methods and Results:
A total of 111 STEMI patients (67.8±11.2 years, 89 male) who underwent percutaneous coronary intervention within 12 hours from symptom onset were included. TIMI flow grade 2 or 3 was achieved in 108 (97%) patients after thrombectomy. Both OCT and IVUS were performed.

Minimum lumen cross-sectional area (MLA) and plaque burden (PB) were 3.14±1.45 mm
2
and 83.0±7.24% by IVUS. Patients were divided into 2 groups on the basis of MLA by IVUS: Group A (MLA <4 mm
2
, n=104) and Group B (MLA >4 mm
2
, n=7). Group A had a higher incidence of PB >70% compared to Group B (99.0% vs 28.6%, p<0.001). OCT revealed that lipid plaque, microchannel and macrophage were more frequent in Group A than in Group B. The incidence of plaque rupture tended to be higher in Group A than in Group B (Figure).

Conclusions:
Among STEMI patients, more than 90% of culprit lesions have a small MLA (<4.0 mm
2
) with large plaque burden. Severely narrowed culprit lesion had more features of vulnerability.
Abstract 13972: Dexmedetomidine Ameliorates Monocrotaline Induced Pulmonary Arterial Hypertension in Rats
Authors: Kajikawa Yusuke , Hosokawa Susumu , Wakabayashi Kenji , Maejima Yasuhiro , Isobe Mitsuaki , Doi Shouzaburoh
Published: July 2021

[Introduction]
Pulmonary arterial hypertension (PAH) is characterized by increased proliferation and apoptosis resistance of pulmonary arterial smooth muscle cells (PASMCs). Dexmedetomidine (DEX) is a selective α2-aderenergic receptor agonist that is used for sedation in clinical practice. It has been reported that DEX inhibits inflammatory responses through cytokines, such as TNF-alpha, IL-6. Furthermore other reports show that G-protein-coupled receptors (GPCRs) are regulated by β-arrestins, which are also involved with inflammation.

[Hypothesis]
DEX ameliorates monocrotaline (MCT)-induced PAH in rats by its anti-inflammatory effect.

[Methods]
We treated 6 weeks-old male Sprague-Dawley rats with a single 60mg/kg intraperitoneal injection of MCT. After 14 days of injection, one group of rats was started to administer dexmedetomidine (dose: 2μg/kg/hour, MCT+DEX group) continuously using osmotic pumps, the other group was not treated with DEX (MCT group). We performed physiological examination and cardiac catheterization to measure right ventricular systolic pressure (RVSP) at day 23.

[Results]
Both RVSP and survival rate of rats in MCT+DEX group markedly improved compared with those in MCT group (RVSP; 38mmHg±11mmHg vs 91mmHg±6mmHg, survival rate; 42% vs 0% at day 30). In histological analysis, DEX reduced the medial hypertrophy of pulmonary arterioles, and decreased phosphorylated-NF-kB p65 (p-p65) positive PASMCs in MCT+DEX group compared with those of MCT group. In addition, DEX suppressed PASMCs proliferation with PCNA staining, and induced apoptosis of PASMCs with TUNEL assay.

Then we examined the involvement of β-arrestins in PAH. It showed that βarrestin1 expressions reduced in MCT group compared with that of MCT+DEX group with western blotting and immunohistochemistry. However β-arrestin2 expressions had no significant difference between the two groups.

[Conclusions]
DEX ameliorates MCT-induced PAH in rats, one of the mechanism of which may be NF-kB inhibition through β-arrestin1. DEX can be a new therapeutic tool for PAH.
Abstract 13974: Association Between Carotid Plaque and Presence, Extent and Severity of Coronary Atherosclerosis and Long-term Clinical Outcome in Asymptomatic Type 2 Diabetic Patients: Evaluation by Coronary CT Angiography
Authors: Kim Jin Jin , Choi Young , Lee Kwan Yong , Lee Young Soo , Park Ha-Wook , Kim Tae-Hoon , Koh Yoon Seok , Park Hun Jun , Kim Pum Joon , Chung Wook Sung , Seung Ki-Bae , Hwang Byung-Hee , Kim Dong-Bin , Jang Sung-Won , Choo Eun Ho , Choi Ik Jun , Lim Sungmin , Ihm Sang-Hyun , Kim Chan Jun , Moon Donggyu , Chang Kiyuk
Published: July 2021

Introduction:
We investigated the association between carotid plaque and the presence, extent and severity coronary atherosclerosis using coronary computed tomography angiography (CCTA) and long-term clinical outcome in asymptomatic type 2 diabetic patients.

Methods:
We consecutively enrolled 788 asymptomatic type 2 diabetic patients without known coronary artery disease (CAD) who underwent CCTA and carotid ultrasound. The presence of carotid plaque was defined as a focal increase in thickness of 1.5 mm or 50% of the surrounding IMT value. We compared the prevalence, extent and severity of coronary atherosclerosis, including coronary artery calcium score (CACS), atheroma burden obstructive score (ABOS), segment involvement score (SIS), and segment stenosis score (SSS) between groups. All-cause mortality during 5 years follow-up was also compared.

Results:
Higher rates of obstructive CAD (p<0.001) and multi-vessel disease (p<0.005) were noted for patients with carotid plaque. Patients with carotid plaque showed greater degree of CACS, ABOS, SIS, and SSS (p<0.001 for all) on CCTA scans, and had a higher risk of all-cause mortality (p=0.025). The presence of carotid plaque was associated with an increased risk of significant coronary stenosis, independent of conventional cardiovascular risk factors (odds ratio 2.102, confidence interval 1.454-3.039, p<0.001).

Conclusions:
The presence of carotid plaque is associated with the increased prevalence, extent and severity of coronary atherosclerosis on CCTA and the risk of all-cause mortality. Moreover, carotid plaque was an independent predictor for significant coronary stenosis in asymptomatic type 2 diabetic patients.
Abstract 13976: Optogenetic Monitoring of Endocardial Calcium Transients
in vivo
Using a Minimally Invasive Fiber Optic Approach
Authors: Menke Laura , van Asten Ivar , Fontes Magda S , van Stuijvenberg Leonie , van Veen Toon A , Vos Marc A , de Boer Teun P
Published: July 2021

Rationale:
In vivo electrophysiology and contraction can be studied very well using minimally invasive methods. Contrarily, myocardial calcium signaling cannot be studied in vivo, although it is a crucial aspect of cardiac remodeling.

Objective:
We aimed to establish a method that can be used to study myocardial calcium signaling in vivo.

Methods and Results:
We employed the optogenetic fluorescent calcium sensor GCaMP3 to record calcium transients from the left ventricular endocardium of closed chest mice (n=8, inducible, cardiomyocyte[[Unsupported Character - Codename ­]]specific GCaMP3 transgenic overexpression). Excitation of the sensor and detection of fluorescence emission was done using a thin plastic optical fiber (250 μm) that was introduced via the carotid artery into the left ventricular cavity. Combining optogenetics with fiber optics, we were able to record endocardial calcium transients with good signal to noise ratio (6.9 ± 0.2) for up to 30 minutes at physiological heart rates, without significant bleaching of fluorescence.

Conclusions:
Our results demonstrate that by employing optogenetics, calcium signaling can be studied in vivo in the presence of physiologically important factors such as hemodynamic load, innervation and interaction with other organs.

We expect that this approach is also suitable for other optogenetic sensors, greatly expanding possibilities for in vivo studies.