bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 2652: Detection of Transient Regional Myocardial Ischaemia in the Emergency Department Using a Novel Modification of Body Surface Electrocardiac Mapping is Superior to the Conventional 12 Lead ECG
Authors: Robinson Monique , Bannister Clare , Reddiar Richard , Curzen Nicholas
Published: July 2021

Diagnosing transient regional myocardial ischaemia (TRMI) in patients presenting to the Emergency Department (ED) with acute chest pain is a challenge. The 12 lead ECG has established limitations and Troponin, though sensitive, is less reliable when used within 12 hours of symptom onset. The PRIME ECG Delta map is derived from 80 electrode electrocardiographic surface maps acquired (a) during chest pain and (b) when pain resolves. ST segment differences between scans are then displayed as colour changes on a torso map. In addition, the Ischaemic Burden (IB) - an index of the total extent of myocardial ischaemia -may be derived from the Delta Map.

Objectives: In a cohort presenting with cardiac-sounding chest pain: 1.To compare the sensitivity and specificity of the PRIME Delta map and the 12 lead ECG for the diagnosis of TRMI using coronary angiography as a diagnostic gold standard. 2. To evaluate whether the IB is a valuable diagnostic tool and examine its relationship with Troponin.

Methods: 80 lead ECGs were acquired for subjects with suspected TRMI when in pain and once pain free and a Delta Map derived. The IB was calculated as the sum of ST segment shift across all 80 electrodes. Subjects then underwent coronary angiography as clinically appropriate.

Results: For 51 adults studied, the PRIME Delta Map was more sensitive for the detection of TRMI than the 12 lead ECG 93% vs. 81%, p 0.04. The Delta map was also more specific for TRMI 57% vs. 29%, p= 0.03.The Delta map was superior to the 12 lead particularly for detecting lateral and posterior regions of TRMI 100 % detection vs. 75%, p= 0.02. The IB correlated with peak Troponin (r= 0.52, p= 0.0001) and was significantly higher in patients with STEMI compared to NSTEMI. ROC curve evaluation of the IB showed it was an accurate measure of myocardial ischaemia with Area Under the Curve of 0.6 (95% CI 0.38 – 0.84)

Conclusion: The PRIME ECG Delta map is a near patient, rapid, accurate and intuitive method for detecting TRMI and is superior to the 12 lead ECG. The IB derived from the Delta map might be a useful early surrogate for Troponin in patients with suspected TRMI. Used together, the Delta Map and IB could potentially facilitate more rapid identification and appropriate treatment in patients with coronary artery disease.
Abstract 2755: Increased Efficacy of Catheter Ablation Of Atrial Fibrillation by Using Adenosine to Reveal Dormant Pulmonary Vein Conduction
Authors: Macle Laurent , Verma Atul , Novak Paul , Khairy Paul , Talajic Mario , Guerra Peter G , Thibault Bernard , Dubuc Marc , Roy Denis , Nattel Stanley
Published: July 2021

Recurrences of atrial fibrillation (AF) after catheter ablation are frequently associated with recovery of conduction between the pulmonary veins (PV) and the atrium. The recovery of PV conduction could be explained by the presence of dormant conduction between the PV and the atrium. Adenosine can be used during AF ablation procedures to reveal transient re-conduction of the isolated pulmonary vein (dormant PV conduction). We prospectively evaluate the utility of iv adenosine to guide elimination of dormant PV conduction by additional radiofrequency (RF) applications during AF ablation procedures. Thirty-four consecutive patients (30 male; age 51+/−8 years) referred for catheter ablation of drug-refractory AF (Paroxysmal 31/Persistent 3) were studied. Electrical PV isolation (PVI) was performed using Irrigated-tip radiofrequency (RF) ablation and was guided by a circular mapping catheter. After PVI, the presence of dormant conduction in each vein was assessed by injection of 12 mg of adenosine. If dormant conduction was present, additional RF energy was delivered at sites of transient re-conduction. Abolition of the dormant conduction was then demonstrated by repeated injections of adenosine. The recurrence rate of arrhythmia after one procedure was evaluated. The results were compared to an historical control group comprising the previous 34 consecutive patients who underwent PVI without the use of adenosine. Electrical PVI was achieved in 100% of PV’s and all 34 patients underwent the adenosine evaluation. Dormant PV conduction was observed in 17/34 patients and could be eliminated in all by additional RF delivery. Procedural and fluoroscopy times were 163±30 and 49±13 minutes, respectively. After a mean follow-up of 8.0±3.1 months, 6/34 (18%) patients experienced AF recurrence with 28/34 (82%) remaining free of arrhythmia without the use of antiarrhythmic drugs. When compared to the 14/34 patients (41%) from the historical control group who had AF recurrence, a significant reduction was observed (P<0.01). The use of adenosine to guide elimination of dormant PV conduction increases the success rate of AF ablation procedures. This needs to be evaluated in a randomized multicenter trial.
Abstract 2771: Abnormal Atrial Electrophysiological Vulnerability and Structural Atrial Remodeling in High-Risk Patients with Brugada Syndrome: Assessment with Electrophysiology and Echocardiography
Authors: Toh Norihisa , Morita Hiroshi , Taniguchi Manabu , Watanabe Nobuhisa , Tanabe Yasuharu , Miura Daiji , Nagase Satoshi , Nakamura Kazufumi , Kusano Kengo F , Ohe Tohru
Published: July 2021

Background:

Atrial fibrillation (AF) often occurs in patients with Brugada syndrome (BS) and BS patients with spontaneous AF often experience ventricular fibrillation (VF) attacks. We have reported that patients with BS had abnormal atrial electrophysiological vulnerability, which provides a substrate for AF, but there are no data regarding the atrial structural attribute. Our objective is to assess the atrial electrophysiological and structural characteristics according to the disease severity and their relations with gene mutations in BS.

Methods:

We studied 41 patients with BS: 9 patients with documented VF and spontaneous AF (Group VF+AF+), 7 patients with VF and without AF (Group VF+AF−), and 25 patients without VF and AF (Group VF−AF−). In electrophysiologic study, intra-atrial conduction time (CT) was defined as the interval from the stimulus at the high right atrium to the atrial deflection at the distal portion of the coronary sinus, and it was measured at constant pacing (CT1) and extrastimuli (CT2). In echocardiographic study, left atrial volume was calculated using the biplane modified Simpson’s method and indexed to body surface area (LA volume index). Mutations of SCN5A gene were examined in all patients.

Results:

CTs, especially CT2, were prolonged in both Group VF+AF+ and Group VF+AF− compared to Group VF−AF− (CT2: Group VF−AF−134.1±15.7 vs. Group VF+AF− 152.8±23.6* vs. Group VF+AF+ 173.5±12.4** ms, *p<0.05, ** p<0.01). Group VF+AF+ had larger LA volume index compared to Group VF−AF−.Group VF+AF− also had large LA volume index although this group did not have spontaneous AF (LA volume index: 22±4 vs. 26±4* vs. 34±8** ml/m
2
, respectively, *p<0.05, ** p<0.01). LA volume index was correlated with CT2 (r=0.58, p<0.01). SCN5A mutation was associated with prolonged CTs (p<0.05) and increased LA volume index (p<0.05), but not with the episode of spontaneous AF and documented VF.

Conclusions:

High-risk patients with BS had both abnormal atrial vulnerability and remodeling even if patients did not have AF. Existence of SCN5A also induced both electrophysiological and anatomical remodeling of the atrium. To identify atrial electrophysiological and structural characteristics may be useful for the risk stratification in patients with BS.
Abstract 2799: Noninvasive Quantification of the Atherosclerotic Aorta Component with Flat-Panel Computed Tomography in Rabbits
Authors: Aboshady Ibrahim , Cody Dianna D , Elayda MacArthur A , Vela Deborah , DuPont Herbert L , Willerson James T , Buja L. Maximilian , Gladish Gregory W
Published: July 2021

PURPOSE

: Flat-panel computed tomography (FpCT) improves spatial resolution and allows better visualization of atherosclerotic lesions than does clinical 64-channel CT scanning (64-CT). In this rabbit study, we demonstrated that noninvasive
in vivo
FpCT imaging can quantify the different components within atherosclerotic plaque.

METHODS:

Six anesthetized Watanabe homozygous hyperlipidemic rabbits were scanned with 64-CT (image thickness, 0.625 mm) and FpCT (image thickness, 0.150 mm). Iohexol (2 ml/kg) was administered via an ear vein for each scan. Scanning was performed during full inspiration at 30, 60, and 90 seconds after injection (64-CT) or immediately after injection (FpCT). Small field-of-view images (16-mm) were generated perpendicular to the center line of the aorta at 1-mm intervals; including minimum-thickness images and 2-mm–thick volumetric images using average-, maximum-, and minimum-intensity projection. Vessel wall thickness and area, lipid pools, and calcific deposits were measured on the 2-mm–thick, average-intensity images. The aortas were serially sectioned (~2.0 to 2.5 mm in thickness) in proximal-to-distal fashion for histologic correlation with CT.

RESULTS:

ANOVA showed a significant correlation - FpCT vs 64-CT,
P
=0.017; 64-CT vs histology (HS),
P
=0.012; FpCT vs HS,
P
<0.001 - in mean wall thickness and vessel wall area as measured by both scanning techniques and by HS (n=192 sections). Plaque with a large necrotic lipid core was observed in 98 FpCT images, 7 64-CT images, and 87 histologic sections. Both FpCT and HS (gold standard) allowed the detection of lipid pools as small as 0.3 mm diameter; 64-CT allowed detection of lipid pools of 1.5 mm diameter or more. In both FpCT and HS images, but not 64-CT images, we identified lesions composed of <5% lipid. Calcific deposits of <1 mm diameter were recognized only in FpCT and HS images. The histopathologic data for plaque eccentricity and circumference, number of lipid pools, and minimal distance of each component from the vascular lumen was better correlated with the FpCT data than the 64-CT data.

CONCLUSION:

FpCT provides better quantification of plaque components than does 64-CT and is a promising tool for characterizing plaque composition.
Abstract 2823: Right Ventricular Septal Versus Apical Pacing: Long Term Impact On Left Ventricular Synchrony And Function
Authors: Ng Arnold , Allman Christine , Vidaic Jane , Tei Hui , Hopkins Andrew P , Leung Dominic Y
Published: July 2021

Background:
Right ventricular (RV) septal pacing has been advocated as an alternative to RV apical pacing to avoid long term detrimental effects. There is conflicting evidence on the benefits of RV septal pacing. No studies have previously compared left ventricular (LV) strain and dyssynchrony between different pacing sites and utilized echocardiography to determine pacing sites.

Methods:
55 patients (22 normal controls, 17 RV septal and 17 RV apical pacing) were recruited. LV circumferential and radial strain were determined in the midventricular short axis views. Circumferential and radial strain synchrony, and longitudinal systolic (SDTs) and diastolic (SDTe) dyssynchrony indices were determined. Echocardiographic determination of pacing sites were compared with ECG and chest x-ray (CXR).

Results:
The median pacing durations were 436 days for RV septal and 2398 days for RV apical pacing. Mean QRS duration were significantly shorter for septal than apical pacing and normal controls (139.8 ± 22.6 vs. 162.4 ± 22.9 vs. 85.9 ± 15.2 msec respectively, p < 0.001). LV mass index, end-systolic volume index and ejection fraction were more impaired in RV septal than apical pacing (108.2 ± 27.2 vs. 91.5 ± 15.4 g/m
2
, 21.3 ± 3.7 vs. 19.4 ± 9.3mL/m
2
, 47.6 ± 8.5 vs. 54.2 ± 7.8% respectively, all p < 0.05). RV septal pacing was associated with more impaired circumferential strain (p < 0.001) and worse circumferential strain dyssynchrony (p = 0.02) than apical pacing and normal controls. There were no significant differences in radial strain, radial strain dyssynchrony or SDTs. RV septal pacing consisted of a heterogeneous group of different pacing sites on echocardiography, and there was only modest agreement between echocardiographic, ECG and CXR determinations of pacing sites.

Conclusions:
RV septal pacing was associated with poorer long term LV function and greater dyssynchrony than RV apical pacing and normal controls.
Abstract 2838: Sequential Changes of Left Ventricular Systolic and Diastolic Synchronicity in Acute ST-Elevation Myocardial Infarction after Primary Coronary Intervention
Authors: Park Seong-Mi , Kim Yong-Hyun , Hong Soon-Jun , Lim Do-Sun , Shim Wan-Joo
Published: July 2021

The aims of this study were to assess the sequential changes of left ventricular (LV) systolic and diastolic synchronicity in patients with acute myocardial infarction (AMI) and to assess their relation with LV recovery and remodeling. Forty-patients with acute ST-elevation MI were examined within 2days, 6weeks and 6months after primary coronary intervention. Fifteen-age matched subjects were enrolled for normal control. The time from the onset of QRS complex to peak systolic velocity (Ts) and to peak early diastolic velocity (Te) were measured on color-coded tissue Doppler imaging. To assess LV synchronicity, SDs of Ts (Ts-SD) and Te (Te-SD) of all 12 segments were calculated (within 2days, at 6weeks and 6months; SD1, SD2 and SD3, respectively). LV recovery was defined as the improvement of wall motion at least more than two segments at 6 weeks. In all AMI patients, the wall motion score index was 1.72±0.27 and LV ejection fraction was 45.9±9.9%. The Ts-SD1 was higher in AMI patients than in controls (45.4±13.5 vs 29.4±13.3ms, p<0.05), but Te-SD1 was not different (18.7±6.9 vs 16.2±10.0). Twenty-two patients (group1) showed a recovery and 18 patients (group2) showed no recovery. The Ts-SD1 was smaller in group1 than in group2 (43.4±12.6 vs 47.9±11.7 ms, p<0.05). In group1, Ts-SD were much decreased as follow up (Ts-SD2, 3; 36.6±14.0 and 31.1±9.5, respectively, p<0.05). In contrast, in group2, Ts-SD was not significantly changed (Ts-SD2,3; 46.7±13.2 and 43.7±8.8, respectively) but Te-SD was increased as follow up (Te-SD1,2,3; 17.8±5.5, 20.4±4.3 and 25.0±3.8, respectively, p<0.05). The LV end-diastolic and systolic volume were increased and the deceleration time of early diastolic mitral inflow velocity was shortened in group2 (p<0.05). This clinical study shows: 1) in acute phase, the regional wall motion abnormalities of AMI had an impact on LV systolic synchronicity; 2) the AMI patients with LV recovery showed better LV systolic synchronicity; 3) the LV systolic synchronicity became better as regional wall motion was improved; and 4) in chronic phase, the LV diastolic synchronicity became worse in AMI patients with no recovery, which might be related to LV remodeling and worsening of LV diastolic function.
Abstract 2879: Targeted and Tailored: A New Approach to Regeneration after a Myocardial Infarction
Authors: Fujii Hiroko , Li Shu-Hong , Miyagi Yasuo , Fazel Shafie , Yau Terrence M , Egashira Kensuke , Weisel Richard D , Li Ren-Ke
Published: July 2021

Rationale:
Targeted: Ultrasound targeted microbubble destruction (UTMD) delivers genes directly to the injured myocardium. Tailored: UTMD could permit recurrent treatment until recovery is complete. Hypothesis: Repeated UTMD is a novel strategy to induce tissue regeneration and improve ventricular function after a myocardial infarction.

Methods:
Microbubbles were mixed with plasmids containing stem cell factor (SCF) and stromal cell-derived factor (SDF)-1α genes. Seven days after coronary artery ligation, adult rats underwent UTMD either 1, 3 or 6 times at 2-day intervals in 4 randomly assigned groups: Control group: 6 UTMD treatments with empty plasmid (n=4); Repeat 1 (n=6), Repeat 3 (n=7), Repeat 6 (n=6) groups: 1, 3 or 6 treatments, respectively, of UTMD with SCF and SDF-1α plasmid DNA. Cardiac function (echocardiography) and myocardial perfusion (myocardial contrast echocardiography) were assessed on days 0, 10 and 24 after the first treatment. Biochemical assessments were performed on day 24.

Results:
Cardiac function was highest in the Repeat 6 group (p<0.05 vs. Repeat 1). Myocardial SCF levels were higher after multiple rather than single UTMD treatments (p<0.05 for Repeat 3 and Repeat 6 vs. Repeat 1), with the highest levels in the Repeat 6 group (p<0.05 vs. Repeat 3). Myocardial SDF-1α levels and c-kit-positive cell counts also increased with the maximum number of treatments (p<0.05 for Repeat 6 vs. Repeat 1). Myocardial CXCR4-positive cells were more numerous in the remote regions of both multiple UTMD groups (p<0.05 for Repeat 3 and Repeat 6 vs. Repeat 1). Both myocardial perfusion in the infarct region and vascular density (Factor VIII or alpha-smooth muscle actin staining) in the border zone increased with repeated treatments (p<0.05 for Repeat 3 and Repeat 6 vs. Repeat 1), with an additional increase in the Repeat 6 group (p<0.01 vs. Repeat 3).

Conclusions:
Targeted ultrasound delivery of SCF and SDF-1α genes to the myocardium induced angiogenesis, recruited progenitor cells and improved cardiac function. Multiple UTMD treatments further enhanced regeneration. Tailoring the treatment by providing the number of interventions required to restore function provides a new approach to cardiac regeneration following a myocardial infarction.
Abstract 3033: Predictive Factors of Target Vessel Revascularization after Drug-eluting Stent Implantation in the NHLBI Dynamic Registry
Authors: Abbott J. D , Vlachos Helen , Selzer Faith , Marroquin Oscar C , Holper Elizabeth M , Williams David O
Published: July 2021

Drug-eluting stents (DES) reduce the risk of restenosis, however, the benefit may not be consistent or result in fewer repeat interventions in all patient and lesion subsets. We sought to identify the clinical presentation and predictive factors of target vessel revascularization (TVR) in unselected patients treated with DES. Patients with all lesions treated with a DES in the NHLBI Dynamic Registry were analyzed. Included were 2790 patients with 3532 target lesions. All patients were followed prospectively for at least one-year. Target vessel revascularization was defined as any repeat percutaneous coronary intervention involving the target vessel. Baseline characteristics of patients with and without subsequent TVR were compared and independent predictors of TVR were determined by multivariate analysis. Clinically driven TVR occurred in 131 patients (4.7%) and 170 lesions (4.8%). The indication for first TVR was myocardial infarction (n = 29) 22.1%, unstable angina (n = 79) 60.3%, stable angina (n = 21) 16%, other (n = 2) 1.5%. Among patients with TVR the rate of stent thrombosis at 1 year was (n = 17) 13% and 15 of these patients had TVR within 3 days of ST. Several predictors of TVR were identified (Table

) the strongest being diabetes, prior in-stent restenosis, and attempted graft lesion. Stent type, sirolimus vs. other (adjusted OR 0.96, CI 0.36 –2.57) and paclitaxel vs. other (adjusted OR 0.75, CI 0.27–2.10), was not associated with TVR. Although the rate of TVR is low in patients treated with DES, certain patient and lesion subsets predict a higher risk of TVR. Of concern, unlike historical bare metal stent restenosis, TVR events were mainly related to acute coronary syndromes. These observations highlight the need for new stent technology to prevent restenosis and stent thrombosis and more aggressive medical therapy to prevent ischemic events in high risk patients. Adjusted Odds Ratio Model For Target Vessel Revascularization
Abstract 3037: Immuno-inflammatory Cascade Activation and Restenosis in Stable and Unstable Angina Patients Undergoing Coronary Interventions
Authors: Karabela Georgia , Adamopoulos Stamatis , Karavolias George , Haidaroglou Antigoni , Degiannis Dimitrios , Voudris Vassilis , Kremastinos Dimitrios T
Published: July 2021

Background:
Inflammation is an important feature of atherosclerotic lesions and associated with the development of restenosis after coronary angioplasty. The purpose of this study was to investigate whether “active” coronary plaque disruption during percutaneous coronary intervention (PCI), further provokes the activation of immuno-inflammatory cascade and predisposes to restenosis, in stable and unstable angina patients.

Methods and Results:
We assessed the levels of soluble intercellular adhesion molecule (s-ICAM-1), vascular adhesion molecule (s-VCAM-1), metalloproteinase (MMP-9), metalloproteinase inhibitor (TIMP-2), monocyte chemoattractant proteine-1 (MCP-1), T cells chemoattractant proteine IP-10, interleukine-6 (IL-6), C-reactive proteine (CRP) and anti-inflammatory marker IL-10, in 43 stable angina (SA) and 46 unstable angina (UA) patients, before, 12 h and 40 h after PCI. As a control group, we studied 19 SA and 20 UA patients, after coronary angiography. After PCI, serum levels of VCAM-1, MMP-9, IL-6 and CRP increased significantly in both groups, in SA (
p
<
0.01)
and UA (
p
<
0.001)
, while levels of ICAM-1, MCP-1, IP-10, TIMP and IL-10, did not change significantly. After diagnostic angiography, a significant elevation in CRP was observed in SA patients (
p
=0.04), while no difference in any inflammatory marker was detected in UA patients. At 6 months follow-up, 27 out of 89 pts underwent re-angiography because of:

positive stress test in 25 pts and

UA in 2 pts.

Restenosis (lumen diameter stenosis ≥50%) was observed in 12 pts (14%). A positive correlation (p=0.04) was found between IL-10 levels at 12h post-PCI and in stent restenosis (Relative risk [RR]=1.14, 95% CI 1.006 –1.2933). We found no correlation between in-stent restenosis and all the other inflammatory markers.

Conclusion:
Our results provide further evidence of the role of iatrogenic plaque disruption inducing immunoinflammatory responses detectable in systemic circulation, especially in UA patients. The elevation of anti-inflammatory cytokine IL-10 after PCI is associated with in-stent restenosis. This anti-inflammatory marker, strong indicator of an activated inflammatory process, could probably be used as independent predictor of in-stent restenosis.
Abstract 3073: Metabolic Syndrome, Inflammation and Risk of Symptomatic Peripheral Artery Disease in Women: A Prospective Study
Authors: Conen David , Rexrode Kathryn M , Ridker Paul M , Pradhan Aruna D
Published: July 2021

Background
Metabolic syndrome (MetS) includes a number of cardiovascular risk factors known to predict vascular disease. Little is known, however, about the interrelationships between MetS, inflammation and the risk of incident peripheral artery disease (PAD).

Methods
We conducted a prospective cohort study among 27111 women participating in the Women’s Health Study. Subjects were free of cardiovascular disease at baseline and followed for the incidence of symptomatic PAD (n=114) over a follow-up period of 13.3 years. We used Cox proportional-hazards models to compare the risk of PAD among women with and without the MetS. We also evaluated relationships between MetS and markers of subclinical inflammation including high sensitivity C-reactive protein (hsCRP) and soluble intercellular adhesion molecule-1 (sICAM-1) and adjusted for these biomarker levels in multivariable models.

Results
At study entry, 25.5% of participants had the MetS. Women with the MetS had a 62% increased risk of incident PAD (HR 1.62; 95% CI 1.10 –2.38). After multivariable adjustment, MetS remained significantly associated with incident PAD (Table

). Similar results were obtained when we assessed the risk of PAD according to the number of MetS defining traits (21% risk increase per additional trait) (Table

). Median plasma levels of hsCRP and sICAM-1 were 4.0 mg/L versus 1.53 mg/L (p<0.0001) and 374 ng/mL versus 333 ng/mL (p<0.0001) in women with and without MetS, respectively. From 0 to 5 MetS defining traits, median hsCRP levels gradually increased from 1.0 to 5.9 mg/L (p<0.0001) and median sICAM-1 levels increased from 321 to 413 ng/mL (p<0.0001). When hsCRP and sICAM-1 were added to multivariable models for incident PAD, risk estimates for the MetS were substantially attenuated and became non-significant (Table

).

Conclusion
Women with the MetS have an increased risk of incident PAD. This increased risk may be largely mediated by the effects of inflammation and/or endothelial activation.

Metabolic Syndrome and Risk of PAD
Abstract 3999: Baseline Proton Pump Inhibitor Use is Associated with Increased Cardiovascular Events With and Without the Use of Clopidogrel in the CREDO Trial
Authors: Dunn Steven P , Macaulay Tracy E , Brennan Danielle M , Campbell Charles L , Charnigo Richard J , Smyth Susan S , Berger Peter B , Steinhubl Steven R , Topol Eric J
Published: July 2021

Ex vivo data suggest that a pharmacokinetic interaction may exist between proton pump inhibitors (PPIs) and clopidogrel, decreasing the antiplatelet effect of the latter. We assessed that baseline PPI use would increase the 28-day and 1-year composite endpoints in patients undergoing, or at high likelihood of undergoing, PCI randomized to a loading dose and 1-year clopidogrel versus just 4 weeks of clopidogrel, in addition to daily aspirin, in the CREDO trial. Twenty-eight day (Death/MI/UTVR) and 1-year (Death/MI/Stroke) primary endpoints were analyzed based on PPI use at study entry. For each primary endpoint, Cox proportional hazard or logistic regression models were fit to identify the risk of PPI use in the patients receiving clopidogrel, placebo, and in the overall population. Clopidogrel reduced adverse events at 1-year to an approximately similar degree whether or not patients were on a PPI (Table 1

). PPI use also increased the incidence of the 28-day endpoint in patients receiving clopidogrel or placebo, although this did not achieve significance (Table 1

). Additionally, PPI use was independently associated with the 28 day (HR 1.6, 95% CI 1.08 –2.5, p=0.022) and 1 year (HR 1.5, 95% CI 1.1–2.1, p=0.012) endpoints in the overall trial population. Baseline PPI was associated with an increase in cardiovascular events at 1-year in both patients receiving clopidogrel and the overall trial population. However, clopidogrel reduced adverse events at one year to an approximately similar degree whether or not patients were on a PPI.

Table 1
Abstract 4038: Prediction of Outcome After Cardiac Arrest and Induced Hypothermia
Authors: Friberg Hans , Rundgren Malin
Published: July 2021

Prediction of outcome in comatose survivors after cardiac arrest is difficult and is further complicated with the introduction of hypothermia as a treatment option, since sedation and intermittent use of paralyzers are mandated. Other means of prognostication, unaffected by pharmaceuticals, are warranted. We present data from a coma project, where the aim was to evaluate prognostic means by themselves or in combination. All patients included to hypothermia treatment after cardiac arrest, independent of the initial rhythm or the location of arrest, were included. A standardised protocol for monitoring and evaluation of neurological function and outcome was used (Fig 1

). Patients were assessed at 72 h after normothermia, at which time a decision on level of care was taken. During a four-year period, 106 consecutive patients were included; 19 were excluded because of death prior to evaluation (15), protocol violation (3) and intracerebral bleeding (1). Of the remaining 87 patients, 50 patients regained consciousness within 72 h after normothermia and 37 patients were still in coma (GCS≤7). Among these 37 patients, 8 patients eventually regained consciousness, whereas 29 did not. Our 8 patients with a late recovery had a positive profile regarding aEEG (continuous pattern), NSE (<27 ug/L at 48 h) and SSEP (cortical response), whereas 27 of 29 patients with persisting coma had at least one other strong marker for a bad outcome. A decision on level of care after cardiac arrest should be based on a neurological examination (GCS≤7) and at least one other prognostic tool. This should be performed no earlier than 72 h after normothermia.

Fig 1:
Abstract 4066: Response to Symptom Management Intervention among Functionally Impaired Older Adults Following Coronary Artery Bypass Surgery (CABS)
Authors: Barnason Susan A , Zimmerman Lani , Schulz Paula
Published: July 2021

Older adults with poor functioning preoperatively are at risk for delayed recovery following CABS. The
purpose
of this study was to determine if a symptom management (SM) telehealth intervention was effective in improving early recovery outcomes (physical activity, physiological and psychological functioning) for older adults with impaired functioning prior to CABS. A
descriptive, repeated measures design
was used in this subanalysis of a larger RCT. Subjects in the parent study (N=232), who met the preoperative impaired functioning criteria [physical component score of Medical Outcomes Study Short-form 36 (MOS SF-36) <50 and a RISKO score of ≥ 6], were included in either the SM intervention group (n=23) or the usual care group (n=31).

Methods
: Physical activity was measured at baseline using the Modified 7-Day Activity Interview; and at follow-up times by the RT3® accelerometer and an Activity Diary. Physiological and psychosocial functioning was measured by the MOS SF-36. Data was gathered prior to hospital discharge, at 3- and 6-weeks and 3-months after hospital discharge.

Findings
: Subjects ranged in age from 65– 85 years, with a mean of 71.6 (± 5.1) years. Analysis of covariance with repeated measures was used on physical activity and functioning measures, with preoperative levels used as covariates. There were significant group by time effects, with the SM intervention group as compared to the usual care group having higher levels of physical activity over time for: average daily activity counts [F (3,37)=3.55, p<.05]; levels of estimated energy expenditure (average kcal/kg/day expended) as measured by both the RT3® [F (3,37)=2.89, p<.05] and Activity Diary [F (3,42)=3.01, p<.05]; and average minutes/day in moderate or higher levels of activity [F (3,42)=3.18, p<.05]. Both groups had significantly (p<.05) increased role-physical, mental and social functioning over time.

Conclusions
: Study findings demonstrated the responsiveness of a subgroup of CABS subjects with impaired preoperative functioning to a SM intervention for older adults. Subjects’ improvements in physical activity functioning can help to decrease their risk for morbidity and mortality that can be associated with poor functioning after cardiac events.
Abstract 4099: Genetic and Clinical Predictors of Response to Rate Control Therapy in Patients with Atrial Fibrillation
Authors: Vaglio Joseph C , Rowan Shane B , Kucera Gayle , Stubblefield Tanya D , Carter Shannon , Roden Dan M , Darbar Dawood
Published: July 2021

Background:
Randomized studies have now shown that ventricular rate control is an acceptable strategy in patients with atrial fibrillation (AF). Beta-blockers are the first line pharmacologic agent used for ventricular rate control. Recently, a non-synonymous polymorphism (G389R) in the beta-1-adrenergic receptor has been found to modulate the outcome of beta-blockade in heart failure patients. Accordingly, in this study we evaluated the impact of clinical factors and of two common polymorphisms in the β1-adrenergic receptor (G389R and S49G) on response to ventricular rate control therapy in patients with AF.

Methods and Results:
We studied 279 patients (200 men, 79 women, ages 55 ± 13 years) prospectively enrolled in the Vanderbilt AF Registry, and managed with rate control. Ventricular rate control was prospectively defined as adequate based on the AFFIRM criteria:

Average heart rate (HR) at rest ≤80 bpm and

Maximum HR during 6-min walk test ≤110 bpm
or
average HR during 24-hr Holter ≤100 bpm.

Non-response was defined when the ventricular rate was inadequately controlled necessitating a change in therapy. In 151 (54.1%) patients, ventricular rate control was classified as adequate. Although the frequencies of the two â1-adrenergic polymorphisms were in Hardy-Weinberg equilibrium (G389R: 0.25 [cases] vs 0.26 [controls]; S49R: 0.14 [cases] vs. 0.24 [controls], both P>0.05), they were not significantly associated with ventricular rate control (P>0.05 for both). However, a history of hypertension, hyperlipidemia, valvular heart disease and cardiomyopathy were significantly associated with inadequate ventricular rate control. Conversely, prior stroke was more common in patients with adequate ventricular rate control (odds ratio [OR] = 0.29; P<0.01).

Conclusions:
We have identified clinical predictors of response to ventricular rate therapy in patients with AF. However, common β1-adrenergic receptor polymorphisms did not modulate response to rate control therapy. Future studies are needed to confirm these findings in other cohorts and to elucidate potential clinical decision-making tools to predict response to rate control therapy in AF patients.
Abstract 4180: Assessment of Hibernating Myocardium by Contrast Enhanced Computed Tomography in a Porcine Model
Authors: Sigurdsson Gardar , McFalls Edward O , Cabrera Jesus A , Crampton Melanie , Ward Herbert B , Kelly Rosemary F
Published: July 2021

Contrast enhanced computed tomography (CT) is able to assess coronary stenosis and left ventricular function. Due to first pass effect it is able to assess surrogate markers of myocardial perfusion. We assessed the hypothesis that computed tomography can detect hibernating myocardium.

Methods and results: A well-established porcine model of hibernating myocardium was used for this study. In this model of chronic coronary stenosis there is ~20% reduction in regional myocardial perfusion. Six pigs underwent instrumentation of the proximal left anterior descending (LAD) coronary artery with an external constrictor. Paired Student-T test was used to compare LAD territory and opposite myocardial segments. After 12 weeks echocardiographic studies detected regional left ventricular dysfunction by M-mode to the LAD territory (Table

). At that time EKG guided computed tomography showed severe stenosis to the LAD. Myocardial signal density (MSD) by CT was assessed in 24 opposing segments during diastole (Hounsfield Units). MSD within the territory of the LAD was significantly lower than MSD of opposing segments (Table

). Ratio of signal density (RSD) between myocardium and left ventricular cavity was significantly lower within the LAD territory in comparison to opposing segments (Table

).

Conclusion: In a well-established porcine model of hibernating myocardium contrast enhanced computed tomography was able to detect areas of decreased attenuation suggesting that CT might be able to detect hibernating myocardium.

Table
Abstract 4210: Evaluation of Coronary Stenoses and their Functional Significance in Patients with Known and Suspected Coronary Artery Disease using MRI and CTA
Authors: Van Werkhoven Jacob , Schuijf Joanne , Jukema J Wouter , Schreur Joop , Heijenbrok Mark , Pundziute Gabija , Schalij Martin , Van der Wall Ernst , Bax Jeroen
Published: July 2021

Objectives:
Non-invasive computed tomography coronary angiography (CTA) is an accurate anatomic imaging technique, but cannot assess the hemodynamic severity of the detected atherosclerotic lesions. In patients with abnormal CTA, optimal treatment strategy may therefore remain uncertain. The purpose of the current study was to compare anatomic observations with CTA to functional assessment with MRI in patients with known and suspected CAD.

Methods:
In this prospective study, 55 patients (62% male, average age 57±9 years, pre-test likelihood low to intermediate 62%) underwent 64-slice CTA and 1.5 Tesla MRI within 40 days. The presence of CAD (normal <30% stenosis, non-significant 30%–50% stenosis, and significant >50% stenosis) was determined on CTA and first pass perfusion during adenosine stress was assessed on MRI.

Results:
CTA was normal in 15 (27%), non-significant in 24 (44%) and significant in 16 (29%) patients. MRI revealed a perfusion defect in 21 (38%) patients, and was normal in 34 (62%). Table 1

shows the CTA results for patients with normal and abnormal perfusion on MRI. CTA was abnormal in almost all patients with an abnormal perfusion. However, a normal perfusion MRI study was associated with abnormal CTA in a large proportion of patients, as non-significant and significant CAD was noted in 15 (44%) and 5 (15%) patients respectively.

Conclusion:
Although abnormal perfusion on MRI correlated well with abnormal CTA, underlying CAD is present in the majority of patients with a normal MRI perfusion study. The combination of both techniques may allow more refined characterization of CAD.

Table 1
Abstract 4217: Prediction of Acute Coronary Syndrome Using Computed Tomography
Authors: Motoyama Sadako , Sarai Masayoshi , Harigaya Hiroto , Hara Tomonori , Inoue Kaori , Naruse Hiroyuki , Ishi Junnichi , Wong Nathan D , Hishida Hitoshi , Ozaki Yukio , Narula Jagat
Published: July 2021

Background: Computed tomographic (CT) characteristics of culprit lesions in acute coronary syndrome (ACS) include positive remodeling (PR) and non-calcified plaques with low attenuation (NCP<30HU). Such imaging characteristics have almost always been described by evaluating the lesions that have already resulted in ACS. In a CT study, we identified the characteristics of atherosclerotic lesions which were associated with subsequent development of acute coronary syndrome (ACS).

Methods: 1067 patients who underwent CT angiography were followed for at least 12 months (mean = 28.0±10.6 months; range=12–50 months). The plaque characteristics of lesions resulting in ACS were compared with those not resulting in ACS.

Results: Twenty-six patients developed ACS after CT examination. Of these, 15 patients could be evaluated the culprit lesions. Of 1067 patients, 72 demonstrated plaque characteristics suggestive of vulnerable plaque; 45 plaques demonstrated both
PR
and NCP<30HU
(probably vulnerable)
; 27 had either PR or NCP<30HU
(possibly vulnerable).
Eight-hundred twenty patients did not demonstrate either of these characteristics
(probably stable).
Ten of 45 who had both PR and NCP<30HU developed ACS (22.2%), 1 had either PR or NCP<30HU (3.33%). Four of 820 patients with no PR or NCP<30HU (0.49%) developed ACS. PR and/or NCP<30HU was detected in 61 patients without subsequent development of ACS. Cox regression analysis was performed using 9 variables including age, gender, hypertension, hyperlipidemia, diabetes mellitus, obesity, smoking, prior myocardial infarction, and the presence of
probably
or
possibly
vulnerable plaques; the presence of
probably
or
possibly
vulnerable plaques was significant independent predictor of ACS (Hazard Ratio 14.38, p<0.001). There was significant increase in occurrence of ACS in patients with probably or possibly vulnerable plaques than patients without these plaque characteristics (15.3% vs 0.4%, loglank test p<0.001)

Conclusions: The CT-based atherosclerotic plaque characteristics responsible for subsequent ACS include NCP<30HU and positive remodeling; the presence of such plaques strongly predict development of ACS in patients with coronary artery disease.
Abstract 4221: Cardiac Computed Tomography Angiography in the Setting of Low-Moderate Coronary Artery Disease Risk - Do Results Change Management?
Authors: Boone Robert H , Heilbron Brett , Andrews Gordon , Forster Bruce
Published: July 2021

CCTA is sensitive and specific for detecting CAD, but the impact on patient management and outcomes is unknown. We describe our experience with consecutive cases performed at a single CCTA centre. Coronary calcium scoring and contrast-enhanced coronary CT angiograms were performed on 114 patients using a Toshiba 64-slice scanner and standard protocols. Information on demographics, risk factors, symptomatology, prior cardiac investigations and medications was collected by questionnaire and verified by the consulting cardiologist just prior to scan performance. Scan results and management recommendations were recorded. Participants were primarily male (76.1%) with a mean age of 59.8±9.9yrs. CAD risk factor prevalence was: 53.2% hypertensive, 10.6% diabetic, 49% ever smoked, 75.7% with a family history of premature CAD, and mean LDL and HDL were 2.68±0.81 and 1.4±0.43 μmol/L. Baseline medical therapy is listed in Table I

. The prevalence of chest discomfort symptoms was: none (55.4%), non-cardiac (4.3%), atypical (15.2%) and typical (25.1%). Prior investigations included MPI (42.1%), and EST (53.5%) with results that were negative (50%, 45.9%) positive (35.4%, 23%) or equivocal (14.6%, 27.9% respectively). A pre-existing diagnosis of CAD was present in 21.9%. Median coronary calcium (Agatston) score was 79 ( range 0→1899). CAD was diagnosed in 71% of patients, and luminal stenosis was >50% in 70% (n=54). Management recommendations included changes to medical therapy (Table I

), further testing (EST (n=3), MPI (n=6), angiography (n=14)), and test cancellation (MPI (n=2)). In no patients did CCTA result in the cancellation of cardiac catheterization. CCTA provided a new diagnosis of CAD in 49% of patients of low-moderate CAD risk, and resulted in a net increase in the number of medications and investigations ordered. The impact on patient morbidity and mortality is the subject of further study.

Table I:

Medications pre and post CCTA results
Abstract 4228: Objective Judgment in Dobutamine Stress Echocardiography: Visualization of Post-Systolic Shortening by Tissue Doppler Imaging
Authors: Onishi Toshinari , Uematsu Masaaki , Tanaka Nobuaki , Nanto Shinsuke , Morozumi Takakazu , Watanabe Tetsuya , Awata Masaki , Iida Osamu , Kawamoto Kenji , Sera Fusako , Minamiguchi Hitoshi , Yano Masamichi , Ikeoka Kuniyasu , Okamoto Shin , Yasui Haruyo , Ishihara Takayuki , Dohi Tomoharu , Nagata Seiki
Published: July 2021

Background:
Although dobutamine stress echocardiography (DSE) is widely used for the detection of coronary artery disease (CAD), interpretation requires expertise. Post-systolic shortening (PSS) is a sensitive maker of myocardial ischemia. We have developed a novel tissue Doppler imaging (TDI) technique that readily visualizes the presence of PSS on 2-dimensional echocardiograms, and investigated whether CAD is objectively detectable by using this technique during DSE.

Methods:
Detection of diastolic abnormality by displacement Imaging (DADI): PSS was detected by using tissue Doppler displacement timing analysis. In this method, end-systole was automatically determined from tissue velocity, and delays of the displacement peaks from the end-systole were displayed from green to red on the left ventricular apical views, depending on the preset time window. DSE was performed in consecutive 51 patients prior to coronary angiography (CAG) who underwent diagnostic CAG for suspected CAD, and presented with normal LV wall motion at rest (male=31, age ranged 44 – 83 years). We measured the time from the end-systole to displacement peak (ΔT) at each segment in the apical, mid and basal segments by the standard apical plane (long axis, 4 chamber and 2 chamber views). The optimal cut-off value of ΔT for discriminating normal from CAD was determined by receiver operating characteristic analysis. Finally, DADI was performed using the optimal ΔT. CAD was confirmed by CAG as having >75% diameter stenosis.

Results:
Angiographic CAD was present in 31 patients (61%). DADI predicted CAD with sensitivity of 87%, specificity of 75%, negative predictive value of 79%, and predictive accuracy of 82% at the cut-ff ΔT of 80 ms at peak DSE.

Conclusion:
DADI was useful in making objective judgment in DSE by readily portraying the presence of PSS, a marker of myocardial ischemia, on 2-dimensional echocardiograms in patients with inducible myocardial ischemia.
Abstract 4237: Advances in Parametric 3D Echocardiography in Quantitative Estimation of Dobutamine Stress Induced Ischemia
Authors: Ahmad Masood , Dimaano Meneleo , Xie Connie
Published: July 2021

Segmental and quantitative estimation of Dobutamine stress induced ischemia is now possible by 3D subtraction contraction front mapping (CFM - bulls eye dynamic plot of LV contraction measured every 25 msec, TomTec). Parametric 3D images of the LV segments were obtained at baseline and at peak Dobutamine stress in 68 pts (age 45 – 89 yrs). SDI (standard deviation of the time to peak contraction in 16 segments) and % delayed segments (% pixels activated after peak global systolic volume) were measured. Stress and baseline maps were subtracted pixel by pixel to obtain a subtraction CFM for measurement of stress induced ischemia. Figure

shows baseline, peak stress and subtraction contraction front maps; blue - normal activation, red - delayed activation, purple - stress induced ischemia. Out of 45 pts with CAD, stress induced LV wall motion abnormality was seen in 2D Dobutamine stress echo in 34 pts (sensitivity 75%) compared to a > 10% increase in 3D SDI in 32 pts, (mean ± SD, SDI, 0.55 ± 0.4 at baseline, 0.63 ± 0.03 at peak, sensitivity 71%). In 23 pts without CAD, SDI decreased from 0.53 ± 0.02 at baseline to 0.3 ± 0.02 at peak, 2D DSE was negative in 21 pts and nondiagnostic in 2 pts. Percent ischemic segments (difference between stress and baseline segmental activation shown in purple in the subtraction map) were 9.62 ± 4.2 in pts with CAD compared to − 0.37 ± 3.48 in pts without CAD (p < 0.01) Dobutamine stress induced delay in LV segmental activation in pts with CAD can be mapped, quantified and displayed in real time. The technique provides an alternative 3D measurement of stress induced ischemia.
Abstract 4305: Long-term Follow-up Of Left Ventricular Function After Acute Myocardial Infarction Treated With Intracoronary Injection Of Autologous Bone Marrow Cells. The ASTAMI Study
Authors: Beitnes Jan Otto , Hopp Einar , Lunde Ketil , Smith Hans-Jørgen , Solheim Svein , Arnesen Harald , Forfang Kolbjørn , Brinchmann Jan E , Aakhus Svend
Published: July 2021

Background:
Long-term effects of cardiac autologous cell therapy are not well known. We performed a 3 year follow-up of the ASTAMI study. Patients with acute ST-elevation anterior wall myocardial infarctions were initially randomized to either intracoronary injection of autologous mononuclear bone marrow cells (mBMCs) (n=50) or control (n=50). At 6 months, LV ejection fraction improved in both groups, with no significant difference between groups.

Methods:
All eligible patients underwent MRI with a 1,5 T scanner (Siemens) 2–3 weeks, 6 months and mean(SD) 3,2 (0,2) years after myocardial infarction and stem cell injection. Infarct size was determined from gadolinium late-enhancement MR images. All images were analyzed by experienced observers blinded for treatment assignment. Left ventricular volumes were calculated by the area-length method.

Results:
There was no significant difference in EDV, ESV or LVEF between baseline and 3 years in neither group. Infarction volume was reduced at 3 years in both groups (p<0,001). No significant effects of mBMC treatment could be identified on LV volumes, LVEF or infarct size. Thus intracoronary injection of mBMCs in acute myocardial infarction does not improve global LV function over a 3 year follow-up.

Left ventricular function after mBMC-treatment