bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 1778: Electrocardiographic and Genetic Screening for Long QT Syndrome: Results from a Prospective Study on 44,596 Neonates
Authors: Stramba-Badiale Marco , Crotti Lia , Goulene Karine , Pedrazzini Matteo , Mannarino Savina , Salice Patrizia , Bosi Giuliano , Nespoli Luigi , Rimini Alessandro , Gabbarini Fulvio , Rosati Enrico , Schwartz Peter J
Published: July 2021

Background.
The long QT syndrome (LQTS), a leading cause of sudden death under 20 years of age, is due to mutations in genes which encode ion channels involved in the control of ventricular repolarization. In a prospective study on 34,000 neonates we found that a prolonged QT interval was associated with a 41 times greater risk for sudden infant death syndrome (SIDS) and, recently, in a case-control study on 201 cases of SIDS we found disease-causing LQTS mutations in 9.5% of the victims. Based on these results the Italian Ministry of Health is considering the possibility of introducing in the National Health Service an electrocardiographic (ECG) screening program in the first month of life to identify infants affected by LQTS. A realistic assessment of the prevalence of infants with LQTS becomes necessary.

Methods.
An ECG was recorded in the first month of life in 44,596 neonates. The QT interval was measured and corrected for heart rate according to the Bazett’s formula (QTc). In the neonates with a markedly prolonged QT (QTc ≥ 470 msec) molecular screening of the LQTS genes was performed.

Results.
A QTc between 440 and 470 msec was observed in 611 neonates (1.4%). A QTc ≥ 470 ms was found in 31 neonates (0.07%). Genetic analysis was performed in 28/31 (90%) neonates and LQTS mutations were identified in 14 of them (50%): 8 were LQT1, 4 LQT2 and 2 LQT3. Besides one
de novo
mutation, all other cases were familial and genetic analysis identified additional family members (37/72, 51%) affected by LQTS who had not been previously diagnosed. Within these 28 infants QTc was longer in the positively genotyped neonates (493±22 vs 479±6 ms, p=0.037) and a LQTS mutation was identified in all the neonates (n=5) with a QTc > 496 ms.

Conclusions.
An ECG performed in the first month of life, with genetic analysis in selected cases, allows early diagnosis of infants with sporadic and familial forms of LQTS, thus leading to institution of effective therapies aimed at preventing sudden death either in infancy or later on in life, not only in the neonates but also in their affected family members. This study also provides a first data-based estimate of LQTS prevalence, likely to be between 1/3,000 and 1/2,500 live births.
Abstract 1779: The Negative Impact of Diagnostic Testing Performed Prior to Adult Congenital Heart Disease Referral - Financial Burden and Cost to the Patient
Authors: Daniels Curt J , Gupta Rakhi , Sparks Elizabeth A , Cook Stephen C , Hickey Jenne , Vaughn Eric
Published: July 2021

Adult congenital heart disease (ACHD) patients (pts) are an underserved, complex, rapidly expanding population and, despite surpassing the volume of pediatric CHD pts, neither IM or pediatric cardiology fellowship fully prepares physicians to care for this group. The diagnostic studies recommended, technical skills required, and unique data interpretation requires specialized training in both disciplines. Therefore, we sought to determine whether pts referred to our ACHD program underwent appropriate and complete testing prior to referral and evaluated the financial impact of unnecessary and repeat testing.

Methods: We reviewed diagnostic testing before and after referral to the ACHD program for consecutive new pts (>18 yo). All cardiovascular testing prior to referral and subsequent testing were recorded.
Unnecessary testing
was defined as those performed outside of guidelines or inappropriate for their CHD.
Incomplete testing
was defined as that which required repeating.
Financial cost
of unnecessary and repeat testing was estimated based on usual insurance billing practice.

Results: From 2/06 to 4/07, 200 new pts were referred to the ACHD program, mean age 33.2 ± 12.7 yrs (range 18.1–72.9 yrs). Common diagnoses included ASD (17%), TOF (14%), bicuspid aortic valve (11%) and COA (10%) with 81% classified as moderate or complex CHD.
Unnecessary testing
consisted of 35 stress studies (25 nuclear and 10 echo), 5 TEEs, and 14 cardiac caths. Repeat studies for
incomplete testing
were necessary in 65/81 TTEs (80%), 9/39 TEEs (23%), 0/5 cardiac CTs, 8/12 CMRs (67%) and 16/31 caths (51%). Overall,105/200 pts (52%) endured unnecessary or repeat testing carrying a conservative
financial burden
of $456,980; 916 patient hours: and 114 patient work days lost.

Conclusions: Diagnostic testing in ACHD requires specialized training from technician to physician. Repeat testing was necessary in 58% of studies, and 52% of the pts were affected by unnecessary or repeat testing. Therefore, ACHD pts frequently endure unnecessary and repeat testing which carries a financial burden to the patient and health care system and medical risk to the patient. Adults with moderate and complex CHD should be referred to appropriately trained ACHD providers prior to diagnostic testing.
Abstract 1787: Vertebral Artery Stent Placement for Symptomatic Patients: One-Year Follow-up
Authors: Patel Samir N , Jenkins J. Stephen , White Christopher J , McMullan Paul , Reilly J.P. , Collins Tyrone J , Ramee Stephen R
Published: July 2021

Background
: Symptomatic vertebral artery stenosis (VAS) has a five-year stroke risk of 30%–35%. Mortality associated with posterior circulation (PC) strokes is high, ranging from 20%–30%. Surgical revascularization is rarely performed due to high morbidity and mortality. Endovascular revascularization with stents offers a potential treatment option for these patients.

Methods
: One hundred nine patients (116 arteries, 70% male) underwent stent placement for extracranial (91%) and intracranial (9%) VAS from 1995–2006. Symptoms included vertigo (63%), visual changes (31%), syncope (11%), ataxia (7%), and drop attack (5%). Four patients had asymptomatic critical stenosis. Sixty-one patients (56%) had bilateral VAS, 74 patients (69%) had concomitant carotid disease, and 43 patients (39%) had a prior stroke. Procedural success was defined as residual stenosis of ≤ 20% without peri-procedural stroke or death. Clinical success was defined as procedural success with symptom resolution. Restenosis was defined as angiographic narrowing within the stent of ≥ 70% or > 50% with recurrent symptoms, or evidence of severe stenosis on non-invasive imaging (ultrasound, CT, or MR).

Results
: Procedural and clinical success was achieved in 108 (99.1%) and 95 (94.3%) patients, respectively. At one year, follow-up was obtained in 91 patients (83.5%), 6 patients (5.5%) had died, 5 patients (5.3%) experienced a PC stroke, and 47 patients (43.1%) underwent repeat angiography and/or non-invasive imaging. Eighty-seven of the 91 patients were initially symptomatic, 69 (79.3%) of which were symptom-free at one year. Three of those that had recurrent symptoms never achieved clinical success, 9 had developed restenosis, and 7 underwent successful re-intervention. At median follow-up of 31 months (lower and upper quartiles of 13.0 and 51.8 months), 72.5% were alive and 71.6% remained symptom-free.

Conclusion
: Our data demonstrates that stenting for VAS can be successfully performed in 99% of patients without peri-procedural stroke or death and is associated with durable symptom resolution in approximately 80% of patients at one year. In these high-risk patients, endovascular therapy for symptomatic VAS appears to be safe and effective at relieving symptoms.
Abstract 1788: Clinical Impact of the Diameter of a Self-expandable Stent in the Superficial Femoral Artery
Authors: Soga Yoshimitsu , Yokoi Hiroyoshi , Urakawa Tomoko , Ando Kenji , Shirai Shinichi , Sakai Koyu , Iwabuchi Masashi , Yasumoto Hitoshi , Nosaka Hideyuki , Nobuyoshi Masakiyo , Odashiro Keita
Published: July 2021

Background
Factors associated with patency of self-expandable stents placed in the superficial femoral artery (SFA) have not been clarified. In this study, we investigated the impact of stent diameter in patients who implanted self-expandable stents in the SFA.

Methods
Self-expandable stents were placed in SFA lesions in 80 patients (84 limbs) at our hospital between January 2003 and December 2005 and we investigated prospectively for 18 months. A total of 144 stents were used: The mean vascular diameter at sites proximal and distal to the stent-placement region on angiography was defined as the vessel diameter, and the stent diameter/vessel diameter (S/V) ratio was calculated.

Results
The age of the patients ranged from 44 to 88 years old (mean: 70.3 ± 6.8 years old), and 68 patients were male (85%). The mean diameter of the treated vessels was 5.1 ± 0.7 mm, the mean lesion length was 93.8 ± 43.8 mm, and 1.7 ± 0.6 stents were used per lesion. Chronic total occlusion was noted in 24 cases (30%). The primary (secondary) patency rates at 6, 12, and 18 months were 91.2% (97.5%), 74.5% (87.2%), and 63.6% (79.1%), respectively as estimated by the Kaplan-Meier method. An S/V ratio >1.3 was noted in 16 of the 80 patients (20%). There was a high percentage of patients with renal dysfunction and a smoking habit in this group, and the length of the treated lesion was long. In contrast, there were fewer patients with a high cholesterol level in this group. Other baseline parameters were similar between the two groups. A Kaplan-Meier estimate showed that the restenosis rate after 18 months was significantly higher in the S/V >1.3 group (87.5% vs. 35.5%, p<0.0001), whereas the primary patency was lower (31.3% vs. 73.4%, p<0.0001). Multivariate analysis indicated that lesion length >100 mm (Hazard ratio (HR) 6.6, p=0.015), chronic total occlusion (HR 6.0, p=0.035), stent fracture(HR 17.5, p=0.022), and S/V >1.3(HR 29.0, p=0.0014) were independent predictors of primary patency at 18 months.

conclusion
The stent diameter of self-expandable stent was strongest predictor in primary patency at 18 months. The stent diameter of self-expandable stent can affect patency in the chronic phase.
Abstract 1796: A Clinical Prediction Rule for Early Emergency Department Discharge of Lower Risk Patients with Chest Pain
Authors: Cotarlan Vlad , Ho David , Pineda John , Netrebko Pavlo I , McConnell Timothy , Qureshi Anwer , Shirani Jamshid
Published: July 2021

Background. Emergency Department (ED) evaluation of patients with acute chest pain and non-diagnostic electrocardiography (ECG) remains a frequent and difficult problem. Stress testing is generally requested and may lead to costly, unnecessary and prolonged ED stay. We aimed to identify clinical characteristics that allow early discharge with outpatient evaluation of such patients.

Methods. Between 02/2006 and 02/2007, 459 adults [age 56±13 years, 228 (50%) men] who presented to ED with chest pain and had no ischemic ECG changes and 2 negative cardiac enzymes measurements on arrival and 6 hours later, underwent stress echocardiography (n=396) or coronary computed tomographic angiography (n=63) prior to discharge.

Results. Non-invasive evaluation for coronary artery disease (CAD) was negative in 367 (80%), indeterminate in 30 (7%) and positive in 62 (13%) [Table

]. Univariate predictors for a normal stress test were lower Framingham risk score, lower age, normal ECG (no ischemic changes), atypical chest pain and the absence of diabetes, hypertension, high cholesterol and previous CAD. Multivariate logistic regression identified normal ECG (RR=2.3, p=0.002), atypical chest pain (RR=3.0, p=0.001), no diabetes (RR=2.5, p=0.001) or absence of previous CAD (RR=2.8, p<0.001) as strong independent predictors for a negative non-invasive test. The same four variables were strong independent predictors of ED discharge. Of 459 patients, 186 (41%) had none of the four independent predictors. None of those had positive non-invasive test or obstructive CAD on angiogram (n=1).

Conclusion. A substantial portion (2/5) of patients seen in ED for chest pain evaluation can be safely discharged after 2 sets of negative cardiac enzymes (~6 hours) if they have a normal ECG, atypical chest pain, no diabetes or previous CAD. These patients can be evaluated for CAD as an outpatient. This strategy may significantly decrease length of stay, ED clutter and cost of in-patient evaluation.
Abstract 1830: New ECG Criteria for Diagnosis of Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy
Authors: Cox Moniek G , Wilde Arthur A , Wiesfeld Ans C , Hauer Richard N
Published: July 2021

Introduction
Desmosomal changes, electrical uncoupling and surviving myocardial bundles embedded in fibrofatty tissue are hallmarks of activation delay (AD) in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). AD is pivotal for reentrant mechanisms and thereby ventricular tachycardia (VT). At present, generally accepted Task Force Criteria (TFC) are used for clinical diagnosis of ARVD/C. We propose additional criteria (AC) on AD and VT to improve identification of affected individuals.

Methods
AD and VT-related electrocardiographic criteria were studied, while off drugs, in 42 patients with proven ARVD/C according to TFC, and 23 controls with idiopathic VT from the RV outflow tract. TFC assessed: epsilon waves, QRS width >110ms in V1–3 in absence of RBBB and negative T-waves in V2 and beyond. The 3 new AC are:

prolonged S-wave upstroke in V1–3 (≥55ms from nadir of S to end of depolarization)

occurrence of LBBB like VT with axis −30° to −150°and

number of different monomorphic VT morphologies (different when Δ axis ≥30°; spontaneous and induced by programmed electrical stimulation (PES)). All ARVD/C patients were screened for mutations in genes encoding desmosomal proteins.

Results
For comparison of ARVD/C patients (pts) and controls: see table

. In ARVD/C pts mean S-wave upstroke duration was 63±20 ms (range 40–140), mean number of different spontaneous VTs 1.8±0.95 (range 0–5) and mean number of spontaneous+induced VTs 2.8±1.08 (range 1–5). All VTs showed LBBB morphology. Plakophilin-2 mutations were identified in 25 (60%) of ARVD/C pts. Parameters measured were not significantly different between mutation carriers and non-carriers.

Conclusions
The newly proposed criteria are sensitive and specific for ARVD/C and thereby useful for its diagnosis, independent of outcome of DNA analysis. Prolonged S-wave upstroke is the most sensitive ECG indicator of activation delay during sinus rhythm. PES contributes to yield of VT morphologies.
Abstract 1848: Coronary Artery Bypass Grafting after Uneventful Percutaneous Coronary Intervention in the Commonwealth of Massachusetts
Authors: Stevens Louis M , Wolf Robert E , Agnihotri Arvind K , Torchiana David F , Lovett Ann , Normand Sharon L
Published: July 2021

Objective
: Percutaneous coronary intervention (PCI) is associated with an increase in coronary re-intervention and cardiac re-hospitalization compared to CABG. We compared mid-term survival of adults undergoing primary isolated CABG more than 14 days and within 5 years of a PCI (P-PCI) to CABG patients without prior PCI (NO-PCI).

Methods
: We linked clinical information from the mandatory MA Adult Cardiac Surgery Database to the MA Inpatient Acute Hospital Case Mix, Charge Database and to the MA Mortality Index Database in order to analyze outcomes of 11,352 adults undergoing primary isolated CABG between 2002 and 2004. Inpatient discharge data were used to identify any occurrence of P-PCI in the 5 years interval prior to the primary CABG. We excluded patients residing outside of MA at time of primary CABG (n = 1,043), with early PCI failure < 14 days prior to CABG (n = 403), or rescue PCI for acute myocardial infarction (n = 438), leaving a final cohort of 9,468. The propensity for P-PCI was determined by logistic regression analysis and each patient with P-PCI was matched to a single NO-PCI patient. Morbidity and mortality differences were estimated by McNemar’s test and length of stay by paired t-tests. Survival was compared using Cox proportional hazards model to account for matching.

Results
: We identified 1,033 patients with P-PCI; the median interval between P-PCI and CABG was 234 days. P-PCI patients were more likely to be younger, female, with lower ejection fraction, hypertension, myocardial infarction > 24 hrs and fewer diseased vessels. They were less likely to present with peripheral vascular disease, left main disease and to present in urgent status. Mean follow-up was 578 ± 316 days and was 100% complete. Using 1,032 matched pairs, no differences were found (P-PCI vs. NO-PCI) in 30-day mortality (1.1% vs. 1.4%; P = 0.7), hospital morbidity (35% vs. 33%; P = 0.4), median length of stay (8 days vs. 9 days; P = 0.06), and survival (HR [95% CI] for P-PCI = 0.88 [0.56, 1.38]; P = 0.6).

Conclusions
: Although CABG patients with P-PCI presented with more comorbidities, mid-term outcomes were similar to a matched NO-PCI CABG population. These results help to refine the indications and trade-offs for the available successful alternatives in coronary revascularization.
Abstract 1870: A Novel Method of Spatially-Dense 3D Speckle Tracking on 4D Echocardiography for Strain Analysis: with Validation by Sonomicrometry
Authors: Song Xubo , Myronenko Andriy , Ashraf Muhammad , Lowe Robert I , Niemann Petra S , Hui Ling , Li Xiao Kui , Thiele Karl , Sahn David J
Published: July 2021

Background:
We have developed a method for spatially-dense 3D speckle tracking that tracks speckle features in myocardium to allow calculation of full 3D displacement and strain from 4D full-volume echo images and have tested its accuracy compared to sonomicrometry in open-chest pigs.

Methods:
The 4D images were acquired using a Philips iE33 on 6 open-chest piglets. An array of 6 sonomicrometers (sono crystals) was implanted as 2 triangular sets at apex and mid-levels in the LV myocardium. The pair-wise crystal distances were computed offline using Sonometrics® software to yield 3D displacements. For 4D computation of speckle based mechanics, Cartesian coordinate images were entered into an envelope detection program, then a volume-based non-rigid registration was used to obtain optimal displacement between end diastolic (ED) and end systolic (ES) volumes. The displacement field was modeled using B-splines, parameterized by the location of a set of control points. Optimal locations of the control points were obtained by minimizing the sum of squared intensity differences between the ED and ES volumes. Sono crystals were located based on anatomic markers in the ED volume before the adjacent speckle patches were tracked, to ensure that image-derived strains were computed for segments matching the distances between sono crystal pairs. The method was implemented in MATLAB.

Results:
The comparison of the systolic strains from dense 4D speckle tracking showed a strong correlation (r
2
= 0.82) with sonomicrometry for 44 segmental strains.

Conclusions:
These studies show that the method we have developed can accurately compute 3D displacement and segmented LV strain from 4D data.
Abstract 1877: Experimental Validation of Circumferential Subendocardial and Subepicardial Myocardial Strain during Dobutamine Stress Echocardiography in Ischemic Conditions
Authors: Reant Patricia , Labrousse Louis , Lafitte Stephane , Tariosse Lilianne , Bonoron-Adele Simone , Padois Philippe , Deville Claude , Roudaut Raymond , Santos Pierre Dos
Published: July 2021

Background: Strain echocardiographic techniques have been developed in order to quantify myocardial contraction but are currently based on a transmural myocardial analysis whereas subendocardial (ENDO) and subepicardial (EPI) layers have different response to ischemia. Recent development in strain software enables to investigate simultaneously strain in 2 myocardial layers.

Objectives: To assess and validate this new tool for the detection of ischemia during dobutamine stress echocardiography (DSE).

Methods: In 6 open-chest anesthetized pigs, circumferential strain (CS) was studied before and during dobutamine infusion, in absence of coronary stenosis and in ischemic conditions produced by: 2 degrees of non flow-limiting stenoses reducing left anterior descending (LAD) artery hyperemic flow by 20% and then by 60% (NFLS20 and NFLS60), and 1 flow-limiting stenosis reducing resting LAD flow by 25% (FLS25). Agreement between CS echocardiography in ENDO and EPI layers in risk area (RA) and sonomicrometry was evaluated by linear regression and Bland-Altman analysis. CS in ENDO and EPI layers were studied in absence or coronary stenosis and in ischemic condition, in RA and in control area (CA).

Results: Good correlations and agreements were observed between echocardiography and sonomicrometry at rest and during dobutamine : ENDO CS: r=0.66, P<0.001 and r=0.69, P<0.0001; EPI CS: r=0.65, P<0.01 and r=0.62, P<0.001. At rest, both ENDO and EPI CS in the RA were significantly decreased in the presence of FLS25. During dobutamine infusion, ENDO CS was significantly reduced in the presence of NFLS20 and EPI CS in the presence of NFLS60.

Conclusions: Multilayer strain echocardiography provides accurate assessment of LV regional function. Evaluation of ENDO and EPI strains during DSE has real potential to improve detection of ischemia in clinical practice.
Abstract 1884: Rosuvastatin Activates Circulating Stem and Progenitor Cells, Promotes Endogenous Tissue Regeneration, and Improves Central Hemodynamics in Patients With Chronic Heart Failure
Authors: Erbs Sandra , Beck Ephraim B , Linke Axel , Adams Volker , Höllriegel Robert , Gielen Stephan , Möbius-Winkler Sven , Hambrecht Rainer , Schuler Gerhard
Published: July 2021

Endogenous regeneration is impaired in patients (pts) with chronic heart failure (CHF), which results in peripheral, but also central hemodynamic alterations. Statins are known to promote stem cell release and enhance phosphorylation of the survival kinase AKT, which is associated with an increased cardiomyocyte contractility. Therefore, the present study aimed to investigate the effects of rosuvastatin on number and function of stem and circulating progenitor cells (CPC), their contribution to tissue neovascularization, and its impact on endothelial function and central hemodynamics in pts with CHF.

Methods:
Forty-two pts with CHF (EF 30±1%; n=12 ischemic, and n=30 dilative cardiomyopathy) were randomized to 12 weeks (wks) of 40 mg rosuvastatin daily or placebo therapy (P) in a double-blind manner. At begin (B) and at 12 wks, the number of circulating CD34
+
stem cells and CD34/KDR
+
CPCs was measured, functional capacity of CPCs was assessed by migration and matrigel assay, and capillary density of skeletal muscle (SM) was quantified. Muscular phosphorylation levels of AKT were determined. Flow-mediated dilatation (FMD) was measured by high-resolution ultrasound and ejection fraction (EF) assessed by echocardiography.

Results:
Rosuvastatin increased the number of CPCs by +132% (p<0.05 vs P), improved their migratory capacity by +83% and their integrative capacity by +91% (p<0.05 vs P), respectively. FMD recovered from +197±25 μm at B to +478±50 μm at 12 wks in the rosuvastatin group. The rosuvastatin-mediated increase in circulating CD34
+
cells was closely correlated to the improvement in FMD (r=0.70, p<0.01) and the augmentation in capillary density of SM (r=0.76, p<0.01). Rosuvastatin enhanced muscular AKT phosphorylation 2.5fold, which was associated with a gain in EF by + 8±1% (p<0.05 vs P). All parameters remained unchanged in the placebo group.

Conclusion:
In pts with CHF, rosuvastatin improves left-ventricular ejection fraction, promotes skeletal muscle neovascularization, and enhances endothelial function, partially through activation of circulating stem and progenitor cells. Therefore, rosuvastatin might be considered as a therapeutic strategy to induce endogenous tissue regeneration and improve central hemodynamics in CHF.
Abstract 1942: Drug-Eluting Stents for Cerebrovascular Disease: Feasibility, Safety and Intermediate-term Outcomes
Authors: Mehta Nirav J , Naidu Srihari S
Published: July 2021

Background:
Cerebral atherosclerosis poses risk of ischemic stroke by embolic or flow-related mechanism. Patients with cerebral vascular disease who are deemed high risk due to critical stenosis or medication failure may have annual risk of recurrent ischemic event in excess of 40%. Major concern with currently used bare metal stents (BMS) is very high rate of restenosis, reportedly > 30%. We analyzed current literature to assess feasibility, safety and short- and intermediate-term outcomes after DES implantation in cerebral circulation.

Methods:
We performed a systematic literature search for reports that evaluated DES in cerebrovascular disease. Data were extracted to analyze baseline characteristics, vessel selection, technical success, and peri-procedure and intermediate-term outcome.

Results:
Three studies totaling 88 patients, 94 vessels, and 88 stent placements met the inclusion criteria. Mean age of the patients was 61.5 ± 13.1 years. The success rate for DES delivery was 94% (88/94 vessels). 54 stents were paclitaxel-eluting and 34 were sirolimus-eluting. Peri-procedure complication rate was low with 2 disabling strokes (modified Rankin scale > 2), 1 minor stroke and 2 asymptomatic non-flow limiting dissections. No death or bleeding complications occurred. Stent thrombosis occurred in two cases despite double antiplatelet therapy, accounting for the disabling strokes. At intermediate follow-up (6.5 ± 3.15 months), 4 (5%) cases of restenosis of > 50% vessel diameter were detected, one of which was symptomatic. Major stroke-free survival by Kaplan-Meier analysis was 96% at 9 months.

Conclusion:
Elective DES delivery in cerebral circulation is technically feasible with low rate of procedural and intermediate-term major stroke or death in high-risk patients. Prospective studies with long term follow-up are required to assess efficacy of DES compared to BMS.
Abstract 1944: Atorvastatin Reduces Intracerebral Hemorrhage after Experimental Stroke
Authors: Elewa Hazem F , Kozak Anna , Rychly David , Ergul Adviye , Frye Reginald , El-Remessy Azza , Fagan Susan C
Published: July 2021

Ischemic stroke is a leading cause of death and disability in the United States and diabetes mellitus is the fastest growing risk factor for stroke. In addition, hyperglycemia, which is usually associated with diabetes, tends to worsen ischemia/reperfusion injury and to induce more oxidative stress damage. Preliminary data from our laboratory showed that diabetic animals (Goto-Kakizaki rats (GKs) are more susceptible to vascular damage leading to intracerebral hemorrhage. Many studies have indicated that statins possess neuroprotective properties even when administered after the onset of ischemia. However, the acute vascular effects of statins after ischemic stroke have not been studied to date.

Objective: to evaluate the efficacy and magnitude of vascular protection of acute statin therapy in both GKs and their normoglycemic controls after experimental ischemic stroke.

Methods: Male Wistar (W) and GK rats (270–305 g) underwent 3 hours of middle cerebral artery occlusion (MCAO) followed by reperfusion for 21 hours. Animals were randomized to receive either atorvastatin (15mg/Kg) or methyl cellulose (0.5%), administered by oral gavage, the first dose 5 minutes after reperfusion and the second dose after 12 hours. Brain tissue was analyzed for infarct volume and hemoglobin content. In another set of Wistar rats (n=3), atorvastatin (15mg/Kg) was administered by oral gavage to compare its pharmacokinetic profile with that of humans

Results: Atorvastatin-treated groups had significantly lower hemoglobin (p=0.0156) and infarct volume (p=0.0132) compared to their controls. Atorvastatin peak concentration (27–77 ng/ml) in rats’ plasma was found to be similar to that seen after 80mg/day of atorvastatin in humans.

Conclusion: Atorvastatin can be a novel vascular protective agent after acute ischemic stroke especially in a high risk population like diabetics. The mechanisms through which these effects are mediated are currently being investigated.
Abstract 1945: Levels Of Circulating Progenitor Cells In Patients With Chronic Heart Failure Predict Outcomes
Authors: Latini Roberto , Lehmann Ralph , Assmus Birgit , Balconi Giovanna , Dimmeler Stefanie , Sarto Patrizio , Carbonieri Emanuele , Gualco Alessandra , Maugeri Fondazione S , Campana Carlo , Matteo IRCCS S , Fiordaliso Fabio , Angelici Laura , Dejana Elisabetta , Zeiher Andreas M
Published: July 2021

Background:
A low level of circulating endothelial progenitor cells (EPCs), a marker of reduced vascular regeneration, is related to worse outcome in patients with coronary heart disease, but little is known on pts with heart failure (HF). The aim was to assess the prognostic value of circulating EPCs in patients with HF.

Methods:
In 68 pts enrolled to GISSI-HF trial by 5 Italian Centers and 45 pts from Frankfurt, mononuclear cells from peripheral blood were isolated and plated; after 4 days, adherent cells were incubated with DiI-labeled acetylated LDL, stained with FITC-labeled Ulex europaeus agglutinin I (lectin), and counted as double positive at confocal microscopy. 66 patients had ischemic etiology, 12 were females, 26 had NYHA class >II, median age 64 y (Q1–Q3 56–70y). Cutoffs for EPCs were assessed by ROC.

Results:
Mean EPCs in pts with HF 34 ± 7 EPCs/mm
2
, 2–3 fold lower than in age-matched controls. Over a median of 2.5 years, 12 CV deaths and 47 first hospitalizations for CV reasons were recorded. Levels of EPCs were unrelated to severity of HF, age or sex. After adjustment for clinical variables, creatinine and BNP, EPCs <30/mm
2
were associated with a 2-fold higher risk of CV death and hospitalization, as shown by K-M curves (figure

) and by Cox multivariate regression. Pts with HF of ischemic etiology gave identical results.

Conclusions
: The level of circulating EPCs is an independent predictor of CV death and hospitalization in pts with chronic HF. The assay of this cellular marker of risk can be performed in blood samples collected in a multicenter setting under controlled conditions, and may offer an accessible tool to assess the role of vascular regeneration in the treatment of HF.
Abstract 1951: Circulating Dendritic Cells May Play an Important Role in Pathophysiology in Heart Failure in Humans
Authors: Sugi Yusuke , Yasukawa Hideo , Kai Hisashi , Fukui Daisuke , Futamata Nobuyoshi , Mawatari Kazuhisa , Ohba Toyoharu , Koga Mitsuhisa , Imaizumi Tsutomu
Published: July 2021

Dendritic cells (DCs) are the most potent antigen-presenting cells and play a central role in initiating the primary immune response. Although increasing evidence supports immune-mediated inflammation plays an important role in the pathophysiology of heart failure, little is known regarding the source and mechanism that trigger immune responses. The present study examined whether circulating DCs have any role in the pathophysiology in heart failure in humans.

Methods and Results:
With multi-color flow-cytometry we determined the numbers of circulating myeloid DCs (mDCs) and plasmacytoid DCs (pDCs) in decompensated heart failure patients with NYHA class III or IV on admission (n=27) and the age-matched control subjects (n=21). DC activation markers such as CD40 and CCR7 were also measured. On admission, circulating mDC and pDC counts were significantly lower in decompensated heart failure patients compared to control subjects (12417 ± 2849 versus 5394 ± 3547 and 3321 ± 1491 versus 1800 ± 1474/ml, respectively, p<0.01). Circulating DCs were activated in the decompensated heart failure patients compared to control subjects (CD40; 1.6 ± 1.8 versus 8.5 ± 9.2, CCR7; 3.5 ± 4.1 versus 13.5 ± 10.0, respectively, p<0.05). Heart failure treatment significantly restored the reduction and the activation of circulating DCs (p<0.05). The increases of circulating DCs numbers after treatment were correlated with the decreases in B-type natriuretic peptide (BNP) and troponin-T (r=0.64, p<0.01 and r=0.46, respectively, p<0.05) and with the increase in left ventricular ejection fraction (LVEF) (r=0.73, p<0.01). Furthermore, we found that patients with smaller circulating DCs numbers (less than 10000/ml) after heart failure treatment had poor prognosis compaired with those who had greater DCs numbers (more than 10000/ml) during the 6-month follow-up (p<0.01). Thus, we found that changes of circulating DCs numbers were well correlated with cardiac injury and function, and that poor recovery of the circulating DCs number after treatment predicted recurrence of decompensated heart failure.

Conclusion
: These findings suggest that circulating DCs may play an important role in pathophysiology in heart failure in humans.
Abstract 1962: Quantification of Longitudinal Right Ventricular Systolic Function and Its Coupling to Left Ventricular Global Function Using Speckle-Tracking Strain Imaging in Patients with Old Myocardial Infarction
Authors: Dohi Kaoru , Onishi Katsuya , Kato Shinya , Takamura Takeshi , Fujimoto Naoki , Kurita Tairo , Yamada Norikazu , Nakamura Mashio , Isaka Naoki , Ito Masaaki
Published: July 2021

Background:
We tested the hypothesis that speckle-tracking strain imaging can quantify longitudinal right ventricular (RV) function and its association with left ventricular (LV) function in patients with myocardial infarction (MI).

Methods:
To quantify longitudinal RV function, 39 patients with old MI (OMI: LV ejection fraction 17 – 77 %, 45 ±16 %) and 29 age matched normal controls (Control: LV ejection fraction 65 ± 5 %) were studied with echocardiography. Longitudinal RV global peak systolic strain was assessed from apical four-chamber view using speckle-tracking imaging (EchoPAC, GE Electronic). RV fractional area change was also analyzed.

Results:
Longitudinal RV global peak systolic strain was significantly impaired in OMI compared to Control (−18 ± 5* and −25 ± 4 %, *p < 0.05 vs. Control) whereas RV fractional area change failed to discriminate from normal to impaired RV function (OMI: 48 ± 11 vs. Control: 52 ± 6 %, p = NS). When divided OMI into three groups regarding to plasma BNP level (Group A: BNP < 100 pg/ml; n = 14, Group B: 100 pg/ml ≤ BNP < 500 pg/ml; n = 14, and Group C; BNP ≥ 500 pg/ml; n = 11), Group A had no significant relations between longitudinal RV global peak systolic strain and LV ejection fraction (y = −0.07x − 11, r = 0.30, p = NS) whereas those were significantly correlated in Group B (y = −0.18x − 11, r = 0.59*, *p < 0.05). Furthermore, the strongest correlation between longitudinal RV global peak systolic strain and LV ejection fraction was observed in Group C (y = −0.58x + 5, r = 0.90*, *p < 0.05).

Conclusion:
Speckle tracking strain imaging quantified longitudinal RV global systolic function and exhibited its BNP-related dependency to LV systolic function in patents with OMI.
Abstract 2013: Predictors of Out-of-hospital Cardiac Arrest Survival: Influence of The Utstein Measures.
Authors: Rea Thomas , Cook Andrea J , Aufderheide Tom P , Beaudoin Tammy , Bigham Blair , Callaway Clif , Chugh Sumeet , Davis Daniel , Idris Ahamed , Morrison Laurie J , Nichol Graham , Powell Judy L , Stiell Ian G , Terndrup Tom , Thiruganasambandamoorthy Venkatesh , Wittwer Lynn
Published: July 2021

Background
The Utstein elements provide measures for comparing out-of-hospital cardiac arrest (OHCA) care and outcomes within and across communities. Whether these measures sufficiently predict survival and explain variation in outcome is not well studied.

Hypotheses
Utstein data elements predict survival to hospital discharge but explain only a portion of survival variation.

Methods

Design
Prospective, population-based cohort using uniform data definitions.

Setting
Ten North American sites participating in the Resuscitation Outcomes Consortium, a prehospital emergency care network.

Population
Persons ≥ 20 years with OHCA from 12/1/2005 – 11/30/2006 (n=9582).

Analyses
We used logistic regression to assess association between Utstein elements and survival and to determine whether they accounted for site survival differences. We evaluated measures of residual variance to assess what proportion of outcome variation the Utstein elements predicted.

Results
Survival was 7.0% overall. Utstein elements were associated with survival (Table

). Relationships were similar when restricted to those with ventricular fibrillation. In analyses assessing variance of residuals, Utstein elements collectively accounted for 15% of variation in survival. Site was also associated with survival, ranging from 3.7% to 15.6%. In multivariable analyses, site association was not attenuated by adjusting for Utstein elements.

Conclusion
Although Utstein elements predict survival, they account for a modest portion of variation overall and do not explain survival differences across sites. Additional factors should be investigated to understand and potentially improve OHCA outcome.
Abstract 2020: The Effect of Global Ischemia and Reperfusion on Long Duration of Human Ventricular Fibrillation: A Multi-Electrode Mapping Study
Authors: Masse Stephane , Hamad Adel K , Dhopeshwarkar Rajesh , Al-Kaabi Salem , Asta John , Ross Heather , Yau Terry , Rao Vivek , Sevaptsidis Elias , Nanthakumar Kumar
Published: July 2021

Introduction:
The most significant change to the latest AHA CPR guidelines is the recommendation of CPR first followed by defibrillation, for un-witnessed arrests. We tested the hypothesis that global myocardial ischemia during ventricular fibrillation (VF) decreases activation rate and short duration of reperfusion would normalize activation rates.

Methods:
We studied 6 Langendorff perfused human hearts which were explanted from cardiomyopathic patients who underwent transplantation. Tyrode solution was used for perfusion and flow was maintained at 0.9 to 1.1 ml/g/min. Multi-electrode mapping was performed for the entire epicardium (112 electrodes sock array) and the LV endocardium (112 electrodes balloon array). VF was induced by applying a 9-volt battery on the epicardium. As soon as the VF episode was induced, perfusion was turned off for 200 seconds mimicking global ischemia. At the end of this period the perfusion system was turned back on at a flow similar to baseline for an additional 140 seconds, mimicking a state of reperfusion. The hearts were then defibrillated and this protocol was repeated twice after a rest period of 5 minutes. For the analysis, 20 s electrograms located on the LV freewall (both endo and epi) were recorded at t = 0, 90, 180, 260 and 320s, for a total of 11520 electrograms. Local Activation Rates (LAR) for each electrogram was determined as the dominant frequency (DF) corresponding to the highest value in the power spectrum between 1.5 and 8 Hz.

Results:
Activation rate decreased from 4.962±0.020 Hz to 3.704±0.022 Hz (p<0.0001) during the 200 seconds of global ischemia. During the 140 seconds of reperfusion the activation rate increased to 4.882±0.024 Hz (p<0.0001). This value was comparable to what was measured at the onset of VF (p = 0.011). These changes of rates were similar for both endocardium and epicardium data (p = 0.0236).

Conclusions:
During long episodes of human VF, global myocardial ischemia leads to slowing of activation rate on the epicardium and endocardium. Two minutes of re-perfusion leads to reversal of this effect. These findings may support the recent change in CPR guidelines.
Abstract 2041: Low P2Y
12
-Specific Platelet Inhibition in Clopidogrel-Treated Patients with Coronary Artery Disease is Common and not Reliably Detected by Conventional Aggregation Tests
Authors: Schaefer Andreas , Weinberger Sarah , Eigenthaler Martin , Ertl Georg , Bauersachs Johann
Published: July 2021

Background: Incomplete inhibition of P2Y
12
-mediated platelet activation during clopidogrel treatment has been associated with increased cardiovascular morbidity and mortality after percutaneous coronary intervention. This study aimed to investigate the incidence of impaired individual clopidogrel-responsiveness using a P2Y
12
-specific and pre-treatment-independent assay in a real world situation.

Methods: 100 consecutive patients with coronary artery disease on clopidogrel treatment (> 5 days including a loading dose of at least 300 mg) were screened for response to ADP-induced platelet signalling. We assessed the vasodilator-stimulated phosphoprotein-based platelet reactivity index (PRI) as the only P2Y
12
-specific assay to determine clopidogrel responsiveness. Insufficient inhibition of P2Y
12
by clopidogrel was defined as a PRI >50% based on previous studies indicating increased risk of stent thrombosis under this condition. The results were compared with conventional assays to assess ADP-induced P-selectin surface-expression and conventional turbinometric platelet aggregation to several concentrations of ADP.

Results: Clopidogrel significantly lowered functional platelet reactivity in patients with coronary artery disease compared to untreated patients. However, insufficient individual response to treatment predisposing for adverse events and therefore previously described as “non-response” was diagnosed in 69% of clopidogrel-treated patients using PRI. Conventional aggregation failed to detect insufficient P2Y
12
-inhibition in 1/3of patients with a PRI>50%.

Conclusion: Using the PRI as the only P2Y
12
-specific assay to evaluate the treatment effect of clopidogrel in patients with coronary artery disease, insufficient P2Y
12
-inhibition was present in the majority of patients in a real-world scenario. Insufficient P2Y12-inhibition could not be reliably detected by conventional aggregation More prospective studies are needed to evaluate the influence of the high prevalence of incomplete clopidogrel responsiveness to major adverse cardiac events.
Abstract 2055: A Fingertip-Mounted Ultrasound Probe for Open-Chest Echocardiographic Imaging During Heart Surgery: Pilot Studies with a New Scanning Method
Authors: Hui Ling , Schutz Ronald W , Corbett Scott , Dudik Evan , Kinnune Shelly , Sahn David J
Published: July 2021

Background:
We report a newly developed fingertip-mounted ultrasound probe (SonicEye®), which has been applied to an open-chest intraoperative imaging study. This probe is small, flexible, and quickly detachable. Its intuitive positioning makes it easy to acquire images in standard as well as unique views including views from the diaphragmatic surface of the left ventricle and behind the left atrium with a “heads up” that can be easily viewed by the surgeon while looking at the heart and the probe.

Methods:
In an open-chest study of two 12–14 kg piglets, the finger-mounted (11 mm radius, 4 – 6 MHz) and a conventional phased array ultrasound probe (Siemens 7V3C, 4 – 6 MHz) were used for scanning on a Siemens Cypress system. Images were recorded and analyzed for quality of image offline.

Results:
The fingertip-mounted ultrasound probe had the same performance as the conventional ultrasound probe as regards to image quality and Doppler performance. Furthermore, the probe could provide unique views from behind the left atrium and/or under the diaphragmatic surface of the left ventricle that even TEE does not match.

Conclusions:
The fingertip-mounted probe was able to capture high quality images during our study. This probe is easy to wear and provides high resolution unique images which should be useful for intraoperative evaluation of cardiac repairs.
Abstract 2106: Quantification of Doppler Flow Velocity-Derived Pulmonary Flow Reserve in Healthy Primates
Authors: Ilsar Rahn , Chawantanpipat Chirapan , Hennessy Annemarie , Waugh Richard , Celermajer David S , Ng Martin K
Published: July 2021

Background: Pulmonary vascular disease (PVD), characterized by progressive pulmonary microvascular destruction, is only clinically evident late in its course when pulmonary artery pressure (PAP) rises. We hypothesized that changes in pulmonary flow reserve (PFR, maximal hyperemic vs. basal flow) may precede the PAP rise and thus aimed to:

validate invasively-measured Doppler flow-velocity (v

dopp

) as a marker of pulmonary blood flow and

define the optimal hyperemic agent and dose for v

dopp

-derived PFR (PFR

dopp

) assessment, in healthy baboons.

Methods: Eight baboons were anaesthetized and a Doppler-sensing guidewire (DSG) placed in a segmental pulmonary artery. Angiographically-determined vessel diameter (
D
) and DSG-measured v

dopp

were obtained at baseline and at increasing intrapulmonary normal saline (NS) infusion rates and boluses. Escalating local doses of adenosine, acetylcholine & papaverine were administered, v

dopp

obtained and PFR

dopp

calculated.

Results: NS administration did not change
D
or v

dopp

(panels A & B, p≥0.4). Adenosine produced a dose-dependent increase in v

dopp

maximal at 200μg/kg/min (p<0.0001, panel C), papaverine to 24mg significantly increased v

dopp

(p<0.0001, panel D) but acetylcholine to 10
−
l concentration reduced v

dopp

(p=0.0008). Adenosine and papaverine-derived PFR

dopp

values were 1.5–2.0.

Conclusions: As
D
does not vary with NS or hyperemic agent administration, v

dopp

is a valid marker of pulmonary blood flow. Adenosine and papaverine can be used with a Doppler-flow wire to derive PFR, with normal baboon PFR

dopp

being 1.5 – 2.0. Thus PFR

dopp

may be a potential novel marker for investigating early PVD.
Abstract 2131: The Association of Coarctation of Aorta Diminishes the Occurrence of Ascending Aorta Dilation in Children and Young Adults with Bicommissural Aortic Valves.
Authors: Nguyen Thieu , Beaton Andrea Z , Lai Wyman W , Ramaswamy Prema , Parness Ira A , Srivastava Shubhika
Published: July 2021

Objectives: To explore the difference in ascending aortic dilatation between subgroups of bicuspid aortic valve (BAV) patients with and without coarctation of the aorta (CoA).

Methods: Our echocardiographic database (1993–2006) was searched for BAV patients with CoA (Group A) and without CoA (Group B). Measurements at the aortic annulus, root, sinotubular junction, and ascending aorta were obtained for each patient, and body surface area-adjusted Z-score values were compared. Exclusion criteria included more than mild aortic stenosis or regurgitation, previous balloon aortic valvuloplasty, or complex left heart disease; plus Turner, Noonan, Williams, and Marfan Syndromes.

Results: The median age in Group A (n=53) was 11.3 yrs (range 0 to 30) with median follow-up of 7 yrs (0 to 12.7); median age in Group B (n=145) was 8.7 yrs (0 to 29) with median follow-up of 4 yrs (0 to 13.1). Group B patients had significantly greater aortic annulus, sinotubular junction, and ascending aortic dimensions (ascending aorta Z-scores shown in Figure

, p<0.0001). Group A ascending aortic dimensions did not differ significantly from the normal population. The rate of growth of the ascending aorta in Group B was higher in the first 10 years of life.

Conclusion: The ascending aorta in patients with bicuspid aortic valve and coarctation does not dilate to the same degree as patients with isolated bicuspid aortic valve. This may reflect an inherent difference in aortic wall properties between the two groups.

Comparison of Ascending Aorta Z Scores