bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13849: Impact of Statin-Ezetimibe Combination on Coronary Atheroma Progression/Regression in Patients With and Without Prior Statin Therapy - Subanalysis of PRECISE-IVUS Trial
Authors: Tsujita Kenichi , Yamanaga Kenshi , Sugiyama Seigo , Shimomura Hideki , Yamashita Takuro , Sakamoto Kenji , Nakao Koichi , Nakamura Sunao , Ishihara Masaharu , Matsui Kunihiko , Yamamoto Nobuyasu , Koide Shunichi , Matsumura Toshiyuki , Fujimoto Kazuteru , Tsunoda Ryusuke , Morikami Yasuhiro , Matsuyama Koushi , Oshima Shuichi , Kaikita Koichi , Hokimoto Seiji , Ogawa Hisao
Published: July 2021

Introduction:
IMPROVE-IT trial showed the clinical benefit of statin-ezetimibe (EZE) combination appeared to be pronounced in patients with prior statin therapy. On the other hand, the PRECISE-IVUS (
P
laque
RE
gression with
C
holesterol absorption
I
nhibitor or
S
ynthesis inhibitor
E
valuated by
I
ntra
V
ascular
U
ltra
S
ound) trial was a prospective, randomized, controlled, multicenter study evaluating the effects of EZE addition to atorvastatin (atorva), compared with atorva monotherapy, on coronary atherosclerosis evaluated by IVUS and lipid profile.

Hypothesis:
We hypothesized that the antiatherosclerotic effect of atorva-EZE combination was pronounced in patients with statin pretreatment.

Methods:
246 patients undergoing IVUS-guided percutaneous coronary intervention were randomized to EZE/atorva combination or atorva alone. The dosage of atorva was uptitrated with a treatment goal of lowering low-density lipoprotein cholesterol (LDL-C) below 70mg/dL. Serial volumetric IVUS was performed at baseline and 9–12 months follow-up to quantify the coronary plaque response in 202 patients. We compared the IVUS endpoints in all subjects, stratified by the presence of statin pretreatment.

Results:
The baseline LDL-C level (100.7±23.1mg/dL vs. 116.4±25.9mg/dL, p<0.001) and lathosterol (55 [38 to 87])μg/100mg TC vs. 97 [57 to 149]μg/100mg TC, p<0.001) was significantly lower, and campesterol/lathosterol ratio (3.9 [2.4 to 7.4] vs. 2.6 [1.5 to 4.1], p<0.001) was significantly accelerated in patients with statin pretreatment. Contrary to the patients without statin pretreatment (-1.3 [-3.1 to -0.1]% vs. -0.9 [-2.3 to 0.9]%, p=0.12), the atorva-EZE combination showed the significantly stronger reduction in delta percent atheroma volume, compared with atorva alone, in patients with statin pretreatment (-1.8 [-3.6 to -0.3]% vs. -0.1 [-1.6 to 0.8]%, p=0.002).

Conclusions:
Compared to atorva alone, atorva-EZE combination demonstrated stronger regression effect in coronary atheroma volume especially in patients with statin pretreatment. Compensatory accelerated cholesterol absorption might be associated with reduced coronary plaque regression. Low-dose statin-EZE combination might be a promising option in statin-hyporesponder.
Abstract 14119: Contrasting Effects of Exercise Training After Acute Myocardial Infarction versus Aortic Stenosis Depend Critically on the Regulation of Endothelial Nitric Oxide Synthase
Authors: Octavia Yanti , van Deel Elza D , de Waard Monique , de Boer Martine , Duncker Dirk J
Published: July 2021

Introduction:
The cardiovascular benefits of exercise training (EX) are widely appreciated. Previously we found that the cardiac effects of EX critically depend on the underlying cause of heart disease.

Hypothesis:
The underlying etiology determines how EX affects the endothelial nitric oxide (NO) synthase (eNOS)-mediated balance between NO and superoxide (O2-).

Methods:
Mice were subjected to sham surgery, myocardial infarction (MI) or transverse aortic constriction (TAC), and subsequently exposed to 8 weeks of voluntary wheel running or sedentary housing. Left ventricular (LV) function was assessed by echocardiography and hemodynamic measurements; fibrosis by Picro-sirius Red staining; peroxynitrite (ONOO-) and O2- production by luminol- and lucigenin-enhanced chemiluminescence respectively, with or without the NOS inhibitor L-NAME; eNOS uncoupling and eNOS S-glutathionylation by western blot and coimmunoprecipitation, respectively; cardiac NO by the Griess reaction.

Results:
EX ameliorated LV dysfunction and fibrosis in MI but not TAC (Table 1). Strikingly, O2- generation was blunted by EX in MI, but exacerbated by EX in TAC, which was largely NOS-dependent. Accordingly, eNOS uncoupling and eNOS S-glutathionylation were corrected by EX in MI but aggravated in TAC mice. In parallel, ONOO- levels was attenuated by EX in MI but aggravated by EX in TAC. Cardiac NO levels were reduced in MI and TAC and normalized by EX in MI.

Conclusions:
The contrasting effects of EX in MI vs TAC can be explained by the highly divergent effects of EX on eNOS regulation, resulting in blunted vs aggravated oxidative stress by EX in MI vs TAC.
Abstract 14287: Ang II-induced Pathological Autophagy is Inhibited by IL-10 via Akt Dependent Inhibition of Beclin 1 in Mice Heart
Authors: Verma Suresh K , Krishnamurthy Prasanna , Girikipathi Venkata N , Abramova Tatiana , Gumpert Anna , Khan Moshin , Emily Nickoloff , Johnson Jennifer , Benedict Cindy , Koch Walter , Kishore Raj
Published: July 2021

Although, autophagy is an essential cellular salvage process to maintain cellular homeostasis, pathological autophagy can lead to cardiac abnormalities and ultimately heart failure. Therefore, a tight regulation on autophagic process would be important to treat chronic heart failure. Previously, we have shown that IL-10 strongly improved cardiac function in chronic heart failure models, but the role of IL-10 in regulation of pathological autophagy is not yet investigated. We tested the hypothesis that IL-10 inhibits angiotensin II-induced pathological autophagy and thus improved cardiac function. Pathological autophagy was induced in wild type (WT) and IL10-knockout mice by angiotensin II infusion. Ang II-induced left ventricular dysfunction and hypertrophic remodeling were accentuated in IL-10 KO mice compared to WT mice. IL-10 KO mice showed exaggerated autophagy with reduced AKT phosphorylation. In neonatal rat ventricular cardiomyocytes, Ang II activated beclin1 and LC3 levels and inhibited AKT/mTORC1 and AKT-Bcl2 signaling. IL-10 inhibited Ang II-induced autophagic marker proteins. Additionally, IL-10 restored Ang II effects on AKT/mTORC1 and AKT-Bcl2 signaling. Both pharmacological/molecular inhibition of AKT via PI3K inhibitor (LY290002) or Akt siRNA, attenuated IL-10 effects on the Ang II-induced pathological autophagy, confirming that IL-10 mediated regulation of pathological autophagy is AKT dependent. Similar results were observed with mTORC1 inhibitor rapamycin. Chloroquine (a lysosome inhibitor) strongly inhibits Ang II-induced autophagic flux. However, chloroquine did not affect IL-10 effects on autophagic flux, suggesting that IL-10 inhibits stress-induced pathological autophagy. Finally, as physical interaction of Bcl2 with beclin 1 is important to inhibit autophagy and IL-10 is strong activator of Bcl2, we performed immunoprecipitation experiment. Immunoprecipitation data suggested that Ang II disrupt the physical interaction of beclin 1 with Bcl2 and IL-10 reestablished this physical interaction to reduce autophagy. Our data give a novel role of IL-10 in regulation of pathological autophagy and thus can act as a potential therapeutic molecule in treatment of chronic heart disease.
Abstract 14303: Low Global Longitudinal Strain in Ischemic Cardiomyopathy Patients at Baseline is Associated With Ventricular Arrhythmias After Cardiac Resynchronization Therapy
Authors: Tayal Bhupendar , Delgado-Montero Antonia , Goda Akiko , Saba Samir , Risum Niels , Sogaard Peter , Gorcsan John
Published: July 2021

Introduction:
Heart failure (HF) patients have an increased risk for ventricular arrhythmias (VA) and in particular patients with ischemic cardiomyopathy (ICM) have a worse prognosis after cardiac resynchronization therapy with defibrillator (CRT-D) compared with non-ischemic patients.

Hypothesis:
We hypothesize that global longitudinal strain (GLS) at baseline has the ability to identify ICM patients at higher risk for VA after CRT-D.

Methods:
We prospectively studied 175 consecutive HF patients implanted with CRT-D from a single center. All of them had class II-IV HF symptoms, LV ejection fraction (≤35%), QRS≥120 ms. GLS was measured from the three standard apical views and presented as absolute values. Outcome event was defined as VA (anti-tachycardia pacing or appropriate shock) after CRT in the first 2 years of follow-up.

Results:
Of 175 patients aged 65±11 years, 135 (77%) were male and 115 (66%) had ICM. They suffered 34 (19%) VA events over 2 years. Mean GLS of the population was 8.1±3.0. GLS (< 6.5%) was associated with VA events after CRT-D with a sensitivity of 70% and specificity of 56%. A cutoff of GLS<6.5% was associated with greater VA events in the ICM patients with HR 2.92 (95% confidence interval 1.48 to 5.77, p=0.002). A similar significant association of GLS was not seen in the non ICM patients (p=0.12).

Conclusions:
Low GLS (<6.5% in absolute values) in ICM patients is associated with increased risk for VA after CRT-D and might represent more extensive myocardial scarring and has prognostic implications.
Abstract 14346: Correlation of Corevalve Device Implantation ‘Cover Index’ With One Month Aortic Regurgitation
Authors: Vavuranakis Manolis , Kalogeras Konstantinos , Kolokathis Angelos_Michail , Lavda Maria , Vrachatis Dimitrios , Kariori Maria , Bei Evelina , Vaina Sophia , Siasos Gerasimos , Oikonomou Euaggelos , Tousoulis Dimitrios
Published: July 2021

Introduction:
Aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) has been demonstrated to be related with haemodynamic deterioration and left ventricle remodeling, leading to impaired long-term prognosis. ‘Cover index’ has been proposed to appraise the congruence between the aortic annulus and the device, correlating with AR after device deployment.

Hypothesis:
Hypothesis of the study was that the annulus-prosthesis-size mismatch, as expressed through ‘cover index’, is correlated with one month AR after implantation of a self-expandable aortic prosthesis.

Methods:
From June 2008 until June 2014, patients who had undergone TAVI with the CoreValve device, were retrospectively studied. The ‘cover index’ was evaluated, as previously shown, as a ratio of: 100 X ([prosthesis diameter - annulus diameter]/prosthesis diameter). The aortic valve regurgitation was echocardiographically evaluated early after the device employment and at 30 days after TAVI and classified as none, mild and moderate.

Results:
A total of 133 patients (mean age 80.5±5.4 yrs, 72 males) were finally enrolled. The implantation was performed either transfemoraly, or through subclavian route (15 patients). Immediately after the implantation, no statistically significant difference was detected, regarding the evaluated ‘cover index’, between the assessed AR classifications. However, a statistically significant difference was found for the ‘cover index’ between the three one month post-TAVI aortic regurgitation classifications (18.7±4.2 for none AR, 17.2±5mm for mild and 15.2±3.9mm for moderate AR, p=0.037 between groups), indicating increased AR for lower ‘cover index’.

Conclusions:
The congruence between the aortic annulus and the device, as expressed with ‘cover index’, is strongly correlated with the mid-term one month AR after CoreValve implantation. These data reinforce the importance of appropriate pre-procedural aortic valve sizing and the dynamic component of the self-expandable valves during the early post implantation period.
Abstract 14563: Improving Monitoring Outcomes and Quality of Life for Heart Failure Patients in Telehomecare Program
Authors: Rac Valeria E , Sahakyan Yeva , Shahid Nida , Stanimirovic Aleksandra , Fan Iris , Ryan Welson , Pechlivanoglou Petros , Abrahamyan Lusine , Krahn Murray
Published: July 2021

Introduction:
Introduced in 2007 by the Ontario Telemedicine Network, the Telehomecare program provides monitoring of patient’s parameters and coaching sessions. There is an inconclusive data on the association of participation and patient-level outcomes.

Hypothesis:
We hypothesized that blood pressure (BP), daily weight fluctuation and quality of life would improve among heart failure patients participating in the Telehomecare.

Methods:
We applied a time series study design to analyze patients’ blood pressure and weight, transmitted via telemonitoring devices on a daily basis. Longitudinal surveys were conducted on a small sample of prospectively enrolled patients (n=22) to assess quality of life using EQ-5D and SF-12 over the three-month period. Daily weight gain was defined as an increase of ≥2 lbs between two consecutive measurements. The data for the period of July 2012 to March 2015 was analysed by repeated measures with generalized linear mixed model procedures in SAS.

Results:
Overall 1354 patients with heart failure (52% women) were enrolled with average age of 76.3±11.1. During the first month of enrolment, one third of the patients (n=433) had elevated BP with a monthly average systolic BP of 150.3±9.6 mm Hg and diastolic BP of 76.7±12.8, in comparison with adequately controlled (n=921) patients, who had an average systolic BP of 118.8±13.5 mm Hg and diastolic BP of 66.4±9.6 mm Hg. Over the seven month period, we found significant reduction in systolic (by 11.0 mm Hg; 95% CI 9.3-12.7) and diastolic BP (by 6.0 mm Hg; 95% CI 4.9-7.3) among patients who had elevated values at baseline, adjusted for age and gender. During the first month of enrolment, weight gain of ≥2 lbs was registered for 8% of days. The likelihood of daily weight gain slightly declined over the seven month period (OR 0.86. 95% CI 0.75-0.98). Physical and mental component scores of SF-12 and EQ 5D’s index score did not improve significantly except for EQ 5D visual analogue scale scores.

Conclusion:
In conclusion, changes observed in the patient monitoring parameters over time pointed out that hypertensive patients might benefit the most from the Telehomecare. The survey evaluations failed to detect any significant impact of the Telehomecare on the patients’ quality of life.
Abstract 14566: Mild Elevation in Cardiac Troponin T is Independently Associated With Long-Term Mortality After Intermediate or High-Risk Vascular Surgery
Authors: Reed Grant W , Horr Samuel , Ellis Stephen G , Lincoff A. Michael , Nissen Steven E , Menon Venu
Published: July 2021

Introduction:
Myocardial injury is a risk factor for adverse outcomes after non-cardiac surgery. However, the prevalence of cardiac troponin T (cTnT) sampling after vascular surgery in real-word practice has not been well studied. Further, whether mild perioperative cTnT elevation is associated with long-term mortality is not established.

Methods:
This was a retrospective study of 13,196 patients who underwent intermediate or high-risk vascular surgery at a single center from January 1, 2010 - May 1, 2015. Patients were assessed for cTnT sampling within 96 hours of surgery. Cumulative 3 year mortality was stratified by absence of cTnT sampling, a normal value of 0.10 ng/mL. Cox proportional hazards analysis was used to adjust mortality for Revised Cardiac Risk Index (RCRI) score and other patient characteristics.

Results:
Mean age was 66.2±14.4 years, and 5,357 (40.6%) were female. Troponin was sampled in 3,296 (25.0%) patients, and among those 747 (5.7%) were elevated (positive yield 22.7%). There were 1,858 (14.1%) deaths. On Kaplan-Meier analysis, all-cause mortality was greatest with elevated cTnT (p<0.0001, Figure - A) and was higher across degrees of cTnT elevation (p<0.0001, Figure - B). After adjusting for RCRI score, age, gender, and diabetes, degree of cTnT elevation remained independently associated with mortality (Table).

Conclusions:
The degree of cTnT elevation independently predicts long-term mortality after vascular surgery. Even mild elevations of cTnT above threshold are associated with heightened risk of mortality, which extends well beyond the acute post-operative period.
Abstract 14598: The Novel Cardiac Biomarker Secretoneurin Provides Independent Prognostic Information in Severe Sepsis and Septic Shock: Data From the ALBIOS Study
Authors: Røsjø Helge , Masson Serge , Caironi Pietro , Stridsberg Mats , Fanizza Caterina , Christensen Geir , Moise Gabriella , Urbano Maria Cristina , Gattinoni Luciano , Latini Roberto , Omland Torbjørn ,   on behalf of the ALBIOS Investigators
Published: July 2021

Background:
Plasma secretoneurin (SN) is directly correlated to cardiomyocyte Ca
2+
handling and provides independent prognostic information in cardiovascular disease. Whether SN may predict mortality in patients with severe sepsis or septic shock is not established.

Methods:
We measured SN levels in serial plasma samples collected on days 1, 2, and 7 in 958 patients enrolled in the multicenter, open-label, randomized, controlled ALBIOS trial, that tested either 20% albumin and crystalloid solutions or crystalloid solutions alone in patients with severe sepsis or septic shock. Endpoints were ICU or 90 day mortality.

Results:
SN levels on day 1 were higher in non-survivors compared to survivors, both for ICU mortality (235 [Q1-Q3 188-290] vs. 192 [155-246] pmol/L, p<0.0001) and for 90 day mortality (227 [183-283] vs. 188 [154-234] pmol/L, p<0.0001). Admission SN levels were influenced by age and lactate, creatinine and NT-proBNP levels. Stratifying patients according to SN quartiles on day 1 separated survivors and non-survivors during follow-up (Figure). After adjusting for clinical risk factors, SAPS II and SOFA scores, and cardiac biomarkers (hs-cTnT and NT-proBNP), SN levels (logarithmical transformed) on day 1 remained significantly associated with ICU mortality (OR 1.29 [95% CI 1.07-1.55], p=0.007) and 90 day mortality (OR 1.22 [1.02-1.47], p=0.03). SN levels on day 2, but not day 7, were also independently associated with ICU and 90 day mortality. SN levels on day 1 and 2 improved prognostic accuracy for ICU and 90 day mortality as assessed by the category-free net reclassification index. We found no interactions between SN levels and randomization to albumin replacement for prediction of mortality during follow-up. Changes in SN levels over time were not predictive of subsequent mortality.

Conclusion:
SN provides incremental information to established risk models and cardiovascular biomarkers in patients with severe sepsis and septic shock.
Abstract 14608: Non-Invasive Derivation of Resting Coronary Artery Flow Directly From CT Angiography (CTA) via the Transluminal Attenuation Gradient (TAG) in Left- versus Right-Dominant Circulation
Authors: Mitsouras DImitrios , Sewatkar Rani , Giannopoulos Andreas A , Agrawal Mukta , George Elizabeth , Cheezum Michael K , Shanbhag Sujata , Blankstein Ron , Chen Marcus Y , Rybicki Frank J
Published: July 2021

Introduction:
The TAG characterizes the dropoff in CTA contrast enhancement along the length of a vessel. It can detect functionally significant CAD without additional CTA radiation or computation. However, its relationship to flow is not established.

Hypothesis:
We sought to establish how TAG relates to previously-reported values of coronary flow.

Materials and Methods:
TAG was measured in the 3 major coronary arteries (LAD,LCX,RCA) of 42 patients (35 right- [RD], 7 left/co-dominant [LD]) with <25% stenosis imaged with single heart-beat 320-row CT. TAG was adjusted for scan kVp based on the relationship of iodine concentration vs blood HU. First, the ratio of TAG in each artery for RD vs LD arteries was compared to that of invasively-measured flow reported in n=496 patients (PREDICTION trial, Sakamoto et al, Am J Cardiol 2013;111:1420). Second, in 34 patients with CTA bolus tracking images available, the rate at which contrast was increasing at CTA (ie, HU increase/sec) was measured as a linear fit of descending aortic attenuation in the tracking images vs time to calculate flow via the following theoretical relationship we derived for TAG and flow (Figure): Q[ml/sec]~Lumen Area[cm^2]*Contrast inflow slope[HU/sec]/TAG[HU/cm]. Lumen area was determined for the arterial length used for TAG measurement.

Results:
TAG LD-to-RD ratios were within 2%, 6% and 30% of flow ratios in the LAD, LCX and RCA respectively (Table). LAD and LCX flow derived from TAG was within 4-16% of reported flow; RCA flow was over-/underestimated by 51%/20% in RD/LD patients, respectively (Table).

Conclusion:
TAG in non-stenotic coronaries is related to resting coronary flow. Knowledge of the temporal change of inflowing contrast concentration enables derivation of reasonable values of coronary flow from CTA using the TAG. This is a critical step toward obtaining the flow boundary conditions for FFR-CT techniques to non-invasively detect functionally significant CAD.
Abstract 14708: Prothrombin Time is a Novel Marker for Congestion in Acute Decompensated Heart Failure Patients Without Anticoagulants
Authors: Okada Atsushi , Sugano Yasuo , Nagai Toshiyuki , Honda Satoshi , Asaumi Yasuhide , Aiba Takeshi , Noguchi Teruo , Kusano Kengo F , Ogawa Hisao , Yasuda Satoshi , Anzai Toshihisa
Published: July 2021

Background:
Where prothrombin time is widely used to monitor anticoagulation in cardiology patients, it is also a classical marker of liver damage. However, the clinical significance of prothrombin time in heart failure patients without anticoagulants is unknown. Therefore, we investigated the prevalence, relationship with clinical characteristics, and prognostic value of prothrombin time in acute decompensated heart failure (ADHF).

Method:
We prospectively studied 651 consecutive patients admitted for ADHF. Prothrombin time internationalized normalized ratio (PT-INR) was measured on admission in all patients. By excluding patients with oral anticoagulants, acute coronary syndrome and liver diseases, 308 patients were assessed. We assessed the relationship between PT-INR and blood tests, echocardiogram, and hemodynamic parameters from right heart catheterization. Cox regression hazard analysis was performed to assess prognostic value of PT-INR on all-cause mortality and cardiovascular mortality.

Results:
Of the 308 patients (75±13 years, 192 male), the mean PT-INR value was 1.10. Patients with prolonged PT-INR(>1.10, n=104) had significantly higher total bilirubin, alkaline phosphatase and gamma-glutamyl transpeptidase (all p<0.05), however, had similar LVEF, blood urea nitrogen, creatinine, and BNP compared to those with less PT-INR(≦1.10, n=204). PT-INR value had strong correlation with pulmonary capillary wedge pressure (r=-0.61, p<0.01) and right atrial pressure (r=-0.59, p<0.01), but not with cardiac index (r=0.23, p=ns.). Twenty-two patients (7%) died during a mean follow up of 317 days, and Cox proportional hazards analysis showed that PT-INR was an independent predictor of both all-cause mortality (HR=1.14, p<0.05) and cardiovascular mortality (HR=1.12, p<0.05) even after adjusted by age, sex, LVEF, creatinine, BNP and hemoglobin.

Conclusion:
Prolonged PT-INR in ADHF patients without anticoagulants was associated with clinical markers of hepatic congestion and elevated right sided pressure. It was also an independent predictor of all-cause and cardiovascular mortality.
Abstract 14779: Soleal Vein Dilatation Assessed by Ultrasonography is an Independent Predictor for Deep Vein Thrombosis After Total Hip Arthroplasty
Authors: Yuda Satoshi , Abe Kiyoshi , Yasui Kenji , Okubo Ayumi , Muranaka Atsuko , Hashimoto Akiyoshi , Teramoto Atsushi , Nagoya Satoshi , Tsuchihashi Kazufumi , Yamashita Toshihiko , Miura Tetsuji
Published: July 2021

Introduction:
Deep vein thrombosis (DVT) develops after lower limb arthroplasty despite the current use of prohylaxis. Thus, accurate risk stratification is warranted to establish new prophylactic strategies. Soleal vein (SV) dilatation is often found by ultrasonography, which is performd for the screeing of the DVT. However, if the SV dilatation is usable for prediction of the DVT after the lower limb arthroplasty remains unclear.

Hypothesis:
We aimed to examine whether the SV dilatation assessed by ultrasonography predicts the DVT after the lower limb arthroplasty.

Methods:
Ultrasonography was performed pre- (mean 5 days) and postoperatively (mean 8 days) in 135 osteoarthritic patients (age 66+/-13 years, 76% women) who underwent total hip arthroplasty (THA; n = 99) or knee arthroplasty (TKA; n = 36). The patients with preoperative DVT were excluded. Presence of DVT was diagnosed by ultrasonography, which was performed from the bilateral femoral to lower limb. Increased diameter of SV (>10 mm) assessed by ultrasonography was defined as the SV dilatation.

Results:
Thirty seven patients (27%) developed the DVT, which was proximal in one (3%) and distal in 36 (97%), after the lower limb arthroplasty. SV dilation was observed in 14 patients (10%). Of these, 11 (79%) had the postoperative DVT. Multivariate logistic regression analysis indicated that age (odds ratio [OR] 1.1, 95% CI 1.01 to 1.11, p=0.016), female (OR 4.9, 95% CI 1.18 to 19.9, p=0.028), TKA (OR 2.7, 95% CI 1.01 to 7.37, p=0.047), and SV dilatation (OR 18.8, 95% CI 4.0 to 88.8, p<0.001), but not presence of comorbidities, medications, operative time, plasma D-dimer value, independently predict postoperative DVT in the whole studied patients. Subgroup analyses according to the operation site demonstrated that the SV dilation was an independent predictor of postoperative DVT in the THA group (OR 11.1, 95% CI 2.1 to 59.0, p<0.01), however, not in the TKA group.

Conclusions:
In addtion to well-known risk factors for postoperative DVT, the SV dilatation assessed by ultrasonography is an independent predictor of the DVT after the THA. Assessment of the SV diameter by ultrasonography is useful for identfying patients with high risk for the postoprtative DVT after the THA.
Abstract 14833: National Trends in Complications and 30-day Re-hospitalization After Lead Removal/extraction: Analysis From a Cohort Of 42,878 Patients
Authors: Mulpuru Siva K , Noseworthy Peter A , Sangaralingham Lindsey R , Mawangi Raphael , Deshmukh Abhishek J , Shah Nilay D , Killu Ammar M , Asirvatham Samuel J , Cha Yong-Mei , Friedman Paul A
Published: July 2021

Introduction:
As the US population ages and indications for cardiac device implantation expand, there is a concomitant increase in patients undergoing lead removal/extraction (LR/E).. We sought to examine trends in outcomes and complications associated with LR/E.

Methods:
We conducted a retrospective analysis using data from a large U.S. commercial insurance database (privately insured and Medicare Advantage patients) identifying all patients undergoing LR/E between 2004 and 2013 with at least one year continuous medical plan enrollment prior to LR/E (to identify baseline comorbidities). Using ICD9 codes and CPT codes, major complications (hemorrhage requiring transfusion, vascular injury, pericardial complications, respiratory complications, cerebrovascular complications, and requirement for cardiac surgery) associated with LR/E and 30-day readmission rates were evaluated.

Results:
Among 42,878 patients who underwent LR/E (median age of 62 ( 54, 72) years, 70% male); approximately 1 in 40 experienced a major adverse event (2.4%) during the study period. Respiratory complications were the most common complication and 311 patients required cardiac surgery. 30-day readmission occurred in 11.1% of the total population. The most common reasons for readmission were heart failure exacerbation (18.7%) and device related complications (13.2%).

Conclusion:
The observed complication rates after LE/R in clinical practice are similar to those seen in recent clinical trials and have been relatively stable over the past 10 years.
Abstract 14841: Definitions of Stage D Heart Failure and Survival: Comparing INTERMACS Profiles, ESC Criteria, and Physician Assessment
Authors: Hedley Jeffrey S , Tahhan Ayman S , McCue Andrew A , Bjork Jonathan B , Yazdani Mariyah , Al-Anbari Raghda , Butler Javed , Georgiopoulou Vasiliki V , Kalogeropoulos Andreas
Published: July 2021

Introduction:
Care for patients with stage D heart failure (HF) is becoming increasingly complex in the era of mechanical circulatory support (MCS). However, an operational consensus definition of stage D HF is currently lacking.

Hypothesis:
Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles better identify outpatients with stage D HF compared to European Society of Cardiology Heart Failure Association (ESC-HFA) criteria and physician assessment.

Methods:
We evaluated 474 outpatients with systolic HF (ejection fraction [EF] <40%) who received care in Q1 2012 and have not previously received advanced therapies (age, 61±15 years; 35.4% women; 44.7% white, 46.8% black; EF 24±10%; 67.2% with ischemic heart disease; 6.3% on home inotropes). We applied INTERMACS profiles (defining stage D as profiles 2-5) and ESC-HFA criteria to identify stage D HF, and compared with physician-derived stage D identification based on evaluations for advanced therapies (MCS, heart transplant, or palliative care). We then compared 3-year mortality across definitions.

Results:
INTERMACS profiles, ESC-HFA criteria, and physicians identified 50 (10.5%), 59 (12.4%), and 64 (13.5%) of 474 patients, respectively, as having stage D HF. Concordance between definitions was low, with
κ
=0.35 (optimal: 1.0). After a median of 3.1 years (1.6, 3.3), 95 patients died (3-year mortality: 21.4%). In addition, 24 patients received MCS and 11 received heart transplant. Mortality was 51.2%, 43.7%, and 34.5% for INTERMACS-, ESC-HFA-, and physician-identified stage D HF patients, respectively (
Figure 1
). The INTERMACS definition provided the best prognostic separation between stage D and C HF patients, as measured by the Royston’s R
2
statistic (
Figure 1
).

Conclusions:
INTERMACS profiles provide a reasonable alternative for the identification of stage D patients in ambulatory systolic HF populations and offer better prognostic information than the ESC-HFA criteria.
Abstract 14848: Meta-analysis of the Effects of Carvedilol vs Metoprolol on All-cause Mortality and Hospitalizations in Patients With Heart Failure
Authors: Briasoulis Alexandros , Mallikethi-Reddy Sagar , Sharma Shikha , Sudhakar Rajeev , Afonso Luis
Published: July 2021

Introduction:
Long-term treatment with appropriate doses of carvedilol or metoprolol is currently recommended for patients with Heart Failure with reduced Ejection Fraction (HFrEF) to decrease the risk of death, hospitalizations and patients’ symptoms. It remains unclear if the b-blockers used in HFrEF patients are equal or carvedilol is superior to metoprolol types.

Methods:
We performed a meta-analysis of the comparative effects of carvedilol vs metoprolol tartrate and succinate on all-cause mortality or/and hospitalization. We conducted an EMBASE and MEDLINE search for prospective controlled trials and cohort studies of patients with HFrEF who were received to treatment with carvedilol vs. metoprolol.

Results:
We identified 4 prospective controlled and 6 cohort studies with 30943 that received carvedilol and 69925 patients on metoprolol types (tartrate and succinate) with an average follow up duration of 36.4 months. All-cause mortality was reduced in prospective studies with carvdedilol vs metoprolol tartrate. Neither all-cause mortality nor hospitalizations were significantly different between carvedilol and metoprolol succinate in the cohort studies.

Conclusion:
In patients with HFrEF carvedilol and metoprolol succinate have similar effectiveness in reducing all-cause mortality.
Abstract 15100: A Decrease in Mitochondrial, but Not Cytosolic, Iron Protects Against Cardiac Ischemia-Reperfusion Damage Through a Reduction in ROS
Authors: Chang Hsiang-Chun , Wu Rongxue , Shang Meng , Ardehali Hossein
Published: July 2021

Introduction:
Iron can catalyze the formation of reactive oxygen species (ROS) and promote tissue damage. While some studies suggested benefits with iron chelation therapy in ischemic heart disease (IHD), several others failed to show any benefits. Mitochondria are a major site of iron utilization and ROS production, and mitochondrial iron accumulation has been associated with increased oxidative stress. We therefore hypothesized that mitochondrial iron plays a causative role in ischemia/reperfusion (I/R) damage, and a decrease in mitochondrial iron (as opposed to cytoplasmic iron) would be sufficient to protect against I/R injury.

Results:
We observed an increase in cardiac mitochondrial iron in mice after I/R injury. Using two iron chelators with distinct mitochondrial permeability, i.e., 2,2’-bipyridyl (BPD, a mitochondria-accessible iron chelator) and deferoxamine (DFO, an iron chelator that does not modulate mitochondrial iron), we demonstrated that mice pretreated with BPD but not DFO were protected against I/R injury. Similar results were obtained
in vitro
. Since these two iron chelators also modulate iron in other subcellular compartments, we used transgenic (TG) mice with cardiomyocyte-specific overexpression of the mitochondrial iron export protein ATP-binding cassette (ABC)-B8 to confirm that modulation of mitochondrial iron alone is sufficient to confer protection. ABCB8 TG mice had significantly lower mitochondrial iron (but normal cytosolic iron) in the heart compared to nontransgenic (NTG) littermates at baseline, but exhibited normal cardiac function. After I/R, ABCB8 TG mice displayed significantly less apoptosis and lower levels of markers of ROS and better preserved cardiac function than NTG littermates, suggesting that a reduction in mitochondrial iron protects against I/R injury, most likely through a reduction in ROS.

Conclusions:
Our findings demonstrate that selective reduction in mitochondrial iron is sufficient to protect against I/R injury. Thus, targeting mitochondrial iron with selective iron chelators may provide a novel approach for the treatment of IHD.
Abstract 15146: Updated Meta-Analysis of Role of Angiotensin Blockade in Reducing Aortic Dilatation in Patients With Marfan Syndrome
Authors: Kundu Amartya , Sardar Partha , Chatterjee Saurav , Aronow Wilbert S , Pape Linda
Published: July 2021

Introduction:
Patients with Marfan Syndrome have an increased risk of sudden death due to aortic dissection, mostly preceded by aortic dilatation.There has been considerable interest in evaluating the role of angiotensin blockade with Angiotensin Converting Enzyme (ACE) inhibitors or Angiotensin Receptor Blockers (ARB) on reducing the progression of aortic root dilatation in these patients. While earlier studies showed considerable benefit with ACE/ARB, recently large scale Randomized Control Trials showed conflicting results. The purpose of this meta-analysis was to assess the role of angiotensin blockade in reducing the rate of aortic root dilatation in patients with Marfan Syndrome.

Methods:
We searched PubMed, EMBASE, and Cochrane Central Register of Clinical Trials from the inception to May 30, 2015 using the terms “Marfan syndrome”, “angiotensin converting enzyme inhibitors” and “angiotensin II-receptor blockers”. Data was extracted using standardized protocol.The main outcome of the present analysis was the change in aortic root diameter with ACE/ABR therapy compared to control. The random effects model of DerSimonian and Laird was used. The statistical analysis was done in line with recommendations from the Cochrane Collaboration using Review Manager (RevMan) version 5.3.

Results:
Six studies enrolling a total of 1252 patients were included in the final analysis. Five were randomized controlled trials and one was an observation study. Analysis showed that there was no significant benefit with ACE/ARB in reducing aortic root dilatation rate compared to control [Mean Difference of -0.24 ; 95 % CI -0.36 to -0.13, P < 0.00001].

Conclusion:
Based on the results of this meta analysis which includes data from the most recent trials, there is no significant benefit with ACE/ARB treatment on reducing the rate of aortic root dilatation in patients with Marfan Syndrome.
Abstract 15163: Recent Trends in Atrial Fibrillation and Short Term Outcomes Following Acute Myocardial Infarction : A Population Based Perspective
Authors: Kundu Amartya , Shaikh Amir , Lessard Darleen , Saczynski Jane , Yarzebski Jorge , Darling Chad , Thabet Ramses , Goldberg Robert , McManus David
Published: July 2021

Introduction:
Atrial Fibrillation (AF) is a common complication during hospitalization for acute myocardial infarction (AMI) and is associated with increased morbidity and mortality in patients with AMI.However, there is limited information on contemporary trends in the incidence of AF in patients admitted with AMI and its impact on clinically relevant in-hospital and post-discharge outcomes.

Methods:
We examined trends in AF complicating AMI using data from the Worcester Heart Attack Study. The study population consisted of 6384 residents of Worcester, Massachusetts hospitalized with AMI for 7 biennial years from 1999 to 2011. Data was abstracted through the review of hospital medical records. Multivariate logistic regression analysis was used to examine the association between occurrence of AF and various in-hospital complications.

Results:
Overall incidence of AF complicating AMI was 10.8 %. The rate increased in the first half of the study period from 1999 to 2003 and declined thereafter .In models adjusting for other factors associated with adverse outcomes following AMI, we noted that compared to patients who did not develop AF, those who developed AF following AMI were at a higher risk of developing stroke [OR 2.53, 95 % CI 1.56 to 4.13], heart failure [OR 1.56, 95 % CI 1.31 to 1.87], and cardiogenic shock [OR 3.72, 95 % CI 2.82 to 4.90]. All-cause mortality during hospitalization was higher in those who developed AF[ OR 2.34, 95 % CI 1.87 to 2.94 ]; as was 30 day post discharge mortality [OR 1.29, 95 % CI 0.90 to 1.86] and 30 day post discharge readmission rate [OR 1.37, 95 % CI 1.09 to 1.72].

Conclusion:
Our findings show that despite advancements in the treatment of AMI and reduced in-hospital mortality over the last 2 decades, new-onset AF remains common and related to multiple in-hospital and post-discharge adverse outcomes. Increased in-hospital monitoring and short-term post-discharge surveillance appears warranted for patients who develop AF in the context of AMI.
Abstract 15233: The Lesion Length Gives a Better Effect on the Fractional Flow Reserve Than the Minimal Luminal Area in the Intermediate Coronary Artery Lesion
Authors: Juneyoung Yoon , Jin Xiongjie , Seo Kyong-Woo , Park Jin-sun , Yang Hyoung-Mo , Cho Jung Rae , Lim Hong-Seok , Choi Byoung-Joo , Choi So-Yeon , Yoon Myeong-Ho , Lee Juyong , Hwang Gyo-Seung , Shin Joon-Han , Tahk Seoung-Jea
Published: July 2021

Introduction:
The pressure gradient of the circulation fluid in a stenosis area depends on minimal luminal area (MLA) of the stenosis, lesion length (LL), and the fluid velocity. However, the correlation of the LL and the MLA; the cutoff values are uncertain.

Hypothesis:
LL and MLA differently influences the FFR.

Methods:
We studied 117 patients with intermediate coronary artery disease who underwent FFR and IVUS measurement out of 302 patients in FAVOR study. This study was a prospective, 1:1 randomized, open label multicenter trial to demonstrate the clinical outcomes between FFR and IVUS-guided PCI. Inclusion criteria were as follows: 1)Angina or documented silent ischemia 2)
De novo
intermediate coronary artery disease (30-70% diameter stenosis) by visual estimation, 3) Reference vessel diameter ≥ 3.0mm by visual estimation. We excluded left main disease, MI, EF< 40%, and graft vessel. There were no significant differences in baseline clinical characteristics. The mean values are the QCA (54.3±14.0 %), MLA (3.6±1.4 mm2) and LL (20.6±1.4mm), respectively. We were performed the path analysis using AMOS 18, and estimated the ROC curve in SPSS 18.

Results:
Standardized estimates were the LL -0.47,QCA -0.28 and MLA -0.21 (R2=0.594, p<0.000) in path analysis. The model is recursive and statistically significant. The FFR was ≤0.80 in 47 lesions (31%). The optimal LL for an FFR of ≤0.80 was 15.8mm (90% sensitivity, 50% specificity, 44% positive predictive value, 87% negative predictive value, area under the curve: 0.75, 95% CI: 0.66 to 0.85; p < 0.001) and MLA 3.9mm (sensitivity 86%, specificity 59%, 35% positive predictive value , 94% negative predictive value, area under the curve: 0.78, 95% CI: 0.67 to 0.85; p < 0.001)

Conclusions:
The lesion length influenced more the FFR than MLA. The lesion length ≥ 15.8mm and MLA ≤ 3.9mm are risk zones, which need to be confirm the functional status with FFR because of the low positive predictive value
Abstract 15338: Determinants of Significant Paravalvular Regurgitation After Transcatheter Aortic Valve Implantation: Impact of Different Iterations of Devices and Degree of Valve Calcification
Authors: Kong William K , van Rosendael Philippe , van der Kley Frank , de Weger Arend , Kamperidis Vasileois , Regeer Madelien , Ajmone Marsan Nina , Bax Jeroen , Delgado Victoria
Published: July 2021

Objectives:
The aim of this study is to assess the impact of iterations of balloon expandable valves (Sapien, Sapien XT and Sapien 3) and degree of aortic valve calcification (AVC) on the severity of paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI).

Hypothesis:
The iterations of the Sapien prosthesis might impact the frequency and grade of PVR.

Methods:
Multidetector computed tomography (MDCT) and echocardiographic examinations were performed in 262 patients (127 men, 81±7 years old, logistic EuroScore of 21±13%) who underwent TAVI with 23- and 26-mm balloon expandable valves. Patients receiving a 29-mm valves or undergoing valve-in-valve procedure were excluded. The degree of AVC was calculated with MDCT. PVR grade was assessed with echocardiography. The cover index was calculated as (prosthesis area- MDCT annulus area)/prosthesis area.

Results:
Sapien, Sapien XT and Sapien 3 prostheses were implanted in respective 103 (39%), 105 (40%) and 54 (21%) patients. Significant PVR (≥moderate) occurred in 14% of patients receiving the Sapien prosthesis and 10% receiving a Sapien XT prosthesis but none in patients of the Sapien 3 group (p=0.019) (Figure 1). Across the groups (Sapien vs. Sapien XT vs. Sapien 3) the aortic annulus size (4.4±0.8 cm2 vs. 4.4±0.7cm2 vs. 4.3±0.7cm2, respectively; p=0.2), degree of calcification (7.7±0.6 Au vs. 7.8±0.7 Au vs. 8.0±0.6 Au, respectively; p=0.1) and cover index (88±16% vs. 90±11% vs. 90±10%, respectively; p=0.4) were comparable. Significant PVR was independently associated with higher degree of AVC (OR 2.89 p=0.02)and cover index (OR 1.08, p=0.03) after adjusting for age, body surface area, gender, aortic annulus area and prosthesis iteration.

Conclusions:
The incidence of ≥moderate PVR significantly decreased over time with improvement in valve design. Significant PVR after TAVI remains independently associated with degree of AVC and cover index independently of the prosthesis iteration.
Abstract 15367: Does the Intra-resuscitation Pupillary Light Reflex Predict Return of Spontaneous Circulation or Neurologic Outcome?
Authors: Reynolds Joshua C , Chassee Todd , Fankhauser Mark , Uber Amy
Published: July 2021

Objective:
We previously demonstrated feasibility of prehospital pupillometry to quantify/qualify the pupillary light reflex (PLR) during resuscitation as a potential neurophysiological marker to guide efforts & provide early neuroprognostication. We now report on the full cohort.

Hypothesis:
PLR during resuscitation is associated with ROSC & neurologic outcome (following commands [FC]; mRS 0-3 & CPC 1-2) at hospital discharge.

Methods:
Prospective, observational cohort in which we deployed hand-held pupillometers (NeurOptics, Inc) to EMS-treated OHCA subjects for serial recordings during pulse checks until ROSC, termination, or hospital arrival. We categorized PLR as normal/abnormal/absent with the Neurologic Pupillary Index (NPi), a continuous scale (0-5) combining facets of PLR (e.g. % change, velocity, latency). We abstracted patient data from prehospital & hospital records, tabulated data, estimated test performance, and performed ROC analysis for best NPi & outcomes.

Results:
From 2/14 - 4/15, 186 subjects were enrolled (61 ± 20 years, 58% male, 41% witnessed, 43% bystander CPR, 25% shockable rhythm). Most (92%) received epi (median 5mg), 12% atropine (median 1mg), 37% defibrillated (median 3.5 attempts). At submission, 173 (96%) had complete follow-up data (44% transported to hospital, 31% ROSC). Of 39 (22%) subjects admitted to hospital (76% hypothermia, 26% cardiac catheterization), 7 survived to discharge with 6 FC & 5 mRS 0-3. Of 1,552 readings attempted (median 7/subject), 39% had usable data & 74% subjects had ≥1 usable reading, Only 15% subjects had PLR during resuscitation. Best NPi > 4.0 classified 92% of FC (LR+ 17; overall AUC 0.69), whereas best NPi > 4.5 classified 98% favorable mRS & CPC (LR+ 67; overall AUC 0.70).

Conclusion:
A minority of subjects had detectable PLR. Normal PLR was rare, but had high overall classification accuracy for FC, & strong likelihood ratios for ROSC & neurologic outcome. Best NPi had fair test performance by AUC.
Abstract 15504: Time Course of Improvement of Diastolic Cardiac Function After Pulmonary Vein Isolation
Authors: Masuyama Kiyoshi , Nishino Masami , Okamoto Naotaka , Tanaka Akihiro , Mori Naoki , Makino Nobuhiko , Egami Yasuyuki , Shutta Ryu , Tanouchi Jun
Published: July 2021

Background:
Pulmonary vein isolation (PVI) is an established method of paroxysmal atrial fibrillation (PAF). It has been reported that maintenance of sinus rhythm improves diastolic cardiac function in the patients with normal ejection fraction (EF). However, it is unknown the time course of improvement of diastolic cardiac function after PVI.

Methods:
We enrolled 87 patients who underwent PVI for PAF and received echocardiography before and 6-month/12-month after PVI. We evaluated left ventricular diastolic dimension, EF, left atrial dimension, EF, mitral early diastolic flow velocity (E), late diastolic flow velocity (A), ratio of early diastolic transmitral flow velocity to mitral annular velocity (E/e’), deceleration time (DcT) by the echocardiography and compared the ratio of pre to 6-mounth after PVI and of 6-mounth to 12-mounth after PVI for each parameter between success group (sinus rhythm≧1year) and recurrence group.

Results:
E/e’ ratio decreased at 6-months after PVI in success group (62patients) than recurrence group (25patients) (0.4334±0.3584% versus 0.0369±0.1169%, p=0.01) (table) but there were no significant differences in the other analyses. In addition there were no significant differences among 6-mounth to 12-mounth parameter.

Conclusion:
Diastolic cardiac function, especially E/e’, can improve in the early phase (within 6 months) if the patients maintained sinus rhythm after PVI.Early follow-up of diastolic function may play an important role to find recurrence of AF.