bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 2994: Gender-Related Differences in the Central Arterial Pressure Waveform Begin in Childhood and are Independent of Height
Authors: Ayer Julian G , Avolio Albert , Marks Guy , Harmer Jason A , Celermajer David S
Published: July 2021

Introduction Women develop age-related LV hypertrophy and symptomatic heart failure to a greater extent than men. Contributing to this may be a higher pulsatile afterload in women, with a higher central arterial systolic augmentation pressure (AP, peak pressure minus pressure at systolic shoulder) and augmentation index (AIx, ratio of AP to pulse pressure). It is unclear if these differences are due to gender
per se
or shorter female stature. We studied 8-year old children to determine if gender-related differences in carotid pressure augmentation are present in early life and if so, whether they are independent of height (Ht).

Methods 406 children (age 8.0 ± 0.1, 49% girls) had anthropometry, brachial systolic and diastolic BP (SBP, DBP), heart rate (HR) and carotid and radial pressure waveforms (by applanation tonometry, calibrated to mean BP and DBP) assessed. Carotid ultrasound evaluated arterial elasticity [Carotid Artery Compliance (CAC), Stiffness Index (SI) and Young’s Elastic Modulus (YEM)].

Results Boys and girls had a similar Ht (129 ± 6
v
128 ± 6 cm), BMI (17.6 ± 3.1
v
17.5 ± 3.0), SBP (100 ± 7
v
101 ± 5 mmHg), DBP (59 ± 6
v
60 ± 5 mmHg) and HR (80 ± 10
v
82 ± 10 bpm). The carotid AP and AIx were significantly higher in girls (−4 ± 3
v
−6 ± 4 mmHg and −12 ± 8
v
−16 ± 9 respectively, p < 0.001), indicating greater systolic pressure augmentation. Time to onset of the reflected wave (
Tr
) and time to peak of the reflected wave were shorter in girls (154 ± 19
v
163 ± 18 msec, p < 0.001 and 206 ± 23
v
212 ± 22 msec, p = 0.03 respectively), indicating earlier wave reflection. Girls had a higher velocity index (Vr) estimated from Ht (
Vr
=
Ht /Tr
, 8.4 ± 1.0
v
8.0 ± 0.9 m/sec, p = 0.001). Ejection duration, maximum rate of pressure rise and time to systolic peak (indicating effect of ventricular ejection on the carotid waveform) were not significantly different between genders. Boys, however, had stiffer carotid arteries than girls [lower CAC (5.8 ± 1.5 v 6.2 ± 1.8 %/10 mmHg, p = 0.016), higher SI (2.7 ± 0.7
v
2.5 ± 0.7, p = 0.012) and YEM (735 ± 217
v
681 ± 237, p = 0.021)].

Conclusion Even in the first decade of life, girls demonstrate greater central arterial pressure augmentation than boys, with earlier wave reflection. This is independent of height and may contribute to cardiovascular morbidity in females, later in life.
Abstract 3043: Population Characteristics, Treatment Assignment and Survival of Elderly Patients with Aortic Stenosis Referred for Percutaneous Valve Replacement
Authors: Otten Amber M , van Domburg Ron T , Serruys Patrick W , de Jaegere Peter P
Published: July 2021

An increasing number of elderly are being referred for percutaneous aortic valve replacement (PAVR). Although case studies are available on treatment and outcome and phase II studies are ongoing, little is known about the demographics of the total population referred in addition to treatment assignment and survival of the entire population. This was subject of the present prospective observational cohort study. Since November 2005, 167 patients were referred for PAVR of whom 65 pts received valve replacement (47 PAVR, 3 balloon valvuloplasty [PABV], 15 surgical [AVR]), 18 refused treatment and 27 were no candidate for PAVR or AVR and received medical therapy. Patients who are still under evaluation (60) were excluded from the analysis. Predefined demographic, clinical, technical, laboratory and procedural variables were prospectively entered into a dedicated database. Follow-up of vital status was obtained by contacting the civil registries. The follow-up was complete for all patients. Treatment assignment, baseline characteristics, risk and mortality at FU are summarized in the table

. Most patients referred for PAVR are female. Although the majority received PAVR, still 14% received AVR and 25% were rejected for valve replacement. AVR treated patients have the lowest risk score, yet a higher mortality than the PAVR group. Patients who refused treatment had the highest mortality. It is conceivable that in the latter group, earlier referral and treatment may reduce mortality. Demographics.
Abstract 3077: Cross-Sectional Associations of Arterial Stiffness Measures and Ankle-Brachial Index: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Wilkins John T , McDermott Mary M , Liu Kiang , Chan Cheeling , Criqui Michael , Lloyd-Jones Donald M
Published: July 2021

The association between tonometry-derived measures of arterial stiffness and peripheral arterial disease (PAD) is unclear. Using baseline data from 2847 female and 2614 male participants of the NHLBI-funded MESA study, we conducted linear regression analyses adjusted for age, demographics and risk factors. Ankle-brachial index (ABI) was the dependent variable and measures of large (C1) and small artery elasticity (C2) and total vascular impedance (TVI), all measured from radial artery tonometry, were the independent variables in separate models. In men and women, lower C1 and C2 values were associated with lower ABI. Higher TVI was associated with lower ABI in men and women [P<0.001]. Significant trends for C1, C2 and TVI were observed across clinical strata of ABI (Table

). In pairwise analyses, compared with participants with a normal ABI (1.1 to <1.3), those with ABI <1.1 tended to have significantly lower C2. Additionally, women with high ABI (1.3–1.5) tended to have significantly higher C2 values. Pairwise comparisons of lower and higher ABI groups compared with normal groups did not yield consistent findings for C1. Significantly higher TVI levels with lower ABI group were noted mostly in women (Table

). We observed a continuum of arterial mechanical characteristics across clinical ABI values, indicating that measures of arterial stiffness are significantly associated with ABI and severity of PAD. These results suggest that changes in C2 occur in patients with advanced lower extremity large-vessel atherosclerotic disease. Of note, female participants with high ABI between 1.3–1.5 had a significantly higher C2, arguing against the accepted “non-compressible” or “calcified arterial disease” explanation for high ABI in women. Associations Between ABI and Pulse Wave Analysis Measurements when adjusted for age, cigarette smoking, diabetes, hypertension, and creatinine level
Abstract 3998: Proton Pump Inhibitors Effect on Clopidogrel Effectiveness: The Clopidogrel Medco Outcomes Study
Authors: Aubert Ronald E , Epstein Robert S , Teagarden J R , Xia Fang , Yao Jianying , Desta Zeruesenay , Skaar Todd , Flockhart David A
Published: July 2021

Background: The anti-platelet properties of clopidogrel are thought to be activated by cytochrome P450 2C19. This isoenzyme is potently inhibited by the most commonly prescribed proton pump inhibitors (PPIs) and therefore may interfere with clopidogrel activation and its anti-platelet effects.

Methods: We investigated the potential impact of PPIs on the effectiveness of clopidogrel to prevent coronary artery stent re-stenosis through a retrospective cohort study using the National Medco Integrated Database file, which covers approximately 19 million lives. We selected patients who underwent stent placement at sometime during a one-year period in 2005–2006, who started taking clopidogrel at the time of stent placement, and who were at least 80% compliant during the ensuing year (n=14,383). We followed these patients for the one-year incidence of major adverse CV events: hospitalization for stroke, MI, angina or CABG. We compared those who took clopidogrel alone (n=9862) vs. those who took clopidogrel with PPIs (n=4521), adjusting for baseline differences in age, gender and comorbidity.

Results: Stent patients with no preceding CV events taking PPIs with clopidogrel showed a 32.5% incidence of a major CV event within one year vs. 21.2% of patients not taking PPIs (adjusted OR 1.79, CI 1.62–1.97). A more pronounced effect was seen among patients with a preceding CV event; 39.8% vs 26.2% (adjusted OR of 1.86, CI 1.63–2.12).

Conclusions: Our findings suggest that the drug interaction between PPIs and clopidogrel may result in serious adverse outcomes within one year of therapy initiation, and further support investigations into the effects of cytochrome P450 2C19 genetic polymorphisms.
Abstract 4016: Does Prasugrel Provide a Clinically Important Treatment Benefit Compared with Clopidogrel? A Bayesian Analysis of TRITON-TIMI 38
Authors: Kaul Sanjay , Shah Prediman K , Diamond George A
Published: July 2021

Background:
In contrast to the conventional frequentist analysis, the Bayesian method is ideally suited to provide a quantitative estimate of a given magnitude of treatment benefit or harm.

Objective:
A reappraisal, with emphasis on both statistical significance and clinical importance, of the recently reported TRITON-TIMI 38 trial that compared prasugrel with clopidogrel in ACS patients scheduled for PCI.

Methods:
Posterior probabilities (Pr) that the relative difference (d) in benefit and risk is greater than the putative threshold value for clinical importance (d>0% to 20%) were derived from a Bayesian analysis using an uninformative or “agnostic” prior (log mean RR, = 0, SD = 2) and empirical evidence from TRITON-TIMI 38.

Results (Table

)

: Although the Pr(d>0%) and Pr(d>10%) difference in the primary endpoint are 100% and 97.5%, respectively, the Pr(d>20%), the “minimum clinically important difference” that the study was powered to detect, is only 40%. Similar patterns are observed with all-cause death/MI/CVA. The Pr(d>10%) harm (for either TIMI major or TIMI major plus minor bleeding) exceeds 90%, and Pr (d>20%) harm exceeds 65%. The Pr(d>20%) harm exceeds the Pr(d>20%) benefit. Combining ischemic endpoints and TIMI major bleeding into net clinical benefit, the Pr(d>10%) benefit is <80% and Pr(d>20%) benefit is <5%. If TIMI major plus minor bleeding is included, the probability of net clinical benefit with prasugrel therapy is reduced even further (<5% for d>10% and <1% for d>20%).

Conclusions:
The probability of clinically important benefit associated with prasugrel treatment in TRITON-TIMI 38 is far less than that implied by conventional statistical significance. Bayesian analysis provides a useful tool in quantifying clinically meaningful difference. Ultimately, the clarity of the balance between “clinically important”, not just “statistically significant”, benefit or harm should influence guideline recommendations and treatment decisions.

Bayesian Analysis of TRITON-TIMI 38 Trial
Abstract 4039: Continuous Positive Airway Pressure From Out-of-hospital Setting To Cardiac Intensive Care Unit In Acute Heart Failure: A Multicenter Randomized Study
Authors: Ducros Laurent , Logeart Damien , Collet Jean-Philippe , Vicaut Eric , Henry Patrick , Montalescot Gilles , Plaisance Patrick , Payen Didier
Published: July 2021

Purpose
: Recent guidelines for acute heart failure (AHF) support the use of continuous positive airway pressure (CPAP) although its early use upstream intensive care unit (ICU) requires more evidence. The aim of this multicenter randomized study was to compare the effects of standard treatment of cardiogenic acute pulmonary oedema to CPAP when started in out-hospital setting and continued in ICU.

Methods
: AHF presenters with respiratory distress were enrolled by 10 emergency medical mobile services. Inclusion criteria were respiratory rate >25, pulse oxygen saturation <90% in air and Killip score ≥3. Each eligible patient was randomly assigned at home to receive standard treatment (ST) including oxygen, nitroglycerin, diuretic and inotropic drug as appropriate, or a combination of ST and CPAP (7.5–10 cmH
2
O). The primary end point, a composite of death, presence of intubation criteria or persistence at the second hour after inclusion, reappearance of the inclusion criteria or circulatory failure, was assessed within the first 48 hours after inclusion. The analysis was done by intention to treat.

Results
: 207 patients (80 ± 10 years, 59% females) were enrolled. Baseline characteristics and standard treatment were balanced between the 2 groups. The mean duration of CPAP was 1 hour prior to admission and 2 hours after admission. The primary end-point was observed in 36% of patients in ST and 21.5% in ST+CPAP (p=0.028). There was no difference in the rate of death (5% vs. 3.75% for ST and ST+CPAP, respectively), although the use of CPAP was associated with a significant reduction of persistent respiratory distress (26% vs 12%, p<0.01), of haemodynamic failure (6% vs 1%, p 0.05) and in the rate of intubation criteria (14% vs 4%, p=0.01). Clinical benefits of CPAP were found irrespective of left ventricular dysfunction and of normo/hypercapnia measured at inclusion.

Conclusion
: the use of CPAP upstream ICU and continued after admission improves improves early clinical outcome of patients presenting with cardiogenic acute pulmonary oedema.
Abstract 4092: Initial Experience with Subxiphoid Percutaneous Epicardial Ventricular Tachycardia Ablation in Patients with Prior Cardiac Surgery
Authors: Mahapatra Srijoy , McDaniel George M , Mason Pamela K , Ailawadi Gorav
Published: July 2021

Introduction: Epicardial ablation via subxiphoid percutaenous access improves VT ablation success rate and is growing in popularity. However, it is unclear if this technique is feasible in patients with prior cardiac surgery because of pericardial adhesions. We describe results in our initial 12 patients with previous cardiac surgery.

Methods: A total of 27 patients (11 women) underwent an epicardial VT ablation after failed antiarrhythmic drug therapy and at least one endocardial ablation. Twelve patients had undergone previous cardiac surgery (7 CABG, 3 valve only, 2 combined). The pericardium was accessed using a Tuohy needle. Then a guidewire and an irrigated tip catheter were used to free up adhesions. VT was mapped and ablated. We compared the results in patients with and without prior surgery.

Results: There was no difference in the age (62±11 vs 58±13 years, p=ns), percent women (41 vs 40%, p=ns), EF (30±9 vs 27±11, p=ns), NYHA class (2.4±1.0 vs 2.1±0.9, p=ns) or use of beta-blockers (100 vs 93%, p=ns) or ACE inhibtors (100 vs 93%, p=ns) among patients with and without prior cardiac surgery. However, patients with prior surgery were more likely to have CAD (100 vs 66% p=0.02) and be on ASA (100 vs 73%, p=0.04.) The mean procedure (298±90 vs 178±45 min, p=0.01) and fluoroscopy time (106±24 vs 45±11 min, p=0.01) was longer in patients with prior surgery versus without surgery. The entire epicardium was mapped in 15/15 (100%) of the nonsurgical patients but only in 7/11 (64%) of the surgical patients due to adhesions (p=0.02.) The acute success rate, defined as elimination of all clinical VTs, was lower in the surgical group (75 vs 100%, p=0.02). Elimination of all VTs was achieved less often in post-surgical patient than non-surgical patients (58 vs 80%, p=0.04.) There were two occurrences of RV perforation in each group both treated with conservative therapy. There were no other complications. After 7±2 months, 66% of surgical patients and 80% of non-surgical patients were VT free (p=0.04) as monitored by ICD or 1, 3, and 6 month monitor. One patient in non-surgical group died of heart failure.

Conclusion: Prior cardiac surgery does not preclude epicardial VT ablation but is associated with longer procedure times and lower success rates.
Abstract 4113: In-Vitro Characterization of Ablation Lesions Using Oct
Authors: Fleming Christine P , Barwick Lee M , Quan Kara J , Rollins Andrew M
Published: July 2021

Radiofrequency ablation (RFA) is a clinical procedure that destroys tissue to cure cardiac arrhythmias. Presently, there is no direct method to monitor RFA lesion formation in real-time. Real time direct monitoring of the tissue could guide ablation and prevent complications such as tissue disruption that leads to perforation. Optical coherence tomography (OCT) provides real-time subsurface imaging with high spatial resolution in three dimensions. We hypothesized that OCT can distinguish necrotic ablated tissue from viable cardiac tissue. Freshly excised right ventricular wedges from swine were placed in a bath with phosphate buffered saline (PBS) maintained at 37°C with super-perfusion flow. RFA lesions were created with a temperature controlled (70°C) protocol, maximum delivered power of 50W for 10, 20, 30, and 60 seconds. Endocardial lesions were created using a 7Fr, 4mm tip RFA catheter. OCT imaging was conducted on a system with a 1310 nm light source and 10μm axial and 18 μm lateral resolution. Staining with 0.1% triphenyltetrazolium chloride in PBS for 15 minutes was used to confirm necrosis and quantify lesion size. The single scattering model of OCT images was used to extract three parameters (attenuation, backscattering, and correlation) to give an indication of tissue scattering, reflectivity, and heterogeneity respectively. OCT images of control (n=26) and ablated tissue (n=87) were analyzed with OCT. Viable tissue had a banding appearance due to the bifriengence property of highly organized myocardial tissue, absent in necrotic tissue caused by ablation. RFA lesions were characterized by increased imaging depth, increased scattering, and a heterogeneous appearance in OCT images. The real-time changes in tissue were detected after onset of ablation. 29 tissue samples had early detection of crater formation and tissue disruption before any adverse effect could occur. The correlation and attenuation coefficients of necrotic tissue were significantly smaller than viable tissue (p<0.01). Using OCT imaging, healthy endocardium and myocardium can be readily distinguished from necrotic tissue produced by RFA. This real-time monitoring may guide ablation by allowing the operator to see ablated tissue before an adverse event can occur.
Abstract 4115: QT Response to Exercise Maneuvers Predicts Genotype in Long QT Syndrome
Authors: Wong Jorge , Skanes Allan C , Yee Raymond , Gula Lorne J , Klein George J , Gray Christopher , Krahn Andrew D
Published: July 2021

Genotyping of patients with suspected LQTS may influence prognosis and response to therapy. It remains expensive and difficult to access in many settings. The resting QT interval is normal or borderline in up to half of genetically affected patients, making expert directed genotyping important in the management of LQTS patients. We examined the use of provocative postural and exercise testing as a tool to diagnose LQTS and predict genotype. Patients with suspected LQTS based on a history of syncope or cardiac arrest, with an affected first-degree relative, or a borderline or prolonged QT interval underwent exercise testing. 117 genotyped patients underwent provocative testing consisting of resting supine and standing ECGs, and exercise testing using a modified Bruce protocol. ECGs were obtained during exercise and at 1-minute intervals during recovery. Medians and IQRs are presented, and compared with Wilcoxon scores. 57 Of the 117 patients had an LQT mutation (LQT+) identified by genetic testing (LQT1=29, LQT2=38). The resting and standing ECGs were most useful in discriminating LQT+ patients from LQT− patients, with a prolonged resting supine QTc that underwent exaggerated prolongation compared to unaffected family members (Table

). Genotype prediction in the LQT+ patients was best achieved using a combination of exercise QT and QTc changes that were most abnormal in LQT1 patients, along with hysteresis that was abnormal in LQT2 patients. Postural QTc changes are useful in identifying mutation positive LQTS patients. In patients with abnormal findings, LQT1 is associated with impaired QT and QTc shortening at peak exercise, and LQT2 patients have exaggerated hysteresis. Exercise testing is a useful simple tool in the diagnosis of LQTS that helps direct genetic testing.
Abstract 4122: What is the Effect of Amiodarone on Cardiac Memory? A Prospective Cohort Study
Authors: Ahmed Shafeeq , Chakravarty Saneka , Coleman Craig I , Kluger Jeffrey
Published: July 2021

Post pacing induced T-wave inversion after resumption of normal ventricular activation is known as cardiac memory. Animal studies have shown that the transient outward current Ikto and L-type calcium channels are altered in cardiac memory. We hypothesize that pacing induced cardiac memory is modified by amiodarone due to its I kto and L-type calcium channel blocking effects. We conducted a prospective cohort evaluation of paced patients at a single institution. Patients were excluded if they were pacemaker dependant or had underlying bundle branch block. All eligible patients had a pacemaker-inhibited standard 12-lead electrocardiogram after informed consent and collection of basic demographic information. Patients who were receiving amiodarone (n=11) at the time of pacemaker interrogation were compared to a control group of patients that were not taking amiodarone (n=28). Cardiac memory was deemed to be present if T-wave inversions were observed in any pre-cordial or inferior lead (V1-V6, II, III, and AVF). Univariate statistics were used to compare both the incidence of cardiac memory and the mean number of cardiac memory leads. Seven patients receiving and 27 patients not receiving amiodarone exhibited cardiac memory (63.6% vs. 96.4%; p=0.02†). (See Table

) In addition, patients receiving amiodarone had cardiac memory observed in significantly fewer pre-cordial or inferior leads (2.91 vs. 5.18; p=0.02†) Amiodarone appears to be associated with attenuation of pacing induced cardiac memory.

Table
Abstract 4127: Dual Chamber ICD Selection is Associated with Racial and Socioeconomic Disparities and Increased Complication Rates Among Patients Enrolled in the NCDR ICD Registry
Authors: Dewland Thomas A , Pellegrini Cara N , Wang Yongfei , Marcus Gregory M , Varosy Paul D
Published: July 2021

Background:
Dual chamber implantable cardioverter-defibrillators (ICDs) offer potential advantages over single chamber devices. Definitive evidence demonstrating improved outcomes with dual chamber ICDs is lacking, however, and the choice of such devices remains controversial. The prevalence, predictors, and procedural complication rates of single versus dual chamber devices in patient populations not enrolled in randomized trials are unknown.

Methods and Results:
Between January 2006 and December 2007, the NCDR ICD Registry recorded 104,049 first-time implantations of single or dual chamber ICDs. Dual chamber devices were implanted in 64,489 patients (62%). After adjusting for potential confounding factors and clustering on patient center using hierarchical logistic regression models, characteristics associated with lower odds of dual chamber ICD implantation included black race (odds ratio (OR), 0.89; 95% confidence interval (CI), 0.85 – 0.93), Medicaid insurance (OR, 0.88; CI, 0.82 – 0.94), diabetes (OR, 0.94; CI, 0.91 – 0.97), and end-stage renal disease (OR, 0.82; CI, 0.76 – 0.89). Complications were more frequent with dual chamber device implantation, including cardiac arrest (0.31% vs. 0.23%, P = 0.01), hematoma (0.92% vs. 0.71%, P < 0.001), pneumothorax (0.53% vs. 0.36%, P < 0.001), pericardial tamponade (0.09% vs. 0.05%, P = 0.01), lead dislodgement (0.88% vs. 0.50%, P < 0.001), and any complication (3.2% vs. 2.1%, P < 0.001). The increased risk of complications associated with dual chamber ICD selection persisted after adjusting for patient demographic characteristics, medical comorbidities, and ICD indication (OR, 1.40; CI, 1.28 – 1.52; P < 0.001).

Conclusions:
While dual chamber ICD selection is more common than single chamber implantation among patients enrolled in the NCDR ICD Registry, both blacks and patients insured with Medicaid are less likely to receive dual chamber devices. Further investigation is needed to determine whether the benefits of dual chamber ICD therapy outweigh the greater risk of peri-procedural complications.
Abstract 4130: Applicability Of Left Ventricular Hypertrophy Electrocardiographic Criteria In Professional Athletes
Authors: Samesima Nelson , Pastore Carlos A , de Matos Luciana D , Fumagalli Fernanda F , Ferreira Mariane V , Garcia Euler V , Azevedo Luciene F , Tobias Nancy M , Liparizi Renata d , Perlingeiro Patricia S , Negrão Carlos E
Published: July 2021

Introduction.
The widely known electrocardiographic criteria for diagnosing left ventricular hypertrophy (LVH) use QRS complex voltages to define whether there is left ventricle enlargement or not. Mild myocardial hypertrophy is detected in many professional athletes and this is a consequence of their daily intensity of training. Thus it is not unusual that athlete’s ECGs show large QRS voltages with normal hearts.

Objective.
To evaluate the applicability of the usual electrocardiographic criteria for LVH - Sokolow-Lyon, Romhilt-Estes, Cornell and Gubner - in a population of professional athletes.

Methods.
The four LVH criteria for diagnosing LVH were applied to analyse ECGs of 107 professional athletes (71% soccer players, 29% marathonists, all male, age 25± 10 years, training for 9± 8 years) by the same observer unaware of echocardiographic results. ECG was considered to be indicative of LVH if: Sokolow-Lyon ≥35mm (V
1or 2
S wave+V
5or 6
R wave); Romhilt-Estes score ≥5 points (frontal plane: R or S waves ≥ 20mm, horizontal plane: R or S waves ≥ 30mm, Morris indices, V
5or 6
strain pattern, left axis deviation ≥ − 30°, intrinsecoid deflection ≥ 0.04s, QRS duration ≥ 0.10s) ; Cornell ≥ 28mm (aV
L
R wave + V
3
S wave); Gubner ≥ 22mm (D
I
R wave + D
III
S wave). Hypertrophy was considered whenever: LV diastolic diameter ≥ 60mm and/or septum ≥ 13mm and/or LV posterior wall ≥ 13mm. Kruskal-Wallis was used to statistically analyse quantitative variables, corrected chi-square test for categorical variables. Significance level: p ≤ 0.05.

Results.
Romhilt-Estes showed the best results (75% sensitivity, 84% specificity, 16 false-positives, 1 false-negative), and was the only criteria with statistical significance (p = 0.047). Sokolow-Lyon showed 100% sensitivity, 15% specificity, p = 0.545, 88% false-positives, 0% false-negative. Cornell and Gubner showed 25% and 0% sensitivity, 95% and 99% specificity, p=0.205 and p = 0.449, respectively.

Conclusion.
In this male population of professional athletes, Romhilt-Estes score proved to be the best criterion for identifying left ventricular hypertrophy, while Sokolow-Lyon criterion did not discriminate normal from abnormal hearts. Cornell and Gubner criteria should not be used in this population because of their low sensitivity.
Abstract 4176: Quantification of Myocardial Blood Flow Reserve by 1st-Pass CT Imaging
Authors: Christian Timothy , Gentchos George , Ahmed Bina , Frankish Mei Lee , Bell Stephen , Jerosch-Herold Michael
Published: July 2021

The accurate assessment of myocardial blood flow (MBF) is a potential adjunct to the anatomy of CT coronary angiography. To compare quantitative parameters from 1st-pass CT (FP CT) imaging with absolute measures of MBF in an animal model of altered MBF. A pig model of intracoronary adenosine (n=9) was used during FP CT. This produces a zone with hyperemic MBF and a control zone within a slice. Fluorescent microspheres (Mcsp) were injected into the left atrium with to determine absolute MBF concurrent with CT imaging. Pigs were placed in a 64-slice (Philips) CT with acquisition performed during IC adenosine. A 40% dilution of Iopamidol 370 (1ml/Kg) was injected IV at 5ml/sec. CT acquisition was ECG gated over 40 cardiac phases with the following parameters: 180° axial mode (pitch=0), field of view=250mmsq, 512×512 matrix, slice thickness=2.5 mm × 10 slices, temporal resolution=210ms, 120KV, 495ma. Mcsp were injected immediately following CT imaging. The heart was sectioned into 2.5mm slices to match the CT images and segmented. Time intensity curves (TIC) were generated from CT in adenosine and control zones based on Mcsp values. Mcsp coronary flow reserve (CFR) = hyperemic/control MBF, and CT CFR was derived from hyperemic/control area under curve from baseline corrected TIC (Klocke, Circ. 2001). MBF control=0.65±0.25, MBF adenosine=2.6±0.7 ml/min/g (p<0.0001). CFR=4.5±1.05, CT CFR=4.4±1.5 (p=NS). There was a significant (r=0.93, p<0.0001) correlation between CFR and CT CFR (figure

). FP CT myocardial perfusion imaging is feasible at clinically relevant radiation dosimetry and provides reasonable estimates of CFR during hyperemia.
Abstract 4192: Unrecognized Myocardial Infarctions are Common in Cardiac Asymptomatic Subjects at High Vascular Risk
Authors: Meijs Matthijs F , Bots Michiel L , Cramer Maarten J , Vonken Evert J , Velthuis Birgitta K , van der Graaf Yolanda , Visseren Frank J , Mali Willem P , Doevendans Pieter A
Published: July 2021

Unrecognized myocardial infarction (UMI), generally assessed by the presence of a Q-wave on the electrocardiogram, is commonly found. Furthermore, mortality associated with UMI appears to be similar as for recognized myocardial infarction. With delayed enhancement cardiac MRI (DE-CMR) both Q-wave and non-Q wave infarctions can be identified. The aim of this study was to investigate the prevalence and determinants of UMI in high risk subjects without symptomatic coronary artery disease using DE-CMR. A DE-CMR was performed in 502 subjects with clinically manifest non-coronary atherosclerotic disease or marked risk factors for atherosclerosis. As all subjects had no known history of coronary artery disease, subendocardial and transmural scar tissue on DE-CMR was considered an UMI. In all subjects information on atherosclerotic risk factors was collected. Multivariable logistic regression was used to study the relation of risk factors with UMI. DE-CMR was of sufficient image quality in 480 (95.6%) subjects. Interobserver agreement was excellent (weighted kappa = 95%). An UMI was present in 45 (9.4%) of all subjects, and in 38 (13.1%) of 291 men and in 7 (3.7%) of 189 women. The risk of UMI increased from 6.0% (95%CI 2.2 – 9.8%) in those with two risk factors up to 26.2% (95%CI 15.2 – 37.3%) in those with 4 or 5 risk factors (male gender, age above mean of 53 years, ever smoking, history of stroke, and history of aneurysm of the abdominal aorta (AAA)). In multivariable analysis the risk of UMI was related to male gender (OR 2.6 (95%CI 1.1– 6.3)), age (OR 1.0 (95%CI 1.0 –1.1) per year), ever smoking (OR 3.1 (95%CI 1.0 –9.0), history of stroke (OR 2.1 (95%CI 1.0 – 4.4)) and history of AAA (OR 2.3 (95%CI 0.9 –5.9)). In high risk cardiac asymptomatic subjects UMI is common. The risk of UMI increases with increasing presence of risk factors.
Abstract 4197: Does Relative Wall Thickness or Left Ventricular Mass Index Best Predict Mortality Risk in Patients With Preserved Systolic Function?
Authors: Patel Dharmendrakumar A , Lavie Carl J , Shah Sangeeta , Gilliland Yvonne , Milani Richard V
Published: July 2021

Background:
Several studies have indicated that left ventricular (LV) geometric patterns predict cardiovascular events. However, little data is available that compares the relative prognostic impact of LV mass index (LVMI) and relative wall thickness (RWT) on mortality in a large cohort of patients with preserved systolic function.

Methods:
The impact of LVMI and RWT on mortality during an average follow-up of 1.7±1.0 years was examined in a sample of 47,701 patients (mean age: 61.6 ± 15.4; females=54.6 %) with preserved ejection fraction(EF), as well as in age groups of <50 yrs(n=10,864; mean age=39.9 ± 8.1; females=58.4 %), 50 –70 yrs (n=20,181; mean age=59.9 ± 5.7; females=52.2 %) and >= 70 yrs (n=16,836; mean age=77.7 ± 5.5; females=55.1 %).

Results:
With increasing age (<50, 50 –70, >=70 yrs), both LVMI (78.5 ± 23.4, 84.3 ± 25.4, 90.3 ± 27.6; p<0.0001) and RWT (0.37 ± 0.08, 0.41 ± 0.08, 0.43 ± 0.09; p<0.0001) as well as mortality (2.2%, 5.0%, 14.2%; p<0.0001) showed significant linear trends and were independent predictors of mortality (Table

, Figure

).

Conclusion:
Although, both LVMI and RWT were independently associated with increased mortality in all groups, RWT was by far the strongest independent predictor of all-cause mortality, especially in younger patients.
Abstract 4200: Global Diastolic Strain Rate During Isovolumic Relaxation Time is a Robust Echocardiographic Parameter of Poorer Outcome in Patients With Non-ischemic Dilated Cardiomyopathy
Authors: Inoue Katsuji , Okayama Hideki , Nishimura Kazuhisa , Nagai Takayuki , Suzuki Jun , Ogimoto Akiyoshi , Ohtsuka Tomoaki , Higaki Jitsuo , Saitoh Makoto , Hiasa Go , Yoshii Toyofumi , Yamada Tadakatsu , Sumimoto Takumi , Funada Junichi
Published: July 2021

[Background] An impairment of the global left ventricular (LV) relaxation is potential to identify patients at a risk of increased incidence of morbidity and mortality in patients with congestive heart failure (CHF). Previous reports have demonstrated that tissue Doppler and speckle tracking imaging methods serve as a quantitative assessment of LV relaxation using strain rate (SR) during isovolumic relaxation time (IVR).

[Aim] This study was aimed to characterize the ability of global SR during IVR (SR-IVR) using speckle tracking imaging in predicting the outcome in patients with non-ischemic dilated cardiomyopathy (DCM).

[Method] This study included 52 consecutive patients with DCM (38 male, 57+/−14 years) without overt CHF at the enrollment. We excluded patients with atrial fibrillation, complete left bundle branch block and predominant valvular heart diseases. The color-coded tissue Doppler and two-dimensional images were obtained with GE Vivid 7 in the 3 apical views for analyzing the global indexes of LV dyssynchrony (Ts-SD: standard deviation of time to peak systolic velocity in 12 LV model) and relaxation (SR-IVR: averaged longitudinal SR during IVR in 18 LV model). In addition, the levels of B-type natriuretic peptide (BNP) were also measured. Cardiac events were defined as the composite incidence of sudden cardiac death, hospitalization for worsening heart failure, and refractory CHF such as NYHA class III or IV despite of optimal medical therapy during the follow-up period.

[Results] The mean values of LV ejection fraction (EF), Ts-SD, SR-IVR and BNP were 37.8%, 36.3 ms, 0.15/s and 274 pg/ml, respectively. SR-IVR was closely associated with LV end-systolic volume index (ESVI), Ts-SD and BNP (p<0.01 for all). During the follow-up period (mean, 22+/−14 months), 15 patients had cardiac events and the negative value of SR-IVR was observed in 8 out of 15 patients with cardiac events. Multivariate analysis showed that among age, EF, ESVI, Ts-SD and SR-IVR, SR-IVR was the only independent echocardiographic predictor of cardiac events in this study population (β= 0.486, p< 0.01).

[Conclusion] The reduction and negative value of global SR-IVR was shown to be a robust echocardiographic parameter for poorer outcomes in patients with DCM.
Abstract 4204: Impact of Left Ventricular Diastolic Functional Reserve on Clinical Outcome in Patients with Diabetes Mellitus
Authors: Kim Sung Ai , Rhee Sang Jae , Shim Chi-Young , Park Sungha , Choi Donghoon , Choi Eui-Young , Chung Namsik , Ha Jong-Won
Published: July 2021

Left ventricular (LV) longitudinal diastolic functional reserve, assessed by the change of early diastolic mitral annular velocity (E′) during exercise, is abnormal in patients with diabetes without overt heart disease. However, its impact on clinical outcome has not been explored previously. We hypothesized that LV diastolic reserve could further stratify diastolic dysfunction, and have a prognostic significance in patients with diabetes. Of 1,170 patients who were referred for diastolic stress echocardiography, 227 consecutive patients (mean age 58 years, male 103, mean ejection fraction [EF] 68 %) with diabetes were identified. LV diastolic function reserve index (DFRI) was calculated as E′
base
x ΔE′; where ΔE′ is the change of E′ from baseline to exercise. The primary end-point was a composite of all-cause death and re-hospitalization for heart failure. The median follow-up duration was 34 months, and the primary end-point was occurred in 14 (6.1%) of 227 patients. Among the predictors that showed a significance in the univariate Cox analysis, including age, coronary artery disease history, renal insufficiency, LV mass index, LAVI, and EF, LV DFRI was the most independent predictor of adverse outcomes. When patients were classified by the median value of DFRI at 50W of exercise, patients with DFRI < 13.5 showed poorer clinical outcomes compared to those with DFRI ≥ 13.5 (p=0.001). The assessment of LV diastolic functional reserve using exercise Doppler echocardiography is helpful in further stratifying diastolic dysfunction, and provides incremental prognostic information in patients with diabetes without overt heart disease.
Abstract 4207: Comparison of 1st-Pass Myocardial Perfusion Imaging by 64-slice CT and by MRI
Authors: Ahmed Bina , Gentchos George , Bell Stephen P , Frankish Mei Lee , Jerosch-Herold Michael , Christian Timothy
Published: July 2021

The purpose of this study was to compare the signal intensity (SI) and image characteristics of 1st-pass (FP) CT imaging vs. MR FP in an animal model of resting myocardial blood flow (MBF). Pigs (n=5) were scanned at rest using FP MRI perfusion imaging. Gd-DTPA was injected IV at 5cc/sec at 0.04mmol/kg. FP MR was acquired at 3T with 3 axial slices 3mm thick per R-R interval during bolus injection using a saturation recovery gradient echo sequence. ECG gated FP CT was performed immediately thereafter on a 64-slice scanner in axial mode with 10 2.5mm thick slices during bolus injection (5cc/sec) of 40% dilution of iopamidol 370. MBF was measured at rest using fluorescent microspheres between studies. SI was measured for baseline and peak myocardial enhancement phases. Contrast enhancement (CE)= (peak-baseline) SI/baseline SI X 100. Rest MBF was 0.60±0.15 ml/min/g. Temporal resolution was similar by technique but more slices were imaged by CT per R-R interval (10 vs 3) and spatial resolution was superior for FP CT. Image characteristics are shown in the table

. Baseline (top) and peak enhancement (bottom) images for FP CT and MRI are shown in the figure

. Results were similar when undiluted contrast was used for each modality. Despite similar absolute change in SI, CE during FP CT is markedly reduced compared to FP MR due to a more than 20-fold higher baseline SI of the myocardium.
Abstract 4223: Low Adiponectin Levels Are an Independent Predictor of Mixed and Non-Calcified Coronary Atherosclerotic Plaques
Authors: Broedl Uli C , Lebherz Corinna , Lehrke Michael , Stark Renee , Zentrum Helmholtz , Greif Martin , Becker Alexander , von Ziegler Franz , Tittus Janine , Reiser Maximilian , Becker Christoph , Göke Burkhard , Parhofer Klaus G , Leber Alexander W
Published: July 2021

We sought to examine the relationship of adiponectin with coronary atherosclerotic plaque morphology in patients with stable typical or atypical chest pain. There is increasing recognition that lesion composition rather than size determines the acute complications of atherosclerotic disease. Low serum adiponectin levels are associated with coronary artery disease and future incidence of acute coronary syndrome. The impact of adiponectin on lesion composition still remains to be determined. Serum adiponectin levels were determined in 303 patients with stable typical or atypical chest pain, who underwent dual-source multi-slice CT-angiography to exclude coronary artery stenosis. Atherosclerotic plaques were classified as calcified, mixed or non-calcified plaques. In bivariate analysis adiponectin levels were inversely correlated with total coronary plaque burden (r=−0.22, p<0.0001), mixed (r=−0.20, p=0.0007) and non-calcified plaques (r=−0.18, p=0.003). No correlation was seen with calcified plaques (r=−0.05, p=0.39). In a fully adjusted multivariate model containing age, sex, body mass index, hypertension, diabetes mellitus, smoking, family history of coronary artery disease, LDL-cholesterol, HDL-cholesterol, triglycerides, hsCRP levels, medication and pericardial adipose tissue volume, adiponectin levels remained predictive of total plaque burden (estimate: −0.035, 95% CI: −0.051 to −0.019, p<0.0001), mixed (estimate: −0.083, 95% CI: −0.127 to −0.039, p=0.0002) and non-calcified plaques (estimate: −0.076, 95% CI: −0.114 to −0.038, p=0.0001). Since the majority of coronary plaques were calcified plaques, adiponectin levels account for only 3% of the variability in total plaque number. In contrast, adiponectin accounts for approximately 20% of the variability in mixed and non-calcified plaque burden. Adiponectin levels predict mixed and non-calcified coronary atherosclerotic plaque burden. Low adiponectin levels may contribute to coronary plaque vulnerability and may thus play a role in the pathophysiology of acute coronary syndrome.
Abstract 4230: Comparison of Dobutamine-atropine Stress Echocardiography and Magnetic Resonance for Detection of Obstructive Coronary Artery Disease by Assessing Wall Motion and Myocardial Perfusion Abnormalities
Authors: Falcao Sandra N , Tsutsui Jeane , Rochitte Carlos E , Silva Luis , Lemos Pedro A , Mathias Wilson
Published: July 2021

Background:
The analysis of wall motion abnormalities (WMA) with dobutamine stress echocardiography or magnetic resonance is an established method for the detection of myocardial ischemia. Contrast echocardiography has been demonstrated a useful technique for evaluating myocardial perfusion (MP). We test the hypothesis that combination of MP and WMA would improve the diagnosis of coronary artery diseasen (CAD).

Objective:
To compare the diagnostic accuracy of dobutamine stress real-time myocardial contrast echocardiography (RTMCE) and gadolinium-enhanced magnetic resonance imaging (G-MRI) for detecting CAD by analyzing left ventricular WMA and MP.

Methods:
We prospectively studied 46 patients (23 males, mean age 58±8 years) referred for coronary angiography, RTMCE and MRI within a maximum interval of two weeks. Protocol used in RTMCE and G-MRI was four-stage dobutamine protocol (10 – 40 mcg/kg/min), with injection of atropine as required to reach 85% of age-adjusted target heart rate. Patients underwent first dobutamine stress RTMCE and then G-MRI using the same doses of dobutamine and atropine. RTMCE was performed using low-mechanical index imaging combined with intravenous commercially available contrast agent (Definity, Bristol-Myers Squibb). Positivity for the stress test was defined as new or worsening WMA or reversible perfusion defects in >2 contiguous segments. Quantitative coronary angiography (QCA) was performed in all patients. CAD was defined as the presence of lesion >50 % in at least one coronary artery territory.

Results:
All patients tolerated well dobutamine stress. In five patients G-MRI was not performed (2 because of claustrofobia, 1 because patient did not fit in MRI, 2 because of extensive ischemia by dobutamine RTMCE). A total of 41 patients underwent dobutamine RTMCE, G-MRI and QCA. The sensitivity, specificity, and accuracy to detect CAD by dobutamine RTMCE were 74%, 89% and 80% for the analysis of wall motion, 83%, 89% and 85% for the analysis of MP and 65%, 83% and 73% for dobutamine stress G-MRI.

C
onclusion:
RTMCE seems to have better performance for detecting angiographically significant CAD than G-MRI using dobutamine stress. The analysis of MP increases sensitivity to RTMCE without changing specificity.
Abstract 4235: Abnormal Myocardial Deformation Is Associated With Mortality Independent Of Hypertrophy In The Absence of Ischemia
Authors: Stanton Tony , Ingul Charlotte Bjork , Hare James L , Haluska Brian , Marwick Thomas H
Published: July 2021

Purpose :
Myocardial deformation has been shown to identify subclinical abnormalities in apparently normal hearts. We investigated the association of these markers with mortality after excluding ischemia in individuals undergoing dobutamine stress echocardiography (DSE).

Methods :
We studied 163 consecutive patients with normal resting LV function and no ischemia at DSE. Mean Bethesda scores indicated a low ten-year risk of coronary disease (men 3.2±2.1%, women 5.3±2.6%). Relative wall thickness (RWT) and LVMI (indexed to height
2.7
) were calculated according to ASE guidelines. Customized software was used to measure peak systolic SR in 18 segments and mean global SR was calculated. Individuals were followed for all-cause mortality for a mean of 5.4±1.4 years.

Results :
Mean RWT 0.46±0.11 (normal ≤ 0.42) and mean LVMI was 46.8±13.0g/m
2.7
(normal <51g/m
2.7
). RWT and LVMI were assessed in the closest approximation to 1 standard deviation (per change of 0.1 for RWT and 10g/m
2.7
for LVMI). In a Cox Proportional Hazards Model the strongest predictor of all-cause mortality was peak systolic SR (HR 3.72, 95%CI 1.8 –7.65, p<0.01). RWT (HR 1.4, 95%CI 1.0 –1.96, p<0.05) was a stronger predictor of all-cause mortality than LVMI (HR 1.2, 95%CI 0.86 –1.96, p=NS). Kaplan Meier curves were constructed by grouping the data into tertiles according to peak systolic SR (p<0.01 overall).

Conclusion :
Peak systolic strain rate is a significant independent predictor of all-cause mortality, superior to LVMI and RWT. This link between myocardial deformation and outcome in the absence of myocardial ischemia may be consistent with an effect of interstitial changes on mortality.
Abstract 4246: Dobutamine-induced Reserve of the Two-dimensional Longitudinal Strain Rate Predicts Clinical and Neurohumoral Improvement After Levosimendan Treatment in Acutely Decompensated Chronic Heart Failure
Authors: Bistola Vasiliki , Paraskevaidis Ioannis , Ikonomidis Ignatios , Parissis Ioannis , Filippatos Gerasimos , Kremastinos Dimitrios T
Published: July 2021

Objective: Levosimendan improves symptoms and the hemodynamic profile in patients with acutely decompensated chronic heart failure (ADCHF). We aimed to investigate:

the association of low dose dobutamine (DSE)-induced changes of two-dimensional strain parameters with the corresponding changes of left ventricular ejection fraction (LVEF) and left ventricular outflow tract velocity time integral (LVOT VTI) in patients with ADCHF, and

whether left ventricular contractile reserve assessed by both conventional and speckle tracking echocardiography is associated with clinical and neurohumoral improvement after levosimendan treatment.

Methods: Thirty one consecutive patients with ADCHF (mean age 65 ± 10 years, NYHA class 3.6 ± 0.3, LVEF 22 ± 6%) were studied by DSE (peak dose 20 μg/kg/min) prior to 24-hour infusion of levosimendan (0.01 μg/kg/min, without bolus). The LVEF, LVOT VTI, mean longitudinal, circumferential and radial strain and strain rate using speckle tracking imaging were measured.

Results: Twenty-three patients (74%) had evidence of contractile reserve (increase of LVEF > 10% and LVOT VTI > 20% after peak dobutamine dose, CR+), and 8 (26%) showed no reserve (CR−). CR+ versus CR- patients demonstrated greater improvement of NYHA class (mean NYHA change: −1.0±0.5 vs −0.5±0.3 NYHA class, p=0.01), and reduction of b-type natriuretic peptide levels (− 34±30 vs + 4±31%, p <0.01) 48 hours after completion of treatment. By multivariate analysis, mean longitudinal systolic strain rate reserve (resting - peak longitudinal strain rate ΔLSR (%)) was the best predictor of improvement of NYHA class (p= 0.039) and BNP (p= 0.042) after levosimendan administration among the reserve of: LV FS, EF, LVOT VTI, longitudinal strain, circumferential and radial strain and strain rate.

Conclusion: Dobutamine-induced reserve of 2-dimentional speckle tracking longitudinal systolic strain rate is associated with clinical and neurohumoral improvement after treatment with levosimendan in patients with ADCHF.