bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 2526: Comparison of 4 Years Efficacy and Durability of Drug-Eluting Stent Implantation in Non-Bifurcation and Bifurcation Lesion of Unprotected Left Main Coronary Arteries: Multicenter Registry in Asia
Authors: Nakamura Sunao , Ogawa Hisao , Bae Jang-Ho , Cahyadi Yeo Hans , Udayachalerm Wasan , Tresukosol Damras , Tansuphaswadikul Sudaratana
Published: July 2021

Aim
: The aim of this study is to compare the 4 years safety and durability of drug-eluting stent implantation in non-bifurcation (ostium and/or mid shaft) (N-Bifur) and bifurcation (Bifur) lesion of unprotected left main coronary arteries (LMT).

Methods
: A prospective analysis of 448 patients with LMT stenosis (324 Bifur and 124 N-Bifur) in five high volume Asian centers after successful stenting in LMT was performed. LMT was treated with 5 strategies (single stenting 195 cases, T-stenting 47 cases, crush stenting 38 cases, Mini-crush stenting 93 cases, culotte stenting 54 cases, kissing stenting 21 cases). Complete clinical follow-up to 4 years is being analyzed for all 448 patients.

Results
: The baseline clinical characteristics between 2 groups were similar. Angiographic and clinical success were achieved in all patients without any major complication. At 4 years overall cardiac events of N-Bifur (14.5%) were significantly lower than Bifur (28.0%) (p=0.011). See figure for clinical results.

Conclusion
: The use of drug-eluting stent in patients with LMT was safe and feasible with low acute complication and low incidence of restenosis. Drug-eluting stent implantation in non-bifurcation lesion of LMT showed lesser incidence of cardiac events (death, myocardial infarction, CABG and PCI) compared with those of bifurcation lesion at 4 years clinical follow-up.
Abstract 2538: Long-Term (up to 6 years) Clinical Outcomes of Patients with Impact of Chronic Kidney Disease in the Treated with Drug-eluting Stents. Insights from the Drug Eluting Stents In the REal World(DESIRE) Registry
Authors: Moreira Adriana , Sousa Amanda , Costa José , Costa Ricardo , Cano Manuel , Maldonado Galo , Romano Edson , Egito Enilton , Feres Fausto , Pavanello Ricardo , Berwanger Otavio , Carballo Mariana , Sousa J Eduardo
Published: July 2021

Background:
Chronic renal disease has been consistently shown to be an independent predictor of poorer long-term clinical outcomes after percutaneous treatment of coronary artery disease, even in DES era. We sought to evaluate the very long-term clinical outcome after DES implantation in this high risk subset in a real world cenario.

Methods and Results:
Between May/2002 and Jan/2007, 2,043 pts treated exclusively with DES were consecutively enrolled in the non-randomized, single-center DESIRE Registry. Recent myocardial infarction (72h), saphenous venous graft and patients with < 6months follow-up were excluded. The remaining pts (n=1500) were divided into 2 groups according to their creatinine clearence: Group I -Clearance ≤ 60 (n= 490) and Group II- clearance >60 (n= 1010). Primary endpoint included combined MACE and stent thrombosis (ST) rate. ST was classified according to ARC definitions. Clinical follow-up was obtained at 1, 3 and 6 months and then annually up to 6 years. Follow-up was achieved in 98% of the eligible cohort (median 3.6 years). Baseline characteristics and late outcomes are displayed in the table

.

Conclusions:
In the DESIRE registry the negative impact of renal dysfunction was considerably minimized by the use of DES, resulting in very low and equivalent rates of myocardial infarction, TLR and ST when compared to patients with preserved renal condition. We especulate that the higher mortality among these very complex pts may reflect the severity of their comorbities.
Abstract 2542: Effect of Lipid Lowering Therapy on Progression of Coronary Fibroatheroma Evaluated by Virtual Histology Intravascular Ultrasound
Authors: Nasu Kenya , Tsuchikane Etsuo , Katoh Osamu , Kimura Masashi , Ehara Mariko , Kinoshita Yoshihisa , Matsuo Hitoshi , Asakura Yasushi , Matsubara Tetsuo , Terashima Mitsuyasu , Suzuki Takahiko
Published: July 2021

Background: The aim of this study is to asses the effect of 12 month treatment with Fluvastatin (60 mg daily) on progression of fibroatheroma in a non-culprit vessel.

Methods: This prospective study was performed at 2 centers and designed to enroll 80 patients. Patients were randomized to receive lipid-lowering therapy by Fluvastatin or a lipid lowering diet. All patients with high low-density lipoprotein-cholesterol level (> 140 mg/dl) were included in the Fluvastatin group. Non-culprit vessels were imaged with a 20 MHz phased-array intravascular ultrasound (IVUS) catheter with motorized pull-back system at 0.5 mm/s. Virtual Histology-derived fibroatheroma (VHD-FA) was defined as 1) percent necrotic core area >20%; 2) percent plaque plus media cross-sectional area >40%. For each image, the area of vessel and each plaque component were calculated. At 12-month followup repeat IVUS measurements were performed.

Results: A total of 44 VHD-FAs in the Fluvastatin group and 47 VHD-FAs in the control group were detected at baseline. In the Fluvastatin group, fibrous and fibro-fatty areas are significantly decreased, necrotic core did not increase, and there was a significant reduction in atherogenic lipoproteins. In the control group, fibrous, necrotic core and dense calcium areas significantly increased (table

).

Conclusion: Lipid-lowering therapy with Fluvastatin prevented progression of coronary fibroatheroma.

Laboratory data and IVUS measurements
Abstract 2549: Natural Course of Lipid-rich Plaques Assessed with Combination of Intra-vascular Ultrasound and Optical Coherence Tomography
Authors: Takarada Shigeho , Kubo Takashi , Tanimoto Takashi , Kitabata Hironori , Nakamura Nobuo , Hirata Kumiko , Tanaka Atsushi , Mizukoshi Masato , Imanishi Toshio , Akasaka Takashi
Published: July 2021

Background
Identification of coronary lesions with morphological characteristic of “rupture-prone plaques” is not sufficient. We examined the natural history of non-culprit lipid-rich plaques in patients with acute coronary syndrome (ACS).

Methods
Fifty patients with ACS who underwent percutaneous coronary intervention (PCI) were enrolled. We retrospectively assessed the extent of residual non-culprit lipid-rich plaques and these fibrous cap thickness (FCT) by use of intra-vascular ultrasound (IVUS) and optical coherence tomography (OCT), respectively, at baseline and after 9-months.

Results
During 9 months follow-up periods, the change in percent area volume (PAV) was 0.42±0.6% and the change in FCT was 14±12%. Percent change in PAV showed a significant positive correlation with percent LDL-C reduction (R=0.52, P<0.01). In contrast, the change in FCT demonstrated no correlation with LDL-C level, but had a significant positive correlation with percent change in high sensitive CRP (R=0.60, P<0.01). And between PAV and FCT changes, no significant correlation was observed. Furthermore, in a multivariable analysis including age, sex, diabetes mellitus, hypertension, several concomitant drugs, only statin-use was the independent predictor for changing well-stabilized plaques, which obtained both PAV reduction and FCT increase.

Conclusion
The change in PAV and in FCT of coronary plaques during 9-months was related to the two different independent factor (reduction rate of LDL-C and high sensitive CRP, respectively). Furthermore, lipid lowering therapy by use of statin has a potential to stabilize them by both plaque reduction and fibrous cap thickening.
Abstract 2570: The Unrestricted Use Of Paclitaxel-eluting Stents: Five-year Results Of The Research Registry
Authors: Onuma Yoshinobu , Kukreja Neville , Garcia-Garcia Hector M , Daemen Joost , van Domburg Ron , Serruys Patrick W
Published: July 2021

Objectives: Although the safety of drug-eluting stents (DES) has been under scrutiny, limited follow-up data up to 5 years are available, particularly among real-world patients. Therefore, we evaluated the 5-year clinical event rates in patients from the The Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital (RESEARCH) registry to establish the safety and efficacy of sirolimus-eluting stent (SES) in an unselected all-comer population.

Methods: On April 16, 2002, our institution commenced the use of SES (Cypher; Cordis Corporation, Miami Lakes, Florida) as the default strategy for all percutaneous coronary interventions at our institution. In the first 6 months of enrollment, 508 patients with de novo lesions were treated exclusively with SES (the SES group) and compared with a group of 450 consecutive patients treated with BMS for de novo lesions in the preceding 6 months (the pre-SES group), matched for stent diameter. Survival data was acquired from municipal civil registries. Health questionnaires have been sent to all living patients to obtain data on adverse clinical events were collected. Medical records will be reviewed and family doctors or referring cardiologists contacted as necessary. The primary end-point was composite major adverse events (MACE: all-cause death, myocardial infarction or target vessel revascularization [TVR]). Secondary endpoints included all-cause death, TVR and stent thrombosis. A propensity score-adjustment will be performed to compensate for differences in baseline characteristics between the groups.

Findings: Survival data is currently available for 94% of the patients after 5 years. The 5-year all-cause mortality rates were 14.0% for SES and 13.4% for BMS (p=0.9). Data on the other 5-year endpoints is currently being collected and will be presented at the time of the meeting.

Conclusions: There is no difference in the 5-year survival rates in the real-world unselected patients treated with SES, compared with BMS.
Abstract 2617: Inhibition of Secretory Phospholipase A
2
Activity Attenuates Acute Cardiogenic Pulmonary Congestion Induced by Isoproterenol Infusion in Mice with Post-Myocardial Infarction
Authors: Kawabata Ken-ichi , Kobayashi Tsuyoshi , Watanabe Yousuke , Watanabe Kazuhiro , Yano Toshiaki , Sato Ryota , Saito Yukio , Nakamura Kazuto , Kugiyama Kiyotaka
Published: July 2021

Several types of secretory phospholipase A
2
(sPLA
2
) are expressed in airway epithelial cells and alveolar inflammatory cells, yielding various eicosanoids that might cause pulmonary edema. This study examined whether inhibition of sPLA
2
activity attenuates acute cardiogenic pulmonary congestion in mice. Acute cardiogenic pulmonary congestion in 10-week-old male C57BL/6J mice was induced by continuous intravenous infusion of isoproterenol (ISP) (10 mg/kg/hr) at 2 weeks after the creation of myocardial infarction by left coronary artery ligation. Just before ISP infusion, a single intraperitoneal injection of 100 mg/kg of LY374388 (LY), a prodrug of LY329722 that is a specific inhibitor of activity of all sPLA
2
, or vehicle was administered. Arterial systolic pressure, heart rate, and LV end-diastolic pressure were comparably increased after ISP in both LY-mice and vehicle-mice. Also, lung expression levels of mRNA and protein of group V and X sPLA
2
were comparably increased from baseline by 3 ~ 5-fold in both groups of mice. sPLA
2
activity in lung tissue after ISP was increased from baseline by 5-fold in vehicle-mice, while the activity was not detected in LY-mice. In isolated neutrophils, incubation with LY329722 inhibited the respiratory burst and migration in response to fMLP or C5a by 40~50%. LY significantly reduced the lung-to-body weight ratio after ISP (71% of vehicle-mice) and attenuated alveolar neutrophil accumulation based on the lung histology (56% of vehicle-mice). Using the Evans Blue extravasation method, pulmonary vascular permeability was suppressed in LY-mice (Evans Blue content in lung; 66% of vehicle-mice). The lung content of thromboxane A
2
and leukotriene B
4
was increased in both groups, but was lower in LY-mice (71% and 64% of vehicle-mice, respectively). In Kaplan-Meyer analysis, the survival rate during the 12hr ISP infusion was higher in LY-mice than vehicle-mice (p < 0.01, n = 15 mice per group). Similar results were obtained with another inhibitor of sPLA
2
activity,
para
-bromophenacyl bromide. Inhibition of sPLA
2
activity suppressed acute cardiogenic pulmonary edema, and sPLA
2
inhibition may have therapeutic value in acute cardiogenic pulmonary congestion.
Abstract 2642: Prevalence and Importance of Cardiac Arrhythmias after Acute Ischemic Stroke
Authors: Jensen Jesper K , Januzzi James L , Atar Dan , Mickley Hans
Published: July 2021

Although heart rhythm monitoring following acute ischemic stroke is widely practiced, the prevalence of arrhythmia during the acute phase of ischemic stroke is debated. Several studies have claimed the potential threat of QT prolongation possibly leading to Torsades de Pointes ventricular tachycardia (VT) or ventricular fibrillation (VF). Furthermore, knowledge of the true rate of occult atrial fibrillation (AF) among ischemic stroke patients is sparse. 224 consecutive patients with acute ischemic stroke underwent daily 12-lead ECG during the first 5 days after hospital admission; as well as 24 hour Holter monitoring was performed in all patients. Patients with prior AF, established ischemic heart disease and heart failure were excluded. Patients were followed for 40 months for vital status. The mean age of the patients was 69 years. No patient had VT or VF. Previously unsuspected AF could be demonstrated in only 13 of 224 patients (6%). All 13 were detected by Holter monitoring, while nearly half were missed by ECG. During follow-up 53 (24 %) patients died. The presence of AF was significantly associated with mortality (log-rank p <0.0001; Figure

). In Cox analysis, patients with AF had an increased mortality compared to patients without AF (HR=2.44; [95 % CI, 1.00 – 6.00],
P
= 0.05) with adjustment for age and stroke severity and renal failure. The fear of serious ventricular arrhythmias in the acute phase of ischemic stroke appears to be groundless. However, new onset AF can be demonstrated in one of 20 patients with acute ischemic stroke and seems to be associated with an increased mortality during long-term follow-up.
Abstract 2664: Clinical Outcome and Left Ventricular Contractile Function After Distal Protection in Primary Percutaneous Coronary Intervention The Drug Elution and Distal Protection in ST-Elevation Myocardial Infarction (DEDICATION) Trial
Authors: Kofoed Klaus F , Kelbæk Henning , Thuesen Leif , Poulsen Steen H , Hassager Christian , Andersen Niels H , Helqvist Steffen , Lassen Jens F , Clemmensen Peter , Kløvgaard Lene , Kaltoft Anne , Engstrøm Thomas , Krusell Lars R , Terkelsen Christian J , Køber Lars
Published: July 2021

Objective
Embolization of material from an infarct-related lesion during percutaneous coronary intervention (PCI) may result in an increased infarct size. We evaluated the effect of distal protection during PCI for ST-segment elevation myocardial infarction (STEMI) on clinical outcome and myocardial function.

Methods and results
Patients with STEMI were randomly referred within 12 hours for PCI with (n = 312) or without distal protection (n = 314). Left ventricular (LV) contractile function was assessed with echocardiography 8 month after PCI. Global LV myocardial wall motion index (WMI) was calculated as the average wall motion score of all myocardial segments. Major adverse cardiac and cerebral events (MACCE) 8 months after PCI was 7.1 % after distal protection and 5.7 % after conventional treatment (p = 0.17). WMI improved by 4.1% at 8 months in patients treated with distal protection compared to patients receiving conventional PCI (p<0.01). In myocardium subtended by culprit coronary vessels treated with distal protection regional LV function was 9 –11% higher than myocardial regions treated conventionally (p<0.02).

Conclusion
Routine use of distal protection during primary PCI is associated with a significant improvement in LV contractile function, with no detectable impact on intermediate term clinical outcome.
Abstract 2666: Randomized Controlled Trial to Compare High-Dose N-Acetylcystein Versus Placebo to Prevent Contrast-Induced Nephropathy and Myocardial Reperfusion Injury in Patients with ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
Authors: Thiele Holger , Eitel Ingo , Hildebrand Lysann , Schirdewahn Carmen , Adams Volker , Fürnau Georg , Grebe Eigk , Gutberlet Matthias , Schuler Gerhard
Published: July 2021

STEMI patients undergoing PCI are at high risk for contrast-induced nephropathy (CIN) because of hemodynamic instability and lack of effective prophylaxis. High-dose N-Acetylcystein (N-ACC) reduced the incidence of CIN in patients with high contrast volumes. In addition, previous animal trials showed that the antioxidant effects of N-ACC reduce reperfusion injury. Aim of this randomized, controlled, single-blinded trial was to assess the effects of N-ACC on CIN and reperfusion injury in patients undergoing primary PCI with moderate contrast volumes. Two hundred-fifty patients undergoing primary PCI were randomized to either high-dose N-ACC (2x1200 mg/d for 48 hours) or placebo plus optimal hydratation. The two primary endpoints were: 1) occurrence of CIN defined as an increase in the serum creatinine concentration of >25% from the baseline value within 72 h; 2) Myocardial salvage measured by T2-weighted STIR-images and delayed enhancement MRI at day 2– 4 after primary PCI. Secondary endpoints were infarct size and microvascular obstruction, ST-resolution at 90 minutes and occurrence of MACE at 30 day follow-up. The median volume of an isoosmolar contrast agent during PCI was 190 ml (IQR 130, 250 ml) in the N-ACC and 180 (IQR 143; 228 ml) in the placebo group (p=n.s.). Baseline creatinine and creatinine clearance were 88 vs 86 μmol/l and 90 vs 95 ml/min, respectively. The primary endpoint CIN occurred in 14% in the N-ACC group and in 18% in the placebo group (p=n.s.). The primary endpoint reperfusion injury measured by myocardial salvage was also not different between both treatment groups (25.4%; IQR 14.1; 38.1 versus 22.5%; IQR 16.8; 36.5; p=n.s.). In addition, no differences in infarct size and microvascular obstruction as well as in ST-segment resolution were observed. The MACE rate after N-ACC was similar to placebo (19.4% versus 19.4%, p=n.s.). Lipid peroxidation as a marker for oxidative stress was reduced by 20% in the N-ACC group (p<0.05), whereas no change was evident in placebo. High-dose N-ACC reduces oxidative stress. However, it does not provide an additional clinical benefit to placebo with respect to CIN and prevention of myocardial reperfusion injury in patients undergoing PCI with moderate doses of contrast medium and optimal hydratation.
Abstract 2668: Critical Role of Granzyme B in Left Ventricular Remodeling after Acute Myocardial Infarction
Authors: Kondo Hideyuki , Hojo Yukihiro , Nishimura Yoshioki , Takahashi Nozomu , Ikemoto Tomokazu , Katsuki Takaaki , Shimada Kazuyuki
Published: July 2021

Background: Granzyme B is a member of the serine esterase family produced by cytotoxic T lymphocytes (CTLs), and has an important role in cellular apoptosis and extracellular matrix degradation. We hypothesized that granzyme B is involved in left ventricular (LV) remodeling after acute myocardial infarction (AMI).

Objectives: To elucidate the role of granzyme B in LV remodeling after AMI.

Subjects and methods: We employed 41 patients with the first AMI (mean age: 61.9±8.9 years old). We obtained peripheral blood on day 1, day 7 and day 14 after onset. Plasma levels of apoptosis-related molecules, including tumor necrosis factor α (TNFα), a soluble form of the Fas ligand (sFasL) and granzyme B were measured. We checked the activation of CTLs by flow cytometry. Patients were treated by percutaneous coronary intervention within 12 hours after onset. Successful myocardial reperfusion (TIMI flow grade 2 or 3) was accomplished in all patients. LV end-diastolic volume index (LVEDVI) was calculated on day 1 and 6 months after onset.

Results: Plasma levels of TNFα, sFasL and granzyme B increased significantly after the onset of AMI (TNFα; day 1: 1.6±0.47, day 7: 3.3±0.65, day14: 4.0±1.2 pg/ml, p<0.05, sFasL; day 1: 72±5.2, day 7: 86±6.7, day14: 95±7.3 pg/ml, p<0.05, granzyme B; day 1: 63±18.4, day 7: 283±57.8, day14: 210.9±46.3 pg/ml, p<0.001). The percentage of CD69± to CD3+ CD8+ lymphocytes was significantly increased (CD69+/CD3+ CD8+; day 1: 14.5±1.7, day 7: 15.8±1.2, day 14: 19.1±1.4%, p<0.05), suggesting that CTLs were activated after onset. Univariate regression analysis showed a significant positive correlation between plasma granzyme B level on day 14 and fold-increase in LVEDVI (r=+0.45, p<0.01). No significant correlation was observed between TNFα and changes in LVEDVI, or sFasL and changes in LVEDVI. Stepwise multivariate regression analysis showed that the plasma granzyme B level on day 14 is a significant explanatory variable for changes in LVEDVI (β = +0.53, p<0.001).

Conclusions: These results first indicate that among proapoptic molecules, granzyme B has a critical role in the progression of LV remodeling after AMI.
Abstract 2720: “Stop telling us what to do and tell us how to do it”: A Qualitative Meta-Analysis of Skill Development in Heart Failure Self-Care
Authors: Dickson Victoria V , Riegel Barbara
Published: July 2021

Background
: Heart failure (HF) self-care requires both knowledge and skill, but little attention has been given to identifying how to improve skill in HF self-care.

Methods:
We assessed what self-care skills are needed and how patients develop these skills using qualitative descriptive meta-analysis techniques. Transcripts from three mixed methods studies (n=85) were re-examined and translated to yield themes about the process of developing skill in HF self-care, defined as behaviors that maintain physiologic stability (maintenance) and the response to symptoms when they occur (management).

Results:
The sample was 63.5% Caucasian and 58.8% male, mean age of 55.69 years (± 13.42). Most (52.9%) were NYHA class III. Narrative accounts of HF self-care revealed that the most challenging self-care maintenance skills were diet, and exercise. The management skill that was most challenging was how to titrate diuretics in response to a weight gain. Skills developed over time through coaching by trusted resources (mostly friends or family with HF). Tactical skills (“how to” prepare low salt meals; “how to” start an exercise plan) were helped by role-playing. Situational skills (“what to do when”) most essential for self-care management were evident in descriptions of how they planned for special occasions. For example, significant others helped patients think through how to manage symptoms of fluid retention while traveling. Few patients saw traditional healthcare providers as resources they could call upon to aid them in developing tactical and situational skills. Patient education was not identified as a factor associated with the development of HF self-care skill. Rather, they struggled to operationalize the self-care knowledge they attained.

Conclusion:
Skill in HF self-care evolves over time, with experience and practice, as patients learned how to make self-care practices fit into their daily lives, but coaching by nurses may help patients develop the skill needed to master self-care skills. Research testing coaching interventions that target skill building tactics such as role-playing in specific situations is needed.
Abstract 2724: Predictors of Depressive Symptoms in Caregivers of Patients with Heart Failure
Authors: Chung Misook L , Pressler Susan J , Lennie Terry A , Moser Debra K
Published: July 2021

Millions of family members deliver informal care and support to patients with heart failure (HF). Accumulating evidence suggests that caregivers of patients with HF suffer from depressive symptoms, but factors associated with depressive symptoms are unknown. Identification of such factors could provide targets for intervention. Three possible factors that are amenable to intervention are caregivers’ functional status, their sense of caregiving burden, and perceived control. (1) To examine differences in functional status, perceived control, and caregiving experiences (time, difficulty, and burden) between depressed and non-depressed caregivers; (2) To examine whether these factors predict caregivers’ depressive symptoms. A total of 92 caregivers (mean age of 57 years; female 75%; spousal caregiver 80%) of patients with HF were recruited from outpatient clinics at two community hospitals and an academic medical center in central Kentucky. Their depressive symptoms were assessed using the Beck Depression Inventory-II (BDI-II). Functional status was assessed using the Duke Activity Status Index. Perceived control was assessed using the Control Attitudes Scale-Revised. Caregiving difficulty, time, and burden were assessed using the Bakas Caregiving Inventory and the Zarit Caregiver Burden Scale. Caregivers were grouped using the standard cut point of 13 on the BDI-II score. The 27% of caregivers with depressive symptoms had poorer functional status (21± 20 vs. 34 ± 19; p =.007), lower perceived control (22 ± 4 vs. 25 ± 4; p = .005), and higher caregiving burden (26 ± 14 vs. 13 ± 10; p< .001) than caregivers without depressive symptoms. Controlling for age and gender in a multiple regression, functional disability (sβ= −.298, p<.001), perceived control (sβ= −.298, p<.001), and caregiver burden (sβ= .328, p=.002) explained 45% of the variance in caregivers’ depressive symptoms. Caregivers’ functional disability, poor controllability, and burden related to caregiving were associated with depressive symptoms. These findings suggest that depressed caregivers of patients with HF may benefit from interventions that improve perceived control, address caregiving burden and functional status.
Abstract 2728: Nonadherence to Prescribed Medications Mediates the Link between Anxiety and Event-Free Survival in Patients with Heart Failure
Authors: De Jong Marla J , Moser Debra K , Chung Misook L , Wu Jia-Rong
Published: July 2021

Anxiety has been linked to adverse outcomes for patients with cardiac disease but the mechanism for this relationship is unknown. Nonadherence to prescribed medications is common in heart disease, particularly heart failure (HF), and may mediate the relationship between anxiety and outcomes. To determine if nonadherence to prescribed medications mediates any relationship between anxiety and clinical outcomes in patients with HF. Patients (N=147; age 61±11 yrs, 44% female, 59% NYHA class III/IV) with chronic HF were followed 389±324 days for clinical events (composite of death, emergency department visit, or hospitalization). Patients completed the anxiety subscale of the Brief Symptom Inventory at baseline. Objective evidence of medication adherence was measured with the Medication Event Monitoring System. Survival and regression analyses were used to test whether medication nonadherence mediated any association between anxiety and outcomes. Patients with highest anxiety had shorter event-free survival than patients with lower anxiety (Fig.

). After adjusting for age, gender, and NYHA class in Cox regression, high anxiety predicted (OR 2.4; p=.001) clinical events. Anxiety predicted medication doses taken (p=.01) and days correct doses taken (p=.008). Medication doses taken (p=.01) and days dose taken (p=.008) also predicted clinical outcomes. Medication nonadherence mediated the relationship between high anxiety and worse outcomes. This is the first study to show that medication nonadherence links anxiety and clinical outcomes. Interventions that decrease anxiety may improve both medication adherence and outcomes.
Abstract 2756: Prevention of Atrial Fibrillation Recurrence after Radiofrequency Catheter Procedure of Pulmonary Vein Isolation by Corticosteroids
Authors: Koyama Takashi , Sekiguchi Yukio , Tada Hiroshi , Arimoto Takanori , Yamasaki Hiro , Kuroki Kenji , Machino Takeshi , Tajiri Kazuko , Zhu Xu D , Kanemoto Miyako , Sugiyasu Aiko , Kuga Keisuke , Aonuma Kazutaka
Published: July 2021

Background:
Catheter based radiofrequency pulmonary vein isolation (PVI) has been shown to be an effective therapeutic option for controlling drug-refractory atrial fibrillation (AF); however, the recurrence of AF has become one of the major problems after procedure. Although the underlying mechanism of the AF recurrence is not well evaluated, previous reports indicated that inflammatory process could be associated with the onset of AF and the use of intravenous hydrocortisone reduced the incidence of AF after coronary artery bypass surgery. We therefore prospectively evaluated the efficacy of the hydrocortisone for the prevention of AF recurrence.

Methods and Results:
This study included consecutive 150 patients with drug-refractory paroxysmal AF. Patients were randomized to receive either hydrocortisone or matching placebos as follows: intravenous hydrocortisone (dose of 2mg/kg) was used in the day of operation, and oral hydrocortisone was administered (dose of 0.6mg/kg/day) for 3 days after PVI. Patients with non-PV-foci AF were excluded in this study (Control group; 4 patients, Hydrocortisone group; 6 patients). Various biophysical data were closely investigated between control group (n=71) and hydrocortisone group (n=69). Rate of total AF recurrence and immediate AF recurrence (recurrence of AF within 3 days after PVI) was significantly lower in hydrocortisone group than placebo group (total AF recurrence; 27.0% vs 46.1%, immediate AF recurrence; 6.7% vs 29.5%, p<0.01). Number of patients who underwent second PVI (8.3% vs 23.1%, p<0.01), rise of body temperature after the procedure (0.675°C vs 1.633°C, p=0.005), any sign of pericariditis (0% vs 6.4%, p<0.01), high sensitive CRP level after the procedure (1.17mg/dl vs 2.09mg/dl, P=0.015) and the number of patients using antiarrhythmics (classIb, classIII) after the procedure (classIb; 0% vs 6.4%, classIII; 6.7% vs 26.9%, p<0.01) were also significantly lower in hydrocortisone group than in placebo group.

Conclusion:
Transient use of hydrocortisone immediately after PVI can be one of the therapeutic options for the prevention of acute AF recurrence after PVI to avoid second procedure and/or the additional antiarrhythmic drug therapy.
Abstract 2758: Effect of Catheter Ablation and Antiarrhythmic Drug Therapy on AF Progression. A Long-term Controlled Follow-up Study
Authors: Santinelli Vincenzo , Radinovic Andrea , Sala Simone , Paglino Gabriele , Ciconte Giuseppe , Sacchi Stefania , Pappone Carlo
Published: July 2021

Background.
In the era of catheter ablation there are no prospective data on AF progression according to AF guidelines classification and management.

Methods.
Of 402 screened patients with first-detected paroxysmal AF, 106 (mean age, 57.5 years) were enrolled for this prospective study. Of them, 54 (mean age, 53.3 years) had lone AF and 52 (mean age, 62.0 years) had comorbidities. Patients were treated according to recent guidelines management. Primary endpoint of the study was the cumulative probability of progression to permanent AF over a 5-year follow-up among patients who underwent catheter ablation or antiarrhythmic drug therapy alone (ADT). Predictors of progression to permanent AF were also analyzed by multivariate analysis.

Results.
At the end of the 5-year follow-up, 50 patients with lone AF had no further recurrences after the first episode in the absence of ADT. The remaining 56 patients at a median follow-up of 19 months after the first episode experienced recurrent episodes of paroxysmal AF requiring ADT (45 patients) or catheter ablation (11 patients) because of ADT failure. Patients who underwent ablation had similar clinical characteristics as patients on ADT. K-M curves demonstrated that patients on ADT were more likely to progress to permanent AF than those who underwent catheter ablation (p=0.029, by log-rank test, Figure 1

). Age (p<0.0001), diabetes (p=0.003) and heart failure (p=0.002) predicted progression to permanent AF.

Conclusions.
Over a 5-year follow-up, catheter ablation is of benefit in delaying arrhythmia progression. Age, diabetes and heart failure predict progression to permanent AF.
Abstract 2796: Coronary Plaque Classification by Multislice Computed Tomography in Comparison with Histopathological Examination of the Atheromatous Tissue Obtained by Directional Coronary Atherectomy
Authors: Kimura Shigeki , Kakuta Tsunekazu , Yonetsu Taishi , Suzuki Asami , Komatsu Yuki , Ri Tetsumin , Isobe Mitsuaki
Published: July 2021

Multislice computed tomography (MSCT) has been reported to characterize plaque morphology using intracoronary ultrasound (ICUS) findings as the reference. However, the histopathological assessment for the efficacy of MSCT to distinguish atherosclerotic coronary plaque components has not been performed in vivo. We sought to find the cutoff values of CT density (CTD) to classify the non-calcified plaques using histopathological findings as the standard of reference. Thirty nine target lesions treated by directional coronary atherectomy (DCA) in 39 patients with coronary artery disease, who underwent preintervention MSCT and ICUS, were investigated. The lesions with calcifications in MSCT were excluded. DCA samples of plaques were histopathologically classified into one of the two types; lipid rich plaque (L) or fibrous plaque (F), and further, these two plaque types were subdivided into each two groups, plaque with calcifications or without (L-C, L-NC, F-C, F-NC). The mean CTD was determined by ROI method (5 ROIs) from three cross-sections of each target lesion. We compared the mean CTD among the groups and determined the best cutoff values to differentiate plaque compositions by receiver operating characteristic (ROC) curve. Sixteen lesions were histopathologically classified as lipid rich (6 with calcification (L-C), 10 without (L-NC)) and 23 lesions as fibrous plaque (11: F-C, 12: F-NC). Although mean CTD was not significantly different among the groups (L-C: 73±28 HU, L-NC: 39±11, F-C: 87±15, F-NC: 70±12, p=0.09), there was a significant difference between L-NC and F-NC (p<0.01). ROC analysis revealed that the best cutoff value to differentiate L from F showed relatively low sensitivity (cutoff value 52HU, sensitivity 69%, specificity 96%, AUC 0.82), whereas very high sensitivity and specificity (cutoff value 44 HU, sensitivity 90%, specificity 100%, AUC 0.97) was detected for the cutoff value to differentiate L-NC from F-NC. Plaque CTD may accurately classify non-calcified plaque compositions comparable to histopathological definitions when the lesions were composed without microscopic calcifications.
Abstract 2806: Whole Heart Coronary Magnetic Resonance Angiography Using 32-Channel Cardiac Coils and High Parallel Imaging Factor
Authors: Nagata Motonori , Sakuma Hajime , Ishida Nanaka , Nakajima Hiroshi , Ishida Masaki , Miyahara Masatoshi , Kato Shingo , Nakamura Mashio , Ito Masaaki , Takeda Kan
Published: July 2021

PURPOSE Coronary MRA provides noninvasive detection of coronary artery disease (CAD) without administration of contrast medium or exposing the patient to radiation. However, use of coronary MRA in excluding patients with CAD has been limited due to lengthy imaging time. The purpose of this study was to reduce acquisition time of coronary MRA by using 32 channel cardiac coils and high parallel imaging factor, and to evaluate diagnostic performance of this method in detecting significant CAD.

METHOD AND MATERIALS Sixty-two patients with suspected CAD were studied. Free-breathing coronary MRA encompassing the entire heart was acquired by using 32-channel coils and SENSE factor of 4. After monitoring motion of the coronary artery on cine MRI, MR angiograms were acquired during diastole in 46 patients (acquisition window 82±57ms) and during systole in 16 patients (50±19ms). Coronary MRA images were interpreted by 2 observers by employing a sliding SLAB MIP method. All patients underwent X-ray coronary angiography within 4 weeks from MRA, and significant CAD was defined as a luminal diameter reduction of 50% or more by QCA. All lesions with a reference diameter of 2mm or more on X-ray angiography were included when determining the accuracy of coronary MRA.

RESULTS Acquisition of MRA was completed in all 62 patients, with the averaged imaging time of 6.1±2.6min. High SENSE factor achieved by 32-channel coils resulted in substantial reduction of imaging time by factor of >2, with the image quality score (4.6±0.2) at least equivalent to that by conventional 5-channel coils and SENSE factor of 2 (4.5±0.2). Significant CAD was observed on X-ray coronary angiography in 39 patients. MRA detected 33(85%) of 39 patients having CAD, with high specificity of 96%(22/23). All 16 patients with double- or triple-vessel diseases were detected by MRA. On a vessel based analysis, Whole-heart coronary MRA demonstrated sensitivity of 83%(49/59), specificity of 94%(119/127) and NPV of 92%(119/129).

CONCLUSION Whole-heart coronary MRA with 1.5T MR imager and 32-chennel coils permits noninvasive detection of CAD with substantially reduced imaging time and high study success rate. High NPV (>90%) indicated the value of this approach in ruling out significant CAD.
Abstract 2812: Accuracy of Delayed Hyper-Enhancement Cardiac Magnetic Resonance Imaging in Patients with Endomyocardial Biopsy Positive Amyloidosis: A Multimodality Imaging Study
Authors: Austin Bethany A , Flamm Scott , Rodriguez Rene , Tan Carmela , Tang W.H. Wilson , Taylor David O , Starling Randall C , Desai Milind Y
Published: July 2021

In patients with suspected cardiac amyloidosis (CA), endomyocardial biopsy (EMB) provides definitive diagnosis. On delayed hyper-enhancement cardiac magnetic resonance (DHE-CMR), CA has a characteristic diffuse enhancement of the subendocardium extending to adjacent myocardium. We sought to determine the accuracy of DHE-CMR, as compared to standard noninvasive parameters, in the diagnosis of patients with suspected CA who underwent EMB. A total of 37 consecutive patients (mean age 60 years, 70 % men, 57 % with NYHA class > 2) with suspected CA underwent electrocardiography (ECG), transthoracic echocardiography (TTE), DHE-CMR (Siemens 1.5 T scanner, Erlangen, Germany) and EMB between 1/05 and 4/08. Low voltage on ECG was defined as the sum of S wave in lead V1 + R wave in lead V5 or V6 < 15mm. Standard TTE (including tissue Doppler) parameters and myocardial performance index (MPI) [(isovolumic contraction time + isovolumic relaxation time)/ejection time] were recorded. CMR was considered positive in the presence of DHE of the subendocardium extending to the adjacent myocardium. Fifteen patients had EMB-positive CA, while 22 had negative EMB. Using EMB as the gold standard, there was 1 false-positive and 1 false-negative CMR. Sensitivity and specificity of DHE-CMR for CA was 93% and 95%, and, positive predictive value (PV) and negative PV of DHE-CMR in the diagnosis of CA were 93 % and 95 % respectively. Logistic regression analysis demonstrating the association between EMB-positive CA and various noninvasive parameters is shown in the Table

. DHE-CMR is highly accurate in noninvasive diagnosis of EMB-positive CA as compared to standard ECG and TTE criteria. Incremental prognostic value of DHE-CMR in CA for clinical outcomes needs to be determined.

Table:

Logistic univariate regression analysis testing the association between endomyocardial biopsy proven cardiac amyloidosis and various noninvasive imaging parameters.
Abstract 2826: Microvascular Obstruction on Cardiac MRI is Associated with an Early Peak Troponin
Authors: Weaver James C , Rees David , Prasan Ananth M , McCrohon Jane A
Published: July 2021

Background
: Microvascular obstruction (MVO) post STEMI, as defined on cardiac MRI (CMR), reflects slow flow in the microvasculature. It has been postulated that MVO may result in impaired washout of troponin (Tn) and therefore a later peak.

Aim
: To use CMR to explore the relationship between MVO and the pattern of TnI release after STEMI.

Methods:
After successful primary angioplasty serial TnI measurements were taken at 6, 14 and 24 hours. Gadolinium (Gd) enhanced CMR was performed at 4.7±2 days and again at 191±17 days. Infarction was defined as a hyperenhanced region 10 minutes after intravenous 0.1mmol/kg Gd and MVO defined as a hypoenhanced region in the centre of this infarcted segment. A 17 segment model was used for wall motion assessment and functional recovery.

Results:
26 patients, age 57 ±11 yrs, were included in the analysis. On early scanning infarct size was 22.1±13% and MVO was 4.3± 4% of LV mass. The 81% of patients with MVO had an earlier peak TnI than those without MVO (p=0.005). Patients with severe MVO, defined as the highest quartile of MVO extent, all had the earliest peak of 6hrs. Those with MVO had higher TnI at 6hrs (p=0.002), 14hrs (p=0.027) and area under the curve (AUC) (p=0.014). TnI levels at all time points in the first 24 hours had a very strong correlation with MVO extent (r=0.80 – 0.88, p<0.001). This was stronger than between TnI and infarct size (r=0.68 – 0.78, p<0.001). Equally an early peak TnI (6hrs compared with 14hrs) was associated with a higher peak TnI level (p=0.013) and AUC (p=0.019). In the 17 patients with follow up scans infarct involution was 19.8±13% and the relationship between TnI level and infarct size did not change significantly. As MVO increased there was less functional recovery (r=−0.49, p=0.046) and increased left ventricular end diastolic volume (r=0.512, p=0.036) at 6 months. Of the 5 patients who developed dyskinetic segments 3 had severe MVO and 4 an early peak TnI.

Conclusion:
MVO presence and extent is associated with an early peak in TnI after reperfused STEMI and more extensive myonecrosis as evidenced by cumulative (AUC) TnI release. These findings favour more complete myonecrosis within the MVO region, rather than impaired washout, as the predominant pathological basis for the relationship between MVO and TnI kinetics.
Abstract 2828: The Relationship Of Left Ventricular Structure And Function With Subclinical Measures Of Atherosclerosis: The Multi-ethnic Study Of Atherosclerosis
Authors: Bahrami Hossein , Lima João A , Brumback Lyndia , Heckbert Susan R , Cooper Richard , Hundley Gregory , Jerosch-Herold Michael , Sinha Shantanu , Bluemke David A
Published: July 2021

Background:
Left ventricular (LV) structure and function are important independent predictors of cardiovascular events, but the relationship of these parameters to indices of subclinical atherosclerosis has not been evaluated in an asymptomatic population.

Methods:
The Multi-Ethnic Study of Atherosclerosis (MESA) includes 6,814 men and women, aged 45– 85 years; white, African-American, Hispanics, and Chinese. LV parameters were measured by MRI. Measures of subclinical atherosclerosis included carotid intima-media thickness (IMT) determined by high-resolution B-mode ultrasonography and coronary artery calcification (CAC) defined as phantom-adjusted Agatston calcium score from brightness adjusted CT images.

Results:
In univariable analyses, LV mass index, LV ejection fraction (LVEF), and LV end-diastolic volume (EDV) were significantly associated with both the presence and the extent of CAC as well as with carotid IMT (Table

). But after adjustment for traditional risk factors, the magnitudes of the associations decreased considerably. Although the relationship of LV mass with carotid IMT and CAC remained statistically significant, the associations of LVEF and EDV with CAC and IMT were not significant in multivariable analyses. LV ejection fraction and LV end-diastolic volume were also associated with CAC and IMT in univariable analyses, but these associations were not significant in multivariable analyses. Although there was no significant effect modification by ethnicity, the association of LV mass with CAC was stronger in African Americans and Hispanics, compared to Caucasians and Chinese Americans.

Conclusions:
Subclinical atherosclerosis is associated with increased LV mass and decreased LV function. However, these associations may be in part due to the relationship of traditional risk factors for atherosclerosis with LV structure and function, independent of an atherosclerotic process.
Abstract 2831: Endomyocardial-to-Epimyocardial Blood Flow Ratio Distinguishes Severity of Coronary Artery Disease: A Perfusion CMR Study
Authors: Patel Amit R , Antkowiak Patrick F , Nandalur Kiran R , Arora Vishal , Kramer Christopher M , Epstein Frederick H
Published: July 2021

Background:
Ischemia propagates as a wave front from the endocardial (ENDO) to the epicardial (EPI) surface. Normally, myocardial blood flow (MBF) is higher in the ENDO than EPI. We hypothesized that the ENDO/EPI ratio could differentiate the severity of coronary stenoses in a clinical patient population.

Methods:
Perfusion CMR was performed in 29 patients within 30 days of x-ray angiography and quantitative coronary analysis. During adenosine infusion and at rest, dual boluses of Gd-DTPA were infused (4ml/s) to quantify arterial input function (0.0075mM/kg) and tissue perfusion (0.075mM/kg) in 3 short axis slices using hybrid gradient echo/echo planar imaging. ENDO and EPI MBF for rest and stress were estimated by determining the peak amplitude of the impulse response derived from Fermi function deconvolution. Stress and rest ENDO/EPI ratios were calculated and then corrected (corr) for rate-pressure product (RPP) using the formula ENDO/EPI * (SBP*HR*10
−4
).

Results:
Coronary stenosis (CS) >50% was present in 23 of 29 patients. Hypertension, diabetes, and dyslipidemia were present in 23, 9, and 26 patients, respectively. Stress corrENDO/EPI (mean±SE) was inversely related to CS (CS<50% = 1.356 ± 0.030, CS 50–70% = 1.266 ± 0.029, and CS>70% = 1.149 ± 0.039; p<0.05) (Figure

). The relationship persisted after exclusion of the 56 segments with a myocardial scar (p<0.05). No relationship existed between CS and rest ENDO/EPI, rest corrENDO/EPI, or uncorrected stress ENDO/EPI.

Conclusions:
Stress corrENDO/EPI is inversely related to the severity of CS. Quantitative stress endo/epi ratios can distinguish intermediate from severe stenoses in patients with known or suspected CS.