bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 9399: Right Ventricular Dysfunction during Exercise: Potential Markers of Exercise Intolerance in Pulmonary Hypertension
Authors: Anjak Ahmad , Edelman Kathy , LÓpez-Candales Angel
Published: April 2024

Background:
Development of exercise-induced pulmonary hypertension (exPH) is a clinically important; but poorly characterized hemodynamic event. Even though bicycle echocardiography (BE) has been suggested as a useful non-invasive test to estimate pulmonary artery pressures (PAP) during exercise; simple measurement of pressures appears to be an unreliable approach to detect exPH. Consequently, we queried our BE database to examine if objective parameters of right ventricular (RV) function might be useful in distinguishing abnormal responses to exercise. To accomplish this goal, we identified patients who develop mild exPH and compared them to normal controls.

Methods:
In this retrospective analysis, we measured RV fractional area change, tricuspid annular plane systolic excursion (TAPSE), RV myocardial performance index (RV MPI), and systolic velocity of the tricuspid annulus (TA TDI). All these measures were collected at each stage of the BE protocol from 10 control individuals, and 10 patients who developed mild exPH with estimated exercise PAP of 62 ± 9.

Results:
Tricuspid regurgitation signal was an unreliable measure to estimate PAP with increasing workloads; however, all objective parameters were collected in all patients at every stage. In control individuals, not only TAPSE and TA TDI increased with each stage but also baseline RV MPI was significantly lower and remained largely unchanged during exercise. In sharp contrast, TAPSE and TA TDI remained largely unchanged (Fig 1 A&B) while the baseline RV MPI not only was higher but also continued to increase with exertion in the mild exPH group (Fig 1 C). Also individuals with exPH were older in age (p value<0.001).

Conclusion:
Even though age might be an unaccountable variable in this pilot study; our data seems to suggest that objective measures of RV function during BE, might be useful for the assessment of RV response to increasing exercise workloads.
Abstract 9422: Electronic Personal Health Record Use in Congenital Heart Disease Patients
Authors: Bradley Tiernan Linda , Khan Munziba , John Anitha , Kuehl Karen
Published: April 2024

Background:
We evaluated if providing congenital heart disease (CHD) patients (pts) with an electronic personal health record would improve medical knowledge, psychological adjustment to illness (PAIS), and satisfaction with medical care.

Methods:
Since 2/2011, 81 CHD pts > 15 years were enrolled in accounts on www.followmyheart.org (FMH). Using standardized surveys, medical knowledge and psychological adjustment were assessed prior to and 12 months after enrollment. Non-parametric testing was used to compare baseline and post-enrollment responses.

Results:
Mean age of pts (44% M) was 28 + 10 years. Ethnic breakdown included: 72% Caucasian, 17% African American, 5% Hispanic, and 6% other. Disease severity ranged from mild (24%), moderate (43%), to severe (33%); moderate to severe disease occurred more frequently in older patients (p<.05). Half of pts reported regular FMH use and two-thirds found the site helpful. There were no differences between FMH users and non-users in gender, race, disease complexity or education level. 23% had lapses in care >3 years and 6% had lapses >10 years. Mean age at first lapse was 19 years due to insurance issues (63%), relocation (56%), and lack of symptoms (50%). Pre-enrollment, few pts were able to identify symptoms of endocarditis (10%) and arrhythmia (38%). Females were unaware of the risks of CHD on contraceptive choices (55%) and pregnancy (48%). Pre-enrollment PAIS analyses revealed worse adjustment with increasing age in the sub-scores of domestic (p<0.005), sexual (p <0.05), social environmental (p<0.005), and psychological distress (p< 0.001) and total T-score (p<0.005). One year post-enrollment, data was available in 49% of eligible patients. More pts were able to identify symptoms of endocarditis (23%) and arrhythmia (44%). Pts reported increased satisfaction with medical care and increased confidence in obtaining medical care without undue financial hardship (p=0.05). There were no statistical differences in PAIS score. FMH use increased with age.

Conclusions:
Use of FMH by CHD pts resulted in improved knowledge of cardiac complications and improved satisfaction with medical care. Longer follow-up is needed to assess the utility of FMH in decreasing lapses in care.
Abstract 9434: Cancer Risk Estimation from Cardiac Catheterization in Children with Heart Disease
Authors: Johnson Jason N , Hornik Christoph P , Li Jennifer S , Pasquali Sara K , Yoshizumi Terry , Reiman Robert E , Frush Donald P , Hill Kevin D
Published: April 2024

Background:
Radiation exposure is a concern in children because of their high radiosensitivity, small body size, and cancer risk. We evaluated the effective dose (ED) of radiation from cardiac catheterization to estimate the lifetime attributable risk (LAR) of cancer.

Methods:
Organ specific radiation doses were measured from conventional angiographic projections using dosimeters placed in 2 anthropomorphic phantoms representing 1 and 5 years of age. We used a proprietary radiation dose calculator developed from the phantom data to determine ED using catheterization fluoroscopy and cineangiography times for 3 patient cohorts (age < 5yrs): those post Norwood operation, heart transplant and ASD device closure. Age- and sex-specific LARs of cancer above baseline were estimated using the approach of the Committee on
Biological Effects of Ionizing Radiation
(BEIR VII).

Results:
Eligible children undergoing catheterization between July 2005 and August 2011 were included in the analysis. The cohort consisted of 67 subjects post-Norwood (191 catheterizations, median time since Norwood: 161 days), 10 post-transplant (91 catheterizations, median time since transplant: 88 days) and 12 post-ASD closure (median age at catheterization 3.9 years). ED and LAR of cancer attributable to catheterization are presented for a single catheterization and for cumulative exposure in those cohorts that undergo repeat procedures (table). LAR of cancer varied depending on age at exposure, gender and ED and was > 0.15% for 80% of all procedures. Adjusting for ED and age at exposure, the median LAR of cancer was twice as high in females vs. males (p<0.01).

Conclusion:
Cardiac catheterization can result in radiation exposure that increases LAR of cancer to up to 6% above baseline in select populations. These data highlight the need for limiting radiation dose in females, children with normal life expectancy and children that require repeat catheterizations.
Abstract 9437: Impact of Positive Airway Pressure Therapy in Elderly Patients with Cardiovascular Disease and Sleep-disordered Breathing
Authors: Nishihata Yosuke , Takata Yoshifumi , Kato Kota , Yamaguchi Tasuku , Shiina Kazuki , Usui Yasuhiro , Yamashina Akira
Published: April 2024

Introduction:
Many studies have identified an association between sleep-disordered breathing (SDB) and cardiovascular disease (CVD). Recent studies have showed that SDB is an independent predictor of poor prognosis and continuous positive airway pressure (PAP) therapy contributes to reduce the risk. However, whether SDB is a risk factor for CVD in elderly patients and whether PAP therapy improves long-term cardiovascular outcomes are unknown.

Hypothesis:

We assessed the hypothesis that PAP therapy improved long-term cardiovascular outcomes in elderly patients with CVD and moderate to severe SDB.

Methods:
We studied 1693 patients who underwent polysomnography between November 2004 and July 2011, and enrolled 131 elderly patients (age ≥65 years old) with SDB (apnea-hypopnea index ≥15 per hour), who had been admitted to hospital due to CVD before polysomnography. They were divided into two groups; a PAP-treated group (n=64; treated with continuous positive airway pressure or adaptive servo ventilation) and an untreated SDB group (n=67; untreated with PAP devices). The frequency of death and hospitalization due to cardiovascular events (acute coronary syndrome, heart failure, stroke, fatal arrhythmias, and aortic dissection) between the groups was analyzed using multivariate analysis.

Results:
The mean follow-up period was 31.8 ± 23.4 months and 34 patients (26.0%) died or were re-admitted to hospital due to cardiovascular events. Kaplan-Meier survival curves indicated that event-free survival was significantly higher in the PAP-treated group than in the untreated SDB group (Figure). Multivariate analysis showed that the risk for death and re-admission due to cardiovascular events was significantly higher in the untreated SDB group than in the PAP-treated group (hazard ratio, 3.21; 95% confidence interval, 1.05 to 10.9; p <0.05).

Conclusions:
PAP therapy improves cardiovascular outcomes in elderly patients with CVD and moderate to severe SDB.
Abstract 9459: Mitral Valve Prolapse-Related Cardiomyopathy
Authors: Malev Eduard , Zemtsovsky Eduard , Pshepiy Asiyet , Reeva Svetlana , Korshunova Aleksandra
Published: April 2024

Purpose:
In some inherited connective tissue diseases with involving of the cardiovascular system, e.g. Marfan syndrome has been reported early impairment of LV function, which has been described as Marfan-related cardiomyopathy. Our aim was to evaluate the LV function in young adults with mitral valve prolapse (MVP) without significant mitral regurgitation using two-dimensional strain imaging and the possible role of transforming growth factor-β (TGF-β) pathway in its deterioration.

Methods:
We studied 78 asymptomatic young subjects (mean age 19.7±1.6, 72% male) with MVP in comparison with 80 sex- and age-matched healthy subjects. Longitudinal strain and strain rate (SR) were determined from three apical views, using spackle tracking (Vivid 7 Dimension, EchoPAC’08) with grey-scale frame rate 50-55/sec. Concentrations of TGF-β
1
and β
2
in serum were determined by enzyme-linked immunosorbent assay using a test system Human Platinum ELISA.

Results:
During the k-means clustering we have identified two clusters of subjects with MVP: first cluster (17 subjects, 28% of the MVP group) and second cluster (61 subjects, 72%). In 1st cluster observed a significant reduction of global systolic strain compared with the control group (-15.5±2.9% vs. -19.6±3.4%; p=0.00001) and the 2nd cluster (-15.5±2.9% vs. -20.6±3.8%; p=0.00001). Diastolic global SR was also decreased compared with the control group (1.3±0.25/s vs. -1.62±0.25/s; p=0.0001) and the 2nd cluster (1.3±0.25/s vs. 1.62±0.25/s; p=0.00001). Global strain in the second cluster did not differ significantly from the control group (p=0.1), but there are significant decrease of local longitudinal systolic strain (-17.1±3.2% vs. -20.7±3.1%; p=0.001) and diastolic SR (1.38±0.25/s vs. 1.55±0.22/s; p=0.00001) in interventricular septum. In first cluster high TGF-β
1
serum level (>14.75 ng/ml) was detected in 2 subjects, TGF-β
2
(>2.0 ng/ml) in 11, and both TGF-β
1
/β
2
in one subject. In 2nd cluster high TGF-β
2
level observed only in 10 subjects (χ
2
=41.1; p=0.00001).

Conclusions:
These changes of deformation may be the first signs of deterioration of the LV function in young adults with MVP, which may be caused by increased TGF-β signaling and myocardial fibrosis.
Abstract 9462: Endothelial Progenitor Cells Predict Five-Year Prognosis In Patients With Stable Angina Treated With Percutaneous Coronary Intervention
Authors: Pelliccia Francesco , Marazzi Giuseppe , Pasceri Vincenzo , Rosano Giuseppe , Mattioli Luigi , Greco Cesare , Gaudio Carlo
Published: April 2024

Background. Endothelial progenitor cells (EPCs) have a pathogenetic role in stent restenosis after percutaneous coronary intervention (PCI). It remains undefined, however, if an association between numbers of EPCs at time of PCI and the subsequent long-term clinical outcome exists. To address this issue, we performed a pre-specified analysis of follow-up data of the PROCREATION (PROgenitor Cells role in Restenosis and progression of coronary ATherosclerosis after percutaneous coronary intervention) study.

Methods. A total of 155 patients (92 men, age 60±11 years) with stable angina treated with PCI were originally included in the PROCREATION study. All patients had flow cytometry the day before elective PCI in order to derive subpopulations of EPCs. After the index PCI, patients underwent 1-year control angiography and were then evaluated at 6-month intervals up to 5 years. The occurrence of major adverse cardiac events (MACE) was recorded in all patients.

Results. During the 5-year follow-up, all-cause death occurred in 16 patients (10%), cardiovascular death in 9 (6%), non fatal myocardial infarction in 6 (4%), and target vessel revascularization in 41 (26%). There were no significant differences in clinical and angiographic variables between patients with or without MACE. After adjusting for age, sex, left ventricular function, and number of diseased vessels, it was found that halving of numbers of CD34+/KDR+/CD45- cells and CD133+/KDR+/CD45- cells (i.e., progenitors of endothelial lineage) increased the risk of MACE by 75% (hazard ratio: 1.75; 95% confidence intervals: 1.1 to 2.8) and 66% (hazard ratio: 1.32; 95% confidence intervals: 0.9 to 2.3), respectively. Conversely, there were no relationships between outcome and numbers of CD14+/CD45+ cells (i.e., which play a role in angiogenesis via a paracrine effect) and CD105+/CD45-/CD34- cells (i.e., which have a receptor for transforming growth factor-beta).

Conclusions. Patients with stable angina treated with PCI who have a worse clinical outcome have lower numbers of circulating EPCs subtypes that are progenitors of endothelial lineage at time of the procedure. Assessment of EPCs at PCI can improve characterization of long-term prognosis. (ClinicalTrials.gov Identifier:
NCT01575431
)
Abstract 9468: Spectrum of ST Amplitude: Athletes and an Ambulatory Clinical Population
Authors: Muramoto David , Findley Clarence , Wong Myo , Adhikarla Chandana , Hadley David , Froelicher Victor
Published: April 2024

INTRODUCTION:
Despite the relationship of the ST segment to chest pain, channelopathies, and early repolarization, there is limited data describing ST amplitudes in apparently healthy populations and athletes.

HYPOTHESIS:
We sought to better characterize the spectrum of ST amplitude with the hypothesis that there is a meaningful difference in ST levels between an ambulatory clinical population and healthy athletes.

METHODS:
We performed a retrospective study of 5,085 computerized ECGs from February, 1997 to December, 1999 at the Veterans Affairs Palo Alto Health Care System, with 4,041 analyzed after exclusion of ECGs with pathological conditions that could cause ST elevation. Twelve-lead ECGs were also analyzed from all 1,117 Stanford University athletes undergoing annual pre-participation physical exams in 2007 and 2008. Using the PR interval as the isoelectric line and an amplitude criterion of >0.1mV, ST amplitudes were measured from the end of the QRS complex.

RESULTS:
Of the clinical subjects, 87% were male, 13% African American (AA),
a
nd 87% Caucasian or other, with a mean age of 55 ± 14 years. Of the athletes, 55% were male, 14% African American, with a mean age of 19 ± 1.5 years. The precordial leads exhibited the largest median ST amplitudes and largest differences in comparison by gender, ethnicity, and group. Compared to females, males had greater median ST levels within both populations with a larger percentage of males with ST amplitudes >0.1mV (for V2: 28.3% versus 17.1%, p<0.0001). Compared to clinical subjects, athletes had greater median ST levels and a greater proportion had ST amplitudes >0.1mV (for V2: 53.0% versus 17.7%, p<0.0001). Compared to Caucasions and others, African Americans had more than twice the prevalence of ST elevation >0.1mV in V5 (8.1% versus 2.9%, p<0.001).

CONCLUSIONS:
When assessing the clinical significance of ST elevation, the differences due to athletic status, gender, and ethnicity illustrated here must be considered.
Abstract 9471: Reverse Left Atrial Remodeling, Contraction and Compliance after Radiofrequency Catheter Ablation in Patients with Fixed Atrial Fibrillation
Authors: Takenaka Sou , Nakashima Takashi , Gunji Takahiro , Ozaki Yukihiro , Nakamura Mitsuchika , Otsuka Masato , Tsurumi Yukio
Published: April 2024

Background & Objectives:
Restoration and maintenance of regular rhythm can be achieved by radiofrequency catheter ablation (RFCA) in patients with fixed atrial fibrillation (AF). However, it still remains undetermined whether this reversal is accompanied with amelioration of atrial function, which is associated with reduced risk of subsequent thromboembolic events.

Methods:
We studied 35 consecutive patients (age: 63±10 years) who had received RFCA for fixed AF. Serial changes in left atrial (LA) size and function were evaluated with echocardiography at baseline, 2 weeks, 3 months and 12 months after the procedure.

Results:
Thirty-one of 35 patients had recovered and maintained regular rhythm over 12 months following RFCA. Of these 31 patients, 7 patients required second or third sessions. LA size and biplane volume index significantly and progressively reduced over the time during 12-month follow-up periods (p<0.001 and p<0.001, respectively). Atrial contractibility, assessed by time-velocity integral of atrial wave and atrial filling fraction (p<0.001 and p<0.001, respectively), was improved after the procedure. In addition, atrial compliance, assessed by peak systolic strain of LA inferior and septal wall (p<0.001 and p<0.001, respectively), was also improved over the time. LA active contraction, assessed by LA late diastolic strain of LA inferior and septal wall, was appeared at 2 weeks after the procedure, and preserved during the follow-up periods. In addition, this improvement of atrial function was accompanied with that of left “
ventricular
” ejection fraction (p<0.001).

Conclusion:
Restoration and maintenance of regular rhythm achieved by RFCA was associated with reduction in atrial size and volume as well as improvement in contraction and compliance. Our findings may encourage usefulness of RFCA for fixed AF, expecting risk of reduction of subsequent thlomboembolic events.
Abstract 9473: Prognostic Significance of Temporal Increase in QRS Duration and Morphological Development of QRS Complex
Authors: Kawaguchi Tamiro , Hayashi Hideki , Miyamoto Akashi , Yoshino Tomohide , Naiki Nobu , Taniguchi Atsushi , Sugimoto Yoshihisa , Itoh Makoto , Murakami Yoshitaka , Horie Minoru
Published: April 2024

Background:
QRS duration and morphology provide an opportunity to derive useful prognostic information. But, prognostic value of temporal increase in QRS duration in relation to the morphological development is yet to be determined.

Methods:
From among a database containing 359,737 ECGs, digital analysis of 12-lead ECG was performed to select patients whose QRS duration increased from <110 ms to ≥120 ms over time. The long-term prognosis was assessed according to QRS morphology. Hospitalization for heart failure was the primary end point, and the cardiovascular composite events of hospitalization for heart failure, device implantation, or cardiovascular death were the secondary end point.

Results:
We enrolled 143 patients (100 males; mean age, 58.9±11.1 years). During follow-up (mean, 12.0±5.3 years), QRS duration increased by 46.4±13.8 ms (49.6%), resulting in the development of right bundle branch block (RBBB) in 99 (69.2%) patients and non-RBBB (i.e., left bundle branch block,RBBB with left anterior hemiblock, or intraventricular conduction disturbance) in 44 (30.8%) patients. During a mean follow-up of 16.6±5.3 years, 44(30.3%),15(10.3%), and 6(4.1%) patients resulted in heart failure hospitalization,device implantation, and cardiovascular death, respectively. Cox proportional -hazards model showed that 1) the temporal increment of QRS duration was significantly associated with the primary end point (HR 1.98; 95% CI 1.05-3.80; P=0.04 for QRS duration ≥4 ms/year versus <4 ms/year) and the secondary end point (HR 2.79;95% CI 1.55-5.00; P=0.0001 for QRS duration ≥5 ms/year versus <5 ms/year),2) QRS morphology was significantly associated with the primary end point (HR 3.02;95% CI 1.59-5.73; P=0.0001 for non-RBBB versus RBBB) and the secondary end point (HR 2.82; 95% CI 1.57-3.09; P=0.001 for non-RBBB versus RBBB), and 3) the temporal increment of QRS duration and the QRS morphology of non-RBBB potentiated each other, leading to the higher primary end point rate (HR 7.73; 95% CI 2.90-22.74;P<0.0001) and the higher secondary end point rate (HR 8.25; 95% CI 3.39-19.85; P<0.0001).

Conclusion:
Newly developed wide QRS complex excluding RBBB played a significant role in heart failure hospitalization and cardiovascular events.
Abstract 9504: Phosphodiesterase Modulation of Cardiomyopathy in Murine and Canine Models of Muscular Dystrophy Treated With Sildenafil and Tadalafil
Authors: Albert Chonyang L , Sleeper Meg , Sweeney H. Lee
Published: April 2024

Patients with Duchenne muscular dystrophy (DMD) suffer from a myriad of musculoskeletal, respiratory, and cardiac symptoms.Cardiomyopathy is the second most common cause of death in DMD patients. The development of cardiomyopathy in these patients is often insidious, but untreated, many patients progress to overt heart failure. Current therapies used to treat the cardiomyopathy of DMD have been poorly studied since many of the same medications are used empirically from patients with congestive heart failure, despite the different underlying mechanical causes of heart failure in DMD patients. Using a well-established murine model of DMD, we treated
mdx
mice with phosphodiesterase-5 (PDE-5) inhibitors (sildenafil or tadalafil) for a duration of 1 month and 8 months. Treatment response was measured by dobutamine stress echocardiography parameters, proteomic expression, and histologic studies. We saw an increase in protein kinase G (PKG) levels in the sildenafil and tadalafil treated mice hearts, afterboth 1 month and 8 months of treatment, which suggests that the PDE-5 inhibitors’ mechanism of action is active in the heart. This was accompanied by a low level of atrial natriuretic peptide in the treated hearts compared to the untreated hearts at 8 months. Our results suggest that PDE-5 inhibition modulates and down-regulates the pro-fibrotic and pro-inflammatory cascade in the dystrophic
mdx
heart through TGF beta and SMAD2/3 pathways in an ERK-independent manner. Moreover, in a canine study in which dogs affected with golden retriever muscular dystrophy were treated with one of these 2 drugs for one month, both PDE-5 inhibitors resulted in improved left ventricular strain as measured with cardiac magnetic resonance imaging. There are some differences between the effects of the two PDE-5 inhibitors which is likely attributable to differences in the potency and specificity of these two agents at PDE5 inhibition. Further studies will continue to elucidate the role of PDE-5 inhibitors in the treatment of the dilated cardiomyopathy of DMD. Supported by Parent Project Muscular Dystrophy
Abstract 9621: Intensive Lipid Lowering Therapy Using Rosuvastatin Associates with Greater Atherosclerotic Aortic Plaques Regression - A Magnetic Resonance Imaging Study -
Authors: Yogo Makiko , Ayaori Makoto , Sato Hiroki , Kihara Teruyoshi , Sasaki Makoto , Iizuka Maki , Takiguchi Shunichi , Uto-Kondo Harumi , Yakushiji Emi , Nakaya Kazuhiro , Komatsu Tomohiro , Momiyama Yukihiko , Nagata Masayoshi , Ikewaki Katsunori
Published: April 2024

Whether intensive lipid-lowering therapy yields greater regression of atherosclerotic plaques remains inconclusive. We therefore performed a prospective, randomized trial comparing standard (achieving LDL-C levels recommended by the Japanese guideline) and intensive (achieving further 30% lower levels than the former) rosuvastatin therapy for 1 year with primary outcome of aortic plaques evaluated by magnetic resonance imaging (MRI).Sixty patients, who were eligible for statins therapy (51 primary, 9 secondary prevention), were randomized to standard or intensive group, and dose of rosuvastatin were titrated to achieve the respective target LDL-C. Average doses of rosuvastatin throughout the study were 2.9±3.1 and 6.5±5.1 mg/day in standard and intensive group, respectively. Although both treatments significantly reduced LDL-C and high sensitive CRP(hsCRP) levels, reduction of LDL-C levels was greater in intensive group than in standard group (-46 vs. -34%). MRI study revealed that both thoracic and abdominal plaques were significantly regressed in both groups with greater regression in thoracic plaques in intensive group compared to standard group (-9.1 vs. -3.2%) (Figure A). Moreover, thoracic plaques regression correlated with reductions in hsCRP (FigureB).In conclusions, the present study demonstrated that intensive lipid-lowering using rosuvastatin led to additive plaques regression compared to standard therapy. Therefore, rosuvastatin may provide long term benefit in patients with increased risk through its potent LDL-C lowering and anti-inflammatory effects.
Abstract 9635: Percutaneous vs. Surgical Pulmonary Valve Implantation: How Does the Right Ventricle Fare?
Authors: Addetia Karima , Martucci Giuseppe , Dancea Adrian , Marelli Ariane , Therrien Judith
Published: April 2024

Introduction.
Percutaneous pulmonary valve implantation (PPVI) to non-invasively correct pulmonary valve dysfunction is a recent advancement. Cardiopulmonary bypass is known to have a negative impact on right ventricular (RV) function. This study was designed to assess RV recovery using echocardiographic parameters post surgical pulmonary graft placement versus PPVI.

Methods.
Retrospective study of consecutive adult patients who underwent PPVI and received graft bioprosthesis between 2007 and 2011. Echocardiographic parameters analyzed included tricuspid annular systolic excursion (TAPSE), RV tissue Doppler velocity (TDV), and myocardial performance index (MPI). Graphs of relative differences (between postoperative and preoperative values) for each parameter were constructed to compare preoperative, early (≤60 days) and late postoperative (≥6-12 months) measurements. Significance of results was determined using T-test.

Results.
Ten patients received PPVI and 26 underwent open heart surgery with graft insertion. Average patient age was 31±20 years. Pre-operative TDV (p=0.008), and MPI (p=0.05) were significantly higher for the surgical population than the percutaneous group. Postoperative, TDV and TAPSE were significantly lower early (p<0.001) and late (p<0.001) in the surgical group than preoperative measures. No significant differences were seen for the PPVI group. On comparison of relative differences in parameters between groups TDI was significantly higher both early (p<0.001) and late (p<0.006) postoperatively in the percutaneous group.

Conclusion.
RV systolic recovery as measured by TDV and TAPSE was significantly impaired post surgery but relatively unchanged post PPVI. On analysis of relative differences in RV parameters, TDI was significantly higher early and late post PPVI than open-heart surgery suggesting that surgery may impact RV function more significantly than its percutaneous counterpart.
Abstract 9641: Effects of Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on Mortality and Cardiovascular Events in Patients Without Heart Failure. A Meta-Analysis of Randomized Clinical Trials in 108,233 patients
Authors: Savarese Gianluigi , Costanzo Pierluigi , Cleland John George Franklin , Vassallo Enrico , Rosano Giuseppe , Perrone-Filardi Pasquale
Published: April 2024

Objective:
To verify whether Angiotensin-Converting-Enzyme inhibitors (ACE-Is) and Angiotensin Receptor Blockers (ARBs) reduce cardiovascular (CV) events in patients without left ventricular systolic dysfunction (LVSD).

Methods and Results:
MEDLINE, Cochrane, ISI Web of Science and SCOPUS were searched for randomized trials comparing ARBs or ACE-Is versus placebo in patients without LVSD. Twenty-six trials enrolling 108,233 participants were included. The effects of ACE-Is and ARBs were analyzed for the occurrence of a composite outcome including CV death, myocardial infarction (MI) and stroke as well for all-cause death, new onset diabetes mellitus and heart failure. Compared to placebo, ACE-Is significantly reduce the risk of the composite outcome (Odds Ratio [OR]:0.831, 95% Confidence Interval [C]I:0.748 to 0.922, p=0.001)(Figure), MI (OR:0.835, CI:0.781 to 0.894, p<0.001), stroke (OR:0.796, CI:0.685 to 0.924, p<0.003), all-cause death (OR:0.908, 95% CI:0.845 to 0.975, p=0.008), new onset heart failure (OR:0.753, CI:0.679 to 0.834, p<0.001) and diabetes mellitus (OR:0.812, CI:0.706 to 0.932, p<0.001), whereas reduction of CV death approximated statistical significance (OR:0.892, CI:0.783 to 1.017, p=0.087). ARBs significantly reduce the risk of the composite outcome (OR:0.936, CI:0.888 to 0.987, p=0.014)(Figure), stroke (OR:0.909, CI:0.840 to 0.983, p=0.017) and new onset diabetes mellitus (OR:0.854, CI:0.797 to 0.915, p<0.001), but not MI, CV death, new onset heart failure and all-cause death.

Conclusions:
In patients at high CV risk but without LVSD, ACE-Is and ARBs reduce the risk of the composite outcome including CV death, MI and stroke, and of new onset diabetes mellitus. At variance with ACE-Is, no significant effects on all-cause death, MI and new onset heart failure are observed for ARBs. Thus, ACE-Is should represent the first choice to reduce CV mortality/morbidity in high-risk patients.
Abstract 9660: The Impact of Anatomical Variation of the Brachial Artery for measuring Flow-mediated Vasodilation in Healthy Subjects and Patients with Cardiovascular Diseases
Authors: Fujii Yuichi , Higashi Yukihito , Hidaka Takayuki , Soga Junko , Idei Naomi , Fujimura Noritaka , Maruhashi Tatsuya , Mikami Shinsuke , Teragawa Hiroki , Kihara Yasuki
Published: April 2024

Background: Measurement of flow-mediated vasodilation (FMD) is widely used for assessment of endothelial function. The purpose of this study was to evaluate the effect of anatomical variation of the brachial artery on FMD in healthy subjects and patients with cardiovascular diseases (CVD).

Methods and results: There was no significant difference in the ratio of existence of a double brachial artery between healthy subjects (6.1%, 13/213) and patients with CVD (6.5%, 11/169). In healthy subjects, FMD was larger in a single brachial artery than in large and small vessels of a double brachial artery (7.2±3.4% vs. 4.7±3.3% and 4.5±2.5%, P<0.01, respectively), while FMD was similar in large and small vessels of a double brachial artery. In patients with CVD, there were no significant differences in FMD among a single brachial artery, large vessel of a double brachial artery and small vessel of a double brachial artery (3.3±1.4%, 3.1±2.3% and 3.6±2.1%). FMD in a single brachial artery was smaller in patients with CVD than in healthy subjects (P<0.01). There were no significant differences in FMD in the large vessel of a double brachial artery between the two groups or in the small vessel of a double brachial artery between the two groups. Nitroglycerine-induced vasodilation was similar in all arteries in healthy subjects and patients with CVD. These findings suggest that when measuring FMD, we should take care about the existence of a double brachial artery, especially a double brachial artery in healthy subjects. FMD measured in a double brachial artery may be underestimated in healthy subjects.
Abstract 9688: Association of Common Variations on Chromosome 4q25 and Left Atrial Volume in Patients with Atrial Fibrillation
Authors: Yarmohammadi Hirad , Hoyt Hana , Khurram Irfan M , Hansford Rozann , Zviman Menekhem , Zimmerman Stefan L , Steinberg Steven J , Judge Daniel P , Tomaselli Gordon F , Halperin Henry R , Cheng Alan , Spragg David D , Henrikson Charles A , Sinha Sunil , Marine Joseph E , Berger Ronald , Calkins Hugh , Nazarian Saman
Published: April 2024

Objectives:
To examine the association between single nucleotide polymorphisms (SNPs) near PITX2 and left atrial size in patients with atrial fibrillation (AF). Background: Recent studies have shown that several genetic variants near the PITX2 locus on chromosome 4q25 are associated with AF. However, the mechanism that mediates this association remains unclear. Basic murine studies suggest that reduced PITX2 expression is associated with left atrial dilatation.

Methods:
We prospectively enrolled 96 patients (mean age 60 ± 10 yrs, 72 % male) with drug resistant AF (57% paroxysmal, 38% persistent and 5% longstanding persistent) who underwent catheter ablation. Following DNA extraction from blood obtained pre-operatively, SNPs rs10033464 and rs2200733 were genotyped using the Sequenom MassARRAY. Left atrial volume (LAV) was determined using 3-dimensional imaging (CT or MRI prior to first ablation) by investigators blinded to genotype results.

Results:
The minor allele frequency at SNPs rs10033464 and rs2200733 were 0.14 and 0.25, respectively. Using multivariate linear regression, the minor allele at rs10033464 (co-dominant model) was independently associated with larger LAV (P = 0.037) after adjustment for age, gender, BMI, type of AF, left ventricular ejection fraction, and history of hypertension. However, no association was found between rs2200733 variant alleles and LAV (P = 0.82).

Conclusion:
SNP rs10033464 near the PITX2 locus on 4q25 is significantly associated with LAV. Left atrial dilatation may mediate the association of common variants at 4q25 with AF.
Abstract 9717: The New ISHLT Cardiac Allograft Vasculopathy Coronary Angiogram Grading Scale: Does it Have Prognostic Relevance?
Authors: Patel Jignesh , Kittleson Michelle , Kansara Pranav , Rafiei Matthew , Stern Lily , Chang David , Azarbal Babak , Czer Lawrence , Esmailian Fardad , Kobashigawa Jon
Published: April 2024

Purpose:
The International Society for Heart and Lung Transplantation (ISHLT) has recently established a cardiac allograft vasculopathy (CAV) nomenclature scale to standardize coronary angiography reporting. In general, the new grading scheme is represented by CAV
0
, no disease; CAV
1
, mild disease; CAV
2
, moderate disease; CAV
3
, severe disease. Restrictive cardiac physiology associated with CAV
1
or CAV
2
will automatically place them into CAV
3
. It has not been established whether increasing CAV grade truly correlates to worse outcome after heart transplantation. In addition, the impact of restrictive cardiac physiology (in this grading scheme) on outcome has not been well established.

Methods:
Between 1994 and 2010, we reviewed 1,341 heart transplant patients (pts) and divided them according to
first
diagnosis of an abnormal specific CAV grade. All pts were then subsequently followed for 5 year actuarial survival after first diagnosis of that specific CAV grade. We also assessed the impact of restrictive physiology on subsequent actuarial 5-year survival in the CAV
3
group.

Results:
5-year subsequent actuarial survival following first time diagnosis of CAV category showed worsening survival from CAV
1
(n=219), CAV
2
(n=96), CAV
3
(n=50) pts (80%, 63%, 52% respectively, p<0.001)(figure). In the CAV
3
group, pts with restrictive cardiac physiology had worse 5-year subsequent actuarial survival compared to those without (41% vs. 58%, p=0.07).

Conclusion:
The new ISHLT CAV nomenclature grading scale appears to predict outcome after heart transplant. Addition of restrictive cardiac physiology as inclusion criteria for CAV
3
grade appears justified as it infers worse prognosis.
Abstract 9778: Harmonizing Cutoff Values for Severe Aortic Valve Stenosis
Authors: Minners Jan , Gohlke-Baerwolf Christa , Bahlmann Edda , Ray Simon , Chambers John B , Gerdts Eva , Wachtell Kristian , Rossebo Anne , Willenheimer Ronnie , Boman Kurt , Egstrup Kenneth , Skjaerpe Terje , Kesaniemi Antero , Pedersen Terje R , Brudi Philippe , Nienaber Christoph A , Neumann Franz-Josef , Jander Nikolaus
Published: April 2024

Background:
Decision making in patients with aortic valve stenosis (AS) and normal left ventricular function may be complicated by inconsistencies in cutoff values for severe AS. Particularly, the constellation of severe stenosis according to aortic valve area (AVA) <1cm
2
and non-severe stenosis according to mean pressure gradient (MPG) ≤40mmHg is a frequent finding which may, at least in part, be due to systematic discrepancies between cutoff values.

Methods:
We evaluated the effect of adjusting the cutoff value for severe AS from AVA 1.0cm
2
to 0.8cm
2
on discrepancies in classification of severity and event rates in 1525 asymptomatic patients with normal ejection fraction prospectively followed for a mean of 46 months from the SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) study.

Results:
The diagnosis of a severe AS was made in 56 (4%) patients according to the MPG >40mmHg criterion, in 470 (31%) based on an AVA of <1.0cm
2
and in 185 (12%) with an AVA of <0.8cm
2
. After dividing the population into quintiles according to AVA and MPG an aortic valve related event rate of 0.40 was observed in patients with a mean AVA of 1.0±0.1cm
2
which was similar to patients with a MPG of 27±2mmHg (0.40, p=ns). In turn, patients with a MPG of 37±5mm had an event rate of 0.65 and patients with an AVA of 0.74±0.1cm
2
had an event rate of 0.53 (figure). Cardiovascular death rates followed a similar pattern.

Conclusion:
Adjusting the cutoff value for severe stenosis in patients with normal left ventricular function from AVA 1.0cm
2
to 0.8cm
2
may harmonize parameters for the assessment of aortic stenosis both with respect to stenosis severity as well as clinical outcome.
Abstract 9797: Right Ventricular Function Can Predict Transplant-Free Survival in Patients with Pulmonary Arterial Hypertension
Authors: Dandel Michael , Kemper Dagmar , Lehmkuhl Hans B , Knosalla Christoph , Hetzer Roland
Published: April 2024

Background
Timely identification of patients with the need for transplantation (Tx) due to severe pulmonary arterial hypertension (PAH) and finding predictors of Tx-free outcome are becoming increasing challenges with prolongation in Tx waiting times. Right ventricular (RV) failure is the main cause of death in PAH. We assessed the predictive value of RV function for Tx-free survival in severe PAH to improve the Tx listing procedures.

Methods
All consecutive potential Tx candidates with PAH (except those with congenital systemic to pulmonary shunts) who were clinically stable at their first evaluation performed in 2006─2010 were selected for the study. At selection, after NT-ProBNP measurement and exercise testing, patients underwent echocardiography including 2D strain imaging. All examinations were repeated at each further follow-up. Collected data were tested for ability to predict Tx-free survival.

Results
Of 64 evaluated patients, 19 showed irreversible RV failure and finally 13 patients died; the other 6 underwent Tx. Comparing data obtained from these 19 patients at time of inclusion in the study with those obtained initially from the 45 patients remaining stable, we found no differences in RV size and RVEF, pulmonary arterial pressure, right atrial size and tricuspid annulus plane systolic excursion (TAPSE). However, patients with subsequent worsening had initially higher NT-proBNP values and lower RV ΔP/Δt ratios (p < 0.05). In unstable patients, RV longitudinal strain analysis also revealed higher systolic dyssynchrony, lower systolic afterload-corrected strain rate (Sr) and higher diastolic early/late strain rate (SrE/SrA) ratio (p<0.05). At certain cut-off values, ΔP/Δt and SrE/SrA ratios showed the highest predictive values (93.3% and 91.1%, respectively) for ≥ 1 year hemodynamic stability. Persistent RV ΔP/Δt reduction of > 20% showed the highest predictive values for short-term (< 1year) irreversible RV failure and patient Tx-free survival (90% and 93.3%, respectively).

Conclusion
In PAH patients referred for Tx, RV ΔP/Δt and certain longitudinal Sr parameters are predictive for the short-term course of RV function and patient Tx-free survival. Our results suggest that these parameters can be useful for Tx listing decisions.
Abstract 9882: Post-Exercise Blood Pressure Predicts Future Cardiovascular Mortality in Asymptomatic Individuals
Authors: Patel Janky , Sharrett A. R , Blumenthal Roger S , Mora Samia
Published: April 2024

Background:
Non-electrocardiographic parameters obtained from exercise testing, including exercise capacity, exercise blood pressure, chronotropic response, and heart rate recovery, are clinically useful in determining prognosis in asymptomatic individuals. We hypothesized a relationship between post-exercise blood pressure (BP) and CVD mortality.

Methods and results:
After performing submaximal Bruce treadmill tests, a total of 6,451 asymptomatic North American study participants (56% males, mean age 44) from the Lipid Research Clinic Prevalence Study were prospectively followed for 20 years (366 CVD deaths). Post-exercise BP was the measured BP taken after ceasing exercise for 2 min, 4 min, and 6 min for systolic (SBP) and diastolic (DBP). The association of CVD mortality was stronger for post-exercise SBP (4 min age- and sex-adjusted hazard ratio 1.42 [95% CI, 1.28-1.55] per 1-SD increment [21 mmHg]) than post-exercise DBP (1.26 [1.14-1.38] per 1-SD increment [12 mm Hg]). After multivariate adjustment, post-exercise DBP was not associated with CVD mortality. By contrast, post-exercise 2 min, 4 min, and 6 min SBP were each positively associated with CVD mortality, with the post-exercise 4 min SBP having the greatest magnitude of risk. After adjusting for standard risk factors, baseline BP, heart rate recovery, and exercise capacity, the adjusted hazard ratios (95% CIs) for increasing quartiles of post-exercise 4 min SBP were 1.00 (reference), 1.47 (0.94-2.31), 1.75 (1.15-2.66) and 2.21 (1.43-3.43), p for trend<0.001 (Table).

Conclusion:
Elevated post-exercise SBP was significantly associated with CVD mortality in asymptomatic individuals independent of other risk factors, including baseline BP. A post-exercise 4 min SBP greater than 150 mmHg identifies higher risk individuals who may warrant more aggressive treatment than is currently recommended.
Abstract 9884: Neonatal Re-Entrant Supraventricular Tachycardia: Clinical Utility of One Year Trans-Esophageal Pacing and Mid-Term Follow-Up Experience
Authors: Ho Jason , Bonney William , Johns James , Radbill Andrew , Kannankeril Prince , Fish Frank
Published: April 2024

Introduction:
Neonatal SVT resolves in many infants by one year of age, but even with clinical quiescence, the substrate for SVT may unknowingly persist. Trans-esophageal pacing (TEP) is a non-invasive means to evaluate persistence of SVT substrate. We describe our experience with one year follow-up TEP studies for neonatal re-entrant SVT.

Methods:
A retrospective chart review was performed for all neonates presenting with SVT between 1998 and 2011. Primary atrial tachycardia was excluded. Follow-up TEP was usually recommended at 1 year for patients followed at our institution who had not experienced recent spontaneous recurrence to assess persistence of SVT substrate.

Results:
Neonatal SVT occured in 175 patients (orthodromic reciprocating tachycardia [ORT] 136, atrioventricular nodal re-entrant tachycardia [AVNRT] 30, undetermined 9). The prevalence of congenital heart disease (39 patients) was 16% for ORT versus 47% for AVNRT (p<0.001). TEP and one year follow-up data were available in 105 infants. The SVT substrate persisted beyond 1 year in 51/88 (58%) with ORT and 8/17 (47%) with AVNRT, based on either TEP inducibility (47 patients) or spontaneous recurrence (12 patients) beyond 6 months. Among 47 neonates with WPW, 27 had persistent pre-excitation at follow-up TEP (57%). Of the 20 patients who lost pre-excitation at 1 year follow-up, 16 underwent repeat TEP, and 8 (50%) had inducible ORT. As previously reported, AVNRT was sometimes inducible at follow-up TEP in infants presenting with ORT (5 patients). To date, none of these have experienced spontaneous AVNRT. All 41 patients with no SVT substrate at follow-up TEP remained free of recurrences over a mean post-TEP follow-up of 2.1 years off therapy (range 0.7-9.8 years).

Conclusions:
Overall, the substrate for neonatal SVT persisted in over half of infants beyond 1 year, regardless of mechanism. Of note, half of patients who lost pre-excitation continued to have substrate for ORT. Follow-up TEP discerns infants in whom the SVT substrate is resolved from those who may remain susceptible. In this cohort AVNRT was more common in neonatal SVT than previously reported, and more commonly associated with congenital heart disease.
Abstract 9886: A Differential role of Cardiac and Leukocyte derived Macrophage migration Inhibitory Factor in Facilitating Inflammatory Responses and Cardiac Remodeling post Myocardial Infarction
Authors: White David , Jennings Nicole , Kanellakis Peter , Kiriazis Helan , Bucala Richard , Fingerle-Rowson Gúnter , Dart Anthony , Morand Eric , Du Xiao-Jun , Gao Xiao-Ming
Published: April 2024

Inflammatory responses to myocardial infarction (MI) are essential for cardiac wound healing. However, excessive inflammation can lead to adverse cardiac remodeling and free wall ventricular rupture. We investigated whether Macrophage migration inhibitory factor (MIF); a pro-inflammatory cytokine, promotes inflammation and exacerbates cardiac injury following MI. MIF knockout (MIFKO) and Wild type (WT) mice were subjected to coronary artery occlusion to induce MI. Incidence of cardiac rupture within 1 week, was lower in MIFKO than WT mice (
29% vs. 69%, median rupture day 5 vs. 4, p=0.002, n=29-39
). MIFKO mice showed a lower density of CD45+ cellular infiltrates at day-3 (
612 vs. 1213 cells/mm, n= 6-7
), suppressed expression of IL-1β, MCP-1 and ICAM-1 (
p<0.05, n= 6
) at 24h, and lower MMP-9 and -2 activities at day-3 and day-7 by gelatin zymography (
p<0.05 vs WT mice, n=5
). Histology revealed reduced collagen deposition (
48% vs. 59%)
and increased infarct wall thickness (
419 vs. 316
μ
m
) in MIFKO hearts at day 14 post MI (
both P<0.05, n=7-9
) To differentiate the role of MIF derived from cardiomyocytes or leukocytes, we generated chimeric mice via bone marrow transplantation (BMT) i.e. WT mice received BMT from MIFKO mice (WT
KO
) and MIFKO mice received BMT from WT mice (KO
WT
). Compared to WT
KO
counterparts, KO
WT
mice post-MI presented a higher incidence of cardiac rupture (
40% vs. 10%, median rupture day 10 vs. 9, p=0.003, n=38-45
), a greater CD45+ cellular infiltration (
p<0.05, n=7-8
), reduced fractional shortening (
16% vs. 25%
) and enlarged ventricular diameter size measured by echocardiography (
both p<0.05, n=11-21
). Moreover, histological analysis demonstrated a larger fraction of the necrotic myocardium (
30 vs. 18%, p<0.05
), decreased collagen deposition (38 vs. 43%) and reduced infarcted wall thickness (
245 vs. 344
μ
m
) in KO
WT
than that in WT
KO
mice at day 7 and 14 post MI respectively (
all p<0.05, n=7-9
). MIF promotes inflammatory actions in the heart following MI. Global deletion of MIF protects the heart against acute cardiac remodelling and rupture via reduced inflammatory responses. Deletion of cardiac MIF delayed the onset of cardiac rupture while inflammatory cell derived MIF plays a crucial role in mediating post-MI cardiac remodelling.