bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 2295: Current Outcomes of Simultaneous Carotid Endarterectomy and Coronary Artery Bypass in North America
Authors: Prasad Sunil M , Li Shuang , O’Brien Sean M , Rankin J. S , Gammie James S , Puskas John D , Shahian David M , Chedrawy Edgar G , Massad Malek G 
Published: July 2021

OBJECTIVE: Management of patients with concomitant carotid and coronary artery disease has been controversial. Divergent strategies have been employed, including simultaneous carotid endarterectomy and coronary bypass (SCC) versus various staged procedures. While no strict comparison group is available, this study defines current outcomes of SCC, as compared qualitatively to two reference categories.
METHODS: Utilizing the STS database from 2003 to 2007, patients having SCC were compared to cerebrovascular disease patients undergoing coronary bypass with prior carotid endarterectomy (Ref Gp I), and those with carotid Doppler stenosis >75% and no carotid intervention (Ref Gp II). Logistic regression analysis adjusted for differences in baseline characteristics, and operative mortality (OM) and a composite of neurological complications (NC) were assessed.

RESULTS: Of 747,932 patients undergoing isolated CABG with/without CEA, 108,271 (14.4 %) had cerebrovascular disease. In this group, 5,732 (5.3%) underwent SCC. The SCC group had more males and less severe coronary disease (both p<0.001). After statistical adjustment for all baseline differences, SCC had clinically and statistically higher OM and NC as compared to any of the reference groups (TABLE

).

CONCLUSION: Although no proper control group exists for comparison, SCC as recently performed in North America carries a high risk, as compared to any of the reference groups. Suboptimal results associated with the SCC strategy suggest a need for quality improvement and research on the optimal management of patients with simultaneous carotid and coronary disease.
Abstract 2557: The Appraisal-Trial: Evaluating RESTEN-MPTM in Patients with Bare Metal Stent de novo Native Coronary Artery Lesions
Authors: Philipp Sebastian , Böse Dirk , Kordish Igor , Brachmann Johannes , Coburg Klinikum , Hardt Stefan , Sack Stefan , Erbel Raimund 
Published: July 2021

Background: Although the use of drug-eluting stents has been shown to limit neointimal hyperplasia, currently available DES may adversely affect re-endothelialization, possibly precipitating late cardiac events. The aim of this study was to evaluate the efficacy and safety of a microbubble delivery of c-myc antisense peptide in preventing restenosis after coronary stenting in de novo stenosis with intravascular ultrasound.
Methods: A BMS was implanted in de novo coronary artery lesions (RD ≥ 2.5- ≤4.0mm; TL ≥ 15- ≤ 30mm in length). Serial intravascular ultrasound analysis were performed in 25 lesions. A dose of 16mg RESTEN-MPTM (AVI BioPharma/Global Therapeutics LLC) was intravenously administered after stenting and again 24 hours later.
Results: A total of 50 patients were enrolled, 34 in Essen, 13 in Coburg and 3 in Heidelberg. Before stenting, the MLD and length of stenosis was determined by QCA. 18 Patients had a LAD lesion, 21 LCX, 12 RCA. 84% (43/51) of the lesions were either Type B2 or C lesions. At six month follow-up, angiography with a QCA was performed. Generally the neointimal proliferation was minor and open vessel lumen could be demonstrated during follow-up. Of the 30 patients currently studied at six-months in the IVUS sub-study, six patients required TLR. Late lumen loss by QCA was 0.47±0.09mm. Volume stenosis by IVUS was 26 ± 4 %. Generally the neointima proliferation was minor and open vessel lumen could be demonstrated during follow-up.
Summary: Microbubble delivery of c-myc antisense seems to be effective in reducing neointimal tissue proliferation without the problem of late stent thrombosis, because the proliferation seems to be attenuated but not fully blocked.
Abstract 3094: Implantable Cardioverter Defibrillator Therapy for Congenital Long QT Syndrome: a Single Center Experience
Authors: Horner Justin M , Kinoshita Masayoshi , Haglund Carla , Friedman Paul , Ackerman Michael J 
Published: July 2021

Background: Long QT syndrome (LQTS) is a potentially lethal yet highly treatable channelopathy underscored by marked heterogeneity that necessitates evidence-based and individualized therapeutic approaches. One such therapy is the implantable cardioverter defibrillator (ICD). Here, we sought to determine the percentage of patients (pts) with LQTS that received an ICD in our LQTS clinic and its short term outcomes.
Methods: An IRB-approved, retrospective analysis of the electronic medical records of 167 LQT1, 113 LQT2, and 29 LQT3 pts evaluated in our LQTS Clinic with subset analysis of those implanted with an ICD in our institution from January 2000 to June 2007.
Results: Forty-eight pts (15% of total, 33 females, 14 LQT1, 20 LQT2, and 14 LQT3) received an ICD. The average age at implant was 30 ± 12 years (range 8 – 52 years). Nearly two-thirds received an ICD as primary prevention. The QTc exceeded 500 ms in 18 (37.5%). With an average follow-up of 42 ± 32 months, 9 (19%) have had an appropriate, VF-terminating therapy including 3 with LQT1 and 6 with LQT2. Notably, 5 of the 6 LQT2 females have already received an appropriate ICD therapy whereas none of the LQT3 pts have received one. Secondary prevention indications (p = 0.006), LQT2 genotype (p = 0.03), QTc > 500 ms (p = 0.001), and surprisingly a negative family history (p = 0.0005) predicted those ICD pts most likely to receive an appropriate therapy. Importantly, none of the non-ICD treated pts (> 250) have died a LQT-related death during the same follow-up. Conversely, 9 pts have experienced an inappropriate shock including 6 with LQT3 and males were more likely to receive inappropriate therapies (p = 0.002).
Conclusions: The majority of pts with LQTS can be treated effectively without an ICD. In this study, potentially life-saving therapies have been rendered so far at a 5– 6%/year rate. Inappropriate shocks occurred with similar frequency. Secondary prevention, genotype, and QTc predicted those ICD recipients most likely to receive appropriate therapy. Although LQT3 status is commonly associated with an ICD recommendation, so far none of the LQT3 positive ICD recipients have needed their device. Instead, the greatest “save” rate has occurred among the LQT2 positive females deemed at high risk.
Abstract 4090: Substrate Modification Using Electroanatomically-guided Linear Ablation During Sinus Rhythm To Treat Post-infarction Ventricular Tachycardia
Authors: Deneke Thomas , Lemke Bernd , Boesche Leif-Ilja , Calcum Bernd , Muegge Andreas , Lawo Thomas , Grewe Peter H 
Published: July 2021

Catheter ablation of ventricular tachycardia (VT) in the setting of ischemic cardiomyopathy can be performed to modify the underlying substrate. We evaluated the efficacy of a linear VT ablation procedure based on sinus rhythm (SR) substrate maps to treat ischemic VT in consecutive patients.
Methods: In 110 consecutive patients with ischemic VT (56% not tolerated) catheter ablation was attempted. During SR left ventricular scar mapping was performed identifying scar tissue (bipolar voltages 1.5mV). Regionalization of VT-exit regions was performed based on pace-mapping within the scar border zone. Ablation was directed towards the identified exit region performing linear ablation along the scar border. ICD-holter interrogation was performed during follow-up.
Results: A mean of 2.7±1.6 different VTs were inducible per patient (total 286). In 97% (107) of all patients (74% of all inducible VTs ablated: 213/286) the clinical VT was successfully ablated. In 68 patients (62%) no sustained monomorphic VT (complete success) was inducible at the end of the ablation procedure whereas in 39 patients (35%) VTs (partial success) were still inducible. Over a median follow-up of 12 months (6 –39) 88 (80%) patients were free from any ventricular arrhythmia. 19 successfully ablated patients had recurrences in between 6 to 36 months post intervention but the number of episodes treated by the ICD was significantly reduced (16±4 within 3 months (3±2) (p=0.02). No difference in patients with tolerated compared to non-tolerated VTs were detected (recurrences in 7/48 (15%) tolerated and 15/62 (24%) non-tolerated; p=0.13). There was a significant difference in freedom from any VT in patients with complete (88%) versus partial success (72%) (p=0.04).
Conclusions: Substrate modification targeting only the scar-border zone including the VT exit site based on SR-maps is highly effective in suppressing the occurrence of a clinical VT in patients with remote myocardial infarction (97%). Based on the electro-anatomical findings complete freedom from any ventricular arrhythmia over a median of 1 year can be achieved in 80% of all patients. No difference in regard to freedom from any ventricular arrhythmia can be documented in patients with tolerated and non-tolerated VTs.
Abstract 4117: A Comparison of Cardiac MRI Peri-Infarct Border Zone Quantification Strategies for the Prediction of Ventricular Tachycardia Inducibility
Authors: Rubenstein Jason C , Lee Daniel , Wu Edwin , Kadish Alan , Passman Rod S , Goldberger Jeffrey J 
Published: July 2021

Peri-infarct border zone (BZ) as quantified by delayed-enhancement cardiac MRI (CMR) has been proposed as a risk stratification tool, and is associated with increased mortality, but has been measured by various methods in the literature. We assessed which BZ analysis best predicts inducible arrhythmia during electrophysiological study (EPS).
Methods: CMR was performed in 47 patients with CAD referred for EPS to assess for ventricular tachyarrhythmias (VT). CMR data was analyzed for BZ quantification by three methods. Method I used pixels 2–3 standard deviations over the mean of normal tissue, expressed as % of LV mass. Method II (Yan) used the same pixels but is expressed as % of infarct size. Method III (Schmidt) used a full-width, half-max method. EPS results were classified as negative (non-inducible) or positive (monomorphic VT). Patients with indeterminate EPS outcomes (VF or polymorphic VT, n=9) were not included in this analysis.
Results: There were 38 subjects-age 60.2 ± 10.8 yrs, 68% male. During EPS, 20 patients were non-inducible and 18 had induced monomorphic VT (MVT). EF was not significantly different between non-inducible patients and those with MVT (33.4 ± 11.9% vs. 28.1 ± 9.3, p=0.13). Infarct size was significantly different (15.0 ± 11.6% vs. 26.4 ± 12.0%, p = 0.005). BZ by method I was significantly different (1.4 ± 1.3% vs. 3.1 ± 1.5%, p = 0.001), but not by method II (15.2 ± 21.3% vs. 8.0 ± 4.8%, p = 0.17) or method III (4.1 ± 4.5g vs. 3.7 ± 3.7g, p = 0.756). Multivariate analysis demonstrated that BZ by method I was an independent predictor of EPS outcome after controlling for infarct size (OR 1.97 per % change, 95% CI 1.04 to 3.73, p = 0.04). Method I BZ remained an independent predictor when controlling for both infarct size and EF, (OR 2.12 per % change, 95% CI 1.06 to 34.22, p = 0.03). Correlation between techniques was variable (Method I vs. Method II R=0.77, p=0.001; Method I vs. Method III R=0.03, p=0.86; Method II vs. Method III R=0.15, p<0.32).
Conclusion: This study demonstrates significant variability between the published methods for measuring BZ. We also show that large BZ by Method I is a stronger predictor of inducible MVT during EPS than EF and infarct size. BZ may be yet another CMR marker of elevated risk of arrhythmia, but requires more rigorous definition.
Abstract 4186: Magnetic Resonance Late Enhancement in Dilated Cardiomyopathy is Related with Complex Ventricular Arrhythmias
Authors: Almeida Ana G , Marques João S , Sargento Luis M , David Cláudio , Dias Nuno C , Lopes Mário G 
Published: July 2021

Late enhancement (LE) by cardiovascular magnetic resonance (CMR) has been found in about two-thirds of patients with dilated cardiomyopathy (DCM). However, the functional significance of this finding is not well established. The aim of this study was to assess, in patients (pts) with DCM, the relationship of LE with complex ventricular arrhythmias.
Methods: 38 consecutive pts (44±8 years-old, 26 men) with DCM were included, after exclusion of ischemic heart disease by coronary angiography and secondary cardiomyopathies by clinical and laboratory investigation. Functional class and plasmatic NT-pro-BNP were assessed. All underwent CMR:

short-axis SSFP encompassing all LV; LV volumes and ejection fraction (EF) were obtained;

LE (segmented inversion-recovery fast gradient-echo sequence), 10 –15 mn after 0.2mmol/kg of Gd-DTPA acquired in 2, 3, 4-chambers and short-axis views; LE was classified in subendocardial or midwall and quantified using plannimetry of LE contours, 6SD from remote myocardium; a fibrosis index was obtained from LE mass/myocardial mass.

All underwent 24 H Holter monitoring, less than one month from CMR, and the number of ventricular arrhythmias (pairs, triplets or ventricular tachycardia) assessed.
Results: 22 pts were in NYHA class II and 17 in class III. Mean NT-pro-BNP was 512 ± 134 pg/ml, LV end-diastolic volume was 161±35mL/m2, mean EF was 31 ± 8%. LE was found in 26 patients (68%) and was always present in the midwall, involving a mean of 8 segments per patient (range 3–13); septal and anterior walls were the most frequently involved. There were repetitive ventricular arrhythmias in 29 pts. In comparison with pts without LE, pts with LE had higher NT-pro-BNP (917 vs 431 pg/ml, p=0.001), larger LV end-diastolic volumes (173 vs 143ml/m2, p=0.001) and lower EF (26% vs35%, p=0.001) and higher number of complex ventricular arrhythmias (p=0,0004). No relationship was found between the fibrosis index and the number of arrhythmias. Using multivariate analysis, the presence of LE was an independent predictor of ventricular arrhythmias (/p=0.002).
Conclusion: In patients with DCM, LE is significantly associated and an independent predictor of complex ventricular arrhythmias among LV volumes, ejection fraction and NT-pro-BNP,
Abstract 4201: A New Echo Index, Left Atrial Volume Index Over Late Diastolic Mitral Annulus Velocity Can Predict Elevated Left Ventricular Filling Pressures And Clinical Outcomes
Authors: Park Hun-Jun , Park Mahn-Won , Shim Byung-Joo , Lee Mi-Jung , Park Jae-Hong , Yoon Sung-Kyu , Baek Joo-Yeoul , Shin Woo-Seung , Koh Yoon-Seok , Shin Dong-Il , Jung Hae-Ok , Baek Sang-Hong , Ihm Sang-Hyun , Kim Pum-Joon , Seung Ki-Bae , Choi Kyu-Bo 
Published: July 2021

Background: Another non-invasive method for prediction of elevated left ventricular filling pressure (LVFP) have attracted attention in clinical practice. Objectives: This study was to verify the clinical usefulness of left atrial volume index over late diastolic mitral annulus velocity (LAVi/A′) for the predictors of advanced (pseudonormal to restrictive physiology) diastolic dysfunction in the presence of elevated LVFP and clinical outcomes using right heart catheterization (RHC).
Methods: 163 patients (95 men, mean age 61±13 years) with dyspnea underwent comprehensive Doppler echocardiography, RHC and B-type natriuretic peptide (BNP) measurement. Using ROC curve, we compared the areas under the curves (AUC) of LAVi/A′, transmitral early diastolic/annular velocity ratio (E/E′), and BNP level for the prediction of advanced diastolic dysfunction. During a median follow-up of 13.3 months, the incidence of the composite outcomes of cardiac death or re-hospitalization for heart failure was compared based on the optimal cut-off value of LAVi/A′.

Results: The AUC of LAVi/A′ was comparable to that of BNP (0.91 vs. 0.90; p=0.78) and E/E′ (0.91 vs. 0.93; p=0.78) for prediction of advanced diastolic dysfunction. 68/163 (41.7%) patients had LAVi/A′ ≥4.0 and they had significantly higher BNP level and longer time difference between atrial reversal flow of pulmonary vein and transmitral late diastolic flow (AR
dur
-A
dur
) compared with those of LAVi/A′ <4.0 (BNP: 1207±1212 vs. 176±365 pg/ml; AR
dur
-A
dur:
24.6±21.1 vs. −3.3±15.9 msec, p<0.001, respectively). The LAVi/A′ had a reasonable correlation with mean PCWP (r=0.64, r
2
=0.41, p=0.001), which was comparable to that of E/E′ (r=0.60, r
2
=0.36, p=0.002). On Cox proportional hazard analysis, EF<50%, age ≥65 years, and LAVi/A′ ≥4.0 were independent outcome predictors with odds ratios of 4.8 (95% CI: 2.0 to 11.7), 3.8 (95% CI: 1.8 to 7.8), and 3.9 (95% CI: 1.5 to 9.8), respectively (p<0.01 for all).

Conclusions: LAVi/A′ ≥4.0 is useful clinical predictors for advanced diastolic dysfunction in the presence of elevated LVFP and clinical outcomes.
Abstract 4365: A Recombinant A-Type Natriuretic Peptide Improves Cardiac Function Probably through Suppression of Intracellular ROS in Heart Failure
Authors: Susa Takehisa , Kobayashi Shigeki , Suetomi Takeshi , Xu Xiaojuan , Ono Makoto , Uchinoumi Hitoshi , Tanaka Takeo , Okamura Takayuki , Kawamura Syuji , Yamamoto Takeshi , Yano Masafumi , Matsuzaki Masunori 
Published: July 2021

Background: We previously reported that reactive oxygen species (ROS) causes Ca2+ leak through the ryanodine receptor (RyR), leading to contractile dysfunction, and eventually heart failure (HF). Here, we clarified an antioxidant action of carperitide, an exogenous A-type natriuretic peptide (ANP) in patients with heart failure and in isolated canine failing cardiomyocytes as well.
Methods and Results: In control subjects (N: n=10) and patients with HF (n=20), blood sampling was simultaneously performed from coronary sinus (CS) and artery (A) to measure 8-hydroxy-2-deoxyguanosine (8-OHdG: ng/ml), a marker of oxidative DNA damage. The serum 8-OHdG level was higher in (CS) than in (A) only in HF (HF: 0.57 ±0.33 in CS; 0.31 ± 0.16 in A; N: 0.17±0.07 in CS; 0.16 ± 0.06 in A), indicating that ROS is produced in failing cardiac tissue. The difference in the serum 8-OHdG between (CS) and (A) was increased as NYHA class elevates (r=0.65, p<0.01). The urine 8-OHdG/creatinine level (ng/mg) also correlated with the NYHA class (r= 0.62, p<0.001), LVEF (r=0.43, p <0.001) and PCWP (r=0.54, p<0.001). As protocol 1, we examined whether ANP (0.25 micrograms/kg/min, i.v.) decreases urine 8-OHdG/creatinine during the treatment of HF (n=8, for 3 days), as compared with that of nitroglycerin (NTG; n=8, for 3 days). Either treatment with ANP or NTG similarly improved hemodynamic parameters, such as cardiac index, PCWP, systemic vascular resistance, and pulmonary arterial resistance. In ANP-treated group, however, urine 8-OHdG/creatinine significantly decreased as compared with in NTG-treated group (ANP: 9.8±3.5; NTG:14.5±4.2, p<0.05). As Protocol 2, we produced canine tachycardia-induced HF model by 4-week’s rapid RV pacing (250 bpm) (EF 27±5%, n=6). Then, using the failing cardiomyocytes, we investigated the direct effect of ANP on intracellular ROS (by 2,7,-dichlorofluorescin diacetate fluorescence). In the failing cardiomyocytes, intracellular ROS markedly increased, as compared with normal cardiomyocyte. Interestingly, ANP (1×10 – 8 mol/L) significantly suppressed ROS production seen in failing cardiomyocyte.
Conclusion: Exogenous ANP has a potent antioxidant action that may contribute to an improvement of hemodynamics in patients with HF.
Abstract 4567: Functional Intraoperative Pulmonary Blood Flow Study is a Sensitive Predictor of Right Ventricular Pressure and Successful VSD Closure for Following Complete Uniforcalization in Patients with Pulmonary Atresia with Ventricular Septal Defect and Major Aortopulmonary Collaterals
Authors: Honjo Osami , Al-Radi Osman O , MacDonald Cathy , Davey Lisa , Caldarone Christopher A , Van Arsdell Glen S 
Published: July 2021

OBJECTIVE: We hypothesized mean pulmonary artery (PA) pressure obtained from an intraoperative pulmonary flow study would better predict the ability to close the ventricular septal defect (VSD) and better predict postoperative right ventricular systolic pressure (RSVP) than classic anatomical parameters after complete uniforcalization in patients with pulmonary atresia, VSD, and major aortopulmonary collaterals.
METHODS: Sixteen consecutive patients (median, 11 mo, range 2 mo – 16 yrs) underwent one-stage (75%) or staged (25%) uniforcalization between 1/03 and 8/07. Intraoperative functional pulmonary blood flow study was achieved by inserting an arterial cannula in a reconstructed central PA. Flow was increased to 2.5 L/min/m2 while measuring PA pressure. RVSP and systemic systolic pressure (SBP) were recorded after VSD closure. Total neopulmonary artery index (TNPAI) (MAPCA + native PA index), total incorporated pulmonary vascular segments, and pulmonary segment artery ratio (PSAR) (ratio of incorporated segment to 18) were analyzed. Spearman rank correlation and area under the receiver operator characteristics curve (ROC-AUC) were used.
RESULTS: The mean PA pressure on flow study was 21.8+/−6.2 mmHg (range, 11–31). Three patients had a pressure of > 30 mmHg. The VSD was closed in 14 (87%). One patient with flow study mean PA pressure of 25 mmHg had suprasystemic RVSP and underwent intraoperative VSD fenestration. One with a flow study mean PA pressure of 30 mmHg had a prospective fenestrated VSD patch placed. There is a weak negative correlation between TNPAI and the flow study PA pressure (rho=−0.4, p=0.12). The flow study mean PA pressure was correlated with post-repair RVSP (rho=0.72, p=0.0027), and with RVSP/SBP ratio (rho=0.67, p=0.0063). TNPAI, total incorporated segments, and PSAR were not correlated with the postoperative RVSP or RVSP/SBP ratio. Flow study mean PA pressure had the highest sensitivity in predicting VSD closure: ROC-AUC (0.82) vs. TNPAI (0.46), pulmonary segment (0.64), and PSAR (0.64).
CONCLUSIONS: Intraoperative pulmonary flow study predicted the ability of VSD closure better than total incorporated segments, TNPAI, and PSAR. Flow study mean PA pressure highly correlated with postoperative RVSP and RVSP/SBP ratio.
Abstract 4572: Reduced Cardiac Progenitors in the Right Ventricle of Cyanotic Heart Lesions: Insights into RV Adaptation
Authors: Mahmut Naila , Kinnear Caroline , Thompson Megan , Shannon Patrick , Chitayat David , Jaeggi Edgar , Mital Seema 
Published: July 2021

The RV in hypoplastic left heart syndrome (HLHS) and Tetralogy of Fallot (TOF) is exposed to hypoxia and abnormal load which may lead to RV dysfunction despite surgical repair. The ability of hypoxia to upregulate angiogenic signaling in the RV is not known. We measured vascular endothelial growth factor (VEGF) mediated regulation of cardiac progenitors in the RV of patients with HLHS and TOF.
Methods: RV myocardial samples were obtained from 6 pts with HLHS (age 0.96±1.5 yrs), 6 pts with TOF (age 3.5±6.3 yrs) and 9 age-matched controls with structurally normal hearts (age 0.16±0.3 yrs) at surgery/transplant/autopsy. The following were measured: VEGF, thymosin β-4 (recruits progenitors), Nkx2.5 (myocyte precursor), Flk-1 (smooth muscle progenitor), CD34 (endothelial progenitor), and von willebrand factor (vWf) (endothelial marker).

Results: (i) VEGF and thymosin β-4 expression was lower in HLHS vs controls. This was associated with reduced cardiac progenitors and lower myocardial capillary density vs controls (0.14±0.01 vs 0.55±0.16, p<0.05). (ii) VEGF expression was preserved but thymosin β-4 was reduced in RV in TOF. This was associated with preserved myocyte progenitors but reduction in endothelial and smooth muscle lineages and reduced capillary density vs controls (0.13±0.03 vs 0.55±0.16, p<0.05) (Figure 1

).

Conclusion: Hypoxia fails to induce an angiogenic response in the RV in cyanotic heart lesions. This may be due to reduced VEGF (HLHS) or impaired coupling of VEGF to thymosin β-4 (TOF). This maladaptation may contribute to post-operative RV dysfunction and lower RV regenerative capacity in later life.

Figure 1:

Reduced capillary density (red) in HLHS and TOF