bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 4484: Predictors of Early vs. Late Stent Thrombosis after Drug Eluting vs. Bare Metal Stent Implantation: A Protective Effect of High Dose Statin Therapy?
Authors: Jeger Raban , Rocca Hanspeter Brunner-La , Leibundgut Gregor , Nietlispach Fabian , Handke Michael , Kaiser Christoph , Pfisterer Matthias 
Published: July 2021

Background: Several predictors of stent thrombosis (ST) after implantation of drug-eluting stents (DES) have been identified. However, no data is available on the differences between early vs. late ST despite their different pathophysiology. In addition, a direct comparison of predictors of ST after DES vs. bare metal stent (BMS) implantation is lacking.
Methods: Baseline clinical and angiographic parameters and 3-year follow-up data of the Basel Kosten Effektivitäts Trial (BASKET; 826 patients randomized 2:1 to DES vs. BMS) were analyzed in univariate and multivariate models regarding early ST, i.e., ST on dual antiplatelet therapy with aspirin and clopidogrel in the first 6 months, and late ST, i.e., ST on aspirin only after the first 6 months (definite, probable, and possible). Separate analyses were done for DES and BMS.
Results: Overall, there were 51 (9.0%) vs. 21 (7.5%) ST in DES vs. BMS treated patients (p=0.51). Multivariate predictors of early ST in DES (n=16) were the use of glycoprotein IIb/IIIa inhibitors (OR 6.65, 95% CI 1.80 –24.57; p=0.005), type C lesions (OR 5.46, 95% CI 1.73–17.23; p=0.004), 3-vessel disease (OR 4.77, 95% CI 1.49 –15.26; p=0.009), statin dose (OR 0.37 per quintile increase, 95% CI 0.19 – 0.74; p=0.005), and intervention in the right coronary artery (OR 0.14, 95% CI 0.03– 0.69; p=0.016), whereas the only multivariate predictor of early ST in BMS (n=11) was age (OR 1.05 per year increase, 95% CI 1.005–1.092; p=0.029). The only multivariate predictor of late ST in DES (n=35) was saphenous vein graft intervention (OR 6.74, 95% CI 2.85–15.85; p<0.0001), whereas multivariate predictors of late ST in BMS (n=10) were saphenous vein graft intervention (OR 5.23, 95% CI 0.92–29.75; p=0.062) and age (OR 1.098 per year increase, 95% CI 1.021–1.18; p=0.011).
Conclusion: Early ST after DES implantation mainly depends on the complexity of the disease and the intervention, with the use of a higher statin dose possibly having a protective effect against early ST. The observation of a strong dose-dependent protective effect of statins to prevent early ST after DES is new, hypothesis-generating, and should be evaluated in an adequately powered prospective randomized trial.
Abstract 4505: Presentation To Non-PCI Center Is Major Modifiable Factor Associated With Delayed Door-to-balloon Time In HORIZONS-AMI
Authors: Blankenship James C , Scott Thomas D , Skelding Kimberly A , Berger Peter B , Parise Helen , Brodie Bruce R , Witzenberger Bernard , Gaugliumi Giulio , Peruga Jan Z , Lansky Alexandra J , Mehran Roxana , Stone Gregg W 
Published: July 2021

Introduction: Many pts with STEMI receive reperfusion later than recommended by current guidelines. Hypothesis: Factors associated with delayed door-to-balloon times (D2B) can identified; some may be modifiable.
Methods: In the HORIZONS-AMI study, 3602 pts within 12 hours of onset of STEMI undergoing primary PCI were prospectively enrolled. Times were recorded for onset of symptoms, arrival at PCI center, arrival in catheterization laboratory, and first balloon inflation. Pts transferred from a non-PCI center to a PCI center were considered separately from pts presenting initially to a PCI center. Logistic regression using 29 demographic/historic variables and 6 pre-PCI adverse events (arrhythmias, CPR, hypotension, respiratory failure) identified factors associated with (1) first door-to-balloon time > 90 minutes, and (2) for each time interval, the highest quintile.
Results: Complete time data was available for 2639 pts. Of 1848 pts presenting directly to a PCI center, 55% had D2B < 90 minutes. Of 781 pts transferred from a non-PCI center to a PCI center, 12% had D2B< 90 minutes. Presentation to a non-PCI center was the strongest predictor of D2B > 90 minutes (OR 9.1 compared to presentation to a PCI center, p < .0001). Other predictors of D2B > 90 minutes included history of congestive heart failure (OR 2.1, p = 0.0133), diabetes (OR 1.45, p = 0.002), prior MI (OR 1.43, p = 0.046), and baseline diuretic use (OR 1.36, p = 0.042), but not pre-PCI adverse events. Demographic factors correlated only weakly with delays in milestones between presentation and balloon inflation. Median D2B was similar for US (91 minutes) versus non-US pts (101 minutes, p = NS). After arrival at the cath lab, balloon inflation was delayed 1 hour (p < 0.001) in pts with prior CABG compared to pts without prior CABG.
Conclusions: In HORIZONS-AMI, D2B < 90 minutes was achieved in only one half of pts presenting to a PCI center and one tenth of pts presenting to a non-PCI center. The only potentially modifiable factor observed in this study was presentation to a non-PCI center. This data highlights the need for ambulance triage of pts with chest pain to bypass non-interventional centers and deliver pts directly to primary PCI centers of excellence.
Abstract 4607: Lycopene Intake Predicts Event-Free Survival in Patients with Heart Failure
Authors: Biddle Martha J , Heo Seongkum , Song Eun Kyeung , Lennie Terry A , Dunbar Sandi , Pressler Susan J , Kim JinShil , Moser Debra K 
Published: July 2021

Background: Higher intake of the dietary carotenoid lycopene may be beneficial for heart disease. A main source of lycopene is processed tomato products, which are high in sodium. Increased dietary sodium intake is a primary reason for heart failure (HF) exacerbation and may counter the positive effects of lycopene.
Purpose: To determine whether lycopene intake stratified by sodium intake predicts event-free survival.

Methods: Detailed 4-day food diaries were kept by 149 HF pts (age 60 ± 12, 38% female). A registered dietitian reviewed the diaries with pt to verify serving sizes and preparation methods. Nutrient analysis was performed using Nutrition Data System software
™
. Pts were stratified into 2 groups by sodium intake based on the median of 2913 mg. Outcomes were then compared in these strata by 2 groups of lycopene intake formed by the median intake of the sample (2624 mcg). Kaplan Meier and Cox regression survival techniques were used to detect differences in event-free survival (survival free of HF or cardiac hospitalization) between lycopene groups in the 2 sodium strata.

Results: High lycopene compared to low lycopene intake was associated with greater event free survival. (p=.012, figure

). This finding held in both sodium strata, although the best event-free survival was in the high lycopene group with the low sodium intake (p=.019). High lycopene intake was a predictor of event-free survival after controlling for age, gender, NYHA and EF (p=.014).

Conclusion: These findings suggest the naturally occurring antioxidant lycopene has the potential for substantial impact on event free survival rates in HF pts, but its positive effect is attenuated by high sodium intake.
Abstract 4680: Rapid Growth in Hospitalizations for Adults with Congenital Heart Disease in the United States
Authors: Opotowsky Alexander R , Siddiqi Omar , Webb Gary D 
Published: July 2021

Background: Adults with congenital heart disease (ACHD) constitute a growing population due to advances in pediatric care and diagnostic testing. This study aimed to better define the growth in ACHD hospitalizations and to provide data on the cost of hospitalization for these patients.
Methods: We utilized data from the 1998 –2005 Nationwide Inpatient Survey, the largest all-payer nationally representative hospital discharge database, to analyze trends in ACHD hospitalizations. We included all patients over 17 years of age with Clinical Classification Software diagnostic code 213 (Cardiac and Circulatory Anomalies). National estimates of hospitalizations and hospital charges by year for ACHD diagnoses were calculated, as were equivalent estimates for specific subsets of patients.

Results: The number of ACHD hospitalizations increased 67% between 1998 and 2005, from 53,212 to 88,610 per year. Over this period, the annual number of admissions increased for both simple (44,781 to 75,911) and complex diagnoses (8,431 to 12,699)(Table

). Patients 55 years or older made up approximately 51% of all ACHD patients, and 40% of those with complex disease. Rates of hospitalization increased similarly for patients under and over 55 years old among all diagnostic categories. Inpatient mortality decreased from 2.6+/−0.2% to 1.7+/−0.1% for simple diagnoses, and 4.4+/−0.5% to 3.7+/−0.4% for complex diagnoses. Mean hospital charges per hospitalization increased 66% from $21,485 to $35,565, and the estimated total national charges for these hospitalizations increased from $1.1 billion to $3.1 billion in 2005 (all in 1998 dollars). In 1998, admissions for ACHD accounted for 0.31% of estimated total national charges for hospitalizations of patients 18 years or older, as compared with 0.47% in 2005.

Conclusions: There has been a striking increase in hospitalizations for ACHD, and the cost of these admissions is rising out of proportion to overall hospital costs.

Number of Adult Congenital Heart Disease Admissions per Year
Abstract 4710: Diagnostic Accuracy of Myocardial Perfusion on Myocardial Contrast Echocardiography in Patients with Acute Coronary Syndrome: Results from the Assessment of Coronary Heart Disease with Myocardial Contrast Echocardiography 2 (ACTMCE2) Multicenter Trial
Authors: Sakata Konomi , Ito Hiroshi , Wada Hiroshi , Watanabe Hiroyuki , Sakuma Tadamichi , Yamada Satoshi , Doi Kaoru , Watanabe Tomoyuki , Yoshino Hideaki , Iwakura Katsuomi , Lin Young-jae , Ota Takahiro , Yoshikawa Junichi 
Published: July 2021

Background: Intravenous myocardial contrast echocardiography (MCE) at rest and during vasodilator stress is a reliable bedside technique for assessment of myocardial perfusion in patients with coronary artery disease. The aim of this study is to evaluate diagnostic accuracy of myocardial perfusion abnormalities using MCE at rest in patients with acute coronary syndrome (ACS). This study is the first MCE multicenter trial for the evaluation of ACS in Japan.
Methods: We performed triggered MCE at rest in 102 patients (mean age: 65 ± 11 years) with suspected ACS. We obtained 1:1 and 1:6 end-systolic triggered MCE images at four- and two-chamber views. We detected myocardial ischemia by the appearance of myocardial perfusion abnormalities (defect or reduction) in 1:1 end-systolic triggered MCE image. We assessed the appearance of regional wall motion abnormality (RWMA) at the same time. Quantitative coronary angiography was performed in all patients within 1 week (2.6 ± 2.2 days) after MCE.
Results: Eighty-four of 102 (82%) patients were diagnosed ACS (unstable angina: 70 patients; non-ST-segment elevation myocardial infarction: 11 patients; ST-segment elevation myocardial infarction: 3 patients) and demonstrated significant coronary artery stenosis (stenosis = or >75%) that required coronary revascularization therapy. The sensitivity, specificity, and accuracy of myocardial perfusion abnormality by MCE at rest for diagnosing ACS were 79%, 86%, and 83%, respectively. On each coronary artery, the sensitivity, specificity, and accuracy of MCE for diagnosing ACS were 85%, 71%, and 79% in the left anterior descending artery; 70%, 92%, and 84% in the left circumflex artery; 77%, 89%, and 84% in the right coronary artery, respectively. The sensitivity, specificity, and accuracy of RWMA for diagnosing ACS were 49%, 90%, and 71%, respectively, and the sensitivity of MCE for diagnosing ACS was significantly higher than that of RWMA.
Conclusion: Intravenous myocardial contrast echocardiography at rest without stress examination is a feasible noninvasive method for accurate diagnosis of ACS. In this multicenter study, MCE at rest improved the diagnostic accuracy of echocardiography for diagnosing ACS.
Abstract 4725: Left Ventricular Myocardium Shows Base-to-Apex Deformation Gradient during Isovolumic Relaxation Period in Healthy Subjects
Authors: Buakhamsri Adisai , Popovic Zoran B , Lim Pascal , Greenberg Neil L , Thomas James D 
Published: July 2021

Introduction: Deformation of LV myocardium during isovolumetric relaxation period (IVR) is not well described.
Methods: We performed echocardiography (Vivid 7, GE Medical) in 90 healthy subjects at rest (mean age 38 ±13 years, 34 males). Standard long and short LV axis views were acquired with high frame rate (65–100 fps) and used for strain rate (Sr) measurement by speckle tracking (EchoPac PC) in three directions: longitudinal (SrL), circumferential (SrC) and radial (SrR). Segmental Sr curves were the average Sr in each LV levels, i.e. base (B), mid (M) and apex (A) and normalized by R-R interval duration (Panel A and B). We then calculated Sr gradients during IVR as maximal instantaneous difference between apex-to-base or mid-to-base LV Sr (Sr(A-B) or Sr(M-B), Panel C). Pulsed wave Doppler flow profiles were used to determine cardiac intervals.

Results: SrL(A-B), SrC(A-B) and SrR(A-B) were 0.53 ±0.43, 0.67 ±0.46, −1.89± 1.52 s-1. SrL(M-B), SrC(M-B) and SrR(M-B) were 0.37±0.15, 0.5±0.34 and −2.14±1.4 s-1. Both types of gradient were identified for all strains (p<0.001 vs. zero), and were also different from each other (p<0.001, Sr(A-B) vs. Sr (M-B) for similar strain). The gradients were driven by faster relaxation in apical and mid LV segment and brief shortening in basal segment (see Figure

inset).

Conclusions: Differential deformation of LV exists during IVR. This deformation difference in the base to apex direction may facilitate changes in LV geometry that result in rapid intra-cavitary pressure reduction.
Abstract 4839: Colocalization of Regional MEF2 Activity With Myocardial Scarring in Hypertrophic Cardiomyopathy
Authors: Konno Tetsuo , Chen Dan , Wang Libin , Wakimoto Hiroko , Teekakirikul Polakit , Seidman Christine , Seidman Jonathan 
Published: July 2021

Background- The molecular triggers activated by a sarcomere gene mutation that remodel the heart and produce histopathologic manifestations of hypertrophic cardiomyopathy (HCM) are incompletely known. Myocyte enhancer factor 2 (MEF2) has emerged as a critical regulator of gene expression in the heart.
Objective- To examine whether MEF2 is essential for HCM pathogenesis, we assessed in vivo MEF2 expression versus myocyte hypertrophy, disarray and interstitial fibrosis, the prototypic histopathology of HCM.
Methods and Results- Wild-type or heterozygous mice harboring an Arg403Gln missense mutation in the alpha-myosin heavy chain gene (MHC403/+ mice) were crossed with transgenic mice harboring a MEF2-dependent reporter gene. Mouse hearts at 30 weeks of the age were evaluated by beta-galactosidase staining to detect transcriptional activity of MEF2 in vivo. Activity of MEF2 was heterogeneously increased in the left ventricle of MHC403/+ mouse hearts compared with wild-type mouse hearts. Gomori’s trichrome staining for collagen revealed that regional activation of MEF2 uniquely colocalized with myocardial scarring in MHC403/+ mouse hearts whereas only baseline activity of MEF2 was detected in the area without myocardial scarring. von Kossa staining revealed myocardial necrosis near to MEF2 staining. To further explore whether MEF2 activity is involved in the pathogenesis of myocardial necrosis, mice carrying a homozygous Arg403Gln mutation (MHC403/403) and the MEF2-dependent reporter gene were analyzed. MEF2 was regionally activated in 3-days old MHC403/403 mouse hearts, in advance of the myocardial necrosis that occurs in homozygous mutant hearts. At 6-days, greater MEF2 activity was observed compared with 3-days old MHC403/403 hearts, and massive necrosis was present where MEF2 was activated.
Conclusions- These findings provide the first evidence for regional activation of the MEF2-pathway is involved in evolution of myocardial fibrosis and necrosis in HCM. Because myocyte loss and myocardial scarring is implicated in the progression of ventricular dysfunction, these data indicate that strategies to prevent MEF2 activation may attenuate remodeling and heart failure development.
Abstract 4870: Cardiovascular Effects Of Apelin In Healthy Volunteers And Patients With Heart Failure
Authors: Japp Alan G , Cruden Nicholas L , Denvir Martin A , Flapan Andrew D , Newby David E 
Published: July 2021

BACKGROUND Apelin is the most potent inotrope yet described. In preclinical models, it increases cardiac output in normal and failing hearts and lowers blood pressure through peripheral vasodilatation. We have recently demonstrated that apelin causes nitric oxide-dependent vasodilatation in man. Here, we aimed to establish the effects of apelin on cardiac and systemic hemodynamics variables.
METHODS All studies were performed in a randomized, double-blinded manner. Forearm blood flow responses to intrabrachial infusions of (Pyr1)apelin-13 (0.3–3 nmol/min), acetylcholine (5–20 μg/min) and sodium nitroprusside (SNP; 1– 4 μg/min) were measured by venous occlusion forearm plethysmography in 12 patients with stable chronic heart failure (CHF; NYHA class II–III) and 12 matched controls. Cardiac index (CI; assessed non-invasively by thoracic electrical bioimpedance) blood pressure and heart rate (HR) were measured during intravenous infusions of (Pyr1)apelin-13 (30 –300 nmol/min) and saline placebo in 6 patients with stable CHF and 7 matched controls. The maximum rate of pressure rise within the left ventricle (dP/dt max) was measured in 4 patients following intracoronary boluses of apelin-36 (20 and 200 nmol) and saline placebo.
RESULTS Apelin infusions were well tolerated with no reported symptoms or ECG abnormalties. Apelin, acetylcholine and SNP caused vasodilatation in forearm resistance vessels of both CHF patients and controls (all p<0.0001). Responses to acetylcholine (P=0.01) but not apelin (p=0.3) or SNP (p=0.9) were diminished in patients with CHF compared with controls. In CHF patients, apelin increased cardiac index by 16% (p<0.05) and lowered mean arterial pressure (MAP) by 7% (p<0.05) but had no effect on HR (p=0.17). In controls, apelin increased CI by 8% (p<0.05) and HR by 13% (p<0.01) and lowered MAP by 8% (P<0.01). Intracoronary injection of apelin appeared to increase cardiac contractility (dP/dt max rise of 8%, p=0.056).
CONCLUSIONS Apelin increases cardiac output and lowers blood pressure in man, through both peripheral arteriolar vasodilatation and increased cardiac contractility. These effects of apelin are preserved in patients with CHF suggesting a potential therapeutic role for apelin agonism in heart failure.
Abstract 5700: Worsening Renal Function and Arrhythmic Event in Implantable Cardioverter Defibrillator Patients with Nonischemic Heart Failure
Authors: Takahashi Atsushi , Shiga Tsuyoshi , Yagishita Daigo , Futagawa Keisuke , Serizawa Naoki , Yamada Norihiro , Suzuki Tsuyoshi , Ejima Koichiro , Satoh Takahiro , Manaka Tetsuyuki , Shoda Morio , Hagiwara Nobuhisa 
Published: July 2021

Purpose: Implantable Cardioverter Defibrillator (ICD) prevents sudden cardiac death in high risk patients with heart failure (HF). Worsening renal function (WRF) is associated with mortality in patients with myocardial infarction or HF, but its effect on lethal arrhythmia is unknown. We evaluated the influence of WRF on the occurrence of arrhythmic events in patients with nonischemic HF and ICD.

Methods: A total of 286 nonischemic HF patients who underwent ICD implantation between 1990 and 2007 were studied. Estimated Glomerular Filtration Rate (eGFR) was calculated using the Modification of Diet in Renal Disease. Renal dysfunction was defined as eGFR <60mL/min/1.73m
2
and WRF was defined as 15mL/min/1.73m
2
per year. Differences in arrhythmia recurrences according to the eGFR and WRF were compared by Kaplan-Meier survival curves.

Results: During a mean follow-up time of 2.2+/−1.0 years, 94 (33%) of 286 patients (mean age; 57+/−15 years, 72% male) experienced appropriate ICD shock therapy. There was a significantly higher cumulative rate of appropriate ICD shock therapy (p<0.05) and electrical storm (p<0.05) in patients with renal dysfunction than others. The patients with renal dysfunction at baseline experience WRF more frequently than other patients (53% vs. 23%, respectively, p<0.01). After correcting for age, sex, left ventricular ejection fraction (LVEF), indication for ICD implantation, and use of beta-blockers in a Cox regression model, WRF was still an independent predictor of the time to first appropriate shock (HR 2.21, 95% CI 1.32–3.69, p<0.05) and electrical storm (HR 2.22, 95% CI 1.19 – 4.13, p<0.05). The result of subgroup analysis of 147 patients with low LVEF (LVEF<35%) indicated that the patients with WRF experienced electrical storms more frequently (p<0.05).
Conclusion: WRF is associated with increased rate of arrhythmic event in nonischemic HF patients. Especially, those patients with low LVEF and WRF experience more frequent ICD shocks.
Abstract 5702: Oxidative Stress in Patients with Lone Atrial Fibrillation
Authors: Kusano Kengo , Nakamura Kazufumi , Ohe Tohru 
Published: July 2021

Background: Lone atrial fibrillation (LAF) is a common arrhythmia, but its mechanism and the aggravated factor of arrhythmia are poorly understood. Oxidative stress has been implicated in the pathogenesis of heart failure. We have previously demonstrated that the amount of 4-hydroxy-2-nonenal (HNE) modified protein, which is a major lipid peroxidation product and a cytotoxic aldehyde, causes intracellular Ca2+ overload via reactive oxygen species (ROS) formation in cardiomyocytes and leads to develop arrhythmia. Accordingly we examined the levels of HNE and major histocompatibility complex (MHC) with the disease severity in LAF patients.
Method: Atrial and ventricular myocardial samples were obtained from twelve patients (11 men and 1 woman, mean 48±14 years old) by endomyocardial biopsy in 10, autopsy sample in 1 and surgical resection sample in 1. Histological assessments and immunohistochemical analysis for HNE modified protein, MHC class-I and -II antigens (grade 0 to 3) were performed and compared with LAF severity.
Results: Histological assessment showed that increased number of interstitial cells (mainly activated T cells) was observed only in the atrium but not in the ventricle. Moderate to severe expression of MHC antigens (grade 2 or 3) was more observed in the atrium than the ventricle (MHC-I: seven in atrium and three in ventricle; MHC-II: ten in atrium and four in ventricle). Atrial myocarditis was detected in 6 out of 11 samples. HNE modified protein was also more observed in the atrium than that in the ventricle. In addition, more severe expression of HNE staining was observed in the samples from persistent/chronic LAF than that in paroxysmal LAF.
Conclusion: These data indicates that oxidative stress plays an important role as an aggravating factor in LAF patients.