bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 10536: Adenosine Triphosphate - Sensitive Potassium Channel Opener Diazoxide Reduces Myocardial Stunning in a Porcine Lad Occlusion Model
Authors: Velez Ana K , Etchill Eric , Giuliano Katherine , Kearney Sean , Jones Melissa , Wang Jie , Cho Brian , Brady Mary Beth , DODD-O Jeffrey M , Thomas Rosmi , Lawton Jennifer S
Published: March 2022

Introduction:
Adenosine triphosphate - sensitive potassium (K
ATP
) channels provide endogenous myocardial protection by coupling cell membrane potential to metabolism, as they are inhibited by ATP and open during times of metabolic stress. Pharmacologic opening of K
ATP
channels mimics ischemic preconditioning, and diazoxide (DZX) preserves myocardial function following prolonged global ischemia.

Hypothesis:
We hypothesized that DZX would reduce myocardial stunning after left anterior descending coronary artery (LAD) occlusion followed by global ischemia, similar to a clinical situation of acute myocardial infarction followed by coronary revascularization.

Methods:
Twelve swine underwent LAD occlusion (30 min), followed by 120 min global ischemia protected with hyperkalemic cardioplegia (CPG) +/- DZX (N=6 each), followed by intermittent CPG (q 20 min), then 60 min reperfusion (RF). Cardiac output (CO), mean time to wean from cardiopulmonary bypass (CPB), left ventricular ejection fraction (LVEF), left ventricular developed pressure (LVDP), caspase - 3 (apoptosis), and infarct size were compared.

Results:
All 6 animals in the DZX group separated from CPB by 30 min RF whereas only 1 and 4 animals in the CPG group had separated at 15 and 30 min, respectively (Figure). DZX was associated with shorter average time to wean from CPB (17.5 vs 27.0 min, p=0.13) and higher CO at all time points during reperfusion (2.9 vs 1.5 L/min at 30 min RF, p=0.05), however, these were not significantly different. DZX was associated with higher LVEF after 30 minutes of reperfusion (42.5 vs 15.8%, p=0.009; Figure). There were no differences between groups in vasopressor use, infarct size, caspase - 3, or LVDP.

Conclusions:
DZX reduces myocardial stunning and facilitates separation from CPB following LAD occlusion and subsequent global ischemia in a porcine model. The addition of DZX to hyperkalemic cardioplegia has the potential to reduce myocardial stunning in the clinical setting.
Abstract 10541: Clinical Risk Factors and Myocardial Fibrosis in Subjects Who Died Suddenly: Pilot Data from A 10-Year Post-Mortem Data Registry
Authors: Hussain Daanyal , Jonnala Vinesh , Hashmi Ariba , Thompson Iain , Simson Matthew , Khazaeli Mahyar , Yatsynovich Yan , Pokharel Saraswati , Tian Lili , Sharma Umesh C
Published: March 2022

Introduction:
Sudden cardiac death (SCD) is responsible for approximately 380,000 deaths per year. One third of the patients dying of heart disease present with SCD as the first manifestation. There are limited data on the clinico-pathological determinants of SCD.

Hypothesis:
We hypothesized that, compared to overall deaths, silent coronary atherosclerosis and myocardial fibrosis could be associated with increased frequency of SCDs.

Methods:
We reviewed the post-mortem data registry from two tertiary care hospitals located at the Buffalo-Niagara Region. Of the 1,314 subjects that underwent comprehensive post-mortem analysis, we identified 187 subjects that died suddenly. For this initial pilot data analysis protocol, we compared the demographic, clinical, electrocardiographic and coronary vascular and myocardial histopathological characteristics of 109 subjects with sudden death vs. 34 age-matched controls with non-sudden death.

Results:
We found that, of the total 1,314 subjects screened, 14% had SCD. Comparison of age-matched SCD with non-SCD subjects (age in years, SCD: 60±14; non-SCD: 61±20) showed that SCD groups had larger cardiac size (heart weight in grams, SCD: 550±150; non-SCD: 480±117, P=0.03), increased wall thickness (posterior wall thickness in cm, SCD: 1.7±0.4; non-SCD: 1.5±0.2, P=0.01), but reduced LV function reported before the event (LV ejection fraction in %, SCD: 41±17; non-SCD: 58±9, P=0.007). In addition, SCD groups had higher frequency of coronary atherosclerosis (SCD, 76% vs., non-SCD, 52%, P=0.007), and myocardial fibrosis involving both left ventricular free wall (SCD, 47% vs., non-SCD, 26%, P=0.03), and interventricular septum (SCD, 29% vs., non-SCD, 3%, P=0.02). There were no differences on serum electrolytes, circulating biomarkers and the extent of right ventricular fibrosis.

Conclusions:
The subjects that died suddenly had larger cardiac size, reduced contractile function with myocardial interstitial fibrosis, and silent coronary atherosclerosis. Further studies are in progress to fully examine the clinico-pathological correlates of SCD in our longitudinal study cohorts.
Abstract 10555: Genetic Testing Underutilization in Patients with Cardiomyopathy: A Real-World Data Analysis
Authors: Morales Ana , Moretz Chad , Ren Sheng , Smith Elizabeth , Callis Tom , Dalton Joline , Hall Taryn , Hatchell Kathryn , Murillo Jaime , Nussbaum Robert L , Regalado Ellen , Rojahn Susan , Vatta Matteo , Esplin Edward D
Published: March 2022

Introduction:
Professional guidelines support genetic testing (GT) for dilated, hypertrophic, restrictive, arrhythmogenic, and peripartum cardiomyopathy to confirm a diagnosis, guide management, enable clinical trials, and/or allow more informed genetic counseling. Analysis of de-identified data from a commercial laboratory showed that 1 in 4 individuals who had cardiomyopathy GT billed to a national health insurer had a positive result; however, which patients undergo GT is largely unknown.

Hypothesis:
GT is underutilized in patients with genetic cardiomyopathy.

Methods:
A retrospective analysis was conducted using commercial and Medicare claims data from the UnitedHealth Group Clinical Discovery Database. The GT-cohort (index: GT dates 1/1/2017-12/31/2020) included patients with 12-months pre-index data including ≥1 ICD-10 codes associated with genetic or unspecified cardiomyopathy and GT Current Procedural Terminology (CPT) code(s). The non-GT cohort (index: outpatient visit dates 1/1/2017-12/31/2020 with 12-month pre-index data) had the same ICD codes, but no GT CPT code. Individuals with a personal and/or family history of cancer were excluded to avoid patients who had GT for cancer. Multivariable logistic regression analysis was performed to examine factors associated with GT.

Results:
Of 300,127 patients with cardiomyopathy, 3,287 (1.1%) had a GT CPT code. Factors that predicted a higher likelihood of GT (p < 0.05) included being younger, living in an area with a higher education level, commercial insurance, no diagnosis of diabetes or myocardial infarction, diagnosis of mild liver disease, a higher number of outpatient medical and cardiology visits, cardiac-related hospitalizations (shorter length-of-stay), a higher number of 30-day all-cause readmissions, a higher number of cardiomyopathy diagnoses, and except for peripartum, all genetic cardiomyopathy types.

Conclusions:
Only 1.1% of patients with a cardiomyopathy ICD code had a GT claim. Considering a potential 25% testing yield, a larger portion could have benefited from a genetics guided diagnosis. More research is needed to investigate barriers related to GT and improve our ability to identify those who could benefit from cardiomyopathy genetic testing.
Abstract 10560: Reducing Cardiovascular Risk Among Participants in a Community Supported Agriculture Program
Authors: Biddle Martha J , Kang Junghee J , Brewer Dawn , Woods Timothy A
Published: March 2022

Introduction:
Eating a diet high in vegetables translates to lower risk for cardiovascular disease. Only 10% of Americans consume the recommended servings of vegetables per day. Community supported agriculture (CSA) programs support local farmers while promoting increased consumption of vegetables. At the University of Kentucky (UK), employees receive vouchers to encourage CSA program participation while giving financial support to local farms that allow them to operate in an economically sustainable manner. Our objective was to examine the effect of participation in a CSA voucher program on CVD risk factors as a new approach to CVD risk management.

Methods:
Participants self-selected in the UK employee Health and Wellness CSA voucher program. Biometric measurements (blood pressure, lipid levels, and noninvasive dermal carotenoid levels via Veggie Meter) and vegetable intake via six-question BRFSS were collected pre- and post- CSA program participation. Descriptive statistics, independent t-tests, paired t-tests and cluster analysis were used to analyze the data.

Results:
Among 204 eligible individuals, 85 enrolled pre-program and 52 completed post program for a 61.2% retention rate. Average participant age was 42
+
10 years, predominantly Caucasian females. Systolic blood pressure was significantly reduced from pre- to post program (125.8 compared to 120.6 mmHg, p = 0.012). Carotenoid levels significantly increased from pre- to post program (286.3 ± 110 to 295.9 ± 124,) while controlling for age and sex (p = <0.001). Frequency of total vegetable, red/orange vegetables, dark green vegetables and other vegetable intake also increased from pre- to post- program while controlling for age and sex (p = 0.003, 0.004, 0.013, < 0.001 and 0.011 respectively).

Conclusion:
Our data identifies participation in a CSA employer incentivized program can effectively reduce blood pressure and increase vegetable intake (dermal carotenoids) and self-reported quantity and variety of vegetable consumption thereby reducing CVD risk.
Abstract 10565: A Systematic and Reliable Process for Performing Cost Containment Analysis within the Operating Room
Authors: Nellis Joseph R , Prabhu Neel , Meza James M , Andersen Nicholas D , Turek Joseph W
Published: March 2022

Purpose:
Healthcare spending within the United States increased 4.6% in 2019 and represented over $3.8 trillion, or 17.7% of our GDP. The operating margin for most hospitals is 1-3%. As costs continue to rise, insurers will continue to shift these financial risks and responsibilities onto hospitals and hospitals eventually onto surgeons.

Methods:
Using a recently introduced surgical receipt function within Epic, we set out to develop cost containment strategies within congenital cardiac surgery at Duke University Hospital. Surgical receipt data was obtained between January 1, 2020 and January 1, 2021. Variability in case costs and product utilization were identified. Findings were discussed with surgeons to identify high impact changes with low barriers to implementation.

Results:
Between January 1, 2020 and January 1, 2021, there were 340 index cases and 449 unique surgical receipts. Four procedures representing 54 patients accounted for more than 50% of the total annual direct operating room supply costs (LVAD, 5 patients, 22.7% of annual costs; Norwood, 20 patients, 12.7%; RV-PA shunt, 16 patients, 9.9%; PVR, 13 patients, 9.4%). Exploration chest for postoperative hemorrhage was associated with the highest variability in case cost. In addition to mechanical devices and valves, cost drivers included the use of disposable vascular clips, suture brand preference between surgeons, and surgical patch material utilization which accounted for 3.7%, 6.6%, and 26.5% of overall annual direct operating room supply costs.

Conclusions:
We project 6-6.5% in annual savings due to changes in suture and surgical clip utilization. Changes to surgical patch utilization should carry an additional 4-4.5% in savings. The surgical receipt represents a reliable and uniform way of reporting surgical costs with broader implications for all surgical subspecialties.
Abstract 10567: Systolic and Diastolic Myocardial Stiffness of the Right Ventricle Free Wall Assessed by Ultrafast Ultrasound Imaging in Humans: Comparison with Pressure-Volume Loop in Healthy Volunteers and Pulmonary Arterial Hypertension Patients
Authors: villemain olivier , Chaturvedi Rajiv , Baranger Jerome , Nguyen Minh , Mroczek Dariusz , Mertens Luc L
Published: March 2022

Background:
Echocardiographic parameters to assess systolic and diastolic RV function are strongly dependent on loading conditions. Myocardial stiffness (MS) is an intrinsic myocardial property that influences both diastolic and systolic cardiac function. MS is independent of loading conditions and pre-clinical studies have demonstrated a correlation between 1) systolic MS and contractility (or ESPVR); 2) end-diastolic MS and compliance (or EDPVR). Shear wave imaging (SWI) by ultrafast ultrasound imaging allows quantitative MS assessment at any time of the cardiac cycle. This noninvasive technique could provide load-independent measure of RV function.

Methods (figure 1):
Ten children, 5 pulmonary arterial hypertension patients (PAH) undergoing diagnostic right heart catheterization (RHC) were prospectively enrolled as well as 5 age-matched heathy volunteers (HV). MS was assessed at baseline and during FiO2 70%+40ppm NO for the PAH group. MS in the RV free wall using SWI every 100ms during the cardiac cycle. RV-ESPVR and RV-EDPVR were assessed by pressure-volume loops using a pressure catheter and real-time 3D-echo volumes.

Results (figure 2):
MS increased significatively in systole compared to end-diastole in both groups (p<0.01) and more significantly in the PAH group (p<0.01). In the PAH group, no difference was found in systolic MS between baseline and during FiO2 70%+40ppm NO (p=0.67). Systolic MS correlated with RV-ESPVR (r=0.75). End-diastolic MS correlated with RV-EDP (r=0.76) and RV-EDPVR (r=0.85).

Conclusions:
Our preliminary data demonstrate that MS could be a quantitative measure of RV contractility and diastolic compliance of the RV.
Abstract 10569: Risk Factors for Adverse Outcome in Prenatally Diagnosed Heterotaxy Syndrome in the Current Era
Authors: Savla Jill J , Rychik Jack , Degenhardt Karl , Falkensammer Christine , Combs Jill , Szwast Anita
Published: March 2022

Introduction:
Fetuses with heterotaxy syndrome (HS) and congenital heart disease continue to have worse outcomes compared to other lesions. We sought to explore differences between asplenia and polysplenia subtypes and to identify risk factors for poor outcome in the current era.

Methods:
All cases of fetal HS seen at our center between 1/2005 and 3/2018 were included in this study. Prenatal echocardiographic parameters and clinical outcomes were recorded. Findings were compared between the asplenia and polysplenia subtypes via Chi-square or Fisher’s exact analysis. Univariate logistic regression was utilized to identify prenatal variables predictive of fetal demise. Postnatal survival was examined with Kaplan-Meier curves and univariate Cox proportional hazards models.

Results:
The cohort consisted of 155 subjects: 86 with asplenia and 69 with polysplenia. There were 36 with biventricular (2V) and 119 with univentricular (1V) physiology. Asplenia subjects were more likely to have 1V physiology, common atrioventricular canal (CAVC), conotruncal anomaly, and pulmonary venous obstruction (all p<0.001). Polysplenia subjects were more likely to have systemic venous anomalies (p<0.001), complete heart block (CHB, p<0.001), ventricular dysfunction (p=.005), and hydrops (p=0.03). There were 105 subjects born alive, 7 fetal demises, 40 terminations, and 3 lost to follow-up prior to birth. Postnatal follow-up data were available for 96/105 (91%) subjects with median follow-up of 5.5 years (IQR 1.2-10.5). Estimated 5-year survival was 72% (95% CI 62-80) for the entire cohort and there was no difference in overall postnatal survival between polysplenia and asplenia subtypes (p=0.24). CHB and ventricular dysfunction were significant risk factors for both fetal demise and postnatal death. Pulmonary venous obstruction and CAVC were additional risk factors for postnatal death.

Conclusions:
Fetuses with HS continue to have high rates of postnatal mortality, particularly if CHB, ventricular dysfunction, or pulmonary venous obstruction are identified. CHB and ventricular dysfunction are also significant risk factors for fetal demise. Further research is needed to improve management of CHB and pulmonary venous obstruction in this high-risk group.
Abstract 10574: Living with Sexual Partner Slowed Klotho Deficiency-Induced Heart Aging
via
Suppressing Renal Sodium-Phosphate Co-Transporters
Authors: Chen Kai , Sun Zhongjie
Published: March 2022

Background:
Staying young at heart is a dream of many aged people. Sexuality is now generally considered beneficial for the overall health. It reduces the risk of a heart attack. However, while the concept of “sex improves health” has been demonstrated, the underlying mechanism remains poorly understood.

Methods & Results:
Klotho mutant homozygous (KL-/-) mice and age- and sex-matched wild-type (WT) mice were used. One male and one female mouse were co-housed from weaning and fed with low-phosphorus diet to reduce serum phosphate level. And the mice co-housing with the same gender were used as control. Body weight was measured weekly and lifespan was recorded. Heart function was measured by magnetic resonance imaging (MRI). Mice were sacrificed just before dying. Klotho-deficient mice demonstrated heart aging phenotype, as evidenced by cardiac remodeling and cardiac dysfunction. The compromised cardiac function was associated with increased oxidative stress, mitochondrial damage and myocyte apoptosis. We showed that hyperphosphatemia contributes to Klotho deficiency-induced cardiac damages. Interestingly, sexuality attenuated cardiac aging. Mechanistically, sex increased estrogen secretion, which decreased hyperphosphatemia through inhibition of renal tubular sodium-dependent phosphate (NaPi) co-transporters. Co-housing sexual partners also attenuated oxidative stress and myocyte apoptosis and improved mitochondrial function. Moreover, living with sexual partners extends the lifespan by 86.8% in KL(-/-) female mice and 38.7% in male mice.

Conclusion:
In the Klotho deficiency-induced aging model, sexuality improves heart aging and extends lifespan. This study demonstrated for the first time that living with sexual partners increases estrogen secretion which inhibits renal NaPi co-transporters leading to attenuation Klotho deficiency-induced hyperphosphatemia and heart aging.
Abstract 10577: Dapagliflozin Improves Cardiac Function in Mice After Myocardial Infarction
Authors: Haseeb Mohsin , Gavini Chaitanya K , Cao Quan , Aubert Gregory
Published: March 2022

Objective:
We examined the effects of SGLT2 inhibition with Dapagliflozin (DAPA) on left ventricular ejection fraction (LVEF) and cardiomyocyte regeneration in mice after myocardial infraction (MI), a model for Heart Failure with reduced EF.

Introduction:
Neonatal mice can regenerate cardiomyocytes, but this ability is lost shortly after birth due in part to a switch from anaerobic glycolysis to fatty acid utilization. This switch is due to pyruvate dehydrogenase kinase 4 (PDK-4) inhibition of pyruvate dehydrogenase (PDH) dependent glycolysis. Empagliflozin use in mice after MI increases PDH activity and promotes glucose utilization.

Hypothesis:
DAPA use in mice after MI can improve LVEF by promoting cardiomyocyte regeneration secondary to increase PDH activity.

Methods:
A total of 49 mice, 8 weeks old, were randomized to LAD ligation (MI) or sham surgery (Sham). 72 hours after surgery, MI (n=19) and Sham (n=21) mice were randomized to PO DAPA (0.02 mg/ml) (MI-DAPA, Sham-DAPA) or vehicle (water) (MI-VEH, Sham-VEH). 20 mice were euthanized after each successive week (wk.) of treatment. Immunofluorescence, using Anti-phospho-Histone H3 (mitosis marker) (PH3)-Anti Cardiac Troponin T co-staining, was done at 2 wks. to assess regeneration. An echocardiogram was done at baseline, 72 hours after surgery, and weekly after treatment to assess LVEF.

Results:
At 1 wk. after MI, no significant change was observed between groups. At 2 wks., DAPA increased LVEF in MI mice (Sham-VEH 66.75%, SEM 1.18; Sham-DAPA 78.63%, SEM 2.82; MI-VEH 56.86%, SEM 4.80; MI-DAPA 74.3%, SEM 0.58%, p<0.05). At 2 wks., MI increased % of PH3 positive cardiomyocyte nuclei (Sham-VEH 0%, SEM 0; MI-VEH 0.4268%, SEM 0.1259; p<0.05). In DAPA treated mice no significant difference was observed as the % of PH3 positive cardiomyocyte increased in Sham-DAPA mice (Sham-DAPA 0.2253%, SEM 0.078; MI-DAPA 0.46%, SEM 0.07; p 0.47). Despite an increase in SHAM-VEH mice, no statistically significant difference was observed between SHAM-VEH and SHAM-DAPA.

Conclusions:
DAPA mitigate cardiac remodeling in mice after MI with increase LVEF after 2 wks. MI increases mitosis in cardiomyocytes after two wks. Despite a trend for increased mitosis with DAPA treatment for 2 wks., no significant change was seen.
Abstract 10581: Sexual Dimorphism in Acute Myocardial Infarction-Induced Acute Kidney Injury
Authors: Habeichi Nada J , Ghali Rana , MROUEH Ali , KAPLAN ABDULLAH , Tannous Cynthia , Jurjus Abdo , Amin Ghadir , Booz George , El-Yazbi Ahmed , Zouein Fouad A
Published: March 2022

Introduction:
Acute kidney injury (AKI) is a common complication of acute myocardial infarction (AMI) in both males and females, increasing mortality rate substantially. Premenopausal females appear to be more protected, suggesting a potential protective role of estrogen.

Hypothesis:
We hypothesized that premenopausal female mice are more protected against AMI-induced AKI and that is potentially due to female sex hormones.

Materials and Methods:
AMI was induced by ligating the left anterior coronary artery in male and premenopausal female mice. Kidney histological, molecular, and functional parameters were assessed after 7 days. Surgical menopause was induced in AMI-female mice to evaluate estrogen-mediation of the observed renal protection.

Results:
7days post-AMI enhanced fibrosis and glomerular retraction were observed in AMI-males, only. Both sexes exhibited a comparable marked increase in glomerular reactive oxygen species (ROS) and DNA fragmentation that was associated with a marked decrease in total NAD kidney levels. Increased release of IL-1β, a pro-inflammatory cytokine, and caspase-3, a proapoptotic marker, and α-smooth muscle actin, a profibrotic biomarker, was seen in AMI-male mice, only. NAD
+
biosynthetic enzymes, including nicotinamide phosphoribosyl transferase and nicotinamide riboside kinase-1, increased only in AMI-females, whereas male counterparts showed a substantial decrease in mitochondrial bioenergetic enzymes such as Sirtuins 1 and 3, along with an increase in Poly [ADP-ribose] polymerase 1, an NAD
+
consuming enzyme. Exacerbated kidney damage in AMI-females post-ovariectomy was seen with aggravated morphological alterations, increased ROS generation, and enhanced pro-inflammatory cytokine release, and altered NAD
+
biosynthetic and mitochondrial bioenergetic enzymes. These changes translated into exacerbated kidney function as evidenced by a decrease in creatinine clearance in AMI-male and female mice, while urine output declined in AMI-male mice only. A further decrease in creatinine clearance and urine output was observed in AMI-female mice following ovariectomy.

Conclusion:
Our findings suggest that AMI induced AKI in both sexes with pre-menopausal female mice being more protected.
Abstract 10590: Trends in Major Adverse Cardiac Events During the Covid-19 Pandemic in Alberta, Canada
Authors: Mackinnon Erin S , Anderson Todd J , Raggi Paolo , Gregoire Jean C , WANI RAJVI J , Packalen Millicent , Oliveira Thiago , Li Shirley , McMullen Suzanne , Cowling Tara , Goodman Shaun G
Published: March 2022

Introduction:
The coronavirus disease 2019 (COVID-19) pandemic has impacted cardiovascular (CV) outcomes and care globally, although to date, limited data exist on the Canadian experience. This study aimed to describe trends in major adverse cardiovascular events (MACE)/procedures during the COVID-19 pandemic in the Province of Alberta, Canada.

Methods:
A repeated cross-sectional study design compared MACE from inpatient and emergency department visits among Albertan adults between March 15, 2019, and September 14, 2020. The Alberta population was 4.4 million in 2020 and all residents are part of a single payer healthcare system. The percent change between each MACE reported in the control (2019) and COVID-19 restriction periods (2020) were calculated. MACE were defined individually and as a primary composite outcome (CV death, acute coronary syndrome [ACS], ischemic stroke, or coronary revascularization procedures). These preliminary data are part of an ongoing study, measuring outcomes throughout the first year of the pandemic.

Results:
Compared to March-June 2019, primary MACE during the initial COVID-19 restriction period (March-June 2020) decreased by 15.6% (n=739 patients), and by 7.3% (n=342 patients) during June-September 2020, when COVID-19 restrictions were eased. Most individual MACE followed similar patterns with reduced reported events/procedures during the initial restriction period and an increase towards previous rates thereafter
(Figure 1):
CV death (17.7% vs 10.2%), ACS (19.1% vs 8.4%), coronary revascularization (17.0% vs 9.2%). The exception was ischemic stroke, which was not notably impacted by pandemic restrictions.

Conclusions:
Declines in MACE/procedures during the COVID-19 pandemic are suggestive of a substantial gap in patient management and healthcare-seeking behaviour that may have negative downstream implications. Ongoing analyses will further explore reported MACE up to one year after the pandemic began.
Abstract 10593: Computationally Modeling Cardiac Growth and Hemodynamics in Healthy Infants
Authors: Hiebing Ashley , Pieper Riley , Witzenburg Colleen
Published: March 2022

Introduction:
Previous computer models have been developed which predict cardiac growth and remodeling in adults with various pathologies, including hypertension, valvular disease, and myocardial infarction. Applying these models to infants and children is complicated by the fact that they also undergo normal, somatic cardiac growth and remodeling.

Objective:
Create a computational model to predict ventricular dimensions and hemodynamics in healthy, growing infants.

Methods:
A left ventricular growth model previously published by our lab for adult canines was modified for healthy infants. The four heart chambers were modeled as time-varying elastances coupled to a circuit model of the circulation. Circulation parameters were allometrically scaled for human infants. Early trends in systemic and pulmonary vascular resistance were fit to clinical data rather than scaled due to the dramatic reduction in pulmonary vascular resistance and marked increase in overall systemic vascular resistance immediately post-birth. Ventricular growth was driven by perturbations in myocyte strain, a non-dimensional metric. Reported heart rate was input directly into the model.

Results:
The model successfully matched clinically measured values of systemic and pulmonary pressures, end-systolic and end-diastolic left and right ventricular volumes, maximum atrial volumes, and left ventricular end-diastolic thickness within one standard deviation of multiple studies for children aged 0-3 years (Figure). LV end-systolic and right ventricular end-diastolic thicknesses followed clinical trends but were outside of established ranges.

Conclusions:
Our model predicts hemodynamics and ventricular dimensions for healthy children from birth to 3 years. From this, we can gain a greater understanding of the interplay between somatic and pathological growth in infants and children with congenital heart defects.
Abstract 10595: Health Related Quality of Life as Predictor of Outcomes in Heart Failure
Authors: Siu Alfonso F , Zhang Mingyuan , Wolhfahrt Peter , Shen Jincheng , Wever-Pinzon Omar , Shah Kevin , Selzman Craig H , Rodriguez-Correa Carlos , Alharethi Rami , Hess Rachel , Drakos Stavros G , Steinberg Benjamin A , Shah Rashmee U , Fang James C , Spertus John A , Kfoury Abdallah G , Greene Tom , Stehlik Josef
Published: March 2022

Introduction:
Accurate assessment of the risk of adverse outcomes can assist in the management of patients with heart failure (HF).

Hypothesis:
Health-related quality of life (HRQoL) can improve prediction of HF outcomes beyond that of the more traditional clinical disease characteristics.

Methods:
We included consecutive patients with HF with reduced ejection fraction (HFrEF) who were seen in the HF clinic and completed patient reported outcome assessment (PROs) as part of routine care. Elastic net and gradient boosting regression analysis were used to build predictive models for HF hospitalization, heart transplant, left ventricular assist device implantation or death (composite outcome), including a range of clinical variables and PRO results as covariates.

Results:
There were 1,165 patients with HFrEF (mean age 60.5±16.2, 65% male) with median follow-up time of 490 days. Addition of PROs to more traditional risk factors improved model performance, as analyzed by C-statistics. The gradient boosting regression was chosen as the final model based on superior prediction performance - c-statistic 0.733 and favorable stratification of patient risk -
Figure 1A
. The Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ) and PROMIS dimensions of Satisfaction with social roles and activities and Physical function were covariates with high variable importance measure in the model. The predictive value of PROs was also confirmed by determining freedom from the composite endpoint in the 20th, 50th and 80th percentiles of PRO strata, while assigning the remaining clinical variables a median value (
Figure 1B
). In this analysis, PROs discriminated outcomes independent of other clinical characteristics.

Conclusions:
HRQoL appears to significantly modify outcome in HFrEF. Routine assessment of PROs could help to more accurately assess risk of adverse outcomes and personalize informed treatment decisions.
Abstract 10596: Telephone-Based Stress Management in Women with Myocardial Infarction: Findings from the Go Red for Women Strategically Focused Research Network
Authors: Spruill Tanya M , Park Chorong , Kalinowski Jolaade , Shallcross Amanda J , Visvanathan Pallavi , Arabadjian Milla E , O'Hare Olivia , Smilowitz Nathaniel R , Hausvater Anais , Bangalore Sripal , Xia Yuhe , Zhong Hua , Hada Ellen , Park Ki , Toma Catalin , Mehta Puja K , Mehta Laxmi S , Wei Janet , Thomas Dwithiya , Ahmed Bina , Marzo Kevin , Trost Jeffrey , Bainey Kevin R , Har Bryan , Dickson Victoria V , Ogedegbe Gbenga , Berger Jeffrey S , Hochman Judith S , Reynolds Harmony R
Published: March 2022

Introduction:
Elevated perceived stress is associated with adverse outcomes following myocardial infarction (MI) and accounts in part for poorer recovery in women compared with men. The goal of this multicenter randomized controlled trial was to assess efficacy of a telephone-based stress management program on perceived stress, depressive symptoms, anxiety and quality of life (QOL) among women with MI.

Methods:
Women with elevated stress levels (Perceived Stress Scale [PSS-4]≥6) at least 2 months after MI were enrolled from 12 hospitals in the U.S. and Canada participating in the NYU Women’s Heart Attack Research Program (HARP). Participants were randomized in 12 cohorts to stress management (mindfulness-based cognitive therapy adapted for telephone; MBCT-T) or enhanced usual care (EUC; heart disease education) and followed for 6 months. Both programs were delivered by phone in 8 weekly sessions (group and individual, respectively). Linear mixed effects models were used to test between-group differences in PSS-10 scores (primary outcome), depressive symptoms (PHQ-9), anxiety (Hospital Anxiety and Depression Scale) and QOL (Seattle Angina Questionnaire, PROMIS-Global) at 6 months.

Results:
The sample included 130 women with elevated stress at ≥2 months from MI (age 59.8±12.8 years, 33.8% racial/ethnic minorities, 26.2% with MI with non-obstructive coronary arteries [MINOCA]). Mean baseline PSS-10 scores were similar (18.2±5.2 MBCT-T vs. 18.3±5.6 EUC). The median number of sessions completed was 7 (IQR 3,8) for MBCT-T and 8 (IQR 6,8) for EUC. The 6-month retention rates were 82.1% (MBCT-T) and 82.5% (EUC). Perceived stress and anxiety declined in the EUC arm (p<.05) and anxiety and depressive symptoms declined in the MBCT-T arm (p<.01) but there were no significant group by time interactions. We will report results of sensitivity analyses that explore predictors of treatment response (e.g., age, race/ethnicity, clinical history, baseline psychosocial factors, intervention adherence, satisfaction).

Conclusions:
Stress management did not improve perceived stress or secondary outcomes more than enhanced usual care. Identifying predictors of treatment response will inform future studies of psychosocial interventions for women with MI.
Abstract 10598: The Impact of Covid-19 on Excess Deaths Among Patients with Heart Failure
Authors: Gilstrap Lauren , Zhou Weiping , Skinner Jonathan
Published: March 2022

Introduction:
During the COVID-19 pandemic in 2020, patients with heart failure (HF) accounted for a large fraction of COVID-19 mortality. In addition, studies suggested that lockdowns and other restrictions may have increased mortality in this population, even among those without COVID-19. The purpose of this study is to provide an overarching measure of excess mortality for HF patients during 2020 in contrast to other Medicare enrollees age 65+ without HF, including those living in the community and in nursing homes.

Methods:
We used 100% fee-for-service Medicare Parts A and B between January 1, 2019 and December 31, 2020. Using International Classification of Diseases (ICD) 10 codes in the preceding year, we created 4 cohorts: 1) HF; 2) non-HF, 3) HF living in the community; 4) HF living in the nursing homes. We calculated excess deaths in 2020 by comparing 2020 observed mortality to corresponding rates in 2019 for each of the four groups; adjusted for age, sex and region.

Results:
In 2020, excess mortality was lower for patients with HF (1.13), compared to patients without HF (1.21; difference -0.08 for HF, p <0.001). Among Black, Hispanic and Asian patients, excess mortality was higher overall, but still lower for with HF compared to those without HF (Figure 1). Patients with HF living in nursing homes also experienced overall higher excess mortality, but nursing home residents with HF also experienced less excess mortality (1.24) than nursing home residents without HF (1.39, p <0.001).

Conclusions:
Mortality rates rose for all elderly groups during 2020, but HF patients’ excess mortality rose by less than those without HF, including among populations with known high burdens of COVID-19. Additional work is needed to understand the mechanism driving this, but restricted dietary options and improved medication compliance during lockdown may be playing a role.
Abstract 10599: The Effects of Gestational Age and Size on Management Strategies and Outcomes in Neonatal Tetralogy of Fallot
Authors: Duhaney Leanne , Steurer Martina A , Baer Rebecca , Chambers Christina , Rajagopal Satish , Mercer-rosa Laura M , Reddy V. Mohan , Jelliffe-Pawlowski Laura L , Peyvandi Shabnam
Published: March 2022

Introduction:
Data suggests there are benefits to both staged (SR) and complete repair (CR) for neonatal Tetralogy of Fallot (nTOF), though data is lacking on whether high-risk groups would benefit from one strategy over another. In a large state with variable practice patterns, we studied the impact of gestational age (GA) and weight by GA (birth weight z-score: BWz) at birth on surgical strategy and outcomes in nTOF, hypothesizing that GA and BWz would influence these outcomes.

Methods:
Population-based cohort study (2011-2017) of infants with nTOF (defined as catheter or surgical intervention prior to 44 weeks corrected GA) was performed. BWz was categorized as appropriate, small or large for GA. Surgical strategy and timing were compared by GA (
<
36 weeks preterm (n= 96), 37-38 weeks early term (n= 97), > 38 weeks full term (n= 152)) and BWz. Multivariable (MV) models were constructed to evaluate composite outcome of mortality or significant morbidity (BPD, IVH, NEC, PVL etc.) at 1 year and total number of hospital days in first year of life.

Results:
There were 345 patients included (SR= 194; CR= 151). Surgical strategy did not differ by GA or BWz. Within CR group, full term and early term neonates underwent surgery 20 (95%CI: -27.1, -14.1; p<0.001) and 15 days (95%CI: -22.1, -8.2; p<0.001) sooner than preterm neonates. BWz was not associated with surgical timing. A stratified analysis trended toward lower survival probability among preterm neonates undergoing CR vs. SR (p= 0.1). In a MV model including GA, BWz, surgical approach and DOL surgery, only GA was associated with the composite outcome. The odds of a poor outcome was 0.45 (95%CI:0.24,0.86) times lower in full term vs. preterm neonates, p= 0.02. The adjusted total burden of hospital days in the first year was 32 (95%CI: -47.7,-16.9; p<0.001) and 22 (95%CI: -36.5,-7.7; p= 0.003) days less in early term and full term compared to preterm neonates.

Conclusions:
In nTOF, GA and BWz were not associated with surgical strategy though premature neonates were more likely to wait longer for their initial intervention. One-year outcomes appear to be strongly influenced by GA and not surgical strategy; however, there was a trend to suggest that SR may result in better survival probability among premature neonates.
Abstract 10601: Transfusion Strategies in Patients with Acute Coronary Syndrome and Anemia: A Meta-Analysis
Authors: Nasir Usama , Waheed Tayyab Ali , Ahuja Keerat , Sandhu Charnjeet , Ameen Muhammad , Hope Earl J
Published: March 2022

Introduction:
Anemia is a known risk factor for ischemic heart disease, and serves as an independent predictor of Major Adverse Cardiovascular Events (MACE) in patients with Acute Coronary Syndrome (ACS). Three randomized clinical trials (RCTs) have compared a Liberal Transfusion Strategy (LTS) with a Restrictive Transfusion Strategy (RTS) in ACS. This meta-analysis pools data from these RCTs to better define Hb thresholds for transfusion in this setting.

Methods:
MEDLINE, EMBASE, and Cochrane databases were searched using the terms “Acute Coronary Syndrome” and “Blood Transfusion” including their synonyms. A total of 3 randomized control trials were included.Restrictive transfusion strategy (RTS) was defined as Hb less than or equal to 8 g/dl with post transfusion goal of 8 to 10 g/dl. Liberal transfusion strategy (LTS) was defined as Hb less than or equal to 10 g/dl with post transfusion goal of at least 11 g/dl. The primary end point was 30-day mortality. Secondary outcomes included recurrent ACS events, new or worsening CHF within 30 days, and MACE. The primary analytic method used was random effects model.

Results:
Out of 821 patients, 400 were randomized to LTS, and 421 to RTS. Mean age was 70.3 in RTS versus 76.4 in LTS. There was no statistically significant difference for 30-day mortality in LTS compared to RTS (Odds Ratio [OR] 1.69; 95% CI: 0.35 to 8.05). Similarly, there was no significant difference in MACE, (OR 0.74; 95% CI: 0.21 to 2.63), CHF (OR 0.82; 95% CI 0.18 to 3.76), and Acute coronary syndrome (OR 1.21; 95% CI 0.49 to 2.95).

Conclusions:
In the setting of ACS, there is no difference between LTS and RTS for the outcome of MACE and mortality at 30 days. The ongoing MINT trial (NCT02981407) will provide further evidence in identifying the appropriate transfusion threshold in patients with ACS.
Abstract 10607: Evaluating Diastolic Function by Echocardiography in a Prospective Cohort of Patients with Hodgkin (HL) and Non-Hodgkin Lymphoma (NHL) Who Received Anthracycline-Based Chemotherapy
Authors: Tawfiq Reema , Boddicker Nicholas , Quintero Martinez Juan , Cordova Sandra , Alam Md Mashiul , Cerhan James , Herrmann Joerg , Thompson Carrie A , Villarraga Hector R
Published: March 2022

Introduction:
Anthracyclines are a first-line chemotherapeutic agent used in the treatment of lymphoma. Myocardial injury can occur with cumulative doses of 250 to 350 mg/m
2
. Echocardiography is the imaging modality for identifying cardiac dysfunction; however, identifying diastolic changes in patients who received anthracyclines is not well represented in the literature. Variables used to identify diastolic dysfunction include lateral e’, medial e’, mitral E velocity, mitral A velocity, E/A, E/e’, and left atrial volume index (LAVI). This study aims to identify if diastolic abnormalities develop in a prospective cohort of patients with HL or NHL who received anthracycline-based chemotherapy.

Methods:
Lymphoma patients treated with anthracyclines from 2013 to 2020 were prospectively enrolled. Echocardiography was obtained at 3-time points: before the start of chemotherapy (T1), at 3-6 months (T2), and 9-12 months (T3). Diastolic variables were measured and analyzed based on the total cumulative dose of Doxorubicin per body surface area. Those that received greater than 250 mg/m
2
and greater than 300 mg/m
2
of Doxorubicin were compared to those that did not. Statistical analysis was done using one-way ANOVA, adjusting for age and gender.

Results:
151 total patients (90 males, mean age 61
+
16 years); 21 (14%) HL, 130 (85%) NHL. 114 and 66 patients received a total cumulative dose of Doxorubicin greater than 250 mg/m
2
and 300 mg/m
2
, respectively. There was no significant association with 250 mg/m2. Lateral e’ at T3 vs. T1, was lower in those that received greater than 300 mg/ m
2
compared to those received less (0.09 vs 0.10, p < 0.02) (Table 1).

Conclusions:
Lateral e’ decreased at 1-year follow-up in those that received higher doses of Doxorubicin. These changes in the lateral e’ could reflect early relaxation abnormalities related to anthracycline-based chemotherapy and suggest that changes in lateral e’ should be considered by itself since E/e’ was normal.
Abstract 10610: Schistosomiasis and Cardiovascular Disease in 1,000 HIV-Infected and Uninfected Tanzanian Adults: A Prospective Cohort Study
Authors: Kingery Justin , Bullington Brooke , Lee Myung Hee , Desdarius Bernard , Fadhil Salama , Kisigo Godfrey , Shigella Peter , Downs Jennifer , Peck Robert
Published: March 2022

Background:
Variations in immune phenotype are increasingly recognized as drivers of cardiovascular disease (CVD). For example, the inflammatory effect of HIV-infection is associated with a 2-fold higher risk of CVD. Conversely, schistosome infection induces an anti-inflammatory immune response, which may counter CVD pathways related to inflammation. Whether the immune regulatory effect of schistosome infection is sufficient to suppress the contrasting stimulatory effect of another disease such as HIV remains unknown and may provide critical insight into the immunologic basis of non-communicable diseases.

Methods:
In this prospective cohort study, we enrolled 1,000 HIV-infected and uninfected adults at a referral HIV clinic in a schistosome endemic area in Mwanza, Tanzania. Standardized history, echocardiography and serum were obtained. Blood pressure was monitored over two years. Regression models adjusted for age and sex were used to quantify associations.

Results:
We enrolled 503 schistosome infected and 497 uninfected adults with a median age of 36 [28- 43]. Schistosome infection was significantly associated with a lower prevalence of hypertension (39.6% vs 46.7%, p=0.016), myocardial diastolic dysfunction (8.1% vs 13.4%, p=0.015) and total-to-high density lipoprotein ratio (1.77 vs 1.82, p<0.0001) as compared to uninfected participants. Additionally, schistosome-infection was associated with significantly improved change in blood pressure over time (0.67 vs 3.35 mmHg increase, p=0.005). When stratified by concurrent HIV-infection, schistosome infection was associated with lower prevalence of diastolic dysfunction and total-to-HDL ratio in HIV- infected adults but lower prevalence of hypertension in those without HIV-infection.

Conclusions:
We provide the first evidence that schistosome infection may directly impact cardiac function and slow the age-related increase in blood pressure over time. Further, associations between schistosome and CVD differ by HIV status, implying that immune mediated interactions may have important physiologic ramifications for CVD. The patterns of these interactions may provide insight into the immunologic mechanisms of cardiovascular diseases.
Abstract 10616: HIV Infection and the Risk of Heart Failure Hospitalization and Mortality: A Systematic Review and Meta-Analysis of Cohort Studies
Authors: Qian Frank , Zhang Xuezhixing , Qian Han-Zhu , Alvi Raza , Erqou Sebhat , Chen Yuqing , Li Xianhong , Wang Honghong , Neilan Tomas , Zanni Markella V , Vermund Sten , Qian Frank
Published: March 2022

Introduction:
Incidence of heart failure (HF) is increased among individuals living with human immunodeficiency virus (HIV). Whether HIV adversely affects hospitalization and mortality rates among patients with diagnosed HF has not been systematically evaluated.

Hypothesis:
We hypothesized that HIV infection would increase the risk of hospitalization and all-cause mortality rates in patients with HF, independent of established risk factors.

Methods:
We performed a systematic search of PubMed, EMBASE, Cochrane Library and Web of Science through March 7
th
, 2021 for cohort studies conducted in adult patients (age≥18 years) with diagnosed HF and ascertainment of HIV infection at baseline. Outcomes assessed include all-cause mortality, HF-associated hospitalization, and all-cause hospitalization. All studies included multivariable adjustments for demographics, cardiovascular risk factors, and comorbidities. Pooled hazard ratio (HR) and 95% confidence intervals (CI) were calculated using a random-effects model.

Results:
We identified 7 studies consisting of 10,363 HF patients living with HIV and 48,933 HIV negative HF controls. HF patients with HIV had a higher risk of all-cause mortality compared to HIV-negative HF patients, HR (95% CI): 1.20 (1.14, 1.25),

I
2

=0%. Similarly, HIV infection was associated with increased risks of both HF-associated hospitalization and all-cause hospitalization, with HR (95% CI) of 1.31 (1.03, 1.65) and 1.27 (1.12, 1.44), respectively; though significant heterogeneity was observed for both of these outcomes,

I
2

=80% and 62%, respectively.

Conclusions:
HIV infection was independently associated with increased risk of all-cause mortality and both HF-associated and all-cause hospitalizations among individuals with HF. Our data may have important implications for HF management in this high-risk population.