bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15764: Evaluation of Pulmonary Hypertension World Health Organization Group II in the Perioperative Setting
Authors: Marak Martin , Tatum Danielle , Moraes Denzil
Published: May 2021

Introduction:
The World Health Organization (WHO) categorizes pulmonary hypertension (PHTN) into 5 groups. Group II classification denotes PHTN secondary to left-heart disease and accounts for nearly 75% of all cases. However, there is limited data regarding the effect of PHTN Group II status on outcomes in the perioperative setting.

Hypothesis:
PHTN WHO Group II is an independent risk factor for adverse cardiopulmonary events in the perioperative setting.

Methods:
Retrospective review of patients who underwent intra-abdominal surgery between January 2014 - August 2019 and had previously obtained an echocardiogram. PHTN Group II was defined as estimated pulmonary artery pressure (EPAP) > 30mmHg on echocardiogram . Other forms of PHTN were excluded. Major adverse cardiovascular events (MACE) were defined as heart failure exacerbation, arrhythmia, myocardial infarction, 30 day readmission, and death. Surgical risk was categorized as low (laparoscopic) or intermediate (open).

Results:
By echocardiogram findings, 65 of the 178 (36.3%) patients included were Group II PHTN. Between surgical risk classes, Group II PHTN was older (mean age 73.7 years v 60.5; P< 0.01), had more comorbidities including systolic (9.70% v 21.5%, P=0.03) and diastolic (22.1% v 34.5%, P < 0.01) heart failure, and were more likely to have a MACE ( 6.2% v 43.1%, P < 0.01). PHTN Group II patients with intermediate-risk surgeries demonstrated significantly more MACE than control (11.2% v 43.7%, P <0.01) without significant difference in comorbidities.

Conclusions:
Group II PHTN is an independent risk factor for MACE in patients undergoing intermediate risk surgery compared to non-PHTN counterparts. Additional studies involving severity of pulmonary hypertension may provide further insight into risk stratification.
Abstract 15768: Social Connectedness is Independently Associated With Cardiovascular Health
Authors: Ambeba Erica J , Sears Dorothy D , Benmarhnia Tarik , Natarajan Loki , Anderson Cheryl A , Zamora Steven , Jankowska Marta
Published: May 2021

Introduction:
Social connectedness (SC) is an important determinant of maintaining overall health, and the strength of connections with others may influence cardiovascular health (CVH) in part through improvement in cardiovascular disease risk factors. However, there is a lack of research on the role of SC in promoting CVH, as defined by the American Heart Association’s 2020 Impact Goals. The objective of this study is to determine the effect of SC on CVH among adults.

Hypothesis:
Higher SC will be associated with higher odds of optimal CVH, relative to inadequate CVH.

Methods:
Data are from the Community of Mine study, a cross-sectional study of 602 participants (42% Hispanic, 56% female, mean age 59 years) living in San Diego County. CVH was based on Life’s Simple 7 using six metrics including smoking, physical activity, body mass index, total cholesterol, blood pressure, and fasting glucose. A 12-point summary score was used to classify participants as having inadequate (0-6), average (7-8), or optimal (9-12) CVH. SC was assessed using a 7-item scale designed to assess social relationships and strength of connections with others (Cronbach’s alpha=0.92). A mean score across all items was generated. Multinomial logistic regression was used to estimate the association between SC and CVH. We adjusted for age, race/ethnicity, governmental cash assistance, income, education, sex, history of medical comorbidities, family history of heart disease, and depressive symptoms.

Results:
SC was independently associated with CVH (p=0.04). More specifically, a 1-unit increase in mean SC score was associated with a 46% increase in relative odds of having optimal CVH compared to inadequate CVH (OR=1.46, 95% CI: 1.07-1.98), and a 21% increase in relative odds of having average CVH compared to inadequate CVH (OR=1.21, 95% CI: 0.96-1.52).

Conclusions:
Higher social connectedness is associated with a greater likelihood of having optimal CVH. Individuals’ perceptions of the strength of their relationships could have cardioprotective benefits through promotion of favorable cardiovascular health behaviors and factors.
Abstract 15777: Induction Immunosuppression is Associated With a Lower Incidence of Post-transplant Diabetes Mellitus in Heart Transplant Recipients: A Propensity-adjusted Analysis
Authors: Gupta Suruchi K , Mostofsky Elizabeth , Li Wenyuan , Hage Ali , Motiwala Shweta R , Murray Mittleman Murray A
Published: May 2021

Introduction:
Post-transplant diabetes mellitus (PTDM) is a common complication among heart transplant recipients resulting in heightened risk of diabetes-related complications and death. While there is evidence that certain maintenance immunosuppression drugs like tacrolimus increase the risk of PTDM, it is not known whether induction immunosuppression does the same. We therefore evaluated whether induction immunosuppression in the early post-transplant period with IL-2 inhibitors, alemtuzumab or anti-thymocyte globulin is associated with PTDM after accounting for potential confounding by indication.

Methods:
Using data from the Scientific Registry of Transplant Recipients, we conducted a cohort study of 23,946 US adults who received a heart transplant in January 2008-December 2018. PTDM was defined as new diagnosis of diabetes at any time 6 months after transplant. We excluded patients with prior organ transplants and diabetes. We used logistic regression to construct propensity scores for predictors of induction immunosuppression and risk factors for PTDM including demographic, clinical and immunologic factors, pre-transplant therapies, steroids, functional status, and transplant year. We estimated the effect of induction immunosuppression in propensity-adjusted Cox proportional hazards models and produced fully adjusted Kaplan-Meier curves using inverse probability of treatment weights.

Results:
The average age was 54 (SD=12.5) years, 26% were female and 12,303 (51%) received induction immunosuppression. Over 84,969 person-years, 2,678 (11%) developed PTDM (32 cases/1,000 person-years). In the propensity-adjusted analysis, induction immunosuppression was associated with a 20% lower rate of PTDM (Figure 1; hazard ratio=0.80, 95% confidence interval 0.74-0.87).

Conclusions:
Adult heart transplant recipients who received induction immunosuppression had a 20% lower rate of PTDM compared to those who did not receive it.
Abstract 15778: The Impact of Health Insurance Status on Heart Transplant Recipients
Authors: Iqbal Mehreen , Zhang Yulin , Gonzales Selena , Dykes John , Almond Christopher S
Published: May 2021

Introduction:
Gaps in insurance coverage have been associated with diminished access to health care for children with chronic illness. Continuity of coverage is associated with improved long-term clinical outcomes among adolescent heart transplant (HT) recipients, but the relationship between insurance status and post-transplant outcomes has not been described across all pediatric HT recipients.

Hypothesis:
HT recipients with changes in insurance status will have worse outcomes as opposed to those with continuous coverage.

Methods:
We queried the United Network for Organ Sharing (UNOS) registry for patients age 0-18 receiving isolated HT or heart re-transplant between 2006 and 2019 and included them in the analysis if they survived at least one year post-transplant. Patients were categorized by insurance coverage at wait listing, HT, and one year follow-up. Cox proportional hazards models were used to characterize the association between coverage pattern and long-term patient survival.

Results:
Among the 3,247 patients in the analysis, insurance coverage patterns included continuous private (37%), continuous public (46%), gain of private (6%), and loss of private (11%). Patients who had continuous public insurance were more likely to be Black or Hispanic, adolescent, and require ICU care. In a multivariate Cox model, continuous public insurance was associated with increased mortality risk (HR = 1.46, P = 0.014), while loss of private insurance trended towards increased risk (HR = 1.14, P = 0.014). Figure 1 illustrates Kaplan-Meier conditional survival curves according to insurance trajectory. Multivariate sub-group analysis by Black race demonstrated no differences in outcomes by coverage pattern.

Conclusions:
In comparison to those with continuous private insurance, having continuous public insurance is associated with higher risk of adverse outcomes in pediatric HT recipients, but it does not account for disparate outcomes in Black patients.
Abstract 15780: The Utility of Exercise Stress Testing in the Evaluation of Ischemia Among Pediatric Patients With Exertional Chest Pain
Authors: Robles Nicholas , Upadhyay Shailendra
Published: May 2021

Introduction:
Exertional chest pain (CP) regularly prompts performing an exercise stress test (EST) out of concern for exercise-induced ischemia. We aimed to study the diagnostic utility of EST in the evaluation of ischemia among pediatric patients without previously diagnosed congenital heart disease (CHD) who present with exertional CP and to correlate EST results with available cardiac imaging findings.

Methods:
Retrospective chart review of all pediatric patients who underwent EST for exertional CP from Jan 2015 to Dec 2019 at our institution. Exercise stress test was performed on treadmill utilizing Bruce protocol. Analysis included demographic medical records and all available cardiac testing.

Results:
A total of 106 patients (56 males; 53%) were included. Cohort mean age, height, and weight were 15.1 ± 2.6 years (range: 7.3 - 19.6yr), 165 ± 12.7 cm, and 67.5 ± 26.2 kg. ST-T wave changes were noted in 8 patients (7.5%), 7 of which were non-specific and read as normal ESTs. One (0.94%) EST was suggestive of ischemic changes. His echocardiogram (echo) showed mild thickening of papillary muscles and ventricular septum. A follow-up exercise myocardial perfusion study showed no abnormality. Echo was performed on 86/106 (81%) patients. Of these, 23/86 (27%) had incidental abnormalities on echo; none contributed to the patients’ CP. Five patients (5/86; 5.8%) had notable coronary artery abnormalities on echo; all had normal ESTs. Two of these were confirmed by Cardiac CTA: 1) Left Main Coronary Artery (LMCA) arising from non-coronary cusp, and 2) dilated LMCA (Z-score 4.67) with slight dilation of Left Anterior Descending (Z-score 2.54). In the other 3 of 5 (
prominent LMCA, possible CA fistula, RCA with more leftward origin
) further coronary evaluations were not performed.

Conclusions:
Incidental non-specific echo abnormalities are common among pediatric patients who undergo EST for exertional CP. EST was negative in patients with coronary artery abnormalities. ESTs have a low yield in identifying cardiac abnormalities among pediatric patients without previously diagnosed CHD undergoing evaluation for exertional CP. Larger studies are needed to better evaluate the utility of EST in patients with coronary artery anomalies.
Abstract 15784: Left Ventricular Structural Remodeling and Cardiomyopathy in Duchenne Muscular Dystrophy Carriers
Authors: Lehrenbaum Hannah , Hieda Michinari , Cheeran Daniel , Bae Yunbeen , Ayers Colby , Araj Faris , Amin Alpesh , De Lemos James A , Drazner Mark H , Peshock Ronald M , Zaha Vlad G , LEVINE Benjamin D , Mammen Pradeep P
Published: May 2021

Introduction:
Duchenne muscular dystrophy (DMD) is an X-linked neuromuscular disorder. DMD-associated cardiomyopathy is the primary mode of premature death in the majority of male DMD patients, but the prevalence of cardiomyopathy and its clinical significance in female DMD carriers is less well characterized.

Hypothesis:
We hypothesized that a significant proportion of DMD carriers develop maladaptive left ventricular (LV) structural remodeling and cardiomyopathy over time.

Methods:
A cross-sectional study was undertaken comparing cardiac magnetic resonance imaging (cMRI) and cardiopulmonary stress test (CPX) parameters between DMD carriers and healthy age- and sex-matched controls from the Dallas Heart Study (DHS). Demographic data, cMRI parameters, and CPX parameters were collected retrospectively on 30 consecutive DMD carriers and 26 control DHS subjects.

Results:
Overall, DMD carriers had a significantly lower LVEF compared to DHS controls (58+8% vs 70+7%,
p<
0.0001). The overall prevalence of reduced LVEF in DMD carriers (defined as LVEF <60%) was 63% compared to 8% in DHS controls. The volumetric variables indexed to body surface area (LVEDVi and LVESVi) were significantly higher in DMD carriers compared to control subjects (72+14 ml/m
2
vs 58+7,
p<
0.0001; 31+10 ml/m
2
vs 17+5,
p<
0.0001; respectively). LV concentricity was also significantly lower among all DMD carriers compared to DHS controls (3.10+0.65 g/mL
0.67
vs 3.73+0.79,
p
=0.002). LV concentricity was significantly lower in DMD carriers with reduced EF compared to controls (3.09+0.51 g/mL
0.67
vs 3.73+0.79,
p
= 0.012), while DMD carriers with preserved EF also had reduced concentricity compared to controls (3.12+0.86 vs 3.73+0.79,
p
= 0.054). Finally, peak VO
2
was lower in DMD carriers compared to DHS controls (23+6 ml/kg/min vs 25+4,
p
=0.076), though this difference did not reach statistical significance.

Conclusions:
Collectively, the data suggest that middle-aged female DMD carriers are at greater risk of developing left ventricular systolic dysfunction and cardiomyopathy associated with decreased exercise capacity. A possible mechanism driving the development of this cardiomyopathy is progressive, maladaptive left ventricular dilatation and cardiac atrophy.
Abstract 15961: Multicenter Prospective Prevention of Sudden Death in High Risk Patients Utilizing Enhanced ACC/AHA Risk Model
Authors: Rowin Ethan J , Maron Martin S , Adler Arnon , Albano Alfred , Varnava Armanda , Leong Kevin , Heitner Stephen , Winters Stephen L , Martinez Matthew , Marsy Dana , Cohen Emilie , Spears Dana , Weissler Snir Adaya , Rakowski Harry , Maron Barry J
Published: May 2021

Introduction:
Strategies for reliable selection of high-risk hypertrophic cardiomyopathy (HCM) patients for prevention of sudden cardiac death (SCD) with implantable cardioverter-defibrillators (ICDs) continue to be debated.

Objective:
Assess the sensitivity of sudden death risk strategies in predicting SCD events (appropriate ICD shocks, sudden death or out of hospital cardiac arrest) among a large multicenter cohort of high-risk HCM patients.

Methods:
Observational longitudinal study from 6-HCM centers in North America and Europe to determine outcomes in consecutive HCM patients considered high risk for sudden death based on an enhanced ACC/AHA (U.S./Canada) guidelines-based risk factor algorithm with primary prevention ICD placement. ESC risk score was retrospectively calculated in this cohort and compared to ACC/AHA risk factor method for predicting SCD events.

Results:
Of 1185 patients with primary prevention ICDs implanted based on ≥ 1 major risk marker, 162 (14%) experienced device therapy terminating VT/VF episodes at 49 ± 18 years of age and 4.6 ± 4.2 years after device implant. Within the 6 HCM centers, only 28 other patients not implanted with ICD died suddenly or had resuscitated cardiac arrests, including 19 (68%) with risk-markers who declined ICDs. Of these 190 high risk patients with SCD or SCD events, 67 (35%) had ESC risk-scores scores ≥6%/5-years, considered sufficient to recommend a prophylactic ICD, while 83 (44%) had low risk scores (<4%/5-years) that likely would have excluded an ICD recommendation. Compared to enhanced ACC/AHA risk factors, the ESC risk-score was less sensitive than ACC/AHA (35% vs. 95%, p<0.01), consistent with identifying fewer high-risk patients with events.

Conclusion:
In this large multicenter study of high-risk HCM patients, an enhanced ACC/AHA risk factor strategy was superior to the ESC risk score in identifying patients at greatest risk for SCD events.
Abstract 15964: Improving the Care of Frail or Vulnerable Patients Undergoing Cardiac Surgery
Authors: Sarkar Shreya , MacLeod Jeffrey , Hassan Ansar , Brunt Keith , Légaré Jean-François
Published: May 2021

Background:
Increasingly frail/ vulnerable patients are undergoing cardiac surgery. The purpose of this study was,
Phase 1:
Create a hospital record-based Frailty Index (FI) to better quantify frailty in cardiac surgery &,
Phase 2:
Implement a novel Telehealth Home monitoring Enhanced- Frailty After Cardiac Surgery (THE-FACS) intervention to improve outcomes.

Methods:
Phase 1:
A 21clinical deficit-based retrospective FI was created using New Brunswick Heart Centre registry, patients grouped into terciles & evaluated for prolonged hospitalization, discharge disposition.
Phase 2:
Vulnerable patients were recruited prospectively to test the applicability of THE-FACS, which used a tablet device to monitor patient responses daily for 30 days. Trained cardiac surgery follow-up (F/U) nurses monitored the data & contacted patients only if the algorithm triggered an alert. Primary outcomes of interest were prolonged hospitalization, non-home discharge & hospital readmission.

Results:
Phase 1:
A FI was constructed with records from 3463 cardiac surgery patients. The most frail patients (n= 898, 26 %) had prolonged hospitalization (7 days vs. 5 days; p< 0.001), non-home discharge (49 % vs. 17 %; p< 0.001), higher 30 day readmission (18 % vs. 10 %; p< 0.001) & mortality (4.8 % vs. 0.7 %; p< 0.001). Multivariable analysis showed that FI was an independent predictor of composite outcome.
Phase 2:
Vulnerable patients (64 from 86 approached) were prospectively recruited, representing 34 % of potential surgeries (86/ 254). Several patients required prolonged hospitalization (15/ 64) or non-home discharge (12/ 64). THE-FACS was used in the remaining 35/ 64 patients. 21/ 35 patients completed the 30 day F/U, largely due to technical difficulties with the system. There were few ER visits (10 %) & no readmission, with THE-FACS being easy (100 %), satisfactory (95 %) & amenable to re-use (67 %).

Conclusions:
Our study highlights that frailty, affecting ~1/3
rd
of patients undergoing cardiac surgery, significantly impacts outcomes. Findings from our pilot, THE-FACS, support the feasibility of targeted interventions in some vulnerable patients. However, our results suggest frequent technical challenges & inability to use early in many patients due to delayed discharge.
Abstract 15974: Non-Invasive Myocardial Work Indices in Normal Adolescents: A Pilot Study
Authors: Pradhan Sarah , Mullikin Anna , Truong Vien T , Mazur Wojciech , Taylor Michael D , Tretter Justin T
Published: May 2021

Introduction:
Myocardial work may provide a different perspective on LV function and energy consumption. Its non-invasive assessment by echocardiography correlates with invasive measures and there are normal values established in adult patients. We aimed to establish normal values in a healthy adolescent population.

Methods:
Nineteen healthy subjects (mean age = 15 ± 2 years, 42% male) with normal echocardiograms were prospectively included. Brachial cuff blood pressure was obtained immediately following apical images in the supine position. Post-processing of echocardiograms with speckle tracking echocardiography and derivation of global myocardial work indices from LV pressure-strain loops was done using EchoPAC (General Electric, v203R73.0) (Figure 1).

Results:
Baseline demographics, echocardiographic measures and global myocardial work indices are reported in Table 1. The mean global work index is 1833 ± 278 mmHg with mean global work efficiency of 95 ± 1.3%. No gender difference in myocardial work indices are found (p>0.05 for all). Correlation between global work indices with age, systolic blood pressure, LV ejection fraction, and global longitudinal strain (GLS) are presented in Table 2.

Conclusions:
This is a pilot study to begin establishing normal adolescent indices of non-invasive myocardial work.

Figure 1.
Example
Abstract 16003: Genetic Variation Associated With Favorable Exercise Response in Patients With Systolic Heart Failure: A Hf-action Trial Substudy
Authors: Coles Sara , Giamberardino Stephanie , Haynes Carol , She Ruicong , Gui Hongsheng , Kraus William E , Lanfear David E , Shah Svati H
Published: May 2021

Background:
Exercise has shown benefit in patients with systolic heart failure, including in the clinical trial Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION). There is heterogeneity in who derives benefit from exercise, and the biologic mechanisms of favorable response to exercise in systolic heart failure are not well understood.

Hypothesis:
Genetic variation is an underlying factor influencing heterogeneity in response to exercise in patients with systolic heart failure.

Methods:
The HF-ACTION trial randomized individuals with systolic heart failure (left ventricular ejection fraction <35%) to supervised exercise versus usual care. In this study, we performed a genome wide association study (GWAS) in the HF-ACTION biorepository using the Axiom Biobank1 genotyping array (13,403,591 single nucleotide polymorphisms [SNPs] after quality control on directly genotyped and 1000 genomes imputed data), in N=377 study subjects who completed the supervised exercise arm. Using change in peak VO2 as our outcome, we ran within-ancestry GWASes, modeling SNP effects as both additive and dominant, and conducted across-ancestry meta-analysis within each genetic model.

Results:
Five loci met genome-wide significance in the European ancestry analyses, 5 loci in the African ancestry, and 8 in the meta-analyses. The two most significantly associated loci across both additive and dominant meta-analysis models were rs111577308 located in the histone acetylation for transcription elongator complex 3 gene (
ELP3,
p=1.212x10
-9
) and rs75444785 located in the phosphodiesterase 4D gene (
PDE4D
, p=1.565x10
-9
). ELP3 is responsible for histone modifications related to DNA transcription factor complexes, and PDE4D is involved in cyclic AMP cell signaling.
In silico
analysis of these loci showed that they are in linkage with regions associated with skeletal muscle and peripheral vascular disease phenotypes.

Conclusions:
Using a genome-wide association study in a well-phenotyped clinical trial of exercise in systolic heart failure, we found common genetic variants in genes involved in DNA transcription histone modification and cyclic AMP cell signaling that are associated with a more favorable response to exercise.
Abstract 16013: Evidence for Improvement in NYHA Class and Freedom From Hospitalization in Bariatric Surgery Patients With an Established Diagnosis of Heart Failure
Authors: Foster Michael W , Badenhausen Sara E , Tewksbury Colleen , Williams Noel N , Rame J Eduardo , Dumon Kristoffel
Published: May 2021

Introduction:
Heart failure patients with severe obesity endure significant morbidity and frequent hospitalizations. Bariatric surgery is proven to provide durable weight loss for those with severe obesity, but the clinical impact and safety of these procedures among patients with heart failure has not been well-demonstrated.

Methods:
We conducted a medical record query of patients who have a previous diagnosis of heart failure (HFpEF and HFrEF) and underwent subsequent Roux-En-Y gastric bypass or laparoscopic sleeve gastrectomy at a high-volume metabolic and bariatric surgery center. We compared clinical, demographic, and echocardiographic data captured just prior to the bariatric procedure to the most recent data available in the medical record for each patient.

Results:
There were 50 patients (88% had HFpEF) included in this study. Time from HF diagnosis to most recent follow-up ranged from 0.2 to 20.3 years (median 6.7 years) and there was no recorded mortality. The median time from HF diagnosis to surgery was 2.3 years and median time from surgery to recent follow-up was 2.9 years. Post-operative median decrease in BMI was 8.8 kg/m
2
, HF hospitalizations were 0.4 per patient year (PPY) to 0.15 PPY, p=0.008, and median NYHA Class was II pre-op and I post-op, p=0.048). LVEF, LVESD, and LVEDD were not significantly changed post-operatively (Table 1).

Conclusion:
Weight loss following bariatric surgery for patients with HF led to improvements in NYHA Class, fewer hospitalizations for HF, and was not associated with perioperative mortality. It is reasonable to consider bariatric surgery for this patient population, but further prospective investigation is warranted.
Abstract 16029: Patient Prosthesis Mismatch Post Transcatheter Aortic Valve Replacement is Associated With Lack of Improved Left Ventricular Diastolic Function
Authors: Ramesh Ashvita , Peters Andrew C , Gong Fei Fei , Jankowski Madeline , Cantey Eric , Chen Vincent , Thomas James D , Malaisrie S , Flaherty James , Maganti Kameswari
Published: May 2021

Background:
Patient prosthesis mismatch (PPM) is a frequent problem after transcatheter aortic valve replacement (TAVR) that results in adverse cardiac remodeling. This study sought to evaluate the association between PPM and changes in diastolic function post-TAVR.

Methods:
339 patients (79.3+8.8 y, 44.4% female) who underwent TAVR for severe aortic stenosis between 2015-2018 with an echocardiogram (echo) at baseline and at 1-year were studied. Echo measurements were performed according to ASE guidelines. Moderate PPM is defined by an indexed effective orifice area (iEOA) of <0.85 to >0.65 cm
2
/m
2
, and severe PPM by an iEOA <0.65 cm
2
/m
2
. The aortic valve acceleration to ejection time ratio (AT/ET) was measured to further stratify patients with PPM and considered abnormal if >0.35. Student’s t-tests were used to compare diastolic function at baseline and 1-year.

Results:
We found that 26.2% of subjects had moderate PPM, 11.8% had severe PPM, and 8.3% had an AT/ET >0.35 (Table 1). Tissue velocity at both the medial and lateral mitral annulus was reduced at baseline and did not improve. Left atrial pressure (LAP) as assessed by E/e` improved in those without PPM (19.5+9.5 to 18.8+9.6, p=0.04) and those with moderate PPM (21+12.2 to 18.2+6.9, p=0.03), but not in those with severe PPM or with AT/ET>0.35. Right ventricular systolic pressure (RVSP) decreased significantly in patients with no or moderate PPM (39.6+13.6 mmHg to 35.5+10.8 mmHg, p=0.02 and 41.2+13.9 mmHg to 36+10.8 mmHg, p=0.006; respectively), while there was no significant decrease for patients with severe PPM or with AT/ET>0.35.

Conclusion:
We found that in patients undergoing TAVR, diastolic function was impaired as evidenced by low mitral tissue velocities, elevated LAP, and elevated RVSP. PPM resulted in less improvement of diastolic parameters including no improvement in LAP and RVSP. These findings suggest that severe PPM has an adverse effect on cardiac remodeling.
Abstract 16041: Examining the Nocebo Effect of Statins Using Statin Adverse Events Reported in the FDA Adverse Event Reporting System
Authors: Moon Jungyeon , Cohen Sedgh Robert , JACKEVICIUS Cynthia
Published: May 2021

Introduction:
Comparison of blinded and nonblinded statin trials have confirmed a nocebo effect, most commonly presenting as subjective muscle and nervous system adverse events (AEs). This study evaluated whether the increase in reported statin AEs over time was associated with the nocebo effect by comparing nocebo-related subjective with objective AEs.

Method:
A retrospective cohort study was conducted using the FDA Adverse Event Reporting System (FAERS) of statin-associated AEs from 1/2010-12/2019. Statins selected for analysis were atorvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin. Subjective AEs included fatigue, subjective muscular, and nervous system AEs. Objective AEs were hepatic and objective muscular AEs. We compared the number of subjective and objective AEs using Mann-Whitney U, and evaluated the association between AEs and gender and country using linear regression. Quantitative detection of signals was estimated using reporting odds ratio (ROR). Institutional Review Board review was exempt since we used de-identified public data.

Results:
Of 2,994,487 statin AE reports, more subjective than objective AEs were reported per quarter (mean ± SD: 4777 ± 1375.45 vs 999 ± 276.95; p<0.0001). Simvastatin-associated reports showed signals for higher objective muscular AEs relative to all other statins (ROR 1.53, 95% CI: 1.49-1.58). Females reported more subjective AEs than males per quarter (fatigue 86.98, p=0.035; subjective muscular AE 417.95, p<0.0001; nervous system AE 273.60, p<0.0001), but fewer objective muscular AEs (-125.23, p<0.0001). More subjective AEs and fewer objective AEs were reported in the US relative to other countries per quarter (p<0.0001).

Conclusion:
This study found that significantly more subjective than objective AEs are reported for statins. Subjective statin AEs, potentially related to the nocebo effect are reported more often by females than by males, and in the US than in other countries.
Abstract 16066: Genomic Autopsy of 103 Sudden Deaths in the Young Reveals the Importance of Cardiomyopathy Genes and Non-Mendelian Risk
Authors: Webster Gregory , Puckelwartz Megan , Pesce Lorenzo , Lisa Dellefave-Castillo , Vanoye Carlos , Page Patrick , Kearns Samuel D , Pottinger Tess , White Steven M , Arunkumar Ponni , Olson Rachael , Kofman Amber , Ibrahim Nora , Ing Alexander , Brew Casey , Yap Kai Lee , Kadri Sabah , George Alfred L , McNally Elizabeth M
Published: May 2021

Introduction:
Genetic testing after sudden death in the young can identify pathogenic cardiac gene variants.

Hypothesis:
Genomic methods, coupled with phenotype evaluation, reveal non-Mendalian risks.

Methods:
We conducted clinical analysis and whole genome sequencing on 103 decedents aged 1-40 (mean age at death 23.7 years) accrued prospectively from 2015 to 2019 across 22 states. Postmortem pathological findings were classified as: known cardiac disorders, findings of uncertain significance (FUS), or sudden unexplained death (SUD, indicating no postmortem pathological diagnosis). Parental DNA and clinical data were obtained where possible. Variants were classified by an independent clinical genetic laboratory.

Results:
Among the 103 decedents, 34 had a postmortem clinical diagnosis, 23 had FUS, and 46 were classified as SUD. Pathogenic/likely pathogenic (P/LP) variants in arrhythmia or cardiomyopathy genes were identified in 17 (16.5%) decedents. The distribution of P/LP variants was not associated with age at death (OR 1.01 [0.97, 1.05], p=0.54); however, a multivariable analysis including decedent phenotype, ancestry and sex demonstrated that younger decedents had a higher burden of curated P/LP/VUS variants (effect size -1.5, p=0.0019). DNA from 31 parent-decedent trios and 14 parent-decedent dyads revealed 9 transmitted P/LP variants and 1
de novo
P/LP variant. More than half of parents transmitting a P/LP variant (5/9) did not have clinical findings associated with the genotype.

Conclusions:
Whole genome sequencing effectively revealed P/LP variants in cases of sudden death in the young, implicating both arrhythmia and cardiomyopathy genes. In addition, both genotype and phenotype analyses suggest additional non-Mendelian risk mechanisms.
Abstract 16067: Unique Challenge of Acs - Anomalous Left Main Coronary Artery From Right Coronary Cusp
Authors: Nadadur Srinivas , Oranefo Justice , Adeel Muhammad , Khaddr Mansour , Mosleh Wassim
Published: May 2021

Introduction:
Anomalous aortic origin of coronary arteries (AAOCA) is uncommon congenital anomalies of the coronary circulation. Anomalous left main coronary artery (LMCA) originating from the right cusp is one of the rarer anomalies (incidence ~ 0.03% of patients undergoing coronary angiography). Mostly asymptomatic, however, this may become clinically significant with symptoms ranging from atypical chest discomfort to sudden cardiac death. We present a case of anomalous origin LMCA from the right coronary cusp.

Case presentation:
A 47-year-old female presented to the ED with three days of substernal chest pressure at rest. BP 106/71 mmHg, pulse 72 bpm, normal regular heart sounds, and clear lungs. The ECG showed new anterolateral T-wave inversions. Troponin-I was 0.31 ng/ mL. Echocardiogram showed normal LVEF without focal wall motion abnormalities. Coronary angiography revealed a dominant patent RCA without any disease. LMCA originated from the right coronary cusp with focal 90% ostial LAD stenosis. The rest of the coronary tree was free of disease. CABG with LIMA to LAD and SVG to OM1 was performed.

Discussion:
AAOCA presents a unique challenge to diagnosis and management. CT coronary angiogram or magnetic resonance angiography is recommended for more accurate delineation of the course of the coronary vessel. The diagnostic challenge to effectively engage the anomalous artery and to obtain coronary angiogram to delineate anatomy is critical in further management. As seen in our case, this is easy to overlook and in the acute event could lead to unnecessary delay.
Abstract 16084: Relationship Between Diastolic Interventricular Septal Flattening and Prognosis in Patients With Severe Tricuspid Regurgitation
Authors: Taku Omori , Uno Goki , Shimada Shunsuke , Shiota Takahiro
Published: May 2021

Introduction:
Diastolic interventricular septal flattening is one of the major findings in patients with severe tricuspid regurgitation (TR). However, the relationship between diastolic interventricular septal flattening and outcome in patients with severe TR is not fully understood. This study aimed to investigate the impact of diastolic interventricular septal flattening on cardiac events in patients with severe TR.

Methods:
We retrospectively reviewed patients who underwent 2 dimensional echocardiography and were diagnosed as severe TR in 2014. Eccentricity index in end-diastole (EI-ED) was measured as septal wall configuration (Figure). Cardiac events investigated as endpoints were cardiac death and heart failure (HF) admission.

Results:
376 patients were diagnosed as severe TR. We excluded 15 patients on mechanical respiratory support during echocardiography and 20 with missing data of clinical information. Remaining 341 severe TR patients (75 ± 16 years, 191 (56%) female) were investigated in this study.232 (68%) patients showed abnormal EI-ED (defined as over 1.0). During a follow-up period (median, 183 days; range. 40 to 983 days), 119 (34%) patients experienced cardiac events (29 cardiac death and 90 HF admission). By the Cox proportional hazard model, the presence of abnormal EI-ED and right atrial pressure (RAP) elevation on echocardiography (defined as more than 8mmHg) were independent predictors for cardiac events with a hazard ratio of 2.71 (95% Confidential interval (CI), 1.25 to 5.86; p=0.011) and of 3.02 (95%CI, 1.08 to 8,47; p=0.036) respectively. The Kaplan-Meier curves showed that severe TR patients with abnormal EI-ED and RAP elevation were at higher risk for cardiac event (Figure).

Conclusions:
The presence of abnormal EI-ED is an important predictor for cardiac events in patients with severe TR. The presence of abnormal EI-ED and RAP elevation can be a potential surrogate marker of advanced therapy for severe TR.
Abstract 16120: The Utilization of Neutrophil-lymphocyte Ratio and Platelets-lymphocyte Ratio as Prognostic Markers for Coronary Artery Disease in Person Living With Human Immunodeficiency Virus
Authors: Farouji Iyad , Chan Kok Hoe , Silm Jihad
Published: May 2021

Background:
Coronary artery disease (CAD) has emerged as an important cause of death in PLWH. T-lymphocyte cells has been shown to regulate the inflammatory response and have an inhibitory effect on atherosclerosis. NLR and PLR has been studied as severity prediction for CAD. However, to our knowledge, there were no studies to date that identify the relationship of NLR and PLR with CAD severity and outcome in PLWH. The aim of the study is to determine if NLR and PLR can be used as independent predictors of CAD severity in PLWH in our population in the United States.

Methods:
A retrospective cohort study of PLWH 18-year-old who underwent cardiac percutaneous coronary intervention was conducted between 2010 and December 2019. Their demographic, clinical and biochemical characteristics were extracted from the electronic medical record. Univariate and multivariate analysis were employed to identify the markers that can be used to predict CAD severity in PLWH. The study end point was number of coronary artery stenosis (85%) vessels involved.

Results:
A total of 74 PLWH were included in this retrospective cohort study. The median age was 60 years old (range from 30 to 79 years old). The male to female ratio was 2:1 (49 males and 25 females). As for ethnicities, 59 (80%) were African American, 9 (12%) were Caucasian and 6 (8%) were Hispanics. Comorbidities present in 64 patients (86%), with hypertension being the most common (77%), followed by CKD/ESRD (39%), diabetes mellitus (27%) and dyslipidemia (24%). Smoking and alcohol use were reported in 56 (76%) and 23 (31%) patients respectively. Female gender (p=0.042), higher triglycerides (r=0.29; p=0.014), history congestive heart failure (p=0.041) and higher CD4/CD8 ratio (r=0.30; p=0.011) were significantly correlated with greater number of coronary artery vessels involved. NLR (p=0.205) and PLR (p=0.567) are otherwise not significant. In multivariate analysis, NLR (odds ratio [OR] 1.553; 95% confidence interval [CI], 0.928-3.611), PLR (OR 0.997, CI 0.983-1.011) and CD4/CD8 ratio (OR 0.676, CI 0.042-1051) were not independently associated with the severity of CAD.

Conclusion:
This cohort study demonstrated that there is no relationship between the NLR and PLR with the severity of CAD in PLWH in our population in USA.
Abstract 16123:
In Vitro
Valve-on-chip Platform to Assess the Effects of Hemodynamic and Mechanical Stimuli on Early Calcific Disease Progression
Authors: Tandon Ishita , Gish Cody , Sturdivant Nasya , Ozkizilcik Asya , Dunn Celeste , Devisetty Ravishankar Prashanth Balaji , Balachandran Kartik
Published: May 2021

Introduction:
Calcific aortic valve disease (CAVD) involves mechanical stress, endothelial dysfunction, matrix remodeling, and mineral deposition. Complex mechanical and hemodynamic environment around the valve closely affects its function, biology, and disease. However, the exact role of these forces in regulating cellular dysfunction during disease initiation is yet to be elucidated.

Methods and Results:
We developed a 3D valve-on-chip (VOC) model that encompasses cell-cell and cell-matrix interactions, flow shear stresses and cyclic strains, better mimicking the native valve. The multilayered VOC construct was built in house using photolithography and soft lithography and a silicon based polymer (Fig.1A). Valve endothelial cells (VECs) are seeded in a monolayer on a porous PDMS membrane (Fig.B) which separates the VECs from the a matrigel-collagen semi interpenetrating hybrid gel housing valve interstitial cells (VICs) (Fig.3C). We simulated either static or 20% (pathological) strain under quiescent or osteogenic conditions. Osteogenic VICs demonstrated nodule formation (Fig.1D) and had reduced redox ratios in 20% stretch conditions suggesting disease progression (Fig.1E,F). Effect of mechanical and hemodynamic forces on structure, function, and phenotypic changes in VECs and VICs particularly during disease initiation will be further assessed.

Conclusions:
This VOC model for VEC-VIC co-culture better mimics the native valve environment and can be used to study the early disease mechanisms. The VOC platform can be used as a drug testing tool and aid in development of treatment strategies through efficient employment in the laboratory. Further exploring the effect of mechanical and hemodynamic forces may reveal mechanosensitive signaling cascades involved in disease progression, which can be targeted for CAVD therapeutics.
Abstract 16135: Higher Body Mass Index in Early Childhood is Associated With Adult Obesity in Patients With a Fontan Circulation
Authors: Chadayammuri Anjali P , ALSAIED Tarek , Powell Adam W , Wittekind Samuel G , Cnota James , Opotowsky Alexander R , Lubert Adam M
Published: May 2021

Introduction:
Obesity is associated with comorbidities that may be detrimental to single-ventricle patients who have had a Fontan procedure. We assessed the prevalence of obesity in adults with a Fontan circulation and evaluated the hypothesis that higher body mass index (BMI) in early childhood is associated with obesity in adulthood.

Methods:
Retrospective cohort study of patients with a Fontan circulation aged 18-32 years, seen 2011-2019. Those with an atriopulmonary Fontan or chromosomal abnormality known to affect growth were excluded. Historical height and weight measurements, results of recent cardiac testing, and body mass index (BMI) over time were recorded. Obesity was defined as BMI ≥30 kg/m
2
. The associations between childhood anthropometrics, adult BMI, and most recent cardiac testing were assessed.

Results:
The cohort included 113 adults with a Fontan circulation (median age 22.7 [IQR 20.2-26.4] years; 44% female). There were no significant differences in age, age at Fontan, Fontan type, or ventricular morphology between obese (n=21, 19%; 52% female) and non-obese (n=92, 81%; 41% female) patients. Compared to non-obese adults, obese patients had higher BMI percentiles at age 2 years (80
th
[33-95] vs 43
rd
[13-82] percentile, p=0.02), at age 4 years (90
th
[73-93] vs 57
th
[22-81] percentile, p=0.002), and at the time of the Fontan procedure (85
th
[51-98] vs 20
th
[5-57] percentile, p=0.002). Being overweight at time of Fontan (BMI percentile >85%) strongly predicted later obesity (OR=18.3, 95% CI 3.7-90.3, p<0.001). Obese adults had lower peak VO
2
(19.1±5.2 vs 25.5±6.6 mL/kg/min, p<0.001,) a trend to a lower % predicted VO
2
(59±13 vs 65±14% predicted, p=0.06), higher systolic blood pressure (121±17 vs 112±12 mmHg, p=0.007) and higher ventricular end-diastolic pressure (11±4 vs 9±3 mmHg, p= 0.03). Adult BMI weakly correlated with ventricular end-diastolic pressure (r=0.24, p=0.048).

Conclusions:
Higher BMI in early childhood is associated with obesity in adults with a Fontan circulation. Adult obesity is associated with worse exercise capacity, higher blood pressure, and higher ventricular end-diastolic pressure. Weight interventions in children with a Fontan circulation may help prevent later obesity and its adverse consequences.
Abstract 16137: Cardiac Implantable Devices Identification Based on Chest-x-rays Using Machine Learning Algorithms
Authors: Melendez Dorys A C , Lowey Seth , Dastmalchi Lily N , Nguyen Tran , Adam Gina , Mercader Marco
Published: May 2021

Introduction:
High-quality care of patients with Cardiac Implantable Electronic Devices, involves early identification of device manufacturer, which leads to timely interrogation using specific programmers. Pacemaker ID is a phone application that aims to identify the manufacturer of pacemakers and defibrillators from a chest X-Ray image. The app utilizes machine learning, including autonomous learning software leading the algorithm to improve over time. Our study aims to investigate the accuracy of the Pacemaker ID app at detecting the manufacturer of cardiac implantable electronic devices

Methods:
A total of 200 consecutive x-rays were collected from a two year period at The George Washington University in Washington DC and Centro Medico Hospital in Honduras. Chest X-Rays with implanted devices were scanned using the app. The device manufacturer was recorded from the initial operative report

Results:
The dataset included 146 Medtronic, 23 Boston Scientific, 24 St. Jude and 7 Biotronik devices. The app has a weighted average precision of 85.5%, recall of 73% and F1-score of 77.28%. Dataset accuracy 73%. Medtronic had the most precise prediction at 95.5%, while Biotronik only had 15.2% precision. Boston Scientific had the best recall at 87%. Medtronic, the most abundant in the dataset, showed a high recall of 72% and a very high precision of 95.5%. The F1-score, where Medtronic score the highest with 82%. Biotronik has a low F1-score, at 25% due to the low precision of estimates, particularly because 17% of the Medtronic images were wrongly identified as Biotronik

Conclusions:
The PacemakerID application was found to have a 73 % overall accuracy in identifying devices. It has the potential to expedite the interrogation process in hospital settings and improve the quality of care among patients with cardiac devices. Taking into account the following limitations: device model, camera type and image quality
Abstract 16139: A Targeted Proteomic Approach to Identify Circulating Biomarkers of Heart Failure Risk in Patients With Type 2 Diabetes Mellitus in DECLARE-TIMI 58
Authors: Berg David , Wiviott Stephen D , RAZ Itamar , Kamanu Frederick , Im KyungAh , Cahn Avivit , Mosenzon ofri , Bhatt Deepak L , Jarolim Petr , Leiter Lawrence A , McGuire Darren K , WILDING JOHN , Huo Yong , Lopez-sendon Jose L , Ardissino Diego , Gause-nilsson Ingrid A , Sabatine Marc S , Morrow David A
Published: May 2021

Background:
Patients (pts) with type 2 diabetes mellitus (T2DM) are at increased risk of heart failure (HF); however, the underlying mechanisms by which T2DM contributes to HF are incompletely understood.

Hypothesis:
We aimed to identify biological pathways associated with risk of hospitalization for HF (HHF) in a well-characterized cohort with T2DM followed for a median of 4.2 yrs.

Methods:
DECLARE-TIMI 58 was a randomized trial of dapagliflozin in pts with T2DM. We performed a nested case-control study of 184 candidate biomarkers (Olink CV II and CV III) in pts hospitalized for HF (n=432) and controls matched on age, sex, prior HF, prior CV disease, and f/u time (n=432). We evaluated associations between baseline biomarkers and HHF using logistic regression with a stringent threshold for significance (Bonferroni). Biomarkers were ranked according to Wald χ
2
values. ORs for the top 10 biomarkers were further adjusted for the components of the TIMI Risk Score for HF in Diabetes (AF, UACR, eGFR, CAD). ORs are per 1-SD.

Results:
45 biomarkers were significantly associated with HHF. The 10 strongest associations were seen with N-terminal pro-B type natriuretic peptide (NT-proBNP), B type natriuretic peptide (BNP), spondin-1 (SPON1), insulin-like growth factor-binding protein 7 (IGFBP7), interleukin-6 (IL-6), fibroblast growth factor-23 (FGF-23), transferrin receptor protein 1 (TR), metalloproteinase inhibitor 4 (TIMP4), matrix metalloproteinase-2 (MMP-2), C-X-C motif chemokine 16 (CXCL16) (
Fig
). All 10 biomarkers were significantly associated with HHF both in pts with and without a history of HF. These proteins represent pathobiological axes implicated in hemodynamic stress, inflammation, myocardial hypertrophy, and cellular senescence, among others.

Conclusions:
A targeted proteomic approach identified established (NT-proBNP, BNP), investigational (IGFBP7, FGF-23, IL-6, TR, TIMP4, MMP-2, CXCL16), and novel (SPON1) biomarkers of HHF in pts with T2DM.