bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Sex on Outcomes of Mechanical Thrombectomy in Basilar Artery Occlusion: A Multicentre Cohort Study
Authors: Tan Benjamin Y.Q. , Siow Isabel , Lee Keng Siang , Chen Vanessa , Ong Natalie , Gopinathan Anil , Yang Cunli , Bhogal Pervinder , Lam Erika , Spooner Oliver , Meyer Lukas , Fiehler Jens , Papanagiotou Panagiotis , Kastrup Andreas , Alexandrou Maria , Zubel Seraphine , Wu Qingyu , Mpotsaris Anastasios , Maus Volker , Andersson Tommy , Gontu Vamsi , Arnberg Fabian , Lee Tsong-Hai , Chan Bernard , Teoh Hock Luen , Seet Raymond C.S. , Sharma Vijay , Yeo Leonard L.L.
Published: April 2022

Introduction: Identifying differences in outcome of basilar artery occlusion (BAO) between males and females may be useful in aiding clinical management. Recent studies have demonstrated widespread underrepresentation of women in acute stroke clinical trials. This international multicentre study aimed to determine sex differences in outcome after mechanical thrombectomy (MT) for patients with acute BAO. Methods: We performed a retrospective analysis of consecutive patients with BAO who had undergone MT in seven stroke centres across five countries (Singapore, Taiwan, United Kingdom, Sweden, and Germany), between 2015 and 2020. Primary outcome was a favourable functional outcome measured by a modified Ranking Scale (mRS) of 0–3 at 90 days. Secondary outcomes were mRS 0–3 upon discharge, mortality, symptomatic intracranial haemorrhage (sICH) and subarachnoid haemorrhage (SAH). Results: Among the 322 patients who underwent MT, 206 (64.0%) patients were male and 116 (36.0%) were female. Females were older than males (mean ± SD 70.9 ± 14.3 years vs. 65.6 ± 133.6 years; p = 0.001) and had higher rates of atrial fibrillation (38.9% vs. 24.2%; p = 0.012). Time from groin puncture to reperfusion was shorter in females than males (mean ± SD 57.2 ± 37.2 min vs. 71.1 ± 50.9 min; p = 0.021). Despite these differences, primary and secondary outcome measures were similar in females and males, with comparable rates of favourable 90-day mRS scores (mean ± SD 46 ± 39.7 vs. 71 ± 34.5; OR = 1.20; 95% confidence interval [CI] = 0.59–2.43; p = 0.611), favourable discharge mRS scores (mean ± SD 39 ± 31.6 vs. 43 ± 25.9; OR = 1.38; 95% CI = 0.69–2.78; p = 0.368) and in-hospital mortality (mean ± SD 30 ± 25.9 vs. 47 ± 22.8; OR = 1.15; 95% CI = 0.55–2.43; p = 0.710. Rates of complications such as sICH (mean ± SD 5 ± 4.3 vs. 9 ± 4.4; OR = 0.46; 95% CI = 0.08–2.66; p = 0.385) and SAH (mean ± SD 4 ± 3.4 vs. 5 ± 2.4; OR = 0.29; 95% CI = 0.03–3.09; p = 0.303) comparably low in both groups. Conclusion: Females achieved comparable functional outcomes compared with males after undergoing MT for BAO acute ischemic stroke.
Adult Height of Patients with SHOX Haploinsufficiency with or without GH Therapy: A Real-World Single-Center Study
Authors: Dantas Naiara C.B. , Funari Mariana F.A. , Vasques Gabriela A. , Andrade Nathalia L.M. , Rezende Raíssa C. , Brito Vinicius , Scalco Renata C. , Arnhold Ivo J.P. , Mendonca Berenice B. , Jorge Alexander A.L.
Published: April 2022

Introduction: Isolated SHOX haploinsufficiency is a common monogenic cause of short stature. Few studies compare untreated and rhGH-treated patients up to adult height (AH). Our study highlights a growth pattern from childhood to AH in patients with SHOX haploinsufficiency and analyzes the real-world effectiveness of rhGH alone or plus GnRH analog (GnRHa). Methods: Forty-seven patients (18 untreated and 29 rhGH-treated) with SHOX haploinsufficiency were included in a longitudinal retrospective study. Adult height was attained in 13 untreated and 18 rhGH-treated (rhGH alone [n = 8] or plus GnRHa [n = 10]) patients. Results: The untreated group decreased height SDS from baseline to AH (−0.8 [−1.1; −0.4]), with an increase in the prevalence of short stature from 31% to 77%. Conversely, the rhGH-treated group had an improvement in height SDS from baseline to AH (0.6 [0.2; 0.6]; p < 0.001), with a reduction in the prevalence of short stature (from 61% to 28%). AH in the rhGH-treated patients was 1 SD (6.3 cm) taller than in untreated ones. Regarding the use of GnRHa, the subgroups (rhGH alone or plus GnRHa) attained similar AH, despite the higher prevalence of pubertal patients and worse AH prediction at the start of rhGH treatment in patients who used combined therapy. Conclusion: The use of rhGH treatment improves AH in patients with SHOX haploinsufficiency, preventing the loss of height potential during puberty. In peripubertal patients, the addition of GnRHa to rhGH allows AH attainment similar to the AH of patients who start rhGH alone in the prepubertal age.
Identification of Survival-Related Metabolic Genes and a Novel Gene Signature Predicting the Overall Survival for Patients with Uveal Melanoma
Authors: Guo Xiaoyu , Yu Xin , Li Fang , Xia Qinyun , Ren He , Chen Zhen , Xing Yiqiao
Published: April 2022

Introduction: Uveal melanoma (UM) is the most common primary intraocular malignancy among adults. Altered metabolism has been shown to contribute to the development of cancer closely, but the prognostic role of metabolism in UM remains to be explored. This study aimed to construct a metabolic-related signature for UM. Method: We collected the mRNA sequencing data and corresponding clinical information from The Cancer Genome Atlas and Gene Expression Omnibus databases. A univariate Cox regression analysis, the Lasso-penalized Cox regression analysis, and multivariate Cox regression analyses were used to construct a metabolic signature based on TCGA. The time-dependent ROC and Kaplan-Meier survival curves were calculated to validate the prognostic ability of the signature. The immune-related features and mutation profile were characterized by CIBERSORT and maftools between high- and low-risk groups. Result: A novel metabolic-related signature (risk score = −0.246*SLC25A38 − 0.50186*ABCA12 + 0.032*CA12 + 0.086*SYNJ2) was constructed to predict the prognosis of UM patients. In TCGA and GSE22138, the signature had high sensitivity and specificity in predicting the prognosis of UM patients (survival probability; p < 0.0001, p = 0.012) . Gene Ontology pathway enrichment analysis and GSEA were used to discriminate several significantly enriched metabolism-related pathways, including channel activity and passive transmembrane transporter activity, which may reveal the underlying mechanisms. The high-risk group had more immune cell infiltration and greater distribution of BAP1 mutations. Conclusion: Our study developed a robust metabolic-gene signature based on TCGA to predict the prognosis of UM patients. The signature indicates a dysregulated metabolic microenvironment and provides new metabolic biomarkers and therapeutic targets for UM patients.
O tratamento déjà vu da religião na Antropologia
Authors: Barreto Marcus Vinicius
Published: April 2022

O presente artigo reflete sobre abordagens antropológicas clássicas acerca do tema da religião, estabelecendo um contraponto com outras linhas de pesquisa que, mais recentemente, privilegiam o papel das mídias na formação de comunidades religiosas. Tomando como base algumas propostas da antropóloga Birgit Meyer, o objetivo é refutar o privilégio tradicionalmente concedido tanto aos discursos de atores religiosos quanto ao significado dos símbolos para a composição etnográfica, passando a enfatizar sensações compartilhadas em um processo de “formação estética”.
Cidade de Giz: experimentações gráficas
Authors: Silva Jeferson Carvalho da
Published: April 2022

Neste ensaio gráfico, apresentam-se os processos criativos de invenção e ocupação da cidade realizados por um dos habitantes de Viçosa, Minas Gerais. Seguindo suas inscrições efêmeras, adentramos uma cartografia descontínua de desencontros etnográficos, aproximando-nos de espaços construídos e imaginados cotidianamente. Este experimento se torna, assim, uma tentativa de pensar e se inscrever na cidade aos modos do Homem de Giz, por meio de seus traços e de suas grafias. Em um “exercício de ficção antropológica”, inspirado por Eduardo Viveiros de Castro, onde os desenhos tornam-se centrais metafórica e metodologicamente, como propõe Tim Ingold, acercamo-nos de uma abordagem antropológica a partir da “cidade em si mesma”, apontada por Michel Agier.
Caspase-8 Promotes Pulmonary Hypertension by Activating Macrophage-Associated Inflammation and IL-1β (Interleukin 1β) Production
Authors: Rong Wuwei , Liu Chenchen , Li Xiaoming , Wan Naifu , Wei Lijiang , Zhu Wentong , Bai Peiyuan , Li Ming , Ou Yangjing , Li Fang , Wang Lingxia , Wu Xuanhui , Liu Jianling , Xing Mingyan , Zhao Xiaoming , Liu Han , Zhang Haibing , Lyu Ankang
Published: April 2022

Background:

Macrophages are involved in the pathogenesis of pulmonary arterial hypertension (PAH). Caspase-8, an apical component of cell death pathways, is significantly upregulated in macrophages of PAH animal models. However, its role in PAH remains unclear. Caspase-8 plays a critical role in regulating inflammatory responses via inflammasome activation, cell death, and cytokine induction. This study investigated the mechanism of regulation of IL-1β (interleukin 1β) activation in macrophages by caspase-8.

Methods:

A hypoxia + SU5416-induced PAH mouse model and monocrotaline-induced rat model of PAH were constructed and the role of caspase-8 was analyzed.

Results:

Caspase-8 and cleaved-caspase-8 were significantly upregulated in the lung tissues of SU5416 and hypoxia-treated PAH mice and monocrotaline-treated rats. Pharmacological inhibition of caspase-8 alleviated PAH compared with wild-type mice, observed as a significant reduction in right ventricular systolic pressure, ratio of right ventricular wall to left ventricular wall plus ventricular septum, pulmonary vascular media thickness, and pulmonary vascular muscularization; caspase-8 ablated mice also showed significant remission. Mechanistically, increased proliferation of pulmonary arterial smooth muscle cellss is closely associated with activation of the NLRP3 (NOD [nucleotide oligomerization domain]-, LRR [leucine-rich repeat]-, and PYD [pyrin domain]-containing protein 3) inflammasome and the IL-1β signaling pathway. Although caspase-8 did not affect extracellular matrix synthesis, it promoted inflammatory cell infiltration and pulmonary arterial smooth muscle cell proliferation via NLRP3/IL-1β activation during the development stage of PAH.

Conclusions:

Taken together, our study suggests that macrophage-derived IL-1β via caspase-8-dependent canonical inflammasome is required for macrophages to play a pathogenic role in pulmonary perivascular inflammation.
Abstract 073: A Mediterranean Diet Pattern Is Associated With Lower Risk Of Adverse Pregnancy Outcomes In US Women: Results From The NuMoM2b Cohort
Authors: Makarem Nour , Chau Kristi , Miller Eliza C , Gyamfi-Bannerman Cynthia , Tous Isabella , Booker Whitney A , Catov Janet M , Haas David , GROBMAN William , Levine Lisa , McNeil Rebecca , Merz Noel N , Reddy Uma , Wapner Ron , Wong Melissa , Bello Natalie A
Published: April 2022

Introduction:
Adverse pregnancy outcomes (APOs) are associated with an increased risk of developing cardiovascular disease (CVD). While the Mediterranean diet pattern has been inversely related to CVD outcomes, its association with APOs in US women has not been previously evaluated.

Hypothesis:
Adherence to a Mediterranean diet pattern during the periconception period is associated with lower risk of APOs.

Methods:
Racially and ethnically diverse women (n=8075, mean age: 27±6y) from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b) cohort were enrolled across 8 US medical centers from 2010-13. An Alternate Mediterranean Diet (aMed) score was computed from data on habitual diet in the 3 months around conception, assessed using a semi-quantitative food frequency questionnaire in the first trimester. APOs were prospectively ascertained and defined as developing 1 or more of the following: gestational hypertension, preeclampsia/eclampsia, gestational diabetes, preterm delivery, small for gestational age, or stillbirth. Multivariable logistic regression was used to examine associations of the aMed score and its components with any APO and individual APOs.

Results:
Women in the highest vs. lowest quintile of the aMed score had 21% lower odds of developing any APO, and 36% and 52% lower odds of preeclampsia/eclampsia and gestational diabetes, respectively; a linear trend across aMed score categories was detected (p-trend<0.05) (
Figure
). When aMed score components were examined separately, higher intakes of vegetables, fruits, legumes, and fish and lower intakes of red meat were related to up to 26% lower odds of APOs.

Conclusions:
Greater adherence to a Mediterranean diet pattern is related to lower risk of APOs, with evidence of a dose-response relationship, highlighting the potential of this diet pattern in CVD primordial prevention efforts in US women. Long-term studies are needed to assess whether dietary modification in the periconception period can reduce risk of APOs and future CVD.
Abstract EP06: Serum Water T
2
And Its Association With Cardiometabolic Health: The Premier Study
Authors: Nicasio Jacob , Sandoval Diana , Campbell Erin , Garza Joshua , Aldana Juan , Dwivedi Alok , Cistola David P
Published: April 2022

Introduction:
Plasma and serum water T
2
are global markers of metabolic syndrome and cardiometabolic health. Serum, in contrast with plasma, lacks fibrinogen, one of the key drivers of the association of plasma water T
2
with metabolic syndrome. Yet, serum water T
2
was able to detect metabolic syndrome with high sensitivity and specificity through its association with other underlying components. Here we examined bio-banked serum samples from a large, diverse study population to investigate the use of serum water T
2
as a marker of cardiometabolic health.

Hypothesis:
Among PREMIER participants at baseline, serum water T
2
is associated with multiple measures of cardiometabolic health.

Materials and Methods:
This is an auxiliary study of the PREMIER trial and has an observational, cross-sectional design. A total of 810 mildly hypertensive participants without diabetes or CVD (63% females, 35% black, and 65% non-black) were enrolled in the parent study. Here, a subset of those participants (n=455) were analyzed based on the availability of serum samples that had undergone a single freeze-thaw cycle. Using a Bruker mq20 benchtop nuclear magnetic resonance relaxometer, T
2
decay curves were recorded at 37°C for unmodified human serum. Water T
2
was distinguished from non-water components using a discrete inverse Laplace transform algorithm. The association of serum water T
2
, the outcome variable, with other potential predictors was examined in four stages: (1) screening of predictors using a bootstrap forest machine learning algorithm, (2) clustering of predictors using principal component analysis, (3) associations with serum water T
2
using multiple linear regression, and (4) validation of regression models using a bootstrap forest algorithm.

Results:
The final model for serum water T
2
included albumin, globulins, non-HDL-cholesterol, household income, urine phosphate, TG/HDL ratio, family history of CVD and the interaction between BMI and race. The adjusted R
2
for this model was 0.55. Thus, serum water T
2
values were independently associated with markers of dyslipidemia, inflammation, insulin resistance, kidney function, family history of CVD, household income, and the categorical interaction between BMI and race. Compared with obese/Black individuals (reference group), non-obese/non-Black individuals showed higher T
2
values (p<0.0001) reflecting improved cardiometabolic health. By contrast, serum water T
2
values for the non-obese/Black (p=0.7417) and obese/non-Black (p=0.7262) participants were not statistically different from the reference group.

Conclusion:
Analysis of bio-banked samples from PREMIER validates serum water T
2
as a biomarker of cardiometabolic health in mildly hypertensive individuals without diabetes or CVD. Serum water T
2
, while similar to plasma water T
2
, revealed some distinct associations with measures of cardiometabolic health.
Abstract EP08: Cardiometabolic Diseases, Quality Of Life And Sleep In Adults With Hiv In The Deep South
Authors: Enogela Ene M , Jones Raymond , Buford Thomas W , Wheeler Pariya L
Published: April 2022

Introduction:
Cardiometabolic diseases (CMDs) are prevalent among middle-aged and older people living with HIV (OPLWH), particularly in the Deep South. However, the role CMDs play on quality-of-life outcomes among OPLWH remain understudied.

Purpose:
The purpose of this observational study was to examine the association between CMDs and physical health-related quality of life (P-HRQOL) and quality of sleep among PLWH in the Deep South.

Methods:
This cross-sectional study included N=261 HIV-infected participants aged 40+ recruited from a University HIV/AIDS clinic located in the Southeastern United States. CMDs were self-reported and consisted of hypertension, heart failure, stroke, diabetes mellitus, Angina due to heart disease, and high cholesterol. P-HRQOL and sleep quality scores were obtained using the Medical Outcome Study HIV Health Survey (MOS-HIV) and Pittsburgh sleep quality index (PSQI). We performed regression analyses (adjusting for demographic confounders and depression) for each outcome to assess the association between CMDs and P-HRQOL and sleep quality among OPLWH.

Results:
The average age of participants was 51.10 ± 6.78, with 82.8% being non-white and 35.6% being males. The overall prevalence of having ≥ 1CMD was 64.4% (High cholesterol: 52.8%; Diabetes Mellitus: 22.8%; Stroke: 5.68%; Angina/chest pain: 4.5%; Heart Failure: 6.8%; Hypertension 84%). P-HRQOL scores were significantly lower in PLWH with ≥1 CMD compared to the non-CMD group (45.53 ± 11.54 Vs. 49.67 ± 10.77, p<0.01). PSQI sleep disturbance scores were significantly higher among participants with ≥1CMD compared to the non-CMD group (9.28 ± 4.42 vs. 7.26 ± 4.17, p<0.01). In the covariate adjusted regression analysis, each additional CMD resulted in a 1.83 decrease in P-HRQOL while PSQI sleep disturbance increased by 0.74.

Conclusion:
In a sample of PLWH in the Deep South, the presence of CMDs increased the risk for poor P-HRQOL and greater sleep disturbances. Interventions that focus on targeting P-HRQOL and sleep quality in OPLWH with CMDs are necessary to improve long-term outcomes.
Abstract EP09: Empiric Dietary Inflammatory Potential Is Associated With Elevated Left Ventricular Mass
Authors: Annabathula Rahul V , Winsor Scott , Sutton Alexandria , Skipina Travis , Soliman Elsayed Z
Published: April 2022

Background:
Recent studies have shown associations between proinflammatory diets and several cardiovascular diseases. Whether a proinflammatory diet, assessed using the empirical dietary inflammatory potential (EDIP), is also associated with elevated left ventricular mass index (LVMI) in the general population is unknown.

Methods:
This analysis included 5,869 participants (55.9 ± 10.5 years; 48.5% male, 71.8% whites) from the Third National Health and Nutrition Examination Survey. EDIP score was calculated from the Food Frequency Questionnaire. LVMI was estimated using a validated electrocardiographic (ECG) model utilizing digitally recorded ECG data, which were processed automatically at a central core laboratory. Elevated left ventricular mass was defined as LVMI values ≥95th percentile (≥149 g/m2). Multivariable logistic regression was used to examine the association between EDIP score (tertiles and per 1-standard deviation (1-SD) increase, separately) and LVMI.

Results:
In multivariable logistic regression models, each 1-SD increase in EDIP score (0.259) was associated with 25% increased odds of elevated LVMI. Higher odds of elevated LVMI were observed with higher levels (tertiles) of EDIP suggesting a dose-response relationship (Table). These results were consistent in subgroups of the participants stratified by demographics and comorbidities.

Conclusions:
Dietary patterns with high proinflammatory properties are associated with an elevated LVMI. Given the association between cardiovascular mortality and an elevated LVMI, there needs to be a greater emphasis on the reduction of proinflammatory diet patterns.
Abstract EP14: Traditional And Non-traditional Cardiometabolic Risk Factors For Type 2 Myocardial Infarction Compared To Type 1 Myocardial Infarction In Young Women (18-44 Years): A National Inpatient Analysis
Authors: Jain Akhil , Agarwala Preeti , Akah Ozo , Ghimire Shristee , Ghimire Samir , Raina Jilmil , Itare Vikram , Deshpande Sohiel , Alukal Thomas , Alvarez Melissa , Desai Rupak
Published: April 2022

Background:
There has been growing interest in studying demand ischemia as a cause of type 2 myocardial infarction (T2MI) in younger patients. Conventional cardiovascular risk factors and their association (and degree) are vaguely defined as predictors of T2MI. Women may be noted to have different predictors given their underrepresentation in clinical trials.

Methods:
We analyzed young female (18-44 years) hospitalizations from the National Inpatient Sample 2018 for multivariate-adjusted predictors (aOR, 95% confidence interval) of T2MI, STEMI and NSTEMI admissions, and divided the significance level into p<0.01, p<0.05 & p<0.1.

Results:
Young females (n=6,152,028) had 0.05% STEMI, 0.16% NSTEMI and 0.08% T2MI admissions. Predictors (Table 1) with the highest significance level of association for T2MI (p<0.01), compared to ST/NSTEMI (either 0.01<p<0.05 or not significant), were black race (aOR 1.49) and CHF (aOR 1.97), pulmonary circulation disorder (aOR 1.83) and OSA (aOR 1.62). Valvular heart disease, paralysis, COPD, deficiency anemia predicted a higher risk of T2MI admissions in young women (p<0.05) but not STEMI/NSTEMI admissions. Hypertension, prior MI, dyslipidemia, family history of coronary artery disease, peripheral vascular disease, coagulopathy and fluid-electrolyte disorder predicted a higher risk of T2MI or STEMI/NSTEMI. Collagen vascular disorders and obesity had a higher risk of T2MI/NSTEMI (p<0.01) but not of STEMI (p=0.07). DM, and cocaine abuse predicted higher odds of STEMI/NSTEMI but not of T2MI. Hypothyroid, liver disease, metastatic cancer, AIDS, depression, alcohol abuse and cannabis abuse did not predict a higher risk of T2MI or STEMI/NSTEMI. Hypothyroid, liver disease, metastatic cancer, AIDS, depression, alcohol and cannabis abuse did not predict higher odds of T2MI or STEMI/NSTEMI in young women.

Conclusion:
Predictors associated with T2MI in young females with a higher order of significance than ST/NSTEMI can be utilized to build a risk score for T2MI in young females.
Abstract EP15: Changes In Metabolite Levels After An Oral Glucose Challenge Are Associated With Incident Cardiovascular Disease And Death
Authors: Gonzalez Izundegui Daniel , Miller Patricia E , Larson Martin , Ramachandran Vasan S , Nayor Matthew G
Published: April 2022

Objective:
We evaluated whether intra-individual changes in blood metabolites in response to an oral glucose challenge were associated with incident CVD and mortality.

Methods:
An oral glucose tolerance test (OGTT; 75g glucose) was administered to a subsample of non-diabetic Framingham Heart Study participants (n=361). Metabolite profiling was performed on blood samples drawn before and 2 hours post OGTT. We compared pre- and post-OGTT log2(metabolite levels) using t-tests; for each metabolite with statistically significant changes from pre- to post-OGTT (Δmetabolites), we calculated log2(post/pre) and standardized values to mean=0, standard deviation=1. We constructed multivariable-adjusted Cox models relating each Δmetabolite with CVD and death. Models were adjusted for clinical risk factors of age, sex, baseline metabolite level, diabetes, systolic blood pressure, hypertension treatment, BMI, smoking, and total/HDL cholesterol.

Results:
Our sample included 42% women, with a mean age of 56±9 years, and body mass index of 30.2±5.3 kg/m
2
. The pre- to post-OGTT change (Δmetabolite) was statistically significant for 170 metabolites (at FDR ≤0.05). A total of 132 CVD events and 144 deaths occurred during follow up (mean 23±5 years for CVD, 26±2 years for death). In Cox models, four Δmetabolites were associated with incident CVD and six Δmetabolites were associated with death, at P<0.05 (
Table
). Notably, baseline metabolite levels were not associated with either outcome in models excluding Δmetabolites. Significant Δmetabolites included those with established roles in cardiometabolic disease (e.g., glutamate, α-ketoglutarate, N-methylmalonamic acid) and metabolites with less defined roles (e.g., glucoronate, lipid species).

Conclusion:
Intra-individual changes in circulating metabolites in response to an OGTT were associated with CVD and death beyond their resting measures. Dynamic changes in metabolite levels with an OGTT have potential relevance for understanding and predicting CVD risk.
Abstract EP17: Associations Between Neighborhood Child Opportunity And Cardiovascular Fitness For New York City Public School Youth
Authors: Zhao Amy , Zewdie Hiwot , Ogletree S. Scott , Messiah Sarah , Armstrong Sarah , Skinner Asheley C , Neshteruk Cody , Hipp J. Aaron , Day Sophia , Konty Kevin , D'Agostino Emily
Published: April 2022

Introduction:
Fewer than 1/4th of US youth meet physical activity guidelines, leading to physical fitness-related cardiovascular disease disparities tracking into adulthood. Neighborhood opportunity may serve as a critical modifiable factor to reduce youth cardiovascular health-related disparities. The present analysis uses the Child Opportunity Index (COI), a comprehensive measure of children’s neighborhood opportunity, to examine associations between neighborhood context and multiple youth cardiovascular fitness outcomes.

Methods:
Data were drawn from the NYC FITNESSGRAM (n = 300,000), comprising of fitness data from New York City (NYC) public school youth (grades K-12). Generalized linear mixed models were run to estimate overall and sex-stratified associations between overall COI and individual COI indicators (greenspace, healthy food, walkability, commute time) and youth cardiovascular fitness (body mass index (BMI) percentiles, curl-ups, push-ups, PACER, and sit and reach). Geographically weighted regression (GWR) models explored spatial variation of COI-fitness associations across NYC.

Results:
Overall COI was associated with improved youth cardiovascular fitness outcomes, with the strongest magnitude of effects across aerobic capacity and muscular strength and endurance measures (PACER: β: 0.15, 95% CI: 0.14, 0.15, curl-ups: β: 0.13, 95% CI: 0.12, 1490.13, and push-ups: β: 0.13, 95% CI: 0.12, 0.13). Greenspace was positively associated with muscular endurance (curl-ups: β: 1.13, 95% CI:0.76, 1.50; push-ups: β: 1.53, 95% CI: 1.21, 1.84), and walkability and commuting time were positively associated with aerobic capacity (PACER: β: 2.11, 95% CI: 1.72, 2.50; β: 2.03, 95% CI: 1.87, 2.19, respectively). Stratified models showed strengthened COI-fitness associations among girls versus boys. GWR models were largely consistent with findings from multilevel models, except for overall COI-BMI associations, which varied in magnitude and direction across regions in NYC.

Conclusion:
Neighborhood opportunity was associated with multiple measures of youth cardiovascular fitness, though geographic models demonstrate that certain associations vary in magnitude and direction across NYC. Continued research on neighborhood factors and cardiovascular fitness may better inform public health efforts to reduce health disparities modifiable through comprehensive place-based interventions.
Abstract EP18: Cardiopulmonary Testing In Long Covid Versus Non-CovidPatients With Undifferentiated Dyspnea On Exertion
Authors: Meza Alejandra , Newman Darrell B , Niven Alexander S , Mueller Michael R , Schwenk Nina M , Ganesh Ravindra , Squires Ray W , Bonikowske Amanda , Cappelloni Lucio , Allison Thomas G
Published: April 2022

Background:
COVID-19 reveals new manifestations not only in the acute phase but also in the long term. The latter is what has been termed as ‘post acute sequelae of SARS-CoV-2 infection’ (PASC) — or “long COVID”— with dyspnea as one of its hallmarks. Cardiopulmonary stress testing (CPET) is increasingly being used to better evaluate such patients.

Objective:
To compare CPET findings of long COVID patients versus non-COVID patients with undifferentiated dyspnea on exertion seen at Mayo Clinic.

Methods:
A cohort study was carried out using Mayo Clinic’s exercise testing database. The study group included 77 PASC patients confirmed by a positive antigen or PCR test with no prior history of heart or lung disease. PASC patients were compared to 766 non-COVID patients with unspecified dyspnea without known diagnosis of cardiac or pulmonary disease. ANOVA according to the general linear model and Pearson’s Chi square were used for the bivariate analysis of the quantitative and categorical variables, respectively. Analyses were controlled for age, sex, and beta blocker use as appropriate. Both HR and SBP at rest and peak exercise were significantly different between groups, although the absolute differences were small.

Results:
Compared with the control group, the post-COVID patients were younger (mean age 47 SD ±14.9 years versus 50.5 SD ±10.1 years) and more likely to be female (70.1% (54 of 77) vs 57.6% (441 of 766)). Although there were many significant differences in the CPET results, the most outstanding were a lower FAC (73 SD ±19.4% vs 85.2 SD ±20.8%) and peak VO2 (22 SD ±6.4 ml/kg/min vs 25.8 SD ±7.37 ml/kg/min) in the study group (p<.0001). Also, CNS changes during CPET were reported at higher rates (19.5% (15 of 77) vs 11.4% (87 of 766)) while dyspnea at lower rates (55.8% (43 of 77) vs 65.7% (503 of 766)) in post-COVID patients (p=0.02). When adjusting for age and sex, weight was significantly higher in the study group (p=0.03) although the absolute difference was modest and BMI remained not significant. PFTs did not suggest any pulmonary abnormalities.

Conclusions:
We identified a high rate of severe exercise limitation among long COVID patients. Young women may be at higher risk for these complications. Pre-exercise PFTs and absence of objective respiratory limitation during CPET argue against a primary pulmonary cause of the observed limitations, though evaluation of cardiac, autonomic, and muscular impairment is pending. Further studies are warranted to untangle the physiologic abnormalities responsible for these observations.
Abstract EP20: Immigrant-related Factors And Prediabetes Prevalence Among Latinos In The Us
Authors: Echeverria Sandra , Vasquez Elizabeth , Murillo Rosenda , Janevic Teresa , Alam Towfiqul , Okpala Peace
Published: April 2022

Background:
Latinos have a nearly two-fold increased risk of diabetes and diabetes-specific mortality compared to non-Latino whites. Until recently, foreign-born individuals have shown a lower prevalence of diabetes. However, limited research has examined the social and demographic factors contributing to prediabetes among Latinos. Directing prevention efforts towards those classified at the prediabetes stage presents a critical window of opportunity to prevent the transition to diabetes and subsequent morbidity and mortality. We characterized prediabetes prevalence across social, demographic, and immigrant factors in a nationally representative sample of Latino adults living in the United States (US).

Hypothesis:
Foreign-born Latinos will have a higher prevalence of prediabetes than US-born for select characteristics.

Methods:
Our study population included Latino adults 20+ years of age sampled in the National Health and Nutrition Examination Survey (NHANES), 2013-2018 (n=4,060). We examined prediabetes prevalence measured via A1C levels of 5.7-6.4 by age, sex at birth, nativity, occupational status, and poverty threshold accounting for the complex sampling design of NHANES. We also tested if nativity modified these social and demographic risk factors.

Results:
A total of 8,237,647 million Latinos met the criteria for prediabetes, resulting in an estimated prevalence of 27.9%. We found an increasing trend for prediabetes for greater time residing in the US (22%, 26%, and 40% for <10 years, 10-19 years, and >20 years, respectively). Moreover, across most social and demographic characteristics, foreign-born Latinos had a higher prevalence of prediabetes than US-born Latinos.

Conclusion:
Our findings suggest clear patterns of increased prediabetes prevalence among foreign-born Latinos relative to their US-born counterparts. Future diabetes prevention efforts are needed to address the higher prediabetes burden among the foreign-born and design tailored interventions for this group that address structural as well as cultural factors patterning these disparities.
Abstract EP22: Sex And Socioeconomic Difference In 30-day Readmission After Hypertensive Crisis
Authors: Park Kyeeun , Ebrahim Mohammed , Aung Pyi Phyo , Konindala Navya
Published: April 2022

Introduction:
Hypertensive crisis (HC) is associated with serious health implication such as hypertensive heart disease, kidney disease and strokes and frequent healthcare utilization, especially unplanned 30-day readmission. ACC/AHA published new guideline for hypertensive crisis in 2017, but its impact on unplanned readmission has not been fully appreciated. Reporting readmission trends by sex and socioeconomic difference is crucial for public health surveillance and improved healthcare equity.

Methods and Results:
We conducted a retrospective analysis of the 2018 to 2019 Nationwide Readmission Database (NRD). Study populations were selected using ICD-10 diagnosis code. Discharge-level weight analysis was used to produce a national estimate. Social economic status (SES) was evaluated using median household income of patient’s ZIP code and dived into quarter. We conducted univariate and multivariable hierarchical regression analysis to calculate odds ratio (OR) with STATA 17. During the study period, there were 1,495,230 hospitalizations with hypertensive crisis of which 53.68% were female. According to SES study, 39.29% of patients were from the lowest quartile followed by 27.00%, 20.80% and 12.90% respectively. The overall incidence of unplanned readmission was 15.85 %( 237,052 of 1,495,230). Readmission rate was higher in female (15.93% v 15.77%; p = 0.006) and lower income quartiles (17.17% v 15.55% v 14.78% v 14.32%; p <0.0001). The most common indication for readmission was repeated hypertensive crisis with higher proportion being female (18.39% v 17.42%) and the lowest income quartile (18.59%). After adjusting for age and comorbidities, female sex (OR 1.05; 95% CI, 1.04 - 1.07; p< 0.0001) and the lowest income quartile (OR 1.12; 95% CI, 1.11 - 1.14; p< 0.0001) were found to be significant predictors for 30-day readmission.

Discussion:
According to prior study, the 30-day readmission rate after HC has been improved with implementation of the ACC/AHA 2017 guideline (15.85% v 17.8%). However, disparities in HC burden and hospital utilization by sex and socioeconomic status persists. Public health interventions are needed to reduce HC hospitalization burden in female and low socioeconomic patients.
Abstract EP25: Socioeconomic Disparities In The Use Of Temporary Mechanical Circulatory Support And Outcome In Cardiogenic Shock
Authors: Park Kyeeun , Aung Pyi Phyo , Nge Htoo Myat
Published: April 2022

Introduction:
There has been limited data on impact of socioeconomic status (SES) on temporary mechanical circulation support (MCS) use and in-hospital outcome of cardiogenic shock (CS). Investigating accessibility of advanced medical device and the outcome by SES is imperative to improve public health and develop interventions to reduce healthcare disparities.

Methods and Results:
We conducted a retrospective analysis of the 2016 to 2018 National Inpatient Sample database and the 2018 to 2019 Nationwide Readmission Database (NRD). Study populations were selected using ICD-10 diagnosis code and ICD-10 procedure code for MCS. SES was evaluated using median household income of patient’s ZIP code and dived into quarter. Discharge-level weight analysis was used to produce a national estimate. We conducted univariate and multivariable hierarchical regression analysis to calculate odds ratio (OR) with STATA 17. During the study period, 466,350 patients were hospitalized with CS of which 30.46% were from 1
st
(lowest), 26.62% from 2
nd
, 23.65% from 3
rd
and 19.27 from 4
th
(highest) quartile. 38.58% of CS was secondary to acute coronary artery syndrome. 19.49% (90,905 of 466,350) of CS led to MCS use with IABP, Impeller, percutaneous left ventricular assist device (pLVD) and extracorporeal membrane oxygenation (ECMO) (73.87%;67,154 of 90,905, 26.05%;23,680 of 90,905, 24.35%;22,135 of 90,905 and 1.45%;1,320 of 90,905 respectively). 18.27% (25,435 of 139,235) of lowest quartile patients utilized MCS in contrast to 20.50 %(18,055 of 88,070) of highest quartile. After adjusting for age, sex and comorbid burden, there was a significant higher mortality for the lowest SES quartile as compared to the highest quartile (OR 1.18; 95%CI 1.14-1.24; p < 0.0001). Similarly, the lowest SES quartile was found to be significant indicator for unplanned 30-day readmission (OR 1.16; 95%CI 1.12-1.21; p < 0.0001). Furthermore, there was a lower utilization of MCS among patients from lower SES compared to higher SES (OR 0.87; 95%CI 0.83-0.91; p < 0.0001).

Discussion:
Patients with lower SES were found to have increased in-hospital mortality, unplanned readmission and decreased utilization of MCS. Further study and public intervention needed to improve CS outcome and accessibility of MCS in low SES patients.
Abstract EP28: SO CLOSE YET SO FAR : HOW WELL ARE WE DOING WITH GDMT FOR HEART FAILURE WITH REDUCED EJECTION FRACTION - A COMMUNITY HOSPITAL ANALYSIS
Authors: Lnu Kriti , khanal Resha , Wert Yijin , Hodara Roberto
Published: April 2022

Background:
The use of maximum tolerated doses of guideline directed medical therapy (GDMT) for patient with heart failure with reduced ejection fraction (HFrEF) has been suboptimal in routine clinical practice. In particular, the rate of adoption of the angiotensin receptor blocker-neprilysin inhibitor (ARNI) has lagged. In this study, we aim to evaluate the use of optimal GDMT and the effect of ARNI on heart failure related re-admission (HFRR) in a real life setting from a single center community hospital.

Method:
Retrospective chart review was conducted in patients who were admitted to our hospital system for HFrEF between December 2019-January 2021. Data was collected for patient demographics, comorbidities, admission and discharge medications, length of stay and rate of 30-day HFRR.

Results:
357 patients were included in the analysis. 92.7% were discharged on beta blockers, 50% were discharged on ACE-I/ARB, 6.4% were discharged on ARNI and 47.75% were discharged on MRAs. The target doses of each were only achieved in 7.3%, 27%, 100% and <1% respectively. 43% patients were not discharged on either ACE-I/ARB/ARNI. Patients discharged on ARNI had numerically lower rates of chronic kidney disease > stage 3, and lower BNP levels than those discharged on ACE-I/ARB. HFRR was lower in patient discharged on ARNI vs ACE-I/ARB (4.17% vs 16%), although this was not statistically significant due to low sample volume (p = 0.20).

Conclusion:
Our study shows that the rate of adoption of GDMT, especially ARNI, in hospitalized HFrEF patients in clinical practice lags significantly behind from that reported in clinical trials. Although there was no statistical significance achieved in comparison due to small sample size, we see a trend of decreased heart failure readmission in patients discharged on ARNI. The wide gap of adoption of GDMT in the real world remains a challenge, and adversely impacts patient outcomes.
Abstract EP31: Use Of Low-density Lipoprotein Cholesterol Raising Medication Among United States Adults, 2013 Through 2018
Authors: Zheutlin Alexander , Chaitoff Alexander , Niforatos Joshua
Published: April 2022

Introduction:
Low-density lipoprotein cholesterol (LDL-C) reduction is a cornerstone to atherosclerotic disease (ASCSVD) prevention. Iatrogenic LDL-C elevation may counteract measures to address ASCVD risk by LDL-C lowering.

Methods:
Participant data from the National Health and Nutrition Examination Survey (NHANES) between 2013-2018 was pooled to determine the use of medication that raised LDL-C as an adverse effect as determined by literature review. Logistic regression was used to determine the association between the use of LDL-C raising medication and ASCVD with adjustment for demographic, socioeconomic, and health-related variables.

Results:
Among NHANES participants with medication data availability (weighted n = 238,995,360), 4.9% were taking LDL-C raising medication. Among adults with ACSVD, 5.5% were taking LDL-C raising medication, compared to 4.7% of participants without ASCVD. LDL-C raising medication were more common among participants with an annual income <$20,000, diagnosed with hypertension, taking an antihypertensive medication, greater BMI, and greater medication count. The unadjusted odds-ratio (OR) of the use of LDL-C raising medication with ASCVD was 1.18 (95% CI 0.97,1.44). Following adjustment for demographic, socioeconomic, and health-related variables the OR was further attenuated (OR 1.08 95% CI 0.82, 1.43).

Discussion:
In this analysis of NHANES, LDL-C raising medication was not associated with presence of ASCVD. However, the use of LDL-C raising medication was prevalent among nearly 5% of U.S. adults and greater monitoring of adverse medication effects may represent an avenue to improve LDL-C reduction
Abstract EP34: Association Of Aortic Valve Calcification And High Levels Of Lipoprotein (a) . A Meta-analysis
Authors: R. Motawea Karam , Fathy Hager , M. Awad Dina , Mohamed Belal Mohamed , Swed Sarya , Aboelenein Merna , Elsayed Talat Nesreen , S. Rozan Samah , Ibrahim Nancy , Sawaf Bisher , Aiash Hani
Published: April 2022

Background:
Some studies reported a positive link between high levels of lipoprotein (a) and aortic valve calcification. The aim of this study is to perform a meta-analysis to find whether aortic valve calcification has a significant association with high levels of lipoprotein (a).

Methods:
We searched PUBMED, WOS and OVID databases. We included cohort studies or clinical trials that measured lipoprotein (a) levels in patients with aortic valve calcium and controls without aortic valve calcium. Case reports, editorials and animal studies were excluded. RevMan software (5.4) was used to perform the meta-analysis. Levels of lipoprotein (a) and number of patients with increased levels of lipoprotein (a) outcomes were presented as standardized mean difference (SMD) and Odds ratio (OR) with 95% confidence interval (CI).

Results:
After complete screening, 7 studies were included with a total number of 446179 patients included in the analysis. The pooled analysis showed a statistically significant association between incidence of aortic valve calcium and increased levels of lipoprotein (a) compared with controls (SMD = 1.71, 95% CI = 1.04 to 2.38, p-value < 0.00001). The pooled analysis showed a statistically significant association between incidence of aortic valve calcium and increased number of patients with high levels of lipoprotein (a) compared with controls (OR = 2.21, 95% CI = 1.26 to 3.87, p-value = 0.006). We observed a significant heterogeneity in both outcomes (
P
< 0.00001) that was not solved by subgroup analysis or leave-one out test.

Conclusion:
This meta-analysis showed a statistically significant association between incidence of aortic valve calcium and increased levels of lipoprotein (a) compared with controls. Patients with high levels of lipoprotein (a) are at increased risk of developing aortic valve calcification. Medications targeting lipoprotein (a) in future clinical trials may be useful in primary prevention of aortic valve calcification in high risk patients.
Abstract EP43: Obesity And Incident Cardiovascular Disease (CVD): The Jackson Heart Study
Authors: Gao Yan , Simino Jeannette M , Hsu Chiu-hsieh , Correa Adolfo , Min Nancy
Published: April 2022

Background:
Although obesity is a well-established risk factor for the development of cardiovascular disease (CVD), it is unclear which anthropometric measure(s) of obesity are the best predictors of CVD.

Methods:
Using data from 3491 African Americans (mean age: 58.3±12.1; 65.2% women) in the Jackson Heart Study, we examined the associations of incident CVD and its individual components (Coronary heart disease (CHD), heart failure, and stroke) with time-dependent obesity measures (body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR)). Time-to-event analyses were conducted using time-dependent Cox regression models. Obesity measures were analyzed both as dichotomous (obese vs. non-obese) and standardized continuous predictors. Covariates included age, sex, systolic blood pressure, diastolic blood pressure, and smoking status.

Results:
There were 331 incident CVD events, including 122 CHD, 192 heart failure, and 95 stroke events. The median follow-up time is 9.04 (Quartile Range: 1.83) years. Comparing obese to non-obese participants, adjusted hazard ratios (aHR) (95% CI) for CVD were 1.38 (1.10, 1.72), 1.36 (1.05, 1.76), 1.23 (0.80, 1.89), and 1.38 (1.04, 1.82) for BMI, WC, WHtR and WHR, respectively. The corresponding aHRs (95% CI) using standardized continuous BMI, WC, WHtR and WHR measures were 1.27 (1.14, 1.43), 1.32 (1.18, 1.47), 1.31 (1.18, 1.46), and 1.24 (1.12 1.39). The significant associations between CVD and obesity measures were largely driven by heart failure. The associations in younger age group (< 60 yrs) were more significant than those in older age group (>= 60 yrs).

Conclusions:
Dichotomous and standardized continuous BMI, WC and WHR measures were all associated with incident CVD. For WHtR, only the standardized continuous measure was significantly associated with incident CVD. The risk of CVD associated with obesity is not evident in the elderly.