bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 10109: High Prevalence and Significant Impact of Arrhythmias on Healthcare Resource Utilization in Hospitalizations of Patients with Prior (corrected) Congenital Heart/Circulatory Disease
Authors: Zalavadia Dipen , Shanker Srija , Nepal Ashish , Fatima Bushra , Singla Tanvi , Mohammad Aamer R , Joseph Deepu , Sachdeva Sonali , Desai Rupak
Published: March 2022

Introduction:
Even after surgical correction, adults with a previously corrected Congenital Heart Disease (CHD) may remain at a significantly elevated risk of arrhythmias. However, there is not much known about the prevalence, comorbidity burden, and impact of arrhythmia in these patients.

Methods:
Using the National Inpatient Sample (2015 Oct-2017), adult admissions with previously corrected CHD were identified. The primary outcome was the prevalence of arrhythmia and secondary outcomes included comorbidities and outcomes between the arrhythmic vs. non-arrhythmic cohort.

Results:
Of 19,395 admissions with previously corrected CHD, 7675 (39.6%) patients experienced arrhythmias [median age 55 (39-68) years, male 51.7%, white 75%]
(Table 1).
The arrhythmic cohort often consisted of relatively older, male, white patients and had higher rates of hypertension (56.4% vs. 41%), hyperlipidemia (33.1% vs. 23%), diabetes (9% vs. 6.5%), renal failure (14% vs. 7.8%), and congestive heart failure (17.6% vs. 9.2%) compared to the non-arrhythmic cohort. The arrhythmic cohort had a higher frequency of patients with at least one CVD risk factor (75.5% vs. 65.4%). All-cause mortality was non-significantly higher in the cohort with arrhythmia (1.6% vs. 1.3%). Furthermore, the arrhythmic cohort was less often routinely discharged and had more frequent transfers/home healthcare requirements, prolonged hospital stay, and higher hospital charges.

Conclusions:
Nearly 40% of admissions among patients with a prior history of surgically corrected CHD experienced arrhythmias which were associated with a considerably higher comorbidity burden and healthcare resource utilization with non-significantly higher all-cause mortality.
Abstract 10111: How Do Patients with Heart Failure Perceive Their Symptoms?
Authors: Lee Solim , Nolan Amy , Guerin Julie , Koons Brittany , Matura Lea Ann , Jurgens Corrine Y , Dickson Victoria V , Riegel Barbara
Published: March 2022

Effective symptom perception may prevent unplanned hospitalizations. However, patients with heart failure (HF) often face challenges that interfere with symptom perception. Little is known about how patients perceive their HF symptoms.

Aim:
To describe how patients with HF perceive symptoms through the processes of monitoring, awareness, and evaluation.

Methods:
Using a qualitative descriptive design, we conducted semi-structured in-person interviews with a purposeful sample of adults experiencing an unplanned hospitalization for a HF symptom exacerbation. We elicited how patients monitor, become aware of, and evaluate symptoms prior to hospitalization. Data were analyzed using directed qualitative content analysis. We identified symptom monitoring behaviors, types of symptoms experienced, and success or failure in linking the symptoms to HF. Categories/subcategories were developed by grouping codes based on similarities and differences. Themes were conceptualized at a higher level of abstraction by combining categories.

Results:
A sample of 40 patients (mean age 62 years, 50% male, median HF duration 6 years, 95% HF stage C/D) was enrolled. Patients demonstrated
Body listening
, which was the use of active and individualized symptom monitoring tactics that involved observing for bodily changes outside one’s usual range.
Trajectory of bodily change
involved the patterns or characteristics of bodily changes as they became apparent. Three subthemes—
sudden and stunning change
,
gradual change
, and
fluctuating change
emerged as different
Trajectories of bodily changes
were identified. The same types of bodily changes could develop in different trajectories. Patients simultaneously experienced all or some of the trajectory types of various symptoms. Patients evaluated symptoms through an
Exclusionary process
, sequentially attributing symptoms to a cause through a cognitive process of excluding possible causes until the most plausible cause remained.

Conclusion:
Three major themes emerged from an in-depth description of the complex symptom perception processes of monitoring, awareness, and evaluation. Identifying where patients have difficulties in symptom perception will facilitate the development of tailored interventions.
Abstract 10114: Secondhand Tobacco Smoke Exposure, Urine Cotinine, and Risk of Incident Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis
Authors: Lin Gen-min , Lloyd-jones Don , Colangelo Laura A , Barr R. Graham , Szklo Moyses , Heckbert Susan , Chen Lin Y , Lima Joao A , Liu Kiang
Published: March 2022

Importance:
Secondhand tobacco smoke (SHS) exposure may reduce heart rate variability and has been associated with atrial fibrillation (AF), but the association of SHS with AF has not been confirmed using objective measures for both SHS and incident AF events.

Objectives:
To investigate the association of self-reported and objective SHS exposure amounts with incident AF.

Design:
Cohort study.

Setting:
The Multi-Ethnic Study of Atherosclerosis (MESA) included 6 USA sites. We used follow-up data from the first visit (2000-2002) through 2015.

Participants:
The study sample consisted of 5,730 participants, aged 45-84 years and free of known AF and other cardiovascular diseases at baseline, who self-reported SHS exposure time in hours per week. We also selected a cohort subset of 3,237 current non-smoking participants who received spot urine cotinine measurements at baseline (2000-2002).

Exposures:
Self-reported SHS exposure time (whole cohort) and urine cotinine levels (cohort subset).

Main Outcomes and Measures:
AF events were identified using Medicare claims, hospital records and electrocardiographic findings. A multivariable Cox proportional hazards regression model was used with simultaneous adjustment for demographic factors, educational level, health insurance status, active smoking status, tobacco pack-years, traditional cardiovascular risk factors, depressive symptoms and medications.

Results:
During a median follow-up of 14.0 years, 856 and 452 AF events were identified in the overall and the cohort subset, respectively. No association of SHS exposure time or urine cotinine with incident AF was found. However, a higher AF risk with greater urine cotinine (8.53-442.0 ng/mL) compared with lower urine cotinine (≤7.07 ng/mL) was observed in never smokers [hazard ratios (HR): 1.60 (95% confidence intervals (CI): 1.16, 2.19)], but not in former smokers [HR: 0.88 (95% CI: 0.63, 1.23)] (p-value for multiplicative interaction: 0.009 and for additive interaction: 0.017, respectively).

Conclusions and Relevance:
Objectively measured greater SHS exposure expressed by urine cotinine might be associated with 1.6-fold higher risk of incident AF in never smokers.
Abstract 10124: Chronic Kidney Disease as Predictor for Length of Stay in Patients with New-Onset Atrial Fibrillation with Rapid Ventricular Response
Authors: Namdarizandi Vahid , Elabidin Awfa , Tappuni Bassman , AlKhayru Ali , Kaseer Belal , Pereira Leanne , Fatuyi Michael , Brandt Dominique , Shemisa Kamal
Published: March 2022

Background:
Atrial fibrillation with rapid ventricular response (AFib with RVR) is an arrhythmia caused by the atria of the heart beating chaotically and irregularly and is frequently associated with worse outcomes in chronic kidney disease (CKD). We sought to investigate the length of stay (LOS) in patients presenting at the emergency department with Afib with RVR and a history of CKD.

Methods:
Comorbidity, clinical outcomes and length of stay (LOS) were analyzed retrospectively in a cohort of 1638 patients presenting with new-onset of Afib with RVR at the emergency department from 2013 to 2018. Patients with a history of CKD vs. no history of CKD were compared using descriptive statistics, chi-square and Mann-Whitney tests.

Results:
The 343 patients admitted with a history of CKD had a median [IQR] glomerular filtration rate of 42 [29.4-51], were older 76(10.4) vs. 70.4(14) years of age, p<.0001, were more likely to be African American 12.5% vs. 6.7% p=0.025,OR 1.99 [1.352-2.93] and had a higher median (IQR) CHA
2
DS
2
-VASc score of 5[4-6] vs. 4[2-5] (P<.0001), and their median LOS was 4[2-6] vs.3[1-4] (Fig 1).

Conclusion:
CKD patients admitted with new-onset of Afib with RVR required additional care and longer LOS. Prevalence of other comorbidities is higher in this population, including heart failure and hypertension (most common), and thyroid disorder and COPD (least common).
Abstract 10131: Alarmingly Rising Burden of Cardiovascular Comorbidities and Risk of Major Adverse Cardiac and Cerebrovascular Events in Nationwide Admissions from Low Income Households (2017 vs. 2007)
Authors: Zalavadia Dipen , Nepal Ashish , Shanker Srija , Kalolia Bansari , Fatima Bushra , Singla Tanvi , Mohammad Aamer , Joseph Deepu , Ali Khan Mir Zeeshan , Desai Rupak
Published: March 2022

Background:
Social determinants of health have an important influence on health equity. Addressing them appropriately is essential to improve population health outcomes and decrease health care disparities. We aimed to compare data from two nationwide cohorts from the US to analyze the shift of cardiovascular risk burden and major adverse cardiac and cerebrovascular events (MACCE) in low-household income (LHI) groups.

Methods:
Adult admissions among patients from LHI (0-25th) quartile were identified from two cohorts in 2007 and 2017 using the National Inpatient Sample. Socio-demographics, and pre-existing cardiovascular/extra-cardiovascular comorbidities were compared between the cohorts and multivariable regression was performed to assess the risk of MACCE (all-cause mortality, acute myocardial infarction and cardiac arrest including ventricular tachyarrhythmias) in 2017 vs. 2007 cohort.

Results:
Hospitalizations among LHI quartile showed 12% relative increase in 2017 (N=10,680,030) as compared to 2007(N=9,510,877). The 2017 cohort was younger (mean age 57 to 54 years) and admissions among male patients increased from 39% to 43.6% between 2007 and 2017. Also, non-elective and Medicaid admissions increased from 74% to 81% and 21% to 32%, respectively in 2017. Traditional CVD risk factors and comorbidities in the LHI quartile increased in 2017 compared to 2007 cohort (Table 1). The risk of composite MACCE was higher in the 2017 cohort compared to 2007 cohort (7.2% vs 6.7%, adjusted OR 1.03, 95%CI:1.03-1.04, p<0.001). Although the hospital stay was comparable (3 days), hospitalization charges increased in 2017.

Conclusion:
Comparative analysis of LHI admissions across a decade shows that increasingly younger, male, non-white patients get hospitalized for non-elective reasons and have a higher burden of CVD risk factors and MACCE in 2017 vs. 2007. This warrants preventive strides to curtail CVD burden in patients of the LHI and improve health outcomes.
Abstract 10135: Cardiotoxicity and Mortality in Chimeric Antigen Receptor T Cell Therapy Recipients
Authors: Mahmood Syed S , Riedell Peter A , Feldman Stephanie , Liu Jennifer , George Gina , Sansoterra Stephen A , Mead Elena , Althaus Thomas , Balkan Lauren , Barbar Tarek A , Lee Chuy Katherine , Harchandani Bhisham , Perales Miguel , Geyer Mark , Park Jae , Palomba M L , Shouval Roni , ALARCON TOMAS Ana A , Yang Eric , Gaut Daria L , Alvi Raza , Rothberg Michael , Weinsaft Jonathan W , Devereux Richard B , Horn Evelyn M , Leonard John P , van Besien Koen , Neilan Tomas G , Steingart Richard
Published: March 2022

Introduction:
Chimeric antigen receptor T cell (CAR-T) therapy harnesses a patient’s own immune system to target cancer. Cardiotoxicity occurs in up to 25% of patients treated with CAR-T. There are limited data characterizing the association between the development of cardiotoxicity after CAR-T and mortality among patients following CAR T cell therapy.

Hypothesis:
We hypothesized that cardiotoxicity following CAR-T treatment would be associated with a higher rate of mortality. Cardiotoxicity was a composite outcome defined as the development of heart failure, cardiogenic shock, or myocardial infarction.

Methods:
We included the first 202 adult patients entered into a multicenter registry receiving anti-CD 19 CAR-T for lymphoma or acute lymphoblastic leukemia (ALL). Of these, 108 died and 94 survived. Covariates included standard baseline cardiovascular and cancer parameters, the occurrence of cardiotoxicity and mortality.

Results:
Those that did and did not die after CAR-T were similar in age, sex, and pre-lymphodepletion chemotherapy regiment. Death after CAR-T was more common in patients with than without hypertension (66% vs. 47%, p=0.009) or ALL (66% vs. 48%, p=0.02), and less common with baseline coronary artery disease (25 vs. 56%, p=0.04). There was no difference in mean cytokine release syndrome (CRS) grade, rate of ≥2 CRS, or in the use of tocilizumab or steroids between those who did and did not die after CAR-T. During a mean follow-up of 372±284 days, 33 (16%) patients experienced cardiotoxicity. Patients with vs. without cardiotoxicity died more often (76% vs. 49%, OR 3.2, CI 1.4 - 7.6, p=0.005). In a Cox model adjusted for covariates identified in univariate analyses, occurrence of cardiotoxicity with CAR-T was independently associated with an increased risk of mortality (adjusted HR: 1.85, 95% CI: 1.17-2.92, p=0.009).

Conclusions:
CAR-T recipients who experience cardiotoxicity have higher mortality.
Abstract 10147: Temporal Change and Its Determinants of Psychological Symptoms During Hospitalization in Patients with Heart Failure
Authors: Hamatani Yasuhiro , Iguchi Moritake , Akao Masaharu
Published: March 2022

Introduction:
Patients with heart failure (HF) could suffer from psychological symptoms such as anxiety and depression. However, these symptoms are rarely evaluated in hospitalized patients with HF, and may be underrecognized in daily practice.

Methods:
We prospectively evaluated consecutive hospitalized patients with HF at our institution between October 2019 and January 2021 using Hospital Anxiety and Depression Scale (HADS) on admission and at discharge. The HADS consists of 7 questions each for anxiety (HADS-A) and depression (HADS-D), both of which are graded by 0-3. Total scores were categorized as follows; 0-7 indicating no symptoms, 8-10 indicating mild, and 11-21 indicating significant anxiety or depression. Worsening symptoms during hospitalization was defined as that category of HADS at discharge was poorer than that on admission.

Results:
Of 224 (mean age: 77.5±12.4 years, median N-terminal pro B-type natriuretic peptide: 4527 pg/mL and mean left ventricular ejection fraction: 44%), 35 (16%) and 62 (28%) had significant symptoms of anxiety and depression, respectively. During hospitalization, HADS-A significantly decreased, whereas HADS-D did not improve (
Figure
). Worsening anxiety and depression during hospitalization occurred in 19 (10%) and 40 (21%), respectively. In multivariable logistic regression analysis, advanced age (odds ratio [OR]: 1.41, 95% confidence interval [CI]: 1.02-1.94; P=0.02), higher natriuretic peptide level (OR: 1.89, 95% CI: 1.23-2.90; P<0.01) and acute on chronic HF (OR: 3.70, 95% CI: 1.25-11.00; P=0.01) were associated with worsening anxiety, and longer hospitalization length (OR: 2.17, 95% CI: 1.08-4.35; P=0.03) was associated with worsening depression.

Conclusions:
Anxiety and depression were common and depression persisted during hospitalization for HF. We found several risk factors for worsening these symptoms, providing the optimal candidate for psychological care in hospitalized patients with HF.
Abstract 10150: Distinct Gut Microbiota Composition Among Older Adults with Impaired Left Ventricular Diastolic Function
Authors: Wong Jie Jun , Purbojati Rikky W , Tan Ru San , Pettersson Sven , Koh Angela S
Published: March 2022

Introduction:
Recent research has demonstrated shifts in intestinal microbial composition in response to cardiovascular disease (CVD) development. Left ventricular (LV) diastolic dysfunction is an early manifestation of myocardial ageing. We aimed to examine whether gut microbial composition is associated with LV diastolic function among healthy older adults.

Methods:
Among community older adults, 15 subjects with preserved LV ejection fraction on echocardiography underwent gut microbial composition examination in this proof-of-concept cross-sectional study. Myocardial relaxation (diastolic function) was impaired in those subjects with lower ratios of peak early (E) to late diastolic (A, atrial contraction) velocities. Metagenomic reads from stool samples were analyzed after excluding human reference genome data, and classified into various microbial taxonomic groups using lowest-common-ancestor algorithm. Statistical analysis was performed using linear discriminant analysis (LDA).

Results:
The subjects (53% males, mean age 75±4 years) were stratified into Groups 1 (n=8) and 2 (n=7) with more severe and lesser diastolic dysfunction, respectively, based on E/A ratios (0.77 vs. 1.28, p<0.0001). In Group 1, there was significantly higher prevalence of certain bacteria (p<0.05), including Bacteroides sp, Ruminococcus sp., and Paraprevotella (Figure 1). The largest relative effect size was with Bacteroides sp., including Bacteroides xylanisolvens (logarithmic LDA score 3.0). In Group 2, there was significantly higher prevalence (p<0.05) of Oscillibacter sp., Peptostreptococcaceae, Clostridioides difficile, Prevotella timonensis, and Blautia producta. Relative effect size was largest with Oscillibacter sp. (log 2.8).

Conclusions:
Distinct gut microbiota were associated with more severe vs. lesser LV diastolic dysfunction. Future validation in larger cohorts is warranted for targeting the microbiome in myocardial ageing.
Abstract 10151: Association of Polygenic Risk Scores for Pre-Eclampsia and Blood Pressure with Hypertensive Pregnancy Disorders
Authors: Nurkkala Jouko , Kauko Anni , Laivuori Hannele , Tanja Saarela , Tyrmi Jaakko , Cheng Susan , Aittokallio Jenni , Niiranen Teemu
Published: March 2022

Introduction:
Blood pressure (BP) is a known risk factor for pre-eclampsia. We examined whether a BP-polygenic risk score (PRS) as compared with a pre-eclampsia-PRS, could also predict gestational hypertension (GHT), pre-eclampsia, and eclampsia.

Methods:
Our study sample included 116434 genotyped, previously-pregnant participants of the FinnGen cohort who were followed up between 1969-2019. PRSs for systolic BP and pre-eclampsia were derived using UK Biobank summary statistics for >1.1 million single nucleotide polymorphisms.

Results:
We observed 6561 cases of GHT, 5263 cases of pre-eclampsia, and 385 cases of eclampsia. As shown in the Figure, we observed that the BP-PRS was associated with GHT (multivariable-adjusted HR for 1-SD increase in PRS, 1.40; 95% CI, 1.36-1.43; p=9x10
-160
), pre-eclampsia (HR, 1.26 (95% CI 1.23-1.30, p=1.6x10
-63
) and with eclampsia (HR, 1.29 (95% CI, 1.16-1.42, p=8.1x10
-7
), respectively. The pre-eclampsia-PRS was also associated with GHT (HR, 1.09; 95% CI 1.07-1.12, p=1.0x10
-12
) pre-eclampsia (HR, 1.09; 95% CI, 1.06-1.12, p=2.2x10
-10
) and eclampsia (HR, 1.12, 95% CI, 1.02-1.24, p=0.023), although these associations were more modest. The model c-statistic for incident pre-eclampsia increased from 0.544 to 0.591 (95% CI for difference, 0.022-0.034, p<1x10
-300
) when BP-PRS was included in a model with pre-eclampsia-PRS.

Conclusions:
Our study confirms that the increased risks for developing GHT, pre-eclampsia and eclampsia are strongly associated with genetic factors related to BP. A BP-PRS seems to be an even stronger predictor of hypertensive pregnancy complications than a pre-eclampsia-PRS. Our results suggest common pathways for the development of these diseases that need to be further investigated.
Abstract 10152: ST-Elevation Myocardial Infarction Induced by Acute Occlusion of an Ostial Left Intermammary Artery Graft Occurring 13 Years After Coronary Artery Bypass Graft Surgery
Authors: Sonoda Taketo , Wada Hideki , Ogita Manabu , SUWA Satoru , Minamino Tohru
Published: March 2022

The left intermammary artery (LIMA) graft is commonly used in coronary artery bypass grafting (CABG) to left anterior descending (LAD) because of its superior long-term patency. Acute occlusion of the LIMA causing ST-elevation myocardial infarction (STEMI) in the late postoperative period is rare, and its pathological mechanism is unclear. We present a case of acute occlusion of the LIMA in a 87-year-old woman who underwent CABG surgery 13 years previously. She was transferred to our hospital because of acute chest pain. Electrocardiography showed ST-elevation in anterior leads. Emergency coronary angiography revealed total occlusion of proximal LAD segment and the ostial LIMA (Figure). Therefore, we judged that the LIMA occlusion was causing anterior STEMI, and performed emergency percutaneous intervention. We successfully implanted a drug eluting stent at the culprit lesion and final angiography showed good reperfusion. Although the LIMA graft is expected long-term patency, early recognition of the possibility of LIMA occlusion might be necessary in patients with AMI after CABG surgery.
Abstract 10157: Incremental Medical Expenditure and Effectiveness of Early Non-invasive Cardiac Testing in Suspected Acute Coronary Syndrome
Authors: Kawatkar Aniket , Sharp Adam , Baecker Aileen , Redberg Rita F , Lee Mingsum , Ferencik Maros , Wu Yi-Lin , Shen Ernest , zheng chengyi , Musigdilok Visanee , Goodacre Steve , Thokala Praveen , Sun Benjamin
Published: March 2022

Introduction:
The relationship between medical expenditure and long-term effectiveness of early (within 72 hours) non-invasive cardiac stress testing (NIT) in reducing future acute myocardial infraction (AMI) is not well understood. We estimated the value of early NIT after an emergency department (ED) evaluation for suspected acute coronary syndrome (ACS).

Methods:
This was a retrospective cohort study of adult (18+) patients with chest pain, presenting at EDs within the Kaiser Permanente Southern California health system from 10/2015-12/2018. We analyzed the direct medical expenditure associated with medical office visits, hospital facility and ED visits, pharmacy utilization, hospice stays, skilled nursing stays, home health, dialysis, laboratory and radiology utilization during the one year following the index chest pain ED visit. We also identified incidence of AMI during the 1-year follow-up. We used 2-stage residual inclusion instrumental variables (IV) techniques to evaluate the marginal effect of early NIT on total all cause expenditure as well as subgroups of utilization. We used control functions IV techniques to evaluate the marginal effect of NIT on AMI and calculated the number needed to treat (NNT) as the inverse of the absolute risk reduction. All models adjusted for socio-demographics, cardiovascular disease (CVD) history and treatment and non-CVD comorbidities.

Results:
The cohort included 91250 patients (mean age 58 years, female 58%) and 19% received early NIT. The marginal difference in total expenditure between the early NIT vs controls was $2,583 (95% CI $591 to $4,575) and was mainly related to the index ED visit (Table 1). Those who received early NIT had slightly lower risk of AMI during the 1-year follow-up (risk reduction 1.3% (-1.9% to -0.7%) resulting in NNT of 75.

Conclusions:
Early NIT offers minor risk reduction of AMI but with an increase of $2583 in expenditure. With a NNT of 75, the cost to avoid one AMI is estimated to be $193,725.
Abstract 10158: Clinical Features and Outcome-Predictors of Patients with Out-of-Hospital Cardiac Arrest Complicating Acute Myocardial Infarction
Authors: Sonoda Taketo , Wada Hideki , Ogita Manabu , TAKAHASHI DAIGO , nishio ryota , Yasuda Kentaro , Takeuchi Mitsuhiro , Shoichiro Yatsu , Shitara Jun , Shuta Tsuboi , Tomotaka Dohi , SUWA Satoru , MIYAUCHI Katsumi , Minamino Tohru
Published: March 2022

Background:
Although short-term mortality of acute myocardial infarction (AMI) has decreased dramatically, sudden cardiac arrest is still one of serious complication. We assessed the clinical characteristics and prognosis’ predictors of AMI patients with out-of-hospital cardiac arrest (OHCA).

Methods:
We retrospectively analyzed consecutive patients with AMI who were treated with emergency percutaneous coronary intervention between 2004 and 2017. Patients with OHCA were compared with those without OHCA.

Results:
Among 2,101 AMI patients, 95 (4.7%) presented OHCA. Younger age (odds ratio [OR]: 0.95; 95% confidence interval [CI]: 0.93-0.97; p<0.0001), absence of coronary risk factors such as, diabetes mellitus (OR: 0.51; 95% CI: 0.30-0.85; p=0.01) or dyslipidemia (OR: 0.56; 95% CI: 0.36-0.88; p=0.01), left main trunk (LMT) and left anterior descending artery (LAD) as culprit lesion (OR: 3.26; 95% CI: 1.99-5.33; p<0.0001), and renal deficiency (OR: 3.64; 95% CI: 2.27-5.84; p<0.0001) were significantly associated with incidence of OHCA. The 30-day mortality of patients with OHCA was more than 5-hold higher compared with those without OHCA (32.6% vs. 4.5%, p<0.0001). In multivariate logistic regression analysis, LMT or LAD as culprit lesion (OR: 12.18; 95% CI: 2.27-65.41; p=0.04), glucose level (OR: 1.01; 95% CI: 1.00-1.01; p=0.01) and renal deficiency (OR: 3.35; 95% CI: 1.07-10.53; p=0.04) were found as independent predictors of 30-day mortality among AMI patients with OHCA.

Conclusions:
About 1 of 20 AMI patients presented with OHCA and younger age, absence of coronary risk factors, and anterior wall infarction were associated with OHCA occurrence.
Abstract 10161: Predicting Life-Threatening Ventricular Arrhythmias in Patients with Non-Ischemic Dilated Cardiomyopathy Using Electrocardiogram-Based Deep Neural Networks
Authors: Sammani Arjan , Leur Rutger R , Meine Mathias , Loh Peter , Hassink Rutger J , Oberski Daniel L , Henkens Michiel T , Heymans Stephane , Doevendans Pieter , te Riele Anneline S , van Es Rene , Asselbergs Folkert W
Published: March 2022

Introduction:
Patients with non-ischemic DCM are at risk of life-threatening ventricular arrhythmias. Improved patient selection for ICD implantation is warranted. Deep neural networks (DNN) can discover complex ECG features without the need for hand-crafted feature extraction. This study aimed to distinguish patients at risk of arrhythmias and detect and visualize ECG characteristics that attribute to the DNN classification.

Methods:
We trained a DNN model on baseline raw ECG samples of adult patients with DCM for the composite outcome of sustained ventricular arrhythmia, (aborted) sudden cardiac death and appropriate ICD therapy in the University Medical Centre Utrecht. Gradient-Weighted Class Activation Mapping was used for visual interpretation of the network. DNN performance was validated both internally and in an external cohort from the Maastricht University Medical University Center.

Results:
26.628 ECGs were used for pre-training the network. In total, 317 patients with DCM were included in the primary cohort with a median age of 52 years (IQR 42 - 61), median LVEF of 25% (IQR 20-33), NYHA II and III (32% and 25%). 233 patients were ICD recipients. Subsequently 84 patients reached the outcome (median follow-up duration of 3.96 years (IQR 1.94 - 7.00)). The DNN focused on subtle but predictive differences in the terminal QRS-segment, the T-wave, and the P-wave (figure). The AUC of the DNN was 0.70 in cross-validation. External validation was similar, with an AUC of 0.66.

Conclusion:
In this study we trained and validated a deep neural network for prediction of life-threatening arrhythmic events. Even though the discriminatory changes on ECG segments were very subtle, the trained DNN was able to predict life-threatening events, focusing on the terminal QRS-segment, the T-wave, and the P-wave. Future studies are warranted to elucidate the identified ECG abnormalities and understand their electrophysiological substrates for LTA prediction in DCM.
Abstract 10173: Risk Factors of Cardiovascular Disease in Breast Cancer Patients
Authors: Kawatkar Aniket , Baecker Aileen , Lee Mingsum , Chao Chun , Ryoo Joan , zheng chengyi , Redberg Rita F
Published: March 2022

Introduction:
Cardiovascular disease (CVD) events during cancer treatment can interfere with the delivery of curative therapy. In adult cancer survivors, CVD mortality is second only to cancer recurrence related mortality. We evaluated the demographic and clinical risk factors of CVD in breast cancer patients.

Methods:
A retrospective cohort study was conducted at Kaiser Permanente Southern California (KPSC) health system. We identified adult members (18+) diagnosed with primary breast cancer from 01/2000-12/2019 using the KPSC cancer registry. We only included patient who had at least one year of continuous health plan enrollment prior to their cancer diagnosis to determine risk factors status and to ensure they did not have any history of CVD (defined as cardiac arrest, cardiomyopathy, congestive heart failure, coronary atherosclerosis, heart valve disorders, myocardial infarction, ventricular fibrillation, dysrhythmias or stroke) prior to their cancer diagnosis. We evaluated the association of age at cancer diagnosis; race; ethnicity; obesity; cancer stage; and history of depression, drug abuse, renal failure, liver disease, lipid disorder, diabetes and hypertension using a proportional hazard model. All patients were followed from their cancer diagnosis to the earliest date of CVD (failure event) diagnosis or death or health plan disenrollment or end of study (12/2020).

Results:
In the cohort of 36,840 patients (Table 1), 11,993 (33%) had a CVD diagnosis during follow-up (average follow-up 5.3 years). The hazard rate of CVD increased significantly with age. Distant metastatic disease was associated with 7-fold higher CVD hazard as compared to in-situ cancer. Most other clinical factors significantly increased the hazard rate (Table 1).

Conclusions:
In breast cancer patients naïve to CVD disease prior to cancer diagnosis, the hazard rate of CVD post cancer diagnosis is significantly higher in older individuals and those with metastatic disease.
Abstract 10175: An Artificial Intelligence-Based Smartwatch Ecg Analysis Improves the Detection of Atrial Arrhythmia
Authors: Fiorina Laurent , Chemaly Pascale , Cellier Joffrey , Younsi Salem , Ait Said Mina , Salerno Fiorella , Horvilleur Jerome , Lacotte Jerome , Manenti Vladimir , Henry Christine , Gardella Christophe , Lefebvre Baptiste
Published: March 2022

Introduction:
Smartwatch ECGs (SW-ECG) have been identified as a noninvasive solution to assess abnormal heart rhythms, especially atrial arrhythmias (AA) which are related to stroke risk. This study assesses the detection of AA with the Apple Watch and compares the accuracy of two algorithms, the original companion application (ECG 1.0 App) and a novel deep neural network (DNN), in a population typical of an electrophysiology department.

Hypothesis/Objective:
To determine if a novel DNN can improve the detection of AA on SW-ECGs.

Methods:
146 simultaneous pairs of 12-lead ECGs (GE Mac 2000 or Mindray BeneHeart R12) and SW-ECGs have been collected on 144 patients from the electrophysiology department of one tertiary center. 12-lead ECGs were adjudicated by an expert electrophysiologist as 40 AA and 106 not AA and considered as ground truth. The SW-ECGs were processed by the ECG 1.0 App and the DNN in parallel. The proportions of inconclusive diagnoses returned and the performances were assessed and compared.

Results:
Overall, the ECG 1.0 App yielded inconclusive diagnoses for 25% (37/146) of all SW-ECGs while the DNN reduced that number to 1% (2/146). After excluding SW-ECGs with an inconclusive diagnosis (37/146), the ECG 1.0 App and the DNN had a sensitivity of 62% (95% CI, 55%-70%) and 96% (95% CI, 93%-99%) respectively, and both had a specificity of 95% (95% CI, 92%-99%).

Conclusions:
A novel DNN improved the performance for the detection of AA. It reduced the burden of inconclusive diagnostics by 24% and improved the sensitivity by 34% with no change in specificity. Routine application of this SW-ECG analysis offers significant promise in arrhythmia diagnosis. Further investigations are needed to assess the classification of atrial arrhythmias more precisely.
Abstract 10176: Absolute Perfusion Increase in Remote Myocardium Following Chronic Total Coronary Occlusion Percutaneous Coronary Intervention
Authors: de Winter Ruben W , Schumacher Stefan P , van Diemen Pepijn A , Jukema Ruurt A , Somsen Yvemarie B , Stuijfzand Wijnand J , Driessen Roel S , Bom Michiel J , Everaars Henk , Van Rossum Albert C. C , van de Ven Peter M , Verouden Niels J , Danad Ibrahim , Raijmakers Pieter G , Alexander Nap , Knaapen Paul
Published: March 2022

Introduction:
Successful revascularization of a chronic total coronary occlusion (CTO) impacts coronary physiology of the remote myocardial territory. This study evaluated the impact of CTO percutaneous coronary intervention (PCI) on absolute perfusion in remote myocardium.

Methods:
A total of 164 patients underwent serial [
15
O]H
2
O positron emission tomography (PET) perfusion imaging at baseline and 3 months after successful CTO PCI to evaluate changes in hyperemic myocardial blood flow (hMBF) and coronary flow reserve (CFR) in remote myocardium subtended by non-target collateral donor coronary arteries.

Results:
Absolute perfusion indices in the CTO and remote myocardium showed a positive linear correlation before (hMBF: r=0.75, p<0.01; CFR: r=0.77, p<0.01) and after (hMBF: r=0.87, p<0.01; CFR: r=0.81, p<0.01) CTO PCI. An increase in absolute myocardial perfusion (hMBF: 2.29±0.67 to 2.48±0.75 mL·min
-1
·g
-1
, p<0.01; CFR: 2.48±0.76 to 2.74±0.85, p<0.01) was observed in the remote myocardial territory between baseline and follow-up. Improvements in remote myocardial perfusion were largest in patients with higher increases in hMBF (β 0.55, 95% CI: 0.46-0.64, p<0.01) and CFR (β 0.52, 95% CI: 0.43-0.61, p<0.01) in the CTO territory, independent of clinical, angiographic and procedural characteristics. Furthermore, lower baseline (hMBF: p<0.01; CFR: p<0.01) and higher post-PCI perfusion (hMBF: p<0.01; CFR: p<0.01) in both the remote and CTO territory were associated with larger perfusion increases in remote myocardium.

Conclusions:
Baseline and post-PCI perfusion indices in remote and CTO myocardium were positively correlated. An overall increase in remote myocardial perfusion was observed following CTO PCI and the absolute perfusion increase in the CTO territory was an independent predictor of remote myocardial perfusion improvement. Successful CTO PCI impacts coronary hemodynamics in the closely interlinked CTO and remote myocardium.
Abstract 10188: Sotatercept Phase 3 Program Design and Rationale: A Novel Treatment for Pulmonary Arterial Hypertension
Authors: Preston Ioana R , Badesch David , Ghofrani H A , Gibbs Simon , Gomberg-maitland Mardi , Hoeper Marius , McLaughlin Vallerie , Souza Rogerio , Waxman Aaron B , Miller Barry , Lu Jonathan , Butler John , Humbert Marc
Published: March 2022

Introduction:
PAH is characterized by pulmonary vascular remodeling and right ventricular dysfunction. Sotatercept acts as a reverse remodeling agent proposed to rebalance anti- and pro-proliferative signaling based on pre-clinical models of PAH. Clinical efficacy and safety of sotatercept are being studied in the Phase 2 PULSAR and SPECTRA studies. Sotatercept will be further investigated in a Phase 3 clinical program comprised of 4 studies to establish efficacy, safety, and its potential value on top of background therapy across the spectrum of PAH.

Methods:
Sotatercept will be administered at a starting dose of 0.3 mg/kg, with a target dose of 0.7 mg/kg, subcutaneously every 21 days. All participants will be on background PAH therapy. The efficacy/safety of sotatercept in patients with WHO FC II/III will be assessed in STELLAR (NCT04576988), a double-blind, placebo-controlled, randomized study. The primary endpoint is change in 6MWD from baseline to week 24. A secondary endpoint is multicomponent improvement (MCI), defined as meeting all the following at week 24 vs baseline: ≥30m increase in 6MWD, decrease in NT-proBNP ≥30% or maintenance/achievement of <300 ng/L, and WHO FC improvement or maintenance of WHO FC II. The effects of sotatercept on PAH patients diagnosed within 6 months of screening, with WHO FC II/III, and at intermediate- and high-risk will be studied in HYPERION (NCT04811092), a randomized, double-blind, placebo-controlled study with a primary endpoint of time to clinical worsening. Sotatercept will also be assessed in PAH patients with WHO FC III/IV at high-risk in ZENITH (NCT04896008), a double-blind, placebo-controlled, randomized study evaluating time to first confirmed morbidity or mortality event. Participants transitioning from parent PAH sotatercept clinical studies will further be evaluated for long term safety/tolerability in SOTERIA (NCT04796337), a long-term follow up study.

Results:
HYPERION, ZENITH and SOTERIA are active, and STELLAR is recruiting, with a target enrollment of 284 participants.

Conclusion:
The robust Phase 3 clinical program has the potential to further characterize the efficacy and safety of sotatercept across a broad spectrum of patients with PAH and provide a novel treatment option.
Abstract 10196: A History of Dengue Infection is Associated with Lower Global Longitudinal Strain by Speckle Tracking Echocardiography in Men from the Amazon Basin
Authors: Kaagaard Molly D , Wegener Alma , Gomes Laura C , Holm Anna Engell , Lima Karine O , Matos Luan O , Vieira Isabelle , Souza Rodrigo , Marinho C , B-S T , ms o , Brainin Philip
Published: March 2022

Background:
Studies have shown that infection with dengue virus may affect the heart in the acute phase, and that men possibly have a higher risk of severe dengue complications. No studies have investigated if dengue infection also may affect long-term cardiovascular function.

Hypothesis:
We hypothesized that adults from the general population with a self-reported history of dengue infection had lower myocardial strain compared to controls. Furthermore, that strain could be even lower in men with a history of dengue.

Methods:
We enrolled individuals from the general population in the Amazon Basin. History of self-reported dengue infection and cardiovascular risk factors were collected by questionnaires. All persons underwent physical examination and bedside echocardiography. We analyzed global longitudinal strain (GLS) and circumferential strain (GCS).

Results:
We included 529 individuals (mean age 39±15 years, 39% men) of which 49% (n=259) had a history of dengue infection. A history of dengue infection was not associated with lower GLS (Figure A). However, when stratifying the population by sex, dengue infection in men was significantly associated with lower GLS (OR 1.13 per 1% decrease [95%CI 1.02 to 1.24], P=0.014) and GCS (OR 1.06 per 1% decrease [95%CI 1.01 to 1.12], P=0.030), whereas no relationship was found for women (Figure A). In multivariable models adjusted for age, blood pressure, heart rate, creatinine, smoking habits, diabetes and income, the association with GLS (OR 1.13 [95%CI 1.02 to 1.25], P=0.016) and GCS (OR 1.07 [95%CI 1.01 to 1.14], P=0.015) remained significant in men (Figure B and C). We found no significant relationship with left ventricular ejection fraction.

Conclusion:
Dengue may potentially have long term effects on left ventricular systolic function as measured by strain in men. This calls for further studies to assess long-term cardiac sequelae and subclinical myocardial impairment in individuals with a history of dengue.
Abstract 10201: Efficacy of Mavacamten in Patients with Symptomatic Hypertrophic Cardiomyopathy: Sub-Group Analyses by Background Beta-Blocker Use from the EXPLORER-HCM and MAVA-LTE Studies
Authors: Jacoby Daniel L , Wheeler Matthew T , Elliott Perry M , Saberi Sara , Sehnert Amy J , Edelberg Jay M , Li Wanying , olivotto iacopo
Published: March 2022

Introduction:
Mavacamten, a selective inhibitor of cardiac myosin, improved symptoms and exercise capacity (pVO
2
) in adults with obstructive hypertrophic cardiomyopathy (oHCM) (EXPLORER-HCM; NCT03470545). Improvements in pVO
2
were observed regardless of whether patients were receiving beta-blockers (BB), but were greater in those not receiving BB. To examine whether BB lessen the effect of mavacamten on other parameters such as function, echocardiographic parameters, biomarkers and symptoms further sub-group analyses of EXPLORER-HCM and the mavacamten long-term extension (MAVA-LTE; NCT03723655) studies were conducted.

Methods:
In the phase 3, placebo-controlled EXPLORER-HCM trial, randomization was stratified by BB usage, and pre-specified sub-group analyses were performed. MAVA-LTE is an ongoing study evaluating long-term mavacamten dosing in patients with HCM who completed EXPLORER-HCM or MAVERICK. Sub-group analyses by BB usage for the same endpoints, if available, were performed post hoc including only patients with oHCM.

Results:
Results are shown in the Table. In EXPLORER-HCM, the majority of patients not taking BB received non-dihydropyridine calcium channel blockers (mavacamten [25/29 patients] or placebo [17/33]); this trend continued in MAVA-LTE. In EXPLORER-HCM, the mean change from baseline in pVO
2
was lower in the sub-group using BB (1.1 ml/kg/min) vs not using BB (2.2 ml/kg/min), while the heart rate-independent parameter, VE/VCO
2
slope (ventilatory efficiency), improved similarly in both groups (-2.4 vs -2.7). Improvements in symptoms (NYHA Class, KCCQ-CSS), LVOT gradients, LAVI, and biomarkers (NT-proBNP and cTnI) were similar between subgroups across both studies.

Conclusion:
In EXPLORER-HCM, the reduced effect of mavacamten on pVO2 in BB users is likely due to the effect of BB on heart rate response during exercise. Mavacamten benefits were observed across a range of clinically meaningful parameters regardless of BB use.
Abstract 10207: Association Between Age and the Von Willebrand Factor-ADAMTS13 Axis in Patients with ST-Elevation Myocardial Infarction
Authors: Osawa Takumi , Koizumi Tomomi , Nakano Koji , Yamada Yu , Abe Yuto , Ito Yuta
Published: March 2022

Introduction:
The incidence of arterial thrombosis increases with age, but its underlying mechanisms are unclear. Myocardial infarction is associated with increased von Willebrand factor (VWF) and decreased a disintegrin-like and metalloproteinase with thrombospondin type-1 motif 13 (ADAMTS13) levels. We aimed to examine the relationship between the VWF-ADAMTS13 axis and age in ST-elevation myocardial infarction (STEMI).

Methods:
Patients who underwent endovascular arterial recanalization for STEMI or acute ischemic stroke (AIS) and had aspirated thrombi at our institute between June 2019 and August 2020 were enrolled. Seventy-one patients were divided into two age groups—<65 years (n = 23) and ≥65 years (n = 48). The ADAMTS13 and VWF antigen levels were evaluated.

Results:
Among all patients (STEMI and AIS), ADAMTS13 levels were significantly lower in the ≥65 years group than in the <65 years group (0.77 ± 0.16 vs. 0.67 ± 0.16 U/mL, p = 0.024). The VWF antigen/ADAMTS13 levels were significantly higher in the ≥65 years group (319 ± 223 vs. 359 ± 160, P = 0.032). Among patients with STEMI, compared to the <65 years group, the ≥65 years group had significantly lower ADAMTS13 levels and a significantly higher VWF antigen-ADAMTS13 ratio. Among patients with AIS, there were no significant differences in ADAMTS13 and WVF antigen levels and VWF antigen-ADAMTS13 ratio between the <65 and the ≥65 years groups.

Conclusions:
Our study demonstrated low ADAMTS13 levels in elderly patients with STEMI, but not in those with AIS. The VWF-ADAMTS13 axis may be more involved in the pathogenesis of STEMI than in that of AIS among elderly patients.
Abstract 10208: Quantitative Comparison of Ablation Area Created by the Conventional- and Larger-Sized Visually Guided Laser Balloon
Authors: Yamasaki Takashi , Hattori Tetsuhisa , Pak Misen , Kakita Ken
Published: March 2022

Introduction:
The visually guided laser balloon (VGLB) ablation catheter has been designed to facilitate pulmonary vein (PV) isolation in patients with atrial fibrillation (AF). Because VGLB is characterized by a compliant and variable diameter balloon, the balloon at the larger inflation size can isolate wider-area circumferential PV antrum. Though the importance of a wider circumferential isolation of PVs, which includes a large portion of the left atrial posterior wall (LAPW), has been suggested in several studies, the extension of the isolation area created by the new VGLB technique remains to be elucidated. We report the quantitative examination of the isolation areas after the conventional- and larger-sized VGLB ablation.

Methods:
Fifty-five patients with AF who underwent VGLB ablation were enrolled in this prospective study. An electroanatomic map of the left atrium was obtained with the PENTARAY catheter and the CARTO-3 system before and after PV isolation using conventional-sized VGLB. The isolation areas were extended by the larger-sized VGLB ablation and remapped in the same way. As demonstrated in figure, the isolation areas were measured after each ablation.

Results:
After PV isolation using the conventional-sized VGLB, the mean left- and right-sided antral PV surface areas of ablation were 13.5±2.9 cm
2
and 16.4±3.7 cm
2
, respectively. The total area of LAPW ablation was 10.9±2.1 cm
2
(45.6±9.3% of the posterior wall). On the other hand, they were 18.6±4.0 cm
2
, 23.7±5.2 cm
2
and 16.3±2.8 cm
2
(65.9±11.2%) after ablation with the larger-sized VGLB. These results revealed that the new VGLB technique yielded statistically greater areas of isolation than the conventional-sized VGLB.

Conclusions:
The larger VGLB ablation technique can create a significantly wider antral PV and LAPW isolation than the conventional-sized VGLB. The resulting LAPW debulking may be greater than the other balloon-based ablation lesions that have been reported previously.