bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 8999: Impact of Coronavirus 2019 on Pediatric and Adult Heart Transplantation Waitlist Activity and Mortality in the United States
Authors: Ashfaq Awais , Gray Geoffrey , Carapellucci Jennifer , Amankwah Ernest K , Ahumada Luis M , PUCHALSKI Michael , Smith Andrew , Rehman Mohamed , Quintessenza James A , Asante-Korang Alfred
Published: April 2022

Introduction:
Transplant centers saw a reduction in solid organ transplantation since the beginning of the coronavirus 2019 (COVID-19) pandemic in the United States. Limited data exists on the impact of COVID-19 on pediatric heart transplant volume and variation in transplant practices. We hypothesized that pediatric heart transplant activity decreased during COVID-19 with associated increased waitlist mortality.

Methods:
The United Network for Organ Sharing (UNOS) database was used to identify waitlisted patients from 2017-2020. Regional and Statewide data was obtained from US Census Bureau. CovidActNow project was used for Covid-19 mortality rates.

Results:
Among pediatric patients, average time on the waiting list decreased by 28 days. Even though the average number of pediatric transplants (n=39) did not change during 2020, there was a temporal decline in the first quarter followed by an increase. Overall pediatric waitlist mortality decreased from 5.31 to 4.73, however female mortality increased by 2%. Regional differences in pediatric mortality included: Northeast, decreased by 7.5%; Midwest, decreased by 9%; West, increased by 3.5%; and South, increased by 13%. North Dakota (0.55), Oklahoma (0.21) and Hawaii (0.33) showed higher mortality per 100,000 than other states. In adults, average time on waiting list increased by 40 days and there was an increase in the number of transplants from 242.06 to 266.09. Adult waitlist mortality had a larger decrease from 18.44 to 15.70 with increase in female mortality of 7%. Regional differences in adult mortality included: Northeast, decreased by 3%; Midwest, increased by 5.5%; West, increased by 4.5% and South, decreased by 5%. Iowa (0.37), Wyoming (0.22), Arkansas (0.18) and Vermont (0.19) had higher mortality per 100,000 than other states .

Conclusions:
Pediatric heart transplant volume declined in early 2020 followed by an increase, while transplant volume in adults increased. Although, overall waitlist mortality for pediatrics decreased, female waitlist mortality increased. Regional differences in waitlist mortality were also observed. Future studies are needed to understand this initial correlation and to determine the impact of COVID-9 on heart transplant recipients.
Abstract 9407: Health Related Quality of Life in the Spironolactone to Reduce Icd Therapy (SPIRIT) Trial
Authors: Sauer Liberato Ana Carolina , Raitt Merritt , Zarraga Ignatius G , MacMurdy Karen , Dougherty Cynthia M
Published: April 2022

Introduction:
The
Spi
ronolactone to
R
educe
I
CD
T
herapy (SPIRIT) trial was designed to determine if once daily spironolactone would: 1) reduce the incidence of ventricular tachycardia (VT) and ventricular fibrillation (VF), and 2) improve health related quality of life (HRQOL) and symptoms over 24 months. The
purpose
of this study is to describe the long term HRQOL outcomes in the SPIRIT trial and compare QOL and symptoms in those who did or did not receive implantable cardioverter defibrillator (ICD) shocks.

Hypothesis:
Patients taking spironolactone would have higher HRQOL and fewer symptoms than those taking placebo.

Methods:
The SPIRIT trial was a RCT comparing spironolactone at 25 mg qd to placebo in determining impact on incidence of VT and VF and HRQOL in patients at high risk for ICD shocks. Patients were randomized to spironolactone (N=44) or placebo (N=46) and followed for 24-months. HRQOL was measured every 6 months for 24 months using 3 instruments: Patient Concerns Assessment (PCA), Short Form Health Survey-Veterans Version (SF-36V), and the Kansas City Cardiomyopathy Questionnaire (KCCQ). Linear mixed modeling was used to compare changes in HRQOL across 24-months. ANCOVA was used to compare HRQOL and symptoms between those getting an ICD shock or not. The study was conducted in the Veterans Administration (VA) health system.

Results:
Over 24-months, 90 patients age 66
+
10 years, 96% men, 75% with NYHA class II, with an ICD at moderately high risk for recurrent VT/VF participated. The spironolactone group received an average of 7.9
+
12.1 ICD shocks, while the placebo group received 6.8
+
14.9 ICD shocks, p=NS. There were no differences in HRQOL or symptoms between the spironolactone vs. placebo groups. The placebo group reported a lower number of symptoms over time (F=3.99, p=0.05). Those who experienced at least 1 ICD shock vs. those with no ICD shocks, reported significantly lower HRQOL (SF36V MCS, F=8.66, p=0.004) and more symptoms (PCA, F=14.5, p<0.001) at 6-months and 24 months (PCA, F=9.61, p=0.003; KCCQ overall summary, F=8.68, p=0.005).

Conclusions:
Spironolactone had no significant impact on HRQOL or symptoms over time. Patients receiving one or more ICD shocks reported significant reductions in HRQOL and higher symptoms over 24 months.
Abstract 9408: Serum and Urine Osmolality as Predictors of Adequate Diuresis in Acute Decompensated Heart Failure: A Prospective Cohort Study
Authors: Salacup Grace , Lo Kevin , Pelayo Jerald , Putthapiban Prapaipan , Torres Ricardo , Naranjo Mario , Rangaswami Janani
Published: April 2022

Introduction:
The utility of serum and urine osmolality in evaluating decongestion and outcomes in heart failure (HF) remain understudied.

Methods:
This is a prospective cohort single center study of patients with acute HF on intravenous diuretics > 18 years old, with BNP > 100 pg/mL or echocardiographic finding of reduced ejection fraction or diastolic dysfunction, and at least 1 symptom of volume overload. Patients with eGFR≤45mL/minute or on dialysis, and with exposure to contrast dye or nephrotoxins were excluded. Serum and urine osmolality were obtained daily for 5 days or until discharge. Wilcoxon signed-rank test was used to check for differences in serum and urine osmolality on admission and on discharge. Mann Whitney U test compared osmolality values between those with and without readmissions. ROC curve and Youden’s index were used to analyze the optimal cut-offs for the osmolality values in the prediction of readmissions.

Results:
A total of 100 hospitalized patients were included. Majority were males (62%) and African American (59%). The mean age was 64.41±12.53 with co-morbidities of hypertension (86%), diabetes (43%), coronary artery disease (39%), and heart failure with preserved ejection fraction (34%). The inpatient mortality rate was 3%, with 6% and 16% 30-day and 60-day readmission rates respectively. Patients with 30-day readmission had higher serum osmolality on admission (305 [299-310] vs 298 [294-303] p=0.044) and had higher drop in serum osmolality between admission and discharge (-7.5 [-9.0 - -1.25] vs -1.0 [-4.0 - 4.0]) [p=0.044]. Serum osmolality on admission of >299 mOsm/kg (sensitivity: 83%, specificity: 61%) and drop in serum osmolality between admission and discharge of >2 mOsm/kg (sensitivity: 83%, specificity: 65%) was associated with 30-day readmissions.

Conclusions:
Measurement of serum osmolality and urine osmolality may have some utility in the management of acute heart failure.
Abstract 9413: Quality Improvement for Improving Awareness of Cardiac Amyloidosis Among Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement (TAVR)
Authors: Lee Dae Hyun , Khadilkar Arjun , Wheeler Rosalind , Bishop jennifer , Mohanty Bibhu D , MATAR FADI , Bezerra Hiram , Oliveira Guilherme H , Fernandez Joel
Published: April 2022

Introduction:
Transthyretin cardiac amyloidosis (ATTR-CM) is an important comorbidity associated with aortic stenosis. Multiple studies have shown that the prevalence of ATTR-CM in severe AS is 15-20%. Concomitant AS and ATTR-CM confers worse outcomes than lone AS.

Hypothesis:
The purpose of this quality improvement project is to raise awareness of ATTR-CM in patients TAVR amongst the provider and patients.

Methods:
We retrospectively reviewed TAVR cases performed at our institution in 2019 (Total cases 87). We interrogated the presence of predefined high-risk features for ATTR-CM based on prior literature and guidelines. We subsequently contacted the identified subjects to discuss our suspicion of ATTR-CM and offered clinical referral to a cardiac amyloid specialist.

Results:
Of the total of 87 patients who underwent TAVR in 2019, 12 patients were deceased at time of chart review. We reviewed 75 patient medical records, of which 50 patients (66.7%) had high-risk features of ATTR-CM. Total of 19 patients (38%) agreed to being referred to a cardiac amyloid specialist. In addition, 7 more patients were found to be deceased on phone call (total 19 patients deceased), 18 patients could not be reached, and 6 patients declined referral.

Conclusions:
Comprehensive risk assessment approach in patients with severe AS may disclose otherwise unsuspected ATTR-CM and allow earlier diagnosis and treatment. These findings served as the basis for implementation of a prospective screening process for ATTR-CM utilizing pyrophosphate nuclear scanning in select patients referred for TAVR in our institution.
Abstract 9422: Assessment of Cardiotoxicity Following Thoracic Radiotherapy and Systemic Stem-Cell Derived Extracellular Vesicle Treatments
Authors: Badiyan Ramin , Montay-Gruel Pierre , Batra Anjan S , Limoli Charles
Published: April 2022

Introduction:
Radiotherapeutic management of certain cancers provides distinct benefits, but also results in variable degrees of cardiac exposure. Resultant radiation-induced heart disease (RIHD) typically manifests at protracted post-irradiation times and can involve a wide range of underlying pathologies including heart failure. Past work from our lab has identified an intervention involving systemic administration of human embryonic stem cell (hESC) derived extracellular vesicles (EV) shown to resolve radiation-induced lung disease (RILD). However, potential treatment-associated complications to the heart were not investigated.

Hypothesis:
In this study, we hypothesized that 1) radiation would cause a certain level of heart dysfunction, and 2) that stem cell-derived EV would not further confound RIHD.

Methods:
Separate cohorts of control (no radiation +/- EV) and treated (radiation +/- EV) mice were implemented in this study. For the treatment groups, mice were subjected to a single dose of image guided thoracic irradiation (14 Gy) and then systemically injected with hESC-derived EV at different time points. Echocardiography was performed in 4 cohorts (n=46); control arm (n=9), radiation alone arm (n=24), EV alone arm (no radiation) (n=5) and toxicity control arm involving 4 EV doses at weeks 0, 1, 2, 3) (n=8). The following parameters were compared between the 4 cohorts: E/A ratio, ejection fraction (EF), shortening fraction (SF), left ventricular mass (LV mass), end diastolic volume (EDV).

Results:
Radiation caused statistically significant lower E/A ratios compared with mice that did not receive radiation, with non-significant changes in other key indicators of cardiac function. Importantly, EV treatments had no effect on E/A ratio or any other indices of cardiac function among the different cohorts.

Conclusions:
Irradiated mice had lower E/A ratios but EF was unchanged, suggesting that thoracic exposures compromised diastolic function without impacting EF. Diastolic dysfunction was most likely linked to increased radiation-induced fibrosis and myocardium stiffness. Importantly, EV treatments were not observed to adversely impact cardiac function, pointing to the safety of this potential intervention for RILD.
Abstract 9425: Coronary Artery Calcium Measurement and Prediction of Cardiovascular Disease by Different Ct Scanner Types: The Multi-Ethnic Study of Atherosclerosis
Authors: Bhatia Harpreet S , Thomas Isac C , Denenberg Julie , Allison Matthew A , McClelland Robyn , Budoff Matthew J , McVeigh Elliot , Criqui Michael H
Published: April 2022

Introduction:
Coronary artery calcium (CAC) scoring is a powerful tool for cardiovascular disease (CVD) risk prediction. The Agatston score weighs lesion area upward for density, and is consistent across computed tomography (CT) scanner type. Considering volume and density separately improves risk prediction, but has not been evaluated by CT scanner type.

Hypothesis:
Our hypothesis was that the predictive value of volume and density scoring would be superior to the Agatston score across CT scanner types.

Methods:
We used data from MESA (Multi-Ethnic Study of Atherosclerosis), a prospective cohort study of participants free of baseline clinical cardiovascular disease. CAC was measured using either EBCT (electron beam CT) or MDCT (multi-detector CT). We compared risk prediction for coronary heart disease (CHD) and CVD events using the Agatston method and the volume and density scores by scanner type using Cox proportional hazards models with multivariable adjustment among those with baseline CAC > 0. HRs are presented as per standard deviation.

Results:
The 3,362 MESA participants with CAC >0 were studied. Using the Agatston method, the HR [95% CI] for CHD was 1.28 [1.16-1.42] for EBCT and 1.22 [1.12-1.34] for MDCT. Using the volume score adjusted for density, the HR for CHD was 2.11 [1.70-2.63] for EBCT and 1.71 [1.41-2.07] for MDCT. Density was strongly and inversely associated with CHD. Similar results were seen for CVD risk and in analyses stratified by sex, BMI, age, and baseline statin use. The volume score demonstrated higher areas under the curve (AUC) than the Agatston score with EBCT (0.702, 95% CI 0.665-0.738 vs 0.677, 95% CI 0.638-0.715, p=0.013) and MDCT (0.669, 95% CI 0.632-0.705 vs 0.653, 95% CI 0.616-0.690, p=0.107).

Conclusions:
Compared with the Agatston score, the CAC volume score, adjusted for density, provides better risk prediction for CHD and CVD events, regardless of CT scanner type. CAC density was strongly and inversely associated with CVD risk.
Abstract 9427: The Use of Cardiac Device Remote Monitoring in the Covid-19 Era of Telehealth Outpatient Medicine
Authors: Wong Edmond , Xie John Z , Rajakariar Kevin , Masman Kevin , Mekel Joris , Nadurata Voltaire
Published: April 2022

Background and Aim:
During the Covid-19 pandemic, outpatient care has utilised telemedicine reviews for cardiac follow-up. We assessed the safety of remote monitoring in context with telehealth medicine for such patients.

Methods:
A retrospective analysis was performed on cardiology pacing clinic patients at a hospital in Victoria, Australia, between March and September 2020. Patients were stratified into those who had face-to-face physician review, in-person cardiac technician review, and telemedicine consultation.

Results:
We identified 408 patients (65% male, age 65 ± 14 years), of whom 230 received telehealth consultation, 115 had technician-only reviews, and 63 had face-to-face physician review. There was no significant difference in baseline demographics. Remote monitors were used in 52% (n=120) of the telehealth cohort. Ventricular arrhythmias were seen in 1.3% (n=3) and 0.9% (n=1) during telehealth and technician review groups respectively, with none seen in the physician group (p=0.642). New atrial fibrillation (AF) was seen in 5.3% (n=12), 8.1% (n=5), and 3.5% (n=4) of groups respectively (p=0.421). Hospital admissions within one month of consultation occurred in 3.1% (n=7), 19% (n=12) and 7% (n=8) of the telemedicine review, physician review, and technician review groups respectively (p<0.001). Of the 73 patients who had cardiac devices implanted, wound issues including haematoma and infection were identified in 3.5% (n=4) of the technician interrogation cohort, 1.6% (n=1) receiving face-to-face clinician review, and none in the telemedicine cohort (p=0.021).We identified 1.8% (n=4), 6.5% (n=4) and 8% (n=7) of patients who had reached elective replacement interval (ERI) in telemedicine, physician review and technician reviews respectively (p=0.036).

Conclusion:
Our study demonstrated no difference in detection of new AF or ventricular tachyarrhythmias between telemedicine and face-to-face consultations. Contrastingly, telemedicine reviews were associated with reduced detection of ERI, less detection of wound complications, compared to patients receiving in-hospital device interrogation. Randomised studies are required to determine the true impact of telemedicine on these outcomes.
Abstract 9434: Cigarette Smoking and Incident Heart Failure With Preserved Ejection Fraction in African Americans: The Jackson Heart Study
Authors: Kamimura Daisuke , Mentz Robert J , Shah Amil M , Oshunbade Adebamike A , Hamid Arsalan , Suzuki Takeki , Clark Donald , Fox Ervin R , Correa Adolfo , Butler Javed , Hall Michael E
Published: April 2022

Background:
Cigarette smoking has been associated with incident heart failure (HF), however the relationships with HF phenotypes have not been adequately investigated, particularly in African Americans.

Methods and Results:
Among 4129 African Americans participants in the Jackson Heart Study without a history of HF or coronary heart disease (CHD) at baseline, we investigated the relationships between baseline smoking status, smoking intensity (number of cigarettes/day) among current smokers, and smoking burden (pack years) among ever smokers and incident HF hospitalization. HF phenotypes were categorized either as HF with reduced ejection fraction (HFrEF: EF<50%) or HF with preserved EF (HFpEF: EF≥50%). There were 2884 (70%) never smokers, 503 (12%) current smokers, and 742 (18%) former smokers. Over a median of 11.0 years follow-up (interquartile range: 10.4-11.0), there were 215 incident HF hospitalizations (95 incident HFrEF, 120 incident HFpEF). After adjustment for traditional risk factors of age, sex, body mass index, systolic blood pressure, anti-hypertensive medication, diabetes, estimated glomerular filtration rate, and incident CHD, current smoking was associated with incident HFpEF (hazard ratio, 3.21; 95% confidence interval, 1.80-5.71), but not with incident HFrEF in comparison with never smokers. Smoking intensity among current smokers (hazard ratio, 1.06 per 1 cigarette/day; 95% confidence interval, 1.02-1.09), and smoking burden among ever smokers (hazard ratio, 1.08 per 10 pack-years; 95% confidence interval, 1.01-1.16) were also significantly associated with incident HFpEF but not with incident HFrEF (Table).

Conclusion:
In this large community-based African American cohort, cigarette smoking (smoking status, smoking intensity, and smoking burden) was significantly associated with incident HFpEF, but not with HFrEF. Smoking cessation in African Americans who smoke may reduce risk for HFpEF in this high-risk population.
Abstract 9457: Safety and Feasibility of a Mixed Reality Head Mounted Display in the Cardiac Catheterization Laboratory
Authors: Chahine Johnny , George Stephen , Bartos Jason , Raveendran Ganesh , Gurevich Sergey
Published: April 2022

Introduction:
Mixed reality (MR) head-mounted displays (HMDs) have been used in a variety of industrial applications. The safety and feasibility of HMDs in cardiac catheterization laboratories (CCLs) for image and procedure guidance have not been studied.

Hypothesis:
We assessed the hypothesis that MR HMDs are safe and feasible for procedure guidance in CCLs.

Methods:
50 patients undergoing diagnostic coronary angiography and right heart catheterization at the University of Minnesota Medical Center were prospectively enrolled in a single-arm trial using an MR HMD for image and procedure guidance including vascular access, fluoroscopy, telemetry, and vital monitoring. Traditional 2D displays were available as back-up. A CCL specific MR HMD (SG Devices LLC, MN) was used. Pearson’s correlation coefficient was used to assess the relationships between procedural outcomes.

Results:
A total of 62 procedures were performed (47% coronary angiograms, 90% radial). Median age was 64 (58-69) with 66% males (Table 1). Mean procedure time was 22 min (+/- 12) with a mean fluoroscopy time of 3.2 min (+/- 4.1). Contrast volume used was 59 cc (+/-5). Fluoroscopy time was correlated to procedure time (R=0.54, p<0.001) and contrast volume (R=0.72, p<0.001). There were no complications observed peri-procedurally (bleeding, myocardial infarction, stroke, death). Procedure success was 98% (1 procedure could not be completed due to a battery issue).

Conclusion:
Dedicated CCL MR HMDs are safe and feasible for invasive diagnostic procedures in the CCL, and may improve procedure time, reduce contrast use, and radiation exposure.
Abstract 9462: Emergency versus Delayed Coronary Angiogram in Survivors of Out-of-Hospital Cardiac Arrest Without St Segment Elevation: Results of the EMERGE Trial
Authors: Spaulding Christian , Hauw-Berlemont Caroline , Lamhaut Lionel , Diehl Jean-Luc , Andreotti Christophe , Varenne Olivier , Leroux Pierre , Lascarrou Jean Baptiste , GUERIN Patrice , Loeb Thomas , Roupie Eric , Daubin Cedric , Beygui Farzin , Vilfaillot AurÃ©lie , Glippa Sophie , Djadi-Prat Juliette , Chatellier Gilles , Cariou Alain
Published: April 2022

Introduction:
In adults, the most common cause of out-of-hospital cardiac arrests (OHCA) is coronary artery disease. If an immediate coronary angiogram (CAG) is recommended for survivors presenting a ST segment elevation (ST +) on the electrocardiogram (ECG) performed after resuscitation, there is still a debate regarding the best strategy in patients without ST +.

Hypothesis:
Performing an immediate CAG after an OHCA without ST + on the post-resuscitation ECG and no obvious non-cardiac cause of arrest leads to a better outcome.

Methods:
The EMERGE trial is a multicenter, randomized, controlled trial that assessed the 180-day survival rate with no or minimal neurologic sequel in patients resuscitated from an OHCA without ST + randomized (1:1) to either immediate or delayed (48 to 96h) CAG. The primary endpoint of the study is the 180-day survival rate with no or minimal neurological sequel (Cerebral Performance Category (CPC) 1 or 2). The secondary endpoints are: occurrence of shock during the first 48 hours, ventricular tachycardia and/or fibrillation during the first 48 hours, change in left ventricular ejection fraction between baseline and 180 days assessed by echocardiogram, neurological status evaluated by the CPC scale at intensive care unit (ICU) discharge and day 90 neurological status assessed by the Glasgow Outcome Scale Extended score (GOSE) at 90 and 180 days, overall survival rate, and hospital length of stay.

Results:
279 patients were enrolled, 141 in the immediate and 138 in the delayed CAG group. Mean age was 65 and 195 were males. The mean delays between randomization and CAG were 0.6 ± 3.7 hours and 55.1 ± 37.2 hours in the immediate and delayed CAG group respectively. The 180-day survival rates among patients with CPC 1 or 2 were 34.1% and 30.7% in the immediate and delayed CAG group, respectively (hazard ratio: 0.87 [95% CI, 0.65; 1.15], P=0.324). The 180-day survival rates in the whole population were 36.2% and 33.3% in the immediate and delayed CAG group, respectively (HR: 0.86 [95% CI, 0.64-1.15], P=0.308).

Conclusions:
In patients successfully resuscitated after an OHCA without ST +, a strategy of immediate CAG was not found to be better than a strategy of delayed CAG with respect to 180-day survival rate with no or minimal neurological sequel.
Abstract 9464: Left Ventricular Ejection Fraction Trajectory Predicts Outcomes in Patients With Heart Failure and Mildly Reduced Ejection Fraction
Authors: Miller Robert J , Nabipoor Majid , Youngson Erik , Kotrri Gynter , Fine Nowell , Howlett Jonathan G , Paterson Ian , Ezekowitz Justin , Finlay McAlister
Published: April 2022

Introduction:
Heart failure and mildly reduced ejection fraction (HFmrEF) is associated with a favourable prognosis compared heart failure with reduced EF. However, HFmrEF may be a transitory state and serial imaging might clarify if these patients demonstrate an increasing, decreasing or stable EF.

Hypothesis:
LVEF trajectory can identify sub-groups of patients with HFmrEF with different prognosis.

Materials and Methods:
Patients with a diagnosis of HF and at least two echocardiograms performed ≥6 months apart were included if the LVEF measured 40-49% on the second study. They were classified based on change from their first echocardiogram as: a) HFmrEF-Incr if LVEF had increased ≥ 10% (n=450), b) HFmrEF-Dec if LVEF had decreased ≥10% (n=512), or c) HFmrEF-stable if they did not meet the other criteria (n=389). The primary outcome was a composite of all-cause mortality or cardiovascular hospitalization (ACM/CVH). Associations with time to first event were assessed with multivariable Cox analyses adjusted for age, medical history, and medications.

Results:
In total, 1351 patients with HFmrEF were included (median age 74, 35.8% women). During a median follow-up of 15.3 months, ACM/CVH occurred in 811 patients (324 ACM, 487 CVH). HFmrEF-Incr was associated with a lower incidence of ACM/CVH compared to patients with HFmrEF-Stable (adjusted HR 0.72, 95% CI 0.59 - 0.87, p<0.001). Patients with HFmrEF-Dec were more likely to experience the composite outcome in unadjusted analyses (unadjusted HR 1.19, p=0.040) but not adjusted analyses (adjusted HR 1.13, 95% CI 0.96 - 1.34, p=0.140).

Conclusions:
Patients with HFmrEF and positive trajectory of LVEF were less likely to experience adverse outcomes, while those with a negative LVEF trajectory demonstrated a trend to higher risk. Categories based on LVEF trajectory provide clinically meaningful information and may help physicians make decisions regarding the need to pursue more aggressive medical therapy and surveillance.
Abstract 9472: Multicenter Comparison of Staged vs. Complete Repair in Young Infants With Tetralogy of Fallot with Pulmonary Atresia and Confluent Branch Pulmonary Arteries
Authors: Boucek Katerina , Mastropietro Christopher , Beall Jonathan , Keller Everette , Beshish Asaad , Flores Saul , Chlebowski Meghan , Yates Andrew R , Choudhury Tarif , Mueller Dana , Kwiatkowski David M , Migally Karl , Karki Karan , Willett Renee , Radman Monique R , Reddy Chetana , Piggott Kurt , Capone Christine , Kapileshwarkar Yamini , Vijayakumar Niranjan , Prentice Elizabeth , Narasimhulu Sukumar Suguna , Martin Renee H , Costello John M
Published: April 2022

Introduction:
Optimal management of neonates with tetralogy of Fallot and pulmonary atresia (TOF/PA) with confluent pulmonary arteries is unknown. We sought to compare outcomes for patients who underwent primary complete repair vs. initial surgical palliation followed by delayed repair.

Methods:
We conducted a retrospective study at 20 centers within CoRe-PCICS (Collaborative Research from the Pediatric Cardiac Intensive Care Society). Data were collected on infants undergoing initial surgical intervention at 0 - 60 days of age with TOF/PA from 2009 to 2018, excluding patients with MAPCAs or those undergoing ductal stenting (n=22). The primary outcome was days alive and out of hospital in first year of life (DAOH). Secondary outcomes were 1 year mortality and a composite major complication outcome (similar to that in prior STS-CHSD studies), defined as occurrence of ≥ 1 of the following: renal failure requiring dialysis, stroke/seizure, permanent pacemaker, ECMO, or diaphragm paralysis during a palliation and/or repair hospitalization, or unplanned reoperation in the first year. Multivariable modeling with generalized estimating equations were utilized to compare outcomes between groups.

Results:
Of 210 subjects, 79 underwent primary complete repair and 131 underwent surgical palliation. Patients who underwent palliation had greater use of preoperative mechanical ventilation at first procedure (26% vs. 8%, p = 0.002). Other baseline characteristics were similar between groups (p > 0.05 for all). There was no statistically significant difference in DAOH between the palliation and primary repair groups [median (25%,75% IQR): 319 (280,336) vs. 338 (314,348 days), adjusted p = 0.20]. Nine (7%) patients who underwent palliation died in the first year of life vs. 4 (6 %) who underwent primary repair (adjusted OR: 1.1, 95% CI: 0.3-4.5; p = 0.9). At least one major complication occurred in 35% of patients who underwent palliation vs. 18% of patients who underwent primary repair (adjusted OR: 2.5, 95% CI: 1.4-4.4, p = 0.001).

Conclusions:
For infants with TOF/PA with confluent pulmonary arteries, a strategy of surgical palliation or primary complete repair resulted in similar DAOH and early mortality, whereas the morbidity incidence favored primary repair.
Abstract 9484: Ferroptosis Inhibitors Reduce Brain Inflammation Due to Cardiac Ischemia/Reperfusion Injury in Rats
Authors: Liao Suchan , Luo Ying , Wu Jun , Chunchai Titikorn , Ongnok Benjamin , Khuanjing Thawatchai , Benjanuwattra Juthipong , Apaijai Nattayaporn , Chattipakorn Nipon , Chattipakorn Siriporn
Published: April 2022

Introduction:
Brain inflammation and microglial hyperactivation are involved in the process of neuronal death including apoptosis, necroptosis, and ferroptosis, following cardiac and cerebral ischemia/reperfusion (I/R) injury. However, the roles of these cell death inhibitors on brain inflammation and microglia following cardiac I/R injury have not been investigated.

Hypothesis:
Inhibitors of apoptosis, necroptosis and ferroptosis effectively attenuate brain inflammation and microglial hyperactivation in rats with cardiac I/R injury.

Methods:
Rats were subjected to either sham or cardiac I/R operation (30 min-ischemia followed by 120-min reperfusion). Rats in cardiac I/R group were divided into 4 treatment groups: 1) vehicle, 2) apoptosis inhibitor (Z-VAD; 3.3 mg/kg), 3) necroptosis inhibitor (necrostatin-1; Nec-1; 3.3 mg/kg), and 4) ferroptosis inhibitor (ferrostatin-1; Fer-1; 2 mg/kg). These drugs were given intravenously at 15 min before ischemia. Finally, the heart and brain tissues were removed and used to determine cardiac infarct size, hippocampal-microglial morphology, and levels of cortical inflammatory cytokines.

Results:
Cardiac I/R injury caused myocardial infarction and brain inflammation as indicated by increased cortical IL-1β mRNA level and hippocampal microglial hyperactivation. Treatment with Z-VAD and Fer-1, but not Nec-1, reduced myocardial infarction and cortical IL-1β mRNA level. Z-VAD and Fer-1 also increased microglial process length and decreased microglial volume. Nec-1 increased microglial process length, but it did not decrease microglial volume. All treatments similarly decreased microglial number and increased microglial complexity after I/R injury
(Fig 1)
.

Conclusions:
Inhibition of apoptosis and ferroptosis, but not necroptosis, effectively reduced myocardial infarction and brain inflammation. Targeting these cell death pathways could be a novel strategy against brain injury due to cardiac I/R.
Abstract 9492: Ventricular Tachycardia During Cardiopulmonary Exercise Testing in Hypertrophic Cardiomyopathy
Authors: Csecs Ibolya , Newman Darrell B , Nederend Marieke , Klarich Kyle W , Allison Thomas G
Published: April 2022

Introduction and Hypothesis:
In patients with hypertrophic cardiomyopathy (HCM), ventricular tachycardia (VT) is associated with adverse prognosis. Cardiopulmonary exercise testing (CPET) is part of the standard clinical evaluation in HCM. However, limited data are available on the incidence of VT and other adverse events during CPET in HCM.

Methods:
We reviewed the Mayo Clinic’s Integrated Stress Center Database for CPETs performed on HCM patients between January 2011 and July 2016. Patients were referred for clinical CPET by a physician, and medications were continued for the test. Electronic medical records were reviewed for clinical information and CPET data.

Results:
A total of 1,208 CPETs were performed on 976 HCM patients during the study period. Most tests were symptom-limited (94.6%), most common symptom was dyspnea (55%). Despite the relatively high number of patients with a history of VT (10.4%) and/or cardiac arrest (1.6%), there was a low rate of adverse events. Non-sustained VT occurred in 6 patients, most frequently during active recovery (3/6), and 2 of these 6 patients had prior history of VT. A 34 year-old female patient experienced sustained VT degenerating into ventricular fibrillation terminated by ICD shock. One patient had syncope during the test but no arrhythmia. Importantly, none of the patients died within 48 hours of the exercise test.

Conclusions:
In a large cohort of HCM patients, the incidence of VT or other adverse events was a rare finding during symptom-limited CPET.
Abstract 9493: Differences in Prognostic Implications of Changes in Echocardiography in Asymptomatic Severe Aortic Stenosis Managed Conservatively
Authors: Muta Eri , Kato Takao , Taniguchi Tomohiko , Kimura Takeshi
Published: April 2022

Background:
No previous study has explored the association between the changes in echocardiographic parameters during follow-up and clinical outcomes in patients with asymptomatic severe aortic stenosis (AS) and who were managed conservatively.

Objective:
This study aimed to investigate the prognostic impact of the changes in echocardiographic parameter at 1-year follow-up in asymptomatic severe AS patients managed conservatively.

Methods:
Among 3815 patients with severe AS enrolled in the multicenter CURRENT AS registry in Japan, we analyzed conservatively managed 555 patients who underwent echocardiography at 1-year follow-up and remained asymptomatic. The primary outcome measure was a composite of AS-related deaths and hospitalization due to heart failure. A decline in left ventricular ejection fraction (LVEF), an increase in left ventricular end-diastolic dimension (LVEDD), and an increase in aortic valve pressure gradient (PG) were defined as above 10%, 5mm, and 30mmHg, respectively, based on the clinically relevant values.

Results:
There were 61 patients (11.0 %) with >10% decline in LVEF and 494 patients (89.0%) without decline. The cumulative 3-year incidence of the primary outcome measure was significantly higher in the decline in LVEF group than in no decline in LVEF group. After adjusting for confounders, the excess risk of the decline in LVEF relative to no decline in LVEF for the primary outcome measure remained significant (hazard ratio; 2.76, 95% confidence interval 1.66-4.45). The cumulative 3-year incidence of the primary outcome measure was significantly higher in the increase in LVEDD group than in no increase in LVEDD group. In contrast, there were no difference in cumulative 3-year incidence of the primary outcome measure between the increase in aortic valve PG and no increase group.

Conclusions:
Severe asymptomatic AS patients with a >10% LVEF decline or >5mm increase in LVEDD at 1-year after diagnosis had worse AS-related clinical outcome than those without under conservative management, whereas there were no differences in the outcomes stratified by changes in aortic valve PG. This indicated the importance in the LV morphology and function during follow-up in asymptomatic severe AS patients when managed conservatively.
Abstract 9495: Prognostic Value of Machine Learning on Clinical Parameters for Cardiac Prognosis in Patinets with Acute Congestive Heart Failure
Authors: Shimizu Masato , Miyazaki Hiroko , cho shummo , Misu Yoshiki , Tateishi Ryo , Yamaguchi Masao , Yamakami Yosuke , Shimada Hiroshi , Manno Tomoko , Isshiki Ami , Kimura Shigeki , Fujii Hiroyuki , Suzuki Makoto , Nishizaki Mitsuhiro , Sasano Tetsuo
Published: April 2022

Introduction:
Congestive heart failure (CHF) in acute phase, many clinical fundamental parameters including vital sign, laboratory data, or initial treatment were investigated, and we can roughly estimate the prognosis with the parameters. However, machine learning method for prediction of the prognosis is still challenging.

Hypothesis:
Machine learning methods have higher performance for predicting cardiac prognosis in patients with CHF than conventional statistical model.

Methods:
We enrolled consecutive 300 patients with CHF (79.5±12.1 years, 158 Males). Patients with acute coronary syndrome, mechanical circulatory support cases, and cardio-pulmonary arrest cases were excluded. Objective variable was set as cardiac death in one year. First, multivariate stepwise logistic regression analysis with Akaike’s information criterion (AIC) was performed, and extracted parameters which had the most versatile predictive value. Propensity score (PS) was calculated with the extracted parameters, and the prediction model constructed by cut-off value of ROC curve analysis of PS. Next, machine learning (random forest method and deep learning) to build predictive model was performed with the predictors. Finally, accuracy of each predictive model was compared.

Results:
Thirty cases showed cardiac death in one year. Logistic regression with AIC extracted 8 predictors, and the cut off-value of propensity score with the 8 parameters was 0.110. The accuracy was 0.714 and area under ROC (AUROC) was 0.836. Conversely, random forest method demonstrated the accuracy as 0.927, AUROC 0.860. On deep learning, the accuracy was 0.937 and AUROC 0.901.The top 4 high feature importance of random forest were Cl/red blood cell count/pH/Anion Gap. However, accuracy of those predictors was lower than that of machine learning.

Conclusions:
Machine learning was a powerful tool to predict cardiac prognosis of CHF, comparing with conventional statistical model.
Abstract 9497: Dose Reduction of Ticagrelor in Ticagrelor Hyper-responders: A Pharmacokinetics and Pharmacodynamics (pkpd) Study
Authors: Lin Ying ying , Tan Doreen , WONG CLIFF , Fong Alan , TIONG LEE LEN , Ang Teck Kee , Lim Patrick Zhan-Yun , Liang Michael , Aw Wan Xin , Imran Syed
Published: April 2022

Introduction:
Ticagrelor has demonstrated superiority to Clopidogrel in reducing major adverse cardiovascular events, but at the cost of higher bleeding risk. However, the benefits were not replicated in the Asian trials, which demonstrated excess bleeding risk. We aimed to study the effect of Ticagrelor dose reduction in Ticagrelor hyper-responders, in addition to explore the effect of genotypes on Ticagrelor PKPD.

Methods:
ST-elevation myocardial infarction patients who undergone percutaneous coronary intervention and tested to be Ticagrelor hyper-responders defined as platelet reactivity of <19U based on multiple electrode aggregometry (
MEA
), were recruited. Peak and trough concentration of Ticagrelor and its active metabolite AR-C124910XX, and platelet reactivity at the corresponding time points were measured when patients were on Ticagrelor 90 mg twice daily (BD) and again when reduced to Ticagrelor 45mg BD for at least 14 days. Platelet reactivity and plasma concentrations were measured using Multiplate
®
Analyzer and liquid chromatography-mass spectrometry respectively.

Results:
Seventeen patients were recruited and 12 were reduced to Ticagrelor 45 mg BD. The mean age of the 12 patients was 55.92 (±9.41). Their average BMI was 25.33 (±4.24), there were 11 males, and comprised of 5 Chinese, 3 Malay, 3 Indian and 1 Eurasian. Plasma concentration (geometric mean) of parent Ticagrelor and its metabolite were 2-2.6 folds (p=0.002) higher at 90 mg compared to at 45 mg [C
trough_Ticagrelor
267.22 ng/mL vs 131.83 ng/mL, C
trough_metabolite
158.25 ng/mL vs 62.34 ng/mL, C
peak_Ticagrelor
619.89 ng/mL vs 255.57 ng/mL and C
peak_metabolite
236.21 ng/mL vs 91.64 ng/mL]. The mean MEA
45mg
was 23U (±8) for trough
45mg
. Even after dose reduction, all patients were still at “responder” MEA levels with responder MEA defined as MEA<47U. CYP3A5*3 heterozygote was associated with higher peak
90mg
and trough
90mg
concentrations; p=0.037 and 0.025 respectively.

Conclusions:
Ticagrelor 45mg BD results in significantly lower serum levels but was still able to confer sufficient platelet inhibition. Larger studies should be conducted to correlate with clinical outcomes, and the impact of CYP3A5*3 on Ticagrelor response.
Abstract 9500: One-Year Safety and Effectiveness of Bivalirudin in Patients Undergoing Elective Percutaneous Coronary Intervention
Authors: Li Jiawen , Yang Yuejin , Yuan Jinqing , Zhao Xueyan
Published: April 2022

Introduction:
A lot of large studies (HORIZONS-AMI, BRIGHT, EUROMAX, etc.) have shown that bivalirudin in acute myocardial infarction patients undergoing primary percutaneous coronary intervention (PCI) could reduce the bleeding while prevent thrombosis. However, data on patients undergoing elective PCI are lacking which warrants research attention.

Methods:
1152 patients undergoing elective PCI anticoagulated with bivalirudin and 10251 patients anticoagulated with UFH were performed propensity score matching at 1:2 ratio. Finally, 957 and 1713 patients were enrolled in bivalirudin and UFH group respectively. The safe endpoints were according to the Bleeding Academic Research Consortium (BARC). The effective endpoint was major adverse cardiac and cerebrovascular events (MACCE).

Results:
During one-year follow-up, multivariate Cox analysis showed bivalirudin group had a reduction in the risk of BARC 2, 3 or 5 bleeding (HR: 0.580, 95% CI: 0.340-0.989, P=0.045), but not in the risk of BARC 3 or 5 bleeding (P=0.214) compared with UFH with or without glycoprotein IIb/IIIa inhibitors (GPI) group. To further study, we also analyzed 254 (14.8%) patients with GPI in UFH group and then found the risk of BARC 2, 3 or 5 bleeding in bivalirudin group reduced (P=0.001). As for MACCE, there was no significant difference between bivalirudin group and UFH with or without GPI group (P=0.159). Moreover, there was also no significant difference in the risk of death, revascularization, intrastent thrombosis or stroke, but a reduction in the risk of MI between bivalirudin group and UFH with or without GPI group (P=0.002).

Conclusions:
In patients undergoing elective PCI, bivalirudin significantly reduced the risk of BARC 2, 3 or 5 bleeding, but not that of BARC 3 or 5 bleeding compared UFH with or without GPI. No significant difference in MACCE between two groups, while bivalirudin significantly reduced the risk of MI.
Abstract 9507: Evening Dosing of Antihypertensive Treatment is Not Associated With a Better Prognosis
Authors: De La Sierra Alejandro , Ruilope Luis M , Martinez-Camblor Pablo , Vinyoles Ernest , Gorostidi Manuel , Segura Julian , Williams Bryan
Published: April 2022

Introduction:
Night BP is the most powerful estimate of cardiovascular prognosis. It has been suggested that bedtime administration of antihypertensive therapy may favour night BP reduction and prognosis.

Hypothesis:
We aimed to evaluate the mortality risk in treated hypertensives, depending on the schedule of treatment administration (entirely in the morning, entirely at bedtime, or combined morning and evening) at the time ABPM was performed.

Methods:
Vital status and cardiovascular death were obtained from death certificates in 26751 treated hypertensives (mean age 62, 60% males), enrolled in the Spanish ABPM Registry, and having a valid 24-h ABPM at entry. Cox-models adjusted for clinical confounders and 24-hour systolic BP were used for HR calculation in groups depending on treatment administration.

Results:
Among the 26751 evaluable patients, most (76.7%) received their medication exclusively in the morning; 13% exclusively in the evening, and 10.3% in a multiple schedule both in the morning and in the evening. Mortality incidence in these 3 groups were 13.7, 17.8 and 21.8 per 1000 patients/year, respectively. Compared to patients receiving their antihypertensive medication entirely in the morning (reference group), those receiving their medication entirely in the evening did not show a significant increase in the HR for total mortality (1.06; 95%CI: 0.93-1.21) or in cardiovascular mortality (1.15; 0.93-1.41) after adjustment for clinical confounders and 24-hour systolic BP. Patients receiving their antihypertensive medication both in the morning and at bedtime had an increased risk for mortality (1.29; 1.14-1.48) and for cardiovascular mortality (1.46; 1.18-1.80). Additional analyses using double-robust propensity score yielded similar results.

Conclusions:
Morning or bedtime dosing of the antihypertensive medication has no effect on prognosis. We have found that patients receiving their medication in a multiple schedule, including morning and evening dosing have an increased risk of mortality and cardiovascular mortality, even after adjustment for confounders. However, we cannot exclude other aspects, such as a poorer treatment adherence, being the responsible of this worse prognosis.
Abstract 9508: The Natural Product Zerumbone Suppresses Pressure Overload-Induced Cardiac Dysfunction by Inhibiting Cardiac Hypertrophy and Fibrosis
Authors: Tojima Mikuto , Katanasaka Yasufumi , Shimizu Satoshi , Funamoto Masafumi , Shimizu Kana , Sunagawa Yoichi , Hasegawa Koji , Morimoto Tatsuya ,   Div of Molecular Medicine, Sch of Pharmaceutical Sciences, Univ of Shizuoka,   Div of Translational Rsch, Kyoto MedCntr,   Shizuoka General Hosp
Published: April 2022

Introduction:
Cardiac hypertrophy and fibrosis are hallmarks of cardiac remodeling and are involved functionally in the development of heart failure (HF). Various food components effectively prevent cardiovascular diseases. However, it is unknown whether zerumbone (ZER), a major active terpene found in endemic wild ginger species, suppresses cardiac hypertrophy, fibrosis, and dysfunction.

Hypothesis:
We assessed the hypothesis that ZER suppresses cardiac hypertrophy and fibrosis
in vitro
and
in vivo
.

Methods:
The effects of ZER on phenylephrine (PE)-induced hypertrophic responses and on transforming growth factor beta (TGF-β)-induced fibrotic responses were examined in primary cultured cardiomyocytes and fibroblasts from neonatal rats. To determine whether ZER prevents the development of pressure overload-induced HF
in vivo
, a transverse aortic constriction mouse model was utilized (n=6-10). One day after surgery, mice were randomly divided into two groups and orally administered with ZER 20 mg / kg or vehicle for 8 weeks. Cardiac function was evaluated by echocardiography. Changes in cardiomyocyte surface area and degree of fibrosis were observed by histological analysis (HE and WGA staining). The total mRNA levels of the genes associated with hypertrophy and fibrosis were measured by qRT-PCR. Protein expression (Akt phosphorylation and α-SMA) were assessed by western blotting.

Results:
ZER significantly suppressed PE-induced increases in cell size, hypertrophic gene expression (ANF and BNP), and Akt phosphorylation in cardiomyocytes. TGF-β-induced increases in collagen synthesis, mRNA levels of POSTN and α-SMA, and protein expression of α-SMA were lower in the ZER-treated cultured cardiac fibroblasts. Echocardiography results showed that left ventricular fractional shortening was increased and wall thickness was reduced in the ZER group compared with the vehicle group. Histological analysis showed that pressure overload-induced cardiac hypertrophy and cardiac fibrosis were inhibited in the ZER group compared with the vehicle group.

Conclusions:
These results suggest that zerumbone ameliorates pressure overload-induced cardiac dysfunction, at least in part by suppressing both cardiac hypertrophy and fibrosis.