bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11711: Quantification of Atherosclerotic Coronary Artery Disease in the Pre/Peri-Menopausal Female Using Cardiac CTA
Authors: Solsi Anup , Bies Roger , Drosten Ralph , Bond Rachel M , Oladokun Femi , Roberts Robert , Bellamkonda Pallavi
Published: March 2022

Introduction:
Coronary Artery Disease (CAD) occurs equally in males and females and is the most common cause of death in both genders worldwide. The pre/peri-menopausal female is believed to have minimal coronary atherosclerosis based primarily on non-invasive techniques, with limited coronary angiography data. Cardiac computed tomography angiography (CCTA) is a more sensitive, non-invasive anatomical diagnostic tool for quantifying coronary atherosclerosis, but pre/peri-menopausal women have been underrepresented and underdiagnosed. The goal of this study was to quantify coronary atherosclerosis in this population.

Methods:
We conducted a retrospective chart review on 510 females aged 35-60 presenting with atypical chest pain and shortness of breath. These were consecutive admissions in which CCTA was performed from January 2014 to December 2019. The degree of coronary atherosclerosis was quantified using the CAD-RADS scoring system.

Results:
Analysis showed 68.82% of patients had no evidence of coronary atherosclerosis. 4.31% had minimal CAD, 18.24% had mild CAD, 6.47% had moderate CAD and 2.16% were found to have severe CAD. Each category of stenosis typically had multiple vessels involved. Over 65% of patients were Non-Hispanic White, 27% Hispanic, 8% African American and 4% Asian. Less than 5% of patients were discharged with statin therapy.

Conclusions:
This is the first study to quantify coronary atherosclerosis in the pre/peri-menopausal female. Quantification was based on coronary angiograms obtained by CCTA, currently the most sensitive diagnostic imaging technique. Despite the perceived protective nature of the premenopausal state in women, 30% of patients had detectable CAD by CCTA. 10% had greater than 50% stenosis (moderate to severe CAD), suggesting the potential for future ischemic heart disease. So few patients were discharged on statin therapy, showing the paucity of guideline therapy used in this population. These results suggest targeting preventative therapy, even late in the pre or peri-menopausal stage, such as favorable lifestyle changes and reducing known modifiable cardiac risk factors, should significantly prevent the progression of coronary atherosclerosis and its subsequent sequelae in menopause.
Abstract 11716: The Impact of a Virtual Multi-Disciplinary Heart Failure Optimization Program on Achievement of Guideline-Directed Therapy
Authors: Pandey Avinash K , Serafini Nicolas , Bonavie Ian , Pandey A Shekhar
Published: March 2022

Introduction:
Current guidelines for management of Heart Failure with Reduced Ejection Fraction (HFrEF) recommend Beta-blockers, Angiotensin Receptor Neprilysin Inhibitors (ARNI), Mineralocorticoid Receptor Antagonists (MRA) and SGLT2 inhibitors. However, guideline-directed medical therapies (GDMT) remain underutilized. The 2018 CHAMP-HF registry of HFrEF patients demonstrated that only 1% of patients were treated with target doses of Beta-blockers, MRA and ACE-inhibitors (ACE-I) and Angiotensin Receptor Blocker (ARB) or ARNI.

Methods:
We conducted a single center study of a virtual, multidisciplinary HFrEF optimization program for achieving GDMT. Patients referred from both inpatient and outpatient settings were enrolled in this 3-month initiative. After an initial cardiology consult, patients were seen virtually once weekly by a kinesiologist for lifestyle optimization and virtually by a nurse once every two weeks for up-titration of guideline-based therapies, with cardiologist oversight. Vital signs, serum creatinine and electrolytes were obtained after medication adjustment.

Results:
Over 9 months, 297 patients were referred and all enrolled in the virtual HFrEF optimization program. Mean age was 69 and 63% were male. Mean ejection fraction was 28% and 54% had ischemic cardiomyopathy. At initial visit, the frequency of patients prescribed optimal dosage for Beta-Blockers was 64%, 7% for MRA and 1% for SGLT2 inhibitors. 88% were prescribed ACE-I or ARB while 1% of patients were on ARNI. At 3 month follow-up, the frequency of patients prescribed optimal dosage for Beta-Blockers was 84% (p<0.01), 58% for MRA (p<0.01), 77% for SGLT2 inhibitors (p<0.01) and 96% for ARNI (p<0.01). Overall, 39% of patients achieved maximal doses of all 4 classes of medications at 3 month follow-up. During the study period, there were no hospitalizations or medication adverse events among participants. The most common causes of failure to achieve GDMT was chronic kidney disease or drug cost or coverage.

Conclusions:
This study demonstrates that a virtual multidisciplinary program can safely and effectively improve usage of GDMT in HFrEF patients. Further studies should examine the effect of similar interventions on patient outcomes in a randomized format.
Abstract 11719: Short Term Moderate Intensity Exercise in an Aged Cohort Reversed Early Findings of Diastolic Dysfunction and Was Associated With Changes in the Serum Metabolome: A Randomized Clinical Trial
Authors: Wong Jie Jun , Ho Jien sze , Teo Louis L , Wee Hai Ning , Chua Kee Voon , Ching Jianhong , Gao Fei , Tan Swee Yaw , Tan Ru San , Kovalik Jean Paul , Koh Angela S
Published: March 2022

Introduction:
We previously reported changes in the serum metabolome associated with sub-clinical diastolic dysfunction in an aged cohort. In this trial, we subjected subjects with mild diastolic dysfunction to exercise intervention and evaluated effects on cardiovascular function and serum metabolome.

Methods:
Thirty (83% females) middle-aged adults (53±4 years) with early diastolic dysfunction were randomly assigned to either 12 weeks of moderate intensity exercise training (n=15) or control (n=15). Central hemodynamics and echocardiography were performed pre- and post- intervention, with serum sampling for metabolomic analyses.(E/A (ratio of peak velocity flow in early diastole E (m/s) to peak velocity flow in late diastole by atrial contraction A (m/s).

Results:
29 adults completed once-weekly (for 12 weeks) aerobic exercise and muscle strength training for sixty minutes each in a laboratory (n=14 in intervention group, one drop-out) with n=15 controls.E/A increased by magnitude (ratio of post to pre intervention timepoints) of 1.059±0.29 in intervention (p<0.0001) and decreased by 0.969±0.225 (p<0.0001) in control groups. After 12 weeks, central pulse wave velocity) was lower in the intervention compared to control group (7.416±0.789 vs 8.117±0.642, m/s, p=0.032). There were significant accumulations of a medium chain acylcarnitine C12:2-OH/C10:2-DC, alanine and arginine (fold-change 1.825 vs 0.9376, p=0.023; 1.1733 vs 0.95344, p=0.035; 1.1379 vs 0.9501, p=0.041 respectively), with reductions in long-chain acylcarnitine C20:2-OH/C18:2-DC (fold-change 0.7136 vs 1.741, p=0.011), among intervention compared to controls.

Conclusions:
Our novel pilot data demonstrated reversal of mild diastolic dysfunction after exercise intervention, associated with cellular fuel oxidation and amino acid pathways. We highlight a role for exercise strategies and central carbon metabolism in treating ageing-associated cardiovascular disease.
Abstract 11720: Loss of Vascular Smooth-Muscle Activity During Moderate Physical Activity as a Hallmark of Aging in Human Subjects
Authors: Shusterman Vladimir , Hoffman Stacy , London Barry
Published: March 2022

Studies have shown a higher risk of adverse outcomes after cardiac surgery in patients with reduced complexity of arterial-pressure dynamics (APD). We hypothesized that this effect is caused by age-related loss of vascular smooth-muscle activity (VSMA). This hypothesis was tested using data from 30 humans and a validated, large-scale theoretical model of circulation with VSMA blocked (T-model). The results were also verified in a realistic physical model of circulation (P-model, Fig.1).

Methods:
ECG and APD data were recorded using a high-fidelity system (APEX, PinMed, Inc.) during moderate physical activity (handgrip followed by leg lifts) in 30 subjects (age: 46±10y, 53% female; pressure ranges for systolic, diastolic, and mean: 90-210, 49-116, and 67-147mm, respectively).

Results:
T-model accurately predicted APD in older subjects ≥48y (n=13, r
2
=0.74; Fig.2); this effect was preserved in both females and males, but not in younger subjects (n=17, r
2
=0.13). The difference between the older and younger subjects was pronounced (40%) and significant (p=0.01, F-test). In P-model, changes in cardiac force produced changes in central arterial pressure that were in excellent agreement with those observed in humans ≥48y (r
2
=0.93, Fig.3).

Conclusions:
Loss of VSMA during physical activity could serve as an important prognostic/diagnostic indicator of cardiovascular aging and disease.
Abstract 11725: Low Left Ventricular Mass and Cardiomyopathy in Muscular Dystrophies: A Different Perspective on Potential Cardiac Mechanisms
Authors: Sheth Rahul , Galvan Daniel , Lehrenbaum Hannah , Cheeran Daniel , Araj Faris , Amin Alpesh , Drazner Mark H , Zaha Vlad G , Peshock Ronald M , Mammen Pradeep P
Published: March 2022

Introduction:
Cardiomyopathy is a common complication in muscular dystrophy (MD) patients, though the mechanism is not clear. Retrospective data from adults with Duchenne muscular dystrophy suggest they have reduced LV mass compared to adults with other forms of non-ischemic cardiomyopathy. This raises the question whether pathologic hypertrophy contributes to the development of neuromuscular-associated cardiomyopathies. In this study, we hypothesized that MD patients have lower LV mass and associated changes in cardiac function as compared to healthy individuals.

Methods:
Utilizing cardiac magnetic resonance imaging (cMRI) data, a retrospective study was undertaken to compare LV mass, structure, and function between adults with MD and healthy age-, sex-, weight-matched controls from the Dallas Heart Study (DHS). Types of MD included dystrophinopathies, facioscapulohumeral MD, Freidreich ataxia, limb-girdle MD, myotonic dystrophy, and other rare MD. Approximately 50% of the MD patients were able to ambulate. MD patients were stratified into normal and reduced LVEF, defined as < 62% on cMRI, for further comparison. Statistical analysis was done using a two-sample, two-tailed t-test.

Results:
There were 339 MD patients (221 male) of mean age 40 and 417 DHS patients (187 male) of mean age 42. MD patients had a significantly lower LV mass, LV mass index, and LVEF than DHS adults. They also had significantly higher absolute and indexed volumes. In those with normal LVEF, all variables except LVESVi were significantly different from DHS. In those with reduced LVEF, all variables were significantly different from DHS. The results are summarized in Table 1.

Conclusions:
Collectively, MD patients have a reduced LV mass compared to healthy adults. In addition, MD patients with normal LVEF have lower LV mass than those patients with reduced LV function. Whether this observed decrease in LV mass represents cardiac hypoplasia or atrophy warrants further investigation.
Abstract 11726: Impact of Digoxin Use on Doses of First-Line Agents Used in Heart Failure
Authors: Hamade Hani , Jabri Ahmad , Nasser Mohamed Farhan , Balakumaran Kathir
Published: March 2022

Introduction:
Digoxin was one of the first agents used in the management of heart failure with reduced ejection fraction (HFrEF). Concerns over its safety, efficacy and the introduction of guideline-directed medical therapy (GDMT) has relegated it to a secondary role. The effects of digoxin are still under debate, and its use in patients on GDMT remains unclear.

Hypothesis:
Patients with HFrEF on digoxin can tolerate higher doses of beta blocker and angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blocker (ARB) or angiotensin receptor-neprilysin inhibitor (ARNI).

Methods:
A retrospective chart review was performed on 233 patients with HFrEF managed at a tertiary care center in Cleveland, Ohio. A bivariate analysis was performed to compare patients on digoxin with patients not on digoxin in terms of ability to progress the dosing of beta blocker and ACEI/ARB/ARNI.

Results:
Cases and controls were similar in age, gender, height, weight, ethnicity, and no significant differences were noted when comparing baseline comorbidities and biochemical testing (Table 1). There was no significant difference between the two groups in terms of patients receiving higher doses of beta-blockers (p=0.34), ACEI (p=0.33), ARB (p=0.57), or ARNI (0.65). Stacked column charts showing the differences in dosing between the groups for all four categories are displayed in Figure 1.

Conclusions:
There was no significant difference between the doses of beta blocker, ACEI, ARB or ARNI among HFrEF patients on digoxin compared to those that were not. From these results, we conclude that digoxin use may not significantly affect the ability to increase the doses of GDMT in patients with HFrEF.
Abstract 11727: Sex Differences in Coronary Endothelial Dysfunction Among Women and Men Living With HIV
Authors: Minhas Anum S , Leucker Thorsten M , Goerlich Erin , Schar Michael , Bonanno Gabriele V , Bagchi Shashwatee , Gerstenblith Gary , Weiss Robert G , Hays Allison
Published: March 2022

Introduction:
Impaired coronary endothelial function (CEF) is a known predictor of cardiovascular (CV) events and occurs in people living with HIV. HIV+ women compared to men have worse CV outcomes, but prior studies include very few women. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is related to endothelial cell inflammation and is elevated in HIV+ men. CEF and PCSK9 are not well studied in women with HIV.

Hypothesis:
We hypothesize that HIV+ women have worse CEF and higher PCSK9 levels compared to risk factor matched HIV- women, and that CEF will be associated with PCSK9 in HIV+ women, similar to prior findings in HIV+ men.

Methods:
A total of 34 HIV+ women and 75 HIV+ men on stable highly active antiretroviral therapy and 17 HIV- women and 8 HIV- men underwent MRI to measure CEF (%change in coronary artery cross-sectional area (%CSA) and coronary blood flow (CBF) during isometric handgrip exercise, an endothelial dependent stressor). Serum PCSK9 samples were obtained on the day of MRI. Comparisons were performed using student’s t-test for normally distributed and Kruskal-Wallis test for data not normally distributed. Robust regression was used for the association of PCSK9 with CEF.

Results:
CEF was significantly reduced in HIV+ women compared to age-, race- and BMI-matched HIV- women (p<0.001 for both %CSA and %CBF change Fig. 1A-B). Both HIV+ men and women had similarly impaired CEF. Women with HIV had significantly higher PCSK9 levels than women without HIV (Figure 1C). Further, PCSK9 was significantly inversely associated with %CSA (ß -0.03(-0.06,0.00); p=0.038) in men but not in women (ß -0.02(-0.04,0.01); p=0.26).

Conclusions:
Coronary endothelial dysfunction is present among HIV+ women as compared to risk factor matched HIV- women. HIV+ women have similarly depressed CEF as HIV+ men. With HIV, PCSK9 is not significantly associated with CEF, suggesting potential alternative mechanisms of impaired CEF in men and women with HIV.
Abstract 11729: Elevated Procoagulant Platelets Predict Myocardial Infarction or Cardiac Death at 10 Months in Symptomatic Carotid Stenosis
Authors: Khattab Mohamad , Prodan Calin I , Xu Chao , Dale George L , Kirkpatrick Angelia
Published: March 2022

Background:
Symptomatic carotid stenosis is associated with elevated myocardial infarction (MI) risk. Better risk prediction and intervention targets may help reduce adverse cardiac events. Coated-platelets, a subset of procoagulant platelets observed upon dual agonist stimulation with collagen and thrombin, predict stroke recurrence in symptomatic carotid disease, but the association with MI risk is unknown. Here we assess whether coated-platelets predict MI or sudden cardiac death (SCD) in symptomatic carotid stenosis.

Methods:
Patients with symptomatic ≥50% carotid artery stenosis were enrolled and coated-platelet levels assayed within 92 hours of stroke onset. Demographics, comorbidities and interventions were recorded. MI (4
th
universal definition) and SCD (death from MI or arrhythmia) were determined by chart review and confirmed by blinded adjudication. The Area Under the Curve (AUC) was calculated for coated-platelet levels for predicting MI or SCD and the most sensitive and specific cutoff identified using Youdon’s Index. Predictors of MI or SCD were determined by Cox Proportional Hazards analysis.

Results:
We enrolled 179 patients (mean age 67, 85% male, 43% diabetic, 44% smokers, 45% with coronary disease, 26% with carotid revascularization at discharge). Eleven MI’s (5 fatal) and 4 SCD’s without MI (8.4%) occurred over 10.1±3.6 months. Baseline coated-platelets ≥54.6% were associated with risk of MI or SCD (AUC, 0.687±0.0842, p=0.0265, 53% sensitivity, 85% specificity). Age (HR=1.074, p=0.0187) and the interaction between elevated coated-platelets and carotid revascularization at discharge (HR=37.6, p=0.0182) were retained as significant on multivariate analysis.

Conclusions:
Our findings revealed a 37.6 increased hazard of MI or SCD among revascularized symptomatic carotid stenosis patients with ≥54.6% coated-platelets. A high rate of often fatal MI was also noted after revascularization, supporting the need to optimize cardiovascular risk management. Our results suggest a role for coated-platelets as biomarkers of perioperative cardiovascular risk and as potential novel treatment targets to reduce perioperative adverse cardiac events in symptomatic carotid stenosis.
Abstract 11730: Data Quality and Monitoring Completion Rates Are Similar Between Clinic-Applied and Self-Applied Continuous ECG Monitoring Patches Prior to and During COVID-19
Authors: Goergen Jack A , Hsu Mike , Wilk Alan , Crosson Lori , Lenane Judith C , Knight Bradley P , Passman Rod S
Published: March 2022

Introduction:
Prior to COVID-19, ECG patches (ECGp) were applied almost exclusively in-clinic (CA) by technicians which required an office visit and fee. Since the pandemic, direct-to-patient, self-applied patch use (SA) has substantially increased, though the metrics surrounding SA are unknown. This study compares monitoring completion rates and data quality between CA and SA ECGp prior to and during COVID-19.

Hypothesis:
CA and SA ECGp have similar data quality and monitoring completion metrics.

Methods:
We performed a retrospective cohort analysis of patients prescribed an iRhythm Zio XT patch at Northwestern Memorial Hospital during the “pre-COVID” (3/1/2019-3/1/2020) and “COVID” (4/1/2020-4/1/2021) timeframes. Differences in ECGp with data available, actual vs prescribed wear time, and analyzable data between groups were assessed. ECGp without data was defined as devices which were not returned or not activated.

Results:
The cohort included 29,118 ECGp prescriptions; 13,180 pre-COVID (45%). The cohort was 56% female with mean age of 59.3
+
17.7 years. Palpitations (29%) and atrial fibrillation (19%) were the most common indications. In the pre-COVID cohort, there were no (0%) SA ECGp and data were available for 12,932 CA patches. In the COVID cohort, 34% of ECGp were SA; data were available for 10,231 CA ECGp and 4,902 SA ECGp. Average delay between prescription and SA ECGp activation was 8.1 ± 12.2 days. Comparisons between percent analyzable data, wear times, and ECGp with data available are shown in figure 1.

Conclusions:
COVID-19 resulted in a rapid adoption of SA ECGp use. Compared to CA, SA was associated with an inherent delay in ECGp application and a higher proportion of ECGp without data. However, there was no difference in actual vs prescribed wear time and a small but statistically significant decrease in percent analyzable data. These differences must be balanced with the additional cost and need for in-person visit for CA vs SA.
Abstract 11733: Gender Differences in Statin Prescriptions for Secondary Prevention in Ambulatory Settings
Authors: Mufarreh Anthony , Shah Amit J , Vaccarino Viola , Kulshreshtha Ambar
Published: March 2022

Introduction:
The American College of Cardiology and American Heart Association (ACC/AHA) 2013 guidelines recommend statin medications and lifestyle counselling for patients with a history of atherosclerotic cardiovascular disease (ASCVD). There is limited data regarding statin prescriptions and lifestyle counselling for secondary prevention in ambulatory settings. We aimed to examine temporal trends in primary care usage of recommended secondary prevention strategies among men and women with ASCVD in a nationally representative, ambulatory care database.

Methods:
The National Ambulatory Medical Care Survey (NAMCS) provides measures of ambulatory medical care services used in the United States. The study sample consisted of adults with ASCVD seen in ambulatory care clinics from 2006-2016. We analyzed the proportion of patients receiving secondary prevention strategies, statin medications or lifestyle counseling (including weight reduction, diet, and exercise) and examined differences by gender. Patient sample weights were applied to enable nationally representative estimates.

Results:
From 2006-2016, there were 7263 total outpatient visits (representing 179.9 million visits) for adults with a history of ASCVD. Average age was 63 (SD, 10), 37% were women. Statin prescriptions ranged from 44% (2006) to 46% (2016). Lifestyle counselling was also recommended very infrequently (16-34% range). Women were less likely than men to receive statins. For example, in 2016 men received statins 49% of the time compared with only 41 % in women. Following 2013 AHA/ACC guidelines, men had a 9% increase in statin prescriptions while for women it increased only 5%. Lifestyle counseling decreased from 25% to 23% post-2013, men decreasing by 6% and women increasing by 5%. Nutrition and exercise counseling was done only in 21% and 13% of the visits in 2016.

Conclusion:
Despite the ACC/AHA guidelines emphasis on statin use and lifestyle recommendations for secondary prevention in high risk ASCVD patients, the overall rates in ambulatory care remain low. Women were less likely to receive these preventive measures.
Abstract 11736: Anatomic Repair of Congenitally Corrected Transposition of the Great Arteries is Associated With Risk of Heart Block and ECMO, but Not Mortality
Authors: Lemley Bethan A , Mille Felina , Maeda Katsuhide , Obyrne Michael L , Cohen Meryl S
Published: March 2022

Introduction:
Congenitally corrected transposition of the great arteries (CC-TGA) is characterized by atrioventricular and ventriculoarterial discordance with circulation remaining in series. The double switch operation and atrial switch with Rastelli are anatomic repairs of CC-TGA, achieving a systemic morphologic left ventricle. In contrast, physiologic repair (addressing associated lesions like ventricular septal defects and pulmonary stenosis) or no repair leave the right ventricle in the systemic position. Anatomic repair may confer superior longevity with increased upfront risk. We sought to determine if anatomic repair was associated with increased short-term risk of mortality, heart block, or extracorporeal membrane oxygenation (ECMO).

Methods:
Single-center retrospective cohort study of CC-TGA patients from 1990-2017. Cox proportional hazard analyses and Fisher’s exact test were performed.

Results:
Inclusion criteria were met by 54 patients, 21 anatomic repair and 33 physiologic/no repair. Median follow-up was 8.9 years (IQR 1.4-18.0) with no difference between cohorts (p=0.38). The anatomic repair cohort was more likely to have ventricular septal defects, 86% versus 33% (p<0.001) and pulmonary stenosis, 43% versus 15% (p=0.02). Mortality was low and did not differ significantly between cohorts (p=0.07). Probability of developing complete heart block was higher in the anatomic repair cohort (p=0.006), with no significant difference after adjusting for anatomy (HR 3.8, 95% CI 0.7-20.5). The anatomic repair cohort had an increased risk of ECMO (p=0.006). There was no difference in quantity of iterative operations (p=0.64).

Conclusions:
Anatomic repair of CC-TGA conferred a higher short-term risk of heart block and ECMO compared to the physiologic/no repair cohort, though risk of heart block was linked with anatomy. This upfront risk did not result in higher mortality in the anatomic repair cohort but long-term risk remains unknown.
Abstract 11737: Higher Frequency of Ventricular Ectopy is Associated With Incident Dementia in Older Adults Without Atrial Fibrillation: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Parikh Romil R , Wang Wendy , Norby Faye L , Zhang Michael J , Matsushita Kuni , Soliman Elsayed Z , Windham B Gwen , Mosley Thomas , Pike James R , Wasserman Bruce A , Johansen Michelle C , Gottesman Rebecca F , Alonso Alvaro , Chen Lin Y
Published: March 2022

Introduction:
Excessive ventricular ectopy (VE) is a risk factor for stroke. It is unclear whether higher frequency of VE is associated with the risk of dementia.

Hypothesis:
Higher frequency of VE, including ventricular tachycardias (VT) and premature ventricular contractions (PVC), are associated with a higher risk of dementia.

Methods:
We included 2167 participants without adjudicated dementia, stroke or atrial fibrillation (mean age, 79 years, 60% female, 26% Black). We measured burden of VT and PVC over 2 weeks at baseline (2016-17) with Zio XT patch: an ambulatory ECG recorder (iRhythm Technologies, Inc.). We quantified PVC burden as: 1) natural log of frequency in episodes/day (due to skewed distribution) and 2) dichotomously, split at the median level of frequency. We quantified VT burden as: 1) presence of any VT, 2) frequency of VT (episodes/day) split at the median, and 3) duration of the longest VT episode split at the median, using ‘no VT’ group as the referent in each case. We adjudicated dementia events through 2019 using cognitive testing at study visits, telephone cognitive interviews, and medical records. We calculated relative risk of incident dementia by Poisson regression with robust error variance.

Results:
At baseline, PVC and VT were present in 99% and 27% of participants, respectively. Over 2 years of follow-up, 66 (3.0%) participants developed dementia. Higher frequency of PVCs and VTs (≥ median vs none), and longer duration of the longest VT episode (≥ median vs none) were associated with a higher risk of dementia independent of cardiovascular (CV) disease and risk factors (Table). These associations were attenuated after adjusting for incident stroke.

Conclusions:
In older adults, higher VE frequency is associated with a higher dementia risk independent of CV risk factors. Our novel findings broaden the scope of “vascular contribution to cognitive impairment and dementia” to include ventricular arrhythmias as novel risk factors for dementia.
Abstract 11740: Outcomes of Durable Left Ventricular Assist Device Implantation in Patients With End Stage Renal Diseases- Latest Outcomes From Nationwide Inpatient Sample (2015-2018)
Authors: Kurpad Krishna Prasad , Sohal Sumit , Mehta Harsh , mathai sheetal vasundara , Hawthorne Keith A , Montgomery Matthew , Kapoor Saurabh , Waxman Sergio
Published: March 2022

Introduction:
Left ventricular assist devices (LVAD) improve survival in patients with advanced heart failure however their use in patients with concomitant end stage renal disease (ESRD) is limited. Previous studies demonstrate higher mortality and morbidity in this subset of patients. Our aim was to assess in-hospital outcomes in patients who undergo LVAD implantation with and without ESRD in a national cohort.

Methods:
Using Nationwide Inpatient Sample (NIS) for years 2015-2018, all patients who underwent LVAD implantation during the hospitalization were identified. Cohort was divided into two groups, with and without ESRD. Baseline characteristics, comorbidities, in-hospital outcomes were compared between both the groups. Statistical significance was assigned at p<0.05. Analysis was performed using STATA.

Results:
A total of 7185 patients underwent LVAD implantation between 2015-2018. 150 patients (2.09%) had ESRD at baseline. Despite having similar baseline characteristics and comorbidities in both groups (Table 1), the in-hospital mortality was significantly higher in patients with ESRD (43.33% vs 7.46% p-value: 0.001). Similarly, patients in ESRD group had longer length of stay (92.56 ±11.6 days vs a 33.72±0.73 days, p=0.001) and their cost of stay was also significantly higher ($2,179,827 vs $915,699, p=0.001). After multivariable analysis, ESRD remained an independent predictor of inpatient mortality (OR: 3.68, 95% CI (1.06-12.6), p=0.03). The bleeding, infectious and thromboembolic outcomes (Table 2) were also significantly higher in patients with ESRD undergoing LVAD implantation.

Conclusions:
Patients who are ESRD and receive LVAD during their admission are at higher risk of mortality, bleeding, infectious and thromboembolic events. More studies are required to improve management strategies and identify specific subgroup of patients who would benefit from LVAD implantation in this subset.
Abstract 11746: Prior Heart Failure Hospitalization and Effects of a Nurse-Led Disease Management Program to Reduce Readmission in Heart Failure
Authors: Huynh Quan , Zisis Georgios , Marwick Thomas
Published: March 2022

Background:
Hospitalization due to heart failure (HF) is a strong predictor of adverse outcomes. This study sought to what extent previous HF admissions impacted on the success of a disease management program (DMP) to reduce readmission.

Methods:
We prospectively enrolled 1363 consecutive HF pts, who were followed for 3 months after discharge. Of these, 431 (31%) received a DMP (1-month duration, including post-discharge home visits, medication reconciliation, exercise guidance and early clinical review). Study outcomes were all-cause readmission or death at 30- and 90-day post-discharge. Previous HF admissions were collected from medical records.

Results:
Of the 1363 HF patients, death or readmission occurred in 386 (28%) at 30 days and 556 (41%) at 90-days post-discharge. Compared to 765 patients without any previous HF admission ever, the 143 patients with a previous HF admission >12 months before the current admission had no higher risks of readmission or death at 30 days (relative risk) and 23% higher risks of readmission or death at 90 days. The 420 patients who had a previous HF admission ≤12 months from the current admission had higher risks of the composite outcome at both 30 and 90 days (Table). DMP was not associated with any reductions in risks of adverse outcomes at both 30 and 90 days among patients with a previous HF admission in ≤12 months, but was significantly associated with a reduction in risks at 30 and 90 days (Table) among those without any previous HF admission in ≤12 months. These findings were independent of HF severity, systolic and diastolic function, comorbidities, cognitive function and any demographic or socioeconomic factors.

Conclusion:
Higher levels of attention should be focused on HF patients with a recent prior HF admission who have higher risks of post-discharge adverse outcomes and appear to be non-responsive to a DMP to reduce readmission.
Abstract 11751: Long Term Quality of Life Improvement After Peripheral Vascular Intervention- Insights From the Liberty 360 Study
Authors: Chowdhury Mohsin , Smolderen Kim G , Mena-hurtado Carlos , Spertus John , Yeh Robert W , Secemsky Eric A
Published: March 2022

Background:
Improving patients’ quality of life (QoL) is a primary indication for peripheral endovascular intervention (PVI) for peripheral arterial disease (PAD). Little is known about the long-term improvement in QoL following PVI or predictors of those who may experience the greatest benefit.

Methods:
We studied 1204 patients enrolled in LIBERTY 360 Study, a prospective, multicenter study that evaluated clinical outcomes in symptomatic PAD patients undergoing lower extremity PVI. Patient reported QoL measures were assessed at 30 days, 12 months and 36 months using EuroQol and VascuQol-25. Multivariable regression was used to identify significant predictors of improved quality of life at 12 months.

Results:
For claudication patients (Rutherford 2-3), the baseline VascuQol total score was 4.3±1.3 and EuroQol composite score indicated that 21.5% had no/slight functional problems (NSFP). Health status significantly improved by 30 days, with VascuQol score 5.4±1.3 and 48.2% with NSFP), and persisted through 3 years (1 year: VascuQol score 5.3±1.3, 46.3% with NSFP; 3 years: VascuQol score 5.3±1.4, 46.9% with NSFP). For patients with critical limb ischemia (CLI; Rutherford 4-6), baseline VascuQol total score was 3.8±1.4 and 16.6% had NSFP. Health status significantly improved by 30 days, with VascuQol score 4.7±1.4 and 29.9% with NSFP, and persisted through 3 years (1 year: VascuQol score 5.0±1.4, 35.0% with NSFP; 3 years: VascuQol score 5.0±1.4, 38.0% with NSFP). In multivariable regression, baseline symptom severity, disease severity, BMI, gender, history of PVI, target lesion residual stenosis and renal disease were significant predictors of QoL improvement post-intervention (Figure 1).

Conclusions:
Endovascular intervention is associated with significant, long-term improvement in QoL measures across different disease severity. Baseline symptom severity and comorbidities were strong predictors of QoL improvement 1 year after intervention.
Abstract 11755: Adverse Events of Third Generation Left Ventricular Assist Devices: Insights From the Manufacturer and User Facility Device Experience Database
Authors: Heaton Joseph , Singh Sohrab , Li Matthew , Vallabhajosyula Saraschandra
Published: March 2022

Background:
Left ventricular assist devices (LVAD) are used frequently to treat end-stage heart failure. The HeartMate 3 (HM-3), the newest LVAD, has limited data on complications. We analyzed the post-marketing surveillance data from the Manufacturer and User Facility Device Experience (MAUDE) database to evaluate complications from the HM-3.

Methods:
We queried the MAUDE database for device event reports of the HM-3 LVAD from 1/1/2017 to 12/31/2019. We screened event reports for completeness, stratified complications into the device and patient effects, and used descriptive analyses on the compiled reported complications.

Results:
In this time period, 3,867 device reports met the search criteria, of which 961 identifiable device-specific complications were reported. The most common device events reported were infusion flow disruptions (21.0%), halted pump (9.2%), and material deformation (8.4%). Additionally, 5,676 events affecting patients were also reported in this period. Not counting death, blood loss (21.8%), infection (17.8%), and thrombus (3.3%) were the most commonly reported clinical events. Lastly, 535 deaths were reported, stemming from cerebral vascular accidents (9.7%) and hemorrhage (6.7%). Device events, patient events, with device and patient events associated with death are represented in
Figure 1
.

Conclusion:
Findings from the MAUDE database provide insight into complications and risks of the HM-3 LVAD. Addressing the complications and understanding the risk may improve clinical outcomes for patients with refractory heart failure.

Figures 1A, 1B, 1C, 1D
Abstract 11766: Late Gestation Fetal Oxygenation is Associated With Birthweight and Head Circumference in Patients With Cyanotic Congenital Heart Disease
Authors: Sun Liqun , Lee Fu-tsuen , van Ameron Joshua F , Portnoy Sharon , Lim Jessie M , Saini Brahmdeep S , Jaeggi Edgar , Kingdom John C , Macgowan Christopher K , Miller Steven P , Seed Mike
Published: March 2022

Introduction:
Abnormal fetal growth and development are evident in patients with cyanotic congenital heart disease (cCHD). However, the relationship between growth and fetal oxygenation is unknown. We sought to investigate the relationship between fetal hemodynamics and fetal growth in cCHD using fetal cardiovascular Magnetic Resonance Imaging (MRI).

Hypothesis:
The impaired fetal oxygenation would be associated with diminished fetal brain and body growth in cCHD.

Methods:
We performed a prospective observational study in fetuses diagnosed with cCHD at our institution from June 2010 to January 2020. Late-gestational fetal cardiovascular MRI was performed in 152 fetuses with cCHD to assess fetal blood flow (phase-contrast MRI) and oxygen saturation (T2 oximetry) in the major fetal vessels to calculate oxygen delivery to the brain and body according to our previously published techniques. Results are provided as medians with IQR and compared with 30 gestational age-matched normal controls using Mann-Whitney U test. A Pearson’s correlation was used to examine the relationships between variables.

Results:
Compared with normal controls, fetuses with cCHD had significantly reduced birth weight Z-scores [-0.41 (-0.29, 0.84) vs. -0.19 (-0.46, 0.37), p = 0.03], and neonatal head circumference Z-scores [0.1 (-1.75, 0.95) vs. 0.69 (0.1, 1.79), p = 0.003]. As a combined cohort, birthweight Z-score was correlated with fetal oxygen delivery (r = 0.33, p = 0.003), umbilical vein flow (r = 0.2, p = 0.006) and oxygen saturation (r = 0.25, p = 0.02). Birth head circumference Z-score was correlated with fetal cerebral oxygen delivery (r = 0.33, p = 0.01) and ascending aorta oxygen saturation (r = 0.33, p = 0.009). We also found an inverse relationship between ascending aorta oxygen saturation and superior vena cava flow (r = -0.24, p = 0.036).

Conclusions:
In conclusion, we observed associations between placental function in late gestation and birthweight, as well as cerebral oxygen delivery in utero and head circumference at birth. Our findings are in keeping with the concept that cCHD impacts fetal development through abnormal circulatory physiology and placental function.
Abstract 11773: Impact of Race on Incident Atrial Fibrillation in a Large Cohort With Cardiac Implantable Electronic Devices
Authors: Goergen Jack A , Varberg Nathan , Nayak Tanvi , Ziegler Paul D , Soderlund Dana , Passman Rod S
Published: March 2022

Introduction:
Prior studies showed lower rates of atrial fibrillation (AF) in African Americans (AA) compared to Caucasians (CC) despite a higher prevalence of AF risk factors. These studies often relied on a clinical diagnosis of AF or limited analyses to Medicare beneficiaries which may bias the results. Our objective is to compare AF-free survival in AA vs CC patients with dual chamber cardiac implantable electronic devices (CIEDs) capable of continuous AF monitoring.

Hypothesis:
There is no significant difference in incident AF between AA and CC patients with dual chamber CIEDs.

Methods:
Using the Optum® de-identified Electronic Health Record dataset (01/2007 to 06/2019) linked with the Medtronic CareLink® device database, we identified self-described AA and CC patients with dual chamber CIEDs and no prior AF history. The primary endpoint was time to first AF ≥ 6 minutes. Cox proportional hazards models were used to examine the association between race and AF while adjusting for age, sex, and vascular risk factors in the pacemaker and ICD cohorts.

Results:
Of the 110,323 patients analyzed, mean age was 69±13 years, 64% were male, 8.9% were AA, and 39% had a pacemaker. CC were older (69.5 vs 63.4 years) and more were male (65% vs 54%). Heart failure, hypertension and diabetes were more common in AA (36% vs 22%; 60% vs 47%; 32% vs 22%, respectively). Over a mean follow-up of 2.3±1.8 years, unadjusted AF-free survival was higher in AA compared to CC in both CIED cohorts (p<0.0001). After adjusting for age, sex and vascular risk factors, CC with pacemakers had a higher risk of incident AF (HR 1.10; 95% CI 1.03-1.17) but a lower risk was observed in CC with ICDs (HR 0.91; 95% CI 0.87-0.94) (Figure 1).

Conclusions:
In contrast to previous studies, this analysis of 110,323 CIED patients showed that adjusted AF-free survival was higher in AAs with pacemakers but not ICDs. These results challenge our understanding of the interaction between race and incident AF.
Abstract 11774: Coronary Artery Calcium and All-Cause Mortality
Authors: Eghtedari Bibinaz , Kinninger April , Roy Sion , Budoff Matthew
Published: March 2022

Objectives:
Coronary artery calcium (CAC) has been demonstrated as a non-invasive, low-cost means of assessing atherosclerotic burden and risk of major cardiovascular events in asymptomatic individuals. While it has been previously shown that CAC progression predicts all-cause mortality, we sought to further quantify this association by examining a large cohort of individuals over a follow-up period of between 1 to 22 years.

Methods:
We studied 3,260 persons aged 30 to 89 years who were referred by their primary care physician for CAC measurement, and had a follow-up scan at least 12 months from initial scan. CAC change was evaluated by absolute change between baseline and follow-up scan. Multivariate analyses using Cox proportional hazards models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between CAC progression and death after adjusting for age, gender, race and other risk factors. Participants were considered at risk from the date of exam 1 to the first occurrence of an event of death or lost to follow-up. The occurrence of death across the follow-up period was verified with the National Death Index.

Results:
The average time between scans was 4.7±3.2 years with an additional average of 9.1±4.0 years of follow-up time. The average age of the cohort was 58.1 ±10.5 years, 70% being male. A total of 164 deaths occurred. A clinical cut point of CAC progression of 100 units was significantly associated with mortality, hazard ratio 1.51 (95% CI 1.10 -2.13) P=0.017, while adjusting for age, gender, race, diabetes mellitus, hypertension, hyperlipidemia, smoking, baseline CAC and family history. Figure 1.

Conclusions:
CAC progression of greater than 100 units predicts all-cause mortality. This may add clinical value in encouraging close surveillance and aggressive treatment of individuals within this range.
Abstract 11779: E-cigarette Nicotine Vapor Increases Aortic Stiffness in Mice
Authors: Mulorz Pireyatharsheny , Mulorz Joscha U , Rhee YaeHyun , Bach Steffensen Lasse , Beck Hans , Wagenhaeuser Markus , Spin Joshua , Tsao Philip S
Published: March 2022

Introduction:
Arterial stiffness is increased by smoking and is a risk factor for various cardiovascular diseases. In recent years electronic cigarettes (e-cigs) have gained worldwide popularity as potentially “healthier” substitutes for conventional smoking, especially among young adults and teenagers. These devices provide nicotine at levels equal to or greater than those from conventional cigarettes. To date, little is known about the effects of e-cigs on vasculature. We investigated whether inhaled nicotine through e-cig vapor leads to enhanced aortic stiffening through extracellular matrix remodeling in both young and adult mice.

Hypothesis:
Inhalation of nicotine vapor augments aortic stiffening process when compared to e-juice only or room air.

Methods:
Young (6-week-old) and adult (14-week-old) male C57BL/6J mice were exposed to unflavored e-cig vapor with or without nicotine (24 mg/ml) at 9 puffs/min for 1 hour/day for 21 consecutive days, or room air.
In vivo
aortic stiffness was assessed by measurement of pulse wave velocity. At the end of the time-course the aorta was explanted for segmental pressure myographic measurements. Blood pressure and pulse rate were tracked throughout the experiment utilizing a non-invasive tail-cuff-system. A subset of aortic tissue was also subjected to exploratory transcriptional profiling.

Results:
Exposure to e-cig vapor containing nicotine significantly augmented aortic stiffness when compared to room air or e-juice only exposed mice. This was apparent in both pulse wave velocity measurements and pressure myography. Observed effects were more pronounced in young mice when compared to adult animals, and occurred in both the thoracic and abdominal aortic segments. Expression array data identified changes between the groups. There were no significant differences between room air-exposed mice and mice exposed to e-juice without nicotine.

Conclusion:
Inhaled e-cig nicotine significantly increased murine aortic stiffness in both aortic segments after three weeks of daily exposure, especially in younger mice. Further clinical investigations into the direct effects of nicotine e-cigarettes on human vasculature, especially in young people, are warranted to contextualize these results.
Abstract 11782: Phenotyping Exercise Intolerance in HFpEF: Which Muscle is Limiting Aerobic Performance?
Authors: Macnamara James P , Sarma Satyam , Balmain Bryce , Hearon Christopher , Tomlinson Andrew , Morris Margot , Livingston Sheryl A , Moran Raksa , Alcala Jessica N , Samels Mitchel , Payne Marcus , Boyd Teverick , Babb Tony , Levine Benjamin D
Published: March 2022

Background:
Low aerobic power (peak VO
2
) is common in patients with Heart Failure with preserved Ejection Fraction (HFpEF). Mechanisms for low VO
2
are diverse and vary between patients. We used the cardiac output (Qc) response to VO
2
during exercise to characterize patients with HFpEF into those with primary cardiac or peripheral defects in oxygen uptake.

Methods:
Patients with HFpEF (n =15, age 69±6 years) underwent invasive cardiopulmonary exercise testing with measures taken at rest, 20W, and peak exercise. A right heart catheter was used to measure end-expiratory PCWP and cardiac output (Qc, direct Fick). Oxygen uptake (VO
2
) was measured using Douglas bags. Patients were “cardiac limited” if their ΔQc/ΔVO
2
relationship was blunted (<5) or “peripherally limited” if ΔQc/ΔVO
2
was normal or high (≥5). Effect size between groups was determined with Cohen’s
d
.

Results:
Seven patients were cardiac limited and eight were peripherally limited. ΔQc/ΔVO
2
slope was lower in cardiac limited patients (4.2±0.7 vs 6.6±1.3, Cohen’s
d
= 1.52). Cardiac limited patients were younger and more often female (Values and Cohen’s
d
shown in
Table
). Peak PCWP was similar between the groups (C: 34±8 vs P: 33±7 mm Hg,
d
= 0.09). Peak VO
2
was higher in cardiac limited patients (C: 12.7±4.3 vs P 9.8±1.3 ml/min/kg,
d
= 0.85). Stroke volume reserve was lower in the cardiac limited patients (C: 9±18% vs P: 37±20%,
d
= 0.77). Peripheral oxygen extraction (ΔAVO
2
) during exercise was lower in the peripherally limited patients (C: 13.2±1.7% vs P: 10.8±1.4%,
d
=1.24).

Conclusions:
Phenotyping exercise intolerance using the Fick equation can identify HFpEF patients with primary cardiac and peripheral limitations causing low aerobic power. Cardiac limited patients were unable to augment stroke volume, while peripherally limited patients were unable to augment the oxygen extraction from skeletal muscles. Exercise based phenotyping may be a useful strategy to match therapies to patient specific physiology.