bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 10791: Regeneration-Associated Cells Derived Exosomes Beneficial Than Mesenchymal Stromal Cells Derived Exosome in the Context of Myocardial Ischemia-Injury
Authors: Salybekov Amankeldi A , Salybekova Ainur , Sheng Yin , Kobayashi Shuzo , Asahara Takayuki
Published: March 2022

Introduction:
Vasculogenic conditioning of pro-inflammatory cells such as macrophages type 1, T cells, and primitive EPCs shifted their phenotype to pro-regenerative cells such as vasculogenic EPCs, M2 macrophages, and reg T cells, also known as regeneration-associated cells (RACs). Here, we investigated therapeutic efficacy of RAC-derived extracellular vesicles (RACev) in comparison with MSC-derived EVs (MSCev) in the context of myocardial ischemia-reperfusion injury (IRI).

Methods:
RACev and MSCev were isolated via ultracentrifugation. EVs quantity and quality were characterized by nanotracking analysis and CD9, CD63, Alix expression. EVs miR was sequenced and regenerative responsible miRs were validated using TargetScan and miRBase. Allogeneic immune response to the RACev and MSCev were evaluated. The function of RACev and MSCev were evaluated using HUVECs proliferation/cell-cycle assays
in vitro,
and repetitive (30min, d1, and d3 after IRI) systemic infusion with either RACev or MSCev in a myocardial IRI model.

Results:
Nanotracking analysis showed significant differences in quantity RACev vs. MSC (P= 0.03).
In vitro
, RACev markedly enhanced cell viability, proliferation, and migration of HUVECs in a dose-dependent manner compared to MSCev. Systemic injection of RACs (5x10
5
) derived EVs improved cardiac functions such as ejection fraction (P= 0.005) than MSCev treated group. In histology, RACev transplanted group showed less interstitial fibrosis and enhanced capillary densities (P =0.05) compared to MSCev. These beneficial effects are coupled with significant expression of angiogenesis, anti-inflammation, cardiomyogenesis, and anti-fibrosis-related miRs in RACev but not in MSCev.
In vivo
bioluminescence and labeled EVs histology tracking analyses depicted preferential accumulation of RACev into the IRI myocardium (P=0.01) than MSCev. Immune phenotyping analysis confirmed similar immunomodulatory effects of MSCev and RACev.

Conclusion:
Repetitive systemic transplantation of RACev is superior to MSCev in terms of cardiac function enhancements via crucial angiogenesis, anti-fibrosis, anti-inflammation, cardiomyogenesis, and anti-apoptosis-related miRs delivery to the ischemic tissue.
Abstract 10793: Duration of Rhythm Monitoring and Arrhythmia Recurrence After Pulmonary Vein Isolation for Atrial Fibrillation: A Systematic Review and Meta-Regression Study
Authors: Unni Rudy R , Odabashian Roupen , Prager Ross , Zhang Jimmy J , Hing Nicholas Ng Fat , Pi Lebei , Chen Lily , Wells George , Nair Girish
Published: March 2022

Introduction:
The effect of the rhythm monitoring strategy after catheter ablation for atrial fibrillation (AF) on reported atrial arrhythmia (AA) recurrence is not well characterized. We aimed to determine whether continuous rhythm monitoring after AF ablation detects more AA recurrence than intermittent rhythm monitoring, and whether the total duration of intermittent rhythm monitoring predicts reported AA recurrence.

Methods:
EMBASE, MEDLINE, and CENTRAL databases were systematically searched for randomized controlled trials (RCT) of adult patients undergoing first catheter ablation for AF from 2007 to 2019. Studies with a minimum of 12 months follow-up were included. We selected trial arms of patients undergoing first-time ablation for AF using pulmonary vein isolation alone, without additional left-sided ablation lesion sets. Studies of surgical and hybrid ablation, or those without full rhythm monitoring details were excluded. Duration of rhythm monitoring was extracted and summed in duplicate. Meta-regression with random effects and mixed-effects models was used to identify any association between duration of monitoring and single-procedure AA recurrence. Analyses were performed separately on arms of patients with paroxysmal AF, and persistent AF (PeAF) or combined PAF/PeAF.

Results:
The search strategy and study selection yielded 47 trial arms from 46 RCTs comprising 4236 patients: 30 arms of patients with PAF and 17 arms of patients with PeAF or both PAF/PeAF. There was less AA recurrence in arms undergoing intermittent monitoring than continuous monitoring in PAF arms (31.1% vs. 44.4%, p < 0.01), but not in PeAF/ PAF-PeAF combined arms (47.1% vs. 63.6%, p=0.22). There was no significant relationship between the duration of intermittent rhythm monitoring and AA recurrence in both PAF (p=0.87) and PeAF/ PAF-PeAF combined arms (p=0.14).

Conclusions:
In RCTs of catheter ablation for PAF, continuous rhythm monitoring detected higher AA recurrence rates than intermittent rhythm monitoring. The duration of intermittent rhythm monitoring did not influence reported AA recurrence. These findings have important implications to the care of patients with AF and to researchers studying AF ablation.
Abstract 10794: Adenosine Induced Dormant Pulmonary Vein Reconnection Predicts Recurrent Atrial Fibrillation After Pulmonary Vein Isolation: Systematic Review and Meta-Analysis
Authors: Shah Kuldeep , Shah Siddharth , Turagam Mohit K , Bhardwaj Rahul , Contractor Tahmeed , Mandapati Ravi , Natale Andrea , Lakkireddy Dhanunjaya , Garg Jalaj
Published: March 2022

Introduction:
Adenosine can be used to reveal dormant pulmonary vein (PV) conduction following pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF).

Hypothesis:
We performed a systematic review and meta-analysis to assess the impact of adenosine administration in patients undergoing PVI for AF.

Methods:
We searched PubMed, Medline, Embase, Ovid, and Cochrane for studies that reported freedom from AF during follow-up compared between those without reconnection and those with reconnection (requiring further targeted ablation). Statistical analysis was performed using
meta-package
for R version 4.0 and Rstudio version 1.2.

Results:
A total of 20 eligible studies (14 prospective, 3 retrospective, 3 randomized) consisting of 3,595 patients (Reconnection group - 1,228 and No Reconnection group - 2,367) were included in the meta-analysis. The follow-up period ranged from 6.1 months to 36 months. The freedom from AF in patients with PV reconnection was 62.45% compared to 68.10% of patients without PV reconnection. There was significant heterogeneity between studies (I2 = 68%; p < 0.001). Random-effects meta-analysis showed significantly higher freedom from AF in patients with no identified reconnection than those with identified reconnection (RR 0.89; 95% CI 0.80 - 0.99; p = 0.03).

Conclusions:
Adenosine-guided dormant conduction was associated with higher AF recurrence despite further ablation, but there was substantial heterogeneity between trials. Future research should be directed to improved techniques, and optimal methodology, including adenosine dosage and wait time between PVI and adenosine administration.
Abstract 10796: Patient and Clinician Perspectives of Decision Quality Surrounding Atrial Fibrillation Ablation: A Mixed-Methods Study
Authors: Reading Turchioe Meghan , Mangal Sabrina , Ancker Jessica , Slotwiner David J
Published: March 2022

Introduction:
Catheter ablation is a common treatment for atrial fibrillation (AF) with nuanced risks and benefits. Shared decision-making (SDM) could guide the decision to undergo ablation based on patient values and goals of care. Understanding whether and how SDM about ablation is conducted in clinical practice would allow us to determine how to optimize patient decision making and decision quality. The objective of this study was to investigate decision quality and SDM practices surrounding AF ablation.

Methods:
We conducted a mixed-methods study guided by Sepucha & Scholl’s (2014) SDM framework which specifies decision antecedents, processes, and outcomes. We recruited a convenience sample of AF ablation patients (n=15) and clinicians (n=5; 3 MDs, 1 PA, 1 NP) from a hospital in Queens, New York. Patients completed the AF Symptom Survey (AFSS), Controls-Preferences scale (CPS), and Decisional Conflict scale (DCS), which were summarized using descriptive statistics (median, interquartile range [IQR], and frequency). Patients and clinicians completed semi-structured interviews, which were analyzed using directed content analysis. Participants received $25 as compensation. The Weill Cornell Medicine IRB approved this study.

Results:
Patients’ median age was 71.0 years (IQR 69.0-78.5), 27% were female, 67% were White, and 73% spoke English. The median AFSS score was 0 (IQR 0-1.0) out of 35 indicating low symptom burden post-ablation. The median DCS score was 7.0 (IQR 0-16.4) out of 100 indicating low levels of conflict. On the CPS 4 patients (27%) preferred to have some control in decision-making; the remainder preferred to share control or relinquish it to clinicians. Qualitative findings underscore low levels of decisional conflict but limited patient agency
(Table)
.

Conclusion:
Findings suggest opportunities to improve decision quality surrounding AF ablation by bolstering patient agency, possibly through educational materials and decision aids.
Abstract 10802: Validation of Artificial Intelligence for Assessing Right Ventricular Function by Transthoracic Echocardiography Compared to Cardiac MRI
Authors: Hsia Brian C , Lai Ashton , Samtani Rajeev , Bienstock Solomon , Liao Steve , Stern Eric , LaRocca Gina , Sanz Javier , Lerakis Stamatios , Stone Gregg W , Croft Lori , Goldman Martin
Published: March 2022

Introduction:
Cardiac MRI (CMR) is the gold standard for right ventricular function (RVF) because echo assessment is limited. Potential echo parameters to assess RVF include RV fractional area change (FAC), RV free wall strain (FWS), and tricuspid annular plane systolic excursion (TAPSE) on apical 4-chamber (A4C) view. We compared a new Artificial Intelligence method that tracks the RV almost instantaneously in a single 4-chamber view (AI, LVivo RV®, DiA Imaging, Figure) to quantify RVF vs CMR.

Methods:
We compared AI RVF against CMR in 125 pts. Abnormal LVEF and RVEF were defined as <57% and <49% respectively. Echo closest to CMR date was analyzed with AI RV to obtain FAC, FWS, and TAPSE. We defined abnormal RVF by DiA Imaging’s predetermined thresholds. Sensitivities and specificities for abnormal RVF and chi-square (χ
2
) tests were calculated for each variable against CMR RVEF.

Results:
Of the 125 pts, 55 (44%) were female with median age 55 [Q1 44, Q3 67] years. Thirty pts (24%) had abnormal RVEF and 78 (62.4%) had abnormal LVEF by CMR. All pts with abnormal RVEF had abnormal LVEF. Compared to CMR, AI RV sensitivities and specificities for abnormal RVEF were: FAC 87% and 60%, FWS 80% and 61%, TAPSE 77% and 54%, any 2 criteria 83% and 61%, and all 3 criteria 63% and 69%. AI RV χ
2
values were: FAC 19.9 (p<0.001), FWS 15.4 (p<0.001), TAPSE 8.4 (p=0.004), any 2 criteria 18.0 (p<0.001), and all 3 criteria 10.4 (p=0.001).

Conclusions:
This is the first validation of a novel AI method (LVivo RV®) that can detect RV dysfunction using 3 standard RV measurements from a single A4C view with good sensitivity and specificity compared to volumetric CMR as the gold standard.
Abstract 10805: Income and Antiplatelet Adherence Following Acute Coronary Syndrome: An Administrative Claims Analysis
Authors: Larosa Anna R , Swabe Gretchen , Magnani Jared W
Published: March 2022

Introduction:
Income and social resources are associated with cardiovascular health and outcomes. We examined income and medication adherence following acute coronary syndromes (ACS). We hypothesized that following percutaneous coronary intervention (PCI), individuals with lower income would have lower adherence to antiplatelet agents than higher income referents.

Methods:
We employed administrative claims of commercially insured and Medicare Advantage beneficiaries (Optum's de-identified Clinformatics® Data Mart Database) with incident ST- and non-ST elevation myocardial infarction from 2017-19. We collected data on age, sex, race, education, and covariates (medications, healthcare visits, insurance type, copay, antiplatelet type, and Elixhauser Comorbidity Index conditions). We compared antiplatelet adherence, measured with proportion of days covered (PDC) using up to 12 months of pharmacy claims, across income categories (<$40K; $40-49K; $50-59K; $60-74K; $75-99K; and ≥$100K). Our multivariable-adjusted regression models determined odds of non-adherence (PDC<80%) with the highest income category as referent.

Results:
Our dataset included 31,272 individuals (age 72.5 ±11.9, 34.3% women, 22.6% non-White) who presented with ACS and underwent PCI. We observed graded, decreased antiplatelet adherence across income categories (Figure): rates of PDC≥80% decreased with successively lower income, from 84.3% (≥$100K) to 73.1% (<$40K). Individuals with income <$40K had 1.6-fold higher odds of non-adherence (95% CI, 1.43-1.75) compared to those with income ≥$100K after multivariable adjustment.

Conclusions:
Lower income is associated with lower adherence to antiplatelet agents following PCI for ACS. These results support consideration of income and long-term barriers to medication access as part of strategies to address adherence.
Abstract 10806: The Association of Hemoglobin Drop with In-Hospital Outcomes in Covid-19 Patients
Authors: Kuno Toshiki , Miyamoto Yoshihisa , Iwagami Masao , Ishimaru Miho , Takahashi Mai , Egorova Natalia
Published: March 2022

Background:
Bleeding events can be critical in hospitalized patients with COVID-19, especially those with aggressive anticoagulation therapy.

Objective:
We aimed to investigate whether hemoglobin drop associated with increased risk of acute kidney injury (AKI) and in-hospital mortality among patients with COVID-19.

Methods:
This retrospective study was conducted by review of the medical records of 6,683 patients with laboratory confirmed COVID-19 hospitalized in the Mount Sinai Health system between March 1
st
, 2020 and March 30
th
2021. We compared patients with and without hemoglobin drop >3g/dL during hospitalization within a week after admissions, using inverse probability treatment weighted analysis (IPTW). Outcomes of interest were in-hospital mortality and AKI which was defined as increased of creatine 1.5 times or 0.3mg/dL.

Results:
Of the 6,683 patients admitted due to COVID-19, 750 (11.2%) presented with a marked hemoglobin drop. Patients with hemoglobin drop were more likely to receive therapeutic anticoagulation within two days after admissions. Patients with hemoglobin drop had higher crude in-hospital mortality (40.8% versus 20.0%, P<0.001) as well as AKI (51.4% versus 23.9%, P<0.001) compared to those without. IPTW analysis showed that hemoglobin drop was associated with higher in-hospital mortality compared to those without (odds ratio (OR) [95% confidential interval (CI)]: 2.21 [1.54-2.88], P<0.001) as well as AKI (OR [95% CI]: 2.79 [2.08-3.73], P<0.001). Finally, the smooth spline curve showed the association of hemoglobin drop and adjusted odds ratio for in-hospital mortality, which reflected the association of hemoglobin drop and in-hospital mortality (Figure).

Conclusions:
Hemoglobin drop during COVID-19 related hospitalizations was associated with a higher risk of AKI and in-hospital mortality.
Figure Legends:
Smooth spline curve of the association of hemoglobin drop and adjusted odds ratio of in-hospital mortality.
Abstract 10811: Hemodynamic Optimization of Left Ventricular Assist Devices During Right Heart Catheterization Ramp Studies
Authors: Hajduczok Alexander , Julian Katherine , Maucione Carly , Bent Brinnae , DiChiacchio Laura , Ali Omaima , Boehmer John
Published: March 2022

Background:
Studies have shown that hemodynamic LVAD ramp studies can be used to optimize speeds and improve clinical outcomes, yet these studies lack external validation.

Methods:
470 LVAD patients, including 3 LVAD subtypes, were retrospectively analyzed and 53 ramp studies were identified. Measurements (RA, mean PA, PCWP, and CI) were taken at speeds +/- 20% of the manufacturer recommended set speed for HM2, HM3, and HVAD devices. Primary outcomes were all-cause and heart failure (HF) hospitalizations in the 6-month period pre- and post-ramp study. Secondary outcomes included final LVAD speed and hemodynamic measurements following ramp study. Time to first hospitalization and cumulative incidence rate of all-cause and HF hospitalization were reported.

Results:
Baseline characteristics of 53 studies included: mean age of 60.1 (+/- 10.9), 84.9% male, 56.6% ischemic etiology, 71.7% destination therapy, and average NYHA class and INTERMACS of 2.5 (+/- 0.7) and 5.9 (+/- 1), respectively. 38 of 53 studies (71.7%) showed PCWP decompression >20%, with average PCWP decompression of 51.2% (+/- 21.0%), and CI increase of 22.5% (+/- 18.7%). Optimal LVAD speeds were chosen to maintain CI > 2.2, PCWP < 15 and minimize RAP, in the absence of suction events. 31 (58.5%) of studies resulted in an LVAD speed change and 16 (30.2%) of studies resulted in diuretic change. All-cause and HF hospitalizations were significantly decreased in the 6-months following ramp studies compared the 6-months pre-ramp (total days hospitalized for all causes: 12.0 vs 26.6, p=0.0002; total days hospitalized for HF, 4.8 vs 22.1, p=0.00003). Speed changes were associated with a nonsignificant improvement in time to first hospitalization.

Conclusion:
This externally validates previous data suggesting that LVAD hemodynamic ramp studies decrease hospitalizations. Larger, prospective studies may elucidate specific hemodynamic targets to improve mortality and reduce rehospitalizations.
Abstract 10814: Prolongation of the Refractory Period is a Key Mechanism of Optogenetic Termination of Atrial Fibrillation in Mouse Hearts
Authors: Nakao Motoki , Watanabe Masaya , Natsui Hiroyuki , Koizumi Takuya , Kadosaka Takahide , Koya Taro , Hagiwara Hikaru , Kamada Rui , Temma Taro , Anzai Toshihisa
Published: March 2022

Backgrounds:
Optogenetics is a new technique that employs light-sensitive channels and manipulates the cell membrane potential. Although painless defibrillation of reentry arrhythmias such as atrial fibrillation (AF) using optogenetics has been reported, the mechanism has not been fully elucidated because of the difficulty to evaluate the action potential (AP) modification by in/ex-vivo light illumination.

Purpose:
Our aim is to clarify the mechanism of optogenetic defibrillation of AF in a mouse heart by voltage-sensitive optical mapping. For this purpose, we employed a novel approach using brief light illumination combined with a systematic electrical stimulation protocol.

Methods and Results:
Hearts from transgenic mice expressing channelrhodopsin-2 in atrial cardiomyocytes were explanted and perfused with tyrode’s solution containing low K
+
concentration (2.7mM) and K
ACh
-channel activator carbachol (2μM). Atrial tachyarrhythmia induced by burst pacing was terminated by blue light (470nm) illumination with a pulse duration of 10 ms and a light intensity of 16 mW/mm
2
with a probability of 64.7 ± 8.1% (n=9). The termination rate depended on the pulse duration and light intensity. Then, we examined whether brief light illumination (10 ms, 6mW/mm
2
) at different time phases from the rise of the AP (phase 0) to the repolarization (phase 4) modify AP shape and prolong the effective refractory period (ERP) using voltage-sensitive optical mapping. Brief light illumination prolonged AP duration and ERP in all time phases. The degree of ERP prolongation was dependent on the pulse duration, but not on the light intensity above 1 mW/mm
2
. Finally, we measured the attenuation of blue light intensity through the atrial tissue and observed that the intensity decreased by 38.1 ± 3.5% at 10mW/mm
2
on 3 mm
2
circular area(n=6), suggesting that high-intensity light also modulates the APs of atrial cardiomyocytes in deeper layers.

Conclusion:
Our results directly demonstrated that brief light illumination prolonged the atrial refractory period depending on pulse duration in a perfused heart and suggests the prolongation of the refractory period is a key mechanism of optogenetic termination of AF.
Abstract 10815: C-Terminal Src Kinase Inhibits Endothelial Fibrosis and is Upregulated in Early-Stage Experimental Pulmonary Arterial Hypertension
Authors: Wertheim Bradley M , Wang Rui-Sheng , Zhang Yingyi , Samokhin Andriy O , Alba George A , Arons Elena , Oldham William M , Maron Bradley A
Published: March 2022

Introduction:
Advanced-stage pulmonary arterial hypertension (asPAH) is characterized by endothelial dysfunction and fibrotic remodeling of pulmonary arterioles that promotes irreversible right heart failure. Thus, identifying mechanisms that regulate vascular fibrosis in early PAH (esPAH) may have translational importance.

Hypothesis:
We hypothesized that profibrotic molecular pathways differentiate esPAH from asPAH.

Methods:
To test this hypothesis, male Sprague-Dawley rats were administered one dose of monocrotaline (60 mg/kg; day 0) to induce inflammatory PAH. Cardiac catheterization and pulmonary artery endothelial cell (PAEC) transcriptomic analyses were performed on days 15 and 21 for esPAH and asPAH, respectively.

Results:
The esPAH profile included: right ventricular-pulmonary arterial (RV-PA) uncoupling (1.13 ± 0.05 vs. 0.90 ± 0.06, RV end-systolic elastance/PA elastance, P=0.02, N=6) and increased indexed pulmonary vascular resistance (50 ± 8 vs. 213 ± 29 mmHg*min*g
-1
*mL
-1
, P<0.001, N=6) without substantial elevation in PA systolic pressure (25 ± 1.2 vs. 33 ± 2.7 mmHg, P=0.02, N=6). Network medicine identified upregulation of c-terminal src kinase (Csk) as a mediator of PAEC fibrosis in esPAH but not asPAH
in silico
. Pulmonary endothelial expression of Csk protein by immunofluorescence correlated with vascular collagen by picrosirius red stain (r=+0.87, P=0.006, N=4). To validate these findings
in vitro
, human PAECs (HPAEC) were treated with an inflammatory stimulus of lipopolysaccaride (0.03 mg/mL) + interferon-γ (50 ng/mL) + interleukin-1β (50 ng/mL), or vehicle control (V). Compared to V-control, inflammation increased Csk protein and mRNA expression by 2.3- and 2.0-fold, respectively (P<0.05, N=4). Inflammation also increased HPAEC hydroxyproline, an indicator of collagen abundance, by 3.1-fold (P=1.4x10
-4
, N=4) vs. V-treated cells. Overexpression of Csk by adenovirus transfection attenuated inflammation-mediated hydroxyproline accumulation by 84% (P=1.3x10
-5
, N=3).

Conclusions:
These data suggest that impaired Csk may underlie HPAEC fibrosis in esPAH, which, in turn, may have potential therapeutic implications for the prevention of fibrotic vascular remodeling and PAH progression.
Abstract 10816: Causal Effect of Atrial Fibrillation on Cardiovascular Diseases - A Mendelian Randomization Analysis in the Million Veteran Program
Authors: Nauffal Victor , Weng Lu-Chen , Treu Timothy , Gunn Sophia , Morrill Valerie N , Galloway Ashley , Khurshid Shaan , Ko Darae , Logue Mark W , Hauger Richard L , Lunetta Kathryn L , Joseph Jacob , Sun Yan , Benjamin Emelia J , Gaziano Michael , Cho Kelly , Wilson Peter , Ellinor Patrick T , Lubitz Steven A
Published: March 2022

Introduction:
Observational studies have implicated atrial fibrillation (AF) as a risk factor for a number of cardiovascular diseases (CVD). Whether AF is causally related to these CVD is unknown.

Methods:
We included participants with both electronic health record-derived phenotypes and imputed genotype data in this study. A genetic instrument for AF consisting of 406 common variants was derived using a pruning and thresholding method (r2<0.3; p-value <5x10-8) on the 2018 AF Genetics Consortium GWAS summary statistics. 1- and 2-sample MR analyses were performed. In 2-sample MR, the inverse-variance weighted method was used as the primary analysis. Additional sensitivity analyses were performed to account for potential violations of the instrumental variable assumptions.

Results:
We included 615,635 participants in the study (440,690 European, 118,531 African, 48,908 Hispanic, 7,506 Asian ancestry). Genetic risk of AF was associated with heart failure in both 1-sample (OR/log odds of genetically predicted AF =1.18, 95% CI 1.15 - 1.20) and 2-sample MR (OR/log odds of genetically predicted AF =1.13, 95% CI 1.11 - 1.15). Additionally, genetic risk of AF was associated with heart failure subtypes and non-ischemic cardiomyopathy. There was no association between genetic risk of AF and pulmonary embolism (PE) or deep venous thrombosis (DVT), however, genetic risk of AF was associated with PE after excluding individuals with concurrent or prior DVT (OR1-sample MR 1.08, 95% CI 1.01 - 1.15; OR2-sample MR 1.06, 95% CI 1.03 - 1.08). Lastly, we confirmed an association between genetic risk of AF and ischemic stroke but not all-cause dementia. Our results were robust to a number of sensitivity analyses.

Conclusions:
In a large multi-ancestry study, we delineate the potential causal contribution of AF to a number of CVD and highlight support for a causal association between AF and isolated PE. Our findings inform how prevention and treatment of AF may affect CVD incidence and outcomes.
Abstract 10817: Association of Hospital Procedural Volumes with Outcomes of Left Ventricular Assist Devices
Authors: Waheed Tayyab Ali , Nasir Usama , Ahuja Keerat , Green Jared , Agnieszka Mochon
Published: March 2022

Introduction:
Left Ventricular Assist Devices (LVADs) are effective and feasible options for stage D heart failure. The impact of procedural volumes on LVAD outcomes has been seldomly investigated.

Methods:
We investigated the Nationwide Readmission Database for the impact of different institutional LVAD volumes on clinical outcomes in 2018. Institutional procedural volumes were stratified into Low (1-7/year), medium (8-24/year) and high (>25/year). Multivariant analysis and adjusted odds ratio was performed to examine association between LVAD hospital volumes and outcomes. Primary outcome was major adverse events (MAE) defined as a composite of mortality, myocardial infarction, stroke or TIA, bleeding requiring transfusion, acute kidney injury, vascular complications and pericardial effusion or tamponade requiring pericardiocentesis or surgery.

Results:
A total of 2315 patients underwent LVAD placement, with a mean age of 57. No difference in age, sex or presence of chronic disease was noted among patient in different procedural volume tiers. There was statistically significant difference in MAE in medium-volume center when comparing to low volume centers. No difference in MAE was present in low and high-volume center. No significant difference was noted in 30-day all cause readmission, 30-day heart failure readmission or in individual components of MAE across different hospital procedural volumes.

Conclusions:
Medium-volume centers are associated with better composite clinical outcomes. Overall, no difference in mortality, stroke or myocardial infarction exists among different volume centers. Further clinical research is warranted to clarify the appropriate minimum LVAD procedural volumes required for accreditation.
Abstract 10823: Familial Hypercholesterolemia in the Brazilian Adult Population: Prevalence and Factors Associated According to the National Health Survey
Authors: Sa Ana Carolina M , Brant Luisa C , Saar Gomes Crizian S , Prates Elton Junio Sady , Malta Deborah
Published: March 2022

Introduction:
Familial Hypercholesterolemia (FH) is a genetic dyslipidemia associated with premature coronary artery disease (CAD) and stroke, however it is underdiagnosed. The World Health Organization recognizes FH as a public health priority and recommends early diagnosis and treatment. In Brazil, the prevalence of FH in population representative studies is lacking.

Objective:
To estimate the prevalence and investigate factors associated with FH in the Brazilian adult population.

Methods:
A total of 8,521 adults over 18 years old from the National Health Survey (NHS, 2014-2015) were included in this cross-sectional analysis. FH was defined by the Dutch Lipid Clinic Network criteria (Dutch MEDPED). Possible FH was defined in individuals who scored 3 to 5 points: premature CAD (2 points) and/or cerebral disease (1 point), and LDL-Cholesterol (mg/dL): 155-189 (1 point), 190-249 (3 points), 250-329 (5 points), ≥330 (8 points). The prevalence of FH was estimated according to sociodemographic, lifestyle, and health conditions variables and differences were evaluated using the chi-square test (p ≤ 0,05).

Results:
The prevalence of possible FH was 0.96% and it was higher in women (1.22%; p = 0.04), individuals of 45 to 59 years (1.74%; p = 0.004), white race (1.13%; p = 0.05), illiterate or with incomplete elementary school (1.55%; p = 0.002), in the presence of hypertension (1.75%; p = 0.002), diabetes (1.85%; p = 0.02), total cholesterol ≥310 mg/dL (53.94%; p < 0.001), and poor/very poor health self-assessment (2.40%; p < 0.001).

Conclusions:
FH was frequently present in the Brazilian adult general population (1:104 individuals). The early identification of FH may contribute to reducing the burden of premature CAD in the country.
Abstract 10824: High Bleeding Risk is Associated with a Higher Prevalence of Severe Calcified Plaque in Patients Requiring Percutaneous Coronary Intervention
Authors: Nagata Takako , Minami Yoshiyasu , Muramatsu Yusuke , Nakata Takuya , Asakura Kiyoshi , Katamine Masahiro , Kinoshita Daisuke , Ako Junya
Published: March 2022

Introduction:
Optimal revascularization strategy and shorter duration of dual antiplatelet are required in patients with coronary artery disease concomitant with high bleeding risk (HBR). More complex percutaneous coronary intervention (PCI) and subsequent high thrombotic risk in patients with HBR have been also demonstrated. However, the characteristics of culprit plaque in patients with HBR remains to be elucidated.

Hypothesis:
HBR is associated with more complex plaque in culprit lesion in patients requiring PCI.

Methods:
A total of 362 consecutive patients with stable coronary disease, who underwent optical coherence tomography (OCT) imaging of the culprit lesion during PCI were included. The characteristics of culprit plaque assessed by OCT were compared between the HBR group (n=196) and the non-HBR group (n=166), which were classified based on the Academic Research Consortium for High Bleeding Risk (ARC-HBR).

Results:
The prevalence of severe calcified plaque (angle >180 degee, thickness >0.5mm and length >5mm) was significantly higher in the higher HBR group than in the non-HBR group (48 vs. 35%,
p
=0.016), although other characteristics were comparable (Panel A). Among patients with HBR, the incremental prevalence of severe calcified plaque according to the number of major ARC-HBR criteria met was observed (
p
<0.001) (Panel B).

Conclusions:
HBR was associated with a higher prevalence of severe calcified plaque in culprit lesion in patients with stable coronary disease requiring PCI. The greater number of major ARC-HBR criteria met was associated with a higher prevalence of severe calcified plaque among patients with HBR.
Abstract 10829: Biradial Access Results in Lower Contrast Use and Fewer Complications Than Transfemoral Access in Alcohol Septal Ablation
Authors: Blaker Noah , Bidwell Katrina , Taylor Eric , Tharp Peyton , Cook Daniel , Nielsen Chris , Fernandes VALERIAN
Published: March 2022

Introduction:
Transradial cardiac catheterization has equivalent efficacy, reduced vascular complications, and is more comfortable and convenient for patients than transfemoral catheterization. The biradial approach for alcohol septal ablation (ASA) has not been well studied. Since 2013, the biradial approach has become the standard approach for alcohol septal ablation at MUSC. This project tested the hypothesis that the biradial approach is equally efficacious and results in fewer complications than the transfemoral approach in ASA.

Methods:
In this study 274 consecutive patients were retrospectively analyzed from the MUSC alcohol septal ablation database (137= biradial approach, 137=femoral approach) and the changes in left ventricular outflow tract gradient (LVOTG), amount of contrast, fluoroscopy time, and complications were recorded. Groups were not significantly different in pre-ASA LVOTG (p=0.88 and 0.06 for resting and provoked LVOTG respectively).

Results:
The procedures were equally efficacious at reducing LVOTG with a mean reduction of resting LVOTG of 91.24% (SEM=1.21) in biradial access and 92.37% (SEM=1.14) in femoral access (p=0.5), and a mean reduction of provoked LVOTG of 80.31% (SEM=1.90) in biradial access and 82.17% (SEM=1.74) in femoral access (p=.47). The biradial approach was associated with significantly less contrast use than the femoral approach (mean of 98.1 ccs, SEM of 3.60, and 110.89 ccs, SEM of 4.84, respectively; p=.035). There were statistically significant differences in fluoroscopy time and incidence of complications between the procedures (fluoroscopy time mean of 17.42 min. (SEM=0.93) biradial and 13 min. (SEM=0.72) femoral; (p= 0.00028). Incidence of cardiac complications of .13 biradial and .23 femoral; (p= 0.04)).

Conclusions:
In this largest study to date, the transradial approach is equally efficacious and is associated with significantly lower contrast use, and fewer complications, albeit with increased fluoroscopy time, than the transfemoral approach in ASA.
Abstract 10831: Comparison of Clinical Outcomes in Transcatheter Aortic Valve Replacement with Edwards Sapien 3 versus Evolut Series: A Systematic Review and Meta-Analysis
Authors: Krishan Satyam , Akhtar Khawaja Hassan , Ijaz Sardar H , Jafry Ali , Yalamanchili Sreeram , Nasir Yusra M , Akhtar Hafiza H , Dani Sourbha
Published: March 2022

Introduction:
The third generation transcatheter heart valve system aimed to improve the safety of transcatheter aortic valve replacement (TAVR). We performed systematic review and meta-analysis to compare clinical outcomes after TAVR with Edwards Sapien 3 (ES3) and Evolut series (MER).

Methods:
A systematic search was conducted by 2 independent researchers in MEDLINE and EMBASE for studies comparing clinical outcomes after TAVR with ES3 and MER. 1 randomized controlled trial and 11 observational studies met the inclusion criteria. Mantel-Haenszel odds ratios were calculated, and for heterogeneity I
2
statistics were reported.

Results:
12 studies with total 7,749 patients were included for final analysis. ES3 and MER were implanted in 4,333 and 3,416 patients respectively. ES3 showed statistically significant decrease in permanent pacemaker implantation at 30-days (OR: 0.60; 95% CI: 0.52-0.70; p< 0.05). Furthermore, TAVR with ES3 showed non-statistically significant trend towards decreased all-cause mortality at 30 days (OR: 0.73; 95% CI: 0.51-1.02; p=0.07), and stroke at 30 days (OR: 0.55; 95% CI: 0.27-1.10; p=0.09). Cardiovascular mortality (OR: 1.03; 95% CI: 0.50-2.15; p=0.93), and acute kidney injury (OR: 1.08; 95% CI: 0.83-1.41; p=0.56) did not show statistically significant difference.

Conclusions:
While ES3 and MER had similar clinical outcomes, patients undergoing TAVR with ES3 had statistically significant decrease in permanent pacemaker implantation and hence may be favored in patients with pre-existing conduction system disease.
Abstract 10836: Outcomes of Biventricular Pacing versus Conventional Pacing (DDD Mode) in Patients with a Normal Left Ventricular Ejection Fraction
Authors: Shah Siddharth , Shah Kuldeep , Turagam Mohit K , Bhardwaj Rahul , Contractor Tahmeed , Mandapati Ravi , Natale Andrea , Lakkireddy Dhanunjaya , Garg Jalaj
Published: March 2022

Introduction:
Cardiac resynchronization therapy (CRT) is beneficial in patients with heart failure with reduced ejection fraction and normal sinus rhythm. However, its role in patients with pacing indication, narrow QRS, and normal ejection fraction remains controversial.

Objectives:
We aimed to evaluate the impact of biventricular pacing (BiV) versus conventional right ventricular (RV) pacing (DDD mode, ventricular pacing avoidance algorithm) in patients with normal ejection fraction.

Methods:
A comprehensive literature search in PubMed, Google Scholar, and Cochrane Review from inception to November 15, 2020, was performed. Outcomes studies were - major adverse cardiovascular events (MACE, composite of cardiovascular death, hospitalization for heart failure or any cardiovascular cause), cardiovascular mortality, change in left ventricular ejection fraction (LVEF, %), left ventricular end-systolic volume (LVESV, mL) and left ventricular end-diastolic volume (LVEDV, mL).

Results:
Four randomized trials (n=457, BiV group=229, mean age 71.6±4.4 years, RV pacing=228, mean age 70.3±4.38 years) met inclusion criteria. There was a significant reduction in MACE (RR 0.68, 95% CI 0.46-0.99, p=0.04), LVESV [mean difference (MD) -6.42, 95%CI -10.27- -2.57; p=0.001], LVEDV (MD -6.12,95% CI -9.30 to -2.94; p=0.0002) in patients with BiV pacing compared to RV pacing. There was no reduction in cardiovascular mortality and a trend towards improvement in LVEF (MD 3.99,95% -0.12-8.10; p=0.06) with BiV pacing compared to RV pacing during the follow-up period (1.95 years).

Conclusion:
BiV pacing may be a feasible option for permanent pacing in patients with normal LVEF and may attenuate untoward effects of conventional RV pacing on the left ventricular function.
Abstract 10844: Integration of Electronic Health Records with Genetics: Burden of Arrhythmia Phenotypes in Monogenic Electrophysiologic Disorders
Authors: Nafissi Navid A , Abdulrahim Jawan , HAYNES CAROL , Kraus William E , Piccini Jonathan P , Daubert James P , Sun Albert , Kwee Lydia , Shah Svati H
Published: March 2022

Background:
Monogenic disorders are relatively common in aggregate, affecting 1/40 individuals, but are underdiagnosed. Electronic health records (EHR) integrated with population-based genetic sequencing provides an opportunity to study the prevalence and penetrance of these disorders. We integrated EHR records with genetic sequencing and identified clinical phenotypes in carriers of rare variants in arrhythmia-related genes.

Methods:
Whole exome sequencing was performed on 8,783 individuals from the CATHGEN cohort, a study of sequential individuals undergoing cardiac catheterization at Duke University. Variants in 47 arrhythmia-related genes were identified and assessed for pathogenicity using the ClinVar database. ACMG criteria were applied to define pathogenic/likely pathogenic (P/LP) variants. Individuals carrying a P/LP variant were grouped by electrophysiologic (EP) disorder and matched 1:5 to noncarriers based on age, sex, and race. Individuals with other P/LP cardiovascular disease variants or variants of unknown significance in arrhythmia-related genes were excluded. Phenotypic data were annotated through curated and manual EHR review.

Results:
Forty P/LP variants in 10 arrhythmia-related genes were identified in 51 individuals. In the arrhythmogenic right ventricular cardiomyopathy (ARVC), Brugada syndrome (BrS), and long QT syndrome (LQTS) groups, P/LP variant carriers met diagnostic criteria in 33%, 0%, and 4% of carriers, respectively. In the
LMNA
-related dilated cardiomyopathy (LMNA) group, 83% of variant carriers were phenotype positive. ECG findings alone were significantly different in variant carriers compared with noncarriers in the ARVC, BrS, and LQTS groups, whereas clinical outcomes including heart transplantation and ventricular tachycardia were significantly different in the LMNA group. Interestingly, clinical features associated with EP disorders, such as syncope and ICD implantation, were not significantly different between variant carriers and noncarriers in any group.

Conclusions:
Based on EHR review, P/LP variants in arrhythmia-related genes among individuals referred for cardiac catheterization are associated with variable phenotypic expression in different EP disorders.
Abstract 10845: Spontaneous Coronary Artery Dissection as the Primary Presentation of Ana-Negative Lupus
Authors: Roy Sumon , Johnson Sandra , Patel Seema , Lawson Barbara D
Published: March 2022

Introduction:
Spontaneous coronary artery dissection (SCAD) is a rare cause of myocardial infarction that most often occurs in middle-aged women with minimal classic risk factors and has been associated with hormonal imbalance, pregnancy, fibromuscular dysplasia, and connective tissue disease. SCAD has been seldom associated with systemic lupus erythematosus (SLE). SLE patients typically exhibit positive ANA titers. Here, we present the first known case report of a patient with SCAD as the primary presentation of ANA-negative SLE.

Case Presentation:
A 55-year-old female with migraines presented for elective kidney donation. Surgery was complicated by hemodynamic instability and NSTEMI. Transthoracic echocardiogram (TTE) showed preserved ejection fraction and hypokinesis of the basal to mid lateral and septal walls. Coronary angiogram was suspicious for type 3 SCAD of the left anterior descending (LAD) coronary artery, and given the clinical course, a coronary wire was advanced to perform intracoronary hemodynamic assessment, which was negative for atherosclerotic disease. Upon retraction of the wire, there was no flow in the LAD, consistent with propagated SCAD, leading to PEA arrest. After resuscitation, the LAD was stented. Repeat TTE showed preserved ejection fraction and normal wall motion. She was discharged on aspirin and clopidogrel. At cardiology outpatient follow up, the patient described symptoms consistent with Raynaud’s phenomenon and was referred to Rheumatology. She ultimately also developed hair loss, oral ulcers, joint pain, photosensitivity, malar erythema, and Sicca symptoms. Her anti-double stranded DNA antibodies were strongly positive twice, but remarkably, ANA screening was repeatedly negative. However, taken together, she met classification criteria for SLE diagnosis.

Conclusions:
SLE can present in highly atypical fashion, clinically and serologically, as with this case. SCAD is rare, but this case highlights the importance of keeping it on the differential for myocardial infarction, particularly in female patients with non-traditional risk factors or rheumatological disease. This case also exemplifies there should be a low clinical threshold for rheumatological workup in patients diagnosed with SCAD.
Abstract 10846: Gender Differences in Outcomes of Mitraclip: A Meta-Analysis
Authors: Aggarwal Gaurav , Thandra Abhishek , Sankaramangalam Kesavan , Bansal Sakshi , Alla Venkata
Published: March 2022

Introduction:
With the approval of transcatheter mitral valve edge-edge repair (TEER) for secondary mitral regurgitation, there has been a significant increase in the volume of TEER. Prior investigators have explored gender differences in outcomes of Mitraclip (the only approved TEER) with mixed results. In this study, we systematically reviewed impact of gender on Mitraclip outcomes and performed a meta-analysis to examine short-term and long-term outcomes in women versus men.

Hypothesis:
Females undergoing TEER with Mitraclip will have higher mortality, major adverse events and less functional improvement compared to men.

Methods:
Pubmed, Google scholar, Cochrane database etc were searched through 31 May 2021 for published studies reporting outcomes with Mitraclip in women versus men. Meta-analysis was performed using comprehensive meta-analysis software using random effects model.

Results:
Ten studies (8 manuscripts and 2 abstracts) with total of 2924 males and 1816 females were analysed. The risk of death at discharge (p=0.71), at 30 days (p=0.32) and beyond 6-12 months (p=0.97) was similar. Acute procedural success (defined by mitral regurgitation grade ≤2 at 30 days), major adverse events at 1 month (p=0.064) and at 1 year (p= 0.98), risk of renal failure (p=0.15), stroke (p=0.71) and 1 year readmission rate (p=0.42) were all similar. Females received more blood transfusion than males (RR: 1.37, CI: 1.03-1.80, p=0.02). Prevalence of NYHA 3/4 class at 1 year post-procedure (RR: 1.36, CI: 1.19-1.56, p<0.01) and MLHFQ scores (RR: 1.91, CI: 1.47-2.48, p=0.01) were higher in females compared to males.

Conclusions:
Females have similar early and intermediate term mortality, major adverse events and rehospitalization rates compared to men following TEER with Mitraclip. However, females have less symptoms improvement as evidenced by greater frequency of NYHA class 3/4 symptoms and higher MLHFQ scores at 6-12 months after Mitraclip implantation compared to males.
Abstract 10851: Statin Shows Significant Antiatherosclerosis and Anti-Inflammatory Effect in Kawasaki Disease Model Mouse
Authors: Motoji Yusuke , Fukazawa Ryuji , WATANABE MAKOTO , Tsuno Kanae , Yasuo Miyagi , Itoh Yasuhiko , Ishii Yosuke
Published: March 2022

Introduction:
Kawasaki disease (KD) is an acute systemic vasculitis, which might promote atherosclerosis in adulthood. The purpose of this study is to verify long-term effect of HMG-CoA inhibitor (statin) for the vasculitis.

Hypothesis:
Statins suppressed inflammatory cell infiltration and plaque arteriosclerosis in KD, and might have a preventive effect on the onset of cardiovascular events in the chronic phase.

Methods:
Candida albicans water-soluble fraction (CAWS) was injected intraperitoneally in 5-week-old male apoE
-/-
mice to create KD-like vasculitis. All mice were fed a high-fat diet 2 weeks after the first injection. Divided into 3 groups, PBS (P), CAWS (C), and CAWS with statin (CS) (orally administered atorvastatin 10mg/kg/day), and sacrificed 6 or 10 weeks after injection and obtained the aorta with the heart (from root to iliac bifurcation). The lipid plaque lesion on the aorta was stained with Oil Red O and the inflammatory cells in aortic root sections were stained with hematoxylin and eosin. These area ratios were quantified and compared.

Results:
Both atherosclerosis and inflammatory cell infiltration were significantly promoted by CAWS (p<0.01). Statin significantly suppressed plaque area after 10 weeks (C 33±1.5%, CS 18±1.7%) and inflammatory cell infiltration after 6, 10 weeks (C 16±0.6%, CS 7.8±0.9% after 6 weeks, and C 20±2.1%, CS 10±1.0 after 10 weeks, respectively). We examined the statistical correlation between the plaque lesion and the inflammatory cell area, so it revealed the trend between the two groups (r=0.97, P<0.001).

Conclusions:
CAWS vasculitis, KD-like vasculitis, promoted the development of atherosclerosis in apoE
-/-
mice. It was newly revealed that long-term oral administration of statin significantly suppressed not only atherosclerosis but also inflammatory cell infiltration. Statin treatment might be expected for secondary prevention of the onset of cardiovascular events in the chronic phase of KD.