bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 19665: Angiographic Predictors of Successful Guide-wire Crossing Through Infrapopliteal Chronic Total Occlusions (CTOs)
Authors: Thiruvoipati Thejasvi , Strobel Aaron , Gagan Singh D , Laird John R , Armstrong Ehrin J
Published: July 2021

Background:
No current scoring system exists to predict successful guide-wire crossing of infrapopliteal CTOs.

Methods:
All patients undergoing peripheral endovascular procedures from 2006 to 2014 at University of California, Davis and Denver Veterans Affairs Medical Centers were reviewed. Interventions performed on anterior tibial, peroneal, or posterior tibial artery CTOs were identified. Angiographic analysis was performed to identify stump morphology, presence of bridging collaterals and side branches near the stump, calcification at entry and within the occluded segment, and the length and the diameter of the lesion. Angiographic predictors of successful wire crossing were then identified.

Results:
215 cases of infrapopliteal CTOs were performed at the two centers during the study period. Antegrade wire crossing was successful in 151 cases (70%). Failure of antegrade wire crossing was associated with a beaded stump morphology (15% of failure cases vs. 4% of successful cases, p<0.01); presence of severe calcification at the entry point (56% of failure cases vs. 34% of successful cases, p = 0.02); presence of severe calcification in the occluded route (52% of failure cases vs. 33% of successful cases, p = 0.04); an occluded segment longer than 200 mm (51% of failure cases vs. 17% of successful cases, p<0.01); and reference vessel diameter smaller than 2.5 mm (63% of failure cases vs. 37% of successful cases, p<0.01). The presence of bridging collaterals and side branches were not significantly associated with success or failure of antegrade wire crossing (Table).

Conclusions:
A beaded stump morphology at the proximal cap, presence of severe calcification at the entry site and in the occluded route, longer occluded segment length, and narrower reference vessel diameter are associated with greater failure of antegrade wire crossing for infrapopliteal CTOs. A scoring system will be developed to identify multivariable predictors of antegrade wire crossing.
Abstract 19749: Cardiac-specific Deletion of Caveolin-3 Delays Repolarization and Increases Susceptibility to Ventricular Arrhythmia
Authors: Markandeya Yogananda S , Feng Li , Ramchandran Vignesh , Vaidyanathan Ravi , Best Jabe , Lea Martin L , Keefe Alexis , Kalscheur Matthew M , O’Hara Thomas , Eckhardt Lee L , Makielski Jonathan C , Trayanova Natalia A , Balijepalli Ravi C , Kamp Timothy J
Published: July 2021

Caveolin-3 (Cav-3) is an essential scaffolding protein for formation of caveolae in muscle cells. Cav-3 is part of a macromolecular complex including several ion channels. Mutations in Cav-3 have been associated with the inherited long QT syndrome as well as a variety of skeletal myopathies. To investigate the role of Cav-3 in heart and whether loss of function of Cav-3 explains the long QT phenotype, we generated cardiac-specific, inducible Cre-lox Cav-3 knockout mice. 8 week old mice were treated with tamoxifen in the chow to induce cardiac-specific recombination. Western blot analysis and transmitted electron microscopy demonstrated a graded loss of Cav-3 and caveolae in Cav-3 KO heterozygous mice (Cav-3-/+), Cav-3 KO homozygous mice (Cav-3-/-) relative to the littermate controls mice (WT). Echocardiography revealed no significant difference in %EF, %FS, LV chamber dimensions, and LV wall thickness between the different genotypes. Histopathological examination demonstrated no significant difference in HW/BW ratio, cardiac structure or fibrosis comparing Cav-3-/- and WT mice. Telemetry ECG recordings revealed a significant increase in QTc interval Cav-3-/- (68.5±7 ms) compared to WT (54.83±6 ms). Whole cell patch clamp analysis from isolated ventricular myocytes indicated a progressive increase in action potential duration (APD) with loss of Cav-3: WT (APD50: 4.7 ± 1ms; APD90: 28.0±3 ms; n=9); Cav-3-/+(APD50: 10.3±2 ms; APD90: 42.4±3 ms; n=13), Cav-3-/- (APD50: 32.4±6ms; APD90: 97.4±7ms; n=12). Whole cell voltage clamp measurements from Cav-3-/- revealed increased late INa, decrease in ICa,L, Ito,Iss current density without altering peak INa compared to WT cells, and these current changes were adequate to explain the increased APD based on computational representation using the Morotti et al. mouse ventricular cell model. Intracardiac programmed electrical stimulation (ventricular burst pacing) induced VT/Vfib in 8 out of 9 Cav3-/- but none of WT mice (0/5). Our results demonstrate that loss of Cav-3 and caveolae in adult mice does not alter cardiac structure or contractile function but leads to prolonged APD, an increased in QTc, and increased susceptibility to ventricular arrhythmias.
Abstract 19818: Coronary CT Angiography for Suspected Acute Coronary Syndrome in the Era of High-Sensitivity Troponins - A Randomized Multicenter Study
Authors: Dedic Admir , Schaap Jeroen , Lamfers Evert , Lammers Jeroen , Post Hans , Rensing Benno , Braam Richard , Nathoe Hendrik , Boersma Eric , Nieman Koen
Published: July 2021

Introduction:
It is uncertain whether a diagnostic strategy supplemented by early coronary CT angiography (CCTA) is superior to contemporary standard optimal care (SOC) encompassing high sensitivity troponins for patients suspected of acute coronary syndrome (ACS) in the emergency department.

Hypothesis:
To assess whether a diagnostic strategysupplemented by early CCTA improves clinical effectiveness compared to contemporary SOC.

Methods:
In a prospective, open-label, multicentre, randomized trial, we enrolled patients presenting with symptoms suggestive of an ACSat the emergency department (ED) of five community and two university hospitals in the Netherlands. Exclusion criteria included the need for urgent cardiac catheterization, history of ACS or coronary revascularisation. The primary endpoint was the number of patients identified with significant coronary artery disease requiring revascularization within 30 days.

Results:
The study population consisted of 500 patients of whom 236 (47%) were women (mean age 54±10 years). There was no difference in the primary endpoint (22 [9%] patients underwent coronary revascularizationwithin 30 days in the CCTA group and 17 [7%] in the SOC group [p= 0·40]). Discharge from ED was not more frequent after CCTA (65% versus 59%, p= 0·16) and length of stay was similar(6·3 hours in both groups, p= 0·80). Direct medical costs were lower in the CCTA group (є337 versus є511, p<0·01). Less outpatient testing was seen with CCTA after index ED visit (10 [4%] versus 26 [10%], p<0·01). There was no difference in incidence of undetected ACS.

Conclusions:
A diagnostic strategy supplemented by early CCTAis safe, less expensive and averts outpatient testing. However, in the era of high-sensitivity troponins, CCTA does not identify more patients with significant CAD requiring coronary revascularization, nor does CCTAshorten hospital stay or allow for more direct discharge from the ED.
Abstract 19831: Pre-clinical in vivo Evaluation of Cormatrix as Right-sided Valved Conduit
Authors: Talacua Hanna , Mulder Khadija , Hout Geert v , Sanders Bart , Grundeman Paul , Vink Aryan , Bouten Carlijn , Kluin Jolanda
Published: July 2021

Introduction:
Although not FDA approved for heart valve repair, decellularized porcine small intestinal submucosa (Cormatrix) is currently used in quite a lot of institutes to reconstruct heart valves in patients. Recently, surgeons experienced clinical failures using Cormatrix as a patch in heart valve repair and words of caution were raised. The aim of this study was to pre-clinically evaluate CorMatrix as right-sided heart valved conduit in a xenogeneic animal model.

Methods:
CorMatrix was used as valved conduit in the right ventricular outflow tract in sheep (n=10) and lambs (n=10). Valved conduits were home-made and explanted after 1 month, 3 months or 6 months. Valve function was assessed by echocardiography directly after implantation and prior to termination. Explants were analyzed using histology, scanning electron microscopy, mechanical testing, biochemical analysis and immunohistochemistry.

Results:
All valved conduits were successfully implanted. 5 sheep and 2 lambs did not survive until planned follow-up. Diseased animals died due to valve failure after 1 or 2 months. Valve leaflets where thickened with signs of a massive inflammatory response. 5 sheep (1 month n=3, 3 months n=1 and 6 months n=1) and 8 lambs (1 month n=3, 3 months n=3, 6 months n=2) survived until planned follow up. In these animals, on echocardiography a well functioning valve with no signs of stenosis or insufficiency was seen. However all explants showed only limited signs of cellular infiltration or neotissue formation.

Conclusions:
In the chronic sheep and lamb model, 13 out of 20 CorMatrix pulmonary valved conduits were intact and showed good functionality, although only limited signs of tissue remodeling. However, 7 out of 20 valves failed owing to a massive inflammatory response. Further analysis is needed to understand the disturbing dichotomous outcome before clinical application can be advised
Abstract 19892: Association Between Estimated-glomerular Filtration Rate and Clinical Outcomes at One Year After Acute Ischemic Stroke
Authors: bu xiaoqing , Zhang Yonghong , Xu Tan , Peng Hao , Chen Jing , He Jiang ,   CATIS Investigators
Published: July 2021

Introduction:
The relationship between estimated-glomerular filtration rate (eGFR) and acute ischemic stroke outcomes remains controversial.

Hypothesis:
We aimed to evaluate the impact of eGFR on all-cause mortality, recurrent stroke, and vascular events in patients with acute ischemic stroke.

Methods:
4036 patients with acute ischemic stroke recruited from 26 hospitals across China from August 2009 to May 2013 were included in our study. GFR was estimated by CKD-EPI equations based on serum creatinine and/or cystatin C (CKD-EPIcr, CKD-EPIcys, and CKD-EPIcr-cys). The Cox proportional hazards models were used to examine the relationship between declined eGFR and 1-year all-cause mortality, recurrent stroke, and vascular events. Declined eGFR was defined as <60 mL/min /1.73 m2.

Results:
Declined eGFR was present in 7.22% (n=281) of patients based on the CKD-EPIcr equation, 3.43% (n=119) based on the CKD-EPIcys equation, and 5.67% (n=170) based on the CKD-EPIcr-cys equation. Compared to patients with an eGFR ≥90 mL/min /1.73 m2, adjusted hazard ratios (95% confidence interval) for all-cause mortality associated with eGFR<60 mL/min /1.73 m2 were 1.68 (1.06 to 2.66, p=0.026), 2.29 (1.29 to 4.06, p=0.005), and 1.79 (1.08 to 2.98, p=0.024) using CKD-EPIcr, CKD-EPIcys, and CKD-EPIcr-cys equations, respectively. For recurrent stroke, adjusted hazard ratios (95% confidence interval) were 0.90 (0.49 to 1.66, p=0.743), 0.60 (0.19 to 1.93, p=0.393), and 0.89 (0.40 to 1.95, p=0.762), respectively. For vascular events, adjusted hazard ratios (95% confidence interval) were 1.33 (0.81 to 2.19, p=0.266), 1.07 (0.46 to 2.47, p=0.880), and 1.31 (0.70 to 2.43, p=0.403), respectively.

Conclusion:
Our study indicates that declined eGFR is a strong independent risk factor for total mortality among patients with acute ischemic stroke. However, there is no association between low eGFR and recurrent stroke or vascular events among patients with acute ischemic stroke. In addition, the association of eGFR with all-cause mortality among patients with acute ischemic stroke is stronger when eGFR was calculated based on the CKD-EPIcys equation compared to CKD-EPIcr and CKD-EPIcr-cys equations.
Abstract 20003: A 15-year Analysis and Descriptive Study of the Incidence, Clinical Characteristics, Management, and Outcomes of Lower Limb Ischemia in Type A and Type B Aortic Dissection Patients: Insights From the International Registry of Acute Aortic Dissection
Authors: Alaei Susan , Sundt Thoralf M , Sechtem Udo , Myrmel Truls , Di Eusanio Marco , Gleason Thomas G , Bhan Anil , Pape Linda , Ota Takeyoshi , Reece Brett , Kline-Rogers Eva , Montgomery Daniel G , Nienaber Christoph A , Isselbacher Eric M , Eagle Kim A
Published: July 2021

Background:
This study assessed the incidence of lower limb ischemia as well as trends in management and outcomes while examining acute aortic dissection patients over a period of 15 years. Additionally, differences in clinical presentation, interventions performed, and mortality between patients with and without lower limb ischemia were investigated.

Methods:
Lower limb ischemia (LLI) was evaluated among 3812 patients enrolled in the International Registry of Acute Aortic Dissection over a 15-year period that was separated into three 5-year intervals: 1996-2001, 2002-2007, and 2008-2012. The cohort was then divided by dissection type and presence or absence of LLI.

Results:
Type A patients presenting with limb ischemia (N=280, 11.4%) were much more likely to have atherosclerosis (p=0.021) and to present with back, abdominal and leg pain versus chest pain (p<0.001 unless noted). Other symptoms of malperfusion, including ischemic spinal cord damage (p<0.001) and coma/altered consciousness (p=0.006) were more common in patients presenting with LLI. Surgery was less commonly performed in Type A LLI patients (79.3% vs 86.1%, p=0.002), a difference that did not change over time (p=0.453, trend p=0.479). Additionally, overall mortality was higher in LLI patients (37.5% vs 22.9%, p<0.001) and did not show improvement among the LLI cohort over time.

Type B patients with LLI (N=102, 7.5%) were more likely to be current smokers (p=0.028), to present febrile (p=0.022), and to have leg pain (p<0.001). As with Type A, ischemic spinal cord damage was more common in the LLI cohort (p<0.001). Patients with LLI were much more likely to be managed with endovascular therapy (19.6% vs 50.0%, p<0.001) than with medication alone (66.5% vs 29.4%, p<0.001), with endovascular repair increasing in LLI patients over time (p=0.008, trend p=0.002). Again, overall mortality was higher in the LLI cohort (24.5% vs 9.7%, p<0.001) and did not change over time.

Conclusions:
Although Type B patients with LLI received more endovascular procedures in later years, overall mortality did not improve. Increased complications and higher mortality in the LLI cohort suggests a need for better monitoring and increased implementation of interventions in this population.
Abstract 20010: Diet-induced Obesity Stimulates Inflammatory Monopoiesis From Hematopoietic Stem Progenitor Cells Through Activating Histone Methylation
Authors: Fang Milie , Mirza Rita , Koh Timothy J , Urao Norifumi
Published: July 2021

Obesity-induced monopoiesis has been implicated in the development of obesity-related complications. Monopoiesis is largely dependent on hematopoietic stem progenitor cells (HSPCs) in the bone marrow (BM). However, little is known about hematopoietic control mechanisms in diet-induced obesity. In a mouse model of diet-induced obesity (DIO), we found leukocytosis (9.465 ± 0.7350 K/ul versus 7.277 ± 0.3450 K/ul in healthy controls, n=7 each? , p=0.023) and increased inflammatory Ly6Chi monocytes in circulation (377.2 ± 40.94/ul vs. 224.8 ± 39.18/ul in lean control; n=7; p=0.023), associated with increased myeloid progenitor cells (60% increase in granulocyte-monocyte progenitor cells, n=4) in the BM. By flow cytometry based profiling, we found that active marks for transcription, histone 3 lysine 4 trimethylation (H3K4me3), are upregulated (1.82-fold increase in mean fluorescent intensity (MFI) vs. lean mice, n=5, p<0.05) in Ly6Chi inflammatory monocytes in DIO mice, along with increased inflammatory gene expression in response to TLR (toll-like receptor) 4 stimulation. In the BM, HSPCs but not myeloid progenitor cells have enriched H3K4me3 in DIO mice (2.84-fold in MFI in cKit+Sca1+Lin- cells, n=5, p<0.05). This activated mark in HSPCs is associated with increased monopoiesis from HSPCs (1.55-fold increase in output CD11b+Ly6Chi monocytes from cultured HSPCs, n=3-5, p<0.01) in response to TLR2 and TLR4 stimulations. Of note, HSPCs produce inflammatory cytokines to promote differentiation into inflammatory monocytes. Moreover, HIF-1a, a potential upstream of H3K4me3, is upregulated (2.29-fold in MFI, n=5, p<0.05) in HSPCs in DIO mice. These results suggest that obesity increases HIF-1a-mediated H3K4me3 enrichment in HSPCs, which in turn contributes to inflammatory cytokine expression and to increased inflammatory monopoiesis. Thus, epigenetic marks in HSPCs could be a target for obesity-related complications.
Abstract 20155: The Adverse Effect of End Stage Renal Disease on Intimal Hyperplasia of Internal Thoracic Artery
Authors: Sato Hirofumi , Ohashi Yuko , Ueki Chikara , Akimoto Takehide , Sakaguchi Genichi
Published: July 2021

Introduction:
Internal thoracic arteries (ITA) are widely used as a reliable conduit in coronary artery bypass grafting surgery (CABG) because they are said to be less affected by arterioscrelosis. Little is known about the relationships between patient’s characteristics and intimal hyperplasia of ITAs.

Hypothesis:
The condition of intima of ITA of patients with end stage renal disease (ESRD) is worse than those of patients without ESRD.

Methods:
The specimens of LITAs and RITAs, obtained from 48 patients who underwent CABG or OPCAB (off-pump CABG) , were evaluated with histopathology; 56 arteries were suitable for morphometric analysis. The severity of disease was evaluated on the basis of percentage of luminal narrowing (%LN) , intimal thickness index (ITI), and intima-to-media ratio (IMR).

Results:
The patients included 36 males, 15 ESRD, 11 HD patients, 8 peripheral arterial disease (PAD) patients, and their average age was 69.3, average estimated glomerular filtration rate (eGFR) was 49.0 ml/min/1.73m
2
. The %LN was 6.26, ITI was 0.24, and IMR was 0.96 in average. In Spearman's rank correlation test, eGFR was associated with %LN (correlation coefficient -0.242, p=0.07). The %LN of patients with ESRD was significantly higher than that of patients without ESRD ( 7.99 vs 5.48, p=0.001).

Conclusions:
The lumen of ITAs of patients with ESRD was significantly narrower than that of patients without ESRD.
Abstract 9815: Nadolol Seems to Be Superior to Selective Beta Blockers in Patients With Catecholaminergic Polymorphic Ventricular Tachycardia: Is a Smaller Arrhythmic Window Part of the Explanation?
Authors: Leren Ida Skrinde , Saberniak Jørg , Majid Eman , Haland Trine F , Edvardsen Thor , Haugaa Kristina H
Published: July 2021

Introduction:
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inheritable arrhythmogenic disease, and typically presents as syncope or sudden cardiac death during exercise. Beta blockers are first choice therapy but little is known about antiarrhythmic effects of different beta blockers in CPVT. Nadolol has shown superior antiarrhythmic effect in other cardiomyopathies.

Hypothesis:
We hypothesized that nadolol is superior to selective beta blockers in arrhythmia protection in CPVT patients.

Methods:
We included 34 CPVT patients (age 34±19 yrs, 44% female, 88% RYR2 mutation positive). We serially performed 2 bicycle exercise tests in each patient; 1)>6 weeks on maximum tolerated dose of selective beta blockers. 2)>6 weeks on maximum tolerated dose of nadolol. We recorded resting and maximum heart rate (HR), HR at first arrhythmia and the most severe arrhythmia occurring. Arrhythmic window was defined as the difference between maximum HR and HR at first arrhythmia. Severity of arrhythmias was scored as arrhythmic score: no arrhythmias (0point), single ventricular extra systoles (1point), bigemini (2points), couplets (3points) and nonsustained VT (4points).

Results:
Resting HR was similar on nadolol and selective beta blockers (54±10bpm vs. 56±14bpm, p=0.50), while maximum heart rate was lower on nadolol (122±21bpm vs. 139±24bpm, p<0.01). First arrhythmias occurred at similar HR at both exercise tests (113±21bpm vs. 113±19bpm, p=1.0). Consequently, arrhythmic window was smaller during nadolol treatment (17±10bpm vs. 32±26bpm, p=0.03) (Figure) and also the arrhythmic score was lower than on selective beta blockers (1.1±1.2 vs. 2.4±0.9, p<0.01).

Conclusion:
Arrhythmic score was lower on nadolol compared to selective beta blockers. Also, arrhythmic window, representing the span of heart rates where arrhythmias may occur and progress in severity, was smaller. This suggests that nadolol should be the beta blocker of choice in CPVT patients.
Abstract 9816: Placenta Characteristics in Women With Heart Disease and Possible Impact on Fetal Outcomes
Authors: Lima Fabio V , Koutrolou-Sotiropoulou Paraskevi , Parikh Puja B , Miller Charles , Avila Cecilia , Butler Javed , Stergiopoulos Kathleen
Published: July 2021

Background:
Pregnant women with cardiomyopathy (CM) have higher rates of major adverse cardiovascular events (MACE) and fetal adverse clinical events (FACE) than those with other heart disease (HD) (congenital, valvular, or arrhythmia) and no HD, per a prior cohort.
1
Fetuses of mothers with CM are at higher risk for death, premature delivery, underweight, respiratory distress, and lower APGAR scores compared to those with HD. We sought to identify whether pregnant women with known CM or HD demonstrate a pattern of placental changes.

Hypothesis:
We anticipate pregnant women with a history of CM will have higher rates of abnormal placental characteristics compared with those with HD.

Methods and results:
We studied 86 pregnancies in women with CM or HD. Of these, 52 (60%) had HD and 34 (40%) had CM. Pathologic analyses were performed on 53 HD and 37 CM placentas. Gestational age in the HD and CM groups were different (38.6 vs 35.5, p < 0.001), as was the incidence of gestational hypertension (21 vs 50%, p 0.003). Among the maternal HD group, 44% had history of congenital heart disease, 33% prior corrective cardiac surgery and 31% had history of arrhythmia. Placental and fetal weight were lower among CM patients compared to those with HD (396 vs. 478 grams, p 0.007; and 2443 versus 3181 grams, p<0.001, respectively). Placentas of those patients with CM compared to those with HD were also more likely to have ischemic changes (65% vs. 34%, p 0.005) and be immature (60% vs. 9%, p<0.001). Pathological villous vascular congestion, fetal membrane abnormalities, fetal surface coloration abnormalities, umbilical cord abnormalities and extent of subchorionic fibrin and placenta calcification were not significantly different between the two groups.

Conclusion:
Abnormal placental pathologic characteristics such as low weight, ischemic changes and immaturity may contribute to fetal adverse events in pregnant women with CM.

1
Koutrolou-Sotiropoulou P, Parikh PB, Miller C, Lima FV, Butler J, Stergiopoulos K. Impact of Heart Disease on Maternal and Fetal Outcomes in Pregnant Women. Am J Cardiol In Press 2015.
Abstract 9860: Safety and Clinical Outcome of Catheter Ablation of Ventricular Arrhythmias Using Contact Force Sensing, Consecutive Case Series
Authors: Hendriks Astrid A , Akca Ferdi , Dabiri Abkenari Lara , Khan Muchtiar , Bhagwandien Rohit E , Yap Sing C , Wijchers Sip , Szili-Torok Tamas
Published: July 2021

Introduction:
Poor catheter-to-myocardial contact can lead to ineffective ablation lesions and suboptimal outcome. Contact force (CF) sensing catheters in ventricular tachycardia (VT) ablations has not been studied for their long term efficacy.

Hypothesis:
The hypothesis is that CF ablation is superior to manual ablation (MAN) and non-inferior to remote magnetic navigation (RMN) ablation for safety and efficacy in acute and long term outcome.

Methods:
A total of 249 consecutive patients underwent VT ablation, with the use of MAN, CF or RMN catheters were included in this single center cohort study from January 2007 until March 2014. The primary endpoints were procedural success, acute major complications and VT recurrences at follow-up. The average follow-up period was ± 20 months.

Results:
Acute success was achieved in 191 out of 249 procedures (75.9%). Acute success in manual ablation, CF ablation and RMN ablation was 70.1%, 72.3% and 85.2% respectively (P = 0.038). Major complications occurred in 3.2% and there was a trend towards less major complications (P = 0.055) in the RMN group. Thirty-six percent of the patients with an initially successful procedure had a recurrence during follow-up (CF 41.2% MAN 37.5% RMN 32.0% P = NS).

Conclusions:
The use of CF sensing catheters does not improve the procedural outcome or safety profile in comparison to non-CF sensing ablation in ventricular arrhythmias. RMN non-CF sensing ablation has the highest procedural success rate. Future studies are necessary to investigate the role of CF in VT ablation and to define the optimal force.
Abstract 9944: Bicuspid and Unicuspid Aortic Valve: Fate of Moderate/Severe Mixed Aortic Valve Disease
Authors: Egbe Alexander , Poterucha Joeseph , Warnes Carole
Published: July 2021

Objectives:
There is paucity of data about mixed aortic valve disease (MAVD) in patients with bicuspid/unicuspid aortic valve (BAV). This study sought to describe the natural history of moderate/severe MAVD in this population.

Methods:
We queried our database for patients with BAV and moderate/severe MAVD from 1994-2013. We excluded patients with NYHA III/IV symptoms, left ventricular ejection fraction <50%, aortic dimension >50 mm, and significant disease of other valves. Primary endpoint was freedom from adverse events (AE) defined as aortic valve replacement (AVR) or death. Secondary endpoint was freedom from developing NYHA III/IV symptoms, and to identify predictors of AE. Cox proportional hazard model was used.

Results:
There were 138 patients (age 51±12 years, males 81%) who were followed for 8.5±4 years. Ninety-two patients (67%) underwent AVR at a mean follow-up duration of 3.7±2.5 years. Mechanical prostheses were implanted in 79% and 52% had concomitant CABG and/or aortic replacement during AVR. No early surgical mortality. Event-free survival was 51%, and 20% at 5 and 10 years. Predictors of AE were age at presentation (hazard ratio [HR] 5.22 Confidence interval [CI] 3.10 to 6.64) for every decade increase in age and having severe stenosis or regurgitation at the time of presentation (HR 1.32; CI 1.05 to 3.16).

Conclusion:
Time (age and duration of follow-up) was the strongest predictor of AE in BAV population unlike in patients with trileaflet aortic valve stenosis where peak aortic velocity was prognostic.

Figure Legend:
pVel: peak velocity group 1: moderate aortic stenosis and regurgitation Group ≥2: severe aortic stenosis or regurgitation
Abstract 24: Changes in Generalized and Central Adiposity are Dynamically Associated with Left Ventricular Remodeling
Authors: Wilner Bryan R , Garg Sonia , Ayers Colby R , Sarma Satyam , Rohatgi Anand , Das Sandeep R , McGuire Darren K , de Lemos James A , Drazner Mark H , Neeland Ian J
Published: July 2021

Introduction:
Obesity is linked to an adverse cardiac structural phenotype in cross-sectional studies. However, the effects of longitudinal changes in generalized and central adiposity on left ventricular (LV) remodeling are unknown.

Methods:
Participants without baseline cardiovascular disease or LV dysfunction in the Dallas Heart Study underwent assessment of body composition and cardiac structure by MRI at baseline and then 7 years later. Associations between change in weight and waist circumference with alterations in structure and function were assessed using multivariable linear regression.

Results:
The study cohort (n=1262) had a mean age of 44 years and was 43% (545 of 1262) male, 44% (556 of 1262) African-American, and 36% (460 of 1262) obese at baseline. At 7 years follow-up, 7% (85 of 1262) had >10% weight loss, 8% (108 of 1262) had 5-10% weight loss, 44% (551 of 1262) had <5% weight change, 20% (248 of 1262) had 5-10% weight gain, and 21% (270 of 1262) had >10% weight gain. Those who gained >10% weight were younger, had lower BMI and LV mass at baseline, and had greater increases in blood pressure, glucose, triglycerides, LDL cholesterol, and hs-CRP over follow-up. In multivariable models adjusted for age, sex, race, and baseline and interim development of comorbidities, 1-standard deviation increases in body weight and waist circumference over follow-up were significantly associated with higher LV mass, LV wall thickness, and concentricity; but minimally or not significantly associated with LV end-diastolic volume or ejection fraction (EF) (Table).

Conclusion:
Increases in generalized and central adiposity are characterized primarily by concentric remodeling, with a more modest impact on LV volume and EF. These results support the notion that the development of specific obesity patterns may impact cardiac remodeling with potential implications for the development of cardiac hypertrophy and heart failure.
Abstract 42: Association of Optimism with Cardiovascular Health: Results From the Hispanic Community Health Study/Study (HCHS/SOL) of Latinos Sociocultural Ancillary Study
Authors: Hernandez Rosalba , Gonzalez Hector , Tarraf Wassim , Carnethon Mercedes , Penedo Frank J , Gallo Linda , Arguelles William , Buelna Christina , Davis Sonia , Gonzalez Franklyn , Isasi Carmen R , McCurley Jessica L , Ruiz John M , Daviglus Martha
Published: July 2021

Introduction:
There is mounting evidence linking positive psychological functioning to restorative health processes and favorable medical outcomes. However, very little is known about the relationship between optimism--an indicator of psychological functioning--and the American Heart Association (
AHA
) defined concept of cardiovascular health (
CVH
), particularly in Hispanics/Latinos of diverse backgrounds.

Hypothesis:
Persons with greater optimism will have more favorable CVH profiles.

Methods:
We analyzed data from adults ages 18-75 that participated in the Hispanic Community Health Study/Study of Latinos (
HCHS/SOL
) Sociocultural Ancillary Study in 2010-11. Optimism was assessed using the Life-Orientation Test-Revised, with scores ranging from 6-24 and higher scores indicative of greater levels of optimism. AHA classification standards were used to derive a composite CVH score with subsequent grouping into categorizes of
poor
(0-7 points),
intermediate
(8-11 points), and
ideal
(12-14 points). Metrics considered when calculating the overall CVH score included diet, body mass index, physical activity, cholesterol, blood pressure, fasting glucose, and smoking status. Multinomial logistic regression was used to examine associations of optimism with ideal and intermediate CVH (poor CVH—ref. group), after adjusting for socio-demographic factors and depressive symptoms.

Results:
Among 4,960 participants with complete data, 9.2% were categorized as having ideal CVH. In multivariable-adjusted models, participants with moderate levels of optimism were more likely to have intermediate [OR = 1.37: 95%CI = 1.08, 1.74] and ideal [OR = 1.61: 95%CI = 1.04, 2.48] CVH when compared to the least optimistic group (
Table 1
).

Conclusions:
The current study offers preliminary evidence for an association between optimism and CVH in a large heterogeneous group of Hispanic/Latino adults. Future studies should explore the concept of optimistic bias and whether exaggerated levels of optimism are detrimental to health.
Abstract MP09: Black-White Differences in the Association Between Sleep Duration and Incident Stroke: The REGARDS Study
Authors: Petrov Megan E , Howard George , Grandner Michael A , Kleindorfer Dawn , Molano Jennifer R , Howard Virginia J
Published: July 2021

Introduction:
Short and long sleep durations are associated with incident stroke. Few studies have investigated these associations by race despite prevalent inequities in stroke between non-Hispanic black and white adults. The aim of this study was to investigate the relationship between sleep duration and incident stroke in a US cohort of blacks and whites.

Methods:
Within the REasons for Geographic And Racial Differences in Stroke study, 15,941 black and white adults (≥45yrs) with no history of stroke or sleep apnea were studied. Participants self-reported their habitual sleep duration. Suspected stroke events were identified every 6 months, and associated medical records were retrieved and physician adjudicated. Proportional hazards analysis was used to estimate hazard ratios for incident stroke associated with sleep duration (<6, 6.0-6.9, 7.0-7.9, 8.0-8.9[reference group], 9+hrs) controlling for sociodemographics, stroke risk factors, and depressive symptoms.

Results:
At baseline, 11.2% of the sample was very short sleepers (<6hrs) and 6.7% were long sleepers (9+hrs). Over an average follow-up of 4.7 ± 1.4 years, 321 stroke events occurred (blacks=114; whites=207). After adjustment, shorter sleep duration was associated with increased risk for incident stroke (6.0-6.9hr: OR=1.41, 95%CI 1.02-1.94; 7.0-7.9hr: OR=1.36, 95%CI 1.01-1.83). The interaction between sleep duration and race was significant (
p
=0.02). In stratified analyses, shorter sleep duration was associated with increased risk for stroke in whites but not blacks (see table).

Discussion:
Among middle-aged to older, white adults with no history of stroke or sleep apnea, shorter sleep duration was associated with increased risk for stroke. There was no association among blacks. Resilience to insufficient sleep as a risk factor for stroke may differ for blacks and whites.

Adjusted for age, sex, education, income, depressive symptoms, hypertension, diabetes, atrial fibrillation, left ventricular hypertrophy, heart disease, and smoking status
Abstract MP33: Heart Failure Following Cancer Therapy in Patients with Hematological Malignancies Aged 18 Years and Under: A Linked Health Data Analysis (1996-2009)
Authors: Berry Narelle M , Ullah Shahid , Versace Vincent L , McCarthy Alexandra L , Atherton John J , Roder David , Koczwara Bogda , Coghlan Douglas , Chowdhury Munir H , Clark Robyn A
Published: July 2021

Introduction:
The causal link between chemotherapy treatments and subsequent cardiotoxicity is well established, particularly for children with hematological malignancies. Little information exists on the characteristics and outcomes for patients with heart failure (HF) after chemotherapy. This study aimed to describe the characteristics, survival and mortality of patients who received chemotherapy for hematological cancer (leukemias, lymphomas and related disorders) before 18 years old and subsequently developed HF compared to those who did not.

Methods:
Linked health data (1996-2009) from the Queensland Cancer Registry, Death Registry and Hospital Administration records for HF and chemotherapy admissions were reviewed. From all breast and hematological cancers patients (n=73,158), 15,987 received chemotherapy, including 819 patients aged ≤18 years at time of cancer diagnosis. Patients were categorized as those with an index HF admission (occurred after cancer diagnosis) and those without an index HF admission (non HF).

Results:
Of the 819 patients, 3.7% (n=30) had an index HF admission. Median age of HF patients at time of cancer diagnosis was 5 years (IQR 3-12) compared to 7 years (IQR 3-14) in the non HF group (p=0.503). Median follow up from cancer diagnosis was 2.5 years in the HF group compared to 5.42 years in the non HF group (p<0.01). Of those who developed HF, 70% (n=21) had the index admission within 12 months of their cancer diagnosis. Of those with HF, 53.3% (n=16) died (all cause) compared to 14.6% (n=115) with no HF. On adjustment for age, sex and chemotherapy admissions, HF patients had an almost 5 fold increased mortality risk compared to non HF patients (HR 4.91 [95% CI, 2.88-8.36]) (Figure 1).

Conclusions:
This study demonstrated that in children with hematological cancers the onset of HF occurred soon after chemotherapy and mortality risk is almost 5 times that of children who do not develop HF. Innovative strategies are still needed for the prevention and management of cardiotoxicity in this population.
Abstract MP57: Associations of Pentraxin 3 with Frailty: The Cardiovascular Health Study (CHS)
Authors: Jenny Nancy S , Arnold Alice M , Kuller Lewis H , Walston Jeremy D , Tracy Russell P , Fried Linda P , Psaty Bruce M , Newman Anne B
Published: July 2021

Background:
Pentraxin 3 (PTX3) is an inflammatory biomarker primarily reflecting vascular damage. PTX3 is associated with cardiovascular disease (CVD); however, associations with frailty, another inflammation-related disease of aging, are unknown.

Methods:
At baseline, we examined these associations in 1,948 white and black men and women (mean age 73 y) in the Cardiovascular Health Study (CHS) who had measures of PTX3 and were free of dementia, Parkinson’s disease and depression. PTX3 was determined by immunoassay (coefficient of variation 10%). Robust regression models were minimally adjusted for age, sex, ethnicity and clinic site with additional adjustments for obesity, smoking, education, C-reactive protein (CRP) and prevalent subclinical or clinical CVD.

Results:
Levels of PTX3 ranged from 0.24 - 23.05 ng/ml, mean 2.36 ng/ml (standard deviation 2.00 ng/ml), in these older adults. PTX3 was significantly associated with unintentional weight loss (p<0.001), slow walk time (p=0.04) and low grip strength (p=0.03), but not the other domains of frailty, exhaustion and physical activity, both p>0.2. Increased PTX3 was also associated with frailty status comparing those who were not frail (0 domains of frailty, N=879) to those who were intermediate frail (presence of 1-2 domains of frailty, N=926) or frail (≥3 domains, N=143). In minimally adjusted models, the relative risk (RR) for intermediate frailty was 1.22 (95% confidence interval 1.04-1.44) and 1.70 (1.25-2.29) for prevalent frailty, comparing both to non-frail. Results were slightly attenuated but remained significant in fully adjusted models; RR 1.19 (1.01-1.41) for intermediate and 1.59 (1.16-2.18) for frail. As some biomarkers show sex-dependent associations, we stratified on sex. In fully adjusted models, increased PTX3 was associated with intermediate frailty (RR 1.3; 1.00-1.69) and frailty (RR 2.14; 1.24-3.67) in men, but did not appear to be associated in women (RR 1.13; 0.91-1.42 for intermediate and 1.28; 0.85-1.92 for frail); however, the interaction term was not significant (p=0.2).

Conclusions:
In these older adults, PTX3 was associated with some domains of frailty and frailty status. Associations were independent of the presence of clinical and/or subclinical CVD and CRP, a biomarker of general inflammation. PTX3 may reflect ongoing vascular damage in multiple aging-related diseases such as CVD and frailty. Further study is needed to evaluate the potential for PTX3 to act as a biomarker of healthy aging.
Abstract MP73: Relationship of Insulin Resistance to Prevalence and Progression of Coronary Artery Calcification Beyond Metabolic Syndrome in a General Population
Authors: Yamazoe Masahiro , Hisamatsu Takashi , Miura Katsuyuki , Kadowaki Sayaka , Zaid Maryam , Kadota Aya , Fujiyoshi Akira , Abbott Robert , Arima Hisatomi , Sekikawa Akira , Maegawa Hiroshi , Horie Minoru , Ueshima Hirotsugu
Published: July 2021

Introduction:
Association between insulin resistance (IR) and prevalence of coronary artery calcification (CAC) has been inconsistent after adjustment for metabolic syndrome (MetS). In addition, relation of IR to progression of CAC has remained unclear. Recent basic science studies have reported that IR could promote atherosclerosis not only through the mechanisms that involve systemic factors such as dyslipidemia and hypertension, but also through the effect of perturbed insulin signaling at the cell level. Therefore we assessed the hypothesis that IR is associated with CAC prevalence or progression independently of MetS components in a general population.

Methods:
We conducted a population-based study in a random sample of men aged 40-79 years living in Kusatsu City, Shiga, Japan, without prior coronary heart disease (Shiga Epidemiological Study of Subclinical Atherosclerosis; SESSA). IR was determined by homeostasis model assessment of IR index (HOMA-IR). We measured CAC at baseline and five years later with noncontrast computed tomography. CAC prevalence was defined as baseline CAC score > 0, and CAC progression as a change > 2.5 between the square root transformed values of baseline and follow-up CAC scores. Multivariate logistic regression was performed to calculate adjusted odds ratios (OR) and 95% confidence intervals (95% CI) in total participants and in those without diabetes.

Results:
Of 1022 total participants at baseline (mean age, 64 ± 10 years), CAC prevalence was found in 658 (64.4%), and of 804 participants at follow-up (mean follow-up duration, 4.9 ± 1.3 years), CAC progression in 371 (46.1%). Even after adjustment for MetS components in addition to other confounding factors, higher HOMA-IR was independently associated with CAC prevalence (OR, 1.35; 95% CI, 1.11-1.64; P = 0.003) and CAC progression (OR, 1.44; 95% CI, 1.18-1.74; P < 0.001). In participants without diabetes (N = 807 at baseline, N = 638 at follow-up), we observed similar positive associations of HOMA-IR with CAC prevalence (OR, 1.30; 95% CI 1.05-1.61; P = 0.016) and CAC progression (OR 1.31; 95% CI 1.03-1.67; P = 0.025). In contrast, fasting glucose and hemoglobin A1c were not related to CAC prevalence and progression.

Conclusion:
In conclusion, higher IR was associated with CAC prevalence and progression independently of MetS components in general men and also in those without diabetes. Adding measuring of IR as routine clinical examination may provide additional predictive value beyond traditional risk assessment especially among population without diabetes.
Abstract MP76: Severe Hypoglycemia and Prevalence of Cognitive Impairment in Older Adults with Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Lee Alexandra K , Rawlings Andreea M , Schneider Andrea L , Sharrett A R , Huang Elbert S , Selvin Elizabeth
Published: July 2021

Introduction:
Hypoglycemia and cognitive impairment are major problems in older adults with diabetes. It is unknown whether persons with prior hypoglycemia have distinct patterns of cognitive impairment compared to persons without hypoglycemia.

Hypothesis:
Compared to older adults with diabetes and no history of hypoglycemia, persons with prior hypoglycemia will have worse cognitive performance across all domains, but particularly in the executive function domain.

Methods:
We conducted a cross-sectional analysis of older adults with diagnosed diabetes using data from the ARIC study (2011-2013). Participants completed eight cognitive tests that measured three domains: memory, language, and executive function. Cognitive impairment in each domain was defined as having at least one test score lower than 1.5 standard deviations below age-, race-, and education-specific norms. We identified prior severe hypoglycemic events through 2012 with ICD-9 codes from hospitalizations and emergency department visits. We used Poisson regression with robust standard errors to generate prevalence ratios (PR) adjusted for demographic and clinical characteristics.

Results:
Among 1,867 adults with diagnosed diabetes: mean age 76 years, 56% female, 32% black, and 3% with prior hypoglycemia. In persons with prior hypoglycemia, 50% had cognitive impairment in at least one domain, compared to 43% in persons without prior hypoglycemia (p=0.24). After adjustment, persons with prior hypoglycemia were more likely to have worse performance in executive function (PR=1.73; 95% CI: 1.14-2.64) and language (PR=1.78; 95% CI: 1.08-2.93) but not memory (PR=1.19; 95% CI: 0.81-1.76) (Figure).

Conclusions:
Persons with prior severe hypoglycemia are a unique subset of older adults with diabetes with greater cognitive deficits in the domains of executive function and language. Their cognitive impairment presents challenges for the management of their diabetes and the prevention of additional hypoglycemic episodes and cognitive decline.
Abstract MP89: Effectiveness of School Procurement Policies for Improving Dietary Behaviors: A Systematic Review and Meta-analysis
Authors: Micha Renata , Bakogianni Ioanna , Karageorgou Dimitra , Trichia Eirini , Shulkin Masha L , Shangguan Siyi , Kashaf Michael , Mozaffarian Dariush
Published: July 2021

Background:
School procurement policies - e.g., free/reduced price provision of healthful foods/beverages, quality standards for competitive foods/beverages, or quality standards for school meals - are increasingly being used to promote healthy diets in kids. However, their effectiveness has not been systematically evaluated.

Methods:
We used MOOSE and PRISMA guidelines to systematically search multiple online databases for original interventions (randomized, quasi-experimental) assessing influence of school procurement policies, alone or as part of multi-component strategies, on dietary intakes in children. Data were extracted independently and in duplicate. Inverse variance-weighted meta-analysis was used to pool estimates. Pre-specified sources of heterogeneity (study design, location; intervention duration, coverage, components; outcome type, ascertainment) were analyzed using meta-regression and subgroup analysis. Funnel plots, Begg’s, and Egger’s tests evaluated potential publication bias.

Results:
From 6,193 abstracts, 76 interventional studies met inclusion criteria. Many were multicomponent. Thirty-two assessed free/reduced price provision of healthful foods/beverages, mostly in cafeterias or classrooms, with average duration 18 mo. In pooled analysis, free/reduced price provision of fruits and vegetables increased fruit intake by 0.22 servings/d (n=14 studies; 95% CI: 0.10, 0.34) and total fruit and vegetable intake by 0.28 servings/d (n=12; 0.07, 0.49), but not vegetable intake alone (n=8; 0.01 servings/d [-0.03, 0.05]). Twenty-seven interventions evaluated policies on competitive foods/beverages (most often sugar-sweetened beverages), with average duration 23 mo. Strategies included restrictions/bans, quality standards, or both. These interventions reduced sugar-sweetened beverage intake by 0.11 (12-oz) servings/d (n=7; -0.16, -0.05). Thirty-two interventions assessed quality standards for school meals (lunch and/or breakfast), with average follow-up 28 mo. Standards were typically based on types of foods, nutrient content, and/or portion size. Dietary targets varied appreciably, and results were generally inconsistent across studies, with no significant overall pooled effect. Findings for secondary outcomes of food content, food availability, and adiposity will be presented. Statistical heterogeneity in these analyses was variable; meta-regression did not identify significant sources. Little evidence for publication bias was seen.

Conclusions:
These findings support efficacy of school procurement policies that provide free/reduced price healthful choices or target competitive foods/beverages. Efficacy of quality standards for school meals appears heterogeneous with less consistent benefits. These findings inform policy priorities for improving diets in children.