bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 10750: Allostatic Load is Associated with Incident Heart Failure in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Authors: Park Christine , Ringel joanna B , Balkan Lauren , Pinheiro Laura , Sterling Madeline R , Banerjee Samprit , Levitan Emily B , Safford Monika , Goyal Parag
Published: March 2022

Introduction:
Allostatic load (AL) is the physiologic “wear and tear” on the body from adapting to stress. AL is associated with mortality for diseases including cancer and diabetes. While stress has been implicated in the development of heart failure (HF), no studies have studied the association between AL and HF.

Hypothesis:
Higher allostatic load is associated with incident HF events.

Methods:
We examined 16,765 participants without suspected HF at baseline from the REGARDS cohort. The main exposure was AL score quartile. AL score was based on baseline heart rate, systolic blood pressure (BP), diastolic BP, waist circumference, glucose, total cholesterol, high density lipoprotein cholesterol, albumin, c-reactive protein, urine albumin to creatinine ratio, and cystatin C. Each parameter was assigned points (0-3) based on quartiles within the sample, and total AL score ranged from 0-33. The main outcome was incident HF hospitalization or HF death. Cox proportional hazards models were adjusted for baseline demographics, geographic residence, socioeconomic factors, and lifestyle/health habits.

Results:
The mean age of the sample was 64
+
9.6 years, 61.5% were women, and 38.7% were Black individuals. Over a mean follow up of 9.9 years, there were 750 HF events (635 incident HF hospitalizations and 115 incident HF deaths). AL score Q1 included scores 1-12, Q2 13-16, Q3 17-20, and Q4 21-33 (Figure). Compared to Q1, hazards for incident HF event increased with AL quartile (Q2 HR 1.29, 95% CI 0.93-1.79; Q3 HR 2.06, 95% CI 1.51-2.81; Q4 HR 3.65, 95% CI 2.68-4.97) in a fully adjusted model.

Conclusion:
AL was associated with incident HF events. This study supports a relationship between physiologic dysregulation due to maladaptive stress response and the development of HF.
Abstract 10753: Exercise-Induced ECG Changes Predict Adverse Outcomes in Pulmonary Hypertension
Authors: Kailas Maya , Layton Aimee , Pesce Meredith , Garofano Robert , Starc Thomas , Berman-Rosenzweig Erika , Liberman Leonardo , Krishnan Usha
Published: March 2022

Introduction:
Cardiopulmonary exercise testing (CPET) is an important tool in assessing the functional status of patients with pulmonary hypertension (PH). During CPET, ECG is used as marker of exercise induced ischemia. We hypothesize that ECG changes with exercise may be an early indicator of clinical worsening in PH and could predict adverse outcomes.

Methods:
Clinical, hemodynamic, and CPET data of 101 PH patients who underwent CPET between 2013 and 2019 were included. ECGs were analyzed for ST depressions and T wave inversions during the earliest CPET in this time frame, along with coincident hemodynamic data. These data were correlated to adverse outcomes, including shunt creation (atrial septostomy or POTTs shunt), lung transplantation, and death.

Results:
Median age was 19 y (7-40 y, IQR 12-26), 68% were female, and median follow up time was 3 y (1-8 y, IQR 1-5). Sixteen patients had an adverse outcome (8 shunt creation, 4 lung transplant, 7 death). Twenty-two patients demonstrated significant ST/T wave changes with exercise, 18 ST depressions and 9 T wave inversions. Multivariate regression, including pulmonary arterial pressure, revealed exercise induced ST/T wave changes to be an independent predictor of procedure-free survival (without lung transplantation or shunt creation) (hazard ratio 11.10, p=.006). Only 21% with ST/T wave changes demonstrated procedure-free survival vs 85% without.

Conclusions:
ST/T wave changes on exercise ECG are significantly associated with adverse outcomes in PH on a medium term follow up study. These ECG changes with exercise can be used as early indicators of clinical worsening in PH and predictors of adverse outcomes.
Abstract 10758: Individuals with Normal-Weight Obesity Exhibit Higher Postprandial Triglycerides, but Similar Endothelial Function and Inflammation Compared to Normal-Weight Controls
Authors: Keirns Bryant H , Hart Samantha M , Sciarrillo Christina M , Poindexter Kara L , Clarke Stephen L , Emerson Sam R
Published: March 2022

Introduction:
Normal-weight obesity (NWO) is defined as having a normal BMI yet high body fat % and is linked to increased cardiovascular disease (CVD) risk. However, the current understanding of NWO’s risk profile is incomplete and, in many cases, their clinical presentation is arguably unremarkable based on common risk factors.

Hypothesis:
We hypothesized that other indictors of CVD risk such as postprandial triglycerides (TG), flow-mediated dilation (FMD), and inflammatory cytokines would be elevated in NWO, consistent with their future CVD risk.

Methods:
Individuals were recruited into 3 groups (n = 10/ group): healthy controls (Con), NWO, and metabolic syndrome (MetS) based on results from a fasting metabolic panel, blood pressure, and DEXA. All participants underwent an abbreviated fat tolerance test where fasting TG were measured, a high-fat shake was consumed (9 kcal/kg; 73% fat), and then TG measured again 4 hrs later. Brachial FMD was measured during the fasted state and postprandially, and a high-sensitivity T cell cytokine bioplex (Millipore; Burlington, MA) was performed with fasting serum. Data were analyzed using one-way ANOVA followed by Fisher’s LSD.

Results:
NWO and MetS had similar body fat % and both were higher than Con (
p
< 0.01). All groups differed with respect to visceral adipose tissue mass, with MetS > NWO > Con (
p
< 0.01). Despite having similar fasting TG to Con, NWO (122.5 ± 46.4 mg/dL) had 4-hr TG intermediate to Con (73.7 ± 13.9 mg/dL) and MetS (178.3 ± 76.4 mg/dL;
p
< 0.01). Across the entire sample, FMD decreased (
p
< 0.01) after the high-fat meal. MetS (3.3 ± 1.2 %) displayed lower fasting FMD than Con (5.1 ± 1.1 %), and NWO (4.5 ± 2.0 %) was similar to both groups (
p
< 0.05). No group differences were observed with postprandial FMD. The majority of cytokines assessed were not different across groups. However, MetS (7.8 ± 2.1 pg/mL) exhibited higher TNF-α than Con (4.8 ± 1.9 pg/mL;
p
< 0.05), and NWO (6.6 ± 3.4 pg/mL) was not different from either group.

Conclusions:
In conclusion, NWO was associated with higher postprandial TG than Con, but displayed little evidence of impaired vascular health or inflammation. MetS had the greatest 4-hr TG, as well as impaired vascular function and signs of inflammation compared to Con.
Abstract 10759: Atp Citrate Lyase: An Attractive Target at the Nexus of Metabolic and Epigenetic Alterations in Pulmonary Arterial Hypertension
Authors: Romanet Charlotte , Bourgeois Alice , Grobs Yann , Shimauchi Tsukasa , Lemay Sarah-eve , Nadeau Valerie , Breuils Bonnet Sandra , Provencher Steeve , BOUCHERAT Olivier , Bonnet Sebastien
Published: March 2022

Introduction:
Pulmonary arterial hypertension (PAH) is characterized by progressive obliteration of distal pulmonary arteries (PAs). As in cancer, excessive proliferation and resistance to apoptosis of PA resident cells (especially PA smooth muscle cells, PASMCs), fueled by metabolic aberrations (metabolic shift toward glycolysis) and interconnected global changes in the epigenetic landscape is a pivotal component of severe PA remodeling, for which current pharmacotherapies have limited efficacy. ATP Citrate Lyase (ACLY), a nuclear cytosolic enzyme that converts citrate to Acetyl-CoA, has recently emerged as a key player and therapeutic target in cancer by favoring Warburg effect, lipid synthesis and chromatin remodeling. However, its role in PAH is unknown.
We hypothesized that ACLY is upregulated in PAH and supports the abnormal phenotype of PAH-PASMCs.

Methods/Results:
Increased expression and nuclear localization of ACLY were observed in lungs and isolated PASMCs from PAH patients compared to controls (n=10, p<0.05; immunoblot and immunofluorescence). Similarly, ACLY was upregulated in PAH animal models (Su/Hx rats and mice). We found that pharmacological or molecular (siRNA) inhibition of ACLY impedes PAH-PASMC bioenergetics (as assessed by TMRM, expression of glycolytic enzymes and seahorse) and decreased P300-dependent histone H3 and H4 acetylation. Consistently, inhibition of ACLY was accompanied by 1) a decrease in proliferation (Ki67 labeling, n=8, p<0.05), 2) an increase in apoptosis (Annexin V and TMRM, n=8, p<0.05) and 3) a downregulation of P300-regulated pro-proliferative/anti-apoptotic factors (western blot of PCNA, Survivin, PLK1 and STAT3). In vivo, inhibition of ACLY using ETC-1002 in both male and female Su/Hx-challenged rats with established PAH resulted in a significant improvement in pulmonary vascular remodeling and right ventricular function (RVSP, mPAP, TAPSE, S-Wave, SV by echocardiography and catheterization). Furthermore, we found that inactivation of
Acly
targeted to smooth muscle cells confers protection in a gene-dosage-dependent manner against Su/Hx-induced PAH in mice.

Conclusion:
We demonstrated that the inhibition of ACLY is a novel and attractive therapeutic strategy to reverse PAH.
Abstract 10763: Atrial Fibrillation and Supraventricular Ectopy in Relation to Brain Morphology and Subclinical Vascular Brain Injury: The Multi-Ethnic Study of Atherosclerosis
Authors: Austin Thomas R , Jensen Paul , Nasrallah Ilya , Habes Mohamad , Rashid Tanweer , Chen Lin Yee Y , Greenland Philip , Hughes Timothy M , Post Wendy , Shea Steven , Watson Karol E , Sitlani Colleen , Floyd James S , Kronmal Richard , Longstreth W T , Bryan Nick , Heckbert Susan
Published: March 2022

Introduction:
Atrial fibrillation (AF) increases stroke risk and is associated with accelerated cognitive decline. Information is mixed about the relationship of AF and other supraventricular (SV) arrhythmias with brain changes on magnetic resonance imaging (MRI).

Hypothesis:
Prevalent AF and SV ectopy are associated with reduced gray matter (GM) volume and subclinical vascular brain injury.

Methods:
In the Multi-Ethnic Study of Atherosclerosis (MESA), participants completed Zio Patch monitoring and brain MRI. Prevalent AF was estimated from ambulatory monitoring, hospital surveillance, Medicare claims, and MESA electrocardiogram (ECG). For secondary analyses, AF was categorized into continuous - AF during 100% of monitoring - and intermittent - prevalent AF with <100% AF during monitoring. Brain MRI measures included GM volume, white matter (WM) lesion volume, WM fractional anisotropy, and presence of cerebral microbleeds (CMBs). Linear and Poisson regression analyses were adjusted for cardiovascular risk factors and socioeconomic status.

Results:
In MESA, 967 participants without a history of stroke or transient ischemic attack (TIA) completed >24 hours of ECG monitoring (median, 14.0 days) and completed brain MRI a median 17 months later. Mean (standard deviation) age was 72 (8) years; 53% were women. A total of 116 participants had prevalent AF, of whom 20 had continuous AF. Compared with no AF, prevalent AF was associated with lower WM FA (-0.22 standard deviations, 95% CI: -0.39, -0.04) and higher prevalence of CMBs (prevalence ratio: 1.46, 95% CI: 1.18, 1.80). In secondary analyses, compared with no AF, continuous but not intermittent AF was associated with lower GM volume (-18.6 mL, 95% CI: -31.4, -5.8). Rates of premature atrial contractions and runs of SV tachycardia were not significantly associated with brain MRI measures.

Conclusions:
In a multi-ethnic sample free of a history of stroke or TIA, prevalent AF was associated with lower WM FA, a measure of WM injury, and presence of CMBs. These results highlight the importance of AF prevention for brain health. Further analysis of subclinical infarcts is needed in this sample, and study in other settings is needed to confirm whether greater AF burden is associated with reduced GM volume.
Abstract 10772: Telemedicine in a Pediatric Lipid Clinic: Feasibility, Acceptability, and Health Care Disparities
Authors: Brothers Julie A , Houng Katherine , Minetola Jared , Craig Sansanee , Fuller Kate , Preminger Tamar J
Published: March 2022

Introduction:
During the COVID-19 pandemic, telemedicine became an essential way to provide patient care. We assessed the feasibility, acceptability, and initial impact on health care disparities of using telemedicine in a large pediatric lipid clinic.

Methods:
Data were collected from a telemedicine (TM) cohort between 4/1/20-3/31/21 and compared to an in-person (IP) cohort between 1/1/19-3/13/20. Families participated in telemedicine visits through an online patient portal. Interpreter services were available. Family surveys were sent after each telemedicine visit; providers were surveyed monthly. We evaluated family and provider satisfaction, cancellation rates, travel-related time and costs, and visit duration (check-in to check-out). Data were analyzed using standard descriptive summaries and student’s t-test.

Results:
Five providers completed 784 lipid telemedicine visits, accounting for 79% of total visit volume between 4/1/20-3/31/21. Average age was 14 years (+/- 3.8 yrs) and 366 (46.7%) were male. Interpreters were used in 11 (1.4%) visits. Payor mix (Medicaid vs. commercial) was comparable between TM (19.9%) and IP cohorts (22.4%). Of 98 completed telemedicine family surveys, 18 (18.4%) noted technical difficulties; however, nearly all families were interested in future telemedicine visits. Sixteen monthly provider surveys were completed: 31% reported technical difficulties and rated telemedicine 9.1/10. The 48-hour cancellation rate decreased from 11% to 7% (IP and TM cohort, respectively,
P
< 0.018), with a decrease from 25% to 5% for Non-Hispanic Black patients (
P
< .001). No show rates were consistent between cohorts at 2%. Total driving distance saved was 20,800 miles with an estimated travel-related savings of $11,440. Average visit time for IP cohort was 87.5 minutes compared to 39.5 minutes for the TM cohort.

Conclusion:
We found that using telemedicine in a pediatric lipid clinic is feasible, time efficient, and associated with travel-related time and cost savings. There was a significant decrease in 48-hour cancellation rates overall, most notably for Non-Hispanic Black patients. Future studies utilizing telemedicine in our clinic will evaluate the effect on long term cardiovascular risk and health care delivery.
Abstract 10777: Circulating and Adipose Tissue Levels of CD147 Are Linked to Vascular Dysfunction in Obese Diabetic Adults
Authors: Ali Mohamed M , Hassan Chandra , MAsrur MArio , Bianco Francesco M , Mahmoud Abeer M
Published: March 2022

Background:
Extracellular matrix metalloproteinase inducer (EMMPRIN; CD147) is a transmembrane glycoprotein that stimulates the production of matrix metalloproteinases (MMPs). These MMPs mediate vascular remodeling and are considered biomarkers for cardiovascular risk. The activity of CD147 depends mainly on its glycosylation, which varies significantly among different conditions. However, it is unclear if CD147 glycosylation or its role in MMP upregulation is influenced by the diabetic milieu characterized by high glucose levels and abundant glycation end products (AGEs). In this study, we sought to investigate the differential expression and glycosylation levels of CD147 in obese, diabetic (OB-T2D) individuals compared to non-OB controls.

Methods:
Blood and adipose tissue (AT) samples were obtained from OB-T2D individuals and controls (n=40, each). DEXA scanning was used for body composition analyses. Flow-induced dilation (FID) was assessed
in vivo
in the brachial artery and
ex vivo
in AT-isolated arterioles. Other cardiometabolic risk factors related to glucose and lipid metabolism and systemic inflammation were measured.

Results:
Circulating CD147 was considerably greater in OB individuals, mirroring the glycosylated CD147 and the N-acetylglucosaminyltransferase, MGAT5 protein levels in the AT. Within the OB-T2D group, AT and circulating CD147 correlated with higher body mass index, total and visceral fat percentage, fasting plasma glucose and insulin, insulin resistance measurement (HOMA-IR), glycosylated hemoglobin, systolic BP, and plasma levels of MMP2/9, AGEs (Carboxymethyl lysine and methyl-glyoxal-lysine dimer), C-reactive protein, interleukin 6, and tumor necrosis factor-alpha. AT-arteriolar FID was significantly lower in the OB-T2D individuals across all pressure gradients, while carotid pulse wave velocity (PWV) was higher, indicating arterial stiffness. CD147 correlated negatively with brachial artery and AT-arteriolar FID and flow-induced nitric oxide production and positively with PWV.

Conclusion:
Our findings imply that vascular dysfunction in OB-T2D patients is linked to higher levels of CD147 and its glycosylated fraction, which in turn is associated with other cardiometabolic risk factors.
Abstract 10778: Long-Term Functional Outcomes in Older Adults After Hospitalization for Extracranial Hemorrhage
Authors: Parks Anna L , Jeon Sun Y , Boscardin John J , Steinman Michael A , Smith Alexander K , Fang Margaret C , covinsky kenneth E , Shah Sachin J
Published: March 2022

Introduction:
Antiplatelet and anticoagulant medications often used to manage cardiovascular disease increase the risk of extracranial hemorrhage (ECH), such as gastrointestinal bleeding. There are few long-term data on the loss of function following ECH. This study’s goal was to measure the acute and persistent loss of independence in activities of daily living (ADLs) after ECH hospitalization.

Methods:
We used data from 1995-2015 from the Health and Retirement Study, a longitudinal, nationally representative survey of older Americans. We included subjects over age 65 who consented to Medicare linkage. We examined the association of ECH hospitalization with ability to perform all ADLs independently (walk across a room, dress, bathe, eat, toilet, get out of bed). To compare rates of ADL independence over time between those with ECH and a control group without ECH, we fit a logistic regression model that included an interaction term between ECH hospitalization and time and adjusted for comorbidities and sociodemographics.

Results:
In a cohort of 8950 with an average follow-up time of 7.3 years (65,335 person-years), 882 (10%) participants were hospitalized for ECH. Mean age was 78, and 59% were women. In the control group without ECH, the baseline rate of ADL independence declined by an average of 3.1% per year (average marginal effect [AME], 95% CI -3.1% to -3.3%). Assuming hospitalization for ECH at 5.2 years, the median time to ECH in this cohort, ECH was associated with an immediate decrease in ADL independence from 68% to 53% (AME -15%, 95% CI -11% to -18%). Following ECH, the average annual baseline rate of function loss did not change.

Conclusions:
In this nationally representative cohort, ECH hospitalization was associated with an immediate and pronounced decline in function that was equivalent to accelerating ADL disability by 5 years. After ECH, ADL independence continued to decline and did not recover to pre-ECH levels of independence over time.
Abstract 10781: Improving Medication Communication Following Percutaneous Coronary Intervention
Authors: Kohlmann Keri Q , Ring Michael T , Fink Angela L
Published: March 2022

Introduction:
Patients undergoing percutaneous coronary intervention (PCI) acquire or continue an average of five medications specific to their intervention during hospitalization, some of which are continued for life. It has been identified that poor communication between health care professionals and patients is a contributor to medication nonadherence. The aim of this quality improvement project was to determine if the implementation of individualized medication education forms and patient-centered medication training would improve nurse-patient medication communication.

Methods:
Project interventions were implemented on a post-PCI telemetry unit from December 2020 to February 2021. Patients with acute coronary syndrome requiring PCI during hospitalization were surveyed on five domains at the time of discharge from October 2020 to February 2021. The five domains included: 1) medication communication 2) confidence in medication name recall 3) ability to manage medications 4) understanding of medication purposes and 5) side effect management.

Results:
A total of 53 patients were included in this analysis, with 28 in the pre-intervention group and 25 in the post-intervention group. Comparatively, patients in the post-intervention group reported a subjective improvement in medication communication, confidence in recalling medication names, ability to manage medications, and understanding of medication purposes and side effects when compared to patients in the pre-intervention group.

Conclusion:
The use of multidimensional, standardized medication education forms and medication training positively impacted medication communication between nursing and post-PCI patients.
Abstract 10788: Temporal Trends in the Utilization of Aortic Valve Replacement for Symptomatic Severe Aortic Stenosis from 2000-2017: Insights from a Multi-Centered Study
Authors: Li Shawn X , Patel Nilay K , Flannery Laura , Selberg Alexandra , Kandanelly Ritvik R , Morrison Fritha J , Tanguturi Varsha K , Crousillat Daniela R , Shaqdan Ayman , Inglessis Ignacio , Shah Pinak B , Passeri Jonathan , Kaneko Tsuyoshi , Jassar Arminder , Langer Nathaniel , Turchin Alexander , Elmariah Sammy
Published: March 2022

Introduction:
Despite the rapid growth of aortic valve replacement (AVR) for aortic stenosis (AS), studies have suggested that symptomatic severe AS remains undertreated.

Hypothesis:
The growth in patients with an indication for AVR has outpaced the number of AVRs performed.

Methods:
We identified patients with severe AS (aortic valve area <1cm
2
) on transthoracic echocardiograms from 2000-2017 at two large academic medical centers. Natural language processing (NLP) models were developed and validated to identify symptoms consistent with severe AS, and patients were classified based on ACC/AHA clinical guideline indications for AVR. Patients were divided into groups based on mean aortic valve gradient (mAVG≥ 40 or <40mmHg) and left ventricular ejection fraction (LVEF≥50% or <50%). Utilization of AVR (transcatheter aortic valve implantation [TAVI] or surgical aortic valve replacement [SAVR]) in patients with a clinical indication was examined over time, and clinical predictors of AVR were identified via multivariate logistic regression.

Results:
A total of 10,795 AS patients were included in this analysis, of whom 6,150 (57%) had an indication or potential indication for AVR and 2,976 (48%) received AVR. The frequency of AVR varied by AS subtype (HG-NEF: 69%, HG-LEF: 53%, LG-NEF: 32%, LG-LEF: 38%, p<0.001). The adoption of TAVI contributed to the growth in AVR volume over time, however there has been a parallel rise in the number of patients with an indication for AVR
(Figure).
In patients with a class I indication for AVR, younger age, coronary artery disease, smoking history, higher hematocrit, outpatient index TTE, and LVEF≥0.5 were independently associated with an increased likelihood of receiving an AVR.

Conclusions:
Over an 18-year study period, the proportion of patients with an indication for AVR who do not receive AVR has remained significant despite the rapid growth of AVR volumes.
Abstract 10789: Effect of Sacubitril-Valsartan on Incidence of Atrial Fibrillation: A Meta-Analysis
Authors: Ahmad Javaria , Sultan Ali , Dominic Paari
Published: March 2022

Introduction:
Sacubitril/valsartan reduces all cause mortality in heart failure (HF) patients compared to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). ACEIs/ARBs have been shown to decrease the incidence of atrial fibrillation (AF).

Hypothesis:
Sacubitril-Valsartan decreases the incidence of AF compared to ACEis/ARBs.

Methods:
Clinicaltrials.gov was searched for trials by terms sacubitril/valsartan, entresto, sacubitril, valsartan. Randomized controlled human trials of sacubitril/valsartan reporting AF were included. Data were extracted independently by two reviewers. Data was pooled using a random effect model. Publication bias was evaluated by funnel plots.

Results:
A total of 11 trials including 11474 patients on sacubitril/valsartan and 10145 patients on ACEI/ARBs were identified. 304 AF events were reported in the sacubitril/valsartan group compared to 284 AF events in ACEIs/ARBs. Patients on sacubitril/valsartan were as likely as patients on ACEIs/ARBs to develop AF (pooled OR=1.054, (95% CI= 0.893 - 1.244), p=0.536). Atrial flutter (AFl) events were reported in 6 trials; 48 out of 9165 patients in the sacubitril/valsartan group developed AFl compared to 46 out of 8759 in ACEi/ARBs group. There was no difference in AFl risk between the two groups (pooled OR=1.028, (95% CI=0.681 - 1.553), p=0.894). Finally, sacubitril/valsartan did not reduce the risk of atrial arrhythmias (AF+AFl) compared to ACEi/ARBs (pooled OR=1.050 (95% CI= 0.900 - 1.225), p=0.533).

Conclusion:
Although sacubitril/valsartan reduces mortality compared to ACEIs/ARBs in HF patients, they do not reduce AF risk compared to these drugs.
Abstract 10792: Immediate Reduction in Left Ventricular End-Diastolic Pressure During Alcohol Septal Ablation in Patients with Hypertrophic Obstructive Cardiomyopathy
Authors: Tharp Peyton , Bidwell Katrina , Cook Daniel , Blaker Noah , Taylor Eric , Dorsey Andrew , Kramer Courtney , Fernandes VALERIAN , Nielsen Chris
Published: March 2022

Introduction:
Alcohol septal ablation (ASA) is an elective nonsurgical procedure proven to be effective for patients with hypertrophic obstructive cardiomyopathy (HOCM). The intraprocedural change in left ventricular end-diastolic pressure (LVEDP) is unknown. In this study we assessed the hypothesis that LVEDP decreases immediately post ablation during ASA in patients with HOCM independently of the effects of sedation and heart rate.

Methods:
We retrospectively identified 133 elective ASA procedures for patients with HOCM between 2015 and 2021 at our institution using an internally maintained database. Pre- and post-ablation LVEDP measurements were taken using the pressure tracing corresponding with end-expiratory R wave of the ECG tracing. LVEDP was recorded for post-“a” wave points on the pressure tracing at three distinct points during the procedure: the immediate start of the procedure (Group A), prior to alcohol injection after sedation had taken effect (Group B), and post ablation (Group C). Heart rate (HR) and left ventricular outflow tract gradient (LVOTG) were obtained from the catheterization report. Paired t-tests, ANOVA, and regression analyses were performed using SPSS Statistics.

Results:
The average patient age was 64 years old; mean NYHA Class 2.7; and 67% were women. There was no difference between LVEDP of Groups A and B (32mmHg, 32mmHg, p=0.92). LVEDP between Groups A and C (32mmHg, 26mmHg, respectively; p<0.001) and Groups B and C (32mmHg, 26mmHg, respectively; p<0.001) were significantly different. There was no correlation between HR and LVEDP for the groups (R2A=0.002, R2B=0.000, R2C=0.054), and similarly, no correlation between the average change in LVEDP and the change in resting or provoked LVOTG (R2=0.033, R2=0.003, respectively).

Conclusions:
These results support that alcohol septal ablation causes an immediate reduction in LVEDP post-ablation independent of heart rate, reduction in LVOTG, and effects of sedation. In conclusion, this instantaneous change in LVEDP may account for the immediate resolution in symptoms reported by patients with HOCM undergoing ASA.
Abstract 10795:
Adam10
Gene Deficiency Impairs Kidney Function via Suppressing Klotho Shedding
Authors: Zhang Bo , Wang Shirley , Chen Kai , Sun Zhongjie
Published: March 2022

A Disintegrin and Metalloproteinase 10 (ADAM10) is a member of the ADAM family of cell membrane-anchored proteins which processes and influences the functions of its substrates by in-/activating them or by liberating biologically active fragments. ADAM10 is primarily expressed in kidney epithelial cells. Thus, the objective of this study is to investigate whether ADAM10 is involved in the regulation and maintenance of normal kidney function. Tamoxifen-inducible kidney-specific cre (Ksp) and ADAM170-floxed mice were cross-bred for generating Ksp/ADAM10-floxed mice. Injection of tamoxifen initiated deletion of the
ADAM10
gene and led to a significant reduction in ADAM10 protein expression in renal distal and proximal tubule cells. Notably, knockout of the
ADAM10
gene largely decreased soluble Klotho levels in urine, indicating that ADAM10 is a critical enzyme in shedding Klotho. We found that renal sodium excretion was decreased in kidney-specific
ADAM1
0 knockout mice (ADAM10 -/-), suggesting that ADMA10 deficiency results in an increase in Na reabsorption or Na retention. Urinary potassium output tended to increase in ADAM10 -/- mice although it did not reach a significant level. It is interesting that
ADAM10
gene deficiency compromises renal tubular function leading to Na retention. Glomerular filtration rate (GFR) was dramatically decreased in ADAM10 -/- mice, indicating that ADAM10 deficiency impairs glomerular function. Interestingly, treatment with recombinant Klotho improved renal glomerular function. Therefore,
ADAM10
gene knockout impairs kidney function likely
via
suppressing Klotho shedding.
Abstract 10797: Applying Cardiotoxicity Risk Prediction Scores in Women with Early-Stage Breast
Authors: Suntheralingam Sivisan , Calvillo Arguelles Oscar , Abdel Qadir Husam , Amir Eitan , Thavendiranathan Paaladinesh
Published: March 2022

Background:
Cardiotoxicity is a common complication of anthracyclines and HER2-targeted therapies in breast cancer patients. Despite recognized risk factors, accurate prediction of cardiotoxicity risk remains a challenge. We applied 3 published risk prediction scores (Table) to a cohort of women with HER2+ breast cancer treated with anthracycline and trastuzumab and described their predictive accuracy.

Methods:
Women with stage I-III HER2+ breast cancer treated at the Princess Margaret Cancer Centre (Toronto) between 2006-2019 were identified retrospectively. Those with a pre-therapy MUGA scan or 2D echocardiography and ≥ 3 follow up scans using the same modality were included. CREC criteria were applied to define cardiotoxicity. Three risk prediction scores (Ezaz
et al.,
Romond
et al.,
and HFA-ICOS proformas) were used to classify patients into low/medium/high cardiotoxicity risk according to pretreatment characteristics. The proportion of patients who developed cardiotoxicity across risk categories were compared within each score using chi-square test.

Results:
Of 629 women (mean age 52.4 ± 10.9 years), 151 (24%) met CREC cardiotoxicity criteria. With the Ezaz
et al.
score
,
proportion of patients that developed cardiotoxicity was 24.4% (n = 141/577), 20% (n = 9/45) and 14.3% (n =1/7), in the low, medium, and high predicted risk groups, respectively (p = 0.665). With Romond
et al.
score
,
this was 17.9% (n = 40/223), 24.5% (n = 50/204) and 30.5% (n = 61/200), respectively (p = 0.01). HFA-ICOS was 15.5% (n = 30/193), 26.9% (n = 109/404), and 37.5% (n = 12/32), respectively (p = 0.002).

Conclusion:
In women with early stage HER2+ breast cancer receiving trastuzumab therapy, risk scores by Romond
et al.,
and the HFA-ICOS proformas predict cardiotoxicity risk. However, for both these scores the incidence of cardiotoxicity in the “low” predicted risk group remains high (15.5%-17.9%). Therefore, there remains a need to develop more accurate risk prediction scores.
Abstract 10800: Pituitary Apoplexy Induced Takotsubo Cardiomyopathy
Authors: Saini Amandeep S , Shargani Kourosh , Wutawunashe Caleb V , Guo Steve
Published: March 2022

Introduction:
Takotsubo Cardiomyopathy (TTC), defined by transient myocardial dysfunction with patterns of regional hyperkinesis, commonly arises after an emotional or physical stressor and hypokinesis. Here, we report a TTC case in the setting of pituitary apoplexy.

Case:
An 82-year-old Male with a history of hypertension, hyperlipidemia, pituitary adenoma, and complete heart block (status post permanent pacemaker) was admitted to the ED after one week of malaise, nausea, and vomiting. The day prior, he developed a severe frontal pressure headache and intermittent blurry vision. He had no chest pain and initially stable vitals, but later became lethargic and febrile to 101.6F with nonsustained ventricular tachyarrhythmias. EKG showed deep T-wave inversions in V2-V4 concerning for pathologic central nervous system T-waves (Fig. 1A). An echocardiogram revealed reduced left ventricular ejection fraction (LVEF) of 20% and akinesis of all mid-myocardial apical segments (Fig. 1B-D). Labs included flat troponin trend, lactate 5 mmol/L, and electrolyte derangements of magnesium 1.5 mEq/L, phosphorous 1.0 mEq/L, and potassium 3.2 mEq/L. In the cardiac care unit, his pacemaker settings were increased from 60 to 80 bpm due to QT prolongation and torsades de pointes on telemetry (Fig. 1E). Given his history of pituitary adenoma, an MRI Sella was performed and was notable for pituitary apoplexy and interval gland enlargement (Fig. 1F). Further labs revealed low cortisol, TSH, and testosterone. Stress dose steroids and levothyroxine were initiated and he underwent transphenoidal resection. Following these interventions, he was afebrile and no longer experienced his chief complaints. Repeat EKG and echocardiogram showed T-wave resolution in V2-V4 (Fig. 1G) and LVEF 50-55%, respectively.

Conclusion:
Neuroendocrine disorders should be considered as possible stressors in TTC. Early recognition and treatment can ensure favorable outcomes with pituitary apoplexy.
Abstract 10809: Socioeconomic Factors Affect Prescription Patterns of the Newer Anti-Diabetic Medications
Authors: Gaddipati Haritha , Antwi-Amoabeng Daniel , reddy pooja , DHULIPALLI ANITA , Gullapalli Nageshwara
Published: March 2022

Introduction:
Sodium-glucose Cotransporter-2 inhibitors (SGLT2) and Glucagon-like Peptide-1 receptor agonist (GLP-1) medications are known to reduce cardiovascular mortality through their insulin-independent mechanisms. The prescription pattern of these medications among diabetes patients is unknown. We sought to classify prescription patterns within our healthcare system and identify factors which influence these patterns.

Hypothesis:
We predicted that socioeconomic factors would influence the likelihood of SGLT2 or GLP-1 prescription for diabetes care.

Methods:
Unique encounters for diabetes care in the outpatient and inpatient setting from January 1, 2020, to December 31, 2020, were identified through a systematic query of our healthcare system’s database. We included patients >18 years old who had an A1C of ≥8%. We abstracted demographic data, SGLT2 or GLP-1 prescription status, diabetes complications and assessed the relationship between these and the likelihood of being prescribed one of the medications of interest.

Results:
Of the 2,746 patients included, 24.4% were prescribed either an SGLT2 or a GLP-1. Prescription status did not differ by sex. Users were more likely to be younger (mean age: 65.1 ± 9.4 years vs. 66.4 ± 9.9 years, p = 0.005); non-Hispanic (86.3%), White (77.9%), likely to live in a middle-income level zip code, and likely to have private insurance. Logistic regression of the predictors of prescription status is shown in table 1.

Conclusion:
Race, age, ethnicity, insurance type, and median annual household income are associated with the likelihood that a diabetes patient would be prescribed either an SGLT2 or GLP-1. Further work is warranted to identify resources and strategies to limit the disparities in prescription patterns
Abstract 10820: Atrial Fibrillation Catheter Ablation Reduces the Risk of Dementia: A Systematic Review and Meta-Analysis
Authors: Shah Siddharth , Shah Kuldeep , Turagam Mohit K , Bhardwaj Rahul , Contractor Tahmeed , Mandapati Ravi , Natale Andrea , Lakkireddy Dhanunjaya , Garg Jalaj
Published: March 2022

Introduction:
Although atrial fibrillation (AF) has a risk of cognitive dysfunction, it is not clear whether AF catheter ablation impacts cognitive function. Catheter ablation for AF prolongs the duration of sinus rhythm, thereby improving the quality of life and theoretically reducing the risk of dementia.

Objective:
We investigated the association of catheter ablation for AF with the occurrence of any dementia.

Methods:
A systematic search using electronic databases was performed from inception until January 15, 2021. Mantel-Haenszel risk ratio (RR) random-effects model (DerSimonian and Laird method) was used to summarize data. The primary outcome was occurrence of dementia during the follow-up period. Statistical analysis was performed using a
meta-package
for R version 4.0 and Rstudio version 1.2.

Results:
A total of 3 eligible studies (retrospective and prospective) consisting of 34,360 patients [Catheter ablation = 10,862 and medical therapy (antiarrhythmic drugs or rate-control drugs) = 23,498] were included in the meta-analysis. Patients in the ablation group were younger compared to medical therapy (59.6 ± 10.4 vs 60.3 ± 10.6 years; p<0.001). Hypertension (55% vs 54.4%, p = 0.31), heart failure (23.7% vs 22.1%, p = 0.001), diabetes (14% vs 15.2%, p = 0.004), cerebrovascular accident (11% vs 10%, p = 0.005) and myocardial infarction (7.5% vs 6.5%, p<0.001) were most common comorbidities, respectively. There was a lower incidence of dementia in AF patients treated with catheter ablation compared to medical therapy (2% vs 3.5%, RR 0.39, 95% CI 0.22-0.70, p<0.01) during a mean follow-up period of 5.44 years.

Conclusion:
AF ablation patients have a significantly lower risk of dementia in comparison to AF patients without ablation.
Abstract 10832: Transient Receptor Potential Melastatin 7 (TRPM7) Contributes to Myocardial Ischemic Injury
Authors: Yue Lixia , feng jianlin , Yue Zhichao , Yue Lixia
Published: March 2022

Introduction:
Ischemic heart disease is the leading cause of death in the USA. Despite the progress of interventional coronary reperfusion strategies, myocardial ischemia reperfusion (I/R) injury remains a substantial challenge for treatment. TRPM7 is a Ca
2+
-permeable nonselective channel which plays an important role in cardiogenesis and atrial fibrillation. However the role of TRPM7 in pathogenesis of myocardial I/R is unknown.

Hypothesis:
TRPM7 contributes to myocardial I/R injury.

Methods:
TRPM7 knockout mice (M7KO) and Cre
-
control littermates (WT) mice were exposed to 45 min ischemia or sham procedure followed by 24 hrs of reperfusion (n=8 to 12/group). Heart function was evaluated by echocardiograph, and in vitro assays were used for mechanistic investigation.

Results:
We found that TRPM7 expression was upregulated in I/R injury WT mouse hearts. Global M7KO (gM7KO) improved heart performance via increasing the ejection fraction and fraction shortening by 29.1 ± 4.2 % and 10.8 ± 3.0 % respectively (p<0.05).
Trpm7
deletion also reduced the infarct size by 31.1 ± 1.2 % in comparison with WT mice (P<0.05). Myocytes specific knockout (mM7KO) exhibited similar protective effect against I/R injury. Moreover, deletion of
Trpm7
significantly reduced tunnel positive cells, suggesting that upregulated TRPM7 in WT mice contributed to myocyte apoptosis in I/R injury. Interestingly, deletion of
Trpm7
also significantly reduced the protein level of NLRP3, cleaved-caspase-1 and mature IL-1β after I/R injury (p<0.05), indicating that TRPM7 contributed to pyroptosis during I/R injury. Consistent with the increased IL-1β level induced by I/R injury in WT mice, the cleaved N-terminal Gasdermin D (N-GSDMD) level was also increased in WT I/R injury hearts versus sham control hearts. Deletion of
Trpm7
significantly attenuated the increase of the cleaved N-GSDMD level induced by I/R injury (p<0.05).

Conclusions:
Trpm7
deletion in cardiac myocytes protects mice against myocardial ischemic injury. This is the first study to demonstrate the important role of TRPM7 in I/R injury through the mechanisms of activation of both apoptosis and pyroptosis. Our results suggest that TRPM7 may serve as a novel therapeutic target for myocardial ischemia/reperfusion injury.
Abstract 10834: Novel Biomarkers and Machine Learning Models for the Prediction of 30-Day Readmission Following Pediatric Congenital Heart Surgery
Authors: Thiriveedi Likhita Sree , Everett Allen D , Parker Devin , Stabler Meagan , Brown Jeremiah R
Published: March 2022

Introduction:
Hospital readmissions after congenital heart surgery (CHS) are common in pediatric patients and are linked to higher risks of complications, mortality, and increased treatment costs. Accurate prediction of 30-day readmission after CHS could help clinicians identify high risk patients and enable tailored care.

Hypothesis:
Novel biomarkers alone enhance prediction of readmission risk using XGBoost model and augmenting clinical features to the Society of Thoracic Surgeons (STS)-risk model improves predictions of 30-day readmissions.

Methods:
The prospective cohort included children of 18 years or younger who underwent congenital heart surgery at Johns Hopkins Hospital. Of the 162 patients, 159 survived discharge and were therefore included in the study. We used pre- and post-operative biomarkers ST2, Galectin-3, NT-proBNP and GFAP as features for the biomarker model, covariates from the STS CHS Database Mortality Risk Model for the STS-risk model and augmenting clinical features to STS-risk variables for clinical model. We implemented the XGBoost model and compared the biomarker model and clinical model performance to the STS-risk model.

Results:
Readmissions within 30 days of surgery occurred among 9% of pediatric patients. Using XGBoost, the STS-risk model derived an AUROC of 0.978 (95% CI: 0.955-1.0). The biomarker model performed better than the STS-risk model with AUROC of 0.982 (95% CI: 0.959-1.0, p=0.8). The augmented clinical model outperformed the STS-risk model with an AUROC of 0.997 (95% CI: 0.99-1, p=0.1).

Conclusions:
Novel biomarkers alone perform better compared to the STS- risk model in predicting 30-day readmission risk. XGBoost model improves risk prediction when adding additional clinical features to the existing STS-risk model which outperformed the STS-risk model. Depending on healthcare systems clinical resources and data availability, an optimized XGBoost model can improve the readmission risk prediction outcome.
Abstract 10837: Prognostic Importance of Atrial Fibrillation in Heart Failure According to Time Elapsed Since Diagnosis
Authors: Schwartz Brian , Schou Morten , Lara Maria Irene Barillas , Monahan Kevin M , Helm Robert , Kober Lars , Gislason Gunnar , Ramachandran Vasan S , Torp-Pedersen Christian , Andersson Charlotte
Published: March 2022

Introduction:
Mortality rates in heart failure (HF) are greatest early after onset and decline rapidly with time (with the survival of the less sick patients). However, it is not known if the presence of atrial fibrillation (AF), a well-known risk factor for mortality in this population, alters such course.

Methods:
From the Danish nationwide administrative database, all first time HF patients were identified between 1998-2018 using ICD coding and followed for all cause mortality until the end of 2018. AF was categorized as occurring antecedent (before), concomitant (with), or after HF diagnosis. Time-dependent Poisson regression model was used to determine mortality rate ratios, using ‘no AF’ as referent, with multivariable adjustment.

Results:
A total of 252,988 HF patients (45% women, mean age 74 ±13 years) were included. Of these, 54,064 (21%) had AF before HF onset and 27,651 (11%) patients had AF diagnosed concomitantly with HF. During follow-up, 30,565 additional patients developed AF. The cumulative mortality and mortality rates were highest early after onset for all groups, but greater for those with AF versus without AF, regardless of the time of onset, Figure A and B. Of note, the rates declined substantially more and faster for patients without AF, rendering AF greater prognostic importance the longer out from initial diagnosis, p for interaction between AF groups and HF duration <0.0001, Figure C.

Conclusion:
While mortality declined in all patients with HF over time, patients with AF experienced substantially less decline in mortality than the no AF group, rendering AF of greater prognostic importance later in the clinical course of HF.
Abstract 10839: Two-year Follow-up Of Patients With Chronic Ischemic Heart Disease In A Specialized Center In Brazil
Authors: Trombini Pinesi Henrique , Moreira Eduardo M , Bolta Paula M , Martins Eduardo B , Pitta Fabio G , Rezende Paulo C , Lima Eduardo G , Hueb Whady , Garzillo Cibele L , Serrano Carlos V
Published: March 2022

Introduction:
Incidence of cardiovascular events in patients with chronic ischemic heart disease (CIHD) may vary significantly between regions. Although populous, Brazil is often underrepresented in international registries.

Objective:
This study aimed to describe the quality of care and 2-year incidence of cardiovascular events and prognostic factors in CIHD patients in a tertiary public health care center in Brazil.

Methods:
Patients with CIHD, denoted as previous revascularization, myocardial infarction (MI) or stenosis > 50% in at least one epicardial coronary artery, were enrolled and followed for at least 2 years. Main endpoint was the composite of MI, stroke or death. We also evaluated prescription, symptoms and laboratory records.

Results:
625 patients with mean age 65 (±9.6) years, 33.3% women, were included. Previous MI was present in 59.8%, CABG in 26.8%, and percutaneous coronary intervention in 40.6%. Diabetes was prevalent in 48.6%, high blood pressure in 83.1%, and chronic kidney disease (creatinine clearance < 60 mL/min) in 34.7%. Residual coronary anatomy was known in 266 patients, of whom 29.3% had multivessel disease, and 11.7% had lesion in the left main artery. At a median follow-up (FU) of 881 days, we recorded 37 events of primary composite endpoint, with 2-year estimate event incidence of 7.05%. Age (HR per 10 years 1.61, 95%CI 1.32-1.97), stroke (3.65, 1.48-9.00) and LDL-cholesterol (1.23, 1.14-1.33) were the main prognostic factors in multivariate analysis. The participants experienced relief of angina symptoms based on Canadian Cardiovascular Society (CCS) scale (baseline vs. FU respectively): 65.7% vs. 81.7% were asymptomatic, 13 vs. 7.2% CCS1, 17.1 vs. 8.3% CCS2, 4.2 vs. 2.9% CCS3 or 4 (p < 0.001). Analysis of therapeutic goals identified better quality of medication prescription, defined as the use of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker plus statin and any antithrombotic agent: 65.8% vs. 73.6% (p<0.001) comparing baseline with FU. On the other hand, there was no improvement in LDL or blood pressure control.

Conclusion:
This study shows that CIHD patients had a 2-year incidence of the primary composite endpoint of 7.05%, LDL was the main modifiable risk factor of worse prognosis.