bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11259: Promoting Discharges in Pediatric Patients with Congenital Heart Disease on Ventricular Assist Device Support: An ACTION Quality Improvement Project
Authors: Bearl David W , Tunuguntla Hari , Connelly Chloe , Conway Jennifer
Published: March 2022

Introduction:
Discharge of pediatric ventricular assist device (VAD) patients is lagging behind adults, especially pediatric patients with concurrent congenital heart disease (CHD). This quality improvement project aimed to increase discharge rates and decrease time to discharge for pediatric patients with CHD on VAD support.

Methods:
Patients with CHD implanted with HeartWare HVAD or HeartMate 3 at participating Advanced Cardiac Therapies Improving Outcomes Network (ACTION) centers were included. Baseline demographics and outcomes including explant, transplant, or death, and time to outcome was collected from April 2018 until October 2019. QI interventions (VAD Flight Plan and Discharge Journey Map) were initiated in November 2019. Percentage discharged on VAD as well as time to outcome were compared before and after intervention.

Results:
Twenty-six patients with CHD (18 single ventricle physiology) were identified (14 pre-intervention and 12-post). The mean age was 16 years old with 27% implanted as Intermacs profile 1. Mortality on device was high at 38%. There were 77% (n=20) considered discharge eligible (alive on device > 30 days) while 42% (n=11) achieved discharge (Table 1). Mean length of stay post-implant for discharged patients was 33 days. A higher percentage of biventricular physiology were discharged (63%) compared to univentricular (33%). QI interventions did not change discharge rate (43% vs 42%), mean time to discharge (46.3 vs 43.4 days), transplant before discharge (17% vs 21%), or death before discharge (42% vs 43%) in the post-intervention group.

Conclusion:
Discharging CHD patients on VAD support from the hospital remains a challenge largely due to the complex and heterogenous nature of this population at the time of implant. Interventions to address optimal timing of VAD implantation and patient selection could impact outcomes.
Abstract 11291: Ectopic Olfactory Receptor Expression in Platelets as Novel Antithrombotic Targets
Authors: Aggarwal Anu , Godwin Matthew , Bhandari Rohan , Josyula Vara Prasad , Shim Sharon , Krauel Krystin , Rondina Matthew T , Wagner Larry , Yule David , CAMERON Scott J
Published: March 2022

Introduction:
Platelets are enriched in orphan G-protein-Coupled Receptors (GPCRs) that could potentially regulate platelet reactivity. A remote study in patients with hereditary anosmia reported dysfunctional platelet responses suggesting the presence of platelet olfactory receptor (ORs) that could regulate thrombosis.

Hypothesis:
Platelet ORs serve as an alternative pharmacological strategy to generate platelet cyclic adenosine monophosphate (cAMP) to prevent thrombosis.

Methods:
Ribonucleic Acid sequencing (mRNAseq) of human megakaryocytes (MKs) was conducted. Various ORs were validated in platelets by RT-qPCR and immunoblotting (IB). Reporter cell lines with stable integration of cloned ORs identified OR ligands and later validated in adult platelets. Fluorophores for OR second messengers (Fura2 for Ca
2+
and MQAE for Cl
-
) and an ELISA for cAMP were used for adult platelets. Platelet reactivity in response to OR agonists was evaluated by FACS and aggregometry, and thrombosis by biomechanical platelet activation was evaluated using
ex vivo
microfluidics and flow cones to simulate disturbed flow (D-flow). OR agonist injection into mice and CRISPR-Cas9 OR knockdown was conducted, with platelet reactivity and thrombosis tested as proof-of-concept.

Results:
Only 15 of >400 ORs in the genome were identified in MKs, and only 3 in all adult platelets (highest expression was OR2L13). A terpene family was identified as OR2L13 agonists, generating cAMP in the platelet, and structural modifications were made with IC
50
values in the low-high μM range for inhibiting agonist-induced platelet activation,
ex vivo
human blood thrombosis by microfluidics, and
in vivo
platelet activation in mice with prolonged tail bleeding. Deletion of OR2L13 (olfr168
-/-
) in mice augmented platelet reactivity with loss of OR agonist-mediated prolonged tail bleeding in olfr168
-/-
. OR2L13 in human platelets is stored and trafficked by alpha granules following surface agonist stimulation and biomechanical activation.

Conclusions:
Like neurons, platelets have a fully functional OR signal transduction cascade which operates as a negative regulator of platelet reactivity and thrombosis in response to both chemical as well as biomechanical platelet activation.
Abstract 11316: Analytical Validation for an Integrated Risk Tool for Cardiovascular Disease Combining Conventional Risk Factors and Polygenic Risk Inferred from Snp Array and Low-Pass Whole Genome Sequencing
Authors: Giner Delgado Carla , Gradovich Eva , Sivley R. Michael , Rehnstrom Karola , Heger Andreas , Tarran William , Lachapelle Alexander , Donnelly Peter , Weale Michael E , McVean Gilean , Seth Priyanka , Plagnol Vincent
Published: March 2022

Genetic risk factors contribute to cardiovascular disease (CVD) risk and are imperfectly captured by family history. The development of integrated risk tools (IRT) that integrate polygenic risk scores (PRS) with conventional risk factors enables improved risk assessment. However, IRTs rely on accurate estimation of the genetic component across millions of genetic variants, either typed or imputed.

To support two real-world implementations of CVD IRTs, we present analytical validation data for three biosample types (whole blood, saliva and buccal swab samples) and two genetic assay technologies (a custom-designed genotyping array (845,608 markers) and low pass whole genome sequencing (lpWGS) with 1.8x average read depth, both combined with computational imputation) across 48 ethnically-diverse donors. IRT measurements (range 4%-23%) were performed on the 10-year CVD risk percentage scale, assuming a non-genetic (pooled cohort equations) risk component of 10%.

We find measurement errors are below 1% across the three biosample types, so that an IRT of 4% will at most be measured as 3% or 5%. Array and lpWGS showed different bias-variance trade offs. The array technology was more reproducible, with a standard deviation on the percentage scale of 0.09 (0.072-0.129 95% CI) for blood samples compared with 0.30 (0.201-0.617 95% CI) for lpWGS. In contrast, the array technology showed somewhat larger bias when compared with high depth sequencing data (mean absolute error on the percentage scale of 0.49 (0.217-0.755 95% CI) for blood samples against 0.30 (0.008-0.597 95% CI) for lpWGS, partially reflecting the sequencing basis of the reference data. Pass rate was high for both technologies and all three biosample types.

In conclusion, both genotyping array and lpWGS approaches were appropriate and performed well for the purpose of assessing the genetic component of integrated cardiovascular disease risk using either blood, saliva or buccal samples.
Abstract 11363: Pericardial Constriction-Like Echocardiographic Findings in Elite Athletes Following Mild Covid-19 Infection: A Propensity Score-Matched Analysis
Authors: Lakatos Balint K , Tokodi Marton , Fabian Alexandra , Ladanyi Zsuzsanna , Vágó Hajnalka , Szabó Liliána , SYDO Nora , Csulak Emese , Kiss Orsolya , Babity Máté , Kiss Anna Reka R , Gregor Zsofia , Szucs Andrea , Merkely Béla , Kovacs Attila
Published: March 2022

Introduction:
The cardiovascular effects of COVID-19 in elite athletes is still a matter of intense scientific debate.

Hypothesis:
We sought to perform a comprehensive echocardiographic characterization of post-COVID athletes by comparing them to a non-COVID athlete cohort.

Methods:
107 elite athletes with COVID-19 were prospectively enrolled (P-CA; 23±6 years, 23% female) 107 healthy athletes were selected as a control group using propensity score matching (N-CA). All athletes underwent 2D and 3D echocardiography. Left (LV) and right ventricular (RV) end-diastolic volumes (EDVi) and ejection fractions (EF) were quantified. To characterize LV longitudinal deformation, 2D global longitudinal strain (GLS) and the ratio of free wall versus septal longitudinal strain (FWLS/SLS) were also measured. To describe septal flattening (SF - frequently seen in P-CA), LV eccentricity index (EI) was calculated.

Results:
P-CA and N-CA athletes had comparable LV and RVEDVi (P-CA vs N-CA; 77±12 vs. 78±13mL/m2; 79±16 vs 80±14mL/m2). P-CA had significantly higher LVEF (58±4 vs 56±4%, p<0.001), while LVGLS values did not differ between P-CA and N-CA (-19.0±1.9 vs -18.8±2.2%). EI was significantly higher in P-CA (1.13±0.16 vs 1.01±0.05, p<0.001), which was attributable to a distinct subgroup of P-CA with a prominent SF (n=35, 33%), further provoked by inspiration. In this subgroup, the EI was markedly higher compared to the rest of the P-CA (1.29±0.15 vs 1.04±0.08, p<0.001), LVEDVi was also significantly higher (80±14 vs 75±11 mL/m2, p<0.001), while RVEDVi did not differ (82±16 vs 78±15mL/m2). Moreover, the FWLS/SLS ratio was significantly lower in the SF subgroup (91.7±8.6 vs 97.3±8.2, p<0.01). P-CA with SF experienced symptoms less frequently (1.4±1.3 vs. 2.1±1.5 symptom during the infection, p=0.01).

Conclusions:
COVID-19 infection might be frequently associated with a constriction-like physiology in elite athletes.
Abstract 11374: Characterization and Prevalence of Ventricular Aneurysms in Patients with Chagas Disease by CMR
Authors: Medina Ramon , Manrique Frida T , Forero Julian F. , Vargas Vergara Diana , Lorena González Russi , Jorge Fajardo , Diaztagle Juan José , Brugada Josep , Olaya Alejandro , Diaz Andrés , Medina Hector M.
Published: March 2022

Introduction:
Ventricular aneurysms (VA′s) are common in patients with Chagas disease (CD). However, its prevalence in this population is not well defined. We aim to determine the prevalence and characteristics of VA′s in CD patients using cardiac magnetic resonance (CMR).

Methods:
We performed CMR in a cohort of CD patients and no history of CAD. We included patients older than 18 years with positive CD serology and analyzed their clinical and CMR variables. VA′s were classified according to their location and the apical ones were subclassified as follows: Microaneurysms (limited to the segment AHA-17), macroaneurysms (with extension to apical segments) and giant aneurysms (with extension to midventricular segments). These findings were noticed during cine and late gadolinium enhancement (LGE) sequences (figure 1).

Results:
A total of 113 patients were included, of whom 57% were women, with a median age of 60 years. VA′s were more common in the apex (96%) vs the infer-lateral wall (4%) with a total prevalence of 23%. Among the 3 VA′s subtypes, macroaneurysm was the most common (48%) followed by microaneurysm (36%) and giant aneurysm (16%). Patients with VA′s had lower LVEF and higher ventricular volumes compared to those without VA′s. LGE was more frequent and had a larger extension in patients with VA′s (Table 1). Ventricular thrombi were identified in 15% of the patients with VA′s.

Conclusions:
In our cohort of CD patients, almost a quarter of the population presented with VA′s during CMR and most of them were located in the apical segments. Of these, macroaneurysm was the most frequent subtype followed by microaneurysm. VA’s are associated with ventricular thrombi in this population.
Abstract 11387: Four-Dimensional Spatiotemporal Characterization of Cardiomyopathy in Duchenne Muscular Dystrophy Using Cardiac Magnetic Resonance Imaging
Authors: Earl Conner C , Pyle Victoria I , Damen Frederick , Markham Larry W , Soslow Jonathan , Goergen Craig J
Published: March 2022

Introduction:
Cardiomyopathy (CM) is the most common cause of mortality in Duchenne muscular dystrophy (DMD). Because CM progression is variable, there is a critical need for biomarkers to detect early onset or rapid progression. Our objective was to evaluate localized kinematic parameters that correlate with function utilizing spatiotemporal analysis of 4D (3D plus time) cardiac magnetic resonance (CMR).
We hypothesized that novel regional strain metrics would correlate with left ventricular ejection fraction (LVEF), providing insight for future DMD CM characterization studies
.

Methods:
Sequential short axis cine CMR images of DMD patients (n=10) with a range of CM severity were compiled into 4D sequences. Epi- and endocardial borders were then segmented across one cardiac cycle for kinematic analysis. We evaluated Green-Lagrange circumferential strain (ε
cc
) at 60 equally spaced short axis slices and across 60 time points to generate a spatiotemporal map. We also evaluated a novel “hybrid strain index” combining basal ε
cc
with posterior free-wall longitudinal strain. Spearman’s rho was used to determine statistical correlation.

Results:
DMD subjects had a median age of 11 years (8-24); 3 had LVEF<55% and 7 had late gadolinium enhancement. Regional peak averages of ε
cc
decreased with LVEF for basal (
rho
=-0.94,
p
<.001) and mid-LV (
rho
=-0.84,
p
=.004) but not at the apex (
rho
=-0.55,
p
=.106). The hybrid strain index also decreased with LVEF (
rho
=0.89,
p
<.001). Qualitative spatiotemporal ε
cc
maps of mild, moderate, and severe DMD cases demonstrate stark differences in regional wall motion (Figure 1).

Conclusion:
4D spatiotemporal analysis of CMR images in DMD patients allows for robust comparison of regional kinematic parameters that correlate with LVEF.

Figure 1:
4D CMR spatiotemporal analysis of DMD cardiomyopathy. A,B) Schematic of circumferential strain (ε
cc
). C,D,E) Example mild, moderate, and severe patient spatiotemporal ε
cc
maps.
Abstract 11418: Fibrosis and Calcium Signaling Regulation Are Critical Mechanisms in a Three-Hit HFpEF Mouse Model
Authors: Li Yijia , Zhang Xiaoying , jin jianguo , Molkentin Jeffery , Houser Steven R , Chen Xiongwen
Published: March 2022

Introduction:
There is a lack of animal models of heart failure with preserved ejection fraction (HFpEF).

Hypothesis:
A mouse model with increased Ca2+ influx receiving a high-fat diet (HFD) and L-NAME (3 hits) could be a model for HFpEF to help reveal the mechanism.

Methods:
Cardiomyocyte (CM) specific, inducible Cavβ2a low expression transgenic (Cavβ2a LE TG) and their control littermate mice were fed with either chow diet (LC and CC), HFD+L-NAME (LHLn, CHLn), or HFD+L-NAME+SAHA (LHLnS, CHLnS) since the age of 4months for 6 months. Echocardiography had been done monthly. Hemodynamic analysis, histological analyses, and Western blotting (WB) had been used to figure out the possible mechanisms after euthanization.

Results:
LHL (3 hits) mice had preserved left ventricular ejection fraction (LVEF) but the highest levels of ANP/BNP and the lowest strain rate. 3-Hit led to obvious diastolic dysfunction indicated by a higher ratio of mitral E wave to mitral annulus e’ velocity (E/e’ ratio), ventricular stiffness index, end-diastolic pressure, and left atrial (LA) dilation rate (90% in LHL mice). LA and LV fibrosis were more severe in the LHL group. Fibrosis-related molecules, including lysyl oxidase, Periostin, transforming growth factor-beta and its downstream transcription factor SMAD2/3 were higher in the LHL group. LHL mice also had lower PLB phosphorylation at Thr17, less SERCA, more NCX, and increased TnI phosphorylation. SAHA treatment could significantly reverse the HFpEF phenotype.

Conclusions:
3-Hit is a model for HFpEF, which can be reversed by SAHA treatment. Fibrosis and altered Ca2+ signaling are critical underlying mechanisms for HFpEF.
Abstract 11453: Beyond Anatomy: Use of Sinus Propagation Mapping to Identify the Slow Pathway for Cryoablation in Pediatric Patients
Authors: Fogarty William M , Kamp Anna , Kertesz Naomi J , Kumthekar Rohan
Published: March 2022

Introduction:
Slow pathway (SP) modification via cryoablation is a common treatment of atrioventricular nodal reentrant tachycardia (AVNRT) in pediatric patients. Traditionally, SP modification was achieved by anatomical landmarks, ideal electrogram characteristics, or low voltage bridge mapping. Recently, sinus propagation mapping (SPM) is a tool that has been used to augment identification of the SP. We hypothesize that the use of SPM will decrease the total number of ablations performed and decrease the number of ablations until the SP was successfully modified without a significant increase in procedure time.

Methods:
We conducted a retrospective review of patients who underwent cryoablation for AVNRT from August 2016 through March 2021. There were no other technological or procedural changes during the study period besides the addition of SPM. We excluded patients greater than 21 years of age, the use of radiofrequency ablation, prior AVNRT ablation, additional pathways or arrhythmias, and those with congenital heart disease. Patients were divided into two groups: those who did and did not undergo SPM. Mann-Whitney U tests were utilized to compare significance between the two groups.

Results:
Out of 122 patients identified by IMPACT database query, 103 met inclusion criteria. Fifty-two patients (50.5%) had SPM completed during their procedures. Age, weight, and BSA were not statistically different between the groups. Ablation was acutely successful in all but two patients, both in the non-SPM group. The median number of ablations needed until successful SP modification was 2 in patients who underwent SPM, and 4 in the non-SPM group (p = 0.03). There was no significant difference between total number of ablations between groups. The median total procedural time was longer in the SPM group (152 vs 125 min, p = 0.01). There was no difference in clinical recurrence or complications between the two groups.

Conclusions:
Sinus propagation mapping can be utilized to further improve the successful treatment of AVNRT with cryotherapy by lowering the number of ablations needed until successful SP modification. However, the technique requires some additional time to collect sufficient data points to create the sinus map.
Abstract 11474: Ti
3
C
2
T
x
MXene Nanosheets for Immunomodulation and Prevention of Allograft Vasculopathy
Authors: Yan Weiang , Rafieerad Alireza , Alagarsamy Keshav Narayan , Srivastava Abhay , Arora Rakesh C , Dhingra Sanjiv
Published: March 2022

Allograft vasculopathy is an aggressive form of accelerated atherosclerosis that manifests uniquely in transplanted hearts, lungs and kidneys. Activated blood vessel endothelial cells (ECs) stimulate alloreactive CD4
+
and CD8
+
T-lymphocytes to result in sustained inflammation. MXenes, an emerging class of transition metal carbides, have recently been shown to have unique immunomodulatory properties that may be leveraged to treat allograft vasculopathy. In this study, we present the synthesis, characterization and application of novel two-dimensional titanium carbide MXene (Ti
3
C
2
T
x
) nanosheets for immunomodulation. MXene nanosheets (MNSs) were selectively etched from bulky Ti
3
AlC
2
MAX phase using hydrofluoric acid. The resultant MNSs are 2 to 5 μm in size and are surface modified with carboxyl, hydroxyl and amine functional groups for biological interactions. Using an
in vitro
co-culture system, we found that MNSs interact with activated human ECs to reduce activation and pro-inflammatory Th1 polarization of allogeneic CD4
+
lymphocytes. Mechanistically, we showed that treatment with MNSs significantly decreased expression of the co-stimulatory molecule CD86 and altered the ratio of endothelial surface co-stimulatory to co-inhibitory molecules. Furthermore, when applied in an
in vivo
rat model of allograft vasculopathy, treatment with MNSs reduced lymphocyte infiltration and preserved medial smooth muscle cell integrity within transplanted vessel segments. Taken together, these findings suggest that these novel MNSs have potential as an effective treatment to prevent allograft vasculopathy.
Abstract 11478: Epicardial Adipose Tissue Volume - Relationship with Coronary Artery Plaque Vulnerability and Myocardial Ischemia in Non-Obstructive Coronary Artery Disease
Authors: Khan Ingela , Eskerud Ingeborg , Larsen Terje H , Berge Caroline , Pedersen Eva R , Lønnebakken Mai Tone
Published: March 2022

Introduction:
Myocardial ischemia is common among patients with chest pain and non-obstructive coronary artery disease (CAD). Epicardial adipose tissue (EAT) accumulation has been associated with inflammation, atherosclerosis and microvascular dysfunction. Accordingly, we hypothesised that EAT volume is associated with coronary plaque vulnerability and myocardial ischemia in patients with non-obstructive CAD.

Methods:
We included 125 patients with chest pain and non-obstructive CAD by coronary computed tomography angiography (CCTA). EAT volume was quantified on non-contrast cardiac computed tomography images by a semiautomatic analysis software. CCTA images were analysed with respect to plaque volume and composition. Plaque vulnerability was assessed as total coronary non-calcified plaque volume and positive remodelling index >1.10. Myocardial ischemia was detected by contrast dobutamine stress echocardiography. Patients were grouped in tertiles of EAT volume and high EAT volume was defined as volumes in the highest tertile (≥125 ml).

Results:
In the total study population (median age 63(58, 69) years and 58% women), the median EAT volume was 104 (77, 141) ml. High EAT volume was more common in men and associated with higher BMI, hypertension and positive remodelling (all p<0.05). There was no difference in age, prevalence of diabetes, total non-calcified plaque volume or presence of myocardial ischemia between groups (all p≥0.34). This was confirmed in univariable logistic regression analyses (Table). After adjusting for covariables in a multivariable model, the association between positive remodelling and high EAT volume was attenuated (Table).

Conclusion:
High EAT volume was associated with positive remodelling, but not with total non-calcified plaque volume or myocardial ischemia, and the association was attenuated after multivariable adjustments.
Abstract 11482: A Neural Network-Based Model Detects Low Ejection Fraction from Electrocardiograms Without Overt Rhythm or Conduction-System Abnormalities
Authors: Yagi Ryuichiro , Goto Shinichi , Macrae Calum , Deo Rahul C
Published: March 2022

Introduction:
While detection of asymptomatic left ventricular dysfunction (LVD) is important given the effectiveness of preventive medical treatments, the gold standard method using echocardiograms requires trained experts and thus is less suitable for widespread screening. Previous studies have found that convolutional neural network (CNN) models could detect patients with LVD from 12-lead electrocardiogram (ECG). However, they were developed in an unselected population which included an unknown number of patients with overt rhythm and conduction system abnormalities, which frequently coexist with LVD. It is unclear to what extent these models relied on such obvious features to detect LVD from ECGs. Herein, we aimed to assess the ability of a CNN-based model to detect LVD using ECGs having no apparent rhythm or conduction abnormalities.

Methods:
56,985 ECGs with an echocardiogram within a 2-week interval were identified from the BWH ECG database. The dataset was split into 28,465, 11,306 and 17,214 ECGs for derivation, validation and test, respectively, with no overlap of patients across groups. A CNN model was trained as a binary classifier to detect LVD, defined as LV ejection fraction < 35 %. The final model was selected as that with the best area under the receiver operating characteristics curve (AUROC) on the validation set and performance assessed on the test set. The model was further tested after excluding ECGs with overt rhythm and conduction system abnormalities defined as the presence of atrial fibrillation, premature atrial complexes, premature ventricular complexes, electronically paced rhythms, left or right bundle branch block.

Results:
The mean patient age in the test set was 69.8 years, and 57.3% of patients were male. prevalence of low LVEF was 9.7%. The test dataset contained 7,633 ECGs with overt rhythm and conduction system abnormalities. The model yielded good accuracy with an AUROC of 0.91 (95% CI:0.90-0.91) to identify patients with LVD in the test data set. The model performed similarly in the presence or absence of rhythm or conduction-system abnormalities (AUROC 0.90 95% CI:0.89-0.92 and 0.89 95% CI:0.88-0.90 respectively).

Conclusion:
The model detected low LVEF from ECG without overt rhythm and conduction system abnormalities.
Abstract 11497: Echocardiographic Features of Severe Mitral Stenosis in Three Different Etiologies
Authors: Kagawa Shunsuke , Taku Omori , Uno Goki , Rader Florian , Siegel Robert J , Shiota Takahiro
Published: March 2022

Background:
In our Heart Center, the cause of mitral stenosis (MS) is usually classified into 3 different categories/etiologies, namely, rheumatic disease, degenerative disease with annular or leaflet calcification, and MS as a consequence of a transcatheter mitral repair with clips for mitral regurgitation. However, differences in the morphology and echocardiographic evaluation among the three etiologies have not been fully elucidated. The aim of this study is therefore to investigate differences in echocardiographic features of these three etiologies of MS.

Method:
We retrospectively studied 157 patients who underwent three-dimensional transesophageal echocardiography (3D TEE) at Cedars-Sinai Medical Center between January 2012 and December 2020, and had severe mitral stenosis defined as 3D TEE derived mitral valve orifice area (MVA) of ≤ 1.0 cm
2
.These patients also had a mean transmitral pressure gradient of ≥ 5 mmHg on transthoracic echocardiography which was performed within 6 months before and after TEE. Other clinical and echocardiographic characteristics were obtained from medical records.

Result:
Of 157 patients, 37 patients had rheumatic MS, 60 patients had degenerative calcific MS and 60 patients had post-clip MS. There was no significant difference among the three groups in 3D TEE derived MVA (Table). Despite comparable 3D derived MVA, patients with post-clip MS had significantly lower mean transmitral pressure gradient than those with other 2 types of MS. Patients with rheumatic MS had larger indexed left atrial volume than patients with other 2 types of MS. Patients with degenerative calcific MS and those with post-clip MS had larger MVA both by pressure half time and by continuity equation than patients with rheumatic MS.

Conclusion:
There were distinct differences in echocardiographic features among the three MS etiologies. The optimal evaluation method and multi-parameter determined grading of MS severity may differ depending on the etiology.
Abstract 11543: Assessing Reporting of Low-Gradient Severe Aortic Stenosis Based on Race and Ethnicity: Observations from a Large Academic Health System
Authors: Shah Nimish N , Sugeng Lissa , Wang Kangxin , McNamara Robert L , Agarwal Vratika , Hur David , Lombo Bernardo , Bellumkonda Lavanya , Forrest John K , Krumholz Harlan M , Velazquez Eric J , Faridi Kamil
Published: March 2022

Introduction:
Though low-gradient (LG) aortic stenosis (AS) is common and frequently reported as non-severe on transthoracic echocardiogram (TTE) in real world practice, the association of race and ethnicity with LG AS type and reported severity is not well understood.

Methods:
We identified all adults ≥ 18 years old from 9/2015-11/2019 with AS, aortic valve area < 1.0cm
2
, and mean gradient <40mmHg on TTE within a large academic health system. We determined frequency of LG AS type (classical low-flow LG [CLFLG], paradoxical low-flow LG [PLFLG], and normal-flow LG [NFLG]) by race and ethnicity. We assessed whether race and ethnicity were associated with reporting severe-range AS on TTE using multivariable logistic regression accounting for age, sex, body mass index, mean gradient, aortic valve area, AS type, and quaternary vs. non-quaternary TTE site.

Results:
Among 2740 adults with LG AS, 92.4% were white, 4.3% were black, and 3.7% were Hispanic. PLFLG AS was the most common LG AS type among white and black patients and the least common among Hispanic patients (Figure). Among those with PLFLG AS, black patients had the highest proportion of TTEs reported as severe-range AS, while Hispanic patients had the lowest; there were no differences in reporting for CLFLG or NFLG AS (Figure). After multivariable adjustment, there were no significant differences in reporting severe-range AS based on black race (adjusted OR 1.63, 95% CI 0.95-2.82) or Hispanic ethnicity (adjusted OR 1.05, 95% 0.39-2.75) compared to white patients. Quaternary site was a strong independent predictor of reporting severe-range AS (adjusted OR 4.97, 95% CI 3.81-6.54).

Conclusions:
There are race- and ethnicity-based differences in frequency of LG AS type, and in reporting severe AS on TTE for PLFLG AS in particular. Differences in reporting for PLFLG AS are attenuated after accounting for factors such as TTE site. Additional factors influencing reporting of LG AS in real-world practice should be investigated.
Abstract 11548: The Strongest Sex Difference in Myocarditis Prevalence Occured in Young Adult Patients - A Descriptive, Multi-Center Cohort Study in 7,031 Patients Over 22 Years
Authors: Thevathasan Tharusan , Kenny Megan A , Schreiber Fabian , Fairweather DeLisa , Cooper Leslie T , Last Jana , Krause Finn Jasper J , Paul Julia , Poller Wolfgang C , Skurk Carsten , Landmesser Ulf , Balzer Felix , Heidecker Bettina
Published: March 2022

Introduction:
Studying the clinical nature of myocarditis on a broad scale across age and sex groups is required to investigate risk factors and patterns of disease. This study aimed to examine patient- and hospital-centered characteristics of patients being hospitalized for myocarditis.

Hypothesis:
Sex differences in myocarditis prevalence are dependent on age.

Methods and Results:
We included all patients being hospitalized in three tertiary care centers between 1999 and 2021 with a diagnosis of acute or chronic myocarditis. We utilized Chi-square, T-test, Fisher exact or Wilcoxon-Mann-Whitney U tests. 7,031 patients with acute or chronic myocarditis were included in total. 231 (3.3%) were of pre-pubescent age (<13 years if male, <11 years if female), 410 (5.8%) were adolescent patients (<18 years), 2,089 (29.7%) young adults (18-35 years), 2,535 (36.1%) middle-aged adults (35-54 years) and 1,766 (25.1%) patients were over 54 years (post-menopausal age). The diagnosis of myocarditis was confirmed by endomyocardial biopsy in 1,337 patients (19%), while it was based on clinical parameters and/or magnetic resonance imaging in the remaining patients. Adolescent patients had the highest levels of procalcitonin (6.98 ±44.6 μg/l), troponin T (450 ±1,550 ng/l) and creatine kinase (360 ±677U/l), while pre-pubescent patients had the highest levels of anti-streptolysin antibody (320 ±470 kU/l) and NT-proBNP (14,000 ±20,800ng/l) compared to all other age groups. Left-ventricular ejection fraction decreased over age groups from 60 ±4% in adolescent patients to 44.0 ±16% in senior patients. The strongest sex difference in myocarditis frequency was observed in young (608 female vs. 1,481 male; P<0.001) and middle-aged adults (1,025 female vs. 1,510 male; P<0.001) (see Figure 1).

Conclusion:
Strong sex differences in myocarditis prevalence were particularly observed in young and middle-aged patients. Sex hormones may determine the risk of developing myocarditis.
Abstract 11565: Revascularization Prior to Renal Transplantation is Not Superior to Medical Therapy Alone in Reducing Mortality in Patients with Coronary Artery Disease
Authors: Siddiqui Muhammad U , Junarta Joey , Marhefka Gregary D
Published: March 2022

Introduction:
Coronary artery disease (CAD) is a common cause of mortality in end stage renal disease and is highly prevalent in patients with chronic kidney disease. Therefore, patients with end stage renal disease are routinely screened for heart disease prior to renal transplant. The role of revascularization remains unclear in this process.

Hypothesis:
There is no difference in all-cause and cardiovascular (CV) mortality in renal transplant patients with coronary artery disease who underwent revascularization prior to transplant when compared to those who were treated with optimum medical therapy (OMT).

Methods:
Medline, Scopus and Cochrane Central Register of Controlled Trials were systematically searched to identify relevant studies. Primary outcomes of interest were all-cause mortality, CV mortality and major adverse cardiovascular events (MACE).

Results:
We included six studies for this metanalysis. There was no significant difference in all-cause mortality (RR 1.16; 95% CI 0.63 - 2.12), CV mortality (RR 0.71; 95% CI 0.24 - 2.09) or MACE (RR 0.78; 95% CI 0.30 - 2.07) in renal transplant patients with CAD who underwent revascularization prior to renal transplant compared to those who were on OMT alone for CAD.

Conclusions:
Studies suggest that revascularization is not superior to OMT for CAD in patients undergoing renal transplant therapy.
Abstract 11670: Psychological Distress and Health Status Perception in Patients With a Previous Myocardial Infarction or Stroke
Authors: Narendrula Aparna , Ajani Kiran , Lang Jacob , Brinza Ellen , Longenecker Chris
Published: March 2022

Introduction:
While understanding the impact of mental health on health status perception improves patient-centered care, this relationship is not well-established in cardiac patients. We examined the association between psychological distress and health status perception in patients with a previous myocardial infarction (MI) and/or stroke.

Methods:
We extracted data for patients with a previous MI and/or stroke from the 2019 National Health Interview Survey (NHIS). Health perception was self-reported and grouped as poor/fair (0) or good/very good/excellent (1). Anxiety and depression were estimated using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-8 (PHQ-8) and grouped based on severity. Multivariable logistic regressions controlling for sex, age, education level, smoking status, race, and BMI were performed to assess our hypothesis that higher GAD-7 and PHQ-8 scores are associated with worse health perception in patients with a previous MI/stroke.

Results:
Of 31,948 individuals for whom data on MI/stroke was available, 6.8% (n=2,181) reported a previous MI and/or stroke. Of these patients, 36.6% (n=799) had scores consistent with anxiety and/or depression on the GAD-7 or PHQ-8. The odds of reporting good/very good/excellent health status were lower for individuals with anxiety (OR 0.245, 95% CI = 0.192-0.314,
P
<0.001) or depression (OR 0.243, 95% CI = 0.197-0.298,
P
<0.001) compared to those without anxiety/depression. Increasing severity of anxiety/depression was also associated with worse perception of health status (
Table 1
). Respondents identifying as “Black” or “Other” race and those with lower education levels also demonstrated significantly worse perceived health status.

Conclusion:
Patients with previous MI/stroke and concomitant psychological distress have worse perception of health status. Understanding the range of patient health perceptions can help physicians provide more patient-centered care.
Abstract 11718: Prevalence and Trends of Overweight and Obesity Among United States Veterans From 2002 to 2016
Authors: Imran Tasnim F , Ho Yuk-lam , Qavi Ahmed H , Gagnon David , Odonnell Christopher J , Cho Kelly , Wilson Peter , Gaziano Michael , Djousse Luc
Published: March 2022

Objective:
To present the age adjusted prevalence of obesity in men and women veterans by race and geographic region, and to examine the trends in body mass index over 14 years.

Methods:
We studied a random sample of one million adults from 2002 to 2016 who had height and weight measured at outpatient visits in the national Veterans Health Administration (VHA) electronic medical record system. We excluded those with prevalent cancer, gastric bypass procedures, and extremity amputations. We calculated the sex-specific and age adjusted prevalence of body mass index (obese >30 kg/m
2
) categories by self-reported race, and geographical region.

Results:
From a total of 791,392 men, and 50,928 women, average age was 68 years for men and 52 years for women in 2016. Mean BMI was 30 ± 6 kg/m
2
for men and 30 ± 7 kg/m
2
for women. In all, 13% (n=97,861) men and 25% (n=12,510) women were Black, 77% (n=573,232) men and 59% (n=29,538) women were White, 0.9% (n=6,479 ) men and 1.2% (n=613) women were Asian, 0.7% (n=5,202) men and 0.9% (n=473) women were Native Hawaiian/Pacific Islander, and 0.7% (n=4,490) men and 1% (n=510) women were American Indian. Over the 14-year period from 2002 to 2016, all racial groups were found to have a steady increase in prevalence of obesity except for Asians (Fig 1). Asian men and women had the lowest prevalence of obesity and morbid obesity (20% and 2% for men, 11% and 1% for women). Hawaiian or Pacific Islander and American Indian men and women had the highest increase in prevalence of morbid obesity comparing 2002 to 2016. Men and women in the Midwest had the highest prevalence of obesity and morbid obesity (32%, 6% for men and 31% and 8% for women). Women in the Northeast were found to have a decline in the prevalence of morbid obesity from 2002 to 2016.

Conclusions:
The prevalence of overweight and obesity has steadily increased in adult men and women veterans from 2002 to 2016 overall. However, there are differences across racial groups and geographic regions.
Abstract 11876: Instantaneous Wave-Free Ratio and Fractional Flow Reserve Are Helpful in the Assessment of Anomalous Aortic Origin of a Coronary Artery
Authors: Doan Tam T , Qureshi Athar M , Gowda Srinath , Sachdeva Shagun , Reaves-O'Neal Dana L , Molossi Silvana M
Published: March 2022

Background:
Anomalous aortic origin of a coronary artery (AAOCA) is the second most common cause of sudden cardiac death in youth during exertion. An optimal method to risk stratify patients with AAOCA and atypical symptoms is yet to be defined.

Hypothesis:
Invasive intracoronary hemodynamic flow measurement can be helpful in scenarios when there is conflict between clinical presentation and non-invasive studies.

Methods:
Case series of patients <21 years old with AAOCA who underwent cardiac catheterization with instantaneous wave-free ratio (iFR)/fractional flow reserve (FFR) measurement at baseline and during adenosine and dobutamine infusion. Baseline iFR
<
0.89 and/or FFR <0.8 were considered hemodynamically significant. All patients underwent dobutamine stress cardiac MRI to evaluate for inducible myocardial ischemia during provocative stress. Post-op assessment was described in patients who underwent surgical intervention.

Results:
A total of 8 patients, including 3 AAOCA of a left (AAOLCA) and 5 AAOCA of a right coronary artery (AAORCA) underwent cardiac catheterization including iFR and FFR measurement [Table]. iFR and FFR were reassuring in 4 patients, and suggestive of significantly impaired coronary flow in 2 AAOLCA and 2 AAORCA. There were no catheterization complications. Shared decision making was discussed, 2 patients with AAOLCA underwent successful surgical repair (patient 4 had normalized iFR/FFR after surgery and patient 8 is awaiting post-op assessment), and 2 are awaiting surgical scheduling. Patients not intervened upon are exercising with no restrictions, except one with concerns for cardiomyopathy.

Conclusions:
Invasive assessment using iFR/FFR with adenosine and dobutamine is helpful in shared decision making of AAOCA with conflicting noninvasive data and contribute to return to play after surgery. Long-term follow-up is essential to understand the predictive values of iFR/FFR in patients with AAOCA.
Accuracy of Cardiovascular Trial Outcome Ascertainment and Treatment Effect Estimates from Routine Health Data: A Systematic Review and Meta-Analysis
Authors: Rodrigues Craig , Odutayo Ayodele , Patel Sagar , Agarwal Arnav , da Costa Bruno Roza , Lin Ethan , Yeh Robert W. , Jüni Peter , Goodman Shaun G. , Farkouh Michael E. , Udell Jacob A.
Published: March 2022

Background:

Registry-based randomized controlled trials allow for outcome ascertainment using routine health data (RHD). While this method provides a potential solution to the rising cost and complexity of clinical trials, comparative analyses of outcome ascertainment by clinical end point committee (CEC) adjudication compared with RHD sources are sparse. Among cardiovascular trials, we set out to systematically compare the incidence of cardiovascular events and estimated randomized treatment effects ascertained from RHD versus traditional clinical evaluation and adjudication.

Methods:

We searched MEDLINE (1976 to August 2020) for studies where outcome ascertainment was performed by both RHD and CEC adjudication to compare the incidence of cardiovascular events and treatment effects. We derived ratios of hazard ratios to compare treatment effects from RHD and CEC adjudication. We pooled ratios of hazard ratios using an inverse variance random-effects meta-analysis.

Results:

Nine studies (1988–2020; 32 156 patients) involving 10 randomized control trials compared outcome ascertainment with RHD and CEC in patients with or at risk of cardiovascular disease. There was a high degree of agreement and interrater reliability between CEC and RHD outcome determination for all-cause mortality (agreement percentage: 98.4%–100% and κ: 0.95–1.0) and cardiovascular mortality (agreement percentage: 97.8%–99.9% and κ: 0.66–0.99). For myocardial infarction, the κ values ranged from 0.67–0.98, and for stroke the values ranged from 0.52–0.89. In contrast, the κ value for peripheral artery disease was low (κ: 0.27). There was little difference in the randomized treatment effect derived from CEC and RHD ascertainment of events based on the ratios of hazard ratio, with pooled ratios of hazard ratios ranging from 0.93 (95% CI, 0.63–1.39) for cardiovascular mortality to 1.27 (95% CI, 0.67–2.41) for stroke.

Conclusions:

Clinical outcome ascertainment using retrospectively acquired RHD displayed high levels of agreement with CEC adjudication for identifying all-cause mortality and cardiovascular outcomes. Importantly, cardiovascular treatment effects in randomized control trials determined from RHD and CEC resulted in similar point estimates. Overall, our review supports the use of RHD as a potential alternative source for clinical outcome ascertainment in cardiovascular trials. Validation studies with prospectively planned linkage are warranted.
Increased Susceptibility of Mice Lacking Renin-b to Angiotensin II–Induced Organ Damage
Authors: Nakagawa Pablo , Nair Anand R. , Agbor Larry N. , Gomez Javier , Wu Jing , Zhang Shao Yang , Lu Ko-Ting , Morgan Donald A. , Rahmouni Kamal , Grobe Justin L. , Sigmund Curt D.
Published: March 2022

Several cardiac and renal diseases are attributed to a dysregulation of the renin-angiotensin system. Renin, the rate-limiting enzyme of the renin-angiotensin system, has 2 isoforms. The classical renin isoform (renin-a) encoding preprorenin is mainly confined to the juxtaglomerular cells and released into the circulation upon stimulation. Alternatively, renin-b is predicted to remain intracellular and is expressed in the brain, heart, and adrenal gland. In the brain, ablation of renin-b (Ren-b
Null
mice) results in increased brain renin-angiotensin system activity. However, the consequences of renin-b ablation in tissues outside the brain remain unknown. Therefore, we hypothesized that renin-b protects from hypertensive cardiac and renal end-organ damage in mice. Ren-b
Null
mice exhibited normal blood pressure at baseline. Thus, we induced hypertension by using a slow pressor dose of Ang II (angiotensin II). Ang II increased blood pressure in both wild type and Ren-b
Null
to the same degree. Although the blood pressure between Ren-b
Null
and wild-type mice was elevated equally, 4-week infusion of Ang II resulted in exacerbated cardiac remodeling in Ren-b
Null
mice compared with wild type. Ren-b
Null
mice also exhibited a modest increase in renal glomerular matrix deposition, elevated plasma aldosterone, and a modestly enhanced dipsogenic response to Ang II. Interestingly, ablation of renin-b strongly suppressed plasma renin, but renal cortical renin mRNA was preserved. Altogether, these data indicate that renin-b might play a protective role in the heart, and thus renin-b could be a potential target to treat hypertensive heart disease.
İŞ TATMİNİ İLE ÖRGÜTSEL BAĞLILIK ARASINDAKİ İLİŞKİNİN ANALİZİ: BİR OTOMOTİV FİRMASINDA ALAN ARAŞTIRMASI
Authors: KURKUT Muammer , KAYACAN Emir
Published: March 2022

Bu çalışma; otomotiv sektöründeki bir firma kapsamında yapılan araştırmayla iş tatmini ile örgütsel bağlılık arasındaki ilişkinin belirlenmesini amaçlamaktadır. Bu araştırma, bahsi geçen ilişkiyi otomotiv sektörü kapsamında inceleyerek literatüre katkı sağlamaktadır.
Araştırmada Türkiye’de otomotiv sektöründe faaliyet gösteren bir firmada istihdam edilen 85 kişinin e-posta yoluyla davet edilerek katıldığı anketler değerlendirilmiştir. Anketin oluşturulmasında iş tatmininin ölçülmesi için “Minnesota İş Tatmini Ölçeği”, örgütsel bağlılığın ölçülmesi için ise Allen ve Mayer’in geliştirdiği ‘’Çoklu Örgütsel Bağlılık Ölçeği” kullanılmıştır. Araştırmadan elde edilen verilerin SPSS paket programı aracılığıyla analizi yapılmış ve ulaşılan sonuçlar literatürdeki çalışmalarla karşılaştırılarak yorumlanmıştır.
Araştırmanın sonucunda, iş tatmini ile örgütsel bağlılık arasında anlamlı bir ilişki olduğu sonucuna ulaşılmıştır. Ayrıca örgütsel bağlılığın alt boyutlarını oluşturan devam bağlılığı, duygusal bağlılık ve normatif bağlılığın da iş tatmini ile anlamlı bir ilişkiye sahip olduğu tespit edilmiştir. Bunun yanı sıra, iş tatmininin alt boyutları olan içsel iş tatmini ve dışsal tatmin ile örgütsel bağlılık arasında da pozitif yönlü bir ilişki olduğu gözlemlenmiştir.
THE ROLE OF WORD-OF-MOUTH COMMUNICATION IN THE FORMATION OF CYNICAL ATTITUDES TOWARDS PRIVATE HEALTH CARE ORGANIZATIONS
Authors: AYDIN Gülnil
Published: March 2022

The aim of this study is to explain the role of negative and positive word-of-mouth communication in consumers' development of cynical attitude towards private health care organizations, and to understand how this role can be shaped, especially when the risk factor comes into play. The role of negative and positive word-of-mouth communication on consumers' purchasing behavior has been the subject of various studies. Previous literature indicates that negative word-of-mouth communication is taken into account more strongly by cynical consumers, while other studies emphasize the importance of recommendations and positive word-of-mouth communication in customers' purchase behavior. Analysis of the data collected from 362 participants in this study shows that, in regards to customers' cynical attitudes, the rate at which positive information abates cynicism is higher than the rate at which negative information reinforces cynicism. As a result of this study, suggestions were made for practitioners and new studies in light of these findings.