bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13641: Serum Vitamin D3 Levels, Left Ventricular Structure and Incident Hospitalization for Heart Failure With Preserved Ejection Fraction in African Americans: The Jackson Heart Study
Authors: Kamimura Daisuke , Shah Amil M , Oshunbade Adebamike , Hamid Arsalan , Mentz Robert , Suzuki Takeki , Musani Solomon K , Fox Ervin R , Correa Adolfo , Butler Javed , Hall Michael E
Published: November 2020

Background:
Lower serum vitamin D3 (VitD3) concentration has been associated with cardiovascular disease. However, the associations between serum VitD3 levels and left ventricular (LV) structure and function and heart failure with preserved ejection fraction (HFpEF) have not been well-characterized community. The prevalence of VitD3 deficiency is higher among African Americans than in other race/ethnicity groups. We hypothesized that serum VitD3 levels are associated with LV concentric remodeling and incident heart failure (HF) in African Americans.

Methods and Results:
Among 4872 African Americans in the Jackson Heart Study cohort, we investigated the relationships between serum VitD3 levels and LV structure and function, evaluated with echocardiography, and incident HF hospitalization, categorized either HF with reduced EF (HFrEF: EF<50%) or HFpEF (EF≥50%). The median and interquartile serum VitD3 levels were 12.0 (8.6-16.7) ng/mL. After adjustment for age, sex, body mass index, systolic blood pressure, anti-hypertensive medication use, current smoking status, and estimated glomerular filtration rate, lower VitD3 levels were associated with greater septal and posterior wall thickness and plasma brain natriuretic peptide (BNP) levels, but not with LV mass index or LVEF (Table). Over a median follow-up period of 11 (10.3~11) years, 313 participants developed incident HF (7.79 cases per 1,000 person-years), including 128 (41%) HFrEF and 185 (59%) HFpEF cases. After adjustment, lower serum VitD3 levels were associated with higher incidence of HF overall and levels seemed to be mostly related to HFpEF (Table).

Conclusion:
In this community-based African American cohort, lower serum VitD3 levels were associated with LV concentric remodeling and incident HF, mainly HFpEF. Further investigation is required to examine whether the supplementation of VitD3 can prevent LV concentric remodeling and incident HFpEF in African Americans.
Abstract 13682: Single Nucleotide Polymorphisms in the Ddah1 Gene Are Associated With Delayed Cerebral Ischemia in Patients With Subarachnoid Hemorrhage
Authors: Hannemann Juliane , Appel Daniel , Seeberger-Steinmeister Miriam , Brüning Tabea , Zummack Julia , Boeger Rainer
Published: November 2020

Introduction:
Delayed cerebral ischemia (DCI) is a major cause of lethality and poor long-term neurological outcome in patients with subarachnoid hemorrhage (SAH). Asymmetric (ADMA) and symmetric dimethylarginine (SDMA) are regulators of vascular NO synthesis from L-arginine. We previously reported that elevated concentrations of both, ADMA and SDMA at ICU admission are associated with the incidence of DCI during follow-up. Dimethylarginines (DMAs) are synthesized by PRMT enzymes; ADMA is metabolized by DDAH1 and DDAH2, whilst SDMA is metabolized by AGXT2.

Hypothesis:
We hypothesized that common genetic variants in genes encoding the core enzymes of DMA metabolism may predispose individuals for the development of DCI after SAH.

Methods:
We measured L-arginine, ADMA and SDMA in plasma and cerebrospinal fluid (CSF) of 51 SAH patients at ICU admission and followed them for clinical status and neurological outcome until 30 days post-discharge. Single nucleotide polymorphisms (SNPs) in the NOS3, DDAH1, DDAH2, PRMT1, and AGXT2 genes were analyzed by PCR, and genotypes were related to biomarker levels and outcome. The primary outcome was the incidence of DCI, which was defined as the appearance of new infarctions on cranial computed tomography or magnetic resonance imaging.

Results:
18 out of 51 SAH patients developed DCI. DCI patients did not significantly differ from those without DCI in clinical scores. However, patients who developed DCI had higher plasma ADMA and SDMA levels and higher SDMA levels in CSF at admission. DDAH1 gene variation was associated with plasma ADMA (p=0.02), whilst AGXT2 gene variation was associated with plasma SDMA (p=0.02). There was a strong association of all three DDAH1 SNPs that we analyzed with DCI, with carriers of the minor allele of DDAH1 rs233112 having a significantly increased relative risk of developing DCI (RR=2.61 (1.25-5.43), p=0.002).

Conclusions:
Sequence variation in the DDAH1 gene is associated with the incidence of DCI in SAH patients, suggesting that SNPs in the DDAH1 gene, which regulates plasma ADMA concentration, significantly influences the risk of cerebral ischemia after subarachnoid hemorrhage.
Abstract 13691: Factors Affecting Extubation Time Post-Cardiac Surgery
Authors: Nguyen Quynh , Coghlan Kevin , Hong Yongzhe , Nagendran Jeevan , MacArthur Roderick , Lam Wing
Published: November 2020

Introduction:
Early extubation, defined as extubation within 6 hours post-operation, was found to be safe and associated with decreased complications and costs. Recent enhanced recovery after surgery guidelines recommend early extubation for cardiac surgery patients. This retrospective study aimed to assess our institution’s extubation strategy and identify predictive factors of early extubation in our cardiac surgery patients.

Methods:
Our study included 13,807 adult patients who underwent cardiothoracic surgery from 2010-2019 at our institution. Forward stepwise multivariable logistic regression analysis was used on patients with complete data (n=10,783) to identify predictors of early extubation.

Results:
Of the 10,783 patients, 3740 (35%) were extubated within 6 hours post-operation. Early extubated patients were younger, had higher BMI and more likely to be fast track designated. These patients more frequently underwent isolated coronary artery bypass graft (CABG), isolated valve or adult congenital surgery than late extubated patients. Early extubated patients had higher incidence of coronary artery disease (CAD) and anxiety, and were less likely to have difficult intubation or require circulatory support post-surgery. Analysis of 10,783 patients showed BMI >30 (OR=1.840, 95% CI=1.624-2.083), fast track designation (OR=1.338, 95% CI=1.12-1.598) and having CAD (OR=1.107, 95% CI=1.007-1.217) to be predictive of early extubation. Data on patient transfer to the ICU were only available from 2014-2018. Within this sub-group of 7296 patients, variables predictive of early extubation included BMI >30 (OR=1.364, 95% CI=1.195-1.557), dayshift transfer to the ICU (OR=1.680, 95% CI=1.516-1.862), fast track designation (OR=1.397, 95% CI=1.115-1.751) and having isolated procedures such as CABG (OR=1.630, 95% CI=1.413-1.880) and valve surgery (OR=1.506, 95% CI=1.300-1.745).

Conclusions:
BMI >30, having fast track designation, and having CAD are associated with early extubation. When taking into account patient transfer to the ICU, BMI >30, having fast track designation, dayshift transfer to the ICU, and having isolated procedures such as CABG and valve surgery are associated with early extubation.
Abstract 13698: Prospective Comparison of Lipid Responses in Plant-based, Mediterranean, Paleolithic an Dash Diets
Authors: Talreja Sophie , Talreja Deepak
Published: November 2020

Introduction:
Cardiovascular disease (CVD) is the leading cause of death in the United States for middle-aged men and women despite the fact that prevention and control of CVD is achievable by modifying risk factors through lifestyle changes and diet therapy. We examined the impact of four diet programs (plant-based (Vegan), Mediterranean, Paleolithic (Paleo) and DASH diets) on the CV risk factor profile of adults in the Hampton Roads area of Virginia.

Hypothesis:
Among the Diets studies, there will be a variable response with regards to impact on lipids.

Methods:
Nondiabetic adults (ages 35-85) with one or more risk factors for CVD were invited to participate in 1 of the 4 diet arms. Participants underwent a comprehensive nutrition education program prior to a 60-day diet intervention in which they kept a daily food log and met weekly with a multi-disciplinary study team. An initial health screen was performed to assess weight, blood pressure (BP), fasting glucose (FPG), A1C, lipids and lipoprotein particles, and repeated after 60 days on the diet and at 6-months follow-up.

Results:
279 subjects completed the 60-day dietary intervention (58 Vegan, 80 Mediterranean, 76 Paleo, 65 DASH), and 199 returned for 6-month follow-up. At baseline, mean FPG, TG and HDL-C were within the normal range, whereas LDL-P and BP were elevated. After 60 days on the respective diets, subjects lost an average of 9 lbs which was associated with improvements in BP across all groups. Subjects on the Vegan and Paleo diets lost the most weight (~6.5%) and showed the greatest improvement in lipid risk factors (11-14% decrease in LDL-P; 10-20% decrease in VLDL and TG).

Conclusion:
All four diets promoted weight loss and improved BP but had variable effects on lipid risk factors.
Abstract 13700: Role of Parp1-pkm2 Axis in the Pathogenesis of Right Ventricular Failure Associated With Pulmonary Arterial Hypertension
Authors: Shimauchi Tsukasa , Omura Junichi , Breuils Bonnet Sandra , Nadeau Valerie , Tremblay Eve , Grobs Yann , Potus Francois , Paulin Roxane , Provencher Steeve , BOUCHERAT Olivier , Bonnet Sebastien
Published: November 2020

Background:
Right ventricular failure (RVF) is a poor prognostic factor for pulmonary arterial hypertension (PAH) patients. Inflammation, oxidative stress-induced DNA damage, and glycolysis are key RVF-driven pathways triggering cardiomyocytes (CM) dysfunction. Persistent DNA damage-dependent Poly (ADP ribose) Polymerase 1 (PARP1) activation was documented to promote glycolysis and pro-inflammatory responses through nuclear retention of Pyruvate Kinase Muscle isozyme 2 (PKM2). Despite the tremendous attention to PARP1/PKM2 axis in many pathologies, their implication in RVF remains unexplored. We hypothesized sustained PARP1 activation accounts for nuclear PKM2 localization, contributing to CM dysfunction and transition from compensated (cRVH) to decompensated RVH(dRVH).

Methods and Results:
We found by WB and IF that PARP1/PKM2 expression/activity is increased in dRVH (patients died from RVF, n=9) compared to cRVH (Cardiac index >2.2, n=14) and control donors (n=14) and correlates with RV hypertrophy and fibrosis. Similar findings were found in two rat models of RVF (monocrotaline; MCT, pulmonary artery banding; PAB). In addition, cardiac inflammation (NF-kB, HMGB1, IL-8, CCL-2, SOCS3, CD68), oxidative DNA damage (MTH1, 8-oxodG), and apoptosis (TUNEL) were significantly increased in dRVH compared to cRVH (human and rat models).
In vitro
, we confirmed by WB and IF that oxidative DNA damage (H
2
O
2
) induce nuclear expression of PARP1/PKM2 in CM leading to the release of inflammatory mediators (NFkB, HMGB1) and cell death. These effects were prevented by pharmacological inhibition of PARP1 (ABT888) and enforced cytosolic retention of PKM2 (TEPP46 and DASA58).
In vivo
, PARP1 inhibition (Olaparib; 10mg/kg) as well as TEPP46 (25mg/kg) delayed progression of RVF (CO, hypertrophy, fibrosis, inflammation, DNA damage, apoptosis) in PAB rats (n=8 per groups). Preliminary data indicate CM-specific inactivation of PARP1 induces resistance to RVF in PAB mice (All p<0.05).

Conclusions:
We demonstrated for the first time that PARP1/PKM2 axis is a critical integrator of oxidative stress, inflammation, and metabolic dysfunction during pathological RVF. Modulating PARP1/PKM2 axis may represent a promising avenue for ameliorating RVF in PAH.
Abstract 13714: Clinical Utility of the Triglyceride-glucose Index Which is a Novel Marker of Insulin Resistance for Predicting the Neointimal Vulnerability After Everolimus-eluting Stent Implantation
Authors: Akutsu Naotaka , Arai Riku , Fukamachi Daisuke , Okumura Yasuo
Published: November 2020

Introduction:
Insulin resistance has been recognized as the cause of cardiovascular disease, but little is known about the influence of insulin resistance to neointimal characteristics after stent implantation.

Hypothesis:
The high triglyceride-glucose index (TyG index) has been reported to indirectly represent a high insulin resistance. It was hypothesized that in-stent neointimal characteristics in the high TyG index patients may be unstable more than the low TyG index patients.

Methods:
In 100 patients, we investigated the relationship between the neointimal characteristics and the TyG index using coronary angioscopy (CAS) and optical coherence tomography (OCT) during follow-up angiography after stent implantation. We divided into 2 groups according to the median value of TyG index (8.8).

Results:
The high TyG index group (n=48) had the higher yellow grade and the higher prevalence of yellow grade 3 by CAS than the low TyG index group (n=52). The prevalence of heterogeneous and layered patterns were more often observed by OCT in the high TyG index group than in the low TyG index group (Figure).

Conclusions:
The high TyG index strongly associated with neointimal vulnerability evaluating by CAS and OCT. The TyG index can be a useful predictor for the neointimal vulnerability after stent implantation.
Abstract 14072: Bioenergetic and Metabolic Impairments in Duchenne Muscular Dystrophy (DMD) Patients' Induced Pluripotent Stem Cell-derived Cardiomyocytes (iPSC-CMs)
Authors: Willi Lubna , Fernandez-Garcia Jonatan , Abramovich Ifat , Freimark Dov , Arad Michael , Gottlieb Eyal , Binah Ofer
Published: November 2020

Introduction:
DMD, an X-linked muscle degenerative fatal disease, is caused by mutations in the
dystrophin
gene. Dilated cardiomyopathy (DCM) is a major cause of morbidity and mortality in DMD patients. Since the DMD DCM treatment is limited, novel therapeutic modalities are urgently needed.

Hypothesis:
We hypothesized that
dystrophin
mutations in DMD lead to cardiomyopathy-causing bioenergetic/metabolic impairments, which can be therapeutically targeted for improving cardiac function.

Methods:
The study included iPSC-CMs from a healthy volunteer and 3 DMD patients (young male, YM; adult male, AM; adult female, AF) and
mdx
mice. We investigated the bioenergetics, electrophysiology, mitochondrial and metabolic features of iPSC-CMs and heart tissues using the SeaHorse Flux Analyzer, patch clamp, confocal fluorescence microscopy and Liquid Chromatography Mass Spectrometry (LC-MS) technologies, respectively.

Results:
To test the hypothesis, we measured the iPSC-CM respiration rate using the SeaHorse. Compared to healthy, in both AM and AF DMD, but
not
in YM DMD cardiomyocytes, ATP production decreased by 75%, and basal respiration decreased by 80% and 45%, respectively. In agreement with impaired oxidative phosphorylation capacity, mitochondrial activity measured by 3D life confocal microscopy was attenuated by 35% in AM, but
not
in YM. Concurring with the healthy-like bioenergetic status, YM iPSC-CMs fired regularly with no arrhythmias, in contrast to the prominent arrhythmias in AM and AF cardiomyocytes. Further, the LC-MS analysis demonstrated that the levels of 13%, 6% and 7% of the 120 metabolite measured, were lower in AM, AF and YM, while 10%, 18% and 43% were higher, respectively, compared to healthy iPSC-CMs (
p<0.05
). For example, in AM and AF (but
not
in YM) the phosphocreatine (PCr) levels were diminished by >80%, compared to healthy iPSC-CMs, indicating a dysfunctional PCr energy system. Finally, the LC-MS analysis of
mdx
ventricular tissue demonstrated a statistically-significant different metabolic profile in 8
mdx
mice vs 8 healthy mice.

Conclusion:
DMD iPSC-CMs and
mdx
mice exhibit bioenergetic/metabolic impairments, which constitute novel targets for alleviating the cardiomyopathy in DMD patients.
Abstract 14103: Impact of Chronic Kidney Disease on the Association of Cardiovascular and Renal Biomarkers With the Presence and Severity of Coronary Artery Disease in Patients With Suspected Coronary Artery Disease: The EXCEED-J Study
Authors: Wada Hiromichi , Shinozaki Tsuyoshi , suzuki masahiro , Sakagami Satoru , Ajiro Yoichi , FUNADA JUNICHI , Matsuda Morihiro , shimizu masatoshi , Takenaka Takashi , Morita Yukiko , Yonezawa Kazuya , Matsubara Hiromi , Ono Yujiro , Nakamura Toshihiro , Fujimoto Kazuteru , Yoshida Kazuro , Kato Toru , Unoki Takashi , Takagi Daisuke , Iguchi Moritake , Kotani Kazuhiko , Abe Mitsuru , Akao Masaharu , Hasegawa Koji
Published: November 2020

Background:
The impact of chronic kidney disease (CKD) on the association of cardiovascular (CV) and renal biomarkers with the presence and severity of coronary artery disease (CAD) in patients with suspected CAD are unclear.

Methods:
Using data from a multicenter, prospective cohort of 2324 patients with suspected but no history of CAD undergoing elective coronary angiography, we assessed the impact of CKD on the association of CV and renal biomarkers with the presence and severity of CAD. Heparin-free fasting serum levels of soluble vascular endothelial growth factor (VEGF) receptor-1 (sFlt-1), VEGF, placental growth factor (PlGF), N-terminal pro-brain natriuretic peptide (NT-proBNP), contemporary sensitive cardiac troponin-I (cTnI), high-sensitivity CRP (hs-CRP), cystatin C, and neutrophil gelatinase-associated lipocalin (NGAL) were measured in 887 CKD and 1437 non-CKD patients enrolled in the EXCEED-J study. The severity of CAD was quantified using the Gensini score.

Results:
The mean age (standard deviation) of the patients was 69.8 (10.8) years; 65.6% were men. Serum levels of all biomarkers except PlGF were significantly higher in CKD than in non-CKD patients. In the entire patient cohort, only natural log-transformed (Ln-) cTnI was significantly associated with CAD, multi-vessel or left main trunk disease (MVD/LMTD), and Ln-Gensini score after adjustment for potential confounders. These associations were still significant in non-CKD, but not in CKD: Ln-cTnI was significantly associated with MVD/LMTD and Ln-Gensini score, but not with CAD. Stepwise regression analyses including potential confounders and all biomarkers revealed that Ln-cTnI was independently associated with CAD, MVD/LMTD, and Ln-Gensini score in the entire cohort and in non-CKD, but not in CKD: Ln-cTnI was independently associated with MVD/LMTD and Ln-Gensini score, but not with CAD. No other biomarker exhibited an independent association with CAD, MVD/LMTD, or Ln-Gensini score in the entire cohort, in non-CKD, or in CKD.

Conclusions:
Among CV and renal biomarkers measured in this study, only Ln-cTnI was independently associated with the presence and severity of CAD in patients with suspected CAD. These associations were attenuated in patients with CKD.
Abstract 14150: Long-pulsed Ultrasound Mediated Microbubble Thrombolysis: Is There an Upper Limit?
Authors: Chen Xianghui , Guo Jun
Published: November 2020

Introduction:
Long-pulsed ultrasound (US) mediated microbubble (MB) has shown successful thrombolystic effects in recent years. Compared to traditional short-pulse US(<5 cycles), long-pulsed US induced more sustained cavitation followed by more complete thrombolysis. It was found more micro-thrombi were dissolved when pulse lengths were increased. However, taking the US safety into consideration, the upper limit of long pulse
in vivo
remains unknown.

Hypothesis:
Long-tone-burst US is able to cause successful thrombolysis through microbubble cavitation, and there is an upper limit for the safe long-pulse length in vivo.

Methods:
Different long- pulse lengths (5,100,500,1000, 5000, 50,000 cycles) were used and their thrombolytic effects in a rat model were observed. About 200μm micro-thrombi were injected into common iliac artery on rats hindlimb to make an embolization model. 1MHz long-pulsed US were delivered at mechanical index 1.8 every 3 seconds (pulse repetition frequency 0.33). The control group was given MBs only without therapeutic US. Contrast echocardiography was performed at three stages: baseline, embolization and 10 minutes post embolization. Peak plateau video intensity (
A
) were obtained for assessment of thrombolytic effects. Finally muscular samples were taken for pathology for assessment of both beneficial and potential detrimental effects from long-tone-burst US.

Results:
100 and 500 cycles long-pulsed US showed successful thrombolysis and peak plateau video intensity (
A
) was significantly elevated post US treatment ( P<0.01 vs. baseline ). Pathology revealed 1000 and 5000 cycles groups were the best parameters to induce optimal sonothrombolysis ( P<0.01 vs. other groups), possibly by more sustained cavitation. However, 50,000 cycles showed endothelial injury and tissue bleeding that may be detrimental and hazard.

Conclusions:
Long-tone-burst US with more than 100 cycles were proved to induce very good micro-thrombi resolution in a rat model of embolization. It seems there is

an upper limit for the cycle length to generate beneficial biomechanical effects, and detrimental effect may occur if it was exceeded.
Abstract 14153: Actigraphy-Derived Rest-Activity Patterns Are Associated With Blood Pressure Level and Hypertension: A Prospective Analysis of the Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Makarem Nour , St-Onge Marie-Pierre , Shimbo Daichi , Aggarwal Brooke A , Baccarelli Andrea , Sears Dorothy D , Shea Steven , Mariani Sara , Marinac Catherine , Zee Phyllis , Ouyang Pamela , Redline Susan
Published: November 2020

Introduction:
Misalignment of lifestyle behaviors with circadian rhythms is related to hypertension (HTN) risk in experimental studies. Estimation of the circadian rhythm of 24 h rest-activity patterns, which serves as a measure of circadian rhythmicity in a free-living population setting, has been linked to health outcomes but its association with HTN is unknown.

Hypothesis:
Less robust and irregular 24 h rest-activity patterns will be associated with higher blood pressure (BP) and HTN.

Methods:
Participants were n=1667 diverse adults (mean age: 67 ± 9 y) in the MESA Sleep Study (2010-13) who completed 7 days of wrist actigraphy. Interdaily stability (IS), intradaily variability (IV), most active 10 h period (M10) and least active 5 h period (L5) timing and counts, and relative amplitude (RA) (defined in Table) were derived from actigraphy data using nonparametric rhythm analysis. Multivariable linear and logistic regression was used to examine associations with BP level and prevalent and incident HTN after 6 y of follow-up at Exam 6 (2016-18).

Results:
Greater RA (more robust rest-activity pattern i.e. higher wake-time activity and lower activity at night), IS (more day-to-day stability in rest-activity patterns), and M10 counts (more active wake period) were associated with lower BP (Table). Higher L5 midpoint and count (later timing and less restful sleep) was associated with higher BP. In sensitivity analyses excluding those taking HTN medication, associations persisted. Those in the highest vs. lowest category of RA and M10 counts had lower prevalent and incident HTN risk, while those in the highest vs. lowest category of L5 midpoint and counts and IV (more fragmented rhythm, lower sleep efficiency) had higher HTN risk.

Conclusions:
A less robust and stable rest-activity pattern, lower wake-time activity, and a less restful and later sleep period are associated with HTN. The timing and regularity of rest-activity patterns may be a novel target for HTN prevention.
Abstract 14168: Hypertension and Clinical Outcomes in Hospitalized Patients With Covid-19; a Multicenter Analysis
Authors: Al-Abcha Abdullah , Wang Ling , boumegouas manel , Zulfiqar Baloch , Do Steven , Ip Randy , Abela george , Ip John
Published: November 2020

Introduction:
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects host cells through ACE2 receptors, leading to coronavirus disease (COVID-19)-related pneumonia. In nationwide study in China, hypertension was associated with increased in-hospital morbidity and mortality. We performed a similar analysis in a US-based population.

Hypothesis:
Hypertension is associated with clinical outcomes in patients with COVID-19.

Methods:
We performed a retrospective analysis of all adult patients with COVID-19 who were admitted to two hospitals in Michigan between 3/1/2020 and 4/30/2020. We divided the patients into two groups according to their pre-admission hypertension status, with hypertension (HTN) and without hypertension (No-HTN). Primary outcome was in-hospital mortality. Secondary outcomes were length of stay (LOS), the risk of intubation, duration of intubation, and the use of vasopressors. Statistical analysis was done using Chi-square tests for binary outcomes and Poisson Regression for count outcomes.

Results:
A total of 215 patients with COVID-19 were included. Mean age was 62.8 years, mean BMI was 30.9, 119 of them (55%) were males, and 135 (63%) had hypertension. Patients with HTN had significantly higher risk of in-hospital death (N=62/135) when compared to patients without HTN (N=20/80) (p=0.002). Patients with HTN also had higher risk of intubation (HTN=74/135 vs No-HTN=23/80, p<0.001) and higher risk of vasopressors use (HTN=56/136, No HTN=19/80, p=0.007). There was no statistically significant difference in LOS (p=0.295), and duration of intubation (p=0.442).

Conclusions:
Hypertension is associated with higher risk of in-hospital death, higher risk of intubation, and higher risk of vasopressors use in hospitalized patients with COVID-19. Larger studies are needed to confirm these results with adjusting for confounding factors.
Abstract 14534: In vitro Assessment of Transvalvular Peak Velocity Measurement for Various Orifice Shapes: Comparison Between 4D Flow MRI vs. Doppler Echocardiography
Authors: Lee Jeesoo , El hangouche Nadia , Ma Liliana , Scott Michael , Markl Michael , Thomas James D
Published: November 2020

Introduction:
4D flow MRI can assess transvalvular velocity, but validation against continuous wave (CW) Doppler echo is limited in high-velocity regurgitation and stenosis situations. We sought to compare 4D flow MRI and echo peak velocity using a pulsatile echo-MRI flow phantom.

Materials and Methods:
An MRI-compatible flow phantom with restrictive orifice situated was driven by a left ventricular assist device at 50 bpm (figure 1A). Three orifice shapes were tested: circular, elliptical and 3D-printed patient-specific mitral regurgitant orifice model of prolapse with areas of 0.5, 0.41 and 0.35 cm
2
, respectively. CW Doppler was acquired with peak velocity extracted from the profile. Retrospectively-gated 4D flow MRI was performed (spatial resolution = 2 mm isotropic, temporal resolution = 36 ms, encoding velocity = 400 cm/s). Maximal velocity magnitude was extracted volumetrically (figure 1B). An echo-mimicking profile was also obtained with a “virtual” ultrasound beam in the 4D flow data to simulate CW Doppler (figure 1C). Bland-Altman analysis was used to assess the agreement of temporal peak velocities.

Results:
4D flow MRI demonstrated a centrally directed jet for the circular and elliptical orifices and an oblique jet for the prolapse orifice (figure 1B). Peak velocities were in excellent agreement between 4D flow MRI vs. echo for the circular (peak: 5.13 vs. 5.08 m/s, bias = 0.06 ± 0.66 m/s, figure 1D) and the elliptical orifice (peak: 4.95 vs. 4.79 m/s, bias = 0.07 ± 0.87 m/s, figure 1E). The prolapse orifice velocity was underestimated somewhat by MRI by ~10% (peak: 4.41 vs. 4.90 m/s, bias=0.26±1.18, figure 1F).

Conclusion:
4D flow MRI can quantify high velocities like echo for simple geometries while underestimating for more complex geometry, likely due to partial volume effects. Further investigation is warranted to systematically investigate the effects of 4D flow MRI spatial and temporal resolution as well as the jet angle on velocity quantification accuracy.
Abstract 14563: Improved Outcomes in Patients With Anthracycline-Induced Cardiomyopathy Undergoing Left Ventricular Assist Devices: 10-Year Longitudinal INTERMACS Study
Authors: Guha Avirup , Caraballo Cesar , Miller Elliott , Owusu-Guha Jocelyn , Clark Katherine , Ahmad Tariq , Baldassarre Lauren A , Addison Daniel , Weintraub Neal L , Desai Nihar R
Published: November 2020

Introduction:
Anthracycline-induced cardiomyopathy (AC-CM) presenting as end-stage heart failure may require mechanical circulatory support.

Hypothesis:
We hypothesize that there is no difference in outcomes after LVAD placement in those with AC-CM compared to other forms of cardiomyopathy.

Methods:
Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) dataset spanning from 2008 to 2017 was utilized to identify adult AC-CM patients undergoing continuous flow LVAD implantation excluding those who required concomitant cardiac procedures and right ventricular support (RVS). AC-CM patients were compared to those undergoing LVAD placement due to idiopathic dilated cardiomyopathy (IDM) and ischemic cardiomyopathy (ICM). Primary outcome of overall mortality was studied using Cox-proportional hazards model. Secondary outcomes of first infection, ischemic stroke, major bleeding and subsequent RVS were evaluated using Fine-Gray competing risk model accounting for appropriate competing risks. Subgroup analysis based on gender, race, ethnicity, and use of pre-transplant goal directed medical therapy (GDMT) for systolic heart failure was performed.

Result:
Overall, 248 AC-CM patients underwent continuous flow LVADs in the 10-year period. At 12-months, 85.1% of AC-CM, 86.0% of IDM and 80.2% of ICM patients were alive (log-rank
P
< 0.001). There was no difference in mortality compared to ICM and IDM (
P
> 0.05). However, pre-LVAD GDMT improved mortality in only the AC-CM cohort when compared to those patients who were not on GDMT (adjusted hazards ratio (HR): 0.44; confidence interval (CI): 0.19 - 0.99). AC-CM patients had a higher risk of major bleeding compared to IDM patients (HR: 1.23; CI: 1.01 - 1.50). AC-CM patients had lower risk of stroke compared to ICM patients (HR: 0.31; CI: 0.15 - 0.62). There was no difference in the three subtypes of cardiomyopathy in hazards of first infection or subsequent RVS.

Conclusion:
Survival rates are similar in AC-CM, ICM and IDM patients who received continuous flow LVAD therapy in the contemporary era. There is improved mortality benefit in AC-CM patients who are on GDMT before LVAD. Further research into bleeding and stroke related disparities is warranted.
Abstract 14565: Simultaneous Heart-Kidney Transplant - Does Hospital Experience With Heart Transplant or Kidney Transplant Have a Greater Impact on Patient Outcomes?
Authors: Catalano Michael A , Pupovac Stevan , Lima Brian , Stevens Gerin R , Hartman Alan R , Yu Pey-Jen
Published: November 2020

Objective:
High institutional transplant volume is known to be associated with improved outcomes in heart transplant and kidney transplant. However, little is known regarding the impact of institutional experience on outcomes in simultaneous heart-kidney transplant (SHKT). The aim of this study was to assess trends and outcomes of SHKT nationally, as well as the impact of institutional heart and kidney transplant volume on mortality for SHKT patients.

Methods:
All adult patients (age ≥18) who underwent SHKT between 2005 - 2019 were identified using the United Network for Organ Sharing (UNOS) database. Annual institutional volume in heart transplant and kidney transplant were determined. Univariate and multivariable analyses were conducted to assess the impact of patient demographics, comorbidities, and institutional transplant volumes on 1-year mortality.

Results:
There were 1564 SHKT identified in the sample, increasing fourfold from 54 in 2005 to 221 in 2019 (p < .001). Median annual institutional heart transplant volume among centers performing SHKT was 35 (IQR 24 - 56); median annual kidney transplant volume was 166 (IQR 89 - 224). One-year mortality was 11.8%. In multivariable analysis, increasing annual institutional heart transplant volume was associated with reduced 1-year-month mortality. Contrarily, annual institutional kidney transplant volume was not associated with mortality. Increasing body mass index, dialysis, requirement for extracorporeal membrane oxygenator support (ECMO) at time of transplant, ischemic times, and total bilirubin levels were independently associated with increased 1-year mortality (Table 1).

Conclusion:
Increased institutional heart transplant volume is associated with reduced mortality in SHKT. A similar association was not identified between institutional kidney transplant volume and mortality. Thus, emphasis should be placed on high-volume heart transplant centers to manage SHKT patients.
Abstract 14575: Systematic Review and Meta-analysis of Intravascular Ultrasound-guided Percutaneous Left-main Coronary Artery Intervention
Authors: Saleem Sameer , Arab Shuaibahmed , Ullah Waqas , Younas Sundas , Al hemyari Bashar , NAZIR SALIK , Singh Aniruddha , Dawson Dowe Jacqueline , Tripathi Avnish , Shoaib Akbar Muhammad , Kazimuddin Mohammed , Abdul-Waheed Mohammad
Published: November 2020

Introduction:
Previous meta-analyses have reported reduced cardiovascular mortality and myocardial infarction in intravascular ultrasound-guided (IVUS) stent implantation in comparison to angiography-only approach. However, these studies have unanimously excluded patients with unprotected left-main coronary artery (LMCA) disease, questioning its widespread applicability. We performed a systematic review and meta-analysis to investigate the prognostic significance of IVUS-guided LMCA intervention.

Methods:
Studies comparing clinical outcomes between IVUS-guided and angiography-only percutaneous LMCA intervention were identified through PubMed, Cochrane and EMBASE databases until June, 2020. Data was analyzed using a random effect model to calculate the relative odds of all-cause death, cardiac death, left-main revascularization, myocardial infarction, stent thrombosis and stroke.

Results:
A total of 13 studies comprising 7680 patients were included. The odds of all-cause death (OR 0.6, 95%CI 0.47-0.78; p<0.0001), cardiac death (OR 0.37, 95%CI 0.26-0.54; p<0.00001), left-main revascularization (OR 0.63, 95%CI 0.45-0.89; p=0.009) and myocardial infarction (OR 0.77 [95%CI 0.60-0.98; p=0.04]) were significantly lower in patients who underwent IVUS-guided LMCA stent implantation compared to angiography-only approach. There was no significant difference observed in the relative odds of stent thrombosis (OR 0.57, 95%CI 0.31-1.05; p=0.07) and stroke (OR 1.7, 95%CI 0.56-5.14; p=0.35) between the two arms at least 1-year of the index procedure. A subgroup analysis based on study design and sensitivity analysis based on the characteristics of the included studies mirrored the pooled results.

Conclusion:
IVUS-guided LMCA intervention is associated with overall improved cardiovascular outcomes than angiography-only approach. Large scale randomized controlled trials are needed to validate our findings.
Abstract 14589: The Zip Code Jeopardy: Living in Disadvantaged Areas is Associated With Significantly Increased Mortality After Percutaneous Coronary Intervention: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium
Authors: Sukul Devraj , Seth Milan , Spehar Stephanie , Thompson Michael , Bonifacio Daniel , Lee Daniel , Rizk Maged , Osman Abdul , Gurm Hitinder S
Published: November 2020

Introduction:
Research suggests that neighborhood-level factors are associated with long-term health; however, there is a dearth of research evaluating this association among patients (pts) undergoing percutaneous coronary intervention (PCI), a population that is usually optimally treated with respect to long-term risk management.

Hypothesis:
We hypothesize that pts living in the most disadvantaged areas have a higher risk of post-discharge mortality after PCI compared with pts not living in the most disadvantaged areas.

Methods:
Using a clinical registry of pts with valid zip codes who underwent PCI between 1/2013 - 3/2018 at 47 Michigan hospitals linked to Medicare claims, we compared long-term outcomes between pts in the highest ADI decile (i.e. most disadvantaged) with the remainder. The Area Deprivation Index (ADI) is a zip-code-level composite measure of neighborhood disadvantage. Unadjusted mortality was depicted on a Kaplan-Meier plot. We used a Cox model to assess the association between the ADI and mortality after adjusting for pt factors.

Results:
Among 26,164 pts, 9.9% lived in the most disadvantaged zip codes and were more likely to be younger, of black race, have both Medicare and Medicaid insurance, and have more cardiovascular comorbidities. Unadjusted rates of mortality were higher among pts living in the most disadvantaged areas compared with the remainder (5-yr mortality: 64.5% vs 70.9%; Fig). After adjusting for pt factors, those living in the most disadvantaged areas had a significantly increased risk of long-term mortality (HR 1.16; 95% CI 1.08 - 1.25), a risk equivalent to an 8% reduction in one’s ejection fraction (HR for 8% EF reduction: 1.16; 95% CI 1.14 - 1.17).

Conclusions:
Medicare pts living in the most disadvantaged areas have a higher risk of post-PCI long-term mortality compared with the remainder. Policies targeting the deleterious health effects of neighborhood disadvantage and social risk are needed to improve survival after PCI.
Abstract 14592: Pregnancy Loss and Cardiovascular Disease Risk Factors in Early Adulthood: Preliminary Findings From Add Health
Authors: Cortes Yamnia I , Zhang Shuo , Berry Diane C , Hussey Jon
Published: November 2020

Introduction:
Pregnancy loss, including miscarriage and stillbirth, affect 15-20% of pregnancies in the United States annually. Accumulating evidence suggests that pregnancy loss is associated with greater cardiovascular disease (CVD) burden later in life. However, associations between pregnancy loss and CVD risk factors in early adulthood (age<35 years) have not been assessed.

Objective:
To examine associations between pregnancy loss and CVD risk factors in early adulthood.

Methods:
We conducted a secondary data analysis using the public-use data set for Wave IV (2007-2009) of the National Longitudinal Study of Adolescent to Adult Health (Add Health). Our sample consisted of women, ages 24-32 years, with a previous pregnancy who completed biological data collection (n=2,968). Pregnancy loss was assessed as any history of miscarriage or stillbirth; and as none, one, or recurrent (≥2) pregnancy loss. Dependent variables included physical measures and blood specimens: body mass index (BMI), blood pressure, diabetes status, and dyslipidemia. Associations between pregnancy loss and each CVD risk factor were tested using linear (for BMI) and logistic regression adjusting for sociodemographic factors, parity, pre-pregnancy BMI, smoking during pregnancy, and depression.

Results:
Six hundred and ninety-three women (23%) reported a pregnancy loss, of which 21% reported recurrent pregnancy loss. Women with all live births were more likely to identify as non-Hispanic White (73%) and report a higher annual income. After adjusting for sociodemographics (age, race/ethnicity, education, income), pregnancy loss was associated with a greater BMI (ß=0.90; SE,0.39). In fully-adjusted models, women with recurrent pregnancy loss were more likely to have hypertension (AOR, 2.50; 95%CI, 1.04-5.96) and prediabetes (AOR, 1.93; 95%CI. 1.11-3.37) than women with all live births; the association was non-significant for women with one pregnancy loss.

Conclusions:
Pregnancy loss is associated with a more adverse CVD risk factor profile in early adulthood. Findings suggest the need for CVD risk assessment in young women with a prior pregnancy loss. Further research is necessary to identify underlying risk factors of pregnancy loss that may predispose women to CVD.
Abstract 14608: Prognostic Value of Diuretic Resistance in Patients Admitted for Acute Decompensated Heart Failure With Reduced, Mid-range, or Preserved Left Ventricular Ejection Fraction
Authors: Kimura Takanari , Yamada Takahisa , Watanabe Tetsuya , Morita Takashi , Furukawa Yoshio , Tamaki Shunsuke , Kawasaki Masato , Kikuchi Atsushi , Kawai Tsutomu , Seo Masahiro , Nakamura Jun , Kayama Kiyomi , Kawahira Masatsugu , Ueda Kunpei , Sakamoto Daisuke , Ito Shota , Kougame Takehiro , Chang Yongchol , Fukunami Masatake
Published: November 2020

Background:
Diuretic resistance is associated with poor clinical outcome in patients with acute decompensated heart failure (ADHF). However, little information is available on the prognostic significance of diuretic resistance in ADHF patients, relating to reduced, mid-range, or preserved left ventricular ejection fraction (LVEF).

Methods:
We studied 400 consecutive patients who were admitted for ADHF and survived to discharge. Diuretic resistance (DR) was defined by furosemide dose per body weight (BW) at discharge. Patients were classified by DR, and high dose group (higher DR) was defined by furosemide dose of > median value of DR (0.580). The endpoint was a composite of all-cause mortality and unplanned hospitalization for worsening heart failure.

Results:
There were 139 patients with heart failure with reduced LVEF (HFrEF, LVEF<40%), 86 with mid-range LVEF (HFmrEF, 40%≤LVEF<50%) and 175 with preserved LVEF (HFpEF, LVEF≥50%). There was no significant difference in DR among the three groups (HFrEF; median 0.541 [IQR 0.360-0.786] mg/kg vs HFmrEF; 0.606 [0.398-0.820] mg/kg vs HFpEF; 0.624 [0.380-0.935] mg/kg, p=NS). During follow-up of 2.4±1.6 years, 195 patients reached the endpoint (HFrEF, n=67, HFmrEF, n=44, and HFpEF, n=84). In multivariate Cox analysis, DR was significantly associated with the endpoint independently of age, estimated glomerular filtration rate, plasma brain natriuretic peptide level and LVEF only in HFpEF patients (p<0.0001). Kaplan-Meier analysis showed that the risk of the endpoint was significantly higher in the patients with higher DR in HFpEF patients, but not in HFrEF or HFmrEF patients (Figure).

Conclusions:
In this study, higher DR was shown to be associated with poor clinical outcome in HFpEF patients admitted with ADHF.
Abstract 14928: The Factors Impacting on Resting Energy Expenditure in Refractory Heart Failure Patients and the Probability of Urine Amino Acids Analysis as an Indicator for Calorie Intake Insufficiency
Authors: Kudo-sakamoto Yoko , Ohtani Tomohito , nakamoto kei , Sera Fusako , Hikoso Shungo , Sakata Yasushi
Published: November 2020

Introduction:
Cachexia is a critical issue in patients with refractory heart failure (HF). Although the elevation of resting energy expenditure (REE) can progress cachexia through relatively insufficient calorie intake, the detail of REE in HF patients remains uncertain and no useful marker for predicting insufficient calorie intake has been established. This study aimed to assess the REE of HF patients and to evaluate the detectability of serum and urine laboratory markers for insufficient calorie intake.

Methods:
We measured REE using indirect calorimetry in 69 HF patients (NYHA class II-IV) in our hospital. In 25 out of 69 patients, serum albumin, amino acids, and 24-hour urine amino acids were measured. The calorie intake insufficiency was determined based on measured REE multiplied by activity index

Results:
As compared to the predicted values by Harris-Benedict equation, 43 patients (63%) had an elevated REE and the mean REE was approximately 4% elevated. There was no significant correlation between the REE and parameters indicating HF severity, including cardiac index on right heart catheterization and BNP level. Only body mass index (BMI) negatively correlated with the REE (r=-0,66, p<0.01). Of 25 patients, 16 (64%) had calorie intake insufficiency. The excreted amount of urine essential amino acids was lower and mostly under normal range, especially significantly decreased in Histidine and Phenylalanine levels in the patients with calorie intake insufficiency compared to those without calorie intake insufficiency, whereas serum levels of albumin and essential amino acids were kept within a normal range in the both.

Conclusions:
Our findings suggest that the patients with refractory HF, especially having low BMI, are likely to be under inadequate calorie intake due to elevated REE. The calorie intake insufficiency could not be identified with serum levels of albumin nor essential amino acids. Instead, urine essential amino acids would decrease first prior to plasma levels, indicating this measurement would be a useful marker to detect calorie intake insufficiency.
Abstract 14933: Brain Emotional Neural Activity is Associated With Complex Plaque Characteristics Resulting Acute Plaque Instability: A Prospective 3D-Rendered 18F FDG-PET/CT Assessment
Authors: Kang Dong Oh , Eo Jae Seon , Park Eun Jin , Nam Hyeong Soo , Song Joon Woo , Choi Cheol Ung , Kim Eung Ju , Rha Seung-woon , Seo Hong Seog , Yoo Hongki , Kim Jin Won
Published: November 2020

Introduction:
Stress-associated neurobiological activity is associated with future cardiovascular events. However, whether the linkage between brain emotional activity and complex plaque characteristics exists during the phase of acute plaque instability needs to be elucidated.

Objectives:
We aimed to prospectively estimate brain amygdalar activity (AmygA), arterial inflammation (AI) and macrophage hematopoiesis (HEMA) according to the presence of complex plaque characteristics in patients with acute myocardial infarction (AMI).

Methods:
In a total of 45 AMI patients (mean 60.0 years, 84.4% male), 18F FDG-PET/CT imaging was performed within 45 days of index episode. Total plaque burden was assessed using the SYNTAX score. The culprit plaque was considered complex, if there were two or more of the following morphologic features: thrombus, ulceration, plaque irregularity, and impaired flow (TIMI<3). The PET signal activities were compared using a customized 3D-rendered PET/CT reconstruction.

Results:
Average SYNTAX score ranged by 16.3±8.4 and 12 (26.7%) patients had intermediate to high score (≥22). Complex culprit plaque and significant flow limitation were present in 34 (75.6%) and 33 (73.3%) patients, respectively. AmygA increased significantly in those who had higher SYNTAX score (≥22; target-to-background ratio [TBR]: 0.68±0.08 vs. 0.63±0.06; p=0.004), complex culprit plaques (TBR: 0.66±0.05 vs. 0.60±0.04; p<0.001), and significant flow limitation (TBR: 0.66±0.05 vs. 0.61±0.06; p=0.008) as compared to those without complex features (Figure). In contrast, carotid AI, aortic AI, and HEMA merely showed significant differences according to the presence of the aforementioned complex angiographic characteristics.

Conclusions:
AmygA was markedly enhanced in AMI patients with complex plaque characteristics. These findings suggest that AmygA closely associates with loco-regional disease activity at the level of coronary vasculature.