bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11352: Frailty in Pediatric Patients After Fontan Palliation is Associated with Impaired Quality of Life and Increased Hospitalizations
Authors: Wilde Megan , Schumacher Kurt , Yu Sunkyung , Lowery Ray , Armstrong Blake P , Stoscup Jessica , Uzark Karen , Lim Heang
Published: March 2022

Introduction:
Frailty is a clinical syndrome common in adults with chronic disease with resultant vulnerability to adverse health outcomes. There is little known about frailty in pediatric patients, including those with congenital heart disease. We hypothesized that the Fontan-palliated population have a high incidence of frailty.

Methods:
This single center, prospective cohort study assessed frailty in patients (10-21 years old) after Fontan palliation. The five domains of frailty including slowness, weakness, exhaustion, shrinkage, and diminished physical activity were evaluated using a modified Fried frailty assessment comprised of validated pediatric tests. Providers also estimated their patient’s frailty. Quality of life (QOL) was assessed using PedsQL generic and cardiac modules. Standard descriptive statistics and univariate analyses identified risk factors associated with frailty.

Results:
Of 54 participants (median age 15.3 years, 61% male), 18 (33%) were identified as frail while 26 (48%) were pre-frail. Patients frequently exhibited frailty in the domains of slowness (93%), weakness (41%), and diminished physical activity (39%). There was poor correlation between frailty scores and provider estimates of frailty (Kappa=0.11). Frail subjects were more likely to have lower PedsQL physical functioning scores (mean 62.8 ± SD 18.5 in Frail vs. 75.7 ± 16.0 in No/pre-Frail; p=0.01). Factors associated with frailty included protein losing enteropathy (p=0.03) and at least one hospitalization in the last year (p=0.047). Higher NYHA functional class (p=0.07) and > 4 clinic visits in the last year (p=0.08) trended toward an association with frailty.

Conclusion:
Frailty was identified in 1/3 of pediatric patients after Fontan palliation with providers inconsistently recognizing it. Frail patients were more likely to have lower physical functioning, and higher healthcare utilization. These findings highlight the need for improved screening and support for an at-risk population that may not be readily apparent to providers. Additional studies are needed to better understand pediatric frailty, its reversibility, and whether it predicts vulnerability to adverse health outcomes as seen in adults.
Abstract 11358: A Standardized Heart Failure Bundle to Provide Better Patient Care and Reduce Readmissions
Authors: Torres Tara , Collins Diane
Published: March 2022

In adults, heart failure (HF) is associated with increased morbidity and mortality, with projected health care costs of 70 billion by 2030. Evidence-based care identifies that early evaluation and management improves lives and is cost-effective. Streamlining strategies to facilitate care delivery can assist heart failure patients in sustaining their complex lifestyles and behavioral modifications while preventing readmissions. Utilizing a standardized heart failure bundle with evidence-based heart failure care across health systems can provide better care and reduce the 30-day readmission rate. An interdisciplinary team identified a shared need and worked together to set the patient up for success providing a seamless transition of care from inpatient to outpatient. A literature review of evidence-based heart failure care was completed. An Information Systems (IS) team was engaged in creating an HF dashboard to measure interventions and show a return of investments. A Physician Champion was brought into the team to lead the group. A nurse coordinates the initiative while ensuring all aspects are met before discharge. The bundle includes standardized patient education, pharmacy medication reconciliation (MR) before discharge, medication counseling, and HF clinic visit within 10-days of discharge.The Standardized HF bundle begins with identifying heart failure admissions utilizing a readmissions risk report. Next, ensuring medication reconciliation is completed before discharge, as well as medication counseling. A self-management tool engaged patients in care as well. Finally, ensuring the patient has a follow-up appointment within 14 days of discharge. Process metrics evaluated include scheduling and completing follow-up (F/U) appointments and completing medication reconciliation by pharmacy. Before the HF bundle, 72% of F/U appointments were scheduled, and 34.3% were completed in March 2020. MR was 55%. After the HF bundle’s implementation, 95.9% of f/U appointments were scheduled, and 69.2% were completed in March 2021. In addition, mr was 77%. The Outcomes data includes HF readmission rates. The HF readmission rates were 30.4% in early 2020. After the implementation of the HF bundle, the HF readmission rate is 18.5%.
Abstract 11362: Revisiting Gender Equality in Mortality After MitraClip Implantation: A Systematic Review and Meta-Analysis
Authors: Nagraj Sanjana , SAFIRIYU ISRAEL , Mathai Sheetal Vasundara , B.s Leena , Faillace Robert
Published: March 2022

Introduction:
The presence of gender disparities in outcomes after non-coronary cardiac interventions is well-recognized, but conflicting data have been reported regarding the impact of gender on mortality after MitraClip (MC) implantation. Identification of sex differences in outcomes is important for effective risk stratification in patients with severe mitral regurgitation, who are at high risk for surgery.

Hypothesis:
We hypothesized that there are no gender-based differences in all-cause mortality after MC procedure.

Methods:
We searched electronic databases PubMed, Embase, and Web of Science from inception up to May 2021 for studies evaluating patient outcomes after MC implantation. The primary outcome of interest was late all-cause mortality ≥ 1 year after MC procedure. Secondary outcome of interest was in-hospital mortality. A random-effects model meta-analysis was conducted, and heterogeneity was assessed using I-squared test.

Results:
Seventeen studies comprising 21,549 patients were included. Women constituted 45.2% of the cohort. Male and female genders were not found to be independent predictors of late all-cause mortality ≥ 1 year after MC procedure (male, Hazard Ratio: 1.08; 95% CI: 0.92-1.26; I
2
= 15% and female, Odds Ratio (OR): 0.91; 95% CI: 0.73-1.14; I
2
= 0%, respectively) (Figure 1). There were no differences in in-hospital mortality between women and men after the index procedure (female, OR: 1.06; 95% CI: 0.61-1.85; I
2
= 29%) (Figure 2).

Conclusions:
There is no gender disparity in mortality with MitraClip implantation, both in-hospital and during long-term follow-up.
Abstract 11371: Prevalence of Cardiometabolic, Mental, and Other Somatic Chronic Conditions in Patients Enrolled in Phase II Outpatient Cardiac Rehabilitation
Authors: Chacin Suarez Audry , Medina-inojosa Jose R , Fischer Karen , Chamberlain Alanna M , Bonikowske Amanda R , Olson Thomas P
Published: March 2022

Introduction:
Multimorbidity is associated with physical disability, increased health care utilization, reduced quality of life, and mortality. Whereas most literature has focused on the co-occurrence of somatic conditions, we aim to (i) establish the prevalence of combined somatic and mental health multimorbidity (SMM) in cardiac rehabilitation (CR) patients, and (ii) determine the most prevalent co-occurrence of cardio-metabolic conditions (CMC) with other somatic or mental health conditions in CR patients.

Methods:
Using the Rochester Epidemiology Project records-linkage system, we identified residents of Southern MN and Western WI who attended (≥1) CR sessions from 1995 to 2019. The prevalence of 18 chronic conditions defined by the US Department of Health and Human Services was electronically extracted. Heat maps were created to assess the pairwise prevalence of cardio-metabolic (CMC; n=6) with mental (n=5) and other somatic (n=7) chronic conditions
(Table 1)
.

Results:
We included 13,056 patients; 68.5% were male. Patients were 65.5±12.5 years old with 44.7% ≤65 years old. Median number of conditions was 7 (Range 0-18) with 52.6% of patients having ≥7 conditions. Hyperlipidemia (89.3%), hypertension (79.5%), and arrhythmias (72.4%) were the most prevalent CMC. The prevalence of combined SMM (≥2 conditions) was 44.9% and was higher in those <65 years (
p
<.0001). Depression (26.8%) and anxiety (24.7%) were the most common mental conditions involved in SMM and frequently co-occurred with CMC. Among other prevalent somatic conditions, arthritis (51.7%), chronic obstructive pulmonary disease (33.5%), and cancer (29.3%) co-occurred with CMC
(Figure 1).

Conclusions:
Half of patients in CR have ≥7 chronic conditions. Somatic and mental health multimorbidity (SMM) is highly prevalent and is more frequent in those younger than 65 years old. Our results highlight the critical need to better understand the clinical burden of SMM in patients undergoing CR.
Abstract 11386: Self-Service Analysis of Best Practice Alert Acknowledgement Comments as a Method for Evaluation Reveals Opportunities for Optimization of Clinical Decision Support for Patients with Prolonged QT Syndrome
Authors: Qian Ray , Johnsen Paul , Bos Johan M , Ackerman Michael J , Caraballo Pedro
Published: March 2022

Introduction:
The main goal of Clinical Decision Support (CDS) is to provide timely and useful information for providers to deliver high-quality and safe care. Issues, like alert fatigue and provider burnout are commonly cited as unintended consequences of the CDS systems. Herein, we describe leveraging electronic health record (EHR) self-service reporting tools to gain insights on a CDS rule designed to avoid providers from ordering QT-prolonging medication in patients with history of QT-prolongation.

Methods:
Our EHR (Epic) SlicerDicer reporting tool was used to identify the frequency of QT-prolongation Best Practice Advisory (BPA) triggerings from 1/1/2020 to 12/31/2020 across Mayo Clinic sites. Additionally, associated patient encounter and BPA-specific data were queried. Text from acknowledgement comments to the BPA were reviewed and central themes and comments were categorized. Epic Clarity Data Warehouse was queried to identify the BPA-triggering medications and frequencies. Comparisons of percent action taken on the BPA were compared internally to Mayo Clinic’s BPA benchmark, and with national benchmarks using Epic BestPractice Pulse dashboard.

Results:
A total of 17,538 BPAs of interest were triggered across the Mayo Clinic sites in 2020, of which 3,696 (20.1%) were acted upon through either monitoring or medication discontinuation. This is below Mayo Clinic’s median of 29.2% for inpatient BPAs and 45.6% BPAs for outpatient, but above the national median of 10% (IQR 6.1-13.1%) for inpatient and 10% (IQR 4.3-19.5%) for outpatient BPAs actioned upon. A total of 30 different medications triggered the BPA, with the most common being ondansetron (41.5%), amiodarone (11.3%), and haloperidol (10.1%). User comments were left on 2,382 orders (13.5%) that acknowledged the BPA, but provided argument to prescribe drug. Three most common themes identified from comments on overridden BPAs: patient previously tolerated medication (19.0%), QT interval not prolonged on recent ECG (14.2%), and patient on hospice care (5.2%).

Conclusion:
Analysis of free text comments of CDS can be and should be performed to reveal opportunities for further improvement of CDS. Providers should be encouraged to provide comments when encountering CDS interventions.
Abstract 11389: Prevalence and Trends of Ideal Cardiovascular Health in 18 Countries: A Pooled Analysis of 68 Nationally Representative Surveys
Authors: Rana Custodio Alejandro , Zhou Bin , Danaei Goodarz ,   On behalf of the NCDRisC
Published: March 2022

Introduction:
Increasing the prevalence of the ideal cardiovascular health (CVH) phenotype over the coming decades would likely result in dramatic improvements in healthy longevity and reductions in healthcare costs. Therefore, it is of paramount importance to understand the global prevalence and trends of the ideal CVH behaviors and factors for monitoring progress and providing evidence to support policy efforts.

Hypothesis:
We aim to describe the prevalence of CVH for the AHA defined metrics of tobacco use, body mass index, total cholesterol, blood pressure and glucose levels, and estimate its trends worldwide.

Methods:
We used data from people aged > 20 years who participated in 68 national health examination surveys from 1983 to 2017 in 18 countries: Australia, Czech Republic, Denmark, Germany, Greece, Ireland, Italy, Malaysia, Mexico, Poland, Seychelles, Slovakia, South Korea, Spain, Sweden, Turkey, the UK, and the USA. We calculated age-standardized prevalence of ideal CVH (no current smoking, BMI < 25 kg/m2, untreated TC < 200 mg/dL, untreated BP < 120 / < 80 mmHg, and absence of diabetes mellitus). Additionally, we examined the trends of the ideal CVH for countries that had at least two individual-level national surveys in two different decades (2000-2009 vs 2010-2019).

Results:
With the exception of Australia and South Korea, age-standardized prevalence of idea CVH was lower than 10% in women and lower than 5% in men across all countries. Older individuals had a lower prevalence of Ideal CVH than younger ones. Those over 65 years of age had a prevalence almost equal to zero. In ages 35-64 years, ideal CVH prevalence ranged from 3.6% to 25.4% among women, and from 0.6% to 7.1% among men. For the 10 countries where trends were estimated by age-sex groups, ideal CVH prevalence did not change or declined in the selected middle-income countries and increased in the selected high-income countries except for South Korea, where it plateaued for men and declined for women.

Conclusions:
Prevalence of ideal CVH worldwide is low and is declining for adults in middle-income countries in recent decades.
Abstract 11391: Association Between Smoking History and Response to Rhythm Control Therapy in Atrial Fibrillation Patients Across Race-Ethnicity
Authors: Al-azzam Bahaa , Aggarwal Ishita , Barney Miles , Diaz Annette , Sreepathy Pranati , Shapiro Katherine , Darbar Dawood
Published: March 2022

Introduction:
Although smoking is associated with increased risk of developing atrial fibrillation (AF) and stroke, whether it also predicts response to rhythm control therapy across race-ethnicity remains unclear.

Hypothesis:
We hypothesize that smokers are less likely to respond to rhythm control therapy for AF than non-smokers.

Methods:
In this cohort study, patients managed with rhythm control strategy at the time of enrollment to the study were prospectively enrolled in an AF multi-center clinical-DNA biorepository. Rhythm control includes antiarrhythmic drugs (AADs) and\or catheter ablation. Successful response was defined as continuation of the same AAD for at least 6 months and/or successful catheter ablation without recurrence of AF for 12 months.

Results:
Of the 362 enrolled, 132 (36.4%) were European American, 155 (42.8%) were African- American and 75 (20.7%) were Hispanic American. 125 patients were smokers and 237 patients were non-smokers. Baseline clinical characteristics were similar in both groups (Table 1). Compared to nonsmokers, smokers were less likely to respond to rhythm control strategy (odds ratio [OR] 1.36, 95% confidence interval [CI]: 0.88-2.11, P-value: 0.07). Adjusted for the type of rhythm control, smokers were more likely to have a recurrence of AF catheter ablation as compared with nonsmokers ([OR] 1.38, 95% [CI]: 1.031-2.348, P-value: 0.044). However, there was no significant difference between smokers and non-smokers in terms of response to AADs ([OR] 1.25, 95% [CI]: 0.560-2.809, P-value: 0.292).

Conclusions:
Patients with a smoking history were less likely to respond rhythm control therapy as compared to nonsmokers. After adjusting for the type of rhythm treatment, smokers were more likely to have a recurrence of AF when compared to non-smokers but there was no difference in response to AADs between the two groups.
Abstract 11396: A Small but Significant Increased Incidence of Acute Pericarditis Identified After Vaccination for SARS-CoV-2
Authors: Knowlton Kirk U , Knight Stacey , Muhlestein Joseph B , Le Viet T , Horne Benjamin D , May Heidi T , Stenehjem Eddie , Anderson Jeffrey L
Published: March 2022

Background:
As SARS-CoV-2 vaccines are being administered on an unprecedented scale, it is critical to carefully assess risks to aid clinicians in the early detection and treatment of potential side effects. Here we examine increases in the risk of pericarditis following SARS-CoV-2 vaccination.

Methods:
We examined pericarditis cases from December 15, 2020, to April 15, 2021 seen within Intermountain Healthcare, an integrated healthcare system. Pericarditis was defined by at least two of the following criteria: chest pain, EKG changes, pericardial effusion, and pericardial rub; excluded cases secondary to non-infectious causes (e.g., AF ablation). We determined vaccination within 60 days prior to pericarditis diagnosis using Intermountain and Utah Department of Health vaccination information. Rates of pericarditis per 10 million patient days for vaccinated patients compared to unvaccinated patients were compared. We also examined a case-crossover design with 4 control dates for each pericarditis case.

Results:
Of the 29 identified pericarditis cases, 13 (44.8%) had a SARS-Cov-2 vaccination within 60 days before the onset of pericarditis. During the same period, 743,774 individuals in the Intermountain Healthcare system had received at least one dose of the SARS-CoV-2 vaccine. Thus, 1.7 per 100,000 vaccinated individuals were diagnosed with acute pericarditis. Within a 60-day post-vaccination window, the rate of acute pericarditis per 10-million patient-days was 3.90 in the vaccinated group and 0.84 in the unvaccinated group. Thus, there was a 4.49 times higher rate of acute pericarditis in vaccinated patients compared to the unvaccinated individuals (p=0.0002). Case-crossover analysis showed the odds of acute pericarditis was 3.33 higher (95% CI: 1.29, 10.14) in the vaccinated versus the unvaccinated group (p=0.01).

Conclusions:
We found acute pericarditis to be a rare post-SARS-CoV-2 vaccination event, but the risk was significantly higher than in comparable unvaccinated subjects. This risk of pericarditis post-SARS-CoV-2 vaccine is eclipsed by the risk of contracting COVID-19 and its associated, commonly seen severe outcomes. Nevertheless, clinicians should be informed of this risk to facilitate earlier recognition and treatment.
Abstract 11400: Circulating Glutathionylated Cardiac Myosin Binding Protein C as a Diagnostic Biomarker for Diastolic Dysfunction
Authors: Zhou Xiaoxu , Jeong Euy-Myoung , Liu Man , Liu Hong , Feng Feng , Dudley Samuel C
Published: March 2022

Introduction:
Cardiac myosin binding protein-C (cMyBP-C) is a thick filament-associated protein localized to the crossbridge-containing C zones of striated muscle sarcomeres, contributing to regulate cardiac contraction and relaxation. Phosphorylation status of cMyBP-C determines cardiac function, and S-glutathionylation of cMyBP-C is increased in human heart failure (HF). In animal models, we demonstrated that elevated S-glutathionylation of cMyBP-C but not phosphorylation correlates with diastolic dysfunction (DD).

Hypothesis:
S-glutathionylated cMyBP-C would be a biomarker for DD.

Methods:
Humans, African Green monkeys, and mice with DD determined by echocardiography (E/e’ ratio > X) were matched by age and gender to controls. Blood samples were acquired and analyzed for S-glutathionylated cMyBP-C by immunoblotting.

Results:
Circulating S-glutathionylated cMyBP-C in DD patients (N=28) was elevated (fold, 1.57± 0.12, P<0.01, t-test) when compared to controls (N=16). We confirmed these results in mice and monkeys with DD demonstrated by echocardiography. In DD monkeys (N=6), the circulated S-glutathionylated cMyBP-C levels were upregulated (fold, 2.7 ± 0.57, P<0.05, t-test) as compared to those in control (CTL) monkeys (N=6). Similarly, S-glutathionylated cMyBP-C was elevated (fold, 1.61 ± 0.23, P<0.05, t-test) in mice with DD (N=5) as compared to controls (N=5).

Conclusions:
Glutathionylated cMyBP-C has been associated with DD in animal models, and circulating glutathionylated cMyBP-C was elevated in humans, monkeys, and mice with DD. Glutathionylated cMyBP-C may represent a disease-specific biomarker for the presence of DD.
Abstract 11417: Association Between Community-Level Violent Crime and Cardiovascular Mortality in Chicago - A Longitudinal Analysis
Authors: Eberly Lauren A , Julien Howard , South Eugenia , Nathan Ashwin S , Dayoub Elias , Groeneveld Peter W , Khatana Sameed Ahmed A
Published: March 2022

Introduction:
Prior studies suggest an association between neighborhood crime levels and cardiovascular (CV) risk factors and disease but have been limited by cross-sectional designs. We investigated whether longitudinal changes in violent crime are associated with CV mortality at the community level in a large US city - Chicago.

Methods:
Chicago is divided into 77 community areas. Using the Illinois Department of Public Health Division of Vital Records, we obtained age-adjusted mortality rates by community area for heart disease, stroke, and coronary artery disease deaths from 2000-2014 aggregated at 5-year intervals. Annual violent crime data were obtained from the City of Chicago Police Data Portal and were geocoded to the community area level. Violent crime was defined as assault, battery, criminal sexual assault, robbery, and homicide. Using a two-way fixed effects estimator, a robust longitudinal estimation method that accounts for measured or unmeasured time-invariant confounders, we assessed the association between longitudinal changes in violent crime and CV mortality after accounting for changes in demographic (proportion of racial/ethnic minorities) and economic (household income, unemployment, housing vacancy, education attainment) variables for each community area.

Results:
Between 2000 and 2014, the median violent crime rate in Chicago decreased from 3620 per 100,000 [IQR 2256, 7777] in the 2000-2004 period to 2390 [IQR 1507, 5745] in the 2010-2014 period (p=0.005 for trend). In the fixed effects model, after accounting for changes in demographic and economic variables, a 1% increase in community-area violent crime was independently associated with a 0.21% (95% CI 0.09, 0.33) increase in heart disease deaths (p=0.0006) and a 0.19% (95% CI 0.04, 0.33) increase in deaths from coronary artery disease (p=0.01). There was no significant association between change in violent crime and stroke deaths [0.17% (95% CI -0.08, 0.42; p=0.017)].

Conclusions:
From 2000 to 2014, an increase in violent crime at the community level was associated with an increase in heart disease and coronary artery disease deaths in Chicago. Detecting rises in community-level violent crime may identify areas with worsening CV health independent of other factors.
Abstract 11429: Post-Mortem Study of the Cause of Excess Mortality in Patients with Atrial Fibrillation and Heart Failure
Authors: Tica Otilia , Tica Ovidiu , Bunting Karina V , de Bono Joseph , Gkoutos Georgios , Popescu Mircea I , Kotecha Dipak
Published: March 2022

Aims:
To provide robust data on mortality in patients with atrial fibrillation (AF) and heart failure (HF), accounting for differences in mode of death using post-mortem information.

Methods and Results:
Retrospective cohort of 1009 patients admitted to a Romanian hospital between 2014-2017, with mean age 73±11 years, 47% women, NYHA class 3.0±0.9, left ventricular ejection fraction (LVEF) 40.1±11.0% and 100% anticoagulated. The primary outcome was mortality during 1.5±0.9 years follow-up, of which 291 (29%) died. Post-mortems were performed in 186 (64%) of patients. Baseline factors associated with mortality were dependent on the cause of death. HF-related death in 136 (47%) was associated with higher NYHA class (hazard ratio [HR] 2.45 per one class increase, 95% CI 1.73-3.46; p<0.001) and lower LVEF (0.95 per 1% increase, 0.93-0.97; p<0.001). Vascular death occurred in 75 (26%) and was associated with hypertension (HR 2.83, 1.36-5.90; p=0.005) and higher LVEF (1.08 per 1% increase, 1.05-1.11; p<0.001). Non-cardiovascular death in 80 (28%) was associated with clinical obesity (HR 2.20, 1.21-4.00; p=0.010), and higher LVEF (1.10 per 1% increase, 1.06-1.13; p<0.001). Across all causes, there was no relationship between mortality and AF type (p=0.77), HF type (p=0.85) or LVEF (p=0.58).

Conclusions:
Supported by post-mortem data, the cause of death in AF and HF patients is heterogeneous, and the relationships with typical markers of mortality are critically dependent on mode of death. The poor prognosis in this group demands further attention to improve management beyond anticoagulation.
Abstract 11430: Etripamil Nasal Spray Reduces Heart Rate in Patients with Paroxysmal Supraventricular Tachycardia Prior to Conversion to Sinus Rhythm
Authors: Ip James E , Stambler Bruce S , Sager Philip T , Shardonofsky Silvia , Coutu Benoit , Pandey A Shekhar , Mondesrt Blandine , Verma Atul , Plat Francis , Chen Michael , Camm Alan J
Published: March 2022

Introduction:
Etripamil (E) is a rapidly and short acting, nasally administered calcium channel blocker being developed to terminate AV nodal-dependent PSVT. The NODE-301 first in class, multicenter study, evaluated self-administration of E nasal spray 70 mg outside a healthcare environment for acute termination of PSVT. This post-hoc analysis addresses the effect of E on heart rate (HR) during PSVT prior to conversion to sinus rhythm (SR).

Methods:
In NODE-301, 156 subjects experienced a vagal-maneuver refractory, symptomatic episode of confirmed PSVT, 107 subjects self-administered E and 49 placebo (P) (2:1 randomization) during PSVT. Each PSVT was documented by an ambulatory cardiac monitoring system that was placed on the chest after symptoms began. Baseline (average of four values before drug administration), and every minute of HR data were captured from baseline until one minute before the PSVT was converted to SR. Adequate HR data were available for 150 subjects, 102 on E and 48 on P. Six subjects were not included in this analysis, 4 converted before one minute (3 E and 1 P) and 2 E subjects experienced an early defect of recording.

Results:
Baseline mean (±SE) HR were 179 (±2.8) and 174 (±4.0) bpm for E and P respectively. Mean change in HR from baseline was greater in the E group than P group (
p
<0.0001). This decrease appeared within the first minute (-5 bpm ±0.9), 3 min (-10 bpm ±1.2), 10 min (-16 bpm ±2.1), 30 min (-14 bpm ±3.4) and 40 min (-13 bpm ±2.9) after E administration. The notable decrease in the E group was sustained through the 60minute observation period. A statistically significant difference in HR was reached between E and P notably at 3 (
p
<0.03), 10 (
p
<0.0001), 30 (
p
<0.0002), and 40 min (
p
<0.004).

Conclusion:
Etripamil significantly decreases the HR in PSVT prior to conversion to SR and is sustained over the 60 min observation. This finding may provide clinical benefits to patients for self-management of PSVT.
Abstract 11435: A New Paradigm in Therapy: A Vaccine Against the Progression of Heart Failure
Authors: Youker Keith A , Shen Haifa , Bhimaraj Arvind , Torre-Amione Guillermo
Published: March 2022

Introduction:
Many therapies have been used to treat the underlying causes of heart failure (HF) and alleviate the symptoms but often the heart failure continues to progress until death or transplant. We have identified a new target which may be a key element in the continued progression and have used a vaccine approach to limit its downstream effects.

Methods:
We used a non-ischemic mouse model of heart failure which included NaCl and L-NAME in the drinking water with implantation of an osmotic pump filled with Angiotensin II to create a hypertensive model of heart failure. The vaccine group (HA Vaccine) was vaccinated with recombinant HSP60 protein along with a potent form of ALUM adjuvant prior to initiation of heart failure.

Results:
The vaccinated mice demonstrated an increase in antibodies to HSP60 and a decrease in the apoptosis rate (Tunnel positive cells/10X field Control=2.0, HF=10.8, HA Vaccine=2.5). There was also a decrease in interstitial fibrotic area in the left ventricle (Control=0.8%, HF=4.3%, HA Vaccine=2.6%); as well as a decrease in heart weight and myocyte size in the vaccinated group. These changes resulted in preservation of cardiac ejection fraction (Control=62%, HF=40%, HA Vaccine=58%) as measured by MRI.

Conclusions:
As far as we know, this is the first time a vaccination approach has been used to address heart failure. It is also the first time the endogenous protein HSP60 has been a target for therapy in heart failure. Our data demonstrates a dramatic reduction in heart failure in mice in response to a vaccine against HSP60.
Abstract 11440: Subclinical Cardiovascular and Non-Cardiovascular Risk Factors for Heart Failure with Preserved and Reduced Ejection Fraction in Black Americans: The Jackson Heart Study
Authors: Zhao Li , Zierath Rani , John Jenine , Claggett Brian , Hall Michael E , Clark Donald , Butler Kenneth R , Correa Adolfo , Shah Amil M
Published: March 2022

Introduction:
Heart failure (HF) disproportionately burdens Black Americans. The contributions of impairments in cardiovascular (CV) and non-cardiovascular (non-CV) function to incident HF with reduced (HFrEF) and preserved (HFpEF) ejection fraction in this group remain unclear.

Methods:
Among 4,356 Black participants in the Jackson Heart Study (JHS) free of prevalent HF at visit 1 (2000-2004), multivariable Cox proportional hazard models were employed to assess the associations of measures of CV and non-CV organ function with incident HF, HFpEF, and HFrEF over a median follow-up of 13 years. Systems considered included: CV: left ventricular (LV) structure (mass index; LVMI), LV systolic function (LVEF), LV diastolic function (left atrial diameter; LAD), systemic arterial function (pulse pressure; PP); Non-CV: pulmonary function (percent predicted FEV1; ppFEV1), renal function (eGFR), body composition (waist circumference), and dysglycemia (hemoglobin A1c; HbA1c). Model covariates included age, sex, hypertension, diabetes, smoking status, and coronary disease history.

Results:
Average age was 54±13 years and 64% were women. Over median 13 (IQR 12-14) years follow-up, incident HF occurred in 315 participants (152 HFpEF, 134 HFrEF, 29 unknown LVEF). In multivariable models incorporating measures reflecting each organ system, significant predictors of incident HFpEF included greater LAD, higher PP, lower ppFEV1, lower eGFR, larger waist circumference, and higher HbA1c (Figure). Predictors of incident HFrEF included greater LVMI, lower LVEF, and lower eGFR. eGFR was the only independent predictor of both HFpEF and HFrEF.

Conclusion:
Subclinical impairments in CV and non-CV organ function differentially associate with risk of incident HFpEF and HFrEF among Black Americans. These findings support partially distinct mechanisms underlying HFrEF and HFpEF, and a greater contribution of multisystem non-cardiac impairments to HFpEF in particular.
Abstract 11449: Classifying Multiple Cardiac Signals Simultaneously Using Radial Basis Function Neural Networks
Authors: Araujo Queiroz Jonathan A , Rocha Priscila L , Silva Luis Fillype d , Barreiros Marta d , Sousa Gean , Carvalho Christian D , Barros Allan Kardec
Published: March 2022

Introduction:
Classifying multiple cardiac signals simultaneously is still a challenge for computational methods. We propose a computational algorithm that performs a multi-class classification. We use a combination of global features of the electrocardiogram (ECG) signal, where we statistically analyze the complete signal, as well as include the local features of the cardiac cycles.

Methodology:
286 ECG signals obtained from the MIT-BIH Database were evaluated:18 healthy, 48 with arrhythmia, 23 with Atrial Fibrillation, 70 with apnea, 78 with supraventricular arrhythmias, 15 with congestive heart failure, 11 with epilepsy, 5 with fetal electrocardiogram, 18 with ventricular tachyarrhythmia. For each of the 286 signals, 1200 cardiac cycles from a total of one second measurement were used, characterized by 400 milliseconds before and 600 milliseconds after the R wave. We calculated variance, skewness and kurtosis from the 286 signals, extracting 1200 features from the cardiac cycles for each of the ECG signals. These hyperparameters were used as input for the Radial Basis Function Neural Networks (RBF), where 80% were for training and 20% for testing, with cross-validation of K-fold = 10. The RBF had one hidden layer with error correction by mean squared error, number of iterations equal to 1000, number of neurons equal to 25 and learning rate 0.01.

Results:
Each group of cardiac signals evaluated in this study had its own features and, therefore, had unique parameters for each of the different pathologies in a three dimensional plot, as illustrated in the figure. The average accuracy of the proposed method for multi-class classification of cardiac signals was 99.98 %.

Conclusion:
The high success rate in the multi-class classification for eleven classes of cardiac signals makes the proposed methodology an promising alternative to aid in the diagnosis of cardiac pathologies.
Abstract 11485: Left Ventricular Dimensions and Cardiovascular Outcomes in Systolic Heart Failure: The WARCEF Trial
Authors: Ito Kazato , Li Siyuan , Homma Shunichi , Thompson John L , Buchsbaum Richard , Matsumoto Kenji , Anker Stefan D , Qian Min , Di Tullio Marco
Published: March 2022

Introduction:
There is limited information on the association between left ventricular (LV) dimensions and cardiovascular (CV) outcomes in patients with heart failure with reduced LV ejection fraction (HFrEF) receiving recommended HF treatment. We investigated the association between LV dimensions and CV outcomes in HFrEF patients receiving recommended HF treatment.

Methods:
We investigated the association between LV echocardiographic dimensions and CV outcomes using conventional Cox models in 1138 HFrEF patients in sinus rhythm randomized to warfarin or aspirin treatment in the WARCEF (Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction) trial.

Results:
LV enlargement, whether by diameter (LV end-diastolic diameter index: LVEDDI, and LV end-systolic diameter index: LVESDI) or volume (LV end-diastolic volume index: LVEDVI, and LV end-systolic volume index: LVESVI), was independently associated with all-cause death [LVEDDI: hazard ratio (HR) per cm/m
2
1.53, LVESDI: HR per cm/m
2
1.65, LVEDVI: HR per 10 ml/m
2
1.07 and LVESVI: HR per 10 ml/m
2
1.10; all p-values < 0.001], CV death (HR 1.68, 1.79, 1.09 and 1.12, respectively; all p-values < 0.001) and HF hospitalization (HR 1.59, 1.79, 1.06 and 1.08, respectively; all p-values < 0.001). No association was observed with myocardial infarction or stroke. The associations were independent of LV ejection fraction values, and incremental to them. LV volumes conferred additional predictive value over LV diameters.

Conclusions:
LV enlargement is an independent predictor of CV events in patients with HFrEF and recommended HF treatment. LV dimensions should be considered in the risk assessment.
Abstract 11506: Optimal Detection of Ascending Aorta Aneurysms in Obese Patients
Authors: Thodeti Sathwika , Drenic Deni , Yim Michael , Godel Ariel , Vallabhaneni Sanjay , mikolich brandon , Mikolich J Ronald
Published: March 2022

Introduction:
Obesity is a known risk factor for the development of aneurysm of the ascending aorta (AscAoA). 2-D echo is the most commonly used cardiac imaging modality. 2-D Echo has a limited 90-degree field of view, and the ascending aorta may not be well visualized. Obesity causes further compromise of the field of view, as the 2-D transducer cannot be positioned in the rib space. Cardiac MRI (CMR) does not have this limitation. This study was designed to assess the detection of aneurysm of the ascending aorta in obese patients comparing 2-D echo and CMR.

Hypothesis:
Because of full field of view capability, CMR may be superior to 2-D Echo for the detection of aneurysm of ascending aorta in obese patients.

Methods:
An institutional cardiac imaging database was queried for all obese patients with a BMI greater than/equal to 30. The study cohort was composed of obese patients who had a 2-D and CMR within a 6-month period. The number of patients with AscAoA, defined as ascending aorta diameter >3.5 cm measured perpendicular to flow, was computed for both 2-D and CMR modalities. Detection rates for AscAoA were statistically compared using McNemar test.

Results:
Of the 6930 patients in the cardiac imaging database, 4373 were obese, of which 275 had both 2-D and CMR within a 6-month period, constituting the study cohort. Only 32 of 275 patients had a 2-D Echo report with an entered value for the diameter of the ascending aorta (10.6%), an indicator of the technical difficulty encountered when measuring the ascending aorta with 2-D Echo. Conversely, 274 patients had a CMR report with an entered diameter value for the ascending aorta (99.64%). The formal CMR report identified 167 AscAoA among the 275 patients in the study cohort, for a detection rate of 58.9%. 2-D Echo only identified 12 patients with an AscAoA in the same patient cohort, for a detection rate of 4.36%. The detection rate of aneurysm of the ascending aorta was significantly different between the 2 modalities (p-value <0.001).

Conclusions:
Despite 2-D and CMR offering similar diagnostic information regarding left ventricular function and valve function in obese patients, CMR reports a numeric value for the ascending aorta diameter 8 times more often than 2-D, and CMR detects AscAoA 13 times more often than 2-D in obese patients.
Abstract 11522: The Risk of Cardiovascular Diseases in Women with Recurrent Pregnancy Loss: A Systematic Review and Meta-Analysis
Authors: Peng Bo , Wang Hong Yu , Kaye Decontee , Cho Yeonjoo , Goulet Delaney , Hansen Matthew , Goulet Dennis
Published: March 2022

Introduction:
Recurrent pregnancy loss (RPL) is defined as two or more ultrasound confirmed pregnancy losses or three or more pregnancy losses at any location. Evidence suggests that women with a history of RPL have an increased risk of coronary heart disease. However, the association between cardiovascular diseases (CVD) and RPL remains unclear. We aim to conduct a systematic review and meta-analysis to investigate whether RPL is a risk factor for CVD.

Methods:
Population-based studies on MEDLINE, CINAHL, Web of Science, and Embase that investigated the risk of CVD in women with or without a history of RPL were included. The incidences of CVD events and its composite endpoints myocardial infarction/coronary heart diseases (MI/CHD), stroke/cerebrovascular diseases (stroke/CeVD), circulatory system diseases (CSD) were extracted and presented with odds ratio (OR) with 95% confidence interval (CI). Heterogeneity was analyzed with I
2
.

Results:
A total of 809 articles were retrieved and 6 studies were included. The incidences of CVD events was significantly increased (OR=1.49, 95% CI 1.11 to 1.99, P=0.008, I
2
=96%) in 13176 women with RPL (≥2 pregnancy losses) compare to 403278 controls; a borderline increase of MI/CHD risk was also found (OR=1.45, 95% CI 1.00 to 2.08, P=0.05, I
2
=78%), whereas no significant differences of stroke/CeVD (OR=1.25, 95% CI 0.79 to 1.98, P=0.35, I
2
=73%) and CSD risks (OR=1.17, 95% CI 0.83 to 1.67, P=0.05, I
2
=93%) were observed. In 1594 women with three or more pregnancy losses, an increased incidence of CVD events was found compared to 311385 women without (OR=1.59, 95% CI 1.04 to 2.40, P=0.03, I
2
=71%). The risks of MI/CHD (OR=3.03, 95% CI 1.45 to 6.35, P=0.003, I
2
=78%) and stroke/CeVD (OR=1.63, 95% CI 1.38 to 1.93, P<0.00001, I
2
=0%) were significantly increased in these women but not CSD (OR=1.27, 95% CI 0.92 to 1.76, P=0.13, I
2
=57%).

Conclusion:
Our study suggested an association between RPL and increased risks of CVD and MI/CHD. The risks of stroke/CeVD may be elevated in women with three or more pregnancy losses. Our work provides a better understanding of the sex-specific risk factors of CVD. Further research may help to identify the causal link between RPL and CVD and determine the need for early screening and intervention in women at risk.
Abstract 11528: Predictors of Ventricular Arrhythmia in Mitral Valve Prolapse
Authors: Chaudry Abdul , Sivaraj Krishan , Weickert Thelsa , Syed Faisal
Published: March 2022

Introduction:
The arrhythmic form of mitral valve prolapse (AMVP) is characterized by complex or frequent ventricular arrhythmia (cfVA) and associated with increased risk of sudden cardiac death (SCD) from ventricular fibrillation, the majority of reported cases of SCD being in premenopausal women. There is limited data on prevalence and predictors of AMVP.

Methods:
We studied all 645 patients aged 18 to 90 years with mitral valve prolapse (MVP) on echocardiography between 2016-2019 at our institution (median age [IQR] 63.6 [51.9-73] years; 52.4% female; 16.2% African American). Echocardiogram images were reviewed to analyze valve morphology, mitral regurgitation (MR) severity and ventricular structure and function. cfVA was identified from resting and ambulatory ECG tracings. These and cardiovascular risk factors associated with cfVA were analyzed using multivariate logistic regression.

Results:
cfVA was present in 188 (29.1%) MVP patients. Independent predictors of cfVA were mitral annular disjunction (MAD, odds ratio [OR, 95% CI] 2.45 [1.48 – 4.06], p=0.0005), bi-leaflet prolapse (2.10 [1.42 – 3.11] vs. uni-leaflet, p=0.0002), inferior ECG T-wave inversion (TWI, 1.79 [1.17-2.75], p=0.007) and moderate+ MR (1.52 [1.01-2.27], p=0.044). AMVP, defined as bi-leaflet MVP with cfVA, was present in 102 (15.8%), with MAD in 38 (37.3%, vs. 58 [10.7%] without AMVP, p<0.0001), inferior lead TWI in 45 (44.1%, vs. 97 [17.9%], p<0.0001) and moderate+ MR in 47 (46.1% vs 134 [24.7 %], p<0.0001). After median 1221 (IQR 1013 – 1456) days follow-up, 12 with AMVP died (11.7%, vs. 45 [8.3%] without, p=0.256) with SCD in 2 (2.0%, vs. 4 [0.9%], p=1.00).

Conclusion:
Ventricular arrhythmia in MVP is predicted by MAD, bi-leaflet prolapse, inferior ECG TWI and MR. These findings may help identify otherwise asymptomatic individuals, such as premenopausal women with MVP, at increased risk of SCD.
Abstract 11535: Persistent Qt Prolongation After Doxorubicin Administration at Doses Similar to Adjuvant Breast Cancer Therapy in African Green Monkeys
Authors: Bodziock George , Melendez Giselle C
Published: March 2022

Introduction:
Cancer patients undergoing doxorubicin (Dox)-based chemotherapy often experience cardiac repolarization abnormalities, including electrocardiography (ECG)-derived QT and corrected QT (QTc) interval prolongation, which increases the risk for life-threatening arrhythmias such as torsades de pointes. We have previously reported that African Green monkeys exhibit CMR-derived myocardial fibrosis long-term after receiving Dox at doses similar to those experienced by women treated for breast cancer. Here, we sought to determine if QT/QTc prolongation persists after treatment cessation and its association with myocardial fibrosis.

Methods:
Five female African Green AGMs (AGMs) aged 13±1 years received Dox (30 - 60 mg/m
2
/ biweekly IV, total cumulative dose: 240 mg/m
2
) and underwent 12-lead ECG and CMR imaging with pre- and post-contrast T1 maps from which extracellular volume (ECV) was calculated, before and 15 weeks after the final dose of Dox treatment. A blinded paired and correlation analysis was performed on ECG-derived heart rate (HR), QRS, QT, QTc interval durations and ECV.

Results:
After Dox, all monkeys exhibited increased QT (BL: 323.2 ± 27.4 ms vs. Post-Dox: 366.4 ± 18.7 ms, p=0.002) and QTc (BL: 440.2 ± 22.8 ms vs. Post-Dox: 500.8 ± 22.0 ms, p=0.009) intervals, without any significant changes in HR or QRS duration (p=0.92 and p=0.47 respectively). Longer QTc intervals were associated with increases in ECV (
r
=0.58, p=0.05) (Figure).

Conclusions:
AGMs that received Dox - in a fashion similar to adjuvant anthracycline chemotherapy for breast cancer- exhibited longer QT and QTc intervals associated with myocardial fibrosis. Our study suggests this may not be solely due to transient ion channel disruption from Dox but rather from persistent changes in the electrophysiological properties of cardiomyocytes and the extracellular matrix. Future longitudinal studies are needed to determine the clinical significance of these findings.
Abstract 11538: Impact of Family History of Premature Coronary Artery Disease on Non-Invasive Testing in Stable Chest Pain: A PROMISE Analysis
Authors: Raygor Viraj , Ayers Colby , Segar Matthew W , Agusala Kartik , Khera Amit , Pandey Ambarish , Joshi Parag H
Published: March 2022

Introduction:
Family history (FH) of premature CAD is a risk enhancer for adverse cardiovascular events. The preferred testing strategy to diagnose CAD in this high-risk population presenting with stable chest pain is unknown.

Methods:
This was a secondary analysis of the PROMISE trial, which randomized participants with stable chest pain to coronary computed tomographic angiography (CCTA) versus functional stress testing for the diagnosis of CAD and followed them for incident CV death or MI. Statistical analyses included logistic regression and Cox proportional hazard modeling. The effect of FH of premature CAD on the relationship between non-invasive testing modality and incident CV death or MI was assessed using interaction testing.

Results:
Patients with FH of premature CAD (n=3,098) were younger (58y vs 60y, p<0.001) and more likely to be women (57% vs 51%, p<0.001) than those without (n=6,584). They also had higher LDL-c levels (115 vs 112 mg/dL, p=0.01) and were more likely to be on aspirin (46% vs 44%, p=0.05) and a statin (48% vs 44%, p<0.001) at baseline. Over a median follow-up of 2.1 years, 60 (1.9%) participants with and 148 (2.3%) participants without FH of premature CAD had a primary outcome event. FH of premature CAD was not associated with an increased risk of the primary composite outcome (HR 1.01; 95% CI 0.66, 1.57). There was no significant difference in CV death or MI whether patients underwent CCTA or functional stress testing, irrespective of FH of premature CAD (FIGURE; FH: 1.9% vs 2.0%, No FH: 2.2% vs 2.3%; interaction p-value=0.8).

Conclusions:
In patients with FH of premature CAD presenting with stable chest pain, an initial strategy of using CCTA to diagnose CAD is similar to functional testing for adverse cardiovascular outcomes.