bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 19979: Endothelium-specific Increase in ROS has Protective Effects on Vascular Endothelium in Ischemic Myocardium
Authors: Shafique Ehtesham , Reichert Karla , Colantuono Bonnie , Torina Anali , Harrington Elizabeth , Sellke Frank , Abid Ruhul
Published: July 2021

Introduction:
Increased ROS is often associated with vascular pathology. Recent findings demonstrated that increases in NADPH oxidase-derived endothelium (EC)-specific ROS improved coronary endothelial function by activating AMPK-eNOS signaling pathway. Here, we examined the effects of EC-ROS on vessel density in post-infarct ischemic myocardium.

Hypothesis:
We tested the hypothesis that increased EC-ROS induces AMPK-FOXO1-mediated overexpression of mitochondrial antioxidant MnSOD, which in turn has protective effects on vascular endothelium in ischemic myocardium.

Methods:
Our binary (Tet-ON/OFF) conditional transgenic mouse (Tet-Nox2:VE-Cad-tTA) induces 1.8±0.42-fold increase in NADPH oxidase-derived ROS in endothelium. Using these animals, we have induced myocardial infarction by LAD (left anterior descending) ligation.

Results:
Co-immunostaining of the ischemic myocardium using anti-CD31 and anti-SMA antibodies demonstrated that there was an increase in capillary density (by 38± 6.45; p<0.05) in Tet-Nox2:VE-Cad-tTA mice with high EC-ROS. Isolated mouse heart ECs showed an increase in AMPK-Foxo1-mediated expression of MnSOD in Tet-Nox2:VE-Cad-tTA mice compared to control. Together, these findings suggest that increase in EC-ROS increases mitochondrial antioxidant MnSOD, which in turn protects coronary endothelium in myocardial ischemia.

Conclusion:
This study demonstrates that the endothelial ROS may play an important role in myocardial preservation.
Abstract 19981: Relationship of Cardiorespiratory Fitness and Adiposity With Left Ventricular Peak Systolic Strain in Middle-age Adults: The Dallas Heart Study
Authors: Pandey Ambarish , Ayers Colby , Neeland Ian J , Matulevicius Susan , Rohatgi Anand , Peshock Ronald , Drazner Mark , Sarma Satyam , De Lemos James , Berry Jarett D
Published: July 2021

Introduction:
Low cardiorespiratory fitness (CRF) and obesity are associated with an increased risk for heart failure (HF). However, the mechanisms through which CRF and adiposity might increase HF risk are not fully understood. Because impaired left ventricular (LV) peak systolic strain is an early subclinical marker of HF, we evaluated the association of CRF and adiposity with LV peak systolic strain.

Methods:
We studied Dallas Heart Study-II participants without cardiovascular disease who had CRF estimated as the peak oxygen uptake from a submaximal treadmill test using the Givoni’s equation and Hellerstein’s formula and total body fat measured by dual x-ray absorptiometry. The participants also had ECG-gated tissue-tagged cardiac MRI imaging using 3-T MRI. Peak mid-wall systolic circumferential strain (Ecc) was determined by harmonic phase imaging. Associations of CRF and measures of overall adiposity [percent body fat (%BF)] and visceral adiposity [waist circumference (WC)] with Ecc were determined using multivariable adjusted linear regression analysis.

Results:
A total of 1,493 participants (57% women, 42% African Americans) were included in the analysis. After adjustment for baseline risk factors, higher LV mass (β = 0.17; P< .0001), lower ejection fraction (β = -0.32; P = < .0001), higher hs-cTnT levels (β = 0.06; P= 0.04), and lower CRF (β = -0.16; P< .0001) were each associated with higher Ecc (indicating worse systolic function). Higher WC was also significantly associated with higher Ecc (β = 0.07; P= .0006) while %BF was not associated with Ecc (P= 0.08). The relationship between CRF and Ecc did not change after additional adjustment for %BF and other significant confounders (Table).

Conclusion:
Lower CRF, but not total body fat, is associated with reduced peak systolic strain independent of LV mass and ejection fraction.These findings highlight the independent contributions of low fitness in mid-life towards heart failure risk at a later age.
Abstract 20008: Echoing Plaque Activity of Coronary Artery With Intracranial Artery in Acute Ischemic Stroke Patients: Coronary CT Angiography and High-resolution MR Imaging Study
Authors: Chung Jong-Won , Cha Jihoon , Choi Jin-Ho , Choe Yeon Hyeon , Bang Oh Young
Published: July 2021

Background:
Atherosclerosis is a systemic disease, and both coronary and intracranial atherosclerosis are common in elderly. Unlikely to coronary artery disease (CAD), intracranial atherosclerotic disease (ICAD) can cause stroke by branch occlusive disease-type (B-type ICAS), subcortical infarcts caused by parent arterial disease occluding perforator’s orifice as well as coronary type rupture of plaque (C-type ICAS).Vascular pathophysiology of coronary atherosclerosis in relationship with different phenotypes of intracranial atherosclerosis is unknown.

Methods:
We prospectively recruited 69 patients with acute cerebral infarcts caused by ICAS who had no history of CAD. Patients underwent both cardiac multidetector computed tomography (MDTC) and brain high-resolution MRI (HR-MRI). Symptomatic steno-occlusive intracranial artery at the maximal stenosis on MRA was analyzed in terms of vascular morphology (stenosis degree, remodeling index, and wall index) and activation (enhancement pattern and volume) using HR-MRI. Asymptomatic CAD burden (number and degree of stenosis) and plaque characteristics (calcified, mixed, and non-calcified) were measured with MDCT. The degree of asymptomatic ICAD was also measured in each patient (number of stenotic arteries and degree of stenosis).

Results:
The mean age of the patients were 65.1±1.5 years, 59.4% were male, and 35 (51.7%) were diagnosed with C-type ICAS. Asymptomatic CAD was observed in most patients, and increase in CAD burden was associated with increased asymptomatic ICAD (p<0.01). Overall CAD burden were not different between B-type and C-type ICAS. However, prevalence of non-calcified coronary plaque were much higher in C-type ICAS (35.3% vs 62.9%, p=0.02). C-type ICAS group also showed higher degree of stenosis (40.4 ±34.5 vs 77.3±17.3, p<0.001), increased positive remodeling index (1.0±0.3 vs 1.3±0.5, p=0.03), and larger proportion of vessels with enhancement (73.5% vs 97.1%, p<0.01) in cerebral arteries compared to B-type ICAS. Conclusions: Plaque characteristics of intracranial and coronary behave in same way. Further studies are needed to find systemic factors associated both intracranial and coronary plaque progression.
Abstract 20082: Feasibility of His Bundle Pacing in Patients Meeting Criteria for Cardiac Resynchronization Therapy and Implantable Cardioverter-defibrillator
Authors: Ajijola Olujimi A , Macias Carlos , Garg Vinisha , Vorobiof Gabriel , Mally Alison H , Shivkumar Kalyanam , Tung Roderick
Published: July 2021

Objective:
The role of His bundle pacing to physiologically narrow QRS duration in patients meeting criteria for CRT/CRT-D is not well understood.

Methods:
Patients with CRT/CRT-D indication with failed CS lead placement, suboptimal coronary venous targets, or those who opted for His bundle pacing underwent implantation of a His bundle lead, along with an RV defibrillator lead if indicated. In all patients, the His bundle pacing lead was placed into the LV lead port with CRT pulse generator. The LV-RV offset was programmed at maximum, with RV lead subthreshold to minimize fusion. An atrial lead was implanted if the patient was not in permanent atrial fibrillation.

Results:
Thirteen patients (65±18 years, 7 males, mean LVEF 27.3±8.9%, QRS duration 180±30ms, and 11 with LBBB) underwent His bundle pacing. The mean PR interval in this cohort was 220±111ms, 3 patients had complete heart block, 3 had permanent atrial fibrillation, and 9 required ICD placement. The His pacing lead (Medtronic 3830 Select Secure) was successfully placed in 12 of 13 patients, with narrowing of the QRS duration to 120±23ms (p<0.0001). No complications or lead dislodgements were seen. At 6-month follow up, LVEF increased by an average of 18.7%, and left ventricular internal dimension in diastole(LVIDd) decreased by 0.9cm. Echocardiographic global longitudinal strain improved from -9.1 to -10.5%.

Conclusions:
In patients meeting criteria for CRT/CRT-D implantation, QRS narrowing achieved by His bundle pacing is feasible, and is associated with favorable mechanical and clinical outcomes.
Abstract 20116: The Impact of Atrial Fibrillation Type on the Risk of Thromboembolism, Mortality and Bleeding: A Systematic Review and Meta-analysis
Authors: Ganesan Anand , Chew Derek , Hartshorne Trent , Selvanayagam Joseph B , Aylward Philip , Sanders Prashanthan , McGavigan Andrew D
Published: July 2021

Introduction:
Thromboembolic risk stratification schemes and clinical guidelines for atrial fibrillation regard risk as independent of classification into paroxysmal (PAF) and nonparoxysmal atrial fibrillation (NPAF). The aim of the current study was to conduct a systematic review and meta-analysis evaluating the impact of AF type on thromboembolism, bleeding and mortality.

Hypothesis:
AF type would predict rates of thromebolism, mortality and bleeding.

Methods:
Pubmed was searched for randomized controlled trials, cohort studies, and case series reporting prospectively collected clinical outcomes stratified by AF type. The incidence of thromboembolism, mortality and bleeding was extracted.

Results:
AF clinical outcome data was extracted from 12 studies containing 99,996 patients. The pooled unadjusted risk ratio (RR) for thromboembolism in NPAF vs. PAF was RR 1.339 (95% CI: 1.140-1.644, P<0.001). In studies providing estimates of thromboembolism risk adjusted for baseline clinical risk factors, the pooled adjusted hazard ratio (HR) in NPAF vs. PAF was HR 1.384 (95% CI, 1.191-1.608, P<0.001). The pooled unadjusted risk ratio for all-cause mortality in NPAF vs. PAF was RR 1.462 (95% CI: 1.255-1.703 P<0.001). The pooled adjusted HR for all-cause mortality in NPAF vs. PAF was HR 1.217 (95% CI: 1.085-1.365, P<0.001. Rates of bleeding in NPAF and PAF were similar, unadjusted RR 1.00 (95% CI 0.919-1.087, P=0.994), pooled adjusted HR 1.025 (95% CI: 0.898-1.170, P=0.715).

Conclusions:
These data suggest a need for re-evaluation of the paradigm of thromboembolic risk equivalence between PAF and NPAF, and emphasize AF type as a powerful predictor of AF-related morbidity and mortality. Future studies exploring integration of AF type into thromboembolic risk models are needed.
Abstract 20133: Not All ST Elevations Mandate Emergent Catheterization: A Case Report of Brugada Syndrome Induced by Severe Hyponatremia
Authors: Martinez Jasmin , Dayanand Sandeep , Kabach Mohamad , Dayanand Pradeep , Borzak Steven
Published: July 2021

Introduction:
Brugada syndrome is a rare channelopathy, which is familial or sporadic in occurrence. Typical ECG findings of Brugada pattern consist of a pseudo-right bundle branch block and persistent ST segment elevation in leads V1 to V2. While fever, stressors and sodium channel blockers have been implicated in unmasking the underlying rhythm, only 2 cases of hyponatremia precipitating Brugada Syndrome have been reported to date. Here in, we report a case of a 61 y/o woman who underwent emergent cardiac catheterization after her EKG demonstrated ST elevation in the anterior leads. Eventual work up revealed Brugada Syndrome induced by hyponatremia. Case: A 61 y/o woman with a known medical history of hyponatremia from chronic alcohol abuse was found to be unresponsive at home. EKG performed by paramedics revealed ST elevation in anterior leads. Based on the EKG and the patient’s presentation, a probable diagnosis of cardiac arrest from ischemic heart disease was made and a decision for emergent cardiac catheterization was made. Catheterization revealed, mild non-obstructive coronary artery disease. The patient was transferred to ICU for further care where she continued to remain unresponsive. Initial work up revealed severe hyponatremia, with a serum sodium of 103. The rest of her electrolytes were within normal limits. Detailed review of her presenting EKG revealed that she had “coved” pattern of ST elevation in the anterior leads. Her severe hyponatremia was corrected with hypertonic saline. Subsequent EKG’s after partial correction of hyponatremia demonstrated resolution of abnormal EKG changes.

Conclusion:
The patient described in this case had a cardiac arrest most likely from sustained ventricular tachycardia secondary to a brugada pattern. Hence, hyponatremia should be recognized as an important etiology in the list of causes that unmask a Brugada pattern in patients with this channelopathy.
Abstract 20168: Enhanced Endothelial Nitric Oxide Production and Cardiac Dysfunction in an Inducible Endothelial-Specific miR-130a Mouse Model
Authors: Harmon Cynthia , Mazurek Stefan , Kim Gene
Published: July 2021

Introduction:
MicroRNA-130a (miR130a) has been shown to be important in cardiovascular gene regulation in both normal and diseased states. We recently reported on the regulation of connexin43 by miR130a.

Methods:
We created an inducible mouse model to express miR-130a in endothelial cells under the control of the VE-cadherein promoter (VE-cad-miR130a). Overexpression of miR-130a was initiated in adult mice at weaning, approximately 4 weeks post-birth.

Results:
Survival analysis revealed >50% mortality by 9 weeks of age with overexpression of miR-130a. By 9 weeks of age, LV function was reduced (26.4% ± 4 vs 33.6% ± 6 in controls, p<0.001, n=10). Prior to the onset of LV dysfunction; we found numerous abnormalities in cardiac function. First, we noted significant bradycardia on ambulatory telemetric recordings (389bpm ± 90 vs 534bpm ± 72 in controls, p<0.0001, n=3). Moreover, the cardiac response to β-AR stimulation was blunted in VE-Cad-miR130a mice relative to control when challenged with isoproterenol. Interestingly, sinus node recovery time was significantly prolonged, supportive of sinus node dysfunction. While predominately in sinus rhythm, we found episodes of spontaneous atrial tachyarrhythmias, which were confirmed on invasive electrophysiologic testing. To investigate further, we performed patch clamp measurements of action potential duration (APD) in atrial cariomyocytes. APD was significantly prolonged in VE-Cad-miR130a myocytes (APD90 325ms vs 60ms, p<0.00001, n=3). Next, we performed invasive blood measure measurements and found a significant decrease in mean arterial blood pressure (76.9mmHg ± 3 vs 94.3mmHg ± 5 in controls, p<0.01, n=4). Based on previous reports of increased nitric oxide in the setting of loss of endothelial connexin43, we found significant elevation of NO concentration in VE-Cad-miR130a. Inhibition of NO synthase via IP administration of L-NAME increased MAP in VE-Cad-miR130a to a maximum steady-state mimicking that of control mice.

Conclusions:
Overexpression of miR-130a in endothelial cells promotes impaired cardiovascular function and abnormal atrial conduction. These results suggest a newly identified role for endothelial miR-130a in the development of hypotension and cardiac dysrhythmias.
Abstract 20170: Plasma Apolipoprotein C-III Levels Correlate With Malignant HDL-Lipid Composition Associated With Coronary Artery Disease in Primary Dyslipidemia
Authors: Nohara Atsushi , Inazu Akihiro , Kawashiri Masa-aki , Tada Hayato , Yoshida Mie , Mori Mika , Nakanishi Chiaki , Yagi Kunimasa , Kobayashi Takeshi , Yamagishi Masakazu , Mabuchi Hiroshi
Published: July 2021

APOC3 has been focused as an emerging therapeutic target beyond LDL. ApoC-III circulates in blood on TG-rich lipoprotein and also on HDL. ApoC-III inhibits LPL activity that is essential for HDL maturation. We investigated the roles of plasma apoC-III on HDL-lipid composition beyond simple HDL-C.

Methods:
Fasting lipid profiles without lipid drugs were analyzed by ultracentrifugation, and free cholesterol (FC), cholesterol ester (CE), triglycerides (TG) and phospholipids (PL) levels in each fraction were determined. 500 patients (285 males, age 56±18 ys, TC 225±51, TG 168±146, HDL-C 50±15 mg/dL) with primary dyslipidemia (Dyslipidemia Group), and also 171 patients (96 males, age 39±19, TC 338±60, TG 126±98, HDL-C 49±15) with genetically confirmed heterozygous familial hypercholesterolemia (FH Group) were analyzed. Coronary stenosis index (CSI) was estimated with angiography in 195 patients (125 males, age 62±11) in Dyslipidemia and 54 patients (29 males, age 53±14) in FH Group.

Results:
ApoC-III correlated with TG, LDL-C, fasting glucose, and BMI in both groups as previously reported. Plasma apoC-III levels were slightly higher in Dyslipidemia Group (12±7 vs. 11±4 mg/dL,
p
<0.01). ApoC-III did not correlate with HDL-C, but negatively correlated with apoAI/AII ratio in Dyslipidemia Group (R
2
15%,
p
<0.0001). In HDL composition, apoC-III strongly correlated with HDL-TG/HDL-PL ratio (R
2
30%,
p
<0.0001) rather than HDL-TG (R
2
25%,
p
<0.0001). ApoC-III did not correlated with HDL-FC, HDL-CE, or HDL-PL, but negatively correlated with HDL-FC/HDL-PL (R
2
9%,
p
<0.0001) in Dyslipidemia Group. These data may suggest the participant of apoC-III in disturbance of HDL maturation. Intriguingly, apoC-III did not correlate with HDL-TG/HDL-PL or HDL-FC/HDL-PL in FH Group.

In angiographic analysis, HDL-TG/HDL-PL ratio strongly correlated with CSI (R
2
10%,
p
<0.0001) rather than TG (R
2
3%,
p
<0.05) or HDL-TG (R
2
3%,
p
<0.05). Highest quartile of apoC-III showed significantly higher CSI compared with other quartiles (
p
<0.05) in Dyslipidemia Group. No such tendency was observed in FH Group.

Conclusion:
Plasma apoC-III strongly correlated with malignant HDL-lipid composition strongly associated with coronary artery disease in patients with primary dyslipidemia.
Abstract 9733: Atrial Fibrosis is Associated With Higher DC Cardioversion Failure Rates in Persistent Atrial Fibrillation
Authors: Labedi Mohamed R , Ahmadjee Abdulmohsin , Koopman Mathias , Marrouche Nassir , Wilson Brent , Akoum Nazem
Published: July 2021

Introduction:
DC cardioversion (DCCV) is commonly performed in atrial fibrillation (AF). We examined the association between atrial fibrosis quantified using late gadolinium enhancement MRI (LGE-MRI) and acute success and recurrence of AF following DCCV.

Methods:
Persistent AF patients without previous catheter ablation who underwent LGE-MRI and DCCV were included in the study. Acute DCCV success was defined by achievement of sinus rhythm. Demographic patient data as well as comorbidities and medications were collected from chart revisions.

Results:
241 patients were included (63% male). 186 patients (77.48%) were on oral anti-coagulation, 31 (12.9%) were on class I anti-arrhythmic drugs (AAD) and 46 (19.1%) were on class III AAD at the time of cardioversion. DCCV was acutely successful in 183 patients (75.9%). AF recurred after DCCV in 194 patients (80.5%) after an average follow up of 81 days. In univariate analysis, atrial fibrosis (HR 1.04; p=0.049) and body mass index (BMI) (HR 1.04; p=0.03) were associated with DCCV failure, while left atrial area, beta blocker, calcium channel blocker, class I and class III anti-arrhythmic drug use were not. In multivariate analysis, only atrial fibrosis was a significant predictor of DCCV failure (HR 1.03; p=0.03). During follow up, anti-arrhythmic drug use (class I drugs HR 0.21; p=0.045; class III drugs HR 0.27; p=0.042) was associated with maintenance of sinus rhythm.

Conclusions:
LGE-MRI quantified atrial fibrosis predicts failure of DCCV in persistent AF patients while AAD use was associated with maintenance of sinus rhythm.
Abstract 9737: Cardiovascular Abnormalities Associated With In-hospital Mortality in Patients With Spontaneous Subarachnoid Hemorrhage
Authors: Elgendy Islam Y , Mahmoud Ahmed , Elgendy Akram Y , Mansoor Hend , Conti C. Richard
Published: July 2021

Introduction:
Neuro-cardiogenic syndrome is frequently encountered in patients with spontaneous subarachnoid hemorrhage (SAH) resulting in a wide spectrum of cardiovascular abnormalities. However, little information is known regarding the prognostic implications of these abnormalities in patients with spontaneous SAH.

Objectives:
To determine the cardiovascular abnormalities that correlate best with in-hospital mortality in patients with spontaneous SAH.

Methods:
All patients admitted to our institution with a primary diagnosis of SAH, and underwent a transthoracic echocardiogram (TTE) from July 2011 until May 2014 were enrolled. Data gathered included patients' demographics, troponin T level, electrocardiographic (ECG) changes, TTE findings, and in-hospital mortality. Multivariate logistic regression to quantify the relationship between cardiovascular abnormalities and in-hospital mortality was performed.

Results:
247 patients were included in the analysis. The mean age of patients was 59 years. 66% of the patients were females. The incidence of in-hospital mortality was 15.6%. The presence of resting segmental wall motion abnormalities on TTE (odds ratio (OR)=2.7, 95% confidence interval (CI) 1.19-6.01, p=0.03), ejection fraction ≤ 35% (OR=3.6, 95% CI 1.24-10.52, p=0.03), positive troponin level (OR=3.0, 95% CI 1.17-7.55, p=0.03), and QTc prolongation on ECG (OR=5.4, 95% CI 1.77-16.29, p<0.005) were associated with increased risk of in-hospital mortality on univariate analysis. On multivariate logistic regression, QTc prolongation was the only independent predictor for in-hospital mortality (OR=5.13, 95% CI 1.04-25.28, p=0.04).

Conclusions:
Among the variable cardiovascular abnormalities seen in patients with spontaneous SAH, prolonged QTc interval on ECG was independently associated with in-hospital mortality. It is unknown whether this is a causative association or a marker of underlying severe clinical presentation of spontaneous SAH.
Abstract 9794: Preoperative Iodine-123 MIBG Scintigraphy Imaging as an Excellent Predictor of Left Ventricular Reverse Remodeling During Ventricular Assist Device Therapy
Authors: Imamura Teruhiko , Kinugawa Koichiro , Nitta Daisuke , Hatano Masaru , Kinoshita Osamu , Nawata Kan , Ono Minoru
Published: July 2021

Introduction:
Although left ventricular reverse remodeling (LVRR) is accompanied by better clinical course during ventricular assist device (VAD) treatment, its preoperative prediction remains uncertain. 123I-metaiodobenzylguanidine (123I-MIBG) is a recently-developed analog of guanethidine, used either to stratify heart failure (HF) or to predict HF patient prognosis by assessing visualized cardiac sympathetic innervation.

Hypothesis:
Preoperative 123I-MIBG may be useful to predict LVRR during VAD support.

Methods:
We enrolled 27 HF patients due to dilated cardiomyopathy, who had received 123I-MIBG scintigraphy before the implantation of VAD and been followed at our institute at 2010-14. We investigated whether preoperative 123I-MIBG data were useful to predict postoperative LVRR defined as LV ejection fraction ≥35% at post-VAD 6 months.

Results:
Among preoperative variables including 123I-MIBG data, washout rate (WR) ≤39% was an only significant independent predictor of postoperative LVRR by uni/multivariate logistic regression analyses (p=0.036 and odds ratio 14.45). Those with LVRR had better exercise capacity including higher peak oxygen consumption at cardiopulmonary exercise test and longer 6 minutes’ walk distances, and more frequent opening of native aortic valve accompanied by lower plasma level of B-type natriuretic peptide at post-VAD 6 months (p<0.05 for all), although their daily dose of β-blocker was comparable with those without LVRR during the study period. All 2 patients who achieved explantation of VAD had experienced LVRR.

Conclusions:
Preoperative lower WR in 123I-MIBG was a novel predictor of LVRR during VAD support.
Abstract 9911: Hypoxia-inducible Factor-1α Knockout in Myeloid Lineage exaggerates Angiotensin II-induced Abdominal Aortic Aneurysm
Authors: Takahara Yusuke , Tokunou Tomotake , Kojima Hiroshi , Ichiki Toshihiro , Hirooka Yoshitaka , Sunagawa Kenji
Published: July 2021

Background:
Hypoxia-inducible factor-1α (Hif1α) is a transcriptional factor that regulates various genes reacting hypoxic conditions. In atherosclerotic legion, Hif1α is thought to be regulating inflammatory responses. We previously reported that myeloid specific Proryl hydroxylase domain protein2 deletion had protective effect on cardiovascular disease in animal model. The roll of Hif1α of myeloid lineage in inflammatory response is not determined.

Methods and Results:
Myeloid specific Hif1α knock out mice (MyHif KO) were created using Cre-lox recombination. MyHif KO mice were crossed with Apolipoprotein E knockout (ApoEKO) mice to create double knock out mice (MyHif/ApoE DKO group, n=18). ApoEKO with Hif1α flox/flox (without Cre recombinase) mice were used as control group (n=11). Two groups were fed with high fat diet (HFD) and infused with Angiotensin II (AII, 1800ng/kg/min) by osmotic mini pump for 4 weeks to promote abdominal aortic aneurysm (AAA) formation. The genotype of mice was blinded during experiment. There was no significant difference in survival rate between two groups. MyHif/ApoE DKO increased AAA formation rate (94.4% vs 81.8% in control) and aortic diameter (2.42mm±0.21mm vs 1.89±0.27mm in control). AAA classification reported by Daugherty et al was significantly exaggerated in MyHif/ApoE DKO group (2.75±0.35 vs 1.63±0.46 in control, P=0.03). Elastin degradation grade was checked by Elastica van Gieson staining. MyHif/ApoE DKO also deteriorated the elastin degradation grade (3.91±0.08 vs 3.25±0.31, P=0.01). The number of macrophages which migrated to abdominal aorta was increased in MyHif/ApoE DKO group (565±110.3/section vs 260.5±136.5/section in control, P=0.0507), whereas MyHif/ApoE DKO did not change the glucose level, blood pressure and body weight. Peritoneal macrophages from MyHif/ApoE DKO were significantly activated the migration induced by monocyte chemotactic protein-1 in dose dependent manner.

Conclusion:
Hif1α of myeloid lineage might have vascular protective effect via suppressing the macrophage activation in the model of AII-induced AAA in mice.
Abstract 9916: Evaluation of the Best Cut-off Value of Ischemia in Instantaneous Wave-Free Ratio in Patients With Aortic Valve Stenosis
Authors: Arashi Hiroyuki , Yamaguchi Junichi , Ri Tonre , Shibahashi Eiji , Itani Ryosuke , Shimazaki Kensuke , Otsuki Hisao , Haruki Shintarou , Nakao Masashi , Kamishima Kazuho , Jujo Kentaro , Minami Yuichiro , Hagiwara Nobuhisa
Published: July 2021

Background:
Instantaneous wave-free ratio (iFR) is a vasodilator free index calculated using trans-lesional pressure ratio during a specific period of diastole that is called “wave-free period”, and reported to have a good correlation with fractional flow reserve (FFR). In patients with severe aortic valve stenosis (AS), evaluation of intermediate coronary stenosis by FFR using vasodilators is thought to be a contraindication in some situations. Moreover, previous studies reported unique coronary flow pattern during diastolic phase in patients with AS. To date, there is no report claiming the correlation of iFR and FFR in this population. The purpose of the present study was to examine the clinical value of iFR in patients with AS.

Method and Results:
We examined consecutive 154 patients (with 214 stenosis) whose iFR and FFR were measured simultaneously. The mean age of AS patients (n=10, mean aortic valve area: 0.75 ± 0.42cm2) was higher than non-AS patients (n=144). Other patients’ characteristics are shown in Table 1. The mean iFR value in AS patients was significantly lower than that of non-AS patients, despite no significant difference was observed in the mean FFR value and % diameter stenosis (Table 2). iFR showed a good correlation with FFR in AS patients (Figure 1) and the best cut-off value of iFR in receiver operator curve analysis to predict FFR ≤ 0.8 was 0.73 in AS patients (AUC 0.84, sensitivity 0.8, specificity 0.86, p=0.016; Figure 2), whereas, 0.90 in non-AS patients.

Conclusion:
The present study demonstrated the good correlation between iFR and FFR in AS patients. Besides, the value below 0.73 of iFR was thought to be a predictor of myocardial ischemia in AS patients, which was lower than standard predictive range of ischemia in iFR. Vasodilator-free assessment by iFR may have potential benefits in evaluating intermediate coronary stenosis in patients with AS.
Abstract 9920: Outcomes Associated With Lead Abandonment versus Lead Extraction Strategies for Revision of Sterile Leads: An NCDR® Analysis
Authors: Zeitler Emily P , Wang Yongfei , Dharmarajan Kumar , Anstrom Kevin J , Peterson Eric D , Daubert James P , Curtis Jeptha P , Al-Khatib Sana M
Published: July 2021

Introduction:
While implantable cardioverter defibrillator (ICD) systems are lifesaving, leads often require replacement over time. When ICD leads require replacement, the existing lead can either be left in (abandoned) or be extracted, yet there are insufficient comparative data between these 2 strategies.

Methods:
We examined in-hospital events among propensity matched subjects undergoing lead replacement where the existing lead was either abandoned or extracted from National Cardiovascular Data Registry (NCDR) ICD Registry (2010 - 2011). Six month complication and 90-day and 1-year mortality rates were examined in a subset of Medicare subjects. We excluded those procedures involving infection and those performed by a cardiothoracic surgeon (extraction predetermined).

Results:
After 1:1 matching, we had 41744 subjects with in hospital outcomes, of which 2362 were Medicare aged and had 6-month complications and survival information. About 1/4 were women; average age was 66 yrs overall and 75 yrs in the Medicare cohort. In hospital events included 2.22% (n=463) and 3.63% (n=758) procedure related complications, and death in 0.21% (n=44) and 0.45% (n=94) in abandonment and extraction patients, respectively (p<0.001 for both). In the Medicare cohort, at 6 months, there was no difference with respect to bleeding (4.92% vs 5.40%), tamponade (0.38% vs 0.66%), infection (2.27 % vs 3.03%), upper extremity thrombosis (0.76% vs 0.95%), pulmonary embolism (0.28% vs 0.57%), or urgent surgery (1.70% vs 0.85%) (p>0.05 for all). At 90 days and 1 year, there was no difference in survival (p=0.55) (See Figure).

Conclusion:
Among propensity-matched patients undergoing ICD lead replacement, there were more in-hospital complications and deaths among extraction versus abandonment subjects. Among a Medicare subset, there were no differences in longer term outcomes. Thus, abandonment may be a reasonable alternative to extraction for sterile lead revision in some cases.
Abstract 01: Supplemental Nutrition Assistance Program (SNAP) Participants Exhibit Higher Rates of Cardiometabolic Mortality Compared to SNAP Eligible Non-participants and SNAP Ineligible Americans
Authors: Conrad Zach , Rehm Colin , Mozaffarian Dariush
Published: July 2021

Introduction:
The Supplemental Nutrition Assistance Program (SNAP) is the largest food assistance program for low-income Americans. Investigating mortality in this population is crucial to determining what further efforts are needed to reduce health disparities. The National Center for Health Statistics (NCHS) does not provide mortality data by SNAP participation status, so diet-related mortality according to SNAP eligibility and participation is not well established.

Objective:
To examine cardiometabolic mortality among SNAP participants, SNAP eligible non-participants, and the SNAP ineligible population.

Methods:
We used data from the National Health Interview Survey for 499,741 US adults age≥25y from 2000-2009 to assess SNAP eligibility and participation. These data were merged with the NCHS Linked Mortality file (2000-2009) to create a nationally representative cohort. Participants were followed until death or through Dec 31, 2011. Survey-weighted Cox-proportional hazards models were used to estimate hazard ratios of cause-specific mortality by SNAP eligibility and participation.

Results:
Over a mean of 6.8 y of follow-up (maximum 11.9 y), we observed 7408 CHD deaths, 2185 stroke deaths and 1376 diabetes deaths. For all outcomes, in particular diabetes, SNAP participants had highest risk, followed by SNAP eligible non-participants, and then SNAP-ineligible individuals (Figure, panel A). Considerable differences in cause-specific risk of mortality were observed between race/ethnicities among SNAP participants, SNAP eligible non-participants, and the SNAP ineligible population (Figure, panel B).

Conclusion:
Major health disparities exist between SNAP participants, SNAP eligible non-participants, and SNAP ineligible Americans, as well as by race/ethnicity. Ways to improve health outcomes of SNAP participants, including potential revisions to SNAP programming, are urgently needed to reduce these inequities.
Abstract 14: Midlife Cardiorespiratory Fitness is Associated with Lower Incidence of Depression and Cardiovascular Death with or without Incident Depression in Later Life
Authors: Willis Benjamin L , Leonard David S , Barlow Carolyn E , Fitzgerald Shannon J , Martin Scott B , DeFina Laura F
Published: July 2021

Introduction:
Depression disorders are common and debilitating conditions which can affect older individuals, especially those with cardiovascular disease (CVD). The association of midlife cardiorespiratory fitness (fitness), an objective measure of habitual physical activity, with later-life depression is not fully understood. Furthermore, although depression is associated with incident CVD, little is known about the long term association of midlife fitness with CVD death following the onset of depression decades later.

Hypothesis:
Fitness measured in midlife will be inversely associated with depression in later life and risk of CVD death with or without intercurrent depression.

Methods:
Linking participant data from the Cooper Center Longitudinal Study with Medicare claims files, we studied 16,728 participants (19% women, mean age 51) without prior history of depression or CVD, who received Medicare coverage from 1999-2009. Midlife fitness was estimated by Balke protocol treadmill time in metabolic equivalents and grouped into age and sex-specific categories: low, moderate, and high fitness. Other midlife risk factors were measured using standard protocols. Depression diagnosis was defined from Medicare claims files according to established algorithms and CVD mortality was determined from National Death Index records. Multivariate survival modeling was used to assess the associations between midlife fitness and time to any of three later life events: incident depression, CVD death without incident depression, and CVD death following incident depression. The model was adjusted for midlife age, gender, year of examination, smoking, systolic blood pressure, cholesterol, BMI, and fasting glucose.

Results:
After 109,143 person years of Medicare follow-up, we observed 2379 cases of incident depression, 570 CVD deaths without incident depression and 218 CVD deaths following incident depression. High fitness in midlife was associated with a 24% lower risk of depression (hazards ratio [HR] 0.76, 95% CI 0.67-0.86 compared to low fit). High fitness was also associated with a 63% lower risk of CVD death without incident depression (HR 0.37, 95% CI 0.30-0.47 compared to low fit) and 50% lower risk of CVD death (HR 0.50, 95% CI 0.34-0.72 compared to low fit) following incident depression.

Conclusion:
Midlife fitness, a modifiable CVD risk factor, is associated with lower risk of depression in later life, lower risk of CVD death without incident depression, and lower risk of CVD death following incident depression decades later. These findings suggest the importance of fitness in primary prevention of depression and mortality in older age.
Abstract 22: Cardiovascular Fat in Women at Midlife: Effects of Race, Overall Adiposity, and Central Adiposity. The SWAN Cardiovascular Fat Ancillary Study
Authors: Hanley Carrie L , Matthews Karen , Brooks Maria M , Janssen Imke , Budoff Matthew J , Sekikawa Akira , Mulukutla Suresh , El Khoudary Samar R
Published: July 2021

Background:
Racial differences exist in overall (BMI) and central adiposity (abdominal visceral fat (VAT)) measures. Recently, it has been shown that white men have higher volumes of cardiovascular fat (CF) that were found to be greater per increment increase in BMI when compared to black men. It is unknown whether similar racial differences exist in women. We assessed whether CF volumes vary by race and tested the effect modification of race on the associations between adiposity measures and CF among women at midlife, a time period marked with increased cardiovascular risk.

Methods:
Volumes of CF depots (epicardial fat (EAT), paracardial fat (PAT), total heart fat (TAT), and aortic perivascular fat (PVAT)), BMI, and VAT were examined among participants from the Study of Women’s Health Across the Nation (SWAN) Cardiovascular Fat Ancillary study. Linear regression was used for statistical analyses. All adiposity measures were log-transformed to achieve normality.

Results:
A total of 543 women (mean age: 50.9 ± 2.9 years; 34% postmenopausal) were included. Women were either white (62%) or black (38%). Significant racial differences existed in volumes of all CF depots with white women having higher volumes compared to black women, after adjusting for age, menopausal status, hypertension, diabetes, and alcohol consumption (all P-values <0.05). These racial differences remained significant after further adjustment for BMI or VAT, with one exception of PAT after adjusting for VAT. Race significantly modified the associations between VAT and EAT (Interaction P-value=0.03) and between BMI and PAT (Interaction P-value=0.01), such that black women had more EAT than white women for every one-increment increase in VAT, while with every one-increment increase in BMI, white women had more PAT than black women. Race-stratified analyses confirmed the effect modification of race on the associations between VAT and EAT (effect size per 1 unit increase in VAT was higher in blacks (β (SE) = 0.62 (0.05) than in whites (β (SE) 0.51 (0.04)) and between BMI and PAT (effect size per 1 unit increase in BMI was higher in whites (β (SE) = 2.56 (0.18) than in blacks (β (SE) 1.92 (0.23)).

Conclusions:
Racial differences existed in CF volumes in midlife women similar to midlife men. Black women with greater central adiposity had higher EAT volumes than white women, while white women with greater overall adiposity had higher PAT volumes than black women. Future research should evaluate the impacts of these significant racial differences in explaining CVD risk disparity.
Abstract 30: Global Electrical Heterogeneity on Electrocardiogram is Associated with Sudden Cardiac Death After Adjustment for Ejection Fraction
Authors: Tereshchenko Larisa G , Waks Jonathan , Biggs Mary , Sitlani Colleen , Kabir Muammar , Sedaghat Golriz , Thomas Jason , Henrikson Charles , Biering-Sørensen Tor , Agarwal Sunil , Sotoodehnia Nona , Siscovick David , Post Wendy , Solomon Scott , Soliman Elsayed , Buxton Alfred , Josephson Mark
Published: July 2021

Introduction:
Electrocardiographic (ECG) measures of myocardial global electrical heterogeneity (GEH) are associated with sudden cardiac death (SCD) in middle-age adults.

Hypothesis:
We hypothesized that time-updated ECG GEH measures are associated with SCD in elderly adults after LVEF adjustment.

Methods:
We analyzed data from 2 prospective cohorts: The Atherosclerosis Risk in Communities (ARIC, n=15,366; mean age 54.1±5.8 y; 44.6% male; 73.2% white) and the Cardiovascular Health Study (CHS, n=5,016; mean age 72.8±5.6 y; 43.1% male; 95.3% white). Mean spatial QRS-T angle, azimuth, elevation, and magnitude of spatial ventricular gradient (SVG), and sum absolute QRST integral (SAI QRST) were calculated from digital 12-lead ECGs and analyzed as baseline variables in ARIC and as time-updated longitudinal variables in CHS (measured yearly at 10 consecutive visits). The primary outcome was adjudicated SCD. Cox regression models were constructed: Model 1 adjusted for age, sex and race. Model 2 further adjusted for cardiovascular disease, beta-blocker use, creatinine, BMI, hypertension, diabetes, smoking, total cholesterol, HDL, triglycerides, physical activity and alcohol use. Model 3 included Model 2 variables and heart rate, QTc, LV hypertrophy and bundle branch block or intra-ventricular conduction delay. Model 4 in CHS included all Model 3 variables plus baseline LVEF and time-updated incident HF and coronary heart disease.

Results:
During median 13-14 y of follow-up SCD incidence was 1.51 (95%CI 1.35-1.69) per 1,000 person-yrs in ARIC, and 2.78 (95%CI 2.41-3.21) per 1,000 person-yrs in CHS. In both cohorts (Table) QRS-T angle, SVG and SAI QRST were associated with SCD. Among older adults (CHS), longitudinal SAI QRST, QRS-T angle and SVG magnitude were associated with SCD independent of LVEF.

Conclusions:
Baseline and longitudinal GEH ECG parameters are independently associated with SCD in middle-age and older adults, respectively. In older adults, GEH ECG parameters provide information on SCD risk beyond LVEF.
Abstract MP08: Higher Diet Quality is Associated with Lower Odds of Inflammation and Peripheral Artery Disease in the Hispanic Community Health Study/Study of Latinos
Authors: Mattei Josiemer , Sotres-Alvarez Daniela , Gellman Marc , Castaneda Sheila F , Hu Frank B , Tucker Katherine L , Siega-Riz Anna-Maria , Kaplan Robert C
Published: July 2021

Introduction:
C-reactive protein (CRP; a marker of inflammation) and the ankle-brachial index (ABI; a marker of peripheral artery disease (PAD)) are considered emerging risk factors for cardiovascular disease (CVD) in addition to traditional cardiometabolic markers. Results on the association of a healthy diet and these emerging risk factors have been inconsistent, and few studies have been conducted on Hispanics/Latinos, who present high prevalence of cardiometabolic risk factors.

Hypothesis:
We hypothesized that higher diet quality as measured with the Alternate Healthy Eating Index (AHEI; range 0-110: lowest to highest quality) would be associated with lower odds of having high-risk levels of CRP and of ABI, independently from cardiometabolic risk factors.

Methods:
Baseline data were analyzed from US-Hispanics/Latinos aged 18-74y without previously-diagnosed CVD participating in the population-based Hispanic Community Health Study/Study of Latinos cohort. There were 14,623 participants with complete CRP data, and 7,892 with ABI data (measured only for those aged ≥45y). Food and nutrients components of AHEI were assessed from two 24-hour recalls. High-risk CRP was defined as >3.0 mg/L, and high-risk ABI was defined as <0.90 or >1.40, with further categorization into PAD (<0.90) and arterial stiffness (>1.40).

Results:
Nearly 35% of Hispanics/Latinos had high-risk CRP levels and 6.3% had high-risk ABI (4.2% had PAD and 2.1% had arterial stiffness). After adjusting for demographic, socioeconomic, and lifestyle factors, as well as cardiometabolic risk factors (diabetes, hypertension, obesity, or dyslipidemia), the odds (95% confidence interval) of having high-risk ABI were 36% (5, 43%) lower for each 10-unit increase in AHEI (p=0.020). The association remained significant for PAD alone, albeit attenuated (p=0.046), but not for arterial stiffness (p=0.210). Each 10-unit increase in AHEI was associated with 21% (10, 31%) lower odds of high-risk CRP(p=0.0003) after similar adjustments. There were no significant interactions between AHEI and sex, background, smoking, or cardiometabolic risk factors for the associations with ABI. The association of AHEI with high-risk CRP was stronger for those with diabetes (0.68 (0.52, 0.89) vs. 0.82 (0.71, 0.94) without diabetes; p-interaction=0.0002) and with obesity (0.70 (0.58, 0.85) vs. 0.86 (0.73, 1.01) without obesity; p-interaction=0.0001).

Conclusions:
A higher diet quality is associated with lower inflammation and PAD among Hispanics/Latinos, independently from traditional cardiometabolic risk factors. Promoting a healthy overall diet may benefit with further lowering CVD-risk related to emerging factors in a population that already presents high prevalence of cardiometabolic markers.
Abstract MP17: Relationship of Accelerometer-assessed Physical Activity and Sedentary Behavior with Predicted CVD Risk in Older Women: Results From the Objective Physical Activity and Cardiovascular Health (OPACH) Study
Authors: LaMonte Michael J , Rillamus-Sun Eileen , Evenson Kelly R. , Lee I-Min , Rosenberg Dori E. , Di Chongzhi , Buchner David , LaCroix Andrea Z.
Published: July 2021

Background:
Use of accelerometers to objectively measure physical activity (PA) and sedentary behavior (SB) in epidemiologic studies may improve understanding of associations with CVD, particularly in older adults. This cross-sectional study examined associations between accelerometer measures of PA and SB with cardiovascular health in 4870 race-ethnically diverse postmenopausal women, ages 63 to 99 years (mean 78.9) enrolled in OPACH, an ancillary study of the Women’s Health Initiative program.

Methods:
Vector magnitude counts per 15-sec epoch from hip worn triaxial accelerometers (minimum of 4 days with ≥10 hours/day wear time) were used to define time spent in SB (0-18 counts/15 sec), low light intensity (19-225), high light intensity (226-518), and moderate-to-vigorous intensity PA (MVPA; ≥519) based on count cutpoints determined from a laboratory calibration study among women of similar age. Predicted 10-year risk of CVD was computed using the Reynolds risk score (RRS), for which higher values reflect higher predicted CVD risk. Relationships between SB, PA and RRS were examined using generalized linear model analyses, adjusting for accelerometer wear time.

Results:
The mean RRS was 13.7±11.9 (range 0.8 to 94.3). Based on regression analysis, every hour/day spent in SB was associated with an average 2.3% increase in the RRS. In contrast, every hour/day spent in low-light, high-light, or MVPA resulted in an average 1.1%, 1.5%, and 5.2% reduction, respectively, in the RRS. A significant positive association was observed between SB and decile of RRS (trend, p<.0001); whereas, significant inverse gradients for time spent in each PA level were observed across decile of RRS (trend, p<.001 for all). Mean hours/day associated with the lowest and highest decile of RRS, respectively, were 12.0 and 13.1 for SB; 3.6 and 3.1 for low light; 1.9 and 1.4 for high light; and 1.3 and 0.6 for MVPA. These patterns of association for SB and PA with RRS were also observed when stratified by race-ethnicity and age.

Conclusion:
Based on objectively assessed SB and PA, this study confirms that prolonged SB is adversely related with cardiovascular health in older women. Results further suggest that even light intensity PA could have cardiovascular benefit in older women. Because a large proportion of daily activity time is spent at lower intensity among older adults, this finding has important public health implications. Prospective studies are needed to confirm these cross-sectional results.