bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 10843: P2Y12 Inhibitor Adherence Patterns in Patients with Acute Coronary Syndrome
Authors: Ozaki Aya , Ko Dennis T , Chong Alice , Fang Jiming , Austin Peter , Sud Maneesh , Jackevicius Cynthia A
Published: March 2022

Introduction:
Dual antiplatelet therapy with P2Y12 inhibitors (P2Y12i) and ASA reduce cardiac events after acute coronary syndrome (ACS). Use has shifted from clopidogrel to ticagrelor, a more potent P2Y12i with higher bleeding risk, dosed twice rather than once daily. As these factors may impact adherence, a better understanding of adherence patterns by agent is needed.

Methods:
We conducted a population-based cohort study using administrative claims data in Ontario, Canada between 4/2014-3/2018. We identified individuals ≥65 years of age who were admitted for myocardial infarction or unstable angina and had filled a P2Y12i prescription within 7 days of discharge. We excluded patients who died within 1 year after discharge. We calculated “good” adherence [proportion of days covered (PDC) 1 year post-ACS ≥80%, and also used group-based trajectory models to characterize longitudinal patterns of good adherence by time over 1 year.

Results:
We included 21,680 ACS patients with 45.0% (n=9,763) prescribed ticagrelor and 55.0% (n=11,917) prescribed clopidogrel [mean age±SD: 73.6±6.8/77.3±8.3 years, 65.4%/56.2% male, PCI during index admission 87.4%/48.5%, respectively]. Overall, the good adherence rate was 73.0% for ticagrelor and 78.9% for clopidogrel. We identified 3 adherence patterns in the year post-ACS: 67.8% of ticagrelor and 75.0% of clopidogrel patients were in the adherent group (PDC≥80%), while 17.1 %/13.4% were in the gradually non-adherent, and 15.1%/11.6% were in the rapidly non-adherent groups, respectively. (Figure)

Conclusions:
Adherence rates and trajectories appeared more favorable for clopidogrel in the first year post-ACS. However, patient characteristics differed between the clopidogrel and ticagrelor populations and these may be associated with the observed adherence patterns. Identification of nonadherence risk factors and barriers specific to each trajectory group is needed to improve adherence and clinical outcomes.
Abstract 10848: Increasing Left Anterior Descending Artery Size is Associated with Worsening Myocardial Function in the Setting of Multisystem Inflammatory Syndrome in Children
Authors: Olsen Benjamin , Nguyen Michael , Pan Zhaoxing , Jone Pei-ni
Published: March 2022

Background:
Multisystem inflammatory syndrome in children (MIS-C) is a hyperinflammatory syndrome after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Cardiovascular complications include left ventricular dysfunction and coronary artery abnormalities (CAA). Little is known, however, about the interaction between LV function and CAA. We aimed to assess the hypothesis that increased coronary artery size is inversely correlated with LV function utilizing left ventricular ejection fraction (LVEF) and indices of myocardial work.

Methods:
Two-dimensional and speckle-tracking echocardiograms were performed in 34 MIS-C patients at admission. Biplane LVEF and coronary artery Z scores were measured, and pressure-strain loops were used to calculate indices of myocardial work: global work index (GWI), global work efficiency (GWE), global wasted work (GWW), global constructive work (GCW), and global longitudinal strain (GS). Treating coronary artery Z-scores as a continuous variable, correlation analysis was performed.

Results:
LVEF and left anterior descending artery (LAD) Z-scores were inversely correlated (Spearman coefficient of -0.47;
P
=0.005). Both GWI and GCW demonstrated an inverse relationship with increasing LAD Z-scores, but both were not statistically significant (Spearman coefficient -0.21;
P
=0.239 and Spearman coefficient -0.21;
P=
0.235). GS also exhibited a trend of worsening (less negative scores) with increasing LAD Z-scores but was not statistically significant (Spearman coefficient 0.29;
P
=0.095). GWE and GWW did not correlate with any coronary artery Z-scores and left main coronary or right coronary artery Z-scores did not correlate with any markers of function.

Conclusion:
Increasing LAD Z-score showed a statistically significant association with decreased LVEF. Additionally, while not statistically significant, GWI, GCW, and GS all demonstrated a trend of decreased indices of myocardial work as LAD Z-score increases. In conclusion, this data suggests that patients with higher coronary artery Z-scores at admission are at increased risk of myocardial dysfunction.
Abstract 10852: Cardiology and Telehealth in the Pandemic
Authors: Mgbemena Okechukwu , Becoats Kyeesha , Tfirn Ian , Velarde Gladys R
Published: March 2022

Introduction:
Historically, healthcare access has been an achilles heel of our healthcare system. Approximately 14.5% of US adults lack readily available access to healthcare and this has been worsened by the COVID-19 pandemic. There is limited data on use of telehealth in cardiology. We share our single-center experience on improving access to care via telehealth at the University of Florida cardiology fellows' clinic.

Methods:
Demographic and social variables were collected 6 months prior to and 6 months after initiation of telehealth. The effect of telehealth was determined via Chi-square and multiple logistic regression while controlling for demographic covariates.

Results:
We analyzed 3,316 cardiac clinic appointments over one year period. 1,569 and 1,747 scheduled clinic visits were prior to and after the start of telehealth, respectively. Patients that attended their scheduled follow-up had significantly greater odds of being in the post-telemedicine group while controlling for marital status and insurance type (OR 1.31, 95% CI 1.07 - 1.62). Patients who attended had higher odds of having city contract insurance (OR 3.51, 95% CI 1.79 - 6.87) compared to private insurance. City contract insurance is an indigenous care plan. There are also higher odds of being previously married (OR 1.34, 95% CI 1.05 - 1.70) or married/dating (OR 1.39, 95% CI 1.05 - 1.82) compared to being single for patients who attended their scheduled visits. Telehealth did not lead to increase in use of Mychart, the electronic patient portal (P-value 0.55).

Conclusions:
Telehealth improved patients’ access to care in a cardiology fellows' clinic during the COVID-19 pandemic. Telehealth as a resource adjunct to traditional care in cardiology fellows' clinic should be further explored.
Abstract 10854: Acute Venous Thromboembolism in Patients with Elevated Body Mass Index, Can We Prescribe Direct Oral Anticoagulants
Authors: Armstrong Justin , Foglesong Adam , Halalau Alexandra , Mando Ramy
Published: March 2022

Background:
Due to the efficacy and lower bleeding risk of direct oral anticoagulants (DOACs) compared to coumadin, they are becoming the treatment of choice for acute venous thromboembolism (VTE). There is limited data in using DOAC’s for treatment of VTE (deep vein thrombosis (DVT) or pulmonary embolism (PE)) in patients with morbid obesity (body mass index >40 kg/mm
2
). We conducted a retrospective study to examine the rates of recurrence (failure of treatment) in patients diagnosed with an acute VTE.

Methods:
Electronic health record (EHR) from 8 hospitals in the Beaumont Health system were queried. A retrospective review of patients
>
18 years old with morbid obesity who were diagnosed with a DVT or PE and treated with a DOAC (rivaroxaban, apixaban or dabigatran) from 2010 to 2020 was performed. Individual charts were reviewed for ultrasound as well as computed tomography angiography results confirming the presence of an acute or chronic DVT or pulmonary embolism. To assess for recurrence, imaging studies performed 3 months after original diagnosis were studied.

Results:
461 patients were included. The mean age was 58.9 years old with a range of 18-88 years old. Majority of patients were female (65.9%). The mean BMI was 46.5 with standard deviation of 7.4. 337 (73.1%) had an acute diagnosis of DVT or PE. When reassessing imaging 3 months after original diagnosis, only 2 (0.6%) patients had findings of recurrence (formation of new DVT or PE).

Conclusion:
In patient with morbid obesity, DOACs appear to be an effective therapy for treatment of DVT and PE. Further prospective studies are needed to confirm the findings of this analysis.
Abstract 10858: Comparison of Clinical Effect of Living Alone Between Urban Area and Rural Area in Patient with Acute Coronary Syndrome
Authors: Takeuchi Mitsuhiro , Dohi Tomotaka , Fukase Tatsuya , nishio ryota , Takahashi Norihito , Endo Hirohisa , Wada Hideki , Doi Shinichiro , Shuta Tsuboi , Kato Yoshiteru , Ogita Manabu , Okai Iwao , Iwata Hiroshi , Okazaki Shinya , Isoda Kikuo , SUWA Satoru , MIYAUCHI Katsumi , Minamino Tohru
Published: March 2022

Background and Objective:
Living alone is reported as an independent risk factor for worse clinical outcomes after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Manifestations of psychological stress in patients living alone is reported to be associated with subsequent cardiovascular events. The impact of living alone on the psychological factors of patients may be differ depending on their living environment. However, comparison of the effects of living alone in different living environment on the prognosis of patients with ACS has not been reported.

Purpose:
The aim of the study was to compare the effect of living alone on clinical outcomes in patients with ACS between urban and rural area.

Methods:
Data from a multi-center, observational study of consecutive ACS patients who underwent emergency PCI between January 2012 and December 2016 were analyzed. The clinical endpoint was major adverse cardiovascular events (MACE) which defined as composite of cardiovascular death, ACS, and stroke.

Results:
In this study, 1349 patients were enrolled and divided into two population according to their living environment; urban area (n=417), and rural area (n=932). 87 patients (20.9 %) in urban area, and 169 patients (18.1 %) in rural were living alone. There were no significant differences in baseline characteristics between the living alone and the living together group in both urban and rural area. During a median follow-up period of 2.1 years, Kaplan-Meier curves showed the living alone group had higher risk of MACE than the living together group in urban area (log-rank, p=0.01). On the other hands, no significant differences were shown in the incidences of MACE between two groups in rural area (p=0.86). After adjustment for other covariates, the living alone was significantly associated with MACE (hazard ratio [HR], 2.83; 95 % confidential interval [CI], 1.16-6.91; p=0.02) compared with the living together in urban area. However, in rural area, the living alone group was not significantly associated with MACE (HR, 1.02; 95 % CI, 0.66-1.57; p=0.92) compared with the living together group.

Conclusion:
Living alone was significantly associated with worse clinical outcomes after emergency PCI of ACS in urban area but not in rural area.
Abstract 10863: Genome-Wide Assessments of 138 Inflammatory Markers Identified Inflammatory Pathways Confer Cardiovascular Disease Risk
Authors: Li Jun , Hu Jie , Han Xikun , Manson Joann E , Hu Frank B , Liang Liming
Published: March 2022

Introduction:
Atherosclerosis, the main underlying causes of coronary heart disease (CHD) and ischemic stroke, is an inflammatory condition. However, therapeutics targeting inflammation for CHD and stroke are limited, partially due to insufficient evidence for causal inflammatory pathways and druggable targets.

Objectives:
We aimed to identify causal inflammatory markers for CHD and ischemic stroke, and to characterize the genetic architecture shared between such an inflammatory profile and CHD/stroke.

Methods:
Pooling multiple databases, we curated the largest genome-wide association summary statistics for 138 markers including 126 inflammatory proteins (C-reactive protein [CRP], N>450k; others such as cytokines, N~3.6k-45k) and 12 blood immune cell types (N>450k) and subsets (N~2.5k); as well as for CHD (N~547k) and stroke (N~521k). We conducted Mendelian randomization (MR) analysis using Causal Analysis Using Summary Effect Estimates and Mode-Based Estimate; and the genome-wide cross-trait meta-analysis using Association analysis based on SubSETs.

Results:
Of the 138 inflammatory markers, MR analyses identified 3 cellular and 4 protein markers showing significant causal effects for CHD (including white blood cell count, CD8+ T count, interleukin 6, and interleukin 22 receptor subunit alpha 1;
FDR
<0.05); and 4 protein markers showing significant causal effects for ischemic stroke (including interleukin 6 and macrophage migration inhibitory factor;
FDR
<0.05). Genome-wide cross-trait analysis identified 456 independent genetic loci that significantly co-regulated cardiovascular disease (CHD or stroke) and at least one of its causal inflammatory markers (e.g.,
APOC1-4
coregulated CHD and 5 causal markers for CHD; lead SNPs showing
P
<5e-8 in each pair of marker-disease meta-analysis and
FDR
<0.01 with each trait). In tissue-specific gene expression analysis, the expressions of genes harboring these loci showed a significant enrichment in blood, blood vessels, and adipose tissue (
FDR
<0.05), and a marginal enrichment in the liver and lung (
P
<0.05).

Conclusions:
We identified cellular and protein inflammatory markers that potentially have a causal role in the development of CHD and ischemic stroke, based on genetic evidence.
Abstract 10866: Effect of Preoperative Atrial Fibrillation on Outcomes After Left Ventricular Assist Device Implantation
Authors: Shah Siddharth , Shah Kuldeep , Turagam Mohit K , Bhardwaj Rahul , Contractor Tahmeed , Mandapati Ravi , Natale Andrea , Lakkireddy Dhanunjaya , Garg Jalaj
Published: March 2022

Introduction:
Although preoperative atrial fibrillation (AF) is common in patients undergoing left ventricular assist device (LVAD) implantation, how AF affects clinical outcomes remains unclear.

Objectives:
We aimed to assess the safety and efficacy of LVAD implantation in AF patients

Methods:
Statistical analysis was performed using
meta-package
for R version 4.0 and Rstudio version 1.2. Mantel Haenszel Odds ratio (OR) random effects model (DerSimonian and Laird method) was used to summarize data. Outcomes studied were - (1) all-cause mortality; (2) systemic thromboembolism; (3) stroke (ischemic and hemorrhagic); (4) pump thrombosis; (5) gastrointestinal (GI) bleed.

Results:
Nine retrospective studies with a total of 6,782 patients (AF=2,170 and non-AF =4,612) were included in analysis. When compared with non-AF group, AF group patients were older (57.9±2.9 vs 52.2±5.8 years, p<0.001) and had less proportion of patients with INTERMACS profile 1, 2 (50.2% vs 54.3%, p<0.001). Preoperative AF was not associated with increased risk of all-cause mortality at 6 months (OR 1.20,95% 0.91-1.57, p=0.19), 12 months (OR 1.35, 95% CI 0.74-2.47, p=0.33) and 24 months (OR 1.23, 95% CI 0.95-1.60, p=0.12). Preoperative AF did not increase the risk of thromboembolism (OR 1.04, 95% CI 0.75-1.43, p=0.81), stroke (OR 0.89, 95% CI 0.74-1.08, p=0.24), and pump thrombosis (OR 1.28, 95% CI 0.97-1.70, p=0.08) after LVAD implantation. However, AF was associated with increased risk of GI bleeding (OR 1.28, 95% CI 1.12-1.47, p<0.001) [median follow up 11.5 months (9.6, 24)].

Conclusion:
Our study demonstrates a significantly increased risk of GI bleeding in LVADs recipients with concomitant AF, with no significant effect on all-cause mortality, stroke, or thromboembolic events (likely driven less sick patient population in AF group).
Abstract 10875: Long-Term Mortality Associated with Use of Carvedilol vs Metoprolol in Heart Failure Patients with and Without Type 2 Diabetes
Authors: Schwartz Brian , Pierce Colin , Madelaire Christian , Schou Morten , Kristensen Soren L , Gislason Gunnar , Kober Lars , Torp-Pedersen Christian , Andersson Charlotte
Published: March 2022

Background:
Carvedilol may have favorable glycemic properties compared with metoprolol, but it is unknown if carvedilol has mortality benefit over metoprolol in patients with type 2 diabetes (T2DM) and heart failure with reduced ejection fraction (HFrEF).

Methods and Results:
Using Danish nationwide databases between 2010-2018, we followed patients with new-onset HFrEF treated with either carvedilol or metoprolol for all-cause mortality until the end of 2018. Follow-up started 120 days after initial HFrEF diagnosis to allow initiation of guideline-directed medical therapy. There were 39,260 patients on carvedilol or metoprolol at baseline (mean age 70.8 years, 35% women), of which 9,355 (24%) had T2DM. Carvedilol was used in 2,989 (32%) patients with TD2M and 10,411 (35%) of patients without T2DM. Users of carvedilol had a lower prevalence of atrial fibrillation (20% vs. 35%), but other characteristics appeared well-balanced between the groups. Totally 11,306 (29%) were deceased by the end of follow-up. We observed no mortality differences between carvedilol and metoprolol, multivariable-adjusted hazards ratio 0.97 (0.90-1.05) in patients with T2DM versus 1.00 (0.95-1.05) for those without T2DM, p for difference =0.99. Rates of new-onset T2DM were lower in users of carvedilol vs. metoprolol; age, sex, and calendar year adjusted hazards ratio 0.83 (0.75-0.91), p<0.0001.

Conclusion:
In a contemporary clinical cohort of HFrEF patients with and without T2DM, carvedilol was not superior to metoprolol for long-term mortality reduction. However, carvedilol was associated with lowered risk of new-onset T2DM supporting the assertion that carvedilol have a more favorable metabolic profile than metoprolol overall.
Abstract 10881: Graph-Based Analysis of Cardiomyocyte Network Connectivity
Authors: Wilson Alexander J , Sands Gregory , Ennis Daniel
Published: March 2022

Introduction:
Cardiomyocytes branch and interconnect with one another, allowing for mechanical and electrochemical coupling. Despite being an essential structural feature enabling coordinated contraction, analysis of this branching structure has been limited. Herein, we use graph-based methods to analyze the cardiomyocyte network structure.

Hypothesis:
Cardiomyocytes are fully-connected, rather than being bundled into discrete, tract-bundles. We therefore expect that the size of connected graph components will increase with graph size, rather than tending towards a constant tract-bundle size.

Methods:
Rodent myocardium (n = 4) was stained for collagen and imaged using extended volume confocal microscopy. A sheetlet portion was segmented (~150 cells). The centerline of each cardiomyocyte was tracked. Vertices were identified where the cell bodies of adjacent cardiomyocytes merged. From the connected network (Fig 1A), an adjacency matrix was determined and the shortest-paths between all vertices calculated. The largest component was recorded as a function of graph size. Simulated fully-connected and tract-bundle networks (Fig 1B) were then compared to cardiomyocyte networks (Fig 1C).

Results:
For the simulated fully-connected network, the largest component increased with graph size, while the tract-bundle network levelled-off based on tract size (Fig 1B). In the cardiomyocyte networks (Fig 1C, red squares), the largest component continued to increase with graph size. Myocardial connectivity appears to lie between a tract-bundle and fully-connected simulated networks (Fig 1C). This suggests that the myocardium tends towards being a fully-connected network, although confirmation requires a larger image volume.

Conclusion:
Graph-based analysis of cardiomyocyte network structure distinguished between simulated fully-connected and tract-bundle networks. Cardiomyocyte networks are more similar to the fully-connected networks.
Abstract 10885: Decreased Hydraulic Force Contributes to Diastolic Dysfunction and Associates with Survival Beyond Conventional Measures of Diastolic Dysfunction
Authors: Soundappan Dhnanjay , Fung Angus , Loewenstein Daniel , Playford David , Strange Geoff , Kozor Rebecca , Otton James , Ugander Martin
Published: March 2022

Introduction:
Decreased hydraulic force has recently been identified as a mechanism contributing to left ventricular (LV) diastolic dysfunction and heart failure with preserved ejection fraction (HFpEF). However, it is unclear if hydraulic forces are independently associated with survival.

Hypothesis:
Decreased diastolic hydraulic force, estimated as the atrioventricular area difference (AVAD), is associated with survival independent of conventional diastolic dysfunction measures.

Methods:
Patients (n=37947, median [interquartile range] 4.9 [2.9-8.0] years follow-up, 6103 events) were selected from the National Echo Database Australia based on the presence of relevant transthoracic echocardiographic measures, LV ejection fraction (LVEF) ≥ 50%, heart rate 50-100 beats/minute, the absence of moderate or severe valvular disease, pericardial disease or mitral annular calcification, and no prior cardiac surgery. AVAD was calculated as the cross-sectional area difference between the LV and left atrium (LA) using circular approximation of LV end-diastolic diameter and LA end-systolic diameter. LV diastolic dysfunction grading was performed according to 2016 guidelines.

Results:
In multivariable linear regression, AVAD was weakly associated with E/e’, e’, peak tricuspid regurgitation velocity, and LVEF (global adjusted R2=0.11, p<0.001), but not associated with left atrial volume index (p=0.83). In multivariable Cox regression, there was an association with survival for both AVAD (chi-square 279, hazard ratio (HR) [95% confidence interval] 1.23 [1.20-1.26], p<0.001) and diastolic dysfunction grading (chi-square 1217, HR 3.21 [3.00-3.42], p<0.001). In a separate multivariable model, there was an association with survival for both AVAD (chi-square 371, HR 1.27 [1.24-1.30], p<0.001) and E/e’ (chi-square 1020, HR 1.39 [1.36-1.42], p<0.001).

Conclusions:
Decreased hydraulic force, estimated as AVAD, is associated with diastolic dysfunction, and provides prognostic information beyond conventional measures used to grade diastolic dysfunction. This suggests that increased LA size relative to LV size is a potential therapeutic target in HFpEF.
Abstract 10888: Lipid Profile Predicts Number and Length of Coronary Artery Stents
Authors: Shen Christine P , Bagsic Samantha R , Jaravata Ashley , Schatz Richard A , Price Matthew J , Stinis Curtiss , Teirstein Paul , Pandey Amitabh C
Published: March 2022

Introduction:
Higher levels of low-density lipoprotein (LDL) are associated with an increased incidence of cardiovascular events. Little is known about the impact of lipid profile on the severity and extent of disease. This study aims to characterize the lipid profile’s ability to predict the number of and total length of coronary artery stents.

Hypothesis:
In patients undergoing percutaneous coronary intervention, the lipid panel is predictive of the total length and number of coronary stents deployed.

Methods:
We retrospectively identified unique, consecutive patients undergoing percutaneous coronary intervention at a single center from April 2018 to March 2021. Inclusion criteria included the availability of a lipid panel in the electronic medical record. Associations between lipid levels with stent number or stent length were tested by univariable linear regression.

Results:
For a single coronary angiogram procedure, 1547 unique patients had a lipid panel in the EMR within 2 weeks of the procedure with a median of 2 stents deployed with median total stent length of 38 mm. High-density lipoprotein (HDL), LDL, but not total cholesterol, triglycerides (TG), were predictive of stent length (HDL inversely,
p
=0.004; LDL
p
=0.01) and number of stents (HDL inversely,
p
=0.008; LDL
p
=0.04).

Conclusions:
These results indicate that the lipid panel has implications for the severity and extent of coronary artery disease found during coronary angiography, reflected in the number of and total length of coronary artery stents.
Abstract 10894: Socioeconomic Status and Differences in Trends of Atrial Fibrillation In-Hospital Mortality Among Black and Non-Black Adults in the United States
Authors: Rojulpote Chaitanya , Patil Shivaraj , Bhattaru Abhijit , Gonuguntla Karthik , Kela Kashyap , Shrivastava Sanskriti , Buradkar Ajinkya , Buch Tapan
Published: March 2022

Introduction:
Race and socioeconomic status (SES) is interconnected. There is scarce data analyzing trends of atrial fibrillation (AF) in-hospital mortality in black and non-black adults based on SES.

Methods:
We queried the National Inpatient Sample database from January 2004 to December 2018 to identify patients admitted with AF. We used ICD-9-CM and ICD-10-CM diagnosis codes to identify all patients who were 18 years of age or older and hospitalized with a primary discharge diagnosis of Atrial Fibrillation. Our cohort was further categorized by race, into black and non-black groups, and socioeconomic status (SES) using median household income (MHI) as a surrogate, into low SES (MHI 0-50) and high SES (MHI 51-100). We excluded all patients with incomplete data on age, gender, race, MHI and in-hospital mortality status. Also, in order to reduce the possibility of data duplication, the patients with an indicator for transfer to another acute-care facility were excluded. Cochran-Armitage Test was utilized to estimate temporal trends.

Results:
Black and non-black adults have had improvement of in-hospital mortality, although black adults still have higher trends as compared to non-black counterparts (p<0.001).

Conclusions:
Trends of AF in-hospital mortality between black and non-black individuals are comparable despite a significantly smaller proportion of blacks in our study. There is a dynamic interplay among social and health risk factors associated with AF in black individuals and further studies are required to better understand this relation.
Abstract 10910: The Role of Extracellular Matrix Biomarkers in Phenotypes of Subclinical Heart Failure
Authors: Halabi Amera , Potter Elizabeth , Yang Hong Hilda , Wang Bing , Wright Leah , Marwick Thomas
Published: March 2022

Introduction:
The extracellular matrix (ECM) plays a pivotal role in the development of heart failure (HF). Matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinases (TIMPs) are key regulators of collagen turnover; several MMP and TIMP enzymes are associated with fibrosis and clinical HF.

Hypothesis:
This study compared ECM biomarkers with clinical biomarkers of cardiac function (N-terminal pro-brain natriuretic peptide [NTpBNP] and troponin-T [tropT]) in subclinical HF.

Methods:
316 asymptomatic patients (71±5 years; 58% female) with at least one HF risk factor (hypertension, obesity, type 2 diabetes mellitus) from two community-based populations underwent a comprehensive echo, including global longitudinal strain (GLS), diastolic function (annular velocity [e’]) and LV geometry (LV mass index [LVMi], relative wall thickness [RWT]). ECM was assessed with MMP-2 and -9, and TIMP-1 and -2.

Results:
In the cohort, systolic function was preserved (GLS -18.4±3%), myocardial relaxation was slightly reduced (7.8±2cm/s) and LVMi was within normal limits (78.7±19g/m
2
). Abnormal GLS (>-16%) was associated with elevated TropT (
p
=0.007) and NTpBNP (
p
=0.008; Table), but no association was found with ECM biomarkers. However, elevated RWT and LVMi were associated with lower MMP-2, MMP-9 and TIMP-1, but not TropT or NTpBNP (Table). In multivariable regression analyses, there were weak negative associations observed between LVMi and MMP-2 (β=-0.05 [95% CI -0.09, -0.02],
p
=0.003), MMP-9 (β=-0.017 [-0.028, -0.007],
p
=0.001) and TIMP-1 (β=-0.03 [-0.05, -0.01],
p
=0.001). However, all ECM biomarkers had poor diagnostic utility in detecting elevated LVMi (AUC MMP-2 61%; MMP-9 58%; TIMP-1 61%). Similar trends were observed with RWT (AUC MMP-2 58%; MMP-9 64%; TIMP-1 61%).

Conclusions:
Although ECM biomarkers are associated mechanistically with cardiac remodelling, they lack clinical utility in recognition of subclinical HF.
Abstract 10950: Real-World Practice of Reperfusion and Revascularization in Patients with St-Segment Elevation Myocardial Infarction in China: Findings from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome Project
Authors: Yang Yiqian , Hao Yongchen , Liu Jun , Yang Na , Huo Yong , Smith Sidney C , Ge Junbo , Fonarow Gregg C , Morgan Louise , Ma Chang-Sheng , Yaling Han , Zhao Dong ,   the CCC-ACS Investigators, Liu Jing
Published: March 2022

Introduction:
Reperfusion and revascularization therapies are key treatments of ST-segment elevation myocardial infarction (STEMI). However, little is known about the contemporary practice among Chinese patients with STEMI. We aimed to explore the recent practice of reperfusion and revascularization among hospitalized patients with STEMI in China.

Methods:
A total of 59442 STEMI patients admitted to 159 tertiary hospitals from 30 provinces in China were included in the Improving Care for Cardiovascular Disease in China (CCC)-ACS project from November 2014 to December 2019. The practice of reperfusion and revascularization were assessed. Associations between therapies and in-hospital MACE after 1 day of admission were examined with multivariate Cox regression.

Results:
Among the 59442 patients, 48897 (82.3%) underwent reperfusion/ revascularization, including 28280 (47.6%) received pPCI within 12 hours, 4649 (7.8%) received pPCI between 12 to 24 hours, 1314 (2.2%) received fibrinolysis alone, and 1751 (2.9%) received pharmaco-invasive strategy. A total of 12903 patients (21.7%) received elective PCI, among which 1486 (11.5%) initially received fibrinolysis. Overall, 37480 patients (63.1%) received reperfusion therapy, including 32929(55.4%) received pPCI, which was 7.2-fold higher than that of fibrinolysis (4551, 7.7%). Among patients receiving fibrinolysis, only 38.4% (1751/4551) received pharmaco-invasive strategy, including 25.2% for pharmaco-invasive PCI and 13.3% for rescue PCI. All PCI strategies, but not fibrinolysis alone, were associated with decreased risk of in-hospital MACE compared with no reperfusion/ revascularization, with the adjusted HR (95% CI) of 0.46(0.38, 0.56) for pPCI<12h, 0.38(0.27, 0.55) for pPCI 12-24h, 0.38(0.16, 0.95) for rescue PCI, 0.27(0.13, 0.59) for pharmaco-invasive PCI, 0.28(0.21, 0.37) for elective PCI, and 0.86(0.57, 1.29) for fibrinolysis alone.

Conclusions:
Revascularization therapies are widely used in patients with STEMI in China. However, there are notable gaps between guideline recommendations and the clinical practice in terms of timely reperfusion, especially pharmaco-invasive strategy. Early reperfusion therapies should be further strengthened.
Abstract 10951: Clinical Outcome of Maze Procedure for Atrial Fibrillation Combined with Mitral Valve Disease and Tricuspid Regurgitation
Authors: yamana fumio , Domae Keitaro , Kodani Noriko , Kin Keiwa , Hata Masatoshi , Masai Takafumi
Published: March 2022

Introduction:
The surgical strategy for atrial fibrillation (AF) combined with mitral valve (MV) disease are still controversial whether biatrial or left atrial maze procedure should be performed concomitantly.

Hypothesis:
Our retrospective study aimed to evaluate the long-term results of two kinds of maze procedure combined with MV surgery and identify the factors involved in AF recurrence.

Methods:
We enrolled 88 patients from January 2010 to December 2020 who underwent MV surgery with maze procedure concomitantly. The patients were divided into two groups; biatrial maze, group F: n=42 and left atrial maze, group L: n=46). Primary endpoint was AF recurrence and we also evaluated early and late complication and preoperative and operative factors related to AF recurrence. The average follow-up term was 2.8 years.

Results:
Preoperative factors of long-standing AF and TR grade were significantly higher in group F than group L (P=0.004, 0.02, respecively). Consequently, tricuspid annuloplasty (TAP) was performed significantly frequent in group F than group L (P=0.002). We encountered 2 hospital deaths (4.4%) due to postoperative cerebral hemorrhage and AMI in group L. There was 1 case (2.2%) required pacemaker implantation (PMI) during hospitalization in group L and 3 cases (7.1%) requiring PMI in Group F in late-period. The AF recurrence rates at 1 and 5-year follow-ups between Group F and Group L were not significantly different (24.4% and 28.4% vs. 22.9% and 32.4%, P =0.79). However, the AF recurrence rate in group L with TAP is significant high than those of the other groups (group F 24.4% and 28.4%, group L with TAP 44.3% and 56.7%, and group L without TAP 7.7% and 14.3% at 1 and 5 years, respectively p =0.005). Subject with group L with TAP were associated with a high risk of AF recurrence, with an adjusted OR of 2.4 (95% CI: 1.31-4.45, P =0.005).

Conclusions:
Our study demonstrated that both concomitant maze procedure was effective for preventing AF recurrence. However, it is also revealed that left atrial maze with TAP significantly increased AF recurrence. It was suggested that preoperative right atrial load was involved in primary occurrence of AF and left atrial maze alone might not control AF recurrence in such situation.
Abstract 10958: Ability of Machine Learning Algorithms to Predict Stage 2 Hypertension Using Health Examination Data from Japanese General Population
Authors: Kawasoe Shin , Kubozono Takuro , Ojima Satoko , Kawabata Takeko , Salim Anwar A , Miyahara Hironori , Tokushige Koichi , Ohishi Mitsuru
Published: March 2022

Introduction:
There is a large amount of specific health examination data in Japan. Efforts to utilize these data to predict the future onset of cardiovascular diseases are important from the perspective of improving prognosis and QOL as well as medical economy. We evaluated the prediction ability of machine learning algorithms for newly developed 5-year hypertension.

Methods:
Among those who underwent examinations from 2008 to 2018, individuals whose baseline (year X), 1 year later (year X+1), and 5 years later (year X+5) data were available were included. Hypertension was defined as
>
140/90 mmHg or under treatment with antihypertensive drugs. Those with hypertension in year X or X+1 were excluded. Three different machine learning algorithms, Support vector machine (SVM), Logistic regression (LR), and Multilayer perceptron (MLP) to predict hypertension on year X+5 from single-year data (year X) or consecutive 2 years data (year X and X+1) were assessed, and the predictive ability was compared. Anthropometric measurements, blood pressure and pulse rate, laboratory measurements, and lifestyle related indices were included as explanatory variables.

Results:
A total of 24,652 participants (age 48.0±10.1 years, male 47.5%) were included and 3,596 individuals (14.6%) had hypertension in year X+5. The indices of predictive ability from single-year data were as follows: SVM, AUC 0.80, accuracy 0.71, precision 0.94; LR, AUC 0.80, accuracy 0.86, precision 0.87; MLP, AUC 0.80, accuracy 0.86, precision 0.86. Those from multi-year data were as follows: SVM, AUC 0.85, accuracy 0.75, precision 0.95; LR, AUC 0.85, accuracy 0.87, precision 0.88; MLP, AUC 0.84, accuracy 0.87, precision 0.89. The variables with the highest importance features were systolic blood pressure (0.49), diastolic blood pressure (0.26), waist circumference (0.13), and body mass index (0.06).

Conclusions:
The ability to predict new onset of hypertension was better when using data from two consecutive years than when using data from a single year. The AUCs ranged from 0.84 to 0.85 and were generally better than previously reported risk models using statistical methods. Anthropometric measures, along with blood pressure levels, have been identified as major contributors.
Abstract 10961: Integrated Coronary Vascular Disease Diagnosis System Based on Two-Step Neural Network Algorithm Trained by Synthetic Model and Patient Biometric Features
Authors: Kim Young Woo , Kim Junhong , Lee Hyeong Jun , LEE JOON SANG
Published: March 2022

Introduction:
Fractional flow reserve (FFR) is the golden standard that determines whether coronary artery disease (CAD) surgery is necessary or not. Invasive FFR uses pressure wire to obtain the pressure ratio of proximal and distal lesion. However, the burden from high cost and time due to invasive process makes it difficult to perform diagnosis. To overcome these limitations, FFR can be measured non-invasive through CFD analysis based on geometry models obtained from observational equipment such as coronary computer tomography (CT). However, obtaining this FFR value consumes considerable time and computer resources in the process of vessel shape extraction and CFD. In this study, we propose a non-invasive artificial intelligence-based FFR prediction technology.

Methods & Results:
The algorithms used in this paper were separated into two steps. The first algorithm is to compute flow features from geometric features trained by synthetic models and CFD analysis. In the second step, we trained classification algorithms and regression algorithms using the flow properties obtained from the first step and patient biometric information. Classification algorithms are used to determine whether to invasive operate, and regression algorithms are used to predict FFR values. The algorithms used are 6 machine learning and 2 neural networks. To improve the performance of the algorithms, outlier data were removed through the IQR method. Among the classification algorithms, random forest had the best accuracy of 80.1%, and in the regression algorithm, artistic neural network had the lowest mean absolute error of 0.04. Furthermore, we analyze the algorithm performance within the gray zone to prove that the algorithm can provide guidance in the case of uncertain situations.

Conclusions:
Algorithms learned in a two-step manner determined whether the lesion need a surgery or not and predicted the FFR value. In particular, we presented guidelines for building FFR prediction algorithms with good prediction performance.
Abstract 10964: Clinical Safety of Tadalafil in Patients Receiving Concomitant Antihypertensive Medication
Authors: Kloner Robert A , Kostis John B , Qiu Chunfu , Gupta Alankar , McGraw Thomas
Published: March 2022

Introduction:
It is important that physicians and patients are aware of the cardiovascular safety of options available to treat erectile dysfunction (ED)/benign prostatic hyperplasia (BPH) while on concomitant antihypertensive medications (AHM).

Objective:
This integrated safety analysis assessed the incidence of hypotension-related treatment-emergent adverse events (TEAEs) and major adverse cardiovascular events (MACE) in patients with concomitant use of tadalafil and AHM.

Methods:
Data were integrated from seventy-two Phase II-IV studies conducted on patients with a diagnosis of ED and/or BPH. Studies were categorized as either All placebo-controlled studies or All studies. The incidences of hypotensive-related TEAEs and MACE were analyzed by indication; by use of concomitant AHM; and by the number of concomitant AHM.

Results:
A total of 15,030 and 22,825 patients were included in the analyses for All placebo-controlled studies and All studies, respectively. In the All placebo-controlled studies, the incidence of hypotension-related TEAEs and MACE was ranging between 0.6-1.5% and 0.0-1.0%, respectively, across all indications and use of AHM. Tadalafil was associated with an increase in hypotension-related TEAEs only in the ED as-needed category not receiving any concomitant AHM (p-value=0.0070); no difference was reported between placebo and tadalafil in all indication categories of patients receiving ≥1 AHM (p-value≥ 0.7386). Similarly, no differences (p-value≥ 0.2238) were observed in the incidence of MACE between tadalafil and placebo treatment groups, with or without concomitant use of AHM, and across all indication categories. In the All studies results were similar.

Conclusion:
The concomitant use of tadalafil alongside AHM did not increase the risk of hypotension-related TEAEs or MACE compared with AHM alone.
Figure
Odds ratio of incidences of hypotension-related TEAEs between placebo and tadalafil groups by number of concomitant AHM
Abstract 10966: Characterization of the Novel Cardiac Splicing Factor Slm2 in Heart Failure, Which Regulates Splicing of Titin
Authors: Boeckel Jes-Niels , Moebius-Winkler Maximilian Nicolas , Müller Marion , Rebs Sabine , Eger Nicole , Schoppe Laura , Tappu Rewatti , Kokot Karoline Elizabeth , Kneuer Jasmin M , Gaul Susanne , martins bordalo diana , lai alain , Haas Jan , Ghanbari Mahsa , Drewe-Boss Philipp , Liss Martin , Katus Hugo A , Ohler Uwe , gotthardt Michael , Laufs Ulrich , Streckfuß-Bömeke Katrin , Meder Benjamin
Published: March 2022

Introduction:
The versatility of the human genome is increased by the process of alternative mRNA splicing. Impaired splicing of the cardiac transcriptome is involved in the pathophysiology of heart failure. Especially, mutations in cardiac-specific splicing factors such as RBM20 cause severe forms of cardiomyopathy.

Aim:
We aimed to identify novel cardiomyopathy-associated splicing factors in the human heart using a score of myocardial tissue specificity including 53 human tissues and disease-associated expression changes in hearts of dilated cardiomyopathy (DCM) patients and controls.

Methods & Results:
We found the splicing factor Slm2 to be significantly upregulated on the mRNA and protein level in the human myocardium of patients diagnosed with DCM (1.88 and 5.3-fold, both P<0.05). Reduction of Slm2
in vivo
resulted in DCM in zebrafish and sarcomere irregularity and altered calcium cycling in human cardiomyocytes. Sequencing of RNAs bound to Slm2 isolated from diseased human hearts, revealed the interaction of Slm2 with important mRNA transcripts encoding for sarcomere constituents, such as troponin I, troponin T, tropomyosin and titin. In the failing human myocardium, Slm2 bound to an alternative titin mRNA variant including retained introns. In detail, Slm2 interacted with exons of the titin mRNA encoding for the PEVK region, which mediates flexibility and contractile properties of the heart muscle. Using a splice reporter assay, which contains parts of titin’s PEVK region, we found Slm2 mediating the splicing process of intron retention.

Conclusion:
Slm2 is a novel splicing factor in the diseased human myocardium, maintaining cardiomyocyte integrity and function by binding and splicing essential sarcomere constituents including titin.
Abstract 10967: Prognostic Value of a Novel Index: Computational Pressure-Flow Dynamics Derived Fractional Flow Reserve in Stable Coronary Artery Disease Patients with Nonischemic Lesions
Authors: LI Kwan Yu , Lam Lok Yee Jane , Leung Ka Lam Calvin , Wu Mei Zhen , Ren Qingwen , Li Hang Long , Yu Si-Yeung , Tse Yi Kei Stephanie , Yu Shuk Yin , Wong Pui Fai , Feng Yundi , Huo Yunlong , Yiu Kai Hang
Published: March 2022

Introduction:
Computational pressure-flow dynamics derived fractional flow reserve (caFFR) is an angiographic-derived index to determine the fractional flow reserve (FFR) in patients with stable coronary artery disease (CAD), without the need of invasive pressure wire and hyperaemic stimulus in FFR. Although the safety of FFR-guided deferral of revascularization in non-ischemic lesions is well-established, clinical events still occur. The aim of the study is to investigate the prognostic implications of caFFR in those without significant ischemia.

Methods:
513 stable CAD patients (mean age=64.3±11.1, 57.7% male) with all lesions being nonischemic, defined by caFFR>0.75, without undergoing revascularization were recruited. The study population was divided into high (n=240) and low (n=273) caFFR groups, according to the median value of caFFR (0.89). The primary endpoint was 3-year major adverse cardiac events (MACE), defined as a composite of all-cause mortality, myocardial infarction (MI), target vessel revascularization (TVR) and hospitalization for heart failure.

Results:
A total of 44 composite events occurred, including 17 all-cause mortality, 2 MI, 8 TVR and 17 hospitalization for heart failure. Following multivariate adjustment, patients in low caFFR group had a significantly higher risk of MACE than those in high caFFR group (adjusted hazard ratio [HR], 3.02; 95% confidence interval [Cl], 1.19-7.71; P=0.02). Every 0.01 decrease in caFFR was associated with a higher risk of MACE (adjusted HR, 1.12; 95%Cl, 1.03-1.21; P<0.01) cardiovascular mortality or TVR (adjusted HR, 1.16; 95%Cl, 1.04-1.32; P=0.02) and hospitalization for heart failure (adjusted HR, 1.18; 95%Cl, 1.04-1.34; P=0.01).

Conclusions:
In stable CAD patients without significant functional ischemia, caFFR provides valuable prognostic information on adverse cardiac outcomes. This novel index could enhance risk stratification in stable CAD patients with nonischemic lesions.
Abstract 10968: Seasonal Variations in In-Hospital Mortality Caused by Acute Cardiovascular Diseases in Japan from JROAD-DPC Dataset
Authors: nakai michikazu , Iwanaga Yoshitaka , Yoko Sumita , Sasahara Yusuke , Kanaoka Koshiro , Miyamoto Yoshihiro
Published: March 2022

Introduction:
Previous studies have shown that the incidence of acute cardiovascular diseases (CVDs) increases in winter. However, there is few research regarding seasonal changes of the in-hospital mortality and its relationship with the detailed conditions.

Hypothesis:
We assessed whether the acute CVDs have related seasonal trends regarding of hospitalized-patients number and in-hospital mortality using a national-wide Japanese registry of all cardiac and vascular datasets-Diagnostic Procedure Combination (JROAD-DPC).

Methods:
Based on International Classification of Diseases, Tenth Revision (ICD-10) code, we identified the hospitalized patients with acute CVDs; acute myocardial infarction (AMI, ICD10:I20), acute heart failure (AHF, ICD10:I50+additional code 30101/30102), and acute aortic dissection (AAD, ICD10:I710) between April 2012 and March 2020. Season was distinguished into four categories (Spring: March-May, Summer: June-August, Fall: September-November, and Winter: December-February). Univariate multilevel mixed-effects logistic regression with institution as a random variable was conducted. Odds ratio (OR) and 95% confidence interval (95% CI) were calculated.

Result:
1,644,135 patients with acute CVDs (age: 76.2 ± 13.5, male: 57.7 %) were identified. The number of hospitalized patients was the most in Winter among the seasons (30.4%). Using Spring as a reference, ORs (95% CI) of in-hospital mortality in Summer were 0.97 (0.95, 0.98) for all, 0.97 (0.94, 0.99) for age younger than 75, 0.98 (0.96, 0.99) for male, and 0.95 (0.93, 0.97) for female. In contrast, those in Winter was 1.03 (1.02,1.04) for all, 1.02 (0.99, 1.05) for age younger than 75, 1.05 (1.03, 1.07) for male, and 1.01 (0.99, 1.03) for female. Furthermore, in each diagnosis, those in Summer were 0.81 (0.79, 0.85) for AMI and 1.06 (1.02, 1.09) for AHF and 0.77 (0.73, 0.82) for AAD, whereas those in Winter were 1.04 (1.01, 1.08) for AMI, 1.01 (0.98, 1.04) for AHF, and 0.94 (0.89, 0.99) for AAD.

Conclusions:
A clear seasonal pattern was found in hospitalized patients with acute CVDs in a recent large-scale nationwide dataset; however, different seasonal trends of in-hospital mortality were found in younger, female, and AHF or AAD patients.