bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13823: Clinical Presentation Rather Than Imaging Findings Determine Outcomes in Cardiac Sarcoidosis
Authors: Bosah Arinze , Doyle Mark , Poornima Indu G
Published: April 2022

Background:
Cardiac PET and MRI have facilitated increased diagnosis of Cardiac Sarcoidosis (CS). Varied clinical presentations such as advanced heart block, ventricular arrhythmias and heart failure (HF) are initiating this diagnostic pathway but it is unclear if prognosis is dictated by clinical presentation or imaging findings. In our quaternary care center, we conducted a retrospective review of patients diagnosed with CS by cardiac MRI/PET and examined outcomes in relation to imaging findings and clinical presentation.

Methods:
223 patients underwent evaluation for suspected CS by cardiac MRI/PET between 2016-2019 and 62 were identified as having CS based on clinical and imaging criteria. We divided this cohort based on their primary clinical indication for imaging- arrhythmia, HF or screening due to history of pulmonary sarcoidosis. Outcome defined as MACE included death, ICD-shock or admission for HF.

Results:
Study population was predominantly male (65%), Caucasian (79%) with mean age 60±10 years, Referral diagnosis was HF in 37 (59%), arrhythmia (defined as high grade AV block/ventricular arrhythmias) in 15 (25%) and screening in 10 (16%). While there were no differences in the CMRI LGE findings or degree of inflammation by FDG-PET, there was a higher incidence of resting anteroseptal perfusion on PET, with a higher summed rest score in the arrhythmia group (mean 2 vs 0 in other groups; p<0.05). Based on imaging findings, 39% were treated with steroids, 25% with immunosuppressant, 10% were on combination. Over mean follow-up of 3.5 years, there were 26 events- 6 deaths, 10 ICD shocks 10 heart failure admissions. Event-free survival was 53%, 76% and 80% in the arrhythmia, HF and screening groups respectively. In multivariable analysis, a model that included VT presentation (OR 11; p<0.05) and global hypokinesis on PET images (OR 10; p<0.05) had a sensitivity of 86% and specificity of 63% for MACE prediction. Compared to the model, neither Inflammation on FDG-PET or LGE (MRI) predicted outcomes and treatment with steroids and/or immunosuppressant did not alter prognosis.

Conclusions:
In this single center study of CS, a primary diagnosis of ventricular arrhythmia and global LV systolic dysfunction, regardless of LVEF, had the worst prognosis.
Abstract 13825: Characteristics of Patients With Exercise-Induced Left Ventricular Systolic Dysfunction and Non-Significant Coronary Artery Disease
Authors: Hubers Scott A , Mohananey Akanksha , Pereira Naveen L
Published: April 2022

Introduction:
Prior studies have shown 30-35% of patients with an abnormal stress test had non-obstructive coronary artery disease. The characteristics and outcomes of this patient population have not been well studied. We tested the hypothesis that there is a distinct group of individuals who have an exercise-induced cardiomyopathy not related to the presence of obstructive coronary artery disease or pre-existing structural heart disease.

Methods:
Our cohort included adults 18 years and older who underwent stress echocardiography at the Mayo Clinic. Patients were included if their resting left ventricular ejection fraction (LVEF) was greater than 50% and decreased by more than 5% to under 50% with exercise. We excluded patients who did not have coronary angiography in the 90 days following stress echocardiography and those with prior diagnosis of coronary artery disease or structural/valvular heart disease.

Results:
A total of 205627 stress echocardiograms were performed between 2003 and 2019, of which 127 patients were analyzed in our cohort. The median age was 68 years, and 76% were female. The median LVEF was 55% at rest and 45% with stress. Left bundle branch block was present in 9% of patients. Median peak systolic blood pressure was 174 mm Hg. Stress electrocardiogram was positive in 14% of patients. Median functional aerobic capacity [interquartile range] as a percentage of age/sex predicted capacity was 101% [73%, 117%].

Conclusion:
We describe a cohort of patients with exercise-induced left ventricular systolic dysfunction not explained by obstructive coronary artery disease or structural heart disease. Forthcoming analyses of long term outcomes will be important to understand how these patients compare to patients without exercise-induced cardiac dysfunction.
Abstract 13828: Lesion Length and Left Ventricular Function Predict Outcome in Patients Undergoing Orbital Atherectomy Prior to Stenting for Severely Calcified Coronary Lesions
Authors: Smith Carson , Hodge Matthew , Zirille Francis , Revtyak George
Published: April 2022

Introduction:
Orbital atherectomy prior to stenting (OAptS) of severely calcified coronary lesions may improve procedural outcomes. However, there is little data identifying specific procedural/clinical factors influencing these outcomes. In this study, we examined the hypothesis that both lesion length and left ventricular ejection (LVEF) influence overall clinical outcomes for OAptS.

Methods:
Between November 1, 2015 and December 31, 2019, clinical data and coronary angiograms for all patients undergoing OAptS for severely calcified coronary lesions at our institution were retrospectively reviewed. Patients were first grouped by lesion length (focal ≤24mm and diffuse >24mm), then subdivided into normal (≥50%) and reduced (<50%) LVEF groups. Demographics, procedural variables and clinical outcomes for all four groups were then analyzed and compared.

Results:
In total, 213 lesions were analyzed (74 focal and 139 diffuse). There was no significant difference in demographics between all four patient groups. Average target lesion stent lengths were longer for diffuse compared to focal lesions (38.1±1.7mm vs. 17.2±0.8mm; p<0.001). Fluoroscopy time was longer in patients with diffuse lesions (p< 0.05), with no significant difference in contrast volumes between all groups (p=NS). The baseline LVEF was lower in patients with diffuse lesions (50.6±13% vs. 54.8±12%; p<0.05). Thirty-day time-to-event analysis (Mantel-Cox) demonstrated earlier and more frequent death/MACE/bleeding in the patient group with both diffuse lesions and reduced LVEF (p<0.01). Death, MACE and bleeding was not statistically different between the other three subgroups.

Conclusions:
In conclusion, our single center, retrospective analysis demonstrates the general safety of OAptS for treating severely calcified coronary lesions of different lengths in patients with normal and reduced LVEF. In addition, it identifies a high-risk patient subgroup (diffuse lesion length and reduced LVEF) at increased risk for a worse procedural outcome.
Abstract 13839: Knowledge, Attitude & Practice of Health Care Workers Regarding Pediatric Early Warning System - A Cross Sectional Study in Karachi, Pakistan
Authors: Aziz Azwa , Abbas Qalab , Jaffer Mehtab , Sultan Noureen , Ladak Laila
Published: April 2022

Introduction:
The Pediatrics Early Warning Scoring (PEWS) system is a quantitative instrument that measures the severity of the clinical situation of children aged 1 month to 18 years.

Hypothesis:
To assess the knowledge, attitude, and practices among nurses and doctors regarding the Pediatric Early Warning Signs (PEWS) system, in a pediatric ward at a tertiary care hospital in Karachi, Pakistan.

Methods:
A cross-sectional study design was used to address the study question. The universal sampling technique was used to recruit a total of 142 eligible nurses and doctors to explore the knowledge and attitude regarding the PEWS system. Medical records of patients who had a Pediatric Rapid Response Team (PRRT) request raised was reviewed for practice assessment of PEWS. The relationship between the study participants’ demographic characteristics and their knowledge and attitude regarding PEWS was assessed through Chi-square for categorical variables and one-way ANOVA for continuous variables.

Results:
The findings of the study revealed that out of 142 study participants, 50% participants had a low level of knowledge yet positive attitude towards the PEWS system. Professional qualification and age of participants were significantly associated with knowledge regarding the PEWS system. Profession, professional qualification, current position of the study participants and specialized training on PEWS had a significant association with attitude regarding the PEWS system.

Medical records of 30 patients were eligible for practice assessment which revealed that 56.7% of the PEWS observations were documented in patient records which were either incomplete or inappropriate. About 50% showed a poor level of practice regarding PEWS.

Conclusions:
Our study revealed a knowledge and practice gap among the nurses and doctors while utilizing the PEWS system. Despite having a low level of knowledge, the participants had a positive attitude towards PEWS to enhance their PEWS knowledge and practices. PEWS should be incorporated in the Pediatric Advanced Life Support (PALS) certification course. Moreover, simulation-based teaching strategies should be planned to improve practice and knowledge regarding the system.
Abstract 13847: Sex-Differences by Body Mass Index After ST-Elevation Myocardial Infarction
Authors: Mattingly Georgia , Yildiz Mehmet , Lantz Rebekah , Okeson Brynn , Aguirre Frank V , Tannenbaum Mark , Garcia Santiago , Henry Timothy D , Quesada Odayme
Published: April 2022

Introduction:
There are significant differences in body composition by sex; however, differences by sex on the association of BMI with cardiovascular outcomes after STEMI remains poorly understood.

Methods:
The Midwest STEMI Consortium consists of 15,039 consecutive STEMI activations. 4,682 patients with 1-year follow-up were included to examine sex-differences in characteristics, treatment, in-hospital and 1-year MACE and mortality risk by BMI groups: normal (18.5-24.9 kg/m
2
), overweight (25.0-29.9 kg/m
2
), and obese (≥30.0 kg/m
2
).

Results:
Among 4,682 patients, 30% were women and 70% were men. Among women, 28% had normal BMI, 30% were overweight, and 42% obese. In
normal
BMI patients women were significantly older, had higher rates of HTN, lower rates of smokers, lower peak troponin, and longer door-to-balloon times compared to men. Women had lower risk of 30-day MACE (1.1% vs. 3%, p=0.045) but there were no sex-differences in 1-year MACE or mortality. Among
overweight
patients, women were significantly older, had higher rates of HTN and diabetes, and lower rates of smokers. Bleeding complication was more common in women (38% vs. 32%, p=0.03) as was cardiogenic shock pre-PCI (13% vs. 8.8%, p=0.02) but no sex-differences were seen in 1-year MACE or mortality. Among
obese
patients, women were significantly older and had higher rates of HTN, diabetes and stroke. Women had lower rates of out of hospital cardiac arrest (8.8% vs. 13%, p=0.005) and more bleeding complication (39% vs. 33%, p=0.025). Women had higher risk of 30-day death (2% vs. 0.8%, p=0.02), 1-year stroke (2.4% vs. 0.7%, p=0.004), and 1-year MACE and mortality (Figure).

Discussion:
Among STEMI patients, we found that obese women were at increased risk of MACE and mortality. Interestingly, there were no differences in MACE or mortality between men and women of normal and overweight BMI ranges, suggesting the importance of BMI when risk stratifying patients, particularly women, that warrants further research.
Abstract 13877: Financial Hardship From Medical Bills Among Non-Elderly Adults With Obesity in the US
Authors: Mahajan Shiwani , Valero Elizondo Javier , Khera Rohan , Taha Mohamad , Acquah Isaac , Cainzos Achirica Miguel , Krumholz Harlan M , Nasir Khurram
Published: April 2022

Introduction:
Obesity is a growing public health challenge in the US and carries a heavy economic toll. Previous work has detailed the overall health expenditures in this population, but we lack a current understanding on how these expenditures translate into financial hardship. We aimed to assess the financial hardship from medical bills, as well as other cost-related healthcare shortcomings experienced by those with obesity.

Methods:
We used the National Health Interview Survey (2013-18), a US nationally representative sample, to assess financial hardship from medical bills - difficulty paying or unable to pay at all (and consequences, including high financial distress, foregone/delayed care due to cost, and cost-related medication nonadherence) in non-elderly adults (18-65 years [i.e., those without universal coverage]) across different BMI strata. BMI was categorized as normal (18.5-24.9 kg/m
2
), overweight (25-29.9 kg/m
2
), obesity classes 1 (30-34.9 kg/m
2
), 2 (35-39.9 kg/m
2
), and 3 (≥ 40 kg/m
2
).

Results:
Among 139,521 surveyed individuals, 12,129 (weighted 8.5%) had class 3 obesity, representing 16 million non-elderly adults annually. A total of 38.0% of non-elderly adults with class 3 obesity reported having financial hardship from medical bills, compared with 24.7% among those with normal weight. Compared with adults with normal weight, those with class 3 obesity had higher odds of financial hardship from medical bills (OR 1.53, 95% CI 1.44-1.64), and among those with any financial hardship, higher odds of its consequences, including high financial distress (OR 1.13, 95% CI 1.01-1.25) and cost-related medication nonadherence (OR 1.16, 95% CI 1.02, 1.32).

Conclusion:
Non-elderly adults with class 3 obesity had 50% higher odds of financial hardship from medical bills, compared with those with normal weight, along with higher odds for its consequences, like financial distress and cost-related medication nonadherence.
Abstract 14031: Effects of Custodiol-HTK and Del Nido Solutions in a Coronary-Perfused Rabbit Ventricular Wedge Model
Authors: Sicouri Serge , Kilcoyne Maxwell , Yan Gan-Xin , Liu Tengxian , Buckley Meghan , Ramlawi Basel
Published: April 2022

Introduction:
Distinct cardioplegic solutions are used in cardiac surgery for myocardial protection. Custodiol-HTK (CUS) solution consists of histidine, tryptophan, ketoglutarate and mannitol to reduce cellular edema. Del Nido (DN) is a nonglucose-based solution containing low calcium and high lidocaine concentrations, preventing intracellular Ca2+ accumulation during ischemia.

Hypothesis:
Using a coronary-perfused rabbit experimental model, this study compares the effects of CUS and DN on transmural electrocardiogram (ECG) and tension parameters.

Methods:
Twelve left ventricular (LV) wedge preparations from 12 rabbit hearts were arterially perfused with Tyrode's solution and stimulated at a cycle length of 1000 ms. Simultaneous recording of transmural ECG and tension were obtained. After exposure to normal Tyrode, the LV wedge preparation was perfused with 20 cc of CUS (n=6) or 20 cc of DN (n=6) leading to complete arrest maintained for 30 minutes. ECG and tension recordings were obtained under baseline conditions and at 5, 15, and 30 minutes after reperfusion with normal Tyrode. Differences in change from baseline ECG and tension parameters after CUS or DN were compared using a mean differences regression model.

Results:
Reperfusion effects of CUS and DN on ECG and tension are shown in
Table 1
. After reperfusion, DN group had a significantly greater increase in QRS duration, significantly more QT shortening and more ST segment change compared to CUS group. At 5- and 15-minutes post-reperfusion, the CUS group had significantly higher tension recovery. Negative T wave were observed in 1 of 6 wedges of the CUS group and 5/6 (83.3%) wedges of the DN group. Conduction block was observed in 0/6 wedges in the CUS group and 5/6 (83.3%) wedges in the DN group.

Conclusions:
In a LV coronary-perfused rabbit wedge preparation, Custodiol-HTK cardioplegia led to less ischemic changes in ECG and faster tension recovery following reperfusion compared to del Nido cardioplegia.
Abstract 14042: Characterization of Multi-Cell-Type Engineered Heart Tissues Containing Human iPSC-Derived Cardiomyocytes, Endothelial Cells, Fibroblasts, Smooth Muscle Cells and Macrophages
Authors: Wrona Kinga M , Krause JUlia , Starbatty Jutta , Ratt Artur , Linder Stefan , Cuello Friederike , Eschenhagen Thomas , Hirt Marc N
Published: April 2022

Introduction:
Induction of a pathological type of hypertrophy in human engineered heart tissues (EHTs) has not yet been fully achieved. We hypothesized that this limitation is caused by the unicellularity of EHTs, which contain only cardiomyocytes (CMs) and lack the interactions with non-myocytes. Thus, we aimed to generate EHTs implementing five native cardiac cell types, i.e., CMs, endothelial cells (ECs), fibroblasts (Fbs), smooth muscle cells (SMCs), and macrophages (Mϕ).

Methods and Results:
CMs were differentiated from hiPSCs by mesodermal induction followed by inhibition of Wnt-signaling. Mesoderm progenitors were also used to differentiate ECs via VEGF stimulation. Differentiation into SMCs and Fbs required Wnt pathway activation followed by stimulation with TGFβ+bFGF or bFGF only, respectively. Finally, Mϕ differentiation required hematopoietic/myeloid specification by IL-3 and M-CSF treatment. Successful differentiation was analyzed by electron microscopy (EM) and expression profiling of hallmark genes and proteins. For instance, Mϕs exhibited high expression of myeloid markers (98.0% CD68
+
, 90.9% CD14
+
) whereas Fbs showed upregulation in genes such as
POSTN, DDR2, COL1A1
(all >100 fold higher than iPSCs). Functionality of all cell types was demonstrated by multiple assays. For example, the native Mϕ function was demonstrated via degradation and phagocytosis assays while ECs exhibited fast and extensive tube formation in matrigel assays. Additionally, Fbs produced 4.6x more collagen after TGFβ stimulation than unstimulated controls. In effect, multi-cell-type EHTs were generated from 60% CMs, 20% ECs, 10% Mϕ, 5% SMCs and 5% Fbs. These EHTs were characterized by confocal microscopy, serial block-face scanning EM, gene expression profiling, and automated contractility measurements. Pilot experiments revealed that the addition of different cell types accelerated the development of EHTs which was associated with earlier onset of beating and shorter diameter of the EHTs.

Conclusion:
Successful application of cell differentiation protocols resulted in the integration of five cell types in a multi-cell-type EHT system. The full functional profile and reaction to a stress stimulus will be investigated in future experiments.
Abstract 14048: Torsades De Pointes Risk Drugs and Out-of-Hospital Cardiac Arrest: A Nationwide Study
Authors: Kroell Johanna , Jespersen Camilla , Fosbøl Emil , Gislason Gunnar , Folke Fredrik , Lippert Freddy , Kragholm Kristian , Jons Christian , Hansen Steen , Wissenberg Mads , Torp-Pedersen Christian , Koeber Lars , Jacobsen Peter Karl , Tfelt-hansen Jacob , Weeke Peter E
Published: April 2022

Introduction:
Pharmacotherapy with proarrhythmic or QT prolonging properties are known to augment the risk of malignant arrhythmias (e.g. TdP). We examined TdP risk drug usage prior to OHCA and how it may be associated with shockable rhythm and survival.

Methods:
Patients ≥18 years with an OHCA of cardiac origin were identified from the Danish Cardiac Arrest Registry (2001-2014). From nationwide registries TdP risk drug usage before OHCA according to CredibleMeds was assessed. We performed multivariable logistic regression to determine factors associated with TdP risk drug usage among OHCA patients and how usage may affect OHCA related factors (e.g. shockable rhythm or survival). Age and sex controls were identified (matching 1:5).

Results:
Overall, 10139 OHCA patients were identified, of which 43% were in treatment with a TdP risk drug 0-30 days before OHCA compared with 15% from the control population. Furthermore, this was significantly more than 61-90 days before OHCA (37%). Most common prescribed drugs with known risk of TdP were citalopram (31.1%), methadone (16.4%), and fluconazole (8.2%). OHCA patients in treatment with a TdP risk drug at the time of event had a significantly higher burden of comorbidities compared with OHCA patients not in treatment (e.g. cancer [19.3% and 8.7%], COPD [20.0% and 6.6%], psychiatric disease [21.9% and 13.5%], p<0.001). TdP risk drug usage was not associated with increased likelihood of the presenting rhythm being shockable (OR=0.9, CI: 0.7-1.1). Moreover, OHCA patients in TdP risk drug treatment had less likelihood of ROSC (OR=0.8, CI: 0.7-0.9).

Conclusion:
Almost half of OHCA patients were in treatment with TdP risk drugs before OHCA. Subsequently, TdP risk drug usage did not modify the likelihood of presenting with a shockable rhythm as first recorded rhythm. However, this could partly be due to the large burden of comorbidities.

Figure:
Factors associated with TdP risk drug usage (adjusted for below mentioned factors).
Abstract 14057: IL-19 Preserves the Metabolic Activity of Adipocytes in Obesity
Authors: Kawai Tatsuo , Petre-Sullivan Rebecca , Autieri Michael , Scalia Rosario G
Published: April 2022

Lack of compensatory vascularization causes hypoxia with adipose tissue dysfunction in obesity. Dysfunctional adipocytes instigate systemic low-grade inflammation which is associated with increased morbidity and mortality of metabolic disorders and related cardiovascular disease. A remaining challenge in the field is how to preserve adipocyte metabolic function by suppressing the negative aspect of inflammation, without blocking its angiogenic function. We investigated the role of IL-19, a uniquely immuno-modulatory, pro-angiogenic interleukin expressed also in adipose tissue. We hypothesize that IL-19 acts as a novel adipokine whose expression in expanding adipose depots is essential for maintaining glucose homeostasis. We report that IL-19 is expressed in adipose tissue at both the transcript and protein level and its expression is increased in inflamed visceral adipose tissue but not subcutaneous adipose tissue (p<0.05). Utilizing
Il19
-/-
knockout mice, we found the loss of IL-19 leads to a metabolic phenotype characterized by reduced glucose and insulin tolerance, increased adipose tissue hypoxia and fibrosis, decreased adipose tissue vessel density and increased adipocyte hypertrophy both in response to standard chow diet and chronic high fat diet (p<0.05). Acute treatment with IL-19 reduced glucose and insulin intolerance in obese wild-type mice (p<0.05). In primary murine epididymal adipocytes the addition of IL-19 leads to increased glucose uptake (p<0.05). These metabolic actions of IL-19 were linked to upregulation of the insulin type-2 receptor and subsequent increased expression/phosphorylation of the protein kinase B (Akt) in adipocytes. Overall, these data propose that IL-19 has novel therapeutic potential in that it can effectively allow adipose tissue expansion without concomitant inflammation and insulin insensitivity.
Abstract 14065: Computational Intelligence: A Novel Way of Uncovering Hidden Information
Authors: Bender Dieter , Morgan Ryan W , Nadkarni Vinay M , Berg Robert A , Kilbaugh Todd J , Sutton Robert M , Nataraj C
Published: April 2022

Background:
This study describes a novel approach to identify diagnostic properties in an electrocardiogram (ECG) waveform to classify cardiac arrest etiologies in human patients. Through an interdependent optimization algorithm linking machine learning and signal processing, the technique allows extensive electrocardiogram analysis, retrieving physiologically relevant and demonstrative characteristics embedded in the waveforms across a population.

Methods:
Secondary analysis of electrocardiography data collected from swine models of either primary VF (n=17) or secondary asphyxia-associated VF (7 minutes of asphyxia prior to VF induction; n=13). Carrying out the analysis, we develop a mutually related algorithm utilizing wavelet synchrosqueezed transform (WSST) and Machine Learning Tree-Classifier (ML-TC). The extraction of the waveform characteristics (WSST) and the learning stage of the ML algorithm (ML-TC) are mutually related through a genetic optimization method to extract the most effective signal characteristics (and their attributes) with respect to the classification performance. This method thus focuses the WSST analysis on a particular frequency bandwidth of the ECG waveform and previously unknown time-dependent frequency patterns that were consistent across all subjects.

Results:
The innovative approach uncovers previously unknown frequency patterns in the ECG waveform. The proposed method achieves an average classification accuracy of 100% when using 35-second ECG segments and 93% while using 5-second ECG segments, this being the best results ever obtained for this specific problem.

Conclusion:
This kind of analytical research demonstrates the benefits of computational intelligence, such as machine learning and optimization. It presents a novel method of viewing frequently used data in electrocardiography and illustrates how new hidden information can be obtained to assist in patient diagnosis and prognosis.
Abstract 14073: Deterioration of Functional Status and Timing of Intervention in Patients With Aortic Stenosis: Results From the PROGRESSA Study
Authors: Tastet Lionel , Shen Mylene , Capoulade Romain , Arsenault Marie , Bédard Elisabeth , Cote Nancy , Clavel Marie-annick A , Pibarot Philippe
Published: April 2022

Introduction:
The assessment of changes in functional status during follow-up is critical to determine the timing of intervention in patients with aortic stenosis (AS). Fast progression of AS (annualized progression of peak jet velocity [V
peak
] ≥30 cm/s) is among the risk markers recommended in the guidelines to trigger early intervention in asymptomatic severe AS. We investigated the association between the progression of AS hemodynamic severity and the change in functional status during follow-up of patients with asymptomatic mild to moderate AS.

Methods:
285 patients with AS prospectively recruited in the PROGRESSA study (NCT01679431) were included in this analysis. Functional status was evaluated using the New York Heart Association (NYHA) classification.

Results:
Baseline NYHA class was similar (class I, II, III: 57%, 41%, 2% versus 58%, 41%, 1%; p=0.75) between patients with moderate (V
peak
progression ≥12 cm/s/year; median of cohort) versus those with slow AS progression rate. During a mean follow-up of 3.9±2.4 years, patients with moderate AS progression rate had larger increase in NYHA class compared to those with slow progression (+0.13±0.48 versus +0.01±0.21 class/year; p=0.008). From baseline to 2 years, a significant worsening of NYHA class occurred but only in the moderate AS progression group (
Figure
). In multivariable analysis, AS progression rate remained significantly associated with the change in NYHA class (p=0.04).A total of 156 clinical events (110 AVR and 46 deaths) occurred during a mean follow-up of 1.1±1.5 years after the last echocardiographic visit. Patients with ≥1 class increase in NYHA (n=70) had significantly higher risk of events (adjusted hazard ratio: 1.75 [95% CI: 1.12-2.75]; p=0.01).

Conclusions:
In this prospective cohort of patients with mild to moderate AS at baseline, the decline in functional status occurs early in the course of the disease and is in large part determined by the progression rate of AS hemodynamic severity.
Abstract 14075: Infective Endocarditis Associated With Irreversible Coronary Spasm and Cardiac Arrest
Authors: ALTermanini Mohammad , Abdelghani Mohamed , Habib Mhd Baraa , Shehadeh Mohanad , Magdi Mohamed , Ahmed Ashraf , Elhaj Maab , Arabi Abdulrahman
Published: April 2022

Introduction:
Coronary artery spasm (CAS) can elicit ischemia with transient ST-segment deviation that usually responds to nitrates; however, CAS can precipitate arrhythmias leading to sudden cardiac arrest. Infective endocarditis (IE) is associated with the acute coronary syndrome (ACS) usually via coronary embolism and compression secondary to peri-annular complications. CAS in association with IE causing ACS is extremely rare.

Case:
A 54-year-old man had a recent ST-elevation (STE) myocardial infarction, which required stenting to obtuse marginal artery (OM2) artery. He presented with a fever for one week. A new diastolic murmur at the aortic area on examination. Echocardiography showed a bicuspid aortic valve with perforation and new-onset aortic regurgitation suggestive of vegetation. Diagnosis of infective endocarditis was established, and the patient was started on medical treatment and was being prepared for surgical repair. During the hospital stay, he had recurrent episodes of severe chest pain accompanied by transient STE on ECG but normal troponin level. It was always responding to sublingual nitrates. CT coronary Angiogram showed no significant coronary stenosis and patent stent in OM2. The patient had again an attack of severe chest pain with ECG showed extensive STE then he developed pulseless electrical activity.

Result:
Resuscitation was started and emergency coronary angiography was performed and showed severe spasms in both LAD and LCX with TIMI-1 flow. A repeated image during resuscitation showed patent arteries with TIMI-III flow. A prolonged CPR in Cath-lab failed and the patient died. Although there was no clear explanation of the mechanism, the simultaneous association between the CAS and IE raises the suspicion of a possible relationship between both pathologies.

Conclusions:
Severe coronary spasm should be considered as a possible cause of ACS in association with IE.
Abstract 14078: Diabetes Attenuates Leukocyte Inflammatory Transcription Following Sleeve Gastrectomy
Authors: Dorcely Brenda , DeBermont Julie , Nasias Dimitrios , Gujral Akash , REID MIGDALIA , Verano Michael , Jay Melanie , Bergman Michael , Goldberg Ira J , Aleman Jose O , Vanegas Sally
Published: April 2022

Introduction:
Individuals with obesity and diabetes have increased risk for atherosclerosis; contributed by chronic systemic inflammation and elevated glycemic variability (GV). Bariatric surgery reduces circulating inflammatory markers. We aimed to determine the differences in GV and the expression of inflammatory genes from circulating white blood cells (WBC) after sleeve gastrectomy (SG) in those with and without non-insulin dependent diabetes.

Methods:
We conducted a prospective cohort study in subjects with obesity and type 2 diabetes (n=10) and subjects with obesity and no diabetes (n=11). Research visits occurred before SG and 6 months postoperatively. Elevated GV was defined by oral glucose tolerance test derived 1-h plasma glucose ≥155 mg/dL and elevated continuous glucose monitor derived GV index-MAGE (reference range 0-2.8 mmol/l). Bulk RNA-sequencing was performed on total WBCs, isolated neutrophils, monocytes, and lymphocytes to analyze genetic expression changes in chronic 6-month weight loss from baseline.

Results:
At 6 months, SG caused equivalent weight loss from baseline in both groups (22%). However, HbA1c, 1-h plasma glucose, and MAGE levels were different after SG between both groups. HbA1c decreased by 3.0±1.3% in the diabetes group (p<0.01) but was in the prediabetes range at 6 months. The mean 1-h plasma glucose levels was 228.7± 74.6 mg/dL in the diabetes group versus 137.8 ± 30.5 mg/dL in the no diabetes group, and MAGE remained elevated (4.9 ±1.5 mmol/l) only in the diabetes group at 6 months. Also, total WBC counts decreased significantly at 6 months in both groups (p<0.05). RNA sequencing analysis of these WBCs revealed that SG induced weight loss changed the expression of fewer total and WBCs subset genes in the diabetes group, and the majority of these gene expression changes (>94% of total genes) were different between both groups. Furthermore, our gene set analysis showed downregulated expression of WBC genes enriched in inflammatory pathways primarily in subjects without diabetes.

Conclusion:
Diabetes dampens the weight-loss induced changes to transcriptomes from WBC subsets that contribute to cardiovascular disease. Elevated GV after SG may contribute to these attenuated changes.
Abstract 14081: Predictors of Left Atrial Ejection Fraction in Patients With Nonischemic Cardiomyopathy
Authors: Salam Donna , Wang Tom K , Chan Nicholas , Turkmani Mustafa , Tang Wai Hong W , Griffin Brian P , Flamm Scott D , Kwon Deborah H
Published: April 2022

Background:
The impact of cardiomyopathy on left atrial function is currently unclear. The aim of this study was to assess the predictors of left atrial function in patients with non-ischemic dilated cardiomyopathy (NICM) utilizing cardiovascular magnetic resonance (CMR) assessment.

Methods:
We evaluated 251 NICM patients who underwent CMR in our study, between 12/2008 - 1/2014. LA volumes were measured by the modified biplane method from 2- and 4-chamber long axis views at end-systole and end-diastole. Left atrial ejection fraction (LAEF) was calculated. Multivariable linear regression was performed to determine significant covariate associations with LA EF.

Results:
We studied 251consecutive patients (61 % male), mean age of 52.5 ± 15.5 years
.
The results of the multivariable linear regression are provided in Figure 1. Younger age, female sex, and less myocardial fibrosis were significantly associated with higher LAEF (p=0.008, p= 0.004, and p= 0.031, respectively). Additionally, increasing left ventricular end diastolic volume index (LVEDVi) and left ventricular ejection fraction (LVEF) was significantly associated with increasing LAEF (both with a significance of p<0.0001). Increased LA volume index (LAVi) was significantly associated with decreased LAEF (p<0.0001). Of note, there was a trend towards less mitral regurgitation fraction being significantly associated with higher LA EF, but did not demonstrate a significant effect on the LAEF (p=0.083). Similarly, right ventricular size and function were not significantly associated with LA EF.

Conclusions:
In patients with NICM, age, sex, LVEDVi, LVEF, myocardial fibrosis, and LAVi were independently associated with LAEF.

Keywords:
Nonischemic cardiomyopathy, left atrial ejection fraction, left atrial function, cardiovascular magnetic resonance
Abstract 14086: A Hybrid Machine Learning Method for Instantaneous Classification of Left Ventricular Filling Pressure Using Femoral Waveforms
Authors: Alavi Rashid , Liu Jing , Ramos Melissa , Hindoyan Antreas , Matthews Ray V , Pahlevan Niema M
Published: April 2022

Introduction:
Non-invasive and instantaneous evaluation of left ventricular end-diastolic pressure (LVEDP) is of high significance in diagnosis and treatment of heart failure patients. We recently proposed the cardiac triangle mapping (CTM), a systems approach that uses information from arterial pressure waveforms and pre-ejection periods to map the global ventricular function (Pahlevan et al. Fluids 4.1 (2019): 16). Here, we propose a hybrid machine learning (ML) method based on CTM theory that uses pressure waveforms at the iliac bifurcation level and ECG to instantaneously classify the level of LVEDP.

Methods:
We studied 46 patients (Age: 39-90 (66.4±9.9), BMI: 20.2-36.8 (27.6±4.1), 12 females) who were scheduled for clinical left heart catheterization or coronary angiogram at the Keck Medical Center of USC. Exclusion criteria were valvular heart disease, left bundle branch block, or atrial fibrillation. Invasive LVEDP and pressure waveforms at iliac bifurcation were measured using a 3F Millar transducer tipped catheter, with simultaneous 3 channel ECG. The range of patients’ LVEDP was from 9.3 to 40.5 mmHg. LVEDP=18 mmHg was used as the ML classification cut-off. A random forest classifier (of n=30 grown decision trees, ensemble learning method: bootstrap aggregation, 6 inputs) was trained using data from 36 patients. The model was blindly tested on 10 additional patients.

Results:
Our ML model showed accuracies of 100.0% and 80.0% for predicting the true class of LVEDP on blind test data (i.e., elevated or normal, respectively) (Fig1). The accuracy on all data was higher than 93.4% for all classes.

Conclusions:
We demonstrated the proof-of-concept that a physics-based ML model can instantaneously classify the LV filling pressure using information extracted from femoral waveform and ECG. Our study is invasive validation; however, all required ML input parameters can be obtained noninvasively and remotely (i.e., using wearable devices or a smartphone).
Abstract 14097: Pharmacometabolomic Profiling Of The General Population: Relation Of Active Metabolite Levels To Cardiovascular Risk Factor Control And Manifest Atherosclerosis
Authors: Johansson Madeleine , Ghosh Nilanjana , Lejonberg Carl , Czuba Tomasz , Landenhed Smith Maya , Fall Tove , Engström Gunnar , Smith J. Gustav
Published: April 2022

Introduction:
The use of medications in the general population has increased over time. Information on active metabolite concentrations for common drugs in the general population is limited. Recent advances in metabolomic technologies have made high-throughput profiling of many active metabolites in large epidemiological cohorts increasingly feasible.

Aim:
1. Prospective assessment of the proportion of measurable active metabolite levels of major drugs in the general population using mass spectrometry.

2. Relation of cardiovascular (CV) drugs with inadequate risk factor control and CV disease.

Methods:
Assessment of CV risk factors by coronary CT angiography and carotid ultrasound imaging in a large prospective cohort of 6,251 individuals randomly selected from the general population in Malmö, Sweden (age 50-64 years). Untargeted metabolomic profiling of fasting plasma was performed by Metabolon, USA in a random subset of 3,986 subjects.

Results:
Intake of at least one prescribed drug was reported in 1840 subjects (46%). Combination drugs were reported in 249 subjects (6%). The most common drug classes reported were lipid-lowering (n=369, 9% of which most were statins), beta blockers (n=307, 8%), ARB (n=272, 7%), and ACE inhibitors (268, 7%), followed by levothyroxine, CCB, antidepressants, glucocorticoids, PPI, antidiabetic, bronchodilators and diuretics. For major CV drugs, detectable active metabolite levels ranged from 54% (atorvastatin and enalapril) to 96% (metoprolol and metformin). Non-detectable levels of lipid-lowering, antihypertensive, and antidiabetic drugs were associated with higher LDL, cholesterol, BP and glucose, although only antidiabetic drugs were significant (p<0.05). Non-detectable levels of lipid-lowering and antihypertensive drugs were also non-significantly associated with increased coronary calcium and carotid plaque.

Conclusion:
Our study provides an overview of the distribution of common drugs with detectable levels in a contemporary Swedish population. Pharmacometabolomic profiling revealed that non-measurable levels of common CV drugs were associated with lower risk factor control and non-significant trends towards more atherosclerotic disease by imaging in a substantial number of subjects.
Abstract 14545: Prevalence of Medication Non-Adherence via Therapeutic Drug Monitoring in Patients With Uncontrolled Hypertension Treated at a Safety Net Hospital
Authors: Osula David
Published: April 2022

Background:
Medication nonadherence presents one of the greatest challenges to hypertension management. Previous studies from our group have shown therapeutic drug monitoring (TDM), biochemical monitoring of drug levels, is more accurate than self-report, detailed questionnaires, or prescription fill rate in detecting nonadherence. Prior studies have also shown a prevalence of nonadherence from 45% to 80% among insured patients with uncontrolled hypertension despite having been prescribed a multi-drug regimen. Previous studies have not assessed adherence to antihypertensive drugs in a safety net population by TDM.

Methods:
We performed a cross-sectional study in patients with uncontrolled hypertension in the primary care Internal Medicine and Cardiology Clinics at Parkland Health& Hospital System (PHHS). Patients with BP of ≥130/80 mmHg, prescribed ≥2 antihypertensive medications, and self-reporting medication adherence were enrolled after informed consent. Plasma samples were obtained for measurement of 44 cardiovascular drugs using liquid chromatography mass spectrometry.

Results:
Among 77 patients with uncontrolled hypertension (57% female, 65% Black, 12% Hispanic), 13 (17%) were nonadherent to at least one anti-hypertensive drug by TDM. The adherent and nonadherent groups had similar systolic (146±13 vs 148±18, p=0.67) and diastolic (83±9 vs 88±10 mmHg, p=0.13) BP. All patients had either medical insurance or some form of prescription financial assistance. Sixty two patients had insurance, while 15 had prescription financial assistance. Nonadherence rates for patients on financial assistance programs did not significantly differ from patients with medical insurance (13% vs 18%, p>0.999).

Conclusions:
We found a surprisingly low prevalence of anti-hypertensive medication nonadherence in this uncontrolled hypertension population despite many barriers to treatment. Our study suggests a lesser role of medication nonadherence in uncontrolled hypertension in the safety net population.
Abstract 8905: Cardiac Troponin Thresholds and Kinetics to Differentiate Myocardial Injury and Myocardial Infarction
Authors: Wereski Ryan , Kimenai Dorien , Taggart Caelan , Doudesis Dimitrios , Lee Kuan Ken , Lowry Mathew T , Bularga Anda , Lowe David , Fujisawa Takeshi , Apple Fred S , Collinson Paul O , Anand Atul , Chapman Andrew , Mills Nicholas L
Published: April 2022

Background:
Whilst the 99th percentile is the recommended diagnostic threshold for myocardial infarction (MI), some guidelines also advocate the use of higher troponin thresholds to rule-in MI at presentation. It is unclear whether the magnitude or change in troponin concentration can differentiate causes of myocardial injury and infarction in practice.

Hypothesis:
Troponin concentration alone cannot to distinguish subtypes of myocardial infarction

Methods:
In a secondary analysis of a multi-centre randomized controlled trial, we identified 46,092 consecutive patients presenting with suspected acute coronary syndrome without STEMI. High-sensitivity troponin I concentrations at presentation and on serial testing were evaluated. The positive predictive value (PPV) and specificity were determined at the sex-specific 99th percentile upper reference limit (URL), and rule-in thresholds of 64 ng/L and 5-fold of the URL for a diagnosis of type 1 MI.

Results:
Troponin concentrations were similar at presentation in type 1 (median [IQR] 91 [30-493] ng/L) and type 2 MI (50 [22-147] ng/L), and in acute (50 [26-134] ng/L) and chronic (51 [31-130] ng/L) myocardial injury (Figure A). The 99th percentile and rule-in thresholds of 64 ng/L and 5-fold URL gave a PPV of 57% (95% confidence interval [CI] 56-58%), 59% (58-61%) and 62% (60-64%), and a specificity of 96% (96-96%), 96% (96-96%) and 98% (97-98%), respectively (Figure B). The absolute, relative and rate of change in troponin concentration was highest in patients with type 1 MI (P<0.001 for all, Figure C). Discrimination improved when troponin concentration and change in troponin were combined compared to troponin concentration at presentation alone (area under curve, 0.661 versus 0.613).

Conclusions:
Troponin concentrations at presentation are insufficient to distinguish type 1 MI from other causes of myocardial injury or infarction in practice and should not guide management decisions in isolation.
Abstract 8911: Incidence and Risk Factors of Aortic Arch Obstruction After the Comprehensive Stage II Procedure
Authors: Gilmore Annaka , Davis Jo Ann , Low Samantha , Chisolm Joanne , Kelly John , Hone Emily , Bai Sasha , McConnell Patrick I , Galantowicz Mark E , Cua Clifford L
Published: April 2022

Introduction:
Minimal data exist about the incidence and risk factors for arch intervention after Comprehensive Stage II (CSII). Goal of this study was to document incidence of arch interventions after CSII and determine if any differences existed between those that underwent an arch intervention (aiCSII) versus those did not have an intervention.

Methods:
Retrospective chart review of all hypoplastic left heart syndrome patients that underwent a CSII between 6/1/2005 through 2/1/2020 was performed. Univariate analysis was conducted in addition to principal components analysis (PCA).

Results:
One hundred patients were evaluated. Sixteen patients underwent 24 arch interventions. Age at initial arch reintervention was 1.3
+
1.2 years (median 1.0 years, range 0.5 - 2.2 years). Univariate analysis showed that the aiCSII group were more likely to be female, to have had a retrograde arch intervention post-hybrid procedure, and to be younger at time of CSII. On echocardiograms, aiCSII group had significantly higher pre-CSII patent ductus arteriosus velocities, arch velocities on their 1
st
post-operative and discharge study post-CSII, and arch velocities pre-Fontan. Gradients were higher in the aiCSII via pre-Fontan catheterization. With PCA, echocardiographic and catheterization data remained significantly associated with aiCSII versus those that did not undergo an arch intervention (OR = 4.5 (1.9, 19.8), p < 0.01). Mortality was not associated with arch intervention.

Conclusions:
Incidence of arch intervention post-CSII was 16%. Echocardiographic arch gradients during the CSII hospitalization were the strongest predictors for subsequent aortic arch interventions. Further studies are needed to determine any modifiable variables that may reduce the incidence of arch interventions.
Abstract 8935: A Study of CMS-Mandated Online Tools for Comparing the Prices of Outpatient Cardiovascular Diagnostic Studies
Authors: Tungate Robert , Garg Parveen K
Published: April 2022

Objectives:
To assess the tools the US Centers for Medicare & Medicaid Services (CMS) price transparency mandate provides to patients to compare prices of cardiovascular (CV) diagnostic studies in US hospitals.

Background:
In January 2019, CMS mandated that hospitals make prices of CV diagnostic and treatment services available to patients to enable cost comparison. These prices are published in price lists called hospital chargemasters.

Methods:
We searched hospital chargemasters for the top 20 hospitals listed on the 2020-21 US News Best Hospitals Honor Roll. We collected published price data for six common CV diagnostic studies. Endpoints included listed prices, the format and uniformity of price listings, and accompanying disclaimers or guides for use.

Results:
Of the 20 studied hospitals, 19 (95%) published a chargemaster on their website, of which 16 were in Microsoft Excel format (84%) and 3 included standardized CPT codes (16%). Disclaimers that prices may not reflect real billing were included with 17 (85%). From available hospital chargemasters (n=19), the following price data were collected.

Conclusions:
The hospital chargemasters available to compare pricing of CV diagnostic studies show wide variation in price and scope, differ by format, and include technical terms and initialisms. Most include disclaimers that prices may not reflect actual out-of-pocket or insurance billing. These findings suggest that these CMS-mandated price transparency tools may be inadequate for patients to estimate or compare prices for CV diagnostic studies.