bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 10064: Pulmonary Hypertension in Patients with Connective Tissue Disease-associated Interstitial Lung Disease and Vascular Changes on Computed Tomography
Authors: Patel Badar , Jesudasen Sirus , Nardelli Pietro , San Jose Estepar Ruben , D'Silva Kristin , Washko George , San Jose Estepar Raul , Montesi Sydney , Rahaghi Farbod
Published: March 2022

Introduction:
Pulmonary hypertension (PH) is a complication in patients with connective-tissue disease-associated interstitial lung disease (CTD-ILD) associated with mortality. In Idiopathic Pulmonary Fibrosis, increased vascular volume has been reported to be associated with poor outcomes. We sought to elicit whether similar changes could be observed in patients with CTD-ILD and pulmonary hypertension.

Methods:
We identified patients with a known diagnosis of CTD-ILD who had undergone chest CT, transthoracic echocardiography (TTE), and right heart catherization (RHC) using the Mass General Brigham Research Patient Data Repository (IRB #2018P000419). The electronic health records (EHR) were reviewed to confirm the diagnosis of CTD-ILD. A 3D reconstruction of the pulmonary vasculature using the Chest Imaging Platform (
www.chestimagingplatform.com
) to compute the total vascular volume was performed on thin sliced CT scans closest to the RHC. Vessels were separated into arterial and venous components using a deep learning approach. Statistical analysis was performed with R 4.01. Values are shown as medians and interquartile ranges and were compared using Wilcoxon Rank-Sum tests.

Results:
A total of 104 patients with CTD-ILD were identified: Pre-capillary PH (n=43), Isolated Post-capillary PH (n=9), Combined Pre- and Post-capillary PH (n=8), and PH Absent (n=44). There was no difference in patient age or lung volume by CT scan. On TTE, RVSP was elevated in PH (52 mmHg, IQR 41-64 mmHg vs 34 mm Hg, IQR 27-49 mmHg, p < 0.0001), as was the arterial total vascular volume (118 mL, IQR 85-152 ml vs 100 mL, IQR 77-126 ml, p = 0.009) with no trend for significance for venous total vascular volume. Addition of total arterial volume remained a statistically significant predictor of presence of PH (p = 0.01) when added to logistic regression models predicting PH by TTE RVSP, with improvement in model AIC (106.1 to 97.9) and AUC (0.75 to 0.80) of the model.

Conclusions:
In this retrospective study of patients with CTD-ILD and available imaging and hemodynamics, patients with PH have increased arterial vascular volume compared to those without PH. Information derived from CT images routinely acquired in this population could be used to improve screening and phenotyping.
Abstract 10066: Right Ventricular Function as a Predictor of Mortality in Patients with Sepsis: A Systematic Review and Meta-Analysis
Authors: Del Rio-Pertuz Gaspar , Toro Juan , Triana Abel , Singh Sneha , Gomez Hernando
Published: March 2022

Introduction:
Sepsis-associated myocardial dysfunction has been described in relation to left ventricular function and reported to have a variable correlation with mortality. However, the extent to which right ventricular (RV) dysfunction contributes to myocardial dysfunction and a poor prognosis in sepsis remains unknown. Our aim is to investigate the association between RV dysfunction and mortality in patients with sepsis.

Methods:
We performed a systematic review of the literature. We systematically searched Cochrane, Embase, MEDLINE, Scopus and Web of Science for full-text articles from inception to June 2020. Studies were included if they reported RV function and mortality in patients with sepsis using echocardiography. Data was extracted using a collection form designed
a priori
. Significance was determined by a two-tailed p value < 0.05. The present study was registered in the PROSPERO (CRD42020204423).

Hypothesis:
RV dysfunction is associated to mortality in adult patients with sepsis.

Results:
Six studies including 526 patients were selected for final analysis. Patients had a mean age of 57 years, 45% were females, and there was an overall mortality of 37%. In three studies, transthoracic echocardiography was performed within 24h of sepsis diagnosis, and reported Tricuspid annular plane systolic excursion (TAPSE) in a total of 366 patients. In pooled analysis, survivors had a higher TAPSE compared to non-survivors ((SMD):1.89 (95%CI 0.14-3.655) p=0.03, Figure1). All other parameters of RV dysfunction assessed did not have a statistically significant difference between survivors and non-survivors (Figure 2-6).

Conclusion:
RV dysfunction as demonstrated by a lower TAPSE is associated with higher mortality in patients with sepsis and/or septic shock. This data suggest that RV dysfunction is an important contributor to sepsis-associated myocardial dysfunction and worsening prognosis in patients with sepsis.
Abstract 10072: Stroke Topology and Neurodevelopment in Infants with Congenital Heart Disease: Does it Differ by Cardiac Physiology?
Authors: Selvanathan Thiviya , Guo Ting , Sheng Min , Seed Mike , Synnes Anne , Peyvandi Shabnam , Pulcine Liza , Chau Vann , Ly Linh G , Barkovich James , McQuillen Patrick S , Miller Steven P
Published: March 2022

Objectives:
Vulnerability to brain injury in infants with congenital heart disease (CHD) may differ by CHD lesion. However, the link between arterial ischemic stroke (AIS) and neurodevelopment, and whether it differs by CHD lesion, is unknown. We sought to determine whether: (1) Stroke
topology
differs between infants with Transposition of the Great Arteries (TGA) and single ventricle physiology (SVP), and relationship with neurodevelopment;(2) Associations between stroke
volume
and neurodevelopment are CHD lesion specific.

Methods:
64 of 312 CHD infants (TGA n=38, SVP n=26) studied prospectively with pre- and/or post-operative brain MRIs had AIS. AIS were segmented on 3DT1 and/or ADC images. 39 infants completed 18-month neurodevelopmental assessments with Bayley Scales (2
nd
or 3
rd
Edition); scores were adjusted to account for differences between versions. Adverse neurodevelopment was defined as <85 points. We used multivariable linear regression models to study associations between AIS volume and neurodevelopment, stratifying by CHD lesion and adjusting for study site. Probability maps demonstrating areas vulnerable to AIS and odds ratio maps reflecting likelihood of a lesion predicting adverse outcomes were developed.

Results:
Most AIS were in MCA territories, with a left-sided predominance (Fig 1A). Stroke volume did not differ between CHD groups (p=0.8). Basal ganglia lesions were most predictive of cognitive (max OR=11) and motor (max OR=6) outcomes (Fig 1B). Stratifying by CHD lesion, AIS volume predicted 18-month cognitive outcomes in infants with TGA (β=-0.6, 95%CI -1.0-(-0.1), p=0.02) but not SVP (β=7.9, 95%CI -72-88). AIS volume did not predict motor outcomes in infants with TGA (β=-0.6, 95%CI -1.6-0.3) or SVP (β=-19.7, 95%CI -91-52).

Conclusions:
Neonatal AIS topology does not differ between infants with TGA and SVP. AIS location and size are important predictors of neurodevelopment at 18 months though this association differs by CHD lesion.
Abstract 10080: Myocardial Physiological Responses to the Third Trimester of Healthy Pregnancy
Authors: Thirunavukarasu Sharmaine , Ansari Faiza , Chowdhary Amrit , Jex Nicholas , Coles Lauren , GREENWOOD John , Plein Sven , Scott Eleanor , Everett Thomas , Levelt Eylem
Published: March 2022

Background:
Pregnancy requires significant cardiometabolic adaptation and is therefore considered a “stress test” for future cardiovascular disease. Cardiovascular magnetic resonance (CMR) allows evaluation of cardiac structure, function and tissue characteristics with excellent reproducibility. There is scarcity of CMR data on pregnancy-associated cardiovascular adaptive changes. Moreover, no studies to date assessed the physiological impact of pregnancy on cardiac high energy phosphate metabolism, measured as the phosphocreatine (PCr)/ATP ratio, using
31
Phosphorus magnetic resonance spectroscopy (
31
P-MRS).

Objectives:
We aimed to investigate the physiological effects of pregnancy in women in the third trimester of a healthy singleton pregnancy on cardiac energetics, function and tissue characteristics using
31
P-MRS and CMR at 3T.

Methods:
Thirty pregnant women and fifteen age-matching nulliparous healthy female controls were recruited.

Results:
Clinical characteristics and CMR/
31
P-MRS results are provided in Table1.Resting heart rates and cardiac output were higher in pregnancy, with no significant differences in left-ventricular volumes, mass or ejection fraction, diastolic function (mitral in-flow E/A), global longitudinal strain or MAPSE. There were subtle reductions in cardiac PCr/ATP in pregnancy. Compared to non-pregnant controls, myocardial T1 was 2% higher in pregnant women, whilst T2 was 5% lower.

Conclusions:
Healthy pregnancy was associated with no significant changes in cardiac size, mass or function. Consistent with the haemodynamic changes in pregnancy, subtle reductions in cardiac energetics were detected, though these remained within normal range.CMR is well tolerated in pregnancy and may play a role in assessing cardiac involvement in women at risk of perinatal complications, offering the opportunity of early initiation of risk modifying treatment and prevention of adverse maternal cardiovascular outcomes.
Abstract 10087: Variable Exposure to Infarct and Ischemia in Stress Echocardiography Among Cardiology Fellows-in-Training
Authors: Bergquist Patrick J , Bierowski Matthew J , Qureshi Umer , Matzelle-Zywicki Madeline , Staub Jacob R , Peterson Brandon R
Published: March 2022

Introduction:
COCATS guidelines recommend that fellows interpret a minimum of 100 stress echocardiograms to achieve proficiency for independent practice. Whether this recommended number is sufficient to gain adequate exposure to varied patterns of infarct and ischemia on stress echocardiography is unclear. We investigated whether cardiology fellows who interpreted the recommend number by COCATS lacked exposure to pathologies of infarct or ischemia on stress echocardiography.

Methods:
We reviewed reports from the first 100 stress echocardiograms interpreted by our fellows who completed training from 2017 through 2021 for findings of infarct or ischemia in the left anterior descending coronary artery (LAD), right coronary artery (RCA), and circumflex coronary artery (CX) territories. Paired T-test was used to compare the mean incidence of studies with and without infarct and ischemia.

Results:
2,400 stress echocardiography reports were reviewed from 24 fellows. Normal stress echocardiograms (mean 81 per fellow) were significantly more common than those with infarct (mean 5 per fellow, p<0.001) or with ischemia (mean 6 per fellow, p<0.001, see figure below). Among the first 100 stress echocardiograms interpreted, 10/24 fellows had no cases with CX infarct, 4/24 had no cases with RCA infarct, 3/24 had no cases with LAD infarct, 3/24 had no cases with CX ischemia, 4/24 had no cases with RCA ischemia, and 4/24 had no cases with multivessel ischemia.

Conclusion:
The recommended number of stress echocardiograms to interpret in COCATS does not ensure adequate exposure to varied patterns of infarct and ischemia due to the relative infrequency of these findings compared with normal studies. To ensure competency-based learning, fellowship programs should identify deficiencies and supplement learning as needed in stress echocardiography beyond what fellows achieve by interpreting the minimum recommended number from COCATS.
Abstract 10095: Beneficial Effects of Intensive Blood Pressure Control on Cardiovascular Outcomes Are Seen in Cohabitating Black Individuals but Not in Those Living Alone
Authors: Inou Kosuke , Watson Karol E , Kondo Naoki , Horwich Tamara B , Hsu William , Bui Alex , Duru Obidiugwu
Published: March 2022

Introduction:
Living alone, a key proxy of social isolation, is a risk factor for cardiovascular disease. In addition, Black race is associated with less optimal blood pressure (BP) control than in other racial/ethnic groups. However, it is not clear whether living arrangement modifies the beneficial effects of intensive BP control on reduction in cardiovascular events among Black individuals. We aimed to examine whether the effects of intensive BP control on cardiovascular events differ by living arrangement among Black and non-Black individuals in the Systolic Blood Pressure Intervention Trial (SPRINT).

Methods:
This secondary analysis of the SPRINT trial included 9,361 participants (30% Black individuals; 29% living alone) who were randomized to a systolic BP target of either <120mmHg (intensive treatment group) or <140mmHg (standard treatment group). Cox proportional hazards model was used to estimate the effect of intensive treatment on the composite cardiovascular outcome according to living arrangement (i.e., living alone or living with others) among Black and non-Black individuals.

Results:
At a median follow-up of 3.2 years, the intensive treatment group showed a significantly lower rate of the composite cardiovascular outcome than the standard treatment group among cohabitating Black individuals (hazard ratio [HR], 0.53 [95%CI, 0.33-0.85]) but not among those living alone (HR, 1.07 [95%CI, 0.66-1.73]; p-for-interaction, 0.04). A significant reduction of the composite cardiovascular outcome was observed among non-Black individuals regardless of living arrangement status.

Conclusion:
Intensive BP control was beneficial to reduce cardiovascular events among Black individuals living with others and non-Black individuals but not among Black individuals living alone. Our findings highlight a potentially important role of assessing living arrangements in tailored approaches to improve cardiovascular health among Black individuals.
Abstract 10099: Loss of CD70 Impairs Nitric Oxide Homeostasis and Augments Intracellular Oxidative Stress in Endothelial Cells
Authors: Pandey Arvind K , Michel Thomas , Loscalzo Joseph
Published: March 2022

Introduction:
TNF superfamily ligands exert multiple effects on endothelial cell (EC) function, metabolism, and redox status. CD70 is a TNF superfamily member classically expressed on antigen-presenting cells and drives T memory cell polarization. Despite evidence of expression by ECs, the role of CD70 in endothelial biology has not been defined. We hypothesized that CD70 affects EC function through regulation of nitric oxide (NO) generation and cellular oxidative stress.

Methods:
Human aortic and pulmonary artery ECs (HAECs and HPAECs, respectively) were transfected with control and CD70-directed siRNA (siCD70). NO levels of individual cells were monitored in real-time after stimulation with ATP using the intracellular fluorescent biosensor c-geNOp. Similarly, intracellular hydrogen peroxide was assayed in real-time using the intracellular fluorescent biosensor Hyper7 following stimulation by auranofin and histamine. For both studies, 70-100 individual cells, averaged over 4 experiments, were analyzed using confocal microscopy. Control and siCD70-treated cell lysates (n = 4-6) were analyzed by Western blot and quantitative RT-PCR, as well as for glutathione peroxidase (GPx) enzyme activity.

Results:
CD70 knockdown was associated with a reduction in agonist-stimulated NO levels in HAECs and HPAECs by 30% and 40%, respectively. Protein levels of eNOS decreased after CD70 knockdown, with a reduction of 50% in HAECs and 75% in HPAECs. Phosphorylation at Ser1177 of eNOS in response to EC stimulation with ATP was reduced after siCD70 treatment, and expression of the key eNOS-stimulatory protein Hsp90 was decreased. Intracellular hydrogen peroxide was significantly increased (20% in HAECs and 80% in HPAECs) following ROS stimulation in siCD70-treated versus control cells. This change in redox status was associated with a decrease in mitochondrial superoxide dismutase protein and an increase in GPx-1 expression and enzyme activity.

Conclusions:
Loss of CD70 in ECs is associated with reduced eNOS expression and bioactivity as well as increased susceptibility to intracellular oxidative stress, potentially from a mitochondrial source. These results suggest an important homeostatic role for CD70 in endothelial function and redox status.
Abstract 10101: Obstructive Sleep Apnea Syndrome Attenuates HDL Functions
Authors: Endo Yasuhiro , Sasaki Makoto , Teramoto Manami , Ayaori Makoto , Nakayama Hideaki , Inoue Yuichi , Ikewaki Katsunori
Published: March 2022

Background:
High density lipoprotein (HDL) exerts anti-atherogenic functions including cholesterol efflux capacity and anti-oxidative activities. Obstructive sleep apnea (OSA) is associated with increased risk for cardiovascular disease via inflammation and oxidative stress. However, HDL functions in patients with OSA remains to be elucidated. We therefore investigated cholesterol efflux capacity and anti-oxidative activity in order to assess whether OSA would affect HDL functions.

Methods and Results:
A total of 116 OSA patients who underwent polysomnography tests from April 2017 to April 2019 were enrolled in this cross-sectional study. Blood samples were obtained at the next day of polysomnography test. We measured cholesterol efflux capacity in OSA patients and found that CEC was significantly lower in SAS groups (apnea hypoxia index (AHI)≧5) compared with non-SAS groups.(AHI<5)(1.06±0.15 vs 0.96±0.14 p=0.01) Among OSA parameters, minimal pulse oxygen saturation(minSpO2), a highly correlated parameter with AHI (r=-0.76 p<0.001), was found to be positively correlated with CEC (r=0.19 p=0.034) In multiple regression analysis , CEC was associated with minSpO2 independently of several clinical parameters including BMI, age, PON1, smoking, hypertension, dyslipidemia, diabetes mellitus, TC, logTG, HDL-C.(β=0.25 p=0.02) Further, CEC was inversely correlated with log hsCRP adjusted with the same model.(β=-0.25 p=0.01).With regard to anti-oxidative function, assessed by AAPH and PON1 activity, AHI or min SpO2 did not correlate with anti-oxidaitive activity by AAPH or PON1 activity.

Conclusion:
Obstructive sleep apnea syndrome attenuated cholesterol efflux capacity. Min SpO2 may be a good predictor of HDL dysfunction in OSA.
Abstract 10104: Sex and Ethnic Disparities in Heart Failure-Related Mortality Rates Among the Young
Authors: Minhas Abdul , Qavi Ahmed H , Khan Safi U , Dani Sourbha , Krasuski Richard , Michos Erin , Greene Stephen J , Fudim Marat
Published: March 2022

Introduction:
Heart failure (HF) accounts for significant morbidity, mortality, and economic suffering. The aim of this study was to examine the trends in HF-related deaths among the young population in the United States from 1999 to 2019.

Methods:
We used the CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) to access National Vital Statistics System data from 1999 to 2019. HF-related deaths among individuals aged 15-44 years were identified from multiple causes of death and were represented as age-adjusted mortality rates (AAMR) per 100,000 population. Joinpoint regression was used to examine changes in trends and annual percentage change (APC) overall, and then stratified by sex and ethnicity.

Results:
Overall, AAMR related to HF remained stable from 1999(2.36) to 2012(2.23) (APC -0.3[95% CI, -0.8 to 0.2]) and then gradually increased until 2019(3.16) (APC 5.0[95% CI, 3.6 to 6.3]). AAMR was higher in men (3.04) than women (1.87). AAMR was highest in non-Hispanic Black (NHB) (6.77) followed by Hispanic (1.51), non-Hispanic White (NHW) (1.91) and lastly non-Hispanic Asian or Pacific Islander (NH-API) (1.11) ethnic groups. After initial decline, APC in AAMR increased in women (5.2) starting in 2012. AAMR did not change significantly in men from 2005 to 2011 and subsequently increased from 2011 to 2019 (APC 4.9). After initially remaining stable, AAMR increased among NHW (APC 4.6) and NHB (APC 4.3) persons from 2012 to 2019. After initial decline, APC in AAMR increased among Hispanic persons (7.2) from 2012 to 2019. APC in AAMR increased in NH-API persons (2.4) during the entire study period (Figure).

Conclusion:
HF-related mortality in young adults has increased over the last decade. Stratification by sex and ethnicity reveals significant disparities. Mortality in NHBs has been growing at a faster rate than any of the other groups and the gap between mortality in NHBs and NHWs is large and widening.
Abstract 10107: Adherence to a Comprehensive History, Physical Exam and AHA Target HF Checklist-A Quality Improvement Study of Heart Failure Readmissions
Authors: raj Kavin , Chandna Sanya , Gurnani Sunayna , Watts Abi , Shah Monarch , Toquica Christian , Dewan Sandesh
Published: March 2022

Introduction:
We planned to study the adherence to the AHA Target HF checklist and the adequacy of history and physical exam (HPE) in a community hospital.

Methodology:
Fifty-one patients readmitted within 30 days with index diagnosis coded as CHF in the year 2019 were included. Data was collected manually.

Results:
A significant proportion of patients (27-86%) did not have documentation of NYHA class, exertional dyspnea, PND/orthopnea, weight gain, S3, JVD, dietary compliance, and smoking status. The exacerbating factor was not identified in 54% (27 of 51) of patients, and reasons for not discharging on GDMT (Goal-directed medical therapy) were not documented in 25% (12 of 51). ACE/ARB was not given on discharge to 47% (24 of 51) of HFrEF patients, likely because of abnormal renal function. Only 19% (10 of 51) of patients received MRA (Mineralocorticoid receptor antagonist) (Table 1).

Discussion:
In our study, we found suboptimal usage of ACE/ARB, MRA, and the lack of a comprehensive HPE. HF patients need a comprehensive HPE and the identification of key exacerbating factors for decompensation to prevent readmissions.AHA Target-HF checklist can improve quality of care and prevent readmissions and hence should be used routinely in all CHF patients. Often the clinicians are not aware of the updated guidelines and the presence of AHA target HF checklists. Although ours was a single-center study, we hypothesize that this may be a major issue in other community hospitals as well. We have designed a comprehensive physician education program, standardized admission notes, discharge notes, order sets, and checklists to be used for the year 2021. We planned to track the readmission rates once these interventions are implemented.
Abstract 10110: Sex and Ethnic/Racial Disparities in Ischemic Heart Disease Related Mortality Rates Among Older Adults
Authors: Minhas Abdul , Bhopalwala Huzefa , NAZIR SALIK , Khan Muhammmad , Goel Sachin S , Fudim Marat , Nasir Khurram
Published: March 2022

Introduction:
Ischemic heart disease (IHD) accounts for significant morbidity and mortality in the elderly population. The aim of this study was to examine the trends in IHD related deaths in elderly population in the United States from 1999 to 2019.

Methods:
We used CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) to access National Vital Statistics System data from 1999 to 2019. IHD related deaths, age >/=75 years were identified from multiple causes of death and were represented as age-adjusted mortality rates (AAMR) per 10,000 population. Joinpoint regression was used to examine changes in trend and annual percentage change (APC) overall and stratified by sex and racial/ethnic groups.

Results:
AAMR related to IHD decreased from 271.9 in 1999 to 137.3 in 2019 (average APC-3.4[95% CI, -3.7 to -3.0]). AAMR was higher in men (241.3) than women (156.9). Among the racial/ethnic groups, AAMR was highest in non-Hispanic whites (NHWs) (195.1) followed by non-Hispanic blacks (NHBs) (185.6), non-Hispanics American Indian or Alaska Natives (NH-AIAN) (152.7), Hispanics (147.4), and lastly non-Hispanics Asian or Pacific Islanders (NH-APIs) (110.5). AAMR was highest in NHW males (250.6). APC in AAMR decreased across all the subgroups. After initial decline, the decrease in APC in AAMR decelerated in both women (-2.7) and men (-2.0) since 2014, NHBs (-2.4) since 2014, Hispanics (-2.9) since 2012 and NH-API (-2.2) since 2015. After initial decline, AAMR remained stable in NHWs (APC -1.5) since 2016. After initially remaining stable, AAMR decreased in NH-AIAN (APC -3.3) since 2004.

Conclusion:
IHD related mortality in elderly has been decreasing at a variable pace across various sex and racial/ethnic groups. The causes of these disparities need to be examined and targeted interventions are required to address these disparities.
Abstract 10112: Who is Leading the Code? Assessing Team Dynamics and Communication Skills During Mock Codes
Authors: Anderson Theresa , Trumpower Brad , Kamphuis Lee , Johnson Lars , McEvoy Joseph , Houchens Nathan , iwashyna T. Jack , Nallamothu Brahmajee K
Published: March 2022

Background:
The Resuscitation Education Initiative (REdI) is a national mock code program for the Veteran Health Administration. We used the REdI rollout to study team dynamics for participants in mock codes.

Methods:
Mock code evaluation data was obtained from 8 Veterans Affairs Medical Centers across the nation in 2019-2020. Sites utilized a standardized templated evaluation sheet, which was modifiable to meet the needs of each mock code session (i.e., using a BLS score system rather than ACLS for a BLS code). Facilitators scored participants with a binary system of inclusion, reflecting successful or unsuccessful completion of a task. Eight categories assessed team dynamics: designating responsibilities, closed loop communication, clear messaging, knowing one’s limitations, knowledge sharing, constructive intervention, mutual respect, and summarizing.

Results:
Forty-four surveys representing unique mock codes were used in analysis. BLS was more often implemented during mock codes (34 vs 12 for ACLS); two codes used both ACLS and BLS, (n=44). In half of the mock code evaluations, participants did not clearly identify responsibilities or engage in closed loop communication (22/44, 50%). Notably mutual respect, which was described as speaking in a professional tone to others, was successfully met by 86.4% of participants (38/44). Participants performed poorly in the remaining categories, not meeting standards by 25% or more on evaluation (see Table).

Conclusion:
Mock codes are used for teaching skills involved in cardiac resuscitation. Participants did not perform well in areas involving team dynamics, and this could be an area for future attention when designing effective mock code programs.
Abstract 10116: Sex and Race Disparities in Mitral Regurgitation Related Mortality Rates Among Older Adults; Data from CDC Wonder 1999-2019
Authors: Minhas Abdul , Ariss Robert , NAZIR SALIK , Ullah Waqas , Muslim Muhammad Osama , Fudim Marat , Nasir Khurram
Published: March 2022

Mitral regurgitation (MR) is the second most common valvular heart disease in the United States with recent improvements in the management of MR including percutaneous therapies. However, MR-related mortality may vary across sex and race groups in the elderly population.

Methods:
We used CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) to access National Vital Statistics System data from 1999 to 2019. MR related deaths, age ≥75 years were identified from multiple causes of death and were represented as age-adjusted mortality rates (AAMR) per 100,000 population. Joinpoint regression was used to examine changes in trend and annual percentage change (APC) overall and stratified by sex and race groups.

Results:
AAMR related to MR decreased from 29.0 in 1999 to 15.4 in 2012 and then increased to 16.4 in 2019 (2012-2019 APC 1.2 [95% CI, 0.5 to 2.0]). AAMR was higher in women (19.6) compared with men (18.6). Among the race groups, AAMR was highest in non-Hispanic whites (NHWs) (20.8) followed by non-Hispanics Others (NH Others) (includes American Indian or Alaska Natives and Asian or Pacific Islanders) (12.7), non-Hispanic blacks (NHBs) (10.5) and lastly Hispanics (10.1). AAMR was highest in NHW females (21.1). After an initial decline, APC in AAMR increased in both men (1.4) and women (1.0) since 2012 and NHWs (0.9) since 2011. AAMR decreased in NHBs (APC -5.0) till 2009 and Hispanics (APC -4.6) until 2013 and remained stable thereafter. APC in AAMR decreased in NH-Others (-1.9) during the entire study period.

Conclusion:
After initial decline, MR related mortality has been increasing recently. Significant disparities exist across various sex and race subgroups. Further studies are needed to understand these trends and address the underlying causes of the disparities and increasing mortality in this patient population.
Abstract 10129: Long-Term Prescription of Beta-Blockers After Myocardial Infarction with Preserved Left Ventricular Function is Associated with Reduction in Recurrent ACS but Not Repeat Revascularization or All-Cause Mortality
Authors: Chiu Michael H , Dong Yuan , Southern Danielle , Fine Nowell , Finlay McAlister , Sajobi Tolulope , Graham Michelle , Van Diepen Sean , James Matthew , Wilton Stephen
Published: March 2022

Background:
Beta-blockers (BB) are cornerstones of medical therapy for acute coronary syndromes (ACS). However, benefits of long-term treatment with preserved left ventricular ejection fraction (LVEF) are not well established. We examined whether long-term BB prescription is associated with risks of recurrent ischemic events or all-cause mortality in patients with LVEF>50% after ACS.

Methods:
We conducted a retrospective observational study in Alberta, Canada by linking data from provincial databases (APPROACH, echo, discharge and pharmacy). We included patients with NSTEMI or STEMI between 2008-2017, in-hospital LVEF≥50%, who survived ≥180 days after index discharge and had a new prescription for a BB post ACS. We used adjusted Cox proportional hazards models to determine the association between duration of BB therapy (dichotomized at 180 days) and the primary composite outcome of recurrent ACS, repeat revascularization or all-cause mortality ≥180 days after index ACS. Secondary outcomes were the components of the composite.

Results:
Of 4,768 included patients (mean age 62.0y, 28.1% female), 1155 (24.2%) discontinued BB before 180 days. During a median follow up time of 56.6 months, 964 patients (20.2%) had a primary outcome event. In the overall population, early BB discontinuation was not associated with an increased risk of the primary outcome (adjusted HR 1.13, 95% CI:0.99-1.29 p=0.07) but was associated with the secondary outcome of recurrent ACS (HR 1.43; 95% CI: 1.164-1.756, p<0.001). In the subgroup with STEMI (n=2,428) early BB discontinuation was associated with increased risk of the primary outcome (HR 1.27; 95% CI: 1.054-1.524, p=0.01), again driven by recurrent ACS. Early BB discontinuation was not associated with secondary outcomes of receipt of repeat revascularization or all-cause mortality.

Conclusion:
In patients discharged after ACS with preserved LVEF, continuation of BB beyond 180 days was not associated with a reduced risk of the composite primary outcome overall, though subgroup analysis suggested a benefit in the subgroup with STEMI, and in the secondary outcome of recurrent ACS. Large-scale randomized trials are required to clarify the appropriate duration of BB therapy after ACS in patients with preserved LVEF.
Abstract 10132: Human Ipsc Derived Cardiac Tissue Matured by Spontaneous Traveling Waves for Improved Drug Assessment
Authors: Li Junjun , HUA YING , Qu Xiang , Sougawa Nagako , Sawa Yoshiki , Miyagawa Shigeru , Liu Li , Kawamura Takuji
Published: March 2022

Introduction:
The precise evaluation of safety and efficacy for newly developed medication is of vital importance for drug discovery. As a promising candidate for the drug assessment, the human iPSC derived cardiomyocytes (hiPSC-CMs) tend to be less mature than adult cardiomyocytes, which could limit their application. We developed spontaneous traveling waves (TW) to rapidly pace and mature hiPSC-CMs. We hypothesized that the TW-matured hiPSC-CMs could serve as a more accurate model for drug discovery and development.

Method and Results:
The silicone wells and pillars were mounted in petri dishes. hiPSC-CMs were plated into the wells to form close-loop tissue where TW originated and paced the CMs in most of the wells (83.33 ± 13.6%, 18 wells from 3 tests). After 14-day culture, the hiPSC-CMs were evaluated by immunostaining, gene expression, western blotting and electron microscopy. Micro electrode array (MEA) were used to evaluate the drug response of CMs. The TW paced the CMs to beat at a much higher rate than the group without TW (TW: 220 ± 74 bpm vs. Control: 32.4 ± 30.1 bpm, n = 18, p < 0.0001, at day 6). After 14 day culture, TW group has significantly higher expression of myosin heavy chain beta, connexin 43, and myoglobin. Electron microscopy indicated TW CMs with larger sarcomeric bundles, well-defined Z disks and myofibrils. In addition, the TW group showed shortened QT interval, more close to the human adult level (female/male: 288 ± 21 and 237 ± 8 ms) than control group (TW: 280 ± 71 ms vs. Control: 460 ± 120 ms, n = 8, p = 0.0018). Moreover, TW group showed enhanced response to the β adrenoceptor agonist ( beat rate with 10 uM isoproterenol : TW: 111.1 ± 15.57 bpm vs. Control: 83.73 ± 10.92 bpm, n = 6, p = 0.0064 ). TW group showed significantly different response to sodium channel blocker and reduced data variation than control ( QT interval at 100 μM mexiletine: TW: 424.4 ± 74.7 ms, CV = 17.6% vs. Control: 694.57 ± 198.38 ms, CV = 28.6%, n = 4, p = 0.035).

Conclusion:
By creating the close-loop cardiac tissue, the traveling wave could spontaneously originate and rapidly pace hiPSC-CMs. The TW paced hiPSC-CMs showed improved sarcomeric and functional maturation, improved drug response with reduced data variation, holding potential as a robust and accurate candidate for drug discovery.
Abstract 10138: Evening Blood Pressure and Heart Rate: An Age-Specific Association of Nocturia in the Japanese at High-Risk of Cardiovascular Disease
Authors: Nagai Michiaki , Hoshide Satoshi , Kario Kazuomi
Published: March 2022

Background:
Earlier epidemiologic studies have reported a significant relationship between hypertension and nocturia. However, the underlying pathophysiology has not been established in relation to heart rate (HR).

Hypothesis:
We hypothesized that blood pressure (BP), HR, and the class of antihypertensive agent might be associated with severity of nocturia in the Japanese at high-risk of cardiovascular disease. In addition, these associations were hypothesized to be moderated by age.

Methods:
In the Japan Morning Surge-Home Blood Pressure Study, measurements of home BP as well as HR at evening (mean 11.2 days) were performed in the 4310 patients with one or more cardiovascular risks (64.9 years old, male 47%). A self-administered questionnaire included items on nocturia was used.

Results:
The mean levels of evening systolic BP (SBP) and HR were 130±15mmHg and 70±9.6bpm, respectively. According to the number of nocturia, we divided into the three groups (no void: n= 2382; one void: n=847;
>
2 voids per night: n=1082). In the multinomial logistic regression analysis adjustment for confounders including age, gender, smoking, total cholesterol, fasting blood glucose, HbA1c, log B-type natriuretic peptide, beta-adrenergic blockade use, clinic SBP and clinic HR, the use of diuretics (OR, 1.23, 95%CI, 1.01-1.50, p<0.05) was significantly associated with one nocturnal void, while evening SBP (OR per 1SD, 1.14, 95%CI, 1.05-1.24, p<0.01) and evening HR (OR per 1SD, 1.12, 95%CI: 1.02-1.24, p<0.05) were significantly associated with multiple nocturnal voids. In the lower aged group (<66yrs), only evening HR remained significant (p=0.003), while only evening SBP remained significant for multiple nocturnal voids in the higher aged group (66yrs
<
) (p=0.007). A significant interaction was found between age and evening HR for multiple nocturnal voids (p<0.05).

Conclusions:
In this study, evening SBP and evening HR were significant indicators of multiple nocturnal voids in the high-risk Japanese population. Increased evening HR was specifically associated with severe nocturia in the lower aged group. Age-stratified approach to reduce BP and HR burdens might be important to improve sleep disturbance caused by nocturia.
Abstract 10143: Rising Burden Of Cardiovascular Disease Risk Factors And Acute Cardiac Events In Young Adults With Comorbid Depression: A Comparison Of Two Nationwide US Cohorts Hospitalized 10-years Apart
Authors: Vyas Ankit , Patel Krupa , Agha Khizran , Sasidharan Nayana , Sultan Waleed , Badarabandi Umarani , Bansal Prerna , Hiba Ambreen NFN , Mansuri Zeeshan , Desai Rupak
Published: March 2022

Background:
Previous literature suggests an association between depression and cardiovascular diseases. Due to the paucity of data in the young, we aimed to investigate the prevalence of cardiovascular disease (CVD) risk factors and associated major adverse cardiac and cerebrovascular events (MACCE) in young adults hospitalized with comorbid depression a decade apart.

Methods:
We conducted a retrospective analysis of the National Inpatient Sample database for the years 2007 and 2017. Young adults (18-44 years) hospitalized with comorbid depression were identified using ICD-9 CM/ICD-10 codes. Frequency and trends in demographics and comorbidities including cardiovascular disease risk factors and MACCE were compared between the 2017 vs. 2007 cohort.

Results:
A total of 1,274,118 (median age 34 [27-40] yrs, 68.7% females) young admissions were recorded with comorbid depression. When the 2007 cohort was compared with the 2017 cohort, a rising trend in depression was observed (5.5% vs. 8.2%) (p <0.001). The 2017 cohort of young adults with depression more often consisted of male, non-white patients . Burden of CVD risk factors (hypertension, diabetes with chronic complications, smoking and obesity) was also greater in the 2017 cohort.. Although the all-cause mortality remained comparable (0.3%) in both cohorts, there was a significantly higher rate and risk of MACCE including acute myocardial infarction (aOR 1.18, 95%CI:1.10-1.26), atrial fibrillation/ flutter (aOR 1.47, 95%CI:1.40-1.54) and stroke (aOR 1.33, 95%CI: 1.26-1.40) (p <0.001) in the 2017 cohort
(Table 1)
.

Conclusion:
This nationwide study reveals alarmingly increased prevalence of CVD risk factors and increase in the rate and risk of MACCE in two cohorts of young adults with comorbid depression studied a decade apart. Burden of mental disorders in young adults has been rising in the last decade and warrants extra vigilance by clinicians to curtail CVD risk and improve MACE-associated outcomes.
Abstract 10144: Xcr1
+
Dendritic Cell-Induced Cd4
+
T Helper-1 Activation Leads to Exacerbation of Remodeling After Myocardial Infarction
Authors: Inui Hiroyasu , Nishida Makoto , Asaji Masumi , Saga Ayami , Kanno Kotaro , Jiuyang Chang , Zhu Yinghong , Okada Takeshi , Tanaka Katsunao , Ohama Tohru , Koseki Masahiro , Yamashita Shizuya , Sakata Yasushi
Published: March 2022

Background and Aim:
Immune response including T cell activation after myocardial infarction (MI) is important mechanism in cardiac remodeling. We established a new model of ischemic cardiomyopathy using SR-BI KO/ApoeR61
h/h
(SRBI KO) mice in which MI is induced by high fat diet (HFD) for 7 days. We aimed to clarify the precise mechanism leading to post-MI cardiac remodeling: activation of inflammatory CD4
+
T-cell subsets and conventional dendritic cells (cDCs), using our non-surgical MI, coronary ligation MI and conditional cCDs KO mice model.

Methods and Results:
Probucol, a potent antioxidant, was known to improve cardiac remodeling in rat MI model. Using SRBI
+/-
mice as a non-MI control group, we fed SRBI KO mice HFD to induce MI (non-treatment group) and added probucol (treatment group). With probucol treatment, survival rate and EF were improved, and fibrosis area was reduced. We analyze CD4
+
cell subsets in the heart, blood and spleen. Th1 was predominantly increased and activated in border and infarcted area, and decreased with probucol treatment. RNA-seq revealed, specifically Th1 related chemokines, CXCR3 was down-regulated with probucol treatment. Flow data revealed, CXCR3 was highly expressed in Th1 (up to 50%) and decreased with probucol treatment. To elucidate the mechanism of the predominant activation of Th1 after MI, we analyze the dynamics of cDCs. XCR1
+
cDCs was activated and decreased with probucol treatment. Furthermore, CXCR3 ligands, CXCL9 and CXCL10, were highly expressed in XCR1
+
cDCs (up to 50%). In bone marrow, siglec-H
–
Ly6C
–
pre-DCs (XCR1
+
cDCs lineage) were increased in non-treatment group and also in coronary ligation MI model, and decreased with probucol treatment. Finally, to confirm the induction of post-MI Th1 type inflammation by XCR1 cDCs, we conducted the conditional depletion of XCR1
+
cDCs. In XCR1 KO mice, infiltration of CXCR3
+
Th1 in the infarcted area and fibrosis area was decreased, and deterioration of EF, which was evaluated by cardiac MRI, was suppressed after MI.

Conclusions:
The predominant activation of Th1 after MI exacerbated cardiac remodeling. CXCR3 chemokine system were characteristic of Th1 and XCR1
+
cDCs. The modulation of Th1- XCR1
+
cDCs interaction could be a novel therapeutic target in post-MI remodeling.
Abstract 10148: Prevalence, Clinical Characteristics and Cardiovascular Outcomes of Acute Coronary Syndrome Attributable to Coronary Subclavian Steal Syndrome in Patients with a History of Coronary Artery Bypass Grafting
Authors: Tomura Nobunari , Kataoka Yu , Yagi Nobuhito , Iwai Takamasa , Sawada Kenichiro , Matama Hideo , Honda Satoshi , Fujino Masashi , Takagi Kensuke , Yoneda Shuichi , Otsuka Fumiyuki , Tahara Yoshio , Asaumi Yasuhide , Satow Tetsu , Kataoka Hiroharu , Fukushima Satsuki , Fujita Tomoyuki , Noguchi Teruo
Published: March 2022

Introduction:
Coronary subclavian steal syndrome (CSSS) is coronary steal phenomenon due to subclavian artery stenosis (SAS) in patients with a history of CABG using internal mammary artery (IMA). While CSSS could cause acute coronary syndrome (ACS), its frequency, clinical characteristics and cardiovascular outcomes remain unknown.

Methods:
The current study was a retrospective multi-center analysis of 142 ACS patients who previously received CABG from January 2007 to October 2020. CSSS was defined as myocardial ischemia due to SAS. Clinical characteristics and cardiovascular events (=cardiac-cause death + myocardial infarction + stroke) were compared in subjects with and without CSSS.

Results:
CSSS was identified in 7.0% (=10/142) of study subjects. Of these, 1, 6 and 3 CSSS cases had SAS at right, left and both subclavian arteries, respectively. The averaged pressure gradient at SAS site was 31±13mmHg. ACS subjects attributable to CSSS were more likely to exhibit NSTEMI (90% vs. 52%, p=0.02), a history of hemodialysis (40% vs. 14%, p=0.03) and peripheral artery disease (70% vs. 20%, p<0.001). Of note, all of 4 CSSS subjects receiving hemodialysis had their arterial-venous fistula at the same side of SAS. With regard to revascularization procedure in CSSS subjects, primary endovascular treatment for SAS was performed in only 2 cases. Furthermore, despite SAS as a culprit lesion of ACS, primary PCI for native coronary lesion was conducted in other 6 cases. As a consequence, most of them (=5/6) required additional revascularization of SAS after primary PCI due to unresolved myocardial ischemia or chest pain. During 50-month observational period, CSSS was associated with a greater likelihood of cardiovascular (p=0.003) and stroke events (p<0.001, Figure).

Conclusions:
A substantially elevated cardiovascular risk was observed in ACS patients attributable to CSSS. This finding suggests clinical needs to meticulously evaluate SAS before and after CABG using IMA.
Abstract 10153: Validation of the Cost Needed to Treat Measure
Authors: Arbel Ronen , Aboalhasan Enis , Azuri Joseph , Hammerman Ariel
Published: March 2022

Introduction:
Several innovative medications have recently demonstrated significant efficacy in preventing major adverse cardiovascular events. In many situations, payers need to understand promptly whether the novel interventions provide good value for their resources invested. Cost-effectiveness analysis (CEA) is the gold standard and cornerstone of pharmacoeconomic evaluation but requires significant resources, and is not always available at the period needed for reimbursement decisions. Therefore, we suggest using the "Cost Needed to Treat" (CNT) measure as a preliminary economic figure for comparing novel preventive therapies' value until valid CEA is available. CNT represents the extra cost of therapy needed to prevent one additional adverse event. The CNT is a product of the number needed to treat (NNT) and the cost of the therapy. A lower CNT indicates more value for money. To validate the usefulness of the CNT measure, we aimed to retrospectively compare outcomes of published CNT evaluations and the later published CEAs.

Hypothesis:
CNT measure and CEA result in comparable recommendations.

Methods:
We compared the conclusions of all published CNT evaluations with available published CEA results.

Results:
Seven published CNT figures, based on cardiovascular outcome trial results, were identified. Four CNTs had matched CEAs. The CNT evaluation and the CEA resulted in the same conclusions in all four cases (Figure 1).

Conclusions:
Outcomes of the published CNT evaluations seem to correlate with published CEA results. CNT seems to be a valuable, prompt tool for comparing novel preventive interventions' economic value.