bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13980: Cardiac Magnetic Resonance Imaging Quantification of Myocardial Ischemia and Necrosis Using a Novel Risk Prediction Model Allows for Better Risk Stratification in Coronary Artery Disease
Authors: Buckert Dominik , Dyckmanns Nils , Rasche Volker , Rottbauer Wolfgang , Bernhardt Peter
Published: July 2021

Background:
Cardiac magnetic resonance imaging (CMR) provides information about inducible myocardial ischemia and necrosis in one single examination in coronary artery disease (CAD) patients. Both variables have been shown to correlate with prognosis. However, there is no consensus on how to assess and quantify these two variables.

Hypothesis:
Objective of the present prospective study in consecutive patients was to provide a simple algorithm for quantification of ischemia and necrosis and to test for risk stratification models.

Methods:
Patients with known or suspected CAD referred for adenosine-stress CMR were consecutively enrolled from 2003 to 2007. Examination was conducted on a 1.5-T whole-body scanner. Reversible ischemia was diagnosed by adenosine stress first pass perfusion imaging. Myocardial necrosis was assessed by late gadolinium enhancement (LGE). In a semiautomatic approach, extent of reversible ischemia and scar was quantified and reported as percentage of the left ventricle. Primary endpoint was defined as cardiac death, non-fatal myocardial infarction and stroke.

Results:
The study cohort consisted of 845 patients. Median age was 64 years, 271 patients were women. During a median follow-up period of 3.8 years 61 primary endpoints occurred.

Statistical analysis yielded a ≥6% optimal threshold for reversible ischemia to predict a primary endpoint (univariate hazard ratio 4.91, p<.0001). Similarly, thresholds for extent of myocardial necrosis were defined (LGE >15% and ≤33%: univariate hazard ratio 2.75, p<.0001; LGE >33%: univariate hazard ratio 16.27, p<.0001). The risk prediction model containing both, quantified ischemia and necrosis, proved to be superior in comparison to the dichotomous model (ischemia present: yes/no; necrosis present: yes/no) on multivariate testing (increase in χ
2
-values: 45.004 to 61.545; increase in integrated discrimination improvement: .02269 to .03187; net reclassification index for optimal model: .25593, p=.001).

Conclusion:
CMR cut-off values for quantification of myocardial ischemia (≥6%) and necrosis (>15% and >33%) have been found which allow for better risk stratification in CAD patients. The combination of both has been shown to yield the superior risk stratification model.
Abstract 14003: Outcomes With Invasive versus Conservative Management of Myocardial Infarction in Patients With Sepsis
Authors: Smilowitz Nathaniel R , Gupta Navdeep , Guo Yu , Bangalore Sripal
Published: July 2021

Background:
Patients hospitalized with sepsis may be predisposed to myocardial infarction (MI). The incidence, treatment, and outcomes of MI in sepsis have not been studied.

Methods:
We analyzed data from the National Inpatient Sample from 2002 to 2011 for patients with a diagnosis of sepsis (CCS category 2). The incidence of MI as a non-primary diagnosis was evaluated. Propensity score matching was performed (1:1, without replacement) to identify patients with secondary MI and sepsis who were managed invasively (defined as cardiac catheterization, percutaneous coronary intervention (PCI), or coronary artery bypass graft surgery (CABG)) or conservatively. The primary outcome was in-hospital all-cause mortality.

Results:
A total of 2,570,098 patients had a diagnosis of sepsis. MI developed in 118,183 (4.6%) patients, the majority with non-ST elevation MI (71.4%). In-hospital mortality was higher among patients with MI and sepsis than for those with sepsis alone (35.8% vs. 16.8%, p<0.0001; adjusted OR 1.24, 95% CI 1.22-1.26). Among patients with MI, 11,899 (10.1%) underwent an invasive management strategy with revascularization in 4668 (39.2%). PCI was performed in 3,413 patients (73.1%), CABG in 1,165 (25.0%), and both CABG and PCI in 90 (1.9%) cases. Trends in mortality are shown in the Figure. In a propensity-matched cohort of 23,708 patients with MI, invasive management was associated with a lower mortality than conservative management (19.0% vs. 33.4%, p<0.001; OR 0.47, 95% CI 0.44-0.50). In subgroups that underwent revascularization, the odds of mortality were consistently lower than corresponding matched subjects from the conservative group.

Conclusions:
Myocardial infarction frequently complicates sepsis and is associated with a significant increase in in-hospital mortality. Patients managed invasively had a lower mortality than those managed conservatively, and patients with MI complicating sepsis may warrant more aggressive management.
Abstract 14022: Effect of Discontinuation and Nonadherence to Oral Anticoagulants on Atrial Fibrillation Stroke Risk
Authors: Yao Xiaoxi , Abraham Neena S , Noseworthy Peter A , Alexander G. Caleb , Sangaralingham Lindsey R , Shah Nilay D
Published: July 2021

Introduction:
Medicines don’t work in those who don’t take them. Although novel oral anticoagulants (NOACs) are more convenient than warfarin due to fewer drug-drug interactions and less need for laboratory monitoring, their considerable costs and lack of regular interactions with the healthcare system may also contribute to poor adherence. Little is known about the persistence and adherence in the era of NOACs, nor how such behaviors are associated with the risk of ischemic stroke and transient ischemic attack (TIA) among patients of varying baseline risk.

Methods:
We conducted a retrospective analysis using a large U.S. commercial insurance database, and identified 61,646 patients with atrial fibrillation who initiated one of OACs (warfarin, dabigatran, rivaroxaban and apixaban) between October 2010 and September 2014. We defined discontinuation as being off OACs for at least 3 months and adherence as the proportion of days covered of at least 80%. Cox proportional hazard models was used to examine whether the time that patients were off OACs, including both the gaps between medication fills and the time of discontinuation, increased the risk of ischemic stroke and TIA.

Results:
Approximately 1 in 3 patients discontinued OACs within one year after initiation and 1 in 10 switched to another OAC. The estimated likelihood of adherence was 0.77 during the time when patients were on their first-line medications. Apixaban had the highest continuation rate (65% at 1 year), while rivaroxaban had the best adherence (predicted probability of adherence 0.83). The event rate of stroke was 1.6 per 100 person years. Patients with high baseline risk (CHA2DS2-VASc ≥2) were more likely to have a stroke when they were off OACs for 1-3 months (HR=1.47, p<0.01), 3-6 months (HR=1.78, p<0.001) and ≥6 months (HR=2.16, p<0.001), compared to off OACs for less than a week. No significant effect was found among low-risk patients (CHA2DS2-VASc 0 or 1). Switching to another OAC was related to 22% increased risk of stroke (p=0.05).

Conclusions:
Despite their greater convenience relative to warfarin, discontinuation and nonadherence to NOACs is high. Lack of persistence and adherence was associated with increased risk of ischemic stroke and TIA among patients with elevated baseline risk.
Abstract 14063: Hand Grip Strength Significantly Predicts Cardiovascular Event Risk in Patients With Type 2 Diabetes
Authors: Rein Philipp , Saely Christoph H , Vonbank Alexander , Zanolin Daniela , Drexel Heinz
Published: July 2021

Introduction:
Muscle fitness is an established indicator of overall health. The power of muscle strength to predict cardiovascular endpoints in patients with type 2 diabetes mellitus (T2DM) is unclear and is addressed in the present study.

Methods:
We studied a high-risk cohort of 209 patients with T2DM who underwent coronary angiography for the evaluation of stable coronary artery disease (CAD). Forearm muscle dynamometry was performed to determine hand grip strength in the dominant arm the day before angiography. Significant CAD was diagnosed in the presence of coronary stenoses with lumen narrowing ≥50%. T2DM was diagnosed according to the ADA criteria. Prospectively, we recorded vascular events over 5.5±2.2 years.

Results:
Grip strength, measured in kilograms, at baseline did not differ significantly between patients with significant CAD and those who did not have significant CAD (34±12 vs. 31±12 kg; p=0.140). Prospectively, hand grip strength significantly predicted the incidence of major cardiovascular events (n=65) after adjustment for age, gender, BMI, smoking, systolic and diastolic blood pressure, LDL cholesterol and HDL cholesterol (standardized adjusted HR 0.72 [0.52-0.99]; p=0.042). This result was not attenuated after further adjustment for the angiographically determined baseline CAD state (HR 0.72 [0.53-0.99]; p=0.046).

Conclusions:
We conclude that hand grip strength in patients with T2DM is inversely associated with vascular events independently both from well established cardiovascular risk factors and from the angiographically determined baseline CAD state.
Abstract 14109: Basic Life Support With Reperfusion Injury Protection Improves 24 Hour Survival Outcomes in a Porcine Model of Prolonged Cardiac Arrest
Authors: Debaty Guillaume , Lurie Keith G , Metzger Anja , Lick Michael , Bartos Jason , Rees Jennifer N , McKnite Scott , Puertas Laura , Yannopoulos Demetris
Published: July 2021

Introduction:
Ischemic postconditioning (PC) using 3 intentional short pauses at the start of cardiopulmonary resuscitation (CPR) improves outcomes after cardiac arrest in pigs when epinephrine (epi) is used before defibrillation.

Hypothesis:
Basic life support (BLS) with PC will protect against reperfusion injury and enhance 24 hour functional recovery in the absence of epi.

Methods:
Female pigs (n=46; wt ~ 40 kg) were anesthetized (isoflurane). PC was delivered using 3 cycles alternating between automated CPR for 20 sec and no CPR for 20 sec at the start of each protocol. Protocol A: After 12 minutes of ventricular fibrillation (VF), 28 pigs were randomized in 4 groups: A/ Standard CPR (SCPR), B/ active compression-decompression with an impedance threshold device (ACD-ITD), C/ SCPR+PC (SCPR+PC) and D/ ACD-ITD+PC. Protocol B: After 15 min of VF, 18 pigs were randomized to ACD-ITD CPR or ACD-ITD + PC. The BLS duration was 2.75 min in Protocol A and 5 min in Protocol B. Following BLS up to 3 shocks were delivered. Without return of spontaneous circulation (ROSC) CPR was resumed and epi (0.5 mg) and defibrillation delivered. The primary end point was the incidence of major adverse outcomes at 24 h (defined as death or coma, refractory seizures and cardio-respiratory distress leading to euthanasia). Hemodynamic parameters and left ventricular ejection fraction (LVEF) were also measured. Data are presented as mean ± standard error of mean.

Results:
Protocol A: ACD-ITD CPR + PC (group D) provided the highest coronary perfusion pressure after 3 min of BLS compared with the 3 other groups (28 ± 6, 35 ± 7, 23 ± 5 and 47 ± 7 for groups A, B, C, D respectively, p= 0.05 by ANOVA). ROSC with BLS was achieved in 0, 3, 0, and 3 pigs in groups A, B, C and D, respectively (p=0.22) with no significant differences in 24-hour survival between groups.

Protocol B: Four hours post ROSC, LVEF was significantly higher with ACD-ITD+IPC vs ACD-ITD alone (52.5 ± 3% vs. 37.5 ± 6.6%, p = 0.045). There was a significantly lower incidence of major adverse outcomes 24 hr after ROSC with ACD-ITD+PC compared with ACD-ITD alone (Log-rank comparison, p=0.027).

Conclusion:
BLS using ACD-ITD + PC mitigates post resuscitation cardiac dysfunction and facilitates neurological recovery after prolonged untreated VF in pigs.
Abstract 14160: Rest and Reserve Functions in Fontan Patients With Right Ventricular Morphology are Worse Than Those With Left Ventricular Morphology
Authors: Masutani Satoshi , Kuwata Seiko , Kurishima Clara , Iwamoto Yoichi , Saiki Hirofumi , Ishido Hirotaka , Tamura Masanori , Senzaki Hideaki
Published: July 2021

Introduction:
Fontan patients with right ventricular morphology (RV-F) are associated with worse outcome and exercise capacity compared with those with left ventricular morphology (LV-F). Diminished cardiac reserve is one of major mechanisms of impaired exercise capacity in heart failure patients. However, it remains unclear whether and how rest and reserve functions differ between RV-F and LV-F.

Hypothesis:
We assessed the hypothesis that rest and reserve functions in RV-F may be worse than those in LV-F.

Methods:
This study included 28 RV-F and 17 LV-F (6.0 vs 6.2 years. p=N.S.). Ventricular pressure-area relationships were determined during cardiac catheterization, both before and after β-adrenergic stimulation with dobutamine (5 microg/kg/min) and increased heart rates by atrial pacing.

Results:
There were no significant differences in heart rate, central venous pressure, and pulmonary vascular resistance between RV-F and LV-F. End-systolic pressure in RV-F was lower than that in LV-F (89 vs 97mmHg), while end-systolic and end-diastolic volume in RV-F were larger than those in LV-F. Consistently, contractile function in RV-F was worse than that in LV-F (20.1±10.5 vs 30.8±19.7 mmHg/cm2 хm2 in Ees index; and 978±237 vs 1186±297 mmHg/s in dp/dt max). The worse contractile function in RV-F was persisted after dobutamine (24.9 vs 45.1 mmHg/cm2 хm2 in Ees index; and 1721 vs 2241 mmHg/s in dp/dt max). Furthermore, the response of Ees index to faster heart rate in RV-F was blunted, which was in striking contrast to positive chronotropic response in LV-F (Figure).

Conclusions:
Compared with LV-F, RV-F has worse systolic function at rest and markedly attenuated chronotropic reserve in systolic function, which can be responsible for worse outcome in RV-F. Given the lack of definitive therapy for Fontan failure, development of medical therapy to improve rest and reserve function should be pursued for better prognosis in Fontan patients.
Abstract 14180: Real-time Visual Feedback During Training Improves Lay People’s CPR Quality: A Randomized Controlled Manikin Study
Authors: Baldi Enrico , Contri Enrico , Somaschini Alberto , Epis Francesco , Dossena Cinzia , Zambaiti Elisa , Di Maggio Marzia , Cornara Stefano
Published: July 2021

Introduction:
It has been demonstrated that feedback devices could have a role in improving CPR quality, but the results regarding lay people are controversial.

Hypothesis:
Our aim is to verify whether the use of CPR feedback devices improves lay people’s CPR quality after a training course and if the final quality reached is influenced by the amount of time spent training with them.

Methods:
450 lay participants to BLS-D courses were randomly divided into three groups with an allocation ratio 1:1:1; group 0 attended a course without any feedback, group 1 a course with 1 minute training with real-time visual feedback and group 10 a course with 10 minutes training with real-time visual feedback. There were no statistically significant differences among the three groups for the anthropometric variables. At the end of each course we recorded 1-min of compression-only CPR.

Results:
There was a statistically significant overall difference among the three groups. In particular, comparing group 0 vs group 1 and group 0 vs group 10 there was a significant improvement in the percentage of compressions with correct depth (66.6% (95%CI, 60.1-73.1) in gr.0 vs 77.8% (95%CI, 72.8-82.8) in gr.1, p=0.005 and 66.6% (95%CI, 60.1-73.1) in gr.0 vs 75.7% (95%CI, 70.7-80.8) in gr.10, p=0.022), in the percentage of compressions with complete chest recoil (71.7% (95%CI, 66.2-77.2) in gr. 0 vs 86.6% (95%CI, 82.4-90.8) in gr. 1, p<0.001 and 71.7% (95%CI, 66.2-77.2) in gr. 0 vs 88.8% (95%CI, 85.6-92.2) in gr. 10, p<0.001), in the percentage of compressions with correct hand position (93.2% (95%CI, 89.7-96.6) in gr.0 vs 98.2% (95%CI, 96.7-99.8) in gr.10, p<0.001 and 93.2% (95%CI, 89.7-96.6) in gr.0 vs 99.3% (95%CI, 98.6-100) in gr.10, p=0.002) and in Total CPR score (79.4% (95%CI, 75.5-83.2) in gr.0 vs 90.2% (95%CI, 87.8-92.5) in gr.1, p<0.001 and 79.4% (95%CI, 75.5-83.2) in gr.0 vs 92.5% (95%CI, 91-94) in gr.10, p<0.001) in the groups in which the feedback was used. Furthermore, there were no statistically significant differences for all the parameters between group 1 and group 10.

Conclusions:
Real-time visual feedback improves lay people CPR quality, thus could improve OHCA survival. 1-minute of feedback is sufficient to reach a better CPR quality and we suggest its use in every BLS-D course.
Abstract 14182: Myocardial Fibrosis and Reverse Remodelling in Nonischaemic Dilated Cardiomyopathy
Authors: Barison Andrea , Ortalda Alessandro , Todiere Giancarlo , Vergaro Giuseppe , Mirizzi Gianluca , Valleggi Alessandro , Chiappino Sara , Pastormerlo Luigi Emilio , Giannoni Alberto , Aquaro Giovanni Donato , Passino Claudio , Emdin Michele
Published: July 2021

Introduction:
In nonischaemic dilated cardiomyopathy (NICM), myocardial fibrosis can be detected by cardiovascular magnetic resonance (CMR) as late gadolinium enhancement (LGE) and is associated with worse prognosis.

Hypothesis:
Absence of myocardial fibrosis is associated with left ventricular reverse remodelling (LV-RR).

Methods:
One-hundred-and-twenty-five NICM patients (age 51±16 years, 82 male) were enrolled and underwent baseline CMR; patients with ischaemic, valvular, congenital heart disease, other cardiomyopathies or contraindications to CMR were excluded. After a 24-month follow-up on optimal medical therapy, all patients underwent a second CMR; patients who died, underwent device implantation or declined a second CMR, were also excluded from the study. LGE was quantified on post-contrast CMR images. LV-RR was defined as an increase in LV ejection fraction ≥10 U or decrease in LV end-diastolic volume ≥10% at follow-up.

Results:
Mean LV ejection fraction was 41±11% at baseline, 47±12% at follow-up: LV-RR was observed in 59 patients (47%), with no age or gender difference (p=NS) . LGE was present in 69 (54%) patients at baseline (mean extent 12±6 g), without significant differences at follow-up (mean extent 13±7 g). Patients experiencing LV-RR during follow-up presented a baseline worse LV ejection fraction (36±12%) than no-LV-RR patients ( 45±9%, p<0.01), greater LV volumes (123±38 vs. 110±22 ml/m2, p=0.02) and worse right ventricular ejection fraction (54±12% vs. 59±10%, p=0.02) . Nevertheless, only 17 (29%) LV-RR patients presented LGE compared to 31 (47%, p=0.04) no-LV-RR patients. Moreover, among LGE-positive patients (n=48), only 17 (35%) developed LV-RR, while among LGE-negative patients (n=77), 42 (55%) developed LV-RR (p=0.04). Multivariate regression analysis showed that the absence of LGE at baseline CMR was a strong predictor of LV-RR (p=0.02), even after correction for age, New York Heart Association class, LV volumes and systolic function.

Conclusions:
In patients with idiopathic dilated cardiomyopathy, absence of LGE was a strong independent predictor of LV-RR at 2-year follow-up, irrespective of the initial clinical status and the severity of ventricular dilatation and dysfunction.
Abstract 14192: Stroke Recurrence and Atrial Fibrillation Occurrence in the Patients With Right Insular Stroke
Authors: Park Hee-Kwon , Ko Sang-Bae , Rha Joung-Ho
Published: July 2021

Introduction:
The right insular cortical lesion is believed to have the arrhythmogenic potential such as secondary atrial fibrillation(AF). The P wave-triggered signal-averaged electrocardiogram(SA-ECG) can detect the P wave dispersion which is related to the risk of AF. The stroke risk of secondary AF after right insular stroke remained unclear.

Hypothesis:
We investigated the arrhythmogenic potential of right insular stroke, using SA-ECG and the stroke recurrence rate related to stroke location.

Methods:
We recruited acute stroke patients who admitted from February 2012 to October 2013 and took routine work-up, including SA-ECG. Patients who had the previous history of AF before admission, were excluded. We checked the stroke recurrence and AF occurrence over two years after index stroke. We analyzed the difference of SA-ECG, AF occurrence and stroke recurrence rate between the right insular cortex lesion and other stroke.

Results:
A total of 252 subjects were enrolled and 49 among them had right insular involvement. The patients with right insular lesion had longer P wave duration than the other stroke patients (154.0+29.6 vs. 133.5+26.5 ms, p<0.001). During observation period, stroke recurred in 28 patients and AF occurred in 50 persons. The patients with right insular lesion suffered from the AF occurrence and the stroke recurrence more frequently than those with other stroke lesions(AF occurrence, 33% vs 17%, P=0.01; Stroke Recurrence 25% vs 6%, P<0.01). Among the patients with AF occurrence, the patients with right insular lesion had the tendency of the higher stroke recurrence rate than those with the other stroke lesion(43.8% vs 20.6%, P=0.089).

Conclusions:
Our result suggests that the right insular lesion is related to increased P wave dispersion and this might explain the development of secondary AF after right insular cortex stroke. Secondary AF after right insular lesion might have the higher stroke risk than that after other stroke lesion.
Abstract 14195: Diagnostic Value of MRI in Patients With Implanted Cardiac Devices: Does the Benefit Justify the Risk?
Authors: Samar Huma , Yamrozik June , Shah Moneal , Williams Ronald B , Doyle Mark , Bonnet Christopher A , Biederman Robert W
Published: July 2021

Background:
MRI is infrequently performed on patients with conventional pacemakers/ICD’s. Multiple recent studies and registries (MagnaSafe) have documented the safety of MRI in these patients, yet the
diagnostic value
of this approach has not been established remaining a critical issue to advance this field in an era of progressive MRI useage.

Objective:
1) to examine a protocol to assess the diagnostic utility of thoracic and non-thoracic MRI in patients with implantable devices and 2) to determine if there is substantial benefit to the pt with regard to diagnosis and/or management.

Methods:
Over 8 years, 134 pts with PM/AICD’s underwent MRI (GE, 1.5T Milwaukee, WI) at a single institution. Specific criteria were followed for all pts to objectively define whether final diagnosis by MRI imaging enhanced patient care. A checklist of three questions was answered following scan interpretation by both the technologist and performing MRI physician(s):1) Did the primary diagnosis change? 2) Did the MRI provide additional information to the existing diagnosis? 3) Did patient management change? If ’Yes’ was answered to any of the above questions, it was considered that the MRI scan was of value to patient diagnosis and/or therapy.

Results:
All 134 pts underwent MRI/CMR without complications: avg scan time 24±9min including 42 pts with ICD’s, 5 pts with a retained lead and 87 non-MR conditional pacemakers. In 83% (n=112) MR added value to patient diagnosis and management. In 64% (n=86) MRI added additional valuable information to the primary diagnosis and in 19% (n=26) MRI was life-saving, changing the principal diagnosis and subsequent management of the pt. There were no deaths, arrhythmias or power-on-resets encountered and no adverse effects were noted in any pt. No post-procedure revisions or reimplantations of generator/lead were required.

Conclusions:
MR imaging in patients with implanted cardiac devices adds substantial value to patient diagnosis and management justifying the risk of the procedure. In this real-world patient population, we have shown that MR imaging retains its very high diagnostic yield. Risk-benefit ratios clearly justify the performance of MRI even in this higher risk population, that is, until such time as MR-conditional devices are universal.
Abstract 14217: Subsequent Sustained Ventricular Arrhythmia in Patients With Transposition of the Great Arteries Undergoing Device Implantation
Authors: Shah Gautam V , Grubb Alex , Krasuski Richard A
Published: July 2021

Introduction:
Current guidelines recommend prophylactic implantable cardioverter-defibrillator (ICD) for patients with an ejection fraction <35%. Whether this applies to patients with transposition of the great arteries (TGA) and ≥moderately depressed systemic ventricular dysfunction is uncertain.

Methods:
From an electrophysiologic database at a large, tertiary care medical center, we identified 71 patients with TGA (40 D-TGA and 31 L-TGA) receiving an implantable cardiac device from 1996-2014. Electronic and paper medical records were fully reviewed and device interrogation data was collected to assess the frequency of sustained ventricular arrhythmia.

Results:
Patients were 31±15 years of age, 32% were women, 53% had ≥moderate systemic ventricular dysfunction and 38% had ≥moderate systemic atrioventricular valve regurgitation. Sixteen (23%) had an ICD placed initially. Of the 55 with a pacemaker as their first device 9 were later upgraded to an ICD for primary prevention of sudden death and 1 patient had sustained arrhythmia and an ICD was placed afterwards. Thus, of the 26 patients who eventually underwent ICD implant, 20 received it for primary prevention and 6 for secondary prevention. Interrogation follow-up data spanned 214 patient-years for primary prevention and 41 patient-years for secondary prevention. Only 2 patients received ICD discharges in the primary prevention group and both were inappropriate. In the secondary prevention group, 67% of patients underwent appropriate ICD discharge (0.39 shocks per patient-year, p<0.001 compared to primary prevention). Patients with ICD discharge were older (49±5 vs. 30±15 years, p=0.011) and more likely to have concomitant heart defects (100% vs. 30%, p=0.011).

Conclusion:
Patients with TGA and sustained ventricular arrhythmia are at high risk for subsequent events and benefit from ICD implantation. The role of prophylactic ICD implant in this patient population, however, remains uncertain.
Abstract 14230: Women Speak up About Personalized Heart Health Awareness: A Women’s Heart Alliance Research Report
Authors: Johnson Paula , Bairey Merz Noel C , Andersen Holly , Keida Mark , Sprague Emily , Walsh Mary N , Greenberger Phyllis , Campbell Susan , Pollin Irene , Jenkins Majorie , Redberg Rita , Robinson British
Published: July 2021

Introduction:
Cardiovascular disease is the number one killer of women in the US, yet too few women personalize awareness. In November 2014, the Women’s Heart Alliance (WHA) conducted a nationwide survey to determine barriers and opportunities to personalize awareness the women’s heart health epidemic.

Methods:
From September 18-26, 2014, a total of 1,011 U.S. women ages 25-60 were interviewed. Fieldwork was conducted online using GfK KnowledgePanel - the only representative panel of the American public. The KnowledgePanel covers 97% of U.S. households. Respondents are selected using random probability address-based sampling; computers and Internet service are provided to respondents who do not have them to ensure fuller representation of the American public. The survey took 15 minutes on average to administer. Final data were weighted by age, region, race/ethnicity, education, and income, according to the March 2014 Current Population Survey. The margin of sampling error for this poll is +/- 3.4 percentage points (total sample); this is higher for subgroups.

Results:
Few (27%) can name a woman in their lives with heart disease. Younger and middle-aged women ages 25-49 are less apt than those in the 50-60 age-range to know a woman affected by heart disease (23% vs. 37%). Even fewer (11%) women can name a woman who has died from it. Women who report knowing another woman with heart disease are more apt to express concern and - importantly - bring up this issue with their doctor (Figure).

Conclusions:
Heart disease in women is largely invisible. A personal connection with heart disease is associated with personalized awareness. Campaigns should make heart disease “real” to the millions of American women who say they have no personal connection to the disease.
Abstract 14254: Right Ventricular Reverse Remodeling and Improved Systolic Function After Upfront Combination Therapy With Ambrisentan and Tadalafil in the Treatment of Scleroderma-Associated Pulmonary Arterial Hypertension
Authors: Pisanello Chiara , Zamanian Roham , Damico Rachel , Kolb Todd , Tedford Ryan , Sato Takahiro , Corona-Villalobos Celia , Zimmerman Stefan , Minai Omar , Torres Fernando , Chin Kelly , Girgis Reda , Mathai Stephen , Hassoun Paul
Published: July 2021

Introduction:
We assessed the effects of upfront, combination therapy with a phosphodiesterase inhibitor (tadalafil) and endothelin receptor antagonist (ambrisentan) on changes in size and function of the right ventricle (RV), in a prospective open label trial for treatment naïve scleroderma-associated pulmonary arterial hypertension (SSc-PAH) patients.

Methods:
In this multicentric open-label trial, 24 treatment naïve SSc-PAH patients received tadalafil (40 mg daily) and ambrisentan (10 mg daily) daily for 36 weeks. Two-dimensional convenctional echocardiography (2D-E) with speckle tracking (ST) study and cardiac magnetic resonance imaging (cMRI) were performed at baseline and 36 weeks.

Results:
Treatment with upfront combination therapy resulted in RV reverse remodeling, defined as a relative decrease in RV end-systolic area of at least 15% at echocardiographic evaluation at 36 weeks. cMRI at follow up showed a reduction in RV end-systolic volume 82.1 (IQR 65.6-97.7) vs 55.8 (IQR 49.4-79.2), p= 0.001, RV mass index 17.2 (IQR 13.4-27.3) vs 15.4 (IQR 11.7-20.3), p= 0.02, and ventricular mass index (VMI= RV/LV mass index) 0.32 (IQR 0.29-0.45) vs 0.27 (IQR 0.23-0.33), p= 0.02. After 36 weeks of therapy, an improvement in RV function was observed by tricuspid annular plane systolic excursion (TAPSE; 1.7 ± 0.5 vs 2.2 ± 0.5, p=0.02) and RV fractional area (FAC; 31.5 ± 12.3 vs 42.8 ± 9.7, p=0.002) changes. Tricuspid annular S’, calculated using ST, was significantly improved (7 ± 2.3 vs 8.9 ± 2.4, p=0.01), while longitudinal strain (-16 ± 6.4 vs -19 ± 4.9, p=0.09) and systolic strain rate (-0.8 ± 0.2 vs -0.9 ± 0.2, p=0.08) showed a trend toward improvement.

Conclusion:
Upfront combination therapy in treatment naïve SSc-PAH patients induces both reverse remodeling of the RV, with reduction in systolic RV volume, RV mass index and VMI, and significant increase in RV systolic function as shown by the increase in TAPSE, FAC and S’.
Abstract 14288: Implementation of a Multidimensional Bundle for Dispatcher Telephone CPR in a Horizontal Dispatch System is Associated With Increased Bystander CPR and Good Neurological Survival From Out-of-Hospital Cardiac Arrest
Authors: Liu Sot Shih-Hung , Chong Kah-Meng , Wang Hui-Chih , Chen Yu-Wen , Hsu Chih-Ming , Tseng Chung-Rong , Hung Chao-Lun , Huang Chien-Hua , Lin Hung-Sung , Yang Yun-Chung , Yang Mei-Fen , Yang Chih-Wei , Liu Yueh-Ping , Ma Matthew Huei-Ming , KO Patrick Chow-In
Published: July 2021

Background:
The resuscitation guidelines indicate pre-arrival dispatcher-assisted telephone CPR (DATCPR) instructions and measurement to increase the proportion of bystander CPR (BCPR), however the impact of those guidelines on survival is not well known.

Objective:
To describe the impact of a comprehensive bundle of DATCPR on BCPR and survival from OHCA in a horizontal computerized-aided dispatch (CAD) system.

Methods:
A centralize CAD system in a metropolitan EMS is studied. Routinely in system the time from call to ambulance dispatch should be within 60 seconds. The audio recordings of confirmed OHCAs were reviewed using a standardized format linked with EMS and hospital process and outcome data. The proportions of BCPR and survival six months after implementation (P1) of a bundle that included guideline-based protocol changes, staff training, computerized audit, feedback to providers and leadership rebuilt are compared with that of the same month period in the prior year as control group (P0), using regression analysis for statistics.

Results:
There were 1437 OHCAs [665 P0, 772 P1; 64% male, median age 62 (IQR: 47-74)](Table 1). The rate of BCPR went from 20.6% in P0 to 35.0% in P1 (p<0.001). Outcome of ROSC (return to spontaneous circulation) upon hospital arrival was significantly higher in P1 (10.4%) compared to P0 (6.6% p=0.037), as was good neurological outcome (CPC 1or2: 5.5% in P1 vs. 2.6% in P0 p=0.029). Survival to hospital discharge was higher in P1 (8.3%, vs. P0: 6.4%) but not statistically significant. After adjusting for witnessed arrest, shockable rhythms, age, sex, and pre-hospital time intervals, good neurological outcome were still significantly higher in P1 vs. P0 [adjusted odds ratios: 2.1 (95% 1.1-4.4)].

Conclusions:
The implementation of a comprehensive bundle of DATCPR in a metropolitan horizontal dispatch system was associated with significant improvements in the rates of BCPR and good neurologic outcome after OHCA.
Abstract 14293: Time to Wound Healing and Major Adverse Limb Events in Patients With Critical Limb Ischemia Treated With Endovascular Therapy
Authors: Reed Grant W , Salehi Negar , Raeisi-Giglou Pejman , Malik Umair , Kafa Rami , Maier Michael , Shishehbor Mehdi H
Published: July 2021

Introduction:
There have been few studies evaluating the influence of time to wound healing on outcomes in patients with critical limb ischemia (CLI) after endovascular therapy.

Methods:
In this prospective study, patients with CLI treated with endovascular therapy were assessed for comorbidities, presence of wounds, wound healing, and major adverse limb events (MALE; major amputation, surgical endartectomy, or bypass) over time. The incidence of MALE was compared across patient and wound characteristics by Kaplan-Meier analysis. Associations between these variables and MALE were determined by Cox proportional hazards analysis.

Results:
A total of 252 consecutive patients with CLI were treated between November 1, 2011 and April 1, 2015; 179 (71%) had wounds, of which 97 (54%) healed. During median follow-up of 12.7 months (interquartile range 3.9 - 23.9 months), 46 (18%) had MALE. Wounds were associated with a greater risk of MALE (Hazard Ratio [HR] 3.5; 95% Confidence Interval [CI] 1.4-8.9; p=0.008). As a time-dependent covariate, wound healing was associated with less MALE (HR 0.23; 95% CI 0.10-0.53; p<0.001), and MALE was more frequent in patients with unhealed wounds (23% vs 11%; p<0.0001) (Figure - A). There was significantly less MALE in patients whose wounds healed within 4 months (24% vs 10%; p=0.032) (Figure - B), and less major amputation in those with healed wounds within 3 months (16% vs 5%; p=0.033). After multivariate adjustment for age, presence of diabetes, renal function, wound size, and procedural failure, independent predictors of MALE were wound healing as a time-dependent covariate (HR 0.18; 95% CI 0.08 - 0.40; p<0.0001), and creatinine ≥ 2 (HR 2.3; 95% CI 1.3-4.2; p=0.005).

Conclusions:
A shorter time to wound healing is associated with less MALE in patients with CLI after endovascular therapy. Efforts should be made to achieve wound healing as quickly as possible in this population, especially in those with renal dysfunction.
Abstract 14295: Increasing QRS Duration Over Time Is Associated With Mortality and Morbidity in an Outpatient Heart Failure Population
Authors: Alfraidi Hassan , McIntyre William F , Torbiak Lindsay , Zieroth Shelley , Seifer Colette M
Published: July 2021

Introduction:
Heart failure is a leading cause of morbidity and mortality. Prolonged QRS duration (QRSd), a marker of intra-ventricular conduction delay, has been shown to be associated with worse left ventricular (LV) systolic function, LV dilation and mitral regurgitation as well as with mortality. There are minimal data in the literature on the progression of QRSd over time, and the association with clinical outcomes.

Hypothesis:
We hypothesized that the progression of QRSd over time would be associated with mortality and hospitalizations in an outpatient heart failure population.

Methods:
Retrospective study of consecutive new adult referrals to a tertiary heart failure clinic over a 1 year period (2012). All patients with a narrow QRSd (defined as <130 ms) were included. Data were collected on demographics, ejection fraction (EF), clinical course and major clinical events. Primary endpoint was mortality and secondary endpoint was heart failure hospitalization.

Results:
A total of 147 patients were included, 90 were males (61%). Mean age was 66 years (+/-15), mean EF was 33% (+/- 15) and mean NYHA class 2.2 (+/- 0.9) at baseline. An ischemic aetiology accounted for 50% of the patients. Mean QRSd was 100 ms (+/- 13) at baseline and 119 ms (+/- 25) at last follow-up, which was a mean of 2.5 years from baseline. Death occurred in 27 patients (18%) and there were 114 hospitalizations in 54 patients. Results of univariate regression analysis are presented in the table.

Conclusion:
An increase in QRSd over time is associated with increased heart failure hospitalizations and all cause mortality in a tertiary care outpatient heart failure population.
Abstract 14298: The Normal Balance Between Antifibrotic Bmp-7 and Profibrotic Tgf-β Signaling is Lost on the Pressure Overload-induced LV Remodeling and Can Be Modified Favorably. A Translational Study
Authors: Nistal Francisco , Merino David , Villar Ana V , Garcia-Lopez Raquel , Tramullas Mónica , Ruiz-Guerrero Luis , Ribas Catalina , Hurle Maria A
Published: July 2021

Introduction:
Cytokynes of the Transforming Growth Factor-β(TGF-β) superfamily are involved in tissue fibrosis: TGF-β promotes fibrosis, whereas Bone Morphogenetic Protein-7 (BMP-7) is antifibrotic. Hypothesis: (i) LV remodeling in the pressure overload condition associates disequilibrium in the cellular signals mediated by these cytokynes; and (ii) BMP-7 exerts beneficial effects on LV remodeling and on reverse remodeling.

Methods:
We studied patients with aortic stenosis (AS; n=45) and surgical controls (n=30), and mice subjected to transverse aortic constriction (TAC; n=24). LV morphology and function were assessed by echocardiography; LV samples were analyzed by qPCR, immunoblotting and histology.

Results:
Pressure overload diminished the expression of BMP-7 and its effectors pSmad1/5/8 and increased the ratio TGF-β/BMP-7 in the LV from AS-patients and TAC-mice. BMP-7 expression correlated inversely with collagens, fibronectin and β-myosin heavy chain, with the degree of hypertrophy, and with the severity of diastolic dysfunction, and directly with systolic function. Multiple linear regression analysis disclosed BMP-7 and TGF-β as predictors, negative and positive, respectively, of hypertrophy. BMP-7 prevented the hypertrophic program elicited by TGF-β in cultured cardiomyocytes, and the transcriptional activation of Col1A1 promoter-luciferase reporter in NIH-3T3 fibroblasts. In TAC-mice, BMP-7 gain-of-function attenuated the development of structural damage and dysfunction, halted ongoing remodeling and facilitated reverse remodeling. BMP-7 loss-of-function exerted opposite effects. Luciferase reporter assays in NIH-3T3 fibroblasts suggested that BMP-7 promoted the transcription of the inhibitory Smad7, who in turn has a repressing effect on TGFβ signaling. Accordingly, in AS-patients and TAC-mice, the LV expressions of Smad7 and BMP-7 correlated directly.

Conclusion:
The disequilibrium between BMP-7 and TGF-β signals plays a relevant role in the pressure overload-induced myocardial remodeling in TAC-mice and AS-patients. We suggest that BMP-7 antagonizes the hypertrophic and profibrogenic effects of TGF-β through a mechanism involving Smad7. Funding: PI12/00999; RD12/0042/0018; RD12/0042/0012.
Abstract 14309: A Novel Fibroblast Activation Inhibitor, NM922, Attenuates Maladaptive Fibrotic Remodeling to Preserve Cardiac Function Following the Onset of Heart Failure
Authors: Bradley Jessica M , Ziblich Craig M , Islam Kazi N , Rushing Amanda M , Polhemus David J , Corral Laura G , Sullivan Robert W , Fung Leah , Chan Kyle W , Swindlehurst Cathy A , Lefer David J
Published: July 2021

Background:
Cardiac fibroblasts are critical mediators of fibrotic remodeling in the failing heart. These maladaptive structural changes can worsen cardiac function accelerating the progression to decompensated heart failure (HF). We investigated the effects of a novel inhibitor of the conversion of normal fibroblast to the myofibroblast phenotype in the setting of pressure overload induced HF.

Methods:
Male C57BL/6J mice (10 wks) were subjected to transverse aortic constriction (TAC; 27 g needle) and NM922 (NovoMedix, LLC50 mg/kg/d i.p.) or VEH (DMSO + HS-15) was administered daily starting at 6 wks post TAC. Echocardiography was assessed at baseline and for 16 wks post TAC. At the 16 wk endpoint, mice were sacrificed and hearts were collected for biochemical and molecular assessment.

Results:
NM922 significantly attenuated TAC-induced left ventricular (LV) dilation at 16 wks post TAC (LVEDD: 3.5 ± 0.1 vs. 4.5 ± 0.2 mm, p < 0.01; LVESD: 2.5 ± 0.2 vs. 3.8 ± 0.3 mm, p < 0.01) compared to VEH. NM922 treated mice displayed reduced wall thickening (LVPWd: 1.0 ± 0.03 vs. 1.2 ± 0.05 mm; p < 0.05) at 10 wks post TAC compared to VEH. LV ejection fraction (LVEF) was preserved in NM922 treated mice at 8-16 wks post TAC compared to VEH (*p < 0.05; **p < 0.001) compared to VEH. Treatment with NM922 resulted in reductions in heart (8.5 ± 0.5 vs. 12.0 ± 0.9 mg/mm; p < 0.01) and lung (8.2 ± 0.3 vs. 11.5 ± 0.6 mg/mm; p < 0.0001) weights compared to VEH. Picrosirius Red staining revealed that NM922 reduced cardiac interstitial collagen volume fraction by 50% (p < 0.05 vs. VEH). Circulating BNP levels trended toward lower (p = 0.08) in the NM922 mice when compared to VEH.

Conclusion:
Chronic treatment with NM922 following the onset of cardiac hypertrophy and HF resulted in attenuated myocardial collagen formation and adverse remodeling with preservation of LVEF. Future studies are aimed at further elucidation of the molecular and cellular mechanisms by which this novel agent protects the failing heart.
Abstract 14326: Inefficient Ventriculoarterial Coupling in Fontan Patients Measured Noninvasively Using Cardiac Magnetic Resonance
Authors: Godfrey Max E , Rathod Rahul H , Keenan Ellen M , Geva Tal , Gauvreau Kimberlee , Powell Andrew J , Prakash Ashwin
Published: July 2021

Introduction:
The ventriculoarterial coupling (VAC) ratio, defined as the ratio of arterial elastance (Ea) to ventricular end-systolic elastance (Ees), reflects the mechanoenergetic efficiency of the cardiovascular system. Extreme high or low values of VAC ratio imply inefficient energy transfer. Despite increasing rates of morbidity and mortality in patients with Fontan circulation, little is known about VAC ratio in this population. We used a previously described cardiac magnetic resonance (CMR) method to assess VAC in a large Fontan cohort and examined its relation to outcomes.

Methods and Results:
We retrospectively measured VAC from CMR and noninvasive blood pressure data on 195 Fontan patients (age 19.6±10.7 years) and 42 controls (age 15.2±2.2 years). VAC was calculated as Ea/Ees (Ea= mean arterial blood pressure (MBP)/ventricular stroke volume; Ees= MBP/end-systolic volume). Compared with controls, Fontan patients had lower body surface area (BSA) adjusted median Ees (1.54 vs. 2.4, p<0.001) and Ea (1.35 vs. 1.48, p=0.01) and a higher median VAC ratio (0.88 vs 0.62, p<0.001) (Figure). After a median follow-up of 4 years (range 1-10), 20 patients reached a composite endpoint of death or heart transplant listing. As seen in the Figure, extreme values of the VAC ratio were associated with higher risk of reaching the endpoint. In a multivariable Cox regression model controlling for EDV/BSA, which has been shown to be a risk factor, being in the highest tertile of the VAC was no longer a risk factor, but patients in the lowest tertile of VAC ratio showed a trend towards being more likely to reach the endpoint (Hazard Ratio 4.06 vs middle tertile, p=0.08).

Conclusion:
In this cohort, Fontan patients demonstrated inefficient VAC as compared with controls. A lower VAC ratio tended to be associated with death or transplantation listing even when controlling for ventricular size. Further investigation of CMR-derived VAC in the Fontan circulation is warranted.
Abstract 14337: Preschool Neurodevelopmental Outcomes in Children With Congenital Heart Disease After Surgical Palliation
Authors: Brosig Cheryl , Bear Laurel , Allen Sydney , Carrig Molly , Mussatto Kathleen
Published: July 2021

Introduction:
Children with congenital heart disease (CHD) are at risk for neurodevelopmental (ND) delays. The American Heart Association (AHA) recommends serial ND evaluation for children with CHD. This study reports preschool ND testing results of children with CHD.

Methods:
Children with CHD meeting the AHA high-risk criteria for ND delay were referred for evaluation at 4-5 years of age. Testing included standardized neuropsychological measures. Parents completed measures of adaptive behavior, emotional functioning, social skills, attention, language, family functioning and child quality of life (QOL). Patient scores and parent ratings were compared to test norms and were classified as: average (within one SD of test mean); at risk (1-2 SDs from the test mean); and impaired (>2SD from test mean). T-tests were used to compare scores based on cardiac anatomy (1V vs. 2V).

Results:
Data on 102 consecutively referred patients were analyzed. Median age at first cardiac operation was 13 days. Mean age at testing was 4.5 years (range 4 to 5.9). Patients had the following characteristics: 1V anatomy 33%; male 63%; prenatal diagnosis 54%; premature 16%; non-white/Hispanic race 16%; and comorbidities: medical 26%, genetic 17%. ND test scores were lower than norms for IQ, pre-spelling, visual-motor, fine motor, adaptive behavior, and social skills, and higher than norms for attention problems; however, means were within one SD of norms for all measures. ND scores did not differ based on cardiac anatomy (1V vs. 2V); however, parents of children with 1V reported lower child QOL scores and worse family functioning than parents of children with 2V (p<0.05). The % of children within the normal, at risk, and impaired range on ND measures is presented in the figure.

Conclusion:
ND outcome for preschool aged children identified more delays than expected in some areas. Most deficits were mild and may not be detected without formal testing. ND outcome was not related to cardiac anatomy.