bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P265: Sex Differences in the Mediation of Relationship Between Depression and Nonadherence by Self-Efficacy
Authors: Peacock Erin , Williams LaKeisha , Muntner Paul , Morisky Donald , Krousel-Wood Marie
Published: March 2022

Purpose:
We tested for sex differences in how self-efficacy explains the relationship between incident depressive symptoms and incident low adherence using data from the Cohort Study of Medication Adherence among Older Adults (CoSMO).

Methods:
A telephone survey was administered to hypertensive older adults three times at yearly intervals. Depressive symptoms were defined as a score ≥16 on the Center for Epidemiologic Studies Depression Scale. Low adherence was defined as a score <6 on the 8-item Morisky Medication Adherence Scale. Item scores on the 26-item Medication Adherence Self-Efficacy Scale were summed to create a self-efficacy score. Analysis was restricted to those without low adherence or depressive symptoms at baseline (n=1478). Mediation of the relationship between incident depressive symptoms and incident low adherence between baseline and first follow-up by self-efficacy at first follow-up was assessed using Baron & Kenny’s procedures, modified to test for sex differences.

Results:
The sample was 58% female and 28% black, with a mean age of 75.2 years. The incidence of depressive symptoms and low adherence were 7.7% and 7.2%, respectively. The indirect effect (IE) – the portion of the effect of incident depressive symptoms on incident low adherence that is explained by self-efficacy - was significant for women (IE=0.029 95% CI 0.005, 0.068), such that 34.1% of the total effect of incident depressive symptoms on incident low adherence was explained by self-efficacy. The IE for women was significantly different from that for men (IE=-0.003 95% CI -0.019, 0.006). The direct effect of incident depressive symptoms on incident low adherence – the portion of the effect that is not explained by self-efficacy – was significantly different for women and men (direct effect (DE)=0.056 95% CI -0.082, 0.155 and DE=0.205 95% CI 0.060, 0.323, respectively).

Conclusions:
Self-efficacy explains some of the relationship between incident depressive symptoms and incident low adherence for women, but not for men.
Abstract P296: Dietary Habits in Primary Care Patients with Recent Intentional Weight Loss
Authors: Barone Gibbs Bethany , Tudorascu Dana , Bryce Cindy , Comer Diane , Fischer Gary , Hess Rachel , Huber Kimberly A , McTigue Kathleen M , Simkin-Silverman Laurey R , Conroy Molly B
Published: March 2022

Introduction:
Primary care physicians are uniquely positioned to provide counselling for weight loss, yet lifestyle habits of primary care patients with recent, intentional weight loss are unclear. Our objective was to characterize diet and exercise habits in primary care patients with recent, intentional weight loss, comparing those with greater (≥10%) to those with lesser (5 to <10%) weight loss.

Methods:
This cross-sectional analysis of baseline data from a weight loss maintenance clinical trial in a primary care setting included patients,18-75 years old, with ≥5% intentional weight loss via lifestyle change in the past 2 years. Recent weight loss was confirmed with medical records. Dietary habits were measured by the Connor Diet Habits Survey.

Results:
Participants (n=192, 74% female, 87% white) had mean (SD) age 53 (12) years, body mass index 30.4 (5.9) kg/m
2
, and recent weight loss of 11 (8) %. Participants had a high burden of comorbidities: high blood pressure (50%), dyslipidemia (43%), diabetes (14%), and cardiovascular disease (10%). Participants reported high median intake of fruits and vegetables (5 servings/day), and low intake of fried foods (1 servings/wk), desserts (1 serving/wk) and sugar-sweetened beverages (0 serving/wk) (see
Table)
. Participants ate at restaurants on average twice/wk and most drank skim milk. Those with greater weight loss had higher intakes of fruits and vegetables (p=0.04) and low fat foods/recipes (p=0.02); other dietary habits were not related to amount of recent weight loss (see
Table
).

Conclusions:
Despite the plethora of studies that support and refute a variety of dietary recommendations to promote weight loss, dietary habits in primary care patients with a high burden of comorbidities and recent, intentional weight loss were consistent with conventional wisdom including: more fruits and vegetables, limited added sugars, and more low fat foods and recipes. Future research should test the effects of this eating pattern in a primary care setting for weight loss and maintenance.
Abstract P310: Effect of Static Stretching Exercise on Aortic Pulse Wave Velocity
Authors: Logan Jeongok G , Kim Suk-Sun , Lee Mijung , Yeo SeonAe
Published: March 2022

Introduction:
Large-artery stiffness (i.e., aortic stiffness) is an independent predictor of hypertension which is a leading cause of excess cardiovascular morbidity and mortality. Carotid-femoral pulse wave velocity (cf-PWV) is considered the ‘gold-standard’ measure of arterial stiffness because it measures along the aorto-iliac pathway, which buffers blood pressure (BP) the most. While there is well-documented evidence on the health benefits of aerobic and resistance exercise, the information for the effect of stretching on aortic stiffness is limited. Previous studies have shown that arterial stiffness is associated with trunk flexibility. Stretching exercise targeted to improve flexibility may exert a beneficial effect on reducing aortic stiffness.

Objectives:
This study aimed to examine effects of a single bout of a structured static stretching exercise on aortic stiffness as well as trunk flexibility, blood pressure (BP), and heart rate (HR).

Method:
This study has a pretest-postest design without a control group. Thirty healthy women from the community were instructed to follow a video demonstration of a structured whole-body static stretching lasting 30 minutes. Each stretching was designed to improve range of motion and enhance flexibility in 10 body areas, and all stretching motions were performed in the sitting position. Aortic stiffness was measured by cf-PWV using the SphygmoCor system (AtCor medical, AU). Trunk Flexibility was measured by the sit and reach method. BP and HR were measured using the WelchAllyn Monitor (WelchAllyn, USA).

Results:
After stretching exercise, cf-PWV (m/s) was significantly reduced (M=6.93, SD=1.54 vs M=6.29, SD=1.17; t(29)=2.708, p =.011). In addition, HR (bpm) was significantly decreased (M=64.88, SD=6.29 vs M=61.77, SD=6.29; t(29) = 7.170, p=.000). A significant increase of lumbar flexibility (inches) was also detected (M=13.37, SD=4.3 vs M=16.45, SD=4.79; t(29) = 12.248, p=.000). Systolic BP and diastolic BP (mmHg) were decreased after stretching exercise from M=107.87 (SD 10.75) to M=106.82 (SD 12.48), from M=63.37 (SD 6.71) to M=61.88 (SD 6.47), respectively; however, the differences did not reach the statistical significance.

Conclusions:
Findings of the current study highlight the potential benefit of static stretching exercise on aortic stiffness independent of BP. The results also demonstrate that HR was significantly decreased after the stretching exercise. Given no sign of over-activity of sympathetic function, a structured static stretching exercise may be prescribed as an effective intervention to reduce aortic stiffness for the people with high risk of cardiac events. In addition, stretching motions that were conducted in the sitting position can be cautiously utilized as an effective intervention for stroke patients, post-surgery patients, and people who have unsteady walking.
Abstract P319: Do Pregnancy Complications Elevate Cardiovascular Risk After Pregnancy? An Examination of Cardiometabolic Biomarker and Risk Factor Trajectories Up to the First Nine Months Postpartum in Low Income Women
Authors: Parikh Nisha I , Laraia Barbara , Nah Gregory , Singhal Meghali , Vittinghoff Eric , Coleman-Phox Kimberly , Adler Nancy , Albert Michelle A , Epel Elissa
Published: March 2022

Introduction:
Preeclampsia, having a small for gestational age (SGA) baby or preterm delivery are associated with later maternal cardiovascular disease (CVD) risk. Therefore, we sought to examine whether peripartum CVD biomarker and risk factor trajectories differed among women with and without CVD-related pregnancy complications.

Methods:
In the Maternal Adiposity Metabolism and Stress (MAMAS) Study, we studied n=110 overweight and obese women in the MAMAS study of 8-week mindful eating and stress reduction intervention, we used mixed linear regression analysis to compare trajectories of CVD risk factors at three periods: 1) intrapartum at 12-20 weeks gestation, 2) 3 months postpartum, and 3) 9 months postpartum. CVD biomarkers/ risk factors studied included serum glucose, insulin, HOMA-IR, leptin, ghrelin, lipids, ALT, IL-6, IL-10, tumor necrosis factor, and blood pressure (BP). Covariates for multivariable adjustment included age, maternal smoking, prepregnancy BMI, BP, age*time and prepregnancy BMI*time.

Results:
Women had mean age =28 y (SD 6), mean prior pregnancies=0.8 (SD 1.0), 13% were White, 36% African American and 32% Latina; n=22 women had one or more CVD-related pregnancy complications. Peripartum glucose and systolic BP trajectories were statistically greater in complicated versus normal pregnancies (p values=0.008 and 0.01 respectively) (
Figure
). Trajectories for lipids, insulin, HOMA-IR, adipokines, ALT, IL-6 and diastolic BP were elevated in complicated versus normal pregnancies, but did not reach statistical significance.

Conclusions:
Glucose and systolic BP rise were significantly higher from early pregnancy to 9 months postpartum among low income women with complicated vs. uncomplicated pregnancies. Cardiometabolic risk factor modification among women with CVD-related pregnancy complications in the peripartum period may be warranted.
Abstract P325: Utilization of Cardiac Rehabilitation in Eligible Medical Cardiac Patients
Authors: Larsen Timothy R , McMunn Jedediah , Gohar Salman , Austin Joseph L
Published: March 2022

Introduction:
Cardiac rehabilitation (CR) is recommended for patients who suffer an acute coronary syndrome (STEMI, non-STEMI, or unstable angina), stable angina, or who receive a percutaneous coronary intervention (PCI). CR reduces both all-cause and cardiovascular mortality and reduces hospitalizations. Despite these benefits the rate of participation among eligible patients in the United States is low- estimated around 20%. Our aim is to identify the rate of participation among our patients, identify patient subsets with low levels of participation, and to identify and remove barriers to participation.

Methods:
We performed a review of all patients treated at a tertiary care hospital from February 2014 to January 2015 with a condition that qualifies for CR based on current ACC/AHA guidelines. We excluded patients with a surgical indication. We limited our search to patients residing in zip codes within 40 miles of a CR facility within our hospital system (five centers in southwest Virginia). Patients were considered to have participated in CR if they attended at least 1 session of phase two CR occurring within 1 year of hospitalization.

Results:
We identified 1910 eligible patients, of these 249 (13%) participated in cardiac rehabilitation. Those who participated in CR tended to be younger (mean age 65 versus 70 years), male (71% versus 59%), and nonsmokers (smoking rate 19% in participants versus 25% in nonparticipants). Those with ACS were most likely to participate (167 of 879 eligible patients, 19%), followed by stable angina (19 of 134, 14%) and PCI (63 of 897, 7%).

Conclusion:
The benefits of CR are substantial including enhanced quality of life and improved survival. We believe all eligible patients should be encouraged to participate in CR. The next phase of our analysis will include identification and removal of barriers to participation. We are actively educating providers on patient eligibility and the benefits of CR with an emphasis on underrepresented demographics (women, elderly, smokers, after PCI, etc).
Abstract P329: Educational Attainment and Lifetime Risk of Cardiovascular Disease: the Atherosclerosis Risk in Communities Study
Authors: Kubota Yasuhiko , Heiss Gerardo , MacLehose Richard F , Roetker Nicholas S , Folsom Aaron R
Published: March 2022

Background:
Estimates of lifetime risk may help raise awareness of the extent to which educational inequalities affect risk of cardiovascular disease (CVD). To date, no study has reported the lifetime risk of CVD according to categories of educational attainment.

Objectives:
To estimate the lifetime risk of CVD from 45 through 85 years according to educational attainment.

Methods:
We followed 13,948 whites and African Americans initially free of CVD from 1,987 through 2,013, and used a life table approach to estimate lifetime risks of life-threatening CVD events (coronary heart disease, heart failure and stroke) according to educational attainment (grade school, high school without graduation, high school graduation, vocational school, college with or without graduation, and graduate/professional school). We adjusted for competing risks of death from underlying causes other than CVD.

Results:
During the 269,210 person-years of follow-up, we documented 4,512 CVD events, and 2,401 non-CVD deaths. Educational attainment displayed an inverse dose-response relation with cumulative risk of CVD, which became evident in middle-age, with the most striking gap between those not completing versus completing high school. Lifetime risk estimates of CVD from age 45 years though 85 years were 55.0% (95% confidence interval, 51.4-58.6) for grade school, 50.5% (47.3-53.3) for high school education without graduation, 41.7% (39.5-43.8) for high school graduation, 39.7% (35.5-43.4) for vocational school, 39.2% (36.4-41.4) for college with or without graduation, and 36.1% (31.9-39.7) for graduate/professional school. For both men and women, and whites as well as African Americans, those who did not graduate from high school had a sizably higher lifetime CVD risk. There was a similar pattern for cumulative CVD risk to 65 years. Lower family income and parental educational attainment were also associated with greater lifetime CVD risk, but individuals with more than a high school education had a lower lifetime risk than those with less educational attainment, regardless of their income or parental educational attainment.

Conclusions:
Educational attainment was inversely associated with the lifetime risk of CVD, and cumulative risk differences were already evident during middle-age, suggesting that greater educational attainment might promote lower lifetime risk of CVD.
Abstract P330: Childhood Material Deprivation and Self-reported, Physician-diagnosed Myocardial Infarction in a Southern Cohort of Middle-aged African American Men and Women
Authors: Barrington Debbie S , James Sherman A
Published: March 2022

Introduction:
The antecedents of cardiovascular disease occur early in life. However, most studies reporting associations between childhood social conditions and adult myocardial infarction (MI) have been conducted on European and US white populations.

Hypothesis:
We hypothesized that adverse childhood social conditions would be associated with increased risk for MI in a Southern cohort of middle-aged African American men and women.

Methods:
Multiple logistic regression models were used to investigate sex-specific associations between childhood material deprivation and 13 year incidence of self-reported-physician diagnosed MI among 413 Black men and 754 Black women in the Pitt County (NC) Study. Cohort members were aged 25 to 50 years in 1988, the baseline year, and were re-interviewed in 2001. For this study, childhood was defined as birth to age 13 years; and childhood material deprivation was measured by a composite index of receipt of public assistance, food insecurity, and the lack of household heat, electricity, or plumbing. Odds ratios (OR) of the association between childhood material deprivation and adult MI were estimated after adjusting for both childhood and adulthood socioeconomic position, demographics, lifestyle, co-morbidities and psychosocial factors. For women, menopausal status was also controlled.

Results:
Men exposed to 1-2 types of childhood material deprivation had 38% lower odds of MI than men unexposed to such deprivation during childhood, OR = 0.62; 95%CI: (0.41, 0.92). However, men exposed to 3+ types of material deprivation during childhood were 3 times more likely to report a physician-diagnosed heart attack than men who were unexposed, OR = 3.07; 95%CI: (1.79, 5.29). No difference in 13 year MI risk was observed between women exposed to 1-2 types of childhood material deprivation and women who were unexposed, OR = 1.23; 95%CI: (0.70, 2.16). However, women exposed to 3+ types of early-life material deprivation were 5 times more likely to report a physician-diagnosed MI compared to women who were unexposed, OR = 5.20; 95%CI: (2.58, 10.48).

Conclusions:
Our findings suggest that early childhood is a sensitive period wherein severe socioeconomic disadvantage may trigger, or exacerbate, biological processes that increase risk of MI, by middle age, in African American men and women.
Abstract P347: The Relationship Between Renal Artery Calcium and Kidney Function: the Multi-Ethnic Study of Atherosclerosis
Authors: Vashishtha Devesh , McClelland Robyn , Ix Joachim , Rifkin Dena , Jenny Nancy , Allison Matthew
Published: March 2022

Background:
Renal Artery Calcium (RAC) has been shown to be associated with a higher odds of hypertension (HTN). The purpose of this study was to determine if the presence and extent of RAC is associated with significant differences in several measures of kidney function.

Methods:
We analyzed cross-sectional data from the Multi-Ethnic Study of Atherosclerosis (MESA). During MESA follow-up visits 2 and 3, a random subsample of 1226 participants underwent computed tomography (CT) of the abdomen and also had venous blood samples assayed for kidney function. RAC was the primary predictor variable and the following measures of kidney function were the outcome variables: eGFR, cystatin-C, micro and macroalbuminuria and CKD stage. CKD stage was divided into the following groups: stage 1 GFR < 90mL/min, stage 2 GFR 60-89 mL/min, stage 3A GFR 45-59 mL/min, and stage 3B GFR 30-44 mL/min. There were no study participants in the stage 4 category of GFR < 30mL/min. The analyses were adjusted for age, gender, race, height, visceral fat, dyslipidemia, diabetes, cigarette smoking, hypertension, interleukin-6 (IL-6), coronary artery calcium (CAC), abdominal aortic calcium (AAC), renin and aldosterone.

Findings:
The average age of this cohort was 66.1 years (SD 9.7) and 44.8% (549 of 1226) were male, 36.3% (445 of 1226) Caucasian, 14.1% (173 of 1226) Chinese-American, 21.6% (265 of 1226) African-American and 28.0% (343 of 1226) Hispanic-American. Compared with those with no RAC, those with RAC > 0 were significantly older but not different by gender or race. After adjustment for age, sex and race, those with RAC > 0 had significantly higher visceral fat, were more likely to have dyslipidemia, diabetes and hypertension, had a higher IL6, and a higher prevalence of CAC and AAC > 0.

In fully adjusted multivariable linear regression models, the presence of RAC was associated with higher creatinine (β = 0.052, p = 0.01) and Cystatin-C (β = 0.052, p < 0.01), as well as a lower eGFR (β = -2.209, p = 0.06). In logistic regression, the presence of RAC was also associated with albuminuria but after adjustment for cardiovascular risk factors including dyslipidemia, diabetes, smoking and hypertension, this association was no longer significant. In fully adjusted ordinal logistic regression, RAC as a continuous variable was associated with increased odds of being in a higher CKD category (β = 1.14, p = 0.05).

Discussion:
Our results suggest a modest relationship between RAC and kidney function, when measured by creatinine, Cystatin-C, eGFR and CKD stage. As such, the identification of RAC on abdominal CT scans obtained as part of clinical practice may be considered in the prevention of chronic kidney disease.
Abstract P349: Kidney Function Modifies the Positive Association of Troponin With 30 Day Mortality After Myocardial Infarction
Authors: Honerlaw Jacqueline P , Ho Yuk-Lam , Gagnon David R , Nguyen Xuan-Mai , Song Rebecca J , Vassy Jason L , Gaziano J M , Cho Kelly , Djousse Luc , Wilson Peter W
Published: March 2022

Introduction:
Increased levels of cardiac troponin at the time of myocardial infarction (MI) have been shown to predict mortality. However, troponin is renally cleared and kidney function itself impacts mortality. We tested the hypothesis that baseline kidney function modifies the relationship between peak cardiac troponin I ratio (cTnI-R) and 30 day mortality after MI.

Methods:
Data from the Veterans Health Administration was used to create a national sample of hospitalized Veterans with a discharge diagnosis of MI between 2002 and 2015. The peak cTnI-R, calculated as the highest cTnI during the hospitalization compared to the upper limit of normal for each assay, was used as a proxy for the date of the MI event. Veterans with a history of cancer or blood vessel surgery 5 days before peak cTnI were excluded. The closest estimated glomerular filtration rate (eGFR) measured within 2 years prior to hospital admission was used as a marker of baseline kidney function.

We created quartiles of peak cTnI-R and clinically relevant levels of eGFR (<30, 30-44, 45-59, and 60+ ml/min/1.73 m
2
) and fitted Cox regression adjusting for calendar year, age, length of hospital stay, region, diabetes, major mental health conditions and baseline use of diuretics, anti-hypertensives and anti-lipemics. We used subjects in the first quartile of troponin with eGFR of 60+ as common reference.

Results:
Among 56,073 Veterans hospitalized for MI, mean age was 67 and 98% were men. During 28 days mean follow up, 4,533 deaths occurred. 30 day mortality steadily increased across quartiles of peak cTnI-R; however, the increase in mortality was higher in eGFR below 30, suggesting effect modification of troponin-mortality relation by eGFR (p for interaction between eGFR and troponin 0.03) (Figure).

Conclusions:
Our data show that the positive relation of troponin with 30 day mortality post MI is modified by kidney function. Veterans with impaired kidney function carry a higher risk of 30 day mortality after MI compared to those with normal eGFR for a given troponin quartile.
Abstract P351: Remnant Cholesterol and Cardiovascular Disease Outcomes in Chronic Kidney Transplant Recipients
Authors: Merhi Basma , Shireman Theresa , Jacques Paul , Pesavento Todd , Kim Joseph , Carpenter Myra , Kusek John , Bostom Andrew
Published: March 2022

Remnant cholesterol (RC) is the cholesterol content of circulating triglyceride-rich lipoproteins. Studies employing a simple calculation of RC from routine lipid/lipoprotein measures have demonstrated associations between RC levels and cardiovascular disease (CVD) outcomes in both observational study, and lipid lowering clinical trial cohorts. There are no published data evaluating the potential relationship between remnant cholesterol and CVD in chronic kidney transplant recipients [KTRs], a population with excess risk for fatal and non-fatal CVD. RC was calculated, using non-fasting plasma samples, as total cholesterol - [HDL cholesterol + LDL cholesterol] in n=3002 FAVORIT trial [NCT00064753] participants at randomization (mean 37.6, standard deviation ± 21.3, range 4-230 mg/dl). During a median follow-up of 4.0-years, the cohort experienced n=419 CVD outcomes [myocardial infarction, stroke, resuscitated sudden death, CVD death, and CVD procedural events, pooled]. Multivariable logistic regression modeling revealed that each 10 mg/dl increase of RC conferred a 16.4% increase [95% CI, 3.6-30.8%] in CVD risk adjusted for age, baseline CVD, diabetes, smoking, race, sex, body-mass index, LDL, HDL, natural log triglycerides, estimated glomerular filtration rate, natural log urinary albumin/creatinine, type of kidney graft, graft vintage, and the use of calcineurin inhibitors, steroids, or lipid lowering drugs. Given the residual risk for CVD after recommended LDL levels are achieved, these data suggest that interventions [i.e., such as eicosapentaenoic acid ethyl ester, which can lower RC by ~25-30%;
Atherosclerosis
2016; 253: 81-87] targeting elevated RC concentrations in KTRs, merit consideration.
Abstract P369: Hepatocyte Growth Factor is Positively Associated With Progression of Atherosclerosis: the Multi-Ethnic Study of Atherosclerosis
Authors: Bell Elizabeth J , Decker Paul A , Stein James H , Tsai Michael Y , Pankow James S , Hanson Naomi Q , Wassel Christina L , Larson Nicholas B , Cohoon Kevin , Budoff Matthew , Polak Joseph F , Bielinski Suzette J
Published: March 2022

Introduction:
Hepatocyte growth factor (HGF) is released in response to endothelial injury, and higher levels of circulating HGF are associated with atherosclerosis. However, the association of HGF with atherosclerosis progression is unknown.

Hypothesis:
Circulating HGF is positively associated with atherosclerosis progression, measured as progression of 1) carotid artery plaque and 2) coronary artery calcium (CAC).

Methods:
The Multi-Ethnic Study of Atherosclerosis is a large, population-based cohort study of adults aged 45-84 and free of clinical cardiovascular disease. Participants had HGF measured in serum at baseline (2000-02), and were followed for progression of carotid plaque and CAC through 2012. We defined CAC and carotid plaque progression as dichotomous variables (progression, no progression). Carotid plaque progression is an increase in the number of carotid plaques. We used the Hokanson method to define CAC progression as an increase of ≥ 2.5 mm
3
in the square root-transformed calcium volume score. Relative risk regression quantified the association between HGF and carotid plaque progression. Cox regression models using inverse-probability-of-attrition weights estimated the association of HGF with progression of CAC. All effect estimates are adjusted for potential confounding variables.

Results:
The cohort included 6714 Americans with HGF measurements: 2593 non-Hispanic white, 797 Chinese, 1848 black, and 1476 Hispanic Americans. In 3363 participants with measurements for both carotid plaque and HGF, each standard deviation (259 pg/ml) increase in HGF was associated with a 4% greater risk (95% CI: 1.01-1.07) of carotid plaque progression (n=1875), which did not differ by race/ethnicity (interaction p = 0.3). Out of 6714 participants with measurements for both CAC and HGF, 2994 had CAC progression during follow-up. The association of HGF with CAC progression differed by race/ethnicity (interaction p = 0.01). Each standard deviation increase of HGF was associated with a 10% greater risk of CAC progression in non-Hispanic white (95% CI: 1.05-1.16) and black Americans (95% CI: 1.03-1.17), while HGF was not associated with CAC progression in Chinese (p = 0.5) nor Hispanic (p = 0.7) American participants.

Conclusions:
Circulating HGF was associated with a modestly increased risk of atherosclerosis progression in this large and diverse population, with the strongest associations between HGF and CAC progression in non-Hispanic white and black Americans. Our results suggest that HGF may have utility as a marker of atherosclerosis progression in some populations.
Abstract 20897: Patient-Reported Outcomes in Tetralogy of Fallot: Baseline Results From a Prospective, International, Multi-Site Study
Authors: Wald Rachel M , Farkouh Michael , Caldarone Christopher , Dahdah Nagib , Dallaire Frédéric , Drolet Christian , Grewal Jasmine , Hickey Edward , Kayedpour Camilla , Khairy Paul , Leonardi Benedetta , McCrindle Brian , Nadeem Syed Najaf , Ng Ming Yen , Oechslin Erwin , Redington Andrew , Silversides Candice , Tham Edythe , Therrien Judith , Vonder Muhll Isabelle , Warren Andrew , Wintersperger Bernd , Kovacs Adrienne
Published: March 2022

Introduction:
In addition to understanding causes of morbidity and mortality following tetralogy of Fallot repair (rTOF), the importance of patient-reported outcomes (PROs) such as quality of life (QOL) is increasingly being recognized.

Hypothesis:
We hypothesized that PROs in rTOF would be associated with selected sociodemographic factors, functional status, and/or clinical variables.

Methods:
As part of a prospective study of patients ≥12 years with rTOF and significant pulmonary regurgitation, participants completed PRO surveys: SF-12 Health Status (physical component summary [PCS] and mental component summary [MCS] t-scores), EQ-5D (5 dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), and a 0-100 QOL linear analogue scale (QOL-LAS). With multivariable regression analysis, we determined the association between PROs and selected predictors.

Results:
We studied n=627 participants (55% male, 26±13 years, 75% adult) at 14 sites (North America, Europe and Asia). Median age at repair was 1.6 years (IQR 0.6, 4.2). In general, scores on the SF-12 and QOL-LAS suggested good outcomes: SF-12 PCS <18 years 52±6 and ≥18 years 51±9; SF-12 MCS <18 years 52±9 and ≥18 years 49±10; QOL-LAS <18 years 83±14 and ≥18 years 78±16. On the EQ-5D, difficulties were reported with usual activities (16%), pain (25%) and anxiety/depression (38%). In multivariable regression analysis, younger age at enrollment emerged as an independent predictor of better physical health status and worse mental health status (p=0.0005 and p=0.029, respectively), but not QOL. Better NYHA functional class was a predictor of better SF-12 PCS and MCS (p<0.0005 and p=0.002) as well as better QOL (p<0.0001). Other factors (including complexity of underlying TOF anatomy, previous shunt palliation and need for arrhythmia intervention) were not associated with PROs.

Conclusions:
Age and NYHA functional class at enrollment were found to be predictors of PROs in rTOF. While global measures of health status and QOL (SF-12 and QOL-LAS) suggest relatively good PROs, this study demonstrates the importance of inquiring about specific health problems (EQ-5D) to achieve a richer understanding of PROs in order to potentially maximize patient well-being.
Abstract 20900: Exercise Training Fails to Improve Cardiac Dysfunction in DNA Repair-Deficient Xpg Mice
Authors: de Boer Martine , te Lintel Hekkert Maaike , de Kleijnen Marion G , Merkus Daphne , Hoeijmakers Jan H , Duncker Dirk J
Published: March 2022

Background & Hypothesis:
The exact molecular mechanisms underlying the pathogenesis of heart failure (HF) remain incompletely understood hampering a more mechanism-based approach to effective treatment and prevention. Every cell contains DNA repair systems to protect against DNA damage-induced cancer and aging-related diseases. Evidence indicates that DNA damage is associated with heart failure. Physical activity is beneficial for maintaining and improving cardiac function. Therefore we hypothesized that voluntary wheel running (EX) would ameliorate cardiac function in cardiomyocyte-specific DNA repair-deficient
Xpg
mice.

Methods:
αMHC-Xpg

c/-

and wildtype (WT) mice were exposed to 11 wks of sedentary housing (SED) or EX, resulting in 4 groups;
αMHC-Xpg

c/-

SED (n=12), WT SED (n=10),
αMHC-Xpg

c/-

EX (n=16) and WT EX (n=13). At age 16 wks, left ventricular (LV) function was assessed using echocardiography and hemodynamic measurements.

Results:
Cardiomyocyte-specific inactivation of
Xpg
resulted in systolic as well as diastolic dysfunction, demonstrated by decreases in fractional shortening (23±2 vs. 39±2 %), LV systolic pressure (82±4 vs. 91±3 mmHg), LV dP/dt at 30 mmHg (5240±350 vs. 7480±440 mmHg/s) and LV dP/dtmin (-6740±830 vs. -10890±780 mmHg/s; all p<0.05). In addition, LV end-diastolic lumen diameter (LVEDD) was markedly increased (3.9±0.1 vs. 3.0±0.1 mm; p<0.05). Total running distance was indistinguishable between
αMHC-Xpg

c/-

EX and WT EX (881±61 vs. 856±39 km resp.). Global LV function was unaffected by EX in WT mice. Contrary to our hypothesis, LV remodeling and dysfunction tended to aggravate by EX in
αMHC-Xpg

c/-

mice, as evidenced by further increases in LVEDD (4.2±0.1 vs. 3.9±0.1 mm; p<0.05) and relaxation time constant tau (19.2±2.6 vs. 13.6±2.9 ms; p<0.06).

Conclusion:
Although,
αMHC-Xpg

c/-

mice display a cardiac phenotype which is largely similar to mice subjected to MI and we have previously shown exercise improves LV remodeling and dysfunction after MI, exercise failed to ameliorate LV remodeling and dysfunction associated with cardiomyocyte-restricted loss of DNA-repair protein Xpg.
Abstract 20906: Prognosis in Heart Failure: A TNM-Like Classification for Risk Stratification
Authors: Alfarano Maria , Severino Paolo , Pucci Mariateresa , Mancini Ilaria , Ferrari Ilaria , Peroni Stefano , Calcagno Simone , Fusto Antonio , Alunni Fegatelli Danilo , Vestri Annarita , Sciomer Susanna , Mancone Massimo , Fedele Francesco
Published: March 2022

Introduction:
NYHA is the most used classification for heart failure (HF), but it does not include patient’s clinical features. We proposed a new staging system for HF, named HLM (JACC 2014;20;63(19):1959-60), analogous to the TNM classification used in Oncology. HLM refers to heart damage (H), lung involvement (L), and malfunction (M) of peripheral organs (i.e. kidney, liver, hematopoiesis and central nervous system).

Hypothesis:
The aim was a preliminary comparison between HLM and NYHA at 6 and 12 months to assess the most accurate prognosis of HF patients in terms of rehospitalization for major adverse cardiovascular and cerebrovascular events (MACCE) and mortality.

Methods:
We enrolled 1064 consecutive patients with the diagnosis of or at risk for HF. According to HLM classification, all parameters for heart, lungs and peripheral organs function were collected and each patient was classified according to NYHA and HLM. At 6 and 12 months patients were followed up for rehospitalization for MACCE and cardiac death rates were calculated.

Results:
At 6 and 12 months follow-up, comparing to NYHA, HLM showed a greater area under the ROC curve (AUC) for rehospitalization as well as for cardiac death (Fig. 1). MACCE and cardiac death rates have been assessed separately for each parameter (H, L and M): L and M showed the most accurate prognostic power; at 1 year follow-up, L2 was significantly correlated (p=0.004) with rehospitalization as well as L3 (p=0.000), M1 (p=0.004), M2 (p=0.008) and M3 (p=0.003). M2 was significantly correlated (p=0.02) with cardiovascular mortality as well as M3 (p=0.004 ).

Conclusions:
Our preliminary data suggest that, compared to NYHA, HLM better stratifies risk of rehospitalization for MACCE and of cardiac death in HF patients. Regarding HLM, lung involvement (L2-3) and two or more organs dysfunction (M2-3) presented the most accurate prognostic power. Those preliminary results need to be confirmed in a greater population with a longer follow up.
Abstract 20911: Outcomes Among Patients With Heart Failure With Reduced Ejection Fraction Undergoing TAVR via the Minimalist Approach vs Conventional Approach
Authors: Panhwar Muhammad S , Patel Toral , Lipinski Jerry , Ladas Thomas , Patel Sandeep , Attizzani Guilherme
Published: March 2022

Introduction:
Patients who undergo transcatheter aortic valve replacement (TAVR) for severe, symptomatic aortic stenosis frequently have heart failure with reduced ejection fraction (HFrEF). TAVR is usually performed via the conventional approach (CA) in a hybrid OR under general anesthesia with transesophageal echocardiographic guidance. We utilize a cost-effective minimalist approach (MA), whereby TAVR is performed in a standard catheterization lab, with local anesthesia, conscious sedation and a surface echocardiogram, thus reducing invasiveness and the hemodynamic burden of general anesthesia. There are scant data on outcomes of HFrEF patients undergoing TAVR via MA vs CA.

Hypothesis:
We hypothesize that HFrEF patients undergoing TAVR via the MA approach have similar or better outcomes compared to those done via CA due to the reduced invasiveness and exposure to anesthesia in the MA approach.

Methods:
We retrospectively assessed 608 patients undergoing transfemoral TAVR at our institution. 174 patients had HFrEF (defined as pre-TAVR EF <50%). 34 patients underwent TAVR via CA while 140 patients underwent TAVR via MA. These patients were followed for 1 year. Primary outcome was survival at 1 year. Secondary outcomes were heart-failure and all-cause readmissions at 1 year. Outcomes were defined per the Valve Academic Research Consortium-2 (VARC-2) consensus statement.

Results:
Of the 174 patients studied, the median age was 83 years (77-87), Society of Thoracic Surgery score of 8 (5-12), and 67% were male. At 1 year, there were no significant differences in mortality (CA 24% vs MA 26%; P=0.308, Fig 1), heart failure readmissions (CA 29% vs MA 29%; P=0.419), or all-cause readmissions (CA 41% vs MA 36%; P= 0.692).

Conclusion:
We show that in patients with HFrEF, TAVR via the MA does not have worse outcomes compared to CA. TAVR via MA may be a viable cost-effective alternative in patients at risk for hemodynamic alterations from general anesthesia exposure.
Abstract 20912: The Impact of Mitral Valve Disease on Atrial Fibrillation Ablation Outcome
Authors: Kheirkhahan Mobin , Baher Alex , Siebermair Johannes , Kaur Gagandeep , Steinberg Benjamin A , Han Frederick T , Chelu Mihail G , Marrouche Nassir F
Published: March 2022

Introduction:
Mitral Valve Disease (MVD) is associated with atrial fibrillation (AF) and can worsen its prognosis. Left Atrial (LA) fibrosis is a known substrate for AF and its extent affects the management.

Hypothesis:
We hypothesize MVD increases LA fibrosis in AF patients and the chance of AF ablation failure. Secondly, even in patients with low levels of LA fibrosis that are optimal candidates for ablation, presence of MVD still worsens the outcome.

Methods:
Patients were categorized in two groups: 140 patients had coexisting MVD and AF, and 100 patients AF without MVD. MVD was defined as any dysfunctionality of mitral valve including mitral stenosis, mitral regurgitation, and history of previous mitral valve surgery . LA fibrosis was quantified by Late Gadolinium Enhancement MRI (LGE-MRI). Baseline characteristics were gathered through chart reviewing. Following ablation, patients were followed for median of 71 months for AF recurrence.

Results:
Patients were 76.4 ± 10.7 years of age in MVD+AF group and 64.2 ± 14.7 in AF group
(p
< 0.0001). Extent of LA fibrosis was 18.1% ± 9.3 and 10.3% ± 5.3 in MVD+AF and AF group, respectively
(p
< 0.0001). The result of our statistical model adjusted for possible cofounders showed that coexistence of MVD in AF patients result in presence of 6.4% more LA fibrosis
(p
< 0.00001) and lowered the chance of remaining AF free after the ablation (recurrence-free ratio of 0.554 vs 0.757 in MVD+AF and AF group respectively, P < 0.05) (Figure 1). In patients with LA fibrosis less than 20% who would be ideal AF ablation candidate, the presence of MVD decreased the chance to remain AF free (0.574 vs 0.775 in MVD+AF and AF respectively, p < 0.05) (Figure 2).

Conclusions:
MVD increases LA fibrosis in AF patients and the chance of AF recurrence post-ablation.
Abstract 20913: Endothelial Cell Inflammation and Antioxidant Capacity Are Associated With 6-Minute Walk Performance in Patients With Symptomatic Peripheral Artery Disease
Authors: Gardner Andrew W , Montgomery Polly S , Zhao Yan D , Ungvari Zoltan , Csiszar Anna , Sonntag William E
Published: March 2022

Introduction:
The aim of the study was to determine whether 6-minute walk total distance and pain-free distance were associated with circulating biomarkers of antioxidant capacity and inflammation, and with endothelial cell inflammation, oxidative stress, and apoptosis in patients with symptomatic peripheral artery disease (PAD).

Methods:
Exercise performance in 251 patients was assessed by pain-free distance and total distance covered during a 6-minute walk test. Patients were further characterized on clinical characteristics, on circulating biomarkers of antioxidant capacity and inflammation, and on the endothelial effects of circulating factors present in the sera using a cell culture-based bioassay on primary human arterial endothelial cells.

Results:
In a multivariate regression model, pain-free distance during the 6-minute walk test was negatively associated with dyslipidemia (p<0.001), chronic kidney disease (p=0.004), and NF-κB (p=0.007), and was positively associated with height (p=0.008). In multivariate analyses, total distance walked during the 6-minute walk test was negatively associated with NF-κB (p< 0.001), coronary artery disease (p=0.009), and BMI (p=0.022), and was positively associated with ABI (p<0.001), male sex (p<0.001), and hydroxyl radical antioxidant capacity (p<0.001).

Conclusions:
6-minute walk performance in symptomatic patients with PAD was associated with vascular biomarkers, as walking distances were negatively associated with endothelial cell inflammation and positively associated with circulating antioxidant capacity. The clinical implication is that behavioral interventions designed to alleviate endothelial cell inflammation and increase circulating antioxidant capacity, such as exercise and antioxidant intake, may improve ambulatory ability in patients with PAD during submaximal exercise that is typically performed during daily activities.
Abstract 20914: Characteristics and the Average 30-Day and 6-Month Clinical Outcomes of Patients With Coronary Heart Disease in a Resource-Limited Indonesian Setting
Authors: Qanitha Andriany , Uiterwaal Cuno S , Alkatiri Abdul H , Mappangara Idar , de Mol Bastianus A
Published: March 2022

Background:
Little is known about characteristics at admission and mid-term outcomes of patients with coronary heart disease (CHD) in a resource-limited South-East Asian setting. We aimed to provide a detailed description of characteristics at hospital admission of patients hospitalized with CHD from a poor setting of Indonesian population and of their clinical outcomes at 30-day and 6-month follow-up.

Methods:
We performed a cohort study of 477 patients diagnosed with CHD (acute coronary syndrome and stable coronary artery disease) admitted at the Makassar Cardiac Center, Indonesia, between February 2013 and December 2014. The outcomes, obtained by active follow-up, were all-cause mortality and major adverse cardiovascular events (MACE).

Results:
Out of 477 CHD patients, the proportion of young age (<60 years) was 53.9% and 72.7% were male. At admission, 44.2% of patients were diagnosed with ST-elevation myocardial infarction (STEMI), 38.6% with diagnosis or signs of heart failure, and 75.1% had previous hypertension. Out of 211 STEMI patients, only 4.7% had been treated by primary PCI and 6.2% received thrombolysis. The time lapse from symptom onset to hospital admission was 26.8 hours (IQR 10.0-48.0), and only 20.1% of all patients had undergone either PCI or CABG. The survival rate at 6 months was 78.9%. The rates of all-cause mortality in hospital, at 30 days, and 6 months were 10.9%, 2.5%, and 7.3%, respectively; the rate of MACE at 30 days was 14.9% and at 6 months was 17.8%.

Conclusions:
Patients with CHD in a resource-limited Indonesian setting are predominantly young males, present late after chest pain onset, and rarely receive guideline-recommended therapy. During 6-month follow-up, more than a third of these CHD patients have adverse clinical outcomes.
Abstract 20924: Threshold Based Infrared Imaging for Prevention of Esophageal Thermal Injury During Atrial Fibrillation Ablation
Authors: Hummel James , Kadado Anis , Baker Matthew , Sadaf Murrium , Gehi Anil , Bhatt Paras , Enriquez Alan , Freeman James , Marieb Mark , Mounsey Paul , Akar Joseph G
Published: March 2022

Introduction:
Cardiac ablation for atrial fibrillation has the potential to cause esophageal thermal injury. Thermocouple and thermistor-based systems are commonly used to monitor esophageal temperature at one or a few discrete locations, however, these systems have not eliminated thermal injuries and employ thresholds that are considerably lower than well-established temperatures required for irreversible tissue damage.

Hypothesis:
To mitigate esophageal thermal injury we modulated delivery of cardiac ablation energy using temperatures obtained from a high-resolution, intra-body, infrared thermography catheter that images esophageal temperatures.

Methods:
Esophageal temperatures were recorded from 28 patients undergoing pulmonary vein isolation using RF energy. An infrared catheter recorded surface temperatures from 7,680 points per second over a 6 cm length of esophagus. Physicians used a stepwise approach to set an esophageal temperature threshold. For initial cases a cutoff of 46
°
C was used and for subsequent cases the threshold was raised to a maximum value of 50
°
C. Full endoscopy was performed 1 to 3 days after the ablation procedure to document and quantify esophageal injury.

Results:
Posterior wall ablation resulted in 196 thermal elevations >40
°
C (mean 7.0±4.2) and nearly all patients (27/28) experienced a peak esophageal temperature (T
peak
) >40
°
C. Eight patients experienced T
peak
>50
°
C; with a maximum recorded T
peak
=53
°
C. T
peak
exceeded the programmed infrared temperature threshold in 12/28 patients. All patients received a full endoscopy. None of these temperature excursions resulted in visible thermal esophageal injury.

Conclusions:
Infrared thermography provided comprehensive monitoring of esophageal temperatures during ablation. By conventional metrics (e.g. Temperature>40
°
C) a large number of thermal elevations were documented. However, infrared imaging provided instantaneous temperatures that allowed for limited interruption of ablation while preserving esophageal tissue integrity.
Abstract 20925: Transverse Tubular Network Structures in the Genesis of Intracellular Calcium Alternans and Triggered Activity in Cardiac Cells
Authors: Song Zhen , Liu Michael , Qu Zhilin
Published: March 2022

Introduction:
The major role of a transverse-tubular (TT) network in a cardiac cell is to facilitate effective excitation-contraction coupling and signaling. The TT network structures are heterogeneous within a single cell, and vary between different types of cells and species. They are also remodeled in cardiac diseases. However, how different TT network structures predispose cardiac cells to arrhythmogenesis remains to be revealed.

Methods:
Based on recent experimental observations, different TT network structures, including uniform and non-uniform random (including patchy, hollow, and sheet-like) TT structures (see Figure), were modeled in a cardiac cell model consisting of a three-dimensional network of Ca
2+
release units (CRUs). We used this model to carry out simulations to systematically investigate the roles of TT network structures and the underlying mechanisms in the genesis of intracellular calcium (Ca
2+
) alternans and triggered activity (TA).

Results:
Our simulations showed that both Ca
2+
alternans and Ca
2+
wave-mediated TA were promoted when the fraction of orphaned CRUs was in an intermediate range, but suppressed in cells exhibiting either well-organized TT networks or low TT densities. Ca
2+
alternans and TA could be promoted by low TT densities when the cells were small or the CRU coupling was strong. Both alternans and TA occurred more easily in uniform TT networks than in non-uniform TT networks. Subcellular spatially discordant Ca
2+
alternans was promoted by non-uniform TT networks but suppressed by increasing CRU coupling strength. These mechanistic insights provide a holistic understanding of the effects of TT network structure on the susceptibility to arrhythmogenesis.

Conclusions:
The TT network plays important roles in promoting Ca
2+
alternans and TA, and different TT network structures may predispose cardiac cells differently to arrhythmogenesis.