bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 10046: Racial Disparity in Patients Undergoing Thoracic Endovascular Aortic Repair for Thoracic Aortic Aneurysms and Dissections
Authors: Serna-Gallegos Derek R , Aranda-Michel Edgar , Brown James , Yousef Sarah , Wang Yisi , navid forozan
Published: March 2022

Introduction:
Thoracic Endovascular Aortic Repair (TEVAR) has become the standard of care for treating complicated type B aortic dissection and descending thoracic aortic aneurysms. There are no large datasets evaluating racial disparities in patients undergoing TEVAR.

Hypothesis:
There is no difference in outcomes between patients of different ethnicities and race undergoing TEVAR.

Methods:
We analyzed adult patients who underwent TEVAR for complicated type B aortic dissection or descending thoracic aortic aneurysm. International Classification of Diseases, Ninth Revision, were used to identify patients. We utilized the National Inpatient Sample database, from January 1, 2010 to December 31, 2017. Appropriate trend weights were used to generate national estimates. Primary outcome measure was in hospital mortality. Predictors of mortality were determined using hierarchical logistic regression and a mixed logistic model was used to account for hospital variations. Excluded patients were less than 18 years old.

Results:
The study population consisted of 25260 patients. There were 17197 (68.07%) white patients, 4959 (19.66%) black patients, 1462 (5.74%) Hispanic patients and 1642 (6.51%) patients of various other ethnicities and races. Although the Elixhauser comorbidity index was not significantly different between groups, white patients were older, underwent more elective repairs, had lower baseline rates of diabetes mellitus, hypertension and chronic kidney disease. There was no significant difference when comparing in hospital mortality between white (reference group), black (OR 0.86, p=0.46), Hispanic (OR 1.54, p=0.13) or other groups (OR 0.78, p=0.45). Non elective TEVAR (OR 2.23, p<0.001), presence of other cardiac conditions (OR 2.68, p<0.001), and preoperative diagnosis of cerebral vascular disease (OR 2.39, p<0.001), peripheral vascular disease (OR 1.62, p=0.00) and chronic kidney disease (OR 1.45, p=0.04) were significant predictors of in hospital mortality.

Conclusions:
While patients of color were older and had more peripheral vascular disease and chronic obstructive pulmonary disease racial differences did not predict in hospital mortality.
Abstract 10048: Accuracy of Detecting Atrial Fibrillation: A Systematic Review and Meta-Analysis of Wrist-Worn Wearable Technology
Authors: Belani Seema , Wahood Waseem , Hardigan Patrick , Placzek Andon , Ely Stephen
Published: March 2022

Introduction:
Atrial fibrillation (AF) is the most commonly diagnosed arrhythmia, and ECG remains the gold standard for diagnosis. Wrist-worn technologies are appealing for their ability to passively process near-continuous pulse signals.

Hypothesis:
Our systematic review and meta-analysis qualitatively and quantitatively analyzes available literature on wrist-worn wearable devices (Apple Watch, Samsung, and KardiaBand) and their sensitivity and specificity in detecting AF compared to conventional methods.

Methods:
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed, yielding 9 studies (N=1,581). Observational studies assessing the sensitivity and specificity of wrist-worn wearables in detecting AF in patients with and without a history of AF were analyzed using a fixed effect model with an inverse-variance method.

Results:
In patients with a history of AF, the overall sensitivity between device groups did not significantly differ (sensitivity: 96.83%; p=0.207). The overall specificity between device groups was statistically significant (specificity: 99.02%; p<0.001). The effect size for this analysis was highest in the Samsung device group.

Conclusions:
Wrist-worn wearable devices demonstrate promising results in detecting AF in patients with paroxysmal AF. However, more rigorous prospective data is needed to understand the limitations of these devices in regard to varying specificities, which may lead to unintended downstream medical testing and costs.
Abstract 10049: Outcomes, Trends and Predictors of Gastrointestinal Bleeding in Patients Undergoing Transcatheter Aortic Valve Implantation
Authors: Zahid Salman , Bapaye Jay A , Khan Muhammmad , Ullah Waqas , Muhammadzai Hamza Zahid Ullah , Nepal Mahesh , Khan Muhammad Atif , UBAID AAMER , Salman Fnu , Tanveer Ud Din Mian , Rai Devesh , Rao Mohan , baibhav bipul , Alraies Chadi , Fischman David L , Alam Mahboob , balla Sudarshan , Depta Jeremiah
Published: March 2022

Introduction:
Gastrointestinal bleeding remains one of the most common cause of major bleeding in patients undergoing transcatheter aortic valve implantation.

Hypothesis:
GI bleed is associated with worse outcomes in patients undergoing TAVI

Methods:
We investigated trends, outcomes and predictors of major bleeding from 2011 to 2018 using the national inpatient sample database.

Results:
A total of 216,023 weighted hospitalizations for TAVI were included in the analysis. Among the included hospitalizations, 2188 patients had GI bleed (1%) whereas 21,385 (99%) patients did not have GI bleed. Presence of peptic ulcer disease was found to be associated with the highest odds of having a GI bleed with an OR 10.24[95% CI, 7.93-13.22] followed closely by colorectal cancer OR 8.02[CI, 185.40-11.91]. Other comorbidities associated with higher adjusted rates of GI bleed were chronic kidney disease ([OR], 1.28[confidence interval (CI), 1.15-1.42]), congestive heart failure (OR, 201.21[CI, 1.08-1.35]), liver disease (OR, 1.82[CI, 1.52-1.2.18]), end stage renal disease (OR, 212.13[CI, 1.79-2.52]), atrial fibrillation (OR, 1.64[CI, 1.50-.77.]) and lung cancer (OR, 2.68[CI, 221.70-4.24]). Over the study period, mortality in patients with a GI bleed with TAVI decreased from 13.6% in 2011 to 11.50% in 2018 along with a decrease in mortality in TAVI without GI bleed group as well. Patients with GI bleed had increased mortality rates as compared those without GI bleed, (12.1% 10 vs 2.1%, p<0.01).

Conclusions:
In conclusion, we report that mortality is higher in TAVI patients with a GI bleed. Presence of peptic ulcer disease, colorectal cancer or baseline comorbidities like atrial fibrillation and end stage renal disease are important predictors of this adverse event.
Abstract 10050: Reliability and Validity of the Self-Efficacy in Palliative Care Scale in Korean Nurses: A Cross-Sectional
Authors: Heo Seongkum , An Minjeong , KIM MIYEONG , You HyunMi , Yang Jisun , Hong Sun Woo , Kim Hee Jung , Shim JaeLan , Chon SaeHyun , Kim JinShil
Published: March 2022

Introduction:
In patients with advanced chronic diseases, such as heart failure, provision of appropriate palliative care is critically important to improve or maintain good quality of life until the end of their lives. To provide appropriate palliative care, nurses need to have appropriate level of self-efficacy in palliative care (self-efficacy). However, assessment methods of nurses’ self-efficacy are limited in Korea.

Hypothesis:
The reliability and validity of the Self-Efficacy in Palliative Care Scale would be supported in Korean nurses.

Methods:
Data on self-efficacy, advanced directive (AD) counseling, and AD education were collected from 272 nurses (Mean age: 30 years). Validity was assessed by exploratory and confirmatory factor analyses (SPSS and Mplus) and the relations of AD counseling and education to self-efficacy (independent t-tests). Reliability was assessed by Cronbach’s alpha and item analyses (SPSS).

Results:
The exploratory and confirmatory factor analyses (Figure 1) supported the four-factor structure (communication, patient management-physical, patient management-psycho-spiritual, and multiprofessional teamworking) with factor loadings > .60 and with good model fit: root mean square error of approximation = .07, Tucker-Lewis Index = .94, comparative fit index =.95, and standardized root mean square residual = .04. The scores of self-efficacy were higher in nurses with experiences of AD counseling (p < .001) and AD education (p = .009) compared to nurses without the experiences. Cronbach’s alphas for the total scale and each of the subscales ranged from .883 to .965. The corrected item-total correlation coefficients of all items in the total scale and each subscale ranged from .61 to .90.

Conclusions:
The findings of this study supported the hypothesis. This instrument can be used to assess nurses’ self-efficacy in palliative care and to test the intervention effects on nurses’ self-efficacy in palliative care.
Abstract 10052: Trends and Outcomes of Ischemic Stroke After Transcatheter Aortic Valve Implantation, a US National Propensity Matched Analysis
Authors: Zahid Salman , Khan Muhammad Atif , Inayat Arslan , UBAID AAMER , Muhammadzai Hamza Zahid Ullah , Rai Devesh , Tanveer Ud Din Mian , Salman Fnu , Alraies Chadi , Alam Mahboob , Fischman David L , Rao Mohan , baibhav bipul , Depta Jeremiah , balla Sudarshan
Published: March 2022

Introduction:
Contemporary data on stroke predictors and outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) remains limited.

Hypothesis:
Patients who develop a stroke while undergoing TAVI have increased in-hospital mortality and adverse events.

Methods:
We analyzed National Inpatient Sample (NIS) data from the year 2011 to 2018.

Results:
A total of 215,938 patients underwent TAVI. Of the patients who underwent TAVI, 4579 (2.2%) suffered from stroke and 211359 (97.8%) did not have a stroke. Adjusted mortality was higher in patients who had a stroke (10.9%) as compared to patients who did not have a stroke (3.1%). Patients with stroke were more likely to be discharged to nursing home compared to patients without a stroke (89.8% vs 47.7%). Multivariate logistic regression analysis showed that at baseline, age, female sex, atrial fibrillation, chronic kidney disease and peripheral vascular disease were significant predictors of stroke. Median Cost of care ($63367 vs $48070) and length of stay (8 vs 4 days) were considerably higher for patients with stroke when compared to the comparison group (p<0.01 for all).

Conclusions:
In conclusion we report that stroke is associated with increased mortality, morbidity, and resource utilization in patients undergoing TAVI. Baseline characteristics like age, gender, atrial fibrillation, chronic kidney disease and peripheral vascular disease are significant predictors of this adverse event.
Abstract 10059: In-Hospital Outcomes of Percutaneous Coronary Intervention versus Coronary Artery Bypass Surgery in Patients with STEMI Due to Unprotected Left Main Disease- A National Propensity Matched Analysis
Authors: Zahid Salman , Ullah Waqas , Khan Muhammmad , UBAID AAMER , Khan Muhammad Atif , Tanveer Ud Din Mian , Muhammadzai Hamza Zahid Ullah , Adil Abid Nawaz Khan , Rai Devesh , Fischman David L , Alam Mahboob , Alraies Chadi , baibhav bipul , Rao Mohan , Depta Jeremiah , balla Sudarshan
Published: March 2022

Introduction:
Comparative outcomes for percutaneous coronary intervention versus CABG surgery for left main coronary artery disease remains limited from a large national database.

Methods:
We studied comparative outcomes of PCI versus CABG using the US national inpatient sample database from 2015 to 2018 for left main disease presenting as STEMI.

Results:
A total of 930 and 535 patients with STEMI underwent PCI and CABG respectively. The patients undergoing PCI were older (67.5 years [Interquartile range (IQR),59-77]vs 67 [59-74]). Adjusted mortality was much higher in CABG (18.80%) as compared to PCI (7.6%). Higher percentage of patients were discharged to home after PCI as compared to CABG (49.70% vs 27.60%). Conversely, as compared to PCI a higher number of patients undergoing CABG were discharged to long-term care facility (71.90% VS 50.20%). Cost of care ($ 48703[IQR, 36803-71262] vs $ 30376 [19161-52207]) was considerably higher with CABG. The odds of in-hospital mortality and adverse events for CABG compared to PCI are depicted in figure 1.

Conclusions:
PCI may be associated with lower in-hospital mortality and adverse events when compared to CABG for unprotected left main disease.
Abstract 10063: Implementation of Appropriate Use Criteria for Cardiac Computed Tomography and Magnetic Resonance Imaging in the Follow-Up Care of Patients with Conotruncal Congenital Heart Disease
Authors: Pickard Sarah S , Armstrong Aimee K , Balasubramanian Sowmya , Buddhe Sujatha , Crum Kimberly , Kelleman Michael , Kong Grace , Lang Sean , Lee Marc , Lopez Leo , Natarajan Shobha S , Norris Mark D , Parra David , Parthiban Anitha , Powell Andrew J , Priromprintr Bryant , Rogers Lindsay , Sachdeva Shagun , Shah Sanket S , Smith Clayton A , Stern Kenan W , Wagner Courtney , Young Luciana T , Sachdeva Ritu
Published: March 2022

Introduction:
To promote the rational use of cardiovascular imaging in the delivery of high-quality and cost-effective care to patients with congenital heart disease (CHD), the American College of Cardiology developed Appropriate Use Criteria (AUC). We aimed to evaluate the appropriateness of indications for cardiac CT and MRI in patients with conotruncal defects and to identify factors associated with Maybe or Rarely Appropriate (M/R) indications.

Methods:
Twelve US centers contributed a median of 147 studies performed prior to AUC publication (01/2020) on patients with conotruncal defects. Studies were excluded if the patient did not receive primary cardiac care at the center or were not seen > 5 years prior to study date. To account for the nesting of physicians within center, a hierarchical generalized linear mixed model was used to account for center-level variation with physicians nested within center.

Results:
Of the 1,753 studies (20% CT, 80% MRI) from 12 centers, 16% (range 4-39%) were rated M/R and 2.4% were unclassifiable (Figure 1). Patients age <1 year accounted for 8.4% of studies. In multivariable analyses, patient- and study-level factors associated with M/R rating included: age <1 year (OR 1.9 [95% CI 1.1-3.4]), truncus arteriosus (vs. TOF, OR 2.2 [95% CI 1.2-4.0]), and CT (vs. MRI, OR 2.5 [95% CI 1.7-3.8]). Center-level factors included: part of an adult hospital (vs. stand-alone children’s, OR 0.8 [95% CI 0.2-0.7]) and annual MRI volume (for every 50 unit increase, OR 0.96 [95% CI 0.92-0.99]. Provider-level factors did not remain significant in the multivariable model.

Conclusions:
Most cardiac CTs and MRIs ordered for the follow-up care of patients with conotruncal defects were rated Appropriate and nearly all were able to be classified. However, there was significant center-level variation and higher annual MRI volume was independently associated with lower odds of M/R rating. These findings inform future quality improvement initiatives.
Abstract 10068: Guideline Directed Medical Therapy in Newly Diagnosed Heart Failure with Reduced Ejection Fraction in the Community: Impact of Heart Failure Clinic
Authors: Dunlay Shannon M , Killian Jill , Roger Veronique L , Schulte Philip , Savitz Samuel , Blecker Saul , Redfield Margaret M
Published: March 2022

Introduction:
Guideline-directed medical therapy (GDMT) dramatically improves outcomes in heart failure with reduced ejection fraction (HFrEF). Our goal was to examine GDMT use in community patients with newly diagnosed HFrEF.

Methods:
We performed a population-based, retrospective cohort study of all Olmsted County, Minnesota residents with newly diagnosed HFrEF (EF≤40%) 2007-2017. We excluded patients with contraindications to medication initiation (allergy, intolerance, heart rate<50 for beta blockers, SBP <80mm Hg for beta blockers, ACEi/ARB/ARNI; high creatinine (>3 mg/dL ACEi/ARB/ARNI, >2.5 men or >2.0 mg/dL women for mineralocorticoid receptor antagonists, MRAs) or hyperkalemia (potassium >5 meQ/L for ACEi/ARB/ARNI, MRA). We examined use and peak dose achieved for beta blockers, HF beta blockers (metoprolol succinate, carvedilol, bisoprolol), ACEi/ARB/ARNI, and MRA in the first year after HFrEF diagnosis. We used logistic regression to evaluate predictors of GDMT use.

Results:
From 2007-2017, 1160 patients were diagnosed with HFrEF (mean age 69.7 years, 65.6% men). Most eligible patients received beta blockers (92.1%) and ACEi/ARB/ARNI (86.5%) in the first year after HFrEF. However, only 63.6% of patients were treated with a HF beta blocker, and most did not receive MRAs (82.6%). The percentage of treated patients reaching medication target doses was 20.5% for HF beta blockers, 25.3% for ACEi/ARB/ARNI, and 11.2% for MRA. Compared to patients not seen in an HF clinic, patients seen in an HF clinic (n=380, 32.8%) were at greater odds of receiving beta blockers (OR 3.85, 95% CI 1.79-8.33); HF beta blockers (OR 3.85, 95% CI 2.63-5.26); ACEi/ARB/ARNIs (OR 3.85, 95% CI 2.17-6.67); and MRAs (OR 3.03, 95% CI 2.08-4.35). Other independent predictors of GDMT use included younger age (beta blockers, ACEi/ARB/ARNI), male gender (MRAs), higher SBP (beta blockers, ACEi/ARB/ARNI), lower EF (HF beta blockers), higher BMI (MRAs), and diabetes (ACEi/ARB/ARNI, p<0.05 for each).

Conclusions:
In this population-based study, most patients with newly diagnosed HFrEF received beta blockers and ACEi/ARB/ARNIs, but goal doses were usually not achieved. GDMT use was much higher in patients referred to an HF clinic.
Abstract 10069: Effect of Renin-Angiotensin-Aldosterone System Inhibitors on Left Ventricular Structure and Function in Duchenne Muscular Dystrophy Carriers
Authors: Lehrenbaum Hannah , Sheth Rahul , Cheeran Daniel , Araj Faris , Amin Alpesh , Peshock Ronald M , Drazner Mark H , Mammen Pradeep P
Published: March 2022

Introduction:
Duchenne muscular dystrophy (DMD) is a rare X-linked neuromuscular disorder affecting 1:5,000 males that results in terminal injury to the skeletal muscle and the heart. Recent evidence suggests that DMD female carriers are also at increased risk of developing cardiomyopathy. Renin-angiotensin-aldosterone system (RAAS) antagonists reduce morbidity and mortality and inhibit adverse left ventricular remodeling in patients with heart failure with reduced ejection fraction. The benefit of RAAS inhibition in DMD carriers has not been studied to date.

Hypothesis:
We hypothesize that RAAS inhibition will improve left ventricular function and induce favorable left ventricular structural changes in DMD carriers over time.

Methods:
A retrospective, single-center cohort study was undertaken to compare cardiac magnetic resonance imaging (cMRI) parameters in DMD carriers at the time of RAAS inhibitor initiation and after treatment with RAAS inhibitors for at least 12 months. RAAS inhibitors included angiotensin converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor neprilysin inhibitors. Through EMR review, demographic data and cMRI parameters were collected retrospectively on 20 consecutive DMD carriers.

Results:
The average time elapsed between cMRIs was 39 months. Overall, left ventricular ejection fraction (LVEF) increased in DMD carriers over time, though the improvement in LVEF did not reach significance (57%
+
8 vs 59%
+
6, p=0.2). However, subgroup analysis of 16 DMD carriers with reduced LVEF (defined as LVEF <62%) demonstrated significant improvement in LVEF following RAAS inhibition (54%
+
6 vs 58%
+
7; p= 0.004). DMD carriers with reduced LVEF additionally demonstrated a significant decrease in left ventricular end systolic volume index (LVESVi) after RAAS inhibition (38
+
10 vs 32
+
10 ml/m2; p= 0.013).

Conclusions:
DMD carriers with reduced LVEF showed significant improvement in LVEF and LVESVi following RAAS inhibition. Collectively, the data suggest that RAAS inhibition significantly improves left ventricular systolic function and significantly reduces maladaptive left ventricular remodeling and dilation in this population.
Abstract 10070: All Caregivers Are Not Alike: Stress, Caregiving Effort, and Self-Care in Heart Failure and Dementia Caregivers
Authors: Riegel Barbara , Lauren Massimo , Bowles Kathryn H , Goba Miatta , Gordon debbie , Hirschman Karen B , Ryan Quinn J , RHODES JOSEPH M , Stawnychy Michael A
Published: March 2022

Introduction:
Caregiving for someone with a chronic condition is stressful. Deferring self-care is common among caregivers but little is known about differences among various caregiver groups. The aim of this study was to compare stress, self-care, and self-care confidence in two groups of caregivers.

Methods:
We compared baseline data from two groups of caregivers (HF and frontotemporal dementia [FTD]) enrolled in an on-going study of an intervention designed to decrease stress and improve self-care. Eligible participants had to report caregiving ≥8 hours/week and neglect of ≥2 self-care behaviors (e.g., adequate sleep). Stress was measured with the Perceived Stress Scale (14 items, 5-point scale, higher score means higher stress). Self-care was measured with the Self-Care Inventory with embedded scales measuring self-care maintenance, monitoring, management, and confidence (30 items, 5-point scale, higher scores mean better self-care). Each self-care scale is standardized 0-100; ≥70 reflects adequate self-care. Baseline data prior to the intervention were compared.

Results:
Compared to HF caregivers, the FTD caregivers were significantly more likely to be Caucasian (87.1% vs. 60.9%), male (25.8% vs. 14.3%), married to the patient (98.8% vs. 72.5%), and older (64.8±10.1 vs. 54.4±15.1) years. The FTD caregivers had been caregiving for fewer years (5.1±3.7 vs. 7.3±8.6) but their daily caregiving effort was higher (Table). Stress levels did not differ significantly and self-care was poor in both groups. Self-care confidence was higher in HF than FTD caregivers.

Conclusions:
Although caregiving effort was higher in FTD caregivers, stress levels were comparable and self-care was poor in both HF and FTD groups. Understanding the source of the stress, barriers to self-care, and the factors that promote self-care confidence are important for developing and testing tailored interventions to promote self-care of caregivers.
Abstract 10071: Improved Accuracy of 4D Flow with Ferumoxytol in Comparison to Gadolinium Contrast for Small Children with Congenital Heart Disease
Authors: Kollar Sarah E , Mandell Jason , Loke Yue-hin , Olivieri Laura
Published: March 2022

Introduction:
Cardiac magnetic resonance (CMR) now allows for time-resolved three-dimensional phase-contrast (4D flow) analysis of congenital heart disease (CHD). In infants with small vessels, the influence of contrast agent type (ferumoxytol vs. gadolinium) on 4D flow has not been investigated. Thus, we investigated the accuracy of 4D flow measurements in ferumoxytol vs. gadolinium-enhanced CMR of small CHD patients.

Methods:
This was a retrospective study consisting of CMR studies from CHD patients less than 20 kg who had ferumoxytol or gadolinium-enhanced 4D flow and standard phase contrast (2D-PC) flow collected. 4D flow clinical software (Arterys) was used to measure flow in great vessels, systemic veins and pulmonary veins. 4D flow accuracy was defined as % difference or correlation against conventional measurements from (2D-PC) of the same vessels. Subgroup analysis was performed on two-ventricular (2V) vs. single ventricular (1V) CHD, as well as low flows (defined as < 1.5 L/min) in 1V CHD.

Results:
Twenty-one ferumoxytol-enhanced and 23 gadolinium-enhanced CMR studies were included, with no difference in age (2.1 ± 1.5 vs. 2.3 ± 1.8 years, p = 0.7), patient size (0.49 ± 0.18 vs. 0.51 ± 0.16 m
2
, p = 0.67), or vessel diameter (11.4 ± 5.2 vs. 12.4 ± 5.6, p = 0.22). 10 CMR studies with 1V CHD were included. Overall, ferumoxytol-enhanced 4D flow measurements demonstrated less % difference to 2D-PC when compared to gadolinium-enhanced studies (Figure 1A). In subgroup analysis of low flows in 1V CHD, ferumoxytol-enhanced 4D flow measurements had stronger correlation to 2D-PC (Figure 1B).

Conclusions:
In infants, ferumoxytol-enhanced 4D flow has improved accuracy when compared to gadolinium, particularly for small vessels in 1V CHD.
Abstract 10073: Characterization of Mechanical Circulatory Support in Peripartum Cardiomyopathy
Authors: Bakir Nadia H , Florea Ioana B , Schilling Joel D , Ewald Gregory A , Kotkar Kunal D , Itoh Akinobu , Masood Muhammad F
Published: March 2022

Introduction:
Peripartum cardiomyopathy (PPCM) is a severe complication of pregnancy which is hallmarked by non-ischemic reduction in left ventricular ejection fraction (LVEF) to <45% late in gestation or shortly postpartum. This study evaluated outcomes among women who required mechanical circulatory support (MCS) for end-stage heart failure in the setting of PPCM.

Methods:
Thirty female patients 18-46 years of age underwent cardiac surgery for PPCM between 2012-2020. Primary heart transplant patients (n=2) were excluded. PPCM patients with a new MCS requirement (n=28) were classified by device type and escalations in device support.

Results:
Mean age was 29±7 years and 21 patients (75%) were African American. Median time from delivery to MCS requirement was 418 [91-1201] days. Nineteen (68%) patients required temporary MCS (tMCS): 12 (63%) on intraaortic balloon pump, 9 (47%) on veno-arterial extracorporeal membrane oxygenation, and 4 (21%) on Impella. Nine (32%) patients underwent left ventricular assist device (LVAD) implant after failure of medical therapy. LVEF and left ventricular end-diastolic diameter (LVEDD) at MCS insertion were 14±5mm and 68±11mm, respectively. LVEF progressed to 24%±16% post-insertion and 29%±17% one year (Figure 1). Of the 19 tMCS patients, 5 (26%) required escalations with additional modalities. Ten (53%) patients were bridged to durable LVAD. Complications included right ventricular failure (n=4), stroke (n=2), sepsis (n=1), dialysis (n=5), and cardiac arrest (n=3). Duration of support was 9±7 days for tMCS and 996±625 days for LVAD. Overall survival to discharge was 89% (n=25). Twelve patients underwent transplant (43%) and two (7%) recovered native heart function.

Conclusions:
Severe PPCM can be effectively managed with tMCS as a bridging strategy to either transplant or durable LVAD. Patients will often require multiple escalations in resource-intensive therapy, but outcomes are excellent with vigilant management.
Abstract 10084: Acute Myocardial Infarction Related Mortality Stratified by State and Region; 1999-2019
Authors: Minhas Abdul , Sheikh Abu Baker , Khan Muhammmad , Wazir Muhammad Hisham Khan , Goel Sachin S , Fudim Marat
Published: March 2022

Introduction:
Acute myocardial infarction (AMI) accounts for significant morbidity and mortality and the mortality may vary across regions and states. The aim of this study was to examine the trends in AMI related deaths stratified by regions in the United States from 1999 to 2019.

Methods:
We used CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) to access National Vital Statistics System data from 1999 to 2019. AMI related deaths, age >/=25 years were identified from multiple causes of death and were represented as age-adjusted mortality rates (AAMR) per 100,000 population. Joinpoint regression was used to examine changes in trend and annual percentage change (APC) overall and stratified by regions.

Results:
AAMR was highest in South (91.7) followed by Midwest (88.2), Northeast (77.3), and West (64.6). APC in AAMR decreased across all the regions at variable pace. After initial decline, the decrease in APC in AAMR decelerated in South (-2.7) since 2012, Midwest (-3.0) and Northeast (-4.0) since 2009 and West (-2.7) since 2010. States with AAMRs >90th percentile included Arkansas (180.8), Kentucky (136.3), Mississippi (129.7), Tennessee (123.2), Missouri (121.2) and South Dakota (117.9) and <10th percentile included Alaska (44.0), Nevada (48.0), Minnesota (48.8), Hawaii (53.4), Colorado (54.0) and Montana (54.6).

Conclusion:
AMI related mortality in elderly has been decreasing at a variable pace in various regions. Significant disparities exist across various regions and states. Further research is needed to examine the underlying causes of these disparities and targeted interventions are required to address these disparities.
Abstract 10086: Cardiac Intravital Microscopy Enables Quantitative Mapping of Capillary-Level Blood Flow in the Murine Heart
Authors: Zhou Yirong , King Kevin R , Aguirre Aaron D
Published: March 2022

Introduction:
Coronary microvascular disease (CMD) is increasingly appreciated as a contributor to adverse cardiovascular outcomes, but underlying mechanisms of CMD remain poorly understood. Investigation of CMD in animal models is limited by a lack of techniques to quantify flow in the heart. We assessed the hypothesis that intravital microscopy (IVM) can enable
in vivo
imaging of red blood cell (RBC) flow profiles in the coronary microcirculation at cellular resolution.

Methods:
C57BL/6 mice (n=20) were used to develop cardiac IVM protocols. Cardiomyocyte membrane staining was achieved using intravenous injection of a voltage dye (di-2-anepeq). RBC labeling was done by ex-vivo staining of cells with Ter119 followed by transfusion. IVM was performed through a thoracotomy with animals anesthetized and ventilated. Confocal and two-photon microscopy was done using a custom tissue stabilizer and an Olympus FV1000MPE microscope synchronized to physiologic signals using custom hardware and software and cardiac pacing protocols. Images were analyzed in MATLAB to extract myocyte contractile properties, capillary diameter, and capillary flow properties.

Results:
Using cardiac and respiratory gating, images with cellular resolution could be measured in the beating heart at all phases of the cardiac cycle. This enabled quantification of cardiomyocyte contractile function and capillary diameter and widefield imaging by stitching of several images (Fig. 1A). Tracking of RBCs over serial images allowed quantification of RBC velocity across multiple capillaries simultaneously (Fig. 1B).

Conclusion:
Cardiac IVM can provide quantification of cardiac function and blood flow at the single cell scale and will provide an exciting tool for investigating CMD in models of heart disease.
Abstract 10088: Atrial Fibrillation/Atrial Flutter Related Mortality Rates Among the Young Population; Data from CDC Wonder 1999-2019
Authors: Minhas Abdul , Jamal Shakeel , Khan Safi U , Ullah Waqas , Muslim Muhammad Osama , Fudim Marat
Published: March 2022

Introduction:
Atrial fibrillation (AF) majorly effects the elderly, but it can also affect the younger population. The aim of this study was to examine the trends in AF related deaths in the young population in the United States from 1999 to 2019.

Methods:
We used CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) to access National Vital Statistics System data from 1999 to 2019. AF associated deaths, age 15- 44 years were identified from multiple causes of death and were represented as age-adjusted mortality rates (AAMR) per 1,000,000 population. Joinpoint regression was used to examine changes in trend and annual percentage change (APC) overall and stratified by sex and racial/ethnic groups.

Results:
AAMR related to AF decreased from 1.3 in 1999 to 3.7 in 2019 (APC 5.4 [95% CI, 4.8 to 6.0]). AAMR was higher in men (3.1) than women (1.3). AAMR was highest in blacks (4.4) followed by whites (1.9) and others (1.5) (includes Asian or Pacific Islanders; and American Indian or Alaska Natives). AAMR was highest in Black males (6.4). APC in AAMR increased in men (5.4) during the entire study period. In women, APC increased till 2010 (2.5) and then further accelerated till 2019 (8.4). APC in AAMR increased in Whites (5.6) and Blacks (5.3) during the entire study period.

Conclusion:
AF associated mortality has been consistently increasing in the younger population across all sexes and races. Further research is needed to understand the underlying factors to help develop preventative strategies.
Abstract 10093: Incidence of Sudden Cardiac Death After Percutaneous Coronary Intervention
Authors: Nakamaru Ryo , Niimi Nozomi , Inohara Taku , Shiraishi Yasuyuki , Ikemura Nobuhiro , Suzuki Masahiro , Noma Shigetaka , Numasawa Yohei , Fukuda Keiichi , Kohsaka Shun
Published: March 2022

Introduction:
Sudden cardiac death (SCD) remains a major concern for the patients that undergo percutaneous coronary intervention (PCI). We sought to investigate the incidence and contributing clinical factors of SCD after PCI.

Methods:
We analyzed 8791 consecutive patients who underwent PCI between 2008 and 2019 from 15 institutions, and evaluated the cumulative incidence of SCD after PCI. The cause of death was adjudicated by an independent event committee. SCD was defined as unexpected death without a non-cardiovascular case in a previously stable patient within 24 hours from the onset. Cox proportional hazards modeling was used with the Fine and Gray method to account for competing SCD risk.

Results:
In the present cohort, the mean age was 68.3±11.3 years, and the prevalence of previous heart failure (HF), which was ascertained from hospital records regardless of systolic function status, was 4.6%. Of these, 4592 (52.2%) underwent PCI for acute coronary syndrome (ACS). The cumulative incidence of all-cause death and SCD was 3.47% and 0.44%, respectively in 2 years. SCDs occurred more frequently immediately after PCI in ACS patients; however, the total incidence of SCD was similar in ACS and stable coronary artery disease (CAD) patients at 2 years (0.45% vs 0.44%, p = 0.91 for log-rank test) (Figure). Overall, presence of previous HF was associated with risk of SCD (crude incidence [vs. non-heart failure patients] 2.29 vs. 0.29%; adjusted hazard ratio 6.60, 95% CI 3.09-14.1, p<0.01) rather than clinical presentation (e.g. ACS vs. stable CAD; adjusted hazard ratio 1.29, 95% CI 0.65-2.54, p=0.47).

Conclusions:
The cumulative incidence of SCD was ~0.5% in the contemporary multicenter PCI registry. Rather than the clinical presentation, the presence of previous HF was associated with a higher risk of SCD.
Abstract 10117: Reactivity Of Myocardial Contractility To Afterload Effects During Peripheral Veno-arterial Extracorporeal Membrane Oxygenation
Authors: Ng Pauline Yeung , Ma Sin Kwan Tammy , Ip April , Fang Shu , Wong Alfred Sai Kuen , Ngai Chun Wai , Chan Wai Ming , Sin Wai Ching
Published: March 2022

Introduction:
Peripheral veno-arterial extracorporeal membrane oxygenation (V-A ECMO) poses increased afterload to the injured heart. The reactivity of myocardial contractility to ECMO blood flow during various phases of acute myocardial dysfunction has not been examined.

Hypothesis:
We hypothesized that myocardial contractility is more reactive to the afterload effects of peripheral V-A ECMO during the acute stage of myocardial dysfunction.

Methods:
Adult patients who were supported by peripheral V-A ECMO between April 2019 and October 2020 were recruited. Serial hemodynamic and cardiac performance parameters were measured by TTE within 48 hours after initiation of V-A ECMO (“acute phase”) and upon weaning (“delayed phase”). Measurements were obtained at 100%, 120%, and 50% of ECMO target blood flow.

Results:
A total of 30 patients were included, 22 (71%) were male, and the mean±SD age was 54±13 years. The main indications of ECMO were myocardial infarction (19 patients, 63%) and myocarditis (5, 17%). TTE was performed on a median of day 1 (1-1) (n=30, “acute phase”) and day 4.5 (3-6) (n=24, “delayed phase”) after initiation of ECMO. Left ventricular contractility was reactive to afterload effects from V-A ECMO in both the acute and delayed phases, with an improvement in LVEF during ECMO flow reduction from 21.5 to 30.9% (p<0.001) and 34.5 to 41.7% (p=0.002), respectively. The change in LVEF was similar in the acute phase compared with the delayed phase when considering the whole cohort [median (IQR) change in LVEF: 8.88 (5.26 - 13.7)% vs 6.12 (0.64 - 15.60)%, p=0.38]. Of the 24 patients who had a TTE during the delayed phase, 16 (66.7%) had myocardial recovery and were weanable from ECMO support. The reactivity of LVEF to ECMO blood flow was similar in the patients who were weanable compared with patients who were not weanable [median (IQR) change in LVEF: 10.21 (2.61 - 16.21)% vs 3.20 (-2.13 - 6.79)%, p=0.14].

Conclusions:
In conclusion, we demonstrated that the reactivity of left ventricular contractility to afterload effects of V-A ECMO was not significantly different at different stages of acute myocardial dysfunction. Future studies should examine the predictive value and clinical utility of these echocardiographic measurements in patients on V-A ECMO.
Abstract 10122: 'Young' Stroke Related Mortality in the United States: A 'Wake-Up' Call
Authors: Minhas Abdul , Qavi Ahmed H , Khan Safi U , Dani Sourbha , Goel Sachin S , Michos Erin , Greene Stephen J , Fudim Marat
Published: March 2022

Introduction:
Important disparities in stroke outcomes persist based on sex, race, and ethnicity. The aim of this study was to examine trends in stroke (ischemic and hemorrhagic) related deaths among young adults in the United States from 1999 to 2019 by sex and race/ethnicity.

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

Results:
AAMR was higher in men (3.3) than women (2.8). AAMR was highest in non-Hispanic Black (NHB) (6.6) followed by non-Hispanic American Indian or Alaska Native (NH-AIAN) (4.36), Hispanic (2.65), non-Hispanic White (NHW) (2.45) and lastly non-Hispanic Asian or Pacific Islander (NH-API) (2.24) ethnic groups. AAMR was highest in NHB males (7.07). AAMR related to stroke decreased from 3.7 in 1999 to 2.69 in 2011 and then increased to 2.87 in 2019 (APC 1.0[95% CI, 0.4 to 1.5]). After initial decline, AAMR increased in men (APC 1.2) since 2011, and women (APC 1.8) since 2013 (Figure, Panel A). AAMR increased among NHW (APC 2.4) persons since 2013 and Hispanic (APC 1.5) persons since 2011 (Figure, Panel B). AAMR decreased in NHB (APC -3.9) persons from 1999-2012, and remained stable thereafter. AAMR decreased in NH-API (APC -0.9) persons and did not change significantly in NH-AIAN persons during the entire study period.

Conclusion:
After initial decline, stroke-related mortality among young adults has increased over the past decade. Stratification by sex and racial/ethnic status reveals significant disparities. Further research is needed to understand and mitigate the factors driving these trends.
Abstract 10130: Immediate Changes of Transesophageal Echocardiographic Findings in Percutaneous Closure of Atrial Septal Defects
Authors: Yokoyama Takehiko , Inukai Sachiko , Furusawa Kenji , Nanasato Mamoru , Takenaka Masaki
Published: March 2022

Introduction:
Atrial septal defects (ASD) are treated with percutaneous closures that subsequently increase the left ventricular volume load. This retrospective study aimed to assess the change in transesophageal ultrasound indices and to determine the search associated post-closure left diastolic index.

Subjects:
We enrolled 62 patients who underwent percutaneous closure of ASD in our hospital between January 2018 and November 2020.

Method:
Percutaneous ASD closure was performed under general anesthesia. We measured left ventricular inflow (early diastolic flow velocity, E; atrial contraction flow velocity, A; E-wave deceleration time, DT), mitral annulus velocity by tissue doppler imaging at lateral annulus (early diastolic myocardial velocity, E'; atrial contraction velocity, A'), and pulmonary venous blood flow velocity (peak systolic velocity, S; diastolic velocity, D; atrial systolic regurgitation velocity, AR; atrial systolic regurgitation time, AD) using transesophageal echocardiography (TEE). The ratio of E and E' (E/E') was calculated for and compared between before (pre) and after (post) ASD closure. Statistical analysis was performed using the EZR software. Wilcoxon's code order test was used for comparison, and multivariate correlation analysis was performed with post-occlusion E/E' as the objective variable. Statistical significance was set at p<0.05.

Results:
Significant changes were seen in A', E', E, S, D, AD, and E/E'. Multivariate correlation analyses revealed a significant association of post E/E’ with the pre E/E’ and pre AR.

Conclusion:
In this study, the pulmonary venous flow velocity was found to decrease during systole and diastole following ASD closure. The DT did not change; thus, there was no change in the stiffness of the left ventricle. We concluded that the increased left ventricular volume load caused the increase in the left end-diastolic pressure.
Abstract 10133: Cerebrovascular Imaging Biomarkers, Neuropsychiatric Symptoms, and Mild Cognitive Impairment
Authors: Vassilaki Maria , Syrjanen Jeremy , Scharf Eugene , Krell-Roesch Janina , Vemuri Prashanthi , Graff-radford Jonathan , Mielke Michelle , Machulda Mary M. , Kremers Walter , Lowe Val , Jack Clifford , Knopman David , Petersen Ronald , Geda Yonas E.
Published: March 2022

Introduction:
Cerebrovascular disease (CVD) and neuropsychiatric symptoms (NPS) are common in older adults and are independently associated with cognitive impairment. In addition, vascular depression (a late-life depression) is hypothesized to be associated with cerebrovascular pathology.

Hypothesis:
CVD pathology imaging biomarkers (e.g., white matter hyperintensities (WMH), infarctions) are associated with depression and anxiety, and both (depression/anxiety and CVD imaging biomarkers) are independently associated with mild cognitive impairment (MCI).

Methods:
This cross-sectional study included 1739 Mayo Clinic Study of Aging participants (≥50 years old) without dementia, with comprehensive cognitive evaluations and available data on the Beck Depression Inventory II (BDI), the Beck Anxiety Inventory (BAI) and imaging CVD biomarkers via FLAIR-MRI (i.e., WMH% of total intracranial volume (TIV) and brain infarctions). We used linear and logistic regression models to examine the associations adjusting for age, sex, education, and apolipoprotein E ε4 status.

Results:
Participants’ mean age (SD) was 71.11 (10.61) years (53.3% males). Higher WMH% TIV burden was significantly associated with higher BDI (b= 0.082, 95%CI: 0.031, 0.133), p=0.002) and BAI scores (b= 0.088, 95%CI: 0.037, 0.140), p=0.001); the presence of infarctions was also associated with a higher BDI score. Both WMH %TIV burden (OR: 1.20 (95%CI:1.05, 1.38), p=0.008) and BDI score (OR: 1.38 (95%CI:1.21, 1.57), p<0.001) were significantly associated with MCI when included simultaneously in the model. We observed similar associations for CVD biomarkers and BAI score with MCI.

Conclusions:
CVD imaging biomarkers and NPS, as measured by BDI and BAI scores, could represent two distinct processes associated with cognitive impairment. Studies are ongoing to further examine these associations and delineate how CVD, NPS, and other pathophysiology processes (e.g., Alzheimer’s disease) interact and are associated with cognitive impairment.
Abstract 10137: Functional Brain Imaging Reveals Decreased Cerebellar Volume and Altered Brain Connectivity in Pulmonary Arterial Hypertension
Authors: Kim Timothy S , Huppert Theodore , Fatukasi Omolara , Al Aaraj Yassmin , Girard Timothy , Mettenburg Joseph , Becker James , Nouraie Seyed , Chan Stephen Y
Published: March 2022

Introduction:
Psychiatric and cognitive deficiencies are increasingly appreciated in pulmonary arterial hypertension (PAH). Brain abnormalities potentially underlying these disease manifestations have been ill-defined.

Hypothesis:
Altered brain structure and functional connectivity correlate with neurocognitive changes in PAH patients.

Methods:
PAH patients at UPMC were enrolled from 2017 to 2018. Participants underwent T1/T2 structural and resting functional brain MRI (fMRI) in addition to cognitive testing. Case data were compared in a 1:4 ratio to that of age-, gender-, and education-matched non-PAH controls. Linear regression analysis with clustered sandwich estimator and adjustment for multiple hypothesis testing was used for comparisons. Most recent hemodynamic data for PAH patients were reviewed including pulmonary vascular resistance (PVR). Pearson correlations were computed between PVR and brain volumes.

Results:
12 PAH patients (median age, 45 years [range 26-61]; 9 women) were enrolled. T1/T2 MRI analysis identified 18 regions with volumetric differences (q<0.05), with notable involvement of limbic (6/18, 33%) and basal ganglia (4/18, 22%) structures. PAH patients showed decreased left cerebellar cortical (45178 ± 1417 vs 53295 ± 583 mm
3
; q=0.01) and right cerebellar white matter volumes (16458 ± 727 vs 39675 ± 5846 mm
3
; q=0.018). Structural changes concorded with results from fMRI analysis: PAH patients had decreased functional connectivity in the left cerebellum (q=0.003). Corresponding with modulation of executive functions by the cerebellum, a trend was seen toward decreased inhibitory control and attention (83 ± 3 vs 95 ± 1; q=0.07) and pattern comparison processing speed (93 ± 5 vs 106 ± 4; q=0.07) in PAH patients. A trend toward negative correlation of PVR with left cerebellar white matter volume (r = -0.82, q = 0.06) was also observed.

Conclusion:
Limbic, basal ganglia, and cerebellar regions were smaller and less functionally connected in PAH cases than in matched controls. Decreased cerebellar volume may correlate with more severe hemodynamic disease. Any links among brain changes, cognitive dysfunction, and PAH pathophysiology deserve further study and may lead to neurologic modalities to diagnose and treat disease.
Abstract 10141: Outcomes in Elderly Patients with Hospitalized Heart Failure Stratified by Left Ventricular Ejection Fraction
Authors: Nakamaru Ryo , Shiraishi Yasuyuki , Kohsaka Shun , Kohno Takashi , Goda Ayumi , Takei Makoto , Nagatomo Yuji , Tanaka Toshikazu D , Nakano Shintaro , Fukuda Keiichi , Yoshikawa Tsutomu
Published: March 2022

Introduction:
The prevalence of heart failure (HF) has increased markedly with age. Given the influence of age and left ventricular ejection fraction (LVEF) on the mortality in HF, the assessment of clinical outcomes in elderly patients stratified LVEF categories may provide better care decisions in clinical settings.

Methods:
Between 2006 and 2017, 3558 consecutive patients enrolled in a prospective multicenter registry in Japan (the West Tokyo Heart Failure registry) were analyzed. We divided the patients into three age groups: <65 years (younger), 75-84 years (elderly), and ≥85 years (very-elderly) by each LVEF subgroup (HF with preserved ejection fraction [HFpEF, LVEF ≥50%] or non-HFpEF [LVEF <50%]). The primary endpoint was all-cause mortality after discharge. We performed a multivariate cox proportional hazards analysis to identify the risk factors for all-cause death using several covariates.

Results:
Overall, 1505 HFpEF (younger: n=182, elderly: n=894, very-elderly: n=429) and 2053 non-HFpEF (younger: n=575, elderly: n=1159, very-elderly: n=319) were included in this study. During the median follow-up period of 2.0 years, the incidence of all-cause death was almost similar in both HFpEF and non-HFpEF groups (19.2% vs. 20.3%, p=0.60 for log-rank test). The mortality increased substantially with increasing age categories, and also differed by LVEF categories (Figure). After multivariable adjustments, age (per 1-year increase) and LVEF (per 1% decrease) were the significant predictors of all-cause death (age: hazard ratio [HR] 1.04, 95% confidence interval [CI] 1.03-1.05, p<0.001; LVEF: HR 1.01, 95% CI 1.01-1.02, p<0.01).

Conclusions:
In contemporary Japanese clinical practice with aging, age was closely associated with higher risks for all-cause death, and the mortality was stratified by LVEF categories.