bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14062: Nation-Wide Screening of Fabry Disease in Patients With Hypertrophic Cardiomyopathy in Czech Republic
Authors: Zemanek David , Januska Jaroslav , Honek Tomas , Curila Karol , Kubanek Milos , Sindelarova Stepanka , Taborsky Milos , Linhart Ales
Published: April 2022

Introduction:
Fabry disease (FD) is a rare X-linked genetic disorder caused by α-galactosidase A (AGALA) deficiency. While "classic" variant has multisystemic manifestation, the more recently described "later-onset" variant is characterized by predominant cardiac involvement that often mimics hypertrophic cardiomyopathy (HCM).

Hypothesis:
Routine screening in patients with hypertrophic cardiomyopathy may detect patients with Fabry disease who are not clinically characterized by a typical multi-organ disorder.

Methods:
Consecutive unrelated patients with HCM were screened for FD in 16 (out of 17) cardiac centers in the Czech Republic covering specialized cardiology care from June 2017 to December 2018. AGALA activity and globotriaosylsphingosine (lyso-Gb
3
) levels were measured in all subjects using the dry blood spot method. FD was suspected in male patients with AGALA activity <1.2μmol/h/L and in females with either low AGALA activity or lyso-Gb
3
>3.5ng/mL. Positive screening results were confirmed by genetic testing.

Results:
We evaluated 589 patients (390 males, 66%) with HCM (mean maximal myocardial thickness 19.1±4.3 mm). The average age was 58.4±14.7 years. In total, 17 patients (11 males, 6 females) had a positive screening results and subsequently six of them (4 males and 2 females) had a genetically confirmed pathogenic variant (total prevalence of 1.02 %). Five of these patients were carrying the p.N215S mutation known to cause a typical later-onset cardiac FD.

Conclusions:
We confirmed the prevalence of FD repeatedly reported in previous screening programs (approximately 1 % irrespective of gender) in a non-selected HCM population in Central Europe. Our findings advocate a routine screening for FD in all adult patients with HCM phenotype including both genders. The dry blood spot method used led to identification of clearly pathogenic variants.
Abstract 14066: Control of Atrial Fibrillation With Short vs Long Duration of Continuous Intravenous Diltiazem
Authors: Sbircea Nicole , Mathis Emily , Pearce Brandon , Mundell Jennifer , Saum Lindsay
Published: April 2022

Introduction:
Continuous intravenous (IV) diltiazem is one of the options for urgent management of atrial fibrillation with rapid ventricular response (RVR). This study assesses the clinical outcomes of utilizing IV diltiazem for less than or greater than 24 hours.

Methods:
A retrospective chart-review of patients receiving continuous IV diltiazem between January 1, 2017 and December 31, 2018 where adult patients were included if they had atrial fibrillation with RVR and were treated with continuous IV diltiazem. Exclusion criteria included initiation of IV diltiazem in the ICU, strict nothing by mouth, only a bolus of IV diltiazem used, no conversion to oral rate controlling agent following discontinuation of IV diltiazem, and if pregnant. Infusions lasting >24 hours and <24 hours were compared. Primary objective was to evaluate duration in goal heart rate for the first 48 hours after conversion to PO diltiazem. Secondary outcomes included length of hospitalization, ICU transfer, 30-day readmission, and development of cardiovascular events including stroke, myocardial infarction, or cardiovascular death.

Results:
146 out of 251 patients met inclusion criteria. 75.3% of patients maintained a goal heart rate (less than 110bpm) for at least 80% of the 48 hours after conversion to oral diltiazem in < 24 hours group compared to only 59% (p =0.037). The <24 hours group had more patients in heart rate goal for >85% of 48 hours after conversion to oral diltiazem compared to the >24 hours group (p=0.03). Diltiazem drips used for >24 hours had a higher percentage of ICU transfers (p = 0.035) and longer hospitalization (p = 0.001). There were no differences regarding major adverse cardiovascular events and readmission rates.

Conclusions:
Diltiazem drip use for <24 hours was associated with greater time spent in goal heart rate as well as a lower rate of ICU transfers and shorter hospitalization when compared to drips used > 24 hours.
Abstract 14067: A Novel Tool for Highly Reliable and Accurate Prediction of Multiple Complications in Patients Undergoing Percutaneous Coronary Intervention
Authors: Hamilton David , Seth Milan , Sukul Devraj , Gurm Hitinder S
Published: April 2022

Introduction:
Precise risk-prediction of post-procedural adverse events and outcomes after percutaneous coronary intervention (PCI) is critical to weighing treatment options and shared decision-making. Post-PCI complications are becoming less coming with quality improvement initiatives, however, there remains a significant risk for acute kidney injury (AKI), bleeding, and death. We hypothesized that with the use of random forest algorithms, we would be able to create accurate models to predict post-PCI complications.

Methods:
Our study cohort included 71,963 PCI procedures from the BMC2 registry performed at 48 hospitals in Michigan between 4/1/2018 and 9/30/2020. Random forest models were created using 74 pre-procedural clinical and laboratory variables to estimate the risk of each in-hospital outcome including mortality, AKI, major bleeding, and the need for a blood transfusion. A reduced model was created with the 20 most influential variables. The entire cohort was randomly separated into two groups for training (n=35,981) and validation (n=35,982). Model performance was evaluated in an independent validation data set using area under the receiver-operating characteristic curve (AUC).

Results:
The overall mortality was 1.76% (n = 1,264), there were 1,743 (2,42%) AKI events, 665 (0.92%) major bleeds, and 1,745 (2.42%) transfusions. The reduced models demonstrated excellent discrimination for all measured outcomes (Fig. 1) including mortality (AUC: 0.936 [95%CI 0.931-0.941]), AKI (AUC: 0.857 [95%CI 0.848-0.865]), major bleeding (AUC: 0.859 [95%CI 0.846-0.872]), and need for transfusion (AUC: 0.881 [95%CI 0.874-0.888]).

Conclusions:
The risk of post-PCI complications including mortality, AKI, major bleeding, and need for transfusion can be accurately calculated using a random forest algorithm of common pre-procedural factors to help better inform clinicians of a patient’s risk for better treatment selection and shared decision-making.
Abstract 14068: Prospective Evaluation of Same-Day Discharge After Cryoballoon Ablation of AF: Results of the Easy-PVI Study
Authors: Tomaiko-clark Emrie D , Bai Rong , Sangrigoli Robert M , Venkataraman Ganesh , Harding John D , Su Wilber
Published: April 2022

Introduction:
With advancements in technology and techniques, catheter ablation for the treatment of atrial fibrillation (AF) has become safer with time. Historically, standard-of-care recommended overnight stay after procedure. With improved safety and shorter procedure times, some centers have allowed for same-day discharge (SDD). We report the results of a multi-center, randomized clinical trial investigating the safety of SDD after cryoballoon (CB) ablation of paroxysmal AF.

Methods:
Patients underwent pulmonary vein isolation (PVI) with the Medtronic Arctic Advance
TM
cryoballoon at 3 experienced U.S. centers. Six hours after procedure, patients were randomized to either stay overnight or be discharged same-day after meeting study inclusion criteria.

Results:
A total of 51 patients were enrolled. Two were determined to be screen-fails following ablation of extra-pulmonary foci. Final analysis encompassed the 46 patients who completed randomization and follow-up, with 23 randomized to each group. No significant adverse outcomes were reported in either group, defined as major cardiovascular or cerebrovascular events. Occurrence of any adverse events, including arrhythmia recurrence, vascular complication, ventricular arrhythmia, syncope, pacemaker implant, pulmonary vein stenosis, and persistent phrenic nerve palsy, did not differ significantly between the two groups (p=1.0). Four patients had symptomatic and/or documented recurrence of atrial arrhythmia, three of which were in the same-day discharge group. Two patients developed cough post-operatively, one from each group. One patient from the next-day discharge cohort was diagnosed with pneumonia >2 weeks post-procedure. No patients from either group required emergency room visits due to delayed procedural-related complications.

Conclusions:
This is the first randomized trial to our knowledge examining the safety of SDD post CB ablation. Based on our results, SDD following CB ablation is a safe option following uncomplicated ablation for PVI. Operators should use their discretion in selecting patients for SDD.
Abstract 14070: Epidemiology of Cardiomyopathy in Haitian Patients Seen in a United States Urban, Safety-Net, Academic Medical Center
Authors: Ibrahim Michel , Behrooz Leili , Saint Croix Garly Rushler , Loubeau Berenice , Barillas Lara Maria I , Paul Ludwine
Published: April 2022

Introduction:
Many studies have described the high incidence of Peripartum cardiomyopathy (PPCM) in Haiti. However, there are only been two known studies that report other causes of heart failure (HF) in Haitians, although these studies were limited by the lack of diagnostic tools available for the appropriate cardiomyopathy work up in Haiti. Haitians make up the second largest share of immigrants in Boston and Boston Medical Center provides health care for many immigrants where patients receive optimal cardiovascular care. Our study will help better characterize cardiomyopathies (CMP) in Haitian patients to help develop tailored diagnostic and treatment interventions.

Methods:
We performed a retrospective analysis on all adult patients of Haitian descent and/or Haitian Creole speaking patient who were evaluated at Boston Medical Center and whom had undergone optimal cardiomyopathy work up.

Results:
Among 88 Haitian patients, 65.9% had moved to the USA prior to 2010, 38.6% were diagnosed with an Ischemic CMP and 19.3% with hypertensive heart disease. Hypertension was prevalent in 80.7% of the population followed by dyslipidemia (59.1%) and diabetes (55.6%). 13.6% of patients are found to be active tobacco users. 69.3% have medical insurance listed. 20.45% died at 1 year.

Conclusions:
Cardiovascular disease (CVD) is the leading cause of mortality among Haitians. Our study is the first Haitian cardiovascular study in the literature to look at the epidemiology of cardiomyopathy in the afro-mentioned population utilizing the availability of optimal cardiovascular resources. We found that ischemic cardiomyopathy is most common etiology of cardiomyopathy contrary to 2 prior studies Haitian studies where non-ischemic cardiomyopathy was found to be more common. Future study will need to focus on collecting data on much larger scale of patient Haitian. patients.
Abstract 14071: Gut Microbial Metabolite Trimethylamine N-oxide Enhances Endoplasmic Reticular Stress and Promotes Endothelial Dysfunction
Authors: Boini Krishna M , singh Abhilasha , Koka Sai S
Published: April 2022

Background:
The intestinal microbe-derived metabolite trimethylamine N-oxide (TMAO) is known to the increase risk of cardiovascular diseases (CVDs). Endothelial dysfunction is associated with most forms of CVDs and is characterized by damage to the endoplasmic reticulum (ER). The current study was aimed to investigate the involvement of endoplasmic reticulum stress (ERS)-mediated protein kinase R-like endoplasmic reticulum kinase (PERK) signaling in TMAO induced endothelial dysfunction.

Methods and Results:
Biochemical analysis showed that PERK, CHOP, IRE-1α, AFT-4, eIF2 α which are indicative of ER stress, increased significantly in a dose dependent manner in response to TMAO treatment in endothelial cells. Western blot and immunofluorescent analysis showed significant increase in the phosphorylation of PERK and eIF2α along with upregulation of CHOP, IRE-1α and AFT-4 in TMAO group (30μM) compared to the control group (n=4/group; p<0.05). TMAO (30μM) treatment for 24h induced mitochondrial dysfunction as evidenced by decreased mitochondrial membrane potential, increased mitochondrial ROS levels, and also enhanced endothelial cell permeability compared to the control (n=6/group; p<0.05) . Furthermore, treatment with a PERK inhibitor (GSK2606414, 50nM, 24h) inhibited TMAO-induced phosphorylation of ER stress-related proteins, PERK and eIF2α and downregulated IRE1α, AFT-4 and CHOP and protected against increased endothelial cell permeability and mitochondrial ROS production.

Conclusion:
Our findings suggest that TMAO induced endothelial dysfunction through the ER stress-mediated PERK- eIF2 α -ATF4signaling pathway. Treatment with PERK inhibitors like (GSK2606414) could be a novel therapeutic strategy in TMAO-induced endothelial dysfunction.
Abstract 14076: Freeze-Dried Human Placental Mesenchymal Stem Cell Prevents the Progression of Acute Respiratory Distress Syndrome in Rats
Authors: Kipshidze Nodar , Kakabadze Zurab , Paresishvili Tea , Chakhunashvili David , Kipshidze Nicholas
Published: April 2022

Introduction:
Acute respiratory distress syndrome (ARDS) is one of the main causes of mortality in patients with COVID-19. Despite numerous studies, therapies for ARDS in COVID-19 remain significantly limited. Currently, there have been reports of the efficient use of mesenchymal stem cell (MSC) for the treatment of ARDS. Several studies have reported that MSC produces anti-inflammatory cytokines, promotes the maturation of dendritic cells, and modulates NK cells. The safety of MSC therapy has been demonstrated in early-stage clinical studies with a relatively small number of patients. We investigated the influence of freeze-dried human placental mesenchymal stem cells (HPMSC) in a preclinical rodent model of ARDS.

Methods:
Sixty rats were randomly divided into three groups of 20: the first group was the control, the second group received dexamethasone, and the third group received HPMSC.

Results:
Survival was highest in the HPMSC group (75%, 95%CI: 50, 88) when compared to the control group. In a cox regression model, mortality of HPMSC group (HR: 11.30 [95% CI: 4.05, 31.50]) when compared to control was statistically significant (p < 0.001). Mortality in the dexamethasone (HR: 64.25 [95% CI: 32.71, 126.19]) was not statistically significant (p = 0.199). Plasma serum TNF-α levels were statistically significant in the HMPSC group when compared to the control (p < 0.001) and dexamethasone group (p < 0.001). Single factor ANOVA comparing TNF-α levels between all groups was also significant (p < 0.0001). Trends (Table 1) indicated that plasma serum cytokine levels for TNF-α, IL-1β, and Il-6 were less in the HPMSC group than the control and dexamethasone groups.

Conclusions:
These experiments demonstrated that HPMSC significantly decreased mortality, endogenous intoxication, and a reduction in the release of pro-inflammatory cytokines. The freeze-dried placental stem cell is a promising biomaterial that can be used nebulized for the treatment of coronavirus disease.
Abstract 14079: Targeted Deletion of Cardiac miR-17-92 Cluster Exacerbates Ischemic Myocardial Injury in Diabetic Mice Through Induction of Sphingolipid Biosynthesis and Cardiomyocyte Inflammation
Authors: Samidurai Arun , Roh Sean , Yerramothu Shruti , Cowart Lauren , Salloum Fadi N , Das Anindita
Published: April 2022

Background:
The miR-17-92 cluster is indispensable for normal cardiac development and its deletion leads to cardiovascular disease. Aberrancies in bioactive sphingolipid metabolism, specifically ceramide (CER), contribute to diabetic cardiomyopathy, where induction of ceramide synthases (CerS) predicts elevated risk of cardiovascular complications. We investigated the role of miR-17-92 in suppression of ceramide synthesis to attenuate cardiac inflammation following myocardial ischemia/reperfusion (I/R) injury in diabetic mice.

Methods and Results:
Hearts from adult high-fat-diet fed diabetic tamoxifen-inducible cardiac-specific miR-17-92-deficient (miR-17-92-def) and wild type (WT) mice were subjected to 30 min of myocardial ischemia (I) and 60 min of reperfusion (R) in Langendorff mode. Myocardial infarct size was exacerbated with severe ventricular dysfunction in diabetic miR-17-92-def mice as compared to diabetic WT mice (
Fig. A
). Cardiomyocytes isolated from diabetic miR-17-92-def and WT mice were subjected to 40 min simulated ischemia and 2-hr reoxygenation (SI/RO). Immunofluorescence staining demonstrated an enhanced inflammasome formation with ASC (apoptosis speck-like protein with a caspase recruitment domain) aggregation (
Fig. B
) and caspase-1 activation (
Fig. C
) following SI/RO in cardiomyocytes isolated from diabetic miR-17-92-def mice. Lipidomics analysis revealed that C16:0 ceramide, a product of Ceramide Synthase 6 (CerS6), was induced after I/R injury and was more prominent in the hearts of diabetic miR-17-92-def mice (Fig. D). Western blot analysis revealed that CerS6 expression was nearly undetectable in the hearts of diabetic WT mice, but was dramatically induced by I/R in diabetic miR-17-92-def mice (
Fig. E
).

Conclusion:
The deletion of cardiac miR-17-92 exacerbates myocardial I/R injury under diabetic condition through accumulation of CER by inducing CerS6 and stimulating inflammation in cardiomyocytes.
Abstract 14091: Systemic Hypoxemia Induces Cardiomyocyte Cell Cycle Re-Entry but Few Myocytes Appear to Truly Divide
Authors: Johnson Jaslyn , Yang Yijun , Gross Polina , Eaton Deborah , Schena Giana , Berretta Remus M , KUBO Hajime , Mohsin Sadia , Tian Ying , Houser Steven R
Published: April 2022

Rationale:
The adult mammalian heart has a very limited capacity to regenerate cardiomyocytes that die from pathological damage. Several studies suggest that those few new myocytes found after injury are derived from pre-existing cardiomyocytes. A recent study suggests that systemic hypoxemia in adult mice can induce their cardiac myocytes to reenter the cell cycle and form two daughter cells. The goal of the present experiments was to determine if hypoxemia can induce adult murine cardiomyocytes to reenter the cell cycle and divide.

Hypothesis:
Hypoxia induces adult cardiomyocytes to complete the cell cycle and form new cardiac myocytes.

Methods and Results:
EdU mini pumps were implanted in 2-month-old C57BL/6 mice. Mice were then placed in a hypoxia chamber and the oxygen was lowered by 1% every day for 14 days to reach a final concentration of 7% oxygen. The animals remained in hypoxia (7% Oxygen) for 2 weeks and then were euthanized. Hypoxic mice had an increase in heart weight and echocardiography documented an increase in cardiac pump function and LV wall thickness when compared to control mice. Analysis of isolated cardiac myocytes in C57BL/6 animals showed an increase in EdU+ cardiomyocytes in hypoxemia and DAPI fluorescence intensity was also increased in these EdU+ myocytes which may indicate DNA synthesis. In fixed heart tissue sections, hypoxic mice contained more EdU+ myocytes and had an increase in the total amount of EdU+ cells in the heart. To further evaluate cardiomyocyte proliferation, we employed a mosaic mouse model with double markers (MADM) in which myocytes entering the cell cycle express both red fluorescent protein (RFP) and green fluorescent protein (GFP) and therefore are yellow in color. When cells complete the cell cycle and divide they express only RFP or GFP. MADM mice were exposed to hypoxia at 7% Oxygen as described above. MADM mice subjected to hypoxemia had increased numbers of yellow myocytes versus controls. There was a much smaller number of hypoxic myocytes with just RFP or GFP.

Conclusion:
Systemic hypoxia induces cardiac myocyte cell cycle re-entry and DNA synthesis, but it seems that very few of these myocytes complete the cell cycle and divide into two daughter cells.
Abstract 14094: Characterizing Dual Combination Therapy Use In Treatment Escalation Of Hypertension: Real-world Evidence From Multinational Cohorts
Authors: Lu Yuan , Li Jing , Wang Xialin , Dorajoo Sreemanee , Feng Mengling , Hsu Min-Huei , Hsu Jason C. C , Hwang Jiyoung , Iqbal Usman , Chen Zhengfeng J , Jonnagaddala Jitendra , Li Yu-Chuan Y , Liaw Teng , Ngiam Kee Yuan , Nguyen Phung-Anh , Park Rae Woong , Pratt Nicole , Reich Christian , Rhee Sang Youl , Sathappan Selva M , Tan Hui Xing , You Seng Chan , Zhang Xin , Krumholz Harlan M , Suchard Marc , Liu Yun , Zandt Mui Van , Xu Hua
Published: April 2022

Introduction:
Over one billion adults have hypertension globally, of whom 70% cannot achieve hypertension control with monotherapy. Data are lacking on patterns of dual combination therapies prescribed to patients who escalate from monotherapy.

Methods:
We described dual combination therapy utilization using eleven electronic health record databases covering 118 million patients across eight countries. We identified patients who newly initiated dual combination of four most commonly used antihypertensive drug classes (angiotensin-converting enzyme inhibitor [ACEi] or angiotensin receptor blocker [ARB]; calcium channel blocker [CCB]; beta-blocker; and thiazide or thiazide-like diuretic) after being on monotherapy.

Results:
We identified 980,648 patients with hypertension initiating dual combination therapy with antihypertensive agents after being on monotherapy: 12,541 from Australia, 6,980 from South Korea, 2,096 from Singapore, 7,008 from China, 16,663 from Taiwan, 103,994 from France, 76,082 from Italy, and 754,137 from the United States (US). Significant variations in treatment utilization existed across countries and patient subgroups. In Australia and Singapore, starting an ACEi/ARB monotherapy followed by a CCB was most common while in South Korea, China and Taiwan, starting a CCB monotherapy followed by an ACEi/ARB was most common. In Italy, France, and the US, sequential use of an ACEi/ARB monotherapy followed by a diuretic was most common. Younger patients were more likely to be prescribed ACEi/ARB followed by either a CCB or a diuretic compared with older patients. Women were more likely to be prescribed diuretics then an ACEi/ARB or a CCB compared with men.

Conclusion:
A large variation in the transition between monotherapy and dual combination therapy for hypertension was observed across countries. These results highlight the need for future research to identify which dual combination therapy is most effective for which patients.
Abstract 14096: Heart Rate Variability in Post-COVID-19 Recovered Subjects Using Machine Learning
Authors: Kunal Shekhar , Shetty Manu K , Shah Bhushan , Girish MP , BANSAL ANKIT , Batra Vishal , Mukhopadhyay Saibal , Yusuf Jamal , Gupta Anubha , Gupta Mohit
Published: April 2022

Introduction:
A significant proportion of patients recovering from COVID-19 infection experience symptoms attributable to autonomic cardiovascular dysregulation. Heart rate variability (HRV) is a non-invasive marker of cardiovascular dysautonomia. Machine learning (ML) models based on HRV can be used to identify post COVID-19 patients with autonomic dysfunction.

Methods:
We evaluated HRV and blood pressure (BP) responses to orthostatic stress (3-min active standing) in 92 patients within 30-45 days of recovery from COVID-19 infection and 120 healthy controls. HRV was evaluated based on 12-lead electrocardiogram over a 60 second period during supine paced breathing. Lead II was used to extract ECG features including (a) average RR interval, (b) R wave height, (c) Heart Rate (HR) standard deviation and (d) HRV root mean square [HRV-RMS]. We also assed for (1) orthostatic hypotension (OH; >20/10 mmHg fall in BP) and (2) postural orthostatic tachycardia syndrome (POTS; HR increase >30 bpm without OH). Using ML, eleven candidate features were tested with eight algorithms (logistic regression, RandomForests, CatBoost, XGBoost, Extra-tree classifier, Multiple Perceptron (ANN), Support Vector Machines and AdaBoost Classifier) to distinguish between COVID-19 recovered and healthy controls.

Results:
HRV was significantly lower in post COVID-19 recovered subjects as compared to healthy controls (6.25+4.9 ms vs 9.8+8.9 ms; P<0.001). OH was reported in 12 patients (13.1%) while two patients (2.2%) had POTS. Patients with OH had a significantly lower HRV as compared to those without OH (3.29+3.16 ms vs 6.69+5.01 ms; P=0.025). Accuracy of various ML models varied between 67-80% with multiple perceptron being top model [80% weighted accuracy, AUC: 79.8%, Matthews’s correlation coefficient: 0.59]. Permutation importance feature ranking showed HRV, Average RR and HR to be top feature that distinguish between COVID-19 recovered and healthy controls.

Conclusions:
A significant proportion of COVID-19 recovered patients experienced autonomic dysfunction as evident by lower HRV and presence of OH and POTS. ML model can help in early identification of autonomic dysfunction thereby leading to proper management in these patients
Abstract 14581: Impact of Heart Failure on 30-day Readmissions After Transcatheter Left Atrial Appendage Occlusion With the Watchman Device
Authors: Abumoawad Abdelrhman , Shatla Islam , Wahood Waseem , Nagy Ahmed , Beran Azizullah , Mhanna Mohammed , Barssoum Kirolos , Rayes Hamza A , Peri-okonny Poghni A , Magalski Anthony , Yousuf Omair , Lopez-candales Angel
Published: April 2022

Background:
The Watchman device reduces the risk of stroke in select patients with atrial fibrillation (AF). AF commonly coexists with heart failure (HF) and these conditions harbor interrelated pathophysiological mechanisms and treatment strategies., the impact of comorbid heart failure on outcomes in patients with AF undergoing Watchman device implantation remains unclear.

Methods:
We identified patients from the Nationwide Readmission Database who underwent Watchman device placement between 2014-2018 using ICD-9 and 10 codes. Patients were classified into 2 groups based on the presence of HF. Outcomes were all-cause and cause-specific 30-day readmissions and mortality rate during readmission. Kaplan-Meier analysis was used to assess the association of HF with 30-day hospital readmission.

Results:
We identified 18,349 recipients, 13,180 had no heart failure (NHF) while 5169 had HF. Mean age was similar between both groups. A total of 789 (5.9%) were readmitted within 30 days in the NHF compared to 439 (8.5%) in the non HF (NHF) group, The 30-day readmission rate was higher and Length of the stay was slightly longer in HF group. Prior stroke was more prevalent in the NHF group. Coronary artery disease, smoking, prior ICD, and obesity were more prevalent among HF group as demonstrated in table 1. The most common causes of readmissions for NHF vs HF were (acute heart failure: 15 vs 30%, p<0.001), (GI bleed: 19 vs 23%, P=0.16), and (AKI: 19 vs 27%, P<0.002). No difference in mortality or time-to readmission observed between both groups (Fig.1).

Conclusion:
In this analysis, post-Watchman 30-day readmission frequency was higher in patients with HF compared with NHF, though the time-to readmission was similar. Interestingly, 1 in 7 patients with NHF at baseline was readmitted with acute HF. Additional studies are now needed to identify which triggers are responsible for these readmissions so that effective preventive efforts can be instituted to reduce these readmissions.
Abstract 8925: Current Clinical AF Treatment Targets Do Not Reflect Patient Priorities
Authors: Zenger Brian , Zhang Yue , Millar Morgan , Bunch T. J , Piccini Jonathan P , Hess Rachel , Steinberg Benjamin A
Published: April 2022

Background:
AF clinical trials define success as freedom from any AF episode >30 seconds. Clinically AF treatment is geared towards managing patient symptoms, yet little is known about patients’ expectations for successful AF treatment.

Objective:
Determine patient expectations for successful AF treatment.

Methods:
Patients with an AF diagnosis from a tertiary electrophysiology clinic were asked to complete the Toronto Atrial Fibrillation Severity Scale (AFSS) from the perspective of current symptoms, worst ever symptoms, and expected symptoms after successful treatment. Survey and patient clinical data were linked through the EMR.

Results:
Of the survey respondents (n=27), 41% were female, mean age was 69 (SD 9.7 years), and 30% had prior ablation. Overall, 59% of these patients considered AF treatment successful even with AF occurring one per year or more, and 70% would still consider treatment successful with episodes lasting minutes or more. When selecting the most important factor of success, 80% of patients selected decrease in AF frequency, 20% selected decrease in severity of symptoms, and 0 selected decrease in episode duration. A minority of patients (19%) considered treatment successful only if they never had AF again.

Conclusion:
A small minority of patients with AF would consider their treatment successful if they never experienced an AF episode again, which contradicts our current assessment of AF treatments. If confirmed in larger cohorts, these data support redesigning AF clinical studies to match outcomes prioritized by patients.
Abstract 8931: The Role of Preoperative Hypertension on Neurocognitive Decline After Cardiac Surgery
Authors: Phillips Ronald K , Feng Jun , Shi Guangbin , Sellke Nicholas C , Scrimgeour Laura A , Ehsan Afshin , Sellke Frank W
Published: April 2022

Introduction:
Up to 80% of patients experience postoperative neurocognitive decline (pNCD) after cardiac surgery with cardiopulmonary bypass.

Objective:
We sought to identify the role of pre-op blood pressure (BP) control in pNCD and describe potential contributing mechanisms.

Methods:
Eligible patients undergoing cardiac surgery with the use of CPB were administered the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) preoperatively and at post-op day 4. We examined 31 patients in this pilot study, of whom 13 experienced pNCD. The highest systolic BP measured within 3 months (maxBP), and the average BP (aBP) taken at clinic visits within 1 year of surgery were used as metrics for BP. T-tests, chi-squared tests, and regression analyses were used. Blood samples were collected 6 hours preoperatively and at postop day 4 to assess cytokine levels (TNFa, C3a, CRP, IL-6) and mRNA expression using Applied Biosystems™ Clariom™ D Pico Assay.

Results:
Patients who maintained an aBP of ≥130mmHg had greater RBANS deficit than their counterparts (n=19, n=12 respectively; p<0.005). There was also a linear relationship between aBP and RBANS score deficit (F<0.04, adjusted R=11%). These relationships persisted within the younger half patients (n=16, p<0.01) vs. older (n=15, p=0.16). Of patients with stage 2 hypertension or above (≥140mmHg, N=12) 67% experienced pNCD vs. 26% (p=0.02). Within hypertensive patients postoperatively, C3a was upregulated in patients who experienced pNCD (p<0.04). Upon genomic analysis, macrophage markers were uniquely upregulated preoperatively, and genes involved in heme biosynthesis, glutathione synthesis, IL-10 inflammatory attenuation, and oxidative stress attenuation were downregulated postoperatively among patients who maintained an aBP of ≥130mmHg.

Conclusions:
BP control prior to surgery may play a role in pNCD. Genomic analysis explains a mechanism: upregulated immune response markers preoperatively and a weaker attenuation of oxidative stress and inflammation postoperatively. These effects are more robust among younger patients. The stage of preoperative hypertension may also influence the frequency of pNCD.
Abstract 8938: The New Myokine Myonectin is Significantly Associated with Type 2 Diabetes in Elderly Patients
Authors: Leiherer Andreas , Muendlein Axel , Geiger Kathrin , Saely Christoph H , Larcher Barbara , Mader Arthur , Maechler Maximilian , Sprenger Lukas , Mutschlechner Beatrix , Benda Magdalena , Fraunberger Peter , Drexel Heinz
Published: April 2022

Introduction:
The novel myokine myonectin is predominantly expressed in skeletal muscle and is involved in the regulation of metabolic homeostasis. A putative association between myonectin and type 2 diabetes mellitus (T2DM) has been discussed controversially in current literature.

Hypothesis:
We hypothesize that there is an association between myonectin and T2DM at different ages - this is addressed in the present study.

Methods:
We measured myonectin in 410 vascular risk patients with a mean age of 66 years.

Results:
Myonectin did not correlate with age (r=-0.19; p=0.697). From our patients 219 (53%) were >65 years, with a mean age of 74 years and 191 ≤65 years, with a mean age of 57 years. The prevalence of T2DM was 40.6% vs. 42.4% in the older as compared to the younger age group. Myonectin concentrations were significantly decreased in elderly patients with T2DM compared to non-diabetic subjects (1.8 vs. 4.2 ng/ml; p=0.002), whereas no significant difference was observed in younger patients (2.6 vs. 2.3 ng/ml; p=0.183). Concordantly, regression analysis revealed an unadjusted odds ratio (OR) of 0.24 [0.07-0.81] (p=0.021) for the association between myonectin and T2DM in elderly patients but not in younger patients (OR=1.08 [0.80-1.45]; p=0.609). The association between myonectin and T2D remained significant after adjusting for sex, body mass index, LDL cholesterol, HDL cholesterol, current smoking, as well as statin intake in elderly but remained non-significant in younger patients (OR=0.23 [0.07-0.81]; p=0.021 vs. OR=1.05 [0.76-1.46]; p=0.769).

Conclusions:
We conclude that plasma myonectin levels are significantly associated with T2DM, particularly in elderly vascular risk patients.
Abstract 8941: Efficacy and Safety of Mechanical versus Manual Compression in Cardiac Arrest and Cardiogenic Shock Patients
Authors: Nagasaka Takashi , Takama Noriaki , Koitabashi Norimichi , Aihara Kazufumi
Published: April 2022

Introduction:
Mechanical chest compression (MCC) provides consistent pressure and timing of each chest compression in line with latest evidenced-based practice. However, there has few evidence about the effectiveness of the mechanical device compared with manual chest compression. Furthermore, few studies focused on cardiogenic shock and cardiac arrest related to heart disease.

Hypothesis:
The aim in this study is to assess the effectiveness and safety of resuscitation strategies using MCC versus resuscitation strategies using standard manual chest compressions in patients with out of hospital cardiogenic shock and cardiac arrest due to heart disease.

Methods:
We conducted a retrospective observational study of comparing the outcomes of mechanical and manual chest compressions at our hospital. A total of 69 consecutive patients with out of hospital cardiogenic shock and cardiac arrest were enrolled between April 2014 and May 2018. 39 patients of them received only manual cardiopulmonary resuscitation (CPR) and 30 utilized a mechanical CPR device (LUCAS® Lund University Cardiac Arrest System, USA) during the resuscitation. Baseline characteristics, resuscitation details, and outcomes were compared between patients who received manual (manual group) and mechanical compressions (MCC group).

Results:
There was no significant difference in age, gender, the rate of bystander CPR, and arterial blood gases at baseline. No differences were found for the rate of ROSC and 30-day survival between two groups (manual group 42.8% vs MCC group 50.1% p=0.13). However, MCC group had significantly higher rate of bleeding events than manual group. In addition, fifty-four patients of them were treated for cardiac arrest or refractory cardiogenic shock with venoarterial extracorporeal membrane oxygenation (VA-ECMO). Among patients underwent VA-ECMO, the rate of 30-day survival was significantly lower in MCC group. (manual group 26.8% vs MCC group 39.1% p=0.014).

Conclusions:
This study showed that mechanical chest compression in cardiac arrest and cardiogenic shock increased bleeding events than manual chest compression. Furthermore, in the patients underwent ECMO, the use of mechanical chest compression might be associated with higher mortality.
Abstract 8943: Type 2 Diabetes and Risk of Major Cardiovascular Events in Peripheral Artery Disease versus Coronary Artery Disease Patients
Authors: Saely Christoph H , Vonbank Alexander , Larcher Barbara , Mader Arthur , Maechler Maximilian , Sprenger Lukas , Mutschlechner Beatrix , Benda Magdalena , Leiherer Andreas , Muendlein Axel , Drexel Heinz
Published: April 2022

Introduction:
The prevalence of type 2 diabetes (T2DM) is higher in peripheral artery disease (PAD) than in coronary artery disease (CAD) patients, and PAD overall confers higher cardiovascular risk than CAD.

Hypothesis:
We hypothesize that the incidence of major cardiovascular events compares between PAD and CAD patients when analyses are stratified by the presence of type 2 diabetes (T2DM).

Methods:
We prospectively recorded major cardiovascular events and death over 10.0±4.7 years in 923 patients with stable CAD, of whom 26.7% had T2DM and in 292 patients with PAD, of whom 42.1% had T2DM. Four groups were analyzed: CAD patients without diabetes (CAD/T2DM-; n=677), CAD patients with T2DM (CAD/T2DM+; n=246), PAD patients without diabetes (PAD/T2DM-; n=169) and PAD patients with T2DM (PAD/T2DM+; n=123).

Results:
When compared to the incidence of MACE in CAD+/T2DM- patients (25.1%), it was significantly higher in CAD+/T2DM+ patients (35.4%; p<0.001), in PAD+/T2DM- patients (30.2%; p=0.022) and in PAD+/T2DM+ patients (47.2%; p<0.001). Patients with both PAD and T2DM in turn were at a higher risk than CAD+/T2DM+ or PAD+/T2DM- patients (p=0.001 and p<0.001, respectively). The incidence of MACE did not differ significantly between PAD+/T2DM- and CAD+/T2DM+ patients (p=0.413). Compared to patients with CAD, Cox regression analyses after multivariate adjustment showed an adjusted hazard ratio of 1.46 [1.14-1.87], p=0.002 for the presence of PAD. Conversely, T2DM increased the risk of MACE after multivariate adjustment in CAD and PAD patients (adjusted HR 1.58 [1.27-1.98], p<0.001).

Conclusions:
In conclusion, our data show that T2DM and the presence of PAD are mutually independent predictors of MACE. Patients with both PAD and T2DM are at an exceedingly high risk of MACE.
Abstract 8956: Association of Serum Irisin Levels with Inflammatory, Biochemical, and Cardiac Imaging Parameters in Patients With Chronic Heart Failure versus Controls
Authors: Luna-Ceron Eder ,   Anna S. Huerta-Delgado,   Daniel N. Roffe-Vazquez,   Adrian M. Gonzalez-Gil,   José R. Villarreal-Calderón,   Elena C. Castillo,   Christian Silva-Platas,   Cecilio Enriquez,   Erasmo de la Peña-Almaguer,   Guillermo Torre-Amione,   Gerardo de Jesus Garcia-Rivas,   Leticia Elizondo-Montemayor
Published: April 2022

Chronic heart failure (CHF) remains one of the most important causes of morbidity and mortality globally. Metabolic and energetic maladaptation has proven to play a critical in the progression of this condition. In this regard, evidence from preclinical studies has shown that irisin, a recently discovered adipomyokine involved in metabolic control, can induce positive cardioprotective effects by improving cardiac remodeling, cardiomyocyte viability, calcium delivery, and reduction of inflammatory mediators. However, data on the clinical associations between irisin levels and inflammatory and functional imaging parameters are scarce in CHF patients. 32 subjects diagnosed with CHF and 32 healthy controls were evaluated in a cross-sectional study. Serum irisin levels were significantly lower in patients with CHF (4.92, IQR [5.4] ng/ml) than controls (6.45, IQR [3.58] ng/ml). We identified a positive correlation between irisin levels and LVEF (R=0.3), fraction shortening (R=0.4), and body fat percentage (R=0.4). In contrast, a negative correlation between irisin levels and BNP (R=-0.4), insulin levels (R=-0.1), and HOMA index (R=-0.2) was reported. Subjects with CHF showed higher levels of TNF-α (22.05 IQR [12.28] pg/ml) and IL-12p70 (5.58 IQR [4.47] pg/ml) in comparison with controls (9.77 IQR [6.24] and 3.05 [1.90] pg/ml ), while controls showed higher levels of IL-10 (16.27 IQR [10.82] pg/ml) in comparison with CHF cases (7.51 IQR [8.47] pg/ml). However, we did not observe significant correlations between irisin levels and inflammatory cytokines. Irisin levels are possibly reduced in patients with CHF due to the intrinsic energetic and metabolic adaptations that occur as a result of the reduction of cardiac output. Reduced irisin levels play a synergic role with the effects of proinflammatory mediators by hazarding the cardiomyocyte viability, adaptation to ventricular remodeling, and response to fibrosis. This additional damage continues compromising cardiac dynamical parameters creating a vicious cycle.
Abstract 8958: Cystatin C is Superior to Creatinine in Risk Prediction After Transcatheter Aortic Valve Replacement
Authors: Kuwabara Kensuke , Zen Kan , Yashige Masaki , Takamatsu Kazuaki , Ito Nobuyasu , Kadoya Yoshito , Yamano Michiyo , Yamano Tetsuhiro , Nakamura Takeshi , Yaku Hitoshi , Matoba Satoaki
Published: April 2022

Introduction:
Cystatin C is an alternative marker of renal function less influenced by age, sex, race, and muscle mass compared with creatinine. No data has been reported about the prognostic meaning of chronic kidney disease classification by cystatin C-based estimated glomerular filtration rate (CKD
Cys
classification) in patients undergoing transcatheter aortic valve replacement (TAVR).

Objective:
The aim of this study was to compare the prognostic value of CKD
Cys
classification and classification by creatinine-based estimated glomerular filtration rate (CKD
Cr
classification) in the risk prediction after TAVR.

Methods:
We retrospectively analyzed consecutive 219 patients with symptomatic severe aortic stenosis who underwent TAVR in our institute between December 2016 and June 2019. Preoperative CKD
Cys
classification and CKD
Cr
classification were evaluated for their prognostic value of 2-year major adverse cardiovascular and cerebrovascular event (MACCE) after TAVR. MACCE was defined as the composite of all-cause mortality, myocardial infarction, cerebrovascular events, and rehospitalization for worsening congestive heart failure.

Results:
There were 59 MACCEs during the median follow-up period of 575.5days. CKD
Cys
classification not CKD
Cr
classification significantly stratified the risk of 2-year MACCE in patients after TAVR by log-rank test (P=0.002) (Figure 1). In multivariate Cox regression analysis, only CKD
Cys
classification stage 3b (hazard ratio=4.37; 95% confidence interval: 1.28 to 14.91; P=0.019) and CKD
Cys
classification stage4+5 (hazard ratio=3.72; 95% confidence interval: 1.06 to 12.99; P=0.040) were the independent predictors for MACCE after adjustment for potential confounders.

Conclusions:
The use of CKD
Cys
classification could provide better risk assessment than CKD
Cr
classification in patients undergoing TAVR. CKD
Cys
classification stage3b and stage4+5 correlated with adverse outcomes.
Abstract 8964: Remnant Cholesterol in Patients With Established Cardiovascular Disease Predicts Cardiovascular Events Both Among Patients With Type 2 Diabetes and Among Non-Diabetic Subjects
Authors: Mader Arthur , Sprenger Lukas , Vonbank Alexander , Larcher Barbara , Maechler Maximilian , Mutschlechner Beatrix , Benda Magdalena , Leiherer Andreas , Muendlein Axel , Drexel Heinz , Saely Christoph H
Published: April 2022

Introduction:
Remnant cholesterol, which is calculated as total cholesterol minus LDL cholesterol minus HDL cholesterol has attracted interest as a marker of cardiovascular event risk.

Hypothesis:
We hypothesize that remnant cholesterol has the power to predict cardiovascular events in patients with established cardiovascular disease.

Methods:
We enrolled 1822 consecutive patients with established cardiovascular disease, including 1472 with angiographically proven stable CAD and 350 with sonographically proven peripheral artery disease. Prospectively, cardiovascular events were recorded over a mean follow-up period of 6.2±3.2 years.

Results:
At baseline, remnant cholesterol was significantly higher in patients with T2DM (n=608) than in non-diabetic subjects (27±25 vs. 21±21 mg/dl; p<0.001). During follow-up, 584 of our patients suffered cardiovascular events; the event rate was significantly higher in patients with T2DM than in non-diabetic subjects (45.4 vs. 32.2%; p<0.001). Remnant cholesterol in Cox regression models adjusting for age, sex, hypertension, smoking, body mass index and LDL cholesterol independently predicted cardiovascular events in the total study population (standardized adjusted HR 1.15 [1.07-1.23]; p<0.001), and in patients with T2DM as well as in non-diabetic subjects (standardized adjusted HRs 1.17 [1.03-1.34]; p=0.013 and 1.12 [1.01-1.23]; p=0.028, respectively).

Conclusions:
From our data we conclude that remnant cholesterol in patients with established cardiovascular disease predicts cardiovascular events both among patients with T2DM and among non-diabetic subjects.
Abstract 8996: Efficacy and Safety of Direct Oral Anticoagulants in Those Identifying as Black or African-American: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Klein Max W , Skipina Travis , Schulman Sam , Gebel Martin , Budzikowski Adam
Published: April 2022

Introduction:
Direct oral anticoagulants (DOACs) are indicated for prevention of stroke in non-valvular atrial fibrillation (AF) and for both treatment and prevention of recurrence of venous thromboembolism (VTE). Very little is known about efficacy and safety of these agents in patients identifying as Black or African-American (AA), as landmark trials demonstrating their non-inferiority to vitamin K antagonists (VKAs) are notable for discrepancies in enrollment by patient’s race. As the primary efficacy and safety outcomes for both AF and VTE are similar, we hypothesized that the cumulative efficacy and safety of DOACs in AA patients would be similar to that of the general population.

Methods:
A systematic review was conducted of clinical trials that investigated the comparison between DOACs and VKAs in patients for both AF and VTE. The Mantel-Haenszel Method was used to estimate pooled risk ratios (RRs) and corresponding confidence intervals (CIs) for the efficacy and safety of DOACs in AAs compared to the general population. Primary efficacy outcome was defined as stroke or systolic embolism in AF or symptomatic, recurrent VTE. Primary safety outcome was defined as major bleeding in both AF and VTE.

Results:
Nine studies were used for meta-analysis, with 26 eliminated due to lack of randomization or subgroup data for AAs. A total of 80,688 of patients were analyzed with 1.67% being AA. Regarding efficacy, the RR for AAs using DOACs compared to VKAs was 0.98 (95% CI 0.62,1.55; I
2
=0%; p=0.94), while the RR for the entire population was 0.90 (CI 0.78,1.04; I
2
=41%; p=0.1). Regarding safety, the RR for AAs using DOACs compared to VKAs was 0.83 (CI 0.56,1.25; I
2
=0%; p=0.92), while the RR for the entire population was 0.78 (CI 0.65,0.93; I
2
=76%; p<0.01).

Conclusions:
The use of DOACs versus VKAs in AF and VTE for AAs results in similar efficacy to the general population. DOACs are non-inferior to VKAs with respect to safety outcomes in AF and VTE for AAs. It is uncertain why superiority of safety outcomes seen in the general population are not seen in the AA population, and will require further studies.