bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13868: Effects of Chronic Electronic Cigarette Vapor Exposures on the Cardiovascular Function in Rats
Authors: Dai Wangde , Shi Jianru , Carreno Juan , zhao Lifu , Kleinman Michael T , Herman David A , Johnson Rebecca M , Renusch Samantha , Hasen Irene , Ting Amanda , Kloner Robert A
Published: May 2021

Background:
We investigated the effects of chronic electronic cigarettes with nicotine (E-Cig) exposure on cardiovascular function in rats.

Methods:
Adult Sprague Dawley rats were exposed to either pure air (n=10) or E-Cig (n=14) for 12 weeks. After 12 weeks of exposure, flow-mediated vasodilation was measured in anesthetized rats with ultrasound to measure femoral artery diameter. Femoral artery flow velocity was measured before and 5 minutes after reperfusion of a 5-minute femoral artery occlusion. Cardiac function was assessed by echocardiogram. A Millar catheter was used to record systemic arterial and LV pressures. Cardiac output was measured using a themodilution catheter.

Results:
The femoral artery internal diameter and blood flow velocity were comparable between the 2 groups before and after artery occlusion. However, in the E-cig group, blood flow velocity significantly decreased from 55.5 ± 5.2 cm/s prior to occlusion to 41.3 ± 4.1 cm/s after reperfusion (p = 0.005); it remained similar prior to (47.8 ± 3.4 cm/s) and after (47.8 ± 5.5 cm/s) occlusion in the air group. There were no statistically significant differences in left ventricular diastolic and systolic dimensions, LV fractional shortening, heart rate or mean blood pressure (80 ± 3 mmHg in air and 79 ± 5 mmHg in E-cig group) , LV end-diastolic pressure (Ped), end-systolic pressure (Pes), peak -dP/dt, Tau, or cardiac output (48.3 ± 3.3 ml/min in air and 47.6 ± 3.9 ml/min in E-cig group) between the E-Cig and the pure air group. There was a trend toward a reduction in peak LV +dP /dt in the E-Cig group (5574 ± 341 mmHg/s) compared to the air group (6166 ± 238 mmHg/s). LV weight and wall thickness were similar between groups.

Conclusions:
Twelve weeks of E-Cig exposure did not affect heart rate or blood pressure; but did tend to reduce contractility. E-cigarette exposure slowed the flow-mediated blood flow velocity probably at a microvascular level, possibly by altering endothelial function.
Abstract 13886: Colchicine for Secondary Prevention of Adverse Outcomes From Cardiovascular Disease: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Zaman Ninad , Grewal Simran , Borgatta Louis , Nudy Matthew , Peterson Brandon
Published: May 2021

Introduction:
Recent evidence suggests colchicine may prevent adverse outcomes from cardiovascular disease (CVD). The objective of this study is to perform a meta-analysis of randomized controlled trials (RCTs) testing colchicine’s effect on CVD adverse events and mortality among participants with known CVD.

Methods:
All RCTs testing colchicine versus control were identified and included in the analysis. The endpoints of interest included CVD adverse events (a composite of acute coronary syndrome, cardiac arrest, acute heart failure and hospitalization, stroke, revascularization, and recurrent myocardial infarction), mortality, and gastrointestinal (GI) adverse events. The primary analysis calculated the summary odds ratio (OR) and 95% confidence intervals (CI) for each endpoint. A secondary analysis tested CVD adverse events for heterogeneity of treatment effect (HTE) using Chi
2
and I
2
tests.

Results:
9 RCTs (N = 7,031, mean follow-up 9 months) were identified comparing colchicine to control. Colchicine decreased the risk of CVD adverse events [OR 0.64, 95% CI 0.45-0.91]. Colchicine did not reduce all-cause mortality [OR 0.84, 95% CI 0.61-1.15]. GI adverse events were more likely in the colchicine group [OR 3.03, 95% CI 1.60-5.75, p = 0.0007; I
2
= 83%] but with significant HTE. When performing the test for subgroup differences, there was significant HTE between placebo and open-label trial for CVD events [Chi
2
= 10.55, p = 0.001, I
2
= 90.5%]. After excluding two open-label trials, colchicine reduced the risk of CVD events [OR 0.77, 95% CI 0.63-0.93].

Conclusion:
Colchicine was associated with reduced CVD adverse events, but not with reduced mortality, among patients with underlying CVD. Colchicine use was associated with increased GI adverse events. Further studies with longer follow-up times are needed to better understand colchicine’s role in the long-term prevention of CVD adverse events.
Abstract 13898: A Comparison of Rate Control Agents in Patients With Atrial Fibrillation: Follow-up Investigation of Affirm Study
Authors: Zaman Ninad , Naccarelli Gerald , Foy Andrew
Published: May 2021

Introduction:
There is limited data from randomized controlled trials comparing rate control agents in patients with atrial fibrillation (AF). We used patient-level data from the AFFIRM trial to compare outcomes in patients randomized to the rate control arm who were treated with a single rate control agent at baseline, including beta-blockers (BB), calcium channel blockers (CCB), or digoxin.

Methods:
Patient-level data from the AFFIRM trial was provided through the NHLBI BioLINCC biologic specimens and data repository information coordinating center. Different data sets were used to obtain the data for analysis. The independent variable for this analysis was the initial study drug used, which was classified as BB, CCB, or digoxin. The dependent variables were time to first hospitalization and time to death. Cox proportional hazards survival models were used to control for baseline differences between groups.

Results:
We analyzed 1144 out of 2027 participants assigned to the rate control group who were on a single rate control agent at the start of the trial. 485 (42.5%) participants were in the BB group, 344 (30%) in the CCB group, and 315 (27.5%) in the digoxin group. The mean age was 69.6 ± 8.0 and the majority of participants (62.9%) were male. Significant differences in baseline characteristics were present between groups, including sex, history of heart disease, left ventricular (LV) ejection fraction, LV diastolic dimension, and history of pulmonary disease. Hospitalization and death occurred in 55.9% and 12.5% of those in the BB group, 58.4% and 16.7% in the CCB group, and 55.2% and 21.1% in the digoxin group, respectively. After adjustment for differences in baseline characteristics, there were no significant differences in time to hospitalization or death for any group compared to another.

Conclusions:
In the AFFIRM trial, the initial rate control drug used was not associated with statistically significant differences in time to hospitalization or death after controlling for differences in baseline characteristics. There is limited data at present to guide the selection of rate control agents in patients with AF.
Abstract 13904: Ex vivo Biomechanical Analysis of Elastic Artificial Chordae Implantation for Beating-heart Transapical Mitral Valve Repair
Authors: Imbrie-moore Annabel M , Zhu Yuanjia , Park Matthew , Paulsen Michael J , Wang Hanjay , Woo Y Joseph Y
Published: May 2021

Introduction:
Beating-heart transapical mitral valve repair represents a significant advancement in the minimally invasive treatment of mitral regurgitation. However, current techniques require increased artificial chordae length and altered anchoring position, which may increase the stresses on the suture. We hypothesized that artificial chordae manufactured with increased elasticity will dampen sharp increases in force, thus theoretically increasing durability.

Methods:
Porcine mitral valves (n=3) were mounted in a heart simulator and isolated mitral regurgitation was induced by cutting posterior primary chordae. Each valve was first repaired with standard CV-5 polytetrafluoroethylene (PTFE) suture affixed to a 3D-printed anchor with an embedded high-resolution Fiber Bragg Grating sensor to measure forces (Fig A). The repair was then repeated with an elastic suture manufactured using a biocompatible silicone and designed with a cross-sectional area of 0.56mm
2
, a geometry calculated to result in a desired 10-15% strain at relevant forces (Fig B).

Results:
Both materials allowed for successful repairs: mitral leakage volume was reduced from 28.29±4.83ml to 1.26±0.99ml (
p
=0.009) with PTFE suture, and to 1.78±0.88ml (
p
=0.008) with the elastic suture, with no significant difference between the repairs. Normalized force tracings (Fig C, standard deviation is shaded) revealed that the elastic suture resulted in a significantly lower peak systolic force when compared to PTFE suture (0.23±0.04N vs 0.32±0.03N,
p
=0.007).

Conclusions:
Artificial chordae with increased elasticity compared to traditional PTFE suture can dampen sharp peaks in force, thus offering a promising advancement in improving transapical repair durability. This proposal has the potential to apply to open-heart artificial chordae implantation as well. Future work to optimize suture material and manufacturability will help translate this development into clinical use.
Abstract 13914: Ischemic Preconditioning Induces MG53 Secretion From the Heart Through H
2
O
2
/PKC-delta Signaling
Authors: Shan Dan , Zhang Yan , Xiao Rui-ping
Published: May 2021

Introduction:
Ischemic heart disease is the leading cause of morbidity and mortality worldwide. Ischemic preconditioning (IPC) is the most powerful intrinsic protection against cardiac ischemia/reperfusion (I/R) injury. Previous studies have shown that a multifunctional TRIM family protein, MG53 (or TRIM72), not only plays an essential role in IPC-mediated cardioprotection, but also as a myokine/cardiokine, can be secreted from the heart and skeletal muscle in response to metabolic stress in addition to its intracellular actions.

Hypothesis:
We hypothesized that IPC-mediated cardioprotection is causally related to MG53 secretion and figured out the underlying mechanism.

Methods and Results:
Using proteomic analysis in conjunction with genetic and pharmacological approaches, we examined MG53 secretion in response to IPC and explored the underlying mechanism using rodents in
in vivo
, isolated perfused hearts, and cultured neonatal rat ventricular cardiomyocytes. IPC profoundly increased perfusate MG53 levels in mouse hearts by 5.50 ± 0.32 and 4.26 ± 0.40 folds from baseline over 0-60 and 60-120 min of reperfusion, respectively. Mechanistically, IPC-induced MG53 secretion is dependent on H
2
O
2
-evoked, Src-mediated phosphorylation of PKC-δ-Y311. Functionally, systemic delivery of recombinant human MG53 proteins (rhMG53) to mimic elevated circulating MG53 not only restored IPC function in MG53-deficient mice, but also protected rodent hearts from I/R injury even in the absence of IPC. Treatment of rhMG53 overtly decreased the infarct size (IF/AAR) induced by I/R compared to the BSA-treated control group (11.9 ± 1.8% vs 27.3 ± 2.0%, P <0.01), and reduced the mortality from 44.7% to 5.3% in rats. Moreover, H
2
O
2
augmented MG53 secretion, and MG53 knockdown exacerbated H
2
O
2
-induced cell injury in human embryonic stem cell-derived cardiomyocytes.

Conclusions:
In conclusion, IPC and oxidative stress can trigger MG53 secretion from the heart via an H
2
O
2
-PKC-δ-dependent mechanism, and secreted MG53 acts as an essential factor conveying IPC-induced cardioprotection against ischemia/reperfusion injury. Recombinant MG53 proteins can be developed into a novel treatment for various diseases of human heart in which the endogenous MG53 is low.
Abstract 13924: Covid-19 Registry to Assess Frequency, Management, and Outcomes of Arterial and Venous Thromboembolic Complications (CORONA-VTE)
Authors: Piazza Gregory , Campia Umberto , Snyder Julia , Rizzo Samantha , Pfeferman Mariana , Leiva Orly , Fanikos John , Nauffal Victor , Almarzooq Zaid , Goldhaber Samuel Z
Published: May 2021

Introduction:
Cardiovascular complications, including myocardial infarction, ischemic stroke, and pulmonary embolism, represent an important source of adverse outcomes in COVID-19.

Hypothesis:
Arterial and venous thromboembolic complications are a common complication in COVID-19, especially in the cirtically ill and hospitalized populations.

Methods:
We analyzed a retrospective cohort of 1114 patients with COVID-19 diagnosed through our healthcare network. The total cohort was analyzed by site of care: intensive care (170 patients), hospitalized non-intensive care (229 patients), and outpatient (715 patients). The primary study outcome was a composite of adjudicated major arterial or venous thromboembolism.

Results:
Patients with COVID-19 were ethnically (22.3% Hispanic/Latinx) and racially (44.2% non-white) diverse. Cardiovascular risk factors of hypertension (35.8%), hyperlipidemia (28.6%), and diabetes (18.0%) were common. Prophylactic anticoagulation was prescribed in 89.4% of patients with COVID-19 in the intensive care cohort and 84.7% of those in the hospitalized non-intensive care setting. Frequencies of major arterial or venous thromboembolism, major cardiovascular adverse events, and symptomatic venous thromboembolism were highest in the intensive care cohort (35.3%, 45.9%, and 27.0 %, respectively) followed by the hospitalized non-intensive care cohort (2.6%, 6.1%, and 2.2%, respectively). The frequency of adverse events in the outpatient cohort was low.

Conclusions:
Major arterial or venous thromboembolism, major adverse cardiovascular events, and symptomatic venous thromboembolism occurred with high frequency in COVID-19, especially in the intensive care setting, despite a high utilization rate of thromboprophylaxis.
Abstract 13928: Subclinical Myocardial Dysfunction With Coronavirus Disease 2019
Authors: Strom Jordan B , Martin Lila M , Fostello Sarah E , Chang James D , Tsao Connie W , Manning Warren J
Published: May 2021

Background:
Coronavirus disease 2019 (COVID-19) is associated with cardiac injury and overt myocardial dysfunction. However, whether COVID-19 is associated with subclinical myocardial dysfunction is unknown.

Methods:
We evaluated patients hospitalized for COVID-19 referred for transthoracic echocardiography (TTE), between March 17 and May 22, 2020, with a left ventricular ejection fraction (LVEF) ≥ 50%. Controls in a 1:1 ratio were selected from patients receiving TTE during the same month. Global longitudinal strain (GLS) was used to assess the association of COVID-19 and subclinical myocardial disease.

Results:
Among 99 patients (49 cases, 50 controls), average GLS was significantly reduced in cases vs. controls (mean ± SD, -14.8 ± 4.0% vs. -21.1 ± 4.0%, p < 0.0001). A total of 82.8% of cases vs. 7.1% of controls had an average GLS below normal (> 18%; p < 0.0001), which persisted despite multivariable adjustment (
Table
). Among COVID-19 patients with a prior TTE, absolute average GLS decreased 3.2% (p = 0.008) despite no change in LVEF (p = 0.41). Average GLS was reduced in non-survivors compared with survivors (p = 0.04), though only septal wall thickness (p = 0.03) was associated with in-hospital mortality on multivariable analysis.

Conclusions:
Among hospitalized patients receiving TTE, COVID-19 is independently associated with subclinical left ventricular systolic dysfunction in the vast majority of patients, and subclinical LV dysfunction is associated with survival. The clinical implications of these findings should be evaluated in future longitudinal multicenter studies.
Abstract 13930: Sex and Race/Ethnic Differences in Primary Prevention of Atherosclerotic Cardiovascular Disease Among Patients Diagnosed With Hypertension
Authors: Glowacki Nicole E , Lauffenburger Julie , Siddiqi Alvia , Khatib Rasha
Published: May 2021

Introduction:
Randomized controlled trials evidence indicates that atherosclerotic cardiovascular disease (ASCVD) can be prevented in patients with hypertension if risk factors such as high blood pressure, high cholesterol, elevated glucose levels, and smoking are controlled. While it is known that sex and race/ethnic disparities persist for ASCVD, disparities in risk factor control have not been well-described in primary care.

Methods:
Hypertensive adult patients free of ASCVD were included in a retrospective analysis of electronic health record data from a large US integrated healthcare system from 2018. Patients were categorized based on achieving clinical practice guideline targets from their last available measurement including blood pressure <130/80 mm Hg; statin therapy among patients with indication (LDL-C >190, diabetic between ages 40-70, or with 10-year ASCVD score ≥7.5%), HbA1c of <7%, and not smoking. Multivariable Poisson regressions were developed to explore associations between achieving three targets (A1c reported separately among patients with value) and sex and race/ethnicity. Results are presented as relative risk (RR) and 95% confidence intervals (95%CI) and adjusted for age, obesity, years since hypertension diagnosis, and insurance, sex, insurance, preferred language.

Results:
Among women, African Americans were 11% more likely to fail to achieve the three targets (RR:1.11; 95%CI: 1.01-1.21). Among men, African Americans were 19% more likely to fail to achieve the three targets compared to Caucasian men (RR: 1.19; 95%CI: 1.05-1.35). The risk of failing to achieve the three targets was not statistically significantly different between Hispanic/Latino groups and Caucasians but trended to be smaller. Hispanic/Latino women (47.2%) and men (50.9%) had the highest proportions of failing to achieve HbA1c targets.

Conclusions:
Disparities were observed in control of ASCVD risk factors among hypertensive patients in primary care and were not fully explained by measured demographic or clinical characteristics. Monitoring of changes in disparities across sex, racial, and ethnic groups is important to ensure equity effectiveness as interventions to prevent ASCVD in primary care are developed, tested, and implemented.
Abstract 13939: Optimizing Telemetry Usage in Non-intensive Care Unit Patients Based on American Heart Association Guidelines: A Quality Improvement Initiative
Authors: Kansara Tikal , Ghosh Kuldeep , Majmundar Monil , Park Hansang , Lenik Joanna , Quesada Fernando , Azhar Abdullah Zoheb , Elmaaz Ahmed , valencia julio , Boma Noella , Visco Ferdinand , Chaudhari Shobhana
Published: May 2021

Introduction:
The overuse of hospital resources is a pervasive issue. Out of the $3.5 trillion, the United States spent on health care in 2017, 30 % was considered excess cost in complications and ancillary orders. Even with established guidelines and revisions over the past few years, overzealous use of telemetry is rampant.

Methods:
The study included observation and admitted patients in September and October of 2018 and 2019. Patients in 2018 constituted baseline cohort (BC) and patients in 2019 were intervention cohort (IC). Both observation and inpatient admissions were analyzed separately. In August 2019, a series of presentations regarding AHA telemetry guidelines and group training for the use of telemetry monitor and software was undertaken. A template was used to document telemetry which consisted of reason for telemetry and day of telemetry in daily progress notes. Daily report of telemetry was shared on secured messaging group for residents. A comparison was made between the cohorts.

Results:
516 patients were included in the study, 335 observation patients and 181 admitted patients. The number of patients on telemetry in combined IC (2019 patients) reduced by 31 % (34.32 % in observation group & 24.86 % in admission group). Taking an average of $ 272 per patient on telemetry (based on hospital billing data), the burden of cost reduced by $ 43,520 in the two months of 2019. “To rule out ACS” and “monitor for arrythmias” were the most common reason for telemetry use in observation and admitted inpatients in both cohorts. There was an increase of 14.59 % patients exceeding 48 hours on telemetry in inpatient admissions of IC. Telemetry triggers in notes (reasoning and justification) increased from 4.04 % to 37.08 %. All changes in IC occurred without any adverse outcome. The comparison is shown in Figure 1.

Conclusions:
Strict adherence to AHA guidelines improves the quality of care and is an effective means to reduce cost for hospitals without significant adverse events.
Abstract 13941: The Prevalence of Cardiovascular Disease in Patients With Von Willebrand Disease; A Potential Therapeutic Target
Authors: Mihyawi Nawfal , AJMAL MUHAMMAD , Hung Jun , Yeneneh Beeletsega T
Published: May 2021

Introduction:
Von Willebrand factor (vWF) plays an important role in the coagulation process at the site of vascular injury. It is unclear whether vWF deficiency is protective against cardiovascular disease (CVD) since investigations are limited in this entity.

Hypothesis:
Our study assessed the hypothesis that the prevalence of CVD is less in patients with than without Von Willebrand disease (vWD).

Methods:
We queried the National Inpatient Sample (NIS) from 2009-2014. Entire data was used with exclusion of patients below 18 and over 75-year-old. We defined cardiovascular disease as any event of myocardial infarction or a diagnosis of ischemic heart disease using the International Classification of Disease, 9th edition (ICD-9). The primary outcome of interest was to compare the odds ratio of CVD in patients with and without vWD.

Results:
A total of 224,475,443 weighted hospital discharge samples were identified. Of these, 82,809 carried a diagnosis of vWD. The odds of CVD were less common in vWD patients (OR 0.54; 95% CI 0.52 - 0.56) (table 1). After multivariate logistic regression analysis, with adjustment for age, gender and the most common CVD risk factors including hypertension, smoking, diabetes, hyperlipidemia, family history of CVD, chronic kidney disease and obesity the likelihood of CVD remained lower in vWD patients (OR 0.65; 95% CI 0.63-0.67) (table 2).

Conclusions:
Our study, the first to involve a large cohort of patients, demonstrated that vWF deficiency is associated with decreased prevalence of CVD. Hence, vWF could potentially be a therapeutic target in CVD management. More investigations are needed for confirmation of these findings and to determine causation.
Abstract 13949: Quantitative Assessment of the Left Atrial Appendage as a More Reliable Method of Thromboembolic Risk Stratification
Authors: Lee KEVIN , Trybula Michael , Slostad Brody D , Frazin Lee J , Konda Sreenivas , Macrinici Victor , Kansal Mayank M
Published: May 2021

Introduction:
Assessment of the left atrial appendage (LAA) in patients with atrial fibrillation (AF) undergoing cardioversion for thromboembolic risk stratification is inherently qualitative. Oftentimes, interobserver assessment may disagree, leading to differences in risk stratification and patient management. We propose a novel method of quantitative LAA assessment and examine its predictive value for future thromboembolic events.

Hypothesis:
Evaluation of LAA using ImageJ pixel density quantification software in patients with AF will be superior to qualitative assessment by expert readers in assessing and predicting future thromboembolic risk.

Methods:
A total of 124 patients (mean age 59 ± 13 years, 70% male) undergoing transesophageal echocardiography to exclude LAA thrombus prior to radiofrequency pulmonary vein isolation or electrical cardioversion for AF were retrospectively studied. LAA were examined by two expert readers and identified as thrombus (
n
= 9), sludge (
n
= 11), spontaneous echocontrast (
n
= 90), or normal (
n
= 138). LAA were then separately examined using ImageJ to calculate a gain-independent ratio between the average pixel density of the LAA cavity and the average pixel density of the LAA wall (C/W ratio).

Results:
There was significant disagreement between the two expert readers in LAA assessment (weighted Kappa 0.510,
p
< 0.0001). Qualitative LAA analysis was significantly related with C/W ratio (
p
< 0.0001) and thromboembolic events (
p
< 0.0002). C/W ratio was also significantly related with thromboembolic events (OR 1.60, 95% CI 1.095 - 2.347, p < 0.0152). According to Area Under the Curve (AUC) of the ROC curve, C/W ratio (AUC 0.73, 95% CI 0.60 - 0.86) was a more reliable predictor for future thromboembolic when compared to qualitative LAA assessment (AUC 0.72, 95% CI 0.53-0.90).

Conclusions:
Quantitative LAA assessment using the C/W ratio provided by ImageJ software is more reliable than qualitative assessment by expert readers for identifying future thromboembolic events while reducing reader variability.
Abstract 14034: Sustaining and Spreading Success: Longer Term Outcomes and Spread of a Multi-Center Quality Improvement Project to Reduce Post-operative Chest Tube (CT) Duration (on Behalf of the Pediatric Acute Care Cardiology Collaborative and Pediatric Cardiac Critical Care Consortium)
Authors: Sheth Shreya S , Kipps Alaina , Madsen Nicolas L , Khadr Lara , Graupe Margaret , Tignor Ashlin , FIGUEROA MAYTE , Greiten Lawrence , Hart Stephen , Jensen Megan , Mauney Jennifer A , Morse Taylor , Patel Madalsa , St John Amelia , Saudek David , Bates Katherine E
Published: May 2021

Introduction:
Using a collaborative learning model, we previously showed reduced post-operative CT duration and length of stay (LOS) after 10 STS benchmark surgeries. Here we report sustained gains across the original 9 centers (labeled era 1) and spread of the project (era 2) to 9 new centers in the PAC
3
-PC
4
network.

Methods:
Data on patients undergoing surgeries was collected across the two eras. Each era consisted of a baseline phase (era 1: 6/2017-6/2018, era 2: 5/2019-8/2019) and an intervention phase (era 1: 7/2018-3/2020, era 2: 9/2019-3/2020). The primary outcome was post-operative CT duration in hours, with aim of 20% reduction in the intervention vs baseline phases. Balancing measures included rate of reinsertion and readmission for effusion. The collaborative learning model included monthly webinars with peer support, data transparency, and QI education. Statistical process control methods and traditional statistics were used to analyze CT duration and LOS over time.

Results:
Among 3656 patients at 18 centers, demographics were comparable across eras. Era 1 cohort (n=2779) sustained a 23.5% reduction in CT duration (median 88.9 vs 67.9 hours, p=<.0001) and a 12.5% reduction in LOS days (median 8 vs 7, p=0.03). Era 2 cohort (n=877) showed a 6.95% reduction (median 68.3 vs 63.5 hours, p=0.03) in CT duration in the first 7 months of intervention phase. Across both eras, rates of reinsertion (1.77% vs 1.25%, p=0.48) and readmission for effusion did not change (1.26% vs 2.29%, p=1.00).

Conclusions:
In this multicenter prospective interventional cohort study, reductions in CT duration and LOS were sustained in 9 centers following a collaborative learning model, without adverse events. Nine new centers show promising early results, suggesting that this intervention can be spread successfully. With its use of phased spread, peer support, data transparency, and education, this project serves as a model for sustaining and spreading clinical quality improvement.
Abstract 14049: Correlation of Cellular Indices and D-dimer/fibrinogen Ratio to Gender Differences in 6-minute Walk Test Distance in Patients Presenting With Acute Pulmonary Embolism
Authors: Antonios Nathalie , Masic Dalila , Porcaro Katerina , Allen Sorcha , Marginean Alexandru , Manshad Ahmad , Kuhrau Shannon , Chowdhury Ibrahim , Merchant Karim , Chan Lucas , Morris Stephen , Haines Jeremiah , Fareed Jawed , Brailovsky Yevgeniy , Darki Amir
Published: May 2021

Introduction:
The six-minute walk test (6MWT) is a simple and well-validated test to assess functional status and predict morbidity and mortality in several chronic cardiopulmonary disease states. Neutrophil to Lymphocyte ratio (NLR) reflects a pro inflammatory state. Increased platelet to lymphocyte ratio (PLR) has been associated with increase in thrombus burden. Elevated D-dimer to fibrinogen ratio (D/f) reflects fibrinolysis activation. No study has investigated the correlation of these indices with gender differences in 6MWT in patients presenting with pulmonary embolism (PE).

Methods:
We retrospectively evaluated all acute PE patients from our Pulmonary Embolism Response Team Registry who completed a 6MWT during their initial hospitalization. Differential complete blood count data along with d-dimer and fibrinogen were collected within 24 hours prior to PE diagnosis.

Results:
A total of 186 patients underwent baseline 6MWT and lab tests between March 2016 and January 2020. The mean walking distance for males (765 ft) was further than females (519 ft; figure 1). NLR, PLR, and D/f did not correlate with 6MWT in males. In females, NLR, PLR, and D/f had a negative correlation with walking distance (r = -0.20, p <0.05; r = -3.0, p<0.01; and r = -0.15, p<0.05; figure 2)

Conclusions:
Female patients, in our study, had significantly shorter walking distance after acute presentation in PE. This may reflect higher inflammatory and prothrombotic state. Future studies will need to expand on these findings.
Abstract 14053: Problematic Feeding is Common and Related to Gastroesophageal Reflux in the First 6 Months After Neonatal Cardiac Surgery
Authors: Pados Britt F , Harrison Tondi M
Published: May 2021

Introduction:
Feeding problems are often reported in infants after cardiac surgery. To date, no studies have followed the development of feeding after cardiac surgery using valid and reliable measures.
Purpose:
To describe feeding problems and the relationship between feeding and gastrointestinal tract symptoms in infants over the first 6 months (mos) after neonatal cardiac surgery.

Methods:
Parents of neonates requiring cardiac surgery were invited to complete surveys when their infant was 2, 4, and 6 mos old. The survey included the Neonatal Eating Assessment Tool (NeoEAT), Infant Gastroesophageal Reflux Questionnaire – Revised (I-GERQ-R), and Infant Gastrointestinal Symptoms Questionnaire (IGSQ). Scores on the NeoEAT subscales (
Infant Regulation, Energy & Physiologic Stability, Gastrointestinal Tract Function, Sensory Responsiveness
, and
Compelling Symptoms of Problematic Feeding)
were categorized as problematic (≥ 90
th
percentile) or not problematic (< 90
th
percentile) based on reference data. Percent of the sample with problematic feeding at each time point was determined. Bivariate correlations were calculated between the NeoEAT, IGSQ, and I-GERQ-R.

Results:
27 parents completed the surveys, reporting on 6 infants with single ventricle and 21 with two ventricle conditions. Problematic feeding scores were common at all times and in both cardiac conditions. Problematic scores were reported on
Compelling Symptoms of Problematic Feeding
for 52% of the sample at 2 mos, 36% at 4 mos, and 22% at 6 mos. Problematic scores occurred in
Gastrointestinal Tract Function
for 22% at 2 mos, 10% at 4 mos, and 39% at 6 mos. Problems occurred in
Sensory Responsiveness
in 17% at 2 mos, 24% at 4 mos, and 33% at 6 mos.
Energy & Physiologic Stability
problems occurred in 13%, 10%, and 22%, respectively. None reported problems in
Infant Regulation
. Symptoms of gastroesophageal reflux (I-GERQ-R) were significantly correlated with the NeoEAT (
p
< .05), but gastrointestinal symptoms (IGSQ) were not.

Conclusions:
Problematic feeding is common in the first 6 mos after neonatal cardiac surgery and is related to gastroesophageal reflux symptoms. Some areas of feeding improved over time, while others worsened, likely related to developmental and disease-related changes.
Abstract 14054: Soluble ACE2, Cardiac Biomarkers, Structure, Function and Events: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Hussain Aliza , Tang Olive , Sun Wensheng , Jia Xiaoming , Selvin Elizabeth , Nambi Vijay , Folsom Aaron R , HEISS Gerardo M , Zannad Faiez , Mosley Thomas , Virani Salim S , Coresh Joseph , Boerwinkle Eric , Yu Bing , Cunningham Jonathan , Shah Amil M , Solomon Scott , De Lemos James A , Hoogeveen Ron C , Ballantyne Christie M
Published: May 2021

Introduction:
Membrane-bound angiotensin-converting enzyme 2 (ACE2) has been identified to a have prominent role in SARS-COV-2 infection and is an important counter-regulator of renin-angiotensin system. But the association of cleaved soluble ACE2 (sACE2) with cardiovascular disease (CVD) remains unclear. We sought to identify the association of sACE2 with cardiac biomarkers, structure, function and events in the Atherosclerosis Risk in Communities (ARIC) Study.

Methods:
sACE2 was measured in a subset of 497 patients from a case-control study of incident heart failure (HF) at visit 5 (2011-2013), mean age 78 (SD 5.4), 53% men and 27% black. We used linear regression to evaluate the associations of sACE2 with cardiac biomarkers (hs-cTnI, hs-cTnT, NT-proBNP) and echocardiographic parameters. We used Cox regression to evaluate associations of sACE2 with risk of HF hospitalization, global CVD events (CHD, ischemic stroke or HF hospitalization) and all-cause death.

Results:
Over a median follow up of 6.1 (4.6, 6.8) years, 282 global CVD events and 190 all-cause deaths occurred. sACE2 levels were higher in men, blacks, those with prevalent CVD, diabetes and hypertension. Higher sACE2 levels were associated with significantly higher hs-cTnI, hs-cTnT, NT-proBNP levels, greater left ventricular (LV) mass index, impaired diastolic function (
Table
) and increased risk for HF hospitalization (adjusted HR 1.32 per log unit increase, 95% CI 1.10-1.58), global CVD events (HR 1.34, 95% CI 1.13-1.60) and all-cause death (HR 1.26, 95% CI 1.01-1.57).

Conclusions:
In an elderly biracial cohort, sACE2 was positively associated with biomarkers reflecting myocardial injury and neurohormonal activation, LV mass index, impaired diastolic function, CVD events and all-cause death. Future research is needed to elucidate the significance of sACE2 in development of CVD, not only in patients with SAR—COV2 infection, but the general population
Abstract 14209: A New
in vitro
Methodology to Evaluate Blood Mononuclear Cells Regenerative Capacity in Diabetes Patients With Acute Myocardial Infarction
Authors: Salybekov Amankeldi A , Sakai Katsuaki , Natsumeda Makoto , Vorateera Kosit , Ikari Yuji , Asahara Takayuki
Published: May 2021

Introduction & Hypothesis:
Diabetes mellitus patients’(DMP) peripheral blood mononuclear cells (PBMNC) regenerative capacity level is impaired. An
in vitro
evaluation of PBMNC pre/post vasculogenic conditioning (VC) facilitates the assessment of immune cells regenerative potential (H1) and possible cell therapy for DMP with acute myocardial infarction (AMI) (H2).

Materials & Methods:
Eighteen DMP with the diagnosis of AMI enrolled. Blood drawn in heparin-coated syringes from AMI patients (between day 3 to 7) along with sixteen healthy control. Isolated PBMNC regenerative capability evaluated pre and post VC (
Fig 1
) with EPCs colony formation assay/unit (EPC-CFA/U) and flow cytometry analysis.

Results:
An
in vitro
EPC-CFA revealed that DMP fresh PBMNC derived definitive EPC (DEPC) decreased compared to control. The differentiation rate of EPC, definitive vs. primitive in control groups composed equal (50%, PEPC vs. 50%, DEPC) while in DMP, PEPC prevails (70% vs. 30%). After VC, DEPC-CFU markedly increased while PEPC-CFU decreased, indicating EPC qualitatively and quantitatively improvement in DMP (Control, PBMNC vs. VC P>0.001; DMP, PBMNC vs. VC, P>0.01). DMP glycoalbumin and Hb1Ac inversely correlated with CD34+ cells (r= -0.48, P>0.03) while VC recovered CD34+ cells (r= 0.17, P<0.54). ROC curve analysis also confirmed that the CD34+ cell number is an independent risk classifier of cardiac vessel lesion (AUC=0.85, P>0.002). In contrast, VC preserved from the senescence by expansion and differentiation of CD34+ (AUC=0.54, P<0.7). Proinflammatory M1 type significantly increased in DMP compared to Control (P>0.03), while VC shifted the M1 type phenotype toward M2 type (P>0001).

Conclusion:
Our EPC-CFA enables us to precisely assess impaired EPC function, while VC enhanced differentiation from PEPC toward DEPC. Furthermore, these methodologies facilitate the evaluation of RACs capacities such as EPC, M1/M2, and Treg cells in DMP with AMI for cell therapy.
Abstract 14213: Different Prognostic Value of Proteinuria According to the Severity of Heart Failure in Patients With Heart Failure With Preserved Ejection Fraction
Authors: Oeun Bolrathanak , Hikoso Shungo , Nakatani Daisaku , Mizuno Hiroya , Kitamura Tetsuhisa , Okada Katsuki , Dohi Tomoharu , Sotomi Yohei , Kida Hirota , Sunaga Akihiro , Sato Taiki , Yamada Takahisa , Yoshio Yasumura , Nakagawa Akito , Nakagawa Yusuke , Tamaki Shunsuke , Takaharu Hayashi , Yano Masamichi , Sakata Yasushi
Published: May 2021

Introduction:
Proteinuria reflects systemic inflammation and endothelial dysfunction, and is a prognosticator in heart failure with preserved ejection fraction (HFpEF). However, it remains elusive whether the prognostic impact of proteinuria is different according to the severity of HFpEF. Recently, we and other groups reported that echocardiographic diastolic dysfunction (DD) is a worse prognostic factor in HFpEF.

Objectives:
We aimed to clarify the prognostic value of proteinuria in HFpEF according to the severity of HFpEF. We used the evidence of DD as criteria of the severity of HFpEF.

Methods:
We assessed 575 discharged-alive patients (pts) in the PURSUIT-HFpEF registry. Pts were divided into 2 groups according to the absence (DD-) or presence of DD (DD+). DD was defined using the 2016 ASE recommendations. Each group was further classified into 2 subgroups according to the absence or presence of dipstick proteinuria (proteinuria trace or more). The study endpoint was a composite of all-cause mortality and HF hospitalization.

Results:
Median age 83 years and 58% female. The number of pts with DD-: 336 pts (221 pts: proteinuria-[G1], 115 pts: proteinuria+[G2]); and DD+: 239 pts (125 pts: proteinuria-[G3], 114 pts: proteinuria+[G4]). G4 had higher NT-proBNP level than G3, but not observed between G1 and G2. Proteinuria+ were more hypertensive, diabetic with worse renal function than proteinuria- in both DD-/DD+. The composite endpoint occurred more often in G4 than G3 (HR: 1.75, 95%CI: 1.18-2.62, log-rank P=0.005), but was similar between G1 and G2 (HR: 1.21, 95%CI: 0.76-1.92, log-rank P=0.431). Multivariable Cox regression adjusting for NT-proBNP, eGFR and other major confounding factors revealed that proteinuria was associated with the composite endpoint in DD+ (HR:1.85, 95% CI:1.16-2.93, P=0.009), but not in DD- (HR:0.96, 95% CI:0.55-1.69, P=0.900).

Conclusions:
Proteinuria may be an additive risk factor in pts with DD but not in those without DD in HFpEF.
Abstract 14226: Resilience in Young Adults With CHD: Predictors and Impact on Quality of Life
Authors: Cianciulli Alana , Ittenbach Richard , Combs Gabrielle , Randazzo Isabel , Licht Daniel J , Hampton Lyla , Gerdes Marsha , Bernbaum Judy C , Burnham Nancy , Gaynor James W
Published: May 2021

Introduction:
Resilience is the ability to recover after stressful events and is believed to help reduce the long-term adverse effects. The role of resilience as a determinant of neurodevelopmental (ND) outcomes and quality of life (QOL) in young adults with congenital heart disease (CHD) has not been fully delineated.

Hypothesis:
Higher resilience in young adults with CHD is associated with better QOL and can be predicted by patient factors and ND status in the preschool period.

Methods:
Prospective evaluation of subjects ≥ 18 years of age enrolled in a study of genetic determinants of ND outcome after repair of CHD at age ≤ 6 months. The subjects had previously undergone a ND evaluation (executive function, attention/impulsivity and social skills) at 4 years of age. For this study, subjects completed the RS-14, a questionnaire that captures the constructs of resilience; and the SF-36, a functional health status questionnaire. Factors associated with resilience were determined using generalized linear (gamma) regression.

Results:
The RS-14 and SF-36 were completed by 151 subjects (74 male and 77 female, mean age 19.5 ± 1.1 years). The median resilience score of 79 (CI
0.95
= 77, 82) was significantly greater than the young adult population median of 76.0,
p
= 0.006. Resilience was graded as moderate or higher in 103 subjects (68%). Higher resilience scores were significantly correlated with higher QOL assessed by the SF-36 Mental Component Summary,
r
= 0.40,
p
< 0.001. By simple regression, Caucasian race was associated with higher resilience scores,
p
= 0.03. Prematurity, low birth weight, presence of a genetic anomaly, and severity of CHD were not associated with higher or lower scores, all
p
> 0.2. No operative management factors were associated with higher or lower scores, all
p
> 0.28. Better performance for executive function (
p
= 0.03) and social skills (
p
= 0.02) at the 4-year ND evaluation were associated with higher resilience. Hyperactivity was associated with lower resilience scores,
p
= 0.02.

Conclusions:
Many young adults with CHD demonstrate good resilience. Higher resilience is associated with better QOL. Performance on ND testing in the preschool period may identify patients with lower resilience and offer an opportunity for intervention.
Abstract 14228: Pericytes Within a Pulmonary Neurovascular Unit in Covid-19-elicited Pathologic Changes
Authors: He Zhen
Published: May 2021

A pericyte-centered hypothesis suggests that embolisms occurring within microvasculature of a neurovascular unit can result in either parenchymal hemorrhage or intravascular congestion. Dysfunctional microvascular pericytes are featured depending on their location in the neurovascular unit. I extend the hypothesis by proposing a concept of pulmonary neurovascular unit (pNVU). In simulating pathophysiology in pulmonary embolisms, acute high-altitude illness and COVID-19, an existing local regulation of microvascular blood flow is believable. This control balances blood flow with oxygen supply to maintain physiological blood oxygen saturation level. We have reported a working module for the neurovascular unit in the sexually dimorphic nucleus of the preoptic area. Pericytes, labeled with alpha-smooth muscle actin immunoreactivity, are significantly denser within the microvasculature of the neurovascular unit in males, signifying their biological functions or potential pathophysiological role in diseases. Noticeably, an illustration provides an explanation of how malfunction of microvascular pericytes causes pulmonary focal hemorrhage, edema or microvascular congestion and thrombi [Fig. 1]. A bypass existing in the pNVU would autonomically deviate blood flow from COVID-19-affected pNVU to other healthy pNVU. Consequentially, systematically applied medicines including chloroquine and/or hydroxychloroquine became valueless due to low concentration of the medicine in the COVID-19-affected regions. Alternatively, a preventive, early antiviral therapy may be efficacious because dysfunctional blood-air exchange precedents and malfunction of pulmonary microcirculation follows. While testing the hypothesis with experimental evidence is urgently needed, supporting therapy aimed at improvement of microcirculation or rebuilding of microvascular pericytes’ physiological function may be recommended during the COVID pandemic.
Abstract 14229: Hepatobiliary Markers in Minority Heart Failure Patients; Echocardiography and Clinical Outcomes
Authors: Casillas Joseph A , Wengrofsky Perry , Srinivasan Maya , Silverstein Noah , Bukharovich Inna
Published: May 2021

Introduction:
AHA sponsored guidelines and studies have focused on cardiac disease and particular heart failure (HF) profiles among minorities like African, Hispanic, and Asian Americans. Previous studies on liver function tests (LFT) in HF patients, like aspartate and alanine aminotransferase (AST, ALT), alkaline phosphatase (ALP), and bilirubin (Bili), have underrepresented minority groups in study cohorts. We investigated the relationship between LFT levels with echocardiographic (ECHO) findings and readmission outcomes among minority patients at the Heart Health Center (HHC) of NYC Health + Hospitals, Kings County, in Brooklyn, New York.

Hypothesis:
In minority HF patients, LFT levels are associated with ECHO parameters, and LFT abnormalities are associated with increased risk of admission.

Methods:
Retrospective review was performed of patients in the HF clinic at the HHC, and during acute HF exacerbation admission from November 2017 - November 2018, with hospitalization monitored through November 2019. Baseline and admission LFT levels were obtained. While abnormal AST, ALP, and Bili levels were classified by the hospital’s laboratory range, abnormal ALT levels were classified based on national gastroenterology guidelines. Regression analysis was used to examine the relationship between LFT levels during acute HF exacerbation and ECHO parameters. Odds ratio (OR) and confidence interval (CI) were used for analysis of readmission outcomes.

Results:
Among 586 HF patients, there was an increased risk of hospitalization with baseline elevations in AST (OR 2.30, CI 1.24 - 4.25, p = 0.008) and ALP (OR 1.99, CI 1.10 - 3.64, p = 0.023). In those hospitalized with acute HF (n = 147), Bili was positively correlated with mitral valve (MV) EA ratio (r = 0.28, p = 0.002) and tricuspid regurgitation max velocity (r = 0.21, p = 0.004). ALT positively correlated with mean MV e’ velocity (r = 0.23, p = 0.009) and negatively correlated with aortic valve (AV) mean velocity (r = -0.24, p = 0.001).

Conclusions:
Understanding the association of ECHO findings and risk of hospitalization in minority patients with baseline and acute HF LFT levels has crucial implications for the identification of high risk patients and for the development of patient centered HF care strategies.
Abstract 14232: The Cathepsin D-m6pr-erk1/2 Pathway Mediates Cellular Senescence and Osteogenic Activities in Human Aortic Valve Interstitial Cells
Authors: YAO Qingzhou , The Erlinda , Ao Lihua , Zhai Yufeng , Fullerton David A , Meng Xianzhong
Published: May 2021

Background:
Calcific aortic valve disease (CAVD) is one of the most prevalent cardiovascular disorders in the elderly, and aortic valve interstitial cells (AVICs) play a major role in valvular calcification associated with CAVD progression. Recent studies found that pharmacological or genetic clearance of senescent cells attenuates aortic valve calcification in animal models, indicating an important role of senescent cells in promoting valvular calcification. However, the mechanism underlying cellular senescence in aortic valves is unclear. Our pilot work found that greater densities of senescent cells in AVIC isolates from diseased human aortic valves are associated with elevated levels of matrilin 2 and cathepsin D in AVICs. We tested the
hypothesis
that matrilin 2 and cathepsin D mediate the senescence and osteogenic responses in human AVICs.

Methods and Results:
AVICs were isolated from normal and diseased aortic valves. Levels of P16 were assessed by immunoblotting, and senescent changes is examined using senescence-associated β-galactosidase (SA-β-gal) staining. AVICs from diseased valves displayed higher levels of P16 and greater SA-β-gal staining. Both recombinant human matrilin 2 (2.0 μg/ml) and recombinant human cathepsin D (40 nM) promoted P16 expression and enhanced SA-β-gal staining in normal AVICs, leading to greater calcium deposition. Knockdown of cathepsin D reduced matrilin-2-induced P16 expression, SA-β-gal staining and calcium deposition in normal AVICs. Moreover, recombinant cathepsin D activated the M6PR-ERK1/2 pathway in normal AVICs. Blocking or knockdown of M6PR (M6P, 10 mM or siRNA, 1.0 nM) or inhibition of ERK1/2 (PD98059, 25 μM) attenuated the effect of cathepsin D on AVIC senescent change and associated osteogenic activation.

Conclusion:
AVICs of aortic valves from patients with CAVD have higher levels of senescence activity. Cathepsin D mediates AVIC senescence and associated osteogenic activation through the M6PR-ERK1/2 pathway and is involved in the mechanism by which soluble matrilin 2 promotes cellular senescence and osteogenic activity in human AVICs. Targeting the cathepsin D-M6PR-ERK1/2 cascade may suppress AVIC senescence activity and attenuate aortic valve calcification.