bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 9545: Indexing Mitral Regurgitant Volume to Left Ventricular Cavity Size Improves Prognostication of Mortality
Authors: Strom Jordan B , Sabe Marwa , Garan A. Reshad , Matos Jason D , Khabbaz Kamal R , Markson Lawrence , Manning Warren J
Published: April 2022

Background:
Indexing mitral regurgitation (MR) regurgitation volume (RVol) for left ventricular (LV) cavity size accounts for concomitant LV remodeling, but whether it improves prognostication of mortality is uncertain.

Methods:
The ratio of RVol to LV end-diastolic diameter (LVDD) was measured in 399 individuals (mean age 70.1 ±16.4 years, 51.1% female) with any MR (mean RVol 49.2 ± 27.7 mL) undergoing echocardiography (TTE). Individuals with prior mitral valve interventions were excluded. The relationship between RVol/LVDD and all-cause mortality was examined. The incremental predictive value of RVol/LVDD was compared to RVol alone.

Results:
Over a median (interquartile range) of 8.8 (3.4-10.5) years follow-up, there were 101 deaths (25.3%). Amongst those treated medically (N = 348), a lower ratio was associated with higher mortality (HR per 1-mL/cm decrease, 1.04, 95% CI 1.01-1.10, p = 0.04), despite a lesser degree of MR (low vs. high RVol/LVDD group, mean RVol, 30.3 ± 11.7 mL vs. 68.1 ± 26.3 mL, p < 0.001), with an inflection for increased risk < 8.4 mL/cm (
Figure
). By contrast, amongst those treated surgically (N = 41), no association was observed (p = 0.69) between RVol/LVDD and mortality, though death was less frequent. This association with risk was observed only amongst individuals with a reduced LVEF and was independent of etiology of MR (e.g. secondary vs. primary). Compared to RVol alone, indexing for LV cavity size improved the prognostication of death (p < 0.001).

Conclusions:
Amongst patients with MR with a reduced LVEF, treated medically, survival was significantly worse amongst individuals with lower RVol/LVDD ratios. Furthermore, indexing for LV cavity size improved prediction of mortality compared to RVol alone. These results overall suggest that RVol should be routinely indexed for LV size to improve prognostication of risk. Moreover, they suggest a threshold may exist where LV size predominates risk in individuals with MR, treated medically.
Abstract 9560: Identifying Best Practices for Education and Training of Resuscitation Teams for In-Hospital Cardiac Arrest
Authors: Anderson Theresa , Krein Sarah , Secrest Kayla , Trumpower Brad , Guetterman Timothy , Harrod Molly , Kronick Steven , Schildhouse Richard J , Pribble James , Chan Paul S , Nallamothu Brahmajee K
Published: April 2022

Background:
In-hospital cardiac arrest (IHCA) leads to poor survival. Research suggests provider skills may play a role, but little is known on how education and training differ across hospitals.

Methods:
We conducted a qualitative analysis of semi-structured interview data obtained from 9 diverse hospitals from the AHA Get With The Guidelines registry, selected based on IHCA survival performance (5 top, 1 middle, 3 bottom). Thematic analysis was used to identify best practices related to training and education of resuscitation teams.

Results:
In total, 129 interviews were conducted with hospital staff including nurses, respiratory therapists, physicians, pharmacists, and other staff yielding 78 hours of interview time. Four themes related to training and education were identified: engagement, clear communication, consistency, and leadership listening. Top hospitals encouraged employee engagement with branding and prioritizing hands-on learning over passive didactics. Clear communication was accomplished with debriefing, structured institutional review, and continual, frequent department education. Consistency was a cornerstone to culture change and achieved with uniform policies for simulation practice as well as routine practice (weekly, monthly, quarterly). Finally, sites excelling in IHCA survival had responsive leadership who listened and adapted programs to fit staff needs. A striking characteristic was also multidisciplinary leadership participation.

Conclusions:
Among top hospitals, we identified core elements for successful training of resuscitation teams. Developing tools to address these areas may help improve IHCA outcomes.
Abstract 9572: Changes of the Incidence of Cardiovascular Risk Factors in General Population During the Covid-19 Pandemic
Authors: Tsuji Hisako , Shiojima Ichiro
Published: April 2022

Background:
To examine influence of COVID-19 pandemic on cardiovascular risk factors in general population, incidence of newly diagnosed hypertension, diabetes mellitus, hypercholesterolemia and excess body weight during the COVID-19 pandemic period was compared with that of those before the pandemic period.

Methods:
Annual incidence of hypertension, diabetes mellitus, hypercholesterolemia and excess body weight was evaluated in subjects who had annual health checkup offered to adult citizens of Moriguchi city, Osaka, Japan in 2019 and 2020. Those with history of cardiovascular disease were excluded. The incidence was compared with that of those who received the checkup in 2018 and 2019 as the control value. The incidence of each risk factor was evaluated in separate models in which subjects with the risk factor of interest at baseline were excluded. Multivariate logistic regression analyses were performed adjusted for clinical valuables including age, sex, hypertension, diabetes, current smoking, drinking habit and excess body weight in each model.

Results:
Characteristics of the subjects at baseline and incidence of the risk factor next year in each model were presented in the table. The incidence of hypertension (odds ratio (OR)=1.45, 95% confidence interval (CI)=1.29 to 1.64, p<0.0001), hypercholesterolemia (OR=1.55, 95% CI=1.37 to 1.76, p<0.0001), and excess body weight (OR=1.50, 95% CI=1.23 to 1.82, p<0.0001) from 2019 to 2020 was significantly higher compared to that from 2018 to 2019 but that of diabetes was not increased (OR=0.94, 95% CI=0.71 to 1.24, p=0.6648).

Conclusions:
Increased incidence of hypertension, hypercholesterolemia, and excess body weight was observed during the COVID-19 pandemic period.
Abstract 9596: Presence and Extent of Aortic Arch Plaques for the Prediction of Cardiovascular Outcomes in Patients with Suspected Coronary Artery Disease Undergoing Wide Volume Scanning Coronary Computed Tomography Angiography
Authors: Otuska Kenichiro , Yamaura Hiroki , Ishikawa Hirotoshi , Shirasawa Kuniyuki , Hirata Kumiko , Kasayuki Noriaki
Published: April 2022

Introduction:
Wide volume scanning with 320-row multidetector CT coronary angiography (WVS-CCTA) enables comprehensive assessment of aortic arch together with coronary artery disease (CAD), without additional contrast media injection (Figure A-E). This study investigated prognostic implication of the presence and extent of aortic arch plaques (AAPs) and coronary high-risk plaque burden, as assessed by low-attenuation plaque (LAP) volume, on major cardiovascular events (MACE).

Methods:
This study consisted of patients with suspected CAD undergoing WVS-CCTA (n=529, mean age 64 yo, 57% of male). Conventional CCTA analysis included the assessment of coronary artery calcium score (CACS), obstructive CAD (diameter stenosis <50%), and %LAP volume (<30 HU). AAP score was defined as the sum of AAP thickness (0: no plaque, 1: <3 mm, 2: 3-5 mm, 3: > 5 mm) and AAP maximum angle (0: no plaque, 1: <120°, 2: 120-240°, 3: > 240°), resulting in a total of 0-6 point(s). The primary endpoint was a MACE composed of all-cause mortality, coronary revascularization, heart failure hospitalization, stroke, and vascular disease requiring invasive treatment.

Results:
The mean AAP score was 2.0 points (> 2 points in 56% and > 4 points in 27%), which is well correlated with CAD extent and severity. During a follow-up period of 2 years, MACE was observed in 15% of the study patients. In Cox hazard model analysis adjusted by age, gender, chronic kidney disease, and left ventricular ejection fraction <50%, the independent factors associated with MACE were diabetes mellitus [hazard ratio (HR), 1.9; p=0.009], obstructive CAD (HR, 3.8; p <0.001), the 4
th
quartile of %LAP volume (HR, 1.8; p=0.016), and AAP score per 1 point increase (HR, 1.2; p=0.008).

Conclusion:
This study demonstrates unique opportunity for comprehensive evaluation of the presence and extent of AAPs together with CAD, providing prognostic implication of AAP score on MACE in patients with suspected CAD.
Abstract 9633: Caveolin-3 Nitrative Modification Exacerbates Ischemic Heart Failure in Pre-Diabetic Mice by Disassembling Cardioprotective Signalosomes
Authors: Meng Zhijun , Zhao Jianli , Yao Peng , Zhang Zhen , tsukuda jumpei , Christopher Theodore , Koa Jonathan , Lopez Bernard L , Gao Erhe , Ischiropoulos Harry , Koch Walter J , Ma Xin , Wang Yajing
Published: April 2022

Rationale:
Diabatic heart is “universally” resistant to protective interventions, including insulin, adiponectin exacerbating ischemic heart failure (HF). Caveolin (Cav) serves as scaffolding regulator, coordinating signal transduction in cell survival. However, whether and how diabetes alter Cav3-centered signalosome integrity, contributing to diabetic ischemic HF remains unclear.We hypothesized that preserving Cav3 signalosome integrity restore cardioprotective signaling, protecting against diabetic exacerbation of ischemia HF.

Methods and Results:
Mice with normal diet (ND) or high-fat-diet (HFD) were subjected to myocardial ischemia and reperfusion (MI/R). Administration of insulin or adiponectin markedly attenuated MI injury (60 minutes MI/24 hours reperfusion) in ND mice, an effect lost in diabetic animals (12 weeks HFD, n=18-20/group). Interestingly, cardioprotective effect of insulin and adiponectin was blunted as early as 4 weeks of HFD (pre-diabetes). In ND heart, Cav3 interacts with AdipoR1 and insulin receptor-β (IRβ), forming signalosomes. Those complexes were significantly reduced in pre-diabetic heart. However, the level of Cav3, AdipoR1, AdipoR2, and IRβ remain unchanged. Among multiple post-translational modifications, Cav3 nitration was the dominant in pre-diabetic heart. SIN-1 (a nitration donor) reduced Cav3/AdipoR1 and Cav3/IRβ complex, and blocked their transmembrane signaling. Mass spectrometry identified Tyr
73
is the site modified in pre-diabetic cardiomyocytes. Phenylalanine substitution of Tyr
73
(Cav3
Y73F
) blocked SIN-1 induced Cav3 nitration, restored signalosome assembling, and rescued insulin and adiponectin transmembrane signaling in diabetic cardiomyocytes. Finally, AAV9-mediated cardiomyocyte specific Cav3
Y73F
re-expression blocked HFD-induced Cav3 nitration, restored transmembrane signaling, rescued the protective action against ischemic HF.

Conclusion:
Nitration of Cav3 at Tyr
73
and complex dissociation is responsible for cardiac insulin/adiponectin resistance in pre-diabetic heart, contributing to ischemic HF progression. Early intervention preserving Cav3-centered signalosome integrity is an effective novel strategy against diabetic ischemic HF.
Abstract 9655: Risk Factors and Clinical Outcomes Associated with Gastrointestinal Bleeding Among Amyloidosis Patients
Authors: Rodriguez Tayana , Ma Jennifer , Sarabia-Gonzalez Alejandro , Ream Sarah , Alvarado Luis , Dwivedi Alok , Mukherjee Debabrata
Published: April 2022

Background:
Amyloidosis is the deposition of abnormal localized or systemic extracellular proteins in tissues. Upper and lower gastrointestinal (GI) bleeds are a known complication of amyloidosis. We assess risk factors and outcomes associated with GI bleeding in hospitalized patients with amyloidosis.

Methods:
This retrospective study used data from the 2015-2018 National Inpatient Sample Database to determine the prevalence of GI bleeding and risk factors associated with GI bleeding in patients with amyloidosis based on ICD-9 codes. Demographics included age, race, and gender. Comorbidities included hypertension, diabetes, heart failure, renal failure and coronary artery disease. Outcomes included death, and length of stay (LOS). The weight adjusted prevalence of GI bleed was estimated using binomial model with 95% confidence interval (CI) and the association was summarized with weighted relative risk (RR) regression analyses.

Results:
This study included 34,894 records of patients with amyloidosis, of which 1,022 had GI bleed. Amyloidosis patients with GI bleeds were older than patients without GI bleeds (63.86 vs. 60.94 years, p= <.0001 and more likely to be male (51.85 vs. 42.04 p= <.0001) and had more renal failure, diabetes, heart failure, and liver disease. Amyloidosis patients with GI bleed had significantly higher length of stay (2.93 [95% CI 2.75-3.12]) and higher mortality than those without GI bleeding (RR 2.64 [95% CI 2.17 - 3.22], p <0.0001).

Conclusion:
Among patients with amyloidosis, GI bleeding was more common in males, older individuals, and those with renal failure, diabetes, heart failure, and liver disease. Patients with amyloidosis and GI bleeds had significantly higher mortality with longer LOS than those without GI bleeding. Patients with amyloidosis with GI bleeding should be targeted for aggressive therapies to improve outcomes.
Abstract 9697: Relation Between Measures of Ventricular Volume/Pressure and Myocardial Damage and Coronary Microvascular Dysfunction Response to Ranolazine
Authors: Asif Anum , Mehta Puja K , Wei Janet , Berman Daniel , Wiens Galen C , Pepine Carl , Merz Noel Bairey
Published: April 2022

Introduction:
Late sodium channel inhibition with ranolazine may beneficially impact coronary microvascular dysfunction (CMD). We hypothesized that markers of ventricular volume/pressure (N-terminal -pro BNP [NT-proBNP]) and myocardial damage (ultra-high sensitivity cardiac troponin I [u-hs-TnI]) are related to therapeutic response.

Methods:
We analyzed CMD response in a randomized, double-blind, crossover trial of ranolazine vs. placebo using invasive coronary function testing or non-invasively cardiac magnetic resonance imaging (cMRI) myocardial perfusion reserve index (MPRI). NT pro-BNP and u-hs-TnI values were available in subgroups prior to trial enrollment. Treatment response was change in MPRI (Δ MPRI) or Seattle Angina Questionnaire, angina stability change (ΔSAQ). Spearman correlations and Wilcoxon Rank Sum test were used.

Results:
Among 128 participants, 12 had NT pro-BNP and 20 had u-hs-TnI available. Median NT pro-BNP and u-hs-TnI were (66 pg/mL) and (0.71 pg/mL), respectively. Higher u-hs-TnI (0.87pg/mL) positively correlated with improved ΔMPRI
(Table),
but not ΔSAQ (r= 0.03 p=0.80). No significant correlations between NT pro-BNP and ΔMPRI (r= -0.09, p=0.58) or ΔSAQ (r=0.005, P=0.976) were observed.

Conclusion:
Our study finds that higher u-hs-TnI, a measure of myocardial damage, related to improved cMRI perfusion reserve to the late-sodium channel blocker ranolazine. These results suggest that CMD accompanied by existing myocardial damage, likely secondary to ischemia, may have more favorable response to anti-ischemic therapy. Further studies are needed to validate these results in a larger cohort.
Abstract 9709: Higher Uric Acid To High Density Lipoprotein Cholesterol Ratio Is Associated With Arterial-ventricular Stiffening In Childhood Obesity
Authors: Harada Kenji , Harada Yukiko
Published: April 2022

Background:
Uric acid and high density lipoprotein cholesterol are both considered as risk factors of cardiovascular mortality. The ratio of uric acid to high density lipoprotein cholesterol (UH ratio) has been reported to be a good predictor of cardiovascular events. However, few studies have examined UH ratio and cardiovascular function in overweight/obese children. The purpose of this study is to assess the relationship between UH ratio and cardiovascular function in children.

Methods:
Echocardiography was performed in 453 children aged 7 to 15 years (body mass index 18 to 34 kg/m
2
). Stroke volume (SV) was measured using aortic diameter and pulsed Doppler velocity profile. SV was indexed for body surface area (SVI). Effective arterial elastance was estimated by end-systolic pressure/SVI. End-systolic elastance was calculated by a modified single-beat method. Lipids, uric acid, fasting glucose, insulin, homeostasis model assessment for insulin resistance (HOMA-IR), and high sensitive C-reactive protein (hs-CRP) were also assessed.

Results:
Effective arterial elastance and end-systolic elastance increased significantly with body mass index (r = 0.35 and 0.22, p < 0.01, respectively). There were significant relationships between body mass index and UH ratio, HOMA-IR, high density lipoprotein cholesterol, uric acid, triglycerides, and hs-CRP (r = 0.53, 0.52, -0.32, 0.46, 0.37, and 0.38, p < 0.01, respectively). Effective arterial elastance correlated significantly with UH ratio, HOMA-IR, uric acid, high density lipoprotein cholesterol, triglycerides, and hs-CRP (r = 0.24, 0.20, 0.18, -0.11, 0.21, and 0.18, p < 0.05, respectively). There were significant relationships between end-systolic elastance and UH ratio, HOMA-IR, uric acid, and triglycerides (r = 0.25, 0.16, 0.15, and 0.11, p < 0.05, respectively). In multiple regression analysis, UH ratio was independent determinants of effective arterial elastance and end-systolic elastance.

Conclusions:
The present study demonstrates that UH ratio is a useful indicator reflecting cardiometabolic risk in obese children. Higher UH ratio and combined arterial-ventricular stiffening may contribute to the increased prevalence of later cardiovascular disorder.
Abstract 9713: Ketosis Decreases Murine Plaque and Aortic Aneurysm Formation
Authors: Sastriques Dunlop Sergio E , Elizondo Benedetto Santiago , Arif Batool , English Sean J
Published: April 2022

Introduction:
Atherosclerosis and aortic aneurysm (AA) are associated with leading causes of mortality worldwide. There is no medical therapy for the treatment of AA, and though diet modification is essential for the management of cardiovascular disease. A ketogenic diet has been accepted as an effective complementary treatment for hypertension and dyslipidemia.

Hypothesis:
We sought to evaluate if a high fat, low carbohydrate diet could attenuate plaque and AA formation in a mouse model.

Methods:
Apo E -/- mice (N=30) 12 weeks old, underwent Angiotensin II pump administration, with daily provision of β-aminopropionitrile (BAPN) over 28 days. Control mice (StD, N=15) received a standard diet (fat 42%, carbohydrates 42.7%, proteins 15.2%); while mice undergoing ketosis induction (KD, N=15) received a high fat, low carbohydrate diet (fat 90.5%, carbohydrates 0.3%, proteins 9.2%). Ketosis was achieved by a β-hydroxybutyrate (BHB) whole blood level >0.5 mmol/L. After 28 days, aortic diameters were measured by surgical microscopy. Isolated whole aortas were en-faced and stained with oil red O (ORO) to assess the grade of lesion area (plaque area + aneurysm degeneration area / whole aorta’s area) and plaque content (plaque area / whole aorta’s area).

Results:
KD mice remained in a ketotic state throughout the experiment. Thoracic and infrarenal AAs were identified in 60% and 74% of StD mice, respectively; however, only 13% and 33% of KD mice developed thoracic and infrarenal AAs, respectively. ORO staining (Fig. 1C and G) demonstrated a significantly smaller lesion area in KD mice (p = 0.04), (Fig. 1D). Furthermore, KD plaque content was attenuated in each segment of the aorta yet only significant in the thoracic aorta (p = 0.04), (Fig. 1H).

Conclusions:
Our results demonstrate that a ketogenic diet can attenuate the development of atherosclerotic plaque and AA degeneration in mice.
Abstract 9716: Association Between Baseline Health-Related Quality of Life and Subsequent Clinical Outcomes in Patients with Atrial Fibrillation
Authors: Ikemura Nobuhiro , Spertus John , Kimura Takehiro , Katsumata Yoshinori , Fujisawa Taishi , Ueda Ikuko , Tanimoto Kojiro , suzuki masahiro , Fukuda Keiichi , Takatsuki Seiji , Kohsaka Shun
Published: April 2022

Introduction:
Recent clinical practice guidelines emphasized the need to quantify patients’ symptoms, and health-related quality of life (HR-QoL) for patients with atrial fibrillation (AF). However, little is known about the associations between patients’ HR-QoL and subsequent clinical outcomes.

Methods:
We extracted data from a registry-based cohort study (KiCS-AF) designed to enroll consecutive AF patients referred to tertiary hospitals in Japan. Patients completed the Atrial Fibrillation Effects on QualiTy-of-Life (AFEQT) at referral. We investigated the association between the AFEQT-overall summary (AFEQT-OS; range 0-100, higher score indicates better HR-QoL) score and cumulative incidence of the composite of all-cause death, stroke, new-onset heart failure hospitalization, and acute coronary syndrome after 2 years of follow-up.

Results:
Among 3,313 AF patients (men 68.4%; age 67.8±11.6 years; 60.1% diagnosed ≤1 year before enrollment to the registry), 3,296 patients (99.4%) completed the AFEQT questionnaire at the time of registration. The mean AFEQT-OS score was 77.1±17.6, and 46.8% had AFEQT-OS <80, which indicated impaired HR-QoL. Female sex, education level, higher heart rate, paroxysmal AF, history of congestive heart failure were independently associated with impaired HR-QoL at registration. After a 2-year follow-up (mean 675±143 days), the patients with impaired HR-QoL were more likely to experience the composite outcomes than those without (8.5% vs 5.8%, adjusted OR 1.32 [95%CI 1.01-1.74] P=0.040), and the differences were mainly driven by the incidence of new-onset heart failure hospitalization.

Conclusion:
In a Japanese, contemporary clinical practice cohort of unselected AF patients with newly diagnosis, almost half of the patients had impaired HR-QoL with worse clinical outcomes after 2-year. Factors associated with patients’ HR-QoL were multifocal and further investigations were needed to clarify the underlying mechanism.
Abstract 9719: Structured Patient Education Improves Adherence with Wearable Cardiac Defibrillators
Authors: Matthia Eldon L , Setteducato Michael L , Ross Steven J , Brice Aaron E , Panna Mark E , Winchester David E
Published: April 2022

Background:
The wearable-cardioverter defibrillator (WCD) tradename LifeVest has emerged as a temporary alternative to implantable cardioverter-defibrillator therapy. However, patient adherence can be variable. We sought to investigate if standardized device education and patient follow-up phone calls could lead to increased adherence.

Methods:
Patients prescribed a WCD from July 2017 to July 2018 comprised the pre-intervention group. The initial post-intervention group from January 2019 to May 2019 enrolled 32 patients. Each patient received standardized device education using a video presentation, and we sought to call each patient within 7 days of discharge to answer questions and administer a questionnaire. 14 patients comprised the second post-intervention group from March 2020 to May 2020, which received refined education with both a video presentation and 30-minute, standardized, hands-on training with the LifeVest representative, as well as similar follow-up phone calls for all patients within 7 days of discharge.

Results:
The pre-intervention group had a median wear time of 19.46 hours/day. In the first post-intervention group, all patients received standardized education; however, only 17 patients were contacted via phone due to time constraints. Patients with standardized education-only had a median wear time 21.55 hours/day, while patients who received both interventions had a median wear time of 23.01 hours/day. The increase in median wear time in pre-intervention compared to post-intervention groups was statistically significant (p= 0.0056) There was no significant difference between the two post-intervention groups (p=0.5485). In the second intervention group, median wear time significantly increased to 22.00 hours/day compared to the pre-intervention group (p=0.0244).

Conclusions:
Implementing standardized device education can improve median WCD wear time. The addition of post-discharge follow-up phone call did lead to improved mean and median wear times, but this was not statistically significant. Similar strategies could be cheaply and easily adopted at other centers in an effort to improve WCD adherence.
Abstract 9726: Simplified Academic Research Consortium for High Bleeding Risk Criteria Predicts Bleeding Events in Patients with Heart Failure
Authors: Sato Yu , Yoshihisa Akiomi , Takeishi Ryohei , Ohara Himika , Sugawara Yukiko , Ichijo Yasuhiro , Hotsuki Yu , Watanabe Koichiro , Abe Satoshi , Misaka Tomofumi , Sato Takamasa , Oikawa Masayoshi , KOBAYASHI ATSUSHI , Nakazato Kazuhiko , Takeishi Yasuchika
Published: April 2022

Introduction:
It has been reported that the simplified Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria in which six rare criteria are excluded are comparable to the original ARC-HBR criteria in predicting major bleeding in patients who undergo percutaneous coronary intervention. We aimed to evaluate the predictive value of the simplified ARC-HBR criteria for bleeding events in patients with heart failure (HF) including those with and without coronary artery disease (CAD).

Methods and Results:
A total of 2,437 patients hospitalized for HF were enrolled. Among them, 56.5%, 23.7%, 15.8%, 4.8%, 4.7%, and 3.0% presented with oral anticoagulation, anemia, renal dysfunction, thrombocytopenia, active malignancy, and stroke of major criteria. Patients were divided into two groups based on the simplified ARC-HBR criteria: patients who are at HBR (HBR group, n = 2,026, 83.1%) and those who are not (non-HBR group, n = 411, 16.9%). The HBR group was older (72.0 vs. 61.0 years old, P < 0.001) and had lower prevalence of CAD (31.1% vs. 36.5%, P = 0.034) than the non-HBR group. The Kaplan-Meier analysis showed that post-discharge hemorrhagic stroke and gastrointestinal bleeding rates were higher in the HBR group than in the non-HBR group (
Figure
). In the Cox proportional hazard analysis, the simplified ARC-HBR criteria predicted both hemorrhagic stroke (hazard ratio [HR] 2.827, 95% confidence interval [CI] 1.019-7.844, P = 0.046) and gastrointestinal bleeding (HR 3.565, 95% CI 1.560-8.145, P = 0.003) irrespectively of CAD (interaction P = 0.931 and 0.761, respectively).

Conclusions:
The simplified ARC-HBR criteria predicts high bleeding events in patients with HF.
Abstract 9727: Predictive Value of Machine Learning on Adenosine Stress Single Photon Emission Computed Tomography for Multivessel Coronary Artery Stenosis
Authors: Shimizu Masato , Miyazaki Hiroko , cho shummo , Misu Yoshiki , Tateishi Ryo , Yamaguchi Masao , Yamakami Yosuke , Shimada Hiroshi , Manno Tomoko , Isshiki Ami , Kimura Shigeki , Fujii Hiroyuki , Suzuki Makoto , Nishizaki Mitsuhiro , Sasano Tetsuo
Published: April 2022

Introduction:
Adenosine stress single photon emission computed tomography (SPECT) is utilized to detect coronary artery stenosis, but the diagnostic performance is recognized not to be enough in patients with multivessel disease (MVD). Estimation of left ventricular (LV) dysfunction on electrocardiography gated SPECT including LV dissynchrony was reported to be valuable to predict MVD, but prognostic value of machine learning of those data was not studied.

Hypothesis:
Machine learning of gated SPECT data has high diagnostic performance for MVD.

Methods:
We enrolled consecutive 256 patients (78±11 years, 188 male) who underwent adenosine stress gated SPECT (99mTechnesium) and coronary angiography in one month. LV function and myocardial perfusion score were evaluated by Heart Risk View (Nihon Medi-Physics Co.,Ltd.). First, multivariate logistic regression analysis underwent with minimum Akaike’s information critetion by stepwise regression. Propensity score (PS) was calculated with the selected predictors, and receiver operation characteristics (ROC) curve analysis was performed to evaluate the predictive value. Next, we constructed prediction model for MVD by machine learning (random forest method and deep learning).

Results:
Thirty-five cases (14%) showed MVD. Stepwise regression with AIC showed 7 predictors as the Figure. Their accuracy and area under ROC were in 0.527-0.809, 0.599-0.689, respectively. PS of the 7 predictors showed the accuracy 0.691 and AUROC 0.758. Random forest method and deep learning built prediction models, and their accuracy and AUROC were 0.840 and 0.788, 0.846 and 0.760, respectively. The top two feature importance of random forest were SD od TES on stress and Phase SD on stress, which indicate the degree of LV dyssynchrony.

Conclusions:
Machine learning of adenosine stress gated STECT had powerful predictive value for MVD, and the degree of LV dyssynchrony on stress played essential role in the prediction.
Abstract 9728: A Novel Emergency Department Syncope Protocol Reduces Unnecessary Hospital Admissions
Authors: Wood Brian , Craig Michael , Williamson Meredith , Gehi Anil K
Published: April 2022

Background:
More than 1.2 million emergency department (ED) visits for syncope occur each year in the US. Many associated admissions and diagnostic studies may be unnecessary.

Objective:
To determine the effectiveness of a novel protocol for syncope care in the ED in reducing unnecessary admissions and diagnostic testing.

Methods:
A multi-disciplinary team developed a decision aid for ED syncope management guided by focused history, physical, and diagnostic testing. Clear indications for diagnostic testing were laid out in the protocol and incorporated into the ED workflow through education and medical record system integration. Patients considered safe for discharge were provided an expedited appointment in a specialty clinic. Rates of admission, utilization of diagnostic studies (head CT, carotid ultrasound, echocardiogram), and rates of return presentation to the ED within 30 days were compared before and after implementation.

Results:
Between September 2019 and December 2019, 308 syncope patients presented to the ED. Between January 2020 and June 2020 (following implementation), 321 syncope patients presented to the ED. The proportion admitted decreased (44.6% to 30.0%, p<0.001. Figure), while the proportion undergoing diagnostic studies was unchanged (19.5% to 16.0%, p=0.303). The proportion returning to the ED within thirty days was unchanged (11.2% to 10.2%, p=0.769). The proportion referred for expedited follow up to a syncope specialty clinic increased (1.5% to 8.8%, p<0.001).

Conclusion:
Implementation of an ED syncope care pathway with utilization of a syncope specialty clinic was associated with significantly reduced hospital admissions. Utilization of diagnostic testing and rates of return ED presentation within thirty days were unchanged. Additional studies to evaluate the scalability and cost benefits of this program are warranted.
Abstract 9738: Impact of Bleeding Event for New Cancer Diagnosis in Patients with Coronary Artery Disease Who Underwent Percutaneous Coronary Intervention
Authors: Sakuma Yuya , Shimizu Takeshi , Kurosawa Yuta , Ohara Himika , Sugawara Yukiko , Watanabe Koichiro , Muto Yuki , Kimishima Yusuke , Misaka Tomofumi , Yoshihisa Akiomi , Yamaki Takayoshi , Kunii Hiroyuki , Nakazato Kazuhiko , Ishida Takafumi , Takeishi Yasuchika
Published: April 2022

Background:
Patients with coronary artery disease who underwent percutaneous coronary intervention (PCI) are at high risk of bleeding due to antithrombotic therapy. However, the impact of bleeding event for new cancer diagnosis in patients after PCI remains unclear.

Methods and Results:
Consecutive 1623 patients with coronary artery disease who underwent PCI (mean age, 69.3 years; male gender, 78.5%) were enrolled. We examined a relationship between bleeding events and new cancer diagnosis. During a mean follow-up period of 48 months, 139 (8.6%) experienced bleeding events of Bleeding Academic Research Consortium (BARC) type-2/3/5, including 48 (3.0%) with BARC type-2 bleeding. Patients with bleeding event of BARC type-2/3/5 were older (72.4 vs. 68.9 years, P = 0.001), and higher prevalence of being at Academic Research Consortium criteria for high bleeding risk (72.3% vs. 46.4%, P < 0.001) than those without bleeding event. Among 1623 patients, 133 (8.2%) were diagnosed as having new cancer. The cumulative incidence of new cancer diagnosis was higher in patients with bleeding event of BARC type-2/3/5 than in those without bleeding event (P = 0.002, left figure). In addition, the cumulative incidence of new cancer diagnosis was higher in patients with bleeding event of BARC type-2 than in those without bleeding (P = 0.016, right figure). In the multivariate Cox proportional hazard analysis after adjusting for confounding factors, bleeding events of BARC type-2/3/5 and type-2 were independent predictors of new cancer diagnosis (hazard ratio 2.00, P = 0.007 and hazard ratio 2.25, P = 0.039, respectively).

Conclusion:
In patients with coronary artery disease after PCI, both major and minor bleeding events were associated with new cancer diagnosis. Even a minor bleeding event should be taken care as the first manifestation of underlying cancer after PCI.
Abstract 9740: Efficacy and Safety of Direct Oral Anticoagulants versus Warfarin in Patients with Venous Thromboembolism or Nonvalvular Atrial Fibrillation and Chronic Kidney Disease a Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Alharbi Maha , Alkazemi Afrah , Doucette Joanne , Eguale Tewodros
Published: April 2022

Background:
Direct oral anticoagulants (DOAC) have proven to be safe and effective alternatives to warfarin for stroke prevention in non-valvular atrial fibrillation (NVAF) as well as treatment of venous thromboembolism (VTE). Chronic kidney disease (CKD) is associated with increased risk of thromboembolism as well as bleeding. The objective of this research is to evaluate the efficacy and safety of DOAC compared to warfarin in patients with either VTE or NVAF across varying renal function.

Methods:
A systematic literature search using PubMed, Embase (1996 -November 2020), and Cochrane CENTRAL databases was conducted. Randomized controlled trials published in English between 1996 and November, 2020 evaluating the safety and efficacy of DOAC versus warfarin in patients with VTE or NVAF and CKD were included. Outcomes of interest were stroke or thromboembolic events, all-cause mortality, major bleeding (MB), and clinically relevant non-major bleeding (CRNMB). Random effects-model was used for meta-analysis. Risk of bias was assessed by utilizing the Revised Cochrane risk-of-bias tool for randomized trials.

Results:
After screening and review, a total of 9 randomized controlled trials with 96,103 participants were included. Of those, 81.5% (n=78,361) had a specific classification of renal function throughout the study. Majority of participants had mild to normal (48.5%) renal function, and 35% had mild impairment and moderate and severe renal impairment accounted for 16% and <1%, respectively. DOAC reduced risk of stroke or thromboembolic events compared to warfarin (RR 0.83, CI 95%: 0.77-0.89;
p
-value<0.01), as well as all-cause mortality (RR 0.91, CI 95%: 0.85-0.97;
p
-value<0.01). For safety outcomes, MB events were less likely to occur in DOAC group (RR 0.76, CI 95%: 0.69-0.84;
p
-value<0.01). Whereas, no significant difference was found between DOAC and warfarin in CRNMB events (RR 0.90, CI 95%: 0.73-1.12;
p-
value 0.36).

Conclusion:
DOAC demonstrated better efficacy in preventing stroke or thromboembolic events and in decreasing all-cause mortality. DOAC also caused less MB events compared to warfarin. No difference in CRNMB events was detected between these agents.
Abstract 9753: Use of Dobutamine in Supraventricular Tachycardia Ablations is Associated with Similar Occurrence of Repeat Ablations as Compared to Isoproterenol
Authors: Dasrat Parmanand , Goldner Bruce
Published: April 2022

Introduction:
Arrhythmia induction during an ablation is most commonly achieved with isoproterenol. However, isoproterenol has become more expensive and its side effect profile is not benign (particularly hypotension at high doses). Dobutamine is a predominantly beta-1 agonist that is being used more often in ablations given its cost benefit and lower risk of hypotension.

Hypothesis:
It has previously been shown that high-dose dobutamine is similar to high-dose isoproterenol in terms of induction of atrial fibrillation and incidence of complications. Given this similar efficacy, it is hypothesized that the occurrence of repeat ablation will be similar among patients who undergo an ablation with dobutamine vs. isoproterenol.

Methods:
A retrospective analysis of medical records, particularly ablation reports, was performed on 1,172 patients who underwent supraventricular tachycardia (SVT) ablations at North Shore University Hospital from 2006 to 2019. This included 969 patients who had ablations using isoproterenol and 203 patients who had ablations using dobutamine. Each outpatient record was examined for any instances of a repeat ablation having been performed, as well as for any procedural complications. Dobutamine was first used in an ablation in this study population beginning in 2015.

Results:
Among the 969 patients who underwent SVT ablations using isoproterenol (mean age at time of ablation 54 years, 37% female, 94% atrial fibrillation), 11% had a repeat ablation (103 cases). Among the 203 patients who underwent SVT ablations using dobutamine (mean age at time of ablation 58 years, 33% female, 97% atrial fibrillation), 8% had a repeat ablation (16 cases). Statistically significant difference was not observed between the two groups (p = 0.31). The need for more than one repeat ablation was minimal, 1% in each group. There was only one complication observed - hypotension in an isoproterenol case.

Conclusions:
In conclusion, there was a similar occurrence of repeat ablations among patients who underwent procedures using isoproterenol vs. dobutamine. Given that dobutamine is becoming more commonly used in ablations, this analysis demonstrates that doing so is not associated with a higher need for repeat ablation or a greater risk of complications.
Abstract 9756: An ECG-Based Machine Learning Model for Predicting New Onset Atrial Fibrillation is Superior to Age and Clinical Variables in Selecting a Population at High Stroke Risk
Authors: Pfeifer John , Raghunath Sushravya , Kelsey Christopher , Ruhl Jeffrey , Hartzel Dustin , Ulloa Cerna Alvaro , Jing Linyuan , vanMaanen David , Leader Joseph , Morland Thomas , Chen Ruijun , Griessenauer Christoph , Zimmerman Noah , Steinhubl Steven R , Fornwalt Brandon , Haggerty Christopher M
Published: April 2022

Background:
Several large trials have employed age or clinical features to select patients for atrial fibrillation (AF) screening to reduce strokes. We hypothesized that a deep neural network (DNN) model risk prediction based on ECG would be superior to age and clinical variables at selecting a population at high risk for AF and AF-related stroke.

Methods:
We retrospectively included all patients with an ECG at Geisinger without a prior history of AF. Incidence of AF and AF-related strokes were identified as outcomes within 1 and 3 years after the ECG, respectively. AF-related stroke was defined as a stroke where AF was diagnosed at the time of stroke or within a year after the stroke. We selected a high-risk cohort for AF screening based on five risk stratification methods - criteria from four clinical trials (mSToPS, STROKESTOP, GUARD-AF and SCREEN-AF) and the DNN model at the qualifying ECG. We simulated patient selection and evaluated outcomes for twenty 1-year periods between 2010-2014 centered around the ECG encounter. For the clinical trials, the patients were considered eligible if they met the criteria before or within the period unless they satisfied exclusion criteria at the time of ECG.

Results:
The DNN model achieved optimal sensitivity (65%), PPV (10%), NNS for AF (10) within this population compared with all other risk models with a NNS for AF-related stroke of 160. Total screening number, sensitivity, positive predictive value (PPV) and number needed to screen (NNS) to capture AF and AF-related stroke are summarized in Table 1. The number of additional screens for the DNN model was slightly higher for two of the other models (SCREEN-AF and STROKESTOP) but lower than the other two (mSToPS and GUARD-AF).

Conclusions:
A DNN ECG-based risk prediction model is superior to contemporary AF-screening criteria based on age alone or age and clinical features in selecting a population for additional screening due to high risk for future AF and potential AF-related strokes.
Abstract 9775: The Effect of Microvascular Injury on Temporal Evolution of Invasive Microvascular Function Indices After Reperfused ST-Segment Elevation Myocardial Infarction
Authors: Demirkiran Ahmet , Robbers Lourens F , van der Hoeven Nina W , Everaars Henk , Hopman Luuk H , Janssens Gladys N , Berkhof Hans J , Lemkes Jorrit S , van Leeuwen Maarten A , Nap Alexander , van Loon Ramon B , van Rossum Albert C , Royen Niels v , Nijveldt Robin
Published: April 2022

Background:
Despite successful primary percutaneous coronary intervention (PCI), the restoration of the microvascular flow fails in up to 50% of the reperfused ST-segment elevation myocardial infarction (STEMI) patients, worsening the prognosis. This study aims to identify how post-STEMI microvascular function indices evolve over 1-month and how these changes are affected by the presence of microvascular injury.

Methods:
The study was performed in 110 STEMI patients who underwent angiography for primary PCI and at 1-month follow-up. Invasive assessment of the coronary microcirculation in the culprit artery was performed during both procedures and included coronary flow reserve (CFR), index of microcirculatory resistance (IMR), and baseline microcirculatory resistance (BMR). Cardiovascular magnetic resonance imaging was performed 2 to 7 days after PCI to evaluate microvascular injury by microvascular obstruction (MVO) and intra-myocardial hemorrhage (IMH).

Results:
Over 1-month, mean CFR, IMR, and BMR all changed significantly (fig. 1). CFR increased in all patients both with and without MVO and IMH (all, p<0.001). IMR significantly decreased in patients with MVO (p<0.001) and IMH (p<0.01), but less apparently in patients without MVO (p=0.04) and IMH (p=0.05). There was no significant difference for the absolute CFR change over 1-month between patients with/without MVO (p=0.34) and with/without IMH (p=0.41). The absolute IMR change over 1-month differed significantly between patients with/without MVO (p<0.01) and with/without IMH (p=0.001).

Conclusion(s):
In STEMI patients, coronary microvascular function indices significantly improved one month after PCI. The occurrence of microvascular damage presented a close interaction with the recovery of IMR but not with the course of CFR.
Abstract 9781: Electromechanical Optical Mapping in Beating,
in Situ
Swine Hearts
Authors: Zhang Hanyu , Patton Haley N , Wood Garrett A , Walcott Greg P , Rogers Jack M
Published: April 2022

Introduction:
Optical mapping is a powerful method for imaging cardiac propagation but is traditionally limited to motion-arrested,
ex vivo
preparations. Extending the method to beating,
in situ
preparations will enable study of bidirectional electromechanical interactions and physiological coupling between the heart and the animal. Challenges in adapting optical mapping to this setting include motion artifact, loading of voltage sensitive dye (VSD), and absorption of excitation and emission light by blood. Here, we outline a system to simultaneously image electrical propagation and contraction of intact beating hearts in an
in vivo
swine model.

Methods:
Fifteen pigs weighting 25-35 kg were anesthetized. Hearts were exposed via median sternotomy. We glued 20-30 fiducial markers (2 mm, ~1 cm spacing) to the anterior LV epicardium. We injected 14 ml of 50 uM di-4-ANEQ(F)PTEA into a catheter placed in the LAD. Blood flow in the artery was blocked during and for 1 min following the injection. This VSD works at longer wavelengths than commonly used VSDs and is therefore less affected by blood. Fluorescence was excited with alternating amber (602 nm) and green (526 nm) LEDs. Emission was long pass filtered (>700 nm) and recorded at 750 Hz with a pair of video cameras (SciMedia MiCAM03-N256) fitted with 35 mm, f/1.4 lenses
.
We analyzed marker motion to (1) quantify contraction and (2) partially correct motion artifact in membrane potential (
Vm
) signals. We also computed the ratio of green- to amber-elicited fluorescence on alternate frames to further correct motion artifact.

Results and Conclusions:
The method successfully images
Vm
and deformation. The figure shows an isochronal activation map of a paced beat (A), bars aligned with systolic principal strain (B), and
Vm
and shortening strain signals from selected sites (C). The method can be used to investigate coupled electromechanics and arrhythmogenesis in a more physiologically realistic setting than previous techniques.
Abstract 9783: Fully Automated Evaluation of Left Ventricular Global Longitudinal Strain in Children: Aiming for a "Hands Off" Future in Functional Assessment
Authors: Kauffman Hunter L , Matsubara Daisuke , Convery Michael , Miller Karen , Quartermain Michael , Banerjee Anirban N
Published: April 2022

Background:
Global Longitudinal Strain (GLS) is a sensitive indicator of cardiac function in children. However, GLS analysis is limited by time-consuming manual tracing and interobserver variability. This study aims to assess clinical feasibility of AutoStrain, a “hands-off” method of GLS analysis in children.

Hypothesis:
AutoStrain will quickly and accurately calculate GLS in children.

Methods:
We prospectively enrolled 168 patients, who underwent clinically indicated echocardiograms (mean age:12±4 years). Strain parameters were measured using three methods: 1) Fully automated (AutoStrain, Phillips Medical Systems), 2) Semiautomated (manual correction of automated measurements), 3) Conventional manual measurements (2D-CPA, TomTec), from apical 4-, 3- and 2-chamber views. Automated analyses were timed with a stopwatch.

Results:
Fully automated measurements were feasible in all cases. The results are depicted in Table 1 and Figure 1. Fully automated AutoStrain showed a strong correlation with manual GLS (R=0.71, p<0.001). Semiautomated AutoStrain showed a much stronger correlation with manual GLS (R=0.90, p<0.001). In our cohort, 21% of patients required manual editing, mostly at the apex, at end-systole. Fully automated AutoStrain calculated GLS in 13±4s, while semiautomated AutoStrain required 73±53s (p<0.001). Interobserver variability for fully automated measurements was zero. Bland Altman analysis revealed a small negative bias in fully automated analysis, indicating slight underestimation of GLS by AutoStrain (Figure 1).

Conclusions:
AutoStrain is a rapid, clinically feasible method for quantifying GLS in children. We speculate that accuracy of AutoStrain may improve in the future with inclusion of pediatric training datasets, as the anatomical intelligence program currently relies on adult datasets. Automated analysis may save time in busy laboratories, with the ultimate aim for a “hands off” future in functional assessment.