bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 18601: Impact of Right and Left Atrial Remodeling on Outcomes From Atrial Fibrillation Rotor Ablation
Authors: Schricker Amir , Baykaner Tina , Zaman Junaid , Lalani Gautam , Hopper Kenneth , Moyeda Antonio , Krummen David E , Narayan Sanjiv M
Published: July 2021

Introduction:
Targets for the ablation of atrial fibrillation (AF) are debated. In particular, recent studies questioning fractionated electrograms and lines has increased focus on AF substrates of rotors and focal impulses. These AF sources are seen in both atria, but have unknown etiology. We hypothesized that differential remodeling between the right atrium (RA), whose structural changes are largely undefined, and left atrium (LA) influence the distribution of AF sources and the outcomes from AF source ablation.

Methods:
In 60 patients at AF ablation (62±10 years, 60% persistent, 5% long-standing persistent), we compared size differences between RA and LA to the number of sources in each chamber and outcomes from AF source-guide ablation. We studied if a 64-pole basket differentially fit the LA or RA, judged by deformation of its splines by the atria (fig. A, B) over multiple cardiac cycles on fluoroscopy. Ablation targeted sources in both atria and was followed by PVI, with follow-up per guidelines.

Results:
Using baskets in both atria, 205 sources (LA 138; RA 67) were identified and ablated. Notably, the same basket in each patient was
dynamically
deformed by RA in 51 (85%) of cases but in the LA in only 39 (65%), indicating greater LA remodeling. The number of AF sources was higher in the presence of basket deformation of RA (n=174) than LA (n=130). LA deformation correlated with LVEF (p=0.05). Freedom from AF at 1 year was reduced in patients with no basket deformation (i.e. dilation) in LA (p=0.07) or RA (p=0.06). Notably, single procedure AF freedom was substantially lower in patients with differential remodeling (deformation in only 1 chamber) of 84% vs. 60% (fig C).

Conclusions:
Structural atrial remodeling influences the number of electrical rotors and focal sources in each chamber. A mismatch between right and left atrial remodeling predicts lower success from rotor ablation. These data also provide novel clinical indices of effective basket positioning.
Abstract 18608: Low Appendicular Skeletal Muscle Mass Predicts the Future Cadiovascular Events in Patients With Acute Decompensated Heart Failure
Authors: Akiyama Eiichi , Konishi Masaaki , Matsuzawa Yasushi , Endo Mitsuaki , Kawashima Chika , Suzuki Hiroyuki , Nakayama Naoki , Maejima Nobuhiko , Iwahashi Noriaki , Tsukahara Kengo , Hibi Kiyoshi , Kosuge Masami , Ebina Toshiaki , Umemura Satoshi , Kimura Kazuo
Published: July 2021

Introduction:
Heart failure (HF) is a clinical syndrome associated with diverse metabolic disturbances. Recent studies suggest that failing heart through secretion of soluble myostatin may induce skeletal muscle wasting in HF patients and skeletal muscle plays an important role in pathogenesis of exercise intolerance in patients with chronic HF. However, the clinical significance of skeletal muscle mass in patients with acute decompensated HF (ADHF) remains unclear.

Hypothesis:
We hypothesized that low appendicular skeletal muscle mass could predict the occurrence of future cardiovascular (CV) events in patients with ADHF.

Methods:
We assessed lean body mass by dual energy X-ray absorptiometry in 96 patients with ADHF (age 72±11, left ventricular ejection fraction (LVEF) 38±15%, B-type natriuretic peptide (BNP) levels on admission 752 [377-1398] pg/ml). Low appendicular skeletal muscle mass index (ASMI, appendicular skeletal muscle mass/height
2
) was defined according to the Asia Working Group for Sarcopenia criteria (<7.0kg/m
2
in male, <5.4kg/m
2
in female). ADHF patients were followed until occurring CV events (CV death, nonfatal myocardial infarction, ischemic stroke, or HF re-hospitalization).

Results:
ASMI significantly correlated with age (r=-0.51, P<0.001), male sex (r=0.53, P<0.001), body mass index (r=0.63, P<0.001), systolic blood pressure on admission (r=0.21, P=0.04), and BNP levels on admission (r=-0.39, P=0.04). ADHF patients with low ASMI (n=54, 56%) had higher BNP levels (968 [552-1773] versus 498 [273-943], p=0.001) and higher rate of clinical scenario 2-3 (48% versus 12%, p=0.001) than those with normal ASMI. 42 patients developed CV events (median follow-up, 16months). Kaplan-Meier analysis demonstrated a significantly higher probability of CV events in the low ASMI group than those in the normal ASMI group (54% vs. 29%, log-rank test, P=0.02). Multivariate Cox hazard analysis identified low ASMI as an independent predictor of the CV events in patients with ADHF (hazard ratio 2.1, 95%-confidence interval 1.1-4.2, P=0.03).

Conclusions:
Low ASMI could predict the future CV events in patients with ADHF, irrespective of LV systolic function and other clinical profile.
Abstract 18615: Impact of Peripheral Atherectomy Utilization on the Outcomes of Lower Extremity Arterial Intervention - A Cross-sectional US Experience
Authors: Arora Shilpkumar , Lahewala Sopan , Patel Nilay , Agnihotri Kanishk , Panaich Sidakpal , Patel Nileshkumar J , Savani Chirag , Dave Abhishek , Thakkar Badal , Patel Achint , Patel Samir V , Bhatt Parth , Patel Sanskruti , Patel Aashay , Sonani Rajesh , Chothani Ankit , Singh Vikas , Jhamnani Sunny , Deshmukh Abhishek , Badheka Apurva O
Published: July 2021

Background:
Contemporary outcome data regarding effects of atherectomy in lower extremity arterial revascularization is lacking.

Methods:
We queried HCUP’s Nationwide Inpatient Sample (NIS) for 2012 using the appropriate primary ICD 9-CM diagnostic code for peripheral vascular disease and procedural codes 39.90 (bare metal stent - BMS), 00.55 (drug eluting stent - DES), 17.56 (peripheral artherectomy) and 39.50 for angioplasty. Only procedures performed in patients >= 18 years were included. Hierarchical mixed effects logistic regression models were generated to evaluate multivariate predictors of outcomes.

Results:
In total 13,206 (weighted: 66,030) lower extremity arterial revascularization were analyzed (65.5% white, 56.2% Male & 97.4% angioplasty). Atherectomy utilization (23.2%) was associated with significant reduction in amputation (11.5% vs 13.4%), any complications (13.2% vs 16.3%) and in hospital morality (0.8% vs 1.4%) compared to no atherectomy group (p < 0.001). Multivariate analysis showed similar results with decrease amputation (OR, 95% CI; p - value) (0.83, 0.71 - 0.97, p = 0.02) and in hospital mortality/any complication (0.79, 0.69 - 0.90, p = 0.001) with atherectomy (similar results were observed with propensity score matching). “Atherectomy only” was utilized only in 2.3%. post-hoc analysis also shows better outcomes when atherectomy was used with either angioplasty or stenting (figure a & b). subgroup multivariate analysis shows significant reduction in amputation when atherectomy was utilized in chronic limb ischemia (0.74, 0.59 - 0.93, p = 0.01) and with angioplasty (0.72, 0.60 - 0.87, p = 0.001) and trend towards advantage while used along with stents but not reaching statistical significant.

Conclusion:
Lower extremity atherectomy utilization was associated with significant reduction in amputation and overall complication. We observed better outcomes when atherectomy was used in conjunction with angioplasty.
Abstract 18634: Favorable Cardiovascular Health and the Compression of Morbidity: Findings From the Chicago Heart Detection Project in Industry Study
Authors: Allen Norrina B , Zhao Lihui , Liu Lei , Daviglus Martha , Liu Kiang , Fries Jim , Shih Tina , Garside Dan , Lloyd-Jones Donald
Published: July 2021

Introduction:
We sought to determine the association of CV health at younger ages with the proportion of life lived free of morbidity, the cumulative burden of morbidity, and average healthcare costs at older ages.

Methods:
The Chicago Heart Association (CHA) study is a longitudinal cohort of employed men and women aged 18-59 years at baseline exam in 1967-1973. Baseline risk factor levels included blood pressure, cholesterol, diabetes, BMI and smoking. Individuals were classified into one of four strata: favorable levels of all factors, 0 factors high but 1+ elevated, 1 high, and ≥2 high risk factors. Linked CMS/NDI data from 1984-2010 were used to determine morbidity in older age providing up to 40 years of follow-up. We included participants who were age 65+ between 1984 and 2010 and enrolled in Medicare FFS. All-cause morbidity was defined using the Gagne score. A CV morbidity score was defined as the sum of 4 CVDs including CHD (includes MI), PVD, cerebrovascular disease and CHF.

Results:
We included 25,390 participants (43% female, 90% White, mean age 44 at baseline); 6% had favorable levels, 19% had 1+ risk factors at elevated levels, 40% had 1 high risk factor and 35% had 2+ high risk factors. As compared to those with 2+ high risk factors, favorable CV health had lower levels of all-cause and CV morbidity from age 65-90 years, and a lower cumulative morbidity burden (p<0.001) translating to lower average annual healthcare costs ($15,905 vs $20,791 per year, p<0.001). Favorable CV health postponed the onset of all-cause morbidity by 4.5 years, the onset of CV morbidity by almost 7 years and extended life by almost 4 years resulting in a compression of morbidity on both the absolute and relative scale (see figure).

Conclusion:
Individuals in favorable CV health live a longer, healthier life and a greater proportion of life free of morbidity. These findings provide support for prevention efforts aimed at preserving cardiovascular health and reducing the burden of disease in older ages.
Abstract 18649: Long-term Outcome and the Mechanisms of Pulmonary Antrum Radial-linear Ablation in Patients With Paroxysmal Atrial Fibrillation
Authors: Zhao Xue , Hu Jianqiang , Huang Yan , Xu Yawei , Zhang Yanzhou , Gong Hui , Liu Zhenguo
Published: July 2021

Objectives:
The aim of this study was to determine the mechanisms and effectiveness of pulmonary antrum radial-linear (PAR) ablation in comparison with pulmonary vein isolation (PVI) in patients with paroxysmal atrial fibrillation (AF) after a long-term follow-up.

Background:
The one-year follow up data suggested that PAR ablation appeared to have a better outcome over the conventional PVI for paroxysmal AF.

Methods:
The enrollment occurred between March, 2011, and August, 2011, with the last follow-up in May, 2014. A total of 133 patients with documented paroxysmal AF were enrolled from 5 centers and randomized to PAR group or PVI group. Event ECG recorder and Holter monitoring were conductedduring the follow-up for all patients.

Results:
The average procedure time was 151±23 min in PAR group and 178±43 min in PVI group (
P
<0.001). The average fluoroscopy time was 21±7 min in PAR group and 27±11 min in PVI group (
P=
0.002). AF triggering foci were eliminated in 59 patients (89.4%) in PAR group, whereas, only 4 patients (6.0%) in PVI group (P<0.001).At median 36 (37-35) months of follow-up after single ablation procedure, 43 of 66 patients in PAR group (65%) and 28 of 67 patients in PVI group (42%) had no recurrence of AF off antiarrhythmic drug (AAD) (P=0.007); and 47 of 66 patients in PAR group (71%) and 32 of 67 patients in PVI group (48%) had no recurrence of AF with AAD (P=0.006). At the last follow-up, the burden of AF was significantly lower in PAR group than in PVI group (0.9% ± 2.3% vs 4.9% ± 9.9%;90th percentile, 5.5% vs 19.6%; P=0.008). No major adverse event (death, stroke, PV stenosis) was observed in all the patients except one case of pericardial tamponade.

Conclusions:
PAR ablation is a simple, safe, and effective strategy for the treatment of paroxysmal AF with better long-term outcome than PVI. PAR ablation might exhibit the beneficial effect on AF management through multiple mechanisms.

Registration:
ChiCTR-TRC-11001191
Abstract 18655: Impact of New Guidelines on Atrial Fibrillation Pattern Classification: The Women’s Health Study
Authors: Wong Jorge A , Sandhu Roopinder K , Conen David , Albert Christine M
Published: July 2021

Background:
Recent US guidelines have updated atrial fibrillation (AF) pattern definitions, reclassifying patients who undergo successful cardioversion within 7 days of AF onset as paroxysmal rather than persistent. The impact of this reclassification on AF pattern designation and risk factor profiles in patients with AF is unknown.

Methods:
We examined all participants with confirmed, new-onset AF among 34,636 women who were aged ≥45 years and free of AF and cardiovascular disease at baseline within the Women’s Health Study. All women were classified by AF type using both 2006 and 2014 ACC/AHA AF guideline definitions. AF type was classified as the most sustained form within 2 years of initial diagnosis. Risk factor profiles of patients reclassified by the 2014 guidelines were then compared to patients where AF pattern classification remained unchanged.

Results:
During a median follow-up of 19.2 years, 1493 women developed incident AF. Application of the 2006 AF guidelines identified 998, 313 and 182 women with paroxysmal, persistent and permanent AF, respectively. Using the 2014 AF guidelines, 107 women with persistent AF (34.2%) were reclassified to paroxysmal. Compared to women classified as persistent by both guidelines, those reclassified to paroxysmal by the 2014 guidelines were younger and had a lower prevalence of hypertension; but had similar weight and BMI (Table). Compared to women classified as paroxysmal by both guidelines, the women reclassified to paroxysmal were again younger but had a higher weight and BMI. Other cardiac risk factors did not differ significantly across AF patterns (Table).

Conclusions:
Using 2014 AF guidelines definitions, AF pattern was reclassified in a significant number of persistent AF patients. The risk factor profile of the reclassified women differed with respect to age, hypertension and BMI; known risk factors for AF progression. Selected AF pattern definition may influence results of future studies on AF progression.
Abstract 18656: The Effect of Targeted Temperature Management is Dependent Upon the Duration of Out-of-hospital Cardiac Arrest
Authors: Drennan Ian R , Lin Steve , Thorpe Kevin E , Buick Jason E , Cheskes Sheldon , Morrison Laurie J
Published: July 2021

Introduction:
Targeted temperature management (TTM) reduces neurologic injury from out-of-hospital cardiac arrest (OHCA). As the risk of neurologic injury increases with prolonged cardiac arrests, the benefit of TTM may depend upon cardiac arrest duration. We hypothesized that there is a time-dependent effect of TTM on neurologic outcomes from OHCA.

Methods:
Retrospective, observational study of the Toronto RescuNET Epistry-Cardiac Arrest database from 2007 to 2014. We included adult (>18) OHCA of presumed cardiac etiology that remained comatose (GCS<10) after a return of spontaneous circulation. We used multivariable logistic regression to determine the effect of TTM and the duration of cardiac arrest on good neurologic outcome (Modified Rankin Scale (mRS) 0-3) and survival to hospital discharge while controlling for other known predictors.

Results:
There were 1496 patients who met our inclusion criteria, of whom 981 (66%) received TTM. Of the patients who received TTM, 59% had a good neurologic outcome compared to 39% of patients who did not receive TTM (p< 0.001). After adjusting for the Utstein variables, use of TTM was associated with improved neurologic outcome (OR 1.60, 95% CI 1.10-2.32; p = 0.01) but not with survival to discharge (OR 1.23, 95% CI 0.90-1.67; p = 0.19). The impact of TTM on neurologic outcome was dependent on the duration of cardiac arrest (p<0.05) (Fig 1). Other significant predictors of good neurologic outcome were younger age, public location, initial shockable rhythm, and shorter duration of cardiac arrest (all p values < 0.05). A subgroup analysis found the use of TTM to be associated with neurologic outcome in both shockable (p = 0.01) and non-shockable rhythms (p = 0.04) but was not associated with survival to discharge in either group (p = 0.12 and p = 0.14 respectively).

Conclusion:
The use of TTM was associated with improved neurologic outcome at hospital discharge. Patients with prolonged durations of cardiac arrest benefited more from TTM.
Abstract 18662: Ablation of Regions of Very Slow Conduction Within a Myocardial Scar and Recurrence of Ventricular Tachycardia After Catheter Ablation
Authors: Aboud Asad A , Shoemaker M. Benjamin , Saavedra Pablo , Estrada Juan C , Shen Sharon , Clair Walter , Rottman Jeffrey , Abraham Robert , Crossley George , Ellis Christopher R , Kanagasundram Arvindh
Published: July 2021

Background:
It has been established that areas of slow conduction within a myocardial scar identified by isochronal mapping during sinus rhythm harbor the functional substrate that is involved in sustaining ventricular tachycardia (VT). We sought to test the hypothesis that targeting the region of slowest conduction during sinus rhythm would reduce VT recurrence following ablation.

Methods and Results:
32 subjects underwent ablation for sustained monomorphic VT associated with structural heart disease from 2013 to 2014. Sustained VT recurred in 12 patients (37.5%). Isochronal late activation maps were created to display activation during sinus rhythm in the region of bipolar scar. The scar was divided into three zones of equal activation time. The zone with the densest isochrones was designated as having the slowest conduction . We retrospectively analyzed isochronal maps and measured the proportion of the slowest zone that was ablated (median 14%, IQR 0-50). During a mean follow-up of 6 months, recurrence of ventricular arrhythmia was significantly associated with ablation of the slowest zone (OR 0.126, CI 0.024-0.68, p 0.016). Furthermore, univariate logistic regression demonstrated reduction of 30% in the 6-month VT recurrence rate for every 10% increase in percent of the slowest zone ablated (OR 0.7, 95% CI 0.5-1.0, p=0.05).

Conclusions:
Patients who had ablation in the region of slowest conduction were significantly less likely to have recurrence of ventricular tachycardia. Our data suggests a strategy to target the slowest region of conduction for substrate modification may hold promise for improving outcomes of scar-mediated VT ablation.
Abstract 18663: Myocardial Heterogeneity in Heart With Postinfarction LV Remodeling and its Response to Cell Therapy
Authors: cui weina , ye lei , jang albert , xiong qiang , zhang pengyuan , zhang jianyi
Published: July 2021

Rationale and Objective:
Human induced pluripotent stem cells (hiPSCs) hold promise for myocardial repair following injury. Here, we investigated the functional impact and myocardial heterogeneity of bioenergetics using a porcine model of post infarction LV remodeling, and 2 dimensional chemical shift imaging (2D CSI) P-31 MR spectroscopy.

Methods and Results:
Ischemia-reperfusion (I/R) injury was surgically induced by occlusion distal LAD (OCCL) for 60 minutes in female Yorkshire farm swine (≈15kg), then randomly assigned to experimental groups: 1) 16 million human induced pluripotent stem cells (hiPSC) derived cardio myocytes (CMs), smooth muscle cells (SMC) and Endothelia cells (ECs) were directly myocardial injected through an epicardial fibrin patch (P+Cell, n= 4), 2) open patch (fibrin patch with no cell) were placed over the injury site (P w/o Cell, n=4). Size matched normal (n=9) and OCCL only (n=5) pigs were also studied. Four weeks after I/R, 2D CSI MRS studies were performed in a 9.4T/ 65 cm bore magnet. In vivo myocardial energetic mapping was achieved using
31
P 2D CSI. To measure the forward flux rate PCr to ATP, 2D CSI data were acquired with or without saturation on ATPγ resonance. I/R injury has a heterogeneous effect on LV myocardial bioenergetics. Myocardial creatine phosphate (PCr)/ATP ratio is significantly decreased in border zone (BZ) of the infarction than the myocardial areas remote from the scar (RZ) in cell treated and patch only groups (1.54+/- 0.05 vs 2.25 +/- 0.10, 1.49+/-0.07 vs 2.34 +/- 0.07, BZ vs RZ, p<0.05). The BZ PCr/ATP ratio is improved in the cell treated group compared with open patch group (1.71 +/- 0.05 vs. 1.54 +/- 0.05, p<0.05). The forward flux rate constant of PCr/ATP (k
pcr→ATP
) in the border zone is slightly increased in cell treated group compared with patch only group (0.29 +/- 0.02 vs 0.22 +/- 0.04 , p<0.05)

Conclusion:
The approach of 2D CSI
31
P MRS can effectively map the heterogeneity of myocardial ATP flux rate via CK In Vivo porcine hearts. Postinfarction LV remodeling heart manifests pronounced heterogeneity in myocardial bioenergetics with most severe alterations in BZ. Cell therapy may effectively improve BZ myocardial bioenergetics.
Abstract 18669: A Simple Noninvasive Score for Predicting Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement
Authors: Routh Jared M , Joseph Lee , Marthaler Brodie R , Bhave Prashant
Published: July 2021

Introduction:
Cardiac conduction abnormalities requiring permanent pacemaker (PPM) are well-recognized complications of TAVR. However, a clinical prediction tool for assessing the risk of post-TAVR PPM placement is not available.

Hypothesis:
The purpose of this study was to create a novel clinical prediction tool for assessing the risk of PPM following TAVR.

Methods:
A total of 114 patients who underwent TAVR using the balloon-expandable Edwards SAPIEN valve at the University of Iowa Hospitals and Clinics were identified. We then excluded patients with a pre-existing PPM, who required conversion to an open/salvage procedure, and those without available CT data. Binomial logistic multivariate regression was performed to construct a scoring system.

Results:
A total of 84 patients were included in the study and PPM was placed in 9 patients (10.7%). From the binomial logistic regression analysis using RBBB, valve size to Sinus of Valsalva diameter ratio, and sex as predictors, pre-existing RBBB (odds ratio [OR]: 6.5, 95% confidence ratio [CI]: 1.1-37.1, p=0.035) and the ratio of valve size to diameter of Sinus of Valsalva (OR: 1.2, 95% CI: 1.03-1.3, p=0.012) were identified as significant predictors of PPM post-TAVR. We created a novel clinical prediction tool for PPM post-TAVR with patients being designated with score 0 if they had no RBBB and valve size to diameter of sinus of Valsalva ratio < 81.4 (optimal cut-off based on ROC curve) and score 1 if they had RBBB, or valve size to diameter of sinus of Valsalva ratio ≥ 81.4, or both (OR: 12.6, 95% CI: 1.5-106.8, p=0.009; sensitivity, 0.90; specificity, 0.59).

Conclusions:
Our clinical prediction score for PPM following TAVR expands upon the available literature for pre-procedural risk-stratification. The components of the score have biological plausibility, as pre-existing conduction system disease and relative valve prosthesis oversizing would be expected to confer a higher risk of post-procedural AV block. Implantation of PPM prior to TAVR in patients at risk for high-grade AV conduction abnormalities, based on this simple risk score, could have important implications for morbidity/mortality, length of stay, and cost. Moving forward, this prediction score requires validation in multicenter cohorts.
Abstract 18744: Rising Costs of Adult Congenital Heart Disease Care: Does Gender Matter?
Authors: Briston David A , Bradley Elisa , Sabanayagam Aarthi , Zaidi Ali N
Published: July 2021

Introduction:
The profile of congenital heart disease (CHD) has shifted, now with more adults than children who have survived. Few studies have provided a global assessment of adult congenital heart disease (ACHD) healthcare cost in the United States.

Methods:
Data from the National Inpatient Sample (2002-2012) utilizing diagnostic ICD-9 codes for moderate and complex ACHD were analyzed. Hospital discharges, total billed and reimbursed amounts, gender and age disparities were evaluated.

Results:
There was an overall increase in ACHD discharges (Moderate CHD: 4,742 vs. 6,545, Severe CHD: 807 vs. 1,115), billed and reimbursed dollar amounts (Billed: $542,703,961 vs. $1,506,945,042, +178%; reimbursed: $221,417,779 vs. $432,797,543, +95%). Women had more discharges in 2002 but not in 2012 (men: women, 2002: 6,503 vs. 7,805; 2012: 7,715 vs. 7,200) [Figure 1A]. Gender-based billed amounts followed a similar trend (2002: $262,918,357 vs. $279,785,604; 2012: $844,923,857 vs. $$662,021,185; p=0.006) as did total reimbursed (2002: $107,766,175 vs. $113,651,604; 2012: $243,183,638 vs. $189,613,905, p=0.008) [Figure 1B,C]. Healthcare expenditure increased across all age groups: this was most prominent in the > 44 vs. 18-44 yr. group (Billed: $617,589,813 vs. $346,652,267, p<0.001; reimbursed: $136,013,528 vs. $75,366,237, p<0.001).

Conclusions:
We are the first to report a change in the rate of gender-based ACHD hospitalizations, whereby men now account for more hospitalizations in the U.S. As ACHD discharges, billed and reimbursed amounts continue to rise over the last decade, we are also the first to demonstrate increased expenditure in older (> 44 yrs.) ACHD patients, a pattern that we predict will continue to grow and requires future investigation.
Abstract 18754: Genetic Predisposition to Coronary Artery Disease and Changes in Lipid Profile in Response to 2-year Weight-loss Diet Intervention: The Pounds Lost Trial
Authors: Wang Tiange , Huang Tao , Zheng Yan , Bray George , Sacks Frank M , Qi Lu
Published: July 2021

Introduction:
Dyslipidemia is a major risk factor of coronary artery disease (CAD), and is affected by interaction between genetic and environmental factors, such as diets. Weight-loss diet intervention has been widely used to improve lipids to mitigate cardiovascular complications of obesity.

Hypothesis:
We hypothesize that the genetic predisposition to CAD may modify lipids metabolism in response to diets.

Methods:
We calculated a genetic risk score (GRS) based on 19 CAD-associated single nucleotide polymorphisms in 744 adults from a 2-year diet intervention study: the POUNDS Lost trial. We examined the changes in total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol and triglycerides by the GRS and diet intervention.

Results and Conclusions:
We found significant interaction between the GRS and dietary fat intake on changes in total cholesterol, HDL and LDL cholesterol (P-interaction=0.02, 0.01 and 0.02, respectively) after the 2-year intervention. Overall, both low- and high-fat diets decreased total cholesterol, LDL cholesterol and triglycerides, but increased HDL cholesterol. At 2 years, in the highest tertile of the GRS, participants eating the low-fat diet showed a greater decrease in total cholesterol and LDL cholesterol than those eating the high-fat diet; whereas participants eating the high-fat diet showed a greater increase in HDL cholesterol than those eating the low-fat diet (all P<0.001). In lower tertiles of the GRS, the difference in lipids changes between the two diet groups was not significant. In conclusion, genetic predisposition to CAD might modify the dietary fat induced lipids changes. Our data suggest that in participants with higher genetic risk, low-fat diet may lower total cholesterol and LDL cholesterol, while high-fat diet may improve HDL cholesterol. And in participants with lower genetic risk, the two diets showed similar effects on improvement of lipid profile.
Abstract 18756: Focal Impulse and Rotor Mapping (FIRM): Analysis of Basket Electrode-endocardial Proximity
Authors: Soma Siva Kumar R , Siddoway Donald R , Bazaz Raveen , Voigt Andrew , Jain Sandeep , Saba Samir , Schwartzman David
Published: July 2021

Introduction/Hypothesis:
Reports of outcomes of atrial fibrillation (AF) ablation guided by FIRM have thus far been promising. FIRM maps are derived from atrial electrograms acquired using a 64 electrode “basket” catheter. There are significant discrepancies between atrial endocardial and basket geometries, and we sought to analyze individual basket electrode-endocardial proximities.

Methods:
In 13 patients with persistent AF undergoing FIRM-guided ablation, extensive fast anatomical mapping of right (RA, N=10) and/or left (LA, N=9) atria using the CARTO™ system (Biosense) yielded comprehensive, high quality endocardial geometries. Basket location projected within these geometries permitted assessment of endocardial proximity of each basket electrode. Proximity was defined as “near” (within 5 mm of nearest endocardial surface), “distant” (5-10 mm), and “very distant” (>10 mm). In analyzing proximity status of groups of electrodes which comprised observed rotors, “uniform near” was defined as all electrodes within 5 mm of endocardium, “mixed” was defined as some electrodes within 5 mm and others beyond 5 mm, and “uniform far” as all electrodes beyond 5 mm.

Results:
Right atrium: Among 10 patients, 54% of electrodes were near, 22% of electrodes were distant, and 24% of electrodes were very distant. Among 15 discrete rotors observed in 7 patients, 6 (40%) were uniform near, 8 (53%) were mixed, and 1 (7%) was uniform far.

Left Atrium:
Among 9 patients, 53% of electrodes were near, 24% of electrodes were distant, and 23% of electrodes were very distant. Among 17 discrete rotors observed in 9 patients, 8 (47%) were uniform near, 9 (53%) were mixed, and none were uniform far.

Conclusions:
Electrodes used to construct FIRM maps are commonly distant from the endocardial surface. Contact heterogeneity is common among groups of electrodes comprising rotors. The implications of these observations for use and utility of the basket-derived FIRM technique are unclear.
Abstract 18801: Light-intensity Physical Activity After Discharge Predicts 6-month Postdischarge Adverse Events in Older Japanese Patients With Heart Failure
Authors: Fujimoto Naoki , Dohi Kaoru , Miyahara So , Moriwaki Keishi , Omori Taku , Takeuchi Testushiro , Kumagai Naoto , Sugiura Emiyo , Nakamori Shiro , Yamada Norikazu , Ito Masaaki
Published: July 2021

Introduction:
Moderate physical activity (PA) is recommended in patients with heart failure (HF). However, patient’ characteristics in those with low PA and the impact of light-intensity PA on postdischarge major adverse cardiovascular events (MACE) remain unclear in older Japanese HF patients.

Methods:
Thirty seven patients (Stage C/D: 76±5 yrs, 21m) who had been admitted due to HF and 23 Stage A/B patients (73±5 yrs) with risk factors were enrolled. PA was measured using the Omuron HJ350IT accelerometer from the day of discharge for 7 days. Light-intensity PA at an intensity of 1.5-3.0 metabolic equivalents (METs), moderate-intensity PA (≥3METs), and total PA were determined. At discharge, knee-extensor muscle strength, 6-min walking distance (6MWD),SF-36 score, and left ventricular (LV) structure by echocardiography were evaluated. Stage C/D patients were stratified into High-PA and Low-PA according to the median total PA value of 8.4 METs·hour/day. Stage A/B patients underwent these measurements, and values were compared. Factors related to the 6-month postdischarge MACE were assessed.

Results:
Stage C/D patients were anemic, took fewer steps per day, and had higher brain natriuretic peptide (BNP) than Stage A/B patients. Patients in Low-PA were less likely to engage in household work, and had shorter active time, fewer steps per day, and lower light- and moderate-intensity PA than those in High-PA. No differences were observed in 6MWD (263±110 vs. 303±77 m), knee-extensor muscle strength, BNP (405±346 vs. 267±179 pg/ml), SF-36 physical composite score, or LV ejection fraction between Low-PA and High-PA. Light-intensity and total PA, but not moderate-intensity PA, were associated with the 6-month postdischarge MACE through univariate analyses. Multivariate regression analysis showed that total PA was the independent predictor of the 6-month postdischarge MACE (odds ratio: 0.66) among functional capacity variables including 6MWD and knee-extensor muscle strength.

Conclusions:
Physical activity, especially at light-intensity, is inversely associated with the 6-month postdischarge MACE in older HF patients. Our results may indicate that postdischarge PA assessed by accelerometer is useful to distinguish those at high risks for MACE.
Abstract 18802: Transcriptome Profiles of Chronically Closed or Cycling Aortic Valve Leaflets are Highly Similar Compared to Chronically Open Valves: Distention Drives Leaflet Homeostasis
Authors: Maeda Katsuhide , Ma Xiaoyuan , Hanley Frank , Riemer R. Kirk
Published: July 2021

Introduction:
Throughout the valve cycle mechanical forces of multiple types and intensities are exerted on the leaflets, sinus and annulus. The mechanisms through which these forces regulate the homeostatic maintenance of valve leaflet architecture are still poorly understood. Ventricular mechanical support with a continuous flow device results in chronic closure of the outflow valve. Whether chronic valve closure affects valve leaflet homeostasis is a significant but unsettled clinical concern.

Hypothesis:
We asked if chronic closure of the aortic valve (AV) impairs leaflet homeostasis by comparing the transcriptome profiles of AV cultured under different mechanical force conditions: Normally cycling (Flow); Not cycling but open (Static); or Not cycling but closed (Static-Closed, SC).

Methods:
Ex vivo culture of native rat aortic valves, (8 valves per bioreactor, 4 valves per condition) was conducted in a flow bioreactor for seven days at 37C in endothelial cell culture media under conditions approximating the normal stroke volume of the rat heart. In each of 4 independent experiments, flow-induced valve cycling (Flow) was compared with either Static or SC condition in paired groups. After culture, leaflets were dissected from 3 valves/condition and pooled, mRNA was extracted and expression was evaluated using whole genome microarrays.

Results:
Statistical-based unsupervised hierarchical clustering analysis of the leaflet transcriptome profiles revealed only two distinct patterns of leaflet gene expression between the three groups of AV. Flow and SC groups had nearly identical profiles whereas the Static valve group was distinctly different (p<0.05).

Conclusions:
These results reveal that the stretching of valve leaflets by a filling volume inducing full coaptation is apparently sufficient to largely preserve their architecture and phenotypic gene expression in the seven day culture period tested. In contrast, the absence of valve closure produces a markedly different pattern of gene expression. Therefore, the absence of flow through the closed AV valve does not appear to be inherently destructive compared with conditions in which the valve remains open.
Abstract 18854: Long-term Follow-up After Percutaneous Left Atrial Appendage Ligation With the Lariat Device
Authors: Gianni Carola , Di Biase Luigi , Mohanty Sanghamitra , Trivedi Chintan , Gökoglan Yalçin , Günes Mahmut , Bai Rong , Burkhardt J D , Horton Rodney , Krumerman Andrew , Palma Eugene , Gibson Douglas , Price Matthew J , Valderrabano Miguel , Lakkireddy Dhanunjaya , Natale Andrea
Published: July 2021

Introduction:
The objective of this retrospective multicenter study is to report the initial long-term performance results after percutaneous exclusion of the LAA with the endo-epicardial Lariat device to prevent AF-related thromboembolic events.

Methods and results:
Patients with successful LAA ligation and at least 1-year follow-up were analyzed (N=355). At 1 year, TEE follow-up was present in 172 patients. A leak was defined as presence of flow into the LAA as assessed by TEE.

At 6 months, 19 (11%) patients had a leak; 2 strokes occurred: 1 in a patient without a leak and 1 associated with mesenteric ischemia in a patient without a known acute leak, who died before repeat TEE could be performed.

At 12 months, 34 (20%) patients had a leak; 6 patients developed a neurological event (5 strokes and 1 TIA), 4 in patients with a leak, 2 in patients without a leak.

3% were followed-up for more than one 1 year (with a mean of 21±9 months). 1 additional thromboembolic event (TIA) occurred 14 months post-implant in a patient without anticoagulation and with a partially excluded LAA (stump), although no leak or thrombus were detected on standard TEE. Among patients with a leak (36% of those with long-term follow-up), 75% were on long-term anticoagulation and no additional TE events were detected.

Out of 355 patients, 9 (2.5%) patients had a neurological event: 4 with a leak, 4 without a leak and 1 in a patient where TEE was not repeated. Considering those with known LAA status, thromboembolic events were more common in patients with a leak (4/34 vs 4/136; RR 4, 95% CI 1.1-15.4).

Conclusion:
In this multicenter experience with the Lariat device, the rate of leaks was high (20% of those with TEE follow-up at 1 year). Thromboembolic events were not rare (overall, 2.5%), and occurred more frequently in patients with a leak (RR 4).
Abstract 18872: The Prognostic Utility of Risk Factors Defined by the AHA/ACCF Expert Consensus Statement on the Evaluation of Cardiac Disease in Liver Transplantation Candidates
Authors: Patel Hena , Alexander Sarah , Teshome Meron , Alkhalil Ahmad , Chan Edie , Doukky Rami
Published: July 2021

Introduction:
The 2012 AHA/ACCF expert consensus statement regarding cardiac evaluation of liver transplant candidates specifies 7 risk factors for identifying candidates for cardiac evaluation prior to liver transplantation. These include age > 60 yrs, hypertension, diabetes, smoking, dyslipidemia, prior cardiovascular disease, and left ventricular hypertrophy. The prognostic value of these risk factors in predicting major adverse cardiac events (MACE) has not been established. Furthermore, the optimal threshold of the sum of risk factors to predict MACE has not been determined.

Hypothesis:
Risk factors set forth by the AHA/ACCF can predict MACE in liver transplant candidates. We sought to identify an optimal threshold sum of risk factors to predict MACE.

Methods:
We conducted a retrospective cohort study of consecutive liver transplant recipients who were followed for MACE, defined as a composite of cardiac death, myocardial infarction, or coronary revascularization. Kaplan-Meier plots, log-rank test, and Cox regression models were used in outcome analyses.

Results:
We retrospectively followed 193 consecutive liver transplant recipients (40% female, mean age 55±10 yrs) for a mean of 51±29 months, during which 24 MACE were observed. Having ≥2 AHA/ACCF risk factors was associated with increased MACE risk (HR, 2.75, P=0.02), whereas having ≥3 risk factors was associated with greater MACE risk (HR, 4.14, P<0.001), Figure 1. Using ≥1 risk factor threshold provided insignificant predictive value of event-free survival (P=0.29).

Conclusion:
This study provides prognostic validation of risk factors set forth by the AHA/ACCF consensus statement for cardiac evaluation in liver transplant candidates. Having ≥2 risk factors is most sensitive for predicting MACE and seems optimal for triggering CAD surveillance in asymptomatic liver transplant candidates.
Abstract 18895: A Novel Gene Involved in Severe Neonatal Cardiomyopathy
Authors: Herkert Johanna C , Almomani Rowida , Verhagen Judith M , Wessels Marja W , Bertoli-Avella Aida M , van Slegtenhorst Marjon A , Verdijk Rob M , du Plessis Frederik A , Frohn-Mulder Ingrid M , Brosens Erwin , Hofstra Robert M , van Spaendonck-Zwarts Karin Y , Asimaki Angeliki , van der Zwaag Paul A , van der Smagt Jasper J , Timmer Bert , van Stuijvenberg Margriet , Sinke Richard J , van Tintelen J. Peter , van de Laar Ingrid M , Jongbloed Jan D
Published: July 2021

Cardiomyopathies (CMP) in children are heterogeneous disorders of cardiac muscle with a relatively high incidence in infancy (8/100.000) as compared to older children (0.7/100.000). Beyond infancy, CMP is the most important indication for heart transplantation and transplantation free survival at 5 years after initial diagnosis is only 54%.

Mutations in over 65 genes encoding sarcomeric, cytoskeletal and calcium-metabolizing proteins, cell-signaling molecules, and mitochondrial enzymes have been shown to cause CMPs. This has led to new recommendations for diagnostic evaluation and family screening incorporating genetic testing. However, present (targeted/custom based) diagnostic tests do not represent the whole spectrum of genetic etiologies and are leading to a correct diagnosis in just a subset of pediatric CMP patients.

We present four children from two consanguineous families of Dutch and Moroccan descent with severe neonatal onset of CMP, ranging from lethal cardiomegaly with reduced contractility in three to severe left ventricular hypertrophy that remained stable in one child.

A combined approach using homozygosity mapping and exome sequencing in both families identified a homozygous splice site variant resulting in exon skipping in the Dutch family, and a homozygous nonsense mutation in the Moroccan family within the same gene. This novel disease causing gene is implicated in the early differentiation of cardiomyocytes. Both variants were confirmed with Sanger sequencing and absent in large control populations. Previously published studies in a knockout mouse model demonstrated the functional role of this gene in CMPs. Additionally, we investigated the effect of the homozygous splice site mutation on the expression of different proteins at myocardial cell-cell junctions and myofibrils. These results point towards a role in intercalated disk remodeling. Electron microscopy- and protein expression studies on heart tissue of the patients are ongoing.

Our findings add a new autosomal recessive gene to the list of genes already implicated in pediatric CMP, underscoring its genetic heterogeneity. Furthermore, our study indicates that the application of exome sequencing can improve the diagnostic yield in pediatric CMP.
Abstract 18914: Comparison of Statin Eligibility Using the Pooled Cohort Equations, ATP-III Framingham and Reynolds Risk Scores Among Adults Who Experienced ASCVD Events: The Atherosclerosis Risk in Communities Study
Authors: Polonsky Tamar , Couper David , Yang Amy , Greenland Philip , Virani Salim , Astor Brad C , Fox Ervin , Hoogeveen Ron C , Mosley Thomas H , Solomon Scott D , Ballantyne Christie M , Nambi Vijay
Published: July 2021

Background:
The 2013 ACC/AHA Guidelines on the Treatment of Blood Cholesterol recommended initiating statin therapy when an individual’s 10-year estimated ASCVD risk ≥7.5% We sought to determine whether adults who eventually experienced ASCVD events were more likely to be identified as having ≥7.5% risk using the ACC/AHA’s Pooled Cohort Equations (PCE) compared to the ATP III-Framingham (FRS) and Reynolds risk scores (RRS).

Methods:
We used data from the biracial Atherosclerosis Risk in Communities Study (ARIC) visit 4 (1996-1998) because hsCRP was measured at this exam. We excluded participants with an ASCVD event prior to visit 4, diabetes, statin use at visit 4, age>74, LDL-C >190 mg/dl, or missing data. Published models for the PCE, ATP III-FRS, and RRS estimated risk. We defined statin eligibility as an estimated 10-year risk ≥7.5% for the PCE and RRS, and ≥10% for the ATP III-FRS. The primary outcome for each score was based on the outcomes originally used to derive the scores: ATP III-FRS (MI or CHD death), PCE (MI, CHD death, stroke) and RRS (MI, CHD death, stroke and revascularization).

Results:
Using the PCE, 2592 participants had an estimated risk ≥7.5% and 2760 <7.5%. The median age among those with estimated risk ≥7.5% was 66; 19% were black and 35% were women. Over a median of 11 years 304 CHD events, 201 strokes and 432 revascularizations occurred. With all 3 risk scores >80% of men who experienced events had an estimated risk ≥7.5% (see Table). In contrast, a much smaller proportion of women who experienced events had an estimated risk ≥7.5%, although the PCE yielded the highest proportion (52%).

Conclusions:
A cutoff of ≥7.5% 10-year ASCVD risk identified the majority of male participants in ARIC who experienced subsequent ASCVD events regardless of the risk score used. Substantially fewer women who experienced events were identified. Lower risk cutoffs or additional markers of ASCVD risk may be required when making decisions about statin therapy for women.
Abstract 18923: Trends in Long-term Survival After In-hospital Cardiac Arrest: Insights From Get With the Guidelines-Resuscitation®
Authors: Thompson Lauren E , Chan Paul S , Tang Fengmeng , Nallamothu Brahmajee K , Girotra Saket , Daugherty Stacie L , Bradley Steven M
Published: July 2021

Background:
Although survival to hospital discharge after in-hospital cardiac arrest (IHCA) has improved over the last decade, it is unknown if these survival gains are sustained after hospital discharge. Accordingly, we evaluated temporal trends in 1-year survival after IHCA.

Methods:
We linked data from Get With The Guidelines-Resuscitation (a national IHCA registry) with Medicare files and evaluated temporal trends in 1-year survival after IHCA between 2000 and 2011, using multivariable Poisson regression models to account for patient factors, clinical factors, cardiac arrest characteristics (e.g. initial rhythm, location of arrest), and hospital site. We examined 1-year survival trends overall, and separately for shockable (ventricular fibrillation [VF] and pulseless ventricular tachycardia [VT]) and non-shockable rhythms (asystole and pulseless electrical activity [PEA]).

Results:
Of 45,567 patients with IHCA, the majority had a presenting rhythm of PEA (43.5%) or asystole (42.2%), and half (53.6%) occurred in an ICU. Overall 1-year survival was 9.4%, with higher survival each successive year (FIGURE). Risk-adjusted 1-year survival increased over time for all IHCA (adjusted rate ratio [RR] per year, 1.05; 95% confidence interval [CI], 1.04 to 1.06; P<0.001 for trend) and separately for VT/VF and PEA/asystole arrests (all p for trend <0.001). Compared with 2000-01, 1-year survival after IHCA in 2011 increased by 62% (adjusted RR, 1.62 [95% CI: 1.44-1.81]) (TABLE).

Conclusions:
Over the past decade, 1-year survival after IHCA has significantly improved each year.
Abstract 18971: Heart Transplantation for Adult Patients With Congenital Heart Disease: Are the Outcomes Still Worse Than in the General Population in 2015?
Authors: Moguillansky Diego , Pietra Biagio A , Fricker Frederick J , Bleiweis Mark S
Published: July 2021

Introduction:
Short and medium term outcome after heart transplantation has steadily improved over the last few decades. Outcomes for adult patients with congenital heart disease (ACHD) who undergo transplantation are generally considered to be less favorable.

Hypothesis:
We hypothesized that the development of heart teams that specialize in ACHD would lead to improved outcomes after transplantation in this population.

Methods:
We reviewed the records of all patients undergoing first heart transplant at a university center with a dedicated ACHD team over the last 10 years. Patients undergoing re-transplantation were excluded. We looked at short (30 days) and medium term (1 year) survival after heart transplantation in ACHD patients.

Results:
Between 1/1/05 and 6/10/15, 258 patients underwent heart transplantation. Of the 258 patients, 17 were re-transplants and were excluded. Of the remaining 241 patients, 12 were ACHD patients and 229 were transplanted for other diagnosis (general group). In the general group 184 of 212 (86.8%) patients were alive at 1 year (the remaining 17 did not have sufficient follow up to be included in the 1-year survival analysis). In the ACHD group 9 of 9 patients (100%) were alive at 1 year. The remaining 3 ACHD patients with insufficient follow up to be included in the 1-year survival analysis were still alive 2.5-9.5 months after transplant, such that all 12 ACHD patients survived at least 30 days and were discharged home after heart transplant. At the end of the study period 160 of 229 (70%) patients were still alive in the general group, compared to 8 of 12 (66.7%) in the ACHD group.

Conclusions:
Short and medium term survival after heart transplantation appears to be no worse for selected ACHD patients compared to the general population. Larger studies with longer follow up are needed to confirm our findings and clarify the intermediate and long-term outcomes of ACHD patients undergoing heart transplantation in the modern era.