bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13903: Accurate Assessment of Hypertension and Belief in Clinical Readings by Cardiologists
Authors: Gulati Martha , Peterson Lori-Ann , Mihailidou Anathasia
Published: May 2021

Background:
The accurate measurement of blood pressure (BP) is essential for the diagnosis & management of hypertension. In clinical practice, BP is estimated using noninvasive methods but there is significant variability in practice, despite guidelines and recommendations for accurate BP assessment. Individual clinical practices implementation of guidelines for BP assessment influence accuracy and clinical certainty of BP measurements.

Hypothesis:
We sought to assess how BP is assessed in clinical practice of cardiologists and to assess the clinical certainty of the BP obtained in their clinics.

Methods:
A survey was administered through professional societies that include predominately cardiologists & via Twitter. Assessment of adherence to guideline recommendations for BP assessment was measured and compared to belief and reliability of BP assessment in clinic.

Results:
612 surveys were completed in 30 days, 364 completed by cardiologists; 49 (13%) preventive cardiologists. Majority of cardiologists based in United States. 53% routinely check BP in both arms at initial visit, 48% check BP only 1X/per visit; 64% wait 5 minutes before initial BP assessment. Automated BP assessment is used in 58% of respondents’ clinics. 83% trust their BP readings in clinic. Only 23% (85) of all cardiologist accurately measure BP as recommended by guidelines & it is more likely to be done by a preventive cardiologist (P=0.017). For those who do measure BP correctly, 80% repeat BP manually compared with 54% who do not measure BP accurately (P<0.001). For those who perform BP accurately, 86% report trusting their BP readings in clinic, similar to those who assess BP inaccurately (P=0.45).

Conclusions:
Accurate BP assessment by cardiologists remains suboptimal. Reliability of BP assessment in clinic requires education, implementation of recommendations and empowerment of the entire team to improve BP assessment & results in improved cardiovascular outcomes for our patients.
Abstract 13915: Cryoballoon Catheter Ablation versus Antiarrhythmic Drug as a First-Line Therapy for Patients With Paroxysmal Atrial Fibrillation: Results of the Cryo-FIRST Study
Authors: Velagic Vedran , Pavlovic NIkola , Chierchia Gian-Battista , Hermida Jean-Sylvain , Healey Stewart , Arena Giuseppe , Badenco Nicolas , Meyer Christian , Chen Jian , Iacopino Saverio , Anselme Frederic , Kuniss Malte
Published: May 2021

Introduction:
Early catheter ablation (CA) may increase procedure efficacy and reduce the risk of atrial fibrillation (AF) disease progression. Cryo-FIRST (NCT01803438) evaluated whether pulmonary vein isolation (PVI) with cryoballoon CA is superior to antiarrhythmic drug (AAD) therapy as a first-line treatment for the prevention of atrial arrhythmia recurrence (AAR) in patients with paroxysmal AF (PAF).

Methods:
Patients with symptomatic PAF, free of heart disease and not administered an AAD for >48 hours were enrolled at 18 sites in 9 countries, randomized (1:1) to cryoballoon CA (Arctic Front Advance, Medtronic) or AAD therapy (Class IC or III). Using a 90-day blanking period, subjects were followed at 1, 3, 6, 9, and 12 months by 7-day Holter monitoring. Primary endpoint failure was defined as AAR lasting >30 s. Safety was evaluated by comparing the incidence of serious adverse events (SAEs). Palpitations were monitored by a patient diary.

Results:
Of the 218 randomized subjects (age 52±13 years, 68% male), 187 (86%) completed the 12-month follow-up. Crossovers occurred in 20 subjects (9%; 1 subject from CA-to-AAD and 19 from AAD-to-CA). By intention-to-treat analysis, freedom from AAR after blanking was achieved in 82.2% of subjects in the cryoballoon CA arm and 67.6% of subjects in the AAD arm (HR=0.48, 95% CI: 0.26-0.86;
P
=0.013). There were no group differences in the time-to-first SAEs (HR=0.76, 95% CI: 0.46-1.26;
P
=0.28), and there was no death, atrio-esophageal fistula, pericardial tamponade, or stroke reported during the study. Also, there was no phrenic nerve injury present at the time of hospital discharge. The incidence rate of symptomatic palpitations after the 3 month follow-up was lower in the cryoballoon CA (4.61 days/year) compared to the AAD arm (15.18 days/year; IRR=0.30, 95% CI: 0.16-0.58; P<0.001) with a mean duration [min]of 54.4 (131.1) for CA and 102.7 (162.8) for AAD.

Conclusions:
Cryoballoon CA was superior to AAD for the prevention of AAR in treatment naïve patients with PAF, and CA was associated with less frequent symptom recurrence. Moreover, CA had a safety profile comparable to AAD therapy. These results suggest cryoballoon CA is an effective first-line treatment for patients with symptomatic PAF.
Abstract 13923: Incidence and Outcomes of Infective Endocarditis After 180 Days in Transcatheter Aortic Valve Replacement and Mitraclip
Authors: Kaur Manpreet , Saad Anas M , Ahuja Keerat , Kaur Simrat , Isogai Toshiaki , Verma Beni R , Shekhar Shashank , Gad Mohamed M , Abdelfattah Omar M , Kapadia Samir R
Published: May 2021

Background:
Infective endocarditis (IE) after Transcatheter aortic valve replacement (TAVR) and Mitra Clip (MC) occurs less commonly but is associated with grave complications. We aim to report the incidence and outcomes of IE within 180 days of TAVR and MC.

Methods:
We used the Nationwide Readmissions Database (NRD) between 2014 and 2017 to select patients who underwent either TAVR or MC between January and June every year (to allow for at least 180 days of follow up in the NRD) using the appropriate International Classification of Diseases-9
th
and 10
th
revision (ICD) codes. We performed a chi-square test to compare baseline characteristics and rates of IE after TAVR and MC procedures. All statistical analyses were performed the using SPSS version 26.

Results:
We included 68,270 and 7,080 patients who underwent TAVR and MC respectively, of which 0.68% vs. 0.94% (P=.012), developed IE respectively within 180 days of procedure. During that index hospitalization, in-hospital mortality rates did not differ between the two groups (15.08% in TAVR vs. 17.91%, in MC P=.587). Other outcomes are presented in table 1.

Conclusion:
Our study suggests that the overall incidence of IE following TAVR and MC is relatively low but appropriate preventive measures should be taken after the procedures to reduce the morbidity and mortality. Further studies and analysis are required in modern MC and TAVR techniques to circumvent this critical complication.
Abstract 13927: Advanced Age and Preferential Use of Vitamin K Antagonists in Severe Renal Impairment: First Results of the XARENO Registry in Patients With Non-valvular Atrial Fibrillation and Non-dialysis Dependent Advanced Chronic Kidney Disease
Authors: Kreutz Reinhold , Deray Gilbert , Floege Juergen , Gwechenberger Marianne , Luft Andreas , Kai Hahn , Persson Pontus , Beyer-Westendorf Jan
Published: May 2021

Introduction:
Patients with chronic kidney disease (CKD) and non-valvular atrial fibrillation (NVAF) are at increased risk for both ischemic stroke and hemorrhage. In addition, treatment with vitamin K antagonists (VKA) has been associated with worsening of renal function compared to direct oral anticoagulants (DOACs). XARENO (Factor XA -inhibition in RENal patients with non-valvular atrial fibrillation Observational registry) is an ongoing prospective, non-interventional, observational study conducted in Europe. XARENO evaluates the effectiveness of rivaroxaban in preserving renal function and preventing thromboembolic events as compared to VKA in NVAF patients with CKD in clinical practice.

Methods:
XARENO included male and female NVAF patients ≥18 years old with an estimated glomerular filtration rate (eGFR) between 15 and 49 mL/min per 1.73 m
2
and an indication for anticoagulation. Enrolment took place from April 2016 until January 2020. Patients treated with either rivaroxaban or VKA were included, while patients in whom physicians were withholding any anticoagulation could be also enrolled. Minimal planned follow-up is one year. Primary observational outcomes include efficacy and safety outcomes (progression of CKD, stroke, other thromboembolic events, major cardiovascular events, major bleeding, and all-cause mortality). First results on outcomes in the full cohort are expected in 2021.

Results:
In this analysis of a first set of 1485 patients (56.1% males), 731 and 666 patients received rivaroxaban and VKA, while 88 patients did not receive any anticoagulation. Mean age at baseline was 77.3 years (67.5% older than 75 years) with a mean eGFR of 38.9 mL/min per 1.73 m
2
. Overall 74.7% of patients had eGFR values below 45 mL/min per 1.73 m
2
and 28.0% below 30 mL/min per 1.73 m
2
. In the latter group, use of a VKA was about twofold more frequent compared to rivaroxaban.

Conclusions:
This first analysis of XARENO patients reveals the very high age of NVAF patients with concomitant non-dialysis dependent advanced CKD and a preferential use of VKA in stage 4 CKD. XARENO aims to provide important information on the real-world effectiveness and safety of rivaroxaban compared with VKA for this vulnerable patient group.
Abstract 13943: Elevated Natriuretic Peptides in Covid-19 Patients With Severe or Critical Illness
Authors: Benhuri Benjamin , Aikawa Tadao , Takagi Hisato , Benhuri Daniel , Kuno Toshiki
Published: May 2021

Introduction:
The worldwide pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in an extraordinary increase in the number of severe and critically ill patients in a relatively short span of time. Cardiovascular risk factors and outcomes are noted as being key contributing features of many patients who ultimately develop severe illness. As such, laboratory markers for cardiac damage and failure have been described as being elevated in this subset of patients.

Hypothesis:
The purpose of this meta-analysis is to identify and compare the values of natriuretic peptides in severely ill patient infected with the SARS-CoV-2 compared to those who are identified as being not severe.

Methods:
PUBMED and Medrxiv were searched through April 15th 2020. The outcome of interest is the difference of BNP or NT-pro BNP in severe versus non-severe

Results:
We identified 9 eligible retrospective cohort studies that observed a total of 1,575 patients that had their natriuretic peptides measured and who were classified by disease severity. Patients who were identified as having a non-severe status with the SARS-CoV-2 infection had a mean difference of -69.56 (95% CI) [-137.35, -1.77, P =0.04, I2=83%) in B-type natriuretic peptide (BNP) levels compared to those with severe status. Similarly, patients who had their N-terminal-pro BNP (NT-proBNP) levels measures had a mean difference of -518.65 (95% CI) [ -884.90, -152.40, P=0.006, I2=86%) when compared to those whom NT-proBNP levels were measured with severe status.

Conclusions:
In conclusion, patients infected with the SARS-CoV-2 virus and were classified as severe had higher levels of natriuretic peptides than patients who were classified as not severe.
Abstract 13947: The Acute and Long-term Effects of Transcatheter Aortic Valve Implantation on Aortic Stiffness and Hemodynamics
Authors: Gardikioti Vasiliki , Terentes-printzios Dimitrios , Aznaouridis Konstantinos , Latsios George , Siasos Gerasimos , Drakopoulou Maria , Oikonomou Evangelos , Tsigkou Vasiliki , Xanthopoulou Maria , Toutouzas Konstantinos , Vavuranakis Manolis , TOUSOULIS Dimitrios , Vlachopoulos Charalambos
Published: May 2021

Introduction:
Transcatheter aortic valve implantation (TAVI) is a procedure that alters dramatically the hemodynamics in patients with severe aortic valve stenosis who undergo this procedure.

Hypothesis:
We investigated the hypothesis that arterial properties and hemodynamics are affected immediately after TAVI as well as in the long-term.

Methods:
We enrolled 90 patients (mean age 80.2 ± 8.1 years, 50% males) with severe symptomatic aortic stenosis undergoing TAVI. Carotid-femoral and brachial-ankle pulse wave velocity (cfPWV and baPWV) were used for the assessment of arterial stiffness. Augmentation index corrected for heart rate (AIx@75) and subendocardial viability ratio (SEVR) were measured non-invasively. Measurements were conducted at baseline, after the procedure (during hospitalization) and at 1 year.

Results:
Acutely after TAVI we observed a statistically significant increase in arterial stiffness (7.5 ± 1.5 m/s vs 8.4 ± 1.9 m/s, p=0.001 for cfPWV and 1,773 ± 459 cm/s vs 2,383 ± 645 cm/s, p<0.001 for baPWV) without a concomitant change in systolic blood pressure (Figure). One year later, arterial stiffness was still increased compared to pre-TAVI measurements (7.5 ± 1.5 m/s vs 8.7 ± 1.7 m/s, p<0.001 for cfPWV and 1,773 ± 459 cm/s vs 2,286 ± 575 cm/s, p<0.001 for baPWV). We also found a decrease in AIx@75 (32.2 ± 12.9 % vs 27.9± 8.4 %, p=0.016) after TAVI that was attenuated at 1-year follow-up (32.2 ± 12.9 % vs 29.8± 9.1 %, p=0.38). SEVR displayed an increase acutely after TAVI (131.2 ± 30.0 % vs 148.4± 36.1 %, p=0.002) and remained improved 1 year after the procedure (131.2 ± 30.0 % vs 146± 32.2 %, p=0.01).

Conclusions:
In conclusion, shortly after TAVI the aorta exhibits a "stiffer" behavior in response to the acute change in hemodynamics, which settles in the long term. Our findings further elucidate the hemodynamic consequences of TAVI and may entail a prognostic role in this growing population.
Abstract 13948: Deep Learning Identification of Brain Structural Atrophy Associated With Heart Failure With Preserved Ejection Fraction Among Patients With Preexisting Dementia Using Clinical Imaging
Authors: Bermudez Noguera Camilo , Kerley Cailey I , Ramadass Karthik , Farber-Eger Eric H , Lin Ya-Chen , Kang Hakmook , Taylor Warren D , Wells Quinn , landman bennett
Published: May 2021

Background:
Heart failure with preserved ejection fraction (HFpEF) and dementia share several cardiovascular risk factors and have been independently associated with brain atrophy. However, it is unclear how HFpEF affects brain morphology in patients with preexisting dementia. Advances in bioinformatics data extraction pipelines, quantitative neuroimaging, and deep learning, have made possible the analysis of the effects of cardiovascular disease on clinical neuroimaging in large datasets.

Hypothesis:
We hypothesized that HFpEF in the setting of dementia would be associated with distinct brain morphology imaging changes compared to dementia in the absence of HFpEF.

Methods:
We used the bioinformatics tools at Vanderbilt University Medical Center to extract and analyze deidentified clinical neuroimaging from patients with a diagnosis of dementia with and without coexisting HFpEF from the electronic health record. We identified a total of 30 patients with HFpEF and dementia who had high-resolution, clinical neuroimaging as well as 301 age- and sex-matched controls. We used an automated pipeline to segment the brain into 132 distinct brain regions and estimate their volume to find structural differences associated with HFpEF.

Results:
We found six regions with significant atrophy associated with HFpEF: accumbens area, amygdala, posterior insula, anterior orbital gyrus, angular gyrus, and cerebellar white matter. There were no regions with atrophy inversely associated with HFpEF (Figure 1).

Conclusions:
Here, we show that patients with HFpEF have a distinct neuroimaging signature on patients with preexisting dementia. A possible mechanism of injury for this region and the subsequent atrophy has been linked to high aortic stiffening secondary to chronic cardiovascular disease and its risk factors, resulting in end-organ damage due to barotrauma and shear forces.
Abstract 14036: Enhanced External Counterpulsation Reduces Blood Pressure in Patients With Chronic Stable Angina: A Meta-Analysis
Authors: Williams Bradley , Aggarwal Mehak , Kiser Cole , Vijayaraghavan Krishnaswami , Shah Sachin A
Published: May 2021

Background:
Hypertension is a modifiable risk factor for ASCVD. Enhanced External Counterpulsation (EECP
®
) is an FDA-approved, non-invasive treatment modality for patients with angina and symptoms of ischemic heart failure. Various studies have demonstrated hemodynamic changes with EECP
®
therapy, but the true magnitude of benefit remains unknown. We conducted a meta-analysis to assess the change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) post- EECP
®
therapy.

Methods:
A literature search across multiple databases was conducted from its inception to March 2020. Studies evaluating the impact of EECP
®
in chronic stable angina patients that reported systolic and diastolic blood pressures were extracted. Human studies published in English, where patients completed 35 hours of EECP
®
(administered as 1-hour sessions) were included for analysis. Studies that reported data in multiple arms were treated as individual studies. The weighted mean difference from baseline for SBP and DBP was calculated using the DerSimonian-Laird random-effects model. Statistical heterogeneity was assessed by the I
2
statistic with publication bias evaluated using the Egger bias statistic. Subgroup analyses were performed to assess for clinical heterogeneity.

Results:
We identified 272 articles, of which 15 unique studies (n=659) reporting data on systolic and diastolic blood pressure were included. Post- EECP
®
treatment, SBP decreased by 8.9 mmHg (95% CI 4.0 to 13.7 mmHg, I
2
=87.3%) and DBP reduced by 3.6 mmHg (95% CI 2.1 to 5.0 mmHg, I
2
=38.9%). Patients with a baseline SBP 130 mmHg appear to derive greater benefit (SBP reduced by 13.0 mmHg, 95% CI 8.3 to 17.6, I
2
=70.4%) compared to patients with a baseline SBP<130 (SBP reduced by 3.2 mmHg, 95% CI 0.4 to 6.0, I
2
=25.2). The Egger bias statistic showed no publication bias for the primary endpoints (both p-values>0.33).

Conclusion:
EECP
®
treatment reduced SBP and DBP by over 8 and 3 mmHg respectively. The pleiotropic benefits from EECP
®
provide additional hypertension control in patients with chronic stable angina.
Abstract 14046: An International Assessment of the Clinic Staff Time Required to Manage Cardiac Device Patients
Authors: Biundo Eliana , Hennion Juliette , Rosemas Sarah C , Lanctin David , Nicolle Emmanuelle
Published: May 2021

Introduction:
Remote monitoring (RM) of cardiac implantable electronic device (CIED) patients is guideline-recommended standard of care alongside in-office follow-up. However, overall workload requirements for device management are not well understood, which may hinder implementation of optimal follow-up strategies including remote solutions. This study sought to characterize processes and clinic staff time required for remote and in-person device follow-up of a CIED patient.

Methods:
A time and motion workflow evaluation was performed in 11 CIED clinics: 6 US; 5 Europe (UK, France, Germany). Participating clinics manage an average of 5,758 (range: 870-22,000) CIED patients. The duration of each CIED management task was repeatedly timed during 1 business week (5 days) of observation at each clinic. All device models/manufacturers were included. Mean staff time for a remote transmission and an in-person clinic visit were calculated, including clinical and administrative tasks. Annual staff time for follow-up of 1 CIED patient was modeled using data on CIED transmission volume, clinical guidelines, and published literature.

Results:
A total of 276 in-person clinic visits and 2,173 RM activities were observed. Mean staff time required per remote transmission ranged from 9.4-13.5 minutes for therapeutic devices, and 11.3-12.9 mins for insertable cardiac monitors (ICMs), while staff time per in-person visit ranged from 37.8-51.0 mins and 39.9-45.8 mins, respectively (Table 1). The estimated annual time to manage one therapeutic device patient was lower (1.6-2.4 hours) than an ICM patient (7.7-9.3 hours), due to fewer device follow-ups.

Conclusions:
RM allows for efficient and continuous care as a complement to in-person follow-up. However, overall CIED patient follow-up requires considerable staff time. These data should be considered in addressing barriers to RM adoption, such as challenges in workflow implementation and inconsistent reimbursement.
Abstract 14052: Differences in Pediatric Cholesterol Screening Rates Between Family Medicine and Pediatrics Correlate With Conflicting Guidelines
Authors: Peterson Amy L , Dodge Ann M , Eickhoff Jens , DeSantes Kathleen , Larson Magnolia , Moreno Megan
Published: May 2021

Introduction:
In 2011, the National Heart, Lung, and Blood Institute released pediatric cardiovascular guidelines, recommending universal cholesterol screening between ages 9-11 and 17-21 years. This guideline conflicts with other organizations, notably the 2016 United States Preventative Services Task Force (USPSTF) statement which did not endorse universal screening. Our institution has utilized educational tools and electronic health record (EHR) modifications to encourage pediatric cholesterol screening.

Hypothesis:
Changes in pediatric lipid screening rates within a single institution correlate with release of national guidelines, as well as local educational tools and EHR modifications.

Methods:
Order placement was defined as ordering a high-density lipoprotein cholesterol level in a patient 9-21 years with ≥ 1 well visit in prior 3 years. Order placement rate (OPR) was calculated per month using 3 months’ moving average smoothing and analyzed based on date and specialty of ordering clinician. Timing of educational tools, EHR modifications, and national guideline release were analyzed for changes in OPR.

Results:
A total of 36,756 visits from 2010-2019 with 21,239 orders were analyzed. Total OPR was 57.8%. Prior to 2011 guideline, pediatrician (P) OPR was 41% (95% CI: 36-47%) and 9% (7-10%) for family medicine (FM). OPR increased in the 12 months after 2011 guideline, educational initiatives, and EHR changes for P (80%, 95% CI: 76-83%) and FM (21%, 95% CI: 19-25%) . Both P and FM had lower rates after 2016, with greater decrease for FM (p<0.001 for all).

Conclusions:
OPR was higher in P than FM, with largest OPR changes correlating with release of guidelines. Larger positive changes in OPR were seen in P compared to FM after 2011 guideline, and larger decrease in OPR in FM compared to P correlating with 2016 USPSTF statement release. Conflicting guidelines may contribute to lower overall OPR as well as different screening rates for children cared for by P and FM.
Abstract 14200: Prognostic Significance of Dipstick Proteinuria in Heart Failure With Preserved Ejection Fraction - Insight From the Pursuit-hfpef Registry
Authors: Oeun Bolrathanak , Hikoso Shungo , Nakatani Daisaku , Mizuno Hiroya , Kitamura Tetsuhisa , Okada Katsuki , Dohi Tomoharu , Sotomi Yohei , Kida Hirota , Sunaga Akihiro , Sato Taiki , Yamada Takahisa , Yasumura Yoshio , Nakagawa Akito , Nakagawa Yusuke , Tamaki Shunsuke , Hayashi Takaharu , Yano Masamichi , Sakata Yasushi
Published: May 2021

Introduction:
Although albuminuria evaluated with urinary albumin-to-creatinine ratio (UACR) was shown to be a prognostic marker in patients with heart failure, measurement of UACR needs special equipment. Urine dipstick test is a simple and convenient method which is available even in community-based health care.

Hypothesis:
We hypothesized that dipstick proteinuria might be a prognosticator in HFpEF.

Methods:
We assessed 738 discharged-alive patients in the PURSUIT-HFpEF registry. Patients received urine dipstick test, and were divided into 2 groups according to the absence or presence of proteinuria (proteinuria trace or more). The study endpoint was a composite of all-cause mortality and HF hospitalization.

Results:
Median age was 82 years and 410 patients were female. Four hundred thirty-four patients: proteinuria-(group 1); 304 patients: proteinuria+(group 2). Group 2 was more likely male with higher frequency of diabetes, previous myocardial infarction and chronic kidney disease, but less likely to take ACEIs than group 1. Higher blood pressure, NT-proBNP, creatinine, E/e’, TRPG, and LV mass index were observed in group 2 than group 1. The composite endpoint and HF hospitalization occurred more often in group 2 than group 1 (HR: 1.43, 95%CI: 1.09-1.87, log-rank P=0.009; HR: 1.57, 95%CI: 1.14-2.15, log-rank P=0.005, respectively); but all-cause mortality did not (HR: 1.40, 95%CI: 0.92-2.11, log-rank P=0.113). Multivariable Cox regression adjusting for NT-proBNP, eGFR and other major confounding factors showed that proteinuria was associated with the composite endpoint (HR: 1.42, 95% CI: 1.05-1.94, P=0.026), and HF hospitalization (HR: 1.51, 95%CI: 1.04-2.18, P=0.030), but not with all-cause mortality (HR: 1.51, 95%CI:0.94-2.43, P=0.092).

Conclusions:
Dipstick proteinuria may be a prognostic marker in patients with HFpEF. Evaluation of proteinuria by urine dipstick test may be a simple but useful method for risk stratification in HFpEF.
Abstract 14235: Aortic Volume and Dimensions by Cardiovascular Magnetic Resonance Predict Incident Cardiovascular Events
Authors: Neisius Ulf , Gona Philimon N , Salton Carol , Oyama-Manabe Noriko , Chuang Michael L , O'Donnell Christopher J , Manning Warren J , Tsao Connie W
Published: May 2021

Introduction:
Pathophysiology of the aorta negatively impacts cardiovascular health.

Hypothesis:
Assessment of aortic anatomy facilitates population-based cardiovascular disease (CVD) risk stratification.

Methods:
Framingham Heart Study Offspring Cohort participants without prevalent CVD (n=1576, 64±9 years, 44% men) underwent 1.5T ECG-gated axial T2W black-blood CMR of the thoracoabdominal aorta (2002-2006). The diameters of the descending thoracic and proximal and distal abdominal aorta (infrarenal and aortic bifurcation) were measured (
Figure A
). Additionally, the maximum diameter and the total intravascular volume of the descending thoracic and abdominal aorta were calculated. Cox proportional hazards regression analyses adjusting for age, gender, systolic blood pressure, total cholesterol/HDL cholesterol ratio, diabetes mellitus, smoking, as well as treatment for hyperlipidemia, hypertension, and diabetes were undertaken to evaluate the association of aortic anatomy with incident CVD (
Figure
).

Results:
During follow-up (median 9.5 years, range 0 - 12.2 yrs), 163 incident CVD events occurred, of which 66 were major events (myocardial infarction, ischemic stroke, and CVD death). In multivariable-adjusted Cox regression models, each SD unit greater descending thoracic and maximum aortic diameter, as well as natural logarithmic transformed total aortic volume were associated with a >20% increased risk for incident CVD (per SD Unit hazard ratio [HR]: 1.21, 95% CI: 1.03-1.42, P=0.019; HR 1.22, 95% CI: 1.04-1.43, P=0.014; HR: 1.24, 95% CI: 1.10-1.39, P<0.001, respectively;
Figure B
). Abdominal aortic diameters were not associated with CVD.

Conclusions:
In this middle-aged community-dwelling Caucasian adult cohort followed over 10 years, greater thoracoabdominal aortic dimensions and volume, predicted incident CVD. Future investigations may determine the implications of aortic size modification on CVD outcomes.
Abstract 14236: Cardiovascular Risk at Presentation for Gender-Affirming Care in the Transgender Population
Authors: Denby Kara J , Patil Meghana , Toljan Karlo , Cho Leslie , Ferrando Cecile A
Published: May 2021

Introduction:
Due to stigma, the transgender (TG) population experiences socioeconomic and health disparities, including decreased access to care. Use of gender affirming hormone therapy (GAHT) may place TG individuals at increased cardiovascular (CV) risk. The objective of this study is to identify the baseline CV risk of TG individuals presenting for gender affirming care.

Methods:
This was a retrospective study of TG patients seeking GAHT from a multi-disciplinary transgender program. Patients were included if they had not yet initiated GAHT. Once patients were identified, the EMR was queried for the following data: demographics, medical history, vitals, medications, and laboratory results. The ACC/AHA ASCVD and QRISK3 risk scores were calculated for all patients who did not have documented CV disease.

Results:
427 patients met inclusion criteria. Demographics are in Table 1. Of the patients, 237 (55.4%) had a chronic medical condition. The incidence of undiagnosed hypertension and hyperlipidemia was 6.8% and11.3% respectively, and of these cases, only 64.4% and 24.1% were on appropriate therapies. Mean ASCVD risk and QRISK3 for ages 40-65 was 8.3% and 12.2%, respectively. Mean QRISK for ages 25-39 years was 4.6%. Of those patients who fell into intermediate or high risk categories, there was limited statin use (Figure 1).

Conclusions:
TG individuals presenting for GAHT have elevated CV risk, including high rates of undiagnosed and untreated CV risk factors with inadequate CV prevention. They appear to be at higher risk than their age matched historical cohorts regardless of gender.
Abstract 14245: Fibroblast Growth Factor 23 and Long-term Cardiac Function: The Multi- Ethnic Study of Atherosclerosis
Authors: Patel Ravi B , Ning Hongyan , de Boer Ian H , Kestenbaum Bryan , Ac Lima Joao , Mehta Rupal , Allen Norrina B , Shah Sanjiv J , Lloyd-jones Donald M
Published: May 2021

Background:
While fibroblast growth factor 23 (FGF23) is associated with incident heart failure (HF) and atrial fibrillation (AF), the mechanisms driving these associations are unclear. FGF23 elevation leads to cardiomyocyte calcium handling abnormalities, suggesting that FGF23 may directly reduce myocardial function.

Methods:
In the Multi-Ethnic Study of Atherosclerosis, a cohort free of cardiovascular disease at recruitment, we evaluated the associations of serum FGF23 (2000-2002) with measures of left ventricular (LV) and left atrial (LA) mechanical function on cardiac magnetic resonance (CMR) at 10-year follow up (2010-2012).

Results:
Of 2,276 participants with baseline FGF23 and CMR at 10-year follow up, participants with higher FGF23 levels were more likely white race, taking anti-hypertensive medications, and had lower baseline glomerular filtration rate (GFR). After covariate adjustment, baseline FGF23 levels were independently associated with worse LV global circumferential strain, worse LV mid-wall circumferential strain, and lower LA total emptying fraction in later life (
Table
). The association of FGF23 and LV global circumferential strain was consistent across the spectrum of GFR (
Figure
). While higher FGF23 was associated with higher LV mass (β coefficient per SD higher: 1.14, 95% CI: 0.16, 2.12, P= 0.02), it was not associated with the presence of macroscopic myocardial scar (OR per SD higher: 1.12, 95% CI: 0.86-1.45, P= 0.42).

Conclusions:
Baseline FGF23 is independently associated with lower LV and LA systolic function in later life. These findings provide mechanistic insight driving the associations of FGF23 with development of both HF and AF.
Abstract 14246: Automated Detection of Arrhythmogenic VT Substrate: Performance of a 2019 HRS VT Consensus Document Recommended Strategy
Authors: Baskaran Abhishek , Shapira Einat , Niri Ahmed , Massé Stéphane , Ha Andrew , Bartal Meir , Baron Tal , Hayam Gal , Nanthakumar Kumaraswamy
Published: May 2021

Background:
During ventricular tachycardia (VT) ablation, clinical VT is often non-inducible or hemodynamically unstable. Hence, a substrate-based approach is often necessary. Although many strategies have been proposed, none have been automated nor incorporated into current day electro-anatomical mapping (EAM) systems. One strategy, recommended in 2019 HRS guideline, is Decrement Evoked Potential (DeEP) mapping for identification of critical VT substrate. We have developed an automated method to identify critical DeEP VT substrate in an EAM system (CARTO
®
3).

Objective:
The performance of this novel automated algorithm was retrospectively evaluated in patients who underwent substrate-based VT ablation.

Methods:
Entire VT ablation using DeEP mapping was performed and recorded in 12 consecutive patients. CARTO
®
3 case data was downloaded and analyzed by a novel automated algorithm for DeEP detection. A blinded electrophysiologist verified the automated electrogram DeEP annotations and assessed its performance in a dichotomous fashion. The effect of bipolar voltage threshold (0.01, 0.02, 0.05, 0.075, 0.1, 0.20, 0.25 and 0.30 mV) on algorithm performance was evaluated. Sensitivity, specificity and ROC curve of the algorithms were calculated. Finally, results from the analysis were merged with voltage map to produce DeEP maps.

Results:
Results from the ROC curve shows that a bipolar threshold of 0.075mV optimizes specificity and sensitivity. At that threshold the algorithm found 848 true positive and 626 true negatives out of a total of 1975 EGMS being analyzed. Sensitivity and specificity were found to be 65.8% and 82.3% respectively.

Conclusions:
We have developed an automatic detection algorithm that identifies and locates critical VT substrates. The performance characteristics have been evaluated for a multimodal VT substrate map to provide clinicians mechanistic substrate map in CARTO 3
®
for VT ablation.
Abstract 14289: The Effect of Vitamin D Supplementation on Cardiovascular Risk in Patients With Prediabetes in the D2d Study
Authors: Desouza Cyrus V , Chatterjee Ranee , Johnson Karen , kashyap sangeeta R , Lewis Michael , Margolis Karen L , Pratley Richard , Rasouli Neda , Sheehan Patricia R , Pittas Anastassios
Published: May 2021

Introduction:
Low blood 25(OH)D levels are associated with increased cardiovascular (CVD) risk; however; it is unknown whether vitamin D supplementation reduces CVD risk or CVD events. In a secondary analysis from the D2d study, a large diabetes prevention trial, we investigated effects of vitamin D on CVD outcomes.

Methods:
Persons with prediabetes (n=2,423) not selected for vitamin D insufficiency were randomized to 4000 IU/day of vitamin D
3
or placebo and followed for a median duration of 2.5 years. The primary outcome for this analysis was first occurrence during the study of a composite 4-point Major Adverse Cardiovascular Events (MACE). Secondary aims evaluated effects on expanded MACE (MACE + revascularization) and on CVD risk variables (BP, lipids, CRP and Atherosclerotic Cardiovascular Disease score). All CVD events were independently adjudicated. In ITT analyses, Cox proportional models compared hazard rates between the two groups on 4-point and expanded MACE.

Results:
Baseline characteristics included 49% women, mean age was 60 years old, and 13% had established CVD by history. There were no significant differences in key baseline characteristics between the two groups. By month 24, the mean serum 25(OHD) D level in the vitamin D group was 54.3 ng per milliliter (from 27.7 ng per milliliter at baseline), as compared with 28.8 ng per milliliter in the placebo group (from 28.2 ng per milliliter at baseline). A primary MACE event occurred in 21 versus 12 subjects in the vitamin D versus placebo group (Hazard ratio 1.81, 95%CI 0.89-3.69). The number of expanded MACE events were the same between the two groups (n=27 in each group, hazard ratio 1.02, 95%CI, 0.59-1.76). CVD risk variables did not change significantly with vitamin D versus placebo.

Conclusion:
In a pre-diabetes population not selected for vitamin D insufficiency, vitamin D supplementation did not lower CVD risk.
Abstract 14293: Echocardiographic Predictors of Symptomatic Cardiotoxicity Among Patients Undergoing Chemotherapy: Systematic Review and Meta-analysis
Authors: Siddiqui Muhammad U , Khan Mohammad S , Yaacoub Youssef , Hanson Heidi-Anne , Siddiqui Muhammad Danial , Yacob Omar
Published: May 2021

Introduction:
Chemotherapeutic agents have been associated with cardiotoxicity and thus require close monitoring. Several echocardiographic variables have been investigated as early predictors of symptomatic cardiotoxicity (SC) in patients undergoing chemotherapy.

Hypothesis:
We hypothesized that global longitudinal strain (GLS) is a better predictor of SC compared to left ventricular ejection fraction (LVEF) in patients receiving chemotherapy.

Methods:
MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials were searched from through March 2019. Adults who developed SC (symptomatic congestive heart failure, decline in LVEF <50%, cardiac death) after undergoing chemotherapy with pre- and post-chemotherapy echocardiographic measures of cardiac function were included. Primary focus was on the prediction of SC. Estimates were reported as random effects hazard ratios (HR) with 95% confidence intervals (CI).

Results:
Eight studies met inclusion criteria. Six studies analyzed LVEF and demonstrated a significant association between LVEF and the prediction of SC (HR 1.27; 95% CI, 1.02-1.57; P=0.03)
(Figure 1)
. Two studies that analyzed GLS found it to be a strong predictor of SC in patients undergoing chemotherapy (HR 1.46; 95% CI, 1.34-1.58; P=<.001)
(Figure 2)
.

Conclusions:
Both LVEF and GLS can predict SC, and therefore can be utilized for monitoring patients on chemotherapy for cardiac dysfunction. The data for GLS is more homogenous but definite evidence that GLS may be superior to LVEF is lacking. More randomized blinded trials are required to identify if one echocardiographic parameter may be superior to the other.
Abstract 14296: Differential Left and Right Ventricle Response to Cold Storage Followed by Reperfusion in Heart Transplantation
Authors: Lei Ienglam , Huang Wei , Pagani Francis D , Chen Eugene , Wang Zhong , Pober Jordan S , Tellides George , Perelli Robin , Shashi Vandana , Landstrom Andrew P , TANG Paul C
Published: May 2021

Introduction:
In heart transplantation, the supply of donor hearts is contributed by the short tolerable preservation period with risk for primary graft dysfunction. Understanding the differential biological responses to preservation between the left ventricle (LV) and right ventricle (RV) may provide critical insights.

Methods:
Murine donor hearts were infused with cold HTK solution and stored on ice for 0h, 4h and 8h followed by 90minutes perfusion with Krebs Buffer. The LV and RV were collected at the end of reperfusion for gene expression and protein analysis by RNA-sequencing and western blot.

Results:
Differential gene expression analysis showed that RV has 1092 upregulated genes and 291 downregulated genes compared to LV after cold storage followed by perfusion. GO analysis show that gene sets related to immune response (padj=7e-27), cell responses to interferon-beta (padj=8.90e-19) were enriched in RV upregulated genes (figure). We also confirmed the upregulation of immune response genes such IL1-β, Myd88 by qPCR and western blot. Moreover, we found that active β-catenin, a potential upstream regulator of IL1- β, also upregulated in RV. Wnt/β-catenin downstream target genes were also enriched in human donor RVs during prolonged preservation. Importantly, donor hearts from murine Myd88-/- showed reduced differences in the transcriptome of the LV vs RV (figure) and demonstrated improved heart function after prolonged cold storage with reperfusion.

Conclusions:
The RV demonstrates more extensive inflammatory response to storage compared to the LV. Selective upregulation of Wnt/β-catenin signaling in the RV may be important for enhancing this inflammatory response to preservation. Deficiency of MyD88 mediated innate immune signaling improved cardiac contractility after prolonged preservation and likely have important clinical implications for transplantation.
Abstract 14316: Diurnal Variation of the Macrophage Expressed Gene-1 Inflammatory Marker in the Timing of Sudden Cardiac Arrest
Authors: Kattel Sharma , Bhatt Hardik , Xu Shirley , Mirza Jibran , Pokharel Saraswati , Sharma Umesh C
Published: May 2021

Background:
In the last decade, inflammatory biomarkers have been implicated in out of hospital sudden cardiac arrest (OH-SCA). However, the role of diurnal variation in these inflammatory markers in relation to the timing of OH-SCA is unknown. Here we report an increased macrophage-expressed gene-1 (MPEG-1) expression, an evolutionary conserved protein with membrane attack complex domain, in relation to the timing of OH-SCA and survival after resuscitation.

Objectives:
To examine the relationship between the circulating MPEG-1protein levels and the timing of OH-SCA.

Methods:
We prospectively enrolled 144 subjects from 4 different tertiary care centers who were successfully resuscitated from OH-SCA. The timing of OH-SCA and other clinical parameters were obtained from medical record review. Serum levels of a novel biomarker, MPEG-1, and other conventional clinical biomarkers including troponin-I and CK-MB were measured in the blood samples obtained within the 6 hours of OH-SCA.

Results:
Approximately 32% of the sudden cardiac arrest happened in the morning hours (
5AM- 12PM
). The higher incidence of the OH-SCA occurring in morning hours correlated with elevated serum MPEG-1 levels as shown in
figure 1
. In 71% of the OH-SCA, the etiology was of cardiac in nature, of which 32% were from acute myocardial infraction. At the end of the hospital stay, 46% of the patients had died.

Conclusions:
This study suggests that the diurinal variation in the propensity to develop OH-SCA is associated with elevated serum levels of MPEG-1. Further research examining this novel biomarkers in larger cohorts can form the basis for accurate and timely risk-prediction.
Abstract 14334: Best Electrocardiographic Criteria for Hyperkalemia in Chronic Hemodialysis Patients
Authors: Shikari Saima , Bartolomei Keith , Landry Daniel , Marenco John , Braden Gregory
Published: May 2021

Introduction:
To date, the effects of hyperkalemia (HK) on the ECG in chronic hemodialysis (HD) patients are inconsistent. No studies examining all of the possible effects of HK on the ECG of HD patients have been performed. We studied the ECGs of 128 consecutive HD patients with acutely clotted grafts or fistulas. ECGs from 46 HK patients with potassium levels ≥5.5 mEq/L were compared to 82 patients with normal potassium (NK) levels < 5.5 mEq/L.

Methods:
Patients with bundle branch block or cardiac events within 3 months were excluded. There were no differences between HK & NK patients for dialysis duration, causes of ESRD, cardiac disease or serum levels of Na
+
, Ca
2+
, HCO3, or phosphorus. ECG analysis included: height & width of P waves, T waves in V4 & Lead II, time intervals of PR, QRS, QT, QTc, PR/QT, PR/QTc & slopes of ascending & descending T waves in Lead II & V4. For the first time ever in HK HD patients, the ECG measurements in 32 HK patients were compared to their own NK ECGs obtained 3 to 6 months from the HK event.

Results:
Univariate analysis between the 46 HK & 82 NK patients showed 4 differences in mean values: V4 T wave height 4.0 vs 2.9mm, Lead II T wave height 2.7 vs. 2.0 mm, & V4 T wave ascending (.03 vs .02) & descending slopes (.04 vs .03). Multivariate analysis for all clinical & ECG findings between HK & NK patients found only the increased height of the T wave in V4 was significant, p<0.05. In contrast, the ECG analysis of the HK patients to their NK ECGs revealed more differences: higher T wave height in V4 (5.0 vs 3.7mm), higher T wave height in Lead II (4.0 vs 2.7 mm), shorter width of T wave in V4 (2.4 vs 4.1ms) & Lead II (2.1 vs 4.1ms), longer PR (188 vs 167ms) & steeper slopes in the T waves in Leads II & V4. Regression analysis of the change in potassium from NK to HK to each ECG measurement above showed that the only significant correlation was to the width (r= -.433, p= .007) & height (r= .333, p=.03) of the T wave in V4. In these HK HD patients T wave tenting in V4 was present in 56%.

Conclusion:
Intra-patient comparison of baseline NK to HK ECGs in HD patients confirms the importance of the height of the T wave in Lead V4 to diagnose HK. Shortened width and increased height of T waves in V4 are the most predictive ECG changes of HK.
Abstract 14342: Redo Surgical Aortic Valve Replacement versus Valve in Valve Transcatheter Aortic Valve Replacement
Authors: Patel Parth M , Chiou Edward , Wei Jane W , Binongo Jose N , Guyton Robert A , Leshnower Bradley G , Grubb Kendra J , Chen Edward P
Published: May 2021

Introduction:
There has been a recent trend towards the increased use of biologic valves at the time of surgical aortic valve replacement (SAVR) with an understanding there may be a potential need for future valve intervention. In this study, we compared the clinical outcomes of Redo-SAVR with valve-in-valve transcatheter aortic valve replacement (VIVTAVR) in patients with a prior history of SAVR.

Methods:
From 2012 to 2019, 263 patients underwent isolated aortic valve reintervention after prior SAVR: VIV-TAVR (n=187) or redo-SAVR (n=86). Multivariable analysis was performed to identify risk factors mortality and aortic reintervention. Sub-analyses were performed to compare VIV-TAVR patients to Redo-SAVR patients undergoing biologic valve explant and implant (Biologic) as well as VIV-TAVR and Redo-SAVR patients matched by STS Predicted Risk of Mortality (STS PROM).

Results:
Operative mortality for the Redo-SAVR and VIV-TAVR was 1.2% (1) and 1.6% (3) respectively (p=0.92). Redo-SAVR patients had an increased stroke rate (7.0% vs 1.1%, p=0.02) and longer postoperative length of stay (7 vs 2 days, p<0.0001). VIV-TAVR patients had a higher rate of ≥1+ paravalvular leak (PVL) (21.4% versus 3%, p=0.0002) and a lesser reduction in transvalvular gradient (-21.9 ± 17.6mmHg vs -30.3 ± 20.7mmHg, p=0.0038). The difference in PVL was maintained during the Biologic Sub-analysis (p=0.0034). In the STS PROM Sub-analysis, early mortality was the same for each group (1.2%), and the differences in PVL (p=0.0002) and in transvalvular gradient reduction (p=0.005) were maintained. Preoperative renal failure (p=0.006) and cerebrovascular disease (p=0.04) were risk factors for mortality and prior myocardial infarction (p=0.04) was a risk factor for aortic reoperation for VIV-TAVR. No risk factors were identified for Redo-SAVR.

Conclusions:
Aortic valve reintervention following prior SAVR is associated with outstanding clinical outcomes. Both Redo-SAVR and VIV-TAVR can be performed with lower than expected predicted mortality. Redo-SAVR was associated with increased morbidity compared to VIV-TAVR, but improved valve function and hemodynamics. Differences in long term valve durability and patient survival between these two therapies are yet to be determined.