bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14490: Sarcopenia Defined by Computed Tomography Psoas Muscle Area Predicts Morbidity and Mortality in Patients Undergoing Left Ventricular Assist Device Implantation
Authors: Koda Yojiro , Nishida Hidefumi , Nguyen Ann , Chung Bow , Kim Gene H , Smith Bryan , Kalantari Sara , Sarswat Nitasha , Grinstein Jonathan , Onsager David , Song Tae , Jeevanandam Valluvan , Ota Takeyoshi
Published: May 2021

Objective:
This study aimed to assess the correlation between psoas-muscle sarcopenia and clinical outcomes in patients undergoing left ventricular assist device (LVAD) implantation.

Methods:
Patients who underwent a LVAD implantation and had a perioperative CT available were included. Bilateral psoas muscle cross-sectional areas at the level of L3 were measured, and a total psoas muscle area was divided by a body surface area (BSA) to calculate total psoas muscle area index (TPAI). Sarcopenia was defined as TPAI<7.5 cm
2
/m
2
, and the cohort was divided into Sarcopenia group (S group) and Non-sarcopenia group (NS group). Postoperative complications, in-hospital mortality, and overall survival were retrospectively assessed.

Results:
Between 7.2008-1.2020, a total of 513 patients underwent a LVAD implantation. Among them, 244 patients with a qualified CT study were identified. The S group was 127 patients (52%), and the NS group was 117 patients (48%). There were no differences in patient characteristics including age, comorbidity, INTERMACS classification, except BSA (S group vs. NS group: 1.99±0.27 vs. 2.07±0.28, p=0.0372) and female gender (S group vs. NS group: 39% vs. 20%, p=0.0011). Postoperative acute kidney injury (AKI) (22% vs. 9%, p=0.0030), newly required dialysis (16% vs. 5%, p=0.0058), and in-hospital mortality (13% vs. 4%, p=0.0174) were higher in the S group compared with the NS group. The causes of in-hospital mortality in the S group included right ventricular failure (RVF) (N=4), stroke (N=4; cerebral hemorrhage 3, subarachnoid hemorrhage 1), sepsis (N=3), respiratory failure (N=2) , bowel ischemia (N=2), bowel perforation (N=1). Those in the NS group were RVF (N=3), sepsis (N=1), and liver failure (N=1). Overall long-term survival was similar with both groups (S group vs. NS group: 72±4 vs. 75±4% at 1 year, 53±5 vs. 53±6% at 3 years, 40±6 vs. 34±9% at 5 years, Log-Rank P=0.6356). The Youden index identified the cut-off value of TPAI of 7.2cm
2
/m
2
for in-hospital mortality (area under curve, 0.699; sensitivity, 76.2%; specificity, 54.3%).

Conclusions:
Sarcopenia (TPAI<7.5 cm
2
/m
2
) was a predictor for postoperative AKI and in-hospital mortality in patients undergoing a LVAD implantation.
Abstract 14635: The Fib-4 Index is a Risk Factor for Incident Cardiovascular Disease in Urban Male Residents: The Suita Study
Authors: Kokubo Yoshihiro , Koseki Masahiro , Watanabe Makoto , Higashiyama Aya , Nakao Yoko , Honda-Kohmo Kyoko , Miyamoto Yoshihiro
Published: May 2021

Introduction:
The fibrosis index based on four factors (FIB-4 index) is a score that predicts liver fibrosis easily, quickly, and inexpensively, but there is little evidence of its relationship with the onset of cardiovascular disease in general population in Japan. Therefore, we examined the relationship between incident cardiovascular disease (CVD) by the FIB-4 index level in urban area residents.

Methods:
We studied 5,333 follow-up Japanese individuals (2,478 men, 2,855 women) with no history of CVD in the Suita Study. The platelet count was measured at the time of medical examination. The FIB-4 index was calculated using age (yrs), alanine aminotransferase (ALT, IU/L), aspartate aminotransferase (AST, IU/L), and platelet count (PLT, 10^9/L) as follow: FIB-4 index = (AST x Age) / (PLT x (square root of ALT)). The primary endpoint was CVD events, including stroke or ischemic heart disease. The risk of CVD was analyzed by the FIB-4 index level using the Cox proportional hazards model adjusted by the components of the ischemic heart disease risk score in the Suita Study.

Results:
The percentage of the FIB-4 index ≥2.67 in the 30s to 80s at the baseline survey was 0%, 1%, 2%, 7,%, 21%, 43% for men, and 0%, 0%, 1%, 5%, 16%, 39% for women, respectively. During the mean follow-up period of 9.3 years, 195 strokes and 137 ischemic heart diseases were observed. Based on men with FIB-4 index <1.30, the adjusted hazard ratio (95% confidence interval) for incident CVD in men with FIB-4 index ≥2.67 was 1.91 (1.05-3.47), those for incident ischemic heart disease in men with FIB-4 index 1.30-2.66 and ≥2.67 were 2.49 (1.33-4.64) and 3.29 (1.32-8.16), respectively.

Conclusion:
The FIB-4 index was considered to be useful as a predictor of ischemic heart disease in urban men in Japan.
Abstract 14649: Chloride Channel Calcium-activated-1 Reduces Mouse Abdominal Aortic Aneurysm by Blocking Macrophage Migration Inhibitory Factor Activity in Macrophage Activation
Authors: Liu Tianxiao
Published: May 2021

Introduction:
Human chloride channel calcium-activated-1 (CLCA1) protein is a secretory protein that goblet cells from trachea epithelium express abundantly where it participates in hypersecretory lung diseases by mucus overproduction. Studies from CLCA1-deficient mice or CLCA1 blocking agents have however yielded inconsistent conclusions. CLCA1 not only regulates mucin expression, but also participates in innate immune responses by binding to yet unidentified molecules on the inflammatory cells and regulating cytokine and chemokine production. Seeking CLCA1 binding proteins identified CLCA1 expression by endothelial cells (EC), smooth muscle cells (SMC), and macrophages in human and mouse abdominal aortic aneurysms (AAA). Ligation of CLCA1 mediated the actions of macrophage migration inhibitory factor (MIF).

Hypothesis:
CLCA1 controls AAA growth by regulating MIF activity.

Methods and Results:
Immunoblots revealed high levels of the 110 and 75-kDa CLCA1 fragments in human abdominal aneurysm lesions, but normal human aortas contained predominantly the 35-kDa carboxyl-terminal fragments. Cultured human EC and SMC contained only the 35-kDa fragment, but human monocyte-derived macrophages contained both the 75 and 35-kDa fragments. Confocal microscopy colocalized CLCA1 and MIF in macrophages from human AAA lesions. CLCA1 immunoprecipitation followed by MIF immunoblot showed that the 35-kDa CLCA1 fragment complexes with MIF in cultured macrophages. Adventitial CaPO
4
-induced AAA in male

Clca1
-/-

mice demonstrated significantly greater aneurysm diameter, and increased lesion neutrophil and eosinophil content, as well as neutrophil- and eosinophil-associated chemokine (CXCL1, 2, 5, CCR3, and eotaxin-2 and 3) expression than those in wild-type or sham-operated mice. Macrophages cultured from

Clca1
-/-

bone-marrow showed enhanced MIF activity compared to those from wild-type mice.

Conclusions:
The 35-kDa CLCA1 fragment reduces formation of experimental AAA by acting as a decoy receptor, sequestering MIF and thus limiting MIF-mediated macrophage activation.
Abstract 14657: Intermuscular Fat is Independently Associated With Coronary Microvascular Dysfunction and Adverse Cardiovascular Outcomes in Patients With No Obstructive CAD
Authors: Souza Ana Carolina A , Troschel Amelie S , Marquardt Jan P , Divakaran Sanjay , Brown Jenifer , Barrett Leanne , Martell Laurel , Bibbo Courtney , Hainer Jon , Blankstein Ron , Dorbala Sharmila , DI CARLI MARCELO F , Fintelmann Florian J , Taqueti Viviany R
Published: May 2021

Introduction:
Intermuscular adipose tissue (IMAT) reflects skeletal muscle quality and is associated with inflammation, a key determinant in cardiometabolic disease. Coronary flow reserve (CFR), a marker of coronary microvascular dysfunction (CMD), is independently associated with BMI, inflammation and risk of heart failure, myocardial infarction and death. Using a novel neural networks algorithm for body composition analysis, we sought to investigate the relationship between skeletal muscle quality, CMD and cardiovascular outcomes.

Methods:
Consecutive patients (N=669) undergoing evaluation for CAD with cardiac stress PET demonstrating normal perfusion and preserved LVEF were followed over median 6 years for events (MACE), including death and hospitalization for myocardial infarction or heart failure. CFR was calculated as the stress/rest myocardial blood flow ratio. Subcutaneous fat (SAT) and IMAT areas (cm
2
) were obtained from PET attenuation correction CTs using a fully automated algorithm validated by manual segmentation at T10 and T12 levels, respectively.

Results:
Median age was 63 years, 70% were female and 46% nonwhite. Nearly half of patients were obese (46% with BMI 30-61) and BMI correlated closely with SAT and IMAT (r=0.8 and 0.7, respectively, p<0.001). Independent of age, sex, race, BMI, LVEF and hypertension, CFR was associated with IMAT (β -0.10, p=0.047). In adjusted analyses, both CFR and increased IMAT were independently associated with MACE [HR 1.6 (1.1-2.4) per -1U CFR and 1.5 (1.2-1.7) per +10 cm
2
IMAT, p≤0.01]. Patients with both CMD and poor muscle quality demonstrated highest risk of MACE (adjusted p<0.02).

Conclusion:
Increased intermuscular fat is associated with CMD and adverse cardiovascular outcomes independently of BMI and traditional risk factors. Combined assessment of skeletal muscle quality and coronary microvascular function may help to redefine at-risk cardiometabolic phenotypes.
Abstract 14660: The Ascvd-10 Risk Estimate as a Predictor for True Resistant Hypertension in High-risk Overweight and Obese Hypertensive Subjects: A Cross-sectional Study
Authors: Haddadin Faris I , Lucas Claire Huang , Wu Lingling , Berookhim Joshua , Moctezuma Sananda , Munoz Estrella Alba , Sud Karan , Patel Dipal , Argulian Edgar
Published: May 2021

Background:
The estimates of 10-year risk for atherosclerotic disease (ASCVD-10) is applicable for individuals who are 40 to 79 years old without prior cardiovascular disease. While multiple components of the risk estimator are shared risk factors for many cardiovascular diseases, the ASCVD-10 does not consider the BMI value and limited studies examined the relationship between the ASCVD-10 risk score and resistant hypertension (RH).

Methods:
This is a cross-sectional study based on an out-patient primary care practice conducted between Oct 2017 to Oct 2018. Subjects with hypertension with either high-risk overweight (BMI ≥27 & ≤29.9 kg/m2 plus ≥1 obesity-related comorbid conditions) and subjects with obesity (BMI ≥30 kg/m2) were included. Subjects with prior ASCVD were excluded. Apparent treatment-resistant hypertension (ATRH) detected with an average of two blood pressure (BP) readings at the office was confirmed with home BP measurement to exclude pseudoresistance and verify true resistant hypertension (TRH). BP cutoff of >130/80 mmHg was used. Multivariate logistic regression adjusted for significantly different baseline variables among subjects with TRH vs non-TRH was used to examine the performance of ASCVD-10 in predicting TRH. Variables that are part of the ASCVD-10 score were excluded from the adjustment.

Results:
We identified 595 eligible subjects. Mean age was 60.4 years and 381 (64.1%) were females. ATRH was detected in 69 subjects but only 35 subjects had TRH after home BP measurement confirmation. Subjects with TRH compared to non-TRH were more likely to be of black race (51.4% vs 33.1%, p=0.022), to have chronic kidney disease (34.2% vs 11.3%, p <0.001), higher mean BMI (36.9 vs 33.1 kg/m2, p <0.001), diastolic heart failure (42.9% vs 12.5%, p <0.001), dyslipidemia (60% vs 41.9%, p=0.037) and diabetes mellitus (71.4% vs 36.8%, p <0.001). After adjustment to the variables mentioned previously that are not part of the ASCVD-10 risk calculator components, a higher ASCVD-10 score predicted the presence of TRH (OR 1.04 for each 1% of the ASCVD-10 score, 95% CI 1.01-1.07, p=0.039).

Conclusion:
The ASCVD-10 risk score can possibly be used as a predictor for the risk of having or developing RH in subjects with obesity or high-risk overweight.
Abstract 14662: Relationships Between Physical Activity, Coronary Artery Calcium, and Cardiovascular Outcomes in the Multi-Ethnic Study of Atherosclerosis: MESA
Authors: German Charles A , Fanning Jason , Singleton Matthew J , Shapiro Michael D , Brubaker Peter H , Bertoni Alain G , Yeboah Joseph
Published: May 2021

Introduction:
Physical activity is associated with decreased rates of atherosclerotic cardiovascular disease (ASCVD) and mortality. However, high levels of physical activity (PA) have paradoxically been linked with elevated levels of coronary artery calcium (CAC). It remains unclear whether high levels of physical activity in the presence of high CAC are associated with adverse outcomes in a diverse, multi-ethnic population.

Hypothesis:
We hypothesized that high compared to low levels of PA are associated with a reduction in incident ASCVD and all-cause mortality, even in the presence of high CAC.

Methods:
Baseline total PA (MET-min/week) in the Multi-Ethnic Study of Atherosclerosis (MESA), obtained via questionnaire, was divided into quartiles. CAC was dichotomized into low (CAC <100 Agatston Units (AU)) and high (CAC ≥100 AU) categories. Outcomes of interest included ASCVD and all-cause mortality. Cox proportional hazard regression analysis was used to assess associations between PA, ASCVD, and all-cause mortality among low and high CAC groups.

Results:
Among the 6,814 participants included in this study, the average age was 62 years, 53% were female, and 38% were non-Hispanic white. In participants with CAC <100 AU and PA in the highest quartile, we observed a significant reduction in ASCVD and all-cause mortality compared with participants in the lowest PA quartile (Table1). In participants with CAC ≥100 AU and PA in the highest quartile, we observed a significant reduction in all-cause mortality, but no difference in the risk of ASCVD compared with participants in the lowest PA quartile.

Conclusions:
Our study suggests that high levels of PA are associated with a reduced risk of ASCVD and all-cause mortality among individuals with low CAC, and a reduced risk of all-cause mortality among individuals with high CAC. There was no evidence to suggest an increased risk of ASCVD from high levels of PA in individuals with high CAC.
Abstract 14663: High Rate of Arrhythmia Diagnoses Following Return of Pathogenic/likely Pathogenic Variants in an Unselected Population
Authors: Davogustto Giovanni E , Glazer Andrew , Shaffer Christian M , Farber-Eger Eric , Dikilitas Ozan , Ning Shang , Pacheco Jennifer , Mosley Jonathan , Van Driest Sara , Wells Quinn , Rinke Lauren L , Kalash Olivia , Wada Yuko , Bland Sarah , Yoneda Zachary T , Kroncke Brett , Iftikhar Kullo , Jarvik Gail P , Gordon Adam , LARSON eric B , Manolio Teri A , Mirshahi Tooraj , Luo Jonathan , Schaid Daniel , Namjou Bahram , ALSAIED Tarek , Singh Rajbir , Singhal Ashutosh , Ralston James D , McNally Elizabeth M , George Albert , Chung Wendy , Carrell David S , Leppig Kathleen A , Hakonarson Hakon , Sleiman Patrick , Sohn Sunghwan , Glessner Joseph , Denny Joshua , Wei Wei-Qi , Shoemaker M. Benjamin , Roden Dan M
Published: May 2021

Background:
Return of incidental genetic findings is recommended for pathogenic/likely pathogenic (P/LP) variants in Mendelian arrhythmia genes. The extent to which these variants are associated with arrhythmia phenotypes in unselected populations is unknown.

Objective:
Assess the impact of return of results (RoR) of P/LP variants in 4 arrhythmia genes in research participants not selected for cardiovascular disease.

Methods:
The cohort included 24,410 participants from the Electronic Medical Records and Genomics Network. Rare variants (minor allele frequency <1%) in
KCNE1
,
KCNH2
,
KCNQ1
, and
SCN5A
were identified and classified according to ACMG guidelines. Arrhythmia phenotypes extracted from electronic health records (EHRs) included atrial fibrillation/flutter (AF/AFL), conduction system disease, long QT syndrome (LQTS), ventricular tachycardia/fibrillation (VT/VF), and premature ventricular contractions (PVCs). P/LP carriers’ phenotypes were compared to non-carriers using logistic regression adjusted for demographic covariates and site. Participants with P/LP variants were informed of their results and the impact of this RoR was assessed after 1 year of follow-up clinical care.

Results:
The participants included 53.7% females and 72.5% white individuals, with a median age of 57 years. 71 participants had a heterozygous P/LP variant in one of the 4 genes. LQTS diagnoses were associated with P/LP carrier status for all 4 genes (
KCNE1
OR 22.8, p=1.0e-4;
KCNH2
OR 35.1, p=1.8e-7;
KCNQ1
OR 27.3, p=3.6e-18;
SCN5A
OR 5.6, p=0.02). Carriers of
SCN5A
P/LP variants were also more likely to have PVCs (OR 4.3, p=0.003). Sensitivity analyses showed the associations predated the RoR. EHRs included a diagnosis of LQTS or Brugada Syndrome in 11/71 (16%) pre-RoR, and 16 more were diagnosed after RoR (27/71, 38%). A total of 47/71 (66%) participants had a documented arrhythmia phenotype 1 year after RoR, although 20 of these participants were not diagnosed with an inherited arrhythmia syndrome.

Conclusion:
Inherited arrhythmia diagnoses could be established in nearly half of participants with P/LP variants. These data indicate that return of incidental P/LP variants in these genes may facilitate the early diagnosis of arrhythmias.
Abstract 14675: Rising Prevalence of Obesity in the Us: National Health and Nutrition Examination Survey (NHANES) 2003-2018
Authors: palmer michael , Toth Peter P
Published: May 2021

Introduction:
Obesity is increasing globally. Obesity exacerbates risk for diabetes, dyslipidemia, hypertension, and ASCVD. We evaluated the prevalence of overweight and obese adults in the US during 2003-2018. HYPOTHESIS: The percentage of men and women overweight/obese is increasing continuously and may exceed the percentage with ‘normal’ weight.

Methods:
From 77007 participants in 8 NHANES surveys (between 2003-2004 and 2017-2018), we selected 39952 aged 20-79 years for this analysis. Participants with BMI data (n = 39440, 98.7%) were categorized as being underweight (BMI < 18.5), normal (BMI 18.5 - <25), overweight (BMI 25 - <30), obese (BMI 30 - <40) or morbidly obese (BMI 40+). Results were extrapolated to the entire US population (50 states plus the District of Columbia) using the direct method to the US Census 2000 population. Statistical analyses were performed in the R language.

Results:
There are statistically significant mean increases in BMI (95% confidence interval and p-value) between successive surveys of 0.18 (0.11, 0.25, p<0.0001) for men and 0.24 (0.14, 0.33, p<0.0001) for women. There are clear trends in morbid obesity (BMI 40+) from 3% in the first survey to 7% among men in the last survey, and from 7% to 12% in women. Obesity/morbid obesity (BMI 30+) increased from 31% to 44% in men and from 34% to 43% in women. About 78% of adult men are either overweight, obese, or morbidly obese (BMI 25+) in the most recent survey, an increase from 71% in the first survey. Among women 70% are either overweight, obese, or morbidly obese, an increase from 63% in the first survey. Very few US adults (1-2%) are underweight (BMI<18.5). About one quarter of US adults have normal weight (BMI 18.5- 25).

Conclusion:
During the period 2003-2018, there has been a substantial rise among both US adult men and women in BMI who are overweight/obese. This necessitates invigorated public education about the clinical hazards posed and the need for lifestyle/dietary modification to stem this crisis.
Abstract 14678: Prevalence Of Sglt2 Inhibitor And Glp-1 Receptor Agonist Prescriptions In Patients With Comorbid Diabetes And Cardiovascular Disease In An Integrated Academic Health System
Authors: Gay Hawkins , Yu Jingzhi , Petito Lucia , Isakova Tamara , Srivastava Anand , Khan Sadiya , Persell Stephen D , Linder Jeffery , Mutharasan Raja K , Huffman Mark D , Shah Sanjiv J , Yancy Clyde W , Ahmad Faraz S
Published: May 2021

Introduction:
Multiple randomized clinical trials have shown that sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP1) receptor agonists reduce the risk of cardiovascular events and mortality in patients with type 2 diabetes (T2D) and cardiovascular disease (CVD). In order to inform implementation strategies, we sought to describe prescribing trends among patients with T2D in clinical practice.

Methods:
We developed a clinical T2D cohort using a validated computable phenotype from the electronic data warehouse of a large academic health system among patients receiving care from January 1, 2013 through December 31, 2019. We retrospectively reviewed outpatient prescribing patterns in this cohort, and stratified results by CVD subtype (heart failure [HF] and atherosclerotic CVD [ASCVD]).

Results:
There were 23,485 patients identified with T2D. Mean (SD) age was 67 years (13), 46% were women, 61% were white, 32% had comorbid CVD (HF or ASCVD), and the mean (SD) hemoglobin A1c was 8.0% (5.7%). The majority of SGLT2 inhibitors and GLP1 receptor agonists were first prescribed by endocrinologists, 52% and 65% respectively. The prescription rate for both medication classes was low, and though SGLT2 inhibitor use increased over time (1% in 2013 to 14% in 2019; p<0.01), GLP1 receptor agonist use did not significantly change (10% in 2013 to 10% in 2019; p=0.93). Among patients with HF, SGLT2 inhibitor and GLP1 receptor agonist use increased annually by 42% and 7%, respectively, while patients with ASCVD experienced year over year growth of 63% and 13% in these categories. See Figure 1 (A and B) for more detail.

Conclusions:
Prescription rates of SGLT2 inhibitors and GLP1 receptor agonists remains low, especially for patients with T2D and CVD, despite a proven reduction in mortality and cardiovascular events. Strategies to increase the use of these proven medical therapies represent a major opportunity to improve outcomes in this high-risk group.
Abstract 14687: Achieved Eicosapentaenoic Acid (EPA) Levels Predicts Regression of Coronary Plaque Volumes by Coronary Computed Tomography Angiography (CCTA) in the EVAPORATE Trial
Authors: Lakshmanan Suvasini , Shekar Chandana , Kinninger April , Golub Ilana , Dahal Suraj , Birudaraju Divya , Cherukuri Lavanya , Rezvanizadeh Vahid , Hamal Sajad , Ahmad Khadije , Roy Sion , Nelson John R , Bhatt Deepak L , Budoff Matthew J
Published: May 2021

Background:
Despite the beneficial effects of statins on progression of coronary atherosclerosis and cardiovascular (CV) events, significant CV risk persists in patients with hypertriglyceridemia. In REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial), icosapent ethyl (IPE) added to statins reduced initial and total CV events by 25% and 30%, but the mechanisms of benefit are unclear. In a follow-up analysis, degree of CV benefit from IPE was predominantly related to achieved serum EPA levels.

Methods:
EVAPORATE is a randomized, placebo-controlled trial, using CCTA to evaluate the effects of IPE as an adjunct to statins on coronary plaque volumes in a cohort with elevated triglycerides. Here, we present the 18-month, pre-specified secondary end-point analysis on association of achieved serum EPA levels, and change in coronary plaque volumes in the pooled cohort.

Results:
80 patients were enrolled, and 68 completed the 18-month visit. Median (IQR) level of serum EPA for the pooled cohort was 20.6 (13.8) ug/ml at baseline and 25.3 (55.5) ug/ml at follow up. At 18 months, EPA levels > 26 ug/ml predicted regression of fibro-fatty plaque (logβ: - 0.75± 0.36), total non-calcified plaque (TNCP) (logβ: - 0.77± 0.33), and total plaque (TP) (logβ: - 0.63± 0.28) volumes (mm3), after adjustment for age, sex, diabetes, hypertension, and baseline TGL levels (p < 0.05 for all).

Conclusions:
Higher serum EPA levels predict regression of prognostically relevant coronary plaque volumes, TNCP, and TP on CCTA. This provides important mechanistic correlation to the CV benefits of IPE.
Abstract 14695: What Lies Ahead? Project Survival Estimates in the Setting of a ’Low Risk’ Fontan Circulation
Authors: Baker David W , Schilling Chris , Zannino Diana , Dennis Mark , d’Udekem Yves , Celermajer David , Cordina Rachael
Published: May 2021

The Fontan procedure has enabled those born with a functionally single ventricle to survive well into early adulthood albeit with high rates of morbidity and mortality. The total cavopulmonary connection (TCPC) has superseded the atriopulmonary connection (APC) and is associated with improved outcomes. However, the chance of survival into late adulthood is unknown and outcomes specifically in young adults without high risk features are not well characterized. We therefore projected the late survival of ‘low risk’ Fontan patients. Patients were included from the Australian and New Zealand Fontan Registry if they survived to age 16y without transplantation, sustained arrhythmia, thromboembolic event, Fontan conversion or takedown, plastic bronchitis, protein losing enteropathy, NYHA class III/IV or
≥
moderate ventricular dysfunction or atrioventricular regurgitation. Estimates of projected survival were obtained via Weibull distribution (Stata software, V15, StataCorp LLC) using current survival curves and extrapolating different modelled scenarios. In ‘optimistic’, Fontan mortality risks continue on current trends until reaching all-cause general population mortality risks. In ‘conservative’, the ratio of mortality risk between Fontan survivors and the general population are maintained from last follow-up. ‘Pessimistic’ was modelled to consider the possibility the TCPC cohort experience significant deterioration, as observed in the APC cohort; here risks were increased to match the APC mortality risk from age 55y. There were 612 ‘low risk’ patients included; 152 APC and 460 TCPC. Survival at 40 years of age was 80% and 89% for APC and TCPC respectively. Projected survival estimates are shown in
Table 1
. Projected survival for low-risk TCPC patients is far more encouraging than previously expected, with 49-67% reaching their seventh decade. There is a growing need for enhanced resources in the specialized area of adult congenital heart disease.
Abstract 14699: Arterial and Venous Thromboembolism in Covid-19: A Study-level Meta-analysis
Authors: Mai Vicky , Tan Kim Boun , Mainbourg Sabine , Frigerri Arnaud , Bertoletti Laurent , Douplat Marion , Dargaud Yesim , Grange Claire , Provencher Steeve , Lega Jean-Christophe
Published: May 2021

Introduction:
The prevalence of venous (VTE) and arterial (ATE) thromboembolic events in patients with COVID-19 remains largely unknown.

Methods:
In this systematic review and meta-analysis, we systematically searched Pubmed MEDLINE, Google Scholar, and Web of Science for observational studies describing the prevalence of VTE and ATE amongst patients with COVID-19 published between Jan 1, 2020 and May 20, 2020. The websites of major journals were also searched.

Results:
We analysed findings from 15 studies totalizing 1,755 patients, mainly in intensive care units (ICU). The weighted frequency of COVID-19-related VTE was 16.6% (95%CI 9.5-25.1%, I
2
=94%, 13 studies: 1,546 patients). The overall prevalence of PE and deep vein thrombosis (DVT) were 9.1% (95%CI 3.7-16.6%, I
2
=95%; 15 studies; 1,755 patients) and, 7.8% (95%CI 3.4-13.8%; I
2
=92%; 13 studies; 1,445 patients), respectively. Few were isolated subsegmental PE or distal DVT. The VTE prevalence was significantly higher in ICU (21.6%; 95%CI 12.6-32.2%; I2=91% versus 4.6%; 95%CI 1.0-10.7%, I
2
=87%, p
interaction
=0.002 in subgroup analysis). The weighted frequency of myocardial infarction/acute coronary syndrome, stroke, and other ATE (6 studies, 812 patients) was 3.2% (95%CI 2.1-4.5%, I
2
=0%), 0.7% (95%CI 0.0-2.2%, I
2
=64%), 2.0% (95%CI 1.2-3.0%, I
2
=40%), and 0.5% (95%CI 0.0-1.6%, I
2
=60%), respectively.

Conclusions:
Patients admitted in the ICU for severe COVID-19 had a high risk of VTE. Conversely, further studies are needed to determine the specific effects of COVID-19 on the risk of ATE or VTE in less severe forms of the disease.
Abstract 14701: Prognostic Role of Cardiac Magnetic Resonance Imaging for Quantification of Functional Mitral Regurgitation in Patients With Non-ischemic Cardiomyopathy
Authors: Wang Tom Kai Ming , Kocyigit Duygu , Choi Harry , Bullen Jennifer , Milinovich Alex , Jian Jin , Popovic Zoran B , Griffin Brian P , Flamm Scott D , Tang Wai Hong W , Kwon Deborah H
Published: May 2021

Background:
Functional mitral regurgitation (MR) is associated with poor outcomes and the prognostic role of cardiac magnetic resonance imaging (CMR) quantification of secondary MR has rarely been studied. We evaluated the associations between CMR-derived MR-fraction and adverse outcomes in non-ischemic cardiomyopathy (NICM) patients.

Methods:
We retrospectively studied 840 consecutive NICM patients undergoing CMR during 2001/4/1-2019/3/31. Multivariable Cox proportional hazards regression was performed for MR-fraction and two composite endpoints: primary (time to death, heart transplant and/or left ventricular assist device) and secondary (primary endpoint plus heart failure hospitalizations).

Results:
The cohort had mean age of 53.0±15.9 years, 319 (38.0) were female, and mean MR-fraction of 14±13% by CMR. There were 141 (16.8%) primary and 223 (26.5%) secondary endpoints over a mean follow-up of 3.6±3.0 years. Multivariable analyses results are shown in the Table. MR-fraction was independently associated with the primary and secondary endpoints with hazards ratios of 1.13 (95%CI 1.07-1.20) and 1.13 (95%CI 1.07-1.19) respectively per 5% increase in MR-fraction. MR-fraction provided stronger prognostic power compared to late gadolinium enhancement (LGE) in both models. Older age and diabetes were independently associated with both composite endpoints, while lower LVEF was independently associated with the secondary endpoint only.

Conclusion:
CMR quantification of functional MR is a powerful predictor of adverse outcomes and demonstrated stronger associations with poor prognosis compared to LGE and left ventricular remodeling in a large cohort of patients with NICM.
Abstract 14721: Impact of Covid-19 on Cardiology Consultation in Tertiary Care Hospital of a Developing Country
Authors: adnan ghufran , Faheem Osman , Khan Maria , Shams Pirbhat , Ali Jamshed
Published: May 2021

Introduction:
COVID-19 pandemic has overwhelmed the healthcare system of Pakistan. There has been observation regarding changes in pattern of patient presentation to emergency department (ED) for all diseases particularly cardiovascular. The aim of the study is to investigate these changes in cardiology consultations and compare pre-COVID-19 and COVID-19 era.

Hypothesis:
There is a significant difference in cardiology consultations during COVID era as compared to non-COVID era.

Method:
We collected data retrospectively of consecutive patients who visited emergency department (ED) during March-April 2019 (non-COVID era) and March-April 2020 (COVID era). Comparison has been made to quantify the differences in clinical characteristics, locality, admission, type, number, and reason of Cardiology consults generated.

Results:
We calculated the difference of 1351 patients between COVID and non-COVID era in terms of cardiology consults generated from Emergency department, using Chi-square test. Out of which 880 (59%) are male with mean age of 61(SD=15). Analysis shows pronounced augmentation in number of comorbidities [Hypertension(6%), Chronic kidney disease (6%), Diabetes (5%)] but there was 36% drop in total cardiology consultations and 43% reduction rate in patient’s ED visit from other cities during COVID era. There was 60% decrease in acute coronary syndrome presentation in COVID era, but fortuitously drastic increase (30%) in type II myocardial injury has been noted.

Conclusion:
There is a remarkable decline observed in patients presenting with cardiac manifestations during COVID era. Lack in timely care could have a pernicious impact on outcomes, global health care organizations should issue directions to adopt telemedicine services in underprivileged areas to provide timely care to cardiac patients.
Abstract 14722: The Utility of Tei Index in Subclinical Cardiotoxicity After Chemotherapy
Authors: Hamamoto Yuki , Yuasa Toshinori , Tokushige Akio , Horizoe Yoshihisa , Yasuda Hisayo , Ohishi Mitsuru
Published: May 2021

Introduction:
It was reported left ventricular global longitudinal strain (LVGLS) was useful to diagnose subclinical cardiotoxicity (SC) after chemotherapy. Doppler Tei index has been known as a noninvasive and useful indicator of systolic and diastolic myocardial performance. Until now, it has not been reported about the utility of Tei index in SC after anthracycline-based chemotherapy.

Methods:
We retrospectively enrolled patients with malignant lymphoma or acute myeloid leukemia receiving anthracycline-based chemotherapy from 2010 to 2019. Thirty patients were performed echocardiographic examination before and after chemotherapy. We measured LV parameters (LVGLS, LV end-diastolic diameter, LV end-systolic diameter, LV ejection fraction, LV-Tei index), and RV parameters (RV fractional area change, RV-Tei index). Patients were divided into SC and non-SC groups according to a relative percentage reduction in LVGLS of greater than 15% to baselines. Then, we compared LV and RV parameters between groups, and explored which parameters were related to SC.

Results:
Five patients (16%) were divided into SC group with decreased %ΔGLS (22.5±6.7%). LV end-diastolic diameter, LV end-systolic diameter, and RV fractional area change were slightly higher in non-SC although still no significance. ΔLV-Tei index and ΔRV-Tei index were significantly greater In SC group compared to non-SC group (0.22±0.10 versus 0.15±0.03, p=0.032. 0.18±0.08 versus 0.14±0.02, p=0.014, respectively). ΔLV-Tei index and ΔRV-Tei index significantly correlated with ΔGLS (r=0.46, p=0.009. r=0.39, p=0.03). Receiver-operating characteristic curve analysis identified the optimal ΔLV-Tei index and ΔRV-Tei cutoff for predicting SC as 0.09 and 0.05 (area under the curve of 0.81, p=0.029. 0.86, p=0.028).

Conclusions:
LV and RV-Tei index was affected by chemotherapy. Our study suggests that Tei index can be a useful indicator for SC after anthracycline-based chemotherapy.
Abstract 14743: Usefulness of Estimated Coronary Flow Velocity Using Quantitative Flow Ratio for Intermediate Coronary Stenosis
Authors: Ichimoto Eiji , Konagai Nao , Horie Sawako , Hasegawa Atsushi , Miyahara Hirofumi , Inoue Toshihisa , Nakamura Yoshitake
Published: May 2021

Introduction:
Quantitative flow ratio (QFR) is a diagnostic modality for functional assessment for intermediate coronary stenosis without the use of pressure wire. QFR is calculated from 3-dimensional quantitative CAG (3D-QCA) using an advanced algorithm that enables fast computation of the pressure drop caused by coronary stenosis.

Hypothesis:
We assessed the usefulness of QFR and the association with an estimated coronary flow velocity (eCFV) for intermediate coronary stenosis.

Methods:
A total of 100 lesions in 80 consecutive patients were assessed Fractional Flow Reserve (FFR) for intermediate coronary stenosis between January 2011 and April 2019. Of these, 97 lesions in 77 patients who underwent QFR were included in this study. Patients were classified into two groups (FFR ≤ 0.80 or FFR > 0.80). QFR and eCFV using contrast were measured by Thrombolysis in Myocardial Infarction (TIMI) frame counts.

Results:
There was no significant differences in target vessels (p = 0.90) and diffuse lesions (p = 0.06) between the two groups (FFR ≤ 0.80 or FFR > 0.80). Mean FFR and QFR values were 0.78 ± 0.12 and 0.77 ± 0.11, respectively. QFR had a good correlation with FFR values (r = 0.86, p < 0.0001). The diagnostic accuracy, sensitivity, and specificity on QFR ≤ 0.80 were 91.8%, 92.7% and 90.5%, respectively. The eCFV of FFR ≤ 0.80 was greater than that of FFR > 0.80 (0.19 ± 0.08 m/s vs. 0.14 ± 0.06 m/s, p<0.001). Figure showed that the eCFV correlated with FFR values (r = -0.29, p < 0.01). Moreover, the eCFV had a high area under the curve (AUC = 0.71, p < 0.01) on Receiver operating characteristics curve (ROC) analysis with FFR ≤ 0.80.

Conclusions:
QFR was useful for the assessment of functional stenosis severity. As eCFV was faster, FFR was lower for intermediate coronary stenosis. The eCFV had a good correlation with FFR and may become one of the evaluations for ischemia.
Abstract 14747: Dwindling Trends of Cardiology Admissions Amidst Covid-19 Pandemic in a Tertiary Care Center of Pakistan
Authors: Ali Jamshed , Faheem Osman , Shams Pirbhat , adnan ghufran , Khan Maria
Published: May 2021

Introduction:
Social containment measures have been adopted globally to control COVID-19 outbreak. Reduction in hospital visits and inpatient admission rates have become cause for concern. Through this study we aimed to analyze the impact of SARS-CoV-2 virus Outbreak on cardiology inpatient admissions at a tertiary care hospital in Pakistan.

Hypothesis:
COVID-19 pandemic has resulted in significant decline in cardiology admissions.

Methods:
We conducted a retrospective study at our center. Admission log was accessed via electronic record system. Comparison was made for same months of 2019 and 2020 with regard to cardiology inpatient admissions.

Results:
A total of 239 patients were admitted to cardiology services in 2019 period and 106 in 2020 period with resultant reduction of 55.6%. Number of patients admitted to the coronary care unit were 179 and 78 respectively where as the numbers declined to 28 from 60 for cardiac step down. Reduction for admission numbered to 52.4% for males and 38.89% for females. 9.3% patients left against medical advice in 2019 and 3.4% in 2020.

Conclusions:
Our study concludes that numbers of cardiology admissions have dwindled. Possible explanation for this can be implementation of social containment and fear of acquiring infection. This has raised a question of whether a significant number of cardiovascular morbidity and mortality has occurred without seeking medical attention and has went unrecorded during the pandemic. This calls for stringent diagnostic measures in future to diagnose previously unrecorded burden.
Abstract 14751: Gender Based Implications in Cardiovascular Presentation and Management in South Asia Region - Pre and Post Covid Analysis
Authors: Shams Pirbhat , Faheem Osman , adnan ghufran
Published: May 2021

Introduction:
Gender disparity in treatment approach is a common observation which could be society driven. COVID-19 pandemic has resulted in reduction in presentation of cardiovascular (CV) diseases. Hence, we analyzed if or not, the drop in presentation was comparable in both the genders and if this had impacted our approach in managing them.

Methods:
We conducted a retrospective study at our center, which is a tertiary care hospital located in largest city of Pakistan. Emergency department (ED) electronic registry was accessed for patients presenting with CV symptoms or diagnosis for same months of 2019 and 2020. Comparison was made for both genders in terms of patient presentation and treatment approach used.

Results:
A total of 536 and 385 consultations were raised for CV reasons for males and females respectively for year 2019 (Mar-Apr). This dropped to 264 and 166 in Mar-Apr 2020. This meant 57% reduction in consults raised for females and 51% reduction for males. ST-elevation Myocardial Infarction (STEMI) and Non-STEMI admissions dropped by 58% and 62% respectively for males and it dropped by 40% (STEMI) and 60% (NSTEMI) in females. All cardiac catheterization lab (CCL) procedures dropped by 46% in males and 60% in females. More females were treated with medical management than males (10 % increase versus 35% decrease).

Conclusion:
Pandemic impact on CV disease exhibited gender disparity. In this part of the world, there was greater inclination to treat females with medical management. This held true for CCL procedures too. There was greater reduction in number of CV consults raised for females. However, drop in cases of CVD was greater in males. This is an eye opener towards gender disparity in setting of low to middle income country during the pandemic. There is a need to urge physicians to reconsider their choices of non-invasive strategy in female gender. Additionally, there is a greater need to reinforce male gender to present for their CV symptoms to ED.
Abstract 14770: Reduction With Evolocumab in Complex Coronary Disease Requiring Revascularization: Insights From the FOURIER Trial
Authors: Oyama Kazuma , Furtado Remo , Fagundes Antonio , Zelniker Thomas A , Tang Minao , Kuder Julia , Murphy Sabina A , Hamer Andrew , Wang Huei , Keech Anthony C , Pedersen Terje R , Giugliano Robert , Sabatine Marc S , Bergmark Brian A
Published: May 2021

Introduction:
Although PCSK9 inhibitors induce plaque regression and reduce the risk of coronary revascularization overall, their ability to specifically reduce the risk of complex coronary atherosclerosis requiring revascularization has not been explored.

Methods:
FOURIER was a randomized trial of the PCSK9 inhibitor evolocumab vs. placebo in 27,564 patients with ASCVD on statin therapy (median achieved LDL-C 32 mg/dL vs. 89 mg/dL) followed for a median of 2.2 years. The study database was blindly reviewed to assess characteristics of coronary revascularization procedures. Complex revascularization was the composite of complex PCI (per GLOBAL LEADERS criteria, at least one of: multivessel PCI, 3 or more stents implanted, 3 or more lesions treated, bifurcation PCI with 2 or more stents, or total stent length >60 mm) or CABG. PCI complications included no-reflow, side branch loss, thrombus formation, major dissection, or perforation. The effects of evolocumab on types of revascularization and PCI complications were evaluated using Cox proportional hazards models.

Results:
1724 patients underwent revascularization procedures during follow-up. Evolocumab reduced the risk of non-complex PCI by 22% (HR 0.78; 95%CI 0.70-0.88; P<0.001) and the risk of complex revascularization by 29% (HR 0.71; 95%CI 0.61-0.84; P<0.001), including complex PCI by 33% (HR 0.67; 95%CI 0.54-0.84; P<0.001) and CABG by 24% (HR 0.76; 95%CI 0.60-0.96; P=0.019; Figure). The incidence of reported PCI complications tended to be lower with evolocumab (HR 0.74; 95% CI 0.49-1.11).

Conclusions:
Adding evolocumab to statin therapy reduced the risk of developing complex coronary disease requiring revascularization, including complex PCI and CABG individually. Together with prior coronary imaging findings, these data suggest very aggressive LDL-C lowering to <1 mmol/L has beneficial effects on coronary atherosclerosis burden, anatomical complexity, and the need for intervention.
Abstract 14772: Effects of Reallocating Time in Different Physical Activity Intensities and Sleep on Cardiovascular Disease Risk Factors in Asian American Women: A Cross Sectional Modeling Study
Authors: Park Chorong , Larsen Britta A , Xia Yuhe , Kwon Simona , Dickson Victoria V , Reynolds Harmony , Spruill Tanya M
Published: May 2021

Introduction:
Physical activity (PA), sedentary behavior (SB) and sleep form the finite 24-hour day; changes to one behavior result in changes to the others. Little is known about how shifting the balance of time spent in these behaviors affects cardiovascular (CV) risk factors. The purpose of this study is to model the effects of changes in PA, SB and sleep on body mass index (BMI), waist circumference (WC) and blood pressure (BP) in Asian American women, who have elevated CV risk.

Methods:
Normotensive middle-aged Asian American women completed 7 days of hip and wrist actigraphy monitoring (Actigraph, GT3X and GT9X) to assess 24-hour activity. Total sleep time was identified using the Cole-Kripke algorithm with sleep diaries, and moderate-to-vigorous PA (MVPA), light PA and SB were classified by Freedson’s cut-points from wake time. Isotemporal substitution models were used to test effects of replacing 30 mins of each behavior with the others on BMI, WC and BP adjusting for age, education and comorbidity.

Results:
Data from 75 women were included (age=61.4±8.0, 57% college educated, median comorbidities=1[IQR=0-2]). On average, their days were composed of 0.5 hrs MVPA, 6.2 hrs light PA, 10 hrs SB and 5.3 hrs sleep (2.1 hrs non-wear time). In partition models, where all behaviors were entered simultaneously, more MVPA and sleep were associated with lower BMI and WC. In isotemporal substitution models that held total wear time constant (Table 1), replacing 30 mins SB with an equal amount of MVPA or sleep decreased BMI by 1.7 and 0.6 and WC by 4.1 and 1.2 cm. Replacing 30 mins light PA with MVPA or sleep decreased BMI by 1.9 and 0.9 and WC by 4.5 and 1.6 cm. None of the modeled behavior changes affected BP.

Conclusion:
These findings suggest that substituting 30 mins of SB or light PA with MVPA or sleep could significantly reduce Asian American women’s BMI and WC. Future studies should test the impact of behavioral interventions that promote these changes on CV risk in Asian American women.
Abstract 14780: Developing a Model for Abdominal Aortic Aneurysm in Swine
Authors: De Leo Nicholas , Melillo Atlee , Badach Jeremy , Miller Henry , Lin Andrew , Williamson John , Zhang Ping , Gaughan John , Brown Spencer , Carpenter Jeffrey P
Published: May 2021

Introduction:
Abdominal aortic aneurysms (AAA) are responsible for over 150,000 deaths worldwide annually. Attempts at producing a reliable large-animal model of AAA have proven challenging. We sought to create a reproducible swine model of AAA using enzymatic degradation of the aortic wall.

Methods:
A total of 9 male Yorkshire swine received periadventitial injections of type 1 collagenase (23.5 mg) and porcine pancreatic elastase (500 mg) into a 4 cm segment of infrarenal aorta. Aortic diameter growth was monitored at POD 7 and 14 using ultrasound. The animals were euthanized on POD 21, and the suprarenal (control) and infrarenal (treated) aorta was harvested for analysis, after gross measurement of aortic diameter under physiologic blood pressure. Sections of control and treated aorta were used to obtain tensile strength using a tensiometer. Additional segments of the aorta were collected for histopathological analysis (H&E, elastin, alpha smooth muscle actin). PCR of matrix metalloproteinases (MMP9) was conducted. Groups were compared with paired t-tests, or ANOVA for repeated measures, where appropriate.

Results:
Average percent growth of aortic diameter at POD 21 for treated segments was 27% +/- 16.5% versus 4.5% +/- 4% for control tissue. The average difference in aortic growth by subject, was 26.7% [14.6%-38.8%]; (p<0.001). Aortic medial thickness was decreased in treated tissue; 235 um +/- 208 um versus 645 um +/- 191 um (p<0.0001). Quantity of both medial elastin fibers, and vascular smooth muscles cells was decreased in treated tissue; 1.8% +/- 3.16%, compared to 9.9% +/- 6.85% (p<0.0001), and 24% +/- 6.8% versus 37.4% +/- 6.9%, respectively. Tensile strength was also decreased in treated tissue; 16.7 MPa +/- 7 MPa versus 29.5 MPa +/- 10.7 MPa (p=0.0002). A 12-fold increase in expression of MMP9 mRNA was also demonstrated in aneurysmal tissue (p=0.002)

Conclusion:
A reproducible, large-animal model of AAA, with anatomical, histopathological, and biomechanical properties that are clinically translatable, can be achieved with extraluminal enzymatic degradation.