bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17223: Castle of Stone or Straw, Radiofrequency Ablation of Atrial Fibrillation in Heart Failure?
Authors: McCauley Brian D , Sharma Esseim , Dudley John , Chu Antony
Published: July 2021

Introduction:
Based on the data from CASTLE-AF trial, in patient with Atrial Fibrillation (AF) and heart failure (HF) catheter ablation may offer a significant reduction in both death, and hospitalization, while promoting maintenance of sinus rhythm as well as improvement in left ventricular ejection fraction (LVEF). This multi-center randomized trial is hailed as a paradigm shifting study in catheter ablation, however it is not without fault. One of the critiques of the CASTLE-AF trial was the high frequency of crossover between the treatment arms. To help sort out this potential source of confounding, we performed a systematic meta-analysis of prospective trials for catheter ablation in AF in patients with Class II through IV heart failure.

Hypothesis:
The reduction in death, and hospitalization, as well as the maintenance in sinus rhythm and improvement in LVEF seen CASTLE-AF trial are support by other similarly designed AF ablation trials.

Methods:
Using the inclusion/exclusion criteria from the CASTLE-AF trial, we performed a systematic meta-analysis of 28 published studies. Randomized and non-randomized observational studies comparing the impact of catheter ablation of AF in HF. Studies were identified using the Cochrane Library, EMBASE, and PubMed.

Results:
A total of 29 studies were identified (n =2,339). Mean follow-up was 25 (95% confidence interval, 18-40) months. Efficacy in maintaining sinus rhythm at follow-up end was 60% (43%-76%). Left ventricular ejection fraction improved significantly during follow-up by 15% (P<0.001).

Conclusions:
Following our meta-analysis, we found data to support the findings of improved LVEF and maintenance of sinus rhythm reported in the CASTLE-AF trial. However, due to differences in study design, we were unable to further validate the reduction in both hospitalization and death seen in CASTLE-AF. We recommend future prospective trials be conducted without cross over to further explore this topic.
Abstract 17235: Attenuation of NPR-C Binding With Muscle-Derived Musclin is Related to Reduced Cardiovascular Disease Risks by Aerobic Exercise Training in Type 2 Diabetic Rats
Authors: Toyama Yuta , Hasegawa Natsuki , Horii Naoki , Inoue Kenichiro , Iemitsu Keiko , Fujie Shumpei , Uchida Masataka , Iemitsu Motoyuki
Published: July 2021

Introduction:
Aerobic exercise training (AT) in type 2 diabetic patients reduces cardiovascular disease (CVD) risks, such as an impairment of NO-derived vasodilation mediated by obese and hyperinsulinemia. Musclin is a muscle-derived myokine and binds to natriuretic peptide receptor-C (NPR-C). Elevation of circulating musclin level deteriorates of insulin resistance. Furthermore, musclin-induced vasocontraction mediated by NPR-C leads to increase in blood pressures. However, the effect of AT on muscle-derived musclin secretion in type 2 diabetes remains unclear.

Hypothesis:
This study aimed to clarify whether AT-induced attenuations of muscle-derived musclin secretion and arterial NPR-C expression levels are related to reduction of CVD risks in type 2 diabetes rats.

Methods:
Twenty 20-week-old male type 2 diabetic (OLETF) rats were randomly divided into two groups; 8-week sedentary control and aerobic exercise training (treadmill running for 60min at 25m/min, 5days/week) (n=7 each group) and seven male LETO rats used as healthy sedentary control. After 8 weeks, we measured carotid-femoral pulse wave velocity (cfPWV, an index of arterial stiffness), QUICKI (an index of insulin sensitivity), plasma and muscle musclin levels and GLUT4 translocation levels, arterial NPR-C protein expression.

Results:
In sedentary diabetic rats, cfPWV, serum insulin and muscle musclin levels, and arterial NPR-C protein expression increased, and QUICKI decreased as compared to healthy sedentary rats (each p<0.05). However, no significant circulating musclin level between sedentary and exercised diabetic rats was observed. In contrast, aerobic exercise training in the diabetic rats induced elevation of QUICKI and reduction of cfPWV, serum insulin, muscle musclin, and arterial NPR-C levels (each p<0.05). NPR-C protein level was positively correlated with cfPWV (r=0.43, p=0.09). Additionally, muscle musclin levels was significantly negatively correlated with muscle GLUT4 translocation (r=-0.78, p<0.01) and QUICKI (r=-0.82, p<0.01).

Conclusions:
These results suggest that attenuation of arterial NPR-C expression and muscle-derived musclin secretion is related to reductions of arterial stiffness and hyperinsulinemia by AT in type 2 diabetic rats.
Abstract 17244: Atrial Fibrillation is Associated With Day 90 Mortality in Patients Undergoing Bone Marrow Transplant
Authors: Subramani Matthew , D’Souza Anita , Rubenstein Jason
Published: July 2021

Introduction:
Atrial fibrillation often occurs after bone marrow transplant (BMT) and has been shown to increase hospital stay and other morbidity. Treatment can be complicated due to contraindications to anticoagulation therapy. Our objective was to describe the incidence of atrial fibrillation in patients within the first 90 days after BMT and risk predictors for overall mortality.

Methods:
Patients with active malignancy undergoing BMT in 2016 at the Medical College of Wisconsin were included (n=259). Medical records were reviewed for baseline patient characteristics, atrial fibrillation risk factors, incidence of atrial fibrillation, and other complications. Patients were categorized based on survival at 90 days post-BMT. Baseline characteristics and risk factors were analyzed to determine if there was an association with the development of atrial fibrillation and all cause mortality at 90 days.

Results:
Overall, 10.4% developed atrial fibrillation within the first 90 days after BMT. Of those that died before 90 days, 33.3% developed atrial fibrillation compared to 9.6% in those who survived (OR 4.7, 1.11-20.13 p=0.04). Those that died before 90 days were also more likely to have heart failure with reduced ejection fraction, prior radiation therapy (XRT), undergo cardioversion, and to be started on an antiarrhythmic drug (Table 1). When all significant univariate variables were included in a multivariate regression, only XRT was independently predicative of mortality (OR 11.5, 2.4-54.9, p=0.002). The development of atrial fibrillation significantly predicted early mortality (Log Rank p=0.009).

Conclusion:
This analysis demonstrated that the development of atrial fibrillation was predictive of early post-transplant all cause mortality. XRT and antiarrhythmic drug use also significantly predicted mortality. Further studies are required to determine if there is a mortality benefit to the prevention of atrial fibrillation in patients after BMT.
Abstract 17248: Statin Therapy Increases Coronary Artery Calcification Scores
Authors: Rivner Harold , Denis Rimsky , Tang Fei , Marzouka George R
Published: July 2021

Introduction:
Coronary artery calcification (CAC) assessment is a noninvasive test to determine atherosclerotic burden. There has been a discordance with the well-known lipid lowering and cardiovascular protection of statins and the progression of CAC in small trials with narrow inclusion criteria. We performed a subgroup analysis of the Multi-Ethnic Study of Atherosclerosis (MESA) dataset to assess the impact of statins on patients with a baseline CAC score of 0.

Hypothesis:
Statin usage will cause patients to have a higher CAC scores despite lowering LDL and reducing cardiac mortality.

Methods:
A subgroup analysis (3235 patients) was performed on the MESA dataset to identify patients with a CAC score of 0 at baseline. Statin usage and cholesterol values were reviewed at 4 examination points. Multivariate regression was performed.

Results:
The number of patients using statins (Table 1) and lipid levels (Table 2) increased throughout the study as expected for an aging population. A consistently larger increase in CAC score was noted in patients receiving statins; this difference was demonstrated in all stratified groups by Framingham score (Table 3). Table 4 shows the results of multivariate linear regression. Excluding gender, statins had the largest impact on CAC; more than any established cardiovascular risk factor.

Conclusion:
This large subgroup analysis of the MESA dataset demonstrates that statins are associated with increasing CAC score. While this is in contrast to the well-established cardiovascular protection of statin therapy, it adds to the growing literature that statin use is associated with progression of CAC, even in low risk patients with baseline CAC of 0. One hypothesis for this finding is that statins promote coronary atheroma calcification which ultimately results in plaque stabilization and less likelihood for progression to unstable plaques. It is therefore necessary for clinicians to take into account statins when interpreting CAC scores.
Abstract 17253: Gender Disparities Across the Spectrum of Valvular Heart Disease in Elderly Chinese Patients
Authors: Zhang Bin , Zhang Haitong , Zhao Qinghao , Xu Haiyan , Wu Yongjian
Published: July 2021

Introduction:
Evidence for the gender gap in valvular heart disease (VHD) has been mixed. This study aimed to investigate the potential gender differences concerning distribution patterns, clinical characteristics, management and in-hospital outcomes of noteworthy VHD in the elderly Chinese population.

Hypothesis:
Gender disparities exist across the spectrum and management of valvular heart disease in elderly Chinese patients.

Methods:
The China Degenerative Valve Disease (China DVD) Cohort Study was conducted from October 2016 to December 2017 in 72 centers from China. It included prospectively 8923 patients aged ≥60 years with moderate to severe native VHD, infective endocarditis, or previous valve intervention. In-hospital outcomes after invasive treatments were evaluated by composite endpoint consisting of death, major bleeding and nonfatal stroke.

Results:
Of all the 8923 VHD patients, men accounted for 52.48%, with aortic regurgitation (AR; 13.2% vs. 6.5%) and aortic stenosis (AS; 5.8% vs. 3.8%) contributing more of the VHD diagnosis than women. By contrast, the proportion of women with mitral stenosis (MS; 4.8% vs. 1.8%) was much higher than men. While the rheumatic causes stayed significant in MS, a growing predominance of degenerative causes was detected regardless of gender in patients with aortic VHD and MR. Body mass index, history of smoking, hypertension, CHD, cardiomyopathy, aortic diseases and previous intervention were significantly higher in men whereas women were more frequently complicated with atrial fibrillation or atrial flutter. Concerning medical intervention, coronary angiography was used in 51.5% of male patients compared to 47.3% of female patients (p=0.01). Among the 2188 patients received invasive treatments, the prosthetic replacement was performed in 61% of women with AS in comparison to 47.2% of men with AS (p=0.006). Conversely, men with AR were more likely to receive prosthetic replacement than women (29.8% vs. 21.3%, p=0.008). No significant differences were found in patients with mitral VHD. Operative mortality was < 5% for single VHD. Multivariate regression analysis revealed an association between in-hospital outcomes and higher BMI as well as concomitant aortic disease regardless of gender.

Conclusions:
This study provides sex-specific data on characteristics and management of elderly Chinese patients with VHD. Pronounced sex-specific patterns were observed for aortic VHD and MS.
Abstract 17255: Standard 12-Lead Electrocardiogram Can Predict Diffuse Myocardial Fibrosis in Patients With Atrial Fibrillation
Authors: Rujic Dragana , Nazarian Saman , Madsen Per L , Desjardins Benoit , Kuo Ling , Graff Claus , Pareek Manan , Hansen Tina , Egstrup Kenneth
Published: July 2021

Background:
The pathophysiology of atrial fibrillation (AF) involves a continuum of myocardial remodeling with increased diffuse fibrosis.

Purpose:
To examine whether the extent of diffuse fibrosis in the left atrium (LA) and left ventricle (LV), evaluated using the surrogate marker, post-contrast T1 myocardial relaxation time on cardiac magnetic resonance imaging (CMR), in patients with paroxysmal and persistent AF is associated with ECG markers obtained during sinus rhythm.

Methods:
This is a prespecified secondary analysis from the randomized controlled trial INSPIRE-AF (n=95) (ClinicalTrials.gov NCT02764619). Patients with paroxysmal and persistent AF underwent CMR. Post-contrast T1 times were quantified in 47 paroxysmal AF (mean age, 63 ±8 years), and 43 persistent AF (mean age, 54 ±7 years) patients using a previously validated modified look-locker inversion-recovery sequence. Standard resting 12-lead ECGs were analyzed using commercially available software.

Results:
Baseline characteristics were generally similarly distributed between AF groups. Mean LA T1 time was 492 +/- 72 ms and mean LV T1 time was 494 +/- 49 ms. P-wave area, P-wave terminal force, PR-interval, P-wave peak amplitude, and P-wave duration were unassociated with LA T1 time, and no significant interactions with AF type were detected. Similarly, neither R-wave duration, corrected QT interval (Bazett’s formula), nor QRS duration were associated with LV T1 time. P-wave terminal force in lead V1 did not differ between groups of investigation, but the joint mean value of -0.04 mm/s in the two groups is prominently different from normal controls. AF type significantly interacted with the association between R-wave duration and T1 time (P=0.03 for interaction), and between QRS duration and T1 time (P=0.009 for interaction). Specifically, R-wave duration and QRS duration were only significantly associated with T1 time among patients with persistent AF.

Conclusions:
Diffuse fibrosis in the LV, defined as post-contrast T1 time, was associated with R-wave duration and QRS duration in patients with persistent AF. Our findings suggest that surface 12-lead ECG obtained in sinus rhythm could provide predictive information regarding diffuse myocardial fibrosis.
Abstract 17269: Incidence of Atrial Fibrillation in Patients With Cobalt and Chromium Containing Hip Arthroplasty
Authors: Sharma Sunita , Ponamgi Shiva , Desimone Christopher , Wyles Cody , Sun Philip , Yogeswaran Vidushei , Padmanabhan Deepak , El-Harasis Majd , Hodge David , Slusser Joshua , Abdel Matthew , Asirvatham Samuel
Published: July 2021

Background:
Worldwide, approximately one million patients have had total hip arthroplasty with 35% being cobalt and chromium Metal-on-Metal (MoM) or Metal-on-Polythelene (MoP) implants. Animal models have suggested that cobalt and chromium can affect all chambers, but there seems to be an atrial predilection. There are several case reports of metal containing hip arthroplasty causing atrial arrhythmias but the true incidence of atrial fibrillation associated with metal hip arthroplasty remains undefined.

Objective:
We sought to determine the incidence of atrial fibrillation in patients with metal containing hip arthroplasty. We also examined the association between serum cobalt and chromium levels and arrhythmias in this cohort and all cause mortality.

Methods:
We retrospectively examined the records of patients from the Mayo Clinic total hip arthroplasty registry (Metal group - Metal-on-Metal: MoM and Metal-on-Polyethylene: MoP, Non-Metal group - Ceramic-on-Ceramic: CoC and Ceramic-on-Polyethylne: CoP) to obtain demographic data, comorbidities, laboratory, ECG, and echocardiographic data. Out of a total of 1756 patients, Cobalt and Chromium levels were available in 138 patients.

Results:
The mean age of patients with metal containing hip replacement was 50 years and were predominantly male. During a follow up period of 10 years, the incidence of atrial fibrillation in our study population was 8% in metal group compared to 2% (p=0.11) in non-metal group. There was no association between cobalt or chromium levels with the incidence of atrial fibrillation. All-cause mortality was significantly higher in metal group versus non-metal group (p=0.005).

Conclusion:
The incidence of atrial fibrillation was relatively more in patients with metal versus non-metal hip arthroplasty but there was no association of serum cobalt or chromium levels with incidence of atrial fibrillation in the subset of patients. In addition, all-cause mortality was significantly higher in the metal group suggesting potential toxic effects of metal containing hip arthroplasty.
Abstract 17290: Tead1 is Required for Cardiomyocyte Proliferation
Authors: Liu Ruya , Jagannathan Rajaganapathi , Li Feng , Lee Jeongkyung , Yechoor Vijay K , Moulik Mousumi
Published: July 2021

Introduction:
Mammalian cardiomyocyte (CM) proliferation peaks in the embryonic and neonatal periods. TEAD1, a key transcription factor regulated by the Hippo pathway, is critical for early embryonic CM proliferation. But mid gestation lethality of Tead1 germline deletion precluded the study of its role in CMs at later developmental stages. We recently generated Tead1 floxed (Tead1
F/F
) mice which allows the study of TEAD1 function in CMs at later stages. The objective of this study was to determine requirement of TEAD1 for neonatal CM proliferation.

Hypothesis:
TEAD1 remains critical for CM proliferation in late embryonic and early neonatal periods through transcriptional regulation of cell cycle promoting genes.

Methods and Results:
We observed that TEAD1 cardiac expression peaks in the perinatal period. Using Myh6-Cre deletor mice, we knocked out Tead1 in CMs at E10.5 (referred as cKO). cKO pups were born in expected Mendelian frequency, but survived only till day of life (DOL) 9. Systolic dysfunction was evident by ECHO in DOL1 cKO pups and progressed to frank heart failure (HF) by DOL9. Histological exam showed decreased myocardial mass with increased intercellular fibrosis. Ventricles of DOL1 cKO pups demonstrated increased expression of Acta1, Nppa, and Nppb, consistent with HF but showed decreased expression of Myh7, suggesting an impairment in the typical fetal gene program activated in HF. Myocardial immunostaining showed reduction in Ki67 (G1/S/G2/M phase marker) (Fig 1) and PH3-S10 (M phase marker) positive CMs by 82% and 46% respectively in DOL1 cKO hearts, indicating significantly reduced CM proliferation. The expression of essential cell cycle proteins showed a significant decrease in the levels of G1/S regulating proteins, CDK4, CDK6, ppRB
S807/811
and S/G2 and G2/M regulating proteins, pWEE1
S642
and Cyclin B1 in cKO hearts (Fig 2). Similar results in ex vivo and in vitro Tead1 knockout models in CMs using neonatal Tead1
F/F
CMs and HL1 cells validated the cell autonomous regulation of CM cell cycle by TEAD1.

Conclusions:
TEAD1 is required for embryonic and neonatal CM proliferation and its loss at mid gestation leads to neonatal HF associated with impaired fetal gene program activation and decreased expression of cell cycle promoting genes.
Abstract 17300: Development and Ex Vivo Validation of Novel Force-Sensing Neo-Tendons for Measuring Chordae Tendineae Tension in the Mitral Valve Apparatus Using Optical Fibers With Embedded Bragg Gratings
Authors: Paulsen Michael J , Bae Jung Hwa , Imbrie-Moore Annabel M , Wang Hanjay , Hironaka Camille E , Lucian Haley J , Edwards Bryan B , Farry Justin M , Deschamps Daniela , Kulkarni Rohun , Thakore Akshara D , Williams Kiah M , Cutkosky Mark R , Woo Y. Joseph
Published: July 2021

Introduction:
Very few technologies exist that can provide quantitative data on forces within the mitral valve apparatus. Marker based strain measurements can be performed, but chordae heterogeneity limits utility. Foil-based strain sensors have also been described, but tend to be bulky, limiting the number of chordae that can be measured.

Hypothesis:
We hypothesize that the use of Fiber Bragg Grating (FBG) sensors—optical strain gauges made of 125
μ
m diameter silica fibers— can overcome the critical limitations of previous methods of measuring chordae tendineae forces.

Methods:
Using FBG sensors, we created a force-sensing neochord that would mimic the natural shape and movement of native chordae tendineae. FBG sensors reflect a specific wavelength of light depending on the spatial period of gratings - when a force is applied, the gratings move relative to one another, changing the reflected light (Fig 1A). This wavelength shift is directly proportional to the force applied. The FBG sensors were housed in a protective sheath fashioned from the outer coil of a 0.025" Amplatz Extra-Stiff guidewire, and attached to the chordae using GoreTex suture (Fig 1B). The function of the force-sensing neochordae were validated in a 3D printed left heart simulator.

Results:
FBG sensors provided high-fidelity force measurements of mitral valve chordae tendineae at a temporal resolution of 1000 Hz. As ventricular pressures increased, such as in the hypertensive condition, forces on the chordae also increased (Fig 1C). The resolution of FBG sensors allow for increased accuracy of not only chordae tension, but also the rate of change of force (dF/dt) - a parameter critical to determining likelihood of leaflet rupture.

Conclusions:
FBG sensors are a viable, durable, and high-fidelity technology that can be effectively used to measure mitral valve chordae forces and overcome limitations of other such technologies.
Abstract 17308: Effect of HIV Protein-Tat & Cocaine on Hippo-YAP Signaling Axis in Pulmonary Arterial Smooth Muscle Cells
Authors: Mohan Aradhana , Sharma Himanshu , Chinnappan Mahendran , Dhillon Navneet K
Published: July 2021

Introduction and hypothesis:
Intravenous drug use (IVDU) is considered to be one of the important risk factors in the development of HIV-associated pulmonary arterial hypertension (HPAH). Our previous findings demonstrate that the exposure of cocaine to HIV infected individuals has an additive effect in enhancing the proliferation of pulmonary smooth muscle cells, thus further amplifying the development of pulmonary arteriopathy. Furthermore, various studies suggest the failure of Hippo pathway and increased YAP/TAZ activity in pulmonary hypertension (PH). Based on this, we hypothesized that YAP axis might be having a role in HIV and cocaine mediated smooth muscle hyperplasia.

Methods:
Primary human pulmonary arterial smooth muscle cells (HPASMCs) were grown and treated with cocaine hydrochloride (1μM) and/or HIV-Tat protein (25ng/mL) for 6h. In addition, primary HPASMC were treated for 24h with extracellular vesicles (EVs) transfected with miR-130a antagomir or scrambled miR followed by treatment of EVs isolated from supernatants of monocyte derived macrophage infected with HIV-Bal (5ng/ml) in the presence or absence of cocaine for 4 days. The expression of Hippo proteins was determined using western blot.

Results:
Combined treatment of HPASMCs with HIV-Tat and cocaine for 6h showed no change in the expression of MST proteins, however reduced expression of phosphorylated LATS1 relative to total LATS1 was observed. This correlated with the decline in the phosphorylated YAP to total YAP ratio. Pre-treatment of HPASMCs with YAP/TAZ inhibitor attenuated the HIV-Tat and cocaine mediated augmentation of cell proliferation. Furthermore, our recent findings demonstrate that EVs derived from HIV infected and cocaine treated MDMs (H+C EVs) when added to HPASMC result in increased proliferation on transfer of miR-130a. We now found that this H+C EVs mediated hyper-proliferation of smooth muscle cells is associated with the increased levels of total YAP protein. In addition, H+C EVs mediated increase in total YAP was prevented on the pretreatment of HPASMCs with EVs carrying anti-miR-130a.

Conclusion:
In conclusion, our preliminary findings suggest increased activation of Hippo-YAP signaling in pulmonary smooth muscle cells on the direct treatment with HIV protein and cocaine and also on exposure to EVs derived from HIV infected and cocaine treated macrophages.
Abstract 17313: Myocardial Remodeling in Atrial Fibrillation is Not Associated With Supraventricular or Ventricular Ectopic Activity: Results From a Cardiac Imaging Study
Authors: Rujic Dragana , Pareek Manan , Egstrup Kenneth
Published: July 2021

Background:
Myocardial remodeling in atrial fibrillation (AF) is a continuum of structural, hemodynamic, and electrophysical changes that often coexist in a complex pathophysiological interplay.

Purpose:
The aim of this study was to evaluate whether cardiac magnetic resonance imaging (CMR) derived myocardial strain, by tracking subtle alterations in myocardial function, was associated with premature atrial (PAC) and ventricular (PVC) complexes, detected by 7-day Holter-monitoring.

Methods:
A total of 95 patients (mean age 63±8.5 years, 52% male) with a history of paroxysmal (51%) or persistent AF (49%) underwent CMR and 7-day Holter-monitoring during sinus rhythm. Left atrial measures, including volume, ejection fraction, peak systolic longitudinal, radial and circumferential strain were assessed using cine CMR feature tracking by commercially available software (Circle, Calgary, Canada). Holter-monitoring was used to determine heart rate and rhythm, including the presence of PACs and PVCs. The associations between strain variables and Holter-variables were examined using multivariable linear regression, adjusted for age, sex, and AF type.

Results:
Left atrial end-diastolic volume was significantly increased, particularly in patients with persistent AF, when compared with healthy controls (persistent AF 132±32 ml vs. healthy 77±14 ml). Similarly, left atrial ejection fraction was significantly reduced in persistent AF as compared with normal reference values (48±10 ml vs. 54±10 ml). There were no significant associations between CMR strain parameters and average PACs per hour, average PVCs per hour, average PACs per sinus beats per hour or average PVCs per sinus beats per hour. These associations remained unaltered after adjusting for age, sex, and AF type. Finally, no significant interactions with AF type were found.

Conclusions:
Despite significant myocardial remodeling in left atrium shown by increased end-diastolic volume and decreased left atrial ejection fraction, there was no correlation with increased ectopic activity as assessed by 7-day ambulatory Holter monitoring.

Image
Abstract 17318: Mexican Mothers’ Depressive Symptomatology Influences Their Children’S C-Reactive Protein
Authors: Majid Danish , Hernandez Rosalba , Inoue Makoto , Schwingel Andiara , Aguayo Liliana
Published: July 2021

Introduction:
Elevated concentrations of inflammatory markers like C-reactive protein (CRP) can predict future development of obesity and cardiometabolic diseases. Elevated CRP levels are found in infancy in children born to mothers with maternal depression. Less is known about the intergenerational influence of maternal depression on offspring’s CRP profiles or its association with obesity risks in childhood, particularly in low-income Mexican populations.

Methods:
Cross-sectional data was collected from low-income Mexican mother-child dyads (n=43) living in central Mexico. Mothers completed the Patient Healthcare Questionnaire (PHQ-9) to screen for depression. Fasting dried blood spots, and body composition measurements through bioelectrical impedance were collected from both, child and mother. An enzyme-linked immunosorbent assay (ELISA) kit was used to measure CRP from dried blood spots. Moderated multiple regression and simple slopes were used in the analysis.

Results:
Mothers ranged in age from 21 to 45 (M=30.91±6.83). A total of 73% of mothers had overweight or obesity and 12% had elevated depressive symptoms (PHQ-9≥9). Mothers’ CRP values ranged from 0.08 to 9.05 mg/L (M= 2.15±2.00). Children were between the ages of 4 to 7 years old (M=4.86±0.91). Of children, 48% were male, 32% of children had overweight or obesity. Child CRP values ranged from 0.03 to 4.83 mg/L (M=.56±0.99). Child CRP was a significant predictor of children’s fat mass (β=0.51, p<0.001). A significant interaction between child CRP and maternal depression status was evident when regressed on the outcome of fat mass for children (β=0.54, p<0.02). Simple slopes of the interaction showed that, for children whose mothers have low depressive symptoms, child CRP values were positively associated with child fat mass (b=0.98; SE=0.38, p=0.01). For children whose mothers have severe depressive symptoms, child CRP values were negatively associated with children’s fat mass (β=-8.24; SE=4.02, p=0.048).

Conclusion:
Findings suggest that among children living with mothers with severe depressive symptoms, elevated CRP is associated with lower fat mass in children. Further investigation is needed to assess the biological pathways through which mother’s depression influences CRP in children.
Abstract 17321: Long-Term Exposures to Air Pollutants and Risk of Peripheral Arterial Occlusive Disease, a Nationwide 10-Year Follow-Up Cohort Study in Taiwan
Authors: Hsieh Ming-Shun , How Chorng-Kuang , Chen Pau-Chung
Published: July 2021

Objective:
Many studies had reported the association between air pollution and cardiovascular diseases. In this current study, we aimed to evaluate the risk of long-term exposure to air pollution (PM2.5, CO and NO2) to the development of PAOD.

Methods:
We linked two nation-scale databases, the national health insurance database and the air quality-monitoring database of Taiwan to conduct this cohort study between 2003 and 2013. Cox proportional regression with time-dependent model was used to evaluate the hazard ratio (HR) of air pollutants to PAOD. The residential areas were divided into four categories according to the daily average concentration of air pollutants, Q1 to Q4 (Q4 = the worst). The cumulative incidence of PAOD was examined by the Kaplain-Meier analysis with log-rank test.

Results:
A total of 1,598 PAOD cases were identified during the follow-up period with 98,540 non-PAOD ones (demographic characteristics were showed in Table 1). In the multivariate analysis, after adjusting for age, gender, urbanization level, residential area, baseline comorbidities, and drug use, the adjusted HRs were that PM2.5 = 1.14 (95% CI 1.13-1.16), NO2 = 1.03 (95% CI 1.02-1.04), and CO = 2.35 (95% CI 1.95-2.84), respectively (Table 2). The Kaplain-Meier analysis showed that CO concentration was strongly associated with cumulative incidence rate of PAOD during the follow-up period (Figure 1).

Conclusion:
Besides of well-known risk factors, air pollutants may also play a potential role in PAOD pathogenesis.
Abstract 17325: Initial False Positive Episodes and Outcomes of Programming Changes With a Novel Implantable Loop Recorder
Authors: Hacker Ethan , Dar Tawseef , Yarlagadda Bharath , Parikh Valay , Wise Brandon , Reddy Y. Madhu , Pimentel Rhea , Berenbom Loren , Emert Martin , Dendi Raghu , Sheldon Seth H
Published: July 2021

Introduction:
Management of voluminous data from implantable cardiac devices is resource intensive. False positive events can be especially problematic with implantable loop recorders (ILRs). We sought to describe our early experience with a novel ILR.

Hypothesis:
Sensitivity adjustment to <=0.10 mV may reduce false positive ILR detection of bradycardia/pauses.

Methods:
A single center retrospective study was performed in patients with the Abbott Confirm RX ILR. Tachycardia, atrial fibrillation (AF), bradycardia, and pause events were reviewed to determine whether they were true or false positives.

Results:
The study included 13 patients (age 67 ±15.8 years, 62% men). The reasons for implant included: AF (n=7, 54%), syncope(n=3, 23%), palpitations (n=2, 15%), and stroke (n=1, 8%). The median follow-up duration was 3.1 months (IQR 1.3-4.4 months). There was no change in serial R waves during mean follow-up of 0.58 months (pre 0.62±0.22 mV, post 0.63±0.22 mV, p=0.52). Tachycardia detection occurred in 6 patients (46%), with only 1 patient having a false positive episode. AF detection occurred in 8 patients (62%), with only 2 patients having true AF episodes. Pause/bradycardia episodes were detected in 5 patients (39%), with false positive episodes in 4 patients. There was no difference in R waves at implant among patients with and without false positive bradycardia/pauses episodes (0.66 ±0.27 vs. 0.44 ± 0.28 mV, p=0.21). The max sensitivity was higher among patients with than without false positive bradycardia/pause episodes (0.14 ±0.01, 0.07 ±0.02 mV, p<0.0001). No patients programmed to sensitivity <=0.10 mV had false positive bradycardia/pause episodes. The sensitivity was adjusted to <=0.10 mV in 3 of 4 patients with false positive bradycardia/pause episodes which eliminated future false positive episodes and did not result in false positive tachycardia/AF episodes. The overall mean monthly rate of false positive bradycardia/pause events was reduced from 387 events/month to zero in these patients.

Conclusion:
Programming the novel ILR to a sensitivity of <=0.10 mV resulted in a marked reduction in false positive bradycardia/pause episodes without an increase in false positive tachycardia/AF episodes.
Abstract 17328: Novel Oral Anticoagulants in Adult Fontan Patients: A Multi-Site Experience
Authors: Kazerouninia Amir , Kendsersky Payton , Byrne Ryan , Chu Patricia , Wang Yunfei , Georgekutty Justin , Rodriguez Fred H , Frischhertz Benjamin , Parekh Dhaval , Ermis Peter , Franklin Wayne J , Lam Wilson
Published: July 2021

Introduction:
Adult Fontan patients are typically prescribed antiplatelet or anticoagulant therapy to manage increased risk for thrombotic and embolic complications (TECs). There is a Class III recommendation against the use of novel oral anticoagulants (NOACs) in this population due to a paucity of data. We hypothesized that NOACs are potentially non-inferior to warfarin in adult Fontan patients.

Methods:
We performed a multi-site retrospective review of adult Fontan patients, evaluated at three major academic medical centers (1995-2018), prescribed NOAC, warfarin, or aspirin therapy.

Results:
We identified 267 adult Fontan patients: 48 on NOACs, 107 on warfarin, and 180 on aspirin (14.4% to 54.2% cross-over amongst groups). Patients were more likely to have clinically significant bleeds (“bleeds”) if on a NOAC (HR=9.3, CI=3.0-28.4) or warfarin (HR=4.1, CI=1.6-10.5) versus aspirin. Bleed hazard ratio differences between NOAC and warfarin patients were not statistically significant (HR=2.3, CI=0.9-5.9). Patients on NOACs were not more likely to suffer TECs than patients on warfarin (HR=1.7, CI=0.4-6.3) or aspirin (HR=2.8, CI=0.7-10.3). Aspirin patients were younger, healthier, and had more favorable Fontan palliation. The traditional scoring systems to predict bleeds (HAS-BLED) and TECs (CHA
2
DS
2
VASc) were not predictive in this patient population. The only risk factor we identified for bleeds was a history of/predisposition to bleeding (OR=10.2, CI=4.4-23.6). Risk factors we identified for TECs included diabetes mellitus (OR=5.0, CI=2.2-11.4), labile international normalized ratio (OR=3.7, CI=1.1-12.4), and CHF (only in the NOAC/warfarin subgroup, OR=4.4, CI=1.2-16.3).

Conclusions:
NOACs are a potentially noninferior alternative to warfarin for adult Fontan patients. Our findings have laid the groundwork for a randomized control trial comparing the use of NOACs to warfarin in adult Fontan patients to test noninferiority or equivalence.
Abstract 17334: Illicit Drug Users Infective Endocarditis: Winter Effect Causing Lowest Incidence but the Highest Mortality
Authors: Dhaduk Kartik , Sonani Hardik , Patel Malav , Bhuva Rushik , Jolly George , Kumar Ashish , Desai Rupak , Desai Jagdish
Published: July 2021

Introduction:
Many cardiovascular diseases are known to have seasonal variation and that helps to better understand the disease. From the national sample, we studied the incidence and mortality pattern in infective endocarditis (IE) in illicit drug users (IDU) to delineate the seasonal effect on the disease.

Methods:
National inpatient sample (NIS) database from the year 2008 to 2014 was used to identify cases of IE and IDU (opiates, cocaine and amphetamine) in between age 15-65 years. After excluding cases with congenital cardiac anomalies, rheumatic, lupus and transfer status (possible doubling in count), data was analyzed using t-test, x
2
test and multivariate logistic regression analysis methods with SAS 9.4 software.

Results:
Out of total 144,593 identified cases of IE, 22,806 cases (15.77%) were illicit drug users infective endocarditis (IDU-IE). Patients in IDU-IE group were younger compare to non-IDU IE group (median± SE, p-value; 35± 0.39 vs 52± 0.11 yr, <0.001) but had higher longer hospital stay (12± 0.27 vs 10±0.1 days, <0.001). On seasonal pattern, highest hospitalisation was found in autumn (25.69%) followed by summer (25.23%), spring (22.8) and winter (19.5%) (figure1). In subgroup analysis, the most vulnerable population was in age group 15-35 years (49.8%), white race (71.8%) with Medicaid insurance (46.6%) in southern USA (37.6%). After adjusting for potential confounders in regression, mortality in winter was highest (aOR (95% CI), p-value; 1.40 (1.00-1.94), 0.04) (figure1). Old age >50 (2.43, (1.76-3.38), <0.001), >1 comorbidities (2.09 (1.59- 2.74), <0.001) and male (1.5 (1.18-1.91), <0.001) were predictors of higher mortality.

Conclusion:
In conclusion, drug use pattern is consistent with drug users IE pattern. But highest mortality despite of lowest incidence rate in winter suggests involvement of environmental and physical factors. Identifying these factors will help improving patient care and health care burden.
Abstract 17341: Novel Lipid Markers of Calcific Aortic Valve Stenosis
Authors: Bogaert Pascal E , Edel Andrea L , Surendran Arun , Raabe Michael , Sandhawalia Shubhkarman , Jassal Davinder , Ravandi Amir
Published: July 2021

Introduction:
Calcific aortic valve stenosis (CAVS) is the most prevalent cardiac valvular pathology, leading to a high incidence of morbidity and mortality if left untreated. The exact pathophysiology of CAVS is largely undefined. Genetic studies have shown a strong correlation of the Lp(a) gene to developing CAVS. Lp(a) is known to be the carrier of plasma Oxidized Phosphatidylcholine and results in Lysophosphatidic acid (LPA) accumulation. The focus of the present study was to determine if OxPC and LPA in calcific human aortic valves relate with echocardiographic markers of CAVS.

Methods:
Aortic valves (n=98) were obtained from patients undergoing AVR. OxPC and LPA were extracted from pulverized aortic valves and analyzed using a targeted mass spectrometry approach. Lipid values are represented relative to an internal standard and normalized by homogenate and leaflet weights. The severity of calcification and aortic stenosis were measured anatomically by Echocardiographic calcification (ECC) score and hemodynamically by mean AV pressure gradient.

Results:
One-palmitoyl-2-(9-oxo)-nonanoyl-
sn-
glycero-3-phosphocholine (PONPC) was the most abundant OxPC among 58 OxPC molecules detected (49.3±3.8ng), in AV tissue. When valves were graded by ECC score, scores of 1 (no calcification) had observably attenuated amounts of mean total OxPC’s (135.3±39.3ng) compared to those with a score of 4 (severe calcification) (310.1±34.8 ng). Total valvular OxPC increased linearly with increased ECC score. Total non-fragmented OxPC’s were also significantly lower in valves with ECC scores of 1 and 2 compared to a score of 4 (
P
=0.03). Six LPA species were also identified with 16:0 and 18:1 being the most prevalent. Mean AV pressure gradient had a significant, positive correlation with Total LPA amounts (r
2
=0.580,
p
<0.001), suggesting that elevated LPA concentrations in CAVS tissue is associated with disease severity.

Conclusions:
Our study is the largest lipidomics study of human aortic valve tissue demonstrating that OxPC and LPA molecules play a significant role in the etiology of CAVS and provides a novel therapeutic target for mitigating disease progression.
Abstract 17347: The Blood Triglyceride Level in Adolescence is Positively Associated With Nonalcoholic Fatty Liver Disease in Adulthood: The Kangwha Study
Authors: Lee Jung Hyun , Lee Su Jin , Jeon Yong-Woo , Kim Hyeon Chang , Suh Il
Published: July 2021

Introduction:
Several studies have examined the association between blood lipids levels and fatty liver. However, there have been few longitudinal studies regarding the association between lipids level in adolescence and nonalcoholic fatty liver disease in adulthood.

Hypothesis:
We assessed the hypothesis that blood lipids level in adolescence is associated with nonalcoholic fatty liver in adulthood.

Methods:
The Kangwha Study was a community-based prospective cohort study that started in 1986 in Kangwha County. A total of 269 participants (148 men; 121 women) were enrolled in our study after excluding heavy drinkers in adulthood, where their blood fasting total cholesterol, triglyceride, and high density lipoprotein (HDL) cholesterol level were measured at least once during adolescence (1992-1996), and the fatty liver was assessed by computed tomography (CT) scan in adulthood (2014-2017). A fatty liver was defined as a liver with values, at least, equal to or larger than 10 of difference between hounsfield unit (HU) of spleen and HU of liver, by measuring CT scan images at L1 vertebral level. For evaluating the association between lipids level at adolescence and fatty liver in adulthood, we used multiple logistic regressions. The fitness of models was evaluated by Hosmer and Lemeshow test.

Results:
The presence of fatty liver in adulthood was 5.6% (15 of 269). Mean age of study participants at enrollment is 13.9 years (SD, 1.6 years), and that in adulthood is 36.1 years (SD, 0.8 years). When adjusted for age, sex, body mass index, and blood pressure in adolescence, the adjusted odds ratio (aOR) of total cholesterol was 0.83 for 10 mg/dl increment (95% confidence interval (CI), 0.63-1.11), that of triglyceride was 1.17 for 10 mg/dl increment (95% CI, 1.02-1.35), and that of HDL cholesterol was 1.77 for 10 mg/dl increment (95% CI, 0.78-4.01). Our model satisfied the goodness of fit (p=0.75).

Conclusions:
In conclusion, the blood triglyceride level in adolescence is positively associated with nonalcoholic fatty liver disease in adulthood, but blood total and HDL cholesterol level is not. The results of our study supported the usefulness of lipid measurements in adolescence.
Abstract 17356: Gender Differences in Clinical Presentation and Outcomes of Patients With Acute Myocardial Infarction and Spontaneous Coronary Artery Dissection: A Nationwide Inpatient Sample Matched Analysis
Authors: Fugar Setri , Yirerong Juliet A , Solomon Alfred , Kolkailah Ahmed A , Akthar Tauseef , Siddamsetti Sisir , Walusimbi Abraham , Gomez Jorge , Sanni Obafemi , Amakye Dominic , Okoh Alexis
Published: July 2021

Introduction:
Spontaneous Coronary Artery Dissection (SCAD) is reported to occur predominantly in young women. Gender differences in the clinical presentation and outcomes of patients with SCAD have not been studied on a population level. We sought to compare the in-hospital outcomes of men and women presenting with acute myocardial infarction (AMI) and SCAD.

Methods:
We identified patients from the National Inpatient Sample (NIS) between 2005 and 2015 who presented with primary diagnoses of AMI and SCAD. We identified SCAD with ICD-9 code 414.12. A 1:1 propensity-matched cohort was created to examine the outcomes between men and women. Primary endpoint was in-hospital mortality. Secondary endpoints included in-hospital cardiac and non-cardiac complications.

Results:
Of the 6617 (32017 weighted national estimates) patients with SCAD over the study period, majority were males 3667 (55.4%). Males were younger than females (60.32 yr vs. 61.59 yr) and presented more often with ST-elevation myocardial infarction (STEMI) (53.0% vs. 45.9% P=<0.001). Propensity matching yielded 2366 males and 2366 females. In the matched group, there was no significant difference in in-hospital mortality between males and females (OR 1.20 95% CI -0.93-1.54). With regards to in-hospital complications, ventricular tachycardia (V-Tach) was significantly less frequent in females as compared to males (8.0% vs. 10.1% OR 0.76 p-value 0.003). There was no significant difference between females and males in the frequency of other complications, including intracranial hemorrhage (0.2% vs 0.2% OR 1.45 p-value 0.50), GI bleed (1.8% vs 1.3% OR 1.35 p-value 0.13), cardiogenic shock (9.8% vs 9.7% OR 1.01 p-value 0.86), acute heart failure (3% vs 2.6% OR 1.18 p-value 0.26), ventricular fibrillation(vfib) (5.6% vs 6.0% OR 0.928 p-value 0.48) or stroke ( 1.5% vs 1.0% OR 1.535 p-value 0.06)

Conclusion:
In our large population-based analysis, compared to females, males were more likely to present with STEMI as compared to females. With the except of V-Tach, which was higher in males, there were no significant gender differences in hospital outcomes namely inpatient mortality, cardiogenic, Vfib or acute heart failure.
Abstract 17381: Cardiac Myosin I as a New Potential Biomarker for Prognosis of Acute Decompensated Heart Failure
Authors: Matsumoto Yuki , Orihara Yoshiyuki , Ando Tomotaka , Okuhara Yoshitaka , Kashiwase Kazunori , Ishihara Masaharu , Masuyama Tohru
Published: July 2021

Background:
Brain natriuretic peptide (BNP) is routinely measured for evaluating the severity of acute decompensated heart failure (ADHF). However, there are no other biomarkers for stratification of ADHF patients in clinical settings. Cardiac myosin I (CM-I) is one of a superfamily of motor proteins, which is mainly distributed in myocardium. Several papers reported that serum CM-I levels increased in patients with acute coronary syndrome (ACS). However, the role of CM-I in ADHF patients is not yet elucidated.

Purpose:
The aim of this study was to clarify the utility of CM-I in ADHF patients.

Methods:
We assessed 114 ADHF patients who visited our institution between December 2017 and May 2018 in a retrospective study. All patients were diagnosed ADHF using Framingham criteria. Eight ACS patients and 22 patients lacking in data of serum CM-I levels were excluded. Finally, we analyzed 84 patients. We calculated the difference in serum BNP levels between on admission and at discharge (delta BNP) as a prognostic surrogate marker.

Results:
Average age was 77.5 years old and 44 patients were male. Numbers of patients with NYHA III and IV were 30 and 36, respectively. Mean serum levels of BNP and Troponin T (TrT) on admission were 934.0 pg/ml and 0.092 ng/ml, respectively. Average left ventricular ejection fraction (LVEF) by echocardiography was 46.1%. Serum CM-I levels on admission and at discharge were 12.8 mg/ml and 7.30 mg/ml, respectively. Serum CM-I levels had a significant correlation with TrT levels (R=0.46, p<0.0001) and a weak correlation with BNP levels (R=0.33, p= 0.006). CM-I levels were not statistically correlated with LVEF. CM-I levels were well correlated with delta BNP(R=0.36, p= 0.0138), but TrT were not associated with delta BNP(R=0.066, p= 0.658).

Conclusion:
We found CM-I was associated with the difference in BNP between on admission and at discharge in ADHF patients. CM-I may be a new potential prognostic biomarker in ADHF patients.