bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P414: Omega-3 Fatty Acids Modify the Genetic Risk of Early Onset Acute Coronary Syndrome
Authors: Leung Yinko Sylvie S , Engert James C , Thanassoulis` George , Stark Ken D , Avgil Tsadok Meytal , Pilote Louise
Published: July 2021

Background:
Recent gene-environment interaction studies suggest that diet may influence an individual’s genetic predisposition to cardiovascular risk. We tested the hypothesis that omega-3 fatty acid intake may influence the risk for acute coronary syndrome (ACS) conferred by genetic polymorphisms among patients with premature ACS.

Methods:
Our study population consisted of 706 patients of white European descent enrolled in GENESIS PRAXY, a multicentre prospective cohort study of patients aged 18 to 55 years hospitalized with ACS. We used a case-only design to investigate gene-environment interactions between the omega-3 index (a validated biomarker of omega-3 fatty acid intake) and 30 single nucleotide polymorphisms (SNPs) that have been robustly associated with ACS. We used logistic regression to study the associations between each SNP and the omega-3 index. Interaction was also assessed between the omega-3 index and a genetic risk score generated from the 30 SNPs as a simple unweighted count of the risk alleles for each SNP. All the SNPs used in the genetic risk score were uncorrelated (r2 <0.3). We further adjusted all models for age and sex.

Results:
The median age of our population was 49 years and 72.1% were male. Median omega-3 index was 3.35% (interquartile range 2.81-4.07%). None of the SNPs deviated from Hardy-Weinberg equilibrium. A synergistic multiplicative interaction for increased ACS risk was found between carriers of chromosome 9p21 variant rs4977574 and low omega-3 index (OR 1.57, 95% CI 1.07-2.32, p=0.02), but did not reach significance after correction for multiple testing. Similar results were obtained in the adjusted model (OR 1.55, 95% CI 1.05-2.29, p=0.03). We did not observe interaction between the genetic risk score and the omega-3 index.

Conclusions:
In conclusion, our results suggest that omega-3 fatty acid intake may modify the genetic risk conferred by chromosome 9p21 variation among ACS patients but require independent replication in other cohorts. Further validation research is also warranted to examine whether this interaction occurs in other ethnic groups.
Abstract P415: Multivitamin Use and the Risk of Cardiovascular Disease in Men
Authors: Rautiainen Susanne , Glynn Robert J , Buring Julie E , Gaziano J. Michael , Sesso Howard D
Published: July 2021

Background:
Although multivitamins are widely used by US adults, few prospective studies have investigated their association with the long- and short-term risk of cardiovascular disease (CVD). The aim of this study was to investigate how multivitamin use is associated with the risk of CVD in initially healthy men free of CVD at baseline.

Methods:
We studied 21,981 male physicians aged ≥40y from the Physicians Health Study I cohort who were free of CVD and cancer at baseline starting in 1982. All men provided a wide range of self-reported lifestyle and clinical factors plus intake of selected food and dietary supplements. Men were categorized at baseline as (1) no current use and (2) current use of multivitamins. Men were followed from baseline to the end of PHS I follow-up. Cox proportional hazards models were used to calculate multivariable-adjusted rate ratios (RR) (95% confidence intervals (CI)).

Results:
During an average of 13.7 y (total of 301,480 person-years) of follow-up, there were 1,269 incident cases of major CVD (defined as nonfatal myocardial infarction (MI), nonfatal stroke, and CVD death). In multivariable analyses, there were no statistically significant RRs (95% CIs) observed when comparing current multivitamin use versus no use for the risk of major CVD events (0.97 (0.79-1.04)), MI (0.94 (0.76-1.16), stroke (0.97 (0.77-1.23), or CVD death (1.02 (0.83-1.14)) but an inverse association was observed for cardiac revascularization (0.87 (0.75-1.00)).

Conclusion:
In this long-term prospective study among initially healthy men, baseline multivitamin use was not associated with the long-term risk of major CVD events.
Abstract P416: Low Vitamin D does not correlate with Cardiometabolic Risk in African Immigrants
Authors: Sumner Anne E , Thoreson Caroline K , O'Connor Michelle Y , Ricks Madia , Chung Stephanie T
Published: July 2021

Controversy exists as to whether low vitamin D levels contribute to the development of cardiometabolic disease. As African descent populations have a high prevalence of low vitamin D levels and cardiometabolic disease, clarification is important. However, current cross-sectional studies linking low vitamin D concentrations to cardiometabolic disease not only provide conflicting results, data specifically on people of African descent is very limited. Therefore, we evaluated the association between vitamin D levels, measured as 25(OH)D, and cardiometabolic risk factors in 78 African immigrants (77% male, age 35±y (mean±SD) age range 22-63y). Participants had oral glucose tolerance tests, insulin sensitivity index (S
I
) determined with the minimal model and abdominal computerized tomographic scans to measure visceral adipose tissue (VAT). Cardiometabolic risk factors were related to 25(OH)D levels by Pearson correlations and one-way ANOVA across quartiles of 25(OH)D. Mean 25(OH)D levels were 22±7, range 10-36 ng/mL. BMI was 27.9±4.4 kg/m2 and 74% of Africans were either overweight or obese. Nine percent had newly identified diabetes and 33% had pre-diabetes. Mean arterial BP was 88±10 mmHg and 44% of Africans had either pre-hypertension or hypertension. Cardiometabolic variables did not change across quartiles of 25(OH)D (Table). In addition, there were no significant correlations between 25(OH)D and the cardiometabolic variables listed in the Table (all r<0.2, all
P
>0.1). As cardiometabolic risk factors do not become more severe as 25(OH)D levels decline, vitamin D may not modulate cardiometabolic risk in people of African descent.
Abstract P419: Diet patterns in Argentinean adults
Authors: Elorriaga Natalia , Irazola Vilma E , Gutierrez Laura , Defagó Maria D , Poggio Rosana , Rubinstein Adolfo L
Published: July 2021

Objectives:
to identify Diet Patterns (DP) in the adult population of Argentina, and explore associations with gender, age and educational level.

Methods:
We defined DP among 3,010 adults between 35 to 74 years old, participating in CESCAS I, a population-based cohort study carried out in two cities in Argentina, Marcos Paz and Bariloche. Data on food intake was obtained from a validated self-administered food frequency questionnaire. Principal component Analysis (PCA) was used to identify DP. A summary score for each pattern was then derived and used in multiple regression analysis to examine the relationship between DP and socio-demographic variables.

Results:
3 major eating patterns were identified. They explained 25% of the total variance.

Factor 1 (Traditional diet pattern) was characterized by a high intake of refined grains, red meat, whole- fat dairy products, vegetable oils and other fat spreads, and “mate”, a traditional South American drink. Factor 2 (Healthy diet pattern), was characterized by a high intake of vegetables, fruit, low-fat dairy products, whole grains, and legumes. Factor 3 (Processed-food diet pattern) consisted mainly of processed meat, snacks, pizza, and “empanadas”, a stuffed bread baked or fried.

After adjusting for energy intake, we found that DP were associated with age, gender, and educational level. Traditional DP score was lower at high educational level (p 0.001), Healthy DP score was higher among women (p 0.000), and high educational level (p 0.001) while men scored significantly higher in the Processed-food DP (p 0.002).

Conclusions:
Local DP has been identified in our population. This study will provide useful information to set priority targets for nutrition interventions, and promote healthy policies based on local food habits.
Abstract P438: Staying Active improves Insulin Resistance independent of the Metabolic Syndrome and Obesity
Authors: Oni Ebenezer T , Muzaik Wasim , Blaha Michael J , Agatston Arthur S , Blumenthal Roger S , Conceiçao Raquel D , Meneghelo Romeu S , J Carvalho A , Santos Raul D , Nasir Khurram
Published: July 2021

Background:
The progression of cardio-metabolic disease is believed to be driven by increasing Insulin resistance (IR). While increased physical activity (PA) is often encouraged among individuals with metabolic syndrome to improve their IR, there is limited information on its impact among individuals without metabolic syndrome (MS) or obesity. We aimed to ascertain the effect of PA on IR across a spectrum of metabolic conditions.

Methods:
We evaluated 5,795 healthy Brazilian subjects (43±10 years, 79% males) without clinical coronary heart disease between November 2008 and July 2010. We defined IR using Triglyceride: High Density Lipoprotein-Cholesterol ratio (TG: HDL) > 3.0. PA was assessed using the International Physical Activity Questionnaire (IPAQ) scale and MS was classified with the IDF criteria. Obesity was defined as having a BMI ≥ 30.

Results:
The prevalence of IR was 39% (n=2,233), 1,316 (23%) were obese and 1,161 (20%) had metabolic syndrome. IR was significantly higher among individuals with the metabolic syndrome (84%) vs. individuals with no metabolic syndrome (27%), p<0.001. Overall 1,308 (23%) were sedentary, 2,008 (35%) minimally active and 2,473(42%) very active. There were significant reduction in IR prevalence with increasing physical activity (sed: 48%, minimally active: 43%, active= 31%, p<0.001). As shown in table below, after adjusting for confounding variables, higher activity levels was 20-56% less likely associated with IR. The benefits appeared to extend to individuals with and without MS or Obesity.

Conclusions:
PA presents a dose response association with insulin resistance independent of the MS or Obesity. Staying active has tremendous benefits in reducing insulin resistance across populations regardless of their metabolic profile.
Abstract P446: External Validation Of The CAMUNI Score, A Long-term Cvd Prediction Equation For Low-incidence Populations.
Authors: Veronesi Giovanni , Donfrancesco Chiara , Chambless Lloyd E , Gianfagna Francesco , Palmieri Luigi , Mancia Giuseppe , Cesana Giancarlo , Giampaoli Simona , Ferrario Marco M
Published: July 2021

Aims:
We assess the external validation, on a “new” set of subjects, of the CAMUNI 20-year risk score, developed in a northern Italian population. Although an external validation analysis is recommended before adopting a score in clinical practice, it is rarely performed in long-term prediction equations as it requires similar long-term follow-up procedures in different cohort studies.

Methods:
The CAMUNI risk score was developed to estimate the 20-year risk of first coronary or ischemic stroke event, fatal or non-fatal, in 5247 (2574 men) 35-69 subjects free of CVD at baseline enrolled in late 1980s-early 1990s in Brianza, northern Italy (derivation set). The score is based on two gender-specific Cox models, including age, total- and HDL-cholesterol, systolic blood pressure, anti-hypertensive treatment, cigarette smoking and diabetes. As validation set, we considered 5307 (2418 men) subjects enrolled in the Rome area in the same time span (MATISS Study). Both the derivation and the validation cohorts shared the same procedures for baseline risk assessment and follow-up procedures, including MONICA definition of acute events. We evaluated the performance of the CAMUNI score in the validation set; the Framingham CVD risk score was used for comparison. The absolute predicted risk from both scores was re-calibrated to the 20-year risk observed in the validation set. We report the calibration slope as a measure of calibration; a value different from 1 is suggestive of a different strength in predictor effects. The Area Under the ROC-curve (AUC) measured the discrimination ability; the AUC in the validation set was compared to the value in the derivation set, corrected for over-optimism.

Results:
The 20-year Kaplan-Meier risk of event was 16.1% (derivation set; 315 events) and 13.2% (validation set; 238 events) in men, and 6.1% (123 events) and 5.6% (119 events) in women. The calibration slope for the CAMUNI score did not significantly differ from 1 in men (1.1; 95% confidence interval 0.9; 1.2) nor in women (1.0; 0.8;1.2). The Framingham score performed equally well in men (1.1; 0.9; 1.2) but worse in women (1.3; 1.1;1.6). In the derivation set, the over-optimism corrected AUC for the CAMUNI model was 0.737 (men) and 0.801 (women); the corresponding figures in the validation set were 0.732 (95% CI: 0.727-0.738) in men, and 0.801 (0.794-0.808) in women. The Framingham score performed less well in men (0.722; 0.717-0.727) and in women (0.705; 0.699-0.711).

Conclusions:
Based on these preliminary results, the CAMUNI 20-year risk score seems to be appropriate for long-term risk prediction in Italy and, more generally, in low-incidence populations.
Abstract P451: Correlates of Prehospital Delay in ACS Patients in a Medically Underserved Appalachian Community
Authors: Abro Masroor A , Gharib Wissam , Warden Bradford , Jain Abnash , Bell Kristen , Waters Jeremy , Arena Christopher , Long Dustin , Poston Walker S , Schmidt Stanley B
Published: July 2021

Introduction:
We evaluated correlates of seeking treatment among ACS patients in a rural, medically underserved community. This study is unique because patient data came from medical records and physician-administered structured interviews and it is the first to evaluate correlates of treatment delay in a rural and medically underserved patients.

Methods:
A physician-administered structured interview was administered to 170 consecutive ACS patients. Patients were recruited from June 2010-December 2012. Inclusion criteria were: 1) chest pain or discomfort with onset outside hospital; and 2) fulfilling the criteria for ACS (i.e., chest pain or discomfort, changes on the ECG and/or an increase in at least one biochemical marker. The structured interview was composed of standardized questions with pre-defined answer categories covering 10 domains: 1) Patient demographics; 2) Presenting symptoms (e.g., first symptoms and type of symptom; symptom intensity/progression, symptom description and knowledge, etc.); 3) Responses to symptoms (e.g., informed someone, summoned help); 4) Symptom context (e.g., activity at time of AMI, place it occurred); 5) factors associated with decision to seek help (e.g., distance to hospital, transportation available, how transported, money, etc.); 6) Psychological/Personality factors (e.g., current depression, anxiety, denial patterns, personality types A or B); 8) Technology use (e.g., time spent watching TV or using smart devices/internet, etc.); 9) Prior cardiac history and risk factors (e.g., history of hypertension, diabetes, obesity, hyperlipidemia, medications, ER laboratory data); and 11) Post admission clinical course (e.g., ECG, arrhythmias, lytic therapy, CCU days, PCI, CABG, TIMI score , complications). Late presentation was defined as greater than 90 minutes for STEMI patients and greater than 180 minutes for NSTEMI patients.

Results:
Among STEMI patients (n=98), only marital status (currently married vs. not married; OR=0.3; CI=0.1-0.9) and concerns about money (OR =26.3; CI = 1.2-500.0) were significantly associated with late presentation for treatment. For NSTEMI patients (n=73), several presenting symptom variables were associated with seeking treatment early including whether they experienced pain radiating to the arms (OR=0.1; CI=0.0-0.59), describing their chest pain as heavy (OR=0.04; CI=0.0-0.4), and reporting that nitroglycerin relieved chest pain (OR=0.2; CI = 0.1-0.9). One post-admission variable (whether they had Acute PCI post-MI; OR=0.1; CI=0.0-0.7) also was associated with late treatment.

Conclusions:
Being unmarried or having concerns about money were associated with delays in treatment for STEMI patients, while mostly symptom-related variables were associated with treatment delays among NSTEMI patients in this cohort of low-income, medically underserved patients.
Abstract 100: Mechanical Devices Are More Effective than Manual Compressions Regarding Resuscitation Concomitant with Emergency Percutaneous Coronary Intervention in Cardiac Arrest
Authors: Dallan Luis A , Vargas Tulio T , Janella Bruno L , Cade Jamil R , Almeida Breno O , Spadaro Andre G , Timerman Sergio , Perin Marco A
Published: July 2021

Introduction:
Cardiac arrest during procedures in the Cath Lab is excessively harmful, as manual chest compressions prevents the continuity of coronary angiography and coronary angioplasty and require the assistance of trained staff in cardiopulmonary resuscitation (CPR) quickly and accurately. AutoPulse® is a mechanical CPR device that consists of mechanical pneumatic band attached to a board that involves the patient’s chest and allows effective and continuous pneumatic compressions, allowing mechanical CPR simultaneously to coronary angiography and angioplasty.

Hypothesis:
We assessed the hypothesis that mechanical CPR may be feasible during percutaneous coronary interventions and more effective than manual CPR by the analysis of intra-coronary pressure curves.

Methods:
The device was used in 6 consecutive cases of cardiac arrests (ventricular fibrillation refractory to attempts of defibrillation and standard treatment) in the Cath Lab, allowing continuity of percutaneous coronary intervention concomitant with CPR. Intra-coronary curves were measured initially during manual chest compressions (manual CPR) and later, after the correct installation of AutoPulse® during mechanical compressions with this device (mechanical CPR).

Results:
It was possible to complete coronary angiography with the device attached to the patient in all cases, and it was also possible to complete coronary angioplasty during mechanical CPR. In all cases, mechanical CPR provided uninterrupted chest compressions more effectively and always stable in stead of manual compressions. Although a mean blood pressure of 40mmHg in both methods, mechanical CPR was able to maintain this pressure for a long time, but manual CPR had an important reduction in mean blood pressure after two minutes of CPR in all cases.

Conclusions:
In conclusion, percutaneous coronary interventions are feasible concurrent with mechanical CPR using AutoPulse® in patients suffering cardiac arrest in the Cath Lab. The device provided uninterrupted chest compressions more effective than manual compressions, as well as allowed the freedom of the physicians to attempt other functions, different from CPR, during the procedures.
Abstract 102: Out-of-Hospital Cardiac Arrest Clinical Trial Control Groups: Time Capsules for Discovery of Secular Trends---Fraction of Patients with Good Neurological Outcomes, 1985 to Present
Authors: Engerer Katelin M , Coleman James V , Valle Luca F , Roginski Matt , Paradis Norman A
Published: July 2021

Introduction:
Over time there have been changes in consensus therapy for out of hospital cardiac arrest (OOHCA), including changes in BLS-ACLS, and recently targeted temperature management. There has been only limited success, however, in determining the effect of specific interventions on neurological outcome using randomized clinical trials (RCT’s) and registries.

Hypothesis:
The control groups in OOHCA RCT’s can be utilized to identify the presence or absence of potential trends in neurological outcome related to secular changes in care.

Methods:
Comprehensive online search for RCT’s in OOHCA with n > 50 in control group, and reporting neurological outcome, 1960 to present. Extraction of demographic and outcome variables. Analysis, fraction of resuscitated patients with good neurological outcome (GNO), defined as CPC 1 or 2 as a function of year.

Results:
n=32 usable RCTS were identified, all since 1985. No significant trends in the fraction of patients with GNO were identified (Figure). There was relatively large variability. Outcomes in the epoch since the promulgation of hypothermia have not changed overall. However, since about 2012 there have been a handful of RCT’s with relatively high fraction of patients with GNO compared to historical norms.

Limitations:
Retrospective methodology and background regional differences limits significance and applicability, hypothesis generating only.

Conclusion:
Between 1985 and the present, there were no trends in GNO rates in the control groups of RCTs, possibly indicating lack of efficacy or toxicity with respect to therapies experiencing changing patterns of utilization, or an offsetting change in substrate.
Abstract 105: Changes in NIRS-Measured Cerebral Tissue Oxygen Saturation During Hyperventilation: A Comparison Between NIRO™ and INVOS™
Authors: Hatanaka Tetsuo , Kaneko Hiroshi , Nagase Aki , Marukawa Seishiro
Published: July 2021

Introduction:
Cerebral tissue oxygen saturation measured with transcranial near-infrared spectroscopy (NIRS) has been reported to predict neurological outcome of cardiac arrest patients. Because NIRS values are confounded by extracranial tissues, there can be considerable inter-device variation in the measured values. We compared hyperventilation-induced changes in NIRS values measured with 2 commercially available devices in healthy volunteers.

Methods:
After obtaining an approval from the ethics committee at Iseikai hospital and written informed consents, 29 healthy volunteers joined the study. Probes of NIRO™ 200NX (Hamamatsu Photonics, Japan) and INVOS™ 5100C (Covidien, USA) were applied respectively on the right and left side of the volunteers’ forehead. After obtaining the baseline values, the volunteers were asked to hyperventilate for 40 seconds attempting to reduce the end-tidal CO
2
by ~20 mmHg. Measurements were repeated, after 20 minutes of resting interval, with the probes applied on the contralateral sides. Hyperventilation-induced response of the NIRS value was categorized as “correct” when the average value over the 5 second period toward the end of the hyperventilation decreased by >15% the baseline or “erroneous” otherwise.

Results:
The mean (± SD) end-tidal CO
2
decreased from the baseline value of 36 ± 5.1 mmHg to 15.2 ± 4.4 mmHg during hyperventilation. Out of 58 measurements with each of the devices, NIRO values were “correct” in 54 (93.1%) measurements, whereas INVOS values were “correct” in 32 (52.2%) measurements. NIRO presented “erroneous” values on both sides of the forehead in no volunteers whereas INVOS presented “erroneous” values in 7 (35%) of 29 volunteers.

Discussion:
Hyperventilation consistently decreases cerebral blood flow in healthy subjects. Thus, the results of the present study suggest that NIRS devices may fail to reflect correct changes in cerebral tissue oxygen saturation in ~7% of measurements with NIRO and in ~48% with INVOS. The bilateral “erroneous” measurements with INVOS in 7 (35%) volunteers may suggest that INVOS is subject to confounding by extracranial tissues. A potential source of confounding may include the scalp where blood flow increases during hyperventilation.
Abstract 10976: Parent-Offspring Association of Metabolic Syndrome in the Framingham Heart Study
Authors: Khan Rumana J , Rotimi Charles N , Gebreab Samson Y , Crespo Pia R , Xu Ruihua , Davis Sharon K
Published: July 2021

Introduction:
Metabolic syndrome (MS) is a clustering of five metabolic risk factors including abdominal obesity (OB), elevated blood pressure, hypertriglyceridemia, low high-density lipoprotein cholesterol (HDL-C), and impaired fasting glucose (IFG). Few studies have fully reported the strength of clustering of these risk factors in a parent-offspring relationship. This analysis describes the associations between parents and their adult offspring in regard to MS. It also estimates the association between each risk factor in parents and the presence of MS in their offspring.

Methods:
We analyzed data for 1193 offspring (565 sons, and 628 daughters) from the Framingham Offspring Study who attended examinations 5, 6, and 7. Information about their parents was collected from examinations 13, 14 and 15 of the Framingham Original Cohort study. We used pedigree file to combine parental and offspring’s data. Participants were classified as having the MS according to the Adult Treatment Panel III criteria. Logistic regression was used to estimate the associations.

Results:
After adjusting for age, education, smoking, alcohol consumption and physical activity level of offspring, no significant association was found between fathers’ and their offspring’s MS. Mothers’ MS was significantly and positively associated with their daughters’ MS (adjusted odds ratio or adj OR:1.63; 95% confidence Interval, CI:1.02-2.61), but not with their sons’ MS. This gender difference was not observed when both the parents had MS. Daughters (adj OR:4.13; 95% CI:1.31_13.07) and sons (adj OR:4.31; 95% CI:0.98-19.77) both had more than 4 folds of increased odds of having MS if both parents had MS compared to offspring whose neither parent had MS. When analyzed by individual components, mothers’ IFG (adj OR:2.03 ; 95% CI:1.02- 9.31), OB (adj OR:1.56; 95% CI:0.98- 2.55) and HDL-C (adj OR: 2.12; 95% CI:1.35-3.32) were associated daughters’ MS. But none of these were significant for their sons’ MS. For fathers, only IFG (adj OR:4.91; 95% CI:2.07- 11.68) was associated with their daughters’ MS.

Conclusions:
We found differential associations between parents and their adult offspring in regard to MS. Daughters with mother’s MS were in higher risk than daughters or sons with father’s MS.
Abstract 11087: Autoantibody Titer Directed Against β1-Adrenergic Receptors is a Predictor of Reverse Remodeling During Carvedilol Therapy for Chronic Heart Failure: Japanese Chronic Heart Failure (J-CHF) Study
Authors: Nagatomo Yuji , Yoshikawa Tsutomu , Okamoto Hiroshi , Kitabatake Akira , Hori Masatsugu ,   J-CHF Investigators
Published: July 2021

Introduction:
Autoimmune disorder is one of the features characterizing congestive heart failure (CHF) not only due to idiopathic dilated cardiomyopathy, but due to other etiologies. Autoantibody directed against β1-adrenergic receptors (β1-AAb) exerts agonist-like action inducing receptor uncoupling, and elicits persistent myocardial damage. We, therefore, attempted to determine the significance of β1-AAb in patients with CHF who received β-blocker carvedilol in the substudy of J-CHF study.

Methods:
In this prospective, randomized, multicenter trial, 117 patients (left ventricular ejection fraction [LVEF] ≤ 40%) with mild to moderate CHF were assigned to 2.5mg/5mg/20mg (n=38/36/43) carvedilol groups according to the target dose. Sera were collected at baseline and β1-AAb titer was determined using ELISA.

Results:
ELISA showed 66 patients as negative and 36/7/7/1 patients as 20-fold (x20) / x40 / x80 / x160 positive, respectively. When the study population was divided into β1-AAb high titer (≥ x40, H) and low titer (≤ x20, L) groups, there were no significant differences in vital signs or cardiac function at baseline between 2 groups. The % change of LVEF during 56 weeks after carvedilol introduction (ΔLVEF) was significantly larger in H than L (H, +85±78% vs. L, +43±65%, p=0.04). LV end-diastolic volume (LVEDV) and end-systolic volume (LVESV) decreased to a greater extent in H than L during 56 weeks (LVEDV, 182±50 to 119±43 ml vs. 202±52 to 167±58 ml, p<0.005 by ANOVA; LVESV, 136±47 to 62±36 ml vs. 141±47 to 97±53 ml, p=0.048 by ANOVA). β1-AAb titer was significantly correlated with ΔLVEF and the % change of LV volume (LVEF, r=0.24, p=0.02; LVEDV, r=-0.26, p=0.02; LVESV r=-0.27, p=0.01). Multiple regression analysis demonstrated that β1-AAb titer was an independent predictor of ΔLVEF and the % changes of LV volume after adjusting for age, gender, allocated dose of carvedilol, heart rate at baseline, plasma BNP at baseline, etiology of CHF and the presence of atrial fibrillation (ΔLVEF β=0.286, p=0.01; ΔLVEDV β=-0.227, p=0.04; ΔLVESV, β=-0.250, p=0.02).

Conclusions:
The findings in the present study suggested that β1-AAb has a crucial role as one of the determinants of reverse remodeling during carvedilol therapy for patients with CHF.
Abstract 11232: Assessment of Diffuse Myocardial Fibrosis With Native T1 Values on Cardiovascular Magnetic Resonance and Its Relationship With Myocardial Function in Asymptomatic Aortic Stenosis Patients
Authors: Lee Seung-Pyo , Lee Whal , Park Eun-Ah , Kim Hyung-Kwan , Kim Yong-Jin , Sohn Dae-Won
Published: July 2021

Introduction:
Aortic stenosis (AS) typically provokes diffuse myocardial fibrosis (DMF). Methods to evaluate DMF using cardiovascular magnetic resonance (CMR) are yet to be made easier and validated for wide clinical use.

Hypothesis:
To test whether T1 mapping, without the use of gadolinium contrast, may be useful for assessment of DMF and whether it correlates with subclinical myocardial dysfunction in asymptomatic AS patients.

Methods:
80 asymptomatic patients with moderate or severe AS and normal LVEF and 15 sex-matched control subjects were prospectively enrolled. Patients underwent 2D-echocardiography, speckle tracking imaging and CMR in a 3.0T scanner including mapping of T1 relaxation time with modified Look-Locker Inversion-recovery (MOLLI) sequence. Patients were divided into three groups according to the native T1 value.

Results:
Native T1 values correlated well with the degree of DMF on intraoperative myocardial biopsy specimens (r=0.777, p-value<0.001) and differed significantly between AS and control subjects (1208±45 vs. 1169±21(msec), p-value<0.001). LV volumes and mass were significantly different between the tertiles (80.8±10.3 vs. 93.4±23.1 vs. 121.5±37.9(mL/m2), 78.0±18.3 vs. 93.4±29.7 vs. 121.1±44.3(g/m2) for LV end-diastolic volume index and LV mass index, all p-value<0.001) as well as the degree of AS severity (0.55±0.14 vs. 0.46±0.12 vs. 0.45±0.13(cm2/m2), p-value=0.008 for indexed aortic valve area on echocardiography). Native T1 significantly correlated with global longitudinal strain by 2D-speckle trackle imaging (r=0.598, p-value<0.001), e’ velocity (r=-0.437, p-value<0.001) and indexed left atrial volume (r=0.475, p-value<0.001).

Conclusion:
Native T1 value using MOLLI sequence in asymptomatic AS patients enables noninvasive, simple quantification of DMF and correlates well with subclinical LV systolic and diastolic dysfunction.
Abstract 114: Effect of Sodium Bicarbonate on Advanced Cardiac Life Support
Authors: Lee Jungyoup
Published: July 2021

Introduction:
Current guidelines do not support routine administration of sodium bicarbonate during cardiopulmonary resuscitation (CPR). Previous studies did not recommend bicarbonate unless there is severe metabolic acidosis or hyperkalemia. We hypothesized that the sodium bicarbonate, regardless of its effect on long-term outcomes, may improve the chance of achieving return-of-spontaneous circulation (ROSC).

Methods:
We used out of cardiac arrest registry in our hospital and analyzed retrospectively. The primary endpoint was to assess the association between 1) the timing first administration as well as 2) the total amount of sodium bicarbonate administered until ROSC and the chance of achieving ROSC. The secondary endpoint was to assess whether there is significant decrease in early survival if sodium bicarbonate was administered during CPR. We built multivariable logistic regression model by the use of the amount of sodium bicarbonate, age, initial base deficit, serum potassium level and usual Utstein template factors with their p-value < 0.1 in univariable analysis.

Results:
Total 697 patients were enrolled. The amount of sodium bicarbonate administered until ROSC (or CPR termination if there is no ROSC) was significantly associated with the chance of ROSC (Odds ratio [OR], 1.10; 95% confidence interval [CI], 1.01-1.19; p=0.028). The association was still valid after additional adjustment with factors with their p-value < 0.1 in univariable conditional logistic regression analysis. (OR, 1.14; 95% CI, 1.01-1.29; p=0.031) The time to first administration of sodium bicarbonate did not show significant univariable association (OR, 0.99; 95% CI, 0.99-1.00; p=0.193). Kaplan-Meyer survival curves showed significantly increased death rate in patients administered with sodium bicarbonate (log-rank test, p=0.002)

Conclusion:
Administration of higher dose of sodium bicarbonate during CPR was associated with increased chance of achieving ROSC. However, such benefit was negated soon after by higher early mortality rate in the group where sodium bicarbonate was administered.
Abstract 11460: Chronic Intermittent Low Level Transcutaneous Electrical Stimulation of the Auricular Branch of the Vagus Nerve Improves Left Ventricular Remodeling in Conscious Dogs With Healed Myocardial Infarction
Authors: Wang Zhuo , Yu Lilei , Wang Songyun , Huang Bing , Liao Kai , Saren Gaowa , Jiang Hong
Published: July 2021

Introduction:
Vagus nerve stimulation (VNS) attenuates left ventricular remodeling after myocardial infarction (MI) by improving the imbalance of autonomic nervous system. Our previous study found Low-level tragus stimulation (LL-TS) had the same antiarrhythmic effects as VNS by regulation of the autonomic nervous system.

Hypothesis:
Chronic intermittent LL-TS could attenuate left ventricular remodeling in conscious dogs with healed myocardial infarction.

Methods:
Thirty beagle dogs were randomly divided into three groups. LL-TS group (n=10) and MI group (n=10) underwent left anterior descending coronary artery and all major diagonal branches ligation to introduce MI under general anesthesia. Control group (n=10) underwent sham surgery. Auricular vagus nerve stimulation (frequency 20Hz, pulse width 1ms) with duty cycle of 5s on and 5s off was delivered to the bilateral tragus in external auditory canal with ear-clips connected to a custom-made stimulator. The voltage slowing sinus rate was used as the threshold for setting LL-TS at 80% below that. The actual voltage of stimulation was in the range of 16 to 24V that did not cause any heart rate changes. LL-TS group was given four hours of LL-TS at 7-9AM and 4-6PM on conscious dogs from the day of MI introduction to the end of 90-day follow-up, MI group and control group were given no stimulations.

Results:
At the end of 90-days follow-up LL-TS group significantly reduced left ventricular dilatation, improve left ventricular contractile and diastolic function, reduced mean infarct size by about 50% compared with MI group. Also LL-TS treatment alleviated cardiac fibrosis around infarction border and significantly decreased protein level of collagen I, collagen III, TGF-β1, MMP-9 in noninfarcted left ventricular free wall tissue after MI. Moreover, the plasma level of hs-CRP, NE and NT-proBNP in LL-TS group was significantly lower than MI group from the 7th day to the end of follow-up.

Conclusions:
Chronic intermittent low-level transcutaneous electrical stimulation of the auricular branch of the vagus nerve can attenuate left ventricular remodeling and improve cardiac function in conscious dogs with healed myocardial infarction.
Abstract 11539: Impact of Adipose Tissue Composition on Cardiovascular Risk Assessment
Authors: Kunimura Ayako , Uetani Tadayuki , Kataoka Takashi , Takeshita Masahiro , Harada Kazuhiro , Okumura Satoshi , Shinoda Norihiro , Harada Ken , Kato Bunichi , Kato Masataka , Marui Nobuyuki , Nanki Michio , Matsubara Tatsuaki , Ishii Hideki , Amano Tetsuya , Murohara Toyoaki
Published: July 2021

Background:
Visceral adipose tissue (VAT) , unlike subcutaneous adipose tissue (SAT), has been shown to be highly correlated with cardiovascular risk factors. The aim of this study was to evaluate the predictive value of adipose tissue composition measured by computed tomography for cardiovascular outcome.

Method:
369 consecutive patients without history of cardiovascular disease who underwent 64-slice computed tomography angiography (CTA) were recruited. The ratio of visceral adipose tissue to the total adipose tissue (%VAT) was calculated as VAT/ (VAT + SAT) х 100. Patients were divided into three groups in accordance with tertiles of %VAT (tertile1, <35.1%; tertile2, 35.1 to 45.0%; tertile3, 45.1%≤). The investigated risk factors were hypertension, hyperglycemia, and dyslipidemia. We analyzed the incidence of major adverse cardiac events (MACE), including cardiovascular death, myocardial infarction, and any revascularization.

Result:
The rate of patients who have two or more concomitant risk factors was significantly increased across tertiles of %VAT (p=0.001). During the median follow-up of 1973 days, 96 events occurred. Event-free survival was significantly associated with %VAT tertiles, with worse event-free survival in tertile 3 (log-rank p=0.001). In Cox analysis, the hazard ratio (HR) of %VAT (per tertile) for MACE was 1.39 (95% confident interval [CI] 1.05-1.82, p=0.02). Among patients with tertile 3, HR for MACE was 1.81 (95% CI 1.01-3.23, p=0.045) compared to tertile 1 after adjustment for confounding factors.

Conclusion:
%VAT is independently associated with MACE, indicating that adipose tissue composition is a useful predictor of cardiovascular outcome.
Abstract 11599: Plasma Amino Acid Profiling Identifies Specific Amino Acid Correlations With Cardiovascular Function in Patients With Systolic Heart Failure: Highlighting the Cardio-Hepatic-Skeletal Muscle Axis
Authors: Hakuno Daihiko , Hamba Yasuhito , Toya Takumi , Adachi Takeshi
Published: July 2021

Background:
The heart has close interactions with other organs’ functions and concomitant systemic factors such as oxidative stress, nitric oxide (NO), inflammation, and nutrition in systolic heart failure (HF). Recently, plasma amino acid (AA) profiling as systemic metabolic indicator has attracted considerable attention in predicting the future risk of human cardiometabolic diseases, but it has been scarcely studied in HF.

Methods:
Thirty-eight stable but symptomatic patients with left ventricular ejection fraction (LVEF) <45% and 33 asymptomatic individuals with normal brain natriuretic peptide (BNP) value were registered as the HF and control groups, respectively. We analyzed fasting plasma concentrations of 41 AAs using high-performance liquid chromatography, serum NO metabolite concentration, hydroperoxide and high-sensitivity C-reactive protein measurements, echocardiography, and flow-mediated dilatation. Univariate and stepwise multivariate analyses including potential confounders were subsequently performed in the HF group.

Results:
(1) In the HF group, 17 AAs and two ratios significantly changed compared with those in the control group. (2) Univariate and multivariate analyses revealed that Fischer ratio and five specific AAs, ie, monoethanolamine, methionine, tyrosine, 1-methylhistidine, and histidine have significant correlation with BNP value, LVEF, LV end-diastolic volume index, inferior vena cava diameter, mitral E/e’, and BNP value, respectively (p<0.05). (3) Unexpectedly, further exploratory factor analysis categorized these AAs into hepatic-related (monoethanolamine, tyrosine, and Fischer ratio) and skeletal muscle-related (histidine, methionine, and 1-methylhistidine) factors. (4) Some categorized AAs showed unique correlations with concomitant systemic factors: monoethanolamine, tyrosine, and Fischer ratio with serum NO concentration (p<0.05); histidine with serum albumin (p = 0.0001); and 1-methylhistidine with flow-mediated dilatation (p<0.05).

Conclusions:
Plasma AA profiling identified correlations of specific AAs with cardiac function and concomitant systemic factors and highlighted the cardio-hepatic-skeletal muscle axis in patients with systolic HF.
Abstract 11639: Interpretation of Diastolic Function in Hemodialysis Patients: The Importance of a Load Independent Index of Left Ventricular Diastolic Compliance
Authors: Dubin Ruth F , Alokozai Dean , Shah Sanjiv J
Published: July 2021

Background:
Prior studies of diastolic function in the setting of end-stage renal disease (ESRD) primarily utilize E/e’, a volume dependent measure of left ventricular (LV) filling pressure. While such studies show that high E/e’ is common and associated with adverse outcomes in ESRD, these findings may not be attributable to intrinsic diastolic function. In contrast to E/e’, the LV end-diastolic pressure-volume relationship (EDPVR) (a load independent index of LV diastolic compliance) describes intrinsic LV diastolic function. Therefore, we sought to examine the effects of hemodialysis on EDPVR, and to delineate correlates of EDPVR in the setting of ESRD. We hypothesized that E/e’ and other indices of diastolic function are volume dependent in ESRD, while EDPVR is not.

Methods:
Twenty-nine patients underwent echocardiography directly before and during the last hour of dialysis. LV diastolic compliance was quantified using a single-beat EDPVR method (P = αVβ). The LV end-diastolic volume at an idealized pressure of 20 mmHg (EDV20) was calculated as a means of comparing EDPVR curves within and between patients (smaller EDV20 = lower diastolic compliance).

Results:
During hemodialysis, EDV20 did not significantly change (median [IQR] pre-dialysis EDV20 112 [93-113] ml; intra-dialysis EDV20 113 [94-138] ml; p=0.2). However, E/e’ decreased on average by 1.2 absolute units (AU) (median [IQR] pre-dialysis 7.0 [6.0-8.9] AU; intra-dialysis 6.0 [5.1-9.7] AU; p=0.004). E/e’ decreased by 2 AU for every 1 L/hr ultrafiltration rate (p=0.07). Significant correlates of lower pre-dialysis EDV20 (stiffer LV) included higher diastolic blood pressure (DBP) (β=-13 ml EDV20 per 10 mmHg DBP, p=0.005) and concentric LV remodeling, (β=-5ml EDV20 per 0.1 g/ml LV mass/volume ratio, p=0.004). NT-proBNP was associated with higher E/e’, (β=0.2 E/e’ per 1000 pg/ml higher NT-proBNP, p<0.001), but was not a significant correlate of EDV20 (p=0.5).

Conclusions:
LV end-diastolic compliance (EDV20) is less volume dependent than LV filling pressures (E/e’) in the setting of ESRD, and thus may be a better measure of intrinsic diastolic function than E/e’. Further studies are needed to determine whether EDV20 predicts adverse outcomes in the ESRD population.
Abstract 11651: Results of the LIMBS Study: Yoga, Alone or in Combination With Other Lifestyle Measures Reduces BP in Untreated Prehypertension and Stage 1 Hypertension
Authors: Cohen Debbie L , Bowler Anne , Townsend Raymond R
Published: July 2021

Introduction:
Hypertension affects 1 in 3 adults in the US. Alternatives to drug therapy in mild hypertension are sought by patients preferring to avoid life long medication. Yoga is increasingly popular and potentially an alternative to chronic medication use.

Methods:
Based on pilot data we conducted an NIH funded study to assess the effects of yoga alone, or with dietary intervention, on BP reduction in subjects with prehypertension and stage 1 hypertension in untreated, healthy, yoga naive adults. Subjects were randomized to 1 of 3 treatment groups for 24 weeks: Group 1 (Yoga): yoga practice in a yoga studio 2-3 x per week. Group 2 (Diet): supervised diet/weight reduction and walking program. Group 3 (Combo): Combination program of both yoga and dietary intervention. Subjects had inpatient 24 hour ambulatory BP monitoring performed at baseline, 12 and 24 weeks.

Results:
The study enrolled 137 subjects and 87 subjects completed the protocol. Results of the study and within group BP changes are shown in the Table below. Results are expressed as mean (SD) or (95% CI). Data is presented for all enrolled subjects and an intention to treat analysis was performed using least square means differences.

Between group changes in SBP between Yoga and Diet from baseline to 12 weeks were (Δ 1.4 mm Hg, p 0.0073) and between Diet and Combo (Δ 1.56 mm Hg, p = 0.0021) favoring Yoga and Combo groups over Diet alone at 3 months. Differences were no longer significant at 6 months. There was no difference between Yoga and Combo groups at any time period.

Conclusions:
SBP and DBP were significantly reduced within all 3 groups at 3 and 6 months. The changes in SBP were significantly greater with yoga alone or with yoga combined with diet at 3 months compared with diet alone. This supports the use of yoga, alone or in combination with other lifestyle measures in reducing BP in prehypertension and stage 1 hypertension.
Abstract 11655: Long Term Cardiovascular Mortality After Radiotherapy for Breast Cancer: A Meta-Analysis
Authors: Sardar Partha , Chatterjee Saurav , Nohria Anju , Nairooz Ramez , Meier Pascal , Bangalore Sripal , Mukherjee Debabrata , Lavie Carl J
Published: July 2021

Introduction:
Cardiovascular disease (CVD) is a late complication of radiotherapy (RT); the mean cardiac dose from irradiation of a left-sided breast cancer is much higher than that for a right-sided breast cancer. However, there is limited knowledge regarding the long-term risk of RT on CVD mortality. This study sought to investigate the use of RT for breast cancer and its association with CVD mortality, in the context of the laterality of breast cancer.

Hypothesis:
Long term cardiac mortalty with left-sided breast cancer radiotherapy is much higher than that for a right-sided breast cancer.

Methods:
Databases were searched from their inception through December 2013. Studies reporting CVD mortality with left versus right sided breast RT were included. Two authors reviewed the studies, abstracted the data and checked for accuracy, quality and strength of evidence. The outcome of interest was CVD mortality. We calculated summary risk ratio (RR) and 95% confidence intervals (CI) with the random effects model.

Results:
The analysis included 289,109 patients from 13 observational studies. Women, who had received RT for left-sided breast cancer, had a higher risk of CVD death than those who received RT for a right-sided breast cancer (RR 1.12, 95% CI: 1.07 to 1.18). Difference in CVD mortality between left versus right breast RT was more apparent after 15 years of follow up (RR 1.23, 95% CI: 1.08 to 1.41).

Conclusions:
Mortality from CVD with left sided RT was significantly higher compared to right sided RT for breast cancer; this difference was more apparent after at least 15 years of follow up.