bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4956: A Risk Stratification Analysis of Predictors of Death or Transplant in Children with Hypertrophic Cardiomyopathy
Authors: Lipshultz Steven E , Orav E J , Wilkinson James D , Towbin Jeffrey A , Messere Jane , Lowe April M , Clunie Sarah K , Cox Gerald F , Lurie Paul R , Hsu Daphne T , Canter Charles E , Colan Steven D
Published: July 2021

We previously reported initial results from a univariate analysis of baseline predictors of death or heart transplant in children with hypertrophic cardiomyopathy (HCM). We present here the final multivariate analysis resulting in risk stratification rules for 6 HCM etiologic subgroups in children. The Pediatric Cardiomyopathy Registry collected longitudinal data on 882 children with HCM from 1990 –2003. The primary outcome was the earlier of death or heart transplantation. Cox regression was used to identify the 3 most important risk factors at time of diagnosis for each HCM subgroup; all echo measures were expressed as z-scores. Multivariate analysis revealed that children with idiopathic HCM diagnosed by 1 year were at higher risk of poor outcome if they had CHF, low BSA, or elevated LV mass, while risk factors for children diagnosed after 1 year were female gender, depressed fractional shortening, and elevated wall thickness. Risk factors for children with malformation syndrome were Black race, CHF and increased wall thickness; Black race, younger age, and elevated LV mass for children with inborn errors of metabolism; younger age, CHF, and increased wall thickness for children with mixed restrictive HCM; and decreased weight, family history of heart disease, and increased wall thickness for children with mixed dilated HCM. Children with multiple risk factors present at diagnosis had a significantly worse prognosis compared to those with 0 or 1 risk factors. (Figure

) Based on etiologic subtype and number of risk factors present at diagnosis, clinicians can reliably estimate the risk of death of transplant in children with HCM.
Abstract 5659: Regular Atrial Tachycardias After Ablation Of Complex Fractionated Atrial Electrograms (CFAE) For Atrial Fibrillation: Acute Incidence And Recurrence In Clinical Follow-up
Authors: Reents Tilko , Hessling Gabriele , Fichtner Stephanie , Wu Jinjin , Estner Heidi L , von Bary Christian , Karch Martin R , Deisenhofer Isabel
Published: July 2021

Background: The catheter ablation of atrial fibrillation (AF) can be performed by ablation of complex fractionated atrial electrograms (CFAE). Endpoint of CFAE ablation is the regularisation or termination of AF. However, the impact of regular atrial tachycardia (AT) occurring during CFAE ablation on long term outcome has not been investigated. Thus, it is not clear whether these tachycardias should be acutely targeted for ablation.

Methods: In 43 patients (31 male, age 62±9 years with paroxysmal (15 patients), persistent (25 patietns) or permanent AF (3 patients) organisation of AF to regular AT was achieved by ablation of CFAE. Mapping of AT with subsequent successful ablation was performed in 14/43 patients (33%), in the remaining 29/43 patients (67%) AT was terminated with external cardioversion or pace overdrive. After ablation procedure, patients were seen in our out-patient clinic with repetitive Holter ECG after 1, 3, and subsequently every 3 months and were intensively screened for the occurrence of regular AT.

Results: In follow-up 22/43 patients (51%) developed sustained AT necessitating in 20 patients repeat catheter ablation (12 patients) or external cardioversion (8 patients). AF had been paroxysmal in 7/22 and persisten in 15/22 patients with AT in follow-up. In 14/22 patients (63%), no attempt for ablation of AT had been made during the initial procedure, in 8/22 AT (36%) had been mapped and initially successful ablated. Of 21 patients without AT occurrence during follow-up, AF had been paroxysmal in 8/21 and persistent or permanent in 13/21 patients. AT had been mapped and ablated in 6 (29%) whereas in 15/21 patients (71%), AT had not been targeted. Ablation of AT during initial procedure, number of ablation applications, procedure and fluoroscopy duration were not predictive for freedom of AT in follow-up.

Conclusion: In our study, mapping and successful ablation of new onset regular atrial tachycardias (AT) occurring during ablation of CFAE for atrial fibrillation was not predictive for the occurrence of AT in follow-up. Thus, results after termination of AT by cardioversion was in long-term comparable to sometimes time-consuming mapping/ablation for AT.
Abstract 5661: Three-Dimensional Reconstructions of Left Atrium and Pulmonary Veins based on Intraprocedural C-Arm Rotational Angiography in Comparison to Electroanatomical Mapping: Integration of a Novel Modality into Atrial Fibrillation Ablation
Authors: Noelker Georg , Asbach Stefan , Gutleben Klaus Juergen , Sinha Anil , Ritscher Guido , Marschang Harald , Rittger Harald , Marrouche Nassir , Brachmann Johannes
Published: July 2021

Preprocedural imaging and its integration into electroanatomical mapping (EAM) is commonly used in atrial fibrillation (AF) ablation. However, intraprocedural imaging based on rotational angiography (DynaCT Cardiac) may be superior in terms of actuality and may lead to an improved work-flow. Feasibility of integrating Dyna CT Cardiac into EAM has not yet been shown. In 23 patients (62±7 years, 16 male) undergoing catheter ablation of paroxysmal (n=10) or persistent (n=13) AF, we intraprocedurally performed rotational angiography enhanced by contrast agent applied to the pulmonary artery with offline segmentation of left atrium (LA) and pulmonary veins (PV). Fig 1

depicts reconstructed LA and PV-anatomy directly importet into CARTOMerge. Distances between the 2 modalities were analyzed. Direct image integration of prereconstructed 3D-anatomy was feasible in all patients. Procedure time was 156 ± 24 minutes including 11 ± 3 minutes for DynaCT Cardiac registration and segmentation. 132 ± 74 mapping points were taken. Mapping points deviated to intraprocedural DynaCT Cardiac 3D-reconstructions by 2.2 ± 0.4 mm (2.3 ± 0.5 mm in patients suffering from paroxysmal atrial fibrillation (AF) vs. 2.1 ± 0.40 mm persistent AF, n.s.). No complications occured. Integration of intraprocedural Dyna CT Cardiac into EAM was feasible and fast. The work-flow seemed to be improved by avoiding additional preprocedural imaging. The novel modality is highly accurate in comparison to EAM.
Abstract 5662: Comparative Ablation Analysis in a Swine Intracardiac Model: Lesion Effectiveness of Ablation Within the Therapeutic Range of 2 Irrigated, One Non-irrigated and one Cryoablation Catheter
Authors: Robichaux Robert , Teplitsky Liane , Carter Heath B , Blackstone Michael , Dosdall Derek , Osorio Jose , Killingsworth Cheryl , McElderry H. T
Published: July 2021

Lesion characteristics including size and transmurality are important factors in the creation of conduction block with respect to catheter ablation. The energy required to create safe and effective lesions may vary from one ablation system to another. Understanding the differences in this energy requirement could allow the operator to titrate the appropriate therapy with each system - generating successful outcomes while minimizing complications. Twenty-two swine underwent an acute ablation procedure whereby 4 lesions were placed with a different catheter in each of the following areas: the left atrium (LA), along the cavo-tricuspid isthmus (CVI) and in right atrial tissue (RA). Four ablation catheters were studied: an 8mm cryoablation catheter, an 8mm standard RF catheter, a 2.5mm insulated open irrigated catheter, and a 3.5mm open irrigated RF catheter. Energy was applied for 30s with the RF catheters and 120sec with cryo, within the therapeutic range for that catheter. Lesion size, RF/Cryo characteristics, popping and other adverse events were recorded. One hundred sixty-three lesions were analyzed. There was no statistical difference between the lesion volumes created by each catheter. The lesion characteristics of the catheters are shown in Table 1

. Transmurality ranged from 75–90% with a trend toward greater transmurality with the 2.5mm irrigated catheter group. There was no evidence of tissue popping or other adverse events. These catheters when used within the therapeutic range on average created similar volume lesions but with wide variation. Cryoablation tended to create the largest lesions but was less likely to be transmural, while the 2.5mm catheter was most likely to deliver transmural lesions.

Catheter comparison
Abstract 5709: The Pediatric Cardiac Quality of Life Inventory: A New Reliable and Valid Disease-specific Quality of Life Measure for Children and Adolescents with Congenital and Acquired Heart Disease
Authors: Marino Bradley S , Tomlinson Ryan , Wernovsky Gil , Drotar Dennis D , Hart Kim W , Buchakjian Elaine , Khoury Philip R , Baker Aimee , Coughlin Kaleigh , Shera David , Newburger Jane , Mahony Lynn , Mussatto Kathleen , Tong Elizabeth , Cohen Mitchell , Wray Jo , Gaynor James W , Helfaer Mark A , Kazak Anne E , Shea Judy A
Published: July 2021

The Pediatric Cardiac Quality of Life Inventory (PCQLI) is a self-administered disease-specific quality of life (QOL) tool with patient and parent-proxy reporting (Child form 8 –12 yrs; Adolescent form 13–18 yrs), designed to assess the QOL of pediatric patients with congenital and acquired heart disease (CHD, AHD). Our purpose was to evaluate the reliability and validity of the PCQLI Seven centers recruited CHD and AHD patients age 8 –18 yrs. Patient-parent pairs completed the PCQLI, a generic QOL tool (PedsQL), and non-QOL questionnaires [Self Perception Profile for Children/Adolescents (SPPC/A); Youth Self Report and Child Behavioral Checklist (Achenbach)]. Test-retest reliability was evaluated by administering the PCQLI at 2 time points, and was assessed by Spearman correlation coefficient. Validity was tested by assessing:

differences in PCQLI score among heart disease subgroups;

associations between PCQLI score and the number of cardiac surgeries, catheterizations, hospitalizations, and doctor visits;

the correlation between patient and parent PCQLI scores; and

correlations between PCQLI score and the scores generated by generic QOL and non-QOL tools.

The study was completed by 1486 patient-parent pairs. Heart disease subgroups included: biventricular repair (45.4%); Fontan palliation (12.6%); unrepaired CHD (12.0%); heart transplant (4.4%); and AHD (25.6%). Correlations evaluating test-retest reliability were high (r=0.78 – 0.90). Lower PCQLI score was associated with Fontan palliation (p<0.001), as well as a greater number of cardiac surgeries, catheterizations, hospitalizations, and doctor visits (all p<0.001). Disattenuated correlations between patient and parent PCQLI scores were moderate (r = 0.51– 0.69). The PCQLI score and generic QOL score were highly associated (r = 0.62– 0.77). Lower PCQLI score was strongly associated with lower Global Self-Worth score on the SPPC/A (p<0.001), and lower Total Competency score (p<0.001), higher Syndrome Scale scores, and higher DSM Oriented Scale scores on the Achenbach (p<0.001). The PCQLI is a new disease-specific pediatric cardiac QOL tool that produces reliable and valid scores in children and adolescents age 8 –18 yrs.

This research has received full or partial funding support from the American Heart Association, AHA Great Rivers Affiliate (Delaware, Kentucky, Ohio, Pennsylvania & West Virginia).
Abstract 5715: Development Of A Temporary Lead For In Utero Pacing: A New Approach For Cardiac Interventions In Fetuses
Authors: Boudjemline Younes , Rosenblatt Jonathan , Bonnet Damien , Jouannic Jean-Marie
Published: July 2021

Background: Cardiac fetal intervention has been applied to human. It is presently limited to

the dilatation of obstructive valvular diseases and

the creation or dilatation of atrial septal defect in fetuses with hypoplastic left heart syndrome and restrictive atrial septal defect.

In this study, we propose a new application of fetal intervention represented by fetal pacing using a specially designed implantable pacing lead in the fetal lamb.

Methods and results: In twelve pregnant ewes (110 –112 days’ gestation), a 17 Gauge needle was placed in contact with cardiac chambers under echo-guidance. Using the lumen of the needle, a 3Fr unipolar pacing lead was advanced and fixed on the cardiac wall using a built-in screw. Pacing was, then, attempted using an external pacing system. Assessment of pacing was confirmed using ultrasound modalities. Pacing lead insertion was successful and uncomplicated in all 15 attempts (atrial and/or ventricular wall respectively n=3 and12) excepted one. In the first fetus, the needle was advanced too far into the right ventricle leading to pericardial bleeding after the retrieval of the needle. The fetal heart rate was overdriven in all at 220/min using the lead. After assessment, pacing lead was unscrewed and retrieved without any complication. Pregnancy was electively interrupted in 6 animals. The other six fetuses were delivered vaginally after an uneventful pregnancy and autopsy at day 3 did not show any significant injury.

Conclusion: Echo-guided fetal pacing is feasible using a specially designed lead. It enlarges present indications of human fetal cardiac interventions.
Abstract 5716: Should We Treat Hyperuricemia in Adult Patients With Cyanotic Congenital Heart Disease?
Authors: Yamamura Hideshi , Inai Kei , Shinohara Tokuko , Tomimatsu Hirofumi , Mori Yoshiki , Nakanishi Toshio
Published: July 2021

Background:
Although hyperuricemia is common, it is thought that gouty arthritis is rare in adult patients (pts) with cyanotic congenital heart disease (CCHD). However, the actual frequency of hyperuricemia and gout has not been documented. Furthermore, whether hyperuricemia should be treated remains undetermined. This study investigated

the incidence of hyperuricemia and gout,

risk factors for hyperuricemia and gout, and

whether the use of allopurinol decreases the incidence of gout in adult patients with CCHD.

Methods:
We studied 92 pts with CCHD, including 19 pts with Eisenmenger syndrome (mean age: 33±11 years of age, ranging from 15 to 61), M/F = 48/44) (CCHD group). Comparative data was obtained from 210 acyanotic CHD pts after biventricular repair (mean age: 31±11 years, ranging from 15 to 83, M/F = 98/112) (ACHD group). Hyperuricemia was defined as serum uric acid (UA) > 7.0mg/dl. The risk factors studied were: age, gender, RBC counts, hemoglobin, hematocrit, oxygen saturation, serum creatinine, glomerular filtration rate, cardiothoracic ratio, brain natriuretic peptide and medications, including diuretics, beta-blocker and aspirin.

Results:
Prevalence of hyperuricemia was 76% in the CCHD group and 24% in the ACHD group. Logistic regression analysis demonstrated that variables that significantly influence hyperuricemia were; hemoglobin over 18g/dl (odds ratio 6.2), oxygen saturation less than 90 (OR 4.8), the use of diuretics (OR 4.0), and serum creatinine higher than 1.0 mg/dl (OR 2.0). Gouty arthritis was observed in 16% in the CCHD group and only 1% in the ACHD group. The prevalence of hyperuricemia and gout in the CCHD group was significantly higher than that in the ACHD group. Of 92 pts in the CCHD group, allopurinol was administered to 37 pts for gout prophylaxis. Of 55 pts without allopurinol, 13 (24%) suffered from gout. In contrast, only 2 of 37 pts (5%) on allopurinol developed gout and the incidence was significantly lower than that in pts without allopurinol.

Conclusion:
These data suggest that in adult patients with CCHD,

the incidence of gout is high,

desaturation, polycytemia, impaired renal function, and the use of diuretics are risk factors for hyperuricemia and gout, and

hyperuricemia should be treated with medication.
Abstract 5728: Abrupt Early Intraventricular Septal Motion In Not Passive But Active In Left Bundle Brunch Block
Authors: Furugen Azusa , Matsuda Naoki , Shiga Tsuyoshi , Yagishita Daigo , Mochida Asako , Ashihara Kyomi , Shoda Morio , Ishizuka Naoko , Hagiwara Nobuhisa
Published: July 2021

Abnormal early septal motion observed in patients with left bundle brunch block (LBBB) has been explained as a difference in right-to-left ventricular pressure. The interventricular septum was thought to be displaced passively into the LV because the right ventricle contracts prior to the LV and the right ventricular pressure exceeds the LV pressure during early systolic phase. Assuming that this theory is right, the interventricular septal wall would be stretched and shown positive strain value in circumferential and longitudinal directions during early systolic phase. We investigated the mechanism of the early septal motion with LBBB using speckle tracking imaging (STI).

Methods:
Systolic septal motion on the middle LV portion level was analyzed in 44 patients with complete LBBB (mean QRS duration 166 ± 35 ms) using M-mode echocardiography and speckle tracking imaging (STI). Time from onset of QRS configuration to peak circumferential strain and longitudinal strain were measured in parasternal short axis and apical views by STI. Furthermore, 20 healthy individuals (mean QRS duration 84 ± 6 ms) were also analyzed. Changes in LV pressure and septal strain were simultaneously measured to evaluate the relationship between them in 6 patients with LBBB.

Results:
Septal displacement into the LV was early and abrupt on M-mode echocardiograms from all patients with LBBB. During this displacement, the STI of the interventricular septum of all patients showed negative strain in both the circumferential and longitudinal directions. Furthermore, early septal displacement almost coincided with peak negative strain. Time to peak septal strain in LBBB patients was significantly shorter than in normal controls in the circumferential (296 ± 80 vs. 356 ± 30 ms; p < 0.05) and longitudinal (317 ± 104 vs. 369 ± 17 ms; p < 0.05) directions. The peak of septal negative strain was followed by an increase in LV pressure in all patients.

Conclusion:
Early motion of the interventricular septum is provoked by its active contraction in LBBB. The septal contraction starts very early and almost isotonically toward a very low load. However, further shortening is suppressed by a subsequently increased load of pressure elevation due to the contraction of other LV segments.
Abstract 5750: Protruding Atheroma in the Thoracic Aorta Detected by Multislice Computed Tomography Can Predict the Future Vascular Events
Authors: Takeda Yoshihiro , Hoshiga Masaaki , Morinaga Izumi , Junko Hotchi , Fujisaka Tomohiro , Yuki Takahito , Tatsugami Fuminari , Tanigawa Jun , Ishihara Tadashi , Hanafusa Toshiaki
Published: July 2021

(Purpose) Protruding atheroma in the thoracic aorta (PATA) has been reported to be associated with coronary artery disease and future embolic disease in previous studies using transesophageal echocardiography. Recently multislice computed tomography (MSCT) has been available for the diagnosis of coronary artery disease and it can also detect PATA. The clinical impact of PATA detected by MSCT has not been examined. The purpose of this study was to investigate whether the presence of PATA by MSCT can predict future vascular events (coronary revascularization (CR) and embolic events).

(Methods) From November 2005 to March 2008, 511 consecutive patients (male 56%, age 66±11y.o.) with suspected ischemic heart disease underwent MSCT. The exclusion criteria were atrial fibrillation, renal insufficiency, or a history of CR or cardiothoracic surgery. According to the aortic plaque thickness, we divided patients into 3 groups: Group 1 (<2mm, n=332), Group 2 (2– 4mm, n=146), Group 3 (>4mm, PATA, n=33).

(Results) Risk factors were: hypertension (68%), diabetes (41%), hypercholesterolemia (57%), and smoking (44%). During follow-up period (15.6-month median), CR was required for 68 patients (59 PCI and 9 CABG). Univariate analysis showed that the patients required for CR were of significantly higher prevalence of all the risk factors, aortic plaque (Group 2, 3) and calcification of coronary artery, aortic and mitral valve. Multivariate analysis showed that requirement of CR was independently associated with aortic plaque, smoking, or coronary calcification, and PATA revealed the highest odds (odds ratio 7.4, 95% confidence interval 3.1 to 17.6) among them. Embolic events occurred in 7 patients (5 brain, 1 bowel, and 1 kidney and lower extremity) during follow-up period. By univariate analysis, only smoking and PATA revealed significantly higher prevalence in patients with embolic events (p=0.02 and<.0001, respectively). Multivariate analysis showed that PATA was an independent predictor for future embolic events (odds ratio 10.7, 95% confidence interval 1.6 to 70.4).

(Conclusions) PATA detected by MSCT can predict future vascular events. We should be aware of the presence of PATA by MSCT as a risk for the future cardiovascular events.
Abstract 014: Predictors of Coronary Heart Disease Risk Among Postmenopausal Women with Rheumatoid Arthritis
Authors: Mackey Rachel H , Kuller Lewis H , Tracy Russell P , Chang Yuefang , Deane Kevin D , Holers V. Michael , Walitt Brian T , Robinson William H , Moreland Larry W
Published: July 2021

Background:
Reasons for increased CHD in rheumatoid arthritis (RA) remain unclear. We conducted a prospective CHD nested case-control study among postmenopausal women with RA in the Women's Health Initiative (WHI) to test hypotheses that CHD was associated with: 1) traditional risk factors, including lipoproteins, 2) inflammatory & coagulation markers, and 3) serological (rheumatoid factor, (RF)) and genetic (the HLA-DRB shared epitope (SE)) markers of RA.

Methods:
At baseline, of the 161,808 WHI participants aged 50-79, 16,461 (10.2%) reported RA. Chart-review in 2 centers documented that the positive predictive value for probable RA was only 15% for self-reported RA but was 62% when combined with self-reported use of disease-modifying anti-rheumatic drugs (DMARDs). To further improve classification, we measured anti-cyclic citrullinated peptide-2 antibody (anti-CCP2), a marker that is >95% specific for RA, on 9,988 (66%) of white, black, or Hispanic WHI participants with reported RA. Probable RA was defined as self-report plus DMARD use or anti-CCP positivity (+). Among 1423 probable RA cases we sampled 116 CHD cases that occurred during ∼ 10 years of follow-up, and controls matched 1:1 on age, anti-CCP positivity (+/−), and WHI component: Clinical Trial vs. Observational Study. We measured lipoproteins by NMR spectroscopy, sVCAM-1, sICAM-1, CRP, fibrinogen, D-dimer, and RF by immunoassay, and HLA-DRB shared epitope (SE) by Luminex/PCR. Odds ratios were calculated using conditional logistic regression.

Results:
Among women with probable RA (
Table
), in separate models, CHD was associated with hypertension, lipoprotein particles (higher total and small LDL, large VLDL, and lower large HDL), and higher CRP, sICAM-1, sVCAM-1 and fibrinogen; however, only lipoproteins were significant. D-dimer, RF+, and S.E. were not associated with CHD.

Conclusion:
Among postmenopausal women with RA, modifiable risk factors, particularly lipoproteins, predicted CHD, emphasizing the potential for CHD prevention in this group.

Predictors of CHD Among Women in the WHI With Probable RA*, n=116 CHD Case/Control Pairs

Predictor (log unit or indicated)
OR
(95% CI)

Hypertension (y/n)
1.45
(0.86, 2.45)

Small LDL-P
1.41
(1.10, 1.81)

Total LDL-P
5.12
(1.74, 15.00)

Large HDL-P
0.47
(0.26, 0.86)

Large VLDL-P
1.40
(1.10, 1.77)

CRP
1.26
(0.99, 1.61)

Fibrinogen
1.66
(0.49, 5.57)

sVCAM-1
1.43
(0.55, 3.69)

sICAM-1
1.99
(0.88, 4.53)

D-dimer
1.12
(0.83, 1.51)

RF (+/−)
1.18
(0.62, 2.23)

#HLA-DRB S.E. (1, 2 vs. 0)
0.74
(0.42, 1.29)

Models adjusted for hypertension, smoking, lipid-lowering and DMARD use. Predictors log-transformed unless indicated
Abstract 016: Sugar-Sweetened Beverage Consumption is Inversely Associated with Coronary Flow Reserve among Male Middle-Aged Twins
Authors: Eufinger Silvia C , Vaccarino Viola
Published: July 2021

Introduction:
Several previous studies have reported a link between sugar-sweetened beverage (SSB) consumption and numerous cardiovascular disease (CVD) risk factors including hypertension, dyslipidemia, and obesity. However, our understanding of how SSB consumption affects cardiovascular function remains limited. We sought to investigate the association between SSB consumption and coronary flow reserve (CFR), a measure of overall coronary vasodilator capacity and microvascular function.

Hypothesis:
Increased SSB consumption is associated with lower CFR.

Methods:
A sample of 320 male middle-aged twins, including 128 monozygotic and dizygotic twin pairs and 64 unpaired twins, with no previous history of coronary heart disease (CHD) and diabetes, was recruited from the Vietnam Era Twin Registry. All twins underwent comprehensive cardiovascular assessments and completed the Willett food-frequency questionnaire. Reported intakes of fruit drinks, regular carbonated beverages with sugar, low-calorie carbonated beverages with sugar, and other SSBs were used to derive habitual daily SSB consumption for the previous 12 months. Positron emission tomography [N
13
] ammonia with quantitation of myocardial blood flow at rest and after adenosine stress was used to measure CFR. Mixed-effect regression analysis was used to examine the association between SSB consumption and CFR both at the individual level and between and within twin pairs. Potential confounders included demographic characteristics, lifestyle factors (including physical activity), traditional CVD risk factors, total energy intake, and other nutritional factors such as intake of cholesterol, fiber, sodium, alcohol, and saturated, monounsaturated, and polyunsaturated fatty acids.

Results:
The mean age of the twins was 55 years (SD = 3.2) and 94.4% (302 out of 320) were white. Across quintiles of twins consuming less than 2 SSBs per day, 2 to less than 4, 4 to less than 6, 6 to less than 8, and 8 or more, adjusted geometric mean CFR measurements were, respectively, 2.49, 2.45, 2.43, 2.37, and 2.18 (
P
= 0.032 for linear trend) with the top quintile having a 12.4% lower CFR than the bottom quintile. The inverse association observed at the individual level persisted between-pairs (
P
= 0.042), but was substantially reduced and no longer significant within twin pairs. These associations did not differ by zygosity.

Conclusions:
SSB consumption is inversely associated with CFR, a measure of coronary microvascular function, independent of traditional CVD risk factors. However, shared familial factors, such as growing up in the same home environment and adopting parental behaviors throughout youth and adolescence, may mediate the association between SSB consumption and CFR. Our study supports the importance of early-life, family-level interventions to promote healthy eating and improve cardiovascular health.
Abstract 017: A Prospective Study of Eating Habits and Incident Coronary Heart Disease in a Cohort of Male U.S. Health Professionals
Authors: Cahill Leah E , Chiuve Stephanie E , Mekary Rania A , Jensen Majken K , Flint Alan J , Hu Frank B , Rimm Eric B
Published: July 2021

Introduction:
The 2010 Dietary Guidelines for Americans concludes that there is currently not enough evidence to support a specific recommendation for behaviors such as snacking and frequency of eating, but does recommend eating breakfast daily to prevent obesity, especially for children and adolescents. Among adults, skipping meals has been shown to be positively associated with excess weight, dyslipidemia, hyperglycemia, and total mortality. However, the influence of eating frequency on risk of coronary heart disease (CHD) remains unclear. Objective and Hypothesis: The objective of this study was to test the hypothesis that abnormal eating habits are related to an increased risk of fatal CHD and non-fatal myocardial infarction.

Methods:
Eating frequency (meals and/or snacks per day), breakfast consumption (yes or no) and eating after going to bed at night (yes or no) were assessed in 1992 in 35,221 men from the prospective Health Professionals Follow-up Study. Between 1992 and 2008, 2761 incident CHD cases were diagnosed. Multivariate Cox proportional hazards regression models were used to estimate relative risks (RR) and 95% confidence intervals (CI) for these eating habits.

Results:
Men who ate <3 times/day, compared to the men who ate 3 times/day, had a 22% higher risk of CHD (
table
). Men who skipped breakfast had a significant 18% higher risk of CHD compared to men who ate breakfast. Those who reported eating after going to bed had a 34% higher risk of CHD compared to the men who did not.

Conclusions:
Even when controlling for known CHD risk factors including diet quality, general infrequent eating was associated with increased CHD risk, as were skipping breakfast and eating after bedtime.

Table

Multivariate
*
RR and 95% CI of CHD by categories of eating habit

Cases (n)
Person Years
Age-RR (95% CI)
MV-RR (95% CI)
p (trend)

Eating Frequency

< 3 times/day
503
85,920
1.26 (1.14-1.40)
1.22 (1.08-1.37)
0.01

3 times/day
1222
217,400
1.00 (Ref)
1.00 (Ref)

> 3 times/day
1036
191,974
1.08 (0.99-1.17)
0.98 (0.90-1.07)

Breakfast Eating

Yes
2164
380,491
1.00 (Ref)
1.00 (Ref)
0.005

No
597
114,802
1.28 (1.16-1.40)
1.18 (1.06-1.31)

Eating After Bedtime

Yes
49
5,515
1.64 (1.23-2.17)
1.34 (1.00-1.79)
0.0009

No
2712
489,531
1.00 (Ref)
1.00 (Ref)

*

Adjusted for: smoking status, race, diabetes, parental MI before 60 years of age, hypercholesterolemia, hypertension, aspirin use, multivitamin use, alternative Healthy Eating Index score, alcohol intake, total energy intake, BMI, and physical activity.
Abstract 022: Atrial Fibrillation and Cognitive Decline: The Cardiovascular Health Study
Authors: Thacker Evan L , McKnight Barbara , Psaty Bruce M , Longstreth W. T , Sitlani Colleen M , Arnold Alice M , Fitzpatrick Annette L , Dublin Sascha , Gottesman Rebecca F , Heckbert Susan R
Published: July 2021

Objective.
We sought to determine whether atrial fibrillation (AF) was associated with cognitive decline in the absence of stroke.

Methods.
We included Cardiovascular Health Study participants aged 65+ who did not have AF or prior stroke at baseline and had at least one Modified Mini-Mental State Examination (3MSE) during the study. AF was identified by hospital discharge diagnoses and annual study ECGs. The 3MSE (score range 0–100) was administered annually up to nine times from 1990/91 to 1998/99. Mixed effects linear regression was used to characterize the relationship of cognitive decline with AF and age, adjusted for birth year, sex, race, education, smoking, alcohol use, diabetes, hypertension, systolic blood pressure, coronary heart disease, and heart failure. Interaction terms for AF and age variables with incident clinical stroke were used to allow estimation of cognitive decline in the absence of stroke.

Results.
Analyses included 5,199 participants with a mean of 6.7 3MSE scores. During follow-up 11% of participants (554 of 5,199) had AF identified. Panel A of the Figure shows mean 3MSE score trajectories for participants without AF (solid line) and after AF was identified at ages 70, 75, 80, and 85 (dashed lines). Panel B shows the trajectory for participants without AF set to zero (solid horizontal line) and differences in mean trajectories after AF was identified relative to participants without AF (dashed lines). Gray shading shows 95% CIs. Having newly-identified AF was not associated with a difference in 3MSE score relative to participants of the same age without AF. However, after AF was identified, 3MSE scores declined 2.3 points faster per five years, relative to participants without AF. For example, after AF was identified at age 80, mean 3MSE score declined 9.1 points by age 85, versus 6.8 points for participants without AF.

Conclusions.
In older adults without clinical stroke, the average rate of cognitive decline was greater after AF was identified.
Abstract 036: The Association between Mid-Life Cardiorespiratory Fitness and Dementia in Later Life
Authors: DeFina Laura , Willis Benjamin , Gao Ang , Radford Nina , Leonard David , Berry Jarett
Published: July 2021

Introduction:
Prior literature suggests that higher levels of physical activity are associated with a lower risk for Alzheimer disease and related dementias (ADRD). However, the association between cardiorespiratory fitness (CRF) in healthy, middle aged adults and ADRD decades later in older age has not been studied.

Methods:
We included 20,195 participants (21.0% female, mean age 49.8 years, and free of vascular disease at baseline) enrolled in the Cooper Center Longitudinal Study (CCLS) between 1970 and 2009. CRF was measured by modified Balke protocol and treadmill time was used to estimate metabolic equivalents (METs) and to stratify CRF into low-, intermediate-, and high-fit categories. Baseline data from the CCLS were matched with Medicare administrative claims data from the Center for Medicare and Medicaid Services (CMS). The primary outcome variable was the diagnosis of ADRD as defined by CMS validated algorithms. We used a Cox proportional hazard model to estimate the association between midlife fitness and the development of ADRD in later life. All models were multivariable-adjusted for age, BMI, hypertension, diabetes, hyperlipidemia, and smoking.

Results:
After more than 120,000 person-years of Medicare exposure, there were 1964 ADRD cases. As expected, we observed marked differences in the age-related prevalence of ADRD (age 70 1.19% vs. age 90 15.68%). In both men and women, higher midlife fitness was associated with a lower risk (per MET) for ADRD decades later [HR 95% CI: 0.96 (0.93–0.99) in men; 0.91 (0.86–0.98) in women]. Findings were similar when fitness was examined according to categories (high vs. low) but with wider confidence intervals in women [0.81 (0.70–0.95) in men; 0.76 (0.57–1.03) in women]. The figure illustrates dementia-free survival by fitness level for men and women.

Conclusions:
Higher mid-life CRF was associated with a lower risk of developing ADRD decades later in older age.
Abstract 050: Fine-mapping and Bioinformatics Characterization of QT Interval Loci in African Americans: The Population Architecture Using Genomics and Epidemiology (PAGE) Study
Authors: Avery Christy L , Sethupathy Praveen , Buyske Steven , He Q. C , Lin Dan Y , Arking Dan E , Duggan David , Fox Ervin R , Anderson Garnet , Deelman Ewa , Fesinmeyer Megan , Hindorff Lucia A , Jeff Janina , Klein Liviu , Patton Kristen K , Shohet Ralph , Sotoodehnia Nona , Young Alicia M , Manolio Teri A , Mohlke Karen L , Whitsel Eric A , North Kari E
Published: July 2021

The QT interval (QT) is a heritable trait and its prolongation is an established risk factor for ventricular tachyarrhythmia and sudden cardiac death. Most genetic studies of QT have examined populations of European ancestry, although the increased genetic diversity in populations of African descent provides opportunity for fine-mapping, which can help narrow association signals and identify candidates for functional characterization. We examined whether eleven previously identified QT loci comprising 6,681 variants on the Illumina Metabochip array were associated with QT in 7,516 African American participants from the Atherosclerosis Risk in Communities study and Women’s Health Initiative clinical trial. Among associated loci, we used conditional analyses and queried bioinformatics databases to identify and functionally categorize signals. We identified nine of the eleven QT loci in African American populations (
P
<0.0045 under an additive genetic model adjusting for ancestry and demographic characteristics:
NOS1AP, ATP1B1, SCN5A, SLC35F1, KCNH2, KCNQ1, LITAF, NDRG4,
and
RFFL
). We also identified two independent secondary signals in
NOS1AP
and
ATP1B1
(
P
< 7.4x10
−6
). Conditional analyses adjusting for published loci in European populations demonstrated that eight of these eleven SNPs (nine primary; two secondary) were independent of previously reported SNPs. We then performed the first bioinformatics-based functional characterization of QT loci using the eleven primary and secondary variants and SNPs in strong LD (r
2
> 0.5) among these African American participants. Only the
SCN5A
locus included a non-synonymous coding variant (rs1805124, H558R, r
2
= 0.7 with primary SNP rs9871385,
P
= 4.7x10
−4
). The remaining ten loci harbored variants located exclusively within non-coding regions. Specifically, three contained SNPs within candidate long-range regulatory elements in human cardiomyocytes, five were in or near annotated promoter regions, and the remaining two were in un-annotated, but highly conserved non-coding elements. Several of the QT risk alleles at these SNPs significantly alter the predicted binding affinity for transcription factors, such as TBX5 and AhR, which have been previously implicated in cardiac formation and function. In summary, the findings provide compelling evidence that the same genes influence variation in QT across global populations and that additional, independent signals exist in African Americans. Moreover, of those SNPs identified as strong candidates for functional evaluation, the majority implicate gene regulatory dysfunction in QT prolongation.
Abstract 057: Increased Incidence of Ischemic Stroke in HIV-Infected Women in a Clinical Care Cohort
Authors: Chow Felicia C , Regan Susan , Feske Steven , Meigs James B , Grinspoon Steven K , Triant Virginia A
Published: July 2021

Introduction:
Coronary heart disease rates are increased among HIV-infected patients compared to control groups, with a relatively greater increase in women compared to men. Whether a similar pattern with respect to gender is true for ischemic stroke is not known. We assessed the hypothesis that the adjusted hazard ratio for ischemic stroke given HIV infection is greater among women compared to men.

Methods:
The study was conducted using data from an HIV observational clinical care cohort at a large Boston-based health care system. A control cohort of non-HIV-infected patients was matched in a 10:1 ratio to the HIV cohort based on age, gender, and race. The observation period was between 1996 and 2009, with right censoring at the initial stroke event or last encounter if prior to 2009. Ischemic stroke events were identified by pre-specified and validated ICD-9-CM codes. Gender-specific stroke incidence rates were calculated. To assess the association of HIV and ischemic stroke within each gender, Cox proportional hazard modeling was employed.

Results:
The cohorts consisted of 4,308 HIV-infected patients (31% women) and 32,423 non-HIV-infected patients (35% women). Among women, ischemic stroke event rates were 5.02 per 1000 person years (PY) in HIV-infected versus 2.31 per 1000 PY in non-HIV-infected patients (40 events in HIV and 177 events in non-HIV) with an unadjusted hazard ratio (HR) of 2.16 (95% confidence interval [CI] 1.53–3.04,
P
<0.001). In contrast, among men ischemic stroke rates were 5.38 per 1000 PY in HIV-infected versus 4.59 per 1000 PY in non-HIV-infected patients (92 events in HIV and 605 events in non-HIV patients) with an unadjusted HR of 1.18 (95% CI 0.95–1.47,
P
=0.14). Comparing HIV-infected to non-HIV-infected patients, incidence rates were significantly increased among women in the 18–29, 30–39, and 40–49 age groups and among men in the 30–39 age group. In a gender-stratified, multivariate regression model adjusting for age, race, hypertension, diabetes, dyslipidemia, smoking, structural heart disease, atrial fibrillation, aspirin use, and warfarin use, the adjusted HR for stroke associated with HIV infection was 1.76 (95% CI 1.24–2.52,
P
=0.002) among women compared with 1.05 (95% CI 0.84–1.32,
P
=0.639) among men.

Conclusions:
Ischemic stroke incidence rates were significantly increased in HIV-infected patients compared to non-HIV-infected patients among young women (< 50) and a subset of young men. HIV infection remained independently associated with stroke among women after adjusting for demographic and traditional stroke risk factors. While further studies are merited investigating causality and potential mechanisms for stroke among HIV-infected women, this group may represent a uniquely at-risk population for accelerated cerebrovascular aging.
Abstract 062: Aortic Stiffness, Blood Pressure Progression and Incident Hypertension: The Framingham Heart Study
Authors: Kaess Bernhard M , Rong Jian , Larson Martin G , Hamburg Naomi M , Vita Joseph A , Levy Daniel , Benjamin Emelia J , Vasan Ramachandran R , Mitchell Gary F
Published: July 2021

Background:
Increased vascular stiffness and excessive blood pressure (BP) pulsatility are important risk factors for age-related morbidity. Vascular stiffness and BP pulsatility are related, with a prevailing view that hypertension antedates and contributes to premature vascular aging and a secondary increase in vascular stiffness. However, temporal relations between comprehensive vascular measures and BP elevation have not been fully delineated in a large community-based sample.

Methods:
We examined longitudinal relations of BP and 3 measures of vascular stiffness and pressure pulsatility derived from arterial tonometry (carotid-femoral pulse wave velocity [CFPWV], forward wave amplitude and augmentation index) over a 7-year period in 1,898 Framingham Offspring participants (mean age 60 yrs, 1,057 women). We also examined relations between measures of microvascular and endothelial function derived from brachial artery Doppler and future progression of BP or vascular stiffness.

Results:
In multivariable-adjusted regression models, baseline tonometry measures were separately and jointly associated with higher systolic and pulse pressure and incident hypertension (
Table
). Conversely, higher baseline BP was associated with higher forward wave amplitude and augmentation index (all p<0.05) but not CFPWV at follow-up. Higher baseline resting brachial artery flow and lower flow-mediated dilation were associated with incident hypertension in models that included BP and tonometry measures (
Table
).

Conclusion:
Higher aortic stiffness (CFPWV), pressure pulsatility (forward wave amplitude), and wave reflection (augmentation index) and lower flow-mediated dilation are associated with blood pressure progression and incident hypertension. Our findings support the notion of aortic stiffness as a precursor of hypertension and further suggest a vicious cycle of increasing pressure pulsatility with advancing age.

Table.

Correlates of incident hypertension.

Predictor Variables (baseline)
OR
95% CI
P

Systolic BP
3.24
(2.17; 4.84)
<0.0001

Diastolic BP
1.47
(1.13; 1.92)
0.0042

CFPWV
1.30
(1.02; 1.67)
0.037

Forward wave amplitude
1.66
(1.32; 2.09)
<0.0001

Augmentation index
1.78
(1.45; 2.17)
<0.0001

Brachial artery baseline flow
1.23
(1.05; 1.45)
0.013

Flow-mediated dilation
0.83
(0.70; 0.98)
0.029

Results of a single multivariable model that further adjusted for age,sex, BMI, height and triglycerides in 1,019 participants free of hypertension at baseline who experienced 337 cases of incident hypertension during follow-up. OR expressed per 1 SD of the independent variable.
Abstract MP011: Effect of a Low-Carbohydrate Versus a Low-Fat Weight Loss Program on Endothelial Function
Authors: Stewart Kerry J , Ouyang Pamela , Silber Harry A , Zakaria Sammy , Desai Dipan , Shapiro Edward P , Dobrosielski Devon A
Published: July 2021

Background:
A concern about low-carbohydrate (CHO) diets is that a higher fat intake may adversely affect vascular health. We hypothesized that the effect of two weight loss programs on endothelial function would be similar. Each program included exercise but differed in that one included a low-CHO diet whereas the other a low-fat diet.

Methods:
Overweight or obese but otherwise healthy persons (n=77), 30–65 years old, were randomly assigned to 6-months of an isocaloric low-CHO or low-fat diet, plus 3 times per week supervised aerobic and resistance exercise training. Endothelial function was assessed with non-invasive peripheral arterial tonometry using the Endopat device. Reactive hyperemia was induced after 5 minutes of upper arm occlusion of SBP. The reactive hyperemia peripheral arterial tonometry index (RH-PAT), the ratio between the digital pulse volume during reactive hyperemia and at rest was measured at baseline and after 6 months, as were body weight, BMI, waist circumference, total body fat and trunk fat percent, and BP.

Results:
Sixty subjects (low-CHO group: n=31,74% women; low-fat group, n=29, 72% women) completed the study. At baseline, there were no group differences in the following variables and the combined values are: age, 50.0±8.7 years; weight, 215.4±32.7 lbs; BMI, 34.2±3.8 kg/m
2
; waist circumference, 103.1±8.7 cm; total body fat, 43.3±7.2%; trunk fat, 46.4±5.7%; SBP, 124.7±13.5 mm Hg; DBP, 74.2±9.5, RH-PAT, 2.32±0.44%. After 6 months, low-CHO versus low-fat subjects had a greater reduction in weight, −28.9±11.0 versus −18.7± 2.0 lbs, p<0.001; BMI, −4.7±2.0 versus −2.9±1.7, p<0.001; waist circumference, −12.1±6.0 versus −6.2±7.8 cm, p<0.01; body fat, −6.8±4.5 versus −4.0±3.9%, p>0.02. The groups did not differ in reduction of trunk fat percent, with an overall loss of − 5.5±5.7%, p<0.001, or BP, overall reduction −10.7±12.1/−8.6±8.2 mm Hg, p<0.001. After 6 months, there was no overall change in RH-PAT, p=0.64. By regression analysis, 6-month RH-PAT, adjusted for the baseline value, did not differ by group. However, an absolute 1% drop in trunk fat percent was associated with an absolute 0.29% (or relative 12.5%) increase in RH-PAT, p=0.05.

Conclusions:
A key finding was the lack of an adverse effect on a marker of endothelial function in the low-CHO group. Successful weight loss and reductions in total and abdominal fat, and BP were achieved with both programs. Greater reductions in weight, BMI, waist circumference, and body fat occurred in the low-CHO group. Though overall endothelial function did not change in either group, when individual variations were examined, a greater percent loss in trunk fat was associated with enhanced endothelial function. These data suggest that loss of central fat is associated with improved vascular health, independent of the dietary content of the weight loss program.