bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 10554: One Year Follow-up After Resuscitated Cardiac Arrest Admitted For Emergency Coronary Angiography: A Prospective, Observational Registry
Authors: DELBAERE QUENTIN , Leclercq Florence , Akodad Mariama , Lattuca BenoÃ®t , Cayla Guillaume
Published: March 2022

Introduction:
Despite improvement of in-hospital survival rate after aborted sudden cardiac death (SCD), cerebral anoxia may have severe neurologic consequences and may impair long term outcome and quality of life of surviving patients.

Methods:
This prospective, observational and multicentre (Montpellier and Nimes) study included patients > 18 yo admitted in the cathlab for CA after aborted SCD between May 1, 2018 to May 31, 2020. Only patients who were discharged alive from hospital were evaluated. The primary end point was survival without neurological sequelae at one year follow-up defined by Cerebral Performance Category (CPC) of 1 or 2. Secondary end points included global mortality, NYHA functional class, neurologic evaluation at discharge, 3-months and 1 year follow-up using the CPC scale, and quality of life at 1 year using the QOLIBRI (Quality of LIfe after BRain Injury) questionnaire.

Results:
Among 143 patients included during the study period, 61 (43%) were discharged alive from hospital and 55 (90%) of them completed follow-up at 1 year. Patients were young (59.4 +/- 14.1), mainly male (77%), with few cardiovascular risk factors. Duration of no and low flow period was short (1.9 +/- 2.4 and 16.5 +/- 10.4 minutes respectively). For 93% of the surviving patients, an initial shockable rhythm (n=57) was observed and acute coronary syndrome (ACS) was diagnosed in 75% of them (n=46). At 1 year, survival rate without neurologic sequelae was 87% (n=48). There were few recurrences of rhythm disorder (5%) or ischemic event (4%). Patients with poor outcome were older (p=0.036), have lower body mass index (p=0.013) and a lower initial LVEF (p=0.046). During follow-up, neurological status improved in 37% of patients presenting sequelae at discharge and overall quality of life was globally satisfying for 66% of patients according to the QOLIBRI questionnaire. No death from cardiac cause was reported, and mean LVEF at 1 year was improved (51.5 ± 9.2 vs 47.5 ± 11.5, p < 0.01).

Conclusion:
Among patients admitted to the cathlab for aborted SCD, mainly related to ACS, less than half of them were alive at discharge. However, their 1-year survival rate without neurological sequelae was high and their overall quality of life was good.
Abstract 10556: A Systematic and Reliable Process for Performing Cost Containment Analysis Within the Operating Room
Authors: Nellis Joseph R , Prabhu Neel , Meza James M , Andersen Nicholas D , Turek Joseph W
Published: March 2022

Purpose:
Healthcare spending within the United States increased 4.6% in 2019 and represented over $3.8 trillion, or 17.7% of our GDP. The operating margin for most hospitals is 1-3%. As costs continue to rise, insurers will continue to shift these financial risks and responsibilities onto hospitals and hospitals eventually onto surgeons.

Methods:
Using a recently introduced surgical receipt function within Epic, we set out to develop cost containment strategies within congenital cardiac surgery at Duke University Hospital. Surgical receipt data was obtained between January 1, 2020 and January 1, 2021. Variability in case costs and product utilization were identified. Findings were discussed with surgeons to identify high impact changes with low barriers to implementation.

Results:
Between January 1, 2020 and January 1, 2021, there were 340 index cases and 449 unique surgical receipts. Four procedures representing 54 patients accounted for more than 50% of the total annual direct operating room supply costs (LVAD, 5 patients, 22.7% of annual costs; Norwood, 20 patients, 12.7%; RV-PA shunt, 16 patients, 9.9%; PVR, 13 patients, 9.4%). Exploration chest for postoperative hemorrhage was associated with the highest variability in case cost. In addition to mechanical devices and valves, cost drivers included the use of disposable vascular clips, suture brand preference between surgeons, and surgical patch material utilization which accounted for 3.7%, 6.6%, and 26.5% of overall annual direct operating room supply costs.

Conclusions:
We project 6-6.5% in annual savings due to changes in suture and surgical clip utilization. Changes to surgical patch utilization should carry an additional 4-4.5% in savings. The surgical receipt represents a reliable and uniform way of reporting surgical costs with broader implications for all surgical subspecialties.
Abstract 10566: Echocardiographic Predictors of Successful Transcatheter Mitral Valve Repair with the Mitraclip System
Authors: Hadjadj Sandra , Freitas-Ferraz Afonso , Paquin Amelie , bernier mathieu , O’Connor Kim , Salaun Erwan , Pibarot Philippe , Clavel Marie-annick , Rodes-Cabau Josep , Paradis Jean-Michel , Beaudoin Jonathan
Published: March 2022

Introduction:
Residual mitral regurgitation (rMR) and elevated transmitral gradients (TMG) are associated with worse outcomes after percutaneous mitral repair. This study aims to assess if pre-intervention MR jet width and its relation to the mitral commissural length (MCL) are able to predict post-procedure rMR and TMG.

Methods:
Preprocedural echocardiographic images were retrospectively reviewed in 74 patients who underwent an edge-to-edge repair (2014-2018). Maximal MR jet width and MCL were measured from a bi-commissural view. Complete follow-up echocardiographic examination was performed at 1-3 months. Left ventricle (LV) and left atrial (LA) severe dilation were defined as LV end-diastolic diameter ≥6.5 cm and LA indexed volume ≥48 ml/m
2
. Presence of rMR ≥moderate, combination of rMR and TMG >5 mmHg (rMR+TMG), and all-cause mortality within 1-year follow-up were examined.

Results:
Of 74 patients, 25 (34%) had rMR [17/25 moderate and 8/25 severe)] and 39 (53%) had either rMR or elevated TMG. Both MR jet width and its ratio with MCL were good predictors for the implantation of >2 clips (p<0.01 for both). Patients with rMR had a significantly larger pre-procedural jet width versus those without MR (1.63±0.54 cm vs 1.29±0.53 cm; p=0.01); without significant difference for the ratio of jet width/MCL (p=0.07). However, this ratio was higher in patients having rMR+TMG (41.05±13.15 % vs 34.26±12.64 %; p=0.03). In univariate analysis, MR jet width was a good predictor of rMR (OR: 3.35, 95%CI: 1.09-10.48; p=0.03) and severe post-intervention LV (OR: 6.43, 95%CI: 1.35-45.01; p=0.03) and LA dilation (OR: 3.02, 95%CI: 1.16-8.69; p=0.03); whereas the ratio was a good predictor of rMR+TMG (OR: 1.69, 95%CI: 1.12-2.70; p=0.02). Patients with rMR and rMR+TMG tended to be at higher risk of mortality at one year, without reaching statistical significance in this small population (24% vs 14%, p=0.17 and 23% vs 11%, p=0.14 respectively).

Conclusion:
MR jet width and its ratio with MCL are respectively associated to rMR or combined rMR+TMG after percutaneous mitral repair. MR jet width was also useful to identify patients who remained with severe LV and LA dilatation post-intervention.
Abstract 10568: The Impact of Gender: Rates of Significant Coronary Artery Disease in Women and Men Undergoing Non-Invasive and Invasive Ischemic Evaluation for Acute Coronary Syndromes
Authors: Kane Jesse , Yoo Jeanwoo , Menashe Eyal , Hotelling Jessica , Parikh Puja , Lawson William E
Published: March 2022

Introduction:
Key differences in the presentation and pathophysiology of cardiovascular disease (CVD) between men and women exacerbate diagnostic challenges when evaluating patients with acute coronary syndromes (ACS).

Hypothesis:
We aimed to better understand the impact of gender on diagnostic approaches and findings in similar cohorts of men and women who presented to rule out ACS and were evaluated with non-invasive cardiac imaging (NI) including Computed Tomography Coronary Angiography (CTCA) or Nuclear Stress Test (NST) prior to coronary angiography (CA).

Methods:
We performed a retrospective chart review to evaluate all patients referred to our catheterization laboratory for ACS over 1 year. Patients with a history of CVD, end stage renal disease or who underwent CA without NI were excluded. Statistical analysis was performed with Paired-T and Mann Whitney U Testing, and CHI-Square analysis.

Results:
150 patients (45 women and 105 men) met our study criteria. There were no significant differences between men and women in age, BMI, GFR, Troponin, BNP, rates of hypertension, diabetes mellitus, hyperlipidemia, obesity, smoking history or utilization of aspirin, or statins. Grace Scores and Diamond Forrester Risk were similar. Women were less likely than men to have significant coronary disease on CA (M:66% W:34% p=0.00) or require intervention (M:73% W:34% p=0.00). There were no significant differences in rates of reported coronary disease on NI testing (M:53%, W:55% p=0.81), however, rates of artifact in NI testing were significantly higher in women (M:26% W:55% p=0.00). Women were significantly more likely to undergo NST rather than CTCA (M:22%, W:45% p=0.00).

Conclusions:
Our study found that women were far less likely to have significant coronary disease on CA after a NI workup, were more likely to have NI studies with reported artifact and were more likely to undergo NST than CTCA. We highlight differences between genders in significant CAD and need for intervention that may be related to higher rates artifact in NI results in women. Furthermore, we demonstrate the correlation with gender and physician decision making when selecting NI imaging, a finding which warrants further study.
Abstract 10570: A New Method for Planning the Surgical Repair of Pediatric Aortic Coarctation: In vitro Design and Performance Evaluation
Authors: Chassagne Fanette , Buddhe Sujatha , Permut Lester , MCMULLAN David , Seslar Stephen P , Aliseda Alberto
Published: March 2022

Introduction:
The surgical treatment of severe aortic coarctation associated with arch hypoplasia combines resection of the stenosed tissue and enlargement of the aortic arch with a patch, designed by the surgeon in the OR. This work aims at creating an
a priori
design method for the patch and evaluating the success of the treatment by measuring the restoration of flow.

Methods:
Treatment was virtually implemented on segmented patient’s CT images based on the surgeons’ experience, identifying the zone to resect and the start of the lumen-widening, and optimized through CFD simulations The optimal patch geometry template was 3D-printed and used to perform surgery on
in vitro
silicon models of the aorta. Repairs were performed by an experienced surgeon using two patch geometries: the optimal patch template designed by our methodology and the patch designed by experience (traditional method). The geometry of the lumen resulting from the surgery was obtained from micro-CTs of the models. Finally, CFD simulations were performed for these geometries to evaluate the two repairs.

Results:
All repairs showed significant increases in aortic flowrate and decreases in pressure gradient. The virtually repaired geometry resulted in a 3-fold increase in flowrate and complete resolution of the obstruction. The traditional repair and the optimal patch repair showed similar effects on flow rate (+300%), and the traditional repair showed no remaining pressure gradient. All repairs reduced the stenosis-induced jet. However, the traditional repair led to large recirculation zones, potentially increasing the risk of thrombosis and pathological aortic remodeling.

Conclusion:
A novel method, combining
in vitro
and
in silico
approaches, was created to help surgical planning. This approach predicted flow and pressure gradients for the evaluation of the repair, but also provided the flow topology that should be taken into consideration to avoid hemodynamics-related complications.
Abstract 10576: Long-Acting Fc-elabela Improves Heart Functional Performance and Markedly Reduces the Infarction Area in a Non-Human Primate Model of Myocardial Infarction
Authors: Gong Da-Wei , Huang Jian , Gottlieb Stephen S
Published: March 2022

Introduction:
Agonists for the apelin receptor APJ have exhibited cardioprotective and anti-heart failure effects in numerous basic and clinical studies. Besides apelin, elabela is a new endogenous peptide ligand for APJ. In a previous study, we have shown that Fc-Elabela (Fc-ELA) has an in vivo half-life of 44 hours in mice and mitigates heart dysfunctions in the rat model of myocardial infarction.

Hypothesis:
We hypothesized that we could reproduce Fc-ELA’s cardioprotective effects in non-human primates.

Methods:
Sixteen 3-6 kg male cynomolgus monkeys were divided into 2 groups of vehicle (Veh, n=9) and Fc-ELA (n=7), each with a mean LVEF of 73%. The animals were subjected to ligation of the LAD for 60 min of ischemia and reperfusion to induce myocardial infarction (MI) and heart failure, and received administration of Fc-ELA at 1 mg/kg, s.c., daily for 4 weeks or vehicle, starting at reperfusion. Ultrasound was performed before operation, after reperfusion, and 1, 2, 3 and 4 weeks after operation. Hemodynamics were measured before and 4 weeks after the procedure. At the end of the experiment, TTC staining for the infarction area and CD31staing for microvessels were performed.

Results:
LVEF decreased from baseline 73% to 64% after MI, gradually decreasing to 50% by the end of week 4 in the Veh group, whereas LVEF remained between 63% and 66% in the entire 4 weeks of Fc-ELA treatment (p <0.001 vs. Veh at Week 2, 3 and 4). dP/dt increased from 2,235 to 3,975 mmHg/s with Veh, but from 2,249 to 5,893 mmHg/s with Fc-ELA (p < 0.05 between groups). LVEDP decreased by 63% with Fc-ELA, but did not change with Veh (p < 0.05 between groups). Systolic BP increased with Fc-ELA as compared to Veh . Fc-ELA reduced the infarct area by 48.2% (MI area ratio: Veh vs. Fc-ELA; 5.0% vs 2.6%, p < 0.01. In addition, the Fc-ELA treatment increased the expression of CD31, a vascular endothelial marker, by 26.3% (p < 0.01), compared to the Veh group.

Conclusions:
In non-human primates, Fc-ELA showed significant cardioprotective effects. Fc-ELA markedly reduced MI infarction area and significantly increased the microvessel density in the model, supporting Fc-ELA as a potential therapeutic for heart failure and MI.
Abstract 10578: Outcomes of Tachy-Arrhythmias in Group 1 Pulmonary Arterial Hypertension versus Non-Group 1 Pulmonary Hypertension: A Comparison of Nationwide Analysis 10 Years Apart
Authors: Rizvi Bisharah , Desai Rupak
Published: March 2022

Introduction:
Cardiac arrhythmias are associated with increased morbidity and mortality in patients with pulmonary hypertension (PH). We study the prevalence and outcomes of tachyarrhythmia in group 1, pulmonary arterial Hypertension (PAH) compared to non-group 1 PH, a decade apart (2007 vs 2017).

Methods:
National inpatient Sample database was used to identify PAH and non-group 1 PH using the ICD9-CM and ICD-10 codes for 2007 and 2017 respectively. Total hospitalizations, prevalence and mortality of cardiac tachyarrhythmia were analyzed.

Results:
Hospitalizations for PAH decreased from 2007 (17,713) vs 2017 (9,330). Hospitalizations for non-group 1 PH increased from 2007 (476,357) vs. 2017 (1,084,395). The most common tachyarrhythmia in PAH group was Atrial fibrillation/flutter (35.4% vs. 35.1% (p=0.648)), followed by Ventricular tachycardia (VT) (3.1% vs. 3.5% (p=0.143)), Supraventricular tachycardia (SVT) (paroxysmal atrial tachycardia, atrio-ventricular reentrant tachycardia and atrio-ventricular nodal reentrant tachycardia) (0.9 vs. 3.2% (p=<0.001)), then Ventricular fibrillation/flutter (0.3% vs. 0.3% (p=0.758)). Only SVT had significantly increased and none were associated with increased in-hospital mortality. Non-group 1 PH also had Atrial fibrillation/flutter (37.2% vs. 46.8% (p<0.001)) as the most common arrhythmia, followed by VT (3.6% vs. 4.5% (p<0.001)), then SVT 0.9% vs. 3.0% (p<0.001) and Ventricular fibrillation/flutter (0.3% vs. 0.6%(p<0.001)). There was significant increase in all tachyarrhythmia when comparing 2007 to 2017, and all arrhythmias were associated with increased in-hospital mortality. In-hospital cardiac arrest increased in both PAH group (1.0% vs. 1.6% (p<0.001)) and non-group 1 PH (0.7% to 1.4% (p<0.001)) and both were associated with increased in-hospital mortality (PAH group (OR 27.22, p<0.001) vs. non-group 1 PH(OR 1.66, <0.001)).

Conclusions:
This study shows that non-group 1 PH has higher prevalance of tachyarrhythmia, and is associated with higher mortality compared to Group 1 PAH. We need to come up with strategies for early prevention and treatment.
Abstract 10591: Epigenetic BET Reader Inhibitor Apabetalone (RVX-208) Counters Proinflammatory Aortic Gene Expression in a Diet Induced Obesity Mouse Model
Authors: Wasiak Sylwia , Daze Emily , Tsujikawa Laura M , Gilham Dean , Sarsons Christopher , Stotz Stephanie , Rakai Brooke , Azhar Salman , Jahagirdar Ravi , Sweeney Michael , Johansson Jan , Wong Norman , Kulikowski Ewelina
Published: March 2022

Introduction:
Obesity increases the risk of type 2 diabetes (DM2) and cardiovascular disease (CVD), due to associated insulin resistance, dyslipidemia, high blood pressure and chronic inflammation. Bromodomain and extraterminal (BET) proteins such as BRD4 enhance the expression of proinflammatory genes by recruiting transcription factors to promoters and enhancers. Inhibition of BET binding to chromatin leads to anti-inflammatory and anti-atherogenic effects in models of DM2 and CVD.

Hypothesis:
BET inhibition with apabetalone, a clinical-stage small molecule, reduces vascular inflammation in a mouse model of diet-induced obesity.

Methods:
From 8 to 30 weeks of age, C57 BL/6J mice were fed a high-fat (HFD) or low-fat diet (LFD). Mice received apabetalone at 150 mg/kg b.i.d between 14 and 30 weeks. Gene expression was analyzed post necropsy in the aorta by PCR, nCounter® Inflammation Panel and Ingenuity® Pathway Analysis. Human aortic endothelial cells (HAECs) treated with TNFα and apabetalone were analyzed by BRD4 ChIP-seq and RNA-seq to assess BRD4 chromatin occupancy and transcriptional changes.

Results:
Profiling of 254 genes in the aorta showed an upregulation of 27 inflammatory genes in HFD-fed mice as compared to LFD (p<0.05), including transcription factors
Rela
(22%),
Hif1a
(25%) and
Tcf4
(44%), involved in inflammation, hypoxia and cell growth, respectively. Other upregulated genes mapped to cytokine, cytoskeleton, coagulation and complement pathways. Apabetalone reduced aortic mRNA expression of transcription factors
Rela
(12%),
Nfkb1
(22%) and Tcf4 (15%), chemokines
Ccl2
(47%),
Ccl7
(49%) and
Ccl8
(69%), leukocyte receptors
Ccr2
(64%) and
Itgam
(29%) and endothelial receptors
Sele
(64%) and
Icam1
(36%). Bioinformatics predicted enhanced signaling by TNFα in the HFD vs. LFD aorta, which was countered by apabetalone. In HAECs, apabetalone lowered gene expression and BRD4 binding to
Rela
,
Hif1a
and
Tcf4
genes and prevented TNFα-mediated BRD4 accumulation in proximity of
Ccl2
,
Sele
and
Icam1
genes.

Conclusions:
HFD induces vascular inflammation in mice. Apabetalone treatment diminishes this proinflammatory phenotype, providing mechanistic insight into how BET inhibitors may reduce CVD risk in DM2 patients.
Abstract 10597: Epidural Sympathetic Afferent Blockade by Resiniferatoxin Reverses Vagal Dysfunction Following Myocardial Infarction
Authors: Hoang Jonathan D , Swid Mohammed A , Kang Ki-Woon , Lokhandwala Zulfiqar A , Chan Christopher A , Jani Neil R , Vaseghi Marmar
Published: March 2022

Introduction:
Myocardial infarction (MI) induces sympathovagal imbalance, predisposing for ventricular tachyarrhythmias (VT). Thoracic epidural anesthesia reduces VT burden through sympathetic blockade. However, it is unknown if sympathetic afferent activation may cause vagal dysfunction, and if blockade of these spinal afferents can improve vagal function and reduce VT burden.

Methods:
Chronic MI was percutaneously created in Yorkshire pigs (n=8). In terminal experiments 6 to 8 weeks post MI, an epidural catheter was placed at the C7-T1 epidural space. After sternotomy, a 56 electrode sock was placed over the ventricles to record activation recovery intervals (ARI, surrogate of action potential duration). Effective refractory periods (ERP) were assessed via extra-stimulus pacing and left ventricular (LV) pressure monitored via a pressure catheter. Vagal function was assessed by baroreflex sensitivity (BRS) after phenylephrine (3 μg/kg, IV). ARIs, ERP, LV function, and BRS were checked before and after epidural RTX (0.6 μg/kg/ml). VT inducibility was assessed by endocardial extra-stimulus pacing from the right ventricular apex.

Results:
Epidural RTX led to a modest hemodynamic response peaking at 10.2 ± 4.2 min post-RTX with stabilization by 118 ± 15 min, characterized by increased LV systolic pressure (121±5.6 to 133±9.7 mmHg;
p
=ns) and contractility (1411±74 to 1514±163 mmHg/s;
p
=ns). While ARI and atrial/ventricular ERP did not change significantly, BRS was significantly augmented by 2 hrs (2.1±0.6 to 4.3±0.8 ms/mmHg,
p
<0.01). 9/9 animals in our chronic MI model were inducible for VT by extra-stimulus pacing whereas only 1/6 were inducible for VT after epidural RTX (
p
<0.001).

Conclusion:
Blockade of nociceptive spinal sympathetic afferents by RTX augments reflexive vagal function without altering basal cardiac function. Blockade of nociceptive afferents and restoration of parasympathetic function alone may be sufficient to suppress VT.
Abstract 10608: Genome-Wide Association Study Identifies Polymorphisms Associated with Heart Failure Mortality in a Diverse Patient Population
Authors: Huang Yimei , Dumeny Leanne , Yang Guang , Lteif Christelle , Arwood Meghan J , McDonough Caitrin W , Desai Ankit A , Cavallari Larisa H , Duarte Julio D
Published: March 2022

Introduction:
Few genome-wide association studies (GWAS) of heart failure (HF) mortality have been published, with most focused on incidence or surrogate endpoints. Our aim was to identify genomic predictors of HF mortality in a racially diverse population.

Hypothesis:
Both ancestry-specific and trans-ancestry variants are associated with survival in HF patients.

Methods:
HF patients with preserved or reduced ejection fraction from the University of Illinois Chicago cardiology clinics were prospectively enrolled and followed until 11/2015. Whole blood was collected. Clinical data were retrospectively acquired through medical records. Genotyping was performed via Affymetrix Axiom Pan-African Array and imputed via TOPMed Imputation Server. Genetic ancestry (African/non-African) was assigned by principal component (PC) analysis. Within each ancestral population, associations between genetic variants and all-cause mortality were assessed by Cox regression model, adjusted for age, sex, NYHA class, HF medication regimen, and PCs. A trans-ancestry fixed-effect meta-analysis was then conducted.
P
< 5.0 x 10
-8
was considered statistically significant.

Results:
The cohort included 319 HF patients (age 63 ± 13 yrs, 51% men, median follow-up 33 mos), comprised of 237 African ancestry (AA) (134 deaths) and 82 non-AA subjects (41 deaths). In the AA GWAS, 5 loci reached genome-wide significance. The top single nucleotide polymorphism (SNP), rs142008984 on chromosome 1 (
P
= 5.21 x 10
-10
, HR = 8.55, 95%CI 4.34 - 16.82), resides in the nitric oxide synthase 1 adaptor protein
(NOS1AP)
gene. No SNPs in the non-AA GWAS reached the defined significance level, and the AA-associated
NOS1AP
SNPs were not present in non-AA. Meta-analysis revealed 2 additional significant loci, among which was the top SNP on chromosome 6, rs79027708 (
P
= 1.43 x 10
-9
, HR = 0.15, 95% CI 0.08 - 0.28), in the phosphodiesterase 10A (
PDE10A)
gene.

Conclusions:
This study identified novel loci associated with all-cause mortality in a racially diverse HF population.
NOS1AP
and
PDE10A
have previously been associated with sudden cardiac death, cardiac hypertrophy, and fibrosis risk. Risk variants specific to AA were also identified, which may contribute to the lower survival in this population.
Abstract 10612: Immune Cells in Calcific Aortic Valve Disease
Authors: Bartoli-leonard Francesca , Aikawa Elena
Published: March 2022

Introduction:
Calcific aortic valve disease is a multifaceted disease in which pathogenic mineralisation of the valvular tissue occurs in tandem with fibrocalcific remodelling of the aortic valve, resulting in a wide variety of clinical presentations. Immunity, both innate and adaptive have been shown to play important roles in chronic cardiovascular diseases. Noteably, 15% of cells within healthy aortic valves are up to hematopoietic origin and these populations are further increased within calcified valves however, the role of the immune system within CAVD remains to be elucidated.

Objectives:
Investigate the prevalence and distribution of immune cells within CAVD.

Methods & Results:
Human calcified aortic heart valves were obtained from valve replacement surgeries. Immunohistological assessment of immune cells within the tissue was conducted, with the presence of T cells, B cells, macrophages and dendritic cells detected in the vicinity of calcific nodules. Flow cytometry analysis of cells isolated from the valve was conducted. 69% of cells isolated from the valve were CD45+, with 57% and 42% of CD45+ CD3+ presenting as CD8+ and CD4+ respectively. Within the CD8+ population, 56% of these were central memory CD8+ T cells, with 24% as activated CD8+ T cells. Likewise, within the CD4+ population 29.5% CD4+ cells were activated T cells and 55% central memory T cells. Small populations of naïve CD4+ and CD8+ T cells; 9% and 13% respectively, were present within the valve. CD45+, CD3+, CD4+/CD8+ cells were isolated via FACS and their global proteomic profile was analysed on the Thermo Scientific Lumos orbitrap mass spectrometer. IL-31RA was present within the T cell population, alongside MAPK pathway mediators were also present. Network analysis of T cell proteomics showed increased IL-4 and IL-13 pathways (p<0.01) indicative of a Type II inflammatory pathway, correlating with the presence of basophils and eosinophils present within the valve.

Conclusions:
Prevalence of immune cells within the valve suggests an inflammatory role in the development of calcific aortic valve disease, with the prevalence of T cells within the valve suggesting an adaptive immune response may be central to the pathology of CAVD.
Abstract 10614: An Automated View Identification Model for Pediatric Echocardiography Using Artificial Intelligence
Authors: Gearhart Addison , Goto Shinichi , Powell Andrew J , Deo Rahul C
Published: March 2022

Introduction:
A fully automated artificial intelligence driven pipeline to perform cardiac structural and functional measurements and disease detection requires accurate identification of individual echocardiographic views. However, there are no view classification algorithms for pediatric echocardiograms where there is a broader range in body size, anatomy, view types, and sweep length than in adult studies.

Hypothesis:
To develop and test a machine learning model to automatically perform view classification on individual pediatric echocardiogram images.

Methods:
Using a derivation dataset of 12,067 echocardiogram cine and still images from patients 0 to 19 years of age, a convolutional neural network (CNN) model was trained and evaluated for the automated identification of 28 pre-selected standard pediatric echocardiogram views that included anatomic sweeps, color Doppler, and Doppler tracings. The model was validated using an additional 6,197 images and trained for 150 epochs. Classification accuracy was evaluated using a test dataset composed of 9,684 images obtained from 100 different patients equally distributed across the age range. The model was subsequently deployed on studies of 524 children with leukemia to identify 6 pre-selected views pertinent to left ventricular function.

Results:
The model identified the 28 preselected views with 90% accuracy. Accuracy was comparable across age groups (89% for 0-4 yr, 91% for 4-9 yr, 90% for 9-14 yr, and 91% for 14-19 yr). Accuracy was 91% for the sweeps with color Doppler, 83% for sweeps without color Doppler, and 91% for Doppler tracings. Among the leukemia cohort, the model identified the 6 preselected views on a per study basis with a positive predictive value of 99% and an accuracy of 81-97%. A second pass of the model with a threshold prioritizing sensitivity achieved 100% detection of the missing views.

Conclusions:
We constructed a CNN model for view classification of pediatric echocardiograms that was accurate across the age spectrum and for cine images, anatomic sweeps, color Doppler images, and Doppler traces. This model lays the groundwork for automated quantitative analysis and diagnostic support to promote more efficient, accurate, and scalable analysis of pediatric echocardiograms.
Abstract 10619: Determination of Cost Drivers and Variation Associated with Isolated Aortic Valve Replacement Surgery: Evaluating the Impact of Interval Feedback and Barriers and Facilitators of Cost Awareness among Cardiac Surgeons and Health Care Providers
Authors: Roy Sophia , Gainer Ryan , Hirsch Gregory
Published: March 2022

Introduction:
Marked variation among surgeons and relevant health care providers (HCPs) in aortic valve replacement (AVR) costs was demonstrated. Despite presentation of these data to HCPs, cost variation persists. We sought input from cardiac HCPsregarding intraoperative cost awareness, decision making and potential motivators towards greater cost consideration.

Objectives:
Three fold purpose: I) Determine the primary intraoperative cost drivers of performing an isolated AVR in a single-center Canadian hospital, II) Evaluate the impact of communicating cost and driver variability on decision making, and III) Identify the barriers and facilitators of incorporating cost considerations in isolated AVRs among HCPs.

Methods:
From May 2017-May 2019, data was collected on AVR cost drivers (n=216). There were three phases of data feedback to HCPs. Separate focus groups were held (Phase III) for cardiac HCPs including surgeons, anesthesiologists, perfusionists , residents, and OR nurses (n=27). Semi-structured interviews were used to elicit provider perspectives. Transcribed audio data was analyzed through the use of thematic analysis to develop a core set of common and comprehensive themes.

Results:
Data collection demonstrated marked inter-surgeon variation around the surgical costs of procedures. After feedback to HCPs, variation persisted and the median cost for AVRs increased. Five themes were identified from HCP groups: cost awareness, intraoperative decision making, influence surrounding intraoperative cost decision making, provider-based motivation for implementing intraoperative cost decision making, and cost drivers for an AVR.

Conclusions:
No difference in cost or variation before and after data feedback to HCPs was insufficient to impact surgeon’s behaviour in case costing, which motivated the qualitative work in the form of focus groups. HCPs demonstrated low cost awareness regarding cost drivers of AVRs. They expressed interest in engaging in cost decision making that was informed by cost containment. Measures such as listing the price of cost drivers in the OR and providing cost feedback could potentially encourage engagement in cost decision making for AVRs.
Abstract 10626: Use of Targeted Bedside Simulation in the Pediatric Cardiac Intensive Care Unit: Codes on the Go
Authors: Hoekstra Nadia E , Zakhar Joseph A , DiMaria Kimberly , Bishop Robert
Published: March 2022

Introduction:
Early recognition of clinical decompensation and rapid intervention are essential to prevention of cardiac arrest (CA). Simulation provides a safe, realistic environment to improve performance of low frequency, high risk skills and practical knowledge. Codes on the Go (COTG) uses mobile bedside simulation emulating the most frequent causes of CA to improve early recognition of clinical changes that may lead to CA and improve performance of crucial tasks.

Methods:
COTG scenarios are based on our cardiac intensive care unit CA data including trends in etiology and knowledge gaps identified in code debriefs. Each simulation lasts 10 minutes (pre-brief, clinical scenario, and educational debrief). For each simulation, completion and timing of pre-identified objectives were recorded and participant feedback was obtained.

Results:
We conducted 56 simulations using our pilot scenario “Agitation & Bradycardia”. Of these, 11 involved staff participating for the second time. When comparing the 45 first-time participants to the 11 repeat participants, the tasks showing the largest increase in completion were identifying that dexmedetomidine (dex) can worsen bradycardia, stopping the dex infusion, and using the appropriate CPR ratio. The average time-to-task decreased for 5 of 6 tasks measured between the first-time participants and repeat participants (Figure 1). The vast majority (98%) of participants agreed that feedback was done in a constructive, non-punitive way and the simulation had no negative impact on patient care or staff workflow.

Conclusions:
COTG is a customizable and low-cost way to improve performance of critical skills and knowledge. Repeat participation in the same scenario improved both completion of objectives and time-to-task without impeding workflow or patient care. This pilot study demonstrated successful proof-of-concept and further implementation of arrest scenario simulations will be implemented to expand its benefit.
Abstract 10629: Effect of Empagliflozin on Blood Volume Redistribution in Patients with Chronic Heart Failure and Reduced Ejection Fraction
Authors: Omar Massar , Jensen Jesper , Burkhoff Daniel , Frederiksen Peter H , Kistorp Caroline N , Videbaek Lars , Poulsen Mikael Kjaer , Gustafsson Finn , Kober Lars , Borlaug Barry A , Schou Morten , Moller Jacob
Published: March 2022

Background:
The relationship between blood volume and pressure in the vascular system can be described in terms of unstressed and stressed blood volume. Stressed blood volume determines venous pressure and provides preload back to the heart, which regulates the generation of cardiac output (CO) via the Frank-starling mechanism. Whether sodium-glucose cotransporter-2 (SGLT2i) favorably modifies stressed blood volume is not known.

Hypothesis:
To investigate the effect of SGLT2i (empagliflozin) on the hemodynamic estimated stressed blood volume (eSBV) in HFrEF patients compared to placebo.

Methods:
A post hoc analysis of investigator-initiated, double-blinded, placebo-controlled, randomized trial. Seventy patients were assigned to empagliflozin of 10 mg or matching placebo once daily for 12 weeks. Patients underwent right heart catheterization at rest and during exercise at baseline and follow-up. Outcome was change in eSBV after 12 weeks of empagliflozin treatment at each level of exercise. We conducted computer-modelling simulations based on invasive hemodynamic assessment to measure eSBV.

Results:
HFrEF patients with mean age was 57 years, mean ejection fraction 27%, 47 (71%) on diuretics were randomized. After 12 weeks treatment exercise eSBV was significantly reduced at 0 watt, 25 watt and 25 % of maximal exercise watt, compared to placebo [(0 watt; –258 mL, 95% CI –476 to –39, p=0.021); (25 watt; –301 mL, 95% CI –561 to –40, p=0.024); and (25% of peak exercise watt; –262 mL, 95% CI –490 to –34, p=0.024)]. There was no effect on rest, or at peak exercise eSBV [(Rest; –75 ml, 95% confidence interval [CI] –279 to 130; p=0.47); and (Peak; –96 mL, 95% CI –444 to 251, p=0.59)]. This was consistent among patients with and without type 2 diabetes, etiology of HFrEF, and diuretic usage (Figure 1).

Conclusion:
Empagliflozin may contribute to shift blood from the effective circulatory beds to the venous reservoir in reducing filling pressure and eSBV, but maintaining CO.
Abstract 10636: Inter-Arm Difference in Systolic Blood Pressure: Prevalence and Associated Factors in an African Population
Authors: GBAGUIDI Gwladys , KABOURE Audrey , Houehanou Yessito Corine NadÃ¨ge , AMIDOU Salimanou , HOUINATO Dismand , Aboyans Victor , LACROIX Philippe
Published: March 2022

Background:
Systolic inter-arm blood pressure differences (IABPD) is associated with increased cardiovascular mortality and morbidity. However, almost all data are issued from western countries, and the epidemiology and associated risk factors of IABPD in sub-Saharan Africa is unknown.

Objectives:
This study aims to determine the descriptive epidemiology of IABPD in a rural community of Benin.

Methods:
A cross-sectional study was conducted among participants of the TAnve HEalth Study (TAHES), a prospective population-based cohort conducted in Benin since 2015. All inhabitants of two villages (Tanve and Dékanme), aged 25 years and over were included. Pregnant woman and participants unable to answer the questions were excluded from the study. Data were collected from February to March, 2020 using the WHO STEPS adapted questionnaire in a systematic door-to-door survey. Brachial BP were recorded at rest on both arm with an electronic device. Three series of BP measures were collected sequentially. On each arm the average of the two last measurements was used for analysis. High IABPD was defined as the absolute value of the difference in systolic BP between the left and right arms ≥ 10 mmHg. A multivariate logistic regression models identified factors associated with IABPD.

Results:
A total of 1,505 participants (median age 40 [32-54] years, 59.3% women) were included in this study. The prevalence of systolic IABPD was 19% (95%CI: 17-21). The prevalence was 19.0% (95%CI: 16-22) in men and 20% (95%CI: 17-22) in women. In the final multivariable model, the probability for systolic IABPD ≥ 10 mmHg increased significantly with age (adjusted OR (aOR) = 1.10 (95%CI: 1.02-1.20) per 10-years), hypertension (aOR = 2.21; 95%CI: 1.68- 2.91) and diabetes (aOR = 1.69; 95%CI: 1.09-2.63).

Conclusion:
Almost one out of 5 native Africans have an IABPD ≥ 10 mmHg, with an increased risk with older age and presence of hypertension and diabetes. The clinical implication of our finding is in the importance of bilateral brachial blood pressure measurement in this setting.
Abstract 10637: A Pooled Multi-National Validation Study of a Machine Learning, High-Sensitivity Troponin-Based Multi-Proteomic Model to Predict the Presence of Obstructive Coronary Artery Disease as Compared to High Sensitivity Troponin Alone in a Subset of Patients with Diabetes
Authors: Gattani Raghav , Ekanem Emmanuel , Ofosu-Somuah Araba , Neumann Johannes T , McCarthy Cian , Shah Palak , Magaret Craig , Rhyne Rhonda F , Barnes Grady , Peters Celine , Westermann Dirk , Defilippi Christopher , Januzzi James L
Published: March 2022

Introduction:
Diabetes Mellitus (DM) is a major risk factor for coronary artery disease (CAD) associated with a two-fold increase in mortality. We aimed to validate the performance of a machine learning based multi-biomarker diagnostic panel to predict obstructive coronary artery disease (oCAD) compared to high-sensitivity cardiac troponin-I (hs-cTnI) alone in a subset of patients with DM.

Methods:
A previously developed multiple biomarker scoring model was utilized. The pooled cohort included 132 patients at Inova Fairfax Hospital, 69 patients at Massachusetts General Hospital and 46 patients at the University Hospital Hamburg-Eppendorf with a mixture of acute and lesser acute presentations. Three clinical factors (sex, age, and previous coronary percutaneous intervention) and three biomarkers (hs-cTnI, Adiponectin, and Kidney Injury Molecule-1) were combined. oCAD was defined as >50% coronary obstruction in at least one coronary artery (for the University Hospital Hamburg-Eppendorf cohort) or >70% coronary obstruction in at least one coronary artery (for the other two cohorts). The multiple biomarker diagnostic panel’s performance to predict oCAD was also compared to hs-cTnI alone.

Results:
The multiple protein panel had an area under the receiver-operating characteristic curve of 0.77 (95% CI, 0.70, 0.84, p <0.001) for the presence of oCAD (Figure 1). At optimal cutoff, the score had 79% sensitivity, 57% specificity, and a positive predictive value of 81% for oCAD. The multiple biomarker panel had a diagnostic odds ratio of 4.82 (95% CI 2.68, 8.67, p<0.01). In comparison, in patients without an acute MI, hs-cTnI alone had an area under the receiver-operating characteristic curve of 0.53 (95% CI, 0.49, 0.57, p = 0.253) for oCAD (Figure 1).

Conclusions:
In this multinational pooled cohort, a previously described novel machine learning, multiple protein biomarker panel provided high accuracy to diagnose patients for oCAD in a subset of patients with DM.
Abstract 10638: The Time to Reach the Minimum Freezing Temperature During Cryoablation is a Predictor of First-Pass Conductional Block of Cavotricuspid Isthmus
Authors: Nodera Minoru , Amami Kazuaki , Hijioka Naoko , Yamada Shinya , Kaneshiro Takashi , Takeishi Yasuchika
Published: March 2022

Background:
Ablation using cryothermal energy has several potential advantages over radiofrequency (RF) ablation including a greater catheter stability due to adherence to the myocardial tissue during applications, reduced risk of thrombus formation, less pain, and etc. Several studies have reported the effects of cryoablation for the treatment of the cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) with similar efficacy and safety rates as reported for RF ablation. However, the details of freezing profile during CTI cryoablation still remain unknown.

Methods:
This study included 40 consecutive patients (32 men; 65±10 years) who underwent CTI cryoablation for common AFL. Patients were divided into 2 groups: one pass group who achieved first-pass conductional block of the CTI (n=30) and non-one pass group who did not (n=10). CTI ablation was performed with 2.5-min freezing cycle and 8-mm tip cryocatheters. A multidetector computed tomography scan with contrast injection which was performed before ablation in all the patients. We examined temperature changes at the catheter tip during first pass in CTI cryoablation and anatomical features of CTI in three regions: anterior, middle, and posterior.

Results:
There was no significant difference in the minimum freezing temperature between the one pass group and the non-one pass group (-82.6±1.6 vs. -83.2±1.2°C, P=0.245) in all the three regions. However, only in the anterior CTI, the time to reach the minimum freezing temperature was significantly shorter in the one pass group than in the non-one pass group (31.4±5.9 vs. 38.7±8.6 sec, P=0.012). The thickness of the anterior CTI was significantly thinner in the one pass group than in the non-one pass group (4.1±1.2 vs. 5.5±1.3 mm, P=0.021). On the other hand, there was no significant difference in the thickness of the middle and posterior CTI between the two groups. The time to reach the minimum freezing temperature showed a significant positive correlation with the thickness of the CTI (R=0.415, P<0.001).

Conclusions:
The time to reach the minimum freezing temperature in the anterior CTI may predict a first-pass conductional block of CTI cryoablation. The thickness of the anterior CTI may relate to this mechanism.
Abstract 10639: Abbreviated Cardiac Magnetic Resonance Imaging versus Echocardiography for Interval Assessment of Systolic Function in Duchenne Muscular Dystrophy: Patient Satisfaction, Clinical Utility and Image Quality
Authors: Chandrasekar Hamsika , Kaufman Beth D , Vasanawala Shreyas , Beattie Meaghan , Syed Ali B , Maskatia Shiraz A
Published: March 2022

Introduction:
Interval assessment of systolic function in patients with Duchenne Muscular Dystrophy (DMD) is challenging by echocardiography (echo). Cardiac magnetic resonance imaging (CMR) has been limited due to study duration and patient experience. We developed an abbreviated CMR (aCMR) protocol which consisted only of cine acquisitions in the short axis, 4 chamber and vertical long axis planes, and compared it to echo in regard to: exam duration, patient satisfaction, clinical utility and image quality scores.

Methods:
DMD patients were recruited prospectively to undergo simultaneous echo and aCMR. Exclusion criteria included need for continuous positive pressure ventilation (PPV) and inability to lay supine ≥ 30 minutes. Subjects completed a patient satisfaction survey (PSS) comparing modalities. The clinical cardiologist completed a survey (CUS) assessing the clinical utility of each modality. A blinded expert reviewer completed an image quality survey (GQAS) for each modality. Results were compared using the Wilcoxon signed-rank test and Spearman correlation.

Results:
19 DMD patients participated. PSS scores and exam duration were equivalent between modalities, while CUS and GQAS scores favored aCMR. ACMR scored particularly higher than echo in RV visualization and judgement of atrial size. Older age had a statistically significant negative correlation with echo GQAS and CUS scores, as well as aCMR PSS scores. Nighttime PPV requirement and non-ambulatory status were associated with worse echo CUS scores. Poor image quality precluding quantification existed in 4 (21%) echo and 0 aCMR studies.

Conclusions:
The aCMR protocol resulted in improved clinical utility and quality scores relative to echocardiography, without detriment in patient satisfaction or exam duration. For DMD patients known to have challenging echo acoustic windows, aCMR should be considered in lieu of echocardiography for interval assessment of systolic function.
Abstract 10641: Changes in Oxygen Uptake Parameters Across High-Intensity Intervals Prescribed Using Rating of Perceived Exertion in Cardiac Rehabilitation
Authors: Content Virginia G , Hammer Shane , Smith Joshua , Olson Thomas P
Published: March 2022

Introduction:
High intensity interval training (HIIT) during early outpatient cardiac rehabilitation (CR) improves peak oxygen uptake (VO
2
) and reduces mortality in patients with cardiovascular disease. In a CR setting, prescribing interval intensity using rating of perceived exertion (RPE) is more feasible than using percent of VO
2peak
. Additionally, prescribing HIIT with RPE may allow for progressive changes in the VO
2
response throughout a single HIIT session. However, the acute cardiopulmonary responses during individual intervals of HIIT prescribed via RPE in CR are unknown.

Hypothesis:
We hypothesized that VO
2peak
would increase and time-to-peak (TTP) would shorten across high-intensity intervals during a single HITT session prescribed with RPE.

Methods:
Patients with CAD (N=14; 2 women; 56±9 yrs; 30.46±4.7 kg/m
2
) referred to CR after an acute coronary event completed a minimum of 25 supervised HIIT sessions during which VO
2
was measured continuously. Each HIIT session included 5 or more (6±1 sessions) 1-minute high intensity intervals (target RPE: 15-17) separated by a 3 to 5-minute low intensity interval (target RPE: <12). The first and last HIIT sessions were used for analysis. VO
2peak
was defined as the highest 3-breath averaged VO
2
during or up to 1 minute following each high intensity interval.

Results:
RPE was 15±2 and 11±2 during the high and low intensity intervals, respectively. Compared to the first HIIT session, VO
2peak
was greater during the high intensity intervals of the last HIIT session (25.4±1.5 vs. 21.8±1.1 mL/kg/min; p=0.04). During the first and last HIIT sessions, VO
2peak
increased across high intensity intervals (p<0.001). Although TTP was not significantly reduced across intervals during the first HIIT session (p=0.14), TTP was reduced across intervals during the last HIIT session (first interval: 67±19 vs. last interval: 58±9 s; p<0.01).

Conclusions:
Prescribing HIIT with RPE resulted in increased VO
2peak
across high intensity intervals within single HIIT sessions and shortened TTP during high intensity intervals across CR. These findings provide evidence for a priming effect on VO
2peak
during HIIT which may contribute to greater cardiopulmonary adaptations in CAD patients.