bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 16890: Coronary Artery Calcium for Personalizing Antihypertensive Therapy: A Pooled Cohort Analysis
Authors: Malla Gargya , Parcha Vibhu , Kalra Rajat , Pandey Ambarish , Khurram Nasir , Arora Pankaj , Arora Garima
Published: May 2021

Background:
The 2017 American College of Cardiology/American Heart Association high blood pressure (BP) guidelines recommend risk assessment of atherosclerotic cardiovascular disease (CVD) to inform hypertension (HTN) treatment in adults with elevated BP or low-risk stage 1 HTN. Use of coronary artery calcium (CAC) score, an excellent imaging risk-prediction tool, to guide HTN therapy has not been well studied.

Methods:
Participants free of CVD were pooled from three population cohort studies; 1) Multiethnic Study of Atherosclerosis, 2) Coronary Artery Risk Development in Young Adults and 3) Jackson Heart Study. Risk for incident CVD events (heart failure, stroke or cardiovascular mortality) by the CAC status and the BP treatment group was assessed. Multivariable Cox proportional hazards models were used to estimate the hazard ratios. The 10-year number needed to treat to prevent a single CVD event was also estimated.

Results:
This study included 11,499 participants (mean age 56 years; 55.2% women; 42.1% blacks). CAC score was non-zero in 38.2% of the participants. Over a median follow-up of 8.5 years, 910 incident CVD events occurred. Compared to those with zero CAC, participants with non-zero CAC score had a higher CVD incidence rate (per 1000 person-years) at all BP levels (elevated BP/low-risk stage 1 HTN: 14.5 vs 2.7; high-risk stage 1 or stage 2 HTN: 27.1 vs 8.8). Multivariable adjusted hazards of adverse CVD events displayed similar patterns (
Figure
). Among those with zero CAC, the 10-year number needed to treat to prevent 1 CVD event was 154 for those with elevated BP/low-risk stage 1 HTN and 47 for those with high-risk stage 1 or stage 2 HTN. Among those with non-zero CAC score, the number needed to treat was lower, 33 and 18 respectively.

Conclusions:
Utilization of CAC score may be an effective precision medicine approach to personalize HTN therapy in elevated BP or low-risk stage 1 HTN when treatment is not recommended by the current guidelines.
Abstract 16895: Interrelation of Exercise Training, Cardiorespiratory Fitness, and Cardiac Biomarkers in Patients Enrolled in the Health Benefits of Aerobic and Resistance Training in Individuals With Type 2 Diabetes Study
Authors: Saha Amit , Patel Kershaw , Ayers Colby , Berry Jarett D , Johannsen Neil , DEFILIPPI Christopher , Church Timothy , De Lemos James A , Pandey Ambarish
Published: May 2021

Introduction:
Low cardiorespiratory fitness (CRF) and elevated biomarker levels of myocardial injury and inflammation are both associated with heart failure (HF) risk. While exercise training (ET) is associated with improvement in CRF, the interrelationships among CRF, cardiac biomarkers, and ET are not well established.

Methods:
Participants of the Health Benefits of Aerobic and Resistance Training in Individuals with Type 2 Diabetes study were included. High-sensitivity cardiac troponin T (hs-cTnT), growth differentiation factor-15 (GDF-15), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and peak oxygen uptake (VO
2peak
) were assessed at baseline and at 9 months on completion of ET. Longitudinal change in cardiac biomarkers across treatment groups (control versus ET) were assessed using paired t-tests. Multivariable-adjusted linear regression was performed to identify factors associated with follow-up cardiac biomarkers and ΔVO
2peak
.

Results:
This study included 166 participants randomized to control (n = 31) and ET groups (n = 135). There was no significant change in hs-cTnT or NT-proBNP from baseline to follow-up among ET and control group participants. GDF-15 increased among participants randomized to the control (P = 0.01) but not the ET group. In adjusted analysis, each ET regimen was independently associated with lower follow-up GDF-15 but not with change in other biomarkers (
Table
). ΔVO
2peak
was not associated with any follow-up biomarker level in adjusted analysis. Among individuals in the ET group, baseline hs-cTnT and GDF-15 were each significantly associated with ΔVO
2peak
[per 1-unit higher log(hs-cTnT): β= -0.18 (95% CI = -0.31, -0.05); per 1-unit higher log(GDF-15): β = 0.08 (95% CI = 0.01, 0.15)].

Conclusions:
Among patients with type 2 diabetes, ET was associated with reduction in GDF-15 but not with change in other biomarkers. Baseline hs-cTnT and GDF-15 were each independent predictors of CRF change in response to ET.
Abstract 16896: Electrogram Morphology Recurrence to Characterize Drivers of Persistent Atrial Fibrillation: Findings at Initial versus Redo Catheter Ablation
Authors: Zaatari Ghaith , Bohorquez Jorge , Mitrani Raul , Ng Jason , Ng Justin , Rivner Harold , Velasquez Alex , Lambrakos Litsa , Arora Rishi , Goldberger Jeffrey J
Published: May 2021

Background:
Electrogram (EGM) morphology recurrence (EMR) mapping of persistent atrial fibrillation (PeAF) quantifies consistency of activation at each site and is expected to be high and rapid near drivers of PeAF.

Objective:
To compare EMR in the left (LA) and right atrium (RA) in patients undergoing first- vs second-time PeAF catheter ablation (CA).

Methods:
Multisite bipolar EGM mapping of the LA (265±153 sites) and RA (224±148 sites) prior to CA for PeAF was performed in 40 patients (29 males, age 63±9 yrs, CHA2DS2-VASc 2.4±1.5, LVEF 48±12%) undergoing first (Group 1, n=31) or second-time (Group 2, n=9) CA. After cross-correlation of each automatically detected EGM with every other EGM in the recording, the most recurrent EGM morphology was identified and its frequency (Rec%) and cycle length of recurrence (CL
R
) were computed (figure). The minimum CL
R
sites were identified.

Results:
In group 1, shortest CL
R
was in the LA in 26 patients (84%) and RA in 5 patients (16%). In the LA, there were 1 (n=23), 2 (n=2), or 3 (n=1) areas of shortest CL
R
, most commonly in the pulmonary veins (PV; n=19). In the RA, there was only 1 area of shortest CL
R
. Minimum CL
R
was 174.1±25.4 ms (LA-179.6±37.4 vs RA-207.9±34.5, p=0.0004), with Rec% 95±10%. In group 2, shortest CL
R
was in the LA in 5 patients and RA in 5 patients (56%)– one had both LA and RA. In the LA/RA, there were 1 (n=3/4) or 2 (n=2/1) areas of shortest CL
R
. The most common LA site was non-PV (6/7, 85.7%). The minimum CL
R
was 182.1±26.2ms (LA-190.8±36.2 vs RA-196.0±30.5, p=0.6), with Rec% 96±5%.

Conclusion:
In 61% of patients undergoing initial CA for PeAF, EMR identified LA drivers in the PVs which may explain why PV isolation has been reported to have 50-60% success rates in PeAF. In patients undergoing a 2
nd
ablation for PeAF, EMR identified predominantly nonPV drivers with even distribution of shortest CL
R
between RA and LA and diminished CL
R
gradient between the LA and RA. EMR may be a useful mapping tool to characterize potential drivers of PeAF.
Abstract 16911: Socioeconomic Status as a Predictor of Post-Operative Mortality and Outcomes in Carotid Artery Stenting vs Carotid Endarterectomy
Authors: Baxi Jigesh , Deng Xiaoyan , Soliman Fady K , Okoh Alexis K , Chao Joshua C , Volk Lindsay , Suhotliv Amy , Ady Justin , Rahimi Saum A , Russo Mark J , Lee Leonard Y
Published: May 2021

Introduction:
The association between socioeconomic status (SES) and adverse surgical outcomes represents an emerging area of concern. Furthermore, with regard to carotid stenosis, Carotid Artery Stenting (CAS) has been demonstrated to pose a greater risk of postoperative complications, such as stroke, than Carotid Endarterectomy (CEA). This study aims to compare the impact of low SES on patients undergoing Carotid Artery Stenting (CAS) versus Carotid Endarterectomy (CEA).

Methods:
The National Inpatient Sample (NIS) was queried from 2010 to 2015. Patients who underwent CAS and CEA were identified. Patients of the highest and lowest median income quartiles by zip code were selected and compared based on demographics, hospital characteristics, and comorbidities (Charleston Comorbidity Index: CCI). Primary and secondary outcomes were in-hospital mortality and postoperative stroke, respectively. Multivariable analysis was used to determine the effect of SES on in-hospital mortality.

Results:
3,516 and 1,909 underwent CAS; 22,852 and 15,547 patients underwent CEA in the low and high SES groups, respectively. Low SES was a significant independent predictor of mortality (OR = 2.07 [1.25-3.53], p = 0.005) for patients who underwent a CEA, but not for those undergoing CAS. CCI and age were strong predictors of mortality for both procedures (CAS odds ratio (OR)(age) 1.05[1.00-1.10] p = 0.05, OR(CCI) 1.45[1.17-1.80] p < 0.001; CEA: OR(age) 1.03[1.01-1.06] p = 0.01, OR(CCI) 1.60[1.45-1.77] p < 0.001). Of secondary outcomes, stroke was strongly associated with CEA, while bleeding was with CAS. [Figure 1].

Conclusions:
Low SES is a significant independent predictor of postoperative mortality in patients who underwent CEA, but not CAS. CEA is also associated with a higher incidence of stroke in these patients. These findings suggest that there may be a benefit to a minimally invasive approach (CAS) rather than the present standard of care (CEA), in selected low SES patients.
Abstract 16937: Gender Differences in Baseline Body Composition Profiles and Improvements With Visceral Fat-Focused Weight Loss Program
Authors: Dembrowski Gerald , Barnes Jessica
Published: May 2021

Cardiovascular disease (CVD) in women remains a leading cause of death. A recent study in the Journal of the American Medical Association highlighted the significant risk that central (or visceral) obesity confers in normal-weight postmenopausal women versus normal-weight women without central obesity- a 31% increase in premature death, including death from CVD and obesity-related cancer. Strategies targeting central obesity (visceral adipose tissue or visceral fat, VF) are a promising means to reduce the risk of, and events associated with CVD. A comprehensive telehealth program (20Lighter, 20L) combining patented customizable VLCD meal plans, nutritional supplementation, and expert daily oversight significantly reduces VF. Here we present data assessing body composition (BC) improvements between female (n= 931) and male (n= 1269) participants. We found the baseline BC profiles differed, with 3 of the 4 measures varying significantly between female and male participants (shown as female versus male, mean ± SEM): BMI (33.7 ±0.722 vs 35.4 ±0.511, p=0.0548), Body Fat (45.7% ±0.754 vs 38.8% ±0.613, p<0.0001), VF (15.2 ±0.664 vs 22.7 ±0.563, p<0.0001), and Intracellular Fluid (38.6% ±0.539 vs 45.2% ±0.303, p<0.0001) (Figure1A). Interestingly, while baseline measures differed, both women and men achieved the same magnitude of relative percentage improvements in BC measures: BMI (12.9% ±0.192 vs 13.3% ±0.228, p=0.1798), Body Fat (19.5% ±0.560 vs 19.7% ±0.634, p=0.8131), VF (24.7% ±0.643 vs 25.9% ±0.633, p=0.1837), and Intracellular Fluid (6.9% ±0.366 vs 7.9% ±0.486, p=0.0970) (Figure1B). Our data suggest that while women and men have different baseline BC profiles, they achieve equally statistically significant and clinically meaningful changes in outcomes in an expert-supervised, structured comprehensive program that are associated with risk reduction for CVD and CVD-associated events including premature death, heart attack, and stroke.
Abstract 16941: Diagnostic Performance of NephroCheck™ in the Prediction of Acute Kidney Injury in Neonates Undergoing Surgery for Congenital Heart Disease
Authors: Ramirez Michelle , Chakravarti Sujata , Ashley Gefen , Jaclyn McKinstry , Raj Sahulee , Alqaqaa Yasir , Busovsky-McNeal Melissa , Kumar T K , Malaga-Dieguez Laura
Published: May 2021

Introduction:
Acute kidney injury (AKI) is a common and serious complication in patients undergoing cardiac surgery and is associated with adverse outcomes. TIMP-2 and IGFBP-7 are cell cycle arrest proteins that are detected in urine during periods of kidney stress or injury. The NephroCheck™ system measures urine concentrations of these two biomarkers and calculates a score which has been validated in adults as a predictor of AKI. The utility of these markers in identifying AKI in neonates after congenital heart surgery (CHS) has not been determined.

Hypothesis:
Concentrations of TIMP-2 and IGFBP-7 as measured by the NephroCheck™ system will be elevated in neonates with AKI following CHS requiring cardiopulmonary bypass (CPB).

Methods:
We conducted a single center, prospective, observational study in neonates less than 31 days old undergoing CHS requiring CPB between 9/2017 and 5/2019. Urine samples were collected and analyzed using the NephroCheck™ system prior to surgery and at 6, 12, 24 and 96 hours (h) post CPB. All patients were evaluated for staging of AKI using the Acute Kidney Injury Network criteria (AKIN). Wilcoxon Rank Sum tests were used to compare the medians of the NephroCheck™ values in the AKIN negative and positive groups for each of the time points. ROC curves and AUCs with 95% CIs were used to measure how well the NephroCheck™ values predict the AKIN negative and positive status of the patients.

Results:
Thirty-six patients were included, 56% were male. Median age and weight were 7 days and 3.14 kg. Pre-surgically, no patients met AKI definition by AKIN criteria or by NephroCheck™ values. Post surgically, 52% of patients had AKI by AKIN criteria. All patients with AKI had elevated biomarkers. The presence of elevated biomarkers as determined by NephroCheck™ had a statistically significant association for the presence of AKI at the 6 h (p = 0.036) and 24 h (p = 0.00037) time points. Of all time points analyzed, samples obtained at 24h were best at predicting the development of AKI in the post-surgical period (AUC: 0.848).

Conclusions:
Elevation in urine concentration of TIMP-2 and IGFBP-7 is associated with AKI in neonates after CHS requiring CPB. Urinary biomarkers levels 24 h after CPB are good predictors of AKI in this population.
Abstract 16945: Total Artificial Heart Implantation in Patients With Intractable Ventricular Arrhythmias
Authors: Tushak Zackary , Doshi Amar , Quader Mohammed , Shah Keyur B
Published: May 2021

Ventricular arrhythmias (VAs) are pathological rhythms that are often incompatible with life and require decisive intervention. If the rhythm is refractory to treatment or causes hemodynamic compromise, mechanical support devices may be required. Oftentimes, patients with underlying heart failure do very poorly with VAs, requiring a higher level of support than can be achieved by most devices, with the exception of LVADs and TAHs. Mechanistically, a TAH is an orthotopic pneumatic biventricular mechanical support device that requires removal of the native cardiac ventricles and replacement with two artificial ventricles. Due to the nature of the procedure, the ventricular substrate, which causes VAs, is removed and the patient receives biventricular mechanical support. This case series retrospectively follows eight patients requiring implantation of a TAH due to intractable VAs between 06/2008 and 03/2017 at VCU Health. On arrival, all patients were in multiorgan failure and requiring hemodynamic support, including a varied combination of support devices, inotropes, and/or pressors. The median time of admission to implantation was 12.6 days. Major adverse events included cerebral vascular attack (CVA), significant bleeding requiring surgical intervention, and surgical site infection. Three patients had ischemic CVAs, three had significant mediastinal hematoma resulting in tamponade requiring intervention, and two had significant operative site infections requiring antibiotics and surgery. Of the original eight patients, six went on to undergo an orthotopic heart transplant, all were alive at one year follow-up. While adverse events can be serious and should be considered when evaluating for implantation, the use of a TAH can be beneficial in patients with intractable VAs and can be used to successfully stabilize patients who would otherwise perish.
Abstract 16947: Barriers to Care in Urban and Rural Dwelling Patients With Adult Congenital Heart Disease
Authors: McGrath Lidija B , Taunton Marshall , Levy Sheldon , Kovacs Adrienne , Broberg Craig S , Khan Abigail
Published: May 2021

Introduction:
Adult congenital heart disease (ACHD) patients face a unique set of medical, psychological, and social challenges, and access to specialized ACHD care has been shown to improve their outcomes. Rural ACHD patients may represent a uniquely disadvantaged group given their complex health care needs and the distance they must travel to access care. The aim of this study was to investigate the challenges faced by ACHD patients in accessing outpatient cardiac care, with a specific focus on understanding barriers related to distance from care.

Methods:
This cross-sectional, survey-based study took place in the ACHD clinic at an academic medical center in a metropolitan area. Additional medical information was abstracted in a retrospective manner from the electronic health record. T-tests and Chi-square tests were used to investigate the relationship between variables.

Results:
A total of 100 patients participated in the study (mean age 40 ± 13 years, 60% female, 18% rural dwelling). The median driving distance to clinic was 20 miles (interquartile range 12 to 77 miles). The most commonly identified barriers to cardiac clinic visits were the financial losses related to taking time off from work (39%), distance of clinic from home (33%), and the weather (33%), whereas finding a ride to clinic, finding childcare, or the time of available clinic appointments were not perceived as significant barriers. As compared to urban dwelling patients, those who were rural dwelling had a lower level of education (p=0.04), more difficulty paying insurance premiums (p<0.001) and copays (p=0.005), and were more likely to identify the distance from clinic (p=0.05) and having to go into the city (p=0.02) as barriers to clinic appointments.

Conclusions:
Loss of compensation from taking time off work to attend a visit and distance to clinic were the most commonly identified barriers to outpatient cardiac care in this cohort of ACHD patients. These barriers, along with difficulty paying insurance premiums, are more common in rural dwelling patients. Initiatives such as telemedicine visits or providing financial subsidies for travel and treatment could help to expand specialty ACHD care and better serve this growing patient population.
Abstract 16962: Maladaptive Atrial Remodeling in Muscular Dystrophy
Authors: Kappalayil Anishka P , Sheth Rahul , Jiang Xuan , Cheeran Daniel , Ayers Colby , Araj Faris , Amin Alpesh , De Lemos James A , Drazner Mark H , Zaha Vlad G , Peshock Ronald M , Mammen Pradeep P
Published: May 2021

Background:
Muscular dystrophies (MD) are genetic disorders that cause progressive peripheral skeletal myopathies. The majority of MD patients will develop atrial and ventricular arrhythmias and/or an associated cardiomyopathy with a high degree of morbidity and mortality. However, it remains unknown the degree of atrial remodeling that may also occur in MD patients. We hypothesize maladaptive atrial remodeling occurs in MD patients.

Methods:
Utilizing the UT Southwestern Cardiomyopathy Clinic, MD [total: 79 patients (34 females, 45 males)] and non-ischemic cardiomyopathy (NICM) [total: 81 patients (29 females, 52 males)] patients were identified who underwent a cardiac MRI (cMRI) between 2011 and 2015. A matched, healthy control cohort from the Dallas Heart Study (DHS) [total: 101 patients (40 females, 61 males)] were identified. Most MD patients had Duchenne/Becker MD, Limb-Girdle MD or myotonic MD. Two blinded, independent readers made volumetric measurements from cMRIs to assess right atrial (RA) and left atrial (LA) dimensions with low inter-reader variability. A third independent investigator analyzed the RA and LA data with aggregate data presented in the Table. The statistical significance of the data (p<0.05) was assessed by performing an unpaired two-tailed Student’s t-test and a one-way analysis of variance (ANOVA) between groups with a Bonferroni’s post-test analysis.

Results:
Analysis of the cMRI data revealed significant differences in both the structure and function of the RA and the LA between MD and NICM patients. In addition, the data revealed significant differences in the LA but not the RA emptying fraction in MD patients as compared to the DHS patients.

Conclusion:
Collectively, the data suggests MD patients develop significant maladaptive remodeling of the LA but not the RA, predisposing these patients to atrial arrhythmias. Investigation into differences in atrial remodeling as a function of gender and the type of MD need to be explored.
Abstract 16967: Predictors for Recovery of Ejection Fraction in Urban Cohort of Patients With Heart Failure
Authors: Francois Jonathan , AlSadawi Mohammed , Abrahim Christian , Ortega Romy R , Bukharovich Inna
Published: May 2021

Introduction:
Despite the clinical and economic impact of heart failure with reduced ejection fraction (HFrEF), understanding surrounding factors associated with resolution of ejection fraction (EF) as well as its prognostic value, remains elusive.

Hypothesis:
Predictors for Recovery of EF may differ in African Americans compared to the general population.

Methods:
We conducted a single center retrospective chart review on patients following up in the adult heart failure clinic at our inner city hospital located in Central Brooklyn. Chart review of 312 patients was performed and data including, demographics, comorbidities, medications and echocardiographic parameters. Patients not on an ACE inhibitor or angiotensin receptor blocker (ARB) were excluded as were those with a diagnosis of heart failure with preserved ejection fraction.

Results:
Of 312 patients identified, 158 (50.6%) were male and 289 (92.6%) identified as African in ancestry. Mean time since diagnosis was 86.2 months (SEM 4.9). There were 113 (36.2%) patients who had recovery of ejection fraction to greater than 50%. There were 59 patients on Angiotensin Receptor-Neprilysin Inhibitor (ARNI) therapy. Patients on ARNI were less likely to have ventricular recovery with an Odds Ratio (OR) of 0.484. The duration of heart failure in the patients with ARNI was significantly less than those on ACE/ARB therapy, 29.15 months versus 99.49 months respectively (2 tailed P value for difference of means <0.0001). Beta blocker use and Aldosterone antagonism were also associated with a reduced likelihood of recovery in ejection fraction (OR 0.177 and 0.294) respectively. Other classes of medication as well as comorbidities including an ischemic etiology had no statistically significant impact.

Conclusion:
In our predominantly African American cohort of patients, key GDMT medication including ARNI, Beta blockers and aldosterone antagonists reduced the odds of EF recovery.
Abstract 16969: Burden of Cardiovascular Disease, ECG Patterns and Echocardiographic Data Among COVID-19 Survivors and Non-Survivors at a Large Health System in New York
Authors: Devanabanda Arvind , Mahmood Eitezaz , SINGH Avneet , Meraj Perwaiz , Ismail Haisam , jauhar rajiv
Published: May 2021

Introduction:
The prognostic importance of cardiac and metabolic risk factors among COVID-19 patients is unknown. The aim of our investigation is to report clinical significance of risk factors, ECG patterns, inflammatory markers and LVEF for survival with COVID-19.

Methods:
10,018 patients and ECGs, from 13 hospitals in New York City area were included in this retrospective analysis between March 1 and April 30, 2020. Survivors and non-survivors were studied for presence of comorbidities and clinical outcomes of length of stay (LOS), ICU stay, ventilator use, inotrope use and pressor use. Differences between the groups were compared with the Student t test.

Results:
There were 7,837 survivors and 2,181 non-survivors.
Table
shows more patients with age > 65 died. Hypertension, diabetes, obesity, coronary artery disease, heart failure and peripheral vascular disease, COPD, chronic kidney disease were significantly elevated in non-survivors. Admission Inflammatory markers were significantly elevated in non-survivors. Significantly increased ECG intervals of QRS, QTc, atrial fibrillation, atrial flutter, and bundle branch block were noted in non-survivors. LVEF < 40% was significantly higher in non-survivors. ICU stay, LOS, pressor use and ventilator use were significantly elevated in non-survivors.

Conclusions:
More patients with age > 65 were survivors. Among non-survivors, cardiac, metabolic comorbidities, burden of atrial arrhythmias, admission inflammatory markers, LVEF< 40%, and clinical outcomes were significantly worse.
Abstract 16976: Derangements in Cardiac Oxidative Metabolism in Humans With Dilated Cardiomyopathy
Authors: Clark Daniel , Davogustto Giovanni E , Bell Susan P , MALLUGARI RAVINDER , Bradham William S , Lawson Mark , Gupta Deepak K , Kronenberg Marvin W
Published: May 2021

Introduction:
Dilated cardiomyopathy (DCM) is associated with impaired myocardial perfusion reserve and impaired myocardial oxidative metabolism. However, the association between myocardial perfusion reserve and oxidative metabolism, is not fully understood.

Hypothesis:
Reduced myocardial perfusion reserve is associated with reduced myocardial oxidative metabolism.

Methods:
Using non-invasive cardiac imaging, we studied 8 DCM patients and 14 normal subjects. Myocardial perfusion reserve index (MPRI) was calculated using cardiac magnetic resonance as the normalized rate of myocardial signal augmentation following gadolinium contrast injection between rest and regadenoson induced stress. Resting oxidative metabolism was calculated as the myocardial mono-exponential decay rate (Kmono) of [
11
C]acetate by positron emission tomography normalized per unit demand (rate-pressure product, RPP) (Kmono/RPP).

Results:
MPRI was lower in DCM compared to controls (1.25 ± 0.22 vs 1.59 ± 0.49, p=0.038). Similarly, Kmono/RPP was lower in DCM compared with normal subjects (0.6x10e-3 ± 0.15 x10e-3 vs 1.2x10e-3 ± 0.9x10e-3, p<0.0001). There was a linear relation between Kmono and RPP in normal subjects. However, DCM patients showed no increase in Kmono regardless of RPP (Figure 1A). Kmono/RPP was not significantly related to MPRI in either group (Figure 1B).

Conclusions:
Patients with DCM exhibit markedly impaired myocardial oxidative metabolism compared to normal subjects. However, this impairment was not quantitatively related to impaired myocardial perfusion reserve. Of the various mechanisms that could explain decrease in oxidative metabolism in DCM, these data suggest that reduced myocardial perfusion is not the principal driver of impaired oxidative metabolism.
Abstract 16997: Reaffirmation of GPD1L-A280V as a Brugada Syndrome Disease-Causing Variant
Authors: Greiner Alexander , Mehdi Haider , Cevan Chloe , Gutmann Rebecca A , London Barry
Published: May 2021

Introduction:
Brugada Syndrome (BrS) is an inherited arrhythmia syndrome characterized by ST-segment elevation in the right precordial leads (V1-V3) and sudden cardiac death; ~20% of cases are caused by mutations in
SCN5A
. Over the past two decades, over 20 genes that may cause BrS have been identified. We reported that a Glycerol-3-Phosphate Dehydrogenase 1-Like mutation (GPD1L;p.A280V, chromosome 3p22.3) was linked to BrS in a large, multigenerational family with a LOD score ~4. Recent efforts in the field have called into question the pathogenicity of non-
SCN5A
genetic variants in BrS.

Hypothesis:
We sought to confirm the role of GPD1L in this family using a high density SNP array to narrow the linkage region and whole exome sequencing (WES) of the proband to rule out other possible mutations. We also sought to test whether BrS susceptibility SNPs in
SCN5A
and
SCN10A
linked to
GPD1L
may play a role in this family.

Methods:
SNPs were identified on an Illumina Global Screening Array and used for fine mapping. The exome of the proband was captured with the Agilent V6+UTR kit. SNPs were called using GATK3. BrS susceptibility SNPs were confirmed by PCR amplification and Sanger Sequencing.

Results:
The linkage region in this family resolved to ~3.07 MB (hg19; 3:29,899,567-32,970,637; Figure). This region contained 14 genes including
GPD1L
, and lacking
SCN5A
,
SCN10A
, or any other BrS-associated gene. WES identified GPD1L;p.A280V as the only coding variant in the linkage region with an allele frequency ≤ 1%. Previously identified BrS risk alleles in
SCN5A
and
SCN10A
were linked to the GPD1L;p.A280V allele in most family members (Figure).

Conclusions:
Our data suggests that GPD1L;p.A280V causes BrS in this family. The pathogenicity of GPD1L;p.A280V may be increased by linkage with
SCN5A
and
SCN10A
risk SNPs. The role of
GPD1L
mutations in the pathogenesis of BrS should be reaffirmed.
Abstract 17002: Assessment of Exercise Function in Children With Hypertrophic Cardiomyopathy
Authors: Przybylski Robert , Alexander Mark E , Colan Steven D , Miliaresis Christa , Rhodes Jonathan
Published: May 2021

Introduction:
Hypertrophic cardiomyopathy (HCM) accounts for nearly half of pediatric cardiomyopathies. While impaired exercise function has been described in adults with HCM, little is known about exercise function in children with HCM.

Hypothesis:
Children with HCM have impaired exercise function.

Methods:
A retrospective cohort study was performed. Pts <21 years with a diagnosis of HCM with a cardiopulmonary exercise test (CPET) between November 1, 2002 and May 31, 2019 were included. Pts with syndromic HCM were excluded. CPETs with respiratory exchange ratio <1.09 were excluded. We compared indices of exercise performance to established population normal values using one-sample T-tests. In pts with multiple CPETs, we compared indices of exercise performance from the first to last CPET using paired T-tests.

Results:
We identified 124 pts with 240 CPETs. The average age at time of CPET was 14.8 ± 3.0 years. Average %predicted peak VO2 (78 ± 20%) was significantly less than the population average (p <0.01), though there was wide variability (range 35-152% predicted). Peak VO2 was <85% predicted in 67%, <50% predicted in 7%, and absolute peak VO2 was <25 cc/kg/min in 30% of tests. However, %predicted peak VO2 was >100% in 13% of tests. The %predicted peak O2 pulse (88 ± 21%; p <0.01; a surrogate for the forward stroke volume at peak exercise) and the %predicted peak heart rate (88.0 ± 12%; p <0.01) were significantly lower than established population normal values. In 63 pts with multiple CPETs, significant declines in %predicted peak VO2 (83 ± 20% v. 75 ± 19%; p <0.01) and O2 pulse (92 ± 22% v. 86 ± 21%; p <0.01) were observed at an average interval of 4.5 years. We found no statistically significant association between %predicted peak VO2 and interventricular septal thickness, resting left ventricular outflow tract gradient or echocardiographic indices of diastolic left ventricular function.

Conclusions:
Exercise function is at least moderately impaired in a substantial portion of children with HCM and this impairment tends to worsen over time. However, there is a significant subset of patient with remarkably well-preserved exercise function. Echocardiographic measurements did not correlate with exercise function in our cohort.
Abstract 17004: Using mHealth to Capture Patient-Reported Sexual Satisfaction in Heart Failure
Authors: Taylor Brittany N , Reading Turchioe Meghan , Goyal Parag , Masterson Creber Ruth M
Published: May 2021

Introduction:
Over 60% of heart failure (HF) patients have reported problems with sexual satisfaction, which is a major reason for medication non-adherence. While many patients are reticent to verbally self-report impaired sexual satisfaction, mobile health (mHealth) technology may improve patient comfort in reporting these symptoms. We aimed to evaluate the feasibility of HF patients using mHealth to self-report sexual satisfaction by comparing responders to non-responders and evaluating symptom burden.

Methods:
We prospectively recruited HF patients from inpatient and outpatient cardiology clinics at an urban academic medical center from October 2016 to January 2017. Patients completed Patient Reported Outcomes Measurement Information System (PROMIS
®
) questionnaires via an mHealth application,
mi.Symptoms
. The specific outcomes of interest were fatigue- and pain-related impairment of sexual satisfaction, due to the prevalence of those symptoms in HF. Data were analyzed using descriptive statistics and Chi-square tests to evaluate differences between responders and non-responders.

Results:
The mean age of participants (n=168) was 59 years (±12.5); 37% were female; 37% were Latino; 32% were Black, 32% White, and 36% Other Race
.
Few significant differences in demographic characteristics of responders and non-responders were noted (
Table
). Of the 117 participants (69.6%) who responded regarding fatigue, 59 (50.4%) indicated that fatigue affected sexual satisfaction “quite a bit” or “very much.” Of the 114 participants (67.9%) who responded regarding pain, 44 (38.6%) indicated that pain affected sexual satisfaction “quite a bit” or “very much.”

Conclusion:
This study showed that mHealth can be a feasible way to collect sexual satisfaction data with fairly high response rates and few differences between responders and non-responders. Participants’ reported high burden of impairment underscores the importance of measuring this symptom.
Abstract 17010: Predicting Risk of Sudden Death With QT Interval-Prolonging Medications
Authors: Chugh Nanki , Bloomfield Sol , Leitner Oliver , Uy-Evanado Audrey , Chugh Sumeet , Reinier Kyndaron
Published: May 2021

Background:
The ongoing pandemic has re-emphasized how QT-prolonging drugs can increase risk of sudden cardiac death (SCD), but azithromycin and hydroxychloroquine are only 2 of many such medications. There remains a critical need to identify individuals who are at high risk of SCD based on their demographic and clinical profile.

Hypothesis:
A modified Tisdale Score (TS), originally designed to assess risk of QTc (corrected QT interval) prolongation with QT-prolonging drugs, could also predict risk of SCD.

Methods:
From the ongoing Oregon Sudden Unexpected Death Study (ORESUDS), we identified a subgroup of SCD patients with coronary artery disease (CAD) and controls (individuals with and without CAD but no history of SCD) on at least one QT-prolonging medication enrolled between 2002 and 2020. Analysis was restricted to subjects with available pre-arrest medical history, including ECGs with QT interval available and details of prescribed medications. We identified QT prolonging drugs from the comprehensive list at crediblemeds.com. Our TS included age, sex, use of loop diuretics, serum potassium levels, history of acute myocardial infarction, history of heart failure, and number of QT prolonging drugs. We used a univariate logistic regression to determine the predictive power of the modified TS for SCD. We performed a backwards stepwise logistic regression considering race/ethnicity, diabetes, and hypertension in addition to TS to improve SCD prediction.

Results:
A total of 964 cases (60% male, mean age 68 years) and 668 controls (62% male, mean age 67 years) met inclusion criteria. TS ranged from 0 to 12 and mean TS was 5.86 ± 2.93 in cases and 4.29 ± 2.74 in controls (p < 0.001). A 1-unit increase in the modified TS was a significant predictor of SCD (odds ratio (OR) 1.21, 95% confidence interval, 1.17 to 1.26). In the multivariable model predicting SCD, both the modified TS (OR 1.20, 95% CI, 1.15 to 1.25) and diabetes (OR 1.42, 95% CI, 1.14 to 1.78) were significant independent predictors of SCD.

Conclusion:
A modified Tisdale Score predicts SCD, and history of diabetes could potentially enhance the utility of this user-friendly clinical tool. These findings have implications for prescription of QT-prolonging drugs, especially during the ongoing pandemic.
Abstract 17013: Voltage Resolution of Standard Bipolar and Omnipolar Ventricular Electrograms
Authors: Jacobson Jason T , Natarajan Gautam , Deno D. Curtis , Reade Daniel , Qanud Khaled , Cervantes Daniel O , Pizzo Emanuele , Iwai Sei , Rota Marcello
Published: May 2021

Introduction:
Standard bipolar voltage (BiV) mapping is dependent on bipole axis orientation compared to the direction of the activation wavefront. In contrast, omnipolar mapping technology (OmniT) allows for direction-independent voltage measurement, yielding a maximum for each site sampled. However, it is unclear if normal voltage values are the same for BiV and OmniT.

Hypothesis:
To determine whether electrical signal obtained with OmniT are greater than BiV, using a single 4x4 grid array catheter (HD Grid) inserted in the left ventricle (LV) of an experimental animal.

Methods:
HD Grid consists of 4 splines, allowing for orthogonal bipoles along (AL) a single spline and across (AC) adjacent splines, allowing for simultaneous OmniT and BiV evaluation. Animals (n=3) underwent transseptal LV mapping during sinus rhythm (SR) and right ventricular pacing (RVP) using HD Grid (4mm interelectrode spacing). Abbott Precision research software was used to generate electroanatomic maps. Peak-to-peak voltage data for OmniT and BiV, both along and across the splines, were exported to a spreadsheet. Data were normalized via log transformation and compared with t-test.

Results:
Mean voltages and 95% confidence interval for OmniT were consistently greater than BiV AL and AC for both SR and RVP (p<0.05), while BiV AL and AC were comparable. No difference was seen when comparing each method during SR and RVP. The absolute BiV difference due to orientation was significant. See Table.

Conclusions:
Amplitude of OmiT electorgrams are greater with respect to BiV, which is consistent with the ability of omnipolar technology to capture maximal signals independently from waveform direction. This should be taken into account when determining the optimal OmniT value for ventricular scar.
Abstract 17014: Cardiologist Assessment and Approval Was the Primary Predictor of Kidney Transplant Candidacy and Transplantation Among Patients With Reduced Left Ventricular Ejection Fraction
Authors: Madden Michelle , Gallen Rory , LeMond Lisa , Steidley D Eric , Keddis Mira
Published: May 2021

Introduction:
End stage renal disease (ESRD) patients with concomitant heart failure (HF) are often denied kidney transplantation (KTx). The aims of this study were to explore factors predictive of suitability for KTx and to assess cardiovascular (CV) outcomes in patients with impaired left ventricular ejection fraction (LVEF) presenting for KTx evaluation.

Methods:
We evaluated 109 consecutive adults with LVEF≤40% at the time of initial KTx evaluation between 2013 and 2018. Post-transplant CV outcomes were defined as non-fatal MI, admission for HF, CV death and all-cause mortality.

Results:
Mean age was 58.2 years (SD11.9), 78% were male, 58% had diabetes, 70% had history of CV events and 42% had ischemic cardiomyopathy. Mean LVEF was 31.5% (SD 6.47). Eighty patients had nuclear stress imaging; 10% were positive for reversible ischemia and 43% for prior infarct. Mean VO2max was 14.4(SD 5.71)ml/kg/min (31 patients). A cardiologist evaluated 93% of patients and was present at 58% of selection committee meetings. Twenty-four patients (22%) were denied by a cardiologist for KTx and 59 (54%) were denied by the selection committee, of whom 43 were due to CV risk. On univariate analysis, the variables associated with denial for KTx were: cardiologist denial, denial due to CV risk, Native American race (6% of cohort), higher NT-pro-BNP, prior MI, coronary intervention, positive stress study, anemia, lower EF and lower VO2max (all p<0.05). On multivariate analysis, cardiologist denial was the only significant predictor of denial for KTx (OR: 29.4, p=0.0007). At median follow-up of 15 months, 5 (5%) suffered non-fatal MI, 13 (12%) were hospitalized for HF exacerbation and 17 (16%) died. Only 22 (20%) underwent KTx. Post-KTx, there was one death, one non-fatal MI and 3 hospitalizations for HF. Mean LVEF improvement was 16% (SD12.9).

Conclusions:
Only 38% of ESRD patients with LVEF≤40% presenting for KTx evaluation were approved and of those, only 52% received KTx. Cardiologist approval was the primary predictor of suitability for KTx. Despite careful selection, prevalence of CV events and mortality after KTx was 23%. There is need for a consistent multidisciplinary approach during KTx evaluation, including cardiologist input, to improve CV outcomes.
Abstract 17015: Understanding Sex Differences With Cardiac Risk Factors in the Young Adult Population
Authors: Davis Erica , Wood Kathryn A , Cimiotti Jeannie , Higgins Melinda , Gary Rebecca , Dunbar Sandra
Published: May 2021

Introduction:
The prevalence of coronary artery disease (CAD) is increasing in young adults (YA) (age<40 years), and greater understanding of their cardiac risk factors is essential to create effective preventive strategies. Given the sex differences for CAD observed in older adults, understanding if sex differences exist for CAD risk factors in YAs is important.

Hypothesis:
There will be several risk factors associated with CAD in YAs that will differ between men and women.

Methods:
In this secondary analysis, 125,017 YAs between the ages of 18-44 were evaluated for health conditions and behaviors considered to be risk factors for CAD. The 2017 Behavior Risk Factor Surveillance System database from the Center for Disease Control was utilized. Frequency procedures, chi-square testing, and logistic regression modeling with odds ratios were analyzed using (SAS) 9.4 software.

Results:
Greater percentages of men (65.5%) than women (56.7%) were found to be overweight (BMI 25-30) or obese (BMI =>30) (p<.0001). Men reported higher rates of hypertension with 18.6% as compared to women with hypertension at 11.5% (p<.0001). High cholesterol and heavy alcohol consumption were characteristic of men in this sample with percentages at 17.8% for high cholesterol and 7.5% for heavy alcohol use. YAs between the ages of 40-44 were over 2 times as likely to develop CAD than those aged 18-24, odds ratio (OR) 2.4. YAs between the ages of 25-29 were least likely to develop CAD compared to 18-24 with the lowest OR 1.3. Overall, significant risk factors for developing CAD in this population were HTN (OR 4.1), age 35-44 (OR >2.2), high cholesterol (OR 2.2), smoking (OR 1.9), and prediabetes (OR 1.7). Physical activity (OR 0.6) and healthcare coverage (OR 0.7) were protective factors against CAD. There were 276 young adults in all who were diagnosed with CAD in this analysis.

Conclusions:
Greater efforts are needed to reduce the number of risk factors in YAs and prevent the development of CAD. There were significant gender differences noted in CAD risk factors within the YA population. Targeted interventions should include counseling as outlined in the American Heart Association Life’s Simple 7 Campaign in an effort to improve cardiovascular health in young adult men and women.
Abstract 17021: A Novel Human Relaxin Receptor Agonist, ML290, Attenuates Atherosclerosis- and Chronic Kidney Disease-Induced Vascular Calcification in Mice
Authors: Ng Hooi Hooi , Medina Daniela , Agoulnik Alexander I , Hutcheson Joshua
Published: May 2021

Introduction:
Vascular calcification is the most significant predictor of cardiovascular morbidity and mortality, but therapeutic options are unavailable. Relaxin has emerged as a vasoprotective molecule, but several drawbacks prevent therapeutic translation. Targeting the relaxin receptor, RXFP1, is safe and well-tolerated in animal models of vascular disease and humans. We identified a biased allosteric agonist of human RXFP1, ML290, and aimed to test the hypothesis that ML290 arrests the progression of vascular calcification in mouse models of atherosclerosis and chronic kidney disease (CKD).

Methods and Results:
Recurrent treatment with ML290 significantly prevented (
P
= 0.0422,
n
= 8) and reversed (
P
= 0.0489,
n
= 6) atherosclerotic calcification in humanized (
hRXFP1/hRXFP1
)

Apoe
-/-

mice fed an atherogenic diet. Longitudinal tracing of mineral formation in the aortic arch of these mice revealed the presence of mineral in vehicle- but not ML290-treated mice after 15 weeks of diet. Accelerated mineral growth was observed in vehicle-treated mice after 20 weeks of the diet, which was reduced by ML290 treatment. In humanized mice with CKD, ML290 significantly prevented (
P
= 0.0344,
n
= 9) medial calcification.
In vitro
, ML290 reduced (
P
= 0.0005,
n
= 3) superoxide production under osteogenic conditions in vascular smooth muscle cells (VSMCs). Osteogenic changes in VSMC phenotype associate with a release of alkaline phosphatase (ALP) in extracellular vesicles (EVs), which promote mineralization. ML290 treatment significantly (
P
= 0.0001,
n
= 3) suppressed the formation of ALP-loaded EVs
in vitro
. Bone morphogenetic protein-4, an inducer of osteogenic transitions, and caveolin-1, a scaffolding protein required for calcifying EV formation, were significantly (
P
= 0.0059,
n
= 4) down-regulated after 24 h treatment with ML290 compared to vehicle-treated VSMCs under osteogenic conditions.

Conclusions:
We demonstrate the therapeutic potential for ML290 to mitigate atherosclerosis and CKD-induced vascular calcification
in vivo
. The actions of ML290 to prevent medial calcification are in part attributed to its ability to limit the release of calcifying EVs as a result of osteogenic differentiation, and to reduce vascular superoxide production.
Abstract 17029: Risk Stratification and Real World Incidence of Cardiac Toxicity With Immune Checkpoint Inhibitors
Authors: Hu Jian , Shnoda Mina , Pappan Nikos , Kyvernitakis Andreas , Poornima Indu G
Published: May 2021

Introduction:
Awareness of cardiac toxicity with immune checkpoint inhibitor (ICI) therapy is increasing with emerging data on the manifestations and diagnosis of cardiotoxicity. However, risk stratification of these patients remains undefined.

Hypothesis:
We examined associations of traditional cardiovascular risk factors with ICI cardiotoxicity and patterns of cardiac evaluation prior to and during ICI therapy within a quaternary integrated health network.

Methods:
We reviewed patients on ICIs for atherosclerotic cardiovascular disease (ASCVD) risk factors, cardiology office visits, patterns of screening for cardiac disease (ECG, echocardiogram, cardiac biomarkers), and correlated with the incident of cardiac adverse events.

Results:
We studied 344 patients receiving ICIs for lung cancer (50%), melanoma (15%), and other malignancies (34%). Smoking (75%), hypertension (71%), and hyperlipidemia (49%) were the most common ASCVD risk factors. Pre-ICI initiation cardiac evaluation included ECG in 60%, TTE in 37%, and 63% of patients had at least one ECG or TTE while on ICIs. Less than 20% were seen by Cardiology before ICI therapy, despite 81% having ≥2 ASCVD risk factors. Cardiac toxicity with ICIs was observed in 12% of patients and was significantly more common in those with more ASCVD risk factors (4.6% vs 9.7% vs 16.4% with 0-1 vs 2-3 vs ≥4 ASCVD risk factors, respectively; P= 0.03) and in patients with atrial fibrillation (AFib) before ICI initiation (26.5% vs 8.5% without AFib; P=0.0008). ICIs were discontinued in 87 patients, of which 15% were due to cardiac toxicity.

Conclusions:
The incidence of cardiac toxicity is high, especially in patients with multiple ASCVD risk factors or AFib, and is often the reason for ICI discontinuation, warranting close surveillance prior to and during therapy. Cardiac evaluation and monitoring for cardiotoxicity were infrequent in patients receiving ICI therapy, despite the high prevalence of ASCVD in this population.