bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13361: How Does Depression Influence Symptom Perception in Patients With Heart Failure?
Authors: Lee Solim , Ketcham Amy , Guerin Julie , Koons Brittany , Matura Lea Ann , Jurgens Corrine Y , Dickson Victoria V , Riegel Barbara J
Published: May 2021

Despite the high prevalence of depression in HF, little is known about how depression affects symptom perception processes of monitoring, detection, and evaluation. If depression impairs symptom perception, it may delay care-seeking.

Aim:
To explore how depression influences HF symptom perception.

Methods:
We enrolled a purposive sample of patients with an unplanned HF hospitalization in this convergent mixed-methods study. Semi-structured in-person interviews were used to explore how patients monitored, detected, and evaluated symptoms prior to hospitalization. HF symptom monitoring, physical symptom presence/severity, and symptom evaluation were measured using the Self-care HF Index, the HF Somatic Perception Scale, and the Illness Perception Scale, respectively. Depression was measured using the Patient Health Questionnaire (PHQ8); score≥10 indicates moderate/severe depression. Qualitative data were analyzed using content analysis to yield categories of symptom type, detection time, and barriers/facilitators for symptom monitoring, detection, and evaluation. To integrate the data, qualitative data were quantified by assigning binary values (e.g. immediacy of symptom detection). Pearson’s correlation and Chi
2
were used to analyze associations.

Results:
A sample of 40 patients (age 62±13 years, 50% female, 55% White, median HF duration 6 years, 75% NYHA III-IV, 58% PHQ8≥10) was enrolled. There was no significant association between depression and HF symptom monitoring, but moderate/severe depression was described as a barrier to symptom monitoring ("When I get into my depression days, I won't get on the scale, or I just won't do anything."). Depressed patients appeared to detect symptoms more rapidly (p=0.051). More depressed patients reported greater physical symptom severity (r=0.44, p=0.005), but the number of symptoms was not associated with depression. More depressed patients had stronger belief in negative consequences of HF (r=0.46, p=0.003), more negative emotional responses to HF (r=0.60, p<0.001), and less perceived control over HF (r= -0.35, p=0.028).

Conclusion:
Depressed patients may have difficulties in symptom monitoring, but not in symptom detection. Depression negatively influences symptom evaluation.
Abstract 13365: Risk-benefit Evaluation in Cessation of Renin-angiotensin-aldosterone Inhibitors in Hyperkalemic Heart Failure Patients: A Japanese Real-world Study From Nationwide Administrative Database
Authors: Kohsaka Shun , Ishizu Tomoko , Okami Suguru , Kikuchi Takashi , Mogalli Rashad , Yajima Toshitaka
Published: May 2021

Introduction:
Hyperkalemia (HK) is frequently encountered in patients treated with renin-angiotensin-aldosterone system inhibitors (RAASi), and is associated with increased mortality in heart failure (HF). While cessation of RAASi is considered an option in HK patients, the serum potassium (sK) threshold for RAASi cessation in HF patients remains unclear . Herein, we sought to assess the impact of RAASi cessation or continuation on risk-benefit balance of hyperkalemic HF patients using propensity score (PS)-matched and cubic spline regression analysis in a nationwide administrative database.

Methods:
An observational retrospective study was conducted using Japanese hospital claims dataset (April 2008-September 2018). HK was defined as at least two sK ≥5.1 mmol/L within 12-months interval. We examined HK patients on RAASi in HF by employing PS matching to compare risk-benefit between patients with or without RAASi cessation. Cubic spline regression was fit to calculated hazard ratios (HR) in each sK strata for this assessment.

Results:
Out of 1,208,894 patients, 5,059 HF with HK patients with RAASi prescriptions met inclusion criteria (mean age 76.63 ±10.96 years). Mean follow-up period was 2.75 ± 1.9 years. Cumulative incidence of RAASi cessation was 34.73% at 1 year. Cessation of RAASi was associated with incremental risk of death (+19%, P=0.009) and hospitalization (+14%, P=0.002) , whereas recurrent HK risk was decreased (-60%, P<0.0001). In PS matching analysis, mortality 12 months after RAASi cessation was greater with HR of 1.33, cessation vs. no cessation ( 95% CI: 1.09-1.64, p=0.006; increased mortality risk was observed in mild (≥5.1 and <5.5 mmol/L) to moderate (≥5.5 and < 6.0 mmol/L) HK with RAASi cessation (Figure).

Conclusions:
Our results suggest that HK management by RAASi cessation should be avoided especially in HF patients with mild to moderate HK considering the worsening risk-benefit balance.
Abstract 13374: Larger Atria and Increased Atrial Filling Pressures in Corrected Atrial Septal Defect Patients
Authors: Karunanithi Zarmiga , Andersen Mads , Mellemkjær Søren , Alstrup Mathias , Waziri Farhad , Poulsen Steen , Hjortdal Vibeke
Published: May 2021

Introduction:
After atrial septal defect (ASD) correction, pulmonary arterial pressures drop and the right-sided chambers start to remodel. Full normalization may not occur, which can explain the increased morbidity and mortality observed later in life. We described cardiac physiology in adults with a corrected ASD in order to understand the long-term morbidity and mortality.

Hypothesis:
ASD patients have enlarged right atria and increased pulmonary arterial pressures despite correction.

Methods:
Participants (percutaneously (n=19) and surgically (n=19) corrected ASD patients and 11 controls of similar age) underwent echocardiography, International Physical Activity Questionnaire, right heart catheterization, cardiopulmonary exercise test, and Holter-monitoring 15-20 years after ASD correction as part of a larger study. Echocardiographic measurements and invasive pressures obtained at rest are reported.

Results:
Right and left atrial end-systolic volumes, volume index, and filling pressures are higher in corrected ASD patients (particularly the surgically corrected) when compared with controls.

Conclusion:
ASD patients (particularly surgically corrected) have higher atrial volumes compared with healthy matched controls 15-20 years after correction, while still within the normal range. During systole, the peak atrial pressures are increased in ASD corrected patients, which correlate well with the atrial volumes seen on echocardiography. These findings show that cardiac remodeling has occurred post-correction, but full normalization is not reached. The differences in atrial size and filling pressure in corrected ASD compared to that in controls may be a marker of ASDs leading to myocardial disease and explain why ASD patients experience increased morbidity and mortality later in life.
Abstract 13384: Cangrelor Pk / Pd Analysesin Neonates After Palliation of Congenital Heart Disease (chd)
Authors: Diacovo Thomas G , Vargas Diana , Zhou Hairu , Yu Xinren , Diamond Scott L , Yeh Justin , Allada Vivekanand , Krishnamurthy Ganga , Schmidhofer Joseph , Kreutzer Jacqueline , Vincent Julie A , Morell Victor , Bacha Emile
Published: May 2021

Background:
Thrombotic events contribute significantly to early mortality in neonates with CHD requiring a systemic-to-pulmonary artery shunt. However, thromboprophylaxis remains suboptimal with few pharmacological agents studied and shown to be of benefit. The P2Y
12
inhibitor cangrelor is effective in preventing early coronary artery stent thrombosis in adults. Cangrelor dosing and safety have yet to be established in neonates.

Hypotheses:
(1) Cangrelor administered by infusion will yield drug levels capable of inhibiting maximal platelet aggregation by
>
90% without causing an increase in bleeding. (2) A novel microfluidic technology can yield robust results related to inhibition of thrombus formation using significantly less blood than for LTA.

Methods:
This IRB approved, prospective, open-label, single-arm study was conducted between January 2017 and August 2019. Cangrelor, 0.5 μg/kg/min (n=7) or 0.25 μg/kg/min (n=8), was administered intravenously 6-10h after placement of a systemic-to-pulmonary artery shunt (n=8), right ventricle-to-pulmonary artery shunt (n=6), or ductal stent (n=1) for 1h. Plasma levels and PD properties of cangrelor were determined, the latter by light transmission aggregometry (LTA) and microfluidic assay (MFA). Informed consent was obtained (NCT02765633).

Results:
15 participants that received cangrelor had single ventricle physiology (12 of 15) and underwent a Norwood procedure (11 of 15). Cangrelor 0.5 μg/kg/min dosing met all PD endpoints, yielding a higher level of platelet inhibition (mean ± SD) than the 0.25 μg/kg/min dose as assessed by LTA (89 ± 11.4% vs 73.3 ± 16.9%, respectively). Results from MF studies were comparable but required 3-fold less blood for testing. PK analysis revealed rapid drug clearance with 86.7% of participants having undetectable levels by 10 minutes post-infusion and 70% with full recovery in platelet function at 1 hour. SAEs and AEs that occurred were not related drug administration, including bleeding.

Conclusion:
Favorable PK and PD properties of cangrelor 0.5 μg/kg/min dosing and an acceptable safety profile warrant further evaluation in neonates following palliative cardiac procedures.
Abstract 13386: Individualized Risk Score Interpretation to Aid Clinical Decisions and Transitions of Care for Acute Heart Failure Patients
Authors: Zhao Claire Y
Published: May 2021

Acute heart failure (AHF) is a complex disease with heterogeneous manifestations and adverse outcomes. The interpretation of machine-learning risk scores is vital to support clinical decisions. Individualized Feature Importance (IFI) was designed to attribute changes in risk scores to clinical features and help contrast decision trajectory for a patient against those of patient subgroups that received distinct clinical decisions. Score Confidence Interval (SCI) was developed to quantify certainty in the prediction, which further encourages clinicians’ interpretation. Study was based on retrospective data from 25 hospitals in the US of 20,640 adult patients, with 87% discharged home (Class 0) and 13% transferred to the ICU or died in hospital (Class 1). IFI is based on Shapley Value, based on which SCI was designed to capture the variation in score if input features are missing. These methods were applied to previously developed risk score for AHF patients in the wards; however, they can be applied to any risk score. The SCI is wide at the beginning of the stay and narrows down towards the end as more clinical measurements become available, indicating the risk score is relatively certain at the end (Fig. 1a). IFI values (Fig. 1b) show how selected features drive changes in the risk score. To aid decision-making at the latest time, top missing features are prompted (Fig. 1c). Decision trajectories show the way top features drive the risk score (Fig. 1d), that this patient is at higher risk to discharge (Fig. 1e) and is more similar to ICU-transfers (Fig. 1f). Fig. 1g shows SCI improves risk score performance by abstaining uncertain cases from decision-making. IFI apportions risk score to clinical measurements. SCI reduces false alarm rates. By providing clinical context, they have the potential to enhance incorporation of risk scores in the clinical workflow to aid medical decisions by identifying patients at risk for deterioration and determining appropriate levels of care.
Abstract 13392: Efficacy and Safety of Dronedarone vs Placebo Across Age and Sex Subgroups: A Post Hoc Analysis of the Athena Study Among Patients With Nonpermanent Atrial Fibrillation/flutter
Authors: Curtis Anne B , Zeitler Emily P , Bogard Andrew , Bhattacharyya Nidhi , Stewart John , Hohnloser Stefan H
Published: May 2021

Introduction:
Dronedarone reduced the risk of cardiovascular (CV) hospitalization or death compared with placebo among patients with nonpermanent atrial fibrillation/flutter (AF/AFL) in the ATHENA study (primary endpoint). Prior work suggests a differential response to AF/AFL management based on age and sex. This post hoc analysis assessed response to dronedarone in these important subgroups.

Methods:
Efficacy and safety of dronedarone vs placebo were analyzed by age (<65y, 65-74y, ≥75y) and sex.

Results:
Median duration of follow-up was 22 months overall in the ATHENA study. Of 4628 patients, 873 (19%), 1830 (40%), and 1925 (42%) were <65y, 65-74y, ≥75y old, respectively; 2459 (53%) were men. Older patients had a higher prevalence of structural heart disease and higher CHA
2
DS
2
-VASc scores. Dronedarone significantly reduced the risk of first CV hospitalization or death in the 65-74y and ≥75y subgroups, with a similar trend among patients <65y (Table). The same pattern was observed for first CV hospitalization and first AF/AFL recurrence. Dronedarone significantly reduced the risk of first CV hospitalization or death in both men (hazard ratio [HR]: 0.74 [95% confidence interval: 0.64, 0.84];
P
< 0.0001) and women (HR: 0.77 [0.67, 0.89];
P
= 0.0002). Dronedarone also significantly reduced the risk of first AF/AFL recurrence in men (HR: 0.85 [0.77, 0.94];
P
= 0.0017) and women (HR: 0.71 [0.64, 0.80];
P
< 0.0001). Treatment-emergent adverse events (TEAEs) led to treatment discontinuation in 8% [6%], 13% [6%], and 15% [11%] of patients with dronedarone [placebo] in the <65y, 65-74y, and ≥75y subgroups, respectively, without sex-based differences.

Conclusions:
In the ATHENA study, dronedarone decreased the risk of CV hospitalization or death and decreased AF/AFL recurrence regardless of patient sex as well as in patients 65y and older. A similar trend was observed in patients <65y. No new drug-related safety signals were identified across age and sex subgroups.
Abstract 13421: Ventricular and Arterial Elastance During Isometric Handgrip Exercise and Post-exercise Circulatory Arrest in Heart Failure With and Without Preserved Ejection Fraction
Authors: Fujimoto Naoki , Moriwaki Keishi , Kameda Issei , Ishiyama Masaki , Omori Taku , Sugiura Emiyo , Nakamori Shiro , Dohi Kaoru
Published: May 2021

Introduction:
Isometric handgrip (IHG) training at 30% maximal voluntary contraction (MVC) lowers blood pressure in hypertensive patients. Impacts of IHG exercise and post-exercise circulatory arrest (PECA), which isolates metaboreflex control, have been unclear in heart failure (HF).

Purpose:
To investigate the impacts of IHG exercise and PECA on ventricular-arterial stiffness and left ventricular (LV) relaxation in HF with preserved (HFpEF) and reduced ejection fraction (HFrEF).

Methods:
We invasively obtained LV pressure-volume (PV) loops in 20 patients (10 HFpEF, 10 HFrEF) using conductance catheter with microtip-manometer during 3 minutes of IHG at 30%MVC and 3 minutes of PECA. Hemodynamics and LV-arterial function including LV end-systolic elastance (Ees) by the single-beat method, effective arterial elastance (Ea), and time constant of LV relaxation (Tau) were evaluated every minute.

Results:
At rest, HFpEF had higher LV end-systolic pressure (ESP) and lower heart rate than HFrEF with similar LV end-diastolic pressure (EDP). The coupling ratio (Ees/Ea) was greater in HFpEF than HFrEF (1.0±0.3 vs. 0.6±0.3, p<0.01). IHG for 3minutes similarly increased heart rate in HFpEF (by 10±8 bpm) and HFrEF (by 14±6 bpm). IHG also increased end-diastolic and LVESP (134±21 vs. 158±30 mmHg and 113±25 vs. 139±25 mmHg) in both groups (groupхtime effect p≥0.25). In HFpEF, Ees, Ea and Ees/Ea (1.0±0.3 vs. 1.1±0.4) were unaffected during IHG. In HFrEF, IHG induced variable increases in Ea. LV end-systolic volume and the ESPV volume-axis intercept were larger, and Ees at IHG 3
rd
min was greater (1.30±0.7 vs. 3.1±2.1 mmHg/ml, p<0.01) than baseline, resulting in unchanged Ees/Ea at IHG 3
rd
min (0.6±0.3 vs. 0.8±0.4, p≥0.37). Tau was prolonged only in HFrEF during IHG and was returned to the baseline value during PECA. During the first 2 minutes of PECA, LVESP was lower than that at IHG 3
rd
min only in HFpEF, suggesting less metaboreflex control of blood pressure in HFpEF during IHG.

Conclusions:
IHG exercise at 30%MVC induced modest increases in LV end-systolic and end-diastolic pressures in HFpEF and HFrEF. Although the prolongation of LV relaxation was observed only in HFrEF, the ventricular and arterial coupling was maintained throughout the IHG exercise in both groups.
Abstract 13423: Impact of Anemia on Growth Differentiation Factor 15 and Mortality in Patients With Stable Coronary Artery Disease: The ANOX Study
Authors: Iguchi Moritake , suzuki masahiro , Matsuda Morihiro , Ajiro Yoichi , Shinozaki Tsuyoshi , Sakagami Satoru , Yonezawa Kazuya , shimizu masatoshi , FUNADA JUNICHI , Takenaka Takashi , Morita Yukiko , Nakamura Toshihiro , Fujimoto Kazuteru , Matsubara Hiromi , Kato Toru , Unoki Takashi , Takagi Daisuke , Wada Kyohma , Wada Miyaka , Masunaga Nobutoyo , ISHII MITSURU , Kotani Kazuhiko , Abe Mitsuru , Akao Masaharu , Hasegawa Koji , Wada Hiromichi
Published: May 2021

Background:
Growth differentiation factor 15 (GDF-15) is a stress responsive cytokine of the transforming growth factor superfamily. Circulating levels of GDF-15 are elevated in various conditions including anemia and stable coronary artery disease (CAD), and associated with the risk of mortality in patients with stable CAD. However, whether anemia modifies the relationship between GDF-15 and mortality in patients with stable CAD is unknown.

Methods:
Using data from a multicenter, prospective cohort of 1460 patients with stable CAD, we assessed the association between anemic status and GDF-15 and the impact of anemia on the association between GDF-15 levels and the risk of all-cause death. GDF-15 was measured in 564 anemic and 896 non-anemic patients enrolled in the ANOX Study.

Results:
The mean age (standard deviation [SD]) of the patients was 71.7 (9.4) years; 74.4% were men. Patients with anemia exhibited significantly higher levels of GDF-15 compared to those without anemia (median [interquartile range], 1953 [1302-3110] vs. 1175 [838-1579] pg/mL, respectively;
P
<0.001). Stepwise multiple linear regression analysis revealed that the log-transformed (Ln-) GDF-15 level was independently associated with higher age, diabetes, current smoking, lower estimated glomerular filtration rate, anemia, no use of aspirin, Ln-N-terminal pro-natriuretic peptide, and Ln-high-sensitivity C-reactive protein (
P
<0.005 for all). In the entire patient cohort, the GDF-15 level was significantly associated with all-cause death after adjusting for potential clinical confounders (hazard ratio per 1-SD increase [HR], 1.51; 95% confidence interval [CI], 1.33-1.71). This association was still significant in patients with anemia (HR, 1.71; 95% CI, 1.44-2.05) and in those without anemia (HR, 1.44; 95% CI, 1.21-1.71). However, GDF-15 provided incremental prognostic information to the model with potential clinical confounders and the established cardiovascular biomarkers in the entire cohort and in patients with anemia, but not in those without anemia.

Conclusions:
Higher levels of GDF-15 were independently associated with anemia in patients with stable CAD. The prognostic value of GDF-15 on mortality was pronounced in patients with anemia.
Abstract 13425: Comparison Between Impella 5.0 and External Corporeal Left Ventricular Assist Device as a Bridge to Decision in Patients With Cardiogenic Shock
Authors: Kondo Toru , Shibata Naoki , kazama shingo , Kimura Yuki , Oishi Hideo , Kuwayama Tasuku , Morimoto Ryota , OKUMURA TAKAHIRO , Murohara Toyoaki
Published: May 2021

Background:
In cardiogenic shock refractory to medical treatment, choosing and changing mechanical circulatory support to stabilize hemodynamics until cardiac recovery or next treatment is a strategic cornerstone for improving the outcome. We aimed to clarify the differences in treatment course and outcome between Impella 5.0 and extracorporeal left ventricular assist device (eLVAD) in patients with cardiogenic shock refractory to medical therapy or other mechanical circulatory support.

Methods:
We performed a retrospective medical record review of consecutive patients who were treated with Impella 5.0 or eLVAD as a bridge to decision (BTD) at our medical center from December 2011 to January 2020.

Results:
A total of 26 patients (median age 40 years, 16 males) were analyzed. Of seven patients managed with Impella 5.0, one patients used Impella CP and four patients used peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) before Impella 5.0 implantation. On the other hand, of 19 patients managed with eLVAD, 11 patients used VA-ECMO before eLVAD implantation. In patients managed with Impella 5.0, Impella 5.0 was removed successfully in two patients (29%) and four patients (71%) underwent the operation for durable LVAD. In patients managed with eLVAD, eLVAD was successfully removed in three patients (16%), nine patients (47%) required durable LVAD, and seven patients (37%) died during eLVAD management. The period between implantation of Impella 5.0 or eLVAD to durable LVAD surgery was significantly shorter with Impella 5.0 (58 [38 - 95] vs. 235 [126 - 318] days, p=0.001). During durable LVAD implantation, cardiopulmonary bypass time was significantly shorter and a significantly smaller amount of red blood cells transfusion was required with Impella 5.0 (149 [125 - 182] vs. 192 [170 - 250] minutes, p=0.042; 7.0 [5.0 - 9.5] vs. 15.0 [10.0- 2.0] units, p=0.019, respectively). There were 4 massive stroke events in eLVAD, but no massive stroke events in Impella 5.0. In Impella 5.0.

Conclusions:
Impella 5.0 facilitates smoother management as a BTD and reduces surgical invasiveness during durable LVAD implantation. Impella 5.0 would be a more effective option for success to cardiac recovery or next therapy than eLVAD.
Abstract 13442: Gabapentin as a Novel Adjunct for Postoperative Management After Superior Cavopulmonary Connection Operation in Children
Authors: Ramsey Evan Z , Collier Hailey , Gunturi Deepthi , Faerber Jen , Thibault Celine , Schwartz Emily , Chen Jonathan , Goldberg David J , Gardner Monique M
Published: May 2021

Introduction:
For infants with single ventricle congenital heart disease, the superior cavopulmonary connection (SCPC) stabilizes pulmonary blood flow but is associated with elevated pressure in the superior vena cava (SVC), often leading to irritability. We describe the off-label use of gabapentin for the treatment of irritability after SCPC.

Methods:
We reviewed our patients who underwent SCPC between 2011-2019. Patients were prescribed gabapentin at provider discretion. Total medication doses during the first seven postoperative days were aggregated in morphine and midazolam equivalents. For those who received gabapentin, maximum dose and use of post-discharge gabapentin were recorded. To determine if included infants were more likely to receive analgesic and anxiolytic medications, a propensity score outcome model was developed accounting for variables that may affect likelihood of gabapentin receipt or outcome risk. Inverse probability weighted logistic regression and linear regression models were used to estimate the effect of gabapentin receipt on morphine dosage and the odds of midazolam receipt.

Results:
The cohort included 323 infants; 61% male, 91% with prior cardiac surgery or intervention. Gabapentin was prescribed in 74 (23%), with a median (IQR) maximum dose of 10.7 mg/kg/day (5.5, 23.4), and was continued at discharge in 54 (73%). Infants prescribed gabapentin were younger at time of SCPC (median 137 days old vs 146 days, p=0.007), had longer postoperative intensive care (median 5.8 days vs 3.1 days, p<0.001), and hospital length of stay (median 11.5 days vs 7 days, p<0.001). Those who underwent SCPC from 2015-19 had increased odds of gabapentin receipt compared to 2011-14 (OR 5.3, 95% CI 2.8, 10.0). All patients received morphine postoperatively while 136 (42%) received midazolam equivalents. Infants prescribed gabapentin received 1 mg/kg more of morphine equivalents (p=0.05) and were twice as likely to be prescribed a midazolam equivalent (OR 2.2, CI 1.2, 4.1, p=0.01).

Conclusions:
Gabapentin was used with increasing frequency over the duration of the study period. Patients prescribed gabapentin tended to be younger and have longer hospital stays, but did not appear to be spared exposure to opioid or benzodiazepine medications.
Abstract 13468: Effect of Listing Criteria on Transplant Rate and Early Outcomes in Adults With Congenital Heart Disease
Authors: Zayed Wagih m , Bansal Neha , Patel Snehal R , Lamour Jacqueline M , GOLDSTEIN Daniel J , Jorde Ulrich P , Hsu Daphne T
Published: May 2021

Introduction:
Heart failure (HF) is the leading cause of death in adults with congenital heart disease (ACHD). Heart transplant (HT) is one of the few options for the treatment of advanced HF in this growing population. In October 2018, the United Network for Organ Sharing (UNOS) implemented a change in organ allocation criteria. The effect of this change on outcomes in ACHD patients (pts) after listing and transplant has not been evaluated.

Hypothesis:
Change in organ allocation criteria negatively impacts outcomes in ACHD patients.

Methods:
Data from the Scientific Registry of Transplant Recipients in pts age
>
18 years old listed for HT between Oct. 2016 and 0ct. 2019 and followed through March 2020 were analyzed. Pts were grouped by diagnosis (ACHD and non-ACHD) and by the time of listing (pre- and post-change in allocation criteria). Differences in comorbidities, outcomes while listed, and 1-year Kaplan Meier survival post-HT were compared among groups. For comparison, post-change criteria (status 1-6) were equated to pre-change criteria (status 1A, 1B, 2).

Results:
Over 3 years, 11,931 patients were listed for HT; 459 had a primary diagnosis of ACHD. ACHD was present in 279/7942 pts listed in the 2 years pre-change and 180/3989 pts in the year post-change. ACHD pts listed post-change were less likely to have a history of cardiac surgery (88% vs. 79%, p=0.01) and more likely to have an abnormal BMI (p=0.015) than ACHD pts pre-change. Post-change, ACHD pts were listed at a higher priority status compared to pre-change ACHD. (Figure). The proportion of pts transplanted with ACHD increased slightly pre- and post-change (3.7% vs. 4.1%). There was no difference in 1-year survival in ACHD pts transplanted pre- and post-change (Figure).

Conclusions:
Recent changes to the UNOS organ allocation policy increased the proportion of ACHD patients transplanted with no change in early post-HT survival.
Abstract 13504: Timely Recognition and Successful Clinical Outcome of an Acute Debakey Type I Aortic Dissection
Authors: Gangadharamurthy Dakshin , Furqan Muhammad M , Klein Allan L , Malhotra Saurabh , Harrison Rachel , Jaikumar Likhitesh , Pidikiti Nanni , Richards Theodore , LeBaron Linnea , Patel Mehul , Jagtap Mandar , Prather John
Published: May 2021

Background:
Acute Aortic dissection is a critical etiology of chest pain with very high mortality. 1% to 2% of patients die per hour during the initial 24 to 48 hours.

Case:
A 62 year old lady with history of diabetes, hypertension, hyperlipidemia, hypothyroidism, smoking and no pertinent family history presented with atypical chest pain. She remained hemodynamically stable with no discrepancy of BP between arms. Labs: troponin 0.64, 0.63 ng/ml. EKG: sinus bradycardia. Chest x-ray: no mediastinal widening or signs of aortic aneurysm. Coronary angiogram showed 20-30 % stenosis in left anterior descending and right coronary arteries. An aortogram showed dilated aortic root over 6 cm with aortic regurgitation.

Decision-making:
An emergent echocardiogram confirmed acute aortic regurgitation and dissection. CT angiogram showed DeBakey type I aortic dissection extending from aortic annulus to infra renal aorta, supra aortic great vessels, celiac axis and left renal artery. She had no signs of malperfusion syndrome. She was started on iv Esmolol and emergently airlifted to tertiary care facility for surgical repair. Intra operative TEE showed findings consistent with acute aortic dissection. She had successful modified Bentall procedure with replacement of aortic valve, aortic root, ascending aorta and hemi arch. She had excellent recovery and continues to do well at follow up visits in our clinic.

Conclusion:
An early diagnosis of acute aortic dissection requires high index of suspicion due to variable symptoms and clinical manifestations. DeBakey type I aortic dissection may have better chance of survival in the absence of malperfusion syndrome if treated early as in this case.
Abstract 13505: Validated Model for Predicting Pacemaker Implantation After Transcatheter Aortic Valve Replacement
Authors: Barrett Christopher D , Nickel Andrew , Rosenberg Michael A , Sandhu Amneet
Published: May 2021

Introduction:
Transcatheter aortic valve replacement (TAVR) has surpassed surgical valve replacement for the management of severe aortic stenosis. High grade AV block is a well-described complication following TAVR. Prior models for predicting risk of pacemaker (PPM) with TAVR lack sensitivity, clinical applicability or cannot be applied pre-procedurally.

Hypothesis:
To aid planning and patient discussion, we sought to produce a simple tool that can be applied at pre-TAVR clinical visits to stratify risk of PPM associated with TAVR implantation.

Methods:
We performed an analysis of all patients undergoing TAVR at the University of Colorado. Clinical, valvular, and electrocardiographic data were recorded. Patients were split into a training cohort for development of a predictive model and a testing cohort for model validation. Multivariable stepwise regression was performed on the training cohort to determine patient characteristics most predictive of pacemaker. Results from the initial regression were then applied to the testing cohort for model validation.

Results:
Of 483 patients analyzed from 2013-2019 in the training cohort, 78 required pacemaker. The need for pacemaker was influenced by 5 pre-procedure variables: RBBB, self-expandable valve, PR interval > 200 ms, ejection fraction > 50%, and albumin > 4.0 g/dL. The regression model produced in our training cohort was highly predictive of need for pacemaker in the validation cohort (Figure).

Conclusions:
Five pre-procedural characteristics primarily influence risk of PPM after TAVR. These can be used to produce a simple but highly predictive risk model for determining which patients will need pacemaker after TAVR.
Abstract 13507: The Role of Weight Loss in Mediating the Effects of a 2-year Caloric Restriction Regimen on Cardiometabolic Risk Markers in Individuals Without Obesity
Authors: Dorling James L , Redman Leanne , Ravussin Eric , Huffman Kim , RACETTE Susan B , Das Sai Krupa , Kraus William E , Höchsmann Christoph , Martin Corby K
Published: May 2021

Introduction:
Caloric restriction (CR) improves cardiometabolic risk, even among individuals without obesity. However, it is unclear whether these aging-related benefits are mediated by weight loss. Mediation analyses inform mechanisms underlying relationships between an exposure and outcome. Using mediation analyses, our aim was to test if 2-year weight loss mediates the beneficial effects of CR on cardiometabolic risk markers in individuals without obesity.

Methods:
Participants without obesity were randomized 2:1 to CR or ad libitum (AL) as part of the 2-year trial, Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE). The CR group aimed to enact 25% CR for 2 years, while AL maintained habitual energy intake. Baseline and year 2 assessments included weight and cardiometabolic risk markers. Using the approaches of Valeri and VanderWeele, mediation was quantified as the natural indirect effect (NIE), defined as the impact of an exposure on an outcome through a mediator. Here, the NIE was the effect of CR (exposure) on cardiometabolic risk markers (outcome) that was accounted for by weight change (mediator).

Results:
In total, 117 and 71 participants in the CR and AL groups, respectively, completed the trial. The CR group achieved 11.9 (± 0.7)% CR and 7.6 (± 0.3) kg of weight loss (
P
< 0.01 versus AL). Weight loss significantly mediated the CR-induced improvements in total cholesterol (NIE = -10.4 ± 3.5 mg/dL), low-density lipoprotein cholesterol (NIE = -8.5 ± 2.8 mg/dL), high-density lipoprotein cholesterol (NIE = 2.9 ± 1.3 mg/dL), triglycerides (NIE = -0.20 ± 0.05 log mg/dL), the homeostatic model assessment of insulin resistance (NIE = -0.22 ± 0.06), and C-reactive protein (NIE = -0.39 ± 0.15 log ug/mL) (
P
≤ 0.02). Weight loss did not mediate CR-induced reductions in systolic (NIE = -0.9 ± 1.4 mmHg) and diastolic (NIE = -1.0 ± 1.1 mmHg) blood pressure (
P ≥
0.37).

Conclusion:
In individuals without obesity, CR-induced improvements in multiple cardiometabolic risk markers are driven by weight loss after 2 years. These findings emphasize that, even in individuals without obesity, weight loss after prolonged CR plays a role in improving cardiometabolic disease risk; however, some CR benefits still occur independent of weight loss.
Abstract 13510: Impact of Adverse Pregnancy Outcomes on Indication for Lipid Therapy in Women
Authors: Sherman Sarah , Kaufman Nik , Park Ki
Published: May 2021

Introduction:
Lifetime risk for cardiovascular disease (CVD) is higher in women who experience adverse pregnancy outcomes (APOs) including pre-eclampsia, preterm birth, gestational hypertension, and gestational diabetes. APOs are risk-enhancing factors for atherosclerotic cardiovascular disease (ASCVD) in contemporary cholesterol guidelines.

Hypothesis:
History of APOs impacts consideration for lipid therapy in a significant proportion of women with borderline to intermediate CVD risk .

Methods:
A single center retrospective chart review of new patients who presented to the University of Florida Women’s Heart Health Clinic between July 2017 - July 2019 was performed. New female patients were routinely screened for pregnancy history with an obstetrics questionnaire, and cardiovascular history and lipid profiles were collected where available. Patients were stratified by age and calculated 10-yr risk of a cardiovascular event using the ACC/AHA Pooled Cohort Equation. APO history within age and risk categories in addition to pregnancy history documentation in electronic health records were then assessed.

Results:
Of the 182 new patients who presented to the University of Florida Women’s Heart Health Clinic between July 2017 - July 2019, average age was 49 years old and 71.3% were Caucasian. 25% of the study population had history of APO, and of patients with history of APO, only 55% had documented lipid profiles, 46% had pregnancy history documented in the obstetrics section of the electronic health record, and 17% had pregnancy history documented in their past medical history section. For patients aged 40-75 y/o with borderline-intermediate 10-yr CV event risk, risk-enhancing factors influenced consideration of potential statin therapy, with 20% of patients in the intermediate risk group having history of APO.

Conclusions:
Pregnancy history impacts potential statin therapy in a significant percentage of women aged 40-75 y/o with borderline-intermediate 10-yr ASCVD risk. However, APOs are often under-recognized and poorly documented as non-traditional CVD risk factors in women. Efforts to improve recognition of APOs in clinical practice should be promoted to improve CVD risk reduction efforts, particularly in young women.
Abstract 13514: Gender-Stratified Difference in the Association Between Coronary Artery Calcium and Incident Peripheral Artery Disease: The Multi-Ethnic Study of Atherosclerosis
Authors: Bakhshi Hooman , BAGCHI PRAMITA , Meyghani Zahra , Tehrani Behnam N , Garg Parveen K , Ambale Venkatesh Bharath , Ohyama Yoshiaki , Wu Colin , Budoff Matthew J , Criqui Michael H , Bluemke David A , Ac Lima Joao , DEFILIPPI Christopher
Published: May 2021

Introduction:
Coronary artery calcium score (CACs) measured by non-contrast cardiac CT has a strong correlation with coronary atherosclerotic burden. Although CACs predicts incident coronary heart disease, its gender-specific association with incident peripheral artery disease (PAD) is not clear.

Methods:
The multi-ethnic study of atherosclerosis (MESA) is a prospective population-based cohort consisting of 6814 men and female free of overt cardiovascular disease at enrollment. In this study we included MESA participants with baseline CACs and at least one ankle brachial index (ABI) measured at follow up exams. We excluded participants with baseline ABI≤ 0.9 or> 1.4. Incident PAD was defined as a follow up ABI≤ 0.9 and decline of ≥15%. Multivariable logistic regression models were deployed to evaluate the association between baseline CACs and incident PAD in female and male.

Results:
The mean age (SD) was 61.29 (9.96) years and 52.6% (3013/5725) were female. Female had lower baseline ABI [1.10 (0.08) vs 1.15 (0.09); p < 0.001]. Over a median (IQR) of 9.23 (8.22-9.60) years, 113(4%) female and 85(3%) male developed PAD. Every one unit increase in log (CACs+1) was associated with 1.11-fold higher odds of incident PAD in male (p=0.001). This association remained significant after adjustment for demographics, traditional cardiovascular risk factor and baseline ABI. Male participants with CACs>300 showed 1.94-fold higher odds of incident PAD compared to participant with CACs=0 (p=0.005). In female there was no statistically significant association between CACs and incident PAD in multivariable analysis.

Conclusions:
Baseline CACs is associated with future PAD independent of traditional cardiovascular risk factors in male participants of a multi-ethnic cohort.

Disclaimer statement:
The views expressed in this abstract are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the U.S. Department of Health and Human Services.
Abstract 13525: The Association Between Multiparity and Adipokine Levels: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Rodriguez Carla P , Ogunmoroti Oluseye , Quispe Renato , Osibogun Olatokunbo I , Ndumele Chiadi E , Echouffo Tcheugui Justin B , Minhas Anum , Bertoni Alain G , Allison Matthew A , Michos Erin D
Published: May 2021

Background:
Multiparity is a risk factor for cardiovascular disease (CVD). However, the mechanism of this relationship is unknown. Adipokines may predispose multiparous women to certain cardiometabolic complications that can increase their risk of future CVD.

Methods:
We studied 975 female MESA participants (ages 45-84 yrs and initially free of CVD) who had complete data on parity assessed at baseline and adipokine levels measured at either Exam 2 or 3. Parity was categorized as nulliparity (reference), 1-2, 3-4 and ≥5 live births. Multivariable linear regression was used to evaluate the association of parity categories with log-transformed levels of leptin, resistin, and adiponectin.

Results:
The women (38% white, 23% black, 13% Chinese, and 26% Hispanic) had mean age at MESA visit 2/3 of 63±9 yrs. Median adipokine levels by parity group are shown in the
Table
. Compared to nulliparity, a history of 3-4 live births was associated with higher leptin levels, even after full covariate adjustment including body mass index (BMI) and CVD risk factors (model 4). Grand multiparity (≥5 births) was associated with greater leptin after adjustment for demographic and lifestyle factors (models 1 & 2), but these associations were no longer significant after BMI adjustment (model 3). Grand multiparity was also associated with lower adiponectin levels in demographic/lifestyle-adjusted models but not after adjustment for BMI. In contrast, grand multiparity remained associated with higher resistin levels after full covariate adjustment (model 4).

Conclusions:
In a multiethnic U.S. cohort of women, multiparity is associated with adipokine levels, specifically with higher leptin and resistin levels. Further studies are needed to determine whether adipokines mediate the relationship between multiparity and CVD.
Abstract 13545: Atlas of Exosomal Microrna Secreted From Human Ipsc-derived Cardiac Cell Types
Authors: Chandy Mark , Rhee June , Ozen Mehmet O , Williams Damon , Pepic Lejla , Liu Chun , Zhang Hao , Malisa Jessica , Lau Edward , Demirci Utkan , Wu Joseph C
Published: May 2021

Exosomes are small particles secreted from cells through an endosomal sorting complexes required for transport (ESCRT)-mediated pathway that releases vesicles into the extracellular matrix following fusion of the endosomal multivesicular body to the plasma membrane. Initially thought to be a waste disposal system for the cell, exosomes are now recognized as important mediators in cellular communication, transporting nucleic acid, protein and lipid. We hypothesize that microRNA (miRNA) transcriptomic profiles isolated from exosomes are distinct for each cardiovascular lineage in healthy control patients. Using induced pluripotent stem cells (iPSC), established differentiation protocols and a high-yield mechanical-sorting device (ExoTIC), we characterized the transcriptomic profiles of exosomal secretions derived from cardiomyocytes (CM), cardiac fibroblasts (CF) and endothelial cells (EC). We identified 120 miRNAs from 94 miRNA genes to be secreted at appreciable levels. We discovered 1) let-7 miRNA precursors are depleted in iPSC secretomes; 2) only a subset of total cellular miRNAs are present; 3) a common core of miRNAs are secreted by all three cardiac cell types; and 4) distinct enrichment or depletion of different mature miRNAs in each exosome type. The exosomal transcriptomic profiles of each lineage was compared to a published atlas of miRNA from seventeen tissue types from the human body. miR-302c known to be specific to pluripotent cells and is enriched in iPSC exosomes and found in bone, reflecting hematopoietic stem cells. miR-1, critical for cardiac development and pathology, is secreted by iPSC-CM and enriched in striated muscle and myocardium. miR-151 is secreted by iPSC-CF and is expressed ubiquitously. The relative enrichment of miRNAs in different cardiac tissues could be used to quantifying the cellular content of heterogenous mixtures of iPSC-derived cardiac lineages. We developed a ratiometric cell purity assay that can sensitively detect iPSC contamination in iPSC-CM differentiations.
Abstract 13570: Diabetes is Probably Associated With Larger Fluid Retention in Patients With Heart Failure With Preserved Ejection Fraction
Authors: IWAKURA Katsuomi , Onishi Toshinari , Inoue Koichi , Okada Masato , Koyama Yasushi , OKAMURA ATSUNORI , Hikoso Shungo , Nakatani Daisaku , Tamaki Shunsuke , Yano Masamichi , Hayashi Takaharu , Nakagawa Akito , Nakagawa Yusuke , Fujii Kenshi , Yasumura Yoshio , Yamada Takahisa , Sakata Yasushi
Published: May 2021

Introduction:
Diabetes is observed in about third of patients with heart failure with preserved ejection fraction (HFpEF), and it is not well elucidated how it would affect the clinical conditions of HFpEF. We investigated the physical and echocardiographic characteristics of diabetes patients in a large-scale, registration study of HFpEF.

Methods:
We analyzed clinical and echocardiography data obtained at admission and just before hospital discharge in the PURSUIT-HFpEF (Prospective, Multicenter, Observational Study of Patients with Heart Failure with Preserved Ejection Fraction), which is a multicenter registration study of patients who were hospitalized for HFpEF.

Results:
We enrolled 862 patients who were hospitalized for HFpEF between June, 2016 and December, 2019 (Age 81±9 years, male gender 44.5%) for the present study. Diabetes was observed in 287 patients (33.3%), and their age was higher (82±8 years vs. 80±9 years, p=0.003) and body mass index before discharge was larger (23.2±4.7 kg/m2 vs. 21.1±4.6 kg/m2, p<0.0001) than those without diabetes. Diabetic patients had higher body weight at admission (63.2±14.9 kg vs. 55.9±13.4 kg, p<0.0001) and before discharge (56.8±13.3 vs. 50.7±12.1 kg, p<0.0001) than non-diabetic patients. Reduction of body weight during hospital stay was higher in diabetic patients (6.4±4.5 kg) than in non-diabetic patients (5.2±4.0 kg) even after correction of body weight discharge or estimated GFR (p<0.001 by ANCOVA). Body weight reduction was significantly associated with HbA1c (p=0.01). There was no difference in use of intravenous diuretics (69.3% vs. 66.6%, p=0.44) and in hospital stay (21.4±15.3 days vs. 19.9±13.7 days, p=0.14) between diabetic- and non-diabetic patients. Whereas no differences were observed in echocardiographic parameters at admission and before discharge between two arms, the diabetic arm showed significantly higher reduction in septal E/e’ ratio during hospital stay (19.0±8.7 to 17.1±7.6) than non-diabetic arm (16.6±8.3 to 16.4±8.2)(p=0.01 by repeated measure ANOVA).

Conclusions:
The present study implied that diabetic patients with HFpEF have more fluid retention before hospitalization than non-diabetic ones, which could affect the changes in diastolic pressure.
Abstract 13590: Demographic and Clinical Characteristics of Patients With Obstructive Hypertrophic Cardiomyopathy in a Large, Nationwide Us Cohort
Authors: Butzner Michael , Sarocco Phil , Rowin Ethan J , Maron Martin S , Robertson Laura A
Published: May 2021

Background:
Obstructive hypertrophic cardiomyopathy (oHCM) has mostly been studied in patients treated in advanced comprehensive Centers of Excellence (COE). Understanding the true prevalence of patients with oHCM in the general US population may improve the screening, identification, and treatment outside of COEs.

Objectives:
To describe the demographics and clinical characteristics of patients with oHCM.

Methods:
This is a retrospective cohort study to assess patient-level data from the IBM Explorys database (observational period: January 1, 2010 to December 31, 2018). The Explorys database amassed electronic medical records from 39 Integrated Delivery Networks (IDN) from ~12,982,704 patients. We identified adult patients (>18 years old) with oHCM and report their demographics and clinical characteristics from index date to the end of study period.

Results:
Of 8,792 patients, 53.0% were female, and 81.2% Caucasian (mean index age: 61.8 years). Primary insurance type was private (58.9%); 54.9% of patients lived in the Midwest. Mean BMI at index was 30.4; 30.9% were nondrinkers. The mean Quan-Charlson Comorbidity Index was 6.35% with the most common comorbidities being congestive heart failure (31.9%), chronic pulmonary disease (20.1%), and diabetes without chronic complications (16.9%). CV drug rates included β-blockers (80.5%), CCBs (46.0%), ACE inhibitors (27.7%), ARBs (18.8%), disopyramide (2.4%) and amiodarone (13.0%). Surgical procedure rates included septal myectomy (22%), ablation (19.8%), implantable cardioverter defibrillator (11.2%), and heart transplantation (0.3%). Major residual side effects subsequent to surgical procedures included atrial fibrillation (31.4%) and reintervention (15.6%). Common reintervention procedures included ablation and septal myectomy.

Conclusions:
This is the first study to examine a national sample of oHCM patients using clinical data from more than 39 IDNs. Leveraging the Explorys database allowed us to analyze a larger, more diverse cohort of oHCM patients across the entire broader US. The results from this analysis may be used to compare the characteristics of patients with oHCM in the general population with those treated in COE.