bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12593: Sex-related Differences in Health Care Utilization in Patients With Atrial Flutter
Authors: Kim Kathryn , Kim Steven , Kim Michael H
Published: May 2021

Introduction:
Sex-related differences in health care utilization have been described for patients (pts) with any atrial fibrillation (AF) either with or without atrial flutter (AFL). Limited data, however, are available when stratified by sex in pts with AFL only.

Methods:
Using MarketScan Commercial and Medicare databases, pts aged ≥ 20 years with a minimum of one inpatient or two outpatient AFL diagnoses in 2005 and a minimum of 12 months of continuous enrollment pre and post index were identified. Any AF pts were excluded. AFL only pts were propensity score matched to pts without AFL or AF based on age, sex, region, payer, and cardiovascular (CV) comorbidities. Using projected prevalence of AFL for 2010, costs were estimated 12 months post index.

Results:
1,042 pts (62 % men) with AFL were identified. Men exceeded women in the age adjusted prevalence of AFL across all age groups (mean age 67 with 8 age ranges from 20 to ≥ 85). Cost projections were made for 74,466 AFL pts. Men ($453 million) had a significantly higher national total incremental cost burden for all expenditures than women ($253 million). Men had higher per patient incremental cost and national cost burden for treatment specific to AFL across the age groups. Men also had a higher per patient incremental cost and national total cost burden ($291 versus $90 million) for CV specific expenditures, especially at ages < 85. Total costs were greatest for men < 55 years old with total costs of 25,643 dollars per patient of which 75 % of the value represented CV specific costs. Per patient costs were more similar for men and women with AFL at 55 years and older. Per patient inpatient costs were greater in men whereas per patient outpatient costs were greater in women. On a national and per patient cost level, AFL treatment specific costs decreased in men and women 75 years and older.

Conclusions:
Costs in pts with AFL only are more driven by men from both a per patient and national cost perspective with the highest burden at younger ages < 55. These sex-related differences in epidemiology and resource utilization need further exploration. Potential disparities in care delivery may exist given these cost data.
Abstract 12606: Meta-analysis of the Normal Ranges of Right Ventricular Strains by Echocardiography in Healthy Adults
Authors: Wang Tom Kai Ming , Grimm Richard A , Rodriguez Leonardo L , Collier Patrick H , Griffin Brian P , Popovic Zoran B
Published: May 2021

Background:
Right ventricular (RV) systolic strain has been increasingly shown to be prognostic in some cardiovascular diseases. Despite this, the reference range including the lower limit of normal (LLN) and factors associated with RV strain measurements are not well-established. This meta-analysis aimed to determine the means and LLNs of two- (2D) and three-dimensional (3D) right ventricular global (RVGLS), free wall (RVFWLS) and septal wall (RVSWLS) longitudinal strains in healthy individuals and factors affecting strain measurements.

Methods:
Pubmed, Embase and Cochrane databases were searched until 31 December 2019 for eligible studies reporting RVGLS, RVFWLS and/or RVSWLS in at least 30 healthy subjects. We pooled the means and LLNs of RV strains by two- (2D) and three- (3D) dimensional echocardiography, and performed meta-regression analyses.

Results:
From 591 articles screened, 37 eligible studies totaling 2970 subjects were analyzed. Pooled means and LLNs (95% confidence intervals) for 2D- strains were RVGLS -23.3% (-24.3%, -22.3%) and -16.2% (-17.2%, -15.1%) in 22 studies; RVFWLS -27.2% (-28.5%, -25.9%) and 18.5% (-20.0%, -17.1%) in 23 studies; RVSWLS -20.4% (-22.0%, -18.9%) and -11.5% (-13.6%, -9.6%) in 10 studies; and similar results for 3D- RV strains (Table). Right ventricular fractional area change and vendor software were associated with 2D-RVGLS and RVFWLS means and LLNs.

Conclusion:
We reported the pooled means and LLNs of RV systolic strains in healthy subjects, to define thresholds for abnormal, borderline and normal strains. Important factors associated with RV systolic strains include right ventricular fractional area change and vendor software.
Abstract 12611: Preclinical in-vivo Testing and Early Clinical Experience With a Dilatable Expanded-polytetrafluoroethylene Cardiovascular Conduit
Authors: Kalra Arush , Nugent Alan W , Pirolli Timothy , Forbess Joseph M , Tannous Paul , Qadir Asad
Published: May 2021

Background:
exGraft is an FDA cleared synthetic vascular conduit. A unique property observed is controllable expansion. Preclinical studies with post-implantation balloon dilation and initial use in infants with congenital heart disease (CHD) are described.

Methods:
Eight piglets (1.5 months (mo)) and 8 lambs (2.5 mo) were implanted with exGraft using an aortic interposition model. Follow up for average 2.5 mo and 3.5 mo respectively allowed somatic growth. Balloon dilation was performed with fluoroscopy and inflation rate was varied to understand optimal expansion method. 3 CHD neonates were implanted with exGraft as a Right Ventricle (RV) to Pulmonary Artery (PA) conduit. Percutaneous balloon dilation of the RV-PA conduit was performed in the interstage period (Table 1).

Results:
Dilation was achieved to 150% of the original size in 6 piglets and 5 lambs when balloons were inflated gradually up to 6 ATM with a 5 second hold at each ATM. Rapid inflation resulted in anastomotic dehiscence in 2 piglets and 3 lambs. Gradual percutaneous exGraft dilation in 3 neonates was to 150-175% of original diameter to increase pulmonary blood flow and reduce cyanosis. There were no adverse events. Final diameter was confirmed upon explant of conduit (Table 1).

Conclusion:
In preliminary pre-clinical and clinical experience, safe serial and gradual exGraft expansion has been demonstrated. Expansion of vascular conduits via catheterization expands the options for CHD management.

Figure 1:
Dilation of 6mm exGraft RV-PA conduit in Patient 1. (A) Baseline angiogram with predominantly proximal stenosis. (B) Fluoroscopy of maximum dilation to 9mm. (C) Final angiogram with increased diameter.
Abstract 12683: Genome-wide Mrna Expression Analysis of Acute Psychological Stress Responses
Authors: Logan Jeongok G , Jeong Mihyun
Published: May 2021

Introduction:
Previous studies have examined effects of acute psychological stress in humans on selected panels of genes. This exploratory study aimed to investigate genome-wide transcriptional activity changes in responses to acute psychological stress.

Methods:
The sample included 40 healthy women who participated in a previous study (22 who had a stress induced experience (experimental group) and 18 who did not (control group)). The psychological stress was induced by the Trier Social Stress Test (TSST). Psychological stress levels (measured by the Subjective Units of Distress Scale (SUDS) and the state anxiety subscale of the Spielberger State-Trait Anxiety Inventory) and hemodynamic changes (measured by blood pressure (BP) and heart rate (HR)) were assessed before and after the TSST. The peripheral blood samples obtained before and after the TSST were processed for mRNA-sequencing.

Results:
The mean age of the participants was 31 years (SD 11.6). The psychological and hemodynamic stress parameters indicated that the TSST successfully induced moderate but statistically significant levels of acute psychological stress in the participants of the experimental group. Compared with the participants in the control group, six genes (
BCL2L14, FAM3B, HCG26, HLA-F-AS1, LOC101928710
, and
SLC22A16
) were up-regulated and 9 genes (
ATP2C2, CA1, CRYBG3, FBXO9, HBD, SLC39A9, SNCA, STRADB
, and
TRMT12
) were down-regulated among those who experienced stress induction. The IPA analysis identified one network of cell-to-cell signaling and interaction, cellular function and maintenance, and hematological system development and function. Thirteen genes out of 15 were found in this network.

Conclusions:
The identified genes including
FAM3B, BCL2L14, SLC22A16
, and
SNCA
, have been proposed as the therapeutic targets of diabetes-related CVDs, certain cancers, and Parkinson’s disease, but have not previously been reported to be associated with psychological stress. Future studies are suggested to examine the pathological mechanisms by which the identified genes may mediate the association between psychological stress and adverse health outcome.
Abstract 12909: Usefulness of Sarcopenia Index for Predicting Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement
Authors: Romeo Francisco J , Seropian Ignacio M , Valle Raleigh Juan M , chiabrando juan guido , Garmendia Cristian M , Smietniansky Maximiliano , Cal Mariela , Agatiello Carla R , Berrocal Daniel H
Published: May 2021

Introduction:
Sarcopenia, a marker of biological senescence, is a robust prognostic indicator of outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS). However, there are no serum markers routinely available for estimating skeletal muscle mass (SMM). The present study aimed to describe a new sarcopenia index (SI, serum creatinine value/cystatin C value x 100) and investigate its association with outcomes after TAVR.

Methods:
The study cohort comprised 100 patients ≥ 65 years of age (mean 83.9±5.7; 36% men) who underwent transfemoral TAVR at Hospital Italiano de Buenos Aires, Argentina from 2016 to 2018. The mean Society of Thoracic Surgeons (STS) score was 3.3±1.7. Sarcopenia was defined according to ROC curve for SI (AUC 0.731, CI 95% 0.599-0.863, p-value=0.001) for predicting the primary endpoint. Both all-cause mortality and/or readmissions for congestive heart failure (CHF) were defined as the primary endpoint within the first year after TAVR.

Results:
According to SI cutoff, half of the study population (SI ≤66) was sarcopenic before TAVR. The 30-day mortality increased significantly in the lowest SI tertile (sarcopenia+) group (12, 3, and 0%, p=.05, respectively). SI strongly correlated with timed-up and go and gait speed but not with body mass index and baseline C-reactive protein levels. Overall survival was worse (Log-rank test= p=0.02) and CHF readmissions were more prevalent in the lowest SI tertile (Log-rank test=p=0.01). On Cox regression analysis, a low SI (SI ≤66) had a significantly higher risk of the primary endpoint (adjusted hazard ratio: 4.01, 95% CI: 1.31-12.27, p=.015).

Conclusions:
SI, a novel-non-invasive method for assessing SMM was able to predict mid-term mortality and CHF readmissions. We suggest careful consideration of sarcopenia prior to TAVR in order to decide the best treatment approaches.
Abstract 12911: Association of Lipoprotein (a) and Coronary Artery Calcification: Prospective Study Assessing Interactions With Other Risk Factors in the Multi-Ethnic Study of Atherosclerosis
Authors: Ong Kwok Leung , McClelland Robyn , Allison Matthew A , Cushman Mary , Garg Parveen , Tsai Michael Y , Rye Kerry Anne , Tabet Fatiha
Published: May 2021

Introduction:
Elevated plasma lipoprotein (a) [Lp(a)] and coronary artery calcification (CAC) are established cardiovascular disease (CVD) risk factors that correlate with each other. In this study we hypothesized that other CVD risk factors could modify the relationship between baseline Lp(a) levels and CAC change over time.

Methods:
A total of 5975 participants from the Multi-Ethnic Study of Atherosclerosis were analyzed. All participants were 45-84 years old, free of apparent CVD at baseline and from one of four major ethnic groups (non-Hispanic white, African American, Hispanic American, and Chinese American). We tested for interactions of 24 study variables related to dyslipidemia, diabetes, insulin resistance, hypertension, inflammation and coagulation with baseline Lp(a) on change in CAC volume and density over 9.5 years.

Results:
Elevated Lp(a) was associated with larger annual absolute increase in CAC volume (3.21 and 4.45 mm
3
/year higher for Lp(a) ≥30 versus <30 mg/dL, and Lp(a) ≥50 versus <50 mg/dL, respectively, both
P
<0.05), but not in CAC density. The association of elevated Lp(a) with absolute change in CAC volume was more prominent in African Americans and Hispanic Americans, than other ethnic groups (
P
for interaction <0.05). After multiple testing correction of 24 study variables, the association of elevated Lp(a) (≥30 mg/dL) with annual absolute change in CAC volume was greater in participants with higher levels of interleukin-2 soluble receptor α, soluble tumor necrosis factor receptor 1 and fibrinogen (change = 15.33, 11.81 and 7.02 mm
3
/year in quartile 4, compared to -3.44, -0.59 and 1.91 mm
3
/year in quartile 1, respectively). A similar trend was seen when expressing Lp(a) ≥50 mg/dL as elevated levels. There were no associations for ln-transformed Lp(a) as a continuous variable, or when assessing the annual relative change in CAC volume and density.

Conclusions:
Elevated Lp(a) was associated with the progression of CAC volume, especially in participants with higher levels of selected markers of inflammation and coagulation. This study suggests that inflammation and coagulation may modify the relation between Lp(a) and CAC.
Abstract 12919: Quantitative Assessment of Cardiovascular Autonomic Impairment in Cancer Survivors: A Single Center Experience
Authors: Noor Benjamin , Akhavan Shannel , Leuchter Michael , Yang Eric H , Ajijola Olujimi A
Published: May 2021

Background:
Cardiovascular autonomic dysfunction in cancer survivors is poorly understood.

Objectives:
To better characterize the clinical characteristics and types of autonomic dysfunction in this population.

Methods:
A retrospective analysis of cancer survivors within an academic cardio-oncology program referred for suspected autonomic dysfunction was performed. Autonomic reflex testing of adrenergic, cardiovagal, and sudomotor function was done. Patients with pre-existing autonomic dysfunction prior to their cancer diagnosis were excluded.

Results:
Of approximately 282 patients in the UCLA Cardio-Oncology program, twenty-four patients met the inclusion criteria. Twenty-two had autonomic impairment on autonomic reflex testing. Eight patients were female, and the mean age at time of autonomic testing was 51.3 years. The average duration from cancer diagnosis to autonomic testing was 10.3 years. The reasons for referral included dizziness, tachycardia, palpitations, and syncope. The majority of patients (75%) had hematologic disorders. The most common chemotherapies administered were vinca alkaloids (54.2%), alkylating agents (66.7%), and anthracyclines (54.2%). Most patients received radiation to the thorax (66.7%) and neck (53.3%). Eleven patients had mild autonomic impairment, seven had moderate, and four had severe autonomic impairment. Dysfunction was commonly present in the sympathetic and parasympathetic branches, but most pronounced in the sympathetic system. The majority of patients were diagnosed with orthostatic hypotension (50%), inappropriate sinus tachycardia (20.8%), and postural orthostatic tachycardia syndrome (12.5%) and had subjective improvement with treatment.

Conclusion:
Cardiovascular autonomic dysfunction occurs in cancer survivors, and commonly affects both the sympathetic and parasympathetic systems. Symptom recognition in patients should prompt autonomic testing and treatment where appropriate.
Abstract 12955: A Novel Algorithm for Automated Titration of Autonomic Regulation Therapy for Heart Failure
Authors: LIBBUS Imad , Stubbs Scott , Dicarlo Lorenzo , Mazar Scott , Amurthur Badri , KenKnight Bruce
Published: May 2021

Background:
Autonomic Regulation Therapy (ART) using chronic vagus nerve stimulation (VNS) is a promising new therapy for patients with heart failure who remain symptomatic despite standard care. In the ANTHEM-HF Pilot Study, a therapeutic VNS intensity was successfully achieved in patients with HFrEF using manually programmed VNS up-titration. An algorithm has been developed for automatically intensifying VNS in small increments to a programmable target and capable of adjustments during up-titration process using a hand-held programmer or magnet.

Methods:
6 healthy canines were implanted with an implantable pulse generator (IPG) and electrical lead for right cervical VNS. IPG programming at implant activated the TA algorithm with (1) a 1-week start delay; (2) initial stimulation intensity of 0.125 mA, 130 μsec pulse width, and 5 Hz frequency; (3) target stimulation intensity of 2.5 mA, 250 μsec pulse width, and 5 Hz frequency; and (4) trajectory to achieve the target intensity in approximately 10 weeks. Magnet placement over the IPG at scheduled intervals tested algorithm design intention to decrement VNS intensity, prolong the time to reach the target intensity, and/or temporarily inhibit VNS.

Results:
All animals underwent successful VNS system implantation and completed all scheduled activities. There was one transient implant-related adverse event (Horner’s Syndrome). The TA algorithm performed as designed. The targeted VNS intensity was achieved as scheduled, and automated titration was well tolerated in all animals. There were no stimulation-related adverse events. ECG monitoring demonstrated no clinically significant cardiac findings. Detailed gross necropsy and macroscopic examinations revealed vagus nerves and all major organs to be normal in all animals.

Conclusion:
An IPG for VNS having a programmable TA algorithm for automatically intensifying VNS to a target intensity and capable of adjustment in response to magnet applications to the IPG, was successfully tested in a preclinical study of healthy canines. The TA algorithm performed as designed, appears to be safe and could dramatically reduce burden of titration in a clinical setting.
Abstract 12957: Delay in Qrs Interval Predicts Risk of Heart Failure and In-hospital Mortality in Patients Admitted With Atrial Fibrillation With Rapid Ventricular Response
Authors: Kaseer Belal , Tappuni Bassman , AlKhayru Ali , Zain Elabidin Awfa , Namdarizandi Vahid , Lobo Gitanjali , Hanumanthu Sai , Winner Marshall W , Kovalchik v Stephanie , Brandt Dominique , Shemisa Kamal
Published: May 2021

Introduction:
Atrial fibrillation is associated with increased risk of heart failure and mortality. The association of QRS duration (QRSd) with morbidity and mortality is understudied in patient with atrial fibrillation (AF)

Hypothesis:
We sought to investigate the association of prolonged QRSd (≥120 ms) and risk of heart failure and in-hospital death in patients admitted for AF with rapid ventricular response (RVR)

Methods:
A retrospective study in a community hospital using EPIC database analyzed 1637 patients from 2013-2018 with admission codes of AF with RVR. The cohort was then stratified based on QRSd ≥120ms vs <120ms. A p-value of <0.05 was considered significant

Results:
Among the 1637 patients who were admitted with AF with RVR, 233 (14%) had QRS ≥120ms. Patient’s characteristics with QRSd≥120 compared to those with QRSd<120ms were mean age [75.9 (11.8) vs 70.9 (13.6), (P<.0001)], history of CAD [41% vs 28%, odds ratio (OR)= 1.78, 95% confidence interval (CI): 1.3-2.3 (P<.0001)], history of PVD [15% vs 7%, OR=2.38, 95% CI: 1.58-3.59 (P<.0001)], history of acute MI [50% vs 33%, OR=1.99, 95% CI:1.5-2.6 (P<.0001)] and CHA2DS2Vasc score [median (IQR) 5(3, 6) vs 4(3, 5) (P<0.001). QRSd≥120ms was associated with higher BNP value [median (IQR) 537(305, 862) vs 371(186, 655) (P<0.001)] and an increased risk of heart failure [(70% vs 55%, OR=1.93, 95% CI:1.43-2.6 (P<.0001)]. Additionally, higher in-hospital mortality rate was observed in patients with QRSd≥120ms [4.3% vs 1.3%, OR=3.11, 95% CI:1.44-6.75 (P=0.006)]

Conclusions:
In patients who were admitted with AF with RVR, QRSd≥120ms was associated with a higher burden of cardiovascular disease, CHA2DS2Vasc score and an increased risk of heart failure resulting in worse clinical outcomes. Higher median BNP values suggest that worsening heart failure contributed to higher in-hospital mortality. Heart failure associated mortality could be alleviated with medical management or cardiac resynchronization therapy.
Abstract 12963: The Prevalence and Predictors of Transthyretin Amyloidosis in Patients Underwent Transcatheter Aortic Valve Implantation
Authors: Muto Yuki , YOSHIHISA Akiomi , Oikawa Masayoshi , KOBAYASHI ATSUSHI , Yamaki Takayoshi , Kunii Hiroyuki , Nakazato Kazuhiko , Fujimiya Tsuyoshi , Takase Shinya , Ishida Takafumi , Takeishi Yasuchika
Published: May 2021

Background:
Several studies have recently reported that transthyretin (ATTR) amyloidosis is present in patients with aortic stenosis (AS). We aimed to 1) examine the prevalence of ATTR amyloidosis in AS patients undergoing transcatheter aortic valve implantation (TAVI), 2) compare clinical characteristics between AS patients with and without ATTR, and 3) identify predictors of ATTR amyloidosis in AS patients.

Methods and Results:
We prospectively analyzed consecutive 32 patients with severe AS who underwent screening tests for ATTR in prior to TAVI. To detect ATTR, we performed cardiac technetium-99m pyrophosphate (
99m
Tc-PYP) scintigraphy in 24 patients and biopsies of fat tissue from the puncture site in 24 patients. Of 32 AS patients who were screened for ATTR, 6 (18.8%) patients were diagnosed as ATTR by cardiac
99m
Tc-PYP scintigraphy (n=2) and fat biopsy (n=5). Compared with non-ATTR patients, ATTR patients presented higher levels of B-type natriuretic peptide (BNP, 242.3 vs. 1101.4 ng/ml, P=0.004), lower left ventricular ejection fraction (LVEF, 62.3 vs. 45.5%, P=0.002) and lower mean pressure gradient of AS (50.2 vs. 32.0 mmHg, P=0.016). In contrast, age, sex, STS score, clinical frailty scale, prevalence of chronic kidney disease and atrial fibrillation, and levels of hemoglobin, albumin, estimated glomerular filtration rate and troponin I were comparable between the two groups. Other echocardiographic parameters including interventricular septal wall thickness, posterior wall thickness and aortic valve area did not differ between the two groups. To detect ATTR among AS patients, receiver operating characteristic (ROC) analysis demonstrated that area under the curve of BNP, LVEF, and mean pressure gradient was 0.814, 0.766 and 0.846, respectively. Although TAVI was successfully completed in all patients, and there was no procedural complication in both groups, one of ATTR patients re-hospitalized due to decompensated heart failure 3 weeks after TAVI.

Conclusion:
In AS patients undergoing TAVI, especially in cases of low-flow low-gradient pattern and high BNP levels, screening of ATTR should be considered. In this population, cardiac
99m
Tc-PYP scintigraphy and fat biopsy are useful to detect latent ATTR non-invasively.
Abstract 12970: High Power Short Duration and Low Power Long Duration in Atrial Fibrillation Ablation: A Systematic Review and Meta-analysis
Authors: Kewcharoen Jakrin , Techorueangwiwat Chol , Kanitsoraphan Chanavuth , Leesutipornchai Thiratest , Vutthikraivit Wasawat , Rattanawong Pattara , Bunch T J , Navaravong Leenhapong
Published: May 2021

Background:
Although high power, shorter duration (HPSD) ablation and low power, longer duration (LPLD) ablation strategies for atrial fibrillation (AF) are frequently advocated to enhance safety and efficacy, there exists a need for comparative data from large populations. We performed a meta-analysis to compare arrhythmia-free survival, procedure time and complications rates between the two strategies.

Methods:
We searched the databases of MEDLINE and EMBASE from inception to April 2020. Included studies were case-control studies, cohort studies, or randomized controlled trials that compared patients undergoing HPSD and LPLD strategies for AF ablation and reported either of the following outcomes: freedom from atrial tachyarrhythmia (AT) including AF and atrial flutter, procedure time, or periprocedural complications. Data from each study were combined using the random-effects model to calculate odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI).

Results:
Ten studies from 2006 to 2020 involving 2,189 patients were included (1,350 patients underwent HPSD strategy and 839 patients underwent LPLD strategy). Both HPSD and LPLD strategies resulted in a similar freedom from AT at 12-month follow-up (OR=1.36, 95% CI:0.91-2.04, p=0.13, Figure 1A). HPSD strategy did result in a significant reduction in total procedure time (WMD=47.34, 95% CI:29.47-65.21, p<0.001, Figure 1B) compared to LPSD. HPSD wasn’t associated with reduction in esophageal ulcer/arterioesophageal fistula (OR=0.35, 95%CI=0.12-1.06, p=0.06) or pericardial effusion/cardiac tamponade (OR=0.96, 95%CI: 0.24-3.79, p=0.95)

Conclusions:
In this large meta-analysis both LPLD and HPSD are equally effective and safe. Although HPSD is often advocated to reduce esophageal injury, risk was similar between approaches. However, HPSD strategy significantly lowers procedure times.
Abstract 12972: Serum-induced Expression of Brain Natriuretic Peptide Contributes to its Increase in Patients With HFpEF
Authors: Okamoto Ryuji , Hashizume Ryotaro , Suzuki Noboru , Kiyonari Hiroshi , Dohi Kaoru
Published: May 2021

Introduction:
Brain natriuretic peptide (BNP) levels are relatively higher in patients with heart failure with preserved ejection fraction (HFpEF) than heart failure with reduced ejection fraction (HFrEF); however, the mechanism remains unclear. BNP is induced by undetermined stretch-activated receptors including mechanically gated channels, which can be activated by a mechanical stimulus alone, and mechanically modulated channels, which require nonmechanical stimuli such as agonists. Thus it is possible that serum-induced expression of BNP may contribute to the increase of BNP in patients.

Purpose:
Our purpose is to examine whether serum-induced BNP expression (iBNP) partly contributes to the increase in BNP in patients with HFpEF.

Methods:
We generated the BNP reporter mice by knocking luciferase cDNA in the initiation site of
NPPB
. Neonatal cardiomyocytes were isolated and cultured from 2-day-old neonates. These cardiomyocytes were stimulated for 24 hours with 20% serum from patients with HFpEF or HFrEF (n=114 and 82, respectively) and the luciferase activity was examined as iBNP and the ratio of iBNP to BNP was measured. The patients’ characteristics and clinical parameters were compared and multivariate regression analysis was performed using SPSS version 25.

Results:
The mean ages were 71 yrs in HFpEF and 67 yrs in HFrEF. The female gender was higher in HFpEF (46% vs 32%). The prevalence of atrial fibrillation and hypertension and the use of calcium channel blocker (CCB) were higher in HFpEF than in HFrEF (31 vs 17%, 66 vs 43%, 28 vs 18%). The prevalence of coronary artery disease, chronic kidney disease and diabetes mellitus were lower in HFpEF than HFrEF (21 vs 42%, 44 vs 74%, 25 vs 44%). The ratio of iBNP to BNP was significantly higher in HFpEF than in HFrEF (26.9 vs 16.1, P<0.001). Multivariate regression analysis showed the existence of HFpEF was an independent predictor for the ratio of iBNP to BNP after adjusting all other measurements (β=0.154, P=0.032). Age, hemoglobin, the use of CCB and the deceleration time were also independent predictors (β=0.167, P=0.025; β=0.203, P=0.006; β=0.138, P=0.049; β=0.143, P=0.049, respectively).

Conclusions:
These results indicate the elevation of BNP in patients with HFpEF is partly due to the iBNP from heart.
Abstract 12973: Atrial Fibrillation is Associated With Increased Central Blood Pressure and Arterial Stiffness
Authors: Pauklin Priit , Eha Jaan , Tootsi Kaspar , Kolk Rein , Paju Rain , Kampus Priit
Published: May 2021

Background:
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in clinical practice, yet there is a lack of information about the hemodynamic profile and arterial stiffness of these patients.

Purpose:
The purpose of this study is to describe the differences in arterial stiffness and central blood pressures in patients with paroxysmal/persistent AF compared to a healthy control group.

Methods:
We included 76 patients with paroxysmal and persistent AF who underwent electrical cardioversion or pulmonary vein isolation (PVI) for AF. Carotid-femoral pulse wave velocity (cfPWV), augmentation index (AIx) and central blood pressure (cBP) were measured by applanation tonometry. All measurements were done in sinus rhythm (SR). We compared the results with 75 healthy age matched individuals.

Results:
Patients with a history of AF had higher cfPWV compared to the control group (8,0 m/s vs 7,2 m/s, p<0,001). AF patients also had higher central systolic blood pressure (cSBP) (118 mmHg vs 114 mmHg, p=0,03) and central pulse pressure (cPP) (39 mmHg vs 37 mmHg, p=0,03), without differences in peripheral systolic pressure (pSBP) (127 mmHg vs 123 mmHg, p=0,13), peripheral diastolic blood pressure (pDPB) (78 mmHg vs 76 mmHg, p=0,14) and peripheral pulse pressure (pPP) (48 mmHg vs 47 mmHg, p=0,37). There was no difference in heart rate (HR) (58 vs 61 bpm, p=0,08) (Table 1). In a multiple regression analysis (adjusted R
2
= 0,37) where cfPWV was set as the dependent variable and adjusting for age, sex, HR, weight, mean central arterial pressure (cMAP), estimated glomerular filtration rate (eGFR), the AF group remained to be an independent predictor for cfPWV (p=0,016).

Conclusions:
Patients with atrial fibrillation have a higher cSBP, cPP and cfPWV compared to healthy subjects without differences in peripheral blood pressure and HR. These findings support the hypothesis that arterial stiffness may play an important role in the development of atrial fibrillation.
Abstract 12984: Long-term Prognostic Value of the Serial Change of Acute Hemodynamic Index During Hospitalization in Patients Admitted for Acute Decompensated Heart Failure
Authors: Yamada Takahisa , Watanabe Tetsuya , Morita Takashi , Furukawa Yoshio , Tamaki Shunsuke , Kawasaki Masato , Kikuchi Atsushi , Kawai Tsutomu , Seo Masahiro , Kayama Kiyomi , Kawahira Masatsugu , Nakamura Jun , Ueda Kumpei , Kimura Takanari , Sakamoto Daisuke , Fukunami Masatake
Published: May 2021

Backgrounds:
Controlled heart rate (HR) and increased pulse pressure (PP) are related to better outcomes in stable heart failure. Hemodynamic response to stress evaluated by an acute hemodynamics index (AHI), the product of HR and PP, has been reported to be associated with poor outcomes in patients admitted for acute decompensated heart failure (ADHF). However, there is no information available on the long-term prognostic value of the serial change of AHI during hospitalization in patients admitted for ADHF.

Methods and Results:
We studied 259 patients admitted for ADHF and discharged with survival. We measured AHI (HR x PP/1000) at admission and discharge. AHI significantly decreased from admission to discharge (6.98±3.04 to 3.81±1.21 bpm·mmHg, p<0.0001). During a mean follow-up period of 5.0±3.2 yrs, 53 patients had cardiac death. The change [ad-dis] of AHI from admission to discharge (AHI[ad-dis]) was significantly less in patients with than without cardiac death (1.98±2.17 vs 3.47±2.87 bpm·mmHg, p=0.0005). Multivariate Cox regression analysis revealed that AHI[ad-dis], but not PP[ad-dis], was significantly associated with cardiac death, independently of prior heart failure hospitalization, body mass index, estimated glomerular filtration rate, hemoglobin level and left ventricular end-diastolic dimension. ROC analysis revealed that AUC in AHI[ad-dis](0.668[0.588-0.749]) was greater than that in PP[ad-dis](0.637[0.572-0.717]). Patients with less AHI[ad-dis] (≤1.79 bpm·mmHg by ROC analysis) had a significantly higher risk of cardiac death than those with greater AHI[ad-dis] (adjusted hazard ratio: 3.19[1.77 to 5.76], 30% vs 13%, p<0.0001).

Conclusions:
Cardiac death was frequently observed in ADHF patients who had less degree of the decrease in AHI during hospitalization. The change of AHI during hospitalization would be a simple and useful marker for risk stratification in patients admitted for ADHF.
Abstract 12994: Impact of the 2017 ACC/AHA Guidelines on the Prevalence of Hypertension in Women: A Comparative Study From India and the United States Using Data From Nationally Representative Surveys
Authors: Gupta Kartik , Kakar Tanya Singh , Gill Vikram Jeet S , jain vardhmaan , Gupta Prakash , Angraal Suveen , Bajaj Navkaranbir S
Published: May 2021

Introduction:
In 2017, the American Heart Association (AHA)/ American College of Cardiology (ACC) revised guidelines for diagnosis of hypertension. The differential impact on prevalence of hypertension among women across high- (United States) and middle-income countries (India) is not known.

Hypothesis:
There are regional differences in the change in prevalence of hypertension with the new 2017 ACC/AHA guidelines among women.

Methods:
We used data from National Family Health Survey (NFHS)-4, and the National Health and Nutrition Examination Survey (NHANES) 2015-16 to estimate prevalence of hypertension among non-pregnant women aged 18-49 years in India and the United States, respectively. Both surveys are conducted by respective federal governments to estimate national health status. Hypertension was defined as an average systolic BP (SBP) ≥130 or diastolic BP (DBP) ≥90 mmHg or on treatment in new and SBP/DBP ≥140/≥90 mmHg or on treatment in JNC-7 (old) guidelines. The Chi-Square test was used to compare the association between categorical variables.

Results:
There were 565,813 and 1,607 eligible participants in NFHS-4 (India) and NHANES (the United States), respectively. Mean age was comparable (31.9±9.0 vs. 33.5±9.4 years, p<0.001). Prevalence of hypertension per old guidelines was higher in USA as compared to India
(Figure Panel A)
. The new guidelines flipped the prevalence of hypertension such that it was significantly higher among women in India as compared to US overall and across all age groups (p<0.001 for all). The overall increase in prevalence among women in India and the United States was 153% (19% to 44%) and 39% (23% to 32%), respectively
(Figure Panel B)
.

Conclusions:
There is a higher impact of new guidelines on the prevalence of hypertension among women in India, across all age groups as compared to the United States. Future studies will help understand the mechanisms, risk factors and impact of this change on treatment and health economics in India.
Abstract 12995: Sex and Race Differences in Ventricular-Arterial Coupling in the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Ding Xuan , Patel Vivek , Xu Meng , Brittain Evan , Shah Sanjiv J , Allen Norrina B , Ac Lima Joao , Kishi Satoru , Terry James G , Carr Jeffrey , Gupta Deepak K
Published: May 2021

Background:
Coupling between the left ventricle and arterial system can be quantified as the ventricular-arterial coupling (VAC) ratio with 1.00 reflecting optimal physiology. VAC has been most studied in heart failure, with higher values associating with worse prognosis, but its correlates among individuals without heart failure are less characterized. Thus, in the Coronary Artery Risk Development in Young Adults (CARDIA) study we tested the hypothesis that VAC ratio differs by sex and race.

Methods:
We studied VAC in 2,812 (42% male, 47% black, median age 50 years) CARDIA year 25 exam participants with transthoracic echocardiogram data available and no history of heart failure, myocardial infarction, peripheral vascular disease, or valvular disease. VAC was calculated as arterial elastance (Ea) divided by LV end systolic elastance (Ees). Ea and Ees were calculated as end systolic pressure/stroke volume and by the modified Chen single beat method, respectively. Associations between sex and race with VAC were tested in multivariable-adjusted linear regression.

Results:
VAC ratio differed by both sex and race with higher unadjusted values in men (median 1.14 [25
th
-75
th
percentile 1.08-1.20]) compared with women (1.11 [1.05-1.17]), p < 0.001, and white (1.12 [1.07-1.18]) compared with black (1.11 [1.06-1.18]) individuals, p = 0.004. In adjusted models, male sex (beta 0.027 [95% CI 0.021 to 0.037], p <0.001) and white race (0.007 [0.002 to 0.012], p = 0.009) remained associated with higher VAC ratio (Figure 1). Sex, LV ejection fraction (beta -0.096 [95% CI -0.099 to -0.093], and total arterial compliance (-0.045 [-0.049 to -0.041]) were the most strongly associated correlates of VAC. Systolic blood pressure, creatinine, heart rate, LDL, and triglycerides inversely associated with VAC. Age and LV remodeling index positively associated with VAC.

Conclusions:
In community dwelling middle-aged adults, male sex and white race independently associated with higher VAC.
Abstract 12997: Impact of Baseline Atrial Fibrillation/Flutter on Short- and Long-term Outcomes After Transcatheter Aortic Valve Replacement With Sapien-3 Valve
Authors: Sammour Yasser , Lak Hassan Mehmood , Chawla Sanchit , Incognito Cameron , Kumar Arnav , Banerjee Kinjal , Svensson Lars G , Yun James J , Popovic Zoran B , Tarakji Khaldoun , Wazni Oussama M , Reed Grant W , Puri Rishi , Krishnaswamy Amar , Kapadia Samir R
Published: May 2021

Introduction:
Pre-existing atrial fibrillation has been linked with poor outcomes among patients undergoing transcatheter aortic valve replacement (TAVR).

Objective:
We sought to study the impact of baseline atrial fibrillation/flutter (AF) on outcomes after TAVR with SAPIEN-3 (S3) valve.

Methods:
All consecutive patients with severe symptomatic aortic stenosis who underwent TAVR with S3 valve at the Cleveland Clinic between April 2015 and December 2018 were included.

Results:
We included 1028 consecutive patients. Overall, the mean age of our study population was 81 ± 8.9 years, 58.8% were males, 95.8% were Caucasians. Pre-existing AF was present in 432 patients (42%). STS risk score was higher with AF compared to no AF (6.7 ± 3.8% vs. 5.4 ± 3.4%; p < 0.001). Baseline left ventricular ejection fraction (LVEF) was lower with AF (54% vs. 58%; p < 0.001). The rates of 30-day permanent pacemaker (PPM) implantation were similar between AF and no AF (11.4% vs. 9.4%; p = 0.326), as were the rates of new-onset left bundle branch block (LBBB) at discharge (9.6% vs. 9.4%; p = 0.901). There was also no difference in stroke rates at 30 days between the 2 groups (1.6% vs. 1%; p = 0.385). Post-TAVR mild or greater aortic regurgitation (AR) was higher with AF compared to no AF (21.5% vs. 16%; p = 0.022). LVEF was lower with AF at both 30 days (56% vs. 58.5%; p < 0.001) and 1 year (56% vs. 59%; p < 0.001). However, the change in LVEF (Δ) after TAVR was similar between AF and no AF (+1.1% vs. +1.4%; p = 0.624). At 2 years, all-cause death was higher with AF (22.9% vs. 12.8%; log-rank p = 0.011). There was no mortality difference between persistent versus paroxysmal AF (log-rank p = 0.714).

Conclusions:
Among our S3 TAVR patients, AF did not affect PPM, new-onset LBBB or stroke rates after the procedure. AF was associated with higher mild or greater AR at 30 days, as well as lower LVEF at both 30 days and 1 year compared to no AF. There was significantly higher all-cause mortality in the AF group at 2 years after TAVR.
Abstract 13013: Grk4-mediated Adiponectin Receptor-1 Phosphorylative Desensitization as a Novel Mechanism of Reduced Renal Sodium Excretion in Hypertension
Authors: Zhang Yan , Zeng Chunyu , Jose Pedro A
Published: May 2021

Introduction:
Hypertensive patients have impaired sodium excretion. However, the mechanisms are incompletely understood. There is interaction between kidney and adipose tissue. Whether and how adiponectin, one of adipokines, contributes to impaired sodium excretion in hypertension has not been previously investigated.

Hypothesis:
Adiponectin promotes natriuresis and diuresis and their impairment is involved in hypertension.

Methods:
We used Wistar-Kyoto (WKY) rats, spontaneously hypertensive rats (SHRs), GRK4g142A>V transgenic mice to test the natriuresis-effect of adiponectin through intrarenal arterial infusion. Renal proximal tubule (RPT) cells, adiponectin knock out (Adipo-/-) mice, mutant plasmid were used.

Results:
We demonstrate that sodium excretion was reduced in Adipo-/- mice. The intrarenal arterial infusion of adiponectin induced natriuresis and diuresis in WKY rats, which was impaired in SHRs. Adiponectin inhibited Na+-K+-ATPase activity in RPT cells from WKY rats but not from SHRs. Increased adiponectin receptor phosphorylation and subsequent uncoupling from Gai, rather than altered adiponectin receptor expression, were responsible for the loss of adiponectin-mediated inhibition of RPT Na+-K+-ATPase activity, impaired natriuresis and diuresis in SHRs. Mutation of the AdipoR1 phosphorylation site restored its linkage to Gai and the adiponectin-mediated inhibition of Na+-K+-ATPase activity in RPT cells from SHRs. Finally, we identified G protein-coupled receptor kinase 4 (GRK4) as the cause of adiponectin receptor hyper-phosphorylation. GRK4g142A>V transgenic mice replicated the abnormal adiponectin function in SHRs, whereas down-regulation of GRK4 by renal-ultrasound directed siRNA restored the adiponectin-mediated sodium excretion and reduced the blood pressure in SHRs.

Conclusions:
The stimulatory effect of adiponectin on sodium excretion is impaired in hypertension, which is attributable to increased renal GRK4 expression and subsequent adiponectin receptor hyper-phosphorylation. Targeting GRK4/adiponectin receptor/Gai may restore the impaired adiponectin-mediated sodium excretion in hypertension, thus representing a novel strategy against hypertension.
Abstract 13016: Clinical Outcomes Following Emergent Percutaneous Coronary Intervention for Acute Total/subtotal Occlusion of the Left Main Coronary Artery
Authors: Shibata Naoki , Umemoto Norio , Tanaka Akihito , Takagi Kensuke , Tashiro Hiroshi , Yoshioka Naoki , Shimizu Kiyokazu , Morishima Itsuro , Ishii Hideki , Murohara Toyoaki
Published: May 2021

Introduction:
Acute coronary syndrome involving the unprotected left main coronary artery (LMCA) is a fatal event. However, data regarding clinical features and outcomes in patients presenting with acute total/subtotal occlusion of the unprotected LMCA remain limited, and the impact of vital status in the emergency room (ER) remains unknown in such subjects.

Methods:
From a multi-center registry of 11977 emergent percutaneous coronary interventions (PCIs), 134 patients due to acute total/subtotal occlusion of the unprotected LMCA were reviewed. ER status classification was defined according to the presence of cardiogenic shock and cardiopulmonary arrest (CPA) in the ER (class 1=no cardiogenic shock; class 2= cardiogenic shock but not CPA; and class 3=CPA). We evaluated in-hospital mortality and cerebral performance category (CPC) as the endpoints.

Results:
One-half (67/134) of the enrolled patients presented with total occlusion of the unprotected LMCA. Regarding ER status classification, class 1, 2, and 3 were observed in 30.6%, 45.5%, and 23.9% of the patients, respectively. In-hospital mortality occurred in 73 (54.5%) patients, then of the remaining patients, 52 (85.3%) could be discharged with favorable neurological outcomes (CPC 1 or 2). ER status classification (odds ratio 4.79 [95% confidence interval: 2.39-9.62]; p<0.001) and total occlusion of the unprotected LMCA (odds ratio 5.79 [95% confidence interval 2.27-14.73]; p<0.001) were strong predictors of in-hospital mortality.

Conclusions:
Acute total/subtotal occlusion involving the unprotected LMCA appeared to be associated with high in-hospital mortality. ER status classification and initial flow in the unprotected LMCA were important predictive factors of in-hospital mortality.
Abstract 13022: Hemodynamic Parameters of Pulmonary Circulation in Acute Coronary Syndrome: Incremental Prognositic Value for Long-term Survival
Authors: Quan Ruilin , He Jianguo
Published: May 2021

Objectives:
To identify right heart catheterization (RHC)-assessed hemodynamic parameters of pulmonary circulation that were prognostic predictive of long-term survival in acute coronary syndrome (ACS), and to explore the incremental value of those parameters to the established risk models of coronary heart disease.

Methods:
Consecutive patients with ACS who underwent coronary angiography together with RHC were retrospectively reviewed. The primary endpoint was all-cause mortality. To identify the association between hemodynamic parameters and survival, Cox proportional hazards models were conducted. The optimal parameter identified was included in three subsequent models, which contained the Global Registry of Acute Coronary Events (GRACE), the Long-Term Intervention with Pravastatin in Ischemic Disease (LIPID) and the Cardiovascular Disease Research Using Linked Bespoke Studies and Electronic Health Records (CALIBER) models respectively. Model performance was evaluated before and after the addition of hemodynamic parameters.

Results:
A total of 251 patients were enrolled, with a median follow-up time of 34.7 months. By Cox analyses, systolic pulmonary arterial pressure [hazard ratio (HR): 1.043, 95% confidence interval (CI): 1.013-1.074], diastolic pulmonary arterial pressure (HR: 1.086, 95% CI: 1.014-1.164), mean pulmonary arterial pressure (HR: 1.077, 95% CI: 1.024-1.132), right ventricular systolic pressure (HR: 1.039, 95% CI: 1.008-1.070) and diastolic pressure gradient (HR: 1.101, 95% CI: 1.015-1.193) were found to be independent predictors of long-term survival. Furthermore, the addition of mean pulmonary arterial pressure to the established risk models yielded an improvement in model performance (integrated discriminatory index for the GRACE, LIPID and CALIBER model: 4.3%, 4.4% and 4.7%, respectively; all had a P<0.05).

Conclusions:
Hemodynamic parameters of pulmonary circulation can be predictive of long-term survival and provide incremental prognostic value to risk assessment in patients with ACS.
Abstract 13041: Stroke Mobile Apps: What About "FAST" and Other Risk Factors?
Authors: Wu Gloria , Pandya Binita S , bhatti harleen , Vijay Arunima
Published: May 2021

Do Stroke Apps Include FAST?

Background:
There are 325,000 mobile health apps, with 3.7 billion downloads annually. Stroke is a major health problem in America, affecting 795,000 annually. Yet, 1 in 3 Americans cannot name the stroke warning signs.

Hypothesis: Mobile health apps that mention stroke fail to include FAST criteria and fail to provide information about stroke risk factors.

Methods:
“Stroke” was used as a search term for iOs and Droid apps. We evaluated free apps, and Stroke warning signs,(F=face droop, A= arm weakness, S=speech, T= call 911, FAST). We looked for risk factors such as Cholesterol (Chol), fasting blood sugar (FBS), smoking, hypertension (HTN), atrial fibrillation (AF), ethnicity, gender, and age.

Results:
We found 500 apps that mentioned stroke, of those, only 7 apps specifically list the FAST criteria. The number of apps mentioning key risk factors are listed: Chol: 3/8, FBS 2/8, Smoking 4/8, HTN 5/8, Vision Loss 6/8, Gender 4/8, Ethnicity:2/8, Afib 3/8. Only 1 app mentioned heart.org, and none mentioned Stroke.org or “cvriskcalculator.”

Conclusion:
Only a small proportion of mobile apps mentioning stroke list the FAST criteria, possibly delaying patients and families from taking appropriate rapid action. Apps also need to have more information about important risk factors for stroke. Improved visibility of these apps is needed to increase public awareness of Stroke.

References:Research2Guidance. 325000 mobile health apps available in 2017.https://research2guidance.com/325000-mobile-health-apps-available-in-2017/. Accessed May 17, 2020.