bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12823: Efficacy, Optimal Duration and Safety of Adjunctive Cilostazol in Acute ST-elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention With Drug-Eluting Stents; a Multicenter, Randomized, Open Label, Phase 4 Trial
Authors: Park Soohyung , Choi Byoung Geol , Choi Se Yeon , Byun Jae Kyeong , Cha Jinah , Lee Kyuho , Back Seungmin , Lee Jieun , Kang Dong , Kim Ji Bak , Choi Jah , Roh Seung-young , Na Jin O , Choi Cheol Ung , Kim Eung Ju , Park Chang Gyu , Seo Hong-Seog , Rha Seung Woon W
Published: April 2022

Background:
Previous studies showed that the triple antiplatelet therapy (TAT) which is an addition of cilostazol on the top of conventional dual antiplatelet therapy (DAT, aspirin + clopidogrel) was associated with better clinical outcomes in ST-elevation MI (STEMI) patients as compared with DAPT but the optimal duration of TAT was not determined yet.

Method:
A total 985 patients underwent primary percutaneous coronary intervention (PCI) with drug-eluting stents (DES) were prospectively enrolled in 14 medical centers in Korea. We randomly assigned patients into 3 groups of DAT (aspiring and clopidogrel) for 12 months, TAT (aspirin, clopidogrel and cilostazol) for 1month or 6months. The primary end point was 1-year major adverse cardiovascular events (MACE), defined as the composite of all-cause death, non-fatal myocardial infarction (MI), stroke or repeat revascularization. The secondary endpoints were the incidence of cardiac death, stent thrombosis, bleeding events and each component of primary end point.

Results:
The primary end point was not different among the 3 groups (8.4% in the DAT, 11.0% in the TAT for 1month, 11.3% in the TAT for 6 months, p=0.427). However, incidence of cardiac death was significantly higher in TAT groups (0.3% vs 2.5% vs 1.3%, respectively, p=0.047). Regarding in-hospital outcomes, higher bleeding events occurred in TAT groups than DAT group (0.3% vs 3.2% vs 1.9%, p=0.027) without significant difference in major bleeding.

Conclusion:
TAT strategy with cilostazol on the top of DAT did not associated with reduced incidence of 1-year MACE as compared with DAT but may be associated with increased cardiovascular death and bleeding risk. Whether routine additional use of cilostazol for STEMI patients would be beneficial need further studies with larger study population.
Abstract 12830: Cardiac POCUS: Another Tool in the Armory
Authors: Vasudeva Rhythm , Challa Abhiram , Chaaban Nourhan , Shah Hamna , Brumfield Elisha J , Duran Brent , Vindhyal Mohinder
Published: April 2022

Introduction:
Cardiac Point-Of-Care-Ultrasound (POCUS) is a valuable bedside tool that has been shown to provide better-quality patient care. Few studies have examined residents’ interest and the educational impact of a hybrid Cardiac POCUS training model in a community-based academic setting.

Material and Methods:
Internal Medicine and Medicine/Pediatrics residents across all post-graduate years (PGY) undertook a structured hybrid (online and hands-on teaching) model of POCUS training. Anonymous surveys with Likert-type scale responses were conducted before and after the curriculum. Questions were categorized into domains to assess the residents’ interest in learning POCUS, their understanding of fundamental cardiac ultrasound (US) concepts, and their confidence in its application. Direct comparisons were made using Fisher’s exact and t-test as appropriate. Odds ratios were estimated to further gauge the impact of the training.

Results:
A total of 27 and 26 residents completed the pre-and post-training anonymous surveys, respectively. A median of 1 previous cardiac US was reported, with the distribution showing a positive skew. Responses inquiring about residents’ interest in learning POCUS were similar post-training compared to the pre-training survey (OR 3.66 [CI 0.86 - 15.59], p = 0.07), a finding consistent amongst sub-groups female gender, and PGY levels 2 & 3. The training did reveal a significant increase in both, the understanding of cardiac POCUS principles (OR 8.25 [CI 1.61 - 42.28], p = 0.005), and the residents’ confidence in its application (OR 13.53 [CI 1.58 - 116.04, p=0.005]. The mean score on confidence level, though higher post-training, was not significant amongst PGY 1 residents.

Conclusions:
Understanding fundamental cardiac ultrasound concepts and the confidence level in its application were significantly greater amongst residents after implementing a structured hybrid teaching model for Cardiac POCUS. This may be most impactful if designed for PGY levels 2 & 3. Future studies with a comprehensive teaching curriculum and more objective assessment tools are needed to gauge its clinical impact, its adoption rate in clinical practice, and a recommendation for incorporation into the residency curriculum.
Abstract 12835: Transitions in Academic Cardiothoracic Surgery From 2018 to 2020
Authors: Bajaj Simar S , Wang Hanjay , Williams Kiah M , Obafemi Oluwatomisin O , Boyd Jack H
Published: April 2022

Introduction:
New training paradigms and increasing surgeon demands have shaped how individuals enter and exit academia. We examined the characteristics of surgeons who moved into and out of academic cardiothoracic (CT) surgery between 2018 and 2020.

Methods:
We created a database of academic CT surgeons in the U.S. at all 77 accredited CT surgery training institutions in 2018 (n=992) and all 79 such institutions in 2020 (n=1065). Surgeon-specific professional history data were obtained from institutional webpages and other publicly available sources. Categorical data are presented as counts with percentage.

Results:
Between 2018 and 2020, 119/992 (12.0%) surgeons exited centers with training programs. Of the 992 surgeons in 2018, 22 (2.2%) passed away or retired, 38 (3.8%) moved to a university center without a training program, and 53 (5.3%) moved to private or community practice. 56/992 (5.6%) surgeons also moved from one training center to another between 2018 and 2020, with 19 (33.9%) moving to an institution with greater National Institutes of Health (NIH) funding. At these 2020 institutions, 15 (26.8%) are now assistant professors, 17 (30.4%) associate professors, and 21 (37.5%) professors; 20 (35.7%) received a promotion in academic rank upon moving. Between 2018 and 2020, 164/1065 (15.4%) surgeons entered centers with training programs. Directly before entering, 9 (5.5%) completed I6 residencies, 45 (27.4%) completed traditional CT surgery fellowships, 39 (23.8%) completed advanced CT surgery fellowships, 34 (20.7%) were attendings at a university center without a training program, and 17 (10.4%) were attendings in private or community practice. Of the 77 institutions in both 2018 and 2020, there was a median increase of 1 surgeon per institution, with 20 (26.0%) programs shrinking in size, 13 (16.9%) staying stable, and 44 (57.1%) expanding.

Conclusions:
Between 2018 and 2020, there has been growth in academic CT surgery with a net increase of surgeon faculty by 4.5% and a majority of training centers expanding faculty size. Among those who switched institutions, more stayed in academia than shifted to private practice. This transition from one training program to another represents one of the many diverse pathways into academic CT surgery.
Abstract 12876: Identification of Pathogenic Immune Cell Subsets in Immunotherapy-Induced Myocarditis
Authors: Zhu Han , Galdos Francisco X , Waliany Sarah , Lee Daniel , Ryan Julia , Neal Joel W , Wakelee Heather A , Reddy Sunil A , Witteles Ronald M , Maecker Holden T , Davis Mark , Nguyen Patricia K , Wu Sean M
Published: April 2022

Introduction:
Immune checkpoint inhibitors (ICIs) are monoclonal antibodies used to activate the immune system against tumor cells. Despite therapeutic benefits, ICIs have the potential to cause immune related adverse events (irAE) such as myocarditis, a rare but serious side effect with up to 50% mortality in affected patients. Histologically, patients with ICI myocarditis have lymphocytic infiltrates in the heart, implicating T-cell-mediated mechanisms. However, the precise pathologic immune subsets and molecular changes in ICI myocarditis are unknown.

Hypothesis:
We hypothesize that ICI myocarditis is associated with significant quantitative and molecular changes in pathogenic immune cell subsets.

Methods:
To identify immune subset(s) associated with ICI myocarditis, we performed time-of-flight mass cytometry (CyTOF) on peripheral blood mononuclear cells from 40 patients and controls with autoimmune adverse events (irAE) on ICI including four patients with ICI myocarditis. We also profiled 15 patients/controls using single cell T-cell receptor (TCR) sequencing and RNA sequencing (scRNA-seq) with feature barcoding for surface marker expression confirmation.

Results:
With both methods, we found expansion of cytotoxic CD8+ T effector cells re-expressing CD45RA (Temra CD8+ cells) in ICI myocarditis patients compared to controls. Using TCR sequencing, these CD8+ Temra cells were clonally expanded in myocarditis patients. Transcriptomic analysis of these Temra CD8+ clones confirmed a highly activated and cytotoxic phenotype with expression of granzyme/perforin. Longitudinal study demonstrated progression of these Temra CD8+ cells into an exhausted phenotype two months after treatment with glucocorticoids. Differential expression of proinflammatory chemokines (CCL4/CCL4L2/CCL5) was uncovered in clonally expanded Temra CD8+ cells, and ligand-receptor analysis implicated their regulation of other inflammatory cells such as monocytes and NK cells.

Conclusions:
Clonal cytotoxic Temra CD8+ cells are significantly increased in patients with ICI myocarditis, and have unique transcriptional changes, including upregulation of chemokines CCL4/CCL4L2/CCL5, which may serve as attractive diagnostic/therapeutic targets.
Abstract 12880: Neddylation Regulates Murine Cardiomyocyte Maturation
Authors: Zou Jianqiu , Ayala Juan , Wang Wenjuan , Littlejohn Rodney E , Wang Jinxi , Zhou Jiliang , Song Long-sheng , Li Jie , Su Huabo
Published: April 2022

From birth to adulthood cardiomyocytes (CMs) undergo a complex maturation process characterized by drastic changes in cell size, ultrastructure, metabolism and gene expression. The molecular mechanisms regulating CM maturation remain poorly defined. Neddylation is a novel post-translational modification that covalently attaches a small ubiquitin-like protein, NEDD8, to target proteins. We found that deletion of NAE1, a critical NEDD8 E1 enzyme that triggers neddylation, in embryonic and perinatal mouse hearts via Nkx2.5
Cre
and aMHC
Cre
, respectively, led to myocardial hypoplasia, heart failure and early lethality. The severe cardiac phenotypes are accompanied by disorganized sarcomere structure and defective fetal-to-adult gene transition, suggesting a possible role for neddylation in CM maturation. To rule out the confounding effect of secondary changes caused by perturbed CM differentiation and cardiac stress response in the mutant hearts, we used AAV9-cTnT-Cre to achieve mosaic knockout of NAE1 in postnatal hearts. High-dose AAV9 deleted NAE1 in 80% CMs and caused heart failure, whereas low-dose AVV9 deleted NAE1 in 30% CMs and preserved heart function. In the context of preserved cardiac function, CMs lacking NAE1 showed severe disrupted transverse tubules (T-tubules) network, which was further exacerbated in hearts with modest dysfunction. In contrast, T-tubule morphology was largely maintained in CMs with intact NAE1 expression from low-dose AAV9 infected hearts, as well as in CMs with deletion of one allele of NAE1, indicating a key, cell-autonomous role of neddylation in T-tubule maturation. Biochemical and histological analyses further revealed dysregulated metabolic and sarcomeric gene expression and disrupted sarcomere ultrastructure in high-dose AAV9 infected hearts, supporting defective CM maturation. In vitro, pharmacological inhibition of neddylation also impaired myofibril assembly in isolated neonatal and adult CMs. Together, our data reveal an important role of neddylation in CM maturation in the developing heart, warranting further investigations of detailed posttranslational mechanisms underlying CM maturation.
Abstract 12891: Loss of Stem Cell Antigen-1 Worsens Vessel Remodeling
Authors: Wang Tao , Momen Abdul , Chiu Felix , Alibhai Faisal , Li Renke , Robbins Clint S , Husain Mansoor
Published: April 2022

Background:
Stem cell antigen-1 (Sca-1)-expressing progenitor cells contribute to vessel remodeling by differentiating into vascular smooth muscle cells and related myofibroblast-like progeny. However, the functional role for Sca-1 expression in vessel remodeling has not been examined. Here, we assessed the requirement for vascular Sca-1 using a mouse model of Sca-1 deficiency.

Methods & Results:
Male and female Sca-1-deficient mice (Sca1KO) and C57BL/6N wild-type mice (WT) controls, aged 12-14-wk, were subjected to wire denudation injury of the left common carotid artery. Sca1KO displayed larger neointima at 14d post-injury [35±3mm
2
vs.
25±3mm
2
, p<0.05, n=11-12/group], and more adventitial matrix at 8d [87±3mm
2
vs.
58±4mm
2
, p<0.001, n=9-11/group] and 14d post-injury [109±10mm
2
vs.
51±11mm
2
, p<0.01, n=11-12/group] by Masson’s trichrome staining. Underlying these differences, cell numbers per cross-section were increased in adventitia at 8d [649±27
vs.
435±30, p<0.001, n=9-11/group] and 14d post-injury [778±45
vs.
485±47, p<0.001, n=11-12/group]. Non-leukocyte proliferation by CD45
-
Ki67
+
staining was increased 1.8-fold in neointima [p<0.01, n=9-11/group] and 1.4-fold in adventitia [p<0.05, n=9-11/group] at 8d post-injury in Sca1KO
vs.
WT. Cell-type analyses of Sca1KO
vs.
WT revealed increased pro-fibrotic vimentin
+
cell proportions at 8d [1.4-fold in neointima, p<0.05; 2.5-fold in media, p<0.001; 1.8-fold in adventitia, p<0.001; n=9-11/group] and 14d post-injury [1.5-fold in neointima, p<0.05; 1.8-fold in media, p<0.05; 1.9-fold in adventitia, p<0.001; n=11-12/group]. CD45
+
leukocyte proportions were increased 1.5-fold in neointima [p<0.01, n=9-11/group] and 1.4-fold in adventitia [p<0.01, n=9-11/group] at 8d post-injury, which was also increased 1.5-fold in adventitia by 14d [p<0.01, n=11-12/group].

Conclusion:
Taken together, our findings suggest that the loss of Sca-1 worsens remodeling by disinhibiting proliferative, pro-fibrotic, and immune responses to injury, demonstrating a critical role for vascular Sca-1 expression, which may inform novel strategies for the prevention and treatment of vessel remodeling.
Abstract 12912: Cardiovascular Magnetic Resonance Characterization of Rheumatic Mitral Stenosis: Findings From India, China, and Mexico
Authors: Vidula Mahesh K , Xu Ziqian , Xu Yuanwei , Alturki Abdullah , Nagabhushana Reddy Bhavana , Viswamitra Sanjaya , Kini Prayaag , Alberto-Delgado Angel , Jacob Ron , Sierra Galan Lilia M , chen yucheng , Han Yuchi
Published: April 2022

Introduction:
Cardiac remodeling in rheumatic mitral stenosis (MS) is incompletely understood. Cardiac magnetic resonance (CMR) imaging has the potential to provide more precise characterization of morphologic and functional changes that occur in response to MS. The objective of this study was to describe CMR findings in rheumatic MS to characterize cardiac structural and functional changes in this population.

Methods:
This retrospective study included 40 patients with rheumatic MS, including 15 patients from China, 19 patients from India, and 6 patients from Mexico. Patients were included in the rheumatic MS cohort if they did not have a prior mitral valve procedure, other concomitant moderate-severe or severe valve disease, or other known cardiovascular conditions. Twenty patients were included in the control group from India. CMR variables pertaining to morphology and function were collected. Late gadolinium enhancement (LGE) sequences were acquired for tissue characterization.

Results:
Forty patients with rheumatic MS (median (interquartile range (IQR)) age: 45 (34-55) years; 75% women) were studied. Compared to the control group, patients with MS had lower left ventricular (LV) ejection fraction (EF) (51% (42%-55%) vs 60% (57%-65%),
p
= 0.0001), lower right ventricular (RV) EF (44% (40%-52%) vs 64% (59%-67%),
p
< 0.0001), larger RV end-diastolic volumes (72 (58-87) mL/m
2
vs 59 (49-69) mL/m
2
,
p
= 0.003), and larger LA and RA sizes. LGE was prevalent in patients with MS, located at the RV insertion sites. Representative CMR images are shown in the Figure, with the arrows pointing to areas of LGE at the RV insertion sites.

Conclusions:
These findings further our understanding of the structural and functional changes that occur in response to rheumatic MS, and demonstrate that biventricular dysfunction is underappreciated in contemporary rheumatic MS. Further studies are required to understand the prognostic implications of these findings.
Abstract 12916: Improving Cardiovascular Health in Black Men Through a 24-week Community-Based Lifestyle Change Intervention: The Black Impact Program
Authors: Joseph Joshua J , Nolan Timiya , Williams Amaris , McKoy Alicia , Zhao Songzhu , Aboagye-Mensah Emmanuela , Kluwe Bjorn , Odei James , Brock Guy , Lavender Dana , Gregory John , Gray Darrell
Published: April 2022

Introduction:
Higher cardiovascular health scores, using American Heart Association’s (AHA) Life’s Simple 7 (LS7), have been associated with lower risk of cardiovascular disease, type 2 diabetes, cancer and mortality among all racial/ethnic groups. Nationally, Black men have the lowest levels of LS7. Thus, a study was conducted to evaluate the impact of a community-based lifestyle change program on LS7 among Black men.

Hypothesis:
A community-based lifestyle change program will increase levels of LS7 among Black men.

Methods:
Black adult males (n=74) from a large Midwestern city participated in Black Impact, a 24-week community-based lifestyle change program adapted from the Diabetes Prevention Program and AHA’s Check, Change, Control Blood Pressure Self-Management Program which incorporates AHA’s LS7 framework. The change in a LS7 score (range 0-14) from baseline to 12 and 24 weeks was evaluated using a linear mixed effects model adjusted for age, education and income.

Results:
The mean age of participants was 52 ±10 years. The men were sociodemographically diverse with annual income ranging from <$20,000 (7%) to ≥$75,000 (25%). Twenty-five percent were college graduates, 73% had private insurance and 84% were employed. In fully adjusted models, LS7 score at baseline was 7.12 and increased 0.67 (95%CI: 0.14, 1.20, p=0.013) and 0.93 (95%CI: 0.40, 1.46, p=<0.001) points at 12 and 24 weeks, respectively, compared to baseline. Sensitivity analysis evaluating 5 components (excluding diet and physical activity) and 6 components (excluding diet) also showed significant increases at 12 and 24 weeks (all p<0.01).

Conclusions:
The Black Impact lifestyle change single-arm pilot program showed that a community-based lifestyle intervention has the potential to improve LS7 in Black men. Further randomized studies are urgently needed to improve cardiovascular health and advance cardiovascular health equity in Black men.
Abstract 12918: COVID-19 Has Not Decreased the Volume of Transcatheter Aortic Valve Replacements Performed in the United States
Authors: Aranda-Michel Edgar , Brown James , Serna-Gallegos Derek , Gada Hemal , Kliner Dustin , Toma Catalin , Sanon Saurabh , Wang Yisi , Sultan Ibrahim
Published: April 2022

Introduction:
Transcatheter aortic valve replacement (TAVR) is the predominant technique for aortic valve replacements. The COVID19 pandemic caused significant disruptions to hospital procedural and surgical volume and revenue, which could affect patients with aortic stenosis.

Hypothesis:
The COVID-19 pandemic may have decreased the volume of TAVRs in the United States.

Methods:
The National Readmission Database (NRD) was reviewed for all adults from 2012 to 2017 who underwent a TAVR procedure based on ICD 9 and 10 coding. A linear regression based on year and quarter was used to project the trend of volume and cost through the end of 2020. Institutional TAVR volume was compared from 2020 to 2019 to generate an estimate of COVID’s effect on volume. This trend effect was utilized for the 2020 projections to create national estimates of changes in volume and hospital costs. The NRD weights were used to generate national estimates, charge-cost ratios were used to convert hospital charges to hospital costs, and all monetary values were adjusted to 2020 dollars via the GDP.

Results:
A total of 172,546 TAVR procedures were performed. TAVR volume has been increasing since 2012 with an estimated 21,516 cases in the last quarter of 2020 (
Figure 1A).
The linear regression was well fit with a R
2
of 0.995. Similarly, hospital costs of TAVR have been increasing since 2012 with a projected 4.18 billion dollars in 2020
(Figure 1B)
. The linear regression was also well fit with a R
2
of 0.968. There were two quarters in which hospital volume outperformed predicted values and two in which it underperformed
(Figure 1C).
Throughout the pandemic, there was a net increase of 1,918 TAVR procedures and an associated increase of 114 million dollars in hospital costs.

Conclusions:
TAVR volumes have been steadily increasing, with commensurate escalation in hospital hosts. The COVID-19 pandemic has caused minimal derailment to this trend, with an actual increase in volume and hospital costs during this time.
Abstract 12926: The Impact of Thoracic Aortic Aneurysm versus Dissection on Postoperative Outcomes After Thoracic Endovascular Aortic Repair
Authors: Brown James , Serna-Gallegos Derek , Aranda-Michel Edgar , Yousef Sarah , Wang Yisi , Navid Forozan , Dunn-Lewis Courtenay , Sultan Ibrahim A
Published: April 2022

Introduction:
As thoracic endovascular aortic repair (TEVAR) is the standard of care for complicated Type B aortic dissection (TBAD) and descending thoracic aortic (DTA) aneurysm, it is critical to understand its outcomes and utilization.

Hypothesis:
Nationwide postoperative complications, admission costs, and 30- and 90-day readmissions after TEVAR are between TBAD and aneurysm.

Methods:
Codes from the International Classification of Diseases (ICD) 9 and 10 identified patients with a primary procedure code for TEVAR from 2010-2017 in the Nationwide Readmissions Database (with trend weights to generate national estimates). After ICD codes identified patients with thoracic or thoracoabdominal aortic dissection as well as aortic aneurysm, the two groups were compared. Mixed model logistic regression identified variables associated with readmission, treating individual hospital as a random effect.

Results:
An estimated 6594 patients underwent non-elective TEVAR, of which 4649 (70.5%) had TBAD and 1945 (29.5%) had aneurysm of the DTA. Patients with aneurysms were more likely to be older, be women, have cardiovascular disease, and have chronic pulmonary disease than patients with TBAD. In-hospital mortality was lower for aneurysm (5.7% vs. 10.9%, p<0.001) than TBAD. For patients with aneurysm, there was less stroke (4.6% vs. 7.1%), paraplegia (2.2% vs. 3.9%), acute kidney injury (18.2% vs. 34.5%), and mesenteric ischemia (2.0% vs. 5.8%) than TBAD. Patients with aneurysm had lower total cost of care during their index admission (48.0 vs. 65.2 x $1000) than TBAD. The proportion of 30-day and 90-day readmissions were similar across each group, with overall 30-day readmission being 23.6%, while 90-day readmission was 38.2%. On multivariable adjustment, aneurysm was not associated with increased odds of 30-day readmission (OR 1.02, 95% CI: 0.84, 1.25, p=0.820) or 90-day readmission (OR 0.97, 95% CI: 0.80, 1.19, p=0.780) compared to TBAD.

Conclusions:
While TBAD was associated with worse in-hospital mortality and higher incidence of complications, aortic disease was not associated with an increased odds of readmission through 90 days. However, the incidence of early readmission was substantial for patients undergoing non-elective TEVAR.
Abstract 12928: The Impact of Medicaid Expansion on Black - White Disparities in Cardiovascular Disease Mortality
Authors: Brown-podgorski Brittany , Jacobs Elizabeth A , Cubbin Catherine
Published: April 2022

Introduction:
Cardiovascular disease (CVD) is a leading cause of mortality among US adults, especially low-income and uninsured adults. Non-Hispanic Black adults, who are overrepresented in these at-risk populations, are disproportionately burdened by poor cardiovascular health and CVD-related premature mortality. Medicaid expansion is associated with reduced CVD mortality overall, however research suggests that Medicaid expansion has had fewer impacts on health outcomes among non-Hispanic Black adults relative to non-Hispanic White adults. Therefore, it is unclear whether Medicaid expansion has lessened the disparate burden of CVD on this population. This study investigated the relationship between Medicaid expansion and Black-White disparities in CVD mortality.

Methods:
We estimated a difference-in-differences model using mortality data (2011 – 2019) from the Wide-Ranging Online Data for Epidemiologic Research (WONDER) system to compare changes in Black-White CVD mortality ratios between counties in expansion and non-expansion states. The age-adjusted mortality ratio (AAMR) was calculated by dividing the county-year age-adjusted mortality rate for non-Hispanic Black adults (ages 45 – 64) by the county-year age-adjusted mortality rate for non-Hispanic White adults. The final sample consisted of 1,720 county-year observations.

Results:
From 2011 – 2019, the AAMR was significantly higher among counties in expansion states (
p
<0.001). Controlling for county-level factors, Medicaid expansion was associated with a 2.01% decrease in the AAMR in CVD, but this relationship was not statistically significant (Figure 1). County-level rate of cardiologists per 100,000 and median household income were associated with a significant increase in the AAMR.

Conclusion:
Medicaid expansion may be associated with reduced CVD mortality overall; however, it is insufficient to counteract social and economic drivers of racial disparities in CVD mortality.
Abstract 12940: Shared Senescence Pathophysiology in Preeclampsia and Peripartum Cardiomyopathy
Authors: Roh Jason D , Yu Andy , Rana Sarosh , SHAHUL Sajid , Castro Claire , Honigberg Michael , Ricke-Hoch Melanie , Yeri Ashish , Kitchen Robert , Hobson Ryan , Chaudhari Vinita , Chang Bliss , Sarma Amy , Kirkland James , Karumanchi Ananth , Gorcsan John , Masataka Sugahara , Damp Julie B , Hanley-Yanez Karen , Arany Zoltan , McNamara Dennis M , Hilfiker-Kleiner Denise , Rosenzweig Anthony
Published: April 2022

Introduction:
Peripartum cardiomyopathy (PPCM) is a rare form of pregnancy-related heart failure associated with preeclampsia. Our understanding of their shared pathophysiology is limited as are treatment options.

Hypothesis:
We hypothesized that plasma proteomic profiling would identify deleterious circulating proteins and provide insights into shared mechanisms driving preeclampsia and PPCM.

Methods:
We performed serum proteomic case-control studies in women with preeclampsia or PPCM to identify biological processes common to both conditions. The top candidate was validated in independent preeclampsia (n=58) and PPCM (n=114) cohorts. Preeclamptic placenta was examined as a potential source of circulating proteins. Therapeutic targeting the top candidate was examined in an animal model of PPCM.

Results:
Paradoxically, we found the senescence-associated secretory phenotype (SASP), a marker of biological aging, to be the most upregulated process in relatively young women with preeclampsia (normalized enrichment score [NES]=3.3;p
adj
=4.0x10
-6
) or PPCM (NES=3.2;p
adj
=1.9x10
-5
). 28 circulating proteins contributed to this common signal, and were strongly enriched in preeclamptic placenta, which expressed markers of increased senescence. The TGFb family member, Activin-A, was the most highly upregulated SASP gene in preeclamptic placentas (5-fold;p<0.001). Circulating Activin-A was elevated in preeclampsia (2.9-fold) and PPCM (2.5-fold) validation cohorts (p<0.001) and correlated with impaired left ventricular global longitudinal strain (r=0.3-0.5;p<0.001). In PPCM, Activin-A increased with worsening heart failure, reflected by NYHA class and BNP levels (p<0.05), and cardiac FSTL3 expression, an indicator of Activin-A signaling, was increased (2.2-fold;p=0.005). Inhibition of Activin-A receptors with a monoclonal antibody improved systolic function and adverse cardiac remodeling in a murine PPCM model.

Conclusions:
These data implicate placental senescence in the increased deleterious circulating proteins seen in preeclampsia and PPCM. We identify multiple new circulating factors associated with these diseases and demonstrate that targeting SASP proteins, such as Activin-A, can mitigate PPCM in mice.
Abstract 12976: Insulin Resistance and Cardiometabolic Risk Profile Among Non-Diabetic American Young Adults: Insights From NHANES
Authors: Parcha Vibhu , Heindl Brittain F , Kalra Rajat , Li Peng , Gower Barbara , Arora Garima , Arora Pankaj
Published: April 2022

Introduction:
The burden of insulin resistance (IR) among young American adults has not been previously assessed. We evaluated the 1) trends and prevalence of IR and cardiometabolic risk factors and, 2) assessed the association between measures of adiposity and IR among adults aged 18-44 years without diabetes and preexisting cardiovascular diseases.

Methods:
Young adult participants aged 18-44 years from the National Health and Nutrition Examination Survey 2007-2018 cycles were analyzed. IR was defined as homeostatic model assessment for IR (HOMA-IR) of ≥2.5. The temporal trends of IR, prevalence of cardiometabolic risk factors (hypertension [HTN], hypercholesterolemia, obesity, poor physical activity, smoking, and poor diet), and the relationship between IR and measures of adiposity were assessed using multivariable-adjusted regression models.

Results:
Among 6,247 young adults, the prevalence of IR was 44.8% (42.0%-47.6%) in 2007-2010 and 40.3% (36.4%-44.2%) in 2015-2018 (P=0.07). There was a modest association of HOMA-IR with higher body mass index (BMI), waist circumference, total lean fat mass, and total and localized fat mass (all p<0.001)(
Fig 1
). Participants with IR had a higher prevalence of HTN (31.3% [29.2%-33.5%] vs. 14.7% [13.2-16.2%]), hypercholesterolemia (16.0% [12.4%-19.5%] vs. 7.0% [5.8%-8.5%]), obesity (56.6% [53.9-59.3%] vs. 14.7% [13.0%-16.5%]) and poor physical activity levels (18.3% [16.4%-20.2%] vs. 11.7% [10.3%-13.1%]) compared to participants without IR (all p<0.05). The prevalence of current smoking status (21.2% [19.1%-23.3%] vs. 21.6% [19.4%-23.9%]) and poor diet (79.1% [77.2%-81.0%] vs. 77.4% [75.2%-79.6%]) was similar between those with and without IR.

Conclusions:
Four-in-ten young American adults have IR which occurs in a cluster with cardiometabolic risk factors. Nearly half of young adults with IR are non-obese. Implementation of IR screening irrespective of BMI may be required.
Abstract 12984: Technology-Delivered Motivational Interviewing Interventions for Patients With Cardiovascular Diseases - A Systematic Review
Authors: Iovino Paolo , Baricchi Marina , Ghizzardi Greta , Trenta Alessia Martina , caruso rosario , Arrigoni Cristina , pedroni cristina , dellafiore federica , Pucciarelli Gianluca , Vellone Ercole
Published: April 2022

Introduction:
Cardiovascular diseases (CVD) are a major source of burden worldwide. COVID-19 pandemic has renewed the importance of remote psychoeducational interventions to improve outcomes in these patients. Technology-delivered motivational interviewing (TD-MI) has proven to be effective in chronic disease populations, yet there has been no attempt to summarize TD-MI characteristics and effectiveness in CVD populations.

Methods:
We searched PubMed, CINHAL, PsychInfo and Web of Science (from inception to May 1, 2021) for randomized controlled trials that enrolled adults with CVD. Record screening, data extraction and risk of bias assessment were performed in duplicate. This review is registered in PROSPERO, CRD42021241516.

Results:
Of the 2,742 records identified, 7 studies were eligible for qualitative synthesis. Participants (n=12,053, mean age = 62.25, 37.5% females) enrolled from community settings and prevalently affected by coronary artery disease (n. studies=5), hypertension (n=3) and heart failure (n=3), received an average of 11 phone (n=6) or video calls (n=1) over an average of 7 months. Interventionists were mostly nurses (n=4), followed by psychologists (n=2) and a social worker (n=1). Treatment fidelity was assessed in 5 trials; 2 trials reported the intervention to be based on a theoretical framework, and 2 studies specified if the interventionist underwent some training before TD-MI administration. Caregivers were never involved. Most targeted outcomes were medication adherence (n=5), quality of life (n=4), disease-related parameters (n=4), and depression (n=3). Risk of bias varied markedly, with the largest source resulting from lack of blinding of participants and assessors (performance bias). The only feasible meta-analysis showed no significant effects of TD-MI on depression (n=3; Z=1.18, p=0.24; I
2
=42%).

Conclusions:
The number of trials involving TD-MI interventions across CVD populations is scarce and their effectiveness is inconclusive. There was lack of reporting of interventionists’ training, description of treatment fidelity, and blinding procedures. More trials with stronger designs and better reporting are needed in the CVD field to inform clinical decision making and research.
Abstract 12985: Genetic Susceptibility for Coronary Artery Disease Accentuates the Cardiovascular Disease Risk Associated With Air Pollution
Authors: Abohashem Shady , Abbasi Taimur , Atlas Samantha , Atlas Diana , Zureigat Hadil , Gharios Charbel , Mezue Kenechukwu , Cardeiro Alexander , Aragam Krishna , Rajagopalan Sanjay , Khera Amit V , Osborne Michael T , Tawakol Ahmed A
Published: April 2022

Introduction:
Air pollution (particulate matter of diameter <2.5 μm, PM
2.5
) and genetic risk for coronary artery disease (CAD) each associate with cardiovascular disease (CVD). It is unknown whether genetic risk for CAD enhances CVD risk associated with air pollution exposure.

Hypothesis:
We tested the hypothesis that high genetic risk for CAD accentuates the adverse impact of air pollution on CVD, (as coronary artery calcium [CAC]) and major adverse cardiovascular events [MACE]).

Methods:
Participants (N=9340, median age 66 yrs, 49% male) in the Mass General Brigham Biobank with genetic and air pollution data were studied. Genome wide polygenic risk score for CAD (PRS
CAD
) and principal components of ancestry (PCI) were determined. Average PM
2.5
exposure one year before each person’s enrollment was derived using home addresses and Environmental Protection Agency data. CAC was assessed on those with available CT images (N=548). MACE and CVD risk factors were evaluated via International Classification of Diseases codes. Socioeconomic status (SES) was assessed as residential zip code level income using US Census data. The presence of an interaction between high PM
2.5
and PRS
CAD
vs. MACE was tested.

Results:
The Combination of high PRS
CAD
and PM
2.5
(both ≥ median vs. others) associated with greater CAC [standardized β (95% CI): 0.13 (0.06, 0.19), p=0.0002,
Fig.1A
] after adjusting for age, sex, and PCI and with further adjustment for CVD risk factors (p=0.007). Over 5 years median follow up, 1139 subjects experienced first time MACE. Combined high PRS
CAD
and PM
2.5
also associated with higher MACE risk [OR (95% CI): 1.20 (1.15, 1.25), p<0.001, p (interaction) <0.001,
Fig.1B
] after adjusting for age, sex, and PCI and with further adjustment for CVD risk factors (p<0.001) and SES (p<0.001).

Conclusions:
Among individuals exposed to air pollution, genetic risk for CAD accentuates CAC and MACE risk in a graded manner. Genetic context may impact the health effects of air pollution.
Abstract 13202: The Accuracy Of EMS Dispatch For Stroke Following The Introduction Of The Stroke Diagnostic Tool
Authors: Bray Janet , Webster Hannah , Nehme Ziad , Eastwood Kathryn , Smith Karen , Cantwell Kate , Finn Judith , Bladin Christopher , Cameron Peter
Published: April 2022

Introduction:
Early identification of stroke in the emergency call is key to timely reperfusion therapy. The Medical Priority Dispatch System (MPDS) is widely used and recent versions include a Stroke Diagnostic Tool (SDxT) using the FAST (Face, Arm, Speech) assessments. We conducted a retrospective observational study to examine whether introduction of the SDxT improved the identification of stroke/TIA in the emergency call in Victoria, Australia.

Methods:
We included all stroke dispatches (MPDS Code 28) for adults (aged ≥20 years) between 2008 and 2015. We linked this data to diagnoses from Ambulance Victoria, and the Victorian Department of Health and Human Services’ databases: the Victorian Emergency Minimum Dataset and the Victorian Admitted Episode Database. We examined the use of SDxT codes, and compared the proportion of stroke/TIA diagnoses before and after the introduction of the SDxT in September 2013.

Results:
Over the study period there were 108,917 Code 28 cases (average 13,600/year), 80% (n=86,906) were transported to an ED and 55% (n=60,334) were admitted to hospital. There were 3,141 diagnoses among the Code 28 cases, with 30% diagnosed with stroke/TIA. No changes was seen in the proportion of stroke/TIAs after the introduction of the SDxT (28.5% vs. 28.2%, p=0.23). The SDxT was used and complete in 63% (n=20,070) of calls. Patients with evidence of stroke on the SDxT were more likely to have stroke/TIA (partial evidence=29%, strong evidence=38% and clear evidence=40%) compared to those with no evidence (20%) and those with no/incomplete SDT (25%).

Conclusions:
Our results suggest a large proportion of stroke dispatches are not stroke/TIA, but evidence of stroke on the SDxT does identify marginally higher proportions. Further research is required to understand use of the tool, and public education on stroke assessments may be needed to realise its full potential.
Abstract 13215: Clinical Features Do Not Identify Risk of Progression From Isolated Post-Capillary Pulmonary Hypertension to Combined Pre- and Post-Capillary Pulmonary Hypertension
Authors: Babu Gautam , Annis Jeffrey S , Freiberg Matthew S , Hemnes Anna R , Brittain Evan L
Published: April 2022

Introduction:
Pulmonary hypertension (PH) is a common sequelae of left heart failure and is designated as either isolated post-capillary pulmonary hypertension (Ipc-PH) or combined pre- and post-capillary pulmonary hypertension (Cpc-PH). Clinical features associated with progression from Ipc-PH to Cpc-PH have not been described.

Hypothesis:
We hypothesized that clinical features do not distinguish patients who progress from Ipc-PH to Cpc-PH.

Methods:
We extracted hemodynamic and clinical data from patients referred for right heart catheterization (RHC) at least two times within 5 years. Ipc-PH was defined as mean pulmonary pressure ≥ 25 mmHg, wedge > 15 mmHg and pulmonary vascular resistance (PVR) < 3 WU. Progression to Cpc-PH required an increase in PVR to > 3 WU at the subsequent RHC. Comparisons made using the Mann-Whitney U and paired T-tests, and logistic regression adjusted for age and sex.

Results:
We identified 157 patients with Ipc-PH at baseline who underwent a repeat RHC after a median of 0.7 years (IQR 0.2, 2.1). The prevalence of Cpc-PH at the second RHC was 31% (49/157). The most common indication for repeat RHC referral was persistent heart failure symptoms (n = 107). Table 1 displays characteristics at the baseline RHC. BMI was lower and HDL higher among those who progressed. No other demographic, clinical, or laboratory features distinguished those who progressed either in univariate comparisons or after adjustment for age and sex. Of note, cardiac index was not significantly changed between baseline and repeat RHC (2.57 vs. 2.30 L/min/m2, p = 0.27) in those who progressed to Cpc-PH, indicating the increase in PVR was not driven by reduced right ventricular function.

Conclusions:
Clinical features alone cannot clearly distinguish patients at risk for progression from Ipc-PH to Cpc-PH. These findings support the need for molecular and genetic studies to identify risk factors for progression of pulmonary vascular disease in patients with heart failure.
Abstract 13236: Differing Relations Of Arterial Stiffness And Carotid Intima-Media Thickness In Adolescence With Metabolic Risks In Young Adulthood: The ALSPAC Study
Authors: Agbaje Andrew O , Barker Alan R , Tuomainen Tomi-Pekka
Published: April 2022

Introduction:
Carotid-femoral pulse wave velocity (cfPWV), a measure of arterial stiffness, and carotid intima-media thickness (cIMT) are strong predictors of cardiovascular and all-cause mortality in adults. However, due to the unavailability of hard outcomes among adolescents and young adults, it remains unclear how cfPWV and cIMT predict metabolic outcomes in these age groups.

Hypothesis:
We tested whether cfPWV and cIMT during adolescence similarly or differently predict higher insulin, glucose, plasma lipid, and increased inflammation in young adulthood.

Methods:
Altogether 3862 British (56% females) participants from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort, England, UK were studied. cfPWV was measured by Vicorder device, cIMT by CardioHealth ultrasound scan, systolic blood pressure (BP) and heart rate by Omron BP/pulse monitor, total fat mass and lean mass by dual-energy Xray absorptiometry, moderate to vigorous physical activity by accelerometer, and smoking status by questionnaire. Insulin, plasma glucose, lipid profiles, and high sensitivity C-reactive protein were measured during a fasting state. Insulin resistance (HOMA-IR) was estimated from (insulin x glucose)/22.5. We conducted linear regression analyses and adjusted for cardiometabolic and lifestyle factors at 17.7 years.

Results:
Participants' mean (SD) age in years at different time points were [17.72 (0.33) and 24.54 (0.73)]. cfPWV at age 17.7 years was inversely associated with high-density lipoprotein cholesterol [β = -0.32 (CI: -0.60 to -0.04); p=0.028] and directly associated with insulin [0.28 (0.05 to 0.50); p=0.019] and HOMA-IR [0.28 (0.04 to 0.53); p=0.026] at 24.5 years. cIMT at age 17.7 years was inversely associated with insulin [-0.33 (-0.59 to -0.07); p=0.024] and HOMA-IR [-0.32 (-0.59 to -0.04); p=0.026] at 24.5 years. cfPWV and cIMT at 17.7 years were unrelated to other metabolic and inflammatory markers at 24.5 years.

Conclusions:
Arterial stiffness during adolescence may be a novel risk factor for predicting reduced high-density lipoprotein cholesterol and increased insulin resistance in young adults. However, carotid wall thickening in adolescence predicted higher insulin sensitivity 7 years later.
Abstract 13246: Utility and Validity of Deep Learning Based Fully Automated Echocardiogram Interpretation in Patients With Congenital and Structural Heart Disease: Importance of Congenital Specific Algorithms
Authors: Benesch Vidal Maria Luisa , Diller Gerhard , Fischer Alicia , Baumgartner Helmut , Orwat Stefan
Published: April 2022

Background:
Automated echocardiographic image interpretation has the potential to transform clinical practice by improving efficiency and supporting serial assessment of structural abnormalities or cardiac function. We hypothesized that neural networks (NN) developed for image segmentation in general/non-congenital cohorts may underperform in the setting of abnormal cardiac anatomy and that deep learning (DL) algorithms trained specifically in this cohort may have superior precision in this setting.

Methods:
Consecutive patients with various forms of congenital or structural heart disease (CHD/SHD) were used to validate an existing convolutional NN trained on 14,035 echocardiograms for automated viewpoint classification (Zhang et al. Circulation 2018). In addition, a new specific deep convolutional network for viewpoint classification was trained and tested in patients with CHD/SHD.

Results:
Overall, 9,793 imaging files (8,363 GE Medical, 1,421 Philips Medical) from 262 patients with CHD/SHD (mean age 48 years, 59.5% male) and 62 normal controls (mean age 45 years, 50,0% male) were included. Congenital diagnoses included among others, Tetralogy of Fallot (30), Ebstein anomaly (18), transposition of the great arteries (TGA) (48), congenitally corrected TGA (34). Assessing correct view classification based on 284,250 individual frames revealed that the non-congenital model had an overall accuracy of 54.2% for correct view classification in patients with CHD/SHD (66.7% in normal controls), compared to 84% in the original derivation sample. In contrast our newly trained convolutional networks for echocardiographic view detection based on over 139,910 frames and tested on 35,614 frames from CHD/SHD patients achieved an accuracy comparable to the general cardiology model, exceeding 90% for standard view classification.

Conclusions:
The current study is the first to validate CHD/SHD specific echocardiographic DL networks and demonstrate its marked superiority compared to generic models which appear to have acceptable accuracy in general cardiology patients, only.
Abstract 13258: Transcriptomic Remodeling of Brugada Syndrome Arises During
in vitro
Cardiac Development
Authors: Cimarosti Bastien , Canac Robin , Forest Virginie , Girardeau Aurore , Gaborit Nathalie , Lemarchand Patricia , Redon Richard , Lamirault Guillaume
Published: April 2022

Introduction:
Recent genetic data suggest that abnormal cardiac development participate to the pathogenesis of Brugada Syndrome (BrS), a rare inherited arrhythmia responsible for sudden cardiac death in young adults.
In vitro
cardiac differentiation of human induced pluripotent stem cells (hiPSCs) mimics cardiac development at the cellular level up to a prenatal stage.

Objective:
This study aims at defining whether BrS impairs cardiac differentiation of hiPSCs.

Methods & Results:
Transcriptomic kinetics (daily bulk 3’RNA-seq from day 0 to day 30 of in vitro cardiac differentiation) were generated in triplicate for 2 control hiPSC lines and 2 BrS-patient hiPSC lines. First, global analysis unveiled that BrS and control kinetics start to diverge as early as day 8, coinciding with the emergence of beating cells. The 500 most differentially expressed genes between BrS and control kinetics revealed 7 main distinct expression profiles. Interestingly, in one of the clusters (Cluster 2), enriched in genes involved in ventricular development (
e.g. IRX4
,
NKX2-5
), the expression levels were higher in BrS as compared to control, starting at day 8. Inversely, another cluster (Cluster 4), enriched in genes involved in atrial development (
e.g. TBX18
,
PITX2
), displayed an opposite expression profile. Cell-type annotation of single-cell RNA-seq data obtained at day 30 of cardiac differentiation for 1 control (n=2; 11,499 cells) and 1 BrS hiPSCs line (n=2; 12,142 cells) confirmed this ventricular-to-atrial imbalance with an average ventricular-to-atrial cell number ratio of 0.97 and 8.27 for control and BrS lines, respectively.

Conclusion:
This first transcriptomic kinetic study supports the hypothesis of an early developmental defect in BrS. Altogether, our data show that BrS hiPSCs are more prone to ventricular specification as compared to control cells. This suggests that an abnormal cell fate during cardiac differentiation may participate to BrS pathogeny.