bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 19189: Long-term Outcomes of Catheter Ablation of Atrial Fibrillation in Elderly Patients
Authors: Matar Ralph , Smith Martin , Bassiouny Mohamed , Chaudhury Pulkit , Chung Mina , Dressing Thomas , Callahan Thomas , Tchou Patrick , Saliba Walid , Lindsay Bruce , Wazni Ousamma , Kanj Mohamed
Published: March 2022

Introduction:
Atrial fibrillation (AF) is highly prevalent in the elderly. Our aim is to evaluate the safety and efficacy of catheter ablation (PVI) in this population.

Hypothesis:
Catheter ablation(PVI) for AF is less effective in the elderly population.

Methods:
Data of 6824 consecutive patients who had PVI between January 2006 and July 2013 were reviewed. Patients ≥ 75 years were included in the study. Ablation strategy included isolation of all pulmonary veins as well as left atrial(LA) substrate modification as needed. Procedural complications and success (defined as freedom from any atrial arrhythmia lasting more than 30 seconds) were analyzed.

Results:
This study included 402 consecutive patients who underwent 452 ablation procedures. Of those patients, 76 were ≥ 80 years old. The mean age was 77.6 ± 2.5. 166 (41%) were female, and 148 (37%) had persistent AF. The median lifetime AF duration was 5 years (IQR: 2.5, 10). The mean CHADS2-VASC was 3.47 ± 2 and mean LV EF was 55.3% ± 9.1. 90% of patients were anticoagulated with warfarin, 8% with dabigatran, 2% with rivaroxaban, and 1 with enoxaparin. 28% of patients were also on aspirin and 2% on clopidogrel. Median follow up period was 394 days (IQR: 182, 777). Major complications included 1 ischemic stroke, 5 cases of tamponade during ablation, 8 cases of groin hematoma that required intervention, and 1 case of hemothorax. Minor complications included 8 small hematomas, and 1 hemodynamically stable pericardial effusion. After a single ablation, 154 (38.3%) patients remained arythmia free. 118 (29.3%) had infrequent paroxysmal AF, 39 (9.7%) had persistent AF, 42 (10.4%) had paroxysmal AF and AFL/AT, and 14 (3.5%) had persistent AF and AFL/AT. 9 (2.2%) had AT/AFL only. 21 (5.2%) patients had incomplete follow up. Five (1.2%) procedures were aborted; 4 due to complications with trans-septal puncture, and 1 due to electric silence of the LA. 50 patients underwent repeat ablation, increasing the freedom of AF to 42.0%

Conclusions:
AF ablation in the elderly is associated with a minimal increase in complications, most commonly in the form of access site hematoma. However, success rates are lower than that previously reported in younger patients.
Abstract 19214: Echocardiographic Diagnosis of Chiari's Network and Arterial Embolic Events
Authors: Joseph Lee , Ward Chad , Alqasrawi Musab , Marthaler Brodie , Shewmake April , Zubairu Josiah , Sonny Abraham , Doshi Hardik , Worden Nicole , Giudici Michael C
Published: March 2022

Background:
The clinical significance of Chiari’s network identified by echocardiogram is not yet established. A few authors have hypothesized that Chiari’s network may be associated with a patent foramen ovale, atrial septal aneurysm and paradoxical embolism. We set out to better understand the relationships of arterial embolic events and echocardiographic diagnosis of Chiari’s network in our adult population.

Methods:
We reviewed unique subject-adult transesophageal echocardiograms (TEE) performed at UIHC between November 2010 and March 2015 (n=3,703); we identified subjects with transesophageal echocardiographic diagnosis of Chiari’s network. Chiari’s network was observed in 6.2% of all TEE studies (n=229); males represented 59.8% with mean age of 61.5±16.3 years and mean left ventricular ejection fraction 53.8% ± 13.6%. Retrospective chart review was then performed to evaluate clinical variables encompassing a median [IQR] follow up of 8 months [2-19].

Results:
Patent foramen ovale and atrial septal aneurysm were present in 22.3% and 11.4% subjects respectively. Approximately one half of patients (n=115, 50.2%) experienced at least one systemic embolic event by the end of the follow up period. Of these, 84 (36.7%) and 30 (13.1%) patients suffered stroke and transient ischemic events respectively. The all-cause mortality rate was high at 13.5%. Atrial tachyarrhythmia was present in 59 subjects (25.8%). The rate of systemic embolic events was higher in those without atrial tachyarrhythmia compared to those with atrial tachyarrhythmia (58.2% vs. 27.1%, p=0.000; OR (95% CI),0.267 (0.139-0.511). Antithrombotic therapy was prescribed in 79% of all subjects, 86.4% of patients with atrial tachyarrhythmia and 95.5% of patients with systemic embolic events.

Conclusions:
Patients with Chiari’s network have a high incidence of atrial tachyarrhythmia and systemic embolic events, primarily embolic stroke and transient ischemic events. Systemic embolic events occurred at significantly higher rates in subjects with Chiari’s network and no atrial tachyarrhythmia than those with atrial tachyarrhythmia. Future studies are warranted to further elucidate the risk of thromboembolic events in patients with Chiari’s network.
Abstract 19236: No Difference in Composite of Patency and Rutherford Class in Patients Receiving Drug Eluting Stents vs. Bare Metal Stents in Peripheral Vascular Interventions
Authors: Meraj Perwaiz M , Doshi Rajkumar , Vijayaraghavan Pavitra , Helfgott Daniel
Published: March 2022

Background:
The presence of peripheral arterial disease (PAD) results in limitation of physical activity due to claudication, and when left untreated, develops into limb ischemia followed by limb loss. The use of drug eluting stents (DES) in peripheral vascular interventions (PVI) has been shown to improve patency over angioplasty (PTA) and bare metal stents (BMS), however this was in a cohort of patients with short lesion lengths. Clinical trials comparing the efficacy of the DES in long lesion lengths are not well described, neither in patency or continued symptom relief at 6 months. Here, we compare the a composite endpoint of patency and Rutherford Class in patients receiving DES.

Methods:
277 patients underwent PVI with either DES or BMS from January 2011 to January 2015 for claudication and/or limb ischemia. The primary end point was patency (either ABI improvement above 0.9 or US velocity <250 m/s) and Rutherford class (Class I to VI) at follow up. A Pearson chi-square analysis and multivariate analysis were used to determine results.

Results:
A total of 20 patients underwent DES placement and 257 underwent BMS placement. Baseline differences existed between the two groups, particularly stent length. No difference in patency or Rutherford class was observed after correcting for all baseline differences in a multivariate analysis.

Conclusion:
After correcting for stent length and baseline characteristics, no significant differences in patency and Rutherford Class was observed. More data is needed in this real world use of DES as the current clinical trials only define very short lesion length, which defines a small subset of the patients treated in modern day practice.
Abstract 19246: The Impact of CT Coronary Angiography on the Business of Acute Chest Pain: Resource Utilization, Cost and Length of Stay
Authors: Bhattacharyya Srija , Christiansen Jonathan , Ayar Zina , Edwards Colin , Hart Hamish , To Andrew
Published: March 2022

Introduction:
Chest pain is one of the most frequent presentations to the emergency department, resulting in a large number of hospital admissions and diagnostic tests. CT coronary angiography (CTCA) has been shown to provide accurate information, without necessarily resorting to invasive, costly tests, such as coronary angiography. Managers and funders are often concerned that CTCA availability may lead to over-investigation and impact unfavorably on hospital budgets. Here, we report on the impact of CTCA on hospital services, with an emphasis on resource utilization, using individual patient data.

Methods:
We compare a cohort of patients presenting with chest pain to the emergency department before and after implementation of the CTCA program at Waitemata District Health Board (WDHB), in August 2011. Information on LOS, investigations performed, demographic/comorbidity details and cost related to the admission were obtained from clinical coding information, existing databases and the accounts department (using a schedule that breaks cost into resource pools). Follow up was 1 year. WDHB provides hospital services for ~600,000 people.

Initial Results:
25,199 patients were admitted with the presenting complaint of chest pain between February 2008 and August 2011, aged 18yrs-106 yrs. The mean LOS was 3.056 days. A total of 2,087 angiograms (8.3%) were performed in this cohort. Between August 2011 and February 2014, 20,642 patients presented with chest pain, aged 18yrs-102yrs. The mean LOS was 2.727 days (p<0.001). A total of 1,442 angiograms (7.0%, p<0.05) were performed in this cohort. A total of 1,246 inpatient CTCA scans were done during this period. There was no significant difference in readmission rate or other non-invasive testing. There was a trend toward lower costs associated with chest pain admissions, without adjusting for inflation.

Conclusion:
The CTCA program appears to have been beneficial in decreasing LOS and the total number of angiograms performed. CTCA availability has not led to uncontrolled service growth. Savings made from decreased resource utilization may justify the capital/staff expenditure required to implement the program. Further research to understand the economics of CTCA would be beneficial.
Abstract 19304: Clinical Profile and Outcomes of Patients Undergoing Combined Heart and Liver Transplantation With Transthyretin Amyloidosis: A Report From the International Consortium on Cardiac Amyloid Transplantation (iCCAT)
Authors: Verkouw Karla C , Vaduganathan Muthiah , Stone James R , Maurer Mathew , De Marco Teresa , Selby Van , Estep Jerry , Patel Jignesh , Hanna Mazen , Seldin David , Zucker Mark , Baran David , Semigran Marc J
Published: March 2022

Background:
Orthotopic heart transplant (OHT) is an accepted treatment option for transthyretin amyloidosis (ATTR) patients with end-stage heart failure. The incremental survival benefit of adjunctive liver transplant remains poorly defined.

Methods:
We aim to describe the clinical profiles/prognoses of patients undergoing OHT/liver transplant compared with OHT alone. From January 1998 to May 2015, 42 of 48 ATTR patients being evaluated for OHT at 10 institutions underwent transplant and were included in the final analysis. Data were entered into an encrypted online database, Research Electronic Data Capture. The primary endpoint of post-OHT all-cause mortality was compared between 3 cohorts defined by transplant and mutation status using Kaplan-Meier survival analysis: OHT alone-wild type (WT) (n=12; Cohort A); OHT alone-ATTR mutation (n=21; Cohort B); and combined OHT/liver transplant (n=9; Cohort C).

Results:
Of those undergoing OHT, 12 (28.6%) were WT, 15 (32.5%) had a V122I mutation, 3 (7.1%) had a T60A mutation, 8 had other mutations, and 4 had unknown mutations. For the subset of 9 patients who underwent combined OHT/liver transplant (4 concurrently, 5 sequentially), the mutations were as follows: V122I (n=3), T60A (n=3), S23A (n=2), and Tyr77 (n=1). Baseline characteristics did not differ significantly across the 3 cohorts for age, sex, LV ejection fraction, and other demographic, clinical, and hemodynamic characteristics. Peripheral neuropathy was present in 2 (17%) of Cohort A, 7 (33%) of Cohort B, and 4 (44%) of Cohort C (p=0.08). Post-OHT all-cause mortality was similar across cohorts (log-rank P=0.218; Figure).

Conclusions:
This is the largest analysis of ATTR cardiac amyloidosis patients receiving heart and liver transplantation. ATTR patients receiving OHT/liver transplant versus OHT alone have similar median-term survival. The added survival benefit of liver transplantation to OHT in ATTR mutant patients should be investigated further.
Abstract 19342: The Impact of PCSK9 Inhibitors on Lipid Levels and Outcomes in Patients With Primary Hypercholesterolemia: A Network Meta-analysis
Authors: Lipinski Michael J , Escarcega Ricardo O , Lhermusier Thibault , Baker Nevin C , Torguson Rebecca , Brewer H. Bryan , Waksman Ron
Published: March 2022

Introduction:
We performed a network meta-analysis of randomized controlled trials (RCTs) in patients with primary hypercholesterolemia to compare the impact of PCSK9 inhibitors with placebo and ezetimibe on lipid levels and outcomes.

Hypothesis:
PCSK9 inhibitors will significantly lower LDL-C greater than ezetimibe and improve outcomes.

Methods:
MEDLINE/PubMed, Cochrane CENTRAL, and ClinicalTrials.gov were searched for RCTs assessing PCSK9 inhibitors versus other therapies in patients with primary hypercholesterolemia. Mixed treatment comparison model generation was performed to directly and indirectly compare PCSK9 inhibition on lipid levels with ezetimibe and placebo. Odds ratios with 95% confidence intervals (OR [95% CIs]) were generated with random-effect models to compare outcomes.

Results:
Our meta-analysis included 17 RCTs with 13,083 patients that were randomized to PCSK9 inhibitors (n=8,250), placebo (n=3,957), ezetimibe (n=846), or PCSK9 inhibitors and ezetimibe (n=30). The mean age was 59±10, 52% were male, 34% had coronary artery disease, 51% had hypertension, 19% had diabetes mellitus, baseline LDL of 122±36 mg/dL, total cholesterol of 199±39 mg/dL, and HDL of 51±14 mg/dL. PCSK9 inhibitors significantly reduced LDL cholesterol by 57% relative to placebo (p<0.001) and 36.1% relative to ezetimibe (p<0.001). PCSK9 inhibitors reduced the incidence of all-cause mortality (OR 0.43 [95% CI 0.22-0.82], p=0.01) with a trend for cardiovascular death (OR 0.50 [95% CI 0.22-1.13], p=0.10) and cardiovascular events (OR 0.67 [95% CI 0.43-1.04], p=0.07) when compared with placebo.

Conclusions:
PCSK9 inhibition significantly improved lipid profiles and reduced the incidence of all-cause mortality compared with placebo. Thus, PCSK9 inhibitor therapy, once approved, may serve as an excellent alternative for patients with statin intolerance and for those who do not respond to conventional lipid reduction therapy.
Abstract 19344: Involvement of Mitochondrial Permeability Transition Pore (mPTP) in Cardiac Arrhythmias: Evidence From Cyclophilin D Knockout Mice
Authors: Gordan Richard , Fefelova Nadezhda , Zhao Zhenhang , Xie Lai-Hua
Published: March 2022

Our previous studies have demonstrated that mitochondrial membrane potential (

ΔΨ
m

) dissipation leads to mitochondrial Ca efflux via the mitochondrial permeability transition pore (mPTP), and consequently promotes spontaneous Ca waves (CaW) in isolated cardiomyocytes. In the present study, we have used a genetic mouse model which lacks cyclophilin D (CypD KO), a necessary regulator for mPTP opening, to assess the cardioprotective effect of mPTP inhibition on cellular CaWs, Ca alternans, and whole-heart inducible arrhythmias. Ventricular myocytes were isolated from wild type (WT) and CypD KO mice. Tetramethylrhodamine (TMRM) was used as an indicator of

ΔΨ
m.

Mitochondrial calcein release was used as the index of mPTP opening. Cytosolic Ca was imaged using Fluo-4-AM. Spontaneous CaWs were induced in the presence of 4mM external Ca. The protonophore FCCP was used to depolarize Δ
Ψ
m
. FCCP caused Δ
Ψ
m
depolarization to the same extent in both WT and CypD KO myocytes, however, CypD KO cells exhibited significantly less mPTP opening than WT cells (p < 0.05). Consistent with these results, treatment with FCCP caused significant increases in WT CaW rate but no increase in CypD KO CaW rate. These results were further confirmed by treating WT cells with the mPTP blocker cyclosporin A (CsA). Furthermore, occurrence of Ca alternans after treatment with FCCP and programmed stimulation was observed in a significantly higher number of WT cells (11 of 13), than in WT cells treated with CsA (2 of 8; p < 0.05) or CypD KO cells (2 of 10; p < 0.01). At the whole-heart level, pseudo-Lead II ECGs were recorded from
ex vivo,
Langendorff-perfused WT and CypD KO hearts, and the incidences of T-wave alternans (a precursor of lethal arrhythimas) and arrhythmias induced by programmed S
1
-S
2
stimulation were compared. We observed T-wave alternans in 5 of 7 WT hearts, but none in 5 CypD KO hearts (p < 0.05) and in only 1 of 6 WT hearts treated with CsA (p <0.05). Consistent with these results, WT hearts exhibited a significantly higher average arrhythmia score than CypD KO (p <0.01) or WT hearts treated with CsA (p < 0.01). In conclusion, CypD deficiency-induced mPTP inhibition attenuates CaWs and Ca alternans during mitochondrial depolarization, and thereby protects against arrhythmogenesis in the heart.
Abstract 19449: Upregulation of Cofilin-2 in Mouse Models Of DCM - Implications for SRF Signaling
Authors: Hoppe Phillip , Zille Elisa , Gantenberg Johanne , Eden Matthias , Kuhn Christian , Frey Norbert , Frank Derk
Published: March 2022

The dilated cardiomyopathy (DCM) is a major cause for heart failure. A causative genetic background is suspected in up to 50% of all DCM cases. However, the underlying molecular pathways remain incompletely understood. Here we analyze a calsarcin-1 deficient (CS1ko) mouse line as a model for DCM. These mice showed strong upregulation of fetal genes (e.g.,
Nppa, Nppb
) and the calcineurin-dependent gene
Rcan1.4.
Interestingly, we could not detect any signes of hypertrophy. In addition, there was no increase of fibrosis in CS1ko mice compared to wildtype controls. A screening experiment revealed upregulation of Cofilin2 (Cfl2), an actin depolymerisation factor and member of the ADF/Cofilin family, in Cs1ko mice (2.6-fold, p<0.002), whereas its inactive, phosphorylated form (Ser3) remained unchanged. We also found increased amounts of Cfl2 in MLP-/- (1,8-fold p<0.05) and Calcineurin TG mice (2.7-fold p<0.01) suggesting a general role for Cfl2 in DCM. As Cfl2 is a known regulator of actin dynamics we investigated the role of Cfl2 in SRF signaling. Using an SRF-responsive luciferase reporter, overexpression of Cfl2 together with RhoA as activator of SRF signaling lead to an increase of SRF activity in C2C12 myoblasts (14-fold vs. 5.8-fold with RhoA alone, p<0.001). SiRNA-mediated knockdown of Cfl2 yielded opposite effects (0.96-fold vs. 4.6-fold, p<0.001). In the heart Cfl2 is predominantly expressed in cardiac myocytes as compared to fibroblasts. Overexpression of Cfl2 in cardiomyocytes (NRVCM) revealed an increase of
Nppa
and
Nppb
, which could be further increased by co-stimulation with phenylephrine (PE). In contrast to these findings, cell size analysis revealed a Cfl2-mediated decrease in cell size with and without PE, while knockdown of Cfl2 did not influence cellular hypertrophy. Taken together, our data imply a role for Cfl2 in the pathogenesis of DCM. Cs-1ko mice show a dilated phenotype, strong upregulation of the fetal gene program without a change in cell size. This correlates with the findings of overexpression of Cfl2 in NRVCM. Furthermore, increased Cfl2 levels induce SRF activity with potential influence on cardiomyocyte function. Further analyses are required to delineate the involved molecular pathways.
Abstract 19451: Preoperative Brain MRI Findings in d-Transposition of the Great Arteries and Relation to Timing of Diagnosis
Authors: Weinberg Jacqueline G , Murnick Jonathan , Carpenter Jessica L , Berger John T , Skurow-Todd Kami , Krishnan Anita , Limperopoulos Catherine , Donofrio Mary T
Published: March 2022

Introduction:
Congenital heart disease is known to be associated with alterations in fetal cerebral blood flow and brain development. Instability in the fetal/neonatal periods may lead to injury. We sought to assess the prevalence of preoperative brain injury in neonates with d-transposition of the great arteries (d-TGA) and the relationship to prenatal/postnatal variables and outcomes.

Methods:
We performed a single center retrospective analysis of neonates with d-TGA who had preoperative brain MRI from 2009-2014. Patients with other cardiac and/or extracardiac anomalies were excluded. Prenatal/postnatal clinical variables were recorded and correlated to brain MRI findings.

Results:
A total of 45 neonates with d-TGA were identified of which 23 (51%) were diagnosed prenatally. The average gestational age was 38 weeks (range 33-41). All underwent an arterial switch procedure with 100% survival. Those diagnosed prenatally were more likely to be born within 5 miles of the tertiary pediatric center (96% vs. 5%, p<0.001), had lower incidence of hypoxia (lowest PaO2 25.3 vs 21.1, p=0.02), shorter time to cardiac intensive care unit admission (85 vs 1025 minutes, p=0.002), and shorter time to balloon atrial septostomy (295 vs 1456 minutes, p=0.007). Brain MRI was abnormal in 14 (31%); 9/23 (39%) with a prenatal and 5/22 (23%) with a postnatal diagnosis. The most common abnormality was small or punctate ischemic white matter lesions (N=14). Three patients had evidence of deep grey matter injury. Those with brain MRI abnormalities had a lower average gestational age (37 vs 39 weeks, p=0.02) and were less likely to have had a balloon atrial septostomy (79% vs 93%, p=0.03). Brain MRI findings were not associated with preoperative acidosis, hypoxia, need for inotropes, time to admission to cardiac intensive care unit, or surgical procedural variables.

Conclusions:
Neonates with d-TGA had similar incidence of preoperative brain injury by MRI whether diagnosed pre or postnatally. Brain injury was associated with lower gestational age and lack of balloon septostomy. Further work is needed to determine any association between prenatal diagnosis and type/severity of brain injury, as well as other in utero factors relating to brain development that may play a role.
Abstract 19473: Safety and Efficacy of Second Generation Self Expanding Portico® Valve System for the Treatment of Failed Aortic Bioprosthesis: Results From an International Multicenter Valve-in-Valve Registry
Authors: Alnasser Sami , Dvir Danny , Walther Thomas , Kim Won-Keun , Bedogni Franscesco , Testa Luca , Amrane Hafid , Boven Ad van , Blomer Han , Pelletier Marc , Rodes-Cabau Josep , Del Trigo Maria , van Mieghem, Nicolas , de Jaegere Peter , Frerker Christian , Manoharan Ganesh , Spence Mark , Worthley Stephen , Asgar Anita , Reda Ibrahim Reda Ibrahim , Carmelo Sgroi Carmelo Sgroi , Gerlando Pilato Gerlando Pilato , Stub Dion , Webb John , Cheema Asim
Published: March 2022

Background:
Portico valve is a second-generation self-expanding repositionable system with a nitinol stent frame and bovine pericardial leaflets, which is increasingly utilized for transcatheter aortic valve replacement (TAVR) . In this report, we describe the procedural and early clinical results from an international multicenter registry of Portico implantation in patients with degenerated aortic bioprosthesis (Portico ViV).

Methodology:
Baseline data and outcomes were collected on standard case report forms and by the Valve-in-Valve International Data network from 14 centers across three continents. Procedural endpoints included implantation success and coronary obstruction. Clinical endpoints included death, myocardial infarction (MI), stroke, major bleeding at 30 days as defined by Valve Academic Research consortium II (VARCII).

Result:
45 patients undergoing Portico ViV were included in analysis. The mean age was 79± 7 years with STS (mortality) score of 7±4. These procedures had mainly utilized peripheral arterial access (93%), with transesophageal echocardiogram guidance (60%) for treatment of surgical valve label size ≤21, >21-<25, and ≥25mm in 36, 38 and 27% respectively. Four (9%) of the failed surgical bioprostheses were stentless. Successful implantation was achieved in 44 (98%) cases with no malposition events or clinically-evident coronary obstruction. Post implantation valve area was 1.3 ±0.4 cm2, mean gradient of 17.1 ± 7.7 mmHg and ≥ moderate aortic insufficiency was observed in 3 (7%). One death (2%) related to ischemic stroke occurred within 30 days. Major bleeding and vascular complication in 5 (11%) and 1 (2%) respectively. One patient required permanent pacemaker implantation (2%).

Conclusion:
Results from this international multicenter registry show that Portico offers a safe and effective treatment of failed surgical bioprosthesis with an added advantage of device retrievability, resulting in low incidence of malpositioning and coronary obstruction. Additional studies and comparison with other transcatheter devices should further determine the hemodynamic and clinical performance of this device for selection of optimal treatment of high risk patients with failed surgical bioprostheses
Abstract 19488: Improved Success in Patency and Symptomatic Relief Using Optical Coherence Tomography Guided Superficial Femoral Artery Chronic Total Occlusion Intervention Compared With Standard Techniques
Authors: Meraj Perwaiz M , Doshi Rajkumar , Vijayaraghavan Pavitra , Helfgott Daniel
Published: March 2022

Background:
Superficial femoral artery (SFA) chronic total occlusion (CTO) peripheral vascular intervention (PVI) is a challenging procedure given the longer procedure times, larger amount of radiation dose, and lesser procedural success. The aim of this single center analysis is to determine if patency and symptom relief is improved using Optical Coherence Tomography (OCT) based Ocelot versus conventional guidewires in SFA CTO PVI.

Methods:
We retrospectively analyzed 213 patients with SFA CTO undergoing PVI with either traditional techniques or the Ocelot device. Outcomes measured were death, vascular complications, procedural success, Rutherford class improvement, and a composite endpoint of ABI improvement above 0.9, ultrasound duplex velocity less than 250 m/s and Rutherford improvement. Unadjusted and multivariate analyses were performed.

Results:
36 cases of SFA CTO were performed with the Ocelot device, while 177 were performed with traditional guidewire techniques. Both improvement in Rutherford Class and the composite endpoint of success were significantly better with using the Ocelot device in the unadjusted analysis. They remained significant after performing multivariate analysis.

Conclusion:
The Ocelot device is a revolutionary device the successful and effective management of SFA CTO PVI. Symptomatic relief and patency are demonstrated here to be significantly improved when utilizing the Ocelot device. Further analysis of lesion length and calcium burden are needed to determine its optimal use for procedural and long term success.
Abstract 19532: Maternal Hyperoxia Increases Cerebral Oxygenation in Fetuses With Complex Congenital Heart Disease: A Functional MRI Study
Authors: You Wonsang , Donofrio Mary , Wessel David , Zun Zungho , De Asis-Cruz Josepheen , Vezina Gilbert , Bulas Dorothy , Jonas Richard , du Plessis Adre , Limperopoulos Catherine
Published: March 2022

Introduction:
Fetal brain growth is altered in congenital heart disease (CHD). The role of disturbed placental and fetal blood flow/oxygenation remains poorly understood. We compared the effect of maternal hyperoxia on cerebral and placental oxygenation in CHD vs control fetuses using blood oxygenation level dependent (BOLD) functional MRI (fMRI).

Methods:
We studied 85 pregnant women (51 healthy /34 CHD fetuses) at 22-39 weeks gestational age (GA), using MRI and Doppler. After 2min baseline recording at normoxia (NO), we made BOLD fMRI measurements in 4 phases, (1) early hyperoxia (HO; 100% O2) for 2min (2) late HO (2min), (3) early return NO (1.75min), (4) late return NO (1.75min). We measured % BOLD signal changes in fetal brain and placenta and correlated these with umbilical artery (UA) pulsatility index (PI) obtained at baseline.

Results:
Mean GA of CHD vs control fetuses was 32 4/7 and 32 2/7 (p=0.77). 41.2% had 1-ventricle (1V; all HLHS) vs 2-ventricle (2V) physiology. In controls, brain BOLD signal increased in phase 1 HO and remained elevated through phase 4. In CHD fetuses, the BOLD signal increased in phase 1 and continued to rise through phase 4. Differences in brain BOLD elevation in CHD vs controls (3.1% vs 0.9%, p=0.04) was significant in phase 4 (Fig. 1). Brain BOLD differed between 1V (3.4%, p=0.04) and 2V (0.9%, p=0.15) in phases 3 & 4. Placental BOLD signal increased during HO in control (4.4%, p<0.001) and CHD fetuses (6.4%, p<0.001). UA PI in CHD fetuses was higher than controls (1.11 vs 1.03, p=0.03). UA PI correlated with placental BOLD during HO in healthy and CHD fetuses (p<0.05).

Conclusions:
In this first report of placental and fetal brain responses to maternal HO, we show a significantly increased brain BOLD response in CHD fetuses, specifically 1V. These data suggest that maternal HO improves brain oxygenation in CHD fetuses in the short-term. Studies evaluating the prolonged effects of HO are needed to determine the role of HO management in select CHD fetuses.
Abstract 19639: Reducing Educational Barriers to Address Cpr Training Disparities in a Large Us Urban Community
Authors: Sheak Kelsey , Hatchman Laura , Dunstan Jenelle , Lynch Helene , Huerta Carlos , Leary Marion , Abella Benjamin S
Published: March 2022

Background:
Bystander CPR (BCPR) is a crucial therapy for cardiac arrest, yet less than 30%of victims receive it in most communities. Previous research has shown that BCPR training rates vary significantly according to community socioeconomicstatus (SES), with black or Hispanic individuals and those with low medianhousehold incomes being statistically less likely to have CPR training. We sought to test whether a community-based mobile layperson training approach that removed both cost and transportation barriers would target these disparities.

Objective:
To characterize the impact of our mobile layperson training intervention in a low-SES population through descriptive statistics and choropleth mapping of CPR training activity and associated SES.

Design/Methods:
A survey study of subjects trained through the mobile training intervention between 03/2013 and 03/2015 in which subjects’ demographics, prior CPR training status, and residential location were collected and analyzed. Subjects’ neighborhood SES at the block group level was ascertained using 2010 United States Census data.

Results:
Of 5789 subjects trained, 70% completed a demographic survey. 65% were female, 32% identified as white-Hispanic, 43% as black non-Hispanic, and 17% as white non-Hispanic. Of those > 18 years of age, 71% did not complete college. 65% reported never having received CPR training. Attached figure represents the census block groups of the City of Hartford by those trained by the mobile project (A) and associated SES (B). The census block groups with > 90 individuals trained were of low SES.

Conclusion:
A CPR training approach without transportation or cost barriers was successful in reaching a population of low-SES trainees with little previous exposure to CPR education. This approach holds promise as a scalable method to address SES disparities in BCPR provision.
Abstract 19647: Obesity is Associated With an Exaggerated Postprandial Pro-atherosclerotic Response to High-energy Food in Children
Authors: Hauser Jakob , Taylor Andrew , Jones Alexander
Published: March 2022

Introduction:
Obesity and unhealthy eating are known cardiovascular disease risk factors but their impact in childhood remains unclear. Evidence in adults suggests that metabolic handling of fat and carbohydrate varies in the obese, promoting disease. Little is known about the multi-system response to such food in adults or children. We studied this in teenagers with varying adiposity.

Methods:
Twenty healthy volunteers (aged 13-19yrs) ingested 300ml of double (heavy) cream mixed with 89g of maltose syrup (energy 1,635 kcal). Blood pressure (BP) and venous bloods were assessed prior to the meal and for up to 4 hours after the meal. BMI was normalized using WHO reference standards. The continuous interaction between BMI and each meal response measure was assessed in time series regression models.

Results:
The figure shows the marginal mean estimates over time for three representative BMI z-scores. High BMI was associated with greater meal responses for systolic BP, VLDL and lymphocyte count (*P<0.001). Differences at rest were not significant. Diastolic BP did not differ. At rest, 1 SD BMI was associated with 0.5 (SE 0.2, P 0.03) higher neutrophil count and 20 (SE 6, P 0.009) higher platelet count but meal responses did not differ. Triglyceride response was associated with BMI in a similar way to VLDL but cholesterol, LDL and HDL did not differ. Haemoglobin and haematocrit did not differ.

Conclusions:
We showed a combined haemodynamic, metabolic and inflammatory response in obese children that is likely to be detrimental to their vascular endothelial health. Higher platelet and neutrophil counts may worsen this pro-atherosclerotic state. This evidence supports the hypothesis that cardiovascular risk processes begin early in life. Better understanding of these processes and discovery of appropriate interventions are needed for effective prevention of cardiovascular disease.
Abstract 19865: Transcriptional Landscape of Cardiomyocyte Maturation
Authors: Uosaki Hideki , Cahan Patrick , Lee Dong I , Wang Songnan , Miyamoto Matthew , Fernandez Laviel , kass David A , Kwon Chulan
Published: March 2022

Introduction:
The term “development” refers to the process of growing to maturity. While decades of progress in developmental cardiology contributed to our understanding of heart development, the efforts were mostly focused on early aspects of development such as cardiomyocyte (CM) differentiation, which is completed at mid-gestation. However, CM maturation, a later developmental process required to generate adult CMs, remains largely unknown. The lack of the knowledge may be attributed to the fact that the process typically takes place over a long period of time after terminal differentiation.

Results:
Here, we analyzed over 200 microarray datasets from early embryonic to adult hearts and found a large number of genes whose expression shifts gradually and continuously throughout the stages. Based on the datasets, we generated an atlas of integrated gene expression, biological pathways, transcriptional regulators, and gene regulatory networks (GRNs). This analysis revealed discrete sets of key transcriptional regulators and pathways that are temporally activated or suppressed over the course of CM maturation. We developed a GRN-based program named MatStatCM that informs the status of CM maturation at the molecular level. The MatStatCM demonstrated that pluripotent stem cell-derived CMs undergo maturation early in culture, but are arrested at the late embryonic stage, accompanied by aberrant expression of key transcription factors.

Conclusions:
Our study provides a foundation for understanding CM maturation.
Abstract 19898: In-vitro Assessment of Coronary Hemodynamics in 3D Printed Patient-specific Geometry
Authors: Xiong Guanglei , Kolli Kranthi , Soohoo Hilary A , Min James K
Published: March 2022

Introduction:
Recent advances in cardiac imaging permit detailed assessment of myocardial perfusion using Single Photon Emission Computed Tomography and integrated evaluation of coronary anatomy and myocardial perfusion using Computed Tomography [CT]. However, neither technique is adequate to evaluate coronary physiology on a per-vessel level, limiting diagnostic accuracy compared to invasive physiologic gold standards, e.g. fractional flow reserve (FFR). Recently, computational fluid dynamics (CFD) applied to CT imaging offers per-vessel hemodynamic analysis and has been shown to improve the diagnostic performance over CT alone compared to invasive FFR. In this study, we developed an alternative in-vitro method to quantify coronary hemodynamics in a 3D printed patient-specific geometry, replicating in-vivo physiologic conditions.

Hypothesis:
Our approach overcome inevitable numerical assumptions (rigid walls and unrealistic boundary conditions) made in CFD and can potentially lead to a more favorable diagnostic performance.

Methods:
In Figure 1, patient-specific replica was fabricated from segmented coronary arteries using high-resolution 3D printing. It was used to examine the hemodynamic variables (velocity, pressure and FFR) by a flow circulation system including a programmable flow pump, tunable flow impedances, pressure sensors, and particle image velocimetry.

Results:
Our initial experiments demonstrated the concordance of our in-vitro results to in in-vivo measurements. Instead of interrogating only one flow condition in CFD, our system allows for assessment of a given coronary lesion under a range of flow conditions from rest to maximal stress at no additional effort after initial setup.

Conclusions:
We expect our approach will provide a new competitive way to identify coronary lesion, and more importantly, the flow condition under which a given lesion becomes hemodynamically significant.
Abstract 19899: Coffee Consumption is Not Associated With Calcified Atherosclerotic Plaques in the Coronary Arteries: The NHLBI Family Heart Study
Authors: Patel Yash R , Gadiraju Taraka V. , Gaziano J. Michael , Djoussé Luc
Published: March 2022

Introduction:
The average consumption of coffee per day in the United States is 3.2 cups. While in a recent meta-analysis of 21 prospective studies, coffee consumption was associated with a lower risk of cardiovascular disease mortality, with the lowest risk observed among consumers of 4 cups/day, limited and inconsistent data are available on the relation of coffee intake with subclinical disease.

Hypothesis:
Our primary hypothesis is that coffee consumption is inversely associated with the prevalence of atherosclerotic plaque in coronary arteries in NHLBI Family Heart Study

Methods:
In a cross-sectional design, we studied 1929 participants of the NHLBI Family Heart Study without known coronary heart disease. Coffee consumption was assessed by a semi-quantitative food frequency questionnaire and coronary-artery calcium (CAC) was measured by cardiac CT. We defined prevalent CAC using an Agatston score of at least 100 and fitted generalized estimating equations to calculate prevalence odds ratios of CAC.

Results:
Mean age and BMI were 56.7 years and 28.8 kg/m2 respectively, and 59% were male. In crude analysis, higher coffee consumption was associated with higher prevalence of CAC. Odds ratio (95%CI) for CAC were 1.0 (reference), 1.34 (0.92-1.94), 2.48 (1.81-3.40), 2.45 (1.82-3.30), and 1.81 (1.29-2.56) for coffee consumption of almost never, <1/day, 1/day, 2-3/day, and ≥4 cups/day. However, controlling for potential confounding factors eliminated such association [Corresponding odds ratio (95%CI) for CAC: 0.92 (0.57-1.49), 1.34 (0.86-2.08), 1.30 (0.84-2.02), and 0.99 (0.60-1.64), respectively, adjusting for age, sex, BMI, smoking, alcohol, physical activity, field center, and total calories].

Conclusions:
These data do not provide evidence for an association between coffee consumption and prevalent CAC in adult men and women.
Abstract 19932: Secular Trends in Complications of Atrial Fibrillation 2004-2012: The Treat-AF Study
Authors: Kaiser Daniel W , Perino Alexander C , Fan Jun , Schmitt Susan , Turakhia Mintu P
Published: March 2022

Background:
Limited data indicates that complications of atrial fibrillation (AF) may be declining. We evaluated secular trends in AF outcomes over 8 years using complete data from the largest integrated health care system in the United States.

Methods:
Using data from the TREAT-AF (The Retrospective Evaluation and Assessment of Therapies in AF) study from the U.S. Department of Veterans Affairs (VA) healthcare system, we identified patients with newly diagnosed, nonvalvular AF between from 2004 to 2012. Using VA and linked Medicare data, we determined the incidence rates for ischemic stroke, intracranial hemorrhage, extracranial hemorrhage, hospitalization for heart failure, and death from inpatient claims and medical record data using validated algorithms.

Results:
In 184,161 patients with newly diagnosed AF (age 70.4±10.7; CHADS-VASC 2.6±1.7) the incidence rates, expressed as events per 1000 person-years, gradually decreased from 2004 to 2014 for ischemic stroke (12.1 to 8.0), intracranial hemorrhage (4.2 to 2.0), and death (86.3 to 63.7) (p < 0.05 for all, Table 1). Heart failure incidence rates slightly increased (44.3 to 50.6). Extracranial hemorrhage events were relatively stable until 2010, when the events gradually decreased from 19.6 to 16.8 events per 1000 person-years.

Conclusions:
Among patients with newly-diagnosed AF from 2004-2012, the incidence rates of stroke (both hemorrhagic and ischemic), hemorrhage, and death have declined while heart failure admission rates have slightly increased. Causes and mediators require exploration but major sequelae following AF have dramatically changed.
Abstract 19945: Acute Alcohol Intoxication and Hemorrhagic Shock Lead to Microvascular Hyperpermeability and Cardiovascular Arrhythmias
Authors: Tipparaju Srinivas M , Doggett Travis M , Tur Jared , Badole Sachin L , Chapalamadugu Kalyan C , Breslin Jerome W
Published: March 2022

Background:
Binge drinking combined with trauma is a major cause of mortality in US. It is known that acute alcohol intoxication (AAI) causes deleterious electrical changes in the heart, including involving QTc dispersion. We also recently demonstrated that acute alcohol intoxication (AAI) increases microvascular permeability. In the current study we investigated the consequences of combined hemorrhagic shock and resuscitation (HSR) and AAI on both microvascular permeability and cardiac electrical activity. Hypothesis and Methods: We hypothesized that AAI combined with HSR causes microvascular leakage and electrical dysfunction in the heart. We used an established rat model of AAI/HSR to test the microvascular and cardiac effects.

Results:
We identified that combined AAI/HSR significantly (p<0.0007) prolongs the QTc interval (ms) compared to control water fed, sham rats (190.8±7.1 vs. 138.4±4.4, p<0.05). Ex vivo acquired left ventricular monophasic action potential (AP) data revealed increased AP duration in the AAI/HSR group at 20 (9.7±0.6 vs. 5.5±0.2; p<0.0004 ), 50 (16±1.1 vs. 8.8±0.6; p<0.001), and 70% (24.7±2.4 vs. 19.5±0.5; p<0.03) repolarization level relative to water/sham controls. Microvascular hyperpermeability was apparent in the mesenteric microcirculation in the AAI/HSR group compared to AAI/sham, water/HSR, and water/sham controls (IOI of 1061.7±208 HSR-alcohol vs. 698.4±311 HSR-water, p<0.05; vs. 209.5±42 sham-alcohol, p<0.001; and vs. 62.3±9 sham-water, p<0.001). Conclusions: We report for the first time the cardiovascular hallmarks of AAI/HSR associated injury, which include prolonged QTc and AP durations and elevated microvascular permeability.
Abstract 19966: Hemodynamic and Metabolic Correlates of Taurine Sodas or Colas in Healthy Young to Middle-age Adults: The IPC Cohort
Authors: Danchin Nicolas , Czernichow Sebastien , Thomas Frederique , Elbez Yedid , Lemogne Cedric , Simon Jean-Marc , Hanon Olivier , Simon Tabassome , Pannier Bruno
Published: March 2022

Background:
The hemodynamic and metabolic correlates of specific sodas have not been extensively studied. We used data from the IPC cohort, a large cohort of presumably healthy individuals having a general medical work-up reimbursed by the French National Health Insurance, to determine blood pressure, heart rate, BMI, waist circumference, glycemia, and LDL-cholesterol according to soda drinking habits. A self-administered questionnaire recorded daily habits for drinking colas or taurine sodas, with a 3-grade scale (no daily consumption, average daily consumption of 1-4 drinks, average daily consumption >= 4 drinks. Because consumption of taurine sodas and colas strongly declined after 50 years, only individuals aged 50 years or less (n=26,127) were included in the present analysis.

Results:
Daily consumption of colas and taurine drinks was reported in 8614 (33%) and 657 (2.5%) individuals, respectively. Compared with non-drinkers, cola and taurine soda consumers were younger (37 vs 34 vs 29 years, respectively, P<0.001), more often male (54 vs 58 vs 73%), more often socially deprived (8% vs 10% vs 10%), and more often current smokers (23% vs 33%, vs52%).

After adjustment for age, sex, education, social status, and smoking status cola consumption was associated with slightly but significantly elevated BMI, waist circumference, blood pressure and heart rate, with no difference for fasting glucose or LDL-c. Taurine soda consumers had significantly higher BMI, and a trend to higher systolic blood pressure.

Conclusion:
Daily consumption of colas was associated with a modest increase in hemodynamic risk factors and body mass index, and the association with taurine sodas was essentially similar. Overall, very high consumers (5+ drinks per day) had hemodynamic nd metabolic effects similar to those of milder daily consumers.
Abstract 19973: Decellularized Extracellular Matrix Exhibits Reduced Stiffness and Immature Collagen Deposition in a Mouse Model of Left Heart Failure
Authors: Morine Kevin , Quinn Kyle , Baugh Lauren , Aronovitz Mark , Georgakoudi Irene , Karas Richard H , Black Lauren , Kapur Navin
Published: March 2022

The extracellular matrix (ECM) is a major determinant of myocardial mechanics in heart failure. Existing methods to evaluate ECM composition are limited. Our objective was to perform a non-destructive microstructural and mechanical analysis of de-cellularized ECM in a mouse model of left ventricular (LV) failure.Methods and Results: Wild-type mice were subjected to 8 weeks of trans-aortic constriction (TAC; n=6) and compared to sham operated controls (Sham; n=5). Compared to sham, TAC mice had increased LV and lung weights, increased LV end-diastolic pressure (4±2 vs 25±5 mmHg, p<0.01) and reduced dP/dT (8249±596 vs 4786±984 mmHg/sec, p<0.01). LV collagen abundance by picrosirius red staining was higher in TAC mice (1±0.1 vs 35±12%, p<0.05) and Type I collagen mRNA and protein levels were increased by 80-fold and 2-fold, respectively (p<0.05 for both). Using non-linear optical microscopy, collagen fiber organization, content and cross-linking were quantified from decellularized sections of the LV free wall. Using cumulative second harmonic generation (SHG), a trend to higher total collagen content per tissue volume was observed in TAC mice (0.02±0.01 vs 0.05±0.3, p=0.09). Two photon excited fluorescence within SHG positive voxels was used to measure cross-linking per collagen fiber. Compared to sham, reduced cross-linking was observed in TAC mice (0.2 ±0.1 vs. 0.11±0.04, p=0.02). Next, using tensile mechanical testing no difference in average ECM stiffness (elastic modulus) was observed between groups (31±15 vs 24±7, sham vs TAC, p=0.19). Conclusions: This is the first mechanical analysis of decellularized ECM in a murine model of LV failure. Despite increased Type I collagen mRNA, protein and histologic fibrosis after TAC, the ECM composition analysis showed reduced collagen cross-linking suggestive of functionally immature collagen deposition. Functional maturation of the ECM may be an important target of therapy for heart failure.