bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11105: Real Time Racial Microaggression and Physiological Stress Responses Among Young and Middle Aged Black Adults
Authors: Nam Soohyun , Jeon Sangchoon , Ordway Monica , Nelson LaRon , Vlahov David
Published: March 2022

Introduction:
Perceived racial discrimination has been associated with dysregulation of sympathetic-adrenal-medullary (SAM) and hypothalamic-pituitary-adrenal (HPA) axis, two major physiological stress response systems linked to cardiovascular disease outcomes. Most studies, to date, used cross-sectional data that captured retrospective measures of lifetime racial discrimination associated with current physiological stress responses. Relative to overt racial discrimination, a subtle form of racial discrimination, known as microaggression is more prevalent, yet most commonly measured retrospectively, and understudied. The purpose of this pilot study was to examine the relationship between microaggression measured in real-time and physiological stress responses.

Methods:
Twelve healthy Black adults (mean age=43.4 years) completed baseline surveys, and self-collected saliva 4x a day for 4 days to measure cortisol and alpha amylase (AA) as a proxy of HPA and SAM systems, respectively. Real-time microaggression was measured using ecological momentary assessments (EMA) sent to participants 5x a day for 7 days. Multilevel models were conducted to examine the relationship between microaggressions and the SAM and HPA axis activities.

Results:
In the bivariate analyses, the area under the curve with respect to ground (AUCg: total cortisol output throughout the day) was significantly associated with the same day microaggression (r=.40, p=.02). Microaggression was associated with cortisol awakening response (CAR) on the same day (r=.34, p=.04). In multilevel models, microaggression was associated with wake-up cortisol level on the same day (β=.22, p=.05). Microaggression was also associated with wake-up AA levels both the same day (β=.58, p<.01) and the next day (β=.40, p=.05).

Conclusions:
Microaggression was associated with same day and next day physiological stress responses. We determined that concurrent use of salivary biomarkers and EMA was feasible methods to examine the temporal relationship between microaggression and physiological stress responses. Future work will include the development of an intervention that buffers the physiologic stress response related to microaggression to improve cardiovascular health.
Abstract 11107: Comparison of Left Atrial Appendage Occlusion and Direct Oral Anticoagulants and Warfarin in Patients with Atrial Fibrillation in Russian Prospective Registry
Authors: Merkulova Irina A , Avetisyan Eric A , Shakhmatova Olga O , Ganyukov Vladimir I , Pevzner Dmitry V
Published: March 2022

Introduction:
Left atrial appendage occlusion (LAAO) is non-inferior to warfarin and direct oral anticoagulants (DOAC) in thromboembolic prophylaxis in atrial fibrillation (AF). However, these antithrombotic strategies in patients with and without contraindications to anticoagulants were not assessed separately before.

Hypothesis:
LAAO is superior to oral anticoagulants (OAC) in net clinical benefit in patients without contraindications for its usage, and superior to no thromboembolic prophylaxis in patients with contraindications for OAC.

Methods:
A prospective registry included 379 patients with nonvalvular AF and high risk of thromboembolic events. Patients were assigned into cohorts with and without contraindications to continuous therapy with OAC. In the first cohort patients with LAA occlusion (n=45), on DOAC (n=99) and on warfarin (n=100) were compared. In the second cohort patients with LAAO (n=75) were compared with those who received no antithrombotic prophylaxis (n = 60). The primary composite endpoint was net clinical benefit (all-cause mortality, ischemic stroke/transient ischemic attack/systemic embolism and major bleeding) in 3 years.

Results:
Using log-rank analysis of Kaplan-Meier curves in the cohort of patients without contraindications to OAC LAAO was superior to warfarin, reaching statistical significance (p=0.048), with a trend towards superiority over DOAC (p=0.061) . In the cohort of patients with contraindications to continuous OAC use, LAAO, in terms of both overall efficacy and safety, was significantly superior to no prophylaxis of thromboembolic events (p=0.003). (Figure 1).

Conclusions:
LAA occlusion demonstrated superiority to warfarin and no prophylaxis of thromboembolic events in terms of net clinical benefit. There was a trend to superiority of LAAO over DOAC in patients with contraindications to OAC.
Abstract 11113: Telemedicine Services Are Acceptable to Neurologists for the Delivery of Outpatient Specialty Neurology Care During the Covid-19 Pandemic, but Require Improvement
Authors: Chao Alyssa , Zeiler Steven R , Abshire Saylor Martha , Bahouth Mona N
Published: March 2022

Introduction:
The COVID-19 pandemic accelerated the adoption of telemedicine services for the delivery of outpatient neurological care. To date, teleneurology has been primarily used in the hospital setting related to both billing restrictions and the need for hands-on maneuvers to complete the neurological assessment. We sought to understand perceptions of neurology specialists during rapid proliferation of telemedicine services into their outpatient practices and the acceptance of this technology.

Hypothesis:
Neurologists may report profound challenges acclimating to the telemedicine platform, completing visits, and making clinical decisions via telemedicine. We also expected that neurology sub-specialties would differ in their attitudes.

Methods:
Adapted from the Telehealth Usability Questionnaire (TUQ), our 29 item questionnaire evaluated the teleneurology system in three domains: quality of the telemedicine platform, ability to conduct a sufficient neurological examination, and areas for improvement. The survey was distributed to 88 clinical Neurology faculty in the Johns Hopkins Health System. Seven-point Likert scale responses were collapsed into “Favorable”, “Neutral”, and “Unfavorable.” Within each domain, responses to individual questions were analyzed by neurology sub-specialty using descriptive statistics.

Results:
We received completed surveys from 46/88 (52%) neurology faculty. Of those, most reported comfort with the current platform (98%) and favorably regarded the system’s ease of use (73%) and quality (80%). However, responses indicated only average ability to troubleshoot telemedicine platform issues when they occurred (55%) and to complete a neurological exam (52%). Sub-specialty comparisons revealed differences in diagnostic confidence; only 30% of neuromuscular faculty indicated they could make accurate neurological diagnoses through a tele-exam as opposed to 84% or greater for other specialties.

Conclusions:
Teleneurology appears to be feasible and acceptable to a majority of academic neurologists, though diagnostic confidence may differ by sub-specialty. Improvements in technological infrastructure and care models are needed to advance telemedicine neurological care delivery.
Abstract 11118: Cardiac Ferroptosis Induced Through Novel Signaling Pathways
Authors: Fefelova Nadezhda , Siri-angkul Natthaphat , Gwathmey Judith K , Xie Lai-hua
Published: March 2022

Background:
Ferroptosis is a newly described form of non-apoptotic cell death caused by iron (Fe)-dependent lipid peroxidation. It remains unclear how different signaling pathways/molecules are involved in ferroptosis induction and prevention in cardiac myocytes. In the present study, we aimed to determine the presence of ferroptosis induction via different pathways and the effects of potential anti-ferroptotic strategies in mouse ventricular myocytes.

Methods:
Ferroptosis was analyzed using the Live/Dead cell viability assay in isolated mouse ventricular myocytes after primary culture and drug treatment. Lipid peroxidation was evaluated by using Liperfluo. Cardiac-specific mitochondrial calcium uniporter (mCU) knockout (KO) mice were used to determine the involvement of mCU.

Results:
Ferroptosis was induced and the level of lipid peroxidation was increased by the treatment with: 1) iron (Fe; ferric ammonium citrate, 0.1-10 mM), 2) RSL-3 (0.4 μM), a direct inhibitor of the glutathione peroxidase 4 (GPX4), 3) erastin (50 μM), an inhibitor of cystine/glutamate antiporter xCT, 4) the ferroptosis suppressor protein 1 inhibitor (iFSP1, 3 μM). Furthermore, the relationship between the induction of ferroptosis and the cardiotoxicity of doxorubicin (an anthracycline anti-cancer drug) was also evaluated. Ferroptosis induced by above-mentioned inducers was prevented by ferrostatin-1 (a lipid radical scavenger) alone or in combination with Fe chelators (deferoxamine or 2, 2’-bipyridyl) or antioxidants (Trolox or mitoTEMPO) consistent with the dependency of ferroptosis on Fe, oxidative stress and lipid oxidation. Importantly, Fe- and iFSP1- induced ferroptosis was abrogated by mCU KO suggesting mCU-mediated mitochondrial Fe uptake plays an essential role in the occurrence of ferroptosis. However, mCU KO did not prevent the occurrence of ferroptosis induced by RSL-3 or erastin.

Conclusions:
Ferroptosis induced via different signaling pathways exhibited differential sensitivities to the currently known anti-ferroptosis approaches reported in other cell types. Combination of various suppressers of ferroptotic pathways to alleviate the progression of ferroptosis may provide a promising therapeutic strategy for heart disease.
Abstract 11134: The Feasibility of a Mail-Out 12-Lead ECG in a Pediatric Cardiac Electrophysiology Telemedicine Environment
Authors: Chubb Henry , Motonaga Kara , Goodyer William R , Trela Anthony , Hanisch Deb , Boramanand Nicole , Lencioni Erin , Maurille Mithras , Dubin Anne M , Ceresnak Scott R
Published: March 2022

Introduction:
The COVID pandemic has driven an expansion of telemedicine. Telemedicine may be well-suited for pediatric electrophysiology (EP) outpatient consultations. However, an ECG forms part of the standard of care and there is no established strategy for performing a remote 12-lead ECG.

Hypothesis:
The use of mail-out 12 lead ECG in a pediatric cardiology telemedicine environment is feasible.

Methods:
Between Nov 2020 and June 2021, select patients with telemedicine EP consultation were offered a mail-out 12 lead ECG (QT Medical, Diamond Bar, CA). The equipment was sent to the patient’s home with technical support from both company and the cardiac clinic. ECGs were read and reported on the electronic health record. ECG quality was independently rated by 2 reviewers. Patient experience was recorded via survey (Qualtrics, Seattle, WA).

Results:
A total of 146 ECG recordings were transmitted in 31 patients [age 13 ± 5 years, 11 female (35%)]. Indications were prior arrhythmia [24 (77%)] or new cardiac symptoms [7 (23%)]. Prior arrhythmia diagnoses included WPW, paced rhythm, Brugada syndrome, ventricular tachycardia, complete heart block, long QT and monitoring of introduction of anti-arrhythmic medication.

A median 3 (IQR 3-6) ECGs were recorded per patient. All patients had recordings suitable for clinical decision-making [21 had an ‘excellent’ recording (68%), 10 ‘good’ (32%), Figure 1]. Total time to perform the ECG (including app set up, application of device and recording transmission) was 46 ± 18 min. 77% found it ‘easy’ or ‘extremely easy’ to perform, and 80% were ‘confident’ or ‘moderately confident’ in the recording. Median travel time to clinic saved was 62 min (IQR 30-151 min). However, only 33% would prefer to perform the ECG at home rather than in clinic

Conclusions:
Clinically acceptable pediatric 12-lead ECGs may be performed at home by the patient and family. This technology may be considered for adjunctive use with telemedicine consultation in pediatric EP.
Abstract 11141: Closing the Gap: Evaluating Gender Differences in TAVR Outcomes
Authors: Dickens Helena , Ambalavanan Manoj , Gokhale Sanket , Rodríguez-Rivera Yolanda , Jarsania Dhairya , Marrero-Rivera Gabriel , Kansal Mayank M , Twing Aamir , Simon Erik , Cho Nicole , Groves Elliott , Shroff Adhir R
Published: March 2022

Introduction:
There are well documented differences in TAVR outcomes among men and women from pre-procedure to 30-days post procedure. However, there is less data comparing the long-term differences in outcomes between genders. This study investigated cardiovascular outcomes between these two groups within 6 months of undergoing a TAVR.

Methods:
We performed a retrospective study among patients undergoing TAVR between March 2018 and June 2020 at the University of Illinois-Chicago (UIC) in Chicago, Illinois. Primary outcomes included composite MACE (CV death, MI and/or CVA) and all-cause death. Secondary outcomes included change in peak gradient, mean gradient, aortic valve area, and ejection fraction. Outcomes were analyzed at 6 months following the procedure. T and Chi square tests were used to analyze continuous/categorical variables, respectively.

Results:
There was a total of 115 patients (female: 25, male: 90) in the analysis. The female cohort was older and had a higher BMI. At baseline, the women had a higher peak gradient when compared to the men (64 vs 48mmHg, p=0.03). At 6 months, MACE (female=1.7 vs male=7%, p=0.9) and all cause death (4 vs 4.4%, p=0.9) were statistically similar. There was no significant difference in the change in ejection fraction or aortic valve area between men and women. There was no difference between peak aortic valve gradient or mean aortic valve gradient (p>0.05) between the groups immediately after the procedure or at 6 months following TAVR.

Conclusion:
Despite having higher baseline aortic valve gradients, women appeared to have similar procedural success and 6-month outcomes following TAVR as compared to men in this analysis. Women presenting with higher baseline gradients suggest that they may be under-diagnosed or misdiagnosed leading to delays in care. Further screening and earlier referral for women is important to maintaining good outcomes.
Abstract 11152: Peripheral Artery Disease and 30-Year Risk of Kidney Outcomes in the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Paskiewicz Amy , Wang Frances M , Ishigami Junichi , Pang Yuanjie , Sang Yingying , Ballew Shoshana , Grams Morgan , HEISS Gerardo M , Coresh Josef , Matsushita Kuni
Published: March 2022

Introduction:
Peripheral artery disease (PAD) increases the risk of various adverse outcomes such as other cardiovascular diseases, lower-extremity amputation, and infection. However, its impact on kidney outcomes is yet to be characterized.

Hypothesis:
Both symptomatic and asymptomatic PAD will be associated with kidney outcomes.

Methods:
Using data from the ARIC study (1987-1989), we categorized 13,864 participants with estimated glomerular filtration rate (eGFR) >15 mL/min (mean age 54 [SD 6 years]) into symptomatic PAD (clinical history or intermittent claudication); asymptomatic PAD (ankle-brachial index [ABI] ≤0.90 but not symptomatic PAD); and ABI categories of 0.91-1.00, 1.01-1.10, 1.11-1.20 (reference), 1.21-1.30, and >1.30. Incident end-stage kidney disease (ESKD) was defined by the need for renal replacement therapy or death due to chronic kidney disease (CKD), and incident CKD was defined by ≥25% decline in eGFR to <60 mL/min or hospitalizations with CKD diagnosis among those with ≥eGFR 60 at baseline. We ran multivariable Cox models.

Results:
There were 580 ESKD cases and 4,602 CKD cases over ~30 years of follow-up. Both symptomatic PAD and asymptomatic PAD were significantly associated with incident ESKD with hazard ratios (HR) of 2.21 (95%CI 1.16-4.22) and 1.59 (1.07-2.36), respectively, after adjusting for potential confounders such as other cardiovascular diseases and diabetes (Table). The corresponding HRs for incident CKD were 1.43 (1.05-1.95) and 1.60 (1.35-1.90). Borderline low ABI 0.91-1.00 showed an elevated risk of kidney outcomes in demographically- adjusted Model 1.

Conclusions:
Symptomatic PAD and asymptomatic PAD were independently associated with a higher long-term risk of ESKD and CKD. These results further support the close link between atherosclerosis and kidney prognosis and highlight the need for kidney monitoring in persons with PAD regardless of leg symptoms.
Abstract 11159: Prevalence and Prognostic Relevance of Heart Failure Stages Among Black Americans in the Community: The Jackson Heart Study
Authors: Vu Katja , Zierath Rani , Claggett Brian , Hall Michael E , Clark Donald , Butler Kenneth R , Correa Adolfo , Shah Amil M
Published: March 2022

Introduction:
Black Americans experience a heightened risk of heart failure (HF) and develop HF at earlier ages than other racial/ethnic groups. Limited data exist regarding the prevalence and prognostic relevance of ACC/AHA HF stages among Black Americans. We aimed to quantify the distribution and prognostic relevance of ACC/AHA HF stages among Black Americans in mid- and late-life.

Methods:
We classified 4,763 Black participants in the community-based Jackson Heart Study who underwent echocardiography at study Exam 1 (2000-2004) by HF stage as follows: Stage A: presence of clinical HF risk factors (prevalent cardiovascular disease, hypertension, diabetes, obesity, metabolic syndrome, or chronic kidney disease) in the absence of structural heart disease; Stage B: structural heart disease (LVEF <50%, LV hypertrophy or enlargement, moderate to severe valvular disease); and Stage C: prevalent HF. Multivariable Cox proportional hazard regression models adjusted for age and gender were used to assess the associations of the HF stage at Exam 1 with incident HF hospitalization and all-cause mortality post-Exam 1.

Results:
Mean age was 55.3 ± 12.7 years and 64% were women. No clinical risk factors or cardiac structural or functional abnormalities (Stage 0) were present in 13% of participants. Stage A was present in 59%, Stage B was present in 26%, and prevalent HF (Stage C) was present in 3%. Over a median of 12.8 [IQR 11.8-13.5] years follow up, 332 participants developed HF and 1,060 participants died. Compared to those free of risk factors or structural remodeling (Stage 0), a more advanced HF stage was associated with greater risk of incident HF, and the composite of HF or death (Figure).

Conclusions:
In this large community-based cohort of Black Americans, HF risk factors (Stage A) and/or asymptomatic structural heart disease (Stage B) was present in 85% of participants. Stage A and Stage B were each associated with heightened risk of HF hospitalization.
Abstract 11173: Long Non-Coding RNA Linc00667 Modulates Cardiac Sodium Channel Downregulation During Ischemia
Authors: Kang Gyeoung-Jin , Xie An , Kim Eunji , Liu Hong , Dudley Samuel C
Published: March 2022

Background:
The voltage-gated cardiac sodium channel α subunit (
SCN5A
; encoding Na
v
1.5) plays a key role in cardiac conduction. The sodium channel is downregulated in cardiomyopathy, contributing to arrhythmic risk. In part, this downregulation is because of abnormal mRNA splicing and reduced mRNA stability. We recently reported that microRNA (miRNA)-448 contributes to the
SCN5A
mRNA instability in ischemic conditions.

Objective:
Long intergenic non-protein coding RNA 667 (LINC00667) is expressed in heart and can bind miRNA-448. We investigated the interaction of these two non-coding RNAs (ncRNAs) in regulating
SCN5A
.

Methods:
The expressions of
SCN5A
, miR-448 and LINC00667 were determined by quantitative real time polymerase chain reaction. The effects of ncRNAs on sodium current were determined in induced pluripotent stem cells-derived cardiomyocytes. The interaction between two ncRNAs was confirmed by pull-down assay.

Results:
LINC00667 has two binding sites for miR-448. A pull-down assay using biotin-tagged miR-448 showed direct binding of LINC00667 to miR-448. This indicates that LINC00667 could act as a competitor through the sponge function to miR-448. The expression of LINC00667 was decreased in human ischemic cardiomyopathy tissues compared to healthy controls. DFX treatment, a hypoxia mimetic chemical, or hypoxic condition (2% O
2
) resulted in reduced LINC00667 and reduced
SCN5A
mRNA in cardiomyocyte. Furthermore, LINC00667 inhibition by siRNA or antisense oligo showed reduction of
SCN5A
mRNA. This reduction is expected to enhance the effect of miR-448 and is expected to be inhibited by treatment with a DNA construct containing the miR-448 binding site of LINC00667 or "miR-448 sponge".

Conclusion:
SCN5A
is downregulated by hypoxia. In addition to upregulation of miR-448, which destabilizes
SCN5A
mRNA by direct binding, LINC00667 inhibition of miR-448 was relieved by hypoxia increasing the effect of miR-448 on
SCN5A
. Therefore, LINC00667 upregulation may represent a method to decrease arrhythmic risk during cardiomyopathy by raising
SCN5A
levels.
Abstract 11174: Effect of APOCIII-L
Rx
on Lipoprotein Size and Particle Numbers Measured by NMR in Patients with Hypertriglyceridemia: Results of the AKCEA-APOCIII-L
Rx
Trial
Authors: Karwatowska-Prokopczuk Ewa , Tardif Jean-Claude , Gaudet Daniel , Ballantyne Christie M , Shapiro Michael D , Moriarty Patrick M , Baum Seth J , St Amour Eric , Alexander Vickie , Xia Shuting , Otvos James D , Witztum Joseph L , Tsimikas Sotirios ,   AKCEA-APOCIII-LRx Trial Investigators
Published: March 2022

Background:
APOCIII-L
Rx
is a hepatocyte-targeted, GalNAc-modified antisense oligonucleotide that decreases plasma levels of apoC-III and triglyceride-rich lipoproteins (TRLs). We examined the effect of APOCIII-L
Rx
on a variety of lipoprotein fractions measured by nuclear magnetic resonance (NMR) spectroscopy.

Methods:
The AKCEA-APOCIII-L
Rx
trial was a dose-ranging study in 114 patients with, or at risk for, ASCVD and fasting serum triglycerides 200-500 mg/dL. Patients (n=114) received AKCEA-APOCIII-L
Rx
(10 or 50 mg every 4 weeks, 15 mg every 2 weeks, or 10 mg every week) or saline placebo subcutaneously for 6-12 months. Comprehensive NMR
LipoProfile
®
analysis was performed by LipoScience/LabCorp in frozen EDTA plasma samples collected at baseline and at the primary analysis timepoint (PAT) at 6 months.

Results:
Results are reported as change from baseline to PAT for the 50 mg every 4 weeks dose versus placebo. APOCIII-L
Rx
resulted in a significant reduction in total TRL particle (TRLP) concentration by 51% (P<0.0001) with largest reductions in large-size (by 68%, P<0.0001) and medium-size (by 63%, P<0.0001) TRLPs. Total LDL particle (LDLP) concentration was not changed, small LDLP numerically decreased by 39% (P= 0.0713) while medium LDLP increased by 187% (P=0.0119), accompanied by an increase in average LDL size by xx 2% (p=0.0039xx). Total HDL particle (HDLP) concentration increased by 15% (P=0.0006), represented primarily by an increase in small HDL subspecies (particle diameters <8.3 mm) of 32% (P=0.0008). Lower cumulative doses of APOCIII-L
Rx
generally reflected a dose-dependent relationship in the above parameters.

Conclusion:
APOCIII-L
Rx
results in favorable changes in lipoprotein concentration and particle size, primarily manifested by reduction in TRLs, remodeling to larger LDL particles, and increase in small HDLP. These findings suggest an improvement in overall atherogenic risk profile.
Abstract 11176: Family Screening in Dilated Cardiomyopathy; Long-Term Incidence and Potential for Limiting Follow-Up
Authors: Vissing Christoffer R , Espersen Kiri , Mills Helen L , Jurlander Rebecca , Vinther Skriver Sofie V , Thune Jens J , Raja Anna A , Christensen Alex H , Bundgaard Henning
Published: March 2022

Introduction:
Guidelines recommend family screening in dilated cardiomyopathy (DCM) to uncover pre-symptomatic familial DCM (FDC). So far, no guidelines provide specific recommendations on the intensity and frequency of follow-up screening. This study sought to provide the first detailed estimates of the incidence of FDC during follow-up and identify baseline markers which could inform future follow-up of relatives.

Methods:
The study was a retrospective, observational, longitudinal cohort study of relatives to DCM probands screened at a regional assembly of family screening clinics in Copenhagen, Denmark, from 2006 to 2020.

Results:
In total, 563 relatives (50% women) from 211 families were included. At baseline, 124 relatives (22%) were diagnosed with FDC: 97 (18%) as a result of screening and 27 (5%) with symptom-onset prior to screening. Genetic sequencing identified the etiology of DCM in 35% of families and classified 90 relatives (17%) as unaffected carriers (n=44) or relatives not at risk of FDC (n=46). As such, the combined clinical and genetic baseline-yield was 31%. In 439 relatives considered unaffected at baseline, 45 (10%) were diagnosed with FDC during follow-up (median 5.0 years). The age-standardized incidence rate of FDC was 2.0% per person-year [CI: 1.4-2.8%] with higher rates in men vs women (3.0% vs 1.4% per person-year). In relatives without predictive genetic findings (n=349), non-diagnostic abnormal baseline-findings on ECG or echocardiography was associated with a higher incidence rate of FDC (figure A), while the risk was low in relatives with normal findings (0.4% vs 4.7% per person-year; figure B).

Conclusion:
Systematic family screening identified FDC or genetic predisposition to FDC in 1 out of 3 relatives at baseline. Relatives without predictive genetic findings and with normal findings on ECG and echocardiography at baseline had a low risk of developing FDC. Follow-up can be limited and may not be warranted in these relatives.
Abstract 11185: Impact of Covid-19 on Acute Myocarditis Hospital Admissions in the National Health Service of England, Uk (2019-2020)
Authors: Lota Amrit S , Meena Devendra , Halliday Brian , Tayal Upasana , Iacob Alma , Hammersley Daniel , Jones Richard , Dehghan Abbas , Tzoulaki Ioanna , Ware James S , Cleland John , Pennell Dudley J , Prasad Sanjay K
Published: March 2022

Introduction:
Acute myocarditis has been reported in patients infected with COVID-19 in case series and imaging-based studies. We sought to assess this link by evaluating trends in hospital admissions due to acute myocarditis and COVID-19 on a national level during the pandemic.

Methods:
Data on all NHS England hospital admissions with a primary or secondary diagnosis of acute myocarditis were acquired and curated from the NHS Digital hospital episode statistics dataset from 2019-2020. COVID-19 data was obtained from the UK government daily statistics. Rolling averages over 28-day periods are presented.

Results:
Across all ages, there were 1,894 hospital admissions due to myocarditis in 2019 compared with 1,610 in 2020 (15% reduction). During the first national lockdown (23
rd
Mar-19
th
Jun 2020), myocarditis admissions were 32% lower than the same period in 2019. During the second lockdown (5
th
Nov-2
nd
Dec), myocarditis admissions were 9% greater than in 2019, although this increase was not sustained throughout December despite the subsequent surge in COVID-19 admissions. In general, patients admitted in 2020, compared to 2019, were older (median age 46 years, interquartile range 28-61 vs 41 years, IQR 26-58; p<0.001), but sex (66% men), ethnicity (39% non-Caucasian, 9% unknown) and duration of hospital admission (median 2 days; IQR 1-4) were similar for both years.

Discussion:
As COVID-19 admissions peaked in early 2020, there was a sharp decline in myocarditis admissions, probably attributed to profound disruptions in healthcare provision, but possibly due to reduced transmission of other viruses during lockdown. Whilst myocarditis admissions increased during the second lockdown, there was no clear association between COVID-19 and myocarditis admission numbers. Further research may identify delayed presentations or sequelae of myocarditis, particularly following the larger COVID-19 peak in January 2021, as well as the impact of the vaccination programme.
Abstract 11190: Impact of the Use of Platelet Function Testing to Guide P2Y12 Inhibitor Usage After Percutaneous Coronary Intervention (PCI): Results of a Large Real-World Experience
Authors: Muhlestein Joseph B , May Heidi T , Anderson Jeffrey L , Bair Tami L , Le Viet T , Horne Benjamin D , Knight Stacey , Whisenant Brian K , Knowlton Kirk U
Published: March 2022

Background:
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor remains standard treatment for patients undergoing PCI, and clopidogrel remains the most used agent. Many patients (pts) are genetically resistant to clopidogrel and may not receive its full benefit. However, the use of platelet function testing to provide individualized management of P2Y12 inhibitor therapy remains controversial. Therefore, we analyzed the impact of the use of platelet function testing after PCI in a large real-world experience.

Methods:
We searched Intermountain Healthcare medical records for pts who underwent PCI followed by DAPT. We compared 1-year outcomes (MACE=death, MI, stroke; and repeat revascularization and major bleeding) in those who did, or did not, receive P2Y12 platelet function testing within 90 days. Cox hazard regression analysis was used to determine multivariable hazard ratios.

Results:
A total of 11,561 pts were included, of which 650 (5.6%) received P2Y12 platelet function testing. Baseline demographics, discharge P2Y12 inhibitor and outcomes are shown in the Table.

Conclusion:
In this real-world analysis of patients undergoing PCI, a small proportion of the patients received P2Y12 platelet function testing. Platelet function testing was associated with increased utilization of prasugrel or ticagrelor and a statistically lower incidence of 1-year MACE (10.8% vs. 12.4%, adjusted odds ratio = 0.69, p=0.03), with a very low incidence of major bleeding. Further investigation regarding the potential benefits of individualized management of DAPT therapy through P2Y12 platelet function testing may be justified.
Abstract 11194: Reducing Arm Muscle Activation by Using an Ablation Catheter Torque Tool: Electromyographic Analysis and User Perception
Authors: Mass Paige , Kumthekar Rohan , Opfermann Justin , Sherwin Elizabeth D , Berul Charles I
Published: March 2022

Background:
Cardiac ablation catheters are small in diameter and require significant finger dexterity and grip strength to maintain stability and maneuver safely. We designed a catheter torque tool to reduce the muscle activation required to manipulate cardiac ablation catheters and improve user perception of task workload.

Objective:
The purpose of this study was to evaluate muscle usage and user perception when completing a simulated ablation task with and without the use of a novel ablation catheter torque tool.

Methods:
Participants, comprised of cardiology attendings and fellows, were fitted with surface electromyographic (EMG) sensors on 6 key muscle groups in the left hand and forearm. Maximum voluntary contraction (MVC) was collected for equal comparison among participants. A standard ablation catheter was inserted into a pediatric cardiac ablation simulator and subjects navigated the catheter tip to 6 specific electrophysiologic targets including a 1-minute simulated radiofrequency lesion. EMG activity normalized to percentage of MVC was collected throughout the task. The task was repeated 4 times, twice with and twice without the torque tool, in randomized order. A NASA Task Load Index (TLX) survey was completed by the participant at the conclusion each task.

Results:
Thirteen participants completed the study. Using Wilcoxon’s test, there was a significant difference (P < 0.01) in mean percent of MVC in 4 of the 6 muscle groups when comparing bare catheter versus catheter with torque tool: abductor pollicis, brachioradialis, flexor carpi ulnaris, and extensor carpi radialis. The total expended energy for the abductor pollicis (P < 0.01) and extensor carpi radialis (P = 0.02) were significantly reduced. Perceived physical demand, effort, and frustration were also significantly reduced when using the torque tool (P < 0.01).

Conclusions:
Use of our novel catheter torque tool reduced the amount of muscle activation necessary to manipulate an ablation catheter during a simulated ablation task. Users’ perceived physical demand, effort, and frustration were less when the tool was used. This tool may improve catheter stability, increase procedure safety, and reduce operator stress and muscle fatigue when performing catheter ablation procedures.
Abstract 11195: Is Personalized Computational Model of Atrial Fibrillation Really Personalized?
Authors: Lluch Eric , Mihalef Viorel , Vizitiu Anamaria , Passerini Tiziano , Audigier Chloe , Halperin Henry , Haschemi Mehdiyar , Ashikaga Hiroshi , Mansi Tommaso
Published: March 2022

Introduction:
Computational modeling-guided, personalized electrophysiology (EP) intervention for atrial fibrillation (AF) is an emerging paradigm of precision medicine. In the published models, advanced imaging and invasive mapping achieve personalization of cardiac anatomy. However, EP cellular personalization is less developed, and parameters are often assumed to be uniform across individual patients

Hypothesis:
Anatomical personalization alone is not sufficient to recapitulate the individual clinical features of AF in personalized models.

Methods:
For each of 57 patients (66±10 yr, 30 persistent) referred for catheter ablation of AF, we constructed a personalized 3-D model using pre-ablation CT, invasive mapping, and Courtemanche-Ramirez-Nattel atrial cell model. In the pre-ablation model, we performed virtual ramp pacing with cycle lengths at 200-120ms within the coronary sinus to induce AF. AF was defined as being inducible when it persists for >15s. Simulation was repeated for 5 different published sets of EP parameters of ionic currents. In total, >10k simulations were performed on an NVIDIA V100 GPU cluster, using the Lattice Boltzmann method with spatial resolution of 0.5mm and temporal resolution of 0.05ms, achieving a runtime of 24s per 1s of simulation (
Fig. A
).

Results:
While 100% AF inducibility was expected in the personalized pre-ablation models, AF inducibility varied between 27% and 96% depending on the set of ionic parameters used (
Fig. B
). The large variability of AF inducibility indicates that those models are highly sensitive to EP parameters, therefore anatomical personalization alone cannot adequately constrain the individual features of AF.

Conclusions:
The patient-specificity of the current paradigm of modeling-guided, personalized EP intervention is limited. There is an unmet clinical need for incorporation of personalized EP as well as anatomical parameters to achieve true precision medicine.
Abstract 11203: Providing Transcatheter Aortic Valve Replacement Therapies to VA Patients Through a Public-Private Partnership
Authors: Dickens Helena , Ambalavanan Manoj , Cho Nicole , Slostad Brody D , Twing Aamir , Simon Erik , Kansal Mayank M , Groves Elliott , Rodríguez-Rivera Yolanda , Gokhale Sanket , Shroff Adhir R
Published: March 2022

Introduction:
Despite the success of Transcatheter Aortic Valve Replacement (TAVR) in improving morbidity and mortality among patients with aortic stenosis, few stand-alone programs currently exist within the VA system. Many VA centers have developed transfer arrangements with partner institutions to provide TAVR for their patients. There is minimal data for VA patients in such programs. We compared the outcomes of VA patients to non-VA patients undergoing TAVR at a partner institution.

Methods:
We performed a single-center retrospective study on all patients undergoing TAVR between March 2018 and June 2020. All procedures were performed at an academic medical center (AMC) in Chicago where VA patients were referred for TAVR. Primary outcomes included composite MACE (death from any cause, MI, CVA). Secondary outcomes included length of stay, bleeding events, AKI, change in ejection fraction, CHF exacerbations, and device-related complications. We assessed outcomes at hospital discharge, 6-month and 12-months.

Results:
There was a total of 115 patients (AMC: 56, VA: 59). Patient demographics between the two groups were significant for the VA group being 57.6% Caucasian and 96.6% male while the AMC group was 33.9% Caucasian and 56.6% male (for both p<0.01). There was no in-hospital mortality in either group. Total length of stay (p=0.6), ICU length of stay (p=0.4), procedure time (p=0.4) and baseline ejection fraction (p=0.8) were similar between both groups. At 6 months, the VA patients experienced a trend towards a higher incidence of composite MACE (VA: 11.9%, AMC: 5.4%, p=0.2). None of the secondary outcomes reached statistical significance. Ejection fraction and CHF exacerbations were similar between groups (p=0.9 and p=0.59). At 12 months there was no statistical difference in primary or secondary outcomes. Similar ejection fractions and CHF exacerbations at 12 months were also recorded.

Conclusions:
No difference between procedural, 6-month or 12-month outcomes between VA patients and non-VA patients undergoing TAVR were observed. Public-private partnerships can provide state of the art therapies to VA patients in an efficient and safe manner.
Abstract 11207: Electronic Hookah Vaping with and Without Nicotine: Insights into Vascular Function and Plasma Fibrinogen
Authors: Rezk-hanna Mary , Cheng Chiao-Wei , Bustos Byron , Brecht Mary-Lynn
Published: March 2022

Introduction:
Electronic nicotine delivery systems (ENDS) are growing quickly in the United States, particularly among youth. Electronic (e-) hookahs are a new category of vaping devices in which the e-bowl is combined with and placed on a traditional waterpipe, allowing the flavored aerosol to pass through a water-filled base before being carried through the hose into the user’s mouth. E-hookah vaping with flavored nicotine acutely impairs endothelial function. However, the relative contribution of flavorings vs. nicotine on e-hookah vaping associated vascular dysfunction is unclear.

Methods:
In a randomized cross-over design study, we investigated the acute effect of flavored e-hookah with and without nicotine and sham vaping, among a cohort of 9 healthy young adult chronic hookah smokers (27±1 years, mean ±SE), on endothelial function, measured by brachial artery flow-mediated dilation (FMD). Fibrinogen, a major plasma protein coagulation factor, as well as smoking exposure biomarkers (plasma nicotine and expired carbon monoxide levels) were collected before and after the sessions.

Results:
Vaping e-hookah with nicotine induced an acute reduction in FMD (from 6.9±0.9 to 5.2±0.8%, pre- vs. post- vaping, p<0.001), suggesting impairment in endothelial function and increased plasma fibrinogen (+14.5±4.1 mg/dL, p<0.001). Though vaping e-hookah in the absence of nicotine did not significantly impair endothelial function (p = ns), it significantly induced an increase in plasma fibrinogen levels (+20.9±7.4 mg/dL, p<0.001), higher than levels induced after vaping e-hookah with nicotine. Plasma nicotine concentrations increased 4-fold more after vaping e-hookah with nicotine, whereas no changes were observed after vaping e-hookah without nicotine or sham-vaping (p = ns). Exhaled CO levels did not change across all three vaping sessions.

Conclusions:
In healthy young adults, our findings to date suggest that while vaping e-hookah with nicotine induces an unfavorable effect on the vasculature, non-nicotine constituents generated from heating the flavored e-hookah aerosol cannot be ignored. Further plans are needed to elucidate the long-term vascular implications of vaping non-nicotine flavored constituents.
Abstract 11208: Usefulness of Remapping with a Multi-Electrode Catheter in Post-Myocardial Infarction Patients Undergoing Substrate-Based Catheter Ablation for Ventricular Tachycardia
Authors: Mohanty Sanghamitra , TRIVEDI CHINTAN G , Della Rocca Domenico G , Zagrodzky William , Romero Jorge , Burkhardt John , Horton Rodney , Bassiouny Mohamed , Di Biase Luigi , Al-ahmad Amin , Natale Andrea
Published: March 2022

Introduction:
Scar-related VT is common in post-MI patients. We evaluated the benefits of remapping with the multi-electrode catheter after acute success was achieved with the single-point ablation catheter in post-MI VT patients undergoing catheter ablation.

Methods:
Consecutive post-MI patients undergoing VT ablation were included. 3-D electroanatomic maps were obtained in sinus rhythm and/or during hemodynamically-stable VT with the multi-electrode PentaRay catheter. All underwent substrate mapping with standard scar settings (≤ 1.5 mV). Ablation was performed with the single-point ablation catheter and acute success was defined as non-inducibility of all VT at the end of the procedure. After acute success was achieved, some operators remapped with the PentaRay catheter to identify residual abnormal potentials.

Results:
A total of 121 patients (table) undergoing VT ablation were prospectively analyzed. Acute success was achieved in 117 (96.6%) cases. Remapping with the PentaRay catheter was performed in 102 (84.3%) cases. Few sites with delayed potentials were detected in 66/102 (61%) cases. These sites were targeted for further ablation. At 1 year follow-up, 76/102 (74.5%) of the remap population and 14/19 (73.6%) patients from the no-remap group remained arrhythmia-free off-AAD (p=NS).

Conclusion:
In our series, detection of few sites with late potentials by remapping with the multi-electrode catheter, after achieving acute success with single-point ablation did not improve the success rate at 1 year. Thus, the clinical benefits of remapping with multi-electrode catheters is not clear in VT patients undergoing substrate-based catheter ablation.
Abstract 11217: Adverse Events Associated with AV Node Ablation in Patients with an Implanted Leadless Pacemaker
Authors: Hauser Robert
Published: March 2022

Introduction:
The Micra leadless intracardiac pacemaker (LICP) is an FDA-approved right ventricular pacemaker that has been available worldwide since 2016. It is frequently implanted in patients who have atrial fibrillation and who undergo atrioventricular node ablation (AVN-AB) for rate control. The potential adverse effects of AVN-AB on LICP performance and function are unknown.

Hypothesis:
AVN-AB may increase LICP pacing thresholds and/or cause exit block or damage the LICP's electronics.

Methods:
The FDA Manufacturers and User Facility Device Experience (MAUDE) database was searched for Micra LICP adverse events associated with AVN-AB that were submitted by the manufacturer and received by the Food and Drug Administration from 2016-April 2021.

Results:
The search found 19 cases of pacing threshold elevation following AVN-AB that were performed during (n=9) or after (n=10) LICP implantation. Exit block resulted in asystole or marked bradycardia in 12 patients (63.2%); 2 of these patients required cardiopulmonary resuscitation. In 8 patients, a persistently high threshold or exit block required LICP replacement with either a new LICP or a transvenous pacemaker. Four explanted LICPs were returned and analyzed by the manufacturer and no pulse generator electronic abnormalities were found.

Conclusions:
AVN-AB during or after LICP implantation may result in persistently high pacing thresholds or exit block and necessitate LICP replacement; this appears to be a local effect at the LICP electrode-tissue interface rather than effects on LICP electronic function. Additional clinical safety data are needed, especially since patients may be rendered pacemaker-dependent after AVN-AB.
Abstract 11229: Clinical and Genetic Atrial Fibrillation Risk and Discrimination of Cardioembolic from Non-Cardioembolic Stroke
Authors: Weng Lu , Khurshid Shaan , Gunn Sophia , Benjamin Emelia J , Ellinor Patrick T , Trinquart Ludovic , Lunetta Kathryn ,   NINDS Stroke Genetics Network, Anderson Christopher D , Lubitz Steven A
Published: March 2022

Introduction:
Prior studies demonstrate correlation between atrial fibrillation (AF) polygenic risk score (PRS) and ischemic stroke, especially cardioembolic (CE) stroke, suggesting shared genetic components. In this study, we hypothesized that an AF PRS can discriminate CE from non-CE strokes.

Methods:
We evaluated AF and stroke risk in 26,145 individuals of European descent from the NINDS Stroke Genetics Network (SiGN) with study-adjudicated TOAST subtypes. AF genetic risk was estimated using two newly derived PRS (LDpred-funct and sBayesR) and two previously validated PRS (pruning and thresholding and LDpred). A clinical risk score (CRS) was derived within separate individuals in UK Biobank utilizing components of the Cohorts for Aging and Genomic Research in Epidemiology (CHARGE-AF) model available in SiGN. We regressed each AF PRS on AF status and separately CE stroke in logistic regression models adjusted for CRS, imputation group, and the first 10 principal components. We calculated discrimination of AF and CE stroke, and compared across models using 2000-iteration bootstrapping and pairwise Z-testing. We also assessed category-free reclassification of CE stroke risk with the addition of PRS to a) CRS, and b) a modified CHA
2
DS
2
-VASc score including all available score components.

Results:
Each AF PRS was significantly associated with AF and CE stroke after adjustment for the CRS. Addition of any AF PRS significantly improved model discrimination as compared to the CRS alone, and LDpred discriminated both AF and CE better than other PRSs (
Figure
;
P
<0.005). Adding LDpred PRS to CRS resulted in appropriate reclassification of CE stroke risk compared to the CRS or the modified CHA
2
DS
2
-VASc score alone (
Figure
).

Conclusions:
Addition of AF polygenic risk to clinical risk factors improves discrimination of CE from non-CE strokes, as well as reclassification of stroke subtype. AF polygenic risk may be a useful biomarker for identifying AF-related strokes.
Abstract 11234: The Impact of Median Yearly Income on Structural Heart Disease Procedural Outcomes
Authors: Dickens Helena , Ambalavanan Manoj , Twing Aamir , Groves Elliott , Jarsania Dhairya , Gokhale Sanket , Cho Nicole , Slostad Brody D , Kansal Mayank , Shroff Adhir R
Published: March 2022

Introduction:
The association of socioeconomic status with health outcomes is well known. This study used zip codes as a surrogate for income and compared outcomes post-procedure and at 6 and 12 months following TAVR at an urban hospital.

Methods:
We performed a retrospective study on patients undergoing TAVR at the University of Illinois-Chicago(UIC) in Chicago, Illinois between March 2018 and June 2020. Using income data from the US Census Bureau, patients were placed into 2 groups: zip codes with a median income less than the national urban mean income of $54,296 (LMI) and greater than the average urban mean yearly income (GMI).Primary outcomes included composite MACE (CV death, MI and/or CVA), length of stay, and all-cause death. Secondary outcomes included CHF exacerbation, and repeat revascularization. Outcomes were analyzed at hospital discharge, 6 months and 12 months. T and Chi square tests were used to analyze continuous/categorical variables, respectively.

Results:
We analyzed 114 patients, 84 patients were categorized as LMI and 30 patients were categorized as GMI. 94.3% of the LMI group was Black, while only 62% of the GMI group was Black. Age and gender distributions were similar between groups. Initial post procedural outcomes showed no statistical difference between the LMI and GMI. The LMI group trended towards a longer length of stay than the GMI group (p=0.1). A history of heart failure was greater in the LMI group (p = 0.025). At 6 months there was a lower repeat revascularization rate in the LMI group compared to the GMI group (0% vs. 1.8%, p = 0.017). However, other outcomes including composite MACE (9.6% vs. 1.8%, p=0.3) and all cause death (6.1% vs. 0.9%p=0.4) were statistically similar. At 12 months only 112 patients had recorded outcomes. At this time, repeat revascularization was still significantly different (0% vs. 2.6%, p = 0.005) but all other outcomes remained nonsignificant.

Results:
Post TAVR, patients in the GMI group experienced a higher rate of repeat coronary revascularization as compared to the LMI group, although, the composite event rate was similar. Further investigation into this observation is warranted; however, overall outcomes between patients from poorer communities seems to be similar to wealthier communities.