bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15640: Long Term Moderate, but Not Intense, Exercise Improves Cognitive Brain Health. Study in a Rat Model
Authors: Sanguesa Gemma , Batlle Montserrat , Munoz Moreno Emma , Soria Guadalupe , Alcarraz Anna , Rubies Cira , Amaro Sergio , Llufriu Sara , Mont Lluis , Guasch Eduard
Published: May 2021

Introduction:
A U-shaped relationship between exercise load and cardiovascular risk has been demonstrated. In the brain, moderate exercise improves cognitive performance but the consequences of intense exercise remain unknown. We aimed to describe the effects of moderate and intensive exercise load on brain structure and function.

Methods:
Male Wistar rats were subjected to moderate (MOD, 35 cm/s for 45 min, n=8) or intense (INT, 60 cm/s for 60 min, n=8) exercise for 16 weeks, 5 days/week; sedentary rats (SED, n=10) were used as controls. At 16 weeks, learning and motivation tests, and brain magnetic resonance (MR) were obtained. In MR, structural brain networks were analyzed using fractional anisotropy normalized connectomes, and cerebral blood flow (CBF) was assessed using pulsed arterial spin labelling. BDNF levels were analysed in plasma, hippocampus and frontal cortex samples with ELISA.

Results:
MOD rats showed a greater motivation than SED rats and enhanced learning capacity than INT rats. In the MR, only moderate exercise increased global and local efficiency and average clustering coefficient. Global CBF was increased by moderate but not intensive exercise (Fig A). CBF was subsequently assessed at specific brain regions. In comparison to SED, MOD rats presented a higher CBF in the right and left cortex, and in the left hippocampus; in INT rats, CBF was higher only in the left cortex compared to SED (Fig B). MOD training induced a significant decrease in BDNF protein levels in the hippocampus compared to both SED and INT groups. No significant differences were found on BDNF levels in plasma and frontal cortex samples among groups.

Conclusions:
In a rat model, moderate exercise induces brain structural and functional improvements that are not perpetuated with intensive exercise, supporting the existence of a U-shaped relationship between exercise load and brain function.
Abstract 15649: Pharmacological Inhibition of Aldose Reductase by AT001 Prevents Abnormal Cardiac Energy Metabolism and Improves Heart Function in an Animal Model of Diabetic Cardiomyopathy
Authors: Gopal Keshav , Karwi Qutuba , Tabatabaei Dakhili Seyed Amirhossein , Perfetti Riccardo , Ramasamy Ravichandran , Ussher John R , Lopaschuk Gary D
Published: May 2021

Introduction:
Diabetic Cardiomyopathy (DCM) is a major cause of death in people with type 2 diabetes (T2D). Alterations in cardiac energy metabolism including increased fatty acid oxidation rates and reduced glucose oxidation rates are key contributing factors to the development of DCM. Studies have shown that Aldose Reductase (AR), an enzyme activated under hyperglycemic conditions, can modulate myocardial glucose and fatty acid oxidation, and promotes cardiac dysfunction.

Hypothesis:
Pharmacological inhibition of AR using a next-generation inhibitor AT-001, can mitigate DCM in mice by modulating cardiac energy metabolism and improving cardiac efficiency.

Methods:
Male human AR overexpressing (hAR-Tg) and C57BL/6J (Control) mice were subjected to experimental T2D (high-fat diet [60% kcal from lard] for 10-wk with a single intraperitoneal streptozotocin injection of 75 mg/kg) and treated for the last 3-wk with AT-001 (40mg/kg/day) or vehicle via oral gavage. Cardiac energy metabolism and
in vivo
cardiac function were assessed via isolated working heart perfusions and ultrasound echocardiography, respectively.

Results:
AT-001 treatment significantly improved cardiac energetics in a murine model of DCM (hAR-Tg mice with T2D). Particularly, AT-001-treated mice exhibited decreased cardiac fatty acid oxidation rates compared to the vehicle-treated mice (342 ± 53 vs 964 ± 130 nmol/min/g dry wt.). Concurrently, there was a significant decrease in cardiac oxygen consumption in the AT-001-treated compared to the vehicle-treated mice (41 ± 12 vs 60 ± 11 μmol/min/g dry wt.), suggesting increased cardiac efficiency. Furthermore, treatment with AT-001 prevented cardiac structural and functional abnormalities present in DCM, including diastolic dysfunction as reflected by an increase in the tissue Doppler E’/A’ ratio and decrease in E/E’ ratio. Moreover, AT-001 treatment prevented cardiac hypertrophy as reflected by a decrease in LV mass in AT-001-treated mice.

Conclusions:
AR inhibition with AT-001 prevents cardiac structural and functional abnormalities in a mouse model of DCM, and normalizes cardiac energetics by shifting cardiac metabolism towards a non-diabetic metabolic state.
Abstract 15652: Cell Therapy in Heart Failure With Preserved Ejection Fraction (CELLpEF)
Authors: VRTOVEC Bojan , Frljak Sabina , Poglajen Gregor , Zemljic Gregor , Cerar Andraz , Sever Matjaz , Haddad Francois , Wu Joseph C
Published: May 2021

Introduction:
Previous studies have demonstrated that cell therapy may improve diastolic parameters in heart failure.

Hypothesis:
We sought to investigate the effects of transendocardial CD34
+
cell therapy in patients with heart failure with preserved ejection fraction (HFpEF).

Methods:
In a prospective crossover study, we enrolled 30 patients with HFpEF (LVEF>50%, E/e'>15, NT-proBNP >300 pg/ml). In Phase 1, patients were treated with stable medical therapy for 6 months. Thereafter, all patients underwent transendocardial CD34
+
cell transplantation. They received bone marrow stimulation with filgrastim (10 mcg/kg, 5 days); CD34
+
cells were collected by apheresis. We performed electroanatomical mapping of the left ventricle, and injected the cells transendocardialy in the areas of local diastolic dysfunction (80 million CD34
+
cells divided into 20 injections). Patients were followed for 6 months after the procedure (Phase 2).

Results:
Our cohort included 23 male and 7 female patients aged 62±10 years, with LVEF of 58.7±7.3%, creatinine of 93±35 μmol/L, and bilirubin of 14.3±6.8 μmol/L. In Phase 1 (medical therapy), we found no change in E/e' (from 18.0±3.5 to 17.4±3.0, P=0.97), global systolic strain (from -12.5±2.4% to -12.8±2.6%, P=0.77), NT-proBNP levels (from 1463±1247 pg/mL to 1298±931 pg/mL, P=0.31), or 6-minute walk test distance (from 391±75 m to 402±93 m, P=0.42). In contrast, in Phase 2 (cell therapy), we found a significant improvement in E/e' (from 17.4±3.0 to 11.9±2.6, P=<0.0001), a decrease in NT-proBNP levels (from 1298±931 pg/ml to 887±809 pg/ml, P=0.02), and an improvement in 6-minute walk test distance (from 402±93 m to 438±72 m, P=0.02). Although global systolic strain did not change significantly in Phase 2 (from -12.8±2.6% to -13.8±2.7%, P=0.36), we found a significant improvement of local systolic strain in myocardial segments that were injected with stem cells (-3.4±6.8%, P=0.005).

Conclusion:
In patients with HFpEF, transendocardial CD34
+
cell therapy appears to be associated with improved left ventricular diastolic parameters, better exercise capacity, a decrease in NT-proBNP levels, and improved local systolic strain at cell injection sites.
Abstract 15681: Reduced Left Atrial Strain is Associated With the Development of Atrial Arrhythmias in Hospitalized Patients With COVID-19
Authors: Goerlich Erin , Minhas Anum S , Barth Andreas S , Wu Katherine C , Hays Allison G
Published: May 2021

Introduction:
Coronavirus Disease 2019 (COVID-19) is a pandemic with frequent cardiovascular (CV) complications, including cardiac arrhythmias. However, little is known about contributing factors to the development of new atrial tachyarrhythmias (ATs) in the inpatient setting. Left atrial strain (LAS) is a novel transthoracic echocardiography (TTE) measure of LA myocardial deformation and predicts arrhythmias. We aimed to compare clinical and echocardiographic variables including LAS in hospitalized patients with COVID-19 who developed new ATs compared to matched controls without arrhythmias.

Methods:
We retrospectively studied 42 patients hospitalized with COVID-19 who underwent clinical TTE. During admission, 20 patients without prior arrhythmia developed new ATs (including sustained atrial fibrillation/flutter/tachycardia, and undifferentiated supraventricular tachycardia) (cases) and were compared to 22 age and sex-matched COVID-19 patients without arrhythmias (controls). TTEs were analyzed for reservoir (peak longitudinal) LAS using 2D-speckle tracking and LA ejection fraction (LAEF) offline using TomTec software. Comparisons were made using Chi-square and t-tests as appropriate.

Results:
Mean age was 65±14 years, and 40% were women. There were no significant differences in CV risk factors, BMI, troponin or peak inflammatory markers between cases and controls. LAS was overall lower than normal and significantly lower in cases compared to controls (23.5±7.5% vs 31.0±6.0% respectively,
P
=0.001; Fig 1). There were no significant differences in left ventricular (LV) ejection fraction (LVEF), LV global longitudinal strain (GLS), LAEF, shock or death.

Conclusions:
COVID-19 patients who developed new ATs have lower LAS on TTE than patients without atrial arrhythmias. LAS may be a sensitive marker for identifying patients with COVID-19 at risk for ATs compared to LVEF, LV GLS, and LAEF. Larger confirmatory studies are warranted.
Abstract 15689: Resistant Rapid Atrial Flutter With Left Atrial Thrombus: A Therapeutic Dilemma
Authors: Patel Kinjal , Correia Joaquim J , Trivedi Krunal
Published: May 2021

Introduction:
Electrical cardioversion (ECV) is highly successful in the treatment of typical atrial flutter (AFL). Patients with AFL with a rapid ventricular rate (RVR) of ≥150 beats per minute (BPM) and significant hemodynamic compromise benefit from urgent CV. This is a unique case of managing chemically resistance AFL with a left atrial (LA) thrombus.

Case Presentation:
A 48-year-old male with medical history of bioprosthetic mitral and aortic valve was admitted for new onset AFL with RVR. Patient complain of (c/o) progressively worsening dyspnea and chest palpitation from 3 days. The patient denied chest pain, dizziness, diaphoresis. On admission blood pressure (BP) was 122/80 mmHg with heart rate (HR) of 158 BPM. ECG showed 2:1 block AFL with RVR. Patient was started on IV heparin and diltiazem drip. However, as the HR remained >150 and patient continued to c/o palpitations, IV amiodarone was added. The BP started to fall with the HR still >150 BPM. An emergent TEE done showed LA thrombus. Hence, the ECV was not performed. Instead a synchronized (sync) 3-joule (J) shock on R wave was attempted to induce atrial fibrillation (AF), to achieve better rate control. Immediately after delivering the shock the cardiac rhythm was successfully converted to AF with HR of <80 BPM.

Discussion:
LA thrombus and clinical thromboembolic events are highly prevalent in AFL. TEE is usually done to exclude thrombus in a patient with AFL for >48 hrs and if presence of thrombus cannot be confidently excluded on TEE, CV should not be performed. As a shock provided during the relative refractory period (RRP) of the ventricle corresponding to the latter part of the T wave, can possibly induce ventricular fibrillation (the so-called “R-on-T Phenomenon”), with similar concept a low voltage sync shock on R wave, the RRP of the atria can possibly induce AF. AF can be more easily rate controlled on antiarrhythmics compared to AFL and a patient with LA thrombus on anticoagulants is at lower risk from embolic events in AF than SR.

Conclusions:
This clinical noninvasive maneuver may be useful and desired in the management of a deteriorating patient with AFL not responsive to chemical rate control and LA thrombus such as ours or for an instance when AF in a patient with LA thrombus was inadvertently converted to SR.
Abstract 15700: Targeted Nanoparticle Delivery of a Protein Arginine Deiminase-4 Inhibitor Limits Arterial Intimal Netosis and Preserves Endothelial Integrity in Mouse Arterial Erosion-like Injury
Authors: Molinaro Roberto , Yu Mikyung , Bichsel Collette A , Corbo Claudia , Lee Gha Young Y , Tesmenitsky Yevgenia , Shvartz Eugenia , Sukhova Galina K , Kloss Frederik , Croce Kevin , Farokhzad Omid C , Shi Jinjun , Libby Peter
Published: May 2021

Introduction:
Superficial plaque erosion has emerged as a growing cause of residual thrombotic complications of atherosclerosis in an era of effective lipid lowering, anti-hypertensive therapy, and smoking cessation. The mechanisms of plaque erosion remain poorly understood, and we currently lack validated effective diagnostics or therapeutics for superficial erosion. Lesions complicated by erosion have a rich extracellular matrix, sparse lipid, and few mononuclear cells, but do harbor neutrophil extracellular traps (NETs). We recently reported that NETs amplify and propagate the endothelial damage at the site of arterial lesions that recapitulate in mice elements of superficial erosion. We previously showed that genetic loss of protein arginine deiminase (PAD)-4 function inhibited NETosis and preserved endothelial integrity.

Hypothesis:
We hypothesized that Col IV-targeted NPs (Col IV-NPs) can deliver PAD4 inhibitors selectively to regions of EC sloughing and collagen IV-rich basement membrane exposure, and attenuate the amplification, persistence, and propagation of superficial erosion and consequent thrombosis.

Methods:
We developed Col IV-NPs to deliver PAD4 inhibitors selectively to regions of endothelial cell sloughing and collagen IV-rich basement membrane exposure using our validated experimental preparation that reproduces in mice some of the conditions ascribed to lesions associated with superficial erosion.

Results and Conclusions:
We first demonstrated the binding of the targeting ligand
in vitro
and evaluated Col IV NP targeting towards areas of denuded endothelium
in vivo
in this mouse preparation. Delivery of the PAD4 inhibitor GSK484 as cargo in these nanoparticles reduced NETs release at sites of eroded areas. Compared to non-targeted NPs, Col IV NPs showed a 1.8-fold increased accumulation at regions of endothelial injury (p<0.0001). When loaded with the PAD4 inhibitor GSK484, Col IV NPs effectively reduced NET accumulation by 2.5 fold at sites of intimal lesions (p<0.01) and preserved endothelial continuity (a 4-fold increase in endothelial continuity percentage, p<0.001). These results indicate the feasibility of using nanotechnology to address the unmet need of specific therapy for superficial erosion.
Abstract 15709: Older and Younger Patients’ Perceptions, Evaluations, and Responses to Worsening Heart Failure Symptoms
Authors: Lin Chin-Yen , Hammash Muna , Mudd-martin Gia , Biddle Martha J , Moser Debra K
Published: May 2021

Background:
Adequate self-care abilities, such as early recognition of and appropriate responses to worsening heart failure (HF) symptoms, are important to prevent further deterioration and avoid unnecessary hospitalization. Patients with HF have difficulty recognizing and responding to worsening symptoms promptly and this problem seems to be worse in older compared to younger patients.

Objective:
The aims of this study were (1) to compare perceptions, evaluations, and responses to worsening HF symptoms before a hospital admission between older and younger patients, and (2) to compare older and younger patients’ responses when they perceived higher symptom distress.

Methods:
Data on patients’ perceptions, evaluations, and responses to worsening HF symptoms were collected using HF Somatic Awareness Scale and Modified Response to Symptoms Questionnaire from 185 patients hospitalized with HF (mean age 62 ± 13 years; 51% male; 66% New York Heart Association class III/IV). We compared data between younger and older patients using a cutoff at age 65. Independent
t
-test, chi-square, and two-way ANOVA were performed.

Results:
Compared with younger patients, older patients were more likely to attribute their symptoms to aging (
p
= 0.003) and to have lower somatic awareness (
p
= 0.014); however, there were no significant differences between older and younger patients in their responses to worsening HF symptoms. In response to higher perceived symptom distress, regardless of age grouping, patients at first did nothing and hoped their symptoms would go away (
p
= 0.004), ignored symptoms and continued doing what was doing (
p
= 0.002), or laid down and tried to relax (
p
< 0.001). No other strategies such as self-medicated, contacted doctors, and went to hospital were significantly associated with higher symptom distress.

Conclusions:
Regardless of age, patients with HF do not respond appropriately to worsening HF symptoms. Older patients have lower somatic awareness, which may partially explain their lack of appropriate response, but younger patients with better somatic awareness do not respond any more appropriately. Interventions should be tested that target better symptom appraisal and promote appropriate symptom responses in patients with HF across all ages.
Abstract 15736: The Sphk1/s1p Signaling Axis Regulates Pulmonary Vascular Inflammation by Activating Nf-kb and Nlrp3 Inflammasome
Authors: Bai Yang , de Brito Carneiro Alan , Lockett Angelia , Gomes Marta T , Jones Nicole , Lai Yen Chun , MacHado Roberto F
Published: May 2021

Rationale:
Pulmonary vascular inflammation is activated during the development of pulmonary arterial hypertension (PAH). Sphingosine kinase 1 (Sphk1) catalyzes the formation of sphingosine-1-phosphate (S1P), which has been shown to promote inflammation by activating nuclear factor kappa B (NF-κB) and the nucleotide oligomerization domain-like receptor 3 (NLRP3) inflammasome. However, the impact of S1P on NLRP3 inflammasome activation in PAH is unknown. Here, we tested whether Sphk1/S1P regulates pulmonary vascular inflammation via activating NF-κB and the NLRP3 inflammasome.

Methods:
Human pulmonary arterial smooth muscle cells (PASMCs) and endothelial cells (PAECs) were treated with S1P or were exposed to hypoxia. Sphk1 plasmid or siRNA was used to increase and decrease Sphk1/S1P levels, respectively. Activation of NF-κB signaling and the NLRP3 inflammasome (increased NLRP3, cleaved caspase-1, IL-1β and IL-18) were detected by western blots or real-time PCR. ELISA was used to measure secretion of IL-1β.

Results:
S1P treatment led to a biphasic phosphorylation and degradation of IκBα accompanied by increased phosphorylation and expression of NF-κB in PASMCs. S1P treatment also resulted in increased expression of inflammasome mediators, NLRP3 and cleaved caspase-1, enhanced intracellular expression of IL-1b and IL-18, and higher levels of secreted IL-1β compared to controls. Notably, over expression of Sphk1 in PASMCs led to increased NF-κB and NLRP3 expression, whereas suppression of Sphk1 expression reduced NLRP3, cleavage of IL-1β and IL-18 expression and phosphorylation of NF-κB. Similar phenomena with respect to inflammasome activation and IL-1β secretion was observed in PASMCs exposed to hypoxia. Increased NF-κB and NLRP3 activation, cleavage of caspase-1 were also observed in S1P treated PAECs, however no changes in IL-1β secretion levels were detected.

Conclusion:
These findings suggest that S1P induces pulmonary vascular pro-inflammatory signaling via activation of NF-κB and the NLRP3 inflammasome, and that the S1P/Sphk1 signaling axis may be involved in this context. Activation of the inflammasome may be an important mechanism underlying PAH pathogenesis, targeting of which may be exploited for the treatment of PAH.
Abstract 15759: Utility of the Sofa Score to Risk Stratify Patients in the Cardiac Intensive Care Unit at a Tertiary Care Center
Authors: Raja Anika I , Genovese Leonard , Vyas Ankit , BAGCHI PRAMITA , Shah Palak , Psotka Mitchell , Bagnola Aaron J , Flanagan M C , Welch Timothy , Rosner Carolyn , Tehrani Behnam N , Truesdell Alexander , Damluji Abdulla , Cole Robert , Cooper Lauren , Desai Shashank , Moukhachen Hala , Garofalo Stephanie , Batchelor Wayne , DEFILIPPI Christopher , Sinha Shashank S
Published: May 2021

Introduction:
The Sequential Organ Failure Assessment (SOFA) score predicts intensive care unit (ICU) mortality within a medical ICU population but utility of the SOFA score in the contemporary cardiac ICU (CICU) is unclear.

Methods:
Data from consecutive patients with primary cardiac (PC) and non-cardiac (PNC) disease admitted to the CICU at a tertiary care center from 1/1/19-2/28/19 and 10/1/19-11/30/19 were collected and analyzed by retrospective chart review, including demographics, comorbidities, primary reasons for admission, labs and SOFA score parameters. Patients were grouped into three categories based on their highest SOFA score within the first 24 hours of CICU admission: SOFA Score ≤ 6, 7-11 and ≥ 12. CICU and in-hospital mortality rates (adjusted for age, gender, race, and comorbidities) were compared using multivariate linear regression.

Results:
Of the 453 patients admitted to the CICU during the studied time period, 321 had PC diagnoses and 132 PNC diagnoses. The mean age was 63.5 and 59.6 (
p< 0.05)
, 65.1% and 50.7% were male (
p< 0.05)
, and 53.6% and 62.9% were white (
p=0.07)
, and 70.4% and 56.8% had at least three or more comorbidities (
p<0.05)
for the PC and PNC cohorts, respectively. The top three comorbidities were hypertension (70%), heart failure (39%), and diabetes mellitus (36%) for the PC group and hypertension (60%), diabetes mellitus (33%), and pulmonary disease (26%) for the PNC group, respectively. Increasing SOFA scores were associated with increased CICU and in-hospital mortality (Table) for patients with both PC and PNC diagnoses.

Conclusion:
Increased SOFA scores were associated with higher risk of CICU and in-hospital mortality. The SOFA score may be useful for risk stratification of CICU patients with both primary cardiac and non-cardiac diagnoses.
Abstract 15793: Joint Prediction of Hard Ascvd by Pooled Cohorts Equations Risk and Presence of Breast Arterial Calcification: The Minerva Study
Authors: Iribarren Carlos , Chandra Malini , Sanchez Gabriela , Sam Danny , Azamian-Bidgoli Fatemeh , Hyo-Min Cho , Ding Ding , Molloi Sabee
Published: May 2021

Introduction:
Prior studies have documented independent associations of breast arterial calcification (BAC) detected on mammographic screening with coronary artery disease or prospective cardiovascular disease outcomes. This study aims to ascertain the additional predictive ability for hard atherosclerotic cardiovascular disease (ASCVD) imparted by presence of BAC on top of the 10-year AHA/ACC Pooled Cohort Equations (PCE) Risk estimator.

Hypothesis:
BAC presence on mammograms will help further risk stratify women for risk of ASCVD.

Methods:
We used data from MINERVA, a multiethnic cohort of women aged 60 to 79 years at baseline (2012-15), free of symptomatic CVD, and recruited after mammography screening at Kaiser Permanente of Northern California. The sample available for analyses with complete data on BAC and PCE was 5,046. A BAC continuous mass score (mg) was obtained from digital mammograms using a validated densitometry method. BAC presence was BAC score > 0 mg. Follow-up for hospitalization and death was through 5/31/20 (mean, 6.2 years). We defined hard ASCVD as acute myocardial infarction or stroke or CVD death (n=122 events).

Results:
The mean (SD) age at baseline was 66 (4) years; 47 percent were non-white. Overall, 26.4 percent had a BAC score > 0 mg, 33 percent had low (< 5%), 36 percent intermediate (between 5 and 10%) and 31 percent high (> 10%) PCE risk. Using Cox models, there was a graded association by level of PCE risk and, within each level of PCE risk, women with BAC presence were at higher risk for ASCVD than women without BAC. In models adjusting for age, race/ethnicity, education level, BMI, statin use, menopausal hormone therapy, breast feeding and parity, being in the intermediate PCE risk group (relative to being at low PCE risk and having no BAC) was associated with 3.1 (95% CI, 1.5 - 6.5) increased hazard of ASCVD when no BAC was present and with 3.8 (95% CI, 1.7 - 8.7) increased hazard of ASCVD when BAC was present. Corresponding hazard ratios for women in the high PCE risks were 4.3 (95% CI, 1.9-9.6) and 7.5 (95% CI, 3.1-17.8), respectively.

Conclusions:
Our findings support additional predictive utility of BAC for ASCVD. In women at intermediate or high risk for ASCVD, BAC presence may help guide primary prevention.
Abstract 15954:
Arriba Por La Vida Estudio
: A Randomized Trial Promoting Standing Behavior to Reduce Sitting Time Among Postmenopausal Latinas
Authors: Talavera Gregory A , Castaneda Sheila , Lopez-Gurrola Maria , Alvarez-Malo Ana Rebeca , Hernandez Johanne , Sears Dorothy , Reuter Chase , Natarajan Loki , Takemoto Michelle , Chang Ya-Ju , avitia yesenia , Haimovich Areilia , Ornales Luis , De La Torre Andrea , Allison Matthew
Published: May 2021

Introduction:
Increased sedentary behavior is independently associated with increased risk of cardiometabolic diseases. There are few community-based RCTs designed to address this behavior, and none among Latinas, who are particularly at risk for cardiometabolic diseases. This study presents the results of an intervention to reduce sitting time among postmenopausal overweight Latina women.

Hypothesis:
Participants randomized to the standing intervention arm will have a greater reduction in sitting time compared to those in the comparison arm.

Methods:
A total of 254 overweight, sedentary postmenopausal Latinas in San Diego were enrolled in a 12-week trial, and randomized to either an intervention to replace sitting time with standing bouts or a comparison group that received heart healthy information. The intervention, based on social-cognitive behavior change, included culturally-tailored coaching. Intervention participants received three in-person health-counseling sessions, one home visit, and five telephone calls using motivational interviewing; the comparison group received an equal number of contacts to discuss topics on healthy aging. The primary outcome was change in sitting time at 12 weeks measured via thigh-worn inclinometers (ActivPAL microTM). Group differences in outcomes were analyzed using linear mixed-effects models.

Results:
The trial arms were comparable at baseline with mean (SD) age 65 (6.5) years, education 10.7 (4.4) years, 32.4 (4.8) kg/m2 BMI, sitting time 540 (86) minutes/day. Significant differences between control and intervention groups were observed in change in sitting time (p<0.001), standing time (p<0.001), and stepping time (p=0.016). For control and intervention groups, mean (SE) in minutes/day of sitting time change was -7.5 (9.1) and -71.0 (9.8); standing time change was 2.5 (6.5) and 49.6 (7.0); stepping time change was 4.7 (2.4) and 13.2 (2.6), respectively.

Conclusions:
The findings demonstrate that our intervention was successful at reducing sitting time and increasing standing time and step counts. Results demonstrate that it is feasible and effective to implement sitting time reduction interventions among older, predominately Spanish-speaking postmenopausal Latinas.
Abstract 15977: Comparison of Clinical and Procedural Outcomes Between High-power Short-duration, Standard-power Standard-duration, and Temperature-controlled Non-contact Force Guided Ablation for Atrial Fibrillation
Authors: Dikdan Sean J , Junarta Joey , Bodempudi Sairamya , Upadhyay Naman , Pang Zachary , Frisch Daniel R
Published: May 2021

Introduction:
High-power short-duration (HPSD) ablation via the St. Jude EnSite™ Velocity™ system (St. Paul, MN) utilizes 50W delivered for up to 15s, guided by a Lesion Size Index of 5-6 specific to the Velocity™ system. HPSD is a novel way to use a contact force-sensing catheter optimized for power-controlled radiofrequency ablation of atrial fibrillation (AF). Procedural and clinical outcomes of HPSD compared to standard-power standard-duration (SPSD; 20-25W until 400-500 gram seconds, up to 60s) and temperature-controlled non-contact (TCNC; 20-40W up to 60s of ablation) settings would inform this strategy.

Methods:
We studied consecutive cases of patients with paroxysmal or persistent AF undergoing pulmonary vein isolation (PVI) with TCNC, SPSD, and HPSD between 7/1/13 to 11/1/19. Procedural data collected include total radiofrequency time (RFT), time to isolate the left pulmonary veins (LPVT), time to isolate the right pulmonary veins (RPVT), and safety outcomes. Clinical data collected include sinus rhythm maintenance 3 and 12-months post-procedure.

Results:
A total of 171 patients were studied (44 TCNC, 51 SPSD, 76 HPSD). There was no difference in age, sex, or AF type between groups. RFT was shorter when comparing HPSD to SPSD (71 vs 101 min; p<0.01), HPSD to TCNC (71 vs 146 min; p<0.01), and SPSD to TCNC groups (101 vs 146 min; p<0.01). This was driven by decreases in LPVT between the HPSD vs SPSD (34 vs 46 min; p=0.04), HPSD vs TCNC (34 vs 72 min; p<0.01), and SPSD vs TCNC groups (46 vs 72 min; p<0.01), as well as decreases in RPVT between the HPSD vs SPSD (42 vs 54 min; p=0.03), HPSD vs TCNC (42 vs 75 min; p<0.01), and SPSD vs TCNC groups (54 vs 75 min; p<0.01). There was no difference in sinus rhythm maintenance after 3 or 12-months between groups overall, and when stratified by AF type, left atrial volume, CHA
2
DS
2
-VASc score, or left ventricular EF. There was a numerical difference in safety with no adverse events in HPSD (0/76 in HPSD vs 1/51 in SPSD vs 3/44 in TCNC; p=0.06).

Conclusion:
AF ablation with contact force utilizing an HPSD ablation strategy reduced procedure times with similar sinus rhythm maintenance compared to SPSD and TCNC approaches. Further research is needed to determine whether clinical outcomes differ with a larger population and longer follow-up.
Abstract 15987: Equitably Identifying Majority and Minority Populations at Risk for Abdominal Aortic Aneurysms
Authors: Bidare Deeksha S , Kougias Panagiotis , LeMaire Scott A , Mills Joseph L , Barshes Neal R
Published: May 2021

Introduction:
Abdominal aortic aneurysm (AAA) screening efforts have had two shortcomings: (1) a high number needed to treat; and (2) persons categorized as black are less frequently identified prior to presenting with a ruptured AAA (rAAA). The goal of this analysis was to identify community-level factors that could be used to identify specific majority and minority populations in Texas that could benefit from directed screening efforts.

Methods:
The study sample was comprised of all patients who underwent surgical or endovascular treatment for intact AAA (iAAA) and rAAA at all non-federal Texas hospitals from 2006-2014, aggregated by county and by metropolitan statistical area (MSA). These were then combined with demographics and other community-level characteristics in multivariate analyses.

Results:
In total, 22,455 patients who underwent treatment of iAAA or rAAA were included. 47% of the variance in the rate of AAA or AAA repair among Texas counties was explained by just two variables: proportion elderly (p<0.001) and proportion categorized as white (p<0.001). Within MSAs, the incidence of rAAA was directly and strongly correlated with iAAA incidence (R
2
=0.58, p<0.001). The rAAA:iAAA ratio demonstrated populations in several MSAs that had higher than expected rAAA rates, with the four most extreme high-outliers comprised of black populations (Figure). The incidence rates of AAA ultrasound relative to AAA repair were lower for persons categorized as black than for those categorized as white in 10 MSAs (58%) despite a higher proportion (81 vs 70%, p<0.0001) living within 50 miles of providers of Medicare-reimbursed AAA ultrasound screenings.

Conclusion:
Readily-accessible, publicly-available data can be used to identify geographic areas and populations that could benefit from more intensive screening efforts. Directing ultrasound screening efforts at persons categorized as black in specific geographic areas may help increase equity in AAA care.
Abstract 15991: African American Women Attending a Community Blood Pressure Screening Program
Authors: LUNDBERG Gina P , Spikes Telisa , Isiadinso Ijeoma , Mehta Puja K
Published: May 2021

Background:
The socioeconomic determinants of health (SEDoH) are contributors to the widening health disparities between White and AA women. Low income is a key contributor to poor cardiovascular (CV) health. Limited data exists on socioeconomic characteristics of African American (AA) women attending community blood pressure (BP) screenings.

Objective:
To examine whether income is related to BP in AA women attending community health screenings.

Methods:
AA women (n=972) attending community health screenings in metro Atlanta were evaluated from 2015 to 2019. Sociodemographics, health histories, point of care lipids, and BP were collected. Hypertension (HTN) was defined as systolic BP (SBP) >130 or diastolic BP (DBP) > 80 mmHg. Descriptive statistics, chi-square, and OLS linear regression were used to examine SEDoH and BP after adjusting for age, body mass index (BMI), smoking, and lipids.

Results:
Mean age was 51±14.1 years, mean SBP 132±19.6 mmHg and DBP 82±12 mmHg. In the unadjusted regression model, income of $48K-$96K (ß=4.1, se=2.0, p=<.04) was associated with a higher SBP compared to those earning $96K and above. After adjusting for covariates, income groups <$24K (ß=7.0, se=2.7, p=.01), $24K-$48K (ß=4.6, se=2.3, p=.05), & $48K-$96K (ß=5.5, se=2.1, p=.01) were associated with a higher SBP. Age (ß=.52, se=.05, p=<.001), BMI (ß=.53, se=.10, p=<.001), current smoking (ß=7.7, se=3.5, p=.03) and total cholesterol (ß=1.0, se=.04, p=.02) were the only covariates significantly associated with increased SBP. Income of $48K-$96K (ß=2.7, se=1.4, p=.05) and current smoking (ß=5.1, se=2.3, p=.03) were associated with a higher DBP in the fully adjusted models.

Conclusions:
Middle-aged AA women have higher prevalence of HTN, even those with higher incomes. Understanding CV risks and SEDoH, between high and low levels of income, is essential to improving culturally appropriate care. Community based BP screenings targeting both low and middle income AA women are needed to identify AA women with HTN and reduce CV events.
Abstract 16015: A Rare Cutaneous Adverse Drug Reaction With Apixaban
Authors: Syed Khezar , Chaudhary Haseeb , Waheed Tayyab Ali , Aziz Ansar
Published: May 2021

We report a case of apixaban-induced macular rash noticed 3 days after its initiation for atrial fibrillation. Patient denied any fever, arthralgias, myalgias or photosensitivity otherwise. On presentation, she complained of generalized pruritus with a bilateral non-blanchable macular rash on distal lower extremities and dorsum of feet. The labs showed normal cell counts, an elevated serum creatinine of 2.29mg/dl with a bland urine on microscopy. Apixaban was switched to LMWH. Serum creatinine returned to baseline with fluid therapy within 24 hours. Patient was re-challenged with apixaban that caused recurrence of generalized pruritus. It was treated successfully with diphenhydramine and prednisone. She was restarted on LMWH and rash disappeared after 3 days of stopping apixaban. She was later commenced on rivaroxaban without any complications. Several cutaneous adverse drug reactions (cADR) have been reported with direct acting oral anticoagulants (DOAC) like rivaroxaban and edoxaban but are extremely rare with apixaban. The overall reported incidence of dermatologic immune reactions with FXa inhibitors is <0.1%. Previously reported skin eruptions from apixaban include palmoplantar psoriasiform rash, leucocytoclastic vasculitis and acute generalized erythematous pustulosis. Our patient’s Naranjo scale was 7 and her rash improved after cessation of apixaban. The case illustrates a hypersensitivity reaction from apixaban that did not have cross-reactivity with other FXa inhibitors. Early recognition of cADR from this widely used DOAC can avoid potential complications. Minor reactions may be managed by switching to different DOAC therapy. Whether a cross-reactivity truly exists must be explored by validated skin testing.
Abstract 16017: Anatomically-Guided Deep Learning (DL) Approach to Late Gadolinium Enhanced (LGE)-CMR Left Ventricle (LV) Segmentation Enables Efficient and Accurate Clinical Analyses
Authors: Abramson Haley G , Popescu Dan M , Yu Rebecca , Lai Changxin , Shade Julie K , Wu Katherine C , Maggioni Mauro , Trayanova Natalia A
Published: May 2021

Rationale:
LV segmentation is crucial to analyzing heart pathologies. DL applications for LGE-CMR image segmentation offer automation and reliability over costly feature learning and manual input. However, existing DL algorithms suffer from poor quality and quantity of training data, lack of clinical relevance in evaluation methods, and low generalizability.

Objective:
We propose a neural network approach to LV segmentation with superior performance and ensured anatomical fidelity on various imaging protocols and patient populations, with direct clinical evaluation via LV volume calculation and ventricular arrhythmia (VA) risk assessment.

Methods:
We train a multistage network for LV segmentation on 4,000 LGE-CMR (PROSe-ICD study) and cine (MICCAI 2009 and 2017 datasets) short-axis images, where cine scans augment the data via a cine-to-LGE style transfer. At testing, images enter a network that crops and refines the region-of-interest (fig. 1A), which is fed into a network for differentiation of viable and hyper-enhanced myocardium (fig. 1B). An autoencoder network takes the union of these images, encodes them to a densely populated, reduced space, finds the nearest neighbor, and decodes them to anatomically correct segmented scans (fig. 1C). To assess VA risk, we fit a Cox regression model to survival data with image features (ex. LV volume) from manual or predicted segmentations.

Results:
Our segmented LGE-CMR scans (0.81 Dice score) surpass an inter-observer Dice score of 0.76, upholding anatomical guidelines across ambiguous regions such as apex and base (fig. 1D). Differences in calculated LV volumes (accuracy 98.4%, precision 78.9%) and C-indices of Cox regression models that stratify VA risk using automatic versus manual segmentations (0.62 vs. 0.60) show no statistical significance.

Conclusion:
We developed a DL LV segmentation algorithm tailored to clinical application, ensuring relevant predictions and outperforming inter-observed Dice scores.
Abstract 16021: Troponin Testing and One-year Hospital Readmission
Authors: Payne Sarah , Haneke Travis , Escobedo Yissela , Fan Jerry , Fry Ethan , Michel Jeffrey , Widmer Robert J
Published: May 2021

Introduction:
Troponin I (TnI) elevation is an important tool for detecting cardiac injury, though it is not disease specific and can be elevated in other conditions such as sepsis or heart failure. Predictive models suggest that TnI elevation correlates with increased mortality, however, it is unclear if TnI testing or elevation has value for predicting readmissions.

Hypothesis:
We hypothesized inpatient TnI testing would correlate with 30-day hospital readmissions.

Methods:
Patient data was collected from January
1st
, 2016 through December
31st
, 2016 and was comprised of 54,039 patients. Analysis was performed on TnI positive patients and correlated with 30-day hospital readmission rates among the entire cohort as well as those subdivided by ICD-10 codes into acute myocardial infarction (AMI), sepsis, pulmonary disease, and cardiac non-AMI. A subsequent propensity-matched logistic regression was performed among the entire cohort with TnI testing as well as resultant positive TnI to calculate odds ratios (OR) and 95% confidence intervals (CI).

Results:
Among the entire cohort, 4,572 patients (8.5%) were readmitted within 30 days. TnI testing was associated with increased readmission within 30 days (3,428/30,173; 11.4%; p<0.0001). Logistic regression analysis revealed an increased odds ratio for 30-day readmission of 2.24 (95% CI [2.08-2.41]; p<0.0001) among those with TnI draw. In those with a resultant positive troponin, however, the odds of 30-day readmission were 1.04 (95% CI [0.95-1.14]; p=0.4006). Although there was no significant increase in 30-day readmission among the AMI cohort who had troponin draw (n=1,722; OR 3.66, 95% CI [0.97-32.53], p=0.12), there were significant increases among those admitted for sepsis (n=4,834; OR 2.41, 95% CI [1.84-3.22], p<0.0001), pulmonary disease (n=2,120; OR 3.92, 95% CI [2.07-8.55], p<0.0001), and cardiac non-AMI (n=9,808; OR 2.34, 95% CI [2.15-2.56], p<0.0001).

Conclusions:
Hospital readmission within 30 days is associated with TnI testing and may be further predictive in non-AMI ICD-10 diagnoses such as sepsis, pulmonary disease, and non-AMI cardiac disease. However, a positive TnI may not be a useful objective data point for prediction of hospital readmission within 30 days.
Abstract 16023: Network Meta-analysis of Randomized Controlled Trials for Graft Patency of a Second Conduit for Coronary Artery Bypass Surgery
Authors: Yokoyama Yujiro , Takagi Hisato , Kuno Toshiki
Published: May 2021

Background:
It has been well documented that the use of the left internal thoracic artery (LITA) to graft the left anterior descending (LAD) artery has a significant benefit in coronary artery bypass graft (CABG) surgery. However, what graft is the best as a second conduit to complement LITA-LAD anastomosis remains uncertain. We thus conducted a network meta-analysis of RCTs to compare graft patency of the radial artery (RA), the right internal thoracic artery (RITA), the right gastroepiploic artery (RGEA), and saphenous vein (SVG) as a second conduit in CABG.

Methods:
MEDLINE and EMBASE were searched through February 8th, 2020 to identify randomized controlled trials (RCTs) that investigated graft patency of a second conduit in CABG. From each study, we extracted the incidence rate ratios (IRR) of the outcome.

Results:
A total of 11 RCTs were identified, including 3,434 patients and 2,171 angiographic results. There was no significant difference of IRR in graft failure among the 4 groups (vs. SVG: RA, IRR [95%CI] =0.66 [0.41-1.07]; RGEA, IRR [95% CI] =2.12 [0.54-8.38]; RITA, IRR [95% CI] =0.71 [0.32-1.60]). (Figure) Sensitivity analyses restricting trials with ≥3 years angiographic follow-up time or ≥5 years angiographic follow-up time showed no significant differences of IRR in graft failure among the four groups in both analyses.

Conclusion:
In a network meta-analysis of the updated outcomes from RCTs, no significant differences were observed in graft patency with the use of RA, RITA, RGEA or SVG as a second conduit in CABG.
Abstract 16030: Myocardial Abnormalities in Competitive Athletes on T1 and T2 Parametric Mapping by Cardiovascular Magnetic Resonance Imaging
Authors: Lee Marc , Lafountain Richard , Varghese Juliet , Hummel Christopher , Borchers James , Raman Subha V , Simonetti Orlando P , Daniels Curt , Rajpal Saurabh
Published: May 2021

Introduction:
Athletic cardiac adaptation is associated with structural changes that can overlap with disease states, unnecessarily limiting sports participation. Cardiovascular magnetic resonance (CMR) is useful in athlete’s heart and provides myocardial tissue characterization by T1 and T2 mapping.

Hypothesis:
CMR in competitive athletes will show abnormal T1 and T2 mapping due to intense exercise induced myocardial edema that can overlap with myocarditis.

Methods:
CMR data including left ventricular ejection fraction (LVEF) and T1/T2 maps were collected using standardized protocols on a 1.5 T scanner and compared between competitive athletes (N = 18, 83% male, median age 20 years), clinical myocarditis (N = 42, 71% male, median age 23 years) and controls (N = 35, 86% male, median age 22 years) between 2016-2020. T2 values of <59 ms and native T1 <1080 ms were defined as normal per institutional data. Extracellular volume fraction (ECV) and late gadolinium enhancement (LGE) were compared between athlete and myocarditis groups.

Results:
Figure 1 (panel A) shows participating sport and indications for CMR in athletes. There were 11 athletes (61%) with elevated T2 values (>59 ms), of which 9 (82%) were without clinical myocarditis. Average T2, native T1, ECV, and LVEF are shown in panels B-E. T2 values were highest in myocarditis, followed by athletes and controls (p = 0.001). ECV was higher in myocarditis compared to athletes (p = 0.002). LGE was present in 8/18 athletes and 41/42 myocarditis patients. 6 athletes had follow-up CMR after a period of deconditioning, with 3 (50%) demonstrating an improvement in T2 values and LGE.

Conclusions:
To conclude, we demonstrate abnormalities on T2 mapping in athletes consistent with myocardial edema or inflammation. Changes in T2 may be related to intense training. Additional studies are required to prospectively evaluate athletes for normative T1 and T2 mapping values, relationship to training, and their correlation with LGE.
Abstract 16043: Effectiveness and Safety of Switching From Warfarin to Apixaban in Advanced Chronic Kidney Disease Patients With Prevalent Atrial Fibrillation in the United States Between 2012 and 2016
Authors: Garlo Katherine , Mavrakanas Thomas , Burdick Elisabeth , Wang Wei , Charytan David
Published: May 2021

Introduction:
Apixaban is the preferred direct acting oral anticoagulant in patients with CKD and has advantages compared with warfarin. Data on effectiveness and safety outcomes after switching from warfarin to apixaban in patients with prevalent AF and CKD are limited.

Methods:
Individuals with advanced CKD not on dialysis and prevalent AF who receive ≥6 months of continuous warfarin prior to Jan 1, 2012 were identified from the United States Data Renal System (USRDS) database. Individuals were followed from Jan 1, 2012 - Dec 31, 2015 to identify switches from warfarin to apixaban. The primary efficacy outcome was combined all-cause stroke, transient ischemic attack, or systemic thromboembolism. The primary safety outcome was major bleeding. Outcomes were compared between patients switching from apixaban and those continuing warfarin. Individuals were censored at the time of the first event or anticoagulation discontinuation, discontinuous Medicare part D coverage, dialysis, kidney transplant, a 2
nd
switch in anti-coagulant, or death.

Results:
1762 individuals with advanced CKD not receiving dialysis with non valvular AF or flutter were on warfarin during the 6 months prior to Jan 1, 2012. Of these, 71 (4.0%; 57.8% male, mean age 78.2 years (SD ±6.6), 78.9% white) switched from warfarin to apixaban and 1691 (41.3%; 47.6% male, mean age 80.1 years (SD ±8.7), 87.9% white) continued warfarin from Jan 1, 2012 - Dec 31, 2015. Incidence of all cause stroke or systemic thromboembolism in the apixaban switch and warfarin continuation groups were 1 (1.4%) and 303 (17.8%) respectively. Incidence of major bleeding events in the two groups were 1 (1.4%) and 201 (11.9%).

Conclusions:
Among advanced CKD patients with AF in the US who switched from warfarin to apixaban the proportion of all cause stroke or systemic thromboembolism and major bleeding events were low. Data is limited by duration of apixaban market authorization and short follow up.