bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11778: Comparison of Prenatal Diagnosis Rates and Cardiac Morphometry in Fetal Coarctation by Ultimate Surgical Repair Type
Authors: Gaitonde Mansi , XIANG YIJIN , Figueroa Janet , Shashidharan Subhadra , Michelfelder Erik
Published: March 2022

Background:
Fetal diagnosis of coarctation of aorta is challenging, with limited data examining prenatal detection rates in patients requiring simple vs. extensive arch reconstruction. This study aims to evaluate prenatal detection rate
s
and fetal cardiac morphometric differences in neonates requiring simple vs. complex coarctation repair.

Methods:
Pre- and postnatal records of neonates with isolated coarctation repair from the Society of Thoracic Surgeons database from Jan 2010 - Dec 2020 at our center were reviewed. Patients were classified as requiring discrete (Group 1) or extended arch repair (Group 2). Fetal echocardiograms were measured by a single observer blinded to repair type.

Results:
Of 228 neonates requiring repair, 67 (29%) had a prenatal diagnosis. The proportion with prenatal diagnosis was not different in group 1 (28%) vs. group 2 (32%) (χ2 = 0.45, p = 0.5). At the first fetal echo (median gestational age (GA) of 21.9 wks in group 1 vs 23.6 wks in group 2, p = 0.2), there were no differences between groups when comparing right ventricular (RV) and left ventricular (LV) dimensions, valvular dimensions, or aortic arch dimensions. At the final fetal echo (median GA of 33.7 wks in both groups, p = 0.6), there were statistical differences between group 1 and 2 in RV geometry with ratio of RV minor to major axis (0.72 vs 0.83, p = 0.03) and ratio of LV to RV minor axis (0.68 vs 0.59, p = 0.02), ascending aorta Z score (-2.6 vs -3.4, p = 0.03), distal arch Z score (-3.9 vs -4.6, p = 0.048), and ratio of isthmus to distal arch dimension (0.88 vs 1.02, p = 0.045) (Figure).

Conclusion:
The rate of prenatal diagnosis in fetuses requiring neonatal coarctation repair remains low, regardless of ultimate surgical repair type. Fetuses ultimately requiring extensive arch repair have smaller aortic sizes, and greater RV/LV size disproportion in the third trimester. This data may be useful in counseling families with regard to postnatal surgical management in fetuses with suspected coarctation.
Abstract 11786: Heart Transplant in Congenital Heart Disease: Trends in Mortality With Ventricular Assist Devices
Authors: Kamsheh Alicia M , Burstein Danielle , Zhang Xuemei , Ampah Steve , Edelson Jonathan , Lin Kimberly , O'Connor Matthew J , Ravishankar Chitra , Wittlieb-Weber Carol , Maeda Katsuhide , Nuri Muhammad , Gaynor James W , Chen Jonathan , Fuller Stephanie M , Rossano Joseph
Published: March 2022

Introduction:
Patients with congenital heart disease (CHD) may require cardiac transplantation for either primary management or failed surgical palliation. This study describes 1-year mortality of patients with CHD listed for transplant, trends in 1-year mortality over three decades, and use of mechanical support in this population.

Methods:
The United Network for Organ Sharing database was queried to identify patients aged 0-30 years with CHD listed for transplant from 1990 to 2019. VAD status at listing and 1-year mortality after listing were examined using the Cochran-Armitage trend test.

Results:
Overall, 9327 patients with CHD aged 0-30 years were listed for transplant between 1990 and 2019 with a total 1-year mortality rate of 26% (n=2466). For non-survivors to 1-year after listing, 66% (n=1619) died before transplant and 34% (n=847) after transplant. Patients <1 year of age were the most frequent age group listed for transplant (n=3678, 39%) and experienced the highest 1-year mortality after listing (n=1264, 34%). The 1-year overall mortality decreased over the study period (1990-1999: 33% vs 2000-2009: 30% vs 2010-2019: 19%, p<0.0001), including in infants <1 year of age (1990-1999: 41% vs 2000-2009: 37% vs 2010-2019: 26%, p<0.0001). Overall, few patients were supported with VAD at listing (3.1%). However, VAD use increased (1990-1999: 1.0% vs 2000-2009: 2.8% vs 2010-2019: 5.0%, p< 0.0001) and the 1-year mortality for patients with VAD at listing decreased over time (1990-1999: 57% vs 2000-2009: 35% vs 2010-2019: 20%, p<0.0001).

Conclusions:
Survival after listing for heart transplant is improving, however mortality amongst infants remains high. While there has been >50% improvement in survival in patients of all ages with CHD supported with a VAD at listing, VADs are used rarely in patients with CHD. Further study is needed to understand which patients may benefit from mechanical circulatory support, especially among infants.
Abstract 11788: Tolvaptan Add-On Therapy on Efficacy Parameters and Outcomes in Patients Hospitalized With Acute Heart Failure
Authors: Kansara Tikal , Gandhi Haresh , Kumar Ashish , Majmundar Monil , Thakkar Samarthkumar J , Patel Harsh P , Mushiyev Savi , Kokkirala Aravind , Basman Craig
Published: March 2022

Introduction:
Even with the adequate use of diuretics and vasodilators, volume overload and congestion are the major causes of morbidity and mortality in patients hospitalized with acute heart failure (HF).

Hypothesis:
We aim to evaluate the additive effect of tolvaptan on efficacy parameters as well as outcomes in hospitalized patients with HF.

Methods:
We searched PubMed, EMBASE, Cochrane library, and Web of Science databases for randomized controlled trials that studied the effects of tolvaptan versus placebo in hospitalized patients with HF. Studies were included if they had any of the following endpoints: mortality, re-hospitalization, and in-hospital parameters like dyspnea relief, change in weight, sodium, and creatinine.

Results:
The meta-analysis analyzed data from 14 studies involving 5945 patients. The follow up duration ranged from 30 days to 2 years. Between tolvaptan and placebo groups, there was no difference in mortality [relative risk (RR) 0.73 (0.46, 1.18) p =0.2] and rehospitalization [RR 0.79 (0.51, 1.22) p = 0.28]. HF patients had a better dyspnea relief score (Likert score) in tolvaptan group [RR 1.19 (1.06, 1.33) p = 0.003] and mean reduction in weight in the first 48 hours (short-term) [mean difference (MD) -2.19 (-.35, -0.86) p = 0.001]. However, at 7 days (medium-term) the mean difference in weight was not significant [MD -0.67 (-1.45, 0.11) p = 0.09]. Serum sodium increased significantly in tolvaptan group [MD 3.75 (2.92, 4.58) p < 0.00001]. There was no difference in creatinine [MD 0.00 (-0.08, 0.08) p = 0.98] among the two groups. (Figure 1)

Conclusions:
Our meta-analysis shows that during hospitalization of HF patients, tolvaptan can be useful in short-term symptomatic dyspnea relief and initial reduction in weight due to its additive diuretic effect. However, this benefit is short-lived and there is no advantage in reducing rehospitalization rates and mortality. Further, tolvaptan is not effective for sustained and long term weight loss.
Abstract 11789: Genetic Determinants of Interventricular Septal Anatomy and Risk of Congenital Heart Disease
Authors: Yu Mengyao , Harper Andrew , Aguirre Matthew , Pittman Maureen , Tcheandjieu Catherine , Amgalan Dulguun , Grace Christopher , Goel Anuj , Farrall Martin , Xiao Ke , Engreitz Jesse , Pollard Katherine , Watkins Hugh C , Priest James R
Published: March 2022

Background:
A large proportion of genetic risk remains unexplained for structural heart disease involving the interventricular septum (IVS) including hypertrophic cardiomyopathy (HCM) and ventricular septal defects (VSD).

Methods:
We performed machine learning to estimate the cross-sectional area of the interventricular septum (IVS.csad) from the 4-chamber view of cardiac MRI in 32,219 individuals from the UK Biobank. We related IVS.csad to relevant clinical phenotypes, and performed genome-wide association studies and Mendelian Randomization.

Results:
Automated measures of IVS.csad were highly accurate, and strongly correlated with anthropometric measures, blood pressure, and diagnostic codes related to cardiovascular physiology. A single nucleotide polymorphism in an intron of
CDKN1A
was associated with IVS.csad (rs2376620, Beta 8.4 mm2, 95% confidence intervals (CI) 5.8 to 11.0, p=2.0e-10), and a common inversion incorporating
KANSL1
predicted to disrupt local chromatin structure was associated with an increase in IVS.csad (Beta 8.6 mm2, 95% CI 6.3-10.9, p=1.3e-13). Mendelian Randomization suggested that inheritance of larger IVS.csad was causal for HCM (Beta 2.45 log odds ratio (OR) HCM per increase in SD of IVS.csad, standard error (SE) 0.48, pIVW = 2.8e-7) while inheritance of smaller IVS.csad was causal for VSD (Beta -2.06 log odds ratio (OR) VSD per decrease in SD of IVS.csad, SE 0.75, pIVW = 0.006)

Conclusion:
Automated derivation of the cross sectional area of the IVS allowed discovery of loci related to cardiac development and Mendelian disease. Inheritance of genetic liability for either large or small interventricular septum, appears to confer risk for HCM or VSD respectively, suggesting that a proportion of risk for structural and congenital heart disease may localize to the common genetic determinants of cardiovascular anatomy.
Abstract 11791: Hospitalized Congestive Heart Failure Patients Without SARS-CoV-2 Had Higher Mortality During the COVID-19 Pandemic vs Non-Pandemic Year
Authors: Singh Harjeet P , Wadhwa Manvir , Heinekel Hyunju S , Napatkamon Ayutyanont , Biswas Mimi S , Kubomoto Scott
Published: March 2022

Introduction:
As COVID 19 swept across the nation, the pandemic imposed many challenges to the United States healthcare system. With limitations in access to care, common conditions including an exacerbation of congestive heart failure (CHF) accounted for a significant proportion of hospitalizations. What remains unclear is the impact that the pandemic had on outcomes including mortality of patients who tested negative for SARS-CoV-2 compared to the year prior.

Hypothesis:
During the COVID-19 pandemic, COVID 19 negative CHF exacerbations patients had increased mortality than patients from the prior non-pandemic period.

Methods:
This was a retrospective multi-center study including 37,340 patients admitted in 154 hospitals in the HCA network. The study primarily evaluated the mortality difference between patients hospitalized with congestive heart failure that tested negative for SARS-CoV-2 polymerase chain reaction (PCR) during the pandemic during the months of March through May 2020 (N=15282) and compared to patients hospitalized with congestive heart failure during the same months in 2019, pre-pandemic (N=22058).

Results:
There was an observed increase in mortality in patients admitted in 2020 when compared to 2019 (2.34% vs 1.98% respectively, p = 0.020). Multivariable logistic regression analysis showed mortality was 24% higher in CHF patients admitted in the studied months March through May 2020 when compared to CHF patients admitted in the same period in 2019 (OR = 1.24, CI [1.07-1.43], p = 0.003), when correcting for age, demographics, comorbidities, and prior beta blocker or diuretic use. Although there was no statistically significant difference in BNP between the two groups as a measure of disease severity, patients that presented to the ED in the studied months in 2020 had higher admission rates (OR = 0.90 CI [0.86-0.95] p<0.001).

Conclusions:
The study revealed that there was an increased mortality rate in hospitalized CHF exacerbation patients who tested negative for SARS-CoV-2 during the pandemic when compared to those the year prior. This illustrates some of the unforeseen consequences of the pandemic on patient healthcare. Further studies are needed to determine the effects of the pandemic in COVID-19 negative patients.
Abstract 11792: Low Penetrance Sarcomere Variants Indicate an Additive Genetic Risk Model in Hypertrophic Cardiomyopathy
Authors: Smith Eric , Elder Brynn , Chen Gabriela , Tsan Yao-chang , Stendahl John , Ingles Jodie , Parikh Victoria N , Wittekind Samuel , Colan Steven , Lakdawala Neal K , Owens Anjali T , Jacoby Daniel L , Day Sharlene , Semsarian Christopher , olivotto iacopo , Ho Carolyn , Russell Mark W , Saberi Sara , Ware James S , Helms Adam S
Published: March 2022

Introduction:
Genetic hypertrophic cardiomyopathy (HCM) is an autosomal dominant inherited condition primarily due to pathogenic variants in sarcomere genes, often with marked clinical variability. We hypothesized that this variability may, in part, be due to additive effects from low penetrance sarcomere variants that would otherwise be dismissed due to high population prevalence.

Methods:
Low-penetrance HCM-associated sarcomere gene variants were identified by meeting a threshold for enrichment in HCM (ascertained from the Sarcomeric Human Cardiomyopathy Registry, SHaRe) versus the general population (ascertained from the Genome Aggregation Database, gnomAD), defined by an odds ratio (OR) >5, and a population prevalence greater than the most common autosomal dominant pathogenic HCM variant,
MYBPC3
R502W (4x10
-5
). Clinical variables and time-event analyses were performed from SHaRe .

Results:
A total of 507 unique sarcomere gene variants were present in 6384 individuals with genetic testing. Ten putative low-penetrance variants were identified in the genes
MYBPC3
(N=2),
TNNT2
(N=1),
TNNI3
(N=2), and
MYH7
(N=5) with a combined OR of 12.7 (range 5.8 - 28.4). These variants had a population prevalence of 4.02x10
-5
to 3.5x10
-4
. Family members of low-penetrance variant carriers were less likely to have HCM (35/171, 20%) than those of
MYBPC3
R502W carriers (44/113, 39%, p<0.005). Age of diagnosis was older in patients with isolated low-penetrance variants than those with pathogenic variants (42 ± 19 vs 37 ± 18, p=0.005). Composite adverse events were less likely in patients with isolated low-penetrance variants than typical pathogenic sarcomere variants, but the risk was additive with both present (see Figure).

Conclusions:
A subset of low-penetrance sarcomere gene variants are tolerated in the general population at higher than expected proportions for HCM and may exert an additive pathogenic effect. These findings support an oligogenic risk model of HCM.
Abstract 11803: Area Deprivation and COVID-19 Outcomes in Patients With and Without Cardiovascular Disease: The Curator Registry of Houston Methodist
Authors: Hagan Kobina , Javed Zulqarnain , Cainzos-Achirica Miguel , Valero Elizondo Javier , Nicolas Charlie , Yahya Tamer , Acquah Isaac , Blankstein Ron , Hyder Adnan , Mossialos Elias , Vahidy Farhaan S , Nasir Khurram
Published: March 2022

Introduction:
Individuals with CVD are at higher risk of COVID-19 complications. However, the impact of social disadvantage on COVID-19 outcomes has not been fully evaluated in people with CVD. We assessed Area Deprivation Index (ADI) associations with COVID-19 positivity, severity, and in-hospital mortality among patients with and without CVD.

Methods:
We used the Houston Methodist COVID-19 Surveillance and Outcomes Registry (CURATOR) of 152,850 consecutive adults tested for COVID-19 between March 6 and October 31, 2020. CVD status was obtained from electronic health records. We matched ZIP codes of patients’ residences to state-level ADI using the Neighborhood Atlas and Census Block information from the American Community Survey 2018. ADI was categorized into quintiles of increasingly higher social disadvantage. For reference, we also analyzed the data of patients without CVD.

Results:
The median ADI ranking of the total sample (mean age 51.3 years; 60% women) was 4 (IQR 1-6). Overall, 37,468 (24.5%) patients had CVD and their median ADI was higher than those without CVD. Of the total sample, 11.9% tested positive for COVID-19 (no CVD: 12.7%; CVD: 9.4%). COVID-19 patients with CVD (v. no CVD) were more likely to be hospitalized (68.4% v. 27.1%), receive intensive care (34.9% v. 16.4%), and die (16.2% v. 4.0%) during admission. Adjusting for demographics and comorbidities, the odds of COVID-19 positivity and hospitalization were at least 50% higher in the most (compared to the least) deprived groups, irrespective of CVD status (Figure). In contrast, associations were null between ADI, need for intensive care, and in-hospital mortality.

Conclusions:
Individuals from the most deprived neighborhoods were more likely to test positive and be hospitalized for COVID-19, irrespective of CVD status. However, once hospitalized, individuals from disadvantaged areas were not at increased risk of requiring intensive care or dying during admission.
Abstract 11812: Hypertrophic Cardiomyopathy, in a Latin American Center
Authors: Medina Ramon , Vasquez Juan Felipe , Campo Esther , Rodriquez Maria Juliana , Jaimes Claudia
Published: March 2022

Introduction:
Hypertrophic cardiomyopathy (HCM) is the most common monogenic cardiovascular disorder, however, data from Latin-American countries are scarce.

Methods:
We conducted a retrospective study to characterize the population with HCM in a cardiovascular care center in Bogotá, Colombia. All cardiac magnetic resonance (CMR) performed between 2017 to 2019 were reviewed. Patients with diagnosis of HCM by imaging findings were included in the analysis. Demographic data, and clinical, and imaging characteristics, were described.

Results:
A total of 2636 CMR were performed between 2017-2019. The diagnostic criteria for HCM were met in 116 (4,4%) patients. The mean age of diagnosis was 63 YO, 54,3% were male. A family history of sudden cardiac death (SCD) was reported in 12%. The most frequent symptoms were dyspnea and chest pain. 26% had atrial fibrillation (table 1). The main phenotype was septal (70%) (figure 1). Most of the patients with HCM (88%) had some alteration of the mitral valve apparatus. Survival at 5 years was 87%. ICD implantation was required in 12,9% of the patients and a septal myomectomy was performed in 6,8%.

Conclusions:
HCM was more frequent in our cohort than that reported in the current literature, however, the clinical characteristics and prognosis were similar. In our population, HCM patients were diagnosed later than other cohorts.
Abstract 11828: Productivity Targets and Performance Reviews for Cardiology Practices in the Veterans Health Administration: Do They Work?
Authors: Kalwani Neil M , Heidenreich Paul A
Published: March 2022

Introduction:
The optimal mode of promoting physician productivity in integrated healthcare systems is unknown. In 2013, the Veterans Health Administration (VHA) introduced a program setting productivity targets for specialty practices based on the ratio of total work Relative Value Units (wRVUs) to clinical full-time equivalents (FTEs). Practices with productivity less than 1.25 SDs below the mean for their complexity group were required to undergo annual performance reviews and develop remediation plans.

Hypothesis:
We hypothesized that performance reviews were associated with increased cardiology practice productivity and clinical volume.

Methods:
We extracted productivity metrics for 125 cardiology practices from fiscal year 2012-2019 reports. We used linear regression to assess the association of reviews with changes in productivity, clinical volume, and access measures, controlling for practice-level trends.

Results:
Performance reviews were associated with a 38% (95% CI 29 to 47%) relative increase in cardiology practice productivity in the year following review. In the year before review, these practices experienced a relative productivity decrease of 24% (95% CI -35 to -14%), suggesting the observed effect was not due to regression to the mean alone. Reviews were associated with a relative annual increase in practice wRVUs of 29% (95% CI 15 to 44%), a decrease in reported clinical FTEs of 12% (95% CI -24 to -1%), an increase in clinical encounters of 32% (95% CI 16 to 49%), and an increase in the total number of patients receiving care of 23% (95% CI 9 to 36%). There was no significant association between reviews and the annual change in the percentage of new or established patients waiting more than 30 days for an appointment.

Conclusions:
A program of productivity targets and reviews of low-performing practices was associated with increased cardiologist productivity and total wRVUs, clinical encounters, and number of patients receiving care at reviewed practices. Programs setting productivity targets for groups of specialist physicians may be an effective way to increase care efficiency in integrated healthcare systems. Future research should investigate the impact of these programs on care utilization, appropriateness, and quality.
Abstract 11833: Prognostic Value of Diffusion-Weighted Cardiac Magnetic Resonance Imaging in Hospitalized Heart Failure Patients
Authors: Kagami Kazuki , Toya Takumi , Kuwaki Shunpei , Sato Atsushi , Yumita Yusuke , Osaki Ayumu , Iwashita Midori , Yasuda Risako , Ikegami Yukinori , Namba Takayuki , Masaki Nobuyuki , Nagatomo Yuji , Steiner John , Adachi Takeshi K
Published: March 2022

Introduction:
Diffusion-weighted imaging (DWI) has been recognized as the golden standard to detect acute phase cerebral infarction; however, there is a paucity of data regarding its utility in cardiac magnetic resonance (CMR).

Hypothesis:
We hypothesized that contrast-free DWI could detect underlying myocardial pathophysiology in patients with heart failure (HF).

Methods:
We included 90 hospitalized HF patients (mean age 62±13 years, 67% males, HFpEF/HFmrEF/HFrEF [N] 21/7/62) who underwent CMR with DWI and late gadolinium enhancement (LGE). We acquired 2 diffusion-weighted images (b=0 and 800 s/mm
2
) to constitute apparent diffusion coefficient (ADC) map (Figure 1). ADC values were automatically calculated for five segments (basal septal, mid septal, apical, mid lateral, basal lateral) on 4-chamber planes. The association between minimum ADC values and major adverse cardiac events (MACE: all-cause mortality, HF hospitalization, or sustained ventricular arrhythmia/ICD shock) was investigated.

Results:
During a median follow-up of 18.1 months (IQR 9.3-32.1), 26 adverse events (8 all-cause deaths, 13 HF hospitalizations, and 5 ventricular arrhythmias) were detected in 20 patients. Event-rates were significantly higher in patients with minimum ADC value lower than median (=3490 mm
2
/s) than those with minimum ADC value higher than median (log-rank p=0.003) (Figure B). Lower minimum ADC value was associated with an increased risk of MACE (unadjusted HR 4.45, 95% confidence interval: [1.49-13.32]) and it remained significant even after adjustment for LGE. Minimum ADC values improved discrimination of risk for MACE after adding it to LGE (Figure C).

Conclusions:
Patients with lower minimum ADC values had an increased risk of MACE. DWI may potentially provide with incremental prognostic values over LGE in HF patients.
Abstract 11835: Increased Incidence of Heart Failure in Patients with Depression Among 479,000 Patients Followed at a Tertiary Care Center
Authors: Pfaff Jamie L , Huang Shi , Annis Jeffrey , Brittain Evan
Published: March 2022

Introduction:
Depressive disorders are associated with development and progression of heart failure (HF). Though these patients have demonstrated worse outcomes, the subpopulations at greatest risk remain under-recognized. We sought to identify patients at risk for HF and depression.

Hypothesis:
Depression is associated with increased risk of incident HF among outpatients followed at a tertiary care center.

Methods:
We used the Vanderbilt de-identified electronic medical record (EMR) to identify patients free of HF who met a medical home definition (at least 3 outpatient visits over 5 years). We defined incident HF and depression as occurrence of one inpatient or two outpatient ICD codes. We report HF incidence rate by sex, self-identified race, and depression status. Risk of incident HF was assessed by a Cox proportional hazard model adjusted for fourteen relevant covariates (see Table footnote).

Results:
Among 2.8 million patients in the EMR, 479,490 met inclusion criteria (50±17 years, 60% women) and were followed for incident HF over median 10.3 years (IQR 7.5, 14.3). Rates of HF were significantly higher in men vs. women (0.56/100PY vs. 0.36/100PY; p<0.001), self-identified black race vs. white (0.54/100PY vs. 0.47/100PY; p<0.001), and among those with co-morbid depression (0.61/100PY vs. 0.41/100PY; p<0.001). When adjusted for confounders, male sex, self-identified black race, and depression were independent risk factors for incident HF (see Table 1; all p<0.001). The highest risk for incident HF was among self-identified black males with depression (HR 1.81, 95%CI 1.70-1.93; p<0.001).

Conclusions:
Among outpatients followed at a tertiary care center, male sex, self-identified black race, and co-morbid depression are associated with increased risk of HF. Self-identified black males appear particularly vulnerable to develop HF. Further study is warranted to determine whether treatment of depression modifies risk of incident HF.
Abstract 11838: Isosorbide Dinitrate Effect May Improve Exercise Tolerance, Venous Pressure and Liver Stiffness in Patients With Fontan Circulation (The NEET Clinical Trial)
Authors: Bigelow Amee M , Riggs Kyle W , Morales David L , Lubert Adam M , Heydarian Haleh C , Dillman Jonathan R , Trout Andrew T , Opotowsky Alexander R , Cooper David S , Wang Yu L , Chin Clifford , Palermo Joseph J , Veldtman Gruschen R , Ollberding Nicholas J , Mays Wayne A , Alsaied Tarek
Published: March 2022

Introduction:
After the Fontan operation, decreased venous capacitance (venoconstriction) and elevated central venous pressure may result in worse clinical outcomes, worse exercise capacity, and increased liver stiffness. This pilot study evaluated the acute effect of isosorbide dinitrate (ISDN), a venodilator, on exercise capacity, peripheral venous pressure (PVP), and liver stiffness in patients with Fontan circulation.

Methods:
In this prospective single-arm trial, 15 individuals with Fontan circulation were evaluated at baseline and after four weeks of treatment with ISDN. Cardiopulmonary exercise testing was performed to assess exercise tolerance, with a primary outcome of peak oxygen consumption (peak VO
2
). The secondary outcome included VO
2
at the anaerobic threshold (AT VO
2
), PVP at rest and peak exercise and liver stiffness measured by ultrasound prior to the exercise test. Repeated measure t-test was used to test for differences in outcomes in response to ISDN.

Results:
The mean age was 23.5 ± 9.2 years (range 11.2-30.6 years), and 10/15 (67%) were male. There was no statistically significant change in peak VO
2
from baseline (1401±428 to 1428±436 ml/min, p=0.128), but there was an improvement in AT VO
2
(1087 ± 313 to 1115 ±302 mL/min, p= 0.03). Treatment with ISDN was associated with lower peak exercise PVP (22.5 ±4.5 to 20.6 ± 2.99 mmHg, p=0.015) without a notable difference in the resting PVP (p=0.357). There was a trend towards lower liver stiffness with ISDN (2.3 ± 0.4 to 2.1 ± 0.5 m/s, p=0.079). Of the patients completing the trial, mild headache was common (67%), but there were no major adverse events.

Conclusions:
Treatment with ISDN for 4 weeks is well-tolerated except for headache and appears safe in patients with a Fontan circulation. ISDN therapy was associated with improvements in certain exercise and hemodynamic parameters as well as a trend towards lowering liver stiffness. Larger studies will be necessary to validate these physiologic findings and further evaluate the effects of nitrates on meaningful clinical outcomes.
Abstract 11840: Serum Apolipoprotein E Levels Predict Residual Cardiovascular Risk in Patients With Chronic Coronary Syndrome Undergoing First Percutaneous Coronary Intervention and On-Statin Treatment
Authors: Fukase Tatsuya ,   Juntendo Univ Graduate Sch of Medicine, Dohi Tomotaka , nishio ryota , Takeuchi Mitsuhiro , Takahashi Norihito , Chikata Yuichi , Endo Hirohisa , Doi Shinichiro , Nishiyama Hiroki , Okai Iwao , Iwata Hiroshi , Okazaki Shinya , Isoda Kikuo , MIYAUCHI Katsumi , Daida Hiroyuki , Minamino Tohru
Published: March 2022

Background:
Little is known about the long-term impact of apolipoprotein E (apoE) on residual cardiovascular risk in the patients with chronic coronary syndrome (CCS) receiving statin treatment.

Methods:
A total of 1109 consecutive patients (mean age, 67±10 years; 83% men) with CCS who underwent their first intervention between 2000 and 2016 were included in this study. All patients had achieved LDL-C <100 mg/dL on statin treatment, as target value recommended by the guidelines at that time, and were divided into two groups based on median serum apoE value. We evaluated the incidence of major adverse cardiovascular events (MACEs), including cardiovascular death, non-fatal acute coronary syndrome, and target vessel revascularization.

Results:
A total of 552 and 557 patients were categorized to the higher, and lower apoE groups, respectively. There were significant relationships between apoE levels and total cholesterol levels, triglyceride levels, high-density lipoprotein cholesterol levels and estimated remnant cholesterol except for LDL-C levels. During the median follow-up period of 5.1 years, 195 patients (17.6%) developed MACEs. Kaplan-Meier analysis revealed that the cumulative incidence of MACEs in the higher apoE group was significantly higher than in the lower apoE group (29.5% vs.23.8% log-rank test, p =0.019). On multivariable Cox hazard analysis, serum apoE level (1-mg/dL increase) (hazard ratio 1.15; 95% confidence interval 1.03-1.29,
p
=0.013) was a most strongly independent predictor of MACEs. Furthermore, after adjustment for various confounders including TG, HDL-C, LDL-C, and traditional cardiovascular risk factors, the higher apoE group was significantly associated with an increased risk of MACEs compared with the lower apoE group (p =0.008).

Conclusions:
Serum ApoE level could be a strong predictor and residual cardiovascular risk in patients with CCS on long-term, even if controlled LDL-C levels with statin treatment.
Abstract 11848: Biomarkers of Glucose-Insulin Homeostasis, Randomized Treatment With Omega-3 and Vitamin D Supplementation, and Incident Type 2 Diabetes: Prospective Analysis From the Vitamin D and Omega-3 Trial (VITAL)
Authors: Qian Frank , Guo Yanjun , Gibson Heike , Gomelskaya Natalya , Liu Yanyan , Demler Olga , Cook Nancy R , Lee I-min M , Buring Julie E , Larsen Julia A , Boring Jennifer , Mcphaul Michael J , Manson Joann E , Pradhan Aruna D , Mora Samia
Published: March 2022

Introduction:
Insulin resistance is central to the development of type 2 diabetes (T2D). Association between specific biomarkers of glucose-insulin homeostasis and T2D have been inconsistent. Whether vitamin D or omega-3 fatty acids (n-3 FA) can modify these associations is also unclear.

Hypothesis:
We hypothesized that higher insulin, C-peptide, insulin resistance score (IRS), and HbA1c are each associated with higher T2D risk, and that these associations would be attenuated among participants who received vitamin D or n-3 FA.

Methods:
VITAL Diabetes (NCT01633177) was a pre-specified ancillary 2x2 factorial study in the VITAL RCT to assess whether vitamin D (cholecalciferol, 2000 IU/d) or n-3 FA (EPA + DHA, 1 g/d) could prevent T2D. Subjects without baseline reported T2D and with HbA1c <6.5% were included. Incident cases were matched 1:1 on age and sex to healthy controls (N=359 pairs). Conditional logistic regression models with adjustment for demographics, risk factors including BMI, and randomized treatment were used to estimate the adjusted odds ratio (aOR) and 95% CI between baseline measurements of insulin, C-peptide, IRS (Insulinх0.0265+C-peptideх0.00511+Creatinineх-3.2641), HbA1c, and T2D. Interaction was tested between each biomarker and treatment groups (placebo vs vitamin D or n-3 FA).

Results:
Mean age of participants was 66 years, approximately 45% were female, and 16% were African American. Each of the glucose-insulin homeostasis biomarkers was associated with T2D risk (
Table 1
), aOR (95% CI) per SD increment, insulin: 1.46 (1.10, 1.94), C-peptide: 1.72 (1.28, 2.31), IRS: 1.59 (1.26, 2.01), and HbA1c: 80.43 (25.90, 249.77). Biomarker associations did not differ by randomized treatment (

P
interaction

>0.05).

Conclusions:
In VITAL Diabetes, insulin, C-peptide, IRS, and HbA1c were each associated with an increased risk of T2D, independent of other risk factors. Randomization to either vitamin D or n-3 FA did not modify these associations.
Abstract 11852: Prognostic Value of B-type Natriuretic Peptide Reduction and Uric Acid Levels as Predictors of 30-day Re-Admission in Patients With Acute Decompensated Heart Failure With Preserved Ejection Fraction
Authors: Madkour Muhammad , Savoj Javad , Biswas Mimi S
Published: March 2022

Introduction:
There is limited data comparing re-admission outcomes in patients with heart failure with preserved ejection fraction (HFpEF). This study aimed to determine the prognostic value of B-natriuretic peptide (BNP) level reduction and uric acid levels in hospitalized HFpEF patients.

Hypothesis:
Higher BNP level reduction and uric acid levels are associated with higher 30-day re-admission rates.

Methods:
This was a multi-center retrospective analysis of 3,398 patients admitted with acute decompensated HFpEF from January 2017 to December 2019. HFpEF was defined as a left ventricular function ≥ 50% and at least stage I diastolic dysfunction. Outcomes were defined by 30-day re-hospitalization rates for the two groups in the inpatient setting. Baseline characteristics, cardiovascular risk factors, admission laboratory data (troponin, sodium, hemoglobin A1c, uric acid), vital signs, length of stay and time to readmission due to heart failure exacerbation were gathered and compared.

Results:
The median age was 75.5 years and the mean length of stay was 11.1 days. The mean BNP at admission was 910 and the second BNP following standard therapy was 786. The median percent change in BNP was found to be 16.95%. Of the hypothesized clinical predictors of re-admission, we found that none of them; including change in BNP reduction and uric acid, were predictive of re-admission. Those who were re-admitted had lower sodium levels (136.6±5.86 vs 137.0±6.07, p=0.06), while improved creatinine levels (1.94±1.31 vs 2.06±1.66, p=0.02) was associated with re-admission for unclear reasons. For those patients who are white, the odds of experiencing re-admission is 1.54 times more likely compares to those who are of other race.

Conclusions:
Lower sodium levels and lower creatinine levels were found to be important risk factors for readmission. None of the hypothesized clinical variables including BNP reduction and uric acid predicted re-admission except for white race, which we feel is a surrogate for socioeconomic status. These findings underline the need for further studies and complexity in planning re-admission prevention algorithms in HFpEF patients.
Abstract 11864: Ironing Out the Details: Increasing the Screening of Iron Deficiency in Heart Failure Patients and the Promotion of Intravenous Iron Replacement
Authors: Ruiz Gabriel , Wilson Zachary , Abdelhabib Mohamed , Vukomanovic Damir , Patel Vikeen J , Tandon Varun , Pandya Shaunak , Anderson Dustin , CRAWFORD JULIE , mehr ali
Published: March 2022

Background:
The American College of Cardiology (ACC) recommends intravenous iron replacement (IVIR) in patients with iron deficiency (ID) and heart failure with reduced ejection fraction (HFrEF). IVIR, in patients with HFrEF and ID, is associated with improvement in patient symptoms, functional capacity, 6-minute walk distance, and quality of life. Emerging data demonstrates IVIR can reduce hospital admissions for HFrEF. The purpose of this study is to enhance screening of ID in the HFrEF population and IVIR in the inpatient setting.

Methods:
This is a single-center, retrospective chart review using ICD 10 codes I50.2 and I50.42 to query the diagnosis of HFrEF in admissions from January 2018 to June 2020. Patients with recent major surgery within the last three months, use of erythropoietin stimulating agents, blood transfusions within a six-week time period, a history of cirrhosis, and/or a diagnosis of end stage renal disease receiving IVIR were excluded. ID in HFrEF is defined as ferritin <100 micrograms/L or a ferritin of 100-299 micrograms/L with transferrin saturation of <20%, per ACC guidelines. Further analysis was performed on 150 of 600 admissions pulled.

Results:
Of the 150 admissions analyzed, 108 of 150 were due to decompensated HFrEF and only 22 of the 150 had iron studies performed during admission. Approximately 15 of 22 patients with iron studies had a diagnosis of ID and only 1 of the 15 patients was initiated on IVIR. Additionally, 22 of the 150 total patients were on oral iron replacement and were not placed on IVIR.

Discussion:
Work-up of ID in patients with HFrEF is frequently omitted in the inpatient setting. In patients that have been diagnosed with ID, few receive appropriate treatment. There should be increased efforts to identify and administer IVIR to hospitalized patients with HFrEF and ID once their acute decompensation has been stabilized. This study aims to increase usage of HFrEF order sets on admissions by including iron studies within the workflow. The initiative includes administering first doses of IVIR in the hospital with subsequent transition to the outpatient setting, providing patient/provider education, and offering clinical decision support at time of ordering.
Abstract 11866: Cardiorespiratory Fitness and Mortality in Older Adults Age 60 to 90 Years
Authors: Thai Tydus , Gyurjian Karo , Hammershaimb Bryant , Phan Derek , Chen Cheng , Schweis Franz , Chen Aiyu , zheng chengyi , Lee Ming
Published: March 2022

Introduction:
With an aging population and advances in technology and surgical interventions, physicians are sometimes faced with difficult treatment decisions for older patients. Invasive treatment options may not be beneficial in older adults with limited survival. Chronological age alone does not fully reflect a patient’s prognosis and should not be the only factor used to guide treatment decisions. In this study, we assessed the association of cardiorespiratory fitness with all-cause mortality among adults age 60 to 90 years.

Methods:
This retrospective cohort study included patients age 60-90 years who underwent symptom-limited exercise treadmill testing at an integrated health system from 2011 to 2019. Patients were categorized into three age groups: 60-70 years, 70-80 years, and 80-90 years. Cardiovascular fitness was categorized into low fitness (<5 METs), moderate fitness (5-10 METs), and high fitness (>10 METs). Median follow-up was 3.5 years. Hazard ratios (HR) associated with exercise capacity were calculated using multivariable Cox regression models.

Results:
The study cohort included 40520 patients: 27021 (66.7%) age 60-70 years, 11638 (27.6%) age 70-80 years, and 1861 (4.6%) age 80-90 years. After treadmill testing, 3494 (8.6%) were categorized as low fitness, 21863 (54.0%) as moderate fitness, and 15163 (37.4%) as high fitness. Older age, female sex and presence of cardiovascular risk factors including hypertension, diabetes, and chronic kidney disease were associated with having low fitness. Low fitness and higher chronological age were independently associated with lower survival. Using the age 60-70 years group with high fitness as reference, the age 80-90 group with high fitness had better survival than their younger counterparts with low fitness (age 80-90 high fitness: HR 2.9, 95% CI 1.2-7.2; age 60-70 low fitness HR 4.3, 95% CI 3.1-5.9; age 70-80 low fitness HR 6.8, 95% CI 5.2-8.9).

Conclusions:
High cardiorespiratory fitness is a strong predictor of survival. When assessing a patient’s prognosis for long-term survival, chronological age alone should not be the only factor considered. Evaluation of cardiorespiratory fitness using treadmill testing may be useful for tailoring prognostic information.
Abstract 11872: Use of Dronedarone and Periprocedural Stroke Risk in Patients Undergoing Catheter Ablation for Atrial Fibrillation
Authors: Poci Saglam Nertila , Gjermeni Diona , Kuehlkamp Volker
Published: March 2022

Introduction:
Dronedarone was introduced as a promising Amiodarone-analogue with a good safety profile and comparing efficacy. Because of a two-fold increase in all-cause death, stroke, myocardial infarction, and hospitalization in permanent AF, recommendations regarding the use of dronedarone therapy are limited. We aimed to evaluate the risk of periprocedural thromboembolic events (TE) in a group of patients who underwent catheter ablation for AF under on-going dronedarone therapy.

Methods:
We retrospectively studied 2254 AF cases who underwent catheter ablation between Jan 2011 and May 2017. A group of 145 cases out of the above cohort (mean age 65 yrs; male 54%; CHADSVASc >2 on 51% of the cases; Persistent AF 21%) was under dronedarone at the time of catheter ablation. We compared the dronedarone (DG) vs non-dronedarone group (nDG) in terms of periprocedural TE, specifically transient ischemic attack and stroke. To assess the impact of other possible explanatory variables we performed a multivariate regression analysis with interaction terms. All patients were under optimal oral anticoagulation at the time of catheter ablation.

Results:
DG showed a significantly higher frequency of 2,06 % periprocedural TE compared to 0.5% in nDG (p=0,024). Significant predictors of TE in DG were found to be age (OR 2,7 p=0,036), persistent AF (OR 3,6 p=0,036), NYHA class at the time of catheter ablation (OR 2,35 p=0,006) and left ventricular systolic function (OR 1,37 p= 0,05).Intraprocedural median ACT (OR 1,04 p=0,024) and electrical cardioversion (OR 10,3 p= 0,003) were the two significant intraprocedural predictors for stroke among patients on Dronedarone at the time of pulmonary vein isolation. Not predictive for periprocedural stroke were the type of catheter ablation technique, gender, HASBLEED score and spontaneous echo contras in left atrium. There was a significantly higher risk of stroke in DG patients under Phenprocoumon vs the ones on NOACs (OR 6, p= 0,047). CHADSVasc > 2 showed a trend in increasing the risk for stroke among DG patients (OR 3,1 p=0,07).

Conclusions:
Dronedarone therapy is associated with an increased risk for stroke in patients undergoing catheter ablation, with higher risk among the elderly, persistent AF, and heart failure patients.
Abstract 11875: Cardiac Tumor: Multiparametric Myo-Mapping Study by Cardiac Magnetic Resonance in Cardiac Tumors
Authors: Yue Pengfei , Xu Ziqian , Xu Yuanwei , Chen Yucheng
Published: March 2022

Introduction:
The characteristics and diagnostic value of T1, T2 mapping in cardiac tumors and myocardium are currently unknown.

Hypothesis:
We aim to explore tissue characteristics and diagnostic values of native T1, T2, and ECV values of left ventricular (LV) myocardium and cardiac tumors.

Methods:
In this prospective study, patients with suspected cardiac mass who underwent cardiac MRI between Nov 2011 and Mar 2021 were evaluated. Inclusion criteria were patients diagnosed with primary cardiac tumors and cardiac metastases based on surgical resection, biopsy, and comprehensive evaluations of medical history, imaging, and long-term follow-up. Patients were separated into primary benign, malignant cardiac tumors and cardiac metastases. Statistical analyses were performed using independent-samples t-test, Mann-Whitney U test, and receiver operating characteristic (ROC) analysis. Reproducibility was assessed by Bland-Altman analysis and coefficient of variation (CoV).

Results:
A total of 87 patients diagnosed as primary benign (n = 54), malignant cardiac tumors (n = 24), and cardiac metastases (n = 9), and 50 age and sex-matched healthy volunteers were included. Patients with primary malignant cardiac tumors (1362.5 ms ± 63.2) showed significantly higher myocardial T1 mapping values compared with patients with benign tumors (1259.7 ms ± 46.0), cardiac metastases (1287.6 ms ± 52.1), and with normal controls (1206.4 ms ± 44.0, all p value < 0.05). No significant difference in T2 mapping values were observed. Myocardial native T1 showed the highest diagnostic value between primary malignant and benign tumors (AUC: 0.917, cutoff value: 1300.2 ms) compared with myocardial T2 and ECV.

Conclusions:
This study indicated that while it is difficult to distinguish benign and malignant tumors based on mapping of cardiac tumors due to the high heterogeneity, myocardial T1 mapping value showed good diagnostic value between primary malignant and benign tumors.
Abstract 11879: The Genetic Characteristics Based on Next Generation Sequencing in Patients With Hypertrophic Cardiomyopathy
Authors: Wang JIE , Yang Fuyao , Han Yuchi , Chen Yucheng
Published: March 2022

Objective:
This study aimed to explore the genetic epidemiological characteristics in patients with hypertrophic cardiomyopathy (HCM).

Methods:
We prospectively enrolled 383 unrelated HCM probands who received genetic testing and 3.0 T cardiac MRI examination, including 118 familial HCM and 265 sporadic HCM. The diagnosis of HCM is based on the diagnostic criteria of the American Heart Association and American College of Cardiology guidelines. Patients with familial HCM underwent targeted next generation sequencing including 117 candidate pathogenic genes associated with cardiomyopathies, while sporadic HCM underwent whole-exome sequencing. The genotypic characteristics were analyzed.

Results:
Among the 383 unrelated Chinese HCM probands, we reported 56 new pathogenic or likely pathogenic gene site mutations, including 3 new rare non-sarcomeric gene mutations and 53 new sarcomeric gene mutations. According to the analysis of genotypic characteristics, it was found that the frequency of rare genes was 3.4%, and the positive rate of sarcomere protein gene detection was 62.4%. Among them,
MYH7
and
MYBPC3
are the most common pathogenic genes, accounting for 61.9% of sarcomere protein gene mutations. Additionally, in the included HCM population, there was no significant difference in the positive detection rate of sarcomere protein gene between familial HCM and sporadic HCM (66.1% vs 64%,
P
= 0.7). The proportion of sporadic HCM carrying polygenic mutations was higher than that of familial HCM (11.2% vs. 1.8%,
P
= 0.003).

Conclusion:
We reported 56 new gene mutations, which expanded the gene spectrum of HCM. Additionally, the frequency of rare disease genes in the HCM cohort is 3.4%, and the composition ratio of sarcomere protein gene is similar to that of North American or European HCM populations. However, the gene positive rate of sporadic HCM is similar to that of familial HCM, but the composition ratio of genotypes is different.