bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 10709: Findings on Cardiology Screening Parameters for Cardiac Amyloidosis Differ Between African American and Non-African American Patients
Authors: Manjunath Sonakshi , Deych Elena , Lenihan Daniel , Zhang Kathleen
Published: March 2022

Introduction:
Prior studies have shown worse outcomes for African American (AA) patients with cardiac amyloidosis as compared to Caucasians. A potential contribution of diagnostic bias to delayed diagnosis of cardiac amyloidosis in AAs has not previously been explored.

Hypothesis:
Standard screening parameters for cardiac amyloidosis have worse diagnostic accuracy in AA as compared to non-AA patients.

Methods:
Patients evaluated at our institution from 2000-2018 for suspected cardiac amyloidosis with diagnostic confirmation by cardiac biopsy were included. Demographic, clinical and laboratory parameters at the time of evaluation were obtained, and ECGs and echocardiograms were analyzed by study personnel. Each parameter was compared between the biopsy positive and biopsy negative groups separately for AA and non-AA patients.

Results:
Among 223 patients with suspected cardiac amyloidosis, 90 were AA (64% biopsy positive) and 133 were non-AA (51% biopsy positive). Older age, low limb lead voltage, increased relative wall thickness, and apical sparing of longitudinal strain were associated with a positive biopsy in both AAs and non-AAs. Male gender, pseudoinfarct pattern, higher E/e’, and lower voltage-to-mass ratio were associated with a positive biopsy in non-AAs (p<0.05), but not in AAs. This is displayed in the figure below. Brain natriuretic peptide level and left ventricular mass index were higher in the biopsy positive patients among non-AAs, and lower in the biopsy positive patients among AAs.

Conclusions:
Several traditional screening parameters for cardiac amyloidosis were not discerning for the diagnosis among AAs who underwent cardiac biopsy for evaluation. The development of cardiac amyloidosis screening tools tailored to AA patients may improve clinical outcomes for AAs with cardiac amyloidosis.
Abstract 10718: Prevalence, Correlates and Associated Mortality of Undiagnosed Angina in People Without Established Cardiovascular Disease in Us Adults: From the National Health and Nutrition Examination Survey 2001-2018
Authors: Chobufo Muchi Ditah , Rahman Ebad , SINGLA ATUL , Osman Mohammed , Zia khan Muhammad , Aronow Wilbert S , balla Sudarshan
Published: March 2022

Background:
The prevalence, correlates and associated mortality of undiagnosed angina in persons without established cardiovascular disease in the USA has not been established. We set out to establish the prevalence and correlates as well as assess mortality outcomes.

Methods and Results:
Included in our study were National Health and Nutrition Examination Survey (NHANES) participants from 2001-2018, aged ≥40years and free of established cardiovascular disease. The diagnosis of angina was established using the Rose Angina Questionnaire. The prevalence of undiagnosed angina was 1.99% (95% confidence interval (CI) 1.79- 2.20), corresponding to 2.6 million (95% CI 2.3 - 2.9) persons. In multivariable analysis, female sex (aOR 1.75, 1.37-2.25), lower education attainment (aOR 1.59, 1.08-2.33), obesity (aOR 2.68, 1.19-2.37), ever smokers (aOR, 1.51, 1.17-1.94), low income(Poverty index ratio <3) aOR 1.89, 1.44-2.47), and hypertension (aOR 1.48, 1.12-1.96) were independent correlates of undiagnosed angina. Only 3.8% of all participants with undiagnosed angina were concomitantly on beta blockers, aspirin and a statin. The death rate was 1.08 per 1,000 person months and 1.71 deaths per 1000 person months among those without angina and those with angina, respectively.

Conclusion:
The prevalence of undiagnosed angina among US adults ≥40years and older was 2%. Female sex, hypertension, obesity, low income, smoking and low education were associated with undiagnosed angina. Harboring undiagnosed angina was associated with higher risk of mortality.
Abstract 10733: Cardiac Magnetic Resonance Characteristics Including Feature Tracking in a Multi-Center Pediatric Study of Atypical Myocarditis
Authors: Caris Elizabeth , Schauer Jenna , Ait-Ali Lamia , Ashwath Ravi , Balasubramanian Sowmya , Choueiter Nadine , Christensen Jason , Cornicelli Matthew , Muniz Juan Carlos , Parra David , Tham Edythe B , Mallenahalli Chikkabyrappa Sathish , Young Luciana T , Soriano Brian , Buddhe Sujatha
Published: March 2022

Introduction:
Atypical myocarditis, presenting as isolated chest pain, elevated troponin and preserved cardiac output in childhood is rare. Beyond small volume single center case series, limited data are reported on CMR characteristics at initial presentation and follow up.

Methods:
This is a pediatric multi-center retrospective study. Patients with chest pain and elevated cardiac troponin who underwent an echo and CMR within 30 days of each other were included. Clinical, echo and CMR parameters were collected at presentation and follow up. CMR global longitudinal strain (GLS) was performed with feature tracking technology (TomTec). Cases were divided into CMR myocarditis positive (Myo+) and CMR myocarditis negative (Myo-) based on Lake Louise criteria. Findings were compared to 19 age matched controls.

Results:
A total of 108 cases were included (88 Myo+ and 20 Myo-). Majority were male (88%) with average age of 15.6 ± 2.1 years. Median troponin was 13 (0.18-260.1 ng/mL), median BNP was 270.8 (12-3949 pg/ml). Abnormal ECG findings were present in 79% at presentation. While CMR LVEF did not differ between cases (56 ± 9%) and controls (60 ± 4%, p 0.06), GLS was significantly worse in cases (-16.2 ± 2.7%) compared to controls (-19.2 ± 2.1%, p <0.001). Unlike LVEF, GLS was significantly worse in Myo+ (-15.7 ± 2.8%) compared to Myo- cases (-18.0 ± 1.3%, p < 0.001). Fifty-four subjects had follow up data with 35 repeat CMRs. Median follow up was 204 (30-944) days. Late gadolinium enhancement (LGE) persisted in 82% of the Myo+ cases. Of the cases with abnormal GLS at presentation, 77% had persistent LGE. At follow up, 14% of cases were on heart failure medications, 33% had abnormal GLS and 39% had abnormal LVEF (<55%). Neither treatment with steroids or IVIG at presentation nor LGE on initial or follow up CMR were associated with the need for heart failure medications or persistent symptoms at follow up.

Conclusions:
In atypical myocarditis, CMR GLS can help differentiate between Myo+ and Myo- cases. Abnormal CMR GLS at presentation has higher association with persistence of LGE at follow up, irrespective of type of treatment. Future studies are needed to identify other characteristics that predict persistently abnormal findings important to clinical management and prognosis.
Abstract 10768: Use of Cellular Indices to Predict All-Cause Mortality Outcomes in Patients with Pulmonary Embolism
Authors: Sagalov Andrew , Darki Amir , Slajus Brett , Reed Trent , Iqbal Omer , Fareed Jawed
Published: March 2022

Introduction:
Pulmonary embolism (PE) is a life-threatening condition with variable severity that results from dysregulation of complex inflammatory and hematologic processes. Current risk stratifications suffer from a low positive predictive variable. Complete blood count data offers a relatively low cost and easily accessible opportunity to supplement current risk models. We aim to identify trends in blood indices in patients with pulmonary embolism to stratify all-cause mortality.

Materials and Methods:
Patients with acute PE (n=231) confirmed on diagnostic imaging were followed during a three-year period for all-cause mortality. Complete blood count with differential was obtained within 24 hours of PE diagnosis through the electronic medical records system. SPSS Statistics was used to conduct bivariate analysis to identify correlations and interquartile ranges of selected indices against mortality.

Results:
Platelet count (PCC=-0.241, p &It0.001) and platelets/mean platelet volumes (PCC=-0.229, p &It0.001) were found to be negatively correlated with all-cause mortality, while platelets/neutrophils (PCC=0.160, p &It0.021) and neutrophils/lymphocytes (PCC=.244, p &It0.001) had a positive correlation. Values with a p value &It0.05 were declared statistically significant. Patients with active infection, malignancy, or undergoing immunosuppressive therapy were excluded from analysis due to potential confounding.

Conclusion:
Our study concludes lower levels of platelets are associated with increased mortality in patients with pulmonary embolism. We hypothesize the large clot burden in PE consumes platelets, which results in thrombocytopenia. By leveraging these findings in a clinical setting, we can supplement scoring criteria for pulmonary embolisms to create a more comprehensive model to predict all-cause mortality.
Abstract 10810: CMR Feature Tracking Can Estimate Right Ventricular Functional Reserve in Rats with Pulmonary Arterial Hypertension
Authors: Sato Haruka , Kumasaka Kazunori , Satoh Wakako , Shindoh Chiyohiko , Ota Hideki , Ryuta Kawashima , Miura Masahito
Published: March 2022

Introduction:
Patient survival with pulmonary arterial hypertension (PAH) is determined from right ventricular (RV) function. CMR feature tracking (CMR-FT) is used to assess RV function. It is not determined, however, whether CMR-FT can assess RV functional reserve in patients with PAH.

Hypothesis:
We assessed the hypothesis that CMR-FT can estimate RV functional reserve in rats with PAH.

Methods:
Rats were received injections with monocrotaline (MCT-rats, n=19) or solvent (Ctr-rats, n=5). After four weeks, retrospective ECG-gated cine MR (16 phases/beat) was imaged using a 7-T MRI scanner, and RVEF, RV global longitudinal strain (RVGLS) and RV global circumferential strain (RVGCS) were measured before and after addition of 0.5~3 nmol endothelin-1 (ET-1). After the measurements, trabeculae were dissected from the RVs and electrically stimulated with 2-s intervals ([Ca
2+
]
o
2.0 mM, 24°C). Force and maximum dF/dt (dF/dt
max
) were obtained using a silicon strain gauge in the absence and presence of 0.1 μM ET-1.

Results:
MCT-rats showed higher RV pressure (RVP), lower RVEF, lower RVGLS, lower developed force and lower dF/dt
max
. RVGLS showed a liner correlation with dF/dt
max
(r=0.53, p<0.05) and had already been reduced in 5 MCT-rats with preserved RVEF (>50%), suggesting that RVGLS reflects RV contractile properties and is reduced earlier than RVEF. Addition of ET-1 increased RVP in MCT-rats (49.0±19.3 to 59.7±16.8 mmHg, n=6) and Ctr-rats (17.3±7.5 to 20.4±7.8 mmHg, n=2) and increased developed force and dF/dt
max
in MCT-rats (12.2±5.7 to 17.4±3.1 mN/mm
2
, 0.08±0.03 to 0.14±0.06 mN/mm
2
/sec, n=6). When MCT-rats with preserved-RVEF (>50%) were divided into 2 groups depending on RVGCS, addition of ET-1 further reduced RVGCS in reduced-RVGCS (>-20%) group but not in increased-RVGCS (<-30%) group, suggesting that RVGCS can reflect RV functional reserve. In addition, ET-1 killed MCT-rats with reduced-RVGCS and reduced-RVEF just after its addition. In contrast, ET-1 did not change RVGCS and RVEF in Ctr-rats.

Conclusions:
CMR-FT can estimate RV functional reserve earlier and more accurately with RVGLS and RVGCS in rats with PAH. Therefore, RV strain with CMR may become an important parameter to assess RV functional reserve in patients with PAH.
Abstract 10813: Impact of Multidisciplinary Rounds in Cardiac Patients
Authors: Sreepathy Pranati , Ahuja Zaneta , Nazir Noreen T
Published: March 2022

Introduction:
A multidisciplinary care approach is the cornerstone of cardiac patient care. Multidisciplinary rounds (MDR) consisting of social workers, nutritionists, pharmacists, physical therapists, nursing and physicians systematically addressing the multifaceted components of hospital care of the cardiac patient have been implemented at many hospitals recently as an effort to increase collaboration throughout the care team and address care gaps. At this time there is little research into the impact of MDR on clinical outcomes.

Hypothesis:
Implementing MDR will decrease mortality, clinical complications, and length of stay (LOS) while also improving communication between ancillary staff and decreasing readmissions.

Method:
A single center case control study was conducted comparing Mortality Index, LOS, Clinical Complications (defined as adverse events documented during hospital stay), 30 day readmissions, and number of ancillary staff consults prior to implementation of MDR and after in patients admitted to the cardiology inpatient service at our major metropolitan academic medical center. Study duration was 34 months total with 2,695 unique hospital encounters studied.

Results:
Mortality Index after MDR implementation decreased from 1.179 to 0.648 and was statistically significant (p-value 0.06, CI -1.087,0.025). Average number of complications decreased by 27% (3.15 to 2.29) in response to MDR and average ancillary consults (Physical Therapy and Nutritional/Dietitian Consults) increased by 39.7% (19.75 to 27.6) and 182% (2.8 to 7.9) respectively. No significant change was observed in 30 day readmissions or LOS.

Conclusion:
MDR had statistically significant decrease on mortality index on cardiac patients admitted. MDR positively impacted resource utilization with appropriate consultations for ancillary services increasing. Continuation of MDR may impact LOS and readmissions over time.
Abstract 10835: Inflammatory Heart Disease After COVID-19 Vaccination: A Preliminary Cardiac MRI Perspective
Authors: Mikolich J Ronald , Thodeti Sathwika , Lattanzio Anthony , Vallabhaneni Sanjay , Khalid Muhammad , Brahmandam Balakrishna , mikolich brandon
Published: March 2022

Introduction:
On June 2, 2021, 6 case reports of myocarditis after the Pfizer COVID-19 vaccine surfaced. Each case had a cardiac MRI (CMR) study using T2 weighted and delayed gadolinium imaging. CMR was performed for post-vaccine symptoms. Although valuable, these data do not shed light on the prevalence of this post-vaccine occurrence. This study was designed to assess the prevalence of inflammatory heart disease(IHD) in a group of patients who had a CMR after receiving a COVID-19 vaccine.

Hypothesis:
Evidence of myocarditis may occur on cardiac MRI after all types of COVID-19 vaccine.

Methods:
From January 1 to June 8, 2021 303 patients underwent a CMR at Sharon Regional Medical Center. The date of vaccination, type of vaccine and COVID testing results and date for each of these patients were ascertained. All patients who were vaccinated prior to the CMR exam constituted the study population. IHD by CMR was defined as abnormality of 2 or more pulse sequences of the Modified Lake Louise Criteria(MLLC) of 2018: T2 STIR, Delayed enhancement after gadolinium, and prolongation of myocardial or pericardial T1 or T2 relaxation times. The number of patients with CMR evidence of IHD was tabulated for Pfizer, Moderna and Johnson&Johnson(J&J) vaccines.

Results:
Of 303 patients with a CMR during the study period, 77 were vaccinated prior to CMR. The mean time between vaccination and CMR was 41 days. 42 patients had a Pfizer vaccine, 30 had Moderna and 5 received J&J. 10 Pfizer receipants had IHD findings on CMR(24%), as did 7 of Moderna(23%) and 2 of J&J(40%). 13 patients had a positive COVID test prior to vaccination and IHD was present on CMR in 9 patients(69%) in this subgroup, while only 8 of 63(13%) without a positive COVID-19 test before vaccination showed evidence of IHD.

Conclusions:
Although retrospective, these data provide valuable information about the occurrence of IHD after COVID-19 vaccination using CMR imaging. A similar percentage of patients vaccinated with any of the 3 vaccines appear to subsequently show evidence of IHD on CMR, more so if previously COVID positive. However, evidence of IHD on post-vaccine CMR does not definitively establish causality. CMR exams before and after COVID-19 vaccination using MLLC will be required to prove a cause-effect relationship.
Abstract 10889: Impact of the COVID-19 Pandemic on Ambulatory Pediatric Cardiology Care by Race/Ethnicity
Authors: Wenren Larissa M , Bucholz Emily M , Perez Maria , Fynn-Thompson Francis , Jenkins Kathy J , Connor Jean , De Ferranti Sarah D , Saleeb Susan F
Published: March 2022

Introduction:
Racial/ethnic disparities in congenital heart disease outcomes are well documented. The impact of COVID-19 on race/ethnicity in access to ambulatory pediatric cardiology care is unknown.

Methods:
To examine differences in ambulatory care visits by race/ethnicity and whether differences were exacerbated by the COVID pandemic (March 2020), we examined number of visits scheduled (0-18 years old) and visit completion (as scheduled, delayed completion within 6 months, incomplete) by race/ethnicity. We focused on early pandemic, April 2020 (vs April 2019) and later pandemic, July 2020 (vs April 2020), using chi-square and logistic regression.

Results:
Annual clinic volume fell by 4.5% during the pandemic (18,725 to 17,866). Race/ethnicity shifted slightly towards white compared to non-white minority (NWM) 30% vs 28%,
p
<0.001. Public insurance was constant at 33%,
p
=0.83. Telehealth visits accounted for 46% of visits during the pandemic (0.8% pre-pandemic), with different utility by white than NWM patients (49% vs 43%,
p
<0.001). Visits in April 2020 fell by 57% from April 2019 and percent of visits completed without delay declined from 69% to 39%,
p
<0.001. Visits in July were similar from 2019 to 2020 but visits completed without delay declined from 71% to 62%,
p
<0.001. Visit completion rates varied by race/ethnicity (Figure 1), with differences between white vs NWM early in the pandemic (
p
=0.01). Differences in visit completion rates by race/ethnicity were not significantly different from the year prior (
p
for interaction=0.74) or from April to July 2020 (
p
for interaction=0.48).

Conclusions:
NWM have higher rates of incomplete/delayed visits compared to whites, though the difference was not statistically heightened by the pandemic. Telehealth visits have become a prominent part of ambulatory care, with higher completion rates by white patients. Efforts to reduce lapses in care are needed across demographics to ensure equitable care delivery.
Abstract 10932: Prediction of 30-Day Hospital Readmission in High-Risk Atherosclerotic Cardiovascular Disease Patients Using Machine Learning Methods on Electronic Health Record Data from Medical Information Mart for Intensive Care-3 Database
Authors: Garg Nitin Kumar , Ray Surajit , Mathur Ashwini
Published: March 2022

Introduction:
Despite significant therapeutic advancements, Atherosclerotic Cardiovascular Disease (ASCVD) patients require frequent hospitalization. Machine learning (ML) algorithms present an opportunity to develop improved and more generalizable prediction models for 30-day hospital readmission due to ASCVD.

Objectives:
The current study aims to leverage electronic health record (EHR) data to predict 30-day hospital readmission in high-risk ASCVD patients.

Methods:
This study utilized the MIMIC III database (a publicly available large, single-centre critical care database of 46,520 patients) comprising of deidentified ~60,000 ICU admissions. Adult patients with the first admission due to ASCVD event and whose length of stay (LOS) in the ICU was >48 hours were included. To develop a prediction model, features representing groups of diagnosis data along with demographics and length of stay in the hospital were used. The performance of ML models was evaluated using the area under the receiver operating characteristic curves (AUCs).

Results:
Our cohort consisted of 22,666 admissions (mean age 70.1 years) due to an ASCVD event. Out of the 9022 readmissions within 180 days, 60.5% were observed within 30 days of discharge. Among the 17 prospective predictors age, LOS and first hospitalization due to coronary atherosclerosis, heart failure, and haemorrhage issues were the most important factors to predict readmission within 30 days (Fig A). Random Forest was the best performing model with an AUC of 0.66 (Fig B).

Conclusions:
This model can be helpful in predicting the readmission of high-risk patients after the first ASCVD event which might address the huge unmet need of aiding healthcare resource planning, better patient care, and prevention of rehospitalization and death by intensifying treatment interventions in those patients and taking appropriate decisions to discharge patients based on their age, LOS and ASCVD events resulting in first hopitalization.
Abstract 11074: Worsening Renal Function in Acute Heart Failure in the Context of Diuretic Response
Authors: Emmens Lisa E , ter Maaten Jozine M , Matsue Yuya , Figarska Sylwia M , Sama Iziah , Cotter Gad , Cleland John , Davison Beth , Felker Michael , Givertz Michael M , Greenberg Barry , Pang Peter S , Severin Thomas , Gimpelewicz Claudio R , Metra Marco , Voors Adriaan A , Teerlink John R
Published: March 2022

Background:
For patients with acute heart failure (AHF), a substantial diuresis after administration of loop diuretics is generally associated with better clinical outcomes but may cause creatinine to rise, suggesting a decline in renal function. We investigated the interaction between diuretic response and worsening renal function (WRF) on clinical outcomes in patients with AHF.

Methods:
In two cohorts of patients with AHF (PROTECT, n=1,698 and RELAX-AHF-2, n=5,586 in current analysis), the prognostic impact of WRF (creatinine ≥0.3 mg/dL increase baseline-day 4, sensitivity analyses were performed incorporating baseline renal function) by diuretic response (kg weight loss per 40 mg furosemide equivalent from baseline-day 4) was investigated with regards to (CV) death or cardiovascular/renal hospitalisation using subpopulation treatment effect pattern (STEPP) plots and survival analyses.

Results:
WRF occurred in 286 (16.8%) patients in PROTECT and 1,031 (18.5%) patients in RELAX-AHF-2. Patients with WRF had higher left ventricular ejection fraction and lower estimated glomerular filtration rate at baseline (P<0.05). Patients with WRF also received higher doses of loop diuretics and had a worse diuretic response (all P<0.001). In patients with a poor diuretic response (≤0.35 kg weight loss/40 mg furosemide equivalent as identified by STEPP), WRF was associated with a higher risk of (CV) death or cardiovascular/renal hospitalisation (P<0.001 in both cohorts), but this was not the case for patients with a good diuretic response (P=0.900 for both cohorts).

Conclusion:
In two large cohorts of patients with AHF, WRF in the first 4 days was not associated with worse outcomes when patients had a good diuretic response. The occurrence of WRF in patients with AHF should therefore be considered in the context of diuretic response.
Abstract 11086: MG53 Suppresses NfκB Activation to Mitigate Age-Related Heart Failure
Authors: wang xiaoliang , LI XIUCHUN , Ong Hannah , Tan Tao , Park Ki Ho H , Bian Zehua , Zou Xunchang , Haggard Erin , Janssen Paul M , Merritt Robert E , Pawlik Timothy M , Whitson Bryan , Mokadam Nahush , Cao Lei , Zhu Hua , Ma Jianjie , Cai Chuanxi
Published: March 2022

Introduction:
Aging is associated with chronic oxidative stress and inflammation that affect the tissue repair and regeneration capacity. MG53 is a TRIM family protein that facilitates repair of cell membrane injury in a redox-dependent manner. However, it is not clear how MG53 regulates cardiac inflammation during aging.

Hypothesis:
We hypothesize that the expression of MG53 is associated with age-related heart failure, and treatment with recombinant human MG53 (rhMG53) protein in aged mice might have beneficial effect on the age-related decline of heart function.

Methods:
qPCR and Western blots were conducted for targeted genes/proteins in non-failing and failing human left ventricular tissues, and mouse heart tissues. A total of sixty mice (24 months, 30 male and 30 female) were enrolled for treatment with rhMG53 (6 mg/kg, subcutaneous, daily for 6 weeks) or saline as control, and subjected to cardiac functional measurement with echocardiography and pressure-volume loop, and cardiac apoptotic and ROS assays. Blood were collected to quantify the serum levels of biomarkers for liver and cardiovascular injury.

Results:
We demonstrate that the expression of MG53 is reduced in failing human heart and aging mouse heart, concomitant with elevated NFκB activation. We evaluate the safety and efficacy of longitudinal, systemic administration of recombinant human MG53 (rhMG53) protein in aged mice. Echocardiography and pressure-volume loop measurements reveal beneficial effects of rhMG53 treatment in improving heart function of aging mice. Biochemical and histological studies demonstrate the cardioprotective effects of rhMG53 are linked to suppression of NFκB-mediated inflammation, reducing apoptotic cell death and oxidative stress in the aged heart. Repetitive administration of rhMG53 in aged mice does not have adverse effects on immune response and major vital organ functions.

Conclusions:
In this study, we showed decreased expression of MG53 and increased NFκB activation in both failing human hearts and aging mouse hearts. Moreover, longitudinal administration of rhMG53 mitigated the heart dysfunction in the aged mice. These findings support the therapeutic value of rhMG53 in treating age-related decline in cardiac function.
Abstract 11147: Associations of Physical and Mental-Health Related Quality of Life and Sleep Disturbance with Cardiovascular Disease Risk in Post-Menopausal Breast Cancer Survivors
Authors: Vasbinder Alexi , Zaslavsky Oleg , Heckbert Susan R , Thompson Hilaire J , Cheng Richard , Saquib Nazmus , Wallace Robert B , Haque Reina , paskett electra , Reding Kerryn
Published: March 2022

Introduction:
Lower health-related quality of life (HRQoL) and greater sleep disturbance (SD) are associated with an increased risk of cardiovascular disease (CVD) in the general population. However, these associations may differ in breast cancer (BC) survivors who experience competing risks from cancer and its associated treatment. We examined whether physical or mental HRQoL (including individual subscales) or SD were associated with CVD risk in BC survivors.

Methods:
We conducted a longitudinal analysis in the Women’s Health Initiative (WHI) of post-menopausal women free of prevalent CVD at baseline and diagnosed with invasive BC during study follow-up from 1993 - 2010. CVD was defined as physician-adjudicated coronary heart disease or stroke. Physical and mental HRQoL, measured by the SF-36 Physical and Mental Component Scores (PCS and MCS, respectively), and SD, measured by the WHI Insomnia Rating Scale (IRS), were recorded post-BC diagnosis. Higher PCS and MCS scores indicate better HRQoL while higher IRS scores indicate worse SD. Time-dependent Cox proportional hazards models were used starting at BC diagnosis until 2010 or censoring adjusted for relevant confounders most proximal to or at BC diagnosis.

Results:
In 2,884 BC survivors, 157 developed CVD during a median follow-up of 9.5 years. After adjustment, higher PCS scores were significantly associated with a lower risk of CVD (Table). For a 5-unit difference, the risk of CVD was 9% lower for those with higher PCS scores (95% CI: 0.83, 0.99). Of the SF-36 sub-scales, higher scores on vitality, physical functioning, and general health were significantly associated with a lower risk of CVD (Table).

Conclusions:
In BC survivors, we found that better physical HRQoL was associated with lower CVD risk. While further research is needed to replicate these findings, our results support existing recommendations that women with breast cancer adopt health behaviors that promote physical health.
Abstract 11153: Massively Parallel, High-Throughput Approach for Identifying Defective
KCNH2
(hERG) Variants
Authors: Ullah Rizwan , Ng Chai , Farr Jessica , Hill Adam , kozek krystian , Vanags Loren , Mitchell Devyn , Vandenberg Jamie , Kroncke Brett
Published: March 2022

Introduction:
Individuals with congenital long QT syndrome (LQTS) are at high risk for the life-threatening arrhythmia
torsades de pointes
. Loss-of-function
KCNH2
(aka
hERG
) variants that reduce repolarizing current,

I
Kr

, are responsible for >30% of LQTS cases with ~6% of sudden death in the young and ~1% in infants. Most
KCNH2
variants are observed in some individual(s) making it difficult to obtain clinical evidence to assign pathogenicity; >80% of
KCNH2
missense variants in ClinVar are listed as variants of uncertain significance. To help adjudicate variants lacking in compelling clinical data, we demonstrate a method to characterize
KCNH2
variant dysfunctions.

Methods:
We combined deep mutational scanning with a HA tagged
KCNH2
construct to enable massively parallel characterization of channel trafficking of missense variants in
KCNH2
. We have applied this method to the first 160 residues of
KCNH2
; 3,123 missense variants in total, a known hotspot for disease causing variants. For a subset of 458 non-redundant single nucleotide missense variants, we compared trafficking data, and
in silico
classifiers, with patch clamp data collected on the SyncroPatch platform.

Results:
Trafficking data is better than
in silico
features at predicting peak tail

I
Kr

values, with an area under the receiver operating characteristic curve of > 0.9 for trafficking data versus 0.8 for
in silico
feature. The Spearman correlation coefficients were 0.73 [0.67-0.78] compared to 0.51 [0.44-0.58] for trafficking and
in silico
predictions respectively. Our assay identified substitution sensitive regions, surrounded by more permissive residues. We also found substitution intolerant sites involved in networked hydrogen-bonding.

Conclusion:
A massively parallel trafficking assay can recapitulate most
KCNH2
defects more effectively than
in silico
methods. Extended application of our method will enable the assessment of all missense variants in
KCNH2
and other cardiac ion channels.
Abstract 11160: Transcriptional Profiling by Direct Digital Mrna Detection Indicates Heart Failure Recovery is Incomplete Post Lvad Therapy
Authors: Dhar Kajari , Qiu Fang , Basma Hesham , Um John , Lowes Brian D
Published: March 2022

Introduction:
Recovery from end-stage heart failure (HF) with left ventricular assist device (LVAD) therapy remains uncommon. In this study we compared targeted gene expression profiles of pre LVAD, post LVAD and non-failing (NF) hearts utilizing direct mRNA detection of HF specific genes. Our goal was to identify molecular mechanisms involved in HF and responses to LVAD therapy.

Method:
Myocardial RNAs were isolated from non-ischemic dilated cardiomyopathy patients at LVAD placement and during transplant (n=10) along with NF controls (n=6). NanoString analysis was used to compare gene expression between groups for 126 heart failure specific genes. NanoString mRNA raw count data were preprocessed and normalized using nSolver 4.0 Analysis Software. At least a 2 fold change in gene expression with a FDR adjusted p<0.05 was considered as significant. Ingenuity Pathway Analysis (IPA) was completed to understand the biological pathways involved.

Results:
Our sample population was 90% male, average age of 56 and 100% Caucasian. In the HF populations average ejection fraction was low <25% and average NYHA was 3.5. In HF, expressions of contractile muscle (MYH6), ion channels protein (KCNIP2) and Ca ATPase (SERCA2) were significantly down regulated when compared to NF controls. Natriuretic peptides (NPPA, NPPB), troponin 1 (TNNI3), nuclear kinases (WEE) and metabolic genes (ATRNL1) were upregulated compared to NF hearts. These differential changes in gene expression persisted post LVAD therapy. There were no significant changes in gene expression between pre and post LVAD HF patients. Ingenuity pathway analysis revealed that these changes in gene expression predispose to arrhythmias.

Conclusion:
Transcriptional changes in HF specific genes persist in many patients post LVAD therapy contributing to incomplete recovery of end stage heart failure and ongoing risk of arrhythmias. These genes are involved in contractile function, calcium handling and ion channels. Direct digital mRNA detection allows for serial analysis of targeted HF specific genes without reverse transcription and amplification of resultant cDNA. New therapies are needed to reverse adverse molecular changes and improve outcomes in heart failure patients who receive LVADs.
Abstract 11180: Contemporary Evidence on Risk Stratification of Anticoagulated Non-Valvular Atrial Fibrillation Patients Grouped by Cha
2
D
2
-vasc Score Levels
Authors: Lip Gregory Y , Murphy Richard , Sahiar Farhad , Dhamane Amol , Ferri Mauricio , Hlavacek Patrick , Preib Madison , Keshishian Allison , Russ Cristina , Rosenblatt Lisa , Deitelzweig Steve
Published: March 2022

Introduction:
The CHA
2
DS
2
-VASc score is an established tool to determine the risk of stroke among atrial fibrillation (AF) patients. The goal of this retrospective claims analysis is to evaluate the incidence of stroke/systemic embolism (SE) and major bleeding (MB) events among patients with non-valvular AF (NVAF) who initiated an oral anticoagulant (OAC; apixaban, dabigatran, edoxaban, rivaroxaban, or warfarin) relative to their CHA
2
DS
2
-VASc score.

Methods:
Adult NVAF patients who initiated OACs were identified from 01JAN2013-31MAR2019 using data from five insurance claims databases. Patients were required to have 12 months continuous enrollment prior to index (OAC claim date) and were followed to the earliest of OAC discontinuation, death, disenrollment, or study end. Results were stratified by CHA
2
DS
2
-VASc score on index: low (0 for males and 1 for females), moderate (1 for males and 2 for females), high risk 1 (2-3 for males and 3 for females) and high risk 2 (≥4 for males and females). The incidence rate and cumulative incidence were reported for stroke/SE and MB, defined by hospitalization with a primary diagnosis of the respective outcomes.

Results:
A total of 1,141,097 NVAF patients were identified including 29,298 low risk, 95,584 moderate risk, 327,766 high risk 1 and 688,449 high risk 2 patients. The median follow-up time for all patients was 160 days. The incidence of stroke/SE and MB was 1.3 and 4.1 per 100 person years, respectively. Cumulative incidence for stoke/SE and MB increased across risk groups (Figure). Significant differences were seen for both stroke/SE and MB, when comparing the high risk 1 or high risk 2 group to the low-risk reference group.

Conclusions:
Assessing stroke/SE and MB events by CHA
2
DS
2
-VASc risk category demonstrates the differences in the rate of events according to the risk groups and provides insight for anticoagulated NVAF patients with clinical risk factors.
Abstract 11198: Role of Different Lipid Parameters and Lipoproteins on Coronary Microvascular Dysfunction in the Young
Authors: Wan Jindong , Liu Sen , Zhou Peng , Wang Peijian
Published: March 2022

Aim:
Young with coronary microvascular dysfunction (CMD) have increased cardiovascular morbidity. Particularly, Asian patients with CMD are considerably younger than their Western peers. Blood lipids are traditionally considered risk factors for myocardial infarction (MI) of the elderly. However, little is known about CMD in the young. The purpose of our study was to test the associations between lipids and lipoprotein particles and CMD in the young.

Methods:
A cross-sectional study was conducted from 2014 to 2020, 1868 young participants were included. CMD was defined as angina but no obstructive coronary disease. All participants had baseline laboratory testing. Lipid parameters, including total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), small dense low density lipoprotein cholesterol (sd LDL-C), high-density lipoprotein (HDL), non-HDL, TC/HDL ratio, TG/HDL ratio and LDL/HDL ratio were measured. Both low- and high-density lipoprotein cholesterol (LDL-C and HDL-C) subfractions were measured using the Quantimetrix Lipoprint System. Logistic regression analysis was performed to determine associated factors for CMD.

Results:
Very low-, intermediate-, small dense-, and low- density lipoprotein particles were positively associated with CMD. HDL particles were inversely associated with CMD apart from small HDL. Cholesterol in large HDL was inversely associated with CMD (odds ratio [OR] = 0.75), whereas cholesterol in small HDL was not (OR = 1.08). TG within all lipoproteins, including most HDL particles, were positively associated with CMD. In multiple logistic regression analyses, non-HDL [OR = 1.56 (1.16-1.87)], sd LDL-C [OR = 1.80 (1.21-2.27)], TC [OR = 1.41 (1.25-1.93)], TC/HDL [OR = 1.26 (1.15-1.68)] were significantly associated with CMD.

Conclusions:
Lipids and lipoproteins showed similar associations with CMD. Within HDL particles, cholesterol concentrations were inversely associated, whereas triglyceride concentrations were positively associated with CMD. Non-HDL, sd LDL-C, TC, and TC/HDL were significantly associated with CMD than others. This result should be considered in future clinical lipid-lowering trials and a routine screening for CMD in the young.
Abstract 11206: In-Hospital Outcomes of Aortic Valve Repair in Diabetes Patients: Data from the National Inpatient Sample
Authors: Khan Sarah , DARGHAM SOHA , Al suwaidi Jassim M , Jneid Hani , Abi Khalil Charbel
Published: March 2022

Introduction:
Diabetes is associated with increased cardiovascular complications.

Hypothesis:
We hypothesized that patients hospitalized for aortic valve repair have a worse outcome in the presence of diabetes.

Methods:
Data from the National Inpatient Sample (NIS) was analysed between 2012 to 2017. We compared hospitalization, in-hospital cardiovascular outcomes and socio-economic outcomes between patients with diabetes vs non-diabetes hospitalized for SAVR and TAVR.

Results:
In diabetes patients undergoing TAVR, mean age of participants decreased from 79.6 ±8 to 67.8 ±8, total cases increased from the number of cases increased from 2280 to 18940 (p<0.002 for both). Mortality, acute renal failure (ARF) and stroke decreased with time. When compared to non-diabetic patients, diabetes patients were younger and had a similar risk of mortality. However, they had a higher risk of stroke and ARF (adjusted OR= 1.174 [1.03-1.34], 1.294 [1.24-1.35]; respectively). In diabetes patients undergoing sAVR, mean age of participants decreased from 70.4 ±10 to 68 ±9 (p<0.001). Total cases remained stable but mortality, bleeding, acute renal failure and vascular complications decreased with time (p<0.036 for all). When compared to non-diabetic patients, diabetes patients were older and had a higher risk of mortality, stroke and ARF (adjusted OR= 1.115 [1.06-1.17], 1.140 [1.05-1.23], 1.217 [1.18-1.26]; respectively). Mortality of diabetes patients undergoing TAVR was initially higher than those in the TAVR group. However, the trend was inversed starting 2014 (Figure 1)

Conclusions:
Mortality and other cardiovascular outcomes are decreasing with time in patients with diabetes undergoing aortic valve repair. In TAVR patients, there was no difference in the burden of diabetes on mortality. However, SAVR patients with diabetes still experience a higher mortality rate. Nevertheless, most post-procedural complications are higher in the presence of diabetes
Abstract 11210: Trends in Invasive Treatment of Patients Hospitalized with Acute Decompensated Aortic Stenosis and Cardiogenic Shock
Authors: Elkaryoni Ahmed , Cohen David J , Lopez John J , Huded Chetan P , Kennedy Kevin F , Arnold Suzanne V
Published: March 2022

Background:
Prior to 2012, balloon aortic valvuloplasty (BAV) was the only potential intervention for patients with decompensated aortic stenosis (AS) and cardiogenic shock. Emergent transcatheter aortic valve replacement (TAVR) is now an option and has shown acceptable outcomes compared with elective TAVR. We explored how treatment patterns for AS and cardiogenic shock have shifted since TAVR was introduced.

Methods:
We identified hospitalizations of patients with AS and cardiogenic shock within the National Readmissions Database, the proportion treated with BAV or TAVR, and in-hospital mortality over the study period by treatment. Due to challenges in determining the timing of surgery vs. onset of shock, patients who underwent surgical AVR were excluded.

Results:
From 2010-2018, there were 17,297 hospitalizations for AS and cardiogenic shock, which have increased over time (Figure A legend). The proportion of hospitalizations where either BAV or TAVR was used has also increased (BAV 3.9%->7.1%; TAVR 3.8%->10.1%; Figure A). In-hospital mortality was very high but has significantly decreased over time for all treatment strategies (no invasive: 46.9%->35.5%; BAV: 45.7%->34.2%; TAVR 18.8%->8.9%; Figure B), with much lower mortality rates the TAVR group at all time points. Compared with BAV, patients treated with TAVR were less likely to require mechanical ventilation (TAVR 34.6% vs BAV 49.1%) or mechanical circulatory support (TAVR 19.9% vs BAV 30.6%; p<0.001 for both). Age and comorbidity burden were similar among groups.

Conclusions:
Over the past decade, hospitalizations for AS and cardiogenic shock have increased as has the proportion in which BAV or TAVR are emergently used. Although in-hospital mortality has declined over time, it remains very high, particularly among patients treated with BAV or those without intervention. This is likely in part due to the lower severity of cardiogenic shock of the patients treated with TAVR.
Abstract 11228: Social Determinants of Rates of Resuscitation in Out-of-Hospital Sudden Death Victims
Authors: Jones Hannah M , Keen Susan , Zhang Jason , Shartle Kaitlin , Senter Elizabeth , Sauter Catherine , Lin Feng-Chang , Simpson Ross J
Published: March 2022

Introduction:
Cardiac causes contribute to 53% of sudden deaths. Receiving prompt cardiopulmonary resuscitation (CPR) greatly increases survival from out-of-hospital cardiac arrest. However, social factors may contribute to the likelihood of a witnessed arrest and prompt CPR. Our aim was to compare the social demographics of sudden death victims who did receive CPR versus those who did not receive CPR.

Methods:
Out-of-hospital deaths of adults aged 18-64 in Wake County, NC, from 2013-2015 were adjudicated based on age, cause, and location of death to identify sudden death victims. Sociodemographic background, clinical characteristics, and CPR initiation were gathered from EMS reports, death certificates, and medical records. Descriptive statistics were compared between victims who did versus did not receive CPR. Chi-square (or Fisher’s exact) tests and t-tests were performed to compare categorical and continuous variables, respectively. We used inverse probability weighting for the association between marital status and CPR initiation when CPR initiation status was missing.

Results:
Of the 399 sudden death victims, CPR was initiated in 131 (32.8%). Compared to those who did not receive CPR, those who did receive CPR were more likely to be Black (42.5% versus 31.0%, p-value 0.035) and live in a high-income census tract (65,539.6 versus 59,951.0, p-value 0.032). Marital status also differed significantly between the groups, with married individuals receiving higher rates of attempted resuscitation than those who were divorced or widowed (p-value 0.012). There was no difference in sex, residence in a rural census tract, history of incarceration, or prevalence of medical comorbidities among those for whom CPR was initiated compared to those for whom CPR was not initiated.

Conclusions:
Race, marital status, and income level are associated with attempted resuscitation in victims of sudden death. We found conflicting findings on the role race plays in the rate of attempted resuscitation among victims of sudden death. Because our results suggest a varied relationship between social determinants and attempted resuscitation, we propose bystander CPR training across all sociodemographic groups.
Abstract 11257: Intersection Between Race and Gender in the Incidence and Control of Hypertension in ELSA Brasil
Authors: Silva Etna K , Barreto Sandhi M , Brant Luisa C , Araujo Edna M , Camelo Lidyane d , Pereira Alexandre , Griep Rosane , Fonseca maria de jesus d , Giatti Luana
Published: March 2022

Background:
Few investigations examined the associations of race and gender with the incidence and control of hypertension (HTN) considering the synergies and heterogeneous experiences of intersectional groups.

Hypothesis:
HTN incidence and inadequate blood pressure (BP) control is higher in black men and women, brown men, and women, compared to their white counterparts. Inequalities are more pronounced in higher education
vis-a-vis
lower education group.

Methods:
Using data from the ELSA-Brasil, 6 intersectional groups of race/gender were identified: white, brown, and black men and women. We calculated by intersectional category: the HTN incidence between baseline (2008-2010) and visit 2 (2012-2014) in 8,528 individuals free of HTN or cardiovascular disease at baseline; and inadequate BP control prevalence in 4,571 individuals with drug treated HTN at visit 2. Generalized linear models with Poisson distribution and logarithmic link function were used.

Results:
After age and HTN family history adjustment, the HTN risk was higher in black men (IDR:2.25; 95%CI:1.65-3.08), brown men (IDR:1.89; 95%CI:1.59-2.25), black women (IDR:1.85; 95%CI:1.50-2.30), brown women (IDR:1.47; 95%CI:1.31-1.67), and white men (IDR:1.76; 95%CI:1.49-2.08) compared to white women. All associations remained significant in fully-adjusted models for sociodemographic, behavioral and health conditions The association between intersectional categories and inadequate BP control varied according to education level in fully-adjusted models: 1) in lower education participants, white men (PR:1.70; 95%CI:1.42-2.04), brown men (PR:1.67; 95%CI:1.43-1.94), black men (PR:1.60; 95%CI:1.37-1.87), and black women (PR:1.28; 95%CI:1.00-1.64) had worse BP control than white women; 2) in higher education participants, only black men (PR:1.55; 95%CI:1.08-2.22) and women (PR:1.49; 95%CI:1.05-2.13) showed worse control than white women.

Conclusion:
Our findings reinforce previous studies regarding the higher risk of HTN and worse BP control in black men, but also reveal that the intersectional approach accentuates the heterogeneity in the incidence and control of HTN, evidencing specific experiences of socially marginalized groups, especially that of black women.