bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 16939: Pediatric Quality of Life While Supported With a Ventricular Assist Device
Authors: Miller Jacob R , Boston Umar S , Epstein Deirdre J , Henn Matthew C , Lawrance Christopher P , Kallenbach Jacob , Simpson Kathleen E , Canter Charles E , Eghtesady Pirooz
Published: July 2021

Introduction:
The Ventricular Assist Device (VAD) has emerged as an important treatment option for bridging pediatric patients with heart failure to transplant. VADs have been shown to improve survival; however, quality of life (QoL) while supported with a pediatric VAD is unknown.

Methods:
In this prospective study, pediatric patients, and their parents, who underwent VAD placement completed a generic PedsQL 4.0 biweekly until heart transplant or death. Data are reported at last follow-up with a VAD and compared to three previously reported groups: age-matched healthy controls, outpatients with severe heart disease and children after heart transplant.

Results:
From December 2007 to August 2013, 13 patients received VAD support for at least two weeks and completed a PedsQL. The mean age at implant was 10.0 ± 4.2 years with a median duration of support of 1.6 months (Table 1). Pre-implant INTERMACS profile was 1 for 3/13 (23%) and 2 for 10/13 (77%). Patients self-reported significantly (p<0.05) reduced total and physical QoL scores when compared to each of the three comparison groups. Self-reported psychosocial QoL scores were significantly lower than healthy controls only. Parent proxy-reported scores were significantly lower than all three comparison groups for all three categories (Figure 1).

Conclusion:
A large deficit exists in the QoL of pediatric patients supported by a VAD compared to outpatient management of severe heart disease or post-heart transplant patients; however, VAD patients do represent a sicker group. Improvements in QoL must be made, as time spent with a VAD is expected to increase. Though a small sample, these data can serve as a baseline for future comparison.
Abstract 16989: Impaired Systolic Function Assessed by Strain Imaging Predicts Cardiovascular Morbidity and Mortality in Heart Failure with Preserved Ejection Fraction
Authors: Shah Amil M , Claggett Brian , Sweitzer Nancy K , Shah Sanjiv J , Anand Inder S , Liu Li , Pitt Bertram , Pfeffer Marc A , Solomon Scott D
Published: July 2021

Introduction:
Left ventricular (LV) systolic function by strain imaging is impaired in heart failure with preserved ejection fraction (HFpEF) but its prognostic relevance is not known.

Hypothesis:
We hypothesized that worse longitudinal strain (LS) is independently associated with adverse outcomes.

Methods:
LS was assessed by 2D speckle-tracking echocardiography in a blinded core laboratory at baseline in 447 patients with HFpEF (left ventricular ejection fraction [LVEF] ≥45%) enrolled in the Treatment Of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial and was related to the primary composite outcome of cardiovascular (CV) death, HF hospitalization, or aborted cardiac arrest, and its components.

Results:
At a median follow-up of 2.6 (IQR 1.5-3.9) years, 115 patients experienced the primary outcome. Impaired LS, defined as an absolute LS < 15.8%, was present in 53% of patients and was associated with the composite outcome (adjusted HR 2.14, 95% CI 1.26-3.66; p=0.005), CV death alone (adjusted HR 3.20, 95% CI 1.44-7.12; p=0.004), and HF hospitalization alone (adjusted HR 2.23, 95% CI 1.16-4.28; p=0.016) after adjusting for age, gender, race, randomization strata (prior HF hospitalization vs elevated B-type natriuretic peptide level), region of enrollment (Americas vs Russia or Georgia), randomized treatment assignment, history of atrial fibrillation, heart rate, New York Heart Association class, history of stroke, creatinine, hematocrit, LVEF, mass, end-systolic volume index, and E/E’ ratio. These findings were similar in the subgroup of 354 patients with LVEF ≥55%.

Conclusions:
Among HFpEF patients enrolled in TOPCAT, impaired LV systolic function, measured by LS, is predictive of adverse CV outcomes independent of clinical and conventional echocardiographic predictors. Impaired LS represents a novel imaging biomarker to identify HFpEF patients at particularly high risk for CV morbidity and mortality.
Abstract 17348: Necrostatin 7 Limits Myocardial Infarct Size and Reduces Cardiac Remodeling After Permanent Coronary Occlusion in Rats
Authors: Dmitriev Yuri , Minasian Sarkis , Dracheva Anna , Karpov Andrey , Chefu Svetlana , Demchenko Elena , Galagudza Michael
Published: July 2021

Background:
Reduction of irreversible myocardial ischemia-reperfusion injury (IRI) remains important. One of the promising strategies aimed at myocardial IRI alleviation is modulation of programmed cell death (PCD) pathways. PCD mode displaying morphological characteristics of necrosis, and amenable to pharmacological manipulation is referred to as necroptosis. Necroptosis inhibitor necrostatin-1 has been shown to exert cardio- and neuroprotective effects. In the present work, the effect of necrostatin-7 (Nec-7) on myocardial injury in the rat model of permanent coronary occlusion was studied.

Methods:
Male Wistar rats (n = 19) were anesthetized with pentobarbital. The animals were subjected to permanent coronary occlusion (PCO) and intraperitoneal (i.p.) Nec-7 administration 1 h prior to PCO at a dose of 14.5 mg/kg in dimethyl sulfoxide (DMSO) or DMSO alone at a dose of 3.1 g/kg. Control rats were treated with saline. Three weeks after PCO, serum levels of NT-proBNP were measured, and histological outcomes were assessed. The infarct size (IS, %) and infarct length (IL, mm) were analyzed morphometrically.

Results:
DMSO caused significant reduction in serum NT-proBNP level vs. Control (0.3 ± 0.19 vs. 0.5 ± 0.22 ng/ml, p = 0.001), while Nec-7 further decreased NT-proBNP level in comparison with DMSO (0.2 ± 0.14 ng/ml, p = 0.008 vs. DMSO). Compared with Control, DMSO reduced adverse left ventricular remodeling, as evidenced by reduction in IS (16.0 ± 2.92 and 12.9 ± 1.72%, p = 0.015) and IL (6.2 ± 0.89 and 3.8 ± 0.35 mm, p = 0.008). Nec-7 treatment resulted in additional reduction of both IS and IL vs. DMSO group (9.0 ± 4.91 % and 2.9 ± 1.62 mm, respectively; p = 0.013 and p = 0.011 vs. DMSO, respectively).

Conclusion:
Nec-7 has cardioprotective properties, reducing myocardial wall stress and myocardial remodeling in the rat model of myocardial infarction.
Abstract 17516: Improvement of the Endothelial Function in Patients with Atrial Fibrillation: Effect of Sinus Rhythm Restoration by Catheter Ablation
Authors: Kanazawa Hisanori , Yamabe Hiroshige , Sugiyama Seigo , Iwashita Satomi , Hoshiyama Tadashi , Ito Miwa , Ogawa Hisao
Published: July 2021

Background:
Endothelial dysfunction has been shown to be correlated significantly with the presence of atrial fibrillation (AF). However, it is not clear to what extent restoration of sinus rhythm by catheter ablation (CA) can improve the endothelial function in patients with AF.

Objectives:
The purpose of this study was to examine the serial change in the endothelial function for 6 months periods following CA in AF patients in whom the AF recurrence was not observed. Furthermore, we compared the endothelial functions of these AF patients obtained before and, 3 and 6 months after CA with that of normal control subjects.

Methods:
Forty-three normal control patients (control group) and 61 consecutive AF patients who underwent CA of AF and showed no AF recurrence for 6 months after the procedure (AF group) were included. AF group consisted of patients without structural heart disease and the history of AF was 4.7±4.9 years. Endothelial function of these two groups were assessed. All patients assessed their endothelial function by the reactive hyperemia-peripheral arterial tonometry (RH-PAT) and the RH-PAT index (RHI) was measured. The RHI was measured before and 3 month and 6 months after CA in AF group. Then the serial change in the RHI was elucidated in AF group. All measurement of RHI was performed during sinus rhythm both in control and AF groups.

Results:
The RHI in control group was 2.21±0.46. The RHI in the AF group before CA was significantly lower than that in control group (2.06±0.49 vs. 2.22±0.46, p=0.036). The RHI in AF group 3 months after CA was significantly improved compared with that before CA (2.40±0.59 vs. 2.06±0.49, p<0.001). The RHI 6 months after CA in AF group was also significantly higher than that before CA (2.24±0.53, vs. 2.06±0.49, p=0.048). The RHI at 3 and 6 months after CA in AF group were not different from that of control group (3 months; 2.40±0.59 vs. 2.21±0.46, p=NS, 6 months; 2.24±0.53, vs. 2.21±0.46, p=NS).

Conclusions:
The endothelial dysfunction was present in AF patients even if the sinus rhythm was observed during measurement of RHI before CA. However, the endothelial function in AF patients was improved to the similar level of the normal control subjects when the sinus rhythm was maintained after CA.
Abstract 17526: The Role of Endothelial Function on Paroxysmal and Chronic Atrial Fibrillation
Authors: Mazaris Savvas , Tousoulis Dimitris , Siasos Gerasimos , Zisimos Konstantinos , Oikonomou Evangelos , Kokkou Eleni , Konsola Theodosia , Lazaros George , Chrysohoou Christine , Stefanadis Christodoulos
Published: July 2021

Introduction:
Atrial fibrillation (AF) is associated with various cardiovascular diseases. Endothelial dysfunction is well validated as a strong predictor of adverse cardiovascular outcomes.

Hypothesis:
We hypothesized that endothelial dysfunction affects the development and progression of AF.

Methods:
We enrolled 152 consecutive subjects with AF. Thirty five subjects had paroxysmal AF and 117 chronic (long standing persistent or permanent) AF. Endothelial function was evaluated by flow mediated dilation (FMD). All subjects underwent two-dimensional echocardiographic assessment. Left ventricle ejection fraction (LVEF) was calculated based on biplane method of discs, left ventricle mass index to body surface area (LVmass/BSA) was calculated with the method of Devereux, left atrial diameter index to body surface area (LAdiam/BSA) was measured from the parasternal window and left atrial volume index to body surface area (LAvol/BSA) was measured based on biplane Simpson’s rule.

Results:
Subjects with chronic AF compared to subjects with paroxysmal AF were older (73±10 years vs. 66±15 years, p=0.002), had impaired LVEF (44±14% vs. 53±9%, p=0.001) increased LAdiam/BSA (26±4mm/m2 vs. 20±3mm/m2, p<0.001), increased LAvol/BSA (41±9.6ml/m2 vs. 29±7.7ml/m2, p<0.001), increased LVmass/BSA (116±35 gr/m2 vs. 99±29 gr/m2, p=0.06) and impaired creatinine clearance (64±18 ml/min/1.73m2 vs. 83±20 ml/min/1.73m2, p=0.001). Importantly, subjects with chronic AF had impaired FMD compared to subjects with paroxysmal AF (4.09±1.67% vs. 6.83±1.38% p<0.001). In addition, there was an inverse correlation between FMD and LAdiam/BSA (r=-0.53, p<0.001), LAvol/BSA (r=-48, p<0.001), LVmass/BSA (r=-0.364, p=0.007) and a positive correlation between FMD and LVEF (rho=0.30, p=0.003). Interestingly, a linear regression model revealed that subjects with chronic AF had impaired FMD [b=-1.61 95%CI(-2.33 to -0.89), p<0.001] even after adjustment for confounders such as age, sex, LVEF, LVmass/BSA, LAvol/BSA, creatinine clearance, arterial hypertension and the presence of diabetes mellitus.

Conclusions:
Endothelial dysfunction is associated with atrial remodeling in patients with AF and is implicated in the progression from paroxysmal to chronic AF.
Abstract 18963: Clinical Significance of Daytime Vs. Nighttime Cheyne-stokes Respiration in Systolic Heart Failure Patients: Findings From 24- Hour Polygraphic Recordings
Authors: Mirizzi Gianluca , Iudice Giovanni , Bramanti Francesca , Giannoni Alberto , Poletti Roberta , Gabutti Alessandra , Mammini Chiara , Raglianti Valentina , Passino Claudio , Emdin Michele
Published: July 2021

Purpose:
Cheyne Stokes respiration, that is periodic apnea/hyperpnea of central origin (CSR), has been separately described both during night (nCSR) and daytime (dCSR) in HF and associated with worse prognosis. The relationships between severity of nCSR and of dCSR have not yet been established.

Methods:
we enrolled 439 consecutive HF patients (aged 65±13 years, 76% males; NYHA class III-IV 33%, LVEF: 32±9%, mean±SD) on current guideline-directed therapy (96% betablockers, 94% ACE-inhibitors/angiotensin receptor blockers, 22% CRT). All patients underwent a 24hour cardiorespiratory polygraphic recording (nasal flow plus chest and abdomen respirograms) for detection of hypo/apnea phenomenon, clinical and neurohormonal evaluation, cardiopulmonary exercise testing, echocardiography and Holter monitoring.

Results:
four groups were identified according to severity of nCSR (AHI <5, 17%; mild, 5 to 15, 24%; moderate, 15 to 30, 30%; severe, >30, 29%) and dCSR (normal, apnea/hypopnea index, AHI <5, 38%; mild, 5 to 15, 32%; moderate, 15 to 30, 29%; severe, >30, 9%); nocturnal obstructive apnea prevalence (AHI >5) was 10% (1% daytime). Notably, in patients with significant (AHI>15) nCSR, dCSR had the highest prevalence (daytime AHI>15, 71%, daytime AHI>30, 26%). Both severe dCSR and nCSR were associated (p<0.01) with age, male gender, NYHA class III-IV, nonsustained ventricular tachycardia at Holter monitoring, higher plasma NT-proBNP and norepinephrine, lower pVO2, ventilatory inefficiency as assessed by the slope of ventilation to carbon dioxide production, LV dilatation (assessed by end-systolic and diastolic diameters) and hypertrophy (assessed by LV indexed mass), right ventricular dimension. Severe dCSR, but not nCSR, was associated with lower LVEF, increased prevalence of atrial fibrillation and diabetes.

Conclusions:
significant dCSR is prevalent in HF, namely in patients with more severe nCSR (AHI>15). Both dCSR and nCSR are associated with neurohormonal activation, greater left and right ventricular volumes, increased ventricular arrhythmic burden and lower functional capacity, while lower LVEF as well atrial fibrillation are associated with dCSR only. Risk stratification and therapeutic strategies should consider dCSR.
Abstract 19748: CD39-associated SNP and Secondary Cardiovascular Events
Authors: Gul Burcu , Delaney Jessica T , Song Yanna , Bowton Erica A , Sutcliffe Cara B , Chepurko Elena , Novitskaya Tatiana , Denny Joshua C , Harrell Frank E , Wells Quinn S , Cleator John H , Gumina Richard J
Published: July 2021

Introduction:
CD39 (ectonucleoside triphosphate diphosphohydrolase) is a nucleotidase expressed on endothelial cells, vascular smooth muscles cells, leukocytes, and platelets. CD39 plays a key role in vascular homeostasis, hydrolyzing extracellular ATP or ADP to AMP. Prior work has demonstrated that the genotype at the single nucleotide polymorphism (SNP) rs10748643 correlates with CD39 expression on HapMap lymphocytes (GG: high, GA: intermediate, AA: baseline).

Hypothesis:
The aim of this study was to determine if an association exists between the rs10748643 genotype and secondary cardiovascular events.

Methods:
Subjects treated with placement of an intracoronary stent and on clopidogrel therapy for coronary artery disease were identified in the BioVU DNA repository that links DNA to Synthetic Derivative, a de-identified electronic health record. Selection of the study population was based on a combination of ICD 9th edition, Current Procedural Terminology codes, laboratory values, and natural language processing in physician notes. “Case” or “control” status was assigned depending on recurrence of a secondary cardiovascular event (myocardial infarction, revascularization and/or death) within two years. Genotyping for rs10748643 was performed using TaqMan.

Results:
The study population included 189 cases and 379 controls, with comparable demographics. There were 47 MIs, 14 deaths, and 166 revascularizations. We compared the composite outcomes of MI and/or death or MI, death and/or revascularization. We found no difference in the composite end-point of MI, death and revascularization, however the GG-genotype at rs10748443 was associated with an increase in the composite end-point of MI and/or death (HR GG:AA: 3.82 95% CI 1.10 - 13.29; P=0.039).

Conclusions:
The GG genotype, was associated with an increased incidence of the composite end-point of myocardial infarction and death in patients who received intracoronary stents for coronary artery disease and were treated with clopidogrel. This is the first study to demonstrate an association of a CD39-associated SNP with human cardiac pathology. Confirmatory studies are underway in a larger cohort.
Abstract 20050: Impact of Median Household Income and Hospital Variation in the Utilization of Do-not-resuscitate Order in Cardiac Arrest: A National Perspective
Authors: Lahewala Sopan , Solanki Shantanu , Patel Neil , Patel Nileshkumar J , Patel Achint , Dhaduk Grishma , Bambhroliya Chirag , Patel Darshan , Arora Shilpkumar , Patel Nilay , Deshmukh Abhishek , Badheka Apurva , Gidwani Umesh , Schreiber Theodore , Grines Cindy
Published: July 2021

Background:
The factors determining DNR status in patients (pts) with cardiac arrest have not been well elucidated.

Objective:
The goal of our study was to assess impact of median household income and inter-hospital variation in utilization of DNR in Cardiac arrest.

Methods:
We queried the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS) database from 2011 using the ICD-9-CM code for cardiac arrest (427.5) as principal diagnosis. We defined pts’ DNR status with ICD code - V49.86 as a secondary diagnosis. Pts with age < 18 were excluded. NIS represents 20% of all US hospital pts. We built a hierarchical two level model adjusted for multiple confounding factors. Discrimination power of models was assessed using c statistics. Inter class correlation (ICC) and Median Odds Ratio (MOR) were generated from the hierarchical model.

Results:
We identified 1854 pts (weighted: 8915) with cardiac arrest across 1854 hospitals in the US, out of which 1.87% pts (366 pts, weighted: 1755) opted for DNR. Pts with higher median household income had decreased utilization of DNR (OR, 95% CI, P-Value) in 4th quartile: 0.59, 0.45-0.78, p<0.001, as compared to all other quartile. Also, with every 10 year increase in age, the rate of DNR increased (1.25, 1.18-1.32, p < 0.001). There was no statistically significant difference in other variables such as female gender, weekend admission, insurance type, teaching status of the hospital or hospital volume. C-statistics of model to generate ICC and MOR was 0.90. ICC was 60.6, which indicates that approximately 60.6 % of variation in utilization of DNR was attributable to the behavior of individual hospitals, and MOR was 8.5 which indicates that a randomly selected patient receiving DNR at a particular hospital would have approximately 9-fold higher odds of receiving DNR than an identical patient at a different randomly selected hospital.

Conclusion:
Our study highlights vast variation in utilization of DNR in randomly selected 2 different hospitals with cardiac arrest pts. It also indicates a disparity in utilization of DNR orders in Pts with higher median household income as compared to lower household income.
Abstract 20128: Effect of Renin-angiotensin Blockers on Left Ventricular Remodelling in Severe Aortic Stenosis
Authors: Goh Serene S , Lee Poay Sian S , Tay Edgar L , Kong William K , Yeo Tiong Cheng , Poh Kian Keong
Published: July 2021

Background:
The use of renin-angiotensin blockers (RAB: angiotensin converting enzyme inhibitors, ACEI and angiotensin receptor blockers, ARB) in severe aortic valve stenosis (AS) remains controversial. We aim to explore the relation on their use with degree of left ventricular (LV) remodelling in patients with normal flow (NF) and low-flow (LF) severe AS despite preserved LV ejection fraction (LVEF).

Methods:
We studied 423 consecutive patients with aortic valve area (AVA) 50%. Subjects with concomitant valvular pathologies, congenital heart disease or prosthetic valves were excluded. NF was categorized as LV stroke volume index (SVi) > 35ml/m2. Increased left ventricular mass index (LVMI) was ≥96g/m2 and 116g/m2 in females and males respectively while abnormal relative wall thickness (RWT) was ≥0.45.

Results:
The median age was 74 yrs (IQR: 65-82). Prevalence of male subjects 52%, diabetes mellitus 61%, dyslipidemia 48% and hypertension 43%. A quarter of the patients were on RAB, with a mean duration of 6.7 months(IQR:1.0-72.3). Median LVMI for patients on RAB was 94.5 g/m2 (IQR: 87.3-144), whilst those without was 120.3 g/m2 (IQR: 102-159) (p=0.005).

RAB use in patients with LF AS was significantly associated with normal LVMI, adjusted for hypertension (OR 2.00, p=0.002). The use of RAB had a duration dependent association with normal LVMI. Patients on RAB for a year were twice more likely to have normal LVMI (OR 2.24, p=0.048). This effect is greater in patients with 2 years of therapy (OR 3.417, p=0.002). In contrast, the use of RAB was not associated with normal LVMI in the NF group (p=0.428). There was no significant difference between use of either ACEI or ARB on LVMI (p=0.855). Patients on RAB had less risk of having concentric hypertrophy (OR= 0.373, p=0.009) and eccentric hypertrophy (0.392, p=0.025) as compared to those without.

Conclusion:
Use of RAB in LF severe AS may be associated with beneficial remodeling of the LV especially if prescribed for more than a year. Further studies are warranted to determine the deferential effects of RAB on clinical outcomes in LF versus NF AS.
Abstract 20288: Quantification and Z-Score “Normalization” of Regional Myocardial Contractile Data in Ischemic Coronary Artery Disease Patients
Authors: Henn Matthew C , Brady Beckah D , Kar Julia , Cupps Brian P , Wallace Kathleen , Braverman Alan C , Pasque Michael K
Published: July 2021

Introduction:
Left ventricular (LV) regional contractile information is currently limited to subjective interpretation of low-resolution echocardiography. In order to establish a more specific and standardized form of imaging, this study compared strain patterns in normal patients to patients with coronary artery disease (CAD) using high-resolution contractile data from cardiac MRI.

Methods:
Sixty normal test subjects underwent cardiac MRI with multiple 3D strain parameters calculated from tissue tag-plane displacement data. 15,300 LV grid points contributed to a normal human strain database. Sixty patients with known CAD underwent cardiac MRI. Normalized z-scores for 3 strain parameters at each of the LV grid-points were calculated by comparing raw strain values to the normal database. The z-scores at each point were then averaged to generate 15,300 normalized strain z-scores. Clinical evidence for prior ischemic events was sought in each patient’s medical record.

Results:
Multi-parametric strain information was successfully obtained in all 60 CAD patients with post-processing display of “quantified” regional ischemic injury over patient-specific LV geometry. We displayed “normalized” micro-regional contractile function by intuitive z-score color-coding of regions (<1 standard deviation=blue; 1-2=yellow; >2=red) over patient-specific 3D LV geometry (Figure). Clinical evidence for prior ischemic events obtained from echo, viability studies, ECG, and left heart catherization correlated well with regional injury patterns.

Conclusions:
The quantitative “normalization” of raw patient-specific values by z-score calculation from a normal human strain database can effectively create vivid displays of prior ischemic events. These high-resolution images provide detailed contractile information that may shape a new paradigm in preoperative surgical evaluation prior to revascularization.
Abstract 310: Body Mass Index and Initial Defibrillation for In-Hospital Cardiac Arrest
Authors: Ogunkua Olutoyosi , Minhajuddin Abu , Pai Jason , Joshi Girish , Whitten Charles , Babar Melik Emine , Hill Gary , Nasir Dawood , Hamza Mohamed , Bradley Steven , Schneider Preston , Ogunnaike Babatunde
Published: July 2021

Background:
Higher transthoracic impedance may influence the success of defibrillation. We evaluated the relationship between body mass index (BMI) and post-defibrillation outcomes for in-hospital ventricular fibrillation or pulseless ventricular tachycardia (VF/VT).

Methods:
Within the Get With The Guidelines - Resuscitation multicenter observational registry, we identified adult patients who received biphasic waveform defibrillation for in-hospital VT/VF cardiac arrest between 2008 and2012. We evaluated the relationship between BMI and defibrillation outcomes using a generalized linear mixed regression to adjust for patient arrest characteristics and comorbidities while accounting for within hospital clustering. The primary outcome was successful termination of VF/VT. Secondary outcomes included termination of VF/VT to an organized rhythm with pulse, return of spontaneous circulation ≥ 20 minutes (ROSC), survival at 24 hours, and survival to discharge.

Results:
A total of 10,561 adult subjects with VF/VT from 268 hospitals were analyzed. BMI was not associated with termination of VT/VF following defibrillation. However, compared to normal BMI patients, underweight and morbidly obese patients were less likely to have termination of VT/VF with restoration of a pulse. Further, underweight patients were less likely to survive to 24 hours and discharge. In contrast, overweight and obese patients were more likely to survive to 24 hours and discharge (see Table).

Summary:
Successful termination of VF/VT was not associated with BMI. However, a non-linear relationship exists between BMI and termination of VF/VT to an organized rhythm with pulse, ROSC, survival at 24 h and survival at discharge.
Abstract 9488: Prognostic Value of Cardiopulmonary Exercise Testing in Patients With Asymptomatic or Equivocal Symptomatic Aortic Stenosis
Authors: Le Van D , Jensen Gunnar V , Carstensen Steen , Kjoller-Hansen Lars
Published: July 2021

Objective:
To access the prognostic value of cardiopulmonary exercise testing (CPX) in patients with asymptomatic or equivocal symptomatic aortic stenosis (AS/ES-AS).

Methods:
Patients with AS/ES-AS without left ventricular dysfunction were prospectively grouped according to their CPX outcome: 1) peak oxygen-consumption (pVO
2
) >83% and peak oxygen-pulse (pO
2
pulse) >95% of that predicted; 2) pVO
2
<83% or pO
2
pulse <95% but CPX pointing to other cause than hemodynamic compromise; 3) pVO
2
<83% and respiratory coefficient >1 or clear exercise-limiting discomfort. At baseline Groups 1 (n=77) and 2 (n=35) were handled conservatively and Group 3 (n=18) referred for aortic valve replacement (AVR). Primary end-point was cardiac death, hospitalization with heart failure or AVR with improvement from just pre-AVR to nine months post-AVR in pVO
2
or Physical Component Score from the SF-36 > the estimated clinical relevant difference (5% and 7.5%, respectively).

Results:
The mean age, valve area and follow-up was 72.1±6.9 years, 0.45±0.11 cm/m
2
and 24±5 months, respectively; 48% were NYHA class ≥II. The end-point was reached in 25.3%, 26.4% and 62.5% in Group 1, 2 and 3, respectively (Group 3 vs. Group 1+2, p=0.007). One patient (0.7%) suffered cardiac death, eight months after recommendation of AVR, and 7 (6.3%) were hospitalized with heart failure. A pO
2
pulse <100% of that predicted was the single predictor of the end-point, odds-ratio 2.55 (95% CI:1.18;5.54) (Table 1).

Conclusions:
CPX appears useful to separate those with a high probability of improvement with AVR from those, including patients with decreased pVO
2
, with a low event-rate with a conservative approach.
Abstract MP73: Leisure Time Physical Activity and Cognitive Decline in the Northern Manhattan Study
Authors: Willey Joshua Z , Gardener Hannah , Cespedes Sandino , DeCarli Charles , Yoshita Mitsuhiro , Stern Yaakov , Sacco Ralph L , Elkind Mitchell S , Wright Clinton B
Published: July 2021

Background:
Leisure time physical activity (LTPA) has been associated with a lower risk of dementia, but whether the effects are specific to particular cognitive abilities or improvement in functional status remains unclear. We examined LTPA in relation to domain-specific neurocognitive (NC) performance and change over time in a diverse community sample.

Methods:
Data on LTPA was collected during enrollment (1993-2001) into the Northern Manhattan Study (NOMAS), a prospective cohort study of risk factors for stroke and cognitive decline, using a validated in-person questionnaire, and two waves of NC assessments were done on a subcohort of participants undergoing brain MRI an mean of six and 12 years later (NC1: 2003-2008; NC2: 2008-2014). Baseline LTPA was defined in two manners: (1) maximum intensity of all activities performed categorized as moderate-heavy, light, and none; (2) total summarized as a continuous variable with the metabolic equivalent (MET) score, a composite of total reported intensity and time. Factor analysis-derived construct-relevant cognitive domains, including memory (MEM), executive function (EXEC), processing speed (PS), and language ability (LA), were computed by averaging z-transformed NC test scores. We used multivariable linear regression to examine LTPA in relation to baseline domain-specific NC performance, and change in performance over time, adjusting for socio-demographics, vascular risk factors, and MRI markers of cerebrovascular injury (white matter hyperintensity volume and total cerebral volume, both adjusted for total intracranial volume, and silent brain infarcts).

Results:
There were 1236 participants (mean age=64 years, 61% women, 67% Latino, 18% black, 15% white) with LTPA and NC data, and 879 with a second NC assessment. Moderate-to-heavy activity was associated with higher baseline LA (p <0.05) and PS (p <0.05), and with a protective effect on change of MEM (p <0.05) and PS (p <0.05); these effects were not attenuated after adjustment for MRI variables. Total MET-score was not associated with baseline NC domain performance. However, participants with greater MET-scores had significantly less decline in processing speed adjusting for age and education. Inclusion of vascular risk factors and MRI markers each attenuated these associations though they remained statistically significant.

Conclusions:
Leisure time physical activity is independently protective against a decline in processing speed and memory, and was partly mediated by MRI markers. Leisure-time physical activity may protect against dementia through preventing cerebrovascular correlates of brain injury.
Abstract P002: Long Term Exposure to Outdoor Air Pollution and Cardiovascular Health
Authors: Singh Sarah , Pilkerton Courtney , Christian Adam , Bias Thomas K , Frisbee Stephanie J
Published: July 2021

BACKGROUND:
Although the link between air pollution and cardiovascular disease has been controversial in recent decades, it remains a top global health concern. Most studies have assessed only the relationship between pollutant concentrations and morbidity or mortality in populous cities. In this study, we investigated the association of long term exposure to major air pollutants with current cardiovascular health. This outcome was a measure of health rather than disease, as measured by the Cardiovascular Health Index (CVHI) developed by the American Heart Association. METHODS: We analyzed 2011 data from 3007 counties across the US using Behavioral Risk Factor Surveillance System and Area Health Resources File. Air Quality Index (AQI) for five major pollutants from 2001-2011; Ozone, Sulfur dioxide and Carbon monoxide and Fine particulate matter (aerodynamic diameter of 10 and ≤2.5 μm) were obtained from the EPA Air Quality System database. Categories were based on the 11-year average pollutant AQI level and using Jenks optimization method; persistently good, variant and persistently bad. Associations between categories and the mean CVHI were evaluated using Poisson regression models adjusting for age, sex, race/ethnicity and socioeconomic status at the individual and population level. RESULTS: PM2.5 was most frequently measured (938 counties) and carbon monoxide least frequently (224 counties). Correlations between pollutants were moderate and significant (p<0.0001), ranging from r=0.30 between CO and Oz to r=0.52 between SD and PM2.5. Four pollutants had 11-year average AQI levels significantly associated with increased mean CVHI score of individuals. Living in a county categorized as ‘persistently good’ or ‘variant’ AQI levels for ozone is significantly associated with an estimated 3% increase in CVHI (95% CI 0.1% - 5.0%) as compared to living in a county of ‘persistently bad’ AQI levels. In addition, living in a county of only ‘persistently good’ AQI levels for PM2.5 is significantly associated with an estimated 5% increase in CVHI (95% CI 3% - 9%) as compared to living in a county of ‘persistently bad’ AQI levels. Inverse relationships existed for both PM10 and carbon monoxide. CONCLUSIONS: It is difficult to tease apart the independent effects of individual air pollutants on health as humans are exposed to a mixture of gases. However we have shown that at the individual level, there is an association between long term exposure to air pollution and its effects on current cardiovascular health. Further research is needed to determine whether these effects exist at varying levels of subject characteristics.
Abstract P058: Serum Fibroblast Growth Factor-23 Does Not Have a Linear Relation to Cardiovascular Mortality
Authors: Krupp Karl , Veledar Emir , Madhivanan Purnima , Cook Robert , Nasir Khurram
Published: July 2021

Introduction:
Fibroblast Growth Factor 23 (FGF23) is bone-derived hormone regulating phosphate homeostasis as part of a newly described bone-kidney axis. Several studies have demonstrated that elevated circulating FGF23 levels are independently associated with cardiovascular mortality.

Methods:
A systematic review was conducted according to Meta-analysis of Observational Studies in Epidemiology Group guidelines. Six databases (PubMed-Central, Ovid-MEDLINE, EMBASE, Web of Science, BIOSIS and Cochrane Database of Systematic Reviews) were searched for articles published between 2000 and 2014 examining the longitudinal association between FGF23 and CVD mortality among populations without prior CVD, Chronic Kidney Disease, or Diabetes. The review yielded 1,961 articles, of which 982 met the inclusion criteria. About 893 abstracts were excluded during the title and abstract screen, and an additional 92 after full text review. Only three articles met the review criteria and were included in the meta-analysis. Data from selected articles were abstracted and independently assessed for quality by two reviewers. Summary estimates and associated 95% confidence intervals were included in fixed and random-effects models. The presence of heterogeneity was evaluated using a Q-statistic with a conservative p-value of 0.10. All analyses were performed using R library meta.

Results:
Data for 15,379 participants were included in the meta-analysis. The hazard ratio for quartiles two and four when compared with quartile one,the reference category, were 1.29 (1.06- 1.58; p=0.01) and 1.31 (1.077-1.59; p=0.0068) respectively. There was no significant difference in CVD mortality between the third and first quartile. There was also no evidence of heterogeneity observed (I2 = 0%, p = 0.611).

Conclusions:
This study found a U-shaped association between FGF23 and CVD mortality suggesting that either low or high serum levels increase risk for CVD mortality. Current strategies focus on lowering high levels of circulating FGF23, but little attention has been given to understanding optimal levels necessary to prevent CVD mortality. If this U-shaped relationship between FGF23 and CVD mortality is real, the possible links, causes, and mechanisms require additional research.
Abstract P122: Fidelity to Motivational Interviewing and Weight Loss in Young Adults: Cellphone Intervention for You (CITY) Trial
Authors: Tyson Crystal C , Lin Pao-Hwa , Corsino Leonor C , Batch Bryan C , Gallis John A , Grambow Steven C , Schwager Jenifer , Ernst Denise , Svetkey Laura P
Published: July 2021

Background:
Weight loss interventions for obese young adults may reduce serious health complications later in life. Motivational Interviewing (MI) is part of behavioral weight loss intervention. Effective delivery of MI is variable; therefore, we assessed whether fidelity to MI was associated with change in weight and dietary pattern in overweight/obese young adults.

Methods:
The Cellphone Intervention for You (CITY) trial was a 24-month behavioral intervention that randomized 365 overweight/obese (BMI >25 kg/m2) young adults (aged 18-35 years) to a weight loss program delivered by either mobile technology or interventionist-led personal coaching (PC) phone calls, or to a control condition. PC participants attended a series of 6-weekly group meetings immediately followed by monthly audio-recorded phone calls conducted by an interventionist trained to deliver weight loss counseling using MI. We coded the first monthly PC phone call using Motivational Interviewing Treatment Integrity Version (MITI) 3.1.1 and evaluated the impact of MITI summary scores on changes in weight and Healthy Eating Index (HEI) at 6 months.

Results:
Our study population was comprised of 74 participants with available audio-recordings. There were 73% (N=54) women and 49% minorities with a mean age of 29 ± 4 years and a mean BMI of 34.7 ± 7.3 kg/m2. Mean change in weight 6 months post-randomization was -3.1 ± 5.3 kg. Mean change in HEI was 3.3 ± 4.7. Mean MITI summary scores for global spirit, percent complex reflections and reflection-to-question ratio were 3.9 ± 0.8, 0.6 ± 0.3, and 0.5 ± 0.2, respectively. None were predictive of weight change 6 months post-randomization (table 1). Percent complex reflection was predictive of HEI, with a counterintuitive negative relationship (table 1).

Conclusions:
In our study population of overweight/obese young adults, greater fidelity to MI in the first coaching call was not associated with greater weight change or improved HEI. Additional research is needed to further explore the impact of MI on behavior.
Abstract P340: Prevalence of Cognitive Dysfunction Among Older Adults With Diabetes
Authors: Rawlings Andreea , Sharrett A. Richey , Knopman David , Parrinello Christina , Palta Priya , Wruck Lisa , Bandeen-Roche Karen , Gottesman Rebecca , Albert Marilyn , Coresh Josef , Mosley Thomas , Selvin Elizabeth
Published: July 2021

Introduction:
Among older adults with diabetes, cognitive dysfunction is of particular concern as it has implications for treatment adherence and diabetes self-management. The prevalence of cognitive dysfunction has not been well characterized in this population.

Methods:
We conducted a cross-sectional analysis of 5509 participants (1815 with diabetes) from visit 5 (2011-2013) of the ARIC Study. Diabetes was defined based on self-reported physician diagnosis, diabetes medication use, or HbA1c ≥ 6.5%. Cognitive function was measured using 8 neuropsychological tests, which were grouped into three cognitive domains representing memory, executive function, and language. Participants were categorized as having cognitive dysfunction if test scores were more than 1.5 standard deviations below age-, race-, and education-adjusted scores derived from a cognitively healthy population. We calculated crude prevalence estimates and used Poisson regression to estimate adjusted prevalence ratios (PRs), comparing cognitive dysfunction in persons with and without diabetes. We adjusted for demographic and clinical characteristics.

Results:
The mean age of participants was 75 years, 59% were female, 79% were white, and 33% had diabetes. In each domain, the prevalence of cognitive dysfunction among persons with diabetes ranged from 14% to 27%. Persons with diabetes were more likely than persons without diabetes to have dysfunction in multiple domains (PR = 1.29, 95% CI: 1.12, 1.49). Prevalence of cognitive dysfunction was significantly higher in persons with versus without diabetes for memory (PR=1.13, 95% CI: 1.02, 1.25), language (PR=1.24, 95% CI: 1.09, 1.45), and executive function (PR=1.10, 95% CI: 1.00, 1.22)(Figure). PRs were similar in crude models.

Conclusions:
The prevalence of cognitive dysfunction among older adults with diabetes is high. These results have implications for how physicians educate patients in appropriate self-management practices and for the prevention of diabetes-related complications.
Abstract 11744: The Association Between Plasma Levels of Anti-angiogenic Isoform of Vascular Endothelial Growth Factor and Clinical Profiles of Peripheral Artery Disease
Authors: Sato Akihiko , Yoshihisa Akiomi , Kanno Yuki , Takiguchi Mai , Miura Shunsuke , Shimizu Takeshi , Nakamura Yuichi , Yamauchi Hiroyuki , Owada Takashi , Abe Satoshi , Suzuki Satoshi , Oikawa Masayoshi , Sakamoto Nobuo , Yamaki Takayoshi , Sugimoto Koichi , Kunii Hiroyuki , Nakazato Kazuhiko , Suzuki Hitoshi , Saitoh Shu-ichi , Takeishi Yasuchika
Published: July 2021

Background:
Although circulating levels of vascular endothelial growth factor (VEGF), known as a stimulator of angiogenesis, were elevated in peripheral artery disease (PAD), patients with PAD is often associated with poor collateral formation, resulting in critical limb ischemia. Recently, it has been reported that VEGF165b, a major splicing variant of human VEGF-A, inhibits angiogenesis in some types of cancer and acts as anti-angiogenic. However, the association between circulating levels of VEGF165b and clinical manifestation of patients with PAD has not been fully examined.

Methods and Results:
This study included 45 patients with PAD who received endovascular therapy and 20 control subjects without PAD in our hospital. PAD was diagnosed according to the PAD management guidelines, such as computed tomography, angiography, and/or ankle-brachial index. We excluded patients with malignancy, end-stage renal disease on dialysis, severe chronic respiratory failure, and active inflammatory disease in consideration of influence on concentrations of VEGF. We measured circulating concentrations of VEGF165b in peripheral blood samples using enzyme-linked immunosorbent assay (ELISA). Plasma levels of VEGF165b were significantly higher in the PAD group than in the control group (91.7 ± 47.8 pg/ml vs. 30.4 ± 18.3 pg/ml, P<0.001). There was no association between the plasma levels of VEGF165b and the symptom grade (Fontaine class), ankle-brachial index and the lesion morphology based on angiographical findings (TASC-II classification, presence of below knee lesion or chronic total occlusion lesion) in PAD group. In the multiple regression analysis, the independent factors to determine plasma levels of VEGF165b were age (ß 0.258, P=0.031), presence of PAD (ß 0.587, P<0.001), hypertension (ß 0.295, P=0.013), dyslipidemia (ß 0.385, P=0.001), history of stroke (ß 0.245, P=0.041), and coronary artery disease (ß 0.292, P=0.016).

Conclusion:
Plasma levels of VEGF165b was elevated in PAD, but there was no association between the severity of PAD and levels of VEGF165b. VEGF165b was related to age, hypertension, dyslipidemia, history of cerebral and coronary artery disease as well as PAD.
Abstract 13210: Concomitant Septal Myectomy Can Improve Left Ventricular and Atrial Function Detected by 2d Speckle Echocardiography as Well as Long term Survival In Patients Undergoing Aortic Valve Replacement With Marked Ventricular Hypertrophy
Authors: Kuroda Kishio , Kato Tomoko S , Kuwaki Kenji , Uto Kenta , Yoshizawa Saeko , Nishikawa Toshio , Amano Atsushi
Published: July 2021

Introduction:
Patients requiring aortic valve replacement (AVR) frequently have left ventricular hypertrophy (LVH) /sigmoid septum, which causes persistent outflow obstruction (LVOTO) postoperatively. Surgical AVR enables such patients to undergo concomitant septal myomectomy. However, the effect on their postoperative myocardial function and long-term outcome is yet to be elucidated.

Hypothesis:
Concomitant myectomy may be beneficial for selected patients undergoing surgical AVR and possible LVOTO.

Methods:
Postoperative outcome and myocardial functional changes before and after surgery were assessed by conventional and 2D speckle tracking echocardiography in patients undergoing AVR and myectomy (Group M, n=16, male 21%, mean age 76.0 years) The results were compared with age/sex-matched controls who had marked LVH/LVOTO undergoing AVR alone (Group C, n=27). The relation between preoperative echo-derived local myocardial function and histology of resected myocardium in Group M was also investigated.

Results:
Preoperative echo parameters were not different between the groups. However, a decrease in LV E/E’ and an increase in the absolute value of basal septum longitudinal strain were seen postoperatively only in Group M (17.3±4.3 to 15.2±2.6, p=0.013, -9.3±4.5 to -12.8±3.8%, p=0.008, respectively). Peak LA strain values increased in both groups, but the improvement was more apparent in Group M (Group M; 20.6±5.3 to 28.3±7.1%, p=0.008, Group C; 21.9±5.9 to 26.9±6.0%, p=0.046,). Survival following surgery was better in Group M than Group C (30 days, 1 and 5 year, 100.0% vs 88.2%, 100.0% vs 75.6%, 100.0% vs 68.8%, respectively, p=0.028). Histology of resected myocardium in Group M showed remarkable fibrosis (mean 6.8%, range 1-17%) and thickness of endocardium (mean 1031μm, range 287-2505μm), and the degree of fibrotic area was significantly correlated with preoperative basal septum strain value (r2=0.6, p=0.041).

Conclusions:
Concomitant septal myectomy with AVR improves postoperative LV diastolic function, as well as LA function. Furthermore, it improved short and long-term survival as compared to those undergoing AVR alone. AVR with myectomy may be a beneficial option for patients with marked LVH /sigmoid septum-related LVOTO.
Abstract 13295: Interaction Between Neural and Peripheral Effects of Intravenous Guanfacine in Determining Arterial Pressure and Sympathetic Nerve Activity
Authors: Kawada Toru , Shimizu Shuji , Fukumitsu Masafumi , Li Meihua , Zheng Can , Uemura Kazunori , Sugimachi Masaru
Published: July 2021

Introduction:
Guanfacine is a selective α
2A
-adrenergic agonist and suppresses sympathetic nerve activity (SNA) by acting on the central nervous system. In the use of intravenous guanfacine in animal experiments, however, arterial pressure (AP) does not necessarily fall much even when SNA is markedly suppressed.

Hypothesis:
Intravenous guanfacine may act on peripheral α-adrenergic receptors to increase AP at a given SNA.

Methods:
To separately assess the neural and peripheral effects of intravenous guanfacine, an open-loop analysis of the carotid sinus baroreflex was performed in 7 anesthetized Wistar-Kyoto rats. Carotid sinus pressure was changed from 60 to 180 mmHg in a staircase manner while steady-state SNA and AP were measured. Effects of intravenous guanfacine (100 μg/kg, bolus) on the baroreflex response was examined.

Results:
As shown in the figure, the neural arc of the baroreflex approximated a sigmoid curve. Guanfacine reduced the response range of the neural arc from 89.8±2.2% to 32.9±10.9% (P<0.01) and the minimum SNA from 11.6±1.9% to 2.4±1.2% (P<0.01). The peripheral arc of the baroreflex approximated a straight line. Guanfacine increased the intercept from 67.6±7.1 to 92.8±8.5 mmHg (P<0.01) without significantly affecting the slope of AP versus SNA. The operating point of the baroreflex was determined from the intersection between the neural and peripheral arcs on the baroreflex equilibrium diagram (denoted by a double circle). The operating-point SNA decreased from 47.5±6.0% to 13.6±3.9% (P<0.01) whereas the operating-point AP was not decreased significantly (from 114.7±4.3 to 109.0±7.1 mmHg).

Conclusions:
The operating-point AP and SNA are determined through the interaction between the neural and peripheral effects of intravenous guanfacine. While the operating-point SNA was significantly decreased, the operating-point AP was relatively maintained via the peripheral effect.