bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12688: Age and Sex Disparities in Hypertension Control: The Multi-ethnic Study of Atherosclerosis (mesa)
Authors: Osude Nkiru , Durazo-Arvizu Ramon A , Markossian Talar , Liu Kiang , Michos Erin D , Kramer Holly
Published: May 2021

Introduction:
Blood pressure (BP) control may decline with age and degree of decline may differ by sex.

Methods:
The Multi-Ethnic Study of Atherosclerosis (MESA) recruited 6814 men and women, age 45 to 84 years, from six communities in the U.S. during 2000-2002 and follow-up exams occurred every two years for a total of 6 exams from 2000-2016. We assessed the association of age and sex with hypertension control using MESA data among participants receiving treatment for hypertension at any of the first five exams At each exam, resting BP was measured in triplicate at 1-minute intervals using an automated oscillometric device; we used the mean of last two measurements. Hypertension control was defined as BP < 140/90 mmHg among adults with treated hypertension. Mixed-effects models were used to examine the association of sex with BP control by age group (45-64, 65-84, 85+ yrs) while accounting for the clustering within sites and intra-individual correlation and adjusting for demographics, co-morbidities, smoking, alcohol use, and education.

Results:
Among the 2,017 adults receiving treatment for hypertension (63.1% controlled), the mean age at exam 1 was 64.0 (9.1) yrs, 43.3% male; race/ethnicity was 33.5% White, 9.2% Chinese, 37.2% Black and 20.1% Hispanic. There was a significant interaction of sex*age group (P < 0.001) in mixed-effects models after adjustment for all covariates. The adjusted probability of BP control was then calculated for each sex and age group. Among women, the probability of BP control declined from 74.6% (95% CI 70.8%, 78.5%) for age 45-64 yrs to 55.9% (50.0%, 61.8%) for age 85+ yrs. Among men, probability of BP control declined from 74.0% (70.0%, 78.0%) for age 45-64 yrs to 70.6% (65.7%, 75.5%) for age 85+ yrs. The figure shows the probability of hypertension control by sex and age at a given exam.

Conclusion:
Hypertension control differs by sex. Interventions are needed to address age-related sex disparities in hypertension control.
Abstract 12691: Long-term Optimal Medical Therapy for Patients With Mid-range Left Ventricular Ejection Fraction After Acute Myocardial Infarction
Authors: KO YeeKyoung , JOO Seungjae , Beom Jong Wook , Lee Jae-Geun , CHOI Joon-Hyouk , KIM Song-Yi , JEONG Myung Ho ,   KAMIR-NIH Investigators
Published: May 2021

Introduction:
In the era of the initial optimal interventional and medical therapy for acute myocardial infarction (AMI), a number of patients with mid-range left ventricular ejection fraction (40% <EF<50%) becomes increasing. However, the long-term optimal medical therapy for these patients has been rarely studied.

Aims:
This observational study aimed to investigate the association between the medical therapy with beta-blockers or inhibitors of renin-angiotensin system (RAS) and clinical outcomes in patients with mid-range EF after AMI.

Methods:
Among 13,624 patients enrolled in the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH), propensity-score matched patients who survived the initial attack and had mid-range EF were selected according to beta-blocker or RAS inhibitor therapy at discharge.

Results:
Patients with beta-blockers showed significantly lower 1-year cardiac death (2.4 vs. 5.2/100 patient-year; hazard ratio [HR] 0.46; 95% confidence interval [CI] 0.22-0.98;
P
=0.045) and MI (1.7 vs. 4.0/100 patient-year; HR 0.41; 95% CI 0.18-0.95;
P
=0.037). On the other hand, RAS inhibitors were associated with lower 1-year re-hospitalization due to heart failure (2.8 vs. 5.5/100 patient-year; HR 0.54; 95% CI 0.31-0.92;
P
=0.024), and no significant interaction with classes of RAS inhibitors (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) was observed (
P
for interaction=0.332).

Conclusions:
Beta-blockers or RAS inhibitors at discharge were associated with better 1-year clinical outcomes in patients with mid-range EF after AMI.
Abstract 12802: Trajectory of Recovery Following Sudden Cardiac Arrest After an Initial Icd in a Social Cognitive Theory Intervention
Authors: Dougherty Cynthia M , Sauer Liberato Ana Carolina , Kwan Ka Yee , Zheng Tao , Auld Johathon , Streur Megan M , Thompson Elaine A
Published: May 2021

Introduction:
Sudden cardiac arrest (SCA) survivorship results in unique issues in return to physical & psychological functioning. The
purpose
of this study was to examine trajectories of recovery between SCA survivors & other patients who received an initial secondary prevention implantable cardioverter defibrillator (ICD) & participated in a social cognitive theory (SCT) intervention.

Hypothesis:
One-year recovery trajectories will differ for SCA survivors vs others who received an ICD for secondary prevention.

Methods:
168 (129 men, 39 women) who received an ICD for secondary prevention [VF cardiac arrest (N=65), ICD other reason (N=103)] were randomized to a SCT intervention (N=85) or usual care (N=83). The SCT intervention consisted of 8 weeks of nurse led telephone coaching & self-management strategies to enhance recovery over 1 year. Outcomes measured at baseline hospital discharge, 1, 3, 6, & 12 months included: 1)
Physical Function
[Patient Concerns Assessment (PCA), SF-36 (PCS)]; 2)
Psychological Adjustment
[State Trait Anxiety Inventory (STAI), CES-D depression, SF-36 (MCS)]; & 3)
Self-Efficacy
[SCA Self-Efficacy (SCA-SE), Self-management behaviors (SMB), Outcome Expectations (OE)]. Outcome differences were compared over 12 months by intervention group (SCT vs UC) & by SCA vs. ICD-other groups, using general estimating equations (GEE), adjusting for baseline age, gender, & ethnicity.

Results:
Participants were Caucasian (89%), averaged 63.95±12.3 years, EF% 33.95±13.9, BMI 28.19±6.2, & Charlson Index 4.27±2.3. No significant demographic differences were noted between groups. Physical function (PCS) remained low & anxiety (STAI) high in all groups over time. Self-efficacy (SCA-SE) was lower in SCA survivors compared to others. Physical symptoms (PCA) decreased significantly (Wald
X
2,
8.38, p=0.04) for SCA survivors vs. ICD-others over 1 year; Psychological Adjustment (MCS) was significantly lower in SCA survivors in the SCT intervention at 6 months & recovered at 12 months (Wald
X
2
, 7.25, p=0.05); OEs were significantly lower for SCA survivors in the SCT intervention (Wald
X
2
, 6.99, p=0.008).

Conclusion:
SCA survivors had fewer physical symptoms, lower levels of mental health & OE over 12 months, despite a SCT intervention.
Abstract 12935: Predictors of Long-term Success After Catheter Ablation of Premature Ventricular Complexes
Authors: Im Sung Il , Voskoboinik Aleksandr , Lee Adam C , higuchi satoshi , lee byron , Hsia Henry H , Moss Joshua , Vedantham Vasanth , Marcus Gregory M , Tseng zian , Lee Randall J , scheinman melvin , GERSTENFELD Edward
Published: May 2021

Introduction:
Some patients(pts) have late recurrence after acutely successful radiofrequency catheter ablation(RFCA) of premature ventricular complexes (PVC).

Hypothesis:
The aim of this study was to evaluate predictors of long term success following acutely successful PVC ablation.

Methods:
From 2016-19, we identified consecutive pts at our institution with frequent PVCs undergoing RFCA and reviewed procedural data and medical records. Earliest local activation on the intracardiac bipolar and unipolar electrogram was measured using digital calipers. Acute success was defined as elimination of targeted PVC for at least 30 mins after RFCA. Long term success was defined as absence of PVC on 12 lead ECG during all follow up (f/u) visits and PVC burden reduction >80% or PVC burden <5% on f/u monitoring at 1 year.

Results:
Among 241 pts, 161 (66.8%) pts had long term success with mean f/u of 17.6±5.8 months.In univariate analysis, diabetes mellitus and alcohol use were associated with PVC recurrence while age, female sex, acute success, ablation time, right ventricular PVC origin, single PVC morphology (sPVC), and earliest bipolar activation>24msec pre-QRS were associated with long-term success. In multivariate analysis, female sex, sPVC and earliest activation >24 msec preQRS were independent predictors of long term success at 1 year. The positive predictive value of earliest bipolar onset preQRS of PVC>24msec for long term success was 0.77(P<0.001). Negative predictive value of earliest onset preQRS <15msec for long term success was 0.86(P=0.003), suggesting that ablation when the local bipolar electrogram preceded the QRS by <15ms was unlikely to result in long term success.

Conclusions:
Female gender, sPVC, and earliest onset of bipolar electrogram preQRS>24msec were predictors of long term success in patients with PVC undergoing RFCA. If local onset is <15ms, RF ablation is not worthwhile. The reason for improved outcome in females requires further study.
Abstract 12936: Impact of Mitral Regurgitation on Heart Failure Hospitalization and Mortality in Older Age Adults With a Preserved Ejection Fraction
Authors: Jiang Ginger Y , Manning Warren J , Markson Lawrence , Garan A. R , Sabe Marwa A , Strom Jordan B
Published: May 2021

Background:
The effect of mitral regurgitation (MR) severity on heart failure (HF) hospitalization and mortality in individuals with a preserved ejection fraction (LVEF) and no prior HF history is uncertain.

Methods:
Transthoracic echocardiogram (TTE) reports from patients with an LVEF > 50% at our institution were linked to complete Medicare inpatient claims, 2003-2017. Patients with HF hospitalization within the 12 months prior to TTE were excluded. We evaluated the relationship of baseline MR severity and time to the composite of all-cause mortality or HF hospitalization using the Kaplan-Meier technique. Secondary outcomes included the individual components of all-cause mortality and HF hospitalization, adjusting for the competing risk of death with Fine-Gray methods.

Results:
A total of 18,315 individuals met inclusion criteria (77.6 ±7.7 years, 54.3% female). Over a median follow-up time of 6.5 (IQR 3.0 to 10.2) years, the primary endpoint occurred in 7566 individuals (50.6%) of whom 6,927 (37.8%) died and 1703 (13.9%) were admitted for HF at a median of 1.4 (IQR 0.2 to 4.3) years and 1.6 (IQR 0.2 to 4.3) years respectively (
Figure
). After multivariable adjustment, MR severity was not associated with the primary or secondary outcome at 1-, 3-, 5-, or 10-years after TTE (p > 0.05 for all). Mitral valve prolapse (MVP) was associated with decreased risk of the primary outcome at 1-year and 3-years (interaction p-value = 0.04 for both). Jet eccentricity did not impact the observed relationship (interaction p-value > 0.05).

Conclusions:
In this large, single institution echocardiographic study of individuals with preserved ejection fraction and no prior history of HF, MR severity was not associated with an increased risk of all-cause mortality or HF hospitalization. Presence of MVP was associated with decreased risk of the primary outcome with increasing MR severity.
Abstract 12968: Impact of Loop Diuretics Use on Skeletal Muscle Depletion Among Patients Being Evaluated for Known or Suspected Coronary Artery Disease a Propensity Score Matching Analysis
Authors: Sahashi Yuki
Published: May 2021

Background:
It is well known that sarcopenia worsens the prognosis among patients with heart failure (HF). Causes and incidence of sarcopenia in patients with HF have become more important because of the increasing number of elderly HF patients worldwide. Although previous basic research suggested that loop diuretics can lead skeletal muscle depletion, the relationship has not been clarified in the clinical settings. The purpose of this study is to investigate the relationship between skeletal muscle loss and use of loop diuretics in patients with HF.

Methods:
We retrospectively evaluated 178 patients being evaluated for known or suspected coronary artery disease with cardiac catheterization from January 2010 to January 2019 and receiving abdominal computed tomography (CT) both baseline and at follow-up (mean 522 days).The skeletal muscle cross-sectional area was measured using CT scan at the level of third vertebra and total volume of the skeletal muscle cross-sectional area with five slices every 1mm apart was evaluated. Impact of loop-diuretics use on skeletal muscle depletion and overall survival was evaluated using 1:1 propensity score (PS) matching analysis.

Results:
A total of fifty-eight patients were evaluated (twenty-nine patients in both loop-diuretics use group and non-loop group) after 1:1 PS matching. The median absolute muscle-loss volume was significantly larger in loop diuretics use group (714 cm
2
) compared to non-loop group (73.3cm
2
). (p=0.026) Univariable analysis revealed that duration-adjusted skeletal muscle depletion volume was significantly associated with loop diuretic use (Δ=480cm
2
/year: 95% confidence interval, 64.1-897: p=0.024). Median overall survival was 796 days in the loop-diuretics use group and 865 days in the non-loop diuretics group (hazard ratio 0·99, 95% CI 0·35-2.75; p=0.979).

Conclusion:
Our study suggested that the use of loop diuretics can be related with skeletal muscle loss among patients being evaluated for known or suspected coronary artery disease.
Abstract 12980: Impaired Left Atrial Function is Associated With Increased Rehospitalisation in Patients With Non-valvular Atrial Fibrillation
Authors: Bhat Aditya , Chen Henry H , Khanna Shaun , Gan Gary , Nawaz Sumreen , Fernandez Fernando , Abhayaratna Walter P , MacIntyre C. Raina , Tan Timothy C
Published: May 2021

Introduction:
Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice with a high clinical and economic burden, largely driven through hospital admissions. Left atrial (LA) size and function have been shown to be powerful predictors of cardiovascular disease. We evaluated the relationship between LA function and AF rehospitalisation.

Hypothesis:
Impaired LA is a predictor of AF rehospitalisation.

Methods:
Consecutive patients admitted to a tertiary referral centre (Jan 2013 - Dec 2017) with a diagnosis of non-valvular AF and who underwent transthoracic echocardiogram during their index admission were evaluated for the primary study outcome of AF rehospitalisation.

Results:
Of the 665 patients (68±14 years, 52% men), 72.2% had paroxysmal AF, 23.4% had persistent AF and 4.4% had permanent AF. The cohort had high cardiovascular comorbidities (33% IHD, 29% HF and 10% previous stroke/TIA). Over a follow-up period of 33 ± 21 months, 253 (38%) patients were rehospitalised for AF. Impaired eGFR (p=0.03), persistent/permanent AF (p=0.05) and indices of LA size and function [see Kaplan Meier curves; LA volume index (LAVI), p<0.01; LA emptying fraction (LAEF), p=0.01; LA expansion index (LAEI), p=0.02; LA function index (LAFI), p<0.01] predicted AF rehospitalisation. Parameters of left ventricular size and function were not predictive of the primary outcome. Multivariable Cox regression models revealed that LAEF (HR 1.58, 95%CI 1.06 to 2.35, p<0.01), LAFI (HR 2.02, 95%CI 1.34 to 3.04, p<0.01) and LAEI (HR 1.58, 95%CI 1.06 to 2.34, p=0.03) were independent predictors of AF rehospitalisation.

Conclusions:
Impaired LA function is a predictor of AF rehospitalisation.
Abstract 12981: Association of Serum Growth Differentiation Factor-15 With Egfr, Hemoglobin and Sarcopenia in Healthy Community-dwelling Older Females
Authors: Fukuda Taira , Toyoda Shigeru , Abe Shichiro , Inoue Teruo , Nakajima Toshiaki
Published: May 2021

Introduction:
Anemia and sarcopenia with renal dysfunction caused by cytokine imbalance can contribute to decreased quality of life for older individuals. Several studies showed that serum GDF-15 level, a member of the TGF-β cytokine superfamily, was negatively correlated with eGFR. In this study, we examined the association of GDF-15 with eGFR, hemoglobin (Hb) and sarcopenia in healthy community-dwelling older females.

Methods:
A total of 66 healthy older community-dwelling females (age: 75.8 ± 6.2 years) were enrolled for this study. Skeletal muscle mass index (SMI) by bioelectrical impedance analysis, hand-grip strength and walking speed were assessed, and sarcopenia was evaluated. Serum GDF-15 concentration was determined by enzyme-linked immunosorbent assay. Hb, serum iron (Fe), serum albumin (Alb) and high-sensitive C reactive protein (hsCRP) levels were measured and estimated glomerular filtration rate (eGFR) was evaluated. Multiple linear regression analyses with serum GDF-15 concentration, eGFR and Hb as the dependent variable were performed to identify influencing independent factors.

Results:
Among the study subjects, 4 (6%) had sarcopenia. The serum GDF-15 level was positively correlated with age (r = 0.486, p < 0.001) and negatively correlated with walking speed (r = -0.363, p = 0.003), but there was no correlation between GDF-15 level

and hand-grip strength or SMI. Serum GDF-15 level was also negatively correlated with eGFR (r = -0.535, p < 0.001) and serum Fe level, but had no correlation with hsCRP, Hb or Alb levels. In multiple regression analysis, eGFR and Hb were independent variables to predict serum GDF-15 level, even after adjusting for age and body mass index (eGFR: β = -0.423, p <0.001; Hb: β = -0.363, p=0.004). Serum GDF-15 level was an independent variable to predict eGFR and Hb.

Conclusions:
Serum GDF-15 level was negatively correlated with eGFR, although it had no correlation with muscle strength or mass. Both Hb and eGFR were predictors for serum GDF-15 concentration in healthy older females. In these community-dwelling older females, renal dysfunction via GDF-15 might be accompanied by anemia, but not sarcopenia.
Abstract 12985: Efficacy and Safety of Mechanical versus Manual Compression in Cardiac Arrest and Cardiogenic Shock Patients
Authors: Nagasaka Takashi
Published: May 2021

Introduction:
Mechanical chest compression (MCC) provides consistent pressure and timing of each chest compression in line with latest evidenced-based practice. However, there has been no evidence from large randomized trials about the effectiveness of the mechanical device compared with manual chest compression. Furthermore, few studies focused on cardiogenic shock and cardiac arrest related to heart disease.

Hypothesis:
The aim is to assess the effectiveness and safety of mechanical chest compressions versus manual chest compressions in patients with out of hospital cardiogenic shock and cardiac arrest due to heart disease.

Methods:
We conducted a retrospective observational study of comparing the outcomes of mechanical and manual chest compressions. A total of 69 consecutive patients with out of hospital cardiogenic shock and cardiac arrest were enrolled between April 2014 and May 2018. 39 patients of them received only manual cardiopulmonary resuscitation (CPR) and 30 utilized a mechanical CPR device. Baseline characteristics, resuscitation details, and outcomes were compared between patients who received manual (manual group) and mechanical compressions (MCC group).

Results:
There was no significant difference in age, gender, the rate of bystander CPR and arterial blood gases at baseline. No differences were found for the rate of ROSC and 30-day survival between two groups. However, MCC group had significantly higher rate of bleeding events than manual group. In addition, fifty-four patients of them were treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO). Among patients underwent VA-ECMO, the rate of 30-day survival was significantly lower in MCC group. (Figure 1).

Conclusions:
This study showed that mechanical chest compression increased bleeding events than manual chest compression. Furthermore, in the patients underwent ECMO, the use of mechanical chest compression might be associated with higher mortality.
Abstract 12989: Long-term Prognostic Value of Fibrosis-4 Index and Albumin-bilirubin Score in Patients Admitted for Acute Decompensated Heart Failure
Authors: Yamada Takahisa , Watanabe Tetsuya , Morita Takashi , Furukawa Yoshio , Tamaki Shunsuke , Kawasaki Masato , Kikuchi Atsushi , Kawai Tsutomu , Seo Masahiro , Nakamura Jun , Kayama Kiyomi , Kawahira Masatsugu , Ueda Kumpei , Kimura Takanari , Sakamoto Daisuke , Fukunami Masatake
Published: May 2021

Backgrounds:
Cardiohepatic interactions have been a focus of attention among heart failure (HF). It was reported that liver stiffness assessed by non-invasive fibrosis marker such as Fibrosis-4(FIB4) index provide prognostic information in HF patients. Furthermore, the albumin-bilirubin (ALBI) score has recently been proposed as a validated index of liver dysfunction. We sought to investigate the long-term prognostic values of the combination of FIB4 index and ALBI score in patients admitted for acute decompensated heart failure (ADHF).

Methods and Results:
We studied 299 ADHF pts with survival discharge. FIB4 index was calculated by the formula: age(yrs) х AST[U/L]/(platelets [10
3
/μL] х (ALT[U/L])
1/2
). The ALBI was calculated using the formula: log
10
(total bilirubin) х 0.66 + albuminх-0.085. During a follow-up period of 4.3±3.3 yrs, 94 patients died. At multivariate Cox analysis, FIB4 index and ALBI score were significantly associated with total mortality, independently of prior HF hospitalization and body mass index after adjustment with systolic blood pressure, left ventricular end-diastolic dimension and left atrial dimension indexes. Patients with both greater FIB4 index (>3.608: top tertile) and ALBI score (>-2.076:top tertile) had a significantly higher risk of total mortality than those with either or none of them (46% vs 34% vs 25%, respectively, p=0.002).

Conclusion:
The combination of FIB4 index and ALBI score might identify higher risk subset for total mortality in ADHF patients.
Abstract 12991: Growth Differentiation Factor-15 is a New Predictor of Cardiovascular Events in Atrial Fibrillation Patients After Elective Percutaneous Coronary Intervention
Authors: Krivosheeva Elena , Kropacheva Ekaterina , Titaeva Elena , Dobrovolsky Anatoly , Samko Anatoly , Panchenko Elizaveta
Published: May 2021

Introduction:
Patients (pts) with AF, undergoing elective PCI, receiving multicomponent antithrombotic therapy (MAT) have high risk of stroke/systemic embolism and coronary events. There is no biochemical markers associated with negative prognosis in AF pts after elective PCI. Growth differentiation factor-15 (GDF-15) has demonstrated strong relationship with adverse prognosis in pts with cardiovascular disease.

Purpose:
To investigate the prognostic value of GDF-15 level in AF pts after elective PCI.

Methods:
150 pts (104 males), aged 70.8±8.5 years, with AF after elective PCI were enrolled in the prospective study. All pts received DOACs and double (89.3%) or single (10.7%) antiplatelet therapy. Median duration of follow up period was 11.5 months [IQR 8.0; 12.0]. Efficacy endpoint of the study was the sum of cardiovascular events (CVE): ACS, ischemic stroke (IS), VTE, cardiovascular death and need for unplanned PCI. Plasma samples for GDF-15 were analyzed using ELISA.

Results:
AF pts receiving MAT demonstrated high thrombotic risk (CHA
2
DS
2
-VASc, Med 5 [IQR 4; 6]), high rate of comorbidity (index Charlson, Med 7 [IQR 5; 9]). Frequency of CVE during follow up period was 16% (ACS 2; fatal IS 2; VTE 2, include 1 fatal pulmonary embolism; cardiovascular death 2; pts needed an unplanned PCI 16). Median GDF-15 level was 1270 pg/ml [IQR 953; 1778]. According to multiple regression analysis GDF-15 level was associated with the D-dimer (t=3.20; p=0.0018), diabetes mellitus (t=3.97; p=0.0001) and clinical and angiographic Syntax II score (t=4.77; p<0.0001). In pts with only coronary artery disease, the level of GDF-15 was significantly lower than in pts with atherosclerotic lesion of 3 vascular pools (p=0,0119). According to ROC analysis GDF-15 level > 1191 pg / ml (sensitivity 83.0, specifity 50.0) increase the probability of the development of CVE (AUC=0.647, p=0.0076, 95% CI 0.565–0.723). Kaplan-Meier curves demonstrated significant difference in CVE free survival between the patients with GDF-15 level > and ≤ 1191 pg/ml (75.9% and 94.0% respectively, log-rank test p = 0.0032, [HR 4.36, CI 1.50-7.48]).

Conclusions:
GDF-15 is a possible marker of CVE determining prognosis in AF pts after elective PCI. The results could be used to individualize the duration of MAT.
Abstract 12993: Oral Anticoagulation Prescription Depends on Both Atrial Fibrillation Duration and CHA
2
DS
2
-VASc Score
Authors: Kaplan Rachel M , Ziegler Paul D , Koehler Jodi L , Landman Sean , Sarkar Shantanu , Passman Rod S
Published: May 2021

Introduction:
Current guideline recommendations for oral anticoagulation (OAC) in patients with atrial fibrillation (AF) are based on CHA
2
DS
2
-VASc score alone. In patients with cardiac implantable electronic devices (CIEDs), it is poorly understood how the interaction between AF duration and CHA
2
DS
2
-VASc score influence the decision to prescribe OAC.

Methods:
Data from the Optum® de-identified Electronic Health Record dataset were linked to the Medtronic CareLink database of CIEDs. An index date was assigned as the later of 6 months after device implant or 1 year after EHR data availability. CHA
2
DS
2
-VASc score was assessed via EHR data prior to the index date. Maximum daily AF burden (No AF, 6 minutes-23.5 hours, and >23.5 hours) was assessed over the 6 months prior to index date. OAC prescription rates were computed prior to the index date as a function of both AF duration and CHA
2
DS
2
-VASc score.

Results:
A total of 35,779 patients with CHA
2
DS
2
-VASc scores ≥1 were identified, including 8,581 who were prescribed OAC and 27,198 not prescribed OAC during the observation period. The overall OAC prescription rate among the subset of 12,938 patients with device-detected AF >6 minutes was 36.7% and the rate was nearly 60% higher for patients with a maximum daily AF burden >23.5 hours (45.4%) compared to those with 6 minutes-23.5 hours (28.7%). OAC prescription rates increased monotonically with both increasing AF duration and CHA
2
DS
2
-VASc score, reaching a maximum of 67.2% for patients with AF >23.5 hours and a CHA
2
DS
2
-VASc score ≥5 (Table).

Conclusion:
In contrast with guideline recommendations, real-world prescription of OAC increased with both increasing duration of AF and CHA
2
DS
2
-VASc score. This mirrors recent evidence demonstrating that stroke risk also increases with both of these features and highlights the need for further research into the role of AF duration, stroke risk, and the need for anticoagulation in patients with devices capable of long-term AF monitoring.
Abstract 13020: Obesity-related Vascular Functional Change Becomes Apparent in Early Childhood
Authors: Harada Kenji , Harada Yukiko
Published: May 2021

Background:
Obesity is associated with structural and functional changes in the artery, but there is little information when arterial dysfunction begins to appear. The purpose of this study is to investigate the relationship between body mass index (BMI) z-score and arterial function from childhood to adolescence.

Methods:
Echocardiography was performed in 779 healthy children. Subjects were divided into 3 age groups: pre-school children group, 4 to 6 year (n =236); school children group, 7 to 12 years (n = 385); adolescents group, 13 to 20 years (n = 158). Stroke volume was calculated using aortic diameter and pulsed Doppler velocity profile. SV was indexed for body surface area (SVI). Effective arterial elastance (Ea) was estimated by end-systolic pressure/SVI and total arterial compliance (Ca) by pulse pressure/SVI. Quantitative B-mode ultrasound scans were used to measure intima-media thickness and diameters of the common carotid artery.

Results:
Intima-media thickness of carotid artery did not change with BMI z-score in the pre-school and school children groups (r = 0.09 and 0.11, p > 0.05, respectively), but a weak but significant correlation between intima-media thickness of carotid artery and BMI z-score was found in the adolescents group (r = 0.20, p < 0.05). In the pre-school children group, Ea and Ca did not correlate with BMI z-score, but there were significant relationships between BMI z-score and Ea and Ca in the school children (r = 0.27 and 0.16, p < 0.01, respectively) and in the adolescents groups (r = 0.38 and 0.29, p < 0.01, respectively). The slope of the relationship between BMI z-score and Ea in the adolescents group was significantly steeper compared with the school children group (p<0.05).

Conclusion:
Obesity-related arterial functional changes begin to appear in younger school children, however, remodeling of the common carotid artery is not yet present. With advancing age, negative effects of obesity on vascular functional and morphological changes become apparent. Our findings suggest that primary prevention programs should be initiated in early childhood.
Abstract 13024: Cardiovascular Disease Beyond the Aorta in Marfan Syndrome
Authors: Andersen Niels H , Groth Kristian A , Berglund Agnete , Gravholt Claus H , Stochholm Kirstine
Published: May 2021

Introduction:
Aortic disease is the major cardiovascular disease in Marfan syndrome (MFS), however numerous studies indicate that other heart conditions may also be a major disease burden for patients with MFS

Hypothesis:
We hypothesized that the burden of non-aortic cardiovascular disease in MFS is considerable and the aim of the study is therefore to assess the extent of this issue in Danish patient with MFS.

Methods:
A register-based population study of Danish patients with a Ghent II verified Marfan Syndrome diagnosis. All patients were alive January 1st 1994, at the beginning of the ICD-10 system. Each patient was age-matched with up to 100 controls with the same sex.

Results:
We identified 407 MFS patients from the Danish healthcare system (1977-2014) and compared our findings with 40,700 persons from the background population. We found the following hazard ratios and confidence intervals:
Mitral valve disease
HR: 60.8 [39.5-93.5], p<0.0001.
Cardiomyopathy
HR:12.7 [5.8-28.0], p<0.0001.
Heart failure
HR 8.2 [5.2-12.9], p <0.0001.
Tachyarrhythmia
HR: 9.7 [7.5-12.6], p <0.0001.
AV-Block
HR: 4.7 [1.5-15.1], p<0.01.
Sudden cardiac death
HR: 8.3 [3.8-18.0], p<0.0001.
Discussion:
The registration of mitral valve disease occurred earlier and more often in women with MFS compared to men with MFS (age at registration: 22 vs. 38 years, HR: 2.2 (1.1-4.6) Among patients with arrhythmia 20 % had ventricular ectopics or tachycardia. Forty percent of the cases with tachyarrhythmia were unrelated to heart surgery and 37 % of the total cohort had tachyarrhythmia without having any surgery done. AV-block was in all cases related to heart surgery. Twenty patients with MFS had a registration with heart failure, whereof 9 were diagnosed unrelated to heart surgery. Looking only at registrations unrelated to heart surgery the HR was 4.8 (2.5-9.5). There was no difference in registration of heart failure between men and women. The sudden cardiac death etiology was unclear due to lack of autopsies.

Conclusion:
The burden of non-aortic cardiovascular disease is massive in patients with MFS and this must be in focus in the caretaking of patients with MFS
Abstract 13033: C-src Phosphorylates the Mitochondrial Ca
2+
Uniporter in Nonischemic Cardiomyopathy
Authors: Xie An , Kang Gyeoung-Jin , Kim Eun Ji , Polina Iuliia , Feng Feng , Jhun Bong Sook , O-uchi Jin , Dudley Samuel C
Published: May 2021

Introduction:
We have described previously an arrhythmic mechanism in nonischemic heart failure (NI-HF) involving an increased mitochondrial Ca
2+
uptake that results in QT prolongation and lethal arrhythmias. This arrhythmic mechanism is associated with mitochondrial Ca
2+
uniporter (MCU) tyrosine phosphorylation (p-Tyr).

Hypothesis:
Here, we determined which kinase was responsible for MCU phosphorylation in cardiomyopathy.

Methods:
NI-HF was induced by hypertension in Wt C57BL6 mice by unilateral nephrectomy, deoxycorticosterone acetate (DOCA) treatment and substituting drinking water with 1% saline for six weeks. Western blot, immunoprecipitation, fluorescence resonance energy transfer (FRET) and patch-clamp techniques were employed in isolated mouse cardiomyocytes.

Results:
When compared to control hearts, the protein level of p-Src
S17
increased significantly accompanied by significant enhancement of tyrosine but not serine/threonine phosphorylation of MCU in NI-HF mouse hearts. In a heterologous expression system, c-Src could bind MCU and tyrosine phosphorylate MCU. This phosphorylation was blocked by a c-Src inhibitor, PP1. Overexpression of constitutive active c-Src (Src-Y527F) significantly increased MCU inward current at -160 mV. It suggested that c-Src activation was directly related to mitochondrial-mediated arrhythmic risk. Downregulation of C-terminal Src kinase (CSK), a regulatory kinase inversely related to c-Src activity, increased p-Src, enhanced mitochondrial and SR contact, and facilitated mitochondrial Ca
2+
uptake in NI-HF mouse cardiomyocytes. Proline-rich tyrosine kinase 2 (Pyk2) did not contribute more phosphorylated MCU during cardiomyopathy as the protein expression of PyK2, p-PyK2
Y402
and p-PyK2
Y579/580
did not change during NI-HF. Correlation using human heart tissue showed that NI-HF patients had significantly increased p-Src
S17
associated with an increased incidence of QTc elongation and arrhythmia.

Conclusions:
During cardiomyopathy, c-Src activation directly tyrosine phosphorylated MCU, increased MCU current, and increased mitochondrial/SR contact, suggesting this kinase is responsible for the increase in mitochondria-mediated arrhythmic risk seen in NI-HF.
Abstract 13039: Loss of Visceral Adipose Tissue Macrophage Subsets Induces Myocardial Infarction Induced Insulin Resistance: Role of Adiponectin
Authors: Vasamsetti Sathish Babu B , zhang xinyi , Coppin Emillie M , Florentin Jonathan , Koul Sasha , Gotberg Matthias , Clugston Andrew S , Thoma Floyd , Sembrat John , Bullock Grant C , Kostka Dennis , St. Croix Claudette M , Chattopadhyay Ansuman , rojas mauricio , Mulukutla Suresh , Dutta Partha
Published: May 2021

Introduction:
Myocardial infarction (MI) is the major cause of morbidity and mortality in the western world. Insulin resistance is a major complication in patients with MI.

Hypothesis:
Loss of visceral adipose tissue (VAT) resident macrophages in MI results in diminished adiponectin production causing systemic insulin resistance.

Methods:
To understand if MI results in insulin resistance, we analyzed UPMC patient records and identified patients who had normal fasting blood glucose levels on average 15 days before ST elevation myocardial infarction (STEMI) and checked their fasting blood glucose levels 30 days after STEMI. To understand the mechanisms of MI-induced insulin resistance, we used a mouse model of coronary ligation in C57BL/6 mice and analyzed the features of insulin resistance by measuring serum insulin, serum adiponectin, AKT activation status in the liver and muscle.

Results:
We found that 50% of non-diabetic patients (fasting blood glucose levels 99±2.5 mg/ dl) developed hyperglycemia (141±13 mg/dl) after MI, suggesting that MI causes insulin resistance. Consistently, mice with MI had higher fasting blood insulin, and reduced p-Akt levels in the liver and skeletal muscles confirming insulin resistance. Concomitantly, mice and patients with MI had reduced number of visceral adipose tissue (VAT) resident macrophages. In line with this, MI resulted in marked reduction in the level of macrophage colony stimulating factor (M-CSF), a cytokine required for tissue resident macrophage survival. M-CSF supplementation in mice with MI improved insulin sensitivity and decreased inflammatory phenotype of VAT macrophages. Furthermore, the systemic level of adiponectin, which is reported to augment insulin sensitivity, was profoundly reduced in mice after MI. Specific depletion of VAT resident macrophages resulted in lower levels of adiponectin in the serum, indicating that this macrophage subset is necessary for adiponectin production by adipocytes.

Conclusions:
Our data demonstrate that diminished M-CSF levels after MI triggers apoptosis of VAT resident macrophages, resulting in reduced adiponectin secretion and systemic insulin resistance.
Abstract 13045: Chronic Beta3-Adrenergic Receptor Antagonist Therapy Rescues Diabetic Cardiomyopathy in a Mouse Model With Type 2 Diabetes: Insights into Cellular Mechanism
Authors: Cao Jing , Sun Xiaoqiang , Cheng Heng Jie , Liu Yixi , Kitzman Dalane , Zhao David , McClain Donald A , Cheng Che
Published: May 2021

Background:
Diabetic cardiomyopathy (DCM) leads to progressive decline in cardiac function, increasing the risk for heart failure. There are no known effective prevention approaches or therapeutic strategies. Recent evidence in diabetes mellitus (DM) human and animal hearts suggests that the up-regulation of β
3
-adrenergic receptor (AR)-mediated inhibitory pathway may be responsible for the progression of DCM. However, its precise role is still being debated. We hypothesize that β
3
-AR antagonists (β
3
-ANT) may rescue the detrimental effects of β
3
-AR activation, improve cardiomyocyte function, and preserve normal β-AR regulation, leading to the regression of DCM.

Methods:
We compared LV myocyte function, [Ca
2+
]
i
transient ([Ca
2+
]
iT
) at baseline and responses to β-AR simulation with isoproterenol (ISO,10
-8
M) in 3 groups wild-type female mice over 14 weeks (W):1)
Type 2 DM
(
T2
) (n=9), 14 W fed high-fat diet (HFD), but after HFD for 4 W receiving streptozotocin (STZ, 40 mg/kg/day, i.p. 5 days); 2)

T2/β
3
-ANT

(n=7), T2 mice at 10 W received L-748,337, a selective β
3
-ANT (10
-7
M/kg/day, mini-pump) for 4 W; and 3)
Vehicle controls
(C) (n=9).

Results:
Versus C, T2DM was induced in mice received HFD and low dose STZ with significantly elevated blood glucose levels (T2: 388, T2/β
3
-ANT: 369 vs C: 128 mg/dl). In T2, LV myocyte basal function and [Ca
2+
]
iT
regulation were impaired measured as significantly decreased myocyte contractility (dL/dt
max
) (76.8 vs 135.2 μm/s), relengthening (dR/dt
max
) (62.1 vs 113.8 μ m/s) and [Ca
2+
]
iT
(0.16 vs 0.21). Furthermore, versus C, in T2 myocytes, ISO-induced increases in dL/dt
max
(T2: 40% vs C: 58%), dR/dt
max
(35% vs 54%) and [Ca
2+
]
iT
(19% vs 30%) were significantly reduced. By contrary, versus T2, T2/β
3
-ANT myocytes showed normal basal cell contraction (127.8 μm/s), relaxation (109.4 μm/s) and [Ca
2+
]
iT
(0.21) with preserved ISO-stimulated positive inotropic effect. Versus C, in T2/β
3
-ANT, ISO caused similar increases in dL/dt
max
(57%), dR/dt
max
(52%) and [Ca
2+
]
iT
(30%).

Conclusion:
Chronic β
3
-ANT leads to the preservation of LV myocyte function, [Ca
2+
]
iT
, and β-AR responsiveness in a mouse model of type 2 diabetes. Thus, antagonizing β
3
-AR might provide a new therapeutic strategy for DM-related decline in myocardial function.
Abstract 13047: Plasma Protein Expression and Incident Cvd, and the Role of Resilience: Results From the Mediators of Atherosclerosis in South Asians Living in America (masala) Study
Authors: Ngo Long , Argentieri Austin , Dillon Simon , Kanaya Alka M , Shields Alexandra , Libermann Towia
Published: May 2021

Introduction:
Few proteomics studies have included non-white individuals, and none have explored the influence of resiliency resources on the association between proteins and cardiovascular disease (CVD). Religious and spiritual beliefs and practices are understudied resiliency resources that may attenuate the influence of proteins associated with increased risk of CVD.

Methods:
We conducted a nested case-control study using data from the MASALA Study. We used baseline plasma samples from 50 South Asian participants with incident CVD and 50 sex- and age-matched controls. We analyzed plasma samples by SOMAscan, an aptamer-based proteomics platform, for 1305 unique proteins. Multivariable logistic regression models and model selection using Akaike Information Criteria were performed on the proteins and clinical covariates. We assessed the influence of measures of spiritual practices on the association between proteins and incident CVD events.

Results:
We identified 36 proteins that were significantly dysregulated among CVD cases compared to matched controls. These proteins are involved in immune cell recruitment, atherosclerosis, endothelial cell differentiation, and vascularization. A final multivariable model found three proteins (Contactin-5, Low affinity immunoglobulin gamma Fc region receptor II-a, Complement factor B) associated with CVD after adjustment for diabetes (c-statistic=0.82). Negative religious coping significantly modified the effect of Contactin-5 and Complement factor B for risk of CVD. (
Table
)

Conclusions:
Three novel plasma proteins were associated with incident CVD, and negative religious coping significantly modified the effect, in this pilot study of South Asians. Further investigation is needed to understand proteomic profiles across diverse communities, and the role that resiliency resources in modifying the putative effect of proteomic signatures.
Abstract 13082: The Impact of Specific Therapy on Glucose Metabolism in Pulmonary Arterial Hypertension Patients - Follow Up Study
Authors: Kazimierczyk Remigiusz , Szumowski Piotr , Nekolla Stephan , Blaszczak Piotr , Malek Lukasz A , Hladunski Marcin , Sobkowicz Bozena , Mysliwiec Janusz , Grzywna Ryszard , Musial Wlodzimierz J , Kaminski Karol
Published: May 2021

Introduction:
Right ventricular (RV) function is a major determinant of survival in patients with pulmonary arterial hypertension (PAH). In our previous study, we confirmed that increased RV fluorodeoxyglucose (FDG) uptake in positron emission tomography (PET) (presented as higher ratio of FDG uptake of RV to LV) was associated with progressive RV dysfunction and preceded hemodynamic and clinical deterioration in PAH patients. Now, we obtained second PET/MRI assessments of the study group after 2-years of PAH-targeted treatment.

Hypothesis:
Altered cardiac glucose uptake in severe PAH patients may change after PAH specific treatment.

Methods:
Twenty-eight PAH patients (51.32±15.91 years) had simultaneous PET/MRI scans performed during baseline visit. Second PET/MRI assessments were done after 2 years in the group of twenty patients (four deaths, four patients did not agree to perform additional scans).

Results:
After follow-up period, we observed significant change of MRI-derived RV ejection fraction (45±10% to 51.2±12.7%, p=0.03), and improvement in hemodynamic parameters obtained from right heart catheterization e.g. mean pulmonary artery pressure, mPAP (48.5±17.2 to 41.8±17.1 mmHg, p=0.01) and pulmonary vascular resistance, PVR (8.7±5.3 to 7.0±4.2 WU, p=0.04). Follow-up SUVRV/SUVLV ratio was lower than baseline (0.84±0.57 vs 1.02±0.75, p=0.05) and significantly correlated with follow-up RV hemodynamic parameters confirming relationship between RV function and metabolic alterations. Interestingly, patients who had improvement in SUVRV/SUVLV (lower follow-up value than baseline, n=11) had significantly higher mPAP at baseline visit (58.9±18.7 vs 40.3±11.8 mmHg, p=0.02), suggesting that RV FDG accumulation in advanced PAH may decrease after the specific PAH-treatment in accordance with the degree of reduction in the pulmonary vascular resistance.

Conclusions:
Impaired RV function is associated with increased glucose uptake of RV myocytes estimated by FDG PET in PAH patients. Targeted treatment may improve RV function and thus affect previously altered cardiac glucose uptake.
Abstract 13091: Pemafibrate Reduced Hepatic Fibrosis and Cardiac Inflammation in Cholesterol-dominant, Atherogenic-Diet Induced Steatohepatitis Model in Mice
Authors: Kanno Kotaro
Published: May 2021

Introduction:
Pemafibrate reduces serum triglycerides level and has been reported that it also decreased hepatic triglycerides. In recent decades, the number of patients with nonalcoholic fatty liver diseases has increased and it has become a problem that the patients with steatohepatitis would develop cardiovascular diseases.

Aim:
The aim of this study is to analyze the effect of pemafibrate on hepatic inflammation and cardiac function in a diet-induced steatohepatitis model.

Methods:
C57Bl/6 wild mice were administered cholesterol-loading atherogenic-diet (Cont group) or the one with pemafibrate 0.1 mg/kg (Pema group) for 3 or 8 weeks, respectively. Serum lipids, hepatic inflammatory cytokines, histology, gene expression, lipid contents, and cardiac magnetic resonance imaging (MRI) were investigated. Left ventricular strain was analyzed by workstation of ENTORRES©.

Results:
In Pema group, serum HDL-C level was increased, non-HDL-C level was decreased. serum TNFα was decreased (82.0±10.8 v.s. 48.0±2.1, p<0.0001). In liver, gene expression of TNFa, Il1b, Il6, Tgfb, Col1a, Col2a showed marked reduction. In HE staining, destruction of the hepatic lobule structure was improved. F4/80 staining demonstrated marked reduction of macrophage infiltration. In Tunel staining, apoptosis cell was suppressed. Liver lipid extraction study showed total cholesterol and free cholesterol were decreased by 50%. MRI scanning demonstrated that heterogeneous attenuation of longitudinal strain of left ventricular (Figure).

Conclusion:
Pemafibrate suppresses liver inflammation and inhibit left ventricular dysfunction caused by cholesterol-rich-atherogenic diet.
Abstract 13093: Clinical Features and Prognosis of Acute Cardiac Injury in Hospitalized Patients With Covid-19: A Retrospective Cohort Study
Authors: XIE Mingxing , Zhang Li , zhang yanting , Sun Wei , WU CHUN , Wang Bin , Xie Yuji
Published: May 2021

Aims:
The fatalities case due to coronavirus disease 2019 (COVID-19) is escalating. However, information on critical complications in hospitalized patients of COVID-19 is scant. We aimed to explore the prevalence of acute cardiac injury and its association with in-hospital mortality in COVID-19 patients.

Methods:
This retrospective study analyzed COVID-19 patients in Union Hospital (Wuhan, China) from Jan 24 to March 18, 2020. Clinical outcomes (discharge, or death) were monitored to April 9, 2020, the latest date of follow-up. Demographic, clinical, laboratory, echocardiographic data, treatment and prognosis were analyzed.

Results:
A total of 235 COVID-19 patients were included in the final analysis. Their median age was 66 years (interquartile range 57 - 73), and 131 (55.7%) were men. 98 (41.7%) patients were diagnosed with acute cardiac injury, of whom 60 (61.2%) died. There were more comorbidities in those who with acute cardiac injury than those without. A higher proportion of patients with acute cardiac injury received glucocorticoid therapy (68.0% vs 37.0%; P < 0.001), immunoglobulin (53.1% vs 30.1%; P < 0.001) and invasive mechanical ventilation (40.8% vs 6.6%; P < 0.001) than those without. The percentage of patients who were admitted to intensive care unit (39.8 % vs 8.0%; P < 0.001) or died during hospitalization (61.2% vs 8.0%, P < 0.001) were also higher in those with acute cardiac injury. Plasma high-sensitivity troponin I level correlated significantly with plasma interleukin -6, procalcitonin and C-reactive protein levels in COVID-19 patients. Echocardiography showed that cardiac function was attenuated in acute cardiac injury patients. Multivariable Cox proportional hazards regression analysis showed acute cardiac injury was an independent risk factor for higher in-hospital mortality in COVID-19 patients (HR, 3.393; 95% CI, 1.647- 6.987, P <0.001).

Conclusions:
Acute cardiac injury is a common condition and may be related to inflammatory response in COVID-19 patients. In addition, our study highlights an association between acute cardiac injury and a higher risk of in-hospital mortality. It is suggested that clinicians should be alert to acute cardiac injury in COVID-19 patients and take prompt treatments to improve outcomes.