bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17331: Elevated Troponin Levels Predict Major Adverse Cardiovascular Outcomes and Mortality in COVID-19 Patients
Authors: Patel Chirag , Ikram Farukh , Nguyen Nicholas , Nguyen Hao , Acharya Priyanka , Sidhu Manavjot S
Published: May 2021

Introduction:
Measurement of cardiac biomarkers such as troponin-I (TnI) are useful in assessing for the presence of cardiovascular events. Chest pain is often not a presenting complaint of COVID-19 patients, yet there have been many cases of patients experiencing possible cardiovascular complications. We sought to examine the value of elevated TnI in predicting the occurrence of major adverse cardiovascular events (MACE) and mortality in COVID-19 patients

Methods:
A retrospective review was performed on 225 hospitalized patients that tested positive for COVID-19 between March and May 2020 at our quaternary care hospital. Baseline characteristics and clinical outcomes of their disease course were identified. During the chart review, we documented the admission and peak TnI levels available in the medical record, and noted the occurrence of MACE (a composite of myocardial infarction, stroke, pulmonary embolism, deep venous thrombosis, or shock requiring vasopressor support) or death. Data were analyzed using Pearson’s chi square test and logistic regression to adjust for age.

Results:
Of the 225 hospitalized patients, only 31(14.83%) complained of chest pain on admission. Among patients with elevated TnI, 49.15% had MACE/ Mortality, compared to 21% with non-elevated TnI. Patients with elevated TnI were nearly 4 times more likely to have MACE/Mortality than patients with non-elevated TnI (p = 0.0001; OR = 3.97; 95% CI [1.88, 8.41]). They were also 3.63 times more likely to have MACE alone (p < 0.0001; OR = 3.63; 95% CI [1.70, 7.79]). Median peak TnI values were higher in patients who had a MACE compared to those who did not (0.0275 ng/mL [IQR 0.012-0.152] vs 0.012 ng/mL [IQR 0.012-0.152], p <0.05). For every one-unit increase in peak TnI levels, the age-adjusted odds of having MACE increased by a factor of 4468.37 (95% CI [9.07 2200316.00]; p = 0.008).

Conclusions:
Based on our data, elevated troponin-I levels predict the occurrence of MACE in patients who are hospitalized with COVID-19. Furthermore, there is an association between elevated troponin-I and eventual MACE, mortality, or both. This suggests that checking troponin-I levels in COVID-19 patients holds prognostic value, irrespective of the presence of chest pain as a presenting complaint.
Abstract 17334: Effects of Alcohol Consumption on Fiver-Year Change in Cardiac Structure and Function: In the Echocardiographic Study of Latinos
Authors: Zamora Cristian , Lee Un Jung , Kansal Mayank M , Hurwitz Barry E , Garcia Mario J , Talavera Greg , Kaplan Robert , Rodriguez Carlos J
Published: May 2021

Background:
The relationship between alcohol consumption and clinical heart failure has been extensively studied. There have been little longitudinal data documenting alcohol effects on cardiac structure and function in a community-based population.

Methods:
The second Echocardiographic Study of Latinos (ECHO-SOL2) was designed to provide echocardiographic parameters that characterized longitudinal cardiac structure and function in a random and representative sample of 1,818 participants ≥45 years old. Participants underwent to serial echocardiograms at 2011-2014 (exam 1) and ~5-6 years later at 2016-2019 (exam 2). Quantification of alcohol was created on a gender-specific basis. Multiple linear regression models were adjusted for age and sex.

Results:
The mean age at enrollment was 56.4 years old, 57% were women. At baseline, impaired left ventricular (LV) systolic function and increased right ventricular (RV) function were associated with binge drinkers (P = 0.01). At 5-6 years later, heavy drinkers had a significant decrease in LV ejection fraction (P = 0.01). Moderate and binge drinkers demonstrated worsening diastolic function over time (P ≤ 0.01). Binge drinkers demonstrated a progressive decrease in LV mass index (P = 0.02), decrease in LV stroke volume (P = 0.01) and further reduction in RV function (P < 0.01).

Conclusion:
Alcohol consumption was associated with longitudinal changes in cardiac structure and function, mostly among binge drinkers, which can lead to impaired myocardial contractility compared to nondrinkers.
Abstract 17343: E-cigarette Aerosol Exposure Acutely Alters Cardiac Conduction and Autonomic Balance and Induces Arrhythmia in Mice
Authors: Carll Alex P , Miles Meredith D , ONeill Emily , Talebi Nima , Zurita Jeff , Bhatnagar Aruni , Conklin Daniel J
Published: May 2021

Background:
E-cigarette (e-cig) use has rapidly increased, especially among youth. Vaping has been linked to adverse cardiopulmonary effects, but the full extent of effects remains unknown. Several constituents in e-cigs may increase cardiac risk partly by disturbing cardiac electrophysiology and the autonomic nervous system.

Hypothesis:
E-cig aerosols will differentially induce pro-arrhythmic changes in cardiac conduction and autonomic balance in mice depending on the presence of nicotine and flavors.

Methods:
Electrocardiograms (ECGs) were collected by telemetry in 5 healthy male mice (C57BL/6) exposed for 6 hours to clean air or e-cig aerosols (9-minute puff sessions every 18 minutes) from JUUL e-liquids (Va. Tobacco, Mango, or Menthol at ≈5% nicotine benzoate), or a nicotine-free mixture of propylene glycol and vegetable glycerin solvents (PG:VG, 30:70 ratio). ECG morphology, heart rate variability (HRV), and arrhythmias were analyzed by mixed models with P < 0.05 (vs. Air) for all effects.

Results:
PG:VG increased high grade supraventricular block arrhythmias (121±45 events/hour) relative to Air (0±0 events/hour) and decreased heart rate (HR, -25±8 beats/min), whereas aerosols from all nicotine-containing e-liquids increased HR and decreased HRV, suggesting sympatho-excitation. However, these effects were significantly attenuated for Mango relative to Menthol and Va. Tobacco. As well, only PG:VG and Mango increased ventricular premature beats (VPBs, 9.6±3.7 and 5.5±1.2 events/hour, ±SEM) relative to Air (1.1±0.24 events/hour). VPBs correlated with changes in standard deviation of RR and mean HR from pre-exposure (Spearman’s
r
: 0.51 and -0.27, P < 0.0001). Prolonged repolarization (QTc) correlated with VPBs during exposures to PG:VG (
r
= 0.38, P = 0.046), but not nicotine-containing e-liquids (
r
= 0.15, P = 0.38).

Conclusions:
E-cigs may increase risk for cardiac arrhythmia through e-liquid solvents, which when thermally aerosolized generate toxic aldehydes and particulates. Nicotine and flavor chemicals may modify the cardiac and autonomic impacts of e-cigs. Further studies are needed to determine how e-cig aerosols induce cardiac arrhythmia and whether these effects translate to cardiac morbidity and mortality in humans.
Abstract 17348: Cardiovascular Risk Prediction in Diabetes From Machine Learning: The ACCORD Study
Authors: FAN WENJUN , Wong David N , Li Xiaowei , Wong Nathan
Published: May 2021

Background:
Atherosclerotic cardiovascular disease (ASCVD) risk prediction in persons with type 2 diabetes (T2DM) using existing calculators is imprecise. We aimed to develop a machine-learning (ML) model for prediction of ASCVD events in adults with T2DM.

Methods:
We utilized subjects with T2DM from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial without known CVD and calculated their 10-year ASCVD risk using the ACC/AHA pooled cohort risk calculator (PCRC) predicting the composite outcome of myocardial infarction, non-fatal stroke and cardiovascular death using age, gender, race, systolic blood pressure (SBP), antihypertensive medication use, total cholesterol, high-density lipoprotein cholesterol, current smoking status and diabetes mellitus status. We developed an ASCVD risk calculator based on Random Forest (RF) ML algorithms using follow-up data from ACCORD with the same 9 predictors. 5-fold stratified random split was applied as cross-validation strategies.

Results:
A total of 6581 T2DM participants without baseline ASCVD were included in our final sample with a median follow up of 9.1 years. The performance of PCRC was modest with an AUC=0.604. In contrast, the ML model had much better performance with a RF AUC=0.866. The figure shows the rank of feature importance (%) from random forest modeling (from high to low): age, systolic blood pressure, total cholesterol, HDL-C, female gender, White ethnicity, current smoker, hypertension treatment.

Conclusion:
The ML ASCVD Risk Calculator outperforms the AHA/ACC PCRC in predicting ASCVD outcomes among those with T2DM from the ACCORD trial. Age, SBP, total cholesterol and HDL-C were the most important features in ASCVD prediction among those with T2DM. Future studies need to validate these and other ML algorithms and to explore their applicability in guidelines.
Abstract 17361: How Leptin Harms the Heart in High Fat Diet-Induced Obesity
Authors: Pini Maria
Published: May 2021

Introduction:
Sedentary lifestyle and excessive calorie intake are risk factors for CVD. We have demonstrated the cardioprotective effect of exercise in aged mice and the critical role of visceral adiposity and its profibrotic secretome in increasing cardiovascular risks in obesity and aging. The association between exercise, lowered plasma leptin and reduced inflammatory leukocytes has been recently shown in patients with atherosclerosis. It remains unclear whether elevated plasma leptin can preserve or alter cardiovascular function in obesity.

Methods:
We analyzed the effect of high fat diet (HFD) in C57BL/6J male mice on the heart in terms of function, structure, histology and key molecular markers. Two interventions were used: 1) active fat mass loss via exercise (daily swimming) during HFD; 2) passive fat mass loss via surgical removal of the visceral adipose tissue (VAT lipectomy) followed by HFD.

Results:
HFD increased body weight and adiposity, leading to higher plasma leptin, glucose and insulin levels, compared to control diet (CD) mice. HFD impaired left ventricle (LV) structure (hypertrophy, interstitial fibrosis) and cardiac function (echocardiography,
in vivo
hemodynamics). Atria of HFD mice had enhanced pro-inflammatory protein production. Exercise reduced circulating leptin levels in HFD mice by 50%, in line with fat mass loss. In contrast, lipectomy reduced visceral fat mass, but body weight, adiposity and plasma leptin did not change. Both exercise and VAT lipectomy improved cardiac contractility, reversed collagen deposition and oxidative stress in HFD mice. Both interventions downregulated LV pro-inflammatory markers. We proved the role of leptin in cardiac remodeling
in vitro
by incubating primary cardiac fibroblasts with hyperleptinemic plasma from HFD mice. Remarkably, plasma from HFD-EX (exercise) suppressed the fibro-proliferative and pro-inflammatory responses of cardiac fibroblasts.

Conclusions:
Leptin directly contribute to cardiac fibrosis in obesity via activation and proliferation of cardiac fibroblasts. Understanding how leptin signals to the heart might have implications in a wide range of CVD, potentially helping early stratification and personalized care.
Abstract 17365: Deep-Learning-Based Intravascular Ultrasound Segmentation for the Assessment of Coronary Artery Disease
Authors: Nishi Takeshi , Yamashita Rikiya , Imura Shinji , Kozuka Kazuki , Yock Paul G , Honda Yasuhiro , Fitzgerald Peter
Published: May 2021

Background:
Accurate segmentation of the coronary arteries with intravascular ultrasound (IVUS) is important to optimize coronary stent implantation. Recently, deep learning (DL) methods have been proposed to develop automatic IVUS segmentation. However, most of those have been limited to the lumen and vessel segmentation, not applied to segmenting stent dimension. Hence, this study aimed to develop a DL method for automatic IVUS segmentation of stent area in addition to lumen and vessel area.

Methods:
This study included a total of 45449 images from 1576 (40- or 45-MHz) IVUS pullback runs. The datasets were randomly split into training, validation, and test datasets (0.7:0.15:0.15). After constructing the convolutional neural network to segment IVUS images using the training and validation datasets, we evaluated the performance through the independent test dataset.

Results:
The DL-based segmentation correlated well with the expert-analysed segmentation with a mean intersection over union of 0.84, the correlation coefficient of 0.99, 0.98, and 0.99 and the mean difference of -0.04±0.05, -0.20±0.11 and -0.12±0.06 mm^2 for lumen, vessel and stent area derived from respectively.

Conclusion:
This automated DL-based IVUS segmentation of stent area in conjunction with lumen and vessel area showed good agreement with manual segmentation by experts, supporting the feasibility of artificial-intelligence-assisted IVUS assessment and strategy-making in patients undergoing coronary stent implantation.
Abstract 17393: Sex Differences in COVID-19 Hospitalization and Mortality in Chicagoland
Authors: Gomez Joanne Michelle D , Du-Fay-de-Lavallaz Jeanne M , Fugar Setri , Simmons J. Alan , Sarau Alexandra , Clark Brian , Doukky Rami , Sanghani Rupa , Aggarwal Neelum , Williams Kim A , Volgman Annabelle S
Published: May 2021

Introduction:
The novel coronavirus disease 2019 (COVID-19) pandemic has affected millions of people worldwide. Higher COVID-19 mortality in men compared to women seen in many countries is not yet explained. We analyzed sex differences in COVID-19 outcomes in a large Illinois-based cohort.

Methods:
This is a multicenter retrospective cohort study of confirmed COVID-19 infections from March 1–June 3, 2020 in Rush University System. We compared men and women with COVID-19 infection for the rates of hospitalization, intensive care unit (ICU) admission, vasopressor use, endotracheal intubation, and death. A multivariable model correcting for age, race, and sum of comorbidities (obesity, hypertension, diabetes, coronary artery disease, heart failure, end-stage renal disease, asthma, chronic obstructive pulmonary disease, active smoking) was used to determine independent association with outcomes.

Results:
Of the 8,086 patients who tested positive, 4,267 (53%) were females, while 3,819 (47%) were males. Males had a higher rate of hospitalization (19% vs. 14%; p<0.001), ICU transfer (8% vs. 4%; p<0.001), vasopressor support (4% vs. 2%; p<0.001), or endotracheal intubation (5% vs. 2%; p<0.001). Of the 132 patients who died (10% of hospitalized patients), 76 were males, while 56 were females (2% vs. 1%; p=0.018). The prevalence of active smoking, coronary artery disease, end-stage renal disease, and HIV were higher in males, while hypertension and asthma were more common in females. Multivariable model correcting for age, race, and sum of comorbidities showed a significant association between male sex and in-hospital mortality (OR 1.78; 95% CI 1.23-2.58; p=0.002).

Conclusions:
There were more women who tested positive for COVID-19 disease. Male sex was independently associated with higher rates of death, hospitalization, ICU admissions, need for vasopressors or endotracheal intubation, after correction for important covariates. The interplay of biological and and behavioral factors is likely responsible for the worse outcomes observed in men with COVID-19 infection. Further investigations into the pathophysiology of sex differences in COVID-19 outcomes responses are needed.
Abstract 17418: Religious Attendance and Ideal Cardiovascular Health in Older Women
Authors: Butler Jonathan Z , Slopen Natalie B , Zaslavsky Alan , Buring Julie E , Albert Michelle A
Published: May 2021

Introduction:
Although religious attendance can act as a protective health factor likely through social support and inherent beliefs, little is known about the relationship between the frequency of religious attendance and ideal cardiovascular health (ICH), particularly in older women, many of whom attend religious activities.

Methods:
We utilized the Women’s Health Study (WHS) follow-up psychosocial stress cohort (n=24360; mean age=71.8, SD= 5.8 years) to evaluate the cross-sectional relationship between current religious service attendance and ICH, as defined by the American Heart Association 2020 ICH score. Frequency of religious attendance was classified as never, at least once a year, at least once a month, and at least once a week.

Results:
Compared to women who never attend religious services, women who participate in religious services at least once a week are more likely to be hypertensive and hypercholesterolemic, less likely to be smokers or to use alcohol, less physically active, had lower education levels and more likely to earn < $50,000 annually/household. In age-adjusted models, religious service attendance at least once a month and once a week was associated with a 17% and 36 % higher odds of ICH, respectively. This relationship persisted in models that additionally adjusted for race/ethnicity, education, income, psychological status and social support for women who attended religious services at least once a week [Table].

Conclusion:
Among women in the Women’s Health Study, compared to non-attenders women who attended religious services weekly displayed a 30% higher odds of ideal cardiovascular health, despite adjustment for social support and other risk factors. These data suggest that religious attendance may be beneficial to the cardiovascular health of older women via additional mechanisms beyond social support.
Abstract 17422: Transcatheter Mitral Valve Thrombosis: A Case Report and Literature Review
Authors: Alarfaj Mohammad , Krepp Joseph , Jain Tushina
Published: May 2021

Background:
Trans-catheter mitral valve replacement (TMVR) is an exciting alternative therapy for complex patients with mitral valve disease. The experience with TMVR is new and there is a lot yet to discover about their durability, long-term outcomes, and complications including, mitral transcatheter heart valve (THV) thrombosis. Many factors have been speculated to be associated with the increased risk of THV thrombosis. Here, we report a case of mitral THV thrombosis then discuss published data on the subject.

Case presentation:
A 72-year-old woman who underwent TMVR for severe mitral regurgitation with mitral annular calcification. She was discharged on aspirin and clopidogrel for thromboprophylaxis. She presented after 30 days with symptomatic heart failure. Her transesophageal echocardiogram showed increased mean trans-mitral gradient with severe subvalvular thickening with immobile neo-anterior leaflet. She was subsequently started on a heparin drip with bridge to warfarin with international normalized ratio goal of 2.5 to 3.5.

Discussion:
Since most patients undergoing TMVR are within a high-risk population, caution should be implemented to minimize complications, valve dysfunction, and failure. We reviewed 42 TMVR papers with total of 1484 patients including 60 with mitral THV thrombosis. We discussed the most common strategies used for mitral THV thromboprophylaxis and treatment.

Conclusion:
Given current evidence, post-TMVR anticoagulation should be considered for at least 3 months, especially in those without significant bleeding risk. Longer anti-coagulation therapy should be considered for patients with multiple risk factors for thrombus formation. Additionally, systematic active screening with close clinical follow up help promptly identify those with subclinical THV thrombosis or need longer anti-coagulation therapy.
Abstract 17438: Sex Differences and Temporal Trends in Revascularization and Outcomes of ST-Elevation Myocardial Infarction in Older Adults in the United States
Authors: Pattisapu Varun , Hao Hua
Published: May 2021

Background:
Prior studies have suggested that women with ST-elevation myocardial infarction (STEMI) have higher in-hospital mortality risk than younger men with STEMI. However, there is a significant STEMI risk in older patients. We analyzed temporal trends and sex differences in revascularization and other in-hospital outcomes in older STEMI patients.

Methods:
National Inpatient Sample databases from 2005 to 2014 were utilized to identify all STEMI patients with age greater than 60 years old. We studied the temporal trends and sex differences in revascularization therapies and in-hospital mortality.

Results:
There were N=192,204 older adults diagnosed with STEMI. Older women with STEMI were less likely to undergo coronary angiography (adjusted OR: 0.90; 95% CI: 0.88 to 0.93) and receive reperfusion (percutaneous coronary intervention (PCI) adjusted OR: 0.90; 95% CI: 0.87 to 0.92) compared to older men. Also, the adjusted odds ratio comparing the likelihood of receiving PCI between women and men decreased by an annual average of 0.9% (P=0.028). Older men were more likely to receive PCI on Hospital Day 0 compared to older women. There was a decreasing trend in both sexes for use of coronary artery bypass graft (CABG), though older men consistently underwent CABG more often than older women (Figure). Older women had higher in-hospital mortality than men (adjusted OR: 1.12; 95% CI: 1.08 to 1.17). However, the differences decreased with increasing patient age. There was no significant change in adjusted in-hospital mortality in both genders (all P>0.05).

Conclusions:
Older women were less likely to receive revascularization for STEMI than men, and this gap increased over the study period. Older women had higher in-hospital mortality compared with older men, but there was no significant temporal change for both genders. Further research is needed to identify the reasons why older women receive less revascularization.
Abstract 17442: Myocardial Damage Assessed by Late Gadolinium Enhancement on Cardiovascular Magnetic Resonance Imaging in Cancer Patients Treated With Anthracyclines and/or Trastuzumab
Authors: Modi Kalpit , Chen Ko-hsuan , Okasha Osama , Velangi Pratik , Hooks Matthew , Nijjar Prabhjot S , Blaes Anne , Shenoy Chetan
Published: May 2021

Aims:
In cancer patients with cardiomyopathy related to anthracyclines and/or trastuzumab, data on late gadolinium enhancement (LGE) on cardiovascular magnetic resonance imaging (CMR) are conflicting, with a prevalence of 0-100%. The patterns of LGE are also poorly described. We aimed to investigate these topics in a large cohort of consecutive cancer patients with suspected cardiotoxicity from anthracyclines and/or trastuzumab.

Methods and Results:
We studied 298 patients, analyzed the prevalence, patterns, and correlates of LGE, and identified their causes. We compared the findings with those from 100 age-matched cancer patients who received neither anthracyclines nor trastuzumab. Overall, 31 (10.4%) patients who received anthracyclines and/or trastuzumab had LGE. The LGE had widely varying extents (3.9-34.7%) and locations (all 17 left ventricular segments were involved). It was in an ischemic pattern in 20/31 (64.5%) patients. There was an alternative explanation for the non-ischemic LGE in 7/11 (63.6%) patients. In the patients who received neither anthracyclines nor trastuzumab, the prevalence of LGE was higher at 27.0%, while the extent of LGE and the proportion with ischemic LGE were not different.

Conclusions:
Treatment with anthracyclines and/or trastuzumab is unlikely to be associated with LGE because LGE was present in only a minority, the LGE did not fit into a single profile that could be attributed to cancer treatment-related cardiotoxicity, the LGE had alternative explanations in almost all cases, and LGE was also present in cancer patients who received neither anthracyclines nor trastuzumab. Absence of LGE can differentiate anthracycline- or trastuzumab-related cardiomyopathy from unrelated cardiomyopathies.
Abstract 17492: Chronic Treatment With a Mavacamten-Like Myosin-Modulator (MYK-581) Prevents Left-Atrial Remodeling, Decreases Cardiac Troponin Leakage, and Blunts Mortality in a Mini-Pig Model of Inherited Hypertrophic Cardiomyopathy
Authors: Bell Kaylyn M , Ryba David M , Smit Trisha , Rohret Frank , Chin Daniel , Hollenbeck Emily , Shahidi-Latham Sheerin , Henze Marcus , del Rio Carlos L
Published: May 2021

Introduction:
Hypertrophic cardiomyopathy (HCM) is a progressive disease characterized by cardiac remodeling, impaired relaxation, left-atrial enlargement, and exertional intolerance. Direct myosin-inhibition with mavacamten can normalize contractility and improve exercise capacity in patients with obstructive HCM (oHCM). However, mavacamten also limits residual cross-bridges during diastole, and therefore, may offer cardiac benefits beyond obstruction relief. This
in vivo
study evaluated the chronic effects of MYK-581, a mavacamten surrogate, in a genetic large-animal model of HCM.

Methods:
Young cloned Yucatan mini-pigs with a heterozygous
MYH7
R403Q mutation were randomly assigned to one of two arms: untreated-controls (CTRL, n = 29) or daily MYK-581 (n = 22; PO); wild-type pigs (WT) untreated served as disease-controls. After 14 weeks of treatment, pigs underwent
in vivo
cMR imaging, including T1 mapping and extracellular volume (ECV) assessments. In a subset of pigs, biomechanical studies were performed in skinned left-ventricular (LV) and left-atrial (LV) fibers. *, #: P<0.05 vs. CTRL or WT.

Results:
In HCM pigs, MYK-581 treatment decreased mortality (9.0* vs. 37.9% in CTRL). MYK-581 blunted cTnT leakage, reducing both absolute values (21.2 ± 3.2* vs. 34.0 ± 4.3 ng/L in CTRL) and the incidence of cTnT > 20 ng/L (36* vs. 81% in CTRL). Treated pigs had smaller LA volumes (16 ± 1* vs. 29 ± 4mL in CTRL) with lower LV T1-times and ECV (27 ± 1* vs. 32 ± 2% in CTRL). LA fibers from untreated HCM pigs showed biomechanical remodeling characteristic of chronic overload: increased maximal force (21.8 ± 1.5# vs. 14.7 ± 1.4 mN/mm2 in WT) and slowed cross-bridge formation rates (Ktr: 4.9 ± 0.4 # vs. 6.6 ± 0.6 s-1 in WT) consistent with a switch towards slow-myosin isoforms. MYK-581 prevented this remodeling (e.g., Ktr: 8.1 ± 1.3 s-1*), preserving normal LA (fast) myosin content.

Conclusions:
Chronic direct myosin attenuation with a mavacamten surrogate prevented left-atrial remodeling, a known prognostic indicator in HCM. Chronic treatment also reduced cardiac troponin leakage characteristic HCM, and, more importantly, decreased mortality. Taken together, these pre-clinical observations show potential salutary effects beyond obstruction relief in HCM.
Abstract 17501: Splenic CD169
+
Tim4
+
Marginal Zone Metallophilic Macrophages Are Essential for Wound Healing and Resolution of Inflammation After Myocardial Infarction
Authors: Ismahil Mohamed Ameen , Guihua Zhou , Bansal Shyam , Patel Bindiya , Limdi Nita A , Xie Min , Antipenko Sergey , Rokosh Gregg , Hamid Tariq , Prabhu Sumanth D
Published: May 2021

Fidelity of wound healing after myocardial infarction (MI) is an important determinant of subsequent adverse cardiac remodeling and failure. Infiltrating Ly6C
hi
blood monocytes are a key component of this healing response; however, the importance of other monocyte/macrophage populations is unclear. Here, we demonstrate in mice an essential role for splenic CD169
+
Tim4
+
marginal zone metallophilic macrophages (MMMs) in post-MI wound healing. CD169
+
Tim4
+
MMMs circulate as Ly6C
low
monocytes, and dynamically populate the naïve heart. After acute MI, mobilization robustly increases to the heart, where these macrophages are obligatory for apoptotic neutrophil clearance and the induction of pro-resolving and reparative tissue macrophages. Splenic MMMs are both necessary and sufficient forpost-MI wound healing, and limit late pathological remodeling.Pharmacological expansion of the splenic marginal zone during acute MI alleviates inflammation and cardiac remodeling. Finally, humans with acute MI also exhibit expansion of blood CD169
+
monocytes. Hence, splenic CD169
+
Tim4
+
MMMs are required for pro-resolving and reparative responses after MI, and can be manipulated for therapeutic benefit to limit long-term heart failure.
Abstract 17502: Using Patient-Centered Outcomes Research Principles to Develop and Implement a Mobile Heart Failure Self-Care Program
Authors: Johnson Amber E , McNamara Dennis M , Ramani Ravi , Taylor Christy N , Davis Esa M
Published: May 2021

Introduction:
Patients admitted with decompensated heart failure (HF) are at risk for hospital readmission and poor quality of life. Remote monitoring and mobile health (mHealth) technologies can help prevent hospitalization for community-dwelling patients. We aimed to develop a HF mHealth application to enhance self-care after HF hospitalization.

Hypothesis:
We hypothesized that 1) a mHealth platform could be designed to increase HF self-care after hospital discharge for a population at high risk for HF readmission and 2) our tool would be user friendly and feasibly deployed.

Methods:
Intervention development included input from the following stakeholders: patients, clinicians, information technology developers, patient education experts, and mHealth researchers. We recruited 32 inpatient adults with HF and randomized them 1:1 to the mHealth program plus usual HF care or usual care only. Patients discharged to a nursing home, with end-stage HF (e.g. awaiting transplant/ventricular assist device or on palliative inotropes), or without a smart phone were excluded. Feasibility was determined by ease of deployment, duration of participant recruitment, and participant attrition. We measured program usability by how often the application was opened and used by patients.

Results:
We developed an educational HF mHealth patient self-care tool consisting of daily videos and self-assessments. Of 202 patients screened: 13 were excluded due to discharge to nursing home; 28 were excluded for end-stage HF; 9 were excluded because they did not have a smart phone. We enrolled 32 patients, 14 of which were randomized to receive the program. Mean age was 60 years (range 22-85). There were 53% male and 81% White. Four of 14 (28.6%) did not fully complete the 90-day program. All survey respondents expressed satisfaction with the intervention.

Conclusions:
We conducted a pilot study of a HF self-care mHealth tool for adults at risk for HF readmission and have determined it to be both feasible and acceptable. Our intervention, although a research prototype, may serve as a novel approach to reduce hospital admission and improve patient ability to manage HF as an outpatient.
Abstract 313: Deep Learning to Assess Cardiovascular Age From Chest Radiographs
Authors: Raghu Vineet , weiss jakob , Hoffmann Udo , Aerts Hugo , Lu Michael T
Published: May 2021

Introduction:
Chronological age is a well-known risk factor for cardiovascular disease, but measures of vascular age may enable more personalized care. We hypothesize that a convolutional neural network (CNN) can assess vascular age from a chest radiograph image.

Methods:
The CNN model, CXR-Age, was developed using data from over 100,000 indviduals from publicly available cohorts and was validated in 1) a subset of the Prostate, Lung, Colorectal, and Ovarian Cancer screening trial’s chest x-ray arm (PLCO, N = 40,967) and 2) the chest radiograph arm of the National Lung Screening Trial (NLST, N = 5,414). The primary outcome was 13-year cardiovascular mortality defined by ICD9 codes for ischemic heart disease, myocardial infarction, and stroke. Results are provided for independent testing datasets only.

Results:
After adjusting for sex, a 5-year increase in CXR-Age was a better predictor of cardiovascular mortality than a 5-year increase in chronological age in PLCO (CXR-Age aHR 2.69 per 5 years [95% CI 2.55-2.84] vs. chronological age aHR 1.84 per 5 years [95% CI 1.75-1.93], p < 0.001) and NLST (CXR-Age aHR 2.06 per 5-years [95% CI, 1.78-2.39] vs. chronological age aHR 1.64 per 5 years [95% CI, 1.44-1.86], p = 0.06). This association with cardiovascular mortality was robust to adjustment for baseline cardiovascular risk factors (chronological age, sex, diabetes, hypertension, smoking) in PLCO (CXR-Age aHR 1.58 per 5 years [95% CI, 1.54-1.63], p < 0.001) and NLST (CXR-Age aHR 1.48 per 5 years [95% CI, 1.36-1.61], p < 0.001). Kaplan-Meier curves (Figure 1) stratified by chronological age groups show CXR-Age has a graded association with cardiovascular mortality in individuals with similar baseline chronological age.

Conclusions:
A CNN model, CXR-Age, can assess vascular age from a chest radiograph image, and this CXR-Age predicts cardiovascular mortality better than chronological age.
Cardiovascular Risk Factor Trajectories Since Childhood and Cognitive Performance in Midlife: The Cardiovascular Risk in Young Finns Study
Authors: Hakala Juuso O. , Pahkala Katja , Juonala Markus , Salo Pia , Kähönen Mika , Hutri-Kähönen Nina , Lehtimäki Terho , Laitinen Tomi P. , Jokinen Eero , Taittonen Leena , Tossavainen Päivi , Viikari Jorma S.A. , Raitakari Olli T. , Rovio Suvi P.
Published: May 2021

Background:

Cardiovascular risk factors, such as high blood pressure, adverse serum lipids, and elevated body mass index in midlife, may harm cognitive performance. It is important to note that longitudinal accumulation of cardiovascular risk factors since childhood may be associated with cognitive performance already since childhood, but the previous evidence is scarce. We studied the associations of cardiovascular risk factors from childhood to midlife, their accumulation, and midlife cognitive performance.

Methods:

From 1980, a population-based cohort of 3596 children (3–18 years of age) have been repeatedly followed up for 31 years. Blood pressure, serum lipids, and body mass index were assessed in all follow-ups. Cardiovascular risk factor trajectories from childhood to midlife were identified using latent class growth mixture modeling. Cognitive testing was performed in 2026 participants 34 to 49 years of age using a computerized test. The associations of the cardiovascular risk factor trajectories and cognitive performance were studied for individual cardiovascular risk factors and cardiovascular risk factor accumulation.

Results:

Consistently high systolic blood pressure (β=–0.262 SD [95% CI, –0.520 to –0.005]) and serum total cholesterol (β=–0.214 SD [95% CI, –0.365 to –0.064]) were associated with worse midlife episodic memory and associative learning compared with consistently low values. Obesity since childhood was associated with worse visual processing and sustained attention (β=–0.407 SD [95% CI, –0.708 to –0.105]) compared with normal weight. An inverse association was observed for the cardiovascular risk factor accumulation with episodic memory and associative learning (
P
for trend=0.008; 3 cardiovascular risk factors: β=–0.390 SD [95% CI, –0.691 to –0.088]), with visual processing and sustained attention (
P
for trend<0.0001; 3 cardiovascular risk factors: β=–0.443 SD [95% CI, –0.730 to –0.157]), and with reaction and movement time (
P
for trend=0.048; 2 cardiovascular risk factors: β=–0.164 SD [95% CI, –0.318 to –0.010]).

Conclusions:

Longitudinal elevated systolic blood pressure, high serum total cholesterol, and obesity from childhood to midlife were inversely associated with midlife cognitive performance. It is important to note that the higher the number of cardiovascular risk factors, the worse was the observed cognitive performance. Therefore, launching preventive strategies against cardiovascular risk factors beginning from childhood might benefit primordial promotion of cognitive health in adulthood.
Renal Outcome and New-Onset Renal and Extrarenal Dissections in Patients With Nontrauma Renal Artery Dissection Associated With Renal Infarction
Authors: Faucon Anne-Laure , Bobrie Guillaume , Azarine Arshid , Mousseaux Elie , Mirault Tristan , Lorthioir Aurélien , Azizi Michel , Amar Laurence
Published: May 2021

We aimed to compare the characteristics of the patients with renal infarction related to nontrauma renal artery dissection (RAD) with versus without an underlying vascular disease and report long-term renal and vascular outcomes, as well as new-onset renal and extra-RADs. Data from 72 consecutive patients with RAD referred to our Hypertension Unit between 2000 and 2015 were analyzed. Radiological data, including a systematic brain-to-pelvis computed tomography angiography, were independently reviewed. Three main causes of RAD were identified at the initial work-up: fibromuscular dysplasia (n=16); dissecting or aneurysmal multisite arterial disease (n=21) not linked to any known vascular disease; and isolated RAD (n=24) without any other arterial lesion. At diagnosis, patients (median age 46 [interquartile range, 40–53] years, 70.5% males, 26.2% preexisting hypertension, 65.6% smokers) had a median blood pressure of 138 (125–152)/87 (78–97) mm Hg. Estimated glomerular filtration rate was 81 (66–95) mL/min per 1.73 m
2
and 18% had renal impairment. Patients were treated with antiplatelet drugs (65.6%), anticoagulant (3.3%). A total of 11.5% underwent angioplasty. No clinical or biological difference was observed between the 3 groups. After 51 (19–92) months follow-up, blood pressure was reduced by 13 (0–29)/9 (3–18) mm Hg; 11.5% of patients had estimated glomerular filtration rate <60 mL/min per 1.73 m
2
. RAD evolved toward healing (67.2%), aneurysmal dilation (24.6%), or stenosis (8.2%). New-onset RAD was as frequent in dissecting or aneurysmal multisite arterial disease (23.8%) than in fibromuscular dysplasia (25%) group, whereas de novo extrarenal dissection was 6-fold more frequent in dissecting or aneurysmal multisite arterial disease (38.1%) than in fibromuscular dysplasia (6.3%) group. No new event occurred in patients with an initial diagnosis of isolated RAD. Initial diagnostic accuracy using thorough systematic exhaustive explorations of arterial sites helps to stratify the risk of new-onset dissection and adapt monitoring accordingly.
Prediction of Cognitive Recovery After Stroke: The Value of Diffusion-Weighted Imaging–Based Measures of Brain Connectivity
Authors: Aben Hugo P. , De Munter Leonie , Reijmer Yael D. , Spikman Jacoba M. , Visser-Meily Johanna M.A. , Biessels Geert Jan , De Kort Paul L.M. ,   on behalf of the PROCRAS Study Group
Published: May 2021

Background and Purpose:

Prediction of long-term recovery of a poststroke cognitive disorder (PSCD) is currently inaccurate. We assessed whether diffusion-weighted imaging (DWI)–based measures of brain connectivity predict cognitive recovery 1 year after stroke in patients with PSCD in addition to conventional clinical, neuropsychological, and imaging variables.

Methods:

This prospective monocenter cohort study included 217 consecutive patients with a clinical diagnosis of ischemic stroke, aged ≥50 years, and Montreal Cognitive Assessment score below 26 during hospitalization. Five weeks after stroke, patients underwent DWI magnetic resonance imaging. Neuropsychological assessment was performed 5 weeks and 1 year after stroke and was used to classify PSCD as absent, modest, or marked. Cognitive recovery was operationalized as a shift to a better PSCD category over time. We evaluated 4 DWI-based measures of brain connectivity: global network efficiency and mean connectivity strength, both weighted for mean diffusivity and fractional anisotropy. Conventional predictors were age, sex, level of education, clinical stroke characteristics, neuropsychological variables, and magnetic resonance imaging findings (eg, infarct size). DWI-based measures of brain connectivity were added to a multivariable model to assess additive predictive value.

Results:

Of 135 patients (mean age, 71 years; 95 men [70%]) with PSCD 5 weeks after ischemic stroke, 41 (30%) showed cognitive recovery. Three of 4 brain connectivity measures met the predefined threshold of
P
<0.1 in univariable regression analysis. There was no added value of these measures to a multivariable model that included level of education and infarct size as significant predictors of cognitive recovery.

Conclusions:

Current DWI-based measures of brain connectivity appear to predict recovery of PSCD but at present have no added value over conventional predictors.
When Ellipsis Can Save Defectiveness and When It Can’t
Authors: Mendes Gesoel , Nevins Andrew
Published: May 2021

We discuss cases of salvation and non-salvation by deletion in the domain of lexical gaps, and distinguish two types of defectiveness: (a) defectiveness that can be saved by PF deletion, which we take to signal the lack of an eligible allomorph for certain environments within a language, and (b) defectiveness that cannot be saved by PF deletion, which we take to signal the lack of a proper alloseme for a given environment. With ellipsis modeled as an instruction for nonpronunciation on the PF branch of the grammar, only gaps on the Exponent List can be saved by it.
The Beard as Spectacle and Scandal in a Thirteenth-century Hebrew Maqāma
Authors: Rosen Tova
Published: May 2021

The Eighth Maqāma by Yaʿacov ben Elʿazar (Toledo, ca. 1200) tells the story of ʿAkhbor, a bearded beggar-preacher who is revealed to be rich and lecherous. His sexual preference for a black maid leads his four white/Arab maids to murder him viciously, but not before taking revenge on his beard. In fact, the most notable feature of the false preacher is his gargantuan beard, which occupies a full one-third of the maqāma, and other beards are also excessively described. Following Robert Bartlett, I will relate to the beard as “social text” and explore its abundant symbolical meanings within the surrounding cultures of Islam and Judaism, as well as against the backdrop of Iberian contemporary society. Further, in order to better understand Ben Elʿazar’s manipulation of both the beard and the genre, as well as his emphasis on sexual, anal and scatological humor, I will have recourse to Mikhail Bakhtin’s theoretical discussions of “the grotesque body,” “the carnivalesque,” and to his generic model of the Mennipea.
A new species of Pabstiella (Pleurothallidinae, Orchidaceae) from Ecuador
Authors: PONERT JAN , ANDRADE MARIO PORTILLA , KARREMANS ADAM P. , CHUMOVÁ ZUZANA , TRÁVNÍČEK PAVEL
Published: May 2021

Pabstiella elegans is newly described based on cultivated material originally collected near Chaucha in Ecuador. It belongs to the group of small, creeping species of Pabstiella section Mentosae and differs from its closest relatives by the two-times larger flower and unusual colour of its sepals, which are creamy white with red dots. It also differs in the genome size (1C-value = 0.537 pg), which is 10.5% higher than its sister species, P. aryter. Phylogenetic placement is supported by an analysis based on nuclear ribosomal ITS and plastid matK regions.
Molecular phylogeny of the grasshopper family Pyrgomorphidae (Caelifera, Orthoptera) reveals rampant paraphyly and convergence of traditionally used taxonomic characters
Authors: ZAHID SUNDUS , MARIÑO-PÉREZ RICARDO , SONG HOJUN
Published: May 2021

The grasshopper family Pyrgomorphidae is one of the most colorful orthopteran lineages, and includes biologically fascinating and culturally important species. Recent attempts to reconstruct the phylogeny of this family have resulted in a large degree of conflicts between a morphology-based study and a molecular-based study, mainly due to convergent morphological traits that affected phylogenetic reconstruction. In this study, a molecular phylogeny of Pyrgomorphidae based on 32 ingroup species and mitochondrial genome data is proposed, which is used to test the monophyly of the taxonomic groupings used in the current classification scheme. Using the ancestral character state reconstruction analyses and character mapping, we demonstrate that some of the morphological characters, including the male genitalia, which were considered to be taxonomically important, have evolved convergently across the phylogeny. We discuss the discrepancies between our phylogeny and the previous studies and propose an approach to establish a natural classification scheme for Pyrgomorphidae.
New species and a new record of Entomobryinae (Collembola, Entomobryomorpha) from Amurskaya Region (the Far East of Russia)
Authors: BAQUERO ENRIQUE , POTAPOV MIKHAIL , JORDANA RAFAEL
Published: May 2021

The studied area (Far East of Russia) is very little investigated for the Entomobryidae family. A specific sampling in the area has made it possible to detect the presence of four and one new species of the genera Entomobrya and Willowsia respectively, which are herein described (E. amurica sp. nov., E. mediostriata sp. nov., E. umbroviolacea sp. nov., E. bicincta sp. nov. and W. babykinae sp. nov.) from the western part of the Far East of Russia. Homidia hjesanica is also recorded.
A New Predictive Framework for Amazon Forest Fire Smoke Dispersion over South America
Authors: Vara-Vela Angel Liduvino , Herdies Dirceu Luís , Alvim Débora Souza , Vendrasco Éder Paulo , Figueroa Silvio Nilo , Pendharkar Jayant , Reyes Fernandez Julio Pablo
Published: May 2021

Aerosol particles from forest fire events in the Amazon can be effectively transported to urban areas in southeastern South America, thus affecting the air quality over those regions. A combination of observational data and a comprehensive air quality modeling system capable of anticipating acute air pollution episodes is therefore required. A new predictive framework for Amazon forest fire smoke dispersion over South America has been developed based on the Weather Research and Forecasting with Chemistry community (WRF-Chem) model. Two experiments of 48-h simulations over South America were performed by using this system at 20-km horizontal resolution, on a daily basis, during August and September of 2018 and 2019. The experiment in 2019 included the very strong 3-week forest fire event, when the São Paulo metropolitan area, located in southeastern South America, was plunged into darkness on August 19. The model results were satisfactorily compared against satellite-based data products and in situ measurements collected from air quality monitoring sites. The system is executed daily immediately after the CPTEC Satellite Division releases the latest active fire locations data and provides 48-h forecasts of regional distributions of chemical species such as CO, PM2.5, and O3. The new modeling system will be used as a benchmark within the framework of the Chemistry of the Atmosphere–Field Experiment in Brazil (CAFE-Brazil) project, which will take place in 2022 over the Amazon.
Suppression of Baroclinic Eddies by Strong Jets
Authors: Hadas Or , Kaspi Yohai
Published: May 2021

The midlatitude storm tracks are of the most prominent features of extratropical climate. Despite the theoretical expectation, based on baroclinic instability theory, that baroclinic eddies strengthen with jet intensification, there is evidence that this relation breaks when the jet is particularly strong. The most known case is the Pacific midwinter minimum in storm track activity. To isolate the effect of jet strength on storm activity, we conduct a series of GCM experiments systematically varying jet intensity. The simulations are analyzed using Lagrangian tracking to understand the response from a single-eddy perspective. The Lagrangian analysis shows that while the response of upper-level eddies is dominated by a reduction in the amount of tracked features, the lower-level eddies’ response is also affected by a reduction in their lifetime. Analyzing the jet strength effect on the pairing between the upper- and lower-level eddies, we find that the jet intensification increases the relative speed of the upper-level eddies, breaking the baroclinic wave structure and limiting its growth. We show that the Lagrangian response correlates with a shift in the midlatitude spectrum to low wavenumbers. The shift settles these results with linear baroclinic instability theory, as under the stronger jet conditions synoptic-scale eddies are predicted to have a sub-optimal growth rate. These results can potentially explain the midwinter suppression of storm activity over the Pacific and the difference from the Atlantic response.