bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14036: Post Transcatheter Aortic Valve Replacement (TAVR) Electrophysiologic (EP) Study Trends and Its Implication on Permanent Pacemaker (PPM) Implantation Rate: Insights From National Inpatient Sample Database
Authors: Dar Tawseef A , Abohashem Shady , Celli Diego , Hanfy Ahmed , Alnajar Ahmed , Abbasi Taimur , Mohiuddin Imran , Sibghat Tul Llah FNU , Qureshi Waqas , Dyal Michael
Published: April 2022

Introduction:
High-risk conduction (HRC) disorders are frequently encountered post transcatheter aortic valve replacement (TAVR). There is a robust expert consensus statement about the management of such patients (e.g.performance of an electrophysiology (EP) study). Yet, it is unclear what the real-world practices are and how they might be influencing outcomes.

Hypothesis:
Accordingly, we sought to study the trends and implications of EP study post TAVR on the PPM implantation rate.

Methods:
The National Inpatient Sample (2011-2018) database was queried, using ICD-9 and ICD-10 codes, for individuals who underwent a TAVR procedure. Patients with a history of PPM were excluded. Outcomes of interest were postprocedural EP study, PPM implantation, mortality, and other non-cardiac complications. Logistic and linear regression models were employed to study hospital outcomes.

Results:
A total of 1,95162 (median age 82 yrs, 47.9% female) underwent TAVR. HRC abnormality and CHB were seen in 19.5% and 11 % of patients, respectively. A total of 12.1% had PPM implantation post-procedure, and 0.77% had an EP study during the same hospitalization. Of all PPM implantations, 2% underwent a prior EP study. Among patients with HRC features (N=33,381), the odds of receiving a PPM were ~3 higher (OR [95% CI] =2.74 [1.92, 3.90], p<0.0001) in those who underwent an EP study (vs. no EP study). Among patients with CHB (N=21,324), there was a 60% (OR [95% CI] =0.39 [0.23, 0.67], p=0.001) decrease in PPM implantation rate in those who underwent an EP study (vs. no EP study). EP study was associated with a longer length of stay (p<0.001) and higher hospital charges (p=0.001) with no difference in mortality rates (p=0.16). The yearly trend of EP study and PPM implantation is shown in figure 1.

Conclusions:
Depending on the type of conduction disorder, EP study has a significant and variable influence on the rate of PPM implantation post TAVR. The clinical implication of such impact needs further studies.
Abstract 14047: Extended Follow-Up Results From a Prospective RCT for Transcatheter Bariatric Embolotherapy for Weight Loss in Obese Subjects
Authors: Reddy Vivek Y , Fried Martin , Neuzil Petr , Rosen Robert , Sramkova Petra , Kipshidze Nodar , kipshidze Nickolas
Published: April 2022

Introduction:
Obesity is an important risk factor associated with poor cardiovascular outcomes. Lifestyle modification, pharmaceutical, and intragastric balloons weight loss therapy are often unsuccessful, unsustainable, or accompanied by risks. Transcatheter bariatric embolotherapy (TBE) is a promising therapy in which the left gastric artery is embolized to reduce the expression of “hunger” hormones from the gastric fundus. Despite several early clinical trials, long-term safety or efficacy has yet to be studied. We originally studied TBE in a double-blind, sham procedure, first in human RCT of 40 obese patients (pts) (NCT03185949). Complete details regarding the initial RCT were previously published, briefly the study demonstrated up to 9.3% TBWL at 1-year post-TBE. Following completion of the initial study at 1 year follow-up, we asked subjects to return for long-term evaluation.

Methods:
Subjects who previously completed the RCT with no major protocol deviations were asked to return for SOC follow-up visits at 2-, 2.5-, and 3-years post-embolization for further evaluation on weight loss, blood pressure, pre-diabetic clinical status, satiety, and Quality of Life (QoL). Given the evolving situation of the COVID-19 pandemic, the study site was unable to complete all planned study visits.

Results:
Between 2-3 years post-TBE subjects (n=11) demonstrated a mean 9% TBWL and 25% EBWL. This cohort of patients demonstrated a long-term weight loss maintenance, with previously reported weight loss of 8% TBWL at 1-year post-embolization. Overall QoL at 2 years post-TBE increased by approximately 22%. The volume to achieve satiety was reduced by 33% in long-term follow-up. Oral Disposition Index increased from 1.89 mM
-1
at 6 months post-TBE to 4.41 mM
-1
2 years post-TBE. 1-hr Oral Glucose Tolerance Test (OGTT) C-Peptide levels decreased from 3.22 nmol/L at 6 months to 2.53 nmol/L at 2 years post-TBE. 2-hr OGTT C-Peptide levels also showed a decrease from 2.95 nmol/L at 6 months to 1.78 nmol/L at 2 years post-TBE, possibly indicating an improvement in pre-diabetic status.

Conclusions:
Bariatric embolization is safe and when used along with lifestyle therapy, results in clinically significant and sustained weight loss up to 2-3 years post-TBE.
Abstract 14064: Echocardiographic Parameters Predicting Left Ventricular Ejection Fraction Improvement Following Transcatheter Aortic Valve Replacement
Authors: Uqaily Muhammad R , Agrawal Pratik , Shotwell Matthew , Hamirani Yasmin , Daggubati Ramesh , ZEB IRFAN
Published: April 2022

Introduction:
There is limited data available in terms of identifying echocardiographic parameters predicting improvement in left ventricular ejection fraction (LVEF) following a transcatheter aortic valve replacement (TAVR). Additionally, association of baseline cardiac disease burden with normal post-TAVR LVEF is poorly understood.

Hypothesis:
Higher baseline cardiac disease burden is associated with lower rates of normal post-TAVR LVEF.

Methods:
We retrospectively studied 352 consecutive patients who underwent TAVR at our institute, and who had 30-day follow-up data available. The patients were divided into two groups: pre-TAVR LVEF < 50% and ≥ 50%. We defined improvement in LVEF as a binary variable by studying for absolute improvement of +5% in LVEF on the 30-day post-TAVR echocardiogram. Furthermore, baseline cardiac disease burden was defined as a composite ordinal score of LVEF, severity of mitral regurgitation, mitral stenosis, coronary artery disease, tricuspid regurgitation, and pulmonary hypertension.

Results:
There was a significant difference in improvement of LVEF between the two pre-TAVR LVEF groups < 50% versus ≥ 50% (67% vs. 31%, p < 0.0001). On multivariate logistic regression analysis of pre-TAVR echocardiographic parameters, clinical variables and TAVR valve-related variables, only aortic valve (AV) area index (r = 3.86, p = 0.004), LV end-diastolic dimension (r = -0.74, p = 0.005), aortic regurgitation severity (r = 1.10, p = 0.010) and 29-mm valve size (r = -1.09, p = 0.021) were significant in predicting improvement in LVEF post-TAVR. LVEF was a weak predictor on multivariate logistic regression model (r = -0.11, p < 0.0001). Furthermore, patients with a higher baseline cardiac disease burden (defined as ≥ median composite score of 7) were significantly associated with lower rates of post-TAVR LVEF ≥ 50% (OR = 5.22 [2.49 - 10.96]; p < 0.0001).

Conclusions:
Higher baseline cardiac disease burden is significantly associated with lower rates of post-TAVR LVEF ≥ 50%. Additionally, specific echocardiographic parameters can predict improvement in LVEF following TAVR.
Abstract 14072: Long-Term Mortality Following 59253 Patients Who Underwent Coronary Artery Bypass Surgery in New South Wales, Australia: A Statewide Population-Linkage Study From 2001-2018
Authors: Eldic Evan , Hyun Karice , Boroumand Farzaneh , Ng Austin , Brieger David
Published: April 2022

Purpose:
To describe changes in long-term mortality following coronary artery bypass graft (CABG) in New South Wales (NSW), Australia, from 2001-2018.

Methods:
Patients who underwent CABG were identified from the NSW Admission-Patient-Data-Collection registry linked to the NSW death registry and were stratified into six, 3-year groups. Changes in comorbidities and procedural techniques over time were determined. Primary outcome was death (end of follow-up: 31-December-2018). Secondary outcome was time to first percutaneous coronary intervention (PCI) post-CABG, with death as the competing event. Outcomes analyses using Cox regression were adjusted for baseline and procedural differences and geographical clustering.

Results:
A total 59253 patients underwent CABG during the study period. From 2001-03 to 2016-18, procedural numbers fell (11875 vs 7606); however patient complexity increased (Charlson comorbidity index [CCI]>0: 40% vs 55%) as did male patients (77% vs 83%). During a median (interquartile range) follow-up of 7.7yrs (3.8-12.1yrs), 16,484 (27.8%) patients died. Factors associated with increased long-term mortality included older age (>75 vs ≤60: hazard ratio [HR]=6.69, 95% confidence interval [CI]=6.33-7.08), female sex (HR=1.06, 95%CI=1.02-1.11), acute myocardial infarction (HR=1.86, 95%CI=1.80-1.92), atrial fibrillation (HR=1.38, 95%CI=1.29-1.47), valvular heart disease (HR=1.84, 95%CI=1.56-2.18), and CCI (per-1-score increase: HR=1.31, 95%CI=1.26-1.35). Multivariable survival analysis showed that, compared to 2001-03, the risk of death reduced from 2004-06 to 2016-18: HR=0.96, 95%CI=0.93-1.00 to HR=0.61, 95%CI=0.54-0.70, respectively. Multivariable time-to-PCI analysis with death as the competing event showed no significant difference over the years.

Conclusion:
Between 2001 and 2018, though CABG volume has decreased, proportionally more males and higher comorbid patients had CABG in recent years. Female sex and other major comorbidities were expectedly related to an increased association with mortality. Overall, mortality has fallen significantly over time, with no significant trend of PCI undertaken over time in these post CABG patients.
Abstract 14074: Machine Learning Applied on ECG Improves Cardiovascular Risk Prediction When Added to Coronary Artery Calcium Scoring in Patients With Cancer
Authors: Siva Kumar Shruti , Al-Kindi Sadeer , Tashtish Nour , Rajagopalan Varun , Fu Pingfu , Rajagopalan Sanjay , Madabhushi Anant
Published: April 2022

Introduction:
Patients with cancer are at increased cardiovascular (CV) risk. Both Coronary Artery Calcium (CAC) and 12-lead ECG features predict CV risk in the general population. However, the impact of these measures has not been investigated in patients with cancer.

Hypothesis:
We hypothesized that machine learning-based analysis of automatically-extracted ECG features, when added to CAC, can improve CV risk stratification in patients with cancer.

Methods:
We analyzed 1825 cancer patients with at least 1 CV risk factor who underwent CAC scoring and a standard 12-ECG as part of the CLARIFY (ClinicalTrials.gov Identifier: NCT04075162) registry. Events were defined as myocardial infarction, revascularization, stroke or death. A total of 445 ECG features were automatically extracted using a commercially available software (ECG Muse, GE healthcare). A LASSO-Cox method was used with 10-fold cross validation to select the most important ECG features with a novel ECG score derived using individual feature coefficients. We evaluated the ability of the combined ECG score with age, sex, and CAC to prognosticate a CV event in comparison to a model that was limited to age, sex, and CAC alone. The models were compared using an ANOVA test.

Results:
Over a median follow-up of 14 months, 224 patients had an event. Using the LASSO-Cox model, 25 ECG features were selected. The novel ECG score was associated with CV events (HR 8.6, 95% CI: 5.1-14.3, P<0.001), which was not attenuated after adjusting for age, sex, and CACS (HR 7.3, 95% CI: 4.3-12.4, P<0.001). Addition of ECG score to a model including age, sex, and CAC improved discrimination (C-Index 0.63 vs 0.72, P=0.0001).

Conclusions:
A novel ML-based ECG risk score using automatically extracted ECG features can improve CV risk stratification when added to CAC and demographics in patients with cancer.
Abstract 14099: Using a Respiratory Resistance Device as a Therapeutic Modality in Patients With a History of Heart Failure, Preliminary Report
Authors: Parks Jordan , Schwartz Jesse , Shea Meredith , Johnson Bruce , Fernandes Regis , Wheatley-Guy Courtney
Published: April 2022

Introduction:
Heart failure (HF) is associated with limited blood flow reserve due to reduced cardiac output (Q). HF is also associated with generalized respiratory muscle weakness, despite patients being exposed to an increased work and cost of breathing due primarily to increased flow resistive work from an altered breathing pattern. We hypothesized that the use of a respiratory training device during aerobic exercise training would positively impact patients with HF by training the inspiratory muscles and modifying their respiratory response to exercise.

Methods:
15 subjects completed all study visits (age 67.5±10.0 yr, Ht 179.3±6.1cm, BMI 28.8±5.7 m/cm
2
). Patients diagnosed with HF and currently enrolled in cardiac rehabilitation (CR) completed the Minnesota living with heart failure questionnaire (MLHFQ), pulmonary function testing, and measures during exercise that included Q (soluble gas method), ventilation (V
E
) and respiratory gas exchange. Measures were made at baseline and after completion of CR. Participants were randomized to no respiratory resistance (NR) or mild-moderate inspiratory resistance (MR, 15 to 20 cmH
2
O) provided by a respiratory resistance mask (Training Mask Co., Cadillac, MI) worn during aerobic portions of CR.

Results:
Participants completed on average 23.9 ± 2.5 CR sessions with 10 subjects in the MR group and 5 in the NR group. The MR group had a decrease on the MLHFQ score of 19.9±26.9 and the NR group had a decrease of 6.0±23.4 (p=0.330). At a matched workload of 30 Watts (W), V
E
declined by 4.0±7.0 L/min and increased by 2.2±13.1 L/min for subjects in the MR and NR groups, respectively (p=0.06). Respiratory rate (RR) decreased in MR by 1.2± 4.9 and decreased in NR by 0.67± 5.9 (p>0.05). Heart rate at 30W decreased with time in both the MR and NR groups 10.4±12.4 and 3.9±8.9 respectively (p=0.036, no difference between groups). Stroke volume at 30W tended to increase for both MR and NR (p>0.05, no difference between groups).

Conclusion:
The addition of moderate inspiratory resistance to the aerobic training during CR was well tolerated by HF patients and preliminarily suggests trends toward improved ventilatory responses when assessed during submaximal exercise.
Abstract 8902: The High Circulating Leptin is Associated With Increased Mortality Risk in Stable Coronary Heart Disease Patients
Authors: Mayer Otto , Bruthans Jan , Seidlerová Jitka , Gelžinský Julius , Kucera Radek
Published: April 2022

Introduction:
Leptin is an adipocyte-derived peptide, involved in energy homeostasis and regulation of body weight. The position of leptin in cardiovascular pathophysiology remained controversial, some studies suggest a detrimental effect of hyperleptinemia on the cardiovascular (CV) system, while others assume the role of leptin as protective.

Hypothesis:
We explore whether high leptin status affects the mortality/ morbidity risk in stable patients with coronary heart disease.

Methods:
975 patients, ≥6 months after myocardial infarction (EUROASPIRE cohort) were followed in a prospective study. All-cause or CV death, non-fatal events (myocardial infarction, stroke or any revascularization) and hospitalizations for heart failure (HF) were registered as outcomes

Results:
High serum leptin concentrations (≥18.9 ng/mL, i.e. 4
th
quartile) indicate inferior survival, as well as a higher incidence of fatal vascular event or hospitalizations for HF (
see
Figure). Even after full adjustment for potential covariates, high leptin was associated with significantly increased 5-years risk of all-cause death [HRR 2.10 (95%CIs:1.29-3.42), p<0.003], CV death [HRR 2.65 (95%CIs:1.48-4.74), p<0.001] and HF hospitalization [HRR 1.95 (95%CIs:1.11-3.44), p<0.020]. In contrast, the incidence risk of non-fatal CV events was only marginally and non-significantly influenced [HRR 1.27 (95%CIs:0.76-2.13), p=0.359]

Conclusions:
High leptin concentration entails an increased risk of mortality (apparently driven by fatal CV events) and future worsening of HF, on top of conventional CV risk factors and the baseline status of left ventricular function.
Abstract 8916: Frequency Analysis of the QRS Differentiates Left Bundle Branch Pacing from RV Septal Pacing
Authors: Niebauer Mark J , Chung Roy , Chung Mina K , Varma Niraj
Published: April 2022

Introduction:
Left bundle branch pacing (LBBP) is an increasingly common procedure. The pacing lead is advanced via the RV septum into the myocardium with the goal of directly stimulating the LBB for more effective left ventricular (LV) activation. We have previously found that QRS frequency is useful for assessing successful LV activation in cardiac resynchronization therapy.

Hypothesis:
We surmised that the QRS complex of patients who underwent LBBP would exhibit significantly different frequency characteristics than simple RV septal pacing.

Methods:
We analyzed the QRS frequency of 36 patients with normal LV ejection fraction (≥50%) who have undergone LBBP for comparison to 33 patients who underwent RV septal pacing. Time frequency analysis was performed which yields a weighted average frequency (AKA: “center of energy” frequency or Cf) of the QRS. Chest lead V2 yielded the best frequency discrimination. We performed ROC analysis for all significant variables in multivariate analysis to obtain the area under the curve (AUC) predictive value.

Results:
See table: QRS duration, LVAT: paced LV activation time, AUC: area under the curve.

Conclusions:
Our data show that the QRS in LBB paced patients is significantly shorter and has a much higher Cf in lead V2 with high predictive value by ROC analysis compared to RV septal pacing. Baseline LVEF and paced LVAT exhibited lower AUC values. Such measurements may be of use during implantation of the pacing lead to ensure capture of the LBB when LV activation times and/or morphologic changes are equivocal.
Abstract 8917: Ankle-Brachial Index and Risk of Sudden Cardiac Death in the Community: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Suzuki Takeki , Zhu Xiaoqian , Adabag Selcuk , Matsushita Kuni , Butler Kenneth R , Griswold Michael , Alonso Alvaro , Rosamond Wayne D , Sotoodehnia Nona , Mosley Thomas
Published: April 2022

Introduction:
Sudden cardiac death (SCD) is an important public health problem. About 356,000 people suffer SCD in the U.S., accounting for 15% of all deaths. The ankle-brachial index (ABI) is a simple, non-invasive measure of subclinical atherosclerosis. The aim of this study was to determine the relation between ABI and SCD in a middle-aged biracial general population.

Methods:
All ARIC (Atherosclerosis Risk in Communities) study subjects with a documented ABI measurement between 1987 and 1989 were included in the study. ABI was categorized as abnormal (≤0.9), borderline (0.9-1), normal [1-1.4], and non-compressible (>1.4). SCD was defined as a sudden pulseless condition presumed to be caused by a ventricular tachyarrhythmia in a previously stable individual. All SCD cases were adjudicated by a committee of cardiac electrophysiologists, cardiologists, and internists.

Results:
Of the 15,135 participants followed for a median of 23.5 years, 558 (3.7%) developed SCD (1.96 cases per 1000 person-years). Abnormal or borderline ABIs were associated with an elevated risk of SCD (HRs with 95 % CIs 2.27 [1.64-3.14] and 1.52 [1.17-1.96], respectively) in comparison to normal ABI. The association between abnormal ABI and SCD remained significant after adjustment for traditional cardiovascular risk factors, but not for borderline ABI (HR 1.63 [1.15-2.32] and 1.24 [0.94-1.63]) (Table).

Conclusions:
Abnormal ABI is independently associated with risk of SCD in a biracial general population. ABI could be incorporated into a future risk SCD prediction model.
Abstract 8928: Le Coeur En Sabot: Shape and Regional Function Predict Adverse Outcome in Patients with Repaired Tetralogy of Fallot
Authors: Mira Anna , Lamata Pablo , Young Alistair , Pickardt Thomas , Tandon Animesh A , Sarikouch Samir , Omens Jeff , Latus Heiner , Beerbaum Philipp B , Koehler Sven , Bissell Malenka , Blair Zachary , Huffaker Tyler , Pushparajah Kuberan , Mauger Charlene , Abraham Georgina , McCulloch Andrew , Greil Gerald , Engelhardt Sandy , Hussain Mohammad
Published: April 2022

Introduction:
“Le Coeur en Sabot” (or the boot-shaped heart) is a radiological description of the appearance of the heart on a plain radiograph of a patient with Tetralogy of Fallot. This highlights the importance of the shape of the heart. Maladaptive remodeling is known to occur in patients with repaired Tetralogy of Fallot (rToF) due to residual lesions such as Pulmonary Regurgitant Fraction (PRF)

Hypothesis:
Shape and function analysis can reveal novel remodeling patterns associated with adverse events in patients with rToF

Methods:
Biventricular shape and function were studied in 192 patients with rToF (median age 15 years). Linear discriminative analysis (LDA) and principal component analysis (PCA) were used to identify shape differences between patients with and without adverse events (AE). AE included death, arrhythmias, and cardiac arrest (median follow-up 10 years)

Results:
LDA and PCA showed that shape characteristics pertaining to adverse events included a more circular LV (decreased eccentricity), dilated (increased sphericity) LV base, increased RV apical sphericity, and decreased RV basal sphericity. Multivariate LDA showed that the optimal discriminative model included only RV apical ejection fraction and one PCA mode associated with a more circular and dilated LV base (AUC = 0.78). PRF did not add value, and shape changes associated with increased PRF were not predictive of AE.

Conclusions:
Remodeling patterns in patients with rToF are associated with AE, independent of PRF. Mechanisms leading to AE include LV basal dilation with a reduced RV apical ejection fraction. That is to say that the old descriptor, “Le Coeur en Sabot'' may also describe that shape that is adverse in rTOF. The toe of this boot would be the dilated and poorly contractile RV apex and the ankle would be the spherical LV base (Figure 1: Top Row Diastole. Middle Systole. Posterior projection (a), anatomical position (b) and superior (c). LV is green)
Abstract 8991: Prognostic Significance of Hyponatremia in Peripartum Cardiomyopathy: Insights from the Peripartum Cardiomyopathy in Nigeria Registry
Authors: Karaye Kamilu M , Ishaq Naser A , Saidu Hadiza , Balarabe Sulaiman A , Adamu Umar Gati G , Mohammed Idris Y , Oboirien Isa O , Umuerri Ejiroghene , Mankwe Abaram C , Shidali Vincent , Dodiyi-Manuel Sotonye , Njoku Paschal , Olunuga Taiwo T , JOSEPHS VERONICA , Ogah Okechukwu S , Mbakwem Amam , Okolie Henry , Talle Mohammed A , Isa Muhammad Sani S ,   Peripartum Cardiomyopathy in Nigeria (PEACE) Registry
Published: April 2022

Introduction:
Hyponatraemia is a well-described independent poor prognostic marker for heart failure (HF). However, its prognostic significance in peripartum cardiomyopathy (PPCM) is unknown.

Hypothesis:
We hypothesized that hyponatremia will have prognostic significance in PPCM patients.

Methods:
In this post-hoc analysis of PEACE registry results, we aimed to determine the prognostic significance of hyponatremia in PPCM patients. We consecutively recruited the PPCM patients from 14 sites in Nigeria and followed them up for a median of 18 months. Serum sodium was measured at baseline, and patients with hyponatremia (<135mmol/L) were compared with those with normal values. Unrecovered LV systolic function was defined as LVEF ≤55%. Predictors of mortality were determined using a Cox-Proportional Hazard Regression model.

Results:
Overall, 90 of 191 (47.1%) PPCM patients had hyponatremia at presentation, with a mean serum sodium concentration of 126.7±22.3mmol/L (Table 1). Baseline clinical characteristics and prescriptions for diuretics and other HF drugs were well-balanced between the 2 groups. All-cause mortality among hyponatremic patients (24/90; 26.7%) was significantly higher than among patients with normal serum sodium (7/101; 6.9%) (p-value<0.001). The risk for all-cause mortality was independently increased by hyponatremia (Hazard Ratio: 3.18 [95% CI: 1.35-7.52; p=0.008]), hypotension (systolic BP<100mmHg) (2.22 [1.03-4.79]; p=0.043) and LVEF <25% (3.14[1.47-6.73], p=0.003), after adjusting for loop diuretics, serum creatinine, preeclampsia and tachycardia. Majority of the patients did not recover LV systolic function and rehospitalization was uncommon in both groups.

Conclusions:
Hyponatremia was common in our cohort of PPCM patients, and associated with 3-fold higher risk for all-cause mortality. It was however not associated with rehospitalization and unrecovered LV systolic function.
Abstract 9419: Quantification and Novel Algorithm of Echocardiography Against Magnetic Resonance Imaging for Isolated Tricuspid Regurgitation
Authors: Wang Tom , Akyuz Kevser , Reyaldeen Reza , Popovic Zoran B , Pettersson Gosta B , Gillinov A , Flamm Scott D , Griffin Brian P , Xu Bo , Desai Milind Y
Published: April 2022

Background:
Transthoracic echocardiography (TTE) is the first-line imaging modality to evaluate isolated tricuspid regurgitation (TR), however comparisons with magnetic resonance imaging (MRI) measurements have seldomly been studied. We assessed the correlation, discriminative ability and derived a novel TTE-based algorithm using TR and right heart parameters to identify isolated severe TR by MRI.

Methods:
Isolated TR patients graded at least moderate-to-severe by TTE and undergoing MRI between January 2007-June 2019 were studied. TR and right heart parameters were analyzed by correlation, receiver-operative characteristics analysis and classification and regression tree algorithm for detection of severe TR by MRI (regurgitant volume
>
45mL and/or fraction
>
50%).

Results:
In 262 isolated TR patients, 108 (41.2%) had severe TR by MRI. There were moderate correlations and discrimination for most TTE-derived TR parameters and indexed right atrial volume (Pearson r=0.428-0.645) for TR quantification by MRI. This included a mean absolute and percentage difference of +10mL and +19% for regurgitant volume by TTE higher than MRI. However, there were none to modest correlations between TTE-derived right ventricle parameters with MRI-derived TR or right ventricle quantification. Key TTE parameters to identify severe TR by MRI in the decision tree regression algorithm were right atrial volume indexed >47cm
2
/m
2
, then effective regurgitant orifice area >0.45 cm
2
, and finally those with right ventricle free wall strain >-9.5% had the highest risk.

Conclusion:
TTE-derived TR and right atrial quantification had moderate correlation and discrimination of severe TR by CMR, from which a novel TTE-based decision tree algorithm was derived, while RV correlation was relatively poor between TTE and CMR.
Abstract 9420: A Striking Contrast Between Lipid Therapy Prescribing Patterns versus Achieving Optimal Lipid Levels in Black and Hispanic Populations Following Acute Coronary Events
Authors: Ambrosino Maxwell , Emerson Sydney , Hernandez Patricia , Jacoby Douglas
Published: April 2022

Introduction:
Guideline directed lipid therapy (GDLT) for patients following acute coronary syndrome (ACS) is well-established secondary prevention. Historically disparities in secondary prevention have been observed among minority populations, however there is limited understanding of GDLT and resultant impact on achieving optimal LDL levels.

Hypothesis:
GDLT may not proportionally result in achievement of LDL <70 mg/dL.

Methods:
A cross-sectional study was employed across all University of Pennsylvania Health System from 2018 to 2019. Electronic medical records were queried for all admitted patients diagnosed with ACS. Data was collected for age, gender, race, GDLT, and lipid profiles up to 1-year post-discharge.

Results:
We identified 3386 patients with whom 2264 (66.8%) were male and 1122 (33.1%) were female. The majority was white representing 63.5% (2152), followed by 21.2% (718) Black, <4% (119) Asian, <3% (89) Hispanic, <2% (50) East Indian, and <1% (7) American Indian. At discharge 75.23% of White patients, 82.60% of Black patients, and 85.80% of Hispanic patients were prescribed GDLT. Non-statin therapy (including Ezetimibe and PCSK9-inhibitors) were prescribed post-discharge to 13.38% White patients, 12.26% Black patients, and 12.76% Hispanic patients. The rate of achieving optimal LDL was 53.89% in White patients, 41.07% in Black patients, and 44.40% in Hispanic patients.

Conclusions:
Black and Hispanic groups were prescribed GDLT at a greater rate than the White population. Despite this, less than 50% of Black and Hispanic groups achieved optimal LDL levels, about 10% less than the White population. Furthermore, non-statin therapy was prescribed slightly less than the White population. We observed disparities among racial groups in achieving optimal LDL levels despite being prescribed GDLT at a higher rate. Future investigation and a holistic approach to existing racial disparities will allow for improved secondary prevention.
Abstract 9424: Single versus Dual Antiplatelet Therapy for Stroke Prevention Following Left Atrial Appendage Occlusion in Patients With High Bleeding Risk
Authors: Mhanna Mohammed , Beran Azizullah , Al-Abdouh Ahmad , Ayesh Hazem , Barbarawi mahmoud , Srour Omar , Abuhelwa Ziad , Sayeh Wasef , Alsaiqali Mahmoud , Eltahawy Ehab A
Published: April 2022

Introduction:
The optimal antiplatelet therapy following Left atrial appendage occlusion (LAAO) in atrial fibrillation patients who are not candidates for long-term oral anticoagulation therapy (OAC) is subject to debate.

Hypothesis:
Is single antiplatelet therapy (SAPT) safe and effective when compared to dual antiplatelet therapy (DAPT) in patients with high bleeding risk?

Methods:
We conducted a comprehensive search for all studies that compared the use of SAPT with DAPT following LAAO for patients in whom OAC is deemed highly risky or contraindicated. The outcomes of our study were device-related thrombosis (DRT), stroke and systemic embolization (SSE), and major bleeding (MB). The risk ratio (RR) with 95% confidence intervals (CIs) are presented as summary statistics and were calculated using a random-effects model.

Results:
A total of 15 observational studies with 3231 patients (SAPT, n=1036; DAPT, n=2195; 64.5% men; median follow-up duration 12 months; mean age 74.7±8.5 years; CHA2DS2-VASc score 4.3±1.6; HASBLED score 3.2±1.2) were included. For DRT, data were available from 10 studies (2910 patients); there was no difference between SAPT and DAPT groups (2.6% vs. 2.3%; RR: 1.41; 95%CI: 0.77-2.59; P=0.26; I
2
:0%). For SSE (8 studies, 959 patients); although numerically more events were observed in the SAPT group, there was no statistical difference between the two groups in the pooled analysis (2.9% vs. 1.5%; RR: 5.43; 95%CI: 0.74-39.81; P=0.1; I
2
:78%). Finally, for MB (8 studies, 1818 patients); although numerically more events were observed in the DAPT group, there was no statistical difference between the two arms (2.3% vs. 3.2%; RR: 1.90; 95%CI: 0.46-7.87; P=0.37; I
2
:72%).

Conclusions:
Our study showed comparable safety and efficacy profiles for SAPT and DAPT after LAAO. Adequately powered randomized studies determining the optimal antithrombotic therapy in the first weeks after LAAO are warranted in patients at high risk for bleeding.
Abstract 9435: An Ultrasound Image of Spleen Shear Wave Elastography Predicts Adverse Outcomes in Heart Failure Patients
Authors: Misaka Tomofumi , Yoshihisa Akiomi , Ichijo Yasuhiro , Sugawara Yukiko , Ohara Himika , Hotsuki Yu , Watanabe Koichiro , Sato Yu , Oikawa Masayoshi , KOBAYASHI ATSUSHI , Takeishi Yasuchika
Published: April 2022

Introduction:
Cardiac and multiple organ network is involved in the pathophysiology of heart failure (HF). Ultrasound shear wave elastography (SWE) is a novel non-invasive imaging that is capable of quantitatively and directly estimating tissue stiffness, but its significance of the spleen has not been fully investigated, and the interactions between the heart and the spleen are poorly understood. This study aimed to clarify the clinical relevance of the spleen in HF patients by splenic ultrasonographic evaluation.

Methods and Results:
We applied the two-dimensional SWE of the spleen in consecutive hospitalized 232 patients with HF. We also measured spleen shear wave dispersion (SWD) to evaluate the tissue viscosity as well as the spleen index to assess the splenic size. In comparison to non-HF patients (n = 35), spleen SWE and SWD were significantly increased in HF patients (2.18 ± 0.28 vs. 2.38 ± 0.54 m/s, P = 0.03 and 11.3 ± 3.4 vs. 13.9 ± 5.3 m/s, P < 0.01, respectively) but spleen index did not differ between the two groups (24.1 ± 8.2 vs. 24.4 ± 9.8, P = NS). In HF patients, spleen SWE was negatively correlated with right ventricular fractional area change (P = 0.01) and positively correlated with the 7S domain of collagen type IV, a marker of fibrosis (P = 0.01). During a mean follow-up period of 303 days, the Kaplan-Meier analysis demonstrated that a higher spleen SWE was associated with a lower cardiac event-free rate from cardiac deaths and decompensated heart failure (
Figure
), but spleen SWD or spleen index was not. A multivariable Cox proportional hazard analysis revealed that spleen SWE was an independent predictor for the cardiac events (hazard ratio 3.4, P < 0.01).

Conclusion:
Among the splenic ultrasonographic parameters, spleen SWE was strongly associated with adverse outcomes in HF patients accompanied by organ fibrosis and right ventricular dysfunction.
Abstract 9445: Gender Disparities in Statin Prescriptions Following Acute Coronary Syndrome
Authors: Emerson Sydney , Ambrosino Maxwell , Hernandez Patricia , Jacoby Douglas
Published: April 2022

Introduction:
Initiation of high intensity statin therapy for patients following acute coronary syndrome (ACS) is well-established secondary prevention. Females with coronary artery disease have historically been associated with lower rates of goal directed medical therapy.

Hypothesis:
Disparities in statin prescriptions and targeted reductions in LDL levels exist between genders.

Methods:
A cross-sectional study was employed across the University of Pennsylvania Health System from 2018 to 2019. Electronic medical records were queried for all admitted patients diagnosed with ACS. Data was collected for age, gender, race, and lipid profiles on discharge and up to 1-year post-discharge.

Results:
The study population included 3386 patients of which 2264 (66.8%) were male and 1122 (33.14%) were female. At discharge after ACS event, 81.1% of males were on GDLT compared to only 71.6% females. Further, at post-discharge follow-up 65.1% males were still on GDLT compared to 58.3% of females. Rates of goal LDL < 70 mg/dL at post-discharge was 55.5% (602/1085) for males compared to 41.2% (226/548) for females. At this time, ezetimibe prescription rates for males was 7.4% and females was 6.9%. At post-discharge, interestingly, PCSK9-inhibitor prescription rates were 2.9% for females compared to 1.9% for males.

Conclusions:
Overall, male patients had higher rates of statin prescriptions than female patients on hospital discharge and at post-discharge follow-up. Further, less than half of female patients had LDL < 70 mg/dL at follow-up. Therefore, over half of female patients should be on further lipid lowering therapies. Yet, less than 7% of females are prescribed ezetimibe and only 2.9% are prescribed PCSK9-inhibitors. Further understanding of discrepancies in statin and non-statin prescription rates for female patients are warranted to allow for appropriate secondary ACS prevention.
Abstract 9448: The Effect of Diabetes on Cardiovascular Events After Coronary Artery Bypass Grafting versus Drug-Eluting Stents for Left Main Coronary Artery Disease: A Meta-Analysis
Authors: d'Entremont Marc-Andre , Yagi Ryuichiro , Salia Soziema J , Zhang Shuqi , Shaban Lamyaa , Bene-Alhasan Yakubu , Papatheodorou Stefania , Couture Etienne L , Huynh Thao , Nguyen Michel , Hamaya Rikuta
Published: April 2022

Background:
The optimal method of coronary revascularization for diabetes mellitus (DM) patients with left main coronary artery disease (LMCAD) is controversial in the drug-eluting stent (DES) era. We performed a systematic review and meta-analysis comparing DES-based percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG) for LMCAD in DM patients and tested for potential effect measure modification (EMM) by diabetes on major adverse cardiovascular and cerebrovascular events (MACCE).

Methods and Results:
We included all randomized controlled trials (RCTs) and observational studies comparing CABG to DES-based PCI including DM patients with LMCAD published up to March 1, 2021. We completed separate random-effects meta-analyses for four RCTs (4,356 patients, mean follow-up of 4.9 years) and six observational studies (9,360 patients, mean follow-up of 5.2 years). DM and non-DM patients were at increased risk of the composite endpoint of all-cause mortality, myocardial infarction, stroke, and unplanned revascularization when comparing CABG to DES-based PCI (p-value for interaction = 0.70) (Figure 1, DM =1, Non-DM =0). In observational studies, there was no difference between DES-based PCI and CABG for all-cause mortality in patients with DM (Figure 2).

Conclusion:
DES-based PCI was associated with an increased risk of MACCE compared to CABG in LMCAD patients irrespectively of DM status. We did not observe significant EMM by DM status. Considering these data, heart teams could consider DM as one of the many components in the clinical decision-making process, but not as a primary deciding factor between DES and CABG for LMCAD.
Abstract 9449: Extracorporeal Membrane Oxygenation versus Impella in Patients with Cardiogenic Shock from Inferior Wall Myocardial Infarction: Analysis from the National Inpatient Sample
Authors: Gill Jashan , Khatri Chhetri Ram Chandra
Published: April 2022

Introduction:
Since the IABP-SHOCK II trial, extracorporeal membrane oxygenation (ECMO), and the percutaneous ventricular assist device, Impella have emerged as the preferred mechanical circulatory assist devices for cardiogenic shock (CS). Studies have shown similar clinical outcomes with Impella and ECMO in patients with CS from unspecified myocardial infarction (MI) locations; however, data in patients with inferior wall MI is lacking.

Hypothesis:
ECMO is associated with an increased likelihood of adverse inpatient complications and medical costs compared to Impella in patients with CS from an inferior wall MI.

Methods:
We queried the National Inpatient Sample (NIS) from 2016-2018 to identify patients 18 years and older with a discharge diagnosis of CS from inferior wall MI who underwent ECMO or Impella placement. To mitigate selection bias, 8-to-1 propensity scoring was used to select matched samples between patients with ECMO and patients with Impella. The scoring was based on a multivariate logistic regression model accounting for age, gender, race, hospital type, income, and medical comorbidities.

Results:
We identified 638 patients with inferior wall MI resulting in CS, 15% (n=96) underwent ECMO and 85% (n=542) received Impella. ECMO was not associated with increased inpatient mortality (52% vs 50.7%; p=0.86) or cardiac arrest (24% vs 15%, p=0.09) when compared to Impella. After applying the multivariate logistic regression model, ECMO was not associated with an increased risk for acute kidney injury (OR 0.67; 95% CI 0.28-1.6, p=0.36), cerebrovascular events (OR 1.06; 95% CI 0.33-3.36, p=0.92), cardiac tamponade (OR 6.85; 95% CI 0.89-52.83, p=0.06) or CPR (OR 1.89; 95% CI 0.9-3.98; p=0.09). However, ECMO was associated with increased blood transfusions (OR 3.56; 95% CI 0.26-10.06, p=0.02), increased length of hospitalization (13.2 days vs 9.4 days; p<0.0001), and medical costs ($501,435 vs 403,120, p<0.0001).

Conclusions:
Our study demonstrates that ECMO is not associated with increased mortality in patients with CS from inferior wall MI compared to Impella, although Impella remains the more cost-effective choice in these patients. Future randomized studies are warranted comparing these circulatory assist devices in patients with CS.
Abstract 9460: Effects of Milk Fat Globule Epidermal Growth Factor VIII on Adverse Aortic Remodeling in Mice With Advancing Age
Authors: Wang Mingyi , telljohann richard , Ni Leng , ZHU Wanqu , Kim Soo hyuk , Liu Lijuan , ZHANG JING , McGraw Kimberly , Monticone Robert , Morrell Christopher , Lakatta Edward G
Published: April 2022

Background:
Milk fat globule epidermal growth factor VIII (MFG-E8), a secreted membrane glycoprotein, is an inflammatory signaling molecule, promoting the proliferation and invasion of vascular smooth muscle cells in vitro. MFG-E8 also is a bridging molecule that connects vascular smooth muscle cells to elastic fibers, forming elastin-smooth muscle unit, an essential contractile element within arterial medial wall. The inflammatory effects of MFG-E8 signaling between cells and matrix on adverse arterial remodeling with advancing age, however, remains unknown.

Methods and Results:
In this study, homozygous MFG-E8 knockout (MFG-E8 KO, n=50) and age-matched wild type male mice (WT, n=50) were investigated. Western blot analysis confirmed that MFG-E8 protein was enriched in the aortic walls of WT mice, but not detected in MFG-E8 KO animals
(Fig. A)
. In WT, aortic MFG-E8 protein was markedly increased (~18-fold, p<0.0001) in 96-week-old versus 40-week-old (
Fig. B
). Importantly, aortic elastin proportion (an index of elastin degradation) was significantly decreased in 96-week- versus 40-week-old while both collagen and calcium deposits proportion were markedly increased in WT mice; however, MFG-E8 deficiency significantly alleviated these age effects (
Fig. C
). The procalcification proteins alkaline phosphatase (ALP) and runt-related transcription factor 2 (Runx2) were markedly increased in 96-week-old WT versus MFG-E8 KO (
Fig. D
). Notably, MFG-E8 deficiency slightly effected on age-associated change in systolic blood pressure (SBP) compared to WT (
Fig. E)
and significantly extended the lifespan compared to WT (p=0.032) (
Fig. F
).

Conclusion:
These findings suggest that MFG-E8 signaling links cells and matrix to age-associated adverse arterial remodeling, including elastin degradation, collagen deposition, and calcification. Thus, the MFG-E8 knockout has beneficial effects on arterial health during advancing age and prolongs the lifespan in mice.
Abstract 9463: Effects of Surgical and FFP2 Masks on Cardiopulmonary Exercise Capacity in Patients With Heart Failure
Authors: Kogel Alexander , Hepp Pierre , Stegmann Tina , Tuennemann-Tarr Adrienn , Falz Roberto , Fischer Patrick , Mahfoud Felix , Laufs Ulrich , Fikenzer Sven
Published: April 2022

Introduction:
Surgical and FFP2 masks are recommended to reduce transmission of SARS-CoV-2. The cardiopulmonary effects of facemasks in patients with chronic heart failure are unknown. This prospective, cross-over study quantified the effects of wearing no mask (nm), surgical mask (sm), and FFP2 mask (ffpm) in 12 patients with clinically stable chronic heart failure (HF) (age 63.8±12 years, left ventricular ejection fraction (LVEF) 43.8±11 %, NTProBNP 573±567 pg/ml).

Methods:
The patients underwent spiroergometry with and without masks in a randomized sequence. Comfort/discomfort was assessed using a standardized questionnaire.

Results:
Maximum power was reduced with both types of masks (nm: 108.3 W vs. sm: 101.2 W vs. ffpm: 95.6 W, p<0.01). Maximum respiratory oxygen uptake (1499ml/min vs. 1481 ml/min vs. 1300 ml/min, p=0.95 and <0.01), peak ventilation (62.1 l/min vs. 56.4 l/min vs. 50.3 l/min, p=0.15 and p<0.05) and O2-pulse (11.6 ml/beat vs. 11.8 ml/beat vs. 10.6 ml/beat, p=0.87 and p<0.01) were significantly changed with ffpm but not sm. Discomfort was moderately but significantly increased (nm: 1.6 vs. sm: 3.4 vs. ffpm: 4.4, p<0.05).

Conclusion:
Both surgical and FFP masks reduce exercise capacity in heart failure patients, while FFP2 masks reduce oxygen uptake and peak ventilation.
Abstract 9479: Novel Predictors of Left Ventricular Reverse Remodeling in Patients With Recent-onset Dilated Cardiomyopathy Using T1 and T2 Mapping on Cardiac Magnetic Resonance
Authors: Yokoyama Ryo , Kanzaki Yumiko , Watanabe Tomohiko , Hoshiga Masaaki
Published: April 2022

Introduction:
The prognosis of patients with idiopathic dilated cardiomyopathy (DCM) has improved in recent decades with guideline-directed medical therapy. There is an essential need for better biomarkers to predict left ventricular reverse remodeling (LVRR) in DCM. Native T1, T2 and left ventricular (LV) global strain by cardiac magnetic resonance (CMR) without contrast agents provides a novel quantitative method for myocardial tissue characterization.

Hypothesis:
CMR parameters predict LVRR in patients with DCM.

Methods:
A total 34 patients ( 58 ± 13 years, 25 male) with DCM underwent baseline CMR imaging (3T Philips), including cine, late gadolinium enhancement (LGE) CMR, and triple-slice T1 and T2 mapping (short modified look locker inversion recovery ShMOLLI sequence). The 6SD-LGE (% area), global circumferential strain (GCS), global radial strain (GRS), global longitudinal strain (GLS), global radial strain (GRS), LV mass index (LVMI), LV end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) were calculated from multiple short-axis views. Echocardiography was conducted before and > 1 year after after optimal medical therapy.

Results:
The patients were divided into two groups, LVRR with LVEF increase of >10% and the final value of ≥40% for those without. There were no significant differences in LV mass index, LVEDV, LVESV, and LVEF between the two groups (80 ± 20 g/m
2
vs 78 ± 19 g/m
2
; 174 ± 54 ml vs 165 ± 48 ml; 134 ± 51 ml vs 122 ± 46 ml; 24 ± 9% vs 28 ± 9%, respectively). The any LV global strain showed no significant difference between the two groups. The 6SD-LGE, native T1, and T2 values were significantly lower in LVRR+ group than in LVRR-group (15.3 ± 15.5 % vs 5.9 ± 6.8%;1376 ± 59 ms vs 1301 ± 42 ms;55 ± 3.5 ms vs 50 ± 2.5 ms,respectively). The LGE-6SD < 13%. native T1 value < 1330 ms and T2 values < 53ms were the best threshold values for predicting LVRR (The LGE-6SD: sensitivity, 82%; specificity, 41%; AUC 0.72, T1:sensitivity, 82%; specificity, 71%; AUC 0.87, and T2: sensitivity, 82%; specificity, 63%; AUC 0.88).

Conclusions:
Native T1 and T2 mapping values may be useful for assessing of the LVRR in patients with DCM even without contrast.