bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14090: Myocardial Infarction Selectively Decreases Cardiac Vagal Afferent Neurotransmission: Implications for Mechanisms Behind Cardiac Parasympathetic Dysfunction
Authors: Lokhandwala Zulfiqar , Devarajan Asokan , Wang Kerry , Shannon Kassandra , Tompkins John D , Vaseghi Marmar
Published: April 2022

Introduction:
Parasympathetic dysfunction after myocardial infarction (MI) predisposes to arrhythmias and heart failure. Mechanisms behind this dysfunction are unclear. It is known that cardiac sensory afferent neurons in the vagal ganglia sense beat-to-beat changes at the level of the heart. This vagal afferent signaling/activation then increases central cardiac vagal efferent drive.

Hypothesis:
We hypothesized that MI causes a functional reduction in vagal afferent signaling that subsequently decreases efferent vagal tone, resulting in parasympathetic dysfunction.

Methods:
A transgenic mouse line was created by crossing mice expressing excitatory vesicular glutamate transporter 2, VGlut-ires-cre, with those expressing channel rhodopsin 2 EYFP (ChR2), resulting in mice with VGlut and ChR2 expression in afferent-specific vagal neurons and fibers. MI was created by left anterior descending artery ligation. Sham animals underwent thoracotomy only. Control animals did not undergo a thoracotomy. Two weeks post-MI or sham, the left cervical vagus nerve was isolated and optically stimulated in vivo using blue light laser (473 nm, 20 Hz, 10 & 20 msec). Heart rate (HR), respiratory rate (RR), and time to activation of efferent vagal effects (time to nadir HR/RR) were assessed.

Results:
In response to optical stimulation, MI animals (n=5) demonstrated significantly reduced HR responses vs. sham (n=4) and control (n=7) animals at both 10 ms and 20 ms, figure. Time to nadir HR was also increased in MI animals (P<0.05 vs. sham/control). RR decreased in all animals, without significant differences between groups.

Conclusions:
MI is associated with decreased efferent vagal responses to similar levels of parasympathetic afferent activation. These results suggests that mechanisms behind decreased vagal tone post-MI may be due altered vagal afferent neurotransmission and signaling capabilities. MI selectively affects cardiac, not respiratory, neural responses.
Abstract 8909: High Hospital-Specific Postoperative Troponin Testing Intensity Was Associated With Improved Outcomes After Major Vascular Surgery
Authors: Azizi Paymon M , Wijeysundera Duminda N , Wijeysundera Harindra C , Austin Peter , Jerath Angela , Han Lu , Koh Maria , Kayssi Ahmed , Ko Dennis T
Published: April 2022

Background:
Acute myocardial injury after non-cardiac surgery is associated with increased mortality and cardiovascular morbidity, but it is not known if systematic postoperative troponin testing will lead to improved patient outcomes.

Methods:
We defined a cohort of vascular surgery patients in Ontario, Canada from January 1, 2010 to December 31, 2017. Hospital-level troponin testing intensity (classified into tertiles) was determined by the proportion of patients that received postoperative troponin testing. Cox proportional hazards modeling was used to assess the association (expressed as hazard ratio [HR]) between hospital-specific testing intensity with 30-day and 1-year major adverse cardiovascular outcomes (MACE) while adjusting for patient-, surgery-, and hospital-level factors. MACE was defined as all-cause mortality, myocardial infarction, or coronary revascularization. Rates of postoperative consultations and new filled prescription medications (≥65y) were also assessed.

Results:
The cohort consisted of 18,467 patients. Mean age was 72y (SD9) and 74.0% were male. The proportion of patients that received postoperative troponin testing were 77.5%, 35.8%, and 21.6% in the high, medium, and low testing intensity groups, respectively. At 30-days, 5.3%, 5.3% and 6.5% of patients in high, medium, and low testing intensity group experienced MACE, respectively. Compared with low-testing intensity, high-testing intensity was associated with a lower hazard of 30-day MACE (HR 0.71; 95%CI 0.57-0.89) and at 1-year (HR 0.83; 95%CI 0.72-0.94; Figure 1). High testing intensity hospitals had higher rates of postoperative cardiology and internal medicine consults and higher rates of new prescription medications filled.

Conclusion:
Patients undergoing vascular surgery at hospitals with higher postoperative troponin testing intensity had better 30-day and 1-year outcomes than patients who had surgery at hospitals with lower testing intensity.
Abstract 8912: The Ceramide- and Phosphatidylcholine- Based Coronary Event Risk Test2 (CERT2) and Cardiovascular Mortality in Men and Women with Type 2 Diabetes
Authors: Leiherer Andreas , Muendlein Axel , Saely Christoph H , Larcher Barbara , Mader Arthur , Maechler Maximilian , Sprenger Lukas , Mutschlechner Beatrix , Benda Magdalena , Laaksonen Reijo , Laaperi Mitja , Jylha Antti , Fraunberger Peter , Drexel Heinz
Published: April 2022

Introduction:
The recently introduced Coronary Event Risk Test version 2 (CERT2) is a validated cardiovascular risk predictor score that uses circulating ceramide and phosphatidylcholine concentrations.

Hypothesis:
We hypothesize that CERT2 hat the power to predict cardiovascular mortality in patients with type 2 diabetes (T2DM).

Methods:
Prospectively, out of 280 male and 121 female patients with T2DM we recorded 55 cardiovascular deaths in men and 19 in women during a mean follow-up time of 7.6±3.6 and 8.1±3.4 years respectively.

Results:
Overall, cardiovascular survival decreased with increasing CERT2 risk categories (figure 1). In Cox regression models, CERT2 significantly predicted the incidence of cardiovascular mortality in male patients with T2DM (unadj. HR 1.82 [1.39-2.37] per standard deviation; p<0.001), the unadj. HR in women was 1.36 [0.83-2.22]; p=0.228). After adjustment for age, BMI, current smoking, LDL cholesterol, HDL cholesterol, hypertension, and statin use the HR in men was 1.73 [1.31-2.29]; p<0.001) and in 1.40 [083-2.36]; p=0.210 women. Interaction terms CERT2 x gender were non-significant both in univariate analysis (p=0.354) and after multivariate adjustment (p=0.359).

Conclusions:
We conclude that sex does not significantly impact the association of CERT2 with cardiovascular mortality in patients with T2DM.
Abstract 8915: Unsupervised Machine Learning Clustering Identifies Low Flow-Low Gradient as High Mortality Risk Phenotypes in Transcatheter Aortic Valve Replacement Patients
Authors: Chao Chiehju , Wu Han-Lun , Agasthi Pradyumna , Rayfield Corbin , Barry Timothy , Fatunde Olubadewa , Seri Amith , Eleid Mackram F , Fortuin Floyd D , Sweeney John , Pollak Peter , El Sabbagh Abdallah , Lester Steven , Holmes David R , Shen Win K , Patel Bhavik , Arsanjani Reza
Published: April 2022

Introduction:
Multiple supervised machine learning (ML) models have been used to assess the outcomes in patients who underwent transcatheter aortic valve replacement (TAVR) procedure, however, supervised ML requires significant expert time for annotation and labeling. Unsupervised ML can provide insight into the dataset without this process.

Hypothesis:
We hypothesized that unsupervised k-means ML can identify distinct phenogroups in TAVR patients that can predict prognosis without a priori knowledge.

Methods:
A retrospective study of patients who underwent TAVR (Jan 2012-Dec 2017) at Mayo Clinic sites was performed. Baseline demographics, EKG, cardiac computed tomography, and echocardiographic data were abstracted. Variables with ≥ 20% missing data were excluded. Prior to the k-means clustering algorithm, principal component analysis was used for dimensionality reduction. Input variables were analyzed according to k-means determined clusters. Kaplan-Meier survival analysis was used to assess the survival of each cluster.

Results:
A total of 1071 consecutive patients were included in the final analysis. A total of 141 unique variables were used. The mean age was 80.7±8.6 years, 58.2% were male. Patients were divided into 2 distinct phenogroups. In the two phenogroups, cluster 0 (n=639) has significantly better survival than cluster 1 (n= 432) (log-rank p=0.0002) (Figure 1). Cluster 1 has features of low flow-low gradient (LFLG) hemodynamic profile, including lower systolic blood pressure, mean aortic valve gradient, peak aortic valve velocity, and worse LV ejection fraction.

Conclusions:
Unsupervised ML can identify distinct phenotype features with prognostic significance in TAVR patients. Our results suggest that patients with LFLG hemodynamic features are intrinsically different from other TAVR patients and require more attention to avoid adverse outcomes.
Abstract 8920: Type 2 Diabetes, Chronic Kidney Disease and Major Cardiovascular Events in Patients with Established Coronary Artery Disease
Authors: Sprenger Lukas , Vonbank Alexander , Larcher Barbara , Mader Arthur , Maechler Maximilian , Mutschlechner Beatrix , Benda Magdalena , Leiherer Andreas , Muendlein Axel , Drexel Heinz , Saely Christoph H
Published: April 2022

Introduction:
Both type 2 diabetes (T2DM) and chronic kidney disease (CKD) confer a high risk of cardiovascular disease (CVD), and these conditions frequently coincide.

Hypothesis:
We hypothesize that there are single and joint effects of T2DM and CKD on major cardiovascular events (MACE) in a high-risk population of patients with established coronary artery disease (CAD).

Methods:
We prospectively investigated 1460 patients with angiographically proven CAD over 10.4±4.8 years, of whom 454 (30.8%) had T2DM and 251 (17.1%) had CKD.

Results:
MACE occurred more frequently in T2DM patients than in non-diabetic subjects (40.4% vs 28.7%, p<0.001) and in patients with CKD (eGFR < 60ml/min/1.73m
2
) than in those with an eGRF ≥60ml/min/1.73m
2
(51.6% vs 28.3%, p<0.001). When both, T2DM and CKD were considered, 863 subjects had neither T2DM nor CKD, 346 had T2DM but not CKD, 148 did not have diabetes but had CKD, and 103 had both T2DM and CKD. When compared with the incidence of MACE among patients with neither T2DM nor CKD (25.3%), MACE occurred more frequently in patients with T2DM who did not have CKD (35.8%; p<0.001) as well as in non-diabetic patients with CKD (47.6%; p<0.001) and occurred most frequently in patients with both, T2DM and CKD (57.4%; p<0.001), in whom the incidence of MACE was higher than in those with T2DM but not CKD (p<0.001) or those without T2DM but with CKD (p=0.025); the incidence of MACE was higher in non-diabetic CKD patients than in T2DM patients who did not have CKD (p=0.041). In Cox regression analysis, T2DM (HR=1.46 [1.20-1.78]; p<0.001) and CKD (HR=1.81 [1.45-2.27]; p<0.001) were mutually independent predictors of MACE after multivariate adjustment.

Conclusions:
We conclude that T2DM and CKD are mutually independent risk factors for MACE in patients with established CAD. CAD patients with both CKD and T2DM are at an extremely high risk for MACE.
Abstract 8962: Meta-Meta-Analysis of Outcomes of Valve-in-Valve TAVI Compared to Redo-SAVR
Authors: Altamimi Abbas , Khan Nida , Aedma Surya K , Raol Karanrajsinh , Raheem Abdur , Jain Shubhi , Madireddy Sowmya , ali nawal , Rabbani Rizwan , Rakholiya Jigisha , Malik Preeti , Patel Urvish K , Pothuru Suveenkrishna
Published: April 2022

Introduction:
Redo-Surgical valve replacement (Redo-SAVR) is the gold standard treatment for failed degenerated bioprosthetic valves. Recently approved less invasive Valve-In-Valve Transcatheter Aortic Valve Implantation (ViV-TAVI) procedure is becoming more popular but with limited evidence of its safety and efficacy compared to redo-SAVR.

Hypothesis:
We aimed to conduct the meta-meta analysis to evaluate the outcomes of ViV-TAVI compared to redo-SAVR.

Methods:
We conducted a systematic search of meta-analysis studies assessing outcomes of ViV-TAVR vs redo-SAVR using PubMed search engine and following PRISMA guidelines from inception to May 2021. A meta-meta-analysis was performed by obtaining a pooled odds ratio, 95% confidence interval (95%CI) using random-effects models to analyze outcomes of 30-day all-cause mortality and procedural mortality.

Results:
Nine meta-analysis studies were included. We found that there was a significantly lower odds of 30-day all-cause mortality (pooled OR:0.60; 95%CI:0.53-0.68; p<0.00001) with 0% heterogeneity (I2= 0%;p=0.53) in the ViV-TAVI compared to redo-SAVR. We also found a reduced risk of procedural mortality with ViV-TAVI compared to redo-SAVR (pooled OR:0.52; 95%CI:0.27-0.98; p=0.04) with 0% heterogeneity (I2= 0%;p=0.69) (Figure).

Conclusions:
ViV-TAVI is significantly associated with reduced risk of 30-day all-cause mortality, and procedural mortality compared to redo-SAVR. Our meta-meta-analysis supports that minimally invasive ViV-TAVI is a safe and better procedure for degenerated bioprosthetic valves in high-risk candidates.
Abstract 8984: Prediction of Functional Results of Percutaneous Coronary Interventions With Virtual Stenting and Quantitative Flow Ratio
Authors: Lee Hyun-jong , Hernán Mejía-Rentería , Escaned Javier , Doh Joon-Hyung , Lee Joo Myung , Hwang Doyeon , Yuasa Sonoka , Choi Ki Hong , Jang Ho Jun , JEON KI-HYUN , LEE JUNEYOUNG , Nam Chang-Wook , Shin Eun-Seok , Koo Bon-Kwon
Published: April 2022

Introduction:
The clinical value of residual quantitative flow ratio (rQFR), a novel function of QFR technique aimed to predict residual ischemia after virtual percutaneous coronary intervention (vPCI) is unknown.

Hypothesis:
We hypothesized rQFR well predict functional results after PCI.

Methods:
This is a sub-study of the COE-PERSPECTIVE registry, which investigated the prognostic value of post-PCI fractional flow reserve (FFR). From pre-PCI angiograms, QFR and rQFR were analyzed and their diagnostic performance was assessed at blinded fashion using pre-PCI FFR and post-PCI FFR as reference, respectively. The prognostic value of rQFR after vPCI was assessed according to vessel-oriented composite outcome (VOCO) (a composite of cardiac death, vessel-specific myocardial infarction, and vessel-specific revascularization) at 2 years.

Results:
Two hundred and seventy-four patients (274 vessels) with FFR-based ischemic causing lesions were analyzed. Pre-PCI QFR and FFR were 0.63±0.10 and 0.66±0.11 (R=0.756, p<0.001). rQFR after vPCI and FFR after real PCI were 0.93±0.06 and 0.86±0.07 (R=0.528, p<0.001). Diagnostic performance of rQFR to predict actual post-PCI FFR was good (area under the curve (AUC): 0.856 [0.804-0.909], p<0.001). rQFR predicted well the incidence of 2-year VOCO after index PCI (AUC: 0.712 [0.555-0.869], p=0.041), being similar to that of actual post-PCI FFR (AUC: 0.691 [0.512-0.870], p=0.061). rQFR ≤0.89 was associated with increased risk of 2-year VOCO (hazard ratio: 12.9 [2.32-71.3], P=0.0035).

Conclusions:
Residual QFR estimated from pre-PCI angiography and virtual coronary stenting predicts procedural functional results and long-term vessel-related clinical events.
Abstract 9400: Mitral Valve Prolapse Induces Regionalized Left Ventricular Fibrosis
Authors: Morningstar Jordan E , Gensemer Cortney , Moore Reece , Fulmer Diana B , Beck Tyler , Wang Christina , Moore Kelsey , Guo Lilong , Vohra Ayesha , Sieg Franz , Nagata Yasufumi , Bertrand Philippe , Spampinato Ricardo , Glover Janiece , Poelzing Stephen , Gourdie Robert G , Richardson William , Levine Robert A , Borger Michael , Norris Russell A
Published: April 2022

Introduction:
Imaging studies patients with mitral valve prolapse (MVP) have previously shown cross sectional evidence of left ventricular (LV) fibrosis as well as increased risk for sudden cardiac death. This, along with evidence for post-repair ventricular dysfunction in Mitral valve surgery patients support a link between fibrosis and MVP. The development of fibrosis as a result of MVP, however, remains poorly understood.

Hypothesis:
Regionalized LV Fibrosis in MVP patients is driven by increased mechanical tension through the chordae tendineae by billowing leaflets.

Methods:
We performed histopathologic analysis on cardiac biopsies of 6 patients who underwent surgical repair for MV prolapse. We additionally performed longitudinal histopathologic analysis on hearts harvested from a mouse modal of human non-syndromic MVP (Dzip1 S14R/+). To assess the cellular response to increased mechanical tension, pathological stretch assays on human cardiac fibroblasts were performed in tandem with RNA seq, as well ATP luminescence assays to assess ATP release from stretched cells.

Results:
Biopsies from peripapillary regions, inferobasal wall, LV septum, and LV apex demonstrated regionalized myocardial fibrosis that correlated with increased macrophages and myofibroblasts. Our mouse model demonstrated similar regionalized deposition of collagen that increased over time, as well as an increase in macrophages and myofibroblasts. Stretching of human cardiac fibroblasts caused significant changes in 232 transcripts (Bonferroni corrected P value <1.72*10-6), and pushed fibroblasts into a pro-fibrotic state, upregulating alpha-Smooth Muscle actin, Collagen, PLOD1, and decreasing MMP1. Additionally, pathologic stretch of fibroblasts increased secretion of ATP, a known chemoattractant for innate inflammatory cells.

Conclusions:
A mouse model of human MVP phenocopied regionalized myocardial fibrosis seen in humans and will provide a useful tool to investigate mechanisms of myocardial fibrosis in MVP patients. Stretch initiates changes in pro-fibrotic gene transcription, and causes ATP release from human cardiac fibroblasts.
Abstract 9412: Establishing a Coronary Calcium Scoring Threshold as a Gateway to Invasive Testing for Firefighters Undergoing Fitness for Duty Exams
Authors: Beroukhim Afrahimi Shiela C , Beroukhim Afrahimi Shiela , Kinninger April , Budoff Matthew
Published: April 2022

Introduction:
Heart disease is the leading cause of death amongst active firefighters. Firefighters undergo exercise treadmill test as a part of fitness for duty examinations screening for heart disease. It has been previously shown that coronary artery calcium (CAC) scoring and CT angiography (CTA) together can be used cost effectively in further screening for obstructive coronary artery disease amongst firefighters. A coronary artery calcium score threshold to predict obstructive CAD however is yet to be established.

Methods:
Firefighters in the County of Los Angeles Fire Department underwent fitness for training tests over a twenty-year period using treadmill ECG tests for cardiac screening. Those with positive tests were referred for further evaluation with coronary calcium scoring (CCS). Individuals with a CCS of > 10 went on to have CTA as prior studies have shown that CCS < 10 is highly unlikely to correlate with obstruction. We used receiver-operating characteristic (ROC) analysis to determine the optimal sensitivity and specificity of a CCS threshold needed to predict which individuals were likely to have a CTA showing greater than 50% stenosis.

Results:
Annually, about 3000 firefighters undergo fitness for duty testing in Los Angeles County. In our sample population from 1999 to 2019, a total of 1425 firefighters had a positive treadmill test. All 1425 of these firefighters underwent CCS with scores varying from 0 to 1400, the distribution vastly skewed toward 0. A ROC curve analysis indicated that a CCS score of 75 was the optimal cutoff for sensitivity (82%) and specificity (62%), in predicting a stenosis greater than 50% in any segment in the CTA firefighter population. However, given the high stress associated with firefighter duty and the high mortality both on-duty and after-duty, we believe prioritization should be geared toward detection and prevention. For this reason, we chose to maximize sensitivity in our statistical analysis and determined that a CAC score of 10 (sensitivity 95%, specificity 13%) to be the most appropriate threshold.

Conclusion:
For future testing, a CCS threshold score of 10 can confidently be used to guide further testing for obstructive coronary artery disease with CTA.
Abstract 9415: Body Mass Index, Waist Circumference and Waist-Hip Ratio in South Asians With Acute Coronary Syndrome
Authors: Karunathilake Parackrama , Kumarihamy Prabhashini , Gunaratne Sujeewa , Ranasinghe Dammika , Bandara Charith , Ralapanawa Udaya
Published: April 2022

Introduction:
Acute coronary syndrome (ACS) is the leading cause of death worldwide, even higher in South Asian countries. South Asia shows a higher incidence of ACS and an increasing trend of overweight and obesity.

Methods:
This cross-sectional descriptive study was conducted at the Teaching Hospital Peradeniya, Sri Lanka, among the patients presenting with ACS. An interviewer-administered structured questionnaire was used to collect data and to take anthropometric measurements. They were analysed to obtain the body mass index (BMI) and the waist-hip ratio.

Results:
A total of 780 patients with ACS were included in the study with a mean age of 60.8 ± 11.3 years. Among them, 316 (40.5%) were females. The mean BMI of females was 25.2 ± 4.4 kg m
-2
which was higher than that of males 23.9 ± 3.8 kg m
-2
, showing a statistically significant difference (p=0.003). The prevalence of overweight and obesity was 37.6% and 21.2%, respectively, significantly higher than the normal values for the ordinary Sri Lankan population (p=0.002). In females, the prevalence of obesity (31.2%) was significantly higher than in males (13.5%) (p=0.000). In males, the prevalence of overweight (40.6%) was significantly higher than in females (33.8%) (p=0.000). The mean waist circumference and waist-hip ratio in females were 88.8 ± 13.8 cm and 0.93 ± 0.10, respectively, which were significantly above the cut-off values for the risk of metabolic complications for South Asians 80 cm (p=0.000) and 0.85 (p=0.000). In males, the mean waist circumference was 86.9 ± 12.9 cm, significantly below the cut-off value for the South Asians (p=0.009), and the mean waist-hip ratio was 0.98, significantly above the cut-off point for South Asians (p=0.000).

Conclusions:
The proportion of overweight and obesity is significantly higher among the South Asians with ACS than the average South Asian population, confirming them as risk factors for cardiovascular diseases. In females, obesity is more associated with the development of ACS than in males. A higher waist circumference and the waist-hip ratio has an excellent predictive value of ACS in females. However, in males, though the waist-hip ratio has an excellent predictive value of ACS, waist circumference shows a negative correlation.
Abstract 9430: A Novel Soluble Epoxide Hydrolase Peptide Vaccine Attenuates Cardiac Remodeling After Myocardial Infarction Through Angiogenesis
Authors: Kitsuka Takahiro , Shiraki Aya , Oyama Jun-ichi , Nakagami Hironori , Tanaka Atsushi , Node Koichi
Published: April 2022

Introduction:
Vaccination therapy has long-lasting effects and solves medication non-adherence. However, vaccination therapy on myocardial infarction (MI) has not been developed. Epoxyeicosatrienoic acids (EETs) play an important role in cardio-protective mechanisms through angiogenesis. Here, we developed a soluble epoxide hydrolase (sEH) peptide vaccine to increase the level of EETs and assessed its therapeutic effect for MI-induced heart failure.

Hypothesis:
We predicted that neovascularization by a sEH vaccine would reduce infract size and prevent post-MI cardiac remodeling.

Methods and Results:
We made a sEH peptide vaccine based on the amino-acid sequences and administrated the vaccine to rats. ELISA showed that the vaccine induced anti-sEH antibody. Mass spectrometry also confirmed that the vaccine significantly increased blood EETs levels compared to the saline group (P=0.007). We evaluated the effects of the sEH vaccine in the rat model of MI. One week after the left anterior descending artery (LAD) ligation, the vaccinated group significantly suppressed the increase of left ventricular systolic diameter (LVDs) and prevented the decline in left ventricular anterior wall (LVAW), fractional shortening (FS), and ejection function (EF) in echocardiography (P<0.001, P<0.001, P=0.002, and P<0.001 respectively). With the pathological evaluation of the hearts, it was clear that the number of micro-vessels increased in the vaccinated group by immunostaining for CD31 and α-SMA (P=0.015 and P=0.027 respectively). Azan staining showed that infarct-induced fibrosis was lower in the vaccinated group (P=0.029). Western blot showed higher vascular endothelial growth factor (VEGF) expressions of heart muscles in the vaccinated group (P=0.040).

Conclusion:
The sEH vaccine therapy for MI induces angiogenesis, which promotes reverse cardiac remodeling. This vaccine is expected to be a treatment option to prevent heart failure after MI.
Abstract 9443: Improving Time to Defibrillation Following Ventricular Fibrillation and Ventricular Tachycardia Cardiac Arrest at Thomas Jefferson University Hospital
Authors: Bodempudi Sairamya , Wus Lisa , Kloo Juergen , Zeniecki Patrick , Mae West Frances , lev yair
Published: April 2022

Problem Definition:
Defibrillation within 2 minutes after ventricular fibrillation (VFib) and ventricular tachycardia (VTach) cardiac arrest has improved survival to discharge and five-year survival rates. The goal of this study was to identify how often patients were defibrillated within this recommended 2-minute interval at a single institution. A retrospective chart review of the code blue database over a 21-month time period revealed 24 VFib/VTach cardiac arrests. Time to defibrillation for each event, defined as time of identification of VFib/VTach arrest to time of delivery of the first defibrillation, was calculated. Approximately 67% (22/34) of patients who experienced VFib/VTach arrest were not defibrillated within 2 minutes and 8% (3/34) did not receive defibrillation at all. The data was further stratified based on event location (ICU versus non-ICU) and compared using chi-squared analysis, with statistical significance defined as p<0.05. A significantly higher number of delayed defibrillations occurred in the non-ICU cohort compared to the ICU cohort (11/34 versus 3/34, p=0.0028).

Intervention:
We utilized code blue simulation sessions and an educational module to train nursing staff, who are often first at bedside, to promptly defibrillate VFib/VTach.

Methods:
36 nurses out of 53 ACLS certified nurses were recruited from a single nursing unit. Groups of 2 or 3 nurses completed code blue simulation sessions to establish a baseline time to defibrillation. They were then given 2 weeks to complete an assigned educational module. Upon completion, they will be brought in for a second round of simulation sessions to assess whether their time to defibrillation has improved.

Results:
Out of the 15 simulation sessions that were done in the first round, 33% (5/15) ended with delayed defibrillation and 27% (4/15) ended with no defibrillation. The simulation data correlated with the retrospective chart review data.

Next Steps:
The second round of simulation sessions will take place in two weeks. Post-intervention data will be collected and analyzed to determine if the nursing educational module was effective. If it is, we hope to make the simulation sessions and educational module a hospital-wide initiative to improve time to defibrillation.
Abstract 9447: Hospital-level Disparities in Management and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction
Authors: Pajjuru Venkata Siva Kumar S , Patlolla Sri , Sundaragiri Pranathi R , Vallabhajosyula Saraschandra
Published: April 2022

Background:
There is limited contemporary data exploring the impact of hospital characteristics on the outcomes of AMI-CA patients.

Methods:
We used the National Inpatient Sample database (2000-2017), to identify adult admissions with a primary diagnosis of AMI and concomitant CA. Inter-hospital transfers were excluded and hospitals were classified based on location and teaching status (rural, urban nonteaching and urban-teaching), and bed size (small, medium and large) as specified by the Agency for Healthcare Research and Quality

Results:
Among 494,083 AMI-CA admissions, 9.3% received care at rural hospitals, 43.4% at urban non-teaching hospitals, and 47.3% at urban teaching hospitals. Compared to urban non-teaching and teaching hospitals, AMI-CA admissions at rural hospitals received lower rates of coronary angiography (36.5% vs 57.7% vs 69.1%), PCI (28.1% vs 42.6% vs 52.1%), CABG (3.4%, 7.6% vs. 10.1%), MCS (10.1% vs 17.8% vs 22.6%), and invasive mechanical ventilation (42.9%, 49.7% vs. 48.7%) (all
p
<0.001). Admissions to urban teaching hospitals had higher rates of acute organ failure, concomitant cardiogenic shock and higher rates of cardiac and non-cardiac procedures. When hospitals were stratified by bed-size, 9.8% of AMI-CA admissions were admitted to small hospitals, 26.0% to medium-sized, and 64.2% to large hospitals. Compared to medium and large hospitals, AMI-CA admissions at small hospitals had lower rates of coronary angiography (48.9% vs 56.8% vs 64.7%), PCI (37.5% vs 42.5% vs 48.4%), CABG (5.3%, 6.8% vs. 9.5%), MCS (14.3% vs 17.3% vs 21%), and invasive mechanical ventilation (48.3%, 50.1% vs. 48%) (all
p
<0.001). In-hospital mortality was higher in urban non-teaching (adjusted odds ratio [aOR] 1.17 [95% confidence interval {CI} 1.14-1.20]; p<0.001) and urban teaching hospitals (aOR 1.36 [95% CI 1.32-1.39]; p<0.001) compared to rural hospitals. Compared to small hospitals, medium (aOR 1.11 [95% CI 1.08-1.14]; p<0.001) and large hospitals (aOR 1.22 [95% CI 1.19-1.25]; p<0.001) were associated with higher in-hospital mortality.

Conclusions:
AMI-CA admissions to large and urban hospitals had higher in-hospital mortality compared to small and rural hospitals potentially due to greater acuity.
Abstract 9473: Implications of Removal of the Race Coefficient from Estimated Glomerular Filtration Rate Calculation on Sodium Glucose Co-transporter-2 Inhibitors Eligibility in Heart Failure and/or Chronic Kidney Disease
Authors: Sedhom Ramy , Antonio Eduardo , Abdelmaseeh Peter , vangapalli Anantha Laxmi L , Akhtar Hamza , Barreira Angelim Lucas , Romero Ardel J , Lo Kevin Bryan , Mathew Roy O , Vaduganathan Muthiah , Rangaswami Janani
Published: April 2022

Introduction:
The implications of race coefficient removal from the eGFR estimation equations on the pool of eligible Black patients with HFrEF and/or CKD for initiation of the Sodium Glucose Co-Transporter-2 inhibitors (SGLT2i) have not been evaluated.

Hypothesis:
To determine the change in eligibility by eGFR criteria for Black patients with HFrEF (EF< 40%) and CKD for initiation of dapagliflozin with/without race inclusion in computing eGFR.

Methods:
Retrospective single-center analysis of Black patients with HFrEF (EF<40%) hospitalized with a diagnosis of acute heart failure. Patients on any modality of dialysis were excluded. The serum creatinine value on discharge was used to compute eGFR using both MDRD and CKD-EPI formulae with and without the race coefficient. Eligibility eGFR value for initiation dapagliflozin for HFrEF was set at >25cc/min/1.73m
2
, and the eGFR range of interest for initiation in CKD was set at the 25-75cc/min/1.73m
2
range.

Results:
A total of 396 Black patients were included in the analysis of which 62% were men. The mean age was 64±15 years and 37% had CKD stage 3-5. The proportion of patients eligible for initiation of dapagliflozin (eGFR>25cc/min/1.73m
2
) for HFrEF did not change significantly (93% with race vs 91% without race p=0.431 for MDRD and 92% vs 90% p=0.450 for CKD-EPI). On the other hand, the proportions for patients eligible by CKD eGFR range of 25 to 75 cc/min/1.73m
2
significantly increased with eGFR estimated without the race coefficient. This was true for both the MDRD and CKD-EPI equations (see Figure 1).

Conclusions:
The proportion of eligible patients for SGLT2i therapy (HFrEF and CKD) significantly increased when eGFR was computed without the race coefficient, driven by an increased CKD stage 3 range re-classification. Race coefficient removal in computation of eGFR did not adversely impact eligibility for SGLT2i when used for HFrEF.
Abstract 9480: Vagus Nerve Stimulation Exerts Cardioprotection Against Doxorubicin-Induced Cardiotoxicity Through Improving Cardiac Mitochondrial Function and Autonomic Tone
Authors: Prathumsap Nanthip , Ongnok Benjamin , Khuanjing Thawatchai , Arinno Apiwan , Maneechote Chayodom , Apaijai Nattayaporn , Chunchai Titikorn , Arunsak Busarin , Kerdphoo Sasiwan , Shinlapawittayatorn Krekwit , Chattipakorn Siriporn , Chattipakorn Nipon
Published: April 2022

Introduction:
Cardiac sympathovagal imbalance is a common pathologic finding in patients receiving doxorubicin (DOX), and is considered as a cardiovascular risk factor. Growing evidence demonstrates that cardiac autonomic modulation by vagus nerve stimulation (VNS) exerted
cardioprotection
in both myocardial ischemia/reperfusion injury and heart failure models. However, the cardioprotection of VNS in DOX-induced cardiotoxicity has never been investigated.

Hypothesis:
Increased cardiac parasympathetic activity by VNS attenuates the
sympathovagal imbalance and mitochondrial dysfunction
, thereby improving left ventricular (LV) function.

Methods:
Rats were divided into a sham group and a VNS group. Two weeks after cervical VNS implantation, all rats were subdivided into 3 groups: control (CON), DOX-treated group (3 mg/kg/day, ip, 6 doses) without VNS (DOX+Sham: DS), and DOX-treated group with VNS (DOX+VNS: DV). VNS was activated simultaneously with the first dose of DOX (20 Hz, 500 μs pulse width, 0.5-0.75 mA, turn ON 14 s and turn OFF 48 s (23% duty cycle), and was maintained for 30 days. At the end of the study protocol, cardiac biochemical and functional analyses were evaluated.

Results:
DOX treatment increased cardiac mitochondrial ROS production, mitochondrial depolarization, and mitochondrial swelling, leading to left ventricular systolic (%LVFS) and diastolic (E/A ratio) dysfunctions (Fig 1). Moreover, LF/HF ratio was increased in DOX-treated rats, indicating cardiac autonomic imbalance (Fig 1F). Interestingly, VNS could effectively protect the Dox-treated heart by alleviating all of those impaired parameters (Fig 1).

Conclusions:
VNS protects against DOX-induced cardiotoxicity by improving cardiac mitochondrial function and attenuating cardiac autonomic dysfunctions, leading to improved LV function. Thus, enhancing parasympathetic activity by VNS could be a novel therapeutic approach to prevent DOX-induced cardiotoxicity.
Abstract 9487: Sildenafil (Viagra) Aggravates the Development of Experimental Abdominal Aortic Aneurysm
Authors: Zhang Chongyang , Mohan Amy , Shi Hangchuan , Yan Chen
Published: April 2022

Introduction:
PDE5 plays a critical role in vascular smooth muscle cell (SMC) contraction by hydrolyzing 3’,5’ cyclic monophosphate (cGMP) and antagonizing cGMP-dependent protein kinase I (PKGI)-mediated vascular relaxation. SMC contractile dysfunction is implicated in the pathogenesis of aortic aneurysm (AA). PDE5 inhibitors, such as Sildenafil, have been used clinically for treating erectile dysfunction (Viagra) and pulmonary hypertension (Revatio), through promoting SMC relaxation via elevating cGMP. However, it has been reported that PDE5 expression is reduced in human thoracic aneurysms and Viagra usage is associated with human aneurysm rupture or aortic dissection in several case reports.

Objective:
We aim to investigate the effect of sildenafil in the development of experimental abdominal aortic aneurysm (AAA), the most common form of AA that mainly occurs in elderly male.

Methods and Results:
AAA was induced in C57BL/6J mouse by periaortic elastase in combination with 3-aminopropionitrile fumarate salt (BAPN) treatment to block elastin/collagen formation. Immunofluorescent staining showed decreased PDE5 expression in mouse AAA. The effect of Sildenafil was examined on pre-existing moderate AAA by providing in drinking water for 28 days. We found that Sildenafil significantly aggravated aneurysmal wall dilation and elastin degradation. Mechanistically, the effect of Sildenafil on the signaling of SMC contraction and PKGI activation were examined in the medial lesion area of AAA. Immunofluorescent staining revealed that Sildenafil significantly decreased the phosphorylation of myosin light chain 2 (MLC2) at Ser19 in AAA, a biochemical marker of SMC contraction. Proximity ligation assay (PLA) revealed an increase of cGMP-PKGI interaction by Sildenafil, an indication of PKGI activation.

Conclusions:
Chronic Sildenafil treatment aggravated experimental AAA development and elastin degradation by dysregulating contractile signaling in SMCs. Our findings may raise caution of clinical usage of Viagra in aneurysmal patients.
Abstract 9490: Home-Based Cardiac Rehabilitation During COVID-19
Authors: Ganeshan Smitha , Tse Crystal , Beatty Alexis
Published: April 2022

Introduction:
Cardiac rehabilitation (CR) reduces morbidity, hospitalizations, and mortality. Increasingly, digital tools have augmented the ease of delivering programs outside of the traditional rehabilitation center setting. Because of the need for distancing during the COVID-19 pandemic, many cardiac rehabilitation (CR) centers suspended in-person services and pivoted to home-based CR (HBCR).

Hypothesis:
In this study, we qualitatively evaluated the implementation of HBCR, which included weekly phone or video visits for individualized exercise plans, nutrition and health education counseling, wellness sessions, and optional mobile phone applications.

Methods:
Patient participants and staff members (physician, nurses, exercise physiologists, dietician, administrative staff) participated in semi-structured interviews. Two independent reviewers coded interview transcripts for emergent themes and pre-specified themes from the Theory of Planned Behavior, Unified Theory of Acceptance and Use of Technology, and the Consolidated Framework for Implementation Research.

Results:
A total of 12 patients and 7 staff were interviewed. Narrative descriptions highlighted the isolation, fear, and disruption of life activities during COVID-19. Key facilitators of the HBCR patient experience included strong relationships with staff who served as coaches and sources of accountability and the ability of HBCR to deliver an individually tailored experience within a patient’s home. Important organizational factors for implementation included leadership buy-in, culture of change, and support for staff. Though technology tools facilitated communication and accountability, not all participants embraced technology and some reported challenges with use. Participants in the modified program (N=57) experience 60.4m (+/- 50.4 SD) improvement in 6 minute walk distance. At the conclusion of the program, 45/62 (72.6%) achieved BP control <130/80.

Conclusions:
Individually tailored HBCR can facilitate access for patients to participate outside of a CR center. Ongoing research is needed to understand the long-term outcomes of flexible delivery models that may include both in-person and remote visits, and the role of technology in these models.
Abstract 9523: Substituting Deep Learning Chest X-Ray Age for Chronological Age in the Pooled Cohort Equations
Authors: Raghu Vineet K , weiss jakob , Paruchuri Kaavya , Natarajan Pradeep , Aerts Hugo , Hoffmann Udo , Lu Michael T
Published: April 2022

Introduction:
Statin eligibility for primary prevention is based on the Pooled Cohort Equations (PCE) 10-year atherosclerotic cardiovascular disease risk calculator. A critical risk factor in the PCE is chronological age; a proxy for age-dependent arterial injury and atherosclerosis. We previously showed that deep learning can estimate a chest x-ray age (CXR-Age) from a chest radiograph image that is associated with cardiovascular mortality and may better measure vascular aging.

Hypothesis:
To test whether substituting an externally-derived CXR-Age for chronological age in the PCE improves prediction of incident major adverse cardiovascular events (MACE).

Methods:
Retrospective study of statin-naive patients (50-75 years old), who had a CXR, no prior MACE or diabetes, and low-density lipoprotein <190 mg/dl. PCE risk was calculated using 1) chronological age 2) CXR-Age substituted for chronological age. The primary outcome was MACE (fatal/nonfatal myocardial infarction and stroke). Accuracy of MACE risk estimates using the PCE based on CXR-Age versus chronological age was compared using Harrel’s c-index and Net Reclassification Improvement. Hazard ratios between statin eligible (PCE ≥ 7.5%) and ineligible individuals were calculated using cox regression.

Results:
In 1,277 patients (mean age 61.0±6.8 years, 43.7% male), 118 (9.2%) MACE occurred over median 6.7 years of follow-up. Harrell’s c-index for the PCE using CXR-Age was higher than the PCE using chronological age (0.61 vs. 0.56; p=0.02). Those statin-eligible by the PCE using CXR-Age had higher hazard ratios for MACE than those eligible using chronological age (HR 2.68 [95% CI 1.76-4.08] vs. HR 1.50 [95% CI 1.05-2.16]; p=0.008). Net Reclassification Improvement using CXR-Age instead of chronological was 0.13 (95% CI 0.04-0.22).

Conclusions:
Substituting a deep learning-based CXR-Age for chronological age in the PCE improves risk prediction in a primary prevention setting.
Abstract 9530: Plaque Rupture, Compared to Plaque Erosion, is Associated With Higher Level of Pan-Coronary Inflammation, Measured by Peri-Coronary Adipose Tissue Attenuation on Coronary Computed Tomography Angiography
Authors: Nakajima Akihiro , Sugiyama Tomoyo , Araki Makoto , Seegers Lena M , Dey Damini , McNulty Iris , Lee Hang , Yonetsu Taishi , Yasui Yumi , Teng Yun , Nagamine Tatsuhiro , Nakamura Sunao , Achenbach Stephan , Kakuta Tsunekazu , Jang Ik-kyung
Published: April 2022

Introduction:
Vascular inflammation plays a key role in plaque rupture, while the role of inflammation in plaque erosion remains less well defined. Peri-coronary adipose tissue attenuation (PCATA) has emerged as a marker specific for coronary artery inflammation. Direct comparison of the level of vascular inflammation between plaque rupture and plaque erosion has not been reported.

Objectives:
To compare the level of coronary inflammation between plaque rupture and plaque erosion using PCATA.

Methods:
Patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) who underwent pre-intervention coronary computed tomography angiography and optical coherence tomography (OCT) culprit lesion imaging were enrolled. PCATA was measured in the culprit lesion and in the proximal 40mm segment of the coronary arteries. The relationship between OCT culprit plaque characteristics and PCATA was also examined.

Results:
Out of 198 patients, plaque rupture was the underlying mechanism in 107 patients (54.0%) and plaque erosion in 91 (46.0%) patients. Plaque rupture had higher PCATA than plaque erosion both at the culprit plaque level (-65.8 ± 7.5 vs. -69.5 ± 11.4 Hounsfield unit [HU], p = 0.010) and at the culprit vessel level (-67.1 ± 7.1 vs. -69.6 ± 8.2 HU, p = 0.024). The mean PCATA of all 3 coronary arteries was also significantly higher in plaque rupture than in plaque erosion indicating a higher level of inflammation (-67.9 ± 5.7 vs. -69.9 ± 6.8 HU, p = 0.030). In the multivariable analysis, plaque rupture was significantly associated with high PCATA at all 3 levels: culprit plaque, culprit vessel, and pan-coronary arteries.

Conclusions:
PCATA in culprit plaque, culprit vessel, and all 3 coronary arteries was higher in plaque rupture than in plaque erosion. The results indicate pan-coronary inflammation plays a more significant role in plaque rupture than in plaque erosion.
Abstract 9538: Comparison of Central Aortic Pressures Obtained Using an Invasive Pressure Catheter and the Noninvasive Sphygmocor Device
Authors: Esposito Cara , Machado Priscilla , Cohen Ira , Mehrotra Praveen , Savage Michael P , Fischman David L , Davis Marguerite , Ruggiero Nicholas J , Walinsky Paul , McDonald Maureen , Dickie Kristopher , Forsberg Flemming , Dave Jaydev K
Published: April 2022

Introduction:
The SphygmoCor (ATCOR, Naperville, IL) device utilizes a generalized transfer function based on patient’s age and gender to derive the aortic pressure pulse from the brachial-cuff based pressure measurements. This study compared aortic pressures obtained using SphygmoCor with aortic pressures obtained during cardiac catheterization.

Hypothesis:
Mean differences in aortic pressures obtained using SphygmoCor and pressure catheters will be less than 5 mmHg.

Methods:
After IRB approval, 136 patients were enrolled. During standard-of-care catheterization procedure, aortic pressure measurements were obtained using fluid-filled catheters. In a subset of patients (n = 13) the aortic pressure values were also obtained using solid-state high-fidelity Millar catheters. Immediately after the catheterization procedure, while the patients were still in the catheterization laboratory (on the procedure table), central aortic pressures were estimated with the SphygmoCor device. The measured and estimated aortic pressures were compared using linear regression and Bland-Altman analysis. A linear fit was performed to derive an additional transfer function to convert SphygmoCor pressure values to catheter-based aortic pressures, and the resulting differences in pressure values were compared. A bootstrap analysis was performed to test the generalizability of this transfer function.

Results:
Mean differences in systolic, diastolic and pulse aortic pressures obtained using the two techniques ranged from 6.5 to 18.0 mmHg (p < 0.001). In the subset with high-fidelity catheters, the differences ranged from 8.0 to 18.9 mmHg. With the linear-fit transfer function, the differences in systolic, diastolic and pulse aortic pressures were low (< 1 mmHg) corresponding to a reduction in bias noted with Bland-Altman analysis. The bootstrap analysis of the transfer function (100 iterations) achieved a coefficient of variation for the root mean square error < 8.4% for systolic, diastolic and pulse aortic pressures.

Conclusions:
The magnitude of the differences between the SphygmoCor-estimated and catheter-based systolic, diastolic and pulse aortic pressures reduced considerably after using the linear-fit transfer function derived in this study.