bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 19180: Targeted Simulation and Education to Improve Cardiac Arrest Recognition and Telephone Cpr in an Emergency Medical Dispatch Centre
Authors: Hardeland Camilla , Soilammi Linda , Skåre Christiane , Kramer-Johansen Jo , Birkenes Tonje , Myklebust Helge , Hansen Andreas E , Olasveengen Theresa M
Published: March 2022

Introduction:
Patient outcome after out of hospital cardiac arrest (OHCA) is dependent on emergency medical dispatchers ability to recognize OHCA and provide effective telephone-assisted CPR instructions to bystanders. The American Heart Association recommends continuous quality monitoring to ensure implementation of educational interventions in emergency medical dispatch centres.

Objective:
Improve dispatcher recognition of OHCA and time to first telephone assisted chest compression.

Method:
Weak aspects of cardiac arrest calls in our dispatch centre were identified, and targeted interventions to improve recognition of agonal respiration and cardiac arrest and to shorten time to first chest compression were implemented. Specifically; 1) Video-based lectures focusing on agonal respiration and continuous coaching 2) Simulation training 3) Structured dispatcher feedback 4) Electronic telephone-assisted CPR training program. Dispatch logs, ambulance records and audio files of confirmed OHCA’s were analyzed before and after the intervention. Recognition of cardiac arrest was reported as (1) recognized, (2) not recognized and (3) delayed recognition (defined as failure to initially clarify consciousness or abnormal breathing before moving on to further questioning).

Results:
289 and 221calls were included before and after intervention, respectively. Recognition of cardiac arrest improved from 74% to 89% (p<0.001), and delayed recognition was reduced from 14% to 5% (p=0.001). Agonal respiration continues to challenge dispatchers, but misinterpretation of abnormal breathing decreased from 25% to 8% (p<0.001) of calls. Median time to first chest compression was reduced by 30 seconds (204 vs. 174 seconds, respectively, p=0,039)

Conclusion:
Targeted simulation and education significantly increased recognition of OHCA and reduced time to first chest compression. Continuous focus and targeted dispatcher training are important to ensure quality of care for OHCA patients.
Abstract 19254: Sex Differences for Patients With New-onset Atrial Fibrillation During Hospitalization
Authors: Chui Philip W , Erande Ashwini , Malik Shaista
Published: March 2022

Introduction:
New-onset atrial fibrillation (AF) during hospitalization has been associated with worse outcomes. However, there is little information on the risk factors associated with the development of new-onset AF. We assessed whether there are sex differences in the incidence and mortality of hospitalized patients with new-onset AF.

Methods:
We utilized the National Inpatient Sample to analyze new-onset AF in a sample of inpatient hospitalizations from 2001 to 2011. New-onset AF was defined by an ICD-9 discharge code of 427.3 not present on admission. We performed multivariate logistic regression for incidence and all-cause in-hospital mortality of female versus male sex for new-onset AF, adjusting for comorbid conditions and other demographic factors (described in Table). We separated our analyses by principal diagnosis of guideline-defined acute conditions associated with new-onset AF: noncardiac surgery, cardiac surgery, myocardial infarction, sepsis, pulmonary embolism, myocarditis, and thyrotoxicosis.

Results:
A total of 38,403,360 cases of new-onset AF were identified. The majority of new-onset AF cases (85%) were associated with admissions for noncardiac surgery (Table). Female sex was associated with decreased incidence of new-onset AF across all acute conditions (p <0.05). Female sex was also associated with decreased mortality of new-onset AF patients admitted for noncardiac surgery and thyrotoxicosis but increased mortality for new-onset AF patients admitted for cardiac surgery, sepsis, myocardial infarction, and pulmonary embolism (p <0.05).

Conclusion:
Female sex is associated with a decreased incidence for new-onset AF; however, it is also a risk factor for in-hospital mortality for a majority of acute conditions linked to new-onset AF. Further quality improvement measures should elucidate and target the mechanisms for this discrepancy.
Abstract 19256: Predicting Exercise Systolic Blood Pressure and Heart Rate at 20 Years of Follow-up: Correlates in the Framingham Heart Study
Authors: Spartano Nicole L , Lyass Asya , Larson Martin G , Lewis Gregory D , Vasan Ramachandran S
Published: March 2022

Introduction:
Blood pressure (BP) and heart rate (HR) responses to exercise may add prognostic information beyond their resting values. Many cardiovascular disease (CVD) risk factors are associated with exercise BP and HR cross-sectionally, but factors influencing exercise hemodynamics over the life-course are unknown.

Methods:
We assessed BP and HR in response to treadmill tests (6 minutes of the Bruce protocol) in a sample of 1231 Framingham Offspring participants who performed the treadmill test during two routine examinations: 1979-1983 (baseline) and 1998-2001 (follow-up). We included participants (55% women, mean age 39±8 years at baseline, 58±8 years at follow up) free of CVD and not taking beta-blockers or anti-hypertension medications at either exam. Baseline diabetes mellitus (DM) cases and individuals taking lipid-lowering medications at baseline were excluded due to small numbers. We related exercise hemodynamics at follow-up to baseline CVD risk factors and their interim changes, also adjusting for baseline exercise hemodynamics.

Results:
Compared with men, women experienced greater change in exercise hemodynamics at 20 y follow-up, relative to baseline exercise hemodynamics (see Table 1). Baseline blood lipid levels, resting SBP and HR, and smoking status were associated with greater exercise SBP at follow-up. Baseline BMI did not independently influence follow-up exercise hemodynamics, but weight gain across exams (the effect of 1 kg/m2 increase in BMI) was associated with higher exercise SBP and higher exercise HR. New-onset DM was associated with ~6 mm Hg higher exercise SBP, independent of weight gain, compared to those who remained free of DM across exams.

Conclusions:
CVD risk factors and their worsening over time were associated with higher exercise SBP and HR on follow-up. Our findings suggest that maintaining an optimal risk factor profile over the lifecourse will favorably impact exercise hemodynamic responsesover time.
Abstract 19270: Heart Failure Incidence is Elevated in Adults With Simple Congenital Heart Defects Compared With the General Population: A Cohort Study
Authors: Olsen Morten , Høfsten Dan E , Madsen Nicolas L , Laursen Henning B , Johnsen Søren P , Videbæk Jørgen
Published: March 2022

Heart failure (HF) is a major cause of morbidity and mortality in adults with congenital heart defects (CHD). However, few data exist on the long-term prognosis of simple CHD. We aimed to estimate the incidence of HF and use of HF drugs in individuals with simple CHD compared with the general population.

Methods:
We identified a nationwide population-based simple CHD cohort, defined by isolated and uncomplicated secundum atrial septal defect (ASD), persistent ductus arteriosus (PDA), ventricular septal defect (VSD) judged to be either muscular or with normal pulmonary flow resistance, or mild pulmonary stenosis (PS) verified by catheterization. Subjects were born and diagnosed from 1963 through 1973 in Denmark. We included patients with no childhood co-morbidity who were alive at 32 years of age (this age was determined by the establishment of a nationwide prescription register in 1995). For each CHD subject, we identified 10 control individuals from the general population using the Danish Civil Registration System, matched by sex and birth year. A unique personal identifier used in all Danish public registries enabled virtually complete follow-up for migration, death, use of HF drugs, or HF diagnoses as identified in a hospital discharge registry covering all Danish hospitals since 1977. Specific indications for drug use were unknown (could be e.g. hypertension). We computed cumulative incidence of first diagnosis of HF and first filling of a HF drug prescription, for CHD subjects and controls, and the corresponding hazard ratios (HR).

Results:
We identified 802 CHD subjects (ASD, n=115; VSD, n=437; PS, n=75; PDA, n=175) and 7,947 controls, 43% male. Cumulative incidence for CHD subjects by age 45 years of HF drug use was 22% (16% for controls), whereas it was 3% (0.4% for controls) for a HF hospital diagnosis. The corresponding HRs comparing CHD subjects with controls were 1.4(95% CI:1.2-1.6) and 6.9(95% CI:4.0-12).

Conclusion:
Adults with simple CHDs were at increased risk of HF. The data on HF drug use should be interpreted with caution as other cardiovascular conditions were likely the indications for many of the prescriptions. However; further studies on the effectiveness of medical follow-up programs for patients with simple CHDs appear warranted.
Abstract 19428: Evaluating the Risk of Rheumatic Heart Disease Among Family Members of Children Identified With Latent RHD in School-based Echocardiographic Screening
Authors: Aliku Twalib , Beaton Andrea , Scheel Amy , Tompsett Alison , Lwabi Peter , Sable Craig
Published: March 2022

Background:
Poorly understood genetic susceptibility factors influence who develops acute rheumatic fever (ARF) and who develops the long-term complication, rheumatic heart disease (RHD). Risk of RHD in family members - and thus the need for screening of first degree relatives - once an index case has been identified, is not known.

Methods:
Sixty RHD positive children (30 borderline 30 definite RHD) and 67 age & gender matched controls were recruited from previous school-based echocardiographic screening. All first-degree relatives ≥ 5 years were invited for echocardiographic screening (2012 World Heart Federation Criteria). Absent family members were recorded with reason for absence including death. Continuous variables were compared using 2-tailed independent samples t-test, categorical variables by Fisher’s Exact Test, and relative risk was used to compare cases and controls.

Results:
A total of 454/733 (62%) family members were screened (106 mothers, 48 fathers & 300 siblings). Definite RHD was more common in childhood siblings of cases than controls (p=0.05), and children with RHD were 4.5 times as likely to have a sibling with RHD compared to controls. Mothers had more RHD than fathers without regard to child’s screening status.

Conclusions:
Siblings of children identified with latent RHD are at greater risk of having RHD and screening of these children should be considered. While no adult RHD screening data exists from sub-Saharan Africa, this study suggests that the prevalence of occult RHD in adult women is quite high (9.4%). Genotyping studies are needed to fully understand individual and family susceptibility to RHD.
Abstract 19469: Quadripolar Left Ventricular Leads are Less likely to Dislodge or Require Repositioning
Authors: Rijal Shasank , Althouse Andrew D , Rattan Rohit , Wolfe Jonathan , Marroquin Oscar C , Mulukutla Suresh R , Saba Samir
Published: March 2022

Objective:
Since quadripolar left ventricular (LV) leads allow pacing from multiple electrodes, they are less likely than other leads to be placed in unstable positions in order to optimize electrical pacing parameters. We therefore investigated the rate of lead revision and dislodgement in quadripolar (QUAD) vs. bipolar (BI) LV lead recipients.

Methods:
We retrospectively collected data for N=545 patients at our institution implanted with QUAD (n=173) vs. BI (n=372) LV leads from 2012-2014 and followed them to the endpoint of LV lead revision or lead dislodgement in the first 6 months after implantation. Time to event was analyzed by lead type using Kaplan-Meier curves, log-rank tests, and Cox proportional-hazards models.

Results:
The cohort was aged 69.6 ± 11.5 years, 89.3% white, with mean BMI 29.8 ± 6.3 kg/m2. Patients were mostly NYHA Class III heart failure (55.7%), while 47.4% had diabetes, 78.9% had hypertension, and 50.8% had atrial fibrillation. Baseline characteristics were comparable in patients that received QUAD and BI leads. Patients receiving BI leads were more likely to require lead revisions during the index hospitalization (BI: 4.8% vs. QUAD: 1.1%, P=0.03). In the first 6 months of follow-up, patients getting QUAD leads had a significantly lower rate of LV lead dislodgement (7.0% vs. 1.7%, P<0.01, see Figure). In a multivariate model adjusted for age, diabetes, prior history of MI, atrial fibrillation, and NYHA class, the difference persisted (HR=0.26, 95% CI [0.08, 0.85], P=0.02).

Conclusions:
Quadripolar LV leads are less likely to dislodge or require lead revision during the index hospitalization or follow-up. These results have important clinical implications
Abstract 19470: Predicted Impact of Carotid Artery Atherosclerotic Disease for Screening of Abdominal Aortic Aneurysm in Women
Authors: Shiratori Yoshitaka , Yokoyama Naoyuki , Kozuma Ken , Isshiki Takaaki , Maruyama Yasuyuki
Published: March 2022

Introduction:
Screening of abdominal aortic aneurysm (AAA) for women has not been established. The aim of this study was to determine the predictive factors associated with ultrasonographic screening for AAA in patients who receive coronary angiogram (CAG) for suspicion of coronary artery disease (CAD).

Methods:
Study patients were consisted with 310 consecutive women over 65 years undergoing initial CAG. Both abdominal and carotid arterial ultrasonography were performed for all patients. Patients with known AAA were excluded in this study. AAA was defined as abdominal aortic diameter ≥30 mm by ultrasonographic examination. Carotid artery atherosclerotic disease (CAAD) was defined as a ≥50% stenosis of internal carotid artery (ICA) in NASCET criteria or ≥150cm/sec of ICA peak systolic velocity. Ankle branch pressure index (ABI) was also performed for all patients, and peripheral arterial disease (PAD) was defined as a ≤0.9 of ABI. CAD was defined as a ≥75% reduction in diameter in at least one major vessel in coronary angiography. Multivariate logistic regression analysis was used to study multiple risk factors (age, hypertension, diabetes, dyslipidemia, smoking, hemodialysis, cerebral infarction, CAD, CAAD and PAD) for AAA.

Results:
Of 310 patients, incidental AAA was detected in 10 patients (3.2%) and 1 had AAA diameter of ≥50mm. Patients with CAD included higher prevalence of AAA than those without (5.6% vs 0.7%, P=0.021). Multivariate analysis revealed that age (RR 1.3, 95% CI 1.1 to 1.5, p = 0.001) and CAAD (RR 8.5, 95% CI 1.3 to 55.7, p= 0.025) were significantly associated with a higher prevalence of AAA.

Conclusions:
Older age and presence of CAAD should be taken into account as a possible criterion for selective AAA ultrasonographic screening in women over 65 years for suspicion of CAD.
Abstract 19475: Cardiovascular Burden in Children With Chronic Kidney Disease
Authors: Deshpande Shriprasad , Eick Stephanie , Winterberg Pamela D
Published: March 2022

Introduction:
Cardiovascular disease is the leading cause of death in children and young adults with chronic kidney disease (CKD) and kidney transplant. Phenotype of cardiac involvement may be variable. In adults with CKD, diastolic dysfunction has been shown to be an independent risk factor for mortality. However, there is overall very limited data in pediatric age group. Additionally, there are no guidelines for appropriate screening, assessment or standardized follow-up for cardiac pathology in pediatric CKD.

The purpose of this study is to assess the overall cardiovascular burden and more specifically, diastolic dysfunction (DD) in pediatric CKD patients.

Methods:
Single center, retrospective cohort study of patients seen for CKD.

Results:
237 patients with CKD /ESRD were identified including 64 patients who underwent renal transplant and 84 on chronic dialysis. Mean age was 14 years (7.6 to 17.5). Systolic hypertension was present in 49.7% while diastolic hypertension in 36.1%. 22% had a BMI greater than 95% percentile. Echocardiographic assessment showed preserved systolic function in majority (mean ejection fraction of 67.8%, range 19-90%). However, LV mass index(LVMI) was > 38 g/m2.7 in 66% (115/173). Tissue Doppler velocities demonstrated a large variation with significant abnormalities indicating abnormal myocardial performance and diastolic dysfunction. Mitral e velocity which was diminished in 79% while severely diminished in 31%. Mitral a,s and E/e’ velocities were abnormal in varying portion of population. Relative wall thickness was significantly increased (>0.41) in 112/213 patients. Serial measures showed a gradual increase in E/e’ ratio mean from 8.1 to 9.9 and increase in LVMI from mean of 44.5 to 53.1 g/m2.7 (p<0.05).

Conclusion:
This is the largest study to date of demonstrating a significant cardiovascular burden in patients with CKD in the form of hypertrophy as well as abnormalities of myocardial performance and diastolic function. Serial measures show the parameters correlate with disease state. Further analysis in underway to identify risk factors and propose guidelines for serial screening.
Abstract 19544: The Familial Hypercholesterolemia Phenotype in the United States is Associated With an Age-dependent Increase in Long-term Coronary Heart Disease Risk
Authors: Marma Amanda K , de Ferranti Sarah D , Gooding Holly C , Ning Hongyan , Wilkins John T , Lloyd-Jones Donald M
Published: March 2022

Introduction:
Heterozygous familial hypercholesterolemia (FH) has an estimated prevalence of 1:200-500, affecting up to 1,500,000 individuals in the US. Available CHD risk prediction equations do not account for lifetime exposure to elevated LDL-C in FH patients, and while relative risks of 7-100 have been reported for CHD in FH, US outcomes of FH are unknown. We aimed to evaluate long-term CHD risk in US adults with an FH phenotype.

Methods:
Using pooled data from 6 US epidemiologic cohorts, participants were stratified by LDL-C level at index ages 25, 35, 45, 55, 65 and 75 years. LDL-C≥190 and <130 mg/dL defined the FH phenotype and referent groups, respectively. We used Cox regression models to assess covariate-adjusted associations of the FH phenotype with the hazard for fatal/nonfatal MI and CHD death and to generate 30-year event-free survival curves.

Results:
A total of 42,390 baseline person-exams were available across the index ages. The table shows the 30-year event rates for patients with the FH phenotype (LDL-C≥190 mg/dL) compared with the referent from each index age, as well as covariate-adjusted HRs for CHD death or fatal/nonfatal MI. As expected, the relative increase in 30-year events is highest for the youngest individuals, with rates up to 12 times higher for CHD death, and attenuates at older index ages. After adjustment, HRs for both CHD death and fatal/nonfatal MI are more modest but show a similar age-dependent pattern. The figure shows the adjusted 30-year survival free of fatal/nonfatal MI for the youngest two index ages, by LDL-C stratum.

Conclusions:
In the US, the FH phenotype is associated with substantial long-term CHD risk in younger adults, with more modest elevations in risk at older ages. The absolute HRs are lower than previously described, possibly due to unique features in the US population, improved management compared to other historical cohorts, or misclassification of some participants who did not have longstanding high LDL-C.
Abstract 19564: Short Term Improvement in Subtle Cardiac Dysfunction in Severely Obese Patients After Bariatric Surgery is Not Associated With Changes in Nt-pro-bnp: A Speckle Tracking Study
Authors: Rodríguez-Flores Marcela , Martin Julie , Poirier Paul
Published: March 2022

Background and objective:
The impact of bariatric surgery on sub-clinical alteration of cardiac function assessed using speckle-tracking strain and its relationship with metabolic changes is unknown. We assessed in obese patients with normal left ventricle (LV) systolic function who underwent the biliopancreatic diversion with duodenal switch (BPD-DS); 1) prevalence of subclinical cardiac dysfunction and dyssynchrony in comparison with gender-matched subjects and, 2) the impact of bariatric surgery on myocardial function and its association with changes in NT-proBNP levels and insulin sensitivity.

Methods:
Prospective, observational study of the effect of BPD-DS after six months on strain, strain rate (SR) and displacement curves using a repeated measures mixed linear regression model analysis. Changes in systolic (LV end-systolic dimension, longitudinal strain) and diastolic (E/A, ESr) parameters were correlated with changes in body mass index (BMI), HOMA and NT-proBNP.

Results:
Thirty-eight severely obese patients (BMI 48.4±7.4 Kg/m
2
) had decreased longitudinal strain (-17.0±2.5%) in comparison with 20 patients without obesity (-19.7±1.5%) (p<0.001), which was comparable to controls after surgery (19.3±1.8%) at a mean BMI of 35.7±6 mg/m
2
. Eighteen patients (47%) had a global longitudinal strain considered clinically abnormal. Following surgery, 94% of these patients improved their LV mechanics, with normalization of their global longitudinal strain (p<0.001). Changes in longitudinal strain were not related with changes in NT-proBNP or improvement in insulin sensitivity.

Conclusions:
There is significant subclinical cardiac dysfunction in patients with severe obesity with normal systolic function. Improvement in longitudinal strain after surgery was not explained by improved insulin sensitivity or changes in NT-proBNP.
Abstract 19569: Racial Differences in Clinical Outcomes and Resource Utilization Associated With Acute Myocardial Infarction Hospitalizations in the United States: A Population-wide Analysis From 2011-2012
Authors: Kumar Nilay , Khera Rohan , Garg Neetika
Published: March 2022

Background and objectives:
Racial-ethnic disparities in cardiovascular diseases are a major public health problem in the US. There are few recent data on racial differences in clinical outcomes and resource utilization associated with acute myocardial infarction (AMI) hospitalizations.

Hypothesis:
There are significant racial-ethnic differences in AMI hospitalization outcomes.

Methods:
We used the 2011-2012 Nationwide/National Inpatient Sample to identify primary AMI hospitalizations. Outcomes of interest included in-hospital mortality, utilization of PCI and thrombolysis, inflation adjusted charges and length of stay. Relevant ICD-9 codes were used. Racial-ethnic differences in outcomes were tested using logistic and linear regression models.

Results:
228,302 AMI hospitalizations representing 1.1 million hospitalizations nationwide were included in the study. After adjusting for age, sex, HTN, DM, PCI, thrombolysis, socioeconomic status (SES) and APR-DRG mortality risk, Blacks had significantly lower (OR 0.88, 95% CI 0.81 - 0.94; <0.001) and Native Americans significantly higher (OR 1.37, 1.03 - 1.81; p=0.03) case fatality compared to Whites (Model ROC=0.88, p<0.001). Blacks were less likely (OR 0.76, 95% CI 0.72 - 0.80; p<0.001) and other races more likely (OR 1.33, 95% CI 1.23 - 1.43; p<0.001) to undergo PCI adjusted for SES. SES adjusted odds of thrombolysis were lower in Blacks (OR 0.80, 0.67 - 0.97; p<0.001) and higher in Native Americans (OR 3.78, 1.42 - 10.07; p=0.01) compared to Whites. There were significant differences in charges and LOS across races.

Conclusions:
Blacks hospitalized for AMI are less likely and NA more likely to die in the hospital compared to Whites. Blacks are less likely to receive reperfusion therapy compared to Whites. Future studies should investigate the mechanism of the apparent protective effect of Black race on in-hospital mortality in AMI.
Abstract 19576: Impaired Fitness is Common in Adults Living With HIV, Despite Viral Suppression, and Correlates With Markers of Immune Dysregulation
Authors: Webel Allison R , Jenkins Trevor , Longenecker Chris T , Sattar Abuds , Moore Shirley M , Josephson Richard
Published: March 2022

Introduction:
Since transitioning to a chronic health condition, treated HIV infection is now recognized as an independent risk factor for cardiovascular disease. The underlying reasons for this risk association are unclear, but may include poor cardiopulmonary fitness.

Objective:
To describe cardiopulmonary fitness in people living with HIV (PLHIV) and its association to lifestyle exercise and HIV characteristics.

Methods:
As part of a larger randomized clinical trial, we conducted a cross sectional analysis of 37 PLHIV at high risk for developing CVD, on HIV medications, with suppressed HIV viremia. All subjects completed a bicycle cardiopulmonary stress test using a ramp protocol, wore an accelerometer on their hip for seven days, and consented to medical chart abstraction. We summarize the exercise habits and baseline cardiopulmonary fitness of our population, and further analyzed associations between continuous variables using Spearman correlation coefficients.

Results:
Overall, the study population had poor cardiopulmonary fitness (Table 1). Subjects exercised on average twice in the past week, but mostly (85%) light activity. Current CD4+ T cell count was significantly associated with VO2 max, peak heart rate, and % peak heart rate (Table 2). As expected, fitness variables were also associated in a graded fashion with time spent exercising in light, moderate, and moderate-vigorous activity.

Conclusions:
Current CD4+ T cell count and lifestyle exercise are significantly and consistently associated with cardiopulmonary fitness. Further work is necessary to understand how these relationships change over time and in response to interventions.
Abstract 19610: Safety of Percutaneous Left Atrial Appendage Suture Ligation: Results From the Largest Us Registry
Authors: Lakkireddy Dhanunjaya , Gunda Sampath , Afzal Muhammad R , Reddy Madhu , Lee Randall J , Nath Jayant , Nagaraj Hosakote , Ellis Christopher , Altman Eric , Lee Brian , Wilber David , Kar Saibal , Ferrell Ryan , Bommana Sudharani , Atkins Donita , Bhadwar Nitish , Sanchez Mauricio , Gadiyaram Varuna , Tschopp David , Evonich Rudolph , Rasekh Abdi , Cheng Jie , Gibson Douglas , Matthew Earnest
Published: March 2022

Background:
Epicardial ligation of left atrial appendage (LAA) is an attractive alternative to oral anticoagulation for patients with atrial fibrillation and high risk of bleeding.

Objectives:
To delineate the safety of epicardial ligation of the LAA for stroke prevention in atrial fibrillation

Methods:
This is a retrospective, multicenter registry of consecutive patients undergoing LAA ligation with the LARIAT device at 14 U.S. sites. The primary endpoint was procedural success, defined as device success (suture deployment and <5 mm leak by post-procedure transesophageal echocardiography), and no major complication at discharge (death, myocardial infarction, stroke, major bleeding requiring transfusion, or cardiac perforation requiring cardiac surgery).

Results:
A total of 610 patients underwent LARIAT exclusion of LAA. The mean age of the participants was 71 (SD: ± 10) years. The mean CHADs2VASc and HASBLED score was 2.74(±1.33) and 3.87 (±1.8) respectively. Epicardial access was obtained using micro-puncture needle in 60 percent of the cases. The acute closure was achieved in 554 (91 %) patients. Cardiac perforation needing continued drainage and transfusion occurred in 12 patients (1.96 %). Perforation of epigastric artery occurred in 2 patients (0.3 %). Eight patients (1.3 %) required open heart surgery. Five patients required > 2 weeks of treatment for pericarditis. No myocardial infarction or stroke happened in the peri-procedural period. One patient died as complication of the procedure. A follow up transesophageal echocardiogram (TEE) was performed in 76 % of the patients that showed a leak of < 5 mm and thrombus in 49 (8 %) and 12 (1.96 %) patients respectively.

Conclusions:
In this largest multicenter experience of LAA ligation with the LARIAT device, the rate of acute closure was high with significantly fewer complications compared to limited contemporary data. The use of micro-puncture is probably safer approach to avoid cardiac injury during epicardial access. A prospective randomized trial is required to adequately define clinical efficacy, optimal post-procedure medical therapy, and the effect of operator experience on procedural safety.
Abstract 19626: Cardio-renal Syndrome in Single Ventricle Patients
Authors: Aydin Scott I , Glotzbach Kristi , Skversky Amy , Hsu Daphne
Published: March 2022

Introduction:
Cardio-renal syndrome (CRS) in single ventricle patients undergoing stage I or II palliation has not been described. CRS in other high-risk pediatric populations has been associated with greater risk of morbidity and mortality. We aim to describe CRS in single ventricle patients undergoing stage I or II palliation and their associations with clinical outcomes.

Methods:
Data was collected from the Pediatric Heart Network (PHN) Infant with Single Ventricle trial. Demographics, survival, and data pertaining to stage I and II palliations were obtained. CRS was determined for each patient based on the estimated creatinine clearance (eCCL) as follows; age 0-days to 12-months eCCL < 40 ml/min/1.73m
2
and > 12-months eCCL < 90 ml/min/1.73m
2
. Descriptive statistics and univariate analyses using the student t-test, Mann-Whitney U, chi-square test or Fisher’s exact test were performed to determine the association between CRS and clinical outcomes as well as mortality, respectively.

Results:
Two hundred twenty-nine patients, with median age 6-days [4-7], underwent stage I palliation during the study period, of which 86 (38%) had CRS after their palliation. The most common diagnosis was hypoplastic left heart syndrome (HLHS) with 144 patients (63%) with 169 patients (74%) undergoing a Norwood procedure with a modified Blalock-Taussig (MBT) or Sano shunt. Of the 229 patients, 167 (73%), with median age 151-days [123-176], underwent stage II palliation during the study period, of which 60 (48%) had CRS after their palliation. Of the 60-patients, 25 (42%) also had CRS after their stage I palliation. Stage I palliation patients with CRS had significantly lower baseline eCCL as compared to patients with no CRS (36 vs. 56, p < 0.001), as well as significantly longer ICU and hospital length of stays (14-days vs. 11-days, p < 0.001 and 29-days vs. 11-days, p < 0.001). Twenty patients (9%) died prior to stage II palliation; of the 20 patients, 14 patients (70%) had CRS. CRS was significantly associated with mortality prior to stage II palliation (odds ratio 2.6; 95% CI 1.03, 6.7; p = 0.03).

Conclusion:
CRS in single ventricle patients is common and associated with lower pre-operative eCCL, longer lengths of ICU and hospital stay, and mortality prior to stage II palliation.
Abstract 19670: Adipose-derived Mesenchymal Stem Cells Attenuate Pulmonary Microvascular Hyperpermeability After Smoke Inhalation
Authors: Ihara Koji , Fukuda Satoshi , Enkhtaivan Baigalmaa , Trujillo Raul , Lopez Ernesto , Cox Robert A , Hawkins Hal K , Herndon David N , Prough Donald S , Enkhbaatar Perenlei
Published: March 2022

Pulmonary edema is a hallmark of acute respiratory distress syndrome (ARDS). Smoke inhalation causes ARDS, significantly increasing the mortality of burn patients. Mesenchymal stem cells (MSCs) exert potent anti-inflammatory properties. The goal of the present study was to test the safety and efficacy of MSCs in a well-characterized clinically relevant ovine model of ARDS.

Methods:
Female sheep (30-40 kg) were surgically prepared 5-7 days prior the study. ARDS was induced by cooled cotton smoke inhalation. Following the injury, sheep were ventilated, resuscitated with lactated Ringer’s solution and cardiopulmonary hemodynamics was monitored for 48 h in a conscious state. Pulmonary microvascular hyper-permeability was assessed by measuring lung lymph flow, extravascular lung water content, protein in plasma and lung lymph. Sheep were randomly allocated to two groups: 1) MSCs: infused with 5 million/kg of intravenous MSCs over 30min starting 1 h post-injury, n=5; 2) control, treated with a vehicle in a similar pattern (200ml of PlasmaLyte A), n=5.

Results:
Lung lymph flow, an index of pulmonary transvascular fluid flux was ~7-fold increased in control sheep compared to baseline. This was associated with a significant protein decrease in plasma and its increase in lung lymph. The treatment with MSCs significantly attenuated these changes (Table). Moreover, the treatment with MSCs almost reversed increased pulmonary vascular permeability index {(lung lymph proteinхlung lymph flow)/plasma protein} and reduced lung water content (Lung wet-to-dry weight ratio). Pulmonary gas exchange was significantly improved by MSCs (PaO2/FiO2 was 406±101 in MSCs and 262±127 in control at 24 hrs, p<0.05). Infusion of the MSCs did not affect pulmonary artery pressure and other hemodynamic variables.

Conclusions:
MSCs infusion was well tolerated. The results suggest that intravenous MSCs modulate pulmonary microvascular hyper-permeability and prevent onset of ARDS.
Abstract 19743: Electrophysiological and Cerebrovascular Effects of Selective Antegrade Cerebral Perfusion in Moderate Hypothermia vs. Deep Hypothermic Circulatory Arrest in a Rat Model
Authors: Rungatscher Alessio , Linardi Daniele , Milani Elisabetta , Menon Tiziano , Tessari Maddalena , Tsenov Grygory , del Pilar Rodriguez Andrea , Tong Giang , Schmitt Katharina , Luciani Giovanni Battista , Faggian Giuseppe
Published: March 2022

Introduction:
Selective antegrade cerebral perfusion (SACP) is adopted by many surgical groups as an alternative to deep hypothermic circulatory arrest. However there are still no preclinical evidences to support this strategy.

Hypothesis:
We hypothesize that SACP in moderate hypothermia vs DHCA could have different modulation of electrophysiological and cerebrovascular processes in vivo.

Methods:
Extra-corporeal circulation with central cannulation was instituted in male Wistrar rats. Animals were randomized to DHCA (16-18°C) or SACP (left carotid artery cannulation; 10 ml/kg/min) in moderate hypothermia (26-28°C). After 20 min of circulatory arrest, rats underwent 60 min of reperfusion / rewarming. EEG activity was recorded during all experiments. Neurological deficit score and survival were determined after 24 hours. Thereafter animals were scarified and brain snap-frozen and analyzed.

Results:
EEG activity 2-40 Hz (Power Spectrum Analysis) decreased in all rats during circulatory arrest. However, SACP determined fast recovery of brain activity and less decreased EEG power spectral density compared to DHCA (p <0.05).

After 24 h survival and neurologic deficit scores were not different in the two groups. However histological damage scores, brain TNF-α, caspase-3, TUNEL and GSH/GSSG ratio were attenuated in SACP compared to DHCA (all p<0.05).

Conclusions:
Selective antegrade cerebral perfusion in moderate hypothermia is superior to DHCA in restoring brain electrical activity and in reducing apoptosis, oxidative stress and neuroinflammation.
Abstract 19747: The Effect of Internal vs. External Shocks on Myocardial Injury in an Animal Model of Myocardial Infarction
Authors: Bianco Nicole R , Perumal Ramu , Szymkiewicz Steven J
Published: March 2022

Introduction:
ICD use early after myocardial infarction (MI) has not proven advantageous, possibly in part due to myocardial injury associated with intracardiac defibrillation shocks. Previous studies have reported myocardial injury with internal defibrillation, but external defibrillation from the wearable cardioverter defibrillator (WCD) has not been investigated. The goal of this study was to determine the acute damage to the heart caused by external defibrillation from the WCD as compared to an ICD in an animal model of myocardial infarction (MI) using typical energy levels and times to shock.

Methods:
Two weeks after MI creation, 20 pigs were anesthetized and induced into VF through direct current applied to the right ventricular endocardium via an implanted transvenous lead. Control animals received 20-J internal shocks from the dual-coil defibrillator lead after 30 seconds of VF, while experimental animals received 150-J external shocks from a WCD after 45 seconds of VF. Each animal received a total of five consecutive internal or external shocks. Blood samples were collected at baseline (prior to first shock), immediately after the last shock, and at 4- and 24-hours post-shocks to determine myocardial biomarkers. Animals that did not survive 24 hours, control animals that had to be rescue-defibrillated externally, or those requiring >5 shocks were excluded from analysis (n=6, 3 per arm). Differences were determined using t-tests.

Results:
Troponin I (cTnI), a specific marker of myocardial damage, was elevated above baseline in both the ICD (n = 7) and WCD (n = 7) groups at the 4 hr and 24 hr post-shock time points (Figure). However, the cTnI at 4 hr and 24 hr was significantly higher in the ICD control group as compared to the WCD (p < 0.05).

Conclusions:
In an animal model of myocardial injury, cardiac-specific cTnI increases are significantly greater following internal 20-J shocks than external 150-J shocks, indicating less myocardial damage with external shocks.
Abstract 19793: Relationship Between Self-care, Functional Health, and Health Resource Use in Adults With Congenital Heart Defects
Authors: McCabe Nancy , Book Wendy , Higgins Melinda , Butler Javed , Reilly Carolyn , Dunbar Sandra
Published: March 2022

Introduction:
Many adults with congenital heart disease (ACHD) face progressive functional decline and increasing health resource use (HRU) related to long-term complications. The ability of ACHD self-care to influence functional decline is relatively unknown. The purpose of this study was to determine the relationship between self-care (maintenance, monitoring, and management behaviors), functional health (exercise capacity, symptom burden) and HRU.

Methods:
Adults with moderate or severe ACHD (mean age 36 ± 11 years, 55% female, 81% Caucasian) were recruited from a single ACHD center (N=132). Participants completed baseline surveys on self-care, symptom burden, and sociodemographics, and a six-minute walk test (6MWT). Clinical data were collected by chart review. Self-reported HRU was collected prospectively for 3 months. Bivariate correlations, linear and logistic regression analyses were used.

Results:
Mean total distance walked on the 6MWT was 1365 ± 275 feet. Participants experienced 7.4 ± 4.8 symptoms in the previous month. A total of 101 (80.8%) participants experienced 310 healthcare encounters (275 office visits, 21 hospitalizations, 20 ED visits); 73 persons (58.4%) had > 1 HRU encounter. In multivariate analysis, self-care management (β=-44.20, p=.001) and monitoring (β=-14.59, p=.03) were independently associated with the 6MWT; self-care maintenance and monitoring were independently associated with symptom burden (β=-.39, p<.001; β=1.52, p<.001); higher self-care monitoring was an independent predictor of ≥ 1 HRU encounter (OR=1.21, 95% CI [1.09, 1.35], p<.001). Conclusions: Self-care may be an important, modifiable predictor of functional health and HRU in the ACHD population. The development of interventions to improve self-care should be pursued in future studies.
Abstract 19804: The Spatial QRS-T Angle Predicts Ventricular Arrhythmias in Patients With Hypertrophic Cardiomyopathy
Authors: Cortez Daniel , Graw Sharon , Mestroni Luisa
Published: March 2022

Introduction:
The spatial peaks QRS-T (SPQRS-T) angle has been shown to differentiate hypertrophic cardiomyopathy (HCM) patients from controls. The SPQRS-T angle has also demonstrated ventricular arrhythmia risk stratification in those with ischemic heart disease.

Hypothesis:
We hypothesize that the spatial QRS-T angle will differentiate HCM patients with ventricular arrhythmias (VA’s) from those without VA’s.

Methods:
A retrospective study of HCM patients (maximum septal or posterior wall thickness of 15mm or greater) was performed. Corrected QT interval (QTc), QRS duration (QRSd) and spatial peaks QRS-T angles (SPQRS-T angle) were assessed on patients with VA’s (>5 consecutive beats) and those without VA’s. Significance, positive/negative predictive values and relative risks were calculated.

Results:
ECG results from 100 HCM patients (32.7 ±17.2 years) were assessed. Twenty patients with VA’s were identified. The QTc differentiated those with VA’s from those without VA’s with values of 440.7±48.1ms and 472.0±43.4ms, respectively (pvalue= 0.013). QTc positive and negative predictive values (PPV and NPV) were 10% and 70.0%, respectively with relative risk (RR) of 0.4 (95% CI 0.2 to 1.0). The SPQRS-T differentiated those with VA’s from those without VA’s, 108.2±45.9 versus 144.0±26.7 degrees (p value<0.001) with PPV and NPV’s of 36.7% 96.1%, respectively with RR of 2.3 (95% CI 1.8 to 3.5). QRSd values did not significantly differ. When those with congestive heart failure (CHF) or VA were compared to HCM patients without VA or CHF, the spatial peaks QRS-T angle PPV, NPV and RR were 42.9%, 96.1% and 2.5 (95% CI 1.8 to 3.5), respectively.

Conclusion:
In our HCM cohort, the SPQRS-T angle and the QTc differentiate HCM with VA’s from those without VA’s. The SPQRS-T angle best differentiated patients with VA’s from those without VA’s with highest predictive values and relative risk.
Abstract 19850: Elevated Exercise Blood Pressure in Middle Aged Women Identifies Features of Stage A Heart Failure With Preserved Ejection Fraction (HFpEF)
Authors: Sarma Satyam , Lawley Justin , Howden Erin J , Cornwell William K , Samels Mitchel , Everding Braden , Livingston Sheryl , Palmer Dean , Berry Jarett , Levine Benjamin D
Published: March 2022

Introduction:
Elevated systolic blood pressure (SBP) during exercise is associated with abnormal vascular function and left ventricular (LV) hypertrophy. While women have lower exercise BP compared to men, few studies have explored the underlying sex differences associated with exercise BP response. We hypothesized women who generated higher exercise SBP would be more likely than men to have abnormal measures of cardiac and vascular stiffness as well as lower aerobic fitness, features associated with stage A HFpEF.

Methods:
We studied 85 (45% male) healthy normotensive middle aged subjects (53 ± 5 yrs). VO2 (Douglas bags) and BP (ECG gated electrosphygmomanometry) were measured at rest and maximal exercise. Resting cardiac function was assessed using echo (2D, 3D) and invasive measurement (right heart catheterization) of LV filling pressure under varying preloads. LV stiffness was calculated by curve fit of the diastolic portion of the pressure-volume curve. Aortic pulse wave velocity (PWV) and central aortic pressure were measured by arterial tonometry. Two factor ANCOVA was used to determine interaction between men and women using SBP as the independent variable.

Results:
In men, low fitness (peak VO2) was the best predictor of elevated exercise SBP. (R2 0.24) Similarly for women, fitness was predictive of exercise SBP in addition to vascular stiffness (PWV). (R2 0.55) When compared to men, women with elevated exercise SBP were distinctly more likely to have higher LV and vascular stiffness, impaired LV relaxation (IVRT; isovolumic relaxation time) as well as higher body fat percentage. (Table)

Conclusions:
In otherwise healthy middle aged women, elevated exercise BP was associated with increased LV and vascular stiffness, impaired LV relaxation and higher body fat, pre-clinical features consistent with stage A HFpEF. These relationships were not seen in men. Elevated exercise SBP in middle aged women may help identify a vulnerable population at risk for future HFpEF.
Abstract 20052: Mortality Reduction With Angiotensin Receptor Blockers in Hypertension Patients With Left Ventricular Hypertrophy
Authors: Odunukan Olufunso W , Filsoof David M , Hodge David O , Schultz Alison B , Nyman Mark A , Nkomo Vuyisile T
Published: March 2022

Background:
Left ventricular hypertrophy (LVH) is considered a marker of stage B heart failure according to the ACC/AHA classification. Current guidelines recommend beta-blocker (BB) therapy for treatment but randomized control trials suggest that Angiotensin Receptor Blocker (ARB) therapy may be superior.

Purpose:
To compare survival among cohorts of LVH patients classified according to use of BB, ARB or neither (NONE) class of medications.

Methods:
A retrospective analysis of hypertension patients seen in the outpatient clinics was done. LVH was defined using the most stringent electrocardiogram (ECG) criteria whereas patients with minimal and moderate voltage criteria were excluded. Using hypertension medications from the year 2009 outpatient visits notes, 869 LVH patients were classified into BB (604), ARB (115) and NONE (150) cohort groups. Cox proportional hazard models were built.

Results:
Survival at 5 years was 85.2% with 17 deaths and 98 censored patients, (unadjusted hazard ratio HR 0.53, p=0.03) in the ARB cohort and 75.5 % with 148 deaths, 456 censored patients (HR 0.91, p=0.61) in the BB group compared to 74.0% in the NONE cohort with 39 deaths and 111 censored patients. After adjusting for age, sex, atrial fibrillation/flutter, heart failure, chronic kidney disease (CKD), coronary artery disease (CAD), acute myocardial infarction, stroke, obesity, diabetes, sleep apnea and pulmonary hypertension, HR was 0.40, p=0.006 for ARB and HR=0.80, p=0.278 for BB compared to the NONE group. At baseline, there was no significant difference in age, sex, and the prevalence in heart failure, stroke, obesity, sleep apnea, and pulmonary hypertension in all three groups although the BB group had significantly highest prevalence of atrial fibrillation/flutter, CAD, CKD and the lowest prevalence of diabetes.

Conclusion:
There was a significant mortality reduction benefit to hypertension patients with ECG diagnosed LVH treated with ARB which was not seen in similar patients on BB when compared to those treated with none of both medication classes. This effect persisted even after adjusting for cardiovascular comorbidities.