bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13288: Risk of Thrombotic Events After Respiratory Infection Requiring Hospitalization
Authors: Smilowitz Nathaniel R , Subashchandran Varun , Newman Jonathan D , Barfield Michael E , Maldonado Thomas S , Brosnahan Shari B , Yuriditsky Eugene , Horowitz James M , Shah Binita , Reynolds Harmony R , Hochman Judith S , Berger Jeffrey S
Published: November 2020

Background:
Thrombosis is a major concern in respiratory infections such as influenza and now COVID-19. We investigated the magnitude and duration of risk for arterial and venous thrombosis following discharge after respiratory infections.

Methods:
Patients with respiratory infections were identified using the United States Nationwide Readmission Database from 2012-2014. Patients admitted with asthma or cellulitis served as comparators. Readmissions for myocardial infarction (MI) and venous thromboembolism (VTE) were evaluated at 30 to 180 days. The likelihood of a thrombotic event after hospital discharge was compared with a 30-day period prior to hospitalization using conditional logistic regression.

Results:
Among 5,271,068 patients discharged after a respiratory infection, 0.56% and 0.78% were readmitted within 30-days with MI and VTE, respectively. Relative to asthma and cellulitis, respiratory infection was associated with a greater age and sex-adjusted hazard of 30-day readmission for MI (adjusted HR [aHR] 1.58 [95% CI 1.52-1.64] vs. asthma; aHR 1.43 [95% CI 1.38-1.48] vs. cellulitis) and VTE (aHR 1.65 [95% CI 1.60-1.69] vs. asthma; aHR 1.45, [95% CI 1.41-1.50] vs. cellulitis). Risks of MI and VTE after respiratory infection attenuated over time, yet remained higher than asthma and cellulitis over 90 and 180 days (Figure). In a crossover-cohort analysis, the odds of MI (OR 1.68 [95% CI 1.62-1.73]) and VTE (OR 3.30 [95% 3.19-3.41]) were higher in the 30 days following discharge after respiratory infection than during the baseline period. The odds of MI (OR 2.44 [95% CI 1.95-3.05]) and VTE (OR 4.49 [95% 3.50-5.76]) at 30-days appeared highest when a viral respiratory pathogen was identified.

Conclusions:
Hospitalization for respiratory infection, particularly when of viral etiology, was associated with an increased risk of myocardial infarction and venous thrombosis that was highest in the first 30-days after discharge and declined over time.
Abstract 13291: Impact of VAD Support Duration on Pediatric Heart Transplant Outcomes
Authors: Butto Arene , Mao Chad Y , Wright Lydia , Wetzel Martha , Kelleman Michael , Carboni Michael P , Dipchand Anne I , Knecht Kenneth R , Reinhardt Zdenka , Sparks Joshua D , Villa Chet , Mahle William T
Published: November 2020

Introduction:
There is wide variability in the timing of heart transplant (HT) listing and consideration of organ offers after ventricular assist device (VAD) implant in children. While some centers wait weeks or months before proceeding with HT, others accept donor hearts within days of VAD surgery. We sought to determine if HT within 30 days of VAD implant impacts post-HT outcomes when compared to HT after ≥30 days of VAD support.

Methods:
Patients on VAD support prior to HT were extracted from the Pediatric Heart Transplant Study database. The primary endpoints were post-HT length of hospital stay (LOS) and one-year survival. Confounding was addressed by propensity score weighting using inverse probability of treatment. Propensity scores were calculated based on age at VAD implant, blood type, primary cardiac diagnosis, decade, VAD type, and allosensitization status. Group balance was verified with standardized differences.

Results:
A total of 1138 children underwent VAD implant prior to HT between 2000-2019 (Table 1). Most underwent HT ≥30 days after VAD (71%). The majority (70%) had an LVAD alone. Infants accounted for 22% of both groups, while those 1-11 years were 46% of the ≥30-day group and patients ≥12 years made up 42% of <30-day group (p=0.001). There was no difference in the prevalence of congenital heart disease vs. cardiomyopathy (p=0.7) or high allosensitization status (p=0.8) between groups. Post-HT LOS was similar between groups (23 vs. 21 days in <30 vs. ≥30 days, p=0.07). One-year survival was 90.5% in the <30-day group vs. 94.5% in ≥30 days (adjusted mortality HR 1.81, 95% CI 1.15-2.86, p=0.01).

Conclusions:
In this large study of children undergoing HT after VAD, we found lower one-year survival in patients on VAD support for <30 days prior to HT compared to those on VAD for ≥30 days before HT. These findings suggest that a strategy of delayed HT listing following VAD implant may favorably impact post-HT survival in the pediatric population.
Abstract 13606: Cardiac Fibroblast Derived Matrix-educated Macrophages Express VEGF and IL-6, and Recruit Mesenchymal Stromal Cells
Authors: Roy Sushmita , Spinali Keith , Schmuck Eric G , Kink John , Hematti Peiman , Raval Amish N
Published: November 2020

Introduction:
Polarizing monocytes into macrophages that possess anti-inflammatory and angiogenic properties could be cardio-reparative following myocardial infarction. Co-culturing cardiac fibroblasts (CF) with monocytes is observed to lead to alternatively activated macrophages. We previously showed that CF produce a unique cardiac matrix (CX) that is fibronectin enriched. Whether decellularized CX can drive differentiation of monocytes to macrophages with angiogenic and anti-inflammatory properties is unknown.

Hypotheses:
(i) CX educated macrophages (CXMq) that secrete VEGF and IL-6, which have known angiogenic and anti-inflammatory properties respectively, (ii) CXMq can recruit mesenchymal stromal cells (MSC), which have known anti-inflammatory properties and (iii) fibronectin is responsible for this effect.

Methods:
Human monocytes (CD14
+
) were cultured on CX, plastic and gelatin. After 3 days, flow expression of the macrophage markers CD14, CD16, CD163, CD206, PDL1, CD86, and HLA-DR was measured. VEGF and IL-6 levels were measured from the spent media. A transwell migration assay was performed by placing monocytes on CX in the lower chamber and MSC in the upper chamber. CX was enzymatically dispersed and flow cytometry was performed for CD14 (macrophage marker) and CD73 (MSC marker). Migration was defined as the % of MSCs reaching the lower chamber (see Figure). Controls included monocytes plated on plastic, and monocyte/CX combination cultured with and without fibronectin integrin receptor inhibitor.

Results:
CXMq secreted high levels of VEGF and IL-6 and also had low expression of inflammatory markers CD16, CD86, HLADR. Further, CXMq recruited MSC more robustly than monocytes and CX alone (see Figure). Selective fibronectin integrin receptor blockade prevented MSC recruitment (*p<0.05).

Conclusions:
CXMq has anti-inflammatory and pro-angiogenic properties that is potentially mediated by fibronectin.
Abstract 13617: Newborn Critical Congenital Heart Disease Screening Fails to Detect Target Lesions or Reduce Mortality
Authors: Miller Robin , Martens Timothy , Jodhka Upinder , Tran Jade , Lion Richard , Amirnovin Rambod , Razzouk Anees , Bock Matthew J
Published: November 2020

Introduction:
Congenital heart disease (CHD) affects over one million children in the United States. Studies show mixed outcomes regarding a survival benefit from newborn cardiac screening (NCS). California began a NCS program on 7/1/13. We evaluated the effect of mandatory NCS on surgical outcomes of our program.

Hypothesis:
Neonates with critical CHD (CCHD), requiring surgery as infants, who are not diagnosed prior to or at the NCS have lower survival than those diagnosed prior to or at the NCS.

Methods:
We evaluated all infants with CCDH undergoing cardiac surgery at our center between 07/01/13 - 12/31/18. Subjects were stratified by timing of diagnosis (pre-screen, screen positive, screen negative). Sensitivity to detect specific lesions was calculated. Primary end-points were operative mortality, absolute mortality, and actuarial survival.

Results:
Two-hundred-seventy-four infants with CCHD were included. Seventy-nine percent were diagnosed prior to screening, while 8% were diagnosed by NCS, and 13% were screen negative. Total anomalous pulmonary venous return (TAPVR) (47%) and aortic coarctation (CoA) (40%) were the most likely to be undiagnosed at time of NCS (p<0.001). Sensitivity to detect target lesions was 38% overall [TAPVR 73%, CoA 12%, hypoplastic left heart syndrome (HLHS) 25%, Tetralogy of Fallot (TOF) 29%]. Primary end-points were not different based on timing of diagnosis (p>0.05) (Figure).

Conclusions:
We found only a 38% sensitivity of mandatory newborn CCHD screening to detect target cardiac lesions requiring surgery in the first year of life. A high proportion of newborns with HLHS, TOF, and CoA remained undiagnosed after screening, though TAPVR was readily detected. There were no differences in survival between the screening groups. Mandatory newborn CCHD pulse oximetry screening can detect some newborns with critical heart disease, but should not replace traditional methods of monitoring in the fetal, newborn, and infant periods.
Abstract 13653: Physical Activity and Arterial Stiffness in Black Adults
Authors: Islam Shabatun , Beydoun Nour , Mehta Anurag , Kim Jeong Hwan , Ko Yi-An , Jin Qingchun , Baltrus Peter , Topel Matthew L , Liu Chang , Vaccarino Viola , Sims Mario , Ejaz Kiran , Searles Charles D , Dunbar Sandra B , Lewis Tene T , Taylor Herman A , Igho-Pemu Priscilla E , Quyyumi Arshed A
Published: November 2020

Introduction:
Arterial stiffness is a precursor for development of hypertension and premature cardiovascular disease (CVD). Physical activity has been associated with lower arterial stiffness among largely White populations, but the types of activity required and whether these findings apply to Blacks remain unknown. We examined whether physical activity levels were associated with arterial stiffness among Blacks in two independent cohorts.

Methods:
In the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity, 458 Black adults (age 53 ± 10, 39% male) without known CVD living in Atlanta, GA were recruited. Arterial stiffness was measured as pulse wave velocity (PWV) using applanation tonometry (Sphygmocor Inc). Total and domain specific physical activity (work, active living, household, and sport/exercise) were assessed by self-report using the Jackson Heart Study Physical Activity Questionnaire. Multiple linear regression models were used to investigate differences after adjusting for age, gender, blood pressure, diabetes, and smoking. Change in the Framingham Risk Score (FRS) was tested as a potential mediator. Findings were validated in the Emory-Morehouse Partnership to Reduce Cardiovascular Health Disparities (META-Health) --another independent cohort of Black adults (n=60, age 50 ± 10, 25% male).

Results:
Lower arterial stiffness was associated with higher self-reported levels of sport/exercise (Beta = -0.54 [-1.03, -0.05], p=0.03, highest versus lowest quartile), but not work, active living, household-related physical activities, or the overall physical activity scores. 26.9% of this improvement appeared to be mediated through changes in FRS factors. These findings were confirmed in an independent group of Blacks in META-Health where higher levels of sport/exercise remained associated with lower arterial stiffness (Beta = -1.46 [-2.80, -0.12], p=0.03, highest versus lowest quartile).

Conclusion:
Higher sport/exercise related physical activity is associated with lower arterial stiffness in Blacks, an association that is only partially attributable to a lower traditional CVD risk factor burden.
Abstract 13660: Initial Revascularization in Chronic Coronary Syndromes With Myocardial Ischemia
Authors: Soares Andrea , Boden William E , Hueb Whady , Brooks Maria M , Vlachos Helen A , Hardi Angela , Brown David L
Published: November 2020

Introduction:
Ischemic heart disease is the leading cause of death worldwide. It is unknown whether initial revascularization using percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) plus optimal medical therapy (OMT) in patients with chronic coronary syndromes (CCS), obstructive coronary artery disease (CAD) and myocardial ischemia improves hard clinical outcomes compared to OMT alone.

Hypothesis:
In CCS patients with obstructive CAD and documented myocardial ischemia, initial revascularization plus OMT does not reduce death or nonfatal myocardial infarction (MI) compared to OMT alone.

Methods:
We searched Ovid Medline, Embase, Scopus, and Cochrane Library databases from inception to March 2020 for randomized controlled trials (RCTs) of PCI or CABG and OMT vs OMT alone for CCS patients in whom stents and statins were used in more than 50% of patients. Random-effects models were used to estimate average treatment effects across trials. The co-primary outcomes were all-cause death and nonfatal MI at 5 years.

Results:
Six RCTs were identified that randomized 10,020 CCS patients. At 5 years, among 5,025 CCS patients assigned to revascularization plus OMT, there were 492 deaths (9.8%) compared to 482 deaths among 4,995 patients (9.6%) assigned to OMT (OR, 1.01, 95% CI: 0.88-1.16; P=0.87). There were 521 nonfatal MIs (10.3%) in those assigned to revascularization plus OMT compared with 593 MIs (11.9%) in those assigned to OMT arms (OR, 0.78, 95% CI: 0.58-1.05; P=0.10). In subgroup analysis, nonfatal MI was not reduced by PCI plus OMT (OR, 0.95, 95% CI: 0.74-1.23, P=0.71) but was significantly reduced in studies of CABG plus OMT compared to OMT alone (OR, 0.38, 95% CI: 0.23-0.64, P<0.001). The overall effect of CABG on reducing nonfatal MI was significantly greater than that of PCI (P=0.002).

Conclusions:
In patients with CCS and myocardial ischemia, initial revascularization with PCI or CABG plus OMT was not associated with a reduction in death at 5 years compared to OMT alone. CABG plus OMT reduced nonfatal MI compared to OMT alone whereas PCI did not. These findings suggest important differences in MI outcomes between those who undergo CABG vs. PCI, but no overall difference in mortality compared with OMT alone.
Abstract 13663: Long-Term Outcome of Cook Formula Stents in Patients With Congenital Heart Disease
Authors: Ramachandra Ramya , sisniega carlos , Yarrabolu Tharak
Published: November 2020

Introduction:
Cook Formula stents are widely used in pediatric cardiology owing to their low profile and availability in a variety of sizes. Literature regarding the long-term outcome of these stents is limited.

Methods:
A single center retrospective cohort study was conducted to investigate the long-term outcome of Cook Formula stents. Demographic and catheterization data were collected for all patients who underwent stent implantation between January 2014 and March 2020. Patients with stents at sites other than the aorta and pulmonary arteries were excluded. Generalized Estimating Equation model was used to determine predictors of expansibility of stents.

Results:
48 patients with 70 stents were included in the study. Of these, 36 stents had no subsequent balloon dilation while 34 stents had one or more balloon dilations during a median follow-up time of 33.3 months. No stent related mortality or stent fractures were seen. 2 stents embolized to a distal location. No decline in median narrowest vessel diameter was noted between any two subsequent catheterizations. Age (OR 1.0, 95% CI 0.13 - 1.0003), sex (OR 0.45, 95% CI 0.08 - 2.5), stent diameter of 5, 6, 7 mm compared to 4 mm (OR 2.6, 95% CI 0.13 - 55.1; OR 1.3, 95% CI 0.13 - 14.4; OR 3.0, 95% CI 0.33 - 27.4 respectively) and initial narrowest vessel diameter (OR 1.5, 95% CI 0.81 - 2.8) were not found to have any significant predictive impact on the ability of stents to reach a target diameter of 10 mm.

Conclusions:
Cook Formula stents are safe in neonates, infants and children. They have a low rate of in-stent stenosis. They are easily expandable to diameters greater than 10 mm irrespective of age, sex and initial stent or vessel diameter.
Abstract 13678: Serum Hepatokine Selenoprotein P is Upregulated by Hepatic Hypoperfusion and Predicts Adverse Prognosis in Heart Failure Patients
Authors: Misaka Tomofumi , Ichijo Yasuhiro , YOSHIHISA Akiomi , Hotsuki Yu , Koichiro Watanabe , Sato Yu , KIMISHIMA Yusuke , Yokokawa Tetsuro , Oikawa Masayoshi , Kobayashi Atsushi , Takeishi Yasuchika
Published: November 2020

Introduction:
Cardiac and multiple organ network is involved in the pathophysiology of heart failure (HF). Hepatokines, which are produced and secreted from the liver, have regulatory functions in the peripheral tissues. However, the interaction between the heart and liver or clinical relevance of hepakokines in HF remains poorly understood. The present study aimed to elucidate the clinical significance of hepatokine selenoprotein P in HF.

Methods and Results:
We enrolled 250 participants including 171 hospitalized patients with HF and 79 control subjects. The serum concentration of selenoprotein P was measured by an enzyme-linked immunosorbent assay. We found that the serum selenoprotein P levels in HF patients were significantly higher than those in controls (14.8 ± 7.5 vs. 8.4 ± 4.6 mg/L, P<0.01). Next, the HF patients were categorized into 4 groups based on the hepatic hemodynamics assessed by abdominal-ultrasonography, which determined liver congestion by shear wave elastography (liver-SWE, >1.33 m/s) and liver hypoperfusion by peak systolic velocity of the celiac artery (celiac-PSV, <62.4 cm/s). Selenoprotein P levels were significantly upregulated in patients with liver hypoperfusion compared to patients with liver congestion (
Figure A
). Selenoprotein P was negatively correlated with celiac-PSV (P<0.01), cardiac output (P<0.01), and left ventricular stroke volume (P=0.03), whereas no correlations were observed between selenoprotein P and indices of congestion such as liver-SWE and right atrial pressure. Kaplan-Meier analysis demonstrated that a higher selenoprotein P group showed a lower event-free rate from re-hospitalization due to worsening HF (
Figure B
).

Conclusion:
Upregulation of liver-derived selenoprotein P was associated with hepatic hypoperfusion, not hepatic congestion, and related to the adverse prognosis in HF. Selenoprotein P may be a novel molecule involved in the cardio-hepatic interaction.
Abstract 13681: Single-cell Gene Profiling Revealed Heterogeneity of Human Skeletal Muscle Derived Stem Cells and Their Paracrine Factors
Authors: Iseoka Hiroko , Miyagawa Shigeru , Torigata Kosuke , Sawa Yoshiki
Published: November 2020

Background:
Transplantation of sheet-shaped autologous skeletal muscle-derived cells (SMDCs) has been shown to produce therapeutic effects via paracrine factors in ischemic cardiomyopathy. SMDCs are heterogeneous cell population consist of myoblasts and non-myogenic cells, and their detailed characteristic and paracrine factors has not been fully analyzed. We herein applied single-cell RNA sequencing (scRNA-seq) to profile the population and paracrine factors of SMDCs.

Methods and Results:
Primary SMDCs of human origin were subjected to scRNA-seq and divided into 5 populations, expressing myogenic markers differently. These included four myogenic populations with higher expression of
MYF5
(myoblasts),
myogenin
(early differentiated cells), mitosis-related gene (proliferating cells), and
MYL3
(moderately differentiated cells) and non-myogenic population with lower expression of myogenic genes. On the other hand,
PAX7
, quiescent satellite cell marker, and
MYH4
, terminally differentiated marker, were not expressed in any populations. Furthermore, regarding the expression of key angiogenic factors,
VEGF
and
HGF
were highly expressed in the non-myogenic population and
HMGB1
was expressed in both populations. Moreover, analysis of the gene expression of angiogenic factors differentially expressed in each population indicated that myoblast population highly expressed
PDGFA
and
CCN
(Cellular communication network factor)
1
, and early differentiated population highly expressed
CCN2
. Although these factors were expressed in other populations, their expression tended to be lower in the moderately differentiated cell population.

Conclusion:
Analysis of SMDCs using scRNA-seq revealed that they are heterogeneous cells consisting of multiple myogenic populations with different degrees of differentiation and cytokine production, suggesting that single-cell gene profiling may be useful for the evaluation on characters of effector cells.
Abstract 13688: Shocking: Cardioversion in Cardiogenic Shock Has Limited Success
Authors: Janes William A , Craig Wendy Y , Nichols Jonathan M , Sesselberg Henry W
Published: November 2020

Introduction:
Atrial fibrillation (AF) and atrial flutter (Aflutter) are common in cardiogenic shock patients in the Cardiac ICU (CICU). Electrical cardioversion (CV) can restore sinus rhythm, but carries the risk of transient hemodynamic deterioration. There has been little research in the efficacy and safety of electrical CV for AF/Aflutter in the CICU.

Objective:
Describe success of CV in AF/Aflutter in cardiogenic shock patients in the CICU.

Methods:
We identified Maine Medical Center CICU patients from 1/1/2015 to 12/31/19 who were in cardiogenic shock and underwent electrical CV for AF/Aflutter. Cardiogenic shock was defined by depressed cardiac index (<2.2L/m^2 or inotrope use), hypotension (systolic BP <90 mmHg, MAP <65 mmHg, or vasopressor use), and Lactate > 2mmol/L. If a patient had multiple CVs, only the first was analyzed.

Results:
Twenty patients met the inclusion criteria. Initially, 16 of 20 CVs were successful, however only 10 patients were in SR 24 hours after CV and only 7 were in SR at CICU discharge (Figure 1). The median LVEF was 20%, similar between groups (p-value = 0.52 initially, 0.37 at 24 hours, and 0.18 at CICU discharge). Only 1 patient was on mechanical support. The type of AF was varied (35% newly diagnosed, 55% paroxysmal, and 10% persistent). In patients with new AF, 85% were in SR initially, 57% at 24 hours, and 28% at CICU discharge. All patients received amiodarone. Inotrope use was similar, however no patients on vasopressors were in SR at CICU discharge (5/13 vs 0/7, p=0.11). Only 1 patient suffered an adverse effect (sinus bradycardia). Diabetes (p = 0.064) was the only characteristic to nearly predict lack of CV success at CICU discharge.

Conclusions:
1. Electrical CV in patients admitted to the CICU in cardiogenic shock had a high initial success rate, however success was short-lived. 2. CV did not cause serious adverse effects. 3. Larger registries/trials are needed to predict which subgroups of CICU patients benefit from CV for Afib/Aflutter.
Abstract 13716: Racial Differences in Patients With Cryptogenic Stroke With Insertable Cardiac Monitors
Authors: heckle mark , Ingram Eva , Pour-Ghaz Issa , Alexandrov Andrei V , Jha Sunil K , Bhole Rohini , Levine Yehoshua , Kabra Rajesh
Published: November 2020

Introduction:
African American (AA) patients have a higher incidence of stroke but lower prevalence of atrial fibrillation (AF). Studies involving long term monitoring with implantable cardiac monitors (ICM) for AF after cryptogenic stroke are limited by the under-representation of the AA population.

Objective:
We sought to assess racial differences in the diagnosis of AF by implantable cardiac monitors in patients with cryptogenic stroke.

Methods:
We performed a retrospective chart review study at Methodist University Hospital, University of Tennessee Health Science Center, Memphis TN. We included patients with cryptogenic stroke who received an ICM from September 2014 to June 2019 to assess for AF. Race and additional demographic characteristics were obtained from the electronic medical records. Interrogation reports from the ICMs were obtained by remote monitoring as well as clinic visits. Fisher exact and student t test were used to compare demographic data as well as the incidence of AF in these patients.

Results:
A total of 219 patients with cryptogenic stroke who underwent ICM implantation were included, of which 129 (58.9%) were AA. In the AA cohort, the patients were significantly younger than (62.3 versus 65.8 years;
p
=0.04) and had a significantly higher prevalence of hypertension (92.2% versus 68.5%;
p
<0.01) and diabetes mellitus (40.3% versus 27.3%;
p
=0.04). Upon a mean follow up of 10.6 months, a total of 39 patients (17.8%) were diagnosed with AF on ICM monitoring. The mean time to the incidence of AF was 7.4 months. There was no significant difference in the incidence of AF in the AA population (17.8%) as compared to the rest of the population (17.8%) (
p
=1.00).

Conclusion:
In this single center study of patients with cryptogenic stroke who underwent long term monitoring with ICM, there was no significant difference in the incidence of AF between AA and the rest of the population. We conclude that ICM’s have an equally important role in AF detection in AA patients as in the general population with cryptogenic stroke.
Abstract 13727: Mapping Analysis Clarifies the Correlation Between Distribution of Patient’s Home Address and Participation in Outpatient Cardiac Rehabilitation
Authors: Nakayama Atsuko , Nagayama Masatoshi , Morita Hiroyuki , Komuro Issei , Isobe Mitsuaki
Published: November 2020

Introduction:
Geographical analysis is developing as a powerful tool for evaluating the quality of medical service and acquiring the fundamental data for medical decision-making. Using a geographical analysis, we can evaluate the impact of the distance from patient’s home to the hospital on the participation in outpatient cardiac rehabilitation (CR).

Methods:
All patients hospitalized for percutaneous coronary intervention, coronary artery bypass grafting, valvular surgery, congestive heart failure and aortic diseases were recommended to participate in outpatient-CR program after discharge. In the dataset of prospective cohort study of CR from 2004 to 2015 (n=9,019), we investigated the impact of the distance from patient’s home to hospital on the participation in outpatient-CR program using the geographical analysis.

Results:
The total participation rate of outpatient-CR was 47% in our study population. The participation rate of outpatient-CR was highest (62%) in patients with road distance from home to hospital < 10 km as compared with those with road distance of 10-20 km, 20-30 km and >30km to hospital (51%, 39%, and 23%, respectively, p<0.001). Patients whose road distance from home to hospital was < 30 km more participated in outpatient-CR as compared with patients whose road distance was ≧30 km (Odds ratio 4.41, 95%CI 3.86 - 5.04). Expecially in patients with heart failure, the longer distance-the less participation rate relationship was menifest (p<0.01).

Conclusions:
Using the geographical analysis, we could successfully evaluate the impact of road distance from patient’s home to hospital on the participation in outpatient-CR after discharge in patients with cardiovascular diseases. Especially in patients with heart failure, “the longer distance, the less participation” relationship was manifest. This geographical analysis will provide us with essential information for future epidemiological and clinical studies as well as medical decision-making, improving the healthcare service.
Abstract 13736: Elimination of Senescent Cells Targeting Senescence Associated Glycoprotein (sagp) Improved the Atherosclerosis and Diabetes
Authors: Suda Masayoshi , Shimizu Ippei , Katsuumi Goro , Yoshida Yohko , Hayashi Yuka , Minamino Tohru
Published: November 2020

Cellular senescence entails an irreversible growth arrest and a pro-inflammatory secretory phenotype, which contributes to aging-associated disorders such as atherosclerosis and diabetes, however, underlying mechanisms are largely unknown. In this study, we identified a novel protein, senescence-associated glycoprotein (SAGP), as a biomarker of cellular senescence and we also found that elimination of senescent cells targeting SAGP attenuated aging-associated disorders such as atherosclerosis and diabetes. First, we identified that SAGP as a senescent marker by microarray analysis of senescent human endothelial cells compared with young endothelial cells. The expression of SAGP was significantly increased in the aorta of chronological aging mice or ApoE-knockout mice. Then we measured SAGP expression in the patients registered in our hospital and found that mean SAGP expression was significantly higher in patients with atherosclerotic diseases compared to patients without atherosclerotic diseases.Recently, it is reported that elimination of senescent cells (senolysis) reversibly improved pathological aging phenotypes and also extended the lifespan. We established senolytic therapy targeting SAGP. We generated SAGP-DTR (diphtheria toxin receptor) transgenic mice, in which we could eliminate the SAGP- positive senescent cells using DT (diphtheria toxin). We found elimination of SAGP positive senescent cells significantly reduced the atherosclerotic plaque burden in the aorta of ApoE-KO mice and improved the glucose metabolism of dietary obese mice. For clinical implication, we then developed a cytotoxic vaccine targeting SAGP. Treatment with SAGP vaccine successfully eliminated SAGP positive senescent cells and attenuated atherosclerosis and metabolic dysfunction. These data indicate that targeting SAGP-positive cells could be a novel strategy for senolytic therapy.
Abstract 13745: Hazardous Alcohol Use is a Common but Infrequently Addressed Problem Among Hospitalized Cardiovascular Patients
Authors: Gobeil Kyle , Medling Theodore , Tarvaez Paolo , sawalha khalid , Abozenah Mohammed , Friedmann Peter , naimi timothy , Pack Quinn
Published: November 2020

Introduction:
Excessive alcohol intake and binge drinking behavior has known detrimental cardiovascular impacts. National estimates suggest that about 7% of U.S. adults has hazardous drinking behavior, but it is unclear if this is different among the inpatient cardiac population and, furthermore, how often this issue is addressed during hospitalization.

Hypothesis:
Prevalence of alcohol use is underappreciated in the cardiac population due to purported health benefits, and therefore, likely to be overlooked.

Methods:
Disorders Identification Test (AUDIT), among patients hospitalized for cardiac surgery, heart failure (HF) or myocardial infarction (MI) between June and September 2019. Problem drinking was defined as an AUDIT score of ≥8 with binge drinking defined as 5+ drinks for men or 4+ for women on a single occasion within the past 30 days. Hazardous drinking was defined as a combination of either problem or binge drinking behavior.

Results:
Of 300 patients approached, a total of 290 (96.7%) completed the survey (33% non-drinkers, age 69 ± 11 years, 70% male, 4% Spanish-speaking, 31% surgical). The rate (95% CI) of problem, binge, and hazardous drinking was 12% (9-16), 16% (12-20), and 18% (14-23), respectively. Irrespective of alcohol use, 58% of patients reported being asked about alcohol use during their admission, mostly by nurses (56%). Patients with hazardous drinking were counseled more frequently about their alcohol use compared to non-hazardous drinkers, (11% vs 3%, p = 0.03), but the large majority (89%) of hazardous drinkers received no advice about their alcohol use while hospitalized and only 34 (12%) patients reported having ever been given a recommendation about alcohol consumption by a cardiologist or cardiac surgeon.

Conclusions:
In patients hospitalized for acute cardiac illnesses, the prevalence of problem drinking was more than double national estimates. About half of patients with problem drinking behavior were asked about their alcohol, and only a minority of patients received counseling. Our findings suggest that hazardous alcohol use is more common that previously appreciated, and that there are substantial health-system gaps in screening and counseling for this important cardiovascular risk factor.
Abstract 14068: One-year Outcomes of Dpp-4 Inhibitor Treatment in Diabetic Patients After Contemporary Percutaneous Coronary Intervention - Ps Matching From Data of Multicenter Registry -
Authors: Hata Takehiro , Jujo Kentaro
Published: November 2020

Introduction:
Clinical prognosis in diabetic patients comorbid with coronary artery disease (CAD) remained poor, even in the current drug-eluting stent (DES) era. However, there has been a limited evidence about the prognosis in diabetic patients with CAD who were treated with dipeptidyl peptidase-4 inhibitors (DPP4i).

Methods:
This study is a subanalysis from the TWINCRE registry that is a multicentral prospective cohort including patients who underwent percutaneous coronary intervention (PCI) at 12 hospitals in Japan between 2017 and 2019. Among 1,905 registered patients who were followed up, we ultimately evaluated 615 diabetic patients. They were divided into two groups depending on the prescription of DPP4i at the hospital discharge after the index PCI; DPP4i group (n=287) and Non-DPP4i group (n=328). For the two groups, we performed propensity-score (PS) matching using variables as follows: age, sex, acute coronary syndrome, left ventricular ejection fraction, serum creatinine, insulin use, prescriptions of statin, beta blocker, aspirin, and ACE inhibitor/ARB. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE) including death, acute coronary syndrome, stent thrombosis, hospitalization due to heart failure and ischemic stroke.

Results:
Overall MACCE was observed in 70 patients (11.4%) during 364 days of median observation period. In unmatched patients, Kaplan-Meier analysis showed that patients in the DPP4i group showed a significantly lower MACCE rate than those in the Non-DPP4i group (Log-rank test, p=0.009, Figure A). In 284 PS-matched patients, patients in the DPP4i group still had lower MACCE rate than those in the non-DPP4i group (hazard ratio 0.39, 95% confidence interval 0.16-0.96, p=0.034, Figure B).

Conclusion:
Propensity-matching analysis showed that hyperglycemia control by DPP4i was associated with better 1-year clinical outcomes in diabetic patients after PCI in the contemporary DES era.
Abstract 14077: One-year Outcome After PCI in Patients Treated Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers - Subanalysis From Multicenter Registry -
Authors: YUSUKE Inagaki , Jujo Kentaro , Tanaka Hiroyuki , Oka Toshiaki , KAMISHIMA KAZUHO , Koganei Hiroshi , Kobayashi Hiroshi , Mori Fumiaki , Sakamoto Tomohiro , Ota Yoshimi , Yamaguchi Junichi , Hagiwara Nobuhisa
Published: November 2020

Background:
The prescription of inhibitors for renin-angiotensin-aldosterone system (RAAS) is associated with improved prognosis but have respectively different mechanisms of action in patients with coronary artery disease (CAD). We aimed to compare the clinical outcomes between angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) therapy in patients with CAD undergoing percutaneous coronary intervention (PCI).

Methods:
This study is a subanalysis from the TWINCRE registry that is a multicentral prospective cohort including patients who underwent PCI. After excluding 18 patients who received both ACEi and ARB from 2,896 registered patients, we ultimately evaluated 369 patients treated with ACEi, 492 with ARB and 541 without ACEi or ARB. The primary endpoint was a major adverse cardiovascular and cerebrovascular events (MACCE) including death from any cause, acute coronary syndrome, stent thrombosis, stroke and hospitalization for heart failure. The impact of RAAS inhibitors on all-cause mortality alone was also evaluated.

Results:
During the observation period with 366 days of a median follow-up, Kaplan-Meier analysis revealed that the ARB group had the lowest rate of MACCE than other two groups (Log-rank for trend, p< for < 0.0001, Figure). Regarding all-cause mortality, the ARB group and ACEi group had comparable rates for MACCE, which were lower than the no-ACEi/ARB group (p< for < 0.0001). In a Cox regression analysis, after adjusting with age, gender, comorbidities, multivessel disease, acute myocardial infarction, and medications at discharge including dual antiplatelet therapy and statins, ARB therapy was still had a superiority to ACEi therapy regarding with MACCE (hazard ratio: 0.54, 95% confidence interval: 0.30-0.98).

Conclusion:
In the multicenter cohort study, ARB therapy was associated with better one-year clinical outcomes compared to ACEi therapy in patients undergoing PCI.
Abstract 14086: Early Results of a Novel EPTFE-based Pulmonary Valved Conduit in a Pediatric Patient Population
Authors: Galantowicz Mark E , Baird Chris , Backer Carl , Del Nido Pedro J
Published: November 2020

Introduction:
This prospective, multicenter, single-arm, early feasibility study evaluates the safety and performance of an investigational ePTFE-based valve for replacement of the pulmonary valve and reconstruction of the Right Ventricular Outflow Tract. A novel polymeric pulmonary valved conduit, resistant to calcification and structural valve deterioration, may provide a more durable therapy option for the pediatric population by preventing loss of right ventricular function and increased freedom from valve-related reintervention and mortality.

Methods:
The primary endpoints at 6 months adjudicated by an independent Clinical Events Committee are valve-related mortality and device-related reintervention. The investigational device is a valved conduit comprised of ePTFE with stretch technology and a flexible tri-leaflet polymeric valve made of an advanced proprietary composite material, which can be tailored to length requirements of the anatomy. All enrolled patients met study inclusion/exclusion criteria and had a signed informed consent form. All patients had pre- and postoperative evaluation via transthoracic echocardiography (TTE). Aspirin was administered for a minimum of three months post procedure and, per institutional protocols, four patients were on temporary Coumadin.

Results:
Of the 17 patients enrolled from three sites, 52.9% were male. Ages ranged from 6 to 17 years (mean 11.5 ± 3.7). BSA ranged from 0.82 to 1.57 m
2
. At six months follow up, 100% of subjects successfully met the primary endpoint of freedom from valve-related mortality and device-related reintervention. No patient exhibited an RVOT gradient > 20 mmHg. No patients had pulmonary regurgitation above baseline (≤ mild) observed through six months. Throughout postoperative serial TTE evaluation at discharge, 1, 3, and 6 months, no evidence of worsening valvular insufficiency was observed. No patient developed endocarditis and TTE detected no clinically significant thrombus formation.

Conclusions:
These preliminary data of a novel Pulmonary Valve Conduit suggest improved pulmonic and right ventricular function based on TTE measurements, no unexpected findings, no valve-related adverse events and encouraging hemodynamic performance through 6 months.
Abstract 14099: Beta-blockers Reduce Mortality in Patients With Heart Failure or Ischemic Heart Disease and Chronic Obstructive Pulmonary Disease
Authors: Ruzieh Mohammed , Baugh Aaron , jebbawi lama , Foy Andrew J
Published: November 2020

Introduction:
In patients with heart failure (HF) and ischemic heart disease (IHD), beta-blockers (BB) are associated with improved mortality. However, in patients with co-morbid chronic obstructive pulmonary disease (COPD), this drug class is less utilized due to concerns about an unfavorable impact on the morbidity and mortality. Patients with COPD and heart disease have higher mortality than those with heart disease alone. There is a need to clarify the safety of BB in this population.
Objective:
To assess the effect of BB therapy on mortality in patients with heart disease and COPD.

Methods:
We performed a systematic search of MEDLINE and PubMed inception until May 30, 2020 to identify articles of BB use in patients with COPD. The risk ratio (RR) of mortality with BB use was calculated using the Mantel Haenszel random effect model. Statistical analysis was performed using Review Manager Web (RevMan Web). A two-sided p value of < 0.05 was considered statistically significant.

Results:
A total of 16 studies were included in this meta-analysis, comprising 133,538 patients (44,893 received BB, 88,381 received no control drug, and 264 received placebo). BB use was associated with reduced risk of mortality overall (14.8% vs. 19.9%, RR: 0.67, 95% CI: 0.57 - 0.79), in patients with IHD (18.6% vs. 26.6%, RR: 0.64, 95% CI: 0.50 - 0.82), and in patients with HF (8.1% vs. 23.6%, RR: 0.56, 95% CI: 0.41 - 0.75), Figure. BB were used to treat hypertension in one study, and it was associated with reduced risk of mortality (6.2% vs. 13.4%, RR: 0.46, 95% CI: 0.28 - 0.78). In contrast, βB use was not associated with statistically significant reduced risk of mortality when given without a specified cardiovascular indication (25.0% vs. 32.5%, RR: 0.82, 95% CI: 0.59 - 1.15), figure.

Conclusion:
Beta-blockers are associated with improved mortality in patients with HF or IHD and COPD. A diagnosis of COPD should not preclude treatment with beta-blockers, as previous concerns likely over-stated risk.
Abstract 14102: Prognostic Impact of Peak Systolic Pulmonary Arterial Pressure in Nonagenarians: An Echocardiographic Study
Authors: Shimada Shunsuke , Omori Taku , Uno Goki , Rader Florian , Siegel Robert J , Shiota Takahiro
Published: November 2020

Introduction:
Recently, a low threshold of estimated peak systolic pulmonary arterial pressure (eSPAP) of 30 mm Hg was reported to be associated with mortality in the general population. However, less is known about the prognostic impact of eSPAP in nonagenarians.

Methods:
We retrospectively reviewed 596 patients ≥90 years of age referred for echocardiography with a recorded eSPAP and left ventricular ejection fraction ≥50%. eSPAPs were characterized according to their quartile distribution: first quartile (reference group) (<30 mm Hg), second quartile (30-38 mm Hg), third quartile (39-48 mm Hg), fourth quartile (>49 mm Hg). The associations between quartiles of eSPAP and all-cause mortality were tested in Cox models (adjusting for age, sex, body mass index, hypertension, coronary arterial disease, atrial fibrillation, diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease, left-sided valve disease, left atrial area, NYHA class ≥II, left ventricular mass and right ventricular fractional area change).

Results:
Of the 596 patients, 61% were female, and the median age was 92 years (IQR 91-95). The median eSPAP was 39.0 mm Hg (IQR 30.3-49.0) (Figure). During the median follow-up of 522 days (IQR 59-1337), a total of 268 deaths (45%) occurred. The adjusted risk of mortality in eSPAP 39-48 mm Hg and eSPAP >49 mm Hg were 1.6 and 1.7 times higher than in eSPAP <30 mm Hg, respectively (Table).

Conclusions:
In conclusion, eSPAP ≥39 mm Hg was independently associated with mortality in nonagenarians. Estimated peak systolic pulmonary arterial pressure could help in prognostic stratification even in oldest-old patients.
Abstract 14116: Favorable Outcomes for Heart Transplantation in Barth Syndrome as Demonstrated by Multicenter/multiregistry Analysis
Authors: Li Yu , Godown Justin , taylor carolyn , Dipchand Anne I , Feingold Brian
Published: November 2020

Introduction:
Barth Syndrome (BTHS) is a rare (~1/350,000), X-linked mitochondrial disease characterized by cardioskeletal myopathy and neutropenia. Reported outcomes after heart transplant (HT) are limited to case reports. We sought to identify a large cohort of BTHS HT recipients to describe clinical outcomes.

Hypothesis:
HT in BTHS is associated with non-inferior survival, acute rejection (AR), infection, and vasculopathy (CAV) relative to non-BTHS dilated cardiomyopathy (DCM).

Methods:
We analyzed data from the Barth Syndrome Registry and Repository (BRR), Pediatric Heart Transplant Society (PHTS), and Scientific Registry of Transplant Recipients (SRTR). To avoid recounting patients occurring in >1 source, we used years of birth, listing, and HT and listing/HT city to link records across registries. BTHS HT recipients were matched 1:4 on age, era, urgency status, and use of ECMO/VAD to male, non-BHTS, DCM HT recipients in PHTS. Survival was analyzed for all BTHS HT recipients. Because BRR and SRTR morbidity data are limited, AR, infection, malignancy, and CAV were analyzed only for those with PHTS data.

Results:
Forty-seven BTHS patients with 51 listings and 43 HTs (including 2 re-transplants) were identified; 29 BTHS HTs (1 re-transplant) had data in PHTS. Median age at HT was 1.9 yrs (IQR: 0.6-5.8) with 35% <1 years-old at HT. Median follow up was 4.2 yrs (2.1-9.1). Mechanical circulatory support at HT was common (VAD 29%, ECMO 5%). We found no difference in survival between BTHS and non-BTHS HT recipients (HR 0.93, 95% CI 0.40-2.14). Freedom from infection (HR 0.63, 0.33-1.20), bacterial infection (HR 0.76, 0.29-1.99), malignancy (HR 0.22, 0.02-2.02), and CAV (HR 0.55, 0.15-1.97) were also similar between the groups. BTHS HT recipients had greater freedom from AR (HR 0.39, 0.17-0.87). Use of induction therapy (62 vs 74%, p=0.21), steroids at 30 days (76 vs 62%, p=0.17), and dual or triple immunosuppression at 1 year (80 vs 84%, p=0.58) were similar for BTHS and non-BTHS recipients.

Conclusions:
In this largest cohort yet reported, BTHS HT recipients show equivalent survival and freedom from infection, malignancy, and CAV, with a lower risk of acute rejection. Thus, individuals with BTHS should not be excluded from HT solely based on the diagnosis of BTHS.
Abstract 14125: An in vitro Pulmonary Vascular Platform From Endothelialized Whole Lung Scaffolds
Authors: Yuan Yifan , Leiby Katherine L , Greaney Allison M , Raredon Micha Sam B , Qian Hong , Baevova Pavlina , Admas Taylor S , Engler Alexander J , Kural Mehmet H , Schupp Jonas C , Hong Young , Kaminski Naftali , Niklason Laura E
Published: November 2020

Introduction:
The development of an in vitro system is critical to studying human diseases including the novel coronavirus disease-19 (COVID-19), and is typically centered on recapitulating native physiology. In the case of the pulmonary vasculature, the endothelium is critical for establishing the fluid-tight barrier in the alveolar compartment, and displays significant phenotypic and functional heterogeneity along vascular tree.

Objective:
Here, we developed an experimental platform that could mimic physiological functions and cellular phenotypes of pulmonary vasculature, during homeostatic and diseased states.

Methods and Results:
Lymphatic
low
pulmonary microvascular endothelial cells (Lymph
low
PMECs) were isolated from Prox1-GFP rodent lungs from regions of having low amounts of lymphatic tissue. Single-cell RNA-sequencing (scRNAseq) data revealed that these cells were becoming phenotypically homogenous over several passages while losing some markers of native differentiation during passaging. Intriguingly, after culturing in decellularized lung scaffolds, the phenotype of the lymph
low
PMEC changed back toward native lung endothelium. Vascular barrier function was partially restored in engineered lungs repopulated with endothelium, while small capillaries with patent lumens were appreciable. To evaluate the ability of the engineered endothelium to modulate permeability in response to exogenous stimuli, lipopolysaccharide (LPS) was introduced into repopulated lungs to simulate acute lung injury. After LPS treatment, the pro-inflammatory signal was significantly increased and the vascular barrier was severely impaired in the repopulated lung.

Conclusions:
Taken together, these results show a novel platform that recapitulates some pulmonary microvascular functions and phenotypes at a whole organ level. This development may help pave the way for using the whole organ engineering approach to model vascular diseases.