bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 9416: Monocyte Subsets and Exercise Capacity in Patients With Atrial Fibrillation With Preserved Left Ventricular Function
Authors: Shahid farhan , Lip Gregory , Shantsila Eduard
Published: April 2022

Introduction:
Monocytes play important roles in inflammation, angiogenesis and tissue repair in cardiovascular disease. This study examined differences in monocyte subset numbers, subsequent markers of inflammation and cardiac fibrosis in patients with permanent atrial fibrillation and preserved left ventricular function with regards to peak exercise capacity (cardiopulmonary exercise testing and 6 minute walk test), quality of life and hospitalisation. Furthermore, the effects of spironolactone vs placebo on the quantitative measurement of these potential biomarkers were assessed in a double blind randomised study over a 2 year period.

Methods:
Three monocyte subsets [CD14++CD16-CCR2+ (Mon1), CD14++CD16+CCR2+ (Mon2) and CD14+CD16++CCR2- (Mon3)] were analysed by flow cytometry and ELISA to quantify makers of fibrosis in the form of Galectin 3, Type III Procollagen Peptide and Type I Procollagen Peptide. SPSS software was used to carry out statistical analysis of all 250 patients in the study cohort using stepwise multivariant linear regression analysis. Independent samples T testing between spironolactone and placebo groups were carried out.

Results:
Monocyte subsets CD16 Mon3 (p=0.001) and CD42 MPA3 (p=0.030) were found to be predictors of peak VO
2
. Comparison of monocyte subsets at end of study showed no differences between Mon1 (p=0.86), Mon2 (p=0.66) or Mon3 (p=0.81) subsets and their subsequent makers of inflammation and fibrosis between the treatment and placebo control group. This held true for further markers of cardiac fibrosis with regards to 6 minute walk test , quality of life assessment and hospitalisation.

Conclusions:
This study shows that monocyte subsets can be potential biomarkers of exercise capacity which in the form of cardiopulmonary testing is known to have morbidity and mortality implications. CD16 Mon3 were significantly related to beneficial outcomes with regards to a peak exercise capacity in respect to VO
2
max (higher CD16 Mon3 count associated with higher peak VO
2
performance). Spironolactone has no impact on primary or secondary outcome in this study.
Abstract 9418: Contrast Volume to Estimated Glomerular Filtration Rate Ratio as a Predictor for 30-Day All-Cause Mortality After Transcatheter Aortic Valve Implantation
Authors: Chehab Omar , Ng Yin Ling Clarissa , Hale Samuel , Malomo Samuel , Berner Juliet C , O'Reilly Nanci , Mathur Anthony , Baumbach Andreas , Ozkor Mick , Kennon Simon , Mullen Michael
Published: April 2022

Introduction:
Contrast-induced acute kidney injury (AKI) has been proven to be associated with early mortality and adverse events. However, in the setting of transcatheter aortic valve implantation (TAVI), previous literature has failed to establish a correlation between the absolute volume of contrast media administered and mortality.

Objective:
We aimed to investigate the impact of contrast volume administered normalised to estimated glomerular filtration rate ratio (V/eGFR) on 30-day all-cause mortality in TAVI patients. Secondary outcomes were AKI and new renal replacement therapy (RRT).

Methods:
We retrospectively analysed a cohort of 1150 patients who underwent TAVI at our unit between 2015-2018.

Results:
Follow-up was complete for all patients. There were 23 deaths within the follow-up period. Receiver operating curve (ROC) analysis showed fair discrimination for 30-day all-cause mortality at a V/eGFR ratio of 3.6 (C-statistic 0.68). 69.7% (n=801) of patients had a V/eGFR of <3.6 and 30.3% (n=349) had a V/eGFR of ≥3.6. In multivariate Cox proportional hazards analysis, V/eGFR as a cut point ≥3.6 was the strongest predictor of 30-day all-cause mortality (hazards ratio 4.35, 95% confidence interval [1.74-10.89], p=0.002). Other independent predictors were procedural urgency (3.40 [1.46-7.92]) and being under general anaesthesia (4.23 [1.62-11.08]). In Kaplan-Meier analysis, patients with V/eGFR ≥3.6 had a significantly greater 30-day mortality than those <3.6 (log rank test p<0.0001). A similar V/eGFR cut point of 3.6 was found to be an excellent predictor for new RRT (C-statistic 0.82), and 3.3 for AKI (C-statistic 0.60).

Conclusions:
In conclusion, a V/eGFR ≥3.6 after TAVI was found to be a strong predictor of 30-day mortality. The maximum contrast volume which can be safely administered in each patient without significantly increasing the risk of mortality can be calculated using this ratio. Future studies are indicated to validate our findings.
Abstract 9429: The Impact of Hypo-Attenuated Leaflet Thickening on Valvular Haemodynamics and Structural Valve Deterioration Following Transcatheter Aortic Valve Replacement
Authors: Rashid Hashrul
Published: April 2022

Introduction:
Hypo-attenuated leaflet thickening (HALT) has been described following transcatheter aortic valve replacement (TAVR). It is unclear if HALT impacts prosthetic haemodynamics or predicts structural valve deterioration (SVD).

Hypothesis:
HALT predicts SVD.

Methods:
We prospectively evaluated 186 patients who had undergone TAVR with 320-slice CT imaging for the presence of HALT, defined as hypo-attenuation of bioprosthetic leaflets. HALT depth (thickness) was the greatest depth in the sagittal view and HALT area was the greatest area in the axial view. SVD was defined as at least one of mean gradient ≥20 mmHg, increase in gradient ≥10 mmHg from baseline and at least moderate valvular regurgitation. Echocardiograms at discharge, one month and annually were assessed by cardiologists blinded to HALT status.

Results:
LT prevalence was 17.7% at a median CT scan of 6 weeks (IQR 4-12). SVD occurred in 8.6% at a median follow-up of 2 years (IQR 1-3); two required valve re-intervention, five required anticoagulation that reversed moderate-severe gradient and nine had mild-moderate gradient that were closely monitored. Patients with HALT were more likely to develop SVD (39.3% vs 1.9%, p<0.01), repeat valve replacement (6.1% vs 0%, p = 0.03) and higher valvular gradients throughout follow-up (up to 3-years). HALT affected 1 leaflet in 17 cases, 2 leaflets in 13 cases and 3 leaflets in 3 cases. Patients with HALT had a median cumulative thickness of 2.9 mm (IQR 1.9-4.7) and a median area of 64.2 mm2(IQR 40.9-91.6). Threshold for the occurrence of SVD with HALT characteristics were cumulative depth of 2.4 mm (Spec. 94.1%, Sens. 75.0%, AUC=0.87) and cumulative area of 28 mm2 (Spec. 92.2%, Sens. 81.3%, AUC=0.86).

Conclusions:
HALT was associated with SVD, repeat valve intervention and higher valvular gradients following TAVR. HALT depth and area were strong predictors of SVD. CT following TAVR may determine patients at-risk of SVD.
Abstract 9431: Preoperative Serum Gdf-15, Endothelin-1 Levels, and Intraoperative Factors as Short-Term Operative Risks for Patients Undergoing Cardiovascular Surgery
Authors: Kato Takashi , Nakajima Toshiaki , Fukuda Taira , SHIBASAKI IKUKO , Kuwata Toshiyuki , Toyoda Shigeru , Inoue Teruo , Fukuda Hirotsugu
Published: April 2022

Introduction:
The Society of Thoracic Surgeons (STS) risk score is widely used for the risk assessment of cardiac surgery. Serum biomarkers such as growth differentiation factor-15 (GDF-15) and endothelin-1 (ET-1) are also used to evaluate risk.

Hypothesis:
To investigate the relationships between preoperative serum GDF-15, ET-1 levels, and intraoperative factors and short-term operative risks including acute kidney injury (AKI) for patients undergoing cardiovascular surgery.

Methods:
Total 145 patients were included in this study (92 males and 53 females, age 68.4 ± 13.2 years). The preoperative STS score was determined, and the serum GDF-15 and ET-1 levels were measured by Enzyme-Linked Immunosorbent Assay. These were related to postoperative risks, including AKI, defined according to the Acute Kidney Injury Network (AKIN) classification criteria.

Results:
AKI developed in 23% of patients. The GDF-15 and ET-1 levels correlated with the STS score. The STS score and GDF-15 and ET-1 levels all correlated with preoperative eGFR, Alb, Hb, and BNP levels; perioperative data (urine output); ICU stay period; and postoperative admission days. Patients with AKI had longer circulatory pulmonary bypass (CPB) time, and male patients with AKI had higher ET-1 levels than those without AKI. The risk of developing AKI increased with increasing preoperative ET-1 level at baseline (OR for 1 pg/mL increase in ET-1, 2.177; 95% CI, 1.034-4.584;
p
= 0.041) and CPB time (OR for 1 h increase in CPB time, 4.194; 95% CI, 2.005-8.773;
p
< 0.001), even adjusted by age, sex, and BMI. In addition, multivariable logistic regression analysis showed that the risk of 30-day mortality plus morbidity increased with increasing preoperative GDF-15 level at baseline, CPB time, and RCC transfusion, even adjusted for age, gender, and BMI.

Conclusion:
The present study provides evidence that preoperative GDF-15 and ET-1 levels as well as intraoperative factors such as CPB time may be helpful to identify short-term operative risk for patients undergoing cardiovascular surgery.
Abstract 9436: Impact of Pulmonary Artery Catheter Use in Cardiogenic Shock: A Systematic Review
Authors: Doshi Harsh , Shah Mahek , Vishnevsky Alec , Garg Jalaj , Alvarez Rene
Published: April 2022

Introduction:
Randomized controlled trials and systematic reviews evaluating the use of pulmonary artery catheters in the critically ill population have not shown beneficial effects on survival. However, many of those studies have excluded patients in cardiogenic shock. We address this evidence gap by providing a comprehensive meta-analysis to investigate the association between pulmonary artery catheter use and outcomes in patients with cardiogenic shock

Hypothesis:
Pulmonary artery catheter use in patients with cardiogenic shock is associated with improved mortality.

Methods:
We performed an extensive literature search using PubMed, MEDLINE, SCOPUS, and the Cochrane databases from January 1990 through June 2021. Data for final analysis was pooled using a random effects model. Odds ratios were used for effect size. Information on eligibility criteria, outcomes, and methodological quality was extracted by two independent reviewers. Primary study outcome was in-hospital mortality rate.

Results:
16 studies were included in the analysis comprising 2,400,618 patients. Of those, 212,122 were managed with a pulmonary artery catheter (8.8%) and 2,188,496 were managed without one (91.2%). In patients with cardiogenic shock, pulmonary artery catheter use was associated with a statistically significant decrease in mortality (OR 0.82 [95% CI 0.73-0.92; p = 0.001]. The pulmonary artery catheter cohort was more likely to receive mechanical circulatory support (OR 2.16 [95% CI 1.90-2.45; p<0.001]), left ventricular assist device (OR 3.09 [95% CI 1.96-4.86; p<0.001]), and renal replacement therapy (OR 1.44 [95% CI 1.17-1.77; p=0.001]). Interestingly, when studies looking only at patients who developed cardiogenic shock due to acute myocardial infarction were analyzed, there was no statistically significant improvement in mortality (OR 0.945 [95% CI 0.75-1.20; p=0.64]).

Conclusions:
Pulmonary artery catheter use in patients with cardiogenic shock is associated with lower in-hospital mortality. Future studies differentiating pulmonary artery catheter use among various cardiogenic shock stages and phenotypes are needed.
Abstract 9437: Impact of Telemedicine Use on Blood Pressure Control During the Covid-19 Pandemic
Authors: Ye Siqin , Anstey David E , Grauer Anne K , Metser Gil , Moise Nathalie , Schwartz Joseph E , Kronish Ian M , Abdalla Marwah
Published: April 2022

Background:
Telemedicine use vastly expanded during the Covid-19 pandemic, with uncertain impact on cardiovascular care. quality.

Objectives:
To examine the association between telemedicine use and blood pressure (BP) control.

Methods:
This is a retrospective cohort study of 32,727 adult patients with hypertension (HTN) seen in primary care and cardiology clinics at an urban, academic medical center from February to December, 2020. The primary outcome was poor BP control, defined as having no BP recorded OR if the last recorded BP was ≥140/90 mmHg. Multivariable logistic regression was used to assess the association between telemedicine use during the study period (none, 1 telemedicine visit, 2+ telemedicine visits) and poor BP control, adjusting for demographic and clinical characteristics.

Results:
During the study period, no BP was recorded for 486/20,745 (2.3%) patients with in-person visits only, for 1,863/6,878 (27.1%) patients with 1 telemedicine visit, and for 1,277/5,104 (25.0%) patients with 2+ telemedicine visits. After adjustment, telemedicine use was associated with poor BP control (odds ratio [OR], 2.06, 95% confidence interval [CI] 1.94 to 2.18, p<0.001 for 1 telemedicine visit, and OR 2.49, 95% CI 2.31 to 2.68, p<0.001 for 2+ telemedicine visits; reference, in-person visit only). This effect disappears when analysis was restricted to patients with at least one recorded BP (OR 0.89, 95% CI 0.83 to 0.95, p=0.001 for 1 telemedicine visit, and OR 0.91, 95% CI 0.83 to 0.99, p=0.03 for 2+ telemedicine visits).

Conclusions:
BP is less likely to be recorded during telemedicine visits, but telemedicine use does not negatively impact BP control when BP is recorded.
Abstract 9438: Unipolar Voltages Are Associated with Left Atrial Wall Thickness and Predict Atrial Fibrillation Recurrence After Pulmonary Vein Isolation
Authors: Kamioka Masashi , Okuyama Takafumi , Watanabe Hiroaki , Yokota Ayako , Watanabe Tomonori , Komori Takahiro , Kabutoya Tomoyuki , Imai Yasushi , Kario Kazuomi
Published: April 2022

Introduction:
This study was conducted to investigate the relationship between left atrial (LA) wall thickness and the corresponding local unipolar/bipolar voltages, and its impact on the atrial fibrillation (AF) recurrence.

Methods:
Two-hundred-forty-two AF patients (196 male; 62 ± 9 years) who underwent successful PVI were enrolled and classified into the 2 groups: AF-Free group (n = 172), AF did not recur during the mean follow-up periods of 18 ± 8 months; and AF-Rec group (n = 70), those who had AF recurrence. LA wall thickness along the pulmonary vein isolation (PVI) line was measured using computed tomography and the voltage heights were measured by 3D electroanatomical map.

Results:
Left-superior PV posterior, right-superior PV (RSPV) posterior and right-inferior PV posterior wall thickness in AF-Rec group was significantly thicker than that in AF-Fee group (P < 0.001, respectively). RSPV posterior wall (RSPV-PW) thickness > 1.5 mm was revealed as cut-off value for AF recurrence with the sensitivity (73%) and specificity (71%) (P < 0.001), and was the independent predictor of AF recurrence (Hazard ratio (HR): 4.511, confidence interval: 2.637-7.717, P = 0.001). Although both of the bipolar and unipolar voltages were associated with RSPV-PW thickness, the latter had a stronger correlation (R
2
= 0.0519, P = 0.043 vs R
2
= 0.5099, P = 0.001, respectively). The unipolar voltages of 3.1 mV was defined as cut-off value for AF recurrence prediction (P = 0.001).

Conclusions:
The current study demonstrated that RSPV-PW hypertrophy had strong correlation with the local unipolar voltages, and that RSPV-PW thickness > 1.5 mm and the unipolar voltage > 3.1 mV can be predictor for AF recurrence, where we should intensively deliver radiofrequency energy for the durable PVI.
Abstract 9442: Acute Coronary Syndrome Treatment Delay in Low to Middle-Income Countries: A Systematic Review
Authors: Demisse Lemlem , L. Leslie Sharon , Alemayehu Bekele , Rebecca Gary
Published: April 2022

Introduction:
Although morbidity and mortality rates are declining for acute coronary syndrome (ACS) in most high-income countries, it is rising at an alarming pace for low to middle-income countries (LMICs), largely due to pre-hospital treatment delays.

Purpose:
This systematic review was conducted to determine the mean length of time from symptom onset to treatment in LMICs and the sociodemographic, clinical, and health system characteristics that contribute to treatment delays.

Methods:
A comprehensive review of the English literature was conducted between January 1990 through May 2020 using predefined criteria. Time to treatment was defined from ACS symptom onset to first medical contact and then further dichotomized as less than (early) or greater than 12-hours (late) treatment. Twenty-nine peer-reviewed studies, which comprised 29,731 subjects with ACS symptoms residing in 14 LMICs. Sample sizes in the studies ranged from 50 to 20,937. Age ranged from 28-72 years and the majority were males. The Newcastle-Ottawa Assessment Scale was utilized to measure study quality.

Results:
The mean time from symptom onset to first medical contact was 12.7 hours, ranging from10-minutes to 96 hours. Being older age, female gender, illiterate, rural residence, having atypical chest pain and lack of ACS symptom knowledge were associated with longer delays. Those directly admitted to an emergency department with the capacity to provide coronary interventions received earlier treatment. Community facilities where ECG machines were available had lower prehospital delay time for referral to reperfusion therapy facilities. Lack of emergency medical systems, poor communication between the community and interventional facilities were also major contributors to ACS treatment delays.

Conclusions:
Pre-hospital delay time remains an important contributor to poorer clinical outcomes and higher mortality in LMICs. Country-wide referral plans are urgently needed to ensure timely transfer of patients from non-cardiac centers to interventional facilities. Health education through the different media outlets will raise awareness of ACS risk factors, accompanying signs and symptoms as well as the need to seek early treatment to improve clinical outcomes.
Abstract 9454: Knowledge, Attitudes, Beliefs of Acute Coronary Syndrome Among Ethiopian Patients Diagnosed With Acute Coronary Syndrome
Authors: Demisse Lemlem , Alemayehu Bekele , Addissie Adamu , Gary Rebecca
Published: April 2022

Background:
Acute coronary syndrome (ACS) morbidity and mortality is increasing in low to middle-income countries (LMICs) such as Ethiopia. The shift in resources from managing communicable diseases to chronic conditions has brought about formidable health challenges.

Purpose:
The purpose of this study was to examine the knowledge, attitudes, beliefs among diagnosed ACS patients admitted to one of 3 emergency departments (ED) in Ethiopia.

Methods:
Sociodemographic (age, gender, education, employment status), clinical (comorbidities) data were collected. Knowledge, attitudes, beliefs about ACS were measured using the modified ACS Response Index questionnaire, with cut-off scores greater than 70% indicating adequate knowledge, attitudes and beliefs about ACS. Data were analyzed using chi-square test and stepwise multivariable logistic regression.

Results:
Participant’s (N=330) mean age was 57.9 ± 14.1, majority male (n= 219, 66.36%). Over half (N=183, 55.4 %) demonstrated adequate knowledge, attitudes (n=178, 53.9%), and beliefs (n=177, 53.64%) about ACS symptoms. Chest discomfort (n= 274, 83%), fatigue (n=267, 80.9%), chest pain (n=266, 80.6%) were recognized as ACS symptoms. Jaw pain (n=101, 30%) neck pain (n=146 ,44.2%), nausea (n=159,48%), were less recognized. Only (n=104, 31%) of participants indicated they would seek help and only (n=116, 35.1%) would use emergency medical services (EMS). Patients who were <=45 years were 2.16 times more likely to have adequate knowledge than older adults (p=0.014), and females were 2.7 times more knowledgeable than males (p= 0.001). Nondiabetics were 0.52 times less likely to have adequate knowledge compared to diabetics (p= 0.008). Illiteracy was 0.14 times more likely to result in unfavorable attitudes (p<0.001) followed by <= high school education 0.44 (p=0.009). Unemployment was associated with 0.47 odds to have unfavorable attitudes towards ACS (p=0.021).

Conclusions:
Despite receiving treatment for ACS in an ED, roughly half of the participants had adequate knowledge of symptoms and less than 40% would utilize EMS. Improving EMS and developing educational awareness in Ethiopia are essential for improving symptom identification, appropriate responses and outcomes related to ACS.
Abstract 9458: Nutritional Status Determines Early versus Late Deaths in Patients With Heart Failure With Preserved Ejection Fraction -Insights from the PURSUIT-HFPEF Registry-
Authors: Okada Masato , Tanaka Nobuaki , Onishi Toshinari , Iwakura Katsuomi , Seo Masahiro , Yano Masamichi , Hayashi Takaharu , Akito Nakagawa , Nakagawa Yusuke , Tamaki Shunsuke , Yamada Takahisa , Yasumura Yoshio , Sotomi Yohei , Hikoso Shungo , Sakata Yasushi ,   the OCVC-Heart Failure Investigators
Published: April 2022

Introduction:
Understanding how patients with heart failure with preserved ejection fraction (HFpEF) die provides insight into the natural history and pathophysiology of this complex syndrome. Factors that influence early death might identify potentially modifiable risk factors that could improve the long-term outcomes

Objectives:
To investigate whether early and late death are associated with different baseline factors in HFpEF patients.

Methods:
An analysis was performed from a prospective multicenter observational registry for HFpEF (PURSUIT-HFpEF Registry) conducted in the Osaka region of Japan. A total of 1095 patients hospitalized for acute HF (diagnosed by using Framingham criteria) met the inclusion criteria: a left ventricular ejection fraction (LVEF) ≥50% and brain natriuretic peptide ≥100 pg/ml. We included 195 patients (age, 85±7 years; females, 52%; atrial fibrillation, 43%) who died after a survival discharge. Early and late deaths were defined as deaths within and over 1 year after discharge, respectively.

Results:
During the median survival period of 11.8 months (IQR, 5.2-24.8), 98 and 97 patients died within and over 1 year, respectively. Patients with early death were older (86±7 vs. 84±7 years, p=0.010) and had a poorer nutritional status (i.e., higher Controlling Nutritional Status [CONUT] score: 5.3±2.3 vs. 4.0±2.3, p <0.001) than those with late death. However, there was no difference in the prevalence of a female gender and the body mass index and LVEF. The cause of death did not differ between early and late deaths. Almost two thirds of deaths were from non-cardiovascular causes. After adjustment for age, gender, body mass index, and LVEF, logistic regression analysis revealed that the CONUT score of >3, above the optimal cut-off value of the score, was the only determinant to predict early death (hazard ratio 2.60, 95% confidence interval 1.20-5.65).

Conclusions:
A considerable number of patients with HFpEF died within 1 year after discharge. Poor nutritional status determined the early death in HFpEF patients.
Abstract 9459: Cardiac Troponin I and the Risk of Cardiovascular or Non-Cardiovascular Death in Patients Visiting Emergency Department
Authors: Park Jong Eun , Choi Jin-Ho , Hwang Sung Yeon , Song Minseok
Published: April 2022

Background:
To identify the magnitude and temporal relationship between cardiac troponin I (TnI) and the risk of cardiac or non-cardiac death.

Methods:
Consecutive patients were included with maximal TnI value within 24 hours of their emergency department visit. Multivariate analyses using parameters selected by Bayesian information criterion was performed to investigate the impact of TnI on the event rate, time-dependent risk, and dose-dependent risk of cardiac or non-cardiac death within 360 days. We investigated the association between cardiac troponin I (TnI) and the risk of cardiac or non-cardiac death according to period.

Results:
A total of 36806 patients were included. There were 5,472 (14.9%) all-cause deaths including 881 (2.4%) cardiac and 4,591 (12.5%) non-cardiac deaths. In patients with positive TnI defined as the ≥99
th
percentile of upper normal limit, the cumulative risk of cardiac and non-cardiac death were 4.4- and 1.4- fold higher compared to negative TnI, respectively. In competing risk analysis, positive TnI was linked to 2.4- and 1.2-fold higher risks of cardiac and non-cardiac death, respectively. TnI value showed positive relationship with the risk of both cardiac and non-cardiac death. In time-dependent risk analysis, the excess risk of cardiac death was concentrated in early few weeks.

Conclusions:
Even a small increase in TnI was associated with increased risk of both cardiac and non-cardiac death, which was concentrated in the early period after emergency department visit.
Abstract 9465: Does Connectedness Matter: The Association Between Mutuality and Job Satisfaction Among Home Health Aides Caring for Adults with Heart Failure
Authors: Shalev Ariel , Ringel joanna , Safford Monika M , Riegel Barbara , Franzosa Emily , Vellone Ercole , Tsui Emma , Goyal Parag , Stawnychy Michael , Reckrey Jennifer , Sterling Madeline R
Published: April 2022

Introduction:
Adults with heart failure (HF) are increasingly aging in place and requiring help at home. However, due to poor compensation and the challenging nature of the work, home health aide (HHA) turnover rates are high. Identifying modifiable factors that can promote HHAs’ job satisfaction may help retain this workforce. We examined whether mutuality, or the connectedness between HHAs and their HF patients, is associated with HHAs’ job satisfaction.

Methods:
We conducted a cross-sectional survey of English-speaking agency-employed HHAs caring for an adult with HF in New York City. Mutuality was assessed with the Mutuality Scale, a validated 15-item scale measuring overall mutuality and its’ four domains (love, shared values, reciprocity, shared pleasurable activities). The overall scale and each domain score range from 0-4; higher scores indicate greater mutuality. Job satisfaction was assessed with one question; responses were categorized using a 4-point Likert scale. We used multivariable robust Poisson regression to examine the association between mutuality and job satisfaction, adjusting for HHAs’ demographics, employment, and HF caregiving history.

Results:
We studied 200 HHAs employed by 22 home care agencies; 94% (187 of 200) were female, 73% (145 of 200) were foreign-born, 43% (82 of 191) were non-Hispanic Black. They had a mean age of 48 years (SD 14), worked as a HHA for a median of 9 years (IQR 5-15), and spent a median of 24 hours/week (IQR 8-36) with a HF patient. The overall mean mutuality score was 2.92 (SD 0.79) and 80% (160 of 200) were satisfied with their job. Mean scores were lowest for reciprocity (2.62 [0.99]) and highest for shared pleasurable activities (3.16 [0.80]). In fully adjusted models, the overall mutuality score and each of the 4 domain scores were associated with increased job satisfaction. Only the shared activities domain was statistically significant (aPR: 1.17 [95% CI 1.04-1.32]).

Conclusions:
Greater mutuality, specifically the shared activities domain, between HHAs and HF patients was associated with higher job satisfaction. Our findings suggest that this modifiable domain of mutuality may be a possible target for interventions to promote mutuality between HHAs and patients as well as HHA job satisfaction.
Abstract 9557: Prognostic Significance of Serum Chloride Level in Patients With Acute Decompensated Heart Failure with Preserved Ejection Fraction: Insights from Pursuit-hfpef Registry
Authors: Seo Masahiro , Yamada Takahisa , Yasumura Yoshio , Hikoso Shungo , Sotomi Yohei , Tamaki Shunsuke , Yano Masamichi , Hayashi Takaharu , Nakagawa Akito , Nakagawa Yusuke , Sakata Yasushi ,   the OCVC-Heart Failure Investigator
Published: April 2022

Backgrounds:
Prognostic value of serum chloride level has been reported mainly in patients with heart failure with reduced ejection fraction. Therefore, the evidence regarding the prognostic value of serum chloride level in patients of heart failure with preserved ejection fraction (HFpEF) is limited. The aim of this study is to clarify the association of serum chloride level and outcomes in HFpEF patients with acute decompensated heart failure (ADHF).

Methods and Results:
Patients’ data were extracted from The Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with Preserved Ejection Fraction (PURSUIT HFpEF) study, which is a prospective multicenter observational registry for ADHF-HFpEF in Osaka. We analyzed 870 patients who were enrolled in the study between June 2016 and March 2020, after exclusion of patients with in-hospital death, missing follow-up data, missing data of serum chloride level or on chronic dialysis therapy. The primary endpoint of this study was cardiac death. During a mean follow-up period of 1.8±1.0 years, a total of 82 patients reached the primary endpoint. On Cox multivariable analysis, serum chloride level (p=0.0018) was independently associated with cardiac death, whereas serum sodium level was no longer significant after multivariable adjustment of major confounders. Kaplan-Meier survival curve analysis demonstrated a significantly increased risk of cardiac death stratified by the tertile of serum chloride level (13% vs 10% vs 5%, p=0.0045).

Conclusion:
Serum chloride level was useful for the prediction of cardiac death in ADHF patients with preserved ejection fraction.
Abstract 9763: Effectiveness of Dabigatran versus Conventional Treatment for Prevention of Silent Cerebral Infarct in Aortic and Mitral Valvular Atrial Fibrillation Patients
Authors: Choi Kee-joon , Cho Min Soo , Kim Minsu , Kang Duk-hyun , Lee Seung-ah , Lee Sahmin , Kim Dae-hee , Kim Jun , Song Jong-Min , Nam Gi-Byoung
Published: April 2022

Background:
Whereas warfarin is the anticoagulation of choice for patients with atrial fibrillation (AF) and rheumatic mitral stenosis (MS), new oral anticoagulants are considered as alternatives in those with other VHD.

Hypothesis:
This study sought to compare the efficacy and safety of dabigatran therapy compared to the conventional treatment in valvular AF including MS.

Methods:
In this prospective, randomized controlled trial, we randomly assigned patients with AF and left-sided VHD to receive either dabigatran or conventional treatment. The primary end point was the composite of occurrences of clinical stroke and new cerebral lesion (silent cerebral infarct and microbleed) on brain magnetic resonance imaging (MRI) performed at the 1-year follow-up.

Results:
Between March 2017 and October 2019, 59 and 60 patients were randomly allocated to dabigatran and conventional treatment group, respectively. In the dabigatran group, all the patients were switched from anticoagulation (n=52), antiplatelet (n=5), or no therapy (n=2) to dabigatran. In the conventional treatment group, all the 42 patients with mitral stenosis continued anticoagulation with warfarin and the remaining 18 patients continued warfarin (n=11) or antiplatelets (n=7). During follow-up, no death or clinical stroke occurred in both groups and 1 major bleeding in the conventional treatment group. At 1-year follow-up brain MRI, silent ischemic infarct and microbleed occurred in 20 and 2 patients in the dabigatran group, and 20 and 4 patients in the conventional treatment group, respectively. The incidence of primary endpoint was not significantly different between the treatment groups (32.2% vs. 36.7%, relative risk [RR] 1.03, 95% confidence interval 0.63-1.31, 0.70-1.51, P=0.608). In the subset of the 82 patients with significant MS, the risk of primary endpoint was also similar between groups (32.5% vs. 33.3%, RR 0.96, 95% CI 0.63-1.54, P=0.936).

Conclusions:
The rates of primary end point after treatment with dabigatran were similar to those with conventional treatment in AF patients with MS and with other VHD. Thus, dabigatran could be a reasonable alternative to warfarin even in AF associated with MS.
Abstract 9788: Advanced Atrio-Ventricular Block in Patients with Active Covid-19 Infection
Authors: mendoza ivan , Gonzalez Karina , Rodriguez Heliodoro , Morr Igor , Blanco Susana , Hernandez Hildelia , Urbaez Elias , Rodriguez Elio , Meza Yolimar , Rojas Elirub , Misticcio Francesca , Torres-Viera Jose , Mendoza Ivan
Published: April 2022

Introduction:
Cardiac arrhythmia is a frequent complication of COVID-19, However, there are currently only a few case reports of advanced atrioventricular block (AVB).

Hypothesis:
We sought to describe a case series of AVB as a complication of COVID-19.

Methods:
We included a series of ten (10) consecutive patients with confirmed COVID-19, who developed advanced AVB in a prospective observational multi-center study. Patients underwent clinical, laboratory evaluation, Holter, telemetry, Echocardiogram, Chest X-Ray, chest CT scan and cardiac MRI.

Results:
Of the ten (10) patients, 5 were female (50%) with a mean age of 62,7 +- 11,5 years. Eight (8) developed complete AVB, one a 3:1 AVB and one 2:1 AVB. None of the patients had a history of cardiac arrhythmia AVB was not related to medication or intubation. Six patients developed AVB during their hospitalization for COVID-19 and 4 after the first month as a late sequela. Four patients were asymptomatic, one presented syncope, two dyspnea and two dizziness. Six patients presented reverse AVB early by a high dose of corticosteroid in six and colchicine in 3 cases, with no recurrent episodes.Four patients required a permanent pacemaker for persistent conduction defect.

Conclusions:
Advanced AVB could be a complication of COVID-19. The conduction disturbance was reversed by corticosteroids with or without colchicine in six of ten cases The resolution with corticosteroids of the advanced AVB in these patients could reflect the transient nature of the viral infection and the inflammatory response associated with it in some patients. Four patients required a pacemaker. Physicians should be aware of this complication.
Revision of the Oligocene pamphiliid genus and species Tapholyda caplani (Cockerell, 1933)
Authors: JOUAULT CORENTIN , WEI MEI-CAI , NIU GENG-YUN , NEL ANDRÉ
Published: April 2022

The position of the enigmatic Oligocene pamphiliid genus and species Tapholyda caplani (Cockerell, 1933) is revised based on new specimens from the late Oligocene of the Creede Formation (Colorado, USA). The study of the wing venation and body characters indicate affinities with the fossil subfamily Juralydinae. The species is transferred to the latter accordingly. We revise the diagnoses of the Juralydinae and Tapholyda caplani. We designate a lectotype for the species and provide an interpretative drawing of its forewing venation. The placement of Tapholyda caplani in the Juralydinae extends the temporal range of the subfamily to the Oligocene.
New insect fossils discovered from the Lower Jurassic Sangonghe Formation at the Turpan Basin, Xinjiang, NW China
Authors: WANG YE-HAO , NEL ANDRÉ , FU YAN-ZHE , SU YI-TONG , CAI CHEN-YANG , LIU YU-MING , GAO JIAN , HUANG DI-YING
Published: April 2022

Early Jurassic insects have been described from the Badaowan and the Sangonghe formations in the Xinjiang Uygur Autonomous Region, NW China. Among them, the insect fossils from the Sangonghe Formation remain poorly explored. Here we report for the first time a diverse assemblage of fossil insects from the Sangonghe Formation near the Daheyan Township, Turpan Basin. They are represented by six groups, including Odonatoptera, Dermaptera, Blattodea, Hemiptera, Coleoptera, and Diptera. Sinoscarterella incompleta Nel, Fu & Huang, gen. et sp. nov. of Dysmorphoptilidae (Hemiptera) and Liassorhyphus liaoi Nel & Huang, gen. et sp. nov. of Anisopodidae (Diptera) are described here. Our discovery provides a window into a potentially diverse entomofauna in the Early Jurassic, increasing our knowledge about the insect diversity during that time in eastern Asia.
The sponge crabs of Western Australia and the Northwest Shelf with descriptions of new genera and species (Crustacea: Brachyura: Dromiidae)
Authors: McLAY COLIN L. , HOSIE ANDREW M.
Published: April 2022

The Dromiidae of Western Australia are summarized primarily based on specimens from the collection of the Western Australian Museum and some additional material from the Australian Museum, Sydney. The genus Alainodromia McLay 1998, is recorded from Camden Sound, Australia, as a new species Alainodromia dambimangari sp. nov. New evidence suggests that the species of Alainodromia are very likely shell carriers that also have direct development. Five species of Cryptodromia are reported from Western Australia and a new genus, Baccadromia gen. nov., is erected for Dromia (Cryptodromia) bullifera Alcock, 1900. The genus Lamarckdromia Guinot & Tavares, 2003 is revised and now includes three species: L. beagle sp. nov., L. excavata (Stimpson, 1858) and L. globosa (Lamarck, 1818). Six species of Dromiidae are new to Australia: Baccadromia bullifera (Alcock, 1900), Cryptodromia amboinensis (De Man, 1888), C. pileifera Alcock, 1901, Epigodromia rotunda McLay, 1993, and Foredromia rostrata McLay, 2002. New records for Western Australia include: Cryptodromia hilgendorfi De Man, 1888, Epigodromia areolata (Ihle, 1913) and Lewindromia unidentata (Rüppell, 1830). A total of 31 species of dromiid crabs are now known from Western Australian coast with five species endemic to the state. There are more than 40 species of Dromiidae known from Australia of which about 40% are endemic.
Morphological variation and genealogical discordance in Caatinga sand lizards Calyptommatus Rodrigues 1991 (Squamata: Gymnophthalmidae) with the description of a new species
Authors: RECODER RENATO SOUSA , MARQUES-SOUZA SERGIO , SILVA-SOARES THIAGO , RAMIRO CAROLINA NISA , CASTRO THIAGO MARCIAL , RODRIGUES MIGUEL TREFAUT
Published: April 2022

In the last decades, a remarkable fauna of psammophilous and fossorial squamates was discovered in sandy habitats of the semiarid Caatinga of northeast Brazil. Despite the increasing accumulation of genetic data from this unique fauna, an incomplete knowledge of its diversity still hampers a better understanding of its origins and diversification. The fossorial lizard genus Calyptommatus (Gymnophthalmidae) is endemic to sandy habitats of the Caatinga, being currently represented by four allopatric species. In this study, we used morphological and molecular data to assess population-level variation in Calyptommatus. We found a new morphotype of Calyptommatus from the state of Bahia, Brazil, readily distinguished from congeners by the presence of a frontal scale. Morphological, nuDNA and geographic data support the recognition of a new species herein described as Calyptommatus frontalis sp. nov. Nevertheless, genetic data revealed mito-nuclear+morphology discordance, with populations with frontal scales distributed in three distantly related mtDNA clades, suggesting either potential historical and/or current introgressions or incomplete lineage sorting. Further data are needed to clarify the status of the two other mtDNA clades displaying a frontal scale.
A new species of Mitius Gorochov, 1985 (Orthoptera: Gryllidae; Gryllinae) from China
Authors: YUAN WEI , MA LIBIN , GU JUN-JIE
Published: April 2022

Mitius was initially described by Gorochov in 1985, using Gryllus flavipes (=Mitius flavipes) Chopard, 1928 as the type species. To date, nine species have been discovered across the world (Storozhenko, Kim & Jeon, 2015; Cigliano et al. 2021). Mitius castaneus (Chopard, 1937) and Mitius vaturu (Otte & Cowper, 2007) have truncate frons similar to Loxoblemmus Saussure, 1877, while the remaining seven species (Mitius blennus (Saussure, 1877), Mitius enatus Gorochov, 1994, Mitius eryuanensis Yuan, Xie & Liu, 2021, M. flavipes, Mitius minor (Shiraki, 1911), Mitius minutulus Yang & Yang, 1995, and Mitius splendens (Shiraki, 1930)) have a standard round frons. A new species with truncate frons that was discovered in Xizang autonomous region, China is described and illustrated in this paper.
Geometry of the Meridional Overturning Circulation at the Last Glacial Maximum
Authors: Pavia Frank J. , Jones C. Spencer , Hines Sophia K.
Published: April 2022

Understanding the contribution of ocean circulation to glacial–interglacial climate change is a major focus of paleoceanography. Specifically, many have tried to determine whether the volumes and depths of Antarctic- and North Atlantic–sourced waters in the deep ocean changed at the Last Glacial Maximum (LGM; ∼22–18 kyr BP) when atmospheric pCO2 concentrations were 100 ppm lower than the preindustrial. Measurements of sedimentary geochemical proxies are the primary way that these deep ocean structural changes have been reconstructed. However, the main proxies used to reconstruct LGM Atlantic water mass geometry provide conflicting results as to whether North Atlantic–sourced waters shoaled during the LGM. Despite this, a number of idealized modeling studies have been advanced to describe the physical processes resulting in shoaled North Atlantic waters. This paper aims to critically assess the approaches used to determine LGM Atlantic circulation geometry and lay out best practices for future work. We first compile existing proxy data and paleoclimate model output to deduce the processes responsible for setting the ocean distributions of geochemical proxies in the LGM Atlantic Ocean. We highlight how small-scale mixing processes in the ocean interior can decouple tracer distributions from the large-scale circulation, complicating the straightforward interpretation of geochemical tracers as proxies for water mass structure. Finally, we outline promising paths toward ascertaining the LGM circulation structure more clearly and deeply.
Breast Density Lacks Influence on Upgrade Rates to High Risk Lesions and Cancer Among Proliferative Breast Lesion Excisions
Authors: Lueders Amelie , Spivey Tara
Published: April 2022

Introduction

Breast density is an independent risk factor for the development of breast cancer. We assessed if upgrade rates to high-risk lesions and cancer were influenced by density when evaluating proliferative complex sclerosing lesions and intraductal papillomas.

Methods

This is a retrospective single institution study. We evaluated 168 women aged 18-86 who received a core needle biopsy revealing a breast proliferative lesion of complex sclerosing lesion (CSL) or intraductal papilloma. We analyzed the upgrade rate to high-risk atypia (HRL) and cancer. Subgroup analysis based on age and breast density was performed.

Results

The patient collective was well balanced—51% had dense breasts and 42% were under 50 years old. Half were diagnosed with papilloma based on CNB and the other half with CSL. For those proliferative lesions without atypia, the upgrade rate to cancer was 1.6%. CNB showed concomitant HRL in 23% of patients with non-dense breasts and in 22% with dense tissue. In 24 cases, the pathology was considered an upgrade by showing either a not prior noted HRL or carcinoma. Most patients with upgrade following surgical excision were over 50 years old. Dense breasts did not show a higher risk of upgrade following surgical excision ( P = .975).

Conclusion

Our data did not reveal a difference between upgrade rates of proliferative lesions excised in dense and non-dense breasts. Further evaluation is warranted to establish whether density should be considered as a meaningful factor in excision vs observation of CSL and papillomas.
A Typology for the Application of Team Coordination Dynamics Across Increasing Levels of Dynamic Complexity
Authors: Gorman Jamie C. , Wiltshire Travis J.
Published: April 2022

Objective

This review and synthesis examines approaches for measuring and assessing team coordination dynamics (TCD). The authors advance a system typology for classifying TCD approaches and their applications for increasing levels of dynamic complexity.

Background

There is an increasing focus on how teams adapt their coordination in response to changing and uncertain operational conditions. Understanding coordination is significant because poor coordination is associated with maladaptive responses, whereas adaptive coordination is associated with effective responses. This issue has been met with TCD approaches that handle increasing complexity in the types of TCD teams exhibit.

Method

A three-level system typology of TCD approaches for increasing dynamic complexity is provided, with examples of research at each level. For System I TCD, team states converge toward a stable, fixed-point attractor. For System II TCD, team states are periodic, which can appear complex, yet are regular and relatively stable. In System III TCD, teams can exhibit periodic patterns, but those patterns change continuously to maintain effectiveness.

Results

System I and System II are applicable to TCD with known or discoverable behavioral attractors that are stationary across mid-to long-range timescales. System III TCD is the most generalizable to dynamic environments with high requirements for adaptive coordination across a range of timescales.

Conclusion

We outline current challenges for TCD and next steps in this burgeoning field of research.

Application

System III approaches are becoming widespread, as they are generalizable to time- and/or scale-varying TCD and multimodal analyses. Recommendations for deploying TCD in team settings are provided.
Perceived Discomfort, Neck Kinematics, and Muscular Activity During Smartphone Usage: A Comparative Study
Authors: Vahedi Zahra , Kazemi Zeinab , Sharifnezhad Ali , Mazloumi Adel
Published: April 2022

Objective

The present study aims to evaluate the effects of posture, task, and handgrip style on discomfort, neck kinematics, and concomitant muscular activity when using a smartphone (SP).

Background

Along with the popularity of smartphones, musculoskeletal disorders have become prevalent among smartphone users. However, comprehensive aspects of discomfort, kinematics, and electromyographic responses across various conditions remain to be investigated.

Method

Twenty-four young smartphone users performed typing, video watching, and reading tasks while holding the smartphone both with one hand and with two hands while either sitting or standing. Neck kinematics and muscular activities were simultaneously recorded.

Results

Working with SPs led to higher discomfort in the neck ( p = 0.01), lower back ( p = 0.01), and shoulder ( p = 0.04) while sitting as compared to standing. Sitting was associated with greater neck flexion and more minor lateral bending for all tasks and grip styles ( p < 0.05). Electromyographic analysis indicated significant differences between sitting and standing, with alterations being dependent on the test condition. Moreover, neck kinematics and muscular activities significantly differed based on the task nature, handgrip, and interactions.

Conclusion

This study highlights the risk of using smartphones in increased neck angle flexion and muscular activities fatigue. Thus, posture and handgrip should be considered while using SPs. As each test condition affects a specific dependent variable, a holistic approach is required to evaluate the responses of SP users’ musculoskeletal systems.

Application

Results can be applied to develop guidelines for musculoskeletal disorders/discomfort prevention among SP users, especially with the rise of smartphone use during the COVID-19 pandemic.