bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 16927: Cardiovascular Magnetic Resonance Stress Perfusion Imaging Predicts One Year Outcomes Following Equivocal or Uncertain Stress Study
Authors: Iyer Arun , Tao Michael , Schelbert Erik B , Wong Timothy C
Published: May 2021

Introduction:
Patients with equivocal nuclear stress test (SPECT) results are at higher risk for cardiac events compared to those with normal studies. Cardiovascular magnetic resonance stress perfusion imaging (SCMR) identifies individuals with coronary artery disease (CAD) with high sensitivity and specificity, with excellent spatial resolution, and without ionizing radiation. The utility of SCMR testing is uncertain in individuals with prior equivocal stress results.

Hypothesis:
SCMR provides high prognostic capability to risk stratify patients after equivocal or uncertain SPECT studies.

Methods:
We retrospectively analyzed patients from 2011 to 2019 with equivocal or uncertain SPECT studies subsequently referred for SCMR within a 6 month window. Equivocal studies included qualifying wording such as significant artifact or technical difficulty. Uncertain studies included documented suspicion of false positive or false negative results. Adverse outcomes were defined as cardiovascular death or obstructive CAD found on unplanned coronary angiography (CA).

Results:
151 patients met inclusion criteria: mean age 58, male 88 (58%). At one year, the negative predictive value of SCMR was 0.97; 122 patients with negative SCMR had a total of 4 events including 1 cardiovascular death and 3 obstructive CAD on CA. 27 patients had positive SCMR for ischemia, of which 9 patients were referred for CA and all demonstrated obstructive CAD. 18 patients were medically managed without adverse events. 2 patients were noted to have non-diagnostic SCMR and subsequent CA showed no significant CAD.

Conclusion:
Following equivocal or uncertain SPECT, SCMR demonstrated high 1-year prognostic capability with negative predictive value of 0.97 for adverse outcomes and high positive predictive value for obstructive CAD. SCMR may represent a reasonable, noninvasive option should additional risk stratification be required in this clinical setting.
Abstract 16928: Discordant Mechanisms in Heart Failure and Hypertrophy
Authors: Binek Aleksandra , Fert-bober Justyna P , Kreimer Simion , Rivas Alejandro , Anna Pyzel , BRADSHAW Amy , Zile Michael R , Van Eyk Jennifer E
Published: May 2021

Introduction:
Patients with heart failure and a preserved ejection fraction (HFpEF) present heart function abnormalities that remain poorly understood. Defining proteomic signature of HF that is independent of left ventricular hypertrophy (LVH) should allow for stratification of its subtypes and potential mechanism that contributes to the disease.

Hypothesis:
We hypothesized that HFpEF proteomic signature would be comprised of the hypertrophy and contractile protein phenotype.

Methods:
Intraoperative left ventricular (LV) myocardial biopsies were obtained from patients (n=21) recruited to undergo coronary artery bypass grafting (CABG). Patients were categorized to: control non-hypertensive (n=9), LVH (n=5), and HFpEF (n=7). Myocardial tissue was subfractionated: cytoplasmic- (neutral pH), myofilament- (acidic pH), and membrane-enriched extract (SDS-soluble). All fractions were assessed for protein quantity and Lys/Arg modifications using liquid chromatography mass spectrometry (LC-MS).

Results:
In HFpEF, 13% of the cardiac LV proteome changed compared to control heart, with a substantial proportion (77%) decreasing in quantity across all three cardiac fractions, while with LVH, 61% of the proteomic LV changes were increased. Although glycolysis and gluconeogenesis increased in both cardiopathies with respect to control, in HFpEF more subtly than in LVH. Modified proteome of the HFpEF was dominated by decreases in protein succinylation (e.g. ATP5L, THIM, IDHP, APOB, GSH1, KNTC1) and to a lesser degree in methylation (ROA3, HSP7C) or acetylation compared to control. This general trend of down-regulation of succinylation can be attributed to depletion in the levels of succinyl-CoA, the cofactor of enzymatic Lys succinylation. Importantly, there was a striking discordant activation/inhibition of cell death and proliferation pathways between the HFpEF and LVH. Two major upstream regulator clusters linked the proteome changes in cell growth and proliferation to RICTOR and Myc that showed completely opposite trends in LVH and HFpEF groups.

Conclusions:
HFpEF has a unique proteome signature compared to LV hypertrophy profile which does not arise from sub-proteome involved in contraction but rather is involved in overall cell death.
Abstract 16929: Right Heart Strain on Presenting 12-Lead Electrocardiogram Predicts Critical Illness in COVID-19
Authors: Raad Mohamad , Parikh Sachin , Singh Gurjit
Published: May 2021

Introduction:
The world has been facing the COVID-19 pandemic. Primarily a pulmonary illness, most deaths have been caused by respiratory failure. Emerging information has revealed that cardiovascular complications, including cardiac injury and cor pulmonale, can also be life-threatening consequences of COVID-19.

Hypothesis:
Signs of right heart strain on presenting 12-lead ECG predicts mortality in patients admitted with COVID-19.

Methods:
We retrospectively evaluated 480 patients consecutively admitted with COVID-19. ECGs from the emergency department (ED) were read by G.S. and S.P. who were blinded to data and outcomes. Right heart strain (RHS) was defined by any new right axis deviation, S1Q3T3 pattern, incomplete or complete right bundle branch block, or ST Depressions with T-wave inversions in leads V1-3 or II, III, aVF. This study was approved by the Institutional Review Board (IRB# 13774).

Results:
ECGs from the ED were available for 314 patients who were included in the analysis. Almost all patients were in sinus rhythm with sinus tachycardia being the most frequent dysrhythmia. RHS findings were present in 12.7% of cases. RHS was significantly associated with mortality and was the strongest predictor even after multivariate regression for mortality [OR 18.3 (6.1-55.3), p<0.001] (figure 1, table 1).

Conclusions:
Among available clinical tools, ECGs are easily performed, cost-effective, and widely available. Patients with evidence of RHS on initial ECG had significantly higher rates of mortality which has not been previously reported. Given that respiratory failure is the most common cause of death in patients with COVID-19, this information is valuable.
Abstract 16950: Exosomes Derived From Podoplanin Positive Cells Induce Fibrosis and Inflammation in Healthy Mouse Heart
Authors: Cimini Maria , garikipati venkata naga srikanth , Elia Andrea , Wang Chunlin , TRUONGCAO MAY , Huang Grace , Mallaredy Vandana , Benedict Cindy , Kishore Raj
Published: May 2021

Superseding fibrosis through paracrine signals enhances the ventricular dysfunction aftermyocardial infarction (MI). We have earlier reported that within 2 days post-MI a cohort ofpodoplanin (PDPN), a platelet aggregation-inducing type I transmembrane glycoprotein,positive cells populate injured heart and enhance inflammatory response by physicalinteractions with monocytes. Here we explored whether exosomes from these cells couldindependently alter healthy heart physiology and structure. PDPN+ cells were isolated 2 daysafter MI, cultured expanded and activated with TNFα and AngiotensinII. Exosomes derived fromactivated PDPN+ cells conditioned media were used in vitro treatment of mouse cardiacendothelial cells (mCECs), mouse embryonic fibroblast (MEF) and monocytes and in vivo forthe treatment of healthy mouse hearts. PDPN+ cells derived exosomes (PDPN-exo)reprogramed mCECs to the lymphatic phenotype enhancing the expression of the majorlymphatic lineage markers and upregulated the expression of fibrotic markers suggesting anendothelial-mesenchymal transition. Furthermore, PDPN-exo drove the MEF to myo-fibroblastphenotype and monocytes toward pro-inflammatory phenotype. Proteomic analysis of PDPN-exo suggest these transitions may depend on NOTCH cleavage trough β-γSecretase. In vivo,PDPN-exo were initially injected into the left ventricle of healthy mouse hearts followed withexosomes boosters delivered by retro-orbital vein injection. Treated mice developed anextended epicardial fibrosis with a subsequent impairment in the contractility and increase ofthe end diastolic and systolic volumes. The fibrotic area was characterized by vessels doublepositive to endothelial and lymphatic endothelial markers, and infiltrating CD45+ cells. Inconclusion these data suggest that PDPN-exo alter the biology of mCECs, fibroblast andmonocytes and participate in adverse remodeling after MI; their specific cargo may representa cohort of targets for the treatment of cardiac fibrosis.
Abstract 16957: Ascending Thoracic Aortic Aneurysm Wall Stresses Evolve in Parallel With Diameter Growth
Authors: Gulati Arushi , Wang Zhongjie , XUAN Yue , LEACH JOSEPH , Hope Michael D , Saloner David , Guccione Julius , Ge Liang , Tseng Elaine E
Published: May 2021

Introduction:
Guidelines for ascending thoracic aortic aneurysm (ATAA) repair use ATAA diameter, with repair recommended at ≥5.5cm, but ATAA biomechanics may better predict acute type A dissection (ATAD) risk. However, little is known regarding changes in wall stresses among clinically followed patients with <5.5cm ATAA over time. This information is important for patient risk stratification.

Hypothesis:
We hypothesized that peak ATAA wall stresses would change over time in a patient-specific fashion alongside diameter.

Methods:
31 nonsurgical ATAA patients (<5.5cm and growth <0.5cm/year) with computed tomography angiography (CTA) scans taken 3 to 5 years apart were identified. Images were used to construct patient specific three-dimensional ATAA models. Peak diastolic circumferential stresses were determined along the ascending aorta (AA), sinotubular junction (STJ), and aortic sinuses using finite element analysis. Diameters at both time points were measured from CTA scans by a single radiologist blinded to stress results. Stress and diameter distributions were compared using paired t-tests.

Results:
In the overall population, ATAA diameter increased over time (4.39±0.4 cm vs. 4.43±0.4 cm, p=0.02), while diastolic circumferential stresses along the aorta did not significantly change. However, we found two distinct patient groups: one where wall stresses increased and one where stresses decreased over time. Separate analysis of these groups showed significant changes in circumferential stress in all three aortic regions (488 ± 120 vs. 340 ± 63 kPa for the sinuses, 472 ± 127 vs 345 ± 76 kPa for the STJ and 337 ± 54 vs 277 ± 28 kPa for AA, p<0.001), and significant increase in diameter in the group with increasing stresses (p=0.02).

Conclusions:
In this nonsurgical group, there is no statically significant change of peak ATAA wall stresses at diastole over 3-5 years. The patients with increased stress were found to be associated with increases in diameter during the corresponding time period. More patient specific data is required to investigate the interaction between wall biomechanics and aortic remodeling. Our results lay the foundation for developing patient-specific ATAD risk predictors for ATAD using patient-specific wall stress changes.
Abstract 16974: Augmentation of Vasoactive Intestinal Peptide Signaling Prevents the Development of Duchenne Muscular Dystrophy-Associated Cardiomyopathy Through Inhibition of NF-κB Signaling
Authors: Huang Jian , Gemelli Terry , Jiang Xuan , Bae Yunbeen , Tassin Tara , Shelton John , Evers Bret , Arnold Sue , Lee John , Mammen Pradeep P
Published: May 2021

Duchenne muscular dystrophy (DMD) is a recessive X-linked neuromuscular disorder characterized by progressive muscle degeneration with DMD-associated cardiomyopathy being the primary mode of death. Vasoactive intestinal peptide (VIP) is a 28 amino acid neuropeptide with biological effects mediated by G protein-coupled receptors. Utilizing a genetically modified form of VIP (PB1046) targeting cardiomyocytes, we hypothesized that augmentation of VIP signaling prevents the development of DMD-associated cardiomyopathy through inhibition of NF-κB. Either PB1046 (1.5 mg/kg) or a Placebo (saline) was injected subcutaneously every other day in three mouse models: DMD

mdx:Utr+/-

, DMD

mdx

, and wild type mice starting at 4 weeks of age for a total of 8 weeks. Cardiac function was assessed by weekly echocardiography. The cardiac tissues were collected at 14 weeks of age for histological and molecular analyses. Drug-treated DMD

mdx:Utr+/-

mice showed preservation of cardiac function (fractional shortening 61%±0.4 vs 45%±1.3,
p
<0.01; n=8-12) and a marked reduction in myocardial fibrosis (2.92%±0.13 vs 6.42% ±0.39,
p
<0.01; n=3) compared with controls. Hydroxyproline levels within drug-treated DMD

mdx:Utr+/-

mice was decreased compared with controls (44.6±5.3 vs 64.3±6.9 nmol/100mg heart weight,
p
<0.05, n=6). RNA-Seq data revealed an upregulation of cAMP signaling with downregulation of NF-kB signaling in isolated cardiac myocytes from drug-treated DMD

mdx:Utr+/-

mice as compared to controls (n=3). Western blot analyses revealed increased phosphorylation of CREB (1.97±0.02 vs 1.00±0.06,
p
<0.05, n=5-9) with decreased phosphorylation of p65 in drug-treated DMD cardiac nuclei as compared to controls (0.62±0.06 vs 1.00±0.09,
p
<0.05, n=3). Collectively, the data revealed augmentation of VIP signaling prevents the development of DMD-associated cardiomyopathy in DMD

mdx:Utr+/-

mice. The molecular mechanism underlying the benefits of VIP signaling suggests an upregulation of cAMP-CREB signaling with downregulation of NF-kB signaling leading to inhibition of inflammation and fibrosis within drug-treated DMD hearts. VIP signaling in DMD may serve as a new therapeutic target for the treatment of DMD-associated cardiomyopathy.
Abstract 16979: Hemodynamic Comparison of Tricuspid Ring Annuloplasty vs. Hetzer Annuloplasty Technique to Repair Functional Tricuspid Regurgitation
Authors: Amedi Alan , Onohara Daisuke , Padala Muralidhar
Published: May 2021

Introduction:
Surgical repair of functional tricuspid regurgitation (FTR) is increasingly performed, and the techniques are evolving. Annuloplasty is currently the technique of choice, with different techniques yielding varied results, and thus require optimization.

Objective:
In this study, we sought to compare tricuspid valve function and kinematics after ring annuloplasty and Hetzer’s double orifice repair in an ex vivo model of FTR.

Methods:
Ten pig hearts were mounted into a right heart simulator, and studied at 70 bpm while maintaining the total volume of working fluid. FTR was created by increasing afterload, which caused acute right ventricular dilation and TV tethering. Tricuspid valve annuloplasty (TVA) was performed with a 26mm MC
3
ring. Hetzer procedure was performed with pledgeted sutures that approximated the anteroposterior and septal annular segments. Flow probes were used to measure FTR, and leaflet kinematics with echocardiography.

Results:
FTR of 17.7±9.2mL(p<0.0001) after RV dilation. Repair with TVA and Hetzer reduced FTR to 8.8±6.8ml(p=0.7142) and 7.8±6.9ml(p=0.0919), respectively, but did not eliminate it. Septal leaflet excursion angle decreased by 48.1% with FTR (p=0.04 vs. baseline
)
. Repair with TVA and Hetzer increased the angle to 17.3±6.7°(p=0.0312) and 21.5±8.3°(vs FTR, p=0.0034), respectively. The Hetzer improved septal leaflet mobility better than TVA (p=0.0145). The posterior leaflet excursion angle decreased by 49.2% compared to baseline to 18.4±10.5° (p=0.0060) and both TVA and Hetzer significantly improved mobility to 33.6±8.4° (p=0.0081) and 31.6±15.6° (p=0.0256), respectively. Anterior leaflet mobility decreased after FTR by 60.7% to 18.1±8.2°. The effect of these repairs on the sub-valvular apparatus was negligible.

Conclusion:
TVA and Hetzer both reduced regurgitation but did not eliminate it. Septal and posterior leaflet mobility was improved, while the anterior leaflet remained tethered.
Abstract 16983: Validation of 3D Volume Measurement Technology to Assess Body Fat Content Using Biplane Imaging From Mobile Devices
Authors: Medina-inojosa Jose R , Chacin Suarez Audry , Saeidifard Farzane , Narayana Gowda Smitha , Robinson Justin , Aseged Kalkidan , Lynne Johnson , Zundel Jennifer , Bonikowske Amanda , Lopez-jimenez Francisco
Published: May 2021

Introduction:
Body fat (BF) content better predicts adiposity-related cardiovascular risk than the body mass index (BMI). Accurate and accepted methods to assess BF are complex, expensive, and accessible only in clinical settings. Multi-sensor 3D body volume (3D-BV) measurement technology has been shown to accurately estimate BF. We assessed the hypothesis that 3D models generated from biplane imaging (i.e., front and side facing photographs) using mobile devices (App), could be used to predict body volume measurements and derive BF.

Methods:
We prospectively enrolled 196 subjects, who underwent 3D-BV (gold standard for body volume) within 24 hours, dual-energy X-ray Absorptiometry (iDEXA) (gold standard for BF) and photographs taken with an Ipad® App at a predefined distance and pose. These photos were post-processed with a computer-assisted algorithm to estimate body length, girth, and volume. These were used to calculate body density (BD) using the bicompartmental principles of body composition (BD=Body Mass/Volume) and derive BF% using the Siri equation [(4.95/BD-4.50) X 100]. Correlation indexes and residual plots were created to compare 3D-BV and iDEXA with the App. Mean differences were compared using a paired t-test.

Results:
Mean ±SD age was 31.9±9.15 years, 53% were women, weight 72.8±14.1 kg, BMI was 25.5±4.5 kg/m
2
.The App volume correlated with 3D-BV (R
2
=0.95,95%CI 0.90,0.95, p<.0001,
Figure 1-A
)
;
average difference between App volume vs 3D-BV volume was -1.2 Liters, 95%CI,0.03, 2.42, p=0.06, (
Figure 1-B
). App BF% correlated with iDEXA BF% (R
2
=0.92, 95%CI 0.90,0.94, p<.0001,
Figure 1-C
)
;
while average difference between App BF% vs iDEXA BF% was -0.13 %, 95%CI -0.6,0.4, p=0.6, (
Figure 1-D
).

Conclusion:
BF can be estimated using volume measurements obtained by biplane imaging from mobile devices and could serve as a home-based, portable, scalable, cost-effective, and convenient measure to assess BF and track changes in body composition over time.
Abstract 17005: Early Goal Directed Fluid Therapy for Patients With Heart Failure and Septic Shock
Authors: Torres Pedro , Al Abassi Baher , Abdul Qader Mohamed , Job Riya , Chen Kai , Ramos Tuarez Fergie , Chait Robert , Pino Jesus E
Published: May 2021

Introduction:
The use of aggressive fluid therapy in patients with heart failure and reduced ejection fraction (HFrEF) who develop septic shock is controversial.

Methods:
This is a retrospective cohort study of 334 patients with heart failure (HF) and septic shock admitted to a tertiary cardiovascular center between 01/2015 and 06/2018. For this study, ejection fraction (EF) was dichotomized into <45% (HFrEF) and ≥45% (HF with preserved EF). The evaluated outcomes included in-hospital mortality, development of pulmonary edema, cardiogenic shock, and 30-day readmission rate.

Results:
A total of 133(40%) patients had HFrEF, and 201(60%) patients had HFpEF (see Table 1, baseline characteristics). Early goal direct fluid therapy and vasopressors were equally implemented in all patients with HF that developed septic shock.

Outcomes:
There was no difference in in-hospital mortality for patients with HFrEF that developed septic shock when compared to patients with HFpEF, 64(48%) vs 102(51%) p=0.6542. Patients with HFrEF had a higher incidence of cardiogenic shock 25(19%) vs 9(4.5%) p<0.0001 and 30-day HF-related readmission 25(36%) vs 17(17%) p=0.0096. However, pulmonary edema requiring urgent intravenous diuresis 82(62%) vs 113(56%) p=0.4186 or mechanical ventilation 70(53%) vs 110(55%) p= 0.6543 was similar between groups.

Conclusions:
Once patients with HF develop septic shock, the mortality is similar for both HFrEF and HFpEF. However, complications such as cardiogenic shock and 30-day readmission are more common in patients with HFrEF. A more individualized treatment approach is needed for this population.
Abstract 17011: Impact of Donor Cardiopulmonary Resuscitation Duration on Survival After Heart Transplantation
Authors: Harloff Morgan , Piechura Laura , Yazdchi Farhang , Keshk Mohamed , Shim Hunbo , Ogawa Mitsugu , Coppolino Antonio , Rinewalt Daniel , MALLIDI Hari R
Published: May 2021

Introduction:
Prolonged cardiopulmonary resuscitation (CPR) duration remains a source of apprehension with regards to the acceptance of donor hearts for orthotopic heart transplantation (OHT). Unfortunately, many of these organs are declined due to concern for adverse outcomes after OHT, further straining an already limited donor pool. Nevertheless, donor hearts with a history of prolonged CPR may represent an opportunity to expand the donor pool for patients with end-stage heart failure on the waiting list for OHT. Therefore, we sought to examine the duration of donor CPR and its impact on recipient survival after OHT.

Methods:
The United Network of Organ Sharing (UNOS) database was retrospectively quarried to identify all adult patients who underwent first-time OHT between 2000 and 2019 from a donor who had experienced cardiac arrest with a quantified downtime duration. The population was divided into five groups with a granular focus on longer downtimes: donors with CPR < 30 minutes, 30-39 minutes, 40-49 minutes, 50-59 minutes, and ≥ 60 minutes. Primary outcome of interest was post-transplant survival. Kaplan-Meier analysis was used to compare recipient survival between groups after OHT.

Results:
In total, 7,470 patients were identified during the study period. Overall survival by Kaplan-Meier analysis was not statistically different among the five groups (p=0.69) (Figure 1). In a Cox proportional-hazards model, duration of CPR was found to have no influence on survival (HR 1.00, p=0.56). Significant predictors of mortality included donor age (HR 1.01, p=0.013), donor smoking history (HR 1.11, p<0.005), and recipient diabetes (HR 1.27, p<0.0001).

Conclusions:
These findings suggest that, for hearts determined appropriate for transplant, duration of CPR performed on the donor heart does not significantly impact survival after OHT. Therefore, donor hearts with a prolonged downtime should be fully evaluated for OHT to maximize the donor pool.
Abstract 17012: Safety of Magnetic Resonance Imaging in Patients With Non-Transvenous Epicardial and Abandoned Cardiac Implantable Electronic Device Leads
Authors: Palmeri Nicholas O , York Linda R , Emily Wacks , Kramer Daniel B
Published: May 2021

Background:
Patients with cardiac implantable electronic devices (CIEDs) commonly require magnetic resonance imaging (MRI). Pivotal studies establishing MRI safety in non-MRI-conditional CIEDs excluded patients with nontransvenous epicardial and abandoned leads, which may be higher risk for pro-arrhythmia. Patients with these systems are therefore excluded from national reimbursement coverage and guideline recommendations, and are sparsely reported in the literature.

Objective:
To describe outcomes of CIED-MRI in patients with epicardial and/or abandoned leads.

Methods:
We reviewed a prospective registry of CIED-MRIs at a single academic medical center for patients with nontransvenous epicardial leads or abandoned leads, including lead fragments from partial extractions. All patients were scanned on a 1.5T magnet with a standardized protocol including deactivation of tachytherapies (for ICDs), change of pacing mode to asynchronous pacing (if dependent) or off/inhibited (if not dependent), and observation with ECG telemetry and pulse oximetry. The primary outcome was adverse events, defined as any clinical arrhythmia or CIED system malfunction requiring revision procedures. Secondary outcomes included whether the MRI was interpretable and clinically useful.

Results:
Among 540 CIED-MRIs performed on non-MRI-conditional systems from 6/2014 to 5/2020, 21 MRIs were performed in 15 patients with epicardial or abandoned leads. The Table describes MRI indications and characteristics of CIED systems scanned (most commonly abandoned RA leads, N=10, and abandoned RV leads, N=5). MRIs were predominantly (86%) of the central nervous system. No adverse events were observed during any of the MRI scans, and no CIED systems required revision. All MRIs were found to be interpretable and provided clinically meaningful results.

Conclusions:
CIED-MRI in patients with epicardial or abandoned leads is safe and provides useful clinical information.
Abstract 17019: Obesity and Cardiovascular Health in Young American Adults
Authors: Suri Sarabjeet S , Parcha Vibhu , Kalra Rajat , Arora Garima , Arora Pankaj
Published: May 2021

Background:
The growing epidemic of obesity in the United States (US) is associated with cardiovascular (CV) morbidity and mortality. We evaluated the impact of the increasing obesity prevalence on the CV health of young American adults.

Methods:
The age-adjusted weighted prevalence of hypertension, diabetes, and hypercholesterolemia was estimated from the 2008-2018 National Health and Nutrition Examination Survey (NHANES) in American adults aged 18-44 years, stratified by the presence of obesity. The trends were evaluated using a piecewise linear regression approach. The odds for CV risk factors were estimated using multivariable-adjusted logistic regression models.

Results:
Among 14,919 young adults, the prevalence of obesity was 33.9% (95% CI: 32.6-35.3%). Obese young adults were more likely to be non-Hispanic Blacks and in lower socioeconomic and educational attainment strata (p<0.05 for all). Obese young adults had a greater risk of having hypertension (adjusted odds ratio [aOR]: 3.0 [95% CI: 2.7-3.4]), diabetes (aOR: 4.3 [95% CI: 3.3-5.6]), and hyperlipidemia (aOR: 1.47 [95% CI: 1.3-1.7]). Among obese, hypertension increased from 36.5% (33.9-39.1%) in 2007-2010 to 39.4% (35.6-43.1%) in 2015-2018 (p= 0.07) and diabetes increased from 4.7% (3.6-5.8%) in 2007-2010 to 7.1% (5.3-9.0%) in 2015-2018 (p=0.11). A modest increase in diabetes was seen in non-obese individuals (
Table
). Hypercholesterolemia prevalence remained unchanged from 12.6% (95% CI: 10.6-14.7%) 2007-2010 to 10.9% (95% CI: 9.0-12.8%) in 2015-2018 (p=0.27) among obese young adults. Non-obese young adults showed a decline in hypercholesterolemia from 9.5% (95% CI: 8.0-11.0%) in 2007- 2010 to 7.1% (95% CI: 5.8-8.4%) in 2015-2018 (p=0.002).

Conclusions:
Nearly one-in-every three young American adults have obesity, which is accompanied by a two-fold higher prevalence of CV risk factors. The CV morbidity in young adults is expected to increase with an increasing prevalence of obesity..
Abstract 17027: Generalizability of the US FDA Label for Dapagliflozin to Patients With Heart Failure With Reduced Ejection Fraction in the GWTG-HF Registry
Authors: Vaduganathan Muthiah , Greene Stephen , Zhang Shuaiqi , grau-sepulveda maria v , Devore Adam D , Butler Javed , Heidenreich Paul A , Huang Joanna C , Kittleson Michelle M , Joynt Maddox Karen E , McDermott Jim , Owens Anjali T , Peterson Pamela , Solomon Scott D , Vardeny Orly , Yancy Clyde W , Fonarow Gregg C
Published: May 2021

Background:
In May 2020, dapagliflozin was approved by the US FDA as the first SGLT-2 inhibitor for HF with reduced ejection fraction (HFrEF) based on the pivotal DAPA-HF trial. Limited data are available characterizing its generalizability to US clinical practice.

Methods:
We studied patients with HFrEF (≤40%) hospitalized at 406 sites in the Get With The Guidelines (GWTG)-HF registry admitted between Jan 2014 - Sept 2019. We excluded patients who left against medical advice, transferred to an acute care facility or to hospice, or had missing critical data. We applied the FDA label (excluding eGFR<30 mL/min/1.73 m
2
, dialysis, or type 1 DM) and eligibility criteria of DAPA-HF to the GWTG-HF registry sample.

Results:
Among 154,714 patients hospitalized with HFrEF, 125,497 (81.1%) would be candidates for dapagliflozin under the FDA label. Across 355 sites with ≥10 hospitalizations, median proportion of FDA label candidates was 81.1% (77.8%-84.6%). This proportion was similar across all study years (80.4-81.7%) and higher among those without type 2 DM than with type 2 DM (85.5% vs. 75.6%). Among GWTG-HF participants, the most frequent reason for not meeting the FDA label was eGFR<30 mL/min/1.73 m
2
(n=28,605). Among patients with available paired admission and discharge data, 14.2% had eGFR<30 mL/min/1.73 m
2
at both time points, while 3.8% developed eGFR<30 mL/min/1.73 m
2
by discharge. While there were more women, more Black patients, and less Asian patients in GWTG-HF, clinical characteristics were qualitatively similar between DAPA-HF trial and GWTG-HF registry participants. Compared with the DAPA-HF trial cohort, there was lower use of evidence-based HF therapies among GWTG-HF patients (
Table
).

Conclusions:
These data from a large, contemporary US hospitalized HF registry suggest that 4 out of 5 patients with HFrEF (with or without type 2 DM) would be candidates for initiation of dapagliflozin, and support its broad generalizability to US clinical practice.
Abstract 17033: Inflammation and Lipids Components: Insights From the VLDL Study
Authors: Alfaddagh Abdulhamied , Quispe Renato , Jones Steven R
Published: May 2021

Background:
Dyslipidemia and inflammation independently contribute to atherosclerosis. The associations between different lipid parameters and inflammatory markers is not fully understood.

Hypothesis:
LDL-C, triglycerides, and HDL-C do not predict inflammation equally.

Methods:
We analyzed data from 784,233 patients from the second harvest of the Very Large Database of Lipid study with lipids and hsCRP measured. The prevalence of having hsCRP≥2 mg/L was compared in 20 quantiles of non-HDL-C, LDL-C, HDL-C and triglycerides. Using linear regression, we estimated the correlations between hsCRP and lipids and to what degree individual lipid components explain the variation in hsCRP values. We then examined these association by sex and age (≥65 vs <65 years) categories.

Results:
The median hsCRP of the population was 2.3 mg/L (IQR, 1.0-5.7). The proportion of patients with hsCRP≥2 mg/L progressively increased with higher non-HDL-C, LDL-C, triglycerides quintiles, but decreased with higher HDL-C quintiles. All lipid measures directly correlated with hsCRP value except HDL-C which was inversely correlated (P<0.001 for all). LDL-C and non-HDL-C values explained very little of the variance seen in hsCRP (univariate R
2
= 0.5% and 0.1%, respectively). Triglyceride levels were the strongest predictor of hsCRP (standardized β, 0.21; P<0.001) and explained 4.5% of variability in hsCRP values. HDL-C was the second best (albeit an inverse) predictor of hsCRP (standardized β, -0.19; P<0.001) and explained 3.8% of its variance. Regardless LDL-C quantile, the prevalence of having hsCRP ≥2 mg/L was lower in those also have low triglyceride or high HDL-C levels (Figure). These associations were consistent by sex and age categories.

Conclusion:
Of major lipid and lipoprotein cholesterol fractions, triglycerides and HDL-C correlated most strongly and non-HDL-C and LDL-C contributed the least to hsCRP.
Abstract 17038: Influence of Cardiac Workload on Vascular Pyridine Nucleotide Redox State
Authors: Dwenger Marc , Moore Joseph , Nystoriak Matthew A
Published: May 2021

Introduction:
Myocardial perfusion is enhanced during periods of elevated cardiomyocyte oxygen consumption. The coupling between blood flow and myocardial oxygen demand is mediated by redox-dependent signals, yet the influence of cardiac workload on arterial myocyte pyridine nucleotide redox status is unknown.

Hypothesis:
Increased cardiac workload acutely alters intramyocardial arterial myocyte [NADH]
i
:[NAD
+
]
i
.

Methods and Results:
The genetically-encoded fluorescent biosensor Peredox-mCherry was used to monitor real-time changes in intracellular [NADH]
i
:[NAD]
i
in isolated arterial myocytes. Treatment of cells expressing Peredox-mCherry with a range of [lactate]
o
:[pyruvate]
o
resulted in significant changes in green (Ex,Em: 400, 510 nm): red (Ex,Em: 585,615 nm) fluorescence ratio (1.903 ± 0.010, 10 mM lactate, 1.072 ± 0.073, 10 mM pyruvate), affording accurate quantification of arterial myocyte [NADH]
i
:[NAD]
i
. Increased arterial myocyte [NADH]
i
:[NAD]
i
was observed in response to reductions in oxygen tension from 5% (0.0021 ± 0.0001) to 1% (0.0050 ± 0.0001; P<0.05). [NADH]
i
:[NAD]
i
was not altered by direct stimulation of arterial myocytes with the beta-adrenergic agonist isoproterenol (1 μM; P = .0630). Furthermore, biosensor-expressing arterial myocytes in co-culture with human induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) recapitulated the effects of elevated [lactate]
o
:[pyruvate]
o
and reduced oxygen tension, exhibiting frequency-dependent increases in [NADH]
i
:[NAD]
I
following electrical pacing (e.g., ~3.3 fold increase in 3 Hz vs. unpaced; P<0.05). Consistent with these results, intramyocardial coronary arteries in mice acutely treated with dobutamine (10 mg/kg, i.p.) to drive high cardiac work exhibited significantly greater lactate:pyruvate ratio, used as a surrogate for [NADH]
i
:[NAD]
i
, compared with those in hearts treated with vehicle (3.17 ± 0.23 vs. 2.21 ± 0.11; P<0.05).

Conclusions:
Our results indicate that acute increases in cardiac workload promote the elevation of [NADH]
i
:[NAD]
i
in intramyocardial arterial myocytes.
Abstract 17039: Angiotensin Converting Enzyme Inhibitors/ Angiotensin Receptor Blockers Decrease Short-Term Mortality in Myocardial Injury After Noncardiac Surgery
Authors: Jogu Hanumantha R , Chevli Parag A , Islam Tareq , Dutta Abhishek , Sunkara Padageshwar , Nadella Geeth Sandeep , Barot Harsh , Thazhathuveetil-Kunhahamed Luqman-Arafath , Huang Chi-Cheng
Published: May 2021

Introduction:
Myocardial injury after noncardiac surgery (MINS) is strongly associated with 30-day mortality, and no guidelines exist to address management in this group. We hypothesized that Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blocker (ACEI/ARB) reduces short-term mortality in MINS patients.

Methods:
We used data from the Wake-Up T2MI registry, which is a single-center, retrospective cohort of adults with elevated troponin (cTn) I (>0.04 ng/dL) during hospitalization without acute coronary syndrome in a 2-year period. Kaplan-Meier curve and a multivariate-adjusted Cox-proportional hazard models were performed to assess all-cause mortality at 30-days and 90-days among patients with and without ACEI/ARBs upon discharge.

Results:
A total of 457 MINS patients were included in the final analysis. There were no significant differences in baseline characteristics and peak cTn among patients stratified by ACEI/ARB status. Prevalence of mortality was significantly lower at 30-days (1.4% vs 6.3%, p = 0.025) and non-significantly lower at 90-days (7.9% vs. 12%, p = 0.188) in patients who were discharged on ACEI/ARBs compared to non-ACEI/ARBs. Patients with ACEI/ARBs upon discharge showed a statistically significant survival benefit at 30-days (log-rank p = 0.023) but not at 90-days (log-rank p = 0.150) (Figure 1). In a multivariate-adjusted model, ACEI/ARBs had a HR of 0.172 (CI: 0.037 - 0.823; p = 0.027) at 30 days and HR of 0.497 (CI: 0.240 - 1.030; p = 0.060) at 90 days (Figure 2).

Conclusion:
In conclusion, ACEI/ARBs on discharge were associated with decreased short-term mortality in MINS patients. Further studies are needed to validate our results.
Abstract 17041: Outcomes After Atrial Fibrillation Ablation With and Without CTI Ablation: Insights From the UC San Diego AF Ablation Registry
Authors: Mylavarapu Praneet S , Aldaas Omar M , Malladi Chaitanya , Lupercio Florentino , Han Frederick , Hoffmayer Kurt S , Krummen David E , Raissi Farshad , Feld Gregory K , Hsu Jonathan C
Published: May 2021

Introduction:
Pulmonary vein isolation (PVI) is a well-established therapy for patients with drug refractory atrial fibrillation (AF). However, it remains unclear whether prophylactic cavotricuspid isthmus (CTI) ablation at the time of PVI improves long-term freedom from AF. Several studies have examined short term outcomes, but none beyond several years post procedure.

Methods:
We performed a retrospective study of all patients who underwent first-time radiofrequency catheter ablation enrolled in the UC San Diego AF Ablation Registry. The primary outcome was freedom from atrial arrhythmias on or off anti-arrhythmic drugs (AAD).

Results:
Of 534 total patients, 63 (11.8%) underwent pulmonary vein isolation (PVI) without CTI ablation, 471 (88.2%) underwent PVI with CTI ablation. Median follow-up duration was 3.9 (0.4 - 6.8) years. CTI ablation did not improve freedom from atrial arrhythmias in those with either paroxysmal AF [Adjusted Hazard Ratio (AHR) 1.15 (95% CI 0.59-2.24) for CTI vs non-CTI ablation] or persistent AF [AHR 0.82 (95% CI 0.38-1.77) for CTI vs non-CTI ablation]. Among all patients, there were also no differences in procedural complications [AHR 1.09 (95% CI 0.33-3.62) for CTI vs. non-CTI ablation] or all-cause mortality [AHR 1.12 (95% CI 0.57-2.23) for CTI vs. non-CTI ablation].

Conclusion:
In this registry analysis, prophylactic CTI ablation at the time of first PVI did not improve freedom from recurrent atrial arrhythmias at 5 years among those with paroxysmal or persistent AF as compared to PVI alone.
Abstract 17042: CCL20 in Psoriasis: A Potential Biomarker of Disease Severity, Inflammation, and Impaired Vascular Health
Authors: Elnabawi Youssef A , Tawil Michael , Barrett Tessa , A Fisher Edward A , Scher Jose , Neimann Andrea , Krueger James , Berger Jeffrey S , Garshick Michael S
Published: May 2021

Introduction:
CV risk calculators that incorporate traditional risk factors underestimate CV risk in psoriasis and guidelines now suggest incorporating psoriasis into clinical decision making. Therefore, the purpose of this study is to use high throughput targeted proteomic panels to investigate the relationship between skin disease activity, inflammatory biomarkers, and vascular health.

Methods:
A targeted proteomics approach of 280 inflammatory proteins was performed in 23 psoriasis patients (age, mean [SD], 42 [14] years; 48% male, psoriasis area and severity index [PASI] 5 [3 - 11]) and 15 controls (41 [14], years; 53% male) recruited into an on-going clinical trial to assess vascular health in psoriasis (NCT03228017). Vascular health was assessed ex vivo through direct transcriptomic analysis of brachial vein endothelial cells. Serum samples were analyzed using the OLINK Proseek multiplex assay Inflammation I, Cardiovascular II/III profiles.

Results:
Targeted proteomics identified CCL20, IL6 and IL7A as the three highest circulating pro-inflammatory cytokines. CCL20 was 80% higher in psoriasis compared to controls (
p
=0.004
)
and revealed a strong association with PASI (
r=
0.57;
p
=0.009). Additionally, CCL20 was positively associated with IL6, IL17A and hsCRP (
p
<0.01 for all). CCL20 positively associated with the mean composite transcriptome of endothelial inflammation (meanEC) (r=0.55, p<0.01), which remained significant even after adjustment for traditional CV risk factors (adjusted [adj]β=0.63,
p
=0.001). Interestingly, CCL20 had a stronger correlation with meanEC than other established pro-inflammatory makers, including IL6 (adj β=0.48,
p
=0.04), IL17a (adj β=0.54,
p
=0.05), TNFα (adj β=0.06,
p
=0.78), and hsCRP (adj β=0.08,
p
=0.79). In nested models CCL20 added value (χ
2
= 79.22, p<0.001) to a model already incorporating PASI, Framingham Risk, hs-CRP, IL-17A and IL-6 (χ
2
= 48.18, p<0.001).

Conclusions:
We demonstrate that CCL20 expression has a strong correlation with PASI score and endothelial inflammation and reflects systemic inflammation better than well-established markers of inflammation in psoriasis including IL-6, IL-17A, and hs-CRP. CCL20 may serve as a potential biomarker of vascular health in this population.
Abstract 17056: Food and Drug Administration Mandated Post-Market Studies for High Risk Cardiovascular Devices Approved 2015-2019
Authors: Hidano Danelle , Dhruva Sanket , Redberg Rita F
Published: May 2021

Introduction:
The Food and Drug Administration (FDA) emphasizes a “life-cycle approach” to medical device regulation, in which the pre-approval process is expedited and more emphasis is placed on post-approval data in order to shorten patient access to new devices. The FDA can mandate post approval studies (PASs) for high-risk devices to augment pre-approval data. This study describes the characteristics of FDA-mandated PASs.

Methods:
We searched the FDA database for all PASs required for original high-risk cardiovascular devices approved from January 1, 2015 and December 31, 2019. Data elements abstracted for each PAS included: study type, presence of controls, blinding, total number of patients enrolled, study duration, and whether primary outcomes were surrogate or composite measures. We also checked the FDA website for any available interim data prior to study completion.

Results:
The FDA approved 71 high-risk cardiovascular devices and ordered a total of 68 PASs for 49 (69%) devices. Most PASs were prospective cohorts (n=47, 69.1%). The median study size was 250 patients (IQR 151-563) and median study duration was 5 years (IQR 3-5). Only 19 studies (28%) included active or historic controls, 12 studies (17.7%) were randomized, 5 studies (7.3%) were single-blinded, and none were double-blinded (Table). Twenty-two (32.4%) studies provided data before completion of study.

Conclusion:
Most PAS are not randomized, lack controls, contain small numbers of patients, and have composite or surrogate primary outcomes that may not be clinically relevant, despite their importance for generating long-term clinical data for high-risk cardiovascular devices. Interim data are often not available. Increased quality and availability of evidence related to PASs would better establish device safety, effectiveness, and appropriate use. Lastly, PAS data should be readily accessible to help clinicians and patients make well-informed decisions.
Abstract 17058: Phenotypically Sex Differences in Transthyretin Amyloidosis V122I Mutation Patients
Authors: Kalinoski-Dubose Victoria , LoRusso Samantha , Efebera Yvonne , Parikh Samir , almaani Salem , Sharma Nidhi , Redder Elyse , Freimer Miriam , bumma naresh , Kahwash Rami , Vallakati Ajay , Campbell Courtney
Published: May 2021

Introduction:
Hereditary transthyretin amyloidosis (ATTR) is an autosomal dominant disease, in which destabilized transthyretin protein misfolds and deposits in tissue leading to organ dysfunction. The most common mutation in the United States, transthyretin valine 122 isoleucine (V122I), primarily affects African Americans and is historically associated with cardiomyopathy phenotype in men. Recent studies have described a mixed V122I phenotype with both cardiomyopathy and polyneuropathy. Sex differences in V122I presentations have yet to be examined.

Methods:
We identified 38 ATTR patients treated at The Ohio State University with genetic testing demonstrating V122I mutation (31.6% female). Clinical data was analyzed for cardiac and nerve involvement including cardiac biopsy or nuclear pyrophosphate scan, echocardiography - interventricular septal thickness (IVSd), posterior wall thickness (PWd), ejection fraction (EF), and electromyography (EMG). Cohorts were divided by sex. Unpaired t-tests were used to calculate statistics. Asymptomatic patients (n=2) were not included.

Results:
In women with V122I ATTR, the clinical phenotypes were polyneuropathy (75%) and cardiomyopathy (25%) with symptom onset most often in the fourth or fifth decade of life. In men with V122I ATTR, the most common phenotypes were cardiomyopathy (52%) and mixed cardiomyopathy/polyneuropathy (48%) with symptom onset in the seventh and eighth decades of life. In affected individuals, EMG data revealed generalized neuropathy with reduced or absent sural nerve sensory response. Carpal tunnel syndrome, often due to thickening of the transverse ligament, was more common in men than women (84% versus 36%). Men had significant cardiac differences compared to women with thickened ventricles (IVSd 19.9 mm vs 12.5 mm, p<0.001 and PWd 17.3 mm vs 12.1 mm, p<0.001) and decreased ejection fraction (40% versus 55%, p=0.008).

Conclusion:
Based on our cohort, female ATTR V122I patients present predominantly with polyneuropathy phenotype at a younger age, and males present with predominantly cardiovascular or mixed phenotype. Recognizing these different sex phenotypes in ATTR V122I will improve diagnosis and treatment of patients.
Abstract 17068: Do Post-Operative Nitrates Increase Mortality in Non-Cardiac Surgery Patients With Perioperative Myocardial Injury?
Authors: Barot Harsh R , Chevli Parag A , Dutta Abhishek , Sunkara Padageshwar , Nadella Geeth Sandeep , Barot Harsh , Islam Tareq , Beekman Daniel , Majeed Chaudry N , Chaudhary Dipendra , Huang Chi-Cheng
Published: May 2021

Introduction:
Myocardial injury after noncardiac surgery (MINS) is strongly associated with 30-day mortality, and data on its management is scarce. We hypothesized that postoperative nitrates (Isosorbide mononitrate, Isosorbide dinitrate, and scheduled Nitroglycerine) increase mortality in MINS patients.

Methods:
We used data from the Wake-Up T2MI registry, which is a single center, retrospective cohort of adults with elevated troponin (cTn) I (>0.04 ng/dL) during hospitalization without acute coronary syndrome in a 2-year period (2009-2010). Cardiac procedures were excluded. Kaplan-Meier curves and a multivariate-adjusted Cox-proportional hazard models were performed to assess all-cause mortality at 90-days and 1-year among patients with and without nitrates upon discharge.

Results:
Total of 457 MINS patients were included in the final analysis. There was no significant difference in baseline characteristics and peak cTn among patients stratified by nitrates status. Prevalence of mortality in the nitrates group was significantly higher at 90-days (35.7% vs 10%, p = 0.002) and non-significantly higher at 1-year (42.9% vs. 22.4%, p = 0.073) compared to non-nitrates group. Survival benefit was significantly lower in the nitrates group at 90-days (log-rank p = 0.002) and at 1-year (log-rank p = 0.031) (Figure 1). In a multivariate-adjusted model, nitrates had a HR of 3.032 (1.018 - 9.026; p = 0.046) at 90-days and HR of 2.022 (0.809 - 5.054; p = 0.132) at 1-year (Figure 2).

Conclusion:
Nitrates on discharge were associated with increased mortality at 3-months and at 1-year in MINS patients. Further large-scale studies are required to validate our results.