bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11638: Cardiologists’ Knowledge and Attitude Toward Geriatric Cardiology Training
Authors: Alfaraidhy Maha A , Brown Jessica P , Beamer Brock A , Blumenthal Jacob B , Forman Daniel E , Kheirbek Raya E
Published: March 2022

Introduction:
By 2030, it is projected that 20% of the population will be 65 or older. Older adults aged 85 and over (the oldest old) are the fastest growing segment of the US population and globally. As the population ages, cardiovascular disease is becoming a major public health challenge. Providing optimal care to older adults with CVD is challenging due to their complexity, competing vulnerabilities and a lack of evidence-based knowledge to bridge the existing gap between guidelines and real-world clinical practice.

Hypothesis:
Exposure to geriatric education during training will associate with attitudes toward treatment of older adult patients.

Objective:
Evaluate current cardiologists’ knowledge and attitude toward geriatric care.

Methods:
IRB-approved, quantitative cross-sectional study using an online survey distributed to all cardiologists and cardiology fellows within a large academic medical system.

Result:
Of the 98 physicians invited, 26 responded (26.5% response rate) of which 19.2% were female; 45% cardiology fellows, 5% early career (< 5 years) and 50% experienced cardiologists (>10 years). Of those surveyed, 77% reported more than half of their patients were over age 65. While 87% believed it was very important for cardiologists to have knowledge about geriatric syndromes, 70% reported little to moderate levels of knowledge about their impact on CV care. Only 20% reported a deep fund of knowledge. Most knowledge was gained through experience rather than formal education. None of the participants were aware of the “Essentials of Cardiovascular Care in Older Adults (ECCOA)” curriculum within the Geriatric Cardiology section of ACC. Two thirds were concerned about potential overtreatment for older adults, whereas 41% were concerned for potential undertreatment.

Conclusion:
Academic-affiliated cardiologists surveyed reported unmet educational needs regarding care of older adults. Efforts to equip cardiologists with the requisite up- to -date knowledge of geriatric cardiology are needed to formulate a balanced and holistic therapeutic plan of care for our most vulnerable patients.
Abstract 11639: Characteristics of Patients Referred to a Cardiovascular Disease Clinic for Post-Acute Sequelae of SARS-CoV-2 Infection
Authors: Wang Stephen Y , Adejumo Philip , Onuma Oyere K , Miller Edward J , Spatz Erica S
Published: March 2022

Introduction:
There is limited literature on the cardiovascular manifestations of post-acute sequelae of SARS-CoV-2 infection (PASC).

Methods:
All consecutive adult patients presenting to the cardiology clinic at Yale-New Haven Hospital since July 2020, with positive COVID-19 serologic testing, were included.

Results:
Of 71 patients, average age was 46 years (range 19-74 years), 44 (62%) were female. 51 (72%) were White. 19 (27%) patients were hospitalized for COVID-19 (
Table
). Comorbidities included Hypertension (27%), hyperlipidemia (25%), diabetes (24%), and obesity (30%). On average, patients presented four months after COVID-19 diagnosis. The most common symptoms at presentation were dyspnea (45%, almost all exertional), palpitations (49%), and chest pain/pressure (49%). Patients also had memory impairment (20%), fatigue (39%), and headache (14%). There was no significant difference in cardiopulmonary symptoms (dyspnea, palpitations, and chest pain/pressure) by hospitalization status (p=0.70). TTE was abnormal in 13 of 62 patients and cardiac MRI was abnormal in 10 of 17 patients. Women experienced more cardiopulmonary symptoms (p=0.02) than men. Hospitalized patients were more likely to have ventricular dysfunction than non-hospitalized patients, although there were no significant differences in abnormal MRI findings (p=0.38). Diagnostic yield included: nonischemic cardiomyopathy (6%); new ischemia (3%); coronary vasospasm (1%); new atrial fibrillation (1%); possible myocarditis based on symptoms, MRI LGE (8%) or inflammation (3%). Two people met POTS criteria; majority of patients had evidence of sinus tachycardia and exertional fatigue consistent with orthostatic intolerance and deconditioning.

Conclusions:
In this cohort of patients referred to a cardiology clinic for PASC, cardiopulmonary symptoms did not differ by hospitalization status, however women were more likely to experience these symptoms than men.
Abstract 11646:
ATVB Outstanding Research Award
: WDFY3 is Required for the Efficient Degradation of Engulfed Apoptotic Cells by Macrophages During Efferocytosis
Authors: Wu Xun , Wang Ziyi , Shi Jianting , Li Fang , Yang Young Joo , Moore Rebecca M. , Chirikjian Margot K. , Tabas Ira A. , Yamamoto Ai , Zhang Hanrui
Published: March 2022

Introduction:
Defective clearance of apoptotic cells (ACs) by macrophages (efferocytosis) contributes to unresolved inflammation. Our recent genome-wide CRISPR screen has discovered WDFY3 as a novel regulator required for the efficient uptake of ACs during efferocytosis. WDFY3 is well known as a scaffold protein facilitating the autophagic degradation of aggregated proteins in neurons. Yet, if and how WDFY3 may also be required for the efficient degradation of engulfed ACs by macrophages have not been characterized.

Hypothesis:
WDFY3 is responsible for the efficient degradation of ACs by interacting with other autophagic proteins to facilitate phagosome-lysosome fusion, a process known as LC3-associated phagocytosis (LAP).

Methods:
Bone marrow-derived macrophages (BMDMs), peritoneal macrophages (PMs), and mice with myeloid-specific
Wdfy3
knockout (LysMCre
+/-
Wdfy3
fl/fl
) or transgenic overexpression of human
WDFY3
(

hWDFY3
Tg

) were used for
in vitro
and
in vivo
assays.

Results:
Wdfy3
knockout BMDMs and PMs showed impaired lysosomal acidification and degradation of engulfed ACs. Mechanistically,
Wdfy3
knockout impedes efficient LC3 lipidation upon AC engulfment, the last step required for phagosome-lysosome fusion and subsequent lysosomal degradation. Pull-down assay supports that WDFY3 interacts with GABARAP, but not LC3B, to mediate LC3 lipidation, supporting the direct involvement of WDFY3 protein in the process. At the transcriptomic level, RNA-seq and pathway analyses further revealed that gene sets of ROS/RNS production by phagocytes, fatty acid oxidation, and autophagosome were enriched in differentially expressed genes downregulated in
Wdfy3
knockout BMDM, supporting the secondary effects of WDFY3-deficiency on the mRNA expression of genes and pathways essential for cargo degradation. Intriguingly, BMDMs and PMs from

hWDFY3
Tg

mice showed enhanced AC uptake and degradation both
in vitro
and
in vivo
, suggesting that WDFY3 has a wide dynamic range in its regulatory capacity.

Conclusion:
We discovered a novel role of WDFY3 in the degradation of ACs during macrophage efferocytosis. Enhancing WDFY3 may represent a therapeutic approach to promote the resolution of inflammation in diseases due to defective efferocytosis.
Abstract 11649: GLP-1 Receptor Agonists in Heart Failure: Insights From a Cardiometabolic Center of Excellence
Authors: Sammour Yasser , Nassif Michael , Gunta Preetham , Tang Fengming , magwire melissa , Fendler Timothy , Khumri Taiyeb , Magalski Anthony , O'Keefe James H , Sperry Brett , Kosiborod Mikhail N
Published: March 2022

Background:
Data regarding the use of GLP-1 receptor agonists (GLP-1RA) in patients with established heart failure (HF) remain limited.

Methods:
We included patients with established HF treated at Cardiometabolic Center (CMC) between January 2019 and December 2020 who had at least two visits and received GLP-1RA. We compared change in outcomes of interest between baseline and last CMC visit.

Results:
Among 151 HF patients treated with GLP-1RA, 88 had HF with reduced ejection fraction (HFrEF) and 63 had preserved ejection fraction (HFpEF); 92% had type 2 diabetes (T2D), the rest had prediabetes, and 27% were on SGLT-2i at baseline. After a median follow-up of 6.6 (3.7-11) months, 92% of patients remained on GLP-1RA, (64% were also receiving SGLT-2i at last follow up). The median time on GLP-1RA therapy was 5.4 (3-9.7) months with HFrEF, and 6.1 (3.4-11.8) months with HFpEF. We observed reductions in median total daily insulin doses in both HFrEF and HFpEF patients (from 60 to 39 units, and 53 to 31 units, respectively, p<0.001 for both), mean HbA1c (7.7% to 6.9%, p<0.001 and 7.2% to 6.8%, p=0.002 respectively), and mean percent body weight (-6.2% and -7.9% respectively, p<0.001 for both) (
Figure
). Additionally, lower rates of hospitalizations or urgent visits for HF were seen in those with HFrEF [13.6% vs. 34.1% (p<0.001)], and HFpEF [from 15.9% vs. 33.3% (p=0.01)] during follow-up time compared with an equal duration prior to care at CMC (6.3 months with HFrEF, and 6.9 months with HFpEF). GLP-1RA therapy was generally well-tolerated with side effects in 31% of patients (mainly gastrointestinal complaints), but only 6% required drug discontinuation. Three patients stopped GLP-1RA due to cost.

Conclusion:
GLP-1RA therapy (in combination with SGLT-2i in most patients) was well-tolerated in both HFrEF and HFpEF, and was associated with significant reductions in insulin dose, HbA1c, body weight, and lower risk of hospitalizations or urgent visits for HF after initiation of therapy.
Abstract 11650: Global, Regional and National Time Trends in Mortality for Congenital Heart Disease, 1990-2019 an Age-Period-Cohort Analysis for the Global Burden of Disease Study 2019
Authors: Su Zhanhao , Liu Yiwei , Li Shoujun , Chen Huiwen , Zou Zhiyong , Kassebaum Nicholas , Patton George , Zhang Hao
Published: March 2022

Introduction:
Congenital heart disease (CHD) is the leading birth defect worldwide. We report trends in CHD mortality in 204 countries and territories over the past 30 years, and associations with age, period, and birth cohort.

Methods:
Cause-specific CHD mortality estimates were derived from the Global Burden of Disease study 2019. We utilized an age-period-cohort model to estimate overall annual percentage change in mortality (net drifts), annual percentage change from 0-4 to 65-69 years (local drifts) and period (cohort) relative risks between 1990 and 2019.

Results:
Global CHD deaths in 2019 were 217,000 (95%UI: 177,000, 262,000). India, China, Pakistan and Nigeria were the top 4 countries accounting for 39.7% of deaths globally. The reduction in age-standardized mortality ranged from 66.3% in high-sociodemographic index (SDI) countries to 30.5% in low-SDI countries. Globally, there was an emerging transition in the age distribution of deaths from pediatric to adult population, except for an increasing trend of mortality in 10~34 years in Mexico and Pakistan. During 1990-2019, favorable mortality reductions were found in most high-SDI countries like South Korea (net drift = -4.0% per year) and United States (-2.3%), and also in many middle-SDI countries like Brazil (-2.7%) and a few low-SDI countries like Ethiopia (-2.3%). However, 52 out of 129 countries with at least 50 deaths had either increasing trends (net drifts≥0.0%) or stagnated reductions (≥-0.5%) in mortality. The relative risk of mortality generally showed improving trends over time and in successively younger birth cohorts among high- and high-middle SDI countries except Saudi Arabia and Kazakhstan. Fourteen middle-SDI countries such as Ecuador and Mexico, and sixteen low-middle-SDI countries like India and twenty low-SDI countries like Pakistan, had unfavorable or worsening risks for recent periods and birth cohorts.

Conclusions:
Improvements in the treatment of CHD should reduce the risk for successively younger cohorts and shift the risk for all age groups over time. Although there were gains in CHD mortality globally, unfavorable period and cohort effects were found in many countries, raising questions about adequacy of their health care for CHD patients across all age-groups.
Abstract 11654: Myofibroblast Smad1 Activation Restrains Cardiac Fibrosis and Attenuates Post-Myocardial Infarction Adverse Remodeling
Authors: Hanna Anis , Frangogiannis Nikolaos
Published: March 2022

Cardiac fibroblasts play a pivotal role in repair and remodeling of myocardial infarction (MI) by transforming to myofibroblasts, and acquiring inflammatory, proangiogenic, or matrix-synthetic phenotypes. Members of the Transforming Growth Factor (TGF)β superfamily (including TGFβs and BMPs) are activated following MI and play an important role in regulating fibroblast phenotype, and cardiac fibrosis. Canonical TGFβ superfamily signaling is mediated through the receptor-activated Smads: TGF-βs activate Smad2/3, whereas BMPs predominantly stimulate the Smad1/5 cascade. Smad3 signaling plays an important role in activation of infarct myofibroblasts; however, the role of the Smad1 pathway has not been studied. We hypothesized that fibroblast-specific actions of Smad1 regulate repair and remodeling in the infarcted myocardium. In mouse infarcts, Smad1 was activated in infiltrating myofibroblasts 7 days after coronary occlusion, not only by BMPs but also by TGF-β isoforms. In order to examine the effects of Smad1 in infarct fibroblasts, we generated mice with myofibroblast-specific Smad1 loss (MFS1KO). Echocardiography at 7 and 28 days following MI revealed that MFS1KO mice had accentuated systolic dysfunction, and increased left ventricular dilation
(p<0.01, N=13-49)
. Worse adverse remodeling in infarcted MFS1KO hearts was associated with scar expansion, and accentuated fibrosis. Smad1 knockdown in control or TGF-β1-stimulated cardiac fibroblasts increased mRNA levels of structural and matricellular genes (including
Col1a1, Col3a1, Postn, Thbs1&3
) while reducing matrix metalloproteinase levels. Analysis of unbiased RNA-seq data revealed that Smad1 loss activates pathways involved in matrix regulation, and collagen biosynthesis, and that the anti-fibrotic actions of Smad1 are carried out through inhibition of pro-fibrotic cascades as the TGF-β/Smad3 axis, p53, and IL4/STAT6 signaling. In conclusion, Smad1 activation in infarct myofibroblasts restrains the fibrotic response and protects the infarcted heart from adverse remodeling through inhibiting key pro-fibrotic signaling pathways. These findings suggest that Smad1 activation may be a promising strategy to restrain cardiac fibrosis in infarcted and failing hearts.
Abstract 11655: Echocardiographic Assessment of Strain and Associations With Markers of Clinical Severity in Multi-System Inflammatory Syndrome in Children (MIS-C) Associated With COVID-19
Authors: McAree Daniel , Arzu Jennifer , Hauck Amanda , Acevedo Jen , Carr Michael R , Patel Ami B , Husain Nazia
Published: March 2022

Introduction:
Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 can cause cardiovascular dysfunction. We aimed to determine if strain abnormalities persist in MIS-C patients 3-10 weeks post-discharge, and whether acute markers of clinical severity are associated with lower strain at subacute follow-up.

Methods:
We performed a retrospective cohort study of MIS-C patients admitted at a single center from 3/2020-3/2021. Demographic and clinical variables during hospitalization were obtained. Global longitudinal strain (GLS), 4-chamber longitudinal strain (4C-LS), mid-papillary circumferential strain (CS), and left atrial strain (LAS) at 3-10 week follow-up were compared to age matched controls (n=10). Bivariate analyses were performed using Spearman rank correlation and two-sample t-test or Wilcoxon rank sum test.

Results:
Sixty MIS-C patients were identified (age 8.9 +/- 4 years, 35/60 male, 39% Hispanic, 29% African American). Hypotension (65%), ICU admission (57%), and inotropic support (45%) were common; 7% received mechanical ventilation. No deaths or need for ECMO were reported. Median length of stay (LOS) was 7 days. LVEF was <55% in 28% during hospitalization (median 57% [52-61]) and 6% at follow-up (median 65% [61-67]). Peak NT-proBNP (median 5321 pg/ml [IQR 1712, 17400]) and peak CRP (median 17 mg/dl [12, 22]) were significantly associated with hypotension, ICU admission, and total ICU days. Forty-five patients had available follow-up imaging for strain. CS (mean -26.0 vs -28.6; p=0.009) and LAS (mean -34.5 vs -51.2; p=0.001) were lower in MIS-C vs controls, but not GLS or 4C-LS. Lower CS (-24.2 +/- 3.1 vs -26.7 +/- 2.7; p=0.04) and lower 4C-LS (-19.1 +/- 1.9 vs -21.2 +/- 3.3; p=0.04) were associated with abnormal EF (<55%) during acute illness. CS was lower in those admitted to ICU (-25.1 +/- 2.6 vs -27.5 +/- 2.9; p=0.03). Peak CRP correlated with lower CS (r= -0.41, p=0.03) and GLS (r= -0.55, p=0.01) at follow-up.

Conclusions:
MIS-C patients show abnormal strain during subacute follow-up despite improvement in EF. Lower CS, GLS, and 4C-LS were associated with in-hospital markers of clinical severity. This data may allow for identification of at-risk MIS-C patients and help guide outpatient cardiology follow-up.
Abstract 11661: Associations of Macronutrient and Sodium Intake With Cardiac Structure and Function in the Hispanic Community Health Study/Study of Latinos
Authors: Flomenbaum David , April-Sanders Ayana , Lee Un Jung , Kaplan Robert , Mossavar-Rahmani Yasmin , Ostfeld Robert , Sotres-Alvarez Daniela , Mattei Josiemer , Daviglus Martha L , Kansal Mayank M , McClain Amanda , Hurwitz Barry E , Shook-Sa Bonnie , Rodriguez Carlos
Published: March 2022

Introduction:
Dietary macronutrient balance and reduced sodium intake are key modifiable risk factors for prevention of cardiovascular disease. Pre-heart failure (HF) (evidence of structural heart disease or abnormal cardiac function) is an independent risk factor for incident clinical HF development. We assessed associations of macronutrient and sodium intake with cardiac structure and function from the Echocardiographic Study of Latinos (Echo-SOL), an ancillary study of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

Hypothesis:
We hypothesized that higher intake of protein and lower intake of fat, carbohydrate and sodium would be associated with healthier cardiac structure and function.

Methods:
Cross-sectional data from HCHS/SOL interviews were analyzed among 1818 adults (57% female, mean age 56 ± 0.17) with complete echo assessments. Intake of carbohydrates, proteins, fats, and sodium in relation to total caloric intake was derived from two 24-hour recalls. Associations between nutrients and pre-HF outcomes were estimated via simple linear regression as well as ANOVA across quintiles of each nutrient. All analyses were weighted and account for complex survey design.

Results:
Mean ± SE macronutrient intake for the overall target population was 52.3 ± 0.1% carbohydrates, 17.1 ± 0.05% protein, and 29.7 ± 0.1% fat. Mean dietary sodium intake was 3,107.2 ± 47.7mg. Higher percent of total daily calories from carbohydrates was associated with lower LV mass (-13.7g per 5%, p<0.01) and lower e’ velocity (-0.37cm/s per 5%, p<0.01). Higher fat consumption was associated with higher LV mass (11.23g per 5%, p<0.01). No significant associations were seen with protein intake. Higher sodium intake was associated with higher LV mass (1.35g per 100mg, p<0.01) and lower ejection fraction (-0.091% per 100mg, p<0.01). Quintile analysis confirmed the presence and monotonicity of the observed associations.

Conclusions:
Our results suggest that a macronutrient balance favoring higher carbohydrate and lower fat consumption along with reduced sodium intake is associated with better cardiac structure and function. These findings have important implications for HF prevention. Future studies should explore the role of specific nutrient types.
Abstract 11663: Evaluation of Health Disparities Based on Gender, Race, and Socioeconomic Status in Patients Presenting With Aortic Dissection
Authors: Shakir Muhammad A , Bhardwaj Akanksha , Meng Stephen Q
Published: March 2022

Introduction:
Aortic dissection can be a catastrophic illness with a high mortality risk. Hypertension is a key predisposing factor, the management of which requires close medical follow up. Access to healthcare and the ability to maintain follow up is an important source of health disparity. In this study, we aimed to investigate disparities in the care of patients presenting with aortic dissection with a focus on gender, race, and socioeconomic status.

Methods:
From 7/2016 to 8/2020, 152 patients were admitted to our hospital with aortic dissection, 65 Stanford type A and 87 type B. Out of 152 patients, 75% had admission BP >130/80 and 70% had no medical contact in the year prior to admission. Among those with no medical contact, we investigated whether disparities existed based on gender, race, or socioeconomic status. For socioeconomic status, we used publicly available median household income data based on zip code. Outcomes are expressed as percentages and compared using a Chi-square test of independence with significance set at 0.05 level.

Results:
Among those with no medical contact, there was no significant difference based on gender. 74% of female and 66% of male patients had no medical contact in the year prior to admission (p>0.05). Similarly, there was no significant difference based on race as 71% of white and 65% of black patients had no medical contact in the year prior to admission (p>0.05). Notably, 66% of admitted patients had a median household income below the US national average of 68,703 USD (2019). Those with a median income <60,000 USD were more likely (58%) to have had no medical contact in the year prior to admission than those with a median income >80,000 (13%). (p <0.05). Further, those with a median income of <60,000 USD were more likely to be admitted with aortic dissection (57%) than those with a median income of >80,000 (14%) (p<0.05).

Conclusion:
Our study showed that most patients presenting with aortic dissection lacked healthcare access in the year leading to the admission. When evaluating for disparities, socioeconomic status was the most significant social determinant of health. Patients with household income less than US national average were more likely to both present with dissection and lack medical contact in the year prior to dissection.
Abstract 11667: Factors Associated With No-Show and Cancellations at Adult Congenital Heart Disease Clinic
Authors: Patel Karishma , Shalen Evan F , McGrath Lidija B , Burton Yunwoo , Khan Abigail
Published: March 2022

Introduction:
Many adults with congenital heart disease (ACHD) do not regularly access cardiology care; this has been associated with adverse outcomes. Clinic no-shows and cancellations limit access to care, and identify a population in need of intervention to improve engagement with care. We investigated factors associated with no-shows and cancellations in our academic ACHD clinic which draws from a large catchment area in Oregon, Washington, Idaho and California.

Methods:
The electronic medical record was queried to identify individuals ≥ 18 years of age with a scheduled appointment in the ACHD clinic from 2017-2020. Demographic and scheduling characteristics were recorded. Multivariate logistic regression was used to test for an association between variables and either no-show or patient-initiated cancellation.

Results:
Our sample included 7616 scheduled visits, and 4191 (55.0%) were completed. There were 332 (4.4%) no-shows and 1320 were canceled by the patient (17.3%). Factors associated with an increased risk of no-show to clinic were Medicaid (OR=1.86 (95% CI: 1.39, 2.49), p<0.001), prior no-show (OR per 1% increase in prior no-show rate 1.13 (95% CI: 1.13, 1.45), p<0.001), and an appointment at an off-site clinic (OR 2.16 (95% CI: 1.32, 3.45), p=0.002). Factors associated with an increased risk of a cancellation were in-person vs. virtual visits (OR 1.89 (95% CI 1.44, 2.53), p<0.001) and being an established patient (OR 1.38 (95% CI 1.17, 1.63), p<0.001). Patient age, day of the week, and appointment time were not associated with no-shows or cancellations.

Discussion:
Medicaid insurance, prior no-show, and off-site clinics are associated with a higher risk of no-show to ACHD clinic. As ACHD remains a limited resource, and lack of ACHD follow-up is associated with adverse events, limiting no-shows and canceled visits is an important goal. This study identifies a high-risk population which may benefit from targeted interventions to improve access to care.
Abstract 11669: “Hearing the Heart” - Validation of a Novel Digital Health Earbud Technology to Measure Cardiac Time Intervals Through Infrasonic Hemodynography
Authors: Wheeler Carmen M , Patel Siddarth , Waldman Carly E , Panchal Jal , Sidhu Rajbir S , Krol Monika , Ye Runyu , Szepieniec Tomasz , Shakya Pratistha , Gupta Saumya , Shahinyan Karlen , Barnacka Anna , Engstrom Hayley , Southard Kayla , Daniel Misty , Stinis Curtiss , Romero Steven , Bridges Charles , Bhavnani Sanjeev
Published: March 2022

Introduction:
The cardiovascular (CV) system produces low frequency, ‘infrasonic’, auditory vibrations during the cardiac cycle. Herein, we report the first-in-person validation of a novel earbud sensor to capture CV time intervals and the feasibility of non-invasive infrasonic hemodynography (IH) using the MindMics ® wireless earbuds for long term in-ear CV monitoring.

Methods:
Infrasonic waveforms were captured during cardiac catheterization (CC) among 5 study subjects wearing the IH ear-buds (Figure A) who underwent CC for the evaluation of coronary artery disease. Simultaneous IH and CC waveforms were acquired and time synchronized at 1000Hz sampling rate as time-series datasets. Each subject underwent echocardiography to identify aortic valve opening/closure (AVO/AVC) and left ventricular (LV) outflow tract flow measurements with hemodynamic waveforms during CC measuring LV ejection time (LVET). Validation of the IH waveform (in-ear acoustic pressure measured in Pascals) was compared to echocardiography (AVO/AVC) and hemodynamic waveforms (LVET) with concordance and Bland-Altman analysis, and with overlaid data visualizations to CV time intervals.

Results:
5 study subjects comprised 257 CV cycles with a total data set of >450,000 time-series data points. IH signals collected simultaneously with the pulsed wave Doppler demonstrated alignment with AVO/AVC (Figure B) and were synchronized to CC waveforms in the aorta (Figure C). A high correlation between LVET measured from IH and CC was observed (R=0.87, p<0.0001, Figure D), with a mean absolute error of 14.7ms and a bias of 7.2ms (Figure E) (mean±SEM of 342.3±2.1ms for CC and 349.5±2.1ms for IH).

Conclusions:
In a first-in-person study, we report high accuracy between IH, echocardiography, and CC hemodynamic waveforms to capture CV time intervals including CV performance measures. Further studies are underway to validate IH and the earbud sensor towards non-invasive hemodynamic monitoring.
Abstract 11673: What Predicts the Use of Cardiovascular Screeners in Primary Care Among Women Veterans With Depression?
Authors: Bean-mayberry B , Chanfreau Catherine , Clair Kimberly , Than Claire , Schweizer Catherine Amanda , Moin Tannaz , Finley Erin , Hamilton Alison , Farmer Melissa
Published: March 2022

Introduction:
One in three American women die of cardiovascular (CV) disease annually, and women Veterans suffer higher risk, especially those with mental health burden. To improve CV risk identification, we implemented a CV risk screener template in 5 VA primary care clinics.

Objective:
To examine factors associated with CV screening in a cohort of women with depression.

Methods:
The cohort included all women with at least one primary care visit during the study period (12/2016-03/2020) with a depression diagnosis. We used t-tests/chi-square to compare CV screener completion vs not, and modeled completion with logistic regression including demographics, CV risk conditions, utilization, and PTSD adjusting for site-level clustering.

Results:
Among 6009 women, 2090 (35%) had diagnosed depression in the past two years and 582 (28% with depression) had a completed screener. For women with depression, screener completion was more likely for women who were older (48 vs. 45 years), White (46% vs. 36%), obese (49% vs. 39%), diagnosed with hyperlipidemia (39% vs. 33%), hypertension (36% vs. 27%), or diabetes (16% vs. 12%), had more primary care visits (3 vs 1) and without PTSD (46% vs. 54%; p<0.01 for each comparison). In the full logistic model, obese women had greater odds (OR 1.8, 95%CI 1.3-2.3), whereas women with PTSD had lower odds (OR 0.7, 95% CI 0.5-0.8) of screener completion.

Conclusions:
Women Veterans have a high prevalence of depression and other mental health conditions putting them at higher risk for CV disease. Our sample of women with depression had more traditional CV risks, yet, obesity and PTSD were the driving factors of the CV screening within primary care. Since PTSD is a significant predictor in ischemic heart disease in women Veterans, mechanisms to leverage CV screening and intervention in this population are paramount so that providers and patients do not miss opportunities for risk reduction.
Abstract 11675: Global Cardio Oncology Registry: Structure for a Multinational Collaboration
Authors: Sadler Diego B , Moudgil Rohit , Arco Teske , Collier Patrick H , Sarkar Abdullah , Barac Ana , Sherry Ann Brown , Herrmann Joerg , Deswal Anita M ,   G-COR Investigators
Published: March 2022

Introduction:
Global collaboration in cardio-oncology (CO) is needed to understand the prevalence of cancer treatment related cardiovascular disease (CTRCD) in different risk groups, practice settings and geographic locations. Furthermore, socio-economic and ethnic disparities may impact access to care.

Methods:
We assembled cardiologists (CA) and oncologists from academic and community settings to collaborate in the first global cardio-oncology registry (G-COR). US and international CO physicians participated in the first global virtual meeting to assess feasibility and structure for G-COR. Subsequently, a survey for sites resources, demographics and intention to participate was conducted.

Results:
Responses with sites demographics from 104/140 sites invited: 43 US sites from 23 states and 61 international sites from 5 continents indicated decision to participate in G-COR. Sites were more commonly led by CA (74/99) than CA and oncologists (25/99) and were more often University/teaching (68/101) than community based (33/101). Significant minorities/disadvantaged CO patient population were reported by 32/43 US sites versus 16/60 international sites. Average number CO patients treated per month was 83, range (5-1,000). Breast cancer was the first or second G-COR priority for 84 centers, hematological malignancies (HEM) for 66 centers, and immune check point inhibitors (ICI) for 36 centers.
Echocardiography with strain imaging is available in 92/95 participating sites and cardiac MRI in 80/86 sites. Biomarkers are used only in suspected or confirmed CTRCD in 56/96 sites and for risk stratification in high risk patients in 40/96 sites. Subsequently, scientific committee and topic committees for breast cancer, HEM, ICI, and disparities in CO were established. A pilot phase utilizing a RedCap Cloud platform will start enrolling patients in the last quarter of 2021 and the registry for all main pillars will launch in early 2022.

Conclusions:
We present a global initiative for conducting collaborative research. Information learned G-COR will help understanding risk factors impacting CTRCD in different geographic locations and therefore help reducing access gaps in CO care. Additionally, mitigating strategies can be devised for the future.
Abstract 11676: Do Heart Failure Admission Rates Change Around Holidays? The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Saxon David T , Yang Hannan , Li Quefeng , Loop Matthew S , Russell Stuart D , Rossi Joseph , Stacey Richard , Chang Patricia
Published: March 2022

Introduction:
Heart failure (HF) exacerbations are often precipitated by dietary noncompliance, which is common around holidays. We examined whether HF hospitalizations would increase after major national holidays.

Methods:
The ARIC Study performed surveillance of HF admissions among patients age ≥55 years in 4 US communities from 2005-2014. HF admissions were identified by ICD-9 codes and validated by physician review. For each holiday (H), 4 days before the holiday (H-4 to H-1), and 4 days after the holiday (H+1 to H+4), we compared average daily HF admission rates, hospital length of stay (LOS), 28-day mortality, and 1-year mortality to the remaining days in each holiday’s month using Poisson regression using a complex sampling design.

Results:
ARIC identified 92,354 HF admissions (weighted). Patients admitted in holiday months were 46% male and 71% white, with average age 75 years. Compared to the holiday months, patients admitted on H were older (78 years, p<0.01). Race, community, and HF by ejection fraction were similar among time periods. Average daily admissions around each holiday are shown in Figure 1. For all holidays combined, average daily admissions compared to the remainder of the holiday months (25.1 per day) were less frequent on both H-1 (18.5, p=0.002) and H-1/H combined (19.5, p=0.005). Hospital LOS was shorter for patients admitted on H for Thanksgiving (5.3 v 6.9 days, p=0.02) and Christmas (4.8 v 7.5, p=0.01), on H-1 for Christmas (5.3 v 7.5, p=0.04) and during H-4 to H-2 for New Year’s Day (6.7 v 8.7, p=0.02). 28-day mortality was lower for patients admitted on H-1 (p<0.001) for Christmas. 1-year mortality was similar for all holidays and time periods.

Conclusions:
HF admission rates, hospital LOS, and mortality were similar in the 4 days following a holiday compared to the remainder of each holiday’s month. However, the day before and/or day of a holiday were associated with lower HF admission rates, shorter hospital LOS, and lower 28-day mortality.
Abstract 11678: Prevalence of Elevated Blood Pressure and Left Ventricular Hypertrophy in Adolescents With Congenital Heart Disease
Authors: Walsh Aaron T , Hor Kan N , Lee Marc , Lee Simon , Tran Andrew H
Published: March 2022

Introduction:
Left ventricular hypertrophy (LVH) is defined as LVM indexed to height
2.7
(LVMi-HT
2.7
≥ 51 g/ht
2.7
in men, ≥ 47 g/ht
2.7
in women), and ≥ 38.6 g/ht
2.7
in the pediatric population. LVH associated with hypertension (HTN) is a predictor of adverse cardiovascular (CV) events in adulthood. Adults with congenital heart disease (CHD) have higher rates of HTN compared to the general adult population. Data on the prevalence of elevated systolic blood pressure (SBP) in youths with CHD is limited. The aim of our study was to determine the prevalence of elevated SBP and LVH in adolescents with CHD.

Hypothesis:
We hypothesized that youths with elevated SBP will have increased LVMi-HT
2.7
by echocardiography.

Methods:
We retrospectively analyzed echocardiograms with a diagnosis code of CHD from 2012 to 2019. We included patients aged 13-17 years with documented BP, height, weight, and echocardiography measurement for LVMi-HT
2.7
. Patients were grouped by BP category into normotensive (NT, SBP < 120 mm Hg), elevated BP (E-BP, 120 ≤ SBP < 130 mm Hg), Stage 1 HTN (HTN-1, 130 ≤ SBP < 140 mm Hg), and Stage 2 HTN (HTN-2, SBP ≥ 140 mm Hg). The prevalence of LVH was reported in each group defined as LVMi-HT
2.7
≥ 38.6 g/ht
2.7
.

Results:
855 patients were included with a mean age of 15.5±1.5 years with 485/855 (56.7%) male, SBP 117±13.5 mm Hg, and LVMi-HT
2.7
34.2±10.5 g/ht
2.7
. 493/855 (57.7%) were in the NT group, 214/855 (25%) in E-BP, 99/855 (11.6%) in HTN-1, and 49/855 (5.7%) in HTN-2. The prevalence of LVH increased with higher SBP with 96/493 (19.5%) in NT, 80/214 (37.4%) in E-BP, 32/99 (32.3%) in HTN-1, and 20/49 (40.8%) in HTN-2. Of the youths with LVH, 49/228 (21.5%) met adult criteria of ≥ 51 g/ht
2.7
.

Conclusions:
Youths with CHD have a high prevalence of elevated BP, HTN, and LVH. These findings support the importance of early detection and screening for high BP in this group because youths with CHD have baseline increased CV risk that may be compounded by HTN. Future studies will be needed to determine longitudinal changes and the influence of body mass index and sex on BP in this group.
Abstract 11681: An Extremely Rare Case of Intercostal Artery Rupture After Percutaneous Coronary Intervention
Authors: Shah Monarch , Chandna Sanya , raj Kavin , Patel Pratik B , Toquica Gahona Christian
Published: March 2022

Introduction:
There are a few case reports of Intercostal artery injury after pleural tap and trauma but none after a PCI.

Case:
A 61-year-old Caucasian male with PMH of T2DM, Hypertension, Hyperlipidemia, former tobacco chewing, family history of premature CAD presented to ED with midsternal chest pressure of 2 hours and three weeks of dyspnea on exertion. He was seen earlier in the outpatient office where an ECHO showed an EF of 55%, and a Nuclear stress test showed moderate inferior ischemia. CT coronary Angiogram showed complex plaques in Mid RCA and mid LAD. Troponin and EKG were normal. A diagnosis of unstable angina was suspected, and he was loaded with clopidogrel and heparin drip. He underwent emergency cardiac catheterization via a trans-radial approach. The standard J wire was switched to an angled-tip stiff Terumo guidewire due to difficulty traversing the aortic arch. The guidewire briefly went down the descending thoracic aorta. There was complex, eccentric stenosis of 99% in mid LAD and mid-RCA, which were stented with DES. The patient developed right chest pain radiating to his back. He became hypotensive, and Hemoglobin dropped from 13 to 8g/dl. CT scan showed a large right-sided hemothorax, and a chest tube was placed. He was resuscitated, and Angiogram showed three pseudoaneurysms and rupture of the right 8
th
intercostal artery with active contrast extravasation. The right 9
th
intercostal artery had one pseudoaneurysm. Both the vessels were embolized by an interventional radiologist.

Discussion:
Intercostal arteries arise from descending thoracic aorta. It is likely the catheter advanced into the descending aorta and the intercostal artery resulting in injury. Proper guidewire advancement under fluoroscopy and confirming the position of guidewire before advancing the guiding catheter may prevent this complication. Prompt recognition and emergency treatment with a chest tube and IR-guided embolization should be done.
Abstract 11684: Meta-Analysis of Contemporary Hybrid Convergent Ablation Outcomes
Authors: shrestha suvash , Plasseraud Kristen , Makati Kevin , Sood Nitesh , DeLurgio David , Greenberg Yisachar , Yang Felix
Published: March 2022

Introduction:
Recent randomized clinical trial data demonstrated safety and effectiveness of hybrid epicardial-endocardial (convergent) ablation for persistent and longstanding persistent atrial fibrillation (PersAF/LSPAF). The objective of this study was to perform a systematic review and meta-analysis focused on contemporary hybrid convergent procedure outcomes.

Methods:
Predefined search terms were used in PubMed/EMBASE in May 2021. Abstracts and full text in English were reviewed for peer-reviewed, primary clinical studies of hybrid convergent procedures in PersAF/LSPAF using the current unipolar device for epicardial ablation and lesion set focused on left atrial posterior wall and pulmonary vein isolation. Meta-analysis was performed with using a random effects model with a restricted maximum likelihood estimator and forest plots. Heterogeneity was tested using Cochran’s Q-test.

Results:
The updated search yielded 155 unique results. Two articles from manual searching were added. Twenty-seven full text articles were assessed for inclusion. Six articles that included 551 patients were identified for qualitative and quantitative analysis. Ninety-six percent of patients had persistent or long-standing persistent AF. Mean/median pre-operative AF duration ranged from 2 to 5 years. The 30-day major adverse event rate was 6% (95% CI 3-8%, n=551, 6 studies). No atrioesophageal fistulas or periprocedural mortality events were reported. Freedom from atrial arrhythmia at one year or later was 69% (95% CI 61-78%; n=523, 6 studies) regardless of anti-arrhythmic drugs (AADs) and 50% (95% CI 42-58%; n=343; 3 studies) off AADs. Heterogeneity was insignificant for effectiveness off AADs (p=0.14) and safety (p=0.23)

Conclusions:
This meta-analysis found favorable effectiveness of contemporary hybrid convergent procedures at one year, even off AADs, and a reasonable safety profile in mostly persistent or long-standing persistent AF.
Abstract 11689: Among Patients Hospitalized for Infective Endocarditis, There is No Association Between Solid Organ Transplant Recipient Status and In-Hospital Mortality: A Retrospective Cohort Study From National Inpatient Sample 2016-2017
Authors: Baral Nischit , Santiago-Rivera Olga , Gupta Tripti , Khan Mahin , Khan Hafiz , Ghatol Abhijeet , Mallikethi Lepakshi Reddy Sagar , Abdelazeem Basel , Adhikari Govinda , Kunadi Arvind , sud parul , Changezi Hameem U
Published: March 2022

Introduction:
Infective endocarditis (IE) is a serious complication following solid organ transplant (SOT) including heart or lung transplant, however, we only have few outcome based studies on this topic.

Hypothesis:
SOT recipients hospitalized for IE have higher in-hospital mortality compared to non-SOT.

Methods:
This is a retrospective cohort study from IE hospitalizations using 2016-2017 National Inpatient Sample (NIS) in patients 18 years or older. The primary outcome was in-hospital mortality. Secondary outcomes were length of stay (LOS), and total charges. We performed multivariable logistic regression (in-hospital mortality) and negative binomial regression models (LOS and total charges) to test our hypothesis. Model were adjusted for potential confounders including age, sex, race, insurance, income level, and comorbidities. STATA 17.0 (Stata-Corp LP, College Station, TX) was used for data analysis.

Results:
There were 14,294,784 hospitalizations in 2016 and 2017. Our final study sample consisted of 5,477 IE discharges with the mean age of 52.1 years old (SD= ±19.12; range 18 to 90 yrs), 0.60 % (n=33) were SOT recipients, 41% were female (p=1.00), and 76.4% were White (p=0.12). Weighted bivariate group (SOT vs non-SOT) analyses suggested that SOT recipients had statistically higher proportion of Charlson comorbidity index of three or more (90.91% vs 33.13%; p<001). SOT IE patients had a higher prevalence for the following co-morbidities: diabetes mellitus (24.24% vs 12.67%; p=0.05) and kidney disease (90.91% vs 21.6%; p<0.001). SOT recipient status did not have statistically significant association with in-hospital mortality (aOR 0.50; 95% CI: 0.07, 3.83; p = 0.508) after controlling for confounders. Similarly, there were not statistically significant difference in length of stay (β= -0.167; linearized SE ±0.17; 95% CI: -0.50, 0.17; p=0.323) or total healthcare cost (β = -0.29; linearized SE ±0.27; 95% CI -0.82, 0.24; p= 0.284).

Conclusions:
Among IE patients, SOT recipient status is not associated with higher or lower in-hospital mortality compared to non-SOT. Moreover, SOT status is not associated with significant differences in resource utilization (hospital LOS and total hospitalization charges).
Abstract 11705: Comparing Healthcare Utilization and Health Outcomes of Infective Endocarditis Between People Experiencing Homelessness and People With Secure Housing
Authors: Lynch Christopher , Sakai-Bizmark Rie
Published: March 2022

Introduction:
Infective endocarditis (IE) is uniformly fatal if left untreated. Lower socioeconomic status has been shown to increase risk for community-acquired bacteremia, leading to possible IE. People experiencing homelessness (PEH) face risk factors for IE, such as inadequate access to personal hygiene, lack of consistent resting places to prevent skin breakdown, substance use, and inadequately treated comorbidities. This study seeks to compare characteristics of health utilization and outcomes for PEH hospitalized for IE with people with secure housing (PSH).

Hypothesis:
Mortality rate and healthcare utilization due to IE are higher for PEH compared to PSH.

Methods:
We used New York Statewide Inpatient Database between 2009 and 2014 to identify patients over 18 years of age admitted with the diagnosis of IE. With homelessness as the exposure variable, outcomes included 1] hospitalization cost per day, 2] length of stay (LOS), and 3] in-hospital mortality. Multivariate regression models, adjusted by patient characteristics, were used to explore the associations between homelessness and outcomes.

Results:
We identified 809,491 IE hospitalizations (25,968 homeless and 783,523 non-homeless). PEH were significantly more likely to be white (16.9% in PEH and 62.6% in PSH, p< .001). Homelessness was significantly associated with lower odds of in-hospital mortality (adjusted Odds Ratio [aOR] 0.88,
p
< .001), lower means ratio of cost (Means Ratio 0.99,
p
< .001), longer LOS (Incidence Rate Ratio=1.03,
p
< .001), and increased risk for readmission within 30 days of hospital discharge (aOR 1.1, p<.01).

Conclusions:
The lower risk of hospital mortality for IE amongst PEH is unexpected given the higher burden of comorbidities and risk factors in this vulnerable group. It is possible that a significant proportion of PEH are dying outside hospital walls due to barriers in connecting with medical care. Lower hospitalization cost per day along with longer LOS could also reflect the time intensive but lower cost services required for complex discharge planning efforts for PEH. These results quantify and highlight the need for further study to understand overall mortality in PEH along with effective discharge planning strategies that address these disparities.
Abstract 11707: Incidence and Clinical Features of Transthyretin Amyloidosis Diagnosed by Histologic Analysis of Tenosynovial Tissue From Patients Undergoing Carpal Tunnel Surgery
Authors: Nandi Saheli , Dibenedetto Michael R , Soong Maximillian , Hunter Alice A , Formica Philip , Ganatra Sarju , Venesy David M , Shah Sachin P , Patten Richard D
Published: March 2022

Introduction:
Transthyretin (TTR) cardiac amyloidosis (CA) is an increasingly recognized cause of heart failure (HF) with preserved ejection fraction (HFpEF) that is associated with a poor prognosis. Retrospective series have demonstrated that amyloidogenic TTR (ATTR) deposition in tenosynovial sheaths such as that causing carpal tunnel syndrome precedes the onset of HF due to ATTR CA by several years.

Methods:
We conducted an analysis of 136 patients (pts) who presented for carpel tunnel surgery from whom tenosynovial material was analyzed with Congo Red staining to determine the frequency of samples positive for ATTR deposition and to explore whether this approach might lead to earlier diagnosis and treatment of ATTR CA.

Results:
Among these 136 pts, 31 were confirmed to have positive Congo Red staining tenosynovial tissue, all of which demonstrated the ATTR subtype determined by liquid chromatography/mass-spectroscopic analysis. ATTR positive pts were significantly older than negative pts (74
+
8 yrs vs. 59
+
13 yrs, p<0.01). 58
%
of ATTR positive pts were male and 42% female. At the time of this submission, only 1 of these 31 subjects demonstrated a TTR mutation (valine-isoleucine 122). 19 pts have undergone cardiac screening of which 2 males demonstrated ATTR CA by bone scintigraphic imaging.

Conclusions:
23% of pts undergoing carpal tunnel release exhibit ATTR amyloid deposition by histologic analysis, all of whom tested positive for the ATTR subtype with 2 asymptomatic male pts exhibiting cardiac involvement. Among our positive ATTR pts, 42% are female exceeding the 10-20% percent female prevalence among patients with HF due to ATTR CA reported previously. This preliminary observation supports a protective role of female gender in limiting progression to HF due to ATTR amyloidosis. The evaluation of this population is ongoing and will be reported at the annual meeting. Broadly, however, our data support that identifying ATTR amyloid protein within tenosynovial tissue obtained during routine surgery is warranted as this approach, when combined with appropriate cardiac screening, facilitates early diagnosis and treatment of ATTR CA before the onset of overt clinical heart failure.