bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 10355: Puzzling St Elevations After Cardiac Shock Wave Therapy
Authors: Gaurav Karsh , Morrow Zachary , Gershon Adam , Singh Varinder
Published: March 2022

Background:
The differential diagnosis of ST elevation is broad, including ischemia, hyperkalemia, benign repolarization, and others. Here we present a case of ST elevations immediately post cardiac shock wave therapy, a non-invasive modality based on the lithotripsy method using low-intensity shock waves to stimulate angiogenesis, reduce angina, and improve myocardial perfusion.

Case:
84-year-old male with a history of coronary artery disease, type 2 diabetes mellitus, hypertension, was admitted to the hospital with unstable angina. He received laser atherectomy, cardiac shock wave therapy, as well as a drug eluting stent to the mid left anterior descending artery. Patient was brought to the coronary care unit (CCU) for post-catheterization monitoring and was immediately noted to have prominent ST elevations in leads V2-V6 (Fig 1), however remained stable and asymptomatic. Bedside echocardiogram showed no new segmental wall motion abnormalities or pericardial effusion. He was taken back to the catheterization lab for a second look revealing the newly placed patent stents. Serial EKGs in the CCU showed resolving ST elevations, without the formation of new q waves, and he was discharged the next morning.

Discussion:
Shock wave therapy was introduced in 1980 as a treatment for ureteral stones. Now, shock wave therapy is delivered to areas of ischemic myocardium to stimulate angiogenesis and reduce refractory anginal symptoms. Electrocardiographic changes after shock wave therapy have not been studied and more importantly, their clinical implications remain unclear. New ST elevations after revascularization is often an ominous sign, indicating continuing ischemia or aneurysm. We postulate that in the setting of cardiac shock wave therapy, ST elevations may represent stunned myocardium as a consequence of the high-voltage discharges. Further studies and case reports are needed to evaluate the clinical implications of ST elevations after shock wave therapy
Abstract 10357: ARO-APOC3, an Investigational RNAi Therapeutic, Shows Similar Efficacy and Safety in Genetically Confirmed FCS and Non-FCS Participants with Severe Hypertriglyceridemia
Authors: Clifton Peter , Sullivan David , Baker John , Schwabe Christian , Thackwray Susan , Scott Russell , Hamilton James , Lira Pineda Armando J , Given Bruce , Melquist Stacey , Chen Iris , San Martin Javier , Watts Gerald F , Goldberg Ira J , Knowles Josh , Gaudet Daniel , Hegele Robert A , Ballantyne Christie M
Published: March 2022

Background:
Familial chylomicronemia syndrome (FCS) is an ultrarare condition caused by biallelic pathogenic DNA variants in lipolysis-associated genes, resulting in severe hypertriglyceridemia (HTG) and associated with high risk of acute pancreatitis with few therapeutic options. In a 16-week Phase 1 study (NCT03783377), subcutaneously administered ARO-APOC3 reduced serum apolipoprotein C3 (APOC3) and TG in healthy volunteers and participants (pts) with HTG and was well tolerated.

Purpose:
To report on the safety/pharmacodynamic (PD) effects of ARO-APOC3 in both FCS pts with biallelic pathogenic variants and pts with severely elevated TG at screening (>880 mg/dL) but without biallelic pathogenic variants (chylomicronemia (MCM)).

Methods:
Four genetically confirmed FCS pts received 50 mg ARO-APOC3 and 26 MCM pts received 10, 25, 50, or 100 mg ARO-APOC3 on Days 1 and 29. Since similar PD responses were observed among MCM pts, results were pooled across dose levels. Safety and PD responses were examined. Maximal mean/median changes from baseline for APOC3, TG, non-HDL-C, and HDL-C were reported.

Results:
Baseline/demographics were comparable between groups, except for mean BMI (22.1 [FCS] and 30.5 [MCM] kg/m
2
), and mean baseline HDL-C , which were lower in FCS pts (Table 1) (p<0.0001 for both). Mean APOC3 was reduced by 98% and 96% in FCS and MCM pts, respectively. Both groups also showed similar maximum median reductions in TG of 91% and 90%, respectively. Similar to the full study, non-HDL-C was reduced and HDL-C increased with treatment in both groups (Table 1). AEs were similar between groups, suggesting a comparable safety profile.

Conclusions:
In patients with severe HTG, ARO-APOC3 was safe, and consistently decreased APOC3, TG, and non-HDL-C, and increased HDL-C, regardless of underlying genetic cause of HTG, and may represent a promising RNAi therapeutic for the treatment of severe HTG.
Abstract 10358: Incidence of Transesophageal Echocardiography-Related Esophageal Mucosal Injury in Patients with Pulmonary Vein Isolation as a Treatment for Atrial Fibrillation
Authors: Omuro Ayumi , Wada Yasuaki , yoshiga yasuhiro , Okuda Shinichi , Tanaka Nobuaki , Yano Masafumi
Published: March 2022

Introduction:
Transesophageal echocardiography (TEE) is the gold standard modality for detecting a thrombus in the left atrium (LA) and the left atrial appendage (LAA) prior to pulmonary vein isolation (PVI) for the treatment of atrial fibrillation. Although TEE is has a good safety profile, it was recently reported that TEE preceding PVI can cause esophageal mucosal injury (EMI). However, the detailed data and mechanism of EMI by TEE remain to be elucidated. Herein, we investigated the incidence and risk factors of TEE-related EMI in patients who underwent PVI for AF.

Methods:
This study included 262 consecutive patients who underwent PVI with preoperative TEE using a 3D TEE probe and postoperative esophagogastroduodenoscopy. The cause of EMI was classified by an experienced gastroenterologist.

Results:
TEE-related EMI was found in 16 (6.1%) patients, whereas PVI-related EMI was found in 5 (1.9%) patients. Only one patient with TEE-related EMI experienced mild chest discomfort. In the multivariate analysis, advanced age was an independent risk factor for TEE-related EMI (odds ratio, 1.08 per 1-year increment; 95% confidence interval, 1.01-1.16; p = 0.0274).

Conclusions:
The incidence of TEE-related EMI, for which advanced age could be a significant risk factor, using a 3D TEE probe was relatively high in patients who underwent PVI. This study suggests that attention should be paid to the indications of TEE before performing PVI, especially in elderly patients, and other modalities for ruling out LA and LAA thrombus should also be considered.
Abstract 10359: Prevalence of Traditional and Non-Traditional Cardiovascular Risk Factors in Adults with Congenital Heart Disease
Authors: Levene Jacqueline , McGrath Lidija , Broberg Craig , Ramsey Katrina , Khan Abigail
Published: March 2022

Introduction:
Previous studies examining the prevalence of cardiovascular risk factors in adults with congenital heart disease (CHD) were mainly based on single center data or non-United States (US) populations. Adults with CHD may be at increased risk of acquired cardiovascular disease (CVD) for a variety of reasons. Understanding the prevalence of non-traditional and traditional cardiovascular risk factors in this population is an important first step in developing strategies to mitigate long-term risk.

Methods:
The Oregon All Payer All Claims database for the years 2010-2017 was queried for adults 18 to 65 years of age with ICD codes consistent with CHD. CVD risk factors were identified using ICD-9 or ICD-10 codes. The prevalence of risk factors in any year were measured and averaged over the 7 year period.

Results:
13,896 individuals with ICD codes consistent with CHD were identified (
Table 1
). 53.2% had at least one risk factor for acquired CVD and 31.1% had ≥ 2 risk factors. The prevalence of ≥ 1 risk factor increased with age (18-24: 19% vs. 77% in those 55-65). The most common risk factor was hypertension (31.7%). Non-traditional risk factors were uncommon (hypertensive disorder of pregnancy: 1.5%, rheumatoid arthritis: 1.5%, lupus: 1.1%, HIV: 0.28%). Risk factors were more prevalent in men than women and in rural-dwelling individuals as compared to urban-dwelling individuals.

Conclusions:
To our knowledge, this is the first comprehensive, population-level attempt to measure both traditional and non-traditional cardiovascular risk factors in adults with CHD in the US. Our data shows that the prevalence of one or more traditional cardiovascular risk factors is high even in the young, and that men and rural-dwelling individuals are at increased risk. Given the potentially additive effect of acquired CVD on CHD with respect to adverse cardiovascular events, identifying and addressing risk factors should be an important priority for adult CHD providers and patients.
Abstract 10360: Trends in Surgical Aortic Valve Replacement Outcomes in the Post Transcatheter Aortic Valve Replacement
Authors: Chahine Johnny , Fiocchi Jacob , John Ranjit , Shaffer Andrew , Knoper Ryan C , Yannopoulos Demetris , Raveendran Ganesh , Gurevich Sergey
Published: March 2022

Introduction:
Transcatheter aortic valve replacement (TAVR) is currently the mainstay of treatment of severe aortic stenosis (AS). We aim to investigate the evolution of transaortic mean gradients in surgical aortic valve replacement (SAVR) patients before and after the Food and Drug Administration (FDA) approval of TAVR.

Hypothesis:
We assessed the hypothesis that mean gradients across the aortic valve were higher in 2011-2012 before FDA approval of TAVR.

Methods:
Patients who underwent SAVR in 2011-2012 (n=138) and 2019-2020 (n=134) at the University of Minnesota Medical Center were included. Those with implanted mechanical valves (n=602) were excluded. Valve size and mean aortic gradients were compared between the 2 study groups.

Results:
Out of 272 patients included in this study, 65.8% were males. Patients underwent SAVR at an older age in 2011-2012 (median 74, IQR 65-82) compared to 2019-2020 (median 67, IQR 60-73). The mean aortic valve gradient post-SAVR was higher in 2011-2012 (median 12, IQR 8-18 vs. median 10, IQR 7-13 in 2019-2020, p=0.016). The median valve size was smaller in 2011-2012 (21 mm vs. 23 mm, p<0.001)
(table)
.

Conclusion:
Patients who underwent SAVR in 2011-2012 were older, more likely to receive smaller valve sizes, and had higher mean aortic valve gradients after SAVR.
Abstract 10370: Personalised Approach is the Key When it Comes to Pacing a Patient with an S-ICD
Authors: ElRefai Mohamed , AbouelAsaad Mohamed , Morgan John , Roberts Paul
Published: March 2022

Introduction:
Patients with an S-ICD may develop a pacing indication. When transvenous pacing is not feasible, the combination of an S-ICD and a leadless pacemaker (LP) might be a sound option. There are increased reports of concomitant use of LPs and S-ICDs. However, the effect of pacing on the S-ICD sensing is not well studied.

Hypothesis:
We hypothesize that pacing changes R and T waves morphology and amplitudes, causing changes in R:T ratios perceived by an S-ICD, increasing the risk for T wave oversensing (TWO) during paced rhythm with a subsequent risk of inappropriate shocks.

Methods:
We ran a prospective study in patients undergoing an electrophysiological study on clinical grounds. Participants were fitted with a Holter®, the leads of which placed to correspond to the three vectors of an S-ICD. We used a standard catheter to pace the right ventricle at four positions (figure 1) for 10 beats each at 8mA/2ms.

We analysed the Holter® traces and used two-way ANOVA to assess the effect of pacing on the R:T ratio.

Results:
A total of 47 patients (mean age 56.02 ± 16.02,72% male) were enrolled (81% structurally normal heart, 15% DCM, 2% ICM, and 2% congenital heart disease). Age, sex, and aetiology had no effect on the R:T ratio. Pacing caused significant decrease in the R/T ratio, but there was no significant difference in the R/T ratio between different pacing sites. (P <0.001). (figure 2)

Conclusions:
Pacing- regardless of position- causes the S-ICD perceived R:T ratio to fall below the eligibility screening threshold in most patients, increasing the risk of TWO and inappropriate shocks. Caution needs to be exercised and tailored programming of both devices is key for concomitant use of LPs and S-ICDs.
Abstract 10371: Trajectories of Glycemic Control and Early Markers of Cardiovascular Disease in Canadian Adolescents with Type 1 Diabetes: The Cardea Study
Authors: Harnois-Leblanc Soren , McNealis Vanessa , Friedrich Matthias G , Van Hulst Andraea , Nuyt Anne Monique , Bigras Jean-Luc , Barnett Tracie A , Benedetti Andrea , Mathieu Marie-Ève , Drapeau Vicky , Sylvestre Marie-Pierre , Henderson Mélanie
Published: March 2022

Introduction:
Adequate glycemic control can prevent or delay complications of diabetes. Little is known about the role of glycemic control trajectories on early markers of CVD in youth.

Hypothesis:
Poor glycemic control trajectory will be associated with increased vascular ageing and altered myocardial structure.

Methods:
Cross-sectional study of 100 youth with T1D recruited at Sainte-Justine Hospital, Canada. Trajectories of glycated hemoglobin (Hb
A1c
) were estimated with group-based trajectory modelling, using 3 to 6 values retrieved from patients’ medical records over the preceding year. Vessel stiffness was assessed by pulse-wave velocity (PWV) and distensibility by velocity time integral (VTI) and acceleration during a brachial flow-mediated dilation test. Cardiac magnetic resonance assessed ejection fraction, left ventricular mass indexed by height (LVMH), papillary mass and wall thickness. Linear regression models were estimated between Hb
A1c
trajectory group and each CVD marker, with age, sex, ethnicity and duration of diabetes at baseline as covariates.

Results:
Mean age was 16.4 yrs (SD=1.3) and median diabetes duration 6.1 yrs (IQR=3.4-10.4). Forty-eight percent were girls, 63% were White and 43% had overweight/obesity. Three trajectories of Hb
A1c
were identified (
Figure
). Compared with the optimal trajectory, belonging to the high Hb
A1c
trajectory was associated with a lower ejection fraction (beta [95% CI]: -2.1% [-6.2; 2.0]), LVMH (-6.3 g/m [-15.4; 2.8]) and papillary mass (-1.2 g [-2.2; -0.2]). Youth in the high Hb
A1c
trajectory displayed higher PWV (0.2 m/s [-0.4; 0.8]) and lower VTI (-2.9 cm/s
2
[-8.4; 2.7]) and acceleration (-63.6 cm/s
2
[-188.7; 61.5]) compared with the optimal trajectory group.

Conclusions:
Poor glycemic control is linked to increased vascular ageing and a lower myocardial mass in youth with T1D, which is consistent with our prior finding that youth with T1D exhibit a lower myocardial mass than healthy controls.
Abstract 10376: Sudden Death in the Formerly Incarcerated
Authors: Fordham Matthew J , Gupta Suhani , Zhang Jason , Lin Feng-Chang , Keen Susan K , Simpson Ross J
Published: March 2022

Introduction:
Poor health and premature death are potential concerns among released prisoners. Our aims are to assess the risk of sudden death and the prevalence of modifiable risk factors in formerly incarcerated sudden death victims compared to matched living controls.

Methods:
From 2013-2015, out-of-hospital deaths aged 18-64 in Wake County, North Carolina (NC) that were reported by emergency medical services were screened to adjudicate 399 sudden death victims. Using the publicly available NC Department of Public Safety database, the 399 victims and 1,114 race- and sex-matched living patients from a regional medical center were screened for history of incarceration. Demographics and clinical comorbidities were abstracted from medical records, death certificates, and autopsy reports. Multivariate modeling was performed to analyze incarceration status and comorbidities.

Results:
Sudden death victims with incarceration were predominantly male (91% vs 66.4%, p=0.004) and Black (57.6% vs 33.1%, p=0.043). Compared to living controls, victims were more likely to have a history of incarceration (8.3% vs 4.3%, p=0.0026) and had twice the odds of incarceration (95% CI 1.3 to 3.2, p=0.003). Sudden death victims with a history of incarceration were more likely than victims without incarceration to have a history of substance abuse (51.4% vs 13.7%, p<0.001), alcohol abuse (48.5% vs 19.4%, p=0.003), type 2 diabetes (45.5% vs 25.7%, p=0.02), stroke (18.2% vs 5.5%, p=0.007), and mental illness (78.8% vs 51.6%, p=0.005). After adjusting for differences in demographics and comorbidities (age, diabetes, CAD, CKD, chronic renal disease, and any mental illness) significant differences in incarceration rates did not persist between sudden death victims and community controls (OR 1.2, 95% CI 0.7 to 2.2, p=0.442). However, after adjustment individuals with any mental illness had significantly higher odds of sudden death (OR 5.3, 95% CI 4.0 to 7.0, p<0.001).

Conclusions:
History of incarceration is associated with traditional cardiovascular risk factors, mental health conditions, and risk of sudden death. Improvement in transitional healthcare services following incarceration has the potential to reduce the incidence of sudden death among former prisoners.
Abstract 10378: A Novel Selectively Flexible Mitral Annuloplasty Ring Designed Based on Human Imaging with Superior Performance in Hemodynamics, Biomechanics, and Annular Dynamics - A Comprehensive Bench to in vivo Large Animal Analysis
Authors: Zhu Yuanjia , Imbrie-moore Annabel M , Park Matthew H , Cork Tyler E , Wilkerson Robert J , Tran Nicholas , Marin-Cuartas Mateo , Baker Sam , Tada Yuko , Mullis Danielle , Wang Vicky , Ethiraj Sidarth V , Madira Sarah , Anilkumar Shreya , Lucian Haley , Morris Kimberly , Mulligan Jack , Kim Ok , Shudo Yasuhiro , Ennis Daniel , Woo Y J
Published: March 2022

Introduction:
We designed a novel mitral annuloplasty ring based on healthy human imaging to allow for the mitral valve (MV) annular conformational changes while restricting the anteroposterior (AP) distance. The objectives were to evaluate ex vivo biomechanics of the novel ring and to validate the annular dynamics after ring implantation in vivo.

Methods:
Cardiac MRI exams were obtained for 3 healthy volunteers. The MV annulus was tracked (Fig. A-C). Based the imaging data, a novel ring was manufactured (Fig. D-F). An ex vivo annular dilation model of mitral regurgitation was used in a left heart simulator (Fig. G, H) to measure hemodynamics and chordal forces at dilated baseline and after repair using the novel, rigid, and flexible rings in 5 porcine MVs. Novel (n = 6) or rigid rings (n = 5) were implanted into male Dorset sheep. Pre- and post-operative cardiac MRI exams were analyzed.

Results:
Repair using the novel, rigid, and flexible ring reduced regurgitation fraction from 30.0 ± 5.8% at dilated baseline to 4.7 ± 2.7%, 2.4 ± 3.2%, and 17.8 ± 10.0% (
p
< .0001,
Fig. I-N
). Peak forces on the primary chordae decreased after ring annuloplasty repair (
p
< .0001,
Fig. O
). The novel ring also showed lower peak forces compared to the rigid ring (p = .03) in secondary chordae (
Fig. P
). MV annular motion was preserved in vivo using the novel ring but restricted to a planar geometry using the rigid ring (
Fig. Q-S
). Annular height to intercommissure ratio at midsystole were similar pre-repair (0.2 ± 0.1) and after novel ring repair (0.2 ± 0.0,
p
= .89). The variance of AP distance during the cardiac cycle was similar between the novel (0.4 ± 0.3) and rigid ring (0.5 ± 0.1,
p
= .58).

Conclusions:
This novel mitral annuloplasty ring demonstrated excellent capability in reducing AP dimension and repairing regurgitation with a superior chordal force profile while facilitating the annular flexible motion. Future studies will focus on evaluating repair durability and effect on left ventricular remodeling.
Abstract 10383: Patent Ductus Arteriosus Stent versus Blalock-Thomas-Taussig Shunt for Initial Palliation of Cyanotic Congenital Heart Disease with Ductal Dependent Pulmonary Blood Flow: Results of a Meta-Analysis
Authors: Tseng Stephanie Y , Truong Vien , Peck Daniel , Kandi Sneha , Brayer Samuel , Jason Don P , Mazur Wojciech , Hill Garick D , Ashfaq Awais , Goldstein Bryan H , Alsaied Tarek
Published: March 2022

Introduction:
In patients with cyanotic congenital heart disease (CHD) and ductal-dependent pulmonary blood flow (DDPBF), initial palliation may include patent ductus arteriosus (PDA) stent or Blalock-Thomas-Taussig shunt (BTTS). This meta-analysis aimed to compare outcomes after PDA stent and BTTS.

Methods:
A comprehensive search of PubMed and Embase databases was performed. Newcastle-Ottawa tool assessed risk of bias in observational studies. Odds ratios and hazard ratios were pooled. Adjusted hazard ratios controlled for covariates and assessed time to event in survival analysis. Meta-analysis was performed using DerSimonian-Laird random-effects models.

Results:
Six retrospective observational studies were included, all low risk of bias. Of 757 patients, 243 (32.1%) had PDA stent and 514 (67.9%) had BTTS. There was no significant difference in mortality between PDA stent (HR 0.71; 95% CI: 0.26-1.93, p=0.50; I
2
=54%) and BTTS. PDA stent was associated with lower risk of complications (OR 0.45; 95% CI: 0.25-0.81, p=0.008; I
2
=0%) and post-procedural mechanical circulatory support (OR 0.27; 95% CI: 0.09-0.79, p=0.02; I
2
=0%). PDA stent was associated with shorter intensive care unit (-4.03 days; 95% CI: -5.99 to -2.07, p<0.001; I
2
=66%) length of stay (LOS), hospital LOS (-5.54 days; 95% CI: -9.20 to -1.88, p=0.003; I
2
=78%) and duration of mechanical ventilation (-3.41 days; 95% CI -5.29 to -1.52, p<0.001; I
2
=88%). There were no differences in pulmonary artery growth or hazard of unplanned reinterventions to treat cyanosis between groups.

Conclusions:
In this large meta-analysis of cyanotic CHD and DDPBF, initial palliation with PDA stent or BTTS demonstrated similar risks of mortality and unplanned reintervention to treat cyanosis. PDA stent was associated with fewer complications and shorter hospital LOS. Given limitations inherent to observational study, this analysis supports the development of a randomized clinical trial in this population.
Abstract 10384: Continuous Blood Pressure Monitoring During Six-Minute Walk Test and the Hemodynamic Response in Patients with Pulmonary Hypertension
Authors: Pattock Andrew M , Kersey Cooper B , Kim Michelle M , Ghoreshi Kayvon , Stafford Patrick , Gomez Domitilo , Baruch Martin , Mihalek Andrew , Mazimba Sula , Kwon Younghoon
Published: March 2022

Introduction:
The six-minute walk test (6MWT) is frequently performed in patients with pulmonary hypertension (PH) to assess exercise capacity. Systolic blood pressure (SBP) values and variation during 6MWT may hold prognostic significance, but technologic limitations have precluded routine measurement. We used a novel device for continuous SBP monitoring during 6MWT and analyzed the relationship with PH severity.

Methods:
Caretaker®, an FDA-approved wireless continuous noninvasive BP device that uses pulse decomposition analysis was worn during 6MWT in patients with and without PH. We compared SBP values before, during, and after 6MWT. A repeated-measures ANOVA was used to compare SBP between groups.

Results:
Of the 80 patients tested, fifty patients (62.5%) demonstrated adequate signal quality for SBP monitoring. SBP varied significantly with the 6MWT in the PH group (N = 26; before vs. during vs. after; 129.1 [18.7] vs. 126.7 [18.6] vs. 140.3 [23.5] mmHg, p = 0.0006), but not in the non-PH group (N = 24; 136.1 [17.6] vs. 137.8 [17.9] vs. 143.1 [20.0] mmHg, p = 0.16). In the PH group, SBP variation while walking was inversely correlated with baseline pulmonary artery systolic pressure (PASP) (R = -0.47, p = 0.039,
Figure 1
).

Conclusions:
Continuous, clinic based SBP monitoring was feasible in nearly two-thirds of patients undergoing 6MWT. SBP response during walking differed between patients with and without PH and may provide clinically relevant insight into a patients exercise response. In patients with PH, change in SBP during 6MWT was inversely correlated with baseline PASP, suggesting dysregulated exertional hemodynamic response in patients with severe PH.
Abstract 10386: Supervised Machine Learning for Relating Echocardiographic Parameters to Invasive Pressure Measurements in Pediatric Diastolic Function Assessment
Authors: Nguyen Minh B , Dragulescu Andreea , Chaturvedi Rajiv , Fan Chun-po S , villemain olivier , Friedberg Mark K , Mertens Luc L
Published: March 2022

Introduction:
Diagnosing diastolic dysfunction (DD) non-invasively in children is challenging as no validated pediatric diagnostic algorithm is available. The aim of this study is to use machine learning (ML) to identify a model that integrates echocardiographic measurements to predict invasive hemodynamic markers of DD in children.

Methods:
We enrolled children with Kawasaki disease, heart transplant, aortic stenosis, and coarctation of the aorta undergoing left heart catheterization. We obtained simultaneous invasive and echo DD measurements. We applied random forest (RF) algorithms to develop separate models for each cath marker (time constant of isovolumic relaxation (Tau), LVEDP, and -dP/dt max) and used demographics, diagnosis, and echo features as inputs. Model approximation was done using a regression tree with the top ranked features of each RF model to improve model interpretability (Figure 1). Spearman correlations were also assessed.

Results:
59 children were included. Spearman correlations were low. However, the RF models' adjusted R
2
values in predicting Tau, LVEDP, and -dP/dt max are 0.62, 0.51, and 0.83, respectively. A representative ML-generated tree for LVEDP is shown in Figure 2. The most important features were propagation velocity (Vp) for Tau; E/Vp ratio for LVEDP; and systolic global longitudinal strain rate for -dP/dt max. Model approximation showed that a Vp < 42 cm/s predicted a Tau > 39 ms, and an E/Vp > 2.4 predicted an LVEDP > 13 mmHg.

Conclusions:
Predicting invasively measured diastolic parameters with echo data may be improved using ML algorithms. Model approximation may help better interpret the complex interactions in ML models.
Abstract 10389: Identifying High-Risk Clinical Phenogroups of Pulmonary Hypertension Through a Clustering Analysis
Authors: Rambarat Paula , Zern Emily K , Wang Dongyu , Zarbafian Shahrooz , Liu Elizabeth E , Wang Jessica K , McNeill Jenna N , Andrews Carl T , Pomerantsev Eugene V , Diamant Nathaniel , Batra Puneet , Lubitz Steven A , Picard Michael H , Ho Jennifer E
Published: March 2022

Introduction:
The classification and management of pulmonary hypertension (PH) is challenging due to clinical and hemodynamic heterogeneity of patients. We sought to identify distinct phenogroups of PH that are at particularly high-risk for adverse events.

Methods:
A hospital-based cohort of patients referred for right heart catheterization between 2005-2016 with PH (mean pulmonary artery pressure > 20 mmHg at rest) were included. Key exclusion criteria were shock, cardiac arrest, cardiac transplant or valvular surgery. K-prototypes, an unsupervised clustering algorithm, was used to cluster patients into subgroups based on 11 clinical covariates. The optimal number of clusters was determined using the silhouette method.

Results:
Among 5208 patients with mean age 64 (SD 12) years, 39% women, we identified 6 phenogroups when clustering on baseline clinical comorbidities (
Table 1
). Phenogroups 2 and 4 had the greatest baseline prevalence of heart failure (both) and diabetes (group 4). Over a median follow-up of 6.3 (IQR 3.6 to 9.8) years we observed 2182 deaths and 2002 major cardiovascular events (MACE). Phenogroups 2 and 4 had the highest risk for future adverse events including death (age and sex adjusted HR 1.33, 95% CI 1.05-1.68 and 1.42, 95% CI 1.13-1.77, each compared with the lowest risk group 3 respectively) and MACE (HR 5.97, 95% CI 4.83-7.38 and 4.06, 95% CI 3.30-4.99, compared with group 3 respectively;
Figure 1
).

Conclusions:
Cluster-based analyses identify patients with PH and specific comorbid cardiovascular burden that are at higher risk for adverse clinical outcomes. Further studies are needed to better understand clinical heterogeneity among patients with PH.
Abstract 10390: Transcatheter and Surgical Aortic Valve Replacement in Children with Congenital Heart Disease: An Institutional Experience
Authors: Robertson Dwight M , Despres Marlayna , Boucek Dana , Martin Mary Hunt , Gray Robert G , Griffiths Eric , Eckhauser Aaron , Ou Zhining , Lambert Linda M , Williams Richard V , Husain Adil
Published: March 2022

Introduction:
Surgical approaches have historically been the mainstay for aortic valve replacement in children and adults, while transcatheter approaches have been increasingly utilized in adults with rare use in children. We hypothesized that short-term outcomes for native aortic valve replacement are comparable between the surgical (SAVR) or transcatheter (TAVR) approach in children.

Methods:
Patients
<
21 years who had native SAVR or TAVR between January 2010 to April 2020 at our institution were included. Analysis focused on short-term outcomes for ages 10-21. SAVR and TAVR were compared using a composite outcome score (stroke within 6 months, readmission within 30 days, death). Pre- and post-procedural characteristics were compared using chi-squared test or Wilcox rank sum test as appropriate.

Results:
Of 77 patients included, 46 were 10-21 yrs (30 SAVR, 16 TAVR). Mean follow-up was 3.7 yrs for the SAVR group and 1.7 yrs for the TAVR group. There was no significant difference in the composite score between groups (3 SAVR, 2 TAVR; p = 1). Patients in the SAVR group were more likely to have undergone concomitant surgical intervention (e.g., Konno procedure, mitral valve repair/replacement, etc.) and have longer hospital stays (Table 1). Death in the SAVR group was secondary to patient non-compliance with recommended medications and follow-up, resulting in severe aortic stenosis with cardiogenic shock and respiratory failure. Death in the TAVR group was secondary to endocarditis of the valve and associated stroke, which converted from ischemic to hemorrhagic following surgical intervention.

Conclusion:
Our study suggests similar short-term outcomes for TAVR and SAVR in children and young adults
>
10 years of age. Long-term studies are essential in the pediatric population to fully explore the option of transcatheter aortic valve replacement as an alternative to surgical aortic valve replacement.
Abstract 10391: Elevated Plasma Branched-Chain Amino Acids Level Promotes Atherosclerosis Progression by Facilitating Macrophage Polarization Toward M1 Phenotype That Results in the Increase of Inflammation
Authors: Zhao Shuai , Lian Kun , Li Chengxiang
Published: March 2022

Introduction:
Few studies have reported that whether elevated plasma branched-chain amino acids (BCAA) level is causally related to atherosclerosis (AS) and the mechanism involved.

Methods:
First, the plasma BCAA level of 258 atherosclerotic cardiovascular disease (ASCVD) patients and 188 normal people was measured. Second, plaque volume, stability and inflammation of AS mice were evaluated. Third, we assayed BCAA level, catabolism-promoting genes and inflammation in the circulating monocytes of ASCVD patients and abdominal macrophages of AS mice. Fourth, inflammation and macrophage polarization were evaluated in BCAA catabolic deficient RAW 264.7 cells. Finally, mitochondrial hydrogen peroxide (mtH
2
O
2
), nuclear H
2
O
2
and High mobility group box 1 (HMGB1) levels in RAW 264.7 cells were measured and RAW 264.7 cells-overexpressing catalase targeted to mitochondria (MCAT), nucleus (NCAT) and HMGB1KD RAW 264.7 cells were built to detect their effect on macrophage polarization.

Results:
First, we found that plasma BCAA level was an independent risk factor of ASCVD. Second, we also found plasma BCAA level was elevated in AS mice, which led to the increase of plaque volume and instability, as well as inflammation. The growth of plaque instability was characterized by increased macrophage amounts and decreased smooth muscle cells (SMCs) and collagen contents. Conversely, when plasma BCAA level was lowered, the above phenomena could be reversed. Third, elevated plasma BCAA level resulting from BCAA catabolic defect occurred in the monocytes of ASCVD patients and the abdominal macrophages of AS mice, which increased inflammatory response by promoting the polarization of macrophages toward M1 phenotype. Fourth, elevated BCAA level-mediated macrophage polarization toward M1 phenotype was regulated by increasing mtH
2
O
2
level to induce secretion of HMGB1 by increasing nuclear H
2
O
2
level. Finally, the improvement of BCAA catabolism of macrophages alleviated AS progression in mice.

Conclusions:
Our data demonstrates that elevated plasma BCAA level is an independent risk factor of ASCVD and promotes AS progression, indicating that plasma BCAA level might be a therapeutic target for ASCVD.
Abstract 10395: Did Prescription Practice Change After Publication of a Landmark Trial for Children and Young Adults with Marfan Syndrome
Authors: Robertson Dwight M , Truong Dongngan , Cox Daniel , MINICH Luann , Carmichael Harris , Ou Zhining , Williams Richard V , Selamet Tierney Elif Seda S
Published: March 2022

Intro:
The Pediatric Heart Network (PHN) trial of β-blockers (BB) vs. angiotensin receptor blockers (ARB) for aortic root dilation in Marfan Syndrome showed similar efficacy, but its impact on prescribing practices is unknown. We hypothesized there would be an increase in single and combination use of BB and ARB after publication in 2014.

Methods:
Prescription data (2007-2016) were derived from outpatient encounters (IBM Marketscan) for children and young adults aged 6 mo to 25 yrs diagnosed with Marfan Syndrome who had ≥4 encounters with an adult or pediatric cardiologist or geneticist. Excluding 2014 as washout, data were divided into 2 time periods: 2007-2013 and 2015-2016. Categories included BB, ARB, angiotensin converting enzyme inhibitors (ACEI), combination (BB/ARB and/or BB/ACEI), and no drug use. We performed interrupted time-series analysis to assess the immediate level change and the change in slope for the prescription trend. We reported odds ratios (OR) and 95% confidence intervals (CI) from logistic regressions with generalized estimating equation methods to account for correlation of prescriptions within subjects.

Results:
Of 1499 patients (mean age 14.1 yrs, 59% female), BB had a downtrend [OR 0.91 (0.89, 0.93), p<0.001] and ARB trended higher [OR 1.12 (1.07, 1.18), p<0.001] 2007-2013, while combination, ACEI, and no drug use remained stable. There was no immediate effect after publication (2013-2015). Although the trend persisted for BB and ARB use (see Figure), the change in slope was not significant (2015-2016). Combination, ACEI and no drug use remained consistent.

Conclusions:
In short term follow-up, the impact of the PHN trial on prescription practices for aortic root dilation in Marfan Syndrome in children and young adults did not reach statistical significance. This may be due to early adoption of ARBs with subsequent confirmation of their usefulness. Longer term data are needed to fully explore the trial’s impact on practice change.
Abstract 10400: The Role of Patient, Community, and Healthcare System Factors in Variability of Hospital Readmissions After Myocardial Infarction
Authors: Saef Joshua , Kochar Arshneel S , Riggs Jennifer , Montgomery Robert A , Martyn Michael , Reed Grant W , Cremer Paul , Kim Yuli Y , Tang Wai Hong , Menon Venu
Published: March 2022

Introduction:
The Hospital Readmissions Reduction Program (HRRP) penalizes hospitals by reducing Medicare (CMS) reimbursement for those institutions with higher rates of readmissions following hospitalizations for myocardial infarction (MI). Understanding the contributors to readmission following MI hospitalization can identify meaningful areas for intervention. We examine whether community and patient or healthcare system factors contribute more to variability in MI readmissions.

Methods:
We compiled CMS hospital data on MI readmissions, CMS physician reimbursement data, and 2020-21 County Health Rankings (Credit: University of Wisconsin). The outcome was the ratio of a hospital’s MI readmissions to MI discharges. Physician/healthcare system factors included total number of cardiac subspecialists, presence of all subspecialties, and the mean proportion of reimbursed charges. Patient and community factors included mean Hierarchical Condition Category (HCC) risk score (quantifies expected healthcare costs for CMS beneficiaries based on ICD-10 coding), median household income, the proportion of residents reporting no physical activity, and access to food stores. Models were created using linear regression. Model of best fit was determined using R
2
, AIC, BIC in model training data and mean absolute prediction error (MAPE) and root mean square prediction error (RMSE) in test data.

Results:
The linear regression model incorporating community and patient factors explained greater variability in MI readmission rates and performed with greater accuracy in the test data (R
2
0.21; AIC -40.2; BIC -5.1; MAPE 0.030; RMSE 0.042) than the model incorporating physician/healthcare system factors (R
2
0.04; AIC 170.0; BIC 195.0; MAPE 0.033; RMSE 0.045). HCC score, level of physical activity, median household income, and number of cardiac specialists were associated with significant effect sizes on the outcome.

Conclusions:
At a county level, community and patient factors appear to contribute more to variability in hospitals’ MI readmission rates. Further analyses should explore other community, patient, and provider factors that contribute. The HRRP does not account for community or patient factors, indicating its limitations.
Abstract 10401: Uptake and Predictors of SGLT2i in Patients with Type 2 Diabetes and Cardiovascular Disease
Authors: Ozaki Aya F , Ko Dennis T , Chong Alice , Fang Jiming , Austin Peter , Stukel Therese , Booth Gillian , Tu Karen , Udell Jacob A , Atzema Clare , Naimark David , Jackevicius Cynthia A
Published: March 2022

Introduction:
While sodium glucose cotransporter 2 inhibitors (SGLT2i) improve cardiovascular outcomes in type 2 diabetes (T2D) and cardiovascular disease (CVD), their uptake in clinical practice in this population is unclear. Therefore, we evaluated trends in SGLT2i use and identified predictors of use in patients with concomitant T2D and CVD.

Methods:
We conducted an observational study using population-based health data in Ontario, Canada from 4/2016-3/2020 of patients ≥65 years old with a first diagnosis of T2D plus CVD. In each yearly cohort, we estimated the prevalent use of SGLT2i (≥1 prescription) within 1 year, including by demographic and comorbidity subgroups. In the overall cohort, we used multivariable logistic regression models to identify factors associated with SGLT2i use.

Results:
We identified 208,303 patients with T2D and CVD [median age 74.0 years (IQR 68.0-80.0); 63.5% male]. The proportion of patients dispensed an SGLT2i increased over time, from 7.0% in 2016 to 20.1% in 2019. In 2019, use in those ≥75 years was 50% lower than those <75 years (12.9% vs. 28.3%;p<.0001), and use in those without chronic kidney disease (CKD) was 50% higher than those with CKD (22.0% vs. 15.0%;p<.0001); although SGLT2i use increased in all groups over time. Independent factors associated with increased odds of SGLT2i use were HbA1c ≥8 vs. <7 (OR 3.33, 95%CI:3.22-3.46), use of 2+ non-insulin antihyperglycemic agents (OR 2.63, 95%CI:2.56-2.71), and an endocrinologist visit in prior year (OR 1.50, 95%CI:1.45-1.55). Those >75 years (OR 0.39, 95%CI:0.38-0.40), with high frailty score (OR 0.38, 95%CI:0.35-0.42), or serum creatinine 1.4-2mg/dL vs. <1.4 (OR 0.55, 95%CI:0.52-0.57) were less likely to use SGLT2i.

Conclusions:
In a real-world population of T2D and CVD, only 1 in 5 patients used an SGLT2i, although use increased over time. Markers of worse diabetes control were associated with increased SGLT2i use, while markers of more comorbidity were associated with less use.
Abstract 10402: H
2
FPEF Score as a Prognostic Tool to Predict Mortality and Hospitalization in Adults with Normal Left Ventricular Ejection Fraction and Dyspnea: A Systematic Review and Meta-Analysis
Authors: Del Rio-Pertuz Gaspar , Triana Abel , correa jose , Rios Jackie , Abohelwa Mostafa , Parmar Kanak , Elmassry Mohamed , Argueta-Sosa Erwin E
Published: March 2022

Introduction:
The score “H2FPEF’’ has been described as a tool to predict heart Failure with Preserved Ejection fraction (HFpEF). The scoring criteria and interpretation are as follows: 0 or 1, exclude HFpEF; 2-5, further examination is needed to confirm the diagnosis; and 6-9, high probability of HFpEF diagnosis. However, predicting the prognosis of patients by using this scoring system is an ongoing topic of interest.

Hypothesis:
H2FPEF score can be used to predict mortality and heart failure (HF) hospitalization in adults with normal left ventricular ejection fraction (LVEF) and dyspnea.

Methods:
We systematically searched Pubmed, Embase, and Scopus for abstracts and full-text articles from inception to May 2021. Studies were included if they evaluated the relationship between a high H2FPEF score (defined as ≥6) and mortality or hospitalization due to HF in adults with normal LVEF and/or dyspnea. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using the random-effects model by DerSimonian and Laird.

Results:
A total of 4 studies were included that had a total of 8071 patients (mean age: 72 years, 49% were females) with an overall mortality of 35%. The relationship between a high H2FPEF score between survivors and non-survivors demonstrated an association with mortality (OR:1.73 CI:1.41-2.11 p<0.01. Figure 1.). The association to mortality persisted in the subgroup analysis of patients who already had the diagnosis of HFpEF and in patients evaluated with unexplained dyspnea, (OR:1.55 CI:1.22-1.96 p<0.01. Figure 2.), (OR:2.02 CI:1.49-2.74 p<0.01 Figure 3.) respectively. In addition, a high H2FPEP was associated with HF related hospitalizations (OR:1.70 CI:1.26-2.29 p<0.01. Figure 4.).

Conclusions:
A high H2FPEF score is associated with mortality and HF hospitalization irrespective of the presence of a known HFpEF diagnosis. This could help identify a population that may warrant more aggressive monitoring and management strategies.
Abstract 10405: Associations Between Ivig Dose and Outcome of Kawasaki Disease Patients in Acute Phase
Authors: Suzuki Takanori , Michihata Nobuaki , Saito Kazuyoshi
Published: March 2022

Background:
The standard treatment of Kawasaki Disease (KD) is intravenous immunoglobulin (IVIG) 2g/kg and aspirin. However, the most effective dosage of IVIG to prevent coronary artery abnormalities (CAA) is not known. The purpose of this study was to identify the dose of IVIG for KD patients in acute phase using a national inpatient database in Japan.

Method:
We used the Diagnostic Procedure Combination database to identify KD patients treated with IVIG between 2010 and 2017. We used multiple logistic regression models to estimate the risk of proportion of CAA and IVIG resistance, and multiple regression models to estimate the difference of length of stay and medical cost. In all models, demographic characteristics and comorbidities were adjusted for as covariates. We generated restricted cubic splines models with the same covariate specification as the fully adjusted model with five knots to examine non-linear associations between IVIG dose and the different outcomes.

Results:
We extracted 42,331 eligible patients from the database. The age was 1.7 years (1.6 SD), male 24432 (58%), and body weight 11.1kg (4.9 SD). The mean dose of IVIG was 1.7g/kg (1.3 SD), proportion of CAA 1325(3.1%), and medical cost 6596 USD (5160- 8689). We found a reverse J-shaped association between the dose of IVIG and the proportion of CAA. IVIG dosage was also found to have U-shaped associations with length of stay and medical costs.

Conclusion:
When IVIG dose was less than 2g/kg, the proportion of CAA increased, and the length of stay and medical cost also increased; when IVIG dose was more than 2g/kg, the length of stay and medical cost could be increased, and 2g/kg IVIG was considered appropriate for the initial treatment of KD.
Abstract 10413: Clinical Outcomes with Metformin and Sulfonylurea Initiation Among Patients with Heart Failure and Diabetes: From Get with the Guidelines-Heart Failure
Authors: Khan Mohammad S , Solomon Nicole , Devore Adam D , Sharma Abhinav , Felker G.Michael , Hernandez Adrian F , Heidenreich Paul A , Matsouaka Roland , Green Jennifer B , Butler Javed , Yancy Clyde , Peterson Pamela , Fonarow Gregg C , Greene Stephen J
Published: March 2022

Background:
Metformin and sulfonylureas are frequently prescribed to patients with diabetes for glycemic control. The impact of these drugs on cardiovascular outcomes among patients with heart failure (HF) and diabetes is unclear.

Methods:
We evaluated Medicare beneficiaries hospitalized for HF in the Get With The Guidelines-HF Registry between 2006 and 2014 who had diabetes and Part D prescription coverage (n=29,181). Patients with glomerular filtration rate <45 mL/min/1.73m
2
or prescribed metformin or sulfonylurea prior to admission were excluded. In separate analyses for metformin and sulfonylurea, patients filling new prescriptions for each therapy within 90 days of discharge were compared with patients not prescribed therapy. Multivariable models landmarked at 90 days evaluated associations between therapy and mortality and hospitalization for HF (HHF) outcomes over the following 12 months. Secondary analyses were stratified by ejection fraction (EF) ≤40% vs >40%.

Results:
Of 5,852 patients, 454 (7.8%) were newly prescribed metformin and 504 (8.6%) were newly prescribed sulfonylurea. After adjustment, metformin prescription was associated with reduced risk of composite mortality/HHF, but not individual components
(Table)
. Associations with mortality/HHF and HHF endpoints were driven by reduced risk among patients with EF>40% (all p for interaction ≤0.04). Sulfonylurea prescription was independently associated with increased risk of mortality, HHF, and the composite. Associations between sulfonylurea prescription and endpoints were consistent regardless of EF (all p for interaction >0.12).

Conclusion:
Among US patients hospitalized for HF with comorbid diabetes, initiation of metformin was independently associated with improved clinical outcomes, driven by improvements among patients with preserved EF. In contrast, sulfonylurea initiation was associated with adverse clinical outcomes regardless of EF.