bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11680: Comorbidity and Cognitive Function Predict Efficiency of a Disease Management Program in Reducing Short-Term Readmission in Heart Failure
Authors: Huynh Quan , Marwick Thomas
Published: March 2022

Background:
Both comorbidity and cognitive impairment are highly prevalent and predictive of outcomes in heart failure (HF). We sought whether these risk factors could identify patients most likely to benefit from a HF disease management program (DMP) to reduce readmission.

Methods:
1363 consecutive HF patients were prospectively followed for 1 month after discharge. Of these, 431 (31%) patients received a DMP (1-month duration, including post-discharge home visits, medication reconciliation, exercise guidance and early clinical review). Primary outcome was all-cause readmission/death at 30-day post-discharge. Charlson comorbidity index (CCI) was calculated based on discharge diagnoses and categorised as mild (CCI≤2), moderate (CCI 3-4) and severe (CCI≥5). Cognitive function was assessed on discharge using the Montreal Cognitive Assessment (MoCA) and classified as normal (MoCA 26-30), low-normal (MoCA 23-25), mildly impaired (MoCA 17-22) and moderate/severely impaired (MoCA≤16).

Results:
28% (386/1363) of patients died or were readmitted within 30 days after discharge. Both CCI (relative risk RR=1.06 [95% CI: 1.03, 1.10] per point) and MoCA (RR=0.95 [95% CI: 0.94, 0.96] per point) were significantly predictive of outcome, with a statistically significant interaction (p=0.032). Cross-classification of CCI and MoCA identified a group of high-risk patients (≥mild cognitive impairment and/or severe Charlson comorbidity index) who had a 2.02-fold higher risk of 30-day readmission/death (34%, 309/903) than patients with mild/moderate CCI and without cognitive impairment (17%, 72/426). The effect size of DMP was significantly stronger (p=0.034) among the high-risk patients (RR=0.62 [95% CI: 0.49, 0.77]) compared to low-risk patients (RR=0.98 [95% CI: 0.61, 1.58]).

Conclusion:
Comorbidities and cognitive impairment strongly predict short-term adverse outcomes in HF and can be used to identify patients who are most likely to benefit from a DMP.
Abstract 11687: Management of Hypertrophic Obstructive Cardiomyopathy Using Septal Coiling
Authors: Addoumieh Antoine , Serauto-Canache Astrid J , Badalamenti Andrew D , Hust Michael A , Arain Salman A , Charitakis Konstantinos , Dhoble Abhijeet , Smalling Richard W
Published: March 2022

Introduction:
Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic disorder associated with dynamic left ventricular outflow tract obstruction (LVOTO). Medical management of HOCM aims at decreasing the outflow tract gradient and improving symptoms. In a subset of patients, septal reduction is necessary to achieve symptomatic relief. Alcohol Septal Ablation (ASA) is an accepted method for septal reduction, though it carries risks of complications including unpredictable ethanol diffusion, complete heart block requiring pacemaker and death. We sought to evaluate septal coil embolization (CE) as another method to achieve hemodynamic improvement in HOCM patients with severe LVOTO.

Method:
We identified 53 HOCM patients that underwent CE at our institution. Baseline septal thickness and LVOT gradients were measured at rest and with Valsalva during echocardiogram (ECHO) and catheterization. Immediate and 2-6 month follow-up post coiling gradients were measured using both modalities and results were compared to baseline. Septal thickness was compared before and after CE. Paired t-test was used to compare pre and post values.

Results:
Mean age was 68, range (31-90) years, 60% were females, 5.6% had prior permanent pacemaker (PPM). Invasive mean gradient (MG) at rest was 56.6 mmHg and immediately post CE was 16.5 mmHg with mean difference (MD) of 40 mmHg (95% CI 10.6-22.4) (p<0.01). Invasive MG following PVC was 123 mmHg pre and 34 mmHg post with MD of 79 mmHg (95% CI 65-111) (p<0.01). ECHO MG at rest was 79 mmHg and 35 mmHg on follow up with MD 44 mmHg (95% CI 27-60) (p<0.01). Septal thickness at baseline was 17.4 mm and was 14.6 mm on follow up with average reduction of 2.8 mm (95% CI 1.5-4.1) (p<0.01). Ninety three percent of patients reported class III-IV NYHA symptoms at baseline, compared to 14% on follow up. A total of 4 patients required new PPM placement and 6 patients required recoiling.

Conclusion:
Our study demonstrated a safe and effective alternative compared to ASA for treatment of severely symptomatic HOCM patients. The use of coils compared to alcohol ablation for septal reduction affords more precise tissue ablation with a concomitant reduction in the need for permanent pacemaker insertion with a similar hemodynamic and symptomatic success rate.
Abstract 11691: Deep Learning Predicts Need for Permanent Pacemaker Following Transcatheter Aortic Valve Replacement
Authors: Adedinsewo Demilade A , Patel Parth , Weston Alexander , Perez-Downes Julio , Salwa Najiyah , Suliman Rayan , Pollak Peter , El Sabbagh Abdallah , Yamani Mohamad H , Carter Rickey
Published: March 2022

Introduction:
Conduction disturbance after transcatheter aortic valve replacement (TAVR) remains a common complication. Predictive tools to identify conduction disturbance requiring pacing are limited. Our main objective was to develop a deep learning model to predict the need for a permanent pacemaker.

Hypothesis:
An electrocardiogram (ECG) based deep learning algorithm can predict the need for permanent pacemaker post TAVR.

Methods:
We evaluated patients who had TAVR at Mayo Clinic between June 2010 and May 2021. Digital ECGs done on the TAVR date or within 24 hours post procedure were partitioned into training, validation, and testing datasets. We trained a deep learning algorithm on the training data and optimized hyperparameters against the validation data. All model performance metrics are based on the reserved test data that were estimated once model architecture was optimized. Need for permanent pacemaker, defined as pacemaker placement due to development of conduction disturbance post TAVR and at least 1% ventricular pacing on device interrogation done at least 2 weeks post pacemaker implantation, was the training target.

Results:
A total of 3021 patients were evaluated for inclusion and 2,407 cases were available for modeling (exclusions: prior pacemaker (n=419), unsuccessful TAVR (n=27) and no ECG within the pre-specified period (n=168)). Overall, the median age was 82 (Q1: 76, Q3: 86) and 41% were female. In the withheld test data, 15% had a permanent pacemaker with at least 1% ventricular pacing. The algorithm detected the need for pacemaker in the test set with an AUC of 0.83 (95% CI: 0.73 to 0.92). Accuracy, sensitivity, specificity, positive and negative predictive were 80%, 72%, 81%, 41% and 94%, respectively.

Conclusions:
This study demonstrates the ability of a deep learning model based on ECG data to assist in making the decision to implant a pacemaker following TAVR with a high negative predictive value. Larger validation studies are warranted.
Abstract 11693: When a Parachute Fails: A Rocky Landing to Heart Transplant
Authors: Jafari Lua , Cruz Daniel , Nsair Ali , Fishbein Michael C , Chonde Meshe , Schwitzer Emily , Zhang Jessica , Yang Eric H
Published: March 2022

A 71 year-old man with heart failure, porcelain aorta, and mitral regurgitation presented for heart transplant evaluation. He was in cardiogenic shock requiring inotropic support. An echocardiogram showed a dilated left ventricle, severely reduced systolic function, restricted mitral valve leaflet motion, an elevated mean transmitral gradient, and severe mitral regurgitation. The differential of mixed stenotic and regurgitant mitral valve pathology included rheumatic heart disease and congenital mitral valve anomaly. Hemodynamic management of cardiogenic shock in the setting of mixed mitral valve disease presented unique challenges due to a narrow therapeutic window of optimal preload, afterload reduction, inotropic support, and chronotropic control. He was not a candidate for percutaneous mitral valve interventions or surgery. A porcelain aorta made him high risk for vascular complications with mechanical circulatory support. His course was complicated by worsening shock requiring escalation of inotropes, rapid atrial fibrillation, and recurrent episodes of acute pulmonary edema. Ultimately, he underwent an orthotropic heart transplant. A transesophageal echocardiogram at the time of transplant suggested a parachute mitral valve, where all chordae appeared be originating from one papillary muscle. However, additional views revealed the presence of two papillary muscles with asymmetric, shortened anterior chordae and a hypertrophied anterior papillary muscle. Findings were consistent with a rare parachute-like asymmetric mitral valve complicated by mild mitral stenosis and severe mitral regurgitation. Examination of the explanted native heart confirmed these findings.This case highlights: 1) complex management of mixed valvular disease in the setting of cardiogenic shock, 2) echocardiographic evaluation of mixed valvular heart disease, and 3) a rare congenital malformation of a parachute-like mitral valve presenting in adulthood.
Abstract 11697: Associations of Soluble Urokinase-Type Plasminogen Activator Receptor and Doxorubicin-Related Cardiotoxicity at Standard Treatment Doses for Breast Cancer
Authors: Chu Jian H , Tung Lillian , cobleigh melody , Rao Ruta , Feinstein Steven B , Usha Lydia , Swoboda April , Reiser Jochen , Okwuosa Tochi M
Published: March 2022

Introduction:
Elevated soluble urokinase type plasminogen activator (suPAR) is a risk factor for renal and cardiovascular (CV) diseases in the general population.

Hypothesis:
We evaluated associations between suPAR and markers of subclinical cardiotoxicity in breast cancer (BCa) patients receiving standard (std) dose doxorubicin (DOX) therapy.

Methods:
We conducted a prospective study of patients at Rush University Medical Center who received std (≤240 mg/m2, 4 cycles) DOX-based chemotherapy for BCa between January 2017 and May 2019. We used mixed effects linear regression models to evaluate associations between suPAR and global longitudinal strain (GLS), NT-proBNP, troponin-I, and hsCRP at baseline, cycle 2 and 4 of DOX, and 3, 6, and 12 months post-DOX treatment with adjustment for baseline demographics, CV risk factors, and CV medications.

Results:
Of the 37 women in our study (age 47±9.3 years, 60% White, 60% left-sided BCa, and 86% adjuvant radiation therapy), the median baseline suPAR was normal at 1.83 (1.31, 3.68) ng/dL. No woman experienced clinically significant cardiotoxicity during treatment (>10% decrease in LVEF to <50%). Baseline GLS was normal (-20.2±2.3%) and the mean change in GLS following DOX therapy was +1.1%. Neither baseline suPAR nor suPAR levels during treatment were associated with GLS, NT-proBNP, hsCRP, and troponin-I (all p<0.05). Surrogate biomarkers of cardiotoxicity such as troponin-I and hsCRP were not associated with GLS (p<0.05) while NT-proBNP was negatively associated with GLS with marginal significance (p=0.04).

Conclusions:
In patients receiving std DOX treatment for BCa ± radiation therapy, there was minimal subclinical cardiotoxicity as evidenced by minimal changes in GLS and lack of associations between cardiac biomarkers and GLS. Furthermore, suPAR was not associated with any of these markers at this std DOX dose for BCa. A normal baseline suPAR level may be associated with low risk for DOX-associated cardiotoxicity.
Abstract 11699: Angiographic Coronary Artery Disease (CAD) and Outcomes in Acute Heart Failure (HF)
Authors: Kosyakovsky Leah B , Ross Heather , Goodman Shaun G , Wang Xuesong , Abdel Qadir Husam , Austin Peter , Lawler Patrick R , Horlick Eric , Czarnecki Andrew , Raslan Ismail , Doumouras Barbara , Farkouh Michael E , Spertus John , Lee Douglas S
Published: March 2022

Introduction:
The association between CAD severity and long-term outcomes in patients admitted with acute HF has not been determined. We characterized the angiographic burden of CAD in patients with acute HF and determined the association between CAD severity and mortality and readmission outcomes.

Methods:
In a multicenter registry of 70 hospitals in Ontario, Canada, we identified acute HF patients who underwent coronary angiography within 14 days of hospitalization (April 2010-March 2013) using stratified random sampling. We selected a cohort of HF patients with a higher a priori risk of CAD, defined inclusively as those with at least one of the following features: previous myocardial infarction (MI), troponin elevation, or angina on presentation. Using angiographic data, we defined obstructive CAD as the presence of > 70% stenosis in at least one epicardial vessel or > 50% left main (LM) stenosis. Multivessel disease (MVD) was defined as the presence of obstructive disease in 2 or more vessels. We determined adjusted associations between coronary anatomy and the rate of cardiovascular (CV) death and readmissions over two years.

Results:
Of 1772 patients undergoing angiography who met inclusion criteria (median age 71 [IQR 62-79] years; 38.5% women), 1039 patients had CAD and 683 had MVD. Increasing CAD burden was associated with higher CV death (Figure). CV death was significantly increased in those with any CAD and HFpEF (HR 2.27, 95%CI; 1.12, 4.59, p=0.023). The rate of CV death was increased in MVD (HR 1.91, 95% CI; 1.32, 2.75, p<0.001) but not single-vessel disease (HR 1.15, 95%CI; 0.75, 1.77, p=0.516), compared to no obstructive CAD. There was no interaction between MVD and HFpEF or HFrEF status for the outcome of CV death (p=0.690). CV readmission was also significantly higher only in MVD (HR 1.28, 95%CI; 1.07, 1.54, p=0.008).

Conclusion:
In patients presenting with acute HF, angiographic MVD is associated with an increased rate of CV death and readmissions over 2 years.
Abstract 11702: Sex Differences in Diabetic Cardiomyopathy: Greater Reduction in Myocardial Perfusion Reserve in Women Than Men Driven by Increased Resting Perfusion
Authors: Yeo Jian L , Gulsin Gaurav S , Brady Emer M , Athithan Lavanya , Arnold Jayanth R , Singh Anvesha , Henson Joseph , Redman Emma , Khunti Kamlesh , Yates Thomas , Ng Leong L , Davies Melanie J , McCann Gerry P
Published: March 2022

Introduction:
Type 2 diabetes (T2D) confers a higher relative risk of heart failure in women than men. Women also have a greater prevalence of heart failure with preserved ejection fraction (HFpEF), linked to microvascular dysfunction. We hypothesize that sex-specific differences are present in the pathophysiological alterations of myocardial structure, function, and perfusion associated with T2D.

Methods:
Cross-sectional case-control study. Participants underwent comprehensive cardiac phenotyping with echocardiography and cardiac magnetic resonance with adenosine stress/rest perfusion. Global myocardial perfusion was derived as a mean of three short axis slices. Image analysis was performed by two observers blinded to all participant information. Statistical analysis was performed with independent-sample T-tests or Mann-Whitney test.

Results:
Individuals with T2D (n=287, 41% female) were compared with age-matched controls (n=87, 41% female). Women with T2D were more obese than men (body mass index 35.7±7.2 vs 32.4±5.3 kg/m
2
, p<0.05). Both women and men with T2D had increased left ventricular (LV) concentric remodelling (greater LV mass/volume ratio), impaired diastolic (higher E/e’) and systolic (lower global longitudinal strain) function compared to controls. LV mass index was significantly increased in women only. Comparing T2D and controls, stress perfusion was not significantly different in both sexes whereas resting perfusion was increased in women (1.4±0.6 vs 1.0±0.4 ml/min/g, p<0.05) but not in men. Consequently, women with T2D have a lower myocardial perfusion reserve than men (2.6±0.9 vs 3.1±0.9, p<0.001).

Conclusions:
In asymptomatic people with T2D, women have increased LV mass index and lower myocardial perfusion reserve than men, driven primarily by increased resting perfusion. These findings support the growing evidence that microvascular dysfunction partly explains the greater risk of HFpEF in women with T2D.
Abstract 11706: His Bundle Pacing and Atrioventricular Nodal Ablation in the Management of Refractory Atrial Fibrillation, a Systematic Review and Meta-Analysis
Authors: Jamal Shakeel , Balian Steve , Qutrio Baloch Zulfiqar , Banga Sandeep , Minhas Abdul , Ijaz Sardar H , Ali Abbas , Wilcox Matthew , Ip John
Published: March 2022

Introduction:
Ventricular rate control is critical in management of atrial fibrillation (AF). When pharmacologic therapy fails in controlling the ventricular rate, atrioventricular nodal ablation (AVNA) and pacing is considered an effective therapy for symptomatic management. His bundle pacing (HBP) is considered a physiologic mode of pacing with AVNA ensuring synchronized activation of right and left ventricles preserving ventricular functioning.

Hypothesis:
HBP and AVNA are feasible, safe, and effective for management of refractory AF.

Methods:
We identified 218 studies after literature review of EMBASE, Medline, and Cochrane databases. Our analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines.

Results:
Six studies (two randomized controlled trials, four observational cohorts) were included in the final meta-analyses. A total of 275 patients underwent attempted permanent HBP and AVNA. The mean age of patients was 70.74 (SD 4.38; 95% CI 62.15-79.32). Mean implant success rate for acute HBP was 94.5% (SD 10.12; 95% CI 74.70, 100.00). Selective HBP was noted in 44.7% (95% CI 12.5-76.9), while Non-selective-HBP was noted at rate of 42.2% (95% CI 10.2-74.2). The mean follow-up duration was 21.71 months (SD 3.77; 95% CI 14.32-29.11). All-cause mortality had a pooled proportion of 0.107 (SD 0.110, 95% CI -0.109-0.323); hospitalization proportion was 0.078 (SD 0.072; 95% CI -0.063-0.219). We noted a significant improvement in left ventricular ejection fraction (LVEF) (Baseline [BL] 41.84%, Follow-up [FU] 53.63%, Standardized mean difference [SMD] 0.646, p 0.028), NYHA class (BL 2.77, FU 1.55, SMD -2.542, p <0.001) and LV end diastolic volume (SMD -0.495, 95% CI -0.721, -0.269, p <0.001). We found a significant rise of threshold potential (BL 1.12 V, FU 1.49 V, SMD 0.393, p <0.001 and an increase between baseline and follow up QRS duration (BL 102.21 ms, FU 106.90 ms, SMD 0.646, p 0.028).

Conclusion:
HBP and AVNA are feasible, safe, effective and has high success rate for management of refractory AF. Further studies are needed to evaluate its role in comparison to left bundle branch area pacing and cardiac resynchronization therapy to evaluate comparative efficacy in refractory AF.
Abstract 11709: The Impact of Hypertension on Disease Expression in Hypertrophic Cardiomyopathy
Authors: Roston Thomas M , olivotto iacopo , Day Sharlene , Parikh Victoria N , Michels Michelle , Ingles Jodie , Semsarian Christopher , Jacoby Daniel L , Colan Steven D , Rossano Joseph , Wittekind Samuel , Ware James S , Zhang Lin , Saberi Sara , Helms Adam S , Ho Carolyn
Published: March 2022

Introduction:
Pressure overload from hypertension (HTN) is an important cause of left ventricular hypertrophy (LVH) in the general population, however its impact on disease expression in hypertrophic cardiomyopathy (HCM), and differences based on the presence/absence of a sarcomeric gene variant are not well characterized.

Hypothesis:
HTN is associated with more prominent manifestations of HCM.

Methods:
Genotyped HCM patients in the Sarcomeric Human Cardiomyopathy Registry were designated SARC+ ((likely) pathogenic sarcomeric variant present) or SARC- and categorized as having HTN (≥140/90 mmHg) or normal blood pressure (nonHTN; <140/90 mmHg). Heart failure (HF; LVEF<35%, NYHA III-IV, transplant/LVAD), ventricular arrhythmias (VA; sudden death, resuscitated arrest, appropriate ICD discharge), atrial fibrillation (AF), and an overall composite (HF, VA, AF, death) were assessed by Kaplan-Meier analysis and logistic regression.

Results:
Of 1706 patients (62% male), 445 (26%) had HTN. Median follow up was 4.2 years. SARC+ nonHTN patients were youngest and SARC- HTN patients oldest (p<0.001; Table). Obstructive physiology was most common in SARC- HTN. SARC+ nonHTN patients had the greatest wall thickness, although absolute differences were minimal (Table). HTN was associated with HF and the overall composite outcome, but not VA or AF (Figure). On multivariable analysis, HTN predicted the HF composite (OR 1.59 [95% CI 1.07-2.26], p=0.02), especially in SARC+ patients (OR 2.34 [95% 1.33-4.11], p=0.003).

Conclusions:
HTN is associated with worse HF outcomes in HCM, especially among SARC+ patients, but has minimal impact on the degree of cardiac remodeling.
Abstract 11714: Strategies for Recruiting Young African American Men for Research
Authors: Aycock Dawn , Oliver Yodit , Steeples Davis Precious , Aycock Dawn M
Published: March 2022

Introduction:
African American (AA) men experience the highest rates of premature mortality and disability than other race/ethnic groups. Stroke is the 8th leading cause of death among young AA men and increases to the 3rd leading cause for older AA men. Despite these realities, AA men continue to be underrepresented in research.

Purpose:
To develop and evaluate a targeted recruitment plan for the Stroke Counseling for Risk Reduction in Men (SCORRE-M) project.

Methods:
A recruitment plan was developed from the researchers’ prior experiences with this population and a review of the literature to identify successful strategies for recruiting AA men for research. The plan was then implemented to recruit AA men, aged 20-35 years, who lived in Georgia and had at least one modifiable risk factor for stroke, to participate in a focus group study to assess their thoughts about stroke and the SCORRE intervention. The goal was to conduct six virtual focus groups of 6-8 men. Respondents who completed the screening survey were asked how they learned about the study and focus group participants were asked what recommendations they had for recruiting young AA men for research.

Results:
Recruitment occurred over 6 weeks. The 81 screening survey respondents were reached by word-of-mouth including snowball sampling (42%), social media (28%), flyers (e-mailed, handouts, posted; 20%), and through prior study participation (7%). Of the 81 respondents, 26 were ineligible (e.g., no risk factors, non-GA resident, age), 41 consented and 32 completed a focus group. During the focus groups, participants recommended incentives (e.g., gift cards, extra credit for students) and using social media to recruit young AA men for future research. They also suggested that learning about the study from a friend, colleague or study participant could motivate participation.

Conclusion:
The recruitment plan was successful in reaching young AA men and enrolling an adequate sample to reach saturation. The findings highlight the importance of social networks and trusted sources for considering research participation. Findings will be used to refine the recruitment plan to implement in a study testing the SCORRE-M intervention in 80 young AA men at risk of stroke.
Abstract 11728: Common Primary Medical Conditions Associated With Secondary Takotsubo Cardiomyopathy
Authors: Li Pengyang , Li Chenlin , Cai Peng , Lu Xiaojia , wei xin , Liu Qi , Pan Su , Dixon Richard A , Wang Bin
Published: March 2022

Introduction:
Secondary Takotsubo cardiomyopathy (TCM) is considered a complication of the patient’s primary medical condition, such as medical, surgical or psychiatric conditions. More than one-third of TCM patients have primary medical conditions and tend to have a worse prognosis. However, there is no comprehensive study on the causes of TCM.

Aim:
We studied the common primary medical conditions in secondary TCM patients and their prognosis.

Methods:
We performed a retrospective analysis using the ICD-10-CM codes for a secondary diagnosis of TCM from the National Inpatient Sample database (2016-2018). We identified the primary medical condition represented by the ICD-10-CM diagnosis codes of secondary TCM patients and aggregated similar codes into clinically meaningful categories using the Clinical Classifications Software Refined. We then compared the mortality rate associated with each condition.

Results:
Of 14,816 patients admitted with secondary TCM, the common primary medical conditions included ‘Sepsis, unspecified organism’ (A419, 13.6%), ‘Chronic obstructive pulmonary disease with (acute) exacerbation’ (J441, 3.6%), ‘Acute respiratory failure with hypoxia’ (J9601, 2.8%), and ‘Pneumonia, unspecified organism’ (J189, 1.8%). After aggregating the individual codes into clinical categories, the common primary medical conditions included septicemia (19.1%), respiratory failure (6.4%), COPD and bronchiectasis (4.6%), hypertension with complications and secondary hypertension (4.2%), and cerebral infarction (3.1%). Primary medical conditions that yielded a higher mortality rate than the overall rate (8.5%) were septicemia (16.5%, P<0.001), respiratory failure (10.7%, P=0.019), cerebral infarction (13.1%, P<0.001), and acute hemorrhagic cerebrovascular disease (26.8%, P<0.001).

Conclusions:
Sepsis is the most common primary medical condition of secondary TCM in admitted patients. Secondary TCM patients with a primary condition of acute hemorrhagic cerebrovascular disease, sepsis, respiratory failure, or cerebral infarction have higher in-hospital mortality than those with other primary medical conditions.
Abstract 11734: 'Whispering Stroke' May Be Very Common in Southeastern African Americans With Uncontrolled High Blood Pressure
Authors: Lee Justin G , Ringel joanna , Baquero Elizabeth , Cummings Doyle M , Halladay Jacquie , Hart Stephanie , Safford Monika
Published: March 2022

Introduction:
High blood pressure (BP) increases risk for stroke, but individuals experiencing stroke symptoms don’t always seek medical attention. Such ‘whispering stroke’ symptoms are reportedly common but have not been examined in African Americans with persistently uncontrolled hypertension.

Hypothesis:
Stroke symptoms without a stroke diagnosis are more common in African Americans with uncontrolled hypertension and are associated with stroke risk factors.

Methods:
We used data from the Southeastern Collaboration to Improve Blood Pressure Control, a randomized controlled trial that enrolled 1596 African Americans from rural AL and NC with persistently uncontrolled hypertension (mean clinic systolic BP >140 mm Hg in the year prior to enrollment, and research-grade BP
>
140/90 mm Hg at enrollment). Stroke symptoms were detected using the Questionnaire to Verify Stroke-Free Status (QVSS) that detects 6 symptoms that could represent stroke. Stroke risk factors included age, blood pressure, diabetes, and cigarette smoking. Multivariable Poisson regression models estimated prevalence ratios (PR) and 95% confidence intervals (CI) for the association between stroke risk factors and report of any stroke symptom without stroke diagnosis.

Results:
The 1239 individuals who reported never having had a stroke or transient ischemic attack (TIA) diagnosis had mean age 57.0
+
12.0 years, 37.4% were men, and 36.1% reported having experienced a stroke symptom. In adjusted models, report of stroke symptoms without a stroke diagnosis were associated with age (PR 0.99, 95% CI 0.99-1.00), systolic blood pressure (PR 1.03, 95% CI 1.00-1.05), diabetes (PR 1.33, 95% CI 1.15-1.55), and current smoking (PR 1.29, 95% CI 1.08-1.55).

Conclusions:
Over one third of this relatively young sample reported stroke symptoms without a stroke diagnosis. Stroke risk factors were associated with stroke symptoms without a stroke diagnosis. Screening for stroke symptoms in individuals with persistently uncontrolled hypertension may be warranted.
Abstract 11738: Outcomes and Readmissions of ST-Elevation Myocardial Infarction With Cardiogenic Shock Patients Supported by Temporary Mechanical Circulatory Support
Authors: Ruiz Ernesto A , Doulamis Ilias P , Kampaktsis Polydoros , Kuno Toshiki , Malik Aaqib , Briasoulis Alexandros
Published: March 2022

Introduction:
Despite advances in the field of temporary mechanical circulatory support (TMCS), in-hospital mortality and morbidity related to cardiogenic shock due to ST elevation myocardial infarction (CS-STEMI) remain high.

Hypothesis:
We sought to investigate readmissions and respective outcomes among patients with CS-STEMI supported by TMCS.

Methods:
The National Readmission Database (NRD) was queried to identify adults who were admitted with CS-STEMI between 2016 and 2018 using the International Classification of Diseases, Tenth Revision (ICD-10) codes. Patients with sepsis, pulmonary embolism, cardiac tamponade, aortic dissection, or missing data were excluded.

Results:
A total of 7,501 patients did not undergo TMCS implantation, while the rest received various types of TMCS (ECMO alone: n=3,659; IABP alone: n=1,268; Impella alone: n=293; ECMO with IABP or Impella: n=525). Readmissions occurred in 16.7% and 25.1% by 30 and 90 days, respectively, with most readmissions occurring in patients requiring ECMO and IABP or Impella (
Table 1
). Multivariable logistic regression revealed age, female gender, diabetes, prior CABG, previous stroke, liver disease and Elixhauser score as risk factors for in-hospital mortality (
Table 2
).

Conclusions:
Our study has unveiled several important factors associated with readmission and mortality. Approaches to identify and prevent readmissions early after TCMS by addressing these factors may lead to lower morbidity, healthcare cost related to readmission, and improved quality of life.
Abstract 11747: Meta-Analysis on Left Atrial Appendage Closure for Atrial Fibrillation During Cardiac Surgery
Authors: Prasad Rohan M , Saleh Yehia , Al-abcha Abdullah , Salam Mohammad Fahad F , Abdelkarim Ola
Published: March 2022

Introduction:
The current guidelines indicate that left atrial appendage (LAA) excision or exclusion during cardiac surgery has a class IIA recommendation for atrial fibrillation. However, the short- and long-term side effects are not well reported or defined.

Methods/Results:
We conducted a meta-analysis of all studies that compared LAA exclusion during cardiac surgery in patients with AF compared to a placebo arm. Five randomized controlled trials (RCTs) and 23 observational studies were included with a total of 540,111 patients. In regards to postoperative stroke/embolic events, the LAA exclusion group had a significantly decreased risk (risk ratio [RR] 0.75; 95% confidence interval [CI] 0.64 to 0.87; p=0.0002, I2=0%). This significantly reduced risk of stroke/embolic events for the LAAC arm was also seen in both the perioperative period (RR 0.82, 95% CI 0.69 to 0.96, p=0.01, I2=41%) and when follow-up was greater than two years (RR 0.70, 95% CI 0.57 to 0.85, p=0.0003, I2=39%). In terms of all-cause mortality, there was no significant difference for the LAA exclusion group in the early perioperative period (RR 0.84, 95% CI 0.56 to 1.28, p=0.42, I2=85%); however, it was significant after a follow-up of greater than two years (RR 0.81, 95% CI 0.68 to 0.97, p=0.02, I2=79%).

Conclusion:
This meta-analysis illustrates a significantly decreased risk of postoperative stroke/embolic events in the perioperative period and after a follow-up period greater than two years. Although the early postoperative all-cause mortality did not show a significant difference between the two groups, there was a significant decreased risk in the LAA excision group after a follow-up duration of two years.
Abstract 11757: Telomerase Treatment Restores Transcriptional Profile and Epigenetic Landscape in Progeria Vascular Cells
Authors: Mojiri Anahita , Xu Qiu , Boulahouache Luay , Morales Elisa , Wang Guangyu , Cooke John P
Published: March 2022

Hutchinson-Gilford progeria syndrome (HGPS) is a model of accelerated vascular aging caused by a
de novo
mutation of a single nucleotide in the Lamin A gene. The accumulation of abnormal lamin A (progerin) in the nuclear envelope induces a nuclear dysmorphology associated with global gene dysregulation, increased expression of inflammatory cytokines, impaired vascular function, and accelerated telomere erosion. These individuals succumb to myocardial infarction or stroke in their mid-teens. We hypothesized that restoration of telomere length might reverse some of the observed derangements in cell function, transcriptional profile and epigenetic alterations. Accordingly, we generated iPSC-derived endothelial cells (ECs) from HGPS children and their unaffected parents. By comparison to the parental controls, HGPS ECs have severely impaired replicative capacity, cellular functions (e.g. NO synthesis, acLDL uptake, network formation, cytokine secretion) and severe telomere shortening. We observed that transient transfection with mRNA encoding human telomerase (hTERT) increases telomere length, restores cellular replicative capacity and improves HGPS-EC functions. Notably, RNAseq studies revealed that that approximately 1200 genes were dysregulated in Progeria, most of which were improved by hTERT treatment, among which approximately 250+ genes were fully normalized. Intriguingly, hTERT treatment reduces DNA damage signals (γH2Ax) and reverses the aberrant chromatin accessibility observed in HGPS-ECs, as assessed by a reduction in the activating histone mark H3K4me3; an increase in the suppressive mark H3K4me3; and normalizes the level of heterochromatin markers HP1, Histone H1 and H3. Preliminary results from ChIPseq studies targeting histone marks characteristic of activators, repressors and enhancers as well as chromatin remodeling proteins; together with Hi-C analyses indicate that there are global changes in topologically associated domains (TADs) and other features of the chromatin landscape in HGPS ECs, which are partially restored by hTERT treatment. We conclude that hTERT treatment has surprisingly global effects on transcriptional profile and epigenetic landscape in addition to telomere extension.
Abstract 11764: Peripheral Artery Disease is an Independent Risk Factor for Heart Failure by ABI
Authors: Bhatt Shubhang K , Murphy Katie , Sykora Daniel , Girardo Marlene , Shipman Justin N , Apolinario Michael , Wennberg Paul W , Liedl David , Shamoun Fadi
Published: March 2022

Introduction:
Patients with concomitant peripheral artery disease (PAD) and heart failure (HF) are known to have increased morbidity and mortality. Though they share common risk factors, the utility of HF screening in patients with PAD remains controversial and without international consensus. We sought to clarify whether PAD is an independent risk factor for HF.

Methods:
We performed a retrospective analysis of adult patients without a history of heart failure who underwent ankle brachial index (ABI) measurement for any indication between 1995-2020. Patients were then stratified by ABI: PAD with low ABI (<1.10), healthy (ABI= 1.10-1.39), and PAD with elevated ABI (>1.39). The associations between PAD and incident diagnosis of heart failure, systolic dysfunction (HF with reduced ejection fraction, HFrEF), and diastolic dysfunction (HF with preserved ejection fraction, HFpEF) were assessed. All patient and outcomes variables were obtained using the institutional electronic health record. Multivariable Cox proportional regression was used to calculate hazard ratios (HR) with 95% confidence intervals (CI) after adjusting for age, sex, hypertension, diabetes, and active tobacco use.

Results:
The cohort included 36,816 patients (median follow-up 4.21 years), of whom 2,116 (5.7%) were diagnosed with HF. Among HF patients, 1,110 (3.0%) had HFrEF and 1,006 (2.7%) had HFpEF. Both low and elevated ABI groups were associated with an increased risk of HF, both HFrEF, and HFpEF. After multivariable analysis, PAD with elevated ABI was associated with higher overall HF risk (HR, 2.36 [95% CI, 2.03, 2.73]) than low ABI (HR, 1.56 [95% CI, 1.40, 1.74]) when compared to normal ABI. Similarly, PAD with elevated ABI was associated with greater risk of HFrEF (HR, 2.37 [95% CI, 1.93, 2.92]) and HFpEF (HR, 1.82 [95% CI, 1.48, 2.25]) than PAD with low ABI (HFrEF: HR 1.77 [95% CI, 1.52, 2.07], HFpEF: HR 1.31 [95% CI, 1.12, 1.52]).

Conclusions:
PAD, especially with elevated ABI, is an independent risk factor for heart failure even after adjusting for common HF risk factors. Our findings support HF screening in PAD patients, but longitudinal data on HF morbidity and mortality is necessary to evaluate the value of this practice.
Abstract 11767: Mechanisms of Nighttime Sudden Death: Arrhythmogenic Potential of Central Nervous System-Affecting Medications
Authors: Visrodia Parth , Ramireddy Archana , Chugh Harpriya , Reinier Kyndaron , Uy-Evanado Audrey , Jui Jonathan , Chugh Sumeet S
Published: March 2022

Introduction:
We have previously reported an independent association between central nervous system-affecting medications (CNS-Meds) and nighttime sudden cardiac death (N-SCD). Hypoxia remains a possible trigger due to somnolence and respiratory depression but direct myocardial effects resulting in lethal arrhythmia have not been explored.

Hypothesis:
Heart rate is significantly lower during sleep, and this increases vulnerability to lethal arrhythmias mediated by prolongation of the QTc interval.

Methods:
From the population-based Oregon Sudden Unexpected Death Study, we evaluated SCD cases that occurred in the community (2002-2016) between 10 pm and 6 am (nighttime) and compared them with daytime cases. Analysis was restricted to subjects with available pre-arrest information regarding prescribed medications. We identified QT prolonging drugs from the comprehensive list at crediblemeds.com. Time of SCA was determined by the 911 call and review of circumstances provided by the emergency medical services. Univariate comparisons were evaluated using Pearson’s chi-square tests and independent samples t-tests.

Results:
A total of 3328 SCD cases (65% male, mean age 67y) met criteria for analysis, and 22% (n=739) were N-SCD. Women were more likely to suffer N-SCD compared to men (25% vs 21%, p=0.002). Anti-depressants (36%) were the most frequently used CNS-Meds among N-SCD cases, followed by pain medications (34%) and anti-epilepsy drugs (26%). Specifically, opioids and serotonin modulators were more likely to be used during N-SCD vs. daytime SCD (34% vs 27%, p<0.01, and 11% vs 8%, p<0.01). Importantly, CNS-Meds that prolong QTc interval were more likely to be used during N-SCD than daytime SCD (48% vs 42%, p<0.01).

Conclusion:
Nighttime SCD was associated with high usage of CNS-Meds especially anti-depressants, pain medications and anti-epileptic drugs. These findings suggest that CNS-Meds may be contributing to nighttime SCD via occurrence of bradycardia-dependent prolonged QTc-associated ventricular arrhythmias. Further investigation is needed to optimize use of CNS-Meds in order to minimize risk of nighttime SCD.
Abstract 11768: Role of Endothelial Shear Stress and Endothelial Shear Stress Gradient in Plaques Associated With Acute Erosion vs. Stable Control Plaques and Relationship Between Plaque Slope and Localization of Plaque Erosion
Authors: Hakim Diaa , Coskun Ahmet U , Maynard Charles , pu zhongyue , Rupert Deborah , Cefalo Nicholas , Sheth Tej , Pinilla-Echeverri Natalia , Olli Kajander A , Siasos Gerasimos , Papafaklis Michail I , Kostas Stefanu , Michalis Lampros K , Croce Kevin , Stone Peter H
Published: March 2022

Introduction:
The role of endothelial shear stress (ESS) in the development of coronary plaque erosion is unknown. High ESS gradient (ESSG) has been hypothesized to promote plaque erosion, but no studies have included matched control stable plaques with the same minimal and reference lumen area (MLA, RLA, respectively). No studies examined the location of plaque erosion (proximal vs distal to MLA of the culprit plaque) related to the max magnitude of upslope vs downslope of the lumen obstruction.

Aims:
(1) to compare ESSG between plaques with erosion and similar control plaques that remained stable; (2) among erosion plaques, to study the effect of max slope steepness (Δ lumen area/frame) up- and down-stream from the culprit plaque MLA on thrombus location.

Methods:
We studied 46 patients from TOTAL and COMPLETE trials who underwent angiography and OCT imaging: 46 arteries: 27 LAD, 6 LCX, 13 RCA. Plaques were divided into Plaque Erosion (n=24) with OCT features of erosion before PCI (17 definite, 7 probable erosion) and matched coronary plaques from separate control patients (n=22) without plaque disruption. Orthogonal angiographic views were used to generate a 3-D arterial reconstruction, and angio centerline was combined with OCT centerline. Local ESS distribution was assessed by computational fluid dynamics and reported in consecutive 3-mm segments. Among the plaque erosions, we calculated the up- and down-slope (Δ lumen area/frame) of lumen obstruction for each culprit plaque.

Results:
See Table

Conclusion:
In plaques with similarly severe obstruction, plaque erosion is associated with higher max ESS and max ESSG vs plaques that remain stable. Proximal plaque erosion/thrombus is associated with steeper plaque upslope vs downslope, and distal plaque erosion/thrombus is associated with steeper plaque downslope vs upslope. Absolute ESSG is higher in downslope vs upslope erosions. These features may help prognosticate individual plaques at risk for future erosion.
Abstract 11770: Clinical Outcomes of Optical Coherence Tomography-Guided Compared With Intravascular Ultrasound-Guided in Low-Risk Percutaneous Coronary Intervention: A Meta-Analysis
Authors: Saleh Yehia , Al-abcha Abdullah , Abdelkarim Ola , boumegouas manel , Abdelfattah Omar M , Abela george , Goel Sachin S , Kleiman Neal S
Published: March 2022

Background:
Axial resolution provided by optical coherence tomography (OCT) is 10 times higher compared with intravascular ultrasound (IVUS), hence OCT could detect fine details such as edge dissections and tissue coverage of stent struts which may be missed by IVUS imaging. Given the lack of robust comparative data, utilization of IVUS or OCT in PCI guidance is mainly based on the operator experience. Recently, multiple studies have compared clinical outcomes between OCT-guided versus IVUS-guided in PCI, thus we performed this meta-analysis.

Methods:
We conducted a meta-analysis of all studies evaluating the clinical outcomes of OCT-guided versus IVUS-guided in low-risk PCI. Studies that included patients with left main disease, bifurcation lesions, long lesions, in-stent stenosis, and patients with history of coronary artery bypass grafting were all excluded. Our primary outcome was major cardiac adverse events (MACE). Secondary outcomes consisted of all-cause death, myocardial infarction (MI), stent thrombosis (ST), and target lesion revascularization (TLR).

Results:
Four RCTs and one propensity-matched observational study were included, with a total of 1,544 patients and a median weighted follow-up period of 1.26 years. Out of the total population, 51% were in the OCT arm and 49% in the IVUS arm. Our pooled analysis showed a similar risk of MACE (OCT 5.0% vs IVUS 4.7%, p=0.90), risk of all-cause death (OCT 2.7% vs IVUS 1.7%, p=0.44), MI (OCT 1.5% vs IVUS 1.3%, p=0.76), ST (OCT 0.3% vs IVUS 0.4%, p=0.66) and TLR (OCT 2.2% vs IVUS 2.6%, p=0.58) between the two groups (Figures 1). Heterogeneity was low in all outcomes (I
2
=0).

Conclusion:
OCT-guided PCI has similar long term clinical outcomes when compared to IVUS-guided PCI in low-risk patients. RCTs with a larger population and longer follow-up periods are needed to confirm these results.
Abstract 11776: Deeper Than the Pandemic: A Retrospective Study Evaluating Outcomes and Mortality Rates on Hospitalized SARS-CoV-2 Negative Patients Presenting With Non-ST Elevation Myocardial Infarction
Authors: Wadhwa Manvir , Singh Harjeet , Kubomoto Scott , Napatkamon Ayutyanont , Hyunju Heineke , Biswas Mimi S
Published: March 2022

Introduction:
The SARS-CoV-2 pandemic has left an ever-lasting impression on the healthcare system, however, less attention has been paid to hospitalized patients without SARS-CoV-2. This study evaluated hospitalized, non- COVID patients presenting with NSTEMI and the affect on trends in mortality rate, initial troponin value, and length of stay compared to the prior non-pandemic period

Hypothesis:
During the pandemic period, length of stay and mortality were increased compared to the prior non-pandemic year.

Methods:
This retrospective multi-center study involved a total of 62,690 patients admitted across 151 hospitals within the HCA network. Eligible patients had a negative SARS-CoV-2 polymerase chain reaction (PCR) upon admission. Using the time period of March - May of both 2019 and 2020, a total of 43,129 patients were investigated in 2019 and 19,561 patients in 2020.

Results:
Initial troponin values were higher in the non-pandemic year of 2019 (3.0 +/- 11.97, std error: 0.0645, p = 0.001) when compared to those of the pandemic period of 2020 (2.69 +/- 9.88, std error: 0.0075, p = 0.001). However, outcomes including mortality and length of stay were found to be worse in 2020 compared to 2019 (Mortality: 7.53% vs 6.65% respectively p= <.001 ) & (length of stay: 6.97 +/- 7.77 days vs 6.00 +/- 7.15 days respectively, p= <0.001). Multivariable Logistic Regression analysis revealed that those NSTEMI patients hospitalized in 2020 had a 13% higher likelihood of mortality compared those in 2019 (OR 1.13 [95% CI (1.05, 1.21), p= <0.001), independent of demographic, comorbidities, or home use statins, anti-platelet agents, or beta blockers. Additionally, length of stay in 2020 was increased by +0.935 days compared to 2019 (std error 0.063, p= <0.001) while holding other factors constant.

Conclusions:
This study demonstrated hospitalized NSTEMI patients without SARS-CoV-2 suffered an increase in mortality rates and length of stay compared to the prior year despite having lower troponin values. Multiple factors may have contributed to the burden faced by hospitals including delays in presentation, lack of outpatient care, and fear of contracting the virus while hospitalized. Further investigation into the impact of the pandemic remains vital for future of healthcare