bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12851: Prognostic Value Of Late Gadolinium Enhancement In Patients With Idiopathic Dilated Cardiomyopathy
Authors: Zhang Robert S , Cao Yulei , Evans Peter T , Han Yuchi
Published: April 2022

Introduction:
The aim of this study was to investigate the association between the extent and pattern of late gadolinium enhancement (LGE) and outcomes in a large idiopathic dilated cardiomyopathy (DCM) cohort

Hypothesis:
LGE is associated with worse outcomes in patient with idiopathic dilated cardiomyopathy

Methods:
In this study, we retrospectively identified all patients with idiopathic DCM who underwent cardiac MRI (CMR) from 2015 to 2020 at a single large academic center. The association between the pattern of LGE and event free survival from transplantation and mechanical circulatory support was analyzed using Kaplan Meier analysis and the log-rank test.

Results:
Of a total of 286 patients (64% male, 62% Caucasian) with idiopathic DCM who underwent CMR, LGE was detected in 59 (21%) patients. Of the patients with LGE, 7 (3%) patients had free-wall LGE, 40 (14%) had septal LGE and 12 (4%) had both septal and free wall LGE. All patients had linear mid-wall LGE and two patients had both linear-mid wall and sub-epicardial involvement. The presence of septal LGE was associated with older age (58 ± 12 vs 47 ± 16 years, p<0.001), a lower LV ejection fraction (EF) (30% ± 12 vs 37% ± 12, p<0.001), higher LV end-diastolic volume index (146 ± 47 vs 126 ± 36 ml/m
2
, p<0.001), lower right ventricular EF (37% ± 13 vs 42% ± 13, p=0.013), higher LV mass index (82 ± 25 vs 73 ± 24 g/m
2
, p=0.013), higher incidence of LBBB (29% ± 16 vs 16% ± 29) and atrial fibrillation (31% vs 17%, p=0.021). Over a mean follow-up time of 26 ± 19 months, patients with septal LGE were less likely to experience event free survival from heart transplant or durable mechanical circulatory support (Figure 1, p=0.009).

Conclusions:
The presence of septal LGE in this large idiopathic DCM cohort is associated with worse outcomes. Additional research is needed to determine whether these findings will aid clinical management of these patients.
Abstract 12852: Acute Stenting Of Persistently Stenotic Cervical Lesions In Atherosclerotic Tandem Occlusions Does Not Improve Neurologic Outcomes
Authors: Troja Weston , Weyhenmeyer Jonathan , Villelli Nicolas W , Bohnstedt Bradley
Published: April 2022

Introduction:
There is a lack of consensus regarding the endovascular management of atherosclerotic tandem occlusions with persistent cervical stenosis during acute ischemic stroke. The aim of this study was to determine if patients who did not undergo stent placement during thrombectomy had better neurological outcomes.

Methods:
A retrospective analysis of consecutive mechanical thrombectomies for large vessel occlusions at our institution was conducted from 2011 to 2019. Atherosclerotic tandem occlusions with persistently severe cervical stenosis (&ge 70%) before and after thrombectomy were identified and evaluated for clinical baseline data, perioperative data, and post-thrombectomy outcomes such as re-occlusion rates and modified Rankin score at 90 days.

Results:
A total of 69 patients with atherosclerotic tandem occlusions were identified. Thirty-five patients underwent acute carotid stent placement. Thirty-four patients did not receive a stent and had persistently severe cervical stenosis after thrombectomy. Demographics, NIHSS, reperfusion rates, and length of stay were similar between groups. Post-thrombectomy carotid re-occlusion (p = 0.434) and neurological outcomes (p = 0.82) were similar between stented and non-stented groups at 90 days after discharge.

Conclusions:
The acute stenting of persistently severe cervical stenosis in atherosclerotic tandem lesions does not reduce the rate of re-occlusion and is not associated with better neurologic outcomes at 90 days after discharge. Randomized clinical trials are warranted to determine a standardized means of endovascular management of atherosclerotic carotid lesions in tandem occlusions during acute ischemic stroke.
Abstract 12858: Outcomes And Healthcare Utilization Among Patients Admitted With Heart Failure On Medicaid Versus Private Insurance
Authors: Arif Abdul Wahab , Gupta Shweta , Mian Arooj , Mehdi Syed A , Vij Aviral
Published: April 2022

Background:
Heart Failure is the most common diagnosis for cardiovascular admissions across the US. We undertook this study to assess differences in outcomes and healthcare utilization in patients less than 65 years old, who were admitted for HF, on Medicaid (HF-M) versus Private Insurance (HF-P) using a national sample.

Methods:
The National Inpatient Sample (NIS) was queried to identify all Medicaid and Private-Insurance admissions in adults <65 years old with a principal admission diagnosis of HF between 2016-2018. We studied socio-demographic differences, medical comorbidities, mortality, length of stay (LOS), total hospital charges (THC). Secondary outcomes included arrythmia, cardiogenic shock, cardiac arrest, respiratory failure, sepsis, septic shock, and acute kidney injury. Statistics were performed using the t-test, linear regression, univariate and multinomial logistic regression using Stata 16 software.

Results:
We identified 329,755 Medicaid and 247,685 Private-insurance admissions with HF. Compared to HF-P, HF-M patients were significantly younger, more likely to be women, Black or Hispanic, more likely to hail from zip-codes with lowest income quartiles. HF-M patients were also significantly more likely to be treated at large sized and urban teaching hospitals. Rates of diabetes, dyslipidemia, CAD and obesity were higher in HF-P patients while COPD, CKD, dialysis and VTE were higher in HF-M patients. Rates of hypertension, smoking and old stroke were similar between groups. More patients died in HF-P group (1.6% vs 1.2%, p<0.0001) and when adjusted for socio-demographics and medical comorbidities, the aOR for death was 0.75 (95%CI 0.67-0.83, p<0.001) in favor of HF-M group. All secondary outcomes were significantly higher in HF-P group except cardiac arrest. HF-P patients also reported higher mean LOS (5.7 vs 5.5 days, p<0.0001) and higher THC ($72,966 vs $59,384, p<0.0001).

Conclusion:
Our study shows that HF-M patients perform better as compared to HF-P patients, in terms of mortality and healthcare utilization when admitted to the hospital with a principal diagnosis of HF. In current times, when a healthcare reform is urgently needed, this study adds support if the country explores designing a single payor healthcare system.
Abstract 12861: Adjoining Myofibroblasts Disrupt Impulse Propagation of Myocardial Tissue via Connexin 43-Mediated Heterocellular Gap Junctional Coupling
Authors: Tsuji Yumika , Ogata Takehiro , Matoba Satoaki , Tanaka Hideo
Published: April 2022

Introduction:
The composite population of myofibroblasts (MFBs) and cardiomyocytes (CMCs) is known to alter impulse conduction in the heart. A previous study reported that structural disruption between cardiomyocytes by fibrosis or myofibroblast proliferation causes conduction delay due to insulating or reducing the intercellular current. However, it is unknown whether and how the conduction is altered when the myocardial tissue faces adjoining with MFB-rich granulation tissue, like,
e.g.
, the border zone of myocardial infarcts during infarct healing.

Objectives:
To clarify the influence of heterocellular gap-junctional coupling between CMCs and MFBs by calcium imaging in an injured myocardial tissue-mimicking model in which CMCs connect with MFBs via microporous membranes.

Methods:
Fluo-8 fluorescence patterns of impulse propagation were spatiotemporally imaged (27 x 18.9 mm, 333 frames/s, 32 °C) in neonatal rat CMC monolayers cultured on the upper sides of the Boyden chamber (pore diameter, 8 μm) of which MFB monolayer was co-cultured on the reverse sides (CMC-MFB group). For comparison, CMC monolayers were cultured on both membrane sides (CMC-CMC group).

Results:
During consecutive pacing at 1 - 4 Hz, CMC monolayers showed concentric propagation from the pacing site with slower conduction velocity (CV) and more irregular wavefronts in a frequency-dependent manner. The conduction slowing and its non-uniformity were more remarkable in the CMC-MFB group than in the CMC-CMC group. We confirmed the gap junction coupling between the upper CMC and lower MFB layers using co-immunostaining and calcein staining. Heptanol, gap junction inhibiter, inhibited calcein dye transfer from the upper CMC layer to the lower MFB layer. The knockdown of Cx43 in MFBs on the reverse layer improved the delay of CV and non-uniformity in the CMC-MFB group.

Conclusions:
In this study, we clarified the electric association between adjoining MFBs and CMCs. Our observations suggest that adjoining MFBs slow down conduction velocity and disrupt conduction uniformity on CMCs via Cx43-mediated heterocellular gap-junctional coupling between CMCs and MFBs.
Abstract 12867: Neuromodulation Of The Renal Nerves In Spontaneously Hypertensive Rats
Authors: Salman Ibrahim M , Ameer Omar Z , Hassan Sarah F , McMurray Sheridan , Sridhar Arun , Hsieh Yee-Hsee , Lewis Stephen J
Published: April 2022

Introduction:
Hypertension is a global burden. Renal denervation has been touted as a possible therapeutic strategy for the treatment of hypertension. However, neuromodulation of the renal nerves’ traffic in hypertension has yet to receive a similar attention.

Aim:
This study investigated cardio-respiratory responses to renal nerve stimulation in a genetic model of hypertension, the spontaneously hypertensive rat (SHR).

Methods:
In pentobarbital-anesthetized male SHRs (n = 9), the left renal nerve was stimulated 5 times (5-6 minutes apart) at 5 Hz, 0.5 ms, 0.5 mA for 30s. Mean arterial pressure (MAP), heart rate (HR), left renal cortical blood flow (CBF) and cortical vascular resistance (CVR), hindquarter aortic blood flow (ABF) and vascular resistance (AVR), upper (UAP) and lower (LAP) airway pressure, airway flow (AF), airway resistance (AR), respiration rate (RR) and diaphragmatic EMG (dEMG) were measured and averaged.

Results:
Cardiovascular responses to renal nerve stimulation were characterized by reductions in MAP, HR, CBF and AVR, which were associated with increases in ABF and CVR. Respiratory responses to renal nerve stimulation, on the other hand, demonstrated increases in AF, RR and dEMG, decreases in AR and no change in UAP and LAP.

Conclusions:
Under hypertensive conditions, the renal nerves not only modulate cardiovascular function but also improve respiratory function. These studies suggest that neuromodulation of the renal nerves may offer a therapeutic alternative for hypertensive patients.
Abstract 12870: Transesophageal Echocardiography to Guide Correct Implantation Site of the Leadless Pacemaker
Authors: Gheyath Bashaer , Khatiwala Roshni V , Malhotra Pankaj , Fan Dali
Published: April 2022

Introduction:
MICRA™ (Medtronic USA) leadless pacemakers are used to avoid complications common to conventional pacemakers, but there is still a 4% risk of complications (e.g., cardiac perforation, tamponade, and embolization). Septal device implantation may decrease risk, but helpful cardiac landmarks (e.g., tricuspid valve, pulmonary valve (PV)) are not seen under fluoroscopy. There is little guidance regarding alternative intra-procedural (IP) imaging. We studied the spatial relationship of the MICRA™ to cardiac landmarks via transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE).

Methods:
Our prospective observational study included 23 patients undergoing MICRA™ implantation with TEE (
Table 1)
. Interventricular septal placement was confirmed by fluoroscopy, electrocardiography (ECG) and TEE. Distances between the device and cardiac landmarks were measured by TTE and TEE and analyzed with ECG parameters during pacing (
Fig 1A, Fig 1B
).

Results:
Septal positioning of the device was achieved in all patients. TEE transgastric (0-20/90-110°) and lower mid-esophageal (40-60/130-150° with biplane) views best visualized device position. The aortic valve (AV) in the TTE apical 5 chamber view was used as a surrogate for RV apex to PV distance. With appropriate septal deployment, QRS morphology showed earlier R wave transition and 44% increased QRS width (
Table 1
).

Conclusions:
TEE can guide appropriate leadless pacemaker septal implantation, and correlates with QRS pacing morphology. Further studies are required to establish reference ranges of distances from the device to cardiac landmarks to prove optimal device deployment.
Abstract 12878: Left Atrial Labyrinth in Fetal Hypoplastic Left Heart Syndrome is Associated With Worse Prognosis
Authors: Qasim Amna , Doan Tam , YIlmaz Furtun Betul , Morris Shaine A
Published: April 2022

Introduction:
Hypoplastic left heart syndrome (HLHS) with restrictive atrial septum (RAS) is associated with poor outcomes. A subset of patients with HLHS have cor-triatriatum sinister, which often presents as a complex network of folds within the LA, which we referred to as LA-labyrinth (Figure 1).

Hypothesis:
We hypothesize that LA labyrinth is associated with worse clinical outcomes among those with a RAS compared to patients without LA-labyrinth.

Methods:
In a single-center retrospective cohort study, all fetuses with HLHS (2010-2020) were included. Fetuses with inadequate images, no follow-up data, pregnancy termination, or postnatal comfort care were excluded. All fetal echocardiograms were reviewed. RAS was defined as a ratio of forward/reverse pulmonary vein velocity time integral (PV-VTI) < 5. Kaplan-Meier analysis from 20 weeks’ gestation was performed to evaluate freedom from the primary outcome (fetal demise, postnatal death, or transplant) by 1-year postnatal life (72 weeks total).

Results:
Of 241 fetuses with HLHS, 179 met inclusion criteria. RAS was present in 43 (24%), and LA-labyrinth was seen in 9 (5%), of which 6 also had RAS. Freedom from death/transplant was worse in RAS with LA labyrinth vs. no LA labyrinth and vs. HLHS-unrestrictive atrial septum (Figure 2). Among those with RAS, those with LA labyrinth were more likely to have early atrial septal intervention (4/6 vs 10/34), and to die or need transplant (4/6 vs 12/37, p = 0.022).

Conclusions:
LA-labyrinth is seen in HLHS with RAS and is associated with worse outcomes than RAS alone. The unique left atrial anatomy may need to be taken into consideration during prenatal counseling and postnatal planning.
Abstract 12903: Frailty Did Not Diminish the Prognostic Advantage of Guideline-Directed Medical Therapy in Elderly Patients With Heart Failure (Multicentral Cohort Study)
Authors: Abe Takuro , Jujo Kentaro , Saito Katsumi , Kazuya Saito , Saito Hiroshi , Kentaro Iwata , Konishi Masaaki , Kitai Takeshi , Kasai Takatoshi , Wada Hiroshi , Momomura Shinichi , Kagiyama Nobuyuki , Kamiya Kentaro , Masashi Yamashita , Hamazaki Nobuaki , Kohei Nozaki , Maekawa Emi , Ako Junya , Matsue Yuya
Published: April 2022

Introduction:
Numerous previous trials revealed that the effectiveness of guideline-directed medical therapy (GDMT) including beta-blockers (BB) and renin-angiotensin system inhibitors (RASi) in patients with heart failure (HF) with reduced/mildly reduced ejection fraction (HFr/mrEF). Although frailty is world-wide concern in HF patients, the impact of physical frailty on the prognostic effect of GDMT in geriatric patients with HFr/mrEF remains unclear.

Hypothesis:
The prognostic impact of GDMT in HF patients depends on whether they exhibit physical frailty or not.

Methods:
From the combined HF database of FRAGILE-HF and Kitasato cohort, 1,054 hospitalized HFr/mrEF patients
>
65 year-old were analyzed. Of them, 715 patients (32%) were on the full GDMT (both BB and RASi) at discharge, and 604 patients (57%) were diagnosed as physically frail. The primary endpoint was death from any cause.

Results:
In the whole population, patients on GDMT at discharge showed a significantly lower 1-year mortality than those without GDMT in Kaplan-Meier analysis (Log-rank, p=0.0014). In multivariable Cox regression analysis including GWTG-HF risk score, log-transformed BNP, left ventricular ejection fraction, anemia and NYHA class, the superiority of GDMT was confirmed (HR 0.53, 95%CI: 0.36-0.78). The rate of risk reduction for 1-year mortality by receiving GDMT was comparable between patients with and without physical frailty after adjusting covariates (HR: 0.57 and 0.59, respectively). Additionally, the prognostic advantages of GDMT were not significantly interacted by the presence or absence of physical frailty (P for interaction=0.77).

Conclusions:
GDMT was associated with the improved prognosis in geriatric hospitalized HFr/mrEF patients regardless of the frailty. We should not hesitate the administration of GDMT in elderly patients even if they are physically frail.
Abstract 12904: National Trends in Aortic Aneurysm and Dissections in Patients With Marfans and Ehlers Danlos Syndrome
Authors: Aranda-Michel Edgar , Brown James , Serna-Gallegos Derek , Yousef Sarah , Dai Yancheng , Wang Yisi , Sultan Ibrahim
Published: April 2022

Introduction:
Marfans (MFS) and Ehlers Danlos syndrome (EDS) predispose patients to acute aortic dissections and aneurysms. Given their low incidence, there are limited large cohort data on mortality.

Hypothesis:
Type of connective tissue disorder will predict mortality in patients with Marfans or Ehlers Danlos Syndrome.

Methods:
The National Inpatient Sample (NIS) was reviewed for adults (>18 years) with MFS and EDS between 2010-2017 via ICD9 and 10 diagnosis codes. Procedure codes were used to distinguish patients undergoing open aortic repair or TEVAR (thoracic endovascular aortic repair) for either a type A aortic dissection or an aortic aneurysm. NIS weights were used to project the 20% NIS volume to national volumes. Univariable logistic regression was used to determine independent predictors of mortality.

Results:
A total of 19,567 patients were identified. The incidence of MFS and EDS was 18 and 22.4 per 100k, respectively. After applying the inclusion criteria, there were 2,553 MFS and 180 EDS patients. EDS patients were more likely older (50 vs 42, P<0.001) and women (47% vs 33%, P<0.001). MFS patients were more likely to have a type A aortic dissection (44% vs 31%, P<0.001). However, in the total cohort, aortic aneurysm was more frequent (56%). EDS patients were more likely to undergo TEVAR (2.8% vs 1.0%, P=0.03). MFS patients were more likely to have a complication of acute kidney injury (P=0.02) whereas EDS patients were more likely to have bowel ischemia (P=0.05). The majority of patients (89%) were treated at urban teaching hospitals. There was no statistical difference in mortality between the MFS and EDS cohorts (4.6% vs 2.8%, P=0.26). In logistic regression for death, aortic aneurysm (HR 0.14, P<0.001) and elective admission (OR 0.28, P=0.003) were protective for death whereas aortic dissection was a predictor for mortality (OR 7.31, P<0.001). Type of connective tissue disease or sex were not significant predictors.

Conclusions:
National level estimates show low mortality for patients with MFS and EDS presenting to the hospital with an aortic dissection or aneurysm. Differences in age and sex can guide aortic surveillance for these patient populations, leading to potentially decreased risk of acute aortic dissections and hospital mortality.
Abstract 12906: Atypical Atrial Flutter Ablation Utilizing Ultra-High-Density Activation Mapping
Authors: Romanowicz Katherine C , Athar Muhammad W , COSTEA ALEXANDRU I
Published: April 2022

Background:
The incidence of atypical atrial flutters has increased in recent years, especially in the presence of atrial scar following valvular surgery involving atriotomy, surgical Maze procedures, or prior extensive radiofrequency ablation for persistent atrial fibrillation. Most are poorly tolerated and ablation is indicated. Ablation of these arrhythmias has historically presented a challenge with lower success rates and high recurrence rates. The concurrent advancement of mapping technology and the development of high-density mapping has allowed for more precise representation of the substrate of these complex arrhythmias.

Objective:
In this series, we report our experience utilizing CARTO3 Coherent mapping and the Confidense module (Biosense Webster, Inc.) in ablating complex left atrial flutters.

Methods:
Twelve patients with atypical atrial flutters and past history of valve surgery, Maze procedure, or persistent atrial fibrillation ablation were identified. We created ultra-high-density 3D maps using 3,000-6,000 points collected with a multipolar PENTARAY catheter and CARTO3 Coherent mapping. Radiofrequency ablation was performed at the narrowest isthmus using a Thermocool Smarttouch SF ablation catheter. Ambulatory ECG monitoring or CIED interrogation following the 3-month blanking period was utilized to evaluate the effectiveness of therapy.

Results:
In all cases, we had success in identifying and ablating small conduction gaps resulting in immediate termination of the arrhythmia. These gaps were not perceptible with voltage mapping and would have led to more extensive ablation and longer procedure time utilizing previous processing systems. Rhythm monitoring at least 3-months post-procedure demonstrated 8 of the 12 patients have not had recurrence of the arrhythmia.

Conclusion:
In our experience, the creation of ultra-high-density 3D mapping utilizing CARTO3 Coherent mapping has allowed for more precise mapping and simplifies the interpretation of arrhythmia mechanisms. Small gaps often responsible for these flutters are now more easily identifiable in comparison to previous mapping systems, facilitating efficient ablation, reducing procedure time, and reducing recurrence rates.
Abstract 12910: Impact of Perioperative Management of Cardiogenic Shock Using Percutaneous Ventricular Assist Device for Cardiovascular Surgery
Authors: Domae Keitaro , Toda Koichi , Hata Masatoshi , Kin Keiwa , Kodani Noriko , yamana fumio , Yoshioka Daisuke , Kawamura Takuji , Masai Takafumi , Miyagawa Shigeru , Sawa Yoshiki
Published: April 2022

Introduction:
Cardiogenic shock (CS) is still most challenging clinical conditions in cardiovascular medicine. Recently, hemodynamic support using percutaneous ventricular assist device (pVAD) demonstrated feasible and safe for CS, however the use of p-LVAD in the perioperative management presenting refractory CS eligible for cardiovascular surgery (CVS) is still unclear.

Hypothesis:
We hypothesize that the perioperative use of pLVAD was safe and effective and allow LV unload that can be associated with the good cardiac recovery.

Methods:
This was a retrospective study including 17 patients admitted at our centers who presented CS and with indication to CSV (average STS score 32.4%), in which p-LVAD was used as a bridge for hemodynamic stabilization. The primary endpoint was the clinical and hemodynamic stabilization before CVS, and the secondary endpoint was cardiac recovery and 30-day mortality.

Results:
The significant increasing of cardiac power output (0.41 to 0.82 W, p<0.05) with titration the dose of inotropes (inotrope score 10.4 to 6.2, p<0.05) was observed. Serum lactate level was also decreased (5.8 to 1.6, p<0.01), which is indicator of tissue perfusion. The perioperative stabilization allowed the 15 patients (88.2 %) to be eligible for scheduled CVS after a median time of 2.0 days under pLVAD. Postoperatively, all patients could wean off p-PVAD with improvement of LVEF (38.6 to 47.4%, p<0.05). 30-day mortality was 17.6 % which was superior to STS score.

Conclusions:
The use of the pLVAD is safe and feasible in patients eligible for CVS presenting refractory CS. It is also effective for clinical and hemodynamic stabilization preoperatively and postoperative cardiac recovery and improvement of clinical outcomes.
Abstract 12911: Outcomes of Transcatheter Aortic Valve Replacement at Teaching versus Non Teaching Hospitals in the United States
Authors: Brown James , Aranda-Michel Edgar , Serna-Gallegos Derek , Gada Hemal , Kliner Dustin , Toma Catalin , Sanon Saurabh , Wang Yisi , Sultan Ibrahim A
Published: April 2022

Introduction:
Transcatheter aortic valve replacement (TAVR) has become widely available across the United States; however, national trends have not been evaluated by hospital teaching status.

Hypothesis:
There will be no differences in outcomes between teaching hospitals (TH) versus non teaching hospitals.

Methods:
This was an observational study of patients undergoing TAVR from 2012-2017, utilizing the Nationwide Readmissions Database with appropriate trend weights to generate national estimates. Codes from the International Classification of Diseases were used to identify patients with a primary procedure code for TAVR. TAVRs were stratified by hospital teaching status, while in-hospital mortality, complications, costs, and 30- and 90-day readmissions were compared between the groups.

Results:
During the study’s timeframe, 123,557 patients underwent TAVR, of which 90% occurred at a TH. The number of TAVRs increased by 744% from 2012 to 2017 (Cochrane-Armitage test, p<0.001), with a larger increase for non-TH. Median age [IQR] was 82.0 [76.0-87.0] and 46.2% were women. Patients undergoing TAVR at a teaching hospital were more likely to have diabetes, dyslipidemia, hypertension, coronary artery disease, congestive heart failure, peripheral vascular disease, and cerebrovascular disease. In-hospital mortality was higher for patients undergoing TAVR at a TH (2.6% vs. 2.2%, p<0.001). After TAVR, there was more stroke (1.5% vs. 0.9%), acute kidney injury (14.6% vs. 11.3%), and myocardial infarction (4.2% vs. 2.8%) in the TH group. TAVR at a TH was associated with higher total cost of care during their index admission (47.9 [37.5-61.9] vs. 44.3 [34.7-58.7] x $1000) and longer length of hospital stay (4.0 [2.0-7.0] vs. 3.0 [2.0-6.0] days). Moreover, patients undergoing TAVR at a TH were more likely to have been discharged to an intermediate care facility or home health care (50.0% vs. 40.9%). 30-day readmissions were higher for the TH group (18.7% vs. 18.0%), while 90-day readmissions were similar across each group (28.4% for the entire cohort).

Conclusions:
While patients undergoing TAVR at a teaching hospital had more comorbidities, they also had higher in-hospital mortality, more postoperative complications, and greater healthcare costs.
Abstract 12927: The Human Ductus Arteriosus Smooth Muscle Cell Transcriptome Indicates a Central Role for Mitochondria in Postnatal Oxygen Sensing
Authors: Bentley Rachel E , Hindmarch Charles C , Dunham-Snary Kimberly J , Mewburn Jeffrey , Snetsinger Brooke , Thebaud Arthur , Lima Patricia , Thebaud B , Archer Stephen L
Published: April 2022

Introduction:
The ductus arteriosus (DA) connects the fetal pulmonary artery and aorta, diverting placentally oxygenated blood from the developing lungs to the systemic circulation. The DA constricts in response to increased oxygen (O
2
) immediately post-partum, resulting in functional DA closure, with anatomic closure ensuing within the first days of life. Failure of DA closure results in patent ductus arteriosus (PDA), a common complication of extreme preterm birth. The DA response to O
2
, though modulated by the endothelium, is intrinsic to DA smooth muscle cells (DASMC). DA constriction is mediated by mitochondria-derived reactive oxygen species, which increase in proportion to PaO
2
. The molecular signature of the DASMC response to O
2
is not well understood.

Methods & Results:
DASMC were isolated from DA obtained from 10 infants at the time of congenital heart surgery. Cells were purified by flow cytometry, negatively sorted to eliminate fibroblasts (CD90+) or endothelial cells (CD31+). DASMC purity was confirmed by α-smooth muscle actin staining. Cells were grown for 96 hours in hypoxia (2.5% O
2
) or normoxia (19% O
2
) and confocal calcium imaging confirmed O
2
-responsiveness of all cell lines: O
2
exposure increased intracellular calcium 18.1%±4.4% and decreased cell length 27%±1.5% relative to hypoxic baseline. RNA sequencing (Seq) of the cells grown in hypoxia and normoxia revealed significant regulation of 1344 genes (corrected p<0.05). Gene Ontology (GO) analysis provided an unbiased assessment of genes differentially regulated by O
2
, revealing enrichment of functional groups including mitochondria, cellular respiration and transcription. Multiple subunits of electron transport chain complex I, NDUF (NADH:ubiquinone oxidoreductase) family genes, are upregulated in hDASMC following normoxia. Upregulated NDUF genes were validated with qPCR (t-test p<0.05): NDUFS5 (Seq = 0.62-fold, PCR = 3.8-fold), NDUFA9 (Seq = 0.8-fold, Seq = 4.3-fold), NDUFA13 (Seq = 0.7-fold, PCR = 6.1-fold), and NDUFS8 (Seq = 0.6-fold, PCR = 7.1-fold).

Conclusion:
This first examination of the effects of O
2
on human DA transcriptomics supports a putative role for mitochondria as O
2
sensors, with mitochondrial subunits as potential future therapeutic targets for PDA.
Abstract 12931: The Association of Depression With Cardiac Rehabilitation Attendance by Age and Sex Among Patients With Myocardial Infarction: Results From the Behavioral Risk Factor Surveillance System
Authors: Zhu Cenjing , Tran Phoebe , Dreyer Rachel P , Lichtman Judith H
Published: April 2022

Background:
Cardiac rehabilitation (CR) is a core component of secondary prevention shown to improve quality of life and reduce all-cause mortality after myocardial infarction (MI). Depression is twice as prevalent among young women (18-44y) versus men with MI and is linked with worse post-MI outcomes, yet information on sex-specific associations of depression and CR attendance is limited, particularly among younger MI patients.

Methods:
Using data from the 2011, 2013, 2015, and 2017 self-reported US Behavioral Risk Factor Surveillance System (BRFSS) surveys, we assessed the association between depression and CR attendance in adults with MI using logistic regression adjusting for sociodemographic factors. We calculated CR rates by sex and age subgroups for MI patients with and without depression. BRFSS survey weighting was applied to all analyses.

Results:
The study included 12,252 MI patients (44.2% women). CR attendance was comparable between MI patients with and without depression (36.1% vs 37.4%, p=0.440) (
Figure 1a
), and the association between depression and CR remained nonsignificant after adjusting for age, sex, race, education, and household income (OR=1.16, 95% CI: 1.00-1.35). CR attendance ranged from 19.0% to 51.0% across age and sex subgroups, with the lowest rate seen among women 18-44y with depression (
Figure 1b
). Women who were 45-64y and 65+y were less likely to attend CR than similarly aged men, regardless of depression status.

Conclusions:
Overall, just over one-third of patients with MI participated in CR, and depression was not associated with CR attendance. We found marked heterogeneity by subgroups, with lower CR rates observed for women across age groups, potentially putting them at higher risk for subsequent adverse cardiac events. Further research is needed to identify barriers leading to sex- and age-specific CR disparities to optimize attendance of post-acute care among subgroups, especially among younger women with depression.
Abstract 12948: Both Electronic and Regular Cigarettes Induce Transcriptional Changes in iPS-Derived Cardiomyocytes
Authors: Basma Hesham , Lowes Brian D , Dhar Kajari , Qiu Fang
Published: April 2022

Introduction:
Cigarette smoking is an important etiology for cardiac diseases and electronic cigarettes are increasing in popularity. In the current study, we sought to assess differential gene expression in iPS-cardiomyocytes after exposure to conventional cigarette smoke extract (CSE) and electronic cigarette extracts (ECE) utilizing direct digital mRNA detection of heart failure targeted genes.

Hypothesis:

Methods:
Human cardiomyocytes derived from iPSCs were acutely exposed for two consecutive days with 2.5% of CSE and ECE. RNAs were isolated and NanoString analysis was used to compare gene expression between groups for 126 heart failure specific genes. NanoString mRNA raw count data were preprocessed and normalized using nSolver 4.0 Analysis SoftwareNano-string of customized target panel was run for mRNA expression of cardiomyocytes with direct exposure to CSE (N=3) and ECE (N=3) and was compared to control (N=3). At least a 1.5-fold change in gene expression with FDR adjusted p<0.05 was considered as significant.

Results:
Five genes were significantly differentially expressed cardiomyocytes exposed to CSE vs control (CETP, ATRLN1, ENOS, C10ORF88 and ERF). In ECE exposed cells, five genes were also significantly differentially expressed compared to control (PDK4, CAV3, PER1, MYH6 and ERF). ERF gene is a transcription factor and protooncogene involved in development, apoptosis, and the regulation of telomerase was significantly overexpressed in cells exposed to both CSE and ECE. Despite different nicotine concentrations in ECE and CSE, no significant gene differences between CSE and ECE were observed.

Conclusions:
ECE and CSE exposure alters transcriptional profiles in iPS-cardiomyocytes compared to controls in heart failure targeted genes. These genes are involved in transcription and circadian regulation, metabolism and contractile proteins. There were no significant differences in transcriptional profiles between ECE and CSE exposed cells.
Abstract 12954: A Genotype-Phenotype Link Between Cardiac Monoamine Oxidase Activity and Arrhythmogenic Potential Using a Translational Approach
Authors: Shi Qian , Hart Alexander , Jatis Andrew , Karlan Nathan , Akhter Shahab , Shih Jean C , Smith Ryan M , Song Long-sheng , Anderson Ethan J
Published: April 2022

Introduction:
Monoamine oxidase (MAO) has emerged as an intriguing drug target for heart disease because of the toxicity of the oxidative catechol metabolites produced. Our group has recently shown that a high rate of MAO activity in atrial myocardium is associated with a greater incidence of postoperative atrial fibrillation (POAF) following coronary artery bypass graft surgery (CABG).

Hypothesis:
Cardiac MAO deficiency lowers arrhythmogenic potential.

Methods and Results:
In a cohort of age-matched CABG patients (N=288, 26% female, 20% African-American), we performed DNA-sequencing analysis of
maoA,B
while assessing maximal MAO-A and -B enzyme activity with norepinephrine (NE) in fresh atrial tissue from a subset (N=110) of these patients. Patients homozygous for
maoA
synonymous variant rs1800464, and
maoB
intron variant rs5905512, had lower NE-supported MAO activity (
Figure 1
, 0 = ref, 1=het, 2=homoz) and lower incidence of POAF (OR 0.6 ± 0.1 and 0.9 ± 0.02, respectively). Mice with cardiomyocyte-specific MAO-A deficiency (cMAOA
-/-
) had 2-fold lower rates of epinephrine/caffeine-induced ventricular tachycardia (VT) compared with wild-type (
Figure 2
, *P<0.05). Moreover, cardiomyocytes from cMAOA
-/-
mice had increased fractional shortening, faster relaxation and shorter Ca
2+
transient duration (P<0.05). Alterations in Ca
2+
handling in the cMAOA
-/-
mice were accompanied by decreased epinephrine-induced phosphorylation of CamKII and ryanodine receptor (P<0.05).

Conclusions:
Collectively, these findings suggest that decreasing MAO activity lowers arrhythmogenic potential in the heart, and that cardiac MAO may be a therapeutic target for POAF.
Abstract 12958: Prognostic Value of Body Composition for Predicting Venous Thromboembolism in Pediatric, Adolescent, and Young Adult Patients With Lymphoma
Authors: Tram Nguyen K , Ettefagh Laila , Chou Ting-heng , Deep Kyra , Hardisky Dariya , Bobbey Adam J , Audino Anthony N , Stacy Mitchel R
Published: April 2022

Introduction:
Body composition (BC) influences chemotherapy toxicity, surgical complication rates, and overall survival in cancer patients. While recent studies have shown the connection between BC and clinical outcomes in adult oncology populations, BC measures are still often overlooked in the pediatric, adolescent, and young adult (AYA) oncology populations. The objective of this study was to determine the effect of BC on the occurrence of venous thromboembolism (VTE) in pediatric and AYA patients with lymphoma.

Methods:
Skeletal muscle (SkM), subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT) volumes were manually segmented at vertebral level L3 from 5 consecutive axial CT images (
Fig. 1A
) acquired in a 5-year retrospective cohort of 78 patients with lymphoma (mean age = 13.3 ± 0.6 years). All CT images were acquired at initial staging of disease. Incidence of VTE, including deep vein thrombosis and pulmonary embolism, was evaluated for 12 months after diagnosis.

Results and Conclusions:
In the first 12 months after diagnosis, 26 of 88 patients (33%) had a VTE event. Patients with VTE had a significantly higher percent of SAT (p = 0.022) and lower percent of SkM (p = 0.036) compared to patients without VTE (
Fig. 1B
). Patients were stratified based on a SkM/SAT cut-off ratio of 0.963, determined using the Receiver-Operating-Characteristic Curve. Patients who were below this SkM/SAT cutoff ratio had a significantly higher probability for VTE in the first 12 months compared to patients who were above the cutoff (log-rank test, p < 0.005) (
Fig. 1C
). This cutoff ratio remained significant after correcting for lymphoma subtype, body mass index, age, and sex using the Cox Proportional-Hazards model. Standard-of-care CT imaging may offer a technique for evaluating BC and predicting outcomes such as VTE in pediatric and AYA patients, thereby offering personalized approaches to cancer care by guiding chemotherapy dosing and nutritional recommendations.
Abstract 12966: Novel, Low-Volume, Point-of-Care Coagulation Test Successfully Detects Anticoagulation Resistance in Hospitalized Patients With COVID-19
Authors: Frydman Galit H , rosovsky rachel P , Lee Jarone , Berger Barry M , Papageorgiou Dimitrios , Mize Ryan , Stefely Jonathan A , Christensen Bianca B , Cone Sullivan Jensyn K , Montgomery Gabriella G , Barranco John P , Piazza Gregory M , Laposata Michael , Van Cott Elizabeth M
Published: April 2022

Introduction:
Severe COVID-19 has been associated with aberrant coagulation factor activities, particularly in patients with a thrombotic event (TE). Management of anticoagulant is critical in the care of hospitalized patients with COVID-19.

Hypothesis:
Evaluation of a point-of-care (POC), functional, clot-time-based coagulation test to detect the anticoagulant effect of therapeutic unfractionated heparin (UFH) in hospitalized SARS-CoV-2-positive patients who developed a TE.

Methods:
An IRB-approved analysis of 36 citrated plasma specimens from 26 SARS-CoV-2-positive patients and 10 matched negative controls was performed. A Clotting Time Score (CTS), a measure of factor-specific inhibition (i.e. anticoagulant activity), was derived for each patient. CTS results were compared with traditional coagulation tests. Five UFH COVID-19 samples with low CTS scores (<10) were spiked with uniform dosing of UFH, low molecular weight heparin (LMWH), apixaban, or argatroban and retested to assess anticoagulation response.

Results:
The CTS detected sub-therapeutic UFH anticoagulation levels more frequently in COVID-19 cases compared with controls (76% vs. 17%). Prothrombin Times, activated Partial Thromboplastin Times, anti-Xa levels, and antithrombin activity did not correlate with each other or with the CTS in the COVID-19 samples. CTS correlated with both FV and Factor X activity (R
2
=0.49, Spearman R=-0.68), which form the prothrombinase complex. The CTS was 94% sensitive and 67% specific for the occurrence of TEs in patients on UFH. CTS demonstrated a consistent anticoagulant response only to argatroban (100%) compared with other anticoagulants (60%).

Conclusions:
The CTS, generated using a novel, low-volume, rapid POC coagulation test is a strong indicator of the therapeutic effect of UFH anticoagulation in COVID-19 patients and may provide a predictive measure of TEs potentially occurring from anticoagulation resistance.
Abstract 12972: Acute Left Main Coronary Artery Thrombosis During Exercise Testing
Authors: Sturzoiu Tudor , Shirani Jamshid
Published: April 2022

Background:
Exercise stress testing (EST) is safe and effective in evaluating suspected coronary artery disease (CAD). Serious complications are rare. We present a unique case of acute left main coronary artery (LMCA) thrombosis during EST.

Case presentation:
A 58-year old man with hypertension and hyperlipidemia presented with two episodes of substernal chest pressure within 2 weeks. He had no known CAD, led an active lifestyle and did not smoke, drink, or use drugs. Initial vital signs, routine labs, troponin, ECG, and echocardiogram (TTE) were normal. EST (Bruce Protocol) was terminated at 3’ 54” due to chest pain, hypotension and down-sloping ST segment depressions in inferolateral leads followed by ST segment elevation in leads V1, V2, aVL and aVR. TTE showed severe hypokinesis of apex and anterior, anteroseptal, and anterolateral walls. Emergent coronary angiography (Figure) revealed complete thrombotic occlusion of LMCA. LMCA was wired and ballooned restoring antegrade flow and resolving ST segment elevation. Minutes later, recurrent ST elevations were noted due to LMCA reocclusion. Flow was restored and patient underwent emergent coronary artery bypass surgery. TTE two days later showed preserved LV systolic function with mild hypokinesis of the LV apex and apical septal wall.

Conclusions:
Pathophysiology of AMI triggered by exercise is only partially understood. Vigorous exercise is shown to increase relative risk of AMI particularly within first hour following exertion. In such a scenario, exercise likely acts as a trigger for plaque rupture in presence of an underlying vulnerable atherosclerotic lesion. Compared to other forms of AMI, those triggered by exercise occur more commonly in men and are more often characterized by total thrombotic occlusion of culprit coronary artery. To our knowledge, acute thrombosis of LMCA has not previously been reported as a complication of EST.
Abstract 12973: Intra-Procedural Change in Platelet Occlusion Time to Predict Hemodynamic and Clinical Outcomes Following Transcatheter Aortic Valve Replacement
Authors: Hecht Sebastien , Bernard Jeremy , Tastet Lionel , Abu-Alhayja’a Rami , Beaudoin Jonathan , Cote Nancy , DeLarochellière Robert , Paradis Jean-Michel , Clavel Marie-annick A , Rodes-Cabau Josep , Pibarot Philippe
Published: April 2022

Background and Objectives:
Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement for the therapeutic treatment of severe aortic stenosis. However, intraprocedural hemodynamic assessment by echocardiography is not always optimal and new tools are needed. A new approach using the blood biomarker measuring platelet occlusion time (CT-ADP) and more specifically its change between the pre-intervention and post-intervention (ΔCT-ADP) could be useful to overcome the lack of accuracy of echocardiography, but also to prevent adverse clinical events following TAVI. The objective of this study is to examine the association between ΔCT-ADP and i) intraprocedural valve hemodynamic performance; and ii) occurrence of all-cause death and rehospitalization for heart failure (HF) in TAVI patients.

Methods:
Three hundred and thirty-eight patients who underwent TAVI at our institute were recruited. Clinical and echocardiographic data were collected before and after the procedure. Two blood samples were collected prior to- and at the end of- TAVI to assess the immediate changes (Δ: pre minus post) in CT-ADP following TAVI. A percentage (Δ/pre-intervention value) was determined for CT-ADP and mean gradient (MG) for each patient.

Results:
Prior to TAVI, 135(40.0%) patients had a prolonged CT-ADP (>180 s). There was a significant but modest correlation between ΔCT-ADP and the change in mean transvalvular gradient immediately after TAVI (r=0.15, p=0.007). A ΔCT-ADP (i.e. decrease) >10% (i.e. median of cohort) was associated with a higher rate of transcatheter valve regurgitation ≥ moderate (0.0% vs 3.0%, p=0.030) following TAVI, and a longer length of hospital stay (7.8±8.3 vs. 9.7±9.0 days, p=0.002). During a median follow-up of 1.2 (1.0-2.4) years, there were 87 clinical events (30 rehospitalizations and 57 deaths). A ΔCT-ADP >10% tended toward higher risk of events in univariable analysis (HR[95%CI]: 1.49[0.94-2.37], p=0.090), but not after adjustment for other risk factors (HR[95%CI]: 1.10[0.53-2.28], p=0.79).

Conclusion:
A >10% decrease in CT-ADP immediately after TAVI is associated with worse hemodynamic outcomes. This association is not independent and appears to be related to other risk factors.
Abstract 13225: In vivo Sino-Atrial Node Mapping in Children and Adults With Congenital Heart Disease
Authors: van Schie Mathijs S , Kharbanda Rohit , Ramdat Misier Nawin , Wesselius Fons J , Taverne Yannick J , Bogers Ad , de Groot Natasja M
Published: April 2022

Introduction:
Sinus node dysfunction (SND) is a common sequel in patients with congenital heart disease (CHD) and encompasses disturbances in sino-atrial node (SAN) impulse generation and/or its propagation from SAN exit sites towards the atrial myocardium. At present, the underlying pathophysiological mechanisms of SND in patients with CHD are incompletely understood. Therefore, we performed epicardial mapping of SAN activity in pediatric and adult patients with CHD undergoing primary surgical correction.

Methods:
Intra-operative epicardial mapping (interelectrode distance 2 mm) of the right atrium (RA) was performed during SR in 12 pediatric patients (0.6 [0.4-2.4] years) and 15 adults (46±14 years) to compare potential characteristics of SAN activation.

Results:
In all pediatrics, SAN activity was solely observed near the junction of the superior caval vein and RA, while SAN activity in adults was observed even up to the middle part of the RA. Within a radius of 8 mm from the SAN exit site, more conduction disorders (11 [8-13] % vs 6 [5-8] %, p=0.011) were seen in adults compared to pediatric patients, while there was no difference in conduction velocity (71 [64-75] cm/s vs 67 [62-75] cm/s, p=0.258). However, within 2 mm of the SAN exit site conduction was significantly slower in adult patients (47 [30-56] cm/s vs 25 [9-50] cm/s, p=0.010). Potential morphology recorded from pediatric patients consisted of a broad monophasic S-wave with high amplitude (4.9 [3.4-6.0] mV) and an R/S ratio close to 1 (0.98 [0.96-1.00]), while the potentials in adults contained smaller S-wave amplitudes (2.6 [1.9-4.2] mV, p=0.014), larger R-wave amplitudes (0.2 [0.1-0.5] mV, p=0.036) and smaller R/S ratio (0.92 [0.87-0.96], p<0.001). In adults, potential duration was substantially longer (45 [37-50] ms vs 66 [60-70] ms, p<0.001) and was more often fractionated.

Conclusions:
For the first time we characterized electrophysiological properties of SAN activation in pediatric and adult patients with CHD. Solely in adults, SAN activation was observed at the middle part of the RA, which may indicate changes in preferential SAN exit site. These novel insights into SAN activation in patients with CHD may partly explain why this population is prone to develop SND relatively early in life.