bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11145: Waist Circumference is a Predicter of All-Cause Death in General Population in Wanshou Lu
Authors: Li Man , Zhu Ping
Published: March 2022

Introduction:
The accumulation of abdominal fat increases risk of metabolic disorders and premature death. Whether waist circumference (WC), a surrogate marker for abdominal adiposity can predict all-cause death in general population is still inconclusive.

Hypothesis:
We assessed the hypothesis that higher level of WC is significantly associated with long-term all-cause death in general population.

Methods:
In this prospective cohort study, a total of 1521 consecutive subjects were included. The subjects. The end point was all-cause death. The association between Waist circumference and outcomes was investigated using multivariable COX regression.

Results:
During a median follow up of 9.1 years, there were 265 patients died. Kaplan-Meier survival estimates indicated that the patients with higher levels of waist circumference (WC> 94cm) had a significantly increased risk of all-cause death (log-rank p<0.001). After adjustment for potential confounders, multiple COX regression models showed that higher level of WC was an independent predictor in developing all-cause death (HR 3.02; 95% CI: 1.88-4.83; p<0.001). We saw a significant increase of AUC in ROC curve after addition of WC to a clinical model, the increase of AUC is (0.586 vs 0.619) for long-term all-cause death (p<0.001). Furthermore, WC significantly improved the net reclassification index (0.629; P=0.001), and integrated discrimination index (0.035; P=0.002).

Conclusion:
In conclusion, higher level of WC is significantly associated with long-term all-cause death. WC may provide incremental prognostic value beyond traditional risks factors.
Key words:
Waist circumference, obesity, all-cause death
Abstract 11164: Better Electromechanical Synchrony During Left Bundle Branch Pacing and His Bundle Pacing as Compared to Right Ventricular Pacing in Atrioventricular Block
Authors: Chen Xueying , SU YANGANG
Published: March 2022

Objectives:
To compare electromechanical ventricular synchrony when pacing from different sites including right ventricular apex pacing (RVAP), right ventricular septum pacing (RVSP), His Bundle pacing (HBP), left bundle branch pacing (LBBP) and RVSP during unipolar pacing from the ring electrode of LBBP lead (RVSP
ring
) in each patient during implantation.

Methods:
Twenty patients with complete atrioventricular block (AVB) indicated for dual-chamber pacemaker implantation were included. Unipolar pacing at different sites including RVAP,RVSP,HBP,LBBP and RVSP
ring
were successively performed in each patient while pacing characteristics and echocardiogram parameters were collected and compared.

Results:
Similar to HBP, narrower paced QRSd was found in LBBP as compared to RVSP
ring
, RVSP and RVAP(p<0.001). LBBP showed comparable pacing parameters to RVAP or RVSP and were significantly better than HBP, with maintained cardiac function. For ventricular mechanical synchrony, TS-12-SD was significantly improved in LBBP(27.00±21.53ms) than RVAP(54.05±34.21ms, p=0.004) and RVSP(47.56±33.26ms, p=0.029) but similar to HBP or RVSP
ring
. Among these pacing strategies, negative values of interventricular mechanical delay(IVMD) were only identified in LBBP(-20.16±18.47ms), significantly different from RVAP(33.68±30.98ms), RVSP (21.68±22.02ms), HBP (4.74±19.04ms) and RVSP
ring
(14.56±26.76ms(all p<0.001). Using Pearson’s analysis, Sti-LVAT was found to be positively corelated with QRS, IVMD, TS-12-SD, LVEDV and LVESV while a negative relationship could be observed for LVEF.

Conclusions:
Similar to HBP, LBBP achieved better electrical and mechanical left ventricular synchrony than conventional RV pacing. For interventricular synchrony, only LBBP initiated earlier LV activation than RV among these pacing strategies, in consistent with the RBBB pattern of paced QRS during LBBP.
Abstract 11168: Right Atrial Adaptation in Pulmonary Hypertension: In-Depth Pressure-Volume Analysis
Authors: Wessels Jeroen N , de Rover Jari , Van Wezenbeek Jessie , Marcus J. Tim , meiboom lilian J , Bogaard Harm J , vonk noordegraaf anton , Strijkers Gustav J , Westerhof Berend E , De Man Frances S
Published: March 2022

Introduction:
Pulmonary hypertension (PH) is associated with increased right atrial (RA) pressure and volume. We hypothesized that RA stroke work and RA stiffness are higher in PH patients in comparison to healthy controls.

Methods:
RA PV loops were created through a novel method. RA volume was measured throughout the cardiac cycle on a magnetic resonance transverse stack of slices (typically 8-10). RA pressure was averaged over at least 10 cardiac cycles and approximately two respiratory cycles. Alignment of RA volume and pressure was done based on the v-wave (peak during ventricular contraction, see figure). RA stroke work was calculated as the area under the PV loop from the p-wave (start of atrial contraction) to the minimal RA volume. RA active emptying as the difference between p-wave and minimal volume. An exponential curve was fitted through the reservoir portion of the PV loop from the x-descent to the v-wave. The slope of this curve at the v-wave (RA end-reservoir elastance) was determined as a measure of RA stiffness.

Results:
RA PV loops were created for healthy controls (n=9) and PH patients (n=27). The averaged PV loops in the figure show RA dilatation in PH patients as well as elevated pressure, especially during atrial contraction. The difference between RA maximal pressure and p-wave pressure was higher in PH patients in comparison with controls (4.01 [3.12-6.75] vs 2.83 [2.54-3.06] mmHg; p=0.001). RA stroke work (493±253 vs 171±50 mmHg*ml; p=0.001) and active emptying (41±13 vs 23±5 ml; p<0.001) were also higher in PH, while RA end-reservoir elastance was not (0.26 [0.23-0.37] vs 0.33 [0.24-0.64] mmHg/ml; p=0.22).

Conclusions:
PH patients have increased RA stroke work and active emptying, as assessed with a novel method to derive RA PV loops. They do not show signs of RA stiffening. Future associations with right ventricular diastolic stiffness will show whether RA stroke work is able to match the increase in RA afterload.
Abstract 11169: The HVCN1 Voltage-Gated Proton Channel Contributes to Ph Regulation in Canine Ventricular Myocytes
Authors: Ma Jianyong , Gao Xiaoqian , Li Yutian , DeCoursey Thomas , Shull Gary E. , Wang Hong-sheng
Published: March 2022

Regulation of intracellular pH (pH
i
) in cardiomyocytes is crucial for cardiac function; however, currently known mechanisms for direct or indirect extrusion of acid from cardiomyocytes seem insufficient for energetically-efficient extrusion of the massive H
+
loads generated under
in vivo
conditions. In cardiomyocytes, voltage-sensitive H
+
channel activity mediated by the HVCN1 proton channel would be a highly efficient means of disposing of H
+
, while avoiding Na
+
-loading, as occurs during direct acid extrusion via Na
+
/H
+
exchange or indirect acid extrusion via Na
+
-HCO
3
-
cotransport. PCR and immunoblotting demonstrated expression of HVCN1 mRNA and protein in canine heart. Patch clamp analysis of canine ventricular myocytes revealed a voltage-gated H
+
current that was highly H
+
-selective. The current was blocked by external Zn
2+
and the HVCN1 blocker 5-chloro-2-guanidinobenzimidazole (ClGBI). Both the gating and Zn
2+
blockade of the current were strongly influenced by the pH gradient across the membrane. All characteristics of the observed current were consistent with the known hallmarks of HVCN1-mediated H
+
current. Inhibition of HVCN1 and the NHE1 Na
+
/H
+
exchanger, singly and in combination, showed that either mechanism was largely sufficient to maintain pH
i
in beating cardiomyocytes, but that inhibition of both activities caused rapid acidification. These results show that HVCN1 is expressed in canine ventricular myocytes and provides a major H
+
-extrusion activity, with a capacity similar to that of NHE1. In the beating heart
in vivo
, this activity would allow Na
+
-independent extrusion of H
+
during each action potential and, when functionally coupled with anion transport mechanisms, could facilitate transport-mediated CO
2
disposal.
Abstract 11181: Transfemoral Transcatheter Aortic Valve Replacement in the Catheterization Lab vs the Operating Room
Authors: Kirkland Jacob T , Jack Godly , Vavalle John
Published: March 2022

Introduction:
Within the past decade, transcatheter aortic valve replacement (TAVR) has become the standard of care for the treatment of calcific aortic stenosis across the surgical risk spectrum. With increasing volumes of procedures, there has a shift in TAVRs into the cardiac catheterization lab and out of the hybrid operating room. A better understanding is needed regarding the impact this has on procedural success and outcomes.

Methods:
Patients undergoing transfemoral TAVR between April 2016 and April 2019 at the University of North Carolina were included retrospectively. Unpaired t-test, Fisher’s exact test, and chi square analysis were used to compare procedure characteristics and outcomes performed in the catheterization lab to TAVR performed in the OR.

Results:
A total of 160 transfemoral TAVRs were performed in the catheterization lab while 119 were performed in the OR. There were no significant differences in baseline or comorbidity characteristics. Table 1 includes data analysis finding no significant difference in procedure time, contrast volume, fluoroscopy time, anesthesia type, aborted procedures, conversions to open surgery, paravalvular leak, endocarditis, stroke, KCCQ-12 difference at 4-7 week follow up, and one year mortality. Figure 1 includes the location of transcatheter TAVR procedures at UNC over time.

Conclusions:
Transfemoral TAVR performed in the catheterization lab is as safe and efficacious as TAVR performed in the OR. This has significant implications for resource utilization, ability to expand this therapy, and the costs associated with TAVR.
Abstract 11182: Reliability of Systolic Pulmonary Artery Pressure by Doppler Echocardiography Compared to Right Heart Catheterization in Patients with Congenital Heart Disease: Analysis in a Large Patient Population
Authors: Dai Hai-Long , Tong Na , Guang Xue-Feng
Published: March 2022

Introduction:
Pulmonary arterial hypertension (PAH) in patients with congenital heart disease (CHD) is associated with increased morbidity and mortality. While Doppler echocardiography (DE) has been a useful screening test in PAH, the presence of structural cardiac defects may affect the ability to reliably predict systolic pulmonary arterial pressure (sPAP).Therefore, this study was to analyze the reliability of sPAP assessment by DE compared to right heart catheterization (RHC) in a large CHD patient population.

Methods:
We retrospectively analyzed simple atrial septal defect (ASD) , ventricular septal defect (VSD) and patent ductus arteriosus (PDA) patients older than 14 years with matched examinations (within 1 months) from 2015 to 2020. Relationships between RHC- and DE-derived sPAP were assessed using the Pearson correlation. Bland-Altman analyses were performed to evaluate the agreement between DE and RHC measurements of sPAP.

Results:
1937 ASD patients,188 VSD patients, 294 PDA patients were included in this study. In ASD patients, sPAP was 47.06±14.33 mmHg by DE and 39.42±13.18 mmHg by RHC(P<0.001). There was moderate correlation between DE and RHC measurements of PASP (r = 0.585, P<0.05). Bland-Altman analysis showed a bias of 7.6 mmHg for sPAP (95% limits of agreement -17.0 to 32.3 mmHg). In VSD patients, sPAP was 60.89±26.36 mmHg by DE and 64.39±35.79 mmHg by RHC(P<0.001). There was highly correlation between DE and RHC measurements of PASP (r = 0.866, P<0.05). Bland-Altman analysis showed a bias of -3.5 mmHg for sPAP (95% limits of agreement -39.7 to 32.7 mmHg). In PDA patients, sPAP was 49.96±19.53 mmHg by DE and 53.10±29.36 mmHg by RHC(P<0.001). There was highly correlation between DE and RHC measurements of PASP (r=0.813, P<0.05). Bland-Altman analysis showed a bias of -3.1 mm Hg for sPAP (95% limits of agreement -37.7 to 31.5 mmHg).

Conclusions:
DE estimates of sPAP are inaccurate in patients with CHD, a significant overestimation of the sPAP in ASD patients, significant underestimate of the sPAP in VSD and PDA patients.
Abstract 11186: A Case for Exercise-Induced Arrhythmogenic Right Ventricular Cardiomyopathy
Authors: Tomaiko Emrie D , Kusne Sharon , Weiss Peter , Zawaneh Michael , Su Wilber
Published: March 2022

Introduction:
Sudden cardiac arrest has been documented in athletes, often secondary to left ventricular (LV) hypertrophy or previously undetected genetic conditions. Some athletes, however, experience these events without evidence of either LV or genetic disease. A hypothetical exercise-induced arrhythmogenic right ventricular cardiomyopathy (ARVC) has been previously described by La Gerche and colleagues, acquired through repeated, intense endurance exercise and associated cardiac remodeling rather than genetic inheritance. We present a case report of an endurance athlete presenting with ventricular tachycardia (VT), suspected to be secondary to exercise-induced ARVC.

Results:
A 40 year-old male endurance athlete was brought to the emergency department when he collapsed following a race in 2006. Upon arrival, he was in sustained wide-complex tachycardia at a rate of 200-220 BPM. Following conversion with IV amiodarone, left heart catheterization was performed, showing no significant coronary disease and LV ejection fraction (EF) measured 30-35%. He then underwent right ventricular outflow tract ablation. Cardiac MRI was inconclusive for ARVC. Biopsy was performed, negative for amyloidosis but with “focal mild to moderate chronic interstitial inflammatory infiltrates associated with focal muscle fiber necrosis.” Genetic testing was negative for pathologic variants or mutations associated with ARVC. Echocardiogram from 2020 showed EF 40-44% with significant RV enlargement and dysfunction. He required repeat VT ablation in 2010, 2014, and 2017. Arrhythmogenic scar was identified by electrophysiology mapping to be located at the sub-tricuspid RV. In combination with the prior RV outflow tract ablation, this is suggestive of the theoretical exercise-induced ARVC.

Conclusions:
There is still debate regarding right ventricular remodeling in endurance athletes. Increased volume and pressure in response to demand for cardiac output associated with this intense exercise has been proposed as a possible etiology of RV cardiomyopathy in athletes without identifiable genetic predisposition. Our case report supports this hypothesis.
Abstract 11189: Obesity is Associated with Better Intra-Hospital Outcome in Diabetes Patients Hospitalized for Stemi: Findings from the National Inpatient Sample
Authors: Bodair Ramez , DARGHAM SOHA , Al suwaidi Jassim M , Jneid Hani , Abi Khalil Charbel
Published: March 2022

Introduction:
An obesity paradox is observed in patients with diabetes.

Hypothesis:
We hypothesized that obese patients with diabetes hospitalized for STEMI have a better intra-hospital outcome.

Methods:
We used data from the National Inpatient Sample (NIS) from 2008 to 2014. Patients with STEMI and diabetes were classified according to their BMI: Underweight (BMI <19), Normal (BMI 19-24.9), Class I Obesity (BMI 25.0-29.9), Class II Obesity (BMI 30.0-39.9), and Class III Obesity (BMI >40). We compared different classes and assessed in-hospital events.

Results:
1.7% patients were underweight, 3.0% had normal weight, 10.4% had Obesity Class I, 54.8% had Obesity Class II, and 30.2% had Obesity Class III. Mean age (SD) was higher in underweight patients (73 ±13) but decreases progressively to reach 58 ± 11 in class III obesity (p<0.001). There were more females in underweight patients and more males in normal weight and obese patients (p<0.001). Obese patients had a significantly lower risk compared to normal weight patients, but not underweight (Figure 1). In cardiogenic shock, underweight and class I obese patients had a similar risk compared to normal weight, but class II (a OR= 0.53 [0.40-0.70]) and class III (OR=0.62 [0.46 - 0.82] had a lower risk. The risk of ventricular fibrillation was not different according to groups. Interestingly, the risk of atrial fibrillation was lower in class I (OR= 0.72 [0.52-0.98]) and class II (OR= 0.7 [0.53-0.93]) patients without being higher in underweight patients. Increasing age was a strong predictor of cardiovascular events (OR of mortality is 7.99 [5.83 - 10.83] for patients >84 years old). Multivariable adjustments did not affect the significance of the results.

Conclusions:
An obesity paradox is observed in patients with diabetes hospitalized for STEMI. Higher BMI is correlated with lower risk of mortality, cardiogenic shock, and atrial fibrillation. Underweight patients did not have a higher risk of cardiovascular events.
Abstract 11199: Insulin-Like Growth Factor Binding Protein-4 is Associated with Pulmonary Arterial Hypertension Severity and Survival
Authors: Torres-viera Guillermo , Yang Jun , Griffiths Megan , Brandal Stephanie , Damico Rachel L , Vaidya Dhananjay , Simpson Catherine , Pauciulo Michael , Ivy Dunbar D , Austin Eric D , Hassoun Paul , Everett Allen D
Published: March 2022

Introduction:
Pulmonary arterial hypertension (PAH) results in progressive elevation of pulmonary vascular resistance and right heart failure. Insulin like growth factor binding proteins (IGFBPs) are a family of growth factor modifiers. As increased IGFBP4 expression is associated with vascular proliferation in lung cancer, it may also be associated with PAH severity.

Hypothesis:
Elevated IGFBP4 is associated with worse disease severity and survival in PAH.

Methods:
Using enzyme-linked immunosorbent assays (ELISA), we evaluated serum IGFBP4 in a multicenter PAH cohort, the NHLBI PAHBiobank (N=2571), and healthy controls (N=125). Hemodynamic and functional measures were used to assess IGFBP4’s association to PAH severity and survival. Spearman’s rank correlation test and Kruskal Wallis test were used for correlations. IGFBP4 was dichotomized at the median and analyzed by Kaplan-Meier survival and Cox proportional Hazard regression.

Results:
Serum IGFBP4 levels were significantly elevated (p<0.0001) compared to controls. After adjustment for age and sex, IGFBP4 above mean was associated with a 40 meter shorter six minute walk distance (95%CI, -55 to -25, p=<0.001). In the IPAH subtype only, higher IGFBP4 was associated with higher mean right atrial pressures (2 mmHg; 95%CI, 1.2 to 2.9, p=<0.001), mean pulmonary arterial pressures (2.0 mmHg; 95%CI, 0.09 to 4.0, p=0.041) and pulmonary capillary wedge pressures (0.75mmHg; 95%CI, 0.18 to 1.3, p=0.010). Cox multivariable analysis demonstrated higher serum IGFBP4 as an independent predictor of survival in the overall PAHB cohort (See Figure 1; HR, 3.6; 95% CI, 2.6-5.0), with worse outcomes for CHD-APAH (HR, 9.9; CI, 2.2-45) and IPAH (HR, 5.3; 95% CI, 2.9-9.7).

Conclusions:
Higher circulating IGFBP4 levels are significantly associated with worse PAH severity and shorter survival. Dysregulation of IGF metabolism/growth axis could play a significant role in PAH cardio-pulmonary pathobiology.
Abstract 11204: Emulating the Cardiac Mechanical and Humoral Cues to Prolong Human Heart Slice Culture
Authors: Meki Moustafa , Miller Jessica , Ou Qinghui , Gebreil Ahmad , Salama AbouBakr , Tang Xianliang , Abouleisa Riham , El-Baz Ayman S , Giridharan Guruprasad , Mohamed Tamer
Published: March 2022

Introduction:
Drug induced cardiotoxicity is a major cause of market withdrawal. The limited availability of human heart tissue has led to inaccurate interpretations of cardiac related drug effects. Our group had developed a culture system for pig/human heart slices that is functionally and structurally viable 6 days under electric stimulation and enriched media and could reliably demonstrate the subacute toxic effect of anti-cancer therapeutics. However, by day 10, the slices underwent cardiomyocyte dedifferentiation and fibrotic remodeling, making them inadequate for long-term cardiotoxicity testing.

Aims:
Including physiological mechanical and humoral cues within the culture system can prolong the viability of the human heart tissue in culture.

Methods and Results:
Following small molecule screening, we found that incorporation of 100 nM Tri-iodo-thyronine (T3) and 1 μM Dexamethasone (Dex) into our culture media preserved microscopic structure for 12 days in pig and human slices. However, RNA sequencing revealed a significant down regulation in cardiac contractile genes as early as day 8 in culture. To address this, we developed a novel bioengineered Cardiac Tissue Culture Model (CTCM) that can electro-mechanically stimulate heart slices with physiological preload and afterload during each cardiac cycle (Figure 1). Transcriptionally, combining CTCM with T3/Dex treatment, CTCM system was able to maintain the cardiac contractile gene expression at the same levels as the fresh hear tissue. Functionally, heart slices cultured in our CTCM with T3/Dex treatment, completely preserved structural viability and metabolic activity for 12 days.

Conclusion:
This study demonstrates a new physiological culture system for human heart slices that provides physiological mechanical and humoral cues for maintaining viability and functionality of the heart slices. CTCM may be an ideal platform for chronic cardiotoxicity testing.
Abstract 11209: KER-012, a Novel Modified ActrII Ligand Trap, Attenuated Cardiac Pathology in a Pulmonary Arterial Banding Model of Right Ventricle Overload
Authors: Babbs Keith , Materna Chris , Fisher ffolliott , Seehra Jasbir , Lachey Jennifer
Published: March 2022

Pulmonary arterial hypertension (PAH) is a debilitating disorder, characterized by right ventricle (RV) pressure overload, cardiac hypertrophy, and progressive RV dysfunction. PAH is associated with unbalanced TGFß signaling, favoring signaling of SMAD2/3 and opposing SMAD1/5/9. The result is an increase in vascular proliferation and disruption of vascular homeostasis. KER-012 is a modified ActRII ligand trap designed to inhibit ligands that signal through SMAD2/3 to promote restoration of vascular homeostasis. To investigate the cardio-protective effects of RKER-012, a research version of KER-012, we evaluated the effect of treatment in a pulmonary arterial banding (PAB) model. In this study, 8-week-old, male C57BL/6 mice underwent sham or PAB surgery to increase RV pressure and induce cardiac remodeling. The sham cohort received vehicle (VEH) treatment and PAB mice received either vehicle (VEH) or 10 mg/kg RKER-012 twice weekly for 3 weeks. Relative to sham mice, all PAB mice had elevated pulmonary arterial pressures on day 1 (all ps<0.0001) that persisted until day 21 (all ps<0.01), indicating that the PAB procedure was effective. VEH PAB mice also exhibited diminished cardiac function, including increased end systolic pressure volume relationship (ESPVR; +79.3%; p<0.001) and increased myocardial performance index (MPI; +45.6%; p<0.0001) compared to Sham VEH. Additionally, VEH PAB mice had markers of cardiac remodeling, including increased Fulton Indices (+54.8%; p<0.0001), increased RV free wall thickness (RVFWT; +95.8%; p<0.0001) and increased cardiac fibrotic tissue (+529.9%; p<0.0001). In contrast, RKER-012 treatment was cardioprotective and prevented changes in cardiac function and tissue remodeling. In treated mice, there was a trend for decreased ESPVR (-14.2%), decreased MPI (-13.2%, p<0.01), decreased Fulton Index (-13.5%; p<0.01), and decreased RVFWT (-22.9%; p<0.0001) compared to VEH PAB. Treated mice also had reduced cardiac fibrotic tissue (-38.9%, p<0.01). Taken together, these data provide evidence that KER-012 has the potential to reduce cardiac remodeling and improve cardiac performance in pathologies involving constricted pulmonary arterial blood flow and could provide benefit in diseases such as PAH.
Abstract 11216: Applicability of US Food and Drug Administration Labeling for Dapagliflozin to Patients with Chronic Kidney Disease in the National Health and Nutrition Examination Survey (NHANES) 2017-2018 Data
Authors: Huang Joanna , Garcia Sanchez Juan Jose , Nolan Stephen , Guzek John , Retat Lise , Webber Laura , Rastogi Anjay
Published: March 2022

Introduction:
Patients with chronic kidney disease (CKD) lack evidence-based therapeutic options to delay progression to end-stage kidney disease (ESKD) and reduce the risk of CV events. Dapagliflozin has been shown to reduce the risk of sustained eGFR decline, ESKD, hospitalization for heart failure, CV death and all-cause mortality, in adults with CKD at risk of progression. To determine the dapagliflozin-eligible CKD population in the US, and to understand the presence of CV comorbidities and use of key medications, NHANES was evaluated.

Methods:
The dapagliflozin-eligible population was extracted from NHANES 2017-2018 data. Inclusion criteria were: UACR ≥ 30 mg/g and/or an eGFR < 60 mL/min/1.73 m
2
in line with the approved indications for dapagliflozin. These patients are at risk of CKD progression, CV events and premature mortality, according to KDIGO 2012 CKD guidelines. Dialysis patients were excluded. Sampling weights were generated using NHANES analytical guidance. The data set was scaled in line with the US population.

Results:
NHANES data indicate that, of the adult US population, 35,422,098 individuals (14.4%) are eligible for dapagliflozin treatment. Of those eligible, 64.5% are non-Hispanic white, 13.2% are Hispanic, and 12.4% are non-Hispanic black. Non-Hispanic Asian and other races account for the remaining 10%. Among the eligible population, 22,104,903 individuals (62.6%) have hypertension, 10,998,581 (32.1%) have diabetes, 3,186,685 (9.1%) have a history of stroke, 2,755,256 (7.9%) have previous myocardial infarction, and 2,688,886 (7.7%) have heart failure. Renin-angiotensin-aldosterone system (RAAS) inhibitor therapy is used in 43% of these individuals.

Conclusions:
NHANES 2017-2018 data indicate a substantial dapagliflozin-eligible CKD population in the US. These patients are at risk of progression to ESKD or CV complications and could benefit from the availability of effective treatment options.
Abstract 11219: Impact of Echocardiographic Assessment During First Outpatient Cardiology Consultation on Patient Management
Authors: Aladham Raed , Naqvi Tasneem Z
Published: March 2022

Background:
Goal directed point of care echo (POCE) has emerged as a quick, bedside tool to assess cardiac structure and function. However, impact of physician performed POCE during cardiac consultation on immediate patient diagnosis, downstream testing and management has not been assessed.

Purpose:
To study the impact of POCE performed by consulting cardiologist (CC) during initial cardiology consult.

Methods:
69 study patients (pts) underwent examination by an expert imaging CC from Jan 2014-May 2016. During 1-hour consultation, medical records were reviewed, medical history and physical exam was performed followed by cardiologist-performed POCE (Philips CX50). We included a matched control group of 65 pts seen by 3 different CCs during the same time period who underwent standard echo (Secho) up to 3 months after the initial visit.

Results:
Baseline characteristics were comparable between the two groups for age (mean of 62
)
, cardiac risk factors, and referral diagnoses. POCE findings and Secho (mean delay of 17.2 days after visit) are shown in Table1 and diagnostic tests ordered following initial visit in both groups in Figure 1. POCE had greater yield of echo abnormalities and led to less referral for noninvasive stress testing, more cardiovascular medication changes (15.3 vs 5.7% pts) and more advanced cardiac testing (21 vs 9% pts) compared to the control group after the initial visit.

Conclusion:
Focused echo at time of consultation leads to more medication adjustments, less referral for noninvasive stress testing, earlier referral for advanced cardiac diagnostic imaging and shortens time to advanced diagnostic workup by about two weeks.
Abstract 11220: Cardiac Bridging Integrator 1 Gene Therapy Rescues Diabetic Cardiomyopathy in Mice
Authors: Li Jing , Richmond Bradley , Walsh Maureen , Bia Ryan , Shaw Kikuyo , Symons J David , Franklin Sarah , Rutter Jared , Funai Katsuhiko , Shaw Robin M , Hong Tingting
Published: March 2022

Introduction:
Diabetes is a major cause of heart failure with preserved ejection fraction (HFpEF), which has limited diagnostic tools and therapeutic options. Abnormal remodeling in the t-tubule calcium handling cardiac bridging integrator 1 (cBIN1)-microdomains has emerged as key to the pathophysiology of failing cardiomyocytes, which can be targeted for cardiac functional improvement. It remains unclear whether cBIN1 replacement therapy is effective in restoring cardiac function in diabetic HFpEF.

Hypothesis:
We hypothesized that cBIN1 gene therapy rescues diastolic failure in mice with diabetic cardiomyopathy.

Methods:
9-wks old male and female db/db mice that received retro-orbital injection of 1x10
11
vg of AAV9 transducing GFP or cBIN1 were compared to non-diabetic control db/m littermates injected with AAV9-GFP (N = 16 mice per group). Mice were terminated 8-wks later for tissue acquisition, imaging, as well as biochemical analysis. Echocardiography, exercise tolerance, and plasma cBIN1 score (CS, an inverse index of plasma cBIN1 concentration) were obtained before and after gene therapy.

Results:
db/db mice developed diastolic failure with reduced E/A, increased E/e’, exercise intolerance, and cardiac hypertrophy with reduced tissue cBIN1 levels and corresponding elevations in plasma CS. Supporting our hypothesis, AAV9-cBIN1 normalized E/A and E/e’ and improved exercise tolerance in db/db mice, which can be distinguished by plasma CS as an inverse marker of cBIN1-microfolds and cardiomyocyte remodeling (Figure 1). Preservation of cBIN1-microdomains in db/db cardiomyocytes reorganized functional SERCA2a and rescued mitochondrial respiration with diminished oxidative stress.

Conclusions:
Exogenous cBIN1 normalizes lusitropic function of diabetic hearts through microdomain-organized effective calcium handling and mitochondrial respiration. cBIN1 gene therapy is a new and effective method for guided treatment of diabetic HFpEF.
Abstract 11221: Counseling in the Time of COVID - Prenatal Diagnosis of Congenital Heart Disease During a Pandemic
Authors: Ronai Christina , Canty Ethan , Kim Amanda , Dukhovny Stephanie , Pilliod Rachel , Madriago Erin J
Published: March 2022

Introduction:
Comprehensive prenatal care of congenital heart disease (CHD) relies on a multi-disciplinary approach that includes timely prenatal counseling and individualized care plans for the pregnancy, delivery and neonatal period. With the COVID-19 pandemic our fetal therapy clinic (FTC) approach to patient care was altered to accommodate restrictions, including the use of telehealth visits. We investigated whether counseling and access to care for fetal patients with CHD was negatively impacted by COVID-19.

Hypothesis:
Fetuses with CHD would experience a delay in timing of diagnosis and referral; parents would receive a shorter counseling session during the COVID-19 pandemic.

Methods:
Retrospective chart review of all fetal cardiology patients seen in our multidisciplinary FTC both before (5/1/19-12/31-19) and during the COVID-19 pandemic (5/1/20-12/31/20). Data collected included gestational age (GA) at referral, GA at first fetal echo, use of telehealth, total time counseled, number of sub-specialty consults, and total number of fetal cardiology visits.

Results:
A comparable number of dyads were seen before and during the pandemic (Table 1). GA at initial diagnosis was similar, but GA at referral and first visit was earlier during the pandemic. Additionally, families seen during the pandemic had longer counselling across all disciplines with significant differences in pediatric cardiology and neonatology. There was no difference in total number of consults or access to care based on insurance.

Conclusions:
While prenatal counseling and referral to FTC is multifaceted, we demonstrated that COVID-19 and alterations in care delivery did not in fact lead to delays in referrals for patients across a large geographical catchment. Moreover, with telemedicine we were able to ensure our families continued to receive multidisciplinary care and families were able to spend more time with our care team developing comprehensive individualized plans.
Abstract 11225: Comparison of Coronary Artery Calcium Scores in South Asians and Other Racial-Ethnic Groups
Authors: Lakshmanan Suvasini , Dahal Suraj , Kinninger April , Manubolu Venkat , Aldana Jairo , Roy Sion , Budoff Matthew
Published: March 2022

Introduction and Hypothesis:
There is a disproportionately higher incidence of atherosclerotic cardiovascular disease (ASCVD) and associated adverse outcomes in South Asians (SA), compared to other races. SA ancestry has been identified as a risk enhancer in the US cholesterol guidelines. Coronary artery calcium (CAC), a validated marker of sub clinical atherosclerosis offers a robust assessment of CVD risk. We sought to compare the distribution of CAC scores as a marker of CVD risk, across various age groups in SA and other races/ethnicities.

Methods:
Our analyses included 33,663 individuals (517 SA, 24,060 whites, 1,509 African Americans (AA), 3,759 Hispanics, 3,818 Asians), who underwent CAC scoring at our center. CAC scores were stratified by age, across various races/ethnic sub-groups. Age groups were classified into quartiles as follows: <51 years, 51-59 years, 59-67 years and >67 years of age. Differences in median CAC across races/ethnicities were tested with the Kruskal-Wallis Test, by age quartiles as described.

Results:
Mean (SD) age was 59 (11.6) years and 63% were men in the entire cohort. SA over 67 years of age, had significantly higher median CAC score 354.0, Interquartile Range (IQR) 36 - 1476, compared to other race/ethnicities (Median CAC (IQR): whites, 195, (21-762), Hispanics 167.5, (19-779), Asians 144, (14-642), AA 159 (8.5-676) (P=0.0019). In age groups from 50-67 years of age, median CAC scores were not significantly different between these groups (Figure 1).

Conclusions:
In older age groups, SA have higher median CAC scores compared to whites and other racial/ethnic groups including AAs, Hispanics and other Asians. The observed differences in atherosclerotic burden provide mechanistic insights to higher CVD risk, in the vulnerable SA groups. Future studies should explore the effects of CAC screening on treatment strategies, such as initiation of statins and prognosis in SA.
Abstract 11231: Rethinking the Disconnect in Patient Outreach: Key Considerations in Addressing Racial Disparities in Hypertension
Authors: Au Sandra , Katie Xu , Jonathan Irene , Douglas Dakota , Murray Evan M , Whitehurst Unique , Tounsel Daniel , Biola Holly , Granger Bradi B
Published: March 2022

Background:
Disparities in hypertension and cardiovascular outcomes among Black men in the US are influenced by social determinants of health (SDOH) and systemic inequity. Self-measured blood pressure (SMBP) monitoring programs may be an efficacious strategy to combat these disparities in the community setting. Leveraging the advantages of SMBP, however, requires improved understanding of barriers to engagement in this population.

Methods:
A total of 258 Black male patients of a Federally Qualified Health Center, with severe hypertension (
>
160mm Hg systolic or
>
100mm Hg diastolic) were eligible. Patients were called using the phone number(s) in the electronic health record (EHR), and callers documented brief summaries of the call. At least 3 attempts were made to offer a free BP cuff, and provide longitudinal SMBP education and heart-healthy lifestyle counseling. NVivo was used for coding and content analysis, employing mixed inductive and deductive approaches to identify barriers to engagement. Coding structure included ‘communication’ and ‘engagement’, stratified by positive and negative attributes.

Results:
Analysis of initial outreach data (n=172) highlighted themes of unfavorable engagement to include excessive burden from competing health priorities and socioeconomic stress, and communication themes included unreliable phone numbers in the EHR hindering contact, and skepticism/mistrust of the caller by those patients reached. (Table).

Conclusion:
Optimizing engagement in SMBP programs to address hypertension disparities remains challenging, however improved SDOH screening and resource connection, system practices in EHR integrity, and understanding of patient mistrust of the health system may be key considerations. Ongoing thematic analyses on sustained SMBP skill-building and patient trust in care navigation may provide further insight on strategies to improve racial disparities in cardiovascular health outcomes.
Abstract 11237: Expression of Mitochondrial, Contractile, and Calcium Regulatory Proteins is Altered in Patients with Atrial Fibrillation
Authors: Rennison Julie H , Cantlay Catherine C , Li Ling , Lin Cheryl R , Lovano Beth S , Castel Laurie , Cantlay Paul J , Gillinov A M , Moravec Christine S , Willard Belinda B , Smith Jonathan D , Chung Mina K , Barnard John , Van Wagoner David R
Published: March 2022

Introduction:
Atrial fibrillation (AF) increases energy demand for contractile and electrical activity. Changes in left atrial (LA) protein expression of AF patients are poorly characterized.

Hypothesis:
Mitochondrial protein expression in patients with AF is altered in an attempt to meet increased energy demand.

Methods:
LA appendage tissue was obtained from 198 patients undergoing Maze surgery. At the time of surgery, 80 were in sinus rhythm (SR) (50 paroxysmal AF, 30 persistent AF) and 118 in AF (65 persistent AF, 53 permanent AF). Protein content was assessed by mass spectrometry and 2539 proteins were identified.

Results:
In AF compared to SR, 257 proteins were differentially expressed (q<0.05); 44 of 62 mitochondrial proteins detected (MitoCarta 3.0) were increased. KEGG pathway analysis revealed Oxidative Phosphorylation was increased (p=1.01E-3) in AF, including 17 subunits of the electron transport chain (A). The Hypertrophic Cardiomyopathy pathway was decreased (p=1.01E-03). Expression of ryanodine receptor, and troponin and tropomyosin subunits decreased, but tropomyosin 4 and myosin heavy chain 9 and 10 increased (B), providing evidence of changes in myofibrillar and calcium regulatory proteins in AF. Among 39 putative AF risk genes detectable at the protein level, 8 were altered in AF (C). The Tricarboxylic Acid Cycle KEGG pathway was decreased (p=2.55E-3) in patients with permanent compared to persistent AF, with no significant changes in other cellular pathways or protein expression of putative AF risk genes.

Conclusions:
In one of the largest proteomic datasets in human LA to date, we find that expression of proteins in metabolic, myofibrillar, and calcium regulation pathways is altered in patients with AF. Additional metabolic changes were detected with progression to permanent AF. These data identify proteins that are altered in patients with AF providing insight into cellular pathways that may be targeted for AF prevention and therapy.
Abstract 11244: Illness Perception and the Impact of a Definitive Diagnosis on Women with Ischemia Without Obstructive Coronary Artery Disease: A Qualitative Study
Authors: Tseng Leslie , Shah Samit , Curry Leslie , Spatz Erica S
Published: March 2022

Introduction:
Women are more likely to have ischemia and no obstructive coronary artery disease (INOCA), and the underlying pathologies of this diagnosis (such as microvascular dysfunction and coronary vasospasm) are often not distinguished. Comprehensive invasive physiology testing at the time of invasive coronary angiography (ICA) allows for improved diagnostic accuracy. However, despite increased recognition of INOCA and expanding access to testing, data lacks on the impact of receiving a mechanism-based, definitive diagnosis (DD) on women.

Methods:
We are conducting in-depth telephone interviews with women with INOCA who recently underwent ICA. Respondents are asked about understanding of diagnosis, healthcare experiences, and health status prior to and following ICA. The interviews are transcribed and analyzed using the constant comparison method.

Results:
To date, 17 women were interviewed (median age: 55), 14 of whom underwent physiology testing and 13 of whom received a DD. Through iterative coding, four major themes emerged: (1) Illness perception and communication: A DD equipped women with a better understanding of their symptoms and subsequent functional status and provided tools for communication; (2) Psychological toll: A DD relieved frustration with repeated testing, lack of validation, and fear about prognosis; (3) Identity: A DD served as a turning point for reclaiming their personal and professional identity; (4) Lifestyle changes and outlook: A DD brought relief and hope for the future and motivation for a healthier lifestyle. See quotes in Table.

Conclusions:
Women with INOCA were eager to share experiences (89% participated). Overall, they described the physical, emotional, interpersonal, and financial toll of seeking a diagnosis for their symptoms. Those who received a DD reported better understanding of disease, healthcare experiences, and well-being. Next steps are to continue interviews until thematic saturation is reached.
Abstract 11252: Transferrin Predicts Trimethlamine-N-Oxide Levels and is a Potential Cardiovascular Disease Biomarker
Authors: Bean Lamuel , Wing Jeffrey J , Milks Michael W
Published: March 2022

Introduction:
Trimethlamine-N-oxide (TMAO) is a circulating biomarker associated with atherosclerotic cardiovascular disease (CVD) risk and results from metabolism of micronutrients choline and L-carnitine, present in foods such as red meat and eggs.

Hypothesis:
The investigators sought to predict serum TMAO quartile levels among healthy individuals at increased risk of CVD, using clinical and dietary consumption data via an ordinal logistic model.

Methods:
Data from patients (n=127) enrolled in a longitudinal observational study on CVD were used to build a predictive model for TMAO using ordinal logistic regression with demographic variables and 40 other variables considered related to CVD risk. First, univariate models for each covariate were run (with serum TMAO quartiles as the dependent variable), and only variables with
p
<0.30 were evaluated further. Second, demographic variables (age, gender, white vs. non-white race) were included in a multivariable model with each previously identified independent variable controlling for potential confounding. Last, the final model included fixed demographics and candidates from the confounder-adjusted model with
p
<0.10.

Results:
Eight candidate variables were included in the final model, with only transferrin and HDL cholesterol with significant associations with TMAO
(Table)
. Patients had 0.16 (Q2), 0.31 (Q3), and 0.20 (Q4) times the odds to be in a higher TMAO quartile compared with patients in the lowest transferrin quartile. Patients in the second quartile of HDL had 2.68 times higher odds to be in a higher TMAO quartile compared with patients in the lowest HDL quartile. Non-Whites had 2.92 times higher odds of being in the highest TMAO quartile as compared to whites in this cohort.

Conclusions:
Transferrin showed the strongest association with TMAO; thus, transferrin may represent a novel potential biomarker of increased CVD risk worthy of further study.
Abstract 11263: Multiple Inflammation Biomarkers and Incident Coronary Heart Disease Risk Among Black and White US Adults: The REGARDS Study
Authors: Akinyelure Oluwasegun P , Colantonio Lisandro , Chaudhary Ninad S , Judd Suzanne E , Cushman Mary , Zakai Neil , Kabagambe Edmond K , Howard Virginia J , Safford Monika , Irvin Marguerite M
Published: March 2022

Introduction:
Inflammation biomarkers have been individually associated with increased risk of coronary heart disease (CHD). However, little is known of the association between multiple inflammation biomarker counts in the high-risk category and incident CHD risk.

Methods:
We used data from the REasons for Geographic and Racial Differences in Stroke study, an ongoing national cohort of 30,239 Black and White US adults aged ≥45 years recruited in 2003-2007. Baseline levels of C-reactive protein (hsCRP), white blood cell count (WBC) and serum albumin were divided into tertiles. High-risk categories of hsCRP and WBC were defined as levels above the 3
rd
tertile (3.75 mg/dL and 6.31 x 10
9
cells/L, respectively) and albumin levels below the 1
st
tertile (4.0 g/dL). Four mutually exclusive groups were derived corresponding to having 0, 1, 2 or 3 biomarkers in the high-risk category. Outcome was a composite of incident non-fatal myocardial infarction and fatal CHD.

Results:
Of 15,738 participants free of CHD at baseline (mean age 63.1 years, 65.3% female, 40.8% black), 38.9% (n = 6,121) had 0, 36.6% (n = 5,765) had 1, 19.7% (n = 3,107) had 2, 4.7% (n = 745) had 3 inflammation biomarkers in the elevated levels. With median follow-up of 10.5 years, 902 (5.7%) participants had incident CHD. The rates of incident CHD and 95% confidence intervals (CI) per 1000 person years increased progressively for individuals with 0, 1, 2, and 3 inflammation biomarkers in the high-risk category: 4.4 (95% CI: 3.9-5.0), 6.3 (95% CI: 5.7-7.0), 8.9 (95% CI: 7.8-10.0), and 10.3 (95% CI: 7.7-12.8), respectively. The fully adjusted hazard ratios (95% CI) for incident CHD associated with 1, 2 and 3 versus no inflammation biomarker in the high-risk category were 1.28 (1.08-1.51), 1.71 (1.42-2.06), and 1.90 (1.43-2.54), respectively (P trend < 0.001) (Table).

Conclusions:
The count of inflammation biomarkers in the high-risk category is associated with increased risk of CHD independent of traditional risk factors.