bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15148: The Impact of the Covid-19 Pandemic on the Mental Distress of Health Care Providers Working in the Coronary Care Unit
Authors: Tamano Sayaka , Tashiro Yumi , Moriyama Shiho , Takahashi Megumi , Yamada Takeshi , Takahashi Akihiko
Published: May 2021

Introduction:
Medical workers fighting current COVID-19 pandemic are considered facing a mental health crisis. However, there is a paucity of data regarding mental distress in those who caring non-COVIT patients. To assess the mental distress of health care provider working in a coronary care unit during the COVID-19 pandemic, we evaluated the changes in occupational stress before and during the pandemic based on Stress Check Program, which was conducted by Japanese government to screen for workers with high psychosocial stress in the workplace.

Methods:
Between January 2019 and March 2020, a total of 115 healthcare providers working in our hospital participated in the routine Stress Check Program. Of those, 30 participants working in the coronary care unit underwent a follow-up stress check between May and June 2020. The mean age of the participants was 36.3 ± 9.23 years, and 24 of them (80%) were women. We used the Brief Job Stress Questionnaire, which comprises four components with a total of 57 items: psychological stressors (17 items), psychological and physiological stress reactions (29 items), social support in the workplace (9 items), and personal satisfaction (2 items). Each item was rated on a 4-point scale ranging from 1 to 4. Scores were expressed as mean ± SD for analysis. The changes in scores from before to during the pandemic in terms of the four components and 57 items were analyzed.

Results:
The mean scores before and during the pandemic for 4 components; psychological stressors, psychological and physiological stress reaction, social support in the workplace, and personal satisfaction were 2.67 ± 0.93 vs. 2.76 ± 0.95 (
p
= 0.14); 1.99 ± 0.94 vs. 2.23 ± 1.01 (
p
< 0.001); 2.18 ± 0.89 vs. 2.18 ± 0.83 (
p
= 0.92); and 2.05 ± 0.65 vs. 2.20 ± 0.78 (
p
= 0.09), respectively.

Conclusion:
Significant worsening during the pandemic was observed for psychological and physiological reactions without no significant change in psychological stressors, social support in the workplace, or personal satisfaction. These results may indicate that the current COVID-19 pandemic was the sole factor contributing to the worsened stress reactions in healthcare providers.
Abstract 15160: Atrioventricular and Ventricular Functional Interdependence in the Community
Authors: Yoshida Yuriko , Nakanishi Koki , Daimon Masao , Ishiwata Jumpei , Sawada Naoko , Hirokawa Megumi , Kaneko Hidehiro , Nakao Tomoko , Mizuno Yoshiko , Morita Hiroyuki , Di Tullio Marco , Homma Shunichi , Komuro Issei
Published: May 2021

Introduction:
Left atrial (LA) and right ventricular (RV) performance play an integral role in the pathophysiology and prognosis of heart failure (HF). However, the alteration of atrioventricular and ventricular functional interdependence in a preclinical setting is unclear. We aimed to investigate the association between LA/RV functional remodeling and subclinical left ventricular (LV) dysfunction.

Methods:
LV global longitudinal strain (LVGLS), RV free wall longitudinal strain (RVLS) and LA reservoir strain were assessed by speckle-tracking echocardiography in 1,080 participants (600 men; 62±12 years) without cardiac disease.

Results:
A hundred and forty-three participants (13.2%) had an abnormal LVGLS (>-18.6%). LA reservoir strain and RVLS were significantly decreased in abnormal LVGLS group compared with normal LVGLS group (both p<0.001). LA and RV dysfunction (LA reservoir strain < 31.4% and RVLS > -19.2%) were present in 18.9% and 19.6% of participants with abnormal LVGLS, respectively (Figure). Decreased LVGLS was significantly associated with worse LA reservoir strain and RVLS (standardized β=-0.20 and 0.11 respectively, both p<0.01) independent of cardiovascular risk factors, pertinent biomarkers and LV geometry and diastolic dysfunction.

Conclusions:
In the general population without overt cardiac disease, approximately 20% subjects with impaired LVGLS exhibited LA/RV dysfunction, and LVGLS was independently associated with both LA and RV strain. Our findings may provide valuable insights for a better understanding of HF pathophysiology and possibly preventive strategies.
Abstract 15163: Differences in Preferences Between Physicians and Patients for the Use and Dosing of Direct Oral Anticoagulants for Atrial Fibrillation
Authors: Rymer Jennifer A , McCall Debbe , Hills Mellanie T , Wang Tracy Y
Published: May 2021

Introduction:
Direct oral anticoagulants (DOACs) are effective in reducing the risk of stroke for patients with atrial fibrillation (AF) only if prescribed at the labeled dose. Little is known about patient or clinician preferences for DOAC selection and dosing.

Methods:
We consented 240 physicians treating ≥20 patients with AF and 343 patients with AF. Physician knowledge of DOAC dosing was tested with 4 hypothetical patient case scenarios. Both patients and physicians were asked to grade the importance of 25 factors in anticoagulation decision-making.

Results:
Among physicians, the median age was 55 years, 13% were female, 23% were primary care providers. Most physicians (63%) stated empirically they would never/rarely use an adjusted lower dose if the patient did not meet dose adjustment criteria. However, in hypothetical case scenarios of a patient indicated for full dose DOAC, 40.8% of clinicians under-dosed apixaban (<5 mg bid daily) and 17.1% for rivaroxaban (<20 mg daily). In scenarios where a patient met dosing criteria for reduced dose DOAC, 64.6% (apixaban 2.5 mg bid daily) and 71.7% (rivaroxaban 15 mg daily) of physicians chose the reduced dose DOAC answer. Only 32.1% of clinicians answered all 4 scenarios correctly. Among patients with AF, the median age was 65 years, 74% were female, 85% had AF >1 year and 89% were currently anticoagulated. Patients and physicians both ranked stroke prevention and avoiding severe bleeding very important when choosing a DOAC. Physicians were more likely than patients to rank cost as very important, patients were more likely than physicians to consider the following very important: may cause minor bleeding, the dose of med can be reduced if need to, reversal agent available, and how long the drug has been on market (
Figure
).

Conclusions:
DOAC dosing strategies may be driven by gaps in physician knowledge, on top of varying treatment beliefs and preferences between physicians and patients.
Abstract 15164: Impact of Conventional Right Ventricular Pacing in Patients With Heart Failure With Preserved Ejection Fraction: Insights From Pursuit-hfpef Registry
Authors: Watanabe Tetsuya , Hikoso Shungo , Nakatani Daisaku D , Yano Masamichi , Tamaki Shunsuke , Morita Takashi , Furukawa Yoshio , Kawasaki Masato , Kikuchi Atsushi , Seo Masahiro , Hayashi Takaharu , Nakagawa Akito , Nakagawa Yusuke , Yasumura Yoshio , Yamada Takahisa , Sakata Yasushi
Published: May 2021

Introduction:
Previous studies suggest that conventional right ventricular (RV) pacing may have a deleterious effect on left ventricular (LV) function. However, there are no reports examining the effects of permanent pacemakers (PM) in patients with heart failure with preserved ejection fraction (HFpEF) admitted with acute decompensated heart failure (ADHF).

Methods and Results:
Patients' data were extracted from The Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with Preserved Ejection Fraction (PURSUIT-HFpEF) study, which is a prospective multicenter observational registry for ADHF patients with LVEF ≥50% in Osaka. Echocardiographic measurements were performed just before and 1 year after discharge. We analyzed 623 patients (median age: 81[30-101] years) after exclusion of patients on dialysis. At the admission, 55 of 623 patients had a previously implanted pacemaker (PM(+)). There were no significant differences in baseline clinical characteristics before discharge such as age, gender, renal function, echocardiographic parameters between PM(+) and PM(-) groups. One year after discharge, left ventricular ejection fraction (LVEF) in PM(+) group was significantly lower (58.3±8.6 vs 62.3±8.4%, p=0.005) than those in PM(-) group. During a mean follow-up period of 1.25±0.84years, 171patients had heart failure hospitalization (HFH). At the multivariate Cox analysis, pacemaker was significantly associated with HFH, independently of age, serum NT-proBNP level, and LVEF after the adjustment with NYHA functional class, sex, and hemoglobin. Kaplan-Meier curve analysis revealed that patients in PM(+) group had a significantly higher risk of HFH than those in PM(-) group.

Conclusion:
The development of cardiac systolic and diastolic dysfunction occurred in patients with HFpEF with a RV pacemaker implantation, which would be associated with poor outcome.
Abstract 15167: Short-term Sequalae of Children With Paediatric Inflammatory Multisystem Syndrome Temporarily Associated With Sars-cov-2 Infection (pims-ts) Assessed by Cardiovascular Magnetic Resonance
Authors: Bermejo Altamar Ivan , Whittaker Elisabeth , herberg jethro , Fraisse Alain , Bautista Carles , Kang Heechan , Giselle Rowlinson , Wage Rick , Lane Mary , Piccinelli Enrico , Di Salvo Giovanni , Mohiaddin Raad , Pennell Dudley J , Krupickova Sylvia J
Published: May 2021

Introduction:
Children with paediatric inflammatory multisystem syndrome temporally associated with SARS CoV2 infection (PIMS-TS) present with evidence of multiorgan dysfunction. Cardiac features include partial or typical Kawasaki disease symptoms or ventricular impairment. The aim of this study was to assess short term sequelae of cardiac involvement in patients with PIMS-TS.

Methods:
17 consecutive paediatric patients with PIMS-TS were referred for CMR at our institution. The referring criteria were: Echocardiographic finding of LV dysfunction at presentation (53%), dilated coronary arteries (27%) and high cardiac markers without LV dysfunction (20%). 16 patients completed the scan and were included into the analysis.

Results:
Age of the patients was 17 months-12 years (mean 6.4 years), 12 (80%) were male. Six (40%) patients required general anaesthesia. The time between the onset of the symptoms and the scan was 12-72 days. All patients had SARS CoV2 PCR negative at the time of scan, 2 patients were previously positive and 12 (80%) had positive IgG. CMR indexed volumes (ml/m2) were in normal range: LVEDV 65±11, LVESV 24±7, RVEDV 67±12, RVESV 27±7. LV mass index were normal 45±8 gr/m2. No overt areas of myocardial oedema or acute inflammation on STIR (short tau inversion recovery) images were found. Mildly reduced LV ejection fraction was found in 1 patient with subtle linear late gadolinium enhancement (LGE) in the midventricular midmyocardial interventricular septum with negative STIR images. Another patient was found to have LGE of the proximal parts of mitral valve papillary muscles, but no abnormalities in the LV ejection fraction or mitral valve function were found. Two patients had a small pericardial effusion. 3 patients had dilated neck and/or innominate veins, 2 of them with phlebectatic appearance. One patient had enlarged liver, another liver and spleen.

Conclusion:
in conclusion no significant myocardial sequelae have been found in most of the patients presenting with PIMS-TS short-term after onset of symptoms. This might indicate rapid recovery of the cardiac inflammation in most of the patients. More follow up is needed to clarify if there will be any potential sequelae from the acute episode as well as the outcome of phlebectasia.
Abstract 15169:
De Novo
Variants of
USP10
in Early Onset Bicuspid Aortic Valve Disease
Authors: Prakash Siddharth K , Yetman Angela T , Michelena Hector I , Bissell Malenka M , Kim Yuli Y , Hui Dawn , Andreassi Maria G , Foffa Ilenia , Guo Dongchuan , Citro Rodolfo , De Marco Margot , DeVicentis Carlo , Tretter Justin T , Body Simon C , Blue Elizabeth E , Nickerson Deborah A , Bamshad Michael J ,   Univ of Washington Cntr for Mendelian Genomics (UW-CMG),   EBAV Investigators
Published: May 2021

Introduction:
Bicuspid Aortic Valve (BAV), the most common congenital heart defect, is a major cause of aortic regurgitation or stenosis requiring valve replacement and thoracic aortic aneurysms predisposing to acute aortic dissections (TAD). The spectrum of BAV ranges from severe early onset valve and aortic complications to sporadic late onset disease.

Hypothesis:
Early onset BAV (EBAV) cases with valve or aortic complications that require intervention prior to age 30 are enriched for rare genetic variants that cause BAV and TAD.

Methods:
We performed whole exome sequencing of 147 EBAV cases in 141 families who were enrolled in the UTHealth Bicuspid Aortic Valve Research Registry. Candidate variants in the EBAV cohort (26% female, mean age 18, 44% with TAD) were compared to unselected controls from the Genome Aggregation Database (gnoMAD) and the Database of Genotypes and Phenotypes (dbGAP). We considered variants with minor allele frequencies (MAF) < 1%, Combined Annotation Dependent Depletion (CADD) scores > 25, and damaging (Polyphen-2) or deleterious (SIFT) functional prediction scores. Genomic copy number variants (CNVs) were detected using CoNIFER and prioritized when deletions involved genes with probability of loss intolerance (pLI) > 0.9. Variants were validated using quantitative PCR or Sanger sequencing.

Results:
We identified 6 rare variants of
USP10
in 6 EBAV families (4% of cohort): 4 CNVs (2 duplications and 2 deletions) that are rare in dbGAP controls (4 in 15,414) and 2 deleterious rare missense variants (MAF<5x10
-5
in gnoMAD). Two of the 4 CNVs were de novo events in trios. In contrast, rare deleterious variants of the known causal BAV genes
NOTCH1
(1),
ROBO4
(1),
GATA4
(1),
GATA5
(1), and
SMAD6
(4) were found in 7 total families.
USP10
encodes a ubiquitin peptidase that is required for endothelial Notch signaling during vascular development.

Conclusions:
We identified rare and de novo variants of
USP10
that implicate
USP10
as a new candidate gene for BAV.
Abstract 15192: Effectiveness and Safety of Reduced Dose of Dabigatran for High Bleeding Risk Patient Subgroups With Atrial Fibrillation
Authors: An Jaejin , Bider Zoe , Luong Tiffany , Cheetham T Craig , Lang Daniel T , Lee Ming-Sum , Reynolds Kristi
Published: May 2021

Off-label reduced dosing of direct oral anticoagulants is common among patients at high bleeding risk with atrial fibrillation (AF), however, outcomes data of reduced dosing are limited. We evaluated the effectiveness and safety of reduced dose of dabigatran [110 mg twice daily (BID)] vs. standard dose [150 mg BID] in high bleeding risk subgroups with AF. We identified adult patients with AF who initiated dabigatran (index date) with creatinine clearance (CrCl) ≥30 mL/min between 2012-2018 from Kaiser Permanente Southern California. Three high bleeding risk subgroups were identified: 1) patients aged ≥80 years; 2) patients with moderate renal impairment (CrCl 30-49 mL/min) regardless of age; or 3) patients with bleeding within 12 months prior to the index date or HAS-BLED score ≥3. Patients were followed through December 2018 for stroke or systemic embolism, major bleeding requiring hospitalization, and all-cause mortality. Cause-specific hazard regression models were used to investigate associations between dabigatran dose and clinical outcomes adjusting for covariates and considering competing risks of death. Among high bleeding risk patients with AF [3,749 aged ≥80 years; 1,716 with moderate renal impairment; 3,051 with recent bleed or high HAS-BLED score], 34% received reduced dose of dabigatran. Patients who received reduced dose were older, had reduced renal function, and had more comorbidities. Compared with standard dose, reduced dose of dabigatran was not associated with an increased risk of stroke or systemic embolism but was associated with lower risk of major bleed in patients aged ≥80 years (
Table
). Reduced dose of dabigatran was also associated with lower risk of mortality among patients aged ≥80 years and patients with moderate renal impairment. A lower risk of bleeds and mortality associated with reduced vs standard dose of dabigatran in high-risk patients with AF suggest a better dosing strategy for these risk groups.
Abstract 15199: Effect of Adherence on an Invasive Approach to Cocaine Associated Non ST Elevation MI
Authors: Jaswaney Rahul , Arora Shilpkumar , Jani Chinmay , ZUZEK ZACHARY , PANAICH SIDAKPAL S , Patel Mohini , Thakkar Samarthkumar J , Josephson Richard A , Zidar David , Shishehbor Mehdi
Published: May 2021

Background:
Guidelines for the treatment of cocaine associated non-ST elevation myocardial infarction (CANSTEMI) suggest benefit with invasive approaches. There is reluctance to pursue invasive options due to concerns of medication non adherence.

Hypothesis:
To determine the effect of a history of medication adherence on invasive approaches to patients with CANSTEMI.

Methods:
The Nationwide Readmissions Database was queried from 2016 - 2017 for ICD-10 CM codes I21.4 in the primary diagnosis field and F14 in secondary fields for CANSTEMI. Coronary angiogram with or without percutaneous coronary intervention (PCI) was defined as invasive approaches. History of non adherence was identified by appropriate ICD-10 CM codes. The primary outcome was a composite of major adverse cardiac events (MACE) at one year. Secondary outcomes were all-cause mortality, myocardial infarction (MI) readmission, stroke readmission, and emergent revascularization at one year. Cox-Proportional Hazard regression was used to adjust for demographic and comorbid confounders.

Results:
We identified 7,372 patients with CANSTEMI, of which 5,236 (71.0%) were adherent and 2,138 (39%) were non adherent. In adherent patients, 1486 (28%) had CA and 1773 (34%) had PCI. In non adherent patients, 538 had CA (25%) and 546 (25%) had PCI. Neither age nor gender were associated with non adherence. Non adherent patients were more likely to have diabetes, COPD, CKD stage 3 or more, and anemia. The primary outcome of MACE was significantly lower at 1 year in adherent patients with invasive approaches, while emergent revascularization was not different. In non adherent patients, there was no difference in MACE with invasive approaches, while there was a significant increase in emergent revascularization (Figure 1).

Conclusion:
Patients with a history of adherence demonstrated significant benefits and reduced risks with an invasive approach, while similar benefit was not observed in non-adherent patients.
Abstract 15203: Acute Electronic Cigarette Exposure Decreases Heart Rate Variability in C57BL/6 Mice
Authors: Cornett Carson G , Castellanos Jocelyn , Luna Karla , Gupta Rajat , Ruenger Dennis , Zhu Yifang , Jordan Maria C , Shao Xuesi M , Roos Kenneth P , Araujo Jesus A
Published: May 2021

Background:
Despite a lack of empirical data, an unprecedented rise in electronic cigarettes (ECs) has been widely perceived as safe. Multiple studies support a causal link between tobacco cigarette (TC) use and a decline in cardiovascular (CV) health; however, there is a paucity of data with EC use. A study showed EC use decreased HRV in humans via increased sympathetic activation- a known mechanism predictive of CV disease from TC use. We aimed to develop a mouse model to determine if acute EC exposure modifies HRV in mice.

Methods:
Telemetry devices were implanted in the abdomen of 6 eight-week-old C57BL/6 mice to monitor ECG activity continuously. Mice underwent a 1-hr acclimation phase in exposure chambers followed by a 1-hour exposure to air (control). EC exposures consisted of two 15-min sessions (4-sec puff/26-sec air) to BluPlus® 2.4% nicotine (Classic Tobacco) with a 15-min period of aerosolized PBS added as a secondary control. For each exposure episode, a 45-min post-exposure event followed. Ponemah v6.20 software was used for HRV analysis of the time domain. A linear mixed-effects model with a robust estimator was used to determine the relationship between air vs. combined EC events and PBS (n = 1,109). R (Version R3.6.3) was utilized to test for statistical significance at α = 0.05.

Results:
EC exposures significantly decreased the standard deviation of NN intervals (SDNN) and root mean square of successive differences (RMSSD) by 5.00 and 9.34 units as compared to air exposures, suggesting reductions in total and short-term autonomic variability (Table 1). Both parameters increased in the post-EC periods as compared with the EC exposures. Conversely, PBS vs. air exposure showed a marked increase in SDNN and RMSSD.

Conclusion:
Short-term exposures to ECs decreased HRV in mice, consistent with similar results in human studies, suggesting that ECs could increase cardiovascular risk in an acute manner.
Abstract 15209:
LPA
Variants Are Associated With Aortic Valve Stenosis, Heart Failure and Chronic Kidney Disease
Authors: Dikilitas Ozan , Satterfield Benjamin A , Safarova Maya , Clarke Shoa L , Tcheandjieu Catherine , Zhu Xiang , Bastarache Lisa , LARSON eric B , Justice Anne E , Shang Ning , Rosenthal Elisabeth , Shah Amy S , Namjou-Khales Bahram , Urbina Elaine M , Wei Wei-Qi , Feng Qiping , Hebbring Scott J , Jarvik Gail P , de Andrade Mariza , Manolio Teri A , Assimes Themistocles L , Kullo Iftikhar J
Published: May 2021

Background:
The pathophysiology of lipoprotein (a) [Lp(a)] remains obscure. We conducted a phenome wide analysis study (PheWAS) to identify pleiotropic effects of LPA variants.

Methods:
Among 51,843 European-ancestry participants (age 58±16 years, 54% female) of the electronic MEdical Records and Genomics (eMERGE) network we assessed whether
LPA
variants exhibited pleiotropic affects through an electronic health record-based PheWAS. We adjusted significant associations by presence of atherosclerotic cardiovascular disease (ASCVD; defined as a composite of coronary heart disease, cerebrovascular disease, and peripheral artery disease) to determine whether those associations were independent of ASCVD.

Results:
In PheWAS analysis, we tested 864 phecodes with 36 independent
LPA
variants. We identified 21 significant associations with non-ASCVD phenotypes including heart failure, aortic valve stenosis, and chronic kidney disease of which 14 were replicated across independent cohorts. The strength of associations between the
LPA
variant rs10455872 and both heart failure and aortic valve stenosis related phecodes were significantly attenuated after adjustment for ASCVD. However, the association with chronic kidney disease phecode remained independent following adjustment for ASCVD without any attenuation in the estimated odds ratio (Table).

Conclusions:
LPA
genetic variants were associated with aortic valve stenosis, heart failure and chronic kidney disease. The observed association of
LPA
variant rs10455872 with aortic stenosis and heart failure appear to be partially mediated by ASCVD, while the association with chronic kidney disease appears to be independent of ASCVD. Additional studies are needed to elucidate potential mechanisms by which Lp(a) may contribute to the pathogenesis of non-ASCVD disease phenotypes.
Abstract 15213: Association of Angiotensin-converting Enzyme Inhibitors or Angiotensin Receptor Blockers Use and Covid-19 Infection Among Patients With Hypertension
Authors: An Jaejin , Wei Rong , zhou hui , Luong Tiffany , Liu Ran , Gould Michael K , Mefford Matthew , Harrison Teresa N , Creekmur Beth , Lee Ming-Sum , Sim John J , Brettler Jeffrey W , Martin John P , Ong Angeline L , Reynolds Kristi
Published: May 2021

Introduction:
Given the limited evidence, we investigated the association between use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) and risk of Covid-19 infection within a large diverse hypertension population.

Methods:
We identified patients with hypertension as of March 1, 2020 (index date) from Kaiser Permanente Southern California, a large US integrated healthcare system. Patient demographics, antihypertensive medication use, neighborhood income and education, and comorbidities were identified from electronic health records within 1-year pre-index date. The study outcome was a positive RT-PCR test for Covid-19 between March 1 - May 6, 2020. We used multivariable logistic regression models to examine the association between ACEI/ARB use and Covid-19 infection.

Results:
Among 824,650 patients with hypertension, 16,898 (2.0%) were tested for Covid-19. Of those tested, 1,794 (10.6%) had a positive result and 547 (30.5% of positive cases) were hospitalized within 14-days of testing positive. Of those tested, 4,878 (28.9%) were on ACEIs, 3,473 (20.6%) were on ARBs, and 4,177 (24.7%) were on other antihypertensive medication classes. Risk of covid-19 infection associated with ACEI use decreased with increasing age (P-interaction = 0.01). In age-stratified analyses, ACEI use was not statistically associated with increased risk of Covid-19 infection among the age groups of 18-39, 40-64, and 65-84 years but was associated with lower risk of Covid-19 among those aged ≥85 years (
Table
). Across all age groups, ARB use was not associated with increased risk of Covid-19, but non-white race, lower neighborhood income and education, and no antihypertensive medication use were associated with increased risk of Covid-19.

Conclusions:
ACEI nor ARB use was not associated with increased risk of Covid-19 infection. The decreased risk of Covid-19 infection among older adults using ACEIs warrants further investigation.
Abstract 15215: Pro-pace: Prospective Randomized Trial of Skin Closure for Pacemaker Implant
Authors: Abboud Jaber , Guenther Celine , Boehmer Andreas , Kaess Bernhard M , Ehrlich Joachim R
Published: May 2021

Introduction:
Pacemaker implantation is a standard technique with largely traditional knowledge and has been performed for over 50 years. Despite its huge distribution, there are hardly any randomized trials regarding technical aspects such as material of skin closure.

Hypothesis:
The aim was to compare if resorbable subcuticular suture skin is superior in terms of clinical or cosmetic endpoints vs. non-resorbable suture.

Methods:
We performed a prospective randomized comparison of non-resorbable subcuticular suture to suture with resorbable material for pacemaker implantation with indications according to current guidelines. All consecutive patients undergoing placement of pacemakers were eligible. Follow-up was 1 year. Scars were observed at day 1, week 6 and 1 year after surgery. Clinically relevant primary endpoints were: bleeding, infection or revision. Secondary endpoints recorded at day 1 were: local hematoma formation > 10cm diameter, wound width, insufficient skin closure. Secondary endpoints at 6 weeks and 1 year: scar width, pathological scarring with kelloid, insufficient skin closure. Cosmetic results were assessed using “
P
atient and
O
bserver
S
car
A
ssessment score (POSA)“.

Results:
We included 115 pts. (77 male) and performed non-resorbable skin closure in 50 cases. There were no differences in clinical characteristics between patient groups. At 1 day after implantation was no difference between regarding clinical or cosmetic endpoints (Scar width P=0.43, POSA P=0.44). At 6 weeks and 1 year post implantation, there were similarly no differences in clinical or cosmetic endpoints between both groups (Scar width P=0.54, POSA P=0.45, figure). No relevant clinical endpoints (bleeding, infection, revision) were associated to either technique of skin closure.

Conclusions:
Based on the present prospective randomized study, suture material does not influence clinical or cosmetic results of pacemaker implantation.
Abstract 15226: The Impact of Chronic Obstructive Pulmonary Disease on In-hospital Outcomes Following Left Ventricular Assist Device Implantation
Authors: Ebner Bertrand , Maning Jennifer , Vincent Louis , Grant Jelani , olarte neal , Olorunfemi Odunayo P , Colombo Rosario A , Chaparro Sandra
Published: May 2021

Background:
Chronic obstructive pulmonary disease (COPD) is well-known cause of ventricular dysfunction. However, in the setting of patients with advanced heart failure undergoing left ventricular assist device (LVAD) implantation, there is paucity data on COPD influence on in-hospital outcomes.

Methods:
This retrospective cohort study based on the Nationwide Inpatient Sample included all patients above 18 years all who underwent LVAD implantation from 2011 to 2017. All data was weight as recommended by Healthcare Cost and Utilization Project.Multivariate logistic regression was used to evaluate the impact of COPD on in-hospital outcomes.

Results:
A total of 25,503 patients underwent LVAD implantation, of those 13.8% had a pre-existing diagnosis of COPD. Individuals with COPD were older (median 62 vs. 58 years, p<0.001), more commonly male (82% vs. 76.4%, p<0.001). Patient with COPD had a greater burden of comorbidities confirmed by significant higher rate of hypertension, diabetes, atrial tachyarrhythmias, dyslipidemia, prior stroke, coronary and peripheral artery diseases, pulmonary hypertension, and chronic kidney disease (p<0.001 for all). No significant difference was found in in-hospital stroke, infections, short-term percutaneous mechanical circulatory support, implant related complications, and LVAD thrombosis. There was a significant higher rate of inpatient acute kidney injury, major bleeding, cardiac complications, thromboembolism, and cardiac arrest in patients without COPD (p<0.05 for all outcomes). Compared to patients without COPD, individuals with COPD had a lower mortality (6.2% vs. 12.4%; OR 0.59; C.I. 0.512-0.685; p<0.05).

Conclusion:
Patients with COPD undergoing LVAD implantation have higher comorbidities, however, it is not associated with increase in-hospital all-cause mortality.Further studies are needed to analyze the differences found between these two groups in more detail.
Abstract 15229: Clinical Phenotype Differences in Outcomes and Responses of Spironolactone in Heart Failure With Preserved Ejection Fraction
Authors: Riordan Maeveen , Kao David P
Published: May 2021

Introduction:
Several clinical phenotypes have been described in patients with heart failure with preserved ejection fraction (HFpEF). This heterogeneity may explain why no therapies have improved outcomes in clinical trials of HFpEF patients. In a secondary analysis of TOPCAT, the authors discovered improved mortality in female HFpEF patients treated with spironolactone. The objective of this study was to determine if outcomes for spironolactone in women with HFpEF varied by female-specific phenotypes.

Methods:
Using 10 clinical variables, a latent class analysis (LCA) of 5196 female patients from 7 clinical trials (BEST, IPRESERVE, MOCHA, NEAT-HFpEF, RELAX, TOPCAT, and SOLVD) was used to identify phenotypes across the LVEF spectrum, which included 3 distinct phenotypes of HFpEF patients. A post-hoc analysis of TOPCAT was completed to analyze the outcomes of spironolactone versus placebo by female phenotype. The outcomes were cardiovascular (CV) mortality, heart failure (HF) hospitalizations, all-cause mortality, and CV hospitalizations.

Results:
Table 1 shows characteristics of 3 female HFpEF phenotypes: phenotype 1 “aging hypertensive”, phenotype 2 “younger hypertensive”, and phenotype 3 “obesity phenotype”. 887 female patients from the TOPCAT trial were analyzed according to these phenotypes. Of these, only phenotype 1 showed a benefit of spironolactone therapy compared to placebo with regards to the primary outcome of CV mortality and HF hospitalizations (20.8% vs 30.2%, p<0.05) as well as the composite of all-cause mortality and CV hospitalizations (41.1% vs 51.3%, p<0.05).

Conclusion:
Older, hypertensive women with HFpEF show a significant reduction in CV mortality and HF hospitalizations when treated with spironolactone vs. placebo, whereas other women did not. Prior studies show that this phenotype is often associated with a higher mortality, thus spironolactone may be particularly important in this patient population.
Abstract 15245: Cd34+ Progenitor Cells in the Progression of Cardiac Allograft Vasculopathy
Authors: Ozcan Ilke , Toya Takumi , Corban Michel , Ahmad Ali , Loeffler Darrell , Ostlie Hunter , Kushwaha Sudhir , Lerman Lilach O , LERMAN Amir
Published: May 2021

Introduction:
CD34+ progenitor cells play a role in vascular repair and plaque stability. However, their role in cardiac allograft vasculopathy (CAV), vessel remodeling, and changes in plaque morphology is incompletely understood.

Hypothesis:
We hypothesized that decreased levels of baseline CD34+ progenitor cells would be associated with Intravascular Ultrasound (IVUS)-defined vulnerable plaque characteristics and CAV progression.

Methods:
In heart transplant patients undergoing annual IVUS, CD34+ cells were counted in peripheral blood using flow cytometry, on the same day as baseline IVUS. Gray-scale and virtual-histology IVUS were used to evaluate vessel size, plaque burden, and plaque composition (fibrous, fibrofatty, necrotic core, calcific). Positive remodeling was defined as expansion of external elastic membrane area on follow-up. Patients were divided into two groups by the median of the change (Δ) in necrotic core volume over the subsequent 3 years.

Results:
A total of 55 patients (mean age 52±15 years, 65% males) were included. Median time after transplant was 4.2 years at baseline. Average vessel area at baseline and three years were 15.8±4.6 and 15.3±5.4 mm, respectively (p=0.32). Twenty-four patients (44%) who showed positive remodeling at follow-up, compared to those who did not, had lower levels of baseline CD34+ progenitor cells (absolute count per 100,000 counts, 980 [690, 1460]) vs. 665 [438, 1015], p=0.02) (Fig. 1A). Patients with greater than median (>1.96 mm3) Δnecrotic core volume, as compared to those with below median Δ, also had lower baseline CD34+ cells (705 [483, 998] vs. 1180 [660, 1620] per 100,000 counts, p=0.04) (Fig. 1B).

Conclusions:
Lower levels of CD34+ progenitor cells are associated with long-term positive coronary vascular remodeling and increased plaque necrotic core volume in patients who underwent allograft heart transplant. This study supports the notion that circulating CD34+ progenitor cells play a role in CAV.
Abstract 15246: Sex-Biased Preoperative Circulating MicroRNA Levels in Patients Who Developed Postoperative Heart Failure With Preserved Ejection Fraction
Authors: Rizvi Farhan , Kroboth Stacie , Emelyanova Larisa , Ross Gracious , Singh Maharaj , Kress David , Tajik A Jamil , Jahangir Arshad
Published: May 2021

Introduction:
Acute postoperative heart failure (PoHF) is encountered in 20-35% of elderly patients after cardiac surgery but predictors are not well defined. Circulating microRNAs (miRNAs) predict HF or postoperative atrial fibrillation, yet, their role in identifying those at risk for PoHF with preserved LV function and gender-related differences is not known.

Hypothesis:
miRNAs involved in CVD can identify patients who develop PoHF in gender-specific manner.

Methods:
Preoperative blood samples from patients with preserved LV function undergoing cardiac surgery with no prior history of HF, supraventricular, or ventricular tachycardia was used for RNA isolation. Differences in relative plasma levels of miRNA between PoHF vs. No-PoHF were assessed using qPCR. Univariate and multiple logistic regressions were performed to assess risk factors for PoHF.

Results:
Out of 68 patients (mean age 68.3±12.4), 13 (19%) developed PoHF (54% males; mean age 64.1±15.1; p=0.23), while 55 (51% males; mean age 69.3y ± 11.6) remained free of PoHF. Although all patients had preserved LV function, those who developed PoHF had lower LVEF, (52 vs 58; P<0.05). No significant differences were observed in the prevalence of hypertension, diabetes, myocardial infarction, heart failure, stroke, COPD, or the use of cardiac medications. Out of 13 miRNAs analyzed, stepwise discriminant analysis showed miR-423 (11-fold), -187 (6-fold), -26a2 (4-fold), and -15b (-1.9-fold) were significantly (p<0.05) altered in patients who developed PoHF. When miRNAs were assessed for gender differences, levels of only four miRNAs [miR-423(P<0.01), -23b2(p<0.05), -15b1(p<0.01), and -29b (p<0.05)] principally involved in TGFβ1-SMAD 2/3 regulated extracellular matrix (ECM) turnover pathways were significantly altered in male but not in female patients who developed PoHF compared to No-PoHF group.

Conclusions:
The differences in preoperative miRNA expression in pathways involved in ECM turnover in male patients who develop PoHF is suggestive of pathophysiological substrate differences between males and females and identifies a group at risk of PoHF with preserved LV function.
Abstract 15249: Association of Coronary Artery and Extra-coronary Calcification With Reduced Physical Function and Frailty in Older Adults: The Atherosclerosis Risk in Communities Study
Authors: Ding Ning , Wang Frances , Cainzos Achirica Miguel , Schoenborn Nancy , Boyd Cynthia , Wagenknecht Lynne E , Butler Kenneth R , Folsom Aaron R , Coresh Josef , Windham B Gwen , Blaha Michael J , Matsushita Kunihiro
Published: May 2021

Introduction:
Coronary artery calcium (CAC) and extra-coronary calcification (ECC) have been associated with age-related phenotypes such as cognitive impairment. However, their relationship with poor physical function and frailty/pre-frailty in older adults is unclear.

Hypothesis:
CAC and ECC (aortic valve, aortic valve ring, mitral valve, ascending aorta, and descending aorta) are associated with poor physical function and frailty/pre-frailty.

Methods:
We defined poor physical function as a Short Physical Performance Battery (SPPB) score ≤9 and frailty/pre-frailty as the presence of at least one frailty criterion: weight loss, slow walking speed, exhaustion, low grip strength, and low physical activity. The number of vascular beds with any calcification (CAC and five ECC sites [0-6]) was calculated for a composite measure of calcification. Logistic regression was used to quantify cross-sectional associations with SPPB or frailty/pre-frailty among 1,564 ARIC participants aged 74-92 without prior CVD at visit 7 (2018-19).

Results:
The prevalence of low SPPB, frailty, and pre-frailty was 50%, 5%, and 56%, respectively. Highest (vs. lowest) quartile of aortic valve and mitral valve calcification was associated with low SPPB (OR 1.47 [1.15, 1.88] and 1.53 [1.19,1.97]) and frailty/pre-frailty (1.34 [1.05, 1.71] and 1.41 [1.10, 1.80]). Aortic valve ring calcification was associated with frailty/pre-frailty, and descending aorta calcification with low SPPB. The total number of calcified vascular beds demonstrated a dose-response relationship to both outcomes (Table), with 5-6 calcified vascular beds demonstrating ~2-fold higher odds.

Conclusions:
Cardiovascular calcification, especially aortic valve and mitral valve calcification, was robustly associated with higher risk of poor physical function and frailty/pre-frailty, suggesting the potential etiological link between cardiovascular calcification and functional decline at older age.
Abstract 15252: Ischemic-Trained Monocytes Improve Arteriogenesis During Hindlimb Ischemia
Authors: Falero-Diaz Gustavo , Barboza Catarina d , Pires Felipe , Vazquez-Padron Roberto I , Velazquez Omaida C , Lassance-Soares Roberta M
Published: May 2021

Introduction:
Recent studies have shown that innate response can build immunological memory. This process called “trained immunity” is an epigenetic reprogramming of the monocytes driven by a metabolism shift towards glycolysis.

Hypothesis:
Since HIF-1a is a major player in monocytes activation and also targets some epigenetic enzymes, we hypothesize that hypoxia/ischemia can lead to “trained immunity” improving arteriogenesis in a mouse model of hindlimb ischemia.

Methods:
Mice subjected to a unilateral single ischemia insult for 24hours (24h group: femoral artery ligation for 24 h) or by ischemia reperfusion cycles (Cycle group: ischemia-reperfusion in 4 cycles of 5 minutes) or non-ischemia (sham group), were used as donors in the monocyte transfer experiment. Recipient mice underwent to permanent hindlimb ischemia one day prior the tail vein injection of bone marrow (BM) monocytes from the ischemic leg. Laser Doppler assessed blood flow recovery before and after hindlimb ischemia. Arteriogenesis was quantified on recipient mice by assessing the diameter of gracilis collaterals. A 24h group monocytes from ischemia and non-ischemia leg was used as donors to test the systemic vs. local effect of the ischemic-trained monocytes. Lin- cells were used as a control. Cultured human monocytes were subjected to 24h hypoxia and gene expression for epigenetic enzymes was performed by real time rt-PCR

Results:
Blood flow recovery in recipients who received ischemic-trained monocytes (24h and cycle) improved overtime compared to sham. Arteriogenesis was significant greater in 24h group compared to sham. Surprisingly, the improvement in blood flow recovery was abolished using combined monocytes from ischemic and non-sichemic, suggesting that ischemia training has a local effect in the monocytes. The Lin- experiment confirmed that the ischemia training is monocyte specific. Moreover, hypoxia regulated epigenetic enzymes responsible for histones methylation in human monocytes.

Conclusions:
Monocytes can be trained by previous ischemia/hypoxia insult and improve arteriogenesis during hindlimb ischemia. The molecular mechanisms that lead the trained immunity by hypoxia still unknown, however epigenetic modifications might play a role in this process.
Abstract 15258: Higer Unipolar Voltage at Cell Injection Sites Correlates With Better Outcomes After Transendocardial Cd34
+
Cell Transplantation in Patients With Chronic Heart Failure
Authors: Poglajen Gregor , Žorž Neža , Zemljic Gregor , Frljak Sabina , Cerar Andraz , Perin Emerson C , VRTOVEC Bojan
Published: May 2021

Introduction:
The evidence supporting the impact of electroanatomic guidance in defining the targets for transendocardial cell injections in chronic heart failure (CHF) remains inconclusive.

Hypothesis:
We evaluated a correlation between electroanatomic properties of the myocardium at the cell injection sites and clinical response to CD34
+
cell therapy in CHF patients.

Methods:
We enrolled 131 consecutive patients with CHF and LVEF<40% undergoing CD34
+
cell therapy at a single study site. All patients received bone-marrow stimulation with filgrastim for 5 days; CD34
+
cells were collected by apheresis and injected transendocardialy (80x10
6
cells per patient). Target injection sites were defined by electroanatomical mapping as myocardial areas with unipolar voltage >8.3mV and local linear shortening <6%. Favorable clinical response was defined as an increase in LVEF≥5% between baseline and 6 months follow-up.

Results:
Of 131 patients 69 (53%) displayed a favorable clinical response (Group A) and 62 (47%) patients failed to respond to cell therapy (Group B). At baseline, the groups did not differ in gender (male: 89% in Group A vs. 84% in Group B, P=0.45), age (53±12 years vs. 55±11 years, P=0.25), CHF etiology (ischemic: 22% vs. 32%, P=0.17), LVEF (29±6% vs. 32±7%, P=0.06), or LVEDD (6.3±1.2 cm vs. 6.7±1.0 cm, P=0.10). Patients in Group A had lower baseline creatinine (81±20 μmol/L vs. 92±24 μmol/L in Group B, P=0.005), and lower levels of NT-proBNP (931±1078 pg/mL vs. 2716±2716, P=0.001). The number of cell injections in Groups A and B was comparable (17.3±2.6 injections vs. 17.6±3.5 injections, P=0.60). When analyzing the electroanatomical properties at cell injection sites, we found significantly higher unipolar voltage in Group A (11.2±3.7 mV vs. 9.5±2.6 mV in Group B, P=0.005). However, we found no differences in injection site local linear shortening between the groups (2.7±3.9% in Group A vs. 3.4±3.4 in group B, P=0.56).

Conclusions:
In CHF patients, higher unipolar voltage at the cell injection sites appears to correlate with better clinical response to transendocardial CD34
+
cell therapy. Thus, cell injections guided by measurements of myocardial viability may offer an advantage over blind cell injection strategies in this patient population.
Abstract 15272: Estimating Life Expectancy of Systolic Blood Pressure Intervention Trial Participants Using Pooled Epidemiologic Cohort Data
Authors: Bellows Brandon , Zhang Yiyi , Zhang Zugui , Lloyd-jones Donald M , Bress Adam P , King Jordan B , Kolm Paul , CUSHMAN WILLIAM , Johnson Karen , Tamariz Leonardo , Oelsner Elizabeth , Shea Steven , Newman Anne B , Ives Diane G , Couper David , Moran Andrew E , Weintraub William S
Published: May 2021

Introduction:
Intensive systolic blood pressure (SBP) treatment (<120 mm Hg) in the Systolic Blood Pressure Intervention Trial (SPRINT) improved overall survival compared to standard treatment (<140 mm Hg). Economic analyses of SPRINT require extrapolation of treatment effects beyond the trial data.

Methods:
We projected life expectancy after SPRINT using six US cohort studies in the National Heart, Lung, and Blood Institute Pooled Cohorts Study (NHLBI-PCS). We included SPRINT-eligible NHLBI-PCS participants as those aged >=50 years with SBP 130-180 mm Hg and increased cardiovascular disease (CVD) risk without diabetes or history of stroke. We used propensity scores to weight NHLBI-PCS participants to resemble SPRINT participants. In SPRINT participants, we estimated in-trial survival (<4 years) using a time-based flexible parametric survival model (FPSM). In SPRINT-eligible NHLBI-PCS participants, we estimated post-trial survival (>=4 years) using an age-based FPSM and applied the formula to SPRINT participants to predict post-trial survival. We combined in- and post-trial survival to project overall life expectancy for each SPRINT participant and compared it to commonly used Gompertz methods.

Results:
We included 8,584 SPRINT and 10,610 SPRINT-eligible NHLBI-PCS participants. After propensity weighting, mean (SD) age was 67.9 (9.4) and 68.7 (8.8) years, 35.5% and 38.3% were female in SPRINT and NHLBI-PCS, respectively. Predicted in-trial survival was similar to that observed in SPRINT with both FPSM and Gompertz models (Figure). Assuming constant treatment effects, projected mean life expectancy using the NHLBI-PCS method was 21.1 (7.4) years with intensive and 19.3 (7.2) years with standard treatment; compared to 11.2 (2.3) and 10.5 (2.2) years, respectively, using the Gompertz method.

Conclusions:
Combining SPRINT and NHLBI-PCS observed data may offer a more realistic estimate of life expectancy than by parametrically extrapolating SPRINT data.