bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 10969: Estimated Number Needed to Treat with Mavacamten vs Placebo to Improve Functional Capacity and Left Ventricular Outflow Tract Obstruction in Patients with Symptomatic Obstructive Hypertrophic Cardiomyopathy
Authors: Semigran Marc , Wang Yan , Xie Jipan , Xu Yaping , Sutton Megan B , Desai Nihar R
Published: March 2022

Introduction:
Mavacamten improved functional capacity and LVOT obstruction in patients with symptomatic obstructive hypertrophic cardiomyopathy (oHCM) in the EXPLORER-HCM study (NCT03470545).

Objective:
To determine the number needed to treat (NNT) to achieve a clinical response comparing 30-week treatment with mavacamten versus placebo in patients with symptomatic oHCM.

Methods:
Data from the EXPLORER-HCM trial were analyzed. Most patients (92%) were receiving beta-blockers or calcium channel blockers. Responses were assessed using several measures: primary efficacy endpoint (improvement of ≥1.5 mL/kg/min in pVO
2
and improvement of ≥1 NYHA class or improvement of ≥3.0 mL/kg/min in pVO
2
and no worsening in NYHA class); symptoms (NYHA class); PROs (Kansas City Cardiomyopathy Questionnaire Clinical Summary Score [KCCQ CSS] and Hypertrophic Cardiomyopathy Symptom Questionnaire Shortness of Breath [HCMSQ SoB]); hemodynamics (resting and post-exercise LVOT gradients); exercise capacity (pVO
2
); biomarkers (NT-proBNP and hs-cTnI). NNT comparing mavacamten versus placebo was calculated as the reciprocal of the difference in response rates between the two groups at week 30 rounded up to an integer.

Results (Table):
The NNT to achieve the primary endpoint was 6. The NNTs were 3 for an improvement of ≥1 NYHA class and 4 for an improvement to NYHA class I. For PROs, the NNTs were 5 for an increase of ≥10 points in KCCQ CSS and 4 for a reduction of ≥2.5 points in HCMSQ SoB, which are considered clinically important changes. For hemodynamics, the NNTs were 2–3. For increases in pVO
2
≥1.5 mL/kg/min and ≥3.0 mL/kg/min, the NNTs were 6 and 9, respectively. For biomarkers, the NNTs were 3 for any reduction in NT-proBNP and 5 for any reduction in hs-cTnI.

Conclusions:
The NNTs comparing mavacamten with placebo were consistently low across several clinical and PRO measures. This suggests that mavacamten may be an effective therapy for the treatment of symptomatic oHCM.
Abstract 10980: Long-Term Clinical Outcomes of Continuous Statin Therapy in Patients with Deferral of Coronary Intervention Based on Fractional Flow Reserve
Authors: Ishii Masanobu , Yamanaga Kenshi , Otsuka Yasuhiro , Tsujita Kenichi , Kuramitsu Shoichi , Takashima Hiroaki , Matsuo Hitoshi , YOKOI HIROYOSHI , Tanaka Nobuhiro
Published: March 2022

Background:
The optimal medication therapy for patients with angiographically intermediate coronary artery stenosis in whom revascularization was deferred by fractional flow reserve (FFR) remains to be fully established. The aim of this study was to investigate the long-term outcomes of continuous statin therapy in those patients.

Methods:
This sub-analysis of the J-CONFIRM registry (Long-Term Outcomes of Japanese Patients With Deferral of Coronary Intervention Based on Fractional Flow Reserve in Multicenter Registry) included 1113 patients who have completed 2-year follow-up and were divided into 2 groups according to continuation of statin treatment. Landmark analyses were performed that compared treatments during the follow-up period between 2 years and 5 years to assess the composite endpoints, including target vessel failure and non-cardiac death in the Cox proportional hazard regression with mixed effects account for institutional variety and inverse probability of treatment weighting (IPTW) analyses. Target vessel failure was defined as cardiac death, target-vessel related myocardial infarction, and clinically driven target vessel revascularization.

Results:
By the start of the landmark at 2-year, 681 (61.2%) patients had continued the statin, whereas 432 (38.8%) had not continued. Composite endpoint was observed in 68 (10.0%) patients with continuous statin and 54 (12.5%) in those with discontinuous statin. The multivariate mixed effects Cox regression model and IPTW adjusted for baseline characteristics, comorbidity, FFR value, culprit vessel, and medication revealed that the continuous statin was not associated with a low risk of composite endpoint (HR: 0.81, 95% CI: 0.54 to 1.21, HR: 0.81, 95% CI: 0.62 to 1.05, respectively). Subgroup analysis showed significant interaction between sex, prior myocardial infarction (pMI) and the continuous statin, indicating that the continuous statin therapy was associated with a low risk of composite endpoint in male (HR: 0.62, 95% CI: 0.41, 0.93) and patients with pMI (HR: 0.42, 95% CI 0.22, 0.82).

Conclusions:
The present study showed that continuous statin therapy was not associated with better long-term outcomes in patients with deferral of coronary intervention based on FFR.
Abstract 10982: The Impact of Successful Electrical Cardioversion for Atrial Fibrillation in Patients with Heart Failure and Preserved Ejection Fraction
Authors: Tsuda Kosuke , Kanzaki Yumiko , Sakane Kazushi , Fujisaka Tomohiro , Hoshiga Masaaki
Published: March 2022

Background:
Although atrial fibrillation (AF) is the major comorbid condition in heart failure with preserved ejection fraction (HFpEF), the evidence, which supports the efficacy of rhythm control for AF in HFpEF is limited.

Hypothesis:
Electrical cardioversion (EC) of AF for maintenance of sinus rhythm (SR) improves recovery in patients with HFpEF.

Methods:
We analyzed 162 subjects hospitalized for acute decompensated heart failure which were documented AF on admission and left ventricular ejection fraction ≥ 50%. We defined the conservative treatment (CT) group as not attempting cardioversion during hospitalization and EC groups as successful EC of AF and maintenance of SR until discharge. Clinical characteristics, composite event of cardiovascular death and heart failure rehospitalization were compared between the two groups.

Results:
Among all patients with AF on admission, 24 subjects (14.8%) were succeeded in restoring and maintaining SR by EC. They exhibited younger (70.8 years vs. 80.3 years, p < 0.01) and a lower level of BNP (88.3 ng/L vs. 156.0 ng/L, p < 0.01) than the CT group (n = 111). The findings from echocardiography demonstrated a smaller left atrial dimension (44.7 mm vs. 55.7 mm, p < 0.01) and lower E wave levels (81.5 cm/s vs. 110.0 cm/s) in the EC group. Concerning medical therapy, the rate of using anti-arrhythmia drugs in the EC group was higher (41.7% vs. 5.2%, p < 0.01). During the observational period (median = 1.6 years), successful restoration of SR was associated with a less frequent incidence of a composite event of cardiovascular death and heart failure rehospitalization (hazard ratio = 0.19, 95% confidence interval = 0.06 - 0.60, p < 0.01).

Conclusions:
Our findings highlight those patients with HFpEF, and AF treated with rhythm control by EC may improve, healthwise. Randomized controlled studies should evaluate the efficacy of EC and the effect of rhythm control for AF about atrial remodeling in HFpEF.
Abstract 10993: Prognostic Value of Low T
3
Syndrome in Patients with Acute Decompensated Heart Failure in Osaka Prefectural Acute Heart Failure Registry (OPAR)
Authors: UEDA KUMPEI , Yamada Takahisa , Watanabe Tetsuya , Morita Takashi , Kawasaki Masato , Kikuchi Atsushi , Kawai Tsutomu , Seo Masahiro , Nakamura Jun , Kayama Kiyomi , Sakamoto Daisuke , Kogame Takehiro , Tamura Yuto , Fujita Takeshi , Nishigaki Keisuke , Fukuda Yuto , Kokubu Yuki , Fukunami Masatake
Published: March 2022

Backgrounds:
It is widely recognized that thyroid dysfunction is a potential cause of heart failure (HF). In HF, one of the alterations of thyroid functions is referred to as low T
3
syndrome marked by a reduction in serum free triiodothyronine (T
3
) with normal levels of thyroid-stimulating hormone (TSH). However, there is little information available about the association between low T
3
syndrome and future cardiac events in patients with acute decompensated heart failure (ADHF), relating to left ventricular ejection fraction (LVEF).

Methods and Results:
We studied 565 patients admitted for ADHF with survival discharge in our prospective cohort study. Laboratory data including free T
3
, thyroxine and TSH were obtained at discharge. Among the patients with euthyroid (0.35 μU/mL <TSH <4.94 μU/mL, n=438), there was 62 patients who were diagnoses as low T
3
syndrome (free T
3
≦1.68 pg/mL). The primary end point of this study was all-cause death (ACD). During a mean follow up period of 2.9±1.4 years, 121 patients died. Study subjects were stratified into two LVEF subgroup as follows; 239 patients had LVEF<50% (HFrEF), and 199 patients had LVEF≧50% (HFpEF). While 68 HFrEF parients died, 53 HFpEF patients died. Kaplan-Meier curve analysis revealed that patients with the low free T
3
group had the greater risk of ACD than those with the normal free T
3
group in both LVEF subgroup (log-rank p=0.0233 in HFrEF and p=0.0265 in HFpEF). Multivariate Cox analysis showed that free T
3
was significantly associated with ACD after multivariable adjustment for major confounders, such as age, sex, systolic blood pressure and plasma brain natriuretic peptide level in both LVEF subgroup (p=0.0039 in HFrEF, p=0.0487 in HFpEF).

Conclusion:
Low T
3
syndrome was significantly associated with poor outcome in ADHF patients with both HFrEF and HFpEF.
Abstract 10996: Predictors of Surgical Reintervention Before Bidirectional Cavopulmonary Shunt in Children with Single Ventricle Physiology Who Underwent Main Pulmonary Artery Banding
Authors: Langanecha Bhavikkumar , kesavan sajith , Seed Mike , Schwartz Steven M , Honjo Osami , Fan Chun-po S , Russell Jennifer , Pereira-Solomos Paula , thomas jennifer , Dragulescu Andreea , Taylor Katherine , Floh Alejandro
Published: March 2022

Introduction:
Unplanned intervention before stage 2 palliation (S2P) in patients with single ventricle (SV) lesions with dual unobstructed outflows palliated with pulmonary artery banding (PAB) is common. The factors contributing to intervention and its association with successfully undergoing S2P are unclear.

Hypothesis:
Early intervention is more common when PAB is placed at a younger age and with a lower initial PAB pressure gradient.

Methods:
Retrospective single center study of patients with SV lesions undergoing PAB between Jan 2000 and Dec 2020. Association with reintervention and successful S2P was modeled using exploratory cause-specific hazard regression. A multivariable model was developed adjusting for clinical and statistically relevant predictors. The cumulative proportion of patients undergoing intervention were summarized using a competing risk model.

Results:
A total of 77 patients - 53% female, 86% term and 12% syndromic - underwent PAB at median (IQR) 47 (24-66) days and 3.73 (3.2-4.5) kg. Within 18 months of PAB, 60 (78%) reached S2P, 9 (12%) died, 1 (1%) transplanted and 7 (9%) were alive without S2P. Intervention occurred in 18 (23%) prior to S2P (10/18) or death (4/18); 16 (21 %) occurred within 6 months of PAB. Intervention included PAB adjustment (n=7), conversion to DKS/BTT shunt (n=5), balloon atrial septostomy (n=4) and addition of a BTT shunt (n=2). Repeat intervention was required in 4 patients. Intervention was associated with genetic syndrome (p= 0.03) and lower weight at PAB (p=0.02) but not with age at PAB, pre/postoperative oxygen saturation, PAB length or gradient. Presence of genetic syndrome was the only risk factor associated with not reaching S2P (p=0.02).

Conclusions:
Intervention is common following PAB and associated with presence of genetic disorder or smaller patient size. Children with genetic syndrome aiming to undergo S2P are at higher risk for intervention and death and may benefit from alternate treatment strategy.
Abstract 10997: Long-Term Prognostic Value of Catheter-Derived Left Ventricular Diastolic Stiffness in Patients Undergoing Transcatheter Aortic Valve Replacement
Authors: Kanzaki Hideaki , Irie Yuki , kakuta takashi , Okada Atsushi , Amaki Makoto , Kawamoto Naonori , Fujita Tomoyuki , Izumi Chisato
Published: March 2022

Introduction:
Despite successful transcatheter aortic valve replacement (TAVR), low flow rate (FR) severe aortic stenosis (AS) patients reportedly experienced poorer clinical outcomes than normal FR AS patients. Left ventricular (LV) diastolic function influences stroke volume, though limited data on TAVR outcomes in patients with severe LV diastolic dysfunction is available.

Hypothesis:
AS patients with severe LV diastolic dysfunction may develop adverse cardiac events, such as heart failure, even after TAVR.

Methods:
Consecutive patients with severe AS and preserved LV ejection fraction (> 50%) who underwent hemodynamic assessment of LV function using cardiac catheterization before TAVR were enrolled. The average slope of the end-diastolic pressure-volume relationship was calculated to determine LV diastolic stiffness. Adverse cardiac events were defined as cardiac death or heart failure hospitalization. High LV stiffness (> 190 mmHg/L) patients were compared to normal LV stiffness patients.

Results:
Of the 78 patients (age 83.2 ± 5.1 years; 21 men), 30 (38.5%) were classified to the high LV stiffness group. Low FR (< 200 mL/s) severe AS was more likely in patients with high LV stiffness than in those with normal LV stiffness (66.7% vs 33.3%,
P
= 0.004). Adverse cardiac events increased in the high LV stiffness group (Figure, Log rank
P
= 0.054). Cox regression analysis revealed that LV stiffness was associated with increased adverse cardiac events, after adjusting for age, sex, aortic valve area, and renal function (HR, 1.008; 95%CI, 1.001-1.014;
P
= 0.026).

Conclusion:
Increased LV stiffness derived from cardiac catheterization was related to low FR and was also associated with poor clinical outcomes after TAVR.
Abstract 10999: Pod-Based E-liquids Induce Vascular Endothelial Cell Dysfunction
Authors: Majid Sana , Weisbrod Robert M , Fetterman Jessica L , Keith Rachel J , Robertson Rose M , Bhatnagar Aruni , Conklin Daniel J , Hamburg Naomi
Published: March 2022

Introduction:
Pod-based e-cigarettes including JUUL represent the most commonly used product type and more efficiently deliver nicotine; however, their cardiovascular effects are poorly understood.

Methods:
We evaluated endothelial function (cell viability by TUNEL and nitric oxide bioavailability using DAF-2DA) in human aortic endothelial cells (HAECs) exposed for 90 minutes to one of four JUUL pod flavors (Menthol, Mint, Mango and Virginia Tobacco) or constituents propylene glycol (PG)/vegetable glycerol (VG) at 30:70 ratio with and without nicotine salt, as well as their heated particle fractions separated with a mini-MOUDI impactor. In healthy young adults, we assessed endothelial cell function in nonusers of tobacco products, pod users and combustible cigarette users for eNOS activation.

Results:
We observed significant increases in cell death with JUUL e-liquid flavors across 0.0001-1% dilutions. PG/VG vehicle alone and with nicotine salt induced cell death to similar levels as the JUUL e-liquids. All JUUL e-liquids at 0.0001% dilution impaired A23187-stimulated nitric oxide production. Exposure to particle fractions of JUUL e-liquids at 0.001% dilution also reduced A23187-stimulated nitric oxide production. Endothelial cells from pod users showed reduced eNOS activation compared with nonusers and similar to reduced levels in combustible cigarette users (figure).

Conclusions:
Our data suggest endothelial toxicity of pod-based e-liquids and their constituents, including in young adult users.
Abstract 11000: Cardiovascular Outcomes in Patients with Diabetes and Hypertrophic Cardiomyopathy, Hospitalized for Heart Failure
Authors: Almohannadi Moza , DARGHAM SOHA , Al suwaidi Jassim M , Jneid Hani , Abi Khalil Charbel
Published: March 2022

Introduction:
Diabetes is a widely prevalent pathology complicating many cardiovascular diseases.

Hypothesis:
We hypothesized that patients with hypertrophic cardiomyopathy (HCM) hospitalized for heart failure (HF) have a worse outcome in the presence of diabetes.

Methods:
The National Inpatient Sample (NIS) was analysed to identify records from 2005-2015 of patients hospitalized for HF as a complication of HCM. We assessed the cardiovascular and socio-economic trend of patients with diabetes and HCM hospitalized for HF, and compared them to those without diabetes.

Results:
Diabetes prevalence increased from 24.8% to 32.7% in all HMC patients hospitalized for HF. In diabetes patients, mean age of patients decreased from 71 ±13 to 67.6 ±14.2 (p<0.01) but hospitalizations increased from 0.2 to 0.5 cases/100 000 US adults (p<0.01) (Figure 1). Mortality, cardiogenic shock, ventricular tachycardia (VTach), atrial fibrillation (AF) decreased with time. Length of stay (LOS) was stable, but charges almost doubled. Age (adjusted OR= 1.04 [1.03-1.05]), female gender (adjusted OR= 1.50 [0.72-0.88]) and the presence of several comorbidities assessed using the Elixhauser score (adjusted OR= 1.09 [1.07-1.11]) predicted a higher risk of mortality in those patients. When compared to non-diabetic patients, diabetes patients were younger and had more comorbidities. Unexpectedly, the risk of mortality (adjusted OR= 0.68 [0.56-0.81]), ventricular tachycardia (adjusted OR= 0.79 [0.72-0.88]), ventricular fibrillation (adjusted OR= 0.28 [0.14-0.56]) and atrial fibrillation (adjusted OR 0.80 [0.76-0.85]) were lower in patients with diabetes. However, LOS was higher in patients with diabetes, so were charges.

Conclusions:
Diabetes is paradoxically associated with lower mortality and lower rates of complications (namely arrhythmias) in HCM patients hospitalized for HF
Abstract 11003: Racial Disparities in Induction Immunosuppression Use Among Heart Transplant Recipients in the United States
Authors: Salia Soziema J , Mostofsky Elizabeth , Gupta Suruchi , Lehman Laura L , Motiwala Shweta R , Murray Mittleman Murray A
Published: March 2022

Introduction:
Black heart transplant recipients have higher rates of acute rejection, graft failure, and mortality compared to other races. Induction immunosuppression in the immediate peri-transplant period may lower the risk of acute rejection among high-risk patients, including Black transplant recipients. However, it is not known whether the odds of receiving this treatment are different across races. Therefore, we evaluated whether there are disparities in the use of induction immunosuppression following heart transplants among Black patients compared to other races.

Methods:
We conducted a cross-sectional study of U.S. adults in the Scientific Registry of Transplant Recipients who received their first heart transplant between 2008 - 2018. We used mixed-effects logistic regression to compare the odds of receiving induction immunosuppression agents (IL-2 receptor antagonists, polyclonal anti-lymphocyte antibodies, and CD52 monoclonal antibodies) across different races.

Results:
Among 23,935 adult heart transplant recipients, 5,160 (21.6%) were Black, including 2,797 (54.2%) who received induction immunosuppression, and 18,775 (78.4%) were non-Black, including 9,499 (50.6%) who received induction immunosuppression. After accounting for demographic and clinical characteristics and treatment center, Black race was associated with 28% higher odds (Odds Ratio=1.28, 95% CI 1.17-1.40) of induction immunosuppression use compared to other races. Similar results were observed when race was further stratified (Table 1).

Conclusions:
In our study, Black heart transplant recipients were more likely to receive induction immunosuppression than transplant recipients of other races. However, further research on post-transplant clinical outcomes including survival following induction immunosuppression among Black patients is needed to formulate treatment guidelines.
Abstract 11005: Electrophysiological Remodelling of Right Atria in Atrial Fibrillation Sheep Model and Role of Succinate in Electrophysiological Properties
Authors: Guillot Bastien , Ramlugun Girish , Caluori Guido , Pallares Lupon Néstor , Walton Richard , Loyer Virginie , Jais Pierre , Pasdois Philippe , Bernus Olivier
Published: March 2022

Introduction:
Atrial fibrillation (AF) is the most common arrhythmia and is associated with deleterious remodelling processes. In AF patients, the plasmatic succinate content increases, indicating a potential role for metabolic remodelling in AF progression.

Objective:
To assess the impact of succinate on the electrophysiological properties of right atria (RA) in a persistent AF sheep model.

Methods:
Optical mapping experiments were performed in ex vivo RA from a burst pacing AF sheep model (SHAM=5; AF=5). The right coronary artery was perfused with Tyrode solution initially containing glucose (5.6mM), subsequently replaced by succinate (5mM). Action potential durations at 80% of repolarization (APD80) and mean conduction velocities (CV) were assessed from 2 to 5Hz pacing frequency and during sinus rhythm (SR). An S1S2 protocol was used to determine effective refractory period (ERP) and a burst pacing procotol (20Hz) to assess ex vivo AF vulnerability. Finally, an organ donation program allowed us to investigate these properties in a human RA from an AF patient.

Results:
SR frequency was higher in AF than SHAM sheep (2.0 vs. 1.6 Hz; p=0.19). Succinate perfusion decreased SR frequency by 18% in SHAM sheep (1.7 vs. 1.4 Hz; p=0.12) and by 43% in AF sheep (2.0 vs. 1.2 Hz; p=0.009). The ERP was lower in AF than SHAM sheep (184 vs. 210 ms; p=0.5) and succinate induced a significant increase of 136% in SHAM sheep (210 vs. 286 ms; p=0.06) and of 188% in AF sheep (184 vs. 346 ms; p=0.0008). Epicardial APD80 was lower when pacing at 2.5Hz in AF than SHAM sheep (165 vs. 197 ms ; p=0.3). Succinate increased APD80 in both SHAM and AF RA (191 to 224 ms; 165 to 231 ms) but its effect was more important in AF than SHAM sheep (148 vs. 117 %; p=0.1). Mean CV was slower in AF sheep than SHAM sheep (110 vs. 130 cm/s; p=0.47). Succinate slowed mean CV on AF sheep (110 vs. 76; p=0.4) but did not affect SHAM RA. In the human RA, APD80 (257 vs; 309 ms) and total activation time were increased by succinate.

Conclusions:
Our results indicate that succinate alters atrial electrophysiological properties, most likely through the associated ROS overproduction. Importantly, AF sheep showed an increased sensitivity to succinate perfusion. Preliminary data in a human RA are in line with these observations.
Abstract 11007: Prolonged QTc in Black and Latinx Cisgender and Transgender Women Who Are Living with Human Immunodeficiency Virus
Authors: Malangu Boniface , Bentil-Owusu Sarah , Mattappallil Arun , Sackey Joachim , Finkel Diana
Published: March 2022

Background:
QT prolongation can predispose to torsade de pointes, which occurs at higher rates in people living with HIV (PLWH). Increased prevalence of prolonged corrected QT interval (QTc) has been reported in PLWH, suggesting that it may play a role in the increased risk for sudden cardiac death in this patient population. However, gaps in research due to limited participation of gender, racial and ethnic minorities continue to limit the interpretation of these findings. Our study assessed the hypothesis that Black and Latinx cis and transgender women living with HIV (WLWH) would have greater odds of having prolonged QTc.

Methods:
A cross-sectional study was conducted by retrospectively reviewing electronic medical records to investigate the duration of the QTc interval between 2 groups, 137 WLWH versus 135 women who are not living with HIV. Associations between long QTc interval and ethnicity, smoking, alcohol use, BMI, medications (methadone, antibiotics, antiretroviral therapy, and psychiatric drugs), CD4 count, hepatitis C, and heart failure were also assessed. QTc >460 milliseconds was considered prolonged.

Results:
In the univariate logistic regression, living with HIV had significantly higher odds of having prolonged QTc than the control group (odds ratio [OR] 1.842, 95% confidence interval [CI] 1.062-3.195, p=0.0298). After adjusting for the covariates selected a priori, living with HIV was associated with even higher odds of having prolonged QTc (OR 2.128, 95% CI 1.115-4.061, p=0.023). Having heart failure was also independently associated with higher odds of having prolonged QTc (OR 3.883, 95% CI 1.672-9.018, p=0.0016) even after adjusting for other covariates (OR 2.973, 95% CI 1.605-9.836, p=0.0029). Ethnicity, smoking, alcohol use, BMI, medications, CD4 count, and hepatitis C were not significantly associated with higher odds of having prolonged QTc.

Conclusions:
This study showed that in cis and transgender women of color, living with HIV and heart failure were both associated with higher odds of having prolonged QTc. In this patient population, implementing routine EKG screening should be considered by clinicians as a strategy, among others, to prevent cardiac rhythm disturbances and cardiovascular morbidity and mortality.
Abstract 11009: Aortic Valve Calcium Score and Mortality Risk Following Transcatheter Aortic Valve Replacement
Authors: Patel Parth P , El Sabbagh Abdallah , Suliman Rayan , Salwa Najiyah , Pollak Peter , Yamani Mohamad H , Parikh Pragnesh , Noseworthy Peter A , Landolfo Carolyh , Adedinsewo Demilade A
Published: March 2022

Background:
Transcatheter aortic valve replacement (TAVR) is an approved alternative to surgical aortic valve replacement. However, as the clinical indication and adoption of TAVR expands, it remains important to identify predictors of mortality after TAVR. We aimed to study the impact of aortic valve calcium score on long term mortality following TAVR in a large patient population.

Methods:
We included consecutive patients who successfully underwent TAVR from June 2010 – June 2019 across all Mayo Clinic sites. Patients were followed through February 2021. Aortic valve calcium scores were obtained from preoperative computed tomography angiography of the chest. Additional data was abstracted from medical records. Cox-proportional hazard regression models were employed to evaluate the independent effect of aortic valve calcium score on mortality.

Results:
A total of 1988 patients were evaluated in the final analysis. Forty-two percent were women, median age was 83 years (Q1: 77, Q3: 87), 16% received a permanent pacemaker following TAVR and 83% received an Edwards Sapien valve. We demonstrate an incremental increase in mortality risk as aortic valve calcium score values increased after adjusting for age, gender, pacemaker implantation, left bundle branch block, and Charlson Comorbidity Index. Selected calcium score cut-points with adjusted hazard ratios (aHR) are displayed: 1200 AU (aHR: 1.13, 95% CI 1.06, 1.20); 2000 AU (aHR: 1.22, 95% CI 1.09, 1.35); 3000 AU (aHR: 1.34, 95% CI: 1.14, 1.58).

Conclusion:
This study demonstrates an association between aortic valve calcium score and long-term mortality in a large patient population. This highlights the potential predictive value of the calcium score in preoperative planning and may provide clinicians with an additional measure for risk stratification prior to TAVR.
Abstract 11014: Circulating Endothelin-1 Levels Are Not Elevated in Atherosclerotic Coronary Artery Disease and Coronary Microvascular Dysfunction Defined Using [
15
O]h2o Pet Perfusion, Invasive Ffr and Coronary Ct Angiography
Authors: Jukema Ruurt , de Winter Ruben , van Diemen Pepijn , Driessen Roel , Danser Jan H , Garrelds Ingrid , Raijmakers Pieter , van de Ven Peter , Knaapen Paul , Danad Ibrahim , De Waard Guus
Published: March 2022

Introduction:
Endothelin-1 (ET-1), the most potent cardiovascular vasoconstrictor in humans, is increasingly being linked to coronary microvascular dysfunction (CMD) and atherosclerosis, thus providing a therapeutically modifiable target. In this study we investigated whether increased ET-1 levels are related to atherosclerosis, high risk plaque (HRP), myocardial perfusion and CMD in chest pain patients.

Methods:
Serum ET-1 was measured by ELISA in 205 patients (64% men; age 58 ± 9 years) with suspected coronary artery disease. All patients underwent 256-slice coronary CT angiography for (quantitative) plaque analysis and coronary artery calcium (CAC) scoring, [
15
O]H2O PET perfusion imaging and invasive FFR measurements in all coronary arteries. A total of 585 vessels were stratified upon four categories based on [
15
O]H2O PET perfusion (hyperemic MBF 2.3 ml/min/g) and invasive pressure measurements (FFR 0.80). Vessels with a FFR >0.80 but with an ischemic hyperemic MBF below 2.3 ml/min/g were defined as CMD.

Results:
In univariable analysis, ET-1 was not related to the CAC score, total plaque volume (TPV) or perfusion (p=0.33; p=0.55; p=0.75, respectively). Also, patients with HRP did not show higher levels of ET-1 (mean logarithmic ET-1 0.29 vs 0.30; p=0.83). ET-1 levels were equally distributed across the four vessel categories and were not elevated in CMD patients (p=0.31).

Conclusions:
Our findings indicate that circulating ET-1 levels are not elevated in stable patients with either atherosclerotic coronary artery disease or coronary microvascular dysfunction, suggesting that ET-1 may not be a useful therapeutic target in these disease states.

Figure 1. A typical case example of a CMD patient with non-flow limiting coronary arteries (A) and an ischemic perfusion (B). ET-1 depicted for the four vessels categories. (C) The upper and lower whiskers represent the 10th and 90th percentile.
Abstract 11017: Prognostic Impact of Simple Nutrition Index on the Long-Term Mortality in Acute Decompensated Heart Failure Patients with and Without Reduced Left Ventricular Ejection Fraction
Authors: Fujita Takeshi , Yamada Takahisa , Watanabe Tetsuya , Seo Masahiro , Morita Takashi , Kawasaki Masato , Kikuchi Atsushi , Kawai Tsutomu , Nakamura Jun , Kayama Kiyomi , Sakamoto Daisuke , UEDA KUMPEI , Tamura Yuto , Kogame Takehiro , Nishigaki Keisuke , Kokubu Yuki , Fukuda Yuto , Fukunami Masatake
Published: March 2022

Background:
The novel nutrition index; triglyceride (TG) х total cholesterol (TC) х body weight (BW) index (TCBI) has been reported to be an easy and useful predictor for patients with coronary artery disease. However, there is no information available on the prognostic role of TCBI in the patients admitted for acute decompensated heart failure (ADHF), relating to left ventricular ejection fraction (LVEF).

Methods and Results:
We studied 605 patients admitted for ADHF in our prospective cohort study (HFrEF[LVEF<45%] n=259 and HFpEF[LVEF≥45%]:n=311). Echocardiography and venous blood sampling including TG, TC were performed just before discharge. TCBI was calculated by the formula; TG х TC х BW / 1000 at discharge. The endpoint of this study is all-cause death. During a follow up period of 2.8±1.4years, 171 patients died (79 patients in HFrEF and 92 patients in HFpEF). TCBI was significantly associated with all-cause death in patients with HFrEF (p=0.004) and HFpEF (p=0.0001) at univariate Cox analysis. All cause-death was significantly frequently observed in patients with than those without lower TCBI (<861.7=medcan value) in HFrEF (23% vs 38%, p=0.003) and HFpEF (20% vs 39%, p=0.00006). After adjustment for major confounders, TCBI remained a significant independent predictor for the total mortality in patients with HFpEF (adjusted hazard ratio: 1.88 [95%CI 1.18-3.00], p=0.008), while TCBI showed no independent association with the total mortality in HFrEF patients (adjusted hazard ratio: 1.15 [95%CI 0.71-1.85], p=0.58).

Conclusion:
TCBI at the discharge, a simple and novel nutrition index, provides a prognostic value for the prediction of total mortality in ADHF patients with HFrEF and HFpEF, although the prognostic significance of TCBI in patients with HFpEF was weakened by adjustment for relevant covariates.
Abstract 11020: Clinical, Psychosocial and Socioeconomic Predictors of Outpatient Cardiac Rehabilitation Participation: The Atherosclerosis Risk in Communities Study
Authors: Mathews Lena , Mok Yejin , Ding Ning , RIEKERT KRISTIN A , Kucharska-Newton Anna , Coresh Josef , Ndumele Chiadi E , Matsushita Kuni
Published: March 2022

Introduction:
Despite robust evidence of its effectiveness for secondary prevention, cardiac rehabilitation (CR) is underutilized. Understanding individual-level predictors of CR use can guide interventions to boost CR participation.

Hypothesis:
Clinical, psychosocial and socioeconomic predictors impact CR participation.

Methods:
We studied 1,255 participants from the ARIC Study with cardiovascular disease (CVD) events eligible for CR (myocardial infarction, coronary revascularization, valve surgery) from data linked to Medicare claims (1991-2015). Predictors including comorbidities, functional status, cognitive function, social support, social network, educational attainment, and household income were ascertained from study visits and annual follow-up at the time point closest to the index CVD event. CR participation was defined as having Current Procedural Terminology codes 93797 and 93798. We examined multiple predictors using logistic regression with the Modified Allen-Cady stepwise backward selection of covariates in addition to age, race, sex, and ARIC center.

Results:
The mean age was 72.4 (SD 5.2) years (16% Black, 43% women) and 26% participated in CR. In multivariate analyses, variables associated with lower CR participation were income <$12,000 (odds ratio (OR) 0.46 [95% CI 0.24 - 0.89]) vs. >$50,000; < high school education (OR 0.48 [0.27 - 0.86]) vs. graduate/professional education; lowest quartile of cognitive function (OR 0.52 [0.32 - 0.85]) vs. the highest quartile; lowest quartile of social support (OR 0.65 [0.44 - 0.96]) vs. the highest quartile; and current smoking (OR 0.55 [0.31 - 0.96]). Comorbidities and social network were not associated with CR participation.

Conclusions:
Cognitive function, social support, and SES were robustly associated with CR participation. Efforts to address the gap in CR participation should focus on interventions that support patients with low cognitive function, social supports, and SES.
Abstract 11022: Aspirin with Ticagrelor or with Low-Dose Rivaroxaban for Secondary Prevention; A Cost per Outcome Analysis
Authors: Tsaban Gal , Alnsasra Hilmi , Abu-Dogosh Ala , Weissberg Itai , Ben-Baruch Golan Yael , Barrett Orit , Westreich Roi , Aboalhasan Enis , Hammerman Ariel , Azuri Joseph , Arbel Ronen
Published: March 2022

Introduction:
Secondary prevention of cardiovascular events among patients with diagnosed cardiovascular disease and high ischemic risk poses a significant challenge in clinical practice. Both Ticagrelor and low-dose (LD) Rivaroxaban have shown superiority in preventing major adverse cardiovascular events (MACE) than aspirin treatment alone. The comparative value for money of these two regimens remains unexplored.

Hypothesis:
Ticagrelor and LD-Rivaroxaban are comparable in their clinical efficacy and cost-effectiveness.

Methods:
We analyzed the annualized cost needed to treat (CNT) of each regimen by multiplying the annualized number needed to treat (aNNT) by the annual cost of each drug. The aNNTs were based on outcome data from PEGASUS TIMI-54 and COMPASS trials. Scenario analyses were performed to overcome variances in terms of population risk. Costs were based on 2021 US prices. Secondary outcomes analysis was performed for myocardial infarction (MI), stroke, and CV death as separate outcomes.

Results:
The aNNTs to prevent MACE with Ticagrelor and with LD-Rivaroxaban were 207 [95% confidence interval (CI):138-553] and 147 (95%CI:104-252), respectively. At an annual cost of $3,541 versus $4,308, the corresponding CNTs were 734,429$ (95%CI:489,619$-1,958,478$) with ticagrelor and 633,003$ (95%CI:446,826$-1,085,149$) with LD-Rivaroxaban. Results of the scenario and secondary outcomes analysis are presented in
Figure 1
.

Conclusions:
LD-Rivaroxaban provides better value for money than Ticagrelor for secondary prevention of MACE. Ticagrelor offers an advantage over LD-Rivaroxaban specifically to prevent MI and should be considered in cases where MI is the primary concern.
Abstract 11029: Heart Failure, India and West - A Major Etiological Difference
Authors: Chauhan Gaurav , Duggal Bhanu , Gore Pranay , Ola Ramlal
Published: March 2022

Introduction:
We conducted the study in all cases of heart failure to assess contributions of the various major risk factor for heart failure in the Indian sub-continent as compared to the rest of the world.

Hypothesis:
Dilated cardiomyopathy is the most common etiology of heart failure in the Indian sub-continent unlike ischemic heart disease in the western world.

Methods:
A study population of 250 patients with heart failure of age >18years with various risk factors and etiologies were included & assessed as per standard norms. Patients with various etiologies were assessed over a period of 6 months.

Results:
Mean age at diagnosis of heart failure was 54years, 75% of patients were male of which 25.5% had diastolic heart failure whereas of the remaining 25% females, 42% had diastolic heart failure. In the study population, rheumatic etiology was there in 14/250 (5.6%) patients, CAD was present in 51/250 (20.4%) patient, dilated-cardiomyopathy in 101/250 (40.4%), restrictive-cardiomyopathy in 4/250 patients (1.6%), tachyarrhythmia-induced-cardiomyopathy in 3/250 (1.2%), CKD was there in 32/250 (12.8%) patients of which 24 patients, 75% patients had HFpEF, diabetes was seen in 57/250(22.8%) patients, of which the predominant population belong to HFrEF group 49/57 (85.9%), hypertension in 122/250 (48.8%) patients of which 53% of the patient was having HFpEF and the rest were in HFrEF. Smoking was there in 44/250(17.6%) patient population of which majority of patients belong to the HFpEF group 95.4% of all smokers.

Conclusions:
As compared to the western population affected cohorts with heart failure in Indians belong to a significantly younger age group (mean age 54years vs. 66years-NHANES-US-Survey and 62-years-SOLVD registry). Among the etiology, the predominant cause in Indians in hilly areas is Dilated-cardiomyopathy followed by ischemic(20%) and rheumatic(5.6%) in contrast to Ischemia as a predominant cause in the west.
Abstract 11030: Impact of the New Heart Allocation Policy on Access to Heart Transplantation
Authors: Golbus Jessica R , Tang Weijing , Li Jinming , Gupta Kashvi , Walsh Mary N , Zhu Ji , Colvin Monica M , Nallamothu Brahmajee K
Published: March 2022

Introduction:
In 2018, a new heart allocation policy was implemented to promote uniform access to transplantation by mandating sharing of donor hearts over larger geographic areas rather than by location within a given Donation Service Area (DSA). The long-term impact of this policy on sharing across DSAs is unknown.

Methods:
Using data from the Scientific Registry of Transplant Recipients, we assessed the association between the new policy and organ sharing at the level of each DSA. We included adult, single-organ heart transplants performed in the mainland US between Oct 1, 2015 and Dec 31, 2020. For each DSA, we evaluated the proportion of donor hearts imported from another DSA, the proportion exported, and their log-transformed ratio (sharing ratio). We performed multivariable regression with heteroscedasticity to evaluate the association between policy period and sharing ratio, adjusting for deaths per DSA population, household income and urbanicity.

Results:
The new policy was associated with increased importation and exportation of donor hearts across DSAs (Figure). The mean import proportion increased from 0.31 (95% CI: 0.27 to 0.36) to 0.74 (95% CI: 0.71 to 0.78) and the mean export proportion from 0.36 (95% CI: 0.31 to 0.40) to 0.75 (95% CI: 0.71 to 0.79) after the policy change. In addition, the mean sharing ratio of import:export shifted from 1.22 (95% CI: 0.91 to 1.53) to 1.01 (95% CI: 0.96 to 1.07) suggesting more balance across DSAs. The variance of the log-transformed sharing ratio was negatively associated with the new policy (β = -1.55; 95% CI, -1.82 to -1.27; P < .001), indicating a 79% drop in the variation of the sharing ratio and more uniform access. Deaths per DSA population was associated with the log-transformed sharing ratio while household income and urbanicity were not.

Conclusion:
The new policy is associated with more balanced sharing of hearts. The broader impact on waitlist survival and post-transplant outcomes remains unknown.
Abstract 11033: Efficacy and Safety of Inclisiran by Baseline Glycemic Status: A Post Hoc Pooled Analysis of the ORION-10 and ORION-11 Phase III Randomized Controlled Trials
Authors: Leiter Lawrence A , Kallend David G , Koenig Wolfgang , Landmesser Ulf , Raal Frederick J , Ray Kausik K , Schwartz Gregory G , chiang yanntong , Garcia Conde Orozco Lorena , Wright R S
Published: March 2022

Introduction:
Disorders of glucose metabolism increase in prevalence globally and contribute to excess risk of ASCVD, necessitating intensive lipid lowering.

Aim:
To analyze efficacy and safety of inclisiran (small interfering RNA targeting hepatic PCSK9 mRNA) across the strata of glycemic disorders.

Methods:
In this post hoc, pooled analysis of ORION-10 and ORION-11, 3174 patients (pts) with ASCVD/ASCVD risk equivalent (including diabetes mellitus [DM]) were randomized 1:1 to receive 300 mg inclisiran sodium (equivalent to 284 mg inclisiran) or placebo (pbo) at baseline (BL), Day (D) 90, and 6-monthly thereafter. Analyses were stratified by BL glycemic status (normoglycemia, pre-DM or DM). LDL-C percentage (%) change from BL to D510 and time-adjusted % change from D90 to D540 were evaluated. Safety was assessed over 540 days.

Results:
BL characteristics were generally balanced between the treatment arms across the glycemic strata (
Table 1
). LDL-C % change and time-adjusted % change were greater with inclisiran vs pbo and were similar across all strata (
Table 2
). Treatment-emergent adverse events (TEAE) and treatment-emergent serious adverse events were generally similar between the treatment arms; TEAEs were reported more frequently in pts with vs without glycemic disorders (not shown). Clinically relevant TEAEs at the injection site were reported more frequently with inclisiran vs pbo across the strata but all were mild or moderate (
Table 2
).

Conclusions:
Twice-yearly dosing with inclisiran (after the initial and 3-month doses) provided effective and sustained LDL-C lowering irrespective of BL glycemic status, and was generally well tolerated.
Abstract 11038: One Year Prognosis After Coronary Intervention in Hemodialysis Patients Accompanied with Triglyceride Deposit Cardiomyovasculopathy, a Novel Type Atherosclerosis with Triglyceride Deposition
Authors: Nakano Yusuke , Ando Hirohiko , Onishi Tomohiro , Ohashi Hirofumi , Suzuki Wataru , Takashima Hiroaki , Hirano Ken-ichi , Amano Tetsuya
Published: March 2022

Introduction:
Triglyceride deposit cardiomyovasculopathy (TGCV) patients presents the massive accumulation of triglyceride in smooth muscle cells characterized by a novel diffuse narrowing atherosclerosis. There are reported prognostic data on hemodialysis cases accompanied with TGCV, however, little prognostic data after coronary intervention are known.

Hypothesis:
There might be poor prognosis after coronary intervention in hemodialysis patients accompanied with TGCV.

Methods:
This retrospective single-center observational study included data from the cardiac catheter database at the study institution between April 2011 and March 2017. Among 654 consecutive patients on hemodialysis, the data for 36 patients implanted DES who could be collated the diagnostic criteria for TGCV using both 123I-β-methyl-iodophenyl- pentadecanoic acid scintigraphy and coronary angiography were analysed. Patients were divided into two groups (TGCV or non-TGCV control group). One-year prognosis after coronary intervention in patients accompanied with and without TGCV were studied.

Results:
The cohort included 13 and 23 patients accompanied with and without TGCV, respectively. Figure showed one-year prognosis, composite of cardiovascular death or non-fatal myocardial infarction or urgent revascularization, between two groups. Incidence of composite events after coronary intervention was higher in the TGCV group than in the control group (log-rank p=0.036). TGCV was a significantly and independently associated with one-year prognosis after coronary intervention even after adjusted confounding factors.

Conclusions:
These results demonstrated that TGCV comorbidity is associated with poor prognosis after coronary intervention in hemodialysis patients, and contributes to the novel risk factor for coronary intervention.
Abstract 11040: Gender Imbalance in Heart Failure Treatment, Use of Implantable Left Ventricular Assist Systems, and Cardiac Transplantation
Authors: Musfee Fadi I , Hamden Randa , Buddha Mrinalini , Naizer Hayden , Zingg Guzman Alexandra , Cecilia Ganduglia Cazaban M , Letsou George V
Published: March 2022

Introduction:
Fewer women than men with heart failure (HF) progress to implantation of a left ventricular assist device (LVAD) or transplant. A comprehensive, large-database analysis of women with HF is lacking.

Methods:
From a commercial and a national Medicare database using OPTUM® Clinformatic® Data Mart and a Medicare National Sample comprising 57,585,519 US patients, we identified 346,345 adults treated for HF during 2014-2016. Comorbidities including diabetes, coronary artery disease, hypertension, and cardiomyopathy were recorded. Patients were monitored for stroke, mechanical ventilation, heart transplant, renal insufficiency, and death through 2019 or until they were no longer enrolled. Sex and age were discerned from enrollment information.

Results:
Approximately equal percentages of men (51%) and women (49%) had HF. Age at HF diagnosis was similar between men and women (60 vs 58 y). Diastolic HF was more common in women than in men prior to LVAD placement (64% vs 36%) . All patients who progressed to LVAD placement had combined systolic and diastolic heart failure. Similar numbers of men and women with HF died within the follow-up period. Women received only 24% of the implanted LVADs. Age at LVAD placement was similar between men and women (61 vs 59 y). More men than women with HF and implanted LVADs had coronary artery disease and ischemic cardiomyopathy. After LVAD implantation, intracerebral bleeding and stroke were more common in women.

Conclusions:
In the largest database analysis to date, HF incidence, age at diagnosis, and age at LVAD placement were similar between women and men. Fewer women progressed to LVAD placement or transplantation. The prevalence of diastolic HF was significantly higher in women prior to LVAD placement. Women’s outcomes after LVAD implantation were significantly worse than men’s, especially with regard to stroke and cerebral injury. These findings support those of smaller studies.