bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 10221: Premature Ventricular Contractions in Chronic Thromboembolic Pulmonary Hypertension Undergoing Pulmonary Thromboendarterectomy Surgery
Authors: Vanam Sai , Munir Muhammad , Darden Douglas , Barat Masihullah , Keyt Lucas , Long Tanner , Feld Gregory K , Hsu Jonathan C , Birgersdotter-green Ulrika , Ho Gordon , Krummen David , Raissi Farshad , Fernandes Timothy , Poch David , Kim Nick , Papamatheakis Demosthenes G , Kerr Kim , Pretorius Victor , Madani Michael M , Han Frederick , Hoffmayer Kurt S
Published: March 2022

Background:
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare and progressive subtype of severe pulmonary hypertension. Premature ventricular contractions (PVC) are common and can be a marker of cardiomyopathy. We aimed to describe the incidence, location and predictors of PVCs in CTEPH patients undergoing Pulmonary Thromboendarterectomy surgery (PTE).

Hypothesis:
PVCs are common in CTEPH patients and the right ventricle would be the most common location of PVCs.

Methods:
We reviewed the charts of 883 consecutive patients who were referred for PTE. 12-lead ECGs were reviewed for presence of PVC. Demographics, baseline lab and imaging were extracted from chart review. Predictors of PVCs were analyzed using multivariate backward logistic regression. PVC location was identified using standard location algorithms based on the 12-lead ECG.

Results:
Overall, 6.5% (n=57) of patients had PVCs. Surprisingly, the majority of PVCs originated from the left ventricle (75.4%, N=43). The most common location was non-outflow tracts with LV non-outflow tract (59.3%, N=34), followed by RV non-out tract (19.3%, N=11). Within the non-outflow tract region, the majority of the PVC location appeared to be septal related (moderator band, posterior fascicle or posterior medial papillary muscle). The mitral annulus was also a common location (15.8%, N=9). In a multivariate model, heart failure (OR 2.8, p=<0.01), coronary artery disease (CAD) (OR 2.8, p=<0.01), sleep apnea (OR 2.2, p=0.02) and obesity (OR 1.6, p=<0.01) increased the odds of having PVCs.

Conclusions:
PVCs are not uncommon in CTEPH patients undergoing PTE surgery. Overall, 6.5% of patients had PVCs with the majority originating in the left ventricle (75.4%). Using standard ECG criteria, the most common location was the LV non-outflow tract. Heart failure, CAD, sleep apnea and obesity increased the odds of having a PVC.
Abstract 10234: Exaggerated Blood Pressure Response to Static Exercise Following Muscle Ischemia-Reperfusion: A Time-Course Investigation
Authors: Qin Lu , Li Jianhua
Published: March 2022

Background:
Peripheral artery disease (PAD) is one of the major cardiovascular concerns and dramatically reduces the blood flow supply in the affected limbs. A combination of revascularization surgery in the femoral artery and supervised exercise intervention is among the most general approaches for the treatment of PAD. However, the effects of ischemia-reperfusion (IR), which is one of the most predominant complications resulting from the revascularization surgery, on exercise-induced arterial blood pressure (BP) response are poorly understood.

Methods:
We examined the BP response to static muscle contraction in rats at different time points after the IR procedure. Four groups were included: 1. Sham rats; 2. Rats with 18 hours following IR (IR 18h); 3. Rats with 66 hours following IR (IR 66h); 4. Rats with 114 hours following IR (IR 114h). One-way ANOVA with LSD post-hoc test was applied to analyze the difference among groups. Data were presented as Mean ± Standard Deviation.

Results:
Compared with Sham group, the BP response to static muscle contraction was significantly increased in rats with all the investigated time points. The response of mean arterial pressure was 19±3 mmHg in Sham rats (n=6); 29±9 mmHg in IR 18h rats (n=8); 26±7 mmHg in IR 66h rats (n=10); 26±4 mmHg in IR 114h rats (n=9) (
P
<0.05; the groups at three time courses
vs.
Sham). There was no significant difference observed in the peak developed tension during muscle contraction among all the groups (Sham rats: 543±101g; IR 18h rats: 520±28g; IR 66h rats: 554±66g; IR 114h rats: 562±45g;
P
>0.05).

Conclusions:
IR significantly exaggerates the static exercise-induced BP response. Whereas the BP response tends to decrease with the prolonged IR time, the exaggerated BP response remains through time points from post IR 18 hours to 114 hours. The data suggest that a chronic time course should be considered to alleviate IR-induced ischemic injury in PAD patients for clinical interventions appropriated and exercise.
Abstract 10237: Activated Protein C Protects Neurons from Alzheimer’s Disease-Related Changes Through Reduction of Tau Hyperphosphorylation
Authors: Murphy Jiayuan , Le Van , Davitt Kayla , Logan Cole , Ren Di , Li Ji
Published: March 2022

Introduction:
Activated protein C (APC) is a blood serine protease that has been shown to have neuroprotective function
via
its downstream signaling cascade. However, there is no study has investigated how the lack of APC signaling is associated with Alzheimer’s disease (AD)-related neuronal changes.

Hypothesis:
Diminished APC signaling is related to AD-associated biomarkers and behavioral symptoms. APC ameliorates these symptoms
via
the activation of the protein kinase B (Akt) signaling pathway which inhibits glycogen synthase kinase 3β (GSK3β) and tau hyperphosphorylation.

Methods:
Immunofluorescence imaging and proteomic analysis were performed on EPCR

R84A/R84A

mice, which had blunted APC activity due to mutated endothelial protein C receptor (EPCR), for examining amyloid β (Aβ) deposition. A rodent model of AD, 5xFAD mice, were subjected to either one-time or chronic daily APC injection (100
μg/kg/d i.p.).
Morris's water maze test was performed to assess spatial memory and learning. The tissue of the hippocampus and cortex were collected for transcriptomic and proteomic analysis.

Results:
EPCR

R84A/R84A

mice showed greater hippocampal and cortical deposition of Aβ comparing to EPCR

WT/WT

counterparts. This result indicates defective APC signaling might contribute to the development of Aβ accumulation and insoluble plaque formation. A one-time injection of APC significantly activated AKT through phosphorylating the Ser
473
site, as well as inhibited AKT’s downstream target, GSK3β,
via
phosphorylation at Ser
9
in both wild-type and 5 x FAD mice. Downregulation of GSK3β activity is associated with decreased tau phosphorylation at Ser
202
/Thr
205
but not Ser
396
, indicating a reduction in the hyperphosphorylated form of tau that is prone to neurofibrillary tangle formation. Additionally, chronic APC administration for 3 months was observed to attenuate the cognitive deficits seen in 5 x FAD mice.

Conclusions:
APC has a crucial neuroprotective role because dampened APC signaling is related to AD-associated neuronal changes. APC has the downstream effect of Akt activation, which in turn inhibits GSK3β and the hyperphosphorylation of tau, ameliorating both the histological and behavioral markers seen in AD.
Abstract 10244: The Long-Term Residual Chest Compression Performance Following a Novel Chest Compression Training: A Cohort Study
Authors: Vincelette Christian , Voizard Philippe , Carrier François Martin , Catalina Sokoloff
Published: March 2022

Introduction:
The Timely Chest Compression Training (T-CCT), a 20-minutes in-situ intervention, was created locally to ensure frequent training in chest compressions for personal support workers (PSW). While it was effective in improving chest compression performance immediately after training, skills retention remained unknown.

Method:
A retrospective cohort study was conducted in a tertiary university-affiliated hospital in Quebec, Canada. Chest compression performance scores were measured with manikins and a subtractive scoring model (Laerdal QCPR®). PSW were invited to participate in a T-CCT. At baseline before receiving any new training, we measured the proportion of PSW that had an “excellent” score, defined as a score greater or equal to 90 out of 100. We compared the baseline performance of PSW who received the T-CCT 10 months prior with those who did not receive it.

Results:
In total, 404 PSW were included. Of these, 229 (55%) had received the T-CCT before and 175 (43%) had not. Close to half of PSW who had received the T-CCT met the excellent performance threshold (46 % [106/229]), as opposed to 30 % (53/175) in those who had not received the intervention 10 months prior. In a univariable log-binomial model, being previously exposed to the T-CCT increased by 1.53 times (RR 1.53, 95%CI [1.17-1.99]) the risk of having an excellent chest compression score. When adjusted for covariables (i.e., age, experience, sex, and belonging to a critical care unit), the effect of the intervention remained (RR 1.57, 95%CI [1.19-2.07]).

Conclusions:
Although the T-CCT is a novel chest compression training intervention, our results suggest that acquired performance is sustained over time. Further research is needed to identify the optimal interval between these training.
Abstract 10254: HDAC Inhibition Regulates Cardiac Function via Myofilament Acetylation
Authors: Eaton Deborah M , Martin Thomas G , Kasa Michael , Djalinac Natasa , Johnson Jaslyn P , Kolesnik Ewald , Ljubojevic-Holzer Senka , von Lewinski Dirk , Poettler Maria , Maechler Heinrich , Zirlik Andreas , McKinsey Timothy A , Kirk Jonathan A , Houser Steven R , Rainer Peter P , Wallner Markus
Published: March 2022

Introduction:
Heart failure (HF) is a global issue and approximately 50% of patients are classified as having HF with preserved Ejection Fraction (HFpEF), with no FDA approved therapies available. We previously characterized a large animal model that recapitulates key features of HFpEF and tested the effects of suberanilohydroxamic acid (SAHA, pan-HDAC inhibitor), which reversed and prevented the development of cardiopulmonary dysfunction. Parallel studies in cardiac tissue from humans and large mammals were designed to evaluate the effects of SAHA at the cellular level.

Hypothesis:
SAHA treatment will improve cardiomyocyte function.

Methods:
Adult feline ventricular cardiomyocytes (AFVM) were isolated from male domestic short hair cats and treated with 2.5μM SAHA or vehicle (DMSO) for 90 minutes, then incubated with a calcium (Ca
2+
) indicator (Fluo-4AM) and electrically stimulated (0.5Hz) to record Ca
2+
transients and contractions. Human left ventricle (LV) trabeculae isolated from non-failing donor hearts were treated with 10μM SAHA or vehicle for 120 minutes while being electrically stimulated (1Hz) to record developed force and relaxation parameters. Skinned myocytes were isolated from treated AFVM and human trabeculae to assess myofilament Ca
2+
sensitivity and passive stiffness. Mass spectrometry (MS) was performed on AFVM skinned myocytes to identify novel acetylation sites.

Results:
There was no difference in AFVM peak Ca
2+
transients with SAHA treatment, but calcium removal was increased (tau, time to 30% baseline). There was a significant increase in contractility (fractional shortening) and relaxation kinetics (time to 50% baseline, return velocity). Trabeculae treated with SAHA had decreased diastolic tension and an increase in developed force. Skinned myocytes were isolated from treated AFVMs and trabeculae and both had a significant improvement in myofilament Ca
2+
sensitivity and significant decrease in passive stiffness with SAHA. MS of AFVM skinned myocytes revealed increased acetylation of the myosin regulatory light chain, driven by lysine 115.

Conclusions:
These findings suggest that SAHA may have an important role in regulating cardiac function via the cardiomyocyte and myofilament in feline and human myocardium.
Abstract 10256: Presence, but Not Severity, of Coronary Artery Calcium Predicts Covid-19 Mortality
Authors: Delfiner Matthew S , Carabelli Evan , Whitman Isaac R , Patel Arjun S , Mishra Suraj , Gangireddy Chethan , Vaidya Anjali , Brisco-Bacik Meredith A , Patil Pravin , Gannon Michael P
Published: March 2022

Introduction:
Coronary artery calcium score (CACS) is a known predictor of cardiac events, however its association with inpatient mortality in COVID-19 infection remains unknown.

Hypothesis:
We hypothesized that elevated CACS is associated with increased mortality in inpatient patients with COVID-19.

Methods:
Inpatients with COVID-19 between March and May, 2020 at a single center were identified. All patients had a non-contrast chest CT during admission, and CACS and Multi-Ethnic Study of Atherosclerosis (MESA) percentile were retrospectively measured. Patients were grouped in quartiles: no CACS (0 AU), mild CACS (1-99 AU), moderate CACS (100-399 AU), and severe (
>
400 AU). Inpatient mortality was compared between groups using logistic regression adjusted for age and troponin level.

Results:
One hundred thirty-nine patients were included with 107 (80%) surviving to discharge. Eighty-two patients self-identified as black or African American (59%) and 66 were female sex at birth (47%). The mean CACS for the survivors was 319 AU and 406 AU for non-survivors (p = 0.02). The mean MESA percentile for survivors and non-survivors was 41% and 60%, respectively (p = 0.03). Fifty-nine patients had no CACS, 19 had mild CACS, 28 had moderate CACS, and 33 had severe CACS. Fifty-three of the no CACS group survived (89%), 13 of the mild group survived (68%), 17 of the moderate group survived (60%), and 24 of the severe group survived (73%). After adjustment for age and troponin level, CACS > 0 AU versus those with CACS of 0 AU had 4-fold higher odds of mortality (OR 4.0, 95%CI 1.3 - 12, p= 0.02). However, there was no significant increased odds of death within higher quartiles of CACS (OR 1.4, 95%CI 1.0 - 2.1, p=0.08).

Conclusion:
The presence of coronary artery calcium positively correlates with inpatient COVID-19 mortality, even after accounting for age and myocardial injury. Severity of CACS, however, is not associated with mortality.
Abstract 10259: Better Prediction of Stroke in Atrial Fibrillation with Incorporation of Malignancy in Cha2ds2vasc Score: Mcha2ds2vasc Score
Authors: Moudgil Rohit , Bungo Brandon , Chaudhury Pulkit , Arustamyan Michael , Rikhi Rishi , Hussain Muzna , Collier Patrick H , Kanj Mohamed H , Khorana Alok , Mentias Amgad
Published: March 2022

Introduction:
Atrial fibrillation (AF) is associated with an increased risk of stroke. Despite a large body of evidence linking malignancy and thrombosis, malignancy is not part of the scoring system.

Hypothesis:
Malignancy is an independent risk factor for the development of thromboembolic stroke in patients with AF.

Methods:
SEER database was utilized to identify patients with lung, colon, breast, and prostate cancers with AF and no prior diagnosis of stroke. These patients were compared to controls within the dataset. The primary endpoint was ischemic stroke. Rates of stroke per 100 person-years were calculated for each group. Cox regression modeling and a nested model comparing CHA
2
DS
s
VASc score (Model 1) with a complete model including cancer diagnosis (Model 2) were performed. Models were compared using Akaike Information Criterion (AKI) and Net Reclassification Index (NRI). A propensity matched cohort with equivalent CHA
2
DS
2
VASc scores determining stroke-free survival was also performed.

Results:
A total of 101,185 patients were included in the analysis, with 48,242 in the Cancer Group and 52,943 in the Non-cancer Group. Stroke rate per 100 person-years was significantly higher in the Cancer Group (2.962) compared with the Non-cancer Group (2.377) (IRR 1·25, 95% CI [1·18-1·31]). The CHA
2
DS
2
VASc model (Model 1) was compared against a model including cancer (Model 2) showing an improved predictability as assessed by both NRI (12·2, 95% CI [10·7-13·7, p<0.01) and AKI. Cox regression analysis calculated a hazard ratio of 1.085 for Cancer (95% CI [1·029-1·44], p = 0·0027), which was comparable to age > 75, female sex, and diabetes. Propensity matched Kaplan-Meier curve demonstrated decreased probability of stroke-free survival in the Cancer Group (p=0·00045).

Conclusion:
Cancers increase the risk of stroke in patients with AF. Consideration should be given for the addition of malignancy to the clinical scoring systems.
Abstract 10260: Risk Factors for Developmental Delay in Congenital Heart Disease Patients Following Surgery
Authors: Taylor Kate , Well Andrew , Mercado Amelia , Reilly Shannon , Whipple Hannah , Spence Carlie , Barnhill Brittany , Krauklis Kimberly , Van Diest Heather , Mery Carlos M , Lamari-fisher Alexandra
Published: March 2022

Introduction:
Children with congenital heart disease (CHD) receiving cardiac surgical intervention are at greater risk for developmental delays (DD). Identification of DD and early interventions may improve long term outcomes. The Ages and Stages Questionnaire (version 3) (ASQ3) is a DD screening tool. We hypothesized that clinical and perioperative risk factors are associated with DD in the early post-operative period.

Methods:
Patients who received an ASQ3 from 2019-2021 post CHD surgery were included. The ASQ3 was administered at outpatient surgical consultation or inpatient, if specific DD risk criteria were met. Those with incomplete operative data were excluded. DD was defined by an ASQ3 score for any domain below the at-risk cutoff. Associations between DD, patient characteristics, clinical factors, and perioperative factors were analyzed utilizing descriptive, univariate, and multivariable statistics.

Results:
A total of 57 patients were identified: median age at screening was 4 [IQR: 2-9] months, 22(39%) had a non-cardiac congenital abnormality (NCAA) and 17 (30%) a chromosomal abnormality (CA) (Table). Median cardiopulmonary bypass (CPB) time was 194 [IQR: 89-239] minutes. Forty-six (81%) patients had a DD. The median time between surgery and screening was 2 [IQR: 1-5] months. Patients with a NCAA (p = 0.037) and CA (p = 0.024) were more likely to have a DD. No other significant differences were found. In models adjusted for NCAA and CA, CPB times were not significant.

Conclusions:
The ASQ3 detected a high prevalence of DD among patients screened post CHD surgery. Despite known associations between CHD surgery and DD, few clinical factors, including CPB times, in our sample were associated with ASQ3 determined DD. More studies are needed to assess if the ASQ3 is sensitive and specific enough to serve as a screening tool in this population.
Abstract 10265: Sex Hormones Impact the Progression of Aortic Stenosis - A Murine Model
Authors: Fleury Marie-Ange , CLISSON Marine , Annabi Mohamed-salah , Voisine Martine , Hervault Maxime , Boilard Anne-Julie , Shen Mylene , Tailleur Mathieu , Marette Andre , Cote Nancy , Clavel Marie-annick
Published: March 2022

Introduction:
Lesions observed in aortic valve stenosis (AS) have been shown to be sex-specific, with women presenting with extensive fibrotic remodeling while men develop more calcium deposits. This study aimed to evaluate the influence of sex and sex-hormones on the pathophysiology of AS.

Methods:
Two hundred and ten (210) LDLr
-/-
ApoB
100/100
IGF-II
+/-
mice were separated into 6 groups: 1) intact males (IM), 2) intact females (IF), 3) castrated males at 8 weeks (CM), 4) ovariectomized females at 8 weeks (OF), 5) CM with testosterone supplementation (CMT), and 6) OF with 17β-estradiol supplementation (OFE). Mice were fed a high fat / high sucrose / high cholesterol diet for 6 months. Hemodynamic progression of AS was measured by transthoracic echocardiography (at 12 and 36 weeks) and aortic valves were collected for histological and digital droplet PCR analysis.

Results:
Hemodynamic progression of AS was comparable in IF and IM (24.2±5.7 vs. 25.8±5.3 cm/s; p=0.68), but IF presented with less severe hemodynamic AS. Between the 3 groups of male mice, AS progression and calcification of the explanted aortic valves at 36 weeks were more important in IM (increase in peak velocity: 24.2±5.7 cm/s; p<0.001) compared to CM (6.2±1.4; p=0.42), and CMT (15.1±3.5; p=0.002). In the 3 groups of female mice, there was no statistical differences in AS progression or valve remodeling. Digital PCR analysis revealed an important upregulation of the osteogenic gene RunX2 in IM (p<0.0001) and downregulation of the pro-calcifying gene ALPL in IF (p<0.05).

Conclusions:
Male sex and testosterone play a role in the upregulation of pro-calcific genes and calcification of the aortic valve, thus in the hemodynamic progression of AS. Female mice appeared to be protected against calcification, characterized by downregulation of pro-osteogenic genes, but presented similar AS hemodynamic progression. Impact of sex-hormone in females requires further studies.
Abstract 10270: Association Between Hypertension and Aortic Stenosis Mortality in a Large Unselected Hospital Population
Authors: Brown Jonathan , Kent David , Terrin Norma , Kusner Jonathan , Wessler Benjamin S , Edelman Elazer R
Published: March 2022

Introduction:
Hypertension (HTN) is common for patients with AS. However, whether it is a sign of a healthy ventricle and therefore a good prognostic sign, or a risk factor remains unclear. We sought to evaluate the effect of HTN on survival in AS patients at a large referral center.

Methods:
Echocardiograms conducted at Tufts Medical Center (Boston, MA) were screened and parameters were extracted from a central database. NLP was used on unstructured clinical visit notes to fill in missing data. AS severity was defined as [mild (Vmax: 2.5- 2.9 m/s, MG: 10-20 mmHg, AVA: > 1.5 cm2), moderate (Vmax: 3.0-3.9, MG: 20-40, AVA: 1.0-1.5) or severe (Vmax: > 4.0, MG: > 40, AVA: < 1.0)]. Cox proportional hazard regression models assessed the association between hypertension stage [Normotensive: SBP < 120 mmHg, Elevated: SBP 120-129 mmHg, Stage 1: 130-139 mmHg, Stage 2: > 140 mmHg] taken at the time of the echocardiographic exam and death. Models were adjusted for age, sex, ejection fraction, BMI, and degree of mitral regurgitation. The last echocardiographic time point prior to death or being censored alive was used for modeling.

Results:
Of the 160,491 echocardiographic exams performed between 2006-2021 2,699 had mild AS or greater. Patients were followed for a median of 533 days for mild (N = 319), 593 days for moderate (N = 1070), and 76 days for severe (N = 1310). Overall mortality was lowest for moderate and severe AS (log-rank test: P < 0.001). HTN was associated with decreased mortality relative to a normotensive state at moderate (HR: Elevated 0.67 CI: 0.35-1.26, Stage 1 0.35 CI: 0.19-0.63, Stage 2 0.52 CI: 0.31-0.87) and severe stenosis (HR: Elevated 0.64 CI: 0.25-1.59, Stage 1 0.29 CI: 0.12-0.66, Stage 2 0.42 CI: 0.22-0.81).

Conclusions:
Contrary to other cardiovascular diseases HTN was associated with decreased mortality for this large cohort with significant AS. This observation raises questions about whether traditional HTN treatment targets are appropriate for patients with AS.
Abstract 10281: Predictors of Gastrointestinal Bleeding in Patients Undergoing Percutaneous Mitral Valve Repair- A Us National Inpatient Database Analysis
Authors: Zahid Salman , Salman Fnu , Shafaqat Madeeha , Adil Abid Nawaz Khan , Baqi Abdul , Ullah Waqas , Muhammadzai Hamza , Tanveer Ud Din Mian , Khan Muhammad Atif , UBAID AAMER , Khan Muhammmad , Khan Muhammad U
Published: March 2022

Introduction:
Data on outcomes and predictors of gastrointestinal (GI) bleeding in patients undergoing percutaneous mitral valve repair (PMVR) remains limited.

Hypothesis:
GI bleed is associated with worse outcomes in patients undergoing PMVR

Methods:
We utilized the national inpatient sample data from the year 2015 to 2018 to evaluate outcomes and predictors of GI bleed in patients undergoing PMVR.

Results:
A total of 21,505 weighted hospitalizations were included in the analysis. Of the patients who underwent PMVR, 285 (1.3%) developed GI bleed whereas 21220 (98.7%) did not have in-hospital GI bleed event. The mean age of patient with and without GI bleed was 77 and 76 years respectively (P<0.01). A logistic regression model was developed for adjusted comparison based on age, gender and baseline comorbidities. On adjusted comparison history of MI (OR 1.56, 95% CI 1.17-2.08), congestive heart failure (OR 1.79, 95% CI 1.18-2.73), African American race (OR 1.75, 95% CI 1.16-2.66) and history of weight loss (OR 2.71, 95% CI 1.97-3.74) were associated with significantly increased risk of gastrointestinal bleeding. Patients who developed GI bleed had significantly higher in-hospital mortality (8.8%) compared to non-GI bleeders (2.1%). Length of stay (16 vs. 4 days) and cost of hospitalization ($ 66118 vs. $49167) was significantly higher for GI bleeders undergong PMVR.

Conclusions:
In conclusion we report that GI bleed is associated with higher in-hospital mortality and resource utilization in patients undergoing PMVR.
Abstract 10285: The Association of Food Deserts with Sudden Death in Wake County, North Carolina
Authors: Cesmat Andrew P , Senter Elizabeth , Lin Feng-Chang , Keen Susan , Simpson Ross J
Published: March 2022

Introduction:
Food deserts (FD) are low-income areas with limited access to healthy foods associated with an individual’s risk of diabetes, hypertension, and atherosclerosis. These factors likely contribute to the risk of sudden death, but their association with sudden death is unknown. In this study, we aim to determine the impact of living in a food desert on sudden death.

Hypothesis:
Sudden death will occur more often in FD census tracts than in non-FD low-income tracts and high-income tracts.

Methods:
Census tract designations of income and FD status were determined from the United States Department of Agriculture's Food Access Research Atlas. The incidence of sudden death in each census tract was determined using a registry of 399 adjudicated out-of-hospital sudden deaths ages 18-64 in Wake County, North Carolina reported by emergency medical services from 2013-2015. A Poisson regression model was fit with FD status as a covariate and adjusted for the population size, percentage of males, and percentage of African Americans in the census tract. A Wald statistic was used to calculate sudden death incidence ratios (IR) with 95% confidence intervals (95% CI) for the populations living in FD tracts and in non-FD low-income tracts, compared with the population residing in high-income tracts (non-low-income and non-FD) as the reference group.

Results:
After adjusting for population size, sex, and race, the incidence of sudden death in FDs was higher than high-income census tracts (IR=1.466, 95% CI: 1.021-2.105). The incidence in non-FD low-income census tracts was also higher than high-income tracts (IR=1.398, 95% CI: 0.993-1.968). However, the FD census tracts had similar incidence to the non-FD low-income tracts (IR=0.954, 95% CI: 0.665-1.367).

Conclusion:
Living a food desert in Wake County, NC is associated with sudden death. Public health initiatives addressing healthy food access and income inequality may reduce the incidence of sudden death. However, a larger study, with a greater geographic distribution, is in development to explore the independent association of poverty and availability of healthy foods.
Abstract 10286: Age-Specific Threshold for Cardiovascular Disease Risk Stratification and Treatment Decision-Making
Authors: Xu Zhe , Wood Angela M
Published: March 2022

Introduction:
Cardiovascular disease (CVD) preventative interventions are targeted at people with predicted CVD risk above pre-specified thresholds. However, younger people with high relative risks and who may benefit from intervention are often missed because their absolute risks are below the threshold. We aim to investigate the use of age- and sex-specific thresholds for CVD risk stratification for allocating statin therapy.

Methods:
We used primary care data from Clinical Practice Research Datalink in the UK on 1,642,498 people, aged 40-85 years and without prevalent CVD. We predicted each person’s 10-year CVD risk, using age- and sex-specific Cox models with conventional risk factors from past medical records. We compared the implications of initiating statins in people identified as being at high CVD risk from 3 strategies: a. predicted risk ≥ 10% (the recommended UK threshold); b. predicted risk ≥ 10% or above the age- and sex-specific 90
th
percentile; c. predicted risk ≥ 7.5% for people aged 40-54 years, ≥ 10% for 55-69 years, and ≥ 15% for 70-85 years (an intermediate “pragmatic” approach). We calculated the C-statistic to assess the ability to discriminate high-risk people and the number needed to screen (NNS) to prevent one CVD event, assuming statin allocation reduced CVD risk by 25%.

Results:
Replacing the single threshold (strategy a) with age- and sex-specific thresholds (strategy b) significantly improved the discriminatory ability to identify high-risk men aged 40-45 years and high-risk women aged 40-60 years (Figure 1a). Similarly, the NNS reduced by 70% for men aged 40-45 years, and 89% for women aged 40-60 years (Figure 1b). Using pragmatic age-group thresholds (strategy c) also showed significant gains, although to a lesser degree, in discrimination and NNS for younger people.

Conclusions:
Our results suggest using age- and sex-specific thresholds can modestly enhance CVD risk stratification for allocation of statin therapy among younger people.
Abstract 10287: Trends in Cardiovascular Death Rates Among Women Veterans
Authors: Ebrahimi Ramin , Sumner Jennifer , Lynch Kristine , Viernes Benjamin , Tzeng Chi-Hong , dennis paul , Treadwell Michelle , Alvarez Carlos , Yano Elizabeth , Shroyer Laurie A , Beckham Jeannie
Published: March 2022

Introduction:
Based on data from the Centers for Disease Control and Prevention (CDC), during 2000-2017 the age-adjusted death rate from diseases of the heart/Cardiac Death (CD) for women in United States of America (US) decreased from 210.9 to 129.6 per 100,000 person-years (39% reduction). Recent trends in CD for women Veterans is not known. The goals of this project were to evaluate trends in CD in women Veterans from 2000-2017 and compare these trends to the corresponding national trends available through CDC (https://wonder.cdc.gov/ucd-icd10.html).

Methods:
Using the national Veterans Affairs (VA) electronic medical records (EMR), all women who visited any VA between 1/1/2000 to 12/31/2017 were identified. Vital status and cause of death were obtained by linking National Death Index (NDI) database to the VA cohort. CD was identified by underlying cause of death defined by International Classification of Disease Tenth Revision diagnostic codes (ICD-10). The same ICD-10 codes used by CDC to identify CD were used in the analysis of the VA cohort (I00-I09,I11,I13,I20-I51). Crude and age-standardized mortality rates were calculated overall and by calendar year. The 2000 US Standard Population was used as the reference population.

Results:
During the study period, 817,912 women Veterans had at least one visit at a VA medical center in US. Overall, 84,897 women died during the study period with 19,022 (22.4%) being heart related death. Figure #1 reveals the age-adjusted CD for US women in general, and women Veterans.

Conclusions:
Discordant from the national trend, age-adjusted CD among women Veterans has increased by more than 49%, from 2000 to 2017. In 2017, age-adjusted CD for women Veterans was more than twice the rate for US women. These results re-enforce the recent call to action to better understand and improve cardiovascular health for women Veterans.
Abstract 10288: Reduced Pulmonary Artery Distensibility: A Predictor of Persistent Pulmonary Hypertension and 2-Year Mortality Post-Transcatheter Aortic Valve Replacement in High-Risk Patients with Severe Aortic Stenosis
Authors: Turner Valery , Maret Eva , Kim Juyong B , Watkins A Claire C , Fearon William F , Haddad Francois , Willemink Martin J , Fleischmann Dominik
Published: March 2022

Introduction:
Persistent pulmonary hypertension (PH) post-TAVR is a better predictor of poor outcome than pre-TAVR PH, possibly due to longstanding vascular damage involving loss of pulmonary artery (PA) elasticity. In this study we sought to evaluate whether PA distensibility (D
PA
) measured on pre-procedural ECG-gated CTA is associated with persistent-PH and 2-year mortality after TAVR.

Hypothesis:
Reduced D
PA
is a predictor of persistent-PH and mortality post-TAVR.

Methods:
336 patients undergoing TAVR between July 2012 and March 2016 were retrospectively included. All patients underwent retrospectively ECG-gated CTA of the chest, with reconstruction of 10 phases over the cardiac cycle (0%- 90% of the R-R interval) prior to TAVR. Patients were followed for all-cause mortality. Main pulmonary artery (MPA) area was measured at 20% (area-MPA
20
) and 80% (area-MPA
80
) of the R-R interval. D
PA
was calculated as follows: [(area-MPA
20
-area-MPA
80
)/area-MPA
20
]%. Persistent-PH was defined as pre-TAVR RVSP>35mmHg which persisted >35mmHg in post-TAVR echocardiography. 2 groups were compared based on D
PA
<8% (specificity of 70% for persistent-PH). Kaplan-Meier, Cox proportional-hazard and logistic regression analyses were performed.

Results:
Median follow-up time was 413 (interquartiles 339-757) days. A total of 68 (20%) patients died within 2 years after TAVR and 183 (54%) had persistent-PH. Those with D
PA
<8% had significantly more atrial fibrillation (50% vs 35%, p<0.001), 2-year deaths (28% vs 15%, p=0.006) and persistent-PH (67% vs 47%, p<0.001), compared to those with D
PA
>8%. Multivariable regression analyses adjusted for age, sex, STS-score, cardiac risk, frailty≥2 and NYHA≥III, showed that D
PA
<8% was independently associated with two-year mortality (HR 2.91 [95%-CI 1.5-5.8], p=0.002) and persistent-PH (OR 2.10 [95%-CI 1.3-4.5], p=0.007). Kaplan-Meier analysis showed that mortality of patients with D
PA
<8% was significantly higher compared to patients with D
PA
≥8% (mortality 28% vs 15%; log-rank p=0.003).

Conclusion:
D
PA
on pre-procedural CTA is independently associated with persistent-PH and two-year mortality in patients who undergo TAVR and could be a valuable parameter for risk stratification of TAVR candidates.
Abstract 10291: Electrocardiographic Markers of Subclinical Myocardial Dysfunction in Patients with Severe Obesity and Normal Ejection Fraction. The FatWest Study
Authors: Grymyr Lisa M , Gerdts Eva , Nadirpour Saied , Schuster Peter , Nedrebø Bjørn G , Cramariuc Dana
Published: March 2022

Introduction:
Patients with severe obesity are predisposed to left ventricular (LV) myocardial dysfunction and increased myocardial oxygen (O
2
) demand despite preserved ejection fraction (EF).

Hypothesis:
To test whether electrocardiography (ECG) may be used to identify patients with severe obesity that have myocardial dysfunction despite normal EF by echocardiography.

Methods:
In the prospective FatWest (Bariatric Surgery on the West Coast of Norway) study, 116 severely obese patients (41±11 years, 75% women, body mass index [BMI] 41.7±4.6 kg/m
2
, 57% with hypertension, EF 61±5%) underwent 12-lead ECG and echocardiography before a Roux-en-Y gastric bypass surgery. Low LV mechanics was defined as global longitudinal strain (GLS) below the median, and high myocardial O
2
demand as LV mass-wall stress-heart rate product above the median value. ECG markers of atrial (P axis and duration) and ventricular (QRS axis and duration, T axis, QRS-T angle, time to intrinsicoid deflection (ID), and corrected QT (QTc)) de- and repolarization were analyzed.

Results:
Median GLS was -15.5%, and median myocardial O
2
demand 1.47 x106 g kdyne/cm
2
bpm. Patients with low GLS had longer QRS, time to ID and QTc duration, while those with high myocardial O
2
demand had increased P axis and duration (all p<0.05). In multivariate regression analyses, longer QTc was associated with lower GLS (R
2
0.24) and increased P axis with higher myocardial O
2
demand (R
2
0.21) independent of age, gender, BMI and hypertension (all p<0.05). A QTc >435ms and P axis >42° had 70% specificity in detecting low GLS and high myocardial O
2
demand (Figure).

Conclusion:
In severely obese patients, ECG measures of atrial activation and delayed ventricular repolarization were independently associated with low LV myocardial function and high myocardial O
2
demand. ECG screening before bariatric surgery may identify patients in whom advanced echocardiography is warranted.
Abstract 10293: The Association of Fibroblast Growth Factor-23 with Cardiac Structure and Function in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Honda Yasuyuki , Ishigami Junichi , Hishida Manabu , Karger Amy , Kitzman Dalane W , Coresh Josef , Selvin Elizabeth , Lutsey Pamela L , Shah Amil M , Matsushita Kunihiro
Published: March 2022

Background:
Fibroblast growth factor-23 (FGF-23), a protein regulating phosphorus levels, is associated with the risk of heart failure, particularly in patients with chronic kidney disease (CKD), and with left ventricular (LV) hypertrophy in CKD. However, few studies have explored this association in the general population, and it is unknown whether FGF23 is associated with other parameters of cardiac structure and function.

Methods:
Among 5,533 Black or White participants attending Visit 5 (2011-2013) of the community-based ARIC study, we quantified the cross-sectional association of serum FGF-23 levels with echocardiographic measures of cardiac structure and function after accounting for potential confounders including kidney function.

Results:
Mean age was 76 [SD 5] years, 58 % were women, and 21 % were Black. Among the echocardiographic parameters tested (
Table
), higher FGF-23 levels were robustly associated with LV hypertrophy (adjusted odds ratio [aOR] 1.35 [95%CI 1.02-1.79] in top vs. bottom quartile), abnormal peak longitudinal strain (aOR 1.88 [1.32-2.69]), and left atrial enlargement based on left atrium volume index (aOR 1.34 [1.05-1.70]). No association was observed with E/e’ ratio. Higher FGF-23 was also associated with end-diastolic right ventricular (RV) enlargement (aOR 1.36 [1.04-1.78]). Similar results were observed when echocardiographic measures were modeled as continuous variables and when we stratified participants by demographics (age, sex, and race) or a history of cardiovascular disease.

Conclusions:
In community-dwelling older adults, in addition to LV hypertrophy, FGF-23 was associated with LV systolic and diastolic function as well as RV size, independent of kidney function and other potential confounders. These findings further support the involvement of FGF-23 in the pathophysiology of cardiac remodeling.
Abstract 10307: Predictors of Growth Trajectory in Infants with Congenital Heart Disease
Authors: Lisanti Amy J , Min Jungwon , Golfenshtein Nadya , Ravishankar Chitra , Costello John M , Fleck Desiree , Huang Liming , Medoff-Cooper Barbara
Published: March 2022

Introduction:
Infants born with critical congenital heart disease (cCHD) are known to experience growth failure in infancy, particularly those with single ventricle physiology. Differences in early weight-for-age Z-score growth trajectory (WAZ-GT) within this population have not been defined. We aimed to describe the WAZ-GT of infants with cCHD after cardiac surgery in the first 4 months of life and assess potential risk factors.

Methods:
This is a secondary analysis of a previously reported RCT, REACH telehealth program (2012-2017, Trial NCT01941667). Sample included both intervention and control infants (n=178). Weights over the first 4 months of life were converted to WAZ using the World Health Organization standards. WAZ-GT classes were identified using latent class growth modeling. Multinomial logistic regression models were used to examine the associations between socio-demographic and clinical characteristics and WAZ-GT classes.

Results:
Four distinct classes of WAZ-GT were identified (maintaining WAZ >0, 14%; stable around WAZ=0, 35%; partially recovered, 28%; never recovered, 23%; see Figure). No differences existed in WAZ-GT when stratified by single and two ventricle physiology or by telehealth intervention and control groups. The stable around WAZ=0 class was assigned as the reference group. Compared with these infants, those in the never recovered class were 3-6 times more likely to have length of stay (LOS) ≥ 14 days, tube feeding at discharge, and low appetite. Partially recovered infants were 3 times more likely to have LOS ≥ 14 days and be an only child. Infants maintaining WAZ >0 were 3 times more likely to have two ventricle physiology and parents with at least a college education and who did not report infant borderline appetite.

Conclusions:
This study is the first to describe distinct classes of WAZ-GT for infants with cCHD early in infancy. We identified associated predictors that can be used to target interventions in this vulnerable population.
Abstract 10308: Rural-Urban Differences in Health Characteristics and Health Behaviors in 14,955 US Stroke Survivors
Authors: Bailey Ryan , Miner Natalie
Published: March 2022

Introduction:
Rural residence is associated with increased CVD risk, including incident stroke. Less is known about the association of rurality on health characteristics and health behaviors among stroke survivors. The purpose of this study was to determine the presence and magnitude of rural/urban differences in health characteristics and health behaviors among stroke survivors.

Methods:
Data from 14,599 stroke survivors were available from the 2017 & 2019 Behavioral Risk Factor Surveillance System, an annual health survey of non-institutionalized US adults. Inclusion criteria included history of self-reported stroke and age ≥65 years. Respondents with missing data regarding rural vs. urban dwelling status were excluded from analysis. Respondents provided self-reported data on sociodemographics (sex, race, marital status, education, and income), health characteristics, and health behaviors (see table for characteristics and behaviors). Logistic regression was used to compute odds ratios and 95% CI’s to examine the association among rural/urban status and health characteristics and health behaviors.

Results:
Prevalence of health characteristics and health behaviors, and computed adjusted odds ratios, are presented in the table. Although the prevalence of disability, poor general health, and insufficient physical activity were higher among rural-dwelling stroke survivors, odds ratios adjusted for sociodemographic and health characteristics demonstrated no association among rurality, health characteristics, and health behaviors.

Conclusions:
Although no differences in health characteristics and behaviors were found between rural and urban-dwelling stroke survivors, prevalences of many CVD risk factors were high, which increase risk for recurrent stroke, secondary conditions, and chronic disease. Interventions for improving risk factors and health behaviors in this health disparate population are needed.
Abstract 10310: Deep Learning for a Diagnosis of Plaque Erosion in Patients with Acute Coronary Syndromes
Authors: Araki Makoto , Park Sangjoon , Nakajima Akihiro , Lee Hang , Ye Jong Chul , Jang Ik-kyung
Published: March 2022

Background:
The diagnosis of plaque erosion by optical coherence tomography (OCT) in patients with acute coronary syndromes (ACS) requires expertise in image interpretation.

Objectives:
This study sought to develop a deep learning (DL) algorithm that enables an accurate diagnosis of plaque erosion even for readers without experience in image interpretation.

Methods:
An image sequence transformer DL algorithm that mirrors the attention given by cardiologists to sequential images during a pull-back, was developed. The DL model was trained and internally validated for a diagnosis of plaque erosion both at the frame-level and at the patient-level in 581 ACS patients from 8 institutions in 4 countries. The model was externally tested in 292 ACS patients from an independent dataset. Training and validation dataset included 237,021 cross-sectional OCT images and testing dataset 65,394 cross-sectional OCT images. The OCT image classification performance was evaluated by area under the receiver-operating characteristic curve (AUC), and sensitivity and specificity. The results were compared against diagnoses made by OCT experts both at the frame-level and at the patient-level.

Results:
In the training and validation data set, 206 (43.2%) patients had plaque erosion, while in the external testing data set, 86 (29.5%) patients had plaque erosion. In the external testing data set, the DL model diagnosed plaque erosion with an AUC of 0.963 (95% CI, 0.962-0.963), a sensitivity of 89.9% (95% CI, 89.7-90.0), and a specificity of 91.1% (95% CI, 91.1-91.2) at the frame-level. At the patient-level, the DL model detected plaque erosion with an AUC of 0.901 (95% CI, 0.900-0.902), a sensitivity of 89.6% (95% CI, 89.4-89.8), and a specificity of 82.0% (95% CI, 81.9-82.2).

Conclusion:
A newly developed DL model enabled the accurate diagnosis of plaque erosion. This novel DL model will help cardiologists make an accurate diagnosis of plaque erosion in patients with ACS.
Abstract 10312: Intermittent Fasting and Increased Galectin-3 Reveal a Potential Protective Mechanism Against Risk of Heart Failure and Type 2 Diabetes
Authors: Horne Benjamin D , Anderson Jeffrey L , May Heidi T , Le Viet T , Galenko Oxana , Drakos Stavros G , Bair Tami L , Knowlton Kirk U , Muhlestein Joseph B
Published: March 2022

Introduction:
Intermittent fasting decreases cardiometabolic risk factors, heart failure (HF) risk, and type 2 diabetes risk. Sodium-glucose transport 2 (SGLT-2) inhibitors reduce diabetes and HF risk and a study of canagliflozin reported that it raised galectin-3 levels (Januzzi 2017). Previously in the WONDERFUL trial (NCT02770313), intermittent fasting caused declines in the Metabolic Syndrome Score (MSS) and homeostatic model assessment of insulin resistance (HOMA-IR). This study evaluated intermittent fasting’s effects on galectin-3 in a
post hoc
analysis of the WONDERFUL Trial.

Methods:
People aged 21-70 years were enrolled who had ≥1 metabolic syndrome feature or type 2 diabetes, were free of anti-diabetic and statin medications, and had elevated LDL-C. Subjects had 26-week galectin-3 data (N=67; n=36 intermittent fasting, n=31 controls). Subjects were randomized to a 24-hour water-only fasting intervention (fasting twice per week for 4 weeks, then once each week for 22 weeks) or a parallel control arm (
ad libitum
eating). This study evaluated the 26-week galectin-3 change score and other changes in HF biomarkers.

Results:
At 26 weeks, the galectin-3 change score was increased in intermittent fasting (0.575±2.63 ng/mL) vs control (-0.624±2.79 ng/mL; p=0.021). Changes in galectin-3 were inversely correlated with HOMA-IR change score (r= -0.288, p=0.018) and MSS change score (r= -0.238, p=0.052). Changes in galectin-3 at 4 weeks (intermittent fasting: 0.345±2.68 ng/mL; control: -0.465±3.18 ng/mL; p=0.27) and 13 weeks (fasting: 0.917±4.96; control: -0.097±2.83 ng/mL; 0.15) were not significantly different. B-type natriuretic peptide went down in intermittent fasting (-0.328±12.29 pg/mL) but this was not significant compared to controls (15.50±75.34 pg/mL, p=0.23). Other HF biomarkers were unchanged.

Conclusions:
Water-only 24-hour intermittent fasting increased galectin-3. This rise in galectin-3 was correlated with declining HOMA-IR and MSS and may be similar to reported effects of SGLT-2 inhibitors. Increased galectin-3 may be an adaptive response that could prevent chronic disease by decreasing inflammation, ameliorating insulin resistance, or modifying related mechanisms.