bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract P017: Serum N-Carboxymethyl-Lysine and Risk of Mortality in Older Adults
Authors: Biggs Mary Lou , Benkeser David , Ix Joachim , Kizer Jorge , Djousse Luc , Siscovick David , Fitzpatrick Annette , Tracy Russell , Mukamal Kenneth 
Published: July 2021

Advanced glycation end products (AGEs) are compounds formed by the non-enzymatic glycation of proteins, lipids, and nucleic acids, and are thought to play a role in the pathogenesis of diseases across multiple organ systems. Carboxymethyl-lysine (CML) is a dominant AGE found in tissue proteins and in the circulation, and a commonly used AGE biomarker. Only a few epidemiological studies have evaluated the association between circulating CML and mortality risk, and none have evaluated the association between CML and cause-specific non-CVD mortality.
We measured CML by ELISA on serum specimens collected from 3,373 Cardiovascular Health Study participants in 1996. Participants were followed for death through 2010, and cause of death was classified using death certificates, medical records, and proxy interview. We used Cox regression to estimate the relative risk of total and cause-specific mortality associated with circulating CML, adjusting for confounders (Models 1 & 2) and estimated glomerular filtration rate (eGFR) as a potential mediator (Model 3). We tested whether sex or diabetes modified the association between CML and mortality.
The mean age among participants was 78 years and 60% were women. The mean CML level among participants was 629 ng/mL. Over median follow-up of 10 years, 2,322 deaths occurred (73.4 per 1,000 person-years). After adjustment for confounders (Models 1 & 2), CML was associated with an increased risk of death from CVD, dementia, infection, fracture/trauma, and renal failure (Table). Aside from renal failure, adjustment for eGFR attenuated the HR estimates modestly. There was no evidence for effect modification of the association of CML and all-cause mortality risk by sex or diabetes.
In a cohort of community-dwelling older individuals, elevated circulating CML was associated with increased risk of mortality from cardiovascular causes, dementia, infection, fracture/trauma, and renal failure. A portion of the increased risk may be mediated through decreased renal function.
Abstract P277: Impact of Fructose and Fructose Containing Sugars on Indices of Cardiometabolic Health When Consumed at Typical Levels
Authors: Lowndes Joshua , Sinnett Stephanie , Grench Kory , Jordan Richard , Rippe James 
Published: July 2021

The American Heart Association recommends that women and men should not consume more than 100 or 150 kcal/day, respectively, from added sugars. Pure fructose in large dosages has been shown to adversely affect indices of cardiometabolic health in a variety of ways. However, pure fructose is rarely consumed, and it is unclear whether the same risks apply to the common sources of fructose in the American diet - sucrose and high fructose corn syrup (HFCS). The purpose of this study was to compare the effect on components of cardiometabolic health of fructose compared to other fructose containing sugars and glucose when consumed at levels typical of the American population.

268 individuals aged 20-60 years old were required to drink sugar-sweetened low fat milk every day for 10 weeks as part of their usual diet. All participants had been at a stable weight (± 3%) for 30 days prior to enrollment and were given recommendations on how to account for calories in the milk, but were given no further dietary guidance. The amount of milk consumed was individualized for each participant based on the estimated number of calories required to maintain body weight (via Miflin St Jeor equation) and random group assignment: Groups 1 and 2 - 9% estimated caloric intake from fructose or glucose respectively added to milk. Groups 3 and 4 - 18% of estimated caloric intake from HFCS or sucrose respectively added to the milk (50
th
percentile population consumption levels of fructose, 180-360 Kcal).

There was a small increase in body mass (162.2 ± 27.8 vs 164.2 ± 28.1 lbs, p<0.001) in the entire cohort, but there were no changes in HDL (52.51 ±12.77 vs 52.36 ± 12.40 mg/dl), CRP (1.63 ±1.77 vs 176 ±1.94 mg/L), fasting glucose (90 ± 6.50 vs 90.66 ±7.89 mg/dl), insulin (8.55 ±6.10 vs 11.20 ±39.32 (μIU/ml), HOMA measurement of insulin resistance (1.60 ±1.43 vs 1.74 ±1.29), or the glucose (13.28 ±2.53 vs 13.16 ±2.56 min*mg/dl) or insulin (2.52 ±1.32 vs 2.54 ± 1.57 min*mU/ml) area under the curve in response to an OGTT (all p>0.05). Small increases in waist circumference (80.88 ±9.45 vs 81.45 ± 9.46cm, p<0.001), abdominal fat measured by DEXA (36.31 ± 11.58 vs 36.84 ± 11.20% p<0.05), and Apolipoprotein B (86.53 ±25.79 vs 90.78 vs 25.62 mg/dl, p<0.001) were observed, but in all cases the type of sugar consumed had no effect on the response of any measure (p>0.05). The one exception was triglycerides, which increased in the entire cohort (101.56 ± 56.47 vs 111.70 vs 79.14mg/dl, p<0.01), but to a greater degree in the group consuming HFCS than compared to the group consuming glucose (98.20 ± 52.46 vs 129.03 ± 120.49 and 100.28 ±56.19 vs 99.86 ± 57.21mg/dl, p<0.05).
These data suggest that when consumed as part of normal diet at typical levels the effects of sugars on cardiovascular risk factors are small and primarily limited to aspects of body composition even when levels are substantially higher than those recommended by the AHA.
Abstract P450: Young Women with Increased Cardiovascular Disease Risk Burden have Poor Health Literacy
Authors: Paul Tracy K , Sciacca Robert R , Rodriguez Juviza K , Giardina Elsa-Grace V 
Published: July 2021

Introduction:
Young women are thought to have low cardiovascular disease (CVD) risk; however, mortality due to ischemic heart disease has actually risen among women aged 35-44 years. We hypothesized that young women with increased CVD risk burden are more likely to misperceive body image and less likely to practice healthful behaviors.

Methods:
To determine CVD risk burden among young women (aged 18-49 years) of a primarily urban population, 569 women visiting outpatient medical clinics were assessed. Anthropometric measures [height, weight, waist, body mass index (BMI)], attitudes towards weight, and lifestyle behavior were determined. Body image self-perception was assessed using validated silhouette scales. Increased CVD risk burden was defined as presence of hypertension, diabetes mellitus, tobacco use, hyperlipidemia, and/or obesity.

Results:
Participants were Hispanic (62.7%; 357/569); non-Hispanic White (20.7%; 118/569); non-Hispanic Black (8.9%; 51/569) and Asian/other ethnicity (7.5%; 43/569); mean age was 35.9 years ± 8.1 and income $39,828 ± $20,229. BMI categories were: obese (BMI ≥ 30 kg/m
2
, 27.4%; 155/569); overweight (BMI 25.0 - 29.9 kg/m
2
, 29.0%; 164/569); normal (BMI 18.5 - 24.9, 41.2%; 233/569); and underweight (BMI ≤ 18.4; 2.3%; 13/569). Women without CVD risk burden were the reference standard.

Nearly half (47.7%; 271/569) had increased CVD risk burden; and 33.5% (190/569) had ≥ 1 CVD risk factor, exclusive of obesity, including hypertension (18.0%), hyperlipidemia (11.5%), current tobacco use (10.2%), and diabetes mellitus (5.8%).
Women with increased CVD risk were less likely to correctly identify body size (48.3% vs. 69.4%, p<0.0001). They were more likely to be concerned about weight (82.0% vs. 65.8%, p =0.01) and actively trying to lose weight (77.3% vs. 65.4%, p=0.03). But, they were less likely to read nutrition labels when making food choices (29.4% vs. 17.9%, p=0.03) and more likely to cite cost (18.7% vs. 12.1%, p=0.03) and difficulty implementing a weight loss regimen (22.2% vs. 15.6%, p=0.05) as barriers to losing weight. Most, regardless of CVD risk burden, knew blood pressure, cholesterol, and blood sugar status. However, women with increased CVD risk burden were less likely to know cholesterol level (81.4% vs. 88.8%, p=0.02). Fewer obese women knew that tobacco contributes to CVD risk compared to non-obese women (92.3% vs. 96.6%, p=0.04).

Conclusion:
Paradoxically, though aware of their CVD risk factors and with heightened weight concerns, young women with increased CVD risk burden misperceive their body size and lack healthy behavior knowledge. A disconnect exists between this group’s recognition of their underlying risk and ability to modify their lifestyle to decrease CVD risk burden.
Abstract 11773: Liver Transplant Candidates: To Stress or Not to Stress?
Authors: Ibrahim Ahmed , Schuster Andres , Alraies M Chadi , Sonny Abraham , Cywinski Jacek B , Jaber Wael A 
Published: July 2021

Background:
The prevalence of coronary artery disease (CAD) in patients with end stage liver disease (ESLD) and the incidence of acute coronary syndromes (ACS) post liver transplantation (LT) remain controversial. Current AHA/ACC guidelines recommend non-invasive stress testing (NIST) for risk stratification of LT recipients based on conventional cardiovascular risk factors (CVRF). The aim of our study was to define the role of NIST in the pre-transplant evaluation of ESLD patients.

Methods:
We retrospectively reviewed the data of 366 patients who were referred to the Cleveland Clinic LT center between the years 2006 and 2008. We collected demographic data, CVRF, NIST, left heart catheterization (LHC) results, incidence of ACS and death.

Results:
In our study population, the mean age was 56±8 years, 68% were males, 83% Caucasian, 34% diabetic, 36% hypertensive, 22% smokers, 17% had hyperlipidemia, 11% known CAD, and 14% had family history of premature CAD; overall, 70% of the patients had at least 3 CVRF. Mean platelet count was 104±70 k/uL, mean INR 1.4 ±0.4, total cholesterol (TC) 143±45 mg/dL and 42% were on beta blockers (BB).

A total of 270 patients underwent NIST with dobutamine stress echocardiography (DSE) or nuclear stress testing. DSE was diagnostic in 76% of the cases and nuclear stress test was performed in 52% of the patients with a non-diagnostic DSE. From the patients with diagnostic NIST, 40 underwent LHC. There were 5 true positive, 22 true negative, 8 false positive, and 5 false negative results giving NIST a negative predictive value of 81%.
After a median follow-up of 6.2 years [IQR 3.4 to 6.7], 264 patients were transplanted, 9 patients developed an ACS and only one of them within the first year of LT. ACS was the cause of death in one patient which occurred more than 3 years from LT. All of these patients had a prior negative NIST. There were no ACS in the non-transplanted group.

Conclusions:
In our ESLD population, NIST had a limited role in the CV risk assessment of LT candidates. This is probably secondary to the low incidence of ACS which could be explained by inherent ESLD factors like thrombocytopenia, low TC, and elevated INR.
Abstract 13009: The Significance of ATP Therapy Failure During Appropriate ICD-Delivered Therapy in Patients With Ventricular Tachycardia
Authors: Giedrimiene Dalia , Coleman Craig , Guertin Danette , Kluger Jeffrey 
Published: July 2021

Prospective clinical trials have demonstrated that ICD-delivered therapy reduces mortality in patients at risk for sudden cardiac arrest due to ventricular tachycardia (VT). ICDs through anti-tachycardia pacing (ATP) modalities are able to terminate spontaneous VT. Although ATP is highly effective in terminating VT in ICD patients, 5 - 30% of these events ultimately need shocks. Unsuccessful ATP attempts, as well as shocks, prolong the duration of the episode and are associated with poor clinical outcomes.

Methods:
Our study focused on 1873 ICD-delivered therapies in pts who received ICD implants from 2008 to 2012 and completed one year follow up. Only patients who received ATP therapy for the first time for a ventricular tachycardia (VT) event were included. All therapy zones contained ATP therapy followed by shock therapy.

Results:
806 pts with ICD implants for primary or secondary prevention were analyzed. Study population consisted of 636 (78.9%) males and 170 (21.1%) females with average age of 72.8±29.8y (range: 29 - 98y). 622 (77.2%) of these patients had successful termination of VT with ICD-delivered ATP therapy. In 184 (22.8%) patients with unsuccessful ATP, appropriate ICD shocks were delivered.

Only 66.8% of patients with failed ATP had successful VT termination after 1st ICD shock. More than 33% of patients required 2 or more ICD-delivered shocks, of which 13% required four or more.
No gender based difference was found regarding success for VT termination after first, second or multiple ICD delivered shocks.

Conclusions:
1) ATP therapy is successful in the majority of patients.

2) After ATP failure only 66.8% of pts respond to first ICD shock. 33.2% require multiple ICD shocks that delay VT termination and may lead to worse clinical outcomes.
3) ATP failure for VT termination may identify patients who are at increased risk for failure to respond to ICD shocks. A careful observation and further clinical correlation is warranted in this group.
Abstract 13230: Attenuation of Clock-bmal1 Transcriptionally Decreases the Expression of β1-ar to Anticipate the Occurrence of Ventricular Arrhythmia After Chronic Heart Failure
Authors: Yuan Jiamin , Zou Jiangang 
Published: July 2021

Circadian rhythms influence the incidence of sudden cardiac death after chronic heart failure (CHF) but the underlying mechanisms are not well defined. We sought to investigate the role of the β-adrenergic receptor (β-AR) in cardiac circadian disorders and ventricular arrhythmia(VA) after CHF.
CHF guinea pigs was created by transverse aorta constriction. Circadian variations of the myocardial expressions ofβ1-AR, β2-AR and circadian genes CLOCK and BMAL1 were examined by real time reverse transcription polymerase chain reaction, Western blot and immunohistochemistry. Sham operated animals showed circadian oscillations in the expression ofβ1-AR and CLOCK-BMAL1(P<0.05). However, the expression ofβ1-AR and CLOCK-BMAL1 were attenuated in guinea pigs with CHF(P<0.05). Then, electrocardiograms of Langendorff-perfused hearts with isoprenaline(β-AR nonselective agonist ,ISO), ISO + CGP-20712A(β1-AR selective antagonist, CGP) and ISO + ICI118551(β2-AR selective antagonist, ICI) at CT3 and CT15 were recorded and ventricular arrhythmias were induced by programmed electrical stimulation (PES). During ISO and ISO + ICI infusion, the diurnal variation in response of β-AR activation translated to a greater incidence of VA in CT15(P<0.05). Next, infections of Ad-CLOCK and/or Ad-BMAL1 were applied to overexpress CLOCK, BMAL1 and CLOCK-BMAL1 in the guinea pig ventricular cardiomyocytes. Ad-CLOCK and Ad-BMAL1 co-infection resulted in overexpression of β1-AR and a greater incidence of arrhythmic activity in myocytes. At last, chromatin immunoprecipitation assay(ChIP) and luciferase(LUC) were applied to determine whether CLOCK-BMAL1 transcriptionally regulateβ1-AR expression. ChIP-qPCR analysis and luciferase revealed that BMAL1 could bind to enhancer of β1-AR to regulate arrhythmia severity after CHF(P<0.05).
We conclude that circadian rhythms of myocardial β1-AR and CLOCK-BMAL1 activities are disturbed after CHF. Attenuation of CLOCK-BMAL1 transcriptionally decreases the expression of β1-AR to anticipate the occurrence of ventricular arrhythmias after CHF.
Abstract 13535: The Synergistic Effects of Incretin-related Drugs for the Treatment of Pulmonary Arterial Hypertension
Authors: Hosokawa Susumu , Haraguchi Go , Maejima Yasuhiro , Doi Shozaburo , Isobe Mitsuaki 
Published: July 2021

Introduction:
A growing body of evidence suggests that inflammation plays a crucial role in the development of pulmonary arterial hypertension (PAH). Dipeptidyl peptidase-4 (DPP-4; also known as CD26), a protease which degrades incretin hormones such as glucagon-like peptide-1 (GLP-1), modulates inflammatory processes by regulating activity of T cells through co-stimulatory pathway.

Hypothesis:
Incretin-related drugs, including both DPP-4 inhibitors and GLP-1 receptor agonists, suppress the progression of PAH by attenuating inflammatory response of PA.

Methods:
Sprague Dawley rats were injected monocrotaline to induce PAH

(N=80). After 14 days from PAH induction, these rats were treated with alogliptin, a DPP-4 inhibitor (M+A, N=20), liraglutide, a GLP-1 receptor agonist (M+L, N=20), both of these drugs (M+A+L, N=20), or vehicle
(M, N=20).

Results:
A significant increase of survival was observed on days 30

after PAH induction both in the M+A and M+L compared to the M (M+A: 45%* vs. M+L: 60%* vs. M: 5%, *
p
<0.05). Both alogliptin and liraglutide markedly improved right ventricular pressure (M+A: 33±4.1mmHg*

vs. M+L: 26±1.9mmHg* vs. M: 85.9±1.2mmHg, *
p
<0.05). mRNA levels of both CD28 and CD86, co-stimulators of T cells, significantly decreased

and the level of caveolin-1 markedly increased in lung tissues of the M+A compared to those in the M. mRNA levels of both Tissue Factor (TF) and PAI-1 significantly decreased in lung tissues of the M+L than those in the M. Consistently, survival of rats in the M+A+L was the highest (65%) among all of the groups of PAH rats. Coimmunoprecipitation assays revealed that CD26 in T cells physically interacted with caveolin-1 in rat
pulmonary vascular smooth muscle cells (rPASMCs). Immunoblot analyses showed that alogliptin suppressed caveolin-1 phosphorylation in rPASMCs. Furthermore, reporter gene assays demonstrated that alogliptin significantly inhibited the transcriptional activity of NF-κB.

Conclusions:
These results suggest that DPP-4 inhibition and stimulation of GLP-1 receptors synergistically mediate salutary effects on monocrotaline-induced PAH by modulating T cell activity and TF-associated signaling pathway. Thus, incretin-related drugs have a potential

as a novel therapeutic tool for PAH.
Abstract 13699: A True World Picture - Surgical Revision After Percutaneous Mitral Valve Repair With the Mitraclip Device
Authors: Hirnle Grzegorz , Seeburger Joerg , Borger Michael A , Garbade Jens , Misfeld Martin , Mohr Freidrich W 
Published: July 2021

Background:
Transcatheter mitral valve (MV) repair is of increasing interest facing however questionable mid term results. We herein report MV reference center experience of 18 patients who underwent MV surgery after failed percutaneous MV repair with MitraClip device (Evalve, Menlo Park, CA).

Methods:
Between June 2010 and October 2013, a total of 141 patients with severe mitral regurgitation (MR) underwent MitraClip procedure at Heart Center Leipzig. 11 patients (7.8%) needed surgical treatment for failed MV repair with the MitraClip device. For the same reasons we admitted 7 patients who underwent MitraClip procedure in other cardiac surgery centers. Mean EuroScore II of the patients was 23,51 (5,17-60,14).

Results:
From the group of 18 patients undergoing surgical treatment after MitraClip repair, 14 patients (77.7%) received one or more clip-implants and 4 patients (22.2%) suffered from failed MitraClip implantation. All patient were symptomatic (n=9, 50% - NYHA III; n=9, 50% - NYHA IV).

The primary indications for surgery were: partial clip detachment (n=11, 61.1%), failed MitraClip implantation (n=4, 22.2%), recurrent MR greater than moderate (2+) (n=3, 16.6%), acute mitral valve endocarditis (n=1, 5.5%), mitral ring and clip detachment (n=1, 5.5%). 13 patients (72.2%) underwent MV replacement, 3 patients (16.6%) received left-ventricular assist device (LVAD), 2 patients (11.1%) underwent MV repair.
One-month mortality reached 27,8% (n=5), and the overall mortality reached 50% (n=9).

Conclusions:
MV repair was feasible in only 2 cases (11.1%). Despite the high operative risk, surgical treatment after percutaneous MV repair failure with the MitraClip device is an option to be considered.
Abstract 14925: Inverse Association between Family History of Premature Coronary Artery Disease and the Risk of Death in Patients with Coronary Artery Disease
Authors: Abdi Ali Ahmed , Shaheen Abdel Aziz , Southern Danielle A , Zhang Mei , Knudston Merril , White James , James Matthew , Wilton Stephen B 
Published: July 2021

Background:
Family history (FHx) of premature coronary artery disease (CAD) is an established cardiovascular risk factor. However the impact of FHx on outcomes of patients with CAD is unclear.

Methods & Results:
The Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) Program is an inclusive prospective registry of patients undergoing coronary angiography. Between April 2002 and Mar 2013, 99,667 patients were enrolled. 30,030 (30%) patients reported FHx, defined as a first degree relative with premature CAD (males <55, females <65 years). We investigated the association between FHx and all-cause mortality at 1 year, using multivariable logistic regression, adjusting for clinical characteristics, comorbidities, and the extent of CAD. Patients with normal angiography (15.2%) were excluded.

Compared to those without FHx, those with FHx were younger (60.1 vs 64.0 years, p<0.0001), more likely female (30.5% vs 29.5%; p=0.0018), and were less likely to have previously diagnosed CAD, congestive heart failure, stroke, or chronic kidney disease (all p<0.0001) Conversely, those with FHx were more likely current smokers (31.8% vs 25.3%) and to have hypertension (68.8% vs 65.5%) and dyslipidemia (75.7% vs 68.1%), all p<0.0001). The indication for angiography was an acute coronary syndrome (ACS) in 55% of both groups (p=0.57), and the extent of CAD was similar.
Overall, FHx was associated with reduced 1-year mortality in fully adjusted models (odds ratio [OR] 0.56, 95% CI 0.51 to 0.62). This protective association was present in patients with and without a previous CAD event (OR 0.66 [95% CI 0.60 to 0.78] vs 0.53 [95% CI 0.47 to 0.59], respectively), and in patients with and without an ACS (OR 0.56 [95% CI 0.50 to 0.63] vs 0.56 [95% CI 0.48 to 0.65], respectively). There was slight attenuation of association with age, but FHx remained protective even in those aged 80 or more (OR 0.72, 95% CI 0.57 to 0.90).

Conclusion:
In patients with angiographic CAD, a family history of premature CAD is associated with lower mortality, independent of clinical characteristics, mode of presentation, and extent of disease. Further investigation of potential patient- and system-level mediators of this seemingly paradoxical relationship is required.
Abstract 14927: Everolimus versus Mycophenolate for Cardiac Transplantation
Authors: Aggarwal Saurabh , Gupta Navdeep , Loomba Rohit S , Al-Khafaji Nawfal , Agarwal Anushree , Ismail Imtiaz , Kaushik Manu , Saurav Alok , Alla Venkata , Arora Rohit R 
Published: July 2021

The role of everolimus in cardiac transplantation is being increasingly recognized.Multiple studies have been published comparing the use of everolimus and mycophenolate with varying results. We aimed to perform a meta-analysis of the published literature.
We searched Pubmed, EBSCO and Cochrane databases for terms “everolimus”, “mycophenolate”, “heart transplantation”, “cardiac transplantation” and their combinations. All studies in which everolimus was compared to mycophenolate were included. Studies in language other than English were excluded.
Rates of biopsy proven acute rejection (OR 0.82 CI 0.67 to 1.00, p = 0.05), hemodynamically significant rejection (OR 0.76, CI 0.39 to 1.50, p = 0.43)or change in glomerular filtration rate (GFR) (mean difference -1.91, CI -6.90 to 3.08, p = 0.45) were similar between everolimus and mycophenolate groups. Everolimus use was associated with significant reduction in average maximal intimal thickness (mean difference -0.04 CI -0.06 to -0.02, p = 0.001) and cytomegalovirus antigenemia (OR 0.38, CI 0.28 to 0.53, p < 0.00001). There was no significant heterogeneity for any endpoint except change in GFR.
As compared to mycophenolate, everolimus use is associated with similar antirejection outcomes after cardiac transplantation but with reduced maximal intimal thickness and cytomegalovirus antigenemia.