bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 15904: Acute Outcomes in Persistent and Long-standing Persistent Atrial Fibrillation Patients Undergoing Rotor Ablation
Authors: Gianni Carola , Metz Tamara , Di Biase Luigi , Mohanty Sanghamitra , Trivedi Chintan , Gökoglan Yalçin , Günes Mahmut F , Bai Rong , Al-Ahmad Amin , Burkhardt J. D , Gallinghouse Joseph G , Horton Rodney , Hranitzky Patrick M , Sanchez Javier E , Tomassoni Gery , Halbfaβ Philipp , Müller Patrick , Schade Anja , Deneke Thomas , Natale Andrea 
Published: July 2021

Introduction:
Focal impulse and rotor modulation (FIRM)-guided ablation targets localized sources that are thought to sustain AF. In previous reports, it has been shown that FIRM is effective in terminating or organizing AF. We sought to evaluate the acute success of FIRM in patients with persistent and LSP AF undergoing ablation in our centers.

Methods:
This was a multicenter prospective observational study. FIRM was performed alone or before conventional ablation. Rotors were ablated as confirmed by their absence during remapping and acute success was defined as AF termination, organization or slowing 10%.

Results:
57 patients were enrolled (mean age 63 ± 10; 7% LSP). Rotors-only ablation was performed in 56% of patients, and preceded conventional ablation in 44%. There were no major periprocedural adverse events.

No focal impulses were found, while rotors were present in all patients (3.9 ± 1.2 per patient; 66% in the LA). In the RA, the majority of rotors were in the lateral wall (53%) and in the septum (30%). In the LA, most of the rotors were in proximity of the pulmonary veins (48%), with the second most common locations being around the mitral annulus or in the septum (17% and 13% respectively).
Mean procedural time for FIRM only procedures was 226 ± 52 minutes vs a median of 210 (168-240) minutes for FIRM + conventional ablation procedures (p = NS). Overall acute success was achieved in 35% of patients (3% AF termination, 16% AF organization, 16% AF slowing) with a mean RF time to complete FIRM ablation of 30 ± 15 minutes; no difference in acute success was found when comparing persistent to LSP patients (28% vs 50%; p = NS). Conventional ablation following FIRM did not significantly increase the rate of acute success (1 additional patient converted to sinus rhythm during pulmonary vein isolation).

Conclusion:
Rotors were present in all patients undergoing ablation for non-paroxysmal AF, most commonly the right atrial lateral wall, septum or around the pulmonary veins. Their ablation was not effective in obtaining AF organization/termination during the procedure.
Abstract 17904: Deficiency of Yes-associated Protein Promotes Cardiac Dysfunction in Response to Pressure Overload in the Mouse Heart
Authors: Byun Jaemin , Del Re Dominic P , Zhai Peiyong , Shirakabe Akihiro , Sadoshima Junichi 
Published: July 2021

Yes-Associated Protein (YAP), a downstream effector of the Hippo pathway, plays an important role in regulating cell proliferation and survival in mammalian cells. We have shown that cardiac-specific loss of YAP leads to increased cardiomyocyte (CM) apoptosis and impaired hypertrophy during chronic myocardial infarction in the mouse heart. However, it remains unclear whether YAP mediates hypertrophy of individual CMs under stress conditions in vivo. We hypothesized that endogenous YAP plays an essential role in mediating hypertrophy and survival of CMs in response to pressure overload (PO).
Three-month-old YAP+/fl;α-MHC-Cre (YAP-cKO) and YAP+/fl (control) mice were subjected to transverse aortic constriction (TAC). Two weeks later, YAP-cKO and control mice developed similar levels of cardiac hypertrophy (left ventricular (LV) weight/tibia length: 7.27±0.38, 6.93±0.29) compared to sham (5.08±0.14, 4.07±0.33). LV CM cross sectional area was similarly increased by TAC in YAP-cKO and control mice compared to their respective shams. Induction of fetal-type genes, such as Anf and Myh7, was also similar in YAP-cKO and control mice. YAP-cKO and control mice exhibited similar baseline LV systolic function (ejection fraction (EF): 75, 76%). YAP-cKO mice had significantly decreased LV function after TAC compared to Sham-control mice (EF: 51%, 76%, p<0.05) and TAC-control mice (75%, p<0.05). LV end diastolic pressure (LVEDP, mmHg) was significantly increased (19.3 ±3.2, 9.8±1.6, p<0.05), and LV +dP/dt (mmHg/s, 7250±588, 9500±453, p<0.01) and -dP/dt (mmHg/s, 6000±433, 7781± 314, p<0.05) were significantly decreased in YAP-cKO compared to in control mice after TAC. LV end diastolic diameter (mm) was significantly greater in YAP-cKO than in control mice after TAC (3.95±0.11, 3.35±0.15, p<0.05), whereas LV pressure was similar, suggesting that LV wall stress was elevated in YAP-cKO compared to in control mice. Since cardiac hypertrophy in YAP-cKO mice is similar to that in control mice despite elevated wall stress, the lack of YAP appears to limit the extent of cardiac hypertrophy in response to increased wall stress.
These data suggest that endogenous YAP plays an important role in mediating adaptive hypertrophy and protecting the heart against PO.
Abstract 18835: Chromatin Gene Cohorts, Not Individual Cardiac Genes, Modulate Cardiac Phenotype in a Genetically Diverse Population
Authors: Karbassi Elaheh , Monte Emma , Lopez Rachel , Kim Joseph , Chapski Doug , Rau Christoph , Wang Jessica , Weiss James N , Wang Yibin , Lusis Aldons J , Vondriska Thomas M 
Published: July 2021

Re-expression of fetal genes is a hallmark of transcriptome change in models of cardiac hypertrophy, but how this remodeling is affected by the common genetic variation present in populations is unknown. We examined gene expression in 86 strains of control and isoproterenol (ISO)-treated mice, which exhibited varying degrees of disease. Correlations between individual fetal genes (Anf, Serca2a, alpha-MHC, beta-MHC) and hypertrophic phenotypes were not significant. Expanded analysis of 37 fetal genes showed sparse correlation (at p<0.05) between expression of individual genes with one or more of 52 systemic phenotypes. We next tested the hypothesis that groups of genes exhibit emergent association with phenotype not observed with individual transcripts. Examining the fetal genes as a group unmasked a correlation with left atrial mass (enriched 3.04-fold vs transcriptome, p<0.001). Grouping cardiac transcription factors (n=31 genes) or genes shown by gain/loss of function studies to contribute to hypertrophic signaling (n=142) revealed no correlation to cardiac phenotypes, whereas chromatin regulators (n=124) were associated with right ventricular mass (1.55-fold, p<0.01), fractional shortening (1.52-fold, p<0.05) and ejection fraction (1.50-fold, p<0.05).
We next analyzed histone genes. HOPACH clustering generated 39 clusters of strains based on the basal transcriptome that collapsed to 13 clusters after ISO, suggesting that adrenergic stress entrains gene expression. We observed transcriptional co-regulation of H2A with H2B, and H3 with H4 (the other pairings did not show correlation), mirroring the protein level assembly, which proceeds via pairs of dimers according to the same logic. Comparison of strain grouping based on partitioning clustering using histone stoichiometry or phenotype revealed that hypertrophic mice were enriched in histone cluster 4, marked by minimal change to histone variant expression (enriched 2.27-fold, p<0.01). The two novel conclusions are: fetal gene regulation is buffered within populations by common genetic variation and is not a good predictor of disease; and cardiac phenotype is influenced in the basal and disease states through global changes in chromatin.
Abstract 19165: Regional Changes in Cellular and Molecular Pathology in Children With End-stage Dilated Cardiomyopathy: Correlation With Cardiac Performance
Authors: Chen Ching Kit , Sun Mei , Slorach Cameron , Ishii Ryo , Redington Andrew N , Friedberg Mark K 
Published: July 2021

Dilated cardiomyopathy (DCM) carries poor prognosis in children, often needing heart transplant. Regional differences in left ventricular (LV) function suggest inhomogeneous expression of contractility related proteins. However, associations between myocardial performance and histological / molecular findings are poorly defined.
We sought to investigate associations of regional myocardial performance with histological and molecular changes in hearts explanted from children with DCM, undergoing transplantation.

Clinical and echo features (including tissue Doppler and strain) were correlated with histological and molecular findings in hearts explanted from 9 children [median age 2.8 years (range 4.4 months-17 years); 6 had LVAD]. Interstitial fibrosis, myocyte volume, and expression of proteins (western blot) implicated in fibrosis and function (
p38
,
ERK
, phospho-
JNK
, phospho-
GSK
,
SMA
, myosin heavy chain, cadherin,
ILK
, sarcoplasmic reticulum Ca
2+
-ATPase [SERCA2a], phospho-
CamKII
, phospholamban [PLN], and phospho-PLN) were correlated with speckle tracking strain from 11 regions per patient (basal and mid regions of anterior septum, anterior, lateral, posterior and inferior LV segments, and right ventricular [RV] free wall).

On average, no significant difference was noted for the percentage of fibrosis and myocyte volume between the various LV segments, and between RV and LV. LV dimension, systolic and diastolic function were not related to interstitial fibrosis, myocyte volume or molecular signaling. Tricuspid annular plane systolic excursion was related to myocyte volume (r=0.89;
p
<0.01). An inverse relationship between the extent of interstitial fibrosis and segmental longitudinal strain was present for LV basal and mid posterior segments (basal posterior, r=0.96,
p
<0.01; mid posterior, r=0.74,
p
=0.05). Global longitudinal strain was related to expression of ILK and SERCA2a (ILK, r=0.78,
p
=0.02; SERCA2a, r=0.71,
p
=0.04).

This study demonstrated association of regional cardiac function in children with DCM with expression of calcium-cycling and contractile proteins, as well as interstitial fibrosis. These findings have implications for diagnosis and therapeutic targets in pediatric DCM.
Abstract P161: Effect of Yoga Program on Cardiovascular Function in Elderly with Stage-I Hypertension
Authors: Patil Satish G 
Published: July 2021

Introduction:
Hypertension is a major cause of cardiovascular (CV) morbidity and mortality in elderly population. Hypertension along with aging leads to left ventricular hypertrophy, systolic and diastolic dysfunction and congestive heart failure. We aimed to determine the effect of yoga program on cardiovascular indices in elderly with stage-I hypertension.

Hypothesis:
We hypothesize that yoga lifestyle modality may induce significant beneficial changes in cardiovascular function in elderly individuals with hypertension. Yoga program may be more beneficial than walking for cardiovascular health in elderly.

Methods:
A parallel arm, open label, single blind, randomized controlled study was conducted on elderly people with stage-I hypertension aged above 60 years (n=44). Yoga group (n=24) was assigned for yoga practice (includes asanas, pranayama and meditation) and control group (n=20) for brisk-walk for one hour in the morning for 6 days in a week for three months. The outcome measures were cardiovascular indices derived from pulse wave analysis such as left ventricular ejection time (ET), diastolic time (DT) pulse duration (PD), percentage of mean arterial pressure (%MAP), upstroke time (UT), ejection slope (ES), ejection duration index (ED%), pre-ejection period (PEP), and heart rate.

Results:
The mean within-yoga group change in PD(ms) was -50.29 (CI=-98.5, -2.07; p=0.042), DT(ms): -49.04 (CI=-88.47, -9.61; p=0.017), ED%: 2.107 (CI=0.92, 3.28; p=0.001), HR(bpm): 4.41 (CI=0.43, 8.4; p=0.031), %MAP: 2.08 (CI=0.71, 3.44; p=0.04), ES (mmHg/ms): 14.62 (CI=-3.99, 33.24; p=0.118), ET (ms): -0.66 (CI=11.89, 10.55; p=0.903), UT(ms): -2.54 (CI=14.95, 9.87; p=0.676), PEP (ms): -1.25 (CI=-4.17, 1.67; p=0.11).

The mean within-control group change in PD(ms) was 11.15 (CI=-52.26, 74.56; p=0.717), DT(ms): 11.3 (CI=-50.56, 73.16; p=0.706), ED%: -0.101 (CI=-2.7, 2.5; p=0.936), HR (bpm): 0.35 (CI=-4.71, 5.41; p=0.887), %MAP: 0.65 (CI=-1.11, 2.41; p=0.451), ES(mmHg/ms): 0.75 (CI=-15.8, 17.38; p=0.926), ET(ms): 2.2 (CI=-10.5, 14.9; p=0.721), UT(ms): 4.7 (CI=-8.19, 17.59; p=455), PEP (ms): 2.1 (CI=-0.52, 4.72; p=0.11).
Analysis of Covariance showed a significant change between-groups in PD (p=0.021), DT (p=0.02), UT (p=0.048), ED% (p=0.049), HR (p=0.036) while no significant difference was observed in ES (p=0.248), ET (p=0.245), PEP (p=0.102) and %MAP (p=0.262).

Conclusions:
These findings indicate that the yoga practice can induce beneficial changes in cardiovascular function in elderly hypertensive subjects. Further, yoga may be better than walking in improving cardiac health in older individuals.
Abstract P30: Disparities in Geographic Access to Emergency Stroke and Myocardial Infarction Care
Authors: Pedigo Ashley , Odoi Agricola 
Published: July 2021

Stroke and myocardial infarction (MI) are serious health conditions that require emergency care; thus, geographic access to appropriate care facilities is critical. However, little is known regarding disparities in timely geographic access to stroke and MI care based on actual travel time, instead of distance to the healthcare facility. Current methods for determining access can be inaccurate since they typically do not include road characteristics and driving restrictions. Therefore, the objective of this study was to identify disparities in access to appropriate and timely stroke and MI care in East Tennessee utilizing a novel epidemiological method.
Travel times to stroke and cardiac specialty care centers were computed using network analysis in ArcGIS9.3, while adjusting for distance, speed limits, road connectivity, and turn impedances for each street segment. Neighborhoods represented by census tracts that were within 30, 60, or 90 minutes travel time were identified and described. Travel time by air ambulance was also calculated in ArcGIS9.3 using a 130 mph flying speed, a 3.5 minute warm-up delay, and a 20 minute patient preparation time delay.
Approximately 8% (66,379 of 857,138) and 15% (127,143 of 857,138) of the study area population do not have timely access to appropriate stroke and MI emergency care, respectively. The disparity was greatest for populations in rural areas. However, the entire study population had timely access to emergency stroke and MI care by air ambulance.
In conclusion, there are disparities in timely access to emergency stroke and MI care in East Tennessee. With specific time sensitive treatments, timely access to appropriate care is critical in improving stroke and MI outcomes. Use of air ambulance or telemedicine programs in the rural areas could play a vital role in addressing these disparities. This information is invaluable for evidence-based population health planning initiatives that seek to address disparities in access to care for stroke and MI.
Abstract P358: Do Cardiac Interventions Affect Noncardiac Mortality?
Authors: Bryg Robert , Yang Tae , Bryg David 
Published: July 2021

Clinical trials of cardiovascular drugs and devices primarily assess benefit and risk in terms of cardiovascular mortality and other major adverse cardiovascular events. There is little data on how noncardiac mortality is impacted in clinical trials. In this study, we sought to determine how noncardiac mortality was affected in clinical trials that were published in the past 12 years in major general medicine journals. We calculated the standardized mortality ratio and its confidence intervals for cardiac, noncardiac and total mortality in all arms of 93 large clinical trials. Relative change and power to detect significant changes in all three components was calculated.
Twenty two studies had a decrease in cardiovascular mortality of at least 20%, while only 4 studies had an increase in cardiovascular mortality more than 20%. Only 7 studies had a statistically significant decrease in cardiovascular mortality. Noncardiac mortality was at least 5% higher in the treatment arm in 31 (33%) of all studies. In 4 of these studies, noncardiac mortality was at least 20% higher in the treatment arm. Noncardiac mortality was at least 5% lower in the treatment arm in 24 studies, with 3 of then having at least a 20% lower mortality rate. In only 1 study was there a significant difference in noncardiac mortality. Only 3 studies were adequately powered to detect a 20% difference in noncardiac mortality. None were powered to detect a 10% difference in noncardiac mortality. Overall, there was no difference in noncardiac mortality in these studies.
There is wide variation in differences in noncardiac mortality determined in clinical trials, with most studies showing at least a 5% difference in noncardiac mortality rates and over 1/3 of the studies demonstrating at least a 10% difference in noncardiac mortality. In primary prevention and hypertension studies, one would only need a 6-10% increase in noncardiac mortality to negate a 20% decrease in cardiac mortality. No studies were adequately powered to evaluate for this effect.
With the strong push to evidence based medicine, studies need to be adequately powered to demonstrate a lack of harm as well as benefit. The increased use of multiple endpoints will exacerbate the problem of assessment of risk in cardiovascular clinical trials.
Abstract 218: Do Weekends Influence Time to Treat?
Authors: Langabeer James R , Alqusairi Diaa , DelliFraine Jami , Segrest Wendy , Henry Timothy ,   Dallas Caruth Scientific Advisory Board
Published: July 2021

In emergency cardiovascular care, time to treat is a key system goal to improve patient outcomes. In patients experiencing ST-elevation myocardial infarction (STEMI), reducing delays requires continuous quality improvement at PCI hospitals to reduce door to balloon (D2B) times. Yet, many of the hospital operational processes are not well situated to accommodate variability in patient presentation patterns. In this study, we questioned whether the day of week influences time to treat, since this could have an effect on hospital staffing, personnel mix, and resource utilization. We analyzed the entire population of 1,247 STEMI patients that presented in all of the PCI facilities in Dallas County Texas during a 24-month period (2010-2012), to assess relationships between arrival patterns and treatment delays. Specifically, we examined the differences in D2B times of patients presenting on weekends versus weekdays. To control for confounding factors, we developed a robust generalized linear model (GLM) regression and relied on estimated marginal means analyses to assess the impact of weekday vs. weekend on hospital D2B, and controlled for a variety of confounding factors.
There was a statistically significant difference in the D2B times between patients who arrived at the hospital on weekends (75 minutes) compared to those who arrived on weekdays (65 minutes) (KW=48.9; df=1; p<.001). Seventy two percent of patients who arrived on weekends or holidays achieved a D2B time of <90 minutes, compared to 79.5% for those who arrived on weekdays. GLM regression results confirmed that arriving on weekends or holidays is associated with statistically significantly higher D2B time (p=0.000), controlling for confounding variables (gender, age, presence of heart failure, cardiac arrest, shock at first medical contact, EMS transportation, and cardiac cath lab activation by EMS). Based on these findings, we recommend careful evaluation and update of hospital activation protocols and staffing policies for weekends.
Abstract 311: Risk Factor Profile and Outcome in Young Adults Presenting With Acute Myocardial Infarction Compared to Older Adults.
Authors: Indramohan Venmathi , Hajjali Raef , Akosah Kwame 
Published: July 2021

Background:
Management of acute myocardial infarction has improved but preventing the first myocardial infarction in the first place continues to be a challenge. Guidelines for prevention have focused on ‘one-size-fits-all’ approach. With the nation’s changing trends in risk factor profile (Diabetes mellitus, obesity and tobacco use), we aimed to examine the risk factor profile for young adults (<50 years) suffering acute myocardial infarction (AMI) and compared to older adults (>50 years).

Methods:
The Nationwide Inpatient Sample (NIS), a part of the Healthcare Cost and Utilization project (HCUP) is the largest publicly available inpatient database designed to provide information on patients discharged from United States community hospitals. Using the NIS database from 2008 to 2010, 374,173 adults with AMI were identified.

Results:
Younger adults had a significantly higher incidence of smoking (51% vs. 18.8%; P< 0.001) and obesity (17.3% vs. 9.9%; P<0.001). The rate of hypertension was similar in both groups.

Younger adults were more likely to present with ST elevation myocardial infarction (42 % vs. 27%) and undergo percutaneous revascularization (62% vs. 41%) as compared to older adults.
In-hospital mortality was lower in younger adults presenting with AMI (1.7 % vs. 6.2%) as expected.

Conclusion:
1). Acute MI in the young adult is more likely to present as STEMI.

2). Young adults are more likely to be obese and use tobacco.
3). The results suggest that there is opportunity to improve AMI in the young by focusing on modifiable risk factors.
4). The lower short term mortality may imply that young adults with MI are beset with greater or long standing burden for complications.
Abstract 237: Prognostic Significance of Left Ventricular Hypertrophy (lvh) by Electrocardiography in a Minority-predominant Heart Failure (hf) Cohort
Authors: Majeed Muhammad U , Oseni Abdullahi , Akanbi Olabisi , Agboto Vincent , Okafor Henry E 
Published: July 2021

Background:
Left ventricular Hypertrophy (LVH) has been associated with higher cardiovascular morbidity and mortality but most of these studies were conducted in majority (white) populations. LVH is known to be more common in African Americans (AA) who also have a higher prevalence of cardiovascular morbidity and mortality. The prognostic significance of LVH in AA with Heart Failure (HF) has not been well studied.

Methods:
We performed a retrospective analysis of a predominantly minority HF cohort (69.3% AA); after obtaining approval from our institutional review board. Our primary goal was to compare the HF outcomes [All-cause hospitalizations (ACH), hospitalizations primarily due to HF and ER visits] in patients with EKG evidence of LVH versus those without LVH. We also examined the racial (Blacks vs Whites), gender (males vs females) and age-based (≥60 Vs <60 years) differential impact of LVH on HF outcomes and determined the prevalence of LVH in the cohort. Levene’s Test and t-test were used to analyze the data for equality of variances and means respectively.

Result:
Our HF cohort consisted of 599 patients (415 AA, 142 Caucasian, 22 others, 20 unknown). The prevalence of LVH in overall cohort was 26.7%. We noted that black had higher prevalence of LVH ( 31%) vs Whites (15.5%) while prevalence of LVH was not very different in males ( 27.9%) vs females( 25.7%) and ≥60 years of age( 27.5%) vs <60 (27.3%).

The analysis showed that there were statistically significant differences in the number of ACH (p-value = 0.014), HF hospitalizations (p-value = 0.019) and ER visits (p-value = 0.001) in the LVH group compared with the non-LVH group. .
There were no racial, gender or age-based statistically significant differences in the impact of LVH on HF outcomes.

Conclusion:
Electrocardiographically determined LVH in a minority - predominant HF cohort is associated with worse outcomes. This needs to be prospectively validated in a larger cohort of HF and could serve as a prognostic marker to guide the care of HF patients.