bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15467: Impact of Thrombocytopenia on Clinical Outcomes in Atrial Fibrillation Patients With Anemia: The Fushimi Af Registry
Authors: Ishigami Kenjiro , Ikeda Syuhei , DOI KOSUKE , Hamatani Yasuhiro , Fujino Akiko , An Yoshimori , ISHII MITSURU , Iguchi Moritake , Masunaga Nobutoyo , Ogawa Hisashi , Esato Masahiro , Wada Hiromichi , Hasegawa Koji , Abe Mitsuru , Akao Masaharu
Published: November 2020

Introduction:
Anemia has been reported to be associated with poor prognosis in patients with atrial fibrillation (AF). Concomitant thrombocytopenia (TP) may or may not affect the prescription of antithrombotic drugs and clinical outcomes in these patients.

Methods:
The Fushimi AF Registry is a community-based prospective survey of AF patients in Fushimi-ku, Kyoto. We defined TP as platelet counts less than 150,000/μL and anemia as hemoglobin less than 11 g/dL. Among 666 patients with anemia, we compared the clinical backgrounds and outcomes of those with TP (n=183) and those without (n=483).

Results:
Compared with patients without TP, patients with TP were more likely to have chronic kidney disease (75.4% vs. 61.8%, p=0.001), and less likely to have hypertension (58.5% vs. 67.0%, p=0.0393), and less likely to have dyslipidemia (27.3% vs. 38.3%, p=0.0079). Age, sex, body weight, CHADS
2
score, CHA
2
DS
2
-VASc score, HAS-BLED score, and previous major bleeding were comparable between the groups. Furthermore, prescription of anti-thrombotic drugs was comparable (Figure A). On Kaplan-Meier analysis, the incidence of all-cause death was higher in TP group (hazard ratio [HR] 1.52; 95% confidence interval [CI] 1.20-1.91, p<0.05) (Figure B-1). There was no significant difference in other adverse events between patients with and without TP (major bleeding: HR 1.11; 95% CI 0.41-3.31, p=0.8, hospitalization for heart failure: HR 1.11; 95% CI 0.74-1.61, p= 0.61 and stroke or systemic embolism: HR 0.91; 95% CI 0.43-1.78, p=0.80) (Figure B-2, 3, 4). Multivariate Cox proportional hazards regression analysis adjusting for potential confounders revealed that TP was an independent determinant of all-cause death (adjusted HR: 1.41, 95% CI; 1.11-1.78, p=0.006).

Conclusions:
Concomitant TP in AF patients with anemia did not affect the prescription of antithrombotic drugs, and was independently associated with all-cause death in the Fushimi AF Registry.
Abstract 15824: Safety and Efficacy of Periprocedural Direct Oral Anticoagulant versus Aspirin Use for Reduction of the Risk of Cerebrovascular Events in Patients Undergoing Ventricular Tachycardia Radiofrequency Catheter Ablation (STROKE-VT)
Authors: Lakkireddy Dhanunjaya , Shenthar Jayaprakash , Padmanabhan Deepak , Banavalikar Bharath , Murtaza Ghulam , Akella Krishna , Atkins Donita , Gopinathannair Rakesh , Di Biase Luigi , Natale Andrea
Published: November 2020

Background:
The STROKE-VT is an ongoing, multicenter, randomized controlled trial that studies the differences in cerebrovascular events between DOAC vs ASA use post procedurally in ischemic and non-ischemic cardiomyopathy patients undergoing left ventricular tachycardia radiofrequency ablation (VT RFA).

Methods:
52 Eligible patients scheduled for VT RFA were randomized 1:1 post procedurally to a DOAC (n=26; Dabigatran-11/Rivaroxaban-12 & Apixaban-3) or ASA (n=26, 81mg) for 30 days. VT ablation was performed under moderate sedation or general anesthesia either through retrograde aortic (n=28) or transseptal (n=24) approach. All patients were given IV heparin for ACT>300msec. Study drug was administered 3 hours after hemostasis. A brain MRI was done within 6-12 hours post VTRFA and at 30 days. NIH stroke scale was used to assess for neurological changes before, after and at 30 day follow up.

Results:
52 patients (M:F- 4.2:1) with 55% ICM were enrolled. DOAC group was slightly older (65±8 vs 60±6 yrs, p=0.04)), had longer procedural (186±76 vs 150±51, p<0.001) and RF time (45 ± 23 vs 24±23, p=0.01) and greater use of transseptal approach (58 vs 42%, p=0.03) compared to the ASA group. One patient in the ASA group had a TIA in the immediate postop period. 31% (16/52) had acute asymptomatic cerebral embolizations (ACE) (25% vs 5% with Retrograde aortic approach). DOAC group had a significantly lower incidence of ACE at 1 month f/u MRI (8 vs 38%, p<0.001). On multivariate analysis predictors of acute post VTRFA ACE were retrograde aortic approach, prolonged procedure and RFA time, while delayed ACE was ASA therapy. Two patients died of progressive heart failure with one in each group. 1 patient had a TIA during f/u in the ASA group.

Conclusions:
DOAC decrease the incidence of delayed ACE after VTRFA. However, retrograde aortic approach and prolonged procedural and RFA time can increase the risk of acute ACE.
Abstract 15830: Uncontrolled and Undertreated Cholesterol in Patients With Severe Hypercholesterolemia at a Large Healthcare System
Authors: Benziger Catherine P , Groth Nicole
Published: November 2020

Introduction:
Patients with phenotypic severe hypercholesterolemia (SH) (low-density lipoprotein-cholesterol (LDL-c) ≥ 190 mg/dL), should have at least 50% LDL-c lowering by treatment with a maximally tolerated statin to goal LDL-c<100 mg/dL for primary prevention. Despite even more aggressive goals in Europe, these targets are not widely implemented.

Methods:
Cross-sectional study using an electronic medical record-based SH registry defined by ever having an LDL-c ≥ 190 mg/dL from 01/01/2000-01/16/2020 (n=17,925) at Essentia Health (MN, WI, and ND). Patients excluded if they had no visit at EH within the past 5 years (n=274), were <20 or >75 years old (n=3,171) or deceased (n=34).

Results:
We included 14,661 SH patients (81.1%) (mean age 59.8 ± 10.3 years; 58.9% female). A total of 40.7% were untreated for SH, 23.2% on a high-intensity statin, and 0.4% on proprotein convertase subtilisin/kexin type 9 inhibitor. Statins were prescribed in 31.8%, 47.9%, 56.1% and 65.4% of patients aged 20-39, 40-49, and 50-59, 60-75 years, respectively. There were 1,111 with a highest ever LDL-c > 250 mg/dL (32.8% not currently on lipid medication (n=365) and 14.5% of this group had LDL-c<100 mg/dL. Overall, 25.0% achieved at least 50% LDL-lowering (Table 1) and 19.8%, a most recent LDL-c<100 mg/dL; 64.1% of men and 69.5% of women treated with any lipid medication still had an elevated LDL-c. In the no medication group, only 17.2% (n=1,025) had a statin allergy/intolerance. Females were less likely to be on a statin than males (p<0.001). High-intensity statin was the strongest predictor of an LDL-c at goal, then highest ideal cardiovascular health score (adjusted RR 13.2; 95% CI: 11.1-15.6).

Conclusions:
Majority of patients at very high risk of CVD with SH remain untreated or undertreated with recent LDL-c levels above target. It is necessary to obtain better control of lipid levels in patients already being treated, increase the detection of SH and improve adherence to the current guidelines.
Abstract 15837: Particulate Matter 2.5 Exposure Increases Risk of Subsequent Myocardial Infarction
Authors: Maxi John K , Herzog Matthew , Entwisle Jonathan , Wilt Jonathan K , Milani Richard V
Published: November 2020

Introduction:
Particulate matter 2.5 (PM
2.5
) are airborne particles small enough to be inhaled into the pulmonary alveoli, and are associated with increased hospitalization rates, morbidity, and mortality. The purpose of this study was to evaluate the levels of PM
2.5
in southeastern Louisiana and describe associated cardiovascular outcomes in patients with a history of myocardial infarction (MI).

Methods:
Air quality monitoring stations were placed around southeastern Louisiana and were analyzed from March 1
st
, 2019 to March 1
st
, 2020. Samples were collected every 80 seconds, and values were aggregated at the hourly and daily level. We used conditional logistic regression models to determine the risk of MI. Control observations per patient were created using PM
2.5
exposure on the same day of the week for the two weeks before and after the event. Temperature, pressure, humidity, and their interactions with PM
2.5
were included in the model.

Results:
The average PM
2.5
exposure for the year was 10.41 ug/m
3
+/- 5.57 ug/m
3
, with a daily low of 1.93 ug/m
3
and a daily high of 31.32 ug/m
3
. Peaks from individual sensors reached PM
2.5
concentrations greater than 100 ug/m
3
. PM
2.5
concentration showed a significant, weakly positive correlation with daily average temperature and a significant, weakly negative correlation with daily average barometric pressure. Among patients (n=263) with history of MI, risk of subsequent MI increased by 24.3% per 10 ug/m
3
increase in PM
2.5
exposure with a lag of three days after exposure. (Figure) No significant risk associated with PM
2.5
exposure was observed at shorter lag times.

Conclusion:
Although the average PM
2.5
levels in southeastern Louisiana were within the WHO guidelines of air quality, PM
2.5
exposure remained a significant risk factor for MI among a those with previous MI.
Abstract 15843: A Novel Role for Telomerase in Calcific Aortic Valve Disease
Authors: Cuevas Rolando A , HORTELLS Luis , Boufford Camille , Regan Cailyn , Chu Claire , Moorhead William , rojas mauricio , Bruemmer Dennis , Gleason Thomas G , St. Hilaire Cynthia
Published: November 2020

Introduction:
Calcific aortic valve disease (CAVD) is a disorder characterized by the slow, but a progressive thickening of the aortic valve leaflet that develops into severe calcification. The only current therapy is aortic valve replacement. Telomerase is an enzymatic complex best known for its telomere-extending activities on the ends of chromosomes yet, the catalytic subunit (TERT) has been implicated in multiple non-canonical transcriptional and epigenetic activities, including priming of mesenchymal stem cells (MSCs) to differentiate into osteoblasts, and transcriptional regulation of inflammatory genes.

Hypothesis:
We hypothesize that non-canonical TERT activity contributes to the progression of CAVD.

Methods:
We performed biochemical assays to study the role of TERT in the calcification process using primary tissues and valve interstitial cells (VICs) from control and CAVD patients, smooth muscle cells (SMCs) from WT and
Tert
knockout mice, and mesenchymal stem cells (MSCs).

Results:
We found that TERT protein is highly expressed in calcified aortic valves and VICs isolated from patients with calcified valves, compared to healthy valves. VICs can be induced to calcify under osteogenic differentiation conditions, and we found that TERT accumulated after fourteen days in this culture, with no effect on either telomere length, proliferation, or senescence. We expanded the scope of our approach by evaluating TERT's influence on calcification of mice aortic smooth muscle cells (mSMCs). We found WT mSMCs readily calcified in vitro, but mSMCs from
Tert
knockout mice did not, and
Tert
deletion also reduced valve calcification in a
Ldlr
/
Tert
double knockout mice model compared to
Ldlr
knockout alone. In VICs, shRNA mediated
TERT
downregulation reduced expression of
RUNX2
. Finally, we found that inflammatory signals intensify in vitro calcification, induce
TERT
expression, and we show evidence that TERT interacts with STAT5.

Conclusion:
Our data suggest that TERT is required for valve calcification by stimulating transcriptional pathways promoting the osteogenic transition of quiescent VICs into calcifying VICs in the aortic valve. These results indicate that TERT is an active contributor to the calcification process of valve tissues.
Abstract 15863: Prevalence, Trends and Impact of Cannabis Use on Hospitalizations With Prior Myocardial Infarction and Revascularization
Authors: Desai Rupak , Singh Sandeep , Gandhi Zainab J , Malik Faizan Ahmad , Desai Virmitra G , Patel Vraj , Khimani Prince , abu hassan falah , Bambhroliya Zarna , Bhuva Rushik
Published: November 2020

Background:
With the rise of cannabis use in the USA, we aim to assess its prevalence and impact on admissions with prior myocardial infarction and revascularization [percutaneous coronary intervention (PCI) and/or coronary artery bypass grafting (CABG)].

Methods:
We queried the National Inpatient Sample (2007-2014) to identify admissions with prior MI/PCI/CABG for the prevalence, trends and impact of cannabis use disorder.

Results:
Patients cohort with prior MI and revascularization with cannabis use consisted of younger (median age years 53 (46-59) vs 72 (63-81), African American (34.3% vs. 10.0%) male (76.5% vs. 61.5%) patients v/s non cannabis users (p<0.001). Co-morbid conditions such as hypertension (71.7% vs. 74.8%), diabetes, uncomplicated (23.6% vs. 32.9%), dyslipidemia (51.3% vs. 57.8%) (p< 0.001) were significantly lower in cannabis users. There were increasing trends of cannabis use from 0.2 to 0.7% over the study period with a higher rate of AMI (7.2% vs 4.5%), PCI (6.2% vs 5.5%) and CABG (1.9% vs 1.5%) in cannabis users as shown in
Fig 1a and 1b
. All-cause mortality (0.8% vs 2.5%), hospital charges (21556 vs 24872) were low among cannabis users. Subsequent AMI in cannabis users was 67% v/s 41% in non-cannabis users.

Conclusion:
There are alarmingly rising trends in cannabis use in patients with prior MI/PCI/CABG from 2017-2014. Even with younger and overall lower comorbidity burden in cannabis users, the frequency of recurrent AMI and revascularization was seen higher but lower inpatient mortality.
Abstract 15876: Tie1 is Essential for Cardiac Repair and Myocardial Regeneration
Authors: Rueda de Leon Elena , tompkins kevin , fu xiaomin , Bersi Matthew R , Baldwin Harold S
Published: November 2020

Introduction:
Cardiac lymphatics are essential in resolving interstitial fluid and inflammatory infiltrate after a myocardial infarction in adults. Little is known about the role of the lymphatic system during neonatal cardiac regeneration following injury in the perinatal animal with an immature lymphatic system.

Hypothesis:
Our hypothesis is that TIE1, an endothelial specific receptor tyrosine kinase essential for lymphatic development in mice, is required for myocardial repair following infarction (MI) in both neonatal and adult mice.

Methods:
Using an inducible and lymphatic specific deletion model,

Prox1Cre-ER
T2
;Tie1
fl/fl

, both mutant and non-mutant control mice undergo myocardial MI with left anterior descending coronary ligation. Adult surgery is performed at 6-8 weeks of age. Conditional
Tie1
deletion is induced by ingestion of tamoxifen enriched chow 48 hours prior to adult ligation and continued until dissection is performed; cardiac function is assessed throughout this time by echocardiogram. Neonatal surgery is performed at postnatal day 2 (P2) and conditional
Tie1
deletion induced with intraperitoneal tamoxifen with functional assessment by echocardiogram at P4 and P21.

Results:
Adult control animals had a robust lymphangiogenic response within the scar infarct border zone at 6 weeks post-MI that was not seen in mutants at 6 weeks. Furthermore,
Tie1
deletion following led to a an increase in maximal injury, severe depression of cardiac function, and a blunted myocardial repair response, noted by histological analysis of the scar area. Similarly, Tie1deletion in the neonatal period resulted in markedly attenuated regenerative response with persistent scar function at P21.

Conclusions:
Lymphatic expression of
Tie1
in the adult is required for myocardial repair following injury. In addition, lymphatic expression of
Tie1
is required for optimal myocardial regeneration in the neonate even though the cardiac lymphatic system is immature in the postnatal period. Further delineation of the mechanisms involved in Tie1 mediated repair and regeneration may provide novel opportunities for therapeutic intervention following cardiac injury in both neonates and adults.
Abstract 15897: Patient Experience With Telemedicine in Adults With Congenital Heart Disease
Authors: Dodeja Anudeep , Granger Matt , Mitchell Deboarah , Chumita Rosemary , sisk tracey , Daniels Curt , Rajpal Saurabh
Published: November 2020

Introduction:
COVID19 pandemic has resulted in drastic changes in healthcare delivery with increase in use of telemedicine. There is limited data on patient experience with telemedicine in adults with congenital heart disease (ACHD).

Hypothesis:
We hypothesized that ACHD patients would prefer in-person clinic visits over telemedicine, and this would be especially true for patients > 65 years who may be at a higher risk of experiencing technical limitations.

Methods:
We conducted a nurse administered telephone survey (Figure 1A) based on Agency for Healthcare Research and Quality recommendations to assess patient experience after ACHD telemedicine visits from March 2020 to June 2020.

Results:
Of 216 patients who had ACHD telemedicine visits, 136 (63%) agreed to participate in the survey. Mean age was 45
+
18 years, majority (65%) being video encounters. Most (98%) said that the telemedicine visit was successful in addressing their healthcare needs. Only 21 (15%) patients reported technical issues. Most patients (76%) were likely to choose telemedicine in the future instead of an in-person clinic visit provided testing was done separately. Given a choice between in-person clinic visit and telemedicine: 103 (76%) preferred telemedicine, 25 (18%) preferred in-person clinic visits, and 8 (6%) had no preference (Figure1B). Of the 25 patients over 65 years, 19 (76%) would choose telemedicine over the in-person clinic, and only one patient reported technical difficulties.

Conclusion:
In conclusion, patients reported a positive experience with ACHD telemedicine, which was true even among elderly patients. Technical limitations were infrequent even amongst the elderly. Majority of patients felt that their healthcare needs were addressed and would consider telemedicine over clinic visits if given a choice. This data is vital as payors move away from supporting telemedicine and hospitals restructure, with and without ongoing COVID 19 concerns.
Abstract 15905: Monocyte Subsets Predict Mortality After Cardiac Arrest
Authors: Krychtiuk Konstantin , Lenz Max , Richter Bernhard , Hohensinner Philipp , Kastl Stefan , Mangold Andreas , Huber Kurt , Hengstenberg Christian , Wojta Johann , Gottfried Heinz , Speidl Walter S
Published: November 2020

Background:
After successful cardiopulmonary resuscitation (CPR) with return of spontaneous circulation (ROSC), many patients show signs of an overactive immune activation. Monocytes are a heterogeneous cell population that can be distinguished into three subsets. The aim of this prospective, observational study was to analyse whether monocyte subset distribution is associated with mortality at 6 months in patients after cardiac arrest (CA).

Methods:
We included 53 patients admitted to our medical intensive care unit (ICU) after CA. Blood was taken on admission and after 72 hours and monocyte subset distribution was analysed by flow cytometry and distinguished into classical monocytes (CD14++CD16-), intermediate monocytes (CD14++CD16+CCR2+) and non-classical monocytes (CD14+CD16++CCR2-).

Results:
Median age was 64.5 (interquartile range (IQR) 49.8-74.3) years and 75.5% were male. Six-month mortality was 50.9% and survival with good neurological outcome was 37.7%. Monocyte subset distribution upon admission to the ICU did not differ according to survival. However, patients who died within 6 months showed a more pronounced increase in the pro-inflammatory subset of intermediate monocytes (8.3% (3.8-14.6)% vs. 4.1% (1.5-8.2)%; p=0.025), and a decrease of classical monocytes (87.5% (79.9-89.0)% vs. 90.8% (85.9-92.7)%; p=0.036) 72 hours after admission. In addition, intermediate monocytes were predictive of outcome independent of time to ROSC and witnessed cardiac arrest, and correlated with the cerebral performance category (CPC)-score at 6 months (R=0.32; p=0.043).

Discussion:
Monocyte subset distribution is associated with outcome in patients surviving a CA. The activation of the innate immune system may play a significant role in CA patients.
Abstract 15921: Correlation Between Repolarization Changes in Signal Averaged Electrocardiography and Myocardial Fibrosis in Adults With Hypertrophic Cardiomyopathy
Authors: Ramirez Damera Ramses , Vera-Sarmiento Hernan L , Hurtado-de-Mendoza David , Dolores-Cerna Ketty , Khan Muhammad I , Abraham Roselle
Published: November 2020

Introduction:
Hypertrophic Cardiomyopathy
(HCM)
is known as one of the most common causes of sudden cardiac death. Its propensity to lethal arrhythmias is a result of myocardial remodeling leading to aberrant conduction and increased reentrant electrical activity. Previous studies suggest an association between the amount of myocardial fibrosis found on Cardiac Magnetic Resonance
(CMR)
and the risk of these ventricular arrhythmias. Signal Average Electrocardiography (
SAECG)
is a noninvasive technique used to detect subtle conduction abnormalities that can be missed on standard Electrocardiography (
ECG
).

Hypothesis:
Non-uniform conduction through fibrotic tissue seen in CMR leads to unsynchronized myocardial depolarization which correlates with further repolarization abnormalities that can be detected by SAECG.

Method:
In this retrospective study, results of SAECG were used to classify 73 HCM patients into Normal or Abnormal groups based on the presence of two or more of three predetermined criteria (fQRS, RMS40, LAS40). Replacement fibrosis was assessed by measuring late gadolinium enhancement
(LGE)
. Interstitial fibrosis was assessed by measuring T1 relaxation times, using the Look-Locker sequence.

Results:
A statistically significant association between the presence of myocardial fibrosis on CMR and abnormal SAECG was found with a difference of proportions of 41.3% between the subgroups. Left ventricular mass index was found to be significantly higher in the abnormal subgroup (Normal: 61.2 ± 19.6; Abnormal: 82.4 ± 37.1; p = <0.003, CI 95% [2.93; 39.47]). The presence of T wave inversions on standard ECG was only seen in those who had an abnormal SAECG exam.

Conclusion:
Abnormal SAECG in patients with HCM is associated with the presence of LGE on CMR. This study showed a subset of patients with absence of LGE despite having abnormal SAECG, which implies that there are other complex mechanisms besides replacement fibrosis, that predisposes this population to ventricular arrhythmias. This can also be highlighted by the fact that there was no difference between the two groups in the T1 mapping time. We believe that SAECG could be an objective assessment of the arrhythmogenic substrate present in patients with HCM.
Abstract 15941: Derivation of Risk-Scores That Stratify Risk of Hospitalization and Death in SARS-CoV-2 Positive Patients
Authors: Knowlton Kirk U , May Heidi T , Knight Stacey , Bair Tami L , Le Viet T , Muhlestein Joseph B , Horne Benjamin D , Anderson Jeffrey L
Published: November 2020

Introduction:
It is well-documented that COVID-19 patients with pre-existing cardiovascular-related disorders are at higher risk of a complicated course. It would be valuable to integrate individual risk factors into overall risk scores for hospitalization and death from COVID-19.

Methods:
The Intermountain Healthcare medical record database was searched for all individuals tested for SARS-CoV-2 infection up to June 8, 2020. Data from test-positive patients (pts) was analyzed to determine the characteristics of pts requiring hospitalization. From these data, 2 risk scores for hospitalization were derived using multi-variable modeling: of only demographic and risk-factor data, or also including concurrent medications. The risk scores were also applied to predict the risk of dying from COVID-19.

Results:
Of 104,018 people tested at Intermountain Healthcare for SARS-CoV-2, 5505 (5.3%) were positive. Of test-positive pts, 451 (8.2%) were hospitalized, and 37 (0.7%) died. Using a demographic/risk factor only score, 1.4, 7.0, and 36.6% of low-, moderate-, and high-risk groups, respectively, were hospitalized (AUC=0.826). Using demographic risk-factors and medications, 1.4, 5.6, and 40.3% of low-, moderate-, and high-risk patients were hospitalized (AUC=0.854, Table 1). The demographic/risk factor-score was also predictive of the risk of dying, with 0%, 0.9% and 4.5% in low-, moderate-, and high-risk groups dying (AUC=0.918). Adding medications to the risk-factors model further improved the prediction of death with 0.1, 0.04, and 4.9% in the low-, moderate-, and high-risk groups dying (AUC=0.942, Table 2).

Conclusions:
We demonstrate the derivation of highly predictive risk scores for COVD-19 patients at low, moderate, and high risks of hospitalization or death. Pending appropriate validation in another cohort, application of these risk-scores may allow healthcare systems to risk-stratify COVID-19 patients requiring variable intensity of care.
Abstract 15947: Predictors and Characteristics of Malignant Arrhythmias in Patients on Ambulatory Inotropic Therapy
Authors: Grubb Christopher S , Truby Lauren , Farr Maryjane , Biviano Angelo B , Garan Hasan , Yarmohammadi Hirad
Published: November 2020

Introduction:
Ambulatory inotropic therapy (AIT) is used in advanced heart failure as a bridge to advanced therapies or palliation. Inotropes are known arrhythmogenic agents. The characteristics, predictors and outcomes of ventricular tachycardia (VT) and ventricular fibrillation (VF) in this population are not well studied.

Methods:
This is a retrospective analysis of patients discharged on AIT. Patients were followed from AIT initiation until transplant, ventricular assist device placement, death, or wean from inotropes. Those without an ICD were excluded. All data was obtained through chart review.

Results:
We included 160 patients (mean age 60±13 years; 70% male). Milrinone was the selected inotrope in 94%. VT/VF occurred in 37/160 (23%) a median 2.6 months after AIT initiation. 20/37 (54%) had a VT/VF event within 3 months. 25/160 (16%) received ICD shocks and 40/160 (25%) received anti-tachycardia pacing (ATP). Inappropriate shocks for atrial arrhythmias occurred in 5 (3.1%). Of 59 episodes with available interrogation data, 70% were VT and 30% were VF. ATP successfully resolved 18/59 (14%), shocks were used in 33/59 (56%), and 8/59 (14%) resolved without device therapy. The mean VT cycle length was 284±63 ms with an average VT/VF time of 44±99 seconds. In univariate analysis previous VT/VF was predictive of VT/VF on AIT (HR: 2.54; 95% CI 1.33-5.86; p=0.01). Beta blocker therapy was protective (HR: 0.45; 95% CI 0.21-0.99; p=.05). Those patients with a VT/VF event in the first 3 months of AIT have higher 1 year mortality (80.4% vs 87.7%, p=0.02, Fig. 1). Prior to AIT initiation, VT/VF had occurred in 52 (33%) patients. Of the 108 patients with no history of VT/VF prior to AIT initiation, 19 (18%) had a de novo episode of VT/VF.

Conclusions:
Patients on AIT are at risk of ventricular arrhythmias. Those with previous VT/VF are at increased risk, but 15-20% with no previous events will have VT/VF. VT/VF within 3 months of AIT initiation may worsen prognosis and increase mortality.
Abstract 161: African Ancestry and Blood Pressure Response Among African Americans in the Systolic Blood Pressure Reduction Intervention Trial
Authors: Rao Shreya , Segar Matthew W , Patel Kershaw , Pandey Ambarish
Published: November 2020

Introduction:
African ancestry (AA) is associated with higher BP prevalence, however the association of AA with response to intensive BP therapy, kidney function changes, and CV outcomes has not previously been explored.

Methods:
The study included participants from the SPRINT trial with available AA proportion. AA proportion was estimated using 106 biallelic genotype markers. Participants were stratified into tertiles from lowest (T1) to highest (T3) AA percentage. Time-dependent changes in SBP and eGFR were assessed by linear mixed-effect modeling after adjustment for potential confounders. Multivariable Cox models were constructed to evaluate the association of AA with risk of composite CV events (non-fatal MI, CV death, and HF event).

Results:
Among 2479 participants (median AA 78% [IQR: 73-87%], age 62 y, 46% female), baseline BP was similar across tertiles. At baseline, the prevalence of average Framingham CV risk (T1 vs. T2 vs. T3: mean 18.2% vs. 17.3% vs. 16.7%, p=0.01) and eGFR decreased (78 vs. 77 vs. 74, p=0.003) across increasing tertiles of AA. In contrast, the burden of DM (1.4% vs. 1.2% vs. 2.7%, p=0.05) and LV hypertrophy by EKG increased across increasing AA tertiles (11.1% vs. 12.0% vs. 15.7%, p=0.02). On follow up, the decline in BP over time was consistent across AA tertiles (mean reduction in SBP: 10 vs. 7 vs. 11 mm Hg, p=0.19) with no treatment interaction by genetic ancestry (p-int=0.60,
Fig. A
). However, there was a greater decline in kidney function over time from T3 vs. T1 (mean eGFR decline = 3.8, 3.3, and 5.0 in T1-3) (
Fig. B
). The risk of adverse CV event was not different across AA tertiles [adjusted HR (95% CI): T3 vs. T1 = 0.93 (0.61-1.44); T2 vs T1 = 0.69 (0.42-1.11)].

Conclusions:
Genetic AA was not significantly associated with baseline BP level or response to therapy in the SPRINT trial. Higher genetic African ancestry was associated with favorable CV risk profiles with no difference in adverse CV event risk, but greater decline in renal function over time.
Abstract 16255: Acute Pericarditis Related Hospitalization and Readmission in the United States
Authors: Acharya Prakash , Sami Farhad , Al-Taweel Omar , Ranka Sagar , Stack Brianna , Sethi Prince , Taduru Siva S , Shah Zubair , gupta Kamal
Published: November 2020

Introduction:
Acute pericarditis accounts for one in every twenty emergency department visits for chest pain and a majority of these patients get admitted to a hospital. However, apart from small studies, there is a lack of data regarding the incidence and predictors of readmissions in these patients.

Methodology:
A secondary analysis of the Nationwide Readmission Database for years 2016-2017 was performed. Patients who were admitted with a primary diagnosis of acute pericarditis in the first six months of each year were identified based on International Classification of Diseases (ICD-10), Clinical Modification codes, and were followed for 180 days. A multivariate cox-regression model was utilized to delineate the predictors of pericarditis related readmissions.

Results:
A total of 21,115 patients were admitted with a primary diagnosis of acute pericarditis. The mean age was 53.3+19 years and 60.83% were males. About 23% of patients had pericardial effusion or tamponade and 19.4% of patients presenting with pericarditis required pericardiocentesis. The mortality rate during index admission was 3.21% and the mean length of stay was 6.4+9 days. The rate of all-cause readmission was 30.8% within 180 days, of which 23.8% were pericarditis related. The mean time to readmission for pericarditis was 37.7+41 days. Females were at higher risk of readmission for pericarditis [OR 1.66, CI (1.38-1.99), p<0.001] after adjustment for multiple variables (including connective tissue disease, congestive heart failure and malignancy). Presence of comorbidities like diabetes mellitus [HR 1.21, CI(1.01-1.45), p=0.04], obesity [HR 1.27, CI(1.05-1.54), p=0.01], and chronic lung disease [HR 1.32, CI(1.12-1.57), p=0.001] also increased risk of pericarditis related readmissions. Moreover, the length of index hospitalization was significantly higher in patients with pericarditis related readmissions [5.4+6 vs1.6+5 days, p<0.001].

Conclusion:
Even though the mortality during index admission in patients admitted with pericarditis is low, about 1 in every 3 patients will be readmitted within 180 days. While females account for a minority of initial admissions for pericarditis, their risk of readmission is significantly higher.
Abstract 16277: Evaluation of Left Peri Atrial Cardiac Sympathetic Activity Using Mibg Scintigraphy Before and After Cryoballoon Ablation of Paroxysmal Atrial Fibrillation
Authors: Fukunaga Hiroshi , Iguchi Nobuo , Asano Sou , Takahiko Nagase , Nitta Junichi , Isobe Mitsuaki
Published: November 2020

Introduction:
Accelerated cardiac sympathetic activity has been implicated in the development of atrial fibrillation. Ablation or excision of atrial epicardial ganglia for the treatment of atrial fibrillation has been reported. However, visualization of the atrial neural network is considered difficult. We attempted to image the sympathetic innervation with
123
I-metaiodobenzylguanidine (MIBG) using a novel solid-state whole-body scanner (VERITON).

Methods:
We performed pulmonary vein isolation using a cryoballoon in 10 patients with paroxysmal atrial fibrillation. MIBG images using specific processing were evaluated before and 3 months after ablation to evaluate the neural network of the left peri-atrial cardiac sympathetic activity and its response to ablation. Discrete epicardial accumulation of MIBG was identified using MIBG images fused with atrial computed tomography images. We quantitatively calculated the discrete MIBG accumulation in each pulmonary vein within 2 cm from its ostium, which may have been modified by balloon ablation.

Results:
Discrete MIBG accumulation was generally reproducible in the pre- and postoperative evaluations. The discrete MIBG accumulation value was 2.8 per case, with an average count of 4.15х10
5
PROPCNTS. Of the overall 28 accumulations, 15 had disappeared and three had changed in accumulation level and location after ablation. There was no specific pattern of sympathetic image modification. However, the group in which accumulation disappeared had a significantly smaller cross-sectional area of the pulmonary vein than the group in which it did not (17.2±3.4 mm vs 19.7±1.7 mm, p=0.0056). For reference, the average cryoballoon size was 28 mm.

Conclusions:
The sympathetic innervation of the left atrium was visualized using MIBG imaging, and the image was modified by cryoballoon ablation. The ability to image sympathetic nerve modification by catheter ablation will be clinically useful.
Abstract 16282: The Development of the New Treatment for Distressed Microvascular Dysfunction in Porcine Dilated Cardiomyopathy Model Using Induced Pluripotent Stem Cell Derived Cardiomyocyte Sheet
Authors: Suzuki Kota , Miyagawa Shigeru , Ito Emiko , Harada Akima , Kawamura Takuji , Kawamura Ai , Sawa Yoshiki
Published: November 2020

Introduction:
The progression of dilated cardiomyopathy (DCM) mainly involves genetic mutations or ischemia at the cellular level, leading to microvascular dysfunction associated with cell death, interstitial fibrosis, and high wall stress. Radical treatment of DCM requires how to ameliorate its microcirculation and integrate cardiomyocytes created ex vivo into recipient myocardium.

Hypothesis:
The induced pluripotent stem cell derived cardiomyocyte sheets (iPS-sheet) has therapeutic potential by the improvement of microcirculation in a porcine DCM model.

Methods:
The iPS-sheets were generated from clinical grade human iPS cells. A DCM model was created by tachycardia pacing, and iPS-sheet was transplanted with immunosuppressive agents 1 month after the initiation of the pacing. We compared the therapeutic efficacy functionally and pathologically between the iPS-sheet transplant group (iPS-group) and the sham group after 1 month of transplantation.

Results:
On echocardiography, the iPS group showed a significant improvement in contractility compared to the sham group (LVEF 4 weeks after transplantation iPS vs. sham 49.0±6.5% vs. 36.4±3.3%, p<0.05, Figure A). Pressure-volume loop analysis revealed that a significant decrease in left ventricular end diastolic pressure and an improvement in end-systolic pressure-volume relationship in the iPS group (Figure B). Ammonia PET showed improvement in myocardial blood flow at both rest and stress in iPS group (Figure C). Histological analysis revealed that the density of CD31-positive capillaries in transplanted area was significantly greater in the iPS group than the sham group. Immunostaining revealed iPS-sheet were detected on the epicardium of the distressed myocardium (Figure D).

Conclusions:
The iPS sheet showed engraftment in distressed myocardium, leading to amelioration in cardiac function through improving microcirculation with angiogenesis in porcine DCM model.
Abstract 16313: Islands of Organized 1:1 Conduction Within Atrial Fibrillation as Potential Targets for Ablation
Authors: Ganesan Prasanth , Bhatia Neal K , Rogers Albert J , Krummen David E , Alhusseini Mahmood , Clopton Paul , Rappel Wouter-Jan , Narayan Sanjiv M
Published: November 2020

Introduction:
Organized regions in atrial fibrillation (AF) substrate are well known, but how they are defined and if they can be used to improve ablation are unclear. We hypothesized that large islands of 1:1 electrogram (EGM) propagation (i.e. ‘atrial tachycardias’) within AF may serve as effective ablation targets.

Methods:
We recruited 40 persistent AF patients at ablation (age 54.5 ± 5.1 years). Group 1 had acute AF termination during ablation (n=20) and Group 2 did not (n=20). Basket catheters (64 poles) were placed in both atria and unipolar EGMs were analyzed to identify islands from vector contours (Wavefront Field, WFF, fig A, left) and if electrograms have 1:1 activation on classical analysis (fig A, right).

Results:
Organized islands of 1:1 EGM within AF were identified by vector analysis of panoramic maps, in 100% of Group 1 and 75% of Group 2 patients (p<0.01). Sites lay outside PVs in both Group 1 (70%) and Group 2 (95%). Organized 1:1 island sites controlled larger areas prior to termination in Group 1 than prior to cardioversion in Group 2 (44.1 ±11.1% vs. 16.6 ± 6.9% mapped atrium, p<0.0001, fig B). In Group 1, sites of AF termination had larger organized islands than competing sites (22.4 ± 7.0%; P < 0.01).

Conclusions:
We demonstrate organized of 1:1 electrograms in AF, akin to ‘atrial tachycardia’. Islands were larger in patients with AF termination, and at their ultimate termination sites than at random sites or patients without AF termination. Future studies should identify mechanisms for organized islands.
Abstract 16318: Care Dyadic Types in Patients With Multiple Chronic Conditions and Their Caregivers
Authors: Ferro Federico , DE MARIA MADDALENA , Vellone Ercole , Ausili Davide , Matarese Maria
Published: November 2020

Introduction:
Multiple Chronic Conditions (MCC) are highly prevalent in patients with cardiovascular diseases. Patients’ informal caregivers play an essential role to achieve both patient and caregiver health outcomes. Four Care Dyadic Types (DTs) of caregiver-patient relationships were previously described in heart failure depending on who is responsible for most of the care: patient-oriented, caregiver-oriented, collaborative, and incongruent (i.e., disagreement on who is responsible for the care). Since DTs in MCC were not described yet, this study aimed to describe the DTs in MCC management, and to identify the patient and caregiver characteristics associated with each type of DT.

Methods:
We conducted a cross-sectional study enrolling 541 dyads in outpatient settings in Italy. Patients were included in the study if they were ≥65 years old, affected by at least two chronic conditions, and had an informal caregiver ≥18 years old. The Dyadic Symptom Management Type scale was used to assess DTs. Logistic regression analysis was used to identify the characteristics associated with each DT.

Results:
Most patients and caregivers were female with a mean age of 76.54 (SD 7.23) years and 52.71 (SD 15.06) years, respectively. One third of the patients had heart failure. Younger patients with better cognitive status, fewer comorbidities, better relationship with their caregivers and male caregivers with a lower burden were associated with patient-oriented DT (14.2%, R
2
0.407). Older patients and caregivers with a higher burden were associated with caregiver-oriented DT (11.6%, R
2
0.388). Patients with more comorbidities, better relationship with their caregivers, and female caregivers with lower burden, perceiving strong social support, were associated with collaborative DT (58.8%, R
2
0.097). Caregivers with lower income, more frequently employed, providing more caregiving hours, and having a lower burden were associated with incongruent DT (15.4%, R
2
0.075).

Conclusion:
Different DTs were described in MCCs identifying specific patients and caregivers’ associated characteristics. This is helpful to classify the dyads and to tailor interventions aimed to empower patients and caregivers in MCCs.
Abstract 16319: Large Weight Loss Improves Left Ventricular Geometry but Not Myocardial Function 6 Months After Bariatric Surgery (the Fatwest Study)
Authors: Grymyr Lisa M , Nadirpour Saied , Gerdts Eva , Hjertaas Johannes , Nedrebø Bjørn , Matre Knut , Cramariuc Dana
Published: November 2020

Background:
Bariatric surgery causes rapid and large weight loss and improves cardiovascular risk profile, yet the effect on left ventricular (LV) systolic function has been less explored.

Methods:
In the prospective FatWest (Bariatric Surgery on the West Coast of Norway) study 98 severely obese patients (44±10 years, 72% women, preoperative body mass index [BMI] 41.8±4.8 kg/m
2
, 36% with hypertension) underwent echocardiography before and 5.9 months after gastric bypass surgery. We assessed changes in LV geometry and systolic function by biplane ejection fraction (EF), midwall shortening (MWS) and mitral annular systolic velocity (s′). LV hypertrophy was defined based on LV mass/height
2.7
. Myocardial O
2
demand was derived from the LV mass-wall stress-heart rate product.

Results:
Patients experienced on average a 10 kg/m
2
reduction in BMI, and a significant drop in heart rate and blood pressure (all p<0.001). LV mass (-12 g) and myocardial O
2
demand improved significantly (all p<0.01). However, LV EF (60 vs. 61%), s’ (8.5 vs. 8.3cm/s) and MWS (16.1 vs. 15.7%) remained unchanged, and 45% of patients had low MWS 6 months after surgery (Figure). In multivariable regression analyses, LV mass reduction was predicted by weight loss and female sex, independent of changes in blood pressure and heart rate (R
2
0.24, p <0.001) while lower myocardial O2 demand was explained by improvement in its three components, particularly lower LV end-systolic wall stress (R
2
0.9, p<0.001).

Conclusion:
In severely obese patients with normal EF, bariatric surgery induces a significant reduction in BMI, LV mass and myocardial O
2
demand, but no improvement in LV myocardial systolic function 6 months after surgery.
Abstract 16320: Enhanced Tissue Repair by Myoblast Administration With Extracellular Matrix Framework Through Regulation of Macrophage Polarization in Hind Limb Ischemia
Authors: Miyake Keisuke , Miyagawa Shigeru , Shibuya Takashi , Sawa Yoshiki
Published: November 2020

Introduction:
How to control inflammation, especially induction of macrophage polarization that are regulated by Extra-cellular matrix (ECM) is a prerequisite for tissue regeneration in damaged organs. In this study, we administered clustered myoblast cells with ECM framework into hind limb ischemia (HLI) model, and evaluated the change in macrophages and effect on tissue regeneration.

Methods:
Myoblast cells isolated from C57BL/6 mice were expanded to form cell patch with ECM framework (10
6
cells/sheet) and then fragmented and administered as cluster cells (CC group, n=6). As control groups, non-clustered single myoblast cells (SC, n=6) or saline (SA, n=6) was administered. Blood perfusion was evaluated with Laser Doppler Perfusion imaging (LDPI). Leg muscles were obtained and analyzed regarding angiogenesis, skeletal muscle regeneration, and inflammation including macrophage status.

Results:
LDPI showed significant improvement in CC compared with SC (P=0.001) and SA (P<0.0001) at day 28. Also, markedly augmented angiogenesis and muscle regeneration were detected in CC. Regarding inflammation, the number of CD68+ macrophages is significantly larger in CC throughout within 7 days after administration, but the character of the macrophages was quite different during time courses. Although in SC and SA macrophage polarization was rarely detected within 7 days, marked polarization was detected at day 5 only in CC. At day 5, CD11c+/CD206- (inflammatory, M1) and CD11c-/CD206+ (anti-inflammatory, M2) macrophages are discerned conspicuously (M1: 148.7±104.4/mm
2
, M2: 185.2±46.3/mm
2
, non-polarized CD11c+/CD206+: 140.9±99.4/mm
2
), while at day 3 non-polarized macrophages were almost exclusive (M1: 2.0±2.3/mm
2
, M2: 3.1±4.0/mm
2
, CD11c+/CD206+: 410.2±90.6/mm
2
). Consistently significant increase in IL-10 and TGF-β, that are cytokines secreted by M2 macrophages, was detected at day 5 and 7 in CC.

Conclusions:
Myoblast cells administration with ECM framework, which was formed during cell patch formation, augmented macrophage polarization to show anti-inflammatory effect, creating appropriate microenvironment for angiogenesis and muscle regeneration in HLI.
Abstract 16330: Evaluation of Cardiac Function in Children Undergoing Liver Transplantation
Authors: Bansal Neha , Ovchinsky Nadia , Lamour Jacqueline M , Kogan-Liberman Debora , Nguyen Trang , Choueiter Nadine
Published: November 2020

Introduction:
Cirrhotic cardiomyopathy is a hemodynamic complication of cirrhosis resulting in cardiac dysfunction. It remains poorly characterized in children. Our aim was to assess cardiac function using speckle tracking echocardiography (STE), a marker of subclinical cardiac dysfunction, in patients undergoing liver transplant (LT) and correlate it with their post-operative (op) clinical course.

Methods:
This is a retrospective study of pre-LT echocardiograms performed on pediatric patients (pts) with cirrhosis at a single tertiary care center who received a LT. Demographic clinical and echocardiographic data was collected and STE was performed by a single observer using TomTec system. Descriptive data was expressed as mean (SD) and number (%). The relationship between clinical data and echocardiographic variables was assessed using Pearson correlation coefficient. Significance was set at P value < 0.05.

Results:
Twenty-three pts underwent LT between 03/2013-12/2019 with median age 7.5 (IQR 0.1, 17) years and 31 % with biliary atresia. Five patients were listed as status 1A/1B. Their mean natural pediatric/model end-stage lived disease (PELD/MELD) score was 15. Their pre-LT echocardiogram showed normal left ventricular (LV) ejection fraction and normal right ventricular (RV) fractional area change. Tricuspid annular plane systolic excursion (TAPSE) was abnormal in 50% of pts. While LV global longitudinal strain (GLS) (23 ± 3%) and LV circumferential strain (27 ± 4%) were normal, RV GLS was abnormal in 65% of pts (22 ± 3%). There was no correlation between echocardiographic parameters and post-operative LT course (length of stay, duration of mechanical ventilation, surgical complications).

Conclusions:
Children undergoing liver transplant have RV dysfunction as evidenced by abnormal TAPSE and RV GLS on speckle tracking echocardiography. Echocardiographic parameters do not correlate with the immediate post-LT clinical status.