bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 16239: Skeletal Muscle Mass Recovery Early After Left Ventricular Assist Device Implantation in Patients With Advanced Systolic Heart Failure
Authors: Vest Amanda R , Chery Joronia , Coston Alexandra , Telfer Laura , Lawrence Matthew , Haynes Abbey , Karanja Pascaline , Singla Arnav , Kiernan Michael S , Couper Gregory , Saltzman Edward
Published: May 2021

Introduction:
Patients with advanced systolic heart failure (HF) are at risk of unintentional weight loss and muscle wasting. It has been observed that left ventricular assist device (LVAD) recipients gain weight after device implantation, although it is unknown whether this represents skeletal muscle or fat mass gains.

Hypothesis:
We hypothesized that LVAD recipients would gain skeletal muscle mass during the first 6 months of LVAD support.

Methods:
We prospectively recruited 28 adults with systolic HF ±21 days from LVAD implantation. Participants underwent whole-body dual X-ray absorptiometry (DXA) to calculate fat free mass (FFM, representing all lean mass), appendicular lean mass (ALM, lean mass in the arms and legs) and fat mass (FM). DXA was repeated at 3 and 6 months after LVAD implantation (±14 days), with study participation ending after either the 6 month visit or heart transplantation, whichever occurred first. Paired t-testing and mixed effects models were used to evaluate changes over time each for FFM, ALM and FM.

Results:
The cohort was 86% (24/28) male, with mean age 56 ±12 years and mean BMI 26.6 ±5.5 kg/m
2
at baseline. The median Intermacs class was 2 and duration of HF 50 months. Per European Working Group on Sarcopenia in Older People (EWGSOP) criteria, 41% of participants had muscle wasting at baseline. There was a significant increase from baseline to 3 months and then 6 months of LVAD support for FFM (Fig 1A; baseline: 56.6 ±11.8 kg, n=27; 3 months: 57.9 ±11.3 kg, n=23; 6 months: 62.7 ±11.1 kg, n=17; p-value for change=0.025) and for ALM (Fig 1B; 22.2 ±5.6 kg; 23.2 ±5.0 kg; 25.4 ± 4.5 kg; p<0.001). There was no increase in FM over the same period (p=0.36). Amongst 22 participants with comparison DXAs, 81% had a ≥5% ALM gain by either 3 or 6 months.

Conclusions:
Among patients with advanced systolic HF and a high baseline prevalence of muscle wasting, there was a significant gain in skeletal muscle mass, as represented by both FFM and ALM, over the first 6 months of LVAD support.
Abstract 16401: Duration of Dual Antiplatelet Therapy in Coronary Heart Disease: A 60,000-patient Meta-analysis of Randomised Controlled Trials
Authors: Bularga Anda , Meah Mohammed , Doudesis Dimitrios , Shah Anoop S , Mills Nicholas L , Lee Kuan Ken , Newby David E
Published: May 2021

Introduction:
Dual antiplatelet therapy (DAPT) is the cornerstone of pharmacological treatment for patients with acute coronary syndrome (ACS) and in those undergoing percutaneous coronary intervention for stable coronary disease. Despite widespread use, the optimal duration of DAPT remains uncertain. We present an updated meta-analysis comparing outcomes in short-term DAPT (≤ 6 months) versus long-term DAPT (≥ 12 months).

Methods:
Four major databases were searched for randomised controlled trials of interest. The primary outcome was all-cause mortality. Secondary safety outcomes included any bleeding and major bleeding. Efficacy outcomes included cardiovascular death, myocardial infarction, stent thrombosis, coronary revascularization and thrombotic stroke. Further subgroup analysis stratified by index presentation and a sensitivity analysis to evaluate shorter duration DAPT (≤3 months) was performed.

Results:
Nineteen randomised controlled trials were included (n=60,879) of which 8 compared shorter duration DAPT (≤3 months) with standard duration (12 months) (n=38,036). Short-term DAPT was associated with an apparent modest increase in myocardial infarction (risk ratio [RR] 1.09; 95% confidence interval [CI], 0.98-1.22) with a major reduction in bleeding (RR 0.68; 95% CI, 0.55-0.83) for major bleeding and (RR 0.66; 95% CI, 0.56-0.77 for any bleeding) and an overall apparent reduction in all-cause mortality (RR 0.90; 95% CI 0.81-1.01). These associations persisted when comparing shorter duration DAPT to standard duration. Subgroup analysis of patients with stable disease or ACS identified no significant heterogenicity in efficacy, safety or mortality outcomes.

Conclusion:
In the largest meta-analysis to date comparing duration of DAPT, we show that short (≤ 6 months) and shorter (≤ 3 months) DAPT is associated with continuing trends for small reductions in all-cause mortality irrespective of index presentation.
Abstract 16402: Epa and Dha Suppressed Myocardial Infarction-induced Systolic Dysfunction by Inhibiting P300 Hat Activity
Authors: Funamoto Masafumi , Sunagawa Yoichi , Katanasaka Yasufumi , Shimizu Kana , Miyazaki Yusuke , sari nurmila , Shimizu Satoshi , Mori Kiyoshi , Wada Hiromichi , Hasegawa Koji , Morimoto Tatsuya
Published: May 2021

Introduction:
p300, an intrinsic histone acetyltransferase (HAT), has a crucial role in the pathological cardiac hypertrophy and the development of heart failure
in vivo
. Although many studies have shown a cardioprotective effect of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), omega-3 fatty acids, little is known about the effects of these acids on cardiac hypertrophy.

Aim:
This study investigated whether EPA and DHA inhibited the development of heart failure in rats with myocardial infarction (MI).

Methods and Results:
To investigate the effects on cardiomyocyte hypertrophy in cultured cardiomyocytes, neonatal rat cultured cardiomyocytes were stimulated with phenylephrine (PE). EPA or DHA significantly inhibited PE-induced cardiomyocyte hypertrophy. EPA and DHA repressed to the same extent PE-induced acetylation of histone H3 in cultured cardiomyocytes. An
in vitro
HAT assay was performed to determine the direct inhibition of p300-HAT activity. The results revealed that EPA and DHA significantly inhibited p300-HAT activity. To assess whether EPA and DHA suppress p300-HAT activity directly in cultured cardiomyocytes, p300 was overexpressed in cultured cardiomyocytes. Treatment with EPA or DHA inhibited the overexpression of p300-induced cardiomyocyte hypertrophy in cultured cardiomyocytes. MI-operated rats (FS < 40%) were randomly assigned to 3 groups: vehicle, EPA (1 g/kg) and DHA (1 g/kg). One week after MI operation, oral administrations were repeated for 6 weeks. Echocardiographic analysis demonstrated that EPA and DHA significantly improved MI-induced cardiac dysfunction. In addition, Masson's trichrome staining showed that EPA and DHA inhibit MI-induced fibrosis response in MI rats. EPA and DHA repressed MI-induced hypertrophic response gene transcriptions such as ANF and BNP with RT-PCR. Western blotting demonstrated that inhibited MI-induced H3K9 acetylation in rats .

Conclusion:
EPA and DHA suppressed hypertrophic responses to the same extent, through the direct inhibition of p300-HAT activity and repressed MI-induced development of heart failure.
Abstract 16411: Intraoperative Nicardipine Use During Rewarming in Norwood Procedures
Authors: Parchment Nathaniel , Holmes Sari D , Kahntroff Stephanie , Niemiec Teresa , Savarese Anne , Donahue Brian , Chaves Alicia , Rosenthal Geoffrey L , Deatrick Kristopher B , Kaushal Sunjay
Published: May 2021

Introduction:
Postoperative tissue edema Norwood procedures contributes significantly to outcomes. As nicardipine preserves ventricular function after hypothermic ischemic arrest, nicardipine treatment could support post-Norwood ventricular function, and decrease edema to improve patient outcomes.

Methods:
All Norwood procedures completed at a single institute between 1/1/2012 - 12/31/2019 were retrospectively reviewed, and the use of nicardipine during rewarming was initiated midway through the study period. We investigated the effects of nicardipine during rewarming on 12-month postoperative mortality, postoperative intubation times, open chest duration, and disposition at discharge.

Results:
Thirty-six Norwood procedures were completed, of whom 14 received nicardipine intraoperatively during the rewarming period. The nicardipine group demonstrated significantly lower 12-month postoperative mortality (0% vs 32%, p-value: 0.028) and significantly greater discharges to home (64% vs 18%, p-value: 0.005). The nicardipine group had lower median length of postoperative intubation (123 vs 146 hrs, p-value: 0.311) and open sternum time (2 [1-3] vs 3 [2-5] days, p-value: 0.067), but these analyses did not reach statistical significance (Fig 1).

Conclusion:
This study demonstrates the safety of nicardipine treatment during Norwood and significant decrease 12-month mortality and increase in discharge to home, with potential for reduced post-Norwood intubation and open sternum times. This study provides the basis for a prospective randomized controlled trial to demonstrate survival benefit provided by intraoperative nicardipine usage during Norwoods.
Abstract 16416: Associations of NT-proBNP and High Sensitivity Cardiac Troponin T Concentrations With 6-year Changes in Left Ventricular Structure and Function in Older Adults: The Atherosclerosis Risk in Community (ARIC) Study
Authors: Myhre Peder L , Claggett Brian , Ballantyne Christie M , Selvin Elizabeth , Matsushita Kunihiro , Kitzman Dalane W , Konety Suma H , Mosley Thomas , Shah Amil M
Published: May 2021

Introduction:
N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high sensitivity cardiac troponin T (hs-cTnT) improve prediction of incident heart failure (HF) and are cross-sectionally associated with left ventricular (LV) remodeling, but their associations with changes in cardiac structure and function are unclear.

Hypothesis:
Concentrations of NT-proBNP and hs-cTnT associate with 6-year change in cardiac structure in older adults.

Methods:
We studied 1,916 participants aged 67-88 in the ARIC Study free of overt cardiovascular disease at baseline (study Visit 5; 2011-13). We quantified the associations of baseline NT-proBNP and hs-cTnT with subsequent changes in LV structure and systolic and diastolic function assessed by echocardiography over a median of 6.6 (IQR 6.1-7.0) years using multivariable linear regression and restricted cubic spline models. Models adjusted for demographics, systolic blood pressure, heart rate, body mass index, diabetes, hypertension, kidney function, and the baseline echocardiographic value of interest at Visit 5.

Results:
Mean age was 75±4 years, 60% were female, 23% were black, median hs-cTnT was 9 (IQR 6-13) ng/L and NT-proBNP was 88 (50-157) ng/L at Visit 5. In adjusted models, higher hs-cTnT was modestly associated with 6-year increase in LV wall thickness (p=0.02) but not with changes in LV function. In contrast, higher NT-proBNP at Visit 5 was associated with 6-year increase in LV mass, decline in LV systolic function (ejection fraction, longitudinal and circumferential strain), and worsening of diastolic function (left atrium volume, E/e’, tricuspid regurgitation peak velocity) (all p<0.01,
Figure
). These associations were non-linear.

Conclusions:
Higher NT-proBNP, but not hs-cTnT, concentrations are associated with greater declines in LV systolic and diastolic function over ~6 years in late life.
Abstract 16418: Physical Frailty Phenotype and Development of Geriatric Syndromes in Older Adults With Coronary Heart Disease
Authors: Damluji Abdulla A , Chung Shang-En , Xue Qian-Li , Hasan Rani K , Forman Daniel E , Batchelor Wayne , Resar Jon R , Gerstenblith Gary
Published: May 2021

Introduction:
Frailty, a clinical state of vulnerability, is associated with subsequent adverse geriatric syndromes in the general population.

Hypothesis:
We hypothesized that frailty influence health outcomes among older patients with coronary heart disease (CHD).

Methods:
We used the National Health and Aging Trends Study, a prospective cohort study linked to a Medicare sample. CHD was identified by self-report and/or ICD codes one-year prior to the baseline visit. Frailty was measured using the Fried physical frailty phenotype (PFP). Geriatric outcomes were assessed during five-year follow-up.

Results:
Of the 4,656 study participants, 1,395 (28%) had a history of CHD one-year prior to their baseline visit. Compared to those without frailty, subjects with frailty were older (Age ≥75: 69.9% vs. 57.1%,
p
<0.001), more likely to be female, belong to an ethnic minority, and had lower BMI. The prevalence of hypertension, stroke, falls, disability, anxiety/depression, and multimorbidity were much higher in the frail, than non-frail, participants. In a multivariable Cox regression model, the incidences of geriatric syndromes including (1) dementia, (2) loss of independence, (3) impairment in activities of daily living, (4) impairment in instrumental activities of daily living (ADLs), (5) and mobility disability were significantly higher in the frail, than in the non-frail CHD

Conclusion:
Among patients with CHD, frailty is a risk factor for accelerated development of geriatric outcomes. Efforts to identify frailty in the context of CHD are needed, as well as interventions to limit or reverse frailty status in CHD patients.
Abstract 16425: Trends and Outcomes of 30-day Readmissions After Left Ventricular Assist Device Implantation
Authors: Ueyama Hiroki , Malik Aaqib h , Kuno Toshiki , Yokoyama Yujiro , BRIASOULIS Alexandros
Published: May 2021

Introduction:
Left ventricular assist devices (LVAD) improve morbidity and mortality in end-stage heart failure patients but high rates of readmissions remain a problem after implantation. We aimed to assess the incidence, trends, outcomes and predictors of 30-day readmissions after LVAD implantation.

Methods:
The National Readmission Database was used to identify patients who underwent LVAD implantation between 2012 and 2017 and those with 30-day readmissions.

Results:
The analysis included a total of 11,947 adults who survived the index hospitalization for LVAD implantation. Among those, 28.2% were readmitted at 30 days. The baseline characteristics were balanced between those with and without 30-day readmission except for the length of stay of index admission, which was significantly higher among those readmitted (39.0 days vs. 34.3 days, p<0.001). As shown on Figure 1, most readmissions occurred in the first 15 days after discharge from the index admission. The most frequent cause of readmissions was gastrointestinal bleeding (21.8% of readmissions), followed by ventricular tachycardia, acute heart failure, abnormal coagulation profile, pump thrombosis and infection. The mean length of stay for readmission was 10.3 days (± 13.5 days). Although the readmission rates remained high during the study period, the rates of stroke and bleeding decreased significantly (Figure 2). Index admission length of stay, female gender, diabetes mellitus and chronic kidney disease were independent predictors of 30-day readmission after multivariate adjustment.

Conclusions:
Over one fourth of LVAD recipients have 30-day readmissions with gastrointestinal bleeding as the most frequent cause.
Abstract 16428: An On-Treatment Comparative Effectiveness Analysis of Ticagrelor vs Clopidogrel in US Real-world Setting
Authors: Olufade Tope , Atreja Nipun , Bhalla Narinder , Venditto John , Bhandary Durgesh , Khan Naeem , Cobden David
Published: May 2021

Background:
Current guidelines recommend ticagrelor over clopidogrel as part of DAPT regimen for ACS treatment. However, real-world head-to-head assessment of ticagrelor and clopidogrel has been methodologically challenging due to prescribing patterns and adherence. Thus, we conducted an on-treatment comparative analysis utilizing a large national payer data within US.

Methods:
A retrospective cohort study of ACS patients discharged on ticagrelor or clopidogrel between January 1, 2012 to September 30, 2019 was conducted utilizing the Optum
TM
Clinformatics
TM
data. Patients were required to have twelve months of continuous enrollment prior to the ACS event and a fill of their index prescription within 30 days of discharge. Hospitalization for MI and major bleeding were evaluated pre and post propensity score matching on demographic and clinical covariates (Table 1). Study outcomes were ascertained from day 31 until outcome of interest, switch from or discontinuation of index prescription or day 365.

Results:
Of 339,387 ACS patients, 14,110 ticagrelor and 57,482 clopidogrel treated patients met the study criteria. Prior to matching, MI hospitalization were significantly lower in the ticagrelor compared to the clopidogrel group (2.2 vs. 4.1 per 100 patient years; 47.3% RRR, p < 0.001). Similarly, in the post-matching population (12,983 ticagrelor, 27,007 clopidogrel), the MI hospitalization rates were 2.2 vs. 3.3 per 100 patient years (33.5% RRR, p <0.001). Hospitalization due to bleeding was 2.1 vs. 2.0 per 100 patient years (-2.7% RRR, p= 0.75 ) in the ticagrelor and clopidogrel patients respectively.

Conclusion:
In this real world on-treatment analysis, patients who were optimally adherent to ticagrelor post-ACS had significantly fewer MI hospitalization as compared to the clopidogrel cohort. Study findings highlight the importance of being adherent to guideline recommended treatment for better clinical outcomes without the added risk of bleeding.
Abstract 16434: Temporal Metabolomic and Transcriptomic Changes in a Large-Animal Model of Hfpef
Authors: Gibb Andrew A , Murray Emma K , Eaton Deborah M , Huynh Anh T , Tomar Dhanendra , Garbincius Joanne F , Kolmetzky Devin W , Berretta Remus M , Wallner Markus , Houser Steve R , Elrod John W
Published: May 2021

Heart failure with preserved ejection fraction (HFpEF) accounts for ~50% of HF cases, with no effective treatments. We previously reported that a feline aortic banding model recapitulates many of the multi-factorial features of HFpEF, including: LV hypertrophy, left atrial enlargement, elevated LV filling pressures, impaired pulmonary mechanics and fibrosis. Importantly, this model lacks obesity and hypertension enabling the discovery of cardiac centric targets independent of comorbidities. We examined early changes in metabolism and transcription to gain mechanistic insight into HFpEF development. Male short-hair kittens (2mo old) underwent aortic banding or sham operation. Cardiac function was assessed at baseline and 1mo post-banding prior to tissue collection and downstream analyses. Following banding, we observed significant cardiac hypertrophy and initiation of LV fibrosis in the absence of changes in cardiac function. We observed LV mitochondrial dysfunction, indicated by impaired complex-I and -II respiration prompting the examination of cardiac metabolism by unbiased metabolomics. 82 metabolites were significantly different (≥ 1.25 fold,
p
≤ 0.1) between 1mo banded and sham hearts, with an overrepresentation of amino acid (aa) and lipid species. Pathway enrichment analysis highlighted an increase in aa metabolism (e.g. serine, proline) that is associated with ECM remodeling and tissue fibrosis. Additionally, an increase in lipid species (i.e. acyl-carnitines) suggests reduced fatty acid utilization and a shift towards glycolysis. Correlations of metabolomics data with mitochondrial function and cardiac phenotyping revealed strong associations between mitochondrial function and the cardiac energy state, as well as aa and LV fibrosis. RNA-seq and enrichment analyses revealed a significant inflammatory response early in disease progression and a decrease in protein/histone acetylation. Collectively, this systems-based approach provides new insights into the cellular biology underlying HFpEF-like disease progression. The metabolic and transcriptional signature that precede the clinical features of HFpEF, will provide new pre-clinical research directions and may yield novel therapeutic targets.
Abstract 16443: Effects of Dietary Salt Intakes on Blood Pressure, Renal Function and Oxidative Stress in Rats Treated With Candesartan
Authors: Zhu Gangyi , Yu Yanting , Wang Xiaoyan
Published: May 2021

Candesartan is one of angiotensin II type1 receptor blockers(ARB) and commonly used as first-line antihypertensive treatment. Low salt diet is often recommended by clinicians to the patients with hypertension and kidney diseases. However,it is not clear whether salt restriction is beneficial to the patients taking ARB. In order to explore this problem, the impacts of different salt diets on blood pressure (BP),renal function and oxidative stress were determined in 2-3 months old male Sprague Dawley rats treated with candesartan. The rats were randomly divided into 4 groups fed agar-gelled food rationally with NaCl content at 0.01%, 0.8%, 2% and 4% respectively(4-7 rats/group) while all rats were intraperitoneally injected with candesartan at 1mg / kg / day for 7 days. SBP started to decline on day 2 in all except 4% NaCl groups relative to day 0 (recorded 5-6 hrs before the first injection). On day 6, systolic BP (mmHg, tail-cuff, Softron,BP-98A) was lower in 0.8% (103.7+2.3) & 0.01% (101.6+3) groups than 2% (113.5+4.1) & 4% (129.9+4.6) groups (one way ANOVA,LSD test, P<0.05) and correlated positively with food NaCl intakes (R
2
=0.9832). DBP was changed in a similar pattern as SBP. Serum creatinine (μmol/L) was higher in 0.01% group (225+39) than groups of 0.8% (1328+350), 2% (2095+242) and 4% (1576+703) while creatinine clearance (ml/day) was lower in 0.01% group (69.3+9) than groups of 0.8% (43.7+9), 2%(27.7+2) and 4%(29+0.6). In order to determine whether oxidative stress plays any role in the BP regulation and renal function maintenance, we also checked renal protein expression of ROS components. Relative to 0.8% group, renal NOXs were not altered in 0.01% group while NOX1 (145+18,% of 0.8% group), NOX2 (240+54) and NOX4 (197+41) was higher in 2% group than other groups. Mn-SOD (77+7.8), not Cu-Zn SOD, was decreased while HO1 (170+16), not HO2, was increased in 0.01% group. Renal abundance of nitrotyrosine was lower in 0.01% than other groups indicating a decreased oxidative stress, possibly caused by increase in HO1. We concluded that salt restriction with candesartan is beneficial to antihypertensive effect of AT1R blockade but disadvantage to maintenance of renal function. Thus, cautions to choice of low salt intakes are necessary when taking ARB agents.
Abstract 16447: Exercise Predicted Peak Oxygen Uptake and Definition of Gas Exchange Phenotypes in an Apparently Healthy Population: An Analysis of the Euroex Trial
Authors: zannoni jessica , SISINNI ANTONIO , oliva omar alessandro , Mazzucca Mattia , poletti enrico , Guazzi Marco
Published: May 2021

Aims:
We aimed at identifying how exercise performance by percent of predicted oxygen uptake defines the exercise gas exchange phenotypes in a population of apparently healthy individuals enrolled in the Euro-Ex population-based trial.

Methods:
782 healthy subjects (age 63 ± 12 years; male 45 %; BMI 28.95 ± 5.2 kg/m
2
) enrolled in the EURO-EX prevention trial with at least one major cardiovascular risk factor (hypertension, diabetes, tabagism, dyslipidaemia, body mass index > 25), but no previous CV events, underwent cardiopulmonary exercise test (CPET) with personalized incremental ramp protocol. Peak oxygen consumption (VO2), the percent predicted normal value and other main CPET- derived variables were obtained. The population was divided into tertiles groups based on the VO2 predicted (I tertile [21%-60%), II tertile [60%-75%], III tertile [75%- 164%]).

Results:
Subjects in the tertile 1 compared to the other two groups were younger (age 60 ± 13 years), more frequently females with a higher BMI (31.12 ± 5.83 kg/m
2
), and smokers in a higher rate (31.89 %). No significant differences in the frequency of diabetes, hypertension and dyslipidemia were observed in the three groups. As reported in the table, the group with lower % predicted peak VO2 showed higher prevalence of exercise oscillatory ventilation, lower exercise tolerance (peak VO2 and VO2 at threshold), peak O2 pulse and VO2/Work slope, higher VE/VCO2 slope. This group showed lower heart rate recovery at first minute and heart rate reserve. Subjects with lower VO2 predicted tertiles had comparatively poorer CPET performance and gas exchange phenotype.

Conclusions:
The use of % predicted peak VO2 appears helpful to phenotype gas exchange and identify the progressive level of cardiovascular risk of apparently healthy subjects. These findings broaden the constellation of targets that need to be considered in the preventive strategies of individuals at risk for cardiovascular events.
Abstract 16449: Sex Differences in Myocardial Injury and Outcomes of Covid-19 Infection
Authors: Talmor Nina , Mukhopadhyay Amrita , Xia Yuhe , Adhikari Samrachana , Pulgarin Claudia , Iturrate Eduardo , Horwitz Leora I , Hochman Judith S , Berger Jeffrey S , Fishman Glenn I , Troxel Andrea B , Reynolds Harmony
Published: May 2021

Background:
Myocardial injury is associated with higher mortality of COVID-19 and more complicated disease course. Little is known about sex differences in COVID-19-associated myocardial injury. We hypothesized that sex modifies the relationship between myocardial injury and severe COVID-19 infection.

Methods:
This is a cross-sectional study of all hospitalized patients with COVID-19 at a large health system in New York City between 3/2/20 - 5/12/20. We defined severe COVID-19 infection as ICU admission, mechanical ventilation, discharge to hospice, or death. Using multivariable logistic regression, we assessed whether sex modified the effect of peak troponin on the odds of severe COVID-19 infection, adjusting for demographics, co-morbidity, and laboratory values, and did the same for D-dimer.

Results:
Among 2,746 patients hospitalized with COVID-19, 650 (23.7%) required ICU admission, 648 (23.7%) required mechanical ventilation, and 680 (24.8%) died or were discharged to hospice. Peak troponin was higher in men than women (median 0.06, interquartile range [IQR] 0.01- 0.10 vs. 0.05 [IQR 0.01-0.10], p=0.02). Men were more likely to be admitted to the ICU and to receive mechanical ventilation (Table). After adjustment for demographics, medical history and other laboratory values, peak troponin level was associated with higher odds of severe COVID-19 illness: OR 1.51 per ng/mL, 95% CI 1.27-1.88, p<0.001. This association was modified by sex: the OR for severe COVID-19 per ng/mL peak troponin was 1.30 in women (95% CI 1.11-1.65) and 1.92 (95% CI 1.42-2.78) in men, p-interaction=0.047. There was no interaction between sex and D-dimer on severe COVID-19.

Conclusions:
Sex modifies the relationship between myocardial injury and severe COVID-19, with men having higher odds of severe COVID-19 infection associated with increasing peak troponin. Sex differences in myocardial injury may play a role in poorer outcome among men.
Abstract 16455: Family Support for Physical Activity Predicts Engagement in Leisure Time Physical Activity Among Hispanic Adults at Risk for Cardiovascular Disease or Type 2 Diabetes
Authors: Alreshidi Salman , Key Kaitlin V , Mudd-martin Gia
Published: May 2021

Background:
Hispanics in the U.S. are less likely to engage in leisure time physical activity than non-Hispanics. Among Hispanics, families influence health behaviors and family support may motivate adults at risk for cardiovascular disease (CVD) or type 2 diabetes (T2D) to participate in physical activity.

Objective:
The purpose of this study was to examine whether family support predicts engagement in leisure time physical activity among Hispanic adults at risk for CVD or T2D.

Methods:
Baseline data from Hispanic adults at risk for CVD or T2D were analyzed. Family support for leisure time physical activity was measured using the Family Support subscale of the Social Support for Physical Activity instrument. This consists of 7 items with response options ranging from never (0) to always (4). Sum scores range from 0 to 28 and higher scores indicate greater family support for engagement in physical activity. Leisure time physical activity was measured using the Health-Promoting Lifestyle Profile II (HPLP-II) physical activity subscale. This consists of eight items with response options ranging from never (1) to routinely (4) with higher mean scores indicating higher levels of engagement in leisure time physical activity. Linear regression was used to examine the association between family support and leisure time physical activity, controlling for age, sex, race, financial comfort, education, acculturation, years living in the U.S, marital status, and employment.

Results:
Participants (N=182) were 40±9 years old; 82.7% were female. The mean HPLP-II score was 1.7±0.5, reflecting low engagement in leisure time physical activity. Results of the regression analysis indicated that greater family support predicted higher levels of engagement in leisure time physical activity (F(10,171)=2.717, p<.004; R
2
=.137).

Conclusions:
Family support for physical activity may increase engagement in leisure time physical activity in Hispanic adults at risk for CVD or T2D. Interventions that promote family support for physical activity could be an important avenue for reducing CVD and T2D risk in this population group.
Abstract 16458: Trends in Treatment and Outcomes of Cardiogenic Shock in the Adult Congenital Heart Disease Population: A Nationwide Analysis From 2007-2017
Authors: Mehta Harsh , Kurpad Krishna , Pahuja Mohit , Sutaria Nishith , AFONSO Luis
Published: May 2021

Introduction:
Heart failure (HF) is common in the adult congenital heart disease (ACHD) population. We sought to assess outcomes of cardiogenic shock (CS) and assess the trends of utilization of mechanical circulatory support (MCS) in these patients.

Methods:
Using the nationwide inpatient sample (NIS) database for the years 2007-2017, adult patients with a primary discharge diagnosis of HF, and a co-diagnosis of CS were identified. They were divided into 2 groups - patients with ACHD and those without ACHD. Statistical significance was assigned at p<.05.

Results:
Out of the 114420 patients with HF who developed CS, 2572 (2.3%) patients had ACHD, and demonstrated an increasing yearly trend (Figure 1). Patients with ACHD were younger (55 vs 64.7 years, p<.01), and had lower rates of comorbidities like hypertension (24.8 vs 38.3 %, p<.01), diabetes mellitus (15.9 vs 27.5 %, p<.01) and chronic ischemic heart disease (27.1 vs 42.1 %, p<.01). Utilization of temporary MCS (25.9 vs 14.8 %, p<.01), Left ventricular assist device (LVAD) (28.4 vs 7.6 %, p<.01), and orthotopic heart transplantation (OHT) (8.0 vs 2.9 %, p<.01) was higher in the ACHD group. Yearly trends are shown in Figure 2. Patients with ACHD had lower in-hospital mortality (16.6 vs 23.7 %, p<.01) and lower adjusted odds of death [0.79 (CI 0.62,0.99), p<.04], but had longer length of stay (22.6 vs 14.6 days, p<.01) and total charges during hospitalization ($444007 vs $212972, p<.01).

Conclusion:
Although low, the rates of CS in ACHD patients is increasing, however, these patients had a lower mortality, likely driven by lower age, fewer comorbidities, and increased utilization of MCS and heart transplantation.
Abstract 16459: Racial and Ethnic Differences in Echocardiographic Abnormalities and Myocardial Injury in Patients With Covid-19: The CIRC-19 Registry
Authors: Miller Michael S , Giustino Gennaro , Kini Annapoorna , Stefanini Giulio , Bragato Renato , Rashed Eman , Vicenzi Marco , Danilov Tatyana , Kukar Nina , Shaban Nada , Fazzari Fabio , Rota Irene , Oates Connor P , Camaj Anton , Bienstock Solomon , Sharma Samin K , Silbiger Jeffrey , Lerakis Stamatios , Goldman Martin E , Croft Lori B
Published: May 2021

Introduction:
Myocardial injury is common amongst patients hospitalized with Covid-19 and is associated with a poor prognosis. It is unknown whether its incidence and its mechanisms differ by race and ethnicity.

Methods:
We conducted a multicenter, international cohort study at 7 hospitals in New York (United States) and Milan (Italy) between March and May 2020. All patients were hospitalized, had laboratory-confirmed Covid-19, and received a transthoracic echocardiogram (TTE) during their hospitalization. We evaluated the association between race/ethnicity and myocardial injury in multivariable logistic regression models. Myocardial injury was defined as any cardiac troponin elevation above the upper limit of normal at each enrolling site.

Results:
A total of 305 consecutive patients were included, of whom 280 had self-reported race/ethnicity. Key demographic, laboratory and echocardiographic characteristics are presented in the Table. All minority groups had higher incidence of a composite of major echocardiographic abnormalities compared to whites, and Asian and Hispanic patients had increased incidence of RV dysfunction. In multivariable models, compared with Whites, Black (adjOR 2.7 [1.1-6.4]), Asian (adjOR 3.3 [1.1-10.2]), and Hispanic (adjOR 2.8 [1.4-5.8]) patients had increased odds of myocardial injury. After adjusting for baseline demographic and clinical variables, both Asian (adjOR 9.9 [2.6-38.6]) and Hispanic (adjOR 5.7 [2.1-15.6]) patients had increased odds of in-hospital mortality compared with White, but not Black (adjOR 2.0 [0.6-7.0]) patients.

Conclusions:
Among hospitalized patients with Covid-19 who received a TTE, minority groups had higher incidence of echocardiographic abnormalities and increased risk of myocardial injury. After adjustment for baseline confounders, only Asian and Hispanic patients remained at increased risk for in-hospital mortality.
Abstract 16460: Differential Effect of the Emory Risk Score on Early versus Late Pacemaker Implantation in TAVR Patients
Authors: APTE NACHIKET MADHAV , Sami Farhad , SHRESHTA AMIT , Dalia Tarun , Ranka Sagar , COURTNEY ALEX , Hockstad Eric S , GREGORY MUELHEBACH , Zorn George , Wiley Mark A , Emert Martin , Ramirez Rigoberto , Dendi Raghuveer , Sheldon Seth , Reddy Madhu , TADROS PETER , Pimentel Rhea C
Published: May 2021

Introduction:
The Emory risk score has been developed to predict new pacemaker implantation in patients undergoing TAVR procedures. There is limited data on assessing risk of early versus late pacemaker implantation in these patients.

Hypothesis:
The Emory risk score is similar for patients with both early and late pacemaker implantation in TAVR patients.

Methods:
A single center observational study was performed at our tertiary care center. All patients who underwent pacemaker implantation after TAVR procedures were included. Patients were categorized as early or late if they had pacemaker implantation within the same admission versus implantation post discharge. Standard statistical tests were used for analysis with two-sided p value <0.05 considered significant. IRB approval was obtained for the study

Results:
A total of 97 patients were studied between January 2017 to April 2020. The mean age was 77.5 ± 7 years and females were 41.2%. At baseline patients with early implantation of pacemakers (n=66) had a higher proportion of underlying RBBB (45.2% vs 23.3%, p=0.43), higher valve size as well as a higher incidence of valve oversizing > 146% (43.9 % vs 19.4 %, p =0.23)when compared to patients with late pacemakers(n=31). There was no difference between patient characteristics, baseline comorbidities, pre procedural ECG parameters as well as use of beta blocking agents. Late pacemaker implantations were associated with a overall lower Emory Risk score (1.06±1.41 vs 1.70±1.35, p =0.037).

Conclusions:
The Emory Risk score is significantly different for early and late pacemaker implantation. Further studies are needed evaluate risk of late pacemaker implantation.
Abstract 16468: Low Dose Amiodarone is Safe and Effective in Control of Atrial Fibrillation
Authors: McGrew Frank A , Charlton Sandy , Dragutsky Brian
Published: May 2021

Introduction:
Amiodarone is the most effective drug for the treatment of atrial fibrillation (AF), but long-term administration of standard doses can have prohibitive side effects. Little data is available for use of lower doses. We sought to determine the lowest effective dose for rhythm control in a single physician practice.

Methods:
Consecutive AF patients treated with Amiodarone using a down-titration schema were prospectively followed. The goal was the lowest dose providing effective rhythm control defined as less than 1% AF burden in patients with devices (42% of patients) or no symptoms or no AF on ECG at last office visit in non-device patients.

Results:
170 patents (89M, 81F) were followed for a mean period of 63 months (range 12-177). 79 of 170 (46%) had devices (6 ILR, 29 PM, 27 ICD, 17 CRT). 5 patients had drug-related transient side effects, including 1 transient hyperthyroidism. No patient had pulmonary fibrosis or death. 130 of 170 patients (76%) had successful control of AF. Table 1 shows the number of patents effectively controlled at each weekly dose level. 51% had success at less than or equal to 400mg per week. Renal disease, systolic heart failure with reduced ejection fraction, and advanced age were common comorbidities.

Conclusions:
Low-dose Amiodarone is safe and effective for control of AF in most patients if carefully used in a down-titration protocol. Device diagnostics aid in patient management.
Abstract 16479: A Comparison of Rates of Significant Coronary Artery Disease Found on Invasive Coronary Angiography in Patients Who Underwent Nuclear Stress Testing or CT Coronary Angiography as a Workup for Acute Coronary Syndrome
Authors: Yoo Jeanwoo , Kane Jesse , Hotelling Jessica , Menashe Eyal , Lawson William E
Published: May 2021

Introduction:
Chest pain syndromes are one of the most common causes of hospital admission. The correct diagnosis as cardiac [acute coronary syndromes (ACS)] with associated morbidity and mortality, or non-cardiac has important medical and legal consequences. Appropriate and timely diagnosis of these conditions is essential, yet limited literature exists comparing two common diagnostic tools, CT coronary angiography (CTCA) and nuclear stress testing (NST) in the acute inpatient setting.

Methods:
We conducted a retrospective analysis to determine rates of ischemia and intervention needed in patients without ischemic cardiac history, who were evaluated for ACS with NST or CTCA and who subsequently underwent invasive coronary angiography (IA) with iFR and angioplasty as appropriate.

Results:
We identified 121 CTCA cases and 45 NST cases. There were no significant difference in age, rates of hypertension, diabetes mellitus, renal disease, aspirin or statin use. However, there were more male patients in the CTCA group and higher mean GRACE scores and creatinine on admission in the NST group. Patients who underwent CTCA were found to have higher rates of significant coronary artery disease defined as iFR < 0.9 or ≥70% stenosis on IA (63% vs 44%), and shorter mean length of stay (4.5 vs 6.5 days). Rates of artifact were higher in the NST group (64% vs 24%) and CTCA demonstrated higher specificity (90% vs 28%) and greater positive predictive value (92% vs. 41%) than NST. (Table 1)

Conclusions:
Our study found that CTCA compared to NST in admitted patients being evaluated for chest pain syndromes was associated with lower rates of reported artifact, shorter length of stay, higher rates of IA confirmed significant coronary disease, and higher specificity and positive predictive value for needed intervention when evaluated with IA. While limited by its single center analysis, our study demonstrates the potential value of CTCA in a real-world population which merits further study.
Abstract 16481: Feasibility and Safety of Transcatheter Closure of Patent Ductus Arteriosus in Infants Weighing <700 Grams
Authors: Chakraborty Abhishek , Philip Ranjit , Waller Rush , Naik Ronak , Harsono Mimily , Abdulmajeed Huma , Sathanandam Shyam
Published: May 2021

Introduction:
Recently, the Amplatzer Piccolo Occluder (APO) was approved for PDA closure for infants weighing > 700 grams. The feasibility and safety of the procedure for anyone below this weight cut-off has not been previously explored.

Hypothesis:
Transcatheter closure of patent ductus arteriosus (PDA) in premature infants who weigh < 700 grams at the time of the procedure is safe and feasible.

Methods:
This is a retrospective, single-center, study to explore the outcomes of transcatheter PDA occlusions performed on infants weighing < 700 grams.

Results:
A total of 18 patients weighing between 540 and 670 grams (mean = 612.8 grams) were identified to have underwent the procedure between the two centers. The gestational age ranged between 22-26 weeks (median 24 weeks), and the average birth weight was 537.5 grams. The mean age at the time of PDA closure was 20 days (range 8-35 days). The implant success rate was 100%. The devices used included the MVP-5Q (N=8), the 3-2 APO (N=5) and the 4-2 APO (N=5). The procedure time was 26 ± 23 minutes and fluoroscopy time was 3.7 ± 3.1 minutes. One patient, weighing 640 grams required chest compressions for resuscitation following the procedure, but recovered and since then has grown normally to hospital discharge. There were no other procedural complications. At the latest follow-up (median 1-year), there have been four non-survivors, all unrelated to the procedure.

Conclusions:
It is feasible and likely safe to perform transcatheter closure of patent ductus arteriosus (PDA) in premature infants who weigh < 700 grams using currently available technologies. There is a learning curve with these interventions. Extreme care must be taken while performing interventions in such small human beings. Further miniaturization of equipment would facilitate better outcomes.
Abstract 16495: Activation of Notch Signaling in the Heart Promotes Electrical Disturbances
Authors: Pizzo Emanuele , Cervantes Daniel O , Comelli Martina , Meo Marianna , meste olivier , Jacobson Jason T , Rota Marcello
Published: May 2021

Notch1 receptor signaling is active in the heart during embryonic development, is progressively silenced after birth, and it is partly restored in the adult myocardium following ischemic damage, a condition characterized by occurrence of arrhythmias. We previously reported that inducible overexpression of Notch1 intracellular domain (gain-of-function, NGoF) in adult mouse cardiomyocytes alters ionic currents and action potential profile. But the consequences of Notch1 signaling activation on electrical properties and arrhythmogenicity of the entire heart remain to be defined. For this purpose, electrocardiograms were obtained in NGoF (n=25) and corresponding control (Ctrl, n=13) mice in the conscious state, over a 10 min period. Electrical signals were obtained at baseline and following administration of an arrhythmogenic cocktail (120 mg/kg BW caffeine and 2 mg/kg BW epinephrine) to test the propensity of these animals to develop electrical disturbances. Moreover, information was also obtained in mice with inducible
Notch1
gene deletion for complete silencing of Notch1 signaling (Notch1 loss-of-function, NLoF, n=5). At baseline, heart rate and QT interval duration were comparable in NGoF (689±30 bpm; 49±2 ms), Ctrl (703±29 bpm; 48±1 ms), and NLoF (697±50 bpm; 48±1 ms) animals. Only a small fraction (~8%) of NGoF mice presented isolated premature ventricular complexes (PVCs) or junctional rhythm, but these events were not observed in Ctrl and NLoF mice. Administration of the arrhythmogenic cocktail induced PVCs in the majority of Ctrl (~56%) and NLoF (~60%) mice and in almost all NGoF animals (~92%). Also recurrent PVCs (≥10/10 min) were 1.7-2.1-fold higher in NGoF mice, with respect to NLoF and Ctrl. Importantly, 77% of NGoF mice developed ventricular tachycardia (VT), whereas VT occurrence was attenuated in Ctrl (56%) and NLoF (~40%) animals. Incidence of sustained VT was 1.7-fold higher in NGoF mice, with respect to Ctrl. Similarly, bidirectional VT was higher in NGoF (~62%), with respect to Ctrl (~52%) and NLoF (~40%). Thus, Notch signaling activation in the heart of experimental animals tends to enhance the occurrence of electrical disturbances, a factor that may be involved in the arrhythmogenic behavior of the post-infarcted myocardium.
Abstract 16505: Sinus Node Sparing Surgical Hybrid Thoracoscopic Ablation for Inappropriate Sinus Tachycardia: Results of a Prospective Multicenter Registry (the Susruta Registry)
Authors: Lakkireddy Dhanunjaya , De Asmundis Carlo , Turagam Mohit K , Lameir Mark , romeya ahmed , Van Meeteren Justin , Krauthammer Yoaav , Koerber Scott M , Akella Krishna , Gopinathannair Rakesh , Gandhi Gaurang , Okum Eric , Shah Hemal , Winner Marshall W , Patel Dilesh , Beaty Elijah , Kincaid Edward , LEE Anson M , Brodt Chad , Vloka Margot E , Colombowala Ilyas K , Romano Matthew , Morady Fred
Published: May 2021

Background:
Medical treatment for inappropriate sinus tachycardia (IST) remains suboptimal. Radiofrequency Sinus node Modification (RFSM) has been used for managing drug-refractory symptomatic IST. Although, acute success is reasonable, it is faced with high complications and recurrence rates. A novel Sinus Node sparing surgical thoracoscopic hybrid ablation (SUSRUTA) has been recently proposed.

Objective:
To report outcomes of SUSRUTA for IST patients from a prospective multicenter registry.

Methods:
This is a multicenter, prospective registry of patients who received SUSRUTA which is SN sparing hybrid ablation using surgical thoracoscopic video-assisted epicardial ablation comprised of a RF bipolar clamp which was used for sparing the SN region (identified by endocardial 3D mapping) and isolation of superior and inferior vena cava with creation of a lateral line across the crista terminalis during IST with isoproterenol challenge. Gaps in the epicardial lesion set are filled in by endocardial RFA. Patients were treated with post op Colchicine and were enrolled in cardiac rehabilitation program.

Results:
Of the 139 patients, mean age was 26±4 yrs, 91% women and mean duration of IST was 40±21.5 months. 90% were on ivabradine, 86% on beta-blocker, 77% on calcium channel blocker and 77% were on class IC antiarrhythmic agent. Heart rate post-procedure was significantly lower when compared with pre-procedure (110±10 vs. 64±11 bpm, p<0.0001). After a blanking period of 3 months, normal sinus rhythm was restored in 100% of patients in the hybrid group. Postop pericarditis was the most common complication in 80%(severe-4%), severe bradycardia (HR <35 bpm) in 5%, pneumothorax 3.5% and pleural effusion requiring drainage in 2.1% of cases. One patient

required a permanent pacemaker. Hospital length of stay was 4.5±0.8 days. At 1041±541 days follow up 94.5% (131/139) were free of symptoms after a single procedure and the 8 patients required a redo-RF catheter ablation.95% patients are off all preprocedural rate controlling medications

Conclusion:
SUSRUTA appears to be efficacious and safe for the treatment of symptomatic drug resistant IST.