bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14523: N-acetylcysteine for the Prevention of Atrial Fibrillation After Noncardiac Thoracic Surgery: A Double-blind, Randomized, Placebo-controlled Trial
Authors: AMAR David , Zhang Hao , Chung Mina K , Tan Kay See , Desiderio Dawn P , Park Bernard , Pedoto Alessia , Roistacher Nancy , Isbell James , Molena Daniela , Milne Ginger , Meyers Bryan F , Rusch Valerie W , Jones David R
Published: November 2020

Introduction:
Adding N-acetylcysteine (NAC) to amiodarone may mitigate inflammation and oxidative stress, preventing postoperative atrial fibrillation (POAF). NAC, reported to reduce cardiac surgery POAF, has not been tested in major thoracic surgery.

Methods:
Patients at high risk for POAF (BNP≥25pg/ml, male, age≥75, or history of AF) who underwent major thoracic surgery (n=154) were randomized to amiodarone + NAC (n=78) or amiodarone + placebo (n=76). Begun on arrival to the PACU were amiodarone 150 mg iv then 1 g/24 h iv x 48 h, and NAC or placebo bolus 50 mg/kg iv then 50 mg/kg/24 h iv x 48 h. The primary endpoint was sustained AF >30 s by telemetry (first 72 h) or symptoms within 7 days of surgery; patients with the primary endpoint underwent home ECG monitoring. Secondary endpoints were AF up to 1-year post discharge and systemic markers of inflammation.

Results:
Baseline characteristics were similar between arms (Table). POAF occurred in 15/78 NAC patients (19%) and 13/76 placebo patients (17%) (p=0.8). The trial was stopped at the interim analysis for futility. Regardless of treatment, of 28 patients with POAF, 3/28 (11%) were discharged in AF, and 1/28 (4%) met the primary endpoint after discharge. At 1-year, 7/28 patients with POAF (25%) had recurrent episodes of AF, and 1 developed persistent AF—none developed stroke. Inflammatory markers were similar between treatment arms; however, regardless of NAC, on postoperative day 2, patients with POAF (n=28) had higher CRP (p=0.008) and IL-6 (p=0.001) than patients without POAF (n=126).

Conclusions:
Compared to amiodarone alone, NAC + amiodarone did not reduce the incidence of POAF nor markers of inflammation early after major thoracic surgery. Recurrent AF episodes are common among patients with POAF within 1-year of surgery.
Abstract 14533: Guideline Directed Medical Therapy Optimization Assisted by Telemonitoring for Heart Failure With Reduced Ejection Fraction Patients: Rationale and Design
Authors: Sandro Romero Erick
Published: November 2020

Background:
Only a small proportion of patients with Heart Failure with Reduced Ejection Fraction (HFrEF) receive optimal Guideline-Directed Medical Therapy (GDMT) despite being eligible based on their clinical profile. The GDMT underuse leads to an important gap in clinical outcomes. In light of this gap, we integrated telemonitoring with a protocol for therapy optimization. We hypothesize that GDMT assisted by telemonitoring can improve the proportion of patients receiving optimal GDMT

Objective:
The aim of this study is to assess the value of telemonitoring in the optimization of GDMT.

Methods:
In a randomized controlled trial control patients will receive standard of care for GDMT, whereas the intervention group will receive GDMT assisted by telemonitoring. Patient eligibility includes HFrEF (LVEF≤ 40%), ACC/AHA stage C while receiving ≥ 1 GDMT medication at <50% of target dose. Patients in the intervention group will record daily Patient Generated Health Data (PGHD) including step counts, weight, blood pressure, and heart rate which will be transmitted to their electronic health records. The heart failure team will review the PGHD and clinical profile every two weeks and recommend dose titration according to the ACC/AHA Guidelines. The patient will be contacted through phone calls to evaluate medication tolerance, discuss laboratory test results and provide instructions for medication titration. This workflow is repeated cyclically until patients reach target doses or further adjustments are not tolerated. The estimated sample size is 206 (103 participants in the intervention and control groups, power of 80%). The primary outcome is the optimal target doses of GDMT at 3-6 months.

Conclusions:
This trial implements and tests the value of GDMT assisted by telemonitoring. Our approach combines telemonitoring in a structured titration program for therapy optimization. Findings may have implications for achieving GDMT adherence in clinical practice.
Abstract 14540: Preliminary Efficacy and Feasibility of an Emotion Regulation Intervention on Physical Activity and Depressive and Anxious Symptoms in Individuals in Cardiac Rehabilitation
Authors: Wierenga Kelly L , Fresco David M , Alder Megan , Moore Shirley M
Published: November 2020

Cardiac rehabilitation (CR) is an important part of overcoming an acute cardiac event, but can be undermined by debilitating levels of depression and anxiety, which can leave cardiac patients at risk for diminished functional capacity. The purpose of this randomized control trial was to evaluate the development and early efficacy testing of a theoretically based emotion regulation treatment (RENEwS) designed to assist people in CR to optimize recovery following acute cardiac events. CR participants (n=30, 83% men) were randomized to 5 one-hour, in-person group sessions of RENEwS or a phone-based active-control group. Participants completed measures of depression and anxiety symptoms at three timepoints. PA was objectively measured for 7 days at each time point using waist-worn actigraphy monitors. Between-group differences were calculated using linear mixed models to evaluate initial efficacy. Qualitative data were collected during RENEwS sessions and analyzed using content analysis with a directed approach to assess intervention feasibility and acceptability. Compared to active-control participants, RENEwS participants showed greater reductions in depression (Cohen’s
f
= .34) and anxiety symptoms (Cohen’s
f
= .40) but only modest improvements in PA from baseline to 5 months (Cohen’s
f
= .08). Descriptive exploratory analysis of within-group changes in the RENEwS group reveals individuals with above mean depressive symptoms and individuals with above mean anxiety symptoms experienced clinically meaningful decreases in psychological symptoms and increases in PA at 5 months. Qualitative analysis of feasibility indicated strengths in acceptability, demand, adaptation, integration, and implementation. Findings show that RENEwS is a promising emotion regulation intervention for CR patients, though revisions are needed to address practicality, expansion, and efficacy.
Abstract 14583: Palliative Care Services in Patients Admitted With Cardiogenic Shock in the United States: Frequency and Predictors of 30-day Readmission
Authors: Feng Zekun , Ziaeian Boback , Fonarow Gregg C
Published: November 2020

Introduction:
Patients admitted with cardiogenic shock (CS) have high in-patient mortality and readmission rates. Palliative care services (PCS) may be underutilized in this population and the association with 30-day readmission and other predictive factors are unknown.

Methods:
Using the 2017 Healthcare Cost and Utilization Project’s National Readmission Database, we identified index admissions in patients with (1) CS (ICD-10-CM code R57.0) and (2) CS with PCS (ICD-10-CM code Z51.5). Patients with orthotopic heart transplant or left ventricular assist device were excluded. We compared differences in 30-day readmission outcomes and identified readmission predictors using logistic regression analysis.

Results:
Among 127,045 survey-weighted CS index admissions, inpatient mortality was 37.0%. In those survived (n=80,030), 21.0% (n=16,779) were readmitted within 30 days and 12.3% (n=9,841) had DNR orders (ICD-10-CM code Z66). Of 26,555 CS with PCS index admissions, 72.5% died inpatient. In those survived (n=7,285), 11.6% (n=844) were readmitted within 30 days and 61.2% (n=4,461) had DNR orders. From CS with PCS index admissions, mean age was 70.7; 39.2% were female; 50.0% discharged to skilled nursing facility and 33.9% discharged to home health care. The average time to readmission was 11.8 days with 36% of all readmissions within first 14 days. Primary causes of readmission were cardiac (47.7%) and infectious (13.7%). Predictors of 30-day readmission for CS group versus CS with PCS group are listed in table.

Conclusions:
Use of PCS in patient admitted with CS remains low at 8.6% in 2017. PCS and DNR orders were associated with lower risk of 30-day readmission. Those receiving PCS during index admission had lower readmission rates at 11.6%. In CS with PCS index admissions, cardiopulmonary and renal diseases were positive predictors while female gender, private insurance, private hospital and higher household income were negative predictors of 30-day readmission.
Abstract 14586: Variability in Indicated Left Ventricular Function Reassessment After Mi: The Acute Myocardial Infarction Quality Assurance (AMIQA) Canada Multicenter Prospective Study
Authors: Wilton Stephen , Bennett Matthew , Parkash Ratika , KAVANAGH Katherine M , Jolicoeur Marc , Halperin Frank , Jolly Umjeet , Leong-Sit Peter , Sas Rozsa , Chew Derek , Singh Sarah , Frisbee Stephanie J , MacLachlan Robert , Manlucu Jaimie ,   AMIQA Canada Investigators
Published: November 2020

Introduction:
Persistently reduced LVEF after acute MI predicts adverse prognosis and directs use of evidence-based treatments to prevent sudden death (SCD) and/or progressive heart failure. We conducted a multicentre, prospective, observational study to assess adherence with guideline recommendations to repeat imaging assessment post-MI in those with initially depressed LVEF.

Methods:
We enrolled 501 patients with type 1 acute MI and LVEF ≤45% during the index hospitalization, from 14 Canadian sites. Outcomes were the proportion having a repeat LVEF assessment by 6 months and the proportion with an actionable reduced LVEF in follow-up: <35%, prompting referral for ICD therapy; <40%, prompting consideration of additional heart failure therapy; or 36% to 50%, prompting referral for participation in SCD risk reduction research

Results:
Mean age was 63.3 ± 13.0, and 113 (22.6%) were female. Overall, 370 (73.4%) presented with STEMI, and 454 (91.6%) had one or more in-hospital revascularization procedures. The mean baseline LVEF was 36.9% ± 6.7%. Over a median follow-up of 198 days, 18 (3.6%) patients died and 27 (5.3%) were lost to follow-up. Of 456 remaining patients, 303 (66.5%) had LVEF reassessment and significant variation was observed across sites (range 46.7-90.0%; p=0.035). Patients from community vs academic hospitals were more likely to undergo LVEF reassessment (73.6% vs. 63.2%, p=0.034), as were those with worse LVEF at baseline (
Figure, panel A
). In those with follow-up LVEF (n=302), 61.6% had an actionable persistent LVEF reduction: 13.9% had LVEF <35%, 28.8% had LVEF <40%, and 47.7% had LVEF between 36 and 50%, with significant variation based on initial LVEF (
Figure, Panel B
).

Conclusions:
One in three patients with at least mild LVEF reduction after acute MI did not undergo indicated LVEF reassessment within 6 months. In those with follow-up imaging, clinically actionable persistent LVEF reduction was identified in over one quarter of patients.
Abstract 14602: Vascular Calcification is Associated With Major Adverse Cardiovascular Events and Mortality in Men With Recurrent Prostate Cancer Undergoing PET/CT Imaging
Authors: Shaikh Preet Ayoub , Som Avira , Lenihan Daniel , Zhang Kathleen W
Published: November 2020

Background:
Hormone therapy is a front-line therapy for men with prostate cancer and is associated with adverse cardiovascular events. The utility of vascular calcification for cardiovascular risk stratification in men with prostate cancer is unknown.

Methods:
211 consecutive patients who underwent 18F-fluciclovine positron emission tomography (PET)/computed tomography (CT) at a single institution for recurrent prostate cancer were retrospectively identified. Clinical and demographic data were obtained from the medical record. Coronary and aortic calcification were qualitatively assessed on non-gated CT scans using standardized scoring systems. The primary outcome was a composite of subsequent major adverse cardiovascular event (MACE; myocardial infarction, stroke, coronary or peripheral revascularization, heart failure hospitalization) or all-cause mortality.

Results:
Median age was 69 (IQR 64, 75) years and cardiovascular comorbidities were common (70% hypertension, 65% hyperlipidemia, 47% current or former smoking, 20% diabetes mellitus). Over a median of 16.5 months, 8 patients (4%) met the primary outcome. Patients with MACE or death were older and had higher prevalence of traditional cardiovascular comorbidities (risk ratio [RR] 1.3 for hypertension, 1.4 for hyperlipidemia, 1.3 for diabetes mellitus; p>0.05 for all). Coronary and aortic calcification were more common in patients with MACE or death. Severe coronary calcification (RR=6.1, 95% CI 1.6-23.2, p=0.008) and severe thoracic aortic calcification (RR=9.9, 95% CI 2.0-47.6, p=0.004) were associated with significantly increased risk of MACE or death.

Conclusions:
Coronary and aortic calcification on PET/CT imaging are associated with significantly increased risk of MACE or death in men with recurrent prostate cancer. Vascular calcification may have utility for cardiovascular risk stratification in men receiving hormone therapy for prostate cancer.
Abstract 14615: Empagliflozin Provides More Value for Money Than Oral Semaglutide for Prevention of Cardiovascular Mortality in Patients With Type 2 Diabetes Mellitus
Authors: Azuri Joseph , Aboalhasan Enis , Hammerman Ariel , Arbel Ronen
Published: November 2020

Introduction:
The AHA 2020 strategic goal of reducing CV mortality by 20% was partially achieved (15% reduction 2011-2019). Empagliflozin, an inhibitor of sodium-glucose cotransporter 2 inhibitor and oral semaglutide, the first oral glucagon-like peptide 1 receptor agonist, both significantly reduce the incidence of cardiovascular mortality (CVM) in patients with type 2 diabetes (DM) and established CVD. However, the addition of either drug to current diabetes treatment regimens may impose a significant burden on healthcare systems.

Hypothesis:
Empagliflozin provides more value for money than oral semaglutide for the prevention of CVM in patients with DM.

Methods:
We calculated the cost needed to treat (CNT) to prevent one case of CVM using either drug, by multiplying the annualized number needed to treat (NNT) to prevent one event, by the annual cost of the therapy. Efficacy estimates were extracted from published randomized controlled trials (RCT) data. We performed a sensitivity analysis to mitigate the primary differences between the RCTs and other uncertainties. Drug costs were calculated as 75% of the US National Average Drug Acquisition Cost listing in June 2020.

Results:
The annualized NNT of empagliflozin in EMPA-REG-OUTCOME was 141 (95% CI: 104-230) versus 140 (95% CI: 98-893) for oral semaglutide in PIONEER 6, while the corresponding annual costs are $4,572 versus $6,680. Therefore, the CNT of empagliflozin was $644,652 ($475,488-$1,051,560) compared to $935,200 (95% CI: $654,640-$5,965,240) with oral semaglutide. The lower CNT of empagliflozin was confirmed in a sensitivity analysis.

Conclusions:
The annualized NNT of empagliflozin and oral semaglutide prescribed for the prevention of CVM in patients with T2DM and established CVD is similar. Therefore, the lower cost of empagliflozin results in a lower CNT and better value for money.
Abstract 14902: The Impact of Bicuspid Pulmonary Valve in Aortic Position After Arterial Switch for Transposition of the Great Arteries onNeoaortic Root and Neoaortic Valve Function; Propensity Score Matched Analysis
Authors: Jeon Bobae , Choi Eun Seok , Kwon Bo Sang , Yun Tae-Jin , Park Chun Soo
Published: November 2020

Objective:
Neoaortic valve regurgitation which might be related to root dilatation is one of the major concerns following arterial switch operation (ASO) for transposition of the great arteries (TGA). This study investigated the effect of bicuspid neoaortic valve on neoaortic root morphology, function, and the long-term clinical outcomes after ASO for TGA using propensity score matching (PSM).

Methods:
From 1997 to 2018, 442 patients underwent ASO for TGA. Patients who underwent staged repair (n=15), were repaired at extremely old age (> 1 year, n=9), and died before discharge (n=46), and were lack of echocardiographic data at discharge (n=20) were excluded. Among a total of 352 eligible patients, 18 patients (5.1%) had a BPV. After PSM (1:4), 15 patients with BPV and 60 corresponding patients with tricuspid pulmonary valve were enrolled for analysis.

Results:
Baseline characteristics in both groups were similar. The median duration of follow-up was 9.9 years (4 months ~ 22.3 years). There was one late death. Freedom from reoperation at 10 years was 93.3 ± 6.4 % in bicuspid group and 88.7 ± 4.4 % in tricuspid group (
p
=0.84). Reoperation for aortic valve or aortic root was rarely required during follow-up. Indexed dimension (z-score) of neoaortic annulus was not increased in both groups (
p
=0.57) (Figure 1A), although there was a little increasing tendency in z-score of neoaortic sinus without intergroup difference (
p
=0.69) (Figure 1B). Deterioration in neoaortic valve function was more prominent in bicuspid group (common odds ratio; 1.40 in bicuspid group [
p
<0.01], and 1.12 in tricuspid group [
p
=0.03],
p
=0.03) (Figure 1C).

Conclusions:
Arterial switch operation could be a safe option in selected patients with TGA associated with BPV without increasing the risk of reoperation. Deterioration of aortic valve function was more prominent in bicuspid group, which suggests that the neoaortic valve function would be deteriorated mainly by valve itself not root pathology.
Abstract 14915: Incidence, Predictors and Clinical Impact of Left Ventricular Functional Recovery Following Coronary Artery Bypass Grafting in Patients With Ischemic Cardiomyopathy
Authors: Nakae Masaro , Kainuma Satoshi , Toda Koichi , Miyagawa Shigeru , Yoshioka Daisuke , Kawamura Takuji , Kawamura Ai , Kashiyama Noriyuki , Ueno Takayoshi , Kuratani Toru , Sawa Yoshiki
Published: November 2020

Introduction:
CABG is considered the standard treatment for patients with ischemic cardiomyopathy (ICM). However, it remains unknown who would achieve postoperative LV function recovery after CABG. Furthermore, the relationship of postoperative LV function recovery with long-term outcomes remains unclear.

Hypothesis:
In patients with ICM who undergo CABG, postoperative LV function recovery, which would be influenced by degree of LV remodeling at baseline, is associated with improved outcomes.

Methods:
This multicenter retrospective study comprised 490 cases with LVEF of ≤40% who underwent CABG between 1993 and 2015. Clinical follow-up was completed in 467 cases (95%), with a mean follow-up of 65±46 months (range, 0-266). A total of postoperative echocardiographic assessments were carried with an average number of 3.7±2.4. LV function recovery was defined as LVEF ≥35% at more than one exam. Association of LV function recovery with mortality after adjustments for clinically relevant covariates was estimated using Cox proportional hazard model. Pre- and intraoperative associates of LV function recovery were identified using logistic regression model.

Results:
During follow-up, there were 203 mortalities (41%) and overall 10-year survival was 45%. LV function recovery was found in 368 cases (75%), while not in 122 (25%). Overall 10-year survival was significantly higher in patients who achieved LV function recovery as compared with those who did not achieve it (52% vs. 23%). Multivariate analysis identified LV function recovery was independently associated with decreased overall mortality (adjusted HR 0.40, p<0.0001). Preoperative LVDs (adjusted OR 0.92, p<0.0001), eGFR (adjusted OR 1.12, p=0.016) and revascularization using bilateral internal thoracic arteries (BITA) (adjusted OR 2.81, p=0.018) are the independent predictors of LV function recovery.

Conclusions:
Among patients with ICM who underwent CABG, 75% achieved substantial postoperative LV function recovery, in association with better long-term survival, as compared with the remaining 25% of patients who did not achieve it. Preoperative less LV remodeling and preserved renal function as well as revascularization with use of BITA might be associated with LV function recovery.
Abstract 14916: Clonal Analysis of the Neonatal Mouse Heart Using Nearest Neighbor Modeling
Authors: Bakovic Melanie , Thakkar Devang , DeBenedittis Paige , Chong Diana , Thomas Michael , Iversen Edwin , Karra Ravi -
Published: November 2020

Introduction:
Heart regeneration has been proposed as a treatment for heart failure. However, the challenge of detecting bona fide heart regeneration has complicated the validation of potential regenerative factors. We sought to develop a method for quantifying cardiomyogenesis in the mouse heart using multicolor lineage tracing.

Hypothesis:
We hypothesized that multicolor lineage tracing in combination with modeling of nearest neighbor distances could be used to quantify clonal expansion of cardiomyocytes (CMs) during growth and regeneration.

Methods:
Myh6- MerCreMer
;
R26R-Rainbow
bitransgenic mice underwent cryoinjury (CI) or sham injury on postnatal day 1 (P1). Tamoxifen was then administered such that limited numbers of CMs were randomly labeled with mCerulean, mOrange, or mCherry fluorophores. Hearts were collected at 21 days post CI. We analyzed a total of 81 sections, across 6 hearts (3 with sham injury and 3 with cryoinury). Images of entire cardiac sections were manually segmented to generate positional information for each labeled CM.

Results:
We used the nearest neighbor distributions of CMs carrying the same fluorophore and CMs carrying different fluorophores to develop a Bayesian model for estimating the probability that two CMs are clonally related. We found that, across a range of recombination efficiency, CMs carrying the same fluorophore within 30 μm are likely to be clonally related. By classifying CMs based on this distance threshold, we were able to confirm that clonally related CMs are smaller than non-clonally related CMs (165.20 ± 13.79 μm
2
vs 252.37 ± 20.51 μm
2
, p = 0.007, Welch t-test). We also confirmed that rates of cardiomyogenesis in cryoinjured and sham injured hearts are approximately the same (8.57 ± 2.69 % in cryoinjured hearts vs 9.45 ± 1.23 % in sham hearts, p=0.788).

Conclusions:
We have developed a robust and objective approach for quantifying cardiomyogenesis in the mouse heart. This method can be applied to studies of heart regeneration and can also be adapted to other tissues.
Abstract 14935: Targeted Optical Molecular Imaging of Atheroma Calcification Using Novel Aldendronate-based Probe
Authors: Kang Dong Oh , Lim Yong Geun , Song Joon Woo , Park Ye Hee , Kim Hyun Jung , Nam Hyeong Soo , Kim Yeon Hoon , Oh Wang-Yuhl , Yoo Hongki , Park Kyeongsoon , Kim Jin Won
Published: November 2020

Background/Objectives:
Vascular spotty calcification is an actively regulated biological process resulting in plaque vulnerability. We investigated the feasibility of a novel alendronate-based near-infrared fluorescence (NIRF)-emitting probe to specifically target atherosclerotic calcification in a murine model in vivo using our customized high-resolution multichannel intravital molecular imaging system (IVFM).

Methods/Results:
We have fabricated a calcium-binding NIRF probe by chemically coupling alendronate, a specific targeting ligand, and NIRF-emitting Cy5.5 to the ends of azide-PEG-NHS ester (Al-Cy5.5). Prepared Al-Cy5.5 has high affinity for calcium phosphate-containing bone minerals. In vitro, Al-Cy5.5 specifically binds to RANKL-induced osteogenic-macrophages as compared to macrophages (p<0.01). On whole body fluorescence imaging to assess time-dependent excretion, NIRF signals remained visible up to 48 hrs. Then, in mice with calcified plaque induced by a combination diet of high-cholesterol and warfarin, Al-Cy5.5 (2.5 mg/kg) was intravenously injected. 48 hrs after administration, murine calcified atheroma was assessed using a customized high-resolution multichannel IVFM, which demonstrated highly enhanced NIRF signals in vivo in the calcified areas of murine carotid plaques (p<0.01, Figure). Ex vivo laser scanning fluorescence microscopic and immune-histological findings from the corresponding sister sections well corroborated the in vivo imaging results, which demonstrated the co-localization of NIRF signals with plaque calcifications (von-Kossa stain).

Conclusions:
Our novel calcification targeted probe, Al-Cy5.5, was able to selectively target atheroma calcification in vivo in a murine model as assessed by optical IVFM. This novel targetable strategy is expected to provide a promising theranostic basis for calcified high-risk plaques by integration with multimodal customized catheter imaging system.
Abstract 14936: Prevention of Contrast-induced Nephropathy by Inferior Vena Cava Ultrasonography-guided Hydration in Chronic Heart Failure Patients
Authors: Yan Yuanming , Ye Mingfang , chen qin , luo yukun
Published: November 2020

Introduction:
Contrast-induced nephropathy (CIN) is a common complication resulting from the administration of contrast media. This study was designed to determine whether inferior vena cava ultrasonography (IVCU)-guided hydration can reduce the risk of CIN in chronic heart failure patients undergoing coronary angiography or coronary angiography with percutaneous coronary intervention (PCI) than standard hydration.

Methods:
This prospective clinical trial enrolled 207 chronic heart failure patients from February 2016 to November 2017, who were randomly assigned to either IVCU-guided hydration group (n = 104) or the routine hydration group (n = 103). In the IVCU-guided group, the hydration infusion rate was set according to inferior vena cava diameter (IVC-D) determined by IVCU; while the control group received intravenous infusion of 0.9% saline at 0.5 ml/((kg·h)). Serum creatinine (SCr) was measured before and 48-72 hours after procedure. All patients were followed up for 18 months. The incidence of nephropathy and major adverse cardiovascular or cerebrovascular events (MACCE) were also compared between two groups.

Results:
Statistically significant difference between two groups regarding the occurrence of CIN were observed (12.5% vs. 29.1%, p = 0.003); The hydration volume of the IVCU-guided group is significantly higher than routine group (p<0.001). In addition, patients receiving IVCU-guided hydration had significantly lower risk of developing MACCE compared with patients in control group during 18 months follow-up (14.4% vs. 27.2%, p = 0.027).

Conclusions:
IVCU-guided hydration is superior to standard hydration in prevention of CIN and substantially reduce longtime composite major adverse events.
Abstract 14952: Hemodynamic Comparison of Left Ventricular Function in Pressure Overload- versus Volume Overload-Induced Heart Failure Models by Invasive Pressure-Volume Analysis
Authors: Ruppert Mihály , Karime Christian , Sayour Alex A , Oláh Attila , Nagy Dávid , Bálint Tímea , Merkely Béla , Radovits Tamás
Published: November 2020

Introduction:
Both sustained left ventricular (LV) pressure overload (PO) and volume overload (VO) induces LV remodeling and eventually development of heart failure (HF). Using rat models, the present study aimed to provide a detailed comparison of distinct aspects of LV function in PO- and VO-induced HF.

Methods:
PO and VO was induced by transverse aortic constriction (TAC, n=12) and aortocaval shunt (AV-shunt, n=12) creation respectively. Controls underwent corresponding sham operations (n=11). LV remodeling was characterized by echocardiography, histology, qRT PCR, and western blot. LV function was assessed by invasive pressure-volume (P-V) analysis.

Results:
Both sustained PO and VO resulted in the development of HF, as evidenced by increased LV BNP mRNA expression, pulmonary edema, and characteristic symptoms. While the extent of LV hypertrophy was comparable between the HF models, PO induced concentric while VO evoked eccentric LV remodeling. P-V analysis revealed impaired systolic function in both HF models. Accordingly, decreased ejection fraction and impaired ventriculo-arterial coupling (calculated as the ratio of arterial elastance/LV contractility [VAC]: 0.38±0.05 vs. 1.30±0.13, ShamTAC vs. TAC and 0.52±0.08 vs. 1.17±0.13, ShamAV-Shunt vs. AV-shunt; p<0.05) was detected in both HF models. However, in case of VO the severely reduced LV contractility (slope of end-systolic P-V relationship: 1.79±0.19 vs. 0.52±0.06, ShamAV-Shunt vs. AV-shunt, p<0.05 and 2.14±0.28 vs. 2.03±0.21, ShamTAC vs. TAC p>0.05) underpinned the contractility-afterload mismatch, while in case of PO the increased afterload (arterial elastance: 0.77±0.07 vs. 2.64±0.28, ShamTAC vs. TAC and 0.80±0.07 vs. 0.54±0.05, ShamAV-Shunt vs. AV-shunt; p<0.05) was the main determinant. Furthermore, prolongation of active relaxation occurred to a greater extent in case of PO. In addition, increased myocardial stiffness was only observed in PO-induced HF.

Conclusion:
Systolic function was reduced in both HF models. However, different factors underpinned the impaired VAC in case of VO (reduced LV contractility) and PO (increased arterial elastance). Furthermore, although diastolic function deteriorated in both models, it occurred to a greater extent in case of PO.
Abstract 14953: Temporal Trends in Non-invasive Diagnostic Tests for Ischemic Heart Disease Among Us Adults Age 64 Years or Younger: Results From the Marketscan Survey, 2010-2018
Authors: Park Soyoun , Hong Yuling , Gillespie Cathleen , Merritt Robert , Sperling Laurence
Published: November 2020

Introduction:
Heart disease is the leading cause of death in the U.S. Ischemic heart disease (IHD) accounts for two thirds of heart disease deaths. Non-invasive cardiovascular tests (NITs) are often the first step to establish an IHD diagnosis.

Methods:
We analyzed 2010-2018 IBM® MarketScan® Commercial Databases. NITs including exercise ECG, stress echocardiography, CT coronary artery calcification score (CT-CAC), single-photon emission computerized tomography (SPECT), cardiac CT angiography (CTA), nuclear positron emission tomography/myocardial perfusion imaging (PET/MPI), stress MRI, were identified using current procedural terminology (CPT) codes. IHD using ICD 9/10 codes (410-414, 429.2/I20-I25) and chest pain (786.59/R07.89) or unspecified chest pain (786.50/R07.9) were identified. The 2000 Census population was used to calculate the age standardized prevalence.

Results:
The data included 20,726,587 individuals (48.1% men, mean age (standard deviation) of 49.1 (13.5) years), among which 67,339 had a diagnosis of IHD or chest pain in 2018. The age standardized prevalence of the overall population that had at least one of the 7 tests is 1.60% in 2018, down from 2.47% in 2010. The responding prevalence for those with IHD or chest pain was 54.3% in 2018 and 61.6% in 2010. Exercise ECG was the most utilized test for the overall population: 0.94% in 2018 down from 1.31% in 2010; SPECT was second most often used with 0.75% in 2018 and 1.24% in 2010. However, SPECT was the most often utilized test among those with CHD or chest pain: 38.2% in 2018, down from 45.0% in 2010, and exercise ECG second most often with 32.6% in 2018 and 34.9% in 2010. An increase in use of CT-CAC, PET/MPI, and CTA tests was observed since 2010, but the prevalence of all were low in 2018. 0.02%. 0.01%, and 0.04% for the overall population and 0.20%, 0.95% and 3.20% for those with IHD or chest pain, respectively.

Conclusions:
Almost 2% of the general younger US adult population and over half of those with IHD or chest pain had undergone at least one of 7 NITs in 2018. While the utilization of overall NITs for both the general population and those with IHD or chest pain has declined since 2010, it has increased for CT-CAC, PET/MPI, and CTA but still less than 1% for CT-CAC and PET/MPI..
Abstract 14957: Comparison of Coronary Tree Detection and Diameter Quantification From a Deep Learning Convolutional Neural Network With Quantitative Coronary Angiography
Authors: Iyer Kritika , Najarian Cyrus , Sankardas Mullasari A , Subban Vijayakumar , Nallamothu Brahmajee K , Figueroa C Alberto A
Published: November 2020

Introduction:
QCA (Quantitative Coronary Angiography) is an accepted standard for assessing coronary artery stenosis severity. QCA computes the percentage diameter reduction of the lesion, improving upon visual inspection since it provides a numerical quantification of stenosis severity. However, it can be costly, and it requires human input to correct the boundaries of the vessel. AngioNet is a fully-automatic deep learning convolutional neural network trained to identify coronary trees and their vessel diameters in angiograms, and could be a cost-effective alternative to QCA. To explore the accuracy of AngioNet, we compared its ability to identify vessels and their diameter when compared with QCA.

Methods:
Angiograms with 3-vessel QCA reports from 89 patients acquired at Madras Medical Mission were used. The entire vessel tree was segmented for each angiogram using AngioNet. A fast-marching method was used to calculate the radius along the vessel’s centerline. Vessel diameter was compared in two regions corresponding to the regions marked in the QCA report: the most proximal region, containing the maximum vessel diameter, and the region of stenosis. If no stenosis was present, the distal region containing minimum diameter was selected. The difference in maximum and minimum vessel diameter between QCA and AngioNet was computed, and a Bland-Altman plot (see figure) was used to determine the interchangeability of both methods.

Results:
The mean absolute difference between both measurements was 0.27mm. The standardized difference was 0.215, corresponding to a 91.5% overlap of their distributions. Lastly, 97% of data points were within the limits of agreement, suggesting minimal clinical differences and that both methods may be interchangeable.

Conclusions:
Deep learning convolutional networks may be used to assess vessel diameters at a level that agrees well with those of QCA. AngioNet has the potential to automate the detection of stenosis severity.
Abstract 14965: Atrial Conduction During Obstructive Sleep Apnea: Comparison of Stacked Versus Isolated Apnea Episodes
Authors: Patel Krishan , Basrawala Hussain , Reddy Pavan , Valladares Edwin , Grbach Vincent , Castriotta Richard J , Somers Virend K , Hodis Howard N , Khoo Michael C , Konecny Tomas
Published: November 2020

Introduction:
Obstructive sleep apnea (OSA) is associated with increased rates of atrial fibrillation (AF). Recent randomized data suggest that traditional scoring of OSA needs to evolve to improve cardiovascular outcomes. Traditional scoring of OSA does not fully reflect pathophysiological links between OSA and AF, particularly regarding OSA-induced prolongation of p-wave duration (PWD), which is the most powerful predictor of AF occurrence.

Hypothesis:
We hypothesized that OSA episodes that closely follow each other (serially stacked apneas, ssOSA) exert greater effect on PWD compared to isolated OSA (iOSA) episodes.

Methods:
Sleeping patients (adults with mild-moderate OSA and presence of both iOSA and ssOSA, but without other cardiovascular comorbidities) undergoing diagnostic polysomnography were recorded by continuous 8-lead ECG. iOSA was defined as OSA episodes with no other episode within 30 seconds. ssOSA consisted of ≥3 consecutive apneas with inter-OSA intervals <30 seconds. PWD was defined from onset of p-wave in any ECG lead to termination in any lead (measured by digital calipers, averaged over 3 beats from first half of OSA and 3 beats from second half of OSA). Wilcoxon rank-sum test was used.

Results:
We analyzed 208 OSA episodes (51.0% iOSA, 49.0% ssOSA) which occurred in 12 patients (7 women; age 63.1±11.5 years; apnea hypopnea index 16.8±5.4). PWD was longer during ssOSA compared to iOSA (median 117.7ms vs 109.6ms; p<0.0001). The following variables did not differ between ssOSA and iOSA: PR interval (p=0.3139), RR interval (p=0.7531), peripheral oxygen saturation (p=0.7776).

Conclusions:
The impact of OSA on atrial conduction delay is exacerbated by the phenomenon of OSA stacking, which seems independent of oxygen desaturation and heart rate. Stacking of OSA episodes may be an underused and cost-efficient variable in evaluating the severity of OSA and the effectiveness of OSA treatments with the ultimate goal of reducing occurrence of AF.
Abstract 14966: Non-biased Fat Scoring System for Human Cardiac Variability and Body Mass Index Correlation Analyses
Authors: Peczkowski Kyra , Fazlollahi Farbod , Mashali Mohammed , Saad Nancy , Kiduko Salome , Huang Amanda , Hare Austin , Torres Matias Gina , Satija Divyaam , Mokadam Nahush , Whitson Bryan , Campbell Courtney , Janssen Paul M
Published: November 2020

Introduction:
It remains unclear if body mass index (BMI) is correlated to the amount of cardiac adipose tissue in humans. Echocardiography is typically utilized to measure epicardial fat in live patients, but has yielded inconclusive results, as it is difficult to measure cardiac adipose tissue levels from a single location on a 1-dimensional image, as fat is not always distributed equally across the heart.

Methods:
Through the Ohio State Cardiac Research Tissue program, we have collected over 200 human hearts of various conditions. Multi-angle photographs are available for every heart. We developed an adipose tissue scoring system, so correlations can be drawn between the adipose tissue score (ATS), and BMI in failing and non-failing human hearts. Hearts were scored based on the multi-angle photographs. Each heart was given an atrial (AATS) and a ventricular score (VATS) ranging from 0-7, based on fat distribution and epicardial fat thickness. Nine sets of scores by individuals blinded to any patient information were averaged for each heart and the average ATS was plotted for correlation analyses against BMI and etiology.

Results:
A strong correlation was not apparent by plotting BMI versus VATS for all failing and non-failing hearts (R
2
= 0.011915 failing, 0.017262 non-failing). It is of interest to note that the lower right quadrant of the correlation plot is empty, indication that in patients with high BMI, the ATS was also high. However, in individuals with low BMI, there was a wide distribution of ATS. VATS and AATS are closely correlated in both failing (R
2
= 0.67082) and non-failing (R
2
= 0.84446) hearts.

Conclusions:
Our analysis shows that in humans, a high BMI is typically correlated with a high ATS score, but a low BMI does not necessarily correlate with a low ATS. The non-failing hearts have a stronger correlation between VATS and AATS compared to the failing hearts, suggesting that failing hearts do not always have an equal distribution of adipose tissue between the atria and ventricle. Future studies will investigate the presence of correlation between ATS with other parameters, such as age, gender, and race.
Abstract 14970: Normative Echocardiographic Data for Premature Infants Between 23 to 26- and 6/7-weeks Gestational Age
Authors: Dragisic Nikola , REINKING Benjamin E , geick Griffin , Hahn Amy , Maldonado Jennifer , Dagle Jonathan , Giesinger Regan E , Darnall Amanda
Published: November 2020

Background:
Echocardiography is utilized to assess cardiac structure and function. In infants, children, and adolescents, a normative data set can be utilized to evaluate cardiac size relative to patient body size and provides the clinician with a quantified z-score based on body surface area. A complete normative data set for premature infants is not yet available. The aim of this study was to develop a normative data set for commonly measured cardiac structures in a cohort of premature infants.

Methods and Results:
Single center retrospective echocardiographic study in a cohort of premature infants without congenital heart disease. A total of 184 infants admitted at the University of Iowa’s Neonatal Intensive Care Unit between 2009-2019 were included in the study. All infants were between 23 to 26- and 6/7-weeks gestational age. We considered patients with a patent ductus arteriosus and/or a patent foramen ovale as having normal intra-cardiac anatomy given their prematurity. Some infants had numerous echocardiograms during this time interval which resulted in 439 utilized echocardiogram. Each echocardiogram used was interpreted individually regardless if the patient had multiple between the gestational ages of 23 and 26- and 6/7-weeks. Commonly examined cardiac structures were assessed via 2-dimensional and M-mode echocardiography. The mean and standard deviations were obtained for each cardiac structure and grouped by week of gestational age (
Table 1
).

Conclusions:
We present normative data for commonly measured cardiac structures based on gestational age in a premature patient population. This information is valuable for clinicians to assess for appropriate cardiac structural development and may be utilized to guide clinical management and need for possible intervention as the child continues to develop and grow.
Abstract 14978: Heart Failure Patient Adherence and Decreased Perception of Illness During Remote Hemodynamic Monitoring
Authors: Rathman Lisa D , Sears Samuel F , Capodilupo Robert C , Bourge Robert C , Desai Akshay S , Heywood J Thomas T , Henderson John , Adamson Philip , Brett Marie-Elena , Stevenson Lynne W
Published: November 2020

Introduction:
Effective management of ambulatory heart failure (HF) requires active patient (pt) participation. In telemonitoring of weights and symptoms, pt adherence to transmission is often halved within 6 months (M). Although ambulatory pulmonary pressure-guided management decreases hospitalizations and improves quality of life, the time course of pt perception of illness and sense of security in relation to monitoring frequency is not known.

Hypothesis:
Pts will perceive decreased impact of their HF during pulmonary pressure-guided management, which may contribute to their engagement in transmission of ambulatory PAP.

Methods:
The post-approval study for the implanted PA sensor was amended to include serial measurements of pt reported outcomes, (PRO, n=143), including the Brief Illness Perception Questionnaire (BIPQ). Treatment was adjusted to a target PA diastolic pressure 8 to 20 mmHg and adherence to transmitting pressure data from home was collected.

Results:
In the PRO cohort, mean age was 68 years, 58% were male, and 55% with HFpEF. Negative illness perception (BIPQ) decreased during each measurement interval. Pts reported improvement in symptoms, sense of security, sense of control and less impact of illness on their emotions at each time point, equally with HFpEF or HFrEF. In this cohort pt adherence to transmitting pressures was high throughout 24 M, Fig.1. Perception of illness was most favorable at 2 years, at which time there was a slight decline in transmission frequency.

Conclusions:
Pt perception of HF was positively impacted during ambulatory hemodynamic monitoring including improvement in symptoms, less emotional effect of illness, improved sense of security and control over their HF throughout follow-up. This was associated with high-level pt adherence to pressure data transmission. The optimal level of chronic monitoring for stable pts to maintain clinical benefit while minimizing disease awareness beyond 2 years is still unknown.
Abstract 14991: Mitochondrial Transplantation by Intraarterial Injection Ameliorates Acute Kidney Injury
Authors: Doulamis Ilias P , Guariento Alvise , Duignan Thomas , KIDO TAKASHI , Orfany Arzoo , Saeed Mossab Y , Weixler Viktoria H , Blitzer David , Shin Borami , Snay Erin R , Inkster James A , Packard Alan B , Zurakowski David , Rousselle Thomas , Bajwa Amandeep , Parikh Samir M , Stillman Isaac E , Del Nido Pedro J , McCully James D
Published: November 2020

Introduction:
Acute kidney injury (AKI) is a common clinical disorder and one of the major causes of morbidity and mortality during the postoperative period. In this study, we investigated the safety and efficacy of autologous mitochondrial transplantation by intra-arterial injection for renal protection in a swine model of bilateral renal ischemia-reperfusion injury (IRI).

Methods:
Female Yorkshire pigs (n=12) underwent percutaneous bilateral temporary occlusion of the renal arteries with balloon-catheters. Following 60 minutes of ischemia, the balloon catheters were deflated and animals received either autologous mitochondria suspended in vehicle (n=6) or vehicle alone (n=6), delivered as a single bolus to the renal arteries.

Results:
Injected mitochondria were rapidly taken up by the kidney and were distributed throughout the tubular epithelium of the cortex and the medulla. Evaluation of plasma electrolytes, acid-base status, complete blood count and biochemical analysis did not reveal evidence of any adverse effects associated with mitochondrial transplantation. After 24 hours of reperfusion, eGFR and urine output were significantly increased (p<0.01) while plasma creatinine and BUN were significantly decreased (p<0.01) in pigs receiving mitochondria compared to vehicle (Figure 1). Gross anatomy, histopathological analysis, acute tubular necrosis scoring and transmission electron microscopy showed that the renal cortex of vehicle group had extensive coagulative necrosis of primarily proximal tubules, while mitochondrial transplanted kidneys showed only patchy mild acute tubular injury. Renal cortex IL-6 expression had a 3.5-fold significant increase (p<0.05) in vehicle kidneys compared to kidneys receiving mitochondrial transplantation.

Conclusions:
Mitochondrial transplantation by intra-arterial injection provides renal protection from IRI, significantly enhancing renal function and ameliorating AKI.
Abstract 14992: Should Patients With Heart Failure With Reduced Ejection Fraction (HFrEF) be Discharged on Sacubitril/Valsartan or ACEi/ARB: A Decision Analysis Approach
Authors: Gilstrap Lauren , Zipkin Ronnie J , Barnes J Aaron , Tosteson Anna
Published: November 2020

Introduction:
In the PARADIGM-HF study, sacubitril/valsartan demonstrated a 16% decrease in all-cause mortality and a 21% decrease in heart failure hospitalization. Cost and concern for a higher risk of side effects especially among older patients may have delayed early diffusion. This study aims to use a decision analysis approach to determine whether discharged on sacubitril/valsartan or ACEi/ARB is optimal after heart failure with reduced rejection fraction (HFrEF) hospitalization and whether this varies by age.

Hypothesis:
Discharge on sacubitril/valsartan will be associated with lower mortality and readmission rates across all age groups.

Methods:
We used an absorbing Markov chain simulation model with 1-month cycle length to determine the association between discharge on sacubitril/valsartan vs. ACEi/ARB and survival. We used a random 40% sample of Medicare A, B and D data from 2016-2017 to create a population of HFrEF patients (n=694,149) to determine the probabilities of drug discontinuation and adverse events. We used estimates from the PARADIGM-HF study to define the relative reduction in mortality and readmission rates with sacubitril/valsartan.

Results:
Among all patients, we found a 3.24 month survival advantage to discharge on sacubitril/valsartan. Among those aged 64-74, there was a 5.85 month survival advantage. Among those aged 74-85, there as a 3.47 month survival and among those aged 85+ there was a 1.38 month survival advantage (
Figure
).

Conclusion:
Among patients of all ages with HFrEF, there is a survival advantage to discharge on sacubitril/valsartan over ACEi/ARB but the magnitude of this benefit decreases with increasing age.