bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13722: There Will be Blood: A Cautionary Tale of Triple Therapy
Authors: Shahandeh Negeen , Yang Eric H , Parikh Rushi
Published: November 2020

A 54-year-old man with coronary artery disease, chronic kidney disease, atrial flutter, and chronic right internal carotid artery (ICA) occlusion was transferred to our institution for management of cardiogenic shock following an anterior ST-elevation myocardial infarction status post percutaneous coronary intervention of the left main coronary artery (LMCA). He was placed on short-term triple antithrombotic therapy. On the day before discharge, he acutely developed left sided neurological deficits and hypotension. Exam was concerning for a right hemispheric stroke. Labs revealed a creatinine of 2.8 mg/dL, INR of 3.7, and a hemoglobin of 6.6 g/dL (previously 10 g/dL). Prior to sending the patient for brain imaging, we performed a bedside echocardiogram to further evaluate his hypotension. This revealed a large pericardial effusion with tamponade physiology. We suspected hemorrhagic cardiac tamponade secondary to triple antithrombotic therapy. His hypotension initially responded to intravenous fluids and packed red blood cells, resulting in an improved neurologic exam and supporting our hypothesis that his deficits represented right cerebral hemispheric hypoperfusion in the setting of a known right ICA occlusion and tamponade. Pericardiocentesis was initially deferred, as the risk of bleeding appeared prohibitive without reversal of apixaban and his coagulopathy, and these measures would subject the patient to a significant risk of thrombosis (e.g. LMCA stent thrombosis). Unfortunately, the patient developed progressive shock. After careful informed consent, we proceeded with high-risk pericardiocentesis involving pre-procedural reversal of apixaban with andexanet alfa and successful evacuation of 300 ml of hemorrhagic fluid. The pericardial pressure improved from 24 mmHg to 4 mmHg with complete resolution of the patient’s shock and neurological deficits. Our case demonstrates the risks associated with triple antithrombotic therapy as well as the nuanced clinical decision-making and risk-benefit assessment required when considering the use of anticoagulant reversal agents to prevent bleeding complications in the context of recent ischemic events and the need for urgent invasive procedures.
Abstract 13723: Racial/ethnicity and Education Disparities in Hypertension Among U.s. Adults and the Role of Nutrient Quality -- The International Study on Macro/micronutrients (intermap)
Authors: Vu Thanhhuyen T , VAN HORN Linda , Chan Queenie M , Gibson Rachel , DAVIGLUS Martha L , Stamler Jeremiah
Published: November 2020

Background:
Limited education and/or being Black are inversely associated with hypertension in the US. Whether nutrient quality influences these associations remains unclear.

Methods:
Diet and blood pressure (BP) were measured in 2,195 US adults ages 40-59 years between 1996-99 in the INTERMAP study. Hypertension was defined by 2017 standards—SBP/DBP ≥130/80 mmHg or on BP medication. OMNIHEART-like nutrient score defined nutrient quality (see Table footnote). Higher-education was defined as 17+years of school.

Results:
Participants were 50% female, 56.2% non-Hispanic (NH) White, 17.4% NH-Black, 12.7% Japanese, 13.6% Hispanic, 24% higher-education, and 42% hypertensive. With multiple adjustments without nutrient score, we observed racial disparity on hypertension in NH-Black vs. NH-White across education levels, and it was more pronounced in the higher-education group; i.e., in the lower-education group, compared to NH-White, relative risk—RR (95% CI) of hypertension in NH-Black was 1.4(1.2-1.6); but it was 2.0 (1.5-2.6) in the higher-education group. Education disparity was seen in NH-White—(RR was 42% lower in those with higher vs. lower-education. Added nutrient score slightly attenuated observed associations (see Table). Nutrient score was also independently associated with hypertension; i.e., compared to the 5
th
quintile, RR (95%CI) of hypertension in the 1
st
quintile was 1.3(1.1-1.5). There were no interactions of nutrient score with race/ethnicity/education. BMI levels attenuated race/ethnicity/education-hypertension relations and diminished the nutrient profile-hypertension relation.

Conclusion:
Education levels modified racial disparity between NH-Black and White but maintained independent effects on hypertension, especially in NH-White. Differences in nutrient quality did not account for race/ethnicity/education disparities on hypertension, rather independent effects were largely explained by BMI levels.
Abstract 13738: Longitudinal Changes and Remodeling in the Right Atrium: The Multi-ethnic Study of Atherosclerosis
Authors: Xie Eric , Kalu Nnena , Ambale-Venkatesh Bharath , Barr Graham , Wu Colin , Chamera Elzbieta , Bluemke David A , Heckbert Susan R , Yeboah Joseph , Kutty Shelby , Ac Lima Joao
Published: November 2020

Introduction:
The role of the right atrium (RA) in the pathogenesis and prediction of cardiovascular disease has been increasingly recognized, however the effects of aging on the RA remain unknown. In this longitudinal study we sought to describe the structural and functional changes in the RA over approximately ten years and explore their association with demographic and clinical risk factors.

Methods:
We included 1509 participants who had cardiovascular magnetic resonance at Exam 1 (2000-2002) and follow-up at Exam 5 (2009-2010) with adequate quality RA imaging at both timepoints. Quantification was performed using multimodality tissue tracking software, which has been extensively validated previously. Volumes were indexed to body-surface area. Adjusted multivariate linear regression used for analysis.

Results:
Participants were on average 58 years old at study onset, 54% female, 43% white, 14% Chinese American, 25% black, and 18% Hispanic. Over 10 years, RA indexed maximum and minimum volumes increased by 32% (8.8 mL/m2) and 37% (5.2 mL/m2) respectively. RA emptying fraction (EF) decreased by 1.3% and global strain trended towards a 0.7% decrease. Older age was associated with greater increases in volume but smaller decreases in function. Men had greater increase in volume and decrease in function, as did black and white races. Baseline obesity (BMI≥30), smoking, and diabetes status were all associated with greater decreases in function. Baseline use of ACE-inhibitors, lipid-lowering medications, and antihypertensives were not associated with larger or smaller changes in structure or function.

Conclusions:
In this large, diverse participant cohort, RA volumes substantially increased and function decreased over 10 years of follow-up. These differences were generally more prominent among men, older individuals, and white and black participants, and were further associated with baseline clinical risk factors.
Abstract 13750: Cardiac Magnetic Resonance to Predict Coronary Artery Compression in Patients Undergoing Transcatheter Pulmonary Valve Implantation Into Conduits
Authors: Romans Ryan A , Lu Jimmy C , Whiteside Wendy , Yu Sunkyung , Aldoss Osamah , Armstrong Aimee K , Boe Brian , Balzer David , Christensen Jason T , Jones Thomas K , Keeshan Britton C , McLennan Daniel , Nicholson George T , Patel Neil , Salavitabar Arash , Shahanavaz Shabana , Sullivan Patrick M , Turner Mariel E , Zampi Jeffrey D
Published: November 2020

Introduction:
Transcatheter pulmonary valve implantation (TPVi) is a widely available option to treat right ventricular outflow tract (RVOT) conduits, but coronary artery compression is an absolute contraindication. Cardiac magnetic resonance (CMR) may evaluate coronary anatomy, but its utility in predicting coronary compression is not well established.

Hypothesis:
CMR prior to TPVi can accurately predict coronary compression risk.

Methods:
We analyzed all patients with a recent CMR (≤ 12 months) and attempted TPVi in an RVOT conduit at 9 centers from 2007-2016. A core lab reviewed all CMRs for the shortest orthogonal distance from a coronary artery to the conduit, the shortest distance from a coronary artery to the most stenotic area of the conduit, and subjective assessment of coronary compression risk. Receiver operating characteristic curve was used to determine optimal predictive distances. Univariate and independent associations of the distances and qualitative assessment with coronary compression were examined using logistic regression.

Results:
Of 231 patients (62% male, median age 19.0 years), TPVi was successful in 198 (86%); in 24 (10%) balloon testing (documented coronary compression or high risk) precluded implantation. Distance to the RV to PA conduit ≤ 2.1 mm (area under the curve [AUC] 0.70) and distance to most stenotic area ≤ 13.1 mm (AUC 0.69) predicted coronary compression (Table). Subjective assessment had the highest AUC (0.78), with 96% negative predictive value. Both distances and qualitative assessment remained independently associated with coronary compression when controlling for abnormal coronary anatomy.

Conclusions:
CMR can predict the risk of coronary compression during TPVi in RVOT conduits but cannot completely exclude the risk of coronary compression. CMR may assist in patient selection and counselling families prior to TPVi, although balloon testing prior to TPVi remains essential.
Abstract 13758: The Value of Plasma Neutrophil Gelatinase Associated Lipocalin in the Diagnosis of Cardiorenal Syndrome Type 1
Authors: Phan Hao T
Published: November 2020

Introduction:
The presence of acute kidney injury in the setting of acute heart failure is very common occurrence and was termed cardiorenal syndrome 1 (CRS1). In CRS1 the diagnosis of acute kidney damage is often delayed by creatinine and urine output following KDIGO standards (Kidney Disease Improving Global Outcomes). Neutrophil gelatinase-associated lipocalin (NGAL) in the blood and urine is one of the earliest markers of acute kidney damage due to anemia or nephrotoxicity.

Hypothesis:
Plasma NGAL has good value in the diagnosis of cardiorenal syndrome type 1.

Methods:
There were 139 patients with acute heart failure or acute decompensated heart failure (ADHF) in the Department of cardiovascular resuscitation and Interventional cardiology at our hospital from September 2018 to June 2019. This is a prospective cohort study

Results:
There were 48 cases (rate 34.5%) with CRS1, medium age 66.12 ± 15.77, men accounted for 50.4%. The optimal cut-off for diagnosing NGAL CRS1 is > 353.23 ng/ml, AUC is 0.732 (95% CI 0.65-0.80, p <0.001), sensitivity 74.47%, specificity 68.48%, positive predictive value 54.7%, negative predictive value 84%. Building the optimal regression model by the BMA (Bayesian Model Average) method with 2 variables NGAL and creatinin day 1: Odds Ratio= e^y while y = - 2.39 + 0.0037 x NGAL + 0.17 x CreatininD1. Moreover, a nomogram with 2 variables NGAL and creatinin day 1 was designed to predict the likelihood of CRS1 with AUC 0.79 and validated on a testing set (consiting of 40 % of the data) by 10-cross-validation method with accuracy 79.82%. Ultimately, a confusion matrix was constructed to determine model accuracy 75.93%, sensitivity 76.74%, specificity 72.73%, positive predictive value 91.67%, negative predictive value 44.44%.

Conclusions:
Plasma NGAL is quite good value in the diagnosis of CRS1 in patients with acute heart failure or ADHF. A predictive model based on NGAL may help early diagnose CRS1 in patients with acute heart failure or ADHF.
Abstract 13767: Cardiac MRI Predictors of Good Long-term Outcomes in Patients With Repaired TOF
Authors: Majeed Amara , Geva Tal , Graf Julia , Lu Minmin , Babu-Narayan Sonya , Mulder Barbara , Wald Rachel , Sleeper Lynn A , Valente Anne M
Published: November 2020

Introduction:
Good outcomes in adults with repaired tetralogy of Fallot (rTOF) are not well explored. Identifying markers of a benign clinical course late after TOF repair can guide resource utilization in this growing population.

Methods:
Clinical and CMR data were analyzed from the International Multicenter TOF Registry (INDICATOR). The clinical outcome was a composite of death, aborted sudden death, sustained ventricular and atrial arrhythmia, non-sustained ventricular tachycardia, and New York Heart Association functional class>II. Multinomial regression explored predictors of the 3-category outcome-Good and intermediate outcomes; defined as freedom from clinical outcome at 50 and <50 years respectively; and bad outcome; defined as having an adverse event at <50 years.

Results:
The cohort had 1088 patients-good outcome, n=96; intermediate, n=747; bad, n=245 with median age at last CMR 44 (40, 47); 21 (15, 28); 31 (20, 39) years respectively. Median follow-up was 8 (5, 11) years after CMR in event-free patients. Right ventricular (RV) parameters associated with a good outcome were smaller RV end-systolic volume index, higher RV ejection fraction (EF), lower RV mass index, and lower RV mass/volume ratio. Left ventricular (LV) parameters associated with a good outcome were lower LV mass index and LV mass/volume ratio. Multivariable models showed RV EF (OR 1.56 per 10% increase, p=.009) and RV mass index (OR 1.51, per 10 g/m
2
decrease, p=.002) as independently associated with good outcome after adjusting for age at CMR. Important thresholds identified in older patients (age ≥37 years) were RVEF ≥42% and RV mass index <39 g/m
2
. Combined, this subgroup had a 56% likelihood of a good outcome.

Conclusions:
Adults with rTOF and CMR findings of adequate RV systolic function and no significant ventricular hypertrophy are likely to have a benign clinical course by age 50 years. Frequency of cardiac testing in such patients may be lower than in those not fulfilling these criteria.
Abstract 14064: Left Circumflex Lesion a Great Masquerader: Stemi Mimicking Classic Pericarditis
Authors: Jha Roshan , Tong Qiu , Hall Cameron
Published: November 2020

Introduction:
Pericarditis and STEMI both present with acute chest pain and ST elevations in the EKG. The pattern of ST-elevation and the nature of chest pain usually aid in clinching the diagnosis but there are exceptions.

Case:
34 Y.o male with Hypertension, tobacco abuse presented with abrupt onset central chest tightness, worsening with inspiration, relieved on sitting up. EKG revealed diffuse concave ST elevation in all leads with PR depression, Posterior EKG was negative for posterior wall MI. Troponin was normal on presentation and was mildly elevated to 0.5 ng/ml 6 hours later. The echocardiogram revealed normal ejection fraction, no wall motion changes. He was being managed for acute pericarditis with colchicine and ibuprofen, 20 hours later, he experienced increased chest pain, repeat EKG was unchanged, troponin up-trended to 6 ng/ml, peaked at 20 ng/ml and was taken for an urgent angiogram. Angiogram revealed an occlusion in the mid circumflex artery and angioplasty was done. Following the procedure, the chest pain subsided.

Conclusion:
A classic presentation of acute pericarditis turned out to be a STEMI with circumflex as the culprit vessel. Vigilance to patient's symptoms and trending of cardiac markers are essential in identifying atypical presentations of STEMI. The circumflex lesion usually has an atypical presentation and should have a low threshold for diagnostic angiogram so as not to miss them.
Abstract 14065: Effectiveness and Tolerability of Perindopril 3.5 Mg/amlodipine 2.5 Mg Single Pill Combination in Newly Diagnosed Patients With Hypertension. The Simple National Study Across Canada
Authors: DASKALOPOULOU Stella S , VILLATTE Romualda
Published: November 2020

Introduction:
The perindopril 3.5 mg /amlodipine 2.5 mg is the only available angiotensin converting enzyme inhibitor and a calcium channel blocker single pill combination (SPC) with market approval as a first-line therapy indication for hypertension.

Hypothesis:
Effectiveness, tolerability of, and the compliance to this SPC in patients with newly diagnosed hypertension.

Methods:
National, prospective, open-label, non-interventional study. Patients (n=1179) were initially prescribed the lowest dose SPC perindopril 3.5 mg/amlodipine 2.5 mg with possible up-titration after 4-weeks treatment (to 7/5 mg up to 14/10 mg). Office blood pressure (BP) at baseline, 3 months (M3), 6 months (M6), and the percentage of patients with normalized BP were assessed. Data were stratified by age, systolic BP category at baseline, and diabetic status.

Results:
Significant early systolic/diastolic BP decreases from baseline (mean±SD) were observed since the first visit: -20.8±14.7/-11.7±9.2 (P<0.001) at M3 and was slightly greater at M6: -22.9±14.5/-13.4±9.1, (P< 0.001), suggesting that the majority of the effect was obtained within the first 3 months; 82% of patients continued at the same dose, 17.5% were up-titrated. BP target was achieved in 61.4% of patients at M3, in 70.2% at M6. Significant BP decreases were observed in all age subgroups, in diabetic and non-diabetic patients. At both visits, significantly higher efficacy was observed in patients with stage 2 hypertension ( -27.0±15.3/-13.2±9.6, at M3 and -29.6±15.4/-15.0±9.2, at M6; p<0.002 for all) than stage 1. The greatest efficacy was observed in non-diabetic patients with stage 2 hypertension at M6 (-35.0±12.5/-17.2±8.9; P<0.001). Good compliance was reported in 95% of patients. During the study, emergent adverse events were reported in 95 (7.2%) patients, with no severe safety concerns raised; the intensity was mostly mild (76.8%) or moderate (21.1%)

Conclusions:
The Canadian SIMPLE study confirms the early benefits, tolerability of and compliance to the SPC perindopril/amlodipine 3.5 mg/2.5 mg, with a possibility of up-titration. This supports the guidelines recommendation for SPC use in newly diagnosed patients with hypertension as a first-line therapeutic option in clinical practice.
Abstract 14073: Omega-3 Fatty Acid Levels and Risk for Incident Bleeding and Atrial Fibrillation: Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Kapoor Karan , Alfaddagh Abdulhamied , Al Rifai Mahmoud , Bhatt Deepak L , Budoff Matthew J , Nasir Khurram , Miller Michael , Welty Francine K , McEvoy John W , Dardari Zeina , Shapiro Michael D , Blumenthal Roger S , Tsai Michael Y , Blaha Michael J
Published: November 2020

Introduction:
The association between plasma OM3 FA levels and key safety endpoints identified in the REDUCE-IT trial such as bleeding and atrial fibrillation (AF) remains uncertain.

Hypothesis:
Consistent with REDUCE-IT, we hypothesized that higher baseline OM3 FA levels, particularly EPA, would be associated with incident bleeding and AF in a population free of clinical ASCVD or AF.

Methods:
We examined the association between baseline plasma OM3 FA levels (expressed as percent mass of total FA) with incident bleeding and AF in MESA. Bleeding events were identified from review of hospitalization ICD-9/10 codes, and AF from participant report, discharge diagnoses, Medicare claims data, and study ECGs performed at MESA visit 5. Multivariable Cox proportional hazard modeling was used to estimate HRs of the association of continuous OM3 FA (log EPA, log DHA, log (EPA+DHA)) and our outcomes.

Results:
Among the 6546 participants, mean age was 62.1(±10.2) and 3468(53%) were female. For incident bleeding, consistent statistically significant reductions were seen with increasing levels of EPA and EPA+DHA in unadjusted and adjusted models including medications that modulate bleeding risk, such as aspirin, NSAIDS, corticosteroids and proton pump inhibitors (Table). For incident AF, a significant reduction was seen with increasing levels of DHA in univariate analyses that did not persist following adjustment for AF risk factors. No significant associations were seen with either EPA or EPA+DHA.

Conclusions:
In MESA, a population free of clinical ASCVD or AF at baseline, higher plasma levels of OM3 FA (EPA and EPA+DHA, but not DHA) were associated with significantly lower risk of hospitalized bleeding events, but there was no significant association with AF. These findings from observational studies will need to be reconciled with clinical trial data of high-dose pharmacologic OM3 FA therapy.
Abstract 14083: Implantable Loop Recorders Change Management in Patients With Cryptogenic Stroke With or Without Atrial Fibrillation
Authors: Fu Danni , Jones Richard , Dai Xing , Wu Michael , Burton Tina
Published: November 2020

Introduction:
Implantable loop recorders (ILR) are widely used for long term arrhythmia monitoring in patients with cryptogenic stroke (CS). Single center study has shown that some patients with incidental arrhythmias found by ILR, aside from atrial fibrillation (AF), resulted in changes in clinical management. Unfortunately, a large portion of the patients had premature ILR explantation before the end of battery life and other studies on incidental arrhythmias are limited.

Hypothesis:
We sought to determine the rate of occurrence of incidental arrhythmias other than AF on ILR monitoring among patients with CS and to characterize the rate of these incidental arrhythmias that result in a change in clinical management.

Methods:
All adult patients with ILR for CS at Rhode Island Hospital between 1/2015-1/2019 were included. Demographics, cardiac risk factors and structural features, and ILR tracings were reviewed.

Results:
Three hundred and twelve patients were identified with a median follow up time of 27.9 months (IQR 18.5-35.8 months). Incidental arrhythmias were identified in 110 patients (35.2%) with a median of 7.8 months (IQR 4.4-16.2 months) at a rate of 20.1 per 100 person-years. AF was detected in 51 patients (16.3%) with a median of 3.9 months (IQR 1.3-12.3 months). Eighteen patients had both AF and incidental arrhythmias and incidental arrhythmias were found after AF in 8 of those patients. Premature explantation occurred in 9.3% of patients with the most common reason being patient preference. Twelve patients with incidental arrhythmias (10.9%) had a resultant change in management; 9 with procedural interventions and 3 with medication adjustments. Overall, the rate of actionable incidental arrhythmias is 2.2 per 100 person-years.

Conclusions:
Other than AF detection, long term EKG monitoring in patients with CS with ILR allows for detection of other arrhythmias. These incidental findings can result in changes in management and potentially favorable clinical outcomes.
Abstract 14087: Psychosocial Determinants of Health Predict Depressive Symptoms and Anxiety in Rural Caregivers
Authors: Smith Jennifer L , Chung Misook L , Miller Jennifer , Biddle Martha J , Schuman Donna , Rayens Mary Kay , Lennie Terry A , Hammash Muna H , Mudd-martin Gia , Moser Debra K
Published: November 2020

Introduction:
Caregivers have an 82% increased risk of cardiovascular disease (CVD) compared to non-caregivers. Depressive symptoms (DS) and anxiety increase CVD risk, and these are worse in rural dwellers. Knowing predictors of DS and anxiety in rural caregivers of patients with chronic illness is important to reduce CVD risk.

Purpose:
To identify predictors of DS and anxiety in rural caregivers at risk for CVD using a social determinants of health (SDH) model.

Method:
In this cross-sectional study we measured multiple SDH. These variables included sociodemographic (i.e., age, gender, race, marital status, health insurance, education, financial status), behavioral (i.e., smoking and body mass index [BMI]), and psychosocial (i.e., caregiver burden measured by the Zarit Burden Interview, perceived stress by the Cohen Perceived Stress Scale, and social support by the Medical Outcomes Study Social Support Survey) factors. The outcomes of DS were measured by the Patient Health Questionnaire-9 and anxiety by the Brief Symptom Inventory – Anxiety subscale. Data were analyzed using two separate multiple regression models, one for DS and one for anxiety. As depression and anxiety are often comorbid, they were considered predictors in the appropriate models.

Results:
In the 262 participants (mean age 53±13, 78% female, 96% Caucasian, 70% were married), mean years of education were 14±2, 56.1% had enough money to make ends meet, and 55% had no insurance or Medicaid only. Significant predictors of worse DS were higher caregiver burden (β=0.05, p=0.004), higher perceived stress (β=2.04, p=0.001), and higher anxiety (β=3.79, p= <0.001). Predictors of worse anxiety, were younger age (β=-0.006, p=0.03), higher caregiver burden (β=0.006, p=0.009), lower social support (β=-0.004, p=0.05), and higher DS (β=0.08, p=<0.001).

Conclusion:
Predictors of DS and anxiety in these rural caregivers were psychosocial variables. Caregiver CVD Interventions could be optimized by including stress management, education about the psychological effects of caregiving, and social support components. Future research is needed on the role of DS and anxiety in CVD to better support rural caregivers at highest risk.
Abstract 14097: A 3D Print Low Cost Aortic Arch Endovascular Simulator
Authors: Neves Gabriel , Schoephoerster Jamee , Perez ENio
Published: November 2020

Introduction:
Simulation-based medical teaching and learning enables trainees to gain competencies in a realistic setting without imposing risks to patients. Within endovascular training, simulations improve patient safety and decrease health care costs. Access of the aortic arch from a femoral puncture site is a key competency in the endovascular field. Here, we show how a low-cost artificial vascular simulator enables accurate replicated catheterization of the aortic arch.

Hypothesis:

Methods:
Digital Imaging and Communications in Medicine (DICOM) data extracted from a computed-angio tomograph (CTA) using an image processing software was selected to include the arterial region of interest. A mold was made with plastisol from the printed 3D toolpath (Fig. 1). After maturation of the mold, the separate sections were assembled into the simulator (Fig. 2).

Results:
Data extracted from a CTA was processed to create a vascular model that was accessed using an arterial access kit, and guided under fluoroscopy, a radiopaque catheter was navigated to the aortic arch. The total consumable cost of the simulator was U$194.64.

Conclusions:
In this proof-of-concept study, we demonstrate the process of producing a low-cost 3D printed artificial vascular simulator made from 3-D printing and image examination. This simulator faithfully replicated the endovascular access of the aortic arch from a femoral puncture site. We recognize the scalability of our technique and its possibility of assisting in endovascular navigation of various interventional radiology procedures in a patient specific manner.
Abstract 14106: The Efficacy of Sodium Glucose Co-transporter 2 Inhibitors in Atrial Fibrillation: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Asad Zain Ul Abideen , Jafry Ali , Akhtar Khawaja , Wang Allen , Khan Mohammad S , Khan Safi U , Chung Mina K , Piccini Jonathan P , Stavrakis Stavros
Published: November 2020

Background:
Atrial Fibrillation (AF) is common in patients with Type 2 diabetes mellitus and it is associated with adverse outcomes. The impact of SGLT-2 inhibitors on incident AF and cardiovascular outcomes is unknown.

Methods:
A systematic review of Medline, EMBASE and other online sources was conducted on 04/22/2020. All randomized controlled trials (RCTs) comparing SGLT-2 to placebo reporting incident AF were included. Mantel Haenszel random effects modeling was used to estimate risk ratios (RR) and I
2
statistics were used to assess heterogeneity.

Results:
A total of 33 RCTs (n=65,505 patients) were included. SGTL-2 inhibitor (canagliflozin, dapagliflozin, empagliflozin, ertugliflozin) use was not associated with statistically significant benefit in preventing AF [RR 0.91 (0.80-1.04)] (Figure-1). Subgroup analysis showed that only Dapagliflozin had a statistically significant effect in preventing AF [RR 0.79 (0.66-0.93), p=0.006, I
2
=0%] (p<0.05 compared to others). SGLT-2 inhibitors were associated with a 25% relative risk reduction in the composite outcome of CV mortality or CV hospitalization in patients with history of AF [RR 0.75 (0.62-0.90)] and 27% in patients with no history of AF [RR 0.73 (0.66-0.81)].

Conclusion:
SGLT-2 inhibitors prevent adverse cardiovascular outcomes regardless of baseline AF status. The protective effects of SGLT-2 inhibitors in preventing AF appear limited to Dapagliflozin.
Abstract 14114: Sodium-glucose Cotransporter-2 Inhibitors Benefit Cardiac Diastolic Function
Authors: Madgula Anantha , Chen Kai
Published: November 2020

Introduction:
Sodium-glucose Cotransporter-2 (SGLT-2) inhibitors are drugs with profound interest because of their beneficial effect on multiple organ systems, including the cardiovascular and renal systems. Their interplay with these systems could prove beneficial in managing complex conditions like heart failure with preserved ejection fraction. We sought to compare cardiac diastolic function in patients on SGLT-2 inhibitors with those on metformin.

Methods:
Data were collected retrospectively after approval from our institutional review board. The study group included patients on SGLT-2 inhibitors (n=75), and the control group had patients on metformin (n=82), primarily for diabetes mellitus. Patients with ejection fraction less than 50% were excluded from the study. Data collected included age, systolic blood pressure (SBP), left ventricular (LV) ejection fraction, LV and left atrial dimensions, and diastolic parameters. Mean values, along with standard deviation, were calculated. Multivariate regression analysis for diastolic function was performed while adjusting for confounders, including age, body mass index, and SBP.

Results:
Study group showed better diastolic function as evidenced by significantly higher e’ medial (6.8 v/s 6.16 cm/s; p = 0.03) and e’ lateral (9.8 v/s 7.9 cm/s; p=0.008) when compared to the control group. E/e’, a marker of pulmonary capillary wedge pressure, was lower in the study group (12.87 v/s 14.36; p=0.08); however, it did not reach statistical significance. LA volume index was significantly lower in the study group, suggestive of favorable hemodynamic status (26.5 v/s 29.6 mL/m
2
; p=0.03). SBP was significantly lower in the study group (127 v/s 135 mm Hg; p=0.01). Multivariate regression model demonstrated SBP as a significant confounder that contributed to e’ (average) difference between the two groups.

Conclusions:
SGLT-2 inhibitors favored better diastolic measurements when compared with metformin alone. The mechanism may be attributed to its BP-lowering effect. A larger prospective study is required to determine the role of SGLT-2 inhibitors.
Abstract 14124: Characteristics and Outcomes of Severe Hypercholesterolemia in Patients With St-segment Elevated Myocardial Infarction
Authors: Groth Nicole , Benziger Catherine P
Published: November 2020

Background:
Patients with severe hypercholesterolemia (SH) are at increased risk of developing cardiovascular disease. The aim of this study was to examine the characteristics and outcomes of ST-segment elevated myocardial infarction (STEMI) patients with SH.

Methods:
We used the Essentia Health (EH) ST-segment elevated myocardial infarction (STEMI) database including all consecutive STEMI activations between 5/01/2009-6/24/2019 (n=2,711). We excluded false-positive events non-type I myocardial infarctions that did not meet non-obstructive coronary artery criteria (N=455). The study population was divided into SH or non-SH based on having a prior LDL-c ≥ 190 mg/dL since 01/01/2000.

Results:
Among the study population of 2,256 STEMI patients, a total of 152 patients had SH. The mean age was similar for SH patients and the non-SH group (63.1 ± 11.1 vs 63.6 ± 12.8 years, respectively), but patients without SH were significantly more likely to be male (70.5%, p<0.001). There were similar co-morbidities in both groups, but the SH group was more likely to be current smokers and less likely to be hypertensive. We identified at least one risk factor for STEMI in 99.5% of all patients and two or more in 40.6%. Of those in the SH group, 63.2% were on a high-intensity statin, 9.9% on ezetimibe and 4.6% a proprotein convertase subtilisin-kexin type 9 inhibitor. Highest ever low-density lipoprotein (LDL) was 217.0 ± 30.3 mg/dL and most recent was LDL 117.5 ± 50.6 mg/dL in the SH group. Mean percentage LDL lowering was 47.2% ± 22.1 and only 15.8% (n=24) had a most recent LDL <70 mg/dL. SH patients were less likely to die in the hospital, at 30 days, and at 1 year after event, compared to patients without SH (p<0.001).

Conclusion:
Nearly 85% of SH patients do not have their LDL treated to goal. Having SH did not predict mortality or readmission after STEMI. Further studies on secondary prevention are warranted.
Abstract 14127: BET Protein Inhibitor Apabetalone Suppresses Inflammatory Hyperactivation of Monocytes From Patients With Cardiovascular Disease and Type 2 Diabetes
Authors: Wasiak Sylwia , Dzobo Kim , Rakai Brooke , Kaiser Yannick , Versloot Miranda , Bahjat Mahnoush , Stotz Stephanie , Fu Li , Sweeney Michael , JOHANSSON Jan , Wong Norman , Stroes Erik , Kroon Jeffrey , Kulikowski Ewelina
Published: November 2020

Introduction:
Hyperactivation of the monocyte inflammatory response is partly controlled by epigenetic mechanisms and contributes to atherosclerotic plaque formation in patients with cardiovascular disease (CVD) and type 2 diabetes mellitus (DM2).

Hypothesis:
Monocyte activation in DM2+CVD is regulated by bromodomain and extraterminal (BET) epigenetic readers and can be inhibited by apabetalone - a clinical stage BET inhibitor.

Methods:
CD14+ monocytes from 14 DM2+CVD patients and 12 matched control subjects were treated
ex vivo
with 25 μM apabetalone ± 25 U/mL interferon γ (IFNγ) for 4h or 24h. Expressed genes (180) were analyzed with the Nanostring™ Innate Immunity Panel. Secreted cytokines were immunoprofiled with a Milliplex® array (42). Bioinformatics were performed with Ingenuity® Pathway Analysis (IPA®) software.

Results:
Unstimulated DM2+CVD monocytes had higher
IL1A
,
IL1B
and
IL8
cytokine gene expression and Toll-like receptor (TLR) 2 surface abundance than control monocytes, indicating proinflammatory activation.
Ex vivo
apabetalone treatment reduced
IL1A
and
IL8
mRNA (p<0.001), as well as MCP-1, MCP-3, GRO-α, and IL-8 secretion (p<0.01), countering the pro-inflammatory activation of DM2+CVD monocytes. Further, DM2+CVD monocytes were hyperresponsive to
ex vivo
stimulation with IFNγ, upregulating genes within cytokine and NF-κB pathways (
TNF
,
CCL7
,
CCL8
,
MYD88
,
RELA
) >30% more than controls (p<0.05). Apabetalone countered IFNγ hyperresponsiveness by reducing expression of overexpressed genes by up to 30% more in DM2+CVD monocytes versus controls (p<0.01).
Ex vivo
apabetalone treatment also countered IFNγ induced secretion of IL-1β and TNFα in DM2+CVD monocytes (p<0.01). Consistently, IPA® analysis of immune gene signatures post IFNγ stimulation in both cohorts predicted a more prominent reduction of Toll-like receptor and cytokine pathways by apabetalone in the diseased state.

Conclusions:
Monocytes isolated from DM2+CVD patients receiving standard of care therapies are in a hyperinflammatory state and hyperactivate upon IFNγ stimulation. Apabetalone treatment diminishes this proinflammatory phenotype, providing mechanistic insight into how BET protein inhibition may reduce CVD risk in DM2 patients.
Abstract 14129: Evaluation of Determinant Factors for Delirium in Patients With Acute Coronary Syndrome
Authors: Ono Yasuko , Fujita Yuna , Tashiro Yumi , Onishi Nonami , Moriyama Shiho , Yamada Takeshi , Mizuguchi Yukio , Takahashi Akihiko
Published: November 2020

Background:
The development of delirium in the intensive care unit (ICU) is associated with increased mortality, prolonged ICU stays, and the development of post-ICU cognitive impairment. There is a paucity of data on factors contributing to the development of delirium in patients with acute coronary syndrome (ACS), who usually have several comorbidities and are subjected to various treatment-related risk factors with impaired cardiac function. This study aimed to identify factors contributing to delirium among patients with ACS.

Methods:
We retrospectively investigated 185 patients with ACS who were consecutively hospitalized in coronary care units (CCU) of a hospital between January 2017 and March 2019. We divided the 185 patients into two groups (delirium and non-delirium) according to the presence or absence of delirium. Delirium was defined as experiencing any one of following symptoms: 1) contradictory conversation, 2) self-removal of drip infusion, 3) impaired orientation, 4) restlessness, 5) delusions and hallucinations, and 6) inability to stay quiet.

Results:
Compared to the non-delirium group, the delirium group was older (80.2±8.8 vs. 65.8±11.0 years old,
p
<0.001); more likely to be living alone, having cerebrovascular disease, and lower left ventricular ejection fraction (43.2 vs. 22.7 %,
p
=0.008; 25.0 vs. 10.6 %,
p
=0.017; 49.8±11.7 vs. 54.7±13.4 %,
p
=0.022, respectively); and more likely to have any one of the central lines, including central venous line, intra-aortic balloon pump, arterial line, and temporary pacing (31.8 vs. 12.8 %,
p
=0.004). Multivariate logistic regression analyses indicated that age and living alone were independent predictors of delirium (OR 1.16, 95% CI 1.10-1.23, p<0.001; and OR 2.68, 95% CI 1.05-6.85, p =0.04, respectively).

Conclusion:
In this study, 23.8% patients with ACS who were hospitalized in CCU suffered from delirium. Results revealed that age and living alone were independent predictors of delirium. However, more attention must be focused on not only physical factors but also social factors to prevent delirium in hospitalized patients with ACS.
Abstract 14130: Effect of Angiovac on Right Ventricular Function Following Removal of Right Atrial Masses in Patients With and Without Malignancy
Authors: OBrien Daniel P , Callese Tyler E , Moriarty John , Yang Eric
Published: November 2020

Introduction:
The AngioVac thrombectomy system (AngioDynamics Inc, Queensbury, NY) is an FDA approved device for removal of thrombi and emboli. Prior studies have shown procedural success for removal of right atrial (RA) and caval masses. This study aims to assess the effect of AngioVac on right ventricular (RV) function in patients undergoing removal of RA masses.

Methods:
Retrospective institutional study of patients undergoing removal of RA masses with AngioVac at a single tertiary medical center were included. Right ventricular fractional change (RVFC) and tricuspid annular plane systolic excursion (TAPSE) values were collected from echocardiograms before and after AngioVac or obtained manually if not present in the report. Paired 2-sample t test was done to assess for a significant difference between the two values.

Results:
The mean difference in RVFC before and after AngioVac was 1.6%, with a p-value of 0.327. Ten of the 28 patients had active malignancy, with a mean difference in RVFC of 0.8% and a p value of 0.683. The mean difference in the TAPSE group was 0.07mm and a p value of 0.48. Eight of the 19 patients had active malignancy, with a mean difference in TAPSE of 0.2mm corresponding to a p-value of 0.24. There was no significant difference in left ventricular ejection fraction before and after AngioVac (mean difference of 2.5%, p-value of 0.11).

Conclusions:
These findings suggest that use of the AngioVac device for removal of RA masses does not cause significant derangements in RV function by echocardiographic assessment. It is a well-tolerated procedure in patients with preprocedural normal RV function. These findings also further assess the use of AngioVac in patients with both right sided cardiac masses and active malignancy.
Abstract 14142: Revascularization in Very Elderly Patients With Left Ventricular Dysfunction Suffering From Acute Myocardial Infarction
Authors: Phan Derek , ROSTOMIAN Ara , Lee Mingsum , moore naing a , mansukhani prakash , aharonian vicken , Brar Somjot S , Zadegan Ray
Published: November 2020

Introduction:
There is limited data on the benefits of revascularization in very elderly patients with left ventricular (LV) dysfunction and coronary artery disease (CAD). Hence, we sought to evaluate the role of coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in very elderly patients with LV dysfunction who present with acute myocardial infarction (AMI).

Methods:
Retrospective study of patients ≥ 80 years old with LV ejection fraction (LVEF) ≤ 40% referred for invasive coronary angiography for AMI at Kaiser Permanente Los Angeles Medical Center between June 2009 and February 2019. Patients were grouped by treatment: PCI, CABG, or medical therapy. Inverse Probability Treatment of Weighting (IPTW) was utilized.

Results:
A total of 480 patients (average age 84.1±3.3years, 30% female) were analyzed. Of these, 206 (42.9%) underwent PCI and 46 (9.6%) underwent CABG. Compared to medical therapy, those revascularized were less likely to have any chronic total occlusion, prior strokes, diabetes, CAD, peripheral vascular disease, atrial fibrillation, and prior CABG; and more likely to have had prior PCI and higher LVEF. Median follow-up was 24.9 months (interquartile range 7.7-48.7months), After IPTW adjustment, revascularization was associated with a reduction in mortality (Hazard Ratio [HR] 0.72, 95% Confidence Interval [CI] 0.61-0.85) and non-fatal MI (HR 0.58, 95% CI 0.44-0.76). Both PCI and CABG were associated with reduced mortality (PCI: HR 0.75, 95% CI 0.63-0.90; CABG: HR 0.51, 95% CI 0.40-0.66) and non-fatal MI (PCI: HR 0.65, 95% CI 0.49-0.85; CABG: HR 0.28, 95% CI 0.16-0.48). Compared to CABG, there were no differences in mortality (HR 1.27, 95% CI 0.96-1.67), but increased non-fatal MI events (HR 3.81, 95% CI 1.82-8.0) with PCI.

Conclusion:
In very elderly patients with LV dysfunction, revascularization is superior to medical therapy. There were no differences in mortality between PCI and CABG, but PCI was associated with increased non-fatal MI events.
Abstract 14156: Automated Electronic Medical Record Mapping to Identify Acute Precipitants of Atrial Fibrillation and Oral Anticoagulation Use
Authors: Sardana Mayank , Shi Qiming , Saleeba Connor , Paul Tenes , Kapoor Alok , Wang Ziyue , Lubitz Steven A , McManus David
Published: November 2020

Introduction:
Atrial fibrillation (AF) that is associated with acute precipitants frequently recurs and is associated with long-term morbidity and mortality. Leveraging a large electronic medical record (EMR) database, we previously reported the performance of an automated EMR-based algorithm to identify the acute precipitants of newly detected-AF, but its validation in other databases has not been performed.

Hypothesis:
Modified EMR-based algorithm would accurately identify acute precipitants of AF and oral anticoagulation (OAC) use after AF diagnosis

Methods:
Among all records (inpatient/outpatient/ER) in a single-institution EMR (10/1/17 - 12/31/19), we first identified 4493 records documenting newly-diagnosed AF (ICD 10: I48). We then applied the modified EMR-based algorithm to identify 13 acute AF precipitants (within 30 days of AF diagnosis, Figure 1) and determine OAC use after an AF diagnosis. We manually adjudicated a random subset of identified records (892 of 4493) to derive performance metrics of the EMR algorithm.

Results:
Of 4493 records with newly-diagnosed AF, the algorithm identified ≥1 acute precipitant in 831 records and ≥2 precipitants in 206 records. The most common precipitants were respiratory failure (38%) and pneumonia (35%). Among patients with CHADS2Vasc ≥2, 44% with an acute precipitant were prescribed an OAC vs. 63% free from a precipitant after initial AF diagnosis. EMR algorithm accurately identified the precipitants and OAC use after AF diagnosis (PPV 89% for both, Figure 1).

Conclusions:
In this validation study, our novel EMR-based automated algorithm was highly accurate at identifying acute precipitants of AF and OAC use after AF diagnosis. We also observed differential rates of OAC use between those with and without an acute precipitant. Application of the algorithm to multi-institutional datasets could help map the gaps in care (e.g., OAC use) AF patients with acute precipitants often experience.
Abstract 14170: Reduction in Venous Thromboembolism With Rivaroxaban versus Placebo in Peripheral Artery Disease After Lower Extremity Revascularization: Insights From VOYAGER PAD
Authors: Hess Connie N , Anand Sonia , Bauersachs Rupert , Patel Manesh R , Debus E. Sebastian , Nehler Mark R , Capell Warren H , Diao Lihong , Muehlhofer Eva , berkowitz Scott , Haskell Lloyd P , Hiatt William R , Bonaca Marc P
Published: November 2020

Background:
Prior studies suggest that atherosclerotic vascular disease may be associated with risk of venous thromboembolism (VTE), though the relationship remains uncertain and has not been well-studied in peripheral artery disease (PAD) after lower extremity revascularization (LER).

Hypothesis:
We hypothesized that patients with PAD undergoing LER are at risk for VTE and that this risk may be reduced by low-dose rivaroxaban plus aspirin versus aspirin alone.

Methods:
VOYAGER PAD randomized 6,564 PAD patients undergoing LER to rivaroxaban 2.5 mg twice daily or placebo on a background of aspirin 100 mg daily. Clopidogrel was allowed for up to 6 months. Patients could not be enrolled if they had an indication for therapeutic anticoagulation, including secondary prevention of VTE. Symptomatic VTE was a prespecified secondary endpoint.

Results:
Over a median of 28 months, there were 66 patients with VTE. In patients randomized to placebo, risk for VTE accrued steadily after randomization at a rate of ~0.5% per year resulting in a 3-year rate of 1.66%. Compared with placebo, rivaroxaban reduced the risk of VTE by 39% (HR 0.61, 95% CI 0.37-1.00, p=0.047), with benefit apparent early and sustained over time (Figure). The efficacy of rivaroxaban was not modified by use of clopidogrel at randomization (without clopidogrel HR 0.55, 95% CI 0.29, 1.07; with clopidogrel HR 0.69, 95% CI 0.32, 1.48; p-interaction = 0.67).

Conclusions:
PAD is associated with continuous and linearly increasing risk for VTE after LER. A strategy of low-dose rivaroxaban plus aspirin versus aspirin alone reduced this risk by 39% with benefits apparent early and continued over time. The addition of clopidogrel does not modify this benefit. VTE, along with arterial thrombotic events, is part of the adverse thrombotic risk profile in PAD patients, and low-dose rivaroxaban plus aspirin provides protection against venous and arterial thrombosis.