bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 16045: Buprenorphine and Methadone Treatment is Associated With Less Heart Failure Hospitalizations in Patients With Opioid Use Disorder
Authors: Tysarowski Maciej , Kazmi Maryam , Barai Rakhee , Efobi Ranye , Matassa Daniel , Gordon Emily
Published: May 2021

Introduction:
Patients with opioid use disorder (OUD) who receive medication for opioid use disorder (MOUD), either buprenorphine or methadone, have decreased all-cause and overdose mortality. Although in patients with congestive heart failure, OUD is associated with a greater number of heart failure hospitalizations (HFH), no studies were conducted on the outcomes of MOUD in this population.

Hypothesis:
We hypothesized that in patients with OUD and congestive heart failure, MOUD is associated with a decreased number of HFH.

Methods:
We retrospectively reviewed records of patients treated at the Rutgers NJMS Ambulatory Care Center, diagnosed with both heart failure and opioid use disorder between 2016 and 2018. We conducted multivariate linear regression to identify predictors of HFH.

Results:
Among 91 included patients, 60% were male, mean age was 58 ± 7 years old. The majority (75%) of patients were of African American ethnicity. Mean left ventricular ejection fraction (LVEF) was 41 ± 18%; 32% patients had preserved, 22% had mid-range and 46% had reduced LVEF. Over the 2-year period, 57% of patients were treated with buprenorphine, and 76% with methadone - a total of 87% of all patients were on MOUD. Less than half (37%) of the patients had medical insurance. Median number of HFH was 2.0 (IQR 0.0 - 8.5). In multivariate analysis (
table
), number of HFH correlated positively with the presence of insurance (β = 4.02 [95% CI 1.06 to 6.98], p = 0.008) and number of missed appointments (β = 0.33 [95% CI 0.11 to 0.55], p = 0.003), and negatively with MOUD (β = –5.41 [95% CI -9.52 to -1.31], p = 0.01). HFH were not associated with LVEF (p = 0.746), diastolic dysfunction (p = 0.855) or age and gender.

Conclusions:
In patients with OUD and congestive heart failure, MOUD is independently associated with less HFH and is one of its strongest predictors. Expanding access to methadone and buprenorphine appears to be critical in improving the quality of care of this vulnerable and underserved population.
Abstract 16053: Impact of COVID-19 Pandemic on Cardiology Fellowship Echocardiography Training
Authors: Varghese Merilyn S , Kannam Joseph P , Riley Marilyn , Manning Warren J
Published: May 2021

Introduction:
Training in the acquisition and interpretation of echocardiograms is integral to cardiovascular disease fellowship training. The American Society of Echocardiography recommends 150 transthoracic echo (TTE) scans and 300 interpretations for level 2 training.

Hypothesis:
The COVID-19 pandemic led to the temporary restructuring of many fellowship programs. At our institution, fellows not involved in essential clinical rotations served in a backup capacity or were re-assigned with the onset of the Massachusetts stay-at-home advisory on March 15, 2020. A one-hour mid-day Zoom TTE reading session was offered when fellows were available. We hypothesized that these restrictions would impact fellow education in TTE scanning and interpretation volumes.

Methods:
We examined the number of TTE performed or interpreted by F1 and F2 fellows between July 2017 and June 2020 as recorded in our echo lab electronic database.

Results:
In the 21 months prior to the onset of the COVID-19 pandemic, 45 + 1 TTE scans/wk were performed by fellows which was reduced to 9 + 3 scans/wk (-80%, p<0.01) during the pandemic. The average number of F1 and F2 TTE interpretations also fell from 64 + 2/wk to 27 + 5 (-58%, p<0.01). When evaluating scans by year of training (see Table), the 2019-2020 F1s and F2s will have the lowest TTE scan and interpretation volumes compared to prior two academic years (F1: -14% scanning, -28% interpretations, F2: - 33% scanning, -10% interpretations).

Conclusions:
By recognizing that there has already been an impact on echo education, fellowship programs will need to optimize fellow exposure and instruction in echocardiography so as to maintain adequate training volumes.
Abstract 16054: Medical Management and Outcomes of Non-obstructive Coronary Artery Disease
Authors: Payne Sarah , Fry Ethan , Michel Jeffrey , Widmer Robert J
Published: May 2021

Introduction:
Non-obstructive coronary artery disease (NOCAD) is associated with increased morbidity and higher medical expenses compared to those without NOCAD. Currently there are no set guideline-directed interventions for this patient population. This study examined the management and subsequent cardiovascular (CV) events in those deemed to have NOCAD.

Hypothesis:
We hypothesized that maximal use of medical therapy would correlate with reduced events.

Methods:
We undertook a retrospective chart review of 1,752 patients who underwent cardiac catheterization from 10/23/2017 through 10/24/2018 at a tertiary care center. NOCAD was defined as patients underwent cardiac catheterization for ischemic symptoms/testing, but did not receive percutaneous coronary or surgical intervention, were not pre-operative, and had at least one year of follow-up post-catheterization. We obtained medications at the time of catheterization as well as subsequent CV testing and events including hospitalizations and emergency department (ED) visits.

Results:
Of the 168 patients diagnosed with NOCAD, 12 patients later suffered a CV event including NSTEMI, heart failure exacerbation, or stroke. Of these patients, 41.7% were not been placed on aspirin, statin, beta-blocker (BB), calcium channel blocker (CCB), aldactone, ACE inhibitor (ACEi), or angiotensin II receptor blocker (ARB). In NOCAD patients on statin therapy there was a reduced utilization of CV testing at one year (43.3% vs 58.7%, p=0.04). Furthermore we note a significant reduction in rehospitalizations and ED visits in those on statin (14.5% vs 29.4%, p=0.02) not seen in patients on aspirin (23.8% vs 20.6%, p=0.63), CCB (22.2% vs 25.0%, p=0.76), aldactone (36.7% vs 19.6%, p=0.05), ACEi/ARB (23.1% vs. 22.2%, p=0.90), and even note a significant increase in events in those on BB (30.3% vs 16.3%, p=0.03).

Conclusions:
While NOCAD is associated with increased morbidity and healthcare utilization, the initiation of statin appears to reduce future CV testing and rehospitalization/ED visits that is not noted with aspirin, BB, CCB, Aldactone, or ACEi/ARB use. Recognition of NOCAD, and initiation of statin therapy could be beneficial in this patient population.
Abstract 16068: Local Anesthesia Using the “Tumescent Technique” versus General Anesthesia for Subcutaneous-implantable Cardioverter Defibirllator Implantation: Description of a Novel Technique
Authors: Romero Jorge , Diaz Juan , Alviz Isabella , Briceno David , Trivedi Chintan , Mohanty Sanghamitra , Patel Kavisha , Della Rocca Dommenico , Burkhardt David , Al-ahmad Amin , Gallinghouse G , Lakkireddy Dhanunjaya , Natale Andrea , Di Biase Luigi
Published: May 2021

Introduction:
General anesthesia is routinely used during the implantation of S-ICD which dramatically prolongs total procedure time, patient recovery time and adds unnecessary potential complications. The tumescent local anesthesia (TLA) technique provides anesthesia of large areas of skin and subcutaneous tissue by means of the direct infiltration of large volumes of a dilute local anesthetic solution into subcutaneous fat.

Hypothesis:
TLA during S-ICD implantation is feasible and associated with a reduction in total procedure time.

Methods:
A retrospective analysis was conducted in two medical centers during 2019. Five patients underwent S-ICD with TLA due to baseline conditions that represented relative contraindications to general anesthesia (e.g, muscular dystrophy). A large volume of a local anesthesia solution (i.e., 1 liter of normal saline, 30 cc of 1% lidocaine, 30 cc of bupivacaine, 1 mg of epinephrine, 12.5 mEq of sodium bicarbonate) was used in each patient and injected 10 minutes prior to incisions. Five other patients who underwent S-ICD under general anesthesia served as controls. The skin-to-skin time, total length of procedure and post-procedural pain levels were compared between groups.

Results:
A total of 10 patients were included (male: 60%; mean age: 62 ± 16). All devices were implanted for primary prevention of sudden cardiac death. TLA was considered the best anesthetic approach in five patients who had medical conditions that represented a high risk of complications if general anesthesia was employed. In the group of TLA, an average of 260 ± 45 cc was administered. The skin-to-skin times were 44.8 ± 13.9 minutes in patients who underwent general anesthesia vs. 46.2 ± 14.3 minutes in TLA (p = 0.3). The total procedural time was 148 ± 28 min vs 64.2 ± 13.4 min (p <0.001) for general anesthesia and TLA, respectively. There was a significant difference between groups in pain scale following the procedure being better pain control with TLA.

Conclusions:
S-ICD implantation using TLA appears to be a feasible and safe option in patients with contraindications to general anesthesia. This technique significantly decreases total procedure time with better post-procedural pain control.
Abstract 16072: Clinical Outcomes of Catheter Ablation for Left Ventricular Summit/intramural Premature Ventricular Contractions Comparing Conventional vs. Fluoroless Techniques
Authors: Romero Jorge , Diaz Juan C , Alviz Isabella , Briceno David , Trivedi Chintan , Mohanty Sanghamitra , Velasco Alejandro , Patel Kavisha , Della Rocca Domenico G , Burkhardt David , Al Ahmad Amin , Gallinghouse G , Lakkireddy Dhanunjaya , Natale Andrea , Di Biase Luigi
Published: May 2021

Introduction:
Radiofrequency catheter ablation (CA) is the preferred treatment for premature ventricular contractions (PVCs). Ionizing radiation has major side effects for both patients and personnel in the electrophysiology laboratory. Fluoroless procedures are routinely performed for atrial fibrillation and simple PVC cases. Nonetheless, left ventricular (LV) summit/intramural PVCs cases are more challenging and clinical outcomes and complications have been poorly studied in this category with the use of fluoroless ablation.

Hypothesis:
We aimed to compare acute, long-term success rate and complications between fluoroless procedures versus standard approach for left ventricular (LV) summit/intramural PVCs.

Methods:
We conducted a retrospective analysis of patients who underwent PVC ablation under fluoroscopy and non-fluoroscopy at two institutions.

Results:
A total of 41 cases were enrolled (male: 61%; mean age: 55 ). Twenty-five cases underwent ablation under fluoroscopy whereas 16 underwent non-fluoroscopy ablation. Acute success was seen in 88% of non-fluoroscopy cases compared to 87.5% in the fluoroscopy group (
p
= 0.9). The PVC recurrence at 12 months was similar between both groups (non-fluoroscopy: 15% vs Fluoroscopy: 18%) (
p
= 0.9). No complications occurred in any group.

Conclusions:
Fluoroless CA is an emerging technique in the treatment of LV summit/intramural PVCs that appears to have similar clinical outcomes and complications compared to conventional fluoroscopic procedures.
Abstract 16083: Risk of Preserved versus Reduced Ejection Fraction in Women With and Without History of Breast Cancer: The Pathways Heart Study
Authors: Rana Jamal S , Greenlee Heather , Cheng Richard , Laurent Cecile A , Shen Hanjie , Roh Janise M , Lee Valerie S , Neugebauer Romain S , Hershman Dawn L , Kushi Lawrence H , Nguyen-huynh Mai N , Iribarren Carlos , Kwan Marilyn L
Published: May 2021

Introduction:
Incidence of heart failure (HF), specifically with preserved ejection fraction (HFpEF), is rising in the general population, yet is understudied. To provide a population-based estimate of HF in breast cancer (BC) survivors, we compared risk of HF in women with and without BC history in the Kaiser Permanente Northern California (KPNC) integrated health system.

Methods:
Data were extracted from KPNC electronic health records. All invasive BC cases diagnosed from 2005-2013 were identified and matched 1:5 with non-BC controls on birth year, race/ethnicity, and KPNC membership at BC diagnosis. Cox regression models assessed the hazard of HF by EF status: HFpEF (EF ≥ 45%), HF with reduced EF (HFrEF; EF < 45%), and unknown EF. Women with prior history of HF were excluded. Models were adjusted for factors known to affect BC risk or CVD and for prevalent CVD at BC diagnosis. We also examined case subgroups who received cardiotoxic chemotherapy, left-sided radiation therapy, and/or endocrine therapy, versus their controls.

Results:
A total of 14,804 women diagnosed with invasive BC and with no history of HF were identified and matched to 74,034 women without BC history. Women were on average 61 years at BC diagnosis and 65% white. Women with HFpEF were older and more likely to have hypertension (p<0.05). Among all cases vs. controls, there was increased risk of HFrEF (HR: 1.5, 95% CI: 1.18, 1.98) but not HFpEF or unknown EF (figure). Compared to their controls, women treated with chemotherapy were more than 3-times likely to develop HFrEF (HR: 3.26, 95% CI: 2.2, 4.8) and more than 1.5-times likely to develop HFpEF (HR=1.61, 95% CI: 1.15, 2.24). Women who received left-sided radiation therapy had nearly double the risk of developing HFrEF (HR=1.85, 95% CI: 1.20, 2.84). No associations were found among women who received endocrine therapy.

Conclusions:
Increased surveillance is warranted for women with BC receiving cardiotoxic chemotherapy for development of both HFrEF and HFpEF.
Abstract 16121: Wellness in Pediatric Cardiac Intensivists - How are We Doing?
Authors: Werho David K , rhodes leslie , Horak Robin , Marino Bradley S , Cooper David S , Cabrera Antonio G , Costello John M , Bai Shasha , Tan Yubo , Tabbutt Sarah , Krawczeski Catherine D
Published: May 2021

Introduction:
Poor physician wellness is associated with detrimental effects on patient outcomes. There are no data on physician wellness in pediatric cardiac critical care. We aimed to define the prevalence of and risk factors for impaired wellness using a targeted survey of the North American pediatric cardiac critical care workforce.

Methods:
We developed a survey to examine physician wellness and potential risk factors, incorporating the Expanded Physician Well Being Index. Unit directors at 120 congenital heart surgery centers were contacted to provide faculty emails. The survey was distributed to each faculty with targeted reminders from June - September 2019. Univariate and multivariable logistic regression analyses were performed comparing the at-risk respondents to those not at risk for poor wellness.

Results:
Of the 477 faculty, 294 completed the survey (62%). Faculty reported working a median of 83 hours on service weeks and 50 hours on non-service weeks. Based on Well-Being scores, 34% were in the “at risk” category; 56% reported feeling burned out in the past month and 46% reported feeling overwhelmed. However, 96% felt their work was meaningful. Faculty reported a high incidence of developing unhealthy habits including poor nutrition (50%), infrequent exercise (56%), and lack of self-care (46%). Factors associated with well-being risk are shown in Table 1. Poor interpersonal experiences, higher work hours, and being primarily trained in critical care with an additional cardiac year were associated with risk of poor wellness. Working >100 hours per service week had a significant increase in risk (odds ratio 2.3, 95% confidence interval 1.31-4.40). Availability of wellness services was associated with reduced risk.

Conclusion:
Burnout and risk of poor wellness are common in pediatric cardiac critical care faculty. Modifiable factors, including wellness service availability and reduced hours of clinical service may improve wellness in the workforce.
Abstract 16128: Association Between Timing of Readmission and Risk of 1-year Mortality Among Patients After Hospitalization for Heart Failure in China: Findings From the China-PEACE Prospective Heart Failure Study
Authors: Ge YILAN , Wang Bin , li jing , zheng xin
Published: May 2021

Introduction:
Although 30-day readmission has been used as a quality metric for treatment of patients hospitalized for heart failure (HF), the association between the timing of readmission with mortality after discharge has been scarcely investigated.

Methods:
We studied a national sample of 4875 patients admitted to 52 hospitals for HF between 2016 and 2018 who were discharged alive from the China PEACE-Heart Failure Study. The timing of readmission was defined as the timing of first readmission from all cause after discharge. Mortality analyses across the timing of readmission were performed using Kaplan-Meier curves and log-rank tests. The associations between the timing of readmission and 1-year all-cause mortality was determined using Cox models.

Results:
The median participant age was 67 (57-76) years, and 37.5% were female. The median duration from discharge to readmission was 88 (28-194) days. Kaplan-Meier analysis revealed 1-year mortality did not differ between patients admitted within 0-30 and 31-60 days, and between patients admitted within 61-90 and 91-180 days after discharge (Figure1A). Then we classified the timing of readmission as early (0-60 days), midrange (61-180 days) and late (181-365 days). The 1-year all-cause mortality for patients experiencing early, midrange and late readmission was 31.8%, 23.2% and 12.0%, respectively (Figure1B). After adjusting for patient characteristics and treatment during hospitalization, the HR for 1-year all-cause mortality was 2.89 (95% CI 2.22-3.77) for patients with early readmission, and 2.07 (95% CI 1.56-2.75) for patients with midrange readmission when compared with patients with late readmission, respectively.

Conclusions:
Earlier readmission are associated with increased risk for 1-year all-cause mortality. Not only 30-day readmission but also readmission within 60 days after discharge could be perceived as an alarming sign of higher risk of death in patients with hospitalized HF in China.
Abstract 16136: Underutilization of Appropriate Testing for Transthyretin Amyloidosis Despite Suspicious Clinical & Echocardiographic Findings
Authors: Young Katelyn , Banerjee Kinjal , Patel Maulin , Prabhakar Bhat Sangeeta , Reynolds Colin , Haggerty Christopher M , Carry Brendan
Published: May 2021

Introduction:
Both hereditary (hATTR) and wild-type (wtATTR) transthyretin amyloidosis are under-recognized causes of cardiomyopathy (CM) and heart failure. Certain findings on Transthoracic Echocardiography (TTE) and cardiac Magnetic Resonance Imaging (cMRI) are suggestive but not diagnostic of ATTR. Although biopsy historically has been the gold standard for diagnosis, patients can be diagnosed with the highly sensitive and specific technetium-99m pyrophosphate scan (Tc-99m PYP). Genetic testing is recommended to confirm hATTR in patients diagnosed with ATTR cardiac amyloidosis. Despite growing awareness of this condition, many cases remain undiagnosed. This study evaluated if patients with TTEs concerning for infiltrative CM received appropriate diagnostic testing for ATTR-CM.

Methods:
Our echocardiography registry was queried from January 2011 to March 2020 for patients with our echo lab’s embedded infiltrative CM code. Data on demographics, comorbidities, TTE variables, cMRI results, PYP scans, genetic testing and biopsy results were retrieved from electronic medical records. Thorough manual chart review excluded other causes of CM. Data was expressed as mean ± SD and n (%).

Results:
We retrieved 510 patients (mean age 64 ± 16 years; 43% female) with TTEs suspicious for infiltrative CM revealing a mean interventricular septal diameter (IVSd) of 1.6 ± 0.3 cm. Only 67 (13%) patients underwent cMRI with 11 (16%) suggestive of cardiac amyloidosis. Of the patients with suspicious TTEs, 16 (3.1%) had PYP scans and 24 (4.7%) had tissue biopsy, with positive results in 7 (44%) and 11 (46%), respectively. Genetic testing in 31 (6%) patients revealed known hATTR mutations in 2 (6.5%) patients. Cardiac amyloidosis was diagnosed in 23 (4.5%) with 11 ATTR (2 hATTR), 5 amyloid light chain, and 7 unknown subtype.

Conclusion:
Despite clinical and TTE findings suspicious for ATTR-CM, many patients did not undergo appropriate confirmatory testing (see Figure 1).
Abstract 16138: Validation of a Non-invasive Approach for the Assessment of Left Ventricular-arterial Coupling Following Transcatheter Aortic Valve Replacement
Authors: Mogadam Emad , Shavelle David , Liu Jing , Giesler Gregory , Matthews Ray , Pahlevan Niema M
Published: May 2021

Introduction:
Transcatheter aortic valve replacement (TAVR) is an established treatment for patients with severe, symptomatic aortic stenosis (AS). Ventriculoarterial (LV-arterial) coupling defined as the ratio of total arterial elastance (Ea) to left ventricular end-systolic elastance (Ees) reflects effective cardiac energetics and is a well-accepted index for quantification of LV-arterial coupling. Despite its usefulness, estimating Ees/Ea has technical difficulties. Intrinsic Frequency (IF) method is a noninvasive and single waveform system-based approach for quantification of LV-arterial coupling. The objective of this study was to compare IF variables with Ea/Ees in predicting optimum LV-arterial energetics following TAVR.

Method:
Twenty-eight patients with severe AS, undergoing TAVR were included. Mean age was 85±4, 53% male with mean ejection fraction 59±6.4. IFs during systole (ω1), diastole (ω2), and total IF variation (Δω=ω1-ω2) were computed from the ascending aortic pressure waveforms at baseline and following TAVR. Ea/Ees was computed using single-beat technique proposed by Takeuchi
et al.
(
Circulation
. 1991;83(1):202-212).

Results:
There was a significant decrease in Ea/Ees (p<0.001) toward optimum coupling immediately after TAVR (Figure 1a). There was a statistically significant correlation between Ea/Ees and Δω (r= 0.68, p<0.01) (Figure 1b).

Conclusion:
IF appears to be an accurate and reliable index for quantification of LV-arterial coupling given significant concordance with Ea/Ees. The management of patients with acutely altered hemodynamic states post TAVR can benefit from the assessment of LV-arterial coupling. Since IFs can be measured noninvasively using hand-held devices (e.g. an iPhone), this approach should broaden the clinical applicability of this useful parameter for assessing systolic function, therapeutic response and ventricular-arterial interaction post TAVR.
Abstract 16141: Women Have More Bleeding Events and Intracranial Hemorrhage Than Men Post LVAD Implantation
Authors: Vellanki Nirupama , kennedy kevin , Grandin Edward W , Nunez Jose , Motiwala Shweta R , Quintero Pablo A , Fleming Lisa M , Feinberg Loryn , Garan Arthur Reshad , Sabe Marwa
Published: May 2021

Intro:
Women have been shown to have higher risk of bleeding after adverse cardiovascular events. Bleeding events are a major cause of morbidity and mortality in patients with continuous flow left ventricular assist devices (cf-LVADs). There are few studies that have demonstrated that women with cf-LVADs may be at higher risk of bleeding, however the sex differences in specific bleeding events has not been studied in a large multi-center patient population of patients with cf-LVADs. We sought to investigate the relationship between sex and specific types of bleeding events in patients with cf-LVADs.

Methods:
We included 16,534 patients from the INTERMACS registry, a national multicenter database of patients implanted with cf-LVAD between 2012-2017. Using a cox proportional hazards model, we assessed the relationship between sex and bleeding events after adjusting for relevant covariates*. Bleeding events were further stratified for the type of bleeding including GI bleeding, intracranial hemorrhage, and non-GI/CNS bleeding.

Results:
Women were more likely to have a bleeding event than men post-LVAD implantation (HR 1.19 p<0.0001). While the majority of bleeding events were GI bleeds, there was no significant difference in risk between men and women (p 0.7). After adjusting for covariates, women were more likely to have an intracranial hemorrhage (HR 1.38, p 0.002) and to have non-GI/non-CNS bleeding (HR 1.25, p<0.0001).

Conclusion:
Females are more likely than men to develop bleeding events post cf-LVAD implantation. While there was no significant sex difference in GI bleeding, women were more likely to have intracranial bleeding and non-GI/non-CNS bleeding.
Abstract 16151: Comparison of Safety and Efficacy of Transradial versus Transfemoral Percutaneous Coronary Intervention for St Elevation Myocardial Infarction: A Meta-analysis of Randomized Controlled Trials
Authors: Khalid Muhammad , El Iskandarani Mahmoud , Ramu Vijay , Donovan Michael , Forrest Terry , Helton Thomas
Published: May 2021

Introduction:
Studies have shown decreased rates of vascular complications and mortality with Transradial (TR) percutaneous coronary intervention approach for treating patients with acute ST elevation myocardial infarction (STEMI) compared to conventional Transfemoral (TF).

Hypothesis:
This meta-analysis aims to compare the safety and efficacy of TR vs TF approach in the light of recently published data.

Methods:
Electronic databases including MEDLINE, ClinicalTrials.gov and the Cochrane Library were searched for all randomized controlled trials (RCTs) published until April 2020 comparing outcomes of TR vs TF PCI in STEMI patients. End points were all-cause mortality, major bleeding, stroke, major adverse cardiac events (MACE), and vascular complications. The ratio risk ratio (RR) with 95% confidence interval (CI) were computed and p <0.05 was considered as a level of significance.

Results:
A total of 18 RCTs (n=13,516) were included in the final analysis. All-cause mortality (RR: 0.72; CI: 0.59-0.88; p=0.002), major bleeding (RR: 0.53; CI: 0.40-0.70; p<0.0001), MACE (RR: 0.78; CI: 0.69-0.88; p=0.0001), and vascular complications (RR: 0.42; CI: 0.33-0.53; p<0.00001) were decreased in the TR group [Figure 1]. There was a non-significant decrease risk of stroke in TF group (RR: 1.51; CI: 0.81-0.2.83; p=0.20) compared to TR group [Figure 1].

Conclusions:
In patients with STEMI, all-cause mortality, MACE and vascular complications were decreased with TR compared to TF group. Further studies needed to confirm the findings of this meta-analysis.
Abstract 16154: Baseline Left Ventricular Diameter Predicts Recovery in New Systolic Heart Failure Syndromes
Authors: Gold Daniel , Kong Nathan , Gold Matthew , Allan Tess , Shah Anand , Blair John
Published: May 2021

Introduction:
It is unknown how often patients with very advanced left ventricular (LV) dilation at initial presentation demonstrate meaningful recovery with medical therapy. Understanding short term treatment outcomes may impact medical decision making and counseling.

Hypothesis:
Patients with left ventricular end diastolic internal diameter (LVEDD) > 6.5cm will be less likely to recover left ventricular ejection fraction (LVEF) as compared to patients with LVEDD < 6.5cm.

Methods:
Patients were retrospectively identified by a database search of echocardiogram studies obtained at the University of Chicago between 2008-2018. Manual review was performed to ensure new diagnosis of systolic dysfunction with LVEF ≤ 35% and follow up echocardiogram study within 3 to 9 months of index study. LVEDD was determined from parasternal long axis views per routine. LVEF recovery was specified as LVEF > 35%. Chart review was done to assess for composite death, hospice, transplant, left ventricular assist device, and sustained ventricular tachycardia. Chi-square, multivariable logistic regression, and Kaplan-Meier survival were used for analysis.

Results:
Out of 100 patients included for analysis, mean age was 59.7 years, 41 were female and 82 were African American. 17.7% of patients’ with LVEDD > 6.5 cm had LVEF recovery compared to 53.0% of patients’ with LVEDD ≤ 6.5 cm (p = 0.008). LVEDD > 6.5 cm was associated with less LVEF recovery even when adjusted for age, gender, hypertension, and diabetes (adjusted odds ratio 0.18, 95% CI 0.04 to 0.65). LVEDD > 6.5cm was associated with worse event free survival (p = 0.004) with a median follow-up time of 2.4 years.

Conclusions:
An LVEDD of > 6.5cm is associated with diminished LVEF recovery and event free survival when compared to those patients with an LVEDD ≤ 6.5cm. Delaying consideration for advanced therapies and device based therapies in hopes of recovery may be inappropriate for many such patients.
Abstract 16157: Catheter Ablation Induces an Increase in Heart Rate With Discordant With a Decrease in Sympathetic Nerve Activity in Patients With Paroxysmal Atrial Fibrillation
Authors: Mukai Yusuke , Murai Hisayoshi , Hirai Tadayuki , Sugimoto Hiroyuki , Hamaoka Takuto , Okabe Yoshitaka , tokuhisa hideki , Takamura Masayuki
Published: May 2021

Background/Introduction:
Paroxysmal atrial fibrillation (PAF) is the most common arrhythmia and catheter ablation (CA) is selected with the aim of rhythm control. CA was reported to increase heart rate (HR), which explains the modulation on the cardiac autonomic nervous system. However, little is known about the relationship between heart rate, sympathetic nerve activity and parasympathetic nerve activity in patient with PAF.

Purpose:
The purpose of this study was to evaluate the effect of CA on direct recording of muscle sympathetic nerve activity (MSNA) and heart rate variability (HRV), and these influences on HR.

Methods:
This study was conducted as a prospective, observational study. Patients with PAF who were scheduled for CA were enrolled. We measured blood pressure, HR, body weight, brain natriuretic peptide (BNP), echocardiogram parameters, high frequency component as cardiac parasympathetic nerve activity and low frequency component as cardiac sympathetic nerve activity in HRV, and MSNA before and 12 weeks after CA.

Results:
21 PAF patients participated in this study. After CA, E/e’ and Ln BNP were significantly reduced(10.6±2.9 to 9.2±2.6, p<0.05. 3.8±1.3 to 3.3±1.6 log/pg/ml, p<0.05, respectively) while no significant changes were observed in EF, SV, left atrial diameter, left ventricular end diastolic and systolic diameters. HR was significantly increased (61.3±7.8 to 71.1±7.6 beats/min, p<0.05, respectively). However, the MSNA burst incidence and frequency were significantly decreased (65.4±12.6 to 41.3±13.4 bursts/100beats, p<0.01, n=21. 39.8±8.8 to 28.1±9.6 bursts/min, p<0.01, n=21. respectively). Also, the reduction in MSNA burst frequency was correlated with the increase in HR (r=0.57, 95%CI 0.183-0.804, p=0.00702). Ln Low frequency component in HRV was significantly decreased (5.72±1.75 to 3.85±2.13 log/ms
2
, p<0.05, n=12), but Ln high frequency (HF) component was not changed . No significant relationship observed between increased HR and HF component.

Conclusion:
CA induced paradoxical increasing heart rate with the reduction in sympathetic nerve activity in patient with PAF. These findings suggest that CA might modulate autonomic interaction between sinus nodes and in left atrium with denervated in ganglionated plexi.
Abstract 16174: Age, Race, and Gender Related Cardiovascular Morbidity of Patients Hospitalized With Periodontal Disease
Authors: Chehab Omar , Doughan Maria , Z. Morsi Rami , Kanj Amjad , Abdallah Ali , Pahuja Mohit , Doughan Bassel , Abidov Aiden A
Published: May 2021

Introduction:
Periodontal disease (PD) is an acquired disorder characterized by inflammation of the gums, resulting eventually in loss of teeth. Epidemiological studies have shown a link between PD and cardiovascular diseases (CVDs). The aim of this study is to evaluate differences in the prevalence of CVD amongst US patients with PD of different age, race and sex.

Method:
Using the US national in-patient sample database (NIS) from 2005-2014, patients with PD and CVD were identified.

Results:
155,732 hospitalizations with PD were included in the study, of which 36.5% had at least one CVD. Ischemic heart disease was the most prevalent CVD (17.6%), followed by heart failure (10.9%), atrial fibrillation/flutter (10.1%) and cerebrovascular disease (CRVD) (9.7%). The overall in-hospital mortality was higher in PD patients with CVD (2.6% vs 1.2%, p<0.0001). Figure 1C highlights the prevalence of various subtypes of CVD among different gender. When stratifying hospitalized patients with PD and CVD based on race and age, there was higher prevalence of CVD among Asians and Pacific Islanders (42.4%) (Figure 1A-B) and with increasing age (≥70, 56-69, and 18-55; 67.4% vs 50.1% vs 20.3%, p<0.001, respectively). Significant increase trends in the prevalence of AF, HF, and CRVD in the young, middle, and older age group was noted (P-trend<0.001) (Figure1A).

Conclusion:
CVD is prevalent in patients with PD and is more common in males and among Asians and Pacific Islanders. Higher mortality was reported among hospitalized PD patients with CVD. An increase in trend in the prevalence of AF, HF, and CRVD was noted across all age groups. This may require age, race, and gender specific strategies in PD patients for primary prevention of different CVD.
Abstract 16176: Newly Identified MiR-6770-3p Dramatically Induces Angiogenesis in Human Endothelial Cells While Uncommonly Decreasing Cell Proliferation
Authors: Besnier Marie , Tang Owen , Genetzakis Elijah , Finemore Meghan , Di Bartolo Belinda , Figtree Gemma A
Published: May 2021

Micro-RNAs (miRs) are small non-coding RNAs that alter the expression of multiple mRNA targets. Although they participate in physiological processes, dysregulation of their expression is implicated in various diseases. We investigated whether miRs could be involved in the regulation of FXYD1 expression, a sub-unit of the Na+/K+-ATPase pump, that we previously described as both cardio- and vasculoprotective, under oxidative stress conditions. Using in silico analysis, we identified 3 potential miRs that could target FXYD1 mRNA: miR-3178, miR-3960 and miR-6770-3p. Using a FXYD1-3’UTR-luciferase reporter assay, we found that the overexpression of miR-6770-3p in HEK293T cells resulted in the largest reduction in luciferase activity, showing a strong targeting of FXYD1 mRNA. A mutation of the binding site in the 3’UTR of FXYD1 restored luciferase activity, confirming the binding site of miR-6770-3p. Mir-6770-3p is a novel miR that currently has no known function. MiR-6770-3p is the minor strand of its 5p/3p miR duplex in both the human endothelial cell (EC) line, EA.hy.926, and human dermal microvascular (HMVECs). Its overexpression dramatically increased endothelial tube formation in a Matrigel angiogenesis assay (>4 fold change vs. control transfection, p<0.05) and was also associated with a 2-3-fold increase of VEGFR2 and Endoglin mRNA levels, respectively, in both cell types. Conversely, it was also uncommonly associated with a decrease in cell proliferation, suggesting that the pro-angiogenic effect of miR-6770-3p was not due to increased proliferation. Interestingly and contrary to our previous findings, miR-6770-3p was the major strand in Human Umbilical Vein ECs (HUVECs). In this cell type, overexpression of the 3p strand in fact decreased tube formation, while retaining its negative effect on proliferation. The difference in miR major and minor strand may partly explain the differences in functional behaviours in HUVECs, as compared to HMVECs. In conclusion, we have identified a novel miR which has the potential to modulate vessel formation in vitro, and induce critical regulators of angiogenesis; however, further work is required to better understand how this miR performs these functions.
Abstract 16189: Cardiovascular Risk Prediction Using Fully Automated Artificial Intelligence Algorithms for the Assessment of Right Ventricular Function From Cardiac Magnetic Resonance Images
Authors: wang shuo , Patel Hena , Miller Tamari , Ameyaw Keith , Narang Akhil , Chauhan Daksh , Besser Stephanie , Kawaji Keigo , Tang Qiang , Mor-Avi Victor , Amit Patel R
Published: May 2021

Background:
It is unclear whether artificial intelligence (AI) can provide automatic solutions to measure right ventricular ejection fraction (RVEF), due to the complex RV geometry. Although several deep learning (DL) algorithms are available to quantify RVEF from cardiac magnetic resonance (CMR) images, there has been no systematic comparison of these algorithms, and the prognostic value of these automated measurements is unknown. We aimed to determine whether RVEF measurements made using DL algorithms could be used to risk stratify patients similarly to measurements made by an expert.

Methods:
We identified from a pre-existing registry 200 patients who underwent CMR. RVEF was determined using 3 fully automated commercial DL algorithms (DL-RVEF) and also by a clinical expert (CLIN-RVEF) using conventional methodology. Each of the DL-RVEF approaches was compared against CLIN-RVEF using linear regression and Bland-Altman analyses. In addition, RVEF values were classified according to clinically important cutoffs: <35%, 35-50%, ≥50%, and rates of disagreement with the reference classification were determined. ROC analysis was performed to evaluate the ability of CLIN-RVEF and each of the DL-RVEF based classifications to predict major adverse cardiovascular events (MACE).

Results:
The CLIN-RVEF and the three DL-RVEFs were obtained in all patients. We found only modest correlations between DL-RVEF and CLIN-RVEF (figure). The DL-RVEF algorithms had accuracy ranging from 0.59 to 0.78 for categorizing RV function. Nevertheless, ROC analysis showed no significant differences between the 4 approaches in predicting MACE, as reflected by respective AUC values of 0.68, 0.69, 0.64 and 0.63.

Conclusions:
Although the automated algorithms predicted patient outcomes as well as the CLIN-RVEF, the agreement between DL-RVEF and the clinical expert’s measurements was not optimal. DL approaches need further refinements to improve automated assessment of RV function.
Abstract 16207: An Uncommon Pathogen Causing Endocarditis and Valve Abscess: Aerococcus Sanguinicola
Authors: Shankar Aditi , Macnamara James P , Assaf Andrew D , Brockie Robert , King Carter A
Published: May 2021

Introduction:
Aerococcus Sanguinicola is a rare pathogen associated with urinary tract infections (UTI). Widespread use of MALDI-TOF can better differentiate Aerococcus species and has led to the identification of A. Sanguinicola as a source of endocarditis.

Case Presentation:
A 55-year-old male with a history of diabetes mellitus and recent cystitis presented to the hospital with confusion, back pain, fever, chills and myalgias. The patient was tachycardic and hypotensive on exam. Leukocyte count was at 16 k/ul with elevated inflammatory markers. Blood cultures were obtained and empiric vancomycin and cefepime were initiated. Transthoracic echocardiogram revealed mild mitral regurgitation. On hospital day 3, gram stain demonstrated gram positive cocci in clusters, and physical exam revealed a new 3/6 holosystolic murmur in the left 6th intercoastal space. Transesophageal echocardiogram demonstrated acute severe mitral regurgitation and multiple large vegetations with abscess on the anterior leaflet (Figure). Gentamycin was added to treat presumed Staphylococcus Aureus endocarditis. Subsequent species identification revealed A. Sanguinicola as the blood-based pathogen. He underwent bioprosthetic mitral valve replacement due to acute heart failure. Anatomic pathology of the valve confirmed A. Sanguinicola infection. He completed a 6-week course of antibiotics. On his follow up visit at 3 months, the patient had recovered.

Conclusion:
This case demonstrates a severe case of A. Sanguinicola endocarditis requiring urgent valve replacement. A. Sanguinicola is known to generate biofilms, which are activated by plasma which contrasts with S. Aureus, for which A. Sanguinicola can be mistaken. Additionally, known case of A. Sanguinicola infection demonstrate B-lactams sensitivity. While the organism has the potential to form abscesses, we present the first reported case of valvular abscess that was successfully cured with antibiotics and surgery.
Abstract 16213: Short QT Syndrome Case Study
Authors: Charles Lawrenshey , Al-Abcha Abdullah , Kemnic Tyler , Qutrio Baloch Zulfiqar
Published: May 2021

Introduction:
Short QT syndrome (SQTS) is a very rare genetic disease of the electrical system of the heart which is associated with an increase risk of abnormal cardiac rhythms and sudden cardiac death. First described in 2000 with the first genetic mutation associated with SQTS described in 2004. We present a case of Short QT syndrome in a 53 year old male.

Case:
A 53 year old male with a PMH of HTN, alcohol abuse, and tobacco dependence presented to the ED with palpitations. Patient endorsed that he was in his usual state of health the day prior to arrival. He went to bed after drinking alcohol and woke up suddenly pale and diaphoretic with dyspnea and a persistent feeling of impending doom. On arrival to the ED, he was tachypneic (26 breaths/min) with a heart rate of 163 bpm and a blood pressure of 100/80 mmHg. EKG showed atrial fibrillation with RVR. The patient converted to normal sinus rhythm after one dose of IV Cardizem 10 mg was administered for rate control. The next day he had multiple episodes of Torsades de Pointe and monomorphic ventricular tachycardia treated with synchronized cardioversion, 2g of magnesium, IV amiodarone and lidocaine drip. He was transferred to the ICU for further evaluation and monitoring. Repeat EKG showed normal sinus rhythm at 75 bpm and short QT (QT= 328). TTE showed normal biventricular size and function (LVEF 60-65%) with no valvular abnormalities. Dual chamber Implantable Cardioverter Defibrillator (ICD) was placed and outpatient genetic testing was scheduled.

Discussion:
SQTS is very rare with roughly 70 cases identified worldwide since the condition was discovered in 2000. It is a congenital channelopathy related to potassium channels and represented by a normal heart rate with accelerated cardiac repolarization. Normal QT range is 350-440 msec while SQTS range is 210-340 msec. Mutations in the
KCNH2, KCNJ2,
or
KCNQ1
genes lead to enhanced flow of potassium ions across the membrane of cardiac muscle cells. Patients can present at any age with palpitations, syncope, atrial fibrillation, and sudden cardiac death. The cornerstone to diagnosing SQTS is an electrocardiogram. Patients with SQTS can be managed with ICD implantation, quinidine (especially with KCNH2 mutation), and sotalol (with other mutations other than KCNH2).
Abstract 16230: Pulmonary Autograft Wall Stresses One Year After Ross Operation
Authors: Alonso Edgardo , XUAN Yue , Emmott Alexander , Wang Zhongjie , Kumar Shalni , Mongeon Francois-Pierre , Leask Richard L , El-Hamamsy Ismail , Ge Liang , Tseng Elaine E
Published: May 2021

Introduction:
The Ross procedure is an excellent option for children and young adults who need aortic valve replacement as this surgery can restore patient survival to that of a normal sex and aged-matched population. However, some patients experience aneurysmal formation during autograft remodeling and require reoperation. As the underlying biomechanics of autograft remodeling are unknown, we investigated patient-specific wall stresses in pulmonary autografts one year post-operatively to better understand systemic pressure-driven early autograft wall stresses.

Methods:
Ross patients (n=16) who underwent intraoperative collection of pulmonary root/aortic specimen, and subsequent one-year MRI follow-up were recruited. Patient-specific material properties from their tissue were experimentally determined and incorporated into autograft ± Dacron and ascending aorta finite element models. A multiplicative approach was used to account for pre-stress geometry from in-vivo MRI. Physiologic pressure loading was simulated with LS-DYNA software.

Results:
At systemic systole, first principal stresses were 567kPa (25-75% IQR, 485-675kPa), 809kPa (691-1219kPa), and 382kPa (334-413kPa) at autograft sinuses, sinotubular junction (STJ), and ascending aorta, respectively. Second principal stresses were 355kPa (320-394kPa), 360kPa (310-426kPa), and 184kPa (147-222kPa) at autograft sinuses, STJ, and ascending aorta, respectively. Mean autograft diameters were 38.3±5.3mm, 29.9±2.7mm, and 26.6±4.0mm at sinuses, STJ, and annulus, respectively.

Conclusions:
First principal stresses were mainly located at STJ, particularly when Dacron reinforcement was applied to constrain STJ dilatation. However, at one-year after the Ross operation, autograft dilatation was not seen despite elevated autograft wall stresses compared to their internal controls, the lower wall stresses in corresponding native distal ascending aorta. In this group of patients, higher risk of dilatation is expected in the sinuses and STJ if not constrained by Dacron than the corresponding ascending aorta. Future follow-up will elucidate the biomechanics of long-term autograft remodeling to develop predictive models for autograft dilatation.
Abstract 16232: Early Morbidity Affects Survival Beyond the Perioperative Period in On-Pump vs. Off-Pump Coronary Artery Bypass Graft Surgery - A Quantitative Morbidity Analysis of the CORONARY Trial
Authors: Hebert Melanie , Lamy Andre , Noiseux Nicolas , Stevens Louis-Mathieu
Published: May 2021

Introduction:
Previous large trials found similar outcomes between on- and off-pump CABG. We assessed the hypothesis that quantified early morbidity affects survival after 30 postoperative days by applying the Clavien-Dindo Complications Classification (CDCC) and the Comprehensive Complication Index (CCI) to the CORONARY trial.

Methods:
All postoperative hospitalization and 30-days follow-up complications were assigned a CDCC grade. CCI were calculated for all patients (n=4752) (
Table 1
). Kaplan-Meier analysis was used to examine 1-year mortality by CDCC grade in patients alive after 30 postoperative days. Wilcoxon and log-rank were used for comparisons.

Results:
Median CDCC was 1 [interquartile range: 0, 2] for off-pump and 2 [1, 2] for on-pump CABG (p<0.001). Median CCI was 8.7 [0, 22.6] for off-pump and 20.9 [8.7, 29.6] for on-pump CABG (p<0.001).

In on-pump CABG, there were more grade I complications (off: n=1093, 46.0% vs. on: n=1280, 53.8%; p<0.001) and grade II complication (off: n=903, 38.0% vs. on: n=1012, 42.6%; p<0.001) (
Figure 1a
). In on-pump CABG, 17.5% (n=417) had grade IIIa or greater morbidity versus 15.9% (n=378) in off-pump (p=0.133).

Survival curves differed significantly based on CDCC grade (
Figure 1b
, p<0.001). The CCI was 8.7 [0, 22.6] in patients who survived (n=4514) and 22.6 [8.7, 44.3] in patients who died (n=94) at one year (p<0.001).

Conclusions:
On-pump CABG is associated with greater early morbidity graded by CDCC and CCI. This affects survival beyond the immediate postoperative period. Similar quantitative analyses have not been used to compare the two techniques and could prove useful to better quantify procedural morbidity in clinical trials.