bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 16143: A Novel Clinical Prediction Model for Familial Hypercholesterolemia: Implementation of a Statin-correction Calculator to Enhance Diagnostic Yield
Authors: Kanji Zahara A , Sheikh Mohammad S , Antwi-Amoabeng Daniel , Beutler Bryce H , Gullapalli Nageshwara , Rowan Christopher J
Published: May 2021

Introduction:
Familial hypercholesterolemia (FH) is an autosomal dominant genetic disorder. Individuals with FH have a 22-fold greater risk of early-onset cardiovascular disease as compared to the general population. Early identification of patients with FH is essential to prevent cardiovascular events. Diagnosis may be challenging however for individuals with underlying FH who are already receiving statin therapy, as criteria for FH rely on pre-treatment low-density lipoprotein (LDL) levels. We calculated pre-treatment LDL levels utilizing prior published literature by adjusting for serum LDL levels in patients receiving statins. This increased the diagnostic yield for gene-positive FH.

Hypothesis:
Integration of statin-correction calculator with the Dutch Lipid Clinical Criteria (DLCC) and Simon Broome Criteria (SBC) for FH will increase sensitivity to identify gene-positive FH.

Methods:
29,797 participants enrolled in the Healthy Nevada Project underwent whole-exome gene testing. 126 had a FH variant; 37 of these participants were on statin therapy. A statin-correction calculator was utilized to predict patients' pre-treatment LDL levels. The likelihood of FH was assessed based on two versions of the DLCC and SBC: the standard versions and enhanced versions with integration of the statin-correction calculator (eDLCC and eSBC). The McNemar test was used to compare the sensitivity of DLCC and SBC with eDLCC and eSBC, respectively, in identifying gene-positive FH.

Results:
By adjusting LDL levels for statin usage, 70.24% and 24.32% of participants with a negative diagnosis of FH were reclassified to positive using eDLCC and eSBC (p=0.001 and 0.008, respectively).

Conclusions:
Integration of statin-correction calculator to correct LDL increases diagnostic yield for clinical FH.
Abstract 16146: Topical Nitroglycerine Reduces Radial Access Site Failure and Femoral Crossover -
Topical Nitroglycerine to Prevent Radial Artery Spasm
(TNTRASP)
Study
Authors: Gopalakrishnan Prabhakaran P , David Manova , Manoharan Pradeep , Rufus Ponniah Sharan , Duffy Brendan
Published: May 2021

Background:
Radial to femoral access crossover has been reported as high as 7.6%. Access site failure, radial spasm and tortuosity are potential reasons.

Methods:
Patients undergoing radial catheterization were randomly assigned to 30 mg of topical nitroglycerine (NTG,
n
=48) or placebo (
n
=52) at least one hour before access. Both groups received 40 mg of topical lidocaine. Radial artery dimensions were measured before drug application and immediately before access. RASP score (Forearm discomfort + Difficult catheter manipulation + Additional intraarterial NTG + Sheath removal difficulty) >0 indicates radial spasm.

Results:
Radial artery cross sectional area (CSA) increased significantly in NTG group (30%
vs.
-3%,
p
<0.001). Radial artery was smaller than the sheath at time of access in fewer patients in NTG group (10%
vs.
27%,
p
<0.05). Fewer patients had spasm in NTG group (17%
vs.
29%,
p
=0.14). Average RASP score was lower in NTG group (0.2
vs.
0.6,
p
=0.10). No crossover to femoral access in NTG group compared to 4 crossovers in control (
p
<0.05). Femoral crossover was 10 times more likely if radial diameter < 2 mm (
p
<0.05). Risk of radial spasm was higher with multiple arterial sticks (
p
<0.01); arterial tortuosity (
p
<0.05); intraarterial heparin (
p
<0.01), use of multiple wires (
p
<0.001); use of multiple catheters (
p
<0.01) and nonhydrophillic catheter use (
p
=0.001). Preprocedural valium reduced risk of radial spasm. Radial spasm was associated with 5 fold risk of hematoma (
p
=0.01) and higher radiation dose (
p
<0.001).

Discussion:
Pre-dilation with topical NTG reduced access site failure and risk of femoral crossover. Radial spasm incidence was lower in NTG but not statistically significant. Radial spasm was influenced by several factors like choice of wires and catheters. Radial spasm increased risk of hematoma as well as radiation exposure.

Conclusion:
Topical nitroglycerine to predilate radial artery reduces risk of femoral crossover and may reduce radial spasm.
Abstract 16156: Association of Electronic Nicotine Delivery Systems (ENDS) Usage and EVALI-like Symptoms
Authors: hart joy L , Payne Thomas J , Groom Allison , Tran Hy , walker kandi L , Kesh Anshula , Robertson Rose M , Vu Thanh-Huyen T
Published: May 2021

Introduction:
Comprehensive studies regarding clinical symptoms related to electronic nicotine delivery systems (ENDS) usage are sparse.

Methods:
The sample included 1,432 current ENDS users, ages 18-64, drawn from a national online survey conducted in 2016. A quota sampling method was used for key demographic characteristics such as age, gender, and race/ethnicity. ENDS use included types of devices, flavors, and knowledge of e-liquid used. Outcomes included any E-cigarette or Vaping use-Associated Lung Injury (EVALI)-like symptoms (e.g., cough, shortness of breath, nausea) and any clinical symptoms (see Table footnotes).

Results:
Of the sample, 50% were female, 23% non-Hispanic (NH) White, 23% NH Black, 54% Hispanic, 18% aged 18-24, 17% LGBTQ, 41% with <$50K income, 55% 1+ any symptoms, and 33% 1+ any EVALI-like symptoms. Cough and nausea were most prevalent among EVALI-like symptoms (27% and 7.3%, respectively). The proportion of having any EVALI-like symptoms was higher in the following groups: younger, Hispanic, current smokers, and current other product users. With multiple adjustments (see Table footnotes), those who used refillable devices, varied nicotine content, flavored products or made their own e-liquids were more likely to have clinical symptoms than their counterparts. For example, the odds (95% CI) of having 1+ EVALI-like symptoms in those who used refillable devices with e-liquid pour or with e-liquid cartridge replacement were 1.70 (1.13, 2.56) and 1.95 (1.27, 2.99), respectively, compared to the non-refillable group (see Table). It should be noted that those who used non-refillable devices were also more likely not to know the nicotine content in their e-liquid. However, their use pattern seemed stable: They tended to use only one brand, one type of device, and non-flavored e-liquid (results not tabulated).

Conclusions:
ENDS use was significantly associated with the odds of having clinical symptoms, including EVALI-like symptoms.
Abstract 16158: Comparative Effects of Bone Marrow Derived versus Umbilical Cord Tissue Mesenchymal Stem Cells in an Experimental Model of Bronchopulmonary Dysplasia
Authors: Benny Merline , Courchia Benjamin , Shrager Sebastian , Sharma Mayank , Duara Joanne , Valasaki Krystalenia , Jian Huang , Chen Pingping , Zambrano Ronald , Wu Shu , Velazquez Omaida C , Hare Joshua M , Khan Aisha , Young Karen C
Published: May 2021

Introduction:
Bronchopulmonary dysplasia (BPD) or chronic lung injury of newborn is a life-threatening condition in preterm infants with few effective therapies. Mesenchymal stem cells (MSC) are a promising therapeutic strategy for BPD. The ideal MSC source for BPD prevention is however unknown. Umbilical cord tissue (UCT) MSC may potentially have more anti-inflammatory and pro-angiogenic properties.

Hypothesis:
We hypothesized that the UCT-MSC will have superior lung regenerative effect in BPD owing to superior anti-inflammatory and pro-angiogenic properties as compared to BM-MSC.

Methods:
Newborn rats (n=10-12/group) were randomly assigned to normoxia or hyperoxia (85% O
2
) from postnatal day (P) 1 to 21 were given intra-tracheal (IT) BM or UCT-MSC (1 x 10
6
cells/50 μl), or placebo (PL) on P3.

Results:
Hyperoxia PL-treated pups had marked alveolar simplification, vascular rarefaction, remodeling and lung inflammation. Administration of both BM-MSC and UCT-MSC significantly improved alveolar structure, vascular density, pulmonary hypertension, vascular remodeling and lung inflammation. However, the improvement in alveolar structure and lung inflammation was more marked in hyperoxic pups who received UCT-MSC. In vitro studies demonstrated greater TSG-6 and IL-10 expression in UCT-MSC as compared to BM-MSC. Moreover, lung epithelial cells incubated with UCT-MSC conditioned media had greater wound healing following scratch injury.

Conclusion:
These findings demonstrate that while both BM and UCT-MSC have lung regenerative effects, UCT-MSC have greater anti-inflammatory and alveolar protective effects in experimental BPD. These findings have significant implications for cellular therapy in BPD, as it suggests that UCT-MSC are a superior cellular source for preterm lung protection.
Abstract 16169: Modes of Failure and Patient Adverse Events of Fractional Flow Reserve Guidewires: Insights From the United States Food and Drug Administration Manufacturer and User Facility Device Experience Database
Authors: Pandey Yagya , Khalid Nauman , Khalid Mirza , Kamran Hassan , Raza Hussain , Jneid Hani , Lakkis Nasser M , Kayani Waleed T
Published: May 2021

Introduction:
Fractional Flow Reserve (FFR) measurement is commonly used in the cardiac catheterization laboratory to assess functional significance of coronary arterial plaques. Robust real-world data on complications and modes of failure of FFR guidewires are limited. We analyzed the post-marketing surveillance data from the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database to report these endpoints for commonly utilized FFR guidewire.

Methods:
MAUDE database was queried from January 1, 2010, to April 1, 2020, for 3 commonly used FFR guidewires (PressureWire
TM
X (Abbott), Comet
TM
(Boston Scientific) and Verrata
TM
(Philips)) by searching for following events: “injury”, “malfunction”, “death”, and “other” yielding 544 reports. After excluding incomplete reports and older devices not in current use, 486 reports were analyzed.

Results:
Figure 1 shows reported modes of failure and patient adverse events. Guidewire tip fracture was the most reported mode of failure in 174 (35.8%) cases. Guidewire kinking (n= 152 (31.3%)), communication failure (n= 141 (29.0%)), and shaft fracture (n= 67 (13.8%)) were also reported. 133 (27.4%) of total device failures resulted in patient adverse events. Most common patient adverse event was retained guidewire tip in 71 (53.4%) cases followed by freshly deployed stent dislodgment (n= 26 (19.6%)) and coronary artery dissection (n=23 (17.3%)) respectively. 6 patient deaths were reported.

Conclusions:
FFR guidewire failures can occur due to a variety of mechanisms and lead to patient adverse events. MAUDE database serves as an important platform for improved collaboration between clinicians, device manufacturers, and regulatory bodies to improve device performance and optimize patient outcomes. Our analysis provides insights into the mechanism of FFR guidewire failure and associated adverse events but cannot verify causality or provide a comparison among different guidewires.
Abstract 16177: Race and Sex-specific Long-term Risk of Incident Heart Failure in Adults Stratified by Fasting Glucose Level: Lifetime Risk Pooling Project
Authors: Sinha Arjun , Ning Hongyan , Ahmad Faraz S , Bancks Michael , Carnethon Mercedes R , Allen Norrina B , Wilkins John T , Lloyd-jones Donald M , Khan Sadiya S
Published: May 2021

Introduction:
While the association of diabetes with heart failure (HF) is well-established, the long-term risk (LR) of incident HF with prediabetes across the life course is not known. Furthermore, race-sex disparities in LR of HF across categories of fasting plasma glucose (FPG) has not been described. To inform HF preventive strategies, we compared the race- and sex-specific LR of HF across categories of FPG in adults.

Methods:
Individual-level data from adults free of baseline HF was pooled from 6 population-based cohorts stratified by baseline age (40-59, 60-79 years) and race-sex groups. We defined FPG status as normal (<100 mg/dL), prediabetes (FPG 100-125 mg/dL) and diabetes (FPG ≥126 mg/dL or use of antihyperglycemic agents). Modified Kaplan-Meier analysis was performed by FPG strata to estimate the LR of HF (30-year in middle-aged and 20-year in older adults) adjusted for the competing risk of non-HF death. We estimated adjusted hazard ratios (aHR) for HF in each FPG strata using Cox proportional regression models.

Results:
Of the 40,117 participants, 24% were black and 56% were women. During 638,910 person-years of follow-up, there were 4,846 cases of incident HF. In middle-aged adults, the LR of HF was significantly higher among individuals with prediabetes (6.1 [4.8, 7.4] to 14.4 [9.6, 19.2]%) compared with normal FPG (3.5 [3.0, 4.1] to 11.7 [9.1, 14.3]%). In older adults with prediabetes compared with normal FPG, LR of HF was significantly higher in white men (13.5 [12.0, 14.9]% vs 10.4 [9.2, 11.6]%) and women (12.2 [10.8, 13.6]% vs 7.8 [6.9, 8.7]%) but not in black men (12.2 [9.0, 15.3]% vs 14.6 [11.6, 17.6]%) or women (13.5 [10.1, 16.8]% vs 11.7 [9.4, 14.0]%). Race-sex specific aHR for HF across FPG strata are shown in the table.

Conclusions:
Compared with normal FPG, prediabetes was associated with significantly greater LR of HF in middle-aged but not in older adults. Of all groups, black women with diabetes qualitatively had a disproportionately higher LR of HF.
Abstract 16181: Impact of Magnetic Resonance Imaging on Functional Integrity of Non-conditional Cardiovascular Implantable Electronic Devices
Authors: Dahiya Garima , Wetzel Adam , Kyvernitakis Andreas , Gevenosky Loretta , WILLIAMS RONALD , Shah Moneal , Farah Victor , Doyle Mark , Biederman Robert
Published: May 2021

Introduction:
Magnetic Resonance Imaging (MRI) non-conditional cardiovascular implantable electronic devices (CIEDs) have historically restricted the use of MRI. We investigated the impact of MRI on the functional integrity of CIEDs.

Methods:
In this prospective, observational single-center study, we enrolled patients undergoing MRI over a 5-year period. Prior to assessing the impact of MRI on CIED integrity, we performed interrogations in sequential duplication to assess the intrinsic variability of the device. Subsequently, we performed interrogations immediately after MRI and monitored changes in device parameters and clinical events.

Results:
We completed 492 MRI studies, 283 (58%) in patients with permanent pacemakers (PPMs), and 209 (42%) with implantable cardioverter defibrillators (ICDs). Subsequent MRI exposures occurred in 73 of 492 (15%) encounters. Accounting for intrinsic variability in CIED lead parameters, there were no significant changes in RA, RV, or LV lead parameters after MRI, regardless of the region of scan (thoracic vs non-thoracic), type of CIED (PPMs vs ICDs) and among those with serial MRIs. When ranked for % change pre- to post-MRI, the majority of RA, RV, and LV metrics for thresholds, sensing, and impedance conformed to ≤20% change. No significant clinical adverse cardiac events or effect on device microcircuitry occurred during the study.

Conclusion:
Incorporating a novel reproducibility tactic, there were no clinically meaningful device parameter changes nor were there adverse clinical events during or following MRIs, suggesting the effects of MRI on non-conditional CIED integrity are far less than previously perceived.
Abstract 16190: Trends in Admissions and Outcomes in Patients With Chronic Limb-threatening Ischemia-a National Inpatient Sample Analysis
Authors: Anantha Narayanan Mahesh , Doshi Rajkumar P , Patel Krunalkumar , Sheikh Azfar B , Llanos-Chea Fiorella , Abbott Jinnette D , Guzman Raul J , Shishehbor Mehdi H , Hiatt William R , Duval Sue , Mena-hurtado Carlos , Smolderen Kim G
Published: May 2021

Introduction:
Chronic limb threatening ischemia (CLTI) morbidity and mortality rates have historically been higher, however recent trends have not been reported. In patients admitted with CLTI, we aimed to examine trends in in-hospital mortality, major amputations, length of stay, and cost of admissions overall, and stratified by type of revascularization procedures.

Hypothesis:
We hypothesized there would be an increase in CLTI-related admissions, with outcomes only marginally improving.

Methods:
Using 2011-2017 National Inpatient Sample data, we identified CLTI-related admissions based on ICD-9 and 10-CM codes. We stratified outcomes based on endovascular or open surgical interventions. We also performed multivariable regression analyses based on age, sex, race, hospital size, type and location.

Results:
We identified 2,643,087 CLI-related admissions between 2011 and 2017. CLI admissions increased from 0.9% to 1.4% P
trend
<0.0001 as well as overall PAD admissions (4.5% to 8.9%, P
trend
<0.0001). In-hospital mortality for the entire CLTI cohort decreased from 3.3% to 2.7%, P
trend
<0.0001 and major amputations decreased from 10.9% to 7%, P
trend
<0.0001. A decline was also noted for length of stay from 5.7 (3.1-10.1) to 5.4 (3.0-9.2) (P
trend
<0.0001), whereas admission costs increased from 11,791 (6,676 - 21,712) to 12,597 (7,248 - 22,748) (P
trend
<0.0001). The volume of endovascular interventions increased (P<0.0001) against a decline in surgical interventions (P<0.0001). Black race, female sex and age ≥60 years were associated with higher in-hospital mortality.

Conclusions:
A relatively small decrease in absolute numbers for mortality and major amputations were observed against a backdrop of increasing CLTI admission volumes over recent years. As patients with CLTI receive more endovascular interventions than surgical interventions over time, mortality rates and length of stay have generally improved.
Abstract 16197: Influence of Coronary Artery Disease on the Prognosis of a Positive Stress Echocardiogram in Patients With Advanced Liver Disease
Authors: Nazif Kutaiba , Mastouri Ronald , Feigenbaum Harvey , Zenisek Joseph , Hess-Green Deborah , Sawada Stephen G
Published: May 2021

Background:
Cardiac complications are the leading cause of mortality after orthotopic liver transplantation (OLT). In the general population, a positive dobutamine stress echocardiogram (DSE) in the absence of coronary artery disease (CAD) still identifies a high risk group whose outcome is similar to those with positive DSE and CAD. DSE is widely employed as a screening method prior to OLT but less is known about the prognostic impact of a positive DSE in the end stage liver disease (ESLD) population and whether CAD also influences their outcome. We investigated the prognostic impact of a positive DSE and clinical factors including CAD in patients with ESLD.

Methods:
Follow-up data was obtained in 61 liver transplant candidates with positive DSE and coronary angiography for cardiovascular events including angina requiring revascularization, heart failure, infarction, and cardiac death. Event free survival was compared between patients with (22 patients >70% stenosis) and without (39 patients) obstructive CAD and Cox regression was used to identify factors associated with events.

Results:
Over a mean follow-up of 27 + 28 months, 21 % (8/39) of patients with positive DSE and no CAD had events compared with 46% (10/22) of patients with positive DSE and CAD, p = 0.04. At one year of follow-up, cardiac death had occurred in 8% (3/39) of patients with positive DSE and no CAD, and in 9% (2/22) of those with positive DSE and CAD. Overall, event free survival was significantly better in those without CAD (p = 0.014). Beta blocker use (HR: 4.1, 95% CI: 1.7 - 9.9, p-value = 0.010), CAD (HR: 4.4 95% CI: 1.8- 10.8, p-value = 0.008), and non-alcoholic steatohepatitis (NASH) (HR: 4.9, 95% CI: 2.0 - 11.7, p-value = 0.04) were independently associated with cardiac events.

Conclusion:
ESLD patients with a positive DSE and no CAD had a one year cardiac mortality that was similar to patients that had a positive DSE and CAD. However, the overall prevalence of cardiac events and the event free survival was significantly worse in the CAD group. Thus, ESLD patients with a positive DSE are at increased risk and the presence of CAD further increases their risk. In addition to CAD, beta blocker use and NASH were independently associated with cardiac events.
Abstract 16212: Ultrasound Jugular Venous Pulsation Outperforms Visual Assessment and Ivc Collapsibility for Central Venous Pressures in Obese Patients
Authors: Wang Libo , Harrison Jonathan , Dranow Elizabeth , KHOR Lillian
Published: May 2021

Introduction:
Accurate volume status assessment is central to heart failure management, but current non-invasive bedside techniques remain a challenge, particularly in obese patients. Studies have shown variability and inaccuracy of the jugular venous pulse (JVP) exam in estimating right atrial pressure (RAP).

Hypothesis:
The accuracy of POCUS imaging of the JVP (uJVP) is preserved in obesity.

Methods:
Prior to undergoing right heart catheterization (RHC), subjects were enrolled for internal jugular vein imaging with a POCUS device, Butterfly iQ™. The vJVP was identified by traditional examination technique along with pIVC (an IVC>2.1 cm and <50% collapsible was considered greater or equal to 10mmHg in RAP). The IJV was identified by POCUS with the patient reclined (head of bed between 30-45°) and followed cranially until tapering smaller than the adjacent carotid artery throughout the entirety of the respiratory cycle. The height of this collapse point from the sternal angle added to 5 centimeters was defined as uJVP.

Results:
41 participants, 24 of whom were obese (BMI > 30 kg/m2), underwent vJVP, pIVC diameter, and uJVP assessments prior to RHC. The receiver operator curve (ROC) or Area under the Curve (AUC) was robust for uJVP and did not significantly differ between non-obese and obese participants (AUC=0.923 and AUC=0.852 respectively) in predicting RAP >=10mmHg. AUC decreased significantly with obesity for vJVP. The AUC was modest for pIVC in the non-obese, but performed poorly in obesity (Figure 1B, 1C).

Conclusions:
This is the first comparative study of bedside, non-invasive methods of volume assessment. The accuracy of vJVP and pIVC deteriorated with obesity, whereas the uJVP, maintained good predictive value irrespective of obesity. The novel uJVP is a promising bed-side tool for volume assessment in the obesity and warrants further study.
Abstract 16216: Increases in Renal Nkcc2 and Ncc Preceded the Elevation of Blood Pressure in Mice Treated With Clozapine
Authors: Ren Zhiyun , Asico Laureano D , Wang Xiaoyan
Published: May 2021

One of major side effects of clozapine, a common antipsychotic drug, is hypertension. In order to explore the pathogenesis of the drug-induced hypertension, we examined the renal sodium transport proteins and BP in the C57Bl6/J male mice treated with clozapine at different doses for 1 week. Clozapine at 20mg/kg/day via osmotic mini-pump increased SBP ( 110±0.6,mmHg, femoral artery, under anesthesia) and DBP (76.7±1) relative to vehicle (97.6±1.2/71.2±2.7) while the renal protein expression of NKCC2 (180±21, % of vehicle) and NCC (171±22), and ENaC-α (140±7), β(166±21) and γ(130±7) was increased without changes in NHE3 and α1-NKA (n=5/group). Clozapine at lower doses (5&10mg/kg/day,IP) did not change the conscious SBP and DBP monitored daily by tail-cuff, even on day 7 in 5 mg/kg group (115.61±1.6/90.1±1.3) and in 10mg/kg group (116.8±2/89.0±1.6) relative to vehicle (111.9±1.5/86.9±1.4) (n=4/group). Urinary excretion of Na
+
& K
+
and serum concentrations of Na
+
, K
+
, Cl
-
, creatinine were similar in all groups. However, renal protein expression of NKCC2 was increased in 5mg/kg (360±80, % of vehicle) and 10mg/kg (247±50) groups; NCC was increased at 5 mg/kg (175±9); α1-NKA was increased in 5mg/kg (216±5) and 10mg/kg (163±2) groups. No increases were found in the protein expression of NHE3 and ENaCs. Those increases in renal NKCC2 &NCC at 5 & 10 mg/kg were consistent with those at 20 mg/kg. AT1R was increased at 5 (221±20) &10mg/kg (255±21) while renin (186±15) and ACE1 (186±5), not ACE2, were increased at 5 mg/kg suggesting an activation of RAAS in kidney. NOX4, not NOX2, was increased at 5 mg/kg (453±69) while NOS3, not NOS1&2, was decreased at 5 (60±21) and 10mg/kg (64±5) groups. TNFα, not IL-6 was increased at 5 (222±18) &10 mg/kg (321±26). In cultured mouse distal convoluted tubule cells, clozapine also increased NCC and α1-NKA at 1nM (169±4;156±7) and 10nm(175±23;183±15) respectively ( 24h,n=4/group). Those changes in kidney, including increases in sodium transport proteins, RAAS components, ROS generation enzymes, inflammation factors and decrease in NO synthase, preceded the elevation of BP suggesting that direct or indirect regulations of clozapine on those proteins may play an important role in the pathogenesis of the drug-induced hypertension.
Abstract 16233: Systemic Arterial Pulsatility Index is a Potential Metric for Microvascular Dysfunction
Authors: Sawch Douglas , Ruth Benjamin , Mazimba Sula , Bourque Jamieson M , Bilchick Kenneth C , Sodhi Nishtha
Published: May 2021

Introduction:
Coronary microvascular dysfunction is associated with both atherosclerosis and heart failure (HF). We aimed to evaluate the prognostic value of global coronary flow reserve (CFR) and systemic arterial pulsatility index, a metric of ventricular-arterial coupling, (SAPi = [systemic systolic pressure-systemic diastolic pressure]/pulmonary capillary wedge pressure) in patients with known or suspected coronary artery disease.

Methods:
This was a retrospective analysis at an academic tertiary care center for patients who underwent right heart catheterization (RHC) and positron emission tomography (PET) imaging within a 6 month period. Global CFR was evaluated with PET imaging and SAPi was calculated using cardiac hemodynamics from RHC. Patients were evaluated for endpoints of non-fatal myocardial infarction, revascularization, and death. Cox proportional hazards regression modeling was used to examine the associations between CFR & SAPi with death and other adverse cardiovascular events.

Results:
Among 74 patients with complete imaging and hemodynamic data (mean age 64.23 ± 11.18 years, 54.67% female) the mean SAPi was 4.87 ± 3.09 and CFR was 52.95 ± 16.17. Increased SAPi as a continuous variable trended towards decreased mortality [HR: 0.814 (95% CI 0.663-1.016, chi square 3.31, p=.07).] Increased CFR as a continuous variable was significantly associated with decreased mortality [HR: 0.964 (95% CI 0.936-0.993, chi square 6.03, p<0.05). Neither were associated with non-fatal myocardial infarction or early revascularization. There was a weak trend toward correlation between SAPi and CFR (r=0.19, p=0.11).

Conclusions:
SAPi a hemodynamic marker of ventricular arterial coupling was weakly associated with CFR. On the other hand, CFR was significantly associated with death in patients with known or suspected coronary artery disease. Future work is needed to assess the correlation between SAPi and coronary microvascular dysfunction.
Abstract 16404: Allergy Associated Myocardial Infarction: A Comprehensive Review of Clinical Presentation, Diagnosis and Management of Kounis Syndrome
Authors: Roumeliotis Anastasios , Davlouros Periklis , Anastasopoulou Maria , Tsigkas Grigorios , Hahalis Georgios , Kounis Nicholas G
Published: May 2021

Introduction:
Kounis syndrome (KS) is defined as acute coronary syndrome (ACS) in the context of a hypersensitivity reaction. Patients may present with normal coronary arteries (Type I), established coronary artery disease (Type II) or in-stent thrombosis and restenosis (Type III).

Hypothesis:
We sought to investigate the clinical presentation, underlying pathophysiology, diagnosis and medical management of patients with KS.

Methods:
We searched PubMed until 1/1/2020 for case reports of KS. Patients with age <18 years, non-coronary vascular manifestations and without an established KS diagnosis were excluded. Information regarding patient demographics, medical history, clinical presentation, allergic reaction trigger, angiographic results as well as management were manually extracted from every report. All data were pulled in a combined data set and descriptive statistics were analyzed.

Results:
Out of the 269 unique patients with KS, 157 (58.4%) had Type I, 64 (23.8%) Type II and 18 (6.7%) Type III while 30 (11.2%) could not be classified. Their mean age was 54.1 years and 190 (70.6%) were male. The majority presented with a combination of cardiac and allergic symptoms [Panel A] and medication was the most commonly reported trigger [Panel B]. Electrocardiographically, 75.1% of cases had ST segment elevation with only 3.3% demonstrating no abnormalities. Coronary imaging was available in 228 (84.8%) patients showing occlusive lesions (32.5%), vascular spasm (16.2%), or normal coronary arteries (51.3%). Percutaneous coronary intervention or coronary artery bypass grafting was performed in 70 (29.4%) of the 238 patients with available information.

Conclusions:
Hypersensitivity induced ACS is most frequently triggered by medications, and the majority of patients have patent coronary arteries suggesting microvascular dysfunction. KS should be considered in the differential diagnosis of myocardial infarction with non-obstructive coronary arteries.
Abstract 16414: Pathologic Description of the Association of Bronchopulmonary Dysplasia and Left-to-right Shunts
Authors: Schmidt Henry , Vermeulen Alyssa M , Sharma Girish , Nguyen Hoang
Published: May 2021

Introduction:
Intracardiac left-to-right shunts, like atrial septal defect (ASD) and patent ductus arteriosus (PDA) have been shown to contribute to pulmonary hypertension in patients with bronchopulmonary dysplasia (BPD). There is no known comparison of heart and lung pathology in this population. The goal of our study was to characterize lung and heart pathology in patients with BPD and intracardiac shunts as well as correlate post-mortem changes with BPD classification.

Hypothesis:
Infants with greater degree of intracardiac shunt or persistent shunt will have more severe BPD classification and more severe heart and lung pathology.

Methods:
A retrospective cohort between 2011 and 2017 of 491 patients with BPD and prematurity were reviewed. There were 16 deceased patients, and 8 with autopsy who were included in the study. Outcomes measured were presence of shunt, pre and perinatal risk factors associated with BPD, degree of respiratory, inotropic and pulmonary vasodilator support, severity of BPD and heart and lung pathology on autopsy.

Results:
There was a low incidence of chorioamnionitis (12.5%), sepsis (12.5%), or maternal smoking (12.5%). Three patients had fetal growth restriction (37.5%). Seven patients (87.5%) received prenatal steroids and surfactant. At time of autopsy, 3 had an ASD, 3 had no shunt, 2 had shunts that had been closed; 1 patient had an ASD device closure, 3 had a PDA ligation and 1had PDA device closure. All patients had either a PDA or ASD at some point in infancy by echocardiogram. Six of the 8 patients had severe BPD and 2 had moderate BPD. All but one patient had abnormal right heart pathology(right atrial enlargement, right ventricular hypertrophy, and enlarged pulmonary artery) and abnormal lung pathology. One patient without right heart pathology had normal lung pathology, an isolated PDA that was ligated and moderate BPD. Patients who had moderate to large ASD (> 6 mm) demonstrated worse lung and heart pathology.

Conclusions:
Infants with larger intracardiac shunts, were found to have more severe lung and heart disease. This data may suggest earlier closure of moderate to large intracardiac shunts, particularly ASD in this population may be beneficial to worsening cardiac and pulmonary disease in this population.
Abstract 16415: Racial Differences in Incidence of Atrial Fibrillation After Cryptogenic Stroke
Authors: Laslett David B , Haddad Abdullah , Gaballa Dianna , Mangrolia Hardik , Follis Olivia , Gangireddy Chethan , Basil Anuj , Greenberg Richard , Yesenosky George , Cronin Edmond , Cooper Joshua M , Whitman Isaac R
Published: May 2021

Introduction:
The incidence of atrial fibrillation (AF) is lower among non-whites compared to whites, despite a higher burden of AF risk factors. Current knowledge of first detection of AF after cryptogenic stroke (CS) by an implantable cardiac monitor (ICM) is based on a predominantly white cohort. The incidence of new AF after CS among minorities is unknown. We hypothesized that the incidence of AF after CS would be lower in non-whites.

Methods:
We reviewed charts of all patients without a history of AF undergoing implantation of an ICM after CS at our hospital from July 2014 to December 2019. Incidence of AF was identified through review of ICM monitoring for each patient, including adjudication of AF episodes for accuracy. Kaplan Meier survival analysis was performed, and cumulative incidence of AF using adjusted Cox proportional hazards regression was compared by race.

Results:
We identified 417 patients who underwent ICM implant after CS during the study period, with a mean follow-up time of 1.5 ± 1.1 years. Mean age was 62 ± 12 years, and 46% (n=190) were male. The majority of patients were non-white (white, 15%, n=63; black, 59%, n=244; Hispanic, 26%, n=110). At baseline, blacks, Hispanics, and whites were of similar age (mean 62.2, 62.1, and 61.5 years, respectively), and blacks and Hispanics had more AF risk factors, including heart failure, hypertension, diabetes, chronic kidney disease, and higher BMI, than whites. Hispanics had more coronary artery disease than whites and blacks (25.5%, 17.5%, 9.1% respectively, p < 0.001). Among blacks, the cumulative incidence of newly detected AF at one, two, and three years was 13.0%, 18.9%, and 23%, which was similar to Hispanics (12.9%, 18.2%, and 20.9%). By comparison, the incidence in whites was significantly higher (20.8%, 34.3%, 40.3%; blacks p=0.02; Hispanics p=0.01)

Conclusion:
In patients undergoing ICM after CS, the incidence of newly detected AF is approximately double in whites compared to both blacks and Hispanics.
Abstract 16424: Cardiovascular Risk Factors Among a Nationally Representative Adult Population With Inflammatory Bowel Disease and Without Clinical Atherosclerotic Cardiovascular Disease
Authors: Agrawal Tanushree , Acquah Isaac , Dey Amit , Hassan Syed Z , Glassner Kerri , Abraham Bincy , Quigley Eamonn , Mehta Nehal N , Mortensen Martin B , Virani Salim S , Blaha Michael J , Blankstein Ron , Nasir Khurram , Cainzos Achirica Miguel
Published: May 2021

Introduction:
Inflammatory Bowel Disease (IBD), comprised of Ulcerative Colitis (UC) and Crohn’s Disease (CD) is a chronic inflammatory disease with systemic involvement. Inflammation predisposes to atherosclerosis and studies suggest that IBD is associated with premature atherosclerotic cardiovascular disease (ASCVD). There is, however, limited population-based data on cardiovascular risk factor (CRF) burden in IBD among those who have not yet developed clinical ASCVD. We sought to study the association between IBD and CRFs among a nationally representative population with IBD and without established ASCVD.

Methods:
The study population was derived from the 2015-2016 National Health Interview Survey database. ASCVD was defined as myocardial infarction, angina or stroke; those with ASCVD were excluded. IBD was defined as either CD or UC. We computed weighted prevalence estimates of various traditional CRFs for the US population by IBD status. Univariate and multivariate logistic regression models were used to evaluate associations between CRFs and IBD. Average and poor cardiovascular risk profiles were defined as 2-3 and ≥4 CRFs, respectively.

Results:
Overall 786 (1.2%) representing 2.6 million ASCVD-free adults reported IBD. Individuals with IBD had higher prevalence of multiple CRFs (Figure, top). In adjusted models those with IBD had significantly higher odds of having prevalent hypertension, diabetes mellitus and hypercholesterolemia (Figure, bottom). These associations were similar among elderly and young participants. Those with IBD were almost 2-fold more likely to have a poor cardiovascular risk profile.

Conclusion:
Our findings from a nationally representative US population suggest an increased burden and clustering of CRFs among IBD patients without clinical ASCVD. Future efforts are needed to understand the underlying mechanisms, and enhance the detection and treatment of these CRFs to reduce ASCVD risk in IBD patients.
Abstract 16435: Contemporary In-Hospital Outcomes of Chronic Total Occlusion Interventions: Update From the PROGRESS-CTO (prospective Global Registry for the Study of Chronic Total Occlusion Intervention) Multicenter International Registry
Authors: Karacsonyi Judit , Alaswad Khaldoon , Karmpaliotis Dimitrios , Krestyaninov Oleg , Choi James , Khatri Jaikirshan , Jaffer Farouc A , PATEL MITUL P , Mahmud Ehtisham , Doing Anthony , Dattilo Philip , Kandzari David E , Koutouzis Michalis , Tsiafoutis Ioannis , Uretsky Barry F , Toma Catalin , Yeh Robert W , Tamez Hector , Wyman R. Michael , Jefferson Brian , Patel Taral , Jaber Wissam , Samady Habib , Sheikh Abdul , Malik Bilal , Potluri Srinivasa , Elbarouni Basem , Love Michael , shah alpesh , Moses Jeffrey , Lembo Nicholas , Parikh Manish , Kirtane Ajay J , Ali Ziad , Vemmou Evangelia , Nikolakopoulos Ilias , Xenogiannis Iosif , Rangan Bavana V , Garcia Santiago , Banerjee Subhash , Ungi Imre , Brilakis Emmanouil S
Published: May 2021

Introduction:
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has been advancing due to improvement of equipment, operator experience, and techniques.

Methods:
We examined contemporary outcomes of CTO PCI by analyzing the clinical, angiographic, and procedural characteristics of 7,031 CTO interventions performed in 6,984 patients at 35 participating centers between 2012 and 2020.

Results:
Mean age was 64.5 ± 10 years and 82% of the patients were men. The patients had high prevalence of comorbidities, such as diabetes (42%), prior coronary artery bypass graft surgery (29%), prior myocardial infarction (45%), and prior heart failure (29%). The most common CTO target vessel was the right coronary artery (53%), followed by the left anterior descending artery (26%), and left circumflex artery (20%). The mean J-CTO and PROGRESS scores were 2.41 ± 1.28 and 1.09 ± 1.01, respectively. The overall technical and procedural success rates were 85.9% and 83.8% and the rate of in-hospital major cardiac adverse events (MACE) was 2.06%. Technical success and procedural success rates were lower for higher values of J-CTO and PROGRESS scores, and MACE rate was higher (
Figure 1
). The final successful crossing strategy was antegrade wire escalation in 53.7%, retrograde in 19.9%, and antegrade dissection reentry in 14.6%. The overall median air kerma radiation dose, contrast volume, procedure and fluoroscopy time were 2.30 (1.30, 3.90) Gray, 225 (160, 305) ml, 115 (75, 170) and 43 (26, 70) minutes, respectively.

Conclusions:
Using a combination of crossing strategies, high success and acceptable complication rates can be achieved in CTO PCI among various centers and patient populations.
Abstract 16446: Human Mesenchymal Stem Cells of Adult and Fetal Origin Do Not Express ACE2 and are Immune to SARS-CoV-2 Spike Pseudotyped Virus
Authors: Bastaroli Francesca , Mura Manuela , Nykjaer Giulia , Gnecchi Massimiliano
Published: May 2021

Background:
Angiotensin-converting enzyme 2 (ACE2) expression in the lung has a protective role against injury. However, ACE2 is the main host cell receptor for the Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) entry. Human mesenchymal stem cells (hMSCs) are currently under investigation for the treatment of pulmonary and cardiac complications of the SARS-CoV-2 disease (COVID-19). However, it is unclear if hMSCs express ACE2 and if they possibly can secrete ACE2. Also, their predisposition to be infected by SARS-CoV-2 is unknown.

Aim:
To assess if hMSCs of fetal and adult origin constitutively express and secrete ACE2 and if they can be infected by SARS-CoV-2.

Methods:
We studied 8 hMSC lines: 4 of fetal origin isolated from human placentas (hA-MSC) and 4 of adult origin isolated from bone marrow aspirates (hBM-MSCs). The lung epithelial cancer cell line CALU-3, which expresses high levels of ACE2, was used as positive control. ACE2 expression was evaluated in both standard culture conditions and after 48 hrs of hypoxia exposure (1% O
2
). We quantified the mRNA levels by RT-qPCR and verified protein content by western blot on both cell lysates and serum-free 48 hrs-conditioned media (MSC-CM). ACE2 levels in MSC-CM were quantified by ELISA assay. Finally, to test MSC viral susceptibility, we produced replication-defective, GFP-tagged retroviral particles bearing the SARS-CoV-2 Spike protein; the pantropic VSV glycoprotein (VSV-G) was used as positive control.

Results:
ACE2 mRNA level in both fetal and adult MSC was 200-fold lower than in CALU-3. ACE2 protein expression was undetectable in MSC lysates and CM, both by western blot and ELISA. Hypoxia slightly increased ACE2 mRNA level, but not protein level, which still was undetectable. Finally, CALU-3 but not MSC were infected by SARS-CoV-2 Spike pseudovirus, whereas both cell types were susceptible to VSV-G pseudovirus infection.

Conclusions:
Both fetal and adult MSC do not express significant levels of ACE2 both under normoxia and hypoxia, and therefore the putative therapeutic mechanism of hMSCs in COVID-19 cannot go through the release of ACE2. Importantly, MSCs are immune to SARS-CoV-2 infection and therefore their use appears safe.
Abstract 16450: Early Identification of High Risk Cardiac Decompensation Phenotypes via Real-time Electronic Health Record Data
Authors: Ratliff William , Wegermann Zachary K , Shi Harvey , Gao Michael , sendak mark , Kansal Aman , O'Brien Cara , Skove Stephanie , Zhao Sicong , Kashyap Sehj , Nichols Marshall , Jones William S , Patel Chetan B , Katz Jason N , Balu Suresh , Kochar Ajar , Patel Manesh R
Published: May 2021

Introduction:
Early identification of cardiac decompensation remains critical for improved patient outcomes. Digital phenotypes using real-time electronic health record (EHR) data offer an unbiased method to detect decompensation in at-risk individuals.

Methods:
Phenotypes designed to detect cardiac decompensation and its sequelae were retrospectively evaluated in 108,697 adult patient hospitalizations at a single center from October 2015-August 2018. The 6 phenotypes included hypotension, end organ dysfunction (EOD), hypoperfusion (concomitant hypotension and EOD), escalating vasoactive medication use (vasoactive meds), respiratory decline, and respiratory intervention. Median time from admission to phenotype development was measured in hours. In-hospital mortality and unanticipated ICU transfers were determined across all phenotypes and phenotype combinations.

Results:
Prevalence and time to detection varied across all six phenotypes (Table 1), with EOD found most frequently (35.7%) and detected earliest (3.4h, IQR 0.9-26.2h). Among individual phenotypes, patients with hypoperfusion had the highest rates of unanticipated ICU transfer (20.62%) and in-hospital mortality (20.99%). Patients meeting at least one phenotype had a 5.90% ICU transfer rate and 5.04% in-hospital mortality rate, compared to 0.62% mortality and 2.19% ICU transfer rates for patients meeting zero phenotypes. Among the 41 measured phenotype combinations, patients meeting all 6 phenotypes had the highest rates of unanticipated ICU transfer (28.75%) and in-hospital mortality (36.45%).

Conclusions:
Digital phenotypes of decompensation using real-world EHR data identify patients at higher risk of unexpected ICU transfer and in-hospital mortality at early times points in the hospitalization. Further studies will evaluate if implementation of a digital phenotype detection tool can improve care pathways and outcomes.
Abstract 16451: The Temporal Trend in the Utilization of Noninvasive Cardiac Test for Chest Pain Evaluation and Its Impact on Cardiac Catheterization Trends
Authors: Hong Stephanie , Teressa Getu
Published: May 2021

Introduction:
Noninvasive diagnostic testing serves as gatekeepers to invasive cardiac catheterization. Computed tomography coronary angiogram (CTCA) has been shown to have high sensitivity and negative predictive value in the diagnosis of coronary artery disease (CAD). However, the temporal trend of CTCA compared to functional tests and the differential downstream impact on cardiac catheterization is unknown.

Objective:
This study aimed to investigate the temporal trend of the use in CTCA for the evaluation of patients with chest pain and how it compares to the temporal trend of stress testing. The secondary aim was to investigate the temporal pattern in the cardiac catheterization rate and how it varies between CTCA and stress testing.

Methods:
We performed a retrospective review of 65,686 patients who presented to a large academic medical center with chest pain between 2012 and 2019. We identified those who received CTCA testing or stress testing as the initial diagnostic testing for diagnosing suspected CAD and collected data on downstream cardiac catheterization. We calculated the testing rate per 1000 for each year.

Results:
Of the patient who received noninvasive imaging (n=18,843), more CTCA was performed (18.6%) compared to stress test (10.1%). After an initial upward trend in CCTA use and a downward trend in stress test use between 2012 and 2014, the trend reversed for both modalities after 2015. The rate of cardiac catheterization increased after 2014, mirroring an increase in stress test utilization. Patients who had stress test first have increased odds of undergoing catheterization compared to those who had CTCA first, even after adjusting for risk factors. However, compared to CTCA, stress test shows a relative decline in the odds of catheterization (Relative adjusted Odd Ratio: 5.6 in 2012 down to 2.8 in 2019)

Conclusion:
In this large single-center study of chest pain patients, stress-testing leads to increased odds of cardiac catheterization compared to CCTA. However, the relative odds of undergoing catheterization following stress testing show a declining trend.