bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15975: Association of Maximum Troponin Levels With Myocardial Infarction Diagnosis and Higher Mortality
Authors: Fan Jerry , Hammonds Kendall , Izekor Bright , Jones Clinton , McGrade Patrick , Michel Jeffrey B , Widmer Robert J
Published: May 2021

Introduction:
Cardiac troponin I (TnI) is a sensitive and specific marker of acute myocardial infarction (AMI). However, a wide range of non-AMI conditions can also cause significant elevations in cardiac troponins. Given the deleterious impact of misdiagnosis, the ability to risk stratify patients who present with an elevated troponin is paramount.

Hypothesis:
We hypothesized that maximum TnI would be more predictive of mortality and the diagnosis of AMI than the initial or change in TnI.

Methods:
Records of 30,173 patients from a nine-hospital system in Texas were reviewed over a 24-month period 2016-2018. Data were collected on patients > 40 years of age and included international classification of disease (ICD-10) diagnoses, TnI, demographic data (age, sex, race, smoking status, chronic medical conditions), death during hospitalization, and readmission within 30 days.

Results:
Notable finding include TnI as a significant predictor of death with odds of death increased by 0.9% (1.009, 95% CI 1.004-1.013) for initial, and 0.7% (1.007, 95% CI 1.005-1.009) for delta and maximum TnI. An ROC curve demonstrated a statistically significant predictive ability of death for the maximum TnI level (0.6782, 95% CI (0.6576, 0.6989)) when compared to the initial and change in TnI. We analyzed the initial TnI as a significant predictor of AMI demonstrating the odds of AMI increased by 7.4% as initial TnI values increased (1.074, 95% CI 1.063-1.085), and 3.1% for delta and maximum TnI (1.031, 95% CI 1.028-1.034). A separate ROC curve demonstrated that the maximum TnI level 0.9401, 95% CI (0.9353, 0.9449) showed a statistically significant predictive ability to predict an AMI compared to initial change in TnI.

Conclusions:
Regardless of TnI level, a detectable TnI results in an increased risk of in-hospital mortality. Our study demonstrates that the maximum TnI level is a more sensitive and specific predictor of mortality when compared to delta or initial TnI. Similarly, the maximum TnI is the most predictive of an AMI versus other causes of TnI elevation. Further studies are needed to correlate TnI levels and clinical manifestations, which may be helpful in redefining AMI to better distinguish AMI from non-AMI diagnoses.
Abstract 15998: Therapeutic Effectiveness Against Heart Failure With Preserved Ejection Fraction by the Activation of the Growth Hormone-releasing Hormone Receptor in a Murine Model
Authors: Dulce Raul A , Kanashiro-takeuchi Rosemeire M , Takeuchi Lauro , Salerno Alessandro , Balkan Wayne , Cai Renzhi , Schally Andrew , Hare Joshua M
Published: May 2021

Introduction:
Heart failure with preserved ejection fraction (HFpEF) accounts for ~50% of heart failure cases and is characterized by impaired relaxation, ventricular stiffening and fibrosis. Growth hormone releasing hormone-agonists (GHRH-As) reduce fibrosis in rat and swine models of ischemic myocardial injury. However, their therapeutic effect in HFpEF is unknown.

Hypothesis:
We hypothesized that activation of GHRH receptor signaling prevents pathological remodeling and targets cardio-myocyte (CM) excitation-contraction coupling, ameliorating the compromised myocardial performance associated with HFpEF.

Methods:
CD1 mice implanted with a mini-osmotic pump (Alzet) to deliver angiotensin-II (Ang-II) for 8 weeks, were randomized at week 4 to receive daily injections of either GHRH-A (MR-356; n=12) or vehicle (n=12). Echocardiographic data and pressure-volume loops were recorded. Biometric measurements and fibrosis were assessed. CMs were isolated and intracellular Ca2
+
and sarcomere length acquired.

Results:
Ang-II-treated mice exhibited functional and morphologic features consistent with HFpEF. CMs exhibited reduced sarcomere length, indicating an inability to relax. The Ca2
+
decay rate and sarcomere re-lengthening were delayed. MR-356 treatment reverted the structural remodeling, including fibrosis, improving diastolic function (Figure Top panel). This treatment also abrogated the HFpEF-associated delay in Ca2
+
decay and further enhanced sarcomere re-lengthening rate (Figure Bottom panel).

Conclusions:
Our findings confirm that chronic infusion of Ang-II mediates functional changes in CMs consistent with HFpEF and demonstrate that activation of GHRH receptor signaling pathways targets mechanisms of excitation-contraction coupling, inflammation and fibrosis, thereby preventing HFpEF-associated dysfunctional CM relaxation and myocardial remodeling.
Abstract 16000: Patient Characteristics and Outcomes Associated With Troponin Testing
Authors: Escobedo Yissela , Haneke Travis , Payne Sarah , Jones Clinton , McGrade Patrick , Izekor Bright , Hammonds Kendall , Michel Jeffrey , Widmer Robert J
Published: May 2021

Introduction:
Troponin I (TnI) is a principal biomarker in diagnosing acute myocardial infarction (AMI). However, large numbers of hospitalized patients are tested for TnI in whom AMI is unlikely or not expected.

Hypothesis:
We hypothesized the baseline comorbidities of those undergoing troponin testing differ from those not tested and that troponin testing is associated with outcomes.

Methods:
In total, 54,039 inpatient admissions from a 9-hospital system in Texas were reviewed over a 24-month period (2017-2018). Data were collected on primary international classification of disease (ICD-10) diagnoses, TnI, risk factors, and death during hospitalization or readmission within 30 days. Odds ratios were calculated for all patients adjusted for demographic differences in the population. Bivariate analysis was performed on the baseline risk factors for both troponin testing and troponin positivity.

Results:
TnI testing occurred in 30,173/54,039 (55.8%) individual hospital admissions. Of those, 19.9% had at least one elevated TnI value >99th% (0.1 ng/ml). Tested patients were older (70.1 [IQR 59.5, 80.9] vs 63.7 [IQR 53.4, 73.1] years), more likely to be male (14,497/30,173 (48.1%) vs 10,845/23,866 (45.4%)) and had a greater burden of cardiovascular disease and risk factors including: gender, race, smoking, hypertension, hyperlipidemia, type 2 diabetes mellitus, coronary artery disease, chronic kidney disease, chronic obstructive pulmonary disease, prior cerebrovascular accident, and prior AMI. Troponin testing was associated with death during hospitalization (OR 3.11, 95% CI 2.63, 3.71, p<0.0001), and an elevated troponin was found to be associated with mortality (OR 4.06, 95% CI 3.49, 4.72, p<0.0001).

Conclusions:
Troponin testing is associated with death during index hospitalization. Troponin values >99th% were associated only with increased mortality. This data suggest that selection plays a role in identifying patients at risk for in-hospital death.
Abstract 16009: Sex Differences in Patients With Suspected Cardiac Sarcoidosis
Authors: Kalra Rajat , Chen Ko-hsuan , Velangi Pratik , Okasha Osama , Markowitz Jeremy , Nijjar Prabhjot S , Von Wald Lisa , Roukoz Henri , Bhargava Maneesh , Perlman David , FARZANEH-FAR Afshin , Shenoy Chetan
Published: May 2021

Introduction:
Cardiac sarcoidosis is increasingly recognized as a cause of cardiomyopathy and mortality. However, there are no data on sex differences in patients with suspected cardiac sarcoidosis.

Hypothesis:
We hypothesized that sex differences exist in the clinical presentation, cardiac involvement, and long-term clinical outcomes of patients with suspected cardiac sarcoidosis.

Methods:
We performed a retrospective cohort study to examine sex differences in presenting features, CMR findings, and the long-term incidence of adverse clinical outcomes among consecutive patients with histologically proven sarcoidosis and suspected cardiac involvement investigated by cardiovascular magnetic resonance imaging (CMR). The primary composite clinical endpoint was all-cause mortality or significant ventricular arrhythmia. The secondary endpoints were all-cause mortality and significant ventricular arrhythmia.

Results:
Among 324 patients, 163 (50.3%) were women and 161 (49.7%) were men. Women reported a greater prevalence of chest pain and palpitations than men, but not dyspnea, presyncope, or syncope. Women were less likely to have LGE or meet the criteria for a clinical diagnosis of cardiac sarcoidosis, indicating lesser cardiac involvement. The long-term incidence of the primary composite endpoint (hazard ratio for women 1.36; 95% confidence interval 0.77-2.43; p = 0.29;
Figure 1
) or the cause of death between women and men (p = 0.62). However, women had a significantly lower cumulative incidence of significant ventricular arrhythmia compared with men (4.3% vs. 13.0%; log-rank p = 0.022).

Conclusions:
There were distinct sex differences in patients with histologically proven sarcoidosis and suspected cardiac involvement. A paradox was noted wherein women had a greater prevalence of chest pain and palpitations than men, but had lesser cardiac involvement, and a similar long-term incidence of all-cause death or significant ventricular arrhythmia.
Abstract 16026: Invasive Hemodynamic Assessment of Patients With Heart Failure With Preserved Ejection Fraction With Anemia and Iron Deficiency
Authors: Subramaniam Anna , Reddy Yogesh , Obokata Masaru , Borlaug Barry A
Published: May 2021

Introduction:
Anemia is associated with increased mortality, cardiovascular events, and decreased quality of life in patients with heart failure with preserved ejection fraction (HFpEF). Iron deficiency may contribute to disease severity independent of effects on red cell mass. The hemodynamic consequences of anemia and iron deficiency in HFpEF remain unclear.

Methods:
We analyzed a cohort of 313 consecutive subjects with HFpEF diagnosed by invasive hemodynamic assessment, and compared echocardiographic and hemodynamic characteristics of anemic versus non-anemic subjects. Anemia was defined as hemoglobin <13 g/dL in men and <12 g/dL in women. Iron deficiency was defined as ferritin <100 ug/L.

Results:
Compared to patients without anemia, HFpEF patients with anemia displayed higher NT-proBNP, elevated pulmonary artery (PA) pressures at rest and at peak exercise, and lower oxygen consumption at peak exercise (Table). There was no difference in pulmonary capillary wedge pressure (PCWP). Patients with iron deficiency were more likely to be women. At rest, patients with iron deficiency displayed lower left ventricular (LV) mass, higher resting SVRI and lower cardiac index (CI), but there were not significant differences with exercise.

Conclusions:
Anemia in HFpEF is associated with greater evidence of congestion and more severe pulmonary hypertension, contributing to reduced exercise capacity. Iron deficiency in HFpEF is more common in women and associated with lower cardiac output at rest, but hemodynamics are otherwise similar. Further study is required to understand the mechanisms by which anemia and iron deficiency influence cardiac function and outcomes in HFpEF.
Abstract 16039: Impact of Different Annuloplasty Methods for Tricuspid Regurgitation; a Network Meta-analysis
Authors: Yokoyama Yujiro , Takagi Hisato , Kuno Toshiki
Published: May 2021

Background:
Although moderate-severe tricuspid valve regurgitation (TR) is an independent risk factor for progressive heart failure and increased mortality, the best method for tricuspid repair remains controversial. As such, we conducted a network meta-analysis to compare early and late outcomes for suture, flexible band, and rigid ring as tricuspid annuloplasty (TAP) in patients with TR.

Methods:
MEDLINE and EMBASE were searched through February 15th, 2020 to identify randomized controlled trials (RCTs) and observational trials that investigated early and late outcomes after TAP for TR. The outcomes of interest were perioperative mortality, long-term survival and TR recurrence. TR recurrence was defined as at least moderate (TR grade 2) on serial echocardiogram.

Results:
Our systematic literature search identified 2 RCTs and 16 observational trials, including 6,788 patients who underwent TAP. Median follow-up period was 1-7.4 year. There were no significant differences of perioperative and long-term all-cause mortality among three TAP methods. Suture TAP was associated with a significant increase in TR recurrence compared to rigid ring TAP (Hazard ratio, 2.31; 95% Confidence Interval, 1.40-3.80;
p
=0.001) (Figure). There were no significant differences were observed in other comparisons in TR recurrence.

Conclusion:
Our network meta-analysis demonstrated significant reduction in TR recurrence for rigid ring TAP compared to Suture TAP. However, there was no significant mortality difference among suture, flexible band, and rigid ring TAP.
Abstract 16048: Placental Pathology in Pregnancies Complicated by Maternal Cardiac Disease: A Study From the Standardized Outcomes in Reproductive Cardiovascular Care (STORCC) Initiative
Authors: Wu Fred M , Quade Bradley J , Schefter Zoe J , Moses Abigail , Lachtrupp Cara L , markley john C , Gauvreau Kimberlee , Economy Katherine E , Valente Anne M
Published: May 2021

Background:
The incidence of pregnancy in women with cardiovascular disease (CVD) has increased, yet there is little known about placental pathology in these women.

Objective:
To describe placental pathology in pregnancies carried by women with CVD and to compare placental findings between categories of maternal CVD.

Methods:
We identified live births within the prospective, single-center Standardized Outcomes in Reproductive Cardiovascular Care cohort for which the placenta underwent histopathologic examination. Pathology reports were reviewed by an experienced placental pathologist (BJQ) for prespecified pathologic findings that were then compared against maternal characteristics.

Results:
271 placentas (Table 1) were identified from pregnancies associated with maternal congenital heart disease (CHD) (65%), arrhythmia (16%), cardiomyopathy (8%), connective tissue disease (7%), and valvular heart disease (4%). Median maternal age at delivery was 32 years (range 19-49). Median gestational age at delivery was 39 weeks (range 25-41). Anatomic pathology, mostly in the form of small placenta by weight, was most common, affecting 43% of placentas. Vascular pathology, mostly maternal vascular malperfusion or fetal flow restriction, was seen in 41% of placentas. Infectious (acute chorioamnionitis) and inflammatory (chronic villitis) pathology was seen in 23% and 10% of placentas, respectively. Inflammatory pathology was more common in maternal CHD than in other CVD categories (14.9% vs. 2.1%, p=0.001), while anatomic, infectious, and vascular pathology were seen at similar rates across all CVD categories.

Conclusion:
Pregnancies among women with CVD commonly demonstrate abnormal placental findings, especially anatomic and vascular pathology. Chronic villitis was more common in women with CHD compared to other types of CVD. Otherwise, the incidence of specific pathology findings did not differ significantly based on maternal characteristics.
Abstract 16060: Cardiac Magnetic Resonance Imaging Diastolic Indices Correlate With Cardiac Catheterization Filling Pressures in Pediatric Heart Transplant Recipients
Authors: Belay Wubishet , Godown Justin , Bearl David W , George-Durrette Kristen , Crum Kimberly , Chrisant Maryanne , Hernandez Lazaro E , Soslow Jonathan H
Published: May 2021

Background:
Atrial and ventricular filling pressures are routinely used in pediatric heart transplant (HTx) recipients to assess graft function. Cardiac magnetic resonance (CMR) can provide a non-invasive assessment of diastolic function, but data are lacking in pediatric HTx. We hypothesized that CMR indices of diastolic function correlate with filling pressures, providing a non-invasive approach to assessment of ventricular dysfunction.

Method:
Pediatric HTx recipients were prospectively enrolled at the time of cardiac catheterization. Pulmonary capillary wedge pressure (PCWP) and right atrial pressure (RAP) were measured. CMR included standard volumetric analysis and T1 and extracellular volume (ECV) mapping in the short axis at the mid-left ventricle (LV) to evaluate extracellular matrix expansion. Filling curves were calculated by contouring every phase in the short axis stack and global longitudinal and circumferential strain (GLS, GCS) were calculated using feature tracking. Correlations were analyzed using Spearman’s correlation.

Results:
A total of 31 patients with a mean age of 16.2 y/o were included, 9 with biopsy-proven acute rejection. The median time from transplant was 6.9 years and the mean LVEF was 58%. Peak LV ejection rate/end-diastolic volume (PER/EDV) correlated with PCWP (rho=-0.43, p=0.02, Fig 1) and RAP (rho=-0.40, p=0.03). GLS and GCS correlated with RAP (rho=0.51 p=0.007, and rho=0.38 p=0.05, respectively); GLS also correlated with PCWP (rho=0.46, p=0.02). Native T1 time-correlated with PCWP (rho=0.54, p=0.003), while the correlation between ECV and PCWP did not reach statistical significance (rho=0.37, p=0.06).

Conclusion:
CMR can be a useful non-invasive modality to assess for early signs of diastolic dysfunction in patients after pediatric HTx. Further research is needed to describe the clinical significance of these associations.
Abstract 16079: The Cusp of Life: Anomalous Origin of All Coronary Arteries From a Single Cusp
Authors: Chowdhury Yuvraj , Patwa Karishma , Shetty Mrinali , Toreli Aleksandre , Sheikh Shaqueel
Published: May 2021

Introduction:
Anomalous origin of coronary arteries has a prevalence of 1% in the population and is independently associated with a risk of sudden cardiac death. While an anomalous coronary artery arising from the opposite sinus is rare, all three coronary arteries arising from separate ostia in a single cusp is an extremely rare phenomenon.

Case:
A 48-year-old male with history of hypertension presented with fevers, cough and shortness of breath of 3 days duration. CXR demonstrated multi-lobar pneumonia and serology returned positive for Influenza A. Treatment was initiated with oseltamivir, vancomycin and piperacillin-tazobactam. Subcutaneous heparin was initiated for VTE prophylaxis. On day 3, the patient developed acute hypoxic respiratory failure from flash pulmonary edema necessitating intubation and mechanical ventilation. ECG revealed ST segment elevation in leads II, III, aVF, V5 and V6 (Fig. 1A). He was taken for urgent cardiac catheterization. Coronary angiography revealed anomalous origins of the left circumflex (LCX) and left anterior descending (LAD) arteries arising from the right coronary cusp (RCC) (Fig. 1B & 1C). 99% thrombotic occlusion of the distal right coronary artery was identified as the culprit lesion (Fig 1D). Percutaneous coronary intervention with a 4 x 30 mm drug-eluting stent was performed.

Discussion:
Absence of the left coronary artery originating from the left coronary sinus should raise suspicion for a coronary anomaly. While an anomalous LCX artery originating from the RCC is seen in 0.7% individuals, the LAD artery arises from the RCC is seen in 0.15% of people. All three coronary arteries arising from the RCC is extremely rare. An abnormal take-off angle, compression between the aorta and the pulmonary trunk, slit-like ostia, coronary hypoplasia and accelerated atherosclerosis are responsible for the increased risk of coronary events in this population.
Abstract 16093: Cardiology Clinic Integration Into a Primary Care Practice: Improving Access and Time to Testing
Authors: Scierka Lindsey E , Smolderen Kim G , Mena-hurtado Carlos
Published: May 2021

Introduction:
The demand for cardiovascular care has been increasing but there are numerous barriers to accessing care. No-show rates are higher for specialist visits and place an economic burden on the health care system. Integrating specialists into primary care practices can improve access and cardiovascular outcomes. We sought to describe a real-world experience of integrating a cardiology clinic into a primary care practice at a large health system and its association with access and process metrics.

Methods:
We compared two cohorts of patients requiring referral to a cardiologist from a primary care clinic at a large academic medical center over two years. The standard-referral cohort was referred to a cardiologist within the health system but outside of the clinic. The integrated-referral cohort was seen by a cardiologist integrated physically and clinically into the primary care clinic during a bi-weekly 4-hour clinic session. Information from both groups included demographics, medical history, referral information, and diagnostic testing. We documented patient access to a sub-specialist (as measured by time from cardiology referral to appointment), no-show rates, and time from referral to diagnostic testing.

Results:
The cohorts contained 27 and 39 patients, respectively. Overall, patients were 52.5% male, 68.9% non-Hispanic, 68.8% had Medicare or Medicaid as their primary insurance, and 47.6% had a prior cardiology referral. There were no statistically significant demographic differences between groups. Time to cardiologist for the standard-referral group was a mean of 49.3 + 11.1 days versus 12.4 + 1.6 days in the integrated referral group (p-value .004). Time to first diagnostic test was a mean of 60.6 + 35 days versus 20.0 + 15.9 days respectively (p-value .003). The no show rate for the standard-referral group was 33.3% and integrated-referral group was 12.8%, X
2
(1, N=66) = 4.017, p= .045.

Conclusion:
Integration of a cardiovascular sub-specialist into a primary care practice in a 4-hour bi-weekly session decreased time from referral to appointment, time to first diagnostic test, and no-show rate among patients in a university primary care practice. Further studies regarding the cost benefit analysis of integration would be beneficial.
Abstract 16096: Successful Pulmonary Vein Isolation Improve Diastolic Dysfunction and Sympathetic Nerve Activity in Atrial Fibrillation Patients
Authors: Mukai Yusuke , Murai Hisayoshi , Hirai Tadayuki , Hamaoka Takuto , Okabe Yoshitaka , tokuhisa hideki , Sugimoto Hiroyuki , Takamura Masayuki
Published: May 2021

Introduction:
Atrial fibrillation (AF) is associated with diastolic dysfunction (DD) at a high rate and the presence of left ventricular DD is also associated with increased muscle sympathetic nerve activity (MSNA). Catheter ablation (CA) of AF was reported to improve cardiac function, including the reverse remodeling of left ventricle and atrium. However, little is known about the effect of CA on MSNA and DD in AF patients.

Purpose:
The purpose of this study was to evaluate the effect of CA on MSNA and DD and the difference in therapeutic effect between two groups with and without DD.

Methods:
This study was conducted as a prospective, observational study. AF patients who were scheduled for CA were enrolled. The patients were divided into two groups, E/e’ ratio≧11 and <11. We measured blood pressure, HR, body weight, echocardiogram parameters, and MSNA before and 12 weeks after CA.

Results:
28 AF patients participated in this study. After CA, in the patients with DD(the group of E/e’≧11, n=12), E/e’ ratio, the MSNA burst incidence(BI) and frequency(BF) were significantly decreased (13.4±2.1 to 10.6±3.0, p<0.01. 64.4±15.8 to 34.0±12.0 bursts/100beats, P<0.01, 39.7±9.3 to 23.5±9.2 bursts/min, p<0.01 respectively). In the patients without DD (the group of E/e’<11, n=16), the BI and BF were significantly decreased (59.7±11.8 to 43.5±11.7 bursts/100beats, P<0.01, 38.1±10.5 to 29.2±8.4 bursts/min, p<0.01 respectively) while there was no difference in E/e’ ratio. Interestingly, in the patients with DD, decrease in BI and BF were more pronounced compared in the patients without DD(-30.4±15.9 to -16.2±11.5 bursts/100beats, P<0.05. -16.3±11.5 to -8.9±13.8 bursts/min, P=0.145 respectively). In both groups, no significant changes were observed in EF and peak acceleration rate of mitral E velocity.

Conclusion:
CA reduced MSNA in AF patients. In the patients with DD, the reduction of MSNA tended to be more remarkable than without DD. These findings suggest that changes of MSNA might reflect the improvement of DD and reduction of AF burden.
Abstract 16097: Impact of Device Miniaturization on Implantable Loop Recorder Utilization in the Pediatric Population: An Analysis of the Marketscan Database
Authors: Nash Dustin , Katcoff Hannah , Faerber Jennifer , Iyer Ramesh , O’Byrne Michael L , Shah Maully , Janson Christopher
Published: May 2021

Introduction:
Implantable loop recorders (ILRs) are an effective technology in the detection of paroxysmal arrhythmias, but utility in the pediatric population has been limited by device size. In 2014, a miniaturized ILR was introduced with a less invasive implant technique. The impact of this technology on ILR utilization in pediatric patients has not been evaluated.

Hypothesis:
We hypothesize an increase in annual pediatric ILR implants since 2014 due to device miniaturization.

Methods:
A retrospective observational study was conducted using administrative claims from Marketscan Medicaid and Commercial insurance claims databases. Utilization of ILR between 1/2013 and 12/2018 was measured (normalized to the total enrolled population ≤18 years) and compared to two balancing measures (Holter ambulatory monitors and encounters with syncope as a diagnosis). Secondary analyses included evaluations of subsequent interventions and complications.

Results:
The study cohort included 33,532,185 individual subjects, of which 769 underwent ILR implantation. ILR subjects were 52% male, with a median age of 16 years (IQR 10-17 yrs). 71% had a history of syncope, 43% had a history of palpitations, and 28% had a history of congenital heart disease. Utilization of ILR increased in 2014, from 5 procedures per million enrollees in 2013 to 11 per million between 2015-2018, while balancing measures remained static (see Figure).Of 393 subjects with ≥1 year of follow-up post-implant, interventions included catheter ablation in 24 (6%), pacemaker implant in 15 (4%) and ICD implant in 7 (1.8%). Among this group, 14 (3.6%) had a device infection and 5 (1.3%) had an erosion.

Conclusions:
Following introduction of the miniaturized ILR, pediatric utilization has rapidly increased. The effect of this change on outcomes and value deserves further attention.
Abstract 16101: Factors Associated With Implantable Cardioverter-Defibrillator Placement Among U.S. Veterans With Left Ventricular Ejection Fraction ≤35% at Least 40 Days After Acute Myocardial Infarction
Authors: Judson Gregory L , Cohen Beth , Muniyappa Anoop , Raitt Merritt , Shen Hui , Tarasovsky Gary , Whooley Mary , Dhruva Sanket
Published: May 2021

Introduction:
Implantable cardioverter defibrillators (ICD) reduce the risk of sudden cardiac death among patients with persistently low (≤35%) left ventricular ejection fraction (LVEF) at least 40 days following acute myocardial infarction (AMI). There are limited data about clinical factors associated with ICD placement following AMI.

Hypothesis:
We hypothesized that increasing age and number of comorbidities would decrease the odds of ICD placement post-AMI among patients with low (≤35%) LVEF, while revascularization for AMI would increase odds of ICD use.

Methods:
We used ICD-9 and 10 codes to identify all Veterans hospitalized for AMI from 2004-2017 and excluded Veterans with prior ICD and those who died during AMI hospitalization. We used a validated natural language processing algorithm to determine LVEF from echocardiograms performed 40-365 days post-AMI and identified patients with LVEF ≤35%. Using multivariable logistic regression, we examined the association of demographics, comorbidities, revascularization status for AMI, and prescription of guideline-directed medical therapy (GDMT) with the primary outcome of ICD placement 41-365 days post-AMI.

Results:
Of 10,447 Veterans eligible for an ICD, 1,966 (18.8%) received an ICD. Of 1,966 patients who received an ICD 7.1% died within 1-year, compared with 26.8% of patients who did not receive an ICD. In multivariable analysis, younger age, fewer comorbidities, revascularization during AMI hospitalization, and use of GDMT were associated with increased odds of receiving an ICD (Table). Eligible Black patients were less likely (OR 0.78, 95% CI 0.67-0.90) to receive an ICD than White patients.

Conclusions:
Many factors affect ICD placement among patients with reduced LVEF post-AMI. In particular, Black patients were less likely to receive ICDs than White patients. Future qualitative work could provide a deeper understanding of how patient and clinician factors influence decisions around ICD use.
Abstract 16140: Fontan Patients With Heart Failure and Preserved Ejection Fraction Have Similar Afterload but More Favorable Ventricular-arterial Coupling Than Fontan Patients With Reduced Ejection Fraction
Authors: Chowdhury Shahryar M , McHugh Kimberly E , Gaydos Stephanie S , taylor carolyn , Graham Eric M , Nutting Arni C , ATZ Andrew M
Published: May 2021

Introduction:
The cardiac mechanics that contribute to the development of heterogenous heart failure phenotypes in Fontan patients have not been investigated. The objective of this study was to investigate the differences in contractility, afterload, and ventriculo-arterial (VA) coupling between patients with heart failure and preserved ejection fraction (HFpEF) versus heart failure with reduced ejection fraction (HFrEF).

Methods:
Core-lab echocardiograms were obtained from the publically-available Pediatric Heart Network Fontan Cross-sectional Study database. Ejection fraction was considered abnormal if < 50%. Diastolic function was defined as abnormal if the diastolic pressure:volume quotient (lateral E:e’/end-diastolic volume) was > 10
th
percentile. Patients were divided into three groups: 1 = normal EF and normal diastolic function, 2 = decreased EF with normal diastolic function, 3 = normal EF with abnormal diastolic function. End-systolic elastance (Ees), a measure of contractility, and arterial elastance (Ea), a measure of afterload, were calculated. VA coupling was defined as Ea/Ees.

Results:
238 patients (61% left, 39% right ventricular dominant) were included. Differences between groups are reported in the Table.

Conclusion:
Both Fontan patients with HFpEF and HFrEF display increased afterload compared to their non-heart failure counterparts. However, HFpEF patients displayed a hypercontractile state to maintain a VA coupling ratio comparable to the non-heart failure group. These measures of cardiac mechanics may be useful in identifying the mechanisms that drive Fontan patients toward HFpEF versus HFrEF phenotypes.
Abstract 16148: Serum Gdf-15 Identifies Patients at Risk for Acute Heart Failure but Not Ventricular Arrhythmias and Sudden Death
Authors: Binder M. S , Pappu Ananya , Yang Wanjun , Wu Katherine C , TOMASELLI Gordon F , Barth Andreas S
Published: May 2021

Introduction:
GDF-15 (Growth Differentiation Factor 15), a member of the transforming growth factor beta superfamily, has been shown to be a biomarker of mitochondrial diseases. Additionally, increased levels of GDF-15 have also been associated with all-cause death and heart failure (HF) in patients with coronary artery disease. Conflicting data exists regarding GDF-15 levels and risk of ventricular arrhythmic events.

Hypothesis:
In a cohort of patients with reduced left ventricular systolic function, GDF-15 identifies patients at high risk of (1) worsening HF and (2) sudden arrhythmic death.

Methods:
PROSe-ICD is a multicenter prospective cohort study of 1,189 patients with ischemic and non-ischemic cardiomyopathy who underwent ICD implantation for primary prevention of sudden death, designed to compare patients who sustain an appropriate ICD firing for rapid VT or VF (surrogate for sudden death) to those who do not. Worsening HF was defined as any admission for acute decompensated HF during an average follow up period of 8 years. Blood samples were obtained on average every 6 months and GDF-15 was measured with an ELISA based assay from a subset of PROSe-ICD patients with appropriate ICD shocks (n=58; 228 samples), worsening HF (n=42; 157 samples), both HF and VT/VF (n=12; 46 samples) and 237 samples from 46 controls without ICD shocks and HF, matched for age and ejection fraction.

Results:
GDF-15 levels were elevated in patients who had acute decompensated heart failure, but not in patients who experienced ICD shocks in the absence of worsening HF (see Figure). Differences in GDF-15 levels were relatively stable over time within individual patients, and did not predict HF events.

Conclusions:
Future studies need to examine whether patients with the highest GDF-15 levels have underlying mitochondrial or nuclear DNA mutations leading to mitochondrial dysfunction and worsening HF.
Abstract 16179: Concordance Between Machine Learning-based Methods of Atrial Fibrillation Subtyping in 49,905 Individuals and Relationship to Genetically Predicted Af Risk and Inflammation
Authors: Davogustto Giovanni E , Farber-Eger Eric , MURRAY Katherine T , Michaud Gregory F , Shoemaker Ben B , Mosley Jonathan , Roden Dan M , Wells Quinn
Published: May 2021

Introduction:
Atrial Fibrillation (AF) is a heterogeneous arrythmia. Identification of subgroups of patients with shared mechanisms, such as genetic predisposition to AF and inflammation, could facilitate precision care. Machine learning (ML) is increasingly applied to define disease subtypes in an unbiased fashion, but the extent to which purported subgroups are robust across ML methods and whether they align with underlying AF mechanisms is unclear.

Objective:
Compare AF subtypes identified using 2 ML methods, and assess the extent to which subtypes relate to genetically-predicted AF and inflammatory state.

Methods:
We identified individuals with AF in a large electronic health record and linked DNA biobank. Using 86 curated clinical features, 5 clusters were found using affinity propagation, which provided
K
for a complementary K-means clustering. Shared cluster membership was assessed with the Adjusted Rand Index (ARI). Polygenic risk scores (PRS) for AF and 5 inflammatory biomarkers (IL-1b, IL-6, TNF-α, IFN-γ, IL-10, and IL-17) were used to interrogate genetic mechanisms underlying clustering.

Results:
We identified 49,905 patients with AF, including 5,532 with genotyping. There was moderate agreement in subgroup membership between the two ML methods (ARI 0.53). Subgroups were distinguished by presence/absence of structural heart disease, comorbidities, mortality, AF ablation, bleeding events, and dialysis (Figure 1). All subgroups had greater mean AF PRS than non-AF controls. Among AF subgroups, the “high comorbidities” group had the lowest AF PRS values (Figure 2). PRS of inflammatory biomarkers were similar between clusters.

Conclusion:
In this real-world AF cohort, there was moderate agreement between 2 clustering methods. The genetically-predicted levels of inflammatory biomarkers were not different among clusters. Clusters have features comparable to clinically recognized AF subgroups, and differ in genetic liability toward AF.
Abstract 16180: Cardiovascular Adverse Events Associated With Androgen Receptor-targeted Therapy Used in the Treatment of Prostate Cancer
Authors: Shrestha Bishesh , Gouli Sugam , Shrestha Asis
Published: May 2021

Introduction:
Prostate cancer is the second most common cancer in males. Its risk increases with age. So does the risk for cardiovascular disease. Androgen receptor-targeted therapy is now recommended to be added to androgen-deprivation therapy in the treatment of prostate cancer. We present common cardiovascular adverse events seen with the use of anti-androgens medication: abiraterone, enzalutamide, apalutamide, and darolutamide.

Methods:
We conducted a meta-analysis of 13 multinational randomized phase III clinical trials looking for cardiovascular adverse events in groups that received abiraterone, enzalutamide, apalutamide and darolutamide for treatment of prostate cancer. We analyzed a cohort of 9867 patients in these trials.

Results:
In the abiraterone usage group (n= 3492), most common cardiovascular adverse event was hypertension reported in 16.03%. Atrial fibrillation was reported in 0.97% and other cardiovascular events (IHD, MI, SVT, VT, and heart failure) were seen in 9.56%. In the enzalutamide usage group (n=4094) hypertension was seen in 10.6%, IHD in 1.88%, and atrial fibrillation was seen in 0.39%. Other unspecified cardiovascular adverse events were reported in 5.98%. In the apalutamide usage group (n=1327) hypertension was seen in 22%. Other cardiovascular adverse events (atrial fibrillation, MI, cardiogenic shock) were seen in 0.96%. In the darolutamide usage group (n=954) hypertension was seen in 6.6%, coronary artery disorders (coronary artery disease, coronary artery occlusion and stenosis) in 3.24%, and heart failure in 1.88%.

Conclusions:
The most common cardiovascular adverse event with use of anti-androgen medication seen in this large cohort analysis was hypertension with highest incidence seen in apalutamide group. Other cardiovascular side-effects noted were atrial fibrillation, SVT, VT, ischemic heart disease, MI, heart failure, and cardiogenic shock. Abiraterone and enzalutamide are the drugs that have been used in most trials. FDA adverse reaction reporting system (FAERS) shows hypertension as the most commonly reported cardiovascular adverse event with abiraterone and enzalutamide use. More prospective studies are needed to further access cardiovascular risk with use of anti-androgen therapy.
Abstract 16182: Prognostic Value of Peak Oxygen Uptake Trajectories for Mortality Risk in Patients With Heart Failure
Authors: Mansour Emily , cao chao , Purtiz Alyssa , Zhong Qiaonan , Soares Andrea , Peterson Linda R , RACETTE Susan B
Published: May 2021

Introduction:
Peak oxygen uptake (VO
2peak
), as determined by cardiopulmonary exercise testing (CPET), is informative of cardiovascular fitness and heart failure (HF) disease progression. Due to their clinical meaningfulness, many patients with HF undergo multiple CPETs throughout their lifetimes. However, a gap in knowledge exists regarding the prognostic value of longitudinal changes in VO
2peak
for mortality risk. The aim of this study was to investigate whether VO
2peak
trajectories are predictive of mortality among patients with HF.

Methods:
Patients with HF who completed two CPETs (separated by at least 3 months, mean = 25.3 months) at Washington University School of Medicine between May 1993 and February 2020 were included in the study. Vital statuses and mortality dates were collected from May 2019 to May 2020 via electronic health records and the Social Security Death Index. Kaplan-Meier and Cox proportional hazards regression analyses were used to evaluate associations between changes in VO
2peak
and mortality.

Results:
The sample included 162 patients with a mean age of 48.5 years (SD 10.5) at baseline. VO
2peak
averaged 18.1 (SD 4.9) ml·kg
-1
·min
-1
in 121 men and 15.1 (SD 4.1) ml·kg
-1
·min
-1
in 41 women. During a median follow-up of 11.8 years (range 1-23 years), 70 patients died. A significant negative association between VO
2peak
and mortality was observed (hazard ratio [HR] = 0.92; 95% Confidence Interval [CI] = 0.87 to 0.98; P = 0.011). Patients whose VO
2peak
increased from their baseline to second CPET had higher survival rates compared to patients whose VO
2peak
decreased. Moreover, the annual rate of change in VO
2peak
was associated with mortality rates. A 9% lower mortality rate was observed for each unit increase in VO
2peak
change (i.e., 1 ml·kg
-1
·min
-1
) for the entire follow-up period (HR = 0.91; 95% CI = 0.85 to 0.97) and at 10-year follow-up (HR = 0.91; 95% CI = 0.85 to 0.98), while a 12% lower mortality rate was observed at 5-year follow-up (HR = 0.88, 95% CI = 0.78 to 1.00) relative to baseline CPETs.

Conclusion:
Increases in VO
2peak
were associated with increased survival rate among patients with HF. These findings highlight the importance of promoting exercise and cardiac rehabilitation for patients with HF.
Abstract 16187: Incidence, Risk Factors, and Outcomes of Atrial Fibrillation After Blood and/or Marrow Transplant
Authors: Pinkhas Daniel , Ning John , Kim Hyun , Subramani Matthew , D'Souza Anita , Rubenstein Jason
Published: May 2021

Introduction:
Atrial fibrillation (AF) is known to occur after blood and/or marrow transplant (BMT) and has been shown to increase morbidity and mortality. Our objective was to characterize the incidence, risk factors, and clinical impact of AF in patients within the first 90 days after BMT.

Methods:
Patients with active malignancy undergoing BMT from 2012-2016 at the Medical College of Wisconsin were included (n=1159). Medical records were reviewed for baseline patient characteristics, AF risk factors, and clinical outcomes. Patients were categorized based on development of AF within 90 days post-BMT. Baseline characteristics and risk factors were analyzed to determine predictors for AF and all-cause mortality at 90 days.

Results:
Amongst the entire cohort, 5.3% of patients developed AF within the first 90 days after BMT. Significant baseline differences between those with or without AF post-BMT are outlined in Table 1. Multivariable analysis showed that a history of AF (OR: 6.7; 95% CI: 3.3-13.6;
P
= <0.001) and prior XRT (OR: 2.3; 95% CI: 1.2-4.6;
P
= 0.018) were independent predictors of developing AF. Univariate analysis demonstrated that AF was associated with 90-day mortality (HR: 7.6; 95% CI: 3.5-16.5; log rank
P
< 0.001). Multivariable analysis (adjusted for age, gender, race, history of XRT, BMT type, and malignancy type) revealed that female gender (HR: 2.6; 95% CI: 1.2-5.5;
P
= 0.016), non-Caucasian race (HR: 2.7; 95% CI: 1.1-6.4;
P
= 0.024) and development of AF (HR: 9.2; 95% CI: 3.7-21.5;
P
< 0.001) were significant independent predictors of early mortality.

Conclusions:
This analysis demonstrated that a prior history of AF and prior XRT were independent predictors for the development of AF in the early period post-BMT and AF is a significant independent predictor of early mortality after BMT. Further studies assessing the potential benefits of AF prevention in patients after BMT is warranted.
Abstract 16196: Nitric Oxide Delivery During Cardiopulmonary Bypass Reduces Acute Kidney Injury: Randomized Trial
Authors: Kamenshchikov Nikolay O , Podoksenov Yuriy K , Anfinogenova Yana J , Kozlov Boris N
Published: May 2021

Introduction:
Acute kidney injury (AKI) is a serious complication of cardiac surgery with cardiopulmonary bypass (CPB). Postoperative AKI develops in 30% to 52% of cardiac surgery patients and 2% to 5% of these patients require renal replacement therapy.

Hypothesis:
We hypothesized that nitric oxide treatment during cardiac surgery with CPB can decrease AKI incidence in adult patients. The aim of study was to evaluate the effects of nitric oxide supplementation to CPB circuit on the development of cardiac surgery-associated AKI.

Methods:
A prospective randomized controlled study included 96 patients with moderate risk of renal complications who underwent elective cardiac surgery with CPB. The study protocol was registered at www.clinicaltrials.gov (#NCT03527381). Patients were randomly assigned to either the nitric oxide supplementation to CPB circuit (NO-treatment group,
n
= 48) or the usual care (control group,
n
= 48). 40-ppm nitric oxide was administered in NO-treatment group during the entire CPB period. The primary outcome was AKI incidence.

Results:
Nitric oxide treatment was associated with a significant decrease in AKI incidence (10 (20.8%) versus 20 (41.6%); RR 0.5 (95% CI 0.26-0.95;
p
=0.023) and a higher urine output during CPB (2.6 [2.1;5.08] versus 1.7 [0.80;2.50] mL/kg/h;
p
= 0.0002). Urinary neutrophil gelatinase-associated lipocalin levels were significantly lower in NO-treatment group 4 h after surgery: 1.12 [0.75;5.8] versus 4.62 [2.02;34.55] ng/mL;
p
= 0.005. Concentrations of nitric oxide metabolites in NO-treatment group significantly increased at 5 min post-clamping, 5 min after declamping, and at the end of surgery. The concentrations of proinflammatory and anti-inflammatory mediators and free plasma hemoglobin did not significantly differ between groups.

Conclusions:
Nitric oxide administration to patients at moderate risk of renal complications undergoing elective cardiac surgery with CPB was associated with a decrease in AKI incidence. The implications of study for clinical practice expand the array of methods, which may be used for prevention of AKI in cardiac surgery patients.
Abstract 16199: Trend of Hypertensive Emergencies in Atrial Fibrillation Hospitalization; National Estimate
Authors: Al-Dabbas Mae'n , Shah Jay , adalja devina , Gundabolu Archana , Kumar Ashish , Shariff Mariam , Thakkar Samarthkumar J , Gandhi Haresh , Patel Harsh P , Gullapalli Nageshwara , Doshi Rajkumar P
Published: May 2021

Introduction:
Hypertension has been reported as one of the most common risk factor causing atrial fibrillation (AF). Also, hypertension is associated with more persistent AF. However the epidemiology for incidence of hypertensive emergency in AF hospitalization is not well documented.

Hypothesis:
We hypothesize that frequency of hypertensive emergency has been increasingly associated with Atrial fibrillation.

Methods:
National inpatient sample from 2005 -2015 was used for the present analysis. Patients over 18 years, with AF as the primary diagnosis were identified using International Classification of Diseases, Ninth Revision-Clinical Modification (ICD-9-CM) code, 427.31. Patients with hypertensive emergency were identified using ICD-9-CM code. 401.0, 402.0, 403.0, 404.0, 405.0.

Results:
A total of 4,988,269 AF patients over 18 years of age were included in the present analysis. Of these hospitalization 49,423 had hypertensive emergency during hospitalizations and the rest 4,938,846 had no hypertensive emergency. There was a monotonic increase in the trend of rates of hypertensive emergency per 1000 AF hospitalizations, from 2005 - 2015. (P value <0.001) [Figure 1].

Conclusion:
There has been a significant increase in the rates of hypertensive emergency among AF hospitalization, over the past decade. Further research is needed to investigate the reason for this increased trend.