bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17103: Elevated NT-proBNP Level is Not a Prognostic Marker for Patients Hospitalized With SARS-CoV-2 Infection
Authors: Ikram Farukh G , Acharya Priyanka , Nguyen Nicholas , Sidhu Manavjot S
Published: November 2020

Introduction:
NT-proBNP is a widely available and frequently utilized laboratory marker in patients with congestive heart failure. Its availability and use as a surrogate marker for elevated ventricular filling pressures and ventricular strain that frequently manifests as shortness of breath makes it an attractive laboratory marker to triage patients with SARS-CoV-2 infection.

Hypothesis:
Elevated NT-proBNP is correlated with higher mortality and/or rate of major adverse cardiovascular events (MACE) in patients admitted with SARS-CoV-2 infection.

Methods:
A retrospective analysis was performed on 225 patients admitted for SARS-CoV-2 infection at a major metropolitan hospital located in the Southwestern United States from the period of March 2020 to May 2020. NT-proBNP levels were recorded in 117 patients (52.7%) on admission. Elevated NT-proBNP was defined as: above 450 pg/ml in patients less than 50 years old, above 900 pg/ml if 50 to 75 years old, and above 1,800 pg/ml if above 75 years old. The primary endpoint was a composite of MACE and mortality during hospitalization. MACE was defined as stroke, myocardial infarction, DVT or PE and shock requiring vasopressor support. Two-sample Wilcoxon rank-sum (Mann-Whitney) test, Pearson’s chi square test and Fisher’s exact test were utilized for data analysis.

Results:
Of the 117 SARS-CoV-2 positive patients that had admission NT-proBNP levels available for analysis, 23 (19.66%) met age-adjusted criteria for elevated NT-proBNP. There was no significant correlation between elevated NT-proBNP levels and MACE (p = 0.482) or mortality (p = 0.737) in patients with SARS-CoV-2 infections. There was no statistical difference in total length of stay (p-value = 0.6384) or ICU admission (p-value = 0.354) between those with elevated admission NT-proBNP and those without.

Conclusions:
An elevated NT-proBNP at time of admission does not significantly correlate with higher rates of MACE, hospital length of stay, ICU admission, and mortality in patients admitted with SARS-CoV-2 infection.
Abstract 17133: The Use of Novel Hematological Markers in Predicting Stroke After TAVR Using a Machine Learning Algorithm
Authors: Hasani Aliaskar Z , Rahgozar Kusha , Wengrofsky Aaron , Kuchimanchi Narasimha , Mustehsan Mohammad Hashim , Latib Azeem , Goldberg Ythan
Published: November 2020

Introduction:
Aortic Stenosis is the most common valvular disorder with a predominance in the elderly. Trans-Aortic Valve Replacement (TAVR) has been an effective procedure with marked improvement in quality of life for patients. The procedure carries a small, yet clinically significant risk of stroke. The use of Neutrophil-Lymphocyte Ratios (NLR) and Platelet-Lymphocyte Ratios (PLR) have been growing as novel markers of systemic inflammation. We investigated the ability of a machine learning algorithm (Light GBM) to predict and weigh these ratios along with other clinical parameters for prediction of stroke after TAVR.

Objective:
To demonstrate the efficacy of the Supervised Machine Learning algorithm, Light GBM, in identifying important variables to predict stroke after TAVR.

Methods:
We performed a retrospective analysis of 291 patients who underwent TAVR from 2015-2019 at Montefiore Medical Center. Age (80±8), 50.2% Female, BMI (28.7 ±6.3). Clinical data was collected through our Hospital EMR. NLR and PLR averages were obtained using the mean of baseline (prior to surgery), Immediate Post-operative, and Post-operative Day 1 values. A supervised machine learning algorithm, Light GBM, used decision tree algorithms with both level-wise growth and leaf-wise growth. The algorithm was trained on 80% of the data and internally validated on the other 20%.

Results:
We identified NLR and PLR as the second and third most important feature of importance (Table 1) Clinical and demographic features of importance included BMI, Age, and Sex. Our model when internally validated yield a Sensitivity of 75.0%, Specificity of 91.5%, Accuracy of 91.5%, and F1 of 0.75. The AUC for the model was 0.84.

Conclusions:
Using Novel hematological parameters in conjunction with machine learning algorithms have highlighted important variables in predicting stroke after TAVR. Extrapolated, average NLR and PLR can be an inexpensive tool in stratifying patients those patients most at risk.
Abstract 17140: Impact of Atrial Fibrillation on the Outcomes of Heart Failure With Preserved Ejection Fraction- A National Inpatient Sample Based Study
Authors: Akhtar Tauseef , Desai Parth V , Sreenivasan Jayakumar , Bhayan Poonam , Syed Roshini , Mattumpuram Jishanth , Ranka Sagar , Dalia Tarun , Del Cid Fratti Juan , Patel Axi , Vasaiwala Smit , Deshmukh Abhishek
Published: November 2020

Introduction:
Atrial fibrillation (AF) adversely affect the outcomes in the patients of heart failure (HF) with reduced ejection fraction, however there are limited data exploring such an association in HF with preserved ejection fraction (HFpEF).

Hypothesis:
AF is associated with worse outcomes in HFpEF.

Methods:
We included all the patients with the primary diagnosis of HFpEF from the national inpatient sample (NIS) database (2012-2014) using ICD-9 codes. Exposure of interest was AF. Primary outcome was in-hospital mortality and secondary outcomes were rates of sudden cardiac arrest (SCA), syncope, cardiogenic shock, embolic stroke, acute myocardial infarction (AMI), acute kidney injury (AKI), passive hepatic congestion, ventricular fibrillation (V fib) and flutter, ventricular assist device (VAD), AICD, cardiac resynchronization therapy (CRT), intra-aortic balloon placement (IABP) placement and heart transplantation. Hospitalization cost was also studied.

Results:
Our study cohorts included 26,51,970 patients of HFpEF with AF and 37,44,101 patients of HFpEF without AF. AF cohort had more numbers of older patients and less female representation. In-hospital mortality was more in AF cohort. Similarly, the odds of SCA, cardiogenic shock, embolic stroke, passive hepatic congestion, Vfib and flutter, AICD and CRT placement were higher in AF cohort. The odds of syncope, AMI and AKI were lower in AF cohort as compared to non-AF cohort. While the odds of heart transplantation and VAD and IABP use remained comparable between the study cohorts, AF cohort incurred greater of cost of hospitalization.

Conclusion:
AF in HFpEF patients is associated with increased in-hospital mortality and cardiogenic shock and should be aggressively treated for improved outcomes.
Abstract 17142: Long Term Results of Non-Invasive Ultrasound Therapy (NIUT) in Severe Symptomatic Aortic Valve Stenosis - First-in-Man
Authors: Messas Emmanuel , Ijsselmuiden Alexander , Vlieger Selina , den Heijer Peter , Goudot Guillaume , Puymirat Etienne , ZARKA Samuel , CHOLLEY Bernard , Spaulding Christian , Hagege Albert A , Marijon Eloi , Tanter Mickael , BERTRAND Benjamin , Remond Mathieu C , Pernot Mathieu , Spaargaren Rene
Published: November 2020

Background:
Not all patients with severe aortic valve stenosis are eligible for open-heart surgery or TAVR. CARDIAWAVE (Paris, France) has developed Valvosoft, a unique non-invasive ultrasound therapy device to treat aortic stenosis. The therapy aims to improve the opening of severely calcified aortic valves by cracking the calcium and reducing the stiffness in the aortic valve tissue by delivering transthoracically local shock waves on the valve leaflets. This study assesses the safety, feasibility and performance of this novel technique.

Methods:
This is a multi-center, prospective, first-in-man study designed to evaluate the safety and feasibility of the Valvosoft device. Ten patients with severe symptomatic calcific aortic stenosis and not eligible for SAVR/TAVR underwent a Valvosoft ultrasound therapy. Echocardiographic evaluation was performed by an independent core lab at baseline, discharge, and at 1, 3, 6 and 12 months along with clinical follow up.

Results:
Enrolled patients were advanced in age (84.1±6.5 yrs) with severe comorbidities (8 with heart failure, 5 with coronary heart disease and 5 with kidney failure). All had extensive aortic valve calcification with mean AVA of 0.61±0.17 cm2 and mean pressure gradient of 37.5±10.5 mmHg. At one-month follow-up, six patients had significantly improved their AVA with increase of 27.5% (p=0.03) and mean pressure gradient decrease of 23.2 % (p=0.025). These patients also received the highest dose and longest treatment duration. During one year follow up, 4 patients died due to progression of end stage heart failure not linked to the procedure and one patient had undergone a TAVR procedure. At 12 months, the five remaining patients has no device or procedure related major adverse events nor deterioration of neurological status. Echo, brain-MRI and clinical follow up will be presented.

Conclusions:
Non-invasive ultrasound therapy is feasible and safe in patients with severe aortic valve stenosis and can improve AVA and hemodynamic parameters. NIUT can be an important tool complementary to TAVI in treating patients with aortic valve stenosis.
Abstract 17158: Patient-Specific Analysis of Pre-Surgical Leaflet Deformations to Predict Outcomes of Surgical Repair for Ischemic Mitral Regurgitation
Authors: Narang Harshita , Rego Bruno , Khalighi Amir , Aly Ahmed , Pouch Alison , Gorman Robert , Gorman Joseph H , Sacks Michael
Published: November 2020

Introduction:
Ischemic mitral regurgitation (IMR) is a highly prevalent disorder, and current methods of repair have suboptimal rates of failure. Accounting for patient-specific variations in the pre-surgical deformation patterns of the mitral valve (MV) may allow for better prediction of post-surgical outcomes.

Methods:
Real-time 3D echocardiographic images of the MV were segmented to create geometric representations for 20 patients (10 with and 10 without IMR recurrence) immediately pre- and post-annuloplasty repair as well as for 5 healthy MVs. To build correspondence between the open and closed valve geometries in each state, we morphed the open state geometry to the closed state shape within a finite element framework. Metrics including directional in-plane strains, leaflet area, and orifice dimensions were then computed and compared between the valves with and without recurrent IMR.

Results:
We found that MVs with IMR had significantly lower magnitudes of compressive circumferential strain in the posterior leaflet and higher radial strains across the whole MV than MVs without IMR (Figure). Patients who would later exhibit MR recurrence were found to have significantly higher circumferential leaflet strain in the anterior commissure prior to surgery than those without recurrence (p = 0.0228). The recurrent MVs also had significantly larger leaflet areas and annuli than the non-recurrent MVs, and their annuli contracted less.

Conclusions:
Key characteristics of IMR including increased downward leaflet tethering, annular dilation, and reduced ability to contract were most pronounced in MVs with recurrent IMR, suggesting that valves with recurrence may be in a more progressed disease state pre-surgically or may have a different manifestation of the myocardial infarct. Such factors could be used to predict post-surgical IMR recurrence and improve surgical planning.
Abstract 17177: Furosemide Promotes Myocardial Fibrosis in Swine Heart Failure
Authors: Plavelil Nisha , Haigney Mark C , Goldstein Robert E , Klein Michael , Shou Matie , Michaelson Luke , Ho Vincent B , Hood Maureen N
Published: November 2020

Introduction:
Although frequently used in heart failure (HF), long-term furosemide exacerbates HF in a swine model. This paradoxical phenomenon may reflect furosemide-induced alterations in signaling proteins of the extracellular matrix (ECM) to increase fibrosis. Examination of the ECM may clarify how treatments like furosemide enhance the progression of HF.

Hypothesis:
The administration of furosemide increased inflammation and fibrosis of the heart, leading to accelerated HF deterioration in a swine model.

Methods:
After
Institutional Animal Care and Use Committee (IACUC)
approval, Yorkshire swine (N=10, 5 = furosemide, 5 = saline) were paced 3 to 5 weeks at 200 beats per minute to induce HF (left ventricular fractional shortening <16% on echocardiogram). Animals were treated with furosemide (1 mg/kg intramuscularly) or saline. Western Blot and histology with Masson’s trichrome stain were performed on transmural LV myocardium to quantify critical determinants of fibrosis. ANOVA with Tukey HSD correction and descriptive statistics were performed using SPSS with significance by α of 0.05; mean ± SEM.

Results:
The overall increase in ECM fibrosis in HF was clearly demonstrated on Masson’s trichrome histology associated with significant, uniform increase in signaling pathways leading to fibrosis associated with furosemide use. SMAD 2-HF Furosemide to Control (p<.05): HF Furosemide 0.266 ±.05, HF Saline 0.183±.02, Control 0.163±.01 ERK-all (p<.05): HF Furosemide 0.312±.02, HF Saline 0.209±.01,Control 0.149±.01 GDF-15-HF Furosemide to Control (p<.05): HF Furosemide 0.095 ±.00, HF Saline 0.073±.01, Control 0.062±.01 MMP-14-all (p<.05): HF Furosemide 0.451±.02, HF Saline 0.374±.03,Control 0.231±.02 TIMP-1-all (p<.05): HF Furosemide 0.184±.01, HF Saline 0.0135±.03,Control 0.033±.01 PAI-1-all (p<.05): HF Furosemide 0.105±.01, HF Saline 0.046±.01,Control 0.043±.00

Conclusions:
Histologic and biochemical analysis showed worsening HF in furosemide-treated paced swine was associated with consistent increases in fibrosis and indices of adverse ECM remodeling. The diuretic intended to reduce water retention during HF appeared to enhance myocardial fibrosis, paradoxically accelerating pathological processes responsible for HF.
Abstract 17183: Severity of Myocardial Injury in COVID-19 Hospitalized Patients
Authors: Sanghvi Saagar K , Schwarzman Logan , Nazir Noreen , Konda Sreenivas
Published: November 2020

Introduction:
Myocardial injury in COVID19 is reported as high as 30% and associated with worsened prognosis (Cooper et al., Circulation). Along with elevated cardiac biomarkers, elevated inflammatory markers of cytokine storm and hemophagocytic lymphohistiocytosis (HLH) are associated with increased illness severity and mortality.

Our study aimed to identify patients at highest risk for myocardial injury and subsequent cardiac decompensation.

Methods:
279 consecutive patients with COVID19 from a major metropolitan academic center, discharged from 3-21-2020 to 5-17-2020, were analyzed. Primary data includes age, sex, race, and peak troponin I during hospitalization. Patients were further stratified to evaluate severe cases with acute respiratory distress syndrome (ARDS) requiring intubation (n=40), and peak levels of CRP, ferritin, and D-dimer were collected. Bivariate and multivariate measures of association between peak inflammatory marker and troponin I levels were estimated.

Results:
Average age of ARDS population patients was 61 +/- 15 years; 50% male and 50% female. Self-identified African Americans(AA) were 35%, Hispanic/Latinos(H/L) were 55%, and Others including two White Americans were 10%. Average peak troponin I in H/L was remarkably higher 0.51 +/-1.16 compared to AA 0.18 +/- 0.23 and Others 0.13 +/- 0.16. Per multivariate regression analysis, D-dimer had the most significant effect on the elevated troponin (p=0.027). Although weakly significant, H/L showed elevated troponin (p =0.09) compared to non-H/L.

Conclusion:
Elevated D-dimer is associated with increased morbidity in COVID19, and also correlates with elevated troponin concerning for increased myocardial injury. Furthermore, the H/L population may be at greater risk for developing myocardial injury and have more injury as shown by higher troponin I levels. Larger studies may better assess the relation between inflammatory markers such as CRP and ferritin and myocardial injury. Our study provides evidence of systemic inflammation contributing to significant myocardial injury in COVID19, especially in the H/L population. Identifying patients at highest risk for myocardial injury early may allow for more effective medical interventions and improved outcomes.
Abstract 17204: Asymmetric Patterns of Cerebral Cortical Development in Fetuses With Complex Congenital Heart Disease
Authors: Lu Yuanchiao , Kapse Kushal , Andersen Nicole , Lopez Catherine , Quistorff Jessica , Krishnan Anita , Vezina Gilbert , Donofrio Mary T , Limperopoulos Catherine
Published: November 2020

Introduction:
Neurodevelopmental disabilities are common among infants with complex congenital heart disease (CHD). While hemispheric asymmetries in normal fetal brain size and shape have been reported, the effect of CHD on hemispheric development of the developing fetal brain remains unknown.

Hypothesis:
We hypothesized that emerging cerebral hemispheric asymmetries of the fetal CHD brain would differ compared to healthy controls using
in vivo
MRI tools.

Methods:
A total of 252 pregnant women were recruited (164 controls; 88 CHD fetuses), in which 328 fetal MRI scans were performed. Single shot fast spin echo T2-weighted images were acquired on a 1.5T GE MRI scanner. High-resolution 3D models of the fetal brain were reconstructed using slice-to-volume registration method for motion correction and Draw-EM algorithm for automatic segmentation. Volumetric analysis of brain tissues was conducted, and cortical folding measures of brain lobes were evaluated. Mixed effects regression was utilized to compare the brain features between right and left hemispheres for healthy controls and CHD fetuses.

Results:
The mean gestational age of all fetal MRI studies was 32.1±3.7 weeks (range: 24.0-39.4). For healthy fetuses, the volume of cortical gray matter was higher in the left hemisphere; however, this pattern was diminished in CHD fetuses. Gyrification indices were higher in the parietal and occipital lobes of the right hemisphere for controls, but not for CHD fetuses. Similarly, Gaussian curvature was higher in the right frontal lobe for controls only. Conversely, the surface area of the left occipital lobe was lower in CHD fetuses, but not in healthy fetuses.

Conclusions:
We report for the first time early disturbances in emerging hemispheric asymmetric patterns of the fetal brain in CHD compared to controls. The extent to which these lateralization differences reflect genetic, epigenetic and/or hemodynamic disturbances in CHD fetuses is under investigation.
Abstract 17205: The Association of Cerebrovascular Autoregulation With Neurodevelopmental Delays Between Infants With and Without Congenital Heart Disease
Authors: Tran Nhu , Votava-Smith Jodie , Tran Michelle , Panigrahy Ashok , Peterson Brad
Published: November 2020

Background:
Children with Congenital Heart Disease (
CHD
) are 5 times more likely to develop neurodevelopmental impairment lasting into adulthood compared to their peers. One theory is that hypoxemia associated with CHD contributes to impaired cerebrovascular autoregulation (
CA
), which in turn may contribute to neurological injuries and impaired neurodevelopmental outcome (
NDO
) in CHD. This study examined the association of CA and NDO between CHD and healthy infants.

Hypothesis:
Impaired CA will be associated with poorer NDO in CHD infants through 9-month development.

Methods:
A prospective, longitudinal study was performed at 3, 6, & 9-month time points. CA was indexed by calculating the difference between 2-minute averaged supine and sitting cerebral oxygenation

(rcSO
2
)

measured by near-infrared spectroscopy for 3 consecutive tilts (0-90°), resulting in change scores. The Bayley Scales of Infant and Toddler Development III measured NDO. Multiple linear regressions quantified the group-by-CA interaction on NDO at each age.

Results:
We enrolled 35 CHD and 26 healthy control (
HC
) infants.
3 months:
As CA worsened (change score in rcSO
2
increased by 1-unit), cognitive compositive scores decreased by 2.6% in the CHD group compared to the HC during the 3
rd
postural change (P=0.003).
6 months:
As CA worsened, the language composite scores decreased by 3.7% in the CHD group at compared to the HC for the 1
st
postural change (P=0.041).
9 months:
As CA worsened, the cognitive composite scores decreased by 2.7% in the CHD group compared to the HC during the 3
rd
postural change (P=0.046). See Table 1.

Conclusion:
We found poorer CA to be significantly associated with worse NDO in CHD infants. These initial results demonstrate the persistence of impaired CA even after surgical repair of CHD, which may be a mechanism of brain injury. Future directions include larger studies and targeted interventions to improve CA to reduce developmental delays in CHD children.
Abstract 17223: Firefighting as an Independent Risk Factor for Atrial Fibrillation
Authors: Vanchiere Catherine , Thirumal Rithika , Hendrani Aditya D , Dherange Parinita , Bennett Angela , APTE NACHIKET MADHAV , Shi Runhua , Smith Denise L , Dominic Paari
Published: November 2020

Air pollution and particulate matter (PM) contribute to respiratory and cardiovascular disease over both chronic and acute exposure periods. Firefighters (FF) are a unique population which experiences these exposures, and likewise has a high risk of cardiovascular disease and death. The mechanisms by which air pollution and PM are proposed to cause disease are also known to contribute to development of arrhythmia, in particular atrial fibrillation (AF). The management of AF in FF is particularly challenging because the high likelihood of physical injury on the job makes anticoagulation more risky. In light of this unique challenge, we were interested in the risk of AF development in FF, and hypothesized that FF have an increased risk of AF. We distributed an electronic survey to FF via representative organizations to collect self-reported demographic, occupational, and clinical data. Multivariate logistic regression was used to assess the odds of having AF with participants stratified by the number of fires fought per year (≤ 10 vs ≥11). 11,965 firefighters completed the survey, of whom 93.53% were male and 96.31% were 65 years of age or younger. FF who fought ≥11 fires/year had a significantly higher lifetime prevalence of AF compared to FF who fought ≤10 fires/year (4.71% vs. 2.70%,
p
<0.001), and this relationship was seen to be dose-dependent (Figure 1). Multivariate logistic regression showed that, in addition to traditional risk determinants of AF like age, male sex, and hypertension, a higher number of fires fought per year (≥11) was independently associated with an increased risk of AF (OR 1.32, 95% CI 1.07 - 1.62,
p
=0.010).FF are a unique population with increased prevalence of AF, possibly related to occupational exposures. With over 1.1 million firefighters in the United States, it is imperative to conduct further research into the mechanisms behind this relationship, and to consider firefighting as a risk factor worthy of earlier screening and intervention.
Abstract 17224: Metabolic Switch and Redox Imbalance Contributes to Pulmonary Hypertension in Glucose-6-Phosphate Dehydrogenase Deficiency
Authors: Valuparampil Varghes Mathews , James Joel , Rafikova Olga , Rafikov Ruslan
Published: November 2020

Introduction:
Pulmonary hypertension (PH) is a fatal disorder with inadequate therapeutic choices and diminished survival rate with later prognosis. We previously reported that several patients with idiopathic pulmonary arterial hypertension had different types of glucose-6 phosphate dehydrogenase (G6PD) deficiency. G6PD is the key regulator enzyme in the pentose phosphate pathway (PPP) and the only source of NADPH in erythrocytes. However, the pathogenic mechanism of how G6PD deficiency contributes to PH development remains elusive.

Hypothesis:
We hypothesize that G6PD deficiency-induced PH is mediated through a multifactorial mechanism by increased red blood cell fragility, oxidative stress, and a metabolic switch.

Methods:
To delineate the contribution of G6PD in PH pathogenesis, we utilized a G6PD knockdown mouse line (11-13 week old) with decreased expression of G6PD (10% from wild-type level).

Results:
Hemodynamic and histological studies confirmed that G6PD deficient mice developed PH phenotype by an increase in right ventricular systolic pressure (30.08±0.91mmHg; p≤0.001), Fulton index (0.358±0.03; p≤0.01) and pulmonary vascular remodeling. G6PD deficiency resulted in increased free hemoglobin and activation of the p38/MAPK pathway, which we recently reported, induces the development of PH in the sugen/hypoxia model via endothelial barrier dysfunction. Metabolomics analysis of G6PD-deficient mice indicates the switch to alternative metabolic fluxes that feed into PPP, resulting in the upregulation of oxidative stress, fatty acid pathway, and reduction in pyruvate production. Thus, G6PD deficiency did not reduce PPP flux that is important for proliferation but activated collateral pathways at the cost of increased oxidative stress. Indeed, we found upregulation of Myo-inositol oxidase (p≤0.05), reduction in GSH/GSSG ratio (p≤0.01), and increased nitration (p≤0.05) in the lungs of G6PD deficient mice. Increased oxidative stress also results in the activation of PI3K, ERK1/2 and AMPK that contributes to the proliferation of pulmonary vasculature.

Conclusions:
Based on these results we infer that G6PD deficiency has a multi-modal effect, including hemolysis, metabolic reprogramming, and oxidative stress leading to PH.
Abstract 17244: Obesity and Serial NT-proBNP Levels in Heart Failure: Insights From the GUIDE-IT Trial
Authors: Parcha Vibhu , Patel Nirav , Kalra Rajat , Suri Sarabjeet , Arora Garima , Januzzi James L , Felker Michael , Wang Thomas J , Arora Pankaj
Published: November 2020

Background:
The prognostic implications of achieving NT-proBNP concentrations ≤1000 pg/mL among obese patients having heart failure with reduced ejection fraction (HFrEF) are not completely known. We evaluated the prognostic implications of body mass index (BMI), and achievement of target NT-proBNP levels of ≤1000 pg/mL in obese HF patients from the GUIDE-IT trial.

Methods:
Survival analysis using multivariable-adjusted Cox proportional hazard models was used to evaluate the risk of adverse cardiovascular (CV) events (HF hospitalization or CV mortality) based on the achievement of target NT-proBNP (≤1000 pg/mL), stratified by obesity status (obese [≥30 kg/m
2
] and non-obese [<30kg/m
2
]). Achievement of NT-proBNP ≤1000 pg/mL was treated as a time-varying measure. We also assessed the risk of the study outcome stratified by baseline obesity status and across BMI quartiles, taking NT-proBNP as a time-varying covariate.

Results:
Compared to non-obese patients, obese patients were mostly younger, Black, females with 59% (95% CI: 39.5-83.5%) lower adjusted NT-proBNP levels. The risk of adverse CV outcomes was 55% lower in obese (HR: 0.45 [95% CI: 0.28-0.74]) and 70% lower in non-obese (HR: 0.30 [95% CI: 0.17-0.51]) HF patients who achieved the target NT-proBNP, compared to their counterparts who did not achieve the target NT-proBNP (
Figure 1
). The was no interaction between obesity and achievement of target NT-proBNP on the study outcome (p>0.10). Obese patients at baseline had a greater risk of developing adverse CV events (HR: 1.52 [95% CI: 1.13-2.03]) compared to non-obese patients. Patients in the third (HR: 1.49 [95% CI: 1.03-2.17]) and fourth BMI quartile (HR: 2.04 [95% CI: 1.36-3.01]) had a higher risk of adverse CV events, compared to those in the first quartile.

Conclusion:
Achievement of NT-proBNP ≤1000 pg/mL has favorable prognostic implications irrespective of obesity status. Obese HF patients had a greater risk of adverse CV events than non-obese patients.
Abstract 17246: Sensitivity and Specificity of Relative Sparing of Apical Longitudinal Strain for Detection of Systemic Light-Chain Amyloidosis versus Transthyretin Amyloidosis
Authors: Jiang Michael , Simkowski Julia M , El Hangouche Nadia , Lee Jeesoo , Marion Milica , Vaitenas Inga , Thomas James D
Published: November 2020

Introduction:
Relative apical sparing of longitudinal strain (RALS, the ratio of apical strain vs the rest of the heart) on echocardiography has been found to have high sensitivity and specificity for differentiating cardiac amyloidosis (CA) from other causes of left ventricular hypertrophy. Previous studies have shown no significant difference between amyloid subtypes, systemic light-chain amyloidosis (AL) and transthyretin amyloidosis (ATTR)

Hypothesis:
There will be a significant difference in sensitivity and specificity of RALS to detect CA across amyloid subtypes.

Methods:
A cohort of patients with either AL or ATTR amyloid was identified, with a control cohort of patients with left ventricular hypertrophy (LVH) of other etiologies. Speckle tracking echocardiography was performed on EchoPAC (GE Medical Systems) software to obtain values of basal, mid, and apical longitudinal strain for each patient; relative apical strain was then calculated.

Results:
The TTR group (n=22) was older (66.4±7.9, 76.6±11.6, p=0.001) and more likely to be female (p=0.009) than the AL group (n=30), both groups had similar rates of hypertension, diabetes mellitus, and end stage renal disease. Echocardiographic markers of diastolic function were decreased in both groups; the AL group had decreased left ventricle end diastolic volume (60.9±25.5, 94.9±50.2, p=0.012) and mean wall thickness (1.4±0.3, 1.6±0.4 p=0.017). ROC analysis using a RALS cutoff of 2 to differentiate AL and ATTR from the LVH control group revealed similar specificity (AL 85%, ATTR 85%) and sensitivity (AL 40%, ATTR 50%). Difference in area-under-curve (AUC) was not significant (p=0.2) (figure).

Conclusions:
ATTR and AL amyloid have similar specificity, but ATTR has a trend towards improved sensitivity over AL for detection of CA using RALS with the previously validated threshold of 2. This might become significant with a larger sample, work that is currently on-going..
Abstract 17267: Outcomes of Patients With Non-ST-Segment Elevation Myocardial Infarction and High Degree Atrioventricular Block Treated With Early vs Delayed Invasive Strategy
Authors: Patel Raj , Patel Harsh P , Thakkar Samarthkumar J , Kutom Fadee , Ludhwani Dipesh , Jani Chinmay , Sheth Aakash , Arora Shilpkumar , Doshi Rajkumar P , Patel Rushin , Patel Bhavin , Nayak Hemal
Published: November 2020

Introduction:
High degree atrioventricular block (HDAVB) is an uncommon complication of non-ST-segment elevation myocardial infarction (NSTEMI), frequently necessitating pacemaker implantation.

Hypothesis:
This contemporary analysis compares the need for pacemaker implantation based on the timing of intervention in acute NSTEMI complicated by HDAVB.

Methods:
We used 2016-2017 National Inpatient Sample (NIS) database to identify all admissions with NSTEMI. Those without HDAVB were excluded from the study. Time to coronary intervention from initial admission was used to segregate the admissions into two groups: early invasive strategy (EIS) (<24 hours) and delayed invasive strategy (DIS)(>24 hours). A multivariate logistic and linear regression analysis was performed to compare in-hospital outcomes among both groups.

Results:
Out of 949,984 NSTEMI related admissions, coexistent HDAVB was present in 0.7% (n=6725) patients which were subsequently included in the study. Amongst those, 55.61% (n=3740) hospitalization included invasive intervention (EIS=1320, DIS=2420) (Figure1). Patients treated with EIS were younger (69.95 vs 72.38, p= <0.05) and had a concomitant cardiogenic shock. Contrarily the prevalence of chronic kidney disease (CKD), heart failure (HF), and pulmonary hypertension was higher in DIS group. EIS was associated with lower length of stay and total hospitalization cost. Although statistical significance was not achieved, a trend towards higher in-hospital mortality and lower pacemaker implantation rates were seen in hospitalizations involving EIS (Table1).

Conclusions:
HDAVB is a rare complication of NSTEMI and it is associated with significant mortality. The timing of revascularization does not appear to influence the rate of pacemaker placement in NSTEMI complicated by HDAVB. Further studies are needed to assess if all patients presenting with HDAVB should be treated with an early invasive strategy.
Abstract 17275: The SGLT2 Inhibitor Empagliflozin Ameliorates Left Atrial Dilatation in Non-Diabetic Patients With Heart Failure With Reduced Ejection Fraction: A Secondary Analysis of the EMPATROPISM Trial
Authors: Santosgallego Carlos G , Requena-Ibanez Juan Antonio , Vargas Ariana , Garcia-Ropero Alvaro , Rodriguez-Cordero Anderly , Pinney Sean , MANCINI Donna M , Lala Anuradha , Contreras Johanna P , Moreno Pedro R , SANZ Javier , Fuster Valentin , Badimon Juan J
Published: November 2020

Background:
SGLT2 inhibitors (SGLT2i) improve prognosis in HFrEF patients. We recently demonstrated in a porcine model of non-diabetic HFrEF that empagliflozin (EMPA) ameliorates adverse cardiac remodeling and improves LV systolic function. However, the effect of EMPA on left atrial (LA) dilatation has not yet been studied

Hypothesis::
Empagliflozin ameliorates left atrial dilatation in non-diabetic HFrEF patients

Methods:
The EMPATROPISM clinical trial investigated the efficacy and safety of EMPA in non-diabetic HFrEF patients. 84 patients were randomized to EMPA 10mg daily for 6 months or placebo on top of optimal medical treatment, and were evaluated with cardiac magnetic resonance (CMR). LA Volumes were quantified by CMR using the Simpson method (the number of slices in the usual short axis SSFP cine sequence was increased to cover both LV and the whole of LA. The primary endpoint was change in LVEDV. Prespecified secondary endpoints were changes in maximal and minimal LA volumes (ΔMax LA Vol and ΔMin LA Vol) at the end of 6 months between both arms

Results:
80 patients completed the follow up period. There were no differences at baseline in LVEDV (220±75 vs 209±68mL for EMPA vs placebo, p=0.5) or LVEF (36±8 vs 37±8%, p=0.7). There were no differences at baseline in both groups in either maximal or minimal LA volume (Table). In the primary endpoint, EMPA-treated patients showed decrease in LVEDV and increase in LVEF (ΔLVEDV -25±25 vs -1±25mL, p<0.001; and ΔLVEF 6±4 vs 0±4%, p<0.001 for EMPA vs placebo). EMPA-treated patients exhibited a reduction of both maximal LA volume (ΔMax LA Vol -16.2±17.8 vs 11.4±25.9mL for EMPA vs placebo, p<0.001) and minimal LA volume (ΔMin LA Vol -11.3±13.3 vs 6.4±19.3mL for EMPA vs control, p<0.001)

Conclusions:
In HFrEF patients without diabetes, treatment with empagliflozin ameliorates left atrial dilatation. As LA volume is a surrogate for chronic filling pressures, this reduced LA volume suggest improved diastolic function with EMPA
Abstract 17278: Mid-Term Clinical Outcomes of Functionally-Guided Treatment of Coronary Bifurcation Lesions
Authors: Vassilev Dobirn , Mileva Niya , Collet Carlos , Nikolov Pavel , Karamfiloff Kiril , Rigatelli Gianluca , Gil Robert , Serruys Patrick W
Published: November 2020

Background:
Rates of major adverse cardiac events (MACE) after functionally guided percutaneous coronary intervention (PCI) of coronary bifurcation lesions have not been specifically analysed.

Methods:
Patients from FIESTA registry (ClinicalTrials.govNCT01724957) with stable angina, bifurcation lesions in a coronary artery with diameter ≥ 2.5 mm and ≤ 4.5 mm and SB diameter≥2.0 mm were included in the analysis. Subjects with ST-segment elevation myocardial infarction, left main disease, hemodynamic instability were excluded. Provisional stenting was the default strategy in all patients. Fractional flow reserve (FFR) was performed using the PrimeWire or PrimeWire Prestige (Volcano Corp., USA). Bifurcation lesion with FFR above 0.80 were deferred from PCI. Follow-up for vital status at every 3-month period was performed and rates of MACE, including cardio-vascular death, nonfatal myocardial infarction and stroke, were analyzed.

Results:
Overall 165 patients were included, mean age was 67±10 years, 66% males, 72 (44%) had functionally significant bifurcation lesions (FSL) and 93 (56%) were with non-significant lesions (nFSL). There were no differences (FSL vs. nFSL) regarding: dyslipidemia (88% vs 96%), diabetes (44% vs. 32%), smoking (52% vs 40%), previous MI (24% vs 15%), previous PCI (54% vs 49%), atrial fibrillation (17% vs 29%), PAD (10% vs. 9%), renal failure (29% vs 31%) – all p>0.05. On a median follow-up of 34±14 months there were no differences between FSL and nFSL regarding rates of cardio-vascular death -12.5% (n=9/72) vs. 7.5% (n=7/93), p=0.4, MACEs - 13.9% (n=10/72)vs 8.6 (8/93), p=0.512. On multivariate Cox-regression analysis factors associated with occurrence of MACE were: presence of cancer OR 3.692, (CI 0.955-14.269); renal failure OR 2.550, (CI 0.961-6.767) SYNTAX ≥9 OR 1.836, (CI 0.490-6.874); SB RVD ≥ 2.4mm OR 2.546, (CI 0.708-9.160); SB BARI 13.5% OR 2.013, (CI 0.652-6.211); WBC≥7OR 3.647, (CI 0.824-16.134); Platelet count ≥ 256.106/ml OR 3.814, (CI 1.220-11.925).

Conclusion:
Less than a half of angiographically significant coronary bifurcation lesions were functionally significant requiring stent implantation. The rates of MACE were not-significantly different in deferred and treated stenoses up to 3 years follow-up.
Marine Pollution in Indonesia and the Regulatory Framework
Authors: Sodik Dikdik Mohamad
Published: November 2020

Oil pollution and marine plastic pollution (MPP) in Indonesian waters have been causing concerns for decades. This article examines the adequacy of the existing Indonesian legislation on oil pollution and MPP consistent with international environmental governance regimes. It is argued that the current Indonesian laws and regulations for dealing with oil pollution and marine debris are inadequate tools to effectively combat the environmental threats from oil pollution and MPP. This article demonstrates the gaps remaining in implementing the relevant legal framework, namely through the rules of a strict liability and MPP, to address marine pollution in Indonesian waters.
Erasmus and the Emotions of Death
Authors: Raeburn Gordon D.
Published: November 2020

This article investigates the presence of emotion, primarily fear, in Erasmus’ work on death and dying. How did Erasmus approach the fear of death, how did he believe people should face this fear, and what were his own personal beliefs on the matter? These questions are addressed here. The recent growth of the study of the History of Emotion has shown just how central to the development of thought and belief in the late medieval and early modern periods the emotions were, and this is no less true of the development of thought and belief concerning death and dying. The various ars moriendi works of the period were fully aware of the natural fear of death that people had, and they approached this fear in several ways. By the time Reformed Protestant artes moriendi began to appear, readers were taught that the fear of death could only be overcome by the constant meditation upon death. In certain respects Erasmus, with his De Praeparatione, bridged the gap between Catholicism, Early Lutheranism, and Reformed Protestantism, and as such his work, and its use of and engagement with fear, is investigated in detail here.
Erasmus and the Colloquial Emotions
Authors: Cummings Brian
Published: November 2020

Cognitive philosophy in recent years has made conversation central to the experience of emotion: we recognise emotions in dialogue. What lesson can be drawn from this for understanding Erasmus’ Colloquies? This work has often been rifled for its treatment of ideas and opinions, but it also offers a complex and highly imaginative treatment of conversation, originating as rhetorical exercises in De copia. This essay reconfigures the Colloquies in such terms, especially those involving female interlocutors, drawing on the riches of ancient interest in conversation in Plato, Cicero and Quintilian, and also on the vogue for dialogue in Renaissance Italy from Leonardo Bruni to Castiglione.
Jules Vuillemin, philosophe analytique contrarié
Authors: Engel Pascal
Published: November 2020

Jules Vuillemin a souvent été considéré comme l’un des parrains de la philosophie analytique en France. Mais il a pris toutes ses distances vis-à-vis de la tournure qu’a prise cette philosophie à la fin du vingtième siècle. Il est cependant resté fidèle aux principes les plus constants de la philosophie analytique à ses origines.
Logique et gnoséologie dans les Principia Mathematica et Inquiry into Meaning and Truth chez Russell
Authors: Vernant Denis
Published: November 2020

Procédant à une relecture de l’article de Jules Vuillemin « Difficultés logiques et problèmes philosophiques dans les Principia Mathematica de Russell », nous montrerons d’abord qu’effectivement la logique pure des Principia ne peut s’appliquer qu’à requérir des engagements existentiels sur des objets logico-mathématiques. Puis, en prolongeant les réflexions de Vuillemin, nous établirons que dans An Inquiry into Meaning and Truth Russell élabore une logique du langage ordinaire pour rendre compte à la fois de notre usage du langage et de nos modes de connaissance empirique.
Monumentality, Counter-monumentality, and Political Authority in Post-socialist Albania
Authors: Isto Raino
Published: November 2020

This article examines the role that monumentality—and efforts to critique it—have played in shaping the experience of public space in post-socialist Albania. It considers artistic and architectural strategies often labeled ‘counter-monumental’ because they were first developed as a way to challenge authoritarian and nationalist monumental structures from the past, and it argues that in Albania these counter-monumental strategies have become wedded to centralized state power. In the conditions of neoliberal capitalism, projects that aim to undo traditional monumentality can effectively obfuscate political agendas. In Albania, where Edi Rama—the current Prime Minister—is also a practicing artist, the discourses of contemporary art have served to increase the centralization of political authority, and the work of architecture and design firms such as the Brussels-based group 51N4E have reinforced the symbolic power of the state at the same time that they claim to open public spaces up for citizen participation.
Part-Peasant, Part-Trader: A Study of the Rural Poor in Republican Shanxi
Authors: Zhang Aiming
Published: November 2020

Mixed occupations are a prominent feature of China’s smallholder peasant economy. For poor peasant households with little land, working in multiple occupations is a survival strategy that represents a more rational or efficient allocation of household labor. In central Shanxi in the 1930s and 1940s, the growth of the commercial economy encouraged peasant households to dedicate their surplus labor to small-scale commercial activities (including itinerant trade and shopkeeping apprenticeship), thus leading to the formation of a mixed “part-peasant, part-trader” 半耕半商 economy. This economy was characterized by the following practices: First, many young, able-bodied men farmed during the busy seasons and peddled goods in the slack seasons. Second, other able-bodied men engaged in off-farm commercial activities year-round, while female and elderly dependents did the farming—often with the help of relatives and neighbors. This represented a rational gendered and intergenerational allocation of labor that undercut labor market prices to maximize household income. Third, any surplus income from commerce, after satisfying basic consumption needs, was used to purchase more land as subsistence insurance against the vagaries of the commercial economy. These mixed practices of mutually supporting agriculture and commerce developed into a robust and competitive part-peasant, part-trader economic system.
The Lyric and Its Reading – Paul de Man’s Theory of Lyric
Authors: Bókay Antal
Published: November 2020

The concept of lyric is a central component of Paul de Man’s theory of poetry. In several papers but first of all in his „Anthropomorphism and Trope in the Lyric” he developed a coherent understanding of the lyric as an act of modernism. Its epistemological character was given through Nietzsche’s often quoted statement on the metaphorical, anthropological and performative nature of subjective language and language use. The development of these ideas, however, took place through a detailed text-interpretation of two Baudelaire poems that served as metapoetical definitions of different poetical stances. It is possible that the idea of the lyric and reading lyric defined through anthropomorphism and phenomenality refers to, can be read like an elaborated epistemology of modern, subjective textuality too.
Warfare in Northern Mozambique, Late Sixteenth to Late Nineteenth Centuries
Authors: Alpers Edward A.
Published: November 2020

Studies of precolonial African warfare are still relatively scarce and northern Mozambique is no exception. This paper examines more than three centuries of African warfare among the Makua of Macuana. It emphasizes continuities in strategy and tactics, while at the same time paying attention to innovations in weaponry, above all the adoption and effective utilization of firearms. Based on a critical assessment of both primary and secondary sources, it analyzes Portuguese claims of cannibalism among the Makua in the sixteenth and eighteenth centuries, and the development of a “gun culture” from the late eighteenth century. It also seeks to locate Makua warfare in a broadly comparative African perspective.
The critically endangered Saint Helena endemic Plantago robusta (Plantaginaceae): typification, complete morphological account and discussion of knowledge gaps

Authors: HASSEMER GUSTAVO , RØNSTED NINA
Published: November 2020

Plantago robusta is a critically endangered species endemic to Saint Helena Island, a remote British island located in the middle of the South Atlantic Ocean. Despite its already acknowledged considerable importance for biodiversity conservation, the species is notably poorly studied from a systematic point of view. In this work we typify the name P. robusta and present a complete account of the morphology of the species, including illustrations, field photographs and a complete description. Furthermore, we discuss important knowledge gaps concerning the species.
Senecio rodolfoi (Asteraceae: Senecioneae), a replacement name for S. luridus Phil. from Chile

Authors: WU XING , SHAO YUN-YUN , GUO XIN-QIANG , LIU LI-HUI
Published: November 2020

Senecio rodolfoi (Asteraceae: Senecioneae) is proposed here to replace S. luridus Phil., which is a later homonym of S. luridus Salisb. and thus illegitimate.
An Empirical Test of Age-Graded Informal Social Control Theory: New Correlates of Youth Deviance
Authors: Unlu Ali , Ekici Niyazi , Tasgin Serkan , Entzminger Phillip
Published: November 2020

This study examines several family structural variables that have a hypothesized effect on delinquency, substance abuse, and violence. We conducted a survey for potential correlates of Sampson and Laub’s age-graded informal social control theory variables within the Turkish context. Our large sample size (31,272), drawn from high school students in Istanbul, Turkey, allowed us to test the effects of family settings on youth deviance by using various statistical tests and programs. Our findings indicate that juveniles exposed to parental substance abuse are more likely to use illegal substances, commit a greater number of delinquent acts, and participate in more instances of violent behavior. Additionally, family social capital, residential mobility, religiosity, and the number of siblings were some other statistically significant correlates of delinquency.