bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 16568: New Algorithms and Tailored Programming of Insertable Cardiac Monitors Reduce Alerts and Time Required to Follow Patients
Authors: Ousdigian Kevin T , Rosemas Sarah , Koehler Jodi L , Cheng Ya-Jian , Kloosterman Esteban M
Published: May 2021

Introduction:
Insertable Cardiac Monitors (ICM) aid in the diagnosis and monitoring of arrhythmias, however, reviewing the data is labor intensive and time consuming.

Hypothesis:
We hypothesized that new algorithms (ALG) and indication tailored programming (ITP) could reduce device-based alerts and clinician review time.

Methods:
Baseline data was obtained from a real-world de-identified Reveal LINQ TruRhythm ICMs database. The arrhythmia alerts and manual transmissions per patient/month was queried in this Control Group of patients with ≥3 months of follow-up. The effect of ALG and ITP was computed and applied to the Control Group. For practical purposes, the results were extrapolated to a 200 ICM clinic. Annualized clinic review time was estimated by assuming the staff time per transmission was 12.9 min., based on prior study. ALG improvements included: 1) Reject noise, loss of contact, and small R-waves for Pauses, 2) Require rapid onset for Tachy, 3) Limit nighttime episodes for Brady, and 4) Eliminate manual patient transmissions. ITP changes included: 1) Patients without Syncope: Pause ≥ 5 sec., Brady ≥ 12 beats and not during night, 2) Patients for AF Monitoring: AF ≥ 6 min.

Results:
The dataset consisted of 248,603 ICMs inserted for Syncope (36%), AF Diagnosis (35%), AF Monitoring (17%), and Other (12%) with an avg. of 1.1 years of follow-up (total 265,938 yrs). Applied to a 200 ICM clinic size, ALG and ITP reduced arrhythmia alerts by 32% (Control: 2,445 to ALG and ITP: 1,655 per clinic/yr). Using the new data transmission scheme eliminated 360 manual transmissions per clinic/yr.(Panel A) In total, the projected annual transmission volume (alerts + manuals in Panel A) and corresponding clinic review time (Panel B) dropped by 41% (247 hrs/yr = 13.1% full-time employee).

Conclusion:
Improved ALG and ITP can significantly reduce the volume of ICM alerts and consequently clinician review time impacting the management efficiency of this patient population.
Abstract 16582: Costimulation Blockade With Anti Cd80 and Cd86 Monoclonal Antibodies Prolonged Graft Survival in Allogeneic Ips Cell-Derived Cardiomyocyte Patch Transplantation
Authors: Nakae Masaro , Miyagawa Shigeru , Kawamura Takuji , Uchida Koichiro , Okumura Ko , Sawa Yoshiki
Published: May 2021

Introduction:
How to avoid immune rejection after transplantation should be elucidated for confirmed efficacy in clinical application of allogenic induced pluripotent stem cell derived cardiomyocyte patch. The blockade of CD28-CD80/86 costimulation is known to induce T cell anergy and immune tolerance by the recruitment of regulatory T cells (T reg) and prolong graft survival in organ transplantation.

Hypothesis:
We hypothesized that the blockade of CD28-CD80/CD86 costimulatory pathway by anti-CD80/CD86 monoclonal antibodies (mAbs) induces T cell anergy in vivo and suppresses immune rejection in allogeneic iPSC-CMs subcutaneous transplantation mice model.

Methods:
T cell anergy was induced in vitro by co-culture of Balb/c and 25Gy irradiated C57BL/6 splenocytes with anti-CD80/86 mAbs for 5 days. The inhibitory effect of anergic cells was evaluated by mixed lymphocyte reaction (MLR) in C57BL/6 and Balb/c splenocytes with anergic cells. IFN-g in MLR supernatants was measured by ELISAs to assess immune response. C57BL/6 iPSC-CMs expressing luciferase were subcutaneously transplanted into Balb/c. Anti-CD80/CD86 mAbs were injected intraperitoneally 250μg/dose on day 0, 1, and 2 (treated mice, n=6). In control mice (n=6), equivalent volume of saline was injected. To evaluate iPSC-CMs graft survival, photon counts of iPSC-CMs were measured by bioluminescence imaging system (BLI). Cells of harvested grafts were analyzed by immunofluorescence staining (IF).

Results:
On ELISAs, IFN-g in MLR supernatants co-cultured with anergic cells was significantly lower as compared with those without anergic cells (12.3±14.4 vs. 251±80.2 pg/ml, p=0.007). The ability to suppress the alloresponses was dose-dependent. BLI showed that photon counts on day 14 in treated mice were significantly higher than in control mice (7397±2651 vs. 2703±1271, p=0.003). IF showed a siginificantly higher ratio of CD4 and Foxp3 double positive cells to CD4-postive cells in the grafts on day 7 in treated mice as compared with in control mice (23±3% vs. 9±3%, p=0.009)

Conclusions:
The blockade of CD28-CD80/CD86 costimulatory pathway might suppress immune rejection in allogeneic iPSC-CMs transplantation mice model and T reg might involve this immune tolerance.
Abstract 16584: Inflammatory Bowel Disease is Independently Associated With Elevated Coronary Artery Calcium Score in Young Patients: Insights From CLARIFY Study
Authors: Al-Kindi Sadeer , Tashtish Nour , Bevan Graham , Rashid Imran , Ansari-Gilani Kianoush , Quigley Eamonn , Mehta Nehal N , Cainzos Achirica Miguel , Nasir Khurram , Rajagopalan Sanjay
Published: May 2021

Introduction:
Chronic inflammatory disease states are associated with higher incidence of premature atherosclerotic cardiovascular disease (ASCVD) in the young. However, data on whether younger patients with inflammatory bowel disease (IBD) are particularly at higher risk for subclinical atherosclerotic disease is scarce.

Methods:
Using data obtained from the CLARIFY registry (Clinicaltrials.gov NCT04075162), a prospective study of no-charge coronary artery calcium (CAC) testing at University Hospitals, we identified all patients with ulcerative colitis or Crohn’s disease and compared the presence (>0) and high (≥100) CAC with all patients in CLARIFY without IBD stratified by age group (non-elderly: ≤65 years; elderly >65 years), and adjusting for traditional ASCVD risk factors.

Results:
A total of 475 patients with IBD (252 UC, 196 CD, 27 both) and 43,437 controls without IBD were included. Compared with control, patients with IBD were more likely to be female (59% vs 50%, P<0.001), to have diabetes (12% vs 17%, P<0.001), and to be smokers (38% vs 22%, P<0.001). Overall, 31% of adults with IBD had CAC>100 compared to 28% without IBD (p=0.10). The respective prevalence was 25% vs. 21% (p=0.08) among non-elderly participants, and 45% vs. 47% (p=0.49) among elderly. In the total population, no association between IBD and CAC>0 or CAC>100 was noted. However, there was evidence of effect modification by pre-specified age strata (p-value for interaction 0.012, figure), where the odds of CAC≥100 was 1.38-fold higher (95% CI: 1.02-1.89) for IBD among participants ≤65 years vs among elderly participants [OR 0.84, 95% CI: 0.57-1.22].

Conclusions:
Non-elderly IBD patients are at increased risk for significant coronary calcified atherosclerotic disease. Further studies are needed to understand underlying biological processes and implications of increased atherosclerotic disease risk among young adults with IBD.
Abstract 16590: Does Use of Intra-Aortic Balloon Pump Improves Outcome in Patients Admitted With Acute Coronary Syndrome and Cardiogenic Shock: An Nationwide Inpatient Sample Analysis
Authors: Patel Neel , Bandyopadhyay Dhrubajyoti , chakraborty sandipan , Amgai Birendra , Hajra Adrija , Patel Zeel , Koirala Soniya , Aronow Wilbert S , Bakhit Ahmed , Khalid mazin
Published: May 2021

Introduction:
Intra-aortic balloon pump (IABP) has been shown to have a neutral effect on patients having cardiogenic shock (CS) in acute coronary syndrome (ACS). However, subgroup analysis of certain studies has shown a beneficial effect of IABP on selected populations presenting with CS.

Hypothesis:
IABP is associated with improved survival and less in-hospital complications in patients with ACS and CS.

Methods:
Nationwide Inpatient Sample 2016 and 2017 had been retrospectively analyzed to identify all patients presenting with ACS and CS (n=79260) with appropriate ICD-10-CM codes. Patients with cardiac arrest, tamponade or pulmonary embolism, free wall rupture, ventricular septal defect, severe peripheral artery disease, aortic regurgitation, age greater than 90 or less than 18 have been excluded (n=14055) to include a final population of 65,180. Among them, IABP was used in 22,725 patients. Propensity score matching using the kernel method was used to generate an adjusted odds ratio (OR). Multiple imputations are used to generate missing variables.

Results:
34% of patients presenting with CS required IABP in our analysis. Patients requiring IABP are younger and more likely to be male. Patients requiring IABP have higher prevalence of hypertension, obesity, dyslipidemia, and CAD. On propensity-matched analysis, the risk of all-cause in-hospital mortality is similar between two groups regardless of IABP use (p = 0.18). IABP appears to be protective for acute kidney injury (AKI) in non-propensity matched analysis (p = 0.007). There is a higher incidence of mechanical ventilation, bleeding, blood transfusion, coronary artery dissection, hemodialysis requirement, and respiratory failure in the IABP cohort. IABP appears to be protective for complete heart block (CHB) (p = 0.016).

Conclusion:
IABP use is associated with increased in-hospital complications without any mortality benefit. There appears to be some benefit towards the prevention of AKI and CHB.
Abstract 16622: Methodological Study for Validation of a Protocol for Behavioral Change in Patients on Warfarin: EmpoderACO
Authors: Barbosa Hannah Cardoso , Pagano Adriana Silvina , Praxedes Marcus Fernando da Silva , Reis Ilka Afonso , da Costa Josiane Moreira , Torres Heloisa de Carvalho , Martins Maria A
Published: May 2021

Introduction:
To achieve stable control in warfarin therapy is challenging in clinical practice. Patients′ active participation is essential to promote self-care and medication adherence. We sought to build a conceptual map to substantiate the validation of EmpoderACO, in Brazilian Portuguese, a protocol for behavior change for patients on warfarin.

Methods:
This methodological study involved the development of a conceptual map focused on identifying self-care domains in warfarin users. Its content guided the development and validation of a behavior change protocol which comprised the following steps: definition of instrument objectives; construction and selection of items; construction and measurement of response scales; iv) structuring and assessment of content validity. The content validity was assessed by a committee of judges (CJ) and calculated by content validity coefficient (CVC). We used the software CmapTools (version 6.04, 2020) to build the conceptual map. Ethical approval 65928316.3.0000.5149.

Results:
Self-care domains in the conceptual map were divided into three categories: understanding and satisfaction with drug therapy; reduction of adverse events; promotion of well-being and healthy habits. The use of the conceptual map allowed the development of the final version of EmpoderACO with 27 items. A total of 34 specialists composed the multiprofessional CJ that analyzed the validity content. The overall average of CVC was ≥0.91, including relevance (0.92), adequacy (0.92) and clarity (0.91).

Conclusions:
The protocol EmpoderACO may contribute to a global approach of patients on warfarin to improve patient′s understanding of drug therapy, self-care behaviors and design of patient-centered care. The application of empowerment principles may be of particular utility in vulnerable populations living in low- and middle-income countries where warfarin is still widely prescribed for oral anticoagulation.
Fig. 1 Conceptual map
Abstract 16641: The SGLT2 Inhibitor Ertugliflozin Induces Oxidative Phosphorylation Gene Expression and Improves Systolic Function Independent of Diabetes in Mice
Authors: Croteau Dominique , Luptak Ivan , Qin Fuzhong , Chambers Jordan M , Hobai Ion A , Goodman Jena , Panagia Marcello , Pimentel David R , Siwik Deborah A , Colucci Wilson S
Published: May 2021

Background:
Inhibitors of sodium glucose linked transporter 2 (SGLT2i) improve heart failure (HF) outcomes in patients independent of diabetes. While animal studies suggest SGLT2i improve cardiac metabolism, the effect of SGLT2i on mitochondrial function in the heart is not known. Our goal was to assess the effects of SGLT2i on mitochondrial function, high energy phosphates and genes encoding mitochondrial proteins in hearts of mice with and without diet-induced diabetes.

Methods & Results:
Ertugliflozin (Ertu; 0.5 mg/g) was given for 4 months to mice fed a high fat, high sucrose (HFHS) diet that causes diabetic cardiomyopathy or control diet (CD). Mitochondrial function was measured in isolated cardiac mitochondria. Myocardial energetics were assessed by NMR spectroscopy simultaneously with systolic function in isolated beating hearts. Myocardial gene expression was assessed by RNA seq using gene set analysis. HFHS diet caused myocardial hypertrophy and diastolic dysfunction, mitochondrial dysfunction (decreased ATP production, increased reactive oxygen species release) and an impaired energetic response to increased work demand - all of which were prevented by Ertu. Systolic function, as reflected by the rate x pressure product (RPP), was super-normalized to a value 124% of CD hearts at high work demand. In control mice, Ertu had no effect on isolated mitochondria function or high energy phosphates, but similar to HFHS hearts, caused super-normalization of RPP to 125% of CD hearts. Myocardial gene expression analysis revealed oxidative phosphorylation (OXPHOS) as the top scoring gene set that was both down-regulated by HFHS with a normalized enrichment score (NES) of -2.08, and up-regulated by Ertu in HFHS (NES, +3.32 vs HFHS). OXPHOS was the top scoring gene set up-regulated by Ertu a) across all groups while controlling for diet (NES, +3.71) and b) in CD-fed mice only (NES, +3.34).

Conclusion:
The super-normalization of systolic function and induction of the OXPHOS gene set by Ertu is independent of diabetic status. Pro-metabolic remodeling of the myocardium by Ertu may support increased systolic function and contribute to the beneficial actions of Ertu in states such as HF that are associated with impaired cardiac mitochondrial function.
Abstract 16673: Empowering Heart Failure Patients Through Technology and Focused Education
Authors: Chemmalakuzhy Jacob , Berk Martin , Kamath Sandeep , Roberts Allison , Duck Gregory , Beeker Lindsay , Esposito Kristi , Boxberger Cherie , Tomei Jacqueline , Redfearn Steven , Scharnott Michelle , Santana Adele , Poudel Remy
Published: May 2021

Introduction:
Heart Failure (HF) patient engagement after hospital discharge is key to preventing readmission and compliance. According to Medicare Hospital Compare the average rate of unplanned readmission is 21.6%

Objective:
The Rise Above Heart Failure™(RAHF) pilot program was created to identify strategies to reduce the burden of common HF complications and ultimately reduce hospitalization. The pilot included targeted quality improvement strategies, provider engagement, and a redesigned patient journey.

Methods:
Three North Texas pilot sites received quality improvement consultation and measured their progress towards improved guideline-directed care by tracking the impact to the 1,347 patients discharged with heart failure in Get With The Guidelines®-Heart Failure (GWTG-HF). The RAHF Pilot Program focused on engaging key stakeholders who working in partnership with AHA staff, developed a new patient journey for patients in the pilot.

Results:
The percent of HF patients who received 60 minutes of heart failure education by a qualified heart failure educator was analyzed and yielded the following results: the program hospitals saw an average adherence of 51.0% in Q2 and 53.9% adherence in Q4 (%Δ =5.8%). Additionally, the pilot program’s average of 50.47% during Q2-Q4 was more than 10% greater than the national average during the same time period. In the outpatient setting, HF PATH app users completed both a pre and post knowledge assessment between Oct 2019 - March 2020. A perfect score on the assessment is 19. The average pre-score for these participants is 16.33, while the average post-score for these participants is 17.

Conclusions:
Midterm results indicate that the program is successfully increasing HF patient education to increase patient awareness and understanding of HF, as represented by higher adherence to the 60 Minutes of Heart Failure Education measure and positive trends in the HF Path app knowledge assessment scores.
Abstract 16686: Improved Diet Quality is Associated With Lower Prevalence of Clonal Hematopoiesis of Indeterminate Potential
Authors: Bhattacharya Romit , Zekavat Seyedeh M , Pirruccello James , Griffin Gabriel K , Bick Alexander G , Natarajan Pradeep
Published: May 2021

Introduction:
Clonal Hematopoiesis of Indeterminate Potential (CHIP) is a pre-cancerous age-associated condition characterized by somatic mutations (typically in
DNMT3A
,
TET2
,
ASXL1
,
JAK2
) in hematopoietic stem cells and is a novel cardiovascular risk factor. Besides tobacco smoking, lifestyle factors that lead to the development of CHIP are currently poorly understood.

Hypothesis:
We hypothesize that healthy dietary habits are associated with reduced CHIP prevalence.

Methods:
We analyzed whole exome sequencing data from blood DNA in the UK Biobank to identify CHIP mutations with a variant allele fraction (VAF) >2% in
DNMT3A
or
TET2
. We scored diet quality (unhealthy, intermediate, healthy, and healthy vegetarian) based on American Heart Association guidelines. We associated diet quality with CHIP using multivariate logistic regression adjusting for age, age
2
, sex, smoking, coronary artery disease, type 2 diabetes, Townsend Deprivation Index score, and genetic ancestry. We used the Cochran-Armitage trend test assessed to associate large CHIP (VAF>10%) with diet quality.

Results:
Among 48,389 individuals in the UK Biobank, CHIP prevalence was 1168 (3.14%). Of these, 543 (1.1%) had unhealthy, 44314 (91.6%) had intermediate, 3111 (6.4%) had healthy, and 421 (0.9%) had healthy vegetarian diets. Poor diet quality was significantly associated with increased prevalence of CHIP. Individuals with an unhealthy diet had higher rates of CHIP (5.0%), compared to intermediate (3.2%, OR 0.63, p=0.05), healthy (2.8%, OR 0.58, p=0.04), and vegetarian diets (1.1%, OR 0.25, p=0.03). Large CHIP clones demonstrated a significant trend with improved diet quality associated with lower CHIP prevalence (p=0.009) among those with unhealthy (1.9%), intermediate (1.3%), healthy (1.0%), and vegetarian (0.0%) diets.

Conclusions:
Diet quality is associated with CHIP prevalence among 48,389 individuals in the UK Biobank.
Abstract 16810: Myocardial Perfusion Abnormalities, Ejection Fraction, and Coronary Calcium Score Are Not Associated With All-Cause Mortality Among Potential Kidney Transplant Recipients at Emory University Hospital
Authors: Cousins Ryan S , Mullinax Billy , Godwin Lehman , Mitchell Adam J
Published: May 2021

Introduction:
Screening for coronary artery disease in patients being considered for kidney transplant is common to stratify morbidity and mortality risk, but the optimal strategy, and its impact on outcomes, remains unclear. Here we test the hypothesis that myocardial perfusion imaging (MPI) abnormalities, left ventricular ejection fraction (LVEF), or coronary artery calcium (CAC) score are associated with all-cause mortality in potential kidney transplant recipients at Emory University Hospital (EUH).

Methods:
In a retrospective chart review, we assessed the relationship between patient demographics, single-photon emission MPI results, and CAC scoring with post-evaluation outcomes at 5 years in consecutive patients referred for pre-transplant stress testing at EUH in 2015. Mann-Whitney U and Chi-Square tests assessed between-group differences in continuous and categorical variables, respectively. Multivariate analysis was performed using logistic regression models.

Results:
During the study period, 589 patients (mean age 54 years; SEM 0.512, 58% male, 65% African American) underwent MPI and 424 also underwent CAC scoring. Overall, 90 patients (15%) had abnormal MPI (defined as any fixed or reversible defect) and 54 (9%) died during follow up. Age (mean 53.2 years; SEM 0.533 vs. 57.7 years; SEM 1.73, p=0.008), previous coronary artery bypass graft (CABG) (2.06% vs. 7.41%, p=0.017), and myocardial infarction (MI) post-evaluation (4.11% vs. 18.5%, p<0.001) were associated with all-cause mortality. Age (p=0.032) and MI post-evaluation (p<0.001) remained significant in multivariate analysis. MPI abnormalities, LVEF, and CAC score were not associated with all-cause mortality.

Conclusions:
Age and MI post-evaluation are associated with increased mortality in potential kidney transplant recipients referred for stress testing at EUH. We found no association between MPI abnormalities, LVEF, or CAC score and all-cause mortality.
Abstract 16811: In-Utero Coxsackievirus Type B Infection is Associated With Congenital Pulmonary Atresia
Authors: Sharma Vipul , Goessling Lisa S , Carvajal Horacio G , Brar Anoop K , Eghtesady Pirooz
Published: May 2021

Introduction:
Maternal exposure to various pathogens during pregnancy has been well established as a cause of congenital heart defects (CHD). Suggestive, although inconclusive, data exists of an association between Coxsackievirus B (CVB) infection during pregnancy and CHD. Therefore, this study was undertaken to examine association between perinatal infection with CVB and CHD.

Hypothesis:
CVB infection during pregnancy may play a role in the pathogenesis of CHD.

Methods:
In a prospective study of 122 pregnant women with pregnancies affected with CHD, circulating CVB IgG and IgM antibodies in the maternal serum were quantified. To determine specific CVB serotypes involved, Neutralizing antibodies (NA) were measured against three CVB serotypes: CVB1-Chi07, CVB3, Nancy, and CVB4, J.V.B.

Results:
A significant number of the women were positive for CVB antibodies; 31.1% for IgG and 6.6% for IgM. Elevated levels of IgG were seen in 50% of women carrying babies with Pulmonary Atresia (PA) (p=0.04). In addition, 55.6% (p=0.100) of moms carrying babies with Hypoplastic Left Heart Syndrome (HLHS), aortic atresia/mitral stenosis (AA/MS) variant and 47.1% (p=0.127) of HLHS AA/mitral atresia (MA) had positive IgG levels. Among babies of women with positive IgM titers, 75% (p=0.001) had isolated Ventricular Septal Defect (VSD), comprising 26.1% (6/23) of all babies with isolated VSD in the cohort.We also show a possible association between CVB4 and CHD in the cohort. All mothers with positive IgM titers whose babies were born with a VSD had elevated CVB4 NA (p=0.001). Among women with elevated IgG having babies with PA, 40.0% (p=0.061) had elevated CVB1 NA, 70.0% (p=0.014) had elevated CVB3 NA, and 40.0% (p=0.876) had elevated CVB4 NA.

Conclusion:
We present data from a clinical study suggesting that CVB infection during pregnancy may contribute to the burden of CHD in affected babies. Our data demonstrates not only an association of CVB with CHD in pregnant women but this is the first report showing significant association between in-utero CVB infection and PA. Our study has broad implications for the future understanding and potential management of CHD as well as introduces a new avenue of research for cardiac defects.
Abstract 16814: Procedural Time in Echocardiogram versus Fluoroscopic Guided Endomyocardial Biopsies: Debunking the Myth
Authors: Chandrasekhar Mahesh , Malaver Diego , O'Neill Thomas J , Pisani Barbara A , Jao Geoffrey
Published: May 2021

Introduction:
Fluoroscopic-guided endomyocardial biopsy (FGEB) of the right ventricle is the most common method for rejection surveillance among heart transplant recipients. Echocardiogram guided endomyocardial biopsy (EGEB) has been shown to be a safe alternative, but not widely adopted, in part due to perceived longer procedural time.

Hypothesis:
EGEB is has comparable total procedural and biopsy time compared to FGEB and significantly lowers radiation exposure.

Methods:
A single center retrospective study was performed on patients who underwent biopsy via right internal jugular vein approach from 1/1/15 to 2/1/19. Biopsy time was time of bioptome insertion to sheath removal. Total procedure time was from physician entrance to exit into procedure lab.

Results:
100, patients, 487 biopsies. The mean biopsy time of EGEB was similar to FGEB; 30.0 ± 10.2 min (95% CI: 27.9-32.1 min) to 29.7 ± 9.91 min (95% CI: 28.7 - 30.7 min) respectively, p = 0.73. The mean total procedural time of the EGEB was similar to FGEB; 70.3 ± 18.9 min (95% CI: 34-125 min) to 73.4 ± 18.5 min (95% CI: 21 - 129 min), p = 0.102. Mean fluoroscopy time for EGEB was lower than FGEB; 1.78 min (95% CI: 1.4-2.2 min) vs 5.53 min (95% CI: 5.22-5.83 min) p < 0.0001. A mixed model analysis of mean fluoroscopy time was performed to account for the same patients receiving multiple endomyocardial biopsies, sometimes by different guidance, showed a difference of 1.89 mins less with EGEB than FGEB (p < 0.0001).

Conclusions:
EGEB has similar biopsy and total procedural time but significantly reduced fluoroscopy time. EGEB should be routinely considered in patients for endomyocardial biopsy.
Abstract 16816: Direct Oral Anticoagulants Compared to Warfarin for the Treatment of Left Ventricular Thrombus: A Multi-Center Experience
Authors: Minciunescu Andrei , Ijaz Naila , Donthi Nisha , Genovese Leonard D , Tehrani Behnam N , Tran Henry A
Published: May 2021

Introduction:
Left ventricular thrombus (LVT) is associated with high risk of major adverse cardiovascular events (MACE) and mortality. Although warfarin is standard of care for LVT prevention and treatment, there is rising interest in the role of direct oral anticoagulants (DOACs). The goal of this study is to evaluate clinical outcomes of patients with LVT treated with DOACs compared to those treated with warfarin.

Methods:
Patients within a regional, multi-center health care system diagnosed with LVT from 2014-2018 were retrospectively identified through search of the electronic medical record. Demographic data, comorbidities, anticoagulation treatment, ejection fraction, and LVT etiology were recorded. Clinical outcomes including LV thrombus resolution, bleeding, and all-cause mortality were determined.

Results:
Demographic data is summarized in Table 1. Of 212 identified patients, 140 (66%) were treated with warfarin, 57 (26.9%) with DOAC, and 7 (3.3%) with low molecular weight heparin. Of these, 158 (74.5%) were on concomitant antiplatelet therapy. One patient was treated with antiplatelet therapy alone, and 7 patients received neither anticoagulation nor antiplatelet therapy. Patients treated with DOAC had no significant differences compared to those treated with VKA with respect to LVT resolution (69.3% vs 64.9, p = 0.95), hemorrhagic stroke (2.1% vs 1.8%, p = 0.86), ischemic stroke (2.1% vs 3.5%, p = 0.58), significant bleed (9.2% vs 12.3%, p = 0.78), and all-cause mortality (13.6% vs 15.8%, p = 0.17).

Conclusions:
In this large, multi-center retrospective study, clinical outcomes and adverse events of patients treated with DOAC for LVT are similar to VKA-treated patients. Given the observational nature of this study, randomized controlled studies are needed to validate these findings.
Abstract 16825: Indigenous Australians Present 9 Years Earlier With Acute Coronary Syndrome With Worse 12 Months Outcomes; A 14-year Registry Analysis
Authors: Moosavi Vahid , Das Souvik K , harvey thomas , Marley Paul , Farshid Ahmad
Published: May 2021

Introduction:
Indigenous Australians have a higher cardiovascular burden than non-indigenous persons. Whether this is associated with more prevalent cardiovascular risk factors or other reasons is not well defined.

Hypothesis:
Indigenous Australians with acute coronary syndrome (ACS) have more cardiovascular risk factors than non-indigenous Australians.

Methods:
We performed a retrospective analysis of our ACS registry comparing indigenous and non-indigenous Australian patients who presented with ACS and underwent percutaneous coronary intervention (PCI) between 2006-2019.

Results:
We treated 9436 patients and 239 (2.4%) were indigenous Australians. On average, Indigenous patients presented 9 years earlier (mean age 55 v 64 years, p<0.0001). In indigenous Australian patients, 32% were under 50 compared with 13% in non-indigenous group (p<0.0001). Comparing the prevalence of traditional cardiovascular risk factors between indigenous Australians and non-indigenous patients, diabetes mellitus (27% v 21%, p=0.016), hypertension (61% v 53%, p=0.028), smoking (54% v 24%, p<0.0001), family history of IHD (43% v 32%, pp=0.0009) and obesity with BMI>30 (46% v 33%, p=0.0001) were higher amongst the indigenous Australians while prevalence of dyslipidemia was similar between the two groups (45% v 46%, p=0.79). Indigenous Australian patients with ACS had worse outcome including higher incidence of acute myocardial infarction within 12 months (11.3% v 4.6% p<0.0001), stent thrombosis (2.51% v 1.06%, p=0.03) and major adverse cardiovascular events (23.8% v 17.2%, p=0.01); however, 12 months mortality (11.7% v 8.7%, p=0.12) was not statistically different between the two groups.

Conclusions:
Indigenous Australians present with ACS 9 years earlier than non-indigenous patients. This is largely explained by significantly higher prevalence of major cardiovascular risk factors. Moreover, Indigenous Australians had higher MACE rates. Closer attention to risk factor management is required in indigenous Australians for primary and secondary prevention.
Abstract 16830: Functional Stenosis After Undersizing Mitral Annuloplasty is Governed by Pre-Operative Mitral Valve Opening Geometry
Authors: Xu Dongyang , Begley Kristin , S Suresh Kirthana , Padala Muralidhar
Published: May 2021

Introduction:
Surgical repair of functional mitral regurgitation (FMR) with undersizing mitral annuloplasty (UMA) is a common practice. Though excessive annular downsizing can improve coaptation, it raises the risk of functional mitral stenosis (FMS). Predicting if certain patients can develop FMS after UMA, can help with surgical planning and inform the safe levels of downsizing. In this study, we sought to investigate that the pre-operative diastolic geometry of the mitral valve can predict the risk of developing FMS with UMA.

Methods:
Pig mitral valves (n=8) were excised and mounted into a left heart simulator with steady diastolic flow only [
Fig1A
]. Three leaflet tethering patterns were mimicked in this model: annular dilation (AD), AD + asymmetric tethering (Asym) and AD + symmetric tethering (Sym) [
Fig1B
]. Under each condition, the annulus was downsized to different levels by an adjustable UMA [
Fig1C
]. Millar pressure catheter and Echocardiography were used to measure MV pressure gradient and diastolic configuration under various conditions.

Results:
Under each tethering geometry (AD, AD + Asym and AD + Sym respectively), pressure gradient gradually increases as the downsizing level increases. Also, at each specific level of downsizing, pressure gradient increases as the subannular tethering increases. Similarly, at each specific level of downsizing, EOA decreases as the subannular tethering increases. Under each tethering geometry, EOA also decreases as the downsizing level increases [
Fig1D
]. In addition, it is demonstrated that at different flow rates, both pressure gradient and EOA correlates with anterior diastolic angle, which is impacted mainly by preoperative subannular tethering [
Fig1E
].

Conclusions:
In FMR, the hemodynamic outcome of MV after UMA depends on both the extent of annular downsizing and preoperative leaflet tethering geometry, both of which should be taken into account when deciding the optimal surgical intervention.
Abstract 16844: Effect of Canagliflozin on Gene Expression and CD34+ Function on Type 2 Diabetes Subjects
Authors: Awal Hassan , Nandula Seshagiri Rao , KUNDU Nabanita , Fakhri Mona , Brichacek Beda , Elzarki Adrian , Aimalla Nikhila , Batistich Bethany , Amdur Richard , Sen Sabyasachi
Published: May 2021

Introduction:
CD34 +ve Endothelial progenitor cells (EPCs) has been shown to be dysfunctional in subjects with type 2 diabetes mellitus (T2DM) leading to poor endothelial cell function (ECF).

Hypothesis:
Canagliflozin, an SGLT2 inhibitor when added to other oral antidiabetic medication such Metformin, Insulin, GLP1-agonists, DPP-IV inhibitor, or sulfonylureas, may improve the cardiovascular risk by improving CD34+ EPCs function such as migration, colony formation and maturation towards endothelium.

Methods:
29 subjects were enrolled in this 16 weeks, double-blind, two-arm, randomized placebo matched trial, with 100 mg Canagliflozin (Cana, low dose) compared to placebo. T2DM (30-70 years old), HbA1c of 6.5-10%, and all stages of CKD were included. Peripheral blood derived CD34+ cell number, migratory function, mRNA gene expression along with cardiometabolic parameters such as arterial stiffness, biochemistry, resting energy expenditure, and body composition were measured. Data were collected at weeks 0, 8, and 16. A mixed model regression analysis was done with a p-value <0.05 considered significant.

Results:
We found a statistically significant reduction in systolic (p=0.008) and diastolic (p=0.038) blood pressure. There was a reduction in blood glucose level (p=0.0047) and HbA1c (p=0.03). There was a statistically significant increase in adiponectin (p=0.0062) and trend level reduction in IL6 (p=0.16), indicating an anti-inflammatory effect of canagliflozin. There is also an increase in mRNA expression of genes associated with endothelial function in CD34+ cells such as VEGFA (p=0.049), VEGF receptor KDR (p=0.13), PECAM-1, a mature endothelial marker was also upregulated (p=0.002) and NOS3 (or eNOS) was also upregulated. There were no significant changes in CD34+ numbers by direct counting and parameters tested. We also tested for serum ketones bodies and found no difference at the dose tested. Data on urine podocyte specific exosome is pending

Conclusions:
Our study indicates that Canagliflozin improves several components of ECF by improving adiponectin, reducing inflammatory cytokines, and by increasing expression of endothelium specific genes.
Abstract 16847: Comparison of Urine Output and Creatinine as Markers for Severe Acute Kidney Injury in the Immediate Post-Operative Period After Pediatric Heart Transplant
Authors: Alali Alexander , Acosta Sebastian , Ahmed Mubbasheer , Akcan Arikan Ayse , Morris Shaine A , Jain Parag
Published: May 2021

Background:
Urine output (UOP) is an important indicator for acute kidney injury (AKI) in the pediatric critical care setting as it captures approximately 20% of patients who would go undiagnosed with creatinine data alone. We hypothesized that UOP remains clinically relevant indicator of severe AKI in the immediate post-operative period after pediatric heart transplant (HT).

Methods:
We performed a retrospective descriptive study of all patients who underwent HT at a single, quaternary care pediatric institution between 1/2016-11/2019. Severe AKI was defined as >= stage 2 using the Kidney Disease Improving Global Outcomes (KDIGO) criteria and measured at POD 1, 2 and 3, respectively. Baseline creatinine was defined as the lowest creatinine value in the 3 months preceding HT. Results were then subdivided into those who met severe AKI based on KDIGO creatinine criteria alone versus and those meeting criteria only by UOP.

Results:
During the study period, 94 patients underwent HT. Median age at HT was 7 years (range 1 month - 23 years). Criteria for severe AKI was met by 40%, 49%, and 52% at POD 1, 2 and 3 respectively. Of these, 95%, 93%, and 94% were captured with creatinine criteria (Figure 1.) Comparatively, only 3%, 3% and 4% were captured with only UOP criteria at POD 1, 2 and 3 respectively. Figure 2 illustrates an almost uniform decrease in UOP at hour 11 (median 0.83 ml/kg/hr, IQR 0.59-1.36 ml/kg/hr) with subsequent dispersion over time.

Conclusions:
Severe AKI is common after OHT and is largely nonoliguric, with significant less capture of severe AKI based on UOP alone. Most patients experience a decline in UOP in the first 12h but were rarely oliguric in the first 48h.
Abstract 16851: Lipid Profile Differences Among Premenopausal and Postmenopausal African American Women and Implications for Treatment Per Guideline
Authors: Bess Courtney , Mehta Puja K , Lundberg Gina P
Published: May 2021

Introduction:
Postmenopausal women have an increased cardiovascular disease (CVD) risk compared to premenopausal women. Though literature demonstrates a relationship between abnormal CVD risk factor patterns, namely lipids, and menopause, less is known about this association in minority racial and ethnic groups. Examining this association in African Americans (AA) is important because they experience disproportionate CVD outcomes. Moreover, recent studies have shown that AA eligible for statin therapy were less likely to receive treatment.

Hypothesis:
Postmenopausal women are more likely to have a more abnormal lipid profile compared to premenopausal women.

Methods:
A cohort of 962 women (mean age 50 ± 14 years) from the 10,000 Women Project were categorized into self-declared premenopausal (n = 475, mean age 40 ± 9.8 years) and postmenopausal (n= 487, mean age 61 ± 9.1 years) groups. Data was obtained at community health screening events through self-declared health history surveys. Lipid profiles were obtained through a non-fasting point-of-care cholesterol test. Several CVD risk factors were compared among these groups that include serum total cholesterol (TC), low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), triglycerides (TG), pooled cohort Atherosclerotic Cardiovascular Disease (ASCVD) 10-year risk of heart disease or stroke score, BMI, waist circumference, and blood pressure. Student’s T test was utilized for statistical analysis.

Results:
Cholesterol testing revealed a significant increase in serum TC (p < 0.0001), LDL (p = 0.0001), and TG (p = 0.001) in the postmenopausal group compared to the premenopausal group. Interestingly, there was also a significant increase in serum HDL in the postmenopausal group (p = 0.0081). Additionally, the ASCVD risk score, which is heavily weighted on age, was significantly higher in the postmenopausal group compared to the premenopausal group (p < 0.0001).

Conclusion:
Menopause is associated with a more abnormal lipid profile and an elevated ASCVD risk score in AA women which places this group at a higher risk of CVD. Prioritizing lipid management, by adhering to cholesterol treatment guidelines, may assist with CVD risk reduction in this high-risk group.
Abstract 16871: Hypertensive Diseases of Pregnancy Are Associated With Longer Delivery Stays and Rehospitalizations
Authors: Lindley Kathryn J , Huang Kristine , El Helou Nicole , Joynt Maddox Karen E , Stout Molly
Published: May 2021

Introduction:
Hypertensive diseases of pregnancy (HDP) are common, and are associated with significant short- and long-term cardiovascular morbidity and mortality, but less is known about their association with post-delivery health care utilization. We sought to assess the association of HDP with 90-day post-delivery unplanned hospital revisits (ED visits, observation stays, and readmissions) in a broad cohort of pregnant women.

Methods:
Retrospective cohort study. Women who delivered from 1/1/2019-12/31/2019 at a large urban hospital were identified using diagnosis related groups. Women with HDP, including eclampsia, preeclampsia, and gestational hypertension were identified using standard ICD-10-CM codes. Logistic regression, controlling for 29 Elixhauser comorbidities including lung disease, obesity, depression, drug use, thyroid disease, renal disease, and others, was used to determine the independent association of HDP with unplanned hospital revisits.

Results:
Out of 3,391 deliveries, 1,225 (36.1%) mothers had HDP. Women with HDP were of similar age and insurance status as those without, but had higher rates of chronic lung disease (19.4% versus 13.5%), obesity (22.7% versus 7.8%), depression (15.8% versus 11.0%), and drug use (13.8% versus 9.9%, p for all <0.001). Mothers with HDP had longer lengths of stay for their delivery visits (4.7 vs. 3.5 days, p<0.001), and a higher percentage had 1 or more 90-day hospital revisits (42.4% versus 33.1%, p<0.001) than those without HDP. After controlling for comorbidities and insurance coverage, hypertensive disease remained independently associated with 90-day unplanned hospital revisits (odds ratio 1.24, 95% CI [1.06, 1.45], p=0.007).

Conclusions:
HDP is associated with a high rate of underlying chronic disease and contributes to excess delivery hospitalization days and rehospitalization rates. Novel strategies are required to optimize post-partum care and inter-pregnancy health for this common condition.
Abstract 16883: Validation of a Deep Neural Network Electrocardiographic-Age as a Mortality Predictor: The CODE Study
Authors: Paixao Gabriela , Lima Emilly M , Ribeiro Antonio H , Gomes Paulo R , Oliveira Derick , Pinto Junior Marcelo M , Sabino Ester , Barreto Sandhi , Giatti Luana , Andrade Lotufo Paulo A , Duncan Bruce , Meira Junior Wagner , Schon Thomas , Ribeiro Antonio L
Published: May 2021

Introduction:
Aging affects the electrocardiogram (ECG) with a higher incidence of abnormalities in older patients. ECG-age can be predicted by artificial intelligence (AI) and can be used as a measure of cardiovascular health.

Hypothesis:
ECG-age predicted by AI is a risk factor for overall mortality.

Methods:
The Clinical Outcomes in Digital Electrocardiography (CODE) study is a retrospective cohort with a mean follow-up of 3.67 years.The dataset consists of Brazilian patients, mainly from primary care centers. Two established cohorts, ELSA-Brasil, of Brazilian public servants, and SaMi-Trop, of Chagas disease patients, were used for external validation. 2,322,513 ECGs from 1,558,421 patients over 16 years old that underwent an ECG from 2010 to 2017 were included. A deep convolutional neural network was trained in order to predict the age of the patient based solely on ECG 12-lead tracings. The ECG database was split into 85-15% training and test datasets, respectively. Death was ascertained using probabilistic linkage with Brazil′s mortality information data. The Cox regression model, adjusted by age and sex, was used for statistical analysis. The model was validated in two cohorts: ELSA-Brasil (n=14,263) and SaMi-Trop (n=1,631).

Results:
he mean predicted ECG-age was 52.0 years (±18.7) with a mean absolute error of 8.38 (±7.0) years. Patients with ECG-age >8y older than chronological age had higher mortality rate (HR 1.79, 95%CI 1.69-1.90; p<0.001), whereas those ECG-age >8y younger than chronological age were associated with a lower mortality rate (HR 0.78, 95%CI 0.74-0.83; p<0.001). These results were similar in ELSA-Brasil and SaMi-Trop external validation cohorts (HR 1.75, 95%CI 1.35-2.27; p<0.001;HR 2.42, 95%CI 1.53-3.83; p<0.001 for >8y difference, retrospectively; HR 0.74, 95%CI 0.63-0.88; p<0.001;HR 0.89, 95%CI 0.52-1.54; p=0.68 for <8y difference, respectively).

Conclusions:
ECG-age, predicted by AI, can be useful as a tool for risk stratification of mortality.
Abstract 16892: Impact of Catheter-Directed Thrombolysis on Hospital Readmission Rates in Patients With Acute Proximal and Caval Deep Vein Thrombosis
Authors: Shafi Irfan , Zlotshewer Brooke , Lakhter Vladimir , Zhao Huaqing , Bashir Riyaz
Published: May 2021

Objective:
To evaluate the readmission rate and identify the predictors of rehospitalization in patients with acute proximal and caval DVT.

Background:
Acute Deep Vein Thrombosis (DVT) is a significant cause of mortality and morbidity in the US that affects more than 600,000 patients each year. Catheter-directed thrombolysis (CDT) is a minimally invasive treatment option that improve acute symptoms as well as quality of life of patients with acute DVT.

Methods:
Patients with index hospitalization for acute proximal and caval DVT between 2016 and 2017 in the U.S. Nationwide Readmission Database were evaluated for the rates, predictors, and costs of unplanned readmission at 30 days. We used Cox proportional hazard model to determine predictors of 30 days readmissions.

Results:
This analysis included 58,306 patients (age>=18 years) with index hospitalization for acute proximal and caval DVT; 8589 (14.7%) were readmitted within 30 days. The significant predictors for 30 day unplanned readmission were Malignancy (HR 1.60, 1.41-1.81), Charlson comorbidity index > 3 (HR 1.43, 1.30-1.57), Insurance Medicare vs Private(HR 1.39, 1.25-1.57), Length of stay more than 2 days (HR 1.34, 1.24-1.45), and Acute Kidney Injury (HR 1.28, 1.17-1.40), COPD (HR 1.25, 1.13-1.38), Age (HR 0.77,0.70-0.85), Catheter directed thrombolysis ( HR 0.83, 0.76-0.90), and Acute Pulmonary Embolism(HR 0.83, 0.76-0.90)(Figure1). The cost of readmission was higher than index hospitalization ($ 56733 vs $ 47396).

Conclusion:
The 30 days readmission rate continue to be high in patients with acute DVT. Patient’s characteristics and comorbid conditions are predictors of readmission. Use of Catheter directed thrombolysis for treatment of acute DVT predicts reduced readmission risk.
Abstract 16921: Relationship Between Biomarkers and Different Types of Myocardial Fibrosis in Severe Aortic Valvular Heart Disease
Authors: Pires Lucas J , Rosa Vitor E , MORAIS THAMARA C , de Santis Antonio S , Fernandes Joao Ricardo C , boer berta p , rossi eduardo , Lavitola Paulo d , Rochitte Carlos E , Nomura Cesar H , Pomerantzeff Pablo M , Tarasoutchi Flavio
Published: May 2021

Introduction:
Aortic stenosis (AS) and aortic regurgitation (AR) patients develop both myocardial hypertrophia and fibrosis. B-type natriuretic peptide (BNP) and troponin are biomarkers whose value in aortic valvular heart disease (VHD) remains controversial. Cardiac magnetic resonance (CMR) imaging can detect replacement myocardial fibrosis (MF) by using late gadolinium enhancement (LGE), and diffuse MF by using extracellular volume (ECV) based measures (relative - ECV fraction - and absolute - indexed ECV) calculated from T1 mapping. Data evaluating the relationship of these biomarkers with both types of MF are scarce in AS, and are missing in AR patients.

Hypothesis:
There is an association between preoperative BNP and troponin and preoperative MF measures in severe aortic VHD patients.

Methods:
Patients with isolated severe AS or AR were prospectively recruited to be submitted to CMR before surgery, including LGE and ECV measures quantifications. They also collected blood samples for quantification of BNP and high sensitivity T troponin. The relationship between biomarkers and MF parameters was evaluated using linear regression and nonparametric conventional tests.

Results:
The study population included 99 patients, 67 with AS and 32 with AR. BNP median was 63 (39-103) pg/mL and troponin median was 17 (5-34) ng/L, no difference between AS and AR (p=0.31 and p=0.88, respectively). BNP and troponin were associated with presence of LGE. BNP median was 47 (32-87) pg/mL without LGE vs. 87 (47-190) pg/mL with LGE (p=0.002). Troponin median was 13 (5-25) ng/L without LGE vs. 30 (10-71) ng/L with LGE (p=0.001). Regarding ECV measures, patients with ECV fraction higher than 28.25% had higher BNP levels (p<0.001) and patients with indexed ECV higher than 24.21mL/m
2
had higher troponin levels (p=0.015) (Figure 1).

Conclusions:
BNP and troponin are associated with quantity of MF in patients with severe aortic VHD with indication of intervention.