bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14693: Rheumatic Heart Disease and Deprivation in the United States: A Retrospective Review
Authors: De Loizaga Sarah R , Arthur Lindsay , Arya Bhawna , Beck Andrew F , Beckman Brian , Belay Wubishet , Brokamp Cole , Choi Tom , Connolly Sean , Dasgupta Soham , Dibert Tavenner , Dryer Marylou M , Gokanapudy Lakshmi , Greene Elizabeth Anne , Kernizan Daphney , Khalid Omar , Klein Jennifer , Kobayashi Ryan , lahiri subhrajit , Lorenzoni Raymond P , Otero Luna Andrea , Marshall Jennifer , Millette Theodore , Moore Lily , Muhamed Babu , Murali Meghna , Parikh Kinjal , Sanyahumbi Amy S , Shakti Divya , Stein Elizabeth , Shah Sanket S , Wilkins Hannah , Windom McAllister , Wirth Scott , Zimmerman Meghan , SABLE Craig A , Ollberding Nicholas , Beaton Andrea Z
Published: May 2021

Introduction:
Rheumatic heart disease (RHD) tracks with other cardiovascular health inequities in the US; however, RHD mortality captures a fraction of those affected and lags behind diagnosis by decades. There is little contemporary data on children living with acute rheumatic fever (ARF) and RHD within the US. This study describes recent pediatric ARF/RHD in the US and examines the association with community deprivation.

Methods:
Sixty US institutions were invited to participate in a 10-year review (2008-2018). Geocoding was used to determine a census tract-based socioeconomic deprivation index (DI) ranging from 0-1 (1 being most deprived). Independent sample t-test was used to compare DI means. Odds ratios (OR) with 95% confidence intervals were obtained from multivariable logistic regression. The DI was scaled to provide ORs for a one standard deviation increase.

Results:
Data for 947 cases from 22 institutions showed median age at diagnosis of 9 years, with half identifying as male (51%) and non-white (52%), and three-quarters (74%) identifying as non-Hispanic. Most identified English as their primary language, had health insurance, and were first diagnosed in the US (84%, 89%, and 82%, respectively). Of the 157 (17%) with travel exposure, Pacific Islands (38%) and Africa (21%) were most commonly identified. Nearly three-quarters (73%) were diagnosed with ARF and most (98%) had an echocardiogram at diagnosis. While 96% of patients were prescribed secondary prophylaxis, only half (58%) were prescribed intramuscular Benzathine penicillin (BPG), the gold standard. The mean DI was 0.39±0.15. Higher deprivation was associated with RHD as opposed to ARF at diagnosis (DI 0.42 vs. 0.38, p<0.001). Additionally, higher deprivation was associated with increased risk of severe RHD (OR 1.34; 95% CI 1.11-1.62) and increased use of BPG vs enteral penicillin for secondary prevention (OR 0.67; 95% CI 0.56-0.8).

Conclusions:
Recent pediatric cases of ARF and RHD in the US are endemic, rather than from foreign exposure and children who live in more deprived communities are at risk for more severe disease. Additional research is needed into why intramuscular penicillin, which has superior efficacy compared to oral penicillin, is prescribed in only half of cases.
Abstract 14696: The Effectiveness of a Unique Community Health System in Detecting Familial Hypercholesterolemia in Kagawa, Japan
Authors: Asako Mizobuchi , Matsunaga Keiji , Tada Hayato , Sasaki Tsuyoshi , Asano Yoshihiro , Ito Shigeru , Yokota Ichiro , Kunikata Jun , Iwase Takashi , Kawashiri Masa-aki , Kusaka Takashi , Minamino Tetsuo
Published: May 2021

Introduction:
Familial hypercholesterolemia (FH) is an autosomal hereditary disease found in patients who have elevated low-density lipoprotein cholesterol (LDL-C) levels from birth. Early detection and treatment of FH during childhood potentially reduces the risk of premature cardiovascular events. In Kagawa prefecture, a unique community health system, involving three steps, has been conducted to prevent lifestyle-related diseases for 10-year-old children. This system includes universal lipid screening, selection by pediatricians, and next-generation sequencing (NGS) of FH-related genes in the hospitals. The aim of this study is to investigate whether this system can be effective in detection of FH.

Methods:
In Kagawa prefecture, the universal lipid screening of children at 10 years of age is performed annually at school, covering over 90% of the target group. After excluding secondary hypercholesterolemia, pediatric clinics introduced children with LDL-C levels >140 mg/dL to four hospitals to perform NGS to detect FH.

Results:
In 2017, 279 children (3.7%) showed elevated LDL-C >140mg/dL among 7,647 ones who received the screening. We performed NGS for 46 children after excluding secondary hypercholesterolemia by pediatricians (LDL-C 186.0±50.3 mg/dL; M/F 27/19) and 26 children (57%) had FH genetic mutations (23 LDL-R, 3 PCSK9). The children with LDL-C >180mg/dL are recommended to receive statin therapy according to the guideline from the Japanese Atherosclerosis Society (JAS). Children with LDL-C levels ≥180 mg/dL have 74% of positive genetic mutations, and even those with 140-180 mg/dl LDL-C levels have as much as 44%, respectively (Table).

Conclusions:
The unique community health system in Kagawa can efficiently detect FH of children. Further investigation will be required for the effective prevention of future atherosclerotic cardiovascular diseases.
Abstract 14719: Prognostic Implications of Traditional and Non-traditional Cardiovascular Risk Factor Profiles in Patients With Non-valvular Atrial Fibrillation
Authors: Bhat Aditya , Gan Gary , Chen Henry , Khanna Shaun , Nawaz Sumreen , MacIntyre C. Raina , Tan Timothy
Published: May 2021

Introduction:
Atrial fibrillation (AF) is a prevalent disease with an associated mortality risk, mediated in large part through its associated cardiovascular risk factors. Standard Modifiable Cardiovascular Risk Factors (SMuRFs; hypercholesterolaemia, hypertension, diabetes and smoking) are established drivers of cardiovascular disease, however the importance of non-traditional mediators of cardiovascular risk such as chronic renal impairment, obstructive sleep apnoea and obesity (NTRFs) is emerging in the literature. The differential impact of these risk factor groups on outcomes in patients with AF is not well studied.

Hypothesis:
SMuRFs and emerging NTRFs will have a differential impact on prognosis in patients with AF.

Methods:
Consecutive patients admitted to our service between 2013-2017 with a primary diagnosis of non-valvular AF were assessed. The clinical course of these patients was followed for up to five years for the composite outcome of all-cause death and major adverse cardiovascular events. We excluded patients with valvular AF, incomplete clinical data and baseline comorbid conditions limiting lifespan to <6 months.

Results:
Of the 1010 patients (62.29±16.81 years, 52% men) included, 154 (15.2%) had no risk factors, 478 (47.3%) had only SMuRFs, 59 (5.8%) had only NTRFs and 319 (31.6%) had both SMuRFs and NTRFs. Over a mean follow-up period of 33.18±21.27 months, a total of 288 patients met the composite outcome. On log rank tests, grouping of risk factor profiles was a significant predictor of the composite outcome (see Kaplan Meier curve). On multi-variable analysis, the coexistence of SMuRFs and NTRFs was an independent predictor of the composite outcome (HR 1.40; 95%CI 1.09-1.82, p=0.01). Other independent predictors included age, heart failure, CHA2DS2VASc score, persistent AF and anaemia.

Conclusions:
Presence of both traditional and emerging NTRFs has prognostic implications in patients with AF.
Abstract 14781: Computational Prediction of Protein Subdomain Stability as a Novel Approach to Cardiac Myosin Binding ProteinC Variant Adjudication and Clinical Risk Stratification in Hypertrophic Cardiomyopathy
Authors: Thompson Andrea D , Helms Adam S , Kannan Anamika , Yob Jaime , Lakdawala Neal K , Wittekind Samuel , Pereira Alexandre D , Jacoby Daniel L , Colan Steven D , Saberi Sara , Ware James S , Ingles Jodie , Semsarian Christopher , Michels Michelle , Mazzarotto Francesco , olivotto iacopo , Ho Carolyn , Day Sharlene ,   SHaRe Investigators
Published: May 2021

Introduction:
Patients with HCM and a pathogenic sarcomere variant have a higher risk of adverse clinical outcomes compared to those without a sarcomere gene variant. Pathogenic truncating variants in MYBPC3 (encoding cardiac myosin binding protein C, MYBP-C) cause loss-of-function and are the most common genetic cause of HCM. However, a substantial number of patients carry missense variants in MYBPC3 that cannot be clearly classified as either pathogenic or benign. Interpretation of these variants of uncertain significance (VUS) remain a significant challenge.

Hypothesis:
We hypothesize that a structural-based algorithm, STRUM, which estimates the effect of missense variants on subdomain protein folding, will enable clinical risk stratification of patients with HCM and a MYBPC3 VUS.

Methods and Results:
Among the 7,963 patients in the multi-center Sarcomeric Human Cardiomyopathy Registry (SHaRe), 19 unique missense pathogenic variants and 120 missense VUSs in
MYBPC3
were identified. Within SHaRe and GnomAD, 110 benign missense variants (allele frequency > 4e-05) were identified. Following structural modeling of each MyBP-C domain, variants were predicted to cause subdomain misfolding if ΔΔG < = -1.2 kcal/mol (STRUM+). 93% of benign variants were predicted to be STRUM (-). Time-event analysis for an overall composite clinical endpoint [defined as the first occurrence of ventricular arrhythmia, heart failure, all-cause mortality, atrial fibrillation (AF), or stroke] demonstrated that patients carrying a STRUM+
MYBPC3
VUS exhibited a higher rate of adverse events compared to those with a STRUM- VUS (Hazard Ratio=2.29, P=0.0282). Of the 120 missense VUSs, 34 (28%) were STRUM+.
In silico
saturation mutagenesis of
MYBPC3
identified 4,943/23,427 (21%) missense variants predicted to cause subdomain misfolding.

Conclusions:
STRUM is capable of clinically risk stratifying HCM patients with a
MYBPC3
VUSs
.
These findings support the routine use of STRUM in variant interpretation algorithms and clinical decision making.
Abstract 15127: Isorhamnetin Reverses Angiotensin Ii-induced Atrial Fibrillation Vulnerability Through Electrophysiological and Structural Reverse Remodeling in Mice
Authors: Aonuma Kazuhiro , Xu Dong-Zhu , MURAKOSHI Nobuyuki , Tajiri Kazuko , Tominaga Kenichi , Ieda Masaki , Isoda Hiroko
Published: May 2021

Background:
Isorhamnetin (ISO), a natural flavonoid compound, has been shown to have strong antioxidant and antifibrotic effects in vivo and in vitro; however, no report has been shown on the effect of ISO on arrhythmic disorders. This study aimed to investigate the effect of ISO on angiotensin-II (Ag-II) induced atrial fibrillation (AF) in mice.

Methods:
Wild-type male mice (C57BL/6J, 8 weeks old) were assigned in 3 groups as follows: control group (Cont), Ag-II group treated with Ag-II and Ag-II & ISO group treated with Ag-II and ISO. Ag-II (1000 ng/kg/min) was continuously administered using an implantable osmotic pump for 2 weeks, and ISO (5 mg/kg) was administered intraperitoneally one week before starting Ag-II administration. We performed AF induction and electrophysiologic study via transvenous electrode catheter and Ca
2+
imaging with isolated cardiomyocyte. We also assessed the gene expression levels of AF-related molecules, and histological examination of atrial fibrosis.

Results:
Compared with Cont, AF inducibility was dramatically increased by Ag-II and significantly decreased by ISO. AF duration was also remarkably prolonged by Ag-II and significantly reduced by ISO. Atrial effective refractory period (A-ERP) (BCL=150msec) was reduced by Ag-II and recovered by ISO. Incidences of diastolic intracellular Ca
2+
abnormal activities (sarcoplasmic reticulum [SR] Ca
2+
leakage) was observed in Ag-II group; however, ISO treatment eliminated these abnormalities. Ag-II induced elevated expression of fibrosis-related molecules (Col1a1, Tgfb1 and Tgfb2) and Ca
2+
-handling related molecules (Camk2 and Ryr2), those were partially normalized by ISO. Histological examination revealed that cell size and the fibrosis ratio were increased by Ag-II, and significantly attenuated by ISO.

Conclusion:
These results suggest that ISO prevented against Ag-II induced AF vulnerability through both electrophysiological and structural reverse remodeling.
Abstract 15129: Outcomes Related to Age of Elective Surgery and Age of Dissection Within Genetically Triggered Aneurysm Conditions: The Gentac Experience
Authors: Holmes Kathryn W , Lemaire Scott A , Devereux Richard B , Ravekes William J , Morris Shaine A , Prakash Siddharth K , Weinsaft Jonathan W , Song Howard , Eagle Kim A , Markwardt Sheila , SILBERBACH Michael M , Milewski Rita C , Roman Mary J ,   GenTAC Investigators
Published: May 2021

Introduction:
The GenTAC Registry (
G
enetically Triggered
T
horacic
A
ortic Aneurysms and Cardiovascular
C
onditions) followed patients with aortopathies over 8 years among 8 centers with the goal of evaluating cardiovascular outcomes.

Methods:
Enrollment initiated in 2007, and data were collected until 2015. We included diagnoses with >100 participants: Bicuspid aortic valve with aneurysm (BAV, n=879), Marfan syndrome (MFS, n=861), Familial thoracic aortic aneurysm or dissection (FTAAD, n=378), Other thoracic aortic aneurysm at < 50 years of age (Other<50, n=524), Turner syndrome (TS, n=298), Vascular Ehlers Danlos syndrome (VEDS, n=149), and Loeys-Dietz syndrome (LDS, n=121). We identified patients who underwent elective ascending aortic replacement, total unique dissections, and time to first dissection. With MFS as a reference population and adjusted for sex, endpoints were analyzed by a Firth penalized Cox-PH regression model to account for diagnosis groups with low event numbers.

Results:
LDS participants at a mean age of (24.5 ± 15.0y) were youngest at elective aortic surgery followed by MFS (32.3 ±12.3y), TS (37.6 ±13.6y), VEDS (35.0 ±SD 7.4y), Other<50 (40.3 ±SD 10.3y), FTAAD (42.9 ±14.2y), and BAV(49.4 ± 13.8 y). Dissections were reported in all diagnosis groups with a total of 472 unique dissections in 3210 patients (14%). Mean age at first dissection was in the third decade for LDS, TS, MFS, VEDS and in the fourth decade for BAV, FTAD, and Other<50. Adjusted hazard ratio for time to first dissection was higher in LDS, 1.77 (95%CI 1.14- 2.77), compared to MFS and other diagnosis groups (Figure 1).

Conclusions:
Reported aortic dissections were prominent in the GenTAC cohort. Despite elective surgery at a younger age, LDS patients had a higher hazard risk of dissection compared to other diagnosis groups.
Abstract 15267: 1-Year Survival Post Trans-Catheter Aortic Replacement in Patients With Low and High-gradient Severe Aortic Valve Stenosis
Authors: Chiang Caleb , Hemu Mohamad , Alward Jaafar , Voudris Konstantinos , Suradi Hassam
Published: May 2021

Introduction:
There is limited data on trans-catheter aortic replacement (TAVR) outcomes in patients with low gradient-preserved ejection fraction aortic stenosis (LGpEF). Our study aims to compare baseline characteristics and procedural outcomes in patients with LGpEF vs. high gradient severe aortic stenosis (HGAS).

Methods:
Patients who underwent TAVR at our institution were divided in 2 groups: 1) HGAS (aortic valve area (AVA) < 1cm
2
, mean gradient (MG) > 40 mmHg); 2) LGpEF (AVA < 1cm
2
, MG <40 mmHg, left ventricular ejection fraction ≥ 50%). Primary outcome included 1-year all-cause mortality post-TAVR. Multivariable cox proportional hazards model was adjusted for covariates of clinical significance (age, Society of Thoracic Surgery (STS) score, chronic kidney disease (GFR < 60 mL/min/1.73m2), para-valvular leak (PVL) day 1 post-TAVR, and baseline New York Heart Association (NYHA) class.

Results:
A total of 140 patients with HGAS (53% female, 81±9 years old) and 73 patients with LGAS (51% female, 80±9.5 years old) were identified. In multivariable analyses, there was no statistically significant difference in mortality between HGAS vs. LGpEF (HR 0.53, 95% CI 0.21-1.3; p=0.16) (Figure). PVL was independently associated with increased mortality in HGAS (HR 2.9, 95% CI 1.2-7.3; p=0.02) but this effect was not observed in patients with LGpEF.

Conclusions:
After adjusting for relevant patient characteristics, TAVR outcomes in patients with LGpEF were similar to those with HGAS at 1-year follow-up.
Abstract 15306: Annual Transplant Volume Does Not Affect Center Specific Mortality- A PHTS Database Study
Authors: Ybarra Aecha M , O’Connor Matthew J , Hollander Seth , Bano Maria , Ploutz Michelle , Vaughn Gabrielle , Lambert Andrea N , Wallendorf Michael , Kirklin James K , Canter Charles E
Published: May 2021

Introduction:
Recent studies have suggested a relationship between mortality and center volume in pediatric heart transplantation; however, these studies utilize databases that lack granularity to assess patient risk profiles.

Hypothesis:
Utilizing the Pediatric Heart Transplant Society (PHTS) database, we hypothesized that there would be a difference in outcomes among centers based on yearly transplant volume, and that the patient’s clinical profiles would differ by center volume.

Methods:
We performed a retrospective analysis of the PHTS dataset from all pediatric (≤ 18 years of age) cases from 2009-2018. Centers were stratified into 5 groups based on annual volume: ≤ 4, 4-6, 6-9, 9-14, and > 14 transplants. We evaluated specific variables, including those identified as significant risk factors in previous PHTS studies including mechanical ventilation, PRA > 10%, high BUN, gender, and Fontan completion, within each group. We used Kaplan Meier for survival, contingency tables with Pearson Chi-square test for association, and analysis-of-variance to compare means. P< 0.05 was considered statistically significant.

Results:
There were 6800 cases among 55 centers. Table 1 demonstrates that there was no significant difference in one-year post transplant survival among the groups, and the patient variables showing statistically significant differences followed no specific pattern among the center volume groups. It also demonstrates that there is no clear association between cumulative risk factors within individual patients and center volume.

Conclusions:
One-year post transplant survival is similar within the PHTS for all centers regardless of case volume. These group differences were different for different variables and did not segregate consistently between lower volume and higher volume groups suggesting there exists a complicated relationship among risk factors and center volume.
Abstract 15317: Risk of Future Adverse Events in Patients Receiving Class IC Antiarrhythmic Drugs Who Have Elevated Coronary Artery Calcium Scores But Low-risk Cardiac Stress Test
Authors: Cutler Michael J , May Heidi T , Bunch T Jared , McCubrey Raymond O , Crandall Brian G , Osborne Jeffrey S , Miller Jared D , Mallender Charles D , Anderson Jeffrey L , Muhlestein Joseph B , Day John D , Knowlton Kirk U , Knight Stacey
Published: May 2021

Background:
Class IC antiarrhythmic drugs (AAD) are a standard treatment of cardiac arrhythmias but are associated with harm in patients with prior myocardial infarction (MI)). Consensus guidelines have advocated that these drugs not be used in patients with coronary artery disease (CAD). However, the risk of Class IC AAD in patients with stable CAD, as demonstrated by an elevated coronary artery calcium (CAC) , but a low-risk cardiac stress test (LRCST), remains unclear. We hypothesized that the risk of future adverse cardiovascular events would not differ according to CAC severity among patients with an LRCST on Class Ic AAD treatment.

Methods:
We identified 355 patients without CAD and an LRCST (<5% ischemia) on cardiac stress PET before initiation of Class IC AAD. CAC was assessed using quantitative scores when available or qualitative CAC assessment on low-dose attenuation correction CT. Patients were divided into no/low CAC (i.e., quantitative score <100 or qualitative assessment of none/mild) or mod/severe CAC (i.e., quantitative score ≥100 or qualitative assessment of moderate/severe) The composite primary endpoint for this analysis was ventricular tachycardia/fibrillation (VT/VF), cardiac arrest, and all-cause death at one-year follow-up.

Results:
The majority of patients had no/low CAC (n = 278 [78.3%]) compared to mod/severe CAC (n = 77 [21.7%]). Those with no/low CAC were younger (62 vs 70, p<0.0001) and were more likely to have a higher BMI (33.1 v 30.4, p=0.007) when compared to the mod/severe CAC group. Other cardiovascular risk factors were similar between groups. There was no difference in the one-year primary composite outcome of VT/VF, cardiac arrest, and death between no/low CAC compared to mod/severe CAC (3.6% vs 5.2%, p=0.51).

Conclusion:
In patients receiving Class IC AAD therapy with an LRCST, an elevated CAC did not increase the risk of future adverse events. These data suggest that using Class IC AAD may be safe in patients with stable CAD (no ischemia/elevated CAC). Future prospective trials are needed to evaluate the safety of Class IC AAD in patients with elevated CAC.
Abstract 15535: Automated Artificial Intelligence-based Myocardial Scar Quantification for Risk Assessment Following Myocardial Infarction
Authors: Lange Torben , Stiermaier Thomas , Backhaus Soeren Jan , Boom Patricia C , Kutty Shelby , Bigalke Boris , Hasenfuss Gerd , Thiele Holger , Eitel Ingo , Schuster Andreas
Published: May 2021

Introduction:
Myocardial infarct size (IS) remains one of the strongest predictors of adverse cardiac events following acute myocardial infarction (AMI). Late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) can precisely quantify the extent of injury but requires manual post-processing. Whether novel user-independent artificial intelligence (AI) based fully-automated analyses may facilitate clinical workflow and deliver similar information for risk stratification is unknown.

Methods:
913 AMI patients from two multi-center trials (AIDA-STEMI n = 704 with ST-elevation myocardial infarction [STEMI] and TATORT-NSTEMI n = 245 with non-ST-elevation-infarction [NSTEMI]) were included in this sub-study. IS was quantified manually using conventional software (Medis, Leiden Netherlands) and fully automated AI-based software (NeoSoft). All automatically detected IS were evaluated visually and corrected if necessary. Analyzed data were tested for agreement and prediction of major adverse clinical events (MACE) within one year after AMI.

Results:
Automated and manual IS were similarly associated with outcome in cox regression analyses (HR 1.05 [95% CI 1-02-1.07] p < 0.001 for automated IS and HR 1.04 [95% CI 1.02-1.06]; p < 0.001 for manual IS). Comparison of C-statistics derived area under the curve (AUC) resulted in equivalent MACE prediction (AUC 0.65 for automated vs. AUC 0.66 for manual, p = 0.53). Manual correction of the automated scar detection did not lead to an improved risk prediction of MACE (AUC 0.65 to 0.66, p = 0.43). There was good agreement of automated and manually derived IS (intraclass correlation coefficient [ICC] 0.75 [0.07-0.89]) which was further improved after manual correction of the underlying contours (ICC 0.98 [0.97-0.98]).

Conclusion:
AI-based software enables automated scar quantification with similar prognostic value compared to conventional methods in patients following AMI.
Abstract 15549: Esophagopleural Fistula Associated Regional Pericarditis Mimicking Inferior Myocardial Infarction
Authors: Thompson Iain J , Fernandez Jorge , Beck Hiroko
Published: May 2021

Introduction:
Regional pericarditis is a rare clinical entity that may mimic myocardial infarction (MI) and occurs most frequently after myocardial injury. We describe a unique case of regional pericarditis secondary to esophagopleural fistula (EPF) in a patient presenting to the catheterization lab for suspected ST-segment MI.

Results:
A 75-year-old man with non-small cell lung cancer presented with hypotension, weakness, dyspnea, and chest pain. The initial electrocardiogram (ECG: Figure 1) revealed normal sinus rhythm with inferior lead ST- segment elevations, a chest X-ray showed a left pleural effusion, and troponin I was <0.01 ng/ml. The patient underwent emergent coronary angiography showing no evidence of obstructive coronary disease. Subsequently, the patient reported palpitations and new onset dysphagia. An ECG revealed atrial fibrillation with rapid ventricular response. A barium esophagram (Figure 2) was performed to evaluate the dysphagia and revealed the presence of an EPF with fluid collection adjacent to the inferior heart border. The patient was treated for pericarditis with colchicine and definitive treatment with esophageal stenting was performed.

Conclusions:
We describe a case of regional pericarditis secondary to EPF masquerading as inferior MI. Given the prevalence and severity of MI, remaining cognizant of its mimickers such as regional pericarditis is important in clinical practice. This case report highlights the utility of maintaining a broad differential and performing a thorough history and physical both at initial presentation and when new information challenges the initial diagnosis.
Abstract 15570: Pathology of In-stent Neointima in Atherosclerotic Porcine Peripheral Artery Treated by Drug-coated Balloon
Authors: Migita Suguru , Kitano Daisuke , Koyama Yutaka , Li Yuxin , Hirayama Atsushi , Okumura Yasuo , Hao Hiroyuki
Published: May 2021

Introduction:
The use of drug-coated balloons (DCB) is a promising technique to treat in-stent restenosis without adding another metal scaffold. Clinical non-inferiority of DCB for treatment of in-stent restenosis (ISR) has been demonstrated compared to drug eluting stents (DES) implantation. However, pathology of neointima treated by DCB remains unclear.

Aim:
Pathological study of neointima after DCB treatment for ISR has not been reported. This study aimed to examine the tissue response after DCB treatment and plain old balloon angioplasty (POBA) for ISR pathologically, by using atherosclerotic femoral artery of porcine model.

Methods:
Using micromini pigs fed high-cholesterol, high-fat diet for 3 months, we stented bare metal stents in femoral arteries. After one month of stenting, dilatation of in-stent region by using DCB, and non-compliance balloon (NCB) as POBA were performed. Optimal coherence tomography and angioscopy showed drug adhesion on luminal surface. One month after the balloon expansion, treated arteries were dissected and stent segments were fixed with 10% buffered formalin and embedded in plastic. Stents were segmented at 3mm intervals and histologic sections were prepared. The neointimal area and blood vessel area were morphometrically evaluated, and the ratio of neointimal area per blood vessel area was calculated. Additionally, number of cells per 1mm
2
neointimal area was counted with digital morphometry.

Results:
We compared the histology between DCB (n=3, 18 histological sections) and POBA (n=3, 18 histological sections) lesions. The ratio of neointimal area per blood vessel area treated by DCB was 0.17 ± 0.01, while that of POBA was 0.21 ± 0.01 (P value = 0.02) respectively. Additionally, the number of cells per 1mm
2
neointimal area was significantly less in the neointima dilated by DCB (1940.9 ± 150.9), compared to that dilated by NCB (2599.8 ± 190.3) (P value = 0.01). These results suggest that DCB treatment after ISR prevents neointimal thickening by inhibiting proliferation of smooth muscle cells.

Conclusions:
We examined the pathology of in-stent neointima dilated by DCB in peripheral artery of atherosclerotic porcine model. Pathological analysis showed suppressed neointimal proliferation after DCB compared to POBA.
Abstract 15591: The Perfect Storm: An Unusual Case of Cardiogenic Shock
Authors: McIlvaine Susan
Published: May 2021

A 77-year-old woman with a medical history of constipation and small bowel bacterial overgrowth presented to an outpatient endoscopy center for EGD/colonoscopy. Both procedures went well with no complications, however while in the recovery room, the patient became abruptly hypotensive to the 70s/30s mmHg with nausea and chest pain. She was transferred to our center for further care. In our emergency room she was initially normotensive with a heart rate of 113 in atrial fibrillation, but subsequently decompensated, requiring intubation and pressors. An EKG revealed ST elevations in V1 and AVR with diffuse ST depressions, and thus a CODE STEMI was activated. Coronary angiography revealed no significant coronary disease. At this point we had to step back and reconsider the cause for this patient’s ongoing profound shock. Our differential was broad, and included obstructive shock secondary to pulmonary embolism or tamponade, hypovolemic shock secondary to a GI procedural complication, and anaphylactic shock. Bedside echocardiogram ruled out pericardial effusion and acute valvular disease, revealing a hyperdynamic LV with systolic anterior motion of the mitral valve. Pulmonary arteriogram ruled out pulmonary embolus. Right heart catheterization revealed significantly elevated biventricular filling pressures with a cardiac index of 1.3 L/min/m
2
. Given suspicion for an outflow tract obstruction, she was temporized with an esmolol drip, phenylephrine, and IV fluids. Electrical cardioversion was successful, with immediate rise in her blood pressure despite only a modest improvement in her heart rate. This case demonstrates an unusual presentation of atrial fibrillation resulting in severe hemodynamic compromise. Typically, atrial fibrillation with rates in the 110s, as in our patient, does not cause profound hypotension. This was the principle driver of diagnostic uncertainty. A perfect storm of volume depletion from colonoscopy prep, diastolic dysfunction, dynamic left ventricular outflow tract obstruction due to systolic anterior motion of the mitral valve, and loss of atrial systole resulted in profound cardiogenic shock. This obstructive physiology must be kept in mind in patients with cardiogenic shock who do not improve with usual care.
Abstract 15606: The Association Between Health System Integration and Quality and Outcomes After Acute Myocardial Infarction
Authors: Dodge Shayne E , Aaron Micah , Beaulieu Nancy , Cutler David , Landrum Mary Beth , Gilstrap Lauren
Published: May 2021

Introduction:
Integrated care has long been put forward as a way to both decrease costs and improve the quality and outcomes. To date however, this hypothesis has not been formally evaluated in nationally representative data. In this study, using 100% Medicare data and a novel enhanced database (EDB), we aim to determine the association between integrated inpatient and outpatient care after acute myocardial infarction (AMI) and quality and outcomes.

Hypothesis:
There will be no difference in quality or outcomes after AMI between integrated and non-integrated inpatient and outpatient care.

Methods:
Using 100% Medicare data and a novel EDB that combines claims data, tax and financial records and proprietary datasets, we classified all hospitals and providers in the US as: “part of a health system” or “not part of a health system.” We then determined whether AMI patients had “integrated” (hospital and outpatient provider in the same system) or “non-integrated” (hospital and outpatient provider not in the same system) care after AMI. Multivariable linear regression was used to determine the association between care integration between hospital and outpatient provider and quality/outcomes.

Results:
The differences in quality and outcomes, based on care integration, are displayed below (
Table
). There were no differences in short-term quality or follow up. Integrated care was associated with significantly higher rates of cardiac rehab enrollment. Long-term quality metric performance and outcomes were uniformly better among patients who received integrated care.

Conclusions:
Integrated inpatient and outpatient care after AMI is associated with higher rates of cardiac rehab enrollment, better long-term quality and improved patient outcomes.
Abstract 15980: Associations of Anemia With Stroke, Bleeding, and Mortality in Atrial Fibrillation: A Systematic Review and Meta-analyses
Authors: Tu Samuel J , Hanna-Rivero Nicole , Elliott Adrian D , Clarke Nicholas , Huang Sonia , Pitman Bradley M , Gallagher Celine , Mahajan Rajiv , Lau Dennis H , Sanders Prashanthan , Wong Christopher X
Published: May 2021

Background:
Anemia frequently co-exists with atrial fibrillation (AF). We performed a systematic review and meta-analyses to comprehensively assess the effect of anemia on stroke/systemic thromboembolism, bleeding, and mortality in patients with AF.

Methods:
MEDLINE and Embase were searched until May 2020. Cohort studies and secondary analyses of randomised controlled trials examining the association of anemia with the above outcomes in AF were included and random-effects meta-analyses of reported hazard ratios were undertaken.

Results:
Twenty-eight studies involving 365,484 patients with mean follow-up of 2.0 years were included. Of the studies that provided the relevant information, 41% of patients were female, mean age was 74.7 years, 76% were on oral anticoagulation, and prevalence of anemia was 16%. Anemia was associated with a 78% increase in all-cause mortality (HR 1.78, 95% CI 1.44-2.20), a 15% increase in stroke/systemic thromboembolism (HR 1.15, 95% CI 1.01-1.31), and a 78% increase in major bleeding (HR 1.78, 95% CI 1.54-2.05). Including studies that reported odds ratios and excluding conference abstracts did not discernibly alter the results. Between-study heterogeneity was substantial in the majority of meta-analyses performed. Additional meta-analyses for cardiovascular/non-cardiovascular mortality and gastrointestinal bleeding as outcomes, and using hemoglobin as a continuous predictor, yielded similar results.

Conclusion:
Anemia is common in patients with AF and is associated with an increased risk of stroke/systemic thromboembolism, major bleeding, and all-cause mortality. Future studies are required to explore the causes of anemia in AF, and whether further investigation and treatment may be clinically beneficial in affected individuals.
Abstract 16032: Determinants of Exercise Capacity Assessed Using Combined Stress Echocardiography and Cardiopulmonary Exercise Testing in Patients Treated for Acute Myocardial Infarction
Authors: Smarz Krzysztof , Jaxa-Chamiec Tomasz , Zaborska Beata , Tysarowski Maciej , Budaj Andrzej
Published: May 2021

Introduction:
Exercise capacity (EC) after acute myocardial infarction (AMI) influences prognosis, but the causes of its reduction are complex and not sufficiently studied.

Methods:
We prospectively enrolled consecutive patients who underwent percutaneous coronary intervention for their first AMI without residual coronary stenosis and with left ventricular ejection fraction (LVEF) > 40% more than 4 weeks after the AMI. We performed combined stress echocardiography and cardiopulmonary exercise testing (CPET-SE) using a semi-supine cycle ergometer to determine predictors of EC (peak oxygen uptake [VO
2
]).

Results:
Among 81 patients (70% male, mean age 58 ± 11 years), 40% suffered AMI with ST-segment elevation (STEMI), and 60% non-STEMI, LVEF was 57 ± 7%; wall motion score index, 1.18 (IQR 1.06 - 1.31); peak VO
2
, 19.5 ± 5.4 mL/kg/min. Multivariate analysis (
Table
) revealed that parameters at peak exercise: heart rate (β = 0.17, p < 0.001), stroke volume (β = 0.09, p < 0.001), and arteriovenous oxygen difference (β = 93.51, p < 0.001) were independently positively correlated with peak VO
2
, with arteriovenous oxygen difference being its strongest contributor. At rest, left ventricular systolic and diastolic function parameters and the extent of myocardial scarring (wall motion score index) did not predict EC (p > 0.05).

Conclusions:
In patients treated for AMI with normal/mildly reduced LVEF, EC is associated with peak peripheral oxygen extraction as well as peak heart rate and peak stroke volume. CPET-SE is a useful tool to evaluate decreased fitness in this group.
Abstract 16076: Elevated Body Mass Index and Blood Pressure Among Male High-School American Style Football Athletes
Authors: Rao Prashant , Johnson Drew , Nair Abhinav , Weiss Max , Shipon David
Published: May 2021

Introduction:
The impact of American Style Football (ASF) participation on cardiovascular health is unclear. Early-life weight gain among ASF athletes is common and is associated with risk of multiple later-life health afflictions. Despite the popularity of ASF participation among the youth, a rigorous comparison of the cardiovascular health profiles between ASF and non-ASF athletes at the high-school level has not been undertaken. We performed an observational cross-sectional study comparing the body mass index and blood pressures of ASF and non-ASF high-school athletes.

Methods:
Between October 2012 to November 2018 we performed voluntary cardiac screens including height, weight and blood pressure among predominantly high-school students. Inclusion criteria included the following: male sex; >10 hours of exercise per week; single-sport athlete; age >14 years old. Of the 6973 young individuals who underwent screening, 508 athletes were included in the analyzed data.

Results:
ASF athletes represented 18% of all high-school athletes. The mean age of ASF and non-ASF athletes was 18.5 and 18.0 years, respectively. BMI was higher in ASF athletes compared to non-ASF participating athletes (26.9 vs 21.2 p<0.0001). There was a higher prevalence of class I and class II obesity among ASF athletes (class I obesity: 15% vs 1%; class II obesity: 10% vs 1%, p<0.0001 for each). ASF athletes had an increased systolic (SBP) and diastolic blood pressure (DBP) compared to non-ASF participating athletes (SBP: 121 vs 114 p<0.0001; DBP: 73 vs 70 p=0.0028). Among all athletes, there was a positive correlation between blood pressure and BMI (SBP: R=0.4149, DBP: R=0.2076, p<0.0001 for each).

Conclusions:
High-school athletes that participate in ASF have a higher BMI, prevalence of obesity and blood pressure compared to their non-ASF counterparts. It is important to screen young ASF athletes for obesity and hypertension in order to optimize cardiovascular health at an early age.
Abstract 16111: Clinical Application of Deep Learning for Stress Analysis of Ascending Thoracic Aortic Aneurysms
Authors: Rahaman Imon , Wang Zhongjie , XUAN Yue , Ge Liang , Tseng Elaine E
Published: May 2021

Introduction:
Current guidelines for elective surgery of ascending thoracic aortic aneurysms (aTAAs) use aneurysm size as primary determinant for risk stratification of adverse events. Biomechanically, dissection may occur when wall stress exceeds wall strength. A widespread method for stress analysis is structural finite-element analysis (FEA). Patient-specific aortic geometries are easily obtainable and stress distributions can potentially predict risk of dissection. However, FEA is a time-consuming and difficult procedure. To bypass this issue, a recent study has developed the first deep learning (DL) approach for a fast and accurate estimation of aortic wall stress distributions.

Hypothesis:
In this study, we assessed the hypothesis that this deep learning approach can be applied to a large clinical dataset. Model performance was measured by comparing FEA and DL stress predictions in parallel.

Methods:
Patients with aTAA (n = 169) were studied. Patient-specific aneurysm geometries were obtained from ECG-gated computed tomography. Shapes were represented by hexahedral meshes with 9648 nodes and 6336 solid elements. FEA peak wall stresses and stress distributions were determined using LS-DYNA software with user-defined fiber-embedded material models under systolic pressure. The DL model was implemented in Julia and consisted of unsupervised and supervised learning algorithms. Training was performed on a training set of 152 shapes and testing set of 17 shapes with 10-fold cross-validation. Mean absolute error (MAE) and absolute error of peak stress values (APE) were used to compare DL model predictions with FEA values considered to be ground truth.

Results:
Average stress values predicted by our DL model were 175.64 ± 4.17 kPa and 95.69 ± 2.15 kPa in the circumferential and longitudinal direction, respectively. We computed a MAE of 5.06 ± 1.08 kPa and APE of 2.58 ± 1.39 kPa in the circumferential direction and MAE of 4.51 ± 0.98 kPa and APE of 2.32 ± 1.84 kPa in the longitudinal direction.

Conclusions:
DL model trained exclusively on clinical data was able to accurately predict stress distributions on complex aortic geometries. Fast and accurate stress predictions will facilitate real-time clinical applications for the risk assessment of aTAAs.
Abstract 16134: A Multicenter Cross-sectional Study of Dyslipidemia Among Adults in New England With Congenital Heart Disease
Authors: Wu Fred M , Mendelson Michael , Drucker Nancy A , Moran Adrian , Yeager Scott , Huang Yisong , Palfrey Hannah , Valente Anne M , Deferranti Sarah ,   New England Congenital Cardiology Association (NECCA)
Published: May 2021

Background:
Improved survival of individuals living with congenital heart disease (CongHD) has highlighted the importance of acquired atherosclerosis. Hypertension and diabetes are known to affect those with CongHD, compared to the general population. However, the prevalence of dyslipidemia among adults with CongHD is not well described.

Objective:
To describe the prevalence of dyslipidemia according to 2018 Multisociety Guideline on the Management of Blood Cholesterol and the frequency of lipid screening among adults with CongHD.

Methods:
We performed a prospective, cross-sectional study of individuals ≥18 years of age seen at four ambulatory congenital cardiology centers within the New England Congenital Cardiology Association regional referral network. Consenting subjects were administered a survey regarding prevalence of cardiovascular risk factors and previous screening. A non-fasting fingerprick sample of capillary blood was obtained from each subject for immediate analysis using a point-of-care lipid analyzer.

Results:
There were 186 subjects recruited with one subject excluded from analysis due to self-reported fever. Of the remaining 185 subjects, 93 (50.3%) were male. The median age was 30 years (range 18-71). CHD anatomy was classified as simple for 21 (11.4%) subjects, moderate for 101 (54.6%) subjects, and complex for 63 (34.1%) subjects. Of those who responded, 67.9% recalled having their cholesterol levels checked previously. Only 14.8% reported a history of high cholesterol or triglycerides. However, 85 (45.9%) subjects met NCEP definition of dyslipidemia, with 60 (32.4%) having HDL <40 mg/dL and 37 (20.0%) having TC ≥200 mg/dL. TC was significantly higher in the simple CHD group than in the moderate and complex groups (178.4 vs. 170.1 vs. 157.6, p=0.03). Conversely, HDL tended to be lower in complex CongHD compared to simple and moderate CHD (44.1 vs. 46.9 vs. 49.8, p=0.05), although this did not reach statistical significance.

Conclusion:
Dyslipidemia is highly prevalent among our cohort of adults with CongHD despite less than 15% reporting a prior diagnosis of high cholesterol. Low HDL, was most common, and predominated in those with complex CHD, while high TC more often affected individuals with simple and moderate CHD.
Abstract 16159: Pacemaker in the Elderly: A Nationwide Cohort to Determine Complications Associated With Pacemakers
Authors: Rojulpote Chaitanya , Bhattaru Abhijit , Gonuguntla Karthik , Patil Shivaraj , Karambelkar Pranav , Buch Tapan , Vuthaluru Kiranmayi , Shrivastava Sanskriti , Perosevic Nikola
Published: May 2021

Introduction:
The geriatric population represents over half of the patients who receive permanent pacemakers (PPM). There are complications associated with the use of PPM in the elderly.

Hypothesis:
There is limited data on the use of PPM in the elderly population. We aimed to analyze complications and trends associated with various PPM device implantations in the geriatric population over the age of 80.

Methods:
We used the National Inpatient Sample Database for the years 2010 to 2014 using the International Classification of Diseases-9 procedure code for PPM Implantation and diagnosis codes for complications associated with pacemaker use in patients above the age of 80 years.

Results:
We identified a total of 265,001 hospitalizations from 2010 to 2014 where patients above the age of 80 years received PPM implantation. Among those who received the PPM, 68 % of patients had Sinus Node Dysfunction (SND) and in-hospital mortality associated with PPM implantation of 1.8%. The majority of this cohort consisted of Caucasians (83%) and males (50%). They had a mean length of stay of 4.4±4.2 (mean ± SD) days. Various types of pacemakers implanted included dual chamber (72 %), single chamber (15 %), and biventricular (13 %). Complications associated with PPM implantation were venous thromboembolism (1%), cardiac tamponade (0.2%), sepsis and severe sepsis (1.1%), septic shock (0.3%), pneumothorax (0.2%), pacemaker hematoma (1.4%).

Conclusion:
As observed in our study, dual chamber pacemaker is the most commonly used implantable device in age 80+ geriatric patient population. This study identified a variety of PPM-related complications, of which pacemaker hematoma was the most common. Although there are associated complications with the use of this device, the benefits outweigh the risks as age should not be considered a barrier to receive a PPM.
Abstract 16438: Combined Prognostic Significance of Heart Failure and Chronic Kidney D in Patients With Acute Myocardial Infarction. The Fast-mi Programme
Authors: Danchin Nicolas , Cayla Guillaume , Cottin Yves , COSTE Pierre , ALBERT Franck , Puymirat Etienne , Ferrieres Jean , schiele francois , Simon tabassome ,   for the FAST-MI investigators
Published: May 2021

Introduction:
We assessed the interplay and potential cumulative effects of heart failure (HF) and chronic kidney disease (CKD) on one-year and 5-year outcomes in patients admitted for acute myocardial infarction (AMI).

Methods:
FAST-MI consists of 3 nationwide French surveys 5 years apart from 2005 to 2015, consecutively including STEMI and NSTEMI patients over 1-month periods. Using Cox regression, we analysed the association between CKD and non-fatal HF and death during the first year after discharge according to absence of HF, previous HF and acute stage HF. In those alive at 1 year, we also analysed the prognostic significance of admission for non-fatal HF after AMI and CKD on 5-year mortality.

Results:
Of 12,301 patients discharged alive, 7960 (64.7%) had normal renal function and no HF. Both CKD and type of HF were independent predictors of one-year death: one-year mortality was 3.6%, 14.3% and 24.5% in patients with no HF, acute stage HF, and prior history of HF, respectively. Within each group, mortality increased by increasing degree of CKD. In patients with no history of HF, CKD was a strong independent correlate of hospital admission for HF within one year of discharge: HR (95%CI) 1.33 (1.01-1.74), P=0.04 for CKD-EPI 30-60, and 1.76 (1.16-2.67), P=0.008 for CKD-EPI <30, as was the case in patients with HF at the acute stage (Figure). Finally, in patients alive at 1year, both HF admission during the first year (adjusted HR 1.85, 1.42-2.39, P<0.001) and CKD (HR 1,23, 1.04-1.47, P=0.02 and HR 1.86, 1.41-2.44, P<0.001, respectively for moderate and severe renal dysfunction), were independent predictors of 5-year death.

Conclusion:
After AMI, CKD and HF are major independent prognostic factors for death and/or subsequent HF admission. Both are likely to be important therapeutic targets to improve long-term outcomes after AMI.