bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15932: Clinical Significance of Coronavirus Disease 2019 in Hospitalized Patients With Myocardial Injury
Authors: Briscoe Michael , Sykes Robert A , Krysztofiak Thomas , Peck Oliver H , Mangion Kenneth , Berry Colin
Published: November 2020

Introduction:
Coronavirus disease 2019 (COVID-19) is a novel cause of myocardial injury. We investigated the clinical significance of COVID-19 in a population of hospitalized patients with myocardial injury.

Methods:
This was a prospective, longitudinal cohort study of hospitalized patients admitted to an urban academic medical center (catchment population 650,000) from March 1 - April 15, 2020. Consecutive patients with myocardial injury were identified using laboratory records by occurrence of ≥1 high-sensitivity troponin-I (hsTnI) result (Abbott ARCHITECT assay) >99
th
percentile sex-specific upper reference limit (URL; male: >34 ng/L; female: >16 ng/L). Cardiac endotypes were defined according to the Fourth Universal Definition of Myocardial Infarction (MI) and laboratory data used to determine presence of COVID-19 infection by PCR. Outcomes of patients with myocardial injury with and without COVID-19 were assessed.

Results:
Of 390 hospitalized patients with elevated hsTnI, 346 were eligible for inclusion; 44 were excluded (
Duplicate: 2; Missing data: 41; Research patient: 1
). 35 (10.1%) had laboratory-confirmed COVID-19 (COVID-19, yes
vs
no: median age [IQR]; 65 [59-74]
vs
74 [63-83] years); 64.8%
vs
43.7% male). Distribution of cardiac endotypes by COVID-19 status (yes
vs
no) were: Type 1 MI (0 [0%]
vs
115 [100%]; p<0.0005), Type 2 MI (13 [16.5%]
vs
66 [83.5%]; p=0.045), and non-ischemic myocardial injury (cardiac: 4 [5.8%]
vs
65 [94.2%]; p=0.191, non-cardiac:19 [22.9%]
vs
64 [77.%]; p<0.0005). Among all patients, those with COVID-19 had lower comorbidity burden (Charlson Comorbidity Index: 3.6
vs
5.1; p=0.002), similar average hsTnI concentrations (initial: 282
vs
316; p=0.853, peak: 560 vs 527ng/L; p=0.911), longer hospital stay (median [IQR]: 16 [20] vs 4 [9] days; p<0.0005) and higher inpatient mortality (66.7%
vs
10.3%; OR=17.5; 95% CI: 8.00, 38.3). Respiratory failure requiring invasive ventilation occurred in 24 (68.6%) patients with COVID-19, whilst 18 (51.4%) and 21 (60%) required renal and/or circulatory support, respectively.

Conclusion:
Presence of both myocardial injury and COVID-19 is associated with high in-hospital mortality. Systemic consequences may be associated with higher mortality risk in this patient group.
Abstract 16240: Knowledge of Clinical Presentation and Diagnostic Pathways for Cardiac Amyloidosis Among Physicians in the Middle East-Gulf Region: on Behalf of the Gulf Cardiac Amyloidosis Working Group
Authors: Al Badarin Firas , Al Ali Juwairia , Bader Feras , Shehab Abdulla M , AlSaid Said , Sulaiman Khadim , Khalifa Adel , Sabbour Hani , Badr Amr , Alzadjali Basma , Alibazoglu Haluk , BAZARGANI NOOSHIN , Al Humood Khaldoon , Perlinin Stefano
Published: November 2020

Background:
There is a growing interest in raising awareness about amyloidosis as an under-recognized cause of heart failure and preserved ejection fraction (HFpEF). Recently, the prevalence of cardiac amyloidosis in the United States has increased, which may partly be attributed to initiatives from major professional societies aimed to improve patient identification and disease detection. Whether this has also impacted physicians’ knowledge about cardiac amyloidosis in the Middle East-Gulf region is unknown but critical to assess, as it would identify a need for dedicated regional educational activities.

Methods:
Physicians practicing in 5 Gulf countries (UAE, Bahrain, Qatar, Oman and Kuwait) were invited to participate in this anonymous, online survey by receiving a unique survey link by email. We assessed awareness of cardiac amyloidosis, knowledge of disease manifestations and approach to diagnosis. Responses to the survey were recorded using a 4- or 5-point Likert scale.

Results:
A total of 272 physicians participated in the survey. Most participating physicians were men (82%) and have been practicing cardiology (71%) for >10 years (65%). Whereas 83% of responders considered themselves to be somewhat or extremely familiar with signs and symptoms of cardiac amyloidosis, only 63% would consider cardiac amyloidosis as a cause of HFpEF, 59% would consider it in patients with heart failure and orthostatic hypotension while only 39% consider cardiac amyloidosis in patients with low-flow, low-gradient severe aortic stenosis. Furthermore, cardiac MRI was found to be useful for diagnosis of cardiac amyloidosis by 92% of responders, while echocardiography, cardiac scintigraphy with bone-seeking radiotracers and biomarkers were felt to be useful by only 81%, 60% and 31% of survey participants, respectively.

Conclusion:
Despite perceived familiarity with cardiac amyloidosis among a group of mid-career cardiologists, there is need to raise awareness about the heterogenous manifestations of the disease and about the respective roles of testing modalities in making this diagnosis.
Abstract 16259:
Gemella Morbillorum
Infective Endocarditis: A Systematic Review
Authors: Steinberger Jared , Mohamed Mohamed , Sudhakar Rajeev
Published: November 2020

Introduction:
Gemella morbillorum is a facultative anaerobic gram positive bacterium that resides as normal flora in the oral cavity and gastrointestinal system. This organism has uncommonly presented as an etiology of infective endocarditis, with varying reports of resistance and complications.

Methods:
Transparent Reporting of Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for the systematic review. A medical librarian (T.R.S) versed in evidence-based medicine systematically searched databases for studies assessing Gemella morbillorum infective endocarditis in patients. Publication year included inception until December 31, 2019. Using Rayyan software, 134 abstracts were screened for eligibility after duplicates were removed. Inclusion criteria was age greater than 18 years old, infective endocarditis with positive culture for Gemella morbillorum, and publication in English. 39 full text articles were reviewed for eligibility, and 38 were included in the final analysis.

Results:
A total of 40 cases of infective endocarditis caused by Gemella morbillorum were identified. The average age of the patients was 54 years old, 72.5% were male patients (29), 20% female (8), 7.5% unknown sex (3). Native valve endocarditis (NVE) was present in 28 of the cases, with prosthetic valve involvement in 5 cases. Left sided endocarditis was more common than right sided with 70% of cases (28) and 12.5% (5) respectively, with 17.5% (7) of cases not listing which valve was infected on echocardiography. The most common predisposing risk factor was thought to be poor dentition in 9 cases. The most common antibiotic regimen in penicillin susceptible NVE was concordant with most recent guidelines, a beta lactam with gentamicin or vancomycin in 57.5% of the cases (23). Complications occurred in 65% of cases (26), with most common complication being need for surgical intervention occurring in 30% of the cases (12).

Conclusions:
Gemella morbillorum infective endocarditis cases reported in literature had a high burden of complications with nearly two thirds of cases. Most common was the need for surgery with valve replacement. Antibiotic regimens in the most recent endocarditis guidelines were effective in treatment for a majority of the cases.
Abstract 16284: Patient Derived Endothelial Progenitor Cells as a Model to Unravel New Mechanisms of Coronary Artery Disease
Authors: Finemore Meghan , Yu Christine , Bubb Kristen J , Kott Katherine , Di Bartolo Belinda , Besnier Marie , Figtree Gemma A
Published: November 2020

Introduction:
Endothelial colony forming cells (ECFCs) are progenitor cells that can differentiate into mature endothelial cells. Ability to culture these cells from peripheral blood mononuclear cells (PBMCs) make them a suitable tool for investigation into individual susceptibility to coronary artery disease (CAD). We hypothesise that patient-derived ECFCs provide a model to study endothelial cell signalling in patients with CAD. Here we aim to identify biasing factors in spontaneous growth of ECFCs, and confirm whether they retain an “imprint” of patient disease burden.

Methods:
ECFCs were purified from patient samples in the BioHEART-CT biobank. Mitochondrial ROS assays (MitoSOX) were performed and protein lysate was collected to determine expression of redox signalling proteins by immunoblotting. CT coronary angiograms were analysed using Gensini scores to determine the burden of disease.

Results:
Spontaneous growth of ECFCs occurred in 178 of the 828 patients (21.50%). Spontaneous growth was lower in those with obesity (BMI ≥ 30: 15.7%, n = 30/191 vs BMI < 30: 23.2%, n = 148/637, p = 0.03) and higher in hypertensive patients (25.4% n = 81/319 vs normotensive 19.1% n = 97/509, p = 0.03), although growth was not affected by presence of CAD (21.0% n = 59/281 vs CAD- 21.8% n = 119/547, p = 0.8). ECFCs expressed endothelial markers such as CD31 and eNOS, validating their differentiation into endothelial cells. However, ECFCs of patients with CAD expressed higher NADPH oxidase-2 protein level (1.9±0.4 fold-change vs CAD-, n = 13, p = 0.02) and were associated with higher mitochondrial superoxide production (Pearson correlation= 0.66, n = 18, p = 0.003).

Conclusion:
Spontaneous growth is affected by obesity and hypertension however the impact of this is reasonably small. The biochemical characteristics identified in these cells correlate with the patient’s disease state indicating that they are a helpful tool to further investigate individual susceptibility to CAD.
Abstract 16292: Selective Platelet Protease-Activated-Receptor (PAR)1 and PAR4 Mediated Thrombin Desensitisation in the Elderly is Correlated With Inflammation and Chronic Thrombin Receptor Stimulation
Authors: Gnanenthiran Sonali R , Pennings Gabrielle , Reddel Caroline , Campbell Heather , Hamilton Justin , Chen Vivien , Kritharides Leonard
Published: November 2020

Introduction:
Platelet activation, by adenosine diphosphate (ADP) via P2Y
12
receptors and thrombin via PAR1 and PAR4, is a key therapeutic target in cardiovascular disease (CVD). The efficacy of antiplatelet agents diminishes in the elderly, but it is unknown whether these pathways change with aging.

Hypothesis:
Platelet activation pathways change with aging.

Methods:
Platelet activity was evaluated in young (20-30yrs), middle-aged (40-55yrs) and elderly (≥70yrs) healthy volunteers (n=174). Whole blood aggregometry and flow cytometry (P-selectin: α-granule release; CD63: dense granule release; PAC1 binding: activated GPIIb/IIIa) were performed under basal conditions and post
ex vivo
stimulation with ADP, thrombin, PAR1 agonist or PAR4 agonist. EC
50
and E
max
values were derived for each agonist. Receptor cleavage and quantification (P2Y
12
; PAR1; PAR4; GPIbα) were assessed with flow cytometry. Thrombin generation (D-Dimer) and inflammation (interleukin [IL]-1β; tumour necrosis factor [TNF]-α) were assessed via ELISA.

Results:
The elderly had higher basal platelet activation markers (P-selectin, CD63, activated GPIIb/IIIa) than the young, with higher basal activity correlating with increasing IL-1β. P2Y
12
receptor density was higher in the elderly and associated with greater ADP-induced platelet aggregation and activation. Elderly subjects had less platelet activation in response to thrombin (higher EC
50
), demonstrating hyporeactivity to selective stimulation of PAR1 or PAR4, more basal PAR1/PAR4 cleavage, and less inducible PAR1/PAR4 cleavage. This was associated with reduced thrombin binding receptor GPIbα and reduced secondary ADP contribution to thrombin-mediated activation. D-Dimer and TNF-α levels were elevated in the elderly, and inversely correlated with platelet thrombin sensitivity, implying a role of desensitization from chronic thrombin receptor stimulation.

Conclusion:
Aging is associated with increased basal platelet activation and hyperreactivity to ADP, but selective desensitization to thrombin. The latter appears mediated by chronic thrombin receptor stimulation and inflammation. Age-specific antiplatelet strategies may require selective targeting of these pathways to treat CVD in the elderly.
Abstract 16295: Smaller Stent Area and Eccentric Expansion are Associated With Increased Adverse Events After Drug-eluting Stent Implantation in Hemodialysis Patients
Authors: Katsura Aritomo , Minami Yoshiyasu , Asakura Kiyoshi , Katamine Masahiro , Kato Ayami , Hashimoto Takuya , Meguro Kentaro , Shimohama Takao , Ako Junya
Published: November 2020

Introduction:
Factors for adverse cardiac events after drug-eluting stent (DES) implantation among patients with hemodialysis (HD) remain to be elucidated.

Hypothesis:
Suboptimal DES implantation is associated with the increased incidence of adverse events in patients with HD.

Methods:
A total of 109 consecutive patients with HD who underwent optical coherence tomography (OCT)-guided DES implantation were included. The impact of post-stent OCT findings on the incidence of device-oriented clinical endpoints (DoCE) at 1 year was investigated. DoCE included cardiac death, target vessel-related myocardial infarction, target lesion revascularization, and stent thrombosis.

Results:
There was no significant difference in baseline clinical characteristics and pre-stent lesion characteristics between patients with DoCE (n=15) and those without DoCE (n=94). Significant hazard ratio (HR) for the incidence of DoCE was not observed in the presence of edge dissection, irregular protrusion, or incomplete stent apposition (Panel A). In receiver operating characteristic curve analyses, the best cutoff of minimum stent cross-sectional area (MSA), %stent expansion [MSA / mean reference lumen cross-sectional area х 100], and eccentricity index (minimum stent diameter / maximum stent diameter) at MSA site for detecting DoCE was 3.4 (mm
2
), 72.0 (%), and 0.71, respectively. Significant HR for the incidence of DoCE was observed in the presence of MSA< 3.4 (HR 3.58, 95% confidence interval [CI] 1.04 - 12.4, p=0.035) and eccentricity index< 0.71 (HR 6.68, 95% CI 1.94 - 23.0, p=0.001) (Panel B).

Conclusions:
Smaller stent area and eccentric expansion were associated with increased incidence of DoCE after DES implantation in patient with HD, although the presence of other post-stent suboptimal findings were not associated with the incidence of DoCE. The present results suggest the importance of larger stent area and concentric stent expansion in patients with HD.
Abstract 16323: Ruling Out Sars-cov-2 Infection With a Fast-track 0/1,5-hour Molecular Testing in Patients With Acute Coronary Syndromes
Authors: Spaccarotella Carmen , migliarino serena , mongiardo annalisa , Curcio Antonio , De rosa Salvatore , Quirino Angela , Barreca Giorgio , Giancotti Aida , Peronace Cinzia , Marascio Nadia , Matera Giovanni , Indolfi Ciro
Published: November 2020

Introduction:
Timely reperfusion with PCI remains the main goal in STEMI patients. In the Covid 19 period, the fear of contagion reduced the number of hospitalized patients for myocardial infarction, and a substantial delay in the hospitalizations was also observed. The fear of the operators to treat non-tested patients did not facilitate the hospitalization and treatment of ACS patients with suspected Covid-19.

Hypothesis:
This study aimed to evaluate the feasibility of a fast-tract protocol to rule out SARS-CoV-2 infection in patients with suspected acute coronary syndrome.

Methods:
In fifty-one patients (mean age 65 ± 12 y) the real-time PCR to extract RNA for SARS-CoV-2 detection was performed with an automated FDA-approved molecular test (Xpert Xpress Cepheid, Sunnyvale, USA). With its 45-minute processing time and with very high sensitivity, this system was tested in patients transferred from spokes centers or from the field to our HUB center. As soon as the patient had arrived in the Cath Lab, the interventional cardiologist, with adequate protection systems, performed the nasopharyngeal swab that was processed with the rapid Cepheid system. In the meanwhile, coronary angiography (CA) or PCI were performed. At the end of the CA/PCI, based on the test response, patients were transferred to the Covid or non Covid areas.

Results:
The time to perform the nasopharyngeal swab in the cath lab was: 10 + 10 minutes. The time spent to transport the nasopharyngeal test to the laboratory was: 30 + 20 minutes. The time to load 300 ul of biological material and extraction, amplification, and detection of viral nucleic acid, targeting the viral genomic regions N2 and E using the rapid test was 68 + 15 minutes. The result of the test was immediately made readily available through the hospital computer system. The total time from the execution of the nasopharyngeal swab to the result was 109 ± 26 minutes.

Conclusions:
This study demonstrates the feasibility of a fast-track protocol with a rapid test to ruling out SARS-CoV-2 Infection in ACS. This pathway allows quick patient stratification and it could of particular importance to detect asymptomatic Covid-19 positive patients with ACS.
Abstract 16324: The Overall Haemostatic Potential: A Novel Coagulation Measure Associated With Sex-specific Differences in Early Atherosclerosis and Metabolic Dysfunction
Authors: Kott Katharine A , Morel-Kopp Marie-Christine , Vernon Stephen T , Takagi Yuki , Ward Christopher , Figtree Gemma A
Published: November 2020

Introduction & Aim:
Plaque micro-ruptures and associated thrombosis are a contributor to the progression of coronary artery disease (CAD). We sought to determine if disorders of haemostasis detectable by a global coagulation assay was a novel risk factor for CAD, or if hypercoagulation was associated with any of the traditional cardiac risk factors.

Methods:
Using the BioHEART biobank of clinical data, imaging data and pathology specimens, a cohort of patients (mean age 62.9 +/- 9.9 years, n=103 female, 103 male) had platelet poor plasma assessed by the overall haemostatic potential (OHP) assay. This assay measures the integrated effect of procoagulant, anticoagulant and fibrinolytic factors via calculation of area under a fibrin time curve. All patients had CT coronary angiograms scored; calcified plaque was identified by the coronary artery calcium score, and non-calcified plaque burden by a soft plaque score (SPS). Analysis was segregated by sex because of baseline differences in coagulation between males and females.

Results:
The OHP was found to be elevated in male patients who had non-calcified CAD [SPS>0 - 10.4 +/- 0.6 (n=62) vs SPS=0 - 8.78 +/- 0.5 (n=41), p=0.04], male patients with obesity [BMI >= 30 - 12.6 +/- 1.1 (n=26) vs BMI < 30 - 8.8 +/- 0.4 (n=77), p<0.01] and in female patients with hyperlipidaemia [hyperlipidaemic 11.8 +/- 0.6 (n=63) vs normolipidaemic 9.2 +/- 0.6 (n=40), p<0.01]. No differences were seen in OHP with calcified CAD, hypertension, diabetes mellitus, current or previous smoking history, or significant family history of CAD.

Conclusions:
These results indicate that hypercoagulation is associated with more biologically active non-calcified plaque, and that disordered coagulation is associated with two significant cardiac risk factors in a sex-discrepant manner. These findings underscore the importance of global coagulation assessments as potential novel, sex-specific biomarker for subclinical atherosclerosis.
Abstract 16344: Pericardial Complications in Patients With COVID-19: A Systematic Review of Published Cases
Authors: Singh Sandeep , Jain Akhil , Chaudhari Priyanka , Malik Faizan Ahmad , Desai Virmitra , abu hassan falah , Shah Vraj , Patel Viral , Desai Rupak
Published: November 2020

Introduction:
COVID-19 has been linked to cardiac damage and life-threatening pericardial complication on which data are trivial which incited us to perform this review of published case reports.

Methods:
PubMed/Medline, Web of Science and SCOPUS were searched until June 2020 for case reports on COVID-19-associated pericarditis, cardiac tamponade or pericardial effusion.

Results:
We identified 8 articles reporting 11 COVID-19 positive cases [mean age: 51.4±14.3 (34-78 yrs) 5 male/6 female)] with pericardial complications. All (100%) cases were COVID-19 positive at the presentation with ~80% having dyspnea, chest pain and cough. Time interval from first symptom to pericardial effusion was 7±8 (1-26) days. Five patients reported heart failure with reduced EF on echocardiography with mean LVEF 36.25%±8.54%. All patients showed nearly normal Troponin-I without angiographically significant stenosis except one. Out of 8 cases on echocardiography 4 cases reported with diffuse hypokinesia, 2 reported inferior and inferolateral walls hypokinesia and 2 reported signs of pericardial tamponade. Out of 11 patients, cardiovascular risk factors in the form of diabetes or hypertension or obesity were present in 5 patients. Cardiovascular comorbidities such as heart failure with low ejection fraction, non-ischemic cardiomyopathy and prior myocarditis were present in 3 patients. ST-segment elevation in 3, sinus tachycardia in 2, T wave inversion in 1 case were noted. Four patients developed cardiac tamponade, 1 developed takotsubo syndrome and 3 patients died.

Conclusions:
COVID-19 patients had signs of a high burden of cardiac injury. Pericardial complications (pericardial effusion and cardiac tamponade) remain infrequent complications which may require prompt care to avoid mortality.
Abstract 16347: Simplified Workflow to Improve the Precision of Non-invasive Radio-ablation of Ventricular Tachycardia Storm
Authors: Ho Gordon , Atwood Todd , Bruggeman Andrew , Moore Kevin , McVeigh Elliot R , Villongco Christopher , Han Frederick , Hsu Jonathan C , Hoffmayer Kurt S , Raissi Farshad , Feld Gregory K , Mundt Arno J , Krummen David E
Published: November 2020

Background:
Stereotactic ablative radiotherapy (SAbR) is an emerging therapy for ventricular tachycardia (VT) storm, but the feasibility and outcomes guided by computational 12-lead ECG mapping and respiratory-gated radiation delivery have not been reported.

Hypothesis:
We hypothesized that a novel 12-lead ECG-based mapping system and respiratory-gated radiotherapy delivery may simplify the workflow and improve precision of SAbR in critically ill patients with VT storm.

Methods:
We enrolled patients with VT storm who were not candidates for catheter ablation. VT was induced using non-invasive stimulation and recorded on 12-lead ECGs. Computational ECG mapping was performed to localize VT exit sites. Target volumes were contoured onto an averaged free-breathing CT. Ionizing radiation (25 Gy) was delivered using a linear accelerator (Varian, Palo Alto). In patients with significant respiratory motion, radiotherapy was delivered at end-expiration, guided by ICD lead fiducials.

Results:
In 5 patients (age 74±6.1 years, EF 29±14%) refractory to 2±1 ablation procedures, 1.5±0.6 VT morphologies were localized on 3D models (Fig 1A) using ECG-based mapping (mapping time 1.2±0.3 min). In patients whom respiratory gating (Fig 1B) was used prospectively due to respiratory variation, the planned target volume (PTV) was smaller compared to patients who were not gated (71 ± 7 vs 153 ± 35 cc, p<0.01). These patients also had VT targets (crux or inferior LV) close to the stomach, and did not experience adverse events. ICD shocks were decreased after SAbR compared to before (0.25±0.5 vs 26±19 shocks, p<0.001) at 4.4±3.4 months follow-up.

Conclusion:
Non-invasive computational mapping based upon the 12-lead ECG alone simplifies radioablation workflow in critically ill VT storm patients and reduces the burden of ICD shocks. Respiratory gated radiotherapy ablation appears feasible and may help reduce target volume of therapy. Studies with longer follow-up are ongoing.
Abstract 16350: Predicted versus Observed 10-year Cardiovascular Event Rates in a Rural Population-Based Health Program: The Heart of New Ulm Project
Authors: Phillips Angela , Sidebottom Abbey , Vacquier Marc , Benson Gretchen A , Sharkey Scott W , Knickelbine Thomas , Miedema Michael D
Published: November 2020

Introduction:
Assessment of 10-year ASCVD risk via the Pooled Cohorts Equation (PCE) is a standard component of the clinician-patient risk discussion to aid treatment decisions for the primary prevention of ASCVD. However, calibration of the PCE to modern populations remains a concern.

Methods:
We studied a sample of individuals participating in the Heart of New Ulm (HONU) Project, a population-based health program aimed at reducing ASCVD risk in a rural, agricultural community of New Ulm, Minnesota. HONU collected baseline survey data on 5,221 individuals in 2009. For this analysis, we included participants who were aged 40-79 years, free of ASCVD at baseline and had adequate data to calculate 10-year ASCVD risk. New Ulm is served by a single healthcare system, allowing surveillance via electronic health records (EHR). EHR data and state death records were used to determine rates of non-fatal myocardial infarction and stroke, and ASCVD death from 2010-2019. ASCVD event rates were compared to estimated 10-year risks calculated using the PCE, and stratified by sex and clinically relevant risk categories.

Results:
The sample (n=2,819, mean age 56.1 ± 9.9 years, 59.6% female) had a low prevalence of tobacco use (8.1% current smokers), diabetes (6.5%) and higher prevalence of hypertension (44.4%) and hyperlipidemia (56.6%). The median estimated 10-year ASCVD risk for the entire sample was 5.7% (interquartile range 2.3 -13.5%) with an observed 10-year ASCVD event rate of 3.4%. ASCVD rates were lower than predicted across all risk categories in both men and women, especially in those with a 10-year risk ≥7.5% (Table).

Conclusion:
In a rural sample exposed to ASCVD risk reduction efforts, observed rates of ASCVD were substantially lower compared to estimated ASCVD risk. The uncertainty of current risk models and the potential for significantly lower than predicted ASCVD event rates in certain populations should be included in the clinician-patient risk discussion.
Abstract 16357: Application of the H2FPEF-score in Pulmonary Arterial Hypertension: Insights From the Amsterdam UMC PAH-cohort
Authors: Kianzad Azar , De Man Frances S , Celant Lucas R , vonk noordegraaf anton , Handoko M M , Bogaard Harm
Published: November 2020

Introduction:
Newly diagnosed idiopathic pulmonary arterial hypertension (PAH) patients increasingly have features of patients with heart failure with preserved ejection fraction (HFpEF). These so-called “atypical” PAH patients can be identified using the H2FPEF-score (Reddy, Circulation 2018). This patient group is often excluded from clinical trials, and it is therefore unclear whether they respond similarly to PAH-specific medication.

Aim:
To assess baseline characteristics and treatment response of patients diagnosed with PAH stratified by the H2FPEF-score.

Methods:
A retrospective analysis of 253 treatment naïve PAH-patients who underwent diagnostic right heart catheterization at baseline. Groups were compared with ANOVA, post-hoc pairwise t-tests with Bonferroni correction and multivariate Cox proportional hazards analysis.

Results:
This cohort included 58 (23%) patients with a low (≤1), 159 (63%) patients with an intermediate (2-5) and 36 (14%) patients with a high (≥6) H2FPEF-score. Patients with a high H2FPEF-score were older and more often male, used more diuretics, had more comorbidities and had more often PAH with severely impaired diffusion capacity compared to patients with a low H2FPEF-score. In addition, patients with a high H2FPEF-score had a significantly lower cardiac index, mixed venous blood gas, oxygen saturation and 6-minute walk distance (6MWD) compared to patients with a low H2FPEF-score. A high H2FPEF-score was associated with worse survival despite correcting for confounders (HR 2.99, 95% CI 1.53-5.84, Fig.1 A). Despite potential survival bias, at 1-year follow-up 6MWD (Fig.1 B) significantly improved in patients with a low and intermediate H2FPEF-score, but did not change in patients with a high H2FPEF-score (interaction p-value< 0.001).

Conclusions:
A high H2FPEF-score is associated with worse survival in PAH. Also, no improvement in 6MWD was observed in patients with a high H2FPEF-score only.
Abstract 16377: Cardiovascular Computed Tomography Can Predict Branch Pulmonary Artery Stenosis in Neonates With Ductal Dependent Pulmonary Blood Flow
Authors: Graff Kirsten K , Chowdhury Shahryar M , Aizcorbe Nicholas , Bradley Scott M , Hlavacek Anthony
Published: November 2020

Background:
A subpopulation of neonates with ductal dependent pulmonary blood flow (PBF) are at risk for branch pulmonary artery (PA) stenosis in the PA that receives the patent ductus arteriosus (PDA). Identification of this population is important in planning initial and future interventions. The objective of this study was to identify novel cardiovascular computed tomography (CCT) measures in the preoperative period that are associated with the need for future branch PA surgical or catheter-based intervention.

Methods:
In this single center retrospective study, we identified neonates (< 28 days) with ductal dependent PBF who underwent CCT prior to initial intervention from 11/2003-12/2019. A single reviewer made conventional and novel measurements of the branch PAs as well as PDA size and configuration. The primary outcome was reached if there was any initial or subsequent surgical or catheter-based intervention on the branch PA that received the PDA.

Results:
A total of 47 neonates (16 female, 31 male) were included. 30 (64%) reached the primary outcome. Upon multivariable regression analysis, PDA origin at the aortic isthmus [OR 7.13 (95% CI 1.01-50.4), p = 0.049] and distance to the largest diameter (DLD) (Figure 1) [OR 1.24 (95% CI 1.01-1.51), p = 0.040] were independently associated with the primary outcome. DLD is the distance of the largest diameter of the PA with the PDA from the bifurcation in confluent PAs or from the insertion of the PDA in discontinuous PAs. On receiver operating characteristic analysis, area under the curve for DLD = 0.75, p = 0.01. A DLD > 6 mm displayed 82% sensitivity and 67% specificity in identifying patients who met the primary outcome.

Conclusions:
PDA origin at the aortic isthmus and DLD can risk stratify patients at high risk for requiring surgical or catheterization-based branch PA interventions. Further analysis is needed to determine if intervention strategies based on these measurements improve patient outcomes.
Abstract 16390: Cost-effectiveness of a CYP2C19 Genotype-guided Antiplatelet Strategy in ST-elevation Myocardial Infarction Patients
Authors: Claassens Danny M , Vos Gerrit J , Boersma Cornelis , Bergmeijer Thomas , Hermanides Rik , van t Hof Arnoud , Van Der Harst Pim , Barbato Emanuele , Morisco Carmine , Tjon Joe Gin Richard M , Asselbergs Folkert W , Mosterd Arend , Herrman Jean-Paul , Dewilde Willem , Postma Maarten J , Deneer Vera H , ten berg jurrien m
Published: November 2020

Introduction:
The POPular Genetics trial demonstrated that a genotype-guided strategy to select antiplatelet therapy in patients with ST-elevation myocardial infarction (STEMI) compared to universal treatment with ticagrelor or prasugrel, resulted in a reduction in bleedings without an increase in the thrombotic risk. The objective of this analysis was to assess the cost-effectiveness of the genotype-guided strategy.

Methods:
In the POPular Genetics trial, STEMI patients who underwent primary percutaneous coronary intervention were randomized to an intervention or a control arm. In the intervention arm CYP2C19 genetic testing for the *2 and *3 loss-of-function alleles took place. Carriers of a loss-of-function allele were treated with ticagrelor or prasugrel, while noncarriers were treated with clopidogrel. In the control arm patients were treated with ticagrelor or prasugrel. An alongside clinical-trial cost-effectiveness analysis was conducted based on a decision-model with 1000 patients in both groups. A hybrid model, consisting of a 1-year decision tree combined with a 25-years Markov model was developed, to estimate the life-time cost-effectiveness from a societal perspective. Outcome measures were costs, quality-adjusted life-years (QALYs) and incremental cost per QALY gained. Deterministic and probabilistic sensitivity analyses were conducted to account for the uncertainty around the key parameters. In an exploratory analysis the price for ticagrelor and prasugrel was the same as clopidogrel, to simulate the effect of generic ticagrelor and prasugrel in the future.

Results:
The genotype-guided strategy resulted in 26.87 QALY gained with cost-savings of є601,807 indicating that the genotype-guided strategy is a cost-saving intervention. The exploratory analysis - keeping the price of antithrombotic therapies at the same price level - resulted in cost-savings of є137,980. Deterministic and probabilistic sensitivity analyses confirmed the robustness of the base-case analysis.

Conclusion:
Based on the POPular Genetics trial, a genotype-guided strategy compared to universal ticagrelor or prasugrel treatment resulted in favorable cost-effectiveness with QALYs gained and cost-savings.
Abstract 16392: The Effect of Dapagliflozin on Anemia in Patients With Heart Failure and Reduced Ejection Fraction: An Analysis of DAPA-HF
Authors: Docherty Kieran , Inzucchi Silvio E , Kober Lars , Kosiborod Mikhail , Langkilde Anna Maria , Martinez Feilpe , Bengtsson Olof , Ponikowski Piotr , Sabatine Marc S , SjÃ¶strand Mikaela , Solomon Scott , Jhund Pardeep S , McMurray John J
Published: November 2020

Background:
Anemia is common and associated with worse outcomes in patients with heart failure and reduced ejection fraction (HFrEF). We examined: 1) whether dapagliflozin corrected anemia in these patients, and 2) the effect of dapagliflozin on outcomes, in patients with or without anemia, in DAPA-HF.

Methods:
Anemia was defined as baseline hematocrit <39% in men and <36% in women (WHO). Correction of anemia was defined as two consecutive hematocrit measurements above these thresholds at any time during follow-up (follow-up visits: 2 weeks, 2 and 4 months and 4-monthly thereafter). The primary outcome was a composite of worsening HF (hospitalization or urgent visit requiring intravenous therapy) or cardiovascular death.

Findings:
Of the 4744 patients randomized in DAPA-HF, 4691 had a baseline hematocrit and 1032 were anemic (22.0%). Anemia was corrected in 62% of patients in the dapagliflozin group, compared with 41% of patients in the placebo group (odds ratio 2.37 [95% CI 1.84-3.04]; p<0.001). The effect of dapagliflozin on the primary outcome was consistent in anemic and non-anemic patients (HR 0.68 [95% CI 0.52-0.88] versus 0.76 [0.65-0.89]; P-interaction=0.44) [Figure]. A consistent benefit was also observed for the secondary outcomes, irrespective of anemia status t baseline. Patients with resolution of anemia had better outcomes than those with persisting anemia: rate of primary outcome 9.9 per 100 patient-years (95% CI 8.0-12.4) in those with resolution versus 24.1 per 100 patient-years (20.4-28.3) in those without anemia resolution.

Interpretation:
Anemia was common in patients in DAPA-HF and associated with worse outcomes. Resolution of anemia was associated with better outcomes than persistence of anemia, regardless of treatment allocation. Although dapagliflozin corrected anemia more often than placebo, treatment with dapagliflozin improved outcomes, irrespective of anemia status.
Abstract 16702: Myocardial Deformation Analysis in Hypertrophic Cardiomyopathy With Sarcomere Mutations: Insights From 2,221 Patients Within the NHLBI-HCM Registry
Authors: Heydari Bobak , Satriano Alessandro , White James A , Merchant Naeem , Mahmod Masliza , Raman Betty , Chan Kenneth , Antiochos Panagiotis , Jerosch-Herold Michael , Ho Carolyn Y , Weintraub William S , Dolman Sarahfaye , Kolm Paul , Geller Nancy , Kim Dong-Yun , Desvigne-Nickens Patrice , Dimarco John P , Desai Milind Y , Watkins Hugh C , Neubauer Stefan , Kramer Christopher M , Kwong Raymond Y
Published: November 2020

Introduction:
Hypertrophic cardiomyopathy (HCM) is caused by mutations in sarcomere genes that alter myocardial contractility and relaxation. Three-dimensional myocardial deformation analysis (3D-MDA) may elucidate left ventricular (LV) abnormalities associated with sarcomere genotype status.

Hypothesis:
We hypothesize that HCM patients with sarcomere mutations have changes in myocardial contractility profiles that are associated with adverse LV architectural changes.

Methods:
3D-MDA was measured using validated feature-tracking software applied to 2D cine cardiac MRI studies in 2,221 genotyped patients within the NHLBI HCM Registry.

Results:
Baseline, cardiac MRI, and 3D MDA-derived strain characteristics stratified by sarcomere status are shown in Table 1. Sarcomere positive patients were younger, had less LV outflow tract obstruction and lower indexed LV mass, but similar LVEF and trend towards higher serum NT-proBNP levels. Maximal wall thickness, measures of diffuse myocardial fibrosis (native T1, extracellular volume fraction) were elevated with corresponding reduction in global radial strain. Global minimum principal and epicardial layer conventional strain values were higher in sarcomere positive patients. Epicardial minimum principal strain was highly correlated with indexed LV mass (r=0.42, P<0.0001), maximal wall thickness (r=0.29, P<0.0001), LVEF (r=-0.33, P<0.0001), late gadolinium enhancement (r=0.22, P<0.0001) and NT-proBNP (r=0.21, P<0.0001) levels in those with sarcomere mutations.

Conclusions:
Sarcomere positive HCM patients had differences in myocardial deformation strain profiles that were correlated to LV architectural changes and NT-proBNP levels despite lower indexed LV mass. More sensitive measures of contractile dysfunction may help elucidate pathophysiological mechanisms by which sarcomere mutations cause disease progression and adverse clinical outcomes in HCM.
Abstract 16705: Prevalence and Outcomes Among Hospitalized Patients With Covid-19 and Atrial Fibrillation or Flutter
Authors: Ghazizadeh Zaniar , Gier Chad , Singh Avinainder , Vadlamani Lina , Eder Maxwell , Pacor Justin , Park Jakob , Pareek Manan , Ahmed Zain , Smolderen Kim G , Meadows Judith L , Ahmad Tariq , Desai Nihar R , Lampert Rachel J , Freeman James V
Published: November 2020

Introduction:
The prevalence and outcomes of patients hospitalized with COVID-19 with atrial fibrillation and atrial flutter (AF/FL) remains unclear.

Methods:
The Yale Cardiovascular COVID Registry is a cohort study of adult patients >=18 years hospitalized with COVID-19 in the Yale New Haven Health System. Retrospective medical record review was performed on consecutive patients from the registry admitted between March and June 2020. We calculated the rates of prior and in-hospital AF/FL and evaluated the unadjusted rates of in-hospital adverse events for both groups; we then calculated the adjusted odds of adverse events using logistic regression.

Results:
Among 396 patients, the mean age was 68.2, 52.3% were men, 56.4% were Caucasian, 28.4% Black and 16.9% Hispanic. 15.7% of patients had prior history of AF/FL. 19.9% of patients had in-hospital AF/FL, 7.83% of which did not have a prior history of AF/FL. Patients with in-hospital AF/FL had significantly more CV complications compared to those without including cardiac injury (78.5% vs 42.7%, p=0.000), type 2 myocardial infarction (53.3 vs 30.3%, p=0.002), and heart failure (32.9% vs 9.2%, p=0.000). In-hospital AF/FL was associated with significantly worse outcomes related to COVID-19 including ICU survival (OR 0.22 [0.08-0.59], p=0.002), heart failure (5.19 [2.56-10.5], p=0.000), myocardial injury (OR 2.87 [1.49-5.49], p=0.001), acute kidney injury (OR 2.02 [1.09-3.74], p=0.027), dialysis (OR 4.07 [1.38-12.03], p=0.011) and hospice/death (OR 2.47 [1.35-4.53], p=0.004).

Conclusion:
AF/FL are common in patients hospitalized with COVID-19 and these patients had significantly worse outcomes, including lower odds of ICU survival and higher odds of heart failure, acute kidney injury, dialysis and hospice/death.
Abstract 16710:
CYP2C19
Polymorphisms and Clinical Outcomes Following Percutaneous Coronary Intervention (PCI) in the Million Veterans Program (MVP)
Authors: Chanfreau-Coffinier Catherine , Anglin-Foote Tori , Lee Kyung Min , Lu Zhenyu , lynch julie , Plomondon Mary E , DuVall Scott L , Friede Kevin A , Voora Deepak , Vassy Jason L , Waldo Stephen W , Cleator John H , Maddox Thomas M , Damrauer Scott M , Rader Daniel J , Assimes Themistocles L , O'Donnell Christopher , Giri Jay , Tsao Philip S , Chang Kyong-Mi , Tuteja Sony ,   On behalf of the VA Million Veteran Program
Published: November 2020

Introduction:
CYP2C19 reduced function (RF) alleles (*2, *3) have been shown to impair clopidogrel effectiveness following percutaneous coronary intervention (PCI) in the setting of acute coronary syndromes (ACS); however, this association has not been explored in the Veterans Health Administration.

Hypothesis:
CYP2C19 RF alleles are associated with major adverse cardiac events (MACE) in patients treated with clopidogrel

Methods:
MACE and CYP2C19 genotype were determined in MVP participants who underwent PCI between 2009-2017 with 1 year follow-up. Age was restricted to <65 years of age to exclude Veterans likely receiving care outside VHA. DNA extracted from whole blood was genotyped using a customized array and imputed to the 1000 Genomes reference panel. MACE, encompassing all-cause mortality, myocardial infarction and ischemic stroke, was ascertained in VA electronic health records using ICD 9/10 codes. Time to first MACE was determined in the whole cohort and in the subgroup with ACS and stable coronary disease using Kaplan-Meier estimators and Cox proportional hazard models adjusted for clinical covariates and clopidogrel exposure modeled as a time-varying covariate.

Results:
Among 4,490 Veterans (age 59.1 ± 5 years, 18% African American, 6% Hispanic, 44% ACS) who were prescribed clopidogrel following PCI, 1,261 (28%) had RF CYP2C19 alleles. The overall MACE rate was 7.0%. MACE was associated with ACS as initial presentation, diagnosis of diabetes, chronic kidney disease, peripheral vascular disease, congestive heart failure, history of stroke, prior MI. Among the subgroup presenting with ACS, the adjusted risk of MACE was greater in participants with RF alleles compared to those with wildtype alleles (HR 1.38, 95% CI 1.002-1.916). There was no impact of RF alleles on MACE risk in those in the non-ACS group (HR 1.00, 95% CI 0.702-1.429).

Conclusions:
These data from the largest integrated health system in the US demonstrate that in Veterans presenting with ACS undergoing PCI, there was a higher risk of MACE in CYP2C19 RF carriers prescribed clopidogrel vs. wildtype carriers. The impact of the CYP2C19-clopidogrel interaction was not observed in the non-ACS patients. Further studies should explore the role of pharmacogenetic testing in Veterans.
Abstract 16712: Safety & Efficacy of Cryoballoon versus Radiofrequency Ablation for Atrial Fibrillation in Elderly Patients
Authors: Akhtar Tauseef , Daimee Usama A , Sivasambu Bhradeev , Hart Erica , Marine Joseph E , Berger Ronald D , Calkins Hugh G , Spragg David D
Published: November 2020

Introduction:
Catheter ablation (CA) for atrial fibrillation (AF) is widely performed, with a rising proportion of patients of advanced age receiving the procedure. There are limited data describing the experience of index radiofrequency (RF) vs. cryoballoon (CB) ablation for AF among elderly patients in the United States.

Hypothesis:
CB ablation is associated with better outcomes in elderly patients.

Methods:
We conducted a retrospective analysis of patients > 75 years undergoing index AF ablation between January 2001 and March 2019 at our center. Major complications and efficacy, defined as freedom from any atrial tachyarrhythmia (ATA) lasting ≥30 seconds after 1 year of follow-up, were assessed in patients with index RF vs. CB ablation. Predictors of ATA recurrence at 1year follow-up were also evaluated.

Results:
In our cohort of 194 patients, the mean age was 78 + 3.1 years, 58.2% were men, and 39.4% had persistent AF. The mean left atrial (LA) diameter was 4.5 + 0.7, while mean CHA2DS2-VASc score was 3.5 + 1.2. The majority (n=149, 76.8%) underwent RF ablation. The incidence of major complications, including bleeding and cardiac tamponade, was similar in the two sub-groups (RF: 2% vs. CB: 0%, p=0.63). No significant difference in success rate at 1year follow-up was found between patients receiving RF vs. CB ablation (57.7% vs. 64.4% Figure, p=0.94). In a multivariable model adjusting for the age, sex, CHA
2
DS
2
-VASc score, AF type, and index RF vs CB ablation, only LA size was associated with ATA recurrence at 1 year follow-up with each increment of 1 cm in LA size was associated with 1.6-fold greater risk of recurrence [HR=1.59, CI: 1.05-2.41, p=0.02].

Conclusion:
In elderly patients undergoing index CA for AF, RF ablation was the predominant modality with similar safety and efficacy relative to CB ablation. LA size was the significant predictor of ATA recurrence at 1year independent of index ablation modality.
Abstract 16713: Major Adverse Cardiovascular Events are Linked to Risk of Mortality in Covid-19 Patients
Authors: Patel Chirag , Ikram Farukh , Nguyen Nicholas , Nguyen Hao , Acharya Priyanka , Sidhu Manavjot S
Published: November 2020

Introduction:
As a predominantly respiratory viral illness, it comes as no surprise that severe respiratory failure has portended greater risk of mortality in COVID-19 patients. We aimed to investigate whether the occurrence of a major adverse cardiovascular event (MACE) was an indicator of higher risk of eventual death in COVID-19 infected and hospitalized patients.

Methods:
A retrospective review was performed on 225 hospitalized patients that tested positive for COVID-19 between March and May 2020 at a major quaternary care hospital in a metropolitan area of the southwestern United States. Baseline characteristics and clinical outcomes of their disease course were identified. Survival analyses were performed on this patient pool, which was divided into two cohorts: (i) patients that experienced a MACE [a composite of myocardial infarction (MI), stroke, pulmonary embolism (PE), deep venous thrombosis (DVT), or shock requiring vasopressor support] and (ii) patients that did not experience a MACE. Pearson’s chi square test was used to examine the difference in mortality between those who had a MACE and those who did not have a MACE.

Results:
Of the 222 hospitalized patients for whom final discharge disposition was available, 59 had a MACE, and 163 did not. Specifically, 19 (8.59%) patients experienced a type 1 or type 2 MI, 3 (1.36%) experienced stroke, 7 (3.20%) experienced PE/DVT, and 37 (16.67%) experienced shock. A significant difference in mortality was observed between those who had a MACE and those who did not have a MACE [p-value <0.0001, OR = 11.23; 95% CI = 4.29 31.33]. In the “No MACE” cohort, 61.52% were alive after
t
= 43 days; 30.33% of the “Yes MACE” were alive after
t
= 43 days. More than 50% of the COVID-19 patients that had a MACE died by day 23 of hospitalization.

Conclusions:
Based on our data, hospitalized COVID-19 patients who experience a MACE are over 11 times more likely to die than those who did not experience a MACE. As such, it is important for clinicians to remain vigilant in assessing for the occurrence of these events, and to promptly respond to them with an evidence-based approach.