bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15865: Analysis of Left Ventricular Assist Device Hemodynamics During Right Heart Catheterization Ramp Studies
Authors: Hajduczok Alexander G , Julian Katharine , Maucione Carly , Boehmer John P
Published: November 2020

Background:
Although hemodynamic-driven Left Ventricular Assist Device (LVAD) speed changes have been shown to improve patient outcomes, there is no standardized algorithm for how to best adjust LVAD speed for optimization of cardiac output (CO) and decompression of left sided filling pressures as measured by pulmonary capillary wedge (PCW).

Methods:
We performed a retrospective study of LVAD patients at Penn State Hershey Medical Center from 2015 to present, to identify those that ramp studies during right heart catheterizations. 470 patients were identified, of which 60 had ramp studies. Only studies with at least 4 of 5 standard ramp speeds were included. Any study that did not exhibit at least a 20% decrease in PCW, suggesting improper LVAD function or recovered heart function, was also excluded. 32 studies were included in final analysis: 11 HVAD, 12 HMIII, and 9 HMII. CO measured by thermodilution was reported. Standard ramp speeds, in rpm, were as follows: HVAD (2100, 2400, 2700, 3000, 3300), HMIII (4500, 5000, 5500, 6000, 6500), and HMII (8000, 9000, 10,000, 11,000, 12,000).

Results:
Combined data showed an average CO improvement of 22.3% and average PCW decrease of 89.7%. HMII and HMIII had similar improvements in CO, 44.4% and 43.8%, respectively; much greater than HVAD (17.2%). HMIII had the largest magnitude of decompression 141.5% versus 106.4% for HMII and 56.1% for HVAD. Suction events occurred at an overall rate of 9.4%, and were greatest in HVADs.

Conclusion:
We report the ramp study hemodynamics for three separate LVADs. Overall, our results suggest the HMIII is most responsive to changes in speed in terms of improvement of CO and decreased PCW. Addition of samples to this analysis may allow for algorithm development to provide clinical guidance regarding LVAD speed settings.
Abstract 15877: Chamber Volumes and Deformation Measures are Abnormal in Chemotherapy-Naïve Cancer Patients: Potential Implications for Surveillance and Definitions of Cardiotoxicity
Authors: Labib Dina , Satriano Alessandro , Dykstra Steven , Mikami Yoko , Slavikova Zdenka , Feuchter Patricia , Rivest Sandra , Sandonato Rosa , Flewitt Jacqueline , Howarth Andrew G , Heydari Bobak , Lydell Carmen , Clarke Brian , Kolman Louis , Pituskin Edith , Cheung Winson , Lee Joon , White James
Published: November 2020

Background:
Cancer Therapeutics-related Cardiac Dysfunction (CTRCD) is defined by an interval drop in contractile performance to below reference lower limits of normal. This definition assumes healthy reference data appropriately represent referral populations with active cancer. However, the influence of active cancer on cardiac chamber volumes and contractile performance has not been established. Using cardiac magnetic resonance (CMR), we studied chamber volume- and deformation-based markers in ~400 cancer patients with comparison to ~100 healthy controls.

Methods:
394 active cancer patients referred for first-time anthracycline-based chemotherapy and 102 healthy volunteers (HV) were recruited. Both underwent identical CMR protocols with quantification of chamber volumes and ejection fraction (EF). Left ventricular (LV) mechanics were also assessed by 3D myocardial deformation analysis (3D-MDA), providing global longitudinal, circumferential, radial and principal peak-systolic strain amplitude and rate.

Results:
The mean age was 53.8±13 years (78% female), with 64% having breast cancer and 36% lymphoma.
Table 1
summarizes CMR findings of cancer patients versus HV, stratified by sex. Chamber volumes were significantly smaller while LV mass was significantly greater versus HV. LV EF and global longitudinal (GLS) were similar. However, cancer patients demonstrated significantly higher radial, circumferential and maximal principal strain amplitude. Peak-systolic strain rates were also consistently elevated.

Conclusion:
Chemotherapy-naïve cancer patients have smaller chamber volumes, greater LV mass, and higher radial, circumferential, and maximal principal strain versus healthy subjects. LV EF and peak GLS remain similar, and therefore are most appropriate to define CTRCD. However, an altered state of cardiac health is apparent by all other CMR-based markers, reflecting a unique cardiac phenotype of patients with active cancer.
Abstract 15912: Parenteral Iron Sucrose Improves Iron Biomarkers in Pediatric Heart Failure Patients With Iron Deficiency
Authors: Lin Michael J , Kronmal Richard , Otero Jessica , Kirk Christa , Albers Erin L , Hong Borah , Friedland-Little Joshua , Kemna Mariska , Law Yuk M
Published: November 2020

Introduction:
Iron deficiency (FeD) is common in adults with heart failure and is associated with worse outcomes. Parenteral iron therapy improves outcomes in this population, but this has not been described in the pediatric population.

Methods:
We conducted a prospective observational cohort study of heart failure patients with FeD, defined as ferritin <100 ng/mL or ferritin = 100-300 with iron saturation <20%, who received parenteral iron sucrose between 01/2007-12/2019. Iron dosing and frequency were based on initial and subsequent iron profiles using a standard replacement protocol. Monthly follow-up lab and clinical data up to 6 months were obtained and analyzed to characterize the effect on iron biomarkers and association with clinical outcomes (B-type natriuretic peptide (BNP), death, transplant, and mechanical circulatory support).

Results:
Among 61 patients who received parenteral iron therapy, 49% were male, with a median age of 23 months (IQR 7 - 117). 30 (49%) had primary cardiomyopathy; 31 (51%) had congenital heart disease with systolic dysfunction, 14 (45%) of which with cyanotic disease. 56 (92%) of the patients had a follow-up iron profile at timepoint 1 (TP 1) at a mean of 24 SD
+
9 days. The interval between the 1st dose of iron and last follow-up (TP Last) was 61
+
50 days. The cumulative number of iron doses received was 3.5
+
1.5 at TP 1 and 4.1
+
2.4 at TP Last. Figure 1 shows the trend in iron biomarkers and BNP. There was a statistically significant increase in ferritin, iron saturation and serum iron levels, as well as a decrease in BNP over time. Clinical outcomes were examined by multivariable analysis. Only an increase in ferritin was associated with a decrease in BNP (p=0.012).

Conclusions:
Parenteral iron therapy for FeD under a standard protocol led to improvement in iron biomarkers in children with heart failure. Our study was limited by a small sample size and further study to assess clinical outcomes specifically related to iron therapy is warranted.
Abstract 15923: A Combined
In Silico
and
In Vitr
o Approach for Surgical Planning of Pediatric Coarctation Repair
Authors: Chassagne Fanette , Buddhe Sujatha , Permut Lester C , MCMULLAN David , Seslar Stephen P , Aliseda Alberto
Published: November 2020

Introduction:
Coarctation of the aorta is a congenital malformation of the proximal descending aorta that results in severe narrowing of the vessel lumen. It causes significant changes in the aortic hemodynamics, including reduced blood flow and an increased pressure gradient in this area of the vasculature. When this congenital cardiac malformation is associated with aortic arch hypoplasia, a two step-surgery is proposed: first, an end-to-end anastomosis in performed to remove all the ductal tissue surrounding the coarctation, and then the aorta is longitudinally incised and patched to increase its diameter. The design of the patch, based on the surgeon’s experience, is done in the OR. A combined
in silico
and
in vitro
approach is proposed to test the possibility of
a priori
design of the patch. This approach would also open the door to optimization of the patch to restore physiological hemodynamics in the aorta.

Methods & Results:
CFD simulations of the hemodynamics in the pre-treatment aortic arch were created from the segmentation of patients’ images who received surgical treatment at Seattle Children’s Hospital.
In vivo
hemodynamics data were used as boundary conditions for the simulation. The design of the patch was created via an in-house code and was based on surgeons’ input: the locations of the start and the end of the lumen enlargement and the length of the aortic segment to be resected. The optimization of the patch design was performed by comparing the simulated hemodynamics (pressure drop, endothelial shear stress, size of the recirculation region, ...) before and after the patch repair. The optimized patch design was then used by the surgeon to perform the
in vitro
surgical treatment on a physical model of the patient’s anatomy, made in a translucent silicon rubber. The repaired anatomical model was scanned by X-ray microtomography and cast in an optically clear silicone. Time-resolved particle image velocimetry measurements were performed to characterize the post-treatment hemodynamics, and compared to the results of the CFD simulation.

Conclusions:
This unique in silico and in vitro approach allows surgeons to perform different repairs on patient-specific physical
in vitro
models and to optimize the design of the patch prior to starting the surgery.
Abstract 15925: Efficacy and Safety of Pulmonary Vein Isolation in Active Duty Military Members With Atrial Fibrillation
Authors: Wilson Andrew S , Bush Kelvin N
Published: November 2020

Introduction:
The efficacy and safety of pulmonary vein isolation (PVI) for atrial fibrillation (AF) in the active duty (AD) military population has not been previously reported.

Hypothesis:
We postulate that PVI is an efficacious and safe treatment for young AD service members with AF.

Methods:
AD military personnel with AF who underwent PVI from 2004 to 2019 were retrospectively analyzed in four age groups (group 1, n=26, 18 to 27 years; group 2, n=38, 28 to 37 years; group 3, n=28, 38 to 49 years; group 4, n=12, ≥50 years). Primary endpoints were (1) PVI procedural efficacy defined as no or rare AF recurrence (<6 episodes) 12 months after last PVI with or without antiarrhythmic drugs (AAD) and (2) procedure-related adverse events and complications.

Results:
104 personnel (mean age 35.6+9 years, 84.6% paroxysmal AF, mean LVEF 60.2+6%, 19.2% maintained on AAD after PVI) underwent 142 PVI procedures with a mean follow up of 55.8+47 months. Procedural efficacy was attained in 96.2% of group 1, 78.9% of group 2, 75.0% of group 3, and 66.7% of group 4 (P=0.004, Figure 1). Freedom from AF was reached in 80.3% of group 1, 55.3% of group 2, 46.4% of group 3, 41.7% of group 4 (P=0.02). AADs were maintained in 11.5% of group 1, 21.0% of group 2, 14.3% of group 3, 41.7% of group 4 (P=0.144) and there was no difference in AF recurrence rates between those with AADs and those without (P=0.091). LVEF <50% trended towards being a significant predictor of AF recurrence (OR, 7; 95% CI, 0.75-65; P=0.051). Complications occurred in only 4 (3.8%) cases (pulmonary vein stenosis, cardiac tamponade, arteriovenous fistula) with no complications in the youngest group.

Conclusions:
This study suggests that PVI is an effective and safe therapy for younger military personnel with AF desiring to decrease their individual AF burden.
Abstract 15935: Socioeconomic Disparities in Urgent versus Elective Transcatheter Mitral Valve Repair: Insights From the National Inpatient Sample
Authors: Spring Alexander M , Catalano Michael A , Rutkin Bruce J , Hartman Alan R , Yu Pey-Jen
Published: November 2020

Objective:
Cardiac interventions performed urgently are known to be associated with poor outcomes compared to electively performed procedures. Transcatheter edge-to-edge mitral valve repair (TMVr) has developed as a reasonable alternative to mitral valve surgery in certain patient populations. We aimed to leverage a national database to identify predictors of urgent versus elective TMVr, as well as the association between urgency and outcomes.

Methods:
The National Inpatient Sample (NIS) was queried to identify weighted hospital discharge records of patients who underwent TMVr from 2016 - 2017. Hospitalizations are identified within the database as elective versus non-elective. Univariate and multivariable analyses were performed to identify patient characteristics associated with urgent procedures. In-hospital outcomes were assessed.

Results:
There were 10,195 cases of TMVr in this cohort, 24.2% of which were performed urgently. In multivariable analysis, Hispanic race, Medicaid insurance, and low income were associated with increased likelihood of urgent hospital admission and TMVr. Additionally, small hospital size and Northeast region were associated with increased likelihood of urgent admission and procedure. Older patients were more likely to undergo elective procedures (Table 1). Urgent TMVr was associated with increased mortality (4.5% vs. 1.6%, p < .001), prolonged length of stay (6.0 vs. 2.0, p < .001), and increased cost ($267,292 vs. $167,889, p < .001).

Conclusion:
Socioeconomic disparities exist in the utilization of TMVr as an urgent versus elective procedure, suggesting differences in access to surveillance and preventive care. Urgent TMVr is associated with increased morbidity and mortality, prolonged length of stay, and increased hospital costs. Priority should be placed on mitigating such disparities to improve outcomes.
Abstract 15940: Wall Shear Stress and Vorticity in Atrial Fibrillation, Pulmonary Hypertension, and Normal Atrial Anatomy Models
Authors: Rutkowski David R , Glukhov Alexey , Roldán-Alzate Alejandro
Published: November 2020

Introduction:
Atrial fibrillation (AF) is a common cardiac rhythm disorder that is often comorbid with pulmonary hypertension (PH) and other conditions associated with abnormal atrial pressure and/or volume overload. In the setting of atrial dilation, mechanoelectric feedback has been linked to the development of ectopic beats that trigger paroxysmal AF mainly originating from pulmonary veins (PVs). However, the precise mechanisms remain poorly understood. Here, we aimed to characterize atrial wall shear stress (WSS) and vorticity in the left atrium of AF, healthy, and at-risk for AF (PH) patient models to develop predictors of AF risk.

Methods:
Magnetic resonance imaging and computed tomography data (10 AF, 10 PH, and 10 healthy volunteers) were obtained retrospectively. The left atria were manually segmented from each data set. Four-dimensional flow MRI was performed on one patient to derive PV flow data. The 30 atrial geometries and PV flow conditions were used to run numerical blood flow simulations, and atrial WSS and blood flow vorticity were analyzed.

Results:
As seen in Figure 1, wall shear stress was highest near the PV roots and on the posterior atrial wall, the most common sources of AF triggers. Average WSS and vorticity were significantly lower in PH patients than in both the healthy (p=0.003(WSS), p=0.011(vorticity)) and AF (p=0.046(WSS), p=0.069(vorticity)) groups. Both WSS (r=-0.66) and vorticity (r=-0.68) were moderately correlated to atrial volume in the PH group. Atrial volume was significantly larger in PH (p<0.001) and AF (p<0.001) groups than in the healthy group.

Conclusions:
The larger atrial volumes of PH and AF patients lead to altered flow profiles and less frequently flow jet impingement on the atrial wall models, leading to abnormal vorticity and WSS profiles. These long term flow abnormalities may influence the development and/or localization of electrical abnormalities and AF; although further study is needed to confirm this hypothesis.
Abstract 15943: Health Status and Quality of Life With Early Invasive and Non-invasive Treatment Strategies for Patients With Claudication
Authors: Angraal Suveen , Hejjaji Vittal , Tang Yuanyuan , Derbas Laith , Patel Manesh R , Heyligers Jan , White Christopher J , Tutein Nolthenius Rudolf , Mena-hurtado Carlos , Aronow Herbert D , Moneta Gregory L , Hiatt William R , Fitridge Robert , Soukas Peter A , Abbott Jinnette D , Spertus John , Smolderen Kim G
Published: November 2020

Introduction:
Improving health status; symptoms, function, and quality of life (QoL) are key treatment goals in patients with peripheral arterial disease (PAD) and claudication.

Hypothesis:
Compared with medical management only, early revascularization in patients with claudication is associated with greater improvements in disease-specific health status.

Methods:
Patients with new or worsening claudication, who underwent revascularization within 3 months of enrolment or were treated non-invasively (statin, aspirin, cilostazol, supervised exercise therapy, risk factor management) were identified from 16 vascular medicine clinics in the US, Netherlands and Australia participating in the PORTRAITregistry. Patients were propensity-matched on the likelihood of receiving invasive therapy. The Peripheral Artery Questionnaire (PAQ) was used to assess patients’ disease-specific health status at enrollment, and at 3, 6 and 12 months of follow-up using hierarchical Generalized Linear Models for repeated measures.

Results:
Among 1142 patients (mean age of 67.7 years, 63.0% male), 229 (20.1%) underwent early revascularization while 913 (79.9%) were managed non-invasively. At baseline, patients who underwent invasive vs. non-invasive management had lower PAQ summary (mean ± SD; 44.41 ± 19.98 vs 50.98 ± 21.79, P<0.001) and quality of life scores (45.52 ± 23.95 vs 52.43 ± 26.19, P<0.001). Compared with patients treated non-invasively, patients who underwent revascularization reported improved health status over time, through 1 year of follow up (P <0.001 for all PAQ domains) (
Figure 1
).

Conclusion:
Patients who underwent early revascularization had worse baseline health status but a greater improvement over 1 year of follow-up when compared with patients managed without revascularization. Summarizing real-world health status benefits following a PAD diagnosis can support preference-sensitive decisions for PAD management.
Abstract 16243: Co-existing Amyloidosis is Associated With Increased Inpatient Mortality in Patient Admitted for Atrial Fibrillation: Analysis of the National Inpatient Sample
Authors: Asemota Iriagbonse , Akuna Emmanuel , Edigin Ehizogie , Shaka Hafeez , Eseaton precious O , Rivera Pavon Mavi , Nwachukwu Praise
Published: November 2020

Introduction:
Amyloidosis is associated with conduction disturbances of the heart such as atrial fibrillation (AF). The outcomes of atrial fibrillation in patients with concomitant diagnosis of amyloidosis is not clearly established. This aim of this study is to compare outcomes of AF hospitalization with and without a secondary diagnosis of amyloidosis

Methods:
We queried the National Inpatient Sample (NIS) 2016 and 2017 database. The NIS is the largest inpatient hospitalization database in the United States (US). The NIS was searched for hospitalization of adult patients with AF as a principal diagnosis with and without a secondary diagnosis of amyloidosis (irrespective of specific organ involvement) using ICD-10 codes. The primary outcome was inpatient mortality while the secondary outcomes were total hospital charge, rates of electrical cardioversion, pharmacologic cardioversion, and pacemaker implantation. STATA software was used for analysis. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders.

Results:
There were over 71 million discharges in the combined 2016 and 2017 NIS database. Out of 821,629 AF hospitalizations, 715 (0.09%) had amyloidosis. AF hospitalizations with amyloidosis had higher inpatient mortality (AOR 4.56, CI 2.15-9.68, P<0.001) compared to those without amyloidosis. There was no difference in rates of ablation (AOR 0.59, CI 0.22-1.63, P=0.314), pacemaker implantation (AOR 1.18, CI 0.38-3.70, P=0.780) and electrical cardioversion (AOR 0.91, CI 0.58-1.41, P=0.650) and pharmacologic cardioversion (AOR 0.99, CI 0.97-1.02, P=0.560) compared to those without amyloidosis.

Conclusion:
Patients admitted primarily for AF with co-existing amyloidosis have increased inpatient mortality compared to those with amyloidosis. Rates of ablation, pacemaker implantation, electrical, and pharmacologic cardioversion were similar in both groups.
Abstract 16245:
Lactobacillus Plantarum
Probiotic Preserves Endothelial Function and Diastolic Performance in the Ischemic Myocardium Through Redox Nrf2 Antioxidant Signaling
Authors: Aboulgheit Ahmed M , Zhang Zhiqi , shi guangbin , Karbasiafshar Catherine , Sodha Neel , Abid Ruhul , Sellke Frank W
Published: November 2020

Introduction:
Oxidative homeostasis is critical to the viability of the vascular endothelium. Nrf2 is a redox-sensitive transcription factor that induces several cyto-protective and antioxidant genes in response to stress.
Lactobacillus plantarum
, a probiotic bacterium, can convert caffeic acid to 4-vinyl catechol, a natural activator of Nrf2.

Hypothesis:
We hypothesized that a diet consisting of applesauce, which is rich in caffeic acid, supplemented with
L. plantarum
can generate sufficient concentrations of 4-vinyl catechol to enhance Nrf2 activity and thereby ameliorate ischemic injury in the myocardium.

Methods:
Fourteen Yorkshire swine received a standard diet with 10 ml of 10% ethanol vehicle for three weeks (NDC; n=7); the treatment group was additionally fed unsweetened applesauce with
L. plantarum
supplements (ND-LP; n=7). Subsequently, an ameroid constrictor was placed around their left coronary circumflex artery (Lcx). Dietary regimens were continued for a period of fourteen weeks thereafter. Finally, cardiac function, myocardial perfusion, vascular density, and molecular signaling were examined.

Results:
The
L. plantarum
-applesauce diet upregulated Nrf2 signaling in the ischemic myocardium, thus inducing several antioxidant enzymes including heme oxygenase1 (HO-1), NADPH dehydrogenase quinone 1 (NQO-1), and thioredoxin reductase (TRXR-1). Reduced ischemic myocardial density of alpha smooth muscle actin (αSMA) and improved myocardial relaxation seen in the treatment cohort may reflect less ischemic fibrosis. Nrf2 activation increased expression of endothelial nitric oxide synthase (eNOS) and lowered concentrations of asymmetric dimethyl arginine (ADMA) in ischemic myocardial tissue, but did not significantly affect blood flow nor endothelial cell density. The expression of hypoxia inducible factor 1α (HIF-1α) and phosphorylated MAPK (pMAPK) was reduced in ischemic myocardial lysates from treatment animals.

Conclusions:
Dietary supplementation with
L. plantarum
and caffeic acid is a safe and effective mean of enhancing Nrf2 activity, which supported endothelial function and diastolic performance, while diminishing hypoxic stimulation of collateral vessel formation in the ischemic myocardium.
Abstract 16260: Thirty Days Major Adverse Cardiac Events Following Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Non-ste-acute Coronary Syndrome: A Meta-analysis With Meta-regression
Authors: Barssoum Kiro , Kumar Ashish , Rai Devesh , Kharsa Adnan , Chowdhury Medhat , Thakkar Samarthkumar J , Tahir Muhammad Waqas , Rao Mohan
Published: November 2020

Background:
The optimum revascularization modality in multi-vessel and left main disease patients presenting with non-ST elevation acute coronary syndrome (non-STE-ACS) is not well studied. The current recommendations are based on studies that primarily included patients with stable angina. Patients with non-STE-ACS were under-represented in clinical trials. We performed a meta-analysis of studies comparing coronary artery bypass grafting (CABG) vs. percutaneous coronary intervention (PCI) in non-STE-ACS, and reporting 30 days major adverse cardiac events (MACE).

Methods:
We searched Medline, EmCare, CINAHL, Cochrane database, and Google Scholar for relevant articles. We excluded studies that included patients with stable coronary artery disease and ST elevation myocardial infarction. Our primary outcome was 30 days MACE defined as all-cause death, stroke, repeat revascularization and re-infarction. We used the Paule-Mandel method with the Hartung-Knapp-Sidik-Jonkman adjustment to estimate risk ratio (RR) with a 95% confidence interval (CI). Heterogeneity was assessed using Higgin’s I
2
statistics. To account for heterogeneity, a meta-regression analysis was performed.

Results:
Five observational studies met our inclusion criteria summing to a total number of 7161 patients. At 30 days, there was no difference between CABG vs. PCI in terms of MACE, RR: 0.96, 95% CI 0.38 to 2.39, I
2
= 81% (Panel A). A meta-regression analysis reported that a history of PCI was associated with a lower risk of MACE with CABG compared to PCI (Panel B).

Conclusion:
At 30 days, there was no difference in MACE between the CABG and PCI groups. However, a history of PCI was associated with a lower risk of MACE in patients who underwent CABG.
Abstract 16263: Association Between Visit-to-Visit Lipid Variability and Cardiovascular Events in Patients With Familial Hypercholesterolemia
Authors: Cao Yexuan , Xu Ruixia , Zhang Huiwen , Jin Jinglu , Liu Huihui , Zhang Yan , Gao Ying , Guo Yuanlin , Wu Naqiong , Zhu Chenggang , Cui Chuanque , Liu Geng , Dong Qian , Sun Jing , Li Jianjun
Published: November 2020

Introduction:
Visit-to-visit variability in lipid has been suggested as an predictor of major adverse cardiovascular events (MACEs). However, no evidence exists on the prognostic value of lipid variability in patients with familial hypercholesterolemia (FH).

Hypothesis:
This prospective cohort study aimed to investigate whether lipid variability affects future MACEs in patients with FH receiving standard lipid-lowering therapy.

Methods:
A total of 254 patients with FH were consecutively enrolled and followed for MACEs. Variability in triglyceride, total cholesterol, high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C) and lipoprotein (a) [Lp(a)] were evaluated from 3 months after discharge using the standard deviation (SD), coefficient of variation (CV) and variability independent of the mean (VIM).

Results:
During a mean follow-up of 49 months, 22 (8.7%) events occurred. Visit-to-visit variability in Lp(a) was significantly higher in the MACE group compared to the non-MACE group. In multivariate Cox analysis, only Lp(a) variability parameters were independent predictors for MACEs. The hazard ratios and 95% confidence intervals of each 1-SD increase of SD, CV and VIM of Lp(a) were 1.42 (1.12-1.80), 1.50 (1.11-2.02) and 1.60 (1.16-2.22), respectively. Kaplan-Meier analysis revealed that patients with higher Lp(a) variability presented lower event-free survival (Log-rank
p
<0.05). The results were consistent in various subgroups.

Conclusions:
This is the first report to evaluate the prognostic value of lipid variability in real-world patients with FH and showed that Lp(a), but not LDL-C variability, was associated with MACEs, which emphasized the importance of regular lipid monitoring in patients with high risk.
Abstract 16264: Ace-inhibitors and Vasoplegia in the Post Cabg Population/valvular Surgery Population: An Updated Systematic Review and Meta-analysis
Authors: Nouthe Brice , Ngongang Ouankou Christian , Spaziano Marco , sia yin T
Published: November 2020

Introduction:
Chronic use of ACE-i has been presented as a risk factor of post operative vasoplegia after cardiac surgery. However, a recent meta analysis of studies in the general cardiac surgery population identified renal failure as the only pre-operative risk factor for vasoplegia. We sought to systematically review the relationship of chronic ACE-i and vasoplegia in patients undergoing CABG /valve surgery.

Hypothesis:
Studies on vasoplegia after CABG / valve surgery were extracted by a research librarian (registered review CRD42017072923) before bias and quality of studies were assessed. We adjudicated vasoplegia as MAP < 60 mmHg and use of at least one non dopaminergic vasoactive drug up to 4 hours post operatively. Otherwise, studies reported vasoplegia as MAP < 60 mmHg, CI > 2.5 l/min/m2 and SVR < 600 dynes/sec/cm2 in the CSICU. We pooled the incidence of vasoplegia then completed a meta-analysis with random effect model using RevMan and Stata.

Methods:
Of the 2337 articles obtained (1940 non relevant, 22 reviews, 5 duplicates and 5 editorials), we pre-selected 365 abstracts and summarized data from 8,818 patients out of 7 articles selected after full text review.

Results:
All but one study looked at patients with LVEF > 40%. The pooled incidence of vasoplegia was 11.2% (95% CI 4.7-28.2). The OR of vasoplegia in patients on chronic ACE-i was 1.74 (95% CI: 1.47-2.06). We could not investigate the importance of pre-existing renal failure on the risk of post operative vasoplegia in patients on ACE-i. Accounting for substantial heterogeneity, the Egger test was in favour of small-study effects due to the number of cases of vasoplegia and the size of the cohorts studied (p=0.073).

Conclusions:
The risk of vasoplegia seems to be higher in patients on ACE-i undergoing CABG/valve surgery in this population. Two RCT's (161 patients) did not prove the benefit of temporary discontinuation of RAS blockade on the incidence of distributive shock during the first days after surgery. Because ACE-i are frequently prescribed in patients awaiting CABG, our work calls for larger and more elaborated studies to reduce the risk of vasoplegia.
Abstract 16281: Non-calcified Coronary Plaque Burden is Related to Epicardial Adipose Tissue and Peri-coronary Adipose Tissue Attenuation in Heart Failure With Preserved Ejection Fraction
Authors: Aldiwani Haider , Wei Janet , Rezaeian Panteha , Kwan Alan C , Pattisapu Varun , Cook-Wiens Galen , Maughan Jenna , Shufelt Chrisandra , thomson louise e , tamarappoo balaji , Berman Daniel , Dey Damini , Bairey Merz C. Noel
Published: November 2020

Introduction:
Coronary inflammation may be a factor in developing heart failure with preserved ejection fraction (HFpEF). Epicardial fat volume (EFV) measured using non-contrast computed tomography (CT) and pericoronary adipose tissue (PCAT) attenuation on coronary CT angiography (CCTA) are considered to be inflammatory mediators, which play an important role in the development of coronary plaque.

Hypothesis:
We hypothesize that there is an interrelationship between these measures in HFpEF and no obstructive coronary artery disease (CAD).

Methods:
28 subjects with HFpEF (European Society of Cardiology criteria), with coronary CCTA-documented absence of obstructive CAD. Non-calcified plaque (NCP), low-density non-calcified plaque (LDNCP), PCAT attenuation were quantified using semi-automated software and EFV was quantified using QFAT software. PCAT attenuation in Hounsfield Units (HU) was measured in a standardized 40 mm segment around the proximal right coronary artery. Statistical analysis was performed using Spearman correlation and multivariable regression models adjusted for age, BMI, EFV, and PCAT tested relations to NCP burden.

Results:
Overall, the mean age of 64.8±12 years, 74% women, BMI 29.3±4, total cholesterol 162±41mg/dl, LDL 85±29 mg/dl, HDL 55±14 mg/dl, systolic BP 132±22mmHg, diastolic BP 77±12mmHg, EFV 139±73 cm
3
and, PCAT attenuation -78±8 HU. Mean total NCP burden 34±13%, total LDNCP burden 3±1.8 %, and coronary calcium score (CCS) 414±920. EFV and PCAT attenuation correlated with the coronary risk markers including CCS and NCP burden variables (Table). In multivariable analysis, age and PCAT (β±SE=0.43±0.2, p=0.04, 0.64±0.3, p=0.03 per 1%-change in NCP burden respectively) were related to NCP burden.

Conclusions:
EFV and PCAT attenuation are associated with non-calcified plaque burden and may play an important role in the pathophysiological process of HFpEF. Further studies are needed to further understand these findings.
Abstract 16285: Use of Non-steroidal Anti-inflammatory Drugs and Risk of First Hospitalization for Heart Failure in Diabetic Patients
Authors: Cho Dong-Hyuk , Song In-Seok , Choi Jimi , Gwon Jun Gyo , Park Seong-Mi
Published: November 2020

Introduction:
Patients with diabetes mellitus are prone to have heart failure (HF), either as new onset or worsening. Non-steroidal anti-inflammatory drugs (NSAIDs) cause sodium, water retention and increase the risk of HF.

Hypothesis:
NSAIDs associated risk of HF in diabetic patients has not been well evaluated.

Methods:
Cohort study with a nested case-control analysis was done based on the Korean National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) database. Among overall 78,453 diabetic patients, 1569 cases with first hospitalization for HF were identified and compared with 1:10 matched controls (n = 15,325). Current user of NSAIDs was defined as the most recent prescription lasted until the index date or ended in the 30 days before the index date.

Results:
In HF group, mean age was older and tended to have more previous HF, ischemic heart disease compared to control. Current NSAIDs user was much higher in HF group compared with control (534, 34 % vs 3,778, 25%, p < 0.001). The risk of a first hospital admission for HF associated with current use of NSAIDs was 1.60 (95% confidence interval (CI) 1.28 to 2.09) after controlling for major confounding factors. Multiple combination, high dose and injection of NSAIDs increased the risk of HF hospitalization (multiple combination; odds ratio (OR): 2.14, CI: 1.64 to 2.78, high dose; OR: 1.72, CI: 1.30 to 2.29, injection; OR: 2.36, CI: 1.79 to 3.09). NSAIDs associated risk of HF hospitalization was more significant, especially in diabetic patients with progressive diabetic retinopathy (OR: 2.23, CI 1.34 to 3.72) or overt neuropathy (OR: 4.59, CI: 2.84 to 7.43).

Conclusions:
Use of NSAIDs increased the risk of hospitalization for HF in diabetic patients, particularly with diabetic retinopathy and overt nephropathy as microvasculopathies. Therefore, the risk stratification for HF should be recommended in diabetic patients when the NSAIDs are prescribed.
Abstract 16294: A Case of Paradoxical Coronary Embolism in a Patient With Undiagnosed Malignancy
Authors: Do Anh , Aurora Lindsey , ZAIDAN MOHAMMAD
Published: November 2020

Introduction:
Coronary embolism is a rare cause of acute myocardial infarction (AMI) in comparison with atherosclerotic plaque rupture. We present a case of an inferior ST elevation myocardial infarction caused by coronary embolism. The source was thought to be from the combination of deep vein thrombosis (DVT) and patent foramen ovale (PFO), accounting for a unique presentation and pathophysiology.

Case:
An 86-year-old female with a history of hypertension, non-small cell lung cancer status post resection with no residual disease, presented with a three-day history of epigastric discomfort, dyspnea on exertion and confusion. On presentation, she was afebrile with normal vital signs. Physical exam revealed epigastric pain on palpation. Initial labs were significant for high sensitivity troponin elevation to 9591 ng/L. ECG showed ST elevations in leads II, III, aVF. Coronary angiogram showed distal left anterior descending artery 71% stenosis and left posterior descending artery 99% stenosis. Given multiple distal locations concerning for coronary emboli, coronary angioplasty was done without stenting given no evidence of plaque rupture. After the angiogram, patient was found to have slurred speech and left sided facial droop. CT head showed multiple embolic infarcts. A transesophageal echocardiogram revealed a small PFO but no valvular vegetation/calcification or left atrial appendage thrombus. Lower extremity dopplers demonstrated lower extremity DVT. CT abdomen showed a pancreatic mass with hepatic metastasis, concerning for metastatic pancreatic adenocarcinoma. Patient was started on atorvastatin and aspirin only as AMI was due to a suspected embolic event. She received an IVC filter due to contraindication of anticoagulation in acute stroke and discharged to follow up with Oncology outpatient.

Conclusions:
In comparison to atherosclerotic plaque rupture, AMI as a result of an embolic coronary phenomena is rare. In fact, less than 1% of AMIs are caused by paradoxical embolism due to a PFO. There are many case reports about embolic AMI due to valvular vegetation or calcification. However, paradoxical coronary embolism due to PFO should be considered in patients with risk factors for a hypercoagulable state such as malignancy or DVT.
Abstract 16310: Association Between the Use of Antithrombotics and Cardiac Implantable Electronic Device Infections: A Systematic Review and Meta-analysis
Authors: Techorueangwiwat Chol , Kanitsoraphan Chanavuth , Kewcharoen Jakrin
Published: November 2020

Introduction:
Studies have shown that the use of antiplatelet and anticoagulant increases the risk of cardiac implantable electronic device (CIED) infection following the implantation. However, results were contradicting. In this study, we performed a systematic review and meta-analysis to explore the effect of antiplatelets and anticoagulants and the risk of CIED infection following the implantation.

Methods:
We searched the databases of MEDLINE and EMBASE from inception to March 2020. Included studies were published studies of patients undergoing CIED implantations which reported effect size of the use of either antiplatelet or anticoagulant, or both, on the risk of CIED infections. CIED infection was defined as either device-related local or systemic infection. Data from each study were combined using the random-effects, generic inverse variance method of Der Simonian and Laird to calculate effect size and 95% confidence intervals (CI).

Results:
Fifteen studies from 2008-2019 involving a total of 72,028 patients were included. In random-effect model, we found that the use of antiplatelet was not associated with an increased risk of CIED infections (risk ratio (RR) =1.13, 95% CI: 0.89-1.44, p=0.314, I
2
=51.3%), while the use of anticoagulant was associated with increased risk of CIED infections (RR =1.50, 95%CI: 1.02-2.21, p=0.038, I
2
=75%). There was no publication bias observed in the funnel plot as well as no small-study effect observed in Egger’s test.

Conclusions:
Our meta-analysis demonstrated that the use of anticoagulant significantly increases the risk of CIED infection following the implantation by up to 1.50-fold, however, this effect was not observed with antiplatelet use. Our study suggested that patients on anticoagulation considering CIED implantations should proceed with caution.
Abstract 16329: Survival Prospects in Congenitally Corrected Transposition of the Great Arteries: Results From a Multi-institutional Study
Authors: van Dissel Alexandra , Opotowsky Alexander , Aboulhosn Jamil A , Kauling Martijn , Ginde Salil , Krieger Eric , Shah Sangeeta , Gupta Tripti , Rodriguez Fred , JOHN Anitha , Jaidzeka Sandra , Cotts Timothy , Stumpf Mary , Dwight Cindy , Woods Patty , Nicolarsen Jeremy , Sarubbi Berardo , Fusco Flavia , Antonova Petra , Fernandes Susan M , Grewal Jasmine , Janzen Mikyla , CRAMER Jonathan , Khairy Paul , Gallego Pastora , O’Donnell Clare , Hannah Jane , Dellborg Mikael G , Vonder Muhll Isabelle , Pylypchuk Stephen , Magalski Anthony , DeZorzi Christopher , Han Frank , Sammons Amanda , Kay Joseph , yeung elizabeth , Baker David , Celermajer David , Burchill Luke , Broberg Craig
Published: November 2020

Background:
Occasionally patients with congenitally corrected transposition of the great arteries (ccTGA) exhibit little clinical evidence of cardiovascular limitation even to their 8th decade. We aimed to assess survival prospects in a large cohort of ccTGA adults.

Methods & Results:
We included 555 ccTGA adults (median age 33.0 years, 48.3% female) under regular follow-up at 28 institutions between 2002 and 2019. The primary outcome was a composite of death, mechanical circulatory support (MCS) and heart transplant. During a median follow-up of 8.1 [IQR 4.4 - 13.3] years, 56 (10.1%) patients died, 10 (1.8%) patients underwent MCS and 14 (2.5%) had a heart transplant. Median age at time of primary outcome was 51.1 [IQR 37.5 - 63.2] years and cumulative incidence at 15 years from baseline was 21.5% [95% CI 16.1 - 26.5]. Leading causes of death were worsening of heart failure (43%) and sudden death (10%). Patients who died were more likely to use heart failure (HF) medications. In multivariable Cox analyses for baseline variables, age, prior atrial arrhythmia and HF admission were each associated with an increased risk of the primary outcome. Figure shows cumulative incidence according to history of atrial arrhythmia. During follow-up, 91 (16.4%) were admitted for HF, pacemaker implantation was performed in 68 (12.3%) patients, ICD in 82 (14.7%), and major cardiac surgery (mostly for systemic AV-valve) in 89 (15.8%) patients.

Conclusion:
In this large cohort of ccTGA adults, survival seemed to be primarily determined by heart failure-related complications. Prior atrial arrhythmia also seems to be a harbinger for adverse outcome. Few patients underwent advanced HF therapies.

Figure:
Cumulative incidence of the composite primary outcome (MCS, heart transplant or death) over a period of 14 years from first visit at an adult congenital heart disease clinic since 2002 stratified according to history of atrial arrhythmia. Shading represents upper and lower 95% confidence limits.
Abstract 16340: Atrial Wall Thickness Features Predefine Human Right Atrial Driver: Insights Gained From Novel Structural Analysis
Authors: Zhao Jichao , Mikhailov Aleksei , Subr Megan , Nalar Aaqel , Kennelly James , dastagir nawshin , Sharma Roshan , Kalyanasundaram Anuradha , LI Ning , Hansen Brian , Whitson Bryan , Hummel John , Fedorov Vadim V
Published: November 2020

Introduction:
Atrial fibrillation (AF) is not effectively treated in clinics due to a lack of adequate tools for identifying AF drivers as targets in ablation treatment. Recent studies revealed that 30-50% of patients with persistent AF have drivers not only in the left atrium (LA) but also in the right atrium (RA). However, the precise substrate underlying RA AF drivers remains elusive.

Hypothesis:
High-resolution analysis of human atrial wall 3D structure can predict the occurrence of right atrial drivers.

Methods:
Coronary perfused explanted human atria (N=10, 46.2±14.7 y.o.;40% female) were optically mapped with high-resolution CMOS cameras. Sustained AF was induced by fast pacing and perfusion of adenosine and/or isoproterenol. Hearts were imaged at ~170μm
3
resolution by 9.4T gadolinium-enhanced MRI (Fig. A). A coupled PDE approach was utilized to estimate the atrial wall thickness (Fig. B). Fibrosis was identified above a signal intensity threshold validated by histology; and fibrosis density was constructed for each voxel by determining the percent of neighboring fibrotic voxels within a radius of 5 voxels.

Results:
Optical mapping identified 9 RA drivers in 6 hearts (H1-6) and 7 LA drivers in 5 hearts (H5, 6 and 8-10, Fig. C). All 9 RA AF drivers were anchored in myobundle structure in close proximity to the crista terminalis (CT). Wall thickness distribution in RA excluding the CT was similar to that in the LA (N=10, Fig. D). Structural analysis showed that RA with AF drivers (N=6) was thicker with greater wall variation and higher fibrosis density than RA without AF drivers (N=4, Fig. E). Furthermore, RA driver regions (N=9) were thicker and varied more than other RA regions (4.64±2.86 mm vs 4.56±2.57mm, p<0.05).

Conclusions:
For the first time, the 3D structural analysis demonstrates that structural features including atrial wall thickness and its variation near the CT can predict RA driver occurrences in human hearts and be used to improve targeted ablation.
Abstract 16352: Baseline Comorbidities and Cardiac Biomarkers are Associated With In-hospital Mortality of Covid-19 Patients
Authors: Koutroumpakis Efstratios , Thannoun Tariq , Pang Jason , Patel Ritesh , Grable Cullen , Damaraju Sarita , Mawji Shamim B , Folivi Messan , Chauhan Siddharth , Fatakdawala Mariya , Powell Christopher , Shabbir Muhammad A , Philbin Edward , Lyubarova Radmila , Damaraju Shikanth , Palaskas Nicolas L , Deswal Anita , Taegtmeyer Heinrich , Garcia-Sayan Enrique
Published: November 2020

Introduction:
In a time span of 6 months, COVID-19 has infected more than 7 million and cost the lives of more than 400,000 people worldwide. Cardiovascular involvement is associated with adverse clinical outcomes.

Hypothesis:
Increased plasma troponin and brain natriuretic peptide (BNP) or NT-proB-type natriuretic peptide (NT-proBNP) levels are associated with the presence of underlying cardiovascular disease and predict increased in-hospital mortality.

Methods:
Here we present a multicenter observational study of patients diagnosed with COVID-19, who were hospitalized in 5 hospitals (4 in Texas and 1 in New York) between March 16
th
and May 22
nd
, 2020. Demographic and clinical characteristics were abstracted after patient’s discharge or death. To address the non-standard troponin and BNP/NT-proBNP assays across institutions we used the upper 99th percentile as the cut-off for abnormal on each test.

Results:
We identified 297 consecutive patients hospitalized with COVID-19. Troponin levels were available in 84% and BNP/NT-proBNP levels in 47% of patients. Troponin levels were increased in 14% and BNP/NT-proBNP in 46% of patients. In multivariate Cox analysis, history of coronary artery disease was independently associated with elevated troponin levels (Hazard Ratio [HR]: 5.24; 95% confidence interval [CI]: 1.37-19.97; p=0.015), while history of congestive heart failure was independently associated with elevated BNP/NT-proBNP levels (HR: 2.58; 95% CI: 1.05 6.31; p=0.038). Older age, history of hypertension, dyslipidemia, or stroke, were associated with elevated troponin or BNP/NT-proBNP levels only in the univariate analysis. Other demographic and clinical characteristics were not significantly associated with cardiac biomarker elevation. Collectively, elevated troponin or BNP/NT-proBNP were significantly associated with in-hospital mortality (HR: 3.47 95% CI: 1.90-6.35 and HR: 3.56; 95% CI: 1.44-8.77, respectively; both p<0.01).

Conclusions:
Increased levels of cardiac biomarkers were associated with a 3-fold increase of in-hospital mortality among patients with COVID-19. Troponin or BNP/pro-BNP testing has a prognostic value and may guide treatment.