bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12852: Cardioembolic Myocardial Infarction in the Setting of Complex Immunologic Disease
Authors: Safren Lowell A , Masson Ravi , Whelton Sean , Taylor Allen , McNamara Martin
Published: November 2020

Background:
The occurrence of left atrial appendage (LAA) thrombus formation and embolic myocardial infarction (MI) is rarely reported in the absence of atrial fibrillation (AF). In patients with a history of immunologic disease, a multidisciplinary approach is critical for prompt evaluation and treatment.

Presentation:
A 46-year-old woman with chest pain and lower extremity paresthesias was found to have NSTEMI. Past medical history was notable for vasculitis and multiple organ infarcts. Coronary angiogram and cardiac MRI showed no obstructive or structural disease. One month later she had recurrent chest pain with inferior ST-elevations on ECG and troponin of 24ng/mL.

Investigations and Outcome:
Coronary catheterization showed multiple embolic occlusions (Figure 1A and 1B). Subsequent TEE showed LAA thrombus (Figure 1C). Continuous telemetry and serial ECGs from initial presentation were negative for AF. Hypercoagulable and antiphospholipid testing was negative. Brain MRI for paresthesias showed dural enhancement and subsequent biopsy found an IgG4 inflammatory process. Treatment with warfarin, corticosteroids, and rituximab was initiated. No atrial fibrillation was detected on serial EKGs and an event monitor during one year of follow-up. There was no embolic recurrence.

Conclusion:
Autoimmune diseases can have complex organ involvement through lesser known mechanisms which often present as diagnostic challenges. This case identifies the potential for cardioembolic events, including myocardial infarction, in IgG4 vasculitis even in the absence of atrial fibrillation or hypercoagulability.
Abstract 13274: Predictors of Mortality in Critically Ill Covid-19 Patients - A Multicenter Prospective Analysis of 159 Patients
Authors: Ip Randy , Qutrio Baloch Zulfiqar , boumegouas manel , Al abcha Abdullah , Do Steven , Arnautovic Jelena , Meka Krishna , Jacob Chris , Wilcox Matthew , Ip John
Published: November 2020

Introduction:
Certain patient demographics and biomarkers have been shown to predict survival in patients infected with COVID-19. However, predictors of outcome in patients who are critically ill and require advanced respiratory support are unclear.

Methods:
We performed a multicenter analysis of 159 consecutive patients with confirmed COVID-19 who were admitted to Intensive Care Unit (ICU) between March 01, 2020 and April 30, 2020. Patients were then followed until May 23, 2020. Demographic data (age, sex, race, BMI) and past medical history (hypertension, diabetes, COPD, CKD, history of cardiac ischemic disease, atrial fibrillation and heart failure) were recorded. Laboratory values (troponin, CPK, pro-BNP, ferritin, LDH and d-dimer) were analyzed. Patient status was classified as either alive or deceased at hospital discharge or the end of follow up period.

Results:
Mean patient age was 66+/-15 and 53% were male. Mean BMI was 31+/- 9. Mean hospital ICU stay was 11+/-8 days. Mortality rate of this ICU cohort at the end of follow-up was 63%. Fifty-five (34%) patients were discharged from the hospital. A multivariable logistic regression analysis identified four factors (age, prior history of diabetes, prior history of atrial fibrillation and elevated troponin) that had significant and independent contributions to the likelihood of survival. Each increase in decade of age above 40 (p = 0.010) was predicted to reduce survival by 30%, the presence of diabetes (p = 0.041) by 57%, a prior history of atrial fibrillation (p= 0.011) by 75%, and each increase of 0.1 ng/mL of troponin above 0.05 ng/ml (p = 0.001) by 55%.

Conclusion:
Mortality of critically ill COVID-19 patients is high. Early aggressive treatment of high-risk patients identified in this study (advanced age, history of diabetes and atrial fibrillation and elevated troponin) could improve clinical outcome. The highly predictive value of elevated troponin levels on survival may indicate cardiac involvement of COVID-19 infection as a determinant of mortality. Additionally, of available published literature at this time, this is the first study that suggests a relationship between atrial fibrillation and increased mortality from COVID-19. Larger studies are needed to confirm these findings.
Abstract 13677: Usefulness of 2-year Iodine-123 Metaiodobenzylguanidine-based Risk Model for the Post-discharge Risk Stratification in Acute Decompensated Heart Failure Patients With Preserved Left Ventricular Ejection Fraction
Authors: Tamaki Shunsuke , Yamada Takahisa , Watanabe Tetsuya , Morita Takashi , Furukawa Yoshio , Fukunami Masatake , Yasumura Yoshio , Nakagawa Akito , Nakagawa Yusuke , Yano Masamichi , Hayashi Takaharu , Hikoso Shungo , Nakatani Daisaku , Sakata Yasushi
Published: November 2020

Background:
A four-parameter risk model including cardiac iodine-123 metaiodobenzylguanidine (MIBG) imaging and readily available clinical parameters has been recently developed for the prediction of 2-year cardiac mortality risk in patients with chronic heart failure (CHF) using a Japanese CHF database consisting of 1322 patients. However, there is no information available on the usefulness of 2-year MIBG-based cardiac mortality risk score for the prediction of post-discharge prognosis in patients with heart failure with preserved LVEF (HFpEF) who are admitted with acute decompensated heart failure (ADHF).

Methods and Results:
Patients' data were extracted from The Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with Preserved Ejection Fraction (PURSUIT-HFpEF) study, which is a prospective multicenter observational registry for ADHF patients with LVEF ≥50% in Osaka. We studied 239 patients who survived to discharge. Cardiac MIBG imaging was performed just before discharge. The 2-year cardiac mortality risk score was calculated using four parameters, including age, LVEF, NYHA functional class, and the cardiac MIBG heart-to-mediastinum ratio on delayed image. The patients were stratified into three groups based on the 2-year cardiac mortality risk score: low- (<4%), intermediate- (4-12%), and high-risk (>12%) groups. The endpoint was all-cause death. During a follow-up period of 1.6±0.8 years, 33 patients had all-cause death. Multivariate Cox analysis showed that 2-year MIBG-based cardiac mortality risk score was an independent predictor of all-cause death (p=0.0009). There was significant difference in the rate of all-cause death among the three groups stratified by 2-year cardiac mortality risk score (Figure).

Conclusions:
In this multicenter study, the 2-year MIBG-based cardiac mortality risk score was shown to be useful for the prediction of post-discharge clinical outcome in HFpEF patients admitted for ADHF.
Abstract 14078: Ros-dependent Sumoylation of Cu Chaperone Atox1 Drives Its Nuclear Translocation to Promote Inflammatory Angiogenesis Induced by Ischemic Injury
Authors: Das Archita , Varadarajan Sudhahar , Fulton David , Hou Yali , Fang Xuexiu , McMenamin Malgorzata , Abe Junichi , Ushio-fukai Masuko , Fukai Tohru
Published: November 2020

Introduction:
Neovascularization in response to ischemia depends on inflammation, angiogenesis and reactive oxygen species (ROS). Copper (Cu) is implicated in inflammation and angiogenesis. We reported that cytosolic Cu chaperone Atox1 activates secretory Cu enzymes lysyl oxidase (LOX), while nuclear Atox1 functions as a Cu-dependent transcription factor to promote ROS/NFkB-dependent inflammation in endothelial cells (ECs). However, mechanism of Atox1 nuclear translocation as well as role of endothelial Atox1 in inflammatory angiogenesis in vivo remain unknown. SUMOylation and its deSUMOylation by SENPs regulates transcription factor function. Silica analysis identified a conserved putative SUMOylation motif at Lys(K3) of Atox1.

Results:
Atox1 expression was dramatically increased in angiogenic ECs in mice hindlimb ischemia model. EC-specific Atox1-deficient mice significantly reduced angiogenesis (CD31+, 67%) and Mac+ inflammatory cells in ischemic tissues. In cultured ECs, inflammatory cytokine TNFα or hypoxia promoted Atox1 nuclear translocation and Atox1 SUMOylation (3.6-fold), which were inhibited by antioxidant NAC or overexpression of “SUMO-dead” Atox1K3R. Mechanistically, TNFα induced Cys603 oxidation/inactivation of SENP1 in cytosol, which in turn increased Atox1 SUMOylation and nuclear translocation. Functionally, siAtox1or Atox1K3R inhibited TNFα-induced inflammatory/angiogenic genes VCAM/ICAM, IL-15 and RANTES. In nucleus with reduced state, ChIP assay using SUMO-Atox1 revealed that Atox1 deSUMOylation by nuclear SENP1 increases Atox1 transcriptional activity for inflammatory genes. In parallel, Atox1K3R which maintains Cu chaperone function inhibited TNFα-induced EC permeability by activating LOX. In vivo, Atox1 SUMOylation was increased after hindlimb ischemia while CRISPR/Cas9-generated SUMO-dead Atox1K3R knock-in mice showed impaired angiogenesis in hindlimb ischemia model.

Conclusion:
Atox1 SUMOylation via oxidative/inactivation of SENP1 in cytosol promotes: 1) its translocation to nucleus where deSUMOylated Atox1 can function as Cu-dependent transcription factor to drive inflammatory angiogenesis and 2) EC barrier dysfunction in inflamed/hypoxic ECs after ischemic injury.
Abstract 14157: Racial Differences in Outcomes of Ischemic Stroke and Mortality With Left Atrial Appendage Closure With Watchman Device in Medicare Population
Authors: Kabra Rajesh , Girotra Saket , Vaughan Sarrazin Mary S
Published: November 2020

Introduction:
Left atrial appendage closure by Watchman implantation is a novel non-pharmacological alternative for stroke prevention in non-valvular atrial fibrillation (AF) patients who are deemed unable to take long term anticoagulation. Blacks and Hispanics were under-represented in the clinical trials for Watchman device and therefore more outcome data is needed in these populations.

Hypothesis:
We sought to study racial differences in outcomes of mortality and ischemic stroke in Medicare beneficiaries who received a Watchman device

Methods:
Medicare claims were used to identify 13,598 patients with AF who underwent Watchman implantation during January 2015 to November 2017. Patient demographics including race and comorbid conditions were identified based on the hospital discharge record. Death and readmission rate for ischemic strokes and transient ischemic attacks (TIA’s) were assessed. Primary readmission diagnoses were classified using the AHRQ Clinical Classification Software.

Results:
The mean age of patients was 78±6.3 years and 40.3% were female. There were 11,955 whites (88%), 453 blacks (3.3%) and 523 Hispanic patients (3.8%). Mean CHAD
2
S
2
VASc score was 4.7 in blacks, 4.6 in Hispanics and 4.5 in whites. One year mortality after watchman implantation was 6.8% in blacks, 8% in Hispanics and 7.69% in whites. After risk adjustment, compared to whites, the Hazard Ratio for death was 0.82 in blacks (p=0.31) and 0.96 in Hispanics (p=0.82). The rate of ischemic stroke and TIA following Watchman implantation was highest at 4.75 per 100 patient years in blacks followed by 2.87 per 100 patient years in Hispanics and 2.37 per 100 patient years in whites. After risk adjustment, blacks continued to have higher risk for ischemic stroke (HR 1.87, p = 0.01) compared to whites, while Hispanics had a similar risk (HR 1.19, p=0.51).

Conclusions:
In the Medicare population undergoing Watchman implantation, after risk adjustment, one year mortality following the procedure was similar in whites, Hispanics and blacks. However, the rate of ischemic stroke was significantly higher in blacks compared to whites even after risk adjustment. Further studies are needed in the real world to monitor the outcomes associated with watchman device in minority population.
Abstract 14527: Utility of Routine Invasive Coronary Angiography Prior to Transcatheter Aortic Valve Replacement
Authors: Case Brian C , Yerasi Charan , Forrestal Brian J , Musallam Anees , Chezar Azerrad Chava , Hahm Joshua , Kumar Sant , Satler Lowell F , ben-dor itsik , Hashim Hayder , Waksman Ron , Rogers Toby
Published: November 2020

Introduction:
Despite the high prevalence of CAD in patients with severe aortic stenosis (AS), the optimal management of concomitant coronary artery disease (CAD) before trasncatheter aortic valve replacement (TAVR) remains controversial.

Hypothesis:
To characterize the contemporary, real-world burden of CAD in contemporary TAVR patients and to evaluate revascularization practices at a high-volume center in the United States.

Methods:
Analysis of all adult patients referred for TAVR at our center between January 2019 and January 2020. Presence of significant coronary artery disease (stenosis >50%) and subsequent management (medical therapy versus revascularization) were recorded. Presenting symptoms, use of non-invasive and invasive ischemia testing and pre-TAVR computed tomography (CT) imaging were all analyzed.

Results:
A total of 394 patients with severe AS were referred to our institution for TAVR. Thirty-nine patients (9.9%) instead underwent surgical aortic valve replacement (SAVR), of which only 5 (1.3%) underwent SAVR plus coronary artery bypass surgery. Of the remaining 355 patients (77.3 ± 9.3 years old and 59.7% males), 218 patients (61.4%) had insignificant CAD. Of the 137 patients (38.6%) with significant CAD, only 30 (8.5%) underwent percutaneous coronary intervention (PCI). Of these, less than half had anginal symptoms, a third had CAD in proximal segments and a third underwent ischemia testing prior to PCI. Pre-TAVR CT accurately identified significant CAD in 28/30 patients (93.3%) who ultimately underwent PCI.

Conclusions:
Only 1 in 25 contemporary TAVR patients had significant CAD and anginal symptoms requiring intervention, questioning the utility of routine invasive coronary angiography before TAVR. A Heart Team approach integrating anginal symptoms and ischemia testing is needed to guide the need, timing and strategy of revascularization. The pre-TAVR CT images could identify significant proximal segment CAD needing PCI.
Abstract 14599: Association of Fibrillation Cycle Length on the Surface Electrocardiogram With Clinical Outcomes in Atrial Fibrillation Patients: The Fushimi AF Registry
Authors: Ogawa Hisashi , An Yoshimori , Esato Masahiro , Ishigami Kenjiro , Ikeda Syuhei , DOI KOSUKE , Hamatani Yasuhiro , Fujino Akiko , ISHII MITSURU , Iguchi Moritake , Masunaga Nobutoyo , Wada Hiromichi , Hasegawa Koji , Abe Mitsuru , Akao Masaharu ,   The Fushimi AF Registry Investigators.
Published: November 2020

Background:
It is unknown whether fibrillation cycle length (FCL) on the surface electrocardiogram is associated with clinical outcomes in patients with atrial fibrillation (AF).

Methods:
The Fushimi AF Registry, a community-based prospective survey, was designed to enroll all of the AF patients in Fushimi-ku, Kyoto. The FCL was calculated using spectral analysis of the fibrillation waves on the surface electrocardiogram in 966 patients (mean age; 73.2 years, female; 40.9%, mean CHA
2
DS
2
-VASc score; 3.21) with AF at baseline. We assessed the association of FCL with the demographics and clinical outcomes.

Results:
Median FCL was 163.8 ms (interquartile range; 148.0, 195.0 ms). We divided the patients into 2 groups: 524 patients with FCL ≥163 ms and 442 patients with FCL<163 ms. Patients with longer FCL were older (74.6 vs. 71.7 years of age; p<0.01), more often female (49.6% vs. 30.5%; p<0.01), more often paroxysmal type of AF (55.2% vs. 33.3%; p<0.01), had lower body weight (58.6 vs. 61.8 kg; p<0.01), higher heart rate (93.1 vs. 86.3 /min; p<0.01), higher CHA
2
DS
2
-VASc score (3.41 vs. 2.98; p<0.01). They were more likely to have history of heart failure (HF) (25.8% vs. 19.5%; p=0.02), valvular heart disease (24.1% vs. 15.6%; p<0.01), coronary artery disease (18.9% vs. 12.7%; p<0.01), and chronic kidney disease (38.6% vs. 26.2%; p<0.01). During the median follow-up of 2,194 days, all-cause mortality occurred in 99 patients (3.5 /100 person-years) with longer FCL and 55 patients (2.2 /100 person-years) with shorter FCL, with an adjusted hazard ratio of 1.46 (95% confidence interval [CI], 1.01-2.13; p=0.043), adjusted by age, sex, body weight, heart rate, type of AF and comorbidities. Adjusted hazard ratios of stroke or systemic embolism and hospitalization for HF for longer FCL were 1.23 (95%CI, 0.73-2.11; p=0.44) and 2.29 (95%CI, 1.52-3.50; p<0.01), respectively.

Conclusion:
The FCL on surface electrocardiogram was associated with higher mortality and incidence of hospitalization for HF in Japanese AF patients enrolled in the Fushimi AF Registry.
Abstract 14913: The Impact of the Wearable Cardioverter-defibrillators on Quality of Life: Insights From the Vest Trial
Authors: Cheung Chris C , Olgin Jeffrey , Pletcher Mark J , Hue Trisha , Vittinghoff Eric , Lin Feng , Lai Mason , Lee Byron K
Published: November 2020

Background:
There is scant research on the effect of wearable cardioverter-defibrillators (WCDs) on quality of life (QOL). One retrospective observational study concluded that WCDs have a negative impact. The VEST Trial was a randomized controlled trial of the WCD allowing a more definitive and complete analysis of QOL among WCD users.

Hypothesis:
We sought to determine if the WCD impacts patient-reported QOL, including depression, anxiety, and physical activity levels.

Methods:
In the VEST trial, participants with severe left ventricular dysfunction (EF≤35%) after MI were randomized in a 2:1 ratio to receive a WCD plus guideline directed therapy (GDMT) versus GDMT alone. During the 3-month follow-up period, participants were asked to complete QOL assessments and health questionnaires.

Results:
1524 participants were randomized to WCD plus GDMT versus 778 participants to GDMT alone. The mean age was 60.9±12.6 years and 61.4±12.3 years in the two groups, respectively. Participants were 73.5% male, had an average body-mass index of 28.4±5.5 kg/m2, and a mean EF of 28%.

During a mean follow-up of 84.3±15.6 days, health questionnaires and QOL assessments were completed by 1340 participants, including 898 receiving WCD plus GDMT, and 442 receiving GDMT alone.

See Table 1 for the results of QOL assessments and health questionnaires. There were no differences in QOL according to the SF-36 physical and mental component scores, and EQ-5D scores between WCD plus GDMT versus GDMT alone. There were also no differences in depression (CES-D 10), anxiety (State-Trait Anxiety Inventory), physical activity (International Physical Activity Questionnaire), or self-reported health scale between groups (all p>0.05).

Conclusions:
In post-MI patients with low EF, the WCD does not affect QOL, depression, anxiety, physical activity, or self-reported health. Prescribers can be reassured that the WCD has no detrimental impact on patient-reported health measures.
Abstract 14986: A Randomized Trial of Statins to Reduce Vascular Endothelial Inflammation in Psoriasis
Authors: Garshick Michael S , Schlamp Florencia , Barrett Tessa , Tawil Michael , Scher Jose , Neimann Andrea , Jelic Sanja , Katz Stuart D , Garcet Sandra , Edward Fisher , Krueger James , Berger Jeffrey S
Published: November 2020

Introduction:
Psoriasis (PsO) is a chronic skin disease associated with increased CV risk. Systemic and vascular endothelial inflammation in PsO is highly prevalent and associated with CVD. Statins reduce LDL-C, systemic inflammation, and CV events. There is minimal data supporting the use of statins in PsO. We, therefore, investigated the effect of statins on circulating and vascular endothelial biomarkers of CV risk in PsO.

Methods:
We performed blood RNA sequencing, targeted proteomics (n=88), and brachial vein endothelial harvesting in PsO participants (n=45, average age 45 ± 14 years, 49% male, body surface area [BSA] of PsO 8 ± 14%, Framingham Risk Score 6 ± 7%) and age- gender-matched controls (n=18). Next, PsO subjects were randomly assigned to 40 mg atorvastatin (n=15) or no-treatment (n=10). A repeat assessment occurred at week two with the primary end-point change in vascular endothelial inflammation (mean composite of
LTB, CCL3, CX3CL1, CCL2, CXCL1, ICAM1, iNOS, IL-8, IL-1B, COX-
2 expression).

Results:
Blood RNA sequencing with pathway analysis revealed inflammasome signaling as highly upregulated in PsO compared to control with protein expression of IL-6 (
r
=0.68,
p
<0.001) and hs-CRP (
r
=0.80,
p
<0.001) each correlated with PsO severity (psoriasis area and severity index [PASI]). Mean vascular endothelial inflammation was also 3-fold higher (
p
=0.02) in PsO compared to control and correlated with both PASI (
r
=0.40,
p
=0.01) and LDL-C (
r
=0.29,
p
=0.05). In PsO patients randomized to two weeks of statin therapy, LDL-C was reduced by ~50% compared to the no-treatment group (60 mg/dL vs. 111 mg/dL,
p
<0.001 respectively). While no decrease in inflammatory pathways at the whole blood transcriptome and protein levels were noted, vascular endothelial inflammation was 60% lower in the statin vs. no-treatment group (
p
=0.02). Change in vascular endothelial inflammation correlated with change in LDL-C (
r
=0.53,
p
<0.05) but not IL-6 (
r
=-0.25,
p
=0.30) or hs-CRP (
r
=0.15,
p
=0.58).

Conclusions:
Two-weeks of high-intensity atorvastatin reduced vascular endothelial but not systemic inflammation in PsO. These findings suggest that statins may reduce CV risk in PsO either through lipid-mediated or a direct effect of statins on the vascular endothelium.
Abstract 14989: Failure to Rescue After Transcatheter Aortic Valve Replacement: Does Experience Matter?
Authors: Tchouta Lise , Hou Hechuan , Kim Karen , Thompson Mike
Published: November 2020

Introduction:
Volume-outcome relationships are well defined in transcatheter aortic valve replacement (TAVR), but little is known about how hospital experience in aortic valve replacement (AVR) informs processes of care to rescue patients once a complication occurs after TAVR.

Hypothesis:
Increasing AVR experience improves post-TAVR rates of failure to rescue (FTR) - defined as in-hospital mortality after major treatable post-procedural complications.

Methods:
Statewide Inpatient Databases from seven diverse states were queried from 2011 to 2017 for patients who underwent TAVR. Hospitals were stratified as low vs high-volume by mean annualized SAVR and TAVR volume using the median as cutoff: SAVR = 43 cases/year, TAVR = 28 cases/year. Crude rates of complications, in-hospital mortality, and FTR were estimated for the overall sample and stratified by SAVR and TAVR volume (low vs high). Logistic regression was used to estimate the adjusted odds ratio of SAVR and TAVR volume, independently, on the outcomes above, adjusting for patient demographics and comorbid conditions.

Results:
A total of 42,025 TAVR patients were identified and categorized as low (N = 2,946) or high-volume (N = 39,079) SAVR centers, and low (N = 7,183) or high-volume (N = 34,842) TAVR centers. Within the high-volume SAVR centers, 84.8% were also high-volume TAVR centers. Low SAVR or TAVR volume was associated with a marginal increase in the risk of developing complications after TAVR (OR 1.26;
P
< 0.001 and OR 1.14;
P
< 0.001) as show in Table 1. There was no statistically significant difference in risk-adjusted in-hospital mortality rates (OR 1.10;
P
= 0.499 and OR 1.10;
P
= 0.273) or FTR rates (OR 0.97;
P
= 0.816 and OR 1.03;
P
= 0.732) after TAVR between low- and high-volume SAVR or TAVR centers, respectively.

Conclusion:
Undergoing TAVR at a high-volume SAVR or TAVR center was associated with lower rates of complications, but volume was not an independent predictor of in-hospital mortality or FTR.
Abstract 15038: Gender Differences Amongst Caucasians and African Americans in Rates of Arrhythmias, Implantable Cardiac Devices, and In-hospital Mortality in Sarcoidosis Patients With Cardiomyopathy
Authors: Rojulpote Chaitanya , Gonuguntla Karthik , Patil Shivaraj , Karambelkar Pranav , Buch Tapan , Bhattaru Abhijit , Vuthaluru Kiranmayi , Perosevic Nikola , Bravo Paco E
Published: November 2020

Introduction:
The prevalence of sarcoid cardiomyopathy (SCM) with female predominance is well known. However, gender differences amongst individual races remains poorly studied.

Hypothesis:
We sought to determine and compare within each gender and race, the rates of arrhythmias, implantable cardiac devices, and in-hospital mortality in patients with SCM after excluding those with a history of coronary artery disease.

Methods:
The Nationwide Inpatient Sample was queried from 2010 to 2014 using ICD-9 diagnosis code (135) for sarcoidosis among patients >18 years old. We combined it with code (425.8) for cardiomyopathy in other diseases including sarcoid and sarcoid heart muscle disease. We excluded patients with a history of prior myocardial infarction, percutaneous coronary intervention and coronary artery bypass graft.

Results:
From 2010 to 2014, we identified 9,063 patients with SCM (mean age = 53.11 ± 11.28 years; men 51.8% and black 52.5%). Upon comparison of gender within races, event rates per 100 patients were (white male, white female, black male, black female; p-value): atrial fibrillation (20.7, 18.8, 18, 16.1; p=0.172), ventricular fibrillation (VF) (4.1, 1.7, 2.3, 2.1; p<0.001), ventricular tachycardia (VT) (33.1, 19.3, 25.1, 21; p<0.001), complete heart block (CHB) (9.1, 8.6, 3.4, 3.6; p=0.58), second degree Mobitz type II (0.3, 0.35, 0.8, 0.4; p=0.717), implantable cardioverter-defibrillator (ICD) (13.3, 9.3, 8.4, 9.2; p<0.001), cardiac resynchronization therapy defibrillator (CRT-D) (5.5, 1.4, 3.4, 2.5; p<0.001), permanent pacemaker (PPM) (2.2, 4.1, 1.1, 1.6; p<0.001), sudden cardiac arrest (SCA) (1.3, 1.7, 1.3, 2.4; p=0.34), endomyocardial biopsy (EMB) (3.6, 2.1, 1.9, 2.3; p=0.011), cardiac MRI (CMR) (1.4, 0.3, 0.7, 1.3; p=0.002), cardiogenic shock (2.5, 1.4, 3, 3; p=0.027), orthotopic heart transplantation (OHT) (2.3, 1.4, 1.1, 0.2; p=0.05), catheter ablation (8.3, 4.5, 3.8, 1.9; p<0.001), and in-hospital mortality (1.7, 3, 2.9, 2.6; p=0.008).

Conclusion:
White males had higher rates of VF, VT, CHB, but they also had a lower in-hospital mortality and SCA rates likely due to higher procedural rates such as EMB, ICD, CRT-D, catheter ablation and OHT as compared to others.
Abstract 15099: Limitations of Predicting Postoperative Left Atrioventricular Valve Regurgitation by Transesophageal Echocardiography
Authors: Ellepola Chalani D , Lin Benita , Goot Benjamin H , Johnson William , Woods Ronald K
Published: November 2020

Introduction:
After atrioventricular septal defect (AVSD) repair, the degree of post-repair left atrioventricular valve regurgitation (LAVVR) at discharge is associated with need for re-intervention. Knowledge of the relationship between post-repair transesophageal echocardiogram (TEE) and discharge transthoracic echocardiogram (TTE) LAVVR could influence intraoperative decision-making. At present, this relationship has not been well-defined and to assess it, we undertook a retrospective study of a large cohort of AVSD patients.

Methods:
Between 11/2012-12/2018, 96 AVSD patients underwent surgical repair. Data included patient demographics, clinical characteristics, preoperative LAVV anomalies, surgical procedure and outcomes. LAVVR was graded as less than moderate or moderate and greater with statistical blinding techniques employed. Cohen’s kappa statistics were calculated to measure interobserver variability. Association between parameters was tested using univariate analysis.

Results:
Median age and weight at surgery for complete AVSD patients (68%) was 5 months and 5.6 kg respectively; for partial AVSD (32%), median age and weight was 27 months and 11.9 kg respectively. The median interval between echo studies was 6 days (IQR 4-12 days) with median length of stay of 8 days (IQR 5-16 days). There were no deaths. Post-repair TEE revealed less than moderate LAVVR in 86 patients (90%) and moderate or greater in 10 (10%). Overall, there was a discrepancy in LAVVR seen at discharge in 25 patients (26%) with 23/25 (92%) demonstrating a higher grade of LAVVR. Two patients underwent reoperation before discharge due to severe LAVVR. In univariate analysis, significant predictors for LAVVR discrepancy were younger age (p=0.032) and lower weight (p=0.032) at repair; preoperative LAVVR grade was a significant predictor for worsening LAVVR (p=0.038).

Conclusions:
Discrepancy between LAVVR grade on post-repair TEE and discharge TTE was present in 26% of AVSD patients with the vast majority changing to a higher grade. This important finding with implications for intraoperative decision-making should prompt further investigations into preoperative LAVV anomalies, surgical technique and postoperative factors influencing valvar function.
Abstract 15803: Effectiveness of Direct Oral Anticoagulant versus Warfarin in the Treatment of Left Ventricular Thrombus
Authors: Isom Nicholas , Ali Zafar , Dalia Tarun , Sami Farhad , Mahmood Uzair , Buechler Tyler , Goyal Amandeep , Shah Zubair , gupta Kamal
Published: November 2020

Introduction:
Left ventricular thrombus (LVT) is associated with a higher risk of ischemic stroke and peripheral embolization. Societal guidelines recommend the use of warfarin, with direct oral anticoagulants (DOACs) only for patients unable to tolerate warfarin. Data on natural history and thrombus resolution with anticoagulation (AC), especially with DOACs is scarce. We studied the natural history of LVT with AC with emphasis on comparing warfarin and DOACs use.

Methods:
This is a single center, retrospective study conducted in an academic medical center. We identified patients (echocardiogram, CT or MRI) with a confirmed LVT study who were followed at our center. Chart review was conducted to collect clinical information at presentation and on follow up. Type and duration of anticoagulation, INR levels and clinical outcomes (bleeding, ischemic stroke or peripheral embolization, mortality) were recorded. Thrombus resolution on follow up imaging was also recorded.

Results:
LVT was confirmed in a total of 110 patients. Mean age was 59±14 years. 79% were men. Underlying etiology was chronic ischemic cardiomyopathy in 58%, non-ischemic cardiomyopathy in 23%. AC was started in 96 (87%) patients (in remaining patients AC was thought to be contraindicated). Of those on long-term AC, 60 patients (63%) were treated with warfarin, 3 patients (3%) with enoxaparin and 32 patients (33%) with a DOACs. At one year follow up, 11 patients (10%) had a stroke while on any AC. Two of these patients had hemorrhagic stroke (both on warfarin) and 9 patients had ischemic stroke. Of those with ischemic stroke 7 were on warfarin and 2 patients on DOACs had ischemic strokes. Of those with ischemic stroke on warfarin, 71% had subtherapeutic INR. The 1-year risk of any stroke was 15% in warfarin group (12% risk of ischemic stroke) compared to 6% in the DOACs group (p= 0.33). Total of 55 (57%) of patient started on AC had resolution of thrombus. 37 (63%) patients on warfarin and 18 (53%) on DOACs had resolution of thrombus (p= 0.85).

Conclusions:
One year risk of stroke with LVT is high (10%) even with AC. Most patients with ischemic stroke on warfarin had subtherapeutic INR. There was no statistical difference in stroke risk or rate of thrombus resolution between warfarin and DOACs treated patients.
Abstract 15844: Predicting the Risk of Significant Coronary Artery Disease in Liver Transplant Patients: The CAD-LT Score
Authors: Rachwan Rayan Jo , Kutkut Issa , Timsina Lava R , Bou Chaaya Rody G , El-Am Edward , Sabra Mohamad , Mshelbwala Fakilahyel S , Rahal Mahmoud , Lacerda Marco A , Kubal Chandrashekhar A , Fridell Jonathan A , Ghabril Marwan S , Bourdillon Patrick V , Mangus Richard S
Published: November 2020

Background:
Patients with significant coronary artery disease (CAD) are more likely to develop post-liver transplant (LT) cardiac events. We developed the CAD-LT screening score and testing algorithm to predict the risk of significant CAD in LT candidates.

Methods:
Patients who underwent pre-LT evaluation at Indiana University (2010-2017) were studied retrospectively (n=1814). Stress tests (ST) (n=1677) and cardiac catheterization (CATH) reports (n=1300) were reviewed. CATH was performed in patients with predefined CAD risk factors. Significant CAD was defined as disease requiring percutaneous or surgical intervention. Multivariable estimates (Adjusted Odds Ratio i.e. AOR [95%CI]) with assessment of model performance using Receiver Operating Curve analysis were used to compute a point-based risk score and stratify patients. A 10-fold internal cross-validation (CV) model was done.

Results:
There were 950 LT and 864 no-LT patients. The risk-adjusted predictors of significant CAD were older age (AOR 1.06 [95%CI 1.03-1.09]), male gender (1.69 [1.13-2.50]), diabetes (1.44 [1.01-2.06]), hypertension (1.50 [1.05-2.15]), current smoking history (1.81 [1.16-2.82]), family history of CAD (1.76 [1.24-2.50]), and personal history of CAD (5.41 [3.48-8.43]). The CAD-LT score is shown in Table 1. Figure 1 is an algorithm for its use. The mean CV Area Under the Curve [95% CI] was 0.75 [0.71-0.79]. The algorithm detected 97% of the patients with significant CAD and would decrease the number of ST by 718 (43%; 671 in high-risk group and 47 in low-risk group) and CATH by 409 (30%).

Conclusion:
The CAD-LT score identifies LT candidates at high risk for significant CAD and guides pre-LT testing.
Abstract 15858: Efficacy of Hypertension Self-management Classes Among Low-Income Patients of a Federally Qualified Health Center
Authors: Eck Cameron , Biola Holly , Bulgin Dominique , Whitney Colette A , Bakovic Melanie , Hayes Tiffany M , Deyo Jennifer , Caesar Awanya , Becerra-Soberan Rosa , Eisenson Howard , Granger Bradi B
Published: November 2020

Introduction:
Racial and socioeconomic disparities in hypertension prevalence and treatment have been observed over numerous decades. There is opportunity to close racial disparities by focusing resources on patient education, skill-building, and self-management.

Methods:
A hypertension-reduction program was established between an academic-affiliated FQHC in the southeast, the American Heart Association, the Centers for Disease Control, and the American College of Preventive Medicine using a multidisciplinary outreach model in the community setting. Participants included 265 high-risk patients from the FQHC with severe hypertension (>160/90 mm HG). Program activities included a weekly class where participants learned about hypertension, were trained to take their blood pressure (BP), and received cuffs to use at home. A prospective pre-post cohort design was used to evaluate this portion of the program. Participants’ attendance at the self-management classes was tracked along with BP measurements at every class attended.

Results:
Over the program’s first 6 months, 93 of the 265 recruited participants attended at least one of 28 BP management classes. The 29 participants who attended multiple classes achieved an average 19 mm HG reduction in systolic BP (
p
=0.004) and an average 14 mm HG reduction in diastolic BP (
p
=0.002).

Patients who were Black were significantly more likely to attend multiple classes than patients who were Hispanic (
p
=0.004). Also, patients who were self-monitoring their BP prior to class attendance were significantly more likely to attend multiple classes than those who were not previously self-monitoring (
p
=0.014). Multiple class attendance was also associated with higher baseline BP (
p
=0.038 for systolic and
p
=0.018 for diastolic).

Conclusions:
Implementation of blood pressure self-management classes showed success in reducing hypertension among many of the high-risk participants. Hispanic patients were much less likely to attend multiple classes, underscoring the need for culturally and linguistically appropriate class content. The low proportion of Hispanic patients previously monitoring their BP points to an opportunity to improve patient awareness about hypertension among Hispanic populations generally.
Abstract 15889: The Role of Physical Deconditioning in Distinguishing Hypertrophic Cardiomyopathy From Athlete's Heart
Authors: khan munim A , Rowin Ethan J , Sridharan Aadhavi , Maron Martin S
Published: November 2020

Background:
Vigorous systematic physical training can result in increased left ventricular wall thickness (LVWT) (i.e., “athlete’s heart”) which can be challenging to differentiate diagnostically from mild non-obstructive hypertrophic cardiomyopathy (HCM). The efficacy of a deconditioning strategy to observe changes in LVWT using cardiovascular magnetic resonance (CMR) that would support a diagnosis of athlete’s heart vs. HCM is not well established.

Methods:
We identified 9 highly trained patients involved in various organized sports who were referred to the Tufts Medical Center HCM center with a maximal LVWT in a diagnostic “gray area” of 13-15 mm. Maximal LVWT and other clinical and imaging variables were compared at baseline and following > 3 months of deconditioning from athletic training. A clinically relevant change in maximal LVWT at the end of athletic deconditioning was defined as a decrease of ≥2 mm, consistent with “athlete’s heart”. Imaging studies were interpreted blinded to study time period.

Results:
Among the 9 patients (23.1 ± 12.3 years old; 100% male), 4 demonstrated a ≥ 2 mm decrease in maximal LVWT (range: 2 mm to 3 mm) to ≤ 12 mm in 3 patients and 13 mm in one patient, with an average decrease of 2.3 mm. Among these 4 patients, LV and LA size also decreased (217.3 ± 31.5 ml to 208.9 ± 16.8 ml; and 55.4 ± 10.0 mm to 51.7 ± 9.1 mm, respectively), and there was no late gadolinium enhancement, pathogenic sarcomere mutation, or family history of HCM. Parameters of diastolic function were normal prior to deconditioning. After deconditioning evaluation and significant change in LVWT, these 4 patients were judged to not have a clinical diagnosis of HCM. The remaining 5 patients had a non-significant change in maximal LVWT after deconditioning of 0.2 mm, with maximal LVWT remaining ≥ 13 mm, and no change in LV or LA cavity size (p>0.2 for each). After deconditioning, these 5 patients were judged to have a clinical diagnosis of HCM. In the 9 patients that underwent a period of deconditioning, there was an average heart rate increase of 6.33.

Conclusion:
In athletes with maximal LVWT within the “gray zone” (13-15 mm) of overlap with HCM, athletic deconditioning using CMR to detect changes in maximal LVWT can aid in the differential diagnosis and inform management decisions.
Abstract 15928: Relative Sparing of Apical Longitudinal Strain for Detection of Cardiac Amyloidosis: Intervendor Variation
Authors: Simkowski Julia M , Jiang Michael , El HANGOUCHE NADIA , Lee Jeesoo , Marion Milica , Vaitenas Inga , Thomas James D
Published: November 2020

Introduction:
Relative apical longitudinal strain (RALS) is defined as (average apical LS/(average basal & mid-ventricular LS)). A threshold of 2 has been found to have high sensitivity and specificity for differentiating cardiac amyloidosis (CA) from other causes of left ventricular hypertrophy (LVH). This threshold was developed using General Electric (GE) software, and its reproducibility among different software vendors is unknown.

Hypothesis:
In patients with CA, regional segmental LS patterns and relative apical longitudinal strain will vary among software vendors.

Methods:
Speckle-tracking echocardiography was retroactively performed by an experienced technician on two patient cohorts, CA (n=52) and LVH (n=52), using software from two independent vendors: EchoPAC (GE Medical Systems) and TomTEC (TOMTEC Imaging Systems GMBH). For each vendor and patient, strain values for the basal, mid, and apical segments were averaged to obtain three regional LS values which were then used to calculate global longitudinal strain (GLS) and RALS.

Results:
EchoPAC demonstrated greater average apical LS (-16.5±5.7 vs -13.1±6.6, p<0.001) and RALS (2.1±0.9 vs 1.7±0.7, p<0.001) compared to TomTEC. Bland-Altman analysis yielded a mean bias of -0.4 with limit of agreement 2.2 (p<0.001) in RALS between the two vendors. ROC curve analysis using a RALS cutoff of 2 to differentiate CA from the overall control group showed similarly high specificity (EchoPAC 85%, TomTEC 83%) between vendors but lower sensitivity for TomTEC (23% vs 45%) (Figure 1). LVH subgroup analysis showed similar comparisons. Overall difference in area-under-curve (AUC) was significant (AUC = 0.78 EchoPAC vs AUC = 0.52 TomTEC, p < 0.001).

Conclusions:
Software measurements of regional LS and thus RALS vary between vendors. Further efforts are needed for intervendor regional strain fidelity. For now, different RALS thresholds to diagnose CA may be needed for various vendors.
Abstract 15937: Gender Disparities in Presentation and Outcomes for Patients Undergoing Endovascular Lower Extremity Interventions for Peripheral Artery Disease
Authors: Lancaster Elizabeth M , Wu Bian , Ramirez Joel , Iannuzzi James , Conte Michael S , Hiramoto Jade
Published: November 2020

Introduction:
Although data suggests higher rates of functional decline and inferior outcomes in women compared to men after interventions for peripheral artery disease (PAD), women remain underrepresented in contemporary studies. We used a large national database to better understand gender-based differences in presentation and outcomes for patients undergoing endovascular treatment for PAD.

Methods:
Patients in the Vascular Quality Initiative (VQI) database that underwent lower extremity (LE) endovascular interventions for symptomatic PAD from 2010-2019 were included. Descriptive statistics and multivariable analysis were performed.

Results:
128,688 patients (40% female) underwent endovascular LE interventions for symptomatic PAD. Women were more likely to have chronic limb threatening ischemia compared to men (54% vs 51%) and more likely to have a preoperative ABI <0.4 (20% vs 14%). Compared to men, women were older (mean [SD]: 68 [11] vs 70 [12]), more likely to be Black (19% vs 14%), and less likely to be smokers (34% vs 36%), diabetic (50% vs 54%), have CAD (28% vs 35%), or be on dialysis (8% vs 9%) (Table 1). Women were less likely to have exclusively infrapopliteal interventions (8% vs 14%) compared to men (p<0.001 for all). Despite shorter procedural times in women, female gender was an independent predictor of in hospital mortality (OR 1.25, 95% CI 1.09-1.44) in a hierarchical multivariable model adjusting for age, race, smoking, and comorbidities. Women were more likely to be discharged to a rehab or nursing home (11% vs 10%, p< 0.001) and less likely to be taking a statin medication (73% vs 78%, p<0.001).

Conclusions:
Compared to men, women undergoing endovascular LE interventions for PAD are older, present with more severe disease, and have higher adjusted rates of in hospital mortality. More aggressive screening and medical treatment for PAD in women is needed to address these gender-based differences in disease presentation and clinical outcomes.
Abstract 15944: Fondaparinux: A Low-hanging Fruit in Heparin-induced Thrombocytopenia
Authors: Sousa JosÃ© P , teixeira rogerio , Lourenço Carolina , Gonçalves Lino
Published: November 2020

Introduction:
Heparin-induced thrombocytopenia (HIT) is a life-threatening disease associated with thromboembolic complications. Therefore, its treatment should comprise non-heparin anticoagulants. As opposed to direct thrombin inhibitors (DTI) and danaparoid, fondaparinux use is generally regarded as off-label.

Purpose:
To perform a meta-analysis to appraise fondaparinux efficacy and safety in the setting of HIT.

Methods:
We systematically searched Embase, MEDLINE, Web of Science, Cochrane CENTRAL and Google Scholar databases, using the terms “heparin-induced thrombocytopenia” and “fondaparinux”, form inception to June 1, 2020. Studies targeting thrombotic complications, bleeding events, platelet count and mortality were included. The primary endpoint was a composite of arterial and venous thromboembolism, amputation, gangrene and HIT-related mortality. Therapeutic arms were those of fondaparinux and a standard non-heparin anticoagulant. A random-effects model with Mantel-Haenszel method was performed to calculate pooled odds ratios (OR) and their 95% confidence interval (CI).

Results:
We encompassed 7 retrospective studies, which accounted for 630 patients, of which 302 were under fondaparinux. The remaining were treated with danaparoid, argatroban, lepirudin or bivalirudin. There were 109 primary endpoint events, 80 hemorrhages, 13 persistent or recurring thrombocytopenia cases and 98 deaths. Fondaparinux was found not only to numerically reduce thromboembolism (6 studies, OR 0.28, 95% CI 0.06-1.20, P 0.09, i
2
45%) but also to significantly lessen primary endpoint events (7 studies, OR 0.26, 95% CI 0.10-0.67, P 0.006, i
2
66%). In parallel, a tendency towards a lower rate of bleeding with fondaparinux use was also unveiled (7 studies, OR 0.78, 95% CI 0.50-1.21, P 0.27, i
2
0%). Likewise, thrombocytopenia cases were less common in the fondaparinux arm (4 studies, OR 0.16, 95% IC 0.05-0.57, P 0.004, i
2
0%). Finally, fondaparinux use was also associated with a survival benefit (6 studies, OR 0.26, 95% IC 0.08-0.90, P 0.03, i
2
54%).

Conclusions:
Fondaparinux seems to be at least as safe and more effective than other non-heparin anticoagulants, in the setting of HIT. Prospective studies are needed to demonstrate this hypothesis.
Abstract 16271: Resolution of Left Bundle Branch Block With Sacubitril/Valsartan in Patients With Heart Failure With Reduced Ejection Fraction
Authors: Abudan Anas , Parimi Nikhil , Sami Farhad , Mahmood Uzair , Schwarz Colton , Pierpoline Michael , Mohammed Moghniuddin , Dendi Raghuveer , Pimentel Rhea C , Berenbom Loren D , Emert Martin , Ramirez Rigoberto , Noheria Amit , Reddy Madhu , Sauer Andrew J , Gupta Bhanu , Sheldon Seth H
Published: November 2020

Introduction:
Sacubitril/valsartan is associated with structural and functional reverse remodeling. It is uncertain if a subset of patients with HFrEF and LBBB treated with sacubitril/valsartan have resolution of LBBB. We aim to assess the effect of sacubitril/valsartan on QRS duration and LVEF in patients with HFrEF and LBBB.

Methods:
We performed a retrospective study of HFrEF patients treated with Sacubitril/Valsartan from January 2014 to June 2019. Minimum duration of treatment and follow-up was 3 months. Electrocardiographic and echocardiographic parameters were reviewed at four time points. Patients with baseline LBBB were identified. Patients with CRT ≧3 months after sacubitril/valsartan initiation were included and censored following CRT implantation.

Results:
Among 368 patients that met study criteria, 56 (15%) had baseline LBBB. Mean age was 64 (± 13.5), 53.6% were male and 78.6% had nonischemic cardiomyopathy. During median (IQR) follow-up of 9.1 months (5-18 mo), five (9%) had resolution of LBBB to normal conduction and two (4%) had improvement to non-specific IVCD. Examples of ECGs illustrating LBBB resolution are shown in Figure 1. Time to resolution of LBBB ranged from 1.2-5.7 months. Long term follow-up was only available in one patient with resolution of LBBB lasting at least 25.6 months after initiation of Entresto. The majority (n=4/5, 80%) had nonischemic cardiomyopathy. There was a trend towards greater improvement in LVEF in those with LBBB resolution vs. persistence (23 ± 6% vs. 9 ± 15%, p=0.11) as well as a trend towards greater reduction in LVIDd (-1.2 ± 0.8 cm vs. -0.5 ±0.7 cm, p=0.08).

Conclusion:
A small subset of patients with LBBB and HFrEF have resolution of LBBB with Sacubitril/Valsartan therapy. This may have important ramifications for timing of CRT implantation and highlights the potential importance of assessing the underlying rhythm in patients that receive a CRT device.