bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12974: Successful VT Ablation Utilising Intracoronary Gelatin Sponge Injection
Authors: Gan Eugene M , Lim Paul C , Chua Kelvin C , Lim Eric T , Chong Daniel T , Tan Boon Yew , Ho Kah Leng , Wong Aaron S , Lim Soo Teik , Teo Wee Siong , Ching Chi Keong
Published: May 2021

Introduction:
We report two cases of recurrent ventricular tachycardia (VT) successfully treated by intra-coronary Gelatin sponge embolization where initial endocardial ablation was unsuccessful and epicardial approaches were unfavourable.

Case Histories:
(1) A 75-year-old male with Inferior STEMI who underwent PCI to oRPDA developed VT storm that required DCCV 11 times. The VT was hemodynamically unstable, hence only substrate modification was performed. He still had recurrent episodes of VT and a second ablation attempt localised VT circuit breakout to the infero-apical septum, but ablation was unsuccessful due to a deep intramural circuit. Epicardial ablation was not attempted due to a 1cm pericardial effusion after the first procedure. Unipolar signals from selective wiring of the distal rPDA with a percutaneous coronary intervention guidewire and microcatheter showed early local electrograms. 5ml of Gelatin sponge injection was injected after a 5x2mm coil failed to occlude the distal rPDA. Post occlusion, VT was not inducible with double ventricular extra-stimuli. He has been VT free for 5 months (2) A 41-year-old female with dilated cardiomyopathy, previous left ventricular assist device and revision was admitted for VT storm. The VT map identified earliest activation with far-field pre-systolic potentials at the baso-lateral LV segment. Pre-systolic far field ventricular EGMs were also seen in the adjacent coronary sinus, consistent with a likely epicardial exit site of the VT. Endocardial ablation failed, and epicardial access was not feasible due to adhesions. Coronary angiography revealed a small calibre non dominant left circumflex artery supplying the VT exit site. Cold saline injection down the mLCX terminated the VT and the vessel was occluded with 5 ml of Gelatin sponge. VT was subsequently not inducible.

Discussion & Conclusion:
Critical portions of VT circuits may course epicardially or intramurally
3
, limiting successful endocardial catheter ablation. Epicardial access was risky. Coronary vessel embolization using coils
4
and ethanol
5
have been performed. Use of absorbable Gelatin sponge has been described in managing coronary perforation
6
, but to the best of our knowledge these are the first cases of its use in VT ablation.
Abstract 13014: Gender Differences in the Incidence of Adverse Cardiovascular Events in Cancer Patients Treated With Immune Checkpoint Inhibitors
Authors: Minhas Sheharyar , Minhas Ahmed , Malik Maira , Dhar Sunil
Published: May 2021

Introduction:
Immune checkpoint inhibitors (ICIs) are increasingly being used for cancer therapy. Cardiotoxicity from ICIs has largely been underestimated since cardiovascular monitoring is not routinely performed after initiating immunotherapy. Cardiotoxic side effects are uncommon but are serious complications of ICIs with a high morbidity and mortality.

Hypothesis:
Adverse cardiovascular events in cancer patients are associated with the number of immune checkpoint inhibitor injections and the gender.

Methods:
In this observational, retrospective, pharmacovigilance study, we used MarketScan Databases to compare cardiovascular adverse events reported in patients who received ICIs. The data used in this study was fully integrated and de-identified data. The study included 9,583 male and 6,991 female patients who had cancer and underwent ICI therapy between Jan 1, 2011 and Dec 31, 2018. ICI drugs in this study included nivolumab, pembrolizumab, atezolizumab, avelumab, durvalumab, and ipilimumab. The time to an event and the end of follow-up was counted from the time of first ICI injection. Our primary exposure variable was gender.

Results:
At least one cardiovascular IRAE was reported in 3,804 (23%) of 16,574 patients enrolled in the study. The hazard time to cardiovascular events (CVEs) between the male and female gender varied by age. There was no difference in CVEs between males and females at a younger age. The hazard time to CVEs increased with age above 60 years in males when compared to females. The hazard of time to CVE in males was 1.18 times the hazard in females at the mean study age of 60.5 years. Adjusted Kaplan-Meier survival curves for males and females stratified by ICI injection categories showed that those with fewer number of ICI injections had a shorter time to CVE.

Conclusions:
The number of ICI injections and the gender both impact adverse cardiovascular events in cancer patients. Managing and reducing cardiotoxicity is vital for safe delivery of this effective therapy. There needs to be multidisciplinary approach between primary care physicians, cardiologists, oncologists, and immunologists for better understanding and management of ICI associated cardiotoxicity.
Abstract 13029: Sonothrombolysis Improves Left Atrial Pressure and Volume in Patients With ST Elevation Acute Myocardial Infarction
Authors: Po Chiang Hsu , Aguiar Miguel , Tavares Bruno , Mathias Wilson , Borges Bruno C , Oliveira Mucio , Soeiro Alexandre d , Nicolau Jose C , Sbano Joao , Goldsweig Andrew M , Kalil Filho Roberto , Ramires Jose A , Porter Thomas R , Tsutsui Jeane M
Published: May 2021

Introduction:
Preclinical studies in ST elevation myocardial infarction (STEMI) indicate that high mechanical index impulses guided with transthoracic diagnostic ultrasound associated with intravenously administered microbubbles results in the dissolution of the thrombus (sonothrombolysis), improving coronary microcirculation and epicardial coronary recanalization rate.

Hypothesis:
Left atrial (LA) echocardiographic parameters are compromised in STEMI and can be accurately measured by two-dimensional echocardiography. To study the effect of sonotrombolysis on the LA pressure and volume we propose our study.

Methods:
A total of 100 patients were randomized, 50 for the control group and 50 for the therapy group. Echocardiographic analysis of LA pressure and volume were performed immediately before and after percutaneous coronary intervention (PCI), 72 hours, 1 month and 6 months of follow-up. LA pressure was classified in normal or elevated, depending on the grade of left ventricular diastolic disfunction (DD): normal diastolic function and DD grade 1 have normal LA pressure, and DD grades 2 and 3 have elevated LA pressure, according to the American and European guideline. LA volume was evaluated by Simpson method and indexed to the body surface area.

Results:
The LA pressure and volume had lower values in the therapy group after 6 months of PCI. The comparison of LA pressure between the therapy and control groups respectively was: before PCI (72% vs. 70% normal; 28% vs. 30% elevated; p=0.826), after PCI (68% vs. 65% normal; 32% vs. 35% elevated; p=0.777), 72 hours (75% vs. 62% normal; 25% vs. 38% elevated; p=0.147), 1 month (68% vs. 52% normal; 32% vs. 48% elevated; p=0.123) and 6 months (84% vs. 64% normal; 16% vs. 36% elevated; p=0.035). The comparison of LA volumes between the therapy and control groups respectively was: before PCI (19.0±6.2 vs. 22.4±9.8 ml/m
2
; p=0.061), after PCI (22.8±7.9 vs. 24.4±12.1 ml/m
2
; p=0.469), 72 hours (25.9±8.5 vs. 26.4±12.7 ml/m
2
; p=0.815), 1 month (27.2±8.3 vs. 29.1±13.1 ml/m
2
; p=0.410) and 6 months (26.7±7.5 vs. 33.1±14.9 ml/m
2
; p=0.013).

Conclusions:
The use of sonothrombolysis as adjuvant therapy in STEMI patients results in better values of LA pressure and volume, demonstrating the benefit of using this new therapy.
Abstract 13030: Causes of Cardiovascular and Non-cardiovascular Mortality in the Ischemia Trial
Authors: Sidhu Mandeep S , Alexander Karen P , Huang Zhen , O’Brien Sean M , Chaitman Bernard R , Stone Gregg W , Newman Jonathan D , Boden William E , Maggioni Aldo P , Steg Philippe Gabriel , Ferguson T Bruce , Demkow Marcin , Peteiro Jesus , Wander Gurpreet S , de Belder Mark A , Szwed Hanna , Doerr Rolf , Alexanderson Erick , Polanczyk Carisi , Henriksen Peter , Conway Dwayne , Miro Vicente , Sharir Tali , Rosenberg Yves D , Bangalore Sripal , Reynolds Harmony R , Hochman Judith S , Maron David J
Published: May 2021

Background:
In the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial, all-cause mortality was similar in patients with stable ischemic heart disease (SIHD) randomized to invasive (INV) and conservative (CON) management strategies. This analysis details specific causes of cardiovascular (CV) and non-CV mortality by treatment group.

Methods:
In ISCHEMIA, 289 deaths occurred after a median follow-up of 3.2 years; 145 (5.6%) in INV and 144 (5.6%) in CON (HR 1.05, CI 0.83-1.32). Deaths were adjudicated by an independent Clinical Events Committee as CV, non-CV with or without a CV contributor or undetermined. The protocol defined CV death as deaths from CV causes, non-CV causes with CV contributor, and cause undetermined; non-CV death was defined as death from non-CV causes without a CV contributor. Multivariable analyses were used to identify factors associated with cause-specific death.

Results:
CV death was similar between groups [INV 92 (3.6%), CON 111 (4.3%); HR 0.87 (CI 0.66, 1.15)], but INV had more non-CV death [INV 53 (2.0%), CON 33 (1.3%); HR 1.63 (CI 1.06, 2.52)]; fewer undetermined deaths [INV 12 (0.5%) and CON 26 (1.0%); HR 0.48 (0.24, 0.95)] and more malignancy deaths [INV 41 (1.6%), CON 20 (0.8%); HR 2.11 (1.24, 3.61)]. In multivariable analysis, risk factors associated with CV death were age [HR 1.42 (CI 1.19-1.70) per 10-year increase], diabetes [HR 1.39 (CI 1.03-1.87)], history of heart failure [HR 1.96 (CI 1.33-2.91)], and eGFR [HR 1.18 (CI 1.11-1.26) per 5-ml/min decrease below 80ml/min]. Factors associated with non-CV death were age [HR 2.31 (CI 1.75-3.03) per 10-year increase] and randomization to INV [HR 1.76 (CI 1.13-2.75)].

Conclusions:
In ISCHEMIA, all-cause mortality was similar for the INV and CON strategies. Excess non-CV deaths in INV with a higher number of deaths from malignancy but a higher number of undetermined deaths in CON requires further evaluation.
Abstract 13040: Left Ventricle Dysfunction is Prevented by the Treatment With Methotrexate Carried in Lipid Nanoparticles in Lipopolysaccharide-injected Rats
Authors: Lopes Natalia M , Guido Maria Carolina , Albuquerque Camila , Jensen Leonardo , Maranhao Raul C
Published: May 2021

Introduction:
In infectious processes, left ventricle (LV) dysfunction is often associated with dysregulation of the immune response. LDE, a lipid core nanoparticle resembling LDL, is able to concentrate in inflammatory sites. We showed that methotrexate (MTX), associated with LDE, modulated inflammation and improved cardiac function in rats with myocardial infarction

Hypothesis:
Investigate therapeutic effects of LDE-MTX on LV function in lipopolysaccharide (LPS)-injected rats

Methods:
Wistar rats were submitted to 2 injections of LPS (10mg/kg ip), with 24h interval. Animals were allocated to control group (CT, without LPS) and 3 LPS groups: LDE, treated with only LDE; MTX, with commercial MTX; and LDE-MTX. LDE-MTX dose was 1mg/kg I.P. 72h after LPS, animals were submitted to echocardiographic analysis. Animals were euthanised for analysis of the LV

Results:
Rats treated with LDE developed diastolic dysfunction and presented decreased diastolic volume and diameter of the LV, which was prevented by LDE-MTX. Only LDE-MTX treatment elicited cardiac hypertrophy through the increase of the thickness of LV septum and posterior wall, LV mass, relative heart weight and myocyte diameter. Inflammatory and apoptotic markers were similar in LPS groups, but LDE-MTX treatment increased macrophage recruitment (CD68). Angiogenesis, represented by vascular endothelial growth factor (VEGF), was higher in LDE-MTX compared to all other groups. Hypoxia-inducible factor 1 alpha, which was remarkably higher in LDE, was normalized by LDE-MTX to CT levels. A1, A2b and A3 adenosine receptors expression was higher in LDE-MTX, compared to CT, indicating an increase in intracellular adenosine. Myocyte diameter was positively correlated with VEGF (r2= 0.52; p<0.0001)

Conclusions:
The increased recruitment of immune cells to the LV indicates that treatment with LDE-MTX was effective in activating immune response, impaired by LPS. LDE-MTX increased intracellular adenosine availability, contributing to an adaptive LV hypertrophy, increase in angiogenesis and diminished cellular hypoxia. These mechanisms conceivably elicited the observed LV improvement of diastolic dysfunction caused by LPS challenge
Abstract 13055: Impact of New Pacing Requirement on Echocardiographic Outcomes After Transcatheter Aortic Valve Replacement With Sapien-3 Valve
Authors: Sammour Yasser , Gajulapalli Rama D , Lak Hassan Mehmood , Chawla Sanchit , Kumar Arnav , Sato Kimi , Banerjee Kinjal , Svensson Lars G , Yun James J , Popovic Zoran B , Tarakji Khaldoun , Wazni Oussama M , Reed Grant W , Puri Rishi , Krishnaswamy Amar , Kapadia Samir R
Published: May 2021

Introduction:
New permanent pacemaker (PPM) requirement has been linked with left ventricular dysfunction after TAVR.

Objective:
We sought to study the impact of new PPM on echocardiographic outcomes after TAVR with SAPIEN-3 (S3) valve.

Methods:
We included consecutive patients who underwent TAVR with S3 valve at the Cleveland Clinic between April 2015 and December 2018. Patients with prior PPM were excluded. Echocardiograms were reviewed to determine left ventricular ejection fraction (LVEF), left ventricular end diastolic volume index (LVEDVi), left ventricular end systolic volume index (LVESVi), left ventricular dimension during diastole (LVDd), posterior wall thickness during diastole (PWTd), interventricular septum during diastole (IVSd), right ventricular systolic pressure (RVSP), inferior vena cava (IVC) diameter and tricuspid regurgitation (TR) grade.

Results:
Among 886 patients, the rate of 30-day PPM was 10.2%. Baseline LVEF was similar between new PPM and no PPM (55.4 ± 12.7% vs. 57.2 ± 11.2%; p = 0.188). There were no differences in the other studied echocardiographic parameters at baseline. Among patients with new PPM, LVEF was lower at both 30 days (54.4 ± 11.3% vs. 58.4 ± 10.1%; p = 0.001) and 1 year (54.2 ± 12% vs. 59.1 ± 11.3%; p = 0.009) compared to no PPM with Δ LVEF -0.9% vs. +1.4%; p = 0.023. There were no differences in LVEDVi (52 ± 20.8 vs. 48.3 ± 17.6; p = 0.186) at 1 year. LVESVi was higher with new PPM (24.8 ± 16.1 vs. 20.2 ± 10.9; p = 0.038). However, Δ LVESVi was similar between the 2 groups (-1.6 vs. -2.6; p = 0.517). There were no differences in RVSP (38.9 ± 14.1 vs. 40 ± 14; p = 0.58). LVIDd, PWTd, IVSd and IVC diameter also did not show variations whether patients were paced or not. Moderate to severe TR rates were similar as well (17.7% vs. 21.5%; p = 0.407).

Conclusion:
Among S3 TAVR recipients, new pacing requirement had a detrimental impact on LVEF at both 30 days and 1 year. However, it did not seem to affect the other studied echocardiographic outcomes after TAVR.
Abstract 13057: High Visceral-to-Subcutaneous Fat Ratio is Correlated With Increased Cardiovascular Events in Patients With Low Body Mass Index With Suspected Coronary Artery Disease
Authors: Itagaki Tadashi , Otagiri Kyuhachi , Machida Keisuke , Takeuchi Takahiro , Kitabayashi Hiroshi
Published: May 2021

Introduction:
Although abdominal fat distribution given by the ratio of visceral adipose tissue (VAT) to subcutaneous adipose tissue (SAT) area (V/S ratio) is possibly associated with an increased risk of cardiovascular disease (CVD), few studies have examined the effect of the V/S ratio and physique stratified by body mass index (BMI) on long-term clinical outcomes.

Methods:
We assessed 945 consecutive patients (mean age, 69 years; 42.5% females) with suspected coronary artery disease who underwent computed tomography (CT) angiography. The patients also underwent plain abdominal CT to measure VAT and SAT areas. The V/S ratio was calculated to assess abdominal fat distribution. The patients were classified into four groups based on the median V/S ratio and median BMI (0.627 and 23.61 kg/m
2
, respectively). We examined the association between the V/S ratio and long-term outcomes in each BMI group. The primary outcome was major adverse cardiac events (MACEs, including all-cause death, acute coronary syndrome, emergent hospitalization due to CVD, and any coronary revascularization).

Results:
Over a median follow-up of 792 days, although the incidence of any cardiovascular event was not associated with the V/S ratio among patients with high BMI, a higher incidence of MACE, all-cause death, and any coronary revascularization was noted among patients with low BMI in the high V/S ratio group than in the low V/S ratio group. In the Kaplan-Meier analysis, a statistically significantly lower MACE-free survival rate was noted among patients with low BMI in the high V/S ratio group than in the low V/S ratio group, despite no differences among high BMI patients in both the V/S ratio groups (Figure).

Conclusion:
Only in patients with low BMI, a high V/S ratio was associated with increased risks of MACE. A high V/S ratio may be an important risk factor for CVD, especially in patients with low BMI. In contrast, abdominal fat distribution did not affect CVD prognosis in patients with high BMI.
Abstract 13078: Evaluation of Ventricular Function in Fetus With Transposition of Great Arteries by Velocity Vector Imaging
Authors: XIE Mingxing , Shan Lin , Qing Lv , Jing Wang , Li Zhang , Haiyan Cao , Liu Hong , Meng Li , Xiaoyan Song , Yali Yang
Published: May 2021

Background:
The aim of this study was to test the hypotheses that (1) fetuses with complete transposition of the great arteries (D-TGA) and Taussig-Bing anomaly (TBA) has decreased the left ventricular (LV) and right ventricular(RV) mechanical function compared with normal fetuses, and (2)the decreased myocardial mechanical function in fetal D-TGA and TBA was associated with the degree of transposition of the great arteries, pulmonary stenosis(PS) and ventricular septal defect(VSD).

Methods:
We retrospectively identified 49 cases of fetal D-TGA and 29 cases of fetal TBA and compared findings to 49 controls of comparable gestational age. Postprocessing analysis of the left ventricle and right ventricle were done using syngo Velocity Vector Imaging version 2.3. Global and regional longitudinal systolic peak velocity, strain and strain rate were generated.

Results:
(1) Comparing with control group, the global and regional longitudinal systolic peak velocity (GLV), strain (GLS) and strain rate (GLSR) of the LV and RV were decreased in the group of D-TGA and TBA (P<0.05). (2) In the group of D-TGA and TBA, the multivariate linear regression analysis, the VSD was the independent determinant of LVGLS and RVGLS (β = 0.270, P=0.014 and β = 0.465, P< 0.001). The PS was the independent determinant of RVGLSR (β = 0.090, P=0.009).

Conclusion:
The ventricular function of fetal D-TGA and TBA were decreased compared with control group. The PS and VSD were the independent determinant factors of the decreased LVGLS, RVGLS and RVGLSR in the fetal D-TGA and TBA.
Abstract 13097: Feasibility and Safety of Trans-nasal Transesophageal Echocardiography Guiding Left Atrial Appendage Closure Without General Anesthesia
Authors: XIE Mingxing , Wei Sun , Bin Wang , Liin He , Qing Lv , Li Zhang
Published: May 2021

Background:
Percutaneous left atrial appendage closure (LAAO), may be an alternative therapy to non-valvular atrial fibrillation (AF) patients. And the transesophageal echocardiography (TEE) is the mainstay of the imaging technology to guide LAAO procedures. However, in the local anesthesia state, LAAO cannot be accomplished under the real-time guidance of conventional TEE with the standard adult TEE probe. The aim of the study was to explore the feasibility and safety of trans-nasal TEE with the microprobe to guide LAAO without general anesthesia.

Methods:
A total of 30 non-valvular AF participants were enrolled in the study. All participants both underwent conventional TEE examination with the standard adult TEE probe before LAAO, and the real-time guidance of trans-nasal TEE with the microprobe intraoperatively under local anesthesia.

Results:
There weren’t significant difficulties to insert the microprobe into the esophagus through the nares. All patients tolerated the trans-nasal approach well. Image quality by the microprobe was reviewed as good (67.3%) and acceptable (36.7%) by two different echocardiographers. The devices were successfully implanted in all participants. No observed significant residual peri-device leaks by the microprobe at the time of the procedure and by the standard TEE on a median of 55 days (interquartile range: 48 to 66 days) postoperatively. 2(7%) patients had mild epistaxis after the procedure, and there were no other severe complications.

Conclusion:
The present study preliminarily showed the feasibility and safety of the trans-nasal micro-TEE and suggested it may become an alternative to conventional TEE to guide LAAO procedure without general anesthesia.
Abstract 13099: Evaluation of Right Ventricular Myocardial Mechanics by 2D-and 3D-STE in Patients With End-stage Heart Failure
Authors: Li Yuman , Tian Fangyan , XIE Mingxing
Published: May 2021

Background:
Speckle-tracking echocardiography (STE) has emerged as a more accurate tool for assessing the right ventricular (RV) function.We aimed to assess RV myocardial mechanics by 2D- and 3D-STE in patients with end-stage heart failure (HF).

Methods:
We enrolled 105 patients with end-stage HF and 50 normal subjects. The results of coronary artery angiography divided these patients into two subgroups : ischaemic cardiomyopathies (ICM, n=23) and non-ischaemic cardiomyopathies subgroups (NICM, n=82). RV end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF) were measured by 3D-STE. RV free wall longitudinal strain (RVLS-fre),and RV septal wall LS (RVLS-sep) were also determined by 3D-and 2D-STE. The conventional RV function parameters (fractional area change [FAC], tricuspid annular plane systolic excursion [TAPSE]) were obtained. We compared these parameters between patients and normal subjects. RVLS-fre and RVLS-sep obtained by 3D- and 2D-STE were compared between ICM and NICM.

Results:
Compared with controls, patients had higher RVEDV, RVESV(P<0.001),and lower RVLS-fre, RVLS-spe, RVEF, RVSV, FAC, TAPSE(P<0.001).In 105 patients, 3D-RVLS-fre was lower than 2D-RVLS-fre (-11.43±3.83% VS -12.30±3.95%;P=0.003); whereas 3D-RVLS-sep was not different from 2D-RVLS-sep. Patients with NICM had significant lower 3D-RVLS-fre(-10.68±3.55% VS -14.06±3.70%;P<0.001)and 3D-RVLS-sep (-6.68±2.76% VS -8.26±2.64%;P=0.006)than patients with ICM. There was no difference in 2D-STE between the two subgroups.

Conclusions:
End-stage HF patients present significant difference in RVLS values between 3D- and 2D-STE. 3D-STE is superior to 2D-STE for RV systolic function assessment in end-stage HF patients with different pathologies.
Abstract 13101: Assessment of Left Ventricular Myocardial Fibrosis Using Two-dimensional and Three-dimensional Speckle Tracking Echocardiography in Patients With End-stage Heart Failure
Authors: XIE Mingxing , Fangyan TiAN , Yuman Li
Published: May 2021

Background:
Previous studies showed that 2-dimensional speckle-tracking echocardiography (2D-STE) correlates with the extent of left ventricular(LV)myocardial fibrosis (MF). However, the utility of 3D-STE in predicting LV MF remains unknown. We aimed to identify which LV strain assessed by 2D- and 3D-STE is the most reliable parameter to predict LV MF in patients with end-stage HF.

Methods:
105 patients with end-stage HF undergoing heart transplantation were enrolled in our study. LV global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS) were measured by 2D- and 3D-STE. LV ejection fraction (EF) was determined by 3D-STE.The degree of MF was quantified by using Masson trichrome stain in LV myocardial samples. The study population was divided into 3 groups according to the degree of MF on histology (mild, moderate, and severe MF).

Results:
Patients with severe MF had lower 2D-STE, 3D-STE, and LVEF compared with those with mild and moderate MF. LV MF strongly correlated with 3D-LVGLS (r =0.73; P < 0.001), modestly with 3D-LVGRS (r =0.53; P< 0.001), weakly with 2D-LVGLS (r =0.49, P<0.001), 3D-LVGCS(r = 0.37, P <0.01), and LVEF (r =-0.46, P<0.001), but did not correlated with 2D-LVGCS and 2D-LVGRS. 3D-LVGLS correlated best with the degree of MF (r = 0.73 vs 0.37~0.53; P<0.05) compared with other 2D- and 3D-STE, and LVEF. 3D-LVGLS had the highest accuracy for detecting severe MF (area under the curve 0.90 VS 0.62~0.80; P< 0.05) compared with the 2D- and 3D-STE, and LVEF. Stepwise multivariate analysis showed that 3D-LVGLS (β=0.79, p < 0.001) was the only independent predictor of the degree of MF.

Conclusion:
3D-LVGLS may be an ideal surrogate marker for LV MF in patients with end-stage HF.
Abstract 13102: Prediction of Incident AF With Deep Learning Can Identify Patients at High Risk for AF-related Stroke
Authors: Pfeifer John , Raghunath Sushravya M , Ulloa Alvaro , Nemani Arun , Carbonati Tanner , Jing Linyuan , vanMaanen David , Hartzel Dustin , Ruhl Jeffrey , Stoudt Nathan J , Johnson Kipp W , Zimmerman Noah , Leader Joseph , Kirchner H Lester , Griessenauer Christoph , Hafez Ashraf , Good Christopher , Fornwalt Brandon , Haggerty Christopher M
Published: May 2021

Background:
Atrial fibrillation (AF) is associated with stroke, especially when AF goes undetected. Deep neural networks (DNN) can predict incident AF from a 12-lead resting ECG. We hypothesize that use of a DNN to predict new onset AF from an ECG may identify patients at risk of sustaining a potentially preventable AF-related stroke.

Methods:
We trained a DNN model to predict new-onset AF using 382,604 ECGs prior to 2010. We then evaluated the model performance on a test set of ECGs from 2010 through 2014 linked to patients in an institutional stroke registry. There were 181,969 patients in the test set with at least one ECG and no prior history of AF. Of those patients 3,497 (1.9%) had a stroke following an ECG that did not show AF. Within the set of patients with stroke, 375 had the stroke within 3 years of the ECG and were diagnosed with new AF between -3 and 365 days of the stroke. We considered these potentially preventable AF-related strokes. We report the sensitivity and positive predictive value (PPV) of the model for appropriately risk stratifying these 375 patients who sustained a potentially preventable AF-related stroke.

Results:
We used F
β
scores to identify different risk prediction thresholds (operating points) for the model. Operating points chosen by F
0.5
, F
1
, and F
2
scores identified 4, 12, and 21% of the population as high risk for the development of AF within 1 year (Figure 1). Screening 1, 4, 12, and 21% of the overall population resulted in PPV of 28, 21, 15, and 12%, respectively, for identification of new onset AF in one year. Using those same thresholds yielded sensitivities of 4, 17, 45, and 62% for identifying potentially preventable AF-related strokes. The different risk prediction thresholds resulted in a low (120-162) number needed to screen to detect one potentially preventable AF-related stroke at 3 years.

Conclusions:
Use of a deep learning model to predict new onset AF may identify patients at high risk of sustaining a potentially preventable AF-related stroke.
Abstract 13107: Nitroglycerin Pretreatment Induces Metabolic Tolerance to Spinal Cord Ischemia-reperfusion Injury Through Nitric Oxide-mediated Mitochondrial Katp Channel Activation
Authors: Ikeno Yuki , Ghincea Christian V , Roda Gavriel , Cheng Linling , Aftab Muhammad , Meng Xianzhong , Weyant Michael , Cleveland Joseph , Fullerton David A , Reece Thomas B
Published: May 2021

Introduction:
Pharmacologic induction of metabolic tolerance to spinal cord ischemia-reperfusion injury (SCI) after thoracoabdominal aortic intervention is not well established. We previously demonstrated that nicorandil pretreatment preserved motor function in a murine SCI model via direct mitochondrial ATP-sensitive potassium (KATP) channel activation and nitric oxide (NO) donation. However, the independent role of NO-mediated neuroprotection has not been elucidated.

Hypothesis:
Nitroglycerin pretreatment will induce neuroprotection through NO-mediated KATP channel activation.

Methods:
SCI was induced by 7 minutes of thoracic aortic cross-clamping in adult male C57BL/6 mice. Pretreatment constituted intraperitoneal injection 3 consecutive days before injury. Experimental groups: sham (no pretreatment or ischemia, n=10), SCI control (normal saline, n=20), nitroglycerin 1 mg/kg (n=18), nitroglycerin 1 mg/kg + 5-hydroxydecanonate 5 mg/kg (5HD, mitochondrial KATP channel blocker, n=13), 5HD 5 mg/kg (n=10), nitroglycerin 1 mg/kg + carboxy-PTIO (cPTIO) 1 mg/kg (NO scavenger, n=16), and cPTIO 1 mg/kg (n=10). Limb motor function and the number of viable neurons within the anterior horn of the spinal cord were evaluated.

Results:
Compared to SCI control, motor function was significantly preserved in the nitroglycerin pretreatment group at every time point after ischemia. In the nitroglycerin+5HD and nitroglycerin+cPTIO groups, motor preservation was significantly attenuated compared to nitroglycerin pretreatment (p<0.001). Histological analysis showed significant neuron preservation in the nitroglycerin pretreatment group compared with SCI control (p=0.011). This preservation was completely attenuated with 5HD or cPTIO co-administration (p=0.001).

Conclusions:
Nitroglycerin pretreatment significantly preserved motor function in a murine SCI model through NO-mediated KATP channel activation.
Abstract 13114:

P22
phox

Protects the Heart Against Pressure Overload
Authors: Nakada Yasuki , Mizushima Wataru , Yang Yanfei , Zhai Peiyong , Oka Shinichi , Fefelova Nadezhda , Xie Lai-hua , Liu Tong , Li Hong , Sadoshima Junichi
Published: May 2021

Introduction:

p22
phox

forms a complex with NADPH oxidases, major sources of O
2
-
and H
2
O
2
. However, the role of

p22
phox

during stress remains to be elucidated.

Purpose:
To investigate the role of endogenous

p22
phox

during pressure overload (PO).

Methods and Results:
The level of

p22
phox

protein in isolated cardiomyocytes after 4 weeks of transverse aortic constriction (TAC) was significantly higher than after sham operation (1.7-fold, p<0.05). The cardiac phenotype of cardiac-specific

p22
phox

knockout (

p22
phox

cKO) mice was normal at baseline. However, four weeks after TAC,

p22
phox

cKO mice exhibited a lower left ventricular ejection fraction (32.0±10.0 vs 53.2±8.4%, p<0.05), a higher lung weight to tibial length ratio (23.0±6.0 vs 13.1±6.6, p<0.05), and more interstitial fibrosis (6.1±1.0 vs 4.4±1.1%, p<0.05) than control mice, indicating that the loss of

p22
phox

exacerbates TAC-induced cardiac dysfunction. The level of oxidative stress in the heart, evaluated by dityrosine immunoblot, was significantly lower in

p22
phox

cKO mice than in control mice (0.71±0.04 vs 1.00±0.04, p<0.01). The peak Ca
2+
amplitude in isolated cardiomyocytes was lower in

p22
phox

cKO mice than in control mice at baseline (2.4±0.1 vs 3.0±0.2, p<0.01). Although mRNA expression of SERCA2a did not differ, there was significantly less SERCA2a protein in

p22
phox

cKO mice than in control mice (0.62±0.10 vs 1.00±0.23, p<0.01) at baseline. The amount of biotinylated iodoacetamide labeled SERCA2a was significantly smaller in

p22
phox

cKO hearts than in control mouse hearts (0.4-fold, p<0.01), indicating that cysteine residues in SERCA2a are oxidized to a greater extent in

p22
phox

cKO hearts than in control mouse hearts. Since cysteine oxidation decreases the stability of SERCA2a, our results suggest that

p22
phox

stabilizes SERCA2a by preventing cysteine oxidation.

Conclusions:
Endogenous

p22
phox

is protective against PO, possibly by maintaining SERCA2a stability.
Abstract 13123: Early Mobilization of Older Adults in the Cardiac Intensive Care Unit
Authors: Goldfarb Michael , Semsar-kazerooni Koorosh , Morais Jose , Dima Diana
Published: May 2021

Background:
Early mobilization (EM) is beneficial in general critical care units and in older hospitalized patients, but little is known about EM in older adults with acute cardiovascular disease.

Methods:
Consecutive admissions of adults ≥ 80 years old to a cardiac ICU at an academic tertiary care centre before (January to December 2017) and after (February 2018 to June 2019) implementation of a structured nurse-driven EM program. Mobility was measured using the validated Level of Function (LOF) Mobility Scale, which ranges from 0 (bed immobile) to 5 (able to walk > 50 feet). The primary outcome was discharge home.

Results:
There were 412 patients included (N=234, intervention; N=178, preintervention). There was no difference in mean age between groups (overall mean age 86.3±4.8 years old) or sex (overall female N=215, 52.2%). In the intervention group, functional impairment was present in 89 patients (38.0%) prior to hospitalization and in 209 patients (89.3%) on admission. Nearly half of patients undergoing EM (N=107; 45.7%) improved their LOF by ≥1 during cardiac ICU stay. Mobilization occurred during nearly all opportunities (838/850; 98.6%) and most mobility activities were completed (2,207/2,553; 86.4%). Adverse events were rare (5/2,207 activities [0.2%]) and transient (N=5). There were no falls, line dislodgements, or healthcare team injuries). Patients in the intervention group were more likely than patients in the preintervention group to be discharged home (74.4% vs. 65.7%, P=0.047, respectively) and had a lower rate of in-hospital death (6.4% vs. 14.6%, P=0.006, respectively). There was no difference in length of hospital stay or re-admission. In the multivariable analysis, predictors of discharge home were younger age, heart failure, and higher prehospital LOF. Outcomes were similar in adults ≥ age 90.

Conclusion:
EM is safe in older adults in the cardiac ICU and is associated with reduced discharge to healthcare facility and in-hospital mortality.
Abstract 13124: Exercise Capacity as a Predictor of the Placebo-controlled Efficacy of Percutaneous Coronary Intervention in Stable Coronary Artery Disease: The Ventilatory Gas Exchange-stratified Analysis of ORBITA
Authors: Ganesananthan Sashiananthan , Rajkumar Christopher , Shun-Shin Matthew , Nowbar Alexandra , Foley Michael , Seligman Henry , Wensel Roland , Davies John , Francis Darrel , Al-Lamee Rasha K
Published: May 2021

Introduction:
Improvement in exercise capacity is a therapeutic goal of percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD). Cardiopulmonary exercise testing (CPET) provides an accurate quantification of cardio-respiratory fitness through analysis of ventilatory gas exchange (VGE). The aim of this secondary analysis from the ORBITA trial is to determine the placebo-controlled effect of PCI on VGE parameters and determine if pre-randomisation exercise capacity predicts the placebo-controlled efficacy of PCI.

Methods:
Following a 6-week medication optimisation phase, patients with severe single vessel CAD underwent pre-randomisation treadmill CPET using the smoothed modified Bruce protocol. Patients were then randomly assigned to PCI or a placebo procedure. At the end of the 6-week follow up period, patients underwent repeat CPET before being unblinded to treatment allocation.

Results:
CPET data was available for 195 patients (mean age 66.1 ± 9.1, 73.3% male). At baseline, peak oxygen uptake (VO
2
) was 21.5±6.7ml/kg/min in the PCI arm (n=102) and 20.6±6.6ml/kg/min in the placebo arm (n=93). At follow up, there was no significant benefit from PCI over a placebo procedure for any ventilatory gas exchange (peak VO
2
, p=0.826; O
2
-pulse plateau, p=0.638) or haemodynamic parameter (rate-pressure product, p=0.215). Although PCI resulted in significantly improved patient-reported freedom from angina (OR, 2.58 [95% CI, 1.35-14.92] p=0.004) and angina frequency score (OR, 1.73 [95% CI, 1.02 to 2.96], p=0.0432), there was no detectable interaction between peak VO
2
and these endpoints (P
interaction(int)
=0.715 and P
int
=0.588 respectively). Similarly, pre-randomisation peak VO
2
did not predict the placebo-controlled benefit of PCI on physical limitation (P
int
=0.293), quality of life (P
int
=0.380), EuroQOL 5 visual analogue score (P
int
=0.695), Canadian Cardiovascular Society angina class (P
int
=0.120) or exercise time (P
int
=0.897).

Conclusions:
When assessed against placebo, PCI does not improve VGE or exercise capacity, assessed by CPET. Furthermore, pre-randomisation exercise capacity does not predict the placebo-controlled effect of PCI on symptom relief, even in patients with lower functional capacity.
Abstract 13129: Chest Pain and Inflammation: A Story Where Hickam’s Dictum Prevailed
Authors: Kumar Kris , Vogt Joshua , Masri Ahmad , Golwala Harsh , Zahr Firas , Divanji Punag , Rahmouni Hind , Nazer Babak
Published: May 2021

A 39-year-old male presented with a chief complaint of chest pain that worsened with deep breathing for one day. He was found to be tachycardic, with distant heart sounds and a skin nodule over his right upper extremity. ECG revealed diffuse ST elevations and PR segment depressions with TTE showing a small pericardial effusion. Troponin I was 8.98 ng/mL and NT-proBNP was 981 pg/mL.

One day after admission, he developed respiratory distress, and repeat TTE showed a large pericardial effusion with collapse of the RV free wall during diastole with variation of mitral and tricuspid valve inflows consistent with tamponade. Pulsus paradoxus was 24 mmHg and he was taken for pericardiocentesis. Skin nodule biopsy revealed nodular and interstitial granulomatous dermatitis. Anti-nuclear antibody and double stranded DNA antibody were positive with pericardial fluid cytology showing acute inflammation with lupus erythematosus cells. Based upon this constellation of findings, he was diagnosed with systemic lupus erythematosus (SLE) myopericarditis, and started on colchicine and immunosuppression, with resolution of symptoms.

One week into hospitalization, the chest pain recurred but was sharp and substernal, with a rising troponin from 1.23 ng/mL to 8.23 ng/mL. TTE showed depressed LVEF of 45% and RCA territory hypokinesis without effusion. CTA PE showed no evidence of thromboembolism and CT coronary demonstrated mural thickening of the mid LAD and aneurysmal dilation of the left main to the LAD and left circumflex bifurcation concerning for vasculitis. The mid RCA was occluded, and patient was taken to the cardiac catherization laboratory revealing thrombotic occlusion of the proximal-to-mid RCA. Despite serial balloon dilation, thrombotic occlusion persisted, Aspiration thrombectomy evacuated organized thrombus prior to deployment of two overlapping drug-eluting stents in the proximal-to-mid RCA, restoring flow. TTE prior to discharge showed normal LVEF and no effusion.

This case illustrates various cardiac manifestations of SLE and the unusual dynamic nature of this patient’s multiple presentations of chest pain. Avoiding “diagnostic anchoring” is important to diagnosing and treating conditions such as SLE, that can affect the heart in multiple ways.
Abstract 13147: Non-invasive Identification of Carditis in Acute Rheumatic Fever and Rheumatic Heart Disease
Authors: Gutman Sarah J , Costello Benedict T , van Leeuwen Melissa G , O'Brien Jessica , Varghese Seeba E , Wright Leah , Brady Stephen , Wong Christopher , Maguire Graeme , Marwick Thomas H , Taylor Andrew J
Published: May 2021

Background:
The pathogenesis of acute rheumatic fever (ARF) and its evolution into rheumatic heart disease (RHD) is poorly understood. We aimed to identify carditis in patients with ARF and RHD using cardiac magnetic resonance (CMR) tissue characterisation with T1 mapping. We hypothesised that prolonged native T1 time on CMR, would be present in ARF and RHD patients.

Methods:
We prospectively recruited 62 patients. We recruited 16 patients fulfilling the Jones Criteria for the diagnosis of ARF, 15 controls with an inflammatory condition and 10 healthy controls. We also recruited 11 patients with echocardiographic evidence of RHD and 10 matched controls. All patients underwent CMR with assessment of non-contrast myocardial T1 mapping. The myocardial T1 time, as an index of myocardial inflammation from carditis, was compared between the groups. All T1 times were converted to Z-scores, to enable comparison with different CMR systems.

Findings:
Patients with ARF had evidence of carditis demonstrated by markedly elevated mean myocardial T1 times. The mean Z score was 2.76(95% CI 1.34-4.17) for patients with ARF compared to 0.32(95% CI -0.25-0.88) for those with non-cardiac inflammatory conditions and 0.00(95% CI -0.72-0.72) for healthy controls, P=0.004. A myocardial T1 Z score greater than 1.4 showed excellent diagnostic performance as a single test for the diagnosis of ARF (AUC = 0.85[0.67-0.99], P=0.001, sensitivity = 82 %, specificity = 92%, Youden’s J = 0.74). Patients with RHD also demonstrated significantly elevated native T1 time compared to matched controls. The mean Z score for RHD patients was 2.79(95% CI 1.3-4.3) compared to 0.00(95% CI -0.72-0.72) in controls, P=0.002.

Interpretation:
Patients with ARF and RHD have markedly elevated myocardial T1 Z-scores on CMR, consistent with carditis. Incorporating CMR T1 mapping into the diagnostic algorithm for ARF may improve diagnostic certainty and lead to more effective delivery of secondary penicillin prophylaxis.
Abstract 13161: Acceptability and Feasibility of Novel Screening Models and Family Communication Methods for Familial Hypercholesterolemia
Authors: Jones Laney K , Walters Nicole , Brangan Andrew , Ahmed Catherine D , Campbell Salome Gemme , Sheldon Amanda , McGowan Mary , Rahm Alanna K , Sturm Amy C
Published: May 2021

Introduction:
Despite familial hypercholesterolemia (FH) being a common cardiovascular genetic disorder, it is vastly underdiagnosed and undertreated. This is partly due to the lack of systematic screening methods to identify possible FH and little to no implementation of cascade screening approaches in the US. Screening models, such as machine learning algorithms, and family communication methods for cascade screening, such as chatbot technology and direct contact of at-risk relatives by a clinician, may help close the gap in FH identification.

Methods:
Focus groups were conducted with individuals with FH and clinicians. Focus groups were audio-recorded, transcribed, and coded for acceptability and feasibility of implementing screening models and family communication methods.

Results:
Individuals with FH and clinicians felt that models analyzing different data sources, including electronic health records, to screen for FH have the potential to activate patients and stimulate patient-clinician conversations about FH. While some expressed privacy and confidentiality concerns, individuals with FH found screening models acceptable, stating that these could have led to an earlier diagnosis and treatment and expressing their frustration with the status quo. Most had a strong desire to be notified of screening models’ outcomes at the same time as their clinician. Clinicians felt strongly that automated models would be helpful in identifying FH. Many with FH felt responsible for notifying their family about FH first; however, some indicated comfort with their clinician, healthcare system, or other professionals helping to communicate FH risk to their relatives via direct contact methods. Further, they indicated a strong willingness to use chatbots to share FH risk information with their relatives. Clinicians felt the need to support their patients and offer their services when sharing FH risk information with relatives, while individuals with FH expressed doubt that their clinicians would have time and resources to provide active support.

Conclusions:
Individuals with FH and clinicians agreed that FH screening models and enhanced family communication methods would be beneficial, acceptable, and feasible to implement in US healthcare systems.
Abstract 13168: Cardiac Magnetic Resonance Imaging in a Phase 2 Study of Rilonacept in Recurrent Pericarditis
Authors: Cremer Paul , Lin David , Nasir Saifullah , Luis Sushil A , Ertel Andrew , Klein Allan L , Beutler Anna , Fang Fang , Paolini John
Published: May 2021

Introduction:
The magnitude of pericardial delayed hyperenhancement (DHE) by cardiac magnetic resonance imaging (CMR) illustrates the severity of inflammation in pericarditis. We report exploratory CMR data from an open-label Phase 2 study of rilonacept (IL-1α/IL-1β inhibitor) in recurrent pericarditis (RP).

Methods:
Patients (pts) with idiopathic RP or post-pericardiotomy syndrome (PPS) enrolled in the study. A subset had CMR at baseline (BL) and final visit (FV, 6 mo). Pain (NRS) and inflammation (CRP) were also collected. CMR images were graded (none, mild, moderate, or severe DHE) by a central core lab blinded to clinical data.

Results:
Of 25 study pts, 11 had CMR at BL and FV; 6 active idiopathic RP, and 5 corticosteroid (CS)-dependent non-active RP (4 idiopathic, 1 PPS). At BL, DHE was severe (3), moderate (2), and none (1) in active RP pts and moderate (1) or mild/none (4) in CS-dependent pts (Figure 1). At FV, DHE was improved (2), resolved (2; one pt example in Figure C/D), or unchanged (2) in active RP pts and was improved (1), resolved (1), unchanged (2) or worsened from none to mild (1) in CS-dependent pts. DHE improvements were associated with decreased pain and CRP and occurred despite discontinuation of CS or reduction in dose level. One pt with severe DHE at baseline and mild DHE at FV experienced a recurrence ~8 weeks after rilonacept discontinuation and enrolled a second time with severe DHE; the patient had reduced CRP and pain NRS during both enrollments and ended the second enrollment with moderate DHE.

Conclusions:
Serial CMR demonstrated improvement in pericardial DHE after 6 mo of rilonacept treatment, consistent with clinical improvement, while corticosteroids were tapered/discontinued. Recurrence in one pt with incompletely resolved DHE after 6 months of rilonacept treatment could indicate that a longer treatment duration is warranted in patients with unresolved DHE. These preliminary results may inform future CMR-guided treatment studies in RP.