bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15147: Outcomes of Interventional Management of Coronary Artery Disease Prior to Renal Transplant
Authors: Lak Hassan Mehmood , Sammour Yasser , Ahmed Taha , Gunasekaran Deepthi , mutti jasmine , Chawla Sanchit , Kaur Manpreet , Chahine Johnny , Mansour John , Simpfendorfer Conrad C , Kapadia Samir R
Published: May 2021

Introduction:
Coronary artery disease (CAD) is a main cause of mortality in kidney transplant (KT) patients. Preoperative cardiovascular risk assessment is a crucial step before clearance for KT.

Hypothesis:
We seek to compare long term outcomes in patients who underwent PCI prior to KT as compared to those who did not need PCI.

Methods:
We identified patients who underwent KT from January 2008 to November 2019 at our institution and had coronary catheterization prior to KT.

Results:
We included 272 patients, of whom 54 (19.9%) underwent percutaneous coronary intervention (PCI), while the remaining 218 patients did not need PCI. The median age in the PCI group was 57.4 (46.9 - 61.2) years, while it was 53.9 (44.6 - 61) years in the control group. Baseline characteristics including gender, race, hypertension, diabetes, smoking, and hyperlipidemia were comparable in both groups. The median time to KT was 2.4 (1 - 5) years in the PCI group vs. 1.2 (0.6 - 3.3) years in the control group (p=0.001). Among patients who underwent PCI, 51.1% had single-vessel disease and 40.4% had multi-vessel disease on the coronary angiograms as compared with 15.4% and 11.8% in the control group (p<0.001). The rate of acute kidney injury within 72 hours after the catheterization was 33.3% in PCI group vs. 14.13% in those who did not need PCI (p=0.01) after excluding dialysis patients. Overall, there was no difference in mortality in the PCI group compared to control group after 10 years of follow-up (p=0.416). In a subgroup analysis of patients who underwent cardiac catheterization within 2 years prior to transplant, there was still no significant difference in mortality between PCI (n=23) and control group (n=139) (p=0.451). The need for PCI after the initial cardiac catheterization was similar between the 2 groups after 10 years of follow-up (p=0.904).

Conclusion:
Patients with CAD can be safely treated with PCI prior to kidney transplant and have comparable outcomes as compared to those who do not require PCI.
Abstract 15149: Aortic Total Clamp Increases Post Coronary Artery Bypass Grafting Stroke: A Multinomial Multifactor Model
Authors: Gelsomino Sandro , Micali Linda R , Prifti Edvin , Parise Gianmarco , Bonacchi Massimo
Published: May 2021

Introduction:
We performed a multinomial multifactor propensity-score based analysis on stroke in patients undergoing CABG. The unique model allowed us to test all the potential technical risk related to aortic manipulation alone or in combination.

Methods:
The study population included 16,255 consecutive patients undergoing isolated CABG between 1997 and 2017. Patients were divided into 7 groups: 1) No Proximal Anastomoses-Off-pump (NPA-OFF) group, 2) Side Biting Clamp-Off-pump (SBCL-OFF) group, 3) No Proximal Anastomoses-Beating Heart-On-Pump (NPA-BH-ON) group, 4) Side Biting Clamp-Beating Heart-On-Pump (SBCL-BH-ON) group, 5) No Proximal Anastomoses-Aortic Total Clamp-On-pump (NPA-ATC-ON) group, 6) Aortic Total Clamp-On-pump (ATC-ON) group, 7) Aortic Total Clamp-Side Biting Clamp-On-pump (ATC-SBCL-ON) group. The main end-point was the incidence of postoperative stroke within 30 days of the procedure. Statistical significance was set for p-values< 0.05 (*).

Results:
The optimal balance with the balance table, effect size plot and Q-Q plot, allowed us to conclude that the groups were similar to support causal estimation of the treatment estimand. As shown in Figure 1, there was no difference between a total no-touch (NPA-OFF group) vs. the same technique on pump (NPA-BH-ON group, p>0.05) and or adding a side biting clamp to these two procedures (SBCL-OFF group and SBCL-BH-ON group, both p>0.05). All procedures including the use of a total clamp (NPA-ATC-ON, ATC-ON and ATC-SBCL-ON groups) had a significantly higher incidence of stroke (all p<0.001). However, the latter procedures did not show difference between them (p>0.05).

Conclusions:
Aortic total clamp is the main factor increasing the incidence of stroke. In contrast, the use of side biting partial clamping, off-pump techniques or cardiopulmonary bypass without aortic clamp and cardioplegic arrest, does not affect the incidence of stroke.
Abstract 15193: Pulmonary Hypertension in Pregnancy: WHO Group 1 Outcomes Improved, Time to Focus on WHO Group 2
Authors: Marshall William H , Gee Stephen , Lim Woobeen , Bradley Elisa A , Lastinger Lauren , Daniels Curt , Benza Raymond L , Cackovic Michael , Rajpal Saurabh
Published: May 2021

Introduction:
Pregnancy is contraindicated in women with pulmonary hypertension (PH), yet many still decide to pursue pregnancy.

Hypothesis:
We hypothesized improved maternal mortality with PH at our center’s cardio-obstetrics program and sought to identify factors to estimate the risk of major adverse cardiac events (MACE).

Methods:
Pregnant women with right ventricular systolic pressure (RVSP) ≥35 mmHg or tricuspid regurgitant velocity > 2.8 m/s on transthoracic echocardiogram (TTE) were identified. Women with intermediate to high probability PH by ESC criteria (TTE or catheterization, n = 70) were classified using the 6
th
World Society of PH definitions.

Results:
In 70 women with PH (30 ± 6 years-old, RVSP 52 ± 16 mmHg) there were 12 (17%) with WHO Group 1 PH, 45 (64%) with Group 2 PH, 4 (6%) with Group 3 PH and 9 (13%) with Group 5 PH (Figure A). Baseline characteristics were similar except: Group 1 PH had 83% on prostacyclin (PC) therapy, higher RVSP (78 ± 20 mmHg vs. Groups 2 (46 ± 9), 3 (44 ± 2 mmHg) and 5 PH (48 ± 10mmHg), p<0.01), and compared to Group 2 PH, more Group 1 PH women were diagnosed pre-pregnancy (9 (75%) vs. 12 (27%), p = 0.01) and had cardio-obstetrics care (10 (83%) vs. 16 (36%), p < 0.01) (Figure B - E). There were no peripartum deaths, however 3 (4.3%) women with Group 2 PH had late mortality (7 ± 4 months post-partum). MACE occurred in 24 (34%) women and was more likely in those with: NYHA FC ≥ 2 (95% CI 4.7-57, p < 0.01), pre-eclampsia (95% CI 1.2-13, p = 0.03), RVSP >50 mmHg (95% CI 1.3-10, p = 0.02) and LVEF <50% (95% CI 1.1-8.8, p = 0.04) (Figure F). Preterm birth occurred in 32 (49%) pregnancies, with no neonatal mortality.

Conclusion:
To conclude, in a large single center cohort we report 100% 1-year survival in Groups 1, 3, and 5 PH, with most Group 1 PH patients on PC therapy and under cardio-obstetrics care. We identify Group 2 PH as an under-recognized group for adverse outcomes in pregnancy, with NYHA FC, pre-eclampsia, RVSP >50 mmHg and LVEF <50% associated with increased MACE.
Abstract 15207: The Risk of Alcohol Consumption Habit in Japanese Atrial Fibrillation Patients: The Fushimi Af Registry
Authors: DOI KOSUKE , Ishigami Kenjiro , Ikeda Syuhei , Hamatani Yasuhiro , An Yoshimori , ISHII MITSURU , Iguchi Moritake , Ogawa Hisashi , Masunaga Nobutoyo , Esato Masahiro , Wada Hiromichi , Hasegawa Koji , Abe Mitsuru , Akao Masaharu
Published: May 2021

Background:
Excessive alcohol intake is the risk of death, cerebrovascular event and bleeding. On the other hand, moderate drinking reduces the risk of cardiovascular event. However, the effect of alcohol consumption habit on mortality and cardiovascular event in AF patients remains unclear.

Method:
The Fushimi AF Registry is a community-based prospective survey of AF patients in Fushimi-ku, Kyoto, which is a typical urban district of Japan. We started to enroll patients from March 2011, and follow-up data were available for 4,466 patients by the end of November 2019. In the entire cohort, data of alcohol drinking were available for 2,944 patients. 834 patients drank daily, 554 socially and 1556 hardly (daily, socially and hardly group, respectively).

Result:
Compared with hardly groups, patients in daily and socially groups were younger, more often male, more in body weight and more likely to have persistent/permanent type AF. Daily and socially groups were less likely to have heart failure, chronic kidney disease and had lower CHA
2
DS
2
-VASc score. Hypertension and prior stroke/SE were the highest in daily group. Pulse rate, diabetes mellitus and prior bleeding were comparable between three groups. During the median follow-up of 1,482 days, the incidence rate of stroke/SE was significantly higher in hardly group than daily or socially groups (daily vs. socially vs. hardly: 1.19 vs. 1.11 vs. 1.49 per 100 person-years, respectively, log rank p=0.006). The incidence rates of all-cause death (2.45 vs. 3.15 vs. 4.44, p<0.0001) and cardiac death (0.26 vs. 0.46 vs. 0.67, p=0.0004) were also significantly higher in hardly group than the other two groups. The incidence rate of major bleeding was not significantly different between three groups (1.35 vs. 1.20 vs. 1.30, p=0.39). On multivariate Cox regression analysis, daily drinking was significantly associated with lower risk of all-cause death and cardiac death. There was no other association between the groups.

Conclusion:
As compared with patients drinking alcohol, the risk of stroke/SE, all-cause death, cardiac death in hardly drinking patients were significantly higher. Daily drinking was significantly associated with lower risk of all-cause death and cardiac death.
Abstract 15217: Combination Phosphodiesterase V Inhibition and Low Dose B-type Natriuretic Peptide Did Not Enhance Renal Function in Acute Heart Failure
Authors: Hubers Scott , benike sherry , Scott Christopher , Johnson Bradley , Chen Horng
Published: May 2021

Introduction:
Cardiorenal dysfunction with impaired cyclic guanosine monophosphate (cGMP) response to volume load is a hallmark of heart failure. Phosphodiesterase V (PDEV) is known to be upregulated and may explain the dysfunction of renal response.

Hypothesis:
We tested the hypothesis that PDEV inhibition in combination with low dose intravenous (IV) B-type natriuretic peptide (BNP) would improve renal function and potentiate urinary sodium and cGMP excretion in patients with acute heart failure.

Methods:
Randomized open label study in 67 patients admitted to the hospital with acute heart failure. These patients were randomized to standard care, low dose IV BNP (0.005μg/kg/min), or combination low dose BNP/PDEV inhibition with sildenafil (25 mg q12 hrs) for 48 hours. Plasma and urine studies were obtained at baseline, 24 hours, and 48 hours after study drug initiation to assess renal function. The primary endpoint was the percent change in estimated glomerular filtration rate (eGFR) and blood urea nitrogen (BUN) from baseline to 48 hours. Changes from baseline were summarized with median and quartiles and groups were compared using two-sample t-test. [ClinicalTrials.gov Identifier: NCT00972569]

Results:
Baseline characteristics were similar between groups. Median age was 78 years and median ejection fraction 39%. Treatment with BNP and BNP/PDEV inhibitor significantly increased plasma cGMP at 24 hr (% increase of 25.6 (8.9, 13.1) and 60.8 (32.3, 103.8) for BNP and BNP/PDEV vs % decrease of 13.5 (-29.1, 14.2) for placebo, p=0.001). BNP levels were significantly higher in both groups at 48 hr compared with placebo. However, there was no significant change in eGFR, BUN, or urinary sodium/cGMP excretion between groups. Hypotension was more common in the BNP/PDEV inhibitor group.

Conclusions:
Low dose IV BNP and combination BNP/PDEV inhibition increased plasma cGMP in patients with acute heart failure but did not improve renal function or urinary sodium/cGMP excretion. Our study does not support the use of low dose IV BNP with or without PDEV inhibition to enhance renal function in patients admitted with acute heart failure.
Abstract 15219: Fully Automated Calcification Segmentation in Intravascular Optical Coherence Tomography Images Using a Two-step Deep Learning Approach
Authors: Lee Juhwan , Gharaibeh Yazan , Zimin Vladislav N , Dallan Luis A , Bezerra Hiram G , Wilson David
Published: May 2021

Introduction:
Major calcifications are of great concern when performing percutaneous coronary intervention as they hinder stent deployment. Calcifications can lead to under-expansion and strut malapposition, with increased risk of thrombosis and in-stent restenosis. Therefore, accurate identification, visualization, and quantification of calcifications are important.

Objective:
In this study, we developed a 2-step deep learning approach to enable segmentation of major calcifications in a typical 500+ frame intravascular optical coherence tomography (IVOCT) images.

Methods:
The dataset consisted of a total of 12,551 IVOCT frames across 68 patients with 68 pullbacks. We applied a series of pre-processing steps including guidewire/shadow removal, lumen detection, pixel shifting, and Gaussian filtering. To detect the major calcifications in step 1, we implemented the 3D convolutional neural network consisting of 5 convolutional, 5 max-pooling, and 2 fully-connected layers. In step-2, SegNet deep learning model was used to segment calcified plaques. In both steps, classification errors were reduced using conditional random field.

Results:
Step-1 reliably identified major calcifications (sensitivity/specificity: 97.7%/87.7%). Semantic segmentation of calcifications following step-2 was typically visually quite good (Fig. 1) with (sensitivity/specificity: 86.2%/96.7%). Our method was superior to a single step approach and showed excellent reproducibility on repetitive IVOCT pullbacks, with very small differences of clinically relevant attributes (maximum angle, maximum thickness, and length) and the exact same IVOCT calcium scores for assessment of stent deployment.

Conclusions:
We developed the fully-automated method for identifying calcifications in IVOCT images based on a 2-step deep learning approach. Extensive analyses indicate that our method is very informative for both live-time treatment planning and research purposes.
Abstract 15259: Breast Cancer and Heritable Pah Due to Bmpr2 Mutation: An Unexpected Discovery
Authors: Toro Victoria , Nadeau Valerie , Helie Pierre , Omura Junichi , Grobs Yann , Martineau Sandra , Paulin Roxane , Potus Francois , BOUCHERAT Olivier , Provencher Steeve , Bonnet Sebastien
Published: May 2021

Introduction:
BMPR2 mutation is reported in 80% of familial PAH and 20% of idiopathic cases. Recently, a rat model of hereditary Pulmonary Arterial Hypertension with a BMPR2 loss-of-function mutation has been generated. Similarly to human, only around 20% of the rats spontaneously developed mild PAH. Unexpectedly, we observed that 20% (95%CI:12-28) of the 82 Bmpr2+/Δ71 rats (93% of females) versus 4% (95%CI:0-9)of the 84 age-matched wild type littermates spontaneously developed mammary masses requiring euthanasia. Interestingly, rats with tumor had elevated PA and clearly exhibit PAH signs.

Hypothesis:
We hypothesized that mammary tumor exacerbates the penetrance of PAH in the BMPR2 mutated female rats.

Methods/Results:
BMPR2 mutated and wild-type female young rats were treated with the breast cancer inducer 7, 12- diméthylbenz(a)anthracene (DMBA) or Vehicle. DMBA causes on average more tumors development in BMPR2 mutated rats versus WT rats (6,2 vs. 4) P=0,0275. Compare to both vehicle-treated and DMBA rats (without tumor) BMPR2 mutated rats with DMBA-induced tumors had a significant increase in mean PA pressure (p<0,0001); total pulmonary resistance (p<0,0001) and a significant decrease in cardiac output (P=0,0293). Histologically, these changes were associated with an increase of pulmonary artery remodelling assessed by immunofluorescence. Mechanistically, development of PAH in the BMPR2 mutated rats with tumor was associated with a significant upregulation of BRD4 (western blot) (p=0,0149); IL-1β (P=0,0052), BRD3 (P=0,0791) and BIRC5 (P=0,0166) mRNA expression levels. Co-culture experiments with breast cancer cells and PASMC from both WT and BMPR2 mutated rats are ongoing to identify whether cancer cells are realising factors responsible for BRD4 activation and thus PASMC proliferation and resistance to apoptosis.

Conclusions:
We demonstrated for the first time that breast cancer exacerbates PAH development in BMPR2 mutated rats. Increased BRDs driven pro-inflammatory signalling is associated with PAH development in BMPR2 mutated rats. We are currently exploring whether BMPR2 mutated patients are more prone to breast cancer development or not and whether PAH development occurs more frequently in breast cancer patients.
Abstract 15265: Trace or Mild Valvular Heart Disease With Cardiac Remodeling, Damage, and Overload in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Gao Yumin , Rubin Jonathan , Cheng Susan , Mathews Lena , Kirtane Ajay , Hoogeveen Ron C , Ballantyne Christie , Selvin Elizabeth , Leon Martin B , Coresh Josef , Solomon Scott , Matsushita Kunihiro , Shah Amil
Published: May 2021

Background:
Few studies have evaluated the link between trace or mild valvular disease with measures of cardiac structure, function, and damage in a general population of older adults.

Hypothesis:
Three left-sided valvular conditions (aortic stenosis, aortic regurgitation, and mitral regurgitation) will be independently associated with cardiac remodeling, damage, and overload.

Methods:
In 4,935 ARIC participants aged 66-99 years in 2011-13, we examined the cross-sectional associations of these three valvular conditions, only in trace or mild forms, with echocardiographic measures (left ventricular mass index, left ventricular end-diastolic diameter [LVDd], ejection fraction [EF], left atrial volume index [LAVI]) and biomarkers (high sensitivity troponin-T [hs-TnT] and natriuretic peptide) using multivariable linear regression. Aortic stenosis was categorized as none or mild by peak transaortic jet velocity and mean transaortic gradient. Regurgitation was categorized as none, trace, or mild based on color Doppler signal (see the Table footnote for detailed definitions).

Results:
The prevalence was 4.3% for mild aortic stenosis, 10.8% for aortic regurgitation (10.3% trace, 0.5% mild), and 44.0% for mitral regurgitation (39.9% trace, 4.1% mild). Each valvular condition showed independent and graded associations with all measures tested (Table), with the exception of aortic stenosis with LVDd and aortic regurgitation with hs-TnT. There was a positive association between aortic stenosis and EF. The associations remained consistent when all three valvular conditions were modeled simultaneously.

Conclusions:
Three prevalent valvular conditions were independently associated with cardiac remodeling, damage, and overload. Although this study cannot determine the directionality of these associations, our results suggest the involvement of mild valvular abnormalities in the pathophysiology of functional and structural alteration of the heart.
Abstract 15266: The Associations Between Pectoralis Muscle Area and Texture on Computed Tomography With Metabolic Syndrome: The Multi-ethnic Study of Atherosclerosis - Arthritis (MESArthritis) Study
Authors: Pishgar Farhad , Shabani Mahsima , Quinaglia A. C. Silva Thiago , Budoff Matthew J , Bluemke David A , Barr Graham , Wu Colin , Ac Lima Joao A , demehri Shadpour
Published: May 2021

Introduction:
Metabolic syndrome (MetS) has been cited as a potentially modifiable risk factor for the cardiovascular outcomes.

Hypothesis
Pectoralis muscle (PM) and intermuscular adipose tissue (IntM AT) areas on chest CT images may be readily obtainable soft tissue biomarkers for MetS screening.

Methods:
Out of 3,204 subjects in the MESA study with available chest CT scan in the exam 5 (4/2010 to 2/2012), 2,975 subjects had quality-essential images and were included in this analysis. The PM and IntM AT areas in the CT images were measured using a framework for image segmentation in the slice above the aortic arch.The presence of MetS subcomponents and the MetS diagnosis for this sample were determined using the NCEP ATP III. The associations between PM and IntM AT areas with MetS subcomponents and diagnosis were studied using regression (adjusted for relevant confounders). The ROC curves were used to defining the optimal cut-off points (using the Youden’s Index) for MetS diagnosis.

Results:
The mean age of subjects was 69.29±9.26 (1,434 men and 1,541 women). In this sample, 1,065 (35.80%) subjects were diagnosed with MetS. IntM AT (OR:1.07(1.02-1.13)), but not the PM (OR:0.98(0.97-1.00)) area, was associated with MetS. Using the ROC curve, the optimal cut-off points of the IntM AT areas and PM for MetS diagnosis were 16.22 and 1.87, respectively. The cut-off point for the PM were highly sensitive (87.1%) but not specific (16.4%).

Conclusion:
Quantitative analysis of PM and IntM AT areas, measured in a predefined “single slice” of the chest CT image using an in-house semiautomatic framework, may be used as an imaging biomarker for MetS.
Abstract 15287: Evolocumab Inhibits the Acute Rise in Lipoprotein(a) in Patients With Non-ST Elevation Myocardial Infarction (NSTEMI)- Results From the EVACS Study
Authors: Vavuranakis Michael , Blaha Michael J , Jones Steven R , Schindler Thomas , Williams Marlene S , Latina Jacqueline M , Schulman Steven P , Gerstenblith Gary , Leucker Thorsten M
Published: May 2021

Introduction:
Elevated Lipoprotein(a) [Lp(a)] is associated with an increased risk of coronary heart disease (CHD). Although Lp(a) is mostly heritable, and controlled by the apo(a) gene, acute increases are described in small studies following acute coronary syndrome (ACS). PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibition modestly reduces Lp(a) in people with stable CHD but its effects during the early phase of an ACS are unknown.

Hypothesis:
Early administration of a PCSK9 inhibitor prevents a rise in Lp(a) following an ACS/NSTEMI.

Methods:
Participants from the EVACS trial (Evolocumab in Acute Coronary Syndrome; NCT03515304), all with a NSTEMI and a troponin-I of > 5 ng/ml were randomized to placebo or to evolocumab. Serum Lp(a) was obtained at study entry prior to study drug and at 30 days. Normally distributed data were summarized using means and standard deviations and non-normally distributed data using medians and interquartile ranges.

Results:
Fifty-six participants were randomized to placebo (27) or to evolocumab (29). Mean age was 55±13 years, 41% were women and 27% were African American. The Scatterplots (Fig.1) demonstrate for those with a baseline Lp(a) of ≤75 nmol/L (the previously described optimal level) there was no increase in Lp(a) over the 30-day study period in either group. However, for those with a baseline Lp(a) of >75 nmol/L there was a significant increase in the placebo group (Panel A), from a baseline of 176.5 nmol/L [131.5, 245.0] to 266 nmol/L [195.8, 302.5] at 30 days, p=0.02, but no increase in the evolocumab group (Panel B; baseline of 142 nmol/L [93, 177] to 137 nmol/L [96.8, 178.3], p=NS). The baseline values of those with Lp(a) of >75 nmol/L did not differ between the groups; at 30 days, however, Lp(a) was higher in the placebo than in the evolocumab group (p=0.02; Panel C).

Conclusions:
Early administration of evolocumab prevents the acute increase in Lp(a) in those with a baseline Lp(a) of over 75 nmol/L following an ACS/NSTEMI.
Abstract 15293: Noninvasive Echocardiographic Cardiac Power Output Predicts Mortality in Cardiac Intensive Care Unit Patients
Authors: Burstein Barry , Anand Vidhu , Ternus Bradley , Tabi Meir , Anavekar Nandan S , Borlaug Barry A , Barsness Gregory W , Kane Garvan , Oh Jae K , Jentzer Jacob C
Published: May 2021

Introduction:
A low cardiac power output (CPO), measured invasively, identifies critically ill patients at increased risk of mortality. CPO can also be measured non-invasively with transthoracic echocardiography (TTE), although prognostic data in critically ill patients is not available.

Hypothesis:
Reduced CPO measured by TTE is associated with increased hospital mortality in cardiac intensive care unit (CICU) patients.

Methods:
Using a database of CICU patients admitted between 2007 and 2018, we identified patients with TTE within one day (before or after) of CICU admission who had data necessary for calculation of CPO. Multivariable logistic regression determined the relationship between CPO and adjusted hospital mortality.

Results:
We included 5,585 patients with a mean age of 68.3±14.8 years, including 36.7% females. Admission diagnoses included acute coronary syndrome (ACS) in 57%, heart failure (HF) in 50%, cardiac arrest (CA) in 12%, and cardiogenic shock (CS) in 13%. The mean left ventricular ejection fraction (LVEF) was 47±16%, and the mean CPO was 1.0±0.4 W. CPO was inversely associated with the risk of hospital mortality (Figure A), including among patients with ACS, HF, and CS (Figure B). On multivariable analysis, lower CPO was associated with higher hospital mortality (OR 0.96 per 0.1 W, 95% CI 0.0.93-0.99, p=0.03). Hospital mortality was highest in patients with low CPO coupled with reduced LVEF, increased vasopressor requirements, or higher admission lactate. Hospital mortality was higher among patients with a CPO <0.6 W (adjusted OR 1.57, 95% CI 1.13-2.19, p = 0.007), particularly in the presence of admission lactate level >4 mmol/L (50.9%).

Conclusions:
Echocardiographic CPO was inversely associated with hospital mortality in CICU patients, particularly among patients with increased lactate and vasopressor requirements. Routine measurement of CPO provides important information beyond LVEF and should be considered in CICU patients.
Abstract 15305: Gastric Ulcer Perforation Mimicking Inferoposterior ST Elevation Myocardial Infarction on Electrocardiogram
Authors: Doshi Amar , Roy Sumon , Tushak Zackary , Kolipakkam Bharadhwaj , Gertz Zachary , Shepard Richard K
Published: May 2021

Introduction:
ST elevation myocardial infarction (STEMI) and gastric perforation are emergencies with progressively higher mortality without emergent intervention. Here we present a case of gastric ulcer perforation presenting as an apparent inferoposterior STEMI.

Case:
A 63-year-old male with hypertension presented with two days of intermittent abdominal pain. While awaiting imaging, the patient developed acute inferoposterior STEMI (figure 1). In route to the cardiac catheterization lab, abdominal CT was emergently reported as gastric ulcer perforation (figure 2). Incorporating multidisciplinary discussions with the cardiac critical care attending, interventionalist, and surgeon, exploratory laparotomy was pursued instead of cardiac catheterization, and the perforation was repaired. Repeat EKG after surgery showed resolution of ST elevations (figure 3) and serial troponins were negative. With no evidence of coronary ischemia, further workup was deferred.

Conclusion:
The unique aspects of this case include how an acute intra-abdominal process can mimic an inferoposterior STEMI and a rapid multidisciplinary approach to decision-making facing two potential concurrent emergencies that was potentially life-saving.
Abstract 15321: Complications of Drug Challenge Testing in Brugada Syndrome: A Systematic Review and Meta-analysis
Authors: Rattanawong Pattara , Vutthikraivit Wasawat , Kewcharoen Jakrin , Hooke Patrick , Srivathsan Komandoor S , Shen Win K , Sorajja Dan
Published: May 2021

Introduction:
Drug challenge testing is performed to unmask Type-1 Brugada pattern. The safety and prevalence of its complications during the test are unclear. We aimed to assess the relation of complications in patients with positive and negative results by a systematic review and meta-analysis.

Hypothesis:
The prevalence of arrhythmic complications is higher in patients with positive drug challenge testing.

Methods:
We comprehensively searched the databases of MEDLINE and EMBASE from inception to June 2020. Included studies were cohort studies that reported ventricular arrhythmia that required interventions (VAI) (sustained ventricular tachycardia [VT], polymorphic VT, ventricular fibrillation, appropriate implantable cardioverter defibrillator [ICD] shock, or sudden cardiac arrest) and ventricular arrhythmias that did not required interventions (VANI) (premature ventricular complexes and non-sustained VT) during drug challenge testing. Data were combined using the random-effects model.

Results:
Thirteen studies involving 2,688 patients (62.7% positive) were included. The overall prevalence of VAI and VANI were 3.7% (95% confidence interval [CI]: 1.8-5.7) and 0.5% (95% CI: 0.1-0.9), respectively. VAI were more common in positive when compared to negative test result patients (1.5% [95% CI: 0.6-2.4] and 0%, respectively) but the prevalence of VANI were similar (2.7% [95% CI: 0.8-4.6] and 2.6% [95% CI: 0.8-4.6], respectively). VAI in positive result patients were more common with flecainide followed by pilsicainide and ajmaline (2.4% [95% CI: -4.3 to 9.2], 2.2% [95% CI: 0.5-4.0], and 1.5% [95% CI: 0.6 to 2.4], respectively). Most of patients with VAI during drug challenge testing underwent ICD implantation (94%). VAI during drug challenge testing in positive result patients carries an increased risk of VAI during 8.6 ± 4.9 years follow-up (odds ratio 3.73, 95% CI: 1.77-7.86, p=0.001).

Conclusions:
VAI were more common in patients with positive drug challenge testing, more often occurring with positive flecainide challenge, and carries an increased risk of VAI over long-term follow-up in patients with positive drug challenge testing.
Abstract 15334: Increased Physical Activity is Associated With Lower Prevalence of Cardiac Symptoms in Adolescents: An Analysis of the Heartbytes Screening Registry
Authors: Nair Abhinav , Weiss Max , Dikdan Sean , Wellings Jennifer , Johnson Drew , Rao Prashant , Langstaff Renee , Shipon David M
Published: May 2021

Background:
The ACC/AHA currently recommend performing a 14-point cardiovascular (CV) evaluation when screening healthy student-athletes for CV disease. This includes a focused history to assess for cardiac symptoms including exertional chest pain, dyspnea, fatigue, palpitations, and syncope. Though the presence of these symptoms may suggest underlying CV disease, additional factors including hours of weekly physical activity may influence the prevalence of reported symptoms. The relationship between physical activity level and the prevalence of cardiac symptoms has not been fully studied in an adolescent population.

Methods:
We analyzed the results of 10683 consecutive athlete screenings (median age 15 years) from HeartBytes, a data registry of pre-participation youth CV screenings utilizing the 14-point AHA evaluation. Cardiac symptoms and hours of weekly physical activity were self-reported. Weekly activity level was reported as less than 2 hours, between 2 and 5 hours, between 5 and 10 hours, or as greater than 10 hours. A chi-squared analysis for independence was performed to evaluate the relationship between physical activity level and each cardiac symptom.

Results:
Chest pain was reported in 5.1% of athletes, and increasing hours of physical activity was associated with less reported pain (

X
2

= 73.01,
p
<.001). Exertional dyspnea was reported in 11.7% of individuals, and increasing activity was associated with less reported dyspnea (

X
2

= 120.53,
p
<.001). Easy fatigability was reported in 7.5% of individuals, with more activity associated with less reported fatigue (

X
2

= 376.61,
p
<.001). Palpitations were reported in 5.1% of those screened, with increasing activity was associated with less reported palpitations (

X
2

= 95.34,
p
<.001). Finally, syncope was reported in 1.1% of athletes, though there was no relationship between activity level and syncope (

X
2

= 5.53,
p
= 0.24).

Conclusion:
Increased physical activity is associated with lower rates of reported chest pain, exertional dyspnea, easy fatigability, and palpitations in adolescents. Further studies are needed to clarify the relationship in youth athletes between symptoms and CV health.
Abstract 15344: Outcomes of the Hybrid Convergent Procedure Compared to Catheter Ablation Stratified by Anti-arrhythmic Drug Usage: Results From Converge Ide, Prospective, Randomized, Multi-center Trial
Authors: De Lurgio David , Crossen Karl J , Gill Jaswinder S , Blauth Christopher , Oza Saumil , Magnano Anthony , Kerendi Faraz , Tschopp David , Taigen Tyler , Calkins Hugh G
Published: May 2021

Introduction:
Atrial fibrillation increases the risk of stroke 5-fold. The efficacy of endocardial catheter ablation (CA) for drug - refractory persistent and longstanding persistent AF (PsAF) is limited and has led to the development of minimally invasive hybrid epicardial/endocardial ablation technique (hybrid Convergent) to achieve a comprehensive lesion set with durable transmural lesions. The CONVERGE IDE randomized controlled trial prospectively evaluated the effectiveness of Convergent ablation compared to CA for the treatment of PsAF.

Methods:
PsAF patients, >18 to <80 years with left atrial sizes up to 6 cm, no limit on the duration of PsAF, refractory/intolerant to class I/III anti-arrhythmic drugs (AADs) were randomized 2:1 to Convergent vs CA at 27 sites (US, UK). Freedom from atrial arrhythmia (AF/AFL/AT) through 12-mo was assessed using 24-hr Holter at 6-mo and 12-mo and ECGs at 3-mo or unscheduled visits. An analysis of freedom from atrial arrhythmia stratified by AAD use was performed.

Results:
One hundred fifty-three patients (102 Convergent, 51 CA) with similar baseline characteristics were treated. Body mass index (mean 33.7, range 19.1- 50.1) and years since PsAF diagnosis (mean 4.4 years, range 0.5 - 26.0 years) were high; 42.5% (65/153) patients had longstanding persistent AF. In the Convergent arm, 4 major adverse events (3.9%, 4/102) were reported through the first 7 days and additional 4 events (3.9%) from days 8 - 30. The safety rates were lower than the performance goal of 12%. Rates of freedom from atrial arrythmia stratified by AAD use are included in Table1. Irrespective of the criteria, the hybrid Convergent procedure demonstrated significantly higher treatment success compared to CA (RR 1.28 - 1.67, p<0.05).

Conclusion:
The hybrid Convergent procedure combining epicardial and endocardial ablation is safe and has superior effectiveness as compared to the endocardial catheter ablation for the treatment of PsAF, irrespective of AAD use.
Abstract 15347: Impact of Covid-19 Pandemia on Provision of Surgical Treatment for Patients With Cardiovascular Disease
Authors: Iafrancesco Mauro , Farina Piero , Bruno Piergiorgio , Pavone Natalia , Mazza Andrea , Cammertoni Federico , Nesta Marialisa , Chiariello Giovanni Alfonso , Grandinetti Maria , Comerci Gianluca , Pasquini Annalisa , Manfredonia Laura , Spalletta Claudio , Massetti Massimo
Published: May 2021

Introduction:
COVID-19 pandemia determined a reduction of healthcare offer to the general population.

Hypothesis:
COVID-19 pandemia increased the number of emergency operations and in particular of life-saving procedures because of the diagnostic delay due to missed follow-up or unwillingness to present to Emergency Departments for the fear of contracting the coronavirus.

Methods:
Retrospective analysis of surgical activity in a large Cardiac Surgery Department from 01 March to 31 May 2020 (study period) compared to the same months of 2019 (control period).

Results:
During the study period there were 191 operations (14% elective and 86% urgent/emergency) versus 225 (44% elective and 56% urgent/emergency) in the control period. Moreover, during the study period four patients presented acutely due to delay of diagnosis: one with ventricular septal defect and free wall rupture due to an evolving acute myocardial infarction (MI) with late presentation; another, who suffered an acute inferior MI several months earlier and did not attend regular follow-up, was operated for a ruptured pseudoaneurysm who was not previously diagnosed; another was operated for aortic and mitral valve endocarditis complicated by cardiogenic shock due to delay caused by a misdiagnosed COVID-19 pneumonia; last patient, previously operated for an acute type A aortic dissection (ATAAD), refused to attend the Emergency Department after the acute onset of back pain and was later diagnosed with severe dilatation (1.4 cm over 6 months) of the thoracic aorta and underwent endovascular stent-grafting. The first patient (who suffered a cardiac arrest after induction of anesthesia) survived with neurological deficit, the second died in the operating room, the third and fourth survived without complications. There were no similar cases in the control period. Finally, two patients were operated for an ATAAD (one COVID-19 positive died of hemorrhagic shock) in the study period versus nine in the control period.

Conclusions:
COVID-19 pandemia resulted in a significant reduction of cardiac surgical activity, mainly related to decrease of elective surgery and an increased number of surgical procedures for life-threatening conditions caused by delayed presentation of acute patients.
Abstract 15350: The State of Renal Sympathetic Denervation for the Management of Patients With Hypertension: A Systematic Review & Meta-analysis
Authors: Syed Moinuddin , Osman Mohammed , Alhamoud Hani , Daggubti Ramesh
Published: May 2021

Introduction:
Sympathetic nervous system plays a central role in the development and persistence of essential hypertension. In recent years Renal Sympathetic Denervation (RSD) has emerged as a promising option for the treatment of patients with hypertension

Hypothesis:
Despite the availability of multiple anti-hypertensive medications, data from the national health and nutritional survey shows that lifelong polypharmacy is failing as a therapeutic strategy due to lack of awareness and compliance with medications. The significant cost in terms of morbidity and mortality associated with uncontrolled hypertension calls for nonpharmacologic approaches for management.

Methods:
We conducted a literature search of PubMed, EMBASE, Cochrane library and Clinicaltrials.gov from inception through May 20, 2020. Outcomes of interest were change in 24-hour ambulatory systolic (ASBP) or diastolic blood pressure (ADBP) and change in office systolic (OSBP) or diastolic blood pressure (ODBP). We pooled data from randomized controlled trials (RCTS) comparing RSD to sham procedures in the management of hypertension using the random effect model.

Results:
A total of 1,363 patients from 8 studies were included in the current meta-analysis. The mean age of the included patients was 56 ± 2.6 years, 29 % were women and the median duration of maximum follow up was 6-month (range 3-12 month). There was more reduction favoring RSD in ASBP (Weighted mean difference (WMD) -3.55; 95%CI -4.91 - -2.19, p<0.001, I
2
=0%), ADBP (WMD -1.87; 95%CI -3.07 - -0.66, p=0.002, I
2
=43%)
,
OSBP (WMD -5.5; 95%CI -7.59 - -3.40, p<0.001, I
2
=7%) and ODBP (WMD -3.20; 95%CI -4.47 - -1.94, p<0.001, I
2
=14%).

Conclusions:
The use of RSD for the management of hypertension resulted in effective reduction in the ambulatory and office blood pressure compared to sham procedure. Adequately powered RCTs of RSD are needed to confirm safety, reproducibility and assess the impact on clinical outcomes.
Abstract 15351: Changes in Left Ventricular End-diastolic Pressure Following Alcohol Septal Ablation in Hypertrophic Obstructive Cardiomyopathy
Authors: Kramer Courtney , Evans Matthew C , Dorsey Andrew , Nielsen Chris , Fernandes VALERIAN
Published: May 2021

Background:
LVEDP is a representation of left ventricular diastolic function. An increased LVEDP correlates to decreased compliance and increased left ventricular workload, which can be seen in HOCM. In HOCM, the interventricular septum is hypertrophied creating a LVOT obstruction and elevated LVEDP. ASA induces a targeted septal infarction to reduce the size of the septum and relieve the LVOT obstruction. Non-targeted infarction in a MI can increase LVEDP. Our study aims to determine the immediate effect of ASA on LVEDP in HOCM patients. It is hypothesized that ASA immediately reduces LVEDP.

Methods:
Retrospective study of 113 patients where pre and post-ablation LVEDP were compared. LVEDP was measured at the end-expiratory R wave of the ECG tracing during the procedure. LVEDP measurements were recorded at the post-“a” wave points at the immediate start of the procedure (Group A), prior to the alcohol injection under mild sedation (Group B), and at the conclusion of the successful ablation (Group C).

Results:
Groups A, B, and C were compared using two-tailed t-tests. We found no statistical difference between groups A and B (mean A=31.34 vs. mean B=31.54; p=0.695). LVEDP was significantly lower in group C when compared to group A (mean A=31.34 vs. mean C=25.82; p=6.525E-9). LVEDP was also significantly lower in group C when compared to group B (mean B=31.54 vs. mean C=25.82; p=4.047E-9). A linear regression model showed no significant correlation between LVEDP and LVOT gradient reduction following ASA (R
2
=0.0258, Significance F=0.0891).

Conclusion:
This data supports our hypothesis that ASA immediately reduces LVEDP despite inducing an infarct of the septal myometrium. There is no effect of sedation on LVEDP during the procedure. Since LVEDP reduction does not seem to correlate with LVOT gradient reduction, the reduction in LVEDP is likely related to other hemodynamics improvements including reduction in mitral regurgitation and immediate improvement in diastolic function. Future studies can include evaluating a correlation between LVEDP reduction and immediate hemodynamic changes. They could also evaluate a correlation between the immediate drop in LVEDP and long-term outcomes to predict the prognosis of HOCM patients based on their ASA outcomes.
Abstract 15358: Cardiac Remodeling in Adults Following Percutaneous Patent Ductus Arteriosus Closure: A Meta-analysis
Authors: Blissett Sarah , Agrawal Harsh , Kheiwa Ahmed , Caughron Hope , Harris Ian , Agarwal Anushree , Foster Elyse , Mallawaarachchi Indika , Mahadevan Vaikom
Published: May 2021

Introduction:
Patent ductus arteriosus (PDA) is often recognized and treated with percutaneous closure in adults. However, the impact on cardiac reverse remodeling following PDA closure in adults is not clear. We performed a meta-analysis to characterize the extent of cardiac remodeling following percutaneous PDA closure in adults.

Methods:
MEDLINE and EMBASE were systematically searched for original studies that reported echocardiographic variables at baseline, immediately post-procedure (within 24 hours), and at follow-up (>1 month) in adults undergoing percutaneous PDA closure. Additionally, we included echocardiographic data from a cohort of patients >18 years of age that underwent percutaneous PDA closure between 01/2015 and 12/2019 at our centre. For parameters with sufficient data for pooling, weighted averages were calculated, and pooled differences were presented as weighted mean differences. Heterogeneity was assessed using the I
2
statistic.

Results:
After screening 278 abstracts, 5 studies were identified. When combined with our own cohort of 13 patients, our meta-analysis encompassed 244 patients. The weighted mean age of all patients was 33 years with all studies predominantly comprised of female patients and the median follow-up was 12 months (ranging from 1 month- 5 years across the studies). When compared to baseline, left ventricular ejection fraction (LVEF) decreased significantly immediately post-procedure and all parameters significantly decreased at follow-up (Table 1).

Conclusions:
As demonstrated by the decreases in the left ventricular and left atrial sizes, reverse remodeling was observed in adults who underwent percutaneous PDA closure. The significantly lower LVEF immediately post-procedure could reflect withdrawal of chronic volume overload or increased afterload. The clinical significance of the statistically significant lower LVEF on follow-up testing is unclear and requires further evaluation.
Abstract 15381: Subjective and Objective Impact of Angiotensin Receptor-neprilysin Inhibitor on Systemic Right Ventricle Patients
Authors: Ephrem Georges , McCollum Jonathan C , Green-Hess Deborah , Sawada Stephen G , Guglin Maya , Rao Roopa A
Published: May 2021

Introduction:
Adult Congenital Heart Disease (ACHD) patients have increased mortality and morbidity from heart failure. Angiotensin receptor-Neprilysin Inhibitors (ARNI) have emerged as a standard of therapy for adults with heart failure. These medicines have not been studied in ACHD patients.

Hypothesis:
ARNIs are associated with subjective and objective improvements in systemic right ventricle (SRV) patients.

Methods:
Eighteen SRV patients were prescribed ARNI at our institution in the last 3 years. Data including demographics, medical history, New York Heart Association functional class (NYHA FC), labs, 3D imaging, echocardiograms, cardiopulmonary stress test (CPET), and hospitalization were obtained by retrospective electronic chart review. Statistical analysis was performed using paired t and Wilcoxon rank sum tests.

Results:
Eighteen SRV patients (mean age 40 years, 72% male) were treated with ARNI (median 13 months) and conventional therapy (beta blocker (83%), loop diuretic (89%), antiarrhythmics (33%), and anticoagulation (50%)). Baseline data include: Mean blood pressure 118/75 mmHg, pulse 75 bpm, creatinine 0.86 mg/dL, potassium 4 meq/L, B-type natriuretic peptide (BNP) 322 pg/mL, and NT-Pro BNP 1091 pg/mL. Nine patients were NYHA FC 2, 7 FC 3, and 2 FC 4. High dose was achieved in 3 (17%) patients, and moderate in 3 (17%). CPET and imaging data were: VO2 18 mL/kg/min, VE/VCO2 38, RVEF 32%, FAC 21%, significant TR (12.5% moderate, and 12.5% severe) and TAPSE 9.4. There was no statistically significant difference pre vs post-ARNI in blood pressure, labs (creatinine, potassium, BNP and NT-ProBNP), or testing (VO2 18 vs 17, p=0.432; VEVCO2 38 vs 39, p=0.850; RVEF 32 vs 32%, p=0.648; FAC 18 vs 21%, p=0.489; TR p=0.317; and TAPSE 9.2 vs 9.1, p=0.906). There was a statistically significant improvement in median NYHA FC (2 vs 2.5, p=0.005), especially if baseline NYHA FC>2 (2 vs 3, p=0.011). There was a noted decrease in cardiac hospitalization (4 vs 9) that did not reach statistical significance (p=0.313).

Conclusions:
ARNIs are associated with noticeable improvement in functional class without impact on objective measures in SRV patients. The study findings are promising and highlight the need for larger, prospective, multicenter studies.