bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15154: Objectively Measured Physical Activity in Patients With Heart Failure
Authors: Klompstra Leonie , Back Maria , Stromberg Anna , Piepoli Massimo , JAARSMA Tiny
Published: May 2021

Introduction:
Novel interventions, such as exergaming, might be promising to increase physical activity (PA). We aim to explore the difference in PA in patients with heart failure (HF) who have access to exergaming compared to patients who received motivational support and to explore predictors of PA increase.

Methods:
This study is part of the HF-Wii study (patients randomized to exergaming or to motivational support) in which a group of HF patients (n=64, mean age 69±9, 27% female, 80% NYHA I/II) wore an accelerometer (Actigraph GT9X). Ten minutes change in daily non-sedentary PA was defined as clinically relevant change. Potential predictors of PA change were, i.e. demographic and clinical variables, self-efficacy (ESS), exercise motivation (EMI), depression (HADs) and Health-related Quality of Life (MLHFQ) analyzed by independent sample t-tests and chi-square. Factors with a significance of 0.15 in the univariate analysis were tested in a logistic regression analysis, corrected for randomization, age, gender and NYHA-class and baseline values for light PA and moderate- to vigorous physical activity (MVPA).

Results:
No differences were found between the exergame group and the control group at 3 months in activity counts (p=0.27), sedentary time (p=0.16), light PA (p=0.69) or MVPA (p=0.17). At baseline, patients had a mean of 173718 (±100545) PA counts/day; 9 hours and 43 minutes a day (±1h 23min) were spent sedentary, 3 hours and 29 minutes a day (±1h 6min) on light PA and 43 minutes a day (±1h 5min) on MVPA ) and 28 patients increased their PA. History of stroke (p=0.05), having grandchildren (p=0.04), recently diagnosed HF (p=0.04), total motivation (p=0.12) and social motivation (p=0.05) were included for the multivariate analysis. Only recently diagnosed HF (p=0.01), a higher social motivation (p=0.02) and a lower amount of light PA at baseline were independent predictors of increasing PA.

Conclusions:
Exergaming did not significantly change PA. A recently diagnosed HF, higher social motivation and lower baseline light PA are factors that need to be considered when developing PA interventions and when motivating patients to become more physically active.
Abstract 15171: Predictive Value of the Wellens’ Sign in an Ethnically Diverse Urban Population
Authors: Arshad Samiullah , Ferrick Neal J , Monrad Scott , Fisher John D , krumerman andrew , Ferrick Kevin J
Published: May 2021

Introduction:
Wellens’ sign is a characteristic finding on ECG, often found to be indicative of severe proximal Left anterior descending artery (LAD) stenosis. Our study sought to identify the prevalence of the Wellens’ sign in the ethnically diverse population of the Bronx, NY and elucidate its relationship to the presence of significant CAD.

Methods:
We retrospectively analyzed an ECG database at Montefiore Medical Center of over 1.7 million ECGs, using six diagnostic codes for anterior ischemia to identify ECGs that resemble the Wellens’ sign. Of the six diagnostic codes, the ECGs of the two highest yielding codes, were identified, then manually reviewed by an electrophysiologist. Patient’s charts and demographics were reviewed and Chi Square test was used to test statistical significance of the data.

Results:
Of the 1,756,742 ECGs done on 433,218 patients between 2012-2019, 26,624 ECGs were isolated. Subsequently, 2186 of these ECGs were manually reviewed. Wellens’ sign was identified in 448 (0.1%) patients, of which, 229 patients underwent cardiac catheterization, while 219 patients were managed medically. There was no statistical difference seen in the prevalence of Wellens’ Type A and B pattern across various ethnic groups (P = 0.213). Significant LAD stenosis was seen in 80 (35%) patients of whom 22 (10%) had proximal, 40 (17%) had mid, 4 (1%) had distal stenosis, while 14 (6%) patients had diffuse LAD disease. Two-vessel disease was seen in 46 (20%) of the patients, and triple-vessel disease was seen in 23 (10%) of the patients. Most common indication for cardiac catheterization was NSTEMI. Takotsubo cardiomyopathy was diagnosed in 19 (8%) patients who had either no or non-obstructive CAD. Among patients with the Wellens’ sign on the ECG but did not undergo cardiac catheterization, majority had a non-ACS presentation.

Conclusions:
No statistical difference in the prevalence of Wellens’ sign was seen among the various ethnic groups. In our study population, Wellens’ sign was a rare ECG pattern with a prevalence of 0.1%. When seen in conjunction with a clinical setting suggestive of angina there is a high probability of underlying CAD. Although significant LAD stenosis is the known most common underlying pathology, multivessel CAD may also occur.
Abstract 15189: Impact of Revascularization Strategy on the Prognosis of Young and Middle-aged Patients With Coronary Artery Disease
Authors: Liu Xiaoyan , Jin Chengyue , Liu Xinyu , Wang Yong , Qiu Hong
Published: May 2021

Introduction:
Despite increasing incidence and mortality of CAD among young and mid-age patients (age ≤ 65), the optimum revascularization strategy remains unclear. We compared outcomes of PCI and CABG in this patient group.

Methods:
“Coronary artery bypass” and “percutaneous coronary intervention” were used to identify articles in PubMed and Cochrane database published prior to February 2, 2020. Both RCTs and observational studies (OSs) comparing PCI and CABG with data of patients or subgroups patients ≤ 65 years of age were included. The quality of study data was assessed by RoB2 and Newcastle-Ottawa Scale (NOS). The primary end point was all-cause mortality. Secondary endpoint includes MI, stroke, repeat revascularization (RR), and a composite endpoint of major adverse cardiac cerebral events (MACCE). We calculated odds ratio using Mantel-Haenszel method with random effects.

Results:
A total of 10 RCTs and 20 OSs with 31226 CAD patients were included in our analysis, of which 1 RCT and 4 OSs focused on population ≤ 65 years old while the rest provided subgroup data. The risk of bias RCTs were low to middle, and quality ratings of OSs were 4-8 by NOS. Compared to CABG, PCI was associated with a higher risk of mortality (OR 1.42, 95% CI 1.24-1.62, P<0.001), MACCE (OR 1.99, P<0.001), MI (OR 2.13, P = 0.011), and RR (OR 3.88, P<0.001). The risk of stroke is similar in both groups (OR 0.883, P= 0.506). However, after stratification, mortality rate is similar in studies with follow-up period ≤ 3 years. (OR 1.27, P=0.255) but remain significant with longer follow-up (OR 1.41, P<0.001).

Conclusions:
Compared to PCI, CABG is associated with lower all-cause mortality in young and middle-aged CAD patients, especially with long follow-up indicating superior long-term survival. Given the longer life-expectancy in this age group, the advantage of CABG is even more prominent. However, given the retrospective nature of this study, dedicated RCT is needed to further address this question.
Abstract 15198: Predictors of Adverse Cardiovascular Outcomes in Patients With Atrial Fibrillation and Heart Failure With Preserved Systolic Function: A Topcat Americas Post Hoc Analysis
Authors: Saksena Sanjeev , Slee April , Lakkireddy Dhanunjaya , Shah Dipen , Di Biase Luigi , Lewalter Thorsten , Natale Andrea
Published: May 2021

Introduction:
Presence of atrial fibrillation (AF) is known to increase mortality and impact cardiovascular(CV) outcomes in heart failure (HF) patients (pts) with preserved systolic function (pEF) but its causes are unknown

Hypothesis:
We hypothesized that AF presentation & clinical factors impact mode of death & CV outcomes of HFpEF pts in the TOPCAT AMERICAS trial.

Methods:
We analyzed demographic, clinical, ECG and AF presentation as predictors of CV mortality, sudden death( SCD) and pump failure death(PFD). We examined two AF presentations 1. Pts in sinus rhythm (SR, n=1319) compared to pts in AF (n=446) on ECG at study entry or 2. Pts with no AF event by history or ECG ( n=1007 ) compared to those with any AF event (n=760 ) during a mean follow up period of 2.9 years(yrs).

Results:
AF pts when compared to the rest of the study population were more likely to be older, male, Caucasian origin, have more alcohol use, diabetes, percutaneous coronary interventions. 5 yr CV mortality was higher in pts with AF on ECG (30%) than those in sinus rhythm (18%, p=0.014) but 5 yr SCD was lower (10% in AF on ECG & 7% in any AF) & comparable to SR (7% & 9% respectively, p=ns). 5 yr PFD was higher (13%) than SR (5%, p=0.007. )Table shows Cox proportional hazards analysis of covariates associated with time to CV death, time to SCD & time to PFD adjusted for baseline imbalances.

Conclusions::
1. CV death risk in HFpEF pts increased with age, in minorities, smokers, diabetics, with lower systolic bp, elevated heart rate & AF on ECG.. 2. SCD was more frequent in males, African Americans & diabetics but was low in both AF & SR, perhaps due to a dominant atrial & limited ventricular arrhythmogenic substrate in HFpEF. 3. PFD in HFpEF increased with age, ECG recorded AF & elevated heart rate.This may reflect importance of atrioventricular synchrony in HFpEF. 4. The recording of AF on ECG at study entry was more strongly associated with CV death & PFD, possibly due to greater AF burden in this group compared to those with any AF even..
Abstract 15212: Long-term Outcomes Between Genders Are Similar Despite Gender Disparities in High-intensity Statin Use in a Contemporary Cohort of Patients Diagnosed With Nonobstructive Coronary Artery Disease by Invasive Coronary Angiography
Authors: Lu Edwin , Hanson Christopher A , Ghumman Saad Sultan , Beller George , Bourque Jamieson M
Published: May 2021

Introduction:
In current practice, high intensity statins are prescribed for patients diagnosed with CAD. However, studies have shown that women are commonly undertreated with statins. We compared long-term outcomes and medication usage patterns related to gender in a contemporary cohort of patients who underwent invasive coronary angiography (ICA) for index evaluation of suspected CAD for an abnormal stress test, stable or unstable angina, following an NSTEMI, or as part of their evaluation for heart failure.

Methods:
A cohort of 850 consecutive patients who underwent ICA for suspected CAD was classified as having normal/near-normal coronary arteries (≤20% stenosis, n=264), nonobstructive CAD (21-49% stenosis, n=114), or obstructive CAD (≥50% stenosis, n=472). We prospectively determined outcomes (cardiac death, nonfatal MI, and late revascularization) via Kaplan-Meier analysis in these 3 groups. We also obtained baseline and follow up data on statin use, and compared usage in the 3 groups related to gender by Chi-square analysis.

Results:
Baseline mean LDL values were 103 in men and 113 in women (p<0.001). At a median follow up of 6.0 years, there was an increase in statin use (51.5% at baseline vs 85.0% at follow up in obstructive CAD group; 54.0% vs 67.3% for nonobstructive CAD group). There were no differences in aspirin, beta-blocker, or overall statin usage by gender across all groups (p>0.05 for all medications). No difference in high intensity statin use (atorvastatin 40/80 mg or rosuvastatin 20/40 mg) was seen between genders in patients with obstructive CAD (61.4% of men vs 62.9% of women, p=0.78). Interestingly, there was a significant difference in usage of high intensity statins between genders in patients with nonobstructive CAD (63.9% of men vs 26.8% of women, p =0.001). Yet, outcomes were similar between genders across all stenosis groups (p>0.05 for all groups).

Conclusions:
Our study shows that fewer women with nonobstructive CAD are treated with high intensity statins compared to their male cohorts. Despite this disparity in treatment, outcomes remained similar between genders. This discrepancy warrants the need for further study and could represent an area for optimization of medical therapy in female patients with nonobstructive CAD.
Abstract 15225: Remote Monitoring Using Implantable Cardiac Defibrillators for Heart Failure Management in a European Cohort: A Meta-analysis
Authors: Ogugua Fredrick M , Gamam Abdulrahman , Addo Basilio , Osei Kofi
Published: May 2021

Introduction:
Remote monitoring (RM) using implantable cardiac defibrillators (ICD) is a rapidly emerging alternative modality in heart failure management. Studies involving US cohorts have shown promising results with RM. We aim to perform a meta-analysis assessing the clinical outcomes of RM versus conventional follow-up among heart failure (HF) patients with an ICD in a European cohort.

Methods:
Electronic database and reference list searches were conducted to identify European studies assessing patient outcomes when managed with RM using ICD versus conventional follow up. After a review of abstracts and selected full-text articles, we identified four randomized trials (RCT) for inclusion. Quality was assessed using the Cochrane Risk of Bias Tool. The primary outcome was the incidence of HF hospitalization and the secondary outcome was all-cause mortality during the follow-up period. A random-effects model was used. All analysis was performed using Cochrane Revman version 5.3.

Results:
Four RCT’s were included, with a total of 4504 participants. Mean follow-up time was 22 months. Rate of HF hospitalization with RM was 678 versus 680 with conventional management (RR: 0.98, 95% CI: 0.88 to 1.10, p = 0.75). All-cause mortality with RM was 252 versus 284 with conventional management (RR: 0.88, 95% CI: 0.75 to 1.03, p =0.11).

Conclusions:
Our study found that in a European cohort, there was no difference in the incidence of HF hospitalization or all-cause mortality among patients managed with RM using ICD and those managed with conventional care. Further research is required to assess the feasibility and generalizability of HF management using ICD’s in different patient populations.
Abstract 15228: Role of Sympathetic Innervation in the Pathogenesis of Abdominal Aortic Aneurysm
Authors: JIANG Bin , Liu Yugang , Ameer Guillermo A
Published: May 2021

Introduction:
The objective of this study is to understand the role of neurological factors, specifically those from the perivascular sympathetic nervous system (SNS), on the initiation and development of Abdominal Aortic Aneurysm (AAA).

Hypothesis:
We hypothesize that the formation of AAA is associated with the loss of perivascular SNS-induced vasoconstriction specific to the aneurysm region.

Methods:
We developed a rat Abdominal Aortic Denervation (AAD) model, where the infrarenal aorta of Spauge Dawley rats was denervated with surgical removal of nerve fibers and chemical denervation with 10% phenol (
Figure. A
). A sham control group was included where the infrarenal aorta was treated with PBS. The arteries were harvested at 1 month after the surgeries for histological assessment.

Results:
The denervated aortas exhibited significant thinning of the aortic wall including the media and the adventitia, compared to the sham controls (
Figure. B
). Moreover, degradation of elastin, demonstrated by the fragmentation of elastic fibers and the decreased number of lamellar units, was also observed in the dennervated aortas in comparison to the sham controls. While the control aortas were well innervated with perivascular nerve bundles adjacent to the adventitia, no nerves were found surrounding the denervated aortas, suggesting successful denervation.

Conclusions:
We generated an AAD model that could be used for mechanistic understanding and therapeutic development of AAA. The preliminary data suggest a direct link between the lack of aortic sympathetic innervation and AAA formation. Long-term studies are currently underway to further characterize changes in the aortic walls after sympathetic denervation.
Figure. (A)
Illustration of the denervated region on the rat infrarenal aorta. (
B
) Histological staining of control and denervated rat abdominal aortas at 1 month after surgery. Yellow stars: para-aortic nerve bundles. Scale bar = 200 μm.
Abstract 15230: Sex and Racial Differences in Normative Reference Ranges and Healthy Aging on Diastolic Function in Ethnic Asians: 2016 Ase Guideline Revisited
Authors: Chang Sheng Nan , Sung Kuo-Tzu , Huang Wen-Hung , Lin Jou-Wei , Chien Shih-Chieh , Hung Ta-Chuan , Su Cheng-huang , Tsai Chia-Ti , Wu Yen-Wen , Chiang Fu-Tien , Yeh Hung-I , Hwang Juey-Jen , Hung Chung-lieh
Published: May 2021

Introduction:
However, the reference ranges for echocardiography might be varying due to ethnicity, gender and age. Therefore, the normal reference ranges obtained from the healthy Asians are important for clinical utility of echocardiography in Asia.

Methods:
Population-based echocardiography dataset from 6,023 healthy ethnic Asians (47.1±10.9 years, 61.3% men) were divided into 6 age decades: ≤29, 30-39, 40-49, 50-59, 60-69 and ≥70 years. We explored age- and sex-related structural/functional alterations according to 2016 American Society of Echocardiography (ASE) diastolic dysfunction (DD) criteria and their correlates with clinical N-terminal pro-brain natriuretic peptide (NT-proBNP) cut-off for heart failure (HF). Racial comparisons were made using data from London Life Sciences Prospective Population (LOLIPOP) study.

Results:
Age- and sex-based normative reference ranges (including mean, median, 10% and 90% lower and upper reference values) were extracted from our large healthy population. In fully adjusted models, advanced age (treated as linear) was independently associated with cardiac structural remodeling and worsened diastolic parameters: larger indexed LA volume (LAVi), lower e’, higher E/e’, and higher TR velocity; all
p
<0.001), and were broadly more prominent in women (P
interaction
: <0.05). in general, markedly lower e’, higher E/e’ and smaller LAVi were observed in ethnic Asians compared to Whites. DD defined by 2016 ASE criteria, despite at low prevalence (0.42%) in current healthy population, increased drastically with advanced age and performed perfectly in excluding abnormal NT-proBNP (≥125 pg/ml) (Specificity: 99.8%, NPV: 97.6%).

Conclusions:
This is to date the largest cohort exploring the normative reference values using guideline-centered diastolic parameters from healthy Asians, with senescence process played as central role in diastolic dysfunction. Observed sex and ethnic differences in defining healthy diastolic cut-offs likely impact future clinical definition for DD.
Abstract 15257: Epicardial and Peri-atrial Fat Attenuation Predict Recurrence in Patients Undergoing Repeat Catheter Ablation for Refractory Atrial Fibrillation
Authors: Brahier Mark S , Zou Fengwei , Migliarese Frank , Tomovic Milos , Taylor Alexandra , Sandfort Veit , Thomaides Athanasios , Bergquist Peter , Srichai Monvadi B , Vargas Jose D
Published: May 2021

Background:
Identifying factors predictive of atrial fibrillation (AF) recurrence after catheter ablation (CA) can improve patient selection. It has been hypothesized that inflammatory paracrine signaling by metabolically active adipose tissue induces pathologic changes in surrounding cardiovascular tissue. In fact, fat attenuation on CT has been previously associated with AF recurrence after de novo CA. The purpose of this study was to investigate the predictive qualities of epicardial and peri-atrial adipose tissue in a population undergoing repeat CA. We hypothesized that higher epicardial and left peri-atrial fat attenuation would predict recurrence as markers of increased localized inflammation.

Methods:
The study population consisted of 84 patients with symptomatic, drug and ablation-refractory AF undergoing repeat CA. All patients had a pre-ablation, contrast-enhanced cardiac CT, which was analyzed for mean fat attenuation in Hounsfield units (HU) and left atrial volume using the post-processing program 3D Slicer. Patients were followed for recurrence of atrial tachyarrhythmias after a 3-month blanking period. We performed logistic regression to adjust for age, sex, BMI, hypertension, smoking history, diabetes, obstructive sleep apnea, and left atrial volume index.

Results:
Repeat CA patients with recurrence (n=52) had a higher epicardial fat attenuation (-84.8 ±5.6 vs -88.1 ±5.2 HU; p=0.009) and peri-atrial fat attenuation (-81.0 ±4.7 vs -83.2 ±4.3 HU; p=0.036) than those without recurrence (n=32) at a mean follow-up period of 26 ±18 months. Logistic regression analysis showed that epicardial fat attenuation (OR 1.21; p=0.005) and peri-atrial fat attenuation (OR 1.27; p=0.007) are predictive of AF recurrence independent of traditional risk factors.

Conclusions:
Epicardial and left peri-atrial adipose attenuation are predictive of recurrence in patients undergoing repeat CA for AF.
Abstract 15268: Development of a Reliable Means of Assessment of Liver Function After the Fontan Operation: Dual Cholate Clearance Assay
Authors: Kim Yuli Y , Everson Greg , Helmke Steve , Carducci Jessica , Glatz Andrew C , Partington Sara L , Ruckdeschel Emily , Rychik Jack , Hoteit Maarouf
Published: May 2021

Introduction:
Currently there is no biomarker or test to accurately measure liver function in Fontan-associated liver disease. The dual cholate test (HepQuant SHUNT) is a noninvasive, flow-dependent assay measuring hepatic clearance of a bile acid, cholate, and may serve as a useful measure of liver function in the Fontan. We aim to measure cholate clearance in a cohort of Fontan patients and compare to normal controls.

Methods:
Single center, prospective pilot study of Fontan patients ≥ 18 years. Hepatic clearance of orally administered d4-cholate and intravenously administered 13C-cholate were measured in peripheral venous samples after 5, 20, 45, 60, and 90 minutes. Portal hepatic filtration rate (HFR), systemic HFR, shunt fraction (systemic HFR/portal HFR), and disease severity index (DSI) were calculated. Decline in HFRs and increase in shunt fraction or DSI is indicative of impaired liver function. Two-sided t-tests were used to compare values between Fontans and controls.

Results:
Twelve Fontan patients were enrolled (33% female, median age 29.9 [range 23.6 - 41.0] years). Median total bilirubin was 0.8 (range 0.3-2.1) mg/dL, AST 30.5 (range 16-55) U/L, ALT 32 (range 11-53) U/L, alkaline phosphatase 87 (range 42-191) U/L and platelets 177 (range 130-428) 10
3
/μL. Mean cardiac index was 3.0 ± 0.5 L/min/m
2
. Cholate clearance was lower in Fontans compared to controls (Figure). Mean portal HFR (mL/min/kg) in Fontans was lower than controls (15.1 ± 10.9 vs 29.1 ± 9.0; p<0.001) as well as systemic HFR (3.7 ± 1.3 vs 6.5 ± 1.5; p<0.001) whereas shunt fraction (%) was not (29.2 ± 11.4 vs 24.1 ± 7.5; p=NS). DSI was higher in Fontans compared to controls (19.4 ± 6.1 vs 9.2 ± 3.4; p<0.001).

Conclusions:
Fontan patients demonstrate reduced hepatic function compared to normal controls but there is considerable variability. Future studies using the dual cholate test will examine the relationship between liver and cardiac function, as well as risk of adverse clinical outcome, in the Fontan.
Abstract 15274: Social Determinants of Suboptimal Cardiovascular Health Among Pregnant Women in United States
Authors: Sharma Garima , Grandhi Gowtham R , Acquah Isaac , Mszar Reed , Mehta Laxmi S , Gulati Martha , Bhugra Priyanka , Satish Priyanka , Yahya Tamer , Blumenthal Roger S , Cainzos-Achirica Miguel , Nasir Khurram
Published: May 2021

Introduction:
Cardiovascular health (CVH) and social determinants of health (SDOH) have a significant impact on maternal morbidity and mortality. We assessed the association and cumulative effects of SDOH on CVH among a nationally representative sample of pregnant women in the United States.

Methods:
We included cross-sectional data of pregnant women aged 18 to 49 years from the National Health Interview Survey (2013-2017). We ascertained CVH based on the following CV risk factors: hypertension, diabetes mellitus, dyslipidemia, smoking, obesity, and physical activity; classifying participants into optimal (0-1) and suboptimal (≥2) CVH. For each individual, SDOH risk score was calculated that represents the cumulative number of distinct variables (present vs absent) identified on 39 sub-components for 6 domains (economic stability, neighborhood and physical environment, community and social context, food, education, and healthcare system access). SDOH risk score was aggregated and divided into 4 quartiles.

Results:
Among 1,433 (3.3%, representing 2.2 million) pregnant women in US, one third (33%) of pregnant women (mean age: 33 years, 13% non-Hispanic black) had suboptimal CVH. The prevalence of hypertension, smoking, obesity and physical inactivity across the increasing SDOH quartiles were noted. Overall, 52% pregnant women with unfavorable (4
th
quartile) vs 27% with favorable (1
st
quartile) SDOH had suboptimal CVH. In multivariable analyses, accounting for demographics and co-morbid conditions, pregnant women with unfavorable SDOH in 4
th
quartile had nearly 3-fold higher odds of suboptimal CVH. (Figure).

Conclusions:
Aggregate SDOH risk score provides significant discrimination of CVH in pregnant women. In pregnant women, suboptimal CVH is common and more than 1 in 2 women with highest risk of SDOH inequities have suboptimal CVH, highlighting the public health urgency for intervention in young high risk women.
Abstract 15296: Systemic Lupus Erythematosus Patients Admitted for Atrial Fibrillation Do Not Have Worse Outcomes: Analysis of the National Inpatient Sample
Authors: Edigin Ehizogie , Eseaton precious O , Rivera Pavon Mavi M , Akuna Emmanuel , Asemota Iriagbonse R , Ojemolon Pius E , Shaka Hafeez , manadan augustine
Published: May 2021

Introduction:
Systemic Lupus Erythematosus (SLE) is known to increase the risk of atrial fibrillation (AF), however it is unclear if SLE worsens outcomes in patients admitted for AF. This study aims to compare the outcomes of patients primarily admitted for AF with and without a secondary diagnosis of SLE.

Methods:
Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 Database. NIS is the largest inpatient hospitalization database in the United States. The NIS was searched for hospitalizations with AF as principal diagnosis with and without SLE as secondary diagnosis using ICD-10 codes. Hospitalizations for adult patients from the above groups were identified. The primary outcome was inpatient mortality. Hospital length of stay (LOS), total hospital charges, odds of undergoing ablation, pharmacologic, and electrical cardioversion were secondary outcomes of interest. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used to analyze the data.

Results:
There were over 71 million discharges included in the combined 2016 and 2017 NIS database. 821,630 hospitalizations were for adult patients, who had a principal ICD-10 code for AF. 2,645 (0.3%) of these hospitalizations have co-existing SLE. SLE group were younger (67 vs 71 years, P < 0.0001) and had more females (85% vs 51%, P < 0.0001). Hospitalizations for AF with SLE had similar inpatient mortality (1.5% vs 0.91%, AOR: 1.0, 95% CI 0.47-2.14, P=0.991), LOS ( 4.2 vs 3.4 days, P=0.525), total hospital charges ( $51,351vs $39,121, P=0.056), odds of undergoing pharmacologic cardioversion ( 0.38% vs 0.38%, AOR: 0.90, 95% CI 0.22-3.69, P=0.880) and electrical cardioversion (12.9% vs 17.5%, AOR 0.87, 95% CI 0.66-1.15, P=0.324) compared to those without SLE. Hospitalizations for AF with SLE had increased odds of undergoing ablation (6.8% vs 4.2%, AOR: 1.9, 95% CI 1.3-2.7, P<0.0001) compared to those without SLE.

Conclusions:
Patients admitted primarily for AF with co-existing SLE had similar inpatient mortality, LOS, total hospital charges, likelihood of undergoing pharmacologic and electrical cardioversion compared to those without SLE. However, SLE group had more odds of undergoing ablation.
Abstract 15300: Epidemiology and Risk of Anxiety and Depression Among Patients With Lown-Ganong-Levine Syndrome
Authors: Zmaili Mohammad , Alzubi Jafar , Alameh Anas , Saliba Walid I , Wazni Oussama M , Hussein Ayman
Published: May 2021

Introduction:
Lown-Ganong-Levine (LGL) syndrome is a rare congenital pre-excitation syndrome with a perinodal accessory pathway. Arrhythmic events may lead to, or be influenced by, a myriad of psychological conditions such as anxiety and depressive disorders. There is no epidemiological data on the co-occurrence of these conditions in patients with LGL syndrome. We sought to describe the epidemiology and risk association of anxiety and depression in LGL syndrome.

Methods:
A multi-institutional database (Explorys Inc, Cleveland, OH, USA), with an aggregate of electronic health record data from 26 major integrated US healthcare systems, was surveyed. A cohort of patients with a Systematized Nomenclature of Medicine—Clinical Terms (SNOMED-CT) diagnosis of “Lown-Ganong-Levine syndrome” between 1999 and 2020 was identified. Demographic characteristics along with relevant clinical and social information were obtained.

Results:
Of 73,044,190 individuals in the database (1999-2020), 1,180 were given the diagnosis of LGL. Compared to subjects without LGL, patients with LGL syndrome were more likely to have anxiety (OR=5.9, p<0.001) and depression (OR=5.2, p<0.001). Within the anxiety and depression cohorts, LGL patients were more likely to be females, and had a higher association with smoking, alcohol and substance abuse. Anxiety but not depression was more common in young adults (18-65 years old). No difference in supraventricular arrhythmias was found between LGL patients carrying these psychiatric diagnoses with those who don’t.

Conclusion:
This is the largest study to date demonstrating the significant association between LGL and common psychiatric conditions. Care should be taken in identifying and managing such conditions as they, along with their pharmacologic therapies, may mimic or exacerbate the symptoms of LGL syndrome.
Abstract 15302: Cardiac MRI Assessment of Cardiac Output Agrees With Simultaneous Fick Assessment in Pediatric Heart Transplant Patients
Authors: Schramm Jennifer , Cronin Ileen , McCarter Robert , Cross Russell , kanter joshua , Downing Tacy E , Olivieri Laura
Published: May 2021

Introduction:
Systemic cardiac output (Qs) and pulmonary blood flow (Qp) can be measured by cardiac magnetic resonance (CMR) and invasive oximetry, with studies showing good agreement between the two modalities. CMR-guided right heart catheterization (MR-RHC) collects simultaneous CMR and oximetry measurements permitting direct comparison. This study assessed agreement between CMR and Fick measurements of cardiac output in the pediatric heart transplant (HT) population.

Methods:
Twenty-three pediatric HT patients (body surface area range 0.6-2 m
2
) with 53 MR-RHC between 2014 -2020 were reviewed. One outlier was excluded due to erroneous pulmonary vein saturation, leaving 52 MR-RHC for analysis. Measurements of un-indexed Qs and Qp from both CMR phase contrast and invasive oximetry using Fick were collected. Bland-Altman (BA) statistical and graphical analyses compared CMR versus Fick estimates of Qs and Qp.

Results:
BA limits of agreement (LOA) and corresponding concordance plot demonstrate good agreement between CMR and Fick (Figure 1). Panels A and B are the BA and concordance plots for Qs, respectively. Panels C and D are the BA and concordance plots for Qp, respectively. The 95% confidence interval LOA are -1.0 to +1.8 for Qs and -1.0 to +1.7 for Qp. Average bias and Lin correlation are similar for Qs and Qp at +0.36 L/min and 0.8, respectively.

Conclusions:
CMR and Fick measurements of Qs and Qp are similar in pediatric HT patients, with a tendency for slightly higher values by Fick estimates and similar LOA to previously published results. CMR acquired hemodynamics offer a radiation-free modality to reduce overall radiation exposure for pediatric HT patients.
Abstract 15311: Drivers Associated With Dense Fibrotic Regions Are Critical Targets in Extra-Pulmonary Vein Ablation in Persistent Atrial Fibrillation
Authors: Subr Megan M , Mylavarapu Uma , Hoenie Lisa , Wilson Allison , Helfrich Katelynn M , Hansen Brian , Mikhailov Aleksei , Pan Yue , Nalar Aaqel , Kennelly James , Zhao Jichao , Simonetti Orlando , Hummel John , Fedorov Vadim V
Published: May 2021

Background:
Multielectrode mapping (MEM) of extra-pulmonary vein (PV) targeted ablation of persistent atrial fibrillation (PsAF) drivers suffers from false positives. Early studies suggest that true AF drivers are anchored to arrhythmogenic fibrosis, which can be visualized with late gadolinium enhanced (LGE) cardiac magnetic resonance (CMR) to distinguish them from false positive drivers on MEM.

Hypothesis:
Driver regions integral to AF correlate with high atrial fibrosis; therefore, ablation of MEM-defined drivers within fibrotic regions may lead to better outcomes than MEM-defined drivers outside fibrosis.

Methods:
Pre-ablation, 10 PsAF patients (Pts) (70% male; 65±11 y/o) underwent LGE-CMR at 3T (0.625x0.625x1.25mm
3
, 0.2mmol/kg gadolinium). During ablation, MEM (64-electrode basket catheter) was used to identify Pt-specific extra-PV drivers. Retrospectively, both left (LA) and right atria (RA) were analyzed with atria-specific fibrosis masks (voxels exceeding an intensity of 3-3.5 standard deviations above the mean intensity of nonfibrotic atrial wall). Ablated drivers were classified as fibrotic driver (dense or patchy) or nonfibrotic driver by LGE-CMR and MEM correlation.

Results:
30 drivers were ablated in 10 PsAF Pts (2±1 LA drivers/Pt, 1±1 RA drivers/Pt) and were classified if anchored to dense (n=16, 45.4±31.7%, 2.6±1.8cm
2
), patchy (n=11, 8.9±13.5%, 2.0±2.5cm
2
), or no (n=3, 2.3±2.0%) fibrosis. At follow-up (13±7 mos), 7/10 Pts remained free from AF and atrial flutter, all of whom had at least one dense fibrosis driver ablated and all but 1 Pt had ablations limited to fibrotic drivers. 2/3 patients with failure at follow-up had a nonfibrotic driver ablated.

Conclusion:
Our results suggest that limiting ablation of AF drivers to those anchored to dense fibrotic substrate may improve long-term AF-free survival. Identification of Pt-specific fibrotic substrate by LGE-CMR may help specificity of MEM ablation targets for successful PsAF treatment.
Abstract 15312: Racial Disparities in Trends in Mortality From Cardiac Arrests in the United States
Authors: Al Zubaidi Anas M , Bevan Graham , Rana Mariam , Al Armashi Abdul Rahman , Alqaysi Mustafa , Al-Kindi Sadeer
Published: May 2021

Background:
African Americans are at increased risk of fatal cardiac arrests, but population-based studies exploring contemporary epidemiology are not available. We sought to identify the trend in race-specific mortality from cardiac arrest in the United States.

Methods:
Using the multiple cause of death database, we identified all patients (Caucasians or African Americans) who died of cardiac arrest (International Classification of Diseases, 10th revision code I46.x listed as underlying cause of death) between 1999 and 2018. Age-adjusted mortality rates were standardized to the 2000 US census data, and stratified by age group (<35 years, 35-64 years, and ≥ 65 years).

Results:
A total of 311,065 cardiac arrest deaths were identified, with an overall age-adjusted mortality of 53.6 per million (Caucasian: 49.1 per million, African American: 90.6 per million). Overall, age-adjusted mortality decreased from 80.1 per million persons (1999) to 44.3 per million persons (2012), followed by 8.8% increase to 48.2 (2018). Between 2012 and 2018, African Americans had higher rates of increase (10.9%) compared with Caucasians (6.9%). Largest disparities in relative changes between 2012 and 2018 occurred in patients younger than 35 years (African American: 35%, Caucasians -11%), and patients ≥ 65 years (African Americans: 8%, Caucasians 4%), figure.

Conclusions:
Although the mortality due to cardiac arrest has declined in the US between 1999 and 2012, a recent increase has been noted between 2012 and 2018, particularly among younger African Americans. Studies should focus on identifying causes of disparities and identifying methods to reduce the racial gap.
Abstract 15313: Analysis of Survival in Octogenarian and Nonagenarian Patients Treated With Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction
Authors: Saxena Aaruni , Ghobrial Hedra , AlSayed Ahmed Ahmed Sayed G , Jamil-Copley Shahnaz , Sprigg Nikola , Uddin Akhlaque
Published: May 2021

Introduction:
With advancement in interventional cardiology an increase in the number of percutaneous coronary intervention (PCI) procedures has been noted in the elderly. However, the post procedure complication and mortality remain a challenge for the physicians. This study aimed to estimate the survival among men and women above 80 years of age who undergo primary PCI for treatment of ST elevation myocardial infarction.

Methods:
We analyzed the data collected prospectively from our cardiac center. The patients were followed up over 10 years. Most patient received stents followed by anti-platelet drugs and preventive measures to avoid further cardiac event. Kaplan Meier curves were generated to study survival post PCI (SPSS v2.2). Survival curves were developed to determine the influence of age, sex, type of stent and degree of coronary flow (TIMI 0-3) on post procedure survival.

Results:
From 2010 to 2019, total 502 patients >80 years received PCI (282 males, 218 females). The median survival in the male and female population were 2.16 yrs. (95% CI 1.66 - 2.66) and 2.36 yrs. (95% CI 1.72-2.99)(P= 0.18). Significant difference of around 1 year (2.7 yrs. octogenarian vs 1.6 yrs. nonagenarian, p<0.001, see figure 1) was found in post PCI survival between octogenarian and nonagenarian. However, the survival was longer in case of Bare metal stents (BMS)(n= 113) as compared to Drug eluting stents(DES)(n= 274) (2.7 yrs. vs. 2.0yr, p<0.001). Similarly, post procedure TIMI flow analysis shows maximum survival in TIMI 3 followed by TIMI 2 and TIMI 1 ensuring the significance of TIMI grade flow.

Conclusions:
Our results demonstrate that PPCI in elderly patients have a better outcome and longer survival in octogenarians than nonagenarians. Similarly, use of BMS could be considered over DES in population above 80 years of age irrespective of gender. No difference in post PCI survival in male and female population.
Abstract 15323: Patients With Heart Failure With Preserved Ejection Fraction Contend With Deficits Across Multiple Domains of Health
Authors: Navid Pedram , Zarzuela Kate , Musse Mahad , Wang Marcos , Siceloff Birgit , Masterson Creber Ruth M , Yaghoobzadeh Hooman , Lachs Mark , Safford Monika M , Goyal Parag
Published: May 2021

Introduction:
The domain management approach to caring for heart failure patients outlines the importance of considering deficits from multiple health domains including: medical, mental and emotional, physical, and social. The extent to which these deficits exist in patients with HFpEF is unknown. We sought to characterize deficits across multiple domains among patients seen in an outpatient HFpEF program.

Hypothesis:
We hypothesized that HFpEF patients would have a high prevalence of deficits across multiple domains.

Methods:
We conducted a retrospective study of 134 patients with HFpEF seen between July 2018 and December 2019 in the Weill Cornell HFpEF Program, which incorporates the domain management approach through several assessments. The medical domain includes an assessment of multimorbidity (≥ 2 comorbid conditions), polypharmacy (≥ 5 medications), malnutrition (Mini Nutritional Assessment < 12), and hearing and vision impairment (self-report). The mental and emotional domain includes cognitive impairment (Mini-Cog < 3), depression (PHQ-9 ≥ 10), and anxiety (GAD-7 ≥ 10). The physical function domain includes frailty (Short Physical Performance Battery < 10), functional impairment (Katz Index < 6), and fall within the past year (self-report). The social domain includes loneliness (UCLA 3-Item Loneliness Scale ≥ 6) and living situation (self-report).

Results:
The median age was 75 years (IQR 69-82), 60% were women, and 64% were White. The Figure shows the prevalence for each deficit across the four domains. The most common deficits were multimorbidity (100%), polypharmacy (98%), frailty (79%), and loneliness (62%). Notably, 13% of patients had deficits in all four domains, 31% in three domains, 47% in two domains, and 9% in one domain.

Conclusions:
HFpEF patients have deficits spanning multiple domains. This supports the importance of considering issues such as multimorbidity, polypharmacy, frailty, and loneliness when caring for these patients.
Abstract 15329: The CADILLAC Risk Score Outperforms the TIMI Risk Score in Accurately Identifying Patients at Low Risk for In-hospital Mortality and Adverse Cardiovascular Events Following ST-Elevation Myocardial Infarction
Authors: Malamas Peter , Lall Sumeet , Dembo Brent , Zaman Ninad , Peterson Brandon , Wilson Ryan
Published: May 2021

The CADILLAC and TIMI risk scores have been used to predict events following revascularization following STEMI. Utilizing these scores may help to identify patients at low risk for mortality and major adverse cardiac events (MACE) following STEMI. We aimed to compare the prognostic accuracy of CADILLAC and TIMI risk scores for identifying patients with low risk for mortality and MACE.

Retrospective review at a tertiary medical center of patients presenting with STEMI from 2014-2018, excluding those who presented with cardiogenic shock, cardiac arrest, or need for mechanical circulatory support. MACE was defined as sustained ventricular arrhythmias, ACS, CHF, and stroke. Low risk patient (CADILLAC 0-2, TIMI 0-1) outcomes were compared to high risk (CADILLAC>2, TIMI>1) using chi square, ROC, and logistic regression analyses. The study includes 341 patients. In hospital CADILLAC score for low risk patients had significantly lower event rate compared to high risk (4.7% vs. 11.7%, odds ratio = 0.37, 95% CI 0.16-0.85, p= 0.028). In hospital TIMI score comparing low vs. high risk patients showed no difference (8.3% vs. 7.2%, odds ratio= 1.18, 95% CI 0.39 - 3.59, p= 0.48). ROC curve predicting event rate showed CADILLAC (C=0.66, odds ratio 1.18; 95% CI 1.04 - 1.33; p=0.0064) vs. TIMI (C= 0.57, odds ratio 1.20; 95% CI 0.98 - 1.46; p=0.071). Evaluating 30 day and 1 year follow up, CADILLAC better predicted event rates vs. TIMI (Figure 1). Logistic regression for CADILLAC at 1 year shows significant association with event rates independent of parameters comprising either risk score (odds ratio 1.29; 95% CI 1.07 - 1.57; p=0.011) while TIMI does not (odds ratio 1.21; 95% CI 0.93 - 1.56; p=0.16). In conclusion, patients defined as low risk by CADILLAC following STEMI have significantly reduced in-hospital event rates. Utilizing this scoring system may help to guide feasibility of early hospital discharge. CADILLAC outperforms TIMI in its prognostic ability both in-hospital and follow ups.
Abstract 15330: Association Between Elective Percutaneous Coronary Intervention Appropriateness and Publicly Reported Outcomes
Authors: Kini Vinay , Hess Paul , Liu Wenhui , Grunwald Gary , Ho Michael , Bradley Steven M
Published: May 2021

Introduction:
Public reporting of percutaneous coronary intervention (PCI) outcomes such as readmission and mortality may cause harm by adversely affecting patient selection for PCI. Little is known about the relationship between these outcomes and elective PCI appropriateness - a validated metric of PCI quality.

Methods:
We identified all patients in the national Veterans Administration healthcare system who underwent elective PCI for stable coronary disease between 2013 and 2015. We defined PCI appropriateness using 2012 criteria. The primary outcome was 90-day all-cause hospitalization or mortality. We used hierarchical Cox proportional hazards regression models adjusted for patient- and facility-level covariates to compare outcomes across PCI appropriateness categories, and a joint survival/logistic model to compare facility-level variation in inappropriate PCI and 90-day outcomes.

Results:
Among 2,561 patients (mean age 66 years, 99% men) undergoing PCI across 59 sites, 29.6% were classified as appropriate, 10.4% as inappropriate, and 60% as uncertain. The proportion of patients who were readmitted or died were 15.6%, 16.4%, and 15.3% among patients who received appropriate, inappropriate, and uncertain PCI respectively. There were no significant differences in 90-day outcomes between the groups (hazard ratio for appropriate compared to inappropriate PCI 0.82 [CI 0.57 to 1.17; p=0.28]). The site level covariance between inappropriate PCI and 90-day outcomes was -0.033 (95% CI -0.117 to 0.047), indicating no site-level correlation between appropriateness and 90-day outcomes (Figure).

Conclusion:
We found no association between elective PCI appropriateness and 90-day outcomes among a national cohort of Veterans. Including appropriateness in public reports may 1) characterize PCI quality more fully and 2) potentially mitigate the harms of reporting outcomes by empowering providers to perform appropriate PCI in higher-risk patients.
Abstract 15357: P2Y12 Inhibitor Monotherapy After Short-term Dual Antiplatelet Therapy in Patients Receiving Percutaneous Coronary Intervention
Authors: Lone Ahmad Naeem , Khan Safi U
Published: May 2021

Introduction:
The safety and effectiveness of new strategy of de-escalating short-term dual antiplatelet therapy (DAPT) (≤ 3-month) followed by P2Y12 inhibitor monotherapy versus 12-month DAPT after percutaneous coronary intervention (PCI) is unclear.

Hypothesis:
Short-term DAPT followed by P2Y12 inhibitor therapy might be safer and equally effective compared with 12-month DAPT.

Methods:
Five randomized controlled trials (n=32,181) comparing P2Y12 inhibitor monotherapy with DAPT after PCI were selected from MEDLINE and EMBASE databases through June 2020. Meta-analysis was performed using random effects model. Results are reported as absolute risk differences (ARDs) with 95% confidence intervals (CIs).

Results:
Short-term DAPT followed by P2Y12 monotherapy was associated with lesser risk of major bleeding compared with 12-month DAPT (ARD, -0.73% [95% CI, -1.32%, -0.14%]). There were no differences between all-cause mortality (ARD, -0.22% [95% CI, -0.50%, 0.07%]), cardiovascular mortality (ARD, -0.24% [95% CI, -0.51%, 0.03%]), myocardial infarction (ARD, -0.13% [95%CI, -0.40%, 0.14%]), MACE (ARD, -0.25% [95% CI, -0.73%, 0.24%]) and stroke (ARD, 0.03% (95% CI, -0.22%, 0.29%]). These results were consistent across use of clopidogrel or ticagrelor.

Conclusions:
Short term DAPT followed by P2Y12 inhibitor monotherapy after PCI is safer and equally effective compared with 12-month DAPT.