bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14356: Initial Experience With Telemedicine for Interstage Monitoring in Infants With Palliated Congenital Heart Disease
Authors: Stagg Alyson , Giglia Therese M , Gardner Monique , Offit Bonnie F , Fuller Kate M , Natarajan Shobha S , Hehir David A , Szwast Anita L , Rome Jonathan J , Ravishankar Chitra , Preminger Tamar J
Published: May 2021

Introduction:
Infants with staged surgical palliation for congenital heart disease are at high-risk for interstage morbidity and mortality. We have previously described the mediated risk for this patient population through close home monitoring. Given high rates of intercurrent illness, geographic and sociodemographic disparities in access to care, and significant family stressors, we instituted a telecardiology (TC) program in 2019.

Methods:
All consecutive patients discharged home were monitored from neonatal operation or intervention to subsequent surgical palliation. All had home scales and pulse oximeters. TC visits (TCVs) were held monthly, and increased to bimonthly during the COVID-19 pandemic. TCVs were launched through the electronic medical record (EMR) through a mobile device, with a full-version EMR available for access to full records and efficient documentation. We tracked how TCVs identified clinical concerns, prevented unnecessary emergency room visits (ERV) and expedited in-person assessment.

Results:
Between 8/2019-5/2020, we conducted 60 TCV for 29 patients (16 had stage 1 palliation, 6 with aortopulmonary shunt or stent and 7 with biventricular physiology with shunt or stents. Initial median weight was 3.4 kg (range 2.3-5.4 kg). Median monitoring time was 199 days (75-264). Median visits per patient were 2 (1-5 V) with average length per visit of 20 minutes. Most scheduled visits were completed (90%); 5% declined, and 5% canceled. Parents reported satisfaction for 97% of visits. In 6 visits (10%) significant clinical findings were identified which avoided ERV or hospital admissions, 4 TCVs (7%) visits led to expedited outpatient assessments, 1 required hospitalization. There were no missed events nor deaths. Additional issues identified included changes to medication (23%), feedings (15%) and equipment malfunction (5%). Frequency of EDV decreased from median 0.4 (0-3.7) V/patient/month the prior year to 0 (0-2.5), p=0.0004].

Conclusions:
TC in these high-risk patients is feasible and effective to identify clinical concerns, no missed events and decrease in ERV per patient. TC was particularly effective during the COVID-19 pandemic allowing for easy adaptation of care to ensure patient safety in this fragile cohort.
Abstract 14357: Straight for the Jugular: Cardiomyopathy After Recent EBV Infection and Lemierre Syndrome
Authors: Dangelo Robert N , GERSZTEN Robert E , Garan Reshad , Pinto Duane S , Freed Jason , Kazi Dhruv
Published: May 2021

A 21-year-old man presented to an outside hospital with 10 days of fever, fatigue, and malaise. On exam, temperature was 106F, blood pressure 85/50 mm Hg, and heart rate 121 bpm. He was cold and clammy, with elevated jugular venous pressure, normal heart sounds, clear lungs, and cool extremities without edema. Laboratory results were notable for elevated white blood cell count (predominantly neutrophils), serum triglycerides, ferritin, C-reactive protein, coagulation parameters, and positive Monospot test. Following blood cultures, he was initiated on broad spectrum antibiotics, fluid resuscitated, and started on norepinephrine, epinephrine, and phenylepehrine. Shortly after transfer to our institution, although asymptomatic, an electrocardiogram demonstrated diffuse 5 mm ST-elevations with elevated cardiac biomarkers. A transthoracic echocardiogram demonstrated biventricular contractile dysfunction with ejection fraction 20% and apical akinesis. The patient was diagnosed with mixed cardiogenic and distributive shock. Cardiogenic shock was attributed to myocarditis with possible vasospasm or cytokine-induced myocardial suppression. Coronary angiogram was deferred given low suspicion for thrombotic acute coronary syndrome. Cardiac MRI showed subepicardial early and late gadolinium enhancement consistent with myocarditis, but negative viral serologies. Distributive shock was thought to be due to sepsis or hemophagocytic lymphohistiocytosis (HLH). The patient received empiric dexamethasone for HLH; and the diagnosis was confirmed on bone marrow biopsy. Blood cultures grew
Fusobacterium necrophorum
and neck imaging revealed thrombosis of the left internal jugular vein. Lemierre syndrome, thought to be bacterial invasion in the setting of tonsillitis was diagnosed. He was treated with antibiotics and dexamethasone with rapid clinical improvement and recovery of biventricular function. We suspect EBV infection lead to Lemierre syndrome and HLH with secondary myocardial suppression from the resultant cytokine storm. This case describes the first case of HLH-related myocarditis and highlights clinical decision-making surrounding the workup and management of mixed etiologies of shock with suspected myocarditis.
Abstract 14367: Abnormal Pulmonary Flow is Associated With Impaired Right Ventricular Coupling in Patients With COPD
Authors: Oganesyan Ani , Barker Alex J , Frank Benjamin S , IVY Dunbar D , Browne Lorna , Hunter Kendall S , Brett Fenster E , Schafer Michal
Published: May 2021

Introduction:
Cor Pulmonale
or right ventricular (RV) dysfunction due to pulmonary disease is an expected complication of COPD resulting from increased afterload mediated by hypoxic pulmonary vasoconstriction as well as the destruction of the pulmonary vascular bed. Early detection of elevated RV afterload has been previously demonstrated by visualization of abnormal flow patterns in the proximal pulmonary arteries. Prior quantitative analysis of helicity in the pulmonary arteries of pulmonary hypertension patients has demonstrated a strong association between helicity and increased RV afterload.

Hypothesis:
Patients with COPD will have abnormal pulmonary flow as evaluated by 4D-Flow MRI and associated with RV function and pulmonary arterial stiffness.

Methods:
Patients with COPD (n=15) (65yrs ± 6) and controls (n=10) (58yrs ± 9) underwent 4D-Flow MRI to calculate helicity (Figure 1A). The helicity was calculated in 2 segments: 1) the main pulmonary artery (MPA) and 2) along the RV outflow tract (RVOT) - MPA axis. Main pulmonary arterial stiffness was measured using the relative area change (RAC).

Results:
COPD patients had decreased helicity relative to healthy controls in the MPA (19.4±7.8 vs 32.8±15.9 s
-2
, P=0.007) (Figure 1B). Additionally, COPD patients had reduced helicity along the RVOT-MPA axis (33.2±9.0 vs 43.5±8.3 s
-2
, P=0.010). The helicity measured in the MPA was associated with RV end-systolic volume (R=0.59, P = 0.002), RVEF (R=0.631, P<0.001), RAC (R=-0.61, P=0.001). e combined helicity along the MPA-RVOT axis was associated with RVEF (R=0.74, P<0.001), RVESV (R=-0.57, P=0.004), and RAC (R=0.42, P=0.005).

Conclusion:
Patients with COPD show quantitatively abnormal flow hemodynamics, when compared with healthy controls, as assessed by 4D-Flow MRI. A strong association between helicity along the MPA-RV outflow tract axis and RV function suggests that 4D-Flow MRI might be a sensitive tool in evaluating RV - pulmonary arterial coupling in COPD.
Abstract 14384: Light Therapy Improves Circadian Blood Pressure Control and Glucose Homeostasis in Rotating Night Shift Workers via Mechanisms Independent of Melatonin
Authors: Hannemann Juliane , Laing Anika , Middleton Benita , Cridland Jonathan , Staels Bart , Marx Nikolaus , Grant Peter J , Federici Massimo , Stenberg Tarja , Skene Debra J , Boeger Rainer
Published: May 2021

Introduction:
Night shift work is associated with high rates of hypertension, heart disease, and metabolic syndrome. These cardiometabolic diseases have been linked to the disruption of circadian rhythms in night shift workers. Rotating night shift work is increasingly common in the working population worldwide.

Hypothesis:
We hypothesized that light therapy might help to normalize disrupted circadian rhythms and stabilize diurnal control of blood pressure and glucose tolerance in rotating night shift workers.

Methods:
We randomized 24 rotating night shift workers (mean age, 36±13 years, 7 males) who had spent a median of 6 years on rotating night shifts with a median of 6 night shifts/month to 12 weeks of light therapy (light during first half of each night shift and in the morning of off-work days) or no intervention and compared them with 12 daytime workers (37±11 years, 6 males). We measured oral glucose tolerance (OGTT), 24h blood pressure and arterial stiffness, and the circadian profiles of melatonin, cortisol, metanephrine and normetanephrine at baseline, after 12 weeks of intervention, and 12 weeks after the end of intervention.

Results:
At baseline, fewer night shift workers showed dipper status of blood pressure as compared to daytime workers (21% vs. 55%; p<0.001). After 12 weeks of light therapy, there was a highly significant increase in the proportion of dippers (to 42%; p<0.0001). We also observed a significant decrease in serum glucose during OGTT in the light therapy group (-22%; p<0.05), with no change in serum insulin. Whilst circadian profiles of melatonin and cortisol were unchanged, there was a significant reduction in nighttime plasma metanephrine and normetanephrine levels in the light therapy group (p<0.01).

Conclusions:
Chronotherapeutic light therapy significantly improves diurnal blood pressure control and glucose tolerance in rotating night shift workers. This effect is unrelated to mechanisms traditionally linked to the circadian clock like melatonin and cortisol, but it is paralleled by reduced catecholamine levels. Our data suggest that chronotherapeutic light therapy may improve the adjustment to atypical working hours in rotating night shift workers, thereby reducing stress and improving cardiometabolic function.
Abstract 14398: African Americans With Transthyretin Cardiac Amyloidosis Have a Lower Prevalence of Atrial Fibrillation but Increased Thromboembolic Events Than Caucasians
Authors: Mitrani Lindsey R , Vilches Silvia , Mussinelli Roberta , Salinaro Francesco , De Los Santos Jeffeny , Gonzalez-Lopez Esther , Caponetti Angelo Giuseppe , Saturi Giulia , Perlini Stefano , Rapezzi Claudio , Garcia-Pavia Pablo , Maurer Mathew S
Published: May 2021

Background:
African Americans (AA) have a higher rate of stroke and of stroke-related death compared with Caucasians (Cau). Paradoxically, atrial fibrillation (AF), a common cause of stroke, affects twice as many Cau compared with AA. Transthyretin cardiac amyloidosis (ATTR-CA) is commonly associated with AF and strokes. We hypothesized that AF race-related patterns in the general population would exist in patients with ATTR-CA with increased thromboembolic events in the AA population.

Methods:
Patients with ATTR-CA (n=615) at four international centers were retrospectively identified. We compared baseline characteristics, presence of atrial fibrillation, and outcomes of thromboembolic events (stroke, transient ischemic attack, and peripheral embolism) and major bleed between AA and Cau.

Results:
Of 615 patients, 545 (88.6%) identified as Cau, and 70 (11.4%) as AA. As shown in table 1, Cau patients were diagnosed with AF more often than AA (p <0.01), while AA were younger and more often had ATTRv disease (p <0.01). Both prevalent and incident thromboembolic events were more common in AA than Cau. Major bleeding was more prevalent at baseline for AA with no difference was shown in follow-up, though AA had more often labile INR (p<0.01). AA more frequently had no anticoagulation compared with Cau (p<0.01) Over a median of 26 months, 24 Cau (4.4%) had thromboembolic events compared with 10 (14.3%) AA (p <0.01).

Conclusions:
These data suggest that while Cau with ATTR-CA more often have AF than AA, thromboembolic events are more common in the AA population. Whether these data relate to mechanism of disease or disparities in healthcare is yet to be determined
Abstract 14407: The Longer-term Efficacy and Safety of Evinacumab in Patients With Homozygous Familial Hypercholesterolemia
Authors: Raal Frederick J , Rosenson Robert S , Reeskamp Laurens F , Hovingh G. Kees , Kastelein John J , Rubba Paolo , Ali Shazia , Banerjee Poulabi , Chan Kuo-Chen , Khilla Nagwa , Pordy Robert , Zhang Yi , Gaudet Daniel
Published: May 2021

Background:
Homozygous familial hypercholesterolemia (HoFH) is a rare genetic lipid disorder characterized by markedly elevated LDL-C and premature ASCVD. For HoFH patients (pts) with complete loss of low-density lipoprotein receptor (LDLR) function in both copies of the
LDLR
gene (null mutations) and some other HoFH pts, statins and PCSK9 inhibitors have limited to no efficacy, presenting a great unmet medical need. The efficacy and safety of evinacumab (EVIN; an angiopoietin-like protein 3 inhibitor) in HoFH pts was assessed during the double-blind treatment period (DBTP) of a phase 3 trial (NCT03399786).

Objective:
To examine longer-term efficacy and safety of EVIN in pts with HoFH who participated in the subsequent open-label treatment period (OLTP) of this phase 3 study.

Methods:
Patients with HoFH on stable lipid-lowering therapies (± lipoprotein apheresis) and screening LDL-C ≥70 mg/dL who completed the 24-week DBTP entered the 24-week OLTP and received IV EVIN 15 mg/kg every 4 weeks.

Results:
In total, 64 pts completed the DBTP and received open-label EVIN. Mean (standard deviation [SD]) baseline LDL-C at DBTP entry was 250.5 (162.3) mg/dL. From baseline to Week 48, EVIN reduced mean LDL-C by 46.3% (mean [SD] reduction of 134.3 [117.3] mg/dL). At Week 48, mean LDL-C reductions with open-label EVIN were 42.7% and 55.8% for pts who received EVIN (n=44) vs placebo (n=20) during the DBTP, respectively (
Figure
). LDL-C reduction observed at Week 48 was similar for pts with null/null mutations (n=19; 47.2%) versus non-null/null mutations (n=39; 45.9%). Adverse events (AEs) occurred in 47 pts (73.4%) during the OLTP; the most common were nasopharyngitis (9.4%) and headache (9.4%). During the OLTP, serious AEs occurred in 7 pts (10.9%; all pts received EVIN during the DBTP); none were considered related to study treatment.

Conclusions:
In pts with HoFH, EVIN showed substantial and sustained LDL-C reduction regardless of LDLR function and was generally well tolerated.
Abstract 14410: A Machine Learning Approach to Predicting Risk of Anthracycline Cardiotoxicity in Pediatric Cancer Survivors
Authors: Chaix Marie , Parmar Neha , Lafreniere-Roula Myriam , Akinrinade Oyediran , Yao Roderick , Miron Anastasia , Lam Emily , Meng Guoliang , Christie Anne , Manickaraj Ashok Kumar , Marjerrison Stacey , Dillenburg Rejane , Bassal Mylène , Lougheed Jane , Zelcer Shayna , Rosenberg Herschel , Hodgson David , sender leonard , Liu Peter , Kantor Paul F , Manlhiot Cedric , Ellis James , Mertens Luc , Nathan Paul C. , Mital Seema
Published: May 2021

Background:
Despite known clinical and genetic risk factors, predicting anthracycline cardiotoxicity remains challenging.

Objective:
To develop a risk prediction model for anthracycline cardiotoxicity in childhood cancer survivors.

Methods:
We performed exome sequencing in 289 childhood cancer survivors at least 3 years from anthracycline exposure. In a nested case-control design, 183 cases with LV ejection fraction (LVEF) ≤55% despite low-dose doxorubicin (DOX) (≤250 mg/m2), and 106 controls with LVEF >55% despite DOX >250 mg/m2 were selected as extreme phenotypes. Rare/low-frequency variants were collapsed to identify genes differentially enriched for variants between cases and controls. The top-ranked genes were functionally evaluated in human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) and variant enrichment was confirmed in a replication cohort. Using random forest, a risk prediction model that included genetic and clinical predictors was developed.

Results:
Thirty-one genes were differentially enriched for variants between cases and controls (p<0.001). Only 42.6% cases harbored a variant in these genes compared to 89.6% controls [Odds ratio (95% CI), 0.086 (0.043-0.171), p=3.98x10
-15
] suggesting that absence of these variants may predispose to cardiotoxicity. A risk prediction model for cardiotoxicity that included clinical and genetic factors had a higher prediction accuracy and lower misclassification rate compared to the clinical model. In vitro inhibition of gene-associated pathways (
PI3KR2, ZNF827
) provided protection from cardiotoxicity in CMs.

Conclusions:
Our study identified variants that protect against cardiotoxicity and informed the development of a prediction model for delayed anthracycline cardiotoxicity, and also provided new targets in autophagy genes for development of cardio-protective drugs.
Abstract 14432: Myocardial Work in Stage I and II Hypertensive Patients
Authors: Jaglan Akshar , Roemer Sarah , Perez Moreno Ana C , Khandheria Bijoy K
Published: May 2021

Introduction:
Myocardial work is a novel parameter that can be used in a clinic setting to assess left ventricular (LV) pressures and deformation. This study sought to distinguish patterns of global myocardial work index in hypertensive vs. non-hypertensive patients.

Methods:
Fifty (25 male, mean age 60±14 years) hypertensive patients and 15 (7 male, mean age 38±12 years) control patients underwent transthoracic echocardiography at rest. Hypertensive patients were divided into stage 1 (26 patients) and stage 2 (24 patients) based on the 2017 American College of Cardiology guidelines. We excluded patients with suboptimal image quality for myocardial deformation analysis, reduced ejection fraction (EF), valvular heart disease, and arrhythmia. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were estimated from LV pressure strain loops utilizing proprietary software from speckle-tracking echocardiography. LV systolic and diastolic pressures were estimated using a noninvasive brachial artery cuff.

Results:
Global longitudinal strain (GLS) and EF were preserved between the two groups with no statistically significant difference whereas there was a statistically significant difference in the GWI (p<0.01), GCW (p=0.03), GWW (p<0.01), and GWE (p=0.03) (Figure and Table).

Conclusions:
Myocardial work gives us a closer look at the relationship between LV pressure and contractility in settings of increased load dependency whereas LVEF and GLS cannot. We show how myocardial work is an advanced assessment of LV systolic function in hypertensive patients.
Abstract 14451: Bone Marrow Cell Therapy Improves Cardiac Function, Survival, and Clinical Outcomes in Patients With Chronic Ischemic Heart Disease
Authors: Ha Jane , Afzal Muhammad R , Samanta Anweshan , Zuba-Surma Ewa , Yoo Ji , Dawn Buddhadeb
Published: May 2021

Introduction:
The effects of bone marrow cell (BMC) therapy in patients with chronic ischemic heart disease (CIHD) remain controversial.

Hypothesis:
We hypothesized that injection of BMCs in patients with CIHD would improve left ventricular (LV) structure and function. We also hypothesized that BMC therapy would improve clinical outcomes in CIHD patients.

Methods:
We performed a systemic review and meta-analysis of pooled data from published randomized controlled trials (RCTs) that evaluated the efficacy of BMC administration in patients with CIHD. The effects of BMC injection on LV ejection fraction (LVEF), LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV), infarct size, and patient outcomes were analyzed using random-effects meta-analysis.

Results:
The literature search yielded 30 RCTs enrolling 1,548 patients. Transplantation of BMCs resulted in an improvement in LVEF in cell-treated patients compared with controls (2.89%; 95% confidence interval (CI): 1.80 to 3.97;
P
<0.001). There was a trend toward reduced LVESV (-4.96 ml; 95% CI: -11.64 to 1.71 ml;
P
= 0.14) and LVEDV (-5.95 ml; 95% CI: -12.09 to 0.18 ml;
P
=0.06). The improvement in LVEDV was more pronounced (-7.42 ml; 95% CI: -13.68 to -1.17ml;
P
=0.02) in patients with baseline LVEF <40%, indicating improved LV remodeling. BMC injection was also associated with marked reduction in the risk of all-cause mortality, rehospitalization due to heart failure, and ventricular arrhythmias in CIHD patients.

Conclusions:
BMC injection improves cardiac function and remodeling in patients with CIHD. These benefits are more pronounced in patients with LVEF <40% at baseline. Perhaps more importantly, BMC therapy also improves clinical outcomes that are critically important for this patient population with LV dysfunction, including survival, rehospitalization due to heart failure, and ventricular arrhythmias.
Abstract 14472: Indications for ICD Implantation Differ Between Women and Men
Authors: Ingelaere Sebastian , Hoffmann Ruben , Mairesse Georges , Vandekerckhove Yves R , le Polain de Waroux Jean-Benoît , Vijgen Johan , Blankoff Ivan , Willems Rik
Published: May 2021

Introduction:
The impact of gender on ICD implantation practice and survival remain a topic of controversy. We analysed differences between men and women in patients implanted with an ICD in Belgium.

Methods:
The Belgian governmental health care institution (RIZIV/INAMI) keeps track of every ICD implantation by a digital registry. Participation is mandatory for reimbursement. From this registry, we analysed all new ICD implantations between 01/02/2010 and 31/01/2019 in Belgian patients. We compared men with women for baseline patient characteristics. We used a Chi
2
test for categorical variables (NYHA class, primary vs secondary prevention, underlying heart disease, type of device, QRS duration, presence of atrial fibrillation, diabetes and other comorbidity, center volume, population density and average income of the area of residency) and a Mann-Whitney U test for continuous variables [age and ejection fraction(EF)]. We used the Bonferroni method to correct for multiple testing. Secondly, we performed a Kaplan-Meier analysis. At last, we performed a multivariate logistic regression for 3-year and total mortality.

Results:
Only 3146 (20.8%) on 14747 implantations were in women. Women were significantly younger and had a better EF compared to men. Except for oncological history, women had less comorbidities (table 1). More women functioned in NYHA class > II and had a QRS > 150ms, which was consistent with a higher CRT-D vs VVI/DDD ratio. Kaplan-Meier showed a survival benefit in women (log-rank, p=<0.001). Further exploration with multivariate logistic regression showed that female gender was significant protective for long-term total mortality, but not for short-term 3-year mortality.

Conclusions:
Only a minority of patients implanted with a new ICD in Belgium are women. Their clinical profile differs from men. Their long-term survival is better, which can in part be explained by differences in indications and comorbidities.
Abstract 14475: Successive Distal Transradial Approach for Coronary Catheterization in the Same Arm
Authors: Yamada Takeshi , Washimi Soichiro , matsubara yuki , Hashimoto Sho , Taniguchi Norimasa , Nakajima Shunsuke , Hata Tetsuya , Takahashi Akihiko
Published: May 2021

Background:
The distal transradial approach (dTRA) for coronary catheterization is a newly introduced alternative to the conventional transradial approach. This study investigated how many times the same distal radial artery can be cannulated for coronary catheterization.

Methods:
A total of 1717 patients underwent 2406 coronary catheterization procedures between April 2018 and March 2020. The dTRA was used as the primary approach whenever feasible in this study period, and the dTRA was used for 1555 patients (90.6%) and 2129 procedures (88.5%). Patients who underwent repeated coronary catheterization after the initial procedure using dTRA were included in this study. The incidence of successive application of dTRA in the same arm and the reasons for access site conversion were investigated.

Results:
A total of 430 patients were included in this study; of these, in 10 patients, the distal radial artery was cannulated on both sides in the initial procedure. The patient group included 320 men (74.4%), and the mean age was 72.2 ± 10.8 years. A 4-, 5-, or 6-French sheath or sheathless system was used in the initial procedure. A maximum of four successive coronary catheterization procedures, including the initial procedure, were carried out. The second procedure involved the distal radial artery on the same side in 394 cases (89.5%), and the fourth dTRA procedure was possible in 81.7% of the cases. Access site conversion during the follow-up procedure, which was observed in 57 cases, was attributed to radial artery occlusion (17.5%), narrowing of the distal radial artery (33.4%), tortuous route of the right upper limb approach (15.8%), and strategic reasons, such as aortography or coronary bypass graft angiography (15.8%).

Conclusions:
The dTRA was successfully applied in the same arm in 89.5% of the cases in the second procedure and 81.7% in the fourth coronary catheterization procedure.
Abstract 14477: Adolescent Lipoprotein Subclass Profile: Reference Ranges, Comparison to Adult, and Association With Carotid Intima-media Thickness
Authors: Pechlaner Raimund , Friedrich Nele , Staudt Anna , Gande Nina , Bernar Benoît , Stock Katharina , Kiechl Sophia J , Hochmayr Christoph , Griesmacher Andrea , Petersmann Astrid , Budde Kathrin , Stuppner Hermann , Sturm Sonja , Cannet Claire , Fang Fang , Schäfer Hartmut , Spraul Manfred , Geiger Ralf , Nauck Matthias , Kiechl Stefan , Kiechl-Kohlendorfer Ursula , Knoflach Michael
Published: May 2021

Introduction:
Atherosclerosis begins in early life. Assessment of comprehensive lipoprotein subclass profiles in adolescents and their relation to atherosclerosis may enhance our understanding of the development of dyslipidemia in early life and inform early vascular prevention

Hypothesis:
Lipoprotein subclass profiles in adolescents are distinct from those in adults and associate with carotid intima-media thickness (cIMT).

Methods:
Content of lipids (cholesterol, free cholesterol, triglycerides, phospholipids) and apolipoproteins (apoB-100, apoA1, apoA2) of 17 lipoprotein subclasses (from least dense to densest: VLDL1-6, IDL, LDL1-6, HDL1-4) was measured in plasma of n=1776 14- to 19-year olds (56.6% female) and of n=3217 adults (51.5% female) by nuclear magnetic resonance. cIMT was ascertained by sonography in adolescents.

Results:
Adolescents compared to adults featured lower triglycerides, total, LDL, and non-HDL cholesterol, and apoB, and higher HDL cholesterol. They showed 27.2 to 60.5% lower triglyceride content of all lipoprotein subclasses and 21.7 to 50.0% lower VLDL lipid content. Concentrations of LDL-4 and LDL-5 were 40.7 to 47.3% lower, with markedly lower levels also of LDL-6 and LDL-3, but 24.3% higher HDL-1 ApoA1. In adolescents, LDL-3, LDL-4, and LDL-5 subclasses were associated with cIMT (difference in cIMT for a 1-SD higher concentration, 4.76 to 5.93μm), whereas no significant association with cIMT was observed for VLDL or HDL.

Conclusions:
Adolescents showed a markedly different and more favorable lipoprotein profile compared to adults. Dense LDL subclasses were the only subclasses associated with cIMT, implicating them as the potential preferred therapeutic target for primary prevention of cardiovascular disease in adolescents.
Abstract 14483: Association Between Four Selected Social Determinants of Health and Readmissions for Patients in the Grady Heart Failure Program, 2018-2019
Authors: Marshall Ashley , Minaya-Junca Jasmin , Lane Rashon , Macleod Kara , Wirth Diane , Onwuanyi Anekwe
Published: May 2021

Introduction:
African Americans have a higher prevalence of heart failure (HF) than white Americans due in part to social determinants of health (SDOH). The Grady Heart Failure Program (GHFP) at Grady Memorial Hospital (GMH) in Atlanta aims to reduce readmissions for primarily low income, underinsured, African American patients with congestive HF. The GHFP addresses barriers to access to care through a community health worker, mobile health visits, transportation support, and low-cost medication. This study examines whether four key SDOH variables from Healthy Planet, a population health module in GMH’s electronic medical record, are associated with readmissions for GHFP patients.

Methods:
We analyzed data on demographics (race, sex, ethnicity) and SDOH variables (homelessness, financial resource strain, inability to afford medications, and issues with transportation to medical appointments) from Healthy Planet linked to HF-related readmissions from the GHFP’s dashboard. A total of 420 patients in the GHFP were included in this analysis from May 2018-April 2019. We evaluated the relationship between SDOH variables and any HF-related readmission and any 30-day HF-related readmission within the 12-month study period using Fishers exact tests.

Results:
Of the 420 patients, 92% were non-Hispanic African American, 62% were male, and 22% were uninsured. In the year prior to their first GHFP consult, 22% experienced homelessness, 49% had financial resource strain, 30% were unable to buy needed medications, and 46% had difficulty with transportation to medical appointments. A total of 76 patients (18%) were readmitted (range 1-5 readmissions), and 26 (6.2%) were readmitted within 30 days (range 1-4 readmissions within 30 days) over 12 months. No SDOH variables were associated with any 30-day HF-related readmission. Transportation issues were associated with any HF-related readmission (
P
=0.04).

Conclusions:
While the majority of GHFP patients experienced SDOH-related barriers to care, none were associated with any 30-day readmissions and only transportation issues were associated with any readmissions. Future studies and models will examine whether the GHFP’s efforts to address social needs have led to a decline in 30-day readmission rates.
Abstract 14489: Physician Perspectives on the Diagnosis and Management of Heart Failure With Preserved Ejection Fraction (HFpEF)
Authors: Padarath Michelle , Ngui Daniel , Ezekowitz Justin , Padarath Michelle , Bell Alan
Published: May 2021

Introduction:
Heart failure with preserved ejection fraction (HFpEF) carries high morbidity and mortality. Compared to heart failure with reduced ejection fraction (HFrEF), HFpEF is more difficult to diagnose and lacks in evidence-based treatments. We assessed the perceptions of CV specialists and primary care physicians (PCP) regarding HFpEF diagnosis and management.

Methods:
The online survey targeted 200 specialists and 200 (PCPs), offering a token honorarium. A total of 159 cardiologists (C), 59 internists (I), and 200 PCPs completed the survey.

Results:
All provinces were represented. The perceived prevalence of HFpEF vs HFrEF was similar across physician types (58% HFrEF, 42% HFpEF). Roughly 25% of PCPs did not differentiate between HF types. All physician types ranked symptom and mortality reduction as treatment priorities. The majority of specialists felt that HFpEF is best co-managed by primary and specialty care. One fifth of PCPs felt that HFpEF should be managed by primary care alone. Compared to specialists, PCPs were more likely to underestimate HFpEF mortality vs. HFrEF, less aware of gender differences, and less able to identify clinical findings of HFpEF vs. HFrEF. Fewer PCPs (33%) than specialists (50%) use natriuretic peptide (NP) levels for diagnosis, with PCPs expressing more uncertainty with NP utility. All physician types listed cost and limited availability as restrictions to use of NP testing. For evidence-based treatments in HF (ACEi/ARB, beta blockers, loop diuretics, mineralocorticoid receptor antagonists), >50% of PCPs incorrectly identified all agents as effective for HFpEF, with <10% stating that none improved outcomes. Cardiologists were more likely than internists to identify the lack of evidence-based treatments.

Conclusions:
This survey reveals substantial knowledge and treatment gaps in the diagnosis and management of HFpEF, specifically amongst PCPs. Given the prevalence of HFpEF in primary care, and its substantial morbidity and mortality, strategies are required to reduce these gaps. All physician types recognized the need for increased availability of NP testing for HFpEF diagnosis.
Abstract 14637: In-hospital Outcomes of Transcatheter Aortic Valve Replacement (TAVR) in Patients With a History of Malignancy
Authors: Grant Jelani , Ebner Bertrand , Vincent Louis , Maning Jennifer , olarte neal , Olorunfemi Odunayo P , Saul Eduardo , Vaz Igor , Colombo Rosario A , Braghiroli joao
Published: May 2021

Introduction:
A history of malignancy is incorporated in the Society of Thoracic Surgeons (STS) Score to assess presurgical risk in patients undergoing surgical aortic valve replacement (SAVR), however data on the prognostic importance in those undergoing TAVR remains limited.

Methods:
The National Inpatient Sample Database was queried from 2012 to 2017 to identify patients who underwent TAVR using International Classification of Diseases (ICD) 9 and 10 procedure codes. These patients were classified into those who had a history of malignancy or not using ICD 9 and 10 diagnostic codes.

Results:
There were 24,615 patients who underwent TAVR, of these 4,735 patients had a prior history of malignancy whereas 19,880 patients had no prior history of malignancy. Patients with a history of malignancy were older than those without (81.1±7.9 vs. 80.1± 6.7 years old, p<0.001). Baseline characteristics are shown in Table 1. Patients with a history of malignancy had similar rates of post-TAVR pacemaker implantation (7.6% vs. 6.8%,p=0.05), deep vein thrombosis/pulmonary embolism (2.8% vs.3.1%, p=0.231), paravalvular leak (0.9% vs. 1.1%, p=0.312) and cardiogenic shock (0.3% vs. 0.3%, p=0.828) as those without. The occurrence of post TAVR ischemic strokes were higher in those without a history of malignancy ( 4.8% vs. 3.6%, p<0.001). Using a multivariate logistic regression model to adjust for confounding factors such as age, gender, hypertension, diabetes, heart failure, chronic kidney disease and coronary artery disease, a history of malignancy was predictive of decreased odds of death in patients undergoing TAVR (odds ratio: 0.69, 95% confidence interval 0.53-0.90, p=0.007).

Conclusions:
In patients with severe symptomatic AS and a history of malignancy, TAVR appears safe with comparable in-hospital outcomes. A history of malignancy should not preclude TAVR in patients with severe symptomatic AS, however larger studies are needed to confirm this finding.
Abstract 14656: Fusion of Fluoroscopy and Echocardiography During the Mitraclip® Procedure Reduces Time to Transseptal Puncture and Radiation Exposure
Authors: Slaven Sarah , Burke Joseph , Hammers Jacob , Quaife Robert A , Jone Pei-ni , Salcedo Ernesto E , Carroll John , Gill Edward A
Published: May 2021

Introduction:
Transseptal puncture (TSP) is an essential step in percutaneous structural heart interventions, such as the MitraClip® procedure. Radiation exposure is a hazard for Interventional Cardiologists, Echocardiographers, and patients. Advancements in shielding and radiation equipment have reduced this exposure, but further reduction is desired. EchoNav® (Philips) fuses fluoroscopy and echocardiography resulting in a single multimodal image display. Prior studies demonstrated reduced time to TSP with use of EchoNav® but failed to show significant reduction in radiation. We hypothesized that increased experience using EchoNav® would further decrease TSP time and radiation dose.

Methods:
Single center, retrospective analysis evaluated 202 patients undergoing MitraClip® procedure pre and post-EchoNav® from 6/2010 to 12/2019: 8 pre and 194 post. We measured time to TSP and radiation exposure by Air Kerma and dose area product (DAP). For the post-EchoNav® cases, we evaluated these variables by 2-year time periods to examine change over time.

Results:
Comparing pre and post-EchoNav
®
procedures, time to TSP was non-significantly reduced overall (40.00±14.95 to 33.63±15.92, p=0.23). However, post-EchoNav
®
had a decreasing trend (48.00±28.39, 43.47±15.86, 28.45±11.94, 27.55±10.64; R
2
=0.89, p =0.009) that was significantly less than pre-EchoNav
®
by the third time period (40.00±14.95 vs 28.45±11.94, p=0.05) and remained less in the fourth (40.00±14.95 vs 27.55±10.64, p=0.03). Radiation was reduced post-EchoNav
®
by both DAP (264.52±150.03 to 109.00±97.68) (p=0.02) and Air Kerma (1472.92±883.50 to 582.49±485.28) (p=0.05). Significant radiation reduction occurred by the third time period for Air Kerma (1472.92±883.50 vs 494.12±413,79, p=0.03) and second time period for DAP (264.52±150.03 to 127.51±110.35, p=0.03).

Conclusion:
These results suggest that use of EchoNav® has a learning curve, but ultimately reduces time to TSP and radiation.
Abstract 14670: A Meta-analysis of Survival Outcomes Between Two Uncommon Mechanical Circulatory Support Device Combinations
Authors: Amancherla Kaushik , Patel Jay , Holder Tara , O'Leary Jared
Published: May 2021

Introduction:
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and Impella devices are being used in increasing frequency for cardiogenic shock. Left ventricular unloading strategies are often used in VA-ECMO. The combination of simultaneous left- and right-sided Impellas, colloquially called “BIPELLA”, also offers biventricular support. There is a paucity of data regarding these combinations of platforms. We performed a systematic review of the literature to assess clinical outcomes in patients treated with ECPELLA and BIPELLA for cardiogenic shock.

Methods:
A systematic search of PubMed using the terms “ECMO”, “ECPELLA”, “BIPELLA”, and “Impella” was performed. Included studies evaluated mortality and complications associated with use of ECPELLA and/or BiPELLA. Reference lists of eligible studies helped identify additional publications meeting inclusion criteria. Case reports and conference abstracts were excluded. Heterogeneity among eligible studies was assessed using the I2 statistic. Publication bias was assessed using Egger’s regression and visual inspection of funnel plots. The primary outcome was in-hospital or 30-day mortality. Secondary outcomes assessed complications.

Results:
The results of publication bias assessment are provided in Figure 1A. Egger’s test was not significant (p = 0.56). A total of 139 patients underwent ECPELLA implantation and 20 underwent BIPELLA implantation. Mortality for the overall cohort was 51% with no significant difference between groups (p = 0.93) (Figure 1B). There was no significant difference between the groups with bleeding (p = 0.74), hemolysis (p = 0.34), and limb ischemia (p = 0.58).

Conclusion:
These data suggest no differences in short-term mortality and certain complications between ECPELLA and BIPELLA strategies. However, the available literature is sparse, with small sample sizes and suffers from a paucity of significant hemodynamic data. Further prospective data are needed.
Abstract 14671: Cardiovascular Outcomes of Diabetic Covid-19 Patients: A Multi-center Research Network Study
Authors: Yousaf Ali , Studney Mark , EL-HAMDANI Mehiar , Patton-Tackett Eva
Published: May 2021

Introduction:
Diabetes mellitus is a known risk factor for COVID-19. It remains unknown if these patients suffer worse cardiovascular outcomes following COVID-19 infection. This study aimed to determine if COVID-19 patients with diabetes are at increased risk of hospitalization and acute myocardial infarction.

Methods:
A real-time search and analysis were performed for adult patients (≥ 18 years old) diagnosed with COVID-19 using the TriNetX (Cambridge, MA, USA) Research Network. TriNetX provided real-time access to electronic medical records (EMR) for o ver 53 million patients from 42 healthcare organizations (HCOs). COVID-19 patients were divided into those with documented diabetes mellitus within 12 months of CoVid-19 diagnosis and those without diabetes. Likelihood of hospitalization and acute myocardial infarction, defined using International Classification of Diseases, 10th Revision, Clinical Modification code I21, were compared between groups with and without propensity score matching for confounding factors.

Results:
Out of 53,516,662 patients, 28,893 patients were identified with COVID-19 of whom 4,543 (15.7%) were diabetic. COVID-19 patients with diabetes were older (62.5 ± 15.0 years vs. 53.2 ± 19.3 years, p<0.001), more frequently male (51.1% vs. 44.8%, p<0.001), and African- American (38.6% vs. 19.8%, p<0.001). After propensity matching on age, gender, race, BMI, chronic kidney disease, cerebrovascular disease, and disorders of the peripheral nervous system, likelihood of hospitalization was significantly increased in the diabetic cohort (risk ratio 1.16, 95% confidence interval [CI] 1.10-1.21, p<0.001). COVID-19 patients with diabetes were significantly more likely to suffer from acute myocardial infarction (risk ratio 1.32, 95% confidence interval [CI] 1.03-1.68, p=0.03) compared to COVID-19 patients without diabetes.

Conclusions:
This study suggests that COVID-19 patients with diabetes have increased likelihood of hospitalization and acute myocardial infarction compared to non-diabetic COVID-19 patients.
Abstract 14676: Landmark-based Functional Computed Tomography Reveals Diminished Left Atrial Appendage Contraction During Atrial Fibrillation
Authors: Chung Jonathan H , Ho Gordon , Schluchter Andrew , Contijoch Francisco , Hsu Jonathan C , Feld Gregory K , Krummen David E , McVeigh Elliot R
Published: May 2021

Introduction:
The formation of thrombus in the left atrial appendage (LAA) and risk for systemic embolization may result in part from stasis and poor blood volume emptying during atrial fibrillation (AF). Functional 4-dimensional computed tomography (4DCT) is a promising technique to measure LAA ejection fraction and blood volume emptying.

Hypothesis:
We hypothesize that the LAA ejection fraction measured by 4DCT is decreased during AF compared to sinus rhythm.

Methods:
256-slice 4DCT scans obtained in patients for coronary artery imaging or pre-procedurally for AF, VT or SVT ablation procedures were analyzed retrospectively. In each patient, LAA volumes were measured at multiple phases during one cardiac cycle using segmentation software (ITK-SNAP and Osirix MD). LAA ejection fraction was calculated as the difference between minimum and maximum volumes and was analyzed using Wilcoxon rank sum.

Results:
Out of 54 patients, 37 patients were in sinus rhythm and 17 patients were in AF. Between NSR vs. AF, mean age was 69.1±12.8 vs 73.2±11.5 years (p=0.13), 28% vs 36% female (p=0.54), LVEF was 58±11% vs 60±9% (p=0.95), and echo-derived left atrial volume index was 29.5±6.1 ml/m2 vs 41.7±12.8 ml/m2 (p=0.06). Patients who were in sinus rhythm during their CT scan had a higher LAA ejection fraction than those who were in AF (58±13% vs. 29±9%, p<0.0001). For patients who were in AF during their CT scan, there was no difference in LAA ejection fraction between patients with a history of paroxysmal AF compared to patients with a history of persistent AF (30±10% vs. 28±10%, p=0.75).

Conclusions:
Analysis of the LAA volumes using functional cardiac CT is a feasible method to quantify blood volume emptying from the LAA. Patients in AF were observed to have significantly decreased LAA ejection fraction and blood volume emptying compared to patients in sinus rhythm. Further studies are needed to determine whether this technique may improve personalized risk stratification for stroke.
Abstract 14677: Distribution of 10- and 30-year Predicted Risks for Atherosclerotic Cardiovascular Disease in the United States: NHANES 2015 to 2018
Authors: Shah Nilay S , Ning Hongyan , Perak Amanda , Allen Norrina B , Wilkins John T , Lloyd-jones Donald M , Khan Sadiya S
Published: May 2021

Introduction:
Premature fatal cardiovascular disease rates have plateaued in the US. Identifying population distributions of short- and long-term predicted risk for atherosclerotic cardiovascular disease (ASCVD) can inform interventions and policy to improve cardiovascular health over the life course.

Methods:
Among nonpregnant participants age 30-59 years without prevalent CVD from the National Health and Nutrition Examination Surveys 2015-18, continuous 10 year (10Y) and 30 year (30Y) predicted ASCVD risk were assigned using the Pooled Cohort Equations and a 30-year competing risk model, respectively. Intermediate/high 10Y risk was defined as ≥7.5%, and high 30Y risk was chosen a priori as ≥20%, based on 2019 guideline levels for risk stratification. Participants were combined into low 10Y/low 30Y, low 10Y/high 30Y, and intermediate/high 10Y categories. We calculated and compared risk distributions overall and across race-sex, age, body mass index (BMI), and education using chi-square tests.

Results:
In 1495 NHANES participants age 30-59 years (representing 53,022,413 Americans), median 10Y risk was 2.3% and 30Y risk was 15.5%. Approximately 12% of individuals were already estimated to have intermediate/high 10Y risk. Of those at low 10Y risk, 30% had high 30Y predicted risk. Distributions differed significantly by sex, race, age, BMI, and education (P<0.01,
Figure
). Black males more frequently had high 10Y risk compared with other race-sex groups. Older individuals, those with BMI ≥30 kg/m
2
, and with ≤high school education had a higher frequency of low 10Y/high 30Y risk.

Conclusions:
More than one-third of middle-aged U.S. adults have elevated short- or long-term predicted risk for ASCVD. While the majority of middle-aged US adults are at low 10Y risk, a large proportion among this subgroup are at high 30Y ASCVD risk, indicating a substantial need for enhanced clinical and population level prevention earlier in the life course.
Abstract 14708: Temporal Relationship Between Erythropoietin Administration and Mitochondrial Dysfunction in Cardiac Ischemia/reperfusion Injury
Authors: Benjanuwattra Juthipong , Apaijai Nattayaporn , Chunchai Titikorn , Chattipakorn Siriporn , Arunsak Busarin , CHATTIPAKORN Nipon
Published: May 2021

Introduction:
Acute myocardial infarction remains a leading cause of mortality. Rapid restoration of coronary blood flow is the cornerstone of treatment. Paradoxically, it leads to a condition known as ischemia/reperfusion (I/R) injury which precipitates more injuries to the heart. Erythropoietin (EPO), a hormone produced by the kidneys in response to cellular hypoxia, reportedly provides cardioprotection following cardiac I/R injury in many preclinical experiments. Unfortunately, clinical trials failed to demonstrate cardioprotection when EPO was given after reperfusion. Therefore, we aim to determine the temporal influences on administering EPO in cardiac I/R injury.

Hypothesis:
Administration of EPO at different time points provides varying efficacy in reducing arrhythmias, LV and cardiac mitochondrial dysfunction after cardiac I/R injury.

Methods:
Male Wistar rats were divided into sham-operated and cardiac I/R group. In I/R group, rats were subdivided into 4 groups (n=10/group): vehicle, EPO pretreatment (P-EPO), EPO given during ischemia (I-EPO), and EPO given at reperfusion onset (R-EPO). EPO was intravenously given to the rats (5000 unit/kg). Rats underwent 30-min LAD ligation followed by 120-min reperfusion. Arrhythmia scores and LV function were recorded throughout the protocol. Then, rats were sacrificed to determine infarct size and mitochondrial function.

Results:
Cardiac I/R injury induced arrhythmias, LV and mitochondrial dysfunction
(Fig
. Administration of EPO before or during ischemia, but not at the onset of reperfusion, significantly attenuated LV dysfunction and infarct size. However, EPO did not reduce arrhythmia scores. Although EPO given at all time points reduced mitochondrial reactive oxygen species, EPO given at reperfusion failed to prevent mitochondrial swelling
(Fig)
.

Conclusions:
Acute EPO treatment before or during ischemia, but not at the onset of reperfusion, exerted cardioprotection against I/R injury.