bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14944: Drug Utilization Study in Heart Failure (HF) Patients Concomitantly Prescribed Sodium-glucose Cotransporter-2 Inhibitors (SGLT2i) and Sacubitril/valsartan (sac/val), a Database Cohort Study Using Optum Electronic Health Record (EHR) US Data
Authors: Loefroth Emil , Hughes Maria , Shi Yulin , Wang Yitong , Proudfoot Clare , Domenico Maximiliano D , Modgill Vikas , Schlienger Raymond , Studer Rachel
Published: November 2020

Background:
Sac/val, an angiotensin receptor neprilysin inhibitor, reduces the risk for cardiovascular (CV) death and hospitalization for HF in HF with reduced ejection fraction (HFrEF). SGLT2i are glucose lowering medications that have shown reduction in CV risk in patients with very high CV risk and diabetes. Recently, the SGLT2i dapagliflozin has shown improvement in outcomes in patients with chronic HFrEF, with or without diabetes, when used in addition to standard of care including sac/val. As the use of SGLT2i in HF evolves, and given the large overlap of HF and type 2 diabetes (T2D) populations, it is of interest to understand the drug utilization of concomitant use of sac/val and SGLT2i. This study describes the time to discontinuation for patients treated concomitantly with sac/val and SGLT2i or with sac/val and dipeptidyl peptidase-4 inhibitors (DPP4i) or glucagon-like peptide-1 receptor agonists (GLP1).

Methods:
This retrospective non-interventional cohort study describes two mutually exclusive adult patient cohorts diagnosed with HF and T2D concomitantly prescribed sac/val and SGLT2i, or sac/val and DPP4i/GLP1. All patients had a minimum follow-up time of 3 months. All patients were identified any time between 1
st
July 2015 and 30
th
Sep 2019 in the Optum® de-identified EHR data from providers across the continuum of care.

Results:
783 patients were prescribed sac/val and SGLT2i (cohort 1) and 1,855 sac/val and DPP4i-/GLP1 (cohort 2). Treatment continuation was higher for cohort 1 compared to cohort 2 (57.3% and 49.9%). 11.1% and 10.6% of patients discontinued sac/val in cohort 1 and 2, respectively, 20.3% discontinued SGLT2i in cohort 1 and 23.1% discontinued DPP4i/GLP1 in cohort 2.

Conclusions:
Of the patients with HF and T2D prescribed sac/val and SGLT2i or DPP4i/GLP1 concomitantly, discontinuation rates of at least one product within 3 months are relatively high. Fewer patients discontinued sac/val compared to SGLT2i or DPP4i/GLP1.
Abstract 14945: Prognostic Value of Cardiac
123
I-MIBG Imaging for Predicting Cardiac Events After Transcatheter Aortic Valve Replacement
Authors: Kadoya Yoshito , Zen Kan , Tamaki Nagara , Yashige Masaki , Takamatsu Kazuaki , Ito Nobuyasu , Kuwabara Kensuke , Yamano Michiyo , Nakamura Takeshi , Yaku Hitoshi , MATOBA Satoaki
Published: November 2020

Introduction:
In patients with aortic valve stenosis (AS), cardiac sympathetic nervous (CSN) dysfunction and its improvement after transcatheter aortic valve replacement (TAVR) have been reported; however, the prognostic impact of CSN function remains unclear. This study investigated the prognostic value of cardiac
123
I-metaiodobenzylguanidine (MIBG) imaging for predicting cardiac events after TAVR.

Hypothesis:
We hypothesized that the improvement in MIBG parameter with TAVR treatment can be an indicator of better prognosis.

Methods:
This single-center prospective observational study enrolled patients with AS between July 2017 and May 2019. MIBG scintigraphy was performed before and after TAVR to evaluate the delayed heart-mediastinum ratio (d-H/M). Patients were classified into three pairs of groups based on the baseline and post-TAVR d-H/M (≥2.0 or <2.0) and on the presence of TAVR-related improvement in d-H/M (i.e. Δ d-H/M [post-TAVR – baseline] >0 or ≤0). The study endpoint was the occurrence of major adverse cardiac events (MACE), defined as a composite of all-cause death, non-fatal myocardial infarction, and hospitalization due to heart failure.

Results:
Among the 187 consecutive patients who underwent TAVR, 107 (27 men; median age: 86 years) were evaluated. Over a median follow-up of 366 days, 15 (14.0%) patients had MACE. The incidence of MACE was significantly low in patients with d-H/M improvement and/or high post-TAVR d-H/M (≥2.0). Baseline d-H/M and frailty were associated with poor response of d-H/M to TAVR treatment. Moreover, post-TAVR d-H/M had significant effects on MACE, with an adjusted hazard ratio of 1.264 (95% confidence interval, 0.034-2.480; p=0.04).

Conclusions:
Both d-H/M improvement and high post-TAVR d-H/M were associated with better prognosis in patients who underwent TAVR. Cardiac MIBG imaging is useful for predicting cardiac events after TAVR.
Abstract 14961: External Applicability of REDUCE-IT in a Large Diabetes Cardiovascular Outcomes Trial: A Post Hoc Analysis of EMPA-REG OUTCOME
Authors: Verma Subodh , Bhatt Deepak L , Leiter Lawrence A , Fitchett David H , Ofstad Anne Pernille , Wanner Christoph , George Jyothis T , Mattheus Michaela , Zinman Bernard , Lawler Patrick R
Published: November 2020

Introduction:
In the REDUCE-IT trial, icosapent ethyl (IPE) was shown to reduce major adverse cardiac events (MACE) including cardiovascular (CV) death in patients with elevated triglycerides (TG) and atherosclerotic CV disease (ASCVD) and/or diabetes. There are limited data evaluating the external applicability of REDUCE-IT inclusion criteria in contemporary diabetes trials. In EMPA-REG OUTCOME, empagliflozin (EMPA) reduced the risk of CV death and hospitalization for HF (HHF). We sought to evaluate the benefit of EMPA on CV outcomes across IPE eligibility in the EMPA-REG OUTCOME trial.

Methods:
In total, 7020 patients with type 2 diabetes and ASCVD were treated with EMPA 10mg, 25 mg, or placebo (PBO). We examined the proportion of patients that had baseline (BL) TG 135 to 499 mg/dl, LDL-C 41 to 100 mg/dl and using a statin (“REDUCE-IT-like patients”). We evaluated the effect of pooled EMPA vs. PBO on CV death, HHF, HHF or CV death (excluding fatal stroke), all-cause death, and 3-point-MACE across the subgroups of patients fulfilling vs not fulfilling the REDUCE-IT criteria at BL using Cox regression.

Results:
A total of 6935 patients had TG and 6932 had LDL-C available. 1810 patients (25.8%) were REDUCE-IT like with TG 206±69 vs. 158±140 mg/dl, and LDL-C 71±15 vs. 91±39 mg/dl in those who did not meet the criteria. At BL, the former had more often coronary artery disease (84 vs. 73%) and higher BMI (31.7±5.1 kg/m
2
vs. 30.3±5.3) vs. the latter group. CV event rates in PBO were similar in patients who met/did not meet the criteria. Treatment effects of EMPA vs. PBO were consistent in patients who met/did not meet the REDUCE-IT criteria (Fig).

Conclusions:
In patients with T2D and established ASCVD treated in EMPA-REG OUTCOME, about one-quarter of patients would qualify for IPE according to the REDUCE-IT inclusion criteria. Empagliflozin consistently reduced CV outcomes and mortality in this sub-group, suggesting that IPE and SGLT2 inhibition may be complementary.
Abstract 14969: A Four Week Exercise Intervention in a Cohort of Young Army Recruits is Associated With Anti-inflammatory and Pro-antioxidant Responses
Authors: Tsoporis James N , Drosatos Alex , Izhar Shehla , Tsirebolos George , Sakadakis Elefterios , Parker Thomas G , RALLIDIS LOUKIANOS , Rizos Ioannis C
Published: November 2020

Introduction:
Regular physical activity is considered a cornerstone of cardiovascular disease prevention and is therefore strongly encouraged by most medical societies. Apart from its beneficial effects on classical cardiovascular risk factors, an anti-inflammatory effect is strongly implicated based on results from observational studies.

Hypothesis:
Data regarding the effect of an exercise intervention on healthy individuals are limited and contradictory. The present study aimed to investigate the effects of a physical activity intervention on the inflammatory marker S100A8/A9, the soluble form of the receptors for advanced glycation end products (sRAGE) and the anioxidant DJ-1.

Methods:
332 young army recruits volunteered and 169 completed the study. The participants underwent the standard basic training of Greek army recruits which includes 2 hours of aerobic exercise, 5 times a week. Plasma S100A8/A9, sRAGE and DJ-1 were measured at the beginning and at the end of the training period.

Results:
At the end of the training period we observed a statistically significant reduction of S100A8/A9 (630.98 vs 472.12 ng/ml, p=0.001) and soluble RAGE (416.21 vs 225.19 pg/ml, p=0.001) while DJ-1 was significantly increased (62.48 vs 74.45 ng/ml, p<0.05). S100A8/A9 reduction was positively correlated with body weight (r=.238 [.106, .375], p=0.002), indicating that heavier individuals could benefit more from an exercise intervention.

Conclusions:
A 4 weeks military exercise training intervention resulted in a reduction of the pro-inflammatory S100A8/A9 complex as well as an increase of the anti-oxidant DJ- 1 protein, supporting the anti-inflammatory and anti-oxidant effects of physical activity. The observed reduction of sRAGEs was interpreted as a sign of diminished AGE-RAGE axis activation.
Abstract 14995: Family History of Coronary Artery Disease in Patients With Vasospastic Angina: What Does it Mean Clinically?
Authors: Teragawa Hiroki , Oshita Chikage , Orita Yuichi
Published: November 2020

Introduction:
It has been reported that a family history of coronary artery disease (FH-CAD) is one of the coronary risk factors for CAD with organic coronary stenosis (o-CAD).

Hypothesis:
However, the indication for FH-CAD in patients with vasospastic angina (VSA) is yet to be fully elucidated. Therefore, we investigated the frequency of FH-CAD in patients with VSA and examined the clinical characteristics of patients with VSA with FH-CAD.

Methods:
A total of 78 patients with VSA diagnosed by coronary angiography and spasm provocation test (SPT) were included. Patients with cardiomyopathies, long QT syndrome, or Brugada syndrome, were excluded. On SPT, VSA was defined as >90% narrowing of coronary artery in response to acetylcholine accompanied with chest symptoms and/or ST- T changes on ECG. Each patient was interviewed about their FH-CAD, and its presence was defined as having known CAD and sudden cardiac death affecting first-degree relatives. According to the presence of FH-CAD, patients with VSA were classified into the two groups: Group I, with FH-CAD; and Group II, without FH-CAD. Conventional risk factors, blood chemical parameters, vascular function, including flow-mediated dilation (FMD) and nitroglycerin-induced dilation (NID), duration of angina, were checked. Furthermore, the frequency of FH-CAD was checked in 161 patients with o-CAD (≥50% coronary stenosis) and 69 patients without o-CAD or VSA (non-CAD) .

Results:
Group I and Group II comprised 17 (21%) and 61 patients (79%), respectively. The frequency of FH-CAD in patients with VSA was not significantly different between o-CAD and non-CAD groups (17% vs. 16%). The conventional coronary risk factors, blood chemical parameters, and FMD (3.2 ± 3.1%, vs. 3.4 ± 3.8%) were not significantly different between Group I and Group II. In contrast, NID and duration of angina were significantly higher in Group I than in Group II, (18.2 ± 9.1% vs. 14.0 ± 5.2%; 52 ± 15 months vs. 16 ± 7 months, respectively; both p < 0.05).

Conclusions:
These findings suggest that the FH-CAD is associated with the duration of angina and abnormal vascular smooth muscle function. Thus, FH-CAD may provide clinically important information regarding the activity and the possible mechanism, even in patients with VSA.
Abstract 14997: Icosapent Ethyl Reduces Ischemic Events in Patients With Prior Coronary Artery Bypass Grafting: REDUCE-IT CABG
Authors: Verma Subodh , Bhatt Deepak L , Steg Philippe G , Miller Michael , Brinton Eliot A , Jacobson Terry A , Ketchum Steven , Juliano Rebecca , Jiao Lisa , Doyle Ralph , Granowitz Craig , Gibson C. Michael , Pinto Duane S , Giugliano Robert P , Budoff Matthew J , Mason Preston P , Tardif Jean-Claude , Ballantyne Christie M , Zenati Marco A
Published: November 2020

Background:
Patients with a prior history of coronary artery bypass grafting (CABG) are at high risk for future ischemic events despite statin therapy.

Methods:
REDUCE-IT, a multicenter, double-blind, placebo-controlled trial, randomized statin-treated patients with elevated triglycerides (135-499 mg/dL), controlled LDL (41-100 mg/dL), and either established cardiovascular disease or diabetes plus other risk factors to receive icosapent ethyl 4g daily or placebo. In the overall trial, the primary composite endpoint (cardiovascular death, myocardial infarction, stroke, coronary revascularization, hospitalization for unstable angina) and the key secondary composite endpoint (cardiovascular death, myocardial infarction, stroke) were significantly reduced. Here we examine the subgroup of patients with a history of CABG.

Results:
A total of 8,179 randomized patients were followed for 4.9 years (median), 1837 (22.5%) of whom had a prior CABG, with a median of 5.1 years (0.7 months to 33.3 years) from CABG to randomization (in the 1263 patients who had the date of CABG recorded). The rate of the primary endpoint was reduced by 24% [22.0% with icosapent ethyl versus 28.2% with placebo (hazard ratio [HR]=0.76; 95% confidence interval [CI], 0.63-0.92; p=0.004; number needed to treat [NNT]=16)]. The rate of the key secondary endpoint was reduced by 31%: [14.7% with icosapent ethyl versus 20.7% with placebo (HR=0.69; 95% CI, 0.56-0.87; p=0.001; NNT=17)].

Conclusions:
In statin-treated patients with a history of prior CABG, the addition of icosapent ethyl significantly reduced ischemic events, with both large relative and absolute risk reductions.
Abstract 15018: Incremental Prognostic Utility of Adverse Right Ventricular Remodeling in Patients With Covid-19 Infection: A Multicenter Cohort Study
Authors: Volodarskiy Alexander , Sultana Razia , Pollie Meridith P , Yum Brian , RoyChoudhury Arindam , Tafreshi Romina , Mitlak Hannah , Shaw Leslee J , Horn Evelyn M , Goyal Parag , Safford Monika M , Devereux Richard B , Weinsaft Jonathan W , Kim Jiwon
Published: November 2020

Introduction:
COVID-19 is a growing pandemic that confers augmented risk for RV dysfunction and dilation; prognostic utility of adverse RV remodeling in COVID-19 patients is uncertain.

Hypothesis:
To test whether adverse RV remodeling (dysfunction/dilation) predicts COVID-19 prognosis independent of clinical and biomarker risk stratification.

Methods:
Consecutive adult COVID-19 patients undergoing clinical transthoracic echo at three NYC hospitals were studied; images were analyzed by a central core lab blinded to clinical and biomarker data.

Results:
Of 510 patients (64±14 years, 66% male) studied, RV dilation and dysfunction were present in 35% and 15%, respectively. RV dysfunction increased stepwise in relation to RV chamber size (p=0.015). During inpatient follow-up (median 20 days), there were 165 deaths (32%) and 229 discharges (45%). RV dysfunction (HR 2.25 [CI 1.26-3.98]; p=0.006) and dilation (HR 1.82 [CI 1.11-2.97]; p=0.02) each independently conferred mortality risk. Patients without adverse RV remodeling were more likely to survive to hospital discharge (HR 1.39 [CI 1.01-1.90]; p=0.04).
Figure 1A
demonstrates prognostic utility for each echo-quantified RV parameter (p<0.05) in relation to all-cause mortality.
Figure 1B
shows RV indices to provide risk stratification beyond biomarker strata, as evidenced by greatest risk for death among patients with both adverse RV remodeling and positive biomarkers, and lesser risk among patients with isolated biomarker elevations. RV remodeling conferred over a 2-fold increase in mortality risk (HR 2.68 [CI 1.70-4.23]; p<0.001), which remained significant when controlling for biomarker elevations, irrespective of whether analyses were performed using troponin, D-dimer, or ferritin. (p<0.01).

Conclusions:
Adverse RV remodeling predicts mortality in COVID-19 independent of standard clinical and biomarker-based assessment.
Abstract 15019: Differential Effects of Omega-3 Fatty Acid Combinations on the Inhibition of Oxidation Of Human Low-density Lipoproteins
in vitro
Authors: Sherratt Samuel , Ferguson James J , Bhatt Deepak L , Mason Preston
Published: November 2020

Background:
Omega-3 fatty acids (O3FAs) reduce levels of triglyceride but may also have additional atheroprotective benefits. Randomized trials have suggested potential clinical outcome differences among O3FAs formulations. Oxidative modification of low-density lipoproteins (LDL) contributes to endothelial dysfunction, inflammation, and other aspects of atherogenesis. Individual O3FAs have been shown to inhibit LDL oxidation to varying degrees, but the antioxidant effects of combining O3FAs is unknown.

Objective:
To compare the dose- and time-dependent antioxidant effects of eicosapentaenoic acid (EPA, 20:5) alone and in combination with either docosapentaenoic acid (DPA, 22:5) or docosahexaenoic acid (DHA, 22:6) in human LDL
in vitro
.

Methods:
Human LDL was isolated from healthy subjects and adjusted to a final ApoB concentration of 100 μg/mL in physiologic buffer (PBS) before being incubated with O3FAs at 37°C. The EPA levels in the combinations were fixed at either 2.0, 3.0, or 4.5 μM, while the DPA or DHA levels were set at 0, 0.5, 1.0, and 2.0 μM. Oxidation was initiated by copper sulfate (10 μM) and measured over time by formation of malondialdehyde (MDA), a lipid oxidation product.

Results:
When combined with EPA, both DPA and DHA increased inhibition of oxidation in a dose- and time-dependent manner, with DPA showing a greater effect and more prolonged inhibition. At high levels of EPA (4.5 μM), DPA showed significantly greater antioxidant activity than equimolar DHA; these differences were more apparent with time. After 8 hours, adding 1.0 μM DPA reduced MDA formation by 61% versus vehicle (3.10 ± 0.42 vs. 7.98 ± 0.56,
p
<0.001), while adding 1.0 μM DHA only reduced MDA formation by 20% (6.40 ± 1.23,
p
<0.05). When 2 μM DPA or DHA were added, after 10 hours only DPA still had a significant degree of inhibition versus vehicle (37%; 6.65 ± 0.95 vs. 8.21 ± 0.53,
p
<0.05). Similar trends were observed in combinations containing 2.0 and 3.0 μM EPA.

Conclusion:
Adding DPA or DHA to EPA provide dose-dependent incremental antioxidant effects, with DPA providing a larger degree and a longer duration of inhibition. These observations highlight potential differences among O3FAs (and their combinations) in novel mechanisms of atheroprotection.
Abstract 15036: Artificial Intelligence for Characterizing Heart Failure in Cardiac Magnetic Resonance Images
Authors: Stolte Skylar E , Fang Ruogu , Wu Yonghui , Hogan William , Gong Yan
Published: November 2020

Introduction:
Congestive heart failure (CHF) increases hospitalization burden and risk of mortality.; However, currently there are no guidelines for preemptive screening for CHF. This study aimed to identify imaging features to classify past CHF in order to predict future CHF in cardiac magnetic resonance images (CMRIs).

Hypothesis:
Machine learning (ML) may reliably segment the heart chambers from CMRIs and these segmentations yield imaging biomarkers to predict CHF.

Methods:
This study extracted CMRIs from 350 subjects with and without CHF in the UK Biobank. Participants with no CHF were randomly selected to match those with CHF. Convolutional neural networks (CNNs) segmented the heart in short and long axis CMRIs. Each model was based on VGGNet with added skip connections that perform transposed convolutions. These convolutions upsampled feature maps at each scale and concatenated them at the network’s resolution. The VGGNet learned deep feature representations, while the transposed convolutions compensated for issues underlying network depth. The resulting segmentations and imaging metadata were parsed to extract clinical parameters related to heart measurements and function. Support vector machines (SVM) consistently yielded the highest performance among all ML classifiers. A following step split the data into 80%/20% training/testing and run five-fold cross validation on the training set to select optimal SVM parameters. Linear SVM provided feature weights that corresponded to relative feature importance.

Results:
The pipeline identified past/current HF with 0.84 accuracy and 0.86 precision. The key features for identifying past/current CHF included left ventricular (LV) end diastolic volume, LV end systolic volume, LV stroke volume, LV ejection fraction (LVEF), LV mass, left atrial volume (LAV) max, and LAV min. Future prediction yielded 0.80 accuracy and 0.80 precision. In comparison, these results resulted in the following key features: LVEF, LV cardiac output, left atrial stroke volume, left atrial ejection fraction.

Conclusion:
CMRI provides a reliable method of extracting indicators for cardiac measurements and function. These values help capture heart health and predict future heart complications like CHF.
Abstract 15042: Heart Rhythm Classification From an Optimal Lead Subset of the 12-lead Electrocardiogram by Deep Learning
Authors: Lai Changxin , Zhou Shijie , Trayanova Natalia
Published: November 2020

Introduction:
Deep learning (DL) has achieved promising performance on common heart rhythms classification using 12-lead electrocardiogram (ECG). However, two major concerns hinder the DL’s application - lack of interpretability and overfitting caused by using the full 12-lead ECG as input.

Objective:
We proposed a hybrid DL model with enhanced interpretability to detect 9 common types of heart rhythms from an optimal ECG lead subset, and to quantitively analyze the overfitting.

Methods:
We used a multicenter dataset of 6,877 annotated 12-lead ECG recordings. The proposed model (Fig. 1A) consists of a feature extraction and a decision-making. The feature extraction used 12 separate neural networks to extract features from each lead. The features were then fed into a random-forest classifier in the decision-making step to classify heart-rhythm types. The classifier was used to interpret the correlations between the heart rhythms and the ECG leads, to find an optimal subset of ECG leads, and to analyze whether using 12-lead ECG added unnecessary complexity to the model and undermined its generalizability.

Results:
The proposed model detected the correlations between the heart-rhythm types and the ECG leads (Fig. 1B), and identified an optimal ECG lead subset (leads II, aVR, V1, V4). The optimal subset was, in comparison with using 12-lead ECG, significantly better (F1 =0.776 vs. F1 = 0.767, P=0.02) on the validation set for classifying the 9 common heart rhythms. There was no statistical difference on the test set. No overfitting caused by 12-lead ECG was detected in this study.

Conclusion:
The hybrid DL model based on an optimal 4-lead ECG can interpret rhythm types without significant loss of accuracy in comparison with the 12-lead ECG.
Abstract 15043: Assessment of Cardiovascular Events Among Symptomatic Outpatients With Suspected Coronary Artery Disease Who Presented During COVID-19 Pandemic
Authors: Mason Steve M , Sekaran Nishant , Ethington Jon-David , Nay Stephanie , Le Viet T , Knowlton Kirk U , Meredith Kent G , Min David B
Published: November 2020

Background:
Infection mitigation efforts during the SARS-CoV-2 pandemic highlights a need to optimize evaluation of symptomatic outpatients (pts) with suspected coronary artery disease (CAD). Successful paradigms must have a low incidence of major adverse cardiovascular (CV) events (MACE) and be efficient and scalable across a large population. We describe a strategy implemented during peak interruption of usual clinical services across an integrated healthcare system looking at short-term clinical outcomes.

Methods:
We evaluated consecutive pts presenting to emergency departments (ED) from March to April 2020 within Intermountain Healthcare. Symptomatic pts were risk stratified using the HEART Score (HS). Those with HS of ≤3 were discharged to “active surveillance”comprised of weekly telephone calls to assess for symptom progression, prompting urgent stress testing. All pts with a HS of ≥4 received cardiac stress PET/SPECT imaging. Physician interpretation guided subsequent pt management. Short-term (minimum 30-day follow-up) clinical outcomes were incident MACE (all-cause mortality, acute MI, stroke, and return ED visits for suspected angina).

Results:
Those with a HS ≥4 (n=212) had an increased burden of CV risk factors compared to HS ≤3 (n=90) (Table 1). Three of the HS ≤3 group had progressive symptoms leading to urgent stress testing (resulting in low-risk findings and no intervention) and one had a MACE event (NSTE-ACS 10 days post index ED visit). In the HS ≥4 group, 123 tests were read as intermediate or high-risk, of which 59 proceeded to coronary angiography and 43 resulted in revascularization. Two pts with HS ≥4 died from complications related to preexisting heart failure. No additional MACE events occurred in the HS ≥4 group.

Conclusion:
Among symptomatic pts with suspected CAD who presented for ED evaluation during the SARS-CoV-2 pandemic, the HS combined with active clinical surveillance appears to be a safe and effective management strategy.
Abstract 15400: Impact of Human Immunodeficiency Virus Infection on Takotsubo Cardiomyopathy Outcomes in a Large Nationwide Sample
Authors: Ali Laith , Ghazzal Amre , Zaghlol Raja , Radwan Sohab , Desale Sameer , Garcia-Garcia Hector M
Published: November 2020

Aim:
Stress-Induced or Takotsubo Cardiomyopathy (TCM) is characterized by transient wall motion abnormalities often preceded by physical or emotional stress. Various baseline medical comorbidities were associated with worse outcomes theoretically due to their effect on chronic stress exposure. The effect of concurrent Human Immunodeficiency Virus (HIV) infection on outcomes of TCM has not been well established.

Methods:
We conducted a US-wide analysis of TCM hospitalizations from 2006 to 2014 by querying the National Inpatient Sample (NIS) database for the International Classification of Diseases-ninth Revision (ICD-9) TCM code, baseline characteristics, and inpatient outcomes. TCM patients with HIV were compared to TCM patients without HIV. Multivariate regression models were constructed to account for potential confounders. We identified 123,050 patients hospitalized with TCM, of those patients 304 had positive HIV status.

Results:
In unadjusted analysis (figure 1), in-hospital outcomes were worse in TCM patients with HIV in terms of development of acute kidney injury (16.8% vs 33.3%,
P
-value 0.002), use of invasive mechanical ventilation (18.3% vs 34.5%,
P
-value 0.003), and mortality (5.3% vs 17.1%,
P
-value <0.0001). After adjusting for age, gender, and comorbidities there was no significant difference in the captured outcomes (table 1).

Conclusion:
TCM patient with concurrent HIV had numerically worse outcomes. After adjusting for potential confounders, the statistical significance no longer existed, suggesting that statistical difference was primarily driven by difference in baseline sociodemographic parameters and coexisting comorbidities.
Abstract 15407: Comorbidities and the Associated Long-term Utilization of Transthoracic Echocardiography Among Medicare Beneficiaries at a Large Academic Center
Authors: Hyland Patrick M , Xu Jiaman , Shen Changyu , Markson Lawrence , Manning Warren J , Strom Jordan B
Published: November 2020

Introduction:
The association between baseline patient characteristics and the long-term utilization of transthoracic echocardiography (TTE) is unknown and may help focus value-based care initiatives.

Methods:
TTE reports from patients with ≥ 2 TTEs at our institution were linked to 100% Medicare Fee-for-service inpatient claims, 1/1/2000 – 12/31/2017. To avoid inclusion of individuals with short-interval follow-up, TTEs with < 1 year between studies were excluded. Validated claims algorithms were used to create 12 baseline cardiovascular comorbidities. Multivariable Poisson regression was used to estimate adjusted rates of TTE intensity according to baseline comorbidities.

Results:
Over a median (IQR) follow-up of 5.8 (3.1 – 9.5) years, 18,579 individuals (69.3 ± 12.8 years; 50.5% female) underwent a total of 59,759 TTEs (range 2 – 59). The median TTE intensity was 0.64 TTEs/patient/year (IQR 0.35 – 1.24; range 0.11 – 22.02). The top five contributors to TTE intensity were heart failure, chronic kidney disease, history of myocardial infarction, smoking, and hyperlipidemia (
Figure
). Female sex was associated with decreased TTE utilization (adjusted RR 0.95, 95% CI 0.94-0.96, p < 0.0001). Atrial fibrillation, hypertension, and history of ischemic stroke or transient ischemic attack were not significantly related to TTE intensity after multivariable adjustment (all p > 0.05).

Conclusions:
Among Medicare beneficiaries with ≥ 2 TTEs at our institution, the median TTE intensity was 0.64 TTEs/patient/year but varied widely. Heart failure, chronic kidney disease, and history of myocardial infarction were the strongest predictors of increased utilization. Female sex was associated with decreased utilization, reflecting broader disparities in utilization of cardiovascular procedures. Further research is needed to clarify reasons for this sex disparity and associations with cardiovascular outcomes.
Abstract 15408: Risk Factors Associated With In-hospital Mortality for Cardiac Device Extraction
Authors: Hammock James B , Colon Chad , Barrios James , Smith Blake , Oruc Vedran , McElderry Hugh T , Maddox William
Published: November 2020

Introduction:
Cardiac device extraction procedures are associated with increased risk of in-hospital mortality. The objective of this study was to determine risk factors for in-hospital mortality of patients undergoing cardiac device extraction.

Methods:
We studied patients undergoing cardiac device removal between January 2016 and December 2019 at a single tertiary care center. Baseline patient characteristics, comorbidities, and preoperative laboratory data were obtained by database query
(Table 1)
. The outcome of interest was in-hospital death following cardiac device extraction. Odds ratios (OR) and confidence intervals (CI) were used to measure relationships between exposures and the main outcome.

Results:
Our cohort consisted of 333 patients who underwent cardiac device extraction procedures. Cardiac device infection was the indication for procedure in 48% of patients (n=161). In-hospital mortality occurred in 9% of patients (n=29). Patients that died inpatient post-operatively were more likely to be male gender (OR 3.59, 95% CI [1.2, 10.6], p = 0.02), have acute kidney failure (OR 3.17, 95% CI [1.42, 7.05], p = 0.005), have anemia (OR 3.22, 95% CI [1.49, 6.99], p = 0.003), or have a diagnosis of severe malnutrition (OR 2.88, 95% CI [1.26, 6.58], p = 0.01). In a subgroup analysis, patients with diabetes undergoing extraction for infectious reasons had an increased risk of in-hospital mortality (OR 4.36, 95% CI [1.54, 12.34], p = 0.005).

Conclusion:
Patients undergoing cardiac device extraction are high risk for in-hospital mortality. Patients experiencing in-hospital mortality were more likely to be male, have acute renal failure, anemia and severe malnutrition. Careful analysis of preoperative risk factors, laboratory data, and nutritional status can help stratify risk for patients and providers.
Abstract 15416: Longitudinal Assessment of Electrical-Mechanical Interactions in Children and Young Adults With Repaired Tetralogy of Fallot
Authors: Yin Suellen M , Mercer-rosa Laura M , Min Jungwon , Goldmuntz Elizabeth , Vetter Victoria L
Published: November 2020

Introduction:
Electrical-mechanical interactions contribute to arrhythmias, sudden cardiac death, and right ventricular remodeling in repaired tetralogy of Fallot (TOF).

Hypothesis:
There are significant changes in electrocardiographic properties and electrical-mechanical interactions that occur over time after complete TOF repair and with pulmonary valve replacement (PVR).

Methods:
This retrospective cohort study of 177 patients, initially recruited for a cross-sectional research protocol, underwent complete TOF repair at 0.3±0.9 years with 21.5±4.2 years of clinical follow-up. We assessed ECG, Holter, cardiopulmonary exercise testing (CPET), and MRI data. We used linear mixed effects models to examine QRS duration (QRSd) and its rate of change over time, associations between comparable ECG and MRI, Holter and MRI, ECG and Holter, ECG and CPET, and pre-PVR and post-PVR results.

Results:
QRSd increased after TOF repair, but the rate of change decreased from 5.2 ms/year 1 year post-operatively to 1.7 ms/year 20 years post-operatively. Twenty years from TOF repair, post-operative arrhythmias included ventricular ectopy: ventricular tachycardia (4 of 20 patients) on Holter and premature ventricular contractions (14 of 19 patients) on CPET. QRSd was positively associated with right ventricular (RV) volumes, RV:left ventricular (LV) end-diastolic volume ratio, and complex ventricular ectopy on Holter; and negatively associated with RV ejection fraction (EF). The association between QRSd and RV volumes was weaker post-PVR. QRSd and its rate of change were associated with increased LV volume post-PVR. Complex ventricular ectopy was associated with lower LV EF, and significant atrial ectopy was associated with higher LV mass-to-volume ratio.

Conclusions:
Substantial ventricular ectopy occurs in adolescents and young adults after repair of TOF. Electrophysiologic changes included QRSd prolongation that progressively slowed. QRSd and its rate of change were associated with published risk factors for arrhythmia and sudden cardiac death, and with indications for PVR. Our ongoing research aims to identify an optimal threshold of pre-PVR QRSd and its rate of change that preserves bi-ventricular electrical-mechanical coupling post-PVR.
Abstract 15428: Network Meta-analysis of Duration of Antiplatelet Therapy Following Transcatheter Aortic Valve Replacement
Authors: Yokoyama Yujiro , Kuno Toshiki , BRIASOULIS Alexandros , Mori Makoto , Iwagami Masao , Takagi Hisato , Bangalore Sripal
Published: November 2020

Background:
Although current guidelines recommend dual antiplatelet therapy (DAPT) for 3 to 6 months following transcatheter aortic valve replacement (TAVR), there are no studies directly comparing outcomes of different durations of DAPT following TAVR.

Methods:
Pubmed and EMBASE were searched through May, 2020 to identify clinical studies that investigated single antiplatelet therapy (SAPT) versus DAPT use following TAVR. Studies using oral anticoagulants and antiplatelet therapy concomitantly were excluded. The DAPT group was subdivided by the duration of DAPT. We extracted the risk ratios (RRs) of major or life-threatening bleeding, stroke, and all-cause mortality.

Results:
Three randomized controlled trials, two propensity-score matched studies, and one observational study were identified, yielding a total of 1,833 patients who underwent TAVR assigned to the SAPT group (n=918), 3-month DAPT group (n=151), or 6-month DAPT group (N=764). Pooled analyses demonstrated that the rates of major or life-threatening bleeding were significantly higher in the 6-month DAPT group compared with the SAPT group (RR [95% CI] =2.54 [1.49-4.33],
P
=0.007) while no such difference was observed between the SAPT vs. 3-month DAPT groups or the 3-month DAPT vs. 6-month DAPT groups (Figure). P-scores were 98.1% (SAPT), 32.3% (3-month DAPT), and 19.6% (6-month DAPT). The rates of stroke and all-cause mortality were similar among the groups.

Conclusions:
In our network meta-analysis, we observed that DAPT for 6 months following TAVR was associated with increased risk of bleeding without decreasing the risk of stroke compared with SAPT, while there was no difference between DAPT for 3 months and 6 months.
Abstract 15432: Observation of Aortic Dilatation in Congenital Conotruncal Anomalies - Tetralogy of Fallot, Double Outlet Right Ventricle and Truncus Arteriosus
Authors: Kim Woojung , Kwak Jae Gun
Published: November 2020

Backgrounds:
Dilatation of aortic root or ascending aorta is often seen in the patients with conotruncal anomalies (CA). How fast these structures dilate and how we manage this phenomenon are not clear.

Methods:
We reviewed medical records of patients who underwent biventricular repair of CA such as tetralogy of Fallot (TOF), double outlet right ventricle (DORV) and truncus arteriosus (TA) from 2004 to 2018. We included 99 patients who had follow-up cardiac computed tomography angiography (CT) images at least 5 years since initial CT in this study. We analyzed changes of diameters of aortic root structures and ascending aorta between initial and follow-up CT images.

Results:
Median follow-up duration was 16.1 years (interquartile range (IQR): 11.8~26.2 years) after operation. Median interval between initial and follow-up CT examination was 9.4 years (IQR: 7.1~11.5 years). Median age of initial and follow-up CT was 4.3 years (IQR: 0.3~12.3 years) and 14.4 years (IQR: 9.2~22.9 years). The median z-scores (with IQR) of sinus of Valsalva (SV, 2.0 (0.8~3.3) → 2.4 (1.4~3.3), p=0.006) and sinotubular junction (STJ, 1.3 (-0.2~2.6) → 2.2 (0.4~3.3), p=0.001) were significantly changed, whereas aortic annulus (AA, 2.4 (0.9~3.4) → 2.3 (0.8~3.3), p=0.21) and ascending aorta (AsA, 1.6 (0.4~2.9) → 1.6 (0.03~2.6), p=0.27) did not show significant changes in CT images. Median increasing rate of diameter of AA, SV, STJ and AsA was 0.72, 0.93, 0.83 and 0.51 mm/year, respectively. Dilatation rate of AA (0.69 in TOF vs. 0.99 in TA, p=0.042) and SV (0.81 in TOF vs. 1.53 in TA, p=0.008) of TA was significantly higher than of TOF.

Conclusions:
In TOF, DORV and TA, SV and STJ significantly dilated, whereas AsA and AA did not significantly dilated for 9 years of follow-up. Although chance of surgical intervention for dilatation of aortic structures was rare, it might be necessary to observe closely aortic valvular function associated with structural deterioration of SV or STJ.
Abstract 15437: Intravenous Nicorandil versus Adenosine for Fractional Flow Reserve Measurement to Assess Coronary Artery Stenosis: A Systematic Review and Meta-analysis
Authors: Nso Nso A , Rezaei Bookani Kaveh , Antwi-Amoabeng Daniel , Beutler Bryce , Atanga Sirri , Nimo-Boampong Joyce , Enoru Sostanie , Awad Munadel , Gullapalli Nageshwara , Radparvar Farshid
Published: November 2020

Background:
Fractional flow reserve (FFR) has become an increasingly accepted modality to assess coronary artery stenosis. Several clinical trials have been conducted to compare the effects of various pharmacologic agents, including nicorandil and adenosine, in achieving maximum coronary hyperemia.

Methods:
We searched PubMed, Cochrane Library, Scopus, and Web of Sciencefor randomized and observational studies comparing nicorandil with adenosine for measurement of FFR. Data were extracted from the eligible studies and pooled in a meta-analysis using the Revman software. Dichotomous data were pooled as risk ratio (RR) and continuous data were pooled as standardized mean difference (SMD) with the corresponding 95% confidence intervals (CI).We aimed to evaluate the average FFR, hyperemia, duration of hyperemia, decrease in systolic blood pressure, and pain scores assessed by visual analog scale (VAS).

Results:
Five studies comprising a total of 595 patients met our inclusion criteria. The combined effect estimate favored nicorandil over adenosine for mean FFR (SMD = -0.17, 95% CI [-0.28, -0.06], P = 0.004). Nicorandil was more effective in achieving adequate hyperemia as compared to adenosine (SMD = -2.06, 95% CI [-4.36, -0.84], P=0.004). However, no significant differences were reported between nicorandil and adenosine in the duration of hyperemia, the decrease in systolic blood pressure, and VAS pain scores.

Conclusion:
Nicorandil is associated with superior clinical outcomes and similar safety profile as compared to adenosine and should therefore be considered as an alternative agent for FFR evaluation.
Abstract 15452: Low Dp/dt
Max
, When Indexed to Central Venous Pressure, is Associated With Severe Right Ventricular Failure Following Left Ventricular Assist Device Implantation
Authors: Beach Leila Y , Hiesinger William , Wheeler Matthew T
Published: November 2020

Introduction:
Right ventricular failure (RVF) is a common complication following LVAD implantation and a significant driver of post-LVAD mortality. dP/dt
max
, the maximum rate of rise in ventricular pressure, is a validated hemodynamic parameter of ventricular contractility that, when indexed to CVP, accounts for loading conditions. This parameter has not, however, been studied in the context of post-LVAD RVF. We therefore evaluated the relationship between dP/dt
max
/CVP and post-LVAD RVF in a cohort of LVAD recipients at Stanford.

Methods:
We conducted a retrospective, single-center analysis of patients who underwent continuous-flow LVAD implant at Stanford between January 2010 and June 2019. Preoperative RV dP/dt
max
/CVP values were extracted from right heart catheterization (RHC) reports. For cases in which dP/dt
max
/CVP was not reported, preoperative RA and RV pressure tracings were utilized to manually calculate the index. We then performed unpaired t-tests to evaluate for the presence of associations between dP/dt
max
/CVP and early post-LVAD RVF, defined as the prolonged (>7 days) requirement for inotropic or pulmonary vasodilator therapy or the need for RVAD support, and between dP/dt
max
/CVP and severe post-LVAD RVF, defined only by the requirement for RVAD support.

Results:
This cohort included 202 LVAD recipients who had available preoperative RHC data. Of these, 14.4% (n = 29) required an RVAD and 50.5% (n = 102) experienced early post-LVAD RVF. Mean values of dP/dt
max
/CVP amongst patients with and without early post-LVAD RV failure were 94.9 ± 128.5 s
-1
and 105.6 ± 125.5 s
-1
(p = 0.56), respectively, while mean values of dP/dt
max
/CVP amongst those who did and did not require an RVAD were 53.2± 42.0 s
-1
and 108.2 ± 129.5 s
-1
(p = 4.2 х 10
-5
), respectively.

Conclusion:
In continuous-flow LVAD recipients, low preoperative RV dP/dt
max
/CVP is strongly associated with severe post-LVAD RVF requiring RVAD support but not early post-LVAD RVF more generally.
Abstract 15802: Diet and Exercise in 2020 in America: Where Are We?
Authors: Yaseyyedi Armaan , Rao Amy , Pratt-Cordova Ashley , Coe Gregory , Cornwell William
Published: November 2020

Introduction:
Cardiovascular disease (CVD) is the primary cause of death among individuals living in the United States. Adherence to heart-healthy diets and exercise reduce risk of CVD. However, a contemporary analysis of specific diet and exercise types adhered to by Americans is lacking. Therefore, the primary objective of this study was to characterize methods by which Americans engage in healthy lifestyle habits.

Methods:
Internet-based materials were collected through an exhaustive search, conducted between 6/1/2019 and 4/30/20. Google, Google Scholar and Pubmed search engines were reviewed to identify relevant articles. Articles were reviewed by the senior author who made the final decision on incorporation into this analysis. 26 and 23 articles on diet and exercise, respectively, were included for analysis.

Results:
Only approximately 20-25% of Americans engage in routine physical activity. Of individuals who do exercise, the majority engage in either low dynamic/low static, high dynamic/low static, or low dynamic/high static types of exercise (
figure 1
). Americans grossly underconsume recommended healthy foodtypes such as vegetables, fruits and dairy products, by 85%, 75% and 85%, respectively, based on recommended daily allowance. Of individuals who follow a specific diet, the most common types were low-carbohydrate (18%), reduced caloric (14%), and ketogenic (11%).

Conclusion:
In a contemporary analysis of American lifestyle habits, adherence to healthy diet and exercise patterns is unacceptably low. Among individuals who do adhere to healthy habits, there is a heterogeneous admixture of diet and exercise types.
Abstract 15821: Patients With Amyloid Cardiomyopathy Who Receive Durable Mechanical Circulatory Support Are at Increased Risk for Mortality and Early Adverse Events
Authors: Michelis Katherine C , Zhong Lin , Tang Wai Hong W , Young James B , Drazner Mark H , Roth Lori R , PELTZ Matthias , Pandey Ambarish , Griffin Jan , Maurer Mathew S , Grodin Justin L
Published: November 2020

Introduction:
Amyloid cardiomyopathy (ACM) is recognized increasingly as a cause of advanced heart failure. There are limited data describing clinical outcomes for ACM patients who receive durable mechanical circulatory support (MCS).

Methods:
This analysis included adult patients in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) with a primary diagnosis of dilated cardiomyopathy (DCM, N=19,921), non-amyloid restrictive cardiomyopathy (RCM, N=248), or ACM (N=48) who received durable MCS of any type or strategy from 2005-2017. We compared baseline characteristics and adverse events for the 3 groups. The primary endpoint was death with heart transplantation as a competing risk with follow-up censored at device explantation.

Results:
Patients with ACM (N=48) were older (61 y [IQR 55-69] versus 58 y [IQR 49-66] for DCM and 55 y [IQR 46-62] for non-amyloid RCM, P<0.001), and more likely to be male (85% versus 79% for DCM and 63% for non-amyloid RCM, P<0.001) and INTERMACS profile 1 (30% versus 18% for DCM and 21% for non-amyloid RCM, P=0.04) at implant. Use of biventricular support (concomitant left and right ventricular assist devices or total artificial heart) was highest in the ACM group (41% versus 7% and 19% for DCM and non-amyloid RCM groups, respectively, P<0.001). ACM patients experienced a higher frequency of major bleeding (48% versus 29% for DCM and 34% for non-amyloid RCM, P=0.005), neurologic dysfunction (22% versus 10% for DCM and 14% for non-amyloid RCM, P=0.006), and renal dysfunction (20% versus 10% for DCM and 17% for non-amyloid RCM, P<0.001) within 3 months. Risk of death at a median follow-up of 1 year was highest for the ACM group compared to DCM and non-amyloid RCM (Log-rank, P=0.014).

Conclusion:
Compared to DCM or non-amyloid RCM patients, those with durable MCS for ACM have the highest risk of early adverse events and lowest survival. These data highlight concerns with durable MCS for ACM.