bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15958: Comparison of In-hospital Outcomes of Patients Undergoing Catheter Ablation for Typical versus Atypical Atrial Flutter
Authors: Ebner Bertrand , Maning Jennifer , Grant Jelani , Vincent Louis , Olorunfemi Odunayo P , Olarte Neal , Colombo Rosario A , mendoza ivan
Published: May 2021

Introduction:
Catheter Ablation (CA) is indicated as definitive therapy for patients with atrial flutter (AF) which is unresponsive to medical therapy. While atrial flutter may be typical (TAF) or atypical (AAF), there is a paucity of data regarding in-hospital outcomes of patients undergoing CA.

Methods:
This retrospective cohort study used the Nationwide Inpatient Sample to identify all patients above 18 years who underwent CA between 2015 and 2017. Individuals were identified using ICD-10-CM/PCS for TAF, AAF and CA. Statistical analysis was performed comparing TAF to AAF.

Results:
A total of 17,390 patients underwent CA for AF, with 33% having AAF and 67% TAF. Patients with TAF were younger (median 67 years vs. 68 years), with lower proportion of females (29.6% vs. 42.8% p≤0.05 for both) compared to patients with AAF. TAF group had higher rates of emergent admission (85.7% vs. 65.5% p≤0.05). Interestingly, subjects with AAF had earlier interventions than patients with TAF (≤3 days of admission, 76.4% vs. 71% p≤0.05). Patients with TAF have a higher rate of hypertension, diabetes, smoking, heart failure, liver disease, and chronic obstructive pulmonary disease (p≤0.05 for all). However, patients with AAF had increased prior strokes and percutaneous coronary interventions (PCI) (p≤0.05 for both). The mean CHA2DS2-VASc score was found to be 2.3 in AAF compared to 2.1 in TAF (controlled for comorbidities, p≤0.05). Multivariable regression showed a significantly higher proportion of cardiogenic shock, acute coronary syndrome, sepsis, cardiac catheterization, PCI, thromboembolism event, transfusion, and longer length of stay in patients with TAF (p≤0.05 for all). Although we found that patients with AAF have significant higher rates of cardioversion, implantation of cardiac device, pericardial complications, and increased hospital charges (p≤0.05 for all), no significant difference was found in mortality.

Conclusion:
In this retrospective cohort study, we found higher complication rates in CA of patients with TAF, even when adjusting for pertinent comorbidities, but no difference in in-hospital all-cause mortality. Variation in CA depending upon the mechanism of AF may underlie these differences, and warrant further study.
Abstract 15966: Abnormal Left Ventricular Strain Correlates With Left Ventricular Dysfunction but Not Aortic Pathology in Marfan Syndrome in Children
Authors: CONNELL Patrick S , Morris Shaine A , Doan Tam , Weigand Justin
Published: May 2021

Introduction:
Cardiomyopathy has been described in some adults with Marfan syndrome (MFS), as demonstrated by low ejection fraction (EF) and abnormal left ventricular (LV) strain. Recent studies from our group show that LV dilation and decreased EF are common in children with MFS. However, LV strain remains understudied in children.

Hypothesis:
Abnormal strain is associated with lower EF, higher aortic root z-score and higher height-adjusted vertebral artery tortuosity index (VTI-h). In addition, abnormal strain with normal EF is associated with a subsequent decline in EF.

Methods:
Patients with MFS, defined as meeting Ghent 2010 criteria and a pathogenic FBN1 variant or ectopia lentis, <19 years of age at first cardiac magnetic resonance imaging study (CMR) from 2003-2018 were included. CMR LV circumferential and longitudinal strain were measured using feature tracking software. CMR aortic root Z-scores were calculated using both pediatric echocardiographic formulas and MRI reference data. VTI-h was measured using previously described methods. We evaluated initial CMR for associations between strain, EF, root z-scores, and VTI using Spearman correlation. A secondary analysis was performed limiting to patients with a normal EF on initial CMR, evaluating for associations between initial strain values and the outcomes of sustained normal EF versus development of low EF (<55%).

Results:
Of 31 included patients, median age at first CMR was 13.5 y (IQR 10.7-16.2 y). Worse circumferential strain was associated with lower EF (basal: rho = -0.586, p = 0.001; mid: rho = -0.573, p = 0.001; apical: rho = -0.406, p = 0.026), while longitudinal strain was not associated with EF (p = 0.063, 0.257, 0.260). Neither circumferential nor longitudinal strain were associated with aortic root z-score or VTI-h. Among patients with normal EF, initial circumferential strain was not different between patients who maintained normal EF or developed low EF.

Conclusions:
Worse LV circumferential strain was associated with lower EF in children with MFS, while longitudinal strain was not. Abnormal strain was not associated with aortic pathology or later development of reduced EF. This suggests that the cardiomyopathy seen in children with MFS is likely independent of aortic pathology.
Abstract 15985: Comparison of Survival Benefit From Angiotensin Inhibitors in Patients With Heart Failure and Reduced Ejection Fraction by Race and Genomic Ancestry
Authors: Luzum Jasmine A , peterson edward , Li Jia , She Ruicong , Gui Hongsheng , LIU BIN , Williams L. Keoki , Sabbah Hani N , Lanfear David E
Published: May 2021

Introduction:
Definitive evidence for the efficacy of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) in Black Americans with heart failure and reduced ejection fraction (HFrEF) is deficient. It is based on retrospective data, and there were very few Black patients enrolled in the landmark ACEI/ARB trials. Moreover, self-reported race does not reliably reflect genomic ancestry, particularly in Black Americans. Therefore, the objective of this study was to assess ACEI/ARB associated survival benefit in a prospective cohort of HFrEF patients, by both self-reported race and proportion of African genomic ancestry.

Methods:
Insured HFrEF patients (n=989) were enrolled in a prospective genomic registry from 2007-2015. ACEI/ARB exposure (ACEI/ARBexp) was calculated from pharmacy claims as % target exposure, and the proportion of African ancestry was determined from genome-wide array data. Cox proportional hazards regression with time-dependent ACEI/ARBexp and adjusted for established risk factors tested the association with all-cause mortality by self-reported race and proportion of African ancestry (≤5% vs. ≥80%).

Results:
Overall, 36% of patients were female, 52% self-identified as Black, average age was 68±12 years, and the mean follow-up was 3.0 years. Self-reported Black patients were significantly younger, more were women, more often had hypertension and non-ischemic etiology, had lower LVEF, and mean proportion African genomic ancestry of 84%. ACEI/ARBexp was similar among self-reported Blacks and Whites (52% and 55%; p=0.228), as was mortality (121 [24%] and 121 [25%]; p=0.526). ACEI/ARBexp was associated with similar survival benefit in all groups (Table 1).

Conclusions:
In this prospective registry, estimates of survival benefit associated with ACEI/ARB use in HFrEF patients appear similar regardless of self-reported race or African genomic ancestry.
Abstract 15986: Plasma Microrna Profiling Reveals Potential Biomarkers of Thiazide Response
Authors: Chekka Lakshmi Manasa S , Langaee Taimour Y , Wang Danxin , Rolf Renne , Chapman Arlene B , Gums John , Turner Stephen T , Cooper-dehoff Rhonda M , Johnson Julie A
Published: May 2021

Introduction:
Thiazide diuretics (TZDs) are the second most frequently prescribed class of antihypertensives. But <50% patients achieve goal blood pressure (BP) on TZD monotherapy, mostly because therapy is chosen overlooking the heterogeneity in patient responses. Circulating microRNAs (miRNAs) remain attractive as non-invasive biomarkers to predict drug response and tailor therapy for optimal outcomes.

Hypothesis:
Plasma miRNAs may play a role in TZD response; we aim to identify those associated with hydrochlorothiazide (HCTZ) response.

Methods:
We profiled 754 miRNAs in baseline (untreated) plasma samples of 36 uncomplicated hypertensive adults (18 Responders (R) and 18 Non-responders (NR) based on their diastolic BP (DBP) response to HCTZ therapy) from the Pharmacogenomic Evaluation of Antihypertensive Responses clinical trial, using the real-time qPCR based TaqMan OpenArray Human microRNA panel. We filtered out miRNAs with low amplification scores and Cq>38 and samples with low miRNA expression. Combination of miR-223 and miR-19b (identified as most stably expressed miRNAs by NormFinder Software) was used to normalize expression across samples. We used MannWhitney U test to identify microRNAs differentially expressed between R and NR; linear and logistic regressions for associations of miRNA expression with BP response. FDA corrected p<0.05 was used as significance threshold, unadjusted p<0.05 as suggestive threshold.

Results:
Mean systolic BP (SBP)/DBP change in R was 14/10 mmHg and in NR 0/1 mmHg. We found 77 miRNAs to be consistently expressed across samples, of which 11 were upregulated and 14 downregulated with >2-fold difference between R and NR. Though no miRNAs reached FDR p<0.05, miR-376a (fold change(fc)= 10.1, p= 0.035) and miR-17 (fc= -0.45, p= 0.017) were differentially expressed between R and NR and their expression associated with DBP and SBP change, along with miR-10b, miR-24, miR-134 associated with SBP change at p<0.05.

Conclusions:
In this first ever genome-wide miRNA study of antihypertensive drug response, we discovered circulating miRNAs associated with BP response to HCTZ. Future studies are planned to validate these findings in a larger cohort, across different race group and across different TZD.
Abstract 15993: Survival Benefit of Mechanical Valve Over Biological Valve for Isolated Mitral Valve Replacement in Young Dialysis Patients: National Database Analysis
Authors: Ogami Takuya , Avgerinos Dimitrios V , Zimmermann Eric , Ning Yuming , Kurlansky Paul , Zhu Roger , Takeda Koji , George Isaac , Takayama Hiroo
Published: May 2021

Introduction:
Optimal valve choice for mitral valve replacement (MVR) in dialysis patients remains unclear.

Hypothesis:
Mechanical valve (MV) provides survival benefit over biological valve (BV) in young dialysis patients who are undergoing MVR.

Methods:
Using the United States Renal Data System, a total of 2,905 patients were found to have undergone isolated MVR from 2000 through 2015. Median follow up period was 1.27 years (IQR: 0.23-3.33). We stratified patients into 3 groups by age, and adjusted baseline characteristics between patients who received BV and MV using propensity score matching in each age group: Group1, 18 to 49 (n=456); Group2, 50 to 69 (n=1030); and Group3, 70 or older (n=338). Primary endpoint was 10-year mortality. Cox-hazard model was used to compare 10-year mortality between BV and MV in matched cohorts.

Results:
Overall in-hospital and 10-year mortality rates were 16.8% and 87.1%, respectively. Use of BV increased from 17.8% in 2000 to 47.2% in 2015 (Figure 1). In the propensity matched groups, Cox hazard analysis revealed BV was independently associated with higher risk of mortality in Group1 (HR 1.51, 95% CI 1.22-1.86, P<0.001), but not for Group 2 (HR 1.01, 95% CI 0.88-1.15, P=0.88) or Group 3 (HR 0.9, 95% CI 0.72-1.13, P=0.37) (Figure 2).

Conclusions:
MV is associated with better long-term survival over BV in well-matched young dialysis patients who are undergoing isolated MVR.
Abstract 16027: Reporting of Neoplasms Following Angiotensin Receptor Blocker Recalls Using the FDA Adverse Event Reporting System Database
Authors: Cohen Sedgh Robert , Moon Jungyeon , JACKEVICIUS Cynthia
Published: May 2021

Introduction:
A worldwide recall of valsartan due to the potential carcinogen N-nitrosodimethylamine in July 2018 received extensive public attention. This was followed by more FDA recalls of other contaminated angiotensin receptor blocker (ARB) products. Our study investigated the association between the FDA recalls and ARB neoplasm adverse events (AEs) reported to the FDA Adverse Event Reporting System (FAERS).

Methods:
Data was retrospectively collected from the FAERS database for reports from 1/2015-12/2019. Reporting odds ratios (ROR) were estimated to detect signals for association between ARBs (valsartan, losartan, and irbesartan) and reported neoplasm AEs using negative (amoxicillin and sertraline) and positive (omeprazole and ranitidine) control exposures. Chi-square test was used to compare categorical variables.

Results:
A total of 2,181,524 AEs, including 19,287 neoplasm AEs were analyzed. 1-year post-recall reported neoplasm AEs were higher for valsartan than losartan (
p
<0.0001) and irbesartan (
p
<0.0001). Monthly ROR (95% CI) of valsartan-associated neoplasms vs. controls (ROR
*
: valsartan/negative exposure; ROR
†
: valsartan/omeprazole; ROR
†
: valsartan/ranitidine) showed the highest numerical signals post-recall in 7/2018 [7.64 (4.78-12.19)
*
; 4.77 (3.36-6.79)
†
; 4.13 (2.50-6.84)
†
] and 8/2018 [(7.87 (5.19-11.94)
*
; 5.65 (4.12-7.75)
†
; 7.20 (4.46-11.63)
†
]. In contrast, the highest post-recall cancer signals for irbesartan and losartan detected in 3/2019 (4.80
*
; 4.06
†
; 3.38
†
) and 4/2019 (3.63
*
; 3.69
†
; 2.52
†
) respectively, were lower.

Conclusion:
Significantly more post-recall neoplasms were reported for valsartan, with higher valsartan-associated cancer signals compared with losartan and irbesartan, even though they all contained the same carcinogenic contaminant. Extensive media coverage of the FDA valsartan recall may have alarmed patients and generated these abrupt, biologically infeasible cancer signals.
Abstract 16035: Socioeconomic Status and 1-year Mortality Among Patients With Heart Failure in China: Findings From the China-PEACE Prospective Heart Failure Study
Authors: Ge YILAN , Gao Yan , Wang Bin , Li Jing , zheng xin
Published: May 2021

Introduction:
Socioeconomic status (SES) has been shown to affect the survival of patients with heart failure (HF) in the developed countries. However, the association between SES with mortality has been scarcely investigated in China.

Methods:
We studied a national sample of 4717 patients admitted to 52 hospitals for HF who had SES record and were discharged alive from the China PEACE-Prospective Heart Failure Study. SES were obtained through questionnaires during hospitalization, and were measured by self-reported employment status (employed, retired, never work), education level (low educational attainment defined as primary school or below; intermediate educational attainment defined as junior high school; high educational attainment defined as senior high school or above) and partner status (having a partner, no partner). We assessed the association between SES and 1-year all-cause mortality using Cox models.

Results:
The median age of study population was 67 (57,76) years, 37.6% were women.17.6% of patients had a job, 72.5% retired and 9.9% never worked. The proportions of patients who had low, intermediate and high educational attainment were 43.0%, 29.0% and 28.0%,respectively. Additionally, 80.8% of patients had a partner. In unadjusted analysis, compared with patients who had a job, who had high educational attainment and who had a partner, respectively, currently no work status (retired group: HR 2.08, 95%CI 1.64 to 2.63; never work group: HR 2.23, 95%CI 1.78 to 3.22), low educational attainment (HR 1.52, 95%CI 1.28 to 1.81) and no partner (HR 1.31, 95%CI 1.12 to 1.54) were all associated to higher mortality. After adjusting for patient characteristics, medication use at discharge and mutually adjusting for socioeconomic status, education level and partner status were not associated with mortality, However, patients without work currently (retired group: adjusted HR 1.52, 95%CI 1.17 to 1.97; never work group: adjusted HR 1.60, 95%CI 1.15 to 2.22) were still more likely to die within 1 year.

Conclusions:
In a national Chinese cohort of patients hospitalized for HF, currently no work status was associated with higher 1-year mortality risk, while the education level and partner status were not correlated with mortality.
Abstract 16037: Hybrid Convergent Ablation for Atrial Fibrillation: Updated Systematic Review and Meta-analysis
Authors: shrestha suvash , DeLurgio David , Kiser Andy , Oza Saumil , Greenberg Yisachar , Yang Felix
Published: May 2021

Introduction:
Hybrid convergent epicardial/endocardial ablation was developed in response to the limited effectiveness of endocardial catheter ablation for persistent (PersAF) and longstanding PersAF (LSPAF). The objective of this study was to perform a systematic review and meta-analysis of reported safety and efficacy outcomes with convergent procedures.

Methods:
Predefined search terms were used in PubMed; the initial search was performed in June 2019 and updated in May 2020. Abstracts and full text in English were reviewed for peer-reviewed, primary clinical studies of hybrid convergent procedures in PersAF/LSPAF. Meta-analysis was performed with using a random effects model with a restricted maximum likelihood estimator and forest plots. Heterogeneity was tested using Cochran’s Q-test.

Results:
The updated search yielded 325 unique results. Two articles from meta-analyses were added. Nineteen articles met inclusion with safety and/or efficacy data. Three overlapping studies were excluded. Results from the randomized CONVERGE trial were added, for a total of 1084 patients in 17 studies; 94% had PersAF or LSPAF. The 30-day major adverse event rate was 3.1% (95% CI 1.9% - 4.3%; n=1084; 17 studies), excluding pericardial effusions (PE) (non-emergent inflammatory response) and 5.1% (95% CI 3.6% - 6.6%) overall. The PEs may be mitigated by anti-inflammatory prophylaxis, pericardial drainage and appropriate patient monitoring. Freedom from AF/atrial arrhythmia at one year or later was 75.0% (95% CI 66.0%-83.9%; n=805; 14 studies) regardless of anti-arrhythmic drugs (AAD) and 64.9% (95% CI 54.7%-75.1%; n=494; 8 studies) off AADs/ absent increased dosage of failed AADs. Heterogeneity across studies was detected for effectiveness (p<0.0001), but not for safety (p=0.12).

Conclusions:
This meta-analysis shows high efficacy of hybrid convergent ablation at one year, even off AADs, and a reasonable safety in mostly persistent or long-standing persistent AF.
Abstract 16044: Association of Area Deprivation Index With Recurrent Cardiovascular Outcomes: Does Cardiac Rehabilitation Participation Mitigate Effects?
Authors: Guhl Emily N , Zhu Jianhui , Johnson Amber , Essien Utibe , Thoma Floyd W , Mulukutla Suresh R , Magnani Jared W
Published: May 2021

Introduction:
Neighborhood location impacts access to health-promoting resources and outcomes. Cardiac rehabilitation (CR) provides a multidisciplinary approach that improves cardiovascular outcomes. We evaluated the association of Area Deprivation Index (ADI) and cardiovascular events in individuals with incident Heart Failure (HF) or myocardial infarction (MI) and the modifying effect of CR.

Methods:
We identified an observational cohort admitted with primary diagnosis of 1) MI with percutaneous coronary intervention or 2) a primary diagnosis of incident HF from 2010-2018 at a multi-site regional center. We derived ADI from patient home address and then categorized into quartiles. Demographics, clinical covariates, and CR participation post-hospitalization were obtained from the electronic medical record. We compared rates of readmission for a cardiovascular primary diagnosis and mortality across ADI quartiles. Analyses were then stratified by CR participation.

Results:
In a cohort of 6957 (38.2% women, 88.7% white) with adjustment for covariates, increasing ADI was significantly associated with higher rates of cardiovascular rehospitalization (p<0.01), Acute Coronary Syndrome (ACS) rehospitalization (p=0.01), HF rehospitalization (p<0.01), and all-cause mortality (p=0.04), Table. When we stratified across CR participation, those with participation had significantly lower rehospitalizations (p<0.01) and mortality (p<0.01) when compared to the no CR group. There was no significant effect of ADI on outcomes in the CR group.

Discussion:
We found increased ADI was adversely associated with mortality and rehospitalizations in cardiac patients. For those participating in CR, there was 1) no significant effect of ADI and 2) decreased incidence of adverse outcomes vs. those who did not participate in CR. Given the benefit of CR participation on ADI’s adverse effect on outcomes, future interventions should focus on increasing CR participation.
Abstract 16056: The Prevalence, Risk Factors and Outcome of Cardiac Dysfunction in Hospitalized Patients With Covid-19
Authors: XIE Mingxing , Li Yuman , Li He , Xie Yuji , Li Meng , Zhang Li
Published: May 2021

Objectives:
We aimed to investigate the prevalence, risk factors and outcome of cardiac dysfunction, and explore the potential value of echocardiographic parameters in hospitalized patients with coronavirus disease 2019 (COVID-19).

Background:
Cardiac involvement is a prominent features in COVID-19. However, the prevalence and clinical significance of cardiac dysfunction in COVID-19 patients have not yet been well described.

Methods:
We studied 157 consecutive hospitalized COVID-19 patients, whose Left ventricular (LV) and right ventricular (RV) structure and function were evaluated by echocardiography.

Results:
RV dysfunction was found in 40 (25.5%) patients, and LV dysfunction in 28 (17.8%) patients consisting of 24 (15.3%) with heart failure with preserved ejection fraction and 4 (2.5%) with heart failure with reduced ejection fraction. Hypertension, acute respiratory distress syndrome (ARDS), high-sensitivity troponin I (hs-TNI) level and mechanical ventilation therapy was associated with cardiac dysfunction, which contributed to higher mortality (LV dysfunction: 28.6% vs 11.6%,
P
= 0.022; RV dysfunction: 37.5% vs 6.8%,
P
< 0.001, respectively). Moreover, LV and RV dysfunction were more frequent in patients with elevated hs-TNI than those without (37.5% vs 12.5 %,
P
= 0.001; 40.0 % vs 22.9%,
P
= 0.043, respectively). During hospitalization, 23 patients died. The mortality was 3.0% for patients without cardiac dysfunction and normal hs-TNI levels, 6.7% for those with cardiac dysfunction and normal hs-TNI levels, 13.3% for those without cardiac dysfunction but elevated hs-TNI levels, and 64.0% for those with cardiac dysfunction and elevated hs-TNI. In Cox analysis, RV dysfunction was independently predictor of higher mortality (hazard ratio=2.79; 95% CI: 1.10 to 7.06; P=0.031). HF, especially HFpEF, was not predictive of increased mortality.

Conclusions:
The prevalence of RV dysfunction was higher than that of HF. Moreover, HFpEF was more common than HFrEF. RV dysfunction is an independent predictor of higher mortality. Additionally, patients with cardiac dysfunction and elevated hs-TNI had the highest mortality, which may prompt physicians to pay attention not only to the hs-TNI level but also the cardiac dysfunction.
Abstract 16062: Hypoglycemia and Risk of Atherosclerotic Cardiovascular Disease (ascvd) in Patients With Diabetes
Authors: Rana Jamal S , Liu Jennifer Y , Moffet Howard H , Karter Andrew
Published: May 2021

Introduction:
Studies evaluating the relationship of severe hypoglycemia (SH) with the risk of atherosclerotic cardiovascular disease (ASCVD) events are limited by size, confounding and inconsistent outcome definitions. The aim of this study was to assess the association of SH, as defined by hypoglycemia-related hospital utilization, with risk of ASCVD.

Methods:
We conducted an observational cohort study of adults with diabetes with or without established ASCVD (as of 1/1/2014). All subjects were members of Kaiser Permanente Northern California, an integrated health care delivery system. Baseline was determined by the date of the first hypoglycemia-related utilization (primary diagnosis of hypoglycemia in the emergency department or principal diagnosis in the hospital) during 1/1/2013 - 12/31/2013. Baseline for those without SH, was a randomly assigned date in 2013. Multivariate Cox proportional hazard models were specified to estimate hazard ratios (HRs) for SH in adjusted models of time to incident ASCVD events. This outcome was defined as a composite of nonfatal myocardial infarction, ischemic stroke, or coronary heart disease death through 12/31/2017.

Results:
Among 233,696 eligible individuals, mean age was 63.6 years, 47.6% were women, and mean follow-up was 3.8 years. There were 2,179 episodes of SH. Age-sex-race adjusted risk of ASCVD among those with SH versus those without was HR 2.59 (95% CI 2.3-2.9). When additionally adjusted for prior ASCVD, the HR was still more than double, HR 2.32 (95% CI 2.1-2.6). In a fully saturated model with additional adjustments for diabetes type, diabetes duration, HbA1c, GFR, Charlson score, insulin use, sulfonylureas, and quartiles of neighborhood deprivation, SH was associated with a 30% increased risk (HR 1.31, 95% CI 1.16-1.5). The substantial attenuation in risk after more comprehensive adjustment suggests that patients at higher risk of SH are likely at higher risk of ASCVD.

Conclusions:
In a large, diverse and contemporary cohort of patients with diabetes, SH as defined by hypoglycemia-related hospital utilization is associated with greater risk of ASCVD. Increased awareness in recognizing this risk and vigilance in care for this higher risk population is warranted.
Abstract 16078: Risk Classification of Familial Hypercholesterolemia Through Screening of the Electronic Health Record Within a Large Healthcare System
Authors: Sheth Samip , Vargas Jose
Published: May 2021

Introduction:
Familial hypercholesterolemia (FH) is a genetic disorder characterized by very high low-density lipoprotein cholesterol (LDL-c) levels. The heterogeneity of clinical risk within FH may lead to differential treatment, management, and outcomes. Screening the electronic health record (EHR) permits risk classification within FH at scale. We leveraged the Georgetown/MedStar Health System (MHS) EHR to perform risk classification while describing other characteristics of suspected FH patients.

Methods:
The Dutch Lipid Clinical Network (DLCN) remains a common scoring algorithm for FH risk classification. Applying the DLCN algorithm to the EHR of MHS enabled risk classification of approximately 1.6 million patients. The classifiers included ‘definite,’ ‘probable,’ and ‘possible’ heterozygous FH (HeFH). ‘Possible’ homozygous FH (HoFH) was determined by LDL-c > 500 mg/dL. Of these suspected FH patients, current age, gender, and race as well as abnormal lipid profile data (high-density lipoprotein cholesterol (HDL-c) cholesterol < 20 mg/dL, triglyceride (TG) > 300 mg/dL) were descriptively described.

Results:
Of 1.6 million patients, the number of definite, probable, and possible HeFH patients were 83 (1:19722), 690 (1:2318), and 5945 (1:266), respectively. The number of possible HoFH patients was 8 (1:200000). The highest reported median LDL-C (IQR) for the three HeFH subpopulations was 377 (346, 430 mg/dL), 262 (251, 282 mg/dL), and 203 (mg/dL), and the majority of all subpopulations were female and non-white. Definite HeFH patients were more likely to present with very low HDL-c and approximately 1:10 suspected HeFH patients presented with very high triglycerides.

Conclusion:
The application of DLCN to the EHR demonstrates risk classification for FH in a large healthcare system. The implications of stratifying suspected FH patients by classifier within the EHR may optimize clinical care as well as registry management.
Abstract 16085: Digoxin is Associated With Increased Mortality in Patients With Atrial Fibrillation Without Concomitant Heart Failure
Authors: Tysarowski Maciej , Rafael Nigri , Kim Hyoeun , Aziz Emad
Published: May 2021

Introduction:
There is conflicting data on the effect of digoxin on all-cause mortality in patients with atrial fibrillation (AF), especially in patients with heart failure (HF).

Hypothesis:
We hypothesized that in patients with AF, mortality rates associated with digoxin treatment are different among patients with HF and without HF.

Methods:
We conducted a cohort study of hospitalized patients with AF assessing the effects of digoxin on all-cause mortality. We divided patients into two groups: with and without HF. We performed Cox regression analysis to assess hazard ratios (HR) for all-cause mortality depending on digoxin treatment and used propensity score matching to adjust for differences in background characteristics between treatment groups.

Results:
Among 2179 consecutive patients, the median age was 73 ± 14 (table), 53% patient were male, 49% had HF, 19% were discharged on digoxin. Median left ventricular ejection fraction in the cohort was 60 (IQR 40-65). Among patients with HF, 35% had preserved, 18% had mid-range and 48% had reduced left ventricular ejection fraction. The mean follow-up time was 3 ± 2.1 years. After adjustment, in patients with HF, there was no statistically significant difference in mortality between the digoxin subgroups (
A
, HR=1.01 [95% CI 0.76 to 1.35], p=0.92). In contrast, after adjustment, in patients without HF there was a statistically significant increased mortality in the digoxin subgroup (
B
, HR=2.23, [95% CI 1.42 to 3.51], p<0.001).

Conclusions:
Digoxin use was associated with increased mortality in patients with AF and without concomitant HF. This suggests that clinicians should be careful in prescribing digoxin for rate control in AF, especially in patients without concomitant HF.
Abstract 16089: Clinical Outcomes Associated With Anti-coagulation versus No Anti-coagulation for Atrial Fibrillation Among Octogenarians and Nonagenarians; a Meta-analysis
Authors: Barssoum Kiro , Kumar Ashish , Rai Devesh , Elkaryoni Ahmed , Thakkar Samarthkumar J , Ibrahim Mounir , Kharsa Adnan , Tahir Muhammad Waqas , Rao Mohan
Published: May 2021

Background:
Octogenarians and nonagenarians are under-represented in major clinical trials studying the role of anticoagulation (AC) in atrial fibrillation (AF). These patients are at an increased risk of bleeding owing to their frailty, their propensity for falls, and frequently impaired kidney function. We performed a meta-analysis of studies that investigated the role of AC in these patients.

Methods:
We queried Medline, EmCare, CINHAL, Cochrane Database, and Google Scholar for studies investigating the role of AC for AF in octogenarians and nonagenarians. Our primary efficacy outcome was major thromboembolism (TE), and secondary safety outcome was major bleeding (MB). We used the PM method with HKSJ adjustment to estimate risk ratio (RR) with a 95% confidence interval (CI). Heterogeneity was assessed using Higgin’s I
2
. R version 3.6.2 was used for statistical analysis. Heterogeneity was addressed using outlier analysis. dmetar() package in R was used, and the pooled estimate was re-calculated, excluding the outliers.

Results:
Ten observational studies, including a total of 34,697 patients were included. There was no difference in the risk of TE [RR: 0.82, 95% CI: 0.49-1.38, I
2
=74%] or MB [RR: 1.00, 95% CI: 0.55-1.83, I
2
=88%] between the AC and Non-AC group. However, the pooled estimates were associated with considerable heterogeneity. Outlier analysis identified two studies "Perera et al., 2009" and "Yamashita et al., 2016" as an outlier for pooled estimation of TE, while [1] "Siu et al., 2014", "Bertozzo et al., 2016", "Ekerstad et al., 2018" and "Alnsasra et al., 2018" were outliers in the pooled estimate of MB. Following exclusion of outliers for each endpoint, the reanalyzed RR for TE and MB were [RR: 0.94, 95% CI: 0.82- 1.09, I
2
=0%] and [RR: 1.57, 95% CI: 1.41- 1.74, I
2
=0%].

Conclusion:
There was no difference in the risk of TE, while the risk of MB increased with the use of AC for AF in octogenarians and nonagenarians.
Abstract 16095: Plasma NT-proBNP Concentrations are Two-fold Lower in Pacific versus European Population Samples: Evidence for Glycosylation Impacting Assay Detection and/or ProBNP Processing
Authors: Faatoese Allamanda , Lasse Moritz , Lewis Lynley , Pemberton Chris J , Richards A M , Cameron Vicky A
Published: May 2021

Introduction:
Pacific Islanders in New Zealand (NZ) have high rates of cardiovascular and metabolic disorders. The Pasifika Heart Study (PHS) recorded ethnic-specific clinical and biomarker data to inform clinical management in community care.

Methods:
For the PHS, Pacific adults (n=200) aged 20-64 years were selected from patients of a Pacific-led health centre in Christchurch, NZ, and screened for existing cardio-metabolic disorders and risk factors. Circulating concentrations of NT-proBNP (Roche Cobas NT-proBNP II), total proBNP and proBNP not glycosylated at Threonine 71 (T71) residue (both by in-house Luminex assays) were measured. Assay data were compared with European participants in the INSPIRE study (n=103 healthy volunteers, 20-70 years).

Results:
PHS participants had a mean age (SD) of 41.7 (11.5) years, 48% were male, mostly of Samoan and Tongan ethnicities (44% and 32% respectively). INSPIRE European participants had a mean age of 46.8 (15.0) years, 46% were male. NTproBNP concentrations measured by Cobas were two-fold lower in the PHS (median = 18.4 ng/L, IQR = [7.3, 35.8]) compared with INSPIRE (40.0 ng/L [19.8, 70.2]) (p<0.001). Moreover, consistently lower concentrations were observedin PHS across a spectrum of either age or BMI (see Figure). In contrast, total proBNP concentrations exhibited a broad range in both cohorts, but did not differ between PHS (192.8 [35.7, 414.2] ng/L) and INSPIRE (36.1 [36.1, 225.1] ng/L, p<0=0.278). This suggests that in the PHS, either the Cobas assay underestimates NT-proBNP due to glycosylation of antibody-binding sites and / or proBNP is not processed to NTproBNP due to glycosylation at the T71 cleavage site. As evidence for the latter, only 8% of PHS had proBNP not glycosylated at T71 versus 31% of INSPIRE (p<0.001).

Conclusions:
Use of NT-proBNP thresholds based on European reference ranges to assess cardiovascular risk in community care may lead to under-diagnosis of evolving heart failure in Pacific Islanders.
Abstract 16099: Predictors of Cardiovascular Implantable Electronic Device-dependence at Long-term Follow-up After Alcohol Septal Ablation in Hypertrophic Cardiomyopathy Patients
Authors: Bode Weeranun D , Bode Michael F , Zhao Megan , Sakhuja Rahul , Fifer Michael A , Mela Theofanie
Published: May 2021

Introduction:
The most common complication of alcohol septal ablation (ASA) is periprocedural high grade AV block (HGAVB). No long-term follow-up of cardiovascular implantable electronic device (CIED) utilization after ASA has been reported.

Hypothesis:
Pacemaker dependence on long-term follow up can be predicted by ECG or procedural characteristics.

Methods:
We analyzed all patients with hypertrophic cardiomyopathy who underwent ASA from December 1998 to December 2019 at our institution and received their first CIED within 30 days after ASA for HGAVB. All available follow-up interrogations were reviewed. CIED dependence was defined as ventricular pacing of ≥5%. CIED programming was determined by the patients’ cardiologists' discretion.

Results:
A total of 103 patients with hypertrophic cardiomyopathy underwent ASA. The average follow up duration was 10.1 years. Within 30 days after ASA, a total 25 patients received a CIED for HGAVB. On long term follow-up 16 patients (64%) were found to be CIED-dependent. Baseline characteristics, including pre and post-ASA ECG, were not significantly different between dependent and non-dependent patients (Table). The only predictor for CIED dependence was >1 ml of alcohol injected during ASA (OR 6.0, p<0.046).

Conclusions:
CIED implantation after ASA is common. Almost two thirds of patients who received CIED for postprocedural HGAVB were CIED-dependent on long term follow up. CIED dependence can be predicted by amount of injected alcohol >1 ml during ASA.
Abstract 16105: Depression Modulates Polygenic Risk of Cardiovascular and Cardiometabolic Disease
Authors: Honigberg Michael C , Sarma Amy , Scott Nandita , Wood Malissa J , Natarajan Pradeep
Published: May 2021

Introduction:
Depression is associated with an increased risk of coronary artery disease (CAD). Whether depression modifies genetic risk of cardiovascular and cardiometabolic disease is unknown.

Methods:
We included genotyped, unrelated European ancestry individuals in the UK Biobank. Using genome-wide significant single nucleotide polymorphisms (SNPs) from studies external to the UK Biobank, we generated polygenic risk scores (PRS) for coronary artery disease (CAD, 74 SNPs), hypertension (75 SNPs), type 2 diabetes (T2D, 64 SNPs), atrial fibrillation (25 SNPs), and ischemic stroke (11 SNPs). Participants were stratified by PRS for each condition as low (quintile 1), intermediate (quintiles 2-4), and high (quintile 5) genetic risk. Cox models tested the association of depression frequency with each incident condition among individuals with high PRS, with adjustment for age, sex, the first 20 principal components, genotyping array, and Townsend deprivation index. Additional models further adjusted for health behaviors (exercise, tobacco and alcohol use, vegetable and fresh fruit intake) and tested associations across the PRS spectrum.

Results:
Among 348,083 individuals, 78,664 (22.6%) reported depression in the past 2 weeks, including 14,776 (4.2%) with depression more than half of days. Depression burden modified the risk of incident CAD across the spectrum of CAD polygenic risk (Figure 1A). Among individuals with high PRS, lack of depression was associated with lower risk of incident CAD (HR 0.70, 95% 0.58-0.86), hypertension (HR 0.58, 95% CI 0.50-0.67), T2D (HR 0.48, 95% CI 0.41-0.55), and atrial fibrillation (HR 0.74, 95% CI 0.62-0.89) compared to those with a high burden of depression. These risk reductions were minimally attenuated after further adjustment for health behaviors (Figure 1B).

Conclusions:
Lower burden of depression was associated was decreased risks of cardiovascular disease among individuals at high genetic cardiovascular risk.
Abstract 16118: Extracorporeal Membrane Oxygenation for Children With Myocarditis: An Update From the Elso Registry
Authors: Gutierrez Maria E E , Guffey Danielle , Anders Marc , Denfield Susan W , rajagopal satish , Lasa Javier J
Published: May 2021

Introduction:
Acute myocarditis causing cardiogenic shock commonly requires mechanical circulatory support. While it has been shown to be associated with survival to discharge in reports comparing indications for ECMO, our understanding of the impact of patient care related factors on outcomes remains limited by single center analyses and lack of consensus on diagnostic criteria. We therefore aimed to describe ECMO utilization and outcomes for pediatric patients requiring ECMO for acute myocarditis by sampling contemporary cohorts from the Extracorporeal Life Support Organization registry.

Methods:
Data was requested from ELSO database to include all pediatric patients under 19 years of age with a diagnosis of acute myocarditis who received ECMO support between 2007 and 2018. Index cases were utilized while non-VA ECMO runs were excluded. Primary outcome was mortality. Characteristics of the population are compared by mortality using t-test, Wilcoxon rank sum test, or Fisher’s exact test. Univariate analysis was performed. Multivariate logistic regression was used for significant factors in the unadjusted logistic regression.

Results:
We analyzed 924 ECMO runs after applying exclusion criteria. Overall survival for the cohort was 69%. Patients experiencing cardiac arrest requiring ECMO (ECPR) were less likely to survive compared to non-ECPR patients (61% vs 72%, p<0.01). The time from intubation from ECMO was found to be associated with mortality, with increased time from intubation to ECMO cannulation in survivors of 6hrs [IQR 2-22] vs non-survivors 9.5hrs [IQR 2-33], p<0.01).

Conclusions:
The results of this multicenter analysis of ECMO utilization and outcomes for pediatric myocarditis reveal a lower likelihood of survival when the indication for ECMO cannulation is ECPR. Increased time from intubation to ECMO cannulation may impact outcomes as much as markers of inadequate oxygen delivery. This suggests that earlier ECMO cannulation may improve outcomes for pediatric patients presenting with acute myocarditis. Further investigation into the factors distinguishing ECPR from non-ECPR patients with myocarditis are needed.
Abstract 16124: Implantable Cardioverter Defibrillators in Patients With Hereditary Transthyretin Cardiac Amyloidosis
Authors: Yalamanchili Sreeram , Brown Matthew T , Blank Evan A , Lyle Melissa A , Bhatt Kunal N
Published: May 2021

Introduction:
Implantable cardioverter defibrillator (ICD) implantation in patients with cardiac amyloidosis is controversial, with no clear guidelines for clinical decision-making.. The role of ICD implantation in hereditary Transthyretin Amyloid Cardiomyopathy (hATTR-CM) is unclear. We sought to establish the burden of ventricular arrhythmias and the outcomes of ICD implantation in a single center cohort of hATTR-CM patients.

Methods:
A total of 69 patients with a confirmed diagnosis of hATTR-CM from genetic testing, and technetium pyrophosphate (PYP) scanning, or endomyocardial biopsy underwent retrospective chart review for demographic, clinical, and arrhythmia data.

Results:
Seventy-four percent of the cohort was male, with a mean age at diagnosis of 68 (SD=18 years). Sixty-five patients (94.2%) patients were African-American; all of whom carried the Valine 122 Isoleucine mutation. Most had systolic heart failure (New York Heart Association Staging II [18, 26%] and III [40, 58.8%]); 37 (54%) patients had an LVEF ≤ 35%. Thirty-six (52.2%) patients had documented episodes of non-sustained ventricular tachycardia (NSVT), three (4.3%) with ventricular tachycardia (VT), and one (1.5%) with ventricular fibrillation (VF). A total of 15 (21.7%) patients had ICDs placed for prevention of sudden cardiac death in the setting of low LVEF (EF <35%). All recorded VT/VF episodes occurred in three patients with ICDs. Of these patients, one experienced two episodes of VT each successfully abated by antitachycardia pacing (ATP), another experienced a single episode of VT abated by ATP, while the final experienced VF with successful 36J shock as well as two episodes of VT each successfully treated with 36J shocks. No inappropriate ICD shocks were delivered, however, there were two instances of ATP for inappropriately detected atrial arrhythmias.

Conclusions:
In a cohort of patients with hATTR-CM, we observed a high incidence of NSVT, yet only 41% of patients with severe systolic heart failure had ICDs implanted. A high rate of successful defibrillation and no inappropriate ICD shocks were noted, suggesting that ICDs should be strongly considered, and may be underutilized, in patients with systolic heart failure and/or arrhythmias in the setting of hATTR-CM.
Abstract 16125: Impact of COVID-19 on Echocardiography Volume at a Large Academic Medical Center
Authors: Varghese Merilyn S , Strom Jordan B , Fostello Sarah , Manning Warren J
Published: May 2021

Introduction:
COVID-19 has significantly impacted hospital systems worldwide. The impact of statewide stay-at-home mandates on echocardiography volumes is unclear.

Methods:
We queried our institutional echocardiography database from 6/1/2018 to 6/13/2020 to examine rates of transthoracic (TTE), stress (SE), and transesophageal echocardiograms (TEE) prior to and following the COVID-19 Massachusetts stay-at-home order on March 15, 2020.

Results:
Among 36,377 total studies performed during the study period, mean weekly study volume dropped from 332 + 3 TTEs/week, 30 + 1 SEs/week, and 21 + 1 TEEs/week prior to the stay-at-home order (6/1/2018-3/15/2020) to 158 + 13 TTEs/week, 8 + 2 SEs/week, and 8 + 1 TEEs/week after (% change, -52%, -73%, and -62% respectively, all p < 0.001 when comparing volume prior to March 15 versus after). Weekly TTEs correlated strongly with hospital admissions throughout the study period (r = 0.93, 95% CI 0.89-0.95, p < 0.001) (
Figure
). Outpatient TTEs declined more than inpatient TTEs (% change, -74% vs. -39%, p <0.001). As of 3 weeks following the cessation of the stay-at-home order, TTE, SE, and TEE weekly volumes have increased to 73%, 66%, and 81% of pre-pandemic levels, respectively.

Conclusions:
Echocardiography volumes fell precipitously following the Massachusetts stay-at-home order, strongly paralleling declines in overall hospitalizations. Outpatient TTEs declined more than inpatient TTEs. Despite lifting of the order, echocardiography volumes remain substantially below pre-pandemic levels. The impact of the decreased use of echocardiographic services on patient outcomes remains to be determined.
Abstract 16126: Cumulative Impact of Social Determinants of Health Risk Score on Obesity Among Young Adults in the United States
Authors: Maqsood Muhammad Haisum , Valero-Elizondo Javier , Singh Rahul , Shah Karan , Hyder Maryam , Sharma Garima , Blaha Michael J , Blankstein Ron , Virani Salim S , Cainzos Achirica Miguel , Nasir Khurram
Published: May 2021

Introduction:
The growing prevalence of obesity has created a major burden on the health care system. To date, studies examining social determinants of obesity in adults have mostly focused on individual social determinants of health (SDOH) components. In this study, we explore the influence of cumulative SDOH on obesity among young adults (< 45) as compared with middle- aged (45-64) and elderly (≥ 65) populations in the US.

Methods:
We examined cross-sectional data on 164,696 adult participants from the National Health Interview Survey (2013-17). For each individual, the unfavorable SDOH risk factor was identified from 39 sub-components, stemming from 6 general domains (economic stability, neighborhood and physical environment, community and social context, food, education, and healthcare system access). Risk factors were then aggregated to develop a cumulative score, wherein individuals were divided into quartiles. Obesity was calculated from self-reported height and weight and defined as BMI ≥ 30 kg/m
2
. Adults with a BMI <18.5 kg/m
2
were excluded from the analysis.

Results:
The age-adjusted prevalence of obesity was 32.5%, which translates to 78 million US adults annually. A linear increase in the prevalence of age-adjusted obesity was noted with increasing unfavorable SDOH prevalence across all age groups. In the overall population, those with the worst (4
th
quartile) vs best (1
st
quartile) SDOH profile had 1.47 higher odds of being obese in adjusted models. There was evidence, however, of effect modification by age (p-value for interaction < 0.001), with a stronger association of unfavorable SDOH risk with obesity in the young (<45 years) as compared with middle age and elderly (Table).

Conclusions:
A higher burden of SDOH is more strongly associated with obesity in young adults. Estimating and understanding the impact of SDOH may have practical implications for informing effective interventions to combat early adulthood obesity and its ensuing complications.