bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15438: Comprehensive Structural, Molecular, and Electrophysiological Maturation of Human Induced Pluripotent Stem Cell Derived Atrial Cardiomyocytes to Serve as a Platform to Model Atrial Fibrillation
Authors: Ly Olivia T , Brown Grace , HONG Liang , Sridhar Arvind , Zhang Meihong , Chen Hanna , Youn Seock Won , Han Yong Duk , Massad Malek , Abdelhady khaled , Alzahrani Zain , KHETANI SALMAN , Darbar Dawood
Published: November 2020

Introduction:
Increasingly, human induced pluripotent stem cells (hiPSC) faithfully recapitulate human models of arrhythmias. However, enhancing hiPSC-derived atrial cardiomyocyte (aCM) maturity is vital as modeling mature CMs will provide insights into cellular mechanisms of atrial fibrillation (AF) and signaling pathways critical to atrial development

Hypothesis:
Combinatorial conditioning of hiPSC-aCMs with biochemical cues (T3, IGF-1, dexamethasone; TID), fatty acids (FA; oleic/palmitic acid), and acute electrical stimulation (ES) at increasing intensity over 45 days comprehensively enhances structural, molecular, and electrophysiological (EP) maturity of hiPSC-aCMs

Methods:
HiPSCs generated from patient specific peripheral blood mononuclear cells were differentiated into aCMs using retinoic acid and glucose starvation. Maturity of atrial iPSC-CMs was enhanced using TID, FA, and acute ES for the final 4 weeks of culture. Structural (immunofluorescence; transmission EM), molecular (qPCR; RNAseq), and EP (patch clamping; multielectrode array; high throughput automated patch clamping) maturity is assessed and compared to untreated hiPSC-aCMs and adult human aCMs harvested from the same patient (optimal maturity)

Results:
We showed improved hiPSC-aCM structural maturity with TID, FA, and ES (
Fig. 1A
). EP maturity also displayed more hyperpolarized resting membrane potential (RMP;
Fig. 1B
), and improved upstroke velocity, action potential duration (APD), and amplitude (not shown). Expression of ion channels, and calcium handling and structural proteins is significantly improved (
Fig. 1C
)

Conclusions:
Combinatorial conditioning with TID, FA, and ES markedly improved structural, molecular, and EP maturity of hiPSC-aCMs. Our findings will serve as a platform to model AF, elucidate underlying cellular mechanisms, and identify novel therapeutic targets for a personalized, mechanism based approach to treat this common condition
Abstract 15446: In-hospital Mortality Outcomes Between Urban and Rural Hospitals for Patients Undergoing Percutaneous Coronary Intervention
Authors: Chang Katie , Chiu Nicholas , Aggarwal Rahul
Published: November 2020

Introduction:
Percutaneous Coronary Intervention (PCI) is among the most common procedures in cardiology. However, in-hospital mortality for patients undergoing PCI procedures based on hospital location and teaching status needs evaluation. Understanding this relationship is necessary for identifying disparities in patient outcomes for PCI procedures.

Hypothesis:
To evaluate whether urban teaching hospitals have lower in-hospital mortality rates for PCI procedures than urban non-teaching and rural hospitals.

Methods:
We used data from the 2016 National Inpatient Sample (NIS) database to identify inpatient PCI hospitalizations. Hospitals were categorized as rural, urban teaching, and urban non-teaching. We used multivariable logistic regression to evaluate in-hospital mortality for PCI by hospital location and teaching status. We controlled for age, sex, race, length of stay, and comorbidities. Analyses accounted for the survey weighting design.

Results:
We identified 80,793 unweighted inpatient hospitalizations for PCI, representing 390,070 admissions when accounting for the survey weighting design. Of the 390,090 admissions, there were 21,020 (5.4%) from rural hospitals and 369,070 from urban hospitals (94.6%). Within the urban hospitals, there were 267,365 (72.4%) admissions from teaching hospitals and 101,705 (27.6%) admissions from non-teaching hospitals. There were no significant differences for in-hospital mortality between urban (6885 +/- 224.2 deaths) and rural hospitals (355 +/- 52.6 deaths, p= 0.6351). In-hospital mortality was found to be lower at urban teaching hospitals (4895 +/- 187.1 deaths) than at urban non-teaching hospitals (1990 +/- 123.5 deaths, p= 0.0096).

Conclusions:
In-hospital mortality for inpatient PCI procedures was not associated with hospital location, but rather with hospital teaching status. Urban teaching hospitals had lower rates of in-hospital mortality for PCI procedures than urban non-teaching hospitals. Further investigation to identify causes for this discrepancy is necessary.
Abstract 15459: Impact of Progression From Paroxysmal to Sustained Atrial Fibrillation on Clinical Outcomes in Patients With Obesity: The Fushimi Af Registry
Authors: Fujino Akiko , Ogawa Hisashi , Ishigami Kenjiro , Ikeda Syuhei , DOI KOSUKE , Hamatani Yasuhiro , Ide Yuya , An Yoshimori , ISHII MITSURU , Iguchi Moritake , Masunaga Nobutoyo , Wada Hiromichi , Hasegawa Koji , Abe Mitsuru , Akao Masaharu
Published: November 2020

Background:
Obesity, which leads to left arterial remodeling, increases the risk for the development of atrial fibrillation (AF). We previously demonstrated the progression from paroxysmal to sustained AF was associated with an increased risk of ischemic stroke or hospitalization for heart failure (HF). However, the risk of progression from paroxysmal to sustained AF in obese patients has not been fully evaluated.

Methods:
Based on the initial type of AF and whether paroxysmal AF progressed to sustained AF during follow-up (FU), patients enrolled in the Fushimi AF registry were categorized into 3 groups; i) paroxysmal AF without progression, ii) paroxysmal AF with progression, iii) sustained AF. Obesity was defined as BMI at baseline >30.

Results:
Obese patients (172/3834) had a higher prevalence of sustained AF at baseline as compared with those without obesity (58.7% vs 51.0%, p=0.047), and they had a higher rate of progression from paroxysmal to sustained AF during a median FU of 4.3 years (2.4% vs 1.5% [per person-year], p<0.01). Both obese and non-obese patients had the highest rate of ischemic stroke in the category of paroxysmal AF with progression as compared with other two categories (obese patients: 0.2% [paroxysmal AF without progression] vs 2.6% [paroxysmal AF with progression] vs 0.7% [sustained AF] [per person-year], non-obese patients: 1.2% vs 2.2% vs 1.8%). In contrast, obese patients had the lowest percentage of hospitalization for HF in the category of paroxysmal AF with progression (2.5% vs 1.8% vs 3.8%), but AF progression was associated with a higher incidence of hospitalization for HF in patients without obesity (2.2% vs 3.9% vs 4.2%).

Conclusions:
Obesity may be the risk of the progression of paroxysmal to sustained AF. The progression may be associated with increased risk of ischemic stroke in both obese and non-obese patients, but the risk of hospitalization for HF might be lower in patients with obesity as compared with those without obesity.
Abstract 15474: New Onset Left Bundle Branch Block Secondary to Severe Hyperkalemia
Authors: Qavi Ahmed H , Minhas Abdul M , Ilyas Fariha
Published: November 2020

Case presentation:
A 79-year-old female with history of renal failure on hemodialysis (HD) presented with generalized weakness. Her last HD was 3 days ago. On examination, she was vitally stable. Blood tests demonstrated a potassium (K+) of 8.3 mmol/L, confirmed on repeat testing. ECG revealed wide QRS, tall T waves and a new left bundle branch block (Figure 1). She was immediately treated with calcium chloride, insulin, dextrose and polystyrene sulfonate. The patient was admitted to the ICU and underwent emergent HD. Repeat K+ post HD reversed to 4.0 mmol/L and ECG reflected normal sinus rhythm with resolution of ST-T wave changes (Figure 2).

Discussion:
Hyperkalemia can lead to cardiac arrhythmias and sudden death. The ECG changes are dependent on severity of hyperkalemia. It can vary from narrow based, peaked T waves to ventricular fibrillation. Hyperkalemia can also lead to interventricular conduction delays, which, with severity, can take the form of right or left bundle branch block (LLLB). The conduction delay from hyperkalemia usually lasts only in initial or terminal portions as opposed to throughout the QRS complex as seen in bundle branch block disease. Association of LLLB with hyperkalemia is an uncommon but important occurrence and has only scarcely been reported in literature. Its prevalence remains unknown. With the growing use of renin-angiotensin aldosterone system inhibitors, more patients are prone to experience life threatening electrolyte disturbances. A thorough knowledge of the ECG manifestations related to hyperkalemia is crucial to ensure emergent treatment. This may result in improved outcomes in such patients with cardiovascular and renal diseases.
Abstract 15488: Epidemiological Profile of Cardiovascular Risk Factors and Outcomes in Patients With Solid Organ and Haematological Malignancies
Authors: Chandrakumar David , Gan Gary , Jethwani Urmi , Li Cindy , Aladdin Aaia , Jeyaprakash Prajith , Bhat Aditya , Johnston Amanda , Kwok Fiona , Scherrer-crosbie Marielle , Tan Timothy C
Published: November 2020

Introduction:
Chemotherapy remains the cornerstone in the management of solid organ malignancies (SOM) and hematological malignancies (HM). Although life-prolonging, it is not without cost, with heart failure and arrhythmia becoming increasingly recognised complications of treatment. Although there is significant overlap in the chemotherapeutic management of SOM and HM, epidemiological information on the differential prevalence of baseline cardiovascular risk factors and outcomes in these populations is scarce.

Hypothesis:
A differential cardiovascular risk profile and clinical course will be appreciated in patients with SOM and HM undergoing chemotherapy.

Methods:
Retrospective observational study design. Patients admitted to our institution undergoing chemotherapy for SOM (2014-2018) or HM (2012-2015) were reviewed. Baseline demographic and clinical data was collated and patients were followed for up to five years following chemotherapy for occurrence of major adverse cardiac events (MACE) defined as the development of new-onset heart failure or arrhythmia.

Results:
545 hematology and 435 oncology patients with malignancy were assessed. Compared to those with HM, those treated for SOM had a poorer cardiovascular risk profile (table 1). At mean follow-up period of 22.8±17.8 months, no significant difference in the incidence of the composite endpoint (9.4% vs 9.0%, p=0.45) or its components was observed. Higher rates of anthracycline therapy was observed in patients with HM (100% vs 17%, p < 0.01), however its use did not have a differential effect on MACE (12% vs 9%, p=0.25).

Conclusions:
Compared to patients treated for HM, patients with SOM had a greater burden of cardiovascular risk factors and lower use of anthracycline chemotherapy. Despite this, MACE occurred at similar rates in both groups. The use of anthracyclines was not associated with the development of MACE, suggesting alternative pathways contributing to its development.
Abstract 15491: Effects of Intensive Smoking Cessation Counseling After Acute Coronary Syndrome on 5-year Incidence of Major Adverse Cardiovascular Events and Smoking Abstinence
Authors: Gilgien Denereaz Lauriane , Auer Reto , Gencer Baris , Carballo David , Raeber Lorenz , Klingenberg Roland , Matter Christian M , Sudano Isabella , Luescher Thomas F , Windecker Stephan , Muller Olivier , Fournier Stephane , Rodondi Nicolas , Mach Francois , Nanchen David
Published: November 2020

Introduction:
Smoking cessation is recommanded after an acute coronary syndrome (ACS). Long-term cardiovascular benefits of smoking cessation counseling during a hospitalization and shortly after discharge for an ACS remains unknown. We aimed to study the 5-year incidence of major adverse cardiovascular events (MACE, defined as cardiovascular death, myocardial infarction, stroke, unplanned coronary revascularization or hospitalization due to angina) and smoking abstinence after ACS, comparing usual care to an intensive smoking cessation counseling intervention in hospital and after discharge.

Methods:
We studied 951 smokers from the SPUM-ACS cohort hospitalized for ACS between 2009 and 2014 in a multicenter prospective study with information available at the 5-year follow-up visit on incident MACE. At baseline in 4 study centers, a non-randomized part of smokers with ACS received proactive in-hospital smoking cessation counseling along with several telephone counseling over a 2 months period after discharge. We compared this intensive counseling group to the usual care group, regarding the incidence of MACE at 5 years. We used a multivariate adjusted Cox-proportional hazards model to estimate hazard ratios (HR) and 95% confidence intervals (CI). The secondary outcome was smoking cessation rate 5 years post-ACS.

Results:
Out of 951 smokers with ACS, 228 (35%) received the intensive in-hospital smoking intervention, of which 186 (82%) accepted to receive counseling after discharge. After multivariable adjustment for age, sex, education and study site, the 5-year risk of a recurrent MACE was comparable between the intensive counseling group and the usual care group, with a multivariable HR of 1.02 (95% CI 0.71-1.46, p=0.92). Among 669 patients alive 5 years post-ACS with known smoking status, 95 (56%) had stopped smoking in the intensive counseling group and 234 (47%) in the usual care group, with a multivariate odds ratio of 0.69 (95% CI 0.47-1.03; p=0.07).

Conclusions:
In this observational study, an intensive smoking cessation intervention during hospitalization for ACS with post-discharge telephone counseling did not reduce 5-year recurrence of MACE. However, this early intervention may confer a benefit for long-term smoking abstinence.
Abstract 15810: Applying an LDL-C Threshold Based Approach to Identify Individuals With Familial Hypercholesterolemia
Authors: Khera Amit , Jasani Reena , Ahmad Zahid , Schneider Ruth , Tujardon Carol , Basit Mujeeb
Published: November 2020

Background:
Familial hypercholesterolemia (FH) is an inherited disorder associated with increased LDL-C and premature coronary heart disease, which remains significantly underdiagnosed. Screening those with very high LDL-C may help identify those with FH, but the optimal means of applying this approach is unclear.

Methods:
Individuals from UT Southwestern Medical Center, a large, tertiary academic center, with an LDL-C level ≥ 190 mg/dL at any time were enrolled in an FH registry. These 5,786 patients were divided into four categories of LDL-C: 190.0 - 219.9, 220.0 - 249.9, 250.0 - 299.9, and ≥ 300.0 mg/dL. One hundred individuals were randomly selected from each category for manual chart review to determine 1) the presence of secondary causes of dyslipidemia (obstructive liver disease, nephrotic syndrome, hypothyroidism, specific medication use, other secondary cause) and 2) diagnosis of possible/definite FH by modified Simon Broome criteria and 3) probable/definite FH by modified Dutch Lipid Clinic Network (DLCN) criteria.

Results:
Of the 400 individuals with an LDL-C level ≥ 190 mg/dL (mean age 52 years ± 14) in this cohort, the presence of secondary causes increased across each LDL-C category (
p
< 0.001) (Figure) with the greatest prevalence in those ≥ 300.0 mg/dL (52%). The prevalence of FH also varied by LDL-C category, with the highest prevalence of FH by Simon Broome criteria in the 220.0 - 249.9 mg/dL category (52%) and by DLCN criteria in the 250.0 - 299.9 mg/dL category (46%).

Conclusions:
Amongst those with LDL-C ≥ 190 mg/dL, the prevalence of secondary causes increases with higher LDL-C, while the diagnosis of FH has a parabolic relationship. Patients with intermediate LDL-C (220 - 299 mg/dL) may be the optimal group to prioritize for FH screening using an LDL-C based approach.
Abstract 15812: Oxidative Stress Promotes Susceptibility to Atrial Fibrillation in
Pitx2
Deficient Mice
Authors: KIM Kyungsoo , Subati Tuerdi , Murphy Matthew B , Van Amburg Joseph C , Christopher Isis L , Johnson Joyce E , Barnett Joey V , Roden Dan M , MURRAY Katherine T
Published: November 2020

Introduction:
The strongest genetic risk factor for atrial fibrillation (AF) is variants on chromosome 4q25, near the paired-like homeobox transcription factor 2 gene
Pitx2
. Mice deficient in
Pitx2
(

Pitx2
+/-

) have increased AF susceptibility, although the mechanism(s) remains controversial. Recent evidence indicates that with cardiac injury,
Pitx2
encodes an antioxidant gene program that promotes repair. Isolevuglandins (IsoLGs) are highly reactive lipid peroxidation products that mediate a major component of oxidative stress-related injury. We used a small molecule scavenger of IsoLGs to test the hypothesis that oxidative stress is enhanced in the setting of
Pitx2
deficiency to cause AF susceptibility.

Methods:

Pitx2
+/-

and

Pitx2
+/+

(wild type littermate control) mice were treated orally with either vehicle or the IsoLG scavenger 2-hydroxybenzylamine (2-HOBA) starting at weaning. At age 16-18 weeks, animals underwent transesophageal atrial pacing, echocardiography, and tissue harvest or flow cytometry to measure atrial inflammation.

Results:

Pitx2
+/-

mice demonstrated a significant increase in inducible AF burden compared to control mice (242.9±105.3 vs 23.6±11 sec; n=7, 14;
P
<0.05). There was also a trend for an increased incidence of sustained AF (71.4% vs 21.4; P=0.055). Flow cytometry revealed that there was no increase in the number of total leukocytes in the atria of

Pitx2
+/-

mice compared to control atria, nor were differences present in selected populations of immune cells (including CD3, CD19, NK1.1, F4/80, Ly6G, or CD11b/MHCII positive cells). For

Pitx2
+/-

mice treated with 2-HOBA, there was trend for a reduction in AF burden (39.6±14.4 sec; n=11;
P
=0.075) as well as sustained AF (27.2%), while the drug had no effect in control mice. Based on cardiac histology (n=5, 5) and echocardiography (n=11, 14), no major histologic, structural, or functional abnormalities were identified in

Pitx2
+/-

mice.

Conclusions:
The reduction in AF burden by the IsoLG scavenger 2-HOBA supports the hypothesis that enhanced oxidative stress is responsible for AF susceptibility in the setting of
Pitx2
deficiency. These results suggest a potential role for genotype-specific AF therapy (in 4q25 variant carriers) using IsoLG scavengers.
Abstract 15815: Left Atrial Strain Characterizes the Atrio-ventricular Substrate Responsive to Cardiac Resynchronization Therapy in Patients With Intermediate Electrocardiographic Criteria
Authors: Huntjens Peter , Sugahara Masataka , Soyama Yuko , Lumens Joost , Faddis Mitchell N , Gorcsan John
Published: November 2020

Introduction:
Guidelines favor patient selection by left bundle branch block (LBBB) with QRS width ≥150 ms for cardiac resynchronization therapy (CRT). Predicting CRT response in patients with QRS width 120 to 149 ms or non-LBBB remains difficult. Left ventricular (LV) global longitudinal strain (GLS) and systolic stretch index (SSI) have shown to characterize the ventricular substrate responsive to CRT. However, the potential application of longitudinal left atrial (LA) strain remains unclear.

Hypothesis:
Baseline LA strain has prognostic value in CRT patients with intermediate ECG criteria.

Methods:
We studied 195 patients who underwent CRT based on routine indications: ejection fraction ≤35% and QRS width ≥120 ms. GLS was assessed using the 3 standard apical views. Radial SSI was derived from the mid LV short axis view. Peak longitudinal LA strain was derived from the 2 and 4-chamber apical view. The predefined combined clinical endpoint was death, heart transplant or left ventricular assist device over 4 years after CRT.

Results:
LA strain was feasible in 162 (83%) of the CRT candidates: QRS duration 156 ± 26 ms, 39.5% had LBBB with QRS ≥ 150ms, 60.5% had intermediate ECG criteria. High peak longitudinal strain (>median, 10.1%) was associated with favorable event-free survival (p<0.001). Patients with intermediate ECG criteria for CRT and both high peak longitudinal LA strain and high GLS (>median, 8.4%) had similar outcome to those with Class I indications for CRT. Multivariable analysis revealed that LA strain had independent prognostic value (hazard ratio 0.9 per LA strain %, p < 0.001) even after adjusted for other clinical, electrophysiological and echocardiographic covariates including QRS morphology and duration, GLS and SSI.

Conclusions:
Peak LA strain had important prognostic value in candidates for CRT. Prognostic value of LA strain was additive to LV strain characteristics and most significant in CRT patients with intermediate ECG criteria for CRT.
Abstract 15823: Diminished Vasoresponsiveness in Patients With Heart Failure
Authors: Papazisi Olga , van Vessem Marieke E , Beeres Saskia L , de Wilde Rob B , Berendsen Remco R , de Jonge Evert , Robert Klautz J , Aarts Leon P , Schalij Martin J , Palmen Meindert
Published: November 2020

Introduction:
Vasoplegia is a severe complication after cardiac surgery and is associated with impaired clinical outcome. Pre-operative heart failure (HF) is considered an independent predictor of post-operative vasoplegia. We hypothesize that HF patients are more susceptible to vasoplegia due to altered vascular responsiveness. In this study, vasoresponsiveness in patients undergoing cardiac surgery for HF is investigated.

Methods:
A prospective, observational study was conducted at Leiden University Medical Center. We included patients with HF (N=18) and without HF (N=18) who underwent cardiac surgery on cardiopulmonary bypass. Vasoresponsiveness was assessed at 4 different timepoints: 1) before induction, 2) after induction, 3) after cessation of cardiopulmonary bypass and 4) on the first postoperative day. The vascular response was recorded as change in systemic vascular resistance (SVR) after the administration of phenylephrine (bolus 2 μg/kg).

Results:
Thirty-six patients were included [67 (61-71) years, 78% male]. Vascular responsiveness was significantly attenuated in patients with HF compared to controls. The response to phenylephrine was already diminished at baseline in HF patients and was almost abolished after cessation of cardiopulmonary bypass (Figure). Roughly the same pattern of vasoresponsiveness was found when excluding patients that received norepinephrine. Moreover, HF patients required a significantly higher amount of noradrenaline [169.80 (IQR 14.77-318.97) ug/kg] compared to controls [3.61 (IQR 0-41.60) ug/kg] to maintain similar SVR during the first 24h postoperatively.

Conclusions:
The vascular responsiveness is altered in patients with HF and this might explain the higher prevalence of vasoplegia in this patient population.
Abstract 15838: Atrial Natriuretic Peptide Compensatory Response is Impaired in Human Acute Decompensated Heart Failure
Authors: Reginauld Shawn H , Sangaralingham Jeson , Iyer Seethalakshmi R , BURNETT John C
Published: November 2020

Atrial and B-type natriuretic peptides (ANP and BNP) are cardiac hormones secreted as compensatory measures to preserve cardiorenal homeostasis. Treating heart failure (HF) with sacubitril/valsartan increased ANP and not BNP, suggesting the ANP system may confer therapeutic benefit. Thus, the presence of an ANP deficient subgroup of HF patients possibly posing higher risk for HF severity, underscores a need to characterize both, the biologically active and inactive (NT-proANP and NT-proBNP) natriuretic peptides (NPs)(latter resistant to degradation), to highlight the extent of NP production in HF. Characterizing neprilysin (NEP) activity may also provide insights into the degree of NP degradation in HF. This study aims to both highlight the cardiac NP response in acute decompensated HF(ADHF) by measuring molecular forms of ANP and BNP together with defining circulating soluble NEP activity as to assess mechanisms impairing the NP response in HF. We recruited 47 healthy individuals with neither cardiovascular nor metabolic disease and compared ANP, BNP, NT-proANP, NT-proBNP, and NEP activity levels with 107 recruited ADHF patients. In ADHF, compared to a healthy setting, median ANP, BNP, NT-proANP, and NT-proBNP were all elevated (15.7 vs. 118.1 pg/mL , p<0.0001; 23 vs. 515 pg/ml, p<0.0001; 60.1 vs. 651.6 pg/mL, p<0.0001; 46 vs. 3330 pg/mL, p<0.0001, respectively). However, circulating NEP activity was significantly lower in ADHF than in healthy circulation (32 vs. 12.3 nM/mL/min, p<0.0001). NPs did not correlate with NEP activity in healthy circulation. However, only ANP (r = 0.4788, p<0.0001) and NT-proANP (r = 0.6819, p<0.0001) correlated with NEP activity in ADHF. The presence of an impaired ANP response in ADHF, underscored by insufficient increases in NT-proANP than NT-proBNP, suggests decreased ANP production may induce not only an ANP deficient ADHF state, but be characteristic of ADHF. The presence of NEP activity in ADHF circulation, despite lower NEP activity compared to healthy individuals, suggests ANP degradation may second impaired production, further lowering ADHF ANP levels. Our studies support augmenting the ANP system in ADHF through either endogenous stimulation or exogenous supplementation as optimal therapeutic strategies.
Abstract 15848: Impact of the Covid-19 Pandemic on D2B Activations in a Single, Tertiary Care, Urban Medical Center in the United States
Authors: Lavenburg Philip , Gannon Michael , O'Murchu Brian , Lakhter Vladimir , Crabbe Deborah L , Bashir Riyaz
Published: November 2020

Introduction:
Initial reports suggest that patients may delay seeking medical attention during the Coronavirus Disease 2019 (COVID-19) pandemic. Our aim was to determine if the COVID-19 outbreak is associated with a higher incidence of late presentations for patients with STEMI, greater need for mechanical circulatory support and PCI.

Methods:
We retrospectively evaluated consecutive patients that presented to a single, academic medical center with acute chest pain and ST-segment elevation on ECG from March 15 through June 17 in years 2019 and 2020. All patients were referred for emergent coronary angiography and the final cohort consisted of 32 patients. Medical records were reviewed to determine time between symptom onset and hospital arrival, need for PCI and/or mechanical circulatory support, total fluoroscopy time and volume of contrast administration during catheterization.

Results:
There was no significant difference in age, gender, cardiac risk factors or history of CAD between the cohorts that presented in 2019 compared with 2020 (Table 1). The mean time from symptom onset to arrival in the ED was 6.5 ± 8 and 9.2 ± 17 hours in 2019 and 2020 (p=0.55), respectively. PCI was performed during the index catheterization in 5 (50%) and 21 (95%) patients in 2019 and 2020 (p=0.01), respectively. Mean volume of contrast media used per case was 142 ± 65 ml in 2019 and 237 ± 104 ml in 2020 (p=0.017). There was a trend towards greater need for mechanical circulatory support and total fluoroscopy time during cases in 2020 (Table 1).

Conclusions:
In patients with suspected STEMI during the COVID-19 pandemic, there was a trend towards longer duration between symptom onset and arrival to the ED. More patients presenting with ST-segment elevation required PCI and there was a trend towards greater utilization of mechanical circulatory support. These findings may reflect a decline in access to outpatient services and/or delays in patients seeking care for acute chest pain.
Abstract 15861: The Role of Body Mass Index in Cryoballoon Ablation Outcomes for Paroxysmal Atrial Fibrillation
Authors: Bose Abhishek , Chevli Parag A , Hashmath Zeba , Mishra Ajay K , Berberian Gregory , ahmad ghasan , Januszkiewicz Jerzy , Dai Qiying , Laidlaw Douglas
Published: November 2020

Introduction:
Cryoballoon ablation (CBA) is recommended for patients with paroxysmal atrial fibrillation (AF) refractory to anti-arrhythmic drugs. However, only 70% of patients benefit from an initial CBA. Obesity is a known risk factor for development of AF but its role in predicting outcomes following CBA for paroxysmal AF remains unclear.

Methods:
We followed 103 patients (Age 60.6 ± 9.1, 29% women) with paroxysmal AF undergoing CBA for one year post procedure. Recurrence was assessed by documented atrial arrhythmias (AA) on EKG or any form of long-term cardiac rhythm monitoring. Using the body mass index (BMI) as a surrogate marker for obesity, we divided patients into five groups: normal <24.9 kg/m
2
, overweight 25-29.9 kg/m
2
, class 1 obesity 30-34.9 kg/m
2
, class 2 obesity 35-39.9 kg/m
2
and class 3 obesity ≥40 kg/m
2
. A multivariable cox proportional hazard model was used to assess if BMI predicted risk of AA recurrence.

Results:
Among our study population, 7 (6.7%) had normal BMI and 34 were overweight (33%) while 17 (16.5%), 14 (13.5%) and 8 patients (7.7%) were categorized as class 1, 2 and 3 obesity respectively. After a one year follow up, 19 (18.4%) participants developed recurrence of AA. Baseline demographics were similar between the two groups except for a higher incidence of hypertension in the class 3 obesity group. On a multivariable model adjusted for baseline demographics and risk factors for AF, neither obesity nor overweight predicted recurrence of AA following CBA (Table, p=0.18). Similarly, on Kaplan-Meier analysis, BMI did not effect time to first recurrence of AA (Figure, p=0.07).

Conclusion:
Obesity is strongly associated with the risk of development of AF. However, in our study population increasing BMI had no influence on the recurrence of AA following CBA for paroxysmal AF.
Abstract 15866: The Utility of Extended Electrocardiographic Monitoring for Detecting Atrial Fibrillation in Cryptogenic Stroke in the African-american Population
Authors: Rodriguez Ortega Romy , AlSadawi Mohammed , Capric Violeta , Sidiqi Baho , Francois Jonathan , Budzikowski Adam
Published: November 2020

Introduction:
Cryptogenic stroke comprises about 25% of all ischemic strokes. Depending on modality and duration of ECG monitoring, subclinical atrial fibrillation (AF) is detectable in 2.7-30% of cryptogenic stroke patients.

Hypothesis:
Extended ECG monitoring has not been studied in the African American (AA) population. This retrospective study aims to study the incidence and risk factors of subclinical AF in African-Americans.

Methods:
We retrospectively reviewed 96 patients who received implantable loop recorders (ILR) for detecting subclinical atrial fibrillation after cryptogenic stroke. In the vast majority of patients, the ILR was implanted during the index hospitalization. Binary univariate and multivariate analyses were performed to determine predictors for AF detection.

Results:
AF was detected in 29% of patients (28/96) at 1000 days. All AF that was detected was exquisitely paroxysmal and ranged in duration between 0.05-103 minutes (mean 8.4 minutes with SD= 22.1 minutes). Baseline characteristics of patients are presented (Table 1A). Binary univariate analysis revealed the use of non-dihydropyridine calcium-channel blockers to be associated with decreased odds of AF detection. (Table 1B, C). Multivariate analysis found coronary artery disease diagnosis to be associated with increased odds of AF detection. Fifty-percent of the events in the AF group were detected within the first 36 days of loop recorder implantation (Fig 1).

Conclusions:
AF detection in our population occurs very early after index stroke and at significantly higher rates than reported in the CRYSTAL AF trial. Baseline characteristics have a poor predictive ability for the detection of AF. These findings emphasize the need for pre-discharge ILR implantation to improve AF detection in all patients with cryptogenic stroke.
Abstract 15885: Disagreement of the Current Diagnostic Criteria for Cardiac Sarcoidosis
Authors: Ueberham Laura , Jahnke Cosima , Paetsch Ingo , Michael Kuehl , Hindricks Gerhard , Dinov Borislav
Published: November 2020

Introduction:
Diagnosis of cardiac sarcoidosis (CS) poses a clinical challenge. Different diagnostic recommendations are proposed from JSNC, WASOG, and HRS expert consensus statement.

Hypothesis:
Current CS scoring systems classify patients inconsistent. The aim of this study was to compare the later with imaging-based cardiac magnetic resonance imaging (CMR) and 18F-fluorodeoxyglucose (FDG)- positron emission tomography (PET) criteria for diagnosis of CS.

Methods:
Between January 2016 and April 2020 patients with suspected cardiac sarcoidosis were systematically evaluated by history, ECG, lab values, echocardiogram, cardiac biopsy and both CMR and PET. Current scoring systems and criteria for diagnosis of CS were applied and compared to proposed imaging classifications.

Results:
Out of 45 patients (mean age 53 ± 9 years, 66.7% males), 40.0% were diagnosed with CS according to the JSNC guidelines. Applying the WASOG criteria, CS was "at least probable" in 91%, whereas the HRS guidelines classified 24.4% as CS patients. Using CMR imaging criteria 13.3%, 48.9% and 11.1% were categorized as possible, probable or highly probable for CS, and based on FDG-PETs 15.6%, 11.1% and 31.1%, respectively. There were only 9 patients (20.0%) that were classified as CS in all 4 scoring systems, and 4 patients (8.9%) that did not fulfil criteria for CS in any of the scoring systems.

Conclusions:
Current scoring systems for cardiac sarcoidosis showed significant disagreement and led to an inconclusive classification of CS likelihood. A refinement of the diagnostic tools for cardiac sarcoidosis is necessary.
Abstract 15892: Reliability of Focused Cardiac Ultrasound in the Post-Operative Assessment of Patients With Congenital Heart Disease: A Single Center Experience
Authors: Hodzic Emina , Ludomirsky Achiau , Bhatla Puneet
Published: November 2020

Introduction:
Early detection of postoperative complications in children with congenital heart disease (CHD) is crucial. The utility of focused cardiac ultrasound (FoCUS) in the assessment of post-operative congenital cardiac surgical patients is not known.

Objective:
To evaluate the reliability of FoCUS in the assessment of children with CHD in the early post-operative period.

Methods:
A prospective observational cross-sectional study was performed in a single pediatric center. All FoCUS studies were performed by one imager within two hours of the paired echocardiographic (ECHO) study performed by a different imager. FoCUS studies were obtained using Philips Lumify
R
and ECHO studies utilized a high-end ultrasound machine (Philips Affiniti
R
). Qualitative ventricular (right and left) function, pericardial effusion, pleural effusion, and degree of mitral regurgitation (MR) and tricuspid regurgitation (TR) were compared. All FoCUS and ECHO studies were sent for review in a random and blinded fashion to two independent noninvasive imaging cardiologists. Weighted k statistics were used to determine the level of agreement between FoCUS and ECHO, and between observers.

Results:
Twenty-three FoCUS studies were performed in 12 patients with a mean age of 16.6 months (range 0-96 months) within two weeks postoperatively. There was inter-observer agreement for ECHO on all parameters and inter-observer agreement for FoCUS on all parameters except for TR. The intra-observer agreement between FoCUS and ECHO for the two cardiologists was fair to moderate for ventricular function (k= 0.470, p< 0.05 and 0.340, p < 0.05), substantial for pericardial effusion (k = 0.617, p< 0.05 and 0.777, p< 0.05), and fair for MR (0.400, p< 0.05). There was no statistically significant agreement for TR and pleural effusion for both observers and MR for one observer.

Conclusions:
FoCUS demonstrated acceptable reliability in the assessment of ventricular function and presence of pericardial effusions, with a limited value in the assessment of atrioventricular valve regurgitation. This tool is valuable in the early post-operative evaluation of pediatric patients with congenital heart disease in the cardiac intensive care unit.
Abstract 15900: Incidence of Mortality and Morbidity in a Cohort of Congenital Complete Heart Block Patients Followed for Over 40 Years
Authors: Weinreb Scott J , Vetter Victoria L
Published: November 2020

Introduction:
Congenital complete heart block (CCHB) is rare, 1:15,000 - 1:20,000 live births. The most important risk factors for mortality and cardiac morbidities in this population are not clear. Our CCHB population with structurally normal hearts is uniquely suited to evaluate natural history, impact of chronic pacing, and associated morbidities.

Methods:
We performed a retrospective cohort study of all identifiable subjects at the Children’s Hospital of Philadelphia from 1/1/1970-4/3/2018 with a CCHB ICD-9 or 10 code and confirmed CCHB by medical record review. We excluded those with structural congenital heart disease, genetic, or acquired cardiac conditions. The primary outcome was a composite of death, cardiomyopathy (CM), heart failure (HF), echocardiographic systolic dysfunction (SD), or cardiac resynchronization therapy (CRT). We applied univariate analysis using chi-square, ANOVA, and determined relative risk.

Results:
The cohort includes 114 subjects, 58% female, 68% white, 65% diagnosed in the first year of life, with 1571 person-years of follow-up. Maternal antibody testing was positive in 49 subjects (42%). Sixteen (14%) were paced on first day of life and 88 (77%) had at least one permanent pacemaker implanted. Median age at first implant was 1.9 years (IQR 0.1-7.9) and median paced duration 11.8 years (IQR 5.8-16.2). Of those born before 2000, 92% received a pacemaker; 66% born since 2000 have a pacemaker. Pacemaker lead fracture or dislodgement occurred in 28 (32% of paced subjects, 28 per 1000 pacemaker-years). Twenty-five (22%, 16 per 1000 person-years) reached the composite outcome, 23 with cardiac dysfunction (HF, CM or SD); 5 received CRT. Seven of the 25 subjects died. Pacing on first day of life and male sex had relative risks of 3.6 (95% CI 1.9-6.8) and 2.6 (95% CI 1.3-5.2), respectively, of reaching the primary outcome. Maternal antibody positivity, in utero diagnosis, age at diagnosis, birth decade, and duration of pacing were not associated with a higher risk of the primary outcome.

Conclusions:
The rate of a composite outcome of death, cardiac dysfunction, or CRT was 16 per 1000 person-years in a cohort of 114 subjects with CCHB. Pacing on first day of life and male sex were associated with a higher risk of the composite outcome.
Abstract 15903: Pulmonary Arterial Pressure During Recovery From Exercise Predicts Outcomes in Patients Undergoing Evaluation for Dyspnea
Authors: Olshan David S , Bhat Rohan , Farrell Robyn , Schoenike Mark , Brooks Liana , Ho Jennifer E , Malhotra Rajeev , Lewis Gregory
Published: November 2020

Introduction:
The post-exercise recovery period poses advantages over the within-exercise period for acquisition of hemodynamic measurements because of attenuated respirophasic changes, ability to time measurements precisely relative to peak exercise, and increased feasibility of multi-modality data acquisition (i.e. echocardiographic imaging). While several studies have linked rest and exercise hemodynamic measurements to outcomes, the prognostic significance of recovery hemodynamics in patients with dyspnea on exertion remains unknown.

Hypothesis:
Impaired recovery of mean pulmonary arterial pressure (mPAP) following exercise predicts poor clinical outcomes.

Methods:
Upright incremental ramp cycle ergometry cardiopulmonary exercise testing with invasive hemodynamic monitoring was performed in patients referred for evaluation of exertional dyspnea. mPAP was obtained at rest, peak exercise, and at two-minutes following peak exercise. In addition, maximum workload was recorded for each patient. mPAP elevation at recovery versus baseline, indexed to peak workload, was determined. Cox regression was performed using the primary outcome of heart failure event-free survival.

Results:
Among 272 patients with dyspnea on exertion and preserved LVEF [age 61 (IQR 49 – 70), 47% male, BMI 29 kg/m
2
(25 – 34), exercise duration 8.1 minutes (6.9 – 9.2), peak workload 91 watts (71 – 121)] we observed an increase in mPAP from 17 (14– 20) to 33 (28 – 41) mmHg with a fall in mPAP to 22 (18 – 29) at 2 minutes of recovery. Median mPAP elevation at recovery versus baseline mPAP, indexed to peak workload, was 0.057 (0.031 – 0.101) mmHg/W. Persistently elevated mPAP, indexed to peak workload, was associated with future risk of HF hospitalization or death both in unadjusted analysis (Cox hazard ratio 1.53 for every standard deviation increase, p=0.003), and when adjusted for age, sex, and BMI (HR 1.40, p=0.025).

Conclusions:
Among patients with dyspnea on exertion undergoing invasive hemodynamic evaluation during exercise, persistently elevated mPAP following exercise predicts future heart failure event-free survival and may be more feasible to estimate non-invasively than measures obtained at peak exercise.
Abstract 15911: Is There a Relationship Between Sports Participation and Peak Aerobic Capacity in Children With Congenital Heart Disease?
Authors: De Souza Astrid M , Tran Nicholas , Naylor Kaelan , Hoskins Kim , Romans Hilary , Potts Jim , Clarke David C , Armstrong Kathryn
Published: November 2020

Introduction:
Underlying structural lesions in congenital heart disease (CHD) result in differences in anatomy and physiology that may affect peak aerobic capacity (VO
2peak
). The relationship between sports participation and VO
2peak
is unclear in these patients. The aim of this study was to determine if children with CHD who participated in sports had a higher VO
2peak
than those who did not.

Methods:
Two-year, single-centre, retrospective review (May 2016-November 2018). Fifty-eight CHD patients were included: 9 aortic valve disease; 13 coarctation; 6 Ross procedure for aortic stenosis; 20 tetralogy of Fallot, and 10 transposition of the great arteries. Sports participation was categorized into 3 groups: 0-1 days/week; 2-3 days/week; and ≥4 days/week. A validated institutional treadmill protocol (BCCH) was used. Criteria for a maximal test included: VO
2
plateau, respiratory exchange ratio>1.0, and/or a peak heart rate >200 bpm. VO
2peak
z-scores, % VO
2
at ventilatory threshold, and O
2
Pulse were calculated. Medians and interquartile ranges are reported. P<0.05 was considered statistically significant.

Results:
Those who participated in sports ≥2-3 days/week had a significantly higher VO
2peak
[39.9 (34.6, 48.1) vs 30.3 (27.8, 39.6) mL/min/kg; p<0.001], VO
2peak
z-score [-0.84 (-1.28,-0.30) vs -1.89 (-2.37, -1.16); p=0.002], and O
2
Pulse [0.20 (0.19, 0.25) vs 0.16 (0.14, 0.21) mL/beat/kg; p=0.004] compared to those who participated 0-1 day/week, respectively. There were no differences between those who participated in sports 2-3 days/week and ≥4 days/week. VO
2peak
was similar between CHD lesions (p=0.21).

Conclusions:
VO
2peak
is higher in those who participate in sports compared to those who do not. It is unclear whether those who have a higher VO
2peak
are more inclined to participate in sports or whether sports participation leads to a higher VO
2peak
. The role of exercise rehabilitation in the 0-1 day/week group needs to be explored.
Abstract 15913: Two-year Results of the Getting to an Improved Understanding of Low-density Lipoprotein Cholesterol and Dyslipidemia Management (GOULD) Registry of Patients With Atherosclerotic Cardiovascular Disease (ASCVD)
Authors: Cannon Christopher P , De Lemos James A , Ballantyne Christie M , Rosenson Robert S , Alam Shushama , Mues Katie , Gao Qi , Bhatt Deepak L , Kosiborod Mikhail N
Published: November 2020

Background:
Atherosclerotic cardiovascular disease (ASCVD) treatment guidelines recommend intensive statin therapy and adding non-statin therapy if LDL-C ≥70 mg/dL.

Methods:
We designed the GOULD registry to assess lipid-lowering therapy (LLT) over time: At 120 U.S. centers, 5006 ASCVD patients on any (LLT) were enrolled in 1 of 3 cohorts: 1) currently on PCSK9 inhibitor (PCSK9i), 2) no PCSK9i and LDL-C ≥100 mg/dL, and 3) no PCSK9i and LDL-C 70-99 mg/dL.

Results:
Over the two years, only 16.8% had some type of LLT intensification, In the cohorts of patients with baseline LDL-C ≥ 100 and 70-99 mg/dL, LLT intensification was present in 21.9% and 14.3% respectively: statin dose was intensified in 6.1% and 6.1%, ezetimibe was added in 6.8% and 4.3% and PCSK9i was added in 6.3% and 2.2% respectively. Conversely, out of the total population, statins were discontinued in 246/4275 (5.8%), ezetimibe in 81/535 (15.1%), and PCSK9i in 47/544 (8.6%). At 24 months, 83.7% were on statin (43.4% high-intensity), with 14.2% on ezetimibe. Lipid panels were measured in 73% by 1 year and 84% by 2 years. Among Pts in the LDL-C ≥100 and 70-99 mg/dL cohorts, 18.6% and 30.4% achieved an LDL-C <70 mg/dL by 1 year, with little further change by 2 years: 21.3% and 33.5% respectively. In the PCSK9 cohort, 53.2% had LDL-C<70 mg/dl. Overall, only 31.7% had LDL-C <70 mg/dL at 2 years (an increase from 6.7% at baseline), while 25.0% had LDL-C >100 mg/dL.

Conclusion:
Of ASCVD patients with suboptimal LDL-C at baseline, even after 2 years of follow up, strikingly only 16% had LLT intensification, and thus most remained uncontrolled. Further intensive efforts are needed to achieve optimal LDL management in patients with ASCVD.
Abstract 15919: Latent Trajectory Patterns of Left Ventricle Ejection Fraction Among Heart Failure Patients With Chronic Inflammatory Disease: Longitudinal Analysis of Electronic Health Records
Authors: Rivera Adovich S , Sinha Arjun , Pawlowski Anna , Lloyd-jones Donald M , Feinstein Matthew J
Published: November 2020

Background:
Immune regulation and inflammation play a role in the pathogenesis and progression of acute and chronic heart failure (HF). While overt inflammatory cardiomyopathy is a well-described clinical entity marked by acute cardiac dysfunction and relatively high rates of recovery, trajectories in cardiac function among people with chronically heightened systemic inflammation are less clear. We hypothesized that there are differences in trajectories of left ventricular ejection fraction among HF patients with different chronic inflammatory diseases (CIDs): human immunodeficiency virus (HIV), systemic lupus erythematosus (SLE), systemic sclerosis (SSc), rheumatoid arthritis (RA), inflammatory bowel disease (IBD), or psoriasis.

Methods:
We analyzed serial echocardiographic data from people with CIDs and HF who had at least three echocardiograms (n=974) at a large academic medical center. We identified latent trajectories patterns of LVEF using latent class trajectory models, then described clinical differences across the different trajectories. We then used multinomial regression to test if CID type and other baseline variables were associated with different trajectories.

Results:
We observed three major LVEF trajectories which paralleled known HF subtypes: preserved/intermediate EF (HFp/iEF, 687, 70.5%), reduced EF (HFrEF, 255, 26.2%), and recovered EF (HFrecEF, 32, 3.3%). These trajectories corresponded closely to accepted clinical definitions. For example, 30/32 (94%) patients in the HFrecEF trajectory had LVEF <40% at baseline that increased ≥15% on ≥1 follow-up. We observed significant differences in associations of CID type, age, sex, and diabetes with a specific LVEF trajectory (Figure) that remained even after regression.

Conclusions:
Among people with HF and CIDs, different trajectories of LVEF are associated with different CIDs and clinical characteristics. This may have implications for therapy and prognosis of HF in CIDs.