bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 16200: Chronic Central Nervous System Actions of Leptin Protect Against Myocardial Ischemia/reperfusion Injury
Authors: Omoto Ana Carolina Mieko , do Carmo Jussara M , Flynn Elizabeth R , Moak Sydney P , Li Xuan , Mouton Alan J , Wang Zhen , Hall John E , da Silva Alexandre A
Published: May 2021

While myocardial reperfusion is the most effective therapy to reduce mortality after myocardial infarction, it can paradoxically exacerbate ischemic injury. We recently showed that leptin, via its actions on the central nervous system (CNS), improved left ventricular function in a model of heart failure induced by permanent ligation of the left anterior coronary artery (LAD). To investigate whether leptin also protects the heart against ischemia/reperfusion (I/R) injury via its actions in the CNS, we instrumented female Wistar rats (15 weeks of age) with an intracerebroventricular (ICV) cannula into the lateral ventricle, and after 7 days of recovery and baseline assessment of cardiac function by echocardiography (VisualSonics VEVO-3100®), myocardial I/R was induced by temporary LAD ligation (60 min). Vehicle (saline, 0.5 μL/hr, n=6) or leptin (15 μg/day, n=7) were infused ICV for 28 consecutive days starting 20 min after reperfusion using osmotic minipump connected to the ICV cannula. Echocardiographic assessment of cardiac function was performed every week and at the end of the 4
th
week of treatment, the heart was collected and processed for protein analysis and histological evaluation of infarct size and collagen deposition. Compared to vehicle treatment, chronic ICV leptin infusion significantly reduced infarcted area (21±2 vs. 37±4 %), septal collagen deposition (2.2±0.2 vs. 4.0±0.7 %), and markedly attenuated systolic dysfunction as evidenced by increased ejection fraction 4 weeks post I/R (59±1 vs. 30±2%), stroke volume (296±19 vs. 159±8 μL) and cardiac output (108±5 vs.63±4 μL/min). ICV leptin infusion also prevented the increase in left atrium to aorta diameter ratio (1.5±0.1 vs. 2±0.1 mm), an index of cardiac congestion. In addition, we found a 2-fold increase in the ratio of phospho-acetyl-CoA carboxylase (p-ACC) to total ACC protein expression, a marker of fatty acid oxidation, in hearts of leptin-treated rats compared with vehicle infusion. These results indicate that leptin exerts powerful beneficial CNS-mediated effects on the heart that improve systolic function and protect the myocardium against I/R injury. Our results also suggest that these beneficial actions may involve improved myocardial bioenergetics.
Abstract 16202: Speckle Tracking Echocardiography for Early Screening for Subclinical Cardiac Sarcoidosis, a Meta-analysis
Authors: Barssoum Kiro , Altibi Ahmed M , Rai Devesh , Kharsa Adnan , Thakkar Samarthkumar J , Elkaryoni Ahmed , Tahir Muhammad Waqas , Rao Mohan , Nanda Navin C.
Published: May 2021

Background:
Cardiac sarcoidosis (CS) affects 35% of patients with pulmonary sarcoidosis (PS). CS presentation varies from asymptomatic patients to sudden cardiac death. The current screening modalities like EKG and conventional echocardiography lack sensitivity for early detection of CS. Speckle tracking echocardiography (STE) has shown potential for early detection of subclinical myocardial damage in patients with PS. We aimed to investigate the role of STE in early detection of CS.

Methods:
We queried Medline, EmCare, CINAHL, Cochrane Database and Google Scholar for articles investigating the role of left ventricle global longitudinal strain (LVGLS) in asymptomatic patients with PS versus (vs) controls. Studies that included patients with suspected or proven CS, patients with cardiac symptoms, arrhythmias, coronary artery disease or valvular abnormalities were excluded. The standard mean difference (SMD) in GLS for both groups was pooled using random effects model.

Results:
Our search yielded a total of 9 studies with a total of 967 patients with PS undergoing screening for CS. In individual studies, the baseline characteristics were not significantly different between both groups. Overall, the studies had more females than males. All patients in our cohort had preserved ejection fraction (EF) and no cardiac symptoms. The LVGLS was significantly decreased in the PS group as compared to controls, SMD: -3.98, (95% CI: -5.32 to -2.64; p-value <0.0001), I
2
= 94.70%, Figure 1.

Conclusion:
As compared to controls, patients with PS with no clinically suspected or proven CS, and normal EF, have impaired LVGLS. More studies are warranted to investigate the role of LVGLS in CS screening.
Abstract 16217: Culturally-tailored Team-based Preventive Cardiology Program Improves Cardiovascular Risk for South Asian Patients
Authors: Pearson Keon , Parameswaran Vijaya , Gibbs-Curtis Destini , Johnson Austin , Josan Kiranbir , Rodriguez Fatima , DASH Rajesh
Published: May 2021

Introduction:
South Asians (SA) have a two times greater prevalence of CAD and metabolic syndrome (MetS) than matched Europeans. Diet and physical activity may be best addressed through culturally-tailored interventions. The Stanford South Asian Translational Heart Initiative (SSATHI) was designed to help SA better understand and improve their risk factors. We tested the hypothesis that a team-based and culturally-tailored clinical intervention for SA would result in a reduction in MetS risk factors.

Methods:
Patients underwent an initial assessment consisting of fasting lipid profile, advanced lipid studies (lipid fractionation, lp (a), apoA1, apoB), inflammatory markers (high sensitivity CRP, homocysteine), and A1c. All non-diabetics underwent two-hour OGTT. Following initial assessment by a cardiologist, a registered dietician developed a personalized nutrition plan based on SA cuisine.

Results:
A total of 395 patients were seen between July, 2011 and July, 2019. Of these, 198 (50%) completed at least two cardiologist visits with baseline and follow up labs. Patients had an average age of 45.5 years and 86% were male. At baseline, SSATHI patients had a mean BMI of 26.4 (IQR = 23.9-28.8), 52% of patients had total cholesterol greater than 190 mg/dl, 21% had systolic BP > 140 mmHg, and 13% had diastolic BP > 90 mmHg. During an average follow-up of 11.8 ± 9.2 months, diastolic BP declined from 80.9 ± 9.32 to 78.9 ± 7.6 mmHg (p = 0.028), total cholesterol decreased from 190.4 ± 46.4 to 153.4 ± 63.7 mg/dl (p < 0.001), total triglycerides declined from 137.1 ± 87.1 to 100.2 ± 67.5 mg/dl (p < 0.001), and LDL declined from 120.4 ± 40.0 to 92.3 ± 46.4 mg/dl (p <0.001). HDL declined from 49.0 ± 15.4 to 44.5 ± 19.8 mg/dl (p = 0.022). ASCVD and A1c were not significantly different.

Conclusion:
A team-based and culturally-informed program targeted to South Asian populations may help improve cardiometabolic risk factors but may be limited by program attrition and generalizability.
Abstract 16225: Protein Energy Malnutrition is Associated With Increased Inpatient Mortality in Patients Admitted for Atrial Fibrillation: Analysis of the National Inpatient Sample
Authors: Akuna Emmanuel , Asemota Iriagbonse , Edigin Ehizogie , Shaka Hafeez , Eseaton Precious O , Nwachukwu Praise , Rivera Pavon Mavi
Published: May 2021

Introduction:
Various forms of protein energy malnutrition (PEM) has been shown to affect different heart pathologies through its underlying pathogenesis of unabating chronic inflammation. The effect of PEM on atrial fibrillation (AF) is unclear. Our study sought to estimate the impact of PEM on clinical outcomes of hospitalizations for AF using a national database

Methods:
We queried the National Inpatient Sample (NIS) 2016 and 2017 database. The NIS is the largest inpatient hospitalization database in the United States. The NIS was searched for hospitalization of adult patients with AF as a principal diagnosis with and without PEM as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality while the secondary outcomes were hospital length of stay (LOS) and total hospital charge. STATA software was used for analysis. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders.

Results:
There were over 71 million discharges in the combined 2016 and 2017 NIS database. Out of 821,629 AF hospitalizations, 3% had PEM. Hospitalization for AF with PEM had a statistically significant increase in mortality (5.2% vs 0.8%, AOR 2.33, 95% CI 1.96 - 2.78, P<0.0001), with an adjusted increase in mean hospital charge of $15,862 (95% CI 11,999 - 19,725, P<0.0001) and a 2 day increase in LOS (95% CI 2.00 - 2.50, P= <0.0001) compared to those without PEM.

Conclusion:
In conclusion, PEM resulted in increased mortality, LOS and total hospital charge in patients hospitalized with AF. Nutritional rehabilitation in patients with PEM and concomittant AF may be needed to improve outcomes.
Abstract 16226: Single-cell RNA Sequencing Coupled With Optical Imaging for Targeted Real-time Visualization of the Cardiac Conduction System
Authors: Goodyer William R , Beyersdorf Benjamin , Van Den Berg Nynke , Puluca Nazan , Buikema Jan , Lee Soah , Salmi Darren , Robinson Elise , Rogalla Stephan , Chubb Henry , Motonaga Kara , Ceresnak Scott R , Dubin Anne M , Rosenthal Eben , Wu Sean M
Published: May 2021

Introduction:
Optical imaging has the potential to revolutionize cardiothoracic surgery by allowing for the real-time visualization of structures often inadvertently damaged due to inadequate visibility. The cardiac conduction system (CCS) consists of specialized cells embedded within the heart that are essential for cardiac function yet indistinguishable from heart muscle tissue. Intraoperative CCS injury is a major complication in cardiac surgery, representing a significant source of morbidity and mortality. To date, there exists no intraoperative method to visualize the CCS.

Hypothesis:
We hypothesized that unique, CCS-specific cell surface markers could be used for the
in vivo
labelling of the CCS.

Objectives:
Use single-cell RNA sequencing (scRNAseq) to discover cell surface markers that may serve as the basis for generating optical imaging agents for real-time CCS visualization.

Methods/Results:
Gene expression analysis of a comprehensive scRNAseq dataset of the entire murine CCS revealed significant enrichment of a host of CCS-specific cell surface genes. A subset of genes were subsequently validated in the CCS of mice and/or human tissue. In total, 7 novel cell surface markers were confirmed to have unique expression patterns throughout or within distinct components of the CCS. Next, optical imaging agents were created consisting of a near-infrared (NIR) dye conjugated to antibodies directed against two distinct CCS-specific cell surface markers. Each optical imaging agent demonstrated high sensitivity and specificity in labeling the entire CCS
in vivo
following a single intravenous injection in mice. Specificity was confirmed within intact, whole hearts using both closed-field NIR imaging and whole mount immunolabeling with volume imaging (iDISCO+). Dosage, timecourse and biodistribution analyses were performed as well as safety validation by surface ECG.

Conclusions:
In summary, we coupled scRNAseq with optical imaging to create novel tools for the real-time visualization of a complex tissue substructure. We provide a proof-of-principle for broadening the scope of optical imaging but also address a significant unmet clinical need, laying the foundation for translational opportunities in cardiac intervention and imaging.
Abstract 16231: Long-term Outcomes of Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention in Patients With Non-st Elevation Acute Coronary Syndrome
Authors: Barssoum Kiro , Kumar Ashish , Rai Devesh , Kharsa Adnan , Chowdhury Medhat , Elkaryoni Ahmed , Thakkar Samarthkumar J , Tahir Muhammad Waqas , Rao Mohan
Published: May 2021

Background:
Long term outcomes of culprit multi-vessel and left main patients who presented with Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) and underwent either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) are not well defined. Randomized trials comparing the two modalities constituted mainly of patients with stable coronary artery disease (SCAD). We performed a meta-analysis of studies that compared the long term outcomes of CABG vs. PCI in NSTE-ACS.

Methods:
Medline, EmCare, CINAHL, Cochrane databases were queried for relevant articles. Studies that included patients with SCAD and ST-elevation myocardial infarction were excluded. Our primary outcome was major adverse cardiac events (MACE) at 3-5 years, defined as a composite of all-cause mortality, stroke, re-infarction and repeat revascularization. The secondary outcome was re-infarction at 3 to 5 years. We used the Paule-Mandel method with Hartung-Knapp-Sidik-Jonkman adjustment to estimate risk ratio (RR) with 95% confidence interval (CI). Heterogeneity was assessed using Higgin’s I
2
statistics. All statistical analysis was carried out using R version 3.6.2

Results:
Four observational studies met our inclusion criteria with a total number of 6695 patients. At 3 to 5 years, the PCI group was associated with a higher risk of MACE as compared to CABG, (RR): 1.52, 95% CI: 1.28 to 1.81, I
2
=0% (PANEL A). The PCI group also had a higher risk of re-infarctions during the period of follow up, RR: 1.88, 95% CI 1.49 to 2.38, I
2
=0% (PANEL B).

Conclusion:
In this meta-analysis, CABG was associated with a lower risk of MACE and re-infarctions as compared to PCI during 3 to 5 years follow up period.
Abstract 16236: Hyperthyroidism Does Not Negatively Impact the Outcomes of Patients Admitted for Atrial Fibrillation: Analysis of the National Inpatient Sample
Authors: Shaka Hafeez , Akuna Emmanuel , Asemota Iriagbonse , Edigin Ehizogie , Eseaton Precious O , Nwachukwu Precious , Rivera Pavon Mavi
Published: May 2021

Introduction:
Hyperthyroidism is a well-established risk factor for developing Atrial fibrillation (AF). The impact of hyperthyroidism in patients admitted for AF is unclear. This study aims to compare the outcomes of patients primarily admitted for AF with and without a secondary diagnosis of hyperthyroidism.

Methods:
We queried the National Inpatient Sample (NIS) 2016 and 2017 database. The NIS is the largest inpatient hospitalization database in the United States (US). The NIS was searched for hospitalization of adult patients with AF as a principal diagnosis with and without hyperthyroidism as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality while the secondary outcomes were hospital length of stay (LOS), rate of ablation and electrical cardioversion. STATA software was used for analysis. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders.

Results:
There were over 71 million discharges in the combined 2016 and 2017 NIS database. Out of 821,629 AF hospitalizations, 1.8% had hyperthyroidism. Hospitalization for AF with hyperthyroidism had similar inpatient mortality (0.5% vs 0.9%, AOR 0.61, CI 0.36-1.04, P=0.069), longer LOS (3.6 vs 3.4 days, p<0.0001), with lower rates of ablation (2.8% vs 4.2%, AOR 0.62, CI 0.49-0.78, P<0.0001) and electrical cardioversion (14.6% vs 17.6%, AOR 0.82, CI 0.73-0.91, P<0.0001) compared to those without hyperthyroidism.

Conclusion:
Hospitalizations for AF with hyperthyroidism had similar inpatient mortality, decreased LOS and less rates of ablation and electrical cardioversion compared to those without hyperthyroidism. Although, hyperthyroidism increases the risk of AF, hyperthyroidism does not negatively impact outcomes of patients admitted for AF based on US national hospital billing database.
Abstract 16406: Epigenetic Regulation of Myofibroblast Differentiation and Persistence is Mediated by Enhanced Glutaminolysis
Authors: Gibb Andrew A , Murray Emma K , Huynh Anh T , Lombardi Alyssa A , Lorkiewicz Pawel K , Kolmetzky Devin W , Lazaropoulos Michael P , Arany Zolt P , Kelly Daniel P , Margulies Kenneth B , Hill Bradford G , Elrod John W
Published: May 2021

Cardiac fibrosis is mediated by the activation and differentiation of resident cardiac fibroblasts. While initially reparative, chronic activation leads to progressive cardiac dysfunction. Associated with myofibroblast formation are changes in metabolites directly linked to the activity of epigenetic-modifying enzymes. To define the signaling linking fibroblast activation with changes to the epigenetic landscape, we treated primary adult murine cardiac fibroblasts (CFs) with the pro-fibrotic agonist, TGFβ, and subjected them to next-gen sequencing techniques (RNA-seq, ATAC-seq). Following activation, we observed alterations in chromatin accessibility corresponding to the transcriptional activation and suppression of key fibrotic genes. Intriguingly, increased chromatin accessibility was strongly associated with both transcriptional activation and suppression, while decreased accessibility correlated with neither transcriptional repression or activation. Regions of increased accessibility were enriched for canonical fibrotic TF binding motifs (e.g. SMADs, NFAT). We recently reported that αKG-dependent lysine demethylases may be required for myofibroblast formation, so we made correlative comparisons between chromatin remodeling and the synthesis and utilization of metabolites critical for (de)methylation by applying unbiased, stable isotope metabolomics. These studies indicated enhanced glutaminolysis as the driver of increased αKG abundance. In the presence of TGFβ, pharmacologic inhibition (CB-839) or genetic deletion (
Gls1
-/-
) of glutaminolysis prevented myofibroblast formation as indicated by αSMA positivity, fibrotic gene program activation, and collagen contraction assays. Following myofibroblast formation, inhibition of glutaminolysis was sufficient to revert activated myofibroblasts to a non-fibrotic phenotype, during sustained stress. Remarkably, these results were recapitulated in CFs from human heart failure patients. Collectively, these findings suggest that metabolic remodeling is necessary for the epigenetic modifications that underlie myofibroblast formation and persistence, providing substantial rationale to evaluate several new therapeutic targets to treat fibrosis.
Abstract 16409: Prevalence of Annual Influenza (flu) Vaccination Among Young Adults (18-44 Years) With Cardiovascular Diseases: BRFSS 2018
Authors: Parekh Tarang , Patel Smit , Yarlagadda Phani Harshitha
Published: May 2021

Introduction:
Influenza (flu) immunization is one of the major goals in Healthy People 2020 and recommended by AHA and ACC as secondary prophylaxis in a person with coronary and other cardiovascular diseases. However, little is known about flu vaccine coverage in young adults with cardiovascular disease (CVD). We aim to take a broader view by assessing the prevalence of flu vaccine by different CVDs among young adults in 2018.

Methods:
We included 117,978 young adults aged between age 18 to 44 years from BRFSS 2018 with information on the history of flu vaccination and CVD. Flu vaccination was defined as having a flu shot or a vaccine within the past 12 months. CVD was defined as having a history of either heart attack/myocardial infarction (MI), angina/congestive heart disease (CHD), or stroke. We used separate weighted univariate analyses to calculate prevalence for a different set of samples based on age groups (18-34 years, 35-44 years).

Results:
Overall flu vaccine rate in 2018 remained higher among adults aged 35-44 years compared to younger adults (18-34 years). The flu vaccination rate was comparatively lower among adults aged 35-44 with any CVD (26.7% vs. 28%) than those without any known CVD. In contrast, the vaccine rate was similar among younger adults aged 18-34 regardless of CVD history. Prevalence of flu vaccination was lower (19.5%) among adults aged 18-34 years with MI compared to those without MI (24.5%). Similarly, adults aged 35-44 years with MI reported lower flu vaccine prevalence (22.3% vs. 28.1%) compared to those without MI. Overall individuals with CHD reported higher vaccination rate than those without CHD. Stroke survivors aged 35-44 years reported significantly lower flu vaccine rate than those without stroke. In contrast, the rate was higher among younger stroke survivors (27.3% vs. 24.5%).

Conclusions:
There is a dire need to increase the annual flu vaccine rate among young adults with CVD to decrease overall morbidity and mortality.
Abstract 16420: Double Internal Thoracic Artery Grafts are Associated to Better 10-year Outcomes After Coronary Artery Bypass Grafting
Authors: Barili Fabio , DErrigo Paola , Rosato Stefano , D'Ovidio Mariangela , Biancari Fausto , Pagano Eva , Parolari Alessandro , Seccareccia Fulvia
Published: May 2021

Introduction:
Few data on long-term follow-up of effectiveness and advantages related to the employ of double internal thoracic artery grafts (BITA) for coronary artery bypass grafting are available and the advantage of the employ of BITA have been recently questioned.

Hypothesis:
This observational cohort study was designed by the PRIORITY planning committee to evaluate 10-year follow-up of isolated CABG performed with and without BITA in order to evaluate the impact of BITA on long-term outcomes.

Methods:
The PRIORITY project was designed to evaluate the long-term outcomes of 2 large prospective multicenter cohort studies on CABG conducted between 2002-2004 and 2007-2008. Data on isolated CABG were linked to 2 administrative datasets. The primary endpoints were death and major adverse cardiac events (MACEs) at follow-up. Time-to-event data were analyzed using Kaplan-Meier estimates and Cox regression. Models generation was performed on the full dataset and the validation was performed with Montecarlo simulations.

Results:
The population consisted of 11021 patients who underwent isolated CABG; double thoracic internal artery grafts was employed in 23.5%. The median follow-up time was 7.9 years (interquartile range 7.4 - 10 years). After adjustment for potential confounding factors, BITA was significantly associated with better survival (HR 0.81, 95%CI 0.73-0.89, p < 0.001). Moreover, the employment of BITA reduced the incidence of MACEs at follow-up (adjusted HR 0.83, 95%CI 0.77-0.89, p < 0.001). In details, BITA was demonstrated to be a protective factor for acute myocardial infarction (adjusted HR 0.83, 95%CI 0.72-0.96, p = 0.001) and for rehospitalization for percutaneous cardiac intervention (PCI; adjusted HR 0.72, 95%CI 0.63-0.84, p < 0.001).

Conclusions:
The employment of double internal thoracic artery grafts for coronary artery bypass grafting has been associated to significant survival advantage at long-term. Moreover, it is a protective factor for acute myocardial infarction and rehospitalization for percutaneous cardiac intervention, reducing the hazard by 28%.
Abstract 16422: Lower Mitochondrial-derived Peptide Humanin in Young Adults Born Preterm vs. Term and Association With Left Ventricular Ejection Fraction
Authors: Ravizzoni Dartora Daniela , Flahualt Adrien , Nobre Pontes Carolina , Altit Gabriel , Deprez Alyson , He Ying , Cloutier Anik , Simoneau Jessica , Lapointe Anie , Villeneuve Andréanne , Burelle Yan , White Michel , Bigras Jean-Luc , Luu Thuy-Mai , NUYT ANNE MONIQUE
Published: May 2021

Introduction:
Preterm (PT) birth is associated with increased risk of cardiovascular diseases (CVD) and heart failure. We previously reported left ventricular (LV) mitochondrial dysfunction in a rat model mimicking the deleterious conditions associated with PT birth. Whether mitochondrial function is altered in humans born PT and associated with LV function changes is unknown. We

aimed

to determine if serum humanin levels, a mitochondrial-derived peptide with cytoprotective effects, are altered in humans born PT and are associated with impaired myocardial function.

Methods:
Data were obtained from 55 young adults born PT (<30 weeks of gestational age, GA) compared to 54 full-term (T) controls of the same age. Serum humanin levels were determined by ELISA and LV ejection fraction (LVEF) by echocardiography. Results are shown as median (interquartile range) and comparisons between groups were performed using non-parametric tests.

Results:
Individuals were evaluated at 23.3 (21.4, 25.3) years, and age and sex distribution were similar between groups. Median GA was 27.5 (26.2, 28.4) weeks in the PT group. Humanin levels (pg/ml) were 132.9 (105.1, 189.3) and 161.1 (123.6, 252) in the PT and the T groups, respectively (p=0.0414). LVEF was within the normal range and similar between groups. Lower LVEF was associated with lower humanin levels (p<0.001), and this association was observed both in the term (p=0.002) and the preterm (p=0.047) groups.

Conclusions:
Serum humanin levels are lower in adult born PT. Since lower humanin levels are also associated with lower LVEF, our results suggest that mitochondrial alterations could play a role in the long-term adverse cardiovascular consequences of PT birth. Humanin analogs improve LV function in experimental models. Our results pave the way for future studies exploring humanin as a therapeutic avenue for the prevention and treatment of CVD in individuals born PT.
Abstract 16430: Risk Factors Associated With Worsening Left Ventricular Function Post-bone Marrow Transplant in Multiple Myeloma Patients
Authors: Chen Jim , Sharma Tanya , Habash Fuad , Sanders Emily , Malkawi Abdullah , Salah Husam , Alaiwah Malek , Joseph Marina , Lopez-Candales Angel
Published: May 2021

Background:
New onset or worsening congestive heart failure (CHF) poses a significant challenge in multiple myeloma (MM) patients post bone marrow transplant (BMT). The aim of this study was to determine co-morbidies that increased the risk of worsening left ventricular (LV) function post-BMT.

Methods:
Retrospective study looking at MM patients between 2013 to 2019 with at least 1 bone marrow transplant. The primary end point was the time from BMT to >10% worsening ejection fraction (EF) noted on echocardiogram, compared to baseline values. A Cox proportional hazards regression model was used to create hazard ratios.

Results:
A total of 524 patients with diagnosis of MM were included who had at least 1 BMT with an average follow up time of 309.3 days. Prior hospitalizations of heart failure prior to BMT significantly increased the risk of developing reduced systolic function post transplant (HR 6.38 [95% CI 2.07 - 19.63]). Other contributing factors for reduced EF include: elevated BMI, history of hypertension, liver disease, peripheral vascular disease, stroke, and lenalidomide prior to BMT.

Conclusion:
This study was able to identify prognostic factors contributing to worsening heart failure.
Abstract 16461: Are Inducible Exercise Left Ventricular Outflow Tract Gradients Associated With Adverse Outcomes in Pediatric Hypertrophic Cardiomyopathy?
Authors: Gaitonde Mansi , Simpson Megan , Wetzel Martha , Border William L , Sachdeva Ritu , Ferguson Matthew , Whitehill Robert
Published: May 2021

Introduction:
Adverse outcomes in hypertrophic cardiomyopathy (HCM) includes arrhythmias, myocardial fibrosis, heart failure, and sudden cardiac arrest (SCA). These are well documented in children. Exercise stress echocardiography (ESE) can identify the severity and mechanism of left ventricular outflow tract (LVOT) obstruction that may not be present at rest. Our aim was to compare clinical outcomes in pediatric patients with varying severity of LVOT obstruction.

Methods:
We reviewed records of patients < 22 years with HCM who underwent staged ESE Jan 2009 - Dec 2019 at our center. Patients were divided into 3 groups: no resting or exercise LVOT gradient (Group 1), no resting gradient with LVOT gradient > 30 mmHg at peak exercise (Group 2), and resting LVOT gradient > 30 mmHg (Group 3). We assessed echocardiographic indices, advanced imaging, and clinical data. Statistical analysis performed with p-value <0.05.

Results:
93 patients met inclusion criteria. 6 SCA events occurred, though not during ESE.. Patients in Group 3 were classified less often as NYHA Class 1 compared to Group 1 or Group 2, (p < 0.01). Group 3 had the highest rate of myectomy (p=0.005) and ICD placement (p=0.003). There was no significant difference in exercise symptoms, peak oxygen consumption, or ischemic changes during ESE between the groups. Peak heart rate was also higher in Group 2 with no difference in blood pressure response. Groups were not associated with family history of disease, positive gene status, SCA, or the presence of fibrosis (Table). LVOT gradients differed as early as Stage 1 in Groups 1 & 2. Inducible LVOT obstruction was most commonly midcavitary in Group 2.

Conclusion:
The presence of resting versus inducible LVOT obstruction in pediatric HCM does not appear associated with adverse outcomes. This may be hampered by the rarity of events in pediatrics. The predominant mechanism of inducible LVOT obstruction was midcavitary, which has a link to adverse long-term outcomes in adult HCM.
Abstract 16466: Greater Body Mass Index Predicts Valve Function Following Transcatheter Pulmonary Valve Replacement in Adults With Tetralogy of Fallot
Authors: Daniels Zachary , Dodeja Anudeep , Shay Victoria , Tan Yubo , Bai Shasha , Berman Darren , Hor Kan N , Kertesz Naomi J , Daniels Curt J , Kamp Anna
Published: May 2021

Introduction:
After the initial surgical repair of tetralogy of Fallot (rTOF), right ventricular outflow tract dysfunction is common, with pulmonary stenosis (PS), regurgitation, or both. Obese adults with rTOF have worse biventricular systolic function, and greater post-operative pulmonary valve replacement morbidity than non-obese patients. Transcatheter PVR (TPVR) is used increasingly, though no studies have examined the impact of body mass index (BMI) on morbidity and hemodynamics in adults with rTOF and subsequent TPVR.

Hypothesis:
BMI affects outcomes of transcatheter PVR in adults with TOF.

Methods:
This was a 10 yr, single center, retrospective review of adults (>18 yo) with rTOF who underwent TPVR. The cohort was split into 2 groups based on BMI at time of TPVR. Group A (Grp A): normal and overweight (BMI <30), group B (Grp B): obese (BMI ≥30). Pre and post-TPVR echocardiogram, cardiac MRI, and catheterization data were reviewed.

Results:
There were 81 adults, 42 (52%) normal, 18 (22%) overweight (Grp A) and 21 (26%) obese (Grp B). Mean follow up was 6.4
+
3.1 yrs. With most recent post-TPVR echocardiogram, there was no significant difference in LV or RV size and function across groups. Compared to Grp A, Grp B patients were more likely to develop any degree of PS (mild, moderate, or severe) following TPVR (69% vs 94%, respectively, p = 0.032). An ROC curve analysis demonstrated BMI ≥ 26.3 had a low sensitivity (45%), but good specificity (89%) for predicting PS post TPVR. There was no difference between groups requiring re- intervention for PVR.

Conclusion:
This is the first study to show greater BMI affects valve function in adults with rTOF following TPVR. BMI >26 was associated with a greater risk of PS in follow up echocardiograms after TPVR. Obesity is an epidemic in the US and patient prosthesis mismatch may be an issue when considering TPVR. Further studies are indicated to determine the long-term effects of BMI on TPVR and the need for re-intervention in adults with TOF.
Abstract 16467: A Novel CT-derived Radiotranscriptomic Signature of Perivascular Adipose Tissue Stratifies COVID-19 Vascular Cytokine Burst and Predicts in Hospital Outcomes
Authors: Kotanidis Christos P , Xie Cheng , Kotronias Rafail , Siddique Muhammad , Thomas Sheena , Schottlander David , Channon Keith , Neubauer Stefan , Deanfield John , Antoniades Charalambos
Published: May 2021

Introduction:
COVID-19 is characterised by severe vascular inflammation. Perivascular adipose tissue (PVAT) has the ability to change its texture in response to vascular inflammation.

Hypothesis:
Computed Tomography Angiography (CTA)-based radiotranscriptomic phenotyping of PVAT may quantify COVID-19-induced vascular inflammation, predicting clinical outcomes.

Methods:
In Study 1, RNA sequencing of 60 internal mammary artery (IMA) biopsies from patients undergoing coronary bypass surgery was performed to build a transcriptomic fingerprint similar to that observed in COVID-19. This fingerprint was used to train an extreme gradient boosting algorithm, C19-RS, using CTA-derived radiomic features of PVAT around the IMA and descending thoracic aorta. In Study 2, C19-RS was validated in pulmonary artery CTAs from an independent cohort of 201 patients for COVID-19 detection and test its prognostic value in COVID-19.

Results:
Unsupervised hierarchical clustering of RNASeq data in Study 1 identified 2 clusters of vascular inflammation (
A
). Machine learning was used to train C19-RS to detect vascular inflammation based on 31 radiomic features. In study 2, 22 deaths and 32 ICU admissions were recorded. Patients with high C19-RS had an OR=3.11[95%CI:1.06-9.85] for COVID-19 adjusted for age, sex, risk factors, hsCRP, WBCC, COPD and CT tube voltage. C19-RS significantly improved the discrimination of a baseline model containing the above variables, for COVID-19 detection (delta[AUC]=0.03, p=0.008,
B
). C19-RS was significantly associated with in-hospital death (
C
), and a composite endpoint of in-hospital death and ICU admission, with adjusted HR: 4.29 (95% CI: 1.48-13.52, p=0.009).

Conclusion:
COVID-19-induced vascular inflammation can be quantified by a radiotranscriptomic signature (C19-RS) derived from CT analysis of PVAT. C19-RS stratifies vascular inflammatory burden in COVID-19, and has striking prognostic value for in-hospital outcomes.
Abstract 16477: Sacubitril/valsartan as a Treatment for Resistant Hypertension in Patients With Heart Failure and Preserved Ejection Fraction
Authors: Jhund Pardeep S , 1 Alice M , Pfeffer Marc A , ZANNAD Faiez , Lefkowitz Martin P , SHI Victor , Vardeny Orly , Solomon Scott , McMurray John J
Published: May 2021

Objective:
Heart failure with preserved ejection fraction (HFpEF) is typically a hypertensive phenotype and many HFpEF patients have difficult to control hypertension. We examined the effect of neprilysin inhibition on resistant hypertension in HFpEF patients in the PARAGON-HF trial. Patients entered a 1 to 4-week valsartan run-in (target dose 80mg bd), followed by sacubitril/valsartan run-in, before randomization to valsartan or sacubitril/valsartan (target doses 160mg bd or 200mg bd respectively).

Design and methods:
Patients were examined according to different definitions of resistant hypertension using systolic blood pressure (SBP) at the end of valsartan run-in. Group 1: SBP≥140mmHg (≥135mmHg if diabetes) despite treatment with a calcium channel blocker (CCB), diuretic and valsartan, Group 2: SBP≥130mmHg despite treatment with a CCB, diuretic and valsartan, or SBP<130mmHg despite treatment with a CCB, diuretic, mineralocorticoid receptor antagonist (MRA) and valsartan, and Group 3: SBP≥140mmHg (≥135mmHg if diabetes) despite treatment with a CCB, diuretic, MRA and valsartan (≥4 classes of SBP-reducing therapy, including MRA). We examined reduction in SBP from end of valsartan run-in to weeks 4 and 16 after randomization and the proportion of patients with controlled SBP at week 16 on sacubitril/valsartan vs valsartan.

Results:
Of 4796 patients randomized, criteria for resistant hypertension were fulfilled in 726 (15%) using the Group 1 definition, 1146 (24%) using the Group 2 definition and 132 (3%) in the third group. The combination of neprilysin inhibitor, angiotensin receptor blocker, CCB and diuretic (+/-MRA) reduced SBP and significantly increased the proportion of patients with controlled SBP (Table).

Conclusion:
Sacubitril/valsartan may be useful in treating resistant hypertension in patients with HFpEF, even in those who continue to have an elevated SBP despite treatment with at least 4 antihypertensive drug classes, including an MRA.
Abstract 16496: Longitudinal Outcomes After Implantation of a Subcutaneous or Transvenous Implantable Cardioverter Defibrillator in Older Patients: A Report From the National Cardiovascular Data Registry
Authors: Friedman Daniel J , Parzynski Craig , Heist E. Kevin , Russo Andrea M , Ranasinghe Isuru , Zeitler Emily P , Minges Karl E , Akar Joseph , Freeman James V , Curtis Jeptha P , Al-khatib Sana M
Published: May 2021

Introduction:
The subcutaneous (S-) implantable cardioverter defibrillator (ICD) is an alternative to the transvenous (TV-) ICD that is increasingly implanted in younger patients. However, data on the safety and effectiveness of the S-ICD in older patients are lacking.

Methods:
We compared S-ICD and single chamber TV-ICD implants in Medicare beneficiaries (≥65yrs) using National Cardiovascular Data Registry ICD Registry data from 9/28/2012 through 12/31/2017. We excluded patients with prior pacemaker or ICD, an indication for pacing or resynchronization, and those undergoing implant in an acute setting. Mortality status was determined using the Medicare master summary beneficiary file. Cox regression analyses with overlap weights were used to compare all-cause mortality. Mean cumulative counts of all-cause readmissions were compared among for Fee for Service beneficiaries.

Results:
A total of 23,717 patients met inclusion criteria [mean age 72.7±5.8 years, 29% female, 69% ischemic heart disease, 33% atrial arrhythmias, 49% NYHA II, 31.7% NYHA III, ejection fraction (EF) 28±9%, 3% dialysis dependent, 20% with prior ventricular tachycardia]. Compared to TV-ICD patients (n=22,264), S-ICD patients (n=1,453, 6% overall) were more often male, black, diabetic, dialysis dependent and were less likely to have atrial or ventricular arrhythmias or ischemic heart disease. There was no difference in age or EF between the 2 groups. In adjusted analyses, during a median follow-up of 2.3 years (IQR: 1.2 - 3.5), there was no difference between the 2 groups in all-cause mortality (HR 1.04, CI 0.91-1.17,
Figure A
) or readmissions (based on overlap of confidence intervals,
Figure B
).

Conclusions:
In a large representative cohort of older patients undergoing ICD implant, all-cause mortality and readmission were similar among S-ICD and TV-ICD recipients. These findings support use of the S-ICD for the prevention of sudden cardiac death in appropriately selected older patients.
Abstract 16499: Hybrid Cryoballoon Pulmonary Vein Isolation and Radiofrequency Posterior Wall Isolation for Persistent Atrial Fibrillation
Authors: Nguyen Heajung L , Macias Carlos , Khakpour Houman , Bradfield Jason S , Shivkumar Kalyanam , Buch Eric F
Published: May 2021

Introduction:
Catheter ablation of persistent atrial fibrillation (AF) is associated with less successful outcomes compared to paroxysmal AF. The optimal ablation strategy for persistent AF is not well established. We report our center’s experience utilizing a hybrid ablation approach of cryoballoon (CB) pulmonary vein isolation (PVI) followed by radiofrequency (RF) left atrial posterior wall isolation (LAPWI).

Methods:
134 patients with persistent AF who underwent catheter ablation between 2016 and 2019 at our center were retrospectively reviewed. Patients with congenital heart disease or prior left atrial ablation or surgery were excluded. Hybrid ablation (n=62) consisted of CB PVI followed by RF roof and floor lines resulting in LAPWI. The control group (n=72) had PVI ±LAPWI with either CB (n=38) or RF (n=34). Outcomes were monitored with office visits and 7-day Holter monitors at 3, 6, 12, and 24 months post-ablation. The primary endpoint was freedom from any documented atrial tachyarrhythmia over 30 seconds.

Results:
Concomitant atrial flutter ablation was performed in 19/62 (31%) and 5/72 (7%) of hybrid and control cases, respectively. There was no significant difference in procedure time, however fluoroscopy time was shorter with hybrid ablation compared to control (p<.01). 18-month freedom from atrial tachyarrhythmias was 70.4% with hybrid ablation and 51.6% with PVI±LAPWI with a single energy source (p=.048). Among those with recurrence, mean AF burden was significantly lower with hybrid ablation (7%) than with a single-energy approach (60%).

Conclusion:
In this single center experience with multiple operators, hybrid CB-RF PVI and LAPWI reduced AF recurrence (incidence and burden) compared to PVI±LAPWI with a single energy source.
Abstract 16503: Comparison of Management Strategies for the Neonate With Symptomatic Tetralogy of Fallot and Hypoplastic Branch Pulmonary Arteries: Results From the Congenital Catheterization Research Collaborative
Authors: Petit Christopher J , Law Mark , Glatz Andrew C , Chai Paul , Romano Jennifer , Zampi Jeffrey , Meadows Jeffery J , Nicholson George , Shahanavaz Shabana , Kelleman Michael , McCracken Courtney , Mascio Christopher , Batlivala Sarosh P , Asztalos Ivor , Kamsheh Alicia , Healan Steven , Smith Justin , Pettus Joelle A , Dailey Schwartz Andrew , Raulston James , Hock Krissie , Pajk Amy , Goldstein Bryan H
Published: May 2021

Introduction:
Symptomatic neonates with tetralogy of Fallot (sTOF) and hypoplastic branch pulmonary arteries (hPA) are at high risk. Management strategies include staged repair (SR) - initial palliation (IP) followed by later complete repair (CR) - or primary repair (PR). A balanced comparison of these approaches is needed in the sTOF neonate with hPA.

Methods:
Consecutive neonates with sTOF and hPA - defined as one hPA z-score <-2.0 with contralateral z-score <0 - who underwent SR or PR from 2005-17 were retrospectively reviewed by the Congenital Catheterization Research Collaborative. Primary outcome was mortality and secondary outcomes included component (IP, CR, PR) and cumulative (SR): hospital, ICU and surgical morbidities, and reintervention. Outcomes were compared between treatment strategies using propensity score adjustment (PSA) to account for baseline differences between groups (PR=reference group).

Results:
The cohort comprised 188 neonates including 121 SR (IP: 29 transcatheter; 54 surgery) and 67 PR patients. Presence of pulmonary atresia, lower gestational age and birthweight were more common in the SR cohort. Median right and left hPA z-scores were -2.19 (IQR -2.65, -1.92) and -2.33 (-2.84, -1.99), respectively. There were significant differences in treatment strategy across centers (p<0.01). Overall survival was similar between groups, before (p=0.33) and after PSA (HR 1.91, 0.48-7.7, p=0.36). Reintervention was more common in the SR group overall (HR 1.7, 1.03-2.7, p=0.04), but there was no difference after definitive repair (HR 1.21, 0.71-2.0, p=0.49). Secondary outcomes are shown in Table 1.

Conclusions:
In this multicenter comparison of SR or PR for management of neonates with sTOF and hPA, after PSA, no difference in mortality was found. Neonatal morbidities largely favored the SR group, but cumulative morbidities and reintervention favored the PR group. Further study is needed to determine late impact of these early advantages to SR.
Abstract 16509: Incidence, Risk Factors and Prognostic Implications of Covid-19 St-segment Elevation Across a Large Health System in New York
Authors: Devanabanda Arvind , Mahmood Eitezaz , Ali Ibrahim , SINGH Avneet , Meraj Perwaiz , jauhar rajiv
Published: May 2021

Introduction:
There is limited evidence on ST elevation myocardial Infarction (STEMI) in COVID-19 patients. The aim of this study is to demonstrate the incidence of STEMI, clinical and angiographic outcomes, risk factors of COVID-19 patients among focal STEMIs, diffuse ST-elevation (STE), and no-STE.

Methods:
We retrospectively identified COVID-19 patients at 13 different hospitals from March 1 to April 30, 2020. All ECGs were analyzed for focal, diffuse or no-STE. Outcomes examined were death, ventilation, ICU admission, pressor and inotrope use and length of stay. Kaplan-Meier method estimated cumulative probability of death by STEMI status. Multivariate regression analysis identified association of STEMI and death.

Results:
There were 10,018 patients with 23,406 ECGs, of which 55 (0.5%) had focal STE, 22 (0.2%) had diffuse STE and 9,945 patients had no-STE. Death, length of stay, ICU stay, ventilator use, inotrope use, and pressor use were all statistically significant (p<0.0001) among no-STE, focal STE and diffuse STE groups. Cardiac catheterization performed on 10 STE patients, showed culprit lesions were left anterior descending artery 30%, right coronary artery 40% and no obstructive disease 30% of the time. Median symptom onset to ER presentation time in COVID STEMI was 12 hours.
Figure 1
demonstrates the overall survival rates of 31%, 33%, and 6% in the no-STE, diffuse STE, and focal STE group, respectively (
P
< .0001).
Table 1
shows the strongest cardiac and ECG predictors of death in COVID-19 population.

Conclusions:
COVID-19 patients with focal STEMI and diffuse STE elevations are associated with worse survival and clinical outcomes.
Abstract 16531: Patient With Left Ventricular Assist Device Presents in Asystole
Authors: Tomaiko Emrie , Tomaiko Emrie , Su Wilber , Weiss J Peter , Kalya Anantharam , Gopalan Radha , Zawaneh Michael
Published: May 2021

Introduction:
Left Ventricular Assist Devices (LVAD) are becoming more common in the treatment of advanced heart failure. Patients with LVADs can present with life threatening sequelae of heart failure such as sustained VT and VF. Despite frequent documented presentations with ventricular arrhythmias in this patient population, presenting with ventricular asystole in patients with LVADs has not been previously described. We present a patient with LVAD, and without ICD, who presented in ventricular asystole.

Case Report:
A 67-year-old male with a history of ischemic cardiomyopathy and Heartmate III LVAD implanted one year prior to presentation as destination therapy presented to our facility complaining of three weeks of fatigue, dizziness with four days of nausea and emesis. He was noted to have an electrocardiogram (ECG) demonstrating artifact associated with the LVAD, however without discernible ventricular activity (Figure 1). Multiple ECGs and cardiac monitor tracings failed to demonstrate ventricular electrical activity, concerning for fine VF versus asystole. Transthoracic Echocardiogram (TTE) demonstrated bi-ventricular standstill. The patient was started on inotropes with Dobutamine then underwent Right Heart Catheterization (RHC). Catheter-induced ventricular potentials were repeatedly recorded, favoring asystole due to complete heart block (CHB) over fine VF. The patient underwent dual chamber ICD implant to allow ventricular pacing, which resulted in hemodynamic improvement.

Conclusions:
There have been several case reports which mentioned patients surviving fatal arrhythmias with an LVAD. To our knowledge, none have described hemodynamic stability with asystole due to CHB as the presenting rhythm. The incidence of conduction disease and arrhythmia in this patient population may indicate necessity of ICD implantation prior to LVAD implant.