bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13636: Evolocumab Shows No Significant Cost-effectiveness for Myocardial Infarction in China
Authors: Liang Zhe , Chen Qi , Zhao Quanming
Published: November 2020

Introduction:
The proprotein convertase subtilisin/kexin type 9 inhibitor evolocumab has been demonstrated to reduce the incidence of cardiovascular events. This study sought to evaluate the value of evolocumab in the healthcare perspective by conducting a long-term cost-effectiveness analysis in Chinese patients with myocardial infarction (MI).

Hypothesis:
We assessed the hypothesis that evolocumab was inefficient for the secondary prevention of MI.

Methods:
A Markov cohort state-transition model was developed in decision analysis software. The model subjects could have non-fatal MI and/or stroke events, as well as die from cardiovascular disease or other causes. We integrated Chinese population specific demographics and event rates with the risk reduction of evolocumab based on large trials and meta-analysis. Age-related change, event costs and utilities were included from published sources. The model had 1-year cycle and the time horizon was 25 years. The primary outcome was the incremental cost-effectiveness ratio (ICER), defined as cost per quality-adjusted life-year (QALY) saved.

Results:
At its current list price (33,748 CNY annually per person), the ICER was 927,713 CNY per QALY gained. In one-way deterministic sensitivity analyses, the ICER was closely associated with the utility of cardiovascular disease event free and the cost of cardiovascular death. Probabilistic sensitivity analyses demonstrated that the probability of the cost-effectiveness of evolocumab was 1.96% at the present willingness-to-pay threshold of 212,676 CNY per QALY gained. To achieve the cost-effectiveness threshold, a net value-based price of 10,255 CNY annually would be required, which is 70% lower than the present price. Alternative scenarios analyses of treatment benefit showed in MI patients with poorly controlled familial hypercholesterolemia (FH), the ICER for evolocumab was 187,736 CNY per QALY gained, which achieved the accepted cost-effectiveness threshold.

Conclusions:
In conclusion, the cost-effectiveness ratio of evolocumab is less favorable in MI; However, it showed good cost-effectiveness in MI patients with poorly controlled FH in China.
Abstract 13640: Effects of Influenza Vaccine on Mortality and Cardiovascular Outcomes Ii Patients With Cardiovascular Disease: A Systematic Review and Meta-analysis
Authors: Yedlapati Siva Harsha , Khan Safi U , Talluri Swapna , Lone Ahmad Naeem , KHAN Muhammad , Khan Mohammad S , Navar Ann M , Gulati Martha , Johnson Heather M , Baum Seth J , Michos Erin D
Published: November 2020

Introduction:
Influenza infection is associated with increased morbidity and mortality in patients with cardiovascular disease (CVD). We assessed the effects of influenza vaccine on mortality and cardiovascular outcomes in patients with CVD.

Hypothesis:
Influenza vaccination in those with CVD is associated with a reduction in mortality and major adverse cardiovascular events (MACE).

Methods:
We searched PubMed, EMBASE, and Cochrane library through January 2020 for randomized-controlled trials (RCTs) and observational studies assessing effects of influenza vaccine on mortality and cardiovascular outcomes in patients with CVD. Estimates were reported as random effects risk ratios (RR) with 95% confidence intervals (CI). Analyses were stratified by study design into RCT and observational studies.

Results:
Overall, 16 studies (n=237,058) encompassing 4 RCTs (n=1,667) and 12 observational studies (n=235,391) were included. The mean age was 69.2±7.01; 36.6% were female, 65.1% had hypertension, 31.1% had diabetes, and 23.4% were smokers. The median follow-up duration was 19.5 (IQR, 12, 43.3) months. Influenza vaccine was associated with a lower risk of all-cause mortality (RR, 0.72 [95% CI, 0.59-0.89], p<0.001) (
Figure 1A
), cardiovascular mortality (RR, 0.82 [95% CI, 0.80-0.84], p<0.001), and MACE (RR, 0.87 [95% CI, 0.80-0.94], p<0.001) (
Figure 1B
), though the association with myocardial infarction was not statistically significant (RR, 0.73 [95% CI, 0.50-1.07]; p=0.10). These finding were consistent across randomized and observational studies.

Conclusions:
This meta-analysis suggests that both randomized and observational data support the use of influenza vaccine in adults with CVD to reduce mortality and MACE events. Efforts to improve utilization of influenza vaccine in this population should continue to reap survival benefits.
Abstract 13645: Cardiologist Evaluation of Patients With Type 2 Myocardial Infarction
Authors: McCarthy Cian P , Olshan David S , Rehman Saad , Jones-O’Connor Maeve , Murphy Sean , Cohen Joshua A , Cui Jinghan , Singh Avinainder , Vaduganathan Muthiah , Januzzi James L , Wasfy Jason H
Published: November 2020

Introduction:
Type 2 myocardial infarction (T2MI) is common and associated with recurrent cardiovascular events. How often T2MI patients are evaluated by a cardiologist and the association between these evaluations and diagnostic testing and treatments are unknown.

Hypothesis:
T2MI patients evaluated by a cardiologist are more likely to undergo cardiovascular testing and be placed on therapies for ischemic heart disease (IHD).

Methods:
We identified adjudicated patients with T2MI at Massachusetts General Hospital between October 2017 and May 2018. We examined baseline characteristics, diagnostic testing performed, and discharge medications, stratified by cardiologist evaluation during their admission.

Results:
We identified 359 patients with T2MI. During admission, 207 patients (57.7%) were evaluated by a cardiologist; 120 (33.4%) received a cardiology consultation and 87 (24.2%) were admitted to a cardiology service. Patients evaluated by a cardiologist were more likely to have hyperlipidemia (67.1% vs 52%, p=0.005), known CAD (58.9% vs. 38.8%, p<0.001), prior MI (27.1% vs. 14.5%, p=0.006), and HF (56.5% vs. 44.1%, p=0.03). Patients evaluated by a cardiologist were more likely to undergo stress testing (13.5% vs 3.3%, p=0.002), transthoracic echocardiography (80.2% vs. 50.7%, p<0.001), and coronary angiography (21.3% vs. 0%, p<0.001) during their index admission. There was no difference in mortality among those who were or were not evaluated by a cardiologist (11.6% vs. 9.2%, p=0.58). Patients evaluated by a cardiologist were more likely to be discharged on a statin (74.5% vs 64.5%, p=0.04) and a beta blocker (72% vs. 55.9%, p=0.002). Only new prescriptions of beta blockers were more commonly prescribed among those evaluated by a cardiologist (20.3% vs. 7.9%, p=0.002). Among those with available follow-up data (N=289), 111 patients (38.4%) had an outpatient cardiology follow-up visit within 6 months of discharge.

Conclusions:
Fewer than 60% of patients with T2MI were evaluated by a cardiologist during their admission and those that did were more likely to undergo further cardiovascular testing and to be discharged on therapies for IHD. Most T2MI patients did not have an outpatient cardiology follow-up visit after their event.
Abstract 13656: Outcomes of Pre-existing Cardiovascular Disease Amongst COVID-19 Patients
Authors: Shah Chail , Singh Harmandeep , Martin Mehwish , Yousuf Salma , Raval Payu , Kaur Nirmaljot , Nwodika Chika , Yogarajah Angelina , Subhedar Rashmi , Rakholiya Jigisha , Patel Urvish K
Published: November 2020

Introduction:
COVID-19 has multiorgan involvement and it is believed that outcomes are poor amongst patients with hypertension (HTN) and pre-existing cardiovascular disorders (CVD).

Hypothesis:
The objective of this meta-analysis is to evaluate outcomes [mortality and invasive mechanical ventilation (IMV) utilization] of COVID-19 in patients with pre-existing HTN and CVD.

Methods:
English full-text-observational studies having data on epidemiological characteristics of patients with COVID-19 were identified searching PubMed using MeSH-terms from December 1, 2019, to April 30, 2020. Studies having CVD or HTN as one of the pre-existing comorbidities and described outcomes including IMV and mortality were selected with a consensus of three reviewers. 29 studies met these criteria. Following MOOSE protocol, data on patients’ characteristics especially age and history of CVD, HTN, IMV, and mortality were pooled using a random-effects model. The pooled prevalence of CVD and HTN were calculated. Meta-regression was performed and correlation coefficient (r) and odds ratio (OR) were estimated to evaluate the effects of pre-existing CVD and HTN on outcomes of COVID-19 patients.

Results:
Out of 29 studies with COVID-19 epidemiology data, 21, 17, 18 and 19 studies have details on mortality, IMV, HTN, and pre-existing CVD, respectively. Pooled prevalence of HTN was 28.2% [95%CI:22.1%-35.1%; p<0.001; 4858/11626 patients; Heterogeneity (I
2
):97.8%] and pre-existing CVD was 12.2% [8.9%-16.6%; p<0.001; 2044/11664 patients; I
2
:96.8%]. In age-adjusted meta-regression analysis, IMV was significantly higher among COVID-19 patients with pre-existing CVD [r:0.28; OR:1.3 (1.1-1.6); I
2
:89.7%; p=0.0028] without significant association with HTN [r:0.01; OR:1.0 (0.9-1.1); I
2
:95.9%; p=0.8161]. HTN [r:0.001; OR:1.0 (0.9-1.1); I
2
:96%; p=0.9685] and pre-existing CVD [r:-0.01; OR:0.9 (0.9-1.1); I
2
:96.3%; p=0.8772] had no significant association with mortality amongst COVID-19 patients.

Conclusion:
In the age-adjusted analysis, though we identified pre-existing CVD as a risk factor for higher utilization of IMV, pre-existing CVD and HTN had no independent role in increasing mortality.
Abstract 13664: Membrane Stiffness as a Function of Plakophilin-2 Expression: Implications to Arrhythmogenic Right Ventricular Cardiomyopathy
Authors: Swiatlowska Pamela , Delmar Mario
Published: November 2020

Mutations in
PKP2
, the gene coding for the desmosomal protein Plakophilin-2 (PKP2), can lead to an inheritable cardiac disease called Arrhythmogenic Right Ventricle Cardiomyopathy (ARVC). Various studies investigated the molecular and electrical properties of cardiomyocytes (CMs) with PKP2 deficiency. However, systematic studies on the mechanical properties of PKP2-deficient CMs, and their relation to the cardiomyopathic phenotype, are lacking. We studied the relation between PKP2 expression, membrane transverse Young’s modulus (tYM; a surrogate measure of membrane stiffness), and their correlation with tubulin expression and with substrate stiffness. Left and right ventricular (LV, RV) CMs were isolated from murine hearts control (ctrl), or with a cardiomyocyte-specific, tamoxifen-activated knockout of PKP2 (PKP2cKO). Three time points were studied: 14, 15 and 21 days post-tamoxifen injection (dpi). The phenotypes at these time points correspond to three disease stages: concealed, arrhythmogenic and cardiomyopathy of RV predominance, respectively. tYM was evaluated by mechanoSICM. Tubulin was visualized by confocal microscopy. tYM in LV myocytes from control hearts showed a tendency toward higher values when compared to RV myocytes (LV 2.9±0.2 kPa vs RV 2.6±0.2 kPa, n=53-59). At 14 dpi, LV and RV PKP2cKO CMs were softer than ctrl (LV 2.1±0.1 kPa, RV 2.1±0.1 kPa vs ctrl, n=30-59). The trend reversed a day later and by 21 dpi there was a clear increase in tYM, particularly in PKP2cKO RV myocytes (LV 4.5±0.3 kPa, RV 4.8±0.6 kPa vs ctrl, n=44-59). Z-groove index, a parameter of membrane organization, decreased in PKP2cKO CMs. Increased tYM at 21 dpi corresponded to upregulation of α-tubulin and particularly, acetylated tubulin, which was reduced at 14dpi but went up in 21dpi. We also observed an inverse correlation between membrane tYM, and substrate stiffness. We conclude that loss of PKP2 expression affects, in a disease stage-specific manner, CM mechanical properties and the MT network organization. Whether these effects are correlative or one is consequence of the other, remains to be determined. We speculate that changes in membrane mechanics at the single cell level are a component of mechanical dysfunction in hearts affected with ARVC.
Abstract 13676: Association of Plant-centered Diet Intake With Cardiovascular Disease and All-cause Mortality: Findings From the Coronary Artery Risk Development in Young Adults Study
Authors: Choi Yuni , Larson Nicole , Steffen Lyn M , SCHREINER Pamela J , Gallaher Daniel D , Duprez Daniel A , Shikany James M , Rana Jamal S , Jacobs David R
Published: November 2020

Introduction:
There is growing data regarding the potential for plant-centered diets to reduce risk for cardiovascular disease (CVD) and mortality. However, additional investigation is needed to strengthen and address inconsistencies in the existing evidence base. We examined the association between cumulative consumption of a plant-centered diet and a shift toward a more plant-centered diet and onset of CVD and all-cause mortality.

Hypothesis:
Nutritionally-rich plant-centered diets will be related to decreased risk of CVD and mortality.

Methods:
We included 4,926 black and white men and women from the Coronary Artery Risk Development in Young Adults (CARDIA) cohort, ages 18-30 years and free of CVD at baseline (1985-1986, exam year [Y0]) and followed until 2018. Diet was assessed through an interviewer-administered diet history at Y0, Y7, and Y20. A Priori Diet Quality Score (APDQS) was used to assess plant-centered diet quality, and high index scores were characterized by higher consumption of nutritionally-rich plant foods with limited consumption of meats and less healthful plant foods. Proportional hazards regression estimated the association of time-varying APDQS, which were cumulatively averaged over follow-up and 13-year change in APDQS (Y7-Y20) with CVD and all-cause mortality. The model was adjusted for sociodemographic factors, energy intake, parental history of CVD, smoking, and physical activity.

Results:
We documented 289 new CVD cases and 445 all-cause deaths during the median 32-years of follow up. In multivariable analysis, the highest quintile of cumulative APDQS was associated with a 52% lower risk of CVD (hazard ratio [HR]: 0.48, 95% CI: 0.28-0.81) compared with the lowest quintile of cumulative APDQS. Increased APDQS over 13 years was related to a 62% lower subsequent 12-year risk of CVD (95% CI: 0.18-0.78) when comparing extreme quintiles. The association for all-cause mortality was only apparent among high educational groups.

Conclusions:
Following a plant-centered, high-quality diet staring from young adulthood was associated with a lower risk of developing CVD and death by middle age. Our findings support the concept that a plant-centered diet may help prevent early CVD and death.
Abstract 13697: Prevalence and Disability Associated With Vitamin D Deficiency Amongst Patients With Cardiovascular and Cerebrovascular Disorders
Authors: Kaur Nirmaljot , Yogarajah Angelina , Nwodika Chika , Subhedar Rashmi , Raval Payu , Yousuf Salma , Shah Chail , Martin Mehwish , Singh Harmandeep , Rakholiya Jigisha , Patel Urvish K
Published: November 2020

Introduction:
Previous studies had provided evidence that vitamin D deficiency is a strong negative predictor for survival and recovery after severe vascular events but national estimate on disability related burden is not clear.

Hypothesis:
We evaluate the prevalence of vitamin D deficiency (VDD) amongst patients with cardiovascular disease (CVD) and cerebrovascular disorders (CeVD) and to find out whether or not CVD and CeVD in the presence of VDD increases the disability.

Methods:
We performed a retrospective analysis of the Nationwide Inpatient Sample data (years 2016-2017) in adults (≥18 years) hospitalizations. We identified patients with secondary diagnosis of VDD and primary diagnosis of CVD (AFib, CHF, IHD, acute MI, and angina) and CeVD (AIS, TIA, ICeH and SAH) using ICD-10-CM codes. We performed a chi-square test and multivariable survey logistic regression to analyze disability of patients with CVD and CeVD in presence of VDD. Disability/loss of function was investigated by APRDRGs severity using 3M Health Information Systems software. (Score 1-4 indicates minor to extreme loss of function)

Results:
Among 58,259,589 US hospitalizations, 3.44%, 2.15%, 0.06%, 1.28%, 11.49%, 1.71%, 0.38%, 0.23% and 0.08% had primary admission of IHD, acute MI, angina, AFib, CHF, AIS, TIA, ICeH and SAH, respectively and 1.82% had VDD. Prevalence of hospitalizations due to CHF (14.66% vs 11.43%), AIS (1.87% vs 1.71%) and TIA (0.4% vs 0.38%) was higher; and IHD (2.62% vs 3.45%), acute MI (1.58% vs 2.16), angina (0.05% vs 0.06%), AFib (1.14% vs 1.28%), ICeH (0.17% vs 0.23%) and SAH (0.05% vs 0.08%) was lower among VDD patients in compare to non-VDD. (p<0.0001) In regression analysis, VDD was associated with higher odds of severe or extreme disability amongst patients hospitalized with AIS (OR:1.1; 95%CI:1.06-1.14), ICeH (1.22; 1.08-1.39), TIA (1.36; 1.25-1.47), IHD (1.37; 1.33-1.41), acute MI (1.44; 1.38-1.49), Afib (1.10; 1.06-1.15), and CHF (1.03; 1.02-1.05) in comparison to without VDD.

Conclusions:
CVD and CeVD in presence of VDD increase the disability amongst US hospitalizations. Future studies should be planned to evaluate the discharge outcomes as well as the effect of identification and in-hospital management of VDD on improvement of the outcomes.
Abstract 13704: Simulation-based Uptraining Improves Provider Comfort in the Management of Critically Ill Patients With Covid-19
Authors: Horowitz James M , Yuriditsky Eugene , Nair Sunil , Kaufman Brian S
Published: November 2020

Introduction:
The COVID-19 surge at our institution required deployment of large numbers of non-intensive care unit (ICU) physicians and advanced practice providers to assist in the management of the critically ill. A 3-hour “uptraining” simulation session was offered to these providers that focused on various aspects of ICU care.

Hypothesis:
We hypothesized that following a 3-hour simulation session, providers would feel more comfortable in managing critically-ill patients with COVID-19.

Methods:
One hundred and seventy-five providers underwent a 3-hour simulation-based session focused on management of shock, acute respiratory distress syndrome, and critical care ultrasound. All participants were sent surveys to assess their comfort with various aspects of ICU care following return to their usual work environments.

Results:
One hundred and eight providers of 175 (62%) completed the surveys. Cardiology fellows and faculty accounted for 36% of the responders, acute care nurse practitioners (NPs) accounted for 16%, while other NPs, residents, and fellows accounted for the remainder. Prior to simulation training, 31% regularly managed patients in the ICU and 28% occasionally managed ICU patients. Following training, 71% of participants were deployed to a COVID-19 ICU as part of their workflow. Overall, 104/108 responders (96%) felt training either significantly or somewhat improved their knowledge in the management of ICU patients. Ninety-four participants (91%) felt training impacted their care of critically ill patients with COVID-19.
Table 1
is a display of specific ICU skillsets taught in the session and if the participants felt better equipped to utilize what was covered post deployment.

Conclusions:
Simulation-based training improved provider comfort in the management of critically ill patients with COVID-19.

Table 1: Participants response to “if they felt better equipped to utilize ICU skills following simulation training”
Abstract 13708: Right Ventricular Strain Comparison Between Quantification Software in Pediatric Normal and Pulmonary Hypertension Patients
Authors: Le Lisa , IVY Dunbar , Jone Pei-ni
Published: November 2020

Background:
Right ventricular (RV) free wall longitudinal strain (FWLS) is a functional assessment in pediatric pulmonary hypertension (PH). RV FWLS analysis requires study transfer to an offline software which can hinder clinical use. Autostrain RV (AS-RV) uses an automatic recognition and speckle tracking that allows for an efficient tool in routine clinical use. We evaluated the feasibility and reproducibility of AS-RV FWLS in controls and PH patients, and compared the timing of AS-RV to the offline analysis.

Methods:
Two and 3-dimensional echocardiography 4-chamber RV images were obtained in 32 PH patients and 33 controls. RV FWLS was analyzed by AS-RV software on the EPIQ machines and offline by TomTec 4D RV strain software. AS-RV timing with and without RVFW adjustments were compared to TomTec. Adjusted AS-RV and TomTec RVFWLS were compared between controls and PH patients using paired T-tests, Intraclass correlation (ICC), and Bland-Altman.

Results:
Controls and PH patients were not statistically different in age, body surface area, or heart rate. PH patients had decreased RV FWLS than controls (-24.1 ± 5.2 vs -28.3 ± 3.6; p<0.001). AS-RV was feasible in all controls and 31/32 PH patients. However, 72% of controls and 75% of PH patients required contour adjustments for accurate tracking. There were significant differences in timing between AS-RV, adjusted AS-RV, and TomTec in controls (4.3 ± 1.0 seconds, 26.5 ± 25.7 seconds, 50.4 ± 6.9 seconds; p<0.0001 respectively) and PH patients (4.4 ± 1.3 seconds, 42.4 ± 29.7 seconds, 52.7 ± 5.5; p<0.0001). ICC of adjusted AS-RV and TomTec showed strong correlation in controls and PH patients (0.70 and 0.78 respectively). Bland-Altman analysis shown in Figure 1.

Conclusion:
RV FWLS evaluation is feasible and reproducible using AS-RV, but frequent adjustments need to be made for data accuracy. Adjusted AS-RV can be incorporated into clinical use with less time, making quantification of RV easier in clinical practice.
Abstract 13712: Association Between Soluble Vascular Endothelial Growth Factor Receptor-2 and Prognosis in Patients With Chronic Heart Failure: The PREHOSP-CHF Study
Authors: Iguchi Moritake , Wada Hiromichi , Shinozaki Tsuyoshi , suzuki masahiro , Ajiro Yoichi , Matsuda Morihiro , Koike Akihiro , Koizumi Tomomi , shimizu masatoshi , Ono Yujiro , Takenaka Takashi , Sakagami Satoru , Morita Yukiko , Fujimoto Kazuteru , Yonezawa Kazuya , Yoshida Kazuro , Ninomiya Akiyo , Nakamura Toshihiro , FUNADA JUNICHI , Kajikawa Yutaka , Oishi Yoshifumi , Kato Toru , Kotani Kazuhiko , Abe Mitsuru , Akao Masaharu , Hasegawa Koji ,   the PREHOSP-CHF Study Investigators
Published: November 2020

Introduction:
Soluble vascular endothelial growth factor receptor-2 (sVEGFR-2) acts as an endogenous inhibitor of VEGF, a key regulator of angiogenesis and lymphoangiogenesis. However, little is known about the critical role of sVEGFR-2 in heart failure (HF).

Methods:
We performed a multicenter prospective cohort study (PREHOSP-CHF Study) to determine the predictive value of sVEGFR-2 for major adverse cardiovascular (CV) events (MACE) among patients with chronic HF (CHF). A total of 1,021 patients were included in the analyses. The mean age (SD) was 75.5 (12.6) years. 59.6% were male. The primary outcome was MACE defined as a composite of CV death or HF hospitalization. The secondary outcomes were all-cause death and CV death. Serum levels of sVEGFR-2 were determined employing specific enzyme-linked immunosorbent assays.

Results:
The patients with lower sVEGFR-2 concentrations were older, and had higher rates of female sex, atrial fibrillation and anemia. The baseline sVEGFR-2 level was inversely correlated with left ventricular ejection fraction, and was positively correlated with the body mass index. During the median follow-up of 730 days, a total of 210 (20.6%) all-cause deaths, 99 (9.7%) CV deaths and 308 (30.2%) HF hospitalizations occurred. Unadjusted Cox proportional hazard analyses revealed that the patients with the lowest quartile (Q1) of sVEGFR-2 did not show a significantly higher risk of MACE (p=0.7), but showed the greatest risks of CV death (p=0.003) and all-cause death (p=0.007). Even after adjusting for established risk factors and CV biomarkers (N-terminal pro-brain natriuretic peptide, contemporary sensitive cardiac troponin-I, and high-sensitivity C-reactive protein), those with the Q1 of sVEGFR-2 exhibited the greatest risk of CV death (p=0.02; hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.17-3.66 [vs. Q2]; HR, 2.42; 95%CI, 1.30-4.68 [vs. Q3]; HR, 1.52; 95%CI, 0.80-2.99 [vs. Q4]), but not that of all-cause death. The sex-stratified analyses revealed that the association between sVEGFR-2 and CV death was still significant in men, but not in women (p for interaction, 0.07).

Conclusions:
A low sVEGFR-2 value was not associated with MACE, but was independently associated with CV mortality among patients with CHF.
Abstract 13717: Autologous Skeletal Myoblast Patch Remodeled Swine Pressure-overloaded Right Heart by Amelioration in Myocardial Ischemia
Authors: Araki Kanta , Miyagawa Shigeru , Kawamura Takuji , Ishii Ryo , Harada Akima , Ueno Takayoshi , Toda Koichi , Sawa Yoshiki
Published: November 2020

Introduction:
Myocardial ischemia (MI) is majorly seen in the right ventricular (RV) dysfunction in patients with congenital heart disease secondary to residual hemodynamic stressors in form of pressure-overloaded, suggesting therapeutic target for RV dysfunction may be how to control MI. Autologous skeletal myoblast patch showed the angiogenetic effect for left ventricular dysfunction by cytokine paracrine effects, which are expected to be sufficiently effective against pressure-overloaded RV dysfunction.

Hypothesis:
An autologous skeletal myoblast patch alleviates the MI in a pressure-overloaded right heart in swine model, leading to amelioration of metabolic and functional dysfunction.

Methods:
Five-month-old mini-pigs underwent pulmonary artery banding. Two months after banding, myoblast patch derived from autologous skeletal muscles were placed on the epicardium of RV free wall. Groups were as follows: control (C, n=6), sheet implantation (S, n=6). Two months after sheet implantation, cardiac function exam and C11-Acetate positron emission tomography (PET) were done, and hearts were dissected for histologic and real-time polymerase chain reaction (RT-PCR) analysis.

Results:
Two months after sheet implantation, RV dysfunction was significantly ameliorated in group S than group C (RVEF; S 44.9+/-2.2 vs C 31.9+/-2.1 % [p=0.0042]). PET revealed the deterioration of myocardial blood flow (Rest/Stress; S 3.22+/-0.39 vs C 2.13+/-0.92 min
-1
[p=0.0421]) and myocardial oxidative metabolism (K
mono
-Rest/Stress: S 3.17+/-0.69 vs C 2.03+/-0.65 min
-1
[p=0.0421]) were suppressed in group S than group C. In histologic analysis, group S presented more angiogenesis in CD31 expression (S 18.3+/-1.5 vs C 10.7+/-2.8 units/cells [p=0.0122]). In RT-PCR analysis, mRNA expression of vascular endothelial growth factor (S 1.28+/-0.35 vs C 0.75+/-0.17 folds [p=0.030]), hepatocyte growth factor (S 1.70+/-0.79 vs C 0.74+/-0.10 folds [p=0.030]), and chemokine stromal cell-derived factor-1 (S 1.49+/-0.97 vs C 0.35+/-0.20 folds [p=0.030]) were upregulated in group S than group C.

Conclusions:
Autologous skeletal myoblast patch ameliorated metabolic and functional dysfunction in a swine model of pressure-overloaded right heart by alleviation of MI.
Abstract 13720: Safety of Same-day Discharge for Atrial Fibrillation Ablation: A Systematic Review and Meta-analysis
Authors: Akhtar Khawaja H , Sami Khadija N , Khan Muhammad H , Jafry Ali H , Chaudhary Amna M , Clifton Shari , Khan Safi U , Khan Mohammad S , Asad Zain Ul Abideen
Published: November 2020

Introduction:
We evaluated the safety of same-day discharge in patients undergoing atrial fibrillation ablation procedure.

Methods:
A systematic search was conducted on 05/05/2020 by 2 independent researchers in MEDLINE, EMBASE and other databases for studies comparing the safety of same-day discharge versus overnight stay for patients undergoing atrial fibrillation ablation. No randomized controlled trials met the inclusion criteria, so observational studies were included in the analysis. Mantel-Haenszel risk ratios (random effects model) were calculated and for heterogeneity I
2
statistics were reported.

Results:
A total of 5 observational studies with 5018 patients were included. There was a non-statistically significant trend towards repeat 30 day hospital visits associated with same-day discharge as compared with overnight stay (RR=1.92, CI 0.44-8.32, p=0.39) (Figure-1). There were no differences between same-day discharge vs overnight stay in other outcomes including vascular complications (RR=1.24, CI 0.48-3.23), cardiac tamponade (RR=1.01, CI 0.15-6.60), stroke/transient ischemic attack/thromboembolic complications (RR=0.88, CI 0.05-16.19) and mortality (RR=1.03, CI 0.05=19.36) (Figure-1).

Conclusion:
Same day discharge after atrial fibrillation ablation is safe and has the potential to be a cost-effective strategy. Randomized trials are needed to validate these results.

Figure-1: Forest plot of outcomes with same-day discharge vs overnight stay for patients undergoing atrial fibrillation ablation.
Abstract 13725: Limited Fatty Acid Use by CD36 Deficiency Accelerates the Development of Diabetic Cardiomyopathy
Authors: Kawakami Ryo , Umbarawan Yogi , Iso Tatsuya , Koitabashi Norimichi , Sunaga Hiroaki , Matsui Hiroki , KURABAYASHI Masahiko
Published: November 2020

Diabetes is an independent risk factor for the development of heart failure. In diabetic hearts, it has been reported that increased fatty acid (FA) uptake and deranged FA use result in accumulation of cardiotoxic lipids and reduced cardiac efficiency that compromise systolic and diastolic function. To date, lipotoxicity hypothesis is prevailing as a key event driving diabetic cardiomyopathy and it is proposed that limited FA use is beneficial for diabetic hearts. However, it has not been fully studied whether limited FA use is actually beneficial in-vivo beating hearts in diabetes. CD36, a transmembrane glycoprotein, has a major role in FA uptake in the heart. CD36 knockout (CD36KO) hearts exhibit reduced rates of FA transport and oxidation with marked enhancement of glucose use. In this study, we explored whether reduced FA use by CD36 ablation suppresses the development of streptozotocin (STZ)-induced diabetic cardiomyopathy. Contrary to our expectations, we found that cardiac contractile dysfunction was deteriorated 16 weeks after STZ treatment in CD36KO mice. Although accelerated glucose uptake, estimated by
18
F-FDG uptake, was not reduced in CD36KO-STZ hearts, total energy supply, estimated by the pool size of the TCA cycle, was significantly reduced in CD36KO-STZ hearts. Isotopomer analysis with
13
C
6
-glucose revealed that accelerated glycolysis, estimated by enrichment of
13
C
3
-lactate,
13
C
2
-alanine,
13
C
2
-citrate and
13
C
2
-malate, in CD36KO hearts was markedly suppressed by STZ treatment. On the other hand, levels of ceramides, cardiotoxic lipids from excessive FA, were not elevated in CD36KO-STZ hearts compared to WT-STZ. Further, increased energy demand induced by transverse aortic constriction resulted in synergistic exacerbation of cardiac contractile dysfunction in CD36KO-STZ mice. These findings suggest that CD36KO-STZ hearts are energetically compromised by reduced FA use and suppressed glycolysis, leading to cardiac contractile dysfunction. Therefore, it is very likely that enhanced FA use in diabetic hearts occurs to compensate for reduced glucose use, and that limitation of FA utilization could be detrimental to the development of diabetic cardiomyopathy.
Abstract 13743: A Tale of Syncope, Prolonged QT and ICD
Authors: Javed Isma N , AHMAD Nazir , Lockwood Deborah J , Beckman Karen J J , Stavrakis Stavros
Published: November 2020

Introduction:
Long QT syndrome (LQTS) was first described in the 1960s. It manifests clinically as syncope, cardiac arrest or sudden cardiac death. LQTS can be caused by 15 different genes. These mutations lead to action potential prolongation by causing impaired repolarizing currents.

Case Discussion:
A 29-year-old previously healthy Caucasian woman was admitted after recurrent episodes of syncope that happened within 1-month prior to the presentation. She was hemodynamically stable with normal vitals. Her ECG showed normal sinus rhythm with corrected QT (QTc) of 598ms. In the ED, she suffered an episode of sustained monomorphic ventricular tachycardia (VT) and underwent cardioversion. She was started on amiodarone infusion. Serial ECGs showed prolonged QTc. She had another episode of pulseless VT that terminated without defibrillation. She was transferred to our facility for further care. Her family history was significant for paternal aunt who had died unexpectedly at the age of 39. All her lab work including electrolytes, thyroid panel, cardiac enzymes, inflammatory markers and extended drug screen was unrevealing. Transthoracic echocardiogram showed normal biventricular size and function.

Decision making:
She was started on propranolol for possible LQTS. Cardiac MR did not show any evidence of structural abnormalities. Genetic panel was sent. Since myocarditis or familial LQTS could not be ruled out, we proceeded with implantable cardioverter defibrillator (ICD) implantation for secondary prevention. She was discharged home on nadolol.

Conclusion:
In the absence of genetic information, LQTS can be diagnosed in symptomatic patients with QTc >480msec on serial ECGs after excluding secondary causes. Schwartz score comprising of ECG findings, symptoms, clinical & family history is diagnostic when greater than 3.5. Beta-blockers are indicated in all patients with a clinical diagnosis. Patients must avoid any QT prolonging agents and strenuous exercise. An ICD is indicated in patients who suffered cardiac arrest. ICD may also be considered for primary prevention in high risk patients.
Abstract 13752: Impact of Pre-ablation Weight Changes on Freedom From Atrial Fibrillation
Authors: Peigh Graham , Vogel Kelly , Kaplan Rachel M , Wasserlauf Jeremiah , Pfenniger Anna , Chicos Alexandru B , Arora Rishi , Kim Susan , Lin Albert , Verma Nishant , Patil Kaustubha , Knight Bradley P , Passman Rod S
Published: November 2020

Introduction:
Obesity is an established risk factor for recurrent atrial fibrillation (AF) after ablation. The impact of pre-procedure weight changes on freedom from AF (FFAF) post-ablation in both obese and non-obese patients is unknown.

Hypothesis:
Weight gain over the year prior to AF ablation is associated with reduced FFAF.

Methods:
A single-center retrospective cohort study of patients undergoing AF ablation using cryoballoon (CBA) was performed. Prior to ablation, all candidates were encouraged to adopt healthy lifestyle habits according to AHA guidelines, including weight loss, by their treating physician. Inclusion criteria included availability of weight measurements 1-year prior to and at the time of CBA, and post-CBA follow up > 90 days. The primary endpoint was FFAF through 1-year after the 3-month blanking period.

Results:
Among 747 CBA performed from 2011-2017, 720 patients (49% male; average age 61.3 ± 10.3 years) met inclusion criteria. Of these, 241 patients (33.5%) were obese (body mass index ≥ 30) and 337 (46.8%) had non-paroxysmal AF. There were 9.5 ± 2.8 freezes per patient and 99 patients had additional ablation lesion sets delivered. Overall, FFAF was observed in 506 (70.3%) patients at 15 months. Multivariate analysis revealed that weight loss (p<0.001), paroxysmal AF (p=0.036), shorter duration of AF diagnosis (p=0.022) and absence of AF during the 90-day blanking period (p<0.001) were associated with FFAF. Kaplan-Meier estimates of FFAF by pre-ablation weight changes in obese and non-obese patients are shown in Figure 1a-b. In obese and non-obese patients, weight loss was associated with FFAF in a dose- dependent and binary manner, respectively.

Conclusions:
Weight gain in the year prior to AF ablation was associated with lower rates of FFAF regardless of baseline BMI. Patient directed weight loss should be encouraged prior to AF ablation.
Abstract 13769: Assessing the Risk for Cardiovascular Diseases According to Lipoprotein(a) Levels
Authors: Tmoyan Narek A , Ezhov Marat V , Afanasieva Olga I , Chubykina Uliana V , Klesareva Elena A , Pokrovsky Sergei N
Published: November 2020

Introduction:
There is no common opinion about threshold lipoprotein(a) [Lp(a)] concentration for atherosclerotic cardiovascular diseases (ASCVD) risk. Different clinical guidelines and consensus documents postulated cut-off Lp(a) level as 30 mg/dL or 50 mg/dL. We assessed the concentration of Lp(a) that associated with ASCVD of different locations.

Methods:
The study included 1224 patients with ASCVD. Lp(a) concentration was measured by enzyme-linked immunosorbent assay in serum. Patients were divided into 3 groups: group I - Lp(a)<30 mg/dL, group II - 30≤Lp(a)<50 mg/dL, group III - Lp(a)≥50 mg/dL (table).

Results:
Coronary heart disease, carotid artery disease, lower extremity artery disease, myocardial infarction and ischemic stroke were diagnosed in 61%; 34%; 23%; 42% and 11% patients, respectively. Lower extremity artery disease, carotid artery disease and myocardial infarction were more frequent in patients with Lp(a) concentration from 30 to 50 mg/dL compared to patients with Lp(a) <30 mg/dL: 36%, 41%, 48% vs. 17%, 30%, 36% respectively, p<0.01 for all. Subjects with Lp(a) 30-50 mg/dL (n=182, 15%) had a greater odds ratio of lower extremity artery disease, carotid artery disease and myocardial infarction compared to patients with Lp(a) <30 mg/dL (table). ROC analysis demonstrated that Lp(a) cut-off levels for lower extremity artery disease, carotid artery disease, coronary heart disease and myocardial infarction were 26; 21; 37 and 36 mg/dL, respectively.

Conclusions:
Our results demonstrate that in case of Lp(a) cut-off level of 50 mg/dL about 15% of patients are underestimated for the risk of ASCVD. Lp(a) cut-off level for ASCVD is between 20 and 40 mg/dL regarding the atherosclerosis location.
Abstract 14063: Circulating Levels of Collagen Formation and Degradation Biomarkers Are Prognostic for Risk of Hospitalization and Mortality in Patients With HFpEF - Results From the TRAINING-HF Cohort
Authors: Reese Petersen Alexander , Palau Patricia , Dominguez Eloy , Karsdal Morten , Genovese Federica , Nunez Julio
Published: November 2020

Introduction:
heart failure with preserved ejection fraction (HFpEF) is projected to become the dominant form of heart failure, and currently there are no viable treatment options to reduce mortality. Extracellular matrix turnover plays an important role in the pathology of heart failure. Our aim was to evaluate the association between adverse outcome in patients with HFpEF and circulating levels of novel collagen formation and degradation biomarkers in samples from HFpEF patients.

Methods:
fifty-nine symptomatic HFpEF patients were included for analysis. Biomarkers of formation of type III, VI, VIII, XXVIII collagens (PRO-C3, PRO-C6, PRO-C8 and PRO-C28) and degradation of type I, III and IV collagens (C1M, C3M and C4M) were assessed in baseline serum by means of competitive ELISA. Three models were generated by logistic regression with forward selection in relation to readmission and mortality, with the aim of assessing prognostic abilities for either outcome. The models were compared head to head using ROC curve analyses. Model 1 (CONF): age, sex, HDL, LDL, systolic blood pressure, diabetes status, BMI and smoking status. Model 2 (FORM): collagen formation biomarkers. Model 3 (DEGR): collagen degradation biomarkers.

Results:
all three models significantly predicted readmission (CONF: P<0.0001, FORM: P=0.0029, DEGR: P=0.0026). For mortality, CONF and FORM were significantly predictive, while DEGR was borderline significant (CONF: P=0.0097, FORM: P<0.0001, DEGR: P=0.059). ROC curves for mortality showed a significant difference between FORM and CONF (P=0.017), while no significant difference was seen when comparing CONF and DEGR. The CONF model was mainly driven by LDL (P=0.02) in relation to readmission, whereas no CONF variables were significant for mortality. No variables in the FORM or DEGR models were independently significant for readmission, but PRO-C6 and PRO-C8 were significant in the FORM model in relation to mortality (both P=0.028).

Conclusion:
in stable symptomatic HFpEF patients, turnover of collagen predicts outcome. Moreover, formation of collagens provides significant information on risk, suggesting a potential role for collagen biomarkers in stratifying HFpEF patients at higher risk of adverse outcomes.
Abstract 14080: A Phase II Randomized, Double-blind, Controlled Trial of Combined Mesenchymal Stromal Cells and C-kit+ Cardiac Progenitor Cells in Ischemic Heart Failure: The CCTRN CONCERT-HF Trial
Authors: Bolli Roberto , Mitrani Raul , Hare Joshua M , Pepine Carl J , Perin Emerson C , Willerson James T , TRAVERSE Jay H , Henry Timothy D , Yang Phillip C , Murphy Michael P , Lewis Gregory , Ac Lima Joao A , Khan Aisha , Lai Dejian , Ebert Ray , Davis Barry R , Simari Robert D ,   Cardiovascular Cell Therapy Rsch Network (CCTRN)
Published: November 2020

Introduction:
Although preclinical studies of cell delivery in models of ischemic heart failure (HF) suggest a beneficial interaction between mesenchymal stromal cells (MSCs) and c-kit+ cardiac progenitor cells (CPCs) resulting in additive therapeutic effects, no clinical trial has examined a combination of different cell types in ischemic HF. Furthermore, comparative studies of different cell products in humans are rare. CONCERT-HF (NCT02501811) is an NHLBI-sponsored, randomized, double-blind, placebo-controlled, Phase II trial of the Cardiovascular Cell Therapy Research Network (CCTRN) investigating feasibility, safety, and efficacy of MSCs and CPCs, alone and in combination, in patients with chronic ischemic HF.

Objectives:
To address the following questions: Is combined treatment with MSCs and CPCs feasible and safe in patients with ischemic HF? Do MSCs and CPCs, given alone or in combination, alleviate LV dysfunction, reduce scar size, improve quality of life, and/or augment functional capacity? Is either cell type more effective than the other? Is the combination of MSCs and CPCs more efficacious than MSCs alone or CPCs alone?

Methods:
Patients were randomized (1:1:1:1) to receive i) the combination of autologous bone marrow-derived MSCs and autologous CPCs, ii) MSCs alone, iii) CPCs alone, or iv) placebo. Target doses were 150 x 10
6
MSCs and 5 x 10
6
CPCs. All patients underwent bone marrow aspiration and right heart catheterization. Endomyocardial biopsy was performed only in the MSC + CPC and CPC alone groups; a “sham biopsy” was performed in the MSC alone and placebo groups. All patients underwent study product injection using the NOGA
®
XP Mapping System and were followed for 12 months.

Results:
A total of 125 patients (116 M, 9 F), 62.5 ± 8.9 years old, were enrolled at 7 CCTRN centers between Nov 2016 and Oct 2018. Baseline LVEF (cardiac MRI) was 28.6 ± 6.1% with a mean scar size of 31.8 ± 10.9 g and NYHA class II (80%) or class III (15.2%).

Conclusions:
CONCERT-HF is the first cell therapy trial to assess a combination of different cell types and to directly compare two different cell products in patients with HF. All patients will complete follow-up by the end of June and final primary (12-month) safety and outcomes data will be available in August 2020.
Abstract 14091: Outcomes of Patients With Recalled Defibrillator Leads: Results From the NCDR-ICD Registry
Authors: Zeitler Emily P , Wang Yongfei , Curtis Jeptha P , PRUTKIN Jordan M
Published: November 2020

Introduction:
Whether to reuse, abandon, or extract functioning, recalled ICD leads at the time of generator replacement is an area of uncertainty as lead failure is more common following generator replacement, and long term failure rates of recalled ICD leads are unknown. We sought to evaluate outcomes following various lead management strategies at the time of generator replacement.

Hypothesis:
Functional St. Jude Riata and Medtronic Sprint Fidelis leads at the time of elective generator replacement are more frequently reused than replaced, and extracting them poses significant procedural risk.

Methods:
We queried the NCDR ICD Registry for Medicare patients undergoing elective generator replacement with a normal Fidelis or Riata lead from 2010-2016 and categorized patients based on the fate of the recalled lead: reused, abandoned, or extracted. We report pre-discharge complications by group.

Results:
There were 9937 generator replacement patients between 2010-2016 with a functioning Riata or Fidelis lead in which lead management was reported. The lead was reused in 9806 (98%) patients, extracted in 55 (0.6%), and abandoned in 76 (0.8%). Compared with the reused group, extracted patients were >10 years younger, had less heart failure and fewer comorbidities. In-hospital death occurred in 4 (7.3%) patients in the extracted group and 7 (0.07%) in the reused group (P<0.0001). The combination of death or any pre-discharge event occurred in 11% of extracted patients compared with 0.3% and 0% in the reused and abandoned groups, respectively.(Table)

Conclusions:
At the time of generator replacement, a small percentage of functional Riata and Fidelis leads were extracted. Even in this highly selected extraction population, extraction posed significant risk of in-hospital mortality and severe complications. Future work will help clarify whether these peri-procedural risks may be justified by improved medium and long term outcomes.
Abstract 14093: High-Sensitivity C-reactive Protein Modifies the Effect of Lipoprotein (a) on Cardiovascular Risk: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Zhang Wei , Speiser Jaime L , Cainzos Achirica Miguel , Nasir Khurram , Tsai Michael , Herrington David M , Shapiro Michael D
Published: November 2020

Introduction:
Lipoprotein (a) (Lp(a)) and inflammation, as represented by elevated high-sensitivity C-reactive protein (hsCRP) concentration, are both considered as risk-enhancers in the 2018 AHA/ACC Cholesterol guidelines. However, little is known as to whether the association of Lp(a) with atherosclerotic cardiovascular disease (ASCVD) risk is modified by inflammation.

Objective:
We assessed whether hsCRP modifies the association of Lp(a) with ASCVD risk.

Methods:
MESA participants with baseline hsCRP and Lp(a) levels were included. Incident ASCVD events were ascertained from baseline through 2017. Time to incident ASCVD was analyzed using Kaplan Meir curves. Cox proportional hazards models were used to assess the association between Lp(a), hsCRP, and time to ASCVD events adjusting for covariates.

Results:
The study included 4,654 participants with mean age of 62 and 52.5% females (1,702 Caucasians, 557 Chinese Americans, 1,336 African Americans and 1,059 Hispanics). With a mean 13.6-year follow-up, 676 ASCVD events occurred among 4,609 participants (Figure 1). In participants with hsCRP <2mg/L, the association of Lp(a) (per 1 Log unit increase) and risk for ASCVD as represented by hazard ratio (HR) and 95%CI was 1.01 (0.79, 1.28). In subjects with hsCRP ≥2mg/L, the risk increased to 1.26 (1.01, 1.58). When compared to the reference group with Lp(a) <50mg/dL and hsCRP <2mg/L, the risk for ASCVD in participants with Lp(a) ≥50mg/dL and hsCRP <2mg/L was 1.13 (0.85, 1.50) and in those with Lp(a) <50mg/dL and hsCRP ≥2mg/L was 1.09 (0.92, 1.31). The risk increased significantly to 1.62 (1.26, 2.07) in participants with Lp(a) ≥50mg/dL and hsCRP ≥2mg/L.

Conclusions:
Lp(a)-related ASCVD risk is modified by hsCRP levels. The findings of this analysis suggest that Lp(a) may serve as a risk enhancing factor in individuals with hsCRP level ≥2mg/L. Future studies are needed to determine whether Lp(a) is associated with risk of ASCVD in the absence of subclinical inflammation.