bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 16116: Chronic Kidney Disease in HIV Population and Cardiovascular Disease
Authors: Ebner Bertrand , Grant Jelani , Vincent Louis , Loyd Quentin , Boulanger Catherine , Powell Alexis , Hurwitz Barry E , Martinez claudia
Published: May 2021

Background:
Chronic kidney disease (CKD) is well known to increase the risk of cardiovascular disease (CVD). However, there is limited knowledge about the association between CKD in persons living with HIV (PLWH) and CVD. We sought to investigate the prevalence and characteristics of CVD in PLWH with and without CKD at a large single center in South Florida.

Methods:
A retrospective chart review of 985 of PLWH from a Special Immunology clinic at a large center in South Florida between 2017-2019 was performed. Data on demographics, clinical, laboratory and diagnostic studies were obtained from electronic health records.

Results:
The prevalence of CKD in PLWH in our cohort was 11%. The group of CKD was older (58 vs. 51 years p<0.05), with significantly more men (66% vs. 53% p=0.012). The CKD cohort had increased rates of hypertension, coronary artery disease (CAD), heart failure, diabetes mellitus, and cerebrovascular disease (<0.05 for all). PLWH with CKD had a significantly higher HbA1C level, systolic and diastolic blood pressure, statin use, and lower LDL-C (p<0.05 for all). Subjects with HIV and CKD had a higher rate of cardiac catheterization (7.2%), with an increased rate of obstructive CAD (6.3%), when compared to PLWH without CKD (1.3% and 0.7%, respectively, p<0.05 for both). The rate of diastolic dysfunction was significantly higher in PLWH with CKD than those without CKD (p=0.004), although, no difference in ejection fraction (p=0.079) was noted. We found a significantly lower average CD4 count in individuals with HIV and CKD compared to those without CKD (483 ± 297 cells/mm
3
vs. 570 ± 342 cells/mm
3
, p=0.006). No significant difference was noted between groups in mean viral load, proportion with undetectable viral load, and use of antiretroviral medications. Prevalence of chronic hepatitis infection (B and/or C) was also higher in the CKD cohort (p<0.05).

Conclusion:
In this study, we found a comparable rate of CKD compared to age-matched patients from the general population. We found higher rates of traditional CVD risk factors and disease in the CKD cohort, without significant difference in HIV-related factors. This supports the importance of CVD risk factor optimization in this population.
Abstract 16119: Dexrazoxane Role in the Prevention of Anthracycline Cardiotoxicity in Sarcoma Patients - A Meta-analysis
Authors: Sousa JosÃ© P , Teixeira Rogério , Lourenço Carolina , Gonçalves Lino
Published: May 2021

Introduction:
Cardiotoxic side effects limit anthracycline use. Dexrazoxane has been proved cardioprotective in the setting of low-dose exposure, but its value in young sarcoma patients, who are treated with higher doses, remains elusive.

Purpose:
To perform a meta-analysis in order to appraise the efficacy and safety of dexrazoxane in sarcoma patients managed with anthracyclines.

Methods:
We systematically searched Embase, MEDLINE, Web of Science, Cochrane CENTRAL and Google Scholar databases, using the terms “sarcoma”, “anthracycline” and “dexrazoxane”, from inception to June 1, 2020. Studies targeting cardiotoxicity, primary cancer outcome (suboptimal response to treatment, disease progression and oncologic death), secondary malignancy and mortality were selected. The primary endpoint was a composite of heart failure, ventricular arrhythmias and left ventricular systolic deterioration. Therapeutic arms were those of dexrazoxane and no drug or placebo. A random-effects model with Mantel-Haenszel method was used to calculate pooled odds ratios (OR) or mean differences (MD) and their 95% confidence interval (CI).

Results:
We encompassed 11 studies, of which 5 were prospective. 9 studies were conducted in children and doxorubicin was the most represented anthracycline. 1574 patients were included, of whom 679 were under dexrazoxane. There were 73 primary endpoint events, 21 secondary malignant neoplasms and 29 deaths. Cumulative doxorubicin dose was higher in the dexrazoxane arm (MD 70.66mg/m2, 95% CI 46.43-94.89, i
2
24%). Nevertheless, this agent reduced the odds of the primary endpoint (OR 0.37, 95% CI 0.20-0.71, i
2
11%), as well as numerically decreased acute heart failure events (OR 0.15, 95% CI 0.02-1.09, i
2
0%) and significantly halted left ventricular ejection fraction deterioration (MD 5.25%, 95% CI 1.98-8.53, i
2
26%). On the other hand, primary cancer outcome and risk of secondary malignancy did not differ between the two arms (OR 1, 95% CI 0.47-2.15, i
2
0% and OR 0.98, 95% CI 0.39-2.47, i
2
0%, respectively). Likewise, all-cause mortality was similar (OR 1.65, 95% CI 0.68-4.00, i
2
0%).

Conclusion:
Dexrazoxane seems to maintain its efficacy and safety in young sarcoma patients managed with high-dose anthracyclines.
Abstract 16133: Racial and Ethnic Differences in Treatment and Outcomes of Left Atrial Appendage Occlusion in Patients With Atrial Fibrillation
Authors: Haddad Abdullah , Garber Rebecca , Bocchese Matthew , Yesenosky George , Basil Anuj , Gangireddy Chethan , Greenberg Richard , Cooper Joshua M , Cronin Edmond , Sherrer Jacqueline , Patil Pravin , O'Neill Brian , Whitman Isaac R
Published: May 2021

Introduction:
Non-white patients have been reported to face barriers to left atrial appendage occlusion (LAAO).

Hypothesis:
We hypothesized that white vs. non-white patients would have disparate wait times for and post-procedural treatment course after LAAO.

Methods:
We identified consecutive patients undergoing LAAO (Watchman
TM
) at our institution between November 2015 - March 2020. In white vs. non-white patients, we compared patient characteristics, indications for LAAO, procedural wait time from index event (IE) and cardiology encounter to LAAO procedure, complications, post-procedure anticoagulation regimen, and adherence to 45-day post-procedural transesophageal echocardiogram (TEE).

Results:
Of 109 consecutive patients receiving LAAO implants, 45% were white (n = 49). White patients were less likely to have prior cerebral vascular accident (14% vs. 43%, p=0.001), heart failure (18% vs. 48%, p=0.001), and end stage renal disease (0% vs. 20%, p<0.001). White patients also had lower CHADS2VASc and HAS-BLED scores (4 vs. 4.8, p=0.006 and 3.5 vs. 4.2, p<0.001, respectively). The majority of both white and non-white patients underwent LAAO due to prior gastrointestinal bleed (66% vs. 76%, p=0.9). Non-white patients were more likely to be in poverty (55% vs. 15% p<0.001). There was no difference in median time from IE or initial cardiology encounter to LAAO procedure in whites vs. non-whites (10.5 vs. 13.7 months, p=0.9 and 1.9 vs 1.8 months p=0.6, respectively), and there was no significant difference in procedural complications, all of which were non-fatal pericardial effusions (4% vs. 5%, p=0.33). After adjusting for CHADS2VASc score, whites may have been more likely to be discharged on oral anticoagulation vs. dual anti-platelet therapy (OR 2.4, 95%CI [0.94-6] p=0.07). Adherence to post-procedural TEE was similar between groups (92% vs 90%, p=0.7).

Conclusions:
Whites and non-whites had similar indications for LAAO, procedural wait time, risk of procedural complications, and adherence to post-procedural TEE, despite a higher burden of co-morbidities. White patients may be more likely to be discharged on oral anticoagulation.
Abstract 16147: Sex, Gender Factors and Cardiovascular Health in Canadian and Austrian Populations
Authors: Azizi Zahra , Gisinger Teresa , Bender Uri , Raparelli Valeria , Norris Colleen M , Kublickiene Karolina , Herrero Maria T , El Emam Khaled , Kautzky-Willer Alexandra , Pilote Louise ,   GOING-FWD Investigators
Published: May 2021

Introduction:
Little evidence exists differentiating the effect of biological sex from gender-related (i.e. psycho-socio-cultural) characteristics in cardiovascular outcomes.

Hypothesis:
Here, we explored the association between sex, gender, and cardiovascular health (CVH) among Canadians (CAN) and Austrians (AT).

Methods:
Data from the Canadian Community Health Survey (CCHS) (n=63,522, 55% Females) and Austrian Health Interview Survey (AT-HIS) (n=15,771, 56% Females), were analyzed. The CANHEART index, a measure of ideal CVH composed of 6 cardiometabolic risk factors ranging from 0 (worst) to 6 (ideal), was calculated in the CCHS as well as AT-HIS databases (ATHEART). A country-specific gender score was computed using principal component analysis-derived propensity score methods. The final gender scores (Range=0-1, higher score identifying characteristics traditionally ascribed to women) included: i) household size, perceived life stress, education, sense of belonging to community, marital status, and income (CAN); ii) household size, frequency of negative emotions, education, marital status and income (AT).

Results:
Median CANHEART and CAN gender scores were 4 [3-5] and 0.53 [0.49-0.60] while median ATHEART and AT gender scores were 4 [3-5] and 0.55 [0.46-0.64]. Although higher gender scores (CCHS: β=-1.33, 95%CI (-1.44,-1.22); AT-HIS: β=-1.11, 95%CI (-1.30,-0.91)) were associated with worse CVH, female sex (CCHS: β=0.35, 95% CI (0.33,0.37); AT-HIS: β=0.59, 95%CI (0.55,0.64)) was associated with better CVH in both populations. Additionally, higher gender scores were associated with a higher risk of heart disease, compared to female sex. The magnitude of this risk was higher in AT population (Table1).

Conclusions:
Individuals with characteristics typically ascribed to women reported poorer CVH and exhibited higher risk of heart disease independent of biological sex. Gender factors must be targeted for improving cardiovascular health.
Abstract 16161: Severe Left Ventricular Dilation at Initial Heart Failure Presentation: Recovery, Outcomes and Mortality
Authors: Kong Nathan , Gold Daniel , Blair John , Bhatia Neal K , Gupta Divya , Shah Anand
Published: May 2021

Introduction:
Guideline directed medical therapy (GDMT) can result in improvement in left ventricular (LV) size and function following heart failure with reduced ejection fraction (HFrEF) diagnosis. Some therapies, such as device based interventions, are thus delayed in hopes of achieving recovery. We report remodeling and clinical outcomes in a large, consecutive series of patients presenting with a severely dilated and dysfunctional LV following 3-6 months of initial GDMT.

Hypothesis:
Patients with HFrEF and LVEDD ≥ 6.5cm at initial diagnosis will have a low likelihood of myocardial recovery in 3-9 months and a high burden of associated morbidity and mortality.

Methods:
Patients were retrospectively identified by a database search of echocardiogram studies obtained at Emory Healthcare hospitals between 2008-2018. Chart review was done to select patients’ with a new diagnosis of HFrEF and LVEDD ≥ 6.5 cm. Myocardial recovery was defined as LVEF > 35% at a follow-up echocardiogram done at least 3 months after initial study. Primary endpoint for Kaplan-Meier survival analysis was freedom from composite of death, enrollment in hospice, left ventricular assist device, or cardiac transplantation.

Results:
339 patients with a median follow-up of 3.4 years were identified. The mean age was 49.0 ± 14.9 year and 68 (20.1%) were female. The mean LVEF at diagnosis was 16.9 ± 7.9% with a mean LVEDD of 7.0 ± 0.4 cm. Median time to repeat echocardiogram was 6.0 months. LVEF at follow-up was 18.3 ± 8.8% with a mean LVEDD of 6.9 ± 0.6 cm. Only 8 (2.5%) patients had myocardial recovery. 1- and 5-year primary event survival was 82.4% and 55.4% respectively. The median event free time was 5.9 years.

Conclusions:
Patients with de novo diagnosis of HFrEF and moderate or severe left ventricular enlargement have very low rates of myocardial recovery. Low survival estimate at 5 years suggests a potential benefit for early consideration of advanced therapies and device based therapies in this cohort.
Abstract 16170: Impact of Anemia on Outcomes in Patients With Heart Failure With Preserved Ejection Fraction: A Meta-analysis
Authors: Majmundar Monil , Kumar Ashish , Doshi Rajkumar P , shah Palak , Shariff Mariam , adalja devina , Kansara Tikal , Rakholiya Vivekkumar , Zala Harshvardhan , Mushiyev Savi , Visco Ferdinand
Published: May 2021

Introduction:
The effect of anemia on outcomes in Heart failure with preserved ejection fraction (HFpEF) patients is not well-established. Some previous studies have shown increased mortality and hospitalizations in HFpEF patients with anemia.

Hypothesis:
We hypothesize that anemia affects all-cause mortality and hospitalization in HFpEF patients.

Methods:
A review of literature for studies comparing outcomes in HFpEF with and without anemia was done in PubMed, MEDLINE, and EMBASE databases through June 1st, 2020. The standard definitions of HFpEF and anemia were used for inclusion criteria. Two investigators extracted the study data independently. The primary outcome of interest was all-cause mortality. The secondary outcome was all-cause hospitalizations. We used the PM estimator of Tau with Knapp-Hartung adjustment to pool adjusted hazard ratio (HR) and 95% confidence interval (CI). P curve analysis was used to assess publication bias. R version 3.6.2 was used for all statistical analyses.

Results:
Seven studies (23,424 patients) were included in the final analysis. Anemia in patients with HFpEF was associated with higher rates of all-cause mortality [HR: 1.35, 95% CI: 1.17-1.55]. Additionally, anemia in HFpEF patients was associated with higher rates of all-cause hospitalization [HR: 1.22, 95% CI: 1.03-1.44]. P curve analysis for all-cause mortality didn’t report publication bias or P hacking
(Figure)
.

Conclusions:
Anemia in HFpEF patients was associated with higher rates of all-cause mortality and all-cause hospitalizations compared to HFpEF patients without anemia.
Abstract 16184: Lamin A Deficiency Leads to Electrophysiological and Nuclear Abnormalities Reminiscent of Atrial Cardiomyopathy in Zebrafish
Authors: Teramoto Ryota , Hayashi Kenshi , Beerens Manu , Chiang David , Kiviniemi Tuomas O , Satoh Masahiro , KC Ashmita , Burch Micah , Zhu Wandi , Dai Wei , Liu Jing , Mahadevan Aparna , Buys Eva , MacRae Calum
Published: May 2021

Introduction:
Mutations in the
lamin A/C
(
LMNA
) gene have been causally linked to atrial arrhythmias and cardiac conduction disease (CCD) in young adults. However, the mechanism by which the laminopathy leads to perturbed cardiac electrophysiology has not been fully elucidated.

Hypothesis:
We hypothesize that protein-truncating variants in
LMNA
will impair the mechano-protection force in the nuclear envelope and will lead to early-onset cardiomyocyte degeneration and CCD.

Methods:
In a multi-regional registry of early-onset CCD and atrial fibrillation in Japan, we performed whole-exome DNA sequencing of 23 probands. Using CRISPR/Cas9, we generated indels of candidate gene homologues in zebrafish and characterized cardiac physiology using optical mapping technology and immunohistochemistry.

Results:
Among all probands, our study revealed four rare nonsense variants in the nuclear protein-coding genes. We focused on a
LMNA
protein-truncating variant, c.339dupT (p.K114X fsX1), and created a variant in the zebrafish
lmna
that produced a similar truncation.

Lmna
-/-

zebrafish larvae showed shortened atrial action potential duration (APD) (msec.) compared to wild-type controls (162 ± 19 vs 227 ± 79, p<0.05), while conduction velocities (CV) did not vary between the genotypes. In contrast, the atrioventricular canal of

lmna
-/-

embryos exhibited prolonged APD (399 ± 51 vs 322 ± 47, p<0.05) and slower CV (mm/sec.) (0.37 ± 0.12 vs 0.57 ± 0.12, p<0.05) than controls. Immunohistochemistry demonstrated that atrial cardiomyocytes of embryonic

lmna
-/-

zebrafish displayed significantly decreased cell numbers and smaller cell size compared to those of controls, which in turn developed into abnormal nuclear structures in adult.

Conclusions:
These findings suggest that
lamin A
is a prerequisite for proper atrial cardiomyocyte morphology in embryonic zebrafish, and is indispensable for correct cardiac electrophysiology and -conduction.
Abstract 16185: Biomarker-based Heart Failure Risk Stratification in Patients With Atherosclerotic Cardiovascular Disease: Observations From HPS-3/TIMI-55-REVEAL
Authors: Berg David , Wiviott Stephen D , Braunwald Eugene , Morrow David A ,   for the HPS-3/TIMI-55-REVEAL Collaborators
Published: May 2021

Background:
Circulating biomarkers reflecting pathways implicated in heart failure (HF) may improve HF risk assessment in patients with stable atherosclerotic cardiovascular disease (ASCVD).

Hypothesis:
We aimed to evaluate the performance of circulating biomarkers of hemodynamic stress, myocardial injury, and inflammation for the prediction of hospitalization for HF (HHF) in a large well-characterized cohort with stable ASCVD followed for a median of 4.1 years.

Methods:
HPS3/TIMI 55-REVEAL was a randomized, double-blind, placebo-controlled trial of the CETP inhibitor anacetrapib in patients with stable ASCVD. We performed a nested prospective biomarker study, measuring high-sensitivity troponin T (hsTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and growth differentiation factor-15 (GDF-15) (all Roche Diagnostics) at randomization (n=29,673). Hazard ratios were adjusted for covariates of
a priori
clinical relevance to HHF risk: age, prior HF, hypertension, diabetes mellitus, eGFR <60, body-mass index, and polyvascular disease. Discrimination was assessed using Harrell’s c-index.

Results:
A significant graded risk of HHF was observed with increasing deciles of hsTnT, NT-proBNP, and GDF-15 (p-trend <0.001 for each) (
Figure
). These associations remained significant after multivariable adjustment for clinical risk factors (p<0.001 for each). When added to a multivariable Cox regression model of clinical risk indicators (c-index 0.74), these 3 biomarkers significantly improved the prognostic performance of the model (c-index 0.85; p<0.001). There was no treatment interaction with anacetrapib.

Conclusions:
In patients with stable ASCVD, biomarkers of myocardial injury, hemodynamic stress, and inflammation provide incremental information for prediction of HHF. Future studies should address whether these patients are more likely to benefit from emerging HF preventive therapies.
Abstract 16186: Intravascular Ultrasound-guided Surgical Unroofing in Symptomatic Patients With Myocardial Bridging of the Left Anterior Descending Artery
Authors: Hashikata Takehiro , Honda Yasuhiro , Wang Hanjay , Pargaonkar Vedant S , Hollak M Brooke , Rogers Ian S , Yock Paul G , Fitzgerald Peter , Schnittger Ingela , Boyd Jack , Tremmel Jennifer A
Published: May 2021

Introduction:
Myocardial bridging (MB) has been shown to cause significant clinical symptoms or adverse cardiac events in patients with no obstructive coronary artery disease. In contrast to medical therapy or stent placement with controversial efficacy, surgical unroofing (supra-arterial myotomy) of MB is considered to directly address the pathology with durable normalization of the altered hemodynamics. In this context, preoperative IVUS assessment can provide a precise map of the MB to guide the unroofing procedure, but it remains unclear if any IVUS parameter is related to the efficacy of this treatment.

Methods:
We evaluated 94 consecutive patients who underwent MB unroofing with serial (preoperative and 6-month follow-up) angina assessments using the Seattle Angina Questionnaire (SAQ). The primary outcome was the SAQ summary score, obtained by averaging the scores of physical limitation, angina frequency, and quality of life. Preoperative IVUS determined total MB length, halo thickness, arterial compression rate, maximal plaque burden upstream of MB, and septal branches originating in the tunneled LAD segment.

Results:
In all cases, preoperative IVUS successfully offered a geographic MB map with quantitative characteristics: MB length = 27.5 (20.2 to 40.3) mm, halo thickness = 0.54 (0.41 to 0.75) mm, arterial compression rate = 34 (26 to 43)%, and plaque burden = 34 (20 to 46)% [median (range) for all]. MB unroofing resulted in significant symptomatic improvements across all scales of SAQ (p<0.001 for all) as well as the SAQ summary score (Figure), without any death or major complications. No significant correlation was observed between the preoperative IVUS parameters and the change in SAQ summary score after the surgery.

Conclusions:
IVUS-guided surgical unroofing safely and effectively achieved significant symptomatic improvements in patients with MB, regardless of the morphologic or morphometric MB characteristics assessed by preoperative IVUS.
Abstract 16194: Prior Atrial Fibrillation and WCD-detected Arrhythmic Outcomes - Data From the WEARIT-II Prospective Registry
Authors: Goldenberg Ido , Younis Arwa , McNitt Scott , Klein Helmut U , Goldenberg Ilan , Kutyifa Valentina
Published: May 2021

Introduction:
The Wearable Cardioverter Defibrillator (WCD) is utilized in patients with assumed but not yet confirmed risk for sudden cardiac death (SCD). Many of these patients also present with a history of atrial fibrillation (AF). However, the rate of WCD-detected ventricular or atrial arrhythmia events in this specific high-risk cohort is not well understood.

Methods:
In WEARIT-II, the cumulative probability of any sustained or non-sustained VT/VF (WCD-treated and non-treated), and atrial/supraventricular arrhythmias during WCD use was assessed using the Kaplan-Meier method, with comparisons by the log-rank test. The incidence of ventricular and atrial arrhythmia events were expressed as events per 100 patient-years, and were analyzed by negative binomial regression.

Results:
The WEARIT-II trial enrolled 2000 patients, 557 (28%) of whom had AF prior to enrollment. The cumulative probability of any sustained or non-sustained WCD-detected VT/VF during WCD use was significantly higher among patients with a history of AF than in patients without AF (6% vs. 3%, p=0.001, Figure). Similarly, the recurrent rate of any sustained or non-sustained VT/VF was significantly higher in patients with prior AF vs. no prior AF (131.5 events per 100 patient-years vs. 22.7 events per 100 patient-years, p=0.001). Patients with prior AF also had a significantly higher burden of WCD-detected atrial arrhythmias/SVT (64 events per 100 patient-years vs 13.7 events per 100 patient-years, p<0.001).

Conclusions:
Our results demonstrate that patients with a history of AF wearing the WCD for risk assessment have a higher incidence of ventricular arrhythmias that may facilitate the decision making for ICD implantation.
Abstract 16195: Socioeconomic Disadvantage is Associated With Higher Long-Term Cardiovascular Mortality Following Myocardial Infarction: The YOUNG-MI Registry
Authors: Berman Adam N , Biery David W , Singh Avinainder , Baek Jonggyu , Wu Wanda Y , Wadhera Rishi K , Divakaran Sanjay , DeFilippis Ersilia M , Hainer Jon , Cannon Christopher P , Plutzky Jorge , Polk Donna M , Nasir Khurram , DI CARLI MARCELO F , Ash Arlene , Bhatt Deepak L , Blankstein Ron
Published: May 2021

Introduction:
Living in a disadvantaged neighborhood is associated with developing cardiovascular disease and poor health outcomes. We hypothesized that socioeconomic disadvantage - as measured by neighborhood level factors - is associated with cardiovascular (CV) mortality for patients who experienced a myocardial infarction (MI) at a young age.

Methods:
Retrospective cohort study of patients with a first MI at age <50 years treated at two medical centers from 2000 - 2016. Each patient’s home address was mapped to their census block group (CBG), a geographically compact region containing ~ 600 to 3000 people. For each CBG, we obtained the Neighborhood Stress Score (NSS) - a standardized score based on 7 census variables that Massachusetts Medicaid uses to measure socioeconomic stress. Patients were assigned an NSS score based on their CBG and stratified into tertiles of risk. Higher scores indicate greater socioeconomic disadvantage. We used Cox proportional hazards modeling to evaluate the association of NSS with CV mortality.

Results:
Of 2097 patients (median age 44; 19% female), addresses were available for 96%. The median NSS score was -0.31, with scores ranging from -1.11 to 5.33. Higher NSS scores were associated with public insurance, hypertension, diabetes, smoking cigarettes, and illicit drug use. Over a median follow-up of 11 years, 12.7% of individuals in the top tertile died versus 7.5% in the bottom tertile, p=0.002. After adjusting for age, sex, race, diabetes, hypertension, dyslipidemia, creatinine, tobacco smoking, use of alcohol or illicit drugs, cardiac catheterization, and statin or aspirin at discharge, each 1-point increase in NSS was associated with a 25% increase in CV mortality (adjusted HR = 1.25, [95% CI 1.01 - 1.55], p=0.045).

Conclusion:
Among patients experiencing an MI at a young age, socioeconomic disadvantage was associated with higher CV mortality. Our data suggest that neighborhood factors have an important effect on post-MI survival.
Abstract 16204: The Use of a Novel Suture Material in Cardiac Device Implantation
Authors: Nakano Emi
Published: May 2021

Background:
Cardiac implantable electric device (CIED) implantation is a minor surgical procedure. One post-surgery complication often experienced is a suture knot projecting out of the skin 1-3 months after surgery. A unidirectional barbed suture (V-Loc; Covidien, Mansfield, MA) is a suture with barbs, which enables securing sutures without knots. The conventional sutures often leave a knot protruding at the suture line end; however, V-Loc eliminates the need to tie surgical knots and leaves a clean surface.

Objective:
We aimed to evaluate the safety and efficacy of V-Loc use in CIED implantation.

Methods:
A total of 153 patients underwent CIED implantation. Eighty-one patients were sutured using conventional string (PDS; Ethicon, Somerville, NJ) and V-Loc was used in 72 cases. A conventional method is to close a wound in three layers. After approximating the subcutaneous tissue in two layers with 3/0 PDS, the skin was closed with 4/0 PDS. Meanwhile, the new technique involves an over-and-over running stitch on the subcutaneous tissue with 3/0 V-Loc, followed by skin closure with 4/0 V-Loc.

Results:
The average suturing time was shorter in the V-Loc group than in the conventional group (9.9±1.7 vs. 18.0±4.1 mins. P<0.01). This translated to a reduction in closure time by 45% (8.1 mins) without complications such as wound infection and dehiscence. In the conventional group, 16 of 81 patients (19.8%) had a suture knot projecting out without infection.

Conclusion:
V-loc suture material offers the possibility of a knotless stitch. We noted positive results in patients who were sutured with V-loc, and suggest its usefulness in CIED implantation.
Abstract 16208: Safety and Efficacy of Arterio-venous Extracorporeal Membrane Oxygenation (SAVE Study) Cannulation by Interventional Cardiologists for Pediatric Population: Results of a Single Center Pilot Study
Authors: Buyukgoz Cihangir , Sandhu Hitesh , Rower Katherine , Waller Benjamin , Boston Umar , Shah Samir H , Sathanandam Shyam K
Published: May 2021

Introduction:
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) cannulations have been successfully performed in adults by interventional cardiologists (IC) for cardiopulmonary resuscitation (CPR) but little data exists in children.

Hypothesis:
This study aimed to describe the safety and efficacy of ultrasound-guided percutaneous VA-ECMO cannulation performed by IC for cardiopulmonary resuscitation.

Methods:
VA-ECMO cannulation performed by IC for CPR between January 2018 - June 2020 in a tertiary care children’s hospital were reviewed. Efficacy was defined as successful initiation of VA-ECMO following CPR without a surgical cut-down. Safety was defined as the absence of the need for additional procedures related to the cannulation event.

Results:
Eight VA-ECMO cannulations were attempted on 7 patients with 100% success; 1 patient was cannulated twice at 2 separate CPR events. Patients had congenital heart disease (n=3), idiopathic pulmonary hypertension (n=1), T-cell lymphoma (n=1) and dilated cardiomyopathy (n=2). Median age was 15 (6-18) years, median weight was 74 (16-109) kg. Uninterrupted CPR occurred during all cannulations. All cannulations were performed from left femoral artery and right femoral vein, 4 (50%) cannulations included additional internal jugular vein access. Reperfusion cannulation for distal limb circulation was also performed percutaneously by IC for 5 cannulations. Median venous cannula size was 22 (15-25) Fr and median arterial cannula size was 17 (15-17) Fr. Median cannulation start time to ECMO flow was 34.5 (18-112) min. Median ECMO duration was 3 (0.3-50) days. Survival at ECMO decannulation was 75% with a 30-day survival of 87.5%. The overall complication rate was 12.5%. One patient developed hematoma at cannulation site that was conservatively managed, and 1 patient (16 kg) developed avulsion of the intima of the left common femoral artery that needed repair. A cardiovascular surgeon was available or present during all ECMO cannulations.

Conclusions:
Pediatric VA-ECMO cannulation for CPR can be performed safely and efficiently by IC without interruption. Larger studies and further investigations are necessary especially in smaller children before advocating for its routine practice.
Abstract 16222: Electrocardiographic Manifestations of Right Ventricular Strain in Covid-19 Patients on Ventilatory Support or With Documented Pulmonary Embolism
Authors: Naseer Usman , Petrossian Gregory , Chopra Amit , Coates Andrew , Torosoff Mikhail
Published: May 2021

Background:
A significant number of COVID-19 patients require mechanical ventilation and suffer from thrombotic events, including pulmonary embolism. Prevalence of ECG changes associated with right ventricular strain in COVID-19 patients on mechanical ventilatory support and with pulmonary embolism have not been well described.

Material:
Data on 106 consecutive patients with COVID-19 infection, treated at a single academic medical center, was collected. Standard 12-lead ECGs were reviewed for evidence of RV strain, including S wave in lead I (S1), Q wave in lead III (Q3), inverted T wave in lead III (T3), right atrial enlargement (RAE), and right bundle branch block (RBBB).

Results:
The study cohort included 37% females, 62+/-15 years old, with histories of diabetes in 28%, myocardial infarction in 10%, CHF in 6%, PVD in 4%, and cancer in 6%. Of the study cohort, 34 (32%) of patients required mechanical ventilation and pulmonary embolism was documented in 4 patients, 2 of whom were on mechanical ventilation, a total of 36 patients, Vented-PE group. Thirty-three patients (30.8% of the study cohort) expired. In Vented-PE patients, prevalence of Q3 (41.7% vs. 19.7% in the rest of the cohort, p=0.016) was significantly increased, which due to supine position at the time of ECG. The prevalence of S1 (33.3 vs. 29.6%, p=0.691), T3 (44 vs. 30%, p=0.127), RBBB (3 vs. 10%, p=0.188), and RAE (2.8 vs. 1.4%, p=0.621) was not significantly different between Vented-PE group and the rest of the cohort. Similarly, except for significantly more common in survivors T3 (5.6 vs. 40.4%, p=0.004), there were no significant differences in prevalence of S1 (44.4 vs. 28.1%, p=0.171), Q3 (233.3 vs 25.8%, p=0.514), RBBB (11.1 vs. 6.7%, p=0.520), or RAE (0 vs. 2.2%, p=0.521) between patients who expired and live discharges, respectively.

Conclusions:
In COVID-19 patients, 12 lead ECG evidence of RV strain has low prevalence and does not allow to differentiate patients who require mechanical ventilation, suffer from pulmonary embolism, or expire. RV strain should not be ruled out in these patients solely based on the normal ECG. Additional imaging studies should be considered in eligible patients with high index of suspicion for the right ventricular strain.
Abstract 16223: Cardiac Arrhythmias in Hospitalized Patients With COVID-19
Authors: Cho Jae Hyung , Namazi Ali , Shelton Richard , Ramireddy Archana , Ehdaie Ashkan , Shehata Michael , Wang Xunzhang , Marban Eduardo , Chugh Sumeet S , Cingolani Eugenio
Published: May 2021

Introduction:
Arrhythmias have been reported frequent in COVID-19 patients, but the incidence and nature have not been well characterized.

Hypothesis:
Atrial and ventricular arrhythmias are common complications of patients with COVID-19.

Methods:
Patients admitted with COVID-19 and monitored by telemetry were prospectively enrolled in the study. Baseline characteristics, hospital course, treatment and complications were collected from the patients’ medical records. Telemetry was monitored to detect the incidence of cardiac arrhythmias. The incidence and types of cardiac arrhythmias were analyzed and compared between survivors and non-survivors.

Results:
Among 143 patients admitted with telemetry monitoring, overall in-hospital mortality was 23.1% (33/143 patients) during the period of observation (mean follow up 19.9 ± 13.7 days). Survivors were younger (68.1 ± 17.2 vs. 77.6 ± 15.9 years old, p=0.006), had higher body mass index (28.1 ± 8.3 vs. 24.3 ± 6.2, p=0.019), were less tachycardic on initial presentation (heart rate 90.6 ± 19.4 vs. 99.8 ± 23.7 bpm, p=0.026) and had lower troponin (peak troponin 0.03 vs. 0.14 ng/ml. p=0.006) and interleukin-6 levels (peak interleukin-6 32 vs. 264 pg/ml, p=0.001). Sinus tachycardia, the most common arrhythmia (occurring in 39.9% [57/143] of patients), occurred more frequently in non-survivors (57.6% vs. 34.5% in survivors, p=0.018). Premature ventricular complexes occurred in 28.7% (41/143), and non-sustained ventricular tachycardia in 15.4% (22/143) of patients, with no difference between survivors and non-survivors. Sustained ventricular tachycardia and ventricular fibrillation were rare (seen only in 1.4% and 0.7% of patients, respectively).

Conclusions:
In this prospective observational study of hospitalized and monitored patients with COVID-19, sinus tachycardia was the most common rhythm disorder, and its presence was associated with higher mortality. Sustained ventricular tachycardia or ventricular fibrillation were infrequent, contradicting previous reports that malignant ventricular arrhythmias are commonly seen in patients hospitalized with COVID-19.
Abstract 16229: Nonsteroidal Anti-inflammatory Drug Use and Heart Failure Hospitalizations: Are Patients Being Screened?
Authors: Levine Evan D , Rabii Kevin , Thampi Shankar , Pasha Khalid , Coplan Neil
Published: May 2021

Introduction:
There is strong evidence that nonsteroidal anti-inflammatory drugs (NSAIDs) increase the risk of heart failure (HF) and mortality in HF patients. Patients admitted with decompensated HF should be screened for NSAID use.

Hypothesis:
NSAID use in patients admitted with HF is often overlooked due to inadequate screening by clinicians.

Methods:
We performed a prospective study of all patients admitted to the cardiology service with a primary diagnosis of decompensated HF. All patients were evaluated for enrollment within 48 hours of admission. Exclusion criteria included shock, cardiac arrest, respiratory failure requiring positive pressure ventilation, altered mental status or toxic metabolic encephalopathy, dementia, cognitive deficit, acute gastrointestinal bleed, acute blood loss anemia, and NSAID allergy. Electronic Medical Record review and in-person interviews were performed to determine if subjects had been screened for NSAID use. Positive screening included: documentation of NSAID use or absence of NSAID use in the admission note, medication reconciliation documenting NSAID use, or answering yes to the interview question “Were you asked if you take NSAIDs or over-the-counter pain medication?”

Results:
The study included 151 subjects (78 men/73 women); mean age 71.7 years. The number of patients who were taking NSAIDs was 34 (22.5%); there was no variation in prevalence between genders. NSAID screening occurred in 15.9% of patients (24/151). Of those taking NSAIDs, 88.3% had not been screened by their providers and 29% had no documented etiology for their HF exacerbation or had documented HF of “unclear etiology.” 56% of patients taking NSAIDs had self-prescribed, while 44% reported prescription by a physician. 82% had been taking NSAIDs regularly for over 1 month. Additionally, of patients on NSAIDs, 53% had coronary artery disease, 56% had hypertension, and 50% had chronic kidney disease.

Conclusions:
Despite strong evidence that NSAIDs are harmful and contraindicated in many cardiovascular conditions, NSAID use in patients with HF is still prevalent. This study highlights the importance of vigilant screening by clinicians and the need for improved patient education on the risks associated with this class of medication.
Abstract 16427: Efficacy and Safety of Inclisiran According to Age: A Pooled Analysis of Phase III Studies (ORION 9, 10 and 11)
Authors: Wright R Scott S , Ray Kausik K , Raal Frederick J , Kallend David , Jaros Mark , Koenig Wolfgang , Leiter Lawrence A , Landmesser Ulf E , Schwartz Gregory G , Wijngaard Peter , Kastelein John J ,   for the ORION Phase III investigators
Published: May 2021

Introduction:
The risk of major atherosclerotic CV events increases with age, as do comorbidities, polypharmacy, and greater vulnerability to adverse drug reactions/events, posing challenges in the treatment of dyslipidemia. Three Phase III placebo-controlled trials evaluated the efficacy and safety of inclisiran according to age.

Objective:
To assess the efficacy and safety of inclisiran in patients across age categories.

Methods:
Patients were categorized according to age: <65 years (not old), ≥65 and <75 years (old), or ≥75 years (very old). The co-primary endpoints were percentage change in LDL-C from baseline to Day 510 and time-adjusted percentage change from baseline after Day 90 up to Day 540. Efficacy and safety parameters were assessed over 18 months.

Results:
Of a total 3660 patients, 1737 [47.5%] were not old, 1431 [39.1%] were old, and 492 [13.4%] were very old. At baseline, the prevalence of comorbidities increased with age (not old, old, very old): stage 3 CKD (8.4%, 19.9%, 31.2%), hypertension (72.9%, 85.2%, 88.1%) and diabetes mellitus (32.2%, 40.0%, 38.0%), respectively. The placebo-corrected percentage change in LDL-C with inclisiran was similar across all ages: from baseline to Day 510 [–51.3% (not old), –49.9% (old), –51.0% (very old);
P
<0.0001 for all] and time-adjusted from baseline to Day 90 up to Day 540 [–49.6% (not old), –51.5% (old), –50.8% (very old);
P
<0.0001 for all]. Overall AE and SAE rates increased with age and were similar between both treatment arms in all groups, except for injection-site reactions that were higher with inclisiran vs placebo across all ages, and were more frequent in not old patients. CK levels >5x ULN were more frequently elevated in the not old category (Table).

Conclusion:
Inclisiran lowered LDL-C similarly across all ages with an acceptable safety profile. Inclisiran added to maximally tolerated statin therapy could be a safe option for older patients with ASCVD who need more intensive lipid-lowering treatment.
Abstract 16429: Questioning the Effect of Hypogastric Artery Exclusion on Erectile Function Following Endovascular Repair of Abdominal Aortic Aneurysm
Authors: Bennett Kyla M , Hurley Landon , Kyriakides Tassos , Matsumura Jon
Published: May 2021

Introduction:
Published reports suggest negative effect of exclusion of antegrade hypogastric artery flow on erectile function after endovascular aneurysm repair (EVR). This has stimulated new branched device development and off-label and open surgical hybrid procedures, trying to maintain antegrade pelvic perfusion in EVR patients. However, proof is lacking that such efforts have positive influence on clinical outcomes with respect to erectile function.

Hypothesis:
We hypothesized that, when analyzed 60 months postoperatively, there would be no difference in patient-reported erectile function outcomes when compared between patients with and without maintenance of bilateral antegrade pelvic perfusion following EVR.

Methods:
OVER trial patients were all male and had erectile function assessed at multiple time points by administration of the IIEF-5 questionnaire. Bayesian hierarchical regression models were created with the outcome variable (erectile function) treated as a latent variable. Primary effects of differences in erectile function between groups with and without preservation of bilateral antegrade hypogastric flow were compared. In addition to visual inspection of the posterior predictive distribution, model convergence was assessed by maximum Gelman-Rubin statistic <1.001.

Results:
252 men from the EVR arm of the OVER trial were included in the analysis. Of these, 202 underwent a repair which maintained bilateral antegrade pelvic flow while 50 did not preserve both hypogastrics. After adjustment for baseline score, age, beta blocker use, ejection fraction, preoperative ABIs and time, loss of bilateral antegrade hypogastric perfusion was not associated with a significant difference in IIEF score compared to maintenance of antegrade perfusion (score change: -0.065; 95% CI: -0.239, 0.109).

Conclusions:
This is the largest aneurysm treatment trial to prospectively collect data on erectile function. There is no evidence that decreased erectile function is mitigated by preservation of antegrade hypogastric flow. Additional radiation exposure and resource utilization for this purpose may be unnecessary.
Abstract 16431: Outcomes of Left Heart Decompression in Children on Veno-Arterial Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-analysis
Authors: Mahajan Siddharth , Lewis Dierdre , Schneider James , Lester Janice , Dipak Kholwadwala , Epstein Shilpi M , Sweberg Todd , Kulkarni Aparna
Published: May 2021

Introduction:
Left heart decompression (LD) is performed in patients on veno-arterial extra-corporeal membrane oxygenation (ECMO) to decrease myocardial wall stress, enhance recovery and decrease complications. Data on outcomes following LD however, are unclear. We sought to evaluate outcomes of death(D) and hospital parameters with a systematic review and meta-analysis (SR-MA) in children without congenital heart disease (CHD) who underwent LD on ECMO.

Methods:
We included citations in non-CHD patients <21 years age on ECMO, from a MESH search for ECMO, LD and D in CINAHL, CINAHL PLUS and MEDLINE, in English up to January 31, 2020. Case reports, systematic reviews, database duplicates and CHD outcomes were excluded. Cochrane ROBINS-I risk of bias (ROB) tool for non-randomized studies was used to assess ROB.

Results:
The search yielded 300 citations, reduced to 36 full text screening of which 7 met inclusion criteria. All were observational retrospective analysis (5 single centers, 2 registries). ROB was critical in 3 studies, and low in 2 (not assessed in 2 abstracts). Of 1,789 included pts, 1,575 were in registries. Median age on ECMO was 6 years and weight 18.7 (range 3-92) kgs. Main diagnoses consisted of myocarditis (n=636,36%) and dilated cardiomyopathy (n=919,52%). Overall, 659 pts died and 75 underwent heart transplantation. Time from ECMO to LD was 15.5 hours (0-113.7 hrs). Dynamic left atrial (LA) LD was performed in 239 pts(13%), static in 135(8%), LA drain in 150(8%) and atrial septal stent in 17(1%). Median LA pressure at the time of decompression was 21 mm Hg. Pts who underwent LD were found to have lower odds ratio for D compared to pts who did not (OR 0.73 [0.5-1.0],I
2
0%). There was inadequate data to assess outcomes of number of days on ECMO (1 study-LD 17+28 vs non-LD 6+4 days), mechanical ventilation (1 study- LD 32+49 vs non-LD 14+19 d), ICU stay (1 study-LD 52+55 vs non-LD 18+10 d) and total length of stay (1 study-LD 60+55 vs non-LD 27+33 d).

Conclusions:
Our systematic review and meta-analysis found that survival was better in non-CHD pts on ECMO who underwent LD compared to pts who did not. Further outcome analysis was limited by inadequate data. Larger registry level analysis is necessary to assess this further.
Abstract 16457: Racial/Ethnic Differences in Cardiac Surveillance Evaluation for Cancer Patients Treated With Anthracycline-based Chemotherapy: The Oneflorida Clinical Research Consortium
Authors: Nguyen Nam K , Fradley Michael G , Chen Yiqing , DeRemer David , Waheed Nida , Langaee Taimour Y , Ahmad Faraz S , Cooper-dehoff Rhonda M , Pepine Carl J , Gong Yan
Published: May 2021

Introduction:
Anthracyclines remain a key treatment for many malignancies but can increase the risk of heart failure or cardiomyopathy. Different guidelines recommend echocardiography (echo) and BNP or NT-proBNP evaluation before and 6-12 months after treatment. It is unknown however if racial/ethnic disparities exist in the cardiac surveillance of cancer survivors exposed to anthracyclines.

Hypothesis:
Racial/ethnic disparities are present in the adoption rates of cardiac surveillance guidelines among survivors treated with anthracyclines.

Methods:
Adult patients in the OneFlorida Consortium without prior cardiovascular disease who received at least 2 cycles of anthracyclines were included in the analysis. Multivariable logistic regression was performed to estimate the odds ratios (OR) and 95% confidence intervals (CI) for receiving echo, BNP or NT-proBNP at 6 months prior (baseline), 6 months after (6M), and 12 months after (12M) treatment among different racial/ethnic groups.

Results:
A total of 2758 patients were identified, with mean age of 54 ± 16 years and 60% were women. Among the entire cohort, 43% had a baseline echo, with 18% receiving an echo at 6M and 21% at 12M. BNP or NT-proBNP were lower: 5.3% at baseline, 6.5% at 6M and 8.7% at 12M. The prevalence of baseline cardiovascular risk factors ranged from 13% for hyperlipidemia and diabetes to 19% for obesity and 29% for hypertension. Compared to Whites, Blacks (OR: 0.56, 95% CI: 0.45-0.70) and Hispanics (0.52, 0.43-0.64) were less likely to receive echo surveillance at baseline. These differences were also observed at 6M and 12M in Hispanics (Figure).

Conclusions:
Significant racial/ethnic differences in cardiac surveillance among cancer survivors were present before and after anthracycline-based treatment as Hispanics are least likely to receive cardiac surveillance. This points to the need for improved education and outreach to ensure all cancer survivors receive appropriate and equitable care.
Abstract 16471: Lipoprotein(a) Cholesterol and Cardiovascular Events in the VITamin D and OmegA 3 TriaL (Vital)
Authors: Farukhi Zareen , Gibson Heike , Cook Nancy R , Demler Olga , Kulkarni Krishnaji R , Ajala Oluremi N , Buring Julie E , Manson Joann E , Danik Jacqueline , Mora Samia
Published: May 2021

Background:
It is unclear if lipoprotein(a) cholesterol (LpaC), the cholesterol carried by Lpa, is associated with CVD similar to Lpa mass, and if omega-3 fatty acids (n-3 FA) modify risk.

Methods:
13,175 participants of the VITAL trial (NCT01169259) had baseline LpaC measured by density-gradient ultracentrifugation and were examined for incident CVD (n=416) by Cox models adjusted for risk factors. In a subset of participants (N=1639) with baseline and 1 year samples, we also analyzed randomized n-3 FA effects (1 g/d EPA+DHA) vs. placebo.

Results:
In unadjusted models, LpaC was associated with increased CVD risk (Table). After adjustment, risk was somewhat attenuated, with borderline significant association for LpaC >30 mg/dL (HR 1.37 [0.99, 1.90), p=0.056). N-3 FA increased median LpaC from 7 mg/dL (IQR, 5-10) at baseline to 8 mg/dL [IQR, 5-10] at 1 year (mean increase of 4.05% vs placebo, p=0.006 using natural logarithmic transformation for mean LpaC percent change). There was no effect modification (P interaction>0.05) by n-3 FA, race, sex or LDL-C.

Conclusion:
Very high LpaC had borderline significant increased risk for incident CVD, without diminution of levels or associated risk by n-3 FA treatment.