bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 16345: Increase in Serum Chloride Level During Hospitalization Leads to Improved Clinical Outcomes in Patients With Heart Failure
Authors: Shirotani Shota , Jujo Kentaro , Kishihara Makoto , Watanabe Shounosuke , Endo Nana , Takada Takuma , Abe Takuro , Minami Yuichiro , Hagiwara Nobuhisa
Published: November 2020

Introduction:
Serum chloride levels both at admission and at discharge in patients with heart failure (HF) are independently associated with the incidence of adverse clinical outcomes. However, there has been few reports focusing on the prognostic impact of the change in serum chloride level during the hospitalization on the long-term prognosis after discharge.

Hypothesis:
We thus hypothesized that changes in serum chloride during the hospitalization is an independent prognostic predictor after discharge in HF patients.

Methods:
This observational study included 1,913 consecutive patients who admitted to hospital due to worsening of HF and discharged alive in a single university hospital. After excluding patients who received regular hemodialysis, 1,762 patients were ultimately analyzed. The primary endpoint of this study was death from any cause.

Result:
Overall serum chloride level was significantly decreased from the admission to discharge (103 [100-106] mEq/L to 102 [99-105] mEq/L, P<0.001). During the observation period with 512 days of median follow-up, 286 patients (16.2%) died. Multivariate Cox regression analysis revealed that increase in serum chloride level during the index hospitalization was independently associated with lower rates of mortality, even after the adjustment of diverse covariates including serum chloride level at admission (hazard ratio (HR): 0.94, 95% confidence interval: 0.90-0.98). When dividing the study population into tertiles by chloride levels at admission, patients with the lower baseline chloride level had the greater reduction in HR of the primary endpoint by the increase of chloride level during the hospitalization (Figure).

Conclusion:
Increase in serum chloride level during hospitalization may be associated with better post-discharge prognosis in HF patients. This could be a new therapeutic target for heart failure to improve long-term prognosis.
Abstract 16355: Impact of Renal Dysfunction on Outcomes After Left Ventricular Assist Device Implantation: A Systematic Review and Meta-analysis
Authors: Ibrahim Michel , Lebrun Sandrine , Saint Croix Garly Rushler , Fattouh Michael , Chaparro Sandra V
Published: November 2020

Background:
Renal dysfunction is a common comorbidity in patients with advanced heart failure who may benefit from left ventricular assist device (LVAD) therapy. The effect of preoperative renal dysfunction on clinical outcomes after LVAD implantation remains uncertain. We conducted a systematic review and meta-analysis to compare outcomes post-LVAD in patients with and without renal dysfunction.

Methods:
PubMed, Medline, and EMBASE databases were searched for studies comparing outcomes in patients with and without renal dysfunction who underwent LVAD implantation for advanced heart failure. The primary outcome of all-cause mortality was reported as random effects risk ratio (RR) with 95% confidence interval.

Results:
Our search yielded 5,229 potentially eligible studies. We included 7 studies reporting on 26,652 patients. Patients with renal dysfunction (glomerular filtration rate (GFR) <60) (n=4,630) were found to have increased risk of all-cause mortality 2.21 (95% CI 1.39-3.51, p <0.01) when compared to patients with normal renal function (GFR >60) (n=22,019).

Conclusion:
Patients with renal dysfunction have increased mortality after LVAD implantation when compared to patients with normal renal function. GFR can be used to risk stratify patients and guide decision making prior to LVAD therapy.
Abstract 16374: Effect of Dapagliflozin According to Duration of Heart Failure: An Analysis of the DAPA-HF Trial
Authors: Yeoh Su E , Docherty Kieran , Inzucchi Silvio E , Kober Lars , Kosiborod Mikhail , Langkilde Anna Maria , Martinez Feilpe A , Bengtsson Olof , Ponikowski Piotr , Sabatine Marc S , SjÃ¶strand Mikaela , Solomon Scott , Jhund Pardeep S , McMurray John J
Published: November 2020

Introduction:
The relationship between duration of heart failure (HF), patient characteristics, outcomes, and the effect of treatment is largely unknown. We investigated these questions in DAPA-HF.

Hypothesis:
We hypothesized that longer HF duration is associated with worse outcomes and that, compared with placebo, the benefit of the SGLT2 inhibitor, dapagliflozin, is consistent, irrespective of HF duration, in patients with HF and reduced ejection fraction (HFrEF).

Methods:
HF duration was categorised as 0-1, >1-2, >2-5 and >5 years. Outcomes were adjusted for prognostic variables and analysed using Cox regression. The primary endpoint was the composite of worsening HF or cardiovascular death. Treatment effect (dapagliflozin versus placebo) was examined within each duration category and by duration threshold.

Results:
The number patients in each category was: 1098 (0-1 year), 686 (>1-2 years), 1105 (>2-5 years) and 1855 (>5 years). Patients with longer-duration HF were older and more comorbid with worse quality of life. The primary outcome rate (per 100 person-years) increased with HF duration: 10.2 (95% CI 8.7-12.0) for the 0-1-year group, 10.6 (8.7-12.9) for >1-2 years, 15.5 (13.6-17.7) for >2-5 years and 15.9 (14.5-17.6) for >5 years. The adjusted hazard ratio was 0.98 (95% CI 0.75-1.27), 1.52 (1.22-1.89) and 1.60 (1.31-1.96) respectively, for >1-2, >2-5 and >5 years compared with 0-1 years. Similar trends were seen for all other outcomes. The benefit of dapagliflozin was consistent across HF duration for all outcomes and on threshold analysis (Figure).

Conclusion:
Patients with longer-duration HF had higher rates of worsening HF and death. The benefit of dapagliflozin was consistent irrespective of HF duration. Starting dapagliflozin has substantial benefits, even in patients with longstanding HFrEF.
Abstract 16378: Increased Extracellular Sodium and Calcium Modify the Extracellular Potassium and Cardiac Conduction Velocity Relationship in a Langendorff-perfused Guinea Pig Heart
Authors: King David Ryan , ENTZ Michael , Blair Grace , Crandell Ian , Hanlon Alexandra , Lin Joyce , HOEKER Gregory , Poelzing Steven
Published: November 2020

Background:
Previous studies have demonstrated a biphasic relationship between extracellular potassium (K
o
) and cardiac conduction velocity (CV). With moderate hyperkalemia, CV increases in what is referred to as supernormal conduction, but further increases in K
o
lead to severe conduction slowing and asystole. We recently demonstrated that altering extracellular sodium (Na
o
) and extracellular calcium (Ca
o
) modulates CV dependence on gap junctions (GJs). We have also shown that increasing Na
o
and Ca
o
can attenuate conduction loss caused by global ischemia ischemia. The purpose of this study was to determine if increasing Na
o
and Ca
o
would alter the K
o
-CV relationship and preserve CV at high K
o
.

Hypothesis:
Increasing Na
o
and Ca
o
will mitigate conduction slowing and the incidence of asystole associated with severe hyperkalemia in conditions of both normal and uncoupled GJs.

Methods:
Langendorff-perfused guinea pig hearts were optically mapped to measure CV. Na
o
was set to 145 or155mM and Ca
o
to 1.25 or 2.0mM. K
o
was varied from 4.6, 6.4, 8, to 10 mM in each experiment. Perfusion order was blinded and randomized. GJs were inhibited using carbenoxolone.

Results:
A biphasic K
o
-CV relationship was observed under all conditions. Maximum CV was achieved at either 6.4 or 8.0mM K
o
followed by a decrease in CV with increased K
o
. Importantly, the degree of CV slowing in the presence of 10mM K
o
was significantly reduced with the 155mM Na
o
/ 2.0mM Ca
o
perfusate compared to all other Na
o
/Ca
o
combinations. Carbenoxolone reduced CV across all K
o
, but did not alter the K
o
-CV relationship. With 145mM Na
o
/ 1.25mM Ca
o
, all hearts became asystolic at K
o
=10.0mM. Increasing Na
o
and Ca
o
significantly reduced the incidence of asystole at K
o
=10.0mM.

Conclusions:
Elevating Na
o
and Ca
o
preserves CV during severe hyperkalemia with or without strong GJ coupling. Increasing Na
o
and Ca
o
significantly reduces the incidence of asystole during severe hyperkalemia. These data suggest that non-linear and combinatorial effects of sodium, calcium, and GJ uncoupling can differentially modulate cardiac conduction during hyperkalemic perfusion. These results have important implications for cardioplegic arrest and ischemic heart disease when potassium and calcium homeostasis are disrupted.
Abstract 16391: Systemic Ventricular Dysfunction and Long Term Outcomes in Patients With D-transposition of the Great Arteries (D-TGA), Atrial Switch, and Systemic Right Ventricle Physiology
Authors: Chiriac Anca , Giardi Davide , Espinosa Samantha , Fitzgerald Patrick J , Cheema Kamal P , Umadat Goyal , Perez-Downes Julio , Hodge David , Phillips Sabrina D , McLeod Christopher J
Published: November 2020

Introduction:
Patients with D-TGA palliated with atrial switch operations have the morphologic right ventricle in the systemic position. There is increased risk of atrial arrhythmias and systemic right ventricle (SRV) failure. We sought to analyze the long term outcomes of these patients.

Methods:
All patients with D-TGA and SRV followed in the Adult Congenital Heart Disease Clinic of a large tertiary care institution were reviewed. A comprehensive retrospective analysis of the medical record was performed, including consult notes, ECGs, echocardiograms and electrophysiology reports.

Results:
A total of 154 patients (63% male) aged 29±11 years were followed for a mean of 10±9 years (range 0-51). During follow-up, 3 patients underwent cardiac transplantation and 15 died; 5 had sudden death, 2 had cardiogenic shock, 5 had non-cardiac death (i.e., infective endocarditis, sepsis) and 3 had unknown causes of death. Heart failure symptoms were present in 53(34%) patients. Severe SRV systolic dysfunction occurred in 37(24%) patients, with a mean EF of 23±5.5%; moderate SRV dysfunction occurred in 67(44%) patients, mean EF 35±4%. Sinus node dysfunction was present in 75(49%) patients, complete AV block in 9(5%) patients, and a pacemaker placed in 60(39%) patients, with cardiac resynchronization therapy in 5. Atrial arrhythmias occurred in 94(61%) patients and ablations were performed in 47(31%) patients. An ICD was implanted in 37 patients; 5 patients had appropriate shocks, but 7 had inappropriate shocks due to atrial arrhythmias. Age (HR 1.07, p=001), heart failure symptoms (HR 4.9, p= 0.007), severe SRV enlargement (HR 3.7, p=0.03), severe systolic dysfunction (HR 5.4, p=0.003), severe systemic AV valve regurgitation (HR 5.2, p=0.002) and a QRS duration> 122ms (HR 3.7, p=0.02) were significant predictors of mortality. The 15 year probability of sudden death was 3.2%(95% CI 0-6.9%).

Conclusions:
Atrial arrhythmias are common after atrial switch operations secondary to atriotomy scars. Further studies will need to determine whether restoration of sinus rhythm or cardiac synchrony may prevent further deterioration of the systemic right ventricle. Severe SRV dysfunction and prolonged QRS duration >122ms were significantly correlated with mortality.
Abstract 16393: In Hospital Outcomes and Prevalence of Comorbidities in Patients With Amyloidosis With and Without Atrial Fibrillation - Insight From National Inpatient Sample (nis) Database (2013-14)
Authors: Kichloo Asim , Jamal Shakeel , Bailey Beth , shah zaib muhammad , Virk HUH , Soni Ronak , AJMAL MUHAMMAD , Ananthaneni Sindhura , SINGH Jagmeet P , Sudhakar Rajeev
Published: November 2020

Introduction:
Amyloidosis is a systemic illness that affects multiple organ systems including cardiovascular, renal, gastrointestinal and pulmonary systems manifesting as restrictive cardiomyopathy, atrial and ventricular arrhythmias, nephrotic syndrome and gastrointestinal hemorrhage. Unknown is whether co-occurrence atrial fibrillation (AF), further worsens the outcomes in systemic amyloidosis.

Hypothesis:
Atrial Fibrillation worsen clinical outcomes in Amyloidosis.

Methods:
Patients with diagnosis of amyloidosis with and without concurrent AF were identified by querying the Healthcare Cost and Utilization (HCUP), specifically, National Inpatient Sample for year 2016 based on ICD10 codes.

Results:
During 2016, a total of 2997 patients were admitted with diagnosis of Amyloidosis, out of which 918 had concurrent AF. There was an increased risk of mortality (7.4% vs 5.6%), heart block (6.8% vs 2.8%), cardiogenic shock (5% vs 1.6%), placement of an ICD/CRT/PPM (14.5% vs 4.5%), renal failure (29% vs 21%), heart failure (66% vs 30%) and bleeding complications (5.7% vs 2.8%) in patients with diagnosis of Amyloidosis and concurrent AF when compared to patients with only diagnosis of Amyloidosis. It’s interesting to note that patients with amyloidosis without comorbid AF had increased risk of stroke when compared to concurrent AF (7.9% vs 3.4%).

Conclusions:
Concurrent AF increases the risk of heart failure, cardiogenic shock, supraventricular tachycardia, bleeding complications and an overall increase in mortality in patients with amyloidosis.
Abstract 16397: Presence of Myocardial Injury on Admission is Associated With an Increase in All-cause Mortality in Patients With COVID-19
Authors: Ahmed Zain , Singh Avinainder , Vadlamani Lina , Eder Maxwell , Ghazizadeh Zaniar , Park Jakob , Pareek Manan , Pacor Justin , Gier Chad , Mena-hurtado Carlos , Velazquez Eric J , Desai Nihar R
Published: November 2020

Introduction:
COVID-19 has emerged as a global health crisis resulting in nearly half a million deaths worldwide to date. Patients with COVID-19 experience significant cardiovascular manifestations including myocardial injury. We sought to determine the risk of myocardial injury within 24 hours of admission on all-cause mortality in patients with COVID-19.

Methods:
This was a prospective cohort study of patients hospitalized with COVID-19 at a major academic medical center between March 1, 2020-June 1, 2020. The combination of cardiac troponin T (cTnT) elevation (defined as ≥0.01 ng/mL) within 24 hours of admission and an elevated NT-proBNP (defined as >450.0 pg/mL) on admission were used as biomarker surrogates for myocardial injury.

Results:
There were n = 415 consecutive patients who were hospitalized with COVID-19 with a median age of 68.5 years (IQR 58-81), 44.8% were women, a median BMI of 28.8 (IQR 24.6-35.6), 5.8% of patients had end-stage renal disease on dialysis, 21.6% had a prior diagnosis of coronary artery disease and 21.8% had a prior diagnosis of congestive heart failure. Among patients with at least one positive cTnT level within 24 hours of admission, the median cTnT level was 0.04 ng/mL (IQR 0.01-0.77 ng/mL). Among those with elevated BNP, the median BNP was 1930 pg/mL (IQR 799-5826 pg/mL) on admission. Patients with COVID-19 who had an elevation in both cardiac biomarkers on admission had higher all-cause mortality than patients with COVID-19 who had negative biomarkers (38.2% vs. 7.5%, respectively, p-value < 0.001), with nearly a 5-fold increase in mortality when adjusted for age, gender, BMI and renal dysfunction (adjusted OR 4.9, p-value: 0.003, 95% CI 1.7-13.9, See Figure)

Conclusion:
Myocardial injury is common in patients with COVID-19 and is associated with a significantly increased risk of death. Cardiac biomarkers on admission can serve as prognostic factors and may guide early management of COVID-19.
Abstract 16706: Chronic Kidney Disease Among U.S.-Born and Foreign-Born U.S. Adults in the 2011-2018 National Health and Nutrition Examination Survey
Authors: Ogungbe Oluwabunmi , Turkson Ocran Ruth Alma N , Baptiste Diana , Nwokeji Uchenna , Commodore-mensah Yvonne
Published: November 2020

Introduction:
Chronic Kidney Disease (CKD) is a major risk factor for cardiovascular disease (CVD) and death. Hispanic and African American persons have poorer control of CVD risk factors and are disproportionately affected by CKD, CVD, and their associated complications compared to White persons.

Objective:
To compare the prevalence of CKD and Reduced Kidney Function (RKF) by nativity status in the U.S.

Methods:
Using pooled 2011-2018 National Health and Nutrition Examination Survey (NHANES) data, we examined the prevalence of CKD in a weighted sample of U.S.- and foreign-born adults. RKF was defined as eGFR <60mL/minute/1.73m
2
(CKD-EPI equation), and CKD was defined as eGFR <60mL/minute/1.73m
2
and an albumin-creatinine ratio ≥30 mg/g. We used multivariable Poisson models to estimate the association between CKD and nativity status, adjusting for covariates.

Results:
We included a sample of 39,143 adults; mean age was 46.8(±0.31) years, 52% female, and 18% were foreign-born. The prevalence of CKD among U.S.-born adults was 14.8%, compared to 11.8% of foreign-born adults. After adjusting for covariates, foreign-born adults were 21% less likely to have CKD (prevalence ratio: 0.79, 95%CI 0.67-0.91) and 29% less likely to have RKF (PR: 0.71, 95% CI 0.56-0.89) compared to U.S.-born (
Table
).

Conclusions:
Foreign-born persons were less likely to have CKD and RKF than U.S.-born adults. Public health efforts are needed to maintain this health advantage among foreign-born adults and to reduce the burden of CKD in the U.S.-born population.
Abstract 16707: Incidence of In-Hospital Venous Thromboembolism Across Heart Failure Subtypes and Their Effect on 30-Day Readmission Due to Thrombotic Complication
Authors: chakraborty sandipan , Bandyopadhyay Dhrubajyoti , Amgai Birendra , Patel Neel , Hajra Adrija , Patel Zeel , Koirala Soniya , Aronow Wilbert S , Bakhit Ahmed , Khalid mazin
Published: November 2020

Introduction:
Heart failure (HF) hospitalizations are associated with increased short-term and long-term risk for venous thromboembolism. We retrospectively analyzed Nationwide Readmission Database (NRD) to identify the incidence of venous thromboembolism (VTE) during index hospitalization based on HF subtypes and whether index VTE events influence 30-day readmission due to VTE.

Hypothesis:
Venous thromboembolism during index admission can influence 30-day readmission risk between different HF subtypes.

Methods:
NRD 2012-2014 was used to identify all patients with discharge diagnosis with HF and categorized into HF with reduced ejection fraction (HF-rEF) and (HF-pEF) using appropriate ICD-9-CM codes. After the exclusion of patients with cancer, 950385 patients with HF-rEF, and 798590 patients with HF-pEF were included for final analysis. Multivariate logistic regression and Cox-regression model were used to calculate adjusted Hazard Ration (HR) and Odds Ratio (OR).

Results:
Patients with HF-rEF were younger, African American, and more likely to be men, whereas HF-pEF population is older, white, and more likely to be women (table 1.). Incidence of anemia, chronic lung disease, hypertension, diabetes, and obesity was higher in the HF-pEF group. In contrast, HF-rEF patients had a higher incidence of prior CABG, PCI, and CAD. HF-pEF patients had lower odds of pulmonary embolism (PE) (OR, 0.80; p < 0.001), deep vein thrombosis (DVT) (OR, 0.73; p < 0.001) and other VTE (OR, 0.50; p < 0.001) during index hospitalization. Patients with HF-pEF who had VTE in index hospitalization had an increased risk of readmission due to DVT (HR, 1.16: 95% CI: 1.07-1.26, p < 0.001).

Conclusion:
Patients with HF-rEF had a higher incidence of VTE during the index admission, whereas HF-pEF patients with index VTE were more likely to be readmitted within 30-day with DVT.
Abstract 16716: Comparison of Blood Troponin I Complexes and Free Form in Acute Myocardial Infarction and End Stage Renal Disease
Authors: Sharma Vikram , Sharma Ruchi , Alansari Shehab A , Maradumane Mohan L , Witherow Conner P , Tang Wai Hong W , Prasad Sathyamangala , Menon Venu
Published: November 2020

Introduction:
Circulating blood troponin complexes and free fractions remain poorly characterised in different conditions where troponin is detectable in blood

Hypothesis:
The aim of the study was to compare the differences in troponin-I(TnI) complexes/free-forms in end stage renal disease (ESRD) compared to acute myocardial infarction(AMI)

Methods:
Blood was collected from patients with AMI(n=7) or ESRD(n=4) at two time points (a)As early as possible after AMI or at initial contact with ESRD patients and (b)24-48 hours later. Western blotting was carried out with HyTest cTnI-560cc antibody on plasma extracted from whole blood. Densitometry analysis was performed and evaluated using the independent samples T-test and paired T-test as appropriate

Results:
Prominent bands were noted at ~45,~37 and ~25 kDa respectively representing low molecular weight(LMW) TnI-TnT-TnC complex, binary TnI-TnC complex and free-TnI. At time-point (a), there was no difference in these bands between STEMI and CKD patients. Interestingly, at time-point (b), AMI patients had significantly lower intensity of the 45kDa and 37kDa bands compared to CKD patients(for 45 kDa band mean difference was 54.3±19.4 AU, p=0.02; for 37 kDa band mean difference was 27.7±10.5 AU, p=0.03) as well as compared to the initial STEMI samples taken at time-point (a)(for 45 kDa band mean difference was 41.4±8.1 AU, p=0.002; for 37 kDa band mean difference was 16.7±6.3 AU, p=0.002) ,however there was no difference in the 25kDa band

Conclusions:
AMI patients had progressively lesser quantities of circulating LMW-ITC and binary IC complexes following AMI compared to ESRD patients, but similar quantities of circulating free TnI. This indicates a constant release of LMW-ITC and binary-IC complexes from the myocardium or reduced glomerular filtration of these complexes in ESRD while in the AMI patients, the LMW-ITC and binary I-C complexes appear to be progressively eliminated from plasma after the initial release
Abstract 16719: Impact of Underlying Cardiovascular Disease for the Hospitalized Covid-19 Patients in Delaware
Authors: Zhang Zugui , Chiam Tze Chao , Gbadebo Bayo , Jurkovitz Claudine , Mount-Campbell Austin , Harrison Cecelia , Bollinger Melissa , Hicks Leroi , Papas Mia
Published: November 2020

Background:
Patients with cardiovascular disease (CVD) are especially vulnerable to respiratory infections caused by the coronavirus. The underlying effect of cardiovascular comorbidities on patients with COVID-19, however, remains to be sufficiently understood.

Methods:
Hospitalized COVID-19 patients from a state-wide large health care system with completed historical clinical conditions during March - June of 2020 were included in this study. The impact of CVD on the mortality, resources utility including the uses of intensive care unit (ICU) and ventilator, length of stay (LOS) and financial burden of COVID-19 inpatients were examined. Logistic analysis was applied to analyze the relationship between CVD and mortality, and non-parametric methods were used to evaluate the impact of CVD on resources utility. Random forest method was used to rank the importance of risk factors.

Results:
Among 811 hospitalized COVID-19 patients, 228 (28.11%) were placed in ICU, 105 (12.95%) spent on ventilators, and there were 94 deaths (11.59%). The mean LOS was 11.93 ± 11.26 (SD, standard deviation), mean time a patient in an ICU was 2.41 ± 5.49 days, and mean ventilator time was 1.29 ± 4.62 days. The mean charge of a patient was $55242 ± 71742) with inter-quarter range of $44124. Age, gender, and race were the top 3 factors of mortality and utilities. Patients who present with heart failure vs. those who do not, have increased mortality (21.47% vs 8.97%; odds ratio [OR], 2.00 (95% CI: 1.25-3.21;
P=0.004),
longer LOS (12.97 ±10.09 vs. 11.61±11.46), p=0.18), higher ICU usage ( 3.32 ± 6.04 vs. 2.14 ±5.26, p=0.02) and ICU requiring ventilator (1.86 ± 4.90 vs. 1.15 ± 4.56, p=0.09), and significant higher charge ($ 66175 ± 68773 vs $ 50736 ±64142, mean difference $15439± 65193 with 95% CI: $4537-26340, p=0.01). Similar results were shown for patients with coronary artery disease or arrhythmia. Patients with hypertension vs those who do not, have increased mortality (14.81% vs. 4.92%; OR=3.22 (95% CI: 1.76-5.90, p=0.01), but the impact was not significant after adjusted by age, race and gender.

Conclusions:
Among COVID-19 hospitalized patients with established cardiovascular disease, there was a worse survival and adverse utility outcomes in hospital resources and financial charges.
Abstract 16728: The Association of 0,1-Hour and 3-Hour Serial Cardiac Troponin T and Positive Coronary Angiogram in Renal Dysfunction Patients
Authors: Kotruchin Praew , Srimakam Nirut , Mitsungnern Thapanawong , Phungeon Pariwat
Published: November 2020

Introduction:
Patients with renal dysfunction particularly have chronic high-sensitivity cardiac troponin T (hscTnT) elevation. Serial measurement of hsTnT at 3 hours was found effective for diagnosing non-ST elevation myocardial infarction (non-STEMI). However, there is limited data on the 0,1-hour serial protocol in patients with renal dysfunction.

Hypothesis:
There is a differential association between the positivity of hsTnT serial protocol; 0,1-hour and 3-hour serial protocol and the positive findings of coronary angiogram (CAG).

Methods:
A retrospective cohort study of patients who presented with angina pectoris, STEMI cases were excluded. Clinical data were collected from hospital electronic records. The positivity of 0,1-hour and 3-hour serial hsTnT was interpreted based on the standard clinical practice guidelines. Renal dysfunction was defined by the estimated glomerular filtration rate <60 ml/min/1.73m
2
.

Results:
A total of 318 patients were enrolled (40.4%, male; mean age, 66±13 years old), 157 patients (40.4%) had renal dysfunction. Positive CAG findings were reported in 99 patients (70.2%) and 86 (58.1%) in the renal dysfunction and the normal renal function group. The positive 3-hour serial hsTnT was significantly associated with the positive CAG findings in the total population (OR 2.00, 95%CI 1.04-3.85) and in the renal dysfunction group (OR 2.98, 95%CI 1.12-7.95) while the positive 0,1-hour serial hsTnT had a significant association with the positive CAG findings in the total population (OR 2.20, 95%CI 1.03-4.71) but not in the renal dysfunction group (OR 2.46, 95%CI 0.56-10.83).

Conclusions:
The positive 3-hour serial hsTnT had a significant association with the positive CAG findings in patients with renal dysfunction. Therefore, the 3-hour serial hsTnT protocol is recommended in renal dysfunction patients.
Abstract 16739: Right Ventricular Size and Exercise Capacity in Arrhythmogenic Right Ventricular Cardiomyopathy
Authors: Woldu Bethel , Scheel Paul , Calkins Hugh G , James Cynthia , Tandri Harikrishna S , Agafonova Julia , Tichnell Crystal , Murray Brittney , Gilotra Nisha A , Hays Allison
Published: November 2020

Introduction:
With improved survival of sudden cardiac death in arrhythmogenic right ventricular cardiomyopathy (ARVC), progressive heart failure is increasingly recognized. Cardiopulmonary exercise testing (CPET) can play a role in prognostication. However, correlation of morphologic disease severity and exercise capacity is lacking.

Hypothesis:
Increased RV size and decreased RV function measured by two-dimensional echocardiography (2D echo) are associated with impaired exercise capacity parameters (peak oxygen consumption (pVO
2
) and ventilator efficiency (VE/VCO
2
slope)).

Methods:
We retrospectively examined 21 patients who underwent 25 echocardiography and cardiopulmonary exercise testing (CPET) studies within 6 months of each other. A Spearman rank correlation was used to determine the relationship between RV dimensions and CPET parameters. Seven (28%) had submaximal effort defined as respiratory exchange ratio <1.05 and were excluded in the analysis of pVO
2
.

Results:
Patients’ mean age was 44 ± 11 years and 28% were women. Despite more than half of patients (54%) being New York Heart Association Class I, mean pVO
2
was decreased at 19 ± 5 mL/kg per minute (63% ± 22% predicted for age and sex). There was a moderate negative correlation between pVO
2
and RV basal diameter (

r
s

= -0.46,
p
=0.05) and RV area in diastole (

r
s

= -0.55,
p
=0.02). There was no significant correlation between RV size or function with VE/VCO
2
slope.

Conclusion:
In this small study of ARVC patients, abnormalities on echo including increased RV basal diameter and RV diastolic area were associated with worse pVO
2
but not VE/VCO
2
slope. These findings suggest that RV structural abnormalities are related to reduced oxygen uptake on CPET, and larger studies are warranted to investigate the prognostic value and clinical course of ARVC patients with regards to the development of heart failure.
Abstract 16759: In-Hospital Outcomes of Coronary Artery Bypass Grafting Candidates Undergoing Percutaneous Coronary Intervention During the Intensive Care Unit Restricted Covid-19 Pandemic: The Multi-Centre Prospective UK-REVASC Registry
Authors: Kite Thomas A , Owens Colum , Chase Alexander , Mozid Abdul , Routledge Helen , Hoole Stephen P , Palmer Nick , Egred Mohaned , Perera Divaka , Kyriacos Mouyis , Sinha Manas , Cahill Tom , Candilio Luciano , Anantharam Brijesh , Murphy Aengus , Farzin Fath-Ordoubadi , Das Paul , Morris Paul , Curzen Nick , Gorog Diana , Hoye Angela , Kean Sharon , Ludman Peter , Stone Gregg W , Berry Colin , Gershlick Anthony H
Published: November 2020

Introduction:
The COVID-19 pandemic has restricted availability of ICU resources. Symptomatic patients with coronary artery disease (CAD) normally considered surgical candidates have therefore required alternative revascularization with percutaneous coronary intervention (PCI). The UK-REVASC registry describes the demographics and in-hospital clinical outcomes of this novel patient cohort.

Methods:
From 1
st
March to 31
st
May 2020, anonymised data of 171 patients from 38 UK centres were enrolled in a prospective, observational registry. All were on surgical waiting lists or considered for surgery.

Results:
The demographics, procedural characteristics and outcomes are shown in Tables 1-3. A comparison with routine PCI British Cardiovascular Intervention Society (BCIS) data and UK isolated coronary bypass surgical data are listed, where available and appropriate. The median age was 68 (IQR 60-76) years. There was significantly more previous MI, PCI and CABG in the routine PCI database than in ReVasc Registry patients, perhaps suggesting a more acute presentation with accelerated symptoms in the test group. These were however complex patients with a mean SYNTAX Score (SS) of 27.8 (range 9-65) and >20x the number of LMS plus multi-vessel disease compared to the routine PCI group, which is reflected in a high use of adjunctive imaging. Radial access was very high at 94.1%. PCI success was 97.0%. Complete revascularization was achieved in 52% with the mean residual SS 1.42 (0-20) in these. There were 2 deaths, however the mortality rate was comparable with published surgical data. Furthermore, a 50% reduction in in-patient stay was observed.

Conclusion:
In this multi-centre UK registry, in-hospital outcomes following PCI for patients with complex coronary disease, who would typically be treated with CABG, compared well with the surgical data. This suggests that the role of PCI could be extended. Future longer term follow-up however is required and planned.
Abstract 16768: Improving Detection and Diagnosis of Rheumatic Fever in Low Resource Settings
Authors: Ndagire Emma , Jafesi Pulle , Oyella Linda , ATALA JENIFER , Sarnacki Rachel , Okello Emmy , Ollberding Nicholas , Smith Laurie , SABLE Craig A , Beaton Andrea Z
Published: November 2020

Introduction:
Acute rheumatic fever (ARF) remains under diagnosed in low resource settings yet it is associated with dire consequences. Application of Jones criteria, the standard criteria used for diagnosis of ARF in these settings is challenging as many of its features are not readily available.

Objective:
To determine the performance of readily available information at each level of the healthcare system in Uganda, to determine the sensitivity and specificity of ARF diagnosis in resource limited settings.

Methods:
Variables that might positively or negatively predict ARF based on typical diagnostic capacity at 3 tiers of Uganda’s health system (community health center, district hospital, and national referral) were selected from a large epidemiological study conducted in northern and central Uganda. These variables were put into three statistical models to determine those that were associated with the disease. Model 1 included those variables commonly found at community health centers (features from history and clinical exam), the second model included all variables from the first model plus laboratory tests that are sometimes available (malaria antigen test, complete blood count and EKG) while the 3
rd
model comprised of all variables from the 2
nd
model and advanced tests that are not commonly available (ASO titers, acute phase reactants and echocardiography).Youden’s index was used to calculate sensitivity and specificity of the models and ROC curves plotted.

Results:
Presence of visible joint swelling and heart murmur were associated with ARF in the first and second models while carditis on echocardiogram had the highest odds ratios in the 3
rd
model. Sensitivity and specificity for ARF were (51.3%, 81.0%), (60.5%, 84%) and (79.8%, 92.5%) for model 1, 2 and 3 respectively.

Conclusions:
Our data supports the importance of including echocardiography for the diagnosis of carditis in Jones criteria for ARF. At the same time, Jones criteria are not practical in endemic settings that not have access to definitive diagnostic testing. A new approach that is appropriate for endemic regions is therefore needed.
Abstract 16769: Intravenous Injection of Neonatal Cardiac Mesenchymal Stem Cells is a Viable Alternative Route to Treat Acute Myocardial Infarction
Authors: Saha Progyaparamita , Mishra Rachana , Sharma Sudhish , Shah Aakash , Davidson Lauren , Gunasekaran Muthukumar , Fu Xuebin , Arfat Mir , Abdullah Mohamed , Li Deqiang , Kaushal Sunjay
Published: November 2020

Introduction:
Cardiovascular disease is major cause of morbidity and mortality around the world and major health care burden indeed. Ischemic heart disease (IHD) and myocardial ischemia (MI) are most devastating cardiovascular disease. Multiple stem cell/ cardiac progenitor cell therapy has been reported previously to treat cardiovascular disease safely. However randomized clinical trials with adult cardiac progenitor cells or cardiosphere-derived cells unable to show long-term efficacy. We have our unique source of human neonatal cardiac tissue derived neonatal cardiac mesenchymal stem cells (nMSCs). Systemic administration is preferred route of stem cell delivery in order to consecutive dosage for most of the clinical trials. We hypothesized that nMSCs have unique proteome profile, which supports their survival, migration and homing. They home to the injured myocardium when administered intravenously (IV) to a wild type male rat subjected to MI.

Methods:
This model was created in 6-week-old Brown-Norway Rats. Rats were subjected to an anterior myocardial Infraction (MI) by permanent LAD ligation. The rats were treated with nMSCs (1^10
6
cells/Kg, 5^10
6
cells/Kg and 10^10
6
cells/Kg) along with placebo and sham, which are delivered intravenously by tail vein injection. Rats are once again treated with nMSCs/placebo 4 days after MI. Baseline echocardiography is performed 24 hours after MI.

Results:
LVEF was significantly higher in the nMSC-treated group than in the placebo group. Other parameters, including fractional shortening (FS) and decreased end-systolic volume (ESV), were also significantly improved when compared with the placebo group, and other LV functional parameter, including cardiac output/body weight and posterior wall thickness tended towards improvement of remodeled heart.

Conclusions:
Twice intravenous administration of nMSCs for MI attenuate the progressive deterioration of left ventricle and adverse remodeling of rat heart.
Abstract 16782: A Nationwide Look at Hospitalized Patients With COVID-19 - Clinical Features and Key Events
Authors: Shah Monica R , Partridge Tanya F , Xue Xiaoqiang
Published: November 2020

Introduction:
While there have been single-center and regional reports describing patients with the coronavirus disease 2019 (COVID-19), to date there has not been a national characterization of hospitalized COVID-19 patients (pts) in the US.

Hypothesis:
To examine baseline features and key clinical events in US hospitalized COVID-19 pts.

Methods:
We interrogated a verified US medical claims database from Jan to May 2020 (110 million pts; 76% private insurance claims, 21% Medicare claims, 4% Medicaid claims). Using the COVID-19 ICD-10 code (U07.1), we assessed baseline characteristics, medications, and key event rates in hospitalized COVID-19 pts.

Results:
From Jan to May 2020, we identified 368,365 pts with a diagnosis of COVID-19. Demographics were: age 60 (IQR 46-72); female sex 198,917 (54%). Key comorbidities were: hypertension 111,940 (30%), coronary artery disease 79,398 (22%), diabetes 70,337 (19%), obesity 33,208 (9%), and heart failure 29,556 (8%). Key medications after admission were: hydroxychloroquine 7,656 (2%), azithromycin 15,361 (4%), methylprednisolone 416 (0.1%), dexamethasone 1,873 (0.5%), and ACE inhibitors/angiotensin receptor blockers/sacubitril-valsartan 18,534 (5%). Among COVID-19 pts, 52,443 (14%) were diagnosed with pneumonia. Key clinical events (ICU admission, intubation, ARDS, and the composite) were significantly higher in COVID-19 pts with pneumonia compared to those without pneumonia (Figure).

Conclusions:
To the best of our knowledge, this is the first national description of hospitalized COVID-19 pts. We observed an equitable distribution by sex, and high rates of cardiometabolic disease. The rates of key clinical events were significantly higher in COVID-19 pts with pneumonia compared to those without pneumonia. This information can be used in a variety of ways - from refining prognosis, resource planning in hospitals, and estimating event rates for COVID-19 clinical trials.
Abstract 16788: Cardiopulmonary Exercise Testing in Pulmonary Atresia With Intact Ventricular Septum
Authors: Patel Krishan , Cheng Andrew L , Souza Andrew , Sabati Arash , Detterich Jon A
Published: November 2020

Introduction:
Pulmonary atresia with intact ventricular septum (PAIVS) is surgically managed with biventricular repair (2V), 1.5 ventricle palliation (1.5V), or single ventricle palliation (1V). Cardiopulmonary exercise testing (CPET) has been increasingly utilized in these patients. However, prognostic ability of CPET is limited by achievement of maximal exercise effort [respiratory exchange ratio (RER) > 1.1]. Even during submaximal exercise, the VE/VCO2 can impact peak VO2. This study aims to identify CPET differences in 1V, 1.5V, and 2V PAIVS patients.

Methods:
A retrospective, cross-sectional study was performed, identifying PAIVS patients undergoing CPET. Contemporaneous echocardiography and CMR data was collected. CPET measures were compared by treatment group using ANOVA, Kruskal-Wallis, and chi-squared test, as appropriate. Comparisons of VE/VCO2 between individual groups were performed using Wilcoxon test. Univariate associations with VE/VCO2 were determined using Pearson correlation.

Results:
Nineteen PAIVS patients were identified (age 12.4 ± 0.68; seven 1V, five 1.5V, seven 2V). Only 7/19 (36.8%) patients achieved RER > 1.1. Sex, age, RER, peak VO2, ventilatory anaerobic threshold, O2 pulse, BSA-adjusted O2 pulse, peak HR, and HR reserve did not differ between treatment groups. The VE/VCO2 ratio was different (p=0.037), with lower VE/VCO2 in 1.5V vs. 1V (p=0.021). Across all PAIVS patients, univariate associations with lower VE/VCO2 were male sex, higher BSA, hematocrit, and O2 pulse, and lower mitral inflow A wave velocity. In the 1.5V and 2V patients, higher RVEF and RV stroke volume by CMR were associated with lower VE/VCO2.

Conclusions:
The 1.5V palliation of PAIVS may be associated with better gas exchange efficiency compared to 1V palliation, while 2V patients were not different from either 1V or 1.5V. BSA-adjusted O2 pulse did not vary between treatment pathways, suggesting similar stroke volume response across all patients.
Abstract 16797: Heart Failure Outcomes in Patients With Ischemic Cardiomyopathy After Ventricular Tachycardia Ablation
Authors: Mamillapalli Himanayani , Florea Viorel G , Mbai Mackenzie , Veligandla Sravya , Murthy Smitha , Li Jian-Ming , Tholakanahalli Venkatakrishna N
Published: November 2020

Introduction:
Patients with congestive heart failure (CHF) are at an increased risk of developing ventricular tachycardia (VT). It is unclear how VT ablation affects CHF outcomes.

Hypothesis:
The goal of this study is to evaluate CHF exacerbations and echocardiogram findings based on location of myocardial scar in patients with Ischemic Cardiomyopathy (ICM) who have undergone VT ablation.

Methods:
This was a selected cohort of consecutive patients with ICM who underwent VT ablation at Minneapolis Veterans Affairs Health Care System between July 2008 and September 2019. CHF outcomes and echocardiogram variables were assessed.

Results:
Seventy-five patients with ICM underwent VT ablation, average age was 67.6 ± 7 years old and 100% male. Inferior wall scar (IWS) was the most prevalent (Figure, Table 1A). On pre-ablation echocardiogram, anterior wall scar (AWS) group overall had a lower mean ejection fraction (EF) of 26%, compared to IWS group of 32% (Table 1B). On post-ablation echocardiogram, patients with AWS had statistically significant (p < 0.03, two-tailed test) lower mean EF of 23% compared to IWS group of 30% (Table 1C). Twenty-five patients had admissions for CHF exacerbation post-ablation, 17 were in the first year after ablation (12 IWS and 5 AWS). Average time from ablation to CHF exacerbation was 2.1 years. Patients with IWS presented earlier with CHF exacerbation compared to AWS group (1.6 vs 1.8 years).

Conclusions:
Patients with ICM and AWS had a statistically significant mean lower EF post VT ablation compared to IWS group. However, patients with IWS had higher rates of admission for CHF exacerbation.
Abstract 17104: Utility of Screening Fetal Echocardiogram Following Normal Anatomy Ultrasound for In Vitro Fertilization Pregnancies
Authors: Spurr Rebecca , Conwell Jeffrey , Young Luciana T , Bhat Aarti , Lewin Mark , Arya Bhawna
Published: November 2020

Introduction:
In-vitro fertilization (IVF) is associated with a higher incidence of congenital heart disease (CHD), resulting in universal screening fetal echocardiograms (F-echo) even when obstetric scan (OB-scan), including cardiac structures is normal. Recent studies suggest that when OB-scan is normal, F-echo may add little benefit and increases cost and anxiety. We aim to determine the utility of screening F-echo in IVF pregnancies with normal cardiac anatomy on prior OB-scan.

Methods:
We conducted a retrospective chart review of IVF pregnancies referred for F-echo at the Seattle Children’s Hospital between 2014 and 2020. OB-scan results and subspecialty of interpreting physician (Obstetrics=OB; Maternal Fetal Medicine=MFM; Radiology=Rads), F-echos, and postnatal outcomes were reviewed. Cardiac anatomy on OB-scans was classified as complete if 4-chamber and outflow-tract views were obtained. Supplemental views (three-vessel and sagittal aortic arch views) on OB-scan were also documented.

Results:
Of 525 IVF referrals, 450 had normal F-echo. OB-scan reports were available for review in 411; 304 (74%) demonstrated normal cardiac anatomy and were interpreted by OB (42%), MFM (61%) and Rads (31%). F-echo was normal in 270 (88%). Of the 34 abnormal F-echo, none required intervention (16 muscular and 5 perimembranous ventricular septal defects, 9 minor valve abnormalities, 2 mild ventricular hypertrophy, 2 arrhythmia). There was no difference in OB-scan accuracy for identifying normal cardiac anatomy when comparing 4-chamber and outflow-tract views vs. addition of supplemental views (88% vs 90% normal F-echo; p>0.1). Evaluation of OB-scan accuracy by interpreting physician subspecialty demonstrated normal F-echo in 93%, 80%, 91% read by OB, MFM and Rads, respectively.

Conclusions:
A majority of IVF referrals with normal cardiac anatomy visualized on OB-scan using 4-chamber and outflow-tract views resulted in normal F-echo, regardless of interpreting physician subspecialty or addition of supplemental views. Of the minority with abnormal F-echo, none required intervention. Consideration should be given to the cost/benefit of screening F-echo for the indication of IVF if normal cardiac anatomy is diagnosed on OB-scan.
Abstract 17106: Prediction of Recurrent Atherosclerotic Cardiovascular Disease Risk Using Machine Learning and Electronic Health Record Data
Authors: Sarraju Ashish , Ward Andrew , Chung Sukyung , Li Jiang , Scheinker David , Rodriguez Fatima
Published: November 2020

Introduction:
Patients with atherosclerotic cardiovascular disease (ASCVD) have high risk for recurrent ASCVD events despite statin use. Pooled cohort equations (PCE) are used for ASCVD risk prediction in primary prevention but there are no validated models for recurrent risk prediction in secondary prevention. Machine learning (ML) demonstrates promise in developing novel risk prediction models using electronic health record (EHR) data.

Methods:
We included adults with prior ASCVD from EHR data from an outpatient Northern California system between January 1, 2009 and December 31, 2018 with at least 2 visits at least 1 year apart and 5 years of follow up. The outcome was a recurrent ASCVD event defined as the first myocardial infarction, stroke, or fatal coronary artery disease in the 5 year follow-up period. We trained ML models to predict recurrent ASCVD risk: random forests (RF), gradient boosted machines (GBM), extreme gradient boosted models (XGBoost), and logistic regression with a standard L
2
penalty (LR) and an L
1
penalty (Lasso). We evaluated performance of ML models and the PCE on a 20% held-out test cohort using the areas under the receiver operating characteristic curves (AUCs).

Results:
Our cohort consisted of 32,192 patients with ASCVD (Mean age 70 years, 46% women, 12% Asian and 6% Hispanic). Less than half (49%) were on guideline directed statins. XGBoost and GBM were the best performing models for recurrent ASCVD risk prediction, while the PCE performed poorly (Figure). The top 20 predictive variables for recurrent ASCVD risk included prior events (ischemic stroke, myocardial infarction), traditional risk factors (age, blood pressure, lipid levels) and socioeconomic factors (income, education).

Conclusions:
EHR-trained machine learning models facilitated recurrent ASCVD risk prediction in real-world secondary prevention patients. Machine learning models developed from large datasets may help bridge contemporary gaps in ASCVD risk prediction.