bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17079: Lower Socioeconomic Status Portends Higher Long Term Mortality Following Isolated Mitral Valve Surgery
Authors: Helmers Mark R , Patrick William , Fowler Cody , Iyengar Amit , Han Jason J , Altshuler Peter , Hargrove W. C , Atluri Pavan
Published: May 2021

Introduction:
Lower socioeconomic status (SES) has been associated with worse outcomes in patients undergoing cardiac surgery; however, this has not been fully elucidated in mitral valve (MV) surgery. We sought to determine the effect of SES on short-term outcomes and long-term mortality following MV surgery.

Hypothesis:
Lower SES is associated with higher mortality following isolated MV surgery.

Methods:
Retrospective analysis of our institution’s MV database was performed between November 1998 and March 2019 for all adult patients undergoing isolated MV surgery in our state and 4 neighboring states. Patients for whom address data was missing were excluded. SES was determined by the Area Deprivation Index (ADI). The ADI uses 17 social determinants of heath to estimate the average SES for all US Census Block Groups (mean 1500 people). This score is then nationally indexed from 1 to 100, with lower SES represented by higher scores. Patients were stratified by ADI quartiles. Baseline characteristics and postoperative outcomes were compared between quartiles.

Results:
Overall, 3,860 surgeries met inclusion criteria during the study period. Of these, 1,795 (46.5%) patients fell into the lowest ADI quartile, 1,216 (31.5%) in the second quartile, 476 (12.3%) in the third quartile, and 344 (8.9%) in the highest quartile. 30-day mortality was not significantly different between ADI quartiles and ADI was not a significant determinate of 30-day survival in a multivariable logistical regression. Figure 1 show the distribution of patient addresses within Census Block Groups as well as 10-year survival by Kaplan-Meier estimates, stratified by ADI quartiles. Cox proportional hazards model revealed that lower SES as determined by ADI was associated with increased 10-year mortality (P = 0.008).

Conclusions:
Lower SES is associated with worse long-term survival in patients undergoing isolated MV surgery. Social interventions to bridge this survival gap are warranted.
Abstract 17081: Outcomes of Percutaneous Coronary Intervention in Cirrhosis: Does the Stent Type Matter?
Authors: Del Cid Fratti Juan Daniel , Salazar Miguel , Palacios Pedro , Akhtar Tauseef , Muñoz Ezequiel
Published: May 2021

Methods:
National Inpatient Sample was queried from 2016-2017 for discharges of adult patients with cirrhosis who underwent percutaneous coronary intervention (PCI) with placement of drug-eluding-stents (DES) and bare-metal-stents (BMS) using ICD-10CM/PCS-codes. Patients were subsequently divided between compensated/decompensated cirrhosis as per the BAVENO Score. The primary outcome was in-hospital mortality. Secondary outcomes were post-procedural complications, length of stay (LOS), total hospital charges/costs. Multivariate logistic regression analysis was performed to adjust for confounders.

Results:
899,899 PCIs were identified out of which 0.6% (n=5,983) had concomitant cirrhosis. Patients with compensated and decompensated cirrhosis had higher odds of BMS placement when undergoing PCI when compared with patients without cirrhosis [aOR 1.57; (P<0.01)], [aOR 1.54; (P=0.05) respectively]. There was no significant difference in mortality between BMS and DES in patients with compensated-cirrhosis, and similar results were obtained in patients with decompensated-cirrhosis. DES was associated to higher LOS when compared to BMS in patients with decompensated-cirrhosis [4.93; (P:<0.01)], and higher total hospital costs [16, 031.94; (P:<0.01)]. Patients with decompensated-cirrhosis and DES had higher risk of post-procedure bleeding when compared with BMS [aOR 4.22; (P:<0.01)].

Conclusions:
Patients admitted for PCI with decompensated-cirrhosis have higher LOS and total hospitalization costs when DES is placed. Likely driven by higher post-procedural bleeding in this set of patients, requiring further intervention. BMS seemed to be safe when used in patients with cirrhosis and is not associated with higher in-hospital mortality even in patients with decompensated-cirrhosis.
Abstract 17082: Recurrent Multisite Spontaneous Coronary Artery Dissections in a Patient Using Prescription Amphetamine
Authors: Jaikumar Likhitesh , Patel Mehul , Jagtap Mandar , Gangadharamurthy Dakshin , Richards Theodore , LeBaron Linnea , Prather John , Priyadarshini Anju
Published: May 2021

Introduction:
Spontaneous Coronary Artery Dissection (SCAD) is an uncommon condition. In patients taking prescription amphetamine or with methamphetamine abuse, SCAD has been reported in some case reports. We describe a case of a young female patient who had recurrent SCAD on prescription amphetamine with multisite involvement.

Case presentation:
A 48-year-old woman with history of active tobacco use, hypertension presented with substernal chest pain radiating to both arms. Her home medications included prescription amphetamine (Amphetamine, Dextroamphetamine) for reported history of ADHD (Attention Deficit Hyperactivity Disorder, diagnosed in childhood). The patient’s electrocardiogram showed ST elevations in V2,V3 and V4 and with reciprocal changes in leads II, III and aVF. On emergent cardiac catheterization we noted dominant left system with 99% occlusion with thrombus of mid LAD with radiolucent lumens and contrast dye extravasation into the arterial wall suggesting type 1 SCAD. Otherwise we noted normal RCA, LCx and OM branches. An IVUS was not used during the procedure. This lesion was revascularized with a drug eluding stent with containment of the dissection and achievement of TIMI 3 flow. We noted that the patient presented similarly two separate times in the past 2 years and cardiac catheterizations at that time revealed type 2B SCAD involving OM3, which appeared angiographically normal on current angiogram and 90% distal LAD occlusion from type 1 SCAD. The patient was treated with aspirin and ticagrelor and discharged 2 days post procedure in stable condition.

Conclusions:
Spontaneous Coronary Artery Dissection (SCAD) has been reported in patients with prescription amphetamine and methamphetamine use, but it is imperative to rule out alternative etiologies and amphetamine related SCAD should be a diagnosis of exclusion. We opted to intervene on the mid LAD dissection and the distal dissections were treated medically.
Abstract 17088: In-Hospital Complications and Outcomes of Leadless Pacemaker Implantation: A Propensity-Score Matched Analysis From Nationwide Database
Authors: Mohammed Moghniuddin , Noheria Amit , Sheldon Seth , Reddy Madhu
Published: May 2021

Introduction:
There are no randomized controlled trials that compared the outcomes of leadless pacemaker (L-PPM) implantation with transvenous pacemaker (TV-PPM) and there is scarcity of data on real world outcomes.

Methods:
We queried National Inpatient Sample to identify all adult patients who had primary discharge diagnosis of conduction disorders or tachy-arrhythmias and excluded patients who had a concomitant procedure for valve replacement, coronary artery bypass grafting, ablation and/or cardiac implantable electronic device removal so that complications can be attributed to the pacemaker implantation. We included only procedures from November 2016 to December 2017 as Micra was the only available L-PPM during that period. For the comparison cohort we selected patients, during the same time period, who had a procedure code for single chamber pacemaker implantation in conjunction with right ventricular lead placement. We performed 1:1 propensity score matching and the variables used for matching are marked with asterisk in Table 1. All the codes used to identify complications has been previously validated from the Micra Post-approval registry and Coverage with Evidence Study.

Results:
Total of 1,305 patients for L-PPM and 13,905 patients in the TV-PPM group were included. Baseline characteristics with standardized mean difference before and after matching are shown in Table 1. Briefly, patients in L-PPM group were younger but had higher co-morbidities compared to TV-PPM group. The complications before and after matching are shown in Table 2.

Conclusions:
In conclusion, we found no significant difference between in-hospital complications after propensity score matching, with the exception of deep venous thrombosis. There was no difference between length of stay but cost for L-PPM was significantly higher. In this real-world analysis, we found that the leadless PPM implantation is safe in comparison to transvenous PPM.
Abstract 17254: Right Ventricular Myoarchitecture is Associated With RV Function in Pulmonary Arterial Hypertension
Authors: da Silva Goncalves Bos Denielli , Leichter Dana , Vang Alexander , Fernandez Nicolas Ana , Nowruzpour Mohsen , Avazmohammadi Reza , Leary Owen P , Mancini Thomas , Gilbert Richard , Choudhary Gaurav
Published: May 2021

Introduction:
Right Ventricular (RV) dysfunction in pulmonary arterial hypertension (PAH) is the major cause of mortality. Myocardial architecture determines the basis of heart function and can be assessed by generalized Q-space imaging by MRI (GQI), yet remains understudied in the RV. Therefore, we assessed myocardial fiber architecture patterns and correlated them with disease severity in two models of PAH.

Methods:
PAH was induced in Sprague-Dawley (SD) and Fischer (CDF) male rats by SU5416 (20 mg/kg; s.c.) followed by 3 wks of hypoxia (10% FiO2). Controls received vehicle and were kept at normoxia. After 4 wks, echocardiography and hemodynamics were performed. Whole hearts were resected in some animals (SD n=9, CDF n=8) and imaged via high-angular resolution GQI using a 7T magnet (512 directions, b=750 s/mm2). Patterns of inter-voxel coherence (tractography) were reconstructed, and transmural helix angle distribution (HAD) were assessed at 3 points across the LV and RV (Panel A) and normalized to a common vector. Finite-element models were developed via registering myofiber direction to anatomical mesh.

Results:
Both animal strains developed PAH, however CDF rats had lower pulmonary artery acceleration time (14±0.6 vs. 19±1.3 ms, p<0.05) and TAPSE (1.5±0.06 vs. 1.9±0.09 mm, p<0.05) and higher RV afterload (1023±167 vs. 285±17, mmHg/mL p<0.05) compared to SD. PAH was associated with steeper slope of the RV transmural HAD in both SD and CDF vs. controls and slightly higher in CDF-PAH compared to SD-PAH (Panel B). No significant changes were noted in the LV (Panel C). Moreover, the RV HAD slope significantly correlated to RV functional parameters (TAPSE r= 0.58, RV global longitudinal strain r= -0.49) and RA area (r= -0.58). Transmural and regional variation in fiber direction was also observed (Panel D).

Conclusion:
Myoarchitectural analysis of the RV in the setting of PAH reveals that myocardial HAD relates to functional parameters and may be a marker of maladaptation.
Abstract 17259: Identification of Biological Pathways of Candidate Atrial Fibrillation Risk Genes Through the Use of Weighted Gene Coexpression Network Analysis
Authors: Wass Sojin Y , Cantlay Catherine , McHale Meghan , Rennison Julie H , Sun Han , Hsu Jeffery , Offerman Erik , Gillinov A , Moravec Christine S , Barnard John , SMITH Jonathan D , Van Wagoner David R , Chung Mina K
Published: May 2021

Introduction:
Over 135 genetic loci have been linked to atrial fibrillation (AF), yet the biological pathways of AF pathophysiology remain elusive. Weighted gene coexpression network analysis (WGCNA) constructs gene modules within a network based on correlations in gene expression, and identifies mechanisms related to AF risk.

Objective:
To identify biological pathways of candidate AF risk genes that will advance our understanding of AF mechanisms.

Methods:
RNA-sequencing was performed on left atrial appendage tissue from 265 patients. RNA-seq data were adjusted for differences in AF rhythm state and other known AF risk factors. Correlations from adjusted data were further adjusted for latent factors then spatial quantile normalized to correct for mean-variance bias. WGCNA was applied to the resulting adjusted and normalized gene-gene correlations to identify gene modules. Ingenuity Pathway Analysis and gene set over representation analysis (GSOR) were applied to each module.

Results:
WGCNA identified 63 modules from 17,434 genes; 47 of these contained at least one candidate AF risk gene. AF risk genes were overrepresented in 7 modules (Table 1). Notable top pathways of AF overrepresented modules include apelin signaling, heme metabolism, intracellular ion homeostasis, and the unfolded protein response. These are known to be involved in calcium signaling, iron homeostasis, glucose regulation, heat shock response, and protein ubiquitination during states of high energy demand and stress. These pathways coincide with larger cellular processes of myocyte remodeling, apoptosis, and cell survival, which were also prominent.

Conclusions:
Biological pathways identified through WGCNA and GSOR suggest that sustained increases in energy demand during AF promotes stress-induced cellular remodeling. Changes in calcium signaling, iron homeostasis, the unfolded protein response and glucose regulation are likely primary mechanisms of AF pathophysiology.
Abstract 17305: Frequency, Predictors and Outcomes of Unplanned Coronary Angiography Following Successful Primary Percutaneous Coronary Intervention in ST Elevation Myocardial Infarction Patients
Authors: Yildiz Mehmet , Schmidt Christian , Garcia Santiago , Garberich Ross , Stanberry Larissa I , Sharkey Scott W , Aguirre Frank V , Tannenbaum Mark , Shivapour Daniel , Coronado-Pacheco Roberto , Smith Timothy , Chambers Jenny , Rohm Heather , Coulson Teresa , Henry Timothy D
Published: May 2021

Introduction:
There is limited data regarding the frequency, predictors and impact of repeat, unplanned coronary angiography following successful reperfusion with primary PCI in STEMI pts.

Methods:
We used the prospective, multicenter Midwest STEMI Consortium database, which was created by unique consolidation of 4 large STEMI systems of care: Iowa Heart Center, Minneapolis Heart Institute Foundation, Prairie Cardiovascular, and The Christ Hospital. Each center has similar, well-established standardized STEMI protocols with collaboration over 100 non-PCI-capable hospitals in Midwest. We included all consecutive STEMI pts who underwent repeat, unplanned coronary angiography within 48-hour of successful primary PCI. We excluded pts who underwent a planned or staged coronary angiography. We compared pts with repeat, unplanned coronary angiography to a propensity-score matched (1:2) pts without repeat coronary angiography within 48-hour.

Results:
Among 6507 STEMI pts treated with primary PCI from 03/2003 to 01/2020, only 136 (2.1%) underwent repeat, unplanned coronary angiography. These pts had higher rates of LAD culprit, history of prior MI, poor pre-PCI TIMI flow (0 or 1) and lower EF. Nearly half of the repeat, unplanned coronary angiographies revealed patent stent (63/136). There were only 32 (24%) in-stent thrombosis and 30 (22%) new occlusions. Compare to the control group, pts with repeat, unplanned coronary angiography were more likely to have major bleeding and longer LOS (p=<0.001) but similar MI, stroke, CV- or all-cause mortality up to 1-year follow-up. Of note, in-hospital MI, which was significantly higher reported in pts with repeat, unplanned coronary angiography, occurred basically prior to repeat coronary angiography
(Table).

Conclusions:
Repeat, unplanned coronary angiography is relatively uncommon after contemporary primary PCI for STEMI pts and is more common with larger, anterior MIs.
Abstract 17310: Feasibility of Contralateral Dialysis Access in Patients With Novel Leadless Devices versus Conventional Transvenous Devices
Authors: Hsu Kevin S , Boubes Khaled , Houmsse Mahmoud , Daoud Emile G , Augostini Ralph S , Kalbfleisch Steven J , Weiss Raul , Okabe Toshimasa , Hummel John , Afzal Muhammad R
Published: May 2021

Introduction:
Patients with end stage renal disease (ESRD) often progress to hemodialysis (HD), where permanent access such as arteriovenous fistula (AVF) is needed. Due to associated cardiovascular comorbidities, several of these patients also require cardiac implantable electronic devices (CIEDs) for pacing or defibrillation needs. HD vascular access is their lifeline, yet prolonged use is fraught with complications which often necessitate the eventual use of both upper extremities. Conventional CIEDs require placement of leads through subclavian veins which limits the ability to use that extremity for AVF. Novel devices such as subcutaneous defibrillator and leadless pacemakers do not require placement of leads in the upper extremity and may offer an advantage in HD patients to preserve both upper extremities for AVF.

Objective:
To compare the incidence of successful use of contralateral upper extremity for AVF following HD access failure in patients with novel and conventional devices.

Methods:
This study included all patients who underwent placement of novel leadless and conventional devices during the last 10 years at the Ohio State University. Incidence of successful use of contralateral upper extremity for AVF following HD access failure was assessed as the primary outcome. Incidence of initial HD access failure was assessed as a secondary outcome.

Results:
A total of 58 patients with novel devices (subcutaneous defibrillator: 30 and leadless pacemaker: 28) comprised the interventional group, while a total of 25 patients with conventional devices comprised the control group. The primary outcome occurred in 18% of the interventional group and 0% of the control group (p < 0.01). Incidence of initial access failure was 46% in the interventional group and 40% in the control group (p= 0.2).

Conclusion:
Patients on HD have a high incidence of access failure and often require use of the contralateral upper extremity for AVF. Presence of novel devices provides the option for contralateral access compared to conventional transvenous devices. Where possible and clinically indicated, novel devices should be preferred over conventional transvenous devices in ESRD and HD patients.
Abstract 17312: Incidence of Periprocedural Complications in Patients With Percutaneous Coronary Intervention of Chronic Total Occlusions and Impact of Mortality
Authors: Mileva Niya , Vassilev Dobirn , Nikolov Pavel , Karamfiloff Kiril
Published: May 2021

Background:
Percutaneous recanalization of coronary chronic total occlusions (CTO) remains one of the biggest challenges in interventional cardiology and is known to be associated with higher complication rate compared to regular coronary angioplasty. The aim of the current study is to explore the frequency and clinical outcomes of patients with procedural complications.

Methods:
All patients with CTOs were included in prospective registry. CTO was defined as a total obstruction of a coronary artery with thrombolysis in myocardial infarction (TIMI) grade flow of 0 and duration of more than three months. Frequency of periprocedural complications were analyzed and all patients were followed-up for vital status.

Results:
For the purpose of current analysis we included 595 patients (66±10 years, 78% males) who underwent a total of 661 PCIs of chronic total occlusions. 623 procedures (94.3%) were successful with TIMI 3 final flow. In 10.9% (n=72) of the procedures there was a periprocedural complication defined as: coronary perforation (type I-III) 3.02% (n=20), puncture site haematoma 1.7%(n=11), coronary intramural haematoma 1.5%(n=10), coronary dissection n=5(0.8%). In 4 people (0.6%) there was perforation with formation of haemopericardium (type IV coronary perforation). On logistic regression analysis factors found to be significantly predictive for occurrence of complication were carotid artery disease (OR=4.794, CI: 1.718-13.374, p = 0.038) and renal failure (OR=1.774, CI: 1.060-2.967, p=0.016). At a median follow-up of 31 months (IQR 13-49) the overall death rate was 20.7% (n=123) and was significantly lower in noncomplicated vs complicated group (104/525, 19.8% vs 19/69, 27.5%, log-rank p=0.042). On Cox-regression analysis procedural complication was independent predictor of death (OR= 1.650, CI 1.011- 2.692, p= 0.042).

Conclusion:
In patients undergoing PCI for CTO the presence of periprocedural complication was independent predictors of mortality and these subjects had higher mortality rate at a median follow-up of 31 months.
Abstract 17323: Personalizing Cholesterol Management Therapy Using Electronic Medical Records and Machine Learning
Authors: Ward Andrew T , Li Jiang , Sarraju Ashish , Valencia Areli , Scheinker David , Rodriguez Fatima
Published: May 2021

Introduction:
Optimal statin treatment decisions for primary prevention of atherosclerotic cardiovascular disease (ASCVD) rely on shared decision-making between patient and provider. We sought to develop a machine learning-based algorithm to personalize cholesterol treatment decisions using electronic medical record (EMR) data.

Methods:
We included EMR data for adults aged 40 to 79 with no prior ASCVD or statin therapy from an outpatient Northern California system between January 1, 2009 and December 31, 2018 with at least two visits at least 1 year apart and at least two low density lipoprotein cholesterol (LDL-C) values. The outcome was the LDL-C measured closest to one year after a patient’s second visit. We modeled four different treatment decisions: no statin use, low-intensity statin use, moderate-intensity statin use, and high-intensity statin use. We trained weighted-K-nearest-neighbor (wKNN) regression models to identify similar patients using each line of therapy to a candidate patient. The algorithm compared outcomes of these similar patients and recommended the treatment which predicted the lowest LDL-C after one year.

Results:
Our study cohort consisted of 50,911 patients (age 54.6 ± 9.84 years, baseline LDL-C 122 ± 34.2 mg/dL, follow-up LDL-C 121 ± 35.9 mg/dL) including 54% female, 47% Non-Hispanic White, 32% Asian, and 7.5% Hispanic patients. Among 8,551 test patients visiting in 2015 or later, 96.9%, 3.08%, and 0.05% were recommended to begin high-intensity, moderate-intensity, and low-intensity statins, respectively. With these recommendations, the LDL-C values at 1-year follow-up were predicted to be 21.5 ± 43.5 mg/dL (17.6%) lower per patient, on average (Figure).

Conclusions:
EMR-trained wKNN models are able to determine patient LDL-C trajectories under different lines of statin therapy. Machine learning models leveraging real-world datasets may provide useful statin therapy treatment recommendations for primary ASCVD prevention.
Abstract 17329: Characterizing Disparities Among Frail Cardiovascular Patients
Authors: Kim Gloria Y , Gangadharan Arati A , Powell Chloe , Corriere Matthew
Published: May 2021

Introduction:
Frailty is associated with increased risk of adverse health events among cardiovascular patients. Phenotype-based approaches to frailty assessment typically rely upon sex and body mass index as co-variables.

Hypothesis:
We hypothesized that race, ethnicity, disadvantaged community index (DCI), and health insurance coverage are associated with frailty. To test this hypothesis, we prospectively measured grip strength in a cohort of cardiovascular patients and evaluated the relationships of frailty with disparity measures.

Methods:
Patients treated in outpatient cardiovascular center clinics were evaluated for frailty using dominant hand grip strength. Grip strength, adjusted by gender and BMI, were used to determine frailty. Insurance status was categorized as Private, Medicaid, or Medicare based on primary coverage. Frailty was then evaluated stratified by DCI and health insurance status. Associations were evaluated using multivariable models.

Results:
Over 10 months, 3,986 patient grips were measured. Of these, 34.9% (n=1,392) were considered frail. Mean age was 63.5±15.6 years and 47.3% (n=1,885) were female. African American/black made up 7.73% (n=308) of the cohort and Asians/Pacific Islander 2.13% (n=85). A third of patients (32.7%) had private insurance, 2,187 (54.9%) had Medicare, and 291 (7.3%) had Medicaid. The average DCI score was 35.3±27.6. Patients with Medicare had the highest prevalence of frailty (47.4% versus 17.0% for Private Insurance and 26.5% for Medicaid; P<0.001). Individuals living in distressed communities were more likely to be frail (39.3% versus 34.4%; P=0.04). Furthermore, patients of Asian backgrounds are most likely to be frail (49.4% versus 34.2% among whites; P=0.01).

Conclusions:
When assessing insurance status related to frailty, frailty incidence was highest among patients with Medicaid insurance status. Further, age, race, insurance status, and distressed community index are associated with frailty defined by grip strength among cardiovascular patients. There may be a large segment of at-risk individuals who are missed because they do not fit the well characterized variables associated with frailty, including older age, female gender, both high and low BMI, and functional decline.
Abstract 17332: Prognostic Impact of Right Ventricular Function and Tricuspid Regurgitation in Functional Mitral Regurgitation: A Meta-Analysis
Authors: Ngo Tam N , Truong Vien T , Phan Hoang T , Pham Thuy T , Quach Tam T , Pham Thanh K , Nguyen Thu Q , Pham Khanh N , Palmer Cassady , Nguyen Tuan M , Bannehr Marwin , Gyoten Takayuki , Butter Christian , Chung Eugene , Mazur Wojciech
Published: May 2021

Introduction:
Right ventricular dysfunction and tricuspid regurgitation grade are associated with cardiovascular mortality in the general population, primary MR, and other cardiovascular diseases.

Hypothesis:
The objective of this study was to investigate the prognostic importance of RVD, and TR in patients with functional mitral regurgitation (FMR)

Methods:
A systemic review and meta-analysis were performed using MEDLINE, Scopus, and Embase to assess the prognostic value of RVD and TR grade for mortality. RVD was defined as a TAPSE ≤ 16 mm or tissue Doppler-derived tricuspid lateral annular systolic velocity (S′TDI) < 10 cm/s.Hazard ratios were extracted from multivariate models reporting on the association of RVD and TR with mortality and described as pooled estimates with 95% confidence intervals. Data were pooled across studies using the DerSimonian-Laird random-effects model.

Results:
A total of 9 nonrandomized studies met the inclusion criteria with eight studies having at least 12 months follow-up. Among the above studies, a total of 1325 patients (74.1% being male) were eligible for being included in our meta-analysis with an overall survival of 68.2% (n = 903). Of the enrolled patients, RVD was present in 39.1% and moderate-severe TR in 32.8%. RVD was significantly associated with mortality compared to normal RV function (HR, 1.89, 95% CI, 1.51-2.38, p < 0.001, I2 =0). Additionally, patients with moderate-severe TR showed increased risk of mortality compared with those in the none-mild TR group (HR, 1.71. 95% CI, 1.36-2.15, p < 0.001, I2 =0)

Conclusions:
This meta-analysis demonstrates the prognostic importance of RVD and TR grade in predicting all-cause mortality in patients with FMR. RV function and TR parameters may therefore be useful in the risk stratification of patients with FMR.
Abstract 17337: The Effect of Digoxin on Hemocompatibility Related Adverse Events in Patients With Durable Left Ventricular Assist Devices
Authors: Balachandran Isabel , Kennedy Kevin , Nunez Jose , Grandin Wilson , Garan Arthur R , Motiwala Shweta , Quintero Pablo A , Fleming Lisa , Sabe Marwa
Published: May 2021

Introduction:
Hemocompatibility-related adverse events (HRAE) including stroke, pump thrombosis, and gastrointestinal bleeding (GIB), is a major cause of mortality in patients with continuous flow left ventricular assist devices (CF-LVAD). Digoxin (dig) is used in treatment of advanced heart failure, and has been implicated in decreasing angiogenesis via HIF-alpha/TGF inhibition. There is conflicting data regarding the effect of dig on GIB rates in patients with cf-LVADs. We investigated the association of dig use in patients implanted with CF-LVADs with HRAE with both centrifugal and axial flow devices.

Methods:
12,002 patients from the INTERMACS registry implanted with cf-LVADs between 2012-2017 and were alive at 1-month were included. The event rates of HRAE at 1-yr post implant were compared in patients with or without dig use at 1-month post implant. Cox proportional hazards modeling was used to assess the independent association of dig use and HRAE.

Results:
There was no significant difference in age, sex, race, Cr, INR, DM, and AST in those who were prescribed vs. not prescribed dig at 1 month. On univariate analysis, dig was associated with decreased HRAE in patients with CF-LVADs at 1-year post implantation (37% vs 41%, p<0.01) (Fig. 1) however this was primarily driven by decreased neurologic events. There was no association with GIB (p 0.18). On multivariate analysis, dig was not found to be an independent predictor of HRAE (HR 0.95, 95% CI 0.89-1.02, p 0.2) (Figure 2).

Conclusions:
Despite previous smaller studies which suggested a decreased risk of HRAE and GIB in patients with cf-LVADs, we found that dig was not an independent predictor of HRAE.
Abstract 17339: Racial and Ethnic Minority Groups Are Under-Represented and Under-Reported in Guideline-Informing Heart Failure Clinical Trials
Authors: Gamino Gerardo , Parizo Justin T , Scheinker David , Rodriguez Fatima
Published: May 2021

Introduction:
Racial/ethnic diversity in clinical trials is essential to ensure that our evidence base reflects the population. We assessed the extent of reporting and representation of race/ethnicity in heart failure (HF) clinical trials referenced in the contemporary ACC/AHA HF guidelines.

Methods:
All randomized trials referenced in the 2013 ACC/AHA Heart Failure Guidelines and the 2017 Focused Update were included. The prevalence of reporting of race/ethnicity, the proportions of racial/ethnic subgroups enrolled, and subgroup analysis based on intervention type - pharmacologic, device, and other - were evaluated.

Results:
We identified 256 trials (545 233 subjects) published between 1950 and 2018. Among these, only 95 reported any race/ethnicity (37.1%), 94 reported white race (36.7%), 58 reported black race (22.7%), 16 reported Hispanic ethnicity (6.3%), and 23 reported Asian race (9.0%). In trials reporting white, black, Hispanic, and Asian race/ethnicity respectively, 76.4% (n = 299 153 of 299872) of patients were white, 11.7% (n = 25 274 of 215 905) of patients were black, 11.2% (n = of 8863 of 79 097) of patients were Hispanic, and 10.5% (n = 14925 of 141 504) of patients were Asian. Comparison of trial population proportions with US Census population demonstrates over-representation of white subjects, and under-representation of Hispanic and black subjects (Figure). Stratification by intervention type demonstrated that no device trials referenced in the guidelines report black or Asian race, and just one reported Hispanic race.

Conclusions:
Trials that dictate clinical care of patients with HF through informing contemporary ACC/AHA HF guidelines under-represent black and Hispanic populations. Additionally, 2/3rds of trials fail to report any race/ ethnicity at all. There is a need for guideline and practice-informing clinical trials to adequately represent all populations, and to provide clinicians the data they need to assess generalizability.
Abstract 17349: Outcomes of Percutaneous Coronary Intervention (PCI) of Acute Myocardial Infarction (AMI) Patients With Chronic Total Occlusion (CTO) - National Database
Authors: Patel Amitkumar , Patel Kirtenkumar , Patel Premalkumar , Patel Krunalkumar , Meraj Perwaiz
Published: May 2021

Introduction:
Presence of Chronic Total Occlusion (CTO) in patients with Acute Myocardial Infarction (AMI) undergoing Percutaneous Coronary Intervention (PCI) has not been studied previously.

Hypothesis:
To study in-hospital mortality & resource utilization of AMI patients undergoing PCI associated with presence of CTO.

Methods:
We queried National Inpatient Sample from October 2015 - December 2017 using ICD 10 codes to identify patients over 18 years of age who underwent PCI & had AMI with presence or absence of CTO. SAS 9.4 was used for univariate and multivariate analysis. Propensity score matching was performed to matched CTO vs Non-CTO group’s baseline characteristics & Elixhauser comorbidities with Absolute standardized difference of 10% as matching limit.

Results:
A total of 576760 patients were identified who underwent PCI with AMI, out of which 525535 (91.12%) had no CTO while 51225(8.8%) had CTO. Each matched group contains 51210 patients. The In-hospital mortality was significantly higher in AMI PCI patients with CTO compared to Non-CTO (4.7% vs 3%,
p
<0.0001). Length of hospital stay was higher in CTO patients (median 2 vs 3,
p
=0.001) and less percentage of patients were discharged to home (78.8% vs 81.1%,
p
<0.0001). Median cost of hospital stay was higher in CTO group (20921$ vs 19856$,
p
<.0001).

Conclusions:
Analysis of this large database of patients undergoing PCI with AMI suggests that presence of CTO results in higher In-hospital mortality, with longer hospital stay & higher cost. Future observational studies should be directed towards CTO based outcomes in AMI patients undergoing PCI.
Abstract 17383: Comparative Analysis of TAVR With PCI and SAVR With CABG - A Nationwide Inpatient Sample Database
Authors: Ullah Waqas , Saleem Sameer , sattar yasar , Zahid Salman , Al hemyari Bashar , Younas Sundas , Moussa Pacha Homam , Al-khadra Yasser , Abdul-Waheed Mohammad , Fischman David L , Zehr Kenton J , Alraies M Chadi M
Published: May 2021

Introduction:
For patients with coronary artery disease (CAD) and severe aortic stenosis (AS), the relative safety of percutaneous approach [transcatheter aortic valve replacement (TAVR) and percutaneous coronary intervention (PCI)] to surgical approach [SAVR and coronary artery bypass graft (CABG)] has not been studied.

Hypothesis:
TAVR+PCI carries a higher risk of complications.

Methods:
The National Inpatient Sample (NIS) from 2002-2014 was queried to identify all cases of TAVR+PCI and SAVR+CABG. Univariate and multiple logistic regression analyses were used to control the outcomes.

Results:
A total of 215829 (TAVR+PCI 1634, SAVR+CABG 214195) patients were included. The unadjusted odds for in-hospital mortality (5.6% vs. 9.5%, uOR 0.57;95% CI, 0.48-0.67, p=<0.001), acute kidney injury (18.9% vs. 26.3%, uOR 0.65; 95% CI, 0.59-0.73, P = 0.001), major bleeding (12.3% vs. 18.6%, uOR 0.61; 95% CI, 0.53-0.69, P = <0.001), vascular complications (2.2% vs. 10.7%, uOR 0.19; 95% CI, 0.16-0.22, P = <0.001), cardiogenic shock (4.5% vs. 8.6%, uOR 0.51; 95% CI, 0.16-0.22, P = <0.001) and septic shock (1% vs. 1.8%, uOR 0.54; 95% CI, 0.38-0.79, P <0.002), were significantly lower in patients undergoing SAVR+CABG compared to TAVR with PCI, respectively. The adjusted odds ratio based on baseline comorbidities, demographic and age closely mirrored the unadjusted odds ratios.

Conclusions:
In patients with the concomitant severe aortic disease and coronary artery disease, TAVR with PCI might have higher odds of in-hospital complications and mortality compared to SAVR+CABG. The mean hospital charges were also lower with the open surgical approach.
Abstract 17394: Measurement of Corrected QT Interval on Apple Watch Series 4 Electrocardiogram Has Moderate to Strong Agreement With 12-lead Electrocardiogram
Authors: Aggarwal Arjun , Saghir Nabeel , Soneji Nisha , Roman Lopez Suely , Rodgers George , HONG MAURICIO , Kurian Thomas
Published: May 2021

Introduction:
The Apple Watch Series 4 (AW) has native hardware to measure a single-lead ECG (corresponding to Lead I) and detect atrial fibrillation. Wearable technology is an attractive area of research for its screening, monitoring, and diagnostic capabilities. One utility is the convenient ambulatory monitoring of the corrected QT (QTc) for pathophysiologic or pharmacologic reasons. The objective of this study was to compare measurements of the QTc on the AW with Leads I, II, and III of a 12-lead ECG.

Methods:
AW and 12-lead ECGs were obtained on healthy volunteers age > 18 years at a university hospital. QT intervals and RR intervals were manually measured with calipers to the nearest 0.25 millimeter on standard ECG paper for both devices. Bland-Altman plots were used to assess the level of agreement between QTc measurements on the AW and 12-lead ECGs. Strong and moderate agreement was defined as < 20 and < 40 milliseconds (ms), respectively, away from the mean difference of the sample.

Results:
Waveforms on the AW ECGs (n=63) and Leads I (n=41), II (n=42), and III (n=39) of the 12-lead ECGs from 20 volunteers (mean age 32 years, 70% female) at a university hospital were analyzed. Six volunteers had sinus bradycardia with mean heart rate (HR) of 55 bpm. No arrhythmias were noted, and none of the volunteers were on antiarrhythmic or QT-prolonging medications. The mean HR was 69 ± 11 bpm on AW and 67 ± 10 bpm on 12-lead ECG. For QTc measurements on AW compared to 12-lead ECG, the mean difference was -13.71 ± 27 ms for Lead I, -11.27 ± 24 ms for Lead II, and -10.38 ± 24 ms for Lead III. Moderate agreement of < 40 ms existed in 56/62 (90%) of QTc measurement comparisons: 18/21 (85.7%) Lead I, 19/21 (90.5%) Lead II, and 19/20 (95%) Lead III. Strong agreement of < 20 ms existed in 32/62 (51.6%) of QTc measurement comparisons: 9/21 (42.9%) Lead I, 13/21 (61.9%) Lead II, and 10/20 (50%) Lead III.

Conclusions:
Moderate to strong agreement of QTc measurements exists between the AW and Leads I, II and III of a 12-lead ECG.
Abstract 17405: Chronic Treatment of Ibrutinib Reduces PI3K Activation and Causes Increased Mitochondrial Oxidative Stress Leading to Heightened AF in

Pitx2c
+/-

Mice
Authors: Sridhar Arvind , menon ambili , HONG Liang , Chalazan Brandon , Zhang Meihong , Ly Olivia T , Darbar Dawood
Published: May 2021

Background:
Ibrutinib, a Bruton’s tyrosine kinase inhibitor which is currently used as first line treatment to various B-cell malignancies is known to cause proarrhythmic effects in patients thus limiting its continual use. Ibrutinib treated patients have been shown to be at a 4-fold increased risk of developing atrial fibrillation (AF), but the underlying molecular mechanisms remain unclear. Studies have shown that
Pitx2
, the nearest gene to the 4q25 locus has been implicated in AF pathology and thus can serve as an experimental model for clinical AF.

Objective:
The goal of this study is to assess the role of the late cardiac Na current (I
Na,L
), PI3K activation, and oxidative stress in mediating the increased susceptibility to AF in

Pitx2c
+/-

mice and atrial human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) exposed to ibrutinib.

Method:

Pitx2c
+/-

mice were administered ibrutinib (30mg/kg/day IP) for 23 days after which their AF burden were assessed using transesophageal rapid pacing (TErP) along with their weight, BP, and plasma glucose. Atrial hiPSC-CMs were exposed to ibrutinib for 48 hrs. ELISA, IHC, Western blotting, cellular patch clamping and, qPCR studies were performed.

Results:

Pitx2c
+/-

mice were exposed to ibrutinib showed a graded increase in AF burden. (
Fig. 1A-C
). There was a decreased activation of the PI3K pathway and pAkt leading to overall decrease in SERCA2a expression (
Fig. 1D-F
). There was a significant increase in mitochondrial fragmentation and superoxide production in ibrutinib treated atrial hiPSC-CMs (
Fig G
) and the action potential duration at 90% repolarization and the I
Na-L
were markedly prolonged after ibrutinib exposure(
Fig H
).

Conclusion:
We showed in

Pitx2c
+/-

mice and atrial hiPSC-CMs that ibrutinib-mediated AF may in part be related to enhanced I
Na-L
, decreased activation of PI3K and SERCA2a and increased fibrosis leading to mitochondrial fragmentation and increased oxidative stress.
Abstract 17417: Pathogenic and Likely Pathogenic Missense Variants in Cardiovascular Disease Genes Cluster Around Functional Domains
Authors: Ten Nicholas S , Grove Megan , Wand Hannah , Ison Hannah , Pariani Mitchel , Wheeler Matthew T , Ashley Euan A , Parikh Victoria N
Published: May 2021

The genetic architecture of inherited cardiomyopathies has mechanistic and potentially therapeutic relevance. We have shown that disease-associated variation in two cardiomyopathy-associated genes clusters in functional protein domains. Here, we extend this hypothesis to a comprehensive list of genes associated with cardiovascular disease. Using ClinVar, we identified 12,043 pathogenic or likely pathogenic (P/LP) variants across 190 cardiovascular disease-associated genes. Only P/LP variants with associated adjudication criteria were included. We interrogated these variants for regional clustering by ranking them by their number of P/LP neighbors within successively larger windows. We found that 87% of variants had at least one nearby variant within a 40 bp neighborhood, and 28% had ≥ 10 neighboring variants (Figure A, p<0.0001 vs. normal distribution). Within variant subtypes, 84% of missense variants and 70% of truncating variants neighbored at least 1 other missense or truncating variant, respectively. 21% of missense and 11% of truncating variants had ≥ 10 neighbors (p<0.0001). LDLR and FBN1 had the highest number of missense P/LP variants within a 40 bp neighborhood. We show that these neighborhoods overlap with functional domains of LDLR and FBN1 (Figure B, C). In summary, we demonstrate that a large portion of P/LP variants are regionally clustered in cardiovascular disease-associated genes, regardless of variant type, and align with known functional domains. Future directions will systematically apply these methods across the genome and explore the potential for novel domain identification and targeting these clusters with genome engineering.
Abstract 17423: Impact of Hypertriglyceridemia on ST-Elevation Myocardial Infarction Outcomes
Authors: Yildiz Mehmet , Schmidt Christian , Garcia Santiago , Garberich Ross , Stanberry Larissa I , Sharkey Scott W , Aguirre Frank V , Tannenbaum Mark , Shivapour Daniel , Coronado-Pacheco Roberto , Smith Timothy , Chambers Jenny , Rohm Heather , Coulson Teresa , Henry Timothy D
Published: May 2021

Introduction:
There has been conflicting data regarding the impact of hypertriglyceridemia (HTG) on STEMI outcomes, including reports of a “lipid paradox” defined as lower event rates in patients with HTG. Therefore, the association between HTG and outcomes in STEMI deserves further investigation especially given the results of REDUCE-IT trial.

Methods:
A prospective, multicenter database of the Midwest STEMI Consortium was examined. The Midwest STEMI Consortium is a unique association of 4 large STEMI systems of care: Iowa Heart Center, Minneapolis Heart Institute Foundation, Prairie Cardiovascular, and The Christ Hospital. We included all consecutive STEMI patients between age of 40 and 75. Those with missing TG levels were excluded (23%). We compared 3 groups of TG levels: normal (<150 mg/dl), moderate (150 to 499 mg/dl), and severe (>500 mg/dl) for MACE (death, MI, or stroke) and all-cause mortality.

Results:
Of 6492 consecutive STEMI patients from 03/2003 to 01/2020, 3760 (58%) met inclusion criteria. The mean (SD) age was 59.1 ± 9.2 and male gender was predominant (76%). A little over one-third of the study participants had moderate HTG (35%). Patients with higher TG levels had lower HDL levels and increased rates of history of premature CAD, DM, and HTN
(Table).
Moderate HTG was not a risk factor for MACE or all-cause mortality. Severe HTG was significantly associated with increased in-hospital (p=0.016) but not 1-year all-cause mortality (p=0.21)
(Figure).

Conclusions:
In STEMI patients, higher TG levels were associated with increased in-hospital but not 1-year all-cause mortality.
Abstract 17451: Use of Intracardiac Echocardiography to Predict Follow-Up Hemodynamic Changes After Transcatheter Pulmonary Valve Implantation
Authors: Rodriguez Franco Salvador Alberto J , Rodriguez Franco Salvador Alberto A , Leahy Ryan A , Randall Jess T , Zablah Jenny E , Morgan Gareth
Published: May 2021

Objective:
Evaluate the correlation between intracardiac echocardiography (ICE) gradients and next-day and one-month transthoracic echocardiography (TTE) gradients, after percutaneous pulmonary valve implantation (PPVI)

Background:
Post-procedure Doppler-derived gradients have gained popularity as acceptable parameters to evaluate valve function after PPVI, but they have no proven correlation with the invasive gradient measured during the procedure, indeed a large disparity between these two measurements has been described. Interestingly, ICE gradients, which are also an invasive assessment, have been suggested to present a strong correlation with post-procedure echocardiographic evaluations, and their application could allow a more accurate and predictable evaluation of valve function, establishing a typical pattern of short-term hemodynamic progression in these patients.

Methods:
We performed a retrospective chart review of 84 patients who underwent PPVI between January 2018 and December 2019 and selected 51 patients in whom ICE was performed after valve implantation. We evaluated the correlation between ICE and RV-PA gradients with post-procedural Doppler-derived gradients. Among the parameters assessed, the one which demonstrated the strongest correlation was used to create a predictive model to estimate the expected gradients after PPVI.

Results:
All the assessed correlation models between Doppler-derived parameters during ICE evaluation and post-procedure TTE evaluations were statistically significant, and presented moderate to strong linear relationships. The strongest correlation was found between ICE Doppler mean gradient and post-procedural Doppler mean gradient. The derived predictive equation was distributed by the size of the device implanted and body mass index. We found this model was capable of predicting post-procedural evaluations (mean Doppler-derived gradients at 1 day and 1 month) within a range of ±5 mmHg from the observed value in more than 80% of cases.

Conclusions:
There is a strong correlation between ICE and post-procedure TTE. This allowed us to derive a predictive equation, distributed by body size and device size that defines expected echo Doppler-derived hemodynamic pathways after PPVI.