bluuebunny/crossref_metadata_2025 huggingface dataset:
Mental Fatigue Has Great Impact on the Fractal Dimension of Brain Functional Network
Authors: Li Gang , Xu Yanting , Jiang Yonghua , Jiao Weidong , Xu Wanxiu , Zhang Jianhua
Published: November 2020

Mental fatigue has serious negative impacts on the brain cognitive functions and has been widely explored by the means of brain functional networks with the neuroimaging technique of electroencephalogram (EEG). Recently, several researchers reported that brain functional network constructed from EEG signals has fractal feature, raising an important question: what are the effects of mental fatigue on the fractal dimension of brain functional network? In the present study, the EEG data of alpha1 rhythm (8-10 Hz) at task state obtained by a mental fatigue model were chosen to construct brain functional networks. A modified greedy colouring algorithm was proposed for fractal dimension calculation in both binary and weighted brain functional networks. The results indicate that brain functional networks still maintain fractal structures even when the brain is at fatigue state; fractal dimension presented an increasing trend along with the deepening of mental fatigue fractal dimension of the weighted network was more sensitive to mental fatigue than that of binary network. Our current results suggested that mental fatigue has great regular impacts on the fractal dimension in both binary and weighted brain functional networks.
Use of Argon Plasma Coagulation and Endoscopic Hemoclips for Postsurgical Gastrointestinal Fistula
Authors: Sohail Abdullah , Khan Ahmad , Shah Hamza , Rezko Ragheb
Published: November 2020

A 72-year-old male was diagnosed with a duodenal mass and underwent extensive surgical resection. The patient’s post-op course was complicated by an anastomotic leak that was first treated conservatively; however, his condition continued to deteriorate. An upper endoscopy was performed, which showed misplacement of drain forming a fistulous track through the lumen of the bowel. We removed the drain and used argon plasma coagulation to de-epithelize the lumen and closed the fistula with hemostasis clips. The patient’s clinical status improved significantly. Our case emphasizes the success of endoscopic techniques as an alternative option in the management of postsurgical anastomotic leaks and fistulas in the right clinical setting and patient population.
Fixed-Point Theorems forθ−ϕ-Contraction in Generalized Asymmetric Metric Spaces
Authors: Kari Abdelkarim , Rossafi Mohamed , Saffaj Hamza , Marhrani El Miloudi , Aamri Mohamed
Published: November 2020

In the last few decades, a lot of generalizations of the Banach contraction principle had been introduced. In this paper, we present the notion ofθ-contraction andθ−ϕ-contraction in generalized asymmetric metric spaces to study the existence and uniqueness of the fixed point for them. We will also provide some illustrative examples. Our results improve many existing results.
Octreotide Infusion for the Treatment of Congenital Chylothorax
Authors: Kobeisy Sumayyah Ahmed Nezar , Alkhotani Abdulaziz , Barzanji Mohammed M.
Published: November 2020

Congenital chylothorax is an uncommon cause of pleural effusion in the pediatric age group, and it should be kept in consideration when evaluating a neonate with pleural effusion, as it is the commonest cause of pleural effusion in this age group (Tutor, 2014). No commonly accepted guidelines have been published so far regarding the management of congenital chylothorax in the neonate, but trials of octreotide have appeared to be promising (Bellini et al., 2018). We present a neonate with congenital chylothorax successfully treated with octreotide infusion.
Purification, Characterization, and Biocatalytic and Antibiofilm Activity of a Novel Dextranase from Talaromyces sp.
Authors: Ebaya Mahasen Mohamed Ahmed , El-Mowafy Mohammed , Adel El-Sokkary Mohamed Mohamed , Hassan Ramadan
Published: November 2020

Dextranase is a useful enzyme that catalyzes the degradation of dextran to low-molecular-weight fractions, which have many critical commercial and clinical applications. Endophytic fungi represent a source of both high heat-stable and pH-stable enzymes. In this study, from Delonix regia bark by plate assay, out of 12 isolated fungal strains, hyaline zones were detected in only one strain. By using the standard ITS rDNA sequencing analysis, the isolated strain was identified as Talaromyces sp. In the case of carbon source, in a medium containing 1% dextran T2000 as the sole carbon source, the maximum dextranase activity reached approximately 120 U/ml after incubation of 2 days where the optimum pH was 7.4. Peptone addition to the production medium as a sole nitrogen source was accompanied by a significant increase in the dextranase production. Similarly, some metal ions, such as Fe2+ and Zn2+, increased significantly enzyme production. However, there was no significant difference resulting from the addition of Cu2+. The crude dextranase was purified by ammonium sulfate fractionation, followed by Sephadex G100 chromatography with 28-fold purification. The produced dextranase was 45 kDa with an optimum activity at 37°C and a pH of 7. Moreover, the presence of MgSO4, FeSO4, and NH4SO4 increased the purified dextranase activity; however, SDS and EDTA decreased it. Interestingly, the produced dextranase expressed remarkable pH stability, temperature stability, and biofilm inhibition activity, reducing old-established biofilm by 86% and biofilm formation by 6%.
Vascular Occlusion Evolution in Endovascular Reperfusion Candidates Transferred from Primary to Comprehensive Stroke Centers
Authors: Flores Alan , Ustrell Xavier , Seró Laia , Pellisé Anna , Rodriguez Paula , Viñas Jaume , Ribó Marc , Krupinski Jurek , Más Natalia , Garcia Sonia , Palomeras Soler Ernesto , Cocho Dolores , Canovas David , Purroy Francisco , Serena Joaquim , Zaragoza-Brunet Jose , Obach Victor , Perez de la Ossa Natalia , Cardona Pere , Molina Carlos A. , Abilleira Sonia , Rubiera Marta ,   on behalf of Catalan Stroke Code and Reperfusion Consortium
Published: November 2020

Background: The evolution of the symptomatic intracranial occlusion during transfers from primary stroke centers (PSCs) to comprehensive stroke centers (CSCs) for endovascular treatment (EVT) is not widely known. Our aim was to identify factors related to partial or complete recanalization (REC) at CSC arrival in patients with a documented large vessel occlusion (LVO) in PSC transferred for EVT evaluation to better define the workflow at CSC of this group of patients. Methods: We conducted an observational, multicenter study from a prospective, government-mandated, population-based registry of stroke patients with documented LVO at PSC transferred to CSC for EVT from January 2017 to June 2019. The primary end point was defined as partial or complete REC that precluded EVT at CSC arrival (REC). We evaluated the association between baseline, treatment variables and time intervals with the presence of REC. Results: From 589 patients, the rate of REC at CSC was 10.5% in all LVO patients transferred from PSC to CSC for EVT evaluation. On univariate analysis, lower PSC-NIHSS (median 12vs.16, p = 0.001), tPA treatment at PSC (13.7 vs. 5.0%; p = 0.001), presence of M2 occlusion on PSC (16.8 vs. 9%; p = 0.023), and clinical improvement at CSC arrival (21.7 vs. 9.6% p = 0.001) were associated with REC at CSC. On multivariate analysis, clinical improvement at CSC arrival (p < 0.001, OR: 5.96 95% CI: 2.5–13.9) and PSC tPA treatment predicted REC (p = 0.003, OR: 4.65, 95% CI: 1.73–12.4). Conclusion: REC at CSC arrival occurs exceptionally in patients with a documented LVO on PSC. Repeating a second vascular study before EVT would not be necessary in most patients. Despite its modest effect, tPA treatment at PSC was an independent predictor of REC.
Pesquisar a imprensa e as transferências culturais no Brasil
Authors: Cerqueira dos Anjos Yuri
Published: November 2020

Professora de História na Universidade Estadual Paulista (UNESP-Franca), a Dra. Valéria dos Santos Guimarães é uma das figuras que lideram a pesquisa acerca da imprensa periódica no Brasil. Seu trabalho tem como foco as transferências culturais que se operam nos séculos XIX e XX por meio da imprensa periódica. Nessa entrevista ela expõe seu percurso, seus projetos, bem como analisa a situação desse campo de pesquisas no Brasil. Por fim, a pesquisadora propõe sugestões aos futuros estudantes que venham a se interessar pelo assunto.
Turismo e Literatura: análises a partir das lentes das mobilidades
Authors: Fraga Carla , Elicher Maria Jaqueline , Moraes Camila Maria dos Santos
Published: November 2020

Este artigo apresenta uma análise da relação entre Turismo e Literatura a partir de uma visão multidisciplinar. O estudo se caracteriza como exploratório e descritivo, partindo de um levantamento bibliográfico. O corpus foi analisado quanto à: distribuição dos resumos por ano de publicação; áreas geográficas de interesse; conteúdo textual dos resumos. Os resultados evidenciam a importância do estudo da interface em si e de como esses dois universos se entrelaçam e se mobilizam, sendo a cidade um ambiente relevante para a ocorrência desta relação.
Abstract 12715: Administration of Activated Protein C Stabilizes Membrane EPCR and Increases Resistance of Heart to Ischemic Insult in Aging
Authors: Ren Di , Fedorova Julia , Zhang Jingwen , He Zhibin , Li Ji
Published: November 2020

Introduction:
Activated protein C (APC) is a circulating protease with anti-coagulant property. Endothelial protein C receptor (EPCR) mediates APC's downstream events. We have revealed that APC exerts cardioprotective effects during ischemia and reperfusion (I/R).

Hypothesis:
There is an impaired APC signaling in aging and administration of APC restores APC signaling of aged heart to improve cardiac tolerance to ischemic insult caused by I/R stress.

Methods:
Young C57BL/6J (3-4 months), aged C57BL/6J (24-26 months), and EPCR

R84A/R84A

(3-4 months, C57BL6/J background) transgenic mice without APC binding affinity were subjected to ischemia (45 min) and reperfusion (24 hrs) by ligation/release of left anterior descending coronary artery. APC, signaling selective APC-2Cys, or anticoagulant selective APC-E170A was injected through jugular vein five-minutes before reperfusion.

Results:
I/R stress triggers APC signaling in both young and aged hearts, but APC activity was significantly impaired in the aged versus young hearts. Serum EPCR measurement demonstrated that membrane EPCR's shedding into circulation was dramatically promoted during I/R stress. Intriguingly, administration of APC significantly reduced EPCR shedding caused by I/R stress in both young and aged hearts but not EPCR

R84A/R84A

heart. The echocardiography data showed that APC and APC-2Cys but not APC-E170A ameliorated cardiac dysfunction by I/R insult in both young and aged mice. Interestingly, APC and APC-2Cys restored aged heart's resistance to a comparable level as young heart to ischemic damage. The cardioprotective effects of APC and ACP-2Cys are diminished in EPCR

R84A/R84A

mice. Furthermore, metabolomics analysis and working perfusion heart results demonstrated that AMP-activated protein kinase (AMPK) signaling mediates acute adaptive metabolic response while protein kinase B (Akt) signaling pathway is involved in chronic metabolic programming in the heart with APCs treatments.

Conclusions:
I/R stress causes membrane EPCR shedding in the heart and APC's cardioprotection against I/R injury is not related with its anti-coagulant activity. Administration of APC prevents I/R-induced cardiac EPCR shedding that is critical for limiting cardiac damage in aging.
Abstract 12726: Crucial Role of
Jak2
V617f-positive Myeloproliferative Neoplasm in the Development of Aortic Aneurysm
Authors: Yokokawa Tetsuro , Misaka Tomofumi , KIMISHIMA Yusuke , Wada Kento , Minakawa Keiji , Sugimoto Koichi , Ishida Takafumi , Ikeda Kazuhiko , Takeishi Yasuchika
Published: November 2020

Objective:
To investigate the impact of hematopoietic JAK2V617F, which causes myeloproliferative neoplasms (MPNs), on the development of aortic aneurysm (AA).

Approach and Results:
We applied a bone marrow transplantation (BMT) strategy using the donor cells from
Jak2
V617F transgenic (JAK2
V617F
) mice into the lethally irradiated apolipoprotein E-deficient mice. To induce the AA formation and progression, the recipient mice (BMT mice) were subjected to continuous angiotensin II infusion. Abdominal aortic diameter in JAK2
V617F
-BMT mice was significantly enlarged compared to the control wild-type (WT)-BMT mice in response to angiotensin II. The incidence of abdominal AA was significantly higher in JAK2
V617F
-BMT mice than in WT-BMT mice. Hematopoietic JAK2V617F accelerated aortic elastic lamina degradation as well as activation of matrix metalloproteinase (MMP)-2 and MMP-9 in the abdominal aorta. The numbers of CD68
+
macrophages and Ly6B.2
+
neutrophils and cytokine expressions such as
Ccl6
and
Tgfb1
were significantly increased in the abdominal aorta of JAK2
V617F
-BMT mice accompanied by STAT3 activation. Bone marrow-derived macrophages carrying JAK2V617F showed elevations of both
Mmp2
and
Mmp9
mRNA expression. Finally, we found that 23% of MPN patients with
JAK2
V617F mutation showed the presence of AA and increases in
TGFB3
and
IL-8
mRNA expression of the peripheral leukocytes.

Conclusions:
Hematopoietic JAK2V617F was involved in the development of AA through increases in the infiltration of inflammatory cells and MMP activation. Our findings provide a novel feature of vascular complication of AA in MPNs due to constitutive activation of the hematopoietic JAK-STAT pathway.
Abstract 12815: Lambda-like St-segment Elevation in Acute Myocardial Infarction: May be a New Risk Predictor for Lethal Ventricular Arrhythmia
Authors: Kim Heng shee , Mahadevan Gurudevan , Lee Chuey Yan , Lu Hou Tee
Published: November 2020

Introduction:
Ventricular arrhythmia (VA) is the frequent most cause of SCD in AMI patients. Among, early VT and VF are associated with high in-hospital mortality. Certain ECG changes during AMI was reported to be associated with lethal VA. We described a case of lethal VA in AMI patient with a specific ECG sign - the Lambda ST elevation.

Case Description:
A 49 year old diabetic and hypertensive man presented with worse ever angina. Examination showed bilateral lung crepitation. ECG revealed wide spread Lambda shaped ST elevation over anteroinferior lead with reciprocal changes. He was treated as anteroinferior STEMI and planned for PPCI. During preparation, he developed VF and resuscitated with CPR and defibrillations. He was then intubated and BP supported with inotropes.

Coronary angiogram showed acute total occlusion of RCA and LAD. We decided PCI to both vessels. Multiple white thrombus aspirated from RCA and successfully established TIMI II flow. Just before deployment of the stent, he developed VF again and resuscitated. RCA was stented after ROSC.

Similarly, multiple red and white thrombus aspirated from LAD. After balloon dilatation, TIMI II flow re-established with no obvious lesion. Unfortunately, he developed VF storm in between and succumbed despite one hour of resuscitation effort with acceptable angiographic results.

Discussion:
The presence of elevated J-wave followed by a steep downsloping elevated ST segment that merges with the inverted T wave, forming a Lambda or shark fin shape, was reported to be associated with fatal VA, cardiogenic shock and in-hospital mortality. It is closely related to early abnormal ventricular repolarization, which involves acute myocardial ischemia and genetic abnormality.

Conclusion:
This case demonstrated that the presence of Lambda-like ST elevation in AMI may be a risk predictor for lethal VA and cardiogenic shock. Early recognition of this high risk group and prompt aggressive treatment strategies can be lifesaving.
Abstract 12817: Comparison of New York Heart Association Classification and Patient-reported Outcomes Among Heart Failure Patients in U.S. Clinical Practice: CHAMP-HF
Authors: Greene Stephen J , Butler Javed , Spertus John , Vaduganathan Muthiah , Hellkamp Anne , Devore Adam D , Patterson J Herbert H , Albert Nancy M , Duffy Carol , Williams Fredonia , Thomas Laine E , Hernandez Adrian F , Fonarow Gregg C
Published: November 2020

Introduction:
How the New York Heart Association classification system compares with patient-reported outcomes for HF patients in contemporary U.S. clinical practice is unclear.

Methods:
Among 2,872 U.S. outpatients with chronic HF with reduced ejection fraction (HFrEF) in the CHAMP-HF registry with complete NYHA class and Kansas City Cardiomyopathy Questionnaire Overall Score (KCCQ-OS) data at baseline and 12 months, longitudinal changes in the 2 measures and their correlation with each other were examined. Multivariable models landmarked at 12 months separately evaluated associations between improvement in NYHA and KCCQ-OS from baseline to 12 months with clinical outcomes occurring from months 12 through 24.

Results:
At 12-month follow-up, 65% of patients had no change in NYHA class, 18% had 1 class improvement, and 13% had 1 class worsening. For KCCQ-OS, 25% had no significant change (i.e., <5 point improvement or worsening), 48% had ≥5 point improvement, and 27% a ≥5 point worsening
(Figure, Panel A)
. NYHA class and KCCQ-OS showed modest correlation at baseline (r=0.33, p<0.01) and 12 months (r=0.33, p<0.01). After adjustment, improvement in NYHA class was not associated with 1-year mortality or composite mortality/ HF hospitalization (
Figure, Panel B)
. For KCCQ-OS, ≥5-point improvement was independently associated with a 41% lower risk of mortality and a 27% lower risk of mortality/ HF hospitalization.

Conclusions:
In this contemporary U.S. outpatient HFrEF registry, as compared with NYHA class, the KCCQ-OS was substantially more likely to show meaningful change over 12-month follow-up and these changes had strong prognostic implications. These data support the advantages and relative importance of patient-reported outcomes for HFrEF, as compared with traditional clinician-reported functional assessments.
Abstract 12820: Beta Blocker Use and Peri-operative Outcomes in Cancer Patients Receiving Immunotherapy
Authors: Oren Ohad , Molina Julian R , Yang Eric H , Oren Michal , Bailey Kent , Kopecky Stephen R
Published: November 2020

Introduction:
The impact of beta blocker use on surgical outcomes of cancer patients receiving immunotherapy is unknown.

Hypothesis:
Beta blocker use is associated with lower post-operative mortality in cancer patients on immunotherapy.

Methods:
We used an institutional Advanced Cohort Explorer to identify all patients who underwent any surgical procedure less than 90 days after receiving immunotherapy. Data on the procedure performed as well as the post-operative outcome were collected and analyzed per the pre-operative beta blocker use status.

Results:
A total of 233 patients underwent surgery between 09/2011-06/2019. Mean age was 64.7 years (range: 16-92). The most common cancer diagnoses were lung (48, 44.4%), melanoma (49, 45.4%) and kidney (11, 10.2%). Immunotherapy medications were pembrolizumab ( 127, 54.5%), nivolumab (51, 21.9%), ipilimumab (43, 18.5%), atezolizumab (11, 4.7%) and avelumab (1, 0.43%). Pre-operative beta blocker use was documented in 140 (60.1%) patients. Most common surgical procedures were skin resection (75, 32.1%), wound repair (47, 20.2%), vascular procedures (36, 15.5%), urethral procedures 16 (6.9%) and sentinel lymph node biopsies (10, 4.3%). The 30-day mortality rate was 10.3% (24 deaths). In a multi-variable logistic regression analysis, pre-operative use of beta blockers was associated with a lower risk of death within 30 days from surgery (OR 0.34, CI 0.13-0.87, P=0.024). 30-day mortality rates were higher in patients undergoing vascular (50%, 17 of 34) versus non-vascular (3.5%, 7 of 199) procedures (P<0.0001) in a Chi Square test.

Conclusions:
Beta blocker use is associated with a lower 30-day mortality rate after surgical procedures in cancer patients treated with immunotherapy. Further investigation is warranted.
Abstract 12876: Impact of Anesthesia Type on Short- and Long-term Outcomes After Transcatheter Aortic Valve Replacement: The Cleveland Clinic Experience
Authors: Sammour Yasser , Kerrigan Jimmy L , Gajulapalli Rama D , Banerjee Kinjal , Chawla Sanchit , Lak Hassan Mehmood , Svensson Lars G , Yun James J , Alfirevic Andrej , Sale Shiva , Mehta Anand , Krishnaswamy Amar , Kapadia Samir R
Published: November 2020

Introduction:
The early approach was to perform transcatheter aortic valve replacement (TAVR) under general anesthesia (GA). Over time, monitored anesthesia care (MAC) has been introduced as a less invasive option to facilitate TAVR.

Objective:
We sought to compare short- and long-term outcomes between TAVR patients undergoing GA versus those receiving MAC.

Methods:
We identified all consecutive patients with severe symptomatic aortic stenosis who underwent Transfemoral (TF)-TAVR at our institution between January 2012 and April 2017.

Results:
We included 998 patients who met our inclusion criteria. Overall, the mean age was 80.4 ± 9.7 years, 57.4% were males and 95.2% were Caucasians. MAC was used in 43.9%. The mean STS risk score (SD) was lower with MAC (6.7 ± 4.3% vs. 7.6 ± 4.5%; p = 0.004). MAC was associated with lower all-cause mortality at both 30 days (0.5% vs. 4.2%; log-rank p < 0.001), and 1 year (11.7% vs. 16%; log-rank p = 0.024). However, this difference was negated at 3 years (37% vs. 39%; log-rank p = 0.271). Further, there were no differences in major adverse cardiac and cerebrovascular events (MACCE) at either 30 days (4.6% vs. 7.6%; log-rank p = 0.089) or 1 year (21.5% vs. 24.2%; log-rank p = 0.242). There were no differences in the rates of myocardial infarction (1.6% vs. 0.9%; log-rank p = 0.375), stroke or transient ischemic attacks (3.1% vs. 3.4%; log-rank p = 0.817) or heart failure hospitalizations (9.6% vs. 9.5%; log-rank p = 0.815) at 1 year. In multivariate analysis, MAC predicted lower all-cause death at 1 year after TAVR (HR 0.672; 95% CI 0.453 - 0.996; p = 0.048) but not at 3 years (HR 0.882 (0.705 - 1.103; p = 0.271). MAC was not an independent predictor of MACCE (HR 0.851; 95% CI 0.643 - 1.126; p = 0.258).

Conclusions:
Compared to GA, MAC was associated with lower all-cause mortality at both 30 days and 1 year, but not at 3 years. There were no differences in MACCE between the two groups at either 30 days or 1 year.
Abstract 12880: A Clinical Index of Myocardial Afterload Can Replace Wall Stress Calculations
Authors: Reichek Nathaniel , Weber Jonathan , Kadiyala Madhavi , Grgas Marie , Merchant Tazim , Jayam 2nd Meghana , Knight Derek , Haigis Liana V , Pollack Simcha , Cheng Yang
Published: November 2020

Introduction:
Afterload at the myocardial level is a principal determinant of LV chamber and myocardial wall function, generated by interplay of LV pressure, volume, and mass. Quantitation has relied on wall stress indices which require additional measurements and calculations as well as incorrect assumptions. Unfamiliar to most clinicians, they have largely fallen out of use, but the role of myocardial afterload in contemporary heart failure pathophysiology and therapy merits reevaluation given the roles of EF and myocardial strains in prognostic indices and treatment guidelines.

Hypothesis:
A simple clinical afterload index using variables fundamental to wall stress indices (systolic pressure(mmHg) * LV volume(ml))/LV mass(g)) or PV/M correlates closely with stress indices and relates similarly to LV EF and myocardial strains.

Methods:
In 277 normals (54% female, mean age 50.9±12.9 yrs) and small cohorts with dilated non-ischemic cardiomyopathy(35), aortic stenosis(12) and cancer chemotherapy(43), each with matched controls, we used CMR LV volumes, mass and brachial systolic pressure during imaging to compare end-systolic PV/M to stress indices and systolic pressure alone using correlations and correlation standard errors(SEs).

Results:
There were extremely close correlations (r= 0.97-0.99, all p< 0.001) with minimal SEs between PV/M and Arts and Alters stress indices with similar slopes in all groups and in normal subgroups by age and gender. Negative correlations with EF, global strains and strain rates were also present and extremely similar in all groups. But Mirsky’s stress index and brachial pressure performed less well.

Conclusions:
A simple clinical afterload index correlates closely with wall stress indices and similarly with LV ejection fraction and strains. It can support efficient reassessment of the role of afterload at the myocardial level in research and potentially, in clinical practice.
Abstract 12885: Sleepless Nights and Squeamish Days: A Conundrum of Recurrent Myocardial Ischemia
Authors: Lehmann H Immo
Published: November 2020

A 63-year old Caucasian female with history of aortic valve replacement and CAD with prior drug-eluting stent placement (DES) to proximal LAD and LCX, presented as a hospital transfer with recurrent episodes of chest pain. Chest discomfort was described as severe chest pressure, radiating to bilateral upper extremities. Episodes were not associated with significant exertion and frequently occurred at night/early morning. Of note, the patient had undergone coronary angiography at the outside hospital, revealing no in-stent restenosis or new coronary lesions. Soon after the patient’s arrival in the CCU, she developed profound chest pressure, accompanied by hypotension, diaphoresis and nausea. Her 12-lead ECG revealed 2-mm ST-elevation in aVR, accompanied by ST-depression in inferior, anterior, and apical leads. Initial high-sensitivity (hs)-troponin T was 26 ng/L. She was given sublingual nitroglycerin and was started on a nitroglycerin and nicardipine infusion, with resolution of symptoms after ~30 minutes, followed by normalization of hs-troponin T. A transthoracic echocardiogram did not reveal focal left ventricular (LV) wall motion abnormalities, mild LV hypertrophy was present. Given the patients’ presentation with no in-stent restenosis or new lesions, frequent episodes of chest pain-not related to exertion with occurrence at nighttime and early morning, her presentation was deemed to be consistent with epicardial coronary vasospasm. Subsequently, the patients’ anti-anginal regimen was uptitrated to include extended-release nitrates, calcium-channel blockade, and I
Na
blockade. Unfortunately, she continued to have frequent episodes of profound angina, accompanied by hypotension, and significant ischemic ECG changes. This prompted us to pursue bilateral sympathectomy. Subsequently, the patient had resolution of prior symptoms. She was continued on an anti-vasospastic regimen, consisting of extended release nitrates and calcium-channel blockade. This case represents the challenging management of medication-resistant epicardial coronary artery vasospasm. As previously described, sympathectomy remains an effective therapeutic option for management in these difficult and life-threatening situations.
Abstract 12891: Psychosocial Factors at Middle Age and Zero Coronary or Extra-coronary Calcium at Older Age: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Honda Yasuyuki , Mok Yejin , Wang Frances , Cainzos Achirica Miguel , Ballew Shoshana , Daumit Gail , Kucharska-newton Anna , Howard Candace , Butler Kenneth R , Wagenknecht Lynne E , Folsom Aaron R , Budoff Matthew J , Blaha Michael J , Matsushita Kunihiro
Published: November 2020

Background:
Psychosocial factors are associated with atherosclerotic disease. However, their link to “healthy cardiovascular aging” is unknown.

Aim:
We aimed to comprehensively investigate the association of psychosocial factors at middle age with zero coronary artery calcium (CAC) or extra-coronary calcium (ECC) at age ≥75 years in the ARIC study.

Methods:
We studied 1,935 participants free of coronary heart disease history, who completed a psychosocial evaluation in 1990-1992 (mean age 53 [SD 4] years) and a cardiac computed tomography scan in 2018-2019. We assessed trait anger by the Spielberger Trait Anger Scale, depressive symptoms by the Maastricht Questionnaire, social support by the Interpersonal Support Evaluation List, and social network by the Lubben Social Network Scale. CAC/ECC was quantified by the Agatston score, and ECC included aortic valve ring, aortic valve, mitral valve, and ascending and descending aorta calcium.

Results:
The proportion of participants with zero calcium was 10 % for coronary artery, 15 % for aortic valve ring, 54 % for aortic valve, 52 % for mitral valve, 74 % for ascending aorta, and 11 % for descending aorta. Less trait anger was independently associated with zero CAC and aortic valve calcium (odds ratios [ORs] for one SD decrement of the score, 1.21 [95%CI, 1.02-1.45] and 1.16 [95%CI, 1.05-1.28], respectively) (
Figure A
). Less depressive symptoms, more social support, and larger social network were not positively associated with zero CAC or ECC (
Figure B-D
). The associations of less trait anger with zero CAC and aortic valve calcium remained significant when we applied inverse probability weighting to account for attrition.

Conclusions:
Among the psychosocial factors at middle age, only less trait anger was independently associated with zero CAC and aortic valve calcium at older age. Our findings suggest that the identification of less trait anger at middle age may be important for healthy cardiovascular aging.
Abstract 12899: Early Intervention in Transient ST-Elevation Myocardial Infarction Decreases Mortality: A Meta-Analysis
Authors: Upadhaya Sunil , Madala Seetharamprasad , Tiwari Kanchan
Published: November 2020

Introduction:
About one-fourth of patient with acute coronary syndrome present with transient ST-elevation myocardial infarction (STEMI). No specific recommendations exist in current guidelines regarding the timing of intervention for such patients due to lack of high-quality randomized trials.

Methods:
The Cochrane library and PubMed databases were searched for relevant studies. Two authors independently screened and included studies that were randomized controlled trials or observational studies comparing early with delayed invasive strategies in transient STEMI. Efficacy outcomes included target vessel revascularization, reinfarction and recurrent ischemia rates. Primary safety outcome was major bleeding. Random-effects model was used for pooled calculation of odds ratio (OR).

Results:
Out of all studies found, only 4 studies were included in our analysis (295 patients in early intervention group and 307 patients in delayed intervention group). Delayed intervention was associated with significant increase in all-cause mortality (OR: 2.81 [1.39-5.68], I
2
= 0%, p value = 0.004) (Figure 1). We did not find any significant difference in reinfarction rate (OR: 0.75 [0.12-4.66], I
2
= 0%, p value = 0.75), target vessel revascularization rate (OR: 0.66 [0.11-4.14] I
2
= 0%, p value = 0.66) and recurrent ischemia rate (OR 1.52[0.40-5.84], I
2
= 18 %, p value = 0.54). In addition, major bleeding rate was also similar in both groups (OR 0.68 [0.25-2.25], I
2
= 12%, p value = 0.60).

Conclusions:
This low to moderate-quality evidence suggests that early invasive strategy might reduce the mortality rate in transient STEMI. There is need of well-designed large randomized studies to gather further evidence regarding the best management of transient STEMI.
Abstract 13206: Blood Pressure Apps: Do They Educate the Lay Public About Risk Factors?
Authors: Vijay Arunima , Wu Gloria
Published: November 2020

Introduction:
Hypertension affects 108 million Americans. To help track and manage hypertension, there are many free and popular mobile health apps that track BP.

Hypothesis:
BP tracking mobile health apps have many downloads but do not fully educate the public about hypertension risk factors.

Methods:
“Blood Pressure” as a search term was used in the Google Play and Apple iOS stores to identify the most popular, free BP tracking apps aimed at the lay public. The top 10 most popular, free apps on each store were evaluated for educating the lay public on hypertension risk factors. Inclusion criteria: top 10 free blood pressure (BP) apps, by highest number of downloads on Google Play and highest rating (out of five stars) on Apple iOS Store (no available data on iOS downloads). Exclusion criteria: non-English, requiring a wearable device, primary purpose other BP tracking.

Results:
Of top 20 apps: BP log: 19/20, BP ranges: 13/20, height: 5/20, weight: 8/20, BMI: 3/20, race: 1/20, gender: 4/20, age: 6/20, diet: 1/20, exercise: 1/20, medication: 4/20, diabetes: 1/20, FBS: 1/20, goals: 3/20, mood/depression: 1/20. 2 apps mentioned the American Heart Association (AHA). None of the apps had information on cvriskcalculator.com, family history, cholesterol, LDL, triglycerides, HbA1c, and alcohol use.

Conclusion:
Most free and popular BP apps monitor BP but largely ignore hypertension risk factors such as cholesterol, LDL, triglycerides, alcohol intake, mood/depression, race, and gender. Furthermore, 7/20 apps do not uniformly educate patients that a normal BP is <120/<80, in accordance with the AHA and ACC guidelines. More collaboration may be needed between physicians and software developers to educate and meet the needs of our hypertensive patients in America.
Abstract 13211: Atrial Fibrillation is an Independent Predictor for Cardiovascular Events in Hypertensive Patients Due to Primary Aldosteronism
Authors: Sakaguchi Shintaro , Okamoto Ryuji , Inoue Chisa , Kamemura Kohei , Kurihara Isao , Takeda Yoshiyuki , Ohno Youichi , Rakugi Hiromi , Katabami Takuyuki , Tanabe Akiyo , Tamura Kouichi , Yano Yutaka , Dohi Kaoru , Naruse Mitsuhide
Published: November 2020

Introduction:
A higher risk of cardiovascular events has been reported in patients with hypertension due to primary aldosteronism (PA) than essential hypertension.

Hypothesis:
This study sought to determine the independent predictors for the risk of cardiovascular events in hypertensive patients with PA.

Methods:
The nation-wide PA registration study (JPAS/JRAS) included patients aged 20 years and older. Data were collected between January 2006 and January 2019, with a mean follow-up duration of approximately 4 years. Characteristics of patients with or without atrial fibrillation (AF) on the diagnosis of PA were compared. Patients were treated by surgery or MR antagonists and incident cardiovascular events were followed up.

Results:
A total of 3,647 patients with PA were included at the time of analysis. Prevalence of AF was 2.4% (87/ 3,647). PA patients with AF were older, more male and had longer duration of hypertension than those without AF. Each prevalence of cerebral infarction, chronic kidney disease, coronary artery disease, heart failure and left ventricular hypertrophy evaluated by echocardiography was higher in PA patients with AF than those without AF. Patients with AF had more kinds of antihypertensive drugs. There was no significant difference of basal plasma aldosterone concentration, plasma renin activity, unilateral subtype and rate of surgery between the 2 groups. PA patients with AF had higher rates of cardiovascular events compared to those without AF (14.9% vs 6.7%, P=0.002). Multivariate cox regression analyses demonstrated AF in addition to older age, male gender, duration of hypertension and surgery performance as an independent prognostic factor for cardiovascular events (HR, 1.950 [95%CI, 1.021-3.726], P<0.05; HR, 1.023 [95%CI, 1.008-1.039], P=0.003; HR, 1.385 [95%CI 1.025-1.870], P<0.05; HR, 1.023 [95%CI, 1.008-1.038], P=0.002; HR, 1.580 [95%CI, 1.168-2.138], P=0.003;respectively).

Conclusions:
Among patients with PA, male gender, older age, and longer duration of hypertension are the predisposing factors of AF in PA patients. In addition, AF was an independent risk factor for cardiovascular events in PA patients. It is warranted to prevent and to treat appropriately AF in patients with PA.
Abstract 13293: Detection of Atrial Fibrillation by Implantable Loop Recorders Following Cryptogenic Stroke: A Retrospective Study of Predictive Factors and Outcomes
Authors: Samaan Sara , Nazeer Beshoy , Stoute Heidi , Zhao Wei , Szpunar Susanna , Azzo Zain , Hassan Sohail
Published: November 2020

Introduction:
Cryptogenic strokes account for up to 40% of ischemic strokes. Atrial fibrillation (AF) is a known cause of ischemic stroke. Current data shows that occult AF can be detected by implantable devices at higher rates than conventional cardiac rhythm monitoring. There are, however, limited data available on risk factors and outcomes associated with AF detection by implantable loop recorders (ILRs).

Objective:
To investigate the risk factors and outcomes associated with occult AF detected by ILR in patients with cryptogenic stroke.

Methods:
We conducted a retrospective chart review of patients admitted with cryptogenic stroke at Ascension St John Hospital and Ascension Macomb-Oakland Hospital in Michigan who had ILRs placed from 1/1/2016 to 1/31/2020. Data were collected on demographics, comorbidities, treatment and outcomes. AF detection was defined as continuous AF for 30 seconds. Data were analyzed using Student’s t-test, the χ2 test and logistic regression.

Results:
We reviewed 172 patients, 52.3% male, 56.4% white, mean age 62.7 ± 13.6 years. The incidence of AF detection by ILR was 14% (24/172) over a mean follow-up of 12.75 ± 10.71 months. The mean duration of monitoring prior to AF detection was 4.5 months (range:1 day to 14 months). The median duration of AF was 6 minutes (range: 37.2 seconds to 11.3 hours). From univariable analysis, older age (p=0.03), male sex (p=0.09), embolic stroke pattern on imaging (p=0.06), and lack of AF symptoms (p=0.001) were associated with AF detection by ILR. From multivariable analysis, patients with detected AF were more likely to be older (OR=1.04, p=0.04), male (OR=3.6, p=0.03), asymptomatic (OR=6.3, p=0.01), and have an embolic stroke pattern on imaging (OR=3.3, p=0.04). 95.7% of patients with confirmed AF were started on anticoagulation for secondary stroke prevention. There was no difference in the incidence of stroke post-hospitalization between those with AF detection and those without (16% vs. 16.4%, p=0.96).

Conclusions:
In patients with cryptogenic stroke, age, gender, stroke pattern, and lack of AF symptoms are independent predictors of occult AF detection by ILR. Most patients with confirmed AF were started on anticoagulation for secondary stroke prevention and had low stroke recurrence rates.
Abstract 13298: The Association Between Coronary Artery Calcium and Atherosclerotic Cardiovascular Disease Risk in Women With Early Menopause: The Multi-Ethnic Study of Atherosclerosis
Authors: Chu Jian , Michos Erin D , Ouyang Pamela , Vaidya Dhananjay , Blumenthal Roger S , Budoff Matthew J , Blaha Michael J , Whelton Seamus P
Published: November 2020

Background:
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality among women, and early menopause (EM) is associated with an increased risk for ASCVD. Coronary artery calcium (CAC) is a non-invasive measurement of an individual’s subclinical atherosclerotic burden that is used to refine ASCVD risk estimation, and the absence of CAC is a robust predictor of low 10-year ASCVD risk. However, it is unknown whether there is a difference in the long-term association between the absence of CAC and ASCVD risk between women with and without EM.

Objectives:
To compare the prevalence of CAC and its association with incident ASCVD between women with and without EM.

Methods:
We performed Kaplan-Meier survival analysis and multivariable Cox proportional hazards modeling using data from 2,456 postmenopausal women in the Multi-Ethnic Study of Atherosclerosis (MESA) with or without EM, defined as occurring at <45 years of age.

Results:
Participants had a mean age of 64.1 years, 39% were White, and 28% (n=688) experienced EM. There were 291 ASCVD events over a mean follow-up of 12.5 years. Women with EM had a slightly lower prevalence of CAC=0 (55.1%) than women without EM (59.7%) (p=0.04) despite no difference in mean age. Among women with CAC=0, the cumulative incidence of ASCVD was slightly higher at 10-year follow-up for women with vs. without EM (5.4% vs. 3.2%, p=0.06) and significantly higher at 15-years (11.4% vs. 6.4%, p<0.01) (Figure). In multivariable Cox models, compared to women with CAC=0, those with CAC 1-99 and ≥100 had progressively increased ASCVD risk that did not significantly differ by EM status.

Conclusions:
More than half of postmenopausal women with EM had CAC=0 and an associated low-to-borderline 10-year risk of ASCVD. When CAC>0, the risk of ASCVD was similar for women with and without EM. Additional research is needed to better understand very long-term differences in ASCVD risk between women with and without EM who have CAC=0.
Abstract 13299: Myocardial Injury in Adults Hospitalized With Covid-19
Authors: Smilowitz Nathaniel R , Jethani Neil , Chen Ji , Aphinyanaphongs Yindalon , Zhang Ruina , Dogra Siddhant , Alviar Carlos , Keller Norma M , Razzouk Louai , Quinones-Camacho Adriana , Jung Albert S , Fishman Glenn I , Hochman Judith S , Berger Jeffrey S
Published: November 2020

Background:
Myocardial injury is frequently identified in patients with Coronavirus Disease 2019 (COVID-19). The incidence and outcome of myocardial injury at presentation and during the course of hospitalization for COVID-19 are uncertain.

Methods:
Consecutive adults (age ≥18) with COVID-19 admitted to a health care system with 4 large hospitals in New York between March 1st and April 16th, 2020 were identified. Initial and peak cardiac troponin (cTn) measurements were recorded. Myocardial injury was defined by cTn above the laboratory upper limit of normal. Thrombotic events, critical illness, and in-hospital mortality was determined.

Results:
Among 3,116 adults with COVID-19 and ≥1 cTn measurement, myocardial injury was present in 606 (19%) patients at hospital admission, with a median cTn of 0.10 ng/mL [range 0.04-91.8 ng/mL]. Patients with myocardial injury were older, more likely male, and more likely to have cardiovascular disease. Thrombotic events (38% vs. 10%, p<0.001; adjusted odds ratio [aOR] 3.54, 95 CI 2.91-4.53), critical illness (58% vs. 32%, p<0.001; aOR 1.55, 95% CI 1.22-1.90) and mortality (41% vs. 17%, p<0.001; aOR 1.67, 95% CI 1.31-2.15), were more frequent in patients with versus without myocardial injury at presentation. Myocardial injury based on the peak cTn during hospitalization was detected in 956 (31%) patients and was also associated with thrombotic events (36% vs. 7%, p<0.001; aOR 6.56, 95% CI 5.09-9.85), critical illness (67% vs. 24%, p<0.001; aOR 6.05, 95% CI 5.05-7.87), and mortality (43% vs. 13%, p<0.001; aOR 3.83, 95% CI 3.15-5.03) versus those without myocardial injury. Patients with the highest cTn had the greatest risk of adverse events (Figure).

Conclusions:
Myocardial injury was observed in 1 in ~5 patients with COVID-19 at hospital presentation, and 1 in ~3 based on the peak cTn. Initial and peak cTn measurements were markers of adverse outcomes. The optimal management of myocardial injury in COVID-19 requires further study.
Abstract 13604: Virulence of Staphylococcus Infection in Surgically Treated Patients With Endocarditis - A Multi-center Analysis
Authors: Luehr Maximilian , Weber Carolyn , Misfeld Martin , LICHTENBERG Artur , tugtekin sems M , Diab Mahmoud , Saha Shekhar , Li Yupeng , Petrov George , Matschke Klaus , Doenst Torsten , Borger Michael A , Wahlers Thorsten , Akhyari Payam , Hagl Christian
Published: November 2020

Introduction:
Infective endocarditis (IE) caused by Staphylococcus species have been noted to increase and are believed to be associated with higher morbidity and mortality rates.

Hypothesis:
Staphylococcus species are more virulent compared to other commonly causative bacteria of IE.

Methods:
The database of the Clinical Multicenter Project for Analysis of Infective Endocarditis in Germany (CAMPAIGN), comprising 4917 consecutive patients (mean age 62.2±14.6 years) undergoing heart valve surgery, was retrospectively analyzed. Uni- and multivariable regression analyses were used for comparison and risk stratification. The Kaplan Meier method was used for long-term survival estimation of the respective groups.

Results:
Staphylococcus patients (n=1260) were significantly more morbid than the Non-Staphylocccus group (n=3657) with regard to NYHA IV (21.4% vs. 16.7%*), CAD (29.0% vs. 25.7%;
p
=0.027), arterial hypertension (64.8% vs. 45.8%*), diabetes (29.9% vs. 24.8%*), renal failure (47.5% vs. 35.2%*), COPD (12.8% vs. 9.9%;
p
=0.007), PAD (11.3% vs. 6.4%*), preoperative stroke (35.1% vs. 18.0%*) and need for mechanical ventilation (18.2% vs. 6.4%*). Overall, Staphylococcus infections were more prevalent on mitral (51.0% vs. 42.0%*) and tricuspid (9.4% vs. 4.4%*) valves and showed higher incidences of large vegetations (87.0% vs. 56.0%*), mitral regurgitation (62.5% vs. 41.5%*) and preoperative septic embolism (51.8% vs. 28.9%*). Postoperatively, need for tracheostomy (13.7% vs. 7.6%*) and dialysis (29.4% vs. 13.6%*) were also significantly increased. The 30-day mortality for Staphylococcus was significantly higher (21.3% vs. 15.9%*) and long-term survival was significantly worse (
Fig. 1
).

Conclusions:
Staphylococcus endocarditis is associated with significantly worse outcome compared to IE by other commonly causative bacteria. Early surgery should be considered to avoid preoperative septic embolism, deterioration and death.

*=
p
<0.0001
Abstract 13608: The Association Between Cardiometabolic Disorders/Cardiovascular Disease and the Distribution of Monocyte Subsets: A Systematic Review and Meta-Analysis
Authors: Oh Ester , Na Muzi , Rogers Connie
Published: November 2020

Introduction:
Monocytes play a crucial role in the pathology of atherosclerosis, a major cause of cardiovascular disease (CVD). Previous studies in preclinical models report that monocyte subsets (i.e. classical, intermediate and non-classical monocytes) may differently contribute to the pathogenesis of atherosclerosis. However, changes in the distribution and the role of each monocyte subset in cardiometabolic disorders (overweight/obesity, metabolic syndrome, hypercholesterolemia, and type 2 diabetes) and CVD in humans is less clear. Therefore, the aim of the current systematic review and meta-analysis was to evaluate the association between the monocyte subset distribution and cardiometabolic disorders/CVD in humans.

Methods:
Articles were systematically searched in CINAHL, Cochrane Central Register of Controlled Trials, and PubMed until April 2020. A total of 1592 articles were independently screened by 2 reviewers. A total of 25 studies were selected for qualitative analyses. Among them, 6 studies reported the percentage of each monocyte subset and were included in the meta-analyses. For the meta-analyses, a random-effects model was used to generate pooled standardized mean differences (SMD) between subjects with cardiometabolic disorders and healthy controls.

Results:
In total, sample size ranged from 22 to 135, and mean age of subjects ranged from 22 to 70 years. The percentage of classical monocytes was lower [SMD = -1.21; 95% CI (-1.92, -0.50);
P
< 0.001;

I
2

= 91%] in subjects with cardiometabolic disorders compared to healthy controls. However, the percentage of intermediate [SMD = 0.56; 95% CI (0.23, 0.88);
P
< 0.001;

I
2

= 65%] and non-classical monocytes [SMD = 1.39; 95% CI (0.59, 2.19);
P
< 0.001;

I
2

= 93%] was higher in subjects with cardiometabolic disorders compared to healthy controls.

Conclusions:
There may be a shift in the distribution of monocytes from classical to intermediate and non-classical monocytes in individuals with cardiometabolic disorders. This shift may be an underlying cause of chronic low-grade inflammation, exacerbate atherosclerotic risk, and contribute to the development of CVD based on preclinical studies. However, additional mechanistic studies are needed in humans to evaluate this question.