bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14101: A Correction Score for Comparison of Aortic Calcification in Post-contrast and Non-contrast Measurements From Computed Tomography Scans
Authors: Horbal Steven R , Brown Edward , Derstine Brian A , Zhang Peng , Rossman Andrea H , Bidulescu Aurelian , Sullivan June A , Ross Brian E , Su Grace L , Holcombe Sven A , Wang Stewart C
Published: November 2020

Introduction:
Aortic calcification can be utilized to assess cardiovascular risk. While contrast is useful for vascular enhancement in diagnostic imaging, enhancement creates heterogeneity between post and non-contrast scans and limits their direct comparability.

Hypothesis:
We hypothesized that post and non-contrast aortic calcification measures will correlate, and a correction score can be developed for statistical comparability.

Methods:
Retrospective CT-scans were obtained from the University of Michigan. Participants (N=330) received abdominal scans with and without contrast enhancement within 120 calendar days. Analytic Morphomics was used to obtain vertebral-indexed measurements of aortic calcium area, and aortic wall obfuscation percentage. Calcification was specifically identified as regions with a given morphology and pixel value five standard deviations above the defined central lumen zone. Pearson correlation and multiple linear regression were used to explain the relationship between aortic measurements with and without contrast. Regressions include calcification percent (Model 1), and area (Model 2). Independent variables were non-contrast measurements and dependent variables were contrast measurements, age, and sex.

Results:
Correlations of calcification percent ranged from 0.86 at T11 and 0.94 and L2. Correlations of calcification area ranged from 0.66 at T12 to 0.84 at L3. In Model 1, for every percent increase in post-contrast calcification, non-contrast calcification percent increased by 11% (β=1.11, p <0.001, R2=0.85). In Model 2, for every mm2 increase in post-contrast calcification area, non-contrast calcification area increased by 0.45 mm2 (β=1.45, p <0.001, R2=0.69). Variance inflation factor for Model 1 was 1.08 and 1.07 for Model 2.

Conclusion:
In conclusion, this research proposes a correction score for comparisons of abdominal aortic calcification measurements in post-contrast and non-contrast scans.
Abstract 14107: Early Right Ventricular Reverse Remodeling Predicts Long-term Survival After Isolated Tricuspid Valve Surgery
Authors: Patlolla Sri Harsha , Schaff Hartzell V , Dearani Joseph A , Greason Kevin L , Pochettino Alberto , Daly Richard C , Frye Robert L , Nishimura Rick A
Published: November 2020

Introduction:
There are limited data on the impact of isolated tricuspid valve (TV) surgery on recovery of right ventricular (RV) function and RV reverse remodeling.

Methods:
Among 223 patients who had isolated TV procedures between 2001 and 2017, 60 (27%) underwent TV repair and 163 (73%) received TV replacement. RV reverse remodeling was assessed by echocardiography at a median of 11.3 months (IQR 5.9-13.5) post dismissal. Kaplan-Meier analysis and the log-rank test were used to estimate and create survival curves. Cox proportional hazards analysis was performed to study the association of clinical and echocardiographic parameters with mortality.

Results:
Mean age was 67.3 ± 13.7 years, and 57% were female. Indication for surgery was functional TR in 64% (n=143) patients. Overall 30-day mortality was 2.7%. After a median follow-up period of 9.5 years (IQR 3.6-12.9) there were a total of 122 (54.7%) deaths. Adjusted Cox regression analysis revealed comparable survival for TV repair and replacement and identified older age, and presence of RV dysfunction (HR 1.84, 95% CI 1.14-2.98; P=0.01) as independent predictors of poor survival. Impact of early RV reverse remodeling on survival after TV surgery was evaluated in 90 patients; In 39 RV function and/or RV size recovered, but in 51 RV dysfunction and/or RV enlargement persisted or worsened. Patients who exhibited RV reverse remodeling had significantly improved survival compared to those who did not (Log-Rank P=0.005) and reverse remodeling was independently associated with improved survival (HR 0.42, 95% CI 0.24-0.74; P=0.003). In a multivariable analysis lower preoperative right atrial pressure (OR 0.83, 95% CI 0.73-0.94; P=0.004) was an independent predictor of early right heart reverse remodeling.

Conclusions:
Isolated TV surgery can be performed with acceptable outcomes, and overall survival is best in patients who receive the operation before developing severe RV systolic dysfunction. Adjusted survival was similar for patients undergoing TV repair or replacement. Reverse remodeling of RV during the first 18 months after surgery appears to provide survival benefit. Preoperative RA pressure is an independent determinant of postoperative RV remodeling.
Abstract 14131: Proof of Concept: Interpretation of EKG With Image Recognition and Convolutional Neural Networks
Authors: Das Subrat , Epland Matthew , Yu Jiang , Suri Ranjit
Published: November 2020

Introduction:
EKGs are the cornerstone of management in cardiovascular diseases. There have been multiple efforts to computerize the EKG interpretation with algorithms, which unfortunately are machine specific and proprietary. We propose the development of an image recognition model which can be used to read EKG strips (which use standard notations) and hence be used universally.

Method:
A convolutional neural network (CNN) was trained to classify 12-lead EKGs between seven clinically important diagnostic classes (Figure 1a). Pre-labeled EKG recordings (6-60s) from a publicly available data set on PhysioNet were used to construct the images. The EKG images displayed the 12 channel traces, of 2.5s each, on a consistent 4x3 grid at a resolution of 800x800 pixels (Figure 1a). The data set (23,336 images) was divided into training, tuning, and validation sets; containing 70%, 15%, and 15% of the images, respectively. An austere variation of the MobileNetV3 model was trained from the ground up on the labeled training set. Stochastic gradient descent (SGD) was used to minimize the cross-entropy loss. Training was halted when the tuning loss had not improved from its previous minimum by 0.05% over the past 10 epochs.

Results:
The model trained over 52 epochs of batches of 32 images. The model’s accuracy was tested using the validation set (which was not used for development of model) and reported as a confusion matrix (Figure 1b). The accuracy per class varies from 69-91%.

Conclusion:
We used a labeled dataset of EKG images to develop a CNN model to predict seven different diagnostic classes with good accuracy. This is a novel approach to EKG interpretation as an image recognition problem and thus generates the ability to create diagnostic algorithms that are not dependent on proprietary voltage signals generated by commercial EKG machines. With the addition of more images to the data set and higher computing power we are confident that we can achieve enhanced accuracy.
Abstract 14140: Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting for Left Main Disease in Very Elderly Patients Suffering Acute Myocardial Infarction
Authors: Phan Derek , ROSTOMIAN Ara , Lee Mingsum , moore naing a , mansukhani prakash , aharonian vicken , Brar Somjot , Zadegan Ray
Published: November 2020

Introduction:
The optimal revascularization strategy for left main disease in very elderly patients is unclear given under-representation in randomized trials. Therefore, we sought to compare percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) for left main disease in very elderly patients presenting with acute myocardial infarction (AMI).

Methods:
Retrospective study of patients aged ≥ 80 years undergoing invasive coronary angiography (ICA) for AMI at Kaiser Permanente Los Angeles Medical Center between June 2009 and February 2019. Patients were grouped by treatment decision: PCI, CABG, or medical therapy. Inverse Probability Treatment of Weighting (IPTW) was used to balance baseline characteristics. All-cause mortality and non-fatal myocardial infarction (MI) was evaluated.

Results:
A total of 172 patients (average age 84.4 ± 3.6 years, 37% female) were analyzed. Of these 54 (31.4%) underwent PCI, 67 (39%) underwent CABG, and 51 (29.7%) were treated with medical therapy. Compared to CABG, the PCI group was significantly older, with more history of CAD, COPD, previous CABG, and previous PCI. Median follow-up was 22.4 months (interquartile range 5.1-46.8 months). After IPTW adjustment, there were no differences in mortality between PCI vs CABG (Hazard Ratio [HR] 1.40, 95% Confidence Interval [CI] 0.97-2.01), but an increase in non-fatal MI with PCI (HR 2.6, 95% CI 1.02-6.69). Both PCI and CABG reduced mortality (PCI: HR 0.46, 95% CI 0.32-0.66; CABG: HR 0.71, 95% CI 0.52-0.96) and non-fatal MI (PCI: HR 0.22, 95% CI 0.11-0.41; CABG: HR 0.09, 95% CI 0.4-0.23) compared to medical therapy.

Conclusion:
In very elderly patients with left main disease presenting with AMI, there was no difference in mortality between PCI and CABG, but an increased risk for non-fatal MI with PCI. However, both PCI and CABG were superior to medical therapy. Either revascularization strategy may be reasonable in this population.
Abstract 14160: Transcatheter Aortic Valve Replacement Associated Infective Endocarditis: Comparison of Early, Intermediate and Late Onset Cases
Authors: Kaur Simrat , Samra Gursharan , Kaur Manpreet , Shrestha Nabin , Gordon Steven , Kapadia Samir R , Krishnaswamy Amar , Reed Grant W , Puri Rishi , Svensson Lars G , Jaber Wael A , Griffin Brian P , Xu Bo
Published: November 2020

Introduction:
Transcatheter aortic valve replacement associated infective endocarditis (TAVR-IE) is a relatively rare complication of TAVR. Little is known about the characteristics of early, intermediate versus late onset TAVR-IE.

Methods:
We studied the risk factors, microbiological patterns, diagnostic and treatment strategies in patients with early (<60 days), intermediate (60-365 days) and late onset (>1 year) TAVR-IE.

Results:
Ten out of 494 definite cases of prosthetic valve IE between 2007 and 2019, were confirmed to have TAVR-IE from the IE registry at our center. The mean age was 78.1 ± 13.7 years, with 50% being female. Most (90%) TAVR procedures were performed via transfemoral route, and one underwent transapical TAVR. Baseline comorbidities were common, with mean BMI 33.1 ± 5.5 kg/m2, diabetes and hypertension in 60% and chronic kidney disease in 50% of cases. Mean STS risk score was 7.8 ± 5.7. Most (60%) TAVR-IE cases had intermediate onset, with Staphylococcus aureus being the most common organism (66.6%). Diagnostic modalities and complications are described in Table 1. Two cases had early onset TAVR-IE, one of which was due to Pseudomonas aeruginosa, and underwent successful surgical treatment. Late onset TAVR-IE was observed in 20% of cases. 18-fluorodeoxyglucose positron emission tomography (18-FDG-PET) aided in diagnosis of TAVR-IE in 20% of cases. Mortality due to IE was observed in 40% of cases. Most of the patients underwent conservative management, and 37.5% survived over a mean follow up of 709 ± 453 days. Two patients underwent surgery, of whom one died day 30 post-operatively from sepsis. Mortality due to IE occurred in 25% of cases in the early and intermediate onset groups, while there was 100% mortality in the late onset group.

Conclusions:
In a single-center cohort, most TAVR-IE cases had an intermediate onset, with Staphylococcus aureus being the most common organism. Late onset TAVR-IE was associated with higher mortality at follow-up.
Abstract 14165: In-hospital Outcomes and 30-day Readmissions in Patients Hospitalized With Myocarditis
Authors: Weidling Robert , vuddanda venkat , Mastoris Ioannis , Lacy Sean , Moala Tiana , Sauer Andrew J , Shah Zubair
Published: November 2020

Introduction:
Myocarditis, induced by various etiologies, remains a major cause of dilated cardiomyopathy. Data on patient characteristics, hospital outcomes and readmissions of myocarditis remains limited. Our study evaluated outcomes and 30-day readmission rates of patients admitted with myocarditis.

Methods:
We retrospectively analyzed the US National Readmissions Database years 2016-2017 for all adults (age ≧ 18 years) with an index admission for myocarditis. The primary outcomes sought were inpatient mortality, ventricular fibrillation (VF)/ sudden cardiac death (SCA) and 30 day readmission rates. Secondary outcomes included: patient characteristics and diagnostic or therapeutic interventions.

Results:
A total of 7100 index admissions with myocarditis were identified whereby males composed the majority of admissions (64.9%). Women were at a significantly greater risk of VF/SCA (5.2% vs 2.1%, p<0.05) and cardiogenic shock (10.2% vs 4.7%, p<0.001). In-hospital mortality was greatest in females (3.8% vs 1.4%, p<0.001). Temporary mechanical circulatory support was utilized more among females as compared to males by way of IABP (2.4% vs 0.9%, p = 0.002) or PVAD (1.9% vs 0.9%, p = 0.009). Mean length of stay was greater in females (3 ± 5 vs 2 ± 3 days, p<0.001). The overall 30-day readmission rate was 6.4% and the top three etiologies for readmission in order of frequency were: myocarditis, acute on chronic systolic heart failure and sepsis.

Conclusions:
Significant gender outcome disparities were noted among identified index admissions for myocarditis. Females had disproportionately higher rates of VF/SCA, cardiogenic shock and inpatient mortality. Additionally, females had a higher rate of temporary mechanical circulatory support utilization and a longer length of stay. The overall 30 day readmission rate was significant at 6.4% with the most frequency causes of readmission being recurrent myocarditis, acute on chronic systolic heart failure and sepsis.
Abstract 14176: Pulmonary Effective Artery Elastance as a Novel Predictor of Adverse Events in Patients With Pulmonary Embolism
Authors: Kamran Hayaan , Hariri Essa , Iskandar Jean-Pierre , Sahai Aditya , haddadin Ihab , Campbell Joseph , Harb Serge C , Delehanty Joseph M , Bartholomew John R , Heresi Gustavo , Cameron Scott J
Published: November 2020

Introduction:
Risk stratification tools including the Pulmonary Embolism Severity Index (PESI) and BOVA rely on complicated calculations that give less attention to hemodynamic parameters predictive of cardiogenic shock in acute pulmonary embolism (PE). We explored the possibility that simultaneous measurement of right sided and left sided non-invasive hemodynamic parameters by echocardiography may predict adverse sequelae in the context of acute PE.

Methods:
We retrospectively reviewed all Pulmonary Embolism Response Team (PERT) activations between 2014 and 2020. The PESI and BOVA scores were calculated and their performance in predicting adverse events was compared to pulmonary artery elastance (PAE). PAE (mmHg/mL) was calculated by dividing the Pulmonary Artery Systolic pressure (PASP) by the LV Stroke (SV). Blood biomarkers (troponin T, NT-proBNP, and lactate) were recorded. The composite primary outcome was: 1) need for advanced intervention, 2) cardiac arrest, and 3) in-hospital mortality. Multivariate and univariate regression was used to analyze outcomes.

Results:
215 of 343 patients met inclusion criteria. Baseline characteristics were similar in patients with PAE <1 and PAE ≥ 1. PAE ≥ 1 was common in intermediate-high risk PE (85.7% vs 63.1%, p <0.001), with greater [NT-proBNP, pg/mL] (3599 vs 1427.5, p=0.001) and [lactate, mM] (2.9 vs 1.8. p=0.003). PAE ≥ 1 predicted the composite endpoint with odds ratio (OR) of 2.31 (95% CI 1.3-4.2, p=0.005), Comparatively BOVA had adjusted OR of 1.3 (95% CI, 1.1-1.6, p = 0.01) and PESI was not significant with OR of 1.4 (95% CI, 1 -2.1, p = 0.055) in predicting composite outcomes.

Conclusion:
In the context of acute high risk PE, PAE ≥ 1.0 is a novel and independent predictor of adverse cardiovascular events and mortality that should be prospectively validated.
Abstract 14178: Characteristics and Outcomes of Young ST Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Intervention
Authors: Tung Benjamin W , Ng Zhe Yan , Kristanto William , Saw Kalyar W , sia winnie C , Chan Siew Pang , Chan Koo Hui , Chan Mark , Lee Ronald C , Loh Joshua , Low Adrian F , Tay Edgar , Tan Huay Cheem , Yeo Tiong Cheng , Loh Poay Huan
Published: November 2020

Introduction:
ST-segment elevation myocardial infarction (STEMI) is associated with significant morbidity and mortality leading to loss of productivity and productive life years, especially in younger patients. Understanding the characteristics of younger patients with STEMI and their outcomes could help focus public health efforts in STEMI prevention within a population.

Aim:
This study aims to compare the characteristics and outcomes of younger versus older patients with STEMI undergoing primary percutaneous intervention (PPCI).

Methods:
Data from the Coronary Care Unit database of the National University Hospital between July 2015 to June 2019 was reviewed. Patients were divided into Young (<50 years old) or Old (≥50 years old) groups.

Results:
Of the 1818 consecutive patients with STEMI and underwent PPCI, 465 (25.6%) were Young patients with mean age 43±4.9 years old as compared to Old patients with mean age 63.2±9.4 years old. Young patients were more likely to be male (94% vs. 85%, p<0.0001), current smokers (61.1% vs. 42.6%, p<0.0001), of Indian ethnicity (32% vs. 16.3%, p<0.0001), and had family history of myocardial infarction (MI) (18.1% vs. 9.5%, p<0.0001). Compared to Old patients, Young patients had better post-MI left ventricular ejection fraction (49.5±10.7 vs. 47.8±11.6, p=0.007) with fewer of them suffered from cardiogenic shock (7.1% vs. 13.2%, p<0.0001), and had lower mortality at one year (3.4% vs. 10.4%, p<0.0001). Although diabetes, hypertension and hyperlipidemia was less common among the Young patients when compared to the Old, the prevalence was high in the range of 28 to 38% (Table 1).

Conclusions:
A sizable proportion of STEMI patients are younger than 50 years old. The risk profile of these younger patients can be attributed to constitutional factors and smoking but other cardiovascular risk factors are also prevalent among them. Although mortality is lower among the younger than the older patients, it is not negligible.
Abstract 14193: Depression Worsens Cardiovascular Health: A Population-based Cohort Study (NHANES, 2015-16)
Authors: Medoff Brent , Baird Andrew , Herbert Brandon , Magnani Jared W
Published: November 2020

Introduction:
Depression increases cardiovascular risk, but associations between depression and cardiovascular risk profiles have had limited investigation. We hypothesized that depression is associated with cardiovascular risk factors in a population-based cohort.

Methods:
We selected participants from the 2015-16 National Health and Nutrition Examination Survey (NHANES) and age ≥25 years. Participants completed the Patient Health Questionnaire (PHQ), a 9-item, validated instrument categorizing minimal (0-4), mild (5-9) or moderate-to-severe (≥10) depression. We employed the American Heart Association’s assessment of cardiovascular health, Life’s Simple 7 (LS7) which uses risk factors (smoking status, BMI, physical activity, diet, cholesterol, blood pressure, and glycohemoglobin) to categorize cardiovascular health as poor (0-1), intermediate (5-9) or ideal (10-14). We related PHQ scores to cardiovascular health as measured by LS7 in regression analyses adjusted for relevant covariates (age, sex, race, education, health insurance and poverty-income level).

Results:
Among 5053 NHANES participants, 4003 (79%) had data for the PHQ and determination of LS7 scores (age 51±16; 52% female; 67% white race). Individuals with mild depression (PHQ 5-9) had 1.4-times greater likelihood (95% CI, 1.07-1.92) of lower cardiovascular health compared to those without depression in multivariable-adjusted models. Likewise, individuals with moderate depression (PHQ≥10) had 3-times greater likelihood (95% CI, 1.90-4.97) of lower cardiovascular health compared to those without depression.

Conclusions:
In a socially diverse cohort, individuals with depression were more likely to have significantly lower cardiovascular health compared to those without depression. Our findings show that depression may be a barrier to cardiovascular health promotion. Addressing depression appears essential to improve cardiovascular health.
Abstract 14514: The Incidence and Natural Progression of New Onset Post-Operative Atrial Fibrillation
Authors: Meykler Marcella , Abdelmoneim Sahar , Rosenberg Emelie , Patel Bimal , Reddy Bharath , Ho Jean , Klem Igor , Singh Jaspal , Worku Berhane , Tranbaugh Robert F , Sacchi Terrence , Heitner John F
Published: November 2020

Introduction:
New onset postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery that is associated with an increased risk for stroke and all-cause mortality. Long term data on POAF recurrence and anticoagulation remains sparse. We aimed to characterize the natural progression and recurrence of new onset POAF during a long-term follow up post cardiac surgery utilizing continuous event monitoring.

Methods:
This is a single-center, prospective observational study evaluating 42 patients undergoing cardiac surgery and diagnosed during indexed admission with new onset, transient POAF who were discharged in sinus rhythm between May 2015 and December 2019. Prior to discharge, all patients received implantable loop recorders (ILR) for continuous monitoring. Study outcomes were the presence and timing of AF recurrence (first and repeated AF recurrence), all-cause mortality and cerebrovascular accidents (CVA).

Results:
Forty-two patients [mean age 67.6± 9.6 years, 74% male, mean CHADS
2-
VASc 3.5±1.5] were evaluated during a mean follow-up of 1.7 ± 1.2 years. AF recurrence after discharge occurred in 30 patients (71%). Twenty-four of these 30 patients (80%) had their first AF recurrence within the first month, 3 (10%) patients during months 1-12, and 3 (10%) patients beyond 1 year. Repeated AF recurrence occurred in 13 (43%) patients between 1 and 12-months. Beyond one year of follow-up, 5 (17%) patients had either their first AF recurrence (3) or repeated AF recurrence (2). During follow-up, there was one death ((-) AF recurrence) and two CVAs ((+) AF recurrence).

Conclusions:
In this study of continuous monitoring with ILR , the recurrence of AF in patients who develop transient POAF is common. Seventy percent of patients had either their first AF recurrence 6 (20%) or repeated episodes of recurrent AF 15 (50%)
after 1-month
post-operative follow-up.
Abstract 14517: Abnormal Flow Conditions Promote Endocardial Fibroelastosis via the Induction of Endothelial-to-mesenchymal Transition, Which is Responsive to Losartan Treatment
Authors: Oh Nicholas , Hong XueChong , Doulamis Ilias P , Meibalan Elamaran , Peiseler Teresa , Melero-Martin Juan M , Garcia-Cardena Guillermo , Friehs Ingeborg , Del Nido Pedro J
Published: November 2020

Introduction:
Endocardial Fibroelastosis (EFE) is a condition defined by the formation of fibrotic tissue on the endocardium, stunting cardiac development. The presence of EFE restricts diastolic compliance, leading to systolic and diastolic heart failure, and contributing to higher morbidity and mortality, particularly in Hypoplastic Left Heart Syndrome. While research suggests that EFE forms through aberrant endothelial-to-mesenchymal transition (EndoMT), the trigger of its formation is still speculative. Anecdotally, however, we have observed EFE development in patients with abnormal left ventricular flow.

Objective:
Our objective is to study whether the absence of normal flow induces EndoMT in neonatal endocardium and promotes EFE development, and whether losartan treatment, which can decrease TGFβ production to impair EndoMT, can abrogate EFE formation.

Methods and Results:
Using a rodent model of EFE, we establish three flow conditions in neonatal hearts: Normal Flow (NF), Static/no flow (S), and Regurgitant Flow (RF). Histologic analysis demonstrates EFE development in S and RF conditions, but not in NF conditions. Using qPCR, Western Blot Assay, and immunohistochemistry, we demonstrate that S and RF significantly increase mRNA and protein expression of EndoMT markers (αSMA, SNAIL), and EndoMT-related signaling pathways (TGFβ, NOTCH1) whereas NF conditions do not. With losartan treatment, we observe a significant decrease in EFE in neonatal hearts documented by histology and decreased mRNA and protein expression of EndoMT markers. To determine whether our findings are translatable to humans, human endocardial endothelial cells were isolated from left ventricular tissue and subjected to two flow conditions: static and laminar shear stress (LSS). By RNAseq analysis, we demonstrate that laminar shear stress suppresses the expression of genes critical for mesenchymal differentiation and Notch signaling, which are both associated with EndoMT progression.

Conclusions:
Our data demonstrates that the absence of normal flow provides an environment that promotes EFE development through activated EndoMT. Further, we identify losartan as a potential therapy for EFE, as it is able to abrogate EFE development in our animal model.
Abstract 14521: Association of Serum Leptin and Abdominal Aortic Inflammation in Rheumatoid Arthritis
Authors: Bhattaru Abhijit , Raynor William Y , Patil Shivaraj , Rojulpote Chaitanya , Bravo Paco E , Gonuguntla Karthik , Karambelkar Pranav , Vuthaluru Kiranmayi , Seraj Siavash M , Zhang Vincent , Werner Thomas , Baker Joshua F , Alavi Abass
Published: November 2020

Introduction:
Rheumatoid arthritis (RA) is an autoimmune disease associated with increased risk of atherosclerosis. Leptin may indirectly contribute to atherogenesis, but its role in RA is not clear.

Hypothesis:
We aimed to study the correlation between leptin and inflammation in the abdominal aorta (AA) assessed by 18F-FDG PET/CT in RA patients.

Methods:
We retrospectively analyzed the data of 18 RA patients (mean age 56.0±11.9, 14 male). All patients were administered 18F-FDG intravenously, and full-body PET/CT scans were acquired 180 minutes later. Regions of interest were delineated around the wall of the AA, with a superior border at the aortic hiatus of the diaphragm and an inferior border at the bifurcation of iliac arteries. Mean standard uptake values per axial slice were averaged to calculate the average SUVmean (aSUVmean). BMI, visceral fat area (VFA), and serum logarithmically transformed leptin (ln-leptin) were obtained. Patients were divided into low- and high-BMI groups, with a cutoff of 25 kg/m2.

Results:
Mean BMI (kg/m2) and VFA (cm2) between the low- and high-BMI groups were 21.7 vs. 31.4 (p<0.001) and 72.3 vs. 157.0 (p=0.002), respectively. Serum ln-leptin and aSUVmean were significantly increased in the high-BMI group (7.2±0.9 vs. 9.8±1.1, p<0.001; 1.4 vs. 1.7, p=0.04). On regression analysis, serum ln-leptin correlated positively with aSUVmean (r=0.59, p=0.01).

Conclusion:
In our study, higher serum leptin levels moderately correlated with 18F-FDG uptake in the AA, which reflects inflammation and atherogenic activity. Future studies are warranted to further elucidate the role of leptin in co-morbid atherosclerosis in patients with RA.
Abstract 14539: Incidence, Risk Factors, Natural History, and Outcomes of Atrial Fibrillation in Patients With Graves’ Disease
Authors: Naser Jwan A , Pislaru Sorin , Stan Marius N , Lin Grace
Published: November 2020

Background:
Hyperthyroidism is associated with atrial fibrillation (AF) with a reported prevalence of 16-60%. However, risk factors for onset of AF with hyperthyroidism are not well defined. We sought to identify patients with hyperthyroidism most likely to develop AF.

Methods:
We reviewed the medical records of 1371 consecutive patients with GD evaluated at our clinic between 2009 and 2019. GD-related AF was defined as AF diagnosed up to 30 days before or at any time after Grave’s disease (GD). Spontaneous recovery was defined as sinus rhythm after attainment of euthyroidism without the need for pharmacologic or electrical cardioversion. Outcomes of major cardiovascular events, all-cause mortality, and cardiac hospitalizations were compared between cases and controls (GD without AF) matched 1:1 for age, gender, and history of coronary artery disease.

Results:
AF occurred in 140 patients with an incidence of 10.2%. Older age (RR 1.63 per 10 years, p <0.001), male gender (RR 2.06, p < 0.001), overt hyperthyroidism (RR 2.48, p = 0.002), COPD (RR 2.14, p =0.006), and higher BMI (RR 1.03 per unit, p=0.023) were independent risk factors for AF. Spontaneous AF recovery occurred in 44 of 128 (34.6%) patients with adequate follow up. The multivariate risk factor for failed recovery was the presence of heart failure (HF) (OR =3.52, p= 0.004). GD patients with AF had higher rates of cardiac hospitalizations (Figure) that persisted even after adjusting to HF presence (27.9% vs 2.9%, p < 0.001).

Conclusion:
Risk factors for AF in GD are similar to those in the general population, although overt hyperthyroidism conferred the highest risk. These data argue for careful monitoring of GD patients with multimorbidity who may be at high risk of developing AF.
Abstract 14576: Durability of Valve-sparing Tetralogy of Fallot Repair
Authors: Stephens Elizabeth H , Wolfe Bryan L , Talwar Abhinav A , Patel Angira , Camarda Joseph , Eltayeb Osama , Monge Michael , Forbess Joseph M
Published: November 2020

Introduction:
While valve-sparing repair is ideal for Tetralogy of Fallot (TOF), it’s durability and which patients may benefit from a transannular patch remains unclear. To this end, we reviewed our experience with valve-sparing TOF repair.

Methods:
Retrospective review was performed of all primary TOF operations at our institution from 1/2008 to 12/2018. Standard demographic, operative, and echo data were collected, along with clinical outcomes. Transannular patch and valve-sparing repair groups were then compared.

Results:
Sixty-eight patients underwent TOF repair with a mean age of 4.1±2.2 months and weight of 5.7±1.8 kg. There was no difference in age or weight between patients who underwent a transannular patch repair and valve-sparing repair (Table). There was also no difference in the frequency of hypercyanotic spells or beta-blocker use. As expected the pre-operative pulmonary valve size and z-score were significantly different between groups. Bypass times were longer in the transannular patch group (176±40 vs. 144±40 minutes, p=0.005). There were no differences in post-operative complications. At last follow-up (median 41.5 months) there was a trend of a higher peak pulmonary valve gradient (p=0.07) in the valve-sparing group, but no difference in pulmonary valve annulus z-scores. Additionally, the pulmonary valve z-scores in the valve-sparing group decreased from -2.3±1.0 on pre-discharge echocardiogram to -1.2±1.6 on last follow-up, with the peak gradient on pre-discharge 20 (33) mmHg stable on last follow-up at 18 (29) mmHg and degree of pulmonary regurgitation stable. There was one reoperation in the cohort: a pulmonary valve replacement in a patient who had undergone a transannular patch repair 6 years prior.

Conclusions:
Valve-sparing TOF patients demonstrated stable repairs with pulmonary valve growth, acceptable gradients, minimal regurgitation, and high freedom from re-intervention during follow-up.
Abstract 14578: Transcatheter Aortic Valve Replacement for Symptomatic Severe Aortic Stenosis in Rheumatic Heart Disease: Analysis of the National Inpatient Sample Database (2012-2017)
Authors: Grant Jelani , Ebner Bertrand , Maning Jennifer , Vincent Louis , Fernandes Amanda , olarte neal , Olorunfemi Odunayo P , Cardoso Rhanderson , Colombo Rosario A , Alfonso Carlos
Published: November 2020

Introduction:
TAVR is widely accepted for the management of symptomatic severe aortic stenosis (AS), but its use in rheumatic heart disease has been limited. We sought to investigate the in-hospital outcomes of patients undergoing TAVR for symptomatic severe rheumatic AS.

Methods:
This is a retrospective NIS Database search from 2012 to 2017 to identify patients with ICD-9 and10 procedure codes for TAVR and for rheumatic AS. We compared baseline characteristics, procedure characteristics, in-hospital mortality and length of hospitalization based on the presence or absence of rheumatic AS.

Results:
From a total of 32,273 patients who underwent TAVR, the incidence of non-rheumatic severe AS was 6.54%. Baseline characteristics are displayed in Table 1. All-cause mortality was similar between both groups (2.3% vs. 2.4%, p=0.780) but length of stay (days) was significantly higher in the rheumatic AS group (6.1 ± 7 vs. 5.8 ± 6.4, p<0.001). Rates of Paravalvular Leak (1.1% vs. 0.7%, p<0.05) and post-procedure ischemic stroke (5.3 vs. 2.0%, p<0.001) were higher in patients with non-rheumatic AS. Using a multivariate logistic regression model, this cohort did not reveal increased odds of in hospital mortality based on the presence of severe rheumatic AS after adjusting for confounders (OR-0.97, 95% CI 0.69 to 1.37, p=0.867).

Conclusions:
This retrospective cohort demonstrated that TAVR may be feasible for rheumatic severe AS. Despite an older population than reported in the literature, mortality rates, complications and hospital length of stay was comparable to patients undergoing TAVR for calcific aortic disease. Further randomized studies are needed to support these findings.
Abstract 14579: Impact of Hospital MitraClip Volume on Short-term Outcomes of Transcatheter Mitral Valve Replacement
Authors: Isogai Toshiaki , Saad Anas M , Shekhar Shashank , Abdelfattah Omar M , Ahuja Keerat Rai , Gad Mohamed M , Kapadia Samir R
Published: November 2020

Introduction:
Transcatheter mitral valve replacement (TMVR) is an alternative to surgical mitral valve replacement for patients at prohibitive or high surgical risk. Both transseptal TMVR and MitraClip procedures require transseptal puncture and subsequent manipulation of a catheter within the left atrium and ventricle.

Hypothesis:
Higher MitraClip experience leads to better procedural outcomes of transseptal TMVR.

Methods:
We retrospectively identified patients who underwent transseptal-TMVR using the Nationwide Readmissions Database 2016-2017. We defined hospital volume as the annual number of MitraClip cases in each hospital and categorized hospitals into high- (≥26 cases/year) and low- (<26 cases/year) volume groups by the median value. We compared the in-hospital and 30-day outcomes between the two groups.

Results:
A total of 1,023 TMVR patients (median 74 years; female 56.1%) were divided into the high- (n=487) and low- (n=536) volume groups. The high-volume group had a higher prevalence of prior valve implantation (30.8% vs. 24.8%; p=0.036), prior coronary artery bypass grafting (28.7% vs. 22.7%; p=0.031), and heart failure (86.7% vs. 79.5%; p=0.003) than the low-volume group. There was no significant difference in the rates of in-hospital death (9.0% vs. 9.5%; p=0.830), stroke (2.1% vs. 3.2%; p=0.330), and pacemaker implantation (2.5% vs. 4.5%; p=0.091), while surgical bailout was less frequent in the high-volume group (2.5% vs. 6.5%; p=0.002). Multivariable logistic regression analyses showed that high volume was significantly associated with a lower risk of surgical bailout, prolonged hospital stay, cardiovascular-cause readmission, but not with other outcomes including in-hospital death (Figure).

Conclusions:
Centers with greater MitraClip experience had a lower risk of surgical bailout, prolonged hospital stay, and early readmission after transseptal-TMVR, although mortality was high irrespective of MitraClip experience.
Abstract 14588: Post-discharge Readmission and Survival After Percutaneous Coronary Intervention Among Patients With a History of Recent Gastrointestinal Bleeding: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium
Authors: Meloche Chelsea , Seth Milan , MADDER Ryan D , Kurlander Jacob , Yaser Jessica , Chattahi Joseph , Collins John , Lingam Natesh , Arora Dilip , Sukul Devraj , Gurm Hitinder S
Published: November 2020

Introduction:
Given the use of potent antithrombotic agents during and after PCI, patients (pts) are at an increased risk of gastrointestinal bleeding (GIB).

Hypothesis:
We hypothesize that pts with a history of recent GIB have a higher risk of post-discharge readmission and mortality compared with those without a history of GIB.

Methods:
We linked clinical registry data from PCIs performed between 1/1/2013 and 3/31/2018 at 48 Michigan hospitals to Medicare claims. A recent history of GIB prior to PCI was defined in the clinical PCI registry as any occurrence of melena or hematemesis in the last 30 days or any history of GIB including peptic ulcer disease that may influence clinical management during this hospitalization. Primary outcomes of interest were 90-day readmission after PCI and long-term mortality. We used 1:5 propensity-matching to adjust for differences in characteristics between pts with and without a history of recent GIB. Log-rank testing was used to evaluate survival at 1 and 5 years. Fisher's exact testing was used to compare the rates of 90-day readmission after PCI.

Results:
Of 30,206 pts, 1.1% had a history of GIB. Pts with a history of GIB were more likely to be older, female, black, and have more cardiovascular comorbidities. After matching 1896 pts, those with a history of GIB (n=316) appeared to have decreased survival early after PCI (Fig); however, the differences in survival were not statistically significant at 1 yr (76.%3 vs. 80.1%; p=0.11) or 5 yrs (52.5% vs. 52.2%; p=0.50) (Fig). There was no significant difference in readmission rates among those with and without a history of GIB (33.5% vs. 30.2%; p=0.26).

Conclusions:
Pts with and without a history of recent GIB had similar risks of readmission and long-term mortality after PCI. Although a history of GIB has previously been shown to be associated with increased post-PCI bleeding complications, a recent history of GIB was not associated with long-term post-PCI outcomes.
Abstract 14594: Association Between Life's Simple 7 and Cardiovascular Disease in Cancer Patients Compared to Noncancer Controls in the Aric Cohort
Authors: Song Evelyn J , Zhang Sui , Prizment Ana E , Polter Elizabeth J , Selvin Elizabeth , Nambi Vijay , Joshu Corinne , Platz Elizabeth , Ndumele Chiadi E , Florido Roberta
Published: November 2020

Introduction:
Cancer survivors have greater cardiovascular disease (CVD) risk through unclear mechanisms. Little is known about whether Life’s Simple 7 (LS7) metrics differ between persons with and without cancer and if the link between LS7 and CVD is similar in cancer survivors compared to persons without prior cancer.

Hypothesis:
Persons who develop cancer have poorer LS7 metrics compared to noncancer controls, and an ideal LS7 score is less protective against CVD events in persons with versus those without prior cancer.

Methods:
A total of 2950 ARIC participants who developed cancer were matched at the time of cancer diagnosis (incidence density sampling) on age, sex, race, and study center, to 5900 noncancer controls. We compared LS7 metrics in individuals who developed cancer (assessed prior to cancer diagnosis) and in matched controls. We used Cox regression to evaluate the prospective association between LS7 score and CVD events (coronary heart disease, heart failure or stroke) stratified by cancer status, with test for interaction between LS7 and cancer.

Results:
Compared to matched noncancer controls, those who developed cancer were less likely to have an ideal smoking history, body mass index, glucose control, physical activity levels, and diet (defined by LS7 metrics;
Table
). Overall those with cancer were less likely to have an ideal LS7 score than noncancer controls (18 vs 23% p<0.0001). Compared to inadequate, an ideal LS7 score was similarly associated with lower CVD risk in persons with and without cancer (HRs 0.37 [95% CI: 0.26-0.52] and 0.40 [95% CI: 0.32-0.50], respectively), with no interaction between LS7 score and cancer status (p = 0.59).

Conclusions:
Individuals who develop cancer have poorer overall cardiovascular health as reflected by the LS7 score, but an ideal LS7 score is associated with similar cardio-protection in those with and without cancer. Cancer survivors may benefit from interventions targeting cardiovascular health metrics.
Abstract 14606: Endothelial Injury Biomarkers and Risk Factors Associated With Discordant Risk of Acute Coronary Syndrome Despite Controlled Low-density Lipoprotein Cholesterol Identified by a Novel Coronary Artery Disease Predictive Algorithm
Authors: Premyodhin Ned , FAN WENJUN , Younus Masood , Harrington Douglas S , Wong Nathan D
Published: November 2020

Background:
Individuals with no history of coronary artery disease can develop acute coronary syndrome (ACS), often in the absence of major risk factors including low-density lipoprotein cholesterol (LDL-C). We identified risk factors and biomarkers that can help identify those at discordantly high risk of ACS who have normal LDL-C using a novel coronary artery disease predictive algorithm (CADPA) incorporating biomarkers of endothelial injury validated in the Multi-Ethnic Study of Atherosclerosis cohort.

Methods:
Five-year predicted ACS risk was calculated using the CADPA for 8589 patients. Common risk factors and serum levels of 9 biomarkers utilized by the CADPA were tracked. We identified a “discordant high ACS” risk group with serum LDL-C < 130 mg/dL but 5-year CADPA predicted risk ≥ 7.5% and a “discordant low ACS” risk group defined as LDL-C ≥ 130 mg/dL but 5-year CADPA risk of < 7.5%. Multiple logistic regression identified risk factors and biomarkers that predicted discordance in two separate models.

Results:
The average age and percent male of the high ACS discordant group was higher compared to non-discordant (68±10 vs 54±13 years and 61% vs 43%, respectively). Diabetes (OR 2.84 [2.21-3.66]), male sex (OR 2.83 [2.40-3.35]), family history (OR 2.23 [1.88-2.64]) and active smoking (OR 1.99 [1.50-2.62]) exhibited greatest odds of high ACS discordance compared to other risk factors (all p < 0.01). Increased serum soluble FAS (OR 2.12 [1.97-2.29]), Hemoglobin A1c (OR 1.60 [1.48-1.72]) and interleukin-16 (OR 1.40 [1.32-1.48]) were the biomarkers most associated with discordant risk, independent of global risk factors.

Conclusion:
Men with diabetes and family history of myocardial infarction who are actively smoking may be at highest risk of developing ACS despite controlled LDL-C. Future studies should examine whether using the CADPA can help identify such individuals that could benefit from earlier targeting of risk factor modification for prevention of ACS.
Abstract 14607: Randomized Controlled Trial of Once-Per-Week Intermittent Fasting for the Reduction of Low-Density Lipoprotein Cholesterol
Authors: Bartholomew Ciera , Muhlestein Joseph B , May Heidi T , Le Viet T , Galenko Oxana , Garrett Kelly D , Brunker Cherie , Hopkins Ramona , Konery Kristin , Anderson Jeffrey L , Carlquist John F , Knowlton Kirk U , Bailey Bruce W , Horne Benjamin D
Published: November 2020

Introduction:
High-frequency intermittent fasting (IF) diets reduce weight similarly to continuous calorie restriction (CR). In patients with type 2 diabetes, twice-weekly IF and CR equivalently reduced HbA1c. IF may improve chronic disease risk factors, but no controlled trial has evaluated whether IF reduces low-density lipoprotein cholesterol (LDL-C), regardless of weight loss, in patients with elevated LDL-C.

Hypothesis:
The Weekly ONe-Day watER-only Fasting interventionaL (WONDERFUL) randomized (1:1) controlled trial (NCT02770313) tested whether IF reduced LDL-C compared to
ad libitum
control over 6 months.

Methods:
Subjects (N=103) were ages 21-70 years, not taking a statin, had elevated baseline LDL-C (90-189 mg/dL for ages 21-39, 90-159 mg/dL for ages 40-70, ≥90 mg/dL for statin intolerant/contraindicated), and had diet-controlled type 2 diabetes or ≥1 metabolic syndrome feature but no anti-diabetes medication. The water-only IF regimen was 4 weeks of 2/week 24-hour IF followed by 22 weeks of 1/week 24-hour IF. Exclusions included pregnant, lactating, or chronic disease (e.g., CAD, MI, stroke/TIA, CKD, COPD, cancer, PE, PAD, DVT, dementia, type 1 diabetes).

Results:
At baseline, IF (n=50) and control (n=53) were, respectively, 49.3±12.0 and 47.0±9.8 years of age, 66.0% and 67.9% females, weight 103±24 and 100±21 kg, and LDL-C 124±19 and 128±20 mg/dL. Lost to follow-up (n=5 IF, n=4 control) and withdrawals (n=7 IF, n=16 control) gave a final sample of n=71 (n=38 IF, n=33 control). LDL-C change from baseline to 6 months was not different between IF and control (Table). HOMA-IR, one of 4 pre-specified secondary endpoints, was improved (-0.75 vs. -0.10) at p≤0.01 vs. control (Table).

Conclusions:
A once-per-week IF regimen did not reduce LDL-C compared to control, but HOMA-IR was significantly reduced. This more sustainable IF regimen may reduce some chronic cardiometabolic disease risks (e.g., HOMA-IR) with minimal effects on cholesterol and weight.
Abstract 14610: Renal Dysfunction in Adults With Congenital Heart Disease in Vietnam
Authors: Kim Ngoc Thanh , Le Thanh Tung , Do Doan Loi , Truong Thanh Huong
Published: November 2020

Introduction:
In Vietnam, knowledge about renal function in adults with congenital heart disease (CHD) is limited.

Hypothesis:
This study aims to estimate incidence of renal dysfunction in adults with congenital heart disease and risk factors.

Methods:
This is a cross-sectional study, including 365 CHD patients more than 16 years old. We collected clinical and para-clinical information, estimated glomerular filtration rate (GFR) and calculated the odds ratio (OR) for reduced GFR.

Results:
Totally, 52.8% patients had GFR < 90 ml/phút/1.73 m
2
. Logistic regression had confirmed the OR for GFR < 90 ml/phút/1.73 m
2
in the group > 60-years-old, the group with atrial fibrillation, the group with heart failure (based on NT-proBNP > 125 pmol/L), and the group with pulmonary arterial hypertension (based on pulmonary artery systolic pressure > 50 mmHg by echocardiography) were 6.46 (95% CI: 1.37 - 30.41), 7.58 (95% CI: 1.66 - 34.56), 2.98 (95% CI: 1.49 - 5.98) and 1.84 (95% CI: 1.02 - 3.33), respectively.

Conclusions:
Renal dysfunction is common in adults with CHD. Age > 60 years-old, atrial fibrillation, heart failure, and pulmonary arterial hypertension were risk factors for renal dysfunction in adults with CHD.