bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15537: An Electronic Health Record Intervention to Optimize Utilization of Transthoracic Echocardiography: Opportunity for Cost Savings in the Era of Value Based-care
Authors: Castaneda Jason , rearick corey , Weber Joseph , Edstrom Eve , Cassidy Kimisha , Arora Vineet , Ward R
Published: May 2021

Introduction:
In the current value-based era, targeting diagnostic resources and minimizing unnecessary testing is of paramount importance. Transthoracic echocardiography (TTE) is a common and costly test, and available Appropriate Use Criteria (AUC) guide optimal utilization. Limited TTE (L-TTE) shortens sonographer time, lowers cost and may be ideal for repeat TTEs (R-TTE) with a focused indication. However, many clinicians are unfamiliar with the AUC and opportunities for L-TTE. We prospectively tested an Electronic Health Record (EHR)-based intervention aimed at optimizing TTE utilization in a large academic medical center.

Methods:
TTE utilization at the University of Chicago Medicine was assessed over a 6-month period and complete TTE (C-TTE), L-TTE and R-TTE (TTE repeated within 6 months) were recorded. An EHR-based intervention was then implemented and TTE utilization was assessed over the ensuing 8 weeks. The intervention included presenting new descriptive L-TTE options (i.e. “Limited TTE: EF or Effusion Only”) when any “echo” was searched in the EHR order panel, an alert to prior TTEs (i.e. date & LVEF) and a link to AUC-based guidance for TTE ordering. Educational materials were also distributed to frequent TTE ordering providers.

Results:
Among 9121 TTEs (53% inpatient) pre-intervention
,
11% (n=1002) were L-TTEs and 25% (n=2320) were R-TTEs. There were more L-TTEs and R-TTEs in pre-intervention inpatients compared to outpatients (L-TTE 14% vs 7%, p<0.0001, R-TTE 33% vs 17%, p<0.0001). Post-intervention (2879 TTEs, 53% inpatient), R-TTEs significantly decreased (22.6% vs 25.4%, p=0.0019) and L-TTEs significantly increased (14% vs 11%, p<0.0001) compared to pre-intervention, with inpatient TTEs most impacted (R-TTE 28% vs 33%, p=0.0016, L-TTE 19% vs 14%, p<0.001). The intervention’s greatest impact was to markedly increase L-TTEs among inpatient R-TTEs (44% vs 35%, p=0.0002).

Conclusions:
Despite AUC discouraging frequent repeat TTEs, R-TTEs are common in an academic medical center and utilization of L-TTE is rare. An EHR-based intervention with prior TTE alerts and descriptive L-TTE options increases L-TTEs and reduces R-TTEs. Further study is warranted to describe the full clinical and financial impact of this intervention.
Abstract 15554: Mendelian Randomization of 436 Circulating Proteins Identifies Putatively Causal Proteins for Cardiovascular Disease and Its Risk Factors
Authors: Yao Chen , Hwang Shih-jen , Huan Tianxiao , Joehanes Roby , Levy Daniel
Published: May 2021

Introduction:
Despite numerous efforts to understand the molecular mechanisms underlying cardiovascular disease, it remains the leading cause of death worldwide. Circulating proteins are frequently used as clinical biomarkers and may serve as effective drug targets.

Hypothesis:
Identifying genetic variants associated with circulating protein concentrations (pQTLs) and combining them with genome-wide association study (GWAS) results may bridge a knowledge gap of unexplained heritability, identify potentially causal proteins, and highlight promising therapeutic targets.

Methods:
We measured concentrations of 436 plasma proteins among 484 Framingham participants using OLINK cardiovascular disease and inflammation panels. For each protein, we conducted a GWAS using 1000G imputed genotypes (imputation quality >20%). Then we performed two sample Mendelian randomization using cis-pQTLs (SNPs within 1Mb of transcriptional start site of the protein coding gene) as instrumental variables and 11 public cardiovascular trait GWAS (coronary artery disease (CAD), HDL cholesterol, LDL cholesterol, triglycerides (TG), body mass index (BMI), obesity, fasting blood glucose, type 2 diabetes, systolic blood pressure, diastolic blood pressure, and Hypertension) as outcomes.

Results:
At Bonferroni-corrected P<0.05, we identified 5281 cis-pQTLs for 76 proteins. Mendelian randomization identified 13 putatively causal proteins for seven cardiovascular traits: FGF-5, IL-6RA, LPL , and TFPI for CAD; CAPG, IGG_FCrrec, LPL, and TFPI for HDL; KIM1, LPL, and TNFB for TG, ENTPD6 for BMI; FGF-5, TFPI, UMOD, IGFBP3, PXN, and NUCB2 for blood pressure traits.

Conclusions:
At Bonferroni-corrected P<0.05, we identified 5281 cis-pQTLs for 76 proteins. Mendelian randomization identified 13 putatively causal proteins for seven cardiovascular traits: FGF-5, IL-6RA, LPL , and TFPI for CAD; CAPG, IGG_FCrrec, LPL, and TFPI for HDL; KIM1, LPL, and TNFB for TG, ENTPD6 for BMI; FGF-5, TFPI, UMOD, IGFBP3, PXN, and NUCB2 for blood pressure traits.
Abstract 15556: Clinical Outcomes After Routine Cox-MAZE IV and Appendectomy and Aggressive Left Atrial Plication Added to Mitral Valve Repair for Atrial Functional Mitral Regurgitation
Authors: Ikeda Naoko , Wakabayashi Kohei , Tanno Kaoru , Yamaguchi Hiroki
Published: May 2021

Introduction:
Atrial functional mitral regurgitation (AFMR) is one of the significant factors to worsen the outcomes in heart failure. The optimal therapy for AFMR is still controversial. Previous studies reported AFMR patients underwent mitral valve repair alone frequently had heart failure re-hospitalization or stroke after surgery. New guidelines recommend adding surgical ablation as a concomitant procedure for class I indications. However, many surgeons avoid concomitant procedure especially in patients with extremely enlarged left atrium (LA) and long atrial fibrillation (AF) duration.

Hypothesis:
Routine strategy of adding surgical ablation and appendectomy and aggressive LA plication to mitral valve repair might improve the outcomes with keeping sinus rhythm and without stroke events in AFMR patients.

Methods and Results:
We investigated 35 consecutive patients with severe AFMR who underwent surgery in our institute between 2014 and 2018. Our strategy was Cox-maze IV and appendectomy for all patients and if LA volume was more than 200 ml by echocardiography, we added LA plication. In addition to clinical data and conventional echocardiographic assessment (Table), left ventricular (LV) function was evaluated using 2D speckle tracking echocardiography. MR grade improved in all patients. Despite enlarged LA, 76% of patients regained sinus rhythm and atrial kick was detected by pulse doppler method (mean value: 55 ± 19 cm/s). After 2-year follow-up, LV global longitudinal strain and LA peak strain were significantly improved (Table). During 4.1 ± 1.3 years observation, no patient experienced heart failure re-hospitalization and stroke.

Conclusions:
Majority of AFMR patients had long duration of AF and severely enlarged LA. The routine Cox-maze IV, appendectomy and aggressive LA plication in enlarged LA patients improved LV and LA function. This strategy may contribute to the better long-term outcomes of AFMR compared to mitral valve repair alone.
Abstract 15558: Characterization of Sarcolemmal K
Atp
Channels in Human Ipsc-derived Cardiomyocytes
Authors: Geiger Robert , Fatima Naheed , Klein Michael , Goldstein Robert E , HAIGNEY Mark C , Flagg Thomas P
Published: May 2021

Background:
The ATP-sensitive potassium channel (KATP) plays a key role in protecting heart muscle during metabolic challenges such as ischemia. KATP activation causes action potential shortening that reduces calcium entry and contraction thus reducing calcium overload induced damage and preserving energy reserves. Cardiomyocytes derived from human inducible pluripotent stem cell (hiPSC) have emerged as a model to study cardiac function, however there are few studies that have focused on KATP.

Methods:
In the present study, cardiomyocytes were either generated from hiPSC using heparin- based chemically defined media or purchased from Cellular Dynamics (iCells2). Expression of the pore-forming (Kir6.2) and regulatory (SUR1 & SUR2) subunits of the KATP channel during differentiation were assessed using western blot. KATP function was assessed by measuring the field potential duration (FPD) and spontaneous beat rate in a confluent monolayer using the Axion Maestro multielectrode array system. Cells were probed using the KATP activators P1075 and diazoxide, specific for SUR2 and SUR1, respectively.

Results:
We found that the pore-forming subunit of the sarcolemmal KATP channel (Kir6.2) was expressed in iPSC and maintained throughout the course of differentiation. Consistent with the typical composition of sarcolemmal KATP, we observe a significant increase of SUR2 but little SUR1 protein following
Wnt
inhibition. Functionally, the FPD is markedly reduced by P1075 in a concentration-dependent manner, with 24% reduction at 100 nM and 92
%
reduction at 100 μM. Moreover, glibenclamide 10μM reduces FPD shortening confirming a role for KATP. Finally, we observe little change in FPD when cells are exposed to diazoxide (100 μM) consistent with reduced SUR1 protein levels.

Conclusion:
These results indicate that cardiomyocytes derived from human iPSC express the KATP channel composed of primarily the SUR2 isoform and suggest that iPSC derived cardiomyocytes would be an effective model for studying the role of KATP during metabolic challenges.
Abstract 15565: Long-term Dietary and Weight Changes Following a Short-term Dietary Intervention Study: 4-year Follow-up of the Evade Cad Trial
Authors: Dogra Siddhant , Getz Alec , Woolf Kathleen , Newman Jonathan D , Xia Yuhe , Slater James , Shah Binita
Published: May 2021

Introduction:
The randomized EVADE CAD trial demonstrated greater reduction in high sensitivity C-reactive protein and LDL-cholesterol with a vegan vs. AHA-recommended diet in patients with coronary artery disease on guideline-directed medical therapy. The 8-week intervention included provision of groceries, cooking tools, and regular contact with a registered dietitian.

Methods:
Trial participants underwent telephone follow-up to obtain self-reported dietary adherence, 24-hour dietary recall, self-reported weight, and major adverse cardiovascular events (MACE). Supporting medical documents for MACE were reviewed by investigators.

Results:
Two participants in the vegan arm withdrew during the trial leaving 98 participants available for follow-up. The vegan group reported significantly lower dietary adherence at all follow-ups when compared to the AHA group; however, adherence rates were numerically higher in both groups when assessed by 24-hour dietary recall vs. self-report (F1A-B). The two groups did not differ in self-reported rating of the healthiness of their current diet (F1C). Both groups continued to have significantly lower weight when compared to baseline up to 3 years follow-up, but only the vegan group remained lower at year 4. Percent weight lost from baseline did not differ between groups. Cumulative MACE incidence also did not differ between groups (F2).

Conclusions:
Although the vegan diet was not sustainable long-term when compared to the AHA-recommended diet, both groups did not differ in self-reported rating of the healthiness of their current diet or incidence of MACE and had sustained weight loss after the active intervention was complete.
Abstract 15568: Profound Increases in Out-of-Hospital Cardiopulmonary Arrest Cases Within Most Metropolitan Municipalities During the COVID-19 Pandemic
Authors: Pepe Paul E , McVaney Kevin E , Maloney Lauren M , Bronsky Eric Stein , Augustine James J , Asaeda Glenn H , Eckstein Marc K , Osterholm Michael T ,   Writing Group for the Metropolitan EMS Med Directors Global Coalition
Published: May 2021

Introduction:
Even though most EMS systems globally experienced dramatic decreases in call volumes during the COVID-19 pandemic, many also reported unexpected increases in out-of-hospital cardiac arrest (OHCA) cases.

Hypothesis:
The pervasiveness of COVID-19 in metropolitan cities might be associated with a greater number of OHCA cases as compared to prior years.

Methods:
Large city EMS system medical directors responsible for about one-quarter of the U.S. population and millions of others in Europe/Australia were asked to tabulate the absolute number of OHCA cases to which EMS responded within their jurisdictions during the first 4 months of 2020. Results were compared to average numbers encountered during 2018 and 2019. A priori, considering the large populations (high corresponding OHCA frequencies) and case complexities, a 15% increase/decrease was to be considered highly significant (usual variation + 4-8% within the 28-31 days/month).

Results:
Of 35 major U.S. cities reporting to date, most had significant increases in OHCA, particularly in April with 71% (25/35) of the cities seeing a very large (>15%) increase. Nine cities (26%), all experiencing a high prevalence of COVID-19, had >50% (1.5-fold) increases. Three cities with highly-publicized inundations of COVID-19, experienced more than twice as many arrests (3.5-fold in the worst case). Meanwhile, 3 other cities with relatively low COVID-19 impact to date, had significantly fewer cases. Still, combining all of the 35 cities studied, OHCA increased from 5,009 (2 prior years’ average) to 8,701 (74% increase) during April (Fig 1). Participating cities outside the U.S. (e.g., Paris, London, Perth) mirrored these findings.

Conclusions:
To date, most, but not all, metropolitan cities have clearly experienced significant increases in OHCA that appear to parallel the prevalence of COVID-19 in their respective jurisdictions. These observations and available forensic data are now part of a work in progress.
Abstract 15585: Sex Dimorphism in Prostaglandins’ Role in Thromboxane-dependent Contraction in the Rat Middle Cerebral Artery
Authors: Pulgar Victor M , Elsaangeedy Ibrahim , Yamaleyeva Liliya M
Published: May 2021

Introduction:
Recent evidences suggest that sex and estrogen can influence cerebrovascular reactivity. We investigated the role of prostanoids and the estrogen receptor (ER)
ex vivo
in isolated middle cerebral arteries from male (M-MCA) and female (F-MCA) rats.

Methods:
MCA segments isolated from 20-week-old male and female Sprague-Dawley rats were mounted on a wire Multi Myograph (DMT) to measure isometric tone. Acetylcholine (ACh) was used to assess endothelium integrity. Concentration response curves to the thromboxane analog U46619 (U4, 10
-11
-10
-5
M) were performed in arteries intact or pre-treated with indomethacin (I,10
-5
M) or the ER antagonist G15 (G, 10
-6
M). Data were acquired with Powerlab 8 (ADInstruments) and recorded with LabChart v8 (ADInstruments). Response to K
+
was expressed in mN/mm whereas U4 maximal contraction as percent of maximal response to 75mM K
+
(%K
MAX
) and sensitivity as pD
2
(-LogEC
50
).

Results:
M-MCA (n=10) and F-MCA (n=13) displayed similar optimal diameters (M vs. F; 214±12
vs.
218±5 μm, p>0.05) and ACh-dependent relaxation (M vs. F; 71±11
vs.
78±10 % pre-constricted tone; 7.3±0.4
vs.
7.2±0.2, p>0.05). A greater contraction to K
+
was observed in M-MCA (M
vs.
F; 1±0.2
vs.
0.6±0.1 mN/mm, p<0.05). M- and F-MCA showed similar maximal contraction (M
vs.
F; 116±6
vs.
109±10 %K
MAX
) and sensitivity (M
vs.
F; 7.2±0.2
vs.
7.3±0.2) to U4. Pre-incubation with Indomethacin lowered maximal response and sensitivity (M vs. M-I; 116±6
vs.
97±5%K
MAX,
p<0.05; 7.2±0.2
vs.
6.8±0.1, p<0.05) to U4 in M-MCA, with no effect on F-MCA (F
vs.
F-I; 109±9
vs.
113±7%K
MAX
; 7.3±0.2
vs.
7.3±0.2). Pre-treatment with G15 increased U4 sensitivity in M-MCA (M vs. M-G; 7.3±0.2
vs.
7.8±0.2, p<0.05), with no effect in F-MCA (F vs. F-G; 7.3±0.2
vs.
7.4±0.3).

Conclusions:
Our data demonstrate sex differences in thromboxane-dependent contraction of MCA in middle-aged rats. Hormonal changes during the estrous cycle may contribute to a greater variability of F-MCA responses.
Abstract 15589: Mitochondrial Metabolites Predict Cardiovascular Outcomes and Heart Failure in People With Type 2 Diabetes Mellitus and Vascular Disease: A Tecos Substudy
Authors: Regan Jessica A , Green Jennifer , Truby Lauren K , Nguyen Maggie , Giamberardino Stephanie , Mentz Robert J , McGarrah Robert W , Zheng Yinggan , Buse John B , McGuire Darren K , standl eberhard , Armstrong Paul W , Holman Rury R , Peterson Eric D , Shah Svati H
Published: May 2021

Introduction:
People with type 2 diabetes mellitus (DM) have a large burden of cardiovascular (CV) morbidity and mortality, but the likelihood of these outcomes varies and existing risk calculators do not fully capture risk for individuals.

Hypothesis:
Circulating metabolites characterizing mitochondrial dysfunction may be novel predictors for CV outcomes.

Methods:
We performed targeted mass-spectrometry metabolite profiling (45 acylcarnitines, 15 amino acids) on baseline plasma samples from 568 cases (498 with major adverse cardiac events (MACE) and 131 with incident hospitalization for heart failure (hHF)) and 568 matched controls (without events) from the patients assigned to placebo in Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS). Matching was based on history of HF, coronary artery disease, BMI, hemoglobin A1C, creatinine, low-density lipoprotein cholesterol, fasting status and ejection fraction. Principal components analysis (PCA) was used for dimensionality reduction, and conditional logistic regression to determine association of PCA factors with MACE or hHF and for individual metabolites within significant factors (false discovery rate q<0.05)

Results:
Of 12 PCA-derived metabolite factors, three were associated significantly with MACE or hHF; these factors were composed of: 1) short-chain dicarboxylacylcarnitines and long chain acylcarnitines (OR 1.50, q=0.03); 2) medium chain acylcarnitines (OR 1.28, q=0.001); 3) C5:1 and one medium-chain dicarboxylacylcarnitine (OR 1.17, q=0.03). Of these three factors, none were significantly associated with the individual components of MACE. Ten individual metabolites, including short- and medium-chain dicarboxylacylcarnitines and medium- and long-chain acylcarnitines, remained significantly associated with MACE (q<0.05). Two metabolites, one short-chain dicarboxylacylcarnitine and one medium-chain acylcarnitine were associated with hHF (q<0.05).

Conclusions:
Metabolites reporting on dysregulated mitochondrial fatty acid oxidation and endoplasmic reticulum stress are elevated in individuals with DM who progress to MACE and/or hHF. These biomarkers may improve CV risk prediction in DM patients and help highlight emerging risk mechanisms.
Abstract 15604: Staging Cardiac Damage in Patients With Secondary Mitral Regurgitation
Authors: Singh Gurpreet , Namazi Farnaz , Hirasawa Kensuke , Ajmone Marsan Nina A , Delgado Victoria , Bax Jeroen J
Published: May 2021

Introduction:
Patients with secondary mitral regurgitation (SMR) often show extra-mitral valvular cardiac damage which can influence the prognosis. SMR can be defined according to stages of extra-mitral valvular cardiac damage. The present study evaluated the prevalence of different stages of extra-mitral valvular cardiac damage and the prognostic implications in moderate and severe SMR patients.

Methods:
A total of 648 patients with moderate and severe SMR were classified according to the extent of cardiac damage on echocardiography: left ventricular damage (Stage 1), left atrial damage (Stage 2), pulmonary artery vasculature damage (Stage 3) or right ventricular damage (Stage 4). Cox proportional hazards analyses were performed, both on, non-censored and censored data (included till the occurrence of mitral valve intervention). The primary endpoint was all-cause mortality.

Results:
The prevalence of each stage of the proposed classification was, 10% in Stage 1, 7% in Stage 2, 16% in Stage 3 and 67% in Stage 4. In the censored data, cardiac damage classification was independently associated with all-cause mortality (HR: 1.182, CI :1.019-1.370; P=0.027), and this was mainly driven by Stage 4 (HR: 1.726 CI: 1.034-2.881; p=0.037, Figure 1A). The non-censored data, showed that Stage 3 was independently associated with all-cause mortality (HR: 1.795 CI:1.121-2.876; P= 0.015), whereas Stage 4 showed an increased non-significant risk for all-cause mortality (HR: 1.472 CI:0.973-2.227; P=0.067, Figure 1B).

Conclusions:
A new proposed staging classification for moderate and severe SMR showed, that cardiac damage staging was independently associated with all-cause mortality in patients censored for mitral valve intervention, and this was mainly determined by RV dysfunction.
Abstract 15607: Right Atrial Reservoir Strain Predicts Survival in Patients With Cardiac Amyloidosis
Authors: Huntjens Peter , Zhang Kathleen , Soyama Yuko , Karmpalioti Maria , Lenihan Daniel , Gorcsan John
Published: May 2021

Introduction:
Myofibril deposition in amyloidosis diffusely may affect cardiac structure and function. Right ventricular involvement has been associated with adverse clinical outcome. However, the utility of right atrial (RA) function assessment by echocardiographic strain imaging is unclear.

Hypothesis:
We hypothesize that right atrial stain has prognostic value in cardiac amyloidosis.

Methods:
We studied 121 consecutive patients with cardiac amyloidosis: 18% had transthyretin and 79% had light chain amyloidosis. Cardiac amyloidosis was either confirmed by endocardial biopsy (36%) or by a combination of non-cardiac tissue biopsy and proof of left ventricular hypertrophy (64%). Speckle tracking peak RA reservoir strain was assessed based on 6 segments from the apical 4-chamber view. All-cause mortality was tracked over a median of 5 years.

Results:
Echocardiographic peak longitudinal RA strain was feasible in 109 patients (90%). 60 CA patients died during follow-up period. Peak longitudinal RA strain was reduced in cardiac amyloidosis non-survivors (8.1%) in comparison to survivors (18.3%, p<0.01), showing RA involvement in cardiac amyloidosis. Peak RA strain was significantly associated with survival (using median 12.5%) (p<0.001). Low peak longitudinal RA strain was associated with a 3.3-fold increase in mortality risk (95% confidence interval: 1.83 - 5.96).

Conclusions:
Reduced peak longitudinal RA strain was significantly associated with survival in patients with cardiac amyloidosis. RA reservoir function assessed by strain appears to be useful as a new means to predict prognosis in cardiac amyloidosis patients and has promise for clinical application.
Abstract 15612: Force, Power, and Temperature Settings in Slow Pathway Modification Utilizing an Irrigated Force Sensing Ablation Catheter
Authors: Blumfield Amit , Chudow Jay , Fisher John D , DiBiase Luigi , Ferrick Kevin J , krumerman andrew
Published: May 2021

Introduction:
Atrioventricular node reentry tachycardia (AVNRT) ablation is typically performed with solid tip catheters set to temperature control (TC) mode. Radiofrequency (RF) output, tip temperature (T), and junctional rhythm response (JRR) during RF application have been well defined. JRR in an intermittent burst, sinus-junction-junction, or sinus-junction-sinus pattern is associated with successful modification of the AV nodal slow pathway (SP). Irrigated force-sensing catheters (IFSC) are often utilized for mapping and ablation of the SP. Despite this, parameters for IFSC used in TC mode resulting in JRR have not been well described.

Hypothesis:
Parameters predicting JRR and successful SP modification with IFSC include power (P), force (F), impedance drop (I), and target temperature (T).

Methods:
Consecutive patients that underwent electrophysiologic study and successful ablation of typical AVNRT with an IFSC were studied. Lesion parameters including P, T, F, time and I change were analyzed. Lesions producing JRR were considered efficacious. Independent T-Test and ANOVA were used to determine significance between the two groups (efficacious and non-efficacious lesions).

Results:
296 lesions in 39 patients (age 52+/-14) were analyzed. All patients had successful SP modification without complication. Average F producing JRR was 8g, average T producing JRR was 41
o
C, average I drop producing JRR was 9 Ohms, and average P producing JRR was 28W. Only RF lesion time was a significant predictor of JRR (p=0.009). (Table 1).

Conclusions:
Successful SP modification with IFSC was accomplished with catheter contact force as low as 2g. Lower average tip T, and lower average P settings compared to parameters typically used with solid tip catheters were observed. Parameters including P, F, T, and I change were not predictive of JRR. Additional studies controlling for catheter location while varying parameters are indicated.
Abstract 15620: Diagnostic Performance of Ultra-high-resolution CT Coronary Angiography in Patients With Severe Coronary Artery Disease: Initial Experience
Authors: Latina Jacqueline M , Shabani Mahsima , Kapoor Karan , Sesso Jaclyn , Trost Jeffrey , Demehri Shadpour , Mahesh Mahadevappa , Ac Lima Joao , Zadeh Armin
Published: May 2021

Introduction:
Conventional resolution coronary CTA (CRCT) is frequently avoided in patients with heavy calcification and prior stents given the diminished diagnostic accuracy. Ultra-high-resolution CT (UHRCT) with detector width of 0.25 mm may overcome partial volume effect limitations.

Hypothesis:
We hypothesize that UHRCT yields high accuracy for detecting obstructive coronary arterial stenoses in patients with severe coronary artery disease using cardiac catheterization as reference standard.

Methods:
Nine patients ≥45 years with severe coronary artery disease referred for invasive coronary angiography were prospectively enrolled at a single center. Patients underwent UHRCT within 30 days prior to catheterization and results for significant coronary artery stenoses (≥70%) by visual assessment by blinded expert readers for the two tests were compared. Diagnostic accuracy assessment was performed at a patient-level (N=9) and vessel-level (N=36).

Results:
Median patient age was 67 (range 53-77). Six patients were obese and 6 had prior stent placement. Estimated radiation dose was 9.3 mSv. Mean Agatston calcium score of patients without stents was 1,688. UHRCT correctly classified all patients as having obstructive or non-obstructive coronary heart disease, respectively, yielding 100% accuracy (95% confidence interval [CI] 64-100%). On a vessel level UHRCT had an accuracy of 93% (95% CI 78-98%).

Conclusions:
Our initial experience with UHRCT in patients with severe coronary calcification or prior stenting suggests high accuracy for detecting and excluding obstructive stenoses. These results warrant further studies to confirm a role of UHRCT in this challenging population.
Abstract 15622: Impact of Cardiac Rehabilitation on Six-Month Adherence to Cardiovascular Pharmacotherapy: Insights From the Ami-Optima 2 Study
Authors: La Fontaine Alexandre , Bruyninx Gladys , Nguyen Michel , Montigny Martine , Mansour Samer , Barabas Melinda , Tardif Jean-Claude , Huynh Thao
Published: May 2021

Introduction:
It remains unclear whether cardiac rehabilitation (CR) can enhance adherence to cardiovascular (CV) medications. We aim to determine the impact of CR on 6-month adherence to CV pharmacotherapy.

Methods:
We conducted a prospective observational cohort study of patients hospitalized for acute coronary syndromes (ACS) in Quebec, Canada, during 2016-2018. The primary endpoint was 6-month adherence to all of these drugs (dual anti-platelets, beta-blockers, hypocholesterolemiants, angiotensin pathway inhibitors). The secondary endpoints were adherence to each individual class of CV medication. Adherence was determined by measuring the proportion of days covered (PDC) (evaluated by pharmacies refills). PDC was measured both as continuous and categorical variables. Suboptimal adherence was defined as PDC< 80%. We used inverse probability weighting to adjust for various factors which may have influenced the referral for CR and confounded the impact of CR on 6-month adherence (age, sex, coronary angioplasty, marital status, education, and occupation). All patients signed informed consent.

Results:
We enrolled 318 patients. Their mean age was 66±12 years; 30% were females. Of these patients, 152 undertook CR and 166 received standard follow-up. The mean age was 68 and 64 years, respectively. The proportions of females were similar in both groups. Overall PDC were 96%±13% vs 93%±17%; 7.2% and 11.2% patients had 6-month suboptimal adherence, respectively in patients who had CR vs patients without CR. After inverse weighting adjustment, CR was independently associated with improved adherence only with hypocholesterolemiants (Table 1).

Conclusion:
CR was not associated with improved 6-month overall adherence. However, patients who undertook CR were more adherent to hypocholesterolemiants than patients who did not undergo CR. CR programs should reinforce further to patients the importance of adherence to all ACS medications.
Abstract 15628: HeartCare: Improving Clinical Practice Through Comprehensive Cardiovascular Genetic Testing
Authors: Murdock David , Hadley Trevor , Venner Eric , Muzny Donna , Metcalf Ginger , Murugan Mullai , Chander Varuna , Jia Xiaoming , Hussain Aliza , Hu Jianhong , Cohen Michelle , Kovar Christie , Gingras Marie-Claude , Korchina Viktoriya , Howard Chad , Riconda Daniel , Pereira Stacey , Smith Hadley , DeVries Paul , Huda Zohra , Buentello Alexandria , Marino Patricia , Civitello Andrew , Chelu Mihail , Leiber Lee , McGuire Amy , Balasubramanyam Ashok , Amos Chris , Boerwinkle Eric , Ballantyne Christie M , Wehrens Xander , Gibbs Richard
Published: May 2021

Introduction:
Cardiovascular disease (CVD) is the leading cause of mortality in the United States, leading to one in four deaths. The role of inherited susceptibility to CVD is well established, from rare monogenic disorders to polygenic traits. For many of these conditions, guidelines exist for medical interventions and other preventative care that can improve outcomes and quality of life.

Methods:
We developed a comprehensive genetic screen, "HeartCare", consisting of a 158 gene panel evaluating 1) Mendelian conditions including cardiomyopathies, aortopathies, arrhythmias, and dyslipidemias, 2) a coronary artery disease polygenic risk score (PRS), 3) variants in the LPA gene encoding Lipoprotein(a) that are an independent risk factor for atherosclerotic CVD events, and 4) pharmacogenetic (PGx) variants contributing to simvastatin-induced myopathy and warfarin metabolism. After sequencing in a CAP/CLIA certified laboratory, results were returned to the ordering physician after a multi-disciplinary sign-out conference and uploaded to the EMR.

Results:
As of June 2020, 678 individuals had completed testing with a 31% overall positive rate for Mendelian genes, elevated polygenic risk, and LPA risk alleles (excluding PGx). Of these, 8.1% had a positive finding for a Mendelian condition, the majority (60%) being dyslipidemias (e.g., FH), followed by 25% cardiomyopathies (e.g., HCM, DCM, ARVC) and 6% aortopathies (e.g., Marfan, Loeys-Dietz). Approximately 20% of individuals carried an LPA risk allele, and 9.3% belonged to the high-risk group according to their PRS. Approximately half had a PGx finding related to simvastatin and/or warfarin metabolism. Nearly one in five individuals had a finding with direct clinical care impact, including referral to specialists, imaging, laboratory studies, therapies/procedures (e.g., PCSK9i, ICD).

Conclusions:
To our knowledge, this is the first test of its kind assaying four distinct categories of genetic variation related to cardiovascular health. Our results demonstrate that comprehensive testing can be routinely used to identify individuals who may benefit from interventions to improve survival, reduce morbidity, and enhance quality of life.
Abstract 15629: Optimal Metrics for Assessing Donor-recipient Size Mismatch in Pediatric Heart Transplantation: A PHTS Multi-institutional Analysis
Authors: Amdani Shahnawaz , Aljohani Othman , Kirklin James K , Cantor Ryan , Koehl Devin , Schumacher Kurt , Nandi Deipanjan , Khoury Michael , Dreyer William , Rose-Felker Kristen , Nasman Colleen M , Kemna Mariska
Published: May 2021

Introduction:
Traditional weight & height ratios as measures of donor-recipient (D-R) matching have been challenged in adult heart transplantation (HT). The optimal metrics for D-R matching in pediatric HT remain unclear, and were evaluated in the present study.

Methods:
All primary pediatric HT recipients in the Pediatric Heart Transplant Society database transplanted from 1993-2019 were included. Multiple metrics of size matching - height, weight, body mass index (BMI), body surface area (BSA), predicted heart mass (PHM) and total cardiac volume (TCV) were assessed to identify the metrics that would best predict 1-year post-transplant (PTx) graft loss (death/re-transplant). Kaplan-Meier analyses (risk unadjusted) and multivariate Cox proportional hazard models (risk adjusted) were used to assess the effect of differences of various size matching metrics on survival.

Results:
Among 6903 D-R pairs, multivariable hazard modeling identified the following risk factors for PTx mortality: female sex, black race, bilirubin, ECMO, VAD, mechanical ventilation, ICU admission at the time of transplant, presence of congenital heart disease, early era of transplant, donor ischemic time and cardiopulmonary bypass time. After adjusting for all covariates, increasing size mismatch by height, BSA, or PHM was associated with increased 1-year PTx graft loss, with a disproportionately higher hazard for undersized donors than oversized donors (Figure). Weight, BMI and TCV were not predictive of 1-year PTx graft loss on multivariate analysis.

Conclusions:
In pediatric HT recipients, increasing size mismatch by height, BSA and PHM is associated with increased 1-year PTx graft loss. Undersizing donors appears to carry a higher risk than oversizing.
Abstract 15642: Race Sex Disparities in Atherosclerotic Cardiovascular Disease in Hospitalized Patients With Diabetes, 2005-2015 Potential Warning Signs for Future U.S. Public Health
Authors: Sidhu Gursukhman , Ward Charisse J , Ferdinand Keith
Published: May 2021

Introduction:
Despite a recent gradually slowing and perhaps recent increase in the burden of atherosclerotic cardiovascular disease (ASCVD) related hospitalization in the United States population with diabetes, it is unclear whether the prior downward trend was uniform or there was an unbalanced division amongst sex and race.

Methods:
Adults aged ≥40 years old with comorbid diabetes as a secondary diagnosis were identified using the U.S. 2005-2015 National (Nationwide) Inpatient Sample (NIS) data. The prevalence of other modifiable cardiovascular risk factors (hypertension, dyslipidemia, smoking/substance abuse, obesity, and renal failure), procedures like major amputations in the secondary diagnosis field and their association with ASCVD (acute coronary syndrome (ACS), coronary artery disease (CAD), stroke, or peripheral arterial disease (PAD)) as the first-listed diagnosis were determined. Complex samples multivariate regression was used to determine the odds ratio (O.D.) with 95% confidence limits (C.L.s). Sex and race risk-adjusted ASCVD related in-hospital mortality rates were estimated.

Results:
The rate of total ASCVD hospitalizations adjusted to the U.S. census population increased by 5.7% for black men compared to 4% for black women cumulatively compared to a stable downtrend in white men and white women. There was a higher odd of an ASCVD hospitalizations if there was comorbid hypertension (Odds Ratio (OR 1.29; 95% Confidence Interval (CI) 95% 1.28 - 1.31), dyslipidemia (OR 2.03; 95% CI 2.01 - 2.05), renal failure (OR 1.84; 95% CI 1.82 - 1.86), and smoking/substance use disorder (OR 1.31; 95% CI 1.29 - 1.33). When compared to white men, black men (OR 1.43; 95% CI 1.3 - 1.57) and black women (OR 1.15; 95% CI 1.04 - 1.27) had a higher likelihood of undergoing a major limb amputation during an ASCVD hospitalization.

Conclusions:
Blacks with diabetes continue to have a higher hospitalizations burden with a concomitant disparity in procedures and outcomes.
Abstract 15651: The Burden of Nontreatment or Undertreatment Among Non-valvular Atrial Fibrillation Patients With Elevated Stroke Risk: A Systematic Literature Review of Real-world Evidence
Authors: Di Fusco Manuela , Sussman Matthew , Barnes Geoffrey , Tao Charles , Gillespie John A , Ferri Mauricio , Adair Nicholas , Cato Matthew , Shirkhorshidian Ilnaz , Guo Jennifer
Published: May 2021

Introduction:
Global treatment guidelines (e.g., AHA/ACC/HRS, ESC, JCS) recommend treatment with oral anticoagulants (OACs) for patients with non-valvular atrial fibrillation (NVAF) and an elevated stroke risk, defined by CHA
2
DS
2
-VASc score ≥2. However, not all patients with NVAF and an elevated stroke risk receive guideline-recommended therapy. A systematic literature review of observational studies was undertaken based on PRISMA guidelines to identify the body of evidence on untreated and undertreated NVAF among patients with elevated stroke risk, and assess its epidemiological and clinical burden.

Methods:
An extensive search of MEDLINE, GoogleScholar, the Cochrane Library, relevant conference proceedings, and health technology assessments (HTAs) was conducted for RWE studies. Studies published between 1/2010-4/2020 were included if they evaluated rates of nontreatment or undertreatment in NVAF. Nontreatment was defined as absence of OACs, while undertreatment was defined as treatment with only antiplatelet agents. Studies focusing on valvular AF were excluded.

Results:
Thirty-nine published studies (13 countries) met inclusion criteria. Rates of nontreatment for patients with elevated stroke risk ranged from 2.0%-51.1% (median: 23.3%), while rates of undertreatment ranged from 10.0%-45.1% (median: 34.6%). Few studies assessed the relationship between nontreatment or undertreatment and clinical outcomes in the evaluated population. Among US outpatients with NVAF and an elevated stroke risk, those undertreated had a higher likelihood of death (HR: 1.22; 95% CI: 1.05-1.41; p=.006) compared to patients treated with OACs. Also, in a separate US study of NVAF patients with varying levels of warfarin exposure, patients with no warfarin exposure had significantly higher rates of ischemic stroke than patients with low adherence (4.41 vs. 1.87 per 100 person-years, p<.001) or high adherence (4.41 vs. 0.72 per 100 person years, p<.001).

Conclusion:
Rates of nontreatment and undertreatment among NVAF patients with elevated stroke risk remain high and are associated with potentially preventable cardiovascular events and death. Strategies to increase rates of treatment may reduce adverse clinical outcomes.
Abstract 15668: Noninvasive Mapping Can Predict Success of Ablation for Atrial Fibrillation
Authors: Ravi Namita , Waddell Kian , Rappel Wouter-Jan , Rodrigo Miguel , Narayan Sanjiv M
Published: May 2021

Introduction:
It is currently not possible to non-invasively identify patients with atrial fibrillation (AF) who may respond acutely to ablation. We hypothesized that high resolution body surface mapping can identify specific distributions of AF in individuals that predict acute success from ablation.

Objective:
To correlate 64 lead body surface ECG in AF to acute ablation response and non-invasively identify patients in whom ablation does and does not terminate AF.

Method:
Fig A shows 64 body surface electrodes in N=17 consecutive AF patients (14 persistent AF, 67 ± 9.06 years). Spectral dominant frequency (DF) from 4096-point FFT, cycle length, AF electrogram amplitude were measured in 200-300 time slices of duration 60s between patches on the body surface representing each atrium (Fig A).

Results:
Ablation terminated AF in N=7/17 patients (41.2%, Fig. B). Patients with AF termination had more organized AF than those without termination, indicated by lower DF on body surface mapping of the regions corresponding to left (5.00 ± 1.33 vs 5.47 ± 1.30, p < 0.001) and right atrium (5.16 ± 1.50 vs 5.50 ± 1.01, p < 0.003) (Fig C shows composite). DF was stable without statistically significant variations across 20s slices spanning the full minute, supporting interpretability of mechanisms from this analysis (p = NS). Further, AF signal amplitude averaged across left and right atria was lower in patients with AF termination (65.47 ± 36.9 vs 120.13 ± 99.9, p < 0.001) (Fig D).

Conclusion:
Body surface analysis of AF can non-invasively identify patients in whom ablation may acutely terminate AF. Future studies should determine if this approach can predict who may ultimately achieve long term freedom from AF, and whether body surface signatures are representative enough to be analyzed days prior to the procedure.
Abstract 15670: Age-related Differences in the Contribution of Systolic Blood Pressure and Biomarkers to Cardiovascular Disease Risk Prediction: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Al Rifai Mahmoud , Ndumele Chiadi E , De Lemos James A , Sun Caroline , Hoogeveen Ron C , AGUILAR David , Khera Amit , Virani Salim S , Taffet George E , Matsushita Kunihiro , Selvin Elizabeth , Ballantyne Christie M , NAMBI VIJAY
Published: May 2021

I
ntroduction:
Systolic blood pressure (SBP) is an important component of all cardiovascular disease (CVD) risk prediction equations but its biological variability and impact on estimated risk is a concern. Furthermore, predictive value of SBP may differ in older individuals where traditional risk factors (TRF) are less predictive.

Hypothesis:
Biomarkers reflecting hypertension-related end organ injury (hsTnT, NT-proBNP, eGFR), improve CVD risk prediction in older but not middle age adults as compared to SBP.

Methods:
Using data from visits 2 (1990-92) and 5 (2011-13) of ARIC, we developed 3 models- Model 1 included all TRF; Model 2- all TRF except SBP + individual biomarkers and Model 3 all TRF + individual biomarkers. C-statistics were used to assess risk discrimination for coronary heart disease, stroke, heart failure, and CVD.

Results:
After excluding those with prevalent CVD, there were 12,567 individuals at visit 2 (mean age 57, SD 6 years; 43% men) and 4,508 individuals at visit 5 (mean age 76, SD 5 years; 37% men). Over a median (IQR) follow-up time of 22 (12.4–26.7) years and 6.2 (5.4–6.8) years, the incidence rates of CVD events (per 1000 person-years) were 19.0 and 21.8 at visits 2 and 5, respectively. At visit 2, the model with SBP and biomarkers resulted in the largest improvement in C-statistic and SBP contributed to all models. However, at visit 5, removing SBP from the models with the biomarkers had no impact on C-statistic while the addition of the biomarkers (especially hsTnT and NT-proBNP) significantly improved C-statistics for most outcomes (
Table
). Among the biomarkers eGFR had the least additive value.

Conclusions:
HsTnT and NT-proBNP significantly improve risk discrimination of CHD, stroke, and HF among middle and older adults, while SBP has value in middle age but not in older age. Biomarkers should be considered in risk prediction equations in older individuals where the value of TRF such as SBP decrease.
Abstract 15674: Cardiovascular Manifestation and Its Association With In-hospital Outcome in Patients Admitted in Intensive Care With Covid19: Middle Eastern Country Multicenter Data
Authors: Alkindi Fahad , alhashmi khamis , Alharthi Salma , alsaidi khalid , alasmi shabib , Alrashdi Tasneem , Alkhalili Huda , Khamis Feryal , Algafri Adil , Allawati Sultan , alfarsi muzna , Murthi Sathiya , Al busaidi Mujahid , balkhair Abdullah , Alhadi Hafidh , Alrasadi khalid , Alsabti Hilal
Published: May 2021

Introduction:
The world has experienced an outbreak of coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The middle east countries were hit like the rest of the world with this pandemic.

Hypothesis:
In-hospital mortality has been reported in many countries, but similar reports from middle eastern countries have not been well described.

Methods:
In this retrospective, multicentre cohort study, we included all adult hospitalized in the intensive care Unit with laboratory-confirmed COVID-19 in the two main hospitals in Oman, Sultan Qaboos University Hospital SQUH and Royal Hospital RH between the period of 1
st
of March to May 30
th
, 2020. Demographic, clinical presentation, treatment and outcome, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death.

Findings:
153 patients admitted in ICU ,60 from SQUH and 93 from RH were included in this study, of whom 131 (85.6%) were discharged and 22 (14.3%) died in hospital. The mean age of the patients was 49.56±15.20. Males were accounted 126 (83.4%) and females were 25 (16.6%). Nearly 40% of them were Omani citizens and rest of 60% were residents of Oman. Those who have history of coronary artery disease found to have higher in hospital mortality rate OR= 4.09, 95% C.I 1.57-10.6) in which mortality in patients on aspirin was (31.8% in non-survival group vs 10.8% in survival group, p=0.047), clopedogril (18.2% vs 2.3%, p=0.009) and statin (31.8% vs 10.6%, p=0.016)At presentation, non-survivals were found to have significantly higher troponin with the risk of 7.07 (C.I. 2.09-23.92. p=0.002). In fact, patients with high sensitivity troponin rise >100 ng/L were more likely to die 5.83 times than the group with troponin <100 ng/L.

Conclusion:
History of coronary artery disease and rise of high sensitivity troponin during admission found to be strongly associated with in-hospital mortality. Rise of high sensitivity troponin of greater than >100ng/L was independent risk factors for death of COVID-19. Identifying these risk factors could help to assess the prognosis of these patients at early stage.
Abstract 15678: In Patients Treated With Immune Checkpoint Inhibitors, Myocarditis is Infrequent Compared With Other Cardiovascular Events
Authors: Hsia Judith A , Thurston Jessica , Kondapalli Lavanya , Miller Ronni , Dale Rita , Bonaca Marc P
Published: May 2021

Introduction:
Cardiotoxicity with immune checkpoint inhibitor (ICI) treatment has predominantly focused on myocarditis, which has been estimated to affect ~1% of treated patients. To contextualize myocarditis risk in relation to other cardiovascular (CV) events, we explored reporting of myocarditis, heart failure, arterial and venous thrombotic events in ICI-treated cancer patients.

Methods:
Data from adults treated with ICI between January 2011 and April 2019 were extracted by the University of Colorado enterprise health data warehouse which draws from electronic medical records and claims data. Medical conditions were determined by International Classification of Diseases (ICD) code; analyses was descriptive.

Results:
Among 1813 ICI-treated patients, mean age (SD) was 62.5 (13.5 years), 41% were women, 90% were white, 6% Hispanic, 2% black, 1% Asian, <1% American Indian/Alaskan native or native Hawaiian/Pacific islander and 1% multiple race. Prior to ICI initiation, 48% had hypertension, 16% diabetes, 11% were current smokers, 46% former smokers, 11% had estimated glomerular filtration rate <60 ml/min/1.73m
2
and 17% reported prior coronary revascularization. The most commonly treated malignancies were melanoma (40%) and lung cancer (31%). 47% of patients received pembrolizumab and 42% received nivolumab, the most often administered ICIs during this time period. Both before and after ICI administration, venous thromboembolism (VTE) and heart failure were the most frequently reported CV events (Figure). After initiation of ICI, myocardial infarction (MI) and stroke were reported for 54 (3.0%) and 73 (4.0%) patients, respectively. Myocarditis was more common after ICI than before ICI initiation (1 vs 9 patients [0.1%vs 0.5%]) but was infrequent compared with other CV events.

Conclusions:
Arterial and venous thrombotic events and heart failure were much more common than myocarditis in patients treated with ICI.