bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15859: Fibroblast Growth Factor 23 and Myocardial Infarction in the Boston Puerto Rican Health Study
Authors: Ochin Chinedu C , Salami Joseph , Veledar Emir , Garelnabi Mahdi O , Tucker Katherine L
Published: November 2020

Background:
FGF-23 is an endocrine regulator of phosphate metabolism as well as also a potent biomarker that mediates cardiovascular remodeling, with markedly elevated plasma concentration associated with the occurrence of morbid cardiovascular events such as myocardial infarction. This association usually indicates risk of developing further adverse cardiovascular events in individuals that are already susceptible to repeat morbid cardiovascular outcomes. This cross-sectional epidemiological study aims at investigating the risk association between FGF-23 and individuals in the 8
th
year cohort of the Boston Puerto Rican Health Study (BPRHS) that have self-reported clinical cardiovascular disease in the form of myocardial infarction.

Methods:
FGF-23 plasma concentration was measured by ELISA in 496 participants of the fourth wave of the Boston Puerto Rican Health Study (BPRHS). Multivariate logistic regressions were used to analyze the cross-sectional association of plasma FGF-23 quartile distribution with self-reported clinical diagnosis of myocardial infarction (MI).

Results:
The crude model for the association between FGF-23 and MI showed increased risk across the 2
nd
, 3
rd
and 4
th
quartiles, OR (95% CI); 1.27 (0.48-3.34), 1.13 (0.42-3.04), and 3.13 (1.33-7.33), respectively. The relationship with the highest vs lowest quartile remained significant after adjusting for age, sex and BMI, OR (95% CI); 2.91 (1.15-7.36). With further adjustment for diabetes, smoking, plasma total cholesterol, HDL cholesterol and triglycerides, results were attenuated, and the latter comparison was no longer statistically significant, OR (95% CI); 2.15 (0.79-5.79). The test for trend across the quartiles yielded a p value of 0.03.

Conclusion:
Within this population of older Puerto Rican adults, FGF-23 was not significantly associated with increased likelihood of self-reported history of myocardial infarction. Longitudinal studies, using clinical parameters that objectively measure the progression of cardiovascular disease are needed to assess the prognostic value of FGF-23 for future cardiovascular outcomes.
Abstract 15868: Title: Accuracy of Fetal Echocardiography in the Antenatal Diagnosis of Three Common Conotruncal Defects
Authors: He Rose , Abeysekera Jayani , Haberer Kim , Young Aisling , Eckersley Luke , McBrien Angela , Adatia Isabella C , Sharma Rishav , Rushfeldt Michelle , Hornberger Lisa K
Published: November 2020

Introduction:
The prenatal diagnosis of conotruncal defects (CTDs) has improved over the past decade, particularly with inclusion of outflow tract imaging at routine ultrasound. Appropriate prenatal counseling for CTDs demands an accurate diagnosis, as even more subtle cardiac pathology could complicate clinical outcomes. We sought to determine the anatomical accuracy of fetal echocardiography in evaluating common CTDs and factors that contribute to accuracy.

Methods:
All cases of tetralogy of Fallot(TOF), double outlet right ventricle(DORV) and truncus arteriosus(TA) encountered in our institution from 2007-2018 were reviewed. Discrepancies in anatomical findings between prenatal (most accurate exam) and postnatal (echo/surgery) or autopsy exams were categorized as: C1) no difference C2) minor difference with no impact on outcome (e.g.aberrant right subclavian artery), C3) minor difference that could make a minor difference to the delivery plan or surgery (e.g.branch pulmonary artery stenosis), C4) major difference that changes the course of the pregnancy, delivery or surgical planning (e.g.ductal dependency).

Results:
Of the 255 CTD cases, 162 had prenatal and postnatal and/or autopsy data available. Of the 162, 107(65.6%) fit C1, 35(21.5%) C2, 12(7.4%) C3, and 8(5.5%) C4. The greatest accuracy was observed in TOF, with 69/71(97.2%) in C1 and C2 versus 56/69(81.2%) in DORV and 16/22(72.7%) in TA(p=0.003). Excluding 5 cases at 10-16weeks, there was a tendency towards a greater proportion in C1 and C2 when examined at 17-23 weeks (60/64, 93.4%) versus 24-32 weeks (50/57, 87.7%) and >32 weeks (28/36, 77.8%) (p=0.06). Era of assessment also revealed a difference with 43/55(78.2%) of studies performed from 2007-2011 in C1 and C2 versus 99/107(92.5%) from 2012-2018 (p=0.01).When we compared pregnancies with one versus serial exams, we observed a lower proportion of C4 cases from 9.6% to 2.7%, respectively. In those with serial exams, 20% had achieved C1 or C2 only at serial exam.

Conclusions:
The diagnostic accuracy of fetal echocardiography in CTDs is generally high, especially for TOF and when performed at 17-24weeks. There has been significant improvement in accuracy since 2011. Serial exams potentially improve diagnostic accuracy.
Abstract 15870: External Validation of a Risk Score for Heart Failure in Acute Myeloid Leukemia
Authors: Cascino Gregory , Doukas Peter , Jovanovic Borko , Altman Jessica , Kang Yu , Scherrer-Crosbie Marielle , Akhter Nausheen
Published: November 2020

Introduction:
HF is a major cause of morbidity and mortality in AML patients. This study was designed as an external evaluation of a risk score to determine the risk of HF in patients treated with anthracyclines for AML.

Methods:
A validation cohort was composed of 204 consecutive patients with AML treated with anthracyclines. 2DSTE was performed using TomTec software to obtain baseline GLS values. LVEF was calculated using modified Simpson’s biplane method. HF hospitalizations were defined using standard clinical criteria. The HF risk score included a baseline GLS > - 15% (6 points), baseline LVEF<50% (4 points), pre-existing cardiovascular disease (4 points), anthracycline dose >/= 250 mg/m
2
(2 points), and age > 60 years (1 point). Patients were stratified into low (0 to 2 points), medium (3 to 9 points), and high risk (10 to 17 points). Statistical analysis was performed to evaluate event-free survival of the risk categories.

Results:
The average age of the cohort was 54 with an average risk score of 7 points. 55% of the patients were male. In total, 44 patients (21%) experienced a hospitalization for HF (median time to hospitalization 1 month) within the follow-up period (median 18 months). The observed incidence of HF by risk category was 14% (18 of 130) in the low, 31% (19 of 61) in medium, and 54% (7 of 13) in high risk group. The association between HF and the risk group category was highly significant (p = 0.001). Event-free survival by risk category (Figure 1) was also statistically significant (p = 0.05), with individuals in the high risk category having a reduced event-free survival.

Conclusions:
This is the first external validation study of a risk score for HF in AML patients. The risk score that we evaluated was successful at identifying patient who were at higher risk of hospitalization for HF. This may be a useful tool in clinical practice to counsel patients regarding the risk of HF after induction chemotherapy with anthracyclines.
Abstract 15873: Novel Contributions of Neutrophil-derived Myeloperoxidase and Hypochlorous Acid to 20-hydroxyeicosatetraenoic Acid Production That Drives Post-ischemic Angiogenesis
Authors: Azcona Juan A , Tang Samantha , Jeitner Thomas M , Schwartzman Michal , Guo Austin M
Published: November 2020

Introduction:
Compensatory angiogenic response to ischemia is often insufficient in maintaining adequate tissue perfusion resulting in critical limb ischemia and amputation. Identifying a novel mechanism by which angiogenesis occurs in these conditions is clinically relevant. We recently uncovered that an increase in 20-HETE, an arachidonic acid metabolite of CYP4A/F ω-hydroxylases, regulates post-ischemic angiogenesis. However, the underlying mechanism resulting in this increase is unknown.

Hypothesis:
Neutrophil-derived myeloperoxidase (MPO) and hypochlorous acid (HOCl) critically contribute to post-ischemic 20-HETE increases that drive angiogenesis.

Methods:
Hindlimb ischemia was established in mice depleted of neutrophils, macrophages, and MPO (MPO
-/-
). Angiogenesis was assessed by laser doppler perfusion imaging and micro-vessel density quantitation in the hindlimb gracilis muscles. MPO and HOCl were detected in these tissues using immunohistochemistry and a HOCl-specific fluorophore. We also determined the effects of MPO and HOCl on 20-HETE production, the expression of 20-HETE synthase CYP4A11, and hypoxia inducible factor-1α in cultured endothelial cells (EC) using LC/MS/MS, real time-PCR and western blot analysis, respectively.

Results:
We found that ischemia failed to increase 20-HETE production in mice depleted of neutrophils and MPO (13 ± 1.5 vs 35 ± 5 and ~2 ± .25 vs 35 ± 5 pg/mg of protein, respectively), accompanied with a decreased post-ischemic angiogenic phenotype. We also detected the formation of MPO and HOCl in post-ischemic gracilis muscles. MPO and HOCl also significantly stimulate CYP4A11 expression and 20-HETE production (40±12 vs 8±5 pg/mg of protein) in EC. Furthermore, HOCl quickly induces CYP4A11 mRNA/protein expression (2-fold,) and the protein expression of HIF-1α (2-fold) in as little as 15 min.

Conclusion:
Our studies establish for the first time that neutrophil-derived MPO and HOCl are responsible for promoting 20-HETE increases that critically drive angiogenesis post ischemia. Thus, identifying these novel mediators can further future therapeutic strategies to balance angiogenic responses during ischemia as well as treating diseases that are associated with abnormal angiogenesis.
Abstract 15875: Prediction of Intensive Care Unit Admission Among Patients Hospitalized for COVID-19: The Intermountain Coronavirus ICU Risk Model (CORONA-ICU)
Authors: May Heidi T , Muhlestein Joseph B , Horne Benjamin D , Knowlton Kirk U , Bair Tami L , Knight Stacey , Le Viet T , Peltan Ithan , Anderson Jeffrey L
Published: November 2020

Background:
Treatment for COVID-19 has created surges in hospitalizations, intensive care unit (ICU) admissions, and the need for advanced medical therapy and equipment, including ventilators. Identifying patients early on who are at risk for more intensive hospital resource use and poor outcomes could result in shorter hospital stays, lower costs, and improved outcomes. Therefore, we created clinical risk scores (CORONA-ICU and -ICU+) to predict ICU admission among patients hospitalized for COVID-19.

Methods:
Intermountain Healthcare patients who tested positive for SARS-CoV-2 and were hospitalized between March 4, 2020 and June 8, 2020 were studied. Derivation of CORONA-ICU risk score models used weightings of commonly collected risk factors and medicines. The primary outcome was admission to the ICU during hospitalization, and secondary outcomes included death and ventilator use.

Results:
A total of 451 patients were hospitalized for a SARS-CoV-2 positive infection, and 191 (42.4%) required admission to the ICU. Patients admitted to the ICU were older (58.2 vs. 53.6 years), more often male (61.3% vs. 48.5%), and had higher rates of hyperlipidemia, hypertension, diabetes, and peripheral arterial disease. ICU patients more often took ACE inhibitors, beta-blockers, calcium channel blockers, diuretics, and statins. Table 1 shows variables that were evaluated and included in the CORONA-ICU risk prediction models. Models adding medications (CORONA-ICU+) improved risk-prediction. Though not created to predict death and ventilator use, these models did so with high accuracy (Table 2).

Conclusion:
The CORONA-ICU and -ICU+ models, composed of commonly collected risk factors without or with medications, were shown to be highly predictive of ICU admissions, death, and ventilator use. These models can be efficiently derived and effectively identify high-risk patients who require more careful observation and increased use of advanced medical therapies.
Abstract 15886: When the Giant is Hidden but Not Dormant
Authors: Brailovsky Yevgeniy , Masoumi Amirali , Bijou Rachel , Oliveros Estefania , Sayer Gabriel T , Takeda Koji , Uriel Nir
Published: November 2020

Background:
Giant cell myocarditis is a rare etiology of cardiogenic shock, which requires high index of suspicion, rapid immunosuppressive therapy, and sometimes mechanical circulatory supportCase presentation69 year old woman with prior medical history of non-ischemic dilated cardiomyopathy and recovered left ventricular ejection fraction (LVEF) presented with cardiogenic shock complicated by acute renal and liver injury requiring support with Impella 5.5. Suspicion for myocarditis was high and patient underwent endomyocardial biopsy and started on high dose steroids. Biopsy was negative for myocarditis. Despite support, patient had progressive shock and incessant ventricular arrhythmia necessitating IV antiarrhytmics and escalation to VA ECMO in addition to Impella and eventually to central Centrimag BiVAD with drainage cannulas in right atrium and LV apex, and reinfusion catheters in pulmonary artery and ascending aorta. (Figure 1) She was urgently listed for heart transplantation as a status 1 and one day later underwent successful orthotopic heart transplantation. Pathological examination of the explanted heart was consistent with Giant cell Myocarditis (Figure 2)

Conclusion:
Giant cell myocarditis is a rare etiology of cardiogenic shock. Suggestive features include rapid hemodynamic deterioration and incessant ventricular arrhythmia. Negative initial endomyocardial biopsy is not enough to rule out the disease in high clinical suspicion. Rapid escalation of support is warranted in fulminant cases to preserve end organ function and improve survival.(Figure 1 Created with BioRender.com)
Abstract 15895: Machine Learning Algorithms to Predict Major Adverse Cardiovascular Events in Patients Undergoing Orthotopic Liver Transplantation: A Retrospective Cohort Study
Authors: jain vardhmaan , Sharma Vikram , Bansal Agam , Kleb Cerise , Sheth Chirag , Quintini Cristiano , Cywinski Jacek , Fares Maan
Published: November 2020

Background:
Post-transplant major adverse cardiovascular events (MACE) are amongst the leading cause of death amongst orthotopic liver transplant(OLT) recipients. Despite years of guideline directed therapy, there are limited data on predictors of post-OLT MACE. We assessed if machine learning algorithms (MLA) can predict MACE and all-cause mortality in patients undergoing OLT.

Methods:
We tested three MLA: support vector machine, extreme gradient boosting(XG-Boost) and random forest with traditional logistic regression for prediction of MACE and all-cause mortality on a cohort of consecutive patients undergoing OLT at our center between 2008-2019. The cohort was randomly split into a training (80%) and testing (20%) cohort. Model performance was assessed using c-statistic or AUC.

Results:
We included 1,459 consecutive patients with mean ± SD age 54.2 ± 13.8 years, 32% female who underwent OLT. There were 199 (13.6%) MACE and 289 (20%) deaths at a mean follow up of 4.56 ± 3.3 years. The random forest MLA was the best performing model for predicting MACE [AUC:0.78, 95% CI: 0.70-0.85] as well as mortality [AUC:0.69, 95% CI: 0.61-0.76], with all models performing better when predicting MACE vs mortality. See Table and Figure.

Conclusion:
Random forest machine learning algorithms were more predictive and discriminative than traditional regression models for predicting major adverse cardiovascular events and all-cause mortality in patients undergoing OLT. Validation and subsequent incorporation of MLA in clinical decision making for OLT candidacy could help risk stratify patients for post-transplant adverse cardiovascular events.
Abstract 15916: Role of Small-cajal Body Associated RNAs (scaRNAs) in Regulation of Cardiomyogenesis
Authors: Kirankumar Shivaani , SIGAMANI VINOTH , Rajasingh Sheeja , Vasanthan Jayavardini , Gurusamy Narasimman , Bittel Douglas C , Johnson Rajasingh
Published: November 2020

Introduction:
The requirement of non-coding RNAs particularly scaRNAs are playing a critical role in alternative splicing and maturation of mRNAs. Dysregulated splicing of mRNAs has been shown to cause heart defects. In this study, we are comparing the role of scaRNAs during differentiation of induced pluripotent stem cells (iPSCs) into cardiomyocytes (iCMCs) from normal individual and Noonan syndrome (NS) patient. We have selected NS patient cells because it is an autosomal dominant genetic disorder which leads to cardiomyopathy and congenital heart defects in humans.

Hypothesis:
We hypothesize that scaRNA1 and scaRNA20 have a significant role in the development of cardiomyocytes, and these scaRNAs are dysfunctional in iCMCs derived from NS.

Methods and Results:
We have compared the normal skin fibroblast-derived iPSCs (N-iPSCs) and N-iCMCs with NS patient-derived NS-iPSCs and NS-iCMCs using quantitative RT-PCR, Western blot and immunofluorescence analyses. We also used the knockdown and overexpression of scaRNA1 and scaRNA20 approaches to delineate the importance of these scaRNAs during cardiomyogenesis. Our qRT-PCR data showed a significantly lower expression of scaRNA1 and scaRNA20
(Fig. A)
as well as the cardiac-specific genes CTT and GATA4
(Fig. B)
in NS-iCMCs when compared to the normal iCMCs. Furthermore, the qRT-PCR data from the scaRNA20 overexpressed N-iCMC showed an increased expression of cardiac-specific genes
(Fig. C)
when compared to the N-iCMCs. These studies clearly indicate that scaRNA1 and scaRNA20 plays an important role in cardiomyogenesis. Further studies are underway to explore the mechanisms of these scaRNAs in regulation of cardiac genes.

Conclusions:
Our findings indicate that scaRNA1 and scaRNA20 are involved in mRNA splicing and maturation of cardiac genes. Moreover, these scaRNAs are dysfunctional in NS patient’s iCMCs and targeting these molecules will have a therapeutic potential for a patient with NS.
Abstract 15931: Associated Genetic and Non-Cardiac Anomalies and Outcomes in Prenatally Detected Tetralogy of Fallot
Authors: Sharma Rishav , Hornberger Lisa K , Caluseriu Oana , Niederhoffer Karen Y , Eckersley Luke , Colen Timothy , Lin Lily , Rushfeldt Michelle , He Rose , McBrien Angela
Published: November 2020

Introduction:
Historically, prenatal detection of tetralogy of Fallot (ToF) was poor and around 60% had major extracardiac (ECA) or genetic anomalies. Recently, prenatal detection of ToF has improved, along with a wider range of genetic testing options. Knowledge of outcomes and risk of associated anomalies is crucial for prenatal counselling. We hypothesize that prenatal ToF now has a different risk profile for ECAs and genetic anomalies than previously reported.

Methods:
A retrospective study of all fetuses with a diagnosis of ToF in our Fetal Cardiology program from 2012-2019. ToF type double outlet right ventricle was excluded. Pre and postnatal charts and imaging reports were reviewed for ToF subtype, additional cardiac and non-cardiac diagnoses and outcomes.

Results:
Of 83 cases, 49 had standard ToF, 24 pulmonary atresia (14 with major collateral arteries, 10 without), and 10 absent pulmonary valve. There was ≥1 ECA in 41% (34/83), including 6% (5/83) with 2 and 4% (3/83) with 3. ECA sub-types were: 10 gastrointestinal, 8 neurological, 8 pulmonary, 7 renal, 4 musculoskeletal, and 8 others. Of 76 with genetic testing, 37% (28/76) had genetic anomalies (32% (9/28) Trisomy 21, 29% (8/28) 22q11 deletion, 7% (2/28) Trisomy 18, 7% (2/28) Trisomy 13, and 25% (7/28) other). Additional diagnoses: 4% (3/76) VACTERL spectrum, 1% (1/76) possible teratogenic effect. Right aortic arch was associated with 22q11 deletion (28% (7/25) vs 2% (1/51) p<0.001). ToF with atrioventricular septal defect (AVSD) was strongly associated with Trisomy 21 (100%, 3/3 tested). Those with ≥1 ECA were more likely to have a genetic abnormality (52% (17/33) vs 24% (9/37), p<0.05). Outcomes were: 22% (18/83) termination, 5% (4/83) intrauterine fetal deaths and 72% (60/83) livebirths, with 1 lost to follow-up. Of live births, there were 3% (2/60) neonatal and 7% (4/60) late deaths, and 90% (54/60) were alive at last follow-up (mean age 3.5±2.4 years).

Conclusion:
ECAs are less common in prenatally diagnosed ToF in the modern era, however the rate of genetic diagnoses is similar to previously published data. ToF with right aortic arch and ToF with AVSD in particular have strong genetic associations. Additionally, genetic diagnoses are more common in those with an ECA.
Abstract 15934: Comparison of Atrial Fibrillation Burden Reduction in Patients With Paroxysmal and Persistent Atrial Fibrillation Undergoing Cryoballoon Pulmonary Vein Isolation
Authors: Musat Dan L , Milstein Nicolle S , Pimienta Jacqueline , Bhatt Advay , Sichrovsky Tina C , Preminger Mark , Pistilli Carissa , Oliveros Susan , Shaw Richard , Mittal Suneet
Published: November 2020

Background:
Pulmonary vein isolation (PVI) is a cornerstone of atrial fibrillation (AF) ablation procedures to treat symptomatic AF. Ablation success is defined by absence of AF recurrence >30 seconds. However, reduction in AF burden (AFB) is also an important endpoint. Whether patients with paroxysmal (PAF) and persistent AF (PeAF) have similar reduction in AFB post-ablation is unknown.

Objective:
To compare the decrease in AFB following cryoballoon (CB) PVI in patients with PAF and PeAF.

Methods:
We enrolled consecutive pts with an implantable loop recorder (ILR) who subsequently underwent CB PVI. All patients were followed prospectively for at least one year, or until repeat ablation; we compared AFB pre and post-ablation.

Results:
The cohort included had 47 patients (66 ± 10 years; 32 [68%] male; PAF [n=23, 49%]; CHA
2
DS
2
-VASc 2.7 ± 1.7, 34 [72%] on AAD at the time of ablation). A median of 136 days [IQR 280, 73; minimum of 30 days] of ILR data pre-ablation were available. The median AFB for PAF was 4.7% [IQR 0.9, 14.8] and PeAF was 6.8% [IQR 1.1, 40.4]. After excluding a 3-month post-ablation blanking period, recurrent AF occurred in 12 (52%) PAF and 11 (46%) PeAF patients. The median AFB post-ablation for PAF and PeAF cohorts was 0.03%, [IQR 0, 0.3] and 0.04%, [IQR 0, 1.1], respectively. This represents a >99% reduction in AFB.

Conclusion:
Although 50% of patients undergoing CB PVI for PAF or PeAF had a recurrence of AF, there was >99% reduction in AFB in both groups. These data highlight the importance of using AFB burden as a marker of therapeutic efficacy post-AF ablation.
Abstract 15938: B-type Natriuretic Peptide Levels Do Not Predict the Need for Mechanical Ventilation in Hospitalized Patients With COVID-19
Authors: perry Daniel , Azam Tariq U , Shadid Husam , Pan Michael , Berlin Hannah , Meloche Chelsea , Feroze Rafey , Leya Jeff , O'Hayer Patrick , Anderson Elizabeth , Kaakati Rayan , Abbas Bitar , Padalia Kishan , Blakley Pennelope , Zhao Peiyao , Zhao Lili , Hayek Salim
Published: November 2020

Introduction:
B-type natriuretic peptide (BNP) is widely used as a biomarker of heart failure and typically rises in response to increased intracardiac pressure. BNP levels have been measured in patients with coronavirus disease 2019 (COVID-19) to assess the cardiovascular contribution to respiratory failure and guide diuresis. Whether BNP levels do predict the need for mechanical ventilation (MV) is however unknown.

Methods:
The Michigan Medicine Covid-19 Cohort (M
2
C
2
) is an ongoing prospective observational study in which detailed clinical, laboratory and outcomes data were collected from chart review of consecutive adult patients hospitalized for COVID-19. Patients who were positive for SARS-CoV-2 infection but without symptoms of COVID-19 were not included in this cohort. We identified 495 patients admitted between March 1
st
and May 1
st
for COVID-19, of whom 290 (58.6%) had BNP levels measured during their hospitalization. We examined the association between BNP and the need for MV during their hospitalization.

Results:
Among the 290 patients evaluated, the mean age was 62 (SD 15), 169 (58.3%) were male, 135 (46.6%) were blacks, and 61 (21.0%) had pre-existing heart failure. The median BNP level was 50 pg/ml, and 104 (35.9%) of patients had a BNP level > 100 pg/ml. A total of 130 (44.8%) required MV during their hospitalization. The median BNP level in patients who required MV was 63 pg/ml (IQR 25-171), compared to 46 pg /ml (IQR 17-187) in patients who did not, P=0.23. In multivariable analysis adjusting for age, gender, race, pre-existing heart failure, and serum creatinine on admission, BNP>100 pg/ml was not associated with the need for MV.

Conclusions:
In patients hospitalized for COVID-19, BNP levels were not associated with the need for MV, suggesting that the cardiovascular contribution to respiratory failure in these patients is likely minor compared to the inflammatory response or direct impact of the virus.
Abstract 15939: Neither Moderate Consumption of Sugarcane Liquor (“Cachaca”) Nor of Red Wine Affect Cardiovascular Risk Biomarkers in Healthy Individuals
Authors: Cellia Pedro H , Lima Eduardo G , Moreira Eduardo , Barbosa Livia B , pitta fabio g , Rached Fabiana H , Strunz Celia M , Favarato Desiderio , Garzillo Cibele L , Serrano Carlos V
Published: November 2020

Introduction:
It is well established that moderate consumption of red wine is associated with reduced risk of cardiovascular (CV) events. Many observational studies have shown that this same benefit could be seen with other alcohol beverages different from wine. However, the correlation between the Brazilian sugarcane liquor (“cachaca”) and CV benefit has not been demonstrated in human trials.

Hypothesis:
Cachaca causes changes in biomarkers of CV risk in the same proportion as wine.

Methods:
In this crossover randomized study, healthy individuals were initially designated to have daily moderate alcohol consumption (MAC) of either cachaca or red wine for a period of 4 weeks. MAC, for both drinks, was denoted as a daily dose equivalent of 28g of alcohol for men and 14g for women. Then, after an abstinence period of 7 days, drink types were switched for more 4 weeks. Analysis of CV risk biomarkers were determined before and after each intervention, and consisted of C-reactive protein, lipid profile, platelet aggregability and glycid profile. (This research was funded by FAPESP 2018/09675-4).

Results:
Of the 37 individuals originally enrolled, 2 refused to continue the study. The average age of the individuals was 41.7 (±15.3 years) and 43.2% were men. Adherence to the protocol was considered essentially ideal, with 100% of regular use in both interventions and only 3 individuals reporting abuse during the study period. There was no significant variation in anthropometric measurements during the study, except for a weight gain (0.6kg) with red wine (p = 0.011). As seen in the table, no significant changes were noted in the inflammatory markers, lipid profile, platelet aggregability nor glycid profile before and after each intervention.

Conclusions:
This study shows that in healthy individuals, neither red wine nor cachaca changed CV biomarkers related to atherosclerotic progression after 4 weeks of MAC. However, there was a marked weight gain with daily wine consumption.
Abstract 16244: Point of Care Ultrasound of the Jugular Venous Pulse in the Upright Position (u
2
Jvp) Predicts Elevated Right Atrial Pressure and Pulmonary Capillary Wedge Pressure on Right Heart Catheterization in Obese and Non-obese Patients
Authors: Wang Libo , Harrison Jonathan , Dranow Elizabeth , Khor Lillian
Published: November 2020

Introduction:
Accurate intravascular volume status assessment is central to heart failure management, but current non-invasive bedside techniques remain a challenge. The visual inspection of jugular venous pulsation (JVP) in a reclined position and measuring its height from the sternal notch has been used as a surrogate for right atrial pressure (RAP). There are no studies on the predictive value of a visible internal jugular vein (IJV) in the upright position (U
2
JVP).

Hypothesis:
Point of care ultrasound (POCUS) for volume assessment in the upright position is predictive of clinically significant hypervolemia.

Methods:
Adult patients undergoing right heart catheterization (RHC) were enrolled prior for IJV imaging with point of care ultrasound (POCUS) device, Butterfly iQ™. The IJV and its size in comparison to the carotid artery was identified on ultrasound with the patient upright. Elevated RAP and PCWP was present if the IJV was still visible and not collapsed throughout the entirety of the respiratory cycle. Valsalva was used to confirm the position of a collapsed IJV.

Results:
72 participants underwent U
2
JVP assessment on the same day prior to RHC. Average BMI was 31.9 kg/m2. The area under the curve (AUC) of U
2
JVP predicting RAP greater than 10 mmHg and PCWP of 15 mmhg or higher on RHC was 0.78 (95% CI 0.66-0.9, p<0.001), with AUC of 0.86 and 0.74 for non-obese and obese subgroups respectively, p= 0.38. The finding of a visible U
2
JVP in the upright position was 70.6 % sensitive and 85.5 % specific with a negative predictive value of 90.4% for identifying both RAP greater than 10 mmHg and PCWP equal or greater than 15 mmHg.

Conclusions:
The U
2
JVP is novel and pragmatic bed-side approach to the assessment of clinically significant elevated intra-cardiac pressures in our increasingly obese heart failure population.
Abstract 16265: Acute Coronary Syndrome in Patients With Familial Hypercholesterolemia: Incidence, Predictors, and Outcomes
Authors: Kheiri Babikir , Fazio Sergio , Simpson Timothy F , Osman Mohammed , Balla Sudarshan , Shapiro Michael D
Published: November 2020

Introduction:
Individuals with Familial Hypercholesterolemia (FH) are at high risk for ASCVD events. However, little is known about the incidence, predictors, and outcomes of admissions for acute coronary syndromes (ACS) in this population.

Objectives:
To describe the in-hospital outcomes, readmission rates, and predictors of recurrent ACS in the FH population.

Methods:
Utilizing the National Readmission Databases from 10/2016 to 12/2017, we identified individuals with FH (ICD-10 E78.01) admitted with ACS. The primary outcome was in-hospital complications, which was compared using propensity-score matching (PSM 1:3). Multivariate logistic regression was performed to identify the predictors of 30-day readmissions.

Results:
There were a total of 1,697,513 ACS admissions during the study period (non-FH=1,969,979 and FH=534). Individuals admitted for ACS with FH were younger (median age 57 vs 69), had fewer comorbidities (hypertension, diabetes mellitus, and heart failure), were more likely to present with STEMI (32.8% vs 22.6%; p<0.01) and more likely to undergo multi-vessels revascularization (CABG 12.7% vs 5.9%, p<0.01; multivessel PCI 11.4% vs 7.6%, p<0.01) than patients without FH. After PSM, FH patients more commonly experienced in-hospital VT arrest [11.8% vs 8.0%; p<0.01] and required more frequent mechanical circulatory support [8.6% vs 3.3%; p<0.01]) compared to those without FH. Although FH patients who survived the initial index admission (97.9%) had lower 30-day readmission rates than non-FH patients (9.3% vs 15.1%; p<0.01), readmission was more frequently for cardiovascular disease (81.5% vs 46.5%; p<0.01). Predictors of 30-day readmission were young age, male sex, diabetes, history of CAD, and smoking (p<0.01).

Conclusions:
Individuals with FH admitted with ACS are younger, have fewer comorbidities, and more frequently present with STEMIs compared to those without FH. FH patients were more likely to suffer in-hospital cardiac complications. These results highlight the high-risk status of ACS and post-ACS care in FH patients.
Abstract 16276: Lipoprotein (a) Predicts Recurrent Worse Outcomes in Type 2 Diabetes Mellitus Patients With Prior Cardiovascular Events: A Prospective, Observational Cohort Study
Authors: Zhang Yan , Jin Jinglu , Cao Yexuan , Zhang Hui-Wen , Guo Yuan-Lin , Wu Na-Qiong , Zhu Cheng-Gang , Gao Ying , Hua Qi , Li Yan-Fang , Xu Rui-Xia , Li Jian-jun
Published: November 2020

Introduction:
Merging studies have reported the association of lipoprotein(a) [Lp(a)] with poor outcomes of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). However, the prognostic importance of Lp(a) for recurrent cardiovascular events (CVEs) is currently undetermined in patients with T2DM and prior CVEs.

Methods:
From April 2011 to March 2017, we consecutively recruited 2,284 T2DM patients with prior CVEs. Patients were categorized into low, medium, and high groups by Lp(a) levels and followed up for hard, recurrent CVEs, including nonfatal acute myocardial infarction, stroke, and cardiovascular mortality. Caplan-Meier, Cox regression and C-statistic analyses were performed.

Results:
During 7,613 patient-years’ follow-up, 153 recurrent CVEs occurred. Lp(a) levels were significantly higher in patients with recurrent CVEs than counterparts (20.44 vs. 14.71 mg/dL, p=0.002). Kaplan-Meier analysis revealed that the event-free survival rate was dramatically lower in high and medium Lp(a) groups than that in low group irrespective of HBA1c status (<7.0%; ≥7.0%, both p<0.05). Furthermore, multivariate Cox regression models indicated that Lp(a) was independently associated with high risk of recurrent CVEs [HR(95% CI): 2.049(1.308-3.212)], such data remains in different HBA1c status (HR(95% CI): <7.0%, 2.009(1.051-3.840); ≥7.0%, 2.162(1.148-4.073)). Moreover, the results of C-statistic were significantly improved by 0.029 when added Lp(a) to the Cox model.

Conclusions:
Our data, for the first time, confirmed that Lp(a) was an independent predictor for recurrent CVEs in T2DM patients with prior CVEs, suggesting that Lp(a) measurement may help to further risk stratification for T2DM patients after they suffered a first CVE.
Abstract 16279: Impact of Race and Socioeconomic Status on Rates of Congestive Heart Failure Admissions, Readmissions, and Length of Stay
Authors: Shakir Muhammad A , Buckley Meghan E , Surkis William D , Clark John M
Published: November 2020

Introduction:
Health disparities due to race and socioeconomic status persist among congestive heart failure (CHF) patients. Our hospital in the Philadelphia area is uniquely situated to study disparities as it sits on the border of a diverse inner city and suburban population. The area west of our hospital is known to have a drastically higher median income than the area to the east. We aimed to evaluate differences in rates of CHF admissions, readmissions, and length of stay (LOS) for patients based on race and socioeconomic status.

Methods:
From 3/1/2018 to 3/31/2020, 6,785 total patients were admitted to our hospital due to acute decompensated CHF. To compare rates of admission, readmission and a LOS > 5 days based on race and socioeconomic status, we used the SlicerDicer function of the EPIC electronic record platform. For race, we compared data for white and black patients. For socioeconomic status, we included a 10-mile radius around our hospital and used public records to collect median household income for 11 zip codes to the east and 11 to the west. The average yearly median household income for the east and west zip codes were USD $27,171 and $134,390, respectively. Outcomes are expressed as percentages and compared using a Chi-square test of independence and 95% confidence interval (CI) for differences. Significance was assessed at the 0.05 level.

Results:
Admission rates were significantly higher among Black patients at 67% compared to White patients at 58% (95% CI 7-11%, p<0.05). There was no significant difference between rates of readmission (60% for Black vs. 58% for White patients, 95% CI 0-4%, p=0.11) or LOS > 5 days (56% for Black vs. 55% for White patients, 95% CI 0-3%, p=0.42). Admission rates were significantly higher among patients from low income areas at 70% compared to high income areas at 56% (95% CI 11-17%, p<0.05). Readmission rates were not significantly different, 57% for low income and 56% for high income areas (95% CI 0-4%, p=0.82). Patients from low income areas were significantly more likely to have a LOS > 5 days at 57% compared to patients from high income areas at 53% (95% CI 0.8-8%, p<0.05).

Conclusions:
Race and socioeconomic status continue to impact CHF patients’ health outcomes including rates of admissions, readmissions, and length of stay.
Abstract 16286: Absence of Fxyd1 is Associated With a Female-specific Pro-inflammatory and Hypercholesterolemic Environment: Implications for Atherosclerosis
Authors: Moosavi Seyed Mojtaba , van Reyk David , Di Bartolo Belinda , Tang Owen , Bubb Kristen J , Figtree Gemma A
Published: November 2020

Introduction:
Bioavailability of nitric oxide (NO) is often compromised in early atherosclerosis, driving disease onset. This is usually due to dysfunctional endothelial nitric oxide synthase (eNOS). We have found that the transmembrane protein, FXYD1, is highly concentrated in the caveolae sub-cellular region and is closely associated with eNOS. Our preliminary data suggest that FXYD1 protects eNOS from redox-dependent inactivation. So, we hypothesise that FXYD1 may protect against atherosclerosis.

Hypothesis:
We aimed to test the role of FXYD1 in a murine model of atherosclerosis

Methods:
We produced a novel mutant mouse line by cross-breeding FXYD1 heterozygote (FXYD1
+/-
) and apolipoprotein E knock out (ApoE
-/-
) mice. FXYD1
-/-
/ApoE
-/-
and FXYD1
+/+
/ApoE
-/-
littermates were fed a high fat/high cholesterol diet from 6-8 weeks of age for 16 weeks. At sacrifice, blood was taken, and plasma was separated for analysis of cholesterol and pro-inflammatory cytokines using ELISA. The thoracic aorta was isolated and formalin-fixed to assess atherosclerotic plaque development using oil red O stain. Immunoblotting for eNOS expression was performed in heart lysates.

Results:
Plasma total cholesterol was significantly increased in FXYD1-/-/ApoE-/- female mice (n = 14 compared to FXYD1+/+/ApoE-/- mice (n = 21; p<0.05)). Circulating IL-1β levels were also significantly increased in female FXYD1-/-/ApoE-/- vs. FXYD1+/+/ApoE-/- mice. Despite this, there was no effect on plaque size as determined by oil red O stain of fixed aortae. eNOS protein expression was decreased in heart tissue from FXYD1-/-/ApoE-/- vs. FXYD1+/+/ApoE-/- female mice which may lead to lower NO generation. All of the FXYD1-mediated changes were specific to female mice as we detected no differences in these parameters in littermate males.

Conclusions:
FXYD1-/- atherosclerotic female mice have higher circulating lipids and pro-inflammatory cytokines, but this does not appear to alter plaque development in the short term. Ongoing studies will determine the effect on plaque stability and role of FXYD1 in lipidomics. FXYD1 appears to have an anti-inflammatory role and may also be involved in cholesterol metabolism or handling. This could provide a novel therapeutic angle for females.
Abstract 16289: Deformation of Tricuspid Annulus After Tricuspid Ring Annuloplasty: A Three-dimensional Transesophageal Echocardiography Study
Authors: Hayashi Atsushi , Akashi Jun , Nabeshima Yosuke , Iwataki Mai , Otsuji Yutaka
Published: November 2020

Background:
Tricuspid ring annuloplasty (TAP) is usually performed for patients with mild or greater functional tricuspid regurgitation (TR) at the time of left-sided valve surgery. However, there were limited data regarding the shape of tricuspid annulus after TAP. The aim of this study was using three-dimensional (3D) transesophageal echocardiography to investigate the impact of the ring annuloplasty on the tricuspid annulus after TAP.

Methods:
3D tricuspid valve was retrospectively analyzed in 20 patients who underwent concomitant left-sided heart surgery and TAP for functional TR. 3D data of tricuspid valve were acquired before TAP, immediate after surgery (intraoperative), and before discharge (15±5 days after TAP). TAP was performed by one surgeon using a Carpentier-Edwards Physio Tricuspid annuloplasty ring. The ring size was determined by measuring the distance from anteroseptal to posteroseptal commissures. 3D tricuspid annular area was measured. The area protruded outside the annuloplasty ring was obtained by subtracting the ring area from the annular area (Figure).

Results:
All 20 patients underwent successfully TAP with less than mild residual TR. Annuloplasty rings size 28mm, 30mm, 32mm, and 34mm were used in 6 (30%), 4 (20%), 5 (25%), and 5 (25%) patients, respectively. Median annular area decreased from 1074 (interquartile rage 893-1276) mm
2
before TAP to 591 (519-706) mm
2
immediate after TAP, but showed significant increase to 645 (501-766) mm
2
at the time of discharge (P<0.001). Percent area protruded outside the annuloplasty ring was 14% immediate after TAP and increased to 24% before discharge (P<0.001). Before discharge, there were 9 patients with more than mild residual TR (2 had moderate TR). Percent area protruded outside the annuloplasty ring was associated with mild or more residual TR at the discharge.

Conclusion:
Tricuspid annular shape after TAP was not always round. Deformation of tricuspid annulus may be associated with residual TR.
Abstract 16297: Persistent and Delayed Depression Predict All-cause Unplanned Rehospitalisations Following Acute Myocardial Infarction
Authors: Toukhsati Samia R , Hare David L
Published: November 2020

Introduction:
Depression following acute myocardial infarction (AMI) is a risk factor for future events and mortality. The aim of this study was to explore the post-AMI trajectory of depression as a risk factor for all-cause unplanned rehospitalisations.

Methods:
A total of 118 adults (101 men; mean±SD age = 64.76±11.16 years) completed the Cardiac Depression Scale (CDS) during and one month following AMI admission. On the basis of their CDS scores during index admission and 30 days post-AMI (≥ 95 = probable major depression) patients were categorized as having chronic; absent; recovered; or delayed depression. All-cause, unplanned rehospitalisations were sourced from electronic hospital databases (Cerner and TrakCare) from the time of the enrolment admission to census (11
th
Dec 2019). Time in the study ranged from 61 days to 4.8 years.

Results:
A total of 41% of the sample (n = 48) had ≥ 1 all-cause unplanned rehospitalisation following their index AMI admission. Kaplan Meier Survival analyses revealed that worsening or persistent depression trajectories had earlier unplanned rehospitalisations (p < .05). Pairwise Log Rank tests showed that patients with delayed depression had significantly less time to their first all-cause unplanned rehospitalisation compared to those with absent or recovered depression (p < .05). Patients with chronic depression had significantly earlier unplanned rehospitalisations than those with recovered depression (p < .05). Cox Regression analyses revealed that chronic (HR = 9.62109 [95% CI 2.53, 36.62] and delayed depression (HR = 2.94 [95% CI 1.08, 7.97] significantly increased the risk of all-cause unplanned rehospitalisations, after adjusting for time in the study, demographic factors, illness severity, heart disease knowledge, state anxiety and psychological resilience.

Conclusions:
Persistent or delayed trajectories of depression from admission to 30 days following AMI independently increases the risk of all-cause unplanned hospital readmissions. Patients should be screened for depression during AMI admission and throughout the early adjustment period (2-3 months post-AMI). Further research to increase capacity to predict post-AMI depression trajectories is warranted.
Abstract 163: Association of Diabetes With Coronary Artery Calcium in South Asians, African Americans, Caucasians, Chinese, and Hispanics: The Multi-Ethnic Study of Atherosclerosis (MESA) and the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study
Authors: Premyodhin Ned , Fan Wenjun , Arora Millie , Younus Masood , Budoff Matthew J , Kanaya Alka M , Kandula Namratha , Palaniappan Latha , Rana Jamal S , Wong Nathan D
Published: November 2020

Introduction:
South Asians (SA) have increased atherosclerotic cardiovascular disease (ASCVD) risk and SA ethnicity is considered a “risk-enhancing factor” in the latest prevention guidelines. Diabetes mellitus (DM) is common in SA, but it is not known how pre-DM or DM may contribute to subclinical atherosclerosis in SA compared to other ethnic groups. We examined the association of pre-DM and DM to coronary artery calcium (CAC) in SA compared to 4 other ethnic groups.

Methods:
We studied data from SA, African Americans (AA), non-Hispanic whites (NHW), Chinese (CH), and Hispanics (HS) aged 45-84 without known ASCVD. SA were taken exclusively from MASALA and other groups from MESA. The prevalence of CAC 0, 1-99, 100-399, and 400+ were examined among those who were normoglycemic, pre-DM and DM. Multiple logistic regression adjusted for age, sex, smoking, cholesterol, and blood pressure identified the associations of pre-DM and DM (compared to normal glucose) on the odds of any CAC > 0 and significant CAC ≥ 100 by ethnicity.

Results:
Of the 7587 included individuals, mean age was 62±10 years, with 48% men, 10% SA, 25% AA, 34% NHW, 11% CH and 20% HS. The prevalence of pre-DM and DM varied significantly (p < 0.01) across ethnic groups: SA (25% and 21%), AA (15% and 18%), NHW (11% and 6%), CH (17% and 13%) and HS (15% and 17%). The prevalence of any CAC and CAC ≥ 100 in those with DM were highest in NHW (80% and 48%) and SA (72% and 41%). Pre-DM was only associated with CAC ≥ 100 in NHW (OR = 1.5, p < 0.01). Compared to other groups, SA with DM (compared to those normoglycemic) had the highest odds ratios (ORs) for CAC > 0 (OR = 3.35, p < 0.01) and CAC ≥ 100 (OR = 3.10, p < 0.01) (p = 0.01 and 0.07 for ethnicity interactions, respectively) (Table).

Conclusions:
Diabetes was associated with higher odds of any or significant CAC among SA compared to other ethnic groups. Ongoing longitudinal follow-up of the MASALA study cohort might help explain if DM contributes to the often premature ASCVD outcomes in SA.
Abstract 16321: Does Yoga Based Cardiac Rehabilitation (Yoga-CaRe) Programme Improve Endothelial Function and Reduce Oxidative Stress in Patients With Acute Myocardial Infarction?
Authors: Patil Satish G , Edmin Christa , Chandrasekaran Ambalam M , Singh Kalpana , Patil Shankar , roy ambuj , Deepak Kishore kumar , Jaryal Ashok , Kinra Sanjay , Prabhakaran Dorairaj
Published: November 2020

Introduction:
Endothelial function and oxidative stress play a vital role in the prognosis following acute myocardial infarction (AMI). We evaluated the effect of Yoga-based Cardiac Rehabilitation (Yoga-CaRe) programme on markers of endothelial function and oxidative stress.

Methods:
Yoga-CaRe trial is a multi-centre randomized controlled trial. Participants with AMI were assessed for eligibility and following randomization, participants underwent Yoga-CaRe program (13 in-hospital sessions supervised by an instructor with encouragement to practice regularly at home) or enhanced standard care (3 educational sessions). We estimated asymmetric dimethylarginine (ADMA), endothelial nitric oxide (eNOS), total nitric oxide concentration (NOx), endothelin-1 (ET-1), oxidized-LDL (Ox-LDL), superoxide dismutase (SOD), total anti-oxidant capacity (TAOC), tumor necrosis factor-alpha (TNFα), C-reactive protein (CRP), P-Selectin, E-selectin, ICAM-1 and VCAM at baseline and at 12 weeks. Blood samples were collected as part of two sub-studies. All the laboratory analysis were conducted in a standardized laboratory. We used ANCOVA to assess the difference between the groups.

Results:
Eighty-two blood samples (43 in Yoga-CaRe and 39 in enhanced standard care) were included in the analysis. The mean age of participants was 52.5±10.6 years and 19.5% were females. At 12 weeks, Yoga-CaRe reduced ET-1 (p<0.001), ADMA (p=0.02) and ICMA-1 (p=0.019) and increased TAOC (p=0.03) than enhanced standard care group. Reduction in E-selectin (p=0.02) and VCAM (p=0.003) were higher in enhanced standard care than Yoga-CaRe group. We found no difference in other parameters.

Conclusion:
These results suggest that Yoga-CaRe may improve the endothelial function (through reduction in ET-1), anti-oxidant status and modulate adhesion molecules in patients following AMI. Our study was exploratory and the findings are intriguing. This needs evaluation in a larger trial.