bluuebunny/crossref_metadata_2025 huggingface dataset:
Baicalin Liposome Alleviates Lipopolysaccharide-Induced Acute Lung Injury in Mice via Inhibiting TLR4/JNK/ERK/NF-κB Pathway
Authors: Long Yu , Xiang Yan , Liu Songyu , Zhang Yulu , Wan Jinyan , Yang Qiyue , Cui Mingquan , Ci Zhimin , Li Nan , Peng Wei
Published: November 2020

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are challenging diseases with the high mortality in a clinical setting. Baicalin (BA) is the main effective constituent isolated from the Chinese medical herb Scutellaria baicalensis Georgi, and studies have proved that it has a protective effect on ALI induced by lipopolysaccharide (LPS) due to the anti-inflammatory efficacy. However, BA has low solubility which may limit its clinical application. Hence, we prepared a novel drug delivery system—Baicalin liposome (BA-LP) in previous research—which can improve some physical properties of BA. Therefore, we aimed to explore the effect of BA-LP on ALI mice induced by LPS. In pharmacokinetics study, the values of

t

1
/
2

and AUC0-

t

in the BA-LP group were significantly higher than that of the BA group in normal mice, indicating that BA-LP could prolong the duration time in vivo of BA. The BA-LP group also showed a higher concentration in lung tissues than the BA group. Pharmacodynamics studies showed that BA-LP had a better effect than the BA group at the same dosage on reducing the W/D ratio, alleviating the lung injury score, and decreasing the proinflammatory factors (TNF-α, IL-1β) and total proteins in bronchoalveolar lavage fluids (BALF). In addition, the therapeutic effects of BA-LP showed a dose-dependent manner. Western blot analysis indicated that the anti-inflammatory action of BA could be attributed to the inhibition of the TLR4-NFκBp65 and JNK-ERK signaling pathways. These results suggest that BA-LP could be a valuable therapeutic candidate in the treatment of ALI.
Determination of the Novel Insecticide Flupyradifurone and Its Two Metabolites in Traditional Chinese Herbal Medicines Using Modified QuEChERS and High-Performance Liquid Chromatography-Tandem Mass Spectrometry
Authors: Fang Nan , Lu Zhou , Zhang Zhongbei , Hou Zhiguang , Liang Shuang , Wang Bo , Lu Zhongbin
Published: November 2020

In this study, an analytical method for the simultaneous determination of the novel insecticide flupyradifurone and its two metabolites in a variety of traditional Chinese herbal medicines was developed for the first time using high-performance liquid chromatography-tandem mass spectrometry. A simple and efficient method using dispersive solid-phase extraction was employed for the pretreatment of the samples. Several extractions and cleanup strategies were evaluated. The recoveries (n = 15) of flupyradifurone and its metabolites at three spiking levels were in the range 71.3%–101.7%, with corresponding intraday and interday relative standard deviations of 1.1%–14.8%. The limits of quantitation were 0.01 mg/kg for flupyradifurone and 0.1 mg/kg for its two metabolites. Overall, our developed method was sensitive and reliable for the fast screening of flupyradifurone and its two metabolites in traditional Chinese herbal medicine samples.
Lenalidomide-Associated Immune Thrombocytopenia: A Case Report and Review of the Literature
Authors: Forehand III William , Ajebo Germame , Toscano Michael , Jillella Anand , Dainer Paul
Published: November 2020

Lenalidomide is indicated in the front-line management of multiple myeloma. More recently, it has been introduced for use in treating other hematologic malignancies. Although the drug is known to cause myelosuppression, there have been rare reports of lenalidomide-associated immune thrombocytopenia (ITP). Here, we review the literature on lenalidomide-associated ITP and report upon a 59-year-old man who was administered lenalidomide due to concern of progressive multiple myeloma more than a year following his having undergone an autologous hematopoietic stem cell transplant. His platelet count precipitously declined and lead to his hospitalization. Despite our withholding of the drug, he did not respond to platelet transfusions or administration of corticosteroids. He was successfully managed with intermittent immune globulin for several months before definitive treatment with splenectomy, which resulted in the complete resolution of his thrombocytopenia. A literature search identified a total of six additional cases of lenalidomide-associated ITP. Similarly, many of the reported cases were associated with persistent thrombocytopenia after discontinuation of the drug. Furthermore, these patients were generally managed successfully with standard ITP therapies, such as corticosteroids or intravenous immune globulin.
Antegrade Therapy for Management of Choledocholithiasis through Endoscopic Ultrasound-Guided Hepaticogastrostomy in a Patient with Surgically Altered Gastrointestinal Anatomy
Authors: Dorrell Robert , Madigan Katelyn , Pawa Swati , Pawa Rishi
Published: November 2020

Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HG) is a technique used to access the biliary tree in patients with surgically altered anatomy. Additionally, development of EUS-HG fistula permits intraductal therapy, thereby preventing patients from requiring surgery or percutaneous transhepatic biliary drainage (PTBD), thus decreasing morbidity. This clinical vignette describes an 83-year-old man with a history of gangrenous cholecystitis requiring cholecystectomy, partial gastrectomy, and Roux-en-Y gastrojejunostomy who presented to an outside hospital with abdominal pain and fever and found to have cholangitis and choledocholithiasis. He underwent two endoscopic retrograde cholangiopancreatography (ERCP) procedures at an outside hospital which were unsuccessful due to an inaccessible major papilla in the setting of the patient’s surgically altered anatomy. On arrival to Wake Forest, the patient underwent EUS-HG with successful biliary drainage and resolution of cholangitis. He returned for ERCP three months later with balloon sphincteroplasty, cholangioscopy, and electrohydraulic lithotripsy (EHL) performed through the existing metal stent (hepaticogastrostomy), resulting in stone fragmentation and antegrade removal with balloon sweeps. Repeat cholangioscopy post-EHL and balloon sweeps showed complete duct clearance with no residual stones. The hepaticogastrostomy stent was subsequently removed, and the patient recovered without any complications.
Mechanical Interpretation of Effects of Aeolian FineSands on Coal Fly Ash in Northern Shaanxi Province, China
Authors: Wei Xin , Gao Chongyang , Ai Keyu , Zhao Jun , Xu Ling
Published: November 2020

The coal fly ash (CFA) is massively produced as a consequence of coal source residues in Northern Shaanxi Province, China. Since disposing the waste materials in mountainous gully widely distributed in the same area is one of the possibilities, the high compressibility and low strength of CFA become a severe problem for the stacking. The aeolian fine sands are close to Mu Us Desert, as the addition material was introduced to improve the mechanical behaviours of CFA. A series of oedometer and triaxial tests were performed on pure CFA, pure sands, and their mixtures containing 25%, 50%, and 80% of sands by weight, respectively. Test results were analyzed within the framework of critical state soil mechanics. With increasing sands content, normally consolidated lines (NCLs) and critical state lines (CSLs) of tested materials change in volume space as well as their compression or shearing paths. The mechanical parameters like Cc, Г, λ decrease as a result of increasing sands content. On the contrary, the M and increase with augmenting sands content. It is concluded that the aeolian sands can significantly decrease the compressibility of the CFA and increase its shear strength. These findings would be useful for the treatment of CFA, which is significant for solving environmental problems in northern Shaanxi Province.
Cartografia poética dos escritores modernistas em belo horizonte – MG: quando arte, literatura e vida se encontram
Authors: Brito Adriana Lacerda de , Oliveira Rosália Caldas Sanábio de , Maciel Viviane Moreira
Published: November 2020

Propomos um roteiro turístico literário pela Belo Horizonte- MG do início do século XX, por meio das vivências dos escritores modernistas da cidade. Hoje, estesencontram-se retratados por meio de estátuas localizadas no centro da metrópole, demarcando um território poético, vivido e expresso em suas lembranças e obras literárias. Esse percurso aqui sugerido foi traçado pelos passos desses escritores, na figura de Carlos Drummond de Andrade, Roberto Drummond, Henriqueta Lisboa, entre outros. Sinta-se convidado a segui-los.
Poesia é espaço (corpo): Textos Pandêmicos
Authors: Fernandes Felipe Moura
Published: November 2020

No diálogo com a poesia concreta, os poemas propõem uma relação entre espaço e corpo.
Abstract 12701: Combined Allometric Normalization of Ascending Aortic Diameter and Assessment of Complication Risk May Support an Earlier Prophylactic Replacement Preventive of Type a Dissection
Authors: Nistal Francisco , Juarez Carlos , Redondo Juan Miguel , evangelista arturo ,   RESA-III Investigators
Published: November 2020

Introduction:
Guideline recommendations of prophylactic surgery in ascending aortic dilation by maximum aortic diameter (MAD) fail to predict > 50% of type-A dissections (AD). Assessment of post-dissection diameters as reference and lack of somatometric normalization may preclude an appropriate risk estimation.

Hypothesis:
The combined assessment of Z-score and Svensson-index (cross-area/height) based on pre-dissection aortic diameters may be advantageous to indicate prophylactic ascending aortic replacement. Such an approach would include information on normalized vascular dilatation together with a clinical aortic risk indicator.

Methods:
During two years (2018-2019), data from 515 AD-patients were prospectively recorded at 32 tertiary Spanish hospitals (Registro Español Síndrome Aórtico-III). Pre-dissection aortic diameters were estimated based on the in vitro observations made by Williams et al. on the perimeter change of normal human aortas after the creation of a dissection (PMID: 9122399). Svensson indexes were correlated with ascending aorta Z-scores using quadratic regression.

Results (Figure):
Setting thresholds of increased risk at Svensson-index >10 cm
2
/m and aortic dilation at Z-score >3, 59% of patients had low Svensson and low Z-score category, 19% low Svensson but high Z-score and 22% high Svensson and high Z-score. No patient with Svensson-index <10 cm
2
/m and Z-score either < or > 3 had an indication for surgery according to guidelines. Among patients with Svensson-index >10 cm
2
/m and aortic dilation at Z-score >3, approximately 1/3 (32%) would have a surgical indication whereas 2/3 (68%) would not.

Conclusions:
According to current guidelines, only one third of high Svensson and high Z group (7% of the total cohort) would deserve elective surgery. More proactive guidelines, suggesting replacement of ascending aorta in patients with Svensson-index >10 and Z-score>3, would spare from dissection 22% of current cases.
Abstract 12702: Association of Posttraumatic Stress Disorder With Incident Ischemic Heart Disease in Women Veterans
Authors: Ebrahimi Ramin , Sumner Jennifer , Lynch Kristine , dennis paul , Tseng Chi-Hong , Viernes Benjamin , Shroyer Laurie , beckham jean
Published: November 2020

Introduction:
Posttraumatic stress disorder (PTSD) is associated with greater risk of ischemic heart disease (IHD). Women veterans represent a growing, yet understudied, population with high trauma exposure and a unique cardiovascular risk profile, but research on the PTSD-IHD relation in this group is lacking.

Hypothesis:
PTSD is associated with incident IHD in women veterans.

Methods:
Veterans Administration (VA) electronic medical records (EMR) was used to identify women veterans who received care from any VA from 1/1/2000-12/31/2017. Exclusion criteria included: no VA follow-up(s) after index visit; IHD diagnosis at or before index visit; IHD diagnosis within 90 days of index visit. Propensity score matching on age at index visit, year of index visit, number of visits before index visit, and presence of traditional and female-specific cardiovascular risk factors and mental and physical health conditions was conducted in a 1:2 ratio to identify 129,510 women veterans with PTSD and 259,020 women veterans without PTSD. PTSD was defined by International Classification of Disease (ICD)-9/ICD-10 diagnosis codes and inpatient or outpatient encounters. Incident IHD was defined as new-onset coronary artery disease, angina, or myocardial infarction diagnoses based on ICD-9/ICD-10 diagnosis codes and inpatient or outpatient encounters.

Results:
The analytic sample was relatively young (mean age=40.3 (
SD
=12.5)). Median length of follow-up was 1,921 days (interquartile range=884-3,547 days). In a propensity score-adjusted Cox proportional hazards model, PTSD was significantly associated with greater risk of developing IHD (HR=1.15, 95% CI 1.10-1.19;
P
<.001). Secondary stratified analyses indicated that women veterans with PTSD who were of younger age (particularly those aged <40 years), Black race, and Hispanic/Latino ethnicity, plus those exposed to military sexual trauma, exhibited some of the greatest elevations in incident IHD risk.

Conclusions:
Findings demonstrate that PTSD is an independent predictor of incident IHD in women veterans, especially in younger women and racial and ethnic minorities. Results may have implications for IHD risk assessment in these vulnerable populations.
Abstract 12718: Ethnic Disparities in Outcomes After Left Ventricular Assist Device Implantation: An Analysis of National Inpatient Sample
Authors: Ueyama Hiroki , Malik Aaqib H , Kuno Toshiki , Yokoyama Yujiro , Shetty Suchith , BRIASOULIS Alexandros
Published: November 2020

Introduction:
Previous studies of patients undergoing various cardiac surgeries demonstrated worse outcomes among African American (AA) patients. It remains unclear if race is a predictor of outcomes among Left Ventricular Assist Device (LVAD) recipients.

Methods:
Patients who underwent LVAD implantation between 2010 and 2017 were identified using the national inpatient sample (NIS). Race was classified as Caucasians vs. AA vs. Hispanics, and endpoints were in-hospital outcomes, length of stay and cost. Procedure-related complications were identified via ICD-9 and ICD-10 coding and analysis was performed via mixed effect models.

Results:
A total of 27,132 adults (5,114 unweighted) underwent LVAD implantation in the U.S. between 2010 and 2017, including Caucasians (63.8%), AA (23.8%) and Hispanics (6%). The number of LVAD implantations increased in both Caucasians and AA during the study period. AA LVAD recipients were younger, with higher rates of females and most of the comorbidities, but lower rates of coronary artery disease and coronary artery bypass grafting compared to Caucasians and Hispanics. Medicaid and median income at the lowest quartile were more frequent among AA LVAD recipients. We did not identify differences in in-hospital mortality, stroke, bleeding complications, infectious complications, and acute kidney injury requiring hemodialysis among racial groups (Table). AA LVAD recipients had lower rates of routine discharge than Caucasians and Hispanics, longer length of stay than Caucasians but similar cost of hospitalization. After adjustment with age gender and clinical comorbidities, race was not a predictor of in-hospital mortality.

Conclusions:
We identified differences in clinical characteristics but not in in-hospital complications among LVAD recipients of different race.
Abstract 12719: Diagnostic and Prognostic Contributions of Cardiac Computed Tomography for Infective Endocarditis Surgery
Authors: Wang Tom Kai Ming , Bin Saeedan Mnahi , Chan Nicholas , Obuchowski Nancy , Shrestha Nabin , Xu Bo , Unai Shinya , Cremer Paul C , Grimm Richard A , Griffin Brian P , Flamm Scott D , Pettersson Gosta B , Popovic Zoran B , Bolen Michael A
Published: November 2020

Background:
Cardiac computed tomography (CT) is emerging as an adjunctive modality to echocardiography in the evaluation of infective endocarditis (IE) and surgical planning. CT studies in IE have, however, focused on its diagnostic rather than prognostic utility, the latter of which is important in high-risk diseases like IE. We evaluated the associations between cardiac CT and transesophageal echocardiography (TEE) findings and adverse outcomes after IE surgery.

Methods:
Of 833 consecutive patients with surgically proven IE during 5/1/2014-5/1/2019 at Cleveland Clinic, 155 underwent both pre-operative ECG-gated contrast-enhanced CT and TEE. Multivariable analyses were performed to identify CT and TEE biomarkers that predict adverse outcomes after IE surgery, adjusting for EuroSCORE II.

Results:
CT and TEE were positive for IE in 123 (75.0%) and 124 (75.6%) of patients respectively. CT identified an additional 11% of vegetations, 13% of pseudoaneurysms or abscesses, 5% of dehiscences and 14% of fistulae when TEE was negative. Thirty-day mortality occurred in 3 (1.9%) patients, and composite mortality and/or morbidities in 72 (46.5%). Pseudoaneurysm or abscess detected on TEE was the only imaging biomarker to show independent association with composite mortality and/or morbidities in-hospital, with odds ratio (95%CI) of 3.66 (1.76-7.59), P=0.001. There were 17 late deaths, and both pseudoaneurysm or abscess detected on CT and fistula detected on CT were the only independent predictors of total mortality during follow-up, with hazards ratios (95%CI) of 3.82 (1.25, 11.7), P<0.001 and 9.84 (1.89, 51.0), P=0.007 respectively (Figure).

Conclusion:
We identified cardiac CT and TEE features that predicted separate adverse outcomes after IE surgery. Imaging biomarkers can play important roles incremental to conventional clinical factors for risk stratification in patients undergoing IE surgery.
Abstract 12722: Cardiac Resynchronization Therapy in Pacing Induced Cardiomyopathy: A Higher Right Ventricle Pacing Percentage Predicts Greater Improvement in Left Ventricle Ejection Fraction
Authors: Lacy Sean , Chandler Jonathan , APTE NACHIKET MADHAV , Sheldon Seth , Reddy Madhu , Dendi Raghuveer , Pimentel Rhea C , Berenbom Loren D , Emert Martin , Ramirez Rigoberto , Noheria Amit
Published: November 2020

Introduction:
Cardiac resynchronization therapy (CRT) upgrade is indicated for improvement of cardiac function in patients with chronic right ventricular (RV) pacing burden >40% and heart failure with reduced ejection fraction. It is uncertain whether the CRT response is different among patients with high (≥90%) versus intermediate (<90%) burden of baseline RV pacing.

Hypothesis:
To assess the impact of baseline RV pacing percent on ECG and echocardiographic response after CRT upgrade for pacing induced cardiomyopathy.

Methods:
We conducted a retrospective study of all CRT upgrades for pacing induced cardiomyopathy at our hospital from January 2017 to December 2018. Cohorts were grouped by RV pacing burden ≥90% or <90%. QRS duration, left ventricle ejection fraction (LVEF), and left ventricular internal dimension systolic (LVIDs) were assessed at baseline and 3-12 months post CRT upgrade.

Results:
We included 82 patients (age 74 ± 12 yr., 71% male) who underwent CRT upgrade for pacing induced cardiomyopathy. The RV pacing burden was ≥90% [median 99% (IQR 98-99%)] in 61 patients, and <90% [median 79% (IQR 69-88%)] in 21 patients. There was a trend towards greater reduction in QRS duration in the ≥90% RV pacing group (28 ± 29 ms vs. 22 ± 38 ms, p=0.5). Improvement in LVEF was greater in ≥90% vs. <90% RV pacing group (14.3 ± 10.1% vs. 6.3 ± 10.1%, p=0.003). The association persisted on multivariable adjustment for age, sex and baseline LVEF (p=0.004). There was a trend towards greater % reduction in LVIDs in the ≥90% vs. <90% RV pacing group (6.4 ± 15.5 % vs. 3.9 ± 14.3 %, p=0.5) [Figure].

Conclusions:
A higher baseline RV pacing burden predicts a greater improvement in LVEF after CRT upgrade for pacing induced cardiomyopathy.
Abstract 12728: Untreated Sleep Apnea Syndrome is Associated With Higher Incidence of Cardiovascular Events After Percutaneous Coronary Intervention
Authors: Fujiyoshi Kazuhiro , Minami Yoshiyasu , Ishida Kohki , Ishida Miwa , Wakabayashi Ken-ichiro , Ako Junya , Inomata Takayuki
Published: November 2020

Introduction:
Sleep apnea syndrome (SAS) is a risk factor of cardiovascular disease. However, the impact of SAS on the clinical course after percutaneous coronary intervention (PCI) remains to be elucidated.

Methods:
A total of 206 consecutive patients who underwent PCI were included. The incidence of major adverse cardiovascular events (MACE) at 3-year was compared among patients with untreated SAS (untreated SAS group; n=60), those with SAS treated by continuous positive alveolar pressure (CPAP group; n=20) and those without SAS (non-SAS group; n=96). MACE included cardiac death, non-fatal myocardial infarction, target vessel revascularization (TVR), and non-TVR (NTVR).

Results:
There was no significant difference in baseline clinical characteristics among the untreated SAS group, the CPAP group and the non-SAS groups, other than in age (74.1 ± 9.6 vs. 71.2 ± 0.33 vs. 68.2 ± 10.7, p = 0.002) and hemoglobin A1c levels (6.54 ± 0.87 vs. 6.61 ± 0.58 vs. 6.09 ± 0.70 %, p < 0.001). The incidence of MACE, TLR and TVR was significantly higher in the untreated SAS group than in the CPAP group and the Non-SAS group although there was no significant difference in the incidence of NTVR among the three groups (Figure). The untreated SAS was independently associated with the incidence of 3-year MACE (odds ratio 3.24, 95% confidence interval 1.36-8.20, p = 0.008).

Conclusions:
The incidence of MACE was significantly higher in patients with untreated SAS than in those treated with CPAP and those without SAS after PCI. The present findings may highlight the importance of SAS management in patients requiring PCI.
Abstract 12759: Diagnostic and Prognostic Utility of T1 Mapping and Extracellular Volume by Magnetic Resonance Imaging for Cardiac Amyloidosis: A Meta-analysis
Authors: Wang Tom Kai Ming , Vega Brizneda Maria , Kwon Deborah H , Flamm Scott D , Hanna Mazen A , Griffin Brian P , Xu Bo
Published: November 2020

Background:
Cardiac magnetic resonance imaging (CMR) is central to the evaluation of cardiac amyloidosis (CA). Native T1 mapping and extracellular volume (ECV) are novel CMR techniques with evolving utility in cardiovascular diseases including CA. This study aims to meta-analyze the diagnostic and prognostic data of native T1 mapping and extracellular volume (ECV) techniques for assessing CA.

Methods:
Pubmed, Cochrane and Embase were searched until 31 March 2020 for studies reporting the accuracy of native T1 mapping and ECV for diagnosing CA or predicting all-cause mortality. Area under the receiver-operative characteristics curves (AUC) and hazards ratios (HR) with 95% confidence intervals (95% CI) respectively were pooled using random-effects models and Open-Meta(Analyst) software.

Results:
Amongst 459 records obtained from the literature search, 41 full-text articles were assessed and 10 studies were eligible totalling 2364 subjects and 1528 patients with confirmed CA. Pooled AUCs (95% CI) for diagnosing CA were 0.924 (0.889-0.959) for native T1 mapping and 0.963 (0.925-1.000) for ECV (Figure panel A/B). Both techniques had similarly high detection rates for AL- and ATTR CA (pooled AUCs of 0.935 and 0.916 for native T1 mapping and 0.980 and 0.952 for ECV). Pooled HRs (95% CI) for predicting all-cause mortality were 1.15 (1.08-1.22) for native T1 mapping as a continuous parameter, 1.19 (1.01-1.40) for ECV as a continuous parameter (Figure panel C/D), and 4.93 (2.64-9.20) for ECV as a binary threshold.

Conclusion:
Both native T1 mapping and ECV had high diagnostic performance for CA and predicted all-cause mortality after CA. These CMR techniques can play important roles in the multi-modality imaging assessment of CA, including when contrast administration is contraindicated.
Abstract 12785: The American College of Cardiology's NCDR Afib Ablation Registry: A Summary of Initial Data Including Patient Characteristics, Procedural Characteristics, and Adverse Events
Authors: Hsu Jonathan C , Akar Joseph , Marine Joseph E , Nichols Sheila , Marcus Gregory M , Natale Andrea , Noseworthy Peter A , selzman kimberly , Varosy Paul D , Masoudi Frederick A , Du Chengan , Freeman James V , Curtis Jeptha P , Kowey Peter R
Published: November 2020

Introduction:
The American College of Cardiology developed the National Cardiovascular Data Registry (NCDR) AFib Ablation Registry to assess prevalence, demographics, procedural management and outcomes of patients undergoing atrial fibrillation (AFib) ablation procedures. The objective of this registry’s first presentation is to summarize initial AFib Ablation Registry data regarding patient characteristics, procedural characteristics, and in-hospital adverse events and outcomes in those undergoing AFib ablation enrolled in the registry.

Methods:
Data were tabulated and summarized with simple proportions for categorical data, and mean ± standard deviation for continuous data.

Results:
A total of 31,345 patients who underwent AFib ablation were included in the registry (mean age 65.0 ± 10.4, 65.2% male, 57.6% paroxysmal AFib), with ablations performed at 120 hospitals, by 501 physicians. The mean CHA2DS2-VASc score of was 2.6 ± 1.6, and mean HAS-BLED score was 1.1 ± 0.9. Successful pulmonary vein isolation was able to be achieved in all veins in 94.5% of patients. The prevalence of any complication during procedural admission was 3.1%; the most common were hematoma (0.5%) and pericardial effusion requiring intervention (0.42%). The mean length of stay during the index admission (days) was 1.4 ± 7.6, and in-hospital death prevalence was 0.04%
[FIGURE]
.

Conclusions:
In conclusion, the NCDR AFib Ablation Registry is a large, national, multi-center, prospective cohort study to describe events outside the clinical trial or research setting, demonstrating successful pulmonary vein isolation in the majority of patients and a low prevalence of adverse events. Future studies from the registry will be able to help support and develop evidence-based guidelines for AFib ablation treatment and optimize patient outcomes.
Abstract 12786: Antithrombotic Therapy After Transcatheter Aortic Valve Implantation in Patients With Concomitant Indications for Long-term Oral Anticoagulation: A Systemic Review and Meta-analysis
Authors: Costa GonÃ§alo , Gonçalves Lino , teixeira rogerio
Published: November 2020

Background:
Ischemic and bleeding complications after transcatheter aortic valve implantation (TAVI) remain prevalent and affect survival. Atrial fibrillation (AF) is common in patients undergoing TAVI and constitutes an indication for long-term oral anticoagulation (OAC). Current guidelines on antithrombotic treatment in patients who have an indication for OAC after TAVI are based on expert opinion and suggest the use of vitamin K antagonist (VKA) either alone or in combination with aspirin or clopidogrel.

Purpose:
To compare OAC (VKA or direct oral anticoagulant) versus OAC in combination with single antiplatelet therapy (SAPT), either aspirin or clopidogrel, as antithrombotic treatment following TAVI in patients with an indication for long-term OAC or the prevention of cerebrovascular events, bleeding events and all-cause mortality.

Methods:
We systematically searched PubMed, Embase and Cochrane databases, in April 2020, for both interventional or observational studies comparing OAC with OAC plus SAPT. Random-effects meta-analysis for OAC and OAC combined with SAPT were performed.

Results:
Four studies were included (three registry-based and one randomized clinical trial) providing a total of 1218 patients, and 69 pooled cerebrovascular events. There was no statistical difference between OAC and OAC plus SAPT for the prevention of cerebrovascular events after TAVI (pooled OR 0.89 [0.51, 1.55], P=0.69, I
2
= 0%) - Figure. Similarly, there was a similar rate of all-cause mortality (pooled OR 0.98 [0.72, 1.35], P=0.91, I
2
= 0%). Furthermore, the rate of major bleeding or life-threatening events was significantly lower for OAC compared with the combined therapy (pooled OR 0.45 [0.29, 0.70], P<0.01, I
2
= 5%).

Conclusions:
Our pooled data suggests that for patients with indication for long-term oral anticoagulation after TAVI, the routine use of double anti-thrombotic therapy (SAPT+OAC) compared to the use of OAC, conferred an increased risk of bleeding
Abstract 12788: Cardiac MicroRNA-150 Confers Cardioprotection by Directly Repressing Pro-apoptotic Small Proline-rich Protein 1a, Sprr1a in Cardiomyocytes
Authors: Aonuma Tatsuya , Moukette Bruno , Barupala Nipuni P , Kim Il-man
Published: November 2020

Background and Aims:
Cardiac injury induces dynamic changes in the expression of microRNAs (miRs). For example, the evolutionarily conserved miR-150 is downregulated in patients with multiple cardiovascular diseases such as myocardial infarction (MI) and cardiomyopathies, as well as in various mouse models of heart failure (HF). MiR-150 is significantly associated with HF severity and outcome in humans. Using a systemic miR-150 knockout (KO) mouse model, we previously showed that carvedilol (Carv)/β
1
-adrenergic receptor/β-arrestin1-responsive miR-150 confers cardiac protection against MI (Left side in Figure). However, the extent to which expression of miR-150 in cardiomyocytes (CMs) regulates MI is unknown and there is a lack of mechanistic insight by which CM miR-150 modulates cardiac protection.

Methods and Results:
Here, we demonstrate using a novel mouse model that conditional CM-specific miR-150 KO (miR-150 cKO) in mice worsens cardiac dysfunction, stress, fibrosis and apoptosis post-MI, without affecting mortality or inflammation. Genome-wide transcriptomic analysis in miR-150 cKO mouse hearts identifies small proline-rich protein 1a (sprr1a) as a novel regulatory target of miR-150. Our mouse and CM studies further reveal that
sprr1a
expression is upregulated in CMs isolated from ischemic myocardium and subjected to simulated ischemia/reperfusion. In contrast, its expression is downregulated in hearts and CMs by Carv. Our human heart data also show that left ventricular
sprr1a
is upregulated in patients with HF with reduced ejection fraction. Mechanistically, the cardioprotective roles of CM miR-150 during MI are in part attributed to the direct and functional repression of pro-apoptotic gene
sprr1a
in CMs (Right side in Figure).

Conclusions:
These findings reveal a pivotal role for the miR-150/sprr1a axis in regulating CM function post-MI, and this novel axis could be a therapeutic target for intervention in ischemic heart disease.
Abstract 12789: Clinical Factors Associated With Mortality Among Patients Hospitalized for Heart Failure in Egypt
Authors: Hassanin Ahmed , Hassanein Mahmoud M , Abdel-maksoud Madiha F
Published: November 2020

Introduction:
Heart failure (HF) is a growing public health burden in many low and middle-income countries (LMIC). However, most HF registries were conducted in high income countries, which often have different ethnic and cultural backgrounds from that of LMIC.

Hypothesis:
Independent clinical variables associated with mortality in patients hospitalized for HF in Egypt are different from those established in the United States (US).

Methods:
Between 2011 and 2014, 1,660 patients hospitalized for HF were enrolled from 20 centers across Egypt as part of the European Society of Cardiology HF long-term Registry. Deceased patients were compared to survivors, to identify demographic, clinical and biochemical variables associated with in-hospital and one-year mortality. Variables associated with mortality on univariate analysis, and independent variables identified in the Acute Decompensated Heart Failure National Registry (ADHERE) and in the Seattle Heart Failure Model, both based in the US, were entered into the multivariate logistic regression model.

Results:
In-hospital mortality was 5%. Only two independent clinical factors associated with in-hospital mortality were identified: elevated serum creatinine (sCr), OR=1.47 [95% CI: 1.23, 1.74] for every point increases above one mg/dl; and low admission systolic blood pressure (SBP), OR=1.54; [95% CI: 1.43, 1.65] for every 10 points decrease in SBP below 140 mmHg. At one-year follow up, mortality was 27%. Independent predictors of one-year mortality were: age, OR=1.47; [95% CI: 1.23,1.75] for every 10-year increase above 40; low discharge SBP, OR=1.30 [95% CI: 1.08, 1.52] for every 10 points decrease below 140 mmHg; low ejection fraction, OR=1.51 [95% CI: 0.59,0.73] for every 5 points decrease from 65%; chronic liver disease, OR=3.0 [95% CI: 1.51,5.88]; history of stroke, OR=3.2 [95% CI: 1.52,6.65]. These variables overlapped with those identified in US registries.

Conclusions:
Independent clinical variables associated with mortality after HF hospitalization in Egypt are similar to those reported in HF registries in the US.
Abstract 12790: Classification of the Different Types of Hypertrophic Cardiomyopathy Responsible for Advanced Heart Failure: From Clinical, Morphofunctional Characteristics to Prognosis and Potential New Therapies
Authors: GALATI GIUSEPPE , Germanova Olga , SABOURET Pierre , Aspromonte Nadia , Dalla Vecchia Laura A , Vranic Ivana , SENNI MICHELE , Metra Marco , Margonato Alberto
Published: November 2020

Introduction:
Advanced heart failure (AdvHF) in HCM was overlooked.

Hypothesis:
Based on a systematic revision, we described prevalence & outcomes of the main HCM phenotypes responsible for AdvHF, heart transplantation (HTx), LVAD implantation & HF-death.

Methods:
We classified the HCM profiles responsible for AdvHF in 1) End-stage HCM (ES-HCM) defined by an LVEF≤50%; 2) LVOTO despite optimal medical therapy (OMT) (Refractory HOCM); 3) Nonobstructive HCM with preserved EF (HNOCMpEF). The study screened 130 manuscripts in MEDLINE and EMBASE on AdvHF in HCM patients (pts) published from 2000 till January 2020, in adults. 8 manuscripts were eligible for the analysis. AdvHF was defined by the presence of severe NYHA symptoms (III & IV) because in all the manuscripts this definition was used. Mean follow-up = 7.6 years.

Results:
Figure 1: Prevalence of phenotypes responsible for AdvHF&HTx/LVAD implantation/HF-Death. Of 205 HCM pts, 119 (58%) underwent HTx, LVAD implantation, or died for HF. Figure 2: Outcome per each clinical phenotype.

Conclusions:
AdvHF in HCM has an ominous prognosis (58% of pts met HTx/LVAD implantation/HF-death) but with significant differences among the 3 phenotypes. HOCM has a very good outcome, indeed only few cases developed a Refractory HOCM & AdvHF & only 1 died for HF. 29.7% of AdvHF were caused by HNOCMpEF due to massive hypertrophy & restrictive physiology & only 16.4% of them died due to HF. ES-HCM represents the main cause of AdvHF in HCM & the major determinant for poor outcomes among all HCM pts (Only 1/3 of them were event-free). This reflects poor attention and portrays an unmet need for ES-HCM pts. Recently it was demonstrated that an extensive amount of myocardial fibrosis (MF) is the major determinant for ES-evolution. Taken together these findings show the importance of a strict follow-up for HCM pts to timely identify ES-HCM & early start HF OMT. Developing specific therapies to lower the burden of MF & stop adverse remodeling it's crucial.
Abstract 12813: Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-analysis
Authors: Satish Mohan , Guddeti Raviteja , Wenzl Florian , Walters Ryan , Alla Venkata M
Published: November 2020

Introduction:
Due to shared risk factors and pathophysiology, atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) frequently coexist. However, the prognostic implications of AF in HFpEF are unclear with conflicting data. Herein, we conducted a systematic review and meta-analysis to assess the impact of concomitant AF on cardiovascular outcomes in patients with HFpEF.

Methods:
PubMed, Scopus, and Google Scholar were comprehensively searched through May 7th, 2020 for studies comparing outcomes of HFpEF patients with and without AF. Outcomes assessed were all-cause mortality and a composite of HF hospitalization or cardiovascular (CV) mortality. Data from selected studies were abstracted and pooled using a random-effects meta-analysis to calculate odds ratios (ORs) and 95% confidence intervals [CIs] for each of the outcomes.

Results:
Our final analysis included 10 studies with 27,440 HFpEF patients (43.2% with AF). AF was associated with significantly increased risk of all-cause mortality (OR 1.37 [1.17-1.61], p < 0.001, Fig. 1A), HF hospitalization or CV mortality (OR 1.66 [1.16-2.36], p = 0.005, Fig. 1B), and HF hospitalization alone (OR 1.34 [1.03-1.76], p = 0.03, Fig. 1C). However, AF was not associated with excess risk of CV mortality alone (OR 1.10 [0.79-1.52], p = 0.57, Fig. 1D).

Conclusions:
In patients with HFpEF, concomitant AF is associated with an increased risk of all-cause mortality and HF hospitalization. Further research into the mechanisms and interventions to mitigate this excess risk is necessary.
Abstract 12826: Age-related Sestrin2 Maintains OXPHOS Integrity to Modulate Cardiac Substrate Metabolism During Ischemia and Reperfusion
Authors: Ren Di , Fedorova Julia , Zhang Jingwen , He Zhibin , Li Ji
Published: November 2020

Introduction:
Sestrin2 (Sesn2) is a stress-inducible protein that declines with aging in the heart. We have reported that rescue Sesn2 levels of aged mouse hearts through gene therapy improves the resistance of aged hearts to ischemic insult caused by ischemia and reperfusion (I/R).

Hypothesis:
Sestrin2 as a scaffold protein maintains mitochondrial integrity to protect heart from ischemic injury during I/R.

Methods:
Young C57BL/6J (3-6 months), aged C57BL/6J (24-26 months), and young Sesn2-KO (3-6 months, C57BL/6J background) mice were subjected to 45 min of regional ischemia and 24 hours of reperfusion. The left ventricle of hearts were collected for transcriptomics, proteomics and metabolomics analysis.

Results:
The protein level of Sesn2 was declined in aged versus young heart. Seahorse measurements demonstrated that Sesn2 deficiency in aged versus young hearts lead to an impaired mitochondrial respiration rate with defects in Complex I and Complex II activity. The Sesn2 targeted proteomics revealed that Sesn2 plays a critical role in maintaining mitochondrial functional integrity through modulating mitochondrial biosynthesis and maintaining oxidative phosphorylation (OXPHOS) complexes. RNA-Sequencing analysis demonstrated that significant alterations in expression of mitochondrial compositional genes and metabolic regulation related genes occurred in both Sesn2 KO and aged hearts versus young hearts. Metabolomics data showed that Sesn2 deficiency in Sesn2 KO and aged versus young hearts augmented glycolysis but compromised citrate cycle process during I/R. The immunoprecipitation data showed that Sesn2 is translocated into mitochondria and directly interacts with OXPHOS components to maintain mitochondrial integrity in response to I/R stress. Furthermore, biochemical analysis revealed that Sesn2 is associated with citrate cycle components to modulate pyruvate dehydrogenase and isocitrate dehydrogenase activities in the mitochondria during I/R stress.

Conclusions:
Sesn2 serves as a scaffold protein to stabilize mitochondrial OXPHOS in the hearts under I/R stress conditions. Age-related downregulation of cardiac Sesn2 degraded mitochondrial functional integrity in response to ischemic stress in the elderly.
Abstract 12850: Isolated and Assisted Transcatheter Coil Embolization of Coronary Artery Lesions: The Cleveland Clinic Experience
Authors: Abdelfattah Omar M , Saad Anas M , Kassis Nicholas , Shekhar Shashank , Isogai Toshiaki , Gad Mohamed M , Ahuja Keerat R , Hariri Essa , Kaur Manpreet , Farwati Medhat , Khatri Jaikirshan , Krishnaswamy Amar , Kapadia Samir R
Published: November 2020

Introduction:
Transcatheter coil embolization (TCE) has been introduced as a modality in treating several coronary artery lesions including coronary artery fistula (CAF), patent left internal mammary artery (LIMA) side branch, coronary artery perforation (CAP), coronary artery aneurysm (CAA), and coronary artery pseudoaneurysm (CAPA) is limited.

Hypothesis:
TCE is underutilized in various coronary lesions despite its efficacy.

Methods:
This is a retrospective, descriptive study of all adult patients who underwent TCE at the Cleveland Clinic between August 2007 and August 2019. A total of 41 patients, including 25 CAF, 7 patent LIMA side branches, 5 CAP, 2 CAA, and 2 CAPA from a total of 121,196 cases, were studied.

Results:
Successful angiographic closure was performed in 37 out of 41 (90%) cases (100% ,100% ,100%, 88%, 80%, of patent LIMA side branch ,CAA, CAPA, CAF, CAP, respectively). Ampatzer vascular plug was used as an adjunctive device in 10% of the total cohort. No adverse events were directly associated with TCE among the LIMA, CAA, and CAPA lesions, and only one patient with CAF required re-intervention at three months due to coil migration. One patient with a large CAP of the mid-left anterior descending artery died while hospitalized due to cardiogenic shock despite successful embolization.

Conclusions:
Transcatheter Coil embolization in our institution was safe and effective in treating different coronary circulation abnormalities with successful angiographic results in 90% of treated cases. Additional study on the utilization of vascular plug devices in cases such as LIMA side branch or CAF would be beneficial to better understand the treatment options.
Abstract 12871: Comparison of Risk Scores at Predicting Mortality and Morbidities After Isolated Tricuspid Valve Surgery
Authors: Wang Tom Kai Ming , Akyuz Kevser , Duran Crane Alejandro , Xu Samantha , Xu Bo , Gillinov A , Pettersson Gosta B , Griffin Brian P , Desai Milind Y
Published: November 2020

Background:
Risk models play important roles in stratification and decision-making towards cardiac surgery. Isolated tricuspid valve surgery (TVR) is a high risk but increasingly performed operation, however the performance of surgical risk models, including the recently developed Society of Thoracic Surgeon’s (STS) TVR score, have not been externally evaluated in these patients. We compared the prognostic utility of contemporary risk scores for isolated TVR.

Methods:
Consecutive patients undergoing isolated TVR at Cleveland Clinic during 2004-2018 were evaluated. EuroSCORE II and STS-TVR score were retrospectively calculated, and their performance for predicting 30-day mortality, post-operative complications and mortality during follow-up were assessed.

Results:
Amongst 207 patients studied, mean age was 54.1±17.9 years, 116 (56.0%) were female, 92 (44.4%) had secondary tricuspid regurgitation, and 151 (72.9%) had surgical repair. Mean EuroSCORE II and STS-TVR scores were 6.3±6.6% and 5.5±6.2% respectively. Operative mortality occurred in 10 (4.9%). C-statistics (95% confidence intervals) for 30-day mortality were 0.83 (0.74-0.93) for EuroSCORE II and 0.60 (0.45-0.75) for STS-TVR score (Table), and observed/expected ratios were 0.78 and 0.89 respectively. EuroSCORE II also had higher c-statistics for composite and most post-operative complications. In univariable Cox regression for mortality during follow-up, hazards ratios (95% confidence intervals) were 1.08 (1.05-1.11) for EuroSCORE II and 1.06 (1.02-1.11) for STS-TVR score.

Conclusion:
EuroSCORE II was superior to STS-TVR score at predicting adverse outcomes after isolated TVR. Although risk scores traditionally under-estimated 30-day mortality after isolated TVR, our excellent surgical results meant that calibration of both scores were satisfactory for our cohort, and provides a benchmark for future studies of isolated surgical and transcatheter tricuspid valve procedures.
Abstract 12873: Clonal Hematopoiesis With JAK2V617F Promotes Pulmonary Hypertension Through ALK1
Authors: KIMISHIMA Yusuke , Misaka Tomofumi , Yokokawa Tetsuro , Wada Kento , Ueda Koki , Sugimoto Koichi , Minakawa Keiji , Nakazato Kazuhiko , Ishida Takafumi , Oshima Motohiko , Koide Shuhei , Shide Kotaro , Shimoda Kazuya , Iwama Atsushi , Ikeda Kazuhiko , Takeishi Yasuchika
Published: November 2020

Rationale:
Pulmonary hypertension (PH) is associated with hematological disorders by unclear multifactorial mechanisms.
JAK2
V617F is the most frequent driver mutation among the myeloproliferative neoplasms and is recently identified in clonal hematopoiesis. However, the impact of clonal hematopoiesis on PH remains unknown.

Objectives:
To elucidate the mechanistic relevance of hematopoietic JAK2V617F in the development of PH.

Methods:
We applied experimental mouse models, mimicking hematological clinical scenarios using
Jak2
V617F-transgenic (JAK2
V617F
) mice and recipient mice transplanted with JAK2
V617F
bone marrow cells (JAK2
V617F
recipients), exposed to chronic hypoxia to induce PH. The presence of
JAK2
V617F was also examined prospectively in PH patients.

Measurements and Main Results:
Increases in right ventricular systolic pressure and right ventricular hypertrophy accompanied by pulmonary arterial structural remodeling after exposure to chronic hypoxia were significantly exacerbated in both JAK2
V617F
mice which showed a myeloproliferative neoplasm-phenotype and JAK2
V617F
recipients which modeled clonal hematopoiesis compared to corresponding controls. JAK2V617F-expressing neutrophils were specifically accumulated in pulmonary arterial regions, accompanied by increases in neutrophil-derived elastase activity and chemokines. RNA sequencing identified progressive upregulation of
Acvrl1
(encoding ALK1) during the differentiation from bone marrow stem/progenitor cells peripherally into mature neutrophils of pulmonary arterial regions in the enrichment of JAK-STAT-related molecules by JAK2V617F. JAK2V617F-mediated STAT3 phosphorylation upregulated ALK1-Smad1/5/8 signaling. Strikingly, ALK1 inhibition completely rescued the development of PH in JAK2
V617F
mice. Furthermore, clonal hematopoiesis with
JAK2
V617F was significantly more common in PH patients than in healthy subjects.

Conclusions:
Our study reveals clonal hematopoiesis with JAK2V617F as a crucial factor that causally leads to PH through ALK1.