bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15362: Epicardial Adipose Tissue Effects on Systolic Function: A Direct or Systemic Metabolic Effect?
Authors: Reddy Shiva , Shankar Aditi , Dias Katrin A , Macnamara James P , Hearon Christopher M , LEVINE Benjamin D , Sarma Satyam
Published: May 2021

Introduction:
Obesity is associated with increased epicardial adipose tissue (EAT). It is unknown if this ectopic fat deposit has direct cardiotoxic paracrine effects on regional systolic function. We have previously shown that EAT mediates diastolic dysfunction via systemic effects, rather than localized effects. We similarly hypothesized regional EAT deposits would have no effect on the left ventricular (LV) strain of adjoining myocardial segments.

Methods:
We studied 28 obese healthy adults (mean age 48 ± 5 yrs, BMI 38.2 ± 5.0 kg/m
2
). EAT was quantified on each individual MRI slice from base to apex and summed to obtain total volume. It was then separated into anterior, lateral, and inferior regions corresponding to the adjacent LV segments. Using MRI feature tracking, global longitudinal LV strain (GLS) and peak regional anterior, inferior, and lateral LV strain were quantified. Associations between total EAT and GLS, and between regional EAT and corresponding regional strain were determined by linear regression.

Results:
Mean total EAT volume was 69.6 ± 29.8 mL and mean GLS was -19.4 ± 2.0%. Individual data points for EAT and longitudinal strain are shown in the figure. Greater total EAT volume was modestly associated with decreased GLS (r2 = 0.127). However, anterior, lateral, and inferior EAT volume did not correlate with a decrease in corresponding regional strain (r2 = 0.003, r2 = 0.088, r2 = 0.016, respectively).

Conclusion:
In obese adults, total EAT volume was associated with a decrease in global LV systolic function measured by GLS. There was no association between regional EAT depots and corresponding regional LV function to suggest localized metabolic cardiotoxic effect. These preliminary results support our previous findings that EAT has little paracrine effect on cardiac function. Rather, EAT likely represents an additional depot of ectopic fat reflective of a general metabolic abnormality.
Abstract 15373: Human Immunodeficiency Virus Infection and Incident Heart Failure: A Meta-analysis of Prospective Studies Among 9 Million Participants
Authors: Chen Yuqing , Gao Yanxiao , Zhou Yaqin , Li Xianhong , Wang Honghong , Polonsky Tamar S , Vermund Sten H , Qian Hanzhu , Qian Frank
Published: May 2021

Introduction:
Long-term exposure to human immunodeficiency virus (HIV) associated immune dysregulation and adverse metabolic effects of highly active antiretroviral therapy could increase the risk for developing atherosclerotic cardiovascular disease (CVD). Previous prospective studies have also identified HIV infection as an independent risk factor for the development of heart failure (HF), though results remain inconsistent. We conducted a systematic review and meta-analysis of prospective studies to assess the association between HIV infection and incident HF.

Hypothesis:
We hypothesized that HIV infection would increase the risk of incident HF, though this association may be modified by other demographic or clinical characteristics.

Methods:
We performed a literature search of PubMed, EMBASE and Web of Science through June 1
st
, 2020 to identify prospective studies which examined the association between HIV infection and incident HF among adults (age≥18 years). Study-specific risk estimates were combined using a random-effects model to calculate the pooled relative risk (RR) and 95% confidence intervals (CI).

Results:
Eight records with a total of 8,949,448 participants with 101,335 incident cases of HF (1,941 among HIV+ individuals and 99,394 among HIV- individuals) were included for meta-analysis. In our overall analysis, HIV infection was positively associated with incident HF, RR (95% CI): 1.80 (1.51-2.15),

I
2

=85.6% (
Figure 1
). This association was largely consistent among individuals without a history of CVD, RR (95% CI): 1.89 (1.51-2.37). HIV infection status tended to be a stronger risk factor for HF among younger adults (age<50 years), women, and individuals with low CD4 (<200 cells/mm
3
) count.

Conclusions:
Our meta-analysis provides additional support that HIV may be an independent risk factor for HF, with potentially important clinical and public health implications for primary prevention.
Abstract 15503: Biophysical Indicators of Acute Pulmonary Vein Isolation With a Novel Cryoballoon
Authors: Anic Ante , Martin Andrew , Breskovic Toni , Ouss Alexandre , Dekker Lukas , Sulkin Matthew , Tran Binh , Yap Sing-Chien , Bhagwandien Rohit E , Lever Nigel , Varma Niraj
Published: May 2021

Introduction:
Low nadir temperature (N
T
) and long thaw times with cryoballoon ablation are associated with successful PVI. Recently, a cryo-system was designed to improve catheter stability during ablation via a balloon (CB, POLARx™, Boston Scientific) that maintains uniform pressure and size. The purpose of this study was to evaluate whether the CB biophysical parameters, including time to -40
o
C (TT40), N
T
, time to thaw (iTT0), and time to 15
o
C (iTT15), are associated with acute PVI success in paroxysmal AF patients.

Methods:
Ablation was delivered for 180s if isolation was achieved in ≤ 60s or 240s if isolation occurred after 60s. PVI was confirmed via entrance and exit block. Biophysical parameters were evaluated for 3 groups: block with 180s ablation, block with 240s ablation, and for unsuccessful initial treatments (gap veins). The diagnostic accuracy for predicting PVI was assessed using area under (AUC) the receiver operator characteristic (ROC) curve for ablations > 120s.

Results:
Forty-six consecutive de novo PVI procedures at 4 centers were analyzed (n=234 ablations). All PVs were isolated using the CB alone, with the vast majority within 60s. During freeze, TT40 and N
T
were significantly shorter and colder for isolated veins compared to gap veins (Table). During thaw, iTT0 and iTT15 were significantly longer for isolated veins compared to gap veins (Table). ROC analysis found iTT15 had the highest diagnostic accuracy for isolation (AUC: 0.85) followed by N
T
(AUC: 0.81), iTT0 (AUC: 0.77), and TT40 (AUC: 0.72). Optimal cutoff values for iTT15 and N
T
were 33.5s and -48
o
C, which had positive predictive values for acute block of 96.6% and 93.5%.

Conclusions:
When using the novel CB, ablations reaching < -48
o
C and having thaw times to 15
o
C > 33.5s were predictive of acute block in PVI, providing guidance toward improved workflow and potential reduction in procedural time.
Abstract 15517: Sarcopenia in Heart Failure Patients Without Dementia is Associated With Local Brain Atrophy and Predicts Poor Prognosis
Authors: Meguro Tomomi , Meguro Yuko , NAGAI TOSHIO
Published: May 2021

Background:
Sarcopenia is age-related loss of skeletal muscle volume and strength. Aged Heart failure (HF) patients without dementia may have potential risk of cognitive impairment (CI) that attenuates the effect of treatment. Patients with CI have severe brain atrophy in parahippocampal gyrus (PHG). However, it is not clear whether sarcopenia is associated with local brain atrophy and predicts prognosis.

Hypothesis:
Sarcopenia in HF patients without dementia is associated with local brain atrophy of PHG, a potential risk of CI, and predicts prognosis.

Methods:
Fifty-four HF patients (age 78+/-8 years, NYHA class II, EF47+/-18 %) were enrolled. We excluded patients with dementia using mini-mental state examination. We took 3D-T1 weighted sagittal images of whole brain using 1.5T magnetic resonance imaging. Image analysis was performed to evaluate the severity of local brain atrophy of gray matter using 2mm voxel-based morphometry by the statistical parametric mapping software. The Z-score value was calculated to evaluate the severity of atrophy in PHG. The cross-sectional area of the erector spinae muscles (CSA), an index of sarcopenia, were measured at the 12th thoracic vertebra using computed tomography.

Results:
Patients were divided into sarcopenia HF group (n=27) and Non-sarcopenia HF group (n=27) according to median of CSA. The severity of total brain atrophy was similar between sarcopenia HF group (8.1 +/-3.8%) and Non-sarcopenia HF group (8.9+/-3.5%). However, as shown in the representative cases (Figure A), the Z-score value in PHG (pink circle), reflecting the severity of atrophy, was prominent in sarcopenia HF group (1.57+/-0.80) (white arrows) in comparison with Non-sarcopenia HF group (0.94+/-0.63, P=0.002). Although age, gender, BNP and hemodynamic factors were similar between groups, sarcopenia HF group had a lower survival rate (Figure B).

Conclusions:
HF patients with sarcopenia without dementia have potential risk of CI and poor prognosis.
Abstract 15518: Impact of Menopause on Cardiovascular Risk Factors Among Women Without Cardiovascular Disease: Insights From the CARTaGENE Study
Authors: Boutet Catherine-Elisabeth , Lopez Laporte Maria , Alturki Ahmed , Ni Jiayi , Nguyen Anh Thi , Tardif Jean-Claude , Gregoire Jean C , Sherman Mark , Dube Marie-Pierre , Ferreira Joao Pedro , Giannetti Nadia , Thanassoulis George , Sharma Abhinav , Huynh Thao
Published: May 2021

Background:
The effect of menopausal status on the risk factors of cardiovascular (CV) disease is not well ascertained. We aimed to evaluate the impact of menopause on several traditional and non-traditional cardiovascular (CV) risk factors.

Methods:
The CARTaGENE study was a prospective cohort study with random sampling of individuals in Quebec, Canada. We completed a seven-year follow-up in 2016. For this analysis, we included only subjects without prior cardiovascular (CV) events (CVE) or CV interventions (CVI). We defined the primary endpoint as CVE which can be any of the following events: acute coronary syndromes, heart failure, strokes, CV deaths, and peripheral vascular events. The secondary endpoint was CVI which included coronary, carotid, or peripheral artery revascularization. We used Cox proportional hazard stepwise multivariate analyses to identify independent predictors of the primary endpoint separately in pre- and post-menopausal women.

Results
Of 9,529 women without prior CV disease, 57% were post-menopausal. The mean age was 47.4 years and 58.6 years for pre-menopausal and post-menopausal women, respectively. There were 793 CVEs and 83 CVIs with a median time to event of 6.6 years. Hypertension, active smoking, increased waist to hip ratio, and glycosylated hemoglobin were independent predictors of the primary endpoint in both pre- and post-menopausal women. Furthermore, advanced age, family history of myocardial infarction, prior cancer, increased gamma-glutamyl transferase, and hyperuricemia also predicted increased riks of the primary endpoint in post-menopausal women.

Conclusion:
Hypertension, active smoking, increased waist to hip ratio, and high glycosylated hemoglobin were associated with increased CV risk in pre-menopausal women. The impact of hypertension was markedly amplified in pre-menopausal women compared to postmenopausal women. Intensive blood pressure control should be considered in pre-menopausal women.
Abstract 15523: Dynamic Protein S-palmitoylation Contributes to Cardiac Remodeling During Aging With Chronic Hypertension
Authors: Miles Madeleine R , Seo John , Wilson Zachary , Jiang Min , Tseng Gea-ny
Published: May 2021

Introduction:
More that 10% of human proteins can be S-palmitoylated, a post-translational modification (PTM) whereby palmitoyl chains are covalently linked to cysteine thiol groups. S-palmitoylation influences protein trafficking, distribution and function. There is no information on the scope of protein S-palmitoylation in the heart, or how this enzyme-mediated reversible PTM is regulated.

Hypothesis:
S-palmitoylation occurs to a wide spectrum of proteins in cardiomyocytes, and is coordinated by membrane-embedded palmitoylating (DHHC) enzymes. DHHC enzymes are subject to remodeling during chronic hypertension.

Methods:
We used resin-assisted capture to purify S-palmitoylated proteins from ventricular myocardium of 3 species: human, dog, and rat. We used global unbiased proteomic search to identify S-palmitoylated proteins. We validated DHHC antibodies and used them to monitor protein level and subcellular distribution of native DHHC enzymes in ventricular myocytes.

Results:
We built a 'composite' cardiac palmitome composed of 462 S-palmitoylatable proteins identified in ≥ 2 species-specific cardiac palmitomes. Enrichment analysis based on GO term 'cellular component' indicated that they are mainly involved in cell-cell and cell-substrate associations, sarcolemma and sarcomere organization, vesicular trafficking, G-protein function, ATP-dependent transmembrane transport, and mitochondria inner and outer membrane organization. Among the 23 DHHC enzymes, we detected ten in hearts across species. In ventricular myocytes with well-defined subcellular compartments, DHHC enzymes exhibited distinct distribution patterns: peripheral sarcolemma (DHHC1), M-lines (DHHC2), Z-lines (DHHC5), vesicles (DHHC7) and intercalated disc (DHHC9). In aging spontaneously hypertensive rats (a model of chronic hypertension, some in heart failure), seven DHHC enzymes were upregulated in the heart, accompanied by a higher degree of S-palmitoylation of CaMK II, caveolin3, Na/Ca exchanger, and Na/K pump α-subunit.

Conclusion:
S-palmitoylation is involved in most, if not all, aspects of cardiomyocyte function. Palmitoylation dysregulation may contribute to pathological progression in hypertrophy leading to heart failure.
Abstract 15543: Association Between Body Mass Index and Prognosis of Patients Hospitalized With Heart Failure
Authors: seko yuta , Kato Takao , Morimoto Takeshi , Yaku Hidenori , INUZUKA YASUTAKA , Tamaki Yodo , Ozasa Neiko , Shiba Masayuki , Yamamoto Erika , Yoshikawa Yusuke , Yamashita Yugo , Kitai Takeshi , Taniguchi Ryoji , Iguchi Moritake , nagao kazuya , Kawai Takafumi , Komasa Akihiro , Nishikawa Ryusuke , Kawase Yuichi , Morinaga Takashi , Toyofuku Mamoru , Furukawa Yutaka , Ando Kenji , Kadota Kazushige , Sato Yukihito , Kuwahara Koichiro , Kimura Takeshi
Published: May 2021

Background:
The prognostic implications of very low body mass index (BMI) values remain unclear in patients with acute decompensated heart failure (ADHF). This study aimed to investigate the prognostic impact of BMI classification based on the World Health Organization criteria in patients with ADHF.

Methods and Results:
Using data from 4056 consecutive patients with ADHF hospitalized in 19 participating hospitals in Japan between October 2014 and March 2016, we analyzed 3509 patients with available BMI data at discharge. The patients were divided into five groups; (1) Severely underweight: BMI<16 kg/m
2
, (2) Underweight: BMI≥16 kg/m
2
and <18.5 kg/m
2
, (3) Normal weight: BMI≥18.5 kg/m
2
and <25 kg/m
2
, (4) Overweight: BMI≥25 kg/m
2
and <30 kg/m
2
(5) Obese: BMI≥30 kg/m
2
. The primary outcome measure was all-cause death. The median follow-up duration was 471 days, with 96.4% follow up at 1-year. The cumulative 1-year incidence of all-cause death was higher in underweight groups, and lower in overweight groups (Severely underweight: 36.3%, Underweight: 23.9%, Normal weight: 14.4%, Overweight: 7.9%, and Obese: 9.0%, P<0.001). After adjusting confounders, the excess mortality risk remained significant in the severely underweight group (HR, 2.38; 95%CI, 1.88-3.02; P<0.001), and in the underweight group (HR, 1.33; 95%CI, 1.10-1.62; P=0.003) relative to the normal weight group, while the lower mortality risk was no longer significant in the overweight group (HR, 0.76; 95%CI, 0.57-1.01; P=0.06), and in the obese group (HR, 0.89; 95%CI, 0.53-1.50; P=0.66).

Conclusions:
Lower BMI, not obesity, was associated with a higher risk for all-cause death after discharge in patients with ADHF.
Abstract 15555: Potential Cure for Hypertension? The Effect of Crispr Genome Editing
Authors: Sun Hualing , Hodgkinson Conrad , Pratt Richard E , Dzau Victor J
Published: May 2021

Hypertension is recognized as one of the largest contributors to the global burden of disease. Unfortunately, for the majority of patients, hypertension is poorly controlled due, in part, to poor medical compliance resulting from the need to take one or more drugs, often several times daily. An ideal therapy would be administered a single time but yield long-term blood pressure control. Under the appropriate condition, we hypothesize that this modality could potentially lead to a cure for hypertension. In this study, we investigated whether that sustained, and possibly life-long, reductions in blood pressure could be achieved via Crispr-Cas9 mediated disruption of a key gene in the RAAS, Angiotensinogen (AGT). In vitro, we demonstrated that expression of Crispr-Cas9 system in the BRL 3A rat liver cell line led to a significant reduction in AGT protein levels (75% reduction, N=3, P<0.01). Delivery of the Crispr-Cas9 system into the liver via systemic delivery of the hepatocyte-targeting AAV8 reduced both AGT mRNA (70% reduction, N=5, P<0.01) and circulating AGT protein (50% reduction, N=5, P<0.01) and Ang II levels (33% reduction, n=5, P<0.01). In the SHR model of hypertension, Crispr-Cas9 mediated loss of AGT expression reduced systolic blood pressure in adult animals with established hypertension (30-35mmHg decrease in both females and males, N=12, P<0.001). Importantly, AGT gene disruption also prevented the spontaneous development of hypertension in young pre-hypertensive SHR (SHR control: 55-60mmHg increase in systolic blood pressure both female and male SHR; SHR plus Crispr-Cas9: 30-33 mmHg increase. N=12. P<0.001). Importantly, in all the models studied, reductions in blood pressure were sustained for at least 4 months. Importantly, the partial disruption of the hepatic AGT gene was sufficient to control hypertension but did not block the renin-angiotensin response to cardiovascular stress such as sodium depletion. In summary, we have demonstrated that targeting the Crispr-Cas9 system to RAAS reduces blood pressure and may be a potential therapy to achieve safe and sustained, possibly life-long, control of hypertension and this approach maybe a cure for hypertension.
Abstract 15564: What Pre-pregnancy, Pregnancy, and Inter-pregnancy Cardiometabolic Factors Contribute to Increased Risk of Recurrent Preeclampsia?: A Longitudinal Analysis in the Boston Birth Cohort
Authors: Ogunwle Michelle , Wang Xiaobin , Bennett Wendy L
Published: May 2021

Introduction:
Women with recurrent preeclampsia represent a group at uniquely high risk for maternal and perinatal morbidity, as well as future cardiovascular complications. The aim of this study is to examine the association of cardiometabolic risk factors with recurrent preeclampsia in the subsequent pregnancy.

Methods:
The Boston Birth Cohort is a racially/ethnically diverse birth cohort with over 8500 women. We identified 618 women with repeat pregnancies. Of those, 78 women had preeclampsia in the index pregnancy, and of those, 33 had recurrent preeclampsia in the subsequent pregnancy. We used log-binomial regression to examine the association between pre-pregnancy, pregnancy, and inter-pregnancy cardiometabolic risk factors (e.g., obesity, hypertension, diabetes mellitus, preterm birth, low birth weight, and gestational diabetes mellitus) and recurrent risk of preeclampsia.

Results:
Among the 78 women who had preeclampsia in their index pregnancy, the recurrence rate of preeclampsia was 42.3%. Several maternal risk factors were associated with this recurrent risk. Compared to women with pre-(index) pregnancy normal weight, the risk of recurrent preeclampsia was 3 times higher for women with pre-(index) pregnancy overweight (RR 3.0 [95% CI: 1.4 to 6.6]) or obesity (RR 3.1 [95% CI: 1.5 to 6.7). Compared to women without new inter-pregnancy chronic hypertension, women with new inter-pregnancy chronic hypertension had a 2-fold higher risk of recurrent preeclampsia (RR 2.4 [95% CI: 1.5 to 3.9]).

Conclusions:
Pre-(index) pregnancy obesity and new inter-pregnancy chronic hypertension was highly associated with recurrent preeclampsia in the subsequent pregnancy. Clinical and public health programs focused on reducing preconception obesity and reducing risk of hypertension in both the pre-pregnancy and inter-pregnancy periods may help reduce recurrent preeclampsia, which, in turn may help prevent or reduce subsequent cardiovascular disease.
Abstract 15572: Gender, Race, and Age Specific Baseline Predictors of All-cause Mortality in STICHES Trial Identified by Machine Learning
Authors: Atkinson Ian C , Husain Anwar , Dandi Gauri , Gani Nuha , Mallick Zyannah , Xin Victoria , Hayashi Scout , Lewis Natalie , Hasan Noah , Mahmood Nayab , Qureshi Khizar , Banerjee Avantika , Dey Amit , Rosenberg Yves D , Hasan Ahmed A
Published: May 2021

Introduction:
NHLBI supported STICHES trial (The Surgical Treatment for Ischemic Heart Failure Extended Study) (NCT00023595) was conducted to test whether blood flow restoration by coronary revascularization recovers chronic left ventricular dysfunction and improves survival, as compared to medical therapy alone in patients with congestive heart failure and coronary artery disease amenable to surgical revascularization. We reused publicly available individual patient-level STICHES trial data from NHLBI Data Repository (BioLINCC) to perform hypothesis-generating secondary analyses by machine learning (ML) using random survival forest (RSF) to identify gender, race and ethnicity, and age specific predictors for all-cause mortality (ACM).

Methods:
The population was sub-grouped by gender (male vs. female), race (white vs. Hispanic/Latinos/non-white), and age (< 55, 55-60, 61-69, and ≥70). RSF was performed on 48 baseline variables from 1212 patients to identify predictors of ACM. Top 10 RSF predictors for each subgroup were included in a multivariate analysis using a Cox proportional hazards model.

Results:
Top 10 predictors of ACM are shown in Table 1. While known cardiometabolic and vascular predictors were among the top predictors, RSF uniquely identified renal function related biomarkers and plasma sodium among important top predictors across the subgroups. Age was an important predictor for male and female, Hispanics/Latinos/non-whites, and patient groups ≥70 years old. Also, top predictors of ACM were current smoking status among age groups of <55 and 55-60, clinical recruitment site in age group 61-69, and female gender in age group 55-60.

Conclusions:
Using ML, we uncovered in an unbiased fashion, gender, age, race and ethnicity specific, unanticipated top predictors of ACM in STICHES trial. This highlights the value of ML for analyzing disease and therapeutic intervention outcomes to help implement precision medicine.
Abstract 15586: Burden of Cardiovascular or Fatal Outcomes in People With Type 2 Diabetes and Cardiovascular Risk Factors Treated With Dulaglutide a Post Hoc Analysis From the Rewind Trial
Authors: Dagenais Gilles , Lakshmanan Mark C , Dyal Leanne , Atisso Charles Messan , Colhoun Helen , Ryden Lars E , Gerstein Hertzel C
Published: May 2021

Introduction:
In the REWIND (Researching cardiovascular Events with a Weekly INcretin in Diabetes) trial, weekly subcutaneous dulaglutide 1.5 mg, a glucagon-like peptide-1 receptor agonist, compared with matched placebo reduced MACE (cardiovascular [CV] death, non-fatal myocardial infarction or non-fatal stroke) (594 versus 663 events) in 9901 participants with type 2 diabetes at moderate CV risk [mean (SD) age 66.2 (6.5) years, 46.3% women, 31% with chronic CV disease and the others with CV risk factors] and followed for a median of 5.4 years. These findings, based on a time to first event analysis, do not reflect total CV event or mortality burden.

Objective:
To better reflect the burden of disease, the following outcomes were assessed: 1) total number of MACE or fatal events and 2) total number of CV (MACE, unstable angina, heart failure or revascularization) or fatal events in the REWIND participants.

Methods:
Incidence was estimated per 1000 person-years (py), and hazard ratios (HR) were calculated using conditional time gap and proportional means models.

Results:
A total of 1972 MACE outcomes or deaths and of 3673 CV outcomes or deaths occurred in the 9901 participants. Of the1128 all-cause deaths, 465 were non-CV. The incidence of total MACE or deaths was 35.8 in the dulaglutide group versus 40.3/1000 py in the placebo group [absolute reduction=4.5/1000 py; conditional time gap HR, 0.90 (95%CI, 0.82-0.98),
P
=0.020, and proportional means HR, 0.89 (95% CI, 0.80-0.98),
P
=0.022]. The incidence of total CV or fatal events on dulaglutide was 67.1 and 74.7/1000 py on placebo [absolute reduction=7.6/1000 py; conditional time gap HR, 0.93 (95% CI, 0.87-0.99),
P
=0.023, and proportional means HR, 0.90 (95% CI 0.82-0.99),
P
=0.028]. Similar effect sizes were noted for the first occurrence of MACE or deaths such that the absolute risk reduction was 4.1/ 1000 py.

Conclusions:
These findings suggest that weekly subcutaneous dulaglutide was associated with reduced total MACE, CV or fatal event burden in people with type 2 diabetes and moderate CV risk. This analysis illustrates the clinical relevance of assessing total events in addition to first events in clinical trials.

Clinical Trial Registration:
https://www.clinicaltrials.gov. Unique Identifier NCT01394952)
Abstract 15590: Genetic Testing and Cardiac Magnetic Resonance Imaging Results Improve Precision Stratification in Dilated Cardiomyopathy
Authors: Amin Ravi , Jones Richard , Hammersley Daniel , gati sabiha , Khalique Zohya , Almogheer Batool , Pennell Dudley J , Pantazis Antonis , Baksi John , Prasad Sanjay K , Halliday Brian
Published: May 2021

Introduction:
Dilated cardiomyopathy (DCM) has a heterogenous aetiology. Precise disease stratification enabling personalised therapy may be key to improving management. Genetic testing and cardiac magnetic resonance (CMR) may help stratify the cause of DCM.

Hypothesis:
Adding genetic testing and CMR to routine tests will improve confidence and reproducibility in DCM stratification and, in turn, guide management.

Methods:
Case profiles for 60 consecutive patients with DCM were sent to 4 independent experts. Using routinely available clinical information, they were asked to determine the aetiology of the phenotype, based on the classification in the ESC Position Statement on DCM, and record their confidence (score 1-3) in the diagnosis. This was repeated after the addition of genetic testing and CMR results in a step-wise manner. Clinicians were also asked whether they would make changes to patient management.

Results:
Overall, 4 physicians reviewed 60 cases, giving 240 responses. Adding genetic testing and CMR resulted in changes to disease stratification (
Table 1
). The most common change was from idiopathic to genetic DCM, following the identification of pathogenic or likely pathogenic variants in 13 cases. Confidence scores improved with the addition of genetic testing and CMR results (routine 1.69±0.53; routine & genetic 1.93±0.61, p<0.0005; routine, genetic & CMR 2.26±0.69, p<0.0005). Adding genetic testing and CMR led to changes in management, with family screening the most common. Where
LMNA
or
DSP
variants were identified (n=3, 5.0%), new recommendations for device therapy were made. Adding genetic and CMR data improved interobserver agreement in stratification (routine κ=0.40; routine & genetic κ=0.66; routine, genetic & CMR κ=0.68).

Conclusion:
Adding genetic testing and CMR to routine tests changed how DCM was stratified, improved confidence and interobserver variability in making this diagnosis, and subsequently, directed management.
Abstract 15593: In Hospital Outcomes and Prevalence of Comorbidities in Patients With Infective Endocarditis With and Without Heart Blocks - Insight From a National Inpatient Sample
Authors: Jamal Shakeel , Kichloo Asim , Albosta michael , Bailey Beth , Soni Ronak , Nanda Navya , Khan Hafiz Waqas , Sadiq Ramsha , SINGH Jagmeet , Haddad Nicholas , kanjwal khalil
Published: May 2021

Objective:
To study inpatient outcomes of infective endocarditis (IE) with concurrent heart blocks

Introduction:
IE complicated with heart blocks can have adverse outcomes and usually requires immediate surgical and cardiac interventions. Data on outcomes and trends in patients with IE with concurrent heart blocks are lacking.

Methods:
Patients with a principle diagnosis of IE with or without heart blocks were identified by querying the Healthcare Cost and Utilization (HCUP) database, specifically, the National Inpatient Sample for year 2013 and 2014 based on ICD9 codes.

Results:
During 2013 and 2014, a total of 18,733 patients were admitted with a diagnosis of IE, out of whom 867 had concurrent heart blocks. There was an increased in-hospital mortality (13% vs 10.3%), length of stay (19 vs 14 days), cost of care (282,573 vs 223,559), cardiogenic shock (8.9% vs 3.2%), placement of an ICD/CRT/PPM (30.6% vs 0.9%), acute kidney injury (40.1% vs 32.6%) and hematologic complications (19.3 vs 15.2%) in patients admitted with IE with heart blocks as compared to those with IE but without heart block. Infective endocarditis and concurrent heart block resulted in increased requirement for aortic (25.7 vs 6.1%) and mitral (17.3% vs 4.2%) valvular replacements as compared to IE without heart block.

Conclusions:
IE with concurrent heart block worsens in-hospital mortality, length and cost of hospital stay. Our analysis clearly demonstrates an increase in the indications for cardiac procedures, specifically aortic and/or mitral valve replacements and ICD/CRT/PPM placement. A close tele monitoring system and prompt interventions may represent a significant mitigation strategy to avoid adverse outcomes observed in this study.
Abstract 15595: Missed Targets: United States Trends in Hypertension Prevalence, Control, and Treatment 2005-2018
Authors: Aggarwal Rahul , Chiu Nicholas , Wadhera Rishi , Shen Changyu , Yeh Robert W , Kazi Dhruv
Published: May 2021

Introduction:
Hypertension is a major risk factor for cardiovascular disease. The US government, through the Healthy People Initiative 2020, set targets to improve hypertension prevalence and treatment rates in US adults by a relative 10% from 2005 to 2020, and increase control rates by a relative 40%. We examined US progress towards this goal from 2005-2018.

Methods:
We analyzed data from 38,876 non-pregnant US adults from the NHANES 2005-2018 surveys to determine nationally representative estimates of hypertension prevalence, treatment rates, and control. Temporal trends in hypertension prevalence, treatment, and control were assessed using weighted linear regression after age adjustment to the 2000 US census (per the Healthy People Initiative approach). In the base case, we defined hypertension as blood pressure >140/90 or on an antihypertensive; we used the ACC/AHA definition of blood pressure >130/80 in sensitivity analyses.

Results:
In 2017-2018, 34.3% (±1.7) of US adults had hypertension, of these 69.7% (±1.5) were on treatment, and 43.7% (±1.6) were controlled. After age-adjustment, no statistically significant changes in hypertension prevalence, treatment rates, or control were observed from 2005-2018 (p for trend 0.91, ,0.98, 0.66, Figure 1). In sensitivity analyses, applying the ACC/AHA definition increased the estimated prevalence of hypertension during the period, but trends in prevalence remained unchanged.

Conclusions:
There has been no material progress in reducing the prevalence of hypertension or improving rates of treatment and control from 2005 to 2018. As planning is underway for Healthy People Initiative 2030, setting of hypertension targets must be accompanied with investments in cost-effective, scalable programs to improve blood pressure control nationwide, with a focus on high-risk populations.
Abstract 15615: Association of Covid-19 With QTc Prolongation: A Need for Routine Ecg Screening
Authors: Vangala Adarsh S , Harkins Michelle S , Mertz Gregory J , Shah Ishan R , Myla Madhura , Sheldon Mark W , Nihart Alexander , Raizada Veena
Published: May 2021

Introduction:
Coronavirus Disease 2019 (COVID-19) has a high risk of death due to respiratory and cardiac complications. Internalization of the virus in the heart may derange myocyte functions such as repolarization, manifesting as QT prolongation on surface electrocardiograms (ECGs). Long QT is associated with cardiac arrhythmias, including sudden arrhythmic death. Previous studies of corrected QT (QTc) in Covid-19 have not controlled for other QTc prolonging comorbidities.

Hypothesis:
This study investigates whether COVID-19 is associated with prolonged QTc independent of other causes of QTc prolongation.

Methods:
QTc values were taken from ECGs of 36 patients with COVID-19 admitted to intensive care and 70 healthy age- and gender-matched control subjects. Patients were excluded if they received QTc-prolonging drugs, had hypokalemia, hypocalcemia, or hypomagnesemia, or history of excessive alcohol use. QTc values of COVID-19 patients were compared against normal control subjects.

Results:
The COVID-19 group included 15 females and 21 males with hypertension (n=11) and diabetes mellitus (n=5) as the most common comorbidities. Electrolytes were normal (K, 3.97 ± 0.41 mEq/L; Mg, 2.41 ± 0.38 mg/dL; and corrected Ca, 10.60 ± 0.60 mg/dL). QTc (msec) was significantly prolonged in COVID-19 compared with control subjects (total 469 ± 36.1 vs 418 ± 17.8; females, 475±29.2 vs 424 ± 11.4, and males 465 ± 40.5 vs 416 ± 19.9; all p<0.001).

Conclusions:
COVID-19 alone, without an associated QT prolonging etiology, is associated with QTc prolongation. Ventricular arrhythmias may be more likely to affect women with COVID-19 than men with the disease. Therefore, it is recommended that, in COVID-19 patients, electrolytes be maintained within normal limits and QT prolonging drugs be avoided.
Abstract 15616: Virtual Care: Empowering Patients and Providers
Authors: Paruchuri Kaavya , Bhattacharya Romit , Pagliaro Jaclyn , Bhatt Ami
Published: May 2021

Introduction:
The COVID-19 pandemic has catalyzed widespread usage of telemedicine due to the unprecedented need for remote patient care. Scaling virtual visits from occasional occurrences to standard of care is not without hurdles. Here we describe operationalizing virtual cardiovascular clinic in one large academic teaching hospital.

Methods:
To avoid implicit bias in perceived comfort with technology, virtual video (VV) visits were offered to all patients whose in-person office visit was cancelled. Those who declined were subsequently offered phone appointments. Patients who agreed to VV were called prior to their appointment time by staff to guide them through setup. Providers were given written, illustrated instructions on setup augmented with short how-to video demonstrations. They each completed a practice session with a staff member acting as a “test patient” to demonstrate basic functions within Zoom including use of chat, virtual waiting room, screen share and inviting additional participants (such as family, staff or interpreters). Providers were trained on workflows to allow seamless transitions across multidisciplinary team members involved in patient care.

Results:
Prior to the pandemic, there were mean (SD) 12.6 (2.8) VV appointments per month. Telemedicine adoption rose rapidly across provider types after travel restrictions were enacted, with the majority of visits initially occurring telephonically (Figure 1A and 1B). VV visits were also noted to increase swiftly with 3,164 VV visits in April 2020 and 5,452 in May 2020. After training sessions, providers felt comfortable using integrated virtual care tools (Figure 1C).

Conclusions:
Virtual clinic can be rapidly implemented and scaled within a healthcare system. Training materials and support for both patients and providers are key to increasing adoption of new technology. Hybrid systems will be needed to harmonize synchronous in-person and asynchronous virtual care in the longer term.
Abstract 15617: Atrial Fibrillation Prevalence, Anticoagulation Practices, and Long-term Outcomes for Patients Discharged With Atrial Fibrillation After Tavr: Results From the Partner 2a and S3i Trials
Authors: Brener Michael I , Kodali Susheel K , Nazif Tamim , Zhang Zixuan , Kosmidou Ioanna , Thourani Vinod H , Dizon Jose , Garan Hasan , Leon Martin B , Biviano Angelo B
Published: May 2021

Background:
Atrial fibrillation (AF) is associated with worse outcomes, including increased mortality, in patients undergoing transcatheter and surgical aortic valve replacement (TAVR/SAVR).

Objective:
To assess: (i) the short- and long-term prevalence of AF in intermediate surgical risk patients undergoing TAVR and SAVR; (ii) determine rates of anticoagulation (AC) prescription in patients with AF; and (iii) evaluate differences in outcomes.

Methods:
A total of 2663 patients from the PARTNER 2A and S3i trials were categorized into 3 groups by their baseline and discharge rhythm (sinus rhythm [SR] vs. AF): SR/SR, SR/AF, and AF/AF. Patients were followed for up to two years.

Results:
Table 1 presents the frequency of AF, AC prescription, and outcomes at 30-days, 1-year, and 2-year follow-up. SR/AF TAVR and SAVR patients continued to manifest relatively high rates of AF at each follow-up point. SR/AF patients were prescribed AC less often than AF/AF patients. For TAVR patients, the development of and discharge in AF was associated with increased bleeding (OR 1.59, 95% CI 1.11-2.26, p=0.01, SR/AF vs. AF/AF) and mortality (OR 1.77, 95% CI 1.04-3.00, p=0.03, SR/AF vs. AF/AF), but not stroke. There were no significant differences in outcomes in the SAVR patients.

Conclusion:
TAVR/SAVR patients who developed and were discharged in AF (SR/AF) were often in AF at 30 days, 1 year, and 2 year follow-up. While anticoagulation rates were lower in the SR/AF vs. the AF/AF group, bleeding and mortality, but not stroke, rates were higher for TAVR SR/AF vs. AF/AF patients. Further analyses of the associations between AF development, anticoagulation use, and outcomes in TAVR and SAVR patients are warranted.
Abstract 15641: Fever. The True Unmasker of My Disease
Authors: Zablah Gerardo , Colombo Rosario A
Published: May 2021

Introduction:
The most common etiology of sudden cardiac death (SCD) from ventricular tachyarrhythmias (VTA) is an acute ischemic event from coronary artery disease (CAD; followed by genetic syndromes, including Brugada Syndrome (BS). The presentation of SCD with an ECG showing RBBB pattern with ST segment elevation (STSE) in leads V1-V3 in healthy patients and in the absence electrolyte imbalances, CAD, or structural heart disease is known as BS. It can be triggered by abundant meals, excessive alcohol intake, cocaine, local anesthetics, tricyclic antidepressants, lithium, propofol and fevers.

Case Presentation:
29 y/o woman presenting with atypical chest pain, malaise, and a remote history of a syncopal episode. She denied family history of SCD. She was febrile to 100.4
o
F, tachycardic, with regular heart sounds and no murmurs. Laboratory work up was normal. ECG from two years ago showed nonspecific interventricular conduction delay. ECG on admission showed STSE in anterior precordial leads which disappeared with resolution of her fever. Due to the Brugada-like pattern in her ECG and remote history of syncope, AICD placement was recommended. Flecainide challenge was not pursued, since the patient was amenable to AICD. Genetic counseling and testing were provided to her family members.

Discussion:
Most patients with BS are healthy adults between 30-40 y/o without significant medical history. A defect in the sodium channel SCN5A, results in a loss of homogeneity in the myocardial action potential. This mutant channel may be exaggerated when exposed to supraphysiologic temperatures, unmasking BS and elevating the risk of VTA and SCD. BS is carried through generations in an autosomal dominant fashion. Medical management alone is ineffective and not recommended. AICD is the only effective treatment for prevention of SCD.

Conclusion:
BS is an identifiable and preventable cause of death. In patients presenting with multiple syncopal episodes or aborted VTA’s, in the absence of significant cardiovascular history, and with known or equivocal family history of SCD, the diagnosis of BS must be considered. Health providers across all practice settings should have the skill of identifying its clinical and ECG presentation in order to decrease the rate of SCD.
Abstract 15656: Manual vs Remote Magnetic Navigation for Ventricular Tachycardia Ablation: A Meta-analysis
Authors: Murtaza Ghulam , Turagam Mohit K , Garg Jalaj , Akella Krishna , Atkins Donita , Koerber Scott M , Gopinathannair Rakesh , Lakkireddy Dhanunjaya
Published: May 2021

Introduction:
The role of remote magnetic navigation (RMN) for ventricular tachycardia (VT) ablation is not well established. In this meta- analysis, we aim to evaluate the safety and efficacy of RMN vs manual navigation (MAN) for VT ablation.

Methods:
A comprehensive literature search in PubMed, Google Scholar and Cochrane Review from inception till November 9th, 2019 was performed. Studies reporting clinical outcomes comparing MAN vs RMN were included. Two investigators independently extracted the data and individual quality assessment was performed. Results were expressed as odds ratio (OR) for dichotomous outcomes and mean differences (MD) for continuous variables with 95% confidence intervals (CI).

Results:
Eight studies including a total of 861 patients (475 in RMN arm and 386 in MAN arm) were included in the final analysis. VT recurrence was significantly lower with RMN compared with MAN (OR 0.65, 95% CI 0.48-0.88, p= 0.005). Acute procedural success was significantly higher with RMN (OR 2.21, 95% CI 1.51-3.23, p < 0.0001). Total procedure time [MD -8.83, 95% CI -17.72- 0.05, p=0.05], fluoroscopy time [MD -10.24, 95% CI -12.28- -8.19, p= 0.00001), and complications [OR 0.36, 95% CI 0.18- 0.72, p= 0.003] were significantly lower in RMN compared to MAN.

Conclusion:
Results of our meta-analysis indicate that RMN is safer and more effective than MAN in patients with VT undergoing ablation. Further, randomized studies are needed to validate these findings.
Abstract 15660: Impact of Telemedicine on Pediatric Cardiac Center’s Ambulatory Response to the 2019 Novel Coronavirus Disease (covid-19) Pandemic
Authors: Mehrtens Kristine M , Krishnan Anita , Moak Jeffrey P , SABLE Craig A , Selekman Rachel , Berul Charles I , Hovis Ian , Helmandollar Carole , Pender Tyrone A , Safo Christiana , ARROYO CARMEN , Becker Jeffrey A , Munoz Ricardo A , Harahsheh Ashraf S
Published: May 2021

Background:
The 2019 novel coronavirus disease (COVID-19) pandemic puts cardiology patients at high risk for worsening of their underlying disease due to a decrease in non-emergent outpatient visits and social distancing concerns. Our aim was to assess the impact of telemedicine on ambulatory cardiology. Our hypothesis was that telemedicine would bridge the drop in ambulatory visits thus allowing surveillance visits to continue.

Methods:
Retrospective study from 3/2 to 6/12/2020 utilizing an administrative ambulatory database. Weekly telemedicine and in-person visits were extracted from EMR schedules. A telemedicine orientation session and individualized in-service sessions were provided to all cardiology staff by an expert in telemedicine. Logistics of scheduling, consenting, conducting the visit, documenting and billing were reviewed. To maximize physical distancing, in-person visits were relocated to regional outpatient centers. Prior to COVID-19, 37 cardiologists and 2 nurse practitioners conducted an average of 350 ambulatory visits/week.

Results:
The number of providers conducting telemedicine visits increased from 3 (8%) pre-COVID-19 to 31 (79%) during the pandemic. Compared to pre-COVID average, the median (IQR) weekly total ambulatory visits during the pandemic was 62% (57-90%). During the COVID-19 pandemic, the median frequency of telemedicine visits was 18% (11-32%). (Figure 1)

Conclusion:
Ambulatory in-person cardiology visits decreased during the COVID-19 pandemic; however telemedicine visits partially compensated for this drop. At the height of stay-at-home orders, cardiology in-person outpatient visits decreased to 25%, but rapidly increased back up to 88% the usual in-person visit volume. Future study is needed to assess the impact on patient outcomes, family satisfaction, cost-effectiveness and revenue of telemedicine visits during the COVID-19 pandemic.
Abstract 15664: Prior Oral Anticoagulant Status and Outcomes in Patients With Atrial Fibrillation With an Acute Coronary Syndrome and/or Undergoing Percutaneous Coronary Intervention: Insights From the Augustus Trial
Authors: Welsh Robert C , Lopes Renato D , Wojdyla Daniel , Aronson Ronald , Granger Christopher B , Windecker Stephan , Vora Amit , Vinereanu Dragos , Halvorsen Sigrun , Parkhomenko Alexander , Mehran Roxana , Alexander John H , Goodman Shaun G
Published: May 2021

Background:
Managing antithrombotic therapy transitions at hospital admission and discharge in patients with atrial fibrillation (AF) and an acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI) is challenging and is affected by prior treatment. We examined oral anticoagulant (OAC) use prior to enrollment and the relationship with outcomes in the AUGUSTUS trial.

Methods:
Patients in AUGUSTUS (N=4,614) were analyzed according to whether they were [n=2262] or were not [n=2352] on a prior OAC. Bleeding and clinical outcomes were compared by Kaplan-Meier (KM) estimates at 180 days. For each outcome, KM estimates and treatment interactions were determined by randomized arm and prior OAC status.

Results:
Those with prior OAC use had higher CHA
2
DS
2
-VASC and HAS-BLED scores and more comorbid medical conditions (hypertension, heart failure, diabetes, prior stroke), and were more likely to have been enrolled following elective PCI. Prior OAC use included vitamin K antagonists (VKAs) 47%, rivaroxaban 22%, apixaban 22%, dabigatran 12%, and edoxaban 1%. There was no difference in combined ISTH major/clinically relevant non-major (CRNM) bleeding with or without prior OAC use (13.5% vs. 13.5%; HR 1.00, 95% CI 0.85-1.18). Patients with prior OAC use had lower risk of death or ischemic events (5.4% vs. 7.6%; HR 0.72, 95% CI 0.57-0.91). No interactions were observed between randomized treatment (apixaban vs. VKA and aspirin vs. placebo) and prior OAC status for outcomes other than MI where apixaban (vs. VKA) was associated with a lower risk of MI in those with prior OAC use (Figure).

Conclusion:
In AUGUSTUS, OAC prior to enrollment was more common in patients with comorbidities and those enrolled following elective PCI. Prior OAC was associated with fewer ischemic events but not more bleeding. Our results support the use of apixaban plus a P2Y12 inhibitor without aspirin for patients with AF and ACS/PCI, irrespective of prior OAC use.