bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15583: Cardiovascular Computed Tomography Aortic Valve Calcification, Myocardial Fibrosis and Adverse Outcome Following Transcatheter Aortic Valve Replacement
Authors: Evertz Ruben , Hub Sebastian , Beuthner Bo E , Backhaus Soeren Jan , Lange Torben , Topci Rodi , Puls Miriam , Zeisberg Elisabeth , Lotz Joachim , Hasenfuss Gerd , Schuster Andreas
Published: May 2021

Introduction:
There is evidence to suggest that subtype of aortic stenosis (AS), degree of myocardial fibrosis (MF) and level of aortic valve calcification (AVC) are associated with adverse cardiac outcome in AS. Since little is known about their respective contribution, we sought to investigate their relative importance and interplay as well as association with adverse cardiac events.

Methods:
100 consecutive patients with severe AS and indication for transfemoral transcatheter aortic valve replacement (TAVR) were prospectively enrolled between January 2017 and October 2018. Patients underwent transthoracic echocardiography, multi detector computed tomography (MDCT) and left ventricular endomyocardial biopsy at the time of TAVR.

Results:
The final study cohort consisted of 92 patients with completed study protocol comprising of 39 (42.4 %) normal ejection fraction high gradient (NEFHG), 13 (14.1 %) low EF high gradient (LEFHG), 25 (27.2 %) low EF (flow) low gradient (LEFLG) and 15 (16.3 %) paradoxical low flow low gradient (PLFLG) AS. The high gradient phenotype (NEFHG and LEFHG) showed the largest amount of AVC (807 ± 421; 813 ± 281 mm
3
respectively) as compared to the low gradient phenotype (LEFLG and PLFLG; 503 ± 326; 555 ± 594 mm
3
respectively, p<0.05). Conversely, MF was most prevalent in low output phenotypes (LEFLG>LEFHG>PLFLG>HEFHG, p<0.05). This was paralleled by larger cardiovascular mortality within 400 days post TAVR (LEFLG n=7>PLFLG n=4>LEFHG n=2>NEFHG n=1). Within LEFLG AS, patients with larger AVC (>476.8 mm
3
) had larger MF (40.2%) and higher cardiovascular mortality (n=5) as compared to patients with less AVC (≤476.8 mm
3
, 17.1% MF, p=0.027, cardiovascular mortality n=2).

Conclusion:
MF is associated with adverse cardiovascular outcome following TAVR which is most prevalent in low ejection fraction situations. Within the low ejection fraction low gradient subtype large AVC was associated with high amounts of MF and adverse cardiovascular outcome.
Abstract 15587: Pericardial Tamponade in Patients With Influenza Infection: A Systematic Review of Published Cases
Authors: Desai Rupak , Raina Jilmil S , Itare Vikram , Jain Akhil , Singh Sandeep , Bhuva Rushik , Malik Faizan Ahmad , Shah Vraj , Hassan Falah A , Sachdeva Rajesh , Kumar Gautam
Published: May 2021

Introduction:
Literature reported cardiac tamponade in patients with influenza virus infection, which incited us to understand patient-level demographics, courses and outcomes.

Methods:
Systematic literature search was performed until May 2020 to review post-influenza cardiac tamponade cases.

Results:
Twenty five publications reported 28 patients (M:F::12:15, age range: 4-69 yrs, 9 pediatric) who had post-influenza cardiac tamponade as shown in
Table 1
. Nine (32.1%) patients had dyspnea and 7 (25%) had chest pain. Onset of tamponade after flu ranged from 1 day-6 weeks. 22 (78.5%) and 3 (10.7%) were infected with Influenza A and B strains respectively. Troponin-T (n=7) ranged from 0.03 ng/dL-10.50 ng/dL. Twelve (42.8%) patients were treated with influenza therapy; 8 (28.5%) with Pseltamivir, 2 (7.1%) with Oseltamivir followed by Peramivir, 1 (3.5%) with Zanamivir, 1 (3.5%) with Zanamivir followed by Peramivir. Pericardiocentesis was done in 25 (89.2%) patients. Seventeen (57.1%) patients required mechanical circulatory/respiratory support: 13 intubations, 3 ECMO, 2 CPR, 1 external defibrillation and 1 noninvasive ventilation. Twenty-three (82.1%) patients recovered while 4 (14.2%) patients died.

Conclusion:
This systematic review of patient-level data showed high recovery rate with early diagnosis and timely pericardiocentesis and nearly 14% of mortality rate.
Abstract 15596: Maturation of Hipsc-cm Electrophysiological and Contractile Function for Enhanced Sensitivity of Cardiac Safety Assays
Authors: Hayes Heather B , Nicolini Anthony M , Arrowood Colin , Millard Daniel
Published: May 2021

Human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) have significantly advanced
in vitro
cardiac safety and disese modeling, yet remain an immature representation of human myocytes. Electrical or mechanical conditioning of hiPSC-CMs facilitates functional maturation, as measured by a positive force-frequency relationship, but current
in vitro
protocols require 2-4 weeks of conditioning. Using array-based contractility and local electrical stimulation, we detected functionally mature phenotypes and compound responses in hiPSC-CMs after only 48 hours of chronic pacing. To mature cardiomyocytes, hiPSC-CMs were cultured on 24- and 96-well MEA plates with a dedicated stimulation electrodes. Later, hiPSC-CMs were electrically or optically paced at 2Hz for 48 hours. Multimodal measures quantified contractile and electrophysiological responses to varied pacing rates and compound addition. After 48 hours of pacing, hiPSC-CMs displayed shortened repolarization timing compared to before chronic pacing (baseline: 423 +/- 21 ms; matured: 316 +/- 15 ms), without significant beat period changes (baseline: 1255 +/- 40 ms; matured: 1314 +/- 84 ms). Contractile beat amplitude was measured using array-based impedance during spontaneous beating and at increasing pacing rates (1, 1.2, 1.5, 2, and 2.5 Hz). Before chronic pacing, beat amplitude decreased with increasing pacing rate; after chronic pacing, the same wells displayed increased beat amplitudes with increasing pacing rate. The matured wells also showed enhanced sensitivity to positive inotropes, such as isoproterenol, digoxin, omecamtiv mecarbil, and dobutamine. Local extracellular action potentials (LEAP) further revealed altered electrophysiological response to ranolazine, a multichannel blocker. Unpaced control wells exhibited dose-dependent APD90 prolongation in response to ranolazine, whereas matured wells showed no APD90 change. Similar results were seen with 48 hour of optogenetic pacing at 2 Hz. Overall, hiPSC-CMs chronically paced for only 48 hours exhibited more mature functional phenotypes, including a positive force-frequnecy relationship, enhanced ionotrope sensitivity, and altered compound response.
Abstract 15608: Atp Citrate Lyase a New Signaling Hub Between Metabolism and Epigenetic in Vascular Remodeling and Right Ventricle Failure in Pulmonary Arterial Hypertension
Authors: romanet Charlotte , Bourgeois Alice , Grobs Yann , Breuils Bonnet Sandra , Nadeau Valerie , Provencher Steeve , BOUCHERAT Olivier , Bonnet Sebastien
Published: May 2021

Objective:
Pulmonary arterial hypertension (PAH) is a lung disease characterized by vascular lesions and obstruction of distal pulmonary arteries (PA) leading to right ventricle (RV) remodeling and death. Similar to cancer cells, PA smooth muscle cells (PASMCs) exhibit an excessive proliferation and resistance to apoptosis, pivot components of vascular remodeling, due to epigenetic reprogramming and Warburg effect. This epigenetic/metabolic signature is attributed in part to the upregulation of ATP citrate lyase (ACLY). By decreasing cytosolic levels of citrate, ACLY supports glycolysis, while by generating acetyl-coA in the nucleus it promotes histone acetylation and signaling pathways supporting pathological processes like proliferation, hypertrophy, and fibrosis, pathological features in PAH. In the cytosol, ACLY controls the synthesis of lipids required for proliferating cells to generate membranes. We thus hypothesized that ACLY is upregulated in PAH and contributes to PA remodeling and RV failure.

Methods/Results:
Using immunoblot, we showed an upregulation of ACLY in human distal PA and isolated PASMCs from PAH patients (p<0.05 ; n=10), like in Sugen/Hypoxia rat model. In vitro, pharmacological inhibition of ACLY significantly decreased PAH-PASMC proliferation (Ki67 labeling), resistance to apoptosis (Annexin V and caspase 3 assays) and restored a proper metabolism (seahorse assay) (p<0.05 ; n=5). Mechanistically, we showed that ACLY inhibition decreases P300-dependent pro-survival factors including Survivin, PCNA, cMYC, PKM2, phospho-PDH / PDH, and restores FOXO3 and AMPK functions know to be decreased in PAH. Besides, we found that ACLY expression was upregulated in failed RV from rats subjected to pulmonary artery banding; its expression correlating negatively with stroke volume and positively with RVEDP; hypertrophy and fibrosis.

Conclusion:
Our preliminary data suggest that ACLY contributes to vascular remodeling in PAH. Current experiments aim to demonstrate whether 1) pharmacological inhibition of ACLY reverses PAH in animal models and 2) whether inactivation of Acly targeted to smooth muscle cells and cardiomyocytes improves pulmonary vascular remodeling and RV dysfunction, respectively.
Abstract 15626: Visualizing Self-reported Symptom Status Can Support Self-management for Heart Failure Patients
Authors: Reading Turchioe Meghan , Grossman Liu Lisa , Myers Annie , Masterson Creber Ruth M
Published: May 2021

Introduction:
Symptom self-management is important in heart failure (HF) but challenging given the high prevalence of associated cognitive impairment. Visualizations may support symptom self-management by improving recognition of meaningful changes in symptoms over time. The purpose of this study was to evaluate whether visualizations of self-reported symptom status were associated with recognition of worsening symptoms
(risk perception)
and intention to act on worsening symptoms
(behavioral intention)
.

Methods:
We recruited hospitalized, English-speaking adults with HF from 2 inpatient cardiac units at an urban academic medical center. A professional designer developed 4 visualizations of simulated changes in self-reported symptoms (e.g., fatigue;
Figure 1
) using best practices for displaying health information to adults with cognitive impairment. Using the participants’ favorite visualization of the 4, we evaluated risk perception and behavioral intention using validated scales. We also collected demographics, health literacy, and cognitive status using the Montreal Cognitive Assessment (MoCA).

Results:
Participants (n=40) had an average age of 61.3 years (±12.5) and were 22% female, 52% White, and 38% Latino. More than half (55%) had low health literacy. Most (88%) had mild/moderate cognitive impairment (MoCA score < 26). The favorite visualization (selected by 42%) was the number line. Regarding risk perception, 70% reported it was very/extremely likely their HF was getting worse and 54% reported they were very/extremely worried about their HF getting worse based on the visualization. Regarding behavioral intention, most (82%) were very/extremely likely to act based on the visualization.

Conclusion:
Visualizations of symptoms over time communicated risk to most patients who in turn reported being more likely to act, and may be an effective tool to support symptom self-management among HF patients with mild/moderate cognitive impairment.
Abstract 15655: Safety and Efficacy of Subclavian Fibroplasty in Patients With Prior Left Ventricular Lead Implant Failure
Authors: SHEHADEH MALIK , Alexander Nebu , Hadadi Cyrus , Costello John , Brar Vijaywant , Eldadah Zayd , Worley Seth
Published: May 2021

Introduction:
Fibrous subclavian vein obstruction (SVO) is a common primary cause of left ventricular (LV) lead implant failure. Such obstruction might be apparent or unrecognized. Balloon dilation of the aggressive fibrosis that develops in response to chronic leads (fibroplasty) can be employed safely to achieve a successful implant.

Hypothesis:
To describe the experience of high-volume referral center with balloon dilation of fibrous tissue in patients with prior LV lead implant failure.

Methods:
We evaluated the role of balloon dilation in 187 patients referred to our institute because of prior LV lead implant failure between June 2017 and November 2019.

Results:
Of the 187 patients, 35 (19%) had apparent SVO as the primary explanation for implant failure. In 152 (81%), SVO was not recognized as contributing to implant failure. In 32 of 35 with apparent SVO (91.4%), it was possible to cross the obstruction and perform fibroplasty successfully. Three cases (8.6%) failed due to inability to advance a wire through the obstruction, none had existing leads to follow. In 33 of 152 (22%) cases without recognized SVO, fibroplasty of the subclavian was required, in addition to another interventional techniques, for successful implantation. There were no major or minor vascular complications related to fibroplasty. There was no distal embolization and no damage to the existing leads.

Conclusions:
In the setting of chronic leads, apparent SVO is commonly recognized as a cause of LV lead implant failure. However, 22% of prior LV lead implant failures without obvious obstruction also required fibroplasty (in addition to another interventional techniques) for success. In conclusion, subclavian fibroplasty is essential for successful implantation in patients with prior LV lead implant failure with and without obvious obstruction and can be safely performed by the implanting physician.
Abstract 15657: Influenza Vaccination and All-cause Mortality Among Adults With Heart Failure in an Integrated Healthcare Delivery System, 2009-2018
Authors: Mefford Matthew T , Liu Ran , Bruxvoort Katia , Qian Lei , Tseng Hung-Fu , Reynolds Kristi
Published: May 2021

Background:
Vaccinations prevent respiratory infections in heart failure (HF) patients, leading to less HF decompensation. Given a growing interest around influenza vaccination and mortality reduction, we examined the association between influenza vaccination and all-cause mortality among members with HF in Kaiser Permanente Southern California.

Methods:
We identified members with HF by ICD-9/10 diagnosis codes prior to September 1 each year from 2009-2017. The first flu vaccination in each season (September 1-May 31) was recorded. Vaccinated/unvaccinated members were matched 1:1 on age, sex, and ejection fraction. Matched pairs were followed from the vaccinated member’s vaccination date through the end of the season for mortality, with the last date of follow-up on May 31, 2018. Frequency of healthcare utilization in the year before each season was compared between vaccinated and unvaccinated members. We calculated unadjusted and utilization-adjusted rate ratios (RR) and 95% confidence intervals (CI) for the association between vaccination and mortality.

Results:
Between 2009-2018, influenza vaccination among HF members increased from 74.8% to 80.3% and the number of vaccinated and unvaccinated matched pairs increased to 4,451 through the 2017-2018 season. The proportions of vaccinated and unvaccinated members with ≥ 1 prior inpatient visit and ≥1 prior emergency department (ED) visit were similar (46.2% vs 44.6% and 34.3% vs 32.6%, respectively). More unvaccinated than vaccinated members had ≥ 5 outpatient visits (41.9% vs 28.1%). After adjustment for inpatient, outpatient and ED visits, vaccinated members had between a 16% and 36% lower mortality rate across all seasons (RR 0.64 [95% CI 0.55, 0.75] in 2013-2014 and RR 0.84 [95% CI 0.73, 0.96] in 2017-2018). (Table)

Conclusion:
Influenza vaccination was likely associated with a lower mortality rate among HF patients. Future work will examine the potential confounding by comorbidities and treatments.
Abstract 15661: Discordant LDL-C Estimates and Incident Atherosclerotic Cardiovascular Disease: The Dallas Heart Study
Authors: Macpherson Nicholas , Vasquez Nestor , Khera Amit , Rohatgi Anand , Martin Seth S , Jones Steven R , Ayers Colby , Quispe Renato , Joshi Parag H , Muthukumar Alagarraju
Published: May 2021

Introduction:
The Friedewald equation (F-LDL-C) and the Martin-Hopkins algorithm (MH-LDL-C) estimate direct LDL-C from a standard lipid panel. Discordant LDL-C estimates by the two methods may carry significant clinical implications. We evaluated the clinical variables associated with discordant LDL-C estimates and the association of discordance with risk of incident atherosclerotic cardiovascular disease (ASCVD) in the Dallas Heart Study (DHS), a multi-ethnic, population based prospective cohort.

Methods:
We estimated F-LDL-C and MH-LDL-C in 2824 DHS participants (42% male; mean age 43.5 years) with TG ≤ 400 mg/dL, who were not on baseline lipid lowering therapy and were free of prior ASCVD. We divided the cohort into quintiles of LDL-C discordance (MH-LDL-C minus F-LDL-C, in mg/dL) and assessed associations with ASCVD risk factors. We evaluated associations between discordance and incident ASCVD by sequentially adjusted Cox regression models, and we generated restricted cubic spline plots of discordance and hazard for ASCVD.

Results:
There were 228 ASCVD events over a median of 12.3 years. Clinical characteristics across discordance quintiles are shown in the
Table
. After adjustment for traditional ASCVD risk factors, there was a linear association between higher LDL-C discordance and increased risk of ASCVD events (
Figure
) with the highest hazard in Quintile 5 (HR 1.5, 95% CI 1.1 - 2.0).

Conclusions:
Discordant LDL-C estimates were largely associated with male sex, White and Hispanic races, and characteristics of the metabolic syndrome. Individuals in the highest quintile of discordant LDL-C estimates, with MH-LDL-C > F-LDL-C, had greater risk for incident ASCVD.
Abstract 15663: Prediction of 5-year Cardiovascular and All-cause Mortality After Myocardial Infarction in United States Veterans
Authors: Lu Bing , Posner Daniel , Vassy Jason L , Ho Yuk-lam , Galloway Ashley , RAGHAVAN SRIDHARAN , Honerlaw Jacqueline P , Tarko Laura , Russo John , Qazi Saadia , Orkaby Ariela R , Tanukonda Vidisha , Djousse Luc , Gaziano Michael , Gagnon David , Cho Kelly , WILSON PETER
Published: May 2021

Objective:
This is a large prospective study aimed to develop risk prediction models of CVD and all-cause mortality in patients who survived MI.

Methods:
Using 2002-2012 national electronic health record data from the Veterans Health Administration, sex-specific risk prediction models for CVD and all-cause death were developed from the 5-year follow-up data of 100,601 first MI survivors aged >30 years. Model performance was evaluated using a 5-fold cross-validation approach.

Results:
We followed 98,657 male and 1,944 female MI survivors up to 5 years (407,199 person-years). There were 31,622 deaths (men 31,147, women 475) and 12,901 CVD deaths (men 12,752, women 149) observed during follow up. Among men, greater age, current smoking, diabetes, atrial fibrillation, heart failure, peripheral artery disease, geographic region, and lower BMI (<20kg/m
2
) were associated with increased risk of subsequent CVD and all-cause-mortality, while statin treatment, hypertension medication, beta-blocker, eGFR level, and high BMI (≥25 kg/m
2
) were significantly associated with reduced risk of CVD and all-cause-mortality. Similar associations were generally observed among women. We observed U-shaped relations between total cholesterol and outcomes, and HDL cholesterol and outcomes.

The prediction models demonstrated good discrimination and calibration. The estimated Harrell’s C-statistics of the final models versus the cross-validation estimates were similar, ranging from 0.75 to 0.81. The predicted risk of death was well-calibrated compared to observed risk.

Conclusions:
We developed and validated risk prediction models of 5-year risk for CVD and all-cause death for patients following MI. Traditional risk factors, co-morbidity, lack of blood pressure or lipid treatment, and geographic region were all associated with greater risk of CVD and all-cause mortality.
Abstract 15673: Racial Disparities in Referral for Pre-operative Cardiovascular Evaluation, Surgical Wait Time, and Weight Loss in Patients Undergoing Bariatric Surgery
Authors: Tragesser Lauren , Ibrahim Kaitlyn , Soans Rohit , Haddad Abdullah , Dalsania Raj K , Eddy Vikram , Zhang Liti , McComb Joseph , Keane Martin G , Whitman Isaac
Published: May 2021

Introduction:
White patients undergo bariatric surgery more frequently and with fewer complications compared to non-white patients. Yet, racial disparities in referral pattern for preoperative cardiovascular evaluation (CVE) are unexplored. We hypothesized that racial disparities exist in preoperative CVE in white vs. non-white patients undergoing bariatric surgery.

Methods:
We identified consecutive patients undergoing bariatric surgery at our institution from 2014-2018. The association of white vs. non-white race with referral for CVE, cardiac testing, surgical wait time, and postoperative weight loss was determined in a multivariate model adjusting for baseline demographic comorbidities and income. Additional adjustment for insurance provider was made for surgical wait time.

Results:
Of the 797 patients undergoing bariatric surgery during the study period, 86% (n=682) were non-white. White vs. non-white patients had similar age, gender distribution, and prevalence of hypertension, hyperlipidemia, Type 2 diabetes, and heart failure. A similar proportion of whites vs. non-whites were referred to cardiology for pre-operative evaluation (65% vs. 68%, p=0.52), while whites were more likely to undergo further preoperative cardiac testing after adjustment (68% vs. 55%, p=0.04; adjusted, OR 0.6, 95%CI 0.35-1.0, p=0.05). Despite less cardiac testing, non-white patients referred to cardiology waited longer for surgery (9.9 months vs. 12.1 months, p=0.008), including after adjustment (HR 0.7, 95%CI 0.53-0.91, p= 0.008. Weight loss at 6 months was higher in whites (12.9 kg/m
2
vs. 11.95 kg/m
2
, p=0.03), but equivalent at 1 year (whites 14.9 kg/m
2
vs. non-whites 14.3 kg/m
2
, p=0.33).

Conclusions:
In a bariatric surgery population, white vs. non-white patients were referred for CVE in similar proportion. However, white patients underwent more subsequent cardiac testing pre-operatively when compared to non-whites yet had a shorter wait time for surgery. Early weight loss was greater in whites, but equivalent between groups at 1 year.
Abstract 15692: Voltage Mapping in Atrial Fibrillation vs Sinus Rhythm: Results From the Mavs Study
Authors: Gianni Carola , Cunningham Jerri A , Mohanty Sanghamitra , TRIVEDI CHINTAN , Della Rocca Domenico G , Al-ahmad Amin , Bassiouny Mohamed A , Burkhardt J D , Gallinghouse G J , Horton Rodney P , Hranitzky Patrick M , Sanchez Javier E , Di Biase Luigi , Natale Andrea
Published: May 2021

Background:
Left atrial (LA) scar can be identified with bipolar voltage mapping during sinus rhythm (SR). It is not clear whether the same voltage criteria can be applied during atrial fibrillation (AF).

Objective:
Aim of this study was to compare voltage maps performed in the same patient both in AF and SR.

Methods:
Voltage mapping was performed using a 10-pole circular mapping catheter in patients with non-paroxysmal AF undergoing first time RF ablation. For descriptive purposes, the LA was divided in 6 regions: septum, posterior wall (PW), inferior wall (IW), lateral wall, anterior wall, and roof. The threshold for low voltage was <0.5 mV (with a color range setting 0.2-0.5 mV). Mild “scar” was defined as an area low voltage 5-20%, moderate 20-35% and severe as >35%.

Results:
16 patients (62% persistent AF, 38% longstanding persistent AF) were included in the study. The map density was comparable during AF and SR (mean points per map 551 vs 547, paired t test P = NS). 2 patients displayed normal voltage during both AF and SR. 14 patients showed areas of low voltage during AF, which were still present during SR in 8. All patients with mild “scarring” during AF (n = 4), showed normal voltage during SR. Of the 7 patients with moderate “scarring”, 2 patients showed normal voltage during SR, while in the remaining 5 “scarring” was only mild during SR. 3 patients showed extensive “scarring” during AF, which was only moderate during SR. During AF, areas of low voltage were more commonly observed in the PW (12/14) followed by the IW (6/14) and antero-septum (4/14); while in SR, in the antero-septum (4/8), PW (3/8) and IW (3/8). Interestingly, in all patients both the PW/IW and (less dramatically) the antero-septum showed more “scarring” during AF as compared to SR.

Conclusion:
Areas of low voltage are more severe and diffuse during AF when compared to SR. When areas of low voltage are detected during AF, they are more commonly seen in the PW, IW and antero-septal areas.
Abstract 15695: Contemporary Trends and Outcomes of Prosthetic Valve Infective Endocarditis in the United States: Insights From the Nationwide Inpatient Sample
Authors: KHAN Muhammad , Munir Muhammad , Khan Muhammad U , Balla Sudarshan
Published: May 2021

Introduction:
Prosthetic valve endocarditis (PVE) carries high mortality and morbidity as compared to native valve endocarditis (NVE).

Hypothesis:
Hospital outcomes have shown improvement over the years in PVE

Methods:
We used the National Inpatient Sample from 2000 to 2017 to identify patients admitted with PVE who 18 years and older using ICD-9-CM and ICD-10 codes (421.0,421.1,421.9, V433.0, I33.0, I33.9, and Z95.2). Patients with prior history of prosthetic valve were identified using the respective ICD-9. Risk-adjusted rates were calculated using an Analysis of Covariance (ANCOVA) with the Generalized Linear Model (GLM). Trends were assessed with linear regression and Pearson’s Chi-square when appropriate. Binomial logistic regression was used to assess predictors of in-hospital mortality.

Results:
We identified 43,602 hospitalizations for PVE. PVE increased from 1803 in 2000 to 3450 in 2017. Risk-adjusted mortality decreased from 10.7% in 2002 to 7.3% in 2017 (P<0.01)(Figure). Logistic regression analysis on mortality showed increase association with age (OR, 1.021[1.017-1.024], Hispanics (OR, 1.493[1.296-1.719],p<0.01) and patients with drug abuse(OR, 1.233[1.05-1.449],p=0.01). co-morbid conditions like congestive heart failure (OR, 1.511[1.366-1.673],p<0.01), renal failure (OR, [1.572[1.427-1.732],p<0.01) and weight loss (OR, 1.425[1.093-1.419],p<0.01) were also associated with higher mortality.

Conclusions:
Adjusted in-hospital mortality from PVE has trended down over the years. The findings reflect improved health care delivery over the study years for patients with PVE.
Abstract 15696: Outcomes With Intra-Aortic Balloon Pump versus Percutaneous Ventricular Assist Device for Left Ventricular Venting in Adults Receiving Venoarterial Extracorporeal Life Support: An ELSO Registry Analysis
Authors: Willar Brooks , Nunez Jose , Kevin Kennedy , Rycus Peter , Tonna Joseph , Kapur Navin K , Shaefi Shahzad , Sabe Marwa , Garan Arthur R , Grandin Edward W
Published: May 2021

Background:
Insufficient left ventricular (LV) unloading during venoarterial extracorporeal life support (VA-ECLS) can result in poor LV recovery and inability to wean from support. Published data suggest a survival benefit with LV mechanical venting (MV), but there is limited data comparing modalities.

Methods:
We queried the ELSO registry from 2010-2019 for adults undergoing VA-ECLS with MV and stratified them by intra-aortic balloon pump (IABP) or percutaneous ventricular assist device (pVAD). We excluded patients with pulmonary embolism, heart transplant, congenital and valvular heart disease, aortic disease, and central cannulation. We performed a subgroup analysis excluding extracorporeal cardiopulmonary resuscitation (ECPR). The primary outcome was in-hospital mortality. Secondary outcomes were on-support mortality, medical and cannula site bleeding, hemolysis, ischemic stroke, limb ischemia, and renal injury. We used multivariable logistic regression modeling to adjust for clinical covariates.

Results:
Among 3353 adults with MV on VA-ECLS, 2782 (83%) were vented with IABP and 571 (17%) with pVAD. IABP patients were less likely to be supported for ventricular arrhythmia (9.6% vs 14.3%) and had lower rates of pre-ECLS arrest (49% vs 66%) and concomitant renal (13.5% vs 34.5%), liver (3.4% vs 9.3%), and respiratory (17.6% vs 37.0%) failure, p<0.001 for all. On-support (40.8% vs 45.5%, p=0.037) and in-hospital (55.9% vs 60.6%, p=0.038) mortality were lower with IABP vs pVAD. In multivariate modeling, IABP was associated with a significantly lower odds of medical bleeding with a trend towards lower in-hospital mortality that was significant after excluding ECPR patients (Figure).

Conclusion:
In adults with MV on VA-ECLS, IABP compared to pVAD is associated with a significantly lower risk of bleeding and a strong signal of improved survival. We cannot exclude residual unmeasured confounding, so prospective studies are needed to compare MV devices.
Abstract 15717: Impact of Mechanical Circulatory Support on Outcomes and In-hospital Mortality of Peripartum Cardiomyopathy Patients With Cardiogenic Shock: An Analysis of the Nis Database
Authors: Maning Jennifer , Ebner Bertrand , Vincent Louis , Grant Jelani , Mahabir Sunita , olarte neal , Olorunfemi Odunayo P , Colombo Rosario A , Chaparro Sandra V
Published: May 2021

Background:
Peripartum cardiomyopathy (PPCM) is an uncommon form of cardiomyopathy that affects young women at the end of pregnancy or in the first few months following delivery, and is associated with increased morbidity and mortality. In selected patients with cardiogenic shock (CS), mechanical circulatory support (MCS) devices improve outcomes. However, data comparing outcomes of patients with PPCM who develop CS and receive mechanical circulatory support (MCS) vs. those treated medically remains limited.

Methods:
Using the National Inpatient Database (NIS) we identified patients with PPCM who were treated for CS from 2012 to 2017. Primary outcome was in-hospital mortality. Multivariate analysis models were adjusted for statistically significant differences in baseline characteristics between the groups.

Results:
A total of 4686 patients were admitted with a diagnosis of PPCM, of these 199 patients developed cardiogenic shock. Only 50 (25.1%) patients received MCS. Patients who received MCS were less likely to have a prior ICD in place (6% vs. 23%, p = 0.008), and were more likely to suffer from end-stage renal disease (6% vs. 0.67%, p = 0.020). There were no other major differences in baseline characteristics among the two groups. The incidence of ICD implant prior to discharge (4% vs. 7.4%, p = 0.243, OR 0.39) and cardiac arrest (16% vs. 7.4%, p = 0.173, OR 2.01) was not significantly different between the groups. There was no significant difference in in-hospital mortality between those who received MCS devices and those treated medically (22% vs 10.1%, p = 0.256, OR 1.73). LOS was longer for the MCS group (23.2% vs. 13.4 mean days, p = 0.001).

Conclusions:
The use of MCS in PPCM patients who developed cardiogenic shock appears to offer similar survival benefit compared to those treated medically, despite being associated with longer length of stay This finding may be related to the complexity and acuity level of patients receiving MCS compared to those treated medically.
Abstract 15735: Neonatal Cardiac Regeneration Depends on IGF1R-signaling
Authors: Schuetz Thomas , Dolejsi Theresa , Bild Alexander , Bauer Axel , Penninger Josef M , Haubner Bernhard J
Published: May 2021

Introduction:
In contrast to other adult tissues myocardium cannot be sufficiently regenerated following significant myocardial infarction (MI). Efficient cardiac regeneration was demonstrated in neonatal mouse myocardial injury models. Similar observations were reported in other neonatal mammals including newborn human babies suffering from MI. The mechanisms of neonatal mammalian cardiac regeneration remain unclear. Here we show the crucial role of IGF1R which was unraveled in a time-course transcriptome analysis of neonatal mouse hearts.

Methods:
IGF1R was specifically knocked-down (KD) in cardiomyocytes of wildtype postnatal day one (P1) mice using adeno-associated virus (rAAV9) delivered shRNAmirs. KD of Renilla served as control (REN-CTRL). 5x10
13
viral genomes per kg bodyweight were injected intrathoracally. Three batches of rAAV9 with different shRNAmirs were used for the IGF1R-KD groups. Viral transduction was confirmed by bioluminescence imaging on luciferase containing rAAV9 copies and by immunofluorescence staining of rAAV9 delivered GFP reporter. KD efficiency was confirmed in vitro using a retrovirus system and in vivo. On P2 mice underwent either left anterior descending artery (LAD) ligation for induction of MI or SHAM surgery. Cardiac function was subsequently assessed by echocardiography 1 day post injury (dpi) and 21 dpi. Thereafter, hearts were harvested and left ventricular fibrosis was analyzed histologically.

Results:
LAD ligation resulted in significant MI in both, IGF1R-KD and REN-CTRL, LAD groups as proven by a markedly reduced ejection fraction (EF) 1 dpi. Importantly, 21 dpi IGF1R-KD and REN-CTRL SHAM groups displayed normal cardiac function proving no effect on neonatal cardiac growth and development of only KD of IGF1R without LAD ligation. In contrast, LAD ligation IGF1R-KD mice presented significantly reduced EF 21dpi compared to the other 3 groups. Histological analysis revealed significant fibrosis in the IGF1R-KD LAD hearts compared to the other 3 groups.

Conclusions:
Whereas IGF1R-KD or control rAAV9 does not alter physiological cardiac development, KD of IGF1R markedly impairs neonatal cardiac regeneration in neonatal mice after MI suggesting a crucial role in neonatal cardiac regeneration.
Abstract 15751: Pharmacodynamic Effect of ARO-ANG3, an Investigational RNA Interference Targeting Hepatic Angiopoietin-like Protein 3, in Patients With Hypercholesterolemia
Authors: Watts Gerald F , Schwabe Christian , Scott Russell , Gladding Patrick , Sullivan David , Baker John , Clifton Peter , Hamilton James , Given Bruce , San Martin Javier , Melquist Stacey , Chang Ting , Rajicic Natasa , Goldberg Ira J , Gaudet Daniel , Knowles Joshua W , Hegele Robert A , Ballantyne Christie M
Published: May 2021

Background:
Angiopoietin-like protein 3 (ANGPTL3) regulates triglyceride (TG) and lipoprotein (LP) metabolism by inhibiting liver and endothelial LP lipases and reduces plasma LDL-C. In Phase 1 Study AROANG1001 (NCT03747224), single and multiple doses of RNA interference therapeutic ARO-ANG3 (100, 200, or 300 mg; n=36) in healthy volunteers substantially reduced ANGPTL3, LDL-C, and other LPs (AHA 2019) compared with placebo (n=16).

Purpose:
We report preliminary results following repeat doses (days 1 and 29) of ARO-ANG3 in patients with heterozygous familial hypercholesterolemia (FH) with elevated LDL-C despite statin therapy and average LDL-C of 130 mg/dL. An additional group (non-FH patients) had LDL-C > 70 mg/dL despite statin therapy.

Methods:
Seventeen FH patients received open-label, subcutaneous, ARO-ANG3 100 mg (n=6), 200 mg (n=6), or 300 mg (n=5). Nine non-FH, high risk patients with elevated LDL-C not at goal received either 200 mg ARO-ANG3 (n=6) or placebo (n=3) using a randomized double-blind design. Pharmacodynamic markers included serum ANGPTL3, LDL-C, TG, and others.

Results:
Results are reported as of 04 May 2020. In FH patients, ARO-ANG3 significantly reduced mean ANGPTL3 levels between 62-92% at week 16 in a dose-dependent manner (Table). LDL-C (23-37%) and TG (25-43%) were consistently reduced at all doses (Table). The mean percent reductions in non-FH patients for ANGPTL3 (85%), LDL-C (28%), and TG (29%) were comparable to those in FH patients, despite their initially lower LDL-C at baseline. As of 15 May 2020, there were no drug-related serious or severe adverse events (AEs) or discontinuations and most AEs were mild. The most common AEs reported in subjects receiving ARO-ANG3 were respiratory tract infection (30% of subjects) and injection site AEs (13% of subjects).

Conclusions:
In FH and non-FH patients, repeat doses of ARO-ANG3 significantly reduced ANGPTL3, LDL-C, and TG, with favorable safety.
Abstract 15754: Coronary Calcification is Associated With Prior GnRH Agonist Therapy in Men With Recurrent Prostate Cancer Undergoing PET/CT Imaging
Authors: Som Avira , Shaikh Preet Ayoub , Lenihan Daniel , Reimers Melissa , Baumann Brian , Zhang Kathleen W
Published: May 2021

Background:
Gonadotropin releasing hormone (GnRH) agonist therapy is associated with major adverse cardiovascular (CV) events in men with prostate cancer. The effect of GnRH agonists on vascular calcification is not known.

Methods:
Consecutive patients who underwent 18F-fluciclovine positron emission tomography (PET) /computed tomography (CT) at our institution for recurrent prostate cancer were retrospectively identified. Clinical and demographic data were obtained from the medical record. Patients without available data on prior prostate cancer therapies received were excluded (n=25). Coronary calcification was qualitatively assessed on non-gated CT scans using a published scoring system. The association of prior GnRH agonist therapy with coronary calcification was evaluated using stratified odds ratio (OR) analysis in a 2x2 contingency table.

Results:
Among 186 men included, median age was 69.0 years (IQR 64.3, 74.5) and CV comorbidities were common (72% hypertension, 68% hyperlipidemia, 43% current or former smoking, and 21% diabetes mellitus). 55 patients (30%) received prior hormone therapy, 50 of whom received a GnRH agonist either as single- or multi-agent therapy. Men with prior GnRH agonists were older than those without prior GnRH agonists (71.4 vs. 68.4 years, p=0.025). There were no significant differences in prevalence of CV comorbidities between the two groups. Men with at least mild coronary calcification were more likely to have received prior GnRH agonist therapy (OR=3.0, 95% CI 1.2-7.1, p=0.015 by Fisher’s exact test), with a stronger association seen in younger men (OR=3.9, age <69 years) than in older men (OR=1.8, age ≥69).

Conclusions:
Coronary calcification is associated with prior GnRH agonist therapy in men with recurrent prostate cancer undergoing PET/CT imaging. The utility of vascular protective therapies including aspirin and statin to mitigate the adverse CV effects of GnRH agonists requires further study.
Abstract 15773: Differences in Atrial Fibrillation Symptoms, Quality of Life, and Response to Therapy Across Race-ethnicity
Authors: Chen Yining , Rodriguez Ziccardi Mary Carolina , Ornelas Aylin , Darbar Faisal , Alzahrani Zain , Mehta Vivek , Twing Aamir , Ahmed Maha , Qiao Victor , Al-azzam Baha'a , Konda Sreenivas , Darbar Dawood
Published: May 2021

Introduction:
Atrial fibrillation (AF) guidelines are heavily predicated on assessing the severity of symptoms experienced by individual patients when selecting either rate or rhythm control strategy. While the severity of symptoms can be highly variable, it remains unclear if race-ethnicity influences AF symptoms and quality-of-life (QoL). We sought to determine whether race-ethnicity modulates severity of AF symptoms, QoL and response to therapy.

Methods:
A prospective cohort study of 415 patients diagnosed with new-onset AF enrolled over a 30-month period in a clinical-genetic registry. Baseline assessment of patients prior to treatment initiation included a detailed patient history and the validated 20-item Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire. We divided the cohort into groups based on race-ethnicity (African American[AA], European American[EA], Hispanic/Latino[H/L]) and treatment strategy (rate or rhythm control).

Results:
Of 306 consecutive patients with AF, 113 (36.9%) were AA, 108 (35.3%) EA and 85 (27.8%) H/L. The mean age was 61.9±13.0 years, and 105 (34.3%) were female with 154 (50.3%) patients treated with rate control versus 152 (49.7%) with rhythm control therapy. Both AA (52.1%) and H/L (65.9%) patients were more likely to be initiated on rate control therapy as compared with EAs (36.1%; P=0.0002) despite lower baseline AFEQT scores (AA: 72.9.9±23.2; H/L: 75.1±20.7; and EA: 80.2±17.9; P=0.24) and greater impairment of QoL. The overall AFEQT scores and QoL improved significantly in AAs (Δscore: 10.4±28.2; P<0.0001) and EAs (Δscore: 11.9±20.1; P<0.0001) and was mostly associated with improvement in activities of daily living. Multivariate predictors of improvement in QoL in patients with AF included not only rhythm control therapy but also a history of both coronary artery disease and obesity.

Conclusion:
The severity and perception of AF symptoms is highly variable in individual patients. Our study showed that ethnic minorities with AF are more likely to receive rate control therapy when compared to patients of European descent despite poorer QoL. Our findings may have important clinical implications for the assessment of symptoms and management of AF in AAs and H/Ls.
Abstract 15779: Unfavorable Social Determinants of Health Profile and Financial Toxicity From Healthcare in Atherosclerotic Cardiovascular Disease
Authors: Valero Elizondo Javier , Khera Rohan , Dudum Ramzi , Acquah Isaac , Hyder Adnan , Andrieni Julia , Sharma Garima , Blaha Michael J , Virani Salim S , Blankstein Ron , Cainzos Achirica Miguel , Nasir Khurram
Published: May 2021

Introduction:
Healthcare expenses for atherosclerotic cardiovascular disease (ASCVD) are associated with substantial financial toxicity (FT). Whether certain social determinants of health (SDOH) portend an increased risk of FT in ASCVD is critical to refine care processes that may be most amenable to interventions.

Methods:
Using National Health Interview Survey (2013-17), we assessed patients with self-reported ASCVD. We identified 35 discrete SDOH items, rated as favorable/unfavorable, across 6 domains: economic stability, education, food access, neighborhood conditions, social context, and health systems. To capture the cumulative effect of SDOH, an aggregate score was computed as their sum, and divided into quartiles, the highest quartile containing the most unfavorable scores. FT included presence of: difficulty paying medical bills/inability to pay them at all, and/or delayed/foregone care due to cost, and/or cost-related medication non-adherence.

Results:
Of 164,696 surveyed adults, of which 15,758 (weighted: 8%) reported ASCVD. Mean (SE) age-adjusted SDOH risk scores among ASCVD vs non-ASCVD patients were 11.8 (0.12) vs 9.5 (0.03), respectively. Among individuals with ASCVD, age-adjusted prevalence of any FT was directly proportional to SDOH aggregate scores, with step-wise increases noted. Prevalence of ≥ 2 FT factors among SDOH quartiles 1
st
vs 4
th
was 8% vs 50% among non-elderly (< 65), and 2% vs 35% among elderly adults with ASCVD, respectively (Figure). Further, in adjusted models, patients in the most unfavorable quartile for SDOH had an 8-fold higher likelihood of FT compared to those in the most favorable group.

Conclusions:
Among ASCVD patients, a higher number of unfavorable SDOH features is strongly associated with the presence of FT, further calling for the development of interventions to alleviate FT among those with unfavorable SDOH profiles.
Abstract 15788: Hypertensive Disorders of Pregnancy in Urban Black Women: The Biosocial Impact on Black Births (bibb) Study
Authors: Dailey Rhonda , Peoples Ashleigh , Rengers Brooke , Wong Ana C , Daughters Kristen , Price Mercedes , Vaughan Sarah , Dove-Medows Emily , Nowak Alexandra , Zhang Liying , Levy Phillip D , Misra Dawn , Giurgescu Carmen
Published: May 2021

Introduction:
Black women experience significant maternal mortality (3.3 times higher) compared to White women, and experience higher adverse outcomes. In the United States, cardiovascular disease is the second leading cause of maternal mortality for Black women. Hypertensive disorders of pregnancy (HDOP) falls under the cardiovascular disease spectrum.

Objective:
To explore differences in women diagnosed with a HDOP compared to those that do not have HDOP.

Methods:
A total of 226 African American women from Metro-Detroit and Columbus, Ohio enrolled in a cross-sectional study who had recently gave birth. Women enrolled in a mixed methods study on social and biological stressors to preterm birth with a completed medical record abstraction were identified as having chronic hypertension or a hypertensive disorder of pregnancy (HDOP) prior to the current pregnancy. HDOP is defined as chronic hypertension, chronic hypertension with superimposed preeclampsia, gestational hypertension, preeclampsia or eclampsia. Perinatal complications and birth outcomes were explored. Sociodemographic was derived from completed prenatal questionnaires. Chi square was used for categorical variable and T-test was used for continuous variables. Significance is defined as p ≤ 0.05.

Results:
The mean age was 26.8±5.9 years. Approximately 70.4% (n=159) were from Detroit, MI and 29.6% were from Columbus, OH. The mean previous live births were 1.9±1.8 (range 0-8). The average number of prenatal visits with a physician were 9.2±2.9 (range 2-19) and the total number of any prenatal visits were 16.0±6.9 (range 1-44). Average baby gestational age is 37.9±2.2 weeks (range 15-26 weeks), and weight is 2998±703.4 grams. Approximately 60 women (26.5%) were identified with a hypertensive disorder of pregnancy. Compared to women not diagnosed with a HDOP, women with a HDOP had an older mean age (28.3±6.4 vs 26.3±5.6), p=0.023; had more prenatal visits (18.2±7.6 vs 15.6±6.5) p=0.007; had babies at a younger gestational age (37.2±2.1 vs 38.2±2.1), p=0.002.

Conclusion:
These findings will aid in determining factors associated with HDOP in our population, and aid in determining next steps to reduce historic mortality in this group.
Abstract 15796: The Inverse Correlation Between Lifetime Occupational Radiation Exposure Duration and Prevalence of Atrial Arrhythmia
Authors: Thirumal Rithika , Vanchiere Catherine , Bhandari Ruchi , Jiwani Sania , Horswell Ronald , Chu San , Bennett Angela , Chamaria Surbhi , Katikaneni Pavan , Bailey Steven , Dominic Paari
Published: May 2021

Introduction:
Fluoroscopy assisted procedures have increased occupational radiation exposure among Cardiologists. Radiation has been linked to cardiovascular complications but its effects on cardiac rhythm has not been extensively explored.

Hypothesis:
We hypothesized that radiation exposure is associated with increased risk of atrial arrhythmias (AA) despite appropriate leaded body coverage.

Methods:
Demographic, social, occupational, and medical history was collected from board-certified cardiologists via an electronic survey. Bivariate and multivariable logistic regression analyses were performed.

Results:
We received 1478 responses from cardiologists; 85.4% were males, 79% were White and 66.1% were ≤65 yrs of age. 35.6% of respondents were interventional cardiologists and 16.4% were electrophysiologists, and of those, 92.2% wore lead apparel during all times of radiation exposure. Cardiologists >50 yrs of age, with >10,000 hours of occupational radiation exposure, had a significantly lower prevalence of AA compared to those with ≤10,000 hours of radiation exposure (11.1% vs 16.7%,
p
=0.019). A multivariate logistic regression was performed and among cardiologists >50 years of age, exposure to >10,000 radiation hours was significantly associated with lower likelihood of AA, after adjusting for age, sex, DM, HTN and OSA (adjusted OR 0.57; 95% CI 0.38 - 0.85,
p
=0.007). Traditional risk factors such as age, sex, HTN, DM and OSA were more prevalent in those with AA and cataracts, a well-established complication of radiation exposure in cardiologists, was more prevalent in those exposed to >10,000 radiation hours compared to those exposed to ≤10,000 radiation hours, validating the dependent (AA) and independent variables (radiation exposure), respectively.

Conclusions:
Radiation exposure in Cardiologists with appropriate lead apparel is inversely related to AA. Large scale prospective studies are needed to validate our findings.