bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15001: Radial Access Has No Impact on Medications Adherence Post Coronary Intervention: A Retrospective Observational Cohort Study Using Real-world Data
Authors: Okleh Nawaf , Swedee Jasim , AL Qahtani Awad , Arafa Salaheddin , Rahhal Ala A , Mahfouz Ahmed S , Al Yafei Sumaya A , Aljundi Amer H , Hamid Yousra R , Al Khalaila Osama N , Khir Fadi K , Al-Amri Maha K , Arabi Abdul Rahman
Published: November 2020

Introduction:
The Transradial artery access for Primary Percutaneous Coronary Intervention (PCI) is the preferred access for coronary interventions in ST Elevation Myocardial Infarction STEMI due to less complications post intervention and it has been shown to improve quality of life of patients post intervention. This decrease in complications may give the patient sense of ease and underestimation of disease severity, and hence worsen the patient’s compliance with medications. This retrospective observation study aimed to assess the impact of radial versus femoral access coronary interventions on adherence to post-PCI medications.

Methods:
We conducted a retrospective analysis for all patients who presented with STEMI and underwent primary PCI in a tertiary cardiac hospital in Qatar between January 1, 2016 and December 31, 2018. Adherence was assessed by refilling the first prescription post discharge. Adherence rates were compared between the patients who underwent PCI with radial versus femoral access using the Chi square test.

Results:
A total of 1339 patients who presented with acute STEMI and underwent primary PCI were included in our retrospective analysis. The majority of patients included were male (96%) with mean age of 51 years. The majority of patients (1082; 81%) underwent radial access, while 257 (19%) underwent femoral access. The two groups were comparable in terms of age, nationality, the presence of full versus partial insurance, and using medications before admission. The patients adherence to medications post-PCI, including aspirin, P2Y12 inhibitor, statin, beta-blocker, angiotensin converting enzyme (ACE) inhibitor/ angiotensin II receptor blocker (ARB) was comparable between the radial versus femoral access (
aspirin:
78% vs. 74%; p-value= 0.16,
P2Y12 inhibitor:
81% vs. 79%; p-value=0.45,
statin:
80% vs. 76%; p-value= 0.15,
beta-blocker:
72% vs. 70; p-value= 0.51,
ACE inhibitor/ARB:
79% vs. 74%; p-value= 0.09).

Conclusion:
In comparison to femoral access in primary coronary intervention in STEMI, the radial access resulted in similar adherence to post-PCI medications assessed by refilling of first prescription post discharge. Therefore, the radial access is a safe approach in terms medications adherence.
Abstract 15005: Associations Between Alcohol Intake and Genetic Predisposition With Atrial Fibrillation Risk in a National Biobank
Authors: Halford Jennifer L , Weng Lu Chen , Choi Seung Hoan , Jurgens Sean J , Morrill Valerie , Khurshid Shaan , Trinquart Ludovic , Benjamin Emelia J , Ellinor Patrick T , Lubitz Steven A
Published: November 2020

Introduction:
Excess alcohol intake and inherited predisposition may increase risk of atrial fibrillation (AF). We sought to characterize the association between alcohol intake and incident AF and determine whether the effect of alcohol is modified by inherited predisposition to AF.

Methods:
We analyzed UK Biobank participants without prevalent AF and with complete alcohol consumption, genomic, and clinical data collected between 2006-2010. Exposures included alcohol consumption (stratified by an acceptable range of ≤98 grams/week for women or ≤196 grams/week for men and analyzed as a continuous variable) and an AF polygenic risk score (PRS). Cox proportional hazard models were adjusted for established AF risk factors. The cumulative incidence of AF was assessed at 5 years.

Results:
Among 376,776 participants (47.5% male, mean age 56.9 years), 6,293 developed AF during a median of 6.9 years of follow-up. Alcohol consumption was associated with AF (hazard ratio [HR] 1.10; 95% CI 1.05-1.16 for intake above an acceptable range; HR 1.04 per 100 grams/week; 95% CI 1.02-1.06). An AF PRS was associated with AF (HR 1.38 per standard deviation [SD]; 95% CI 1.35-1.41). In models including both alcohol intake and the AF PRS, each remained associated with AF. The 5-year cumulative incidence of AF for individuals with alcohol intake above an acceptable range and in the highest decile of polygenic risk was 2.33% (95% CI 2.07-2.59), compared to 0.69% (95% CI 0.58-0.80) for those with alcohol intake within acceptable range and in the lowest decile of polygenic risk.

Conclusions:
Alcohol consumption is associated with risk of incident AF across a range of polygenic predisposition to AF. Preventive counseling regarding alcohol intake may reduce the risk of AF regardless of the degree of risk conferred by inherited predisposition.
Abstract 15008: Improvement in Patient Ratings of Hypertension Care in a Pragmatic Cluster-randomized Trial of Home Blood Pressure Telemonitoring and Pharmacist Care (Hyperlink 3)
Authors: Margolis Karen L , Solberg Leif I , Crain A Lauren , Ziegenfuss Jeanette Y , Bergdall Anna R , Beran MarySue , Anderson Jeffrey P , Pawloski Pamala A , Rehrauer Daniel J , Norton Christine , Haugen Patricia K , Green Beverly B , McKinney Zeke J , Kodet Amy J , Appana Deepika , Sharma Rashmi , Trower Nicole K , Crabtree Benjamin F , Haapala Jacob L , Kottke Thomas E , O'Connor Patrick J
Published: November 2020

Introduction:
Patient ratings of their experience of care are part of the “Triple Aim”. Improvements are highly valued by health care organizations, but are hard to achieve.

Hypothesis:
We tested the effect of a telehealth intervention on satisfaction with hypertension care.

Methods:
Hyperlink 3 is an ongoing pragmatic cluster-randomized trial in 3072 patients with uncontrolled hypertension in 21 primary care clinics in HealthPartners, an integrated health system in Minnesota and Wisconsin. Clinics were randomized to Clinic-based Care (CC, 9 clinics, 1648 patients) or Telehealth Care (TC, 12 clinics, 1424 patients). CC patients received guideline-based hypertension care in face-to-face visits. TC patients were additionally offered home blood pressure (BP) telemonitoring with pharmacist care management. Patients were surveyed at baseline and after 6 months of study enrollment and asked to rate their hypertension care in the previous 6 months on a scale of 0-10. We compared change in the proportion of patients rating their care at the highest level (9 or 10).

Results:
In the TC group, about 37% of patients attended an intake pharmacist visit and 434 (30%) participated in home BP telemonitoring. Baseline surveys were completed by 1719 (56%) of patients at baseline (goal 50% completion) and 1301 (76%) of those completing the baseline survey completed the 6 month survey (goal 75% completion). Baseline survey respondents’ mean age was 62 y (non-respondents 58 y), 46% were men (non-respondents 48%), 19% were black (non-respondents 20%), and mean BP was 164/93 mm Hg (non-respondents 164/95 mm Hg.) Nearly all patients (over 90%) took antihypertensive medications (median 2). Hypertension care ratings of 9 or 10 were 27.9% at baseline and 30.2% at 6 months in CC, compared with 29.0% at baseline and 39.5% at 6 months in TC. The odds ratio (OR) for change over time in 9 or 10 ratings was 1.11 (95% CI 0.87 - 1.42) in CC, and 1.61 (95% CI 1.26 - 2.07) in TC. The OR for change in 9 or 10 ratings over time in TC vs CC was 1.45 (95% CI 1.03 - 2.06).

Conclusions:
Home BP telemonitoring with pharmacist care management increased the proportion of patients who highly rated their experience of hypertension care, even though only a minority of the TC patients received the intervention.
Abstract 15011: Association of Pulmonary Hemodynamics and Right Ventricular Function With Incident Atrial Fibrillation: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Parikh Romil R , Norby Faye L , Wang Wendy , Thenappan Thenappan , Prins Kurt W , Lutsey Pamela L , Solomon Scott , Shah Amil M , Chen Lin Y
Published: November 2020

Introduction:
Higher pulmonary artery systolic pressure (PASP) and right ventricular (RV) dysfunction are associated with higher risk of heart failure (HF) and mortality. Whether higher PASP and lower RV function are associated with risk of atrial fibrillation (AF) is unclear.

Hypothesis:
Higher PASP, higher pulmonary vascular resistance (PVR), and lower RV function are associated with incident AF after accounting for left atrial (LA) size and function, and left ventricular (LV) systolic and diastolic function.

Methods:
ARIC participants free of prevalent coronary heart disease (CHD), HF, AF, and with LA volume index (LAVi) <34ml/m
2
and average E/e’ ratio <14 in 2011-13 were included. We measured PASP, PVR, RV fractional area change (RVFAC), and RV-PA coupling (defined as RVFAC/PASP ratio) from 2D-echocardiograms. Incident AF (through 2018) was ascertained from hospital discharge codes and death certificates. We used Cox proportional hazards regression in our analysis.

Results:
We included 1915 participants (mean age 75 years, 69% female, 24% black) of whom 176 developed AF over a median follow-up of 6.3 years. PASP, PVR, and RV-PA coupling were significantly associated with incident AF after adjusting for measures of LA and LV structural and functional remodeling. RVFAC was not significantly associated with incident AF.

Conclusions:
In persons without CHD, HF, and LA enlargement, higher PASP and lower RV-PA coupling are associated with higher risk of AF after accounting for LA and LV structural and functional remodeling. This finding, which suggests a possible etiological role of RV remodeling for AF, needs further confirmation.
Abstract 15017: Early Post-discharge Follow-up Delay After Hospitalization for Heart Failure With Preserved Ejection Fraction Reduces Readmission for Heart Failure in the Following Year
Authors: Prudhomme Patrick , Gabriel Brault , Laurence Pusca , Roxanne Coderre , Marianne Tétrault-Langlois , Lortie Hugo , Nguyen Michel T , Lepage Serge
Published: November 2020

Introduction:
Early physician follow-up after hospital discharge for acute decompensated heart failure (ADHF) is recommended by the AHA to prevent early hospital readmission. This recommendation has not been specifically evaluated for heart failure with preserved ejection fraction (HFpEF).

Hypothesis:
Earlier follow-up should lead to decrease in readmissions for ADHF in the HFpEF population even when adjusting for confounding factors.

Methods:
Consecutive ADHF hospitalisation that occurred inclusively between 2015 and 2018 were reviewed. Main inclusion criterion was left ventricular ejection fraction ≥45%. The major exclusion criteria were: severe valvulopathy, hypertrophic cardiomyopathy, acute coronary syndrome 3 months before hospitalisation, chronic kidney failure (eGFR <30 ml/min), severe chronic respiratory disease and death before discharge. Follow-up delay after discharge was dichotomized (early vs late/no follow up) by using the median delay. Main outcome was hospital readmission in the year following discharge. Multivariate logistic regression was performed for main outcome according to follow-up delay and adjusted for age, sex, medication at discharge and major comorbid conditions.

Results:
A total of 163 heart failure readmission (37% of patients) occurred in 438 patients in the year following the first hospitalisation. Median readmission delay was of 62 days. Median dedicated follow-up delay was 30 days and was arranged in 68% of cases. After adjusting for confounding variables, early follow-up was significantly associated with fewer readmission (adjusted odds ratio 0.57, 95% CI; 0.34-0.97).

Conclusions:
Early dedicated follow-up after discharge for HFpEF was associated with fewer readmission over the year following discharge even when adjusting for major confounding variables.
Abstract 15044: Impact of Chronic Kidney Disease on the Pharmacodynamic and Pharmacokinetic Effects of Ticagrelor in Patients With Diabetes Mellitus and Coronary Artery Disease
Authors: Franchi Francesco , Rollini Fabiana , Been Latonya , Maaliki Naji , Abou Jaoude Patrick , Rivas Andrea , Zhou Ricky , Jia Sida , Briceno Maryuri , Lee Chang Hoon , Pineda Andres , Suryadevara Siva , Soffer Daniel , Zenni Martin , Bass Theodore , Angiolillo Dominick J
Published: November 2020

Background:
Diabetes mellitus (DM) is a key risk factor for the development of chronic kidney disease (CKD) and patients having both risk factors have increased risk of atherothrombotic events, underscoring the importance of antiplatelet therapy. Ticagrelor reduces ischemic events compared with clopidogrel, with the greatest risk reduction in patients with both DM and CKD. However, how CKD status affects the pharmacodynamic (PD) and pharmacokinetic (PK) profiles of different ticagrelor dosing regimens in DM patients is unknown.

Methods:
This was a prospective, randomized, cross-over study testing the PD/PK profiles of ticagrelor 90mg bid and 60mg bid among DM patients with and without CKD. All patients had coronary artery disease and were on dual antiplatelet therapy with aspirin (81mg qd) and clopidogrel (75mg qd). PD and PK assessments were performed at 3 visits: baseline, after 7-10 days of ticagrelor therapy (pre-crossover; peak and trough), and after 7-10 days of alternative ticagrelor regimen (post-crossover; peak and trough).

Results:
A total of 92 patients were randomized (CKD-, n=48; CKD+, n=44). Platelet reactivity as assessed by multiple assays (VASP-PRI; VerifyNow P2Y12; LTA) was increased with 60mg compared with 90 mg, which was statistically significant in CKD- but not in CKD+ patients for most PD measures (Figure). Although trough levels of platelet reactivity were numerically lower in CKD+ patients compared with CKD-, there was no significant difference in the pre-defined primary endpoint (trough levels of VASP-PRI following ticagrelor 90 mg dosing) between DM subjects with and without CKD (31±20 vs 25±14; mean difference= 6.4; 95% CI: -1.1 to 14.3; p=0.105; primary endpoint; Figure). PK assessments tracked PD profiles.

Conclusions:
In patients with DM, platelet inhibition by ticagrelor is similar irrespective of CKD status. However, the PD effects of the 60mg ticagrelor regimen is reduced compared with the 90mg regimen in patients without CKD.
Abstract 15048: Ischaemic Pre-conditioning: A Non-invasive Intervention That Improves Maternal Endothelial Function in Women With Preeclampsia And at Risk of Preeclampsia
Authors: Kubba Tamara , Davidson Sean M , Williams David
Published: November 2020

Introduction:
Preeclampsia is a pregnancy syndrome defined by the gestational onset of hypertension and proteinuria and characterised by maternal endothelial dysfunction with placental ischaemia. Preeclampsia affects approximately 4% of first-time pregnant mothers, but approximately 20% of women with pre-existing hypertension. Ischaemic pre-conditioning (IPC) is a phenomenon whereby transient episodes of ischaemia protect against future ischaemic injury. IPC has never previously been studied in pregnant women. We investigated whether IPC could improve maternal endothelial function in women at risk of preeclampsia and with preeclampsia.

Hypothesis:
We hypothesised that IPC would improve maternal endothelial function in women with preeclampsia and at risk of preeclampsia.

Methods:
We measured brachial artery flow mediated dilatation (FMD), before and after IPC in 3 groups of pregnant women between 24+0 and 36+6 weeks gestation: normotensive pregnancy (n=42), at risk of preeclampsia (n=20) and established preeclampsia (n=11). Following a baseline measure of brachial artery FMD, 3 cycles of 5-minutes of upper arm ischaemia were alternated with 5-minutes of reperfusion. Twenty-four hours later, maternal FMD was re-measured.

Results:
Women with preeclampsia had the lowest baseline FMD 4.09% +/- 0.73%: mean +/- SEM, which increased to 6.25% +/- 0.83% (p=0.0024) following IPC. Women at risk of pre-eclampsia had baseline FMD 7.57% +/- 0.82%, which increased to 8.93% +/- 0.73% (p=0.025) following IPC. Normotensive pregnant women had the highest baseline FMD (10.32% +/- 0.69%), which did not increase further following IPC (10.52% +/- 0.69%). However, normotensive pregnant women reached peak flow-mediated dilatation more quickly following IPC; 414 s +/- 2.94 s v 425 s +/- 4.22 s (p=0.0302).

Conclusions:
IPC is a non-invasive technique that we have shown improves local endothelial function in women with preeclampsia and at risk of preeclampsia. IPC merits further study as an intervention to improve systemic endothelial function and pregnancy outcomes for women with hypertensive pregnancies.
Abstract 15092: The Yin-yang of Bmpr2 and Ces1 in the Pulmonary Endothelium Aad Its Role in Pulmonary Arterial Hypertension
Authors: Agarwal Stuti , Chakraborty Ananya , Condon David , Tello Salvador , Suresh Karthik , Hammock Bruce D , RABINOVITCH Marlene , Nicolls Mark , Huang Flora , De Jesus Perez Vinicio A
Published: November 2020

Background/Hypothesis:
Pulmonary Arterial Hypertension (PAH) is a life-threatening disease characterized by loss of pulmonary microvessels and vascular remodeling. Loss of function BMPR2 mutations contribute to pulmonary endothelial cell (EC) apoptosis and oxidative stress, but their reduced penetrance suggests need for additional modifiers. Carboxylesterase1 (CES1) is endoplasmic reticulum (ER) enzyme responsible for detoxification, proteostasis, and redox balance. Similar to BMPR2 mutations, we found that loss of CES1 is associated with oxidative stress and apoptosis. In this study, we explore a plausible link between BMPR2 pathway and CES1 regulation in promoting EC survival and angiogenesis.

Methods:
PECs & lung tissue from healthy donors and PAH patients were obtained from PHBI. To induce oxidative stress, we used H
2
O
2
(100 μM) & methamphetamine HCl (METH, 0.5-2mM). Both siRNA and pharmacological approaches were used to inhibit BMPR2, Nrf2, and CES1 expression. Caspase and Matrigel assays were used to assess PEC survival and tube formation, respectively.

Results:
RNAseq of BMPR2-mutant PECs showed significantly less CES1 expression, which correlated with reduced protein expression in PEC lysates and within lung vascular lesions. In healthy PECs, BMP9 stimulation led to increase in CES1 expression that was absent post BMPR2 knockdown. CES1 gene transcription was by BMPR2-dependent activation of Nrf2, a transcription factor responsible for antioxidant gene expression and mitochondrial biogenesis. Inhibition of Nrf2 activation by ML385 (5μM) abrogates BMP9 induced CES1 mRNA levels similar to BMPR2 knockdown. The connection between BMPR2 and CES1 was further strengthened by CES1 knockdown studies in PECs that demonstrated reduction in BMPR2 protein synthesis associated with ER stress and reduced autophagy. Finally, lung examination in CRISPR generated CES1
+/-
mice demonstrated increased microvascular muscularization at normoxia compared to wild type mice.

Conclusion:
BMPR2 and CES1 are part of common signaling pathway that protects PECs against oxidative stress and mitochondrial damage through a positive feedback loop. Interventions that restore CES1 activity could rescue BMPR2 signaling and serve as novel PAH therapeutics.
Abstract 15098: New-Onset Diabetes Mellitus Risk in Statin Users Depends on Baseline HemoglobinA1c Value - Results of VA Database Analysis
Authors: Ziganshina Anna P , Gemoets Darren , Kaminsky Laurence , Gosmanov Aidar R
Published: November 2020

Introduction:
Statin use in non-diabetic patients is associated with an increased risk of development of new-onset diabetes mellitus (NODM). However, little is known if baseline hemoglobin A1c (HbA1c) can affect diabetogenic risks and mortality benefits of statin therapy.

Methods:
In a retrospective cohort study between 01/2011 and 12/2018 we collected the data of 152358 non-diabetic US veterans on statin and not on statin therapy who had available baseline HbA1c value and full demographic and clinical information prior to DM diagnosis. The risk of statin-induced DM and all-cause mortality rate were assessed in the whole cohort and based on baseline HbA1c categories: ≤5.6%, 5.7-5.9% and 6.0-6.4%. DM rate and mortality rate were calculated by Cox proportional hazards model adjusted for case-mix.

Results:
After mean follow up of 6.89 (SD 2.26) years in non-statin users and 3.85 (SD 2.29) years in statin users and adjustments for multiple covariates such as age, gender, ethnicity, obesity, hypertension (HTN), cardiovascular disease, and metformin use, we found that the rate of statin-induced DM depends on baseline HbA1c (Table 1). Analysis by HbA1c categories showed that NODM rate is inversely related to HbA1c level, while statin use in patients with HbA1c 6.0-6.4% was not associated with increased rate of NODM. We did not observe increase in all-cause mortality in statin users and statin users with HTN across HbA1c categories. Atorvastatin use was associated with decrease in all-cause mortality in HTN patients (Table 1).

Conclusions:
The results of this largest to date analysis of non-diabetic US veterans closely matched for baseline characteristics suggest that the rate of statin-induced DM depends on baseline HbA1c. The significant increase in NODM rate is only observed in patients with baseline HbA1c <6.0% regardless of statin type prescribed. The increased NODM risk is not associated with all-cause mortality in statin users in general including patients with HTN.
Abstract 15412: Long-term Outcomes of the Truncal Valve in Truncus Arteriosus
Authors: Gellis Laura , Binney Geoffrey , Lu Minmin , Alshawabkeh Laith , Mayer John E , Mullen Mary P , Valente Anne M , Sleeper Lynn A , BROWN David W
Published: November 2020

Objectives:
Long-term survival in patients with truncus arteriosus (TA) is favorable, but there remains significant morbidity associated with need for ongoing re-interventions. The purpose of this study was to understand the long-term outcomes of the truncal valve (TV) and identify risk factors associated with the need for TV intervention.

Methods:
We retrospectively reviewed 170 patients who underwent initial TA repair at our institution from 1985-2015. Analysis of long-term outcomes was performed on the 148 patients who survived greater than 30 days post-operatively and to hospital discharge using multivariable competing risks Cox regression modeling.

Results:
Median follow up time was 12.6 years (IQR 5.0, 22.1 years) after full repair. Freedom from death or transplant at 1, 5, 10, and 20 years was 93.1 ± 2.1%, 88.0 ± 2.7%, 86.2 ± 3.0% and 78.3 ± 4.1%. Thirty patients (20%) underwent at least one intervention on the TV (22 repairs, 21 replacements). Freedom from any TV intervention at 1, 5, 10 and 20 years was 99 ± 1%, 94 ± 8%, 82 ± 9%, and 70 ± 5%. Of those with TV repair, 59% subsequently underwent TV replacement. Independent risk factors for need for TV intervention included ≥moderate TV regurgitation (TVR) (HR 4.77, p<0.001) or stenosis (HR 4.12, p<0.001) prior to full repair, and ≥moderate TVR at initial hospital discharge after full repair (HR 8.6, p<0.001). A single coronary ostium was also independently associated with need for TV intervention (HR 6.94, p=0.01). Quadricuspid valve morphology and TV repair at initial TA repair, risk factors in univariate analysis, were not independent predictors on multivariable analysis. Overall, 28% of patients progressed to ≥moderate TVR and to Z-scores of greater than 5 for valve dimensions.

Conclusion:
Long-term need for TV intervention remains significant. Moderate or worse initial TVR or stenosis, residual TVR after initial TA repair, and single coronary ostium are risk factors associated with need for subsequent TV intervention.
Abstract 15418: An Arrhythmogenic Isolated Septal Aneurysm
Authors: Kviatkovsky Bina , Cinelli Michael P , Saouma Samer , Akhrass Philippe , Kowalski Marcin , Shah Rina , Bekheit Soad
Published: November 2020

Background:
Septal infarct due to isolated occlusion of a perforator branch is extremely rare. Few reported cases only describe either the EKG findings, imaging abnormalities or revascularization techniques.

Objective:
We report a case of an isolated septal aneurysm (ISA) caused by the acute occlusion of the second septal perforator presenting with recurrent ventricular fibrillation (VF).

Results:
A 63 year old woman presented to the hospital with chest pain. EKG showed an ST segment elevation localized to lead V3 (Fig1A), troponin 18.23. Angiogram showed an isolated 95% tubular stenosis of large second septal branch of LAD (Fig1B). No revascularization was performed. The patient subsequently had cardiac arrest (VF) requiring cardioversion. Repeat angiogram was unchanged. Echo showed isolated mid septal dyskinetic segment (Fig1C). LVEF was 60%. The patient was discharged with an external defibrillator. Repeat echo showed unchanged EF but presence of the isolated dyskinetic segment. An electrophysiologic study (EPS) showed VF induced with 2 extra stimuli at 250 ms with a drive cycle of 600 ms (Fig1D). An ICD was implanted for prevention of SCD.

Conclusion:
We describe the first case of an arrhythmogenic ISA in the presence of normal LVEF. The interventricular septum is composed of right and left ventricular endocardium. Experiments have shown that acute septal ischemia produces trans-septal asymmetry in expression of membrane ion channels and action potentials in local conduction velocity and gradients. This results in trans-mural heterogeneity of tissue excitability, a substrate for transmural re-entry and ventricular tachyarrhythmias, in septal infarction. This also explains the persistence of enhanced arrhythmogenicity in our patient during the initial and chronic phases of ischemia. ISA is rare but potentially arrhythmogenic. ISA with preserved LVEF, EPS for arrhythmogenicity and ICD for secondary prevention of SCD should be considered in such cases.
Abstract 15426: Comparison of Multimodality Imaging in Mitral Leaflet Lengths in Patients Undergoing Surgical Myectomy: A Prospective Study in Hypertrophic Obstructive Cardiomyopathy Patients
Authors: Fava Agostina M , Mehta Anand , Bittel Barbara , Bauer Andrew , Popovic Zoran B , Thamilarasan Maran , Lever Harry M , Wierup Per , Smedira Nicholas G , Desai Milind Y
Published: November 2020

Introduction:
In hypertrophic obstructive cardiomyopathy (HOCM), mitral valve (MV) leaflets in often contribute to left ventricular outflow tract obstruction (LVOTO). Hence, MV assessment is crucial during surgical planning. 2 or 3-dimensional transesophageal echocardiography (2D or 3D TEE) & cardiac magnetic resonance (CMR) are used to measure MV length.

Hypothesis:
We sought to compare MV leaflet lengths using intraoperative TEE [2D, zoom 3D, automatic quantification of mitral valve (AMVQ)], & preoperative CMR.

Methods:
We prospectively studied 50 HOCM patients (59±12 years, 46% men, basal septum 18±5 mm, LVOT gradient 87 ±56 mmHg) undergoing surgical relief of LVOTO. We compared MV leaflet length on a) long-axis 2DTEE b) 3DTEE using multiplanar reconstruction c) AMVQ, EchoPAC, General Electric & d) CMR.

Results:
Mean anterior leaflet lengths (mm) were as follows: 2D TEE (3.3 ±0.3), 3DTEE (2.9±0.5), CMR (3.1±0.4), & AMVQ (2.9±0.5). Mean posterior leaflet lengths were 1.7±0.3, 1.7±0.4, & 1.7±0.2 & 1.9±0.4 mm, respectively. Assuming 3DTEE as the gold standard, the closest correlation for anterior leaflet was with CMR (average overestimation by CMR of 0.5 mm [root mean square deviation or RMSE% 17]), intermediate correlation with 2DTEE (average deviation of 0.6 mm [RMSE%:21]) & no correlation with AMVQ (deviation of 0.7mm [RMSE% 24]), Fig 1A-C & 2A-C. No correlation was found for posterior leaflet,Fig 1D-F & 2D-F.

Conclusions:
There are significant differences in measuring MV lengths using different imaging techniques. In HOCM patients undergoing surgery, precise measurement of MV leaflet lengths is crucial & extrapolation from one technique to other is not recommended.
Abstract 15479: Adherence to Healthy Lifestyles Among Chinese Adults
Authors: Zhang Xingyi , Lu Jiapeng , Wu Chaoqun , Cui Jianlan , Wu Yue , Hu Anyi , Li Jing , Li Xi
Published: November 2020

Introduction:
Healthy lifestyles are effective means to reduce premature deaths. However, comprehensive knowledge about adherence to multiple healthy lifestyles in Chinese adults is still lacking.

Methods:
We interviewed 938,545 adults aged 35-75 years from 248 counties/districts of China in a national population-based epidemiological project, the China PEACE-MPP. We defined four healthy lifestyles as non-smoking, none or moderate alcohol use, sufficient leisure-time physical activity (LTPA), and healthy diet. We established multi-level logistic regression models to explore the factors associated with the adherence. Multivariable Cox proportional hazard models were fitted to assess the impact of adherence to healthy lifestyles on all-cause and cardiovascular mortality.

Results:
Among the participants, 78.6% were non-smokers, 98.0% had none or moderate alcohol use, 25.7% had sufficient LTPA, 19.7% had healthy diet, and only 5.8% adhered to all four heathy lifestyles. The overall adherence varied substantially across seven regions (P<0.01, median odds ratio=3.2), which was highest in the North China (7.5%), and lowest in the Southwest (3.4%). Participants who were female, elder, non-farmers, with higher education, with higher household income, married, hypertensive or diabetic, having cardiovascular disease history, or living in urban areas were more likely to adhere to all four healthy lifestyles in general. Adherence to none or moderate alcohol use, however, was associated with lower education and income. During a median follow-up of 1.66 years (IQR 0.66-2.63), those adhered to all four healthy lifestyles had lower risk of all-cause mortality (HR 0.43, 95% CI 0.30-0.60) and cardiovascular mortality (HR 0.38, 95% CI 0.21-0.68), compared with participants who did not adhere to any healthy lifestyle.

Conclusions:
The adherence to healthy lifestyles in Chinese adults was far from ideal. Targeted health promotion strategies were urgently in need.
Abstract 15482: Variation in Right Atrial Sizes Affects Locations of the His Bundle and Coronary Sinus Os
Authors: Lee Chin C , Eskander Michael , Lowe Katherine , Chung Jonathan , Hsu Jonathan , Krummen David E , Feld Gregory , Birgersdotter-Green Ulrika , McVeigh Elliot , Ho Gordon
Published: November 2020

Background:
Difficulties in HIS bundle (HBP) and coronary sinus (CS) lead delivery may be contributed by differences in right atrial (RA) anatomy. The distance from the lateral superior vena cava / right atrial junction (SVC) to the HIS bundle or CS os reflects the distance required by a delivery sheath to reach the cannulation target. However, RA geometry is not well characterized using standard 2D echo, but is well characterized by cardiac computed tomography (CT) and invasive electroanatomic mapping (EAM).

Objective:
The objective of this study is to characterize the variations in the distance from the SVC-RA JXN to the 1) HIS bundle and 2) coronary sinus os, and determine the correlation of these distances to standard measurements obtained from 2D echo.

Methods:
Cardiac CT (256 slice), electroanatomic maps, and 2D echo from patients undergoing ablation for atrial and ventricular arrhythmias were analyzed using 3D modeling software (Horos). The distances from the SVC were measured to the HIS and CS os on the CT which were co-registered to electroanatomic mapping (Fig 1A). Pearson’s coefficient analysis was performed to assess the correlation of these RA measurements with standard left-sided 2D echo measurements.

Results:
41 patients (age 6210 yrs, 31% female, 69% AF ablation) were analyzed. The mean distance between SVC-HIS was 37.2 mm 8.3 mm (range 22-56mm), and the mean distance between SVC-CS os was 66.1 mm 10.1 mm (range 49-92mm), Fig 1B. Both RA measurements correlated (Fig 1B) with LA volume index (R=0.6, p<0.001) but not LV diameter (R=0.079, p=0.3).

Conclusion:
The distance from the SVC/RA JXN to the HIS and CS os varies widely and may contribute to difficulties in HIS bundle and CS lead implantation. In the absence of pre-procedural cardiac CT or EAM, left atrial measurements from 2D echo may correlate with RA dimensions. Prospective studies are needed to test whether these measurements may help predict optimal delivery sheath sizes for HBP and CS lead placement.
Abstract 15495: Interleukin 18 Binding Protein Predicts Future Cardiovascular Morbidity and Mortality in Subjects Undergoing Coronary Angiography - the Casablanca Cohort
Authors: Rutten Joost H , van den Munckhof Inge C , Magaret Craig , Rhyne Rhonda F , Joosten Leo A , Netea Mihai G , Riksen Niels P , Januzzi James L , van Kimmenade Roland
Published: November 2020

Introduction:
Increased systemic inflammation is one of the key triggers in the initiation and progression of atherosclerosis. We investigated interleukin 18 binding protein (IL-18BP), a new inflammatory marker of the IL-1 cytokine family, on its predictive value for cardiovascular disease in subjects under investigation for stenotic atherosclerotic disease.

Methods:
We performed a prospective, single-center, investigator-initiated, observational cohort study in 927 subjects who underwent coronary and/or peripheral angiography. The cohort was randomly split into a discovery (n=627) and a validation set (n =267). Predictive value for incident cardiovascular events (composite of cardiovascular death, myocardial infarction and stroke), cardiovascular mortality and all-cause mortality was investigated using Cox proportional hazard models, including concordance index analyses and assessment of net reclassification for 10-year cardiovascular risk categories using Weibull modelling.

Results:
An one standard deviation increase in log-transformed IL-18BP was strongly associated with cardiovascular events (HR 1.96, 95% CI 1.54-2.51), cardiovascular mortality (HR 1.59, 95% CI 1.04-2.44) and all-cause mortality (HR 1.72, 95 CI 1.43-2.07), independent of the traditional cardiovascular risk factors, including body mass index. C-index of a clinical model for prediction of cardiovascular events improved from 0.69 (95% CI to 0.62-0.75) to 0.73 (95% CI 0.67-0.79) with inclusion of IL-18BP in the model; in doing so, a reclassification of 35.9% (p < 0.001) for events was demonstrated.

Conclusions:
Among a population of patient undergoing coronary angiography, results of IL18-BP measurement improved cardiovascular risk prediction beyond the traditional risk factors. Kaplan-Meier survival curves for CV events during one-year follow up comparing tertiles IL-18BP (discovery set)
Abstract 15800: Inter-race and Ethnicity Comparisons in Pulmonary Hypertension From the Pulmonary Vascular Phenomics (PVDOMICS) Program
Authors: Rischard Franz , Radeva Milena , Rosenzweig Erika B , Frantz Robert , Hassoun Paul , Hemnes Anna R , Horn Evelyn M , Leopold Jane A , Tang Wilson , Study Group and the PVDOMICS
Published: November 2020

Intro:
Recent World Symposium of Pulmonary Hypertension (WSPH) Group 1 data indicate significant racial and ethnic disparities in disease severity and mortality. It is unclear if these differences extend to other forms of PH and if they are a reflection of comorbidities. The PVDOMICS program incorporates deep phenotyping across all WSPH groups allowing for a first-time side-by-side comparison. The aims of this study are to evaluate inter-racial/ethnic factors of disease severity and comorbidities among patients with PH.

Methods/Results:
Participants in PVDOMICS prospectively underwent comprehensive testing for echocardiography, PFT, chest imaging, 6-minute walk, cardiac MRI, and hemodynamics with provocation. WSPH group assignment was assessed according to guideline recommendations. Race and ethnicity were self-reported. Statistical testing and sample sizes are described in the
Table
.

In 692 PH participants, Non-Hispanic whites (NHW) were older and more often male than non-Hispanic African American (AA) and Hispanic patients. WSPH Group 1 was less but Groups 4 and 5 more common in AA than NHW. There were no inter-race/ethnicity differences in the percent of PH patients on PH therapy (range 53-63%, p=0.23). Comorbidities such as diabetes and lung disease were more common in AA vs. NHW. Hispanics showed lower left atrial (LA) volume on echo, LA filling pressures with exercise, as well as increased cardiac index relative to NHW. Right ventricular function on cardiac MRI was similar between groups (
Table
). When WSPH Group 1 was analyzed separately, inter-racial/ethnic comparisons were generally similar.

Conclusions:
Significant inter-racial/ethnic differences are evident across all WSPH groups. Comorbidities appear to drive part of the differences among AA patients while Hispanic patients exhibit factors that may prove beneficial. How these differences contribute to varying disease risk and outcomes across race and ethnicity remain to be seen.
Abstract 15808: Relationship Between Myocardial Injury, Wall Motion Abnormalities and Mortality in Patients With Covid-19: The Circ-19 Registry
Authors: Camaj Anton , Giustino Gennaro , Miller Michael , Kini Annapoorna , Stefanini Giulio , Bienstock Solomon , Bragato Renato , Silbiger Jeffrey , Vicenzi Marco , Danilov Tatyana , Kukar Nina , Shaban Nada , Oates Connor , Sharma Samin K , Lerakis Stamatios , Croft Lori B , Goldman Martin E
Published: November 2020

Introduction:
Myocardial injury is commonly observed in patients (pts) with Coronarvirus disease 2019 (Covid-19) but its anatomical correlate has not been elucidated. We evaluated the association between presence of transthoracic echocardiographic (TTE) left ventricular (LV) regional wall motion abnormalities (RWMA), myocardial injury and outcomes in Covid-19 pts.

Methods:
We conducted a cohort study including 7 hospitals in New York City (US) and Milan (Italy) of hospitalized pts with confirmed Covid-19 who had a TTE during their index hospitalization. Myocardial injury was defined as any elevation in cardiac troponin (cTn) during the hospitalization. Using multivariable logistic regression, we analyzed the association between RWMA, myocardial injury and in-hospital death.

Results:
Among 305 total pts included in the study, 49 (16%) had RWMA and 44 (14%) had global LV systolic dysfunction. Among those with RWMA, 31/49 (63%) had LV ejection fraction <50%. Compared to pts without RWMA, pts with RWMA more commonly had chest pain at time of presentation (36% vs. 14%; p=0.001), ST segment changes on ECG (33% vs. 6%; p<0.0001) and myocardial injury (90% vs. 57%; p<0.001). After multivariable analysis, RWMA remained associated with myocardial injury (adjOR: 5.92; 95% CI: 2.17-16.17), but not death. Left heart catheterization (LHC) was performed in 9 of the 49 (18%) pts with RWMA, 8 of which had confirmed ACS and 7 underwent PCI. Myocardial injury was associated with higher risk of death regardless of the presence or absence of RWMA (
Figure 1
).

Conclusion:
In Covid-19 pts, RWMA are associated with typical ACS presentation: chest pain, ST changes and cTn elevations. Accordingly, a large proportion of pts with RWMA who underwent LHC had confirmed ACS warranting PCI. Though myocardial injury was associated with increased risk of in-hospital death regardless of the presence of RWMA, LHC should be considered for pts with RWMA and myocardial injury to rule-out obstructive disease.
Abstract 15809: 68 Gallium Fibroblast Activating Protein Inhibitor Positron Emission Tomography is Able to Diagnose Checkpoint Inhibitor-induced Myocarditis
Authors: Finke Daniel , Heckmann Markus B , Herpel Esther , Katus Hugo A , Haberkorn Uwe , Leuschner Florian , Lehmann Lorenz H
Published: November 2020

Introduction:
Checkpoint inhibitors (ICIs) have gained importance in recent years regarding the treatment of a variety of oncologic diseases. The possibilities of diagnosing cardiac adverse autoimmune effects of ICIs are still limited. We aimed to implement FAPI PET/CT imaging in detecting ICI-induced myocarditis.

Methods:
In a retrospective study, FAPI PET/CT scans of 26 patients who received ICIs from 01/2017 to 10/2019 were analyzed. We compared tracer enrichment in the heart of patients without any signs of a cardiac disease (n=23) to three patients with suspected ICI-induced myocarditis. To exclude any significant coronary heart disease, cardiac catherization was performed. Myocardial biopsies were examined, especially in regard to the infiltration of immune cells.

Results:
Three patients showed clinical manifestations of an ICI syndrome including myocarditis with elevated levels of hsTnT (175 pg/ml, 1771 pg/ml, 157 pg/ml). Further cardiological assessments revealed ECG abnormalities, lymphocyte infiltration of the myocardium in the biopsies or wall motion abnormalities in echocardiography. These patients’ FAPI PET/CTs showed a locally defined cardiac enrichment of the marker which was absent in patients receiving ICIs without any signs of immunological adverse effects and cardiac impairment (n=23) (Median SUV myocarditis patients: 1.79 (IQR: 1.65, 1.85), median SUV non-myocarditis patients: 1.15 (IQR: 0.955, 1.52)).

Conclusions:
Myocardial biopsy, the current gold standard of the diagnosis of ICI-induced myocarditis, is susceptible to sampling errors and results arrive within a few days. We provide first evidence that FAPI PET/CT is able to diagnose ICI-induced myocarditis and can demonstrate locally enhanced manifestation of ICI-induced myocarditis on time.
Abstract 15817: Transcatheter Closure of Paramitral Leaks: Use of the Agilis™ Nxt Steerable Sheath to Aid Device Placement
Authors: Ahluwalia Neha , Pass Robert , Love Barry a
Published: November 2020

Introduction:
Paramitral leak (PML) has been reported in 5-17% of patients after surgical prosthetic mitral valve replacements. Transcatheter closure of PML has emerged as a Class IIa alternative to surgical repair by the AHA/ACC. Reaching all areas around the mitral annulus for device delivery from a transseptal approach can be difficult. We describe our center’s experience utilizing a transseptal approach with use of a steerable sheath and real-time 3D echo to facilitate closure.

Methods:
Retrospective review of cases of transcatheter PML repair from 9/09 to 2/19 at Mount Sinai Medical Center.

Results:
32 patients underwent 43 catheterizations for PML closure (see Table 1). Indications for PML repair were CHF in (78%) and hemolysis (22%). 25/32 were bioprosthetic valves and the rest mechanical (7/32; table). PML’s could be crossed in 41/43 attempts (95%). Location of leaks/devices demonstrated in Figure 1. The median number of devices placed at one cath was 1 (range 1-3) and the most commonly used device was the Amplatzer muscular VSD device (64/71devices; 90%). 9/32 (28%) required an additional cath to complete PML closure. At last cath, clinical PML closure was achieved in 26/32 (81%) pts attempted. 3/32 (9%) had hemolysis from residual PML after closure and required surgical mitral valve replacement. Aside from failed attempts or those requiring repeat cath, there were no serious complications.

Conclusions:
Use of the Agilis™ NxT Steerable Sheath allowed closure of the majority of PML encountered. Success rates were high though a large percentage required additional caths to achieve success. Serious complications were uncommon.
Abstract 15884: Life-threatening Arrhythmias With Autosomal Recessive TECRL Variants
Authors: Webster Gregory , Aburawi Elhadi H , Chaix Marie , Chandler Stephanie , Foo Roger , Islam A. K. M. Monwarul , Kammeraad Janneke A , Rioux John D , Al-Gazali Lihadh , Sayeed Md. Zahidus , Xiao Tingting , Zhang Han , Xie Lijian , Hou Cuilan , Wilde Arthur A , Bhuiyan Zahurul A
Published: November 2020

Introduction:
Sudden death and aborted sudden death have been observed in patients with biallelic variants in
TECRL
. Phenotypes have only begun to be described and no data are available on medical therapy after long-term follow-up.

Methods:
An international, multicenter retrospective review was conducted. We report new cases associated with
TECRL
variants and long-term follow-up from previously published cases.

Results:
We present 10 cases and 37 asymptomatic heterozygous carriers. Median age at onset of cardiac symptoms was 8 years (range 1-22 years) and cases were followed for an average of 10.3 years (SD 8.3), right censored by death in 3 cases. All patients on metoprolol, bisoprolol or atenolol were transitioned to nadolol or propranolol due to failure of therapy. Phenotypes typical of both long QT syndrome and catecholaminergic polymorphic ventricular tachycardia were observed. We also observed divergent phenotypes in some cases despite identical homozygous variants. None of 37 heterozygous family members had a cardiac phenotype.

Conclusions:
Patients with biallelic pathogenic
TECRL
variants present with variable cardiac arrhythmia phenotypes, including those typical of long QT syndrome and catecholaminergic polymorphic ventricular tachycardia. Nadolol and propranolol may be superior beta-blockers in this setting. No cardiac disease or sudden death was present in patients with a heterozygous genotype.
Abstract 15904: Echogenic Immunoliposome-targeted Mesenchymal Stem Cells for Imaging and Treatment of Atheroma
Authors: Geng Yong-jian , Klegerman Melvin E , McPherson David D , Gao Song , Ghosh Saurendro , Shelat Harnath S , Gareeb Mohammad
Published: November 2020

Background:
Vascular stem cell dead impairs the regenerating capacity of the arterial wall with atherosclerosis. A patented technology has been developed to employ biofunctional echogenic immunoliposomes (BF-ELIP) for enhancing entry of stem cells to atherosclerotic lesions.

Objective:
Determine whethere ultrasound-enhanced delivery of BF-ELIP-targeted stem cells visualize and treat atheroma simultaneously.

Methods and Results:
BF-ELIP were prepared by conjugating thiolated antibodies specific for the mesenchymal marker CD146 and murine ICAM-1 to phosphatidyl-ethanolamine liposomes through a thioether linkage. CD146
+
bone marrow-derived mesenchymal cells (BM-MSC) were prepared from green fluorescence protein (GFP)-transgenic mice. By fluorescence microscopy, BF-ELIP targeted CD146
+
cells were clearly visualized being adherent on cultured human endothelial cells that expressed ICAM-1 induced by tumor necrosis factor alpha (TNF-α) (Fig. 1a). BM-MSC/BF-ELIP mixtures were intravenously injected into ApoE-/- mice (n=9). Ultrasound illustrated intense echo signals of BF-ELIP in the aortic arch 15 min after injection of the BM-MSC/BF-ELIP preparation into ApoE-knockout mice (Fig. 1b). Histopathology of the aorta analyzed by H&E and Oil-Red O staining of aortic sections showed that the BF-ELIP targeted MSC delivery reduced plaque sizes, inflammation and lipid loading. Neither normal wild type C57BL/6J nor ApoE-knockout mice without injection showed the intensified echo signals and histological changes in their aortic arch regions.

Conclusions:
BF-ELIP enhancement of vascular stem cell adherence to inflammatory endothelium facilitates vulnerable plaque detection and targeted stem cell therapy for atheroma. This proof of concept study illustrates on the development of ultrasound-enhanced, BF-ELIP-mediated stem cell delivery and therapeutic approach to stabilize atheroma.