bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 16332: Novel Risk Model for Predicting Cardiovascular Outcome in Breast Cancer Survivors
Authors: Kim Do Young , Youn Jong-chan , Park Myung-Soo , Lee Sunki , Choi Jae Hyuk , Mi-Hyang Jung , Ryu Kyu-Hyung , Han Seongwoo
Published: November 2020

Introduction:
Both conventional cardiovascular (CV) risk factors and breast cancer (BC) therapy-related CV risk factors play an important role in CV mortality among BC survivors.

Hypothesis:
A risk stratification scheme which is based on both conventional CV risk factors and cancer treatment-related risk factors may have a good performance toward estimating the risk of CV the event among these survivors.

Methods:
The cohort of the study consists of 1,256 female BC patients from 4 medical centers in South Korea with a mean follow up duration of 51.6 ± 30.8 months. The cohort was randomized on a 1:1 ratio into the derivation group and validation group. A competing risk analysis model was used to derive the risk scheme. The primary endpoint was the composite of CV mortality, myocardial infarction (MI), congestive heart failure (CHF), and transient ischemic attack (TIA)/stroke.

Results:
We developed the CHEMO-RADIAT score (CHF [2 point], Elderly [age≥60; 1 point], prior MI/peripheral artery disease [2 points], Obesity [body mass index ≥30 kg/m
2
; 1 point], Renal failure [glomerular filtration rate <60 ml/min/1.73 m2; 1 point], Abnormal lipid profile [1 point], Diabetes mellitus [1 point], Irradiation to left side breast [1 points], Anthracycline dose [1 point per 100mg/m
2
doxorubicin equivalent dose], TIA /stroke [2 points]) from the development group. The time-dependent C-index improved significantly when conventional CV risk factor data was incorporated into the BC treatment-related factors in the development (0.739 vs. 0.582, p=0.017). The time-dependent C-index of the CHEMO-RADIAT score at 5 years was 0.739 (95% confidence interval [CI] 0.615-0.864), and 0.848 (95% CI 0.721-0.976) in the derivation and validation group, respectively.

Conclusions:
A simple score for predicting CV risk in breast cancer patients was developed and validated well in this multi-center cohort. The CHEMO-RADIAT score may provide overall CV risk stratification in breast cancer.
Abstract 16360: Clinical Progression of Aortic Disease Among Adults Enrolled in the National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions Database
Authors: Lewis Erin R , Roberts Andrews Tracy , ASCH Federico M , Roman Mary J , Pyeritz Reed E , Lemaire Scott A , Shalhub Sherene , Eagle Kim , Di Luozzo Gabriele
Published: November 2020

Objective:
Evaluating progression of distal aortopathy among patients with GT-TAA.

Methods:
1,160 patients (2007-2014) including 226 patients with >=2 CT/MRI scans; mean surveillance=1.5±1.4 years. Rapid progression (RP) was within the fourth quartile growth rate. Multivariable logistic regressions analyzed RP, proximal surgery and downstream growth. Kaplan Meier analysis described the event-free survival.

Results:
Patients were white (85%), male (58%), with Marfan syndrome (35%) and median age 44.5 years; 65% underwent surgical intervention. 3 lost to follow-up and 12 died.142 patients were RP. Median inter-scan duration 24 months. RP was 2.5-times higher with initial distal diameters >=3cm (p=0.032). Distal repairs more common with RP (41% vs. 20%, p=0.016); proximal interventions 55% less likely (p=0.009). Proximal interventions did not influence distal ROG but increased likelihood of distal intervention 5-fold (p=0.001). Calcium channel blockers were associated with 10.7-fold risk for RP (p=0.032). Overall, 5-year event-free survival was 37% with RP versus 34% for counterparts (p=0.706). Logistic regression found 22-fold higher likelihood of death in RP (p=0.055).

Conclusions:
Inter-scan intervals <24 months is important due to vascular-related complications. Calcium channel blockers were associated with greater ROG. Despite the need for more distal interventions, RP median event-free survival similar to counterparts.

Keywords:
aorta, aneurysm, genetics, surveillance
Abstract 16370: Pathology of Coronary Artery After Third-generation Abluminal Biodegradable-polymer Drug-eluting Stent Implantation in Atherosclerotic Porcine Model
Authors: Migita Suguru , Kitano Daisuke , Li Yuxin , Koyama Yutaka , Onishi Akira , Fuchimoto Daiichiro , Suzuki Shunichi , Nakamura Yoshiyuki , Hirayama Atsushi , Okumura Yasuo , Hao Hiroyuki
Published: November 2020

Introduction:
Third-generation drug-eluting stent (3rd DES) is widely used in percutaneous coronary intervention. Clinical superiority of 3rd DES has been demonstrated, however, pathological response after 3rd DES remains unclear. We aimed to examine the histology after 3rd DESs in low-density lipoprotein receptor knockout (LDLR -/-) minipigs’ coronary arteries.

Methods:
Using LDLR -/- minipigs, second-generation drug-eluting stents (2nd DESs) and 3rd DESs were deployed in coronary arteries. Two weeks (n = 2) or four weeks (n = 4) after stent implantation, coronary angiography for the follow up was performed. For evaluation of the features of neointima, optical coherence tomography (OCT) examination was performed in all stented vessels. The stent-implanted arteries were dissected immediately after OCT and investigated histologically.

Results:
OCT analysis for four-week models showed that the thickness of neointima over 3rd DESs was significantly thinner than that over 2nd DESs (3rd DESs; 43.29 ± 3.29 μm vs. 2nd DESs; 61.67 ± 5.51 μm, P = 0.009). In two-week models, numerous inflammatory cells were observed on the luminal side of 2nd DESs’ struts, while this response was absent in 3rd DESs. Fibrin deposition around 3rd DES’s strut was 2347.9 ± 875.6 μm
2
, while that around 2nd DES’s strut was 4738.9 ± 691.0 μm
2
(P = 0.041) in four-week models. Moreover, when defining the density of smooth muscle cells as ratio of hematoxylin-eosin stained area, it was significantly higher in the neointima above 3rd DESs than that above 2nd DESs in four-week models (3rd DESs; 0.373 ± 0.011 vs. 2nd DESs; 0.265 ± 0.030, P = 0.026). Although neointima over 3rd DES was thin, the density of smooth muscle cells that compose the neointima was higher and seemed to be well-matured.

Conclusion:
Our pathological analysis showed advanced healing process in 3rd DES compared to 2nd DES lesions. This result may attributed to the absence or the presence of polymer applied on the luminal side of struts, which triggers severe inflammation in the early term after stent implantation, leading to formation of fibrin deposition, unnecessary neointimal thickening, and inhibition of neointimal maturation.
Abstract 16382: The Surface ECG May Provide Information About Left Ventricular Systolic Function in Patients With Right Bundle Branch Block
Authors: Gupta Anshul , Pavri Behzad B
Published: November 2020

Introduction:
In patients (pts) with right bundle branch block (RBBB) and heart failure, assessment of left ventricular (LV) function is vital to management, but echocardiograms (ECHO) may not always be readily available. We studied the utility of using the
Superimposed Median Format
(available on digital ECG systems) in assessing LV function. This format allows visual recognition of change in dV/dT when rapid initial impulse propagation over the left bundle branch (LBB) and LV Purkinje network transitions to slower muscle-to-muscle propagation to the right ventricle (RV) in the setting of RBBB.

Hypothesis:
With a normal LBB and healthy LV myocardium, the transition from rapid forces to slower depolarization would occur in the 1
st
half of the QRS complex (
Early Transition Group - ET)
whereas in patients with abnormal LV function, this transition would occur in the 2
nd
half
(Late Transition Group - LT)
of the QRS complex.

Methods:
Digital superimposed median format ECGs of 108 pts with RBBB were analyzed. Pts were divided into 2 groups: ET or LT. See figure. LVEFs were obtained from ECHO. LVEF ≥ 50% was considered normal.

Results:
ET: n = 69. LT: n = 39. Mean QRS durations were not different in the 2 groups. ET pts were more likely to have normal LVEF (p < 0.01). See figure. PPV of ET in predicting LVEF ≥50% = 90%; NPV = 71%. Accuracy = 82%.

Conclusions:
These data, if confirmed, suggest that in pts with RBBB, visual analysis of the QRS complex from the surface ECG using the superimposed median format may provide valuable clues about LV systolic function, and may be clinically useful when ECHO are not readily available.
Abstract 16383: Inhibition of Egfr Signalling Promotes Maladaptive Cardiac Remodelling in Hypertensive Heart Disease
Authors: Cooper Susanna , Haines Zoe , Alcantara Alonso Viridiana , Cull Joshua J , Ahmad Feroz , Alharbi Hajed O , Fuller Stephen , Sugden Peter , Clerk Angela , Meijles Daniel N
Published: November 2020

Introduction:
Epidermal growth factor (EGF) receptors (EGFRs: ERBB1-4) are activated by a family of ligands (e.g. EGF, Hb-EGF, EREG, TGFa), signaling through ERK1/2 and Akt to promote cell division and cancer. Antibody-based inhibition of ERBB2 in breast cancer can cause heart failure, but the role of other receptors and EGFR ligands in the heart, and potential cardiotoxicity of generic EGFR inhibitors is unclear.

Hypothesis:
We hypothesize that EGFR ligands play an important role in cardiac adaptation to hypertension, acting through EGFRs to promote adaptive remodelling.

Methods & Results:
EGF ligand/receptor mRNA expression was assessed in human failing hearts and normal controls (n=12/8). EGFRs were expressed at similar levels, but ligand expression differed with significant up- or downregulation of EGF/Hb-EGF vs EREG/TGFa, respectively, in failing hearts (p<0.05). EGF potently activated ERK1/2 and Akt (assessed by immunoblotting) in neonatal rat cardiomyocytes, leading to hypertrophy (p<0.05, n=4). The anti-cancer drug afatinib inhibits EGFRs. To assess the role of EGF signaling in cardiac adaptation to hypertension
in vivo
, C57Bl/6J mice (n=6) were treated with 0.8 mg/kg/d angiotensin II (AngII; 7d) ± 0.45 mg/kg/d afatinib. AngII promoted cardiac hypertrophy with increased left ventricular (LV) wall thickness (WT) and decreased LV internal diameter (ID; assessed by echocardiography). Afatinib enhanced AngII-induced hypertrophy with significantly increased WT:ID ratios (1.30-fold and 1.54-fold in diastole and systole, respectively; p<0.05) but inhibited AngII-induced increases in
Nppb
mRNA expression and cardiomyocyte cross-sectional area (208.80±9.78 vs 161.10±3.87μm
2
; p<0.05). In contrast,
Col1a1
mRNA expression was enhanced by afatinib, along with interstitial and perivascular fibrosis (3.21±0.38 vs 5.61±0.46, 0.98±0.06 vs 1.45±0.18 % area; p<0.05).

Conclusion:
EGFR signaling is modulated in human heart failure, promotes cardiomyocyte hypertrophy and is required for cardiac adaptation to hypertension. Since EGFR inhibition in hypertension prevents adaptive cardiomyocyte hypertrophy whilst promoting fibrosis, EGFR inhibitors are likely to cause cardiac dysfunction and be cardiotoxic in hypertensive patients.
Abstract 16721: A Meta-Analysis of Early versus Delayed Revascularization Among Patients With Non-st-segment Elevation Myocardial Infarction
Authors: Faisaluddin Mohammed , Thakkar Samarthkumar J , Kumar Ashish , Alweis Richard , Barssoum Kirolos , Mohammed Yaqub Nadeem , Patel Harsh P , Patel Raj , Doshi Rajkumar P , Arora Shilpkumar , PANAICH SIDAKPAL S
Published: November 2020

Introduction:
Several randomized control trials (RCTs) have compared early versus delayed coronary revascularization in non-ST-segment elevation myocardial infarction (NSTEMI) and have reported contradicting results.

Hypothesis:
We performed a meta-analysis of all the available RCTs to date to determine the best strategy in NSTEMI.

Methods:
We performed a comprehensive search of PubMed, EMBASE, and Cochrane databases for all RCTs comparing an early versus delayed revascularization in NSTEMI. The primary endpoint was all-cause mortality. The secondary endpoints were re-infarction and refractory ischemia. We used the Paule-Mandel (PM) estimator of Tau with Knapp-Hartung adjustment to calculate relative risk (RR) with a 95% confidence interval (CI).

Results:
Thirteen RCTs were included in the final analysis. The median time between randomization and angiography ranged from 0.5 to 14 h in the early group and 18.3 to 86.0 h in the delayed group. There was no difference in mortality (5.7% vs 6.6%; RR 0.90; 95% CI 0.78-1.04; p = 0.83) (PANEL A) as well as rate of re-infarction (6.7% vs. 7.7%; RR 0.83; 95% CI 0.10-6.71; p = <0.001) (PANEL B) among both the strategy. However, early revascularization was associated with a reduction in refractory ischemia (4.8% vs 7.4%; RR 0.64; 95% CI 0.44-0.94; p=0.002) (PANEL C)

Conclusions:
Early revascularization for NSTEMI does not reduce the risk of mortality or re-infarction compared with delayed revascularization. Nonetheless, an early invasive approach does decrease the rate of refractory ischemia in NSTEMI.
Abstract 16731: Early Onset of Menopause and Premature Cardiovascular Disease: The Coronary Artery Risk Development in Young Adults Study
Authors: Misha Ruth , Colangelo Laura A , Petito Lucia , Lewis Cora E , Schreiner Pamela , Wellons Melissa , Kim Catherine , Terry James G , Lloyd-jones Donald M , Allen Norrina B , Khan Sadiya S
Published: November 2020

Introduction:
Cardiovascular disease (CVD) is the leading cause of death in women and early onset of menopause before the age of 40 years has been identified as a risk enhancer for future CVD events. Quantifying the magnitude of risk for premature CVD among women with early menopause may inform and guide the intensity of sex-specific preventive strategies.

Methods:
We included all women in the Coronary Artery Risk Development in Young Adults (CARDIA) study who attended a follow-up exam after the age of 40 years, had available data on menopausal status, and had not experienced premature CVD before 40 years. We performed multivariable Cox proportional hazards regression to examine the relationship between early onset of menopause defined as <40 years and incident CVD (coronary heart disease, peripheral arterial disease, stroke, and heart failure) prior to the age of 65 years. We performed Cox proportional hazards models and adjusted for risk factors levels at baseline: age, race, age at menarche, years of education, smoking status, body mass index, diabetes, hypertension, and total cholesterol: high-density lipoprotein ratio.

Results:
Among 2136 women with mean age of 43.0 (SD 3.0), 9.1% reported premature menopause before the age of 40 years (4.5% in white and 13.9% in black women). Over a median follow-up of 14.0 (IQR 11.5, 16.9) years, 81 premature CVD events occurred. Incidence rate (95% CI) of CVD was 6.46 (2.43, 17.22) and 1.41 (0.92, 2.17) per 1,000 per person-years for white women with and without early onset menopause, respectively; 4.94 (2.66, 9.16) and 3.92 (2.94, 5.24) per 1,000 person-years for black women with and without early onset menopause (FIGURE).

Conclusions:
In a population-based sample, white women with early onset of menopause had a 3-fold higher rate of premature CVD events, independent of perimenopausal risk factor levels. Interventions to intensify CVD prevention in at-risk women are needed following early onset of menopause.
Abstract 16744: MR Lymphatic Burden in Fontan Correlates With Outcomes
Authors: Vaikom House Aswathy , David Dawn R , Aguet Julien , Dipchand Anne I , Honjo Osami , Jean-st-michel Emilie M , Seed Mike , Yoo Shi-Joon , Barron David , Lam Christopher Z
Published: November 2020

Introduction:
The importance of the lymphatic circulation in Fontan physiology is incompletely understood and may have implications in Fontan ‘failure’. Non-invasive imaging of the lymphatic system with heavily T2-weighted MRI sequences could be a useful tool for patient surveillance and prognostication. We sought to quantify lymphatic burden in Fontan patients and correlate with clinical status.

Methods:
Consecutive pediatric Fontan patients, <18 years-old with clinical cardiac MRI that had routine acquisition of lymphatic 3D T2 FSE imaging performed from May 2017 to Oct 2019 were included. ‘Lymphatic burden’ was quantified by thresholding-based segmentation of the 3D T2 FSE maximum intensity projection image (fig), generating a surrogate measurement of lymphatic volume, and was performed by 2 independent readers blinded to patient status. Spearman correlation and Mann-Whitney tests were used.

Results:
There were 48 patients (27 males) with median age at MRI of 12.9 (9.4-14.7) years, age at Fontan of 3.3 (2.9-3.8) years, and time from Fontan at MRI of 9.2 (5.9-10.4) years. Inter-rater agreement for lymphatic burden was excellent (ICC 0.96 [0.94-0.98]). Greater lymphatic burden correlated with hospital length of stay and duration of chest tube drainage post-Fontan (r =0.423, p=0.003 and r=0.419, p=0.003). Median lymphatic burden was greater in patients that had chylous effusions post-Fontan (286 (157-492) ml vs 123 (60-271) ml, p=0.011) and in patients with composite adverse outcome (n=12) defined by heart failure (n=3), transplant assessment (n=2), recurrent effusions (n=8), Fontan thrombus (n=2), and/or PLE (n=6) post-Fontan; (458 (266-2016) ml vs 130 (272-256) ml, p=0.005). Pre-Fontan mean PA pressure and time from Fontan did not correlate with lymphatic burden (r=0.062, p=0.676 and r=0.139, p= 0.343).

Conclusion:
Quantification of MR lymphatic burden is a reliable tool to assess lymphatic status post-Fontan and is associated with clinical outcomes.
Abstract 16747: The Artificial Pulse of the HeartMate3 LVAD Alters Mean Arterial Pressure Calculation, and the Relationship Between Arterial Pulse Pressure and Pulsatility Index
Authors: Braghieri Lorenzo , Pinsino Alberto , Mondellini Giulio , Gaudig Antonia , Javaid Azka , Wang Yu-Chiang , Onat Hatice D , Takeda Koji , Naka Yoshifumi , Sayer Gabriel T , Uriel Nir , Demmer Ryan , Yuzefpolskaya Melana , Colombo Paolo C
Published: November 2020

Introduction:
The HeartMate (HM3) left ventricular assist device (LVAD) uniquely features an artificial pulse (AP) (designed to reduce blood stasis and simulate physiologic pulsatility) that alters arterial blood pressure (BP) tracings (
Fig. 1A
). Pulsatility Index (PI) corresponds to the magnitude of flow pulse through the LVAD and is used as a surrogate measure of arterial pulse pressure (PP). The effect of the AP on: i) relative contribution of systolic BP (SBP) and diastolic BP (DBP) to mean arterial pressure (MAP) calculation; and ii) association between PP and PI is presently unknown. Thus, we aimed to compare: i) MAP calculations; and ii) relation of PI with PP in HM3 vs HM II (LVAD with no AP) pts with arterial line (A-line) monitoring.

Methods:
A-line BP and LVAD PI data were prospectively collected in 48 HM3 and 29 HMII pts. MAP was calculated with the formula conventionally used in non LVAD pts (MAP = 2/3 DBP + 1/3 SBP) and compared to A-line MAP. Among HM3 pts, a multiple linear regression model was fit with A-line SBP and DBP as predictor variables, and A-line MAP as the dependent variable to derive the
HM3 MAP Formula
. The relation between arterial PP and PI in HM3 and HMII pts was assessed using Pearson’s correlation.

Results:
MAP calculated using the conventional formula accurately estimated A-line MAP in HMII pts, but overestimated A-line MAP in HM3 pts. The
HM3 MAP Formula
more closely approximated A-line MAP. Mean observed difference (MOD) and mean absolute difference (MAD) between calculated MAPs and A-line MAPs are reported in
Fig. 1B
. While median PP was similar in HM3 and HMII pts (16 vs 20 mmHg, p=0.11), median PI was significantly higher in HMII pts (3.45 vs 5.6, p<0.001). PI correlated with PP in HMII pts (
r
0.47, p=0.01). However, no significant correlation was found between PI and PP in HM3 pts (
r
0.24, p=0.1;
Fig. 1C
).

Conclusions:
In HM3 pts, the AP significantly alters the relative contribution of SBP and DBP to MAP. Unlike in HM2 pts, PI does not relate to arterial PP in HM3 pts.
Abstract 16752: Cumulative Social Determinant of Health Risk Score and Prevalent Atherosclerotic CVD Among National Representative Adult Population in US
Authors: Dudum Ramzi , Elizondo Javier , Yahya Tamer , Jilani Mohammad Hashim , Andrieni Julia , Hyder Adnan , Blankstein Ron , Sharma Garima , Virani Salim S , Blaha Michael J , Cainzos Achirica Miguel , Nasir Khurram
Published: November 2020

Introduction:
Social determinants of health (SDOH) are contextual factors and shared experiences that impact an individual’s life and health. Unfavorable SDOH are recognized as a major source of excess cardiovascular disease (CVD) risk; however, prior studies have focused on restricted sets of SDOH domains. We aimed to assess the burden of multiple unfavorable SDOH at the population level, and the association between increasing cumulative burden of unfavorable SDOH features and atherosclerotic CVD (ASCVD) prevalence.

Methods:
Using a nationally-representative sample of 164,696 adults from the National Health Interview Survey (2013-17) we identified 39 parameters (classified as favorable or unfavorable) from the Healthy People 2020SDOH domains: Economic stability, Education, Food access, Neighborhood conditions, Social context, Health systems. An aggregate score of these features ranging 0-36 was then divided into quartiles-- the most unfavorable scores in the highest quartile. ASCVD was ascertained via self-report.

Results:
15,758 individuals (8%), representing ~19.6 million Americans, had ASCVD and were more likely to experience economic instability, adverse neighborhood and social cohesion, psychologic distress, food scarcity, and significant cost and non-cost-related healthcare barriers than those without ASCVD. The age adjusted mean (SD) SDOH risk score among ASCVD vs non-ASCVD participants was 12.5 (0.13) vs 0.9 (0.03) respectively. We observed a graded increase in ASCVD prevalence with higher SDOH quartiles (Figure). In multivariate analyses, adults with highest SDOH scores had 2-fold higher odds of having ASCVD compared to those with lowest scores (Figure).

Conclusions:
In the US, aggregate SDOH risk significantly discriminate risk of prevalent ASCVD among US adults. Standardized SDOH risk scores have the potential to inform risk stratification models at the individual level for addressing avoidable social inequities in health status.
Abstract 16780: Disease Severity Assessed by Thromboelastography in a Minority Population With COVID-19
Authors: Bliden Kevin , Rout Amit , Chaudhary Rahul , Barnes Jaime , Tantry Udaya , Gurbel Paul A
Published: November 2020

Background:
Thromboelastography (TEG®) is used across a wide range of clinical settings to identify patients at risk for thrombosis and coagulopathic bleeding and may be a useful diagnostic tool to guide antithrombotic treatment in patients with COVID-19.

Hypothesis:
TEG® identifies symptom progression in COVID -19 patients, particularly in the high-risk minority population known to have worse clinical outcomes.

Methods:
Whole blood from African American and Hispanic hospitalized COVID positive (n=22) and negative outpatients (n=24) was analyzed using point-of-care TEG®6s (Haemonetics, Corp). TEG® parameters including clot initiation (R), fibrin clot strength (FCS), platelet-fibrin clot strength (PFCS) and clot lysis (LY30) were compared across disease severity groups (table). Routine labs including D-Dimer, C-reactive protein (CRP), ferritin, and procalcitonin were also collected.

Results:
Ninety- five percent of COVID positive patients had at least one co-morbidity with the incidence of hypertension (73%), diabetes (55%), and obesity (45%) being the most frequent. R time was more rapid, and FCS and PFCS was significantly higher in COVID positive as compared to negative groups (p<0.03). A stepwise increase in FCS and PFCS was observed with worsening respiratory function (table). Similarly, D-Dimer, CRP, ferritin, and procalcitonin levels were highest in patients receiving ventilator support. No differences were observed in clot lysis between the groups despite elevated D-Dimer levels.

Conclusion:
We have demonstrated that TEG®6s can identify a prothrombotic phenotype characterized by rapid clot initiation and increased fibrin and platelet-fibrin clot strength in a minority population with COVID-19. Future studies are warranted implementing the TEG6s® in clinical trials to personalize antithrombotic therapy in COVID-19 and improve outcomes.
Abstract 16795: Fate of Dislodged Micra Transcatheter Pacing System in Coronary Sinus
Authors: Prabhakar Bhat Sangeeta , Singh Vijay Pratap , Young Wilson
Published: November 2020

Background:
Micra Transcatheter Pacing System is a leadless pacemaker for treatment of symptomatic high-grade atrioventricular block and persistent atrial fibrillation. We present a case report of dislodgement of a Micra device into the coronary sinus.

Case presentation:
An 87 year old man with permanent atrial fibrillation presented to the hospital with dizziness and fall. His medications included Lasix and Metoprolol. Electrocardiogram revealed atrial fibrillation with slow ventricular response. Metoprolol was held. During the hospital stay, telemetry monitoring revealed heart rates of 30-40 bpm. Micra device implantation was indicated for symptomatic bradycardia. After deployment, the Micra dislodged into the right atrium. Efforts to retrieve the device led to its embolism into mid-coronary sinus and dissection of the coronary sinus. Given comorbidities, the Micra was deactivated and a single chamber pacemaker was implanted with serial radiographic monitoring of Micra. Post procedure Chest X-ray (Fig. 1) and Computed Tomography Angiography of the chest (Fig. 2) confirmed location of Micra in the coronary sinus.

Discussion:
This is the first described case of dislodged Micra device in the coronary sinus. Device retrieval attempts resulted in dissection of the coronary sinus and there was no myocardial capture when pacing from the device. Serial CXR showed stable Micra position over the next two years.

Conclusion:
Embolization and dislodgement of Micra leadless pacemaker into the coronary sinus is possible and chronic management with serial imaging after abandoning the device is feasible.
Abstract 17148: Transcatheter Aortic Valve Replacement in Low-Risk Patients With Symptomatic Severe Aortic Stenosis: Two-Year Results From the LRT Trial
Authors: Waksman Ron , Shults Christian , Torguson Rebecca , Gordon Paul , Ehsan Afshin , Wilson Sean R , Goncalves John , Levitt Robert , Hahn Chiwon , Parikh Puja , Bilfinger Thomas , Butzel David , Buchanan Scott , Hanna Nicholas N , Garrett Robert , Buchbinder Maurice , ASCH Federico M , WEISSMAN Gaby , ben-dor itsik , Shea Corey , Ali Syed , Garcia-Garcia Hector M , Satler Lowell F , Rogers Toby
Published: November 2020

Objective:
To evaluate clinical outcomes and transcatheter heart valve hemodynamics at 2 years after transcatheter aortic valve replacement (TAVR) in low-risk patients.

Background:
Early results from the Low Risk TAVR (LRT) trial demonstrated that TAVR is safe in patients with symptomatic severe aortic stenosis (AS) who are low surgical risk.

Methods:
The LRT trial was an investigator-initiated, prospective, multicenter study and was the first Food and Drug Administration-approved Investigational Device Exemption trial to evaluate feasibility of TAVR in low-risk patients. The primary endpoint was all-cause mortality at 30 days. Secondary endpoints included clinical outcomes and valve hemodynamics at 2 years.

Results:
The LRT trial enrolled 200 low-risk patients with symptomatic severe AS to undergo TAVR at 11 centers. Mean age was 73.6 years and 61.5% were men. At 30 days, there was zero mortality, zero disabling stroke, and a low permanent pacemaker implantation rate. At 2-year follow-up, mortality was 4.4%, stroke rate was 4.6%, and permanent pacemaker implantation rate was 9.0%. Four patients (2.3%) presented with endocarditis; two of these underwent surgical reintervention. Of the 14% of TAVR subjects who had evidence of subclinical leaflet thrombosis at 30 days, there was no impact on valve hemodynamics at 2 years or stroke rate (4.8%) versus 4.2% in patients who did not have leaflet thickening.

Conclusions:
TAVR in low-risk patients with symptomatic severe AS remains safe at 2 years. Subclinical leaflet thrombosis, observed in a minority of TAVR patients at 30 days, did not impact valve hemodynamics in the longer term.
Abstract 17153: Race/Ethnicity, Education, and Health Status Predict Shared Decision Making in Hypertension Care in the Rich Life Project
Authors: Elias Sabrina S , Commodore-Mensah Yvonne , Cooper Lisa A , Himmelfarb Cheryl
Published: November 2020

Introduction:
In shared decision making (SDM), clinicians and patients make decisions together using the best evidence, along with patients’ preferences and values. Though SDM is a strategy recommended in guidelines to improve hypertension (HTN) control, SDM likely varies by individual characteristics such as race/ethnicity.

Hypothesis:
SDM and its determinants will vary by race/ethnicity.

Methods:
Within a pragmatic trial (The RICH LIFE Project) to reduce HTN disparities among individuals with uncontrolled HTN, we examined individual characteristics at baseline (ie, systolic and diastolic blood pressure (BP), age, sex, race/ethnicity, education, health literacy, subjective numeracy, and health status) to identify determinants of SDM at 12 months using multivariable logistic regression. SDM was measured using CollaboRATE; “top score” reflected highest possible score of 27.

Results:
Participants (n=1,266) were non-Hispanic (NH) Black (57%), NH White (35%) and Hispanic (8%); 41% male; with mean age 61 (±11.68). At baseline, Hispanics were more likely to have ≤ high school education (87%), <15,000 household income (44%), poor health status (24%), poor HTN knowledge (26%), and inadequate health literacy (59%) compared to NH Blacks and Whites (p<0.001). Mean systolic (153.6±13.1) and diastolic (87.5±12.24) BP were highest among NH Blacks. At 12 months, SDM mean scores were higher among NH Blacks, 7.5± 2.4, than Hispanics, 6.9±3, and NH Whites, 6.6± 2.9. Black race, higher education, and better health status predicted higher SDM (highest score of 27 on CollaboRATE scale) (Table).

Conclusion:
Race/ethnicity, education, and health status predict SDM among individuals with uncontrolled hypertension. Further research is needed to understand factors influencing SDM and opportunities for cultural-tailoring of interventions to improve SDM and HTN control.
Abstract 17167: Black Women Have Evidence of Cardiometabolic Risk and Damage to the Microvascular Glycocalyx 1 to 10 Years After Uncomplicated Pregnancy
Authors: Gandley Robin , Gandley Robin , Tuft Marie , Jeyabalan Arundhathi , Santillan Mark K , Pierce Gary L , Tang Gong , Hubel Carl A , Catov Janet M
Published: November 2020

Introduction:
Endothelial glycocalyx (GCX) is a proteoglycan/glycoprotein rich surface layer that regulates vascular health and function and can be damaged in diabetes and cardiovascular disease. Given the excess risk of adverse pregnancy outcomes (APO), chronic hypertension and CVD in Black compared to White women, we considered that microvasculature and glycocalyx may also differ between groups and contribute to adverse clinical outcomes.

Objective:
The first step was examining the microvasculature in women with no complications in the index pregnancy (from the medical record) and cardiometabolic risk markers.

Methods:
Sidestream dark-field imaging of the sublingual microcirculation and glycocalyx was used to compare density, median diameter, perfusion (RBC filling %), and penetration of red cells into the glycocalyx of vessel segments of 20-25μm diameter (PBR), in women 1-10 years after the index pregnancy (mean 8 years after index pregnancy). The study included 67 Black women and 167 White women with no complications (preeclampsia, gestation hypertension, preterm delivery, intrauterine growth restriction or gestational diabetes) in the index pregnancy. Health and pregnancy history were obtained by questionnaire at the study visit.

Results:
Black women had a greater penetration of red blood cells into the glycocalyx of microvascular segments20-25μm (PBR:2.54±0.41 vs White women 2.40±0.43μm, p=0.02). Perfusion in Black women was reduced (70.5±4.2% vs 72±4.8% p=0.003) compared to white women. Associations remain after adjusting for age, BMI, and time to follow-up. Black women were significantly younger (25± 6 vs 30±5 yrs p<0.001) at index delivery and study visit (34±6 vs 38±6yrs p=0.001); they also had higher BMI both pre-pregnancy (28±7 vs 25±6, p=0.007) and at the study visit (32±7 vs 27±7, p<0.001) and higher fasting insulin(17±36 vs 7±9 p=0.002) at the visit compared to White women. Self-reported history of hypertension, diabetes and APO (outside the index pregnancy) was significantly more common among Black at follow-up.

Conclusion:
Compared to White women, Black women of reproductive age had evidence of more pronounced microvascular changes potentially related to cardiometabolic risk 1-10 years after an uncomplicated index pregnancy.
Abstract 17195: Hydroxychloroquine Associated Electrocardiographic Changes in Patients With COVID-19 Extend Beyond QTc Prolongation and Are Accentuated in Those With Myocardial Injury
Authors: Abou Ziki Maen D , Taoutel Roy , Park Jakob , Chamoun Romy , ragheb elio , Rosenfeld Lynda D
Published: November 2020

Introduction:
Hydroxychloroquine (HCQ) is known to cause QTc prolongation, however its association with other ECG changes and how those are related to markers of myocardial injury in COVID-19 patients (pts) are not well described.

Hypothesis:
To study ECG changes in COVID-19 pts with or without troponin (Tn) elevation >3X normal (Tn +/-), who were or were not treated with HCQ (+/-).

Methods:
This is an observational study of pts admitted with COVID-19. All had at least 3 ECGs during admission; on day 1, day 2-3 and day 4-6. Pre-admission and final ECGs were included when available. Pts were excluded if they had atrial fibrillation, paced QRS, QRS>120msec, STEMI, or end stage renal disease. QRS, QTc, PR, P wave duration, QRS amplitude and the sum of T wave deflections in both limb and precordial leads were measured. Data were collected on medical history, illness severity, electrolytes, and medications within the 12-hour window of each ECG.

Results:
A total of 116 pts were included: 85 HCQ+ (40% Tn+) and 31 HCQ- (48% Tn+). There were no differences between the two groups in baseline characteristics, illness severity or mortality. Significant QTc prolongation was noted only in the HCQ+ group (p<0.001) peaking at +13.6 ms on day 5 compared to admission (p<0.01) and was accentuated in the HCQ+/Tn+ group (peak of +23.7 ms, p<0.01). QRS prolongation was seen in the HCQ+ group (p<0.001) peaking at +3.5 ms on day 5, and was accentuated in Tn+ pts peaking at +5.2 ms compared to Tn- pts +2.5 ms (p<0.05, both comparisons). The sum of precordial T-wave amplitude decreased in HCQ+ pts (-2.2 mm on final ECG, p=0.015) but this change was only significant in the Tn+ subgroup (peak of -3.6 mm, p<0.01). Finally, the PR interval was prolonged in the HCQ+ group, peaking at +7.6 ms on day 5 (p<0.01), but was again was more marked in the Tn+ subgroup (peak of +9.6 ms, p<0.05).

Conclusions:
HCQ related ECG effects extend beyond QTc prolongation. These are most notable in pts with evidence of myocardial injury.
Abstract 17201: TEG R-time as a Comparable Method to aPTT and Heparin Levels in Pediatric Patients on Heparin Therapy
Authors: Diallo Mamadou , Diallo Fatoumata , Torres Andrew , Emani Sitaram , Emani Sirisha
Published: November 2020

Introduction:
Hemorrhage post cardiac surgery continues to be a common morbidity despite the advancement in technology in coagulation diagnostics. Although, activated partial thromboplastin time (aPTT) and FXa function (heparin levels) are commonly used methods, there is often discrepancy in results between the methods.

Hypothesis:
In this study, we analyzed the use of Thromboelastography (TEG) reaction-time (R-time) as an additional diagnostic method for comparison to help guide blood product management.

Methods:
In a retrospective study of pediatric patients (N=292) who were given heparin, TEG R-time results along with aPTT and heparin levels were collected from the electronic patient records after the approval from our institution review board. Comparisons were made between the three methods using Pearson r correlations. Correlations between the three methods and bleeding events was also analyzed.

Results:
There were positive moderate correlations between R-time ≥15 min vs. aPTT ≥50s (
r
=0.51), R-time ≥15min, vs. heparin levels ≥0.1 IU/ml (
r
=0.54); and aPTT ≥50s vs. heparin levels ≥0.1 IU/ml (
r
=0.55). When R-time was ≥15min, 74% of the patients had aPTT ≥50s (
p
<0.001) and 81% of the patients had heparin levels ≥0.1 IU/ml (
p
<0.001). When aPTT was ≥50s, 78% of the patients had heparin levels ≥0.1 IU/ml (
p
<0.001). However, no correlation was found between bleeding events vs. R-time ≥15min, aPTT ≥50s and heparin levels ≥0.1 IU/ml.

Conclusions:
Correlation between TEG R-time versus aPTT or heparin levels was comparable to the correlation between aPTT versus heparin levels. In conclusion, TEG R-time could be used as an additional diagnostic method to help guide blood product management.
Abstract 17207: Impact of Racial Differences in Treatment Intensification and Missed Visits on Disparities in BP Control
Authors: Fontil Valy , Pacca Lucia , Bellows Brandon , Khoong Elaine , McCulloch Charles , Pletcher Mark , Bibbins-Domingo Kirsten
Published: November 2020

Introduction:
Hypertensive black patients have the lowest rates of blood pressure (BP) control. It is unknown to what extent variation in healthcare processes like treatment intensification (TI) and missed visits explain this disparity.

Hypothesis:
We hypothesized there would be no racial differences in TI but missed visits would be more frequent among black patients and mediate a sizable percentage of BP control disparities.

Methods:
We used a structural equation multivariate regression model to estimate the likelihood of BP control (BP<140/90 mm Hg) in black vs. white hypertensive patients, mediated by TI and missed visits. We included 6,556 patients who had diagnosis of hypertension and at least one clinic visit with uncontrolled BP (≥140/90 mm Hg) in 12 safety-net clinics in San Francisco from 2015-2017.We used the standard-based method (SBM), which is predictive of BP control, to calculate TI (dose increase or medication addition). We measured missed visits as the number of “no-shows” in the four weeks after an uncontrolled BP. BP control was defined based on the most recent BP as of Nov 15, 2017. The model adjusted for gender, age, first recorded BP between Jan 2015 and Nov 2017, visit frequency, and diagnosis of diabetes.

Results:
The mean (SD) age was 57.0 (11.2), 41% were female, and 44% were black. Compared to whites, blacks had more missed opportunities for TI (β=-0.02, p<0.001) and missed more visits (β=0.37, p<0.001). After accounting for these differences, black patients remained less likely than whites to achieve BP control (β=0.16, OR=0.85, 95% CI=0.76-0.95). The indirect effect of decreased TI and missed visits accounted for 22% and 13% of the total effect of black race on BP control, respectively (Figure).

Conclusion:
Racial inequities in treatment intensification may be responsible for over 20 percent of racial disparities in hypertension. Efforts to ensure more equitable treatment intensification may reduce black-white disparities in BP control.
Abstract 17222: MRSA Infection is Associated With Worse Outcomes After Device Infection
Authors: KHAN MUHAMMAD ZUBAIR , Khine Kay , Saltzman Heath , Kutalek Steven P , Gupta Ashwani
Published: November 2020

Introduction:
Methicillin-resistant Staphylococcus aureus (MRSA) is more virulent compared with other bacteria. Data regarding outcomes after transvenous lead extraction (TLE) for device infection with various staphylococcal and non-staphylococcal species are lacking

Hypothesis:
We hypothesized that MRSA infection is associated with worse outcomes after TLE for device infection compared with other infections

Methods:
We collected data for all patients undergoing TLE for infectious indication between April 2004 and June 2015. Patients were divided into 5 groups- group 1 had MRSA infection, group 2 had methicillin-sensitive Staphylococcous aureus (MSSA), group 3 had coagulase-negative Staphylococcus (CoNS), group 4 had non-staphylococcal infection and group 5 were culture negative.

Results:
Out of total 700 TLE procedures for infectious indication, 134 (19.1%) had MRSA, 143 (20.4%) had MSSA, 229 (32.7%) had CoNS, 109 (15.6%) had other bacterial infections and 59 (8.4%) were culture negative. Pocket infection was more commonly associated with CoNS (40.3%) and negative cultures (18.2%). Systemic infection was unlikely to be associated with negative cultures (2.9%) and equally distributed among other 4 groups.There was no difference in procedural outcomes between the groups. Complications during hospital stay were equally common with MRSA, MSSA and CoNS infections (22.5%, 27.2%, 24.9%, respectively) and less common with other infections (16.2%) and culture negative group (9.2%). Kaplan-Meier survival curves showed worse mortality with MRSA, compared with other infections. MRSA and MSSA have similar worse mortality up to 9 months, after which curves diverge and continue to diverge up to 4 years follow up.

Conclusions:
MRSA and MSSA infections are associated with worse mortality up to 9 months after TLE for device infection. After 9 months, MRSA infection is associated with worse mortality and curve continues to diverge up to 4 years follow-up.
Abstract 17231: Adult Protein Energy Malnutrition is an Independent Risk Factor With Increased Odds of Cardiogenic Shock in Patients With Infective Endocarditis Who Had Valve Replacement
Authors: Ojemolon Pius , Shaka Hafeez , Edigin Ehizogie , Asemota Iriagbonse , Akuna Emmanuel
Published: November 2020

Introduction:
Protein Energy Malnutrition (PEM) is common among adults with chronic medical conditions, especially in patients with chronic heart, lung disease and malignancies. These conditions are associated with worse in hospital outcomes. However, the complex relationship between chronic medical conditions and PEM make the true effect of PEM on outcomes difficult to ascertain. This is compounded by the relative underdiagnosis of PEM in adults. Our study aimed to determine if PEM is an independent risk factor for adverse outcomes among patients with infective endocarditis (IE) who had mitral valve (MV) and /or aortic valve (AV) replacement surgery.

Methods:
Data was obtained from the National Inpatient Sample for 2016 & 2017. Studied cohort were patients with IE who underwent AV and /or MV replacement. This group was divided by presence or absence of PEM using ICD-10 codes. Primary outcome was inpatient mortality. Secondary outcomes were total hospital charges, length of stay (LOS), NSTEMI, post procedural cardiac complications, acute kidney failure (AKI) and need for intra aortic balloon pump (IABP). Multivariate logistic and linear regression models were used to compare outcomes.

Results:
A total of 4275 hospitalizations met the inclusion criteria, of which about a fifth (20.12%) had PEM.Patients with PEM had higher adjusted odds of post procedural cardiogenic shock (aOR: 3.65, 95% CI: 1.724 - 7.746), and need for IABP placement (aOR: 4.01, 95% CI: 1.958 - 8.199), as well as significantly higher mean difference in total hospital charges and length of stay, relative to patients without PEM. There was however no significant difference in mortality, composite post procedural cardiac complications, NSTEMI or AKI between the PEM and non-PEM subgroup.

Conclusion:
PEM is associated with post procedural cardiogenic shock and intra-aortic balloon pump placement in patients with infective endocarditis who underwent valve replacement surgery but this impact did not translate to higher mortality. More research is needed to elucidate the role of PEM as a major comorbidity.
Abstract 17235: Comparision of Outcomes in Patients Undergoing Catheter versus Surgical Ablation for Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction
Authors: Patel Krunalkumar , Patel Kirtenkumar , Shah Jay , Doshi Rajkumar , Patel Amitkumar , KHAN MUHAMMAD ZUBAIR
Published: November 2020

Introduction:
There is a lack of research comparing outcomes of Surgical Ablation (SA) and Catheter Ablation (CA) among Atrial Fibrillation(AF) patients with heart failure with Preserved Ejection Fraction (HFpEF) and .

Hypothesis:
The main objective is to compare short-term clinical outcomes of SA and CA in AF patients with HFpEF.

Methods:
We used the national inpatient sample to identify patients over 18 years with HFpEF hospitalization and AF, and undergoing SA and CA from 2016 - 2017. The clinical outcomes of SA versus CA in AF stratified as non-paroxysmal and paroxysmal were analyzed.

Results:
1,530 HFpEF hospitalizations with AF who underwent SA and 1,045 HFpEF hospitalizations with AF who underwent CA were included in the analysis. Patients undergoing CA had higher baseline comorbidity. The in-hospital mortality between HFpEF with AF undergoing SA as compared to CA was similar (1.9% versus 1.4%, adjusted P-value 0.04). Patients undergoing SA had a significantly longer length of hospital stay, a higher percentage of post-procedural, and cardiac complications. In HFpEF patients with non-paroxysmal AF, SA as opposed to CA was associated with a higher percentage of in-hospital mortality (2.7% versus 0%, adjusted P-value=0.23), a longer length of stay, a higher cost of treatment, and a higher percentage of cardiac complications.

Conclusions:
In conclusion, CA is associated with lower in-hospital outcomes as compared to SA among AF with HFpEF patients. Further research with freedom from AF is needed between this group with long-term out
c
omes.
Abstract 193: Multiple Prior Live Births Are Associated With Cardiac Remodeling and Heart Failure in Women
Authors: Sarma Amy , Paniagua Samantha , Liu Elizabeth , Lau Emily , Larson Martin , Levy Daniel , Psaty Bruce M , Allen Norrina B , Ramachandran Vasan S , Gottdiener John S , Shah Sanjiv J , Cheng Susan , Ho Jennifer E
Published: November 2020

Introduction:
Greater parity has been associated with increased risk of cardiovascular disease, though effects on cardiac remodeling and heart failure risk remain unclear.

Hypothesis:
We hypothesized that multiple prior live births are associated with (1) structural and functional cardiac remodeling and (2) risk of future heart failure.

Methods:
We examined the association of number of live births and echocardiographic measures of cardiac structure and function in women participants of the Framingham Heart Study (FHS) using multivariable linear regression. We next examined the association of parity with incident heart failure (HFpEF, HFrEF) using Cox models in a pooled analysis of n=10,431 participants of FHS, the Cardiovascular Health Study, and the Multi-Ethnic Study of Atherosclerosis.

Results:
Among n=3931 FHS participants (mean age 48 ± 13 years), higher number of live births was associated with worse LV fractional shortening (multivariable β -1.11 (0.31), p= 0.0005 in ≥ 5 live births vs nulliparous women, p trend= 0.02,
Figure
). In addition, greater parity was associated with worse cardiac mechanics including global circumferential strain and longitudinal and radial dyssynchrony (p< 0.01 for all comparing ≥ 5 live births vs nulliparity). Over a mean follow-up of 11.7 ± 3.2 years, 298 HFpEF and 225 HFrEF events occurred. Women with ≥5 live births were at higher risk of developing future HFrEF compared with nulliparous women (HR 1.93, 95% CI 1.19-3.12, p=0.008); by contrast, a lower risk of HFpEF was observed (HR 0.58, 95% CI 0.37-0.91, p=0.02, p trend= 0.04).

Conclusions:
Greater number of live births are associated with worse cardiac structure and function, as well as increased risk of incident HFrEF. Further studies are needed to better understand mechanisms by which repeated pregnancies portend adverse cardiovascular risk.