7040 Background: Identification of pathogenic molecular mutations (PMM) as drivers in the development of acute myeloid leukemia (AML) and in initial prognostic assessment has become clinical practice. Persistence of PMM in a morphologic leukemia free state is correlated with high risk of relapse and poor prognosis. Therapy for induction of remission and elimination of all markers of residual disease remains controversial, especially with the addition of venetoclax to hypomethylating agents (HMA). Here we compare the rates of PMM clearance between intensive chemotherapy (IC) and less intensive chemotherapy (LIC) regimens. Secondary, we assessed differences in ethnicity between white and black patients (pts). Methods: Retrospective study from a leukemia treatment center in Louisiana. De-identified pt records from 2018-2022 assessed for demographics: race, age, sex and diagnosis: AML, ELN 2017 staging, and mortality by IC vs. LIC regimen. IC included anthracycline and cytarabine containing regimens. LIC included HMA, with or without venetoclax. Chi-Squared analysis preformed, threshold for significance at p < 0.05. Results: 408 pts with non-M3 AML who underwent treatment, 180(44.1%) were female, 91(22.3%) were black, 303(74.3%) were white, 273(66.9%) received IC while 135(33.1%) received LIC. NGS found a total of 280 pre-treatment PMM. Among 217 pts who received treatment, the rate of mutation clearance with IC was 55.2%, compared with 50.8% LIC(p = 0.55). Stratifying by race, black pts had a twofold mutation clearance compared to white pts OR = 1.76, 95% CL (0.91 – 3.44). Similar proportions of pts received LIC vs IC among both white (74.1% vs 74.4%) and black (22.2% vs 22.3). There was no statistically significant difference for overall survival on chemotherapy regimen intensity (p = 0.1991), race (p = 0.2736), or gender (p = 0.6912). Conclusions: In our study, PMM clearance was similar between IC and LIC inductions. Although these findings are from a single center, the ability to clear driver mutations at a similar rate to IC may offer a significant advantage of LIC with venetoclax. Mutation clearance is often used as a surrogate marker for residual disease, it may be reasonably inferred that these regimens serve as suitable induction regimens for pts who may be considered for allogeneic stem cell transplantation. Blacks make up a greater proportion of the population in Louisiana (~33%) as compared to the national average (~13%). Often underrepresented in prospective clinical trials, blacks made up 22.7% of subjects providing increased insight to clinical responses. No difference in mortality based on race and a trend toward greater mutational clearance in blacks. Emphasizing the importance of standardizing care in treatment centers and the need for greater representation in prospective clinical trials to understand better how differences in race may impact treatment outcomes.

Pathologic Complete Response in Triple Negative Breast Cancer of Black vs White Patients in the Post-Keynote 522 Era Melanie Sheen MD, Victoria Chung DO, Ruby Maini MD, Michael Duggan BS, Julia Levy BS Background Triple-negative breast cancer (TNBC) is an aggressive form of breast cancer that lacks estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER-2) gene amplification. Women with TNBC have worse survival outcomes and increased rates of relapse and distant metastasis as compared to women with non-TNBC. Treatment of TNBC has recently been focused on neoadjuvant chemotherapy (NACT) with a goal of achieving a pathologic complete response (pCR) which is associated with longer event-free survival and overall survival. The KEYNOTE-522 trial was presented at the San Antonio Breast Cancer Symposium in December 2019 and found that patients who received pembrolizumab, an anti–programmed death 1 (PD-1) monoclonal antibody, plus NACT were more likely to achieve pCR than women who received placebo plus NACT. On July 26, 2021, the FDA approved the use of pembrolizumab in combination with NACT for high risk, early stage TNBC. KEYNOTE-522 did not collect race as a baseline demographic characteristic, and since TNBC disproportionately affects younger women and Black women, confirming the efficacy of achieving pCR in these groups is essential. Further investigation of the factors that may contribute to achieving pCR in women treated with pembrolizumab for TNBC is warranted. We set out to perform a retrospective analysis examining the rates of pCR in Black versus White patients with TNBC since the initial revelation of the KEYNOTE-522 data. Methods This retrospective chart review of a regional health care network included patients who had been diagnosed with Stage II/III TNBC, documented race as Black/African-American or White, and received treatment with pembrolizumab in the NACT setting. Exclusion criteria included ER-positivity, PR-positivity, HER2-positivity, or unknown receptor status, no pembrolizumab in the neoadjuvant setting, absence of documented race, and age < 18 years-old. Data was collected using Epic SlicerDicer program. Results 118 patients met inclusion criteria. 59 (50.0%) were Black/African American, 59 (50.0%) were white. There were 57 (48.3%) patients who had pCR status identified through pathology reports while the remaining 61 (51.7%) are still undergoing NACT awaiting surgery. 34 Black women and 17 white women have not had surgery yet. Of women who underwent surgery, 12 Black women achieved pCR compared to 15 White women. 13 Black women and 16 White women did not have pCR Discussion Analysis of the data demonstrates an equal number of Black and White women receiving NACT with pembrolizumab. Of those women, there was relatively equal number of pCR between Black and White women. This data shows no appreciable difference in outcomes of Black and White women in terms of response to therapy. Conclusion Given the known association of pCR with increased survival, pembrolizumab should be considered in the treatment regimen for both Black and White women with stage II/III TNBC. This retrospective study is limited by a small patient population. Continued data collection is underway and will be updated. Citation Format: Melanie Sheen, Victoria Chung, Ruby Maini, Michael Duggan, Julia Levy. Pathologic Complete Response in Triple Negative Breast Cancer of Black vs White Patients in the Post-Keynote 522 Era [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-06-11.

Background Breast cancer (BC) is the most common cancer among women and the second most common cause of cancer-related mortality among women. Much attention has been paid to factors that increase the risk of developing BC. Among these are weight, typically defined by body mass index (BMI), and race. Elevated BMI has not only been shown to increase the risk of BC in some patients but has also been associated with increased rates of hormone receptor (HR) positive BC, particularly among postmenopausal patients. In premenopausal patients, an inverse relationship has been established between obesity and BC. In fact, a 2008 meta-analysis of obesity and malignancy evaluated almost 8,000 cases of premenopausal BC and showed a BC risk reduction of 8% for every 5 kg/m2. However, this study was not inclusive of African American (AA) patients. AA women are more likely to be obese than any other racial group in the US. They are also at higher risk of aggressive breast cancers, and at an earlier age. We sought to evaluate the relative risk of breast cancer diagnosis among obese vs nonobese patients of different races, as well as the rate of HR positivity in patients diagnosed with BC. Methods BMI, age, and self-declared race were collected from the electronic health record for all female patients presenting to our health system located in Louisiana and Mississippi between 2012 and 2022. This same data was collected for female patients who were diagnosed with BC in the same time period (n=9123), as well as HR positivity vs HR negativity. Patients less than 50 years old were considered premenopausal, and patients greater than 50 years old were considered postmenopausal. BMI greater than 30 was used to define obesity. The relative risk of BC was calculated for demographic groups according to premenopausal or postmenopausal status, White or Black/African American race, and BMI less than or greater than 30. The relative risk of HR positive BC was calculated among the same demographic groups. Discussion Data collected across the largest health system in Louisiana and Mississippi shows that a higher BMI is linked to an increased risk of BC, regardless of age or race. This was seen across both stratifications and was statistically significant except in postmenopausal AA women. This is contrary to what is frequently published in the literature that premenopausal obesity is protective against BC. Additionally, this data demonstrates that there is not a link between obesity and HR+ BC. This data did show that obesity in younger white patients may be protective against HR+ BC, which is aligned with prior research. Conclusion The association between obesity and BC incidence has been well-described in the literature, primarily in the postmenopausal setting. This large, retrospective analysis confirms that association, but also shows a strong association in premenopausal patients. Unlike other studies, this review did not show an association between obesity and HR positivity, and additionally did not show significant differences between AA patients and White patients. This provides needed insight into the inequities faced by AA women with BC. Further studies should be done to evaluate the association of socioeconomic status with BC subtypes. Table 1: Breast cancer cases (5/1/2012-5/1/2022) among women by BMI, age group, and race Table 2: Hormone receptor positivity (5/1/2012-5/1/2022) among women with breast cancer by BMI, age group, and race Citation Format: Victoria Chung, Ruby Maini, Rabia Cattie, Susan Olet, Melanie Sheen. PD12-04 Impact of Race and Body Mass Index on Breast Cancer Diagnoses [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD12-04.

Introduction: Multiple myeloma is a plasma cell neoplasm that predominately impacts black patients. It is well documented that racial disparities exist among blacks vs whites. This disparity adversely impacts survival and rates of autologous stem cell transplant among black patients, hypothesized to be due to unequal access to care. We seek to evaluate racial survival disparities among patients with multiple myeloma who underwent autologous stem cell transplant from 2011-2021 at one of the largest bone marrow transplant centers in Louisiana. Methods: Retrospective study from a large bone marrow transplant center in Louisiana. De-identified patient records assessed for patient demographics, including self-reported race, age, sex, and diagnosis characteristics including diagnosis of multiple myeloma, PET staging, R-ISS staging, date of transplant and death. Data was analyzed using Chi-Squared analysis. Statistical significance was measured as p<0.05. Results Of 238 patients with multiple myeloma who underwent autologous stem cell transplants from 2011-2021, 101 patients were female, and 137 patients were male. 107 patients were self-identified as black, 124 self-identified as white, 7 patients as other. Both racial groups (black and white) had equal number of patients in R-ISS stage I-III. Analysis of one-year survival post-autologous stem cell transplant among black vs white patients was not statistically significant. There was no trend of increased mortality among either racial groups. There was no evidence of increased progression among racial groups. There was also no correlation between sex and survival. Conclusion Louisiana encompasses a greater proportion of black population (33%) as compared to the national average (13%). Using retrospective data from one of the largest bone marrow transplant centers and referral centers, there was no evidence of a one year survival disparity among race and progression free survival among patients with multiple myeloma who received autologous stem cell transplant from 2011-2021. This may be due to equal access to care, referral-based process, and navigation assistance.

e20023 Background: The IMWG recommends using 18F-FDG PET/CT (PET) to monitor response to therapy in multiple myeloma (MM). Prior studies in patients who received chemotherapy before autologous stem cell transplant (ASCT) found that severe FDG uptake on PET was associated with inferior event free survival. However, novel agents and monoclonal antibodies have changed the landscape of MM and chemotherapy is no longer used as initial treatment making the role of PET before ASCT unclear. This study explores findings on pre-ASCT PET that may predict shorter remissions after ASCT. Methods: This was a retrospective cohort study. Patients were included if they had a PET at least 60 days before ASCT between 2014 and 2021. All patients achieved at least a partial response (PR) prior to ASCT. The primary endpoint, PFS was defined as time to progression on labs, imaging or bone marrow biopsy necessitating change in therapy or resulting in death after ASCT. The cytogenetic risk category (CG), number of bone lesions at diagnosis, presence of severe FGD uptake on PET (defined as SUV max ≥ 4.2) and persistence of lesions on PET was recorded. Patients who did not experience the event of interest were censored at their last date of clinic follow up. Hazard ratios (HR) for disease progression were estimated using Cox proportional hazards models. Results: 151 patients were included in our study. All patients underwent induction with a 3-drug regimen containing a proteasome inhibitor (PI) and/or an immunomodulatory agent (IMiD). 32% had high risk CG, 44% had > 3 bone lesions at diagnosis, 24% had severe FDG uptake and 29% had > 3 lesions on pre-ASCT PET. The presence of high-risk CG [HR 2.08 (1.03 – 4.17)] and severe FDG uptake on diagnostic PET [HR 6.43 (2.58 – 16.07)] was associated with more aggressive disease and shorter PFS. Patients with > 3 lesions in their pre-transplant PET had a statistically significant decreased PFS [HR 2.01 (1.02 – 3.96)] compared to those with ≤ 3 lesions. Conclusions: This study found that that persistence of > 3 lesions on pre-ASCT PET were an adverse finding associated with an increased risk of progression. To our knowledge these findings have not previously been shown in patients treated with PIs and IMiDs before ASCT. Significantly shorter PFS was observed in patients with high-risk CG and severe FDG uptake on initial PET, consistent with our knowledge of MM. In addition to established risk factors for aggressive disease, persistence of > 3 bone lesions on PET/CT could be used to identify a high-risk group of patients who may benefit from more intensive surveillance or therapy after ASCT. [Table: see text]

Background The objective of our study is to retrospectively investigate if the HOSPITAL score, LACE index, and RAHF scale exhibit any bias based on gender and race in heart failure readmissions. Methods This is a retrospective cohort study with all adult medical patients discharged with congestive heart failure from 2016 to 2018 from Southern Illinois University School of Medicine Hospitalist service. The receiver operating characteristic (ROC) curve was constructed comparing prediction tools (HOSPITAL score, LACE index, and RAHF scale) performance based on gender and race by measuring the area under the curve (AUC). Absolute Between-ROC Area (ABROCA) values were calculated. All statistical analyses were performed using R version 3.6.2. Results The performance of the HOSPITAL score in the majority and minority population showed a statistically significant difference between AUCs (0.714 and 0.633, p = 0.029) and an ABROCA of 0.081 indicating superior performance in predicting hospital readmissions in the majority group vs. the minority. The performance of RAHF score in females and males showed statistically significant differences between AUCs (0.567 and 0.527, p = 0.04) and an ABROCA of 0.04 indicating the superior performance of the RAHF score in females compared with males. Conclusions Our study demonstrated that the HOSPITAL score and the RAHF scale showed significant differences in predicting 30-day readmissions risk based on race and gender, respectively, in heart failure patients, whereas the LACE index did not show any significant difference.

Objectives: The objective of our study was to use the parameters of social vulnerability index (SVI) to observe their association with the 30-day hospital readmissions in the heart failure population.Methods: Data required for analysis were extracted from the electronic medical record. The geographic SVI data was then merged with the clinical data. Qualitative variables and reported as frequency and quantitative variables and reported as the mean ± standard deviation. Variables from univariate analysis with a P value of ≤ 0.10 were evaluated using multivariate logistic regression with stepwise backward variable selection and receiver operating curve (ROC) analysis.Results: The odds ratio of readmission predicted by HOSPITAL score was 1.137 (P value = 0.004, 95% CI = 1.041-1.241). SVI parameter recording disability showed odds ratio of 1.521 (P value = 0.006, 95% CI = 1.125-2.058) and SVI parameter tracking vehicle ownership showed odds ratio of 15.355 (P value = 0.014, 95% CI = 1.755 - 134.383). The ROCs were generated for three scenarios: (i) HOSPITAL score only which had area under the curve (AUC) of 0.702 (P value = 0.015), (ii) SVI indicators tracking vehicle ownership and disability resulted in the AUC of 0.589 (P value = 0.016), and (iii) all of the above combined increased the AUC increased to 0.718 (P value = 0.015).Conclusions: Two social parameters (limited vehicle access and prevalence of disability) from the SVI showed a strong association with 30-day hospital readmissions.

e12548 Background: Chemotherapy-induced cardiotoxicity has been associated with certain breast cancer therapy regimens, such as anthracyclines. With the development of newer therapies, just as the anti HER2 agents,another association with cardiotoxicity has been recognized in these drug groups. We report the cardiac safety of anti-HER2 agents and anthracyclines. Methods: A retrospective chart review was conducted of patients diagnosed with breast cancer between January 1st 2014 and December 31st 2017, treated with chemotherapy were identified from a large cancer center database. Heart failure, ACS, and other comorbidities were identified using billing codes. Primary outcome was cardiac event,defined by New York Heart Association class II, III or IV heart failure, ACS and heart failure hospitalization. Fisher's exact test was used to test associations between medication categories and cardiac events. Results: A total of 478 patients were included in our study.Our results indicated a significant association of anti HER2 agents with new heart failure with 12.24% (6/49) of patients, compared to 4.04% (12/297) in the control group (p = 0.0288). For the compound of all cardiac events, patients on the anti HER2 arm did not have a significant association, representing 12.50%(6/48) (p = 0.117).Regarding anthracyclines, results demonstrated a significant association of cardiac events, with an incidence of 17.46%(11/63) compared to 4.59%(14/305) in the control group (p = 0.001). We also found that specifically for new onset heart failure, the anthracycline group had a proportion of 13.64%(9/66), in comparison to the control group which had an incidence of 3.21%(9/280) (p = 0.0023). Conclusions: These findings are comparable to rates reported in studies evaluating cardiac safety of anthracyclines and anti-HER2 agents,calling attention to the importance of novel techniques and treatments for the management of chemotherapy-induced cardiotoxicity.

INTRODUCTION: Malignant mesothelioma is a rare disease with the majority of cases arising from the pleura.While approximately 80% of cases of pleural mesothelioma report exposure to asbestos, causes of malignant peritoneal mesothelioma vary.1 We report a case of rapidly progressive malignant peritoneal mesothelioma. CASE PRESENTATION:An 89-year-old male presented with dyspnea on exertion for 1 week.He denied history of heart failure, cough, fevers, chills, appetite loss or weight loss.He had a history of hypertension, benign prostatic hyperplasia and former tobacco use.He reported quitting more than 30 years ago.He denied history of environmental or occupational exposures.On physical examination, the patient was afebrile with SpO2 90% on 3 L oxygen and would pause while speaking due to breathlessness.He had decreased breath sounds over his left lung base.This was the patient's second presentation in the year with dyspnea.His initial visit was 7 months prior due to a large left-sided effusion without evidence of pleural lesions, along with bilateral hydronephrosis on chest computed tomography (CT).Thoracentesis demonstrated cytology that was negative for malignant cells.Pleural fluid studies returned negative for bacterial, fungal and mycobacterial infections; however, studies were significant for a transudative effusion with pleural fluid creatinine > 1, confirming urinothorax and a foley catheter was inserted due to obstructive uropathy.During the current admission, he underwent evaluation with chest CT, revealing a left pleural effusion with marked thickening of the left mid-to-lower pleura.Left interlobular septal thickening was also noted.CT of the abdomen and pelvis revealed a large amount of peritoneal and omental implantation, concerning for metastatic disease.The patient then underwent CT-guided biopsy of the peritoneum via the right lower quadrant.Unfortunately, during the course of the patient's stay his respiratory status declined, requiring up to 8 L oxygen.Pathology returned for malignant peritoneal mesothelioma.Ultimately, the patient decided to pursue comfort focused care.DISCUSSION: Malignant peritoneal mesothelioma is a rare disease which occurs in about 7-30% of all mesothelioma cases.Symptoms are non-specific which accounts for delayed diagnosis and overall poor prognosis.Our case highlights the rapid progression of malignant mesothelioma despite having complete imaging 7 months prior.This also encourages the question of whether further investigations be considered in patients with recurrent pleural effusions. CONCLUSIONS:We emphasize the importance of identifying malignant peritoneal mesothelioma and need for further awareness of this diagnosis.If initial diagnostic tests are inconclusive a high degree of suspicion is needed to recognize the atypical presentation of malignant pulmonary mesothelioma.

INTRODUCTION: Various forms of vasculitides ranging from benign and self-limiting to potentially life-threatening exist.Here, we report a case of a patient who harbored an asymptomatic coronary vasculitis followed by a life threatening pulmonary-renal syndrome (PRS) secondary to anti-neutrophilic cytoplasmic antibody (ANCA)-associated vasculitis (AAV).CASE PRESENTATION: 75-year-old male presented to us with hemoptysis.Four months prior to current admission, he reported dyspnea upon exertion and was diagnosed with atrial fibrillation with rapid ventricular response for the first time.A chest x-ray was unremarkable whereas an echocardiogram revealed worsening of his aortic stenosis compared to the prior year.Elevated troponin and ST-T wave changes in EKG prompted a left heart catheterization that revealed multivessel coronary artery disease necessitating consideration of coronary artery bypass graft (CABG), surgical aortic valve replacement, and a maze procedure.During the procedures, his left atrial appendage was excised and sent for histopathological examination (HPE).Post CABG, on a routine outpatient follow up, he was found to have hyperkalemia with a potassium of 6.0 mmol/L and acute renal failure with a creatinine of 6 mg/dL (baseline creatinine of 1.0 mg/dl), prompting a second hospitalization.Bilateral renal ultrasound were unremarkable.Serum myeloperoxidase anti-neutrophilic cytoplasmic antibodies (MPO-ANCA) were elevated.Renal biopsy revealed a severe vasculitis of small vessels without any granulomas.No immune deposits were noted.He was diagnosed with AAV and was treated medically.Later in the course, he was also started on hemodialysis.Four months after the onset of his initial dyspnea patient presented with frank hemoptysis leading to a third hospitalization.CT of the chest with contrast revealed bilateral new extensive mixed ground-glass and consolidative opacities.He had developed severe PRS.Patient failed to improve with medical management; decided to undergo comfort care measures and passed away the same day.Retrospective chart review of the patient's left atrial appendage biopsy revealed vasculitis involving medium-sized myocardial and pericardial blood vessels.DISCUSSION: In this case, coronary vasculitis was a clinically silent disease with a histopathologic diagnosis whereas PRS secondary to AAV was a fulminant vasculitis with a fatal course despite therapy with pulse steroids, cyclophosphamide, plasmapheresis and hemodialysis.It is unclear whether coronary vasculitis in the patient was a prodrome to an impending serious illness or merely an incidental finding with no association to subsequent AAV.CONCLUSIONS: Vasculitis of the coronary arteries is uncommon, yet when involved in a patient portends a poor prognosis.While immunosuppression and plasma exchange therapy remain the cornerstone in management of AAV, therapeutic dilemma persists with regard to the clinically silent coronary vasculitis.

SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Pressure recovery results in differences in peak instantaneous pressure readings across the aortic valve when measured using continuous wave-doppler echocardiography and cardiac catheterization. This causes a discrepancy in aortic valve area calculations in aortic stenosis, most pronounced in patients with a small aorta. We describe a patient with a very small aorta were not accounting for pressure recovery would have led to significant underestimation of the patient’s aortic valve area [1]. CASE PRESENTATION: A 78-year-old female was referred for a trans-esophageal echocardiogram for evaluation of a watchman device. The study showed LVEF of 55%, moderate concentric LVH, and a left atrial appendage thrombus. Her aortic valve peak velocity was 2.12 m/s, peak gradient was 17.9mmHg, valve area (AVA) of 0.95cm2 by Vmax, and 1.04 cm2 by velocity-time integral (VTI), and stroke volume index was 31.8 ml/m2. This suggested low flow, low gradient aortic valve stenosis which was approaching severe by calculated valve area. However, planimetered valve area was 1.35cm2 and the Dimensionless Index was 0.42. The patient had a very small aorta with proximal ascending aorta size 2.00 cm. Turbulent flow in the ascending aorta was noted. The calculated aortic valve area by VTI when corrected for pressure recovery was 1.44 m2 and her degree of aortic stenosis was reclassified as mild to moderate. DISCUSSION: Recognition of the phenomenon of pressure recovery allowed for correction of the calculated aortic valve area for small aortic size. This prevented her from being misclassified as severe low flow-low gradient aortic stenosis which would have led to unnecessary invasive workup. The formula used for correction was AVA (predict)= {AAA x AVA (doppler)}/ {AAA-AVA (doppler)} where AAA is the cross-sectional area of the proximal ascending aorta (1). CONCLUSIONS: When not corrected for pressure recovery, underestimation of the aortic valve area can be seen. Therefore, careful evaluation should be done during imaging, and the valve area should be corrected for aortic size when significant pressure recovery is suspected. Reference #1: 1.Spevack, Daniel M., et al. "Routine adjustment of Doppler echocardiographically derived aortic valve area using a previously derived equation to account for the effect of pressure recovery.” Journal of the American Society of Echocardiography 21.1 (2008): 34-37. DISCLOSURES: No relevant relationships by Mohammad Al-Akchar, source=Web Response No relevant relationships by Odalys Lara-Garcia, source=Web Response No relevant relationships by Ruby Maini, source=Web Response No relevant relationships by Priyanka Parajuli, source=Web Response No relevant relationships by Manjari Regmi, source=Web Response No relevant relationships by Momin Siddique, source=Web Response No relevant relationships by Nitin Tandan, source=Web Response

Background: Postoperative atrial fibrillation (POAF) is a relatively common phenomenon, occurring in approximately 20-40% of cases. Previous studies and guidelines from the AHA/ACC recommended initiating anticoagulation in patients with POAF lasting over 48 hours. However, a few recent studies suggest improved outcomes after anticoagulation even at 5 minutes of POAF. Our meta-analysis aims to clarify primary outcomes of ischemic stroke and mortality in patients with POAF and to offer guidance on whether these patients would benefit from chronic anticoagulation. Objective: To assess whether patients with POAF benefit from chronic anticoagulation. Methods: Through PubMed, OVID, and MEDLINE, we performed a literature review of several studies to assess whether patients with short-lived atrial fibrillation benefit from anticoagulation. Although several studies provided valuable information, we selected 6 studies that reported the duration of POAF, risks of ischemic stroke, and mortality. Results: We found that patients that received anticoagulation due to newly diagnosed POAF were 3.5-times less likely to experience an ischemic stroke than patients who did not receive anticoagulation with newly diagnosed POAF (IRR 3.54 (95% CI 2.12-5.91), p=0.001.). There were no statistically significant differences found in mortality outcomes between POAF patients that received anticoagulation as compared to those patients that did not receive anticoagulation (Pooled IRR = 1.1449 (95% CI = 0.738952 to 1.773857, P = 0.5447). Conclusion: Patients with POAF over 24 hours duration were less likely to experience ischemic stroke if they were placed on anticoagulation.We hope that this meta-analysis would promote further prospective studies into the question of length of POAF and how chronic anticoagulation therapy plays a role in decreasing risks of ischemic stroke and/or mortality.

Lipomatous hypertrophy of the atrial septum (LHAS) is a benign anomaly of the heart characterized by an infiltration of adipocytes into myocytes of the atrial septum. We report a case of a large lipomatous mass primarily localized to the limbus portion of the atrial septum which occupied the right

e12616 Background: The most common female malignancy diagnosed in the US is breast cancer. Early breast cancer therapy is often treated with radiation therapy; one of the unfortunate side effects of radiotherapy in the past has been cardiotoxicity, especially coronary artery disease. Recent usage of dose reduction techniques have helped reduce these effects. Here, we present our analysis of breast cancer patients that received radiation therapy and the likelihood of cardiotoxicity. Methods: An IRB-approved retrospective study was performed utilizing ICD codes to analyze patients diagnosed with biopsy-confirmed breast cancer between January 1, 2014 and December 31, 2017. 478 of 1618 de-identified patients qualified for this study. Statistical analysis was performed with SAS v9.4. Descriptive statistics were computed for all study variables. Continuous variables were described with measures of central tendency (mean, median) and dispersion (range, standard deviation). Categorical variables were summarized as frequencies and percentages. Comparisons between categorical variables were compared with the Chi-Square test (or Fisher’s Exact) where appropriate. Survival curves were estimated using Kaplan-Meier methodology and analyzed with a log rank test. Predictors of survival were assessed with Cox proportional hazards regression analyses. All significance is assumed at the p < 0.05 level. Results: Of the 478 eligible patients, heart failure (HF), HF hospitalizations, acute coronary syndrome and overall cardiac events were compared among breast cancer patients. Patients who received radiation experienced HF 6.02% compared to 4.61% without radiation (p = 0.574). HF hospitalization was recorded as 2.27% in radiotherapy compared to 1.23% in non-radiotherapy patients (p = 0.686). Patients who radiation experienced ACS 2.27% of the time as compared to 1.21% in patients who were not treated with radiation. Of note, 9.25% receiving radiation experienced cardiac events compared to 4.24% in patients without radiation (p = 0.068). While results were not statistically significant, the trend of elevated cardiac events in breast cancer patients receiving radiation is noteworthy. Conclusions: Per our study, although statistically insignificant, radiation therapy may result in higher incidence of cardiac events in breast cancer patients. Further large-scale, prospective studies should be performed to confirm the aforementioned trends with respect to survival outcomes in urban and rural populations.

e13622 Background: Breast cancer is the most prevalent malignancy affecting the female population in the United States and poses a significant mortality risk. In central Illinois, our objective was to analyze cardiac events (described as a new diagnosis of heart failure, heart failure hospitalizations, and acute coronary syndrome) in patients diagnosed with breast cancer and overall survival. Methods: A retrospective analysis completed in February 2020 identified patients (n = 1618) based on ICD diagnosis codes with a primary diagnosis of breast cancer. The inclusion criteria comprised of confirmed pathology report with diagnosis of breast cancer between January 2014 and December 2017. A cohort of 478 patients was identified as having met the inclusion criteria. Baseline characteristics and qualitative information were obtained from retrospective chart review. Continuous variables were described with measures of central tendency (mean, median) and dispersion (range, standard deviation). Categorical variables were summarized as frequencies and percentages. Furthermore, comparison between categorical variables were analyzed using Chi-Square test. Survival curves were estimated using kaplan-meier methodology and analyzed with a log rank test. Qualitative variables were analyzed using chi-square test and reported as hazard ratio using SAS software. All significance was assumed at the p < 0.05 level. Results: Of the 478 patients that were included as part of the analysis, 425 (89.6%) were of caucasian background and 49 (10.34%) were minorities (Asian, African American, and Hispanic). In regards to heart failure, our data demonstrated increased heart failure hospitalizations in minorities (7.89%) compared to caucasians (1.22%) which was a significant association (p = 0.026). In the overall survival among caucasian and minority groups there was no statistically significant difference (hazard ratio 0.939 with a 95% CI between 0.218-4.048), however it showed slight trend suggesting improved survival in the caucasian population. Conclusions: Our data illustrates that minorities with breast cancer experienced a higher incidence of heart failure when compared to the caucasian population. This supports closer observation at cardiac risk factors of such patients and medical optimization in an effort to prevent cardiac complications. While we did not see a significant difference in overall survival, further studies may be warranted in such population.

e12549 Background: Breast cancer remains the number one threat to women’s health while cardiovascular disease (CVD) continues to be the leading cause of mortality in women worldwide. Adjuvant therapy with endocrine therapies (selective estrogen receptor modulators (SERM), estrogen receptor blockers (ERB), and aromatase inhibitors (AI) although known to reduce the recurrence of breast cancer in hormone receptor positive breast cancer patients, raise a concern for increased risk of cardiovascular disease. Our study aims to examine breast cancer survival outcomes on patients receiving endocrine therapy who have pre-existing CVD including heart failure. Methods: An institutional database of 478 patients with histologically confirmed hormone receptor positive breast cancer diagnosed between 01/01/2014 to 12/31/2017 was reviewed after IRB approval. Preexisting CVD included coronary artery disease (CAD), history of myocardial infarction (MI), and prior diagnosis of heart failure (HF). Patients were divided in groups depending on treatment with endocrine therapy and underlying CVD. Statistical analysis was performed with SAS v9.4. software. Survival curves were estimated using Kaplan-Meier methodology and analyzed with a log rank test. Predictors of survival were assessed with Cox proportional hazards regression analyses. All significance was assumed at the p < 0.05 level. Results: Of 478 patients who met the inclusion criteria, 336 (70%) patients were postmenopausal. Out of those 336 patients, 62.2 % (n = 209) received at least one of the endocrine therapies consisting of AI, SERM or an ERB. Of these patients, 2.9 % (n = 6), 9.6% (n = 20) and 5.7% (n = 12) had a significant medical history of underlying MI, HF and CAD, respectively. Survival analysis was performed on 80% (n = 168) patients of the 209 patients with 2.3% (n = 4), 8.9% (n = 15) and 5.2% (n = 11) with underlying MI, HF and CAD respectively. There was no statistically significant difference in survival in these postmenopausal women who received endocrine therapy despite preexisting cardiovascular disease (HR 3; 95% CI, 0.5-16, p > 0.05). Conclusions: A commonly known toxicity related to the adjuvant therapy including endocrine therapy of breast cancer is cardiac toxicity. Patients with history of CVD might be at the highest risk for such toxicity. Our finding is reassuring that endocrine therapy in patients with preexisting CVD including heart failure did not result in reduced survival for our patient cohort.

INTRODUCTION:In 2019, the second most common malignancy in the United States was lung cancer.Squamous cell carcinoma accounts for approximately 25% of non-small cell lung cancers.Until recently those with advanced squamous cell carcinoma were predominantly being treated with cytotoxic chemotherapy alone; however, with the advent of immune checkpoint inhibitors we are seeing improved overall survival.While immunotherapies have improved survival, significant adverse events may limit their use. CASE PRESENTATION:A 67-year-old male presented with left lower extremity pain for 2 weeks with radiation down his left hip.He had seen a chiropractor who obtained magnetic resonance imaging of the left lower extremity.His social history was notable for a 50-pack year smoking history and reportedly quit about 5 years ago.Physical examination was remarkable for anterolateral hip pain which was exacerbated with palpation and passive movement of the limb.Magnetic resonance imaging (MRI) of the left lower extremity revealed a 4 x 4 x 5 cm marrow-replacing lesion of the intertrochanteric left femur with extensive marrow edema.Pertinent diagnostic testing included computed tomography (CT) of the torso, a whole-body bone scan, and a bone marrow biopsy of the osseous lesion.CT of the chest revealed a 6.4 x 5.3 cm mass in the left upper lobe extending into the upper pole of the left hilum.Bone scan was remarkable for increased radiotracer uptake within the proximal left femur involving the femoral neck and intertrochanteric region.Pathology of the left femur returned for metastatic squamous cell carcinoma with positive PD-L1 marker (80% expression).The patient underwent a left total hip arthroplasty which confirmed the diagnosis as well.Brain MRI was unremarkable for metastasis.Patient received 6 cycles of paclitaxel, carboplatin plus pembrolizumab.Posttreatment CT of the chest revealed reduction of the left upper lobe malignancy to 1.8 x 1.0 cm.After completion of 6 cycles of chemotherapy, the patient reported weakness, fatigue, and weight gain.Thyroid function tests confirmed diagnosis of hypothyroidism, and he was started on levothyroxine.DISCUSSION: Immune-related adverse events are emerging with the use of immune checkpoint inhibitors in various cancers.Hypophysitis and thyroid dysfunction are the most common endocrinopathies identified.However, there is limited literature indicating how frequently endocrine organs should be monitored.Thyroid dysfunction can develop variably during therapy and thyroid function tests should be obtained consistently throughout therapy. CONCLUSIONS:The use of immune checkpoint inhibitors increases the risk of immune-related adverse events.One should closely monitor thyroid function tests to prevent early-onset drug-induced thyroiditis, leading to permanent hypothyroidism.

Blastomycosis is a systemic fungal infection which primarily involves the lungs but can disseminate to involve extrapulmonary sites. Current testing that exists includes sputum, urine, serum, and pathological tissue analysis. Radiological testing is often non-specific and highly variable. Here we present five cases of pulmonary blastomycosis with challenging radiographic presentations.

e13635 Background: Approximately 40% of females over the age of 65 are newly diagnosed with breast cancer. When considering elderly patients with breast cancer ( > 65 years old), complex decision making is required as patients have multiple cardiac comorbidities that may confound treatment goals. In this abstract, we aim to identify survival and cardiac outcomes in elderly individuals. Methods: This study was conducted using a retrospective cohort design with use electronic patient records. ICD diagnoses codes were used to identify breast cancer patients. Our initial search criteria revealed 1618 patients. Our eligibility criteria included adult patients 18 years and older with newly diagnosed breast cancer from January 1st, 2014 – January 31st, 2017 which yielded 478 patients. All data was collected through retrospective chart review. Analysis was performed with SAS v9.4 software. Qualitative variables were analyzed using Chi-Square Test. Survival curves are estimated using Kaplan-Meier methodology and analyzed with a log rank test. Predictors of survival are assessed with Cox proportional hazards regression analyses. All significance was assumed at the p < 0.05 level and reported as hazard ratios (HR). Results: Of our 478 breast cancer patients, 260 (59.5%) patients were less than age 65 and 177 (40.5%) patients were older than age 65. Of these two age groups, cardiac events including new diagnosis of heart failure (HF), heart failure (HF) hospitalization, and acute coronary syndrome were studied. For patients with age less than 65: n = 11 for new diagnoses of HF, n = 4 for HF hospitalizations, and n = 3 for ACS. For patients with age greater than 65: n = 5 for new diagnoses of HF, n = 3 for HF hospitalizations, and n = 2 for ACS. Comparing these two groups, there was no statistically significant cardiac event (p = > 0.05). Comparing survival among these two age groups also did not yield statistically significant results (p > 0.05). Conclusions: Per our data, it appears that there is no statistically significant difference in cardiac outcomes in different age groups for patients with breast cancer. Additionally, there was no difference in mortality among different age groups with breast cancer patients. Further prospective studies should be performed to confirm trends of mortality.