Introduction: Aortic Stenosis (AS) is increasingly recognized as one of the underdiagnosed manifestations of cardiac amyloidosis (CA) and existing literature shows conflicting evidence on the impact of CA on AS. Methods: A retrospective analysis of 2016-2019 NIS was conducted to identify hospitalizations (Age≥18) who underwent TAVR using ICD-10 codes. Existing literature was reviewed to select variables before conducting a univariate screen and balancing between groups with CA vs without CA. Propensity score weights were generated using Doubly robust estimation, and IPTW matching was done. The ATET was calculated by extrapolating propensity weights and using weighted multivariate analysis. Results: Out of 227,200 TAVR, only 245 (1.1%) had a concomitant diagnosis of CA. Hospitalizations with CA had a mean age of 80.49, 71.43% males, 82.98% white, 12.77% black, and others. Analysis total of 3,205 deaths, CA was associated with lower odds of mortality (OR 0.25, p 0.00). Factors associated with increased mortality in TAVR were age, HTN, low household income, elixhauser comorbidity index, mechanical vent >24 hrs, Shock on pressors/device, Pericardial effusion/tamponade, AKI, ESRD on HD, and Acute stroke. Out of 17,590 pacemakers (PPM) implantations, CA was associated with lower odds of getting a PPM (OR 0.13, P 0.00). Factors increasing the risk of getting a PPM were high degree AV block, age, male sex, DM, and ventricular arrhythmias. A total of 4280 acute strokes occurred, and CA was not associated with increased risk following TAVR (OR 0.46, p 0.38). Factors increasing the acute stroke risk after TAVR were age, mechanical vent >24hrs, and anemia. 3460 valve complications occurred, and CA was not associated with increased risk (paravalvular leak, displacement, infection, breakdown, and others) (OR 10.20, p 0.16). A significant risk factor for valve complications after TAVR was the presence of pericardial effusion/tamponade. Conclusions: The presence of CA does not result in poor outcomes in TAVR. Limitations of our study are a small sample, retrospective analysis, and lack of cardiac imaging data. Further studies that eliminate our study's limitations are required to conclusively evaluate the impact of CA in patients who undergo TAVR.

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Apical ballooning syndrome (ABS), also known as Takotsubo cardiomyopathy, is a form of acute dilated cardiomyopathy associated with excessive catecholamine release. A 74-year-old female, chronic smoker with previously diagnosis of obstructive lung disease presented in the emergency department with severe shortness of breath and increase sputum production for the last 24hr. The patient was diagnosed with severe COPD exacerbation and received multiple doses of albuterol, methylprednisolone, ipratropium bromide/albuterol, and azithromycin. Despite this, the patient remained tachypneic and tachycardic with signs of impending respiratory failure. She was transferred to the ICU and intubated. After intubation, the patient received a continuous albuterol nebulizer, methylprednisolone, and ceftriaxone. A few hours later, the patient complained of chest pain, and EKG was done showing T wave inversion in lateral leads, troponin levels were 1.08 ng/mL (ULN 0.12ng/mL), and 2D Echo showed EF 50-55%, apical ballooning with dyskinesia, and inferior wall hypokinesis. Left heart catheterization showed non-obstructive coronary artery disease with 50% stenosis on the left anterior descending artery and distal ostial artery. Based on the previously recommended criteria, the diagnosis of the ABS was made. The patient had resolution of symptoms and echocardiogram findings after follow up. Although albuterol acts mainly on beta-2 receptors, cross-activation of beta-1 receptors can potentially lead to tachycardia. Previous case reports also support that excessive albuterol use in cases of asthma and COPD exacerbation may lead to ABS. This case may raise awareness that the extensive use of albuterol could have dramatic effects. Early switch to beta-2 agonist with higher specificity such as levalbuterol could be a reasonable approach in patients with severe COPD exacerbation.

Introduction: Limited data exist on the in-hospital and readmission outcomes in sarcoidosis patients after surgical or transcatheter aortic valve replacement (SAVR/TAVR). Hypothesis: Sarcoidosis can lead to cardiac conduction abnormalities and cardiomyopathy which can lead to poor outcomes after aortic valve intervention (AVI). We hypothesize that SAVR/TAVR in sarcoidosis patients has the worst outcomes. Methods: The NRD was queried for all sarcoidosis patients who underwent SAVR/TAVR from 2016-2019. Our outcomes of interest were in-hospital mortality, in-hospital complications, and 30-day readmissions for heart failure and pacemaker implantation. Clinical outcomes were modeled using logistic regression for binary outcomes and linear regression for continuous outcomes. Results: We identified a total of 507,441 SAVR/TAVR hospitalizations of which 1429 were of sarcoidosis patients. Patients with sarcoidosis were younger (mean age 70.1 years vs 72.4 years) and had more women (48.3% vs 38.2%, p<0.001). In-hospital mortality occurred in 35 (2.5%) patients with sarcoidosis and in 13,367 (2.6%) patients without sarcoidosis. After SAVR/TAVR, the risk of in-hospital mortality in sarcoidosis patients was similar to patients without sarcoidosis (OR: 0.86, 95% CI 0.50 - 1.48, p = 0.58). Risks of stroke, cardiogenic shock, pacemaker implantation, paravalvular leak, AKI requiring dialysis, hemorrhage requiring transfusion, cardiorespiratory complications, need for cardiothoracic procedures, 30-day heart failure and pacemaker implantation readmissions were also similar in patients with and without sarcoidosis. Conclusions: Sarcoidosis is not associated with an increased risk of in-hospital mortality, in-hospital complications and 30-day readmissions for heart failure and pacemaker implantation. Thus, AVI is possibly not futile in sarcoidosis patients and future studies are necessary to understand the benefits of AVI in these patients.