bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 18863: Clinical Assessment of Volume Status in Heart Failure is Inaccurate at Detecting Hypervolemia and Anemia as Quantified by Blood Volume Measurement
Authors: Joseph Jacob , Nguyen Wendy , MURRAY KAREN , Kohl Noa , Bart Bradley , Feldschuh Jonathan
Published: December 2023

Introduction:
Blood volume status is a crucial input for care decisions, especially the use of diuretics for decongestion, in acute decompensated heart failure (ADHF). In the absence of direct measurements, total blood volume (TBV) status is typically measured via clinical assessment of external fluid overload (edema, jugular venous distension, etc.), and red blood cell volume (RBCV) is assessed via hematocrit. A recent retrospective analysis showed that direct blood volume assessment (BVA) leads to better outcomes in ADHF.

Hypothesis:
We hypothesize that BVA-guided ADHF care can be protocolized and integrated into clinical workflow of ADHF management.

Methods:
The objective of this study is to prospectively compare the efficacy of standard care treatment decisions to those in a BVA-guided fluid management protocol. ADHF patients admitted to a Veterans Affairs Medical Center were randomized to either a control (n=8) or BVA-guided (n=8) arm. TBV, plasma volume (PV) and RBCV were measured at admission and prior to discharge by BVA utilizing an I-131 labeled albumin indicator-dilution technique (Daxor BVA-100). Clinician assessments of volume status were collected for all patients prior to BVA measurement. TBV status was defined relative to patient norms as: Hypovolemic (< -10%), Euvolemic (-10% to +10%), Hypervolemic (> +10%). RBCV status was defined as Anemic (< -10%) Not Anemic (> -10%).

Results:
Measured volume status at admission was quite heterogeneous, with 62.5% Anemic, and with 37.5% Hypovolemic, 31.25% Euvolemic, and 31.25% Hypervolemic. Clinical assessment at admission was notably inaccurate, with only 56% accuracy (sensitivity 40%, specificity 83%) on the presence of anemia, and only 31% accuracy on the presence of hypervolemia, with 94% of patients assessed by clinicians as hypervolemic. Non-hypervolemic patients in the BVA-Guided group received less diuretic treatment than non-hypervolemic controls.

Conclusions:
We successfully embedded a BVA guided treatment protocol into the clinical workflow of ADHF management at a large medical center. Clinical assessment of volume status was less accurate that direct BVA. Future studies will address whether BVA guided treatment leads to better outcomes in ADHF.
Abstract 18867: A Novel Light-Sensitive Ex-Vivo Rat Atrial Anatomical Model for Studying Atrial Arrhythmias and Cardioversion
Authors: Glatstein Shany , Ghiringhelli Matteo , wexler yehuda , Haimovich-Caspi Lilac , Huber Irit , Gepstein Lior
Published: December 2023

Introduction:
Atrial arrhythmias, including atrial fibrillation (AF), contribute to significant morbidity and mortality. However, the lack of suitable tissue models in small animals hampers our understanding of the underlying mechanisms. Optogenetic actuators offer precise and reversible stimulation with high spatiotemporal resolution, presenting a unique opportunity to investigate atrial arrhythmias.

Hypothesis:
Our aim was to develop a light-sensitive ex-vivo anatomical model in rats for studying atrial arrhythmias and to utilize this model for optimizing optogenetic stimulation and cardioversion strategies.

Methods:
We injected purified AAV particles containing the transgenic light-sensitive channel (CoChR) into 5-day-old Wistar rats, followed by an 8-10 week period for atrial growth. The atria were then isolated, flattened, and affixed to a custom-made silicon plate. Superfusion with oxygenated Tyrode's solution and loading with Di-4-ANBDQBS allowed for high-resolution optical mapping. Atrial arrhythmias were induced through targeted tachypacing combined with carbamylcholine treatment. Additionally, we compared different optical and pharmacological treatment strategies to evaluate their efficacy in modulating atrial arrhythmias.

Results:
Immunostaining confirmed atrial expression of CoChR. Optical mapping revealed a functional syncytium with sinus node activation and propagation throughout the atria. Pacing at increasing frequencies resulted in a relatively flattened action potential duration restitution curve. Successful induction of reentrant arrhythmias was achieved. Additionally, we demonstrated the feasibility of optogenetic actuators for atrial pacing, modulation of spontaneous activity, and optical termination of arrhythmias.

Conclusions:
The developed optogenetic superfused atria model provides a valuable platform for studying atrial electrophysiology and modeling reentrant arrhythmias. Furthermore, it enables the optimization of optogenetic stimulation and cardioversion strategies. This integrated approach enhances our understanding of atrial arrhythmias and holds promise for the development of novel therapeutic interventions.
Abstract 18873: Microvascular Calcification Varies Across Brain Regions in Humans With and Without Dementia at Death
Authors: BORGES KELLY A , Aabye Joseph D , Romano Isabella , Lombardi Isabelle , Sivilli Mackenzie , Savinova Olga V
Published: December 2023

Background:
Vascular calcification (VC) is an independent predictor of cardiovascular and cerebrovascular events. While the clinical significance of coronary VC is well recognized, less is known about the prevalence and implications of VC in brain microcirculation.

Aims:
In this exploratory study, we aimed to compare calcification volume (CV) across brain regions in subjects with and without dementia documented at death.

Methods:
In a cohort of human donor cadavers (n=14, 57% female, all >70 y/o), brain tissue was sampled bilaterally from basal ganglia (BG), substantia nigra (SN), subventricular zone (SVZ), hippocampus (Hc), and posterior cingulate cortex (PCC), and scanned by microCT at 10 μm resolution. Reconstructed images were segmented into standardized regions of interest (ROI). CV was defined as voxel quantity ≥130 Hounsfield units within each ROI. Findings were confirmed by histologic evaluation.

Results:
By two-way ANOVA, CV differed significantly by region (p=0.0006) and condition (p=0.0104). Hc and PCC CVs were significantly greater in subjects with dementia compared to age-matched subjects (9.3х10e7 μm
3
vs 1.4х10e7μm
3
, p=0.007; 2.6х10e7 μm
3
vs 4.7х10e6 μm
3
, p=0.017).

Conclusions:
All subjects in our cohort exhibited VC in at least one brain region, indicating that the prevalence of intracranial VC exceeds published estimates. Subjects with dementia exhibited significantly higher Hc and PCC CVs than age-matched subjects without documented dementia. Although limited by small sample size, our findings support recent reports of hippocampal and BG calcification in post-mortem brain samples from humans with Alzheimer disease.
Abstract 18897: Safety and Efficacy of Coronary Intravascular Lithotripsy for Percutaneous Coronary Intervention of Severely Calcified Left Main Stenosis
Authors: Chhikara Sanya , Kumar Mahesh N , Shrivastava Abhinav , Gupta Ankush
Published: December 2023

Introduction:
Coronary Intravascular Lithotripsy has been shown to be a safe and effective modality for the modification of non-left main calcific stenosis. This study was done to evaluate the safety and efficacy of IVL during percutaneous coronary intervention (PCI) of severely calcified left main (LM) bifurcation disease.

Methods:
This was a prospective, single-arm observational study in which 22 patients with significant calcific LM bifurcation disease undergoing angioplasty were enrolled. Pre and Post-IVL Optical coherence tomography (OCT) was done in all patients as an imaging modality. The primary safety end-point was peri-procedure complications and freedom from major adverse cardiovascular events (MACE) defined as cardiac death, non-fatal MI, and target vessel revascularization at 30 days, and the primary efficacy endpoint was stent expansion of more than 80% in stratified stented segment. The secondary efficacy endpoint was mean stent area more than the accepted target value of 5.0 mm
2
, 6.3 mm
2
, and 8.2 mm
2
for the ostial LCX, ostial LAD, and distal LM, respectively.

Results:
15 (68.2%) patients underwent LM bifurcation angioplasty using provisional strategy and 7(31.81%) using upfront two stent strategy (DKC 22.7% & TAP 9.1%). A total of 55 Ca lesions were modified using one IVL per patient with a mean size of 3.38 ± 0.40mm. Stent expansion at LM was 95.64±5.89%, left anterior descending (LAD) was 87.20±6.81% and left circumflex (LCx) was 85.56±5.89%. The primary efficacy endpoint of more than 80% stent expansion was noticed in all LM segments (22/22), 18/20 (90%) LAD segments, and 9/9 LCX segments. The primary safety endpoints were met in 21 (95.45%) patients undergoing IVL-assisted distal LM bifurcation angioplasty. Target MSAs were achieved in all 22 (100%) of all IVL-treated segments, and stent apposition was achieved in 21 (95%) of all stented segments. No perforation (0%) or slow/no flow (0%) were observed, while minor 3 (13.6%) and major dissections 3 (13.6%) were seen. None of the major dissections were flow-limiting.

Conclusions:
IVL appears to be a safe and effective device for percutaneous coronary intervention of severely calcific LM disease with a high success rate.
Abstract 18901: Critical Role of Endothelial Injury in the Initiation of Aortic Dissection
Authors: Zhang Chen , Zhang Lin , Devkota Laxman , Li Yanming , Deborah Vela , Li Yang , Chakraborty Abhijit , Rebello Kimberly , Xu Samantha , Vasquez Hernan G , Ghaghada Ketankumar B , Lemaire Scott A , Shen Ying H
Published: December 2023

Introduction:
Endothelium forms a protective barrier and maintains vascular hemostasis. However, the role of endothelial injury in aortic aneurysms and dissections (AAD) remains poorly understood. Receptor-interacting protein kinase 3 (RIP3)-mediated necroptosis and gasdermin D (GSDMD)-mediated pyroptosis trigger necrotic cell death. We hypothesize endothelial cell (EC) death induced by necroptosis and pyroptosis contributes to AAD formation.

Methods:
Endothelial integrity and gene expression were examined in ascending aortic tissues from ascending thoracic aortic aneurysm (ATAA) patients (n=9) and organ donor controls (n=8) by single-cell transcriptome analysis. Effects of EC death on AAD formation were determined in EC-specific Rip3 knockout (EC-Rip3
-/-
, n=26), EC-specific Gsdmd knockout (EC-Gsdmd
-/-
, n=21), and necroptosis/pyroptosis inhibitor necrosulfonamide (NSA) treated mice (n=15) in sporadic AAD models induced by angiotensin II (Ang II) infusion. Evans blue staining and nanoparticle-mediated contrast-enhanced CT (n-CECT) detected endothelial hyperpermeability

Results:
Single-cell transcriptome and immunostaining analyses revealed significant upregulation of pro-death genes (e.g., RIP3 and GSDMD), but downregulation of cell junction genes (e.g., TJP1 and GJA1) in ECs of ATAA patients compared with controls. In the mouse AAD model, endothelial injury and hyperpermeability were detected 2-5 days after Ang II infusion and were associated with intramural nanoparticle accumulation, elastic fiber fragmentation, and macrophage infiltration. Importantly, EC-Rip3
-/-
mice and EC-Gsdmd
-/-
mice showed preserved EC barrier function, reduced nanoparticle accumulation and elastic fiber fragmentation, and reduced AAD incidence (including aneurysm, dissection, and rupture) compared to their littermate controls (EC-Rip3
-/-
mice: 52% vs 23.1%, P=0.033; EC-Gsdmd
-/-
mice: 52.6% vs 14.3%, P=0.01). Blocking necroptosis/pyroptosis by NSA treatment reduced the incidence (65% vs 27%; P=0.04) and severity of AAD.

Conclusions:
Endothelial injury and subsequent barrier dysfunction and infiltration are key features of AAD formation. Prevention of EC necrotic cell death can be a potential AAD therapeutic target.
Abstract 18916: Myocardial Proteomic Signatures in Human Heart Failure With Preserved Ejection Fraction
Authors: Jani Vivek , Yoo Edwin J , Kass David A , Hahn Virginia S
Published: December 2023

Introduction:
Heart Failure with Preserved Ejection Fraction (HFpEF) constitutes more than half of all heart failure but has few effective therapies. Recent myocardial transcriptomics and metabolomics have revealed major differences between HFpEF and controls and HF with a reduced ejection fraction (HFrEF); however, how this translates at the protein level is unknown.

Methods:
Endomyocardial biopsies from patients with HFpEF, nonfailing donor controls and analyzed by data-dependent (n=10 HFpEF, n=9 non-failing controls) and data-independent (n=44 HFpEF, n=5 non-failing controls) mass-spectrometry-based proteomics.

Results:
The results were integrated with reported RNAseq and clinical characteristics. Proteomics data were analyzed with machine learning and gene ontology (GO) pathway analysis. Both HFpEF and HFrEF proteomes exhibited remarkable similarities, showing upregulation of cytoskeletal pathways and down regulation of oxidative phosphorylation pathways. Notably, structural ribosomal proteins and proteins associated with EIF
2
signaling were downregulated in HFpEF but not HFrEF. Integration with prior transcriptome data found a striking discrepancy between gene (up) and protein (down) expression for oxidative phosphorylation pathways in HFpEF, versus concordant reduction in HFrEF. Agnostic clustering of the HFpEF proteome identified two sub-groups, one with marked downregulation of oxidative phosphorylation and translational initiation pathways versus the other. This sub-group also had the highest proportion of HFpEF patients above the median BMI (40 kg/m
2
in our cohort).

Conclusions:
To our surprise, no hemodynamic and echocardiographic differences were observed between these groups. Despite marked differences in clinical presentation and pathophysiology, both HFpEF and HFrEF had very similar changes in protein abundance related to cytoskeletal and oxidative phosphorylation related pathways. Integration of proteomics, transcriptomics, and pathway analysis identifies a major deficit in protein translation in HFpEF that is not predictable based on clinical indices. These data reveal a unique proteomic HFpEF signature and identify potential proteins and pathways for therapeutic intervention.
Abstract 18925: Hypertension Predicts Polycystic Kidney Disease 11 Years Ahead of Time in PKD1 and PKD2 Carriers, With a PPV of 71%
Authors: Telis Natalie , McEwen Lisa , Bolze Alexandre , Judge Daniel , Pawloski Pamala , Grzymski Joseph , Schiabor Barrett Kelly , Washington Nicole , Cirulli Elizabeth
Published: December 2023

Introduction:
Autosomal dominant polycystic kidney disease (ADPKD) is the leading hereditary form of kidney disease and is characterized by the formation of fluid-filled cysts that decrease kidney function and lead to complications including cardiovascular disease, kidney failure, and other organ failure. Although causal variants in the PKD1 and PKD2 genes have been identified, penetrance, morbidity, and outcome are known to vary widely in carriers. We propose to identify early markers of disease and to characterize disease presentation at the level of biomarkers, metabolites, and comorbidity incidence.

Methods:
This study is based on exomes and medical information from the UK Biobank (n=470k) and 3 American cohorts (n>70k) sequenced with Helix: the Healthy Nevada Project, In Our DNA SC, and myGenetics. We identified individuals with rare LoF variants in either PKD1 or PKD2. We subsequently analyzed these individuals’ medical records, blood labs, and NMR-based metabolomics data (n~120k) to characterize the detailed clinical and biomarker-level disease presentation.

Results:
We find that 0.05% of the general population has a relevant variant in PKD1 or PKD2 (1/2000 people). In this population-level sample, the prevalence of kidney disease in carriers with hypertension is 71% (74% for PKD1 and 66% for PKD2) compared to 12% for noncarriers with hypertension. For carriers without hypertension, the prevalence is 14% (2% for PKD1 and 30% for PKD2) vs. 1% for noncarriers without hypertension. Importantly, the hypertension diagnosis precedes the kidney disease diagnosis by a mean of 11 years in these carriers. We additionally identify a subset of carriers who are outliers for a set of metabolites that includes cystatin C, creatinine and urea. Assessed prospectively, these carriers have decreased eGFR and a number of other signs of early stage kidney disease a mean of 5 years prior to their KD diagnosis.

Conclusion:
Identifying PKD1 and PKD2 carriers with hypertension would allow prediction of kidney disease a mean of 11 years in advance of the disease, with a PPV of 71%. Additionally, aberrant but subclinically significant biomarkers can provide an early warning of morbidity.
Abstract 18938: Identification and Diagnosis of Culprit Lesions by Optical Coherence Tomography (OCT) in Patients With Non-ST Elevated Acute Coronary Syndromes
Authors: Zainab Alina , Younus Shifa , Jumani Laraib , Gulraiz Azouba , Neelam FNU , Mehmood Saad , Raza Samina
Published: December 2023

Introduction and Hypothesis:
Optical coherence tomography (OCT) is a reliable imaging modality for plaque characterization in patients with acute coronary syndromes (ACS). While numerous studies have provided insight into the utility of OCT in ST-elevated ACS patients, our study sought to evaluate the frequency and morphological characters of lesions in patients with non-ST elevated acute coronary syndromes (Unstable angina (UA) and Non-ST elevated myocardial infarction (NSTEMI)).

Methods:
This multi-center, observational study included 170 patients admitted with a working diagnosis of NST-elevated ACS from October 2021 to January 2023. OCT imaging was obtained during coronary angioplasty for lesion characterization and morphology. Frequencies were compared between UA and NSTEMI sub-groups.

Results:
OCT imaging in patients with non-ST elevated acute coronary syndromes showed plaque erosion in 46% (n= 78), plaque rupture in 35% (n= 60), tight stenosis in 13% (n= 22), and calcified nodules in 6% (n= 10). Sub-group comparative analysis showed a statistically significant increase in plaque erosion in NSTEMI compared to UA (p<0.005), while tight stenosis was significantly more common in UA (p=0.017). Morphological analysis showed a high presence of calcified nodules and red thrombus in NSTEMI patients compared to UA patients (p<0.005).

Conclusions:
Our study concluded that optical coherence tomography is reliable in identifying and characterizing lesions in patients with non-ST elevated ACS. NSTEMI patients have a higher occurrence of plaque erosion, plaque rupture, calcified nodules, and red thrombus than patients with unstable angina.
Abstract 18981: Regional Variation in Inpatient Hospital Resources Utilized in Cardiac Surgery Performed in Children
Authors: Chowdhury Devyani , Gauvreau Kimberlee , Ather Mishaal , Gray Darryl T , Jenkins Kathy J
Published: December 2023

Introduction:
Care for congenital heart disease is highly resource-intensive due to its complexity, and due to patients’ need for surgery and other inpatient care. Understanding regional variation in resource utilization for cardiac surgical care can promote collaborative learning opportunities that could help optimize resources for patient-centered care.

Methods:
This cross-sectional analysis used the nationally representative 2012 Kids’ Inpatient Database, managed by the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. Based on International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes, we identified hospital discharges of cardiac surgery patients under 18 years of age. We excluded patients undergoing cardiac transplantation and newborns under 31 days of age who only underwent ligation of isolated patent ductus arteriosus. Included cases were aggregated based on the nine US geographic divisions used by the US Census Bureau. Regional variation in observed inpatient billed charges, estimated hospital costs based on cost-to-charge ratios and inpatient length of stay (LOS) were analyzed. The log transformed outcomes were compared unadjusted, and after adjusting for RACHS-1 inpatient surgical mortality risk, admission type, expected primary payer and coded complications (as appropriate).

Results:
Among 15,350 analyzed discharges, the mean nationwide adjusted in-hospital mortality was 3%. It was highest in East South Central (5%). However, the differences among divisions were not significant for all RACHS-1 categories. Mean adjusted complications frequencies ranged from 21 to 32%.LOS showed only minor variations across divisions. Median billed hospital charges ranged from $93,869 to $226,061. For all RACHS-1 categories, New England (lowest) and East North Central had significantly lower charges than did the Mid-Atlantic division. Estimated costs were significantly lower than charges, ranging from $44,402 to $66,726 across all divisions. Costs were lowest in the Mid-Atlantic division.

Conclusions:
There is regional variation in resource utilization in cardiac surgical care for CHD with no observed correlation with LOS, case mix or complications.
Abstract 18998: Deletion of the Duffy Antigen Receptor for Chemokines Impairs Blood Flow Recovery in the Mouse Hindlimb Ischemia Model: Role of CCL11
Authors: Aboud Ghaith , Harb Ragheb , Kim David , Goo Brandee , OGBI Mourad , Veerapaneni Praneet , Chouhaita Ronnie , Coffey Philip , Lee Richard , Hou Yali , Guha Avirup , Shi Hong , Ushio-Fukai Masuko , Annex Brian H , Kim Ha Won , Weintraub Neal L
Published: December 2023

Introduction:
Peripheral Artery Disease (PAD) is characterized by obstruction of the arteries in the lower extremities. Impaired angiogenesis plays a major role in the progression of PAD. Pro-angiogenic and anti-angiogenic chemokines are modulated by binding to the Duffy antigen receptor for chemokines (DARC), a non-signaling receptor expressed primarily on erythrocytes. Incidence and severity of PAD is greater in Blacks, ~70% of whom do not express DARC on their erythrocytes due to a common gene variant. Here, we tested the hypothesis that hematopoietic-specific deletion of DARC impairs blood flow recovery in mouse hindlimb ischemia model.

Methods:
Twelve week old female DARC Flox/Vav1-Cre+ (DARC
HKO
) and littermate Vav1-Cre- (wild type, WT) mice underwent unilateral femoral artery ligation and excision. Ischemic muscle tissue and plasma were analyzed at early ischemic phase (day three post ligation) and late ischemic phase (day fourteen post ligation). Blood flow recovery was measured weekly via laser Doppler imaging.

Results:
DARC
HKO
mice had poor blood flow recovery compared to WT mice (p<0.05), along with reduced capillary formation and increased inflammation, necrosis and fibrosis in the ischemic gastrocnemius muscles. Amongst the various DARC-bound chemokines assayed, levels of CCL11 (a pro-angiogenic strong DARC-bound chemokine) were significantly reduced in the plasma of DARC
HKO
mice, both at early and late ischemic phases (p<0.01). CCL11 levels strongly correlated with capillary formation in ischemic hindlimb. CCL11 levels in ischemic muscle tissue were significantly reduced in the DARC
HKO
mice in the early, but not late, ischemic phase.

Conclusions:
Loss of DARC on hematopoietic cells has a negative impact on the recovery of perfusion and angiogenesis in the murine hindlimb ischemia model, possibly due to reduced levels of CCL11 consequent to DARC deletion. These findings may be relevant to ethnic differences in susceptibility to PAD and suggest that therapies directed towards increasing CCL11 may be beneficial in Blacks with PAD.
Abstract 19028: Revascularization in Ischemic Cardiomyopathy With Left Ventricular Systolic Dysfunction- Percutaneous Intervention (PCI) vs Medical Therapy
Authors: Mathew Kalathil Ruth ann , Machanahalli Balakrishna Akshay , Pusapati Suma , Aboeata Ahmed
Published: December 2023

Background:
The benefits of percutaneous revascularization in patients with reduced Left Ventricular (LV) systolic function secondary to stable coronary artery disease (CAD) is still ambiguous. We aim to compare the survival benefits of PCI in patients with Ischemic cardiomyopathy with reduced LV Ejection Fraction (LVEF <35%) compared to Medical Therapy (MT) alone.

Methods:
A systematic search was conducted in PubMed, Google Scholar, and Cochrane databases from inception to 5
th
June 2023. Among 108 results from the systematic search, a total of 4 studies (2080 patients) were included. Our outcome of interest was all-cause mortality in patients undergoing PCI vs. medical therapy. We used random-effects models to aggregate data and to calculate pooled incidence and relative risk (RR) with 95% confidence intervals (CIs).

Results:
Of 1082 patients undergoing revascularization with PCI and 998 patients in the medical therapy arm, the outcome of all-cause mortality occurred in 168 patients (15.5%) in the PCI group and in 200 patients (20.0%) in the medical therapy group (Hazard ratio, 0.88; 95% confidence interval [CI], 0.71 to 1.09; P=0.25). However, a non-statistical trend toward lower mortality was noted in the PCI arm. Low heterogenicity was noted between the studies.

Conclusions:
In patients with ischemic cardiomyopathy with reduced LV systolic function (EF <35%), revascularization with PCI is associated with similar all-cause mortality compared to medical therapy.
Abstract 19038: Insights of Optical Coherence Tomography Into the Safety and Efficacy of Coronary Intravascular Lithotripsy for Calcified Nodule Modification During Percutaneous Coronary Intervention
Authors: Chhikara Sanya , Kumar Mahesh N , Shrivastava Abhinav , Gupta Ankush
Published: December 2023

Background:
Among calcified lesions, nodular calcium is the most challenging subset to deal with during percutaneous coronary intervention (PCI), as there are limited options available for its modification. This study was done to assess the safety, efficacy and impact of coronary intravascular lithotripsy (IVL) on calcified nodule (CN) using optical coherence tomography (OCT).

Methods:
A total of 17 patients with 40 CN undergoing PCI using coronary intravascular lithotripsy were prospectively enrolled in the study. OCT parameters studied were pre-IVL minimum lumen area (MLA), calcium (Ca) score, number of CN, proximal and distal reference diameter, post-IVL gain in MLA, calcium fracture, major dissection, post-PCI minimum stent area (MSA), stent expansion, apposition, edge dissection and spherical index at CN. Spherical index was calculated by dividing the shortest and longest diameter at CN after stent placement. The primary safety endpoint was freedom from major adverse cardiovascular events (death, MI and target vessel revascularization) during hospitalisation and at 30 days. Primary efficacy endpoints were gain in MLA after stent placement and stent expansion.

Results:
Pre-IVL mean MLA at CN was 3.87±2.25mm
2
, Ca score was 3.94±0.24, Ca arc 190.59±54.02
o
, Ca depth 0.97±0.31mm, Ca length 22.73±9.87mm and CN height-1.04±0.30 mm. All 17 (100%) patients developed Ca fractures, post-IVL MLA at CN was 5.20±2.31mm
2
, CN height 0.83±0.19mm and luminal gain at CN was 0.76 ± 1.71mm
2
. 10 (58.8%) patients developed fractures at base of CN and rest developed fractures at apex. Patients with fractures at base showed decrease in luminal area after IVL due to luminal shift of nodule, but all these patients had good stent expansion, likely due to Ca softening. Post-IVL OCT showed minor dissections in 5 (29.4%) and major in 3 (17.6%) patients. There was no perforation, slow flow or abrupt vessel closure. Stent expansion and MSA at CN was 107.12 ± 18.98% and 8.57±2.54 mm
2
respectively with spherical index of 0.83±0.12. All patients were free of MACE during hospitalization and at 30 days.

Conclusion:
Coronary intravascular lithotripsy is safe and effective for modification of coronary calcified nodules during percutaneous coronary intervention.
Abstract 19045: Detection of Left Ventricular Systolic Dysfunction From PDF Outputs of ECGs Obtained on Wearable Devices
Authors: Sangha Veer , Khunte Akshay , Dhingra Lovedeep S , Oikonomou Evangelos K , Khera Rohan
Published: December 2023

Background:
Left Ventricular Systolic Dysfunction (LVSD) affects 5% of adults with available therapies, but most are diagnosed after the onset of symptoms. AI-ECG tools that detect LVSD from clinical ECGs are not suitable for community screening. Wearable devices offer broad access to ECGs but end users rely on PDF outputs of single-lead data, with limited access to underlying signal data.

Methods:
We simulated wearable PDF outputs from commercial wearable devices using lead I data from clinical 12-lead ECGs during 2015-2021. We selected the subset with echocardiography within 15 days of the ECG to define LVSD, based on LVEF < 40%. We developed a model to detect LVSD from wearable-adapted PDF outputs using an EfficientNet-B3 convolutional neural network with self-supervised pretraining. The model deployment pipeline was optimized to segment and process PDF outputs across all commercially available devices as inputs to the model (Fig A & B).

Results:
385,601 ECGs with paired echocardiograms were used for model development. In a held-out test set of 11,611 ECGs from unique patients (8.2% with LVEF < 40%) the model demonstrated high discrimination power for detection of LVSD with an AUROC of 0.88, AUPRC of 0.45, sensitivity 0.88, and specificity 0.72. An ECG suggestive of LVSD portended over 18-fold higher odds of LVSD in the held-out set (OR 18.3, 95% CI, 15.0-22.4). It also represents a digital biomarker in those with a false positive vs a true negative prediction at baseline, with a false positive assessment being associated with 3.6-fold (95% CI, 2.97-4.34) increased risk of developing incident LV systolic dysfunction in the future (Fig C).

Conclusions:
We developed and validated a deep learning model that can identify LVSD from PDF image outputs of wearable and handheld single-lead devices. This approach broadens access to screening for LVSD to anyone with access to a wearable device with ECG.
Abstract 19053: Peripheral Eosinophil Count is Associated With Left Ventricular Systolic Dysfunction During Spontaneous Coronary Artery Dissection
Authors: Lavelle Bianca J , Pawlowski Anna , Feinstein Matthew J
Published: December 2023

Background:
Spontaneous coronary artery dissection (SCAD) is an underdiagnosed condition disproportionally affecting young women, particularly during the peripartum period and/or in the presence of systemic inflammatory and autoimmune diseases. Tissue-level studies have demonstrated inflammatory infiltrates with adventitial or peri-adventitial eosinophilia at the site of SCAD lesions. Less is known regarding how systemic markers of immune activation associate with cardiac dysfunction in SCAD.

Hypotheses: Higher eosinophil count and Neutrophil-to-Lymphocyte Ratio (NLR) associate with LV systolic dysfunction in SCAD patients.

Methods:
In individuals diagnosed with SCAD who underwent CBC with differential and echocardiography within the same presenting hospital encounter, we performed age- and sex-adjusted logistic regressions with eosinophil count (% of differential) and NLR (% of differential) as primary exposures and LVEF<55% as the dichotomous endpoint. A p<0.05 was considered statistically significant. We explored associations of neutrophil, lymphocyte, monocyte, and basophil counts with LVEF in secondary analyses.

Results:
In SCAD patients with complete CBC and LVEF data (N=36; mean age 49.9 years at diagnosis, 28 female), peripheral eosinophil count was associated with significantly higher odds of systolic dysfunction [OR of LVEF<55% per every 1% higher eosinophil count = 1.87; 95% CI 1.04, 3.36; p=0.04]. NLR ratio was not associated with LV systolic dysfunction (OR 1.05; 95% CI 0.94, 1.18; p=0.35) nor were other circulating leukocyte fractions.

Conclusion:
Peripheral eosinophil count, but not other circulating leukocyte counts, was associated with LV systolic dysfunction as measured by LVEF <55%. These findings provide complementary support to pathology-based evidence of eosinophilia observed in SCAD lesions and require confirmation in future longitudinal studies of changes in LV function following SCAD events.
Abstract 19066: God Fixed It! A Case of Mitral Valve Prolapse
Authors: Bondi Gayatri , Gopal Shwetha , Zoltick Jerel M
Published: December 2023

Background
Mitral Valve prolapse (MVP) occurs in 1.2 to 3% of the population. Myxomatous degeneration is the most common cause of MVP in the United States. Clinical features range from asymptomatic to serious complications such as heart failure, endocarditis, arrhythmias, and sudden cardiac death. Patients with MVP may develop severe mitral regurgitation (MR) requiring surgery. We present a unique case of severe MR in a patient with MVP.

Case
A 67-year-old male with a history of Dysautonomia and Parkinson’s disease presented to the cardiology clinic with complaints of exertional dyspnea, lightheadedness, and palpitation. Transthoracic echo was obtained as part of the workup revealing ejection fraction>55%, Myxomatous Mitral Valve with significant prolapse of the posterior leaflet which was partially flail causing severe MR, regurgitant volume of 149 cc, and percentage of 69%. Cardiac catheterization showed normal coronaries. A transesophageal echo to evaluate the MR and surgical repair of the mitral valve was offered, but the patient refused surgery. He was later lost to follow-up. After 4 years, he presented to the clinic with some exertional dyspnea. Repeat echo revealed moderately calcified posterior leaflet with less mobility causing only moderate MR. His MR continued to improve, an echo after 5 years revealed increasing calcific changes involving posterior leaflet and chordal attachment, causing mild MR and mitral stenosis.

Discussion
Isolated MVP can develop degenerative MR in up to 25%, and 0.4 to 1.9% can suffer sudden cardiac death. Surgery is recommended for severe symptomatic MVP with MR and it is considered fatal if left unrepaired. In this case, the patient refused surgery and had an unusual natural history of valve calcification leading to decreased mobility, reduced prolapse, and converting severe MR into mild. To our knowledge, this is the first case in literature where there is a self-correction of MVP due to the calcification of the valve leaflet.
Abstract 19079: Assessment of Heart Sounds, Physiologic Changes, and Sleep Performance Using Non-Invasive Monitoring in a Volume Depleted Heart Failure Patient
Authors: Hajduczok Alexander , Shyam Kumar Prashanth , Ahmed Mohammad , Maucione Carly , Varadan Vijay , Rai Pratyush , Ramasamy Mouli , Boehmer John
Published: December 2023

Case:
A 46-year-old male with EF 15% who was co-enrolled in two non-invasive remote monitoring clinical trials, using the WHOOP strap and Nanowear vest to track heart failure (HF) progression at Hershey Medical Center was readmitted for volume depletion. Our patient presented to his PCP’s office complaining of daytime fatigue. Review of systems was negative including no dizziness or light headedness. Blood pressures during this visit was 85/50 and 79/49. He was sent to the emergency department where he had persistent hypotension with a creatinine elevation from 2.4 to 3.71. He was admitted for IV fluid resuscitation and diuretic optimization.

Methods:
We report cumulative metrics pre- and post-hospitalization showing significant changes in sleep performance and S3 heart sound magnitude. Other measured variables with WHOOP included heart rate (HR), respiratory rate (RR), rapid eye movement (REM) sleep, and heart rate variability (HRV).

Results:
Following adequate hydration, return to euvolemia, and diuretic adjustment, the patient had statistically significant improvement in sleep metrics (Figure 1, Graph C). Patient’s daily strain, a surrogate of HR elevation over time, was also significantly decreased post discharge (5.19 to 0.73, p <0.01). Patient’s S3 heart sounds were measured during both hospitalizations and showed a decrease in amplitude consistent with volume depletion (Figure 1, Graphs A/B).

Conclusion:
We report physiologic trends that correlate with clinical status as measured using two novel non-invasive monitoring strategies. Poor sleep secondary to orthopnea and paroxysmal nocturnal dyspnea are considered signs that indicate volume overload. This case, indicates that volume depletion in patients with severely reduced EFs could also contribute to poor sleep performance, indicating a narrow therapeutic window. Further studies may validate these devices as remote monitoring tools for HF management.
Abstract 19097: Socioeconomic Disparities in Symptomatic Heart Failure in Patients With Acute Myeloid Leukemia
Authors: Kang Yu , Vakilpour Azin , Lefebvre Benedicte , Denduluri Srinivas , Smith Amanda , Scherrer-Crosbie Marielle
Published: December 2023

Introduction:
Patients with acute myeloid leukemia (AML) have a high risk of symptomatic heart failure (HF). In addition, socioeconomic status (SES) has a significant effect on cardiovascular health. However, little is known about the association of SES and HF in patients with AML.

Hypothesis:
To investigate the impact of SES in HF occurring after AML.

Methods:
All adult patients diagnosed with AML between August 2006 to November 2019 at the hospital of University of Pennsylvania were studied. The primary outcome was new-onset symptomatic HF defined by 2017 ACC/AHA guidelines. The median household income (MHI) was identified based on ZIP codes using the data.census.gov. Low-income was defined as MHI lower than the MHI of the United States in the same time period. Differences between low-income Black and other patients were determined using t-tests, chi-square or Mann Whitney U test. Fine and Gray’s subdistribution hazard regression analysis was used to identify characteristics associated with HF.

Results:
A total of 770 patients (404 men, age: 62±15 years) were included; 101 (13.1%) were Black, 669 (86.9%) White. Seventy-six patients (9.9%) experienced symptomatic HF during a median follow-up period of 442 days. The median time to HF was 106 days [46-243]. Seventy-six (75%) Black and 181 (27.1%) White patients had low-income. Low-income Black had more cardiovascular (CV) risks (≥ 2 CV risks 39.5% vs 25.1%, p=0.009) and more HF events (11 events, 19% vs 65 events, 9.1%, p=0.022), than other patients. No differences were noted in history of cardiovascular diseases, cardiovascular treatments, doses of anthracyclines, and non-cardiac death between low-income Black and other patients. The cumulative incidence of HF in low-income Black patients was higher (p=0.01). Low-income Black (HR: 2.02; 95% CI: 1.05 to 3.88; p=0.036) and hypertension (HR: 1.90; 95% CI: 1.14 to 3.16; p=0.014) were independent factors associated with HF.

Conclusions:
Low-income Black patients with AML have a higher rate of new-onset symptomatic HF, independently of their cardiovascular and cancer treatment. Whether these differences are due to genetic or environmental factors remains unknown.
Abstract 207: Soluble Urokinase-Type Plasminogen Activator Receptor in Comatose Survivors After Out-of-Hospital Cardiac Arrest Treated With Targeted Temperature Management
Authors: Bro-Jeppesen John , Grejs Anders , Andersen Ove , Jeppesen Anni N , Duez Christophe Henri Valdemar , Kirkegaard Hans
Published: December 2023

Introduction:
Exposure to whole-body ischemia/reperfusion after out-of-hospital cardiac arrest (OHCA) triggers a systemic inflammatory response where soluble urokinase plasminogen activator receptor (suPAR) is released.

Aims:
This study investigated serial levels of suPAR in patients treated with differentiated target temperature management (TTM) and the associations with mortality and neurological outcome.

Methods:
In this single center sub-study of the randomized Targeted Temperature Management for 24 vs 48h (TTH-trial), we included 82 patients and measured serial levels of suPAR at 24, 48 and 72 h. We assessed all-cause mortality and neurological function evaluated by the Cerebral Performance Categories at six months after OHCA. Levels of suPAR between TTH groups were evaluated in repeated measures mixed models. Mortality was assessed by the Kaplan-Meier method. Good neurological outcome at six months was assessed by logistic regression analyses. The predictive value of suPAR was evaluated with the area under the receiver operating characteristic (ROC) curve.

Results:
Levels of suPAR were significantly different between TTH-groups (p
interaction
=0.04) with the highest difference at 48h, 4.7 ng/mL (95%CI: 4.1-5.4 ng/mL) in the TTH24 group compared to 2.8 ng/mL (95%CI: 2.2-3.5 ng/mL) in the TTH48 group, p<0.0001. Levels of suPAR above the median value (2.6 ng/mL) was significantly associated with increased all-cause mortality at any timepoint (p
log-rank
<0.05). The interaction of suPAR levels and TTH group was not significant (p
interaction
=NS). A two-fold increase in levels of suPAR were significantly associated with a decreased odds ratio of a good neurological outcome in both unadjusted and adjusted analyses without interaction of TTH group (p
interaction
=NS). AUC at 24h was 0.78 (95%CI: 0.67-88, p<0.0001). The optimal cutoff value for suPAR in predicting 180 mortality was 2.6 ng/mL (sensitivity: 0.75, specificity: 0.63).

Conclusion:
Prolonged TTM of 48 hours vs. 24 hours was associated with lower levels of suPAR. High levels of suPAR were associated with increased mortality and lower odds for good neurological outcome at six months with no significant interaction of TTH group. The biomarker suPAR was a modest predictor of outcome.
Abstract 232: Predicted One Third Improvement in Survival for Shockable Rhythms of a Proposed First Responder and Drone Automated External Defibrillator Delivery Program in North Carolina
Authors: Chu Jamal , Starks Monique A , Leung K.H. Benjamin , Blewer Audrey L , Granger Christopher B , McNally Bryan F , Mark Daniel B , Chan Timothy
Published: December 2023

Background:
Drone-delivered AEDs can improve access to defibrillation for OHCA. If drone-delivered AEDs arrive at the OHCA before EMS, then the OHCA’s first recorded rhythm may differ from that recorded by EMS. We estimate the clinical impact of a proposed program of first responder (FR) and drone AED delivery in North Carolina while accounting for this potential unobserved change in shockable rhythm.

Methods:
Using the CARES registry data, we identified OHCAs in 48 counties between Jan. 2013-Dec. 2019. OHCAs were stratified by whether they were bystander-witnessed. For each subpopulation three separate logistic regression models were trained to predict: 1) shockable initial rhythm 2) survival to discharge for shockable OHCAs and 3) survival to discharge for non-shockable OHCAs. Predictions from these models were combined to predict overall survival of a proposed program of first responder and drone AED delivery optimized for 5-minute coverage (proportion of OHCAs with response within 5 minutes).

Results:
We included 21,987 OHCAs to fit the outcome prediction models and used these models to predict the estimated clinical impact on the OHCAs with improved response time due to the FR and drone intervention (n=16, 321). For witnessed OHCAs, predicted rates of shockable initial rhythm increased by 14.9% (29.5% to 33.9%), and predicted rates of survival to discharge rose by 31.1% (13.2% to 17.3%). For unwitnessed OHCAs, predicted rates of shockable initial rhythm increased by 5.1% (11.8% to 12.4%), and predicted survival to discharge rose by 14.6% (4.8% to 5.5%). Witnessed OHCAs with <5-min response had the largest predicted benefit with survival rates increasing by 34.5% (14.5% to 19.5%).

Conclusion:
When accounting for changes in the likelihood of shockable rhythm due to improved response time, we estimated that a FR and drone AED delivery program may substantially improve survival rates of witnessed arrests and marginally improve survival rates of unwitnessed arrests.
Abstract 251: Approach to Prognostication for Patients Enrolled in a Post-Arrest Clinical Trial
Authors: Steinberg Alexis M , Yang Yanran , Fischhoff Baruch , Callaway Clifton W , Coppler Patrick J , Geocadin Romergryko , Silbergleit Robert , Yeatts Sharon D , Meurer William J , Elmer Jonathan
Published: December 2023

Introduction/Background:
Neuroprognostication after cardiac arrest is complex and the way clinicians prognosticate is not well understood.

Research Question/Hypothesis:
How do clinicians describe their approach to post-arrest prognostication in general and in specific patients they have treated?

Goals/Aims:
Characterize one or more prevailing themes in clinical decision-making about neuroprognostication.

Methods/Approach:
We surveyed and performed semi-structured interviews with clinicians who had cared for a subject enrolled in the Influence of Cooling Duration on Efficacy in Cardiac Arrest Patients (ICECAP) trial (NCT04217551). We performed interviews after trial subject died or was discharged. Our interviews explored clinician’s approach to neuroprognostication. Two authors (AS and YY) independently performed thematic analysis using inductive coding, then discussed any discrepancies and reached a consensus. Early in coding, we identified “clinical gestalt” as a common theme, defined as prognosticating based on patients overall appearance or impression of their history in the absence of any definitive prognostic tests. Each clinician provided their demographic information and local standard practices. We presented emerging themes and discrete responses with descriptive statistics as appropriate. We did not have access to subjects’ clinical identifiers or treatment arm of the trial.

Results/Data:
We interviewed 30 clinicians, who practiced at 19 US hospitals. Clinicians were primarily attendings (n=20) and most practiced critical care (n=21). Many (21/30) clinicians reported using clinical gestalt to formulate their early impressions. Of these, 9/21 reported high certainty in their initial predictions. Clinical gestalt informed both prediction of good and poor outcomes. Clinicians described different ways of incorporating gestalt into prognostication, including arrest history (17/21), severity of initial shock or multi-system organ failure (13/21), past clinical experience (10/21), comorbidities (10/21), and patient physical appearance (6/21).

Conclusion:
Clinicians often use gestalt when formulating early impressions of patient’s prognosis, an approach rarely discussed in prognostication literature.