bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 16605: Differential Impact of Nighttime Home Blood Pressure on Between Patients With and Without Subclinical Heart Failure
Authors: Komori Takahiro , Hoshide Satoshi , Kario Kazuomi
Published: December 2023

Introduction:
Nighttime blood pressure (BP) has stronger association with cardiovascular events than office BP, 24-hr BP, and awake BP. However, it was not clear whether the impact of nighttime BP is different for patients with or without heart failure (HF).

Hypothesis:
Nighttime home BP has stronger association with cardiovascular events in patients with HF.

Methods:
We analyzed the data from the Japan Morning Surge-Home Blood Pressure study with NT-proBNP and nighttime home BP measurement. We enrolled 2494 patients who had at least one cardiovascular risk factor. Morning, evening, and nighttime home BP were measured and cardiovascular events were followed up.

Results:
During 7.1 years follow-up, 168 events occurred. When NT-proBNP of 125pg/ml was used as cutoff, the patients with NT-proBNP>125pg/ml was higher daytime home SBP and nighttime home SBP than the patients with NT-proBNP≤125pg/ml (137±16 vs 132±13 mmHg, p<0.01, 126±18 vs 120±14 mmHg, p<0.01, respectively). In Cox regression analysis adjusting for significant covariates, daytime and nighttime home SBP were significant predictor for the outcome in the patients with NT-proBNP>125pg/ml (HR 1.02, 95%CI:1.01-1.03, p<0.01, HR 1.02, 95%CI:1.00-1.03, p=0.045, respectively). On the other hands, only nighttime home SBP was remained as a predictor for the outcome in the patients with NT-proBNP≤125pg/ml (HR 1.02, 95%CI:1.00-1.03, p=0.01).

Conclusions:
Nighttime home BP was associated with prognosis in patients with and without subclinical HF. Daytime home BP was associated with prognosis in patients with subclinical HF but not in the without subclinical HF.
Abstract 16616: Automatic Measurement of Short-Term Variability of Repolarization Captures Modulation by Pacing on Human Intracardiac Electrograms
Authors: Loen Vera , Aranda Alfonso , Smoczynska Agnieszka , Sprenkeler David , Tuinenburg Anton E , Scheerder Coert O , DeGroot Paul J , Vos Marc A , Meine Mathias
Published: December 2023

Introduction:
Short-term variability of repolarization (STV) increases prior to ventricular arrhythmias (VA) both in humans and in animal models of VA, and is therefore a promising tool for real-time monitoring of arrhythmic risk. To integrate this concept in cardiac devices, a method to automatically determine STV on intracardiac electrograms (EGM) was developed. This STV algorithm demonstrated high efficacy in predicting life-threatening VA in animal studies, but still needs to be evaluated on human signals.

Objective:
To assess the performance of the novel automatic method of STV measurement on human EGMs during sinus rhythm (SR) and pacing.

Methods:
ECG and EGM signals with a 1 kHz sampling frequency were recorded in 14 dual chamber implantable cardioverter-defibrillator (ICD) patients during implantation (n=4) or replacement (n=10) procedures. Recordings were obtained in SR, atrial pacing at 80 beats per minute (AAI80) and atrioventricular pacing at the same frequency (DDD80). STV was calculated over 31 consecutive beats as Σ
Abstract 16635: Cost Effectiveness Analysis of the Percutaneous Revascularization for Ischemic Left Ventricular Dysfunction REVIVED Trial Data
Authors: Chivardi Carlos , Sculpher Mark , Dodd Matthew , Morgan Holly , Ryan Matthew J , Evans Richard , Rinaldi C Aldo , O'Kane Peter , Clayton Tim , Petrie Mark , Perera Divaka , Saramago Pedro
Published: December 2023

Introduction.
Evidence on survival benefits of percutaneous coronary intervention (PCI) in patients with severe ischemic left ventricular systolic dysfunction (ILVD) is scant. The REVIVED trial showed that, compared to optimal medical therapy (OMT), revascularisation by PCI did not reduce the incidence of death from any cause or heart failure hospitalization (HF); it also failed to provide sustained improvements in health-related quality of life. REVIVED data are used to evaluate the economic consequences and health outcomes of PCI+OMT and OMT alone in HF patients in the UK.

Methods.
700 patients with ILVD were randomised to either PCI+OMT or OMT. Healthcare resource use and patient-reported health outcomes data EuroQol on each patient were collected at baseline and over a period of 8 years post randomisation (median follow up of 3.5 years). Health resources were costed using publicly available national unit costs from the perspective of the UK health system. Within trial mean total costs and quality adjusted life years (QALYs) were estimated and incremental cost effectiveness was evaluated. Regression analysis on total costs and total QALYs was used to adjust for clinically relevant baseline covariables. Probabilistic sensitivity analysis was used to reflect parameter uncertainty.

Results.
Statistical modelling identified gender, BMI, hypertension, diabetes, NYHA grade and previous hospitalisation as the most relevant baseline predictors of costs and benefits. Over the 8 years of fu, patients undergoing PCI yielded, on average, similar health benefits (4.13 QALYs IC [4.10 - 4.16]) at higher costs (£14,674 IC[£14,334 - £15,014]), compared to OMT (4.16 QALYs [4.13 - 4.19]; £5154 IC [£5,034 - £5,273]).

Conclusion.
We found no difference in total QALYs between arms and PCI+OMT was not cost-effective compared to OMT, given its additional costs. Therefore, a strategy of routine PCI to treat ILVSD does not appear to be a justifiable use of healthcare resources.
Abstract 16638: 4D Flow MRI Analysis of the Left Atrial Hemodynamics After Atrial Fibrillation Surgery
Authors: Maeda Motohiro , sakamoto shunichiro , HIROMOTO ATSUSHI , SUZUKI KENJI , Ishii Yosuke
Published: December 2023

Introduction:
Postoperative anticoagulation therapy after atrial fibrillation (AF) surgery remains a controversial topic because left atrial (LA) blood flow velocity and pattern remain unclear. This study utilizes four-dimensional (4D) flow magnetic resonance imaging (MRI) to analyze postoperative LA hemodynamics following various atrial fibrillation surgeries.

Methods:
This retrospective study included nine patients (mean age, 73 ± 8 years; range, 56-83 years) who underwent AF surgeries from August 2021 to June 2022. Maze surgery was performed in 3, pulmonary vein isolation (PVI) and left atrial appendage closure (LAAC) in 3, and the LAAC alone in 3 patients. Postoperative 4D flow MRI scans of the left atrium were performed, and image analysis was conducted. Blood flow velocity in the left atrium was measured, with velocities below 10 cm/s considered flow stasis. The percentage of flow stasis within one systolic-diastolic cycle was evaluated as % stasis. Furthermore, the presence or absence of a physiological vortex flow was assessed from the flow images.

Results:
Sinus rhythm was postoperatively maintained in 6 patients, and 3 patients were analyzed in AF. The left atrial % stasis was significantly low in the sinus rhythm group (46.0 ± 22.7 in the sinus rhythm group vs. 100 in the AF group, p=0.027). The absence of vortex flow was observed during sinus rhythm in one patient after Maze surgery. Conversely, vortex flow was identified during AF in the patient after LAAC, being accompanied by moderate mitral regurgitation.

Conclusions:
Any type of AF surgery does not always provide physiological LA blood flow. Further, 4D flow MRI analysis contributes to our understanding of the discrepancy between ideals and reality which may or may not require anticoagulant therapy regardless of postoperative rhythm.
Abstract 16646: Evidence of Protein Dysregulation in Patients With Post-Acute COVID-19 Syndrome With- and Without Postural Orthostatic Tachycardia Syndrome
Authors: Zhao Allan , Mahdi Ali , Fredengren Emelie , Fedorowski Artur , Braunschweig Frieder , Brodin Petter , Nygren-Bonnier Malin , Runold Michael , Bruchfeld Judith , Nickander Jannike , Deng Qiaolin , Checa Antonio , Desta Liyew , Pernow John , Stahlberg Marcus
Published: December 2023

Introduction:
Approximately 30 % of patient with Post-acute COVID-19 Syndrome (PACS) develop postural orthostatic tachycardia syndrome (POTS). The pathophysiological mechanisms behind PACS and associated POTS remain largely unknown.
Hypothesis:
PACS and POTS-specific phenotype are associated with dysregulation of proteins involved in cardiovascular regulation.

Methods:
We recruited 20 (19 female) patients with PACS and POTS (age 39±11 years, 18±3 months after SARS-CoV-2 infection) and 22 patients (all female) with PACS without POTS (age 44±11years, 19±3 months after SARS-CoV-2 infection). Head-up TILT test was performed in both groups. Age- and sex matched healthy volunteers (n=21; 20 female, age 43±6 years) without- (n=16) and with (n=5) a history of SARS-Cov-2 infection but without symptoms served as control group. Plasma levels of 700 proteins involved in cardiovascular regulation was analysed using Proximity Extension Assay (Olink® Explore 384 Cardiometabolic Assays I and II).

Results:
Several proteins were dysregulated both in patients with PACS and POTS (n=206/700, 29%) and in PACS patients without POTS (201/700=29%) compared to healthy controls (figure 1A). Only 13 proteins were uniquely up- and 3 down-regulated in PACS and POTS compared to healthy controls (figure 1B). Gene ontology pathway enrichment analysis revealed upregulation of pathways controlling inflammation, hemostasis, platelet activation and apoptosis in PACS compared to healthy controls (figure 1C).

Conclusions:
PACS is associated with a substantial protein dysregulation regardless of concomitant POTS up to 18 months after a mild primary SARS-CoV-2 infection. This suggests that PACS-associated POTS exist on a background of protein dysregulation but other pathophysiological mechanisms for PACS-induced POTS need to be established. Whether the dysregulated proteins observed in PACS constitute potential treatment target should be explored.
Abstract 16686: A Novel Co-Culture 3D Cardiac Organoid Models Early Heart Development
Authors: LIU YINGJUAN , Xu Honglin , Keavney Bernard D
Published: December 2023

Introduction:
Embryoid body-derived cardiac organoids (CO), incorporating complex chamber-like structures, have been reported since 2021. By contrast, co-culture COs described so far, which have been assembled from primary or hESC derived-cardiomyocytes, endothelial and fibroblast cells, lack complex structures. Cells of the endocardial lineage have a critical role in heart septation and chamber formation
in vivo
, but their potential role in engineering complex COs is hitherto unreported. We present a co-culture CO method incorporating endocardial lineage cells, showing these cells' critical contribution in forming chambered and vascularised COs suitable to model heart development and congenital heart disease (CHD).

Methods:
hESC-cardiomyocytes (CM, Day12), hESC-endothelial cell (EC, Day16), hESC-cardiac fibroblasts (Fb, Day16), and hESC-endocardial like cells (ECC, Day12) are differentiated with 2D protocols. COs are formed by co-culturing cells (1-2x10
^
4
cells/organoid) in ultra low attachment plates. Mature COs contain CMs, ECs and Fbs (3:1:1). Developing COs contain CMs, ECs, and ECCs (2:1:2). After four weeks, COs are characterised by immunostaining and optical mapping.

Results:
Mature and Developing COs form in three days of co-culture, with beating activities restoring during 2-7 days. Fig1A shows that both mature COs and developing COs beat regularly. Mature COs show evenly distributed cell populations (Fig1B). Developing COs form chamber-like cavities with surrounding vascular lumens (Fig1C). The inside chamber is layered by endocardial cells (Fig1C); vascular lumens form networks (Fig1C) within the middle compartment of CMs (Fig1D). Fibroblasts mainly specify the outside layer of developing COs (Fig1D).

Conclusions:
Endocardial lineage is critical in forming chamber-like structures in COs. This lineage-controllable developing CO can apply to drug screening and model early heart development and CHDs.
Abstract 16689: Stress Cardiomypoathy in the Patient on Immune Checkpoint Inhibitors; a Pharmacovigilance Study From 2013-2023 FAERS Database
Authors: Alwifati Nader , Daloub Shaden , Faisaluddin Mohammed , Salah Mohamed Mohamed , Abosbeta Mohamed , Al-Ali Omar , Iqbal Uzma
Published: December 2023

Introduction:
Immune checkpoint inhibitors (ICIs) are a form of immunotherapy widely used in the treatment of different cancers. These inhibitors function by blocking specific proteins, such as PD-1 (programmed cell death protein 1) or CTLA-4 (cytotoxic T-lymphocyte-associated protein 4), which regulate the immune response. While ICIs have demonstrated significant benefits, they can also lead to immune-related adverse drug reactions (ADRs). Although rare, cardiac immune-related ADRs are associated with high mortality rates.

Hypothesis:
The aim of this study to investigate the potential association between stress cardiomyopathy and the use of immune checkpoint inhibitors.

Methods:
We conducted an analysis using individual case safety reports obtained from the FDA Adverse Event Reporting System (FAERS) Database. These reports encompassed the period from the marketing authorization of each specific ICIs (ipilimumab, nivolumab, pembrolizumab, atezolizumab, durvalumab, avelumab, and cemiplimab) up until March 2023. The synthesized data was further examined based on outcome severity, age, and gender.

Results:
Among 9,772 individual cardiac adverse events associated with immune checkpoint inhibitors, 121 cases (1.2%) of stress cardiomyopathy were reported from 2013 to 2023. The highest occurrence of stress cardiomyopathy adverse events (57.8%) was observed in the age group of 65-85 , compared to 26.4% in the age group of 14-64. Females were more frequently affected, accounting for 55.3% of the cases, while males constituted 41.3%. The three most commonly reported ICIs associated with stress cardiomyopathy were pembrolizumab (39.6%), nivolumab (33.8%), and ipilimumab (16.5%). Among the 121 cases, 19% resulted in mortality, while 26.5% had life-threatening outcomes. Additionally, 79.3% of cases required hospitalization, 5.7% experienced disability, and 57.8% had outcomes that were not characterized.

Conclusions:
Immune checkpoint inhibitor-induced cardiac ADRs, specifically stress cardiomyopathy, were found to be serious and associated with unfavorable outcomes. Physicians should remain vigilant regarding cardiac symptoms in patients receiving immune checkpoint inhibitors, as early detection can improve overall outcomes.
Abstract 16704: Impact of Infective versus Sterile Transvenous Lead Removal on Outcomes in Cardiac Implantable Electronic Devices
Authors: Talaei Fahimeh , Ang Qi-Xuan , Hassan Mustafa , Lee Justin Zon-ern , Tamirisa Kamala
Published: December 2023

Introduction:
Transvenous lead removal (TLR) is associated with increased mortality and morbidity. This study sought to evaluate the impact of TLR on in-hospital mortality and outcomes in patients with and without CIED infection.

Methods:
Using the nationally representative, all-payer, Nationwide Readmissions Database, we evaluated patients undergoing TLR for CIED infection between January 1, 2017, and December 31, 2020. The indications of TLR were determined on the basis of the presence or absence of bacteremia, septicemia, sepsis, or endocarditis during the initial admission for CIED infection. The impact of infective vs sterile indications of TLR on mortality and major adverse events was studied.

Results:
Of the 25,144 patients who underwent TLR, 14,037 (55.8%) underwent TLR due to sterile indications and 11,114 (44.1%) underwent TLR due to infective indications with 4,495 patients with (40.5%) systemic and 6,612 (59.53%) with isolated pocket infection. Infective indications of TLR were associated with a significant increase in in-hospital mortality (8.73% vs 0.96%; OR= 5.89; 95% CI 4.81-7.20; <0.001) but not conversion to open heart surgery. Infective indications of TLR were also associated with a significantly increased risk of thromboembolic events of pulmonary emboli and embolic stroke (OR= 3.80; 95% CI 3.23-4.47, <0.001).

Conclusions:
A higher rate of thromboembolic events associated with infective indications of lead removal may warrant further pursuing this diagnosis in asymptomatic patients.
Abstract 16721: Concentrations of Troponin I but Not Cardiac Troponin T Are Associated With 7-year Changes in Left Ventricular Structure and Function in Older Adults: The Atherosclerosis Risk in Community (ARIC) Study
Authors: Myhre Peder L , Claggett Brian , Ballantyne Christie M , Selvin Elizabeth , Matsushita Kuni , Kitzman Dalane W , Konety Suma H , Mosley Thomas , Shah Amil M
Published: December 2023

Introduction:
High-sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI) are strongly associated with incident heart failure (HF) and left ventricular (LV) remodeling. Their associations with longitudinal changes in cardiac structure and function are less clear.

Methods:
Among 1,908 participants in the Atherosclerosis Risk in Communities (ARIC) study who were free of coronary disease, HF, or atrial fibrillation and had echocardiography at study Visits 5 (2011-2013) and 7 (2017-2019), we assessed the associations of log-transformed hs-cTnT and hs-cTnI at Visit 5 with absolute changes in LV structure and function between Visit 5 and 7 (median of 6.6 [IQR 6.1-7.0] years) using multivariable linear regression with the exposures modeled as restricted cubic spline models. Models were adjusted for age, sex, race, BMI, diabetes, hypertension and eGFR at Visit 5, blood pressure and heart rate at both visits.

Results:
At Visit 5, the mean age (years) was 74 (SD 4), 60% were female, 24% reported Black race and the median (p25-p75) concentrations of hs-cTnT and hs-cTnI were 9 (6-13) ng/L and 2.7 (1.9-4.0) ng/L respectively. In adjusted models, higher hs-cTnI concentration was associated with 7-year decline in LV systolic function (ejection fraction, global longitudinal and circumferential strain;
Figure
). In contrast, hs-cTnT was not consistently associated with changes in cardiac function. Changes in hs-cTnI, but not hs-cTnT, were also associated with greater increases in left atrial volume. Neither were associated with changes in LV mass or volume.

Conclusions:
Higher hs-cTnI, but not hs-cTnT, concentrations are associated with greater declines in LV function over ~7 years in late life independent of traditional cardiovascular risk factors. These findings support previous findings of cTnI to be more cardiac specific than cTnT.
Abstract 16723: Comparison of Myocardial Strain During Active Labor in Parturients With Hypertensive Disorders of Pregnancy via Speckle-Tracking Echocardiography
Authors: Kouassi-Brou Marilyn , Choi Eunjung , Martinez-Camblor Pablo , Hickerson Leigh
Published: December 2023

Introduction:
Hypertensive disorders of pregnancy (HDP) are increasing in prevalence in the USA and affect maternal morbidity and mortality.

Hypothesis:
Echocardiographic strain abnormalities may be more prevalent in patients with HDP in active labor, which may unmask subclinical left ventricular dysfunction.

Methods:
A total of 59 healthy term parturients (≥37 wks gestational age) in active labor (≥6cm cervical dilation) underwent echocardiography to assess cardiac function during peak physiologic stress. Speckle tracking strain analysis was performed using apical 4-, 3- and 2-chamber views during uterine contraction and relaxation with a S5-1 Philips Sparq probe and analyzed with Qlab 9 strain analysis software (Philips, Andover, MA, USA). Abnormal strain cutoff was >-20%. Mean ± SD summarized continuous variables; absolute and relative frequencies for categorical. Welch T-test and Chi-square were used for group comparisons.

Results:
HDP was present in 21 subjects and absent in 39. Mean age, parity, and prevalence of diabetes did not differ significantly between the two groups. The HDP group had a higher mean BMI (Table 1). The non-HDP group had strain abnormalities in two segments during uterine relaxation, absent during contraction. The HDP group had abnormalities in 5 segments during uterine relaxation, 4 of which were persistently abnormal during uterine contraction (Fig 1).

Conclusions:
Abnormal strain values were detected at a higher rate in HDP group than in non-HDP group in active labor. Future research is needed to determine if subclinical strain abnormalities in those with HDP during active labor are predictive of developing future cardiovascular disease.
Abstract 16784: Utility of 4D Flow MRI to Quantify Improvement of Left Atrial Hemodynamics Following Cardioversion for Atrial Fibrillation
Authors: Zaatari Ghaith , Pattany Pradip M , Fishman Joel , Markl Michael , Lee Daniel C , Mitrani Raul , Goldberger Jeffrey J
Published: December 2023

Background:
Cardioversion (CV) for persistent atrial fibrillation (PeAF) restores sinus rhythm (SR) but its effects on left atrial (LA) and LA appendage (LAA) flow are not well established.

Research question:
Does restoring sinus rhythm improve LA/LAA hemodynamics in patients with PeAF?

Aims:
To compare changes in LA/LAA 4D flow MRI characteristics post-CV for PeAF versus repeated measurements in a control group without AF.

Methods:
We performed 4D flow MRI (3T Skyra) in 9 PeAF patients (8 males, age 68±8 yrs, 78% HTN, 44% DM, 22% CAD, CHA2DS2-VASc 2.7±1.5, LVEF 53±17%) prior to and 62±44 days after CV (in SR) (minimum 4 weeks after CV). We also performed repeat MRIs in 9 SR controls (6 males, age 51±11 yrs, 78% HTN, 22% DM, 11% CAD, CHA2DS2-VASc 1.6±0.9, LVEF 62±4%) 60±19 days apart, both in SR (minimum 4 weeks apart). Data analysis included 3D segmentation of LA and LAA for evaluation of atrial velocity data. Absolute atrial velocities were calculated for each voxel and time frame inside the LA and LAA, and used to derive blood stasis (quantified by determining number of cardiac time frames with velocities below a threshold of 20 cm/s, normalized by the total number of cardiac time frames: Stasis%= (Nstasis/ NTotal)*100 ) and median velocity.

Results:
In PeAF, restoring SR improved 4D flow characteristics by reducing stasis and increasing median velocity (p<0.003, figure). In the controls, there was no significant change in median velocity or stasis % between the two scans in either the LA or LAA. Bland-Altman analysis for the two control scans showed no significant differences in the controls. Pre-CV median velocities and stasis% in PeAF significantly differed from controls while post-CV, they did not.

Conclusion:
AF is associated with impaired LA and LAA flow characteristics that improve substantially with CV toward control values. Use of 4D MRI to quantify LA and LAA hemodynamic function is feasible; future studies are needed to correlate 4D MRI measurements to thromboembolic risk.
Abstract 16787: Impact of Metabolic Healthy Obesity on Cardiovascular Outcomes of Hospitalized Postmenopausal Women (Age>55 Years) and Associated Disparities: A Population-Based Analysis
Authors: Pingili Adhvithi , Lakkimsetti Mohit , vempati Roopeessh , Madhavaram Hasmitha J , Vemula Madhusha , Sagoo Gurbina , Majooju Mounica , Vasudev Ishita , Sunkara Praveena , Gummadi Jyotsna , Singh Sandeep , Nanjundappa Athmananda , Desai Rupak
Published: December 2023

Introduction:
Metabolically healthy obesity's (MHO) impact on cardiovascular outcomes is debated. However, MHO's impact on cardiovascular outcomes in postmenopausal women is unexplored. Our study explored MHO's prevalence and correlation with in-hospital major adverse cardiac and cerebrovascular events (MACCE) in postmenopausal women.

Methods:
Data was analyzed from National Inpatient Sample 2020 for admissions of postmenopausal women (>age 55 years) with and without obesity. Metabolically healthy patients were identified by excluding diabetes, hypertension, and hyperlipidemia using Elixhauser comorbidity software. After propensity score matching (PSM) patients with MHO and non-MHO for age, we performed a multivariable regression analysis for in-hospital MACCE. Also, using tests of model effects, we determined predictors of MACCE in postmenopausal women with MHO.

Results:
In 2020, 1304185 metabolically healthy postmenopausal women over age 55 years were admitted; 1155935 (88.6%) had no MHO, and 148250 (11.4%) had MHO. However, after PSM for age, there were 148250 in each cohort. In MHO cohort, median age was 65 years, 78.6% were white, 8.1% were African-American, and 28.2% were from lowermost income quartile. Most common comorbidities in MHO cohort were chronic pulmonary disease (29.2%), hypothyroidism (20.7%), and tobacco use disorder (23.9%). We observed a statistically significant difference in overall MACCE [odds ratio (OR) 1.08, 95% confidence interval (CI) 1.01-1.16, p=0.028] among MHO and non-MHO cohorts, especially in patients from African-American ethnicity (OR 1.23, 95% CI 1.01-1.49, p=0.035) and lowermost income quartile (OR 1.24, 95% CI 1.06-1.44, p= 0.007). However, no significant all-cause mortality was observed (OR 1.02, 95% CI 0.94-1.12, p=0.621). Several predictors of MACCE in postmenopausal women with MHO were observed, with non-elective admission being the strongest (OR 7.38, 95% CI 5.91-9.22, p<0.001).

Conclusion:
This large population-based analysis revealed that postmenopausal patients with MHO are at risk of MACCE, particularly those from African-American ethnicity and lowermost income quartile. Larger prospective studies are needed to "demystify" the controversial MHO in cardiovascular diseases.
Abstract 16794: Trends and Predictors of In-Hospital Mortality in Elderly STEMI Patients With Cancer - 2016-2019
Authors: Bandaru Revanth Reddy , Sankaramangalam Kesavan
Published: December 2023

Introduction:
As cancer survivors have imported survival rates, they are more likely to develop cardiovascular diseases (CV), identifying elderly cancer patients who are at high risk of mortality with the development of ST-segment elevation myocardial infarction (STEMI) becomes important.

Methods:
Using 2016-19 National Inpatient Sample, we identified elderly (>65 years) cancer patients with STEMI admissions and were analysed for demographic and clinic risk factors of all-cause mortality (ACM).

Results:
Of 13470 selected STEMI admissions with cancer patients, decreased cohort had higher rates of females (41.8 vs 33.8%, p<0.001), blacks & Asian/Pacific Islanders (8.1 vs 0.6%; 3.1 vs 2.5%; p=0.035), patients from lower income quartile (29.5 vs 25.2%, p<0.001), with severe renal failure (2.4 vs 1.6%, p<0.001) vs. those who survived. STEMI-cancer patients with hypertension, hyperlipidemia, smoker status, obesity, prior MI, and prior PCI/CABG had steady trends in ACM with DM interestingly showing improving trends in mortality (24% vs 18.1%) from 2016-19. Multivariate regression also did not reveal the worse impact of traditional cardiovascular risk factors on ACM.

Conclusions:
We identified elderly Hispanics being the only predictor of all-cause mortality in elderly cancer patients that develop STEMI.
Abstract 16801: Effect of Cyclosporine A on Infarct Size in Rat Hearts Donated After Circulatory Death
Authors: Kiernan Zachary , Chen Qun , Lesnefsky Edward J , Quader Mohammed
Published: December 2023

Introduction:
Ischemia-reperfusion injury (IRI) is inherent in heart donation after circulatory death (DCD), hence only hearts with <30 minutes of ischemia are used for transplantation. Mitochondrial permeability-transition pore (MPTP) opening has been implicated in IRI. Cyclosporine A (CyA) is known to inhibit MPTP opening. No data on infarct size reduction with CyA exists in a DCD heart.

Hypothesis:
CyA given during reperfusion will reduce infarct size in DCD hearts.

Methods:
Male Sprague-Dawley rats were assigned to either DCD + CyA, DCD + vehicle, or control-beating heart donors (CBD) (n=10 per group). Rats were anesthetized with pentobarbital, intubated and ventilated. Vecuronium and heparin were given for muscle paralysis and anticoagulation respectively. For DCD group, ventilation was terminated (start of anoxia/ischemia time), and hearts procured after 5, 10, 15, 20, 25 minutes. CBD hearts were procured without ischemia. Hearts were then perfused on a Langendorff setup for 90 minutes. Vehicle and CyA groups received DMSO and CyA (2μM) in KH buffer, respectively, for first 15 minutes followed by 75 minutes of KH buffer. Developed pressure (DP) was measured via a balloon tip catheter placed in the left ventricle. Infarct size was measured using triphenyltetrazolium chloride staining. CBD hearts perfused with KH buffer only served as controls.

Results:
Percent infarct size following 5, 10, 15, 20, and 25 minutes of ischemia was 17.7 ± 4, 19.3 ± 6, 25 ± 4, 27.3 ± 3, and 25.4 ± 11 respectively. CyA given to 25 minutes ischemia group reduced infarct size to 14.7%, corresponding to 6 minutes of ischemia. At 60 minutes CyA treated hearts had higher DP (mmHg) compared to vehicle group (34 ± 13 vs. 51 ± 17,
p=0.017
).

Conclusions:
CyA given during reperfusion to DCD hearts significantly reduced infarct size and preserved function. CyA use may allow for longer ischemia times during DCD heart procurement.
Abstract 16808: Inflammasome Formation in Acute, Subacute and Chronic Myocarditis
Authors: Toldo Stefano , Merlo Marco , Bussani Rossana , Nordio Andrea , Anzini Marco , sinagra Gianfranco , Mezzaroma Eleonora , Abbate Antonio
Published: December 2023

Background:
Myocarditis is a syndrome of inflammation resulting in myocardial injury. The inflammasome is formed in response to injury and may lead to further injury and fibrosis. We assessed for differences in inflammasome formation in patients with biopsy-proven myocarditis myocarditis (>90 days of symptoms onset) as acute (<30 days), subacute (31-90 days), chronic myocarditis.

Methods:
We studied inflammasome formation by immunofluorescence for the scaffold protein of the inflammasome, apoptosis-associated speck-like protein containing a caspase-recruitment domain (ASC), in 23 patients with biopsy-proven lymphocytic myocarditis. The number of inflammasome (cells with ASC aggregates) were counted in random high-power fields (x40). Clinical data, including the duration of symptoms, was retrieved from the Cardiomyopathy Registry. Data are presented as N [%] or median [interquartile range]. Differences between groups were assessed with Kruskal-Wallis test and correlations with Spearman test.

Results:
Of the 23 patients (13 [56%] males, 45 [36-52] years of age), 9 were studied during the acute phase (10 [1-20] days), 7 in the subacute phase (60 [40-67] days) and 7 during the chronic phases (150 [150-180] days). Inflammasome formation was detected in all 23 (100%) patients. We found no statistically significant differences in the total number of inflammasomes comparing acute, subacute, and chronic myocarditis (8.2 [4.2-15.5], 6.2 [3.1-22.0], 5.0 [3.7-23.0], and respectively, P=0.99, Figure), and no statistically significant correlation between the duration of symptoms and inflammasomes (R=-0.37; P=0.87).

Conclusions:
Patients with biopsy-proven myocarditis show persistent inflammasome formation over a range of time from symptom onset, with no significant difference between acute, subacute and chronic presentation. Further studies are needed to determine whether the inflammasome contributes to ongoing injury in patients with myocarditis.
Abstract 16820: Outpatient Intravenous Diuresis in Decompensated Heart Failure: A Systematic Review
Authors: Kalkur Roshni S , Hintz John P , Pathangey Girish , Manning Katharine A
Published: December 2023

Introduction:
Heart failure (HF) burdens the US healthcare system, with persistent 30-day readmission (25%) and mortality rates (10%), and annual costs exceeding $30 billion. Outpatient intravenous (OP IV) diuresis in clinic or home settings may potentially improve outcomes and reduce costs, though limited data exist. This systematic review evaluates the safety, efficacy, and outcomes of OP IV diuresis in managing decompensated HF as a hospitalization alternative.

Methods:
Following PRISMA 2020 guidelines, this systematic review used MeSH terms in MEDLINE, SCOPUS, CINAHL Complete, and Cochrane Central. From 16 selected studies, 15 were single-center; 6 prospective, 9 retrospective; and 1 was a randomized trial comparing OP IV diuresis to oral home regimen. Demographics, visit data, and outcomes were collected, and 30-day outcomes were compared to inpatient IV (IP IV) diuresis from 2021 Medicare HF hospitalizations.

Results:
The review included 2088 unique patients, with a mean age of 69±6 years, 62% male, and 75% NYHA III-IV. Minimal adverse post-diuresis events such as hypokalemia, hypotension, and worsening renal function occurred (4.3%, 0.7%, and 2.2% respectively). Post-visit mean weight loss was -2.2±1.1 kg. The 30-day readmission rate for OP IV diuresis was comparable to IP IV diuresis (22.6 % vs. 22.6%; p=0.995), while 30-day mortality was lower (5.6% vs. 10.7%; p<0.001). In addition, mean 1-year mortality for OP IV diuresis was under 20%, compared to 25-30% for IP IV diuresis. Estimated cost savings per patient ranged from $1,632-10,395.

Conclusions:
OP IV diuresis is a safe and effective treatment for decompensated HF with minimal risk of adverse events. Data demonstrates comparable readmission rates to IP IV diuresis with significantly lower mortality rates and costs. These findings highlight the potential of OP IV diuresis as an enhanced alternative for HF care; however, further randomized control trials are needed to evaluate long-term outcomes.
Abstract 16823: The Mediating Effect of Perceived Stress on the Relationship Between Adverse Childhood Experiences and Depressive Symptoms in Rural Adults With Cardiovascular Disease
Authors: Miller Jennifer , Chung Misook L , Smith Jennifer , Moser Debra K
Published: December 2023

Background:
Adverse childhood experiences (ACEs), defined as abuse, household dysfunction, and neglect before age 18, increase the risk of depressive symptoms and cardiovascular disease (CVD). Fifty-two percent of people have reported 1 ACE with 6.2% reporting 4 or more. People in rural environments experience higher levels of stress and depressive symptoms, but little is known about the relationship of ACEs with stress and depressive symptoms in rural adults with CVD.

Aim:
To determine the prevalence of ACEs and the mediating effect of perceived stress on the relationship between ACEs and depressive symptoms in a sample of rural adults with CVD.

Methods:
We used Hayes PROCESS for SPSS (model 4) to determine the mediating effect of perceived stress (Cohen’s Perceived Stress Scale) in the relationship between ACEs (ACE questionnaire), and depressive symptoms (Patient Health Questionnaire-9) controlling for age, gender, financial status, and perceived control.

Results:
Of 210 rural adults with CVD (mean age 59 ± 13, ACE score 2.4 ± 2.5, and education 14 ± 3, 45.7% female, and 3.3% non-white) 20% reported 1 ACE with 30% reporting 4 or more. Adverse childhood experiences significantly predicted perceived stress (a = .2553,
p
= .001) and perceived stress significantly predicted depressive symptoms (b = .7419,
p
< .001). The total (c = .4881,
p
= .001) and direct effects (c’ = .2987,
p
= .038) of ACEs on depressive symptoms in this sample were significant, as was the indirect effect of perceived stress (ab = .4144, 95% CI [.2449 - .6231]).

Conclusion:
The prevalence of ACEs in this sample of rural adults with CVD was 5 times higher than reported in the general population. Perceived stress is a mediator of the relationship between ACEs and depressive symptoms in rural adults with CVD. Interventions to decrease depressive symptoms in rural adults with CVD should include an assessment of ACEs and address management of perceived stress.
Abstract 16829: Systemic Arterial Pulsatility Index Correlates With Long Term Mortality in Cardiogenic Shock
Authors: PURVIS ADAM , Stafford Patrick , Rokicki Alicia , Bilchick Kenneth , Mazimba Sula
Published: December 2023

Introduction:
Systemic arterial pulsatility index (SAPi) is a marker for ventriculo-arterial coupling that incorporates the contractile properties of the left ventricle with aortic impedance. Prior studies have demonstrated the association of SAPi with adverse outcomes in advanced heart failure. The association of SAPi in cardiogenic shock has not been studied. We evaluated the association of SAPi with mortality in patients with cardiogenic shock with comparison to cardiac output.

Methods:
Consecutive patients with cardiogenic shock at University of Virginia from 01/2017 to 09/2021 with right heart catheterization data were included in this analysis. Baseline SAPi [systemic systolic blood pressure-systemic diastolic blood pressure]/pulmonary artery wedge pressure] and cardiac output were calculated on admission. Patients were stratified into high and low SAPi based on median SAPi. Cox proportional hazards regression was used to evaluate the association of SAPi stratas with mortality at 1 year. Receiver-operating characteristic (ROC) analysis was performed.

Results:
Among 120 patients (mean age 55.9, 34.1% female), 40 patients died (33.3%) within 12 months of admission. The median SAPi was 1.96 (IQR 1.25-2.49).Lower values of SAPi were associated with increased mortality at both 1 month (AUC =0.62, p=0.45) and 12 months (AUC =0.63, p=0.02) 12 months mortality with AUC of 0.63 (p=0.02) (Figure 1). The baseline cardiac output was not associated with this survival.

Conclusions:
In a contemporary cohort of cardiogenic shock patients, low SAPi was associated with increased mortality at both 1 and 12 months after admission for cardiogenic shock and provided better prediction than the baseline cardiac output. Further studies are needed to evaluate the utility of SAPi in hemodynamic monitoring of cardiogenic shock patients.

Figure 1
Abstract 16841: Skeletal Muscle Fat Predicts Exercise Intolerance and Decreased Survival in Symptomatic Heart Failure With Preserved Ejection Fraction
Authors: Lewsey Sabra C , Samuel T. Jake J , Schaer Michael , Hays Allison , Sourdon Joevin , Gerstenblith Gary , Weiss Robert G
Published: December 2023

Introduction:
Heart failure with preserved ejection fraction (HFpEF) is characterized by marked exercise intolerance (EI) and increased mortality. HFpEF is now thought to involve multi-organ dysfunction and skeletal muscle (SkM) changes including muscle loss and muscle fatty infiltration have been reported in HFpEF patients. However, it is not known if SkM changes are associated with cardiovascular (CV) mortality.

Hypothesis:
Skeletal muscle fat accumulation in symptomatic HFpEF patients is associated with worse EI and decreased survival.

Methods:
Patients with a clinical diagnosis of HFpEF and left ventricular ejection fraction
>
50% (n=64, age 65.2±11.2, BMI 38.6±8.2, mean±SD, 53% women) underwent 3T conventional magnetic resonance imaging (MRI) of the calf muscle to determine SkM mass and T2-weighted MRI for SkM fat fraction (FF) with subcutaneous fat excluded. Baseline EI was quantified by six-minute walk distance (6MW). HFpEF patients were followed prospectively for a minimum of 18 months for survival (median follow up 39.3 months). Simple linear regression was used to determine relationships with EI while Kaplan-Meier survival curves with log rank tests were created to explore CV mortality.

Results:
SkM FF was closely and inversely associated with 6MW (1A), but SkM mass (1B) was not, indicating that EI in HFpEF is more closely associated with SkM quality than quantity. SkM FF was not related to body mass index (BMI) (1C). When the HFpEF cohort was stratified based on median FF (median=18.79%), SkM FF predicted significantly worse survival from CV death (1D, p=0.0192).

Conclusions:
This is the first report to show that SkM fat content predicts cardiovascular mortality in HFpEF patients. Further, EI in HFpEF patients is closely associated with SkM fat accumulation but not sarcopenia. Thus, reducing SkM fat content may represent a new target for reducing EI and improving CV survival in HFpEF patients.
Abstract 16866: Complete Revascularization for Left Main Acute Myocardial Infarction
Authors: Kim Sun Oh , Jung Yu Jung , Jeong Jun Chang , Son Byung Ju , Park Jong-Il , Choi Kang-Un , Nam Jong-Ho , Son Jang-Won , Kim Ung , Park Jong-Seon
Published: December 2023

Background:
In patients presenting with acute myocardial infarction (AMI) with left main (LM) culprit lesion and multivessel disease, percutaneous coronary intervention (PCI) of non-culprit lesions in LM culprit AMI is challenging and whether it reduces mortality and adverse events is unclear.

Hypothesis:
Complete revascularization will show better outcome than culprit-only revascularization in multi-vessel LM AMI PCI.

Methods:
We reviewed total of 16831 patients among from July 2016 to June 2020 Korean Acute Myocardial Infarction Registry (KAMIR) and 395 patients were enrolled with LM culprit multi-vessel AMI treated by PCI. We excluded in-hospital death 35 cases then categorized patients whether treated with complete revascularization (n=198) or culprit-only revascularization (n=162). Study outcome was a composite of major cardiac adverse events (MACE) including cardiac death, myocardial infarction, re-PCI, stent thrombosis and rehospitalization due to heart failure. We used propensity score (PS) matching method and cumulative event-free survival and MACE were analyzed over 3 years follow-up.

Results:
After PS matching, baseline and angiographic characteristics were similar between two groups (Complete group, n=142 versus Culprit-only group, n=142). Killip classification (Class IV : n=13 (9.2%) versus n=14 (9.9%),
p
-value=0.762) and initial diagnosis (STEMI : n=47 (33.1%) versus n=52 (36.6%),
p-
value=0.618) at admission were also not different between two groups. There was no difference in MACE between two groups (n=27 (19%) versus n=28 (19.7%), log-rank test
p-
value = 0.64).

Conclusion:
Although, other studies had shown better outcome of complete revascularization in multi-vessel AMI, in multi-vessel LM AMI PCI, complete revascularization should be carefully decided depending on the patient's condition.
Abstract 16867: Predictors of Long-Term Mortality in Chronic Limb Threatening Ischemia Derived From a Random Forest Machine-Learning Model
Authors: Callegari Santiago , Romain Gaelle , Cleman Jacob , Scierka Lindsey , Provance Jeremy , Mena-Hurtado Carlos , Smolderen Kim G
Published: December 2023

Introduction:
Optimizing limb survival in patients with chronic limb-threatening ischemia (CLTI) undergoing peripheral vascular intervention (PVI) is a major focus. Care plans that consider patients’ high-mortality risk are less common. Understanding which patients have the highest mortality risk would enable more personalized care plan designs to enable person-centered care. We aimed to leverage a random forest machine learning (RFML) model to predict long-term mortality in patients with CLTI undergoing PVI.

Methods:
A cohort of patients with CLTI undergoing PVI from 2017 to 2019 from the Medicare linked Vascular Quality Initiative registry was derived. Using 89 pre-procedural variables, we constructed a RFML model predicting 3-year mortality. Missing data were addressed by random forest imputation. The data were divided into a training sample (80%) and a test sample (20%) using random sampling without replacement comprising. Variables that most frequently caused branch splitting closest to the tree′s origin of were defined as the most predictive factors, with a total of 1,000 trees being built. Accuracy was assessed using the Continuous Ranked Probability Score (CRPS) and Harrell’s C-index.

Results:
A total of 10,114 patients were included (mean age 72 ± 11 years, 59% male, 74% white). The 3-year mortality rate was 39.1% (Median survival: IQR: ), Among the 15 most predictive variables, 14 variables are potentially modifiable, Remarkably, 5 functional or psychiatric variables were among the most predictive factors. CRPS and Harrerl′s C-index were 0.172 and 0.70, respectively.

Conclusion:
Our RFML model successfully predicted 3-year all-cause mortality in patients with CLTI undergoing PVI. Predictors of mortality in CLTI extend beyond medical history and encompass functional and behavioral variables. A shared decision-making individualized plan focusing on patient-centered care is needed to improve long-term mortality in patients with CLTI.
Abstract 16877: Role Of Short Term Atrial Fibrillation in Different Stroke Entities
Authors: Buerke Michael , Boettger Priyanka
Published: December 2023

Introduction:
Stroke including ESUS is one of the most common causes of disability and death in the world. Atrial fibrillation (AF) of more than 30 sec is considered as reason for cardioembolic stroke.

Hypothesis:
Nevertheless, shorter periods of AF might also be a possible risk factor.

Methods:
We determined periods of AF of 0-14 sec, AF 15-30sec and AF> 30 sec in patients with different stroke entities. We analysed all ischemic strokes and transient ischemic attacks at the Stroke Unit in Siegen over 6 months. All stroke patients were prospectively ECG monitored over a minimum of 24h and characterized for the different AF periods.

Results:
A number of 714 patients over 6 months were hospitalized suffering a stroke. Among them 163 (30.8%) had a cryptogenic Stroke, including 98 (19%) ESUS patients. Furthermore, 185 (26%) TIA, 209 (39%) cardioembolic, 110 (21%) atherosclerotic, 40 (8%) lacunar and 7 (1%) other specific strokes were registered. Manifest atrial fibrillation (>30s) showed a prevalence within our stroke population of 23%. Whereas 15% had an AF episode of 15-29 s and 16% presented AF episode of 0-14 s. Among cardioembolic infarcts, 45% had manifest atrial fibrillation (>30 s), 20% had an atrial fibrillation episode of 15-29 s, and 22% showed an atrial fibrillation episode of 0-14 s. Taken together, more than 90% of cardioembolic infarcts show an episode of atrial fibrillation of any duration. An AF episode of 15-29 s or 0-14 s is also found in almost 35% of ESUS patients;similar to cryptogenic infarcts. In 22% of TIA patients manifest atrial fibrillation has been detected. 7% of TIA patients showed one or more episodes of AF of 15-29 s and 10% an episode of 0-14 s. Among the atherosclerotic infarcts, the proportion of AF >30 s is significantly lower at 12%, however the percentage of AF for 15-29 s was 14.

Conclusions:
In our study, AF showed the largest ratio with 48% among cardioembolic infarcts. Since a manifest AF is an exclusion criterion for ESUS, none suffered from manifest AF. However, it is striking that 15% had an AF episode of 15-29 s and 18% had an AF episode of 0-15 s. Possibly, the definition of AF has to be adjusted or at least advanced rhythm monitoring should be provided. This should be investigated in future prospective studies.