bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11052: Implanting Cardiovascular Electronic Devices With a Biologic Tissue Envelope Improves Healing and Facilitates Reoperative Procedures
Authors: Catanzaro John N , Bilchick Kenneth C , Christopher Thomas J , DSouza Benjamin A , ISSA ZIAD F , Sangosanya Afolabi O , Vora Aaditya , Yarmohammadi Hirad , Deering Thomas F , Riebman Jerome B
Published: June 2023

Introduction:
Fibrous encapsulation of implanted cardiovascular implantable electronic devices (CIED) may create a hostile environment during device reoperation. An acellular biologic extracellular tissue CIED envelope (CanGaroo®, Aziyo Biologics) may attenuate host foreign body response to the implant, decrease fibrosis and enable adaptive vascularized healing to facilitate reoperation & decrease complications.

Hypothesis:
CIED implant site findings at reoperation differ in patients who previously received a biologic envelope (BIO) vs no envelope (NO-BIO) at time of device implant.

Methods:
Patients undergoing reoperative CIED procedures (9 BIO, 12 NO-BIO) were assessed (medical profiles, procedural notes, scaled scoring of intra-operative assessments & tissue biopsy histology of the implant pocket).

Results:
There were no significant cohort differences in mean age, gender or implant location. Median capsular lead adhesion classification (semi-qualitative scale) was significantly lower (less severe) for BIO implants (p=0.02) [Fig. 1, double arrows]. Physicians scored BIO reoperations (10-pt scale) as 39% less difficult in generator mobilization (p=0.04), 43% less difficult in lead mobilization (p=0.04) and 45% less overall procedural difficulty (p=0.01). BIO pockets required 63% fewer capsulectomies (p=0.18). Multipoint histologic assessment of fibrotic capsule thickness (16 matrixed measurements, 5 BIO vs 11 NO-BIO with complete datasets) revealed a 39% reduction in BIO implant pockets (p=0.05), with no significant differences between groups in capsule mature collagen density [Fig. 1, single arrows].

Conclusions:
When a BIO envelope was used at initial CIED implantation (vs no envelope), we observed significantly less fibrous lead entrapment, easier generator & lead mobilization, and thinner mature fibrotic capsules at reoperation. Biologic tissue envelopes may prevent operative complications and enhance clinical outcomes.
Abstract 11054: Switching From Dual Antiplatelet Treatment Regimens With Aspirin Plus a P2Y
12
Inhibitor to Dual Pathway Inhibition With Low-Dose Rivaroxaban in Adjunct to Aspirin in Patients With Coronary Artery Disease: The SWAP-AC Study
Authors: Ortega-Paz Luis G. , Rollini Fabiana , Galli Mattia , Been Latonya , Ghanem Ghussan , Shalhoub Awss , Ossi Tiffany , Rivas Andrea , Zhou Xuan , Pineda Andres , Suryadevara Siva , Soffer Daniel , Zenni Martin , Angiolillo Dominick J , Franchi Francesco
Published: June 2023

Introduction:
Dual antiplatelet therapy (DAPT) and dual pathway inhibition (DPI) are potential long-term antithrombotic strategies for patients with coronary artery disease (CAD). However, patients already on DAPT are most likely to remain on the same treatment regimen rather than switching. To date, there is no data on the feasibility of switching from DAPT to DPI and the pharmacodynamic (PD) effects of such approach.

Methods:
SWAP-AC was a prospective, randomized, PD study conducted in 90 patients with CAD on DAPT with aspirin (81mg/qd) plus a P2Y
12
inhibitor [clopidogrel (75 mg/qd; n=30), ticagrelor (90mg/bid; n=30), or prasugrel (10mg/qd; n=30)]. Patients in each cohort were randomized to maintain DAPT or switch to DPI (aspirin 81mg/qd plus rivaroxaban 2.5mg/bid). PD assessments included VerifyNow P2Y
12
reaction units (PRU), light transmittance aggregometry (LTA) using 20 μM ADP, tissue factor (TF), and a combination of collagen + 5 μM ADP + TF (CATF, a marker of platelet-mediated global thrombogenicity), and a thrombin generation (TG) assay. Assays were performed at baseline (on DAPT) and 30 days post-randomization [trough (before maintenance dose) and peak (2 hours after maintenance dose) levels].

Results:
Switching from DAPT to DPI occurred without side effects. TG was reduced with DPI. In each cohort, DAPT was associated with lower PRU levels than DPI (
Figure
); LTA following ADP stimuli showed consistent results (data not shown). LTA following CATF stimuli (primary endpoint) showed no differences between DPI and DAPT in the ticagrelor and prasugrel, but not clopidogrel, cohorts (
Figure
). There were no differences in any of the cohorts with LTA using TF.

Conclusions:
SWAP-AC is the first study supporting the feasibility of switching to DPI patients with CAD on different maintenance DAPT regimens. Such approach was associated with increased P2Y
12
reactivity but reduced thrombin generation with a limited impact on platelet-mediated global thrombogenicity.
Abstract 11059: Sexual Dimorphism of Therapeutic Fasting in Mitigating Metabolic and Cardiovascular Dysfunction in Prediabetes: Possible Role of Adipose Dysfunction
Authors: Dwaib Haneen , Ajouz Ghina , Mougharbil Nahed , Obeid Omar , El-Yazbi Ahmed
Published: June 2023

Our previous work on non-obese prediabetic male rats showed that early cardiovascular (CV) and metabolic impairment was associated with localized perivascular adipose tissue (PVAT) dysfunction characterized by inflammation and hypoxia fueled by uncoupling protein 1 (UCP1) overexpression and hypertrophied adipocytes.Since there has been neither recommendations for pharmacological treatment for interrupting the hypoxia machinery in PVAT, nor a clear understanding of sexual dimorphism in PVAT involvement at this stage, therefore, we hypothesized that therapeutic fasting (TF) can alleviate PVAT dysfunction, metabolic and CV stress among prediabetic rats in a sex dependent manner. Male and female rats were fed ad libitum either a control or a mild hypercaloric diet (MHC) for 12 weeks, the typical protocol to induce prediabetes in male rats. To assess the role of female sex hormones 3 additional groups of females were bilaterally ovariectomized (OVX) on week 12. Afterwards, only the TF groups were subjected to daily fasting from 7.00pm-7.00am for 12 weeks with free access to water and to MHC during the light phase. Food intake, body composition, blood pressure, blood glucose profile, echocardiography, and serum lipid profile were examined regularly. At week 24 rats were catheterized for invasive hemodynamic examination, to assess baroreceptor sensitivity. After sacrifice, aortic contractility and endothelial function were assessed and molecular investigations were performed on various pools of adipose tissue.MHC feeding induced non-obese prediabetes, signs of early cardiovascular and metabolic dysfunction with PVAT impairment malfunctioning brown adipose tissue (BAT) only in male rats. Intact female rats resisted MHC-induced derangements, while OVX rats presented an obese prediabetic phenotype, with CV and metabolic impairment and PVAT dysfunction. Strikingly,TF in the presence of MHC feeding and in the absence of calorie restriction, and estrogen in the case of females, seemed to substantially correct these dysfunction in both male and OVX rats and interrupt hypoxia in PVAT and BAT in a UCP1 dependent manner. Taken together, our work suggests a novel mechanistic understanding of which TF interferes with the hypoxia machinery in PVAT
Abstract 11065: Stress T1 Mapping Demonstrates Coronary Microcirculatory Dysfunction in Both Nonhypertrophied and Hypertrophied Myocardium of Hypertrophic Cardiomyopathy
Authors: Kosuge Hisanori , Hachiya Shoko , Fujita Yasuhiro , Hida Satoshi , Chikamori Taishiro
Published: June 2023

Introduction:
Coronary microcirculatory dysfunction (CMD) in hypertrophic cardiomyopathy (HCM) is associated with clinical deterioration. We have shown that stress T1 mapping could detect CMD of hypertrophied interventricular septum (IVS). However, CMD in nonhypertrophied left ventricular free wall (LVFW) has not been fully elucidated.

Hypothesis:
We assessed the hypothesis that regional CMD in LVFW of HCM can be detected using stress T1 mapping.

Methods:
We evaluated 36 consecutive subjects (26 HCM patients and 10 control subjects, mean age: 61±3 years) who underwent CMR at 3T. Cine imaging, rest and adenosine stress T1 mapping, late gadolinium enhancement (LGE) and phase-contrast imaging of coronary sinus flow were performed. The T1 values at rest and after adenosine stress were measured as an averaged T values of 3 short-axis slices of LV myocardium and T1 reactivity (ΔT1) was calculated as follows: ΔT1 (%) = (T1stress - T1rest)/T1rest х 100. Coronary flow reserve (CFR) was measured coronary sinus blood flow during adenosine stress divided by that at rest.

Results:
The T1 values at rest were significantly higher in HCM than control (1245±9ms vs. 1196±11ms, p=0.0027), and the T1 values after adenosine stress significantly increased in both groups (HCM: 1285±10ms, p=0.0018 vs. rest, control: 1244±9ms, p=0.0128 vs. rest, Figure 1). Both IVS and LVFW demonstrated significantly lower ΔT1 in HCM than control (IVS: 3.95±0.35% vs. 5.68±0.41%, p=0.0163, LVFW: 4.80±0.39% vs. 6.75±0.65%, p=0.0163, Figure 2). CFR in HCM significantly decreased than that in control (2.48±0.40 % vs. 5.97±1.31 %, p=0.0051). Multiple regression analysis revealed that ΔT1 of both IVS and LVFW was correlated with CFR (β=0.527, p=0.0026, β=0.445, p=0.0325).

Conclusions:
T1 reactivity significantly decreased in both nonhypertrophied and hypertrophied myocardium of HCM compared to control. Stress T1 mapping have the advantage of being able to estimate regional CMD in addition to global CMD.
Abstract 11069: Evaluation for Ischemic Cardiomyopathy After Heart Failure Diagnosis is Associated With Reduced Mortality in a Safety-Net Setting
Authors: Durstenfeld Matthew S , Thakkar Anjali , Ma Yifei , Zier Lucas , Davis Jonathan D , Hsue Priscilla
Published: June 2023

Introduction:
Ischemic cardiomyopathy is a common cause of heart failure (HF). Many commercially insured HF patients are not evaluated for ischemia, but rates of testing in a safety net setting have not been investigated, and the effect of testing on mortality is not clear.

Methods:
We developed an EHR cohort of individuals with HF by ICD9 or 10 code in San Francisco’s municipal health system during 2001-2019. Invasive coronary angiography, nuclear stress, and coronary CT angiography were considered as ischemic testing. Proportions tested and adjusted relative risks [ARR] for testing were adjusted for age, sex, diabetes, hypertension, and tobacco use. To estimate the effect of testing on mortality, we created a “target trial” of patients with incident HF without known CAD using propensity score models.

Results:
Out of 15,558 individuals with HF, 4,215 (27.1%) ever underwent ischemic testing, without increase over time (p=0.33). Excluding those with prior testing, 2,483/13,821 (18.0%) had testing at a median 25 days after HF diagnosis (IQR 0-417). Groups less likely to receive testing included women (ARR 0.89, 95%CI 0.82-0.96; p=0.003), unstably housed individuals (ARR 0.45, 95%CI 0.37 to 0.54, p<0.0001), people with HIV (ARR 0.67, 95%CI 0.57-0.79, p<0.0001), and methamphetamine users (ARR 0.77, 95%CI 0.69-0.86; p<0.0001). Those hospitalized for HF were more likely to be tested (ARR 2.21, 95% CI 2.05-2.39; p<0.0001). Testing within 30 days was associated with a 4% absolute reduction in mortality (95%CI -6.5 to -1.6%; p<0.001) independent of hospitalization. Testing within 30 days and ever were associated with 22% and 27% lower mortality hazard, respectively (Figure).

Conclusions:
In a municipal health system in San Francisco, women, people with HIV, without stable housing, and methamphetamine users were less likely to receive ischemic testing. Ischemic testing was associated with improved survival. Ischemic testing should be considered for everyone with HF.
Abstract 11084: Procedural Parameters During Cryoballoon Ablation Predict Early Pulmonary Vein Reconnection and Atrial Fibrillation Recurrence
Authors: Chahine Yaacoub , Afroze Tanzina , Bifulco Savannah , Macheret Fima , Abdulsalam Nashwa , Boyle Patrick M , Akoum Nazem W
Published: June 2023

Introduction:
Cryoballoon ablation (CBA) is an established procedure for the management of atrial fibrillation (AF). We sought to assess procedural parameters as predictors of early PV reconnection and AF recurrence following CBA.

Methods:
119 patients undergoing CBA for AF were included. Balloon temperature (BT) recorded by the console during CBA targeting each of the four pulmonary veins (PV) was monitored to determine the time needed to reach -15°C and -40°C from the start of the freeze. BT at 30 seconds (s), 60 s and the temperature nadir point were also recorded. Rewarming (thaw) time from the nadir point to 0 °C, was also determined. PVs were assessed for early reconnection and patients were followed for arrhythmia recurrence.

Results:
Early PV reconnection was identified in 39 (8.3%) of 471 PVs. BT was significantly colder in the absence of early PV reconnection (30 s: -33.5°C vs -29.5°C, p=0.001; 60 s: -41°C vs -36.5°C, p<0.001; nadir: -47°C vs -41.5°C, p<0.001). Early PV reconnection was associated with significantly shorter time to reach -15°C and -40°C (12s vs 14.5s, p=0.023; and 46s vs 75s, p=0.005) and longer rewarming time (7s vs 5.75s, p=0.012) (Panel A). A logistic regression model with the procedural parameters was created to predict early PV reconnection and the corresponding ROC analysis had an AUC=0.71 (Panel B). During an average follow-up period of 559 days, AF recurrence occurred in 51 (49%) patients. Kaplan Meier analysis showed better arrhythmia free survival for patients in whom BT decreased below -40°C in all PVs and patients who had no early PV reconnections, compared to patients where BT below -40°C was not achieved in at least one PV (Log Rank = 6.3, p=0.012) and patients who had PV reconnections (Log Rank = 4.1, p=0.043) (Panel C).

Conclusions:
Slower BT decline, warmer BT nadir, and faster rewarming time predict early PV reconnection. A lower rate of AF recurrence was associated with absence of early PV reconnections and achieving a BT below -40 °C in all PVs.
Abstract 11100: Persistent Gender Disparities in STEMI Mortality: Insights From the Midwest STEMI Consortium
Authors: Kompella Divya , Yildiz Mehmet , Okeson Brynn , Patel Kirtan , Aziz Dalia , Pico Madison , Garberich Ross , Jollis James , Chambers Jenny , Aguirre Frank , Garcia Santiago A , Sharkey Scott W , Henry Timothy D , Quesada Odayme
Published: June 2023

Introduction:
Over the past two decades, national and regional initiatives have been dedicated to closing the gender gap and resolving disparities in STEMI care and outcomes for females. In this study, we explored how gender disparities have evolved in a well-established regional STEMI system in the US.

Methods:
Using the Midwest STEMI Consortium database, we examined sex differences in STEMI treatment and outcomes when stratified by decade from 2003 to 2009 versus 2010 to 2020.

Results:
Among 12,878 consecutive STEMI patients, 30.3% were female. Females were older and more likely to have a history of hypertension and diabetes as compared to males in both time periods (2003-2009 and 2010-2020). Females persistently had longer door-to-balloon times, underwent less revascularization with PCI, and received GDMT less often than males in both time periods. From 2003 to 2009, the incidence of cardiogenic shock was higher in females. Despite improvements in the rate of in-hospital mortality in the last decade, the post-discharge to 1-year mortality risk was significantly higher in females compared to males in both time periods.

Conclusions:
Over the past two decades, gender disparities in STEMI care and outcomes have persisted. Despite an improvement in the rate of in-hospital mortality, sex differences persist with females having a higher risk of discharge to 1-year mortality. This is in part due to persistent discrepancies in baseline comorbidities and patient care, including longer door-to-balloon times and less GDMT at discharge. These findings underscore the need for both regional and national efforts to close this persistent gap.
Abstract 11123: Effects of Home-Based Ischemic Leg Symptom-Inducing Exercise on Simultaneous Improvement in Treadmill Walking Distance and Patient Reported Outcomes and in Peripheral Artery Disease: The LITE Randomized Clinical Trial
Authors: Whipple Mary O , Spring Bonnie , Treat-Jacobson Diane J , Polonsky Tamar S , Guralnik Jack , Forman Daniel E , Zhang Dongxue , Xu Shujun , Leeuwenburgh Christiaan , Manini Todd , Rejeski W. Jack , McDermott Mary M
Published: June 2023

Introduction:
An optimal exercise intervention for individuals with peripheral artery disease (PAD) should improve both objective measures of walking and patient reported outcomes (PROs). This study evaluated whether home-based walking exercise conducted at a pace that induced ischemic leg symptoms (high intensity) improved both treadmill walking distance and related PROs more often than walking exercise conducted at a pace that did not induce ischemic leg symptoms (low intensity) and a non-exercise control group (control), respectively.

Methods:
Post-hoc analysis of PAD patients who participated in the 12-month LITE Trial and were assessed at 12 months follow-up. The LITE Trial randomized people with PAD into home-based high intensity exercise, low intensity exercise, or control. Objective measures of walking were pain-free treadmill walking distance (PFWD) and maximal treadmill walking distance (MWD). PROs related to physical functioning consisted of Walking Impairment Questionnaire (WIQ) and the Short Form-36 (SF-36) physical function score. Participants were categorized into one of four groups at 12-month follow-up: 1) improved both treadmill outcome and PRO, 2) improved treadmill outcome but not PRO, 3) improved PRO but not treadmill outcome; and 4) improved neither treadmill outcome or PRO. Improvement was defined as follow-up score minus baseline >0.

Results:
Of the 305 people with PAD randomized, 186 (61% Black, 46% female) had data for both treadmill testing and at least one PRO available at baseline and 12-month follow-up (age, sex, race). Participants randomized to high intensity exercise were significantly more likely to improve both MWD and WIQ distance and speed (Table), as well as both PFWD and WIQ speed, compared to the other groups.

Conclusions:
To improve both treadmill outcomes and PROs, patients with PAD should be encouraged to walk for exercise at a pace inducing ischemic leg symptoms, and not at a pace without ischemic leg symptoms.
Abstract 11127: Effectiveness of Sodium-Glucose Cotransporter-2 Inhibitors in Patients With Heart Failure With Preserved Ejection Fraction and Type 2 Diabetes
Authors: Fu Edouard L , Patorno Elisabetta , Everett Brendan , Vaduganathan Muthiah , Solomon Scott , Levin Raisa , Schneeweiss Sebastian , Desai Rishi
Published: June 2023

Introduction:
Limited information exists on the effectiveness of sodium-glucose cotransporter-2 inhibitors (SGLT2i) among patients with heart failure with preserved ejection fraction (HFpEF) in routine clinical care. Further, it remains uncertain if all agents in the SGLT2i class confer similar benefits in HFpEF.

Methods:
We compared initiators of SGLT2i versus sitagliptin, a DPP-4 inhibitor, using US Medicare data (04/2013-12/2018). Patients were required to have a diagnosis of type 2 diabetes (T2D) and HFpEF, identified using a validated prediction model. The primary outcome was a composite of all-cause mortality or worsening HF, i.e., outpatient use of intravenous diuretics or hospitalization for heart failure (HHF). Hazard ratios (HR) were estimated using Cox regression adjusting for 121 confounders. To address potential unmeasured confounding, we calibrated our results using estimates for HHF from a meta-analysis of HF RCTs of SGLT2i.

Results:
We included 33,475 patients with HFpEF and T2D (6,924 initiated SGLT2i and 26,551 initiated sitagliptin). Initiation of SGLT2i was associated with a lower risk of the primary composite outcome (adjusted HR 0.60; 95% CI 0.54-0.68), all-cause mortality (0.62; 0.53-0.74) and worsening HF (0.58; 0.52-0.66). We observed similar associations with the primary outcome for 3 SGLT2i agents (p-value for interaction 0.28) and across subgroups based on demographics, comorbidities, and HF treatments (Figure). Bias calibrated HR were 0.79 (0.69-92) for the primary composite outcome and 0.81 (0.63-1.03) for all-cause mortality suggesting our results cannot be fully explained by residual confounding.

Conclusions:
In routine US clinical practice, SGLT2i demonstrated robust clinical effectiveness in older adults with HFpEF and T2D without apparent heterogeneity across the class. Given the observational nature of the study, potential confounding and HFrEF/HFpEF misclassification cannot be entirely ruled out.
Abstract 11138: Short-Term Outcomes in Patients With a St-Elevation Myocardial Infarction and Concomitant Lung Cancer
Authors: Gill Ahmad , Al-Taweel Omar , He Emily , Jaradat Mohammad , HAWWASS DALIA , Ahsan Chowdhury
Published: June 2023

Introduction:
Patients with a ST-Elevation Myocardial Infarction (STEMI) and concomitant lung cancer are an understudied cohort. In this study, we explore the in-hospital outcomes of STEMI patients with and without lung cancer.

Methods:
We queried the National Inpatient Sample database (2016-2019) to identify patients admitted with a principal diagnosis of STEMI and secondary diagnosis of lung cancer. We conducted propensity score matching using a greedy nearest neighbor 1:1 model. Multivariable logistic regression was used to compare mortality.

Results:
7020 patients met our inclusion criteria. Patients with a STEMI and lung cancer had 1.84 times higher odds of suffering in-hospital mortality compared to STEMI patients without lung cancer (aOR 1.84, 95% CI: 1.55-2.17; p < 0.001). When separated by race, STEMI patients with lung cancer had a higher mortality rate amongst White (11.5% vs 6.5%, p < 0.001) and Black (11.9% vs 6.5%, p = 0.03, Figure 1) patients. STEMI patients with lung cancer were less likely to undergo percutaneous coronary intervention (22.3% vs 32.0%, p < 0.001). There was no difference in intraoperative and postoperative cardiac arrest, cerebral infarction and respiratory failure. Additionally, STEMI patients with lung cancer had longer hospital stays (4.9 days vs 4.4 days, p < 0.001, Table 1).

Conclusions:
Patients with a STEMI and lung cancer had higher odds of suffering in-hospital mortality compared to patients with a STEMI without lung cancer. Our findings emphasize the importance of risk-benefit analysis and collaborative discussion amongst the care team prior to choosing the appropriate treatment modality.
Abstract 11139: Role of Esophageal Cooling in the Prevention of Esophageal Injury in Atrial Fibrillation Catheter Ablation: A Systematic Review and Meta-Analysis of Randomized Controlled Studies
Authors: Hamed Mohamed , Elseidy Sheref , Abdelsabour Mohamed , Barakat Amr F , Elbadawi Ayman
Published: June 2023

Introduction:
Trials evaluating the role of esophageal cooling in the prevention of esophageal injury in patients undergoing atrial fibrillation (AF) catheter ablation have yielded mixed results. The aim of our study is to evaluate the efficacy of esophageal cooling in the prevention of esophageal injury in patients undergoing AF catheter ablation.

Methods:
Comprehensive search of MEDLINE, EMBASE, and Cochrane databases through April 2022 for randomized controlled trials (RCTs) evaluating the role of esophageal cooling compared with control in the prevention of esophageal injury during AF catheter ablation. The study's primary outcome was the incidence of total esophageal injury. Secondary outcomes included the incidence of severe esophageal injury, the incidence of mild to moderate esophageal injury, procedural duration, posterior wall duration, total radiofrequency (RF) time, acute reconnection incidence, and ablation index.

Results:
The meta-analysis included 4 RCTs with total of 294 patients. There was no significant difference in the incidence of total esophageal injury between esophageal cooling and control (15% vs. 19%; Relative Risk [RR] 0.86; 95% confidence interval [CI] 0.31 - 2.41; I
2
= 63%). However, compared with control, esophageal cooling showed lower risk of severe esophageal injury (0.01% vs. 0.09%; RR 0.21; 95% CI 0.05 - 0.80). There were no significant differences among the two groups in mild to moderate esophageal injury (13.6% vs. 12.1%; RR 1.09; 95% CI 0.28 - 4.23), procedure duration (standardized mean difference [SMD] -0.03; 95% CI -0.36 - 0.30), posterior wall duration (SMD 0.27; 95% CI -0.04 - 0.58), total RF time (SMD -0.50; 95% CI -1.15 - 0.16), acute reconnection incidence (RR 0.93; 95% CI 0.02 - 36.34), and ablation index (SMD 0.16; 95% CI -0.33 - 0.66).

Conclusions:
Among patients undergoing AF catheter ablation, esophageal cooling did not show a significant difference in the incidence of total esophageal injury. However, it has shown a significant decrease in the risk of severe esophageal injury without affecting the ablation process. This can help decrease the progression to atrial-esophageal fistula. Further large RCTs are needed to better evaluate the role of esophageal cooling in the prevention of esophageal injury.
Abstract 11165: Characterization of Heart Failure Patients in an Academic Home Hospital Program and Identification of Patient Factors Requiring Escalation of Care
Authors: Achanta Aditya , Moss Carson , Phadke Neelam , Wasfy Jason H , Thompson Ryan W , Weiner Rory B
Published: June 2023

Background:
Hospital capacity concerns exacerbated by the COVID-19 pandemic have accelerated growth of hospital at home (HaH) programs. However, for HaH admissions related to heart failure, information on patient characteristics and clinical outcomes remain sparse. We aimed to better characterize heart failure admissions in a HaH model and assess characteristics of patients who later needed escalation of care to a traditional hospitalization.

Methods:
This retrospective, descriptive study examined HaH admissions for heart failure at an academic medical center between 2017 and 2022. We compared baseline characteristics and outcomes using the Chi-squared test for categorical variables and t-test for continuous variables for patients who required escalation of care to those who did not. Using the same methods, we also compared patients based on their location prior to admission (e.g. emergency department (ED), home).

Results:
Heart failure was the primary diagnosis for 32% of HaH admissions. The majority of the heart failure cohort (N=199, average age 80.6 years), 73.9%, had heart failure with preserved ejection fraction (HFpEF). Escalation of care to traditional hospitalization was required for 22.6% of patients. 9.0% of patients died within 90 days, and 20.1% and 36.2% of patients were readmitted for any reason within 30 and 90 days respectively. Patients whose care was escalated were more likely to have a history of chronic kidney disease (84.1% vs 66.9%, p=0.043), higher admission BUN (41.5 vs 31.1, p=0.004) and creatinine (1.74 vs 1.41, p=0.011), and a history of PCI (20.5% vs 5.3%, p=0.005). Patients referred directly from home compared to the ED had similar baseline characteristics and rates of 90 day inpatient readmission and mortality.

Conclusions:
Patients admitted to HaH for heart failure represent a high risk cohort who are commonly older with multiple comorbidities and more likely to have HFpEF. Among this cohort, patients with kidney dysfunction and/or history of percutaneous coronary intervention are more likely to require escalation of care. These results suggest that heart failure patients admitted to HaH who will later need traditional hospitalization could be identified prospectively using these characteristics.
Abstract 11171: Smoking Modulates Response to Anti-Arrhythmic Therapy for Atrial Fibrillation Patients Across Race-Ethnicity
Authors: Aggarwal Ishita , Al-azzam Bahaa , Diaz Annette , Sreepathy Pranati , Barney Miles , Shapiro Katherine , Darbar Faisal , Ornelas Aylin , Chen Yining , Bhan Adarsh , Konda Sreenivas , Tofovic David , Darbar Dawood
Published: June 2023

BACKGROUND:
Smoking is associated with increased risk of developing atrial fibrillation (AF) and stroke. Yet, it remains unclear if it also predicts response to rhythm control therapy across race-ethnicity. We sought to determine if response to rhythm control therapy for AF is modulated by smoking across race-ethnicity.

Methods:
529 patients treated with a rhythm control strategy were prospectively enrolled in the Chicagoland area. Patients were classified into White, Black or Hispanic\Latino based on race\ethnicity and ancestry markers. Rhythm control included antiarrhythmic drugs (AADs) and/or catheter ablation. Successful response was defined as continuation of the same AAD for at least 6 months and/or successful catheter ablation without recurrence of AF for 12 months.

Results:
235 (44%) were Black, 192 (36%) were White, and 102 (19%) were Hispanic. 299 (57%) were treated with AADs and 230 (44%) with catheter ablation. One-hundred sixty-eight (35%) patients had a history of smoking. Baseline co-morbidities were similar across responders and non-responders. In multivariate regression analysis (Table 1), patients with a smoking history were more likely to have a recurrence of AF when treated with a rhythm control strategy (odds ratio [OR] 1.51, 95% confidence interval [CI] 1.03-2.21,
P
=0.03). Stratified multivariate regression analysis showed that smokers were more likely to have a recurrence of AF after ablation therapy as compared to AADs (OR 1.49, 95% CI 1.03-2.17,
P
= 0.03). Multivariate logistic regression showed that patients that smoked for >20 years were twice as likely to have a recurrence of AF with a rhythm control therapy than those who smoked for <20 years (OR 1.88, 95% CI 1.20- 2.93,
P
= 0.01).

Conclusions:
A smoking history modulates response to rhythm control therapy for AF across race-ethnicity. Our study highlights the importance of smoking cessation before initiation of rhythm control agents in patients with AF.
Abstract 11183: Unusual Color Flow Leads to Diagnosis of Unroofed Coronary Atrial Septal Defect
Authors: Mehlman Andrew , Swearingen Sean , Derbas Laith , Patel Priya , Shaban Nada
Published: June 2023

Introduction:
Unroofed coronary sinus-atrial septal defect (CS-ASD) is a very rare anomaly that may be easily missed by transthoracic echocardiography.

Case:
A 59 year old woman presented with chronic and progressively worsening dyspnea. TTE demonstrated preserved ejection fraction, right ventricular and atrial dilation, and elevated pulmonary artery pressures. Color doppler demonstrated a persistent diastolic flow at the interatrial septum immediately above the plane of the tricuspid valve, suspicious for atrial septal defect (Fig. 1). Such aberrant flow was not observed on multiple prior TTEs.

Decision-Making:
Given the uncertain nature of the abnormal color flow seen, further imaging was pursued with a gated Cardiac CT with contrast. CT imaging demonstrated a dilated coronary sinus with a communication between the roof of the terminal coronary sinus and the left atrium, consistent with an unroofed coronary sinus-atrial septal defect (CS-ASD) (Fig. 2). There was no evidence of a persistent left superior vena cava. Cardiac MRI demonstrated a significant right to left shunt with a Qp/Qs of 1.53 using phase contrast imaging.

Discussion:
CS-ASD is a very rare cardiac anomaly and is the most uncommon type of ASD (<1%), often associated with a persistent left superior vena cava. Given the posterior nature of the defect, it is often missed on TTE. In our case, suspicion was raised by a small abnormal color jet of flow coming from the interatrial septum. Cardiac CT is an excellent diagnostic modality for CS-ASD given its excellent visuospatial capabilities and ability to evaluate pulmonary veins. Cardiac MRI may serve as a helpful adjunct in quantification of shunt flow.
Abstract 11189: An Integrated Framework With Machine Learning and Radiomics Score for the Prediction of Coronary Artery Calcium Score From Chest Radiographs
Authors: Park Hyung-Bok , Jeong Hyunseok , Hong Youngtaek , Chang Hyuk-Jae
Published: June 2023

Introduction:
Recently introduced radiomics technology enables the detection of hidden information from commonly disregarded medical images, including CXR.

Hypothesis:
The purpose of this study was to evaluate the feasibility of a novel technique involving radiomics features combined with machine learning to identify moderate-to-severe coronary artery calcium (CAC) using simple chest X-ray radiography (CXR).

Methods:
We included 559 patients (women, 44.9%; mean age, 62.4 ± 9.4 years) from two independent clinical studies who underwent a calcium scan and CXR within 6 months. The total cohort was allocated to the training and validation cohorts in a 7:3 ratio, with all clinical characteristics well-matched, including the CAC score. Radiomics features were extracted from manually delineated cardiac contours, and a radiomics score formulation for the prediction of a CAC score ≥100 was generated using the machine learning method in the training cohort. To evaluate the incremental performance of the radiomics score, a basic clinical model including age, sex, and body mass index (model 1) and a radiomics score added model (model 2) were utilized.

Results:
The radiomics score was the most prominent predictive factor for CAC score ≥100 (odds ratio [OR] = 2.33; 95% confidence interval [CI] = 1.62-3.44; p < 0.001). In the training cohort, model 2 demonstrated significant incremental validity in predicting CAC scores ≥100 compared to model 1 (area under the curve [AUC]; 0.73 vs. 0.69, p = 0.022). The performance of model 2 was also similar in both the training and validation cohorts (AUC 0.73, 95% confidence interval [CI] 0.68 - 0.78 vs. AUC 0.72, 95% CI 0.64 - 0.80).

Conclusions:
We developed a machine learning-based radiomics scoring model that could be utilized as a potential imaging marker for predicting CAC scores from CXR. This novel method may be widely applicable to clinical practice and can improve the pre-test probability of coronary artery disease.
Abstract 11195: Transcatheter versus Surgical Aortic Valve Replacement Outcomes Among Solid Organ Transplant Patients: A Systematic Review and Meta-Analysis
Authors: Jaiswal Vikash , Kalra Kriti , Ishak Angela , Attia Abdelrahman , sharma prachi , Jaiswal Akash , Grubb Kendra J
Published: June 2023

Introduction:
The safety and clinical outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) among solid organ transplant patients are not well documented.

Objective:
This study aimed to evaluate the clinical outcomes of TAVR and SAVR among patients with a history of solid organ transplantation.

Method:
We performed a systematic literature search of databases for relevant articles from inception until April 20, 2022.

Result:
A total of 342 studies were identified, resulting in 7 studies with a total of 6,128 patients included in the final analysis. The odds of in-hospital mortality (OR 0.29, 95% CI 0.16-0.52, p < 0.0001), blood transfusion (OR 0.30, 95% CI 0.22-0.40 p < 0.00001), postoperative bleeding (OR 0.40, 95% CI 0.33-0.48 p < 0.00001), acute kidney injury (OR 0.50, 95% CI 0.38-0.67 p < 0.00001), and sepsis or infection (OR 0.37, 95% CI 0.25-0.56, p < 0.00001) were significantly lower in patients undergoing TAVR compared to SAVR. Permanent pacemaker implantation was significantly higher in patients who underwent SAVR (OR 2.96, 95% CI 1.98-4.44, p = <0.00001) than those who had TAVR. The odds of 30-day mortality, one-year mortality and acute myocardial infarction were similar between the two groups respectively. Length of hospital stay was significantly lower in patients undergoing TAVR (MD -4.12 mmHg, 95% CI -5.06--3.18, p = <0.00001) compared to those who underwent SAVR.

Conclusion:
TAVR is confirmed to be advantageous in short term with improved in-hospital survival and lower rates of major complications
Abstract 11201: Relationship Between Periodontitis and Atrial Fibrosis in Atrial Fibrillation: Histological Evaluation of Left Atrial Appendages
Authors: Miyauchi Shunsuke , tokuyama takehito , Okubo Yousaku , okamura sho , Miyamoto Shogo , Oguri Naoto , Takasaki Taiichi , Katayama Keijiro , Takahashi Shinya , Nakano Yukiko
Published: June 2023

Introduction:
Atrial fibrosis contributes to the onset and persistence of atrial fibrillation (AF) and AF-related stroke. Periodontitis, a common infectious and inflammatory disease, aggravates some systemic diseases. However, the association of periodontitis with AF and with atrial fibrosis has remained unclarified.

Hypothesis:
We hypothesized that periodontitis aggravates atrial fibrosis and conducted a histological study using resected left atrial appendages (LAAs).

Methods:
Seventy-six patients with AF (55 with nonparoxysmal AF, 25 with mitral valve regurgitation [MR], 18 with LAA thrombus) who were scheduled to undergo LAA excision during cardiac surgery were prospectively enrolled. All patients underwent an oral examination, and remaining number of teeth, bleeding on probing (BOP), periodontal probing depth (PPD), and periodontal inflamed surface area (PISA) were evaluated as parameters of periodontitis. The degree of fibrosis in each LAA was quantified by Azan-Mallory staining.

Results:
BOP (
R
= 0.48,
P
< 0.0001), PPD of
>
4 mm (
R
= 0.26,
P
= 0.02), and PISA (
R
= 0.46,
P
< 0.0001) were positively correlated with atrial fibrosis. Among patients with >10 remaining teeth, PISA was positively and strongly correlated with atrial fibrosis (
R
= 0.57,
P
< 0.0001; Figure). After adjustments for age, AF duration, BMI, MR, and CHADS
2
(congestive heart failure, hypertension, age, diabetes, previous stroke/transient ischemic attack) score, PISA was significantly associated with atrial fibrosis (
β
= 0.016,
P
= 0.0002).

Conclusions:
We histologically revealed the association of periodontitis with atrial fibrosis. This indicates that periodontitis, which is modifiable, is a risk factor for AF.
Abstract 11204: Intraoperative Vital Parameters Improve the Accuracy of Machine Learning Based Prediction Model for Perioperative Stroke in Patients With Non Cardiac Surgery
Authors: Oh Mi-Young , Jung Young Mi , Kim Wonpyo , Lee Hyung-Chul , Lim Jaehyun , Lee Seung Mi
Published: June 2023

Introduction:
Perioperative stroke is one of the most devastating events after surgery. To prevent perioperative stroke and stratify the patients at risk, several prediction models or scores based on the preoperative factors were suggested. However, there had been never reported a prediction model using intraoperative physiologic parameters.
Aim:
We aimed to develop a prediction model for perioperative stroke by analyzing pre- and intraoperative factors using machine learning techniques.

Methods:
This retrospective cohort study included patients who underwent non-cardiac surgery between 2016 and 2019 at Seoul National University Hospital. Perioperative stroke was defined as a newly developed ischemic lesion at diffusion weighted imaging within 30 days after surgery. Preoperative factors were age, risk factors and laboratory data. Intraoperative variables were blood pressure, heart rate, saturation monitoring value, total amount of fluid and urine volume during surgery. We developed a random forest based prediction model composed of pre- and intraoperative factors and compared with a model consisting of only preoperative features. We validated the model in an external cohort of patients at another hospital between 2020 and 2021.

Results:
A total of 15752 patients were included in the development cohort, and 109 patients had perioperative stroke. In external validation cohorts, stroke occurred in 11 of 449 patients. The area under the receiver operating characteristics curves (AUC) for integrated models using pre- and intraoperative parameters was significantly higher than that of model using only preoperative factors, as shown in figure(0.822, 95% confidence interval, 0.760-0.883,
p
<0.001). The AUC of integrated model in external validation cohorts showed the trend in line with that of development cohorts.

Conclusions:
We demonstrated that using both pre- and intraoperative features may improve the accuracy of prediction for perioperative stroke.
Abstract 11223: Left Atrial Volumetric/Mechanical Coupling Index: A Novel Predictor of Clinical Outcomes in Heart Failure With Preserved Ejection Fraction
Authors: Okada Masato , Tanaka Nobuaki , Toshinari Onishi , Iwakura Katsuomi , Seo Masahiro , Hayashi Takaharu , Yano Masamichi , Nakagawa Akito , Nakagawa Yusuke , Tamaki Shunsuke , Yamada Takahisa , Yoshio Yasumura , Sotomi Yohei , Nakatani Daisaku , Hikoso Shungo , Sakata Yasushi ,   the OCVC-Heart Failure Investigators
Published: June 2023

Background:
Left atrial (LA) dysfunction is common in heart failure with preserved ejection fraction (HFpEF). A higher LA volumetric/mechanical coupling index (LACI), calculated as the LA volume index (LAVI) divided by the diastolic late mitral annular velocity (a’), corresponds to weaker atrial mechanical activity for a larger volume index. Recently, the prognostic importance of the LACI has been reported in patients with heart failure with reduced ejection fraction, but data in patients with HFpEF are limited.

Purpose:
To investigate whether the LACI is associated with prognosis in patients with HFpEF.

Methods:
An analysis was performed from a prospective multicenter observational registry for HFpEF (PURSUIT-HFpEF Registry) conducted in the Osaka region of Japan. A total of 1231 patients hospitalized for acute heart failure (diagnosed by using Framingham criteria) met the inclusion criteria: a left ventricular ejection fraction (LVEF) ≥50% and brain natriuretic peptide ≥100 pg/ml. After excluding patients with persistent atrial fibrillation, we enrolled 508 patients (age, 80±10 years; females, 58.9%; paroxysmal atrial fibrillation, 18.5%) whose LAVI and a’ at discharge were available. Heart failure hospitalizations and cardiovascular deaths were the primary endpoint.

Results:
There was a weak negative correlation between the LAVI (median 42, interquartile range [IQR] 32-55 ml/m
2
) and a’ (median 6.9, IQR 5.3-8.6 cm) (r=-0.26, p <0.001). As a result, the overall LACI was 6.28 (IQR 4.11-9.46). During a median follow-up of 729 (IQR 407-1180) days after discharge, 171 patients experienced the primary endpoint. The incidence incrementally increased with the LACI quartile groups (Q1: 22.1%, Q2: 33.1%, Q3: 38.6%, Q4: 40.9%, log-rank p = 0.003). After adjusting for age, gender, body mass index, left ventricular filling pressure, and serum brain natrium peptide levels, the LACI (hazard ratio, 1.18 per quartile increase; 95% confidence interval, 1.00-1.38; p = 0.045) was a significant predictor of the primary endpoint.

Conclusions:
The LA mechanical activity decreased with enlargement of the left atrium. The LACI was a novel index for predicting clinical outcomes in patients with HFpEF
Abstract 11228: Association Between Nonalcoholic Fatty Liver Disease Risk Alleles and Atherosclerosis
Authors: Ikezaki Hiroaki , Schaefer Ernst J , Murata Masayuki , Shimono Nobuyuki
Published: June 2023

Introduction:
Nonalcoholic fatty liver disease (NAFLD) risk alleles are associated with lipid metabolisms. However, the association between those variants and atherosclerosis has not yet been fully evaluated.

Hypothesis:
We hypothesized that NAFLD genetic risk alleles are associated with the progression of atherosclerosis.

Methods:
A total of 1,050 Japanese men and women (median age 55 years and median body mass index 22.9 kg/m2) free of cardiovascular disease, dyslipidemia, hypertension, and diabetes were studied. Among NAFLD risk SNPs, variants of patatin-like phospholipase domain containing 3 (
PNPLA3
), transmembrane 6 superfamily member 2 (
TM6SF2
), glucokinase regulator (
GCKR
), and neurocan (
NCAN
) were assessed. Plasma total cholesterol, low-density lipoprotein cholesterol (LDL-C), small dense LDL-C, LDL-triglycerides, high-density lipoprotein cholesterol (HDL-C), HDL3-C, triglycerides, remnant-like particle cholesterol, lipoprotein(a), and adiponectin were also measured. At both baseline and after a five-year follow-up, carotid intima-media thickness (cIMT) was assessed. Atherosclerosis was defined as cIMT more than 1.1mm or the presence of a plaque. Univariate and multivariate analyses and chi-square and Fisher’s exact tests were performed to examine the associations between NAFLD risk SNPs, lipoproteins, and progression of atherosclerosis.

Results:
Both median and maximum cIMT of total participants did not differ between baseline and after a five-year follow-up. Among participants without atherosclerosis at baseline, the rate of plaque development was 13.8% (121/880) with the major allele (CC) of
NCAN
being significantly higher than other alleles. Variants of
NCAN
were associated with the development of plaque (
P
= 0.04, Fisher’s exact test). Variants of
PNPLA3
,
TM6SF2
,
GCKR
, and
NCAN
were not associated with changes in lipoproteins.

Conclusions:
A
NCAN
variant, one of the NAFLD risk SNPs, was associated with the development of plaque independent of lipoproteins alterations among healthy Japanese participants.
Abstract 11232: Coronary Artery Bypass Graft Surgery Shows Improved Restricted Mean Survival Time and Time Lost Compared to Medical Therapy in Patients With Left Ventricular Dysfunction: From the STICH Trial
Authors: Reinhardt Samuel W , Huang Haocheng , Parise Helen , Ahmad Tariq , Velazquez Eric J , Faridi Kamil F
Published: June 2023

Background:
Restricted mean survival time (RMST) and restricted mean time lost (RMTL) are alternative clinical trial outcome measures that can be used to quantify treatment effects. In this study we evaluated RMST and RMTL in the STICH trial to quantify long-term treatment effects of coronary artery bypass graft surgery (CABG) vs. medical therapy in patients with coronary artery disease (CAD) and depressed left ventricular ejection fraction (LVEF).

Methods:
RMST was calculated as the average event-free survival up to follow-up at 10 years. RMST was calculated separately using i) the trial follow-up time and ii) age instead of time with estimation of age-specific events rates. Delta RMST was determined for CABG vs. medical therapy, with delta RMST >0 favoring CABG. The RMTL ratio was calculated by dividing the RMTL of the CABG group by the RMTL of the medical therapy group, with a ratio <1 favoring CABG. Analysis was performed for the primary and secondary outcomes for the entire cohort and prespecified subgroups.

Results:
For the primary outcome of all-cause mortality, RMST for the CABG group was 2714 days vs. 2501 days for the medical therapy group (delta RMST = 213 days [95% CI 21.63, 404.63]; p=0.029). The RMTL ratio for all-cause mortality was 0.90 (95% CI 0.82, 0.99; p = 0.030). For the secondary outcomes of death from cardiovascular (CV) causes, all-cause mortality or CV hospitalization, and all-cause mortality or revascularization, delta RMST and the RMTL ratio favored CABG over medical therapy (Figure). In subgroup analyses of all-cause death, delta RMST and RMTL ratio favored CABG in patients under 60 years old, racial/ethnic minorities, and those with 3-vessel disease.

Conclusion:
In 10-year follow up in the STICH trial, RMST and RMTL both favored CABG compared to medical therapy for all-cause mortality and other cardiovascular endpoints in patients with CAD and low LVEF. These findings can be used to help quantify the potential benefits of CABG in this population.