bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11245: Trends in Cardiovascular Risk Factors Among Women Veterans
Authors: Ebrahimi Ramin , Leng Mei , Shroyer Annie L
Published: June 2023

Introduction:
Women Veterans (WV) have been identified as a high-risk population for developing ischemic heart disease (IHD). Trends for prevalence of IHD risk factors for WV over the past two decades is unknown. The goal of this study was to evaluate these trends.

Methods:
Veterans Affairs (VA) electronic health records were used to identify WV aged ≥18 years who visited any VAs nationwide from 1/1/2001-12/31/2017. Risk factors studied included diabetes, hypertension, hyperlipidemia, smoking, and obesity. Prevalence of each risk factor was calculated based on the number of patients alive, and of those, the number of patients with the specific risk factor on December 31
st
of each year. Diagnosis of each risk factor was based on the International Classification of Disease versions 9 and 10 codes.

Results:
Table 1 reveals the prevalence of each risk factor from 2001-2017. During this period the prevalence of these risk factors increased by, 28% for hypertension, 67% for diabetes, 71% for obesity, 140% for hyperlipidemia and 178% for smoking. Alarmingly, in 2017, the prevalence of obesity in WV was >43%.

Conclusions:
The prevalence of each of these cardiovascular risk factors significantly increased from 2001-2017 in WV. Research towards prevention of these risk factors is warranted in this high-risk population.
Abstract 11248: The Impact of Acute Coronary Syndrome on Early In-Stent Neoatherosclerosis Using Optical Coherence Tomography
Authors: Nakao Kazuhiro , Yamazaki Takanori , Kure Yusuke , Shimada Takenobu , Yamaguchi Tomohiro , Okai Tsukasa , Otsuka Kenichiro , Takeshita Hiroaki , Izumiya Yasuhiro , Fukuda Daiju
Published: June 2023

Introduction:
Patients with acute coronary syndromes (ACS) are known to have a higher risk of target vessel revascularization after percutaneous coronary intervention (PCI) and worse long-term prognosis than patients with stable angina. Neoatherosclerosis is one of the significant factors at very late stent thrombosis. And the presence of in-stent neoatherosclerosis is independently associated with major adverse cardiac event. Although many studies have been reported on neoatherosclerosis, few have been reported on short-term in-stent neoatherosclerosis. Moreover, none have evaluated the impact of ACS. We investigated the impact of ACS on in-stent neoatheroscrelosis using Optical Coherence Tomography (OCT) in the present study.

Methods:
From March 2017 to November 2020, we investigated 102 patients (122 lesions) who had undergone PCI using drug eluting stent during that period and were followed up for OCT within one year. Subjects were categorized as ACS or non-ACS according to clinical findings at the time of target lesion intervention. We used OCT to investigate the presence of early in-stent neoatherosclerosis.

Result:
ACS group consisted of 21 (20.6%). In patients with ACS, women tended to be more common (38% vs 19%,
P
=0.0777). There were no differences in age or presence of diabetes or dyslipidemia during treatment. There were also no significant differences in LDL-C levels at the time of PCI (88 (73-114) mg/dL vs 100 (85-124) mg/dL,
P
=0.319) and when observed by OCT (67 (55-81) mg/dL vs 68 (57-89) mg/dL,
P
=0.622). The ACS group was significantly more likely to have a previous history of ACS (38% vs 12%,
P
=0.0104). Stent length was significantly shorter in ACS patients (24 (18-28) mm vs 32 (23-38) mm,
P
=0.0365). The mean dulation from PCI was 292 days. In-stent neoatherosclerosis was more frequent in the ACS group (31.8 % vs 9.9 %,
P
=0.014).

Conclusion:
This observational study using OCT indicates that stenting for ACS lesion is associated with early in-stent neoatherosclerosis.
Abstract 11270: SGLT2 Expression in the Coronary Microvessel Endothelium and Cardiomyocytes of Cardiac Patients: Determinant Role of Low-Grade Inflammation and Induction of Endothelial Dysfunction
Authors: MROUEH Ali , Fakih Walaa , GONG Dal-Seong , Auger Cyril , Matsushita Kensuke , Morel Olivier , Mazzucotelli Jean-Philippe , Schini-Kerth Valerie
Published: June 2023

Introduction:
Sodium-glucose co-transporter2 inhibitors (SGLT2i) showed benefit in major cardiovascular diseases characterized by low-grade inflammation. However, the role and function of SGLT2 in the heart remain unclear.

Hypothesis:
This study evaluated whether SGLT1/2 are expressed in the heart of patients with cardiac diseases, and determined the role of low-grade inflammation and the functional consequences.

Methods:
Human left ventricle (LV) biopsies were collected from 17 patients with aortic and mitral valves stenosis or hypertrophic cardiomyopathy at Strasbourg Hospital. Cultured endothelial cells (EC) were from pig coronary arteries. Expression levels were assessed by RT-qPCR, Western blot analysis and immunofluorescence staining, and the level of oxidative stress and nitric oxide (NO) using fluorescent probes.

Results:
SGLT1/2 protein levels were observed in the LV of cardiac patients and correlated p-p65 NFκB levels. SGLT2, VCAM-1 and TNF-α staining was observed in the endothelium of coronary microvessels and, to some extent, cardiomyocytes. TNF-α upregulated SGLT1 and 2, VCAM-1, AT1R and ACE expression and decreased that of eNOS and the bradykinin-stimulated NO formation in EC. The stimulatory effect of TNF-α was inhibited by an NF-kB inhibitor and SGLT2 siRNA but not by SGLT1 siRNA. Oxidative stress in LV sections and TNF-α-treated EC was inhibited by VAS-2870 (NADPH oxidase inhibitor), losartan (AT1R antagonist) and empagliflozin (SGLT2i), and in LV by infliximab (TNF-α receptor inhibitor).

Conclusions:
The findings indicate that SGLT2 is expressed in the LV of cardiac patients in the coronary endothelium and cardiomyocytes, and associated with their low-grade inflammatory status. Moreover, TNF-α upregulated the AT1R/NAPDH oxidase/SGLT2 crosstalk to sustain oxidative stress promoting endothelial dysfunction. Thus, SGLT2 appears as an interesting target to protect the coronary microcirculation.
Abstract 11289: Suppression of
De Novo
Purine Synthesis Reduces Development and Progression of Pulmonary Hypertension in Rodent Models
Authors: Ma Qian , Yang Qiuhua , Xu Jiean , Bordan Zsuzsanna , Barman Scott A , Fulton David , Su Yunchao , Huo Yuqing
Published: June 2023

Aims:
Proliferation of vascular smooth muscle cells (VSMCs) is a hallmark of pulmonary hypertension (PH). Proliferative cells utilize purine bases from the
de novo
purine synthesis (DNPS) pathways for nucleotide synthesis, however, it is unclear whether DNPS plays a critical role in VSMC proliferation during development of PH. The last two steps of DNPS are catalyzed by the enzyme 5-aminoimidazole-4-carboxamide ribonucleotide formyltransferase/inosine monophosphate cyclohydrolase (ATIC). We investigated whether ATIC-driven DNPS affects the proliferation of pulmonary artery smooth muscle cells (PASMCs) and the development of PH.

Methods and Results:
Metabolites of DNPS in proliferative PASMCs were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS). ATIC mRNA and protein expression was assessed in platelet-derived growth factor (PDGF)-treated PASMCs and in the lungs of PH rodents and patients with pulmonary artery hypertension (PAH). Mice with global and VSMC-specific knockout of
Atic
were utilized to investigate the role of ATIC in hypoxia-induced PH. ATIC-mediated DNPS at the mRNA, protein and enzymatic activity levels were increased in PDGF-treated PASMCs or PASMCs from PH rodents and patients with PAH. In cultured PASMCs,
ATIC
knockdown decreased DNPB, nucleic acid DNA/RNA synthesis and reduced cell proliferation. Global or VSMC-specific knockout of
Atic
attenuated vascular remodeling and inhibited the development and progression of hypoxia-induced PH in mice.

Conclusion:
Targeting ATIC-mediated DNPS compromises the availability of purine nucleotides for incorporation into DNA/RNA, reducing PASMC proliferation and pulmonary vascular remodeling and ameliorating the development and progression of PH.
Abstract 11290: Sex Differences in the Progression and Long-Term Outcomes of Native Mild to Moderate Aortic Stenosis
Authors: Badwan Osamah , Hariri Essa , Kassis Nicholas , Layoun Habib , Harb Serge C , Kapadia Samir R
Published: June 2023

Background:
Despite evidence of sex-based divergences in the natural history of aortic stenosis (AS), there is limited data on the sex differences in the hemodynamic progression and long-term outcomes of early-stage AS.

Methods:
This is a retrospective longitudinal study of patients aged ≥ 60 years with mild to moderate native AS who were identified from a tertiary care referral center between 2008-2016 and followed until 2018. All patients had at minimum 2 echocardiograms. The primary outcomes of all-cause mortality and aortic valve replacement (AVR) were both assessed by time-to-event analyses with multivariable-adjusted Cox regression. The secondary outcome of AS progression was assessed by annualized changes in echocardiographic parameters in a 1:1 propensity-matched group of males and females.

Results:
Of 2,660 included patients followed over a median duration of 5.6 years, the mean age was 74 years and 1,128 (42%) were female. There was no difference in all-cause mortality between sexes, irrespective of age, baseline AS severity, and receipt of AVR. Relative to males, females had a lower risk of AVR (aHR=0.77, 95% CI [0.65-0.92]; p=0.004) irrespective of age, type of aortic valve and baseline severity of AS (Figure). This finding persisted on sensitivity analyses excluding patients with a history of coronary artery disease, prior coronary bypass surgery (CABG), and who underwent concomitant CABG and AVR. On 1:1 propensity-matched analysis, females had significantly slower annualized decrease in indexed aortic valve area (-0.039 vs. -0.021 cm
2
/m
2
/year, p=0.04) and slower increase in mean gradient (1.60 vs. 1.01 mmHg/year, p<0.001),and maximum transvalvular velocity (0.08 vs. 0.11 m/s/year; p=0.04).

Conclusion:
In patients with mild to moderate AS, females had slower hemodynamic progression of AS and lower incidence of AVR despite similar mortality between sexes. Our findings suggest the need for sex-specific evaluation and management of native AS.
Abstract 11292: Reducing Telemetry Utilization in Hospitalized Comfort Care Patients
Authors: Park Christine , Kalil Ramsey , Lee Jihui , Sholle Evan , Daniels Brock , Lee Jennifer
Published: June 2023

Introduction:
Telemetry overutilization increases costs and interventions that may result in patient harm, particularly at the end of life. ‘Comfort care’ (CC) patients are especially vulnerable to unnecessary telemetry use.

Hypothesis:
Using provider education and electronic medical record (EMR) modification, we anticipated a reduction in the use of telemetry in hospitalized CC patients at our institution by 25% compared to baseline.

Methods:
We included inpatient medicine house staff (HS) and physician assistants (PA) teams. We provided education only to HS (a total of 140 providers) on indications for telemetry and proper discontinuation of telemetry orders in the EMR. Subsequently, we modified the CC order set for all providers to simplify telemetry discontinuation in CC patients. We measured the rates of CC patients with active telemetry, correctly discontinued telemetry, and telemetry reordered after discontinuation over time.

Results:
From October 2020 to April 2022, the median number of CC patients with telemetry orders decreased from 16 to 8 monthly (Figure 1), and telemetry discontinuation improved by 54% on HS and 48% on PA services (Figure 2). HS discontinued telemetry sooner after CC orders were placed compared to PA. 93% of HS and 100% of PA discontinue telemetry orders were placed within 2 hours of CC orders in the intervention period. The rate of reordering telemetry after discontinuation remained unchanged at 4%.

Conclusions:
In hospitalized CC patients, provider education yielded earlier time to discontinuation of telemetry orders and reductions in telemetry use. EMR modification prompted substantial reductions in telemetry use among both HS and PA teams.
Abstract 11310: Neurologic, Renal, and Visceral Malperfusion are Associated With Increased Mortality in Acute Type A Dissection but Not Lower Extremity Malperfusion
Authors: Schwarze Erik , Natour Abdul Kader , Chalek Adam , Kabbani Loay , Miletic Kyle , Alnajjar Raed
Published: June 2023

Introduction:
The aim of this study was to evaluate malperfusion in patients presenting with acute type A dissection (ATAD) and correlate with mortality based on organ system involved.

Methods:
A registry of all patients who underwent ATAD repair at our tertiary referral center between 2002 and 2018 was retrospectively queried. Patients with type B aortic dissection and chronic type A aortic dissections (time from presentation > 14 days) were excluded. Malperfusion syndromes at presentation including central nervous system (brain and spinal cord), visceral renal, and lower extremity (LE) were documented. Preoperative and intraoperative variables were analyzed, and post-operative outcomes were correlated with the malperfused organ system.

Results:
From 2002 to 2018, 378 patients underwent ATAD repair at our tertiary referral center. The average age was 57 years, 68% were male, and 51% were white. Approximately 70% of the cohort were transferred from an outside hospital. A total of 124 patients (33%) presented with malperfusion of at least one organ: 16% (N=62) LE, 8% (N=31) brain, 8% (N=30) renal, 3% (N=11) with visceral malperfusion, and 2% (N=8) with spinal cord malperfusion. On multivariate analysis, 30-day mortality was significantly increased in patients presenting with visceral ischemia (OR=3.7, P=0.04). The average follow-up was 2.3 years. Kaplan Meier survival curves showed a significant decrease in long term survival in patients presenting with brain (P=0.01), visceral (P=0.002), and renal ischemia (P<0.001). No difference in short or long-term survival was seen in patients presenting with LE ischemia (P=0.28).

Conclusions:
In this review, 33% of ATAD patients presented with malperfusion of at least one organ system. Visceral malperfusion was associated with poor short-term survival, whereas CNS, renal, and visceral malperfusion had decreased long term survival. LE malperfusion had no association with short or long-term mortality.
Abstract 11319: Post-Operative Dialysis in Failing Fontan Patients Undergoing Heart Transplant: How Well Does the Pre-Transplant Creatinine Clearance Risk-Stratify Patients?
Authors: Ahmed Humera , Dykes John , Chen Sharon , Chrisant Maryanne , Daly Kevin P , Ameduri Rebecca K , Knecht Kenneth R , Richmond Marc , Richmond Marc E , Lin Kimberly Y , Urschel Simon , Simmonds Jacob , SIMPSON KATHLEEN , Schumacher Kurt , Almond Christopher S
Published: June 2023

Introduction:
The need for dialysis early post-heart transplant (HT) can be suprisng when it occurs in the setting of purportedly normal renal function pre-HT, as has been described in failing Fontan (FF) patients.

Hypothesis:
We hypothesized that FF patients may have an increased incidence of post-operative dialysis (POD).

Methods:
The Pediatric Heart Transplant Society (PHTS) database was used to identify all children ≥2 years of age with failing Fontan (FF) physiology or cardiomyopathy (CM, benchmark lesion) who underwent isolated HT from 2005-2019. The primary endpoint was POD, defined as any form of dialysis within the first 30 days post-HT. Pre-transplant estimated glomerular filtration rate (eGFR) was calculated using the modified Schwartz formula, and a subset of patients with provided supplemental data additionally had renal function evaluated by a non-creatinine-based method.

Results:
Of 2003 children who met the inclusion criteria, 263 had FF (13%) and 1740 had CM (87%). Whereas the mean ages were similar (FF 11.2 vs CM 12.2 years, P=0.3), FF patients were 11% shorter (134 vs. 148, P<0.001) and 9 kg lighter (31.2 vs. 40.2, P<0.001), and had a lower serum creatinine (0.57 vs. 0.64 mg/dl, P=0.001) but similar eGFR pre-transplant (110.2 vs. 106.7 L/min/1.73m
2
, P=0.26). In a subset of 22 FF patients with available results from 24-hour urine collection or nuclear medicine scan, the Schwartz formula overestimated the GFR in 15/22 patients by an average of 40.2 ml/min/1.73 m2 (range 2.6 to 91.8). Overall, compared to CM patients, FF patients had a 4.7-fold higher risk of requiring POD (3.8% vs. 0.8%, P<0.001). Of those who required POD, the difference in 30 day post-HT mortality was not significant (40% vs. 14%, 0.3). Multivariable analysis revealed that pre-HT ECMO and longer CPB times were independently associated with POD; there was a trend toward association of higher pre-HT eGFR (P=0.06).

Conclusions:
Fontan patients have a ~5-fold higher risk of post-operative dialysis compared to cardiomyopathy patients, and despite a normal or even supraphysiological pre-transplant estimated CrCl. Non-creatinine-based methods independent of malnutrition status should be considered in the FF population.
Abstract 11323: Superior Vena Cava Endocarditis in a Patient With Sickle Cell Disease
Authors: Sharma Arindam , Cruz Torres Rosa N. , Sharma Arunima , Venkat Pajjuru , Vargha Jalal
Published: June 2023

Introduction:
Patients with sickle cell disease are at risk for many types of cardiac complications. We present a case of endocarditis of the superior vena cava (SVC) in a 22-year-old male with sickle cell disease.

Case study:
A 22 year old male with sickle cell disease presented to the hospital with 3 days of fever, night sweats, generalized body pains, vomiting and poor oral intake. 6 weeks ago, he had been admitted to an outside hospital for Methicillin related Staphylococcus aureus (MRSA) bacteremia. At that time an implanted venous access port in the patient’s chest was removed and 4 weeks of intravenous(iv) vancomycin were administered. He was admitted to the hospital for sepsis. Blood cultures were drawn which were positive for MRSA. A transesophageal echocardiogram revealed a large mobile vegetation in the SVC ( Fig. 1) The proximal end of the vegetation extended beyond the echocardiographic field of view, so a CT scan of the chest with contrast was performed (Fig. 2) This showed intraluminal filling defects in the distal SVC along with pulmonary emboli in the lower lobes of the lungs bilaterally. His antibiotics were changed to iv daptomycin and ceftaroline but he remained persistently bacteremic for 14 days. Therefore, removal of the SVC vegetation/thrombus was performed using AngioVac venous drainage cannula system. This was followed by resolution of bacteremia, and he was discharged from the hospital 9 days later.

Conclusion:
Echocardiographic evaluation of endocarditis should involve a comprehensive evaluation of all cardiac structures and not be limited to valves only. AngioVac venous drainage cannula system can be used to remove infected vegetations/thrombus.
Abstract 11328: Coronary Artery Calcium and Cardiovascular Outcomes in Patients With Diabetes: A Meta-Analysis
Authors: Guo Chen-yu C , Budoff Matthew
Published: June 2023

Background:
Presence of coronary artery calcium (CAC) has been demonstrated to increase mortality and major adverse cardiovascular events (MACE) in both diabetic and non-diabetic patients. A dose response relationship has been suggested between CAC score and cardiovascular outcomes. We performed a meta-analysis to compare the relative risk (RR) of mortality and MACE between categories of CAC scores in patients with diabetes.

Methods:
We searched the PubMed database to identify studies that investigated cardiovascular outcomes among diabetic patients with CAC. Only studies that used CAC=0 as reference group were included. We performed meta-analyses to obtain pooled RRs for mortality and MACE, as well as the composite outcome of both.

Results:
A total of 299 publications were identified and 6 studies (N=11,043) were included. With CAC=0 as the reference, CAC=1–100 has a RR of 1.64 (95% confidence interval: 1.34–1.99) for the composite outcome, 1.48 (1.18–1.87) for all-cause mortality, and 2.17 (1.47–3.19) for MACE. CAC=100–400 has a RR of 2.34 (1.9–2.9) for the composite outcome, 2.15 (1.67–2.78) for all-cause mortality, and 2.85 (1.94–4.21) for MACE. CAC>400 has a RR of 3.78 (2.6–5.49) for the composite outcome, 3.29 (2.57–4.21) for all-cause mortality, and 5.87 (1.99–17.32) for MACE.

Conclusion
Among patients with diabetes, presence of CAC increases risk for both mortality and MACE, and higher CAC scores are associated with higher relative risk. CAC scoring is demonstrated to be a useful tool for prognostication and risk stratification among individuals with diabetes, and our analyses showed that even the pooled RRs of the lowest category had reached statistical significance.
Abstract 11330: Association of Left Ventricular Wall Stress and Incident Heart Failure in Elderly Community Dwelling Individuals
Authors: White Audrey , Dixon Debra , Agrawal Vineet , Brittain Evan , MALLUGARI RAVINDER R , Mosley Jonathan , Wells Quinn , Gupta Deepak K
Published: June 2023

Introduction:
Greater left ventricular (LV) wall stress is associated with adverse outcomes among patients with prevalent heart failure (HF). Less is known about the association between LV wall stress and risk of incident HF in community dwelling individuals.

Methods:
Using data from the NHLBI Biologic Specimen and Data Repository Information Coordinating Center, we studied 4,601 participants of the Atherosclerosis Risk in Communities study without prevalent HF who underwent echocardiography at visit 5 (2011-2013). LV end systolic and diastolic wall stress (LVESWS, LVEDWS) were calculated from chamber and wall thickness measures, E/e’ as a surrogate for LV end diastolic pressure, and systemic blood pressure. Incident HF was assessed by cohort surveillance for hospitalized HF through December 31, 2016. The relationship between LVESWS and LVEDWS was examined by Spearman rank correlation. The association between wall stress and risk of incident HF was tested in Cox regression adjusted for demographics, traditional CV risk factors, prevalent CAD and atrial fibrillation, as well as creatinine, NT-proBNP, troponin, triglycerides, C-reactive protein, LV ejection fraction, and LV mass.

Results:
The cohort was elderly (median age 75 years), predominantly female (58%), with 18% of individuals identifying as black. Median LVESWS and LVEDWS were 48.8 (IQR: 39.3, 60.1) and 18.9 (IQR: 15.8, 22.5) kdynes/cm2, respectively. LVESWS and LVEDWS were modestly correlated (rho = 0.30, p <0.001). Over a median follow-up of 4.6 years, 156 individuals developed incident HF. In multivariable Cox regression mutually adjusted for LVEDWS and LVESWS, each 1-unit increase in LVEDWS significantly associated with an increased risk of incident HF (HR: 1.03; 95% CI 1.01 - 1.06) (Figure), while LVESWS did not (HR: 1.00; 95% CI 0.99-1.01).

Conclusions:
Among community dwelling elderly individuals, greater non-invasively measured LVEDWS is associated with an increased risk for incident HF.
Abstract 11342: Prognostic Impact of Nutritional Status and Rehabilitation Education Based on Cardiopulmonary Exercise Testing in Japanese Patients With Acute Coronary Syndrome
Authors: Fujimoto Naoki , Murakami Hiroaki , Ito Hiromasa , Takasaki Akihiro , Kurita Tairo , Dohi Kaoru
Published: June 2023

Introduction:
Cardiopulmonary exercise testing (CPET) coupled with rehabilitation education improves outcomes in patients with ACS. While, malnutrition may be an under-recognized risk for poor outcomes in ACS patients.
Purpose:
To evaluate the prognostic factors including Controlling Nutritional Status (CONUT) score and CPET implementation on 2-year outcomes in patients with ACS in Mie Prefecture, Japan.

Methods:
We enrolled 3,146 ACS patients without hemodialysis using Mie ACS registry data, between 2013 and 2017. The CONUT score was measured on admission. By using CONUT score, patients were stratified into normal (0 and 1), mild risk (2-4), and moderate to severe risk (5-12) for malnutrition. Prognostic factors including exercise education based on CPET and nutritional status were determined.

Results:
CONUT score on admission was available in 2,621patients. 431 patients received CPET-based rehabilitation education at discharge. During the 2-year follow-up, there were 198 all-cause deaths. In the whole cohort, multivariate Cox regression analysis demonstrated that CPET implementation (hazard ratio, 0.52; p=0.047) and hemoglobin were independent negative predictors of all-cause death. While, age, male gender, hospitalization length>21 days, Killip ≥2 were positively associated with death. When analyzed in patients with CONUT score, malnutrition status (mild risk: hazard ratio, 1.49; moderate to severe risk: hazard ratio, 1.86, p≤0.05) was added as a positive predictor of all-cause death. Although not statistically significant, CPET implementation had tendency toward reducing all-cause death.

Conclusions:
CPET implementation was the decreased 2-year risk of all-cause death in the whole cohort. As patients with higher CONUT score had worse outcomes, cardiac rehabilitation program including nutritional education was necessary even for patients with mild risk for malnutrition.
Abstract 11351: Surgical Myectomy versus Alcohol Septal Ablation Among Patients With HOCM: A Systematic Review and Meta-Analysis
Authors: Jaiswal Vikash , Attia Abdelrahman , Kalra Kriti , Patel Nirmit , Manohar Hasitha , Jaiswal Akash , Savaliya Mittal R , Verma Deepak , Shrestha abhigan babu , Khan Nida , Nasir Yusra , Biswas Monodeep
Published: June 2023

Background:
Surgical myectomy (SM) and Alcohol septal ablation (ASA) are two known therapies recommended for symptomatic hypertrophic cardiomyopathy patients. Although, their results are contradictory between the outcomes of these two procedures to this day.

Hypothesis:
This meta-analysis evaluates and compares the two procedure-related clinical outcomes.

Method:
We performed a systematic literature search on PubMed, Embase and Cochrane for relevant articles from inception until May 20, 2022. Unadjusted odds ratios (OR) were pooled using a random-effect model, and a p-value of <0.05 was considered statistically significant.

Result:
A total of 23 articles with 17165 patients comparing the outcomes among SM vs ASA with a mean follow-up of 44.18±24.06 months. The odds of short-term mortality [OR, 0.51(95%CI: 0.33-0.79), p = 0.002] were significantly lower in ASA group, while reintervention [OR, 2.93 (95%CI: 0.99-8.70), p = 0.05], and pacemaker implantation [OR, 1.97(95%CI: 1.28-3.03), p = 0.002] were significantly higher among ASA group compared to SM. Long term mortality [OR, 0.91(95%CI: 0.57-1.47), p = 0.71], SCD [OR, 1.55(95%CI: 0.76-3.17), p = 0.23], CVM [ OR, 0.76(95%CI: 0.39-1.46), p = 0.40], Stroke [OR, 1.24(95%CI: 0.24-6.26), p = 0.80], and MI [OR, 1.04(95%CI: 0.19-5.57), p = 0.97] were not different between both procedures.

Conclusion:
ASA and SM procedure for treating HOCM carries a similar risk of long-term mortality and other cardiovascular and cerebrovascular outcomes among both groups. However, ASA carries a lower incidence of short-term mortality and higher incidence of reintervention and pacemaker implantation than SM.
Abstract 11363: Renal Artery Velocity Time Integral is a Predictor of Improvement in Renal Function After Transcatheter Aortic Valve Implantation
Authors: Muto Yuki , Sato Akihiko , Watanabe Koichiro , Abe Satoshi , Misaka Tomofumi , Oikawa Masayoshi , KOBAYASHI ATSUSHI , Yoshihisa Akiomi , Nakazato Kazuhiko , Ishida Takafumi , Takeishi Yasuchika
Published: June 2023

Background:
It has been reported that renal function (RF) is improved in a certain number of patients who undergo TAVI. However, the mechanisms and predictors of RF improvement remain unclear. We investigated whether preoperative renal hemodynamics assessed by intrarenal doppler ultrasonography (IRD) could predict RF improvement after TAVI.

Methods and Results:
We enrolled consecutive 84 patients with severe aortic stenosis (AS) who underwent TAVI in our hospital. To assess preoperative intrarenal hemodynamics, we measured renal artery velocity time integral (RA-VTI) as a marker of renal perfusion and renal venous stasis index (RVSI) as a marker of renal congestion using IRD before TAVI (Fig 1). We calculated RVSI as follows: (cardiac cycle time - venous flow time)/cardiac cycle time. RF improvement was defined as an increase >10% of estimated glomerular filtration rate (eGFR) after TAVI. Of the 84 patients, 45 patients (53.5%) showed RF improvement and remaining 39 patients did not. Clinical characteristics including STS score, clinical frailty scale, comorbidities, medications, amount of contrast media and occurrence of procedural complications associated with TAVI were comparable between the two groups. In addition, laboratory data including baseline eGFR and echocardiographic parameters including severity of AS, left ventricular ejection fraction and stroke volume index were also similar between the two groups. RA-VTI determined by IRD was significantly lower in patients with RF improvement compared to those without RF improvement (34.0 ± 12.6 vs. 39.9 ± 12.5 cm, P=0.03). In contrast, there was no difference in RVSI (0.08 ± 0.13 vs. 0.05 ± 0.09, P=0.19). Logistic regression analysis indicated that RA-VTI was a predictor for RF improvement after TAVI (odds ratio 0.96, 95% confidence interval 0.93-0.99, P=0.04).

Conclusions:
Preoperative RA-VTI, a marker of renal perfusion, is a predictor for RF improvement after TAVI.
Abstract 11364: Risks Factors for Malignant Arrhythmias and Sudden Cardiac Death in Patients With Mitral Valve Prolapse: A Systematic Review and Meta-Analysis
Authors: Benjanuwattra Juthipong , Kewcharoen Jakrin , Leelaviwat Natnicha , Mekraksakit Poemlarp , Del Rio-Pertuz Gaspar , Abdelnabi Mahmoud , Sripusanapan Adivitch , Trongtorsak Angkawipa , Thangjui Sittinun , Navaravong Leenhapong
Published: June 2023

Introduction:
Mitral valve prolapse (MVP) is a common valvular disorder affecting approximately 3% of the population. Several risk factors in patients with MVP for malignant arrythmias, including ventricular tachycardia (VT), fibrillation (VF), and sudden cardiac death (SCD), have been proposed. We performed systematic review and meta-analysis to evaluate risk factors for malignant arrhythmias in patients with MVP.

Methods:
We comprehensively searched the databases of MEDLINE from inception to May 2022. Included studies were published cohorts comparing patients with MVP and malignant arrhythmias or SCD versus MVP without those events. Data from each study were combined using the random-effects model. Pooled odd ratios (OR) and 95% confidence intervals (CI) were calculated.

Results:
Five studies from 1985 to 2021 were included involving 769 patients with MVP [100 patients with SCD, VF, VT, and/or implantable cardioverter defibrillator (ICD) shocks]. We found that T-wave inversion (pooled OR=3.14, 95%CI: 2.18-4.5, p<0.001), bileaflet (pooled OR=2.37, 95%CI: 1.39-4.04, p=0.002), late gadolinium enhancement (pooled OR=41.8, 95%CI: 10.7-163, p<0.001), mitral annular disjunction (pooled OR=4.8, 95%CI: 2.7-8.4, p<0.001), redundant leaflets (pooled OR=4.6, 95%CI: 1.02-21.0, p=0.048), and history of syncope (pooled OR=2, 95%CI: 1.002-4.02, p=0.049), were associated with malignant arrythmias and SCD. However, female sex (pooled OR=0.83, 95%CI: 0.26 - 2.65, p=0.748) and moderate-to-severe mitral regurgitation (pooled OR=0.85, 95%CI:0.15-4.91, p=0.853) did not increase the risk.

Conclusion:
T-wave inversion, mitral annular disjunction, late gadolinium enhancement, history of syncope, redundant leaflets and bileaflet prolapse are associated with an increased risk of malignant arrhythmias and SCD in patients with MVP. Further studies are needed to evaluate the role of electrophysiologic study and ICD in this high-risk population.
Abstract 11383: Risk of Stroke Among Patients With Left Ventricular Thrombus Undergoing Percutaneous Coronary Intervention: A 5-Year Retrospective Review Using Real-World Data
Authors: Shehadeh Mohanad , Rahhal Alaa , Ahmed Ashraf , AlKhalaila Osama , Abdelghani Mohamed , Shunnar Khaled , Mahfouz Ahmed , Alyafei Sumaya , Arabi Abdulrahman
Published: June 2023

Introduction:
Left ventricular thrombus (LVT) is a well-established risk for ischemic stroke. Nevertheless, it remains uncertain if percutaneous coronary intervention (PCI) in the setting of LVT further augments the risk of stroke. Therefore, in this study, we evaluated the risk of stroke among patients with LVT undergoing PCI.

Methods:
This retrospective observational cohort study included the patients admitted with LVT to Heart Hospital in Qatar between April 1, 2015 and March 31, 2020. The study population was divided into two groups: (1) patients with LVT who underwent PCI; (2) patients with LVT who did not undergo PCI. The primary outcome evaluated was stroke during the index admission, and the secondary outcomes were in-hospital mortality, all-cause mortality, and stroke at 12 months post discharge. Logistic regression was used to determine the risk of stroke associated with PCI among patients with LVT. A p<0.05 indicated statistical significance.

Results:
Of the 210 patients included, 119 underwent PCI, while 91 patients did not undergo PCI. Most of the patients were Asian (67%), male (96%) with a mean age of 56 yearsIschemic cardiomyopathy was the main etiology of LVT in both groups (96% in the PCI group and 80% in non-PCI group). Around 70% of the patients in the PCI group underwent intervention to the left anterior descending artery. During the index admission, stroke among patients with LVT did not differ between the PCI and non-PCI groups (5% versus 3.3%; odds ratio (OR) 1.6, 95% confidence interval (CI) 0.34-6.4, p=0.539; adjusted OR 0.9, 95% CI 0.09-10.6, p=0.968. Similarly, in-hospital mortality, all-cause mortality, and stroke at 12 months did not differ between the study groups.

Conclusion:
Performing PCI among patients with LVT was not associated with increased risk of stroke during admission or at 12 months in comparison to patients who did not undergo PCI, which may reassure cardiologists to safely perform PCI among patients with LVT and defer delaying the procedure among patients with acute coronary syndrome due to presumed risk of stroke.
Abstract 114: Postconditioning With Argon Has No Direct Lung-protective Effect Against Ischemia Reperfusion In A Rat Isolated Lung Model
Authors: Hees Josephine E , Cleveland William J , Balzer Claudius , Riess Matthias L
Published: June 2023

Cardiac arrest (CA) remains a significant medical problem with stagnating low survival rates. Ventilation with the noble gas Argon (Ar) after return of spontaneous circulation improved neurologically favorable survival in a porcine CA model. We hypothesized that postconditioning with Ar attenuates global ischemia reperfusion (IR) injury in a rat isolated lung model.

Following Institutional Animal Care and Use Committee approval and conforming with the "Position of the American Heart Association on Research Animal Use", lungs of adult male Sprague Dawley rats (250-350 g) were isolated and positive-pressure ventilated (10 mL/kg body weight [BW]) at a respiration rate of 30 breaths/minute. Lungs were perfused with physiological crystalloid buffer at a constant flow of 40 mL/kg BW. The control (C) group (n=6-7) was ventilated with 65% N
2
, 5% CO
2
, 30% O
2
,

the Ar group (n=6) with 65% Ar, 5% CO
2
, 30% O
2
before global no-flow ischemia for 8 min followed by reperfusion. Mean arterial (MAP) and airway pressures (AWP) were recorded continuously. Lung viability as survival time until development of fulminant pulmonary edema was noted. Data are mean +/- SEM. Statistics: Student's t-Test with *p< 0.05.

IR significantly increased MAP and AWP throughout reperfusion compared to baseline; contrary to our hypothesis, though, ventilation with Ar did not signficantly increase survival time (panel A) or lower MAP (B) or AWP (C) of the isolated lung during reperfusion in this model.

In-vivo models may be better-suited to assess Ar’s organ-protective effects following CA.
Abstract 11414: Anti-Mir-7110-3p as a Therapeutic Molecule in Monocrotaline Induced Pulmonary Arterial Hypertension Rat Model
Authors: K Auxzilia Preethi , Selvakumar Sushmaa Chandralekha , Sekar Durairaj
Published: June 2023

Introduction:
Pulmonary arterial hypertension (PAH) is a chronic condition marked by unusually increased blood pressure in the pulmonary artery which transports blood from the heart to lungs. Advances in PAH treatment have improved PAH patients outcomes and prognosis, but still continues to be a life-threatening condition and also the current treatment strategies have failed to address the underlying cellular and molecular problems. MicroRNAs are short noncoding RNAs that suppress gene expression by binding to the 3' UTR of their target mRNA. According to our prior findings, there is evidence that miR-7110 has a prominent role in PAH.

Hypothesis:
In this study, we assessed the hypothesis to determine whether anti-miR-7110-3p can help to prevent PAH in monocrotaline-induced PAH (MCT-PAH) rat model via PKCδ/STAT3 signaling pathway.

Methods:
Pulmonary arterial smooth muscle cells (PASMCs) were transfected with anti-miR-7110-3p to investigate the effect of miR-7110-3p on PASMCs proliferation and apoptosis in
in vitro
condition. To induce PAH, male Sprague Dawley rats were given an intraperitoneal injection of 50 mg/kg monocrotaline. The expression of miR-7110-3p/PKCδ/STAT3 were assessed using RT-qPCR and western blotting analysis, while the activity of miR-7110-3p and its target STAT3 was determined using luciferase reporter assay. Systolic pulmonary arterial pressure was recorded using PowerLab data acquisition system and after obtaining the readings the rats were immediately sacrificed. The lower lobe of right lung tissue was collected, fixed in 4 % paraformaldehyde, sectioned and processed for histological analyses.

Results:
Our results demonstrated that miR-7110-3p has a proliferative and anti-apoptotic effect on PASMCs. Additionally, in vitro studies revealed that miR-7110-3p/ PKCδ/STAT3 axis in involved in PAH. Our histological analyses suggested that anti-miR-7110-3p was able to reduce the pulmonary vascular remodeling. As a result, the relationship between miR-7110-3p, STAT3 and anti-miR-7110-3p is an important step in gene expression analyses.

Conclusions:
In conclusion, our findings suggest that miR-7110-3p may be used as a biomarker and anti-miR-7110-3p can be used as a therapeutic molecule for the treatment of PAH.
Abstract 11419: Prognostic Value of Vagal Dysautonomia in Patients With Chagas Disease: 14-year Results of a Population Cohort of the Elderly
Authors: Moraes Diego N , Nascimento Bruno R , Ribeiro Antonio L
Published: June 2023

Introduction:
The cardiac form is the main responsible for morbidity and mortality of Chagas disease (ChD), given its prevalence and unpredictable clinical evolution. A great part of ChD mortality occurs due to sudden ventricular arrhythmias, and the frequently observed autonomic dysfunction may be associated with unfavorable outcomes. We aimed to evaluate the predictive value of autonomic dysfunction indexes in ChD patients.

Methods:
The Bambuí Study of Aging is a prospective cohort of residents ≥60 years at study onset (1997), living in the southeastern Brazilian city of Bambuí (15,000 inhabitants). Consented participants underwent annual follow-up visits, and death certificates were tracked. For assessment of respiratory sinus arrhythmia (E:I ratio), patients were instructed to breathe deeply in a 10-second cycle (5 inhales and 5 exhales) while ECG was recorded. Heart rate variability indices (SDRR (standard deviation of adjacent RR intervals) and RMSSD (square root of the mean of the sum of squares of the differences between adjacent RR intervals)) were calculated using a computer algorithm, supervised by an independent cardiologist blinded to clinical data. Multivariable regression was performed to access the prognostic value of autonomic dysfunction indexes, expressed as tertiles, for all-cause mortality, after adjustment for demographic, clinical and ECG variables.

Results:
From 1,742 qualifying residents, 1,606 were enrolled, being 557 with positive ChD serology. Among these, mean age was 68 (64-74) years, and 32.5% were men. The most frequent ECG abnormality was right bundle branch block (23.2%). In 14 years, loss-to-follow-up was 7.9% and overall mortality was 51.9%. At total 321 ChD patients had valid autonomic indexes measurements. In univariate analyses, measurements of autonomic function predicted all-cause death: E:I ratio (HR: 1.20 (95% CI 1.09-1.33)), SDRR (HR: 1.26 (95% CI 1.14-1.40)) and RMSSD (HR: 1.12 (1.01-1.23)). After adjustment for sex, age and cardiovascular risk factors, none of these indexes remained as independent predictors of mortality.

Conclusions:
In a long-term cohort of elderly patients with ChD, abnormalities in autonomic function indexes were not independent predictors of 14-year mortality.
Abstract 11420: A Subgroup Meta-Analysis Comparing the Renal Denervation Sham Controlled Randomized Trials Among Those With Resistant and Nonresistant Hypertension
Authors: Ahmed Mohammad , Nudy Matthew , Bussa Rahul , Foy Andrew
Published: June 2023

Introduction:
Renal denervation (RD) has been investigated as an invasive blood pressure (BP) lowering treatment for hypertension (HTN). Resistant HTN (RHTN) has been defined as uncontrolled BP despite use of 3 antihypertensive medications of different classes, including a diuretic, at maximum tolerated doses. The impact RD on RHTN remains under investigation.

Methods:
Ten sham-controlled trials testing RD were included in this trial-level analysis. A prespecified subgroup analysis was conducted to test whether efficacy of RD differed in patients with and without RHTN. The primary endpoints were change in 24-hour ambulatory systolic (SBP) and diastolic (DBP) using raw mean difference (RMD) between sham control and RD.

Results:
Ten studies (6 RHTN and 4 nonresistant HTN) were identified that included 1,544 participants (1,001 RHTN and 543 essential HTN) with cumulative mean age (±SD) of 56 (±11) years. Cochran risk of bias assessment showed 88% of the domains to be low risk of bias for the RHTN studies and 92% of the domains to be low risk of bias for the nonresistant HTN studies. The RMD for 24-hourr SBP between RD and sham-control was statistically significant for nonresistant HTN trials (-4.19 mmHg; 95% CI -6.07 to -2.30) but was not statistically significant for RHTN trials (-1.86 mmHg; 95% CI - 3.89 to 0.16). Despite the numerical difference in the subgroups, the interaction between subgroups failed to reach statistical significance (p = 0.10). The RMD for 24-hour DBP between RD and sham-control was statistically significant for nonresistant HTN trials (-2.60 mmHg; 95% CI -3.79 to -1.42) but was not statistically significant for RHTN trials (-0.67 mmHg; 95% CI -1.84 to 0.50). The interaction between subgroups was statistically significant (p = 0.02).

Discussion:
Our analysis indicates RD does not seem to be an efficacious intervention for patients with RHTN. This data may be beneficial for clinicians to consider when assessing patients with RHTN for RD.
Abstract 11426: Processes and Outcomes for 121,576 Patients With ST Elevation Myocardial Infarction in the AHA Get With the Guidelines®-Coronary Artery Disease (GWTG-CAD) Registry, 2018-2021
Authors: Jollis James G , Tamis-Holland Jacqueline E , Goyal Abhinav , Henry Timothy D , Zegre-Hemsey Jessica K , French William J , Ali Murtuza J , Stone Harper , Roettig Mayme L , Poudel Ram , Granger Christopher B , Jacobs Alice K
Published: June 2023

Introduction:
Timely treatment of ST elevation myocardial infarction [STEMI] requires ongoing coordinated care between emergency departments, paramedics, and primary percutaneous coronary (PCI) intervention facilities.

Methods:
To provide a current view and a national benchmark, we examined 121,576 patient records submitted by 648 hospitals participating the GWTG-CAD registry from Q2 2018 through Q3 2021 [median age 63, women 29%, Black 11%, Hispanic 8%, admission cardiac arrest 5%, shock 7%, heart failure 7%, Covid 0.2%, presentation EMS 47%, walk in 27%, transfer 22%]

Results:
Reperfusion method for all patients included primary PCI 87%, fibrinolysis 5%, and no reperfusion 8% [increasing from 7 to 9% during the study period]. Median time from symptom onset to reperfusion was shortest for EMS patients 148 minutes, followed by walk-in 195 minutes, ground transferred 238 minutes, and air transferred 247 minutes. Process times did not improve during the study period. First medical contact to device times increased by 5 minutes for EMS and ground transferred patients in Q2 2020 corresponding with the pandemic onset, and adjusted mortality was significantly higher in the final 3 quarters compared to Q2 2018 [OR, 95% CI 1.28(1.07-1.53); 1.35(1.13-1.61); 1.23(1.03-1.48)]. Patients treated within guideline goals had significantly lower mortality [Figure].

Conclusions:
These data reaffirm the association between process times and lower mortality for STEMI patients. They also identify concerning trends and opportunities for improved care. Increasing delays in treatment, particularly for hospital transfer, greater numbers of untreated patients, and increased risk-adjusted in-hospital mortality all provide strong impetus for renewed focus on STEMI systems. Regional collaborative efforts led by coordinators and informed by a common data system have the potential to reverse these trends and improve survival.
Abstract 11428: A Comparison Between Endothelin Receptor Antagonists and Renal Denervation for Resistant Hypertension: A Systematic Review and Meta-Analysis of Sham and Placebo Controlled Trials
Authors: Ahmed Mohammad , Bussa Rahul , Nudy Matthew , Foy Andrew
Published: June 2023

Introduction:
Endothelin-1 causes vasoconstriction by activation of calcium flux in smooth muscle cells. Use of endothelin receptor antagonists (ERAs) has remained controversial. Renal denervation (RD) has also been investigated as a treatment option for resistant hypertension (RHTN). The efficacy of these two novel treatment strategies was compared.

Methods:
Placebo-controlled and sham-controlled randomized clinical trials testing ERA or RD as treatments for RHTN were selected. Prespecified subgroup analyses comparing the efficacy of ERA and RD were conducted for outcomes of 24-hour (hr) blood pressure (BP) and office BP.

Results:
Nine studies (3 ERA and 6 RD) were identified that included 1,708 participants (816 ERA and 892 RD). Cochran risk of bias assessment showed 72% of the domains to be low risk of bias for the ERA studies and 88% of the domains to be low risk of bias for the RD studies. The raw mean difference (RMD) between ERA and placebo control was statistically significant for 24-hr systolic (SBP) (-8.34 mmHg; 95% CI -11.51 to -5.81, 24-hr diastolic (DBP) (-6.77 mmHg; 95% CI -8.90 to -4.63), office SBP (-4.50 mmHg; 95% CI -6.92 to -2.08), and office DBP (-2.01 mmHg; 95% CI -2.13 to -1.88). The RMD between RD and sham control was not statistically significant for 24-hr SBP (-1.85 mmHg; 95% CI -3.88 to 0.18), 24-hr DBP (-0.67 mmHg; 95% CI -1.84 to 0.51), office SBP (-1.93 mmHg; 95% CI -5.17 to 1.31), and office DBP (-1.55 mmHg; 95% CI -3.43 to 0.33). The interaction between the treatment subgroups was statistically significant for 24-hr SBP and DBP, but not for office SBP and DBP.

Discussion:
ERAs had greater reduction in 24-hr and office BP compared to RD among patients with RHTN. Despite efficacy in reducing BP in RHTN, use of ERAs remains controversial given the cost and side effect profile. RD does not reduce BP among patients with RHTN. Medications are the optimal treatment for RHTN and sham controlled data showing efficacy is needed prior to widespread use and adoption of RD in RHTN.