bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15589: Impact of Preprocedural Anemia on In-Hospital and Follow-Up Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention
Authors: Rempakos Athanasios , Kostantinis Spyridon , Simsek Bahadir , Karacsonyi Judit A , Alexandrou Michaella , Mutlu Deniz , Choi James , Poommipanit Paul , Khatri Jaikirshan , Young Laura , Davies Rhian , Benton Stewart , Jaffer Farouc A , Chandwaney Raj , Azzalini Lorenzo , Alaswad Khaldoon , jefferson brian , Frizzell Jarrod D , Abi Rafeh, MD, FACC Nidal , El Guindy Ahmed , GOKTEKIN OMER , Rangan Bavana V , Mastrodemos Olga , Al-ogaili Ahmed , Allana Salman S , Sandoval Yader , Burke M Nicholas , Brilakis Emmanouil S , gorgulu sevket
Published: December 2023

Background:
The impact of preprocedural anemia on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study.

Methods:
We examined the clinical and angiographic characteristics and procedural outcomes of 8,633 CTO PCIs performed at 39 US and non-US centers between 2012 and 2023. Anemia was defined as a hemoglobin level of <13 g/dL for men and <12 g/dL for women.

Results:
Anemia was present in 1,652 (19%) patients undergoing CTO PCI. These patients had a higher incidence of comorbidities, such as diabetes mellitus, hypertension, dyslipidemia, heart failure, cerebrovascular disease, and peripheral arterial disease. CTOs in anemic patients were more likely to have complex angiographic characteristics, including smaller diameter, longer length, moderate to severe calcification, and moderate to severe proximal tortuosity. Anemic patients required longer procedure (119 vs. 107 min; p<0.001) and fluoroscopy (45 vs. 40 min; p<0.001) times but received similar contrast volumes. Technical success was similar between the two groups. In-hospital major adverse cardiac events (MACE) rates were higher in patients with anemia; however, this association was no longer significant after adjusting for confounding factors. Baseline anemia was independently associated with follow-up MACE (adjusted HR: 1.63; 95% CI: 1.07-2.49; p=0.023) and all-cause mortality (adjusted HR: 3.03; 95% CI: 1.41-6.49; p=0.004).

Conclusions:
Preprocedural anemia is associated with more comorbidities, higher lesion complexity, longer procedure times, and higher follow-up MACE and mortality after CTO PCI.
Abstract 156: Incidence and Long-Term Outcomes of Acute Myocardial Infarction Among Survivors of Out-of-Hospital Cardiac Arrest
Authors: Yeo Jun Wei , Huili Zheng , Ng Celeste , Pek Pin Pin , Ng Benny , Chin Yip Han , Jia Rong Lam Timothy , Ostbye Truls , Tromp Jasper , Ong Marcus E , Ho Andrew Fu Wah
Published: December 2023

Introduction:
Despite the increasing long-term survival after out-of-hospital cardiac arrest (OHCA), the risk of subsequent acute myocardial infarction (AMI) remains poorly understood. We aimed to determine the incidence, predictors, and long-term outcomes of AMI among OHCA survivors.

Methods:
We assembled a retrospective cohort of patients with OHCA who survived to 30 days or discharge from hospital regardless of time from index event between 2010-2019 by linking the Pan-Asian Resuscitation Outcomes Study (Singapore participants), Singapore Myocardial Infarction Registry, and the Singapore Registry of Births and Deaths. We calculated the risk of subsequent AMI defined as AMI occurring 30 days after index OHCA or following discharge from hospital post-OHCA, among OHCA survivors compared to the general population using age- and sex-specific standardised incidence ratios (SIR) and the cumulative incidence of subsequent AMI among OHCA survivors. We investigated predictors of subsequent AMI among OHCA survivors and whether AMI predicted mortality using Cox regression hazard ratios for time-to-event analyses.

Results:
In total, 882 OHCA survivors were analysed. OHCA survivors had an increased risk of subsequent AMI compared to the general population when matched for age and sex (SIR 4.64, 95% CI: 3.52-6.01). Age-specific risks of subsequent AMI for males (SIR 3.29, 95%CI: 2.39-4.42) and females (SIR 6.15, 95%CI: 3.27-10.52) were significantly increased. 7.2%, 8.3%, and 14.3% of OHCA survivors had subsequent AMI at 3 years, 5 years, and end of follow-up respectively. Age at OHCA (HR 1.04, 95%CI: 1.02-1.06) and past medical history of prior AMI, defined as any AMI preceding or during the index OHCA event (HR 1.84, 95%CI: 1.05-3.22), were associated with subsequent AMI. OHCA survivors with subsequent AMI had a higher risk of mortality (HR 1.58, 95%CI: 1.12-2.22) than those without.

Conclusion:
Long-term OHCA survivors have an increased risk of subsequent AMI, compared to the general population. Prior AMI significantly increases this risk and subsequent AMI predicts mortality. Intensive cardiovascular risk factor control and revascularisation may improve outcomes in selected patients with a cardiac etiology.
Abstract 15621: Pelvic Vein Compression in Patients Diagnosed With Postural Orthostatic Tachycardia Syndrome
Authors: Garcia Mariana , Almuwaqqat Zakaria , Steinberg Rebecca , McGeoch Catherine , Bortfeld Kristina , Thadani Siya , Gilliland Charles , Cutchins Alexis
Published: December 2023

Introduction:
Postural Orthostatic Tachycardia Syndrome (POTS) is a condition characterized by chronic orthostatic intolerance and a significant increase in heart rate. Patients with POTS often exhibit symptoms suggestive of pelvic venous congestion. While venography is the standard method for diagnosing venous compression disorders in the abdomen and pelvis, its potential use in identifying undiagnosed venous abnormalities and its relationship in POTS patients has not been studied.

Research Question:
This study aimed to investigate the findings of antegrade venography and intravascular ultrasound in patients diagnosed with POTS with high suspicion of May-Thurner Syndrome (MTS) and/or pelvic congestion syndrome, based on initial diagnostic tools such as ultrasound, and who exhibited symptoms of pelvic venous insufficiency (PVI).

Methods:
Patients clinically diagnosed with POTS underwent antegrade venography and intravascular ultrasound due to a high suspicion of PVI. Demographic, clinical presentation, and venography findings were extracted from the electronic medical records of patients referred to Emory University for POTS/dysautonomia/long COVID evaluation. Patients were diagnosed with MTS if they demonstrated stenosis of the left common iliac vein of 50-70% with associated symptoms like pelvic pain and lower extremity swelling.

Results:
We identified 28 patients with POTS who had symptoms of PVI. The mean age was 31.6 years (range 18-54), and 96% were female. Doppler ultrasonography revealed venous reflux in the common femoral vein in 82% of the patients. All participants met the criteria for MTS and were referred for stenting. Additionally, 21% of those evaluated had significant bilateral iliac vein compression.

Conclusions:
This is the largest cohort of POTS patients with pelvic venous compression to date, and our findings suggest a potential association between venous disease and the pathophysiology of POTS. Further research is needed to establish a causal link and explore the clinical implications of venography findings after intervention with angioplasty and stenting. Understanding the venous component in POTS may aid clinicians in the earlier diagnosis and management of PVI.
Abstract 15646: Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With Prior Coronary Artery Bypass Graft Surgery
Authors: Alexandrou Michaella , Kostantinis Spyridon , Rempakos Athanasios , Simsek Bahadir , Karacsonyi Judit A , Choi James , Poommipanit Paul , Alaswad Khaldoon , Basir Mir B , Megaly Michael S , Davies Rhian , Benton Stewart , Jaffer Farouc A , Karmpaliotis Dimitrios , Azzalini Lorenzo , Kearney Kathleen , ElGuindy Ahmed M , Abi Rafeh Nidal , GOKTEKIN OMER , gorgulu sevket , Khatri Jaikirshan , Aygul Nazif , Jaber Wissam , Nicholson William , Rinfret Stephane , Krestyaninov Oleg , Khelimskii Dmitrii , Rangan Bavana V , Mastrodemos Olga , Allana Salman S , Mutlu Deniz , Al-ogaili Ahmed , Sandoval Yader , Burke M Nicholas , Brilakis Emmanouil S
Published: December 2023

Background:
The long-term outcomes of chronic total occlusion (CTO) percutaneous coronary interventions (PCI) in patients with prior coronary artery bypass graft surgery (CABG) have received limited study.

Methods:
We examined the baseline characteristics and outcomes of CTO PCIs performed at 47 US and non-US centers between 2012 and 2023.

Results:
Of the 12,164 patients who underwent CTO PCI during the study period, 3,475 (29%) had prior CABG. Prior CABG patients were older, more likely to be men, with higher incidence of comorbidities and lower left ventricular ejection fraction and eGFR. Their CTOs were more likely to have moderate/severe calcification and proximal tortuosity, proximal cap ambiguity, longer lesion length and higher J-CTO scores. The first and final successful crossing strategy was more likely to be the retrograde approach. They had lower technical (82.1% vs 88.2%, p<0.001) and procedural (80.8% vs 86.8%, p<0.001) success, but similar incidence of in-hospital major complications. The incidence of in-hospital death (0.8% vs 0.3%, p<0.001), acute myocardial infarction (0.9% vs 0.5%, p=0.007) and perforation (7.0% vs 4.2%, p<0.001) was higher in prior CABG patients, while pericardial tamponade was less common (0.1% vs 1.3%, p<0.001). At 2-year follow-up, the incidence of major adverse cardiac events, repeat PCI and acute coronary syndromes was significantly higher in prior CABG patients, while all-cause mortality was similar.

Conclusions:
Prior CABG patients undergoing CTO PCI have more complex clinical and angiographic characteristics and lower success rate, but similar incidence of in-hospital major complications, and had higher incidence of MACE but similar all-cause mortality during long-term follow-up.
Abbreviations:
eGFR= estimated glomerular filtration rate
Abstract 15651: Astrocytic Chordin-Like 1 Regulates AMPAR Synaptic Content and Motor Recovery in a Mouse Model of Ischemic Stroke
Authors: Blanco Suarez Elena , Collyer Eileen , Boyle Bridget , Gomez-Galvez Yolanda , Iacovitti Lorraine
Published: December 2023

Introduction:
Ischemic stroke triggers a series of molecular events that impairs receptor levels at excitatory synapses. AMPA receptors (AMPARs), the main excitatory receptors in the mammalian brain, are crucial in maintaining proper brain function. In response to ischemic stroke, their subunit composition and location at the synapse are deeply altered and trigger apoptotic cell death cascades. We previously found that Chordin-like 1 (Chrdl1), an astrocyte-derived protein that regulates AMPARs, is highly upregulated in the peri-infarct region at early stages after stroke (1 and 7 days post-stroke, dps). When Chrdl1 was absent, neurons were protected from stroke-induced structural degeneration.

Hypothesis:
Elimination of Chrdl1 prevents stroke-induced aberrant AMPAR synaptic levels, limits AMPAR-mediated apoptotic cascades and alleviates behavioral deficits.

Methods:
We used photothrombosis to model ischemic stroke in the motor cortex of adult male and female WT and Chrdl1 KO mice and performed analyses at 1 and 7 dps in the peri-infarct area. We used fluorescent
in situ
hybridization to analyze mRNA levels of Chrdl1, immunohistochemistry to determine synaptic AMPAR levels and subunit composition, TUNEL to determine apoptotic cell death, MRI to monitor the progression of injury volume, and adhesive removal and grid walk tests to assess sensorimotor and motor behaviors.

Results:
WT mice, after photothrombotic injury showed important impairments in the AMPAR synaptic distribution and composition. This aberrant AMPAR subunit composition and location at synapses was abolished in Chrdl1 KO mice. This resulted in reduced apoptotic cell death and faster motor recovery in Chrdl1 KO mice compared to WT in both male and female mice.

Conclusions:
This study shows that targeting Chrdl1 has therapeutic potential to reduce apoptotic cell death and aid motor recovery after ischemic stroke via synaptic regulation of AMPARs. Astrocyte-derived proteins, such as Chrdl1, may represent new molecular targets that can restore synapses to favor functional recovery after ischemic stroke.
Abstract 15667: The Transvalvular Pressure Gradient to Valve Area Ratio: A Novel, Simple Doppler Echocardiographic Parameter to Adjudicate Low-Gradient Aortic Stenosis Severity
Authors: Hecht Sebastien , Annabi Mohamed-salah , Stanova Viktoria , Dahou Abdellaziz , Burwash Ian G , Koschutnik Matthias , Bartko Philipp , Bergler-Klein Jutta K , MASCHERBAUER Julia , Orwat Stefan , Baumgartner Helmut , Cavalcante Joao , Ribeiro Henrique , Rodes-Cabau Josep , Clavel Marie-Annick A , Pibarot Philippe
Published: December 2023

Background:
In patients with low-gradient (LG) aortic stenosis (AS), dobutamine stress echocardiography (DSE) or aortic valve calcium scoring (AVCS) by computed tomography is required to confirm AS severity and the indication for intervention.

Hypothesis:
We hypothesized that the mean transvalvular gradient to effective orifice area ratio (MG/EOA, in mmHg/cm
2
) measured during rest echocardiography predicts true-severe AS (TSAS) and clinical outcomes in LG-AS patients. The present study aimed to assess the diagnostic accuracy and prognostic value of the MG/EOA ratio in LG-AS patients.

Methods:
The diagnostic accuracy of the MG/EOA ratio to predict TSAS was assessed in: i) an in vitro dataset obtained in a circulatory model, and ii) an in vivo dataset collected in 198 patients recruited in the prospective observational cohort TOPAS study (NCT01835028), using receiver operating characteristic (ROC) curve analysis. The prognostic value of this parameter was assessed using spline curve analysis and multivariate Cox regression, using a composite of aortic valve replacement or all-cause mortality at 2-years as clinical endpoint.

Results:
The MG/EOA ratio at rest predicted TSAS with an area under the ROC curve of 0.99 [0.98-1.00] in the in vitro dataset and 0.92 [0.87-0.95] in the in vivo dataset of LG-AS patients. In the in vivo dataset predominantly composed of patients with a low flow state, the optimal cut-off of MG/EOA ratio was 29 mmHg/cm
2
with a normal flow state (percentage of correct classification: 95%) and 25 mmHg/cm
2
with a low flow state (85%). In LG-AS patients, a MG/EOA ratio ≥ 23 mmHg/cm
2
was associated with increased risk of the composite endpoint (unadjusted HR=2.16 [1.58-3.06], p<0.001; adjusted HR=2.80 [1.94-4.03], p<0.001). The net reclassification index (NRI) of the resting parameter MG/EOA was 0.57 (p<0.001), which was similar to projected EOA (NRI=0.61, p<0.001) measured by DSE.

Conclusion:
We propose a new, easily obtainable parameter from standard echocardiography that outperforms other rest echocardiographic parameters and is non-inferior to DSE with respect to diagnostic accuracy and prognostic value. The MG/EOA ratio can be useful in LG-AS to confirm AS severity and may thus avoid the use of additional tests such as DSE or AVCS.
Abstract 15671: Research Participants Are Hesitant About the NIH’s New Data Sharing Policy and Its Implications for Cardiac Research
Authors: Nino de Rivera Stephanie , Omollo Shalom , Myers Annie , Zhao Yihong , Masterson Creber Ruth M
Published: December 2023

Objective:
To evaluate participant preferences for the NIH’s Data Sharing (DMS) Policy and its implications for cardiac research. Introduction: The recent NIH DMS Policy went into effect in January 2023, yet it is unclear how the intended expansion to study data by the public will impact participant willingness to participate in research. Minoritized communities are already underrepresented in research and this could create distrust and increase hesitancy to participate in research. Giving participants options about future use of data, how it is stored and shared all requires further research.

Methods:
A representative sample of adults in the US (n=610) were surveyed using an online platform (Prolific). Questions assessed participants’ agreeability with the new policy, change in willingness to participate in research, and preferences for consenting to future data sharing. Descriptive statistics and bivariate analyses were conducted using Pearson’s chi-squared test and Fisher’s exact test for categorical variables.

Results:
Participants' mean age was 45 (19-93) years, 49.7% were female, 12.8% were Black/African American, 5.9% Asian, and 77.9% White, with the remainder identifying with another race (3.4%). Notably, fewer Black/African Americans (50%) agreed to the new NIH data sharing policy compared to White (67%), Asian (72%), and other races (86%). The results for additional questions relating to the new NIH policy and preferences for sharing clinical data are presented in Figure 1.

Conclusion:
The new NIH DMS policy can increase hesitancy towards participating in research, especially in minoritized communities. Future work should focus on methods to increase representation in cardiac research by ensuring patient preferences for data sharing are upheld.
Abstract 15693: Weekend Sleep Extension (Catch-up Sleep) is Associated With Lower Incidence of Coronary Calcium Score:
The Elsa-Brasil Study
Authors: Peixoto de Miranda Érique José , Khonangz Parise Barbara , Santos Ronaldo , Giatti Soraya , Nogueira Aielo Aline , Cunha Lorenna , A Silva Wagner , Souza Silvana , Lotufo Paulo A , Bensenor Isabela M , Bittencourt Marcio , Drager Luciano F
Published: December 2023

Background:
Insufficient sleep is a worldwide public health problem with potential cardiovascular consequences. Therefore, strategies aiming at improving sleep patterns are highly desired. Cross-sectional studies showed that weekend sleep extension (catch-up sleep) is associated with better glucose metabolism and cognitive function profiles, but longitudinal studies are lacking.

Hypothesis:
Catch-up sleep may have protective effects on subclinical atherosclerosis.

Methods:
In this prospective cohort study, we performed a 7-days wrist actigraphy for monitoring sleep duration and a sleep study to detect sleep apnea. Catch-up-sleep was measured by calculating weekend sleep duration (Friday-Saturday nights) minus weekday sleep duration (Sunday-Thursday nights). Coronary artery calcium, CAC (64-slice multi-detector computed tomography) was measured at two different time points throughout the study (baseline, between 2010-2014, and follow-up, between 2016-2018). Incidence of subclinical atherosclerosis was defined as baseline CAC=0 followed by CAC>0 at a 5-year follow-up visit. The association of incident CAC outcome was assessed using logistic regression adjusting for age, sex, race, body mass index, hypertension, diabetes mellitus, smoking, low- and high-density lipoprotein, use of statin, sleep apnea and interscan period). Analysis of incidence was Inverse probability censoring weighted.

Results:
We analyzed 1,832 participants with available CAC scores at baseline (age: 48.8±8.0years; 57.8% women; 32.1% with sleep apnea). The mean sleep duration was 6.6±1.0 hours. Catch-up-sleep >90 minutes was observed in 28.0%. Incidence of CAC was 27/141 (19.1%) among subjects with catch-up-sleep >90 minutes and 326/1029 (31.7%) among those with catch-up-sleep ≤90 minutes (P<0.001). In covariate-adjusted analyses (n=1,170, follow-up=5.4±0.90 years), we found a lower incidence of CAC in those participants with weekend sleep extension >90 minutes (OR=0.62; 95% CI 0.52-0.74).

Conclusion:
Catch-up sleep is independently associated with a lower incidence of CAC. These results underscore that catch-up sleep may mitigate the adverse cardiovascular effects of weekdays sleep restrictions frequently observed in our Society.
Abstract 15700: What Role Does Physical Activity Play in Health-Related Quality of Life (HRQoL) of Children With Hypertrophic Cardiomyopathy (HCM)?
Authors: Conway Jennifer , Pidborochynski Tara , Lemaire-Paquette Samuel , Khoury Michael , Cunningham Chentel , DHILLON Santokh S , Laroussi Nassiba , Vaujois Laurence , Dallaire Frederic , Schantz Daryl , Armstrong Kathryn , Mawad Wadi , Bradley Timothy J , Jeewa Aamir
Published: December 2023

Introduction:
Higher levels of physical activity (PA) have been associated with better health-related quality of life (HRQoL). Whether this is true for patients counselled to restrict PA is unknown. Our aim was to examine the relationship between objective measures of PA and HRQoL in children with hypertrophic cardiomyopathy (HCM).

Methods:
A cross-sectional study of children with HCM, aged 10-18 yrs, enrolled from 10 Canadian sites (2016-23), who underwent cardiovascular screening including the PedsQL Quality of Life Inventory to measure HRQoL. PA measured via Fitbit occurred over 2 weeks. PA parameters included average daily heart rate, step-count, distance covered (Kms), stair flights, activity and sedentary time. Multiple linear regressions were performed to assess the relationship between PA and HRQoL. Covariate adjustments included: age/sex/BMI class at enrollment, cardiac arrest history, previous ICD implant and PA restriction. Correlation matrix was calculated for PA parameters.

Results:
Fifty-six patients were enrolled [71.4% male; median age 15.5 yrs (IQR 13.8-16.8), median BMI 23.3 Kg/m
2
(IQR 19.5-27.7)], including 11% with a cardiac arrest, 30.4% with an ICD implant and 75% PA restricted. The Fitbit was worn for a median of 14 days (IQR 13.3-14). Average daily steps were 7586 (IQR 5333-10324]) and median sedentary time 893 mins (IQR 735-1141). After adjustment, the average daily steps were associated with Physical HRQoL scores [mean difference (MD) of 2.0 [95% CI 0.3-3.0] per each 1000 steps increase (p=0.02)]. Similar effect sizes were seen for Physical HRQoL with average daily Kms, active time and stairs flights. These outcomes were highly correlated with daily steps (Spearman's ρ; 0.97, 0.81 and 0.6). Conversely, 100 mins of sedentary time decreased mean Physical HRQoL scores by 2 (MD = -2 [-4--0.4]; p=0.02). Only average daily stair flights (MD = 0.6 [0.1-1.1]; p=0.02) was associated with a higher Total HRQoL.

Conclusions:
Increasing PA in children with HCM, especially with flights of stairs, was associated with higher Physical/Total HRQoL, whereas sedentary time had a determinantal effect on Physical HRQoL. Efforts to decrease sedentary time and improve PA may improve the overall physical and total HRQoL of children with HCM.
Abstract 15716: Meta-Analysis of Randomized Controlled Trials Comparing Ablation Targets Beyond Pulmonary Vein Isolation versus Pulmonary Vein Isolation Alone in Patients With Persistent Atrial Fibrillation
Authors: Kaur Arpanjeet , Dhaliwal Arshdeep , Markovic Nebojsa , Das Subrat , Kong Darren , Kansal Dhruv , Marcus Mason , Farhan Serdar , Suri Ranjit
Published: December 2023

Introduction:
Catheter ablation for persistent atrial fibrillation (PeAF) is challenging and pulmonary vein isolation(PVI) alone has limited success. Adjunctive ablation strategies like posterior wall isolation (PWI), linear ablation, substrate modification utilizing complex fractionated atrial electrograms (CFAE) or MRI guided fibrosis ablations have demonstrated variable results beyond PVI alone. We performed a meta analysis of randomized controlled trials (RCTs) comparing efficacy, safety and procedural outcomes of PVI plus adjunctive ablation strategies versus PVI alone.

Methods:
We performed a comprehensive search of electronic databases from inception to April 2023 searching RCTs comparing PVI alone versus PVI+adjunctive strategies(linear ablations, CFAE, PWI, low voltage area ablation and MRI-guided atrial fibrosis ablation). Primary efficacy outcome was recurrence of atrial arrhythmias > 30s after a single ablation procedure, with or without antiarrhythmics. Secondary safety outcome was composite of access site complications, tamponade, hemopericardium, pericardial effusion, pericarditis, stroke/TIA, pulmonary vein stenosis, atrioesophageal fistula or phrenic nerve palsy. Procedural characteristics included mean procedural time and mean ablation time. Pooled risk ratio (RR), mean difference (MD) and 95% confidence interval (CI) were calculated. Statistical analysis was performed using RevMan5.4.1

Results:
10 RCTs with a total of 3042 patients (PVI plus adjunctive n= 1717; PVI alone n= 1325) were included. The mean age was 61.6 ± 0.14 years. The mean follow-up was 16.5 months. There was no significant difference in primary efficacy outcome (RR: 0.99; CI: 0.88-1.12; p> 0.05; I2 = 28%) or secondary safety outcome (RR: 1.46; CI: 0.97-2.18; p> 0.05; I2 = 16%), between two groups. Procedural characteristics including mean procedural time in minutes (MD: 31.84; CI: 4.92-58.75; p< 0.05; I2 = 95%) and mean ablation time in minutes (MD: 20.30; CI: 8.16-32.43; p< 0.05; I2 = 95%) were significantly shorter for PVI alone group.

Conclusions:
Adjunctive ablation strategies provide no additional benefit over PVI alone in PeAF, but are associated with significantly longer procedural and ablation time.
Abstract 15719: Prognostic Interplay Between Myocardial Flow Reserve and Left Ventricular Ejection Fraction
Authors: Nayfeh JR Malek , Al Rifai Mahmoud , Ahmed Ahmed Ibrahim , Alahdab Fares , Al-Mallah Mouaz
Published: December 2023

Introduction:
Myocardial flow reserve (MFR), measured using positron emission tomography (PET), has been shown to add incremental prognostic value in multiple patient populations. Whether this association is modified by left ventricular ejection fraction (LVEF) is not well studied. The aim of this analysis is to determine whether there is a prognostic interplay between myocardial flow reserve and LVEF.

Methods:
The study population included patients who had clinically indicated PET myocardial perfusion imaging and were prospectively followed for incident events. MFR was calculated as the ratio of stress to rest myocardial blood flow (MBF) (ml/min/g). Rest LVEF was calculated from end systolic and end diastolic LV volumes on gated images. Cox proportional hazards were used to study the association between MFR (<2 vs ≥2) and incident cardiovascular events stratified by LVEF (<50% vs ≥50%).

Results:
The study population included 5,523 patients (mean±SD age 67±12 years, 53% male), 16% of LVEF<50% and 47% MFR <2. Rest MBF was similar among patients with normal or reduced LVEF while stress MFR was lower with lower EF. In adjusted analysis, patients with impaired MFR had a higher incident event rate regardless of LVEF (Figure 1). Patients with MFR<2 had a higher risk of incident outcomes in both LVEF ≥50% (HR=2.58, 95% CI:1.93 - 3.46, p<0.001) and LVEF <50% (HR=2.76, 95% CI: 1.62 - 4.70, p<0.001); p-value for interaction= 0.045.

Conclusions:
Impaired MFR is associated with a higher risk of cardiovascular outcomes and death in patients with high or low LVEF.
Abstract 15725: Access to Pacemaker Implantation Amongst Medicare Beneficiaries: Travel Distance and Time to Nearest Clinician
Authors: Khaloo Pegah , Wheelock Kevin , Kapadia Sohum , Khera Rohan
Published: December 2023

Background:
Despite being an essential procedure with rising use in the United States, the availability and accessibility of procedural care for a permanent pacemaker are not known. We investigated access to pacemaker implantation among Medicare beneficiaries.

Methods:
US Medicare physician claims from 2020, and county population characteristic data from AHRQ were used to evaluate the density of providers and beneficiaries across states and counties. For each US zip code, we determined the closest pacemaker implantation center using the haversine formula, then assessed the travel duration for each route using the Google Maps API.

Results:
There was a median of 5 providers performing pacemaker placement per 100,000 individuals over 65 years across all states, with an IQR of 4.5 to 6. At the county level, only 20% of counties in the US had a center offering transvenous pacemaker implantation, and 4% had a center offering leadless pacemakers. Individuals in metropolitan counties drove a median 29 (IQR 18 - 47) minutes to reach a center for pacemaker implantation, while those in non-metropolitan counties drove a median of 72 (IQR 52 - 102) minutes. In counties where >25% of the population is ≥65 years old, the median drive time to a pacemaker center is 86 (IQR 57 - 126) minutes. Residents of counties with a lower median household income (Spearman’s r = 0.45, p < 0.001) and a higher percentage of residents using public insurance had longer drive time to a pacemaker center (r = 0.23, p < 0.001). Out of the estimated 55,356,000 individuals ≥65 years old in the United States, 20,000,000 (36%) had to drive more than one hour, and 4,383,955 (8%) had to drive more than two hours to a site where a pacemaker implantation procedure is performed.

Conclusion:
Over one-third of the population in the United States has significant access issues to basic electrophysiologic care, highlighting the need for increased resources and improved accessibility.
Abstract 15744: Worse Impact of Diabetes on All-Cause Mortality in Women Following CABG
Authors: Paquin Amelie , Voisine Pierre , Roberge Jeanne , Poirier Paul , Piche Marie Eve E
Published: December 2023

Introduction:
Women referred for coronary artery bypass grafting (CABG) have worse metabolic disorders. The latter are associated with adverse cardiovascular (CV) events and bear a worse prognosis in women. Yet, our understanding of the sex-specific impact of metabolic disorders on mortality after CABG is limited. Aim: To evaluate the interaction of sex with metabolic abnormalities on mortality after CABG, with the hypothesis that they would lead to higher mortality in women.

Methods:
In a prospective cohort (2006-19), we selected patients who underwent elective isolated CABG, excluding early (<48h) mortality, atrial fibrillation/flutter, pacemaker/defibrillator or heritable dyslipidemia. Sex-specific predictors of all-cause mortality after CABG and their interaction with sex were assessed with Cox proportional hazard models (stepwise selection for each model). Diabetes was defined as per Canadian Diabetes Association Guidelines.

Results:
We included 6,177 individuals (17% women) in this analysis. All-cause mortality incidence was 438 (9%) and 119 (11%) in men and women respectively (p=0.01) over a median of 5.7 yrs. Compared to men, women were older (67 ± 9 vs 65 ± 9 yrs), more likely to have hypertension (85% vs 78%), diabetes (40% vs 34%), abdominal obesity (82% vs 51%), chronic kidney disease (27% vs 15%), LVEF ≥40% (94% vs 92%) and had higher LDL-cholesterol (72 [17-238] vs 67 [10-221] md/dL) (all p<0.05). Prior myocardial infarction was similar in both sexes (11%, p=0.48). Predictors of mortality are in Figure 1. An interaction between sex and diabetes was found (p=0.03), suggesting worse impact of diabetes in women after CABG.

Conclusion:
Women undergoing CABG have worse CV risk factors and metabolic risk profile, including diabetes which significantly increased mortality risk vs men. Studies are needed to evaluate which sex- or gender-related factors, like poorer diabetes management or reduced participation in cardiac rehabilitation, may be involved.
Abstract 15747: AMPK Cysteine Oxidation by SOD3-Derived H
2
O
2
Mediates Exercise-Induced Restoration of Skeletal Muscle Angiogenesis in Type2 Diabetes
Authors: Varadarajan Sudhahar , Abdelsaid Kareem , McMenamin Malgorzata , Fukai Tohru , Ushio-Fukai Masuko
Published: December 2023

Background:
Exercise restores decreased capillary density in skeletal muscle (SKM) (capillary rarefaction) in type2 diabetes (T2D) that has eNOS uncoupling/excess O
2
-
, which is required for treatment of diabetic peripheral vascular disease (PAD) via unknown mechanisms. AMP-activated protein kinase (AMPK) is a key angiogenic/metabolic kinase mainly regulated by phosphorylation and is required for baseline, but not exercise-induced capillary density in SKM under healthy conditions. AMPK senses H
2
O
2
signal to increase its activity via oxidative modification of Cys299/304
in vitro.
In addition, extracellular SOD (SOD3) that catalyzes the dismutation of O
2
-
to H
2
O
2
is increased in response to exercise. However, the role of AMPK and SOD3 in exercise-induced SKM angiogenesis in T2D has not been reported. Oxidation of Cysteine residues to generate cysteine sulfenic acid (Cys-OH) is a key event in H
2
O
2
-mediated signaling.

Results:
Here we show that reduced CD31+ capillary density in SKM of high fat diet-induced T2D mice was restored (2.4-fold) by voluntary wheel exercise training (2 weeks) with enhanced SOD3 activity (224%) and extracellular H
2
O
2
levels (3.2-fold). Of note, exercise in T2D mice increased AMPK activity (by p-ACC) via inducing CysOH formation of AMPK (3.6-fold), but not p-AMPK induction, which was inhibited by SOD3
-/-
/T2D mice that reduced exercise-induced H
2
O
2
. To demonstrate functional significance of AMPK Cys oxidation, we generated CRISPR/Cas9-genome editing “redox-dead” AMPK-Cys299/304Ala (AMPK-C/A) knock-in (KI) mutant mice and found that AMPK-C/A KI mice showed significant inhibition of exercise-induced angiogenesis (44%) via reducing angiogenic PGC1α and VEGF protein expression in SKM of T2D mice. In vitro, C2C12 skeletal muscles overexpressing SOD3 treated with palmitate (mimic T2D with exercise) induced AMPK-CysOH formation and VEGF secretion. Its conditioned media promoted angiogenic responses such as EC migration (1.8-fold) and tube formation (1.7-fold), which was inhibited by C2C12 cells overexpressing AMPK C/A mutant.

Conclusion:
Novel exercise-induced AMPK CysOH formation at Cys299/304 restores angiogenesis in SKM of T2D via SOD3-mediated H
2
O
2
, which may contribute to revascularization in diabetic PAD.
Abstract 15754: The Incidence and Effect of Cardiac Function Decline After Lower Extremity Revascularization
Authors: Jamil Yasser , Huttler Joshua , Alameddine Dana , Zhuo Haoran , Mena-Hurtado Carlos , Velazquez Eric J , Guzman Raul J , Ochoa Cassius I
Published: December 2023

Introduction:
The impact of cardiac function decline on major adverse limb events (MALE) following lower extremity revascularization (LER) in patients with peripheral arterial disease (PAD) has not been described.

Methods:
The electronic records of patients undergoing LER for PAD in a single center were reviewed. Two transthoracic echocardiograms were captured, the first within 6 months of LER and the second on later follow-up. Patients were then divided into 2 groups: cardiac function decline (decrease in left ventricular ejection fraction (EF) by ≥10%) or stable cardiac function (reduction in EF<10% or improved EF). Patient characteristics and outcomes were compared, including MALE.

Results:
Of the 922 patients who underwent LER, 221 (24.0%) experienced a cardiac function decline. Out of the 701 patients with stable cardiac function, 599 (65.0%) had a <10% reduction in EF, and 102 (11.0%) had an EF improvement. Patients with cardiac function decline were more likely to have diabetes mellitus and heart failure. Furthermore, patients with cardiac function decline were more likely to undergo open surgical revascularization. Patients with cardiac function decline demonstrated higher rates of periprocedural bleeding after initial LER. After a 3-year follow-up, patients with cardiac function decline had higher mortality and lower overall frequency of reinterventions. However, Kaplan-Meier analysis revealed no difference in freedom from MALE between the 2 groups.

Conclusion:
Patients with cardiac function decline after LER for PAD have increased mortality but no significant difference in limb outcomes compared to patients with stable cardiac function.
Abstract 15792: COVID-19 and Pericoronary Fat Attenuation Index; Is There a Link?
Authors: Nayfeh JR Malek , Ahmed Ahmed Ibrahim , Alahdab Fares , Al Rifai Mahmoud , Al-Mallah Mouaz
Published: December 2023

Introduction:
Pericoronary fat attenuation index (pFAI) is a marker of coronary inflammation, a key step in atherosclerotic plaque formation. COVID-19 infection has also been shown to be associated with significant systemic inflammation. The aim of this study is to assess the impact of active COVID-19 infection on pFAI.

Methods:
Cases consisted of patients with acute or subacute COVID-19 infection who underwent clinically indicated coronary computed tomography angiography (CCTA) and were matched 1:3 on clinical and cardiovascular risk factors to controls having no prior or active COVID-19 infection. pFAI was measured for all 3 major epicardial coronary vessels (LAD, LCx and RCA). Per-vessel and per-patient analysis were done. SARS-COV-2 variant was determined as the predominant variant at the time of diagnosis.

Results:
We included 102 cases matched to 386 controls (64 ± 12 years, 42% men). Mean pFAI in overall cohort was higher in COVID-19 cases vs controls on both per patient (mean: -75.16 vs -77.15, p=0.024; LAD: -75.98 vs -78.65, p=0.004, LCx: -72.56 vs -74.38, p=0.047)
(Figure 1a)
and per-vessel (-75.17 vs -77.13, p=0.0001) analyses. Results of subgroup analysis of patients with no CAD and patients with CAD-RADS 0 showed a similar trend
(Figure 1b-1c)
. In univariable linear regression, there was a positive association between COVID-19 and pFAI for mean per patient (beta coefficient=1.90, 95% CI: 0.26 - 3.53, p=0.02) and per-vessel (beta coefficient=1.96, 95% CI: 0.85 - 3.07, p=0.00) analyses. The association remained significant after adjusting for age, sex, and cardiovascular risk factors.

Conclusions:
There is a weak but statistically significant association between COVID-19 infection and elevated pFAI.
Abstract 15799: Frequency and Etiology of Post-Operative Leukocytosis After Heart Transplantation
Authors: Sigal Ian R , Molina Maria , Wang Teresa , Atluri Pavan , Cevasco Marisa , Blumberg Emily , Thomasson Arwin , McLean Rhondalyn C , Goldberg Lee R , Holzhauser Luise L , Genuardi Michael V
Published: December 2023

Introduction:
Many factors contribute to post-operative leukocytosis after heart transplantation; it may be challenging to determine whether post-operative leukocytosis is caused by infection.

Objective: To describe the frequency and causes of leukocytosis after heart transplantation.

Methods:
A representative sample of 207 of 308 patients who underwent heart transplant at our institution between 1/1/17 and 12/31/22 was examined. Leukocytosis was defined as a white blood cell (WBC) count peak >11 th/μL or a 30% increase in WBC if pre-transplant baseline was >11 th/μL. Leukocytosis was classified as early (post operative day [POD] 0-3), delayed (POD 4-7), or late (POD 8-60). Culture, biopsy, and other clinical data were used to adjudicate etiology. Groups were compared using χ
2
, Fisher’s, or t-test as indicated.

Results:
The sample was 27% female with a mean age of 51.2 (±12.6) years. A total of 404 leukocytosis episodes were identified affecting 204 patients. Common etiologies included: post-transplant surgery (47.0%), true infection (27.2%), corticosteroid bolus (4.0%), subsequent surgery (3.5%), rejection (3.0%), and thrombus (3.0%). Delayed (24/47) and late (59/146) leukocytosis were more likely to be associated with infection than early leukocytosis (27/211, p<0.0001 for both comparisons). Common causes of infection were: pneumonia (33%), bloodstream infection (20%), skin and soft tissue (12%), unknown (9%), urinary (5%), and colitis (3%). Post-operative infection was associated with increased hospital length of stay after transplantation (17 vs 46 days, p<0.0001), and increased in-hospital mortality (9.6% vs 2.7%, p=0.040). ECMO (p=0.08), non-ECMO temporary mechanical circulatory support (p=0.70), prior cardiac surgery (p=0.08), and donor bloodstream infection (p=0.40) were not associated with post-operative infection. There was no significant difference in cross clamp time (p=0.42), ischemic time (p=0.27), or age (p=0.07) in patients with vs without infection.

Conclusion:
Leukocytosis after transplant is nearly universal. Patients developing leukocytosis on POD ≥4 have a high rate of concurrent infection compared to those with early leukocytosis, which is in turn associated with increased LOS and in-hospital mortality.
Abstract 15816: Contemporary Nationwide Trends in Major Adverse Cardiovascular and Cerebrovascular Events Among Elderly Chronic Kidney Disease Patients With versus Without Obstructive Sleep Apnea and Associated Sex and Racial Disparities, 2016-2019
Authors: Borra Vamsikalyan , Ogbu Ikechukwu , Bondi Gayatri , Borra Nithya , Machineni Naga Vamsi Krishna , Yartha Sai Goutham Reddy , Mundla Sravya , Ramasahayam Karthikeya , Kuchipudi Purnachandra Rao , AGARWAL CHARU , Bansal Prerna , Bathija Sagar , Desai Rupak
Published: December 2023

Background:
End-stage renal disease (ESRD) patients with more intensive renal replacement therapy have been shown to alleviate the severity of sleep apnea, specifically obstructive sleep apnea (OSA). Our study aims to analyze the trends in combined cardiovascular events among geriatric CKD patients, comparing those with and without OSA.

Methods:
We conducted a comprehensive analysis using nationwide data from 2016 to 2019 to identify geriatric CKD patients based on ICD-10 codes. A comparative assessment was performed between elderly CKD patients with and without OSA, examining their baseline characteristics and potential disparities related to sex and race.

Results:
From 2016 to 2019, 14,157,877 geriatric CKD patients were analyzed. OSA is more prevalent in men (60.5% v/s 50.5%) and in the white race(79.3% v/s 72.5%) compared to the non-OSA group. In the OSA group, men had an increased prevalence of major adverse cardiovascular and cerebrovascular events (MACCE) (12.0% v/s 9.7%) and acute myocardial infarction (AMI)(7.0%-5.2%) with p<0.001. OSA patients had a decrease in all-cause mortality (3.2% v/s 4.7%), AMI (6.3% v/s 7.2%), and cardiac arrest (1.0% v/s 1.3%), with p<0.001. Patient’s on BiPAP/CPAP therapy have further decreased ODD’s of MACCE and is statistically significant, p<0.001.

Conclusion:
OSA patients with or without BiPAP/CPAP are associated with decreased MACCE in elderly CKD patients. The potential impact of Interventions like BiPAP/CPAP therapy on kidney function and cardiovascular outcomes requires further investigation to better understand and manage chronic kidney disease and OSA cardiovascular paradox.
Abstract 15819: The Outcome of Transcatheter Aortic Valve Replacement for Pure Aortic Regurgitation: A Updated Systematic Review and Meta-Analysis
Authors: Peng Bo , Badheka Apurva O
Published: December 2023

INTRODUCTION:
Although the current treatment of choice of severe pure aortic regurgitation (AR) is surgical aortic valve replacement, increasing evidence has shown the potential of transcatheter aortic valve replacement (TAVR) in the management of patients who have high surgical risk profiles.
AIMS:
To conduct a systematic review and meta-analysis in evaluating the outcome of TAVR for pure AR based on current emerging evidence.

Methods:
Articles on MEDLINE, CINAHL, Web of Science, Embase, and Cochrane that studied the outcome of TAVR for the management of pure native AR were extracted. Device success rates, post-procedure moderate to severe AR rates as well as in-hospital, 30-day, and 1-year all-cause mortality rates were pooled for meta-analysis. Subgroup analyses of the above outcome comparing early-generation devices (EGD) and new-generation devices (NGD) were performed. Data were presented with incidences and 95% confidence intervals (CI), and I
2
was used to analyze heterogeneity.

Results:
Twenty-four studies involving 4435 patients were included. The pooled device success rate was 89.6% (95% CI 81.7% to 92.2%, I
2
= 91.63%), and 88.2% (95% CI 83.4% to 92.9%, I
2
=86.0%) of device placement was achieved by single implantation. Compare to EGD (72.2%, 95% CI 58.3% to 86.1%, I
2
=94.1%), NGD (91.6%, 95% CI 87.4% to 95.8%, I
2
=83.8%) has a higher device success rate. The overall in-hospital, 30-day, and 1-year all-cause mortality of TAVR for AR was 3.7% (95% CI 2.1% to 5.2%, I
2
=70.2%), 6.9% (95% CI 4.8% to 9.0%, I
2
=79.5%), and 13.9% (95% CI 8.5% to 19.2%, I
2
=89.1%), respectively. A higher 30-day all-cause mortality rate was observed in patients who received EGD implantations (12.6%, 95% CI 7.7% to 17.5%, I
2
=61.4%) than those have NGD placements (6.3%, 95% CI 3.9% to 8.7%, I
2
=51.0%). About 6.9% (95% CI 4.6% to 9.3%, I
2
=72.4%) and 4.6% (95% CI 1.5% to 7.7%, I
2
=86.2%) of patients continue to have moderate to severe AR post-procedure and at 30 days, respectively.

CONCLUSION:
Our current systematic review and meta-analysis suggests that TAVR may be a feasible option for patients with pure AR who have high surgical risks. NGD is superior to EGD in AR management due to its higher device success rate and favorable mortality outcome.
Abstract 15837: Anomalous Bronchial Artery Origin- The Canary in the Coal Mine- For the Diagnosis of Chronic Thromboembolic Pulmonary Hypertension
Authors: Jyothi Ramachandran Nair Devi Parvathy , Zachariah Shilla , SACKS DAVID , Koslow Michael , Hingorani Rittu
Published: December 2023

Introduction-
Anomalous bronchial artery origin is seen in 8.3% to 35% of cases with most originating from the aortic arch, internal mammary artery, and subclavian artery. Origin of this vessel from a coronary artery is extremely rare.

Case presentation-
A 49-year-old male with history of unprovoked pulmonary embolisms (PE) in the setting of triple antibody positive Antiphospholipid antibody syndrome on lifelong anticoagulation presented with left sided chest pain and dyspnea. Initial lab work showed a troponin of 5.46 ng/mL, BNP of 602 pg/mL and D-dimer of 0.62 ug/mL. EKG showed normal sinus rhythm with non-specific ST segment changes in anterior leads. Computed Tomography Angiography (CTA) was positive for a PE. There was concern for a false positive result due to previous history of multiple PEs while on therapeutic levels of warfarin and near normal D-dimer. Echocardiogram showed ejection fraction of 38% with akinesis of anteroapical and inferoapical segments and no evidence of shunt on bubble study. Cardiac catheterization showed non-obstructive coronaries. From the ostium of the right coronary artery there appeared a fistula like structure extending into the pulmonary vasculature. Pulmonary angiogram was performed and showed chronic occlusion in branches of right pulmonary artery (RPA), pulmonary hypertension (PH) with mean pulmonary artery pressure of 36 mmHg and no evidence of acute thrombus. There was aberrant origin of the right bronchial artery from the right coronary artery that was hypertrophied as it supplied collateral flow to the area of the occluded RPA. The patient was started on guideline directed medical therapy for heart failure and follow up was arranged for further outpatient management of PH.

Discussion-
A rare congenital anomaly was used to guide the diagnosis of a potentially devastating and treatable medical condition. It shows the limitations of a CTA in the setting of chronic PE.