bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14693: Venous Thromboembolism in the Modern Era of Multiple Myeloma : An Analysis of Real-World Data From a Nationwide Claims Database in Japan
Authors: SHIINA TETSUYA , Dohi Tomotaka , Ohtsu Hiroshi , Yonemoto Naohiro , Sase Kazuhiro , Minamino Tohru
Published: June 2023

Introduction:

Treatment for Multiple Myeloma (MM) with new therapeutic agents has dramatically improved outcomes and increased the number of survivors. Although venous thromboembolism (VTE) is common in MM, the pathophysiological interplay between VTE and MM, including risk factors related to the patient, disease, and modern treatments, is complex and incompletely understood.

Objectives:

To evaluate real-world data on the risk factors of VTE and outcomes of patients with MM using a nationwide claims database.

Methods:
This study involved the retrospective observational analysis of the Japan Medical Data Center (JMDC, Tokyo, Japan) database, an anonymized patient-level claims database younger than 75 years old. We identified cases with diagnosis and treatment of MM with codes provided by JMDC. Patients with a tentative diagnosis code of MM [C90] were included. Cases with a history of VTE or a pre-diagnostic history of fewer than six months were excluded. Propensity score (PS) was calculated using logistic regression based on age, gender, and cardiovascular risk factors.

Results:
We identified 2,023 eligible cases (mean age 53.6 ± 11.8 years) between January 2015 and December 2020. After 1:1 PS matching, the number of patients, mean age (years), follow-up (months) were as follows: MM group (n=280, 58.7 ± 8.1, 18.6 ± 14.8), Control group (n=280, 58.5 ± 8.1, 24.4 ± 18.4). Kaplan-Meier analysis indicated that the rate of VTE within 60 months was significantly higher among MM than in Control (25.7% vs 2.5%, Log-rank p<.001). Within the MM group, multivariable Cox proportional hazard model showed that lenalidomide had a risk of VTE (Hazard Ratio 1.16 [95% Confidence Interval: 1.19-7.69]) among modern therapies (stem cell transplantation 37.1%, elotuzumab 6.4%, daratumumab 16.8%, bortezomib 88.9%, carfilzomib 21.8%, ixazomib 11.8%, thalidomide 3.9%, lenalidomide 78.9%, and pomalidomide 15.4%).

Conclusions:
Patients who underwent modern MM therapies, including immunomodulatory agents, had significantly higher VTE risk than PS-matched Control. Therefore, further studies using real-world data to improve prevention, early detection, and treatment of MM-related VTE are warranted.
Abstract 14703: Short Term Safety and Efficacy of Escalating Doses of Atorvastatin for Dyslipidemia in Children With Predialysis Chronic Kidney Disease Stage 2-5
Authors: Ramesh Punitha L , Khandelwal Priyanka , Sinha Aditi , R Lakshmy , Hari Pankaj , Bagga Arvind
Published: June 2023

Introduction:
Dyslipidemia is a potentially modifiable risk factor in patients with chronic kidney disease (CKD). Information on safety and efficacy of statins in pediatric CKD is limited.

Methods:
Patients with CKD stage 2-5, aged 5- 18 years with low density lipoprotein cholesterol (LDL-C) >130mg/dL and/or non-high density lipoprotein cholesterol (non HDL-C) >145mg/dL were enrolled from September 2019 to February 2021. All patients were administered atorvastatin 10 mg/day, and escalated to 20 mg/day if LDL-C>100 mg/dL and/or non-HDL >120mg/dL at 12 weeks. Proportion of patients achieving target lipid levels (LDL-C ≤100 mg/dL and non HDL-C ≤120mg/dL), change in lipid and adverse effects were assessed at 24 weeks. Wilcoxon sign rank test was used to assess percentage change in lipid.

Results:
Of the 31 patients enrolled, target lipid levels were achieved in 45.2% patients (95% CI 27.8%-63.7%) at 24-week; 22 patients required dose escalation to 20 mg at 12 weeks. There was no difference in median reduction in lipid levels with 10 mg/day (n=9) versus 20 mg/day (n=22; p=0.3). Higher baseline LDL-C (OR 1.06, 95% CI 1.00 to 1.11) and older age (OR 36.50 95% CI 2.57 to 519.14) were independent predictors of failure to achieve target lipid levels with 10 mg/day atorvastatin. None had persistent rise in AST/ALT >3 times upper normal limit (UNL) or CPK >10 times UNL. No differences were noted in the adverse effects of atorvastatin 10 mg/day and 20 mg/day.

Conclusions:
Atorvastatin (10-20 mg/day) administered for 24 weeks was safe and effectively reduced LDL-C and non HDL-C in children with CKD stage 2-5. Patients with higher baseline LDL-C required higher doses to achieve the target.
Abstract 14741: Sudden Desaturation in the Presence of Severe Hypertensive Blood Pressure Response to Exercise, What Next?
Authors: Ha Francis , Trytell Adam , Warren Josephine , Lindqvist Anniina , Wallace Imogen , Manca Stefano , Moneghetti Kegan
Published: June 2023

62 year old male was referred for evaluation of exertional breathlessness, predominantly when commuting to work by bicycle. There was no associated chest pain, palpitations, syncope or family history of cardiovascular disease. He had untreated hypertension, a remote history of hairy cell leukemia treated with cladribine in remission and polycythemia rubra vera treated with venesection and pegylated-interferon therapy. Trans-thoracic echocardiogram demonstrated normal biventricular size and systolic function with normal valvular function. There was insufficient tricuspid regurgitation to estimate pulmonary pressure. A stress echocardiogram was negative for ischemia at submaximal exercise capacity due to the protocol used. Previous spirometry testing demonstrated preserved lung volumes, forced expiratory volumes and vital capacity. DLCO (lung diffusion capacity for carbon monoxide) was at the lower limit of normal. A ventilation-perfusion scan excluded pulmonary emboli. Cardiopulmonary exercise testing demonstrated good exercise capacity (peak VO2 40.8 ml/kg/min). An abrupt desaturation was seen at the respiratory compensation point, (Figure 1 - left) with an oxygen saturation nadir of 75% (measured in two peripheral locations), which resolved rapidly in early recovery. This coincided with a profound hypertensive response peaking at systolic blood pressure 252mmHg (Figure 1 - right). The test was ceased due to dyspnea and generalized fatigue. This case demonstrates that while maximal oxygen consumption is a prognostic marker, an above average exercise capacity does not exclude underlying pathology. Pulmonary capillary stress failure resulting in transient pulmonary edema and early pulmonary hypertension cannot be excluded. However, with normal exercise capacity, justification of invasive diagnosis is difficult and there are currently no guidelines regarding an optimal surveillance plan.
Abstract 14742: Driveline Infections Are Associated With Increased Hospitalizations Amongst Heartmate III Recipients
Authors: Feinman Jason , Mathew Alvin , Golec Sophia , Rao Aarti , Roldan Julie , Lala Anuradha , Moss Noah , Parikh Aditya
Published: June 2023

Introduction:
The Heartmate III (Abbott, Chicago) is the only currently available durable left ventricular assist device (LVAD). Driveline infections (DLI) are a potential complication of durable mechanical circulatory support (MCS). We sought to analyze the impact of driveline infections on post-implantation outcomes.

Methods:
Consecutive patients who underwent implantation of a Heartmate III LVAD at our institution were analyzed. Patients were excluded if the device was placed as part of an exchange for another durable MCS device. Patients were followed until transplant, device exchange, death, or end of follow up. The primary outcome was the difference in number of hospitalizations and days hospitalized between patients with driveline infections compared to those without.

Results:
130 patients (average age 59 years, 71% male) underwent implantation of a Heartmate III LVAD between September 2015 and March 2021. Over an average follow up of 23 months, 51 patients developed a documented DLI. The average time to DLI was 336 days. 90 percent of the initial DLI were caused by single organisms and 53 percent of these organisms were gram-positive. The number of total hospitalizations (2.6 vs. 5.9, p=0.00001) and total days hospitalized (28.8 vs. 62.7, p=0.0002) were increased in patients with DLI. Patients with DLI spent an average of 27 days hospitalized for reasons related to their DLI. 23 percent of patients with DLI required extended treatment with IV antibiotics for their first infection. 31 percent of patients with DLI were later transitioned from oral to extended treatment with intravenous antibiotics. 16 patients with DLI required debridement and 5 ultimately required device exchange.

Conclusions:
Despite improvement in device design and hemocompatibility, driveline infections remain a common source of morbidity for patients supported by Heartmate 3 LVAD and are associated with increased hospitalizations and hospitalization days. The potential morbidity should be discussed with patients prior to implantation and diligent care must be taken post-implantation to reduce the impact of this common complication.
Abstract 14753: Impact of Automation on Time Burden of Echocardiographic LVEF Measurements: A Systematic Review and Meta-Analysis
Authors: Nolan Mark , Marwick Thomas , Thavendiranathan Paaladinesh
Published: June 2023

Introduction:
Impact of time savings with the use of automated left ventricular volume measurements has not been systematically quantified.

Hypothesis:
Automated measurement of left ventricular volumes will lead to significant time savings.

Methods:
Electronic search of MEDLINE and EMBASE was performed. Inclusion criteria included 1) LVEF (either 2D or 3D) quantification using completely automated software, 2) comparator group of manual measurements and 3) stated mean and standard deviation of measurement time. Meta-analysis was performed with studies weighted by DerSimonian-Laird method and pooled using random-effects model.

Results:
6 studies of automated 3D-LVEF measurement were identified with total of 697 pts. Time savings for 3D-LVEF automation was -371.0 seconds per study (95%CI -754.6 to +12.6 seconds, p = 0.058, Q (df=5) 2104.3, I2 99.9%), which was non-significant. HeartModel (Phillips) was used in 4 studies with 550 patients with non-significant time savings of -452.3 seconds (95%CI -1029.5 to +124.9 seconds, p=0.12, Q(df=3) 1954.1, I2 99.9%). 4D AutoLVQ (GE) was used in 1 study of 103 patients with significant time savings (142±30 sec vs. 226±114 sec, p<0.001). A single study of 44 pts used eSieLVA(Siemens) with significant time savings (37 ± 8 sec vs 371 ± 116 sec, p<0.001). For automated 2D-LVEF measurements, 6 studies were identified with total of 681 pts with total time savings with automation of -65.8 seconds, (95%CI -86.3 to -45.3 seconds, p < 0.001, Q(df=5) 86.1, I 2 98.7%). AutoEF (GE) was used in 3 studies with total of 230 pts with time-savings of -49.6 seconds (95%CI -59.6 to -39.7, p<0.0001, Q(df=2) 15.3, I2 88.2%). Auto EF (Siemens) was used in 2 studies, total 267 pts, with time savings of -75.2 seconds, (95%CI -118.3 to -32.1 sec, p=0.0006, Q(df=1) 24.7, I2 96.0%). A2DQ(Phillips) was used in 1 study of 184 pts (41 ± 5 sec vs. 98 ± 8 sec, p<0.001). Subgroup analysis did not reveal significant difference in time savings between 2D-LVEF software (p=0.26).

Conclusions:
Significant time savings were observed for automated 2D-LVEF measurements with nonsignificant trend for automated 3D-LVEF measurements. Adoption of automated LVEF measurements may contribute to improved echocardiography lab efficiency.
Abstract 14757: Affected Patients and Clinical Outcomes After Transcatheter Relief of Superior Vena Cava Stenosis
Authors: Pradhan Sarah , Raga Luisa E , Batlivala Sarosh P , Ollberding Nicholas , Szugye Nicholas , Shahanavaz Shabana , Hirsch Russel
Published: June 2023

Background:
Obstruction of the superior vena cava (SVC) is thought to be mostly iatrogenic. Transcatheter interventions relieve stenosis with good long-term results, but there is a paucity of published data. We aim to describe patient characteristics and outcomes after transcatheter SVC intervention.

Methods:
Single-center, retrospective study of patients who underwent transcatheter SVC intervention from December 2006 to January 2020. Patient characteristics included age, gender, height, weight, and BSA. Clinical parameters included congenital heart disease (CHD), orthotopic heart transplant (OHT), upper extremity central venous line (CVL), extracorporeal membranous oxygenation (ECMO), mortality, and symptoms. Procedural data included pre- and post-intervention SVC pressure gradient, dimensions, and complications.

Results:
A total of 42 patients (median age 1.5 years, IQR [0.31-15], 64.2% male) underwent 81 procedures with 1 major complication, and 20 patients (47.6%) had re-interventions. 12 patients (31.5%) had symptoms. Affected patient groups were as follows: history of CVL (92.9%), CHD (76.2%), post-OHT (42.9%), and post-ECMO (30.9%). Those who underwent initial balloon angioplasty were significantly younger (mean ± SD: 3.9 ± 6.8 vs. 13.1 ± 11.3 years, p<0.01) and smaller (15.9 ± 20.4 vs. 39.9 ± 31.2 kg, p<0.01) than those with initial stent. A lower pressure gradient and larger post-intervention dimension was achieved after stenting (p<0.01). Re-intervention rates were similar; 50% after balloon and 43.8% after stent, but nearly half of the angioplasty cohort resolved after repeat angioplasty alone, while most stents (85.7%) required serial re-dilation. Affected patient groups were not associated with re-intervention, and there were no significant differences in patient or procedural characteristics between those who did and did not require re-intervention.

Conclusions:
We describe at-risk groups who warrant surveillance of SVC stenosis in the setting of a low-symptom rate. Strongly consider balloon angioplasty as initial therapy, which may avoid the need for stent and subsequent re-dilations associated with growth. Re-intervention is likely after balloon angioplasty and stenting, but both are safe and effective.
Abstract 14766: Development of an Ex-Vivo Vascular Bioreactor to Investigate Viability of Coronary Arteries
Authors: Razzi Francesca , Stijnen Marco , Duncker Dirk J , van Steijn Volkert , Van Beusekom Heleen M
Published: June 2023

Introduction:
The cardiovascular disease that causes most of the deaths is atherosclerosis. The current research to assess efficacy of treatments is based on animal models, but these present several limitations related to time and costs associated. Ex-vivo systems represent useful models to study vascular biology and to test medical devices. The main goal of this research was to culture coronary arteries in an ex-vivo vascular bioreactor in order to maintain them alive and functional by mimicking physiological conditions.

Methods:
Culture experiments were performed on porcine right coronary arteries (RCA). Duration was set to 2 (n=3), 4 (n=3), and 9 days (n=3). The RCAs were dissected from hearts harvested from a local slaughterhouse. The bioreactor containing the dissected RCA was placed in a 38°C incubator. The RCA was cultured in a blood-mimicking culture medium. To assess RCA morphology and diameter, ultrasound imaging was performed. Pressure and flow rate were monitored daily. The flow rate was set to ensure a physiological peak endothelial shear stress of around 0.8-1.8 Pa. After 2, 4 or 9 days of culture, the RCA was embedded in paraffin and cut into 4 μm sections. Histological stainings (H&E and RF) were performed on the sections.

Results:
During RCA cultures, the mean pressure was 60-100 mmHg, and the peak flow rate was around 60 ml/min. Ultrasound imaging showed that the morphology and structure of cultured arteries was maintained during the culture. Histological analyses showed preserved endothelium and extracellular matrix. After 2 days of culture, endothelial coverage was not complete while after 4 days it was completely restored. After 9 days of culture, a layer of newly formed neointima was visible.

Conclusions:
The cultured RCAs maintained their physiological morphology up to 9 days of culture. The investigated model represents a useful tool for testing vascular therapies and devices, supporting the translational phase between in-vitro and in-vivo studies.
Abstract 14774: Association Between Cumulative Lipoprotein(a) Exposure and Adverse Cardiovascular Outcomes in Patients With Prediabetes or Diabetes: Insights From an Asian Cohort Following Percutaneous Coronary Intervention
Authors: Wang Peizhi , Yuan Jinqing
Published: June 2023

Introduction:
Lipoprotein(a) is a complex circulating lipoprotein and growing evidence has demonstrated its role as a risk factor for coronary artery diseases and as a promising therapeutic target. However, the impact of cumulative Lp(a) exposure on long-term cardiovascular prognosis remains indistinct.

Hypothesis:
The aim of this study is to determine the impact of cumulative Lp(a) exposure [CumLp(a)] on long-term cardiovascular prognosis in patients with CAD and different glycemic metabolism status.

Methods:
We consecutively enrolled 10,724 patients with CAD hospitalized for PCI from January to December in 2013. Cumulative Lp(a) exposure was calculated as the area under the Lp(a) versus age trajectory. According to the optimal cut-off value of CumLp(a) for the major adverse cardiac and cerebrovascular events risk prediction and different glycemic metabolism status, patients were categorized into six groups.

Results:
9,329 patients were ultimately enrolled in the current study. 2,073 MACCEs were documented during a median of 5 years’ follow-up. CumLp(a) was a significantly independent prognostic factor in the total population, in the Pre-DM groups and in the DM groups (HR: 1.45, 95% CI 1.12-1.89, P = 0.006; HR: 1.08, 95% CI 1.01-1.16, P = 0.018; HR: 1.07 95% CI 1.00-1.13, P = 0.037; respectively). Moreover, compared to ones with CumLp(a)-L and non-DM, patients with CumLp(a)-H and DM, CumLp(a)-H and Pre-DM, and CumLp(a)-L and DM had increased risk of 5-year MACCEs (HR: 1.50, 95% CI 1.21-1.87, P < 0.001; HR: 1.39 95% CI 1.11-1.73, P = 0.004; HR: 1.33, 95% CI 1.08-1.64, P = 0.008; respectively).

Conclusions:
In this real-world study, higher level of CumLp(a) combined with DM or Pre-DM was significantly related to worse 5-year cardiovascular outcomes among patients with CAD undergoing PCI, suggesting that evaluation of CumLp(a) and impaired glycemic metabolism status may help identify high-risk individuals who would benefit from further therapeutic interventions.
Abstract 14784: Outcomes Associated With Implementation of an Intravenous Sotalol Initiation Protocol
Authors: Liu Albert Y , Charron Jessica , Fugaro Dana , Spoolstra Scott , Kaplan Rachel , Lohrmann Graham , Gao Xu , Gay Hawkins , Passman Rod S , Kim Susan , Lin Albert , Chicos Alexandru , Arora Rishi , Patil Kaustubha , Pfenniger Anna , Knight Bradley P , Verma Nishant
Published: June 2023

Introduction:
Oral sotalol initiation frequently requires a multi-day hospitalization for electrocardiographic monitoring. A one-day intravenous (IV) sotalol loading protocol was approved by the FDA in March 2020, but limited data on its clinical use currently exists. The aim of this study was to describe the outcomes of implementation of the IV sotalol initiation protocol within an integrated health system.

Methods:
An IV sotalol loading protocol was started in August 2021 for adult patients who were candidates for oral sotalol and had a creatinine clearance (CrCl) > 30 mL/min. Patients with a heart rate < 60 bpm or QTc > 450 ms (500 ms for those with widened QRS) were excluded. Patients with persistent atrial arrhythmias were cardioverted prior to drug infusion. IV sotalol infusion was administered in the Cardiac Recovery and Observation Unit with one-on-one nursing and was stopped for a heart rate < 50 bpm or QTc > 500 ms (550 ms for those with widened QRS). Patients were admitted for monitoring post-infusion and received two oral sotalol doses prior to discharge. Serial EKGs were performed according to protocol. Expected length of stay (LOS) with oral initiation was calculated for the same patients using CrCl.

Results:
A total of 27 patients (average age 66 years, 26% women) underwent IV sotalol initiation. Average LVEF was 52% and average CrCl was 91.4 ± 24.8 mL/min. Primary indication was atrial arrhythmia for 74% and ventricular arrhythmia for 26%. Sotalol loading was successfully completed in 21 (78%) patients. Adverse events interrupting sotalol load included bradycardia (5 patients, 19%) and QT prolongation (2 patients, 7%). No patients developed sustained ventricular arrhythmias. LOS for patients completing IV load was 2.3 days shorter (mean 1.0 vs 3.3, p<0.001) compared to expected LOS with oral load.

Conclusions:
A one-day IV sotalol loading protocol is a safe alternative to a multi-day oral sotalol initiation protocol and significantly shortens hospital LOS, potentially leading to significant cost savings.
Abstract 14789: Vascular Growth Factors and Their Association With Arterial Stiffness in the 1986 Jamaica Birth Cohort: A Longitudinal Analysis
Authors: Bennett Nadia R , Ferguson Trevor S , Younger-Coleman Novie O , Tulloch-Reid Marshall , Wilks Rainford , Cruickshank J K
Published: June 2023

Introduction:
Vascular growth factors (VasGFs) and increased arterial stiffness provide an early indication of structural and functional blood vessel changes that lead to cardiovascular disease. We aimed to determine if there was an association between serum levels of vascular endothelial growth factor (VEGF), epidermal growth factor (EFG), angiopoietin 1 (Angp1) and angiopoietin 2 (Angp2) with arterial stiffness in 28-30-year-old adults from a birth cohort.

Methods:
Participants were a subset of members of a longitudinal study of children born in Jamaica between September and October 1986. Sociodemographic and anthropometric measurements were taken at the 18-20 and 28-30 follow-up visits, while serum was collected at the 18-20 year old visit. The pulse wave velocity (Arteriograph
TM
) was used to measure arterial stiffness at the 28-30-year-old visit. Analyses were limited to participants who had pulse wave velocity measurements. Multiple imputation using chained equations was done to account for missing data on the explanatory variables. Linear regression models were used to explore bivariate associations. The final multivariable model included VEGF, EGF, Angp1, Angp2, age, sex, BMI, SBP, DBP, smoking and education.

Results:
Analyses included 387 participants (47% male). At 18-20yrs median serum concentrations of VEGF 75.4 pg/ml; EGF 951.4 pg/ml; Angp1 67863.7 pg/ml; and Angp2 691 pg/ml. At 28-30 there were sex differences in BMI (M:25.2 vs F:28.8kg/m
2
), SBP (M:114 vs F:108 mmHg), current smokers (M:29% vs F: 5.4%) tertiary education (M:22% vs F:39%) and arterial stiffness (M:6.4 vs F:6.8m/s). In the final multivariable model both VEGF and EGF were associated with arterial stiffness. VEGF coef (95%CI) 0.095 (0.014, 0.176) p= 0.022 and EGF -0.087 (-0.169, -0.004) p =0.039. There was no association between angp1 or angp2 and pulse wave velocity.

Conclusion:
VEGF concentrations at 18-20 of was positively associated with arterial stiffness at 28-30 years old, while and EGF showed inverse association. VEGF and EGF may be useful biomarkers of vascular function in young adults.
Abstract 14804: Are Mobile Cardiac Outpatient Monitors Reliable to Monitor Qtc in Comparison to 12 Lead ECG
Authors: Ahmed Adnan , Garg Jalaj , Charate Rishi , Pothineni Naga Venkata K , Kabra Rajesh , Gopinathannair Rakesh , Lakkireddy Dhanunjaya
Published: June 2023

Introduction:
Use of mobile cardiac outpatient monitor (MCOT) increased during the COVID-19 pandemic as a substitute for telemetry and monitoring of arrythmias during loading of antiarrhythmic drugs (AAD). However, data comparing difference of QTc interval between a MCOT, and 12 lead ECG is scare.

Hypothesis:
To assess the accuracy of mobile cardiac outpatient monitor in comparison to 12 lead ECG for QTc monitoring

Methods:
We prospectively evaluated 24 patients at our institution who received IV sotalol as single day loading dose for initiation of oral sotalol therapy for atrial fibrillation/atrial flutter (AF/AFL). All patients were discharged 6 hours after the IV loading dose with a MCOT for 3 days. All patients had a 12 lead ECG within 12-18 hours of the baseline line MCOT transmission. Variation in heart rate and QTc was assessed.

Results:
A total of 24 patients were included in the study. The mean age was 65
+
7.3 years, 80% of patients were men. The mean difference between the QTc interval measured on 12 lead ECG and MCOT was 5.1
+
6 milliseconds [450
+
33 (EKG) - 445
+
39 (MCOT)], p=0.92. The mean heart rate difference between the two modalities was also not significant, p=0.726 [ 70.4
+
19 (EKG) -72
+
11.8 (MCOT), ΔHR=1.6
+
7.2 beats per minute].

Conclusions:
MCOT can be considered as a reliable alternate to 12 lead ECG for monitoring of QTc in patients receiving AAD.
Abstract 14816: Heart Failure Symptoms Are Associated With Markers of T Cell Activation and Tissue Remodeling
Authors: Butts Brittany , Davis Erica , Morris Alanna A , Dunbar Sandra B
Published: June 2023

Introduction:
Heart failure (HF) is a complex syndrome involving the interplay of pathophysiologic processes, such as inflammation and myocardial remodeling. T cell activation contributes to HF progression through cytokine release leading to cardiac fibrosis and hypertrophy. HF is characterized by physical symptoms that have been shown to predict morbidity and mortality. However, the pathophysiologic mechanisms driving symptoms are not well understood. Despite disparities in HF severity and morbidity among Black adults, relationships between inflammation and symptom burden are not well characterized in this population.

Hypothesis:
HF physical symptoms are positively associated with T-cell associated cytokines and chemokines.

Methods:
Black adults with HF (N=30) and LVEF <50% were enrolled in this study. Symptoms were assessed with the PROMIS Dyspnea Severity Short Form 10a and Heart Failure Somatic Perception Scale (HFSPS). Biomarkers were measured via multiplex immunoassay.

Results:
The mean age was 55.38 ± 12.4 years, and 67% were female. Mean LVEF was 30 ± 13%. Dyspnea severity was positively associated with matrix metalloproteinase (MMP)-1 (r=0.412, p=0.041) and MMP-12 (r=0.496, p=0.014). HFSPS was positively related to cytokines associated with T-cell activation and differentiation [interleukin (IL)-1β (r=0.526, p=0.007), IL-6 (p=0.510, p=0.011), and IL-15 (p=0.528, p=0.019)], and with chemokines involved in T cell recruitment [C-C motif chemokine ligand(CCL)-11 (r=0.399, p=0.048), CCL-19 (r=0.421, p=0.036), C-X-C motif chemokine ligand (CXCL)-8 (r=0.528, p=0.007), and CXCL-11 (r=0.418, p=0.037)].

Conclusions:
Somatic symptoms were associated with T cell-related cytokines and chemokines. Dyspnea was associated with enzymes that promote tissue remodeling and breakdown of collagen and elastin. These findings suggest tissue remodeling may play a role in HF symptoms, providing a potential therapeutic target for attenuating factors associated with HF symptom burden. Considering the pleiotropic nature of cytokines, further mechanistic work is needed for a better understanding of the pathophysiologic processes that could be targeted with interventions to reduce symptom burden in persons with HF.
Abstract 14820: Pericardial Adipose Tissue Thrombospondin-1 Associates With Anti-Angiogenesis in Ischemic Heart Disease
Authors: Ahmed Bulbul , Farb Melissa G , Sroczynski Emily , Karki Shakun , Edwards Niloo , Gokce Noyan
Published: June 2023

Defective angiogenesis contributes to mechanisms of ischemic heart disease. Accumulation of ectopic pericardial adipose tissue has been associated with cardiovascular complications which, in part, may relate to adipose tissue-derived factors. We sought to characterize adipose tissue microvascular angiogenic capacity in individuals undergoing elective cardiac surgeries including aortic, valvular, and coronary artery bypass grafting (CABG). Pericardial fat was collected intraoperatively and examined for capillary sprouting capacity using an established
ex vivo
Matrigel-based methodology quantified for growth over seven days. Angiogenic capacity was significantly blunted (2.5-fold, p<0.001) in subjects with CAD (age 59±2 years, BMI 32±1 kg/m
2
, LDL-C 92±45 mg/dl, n=37) compared to age-, BMI-, and LDL-cholesterol matched individuals without angiographic obstructive CAD (age 56±4 years, BMI 32±1 kg/m
2
, LDL-C 110±40 mg/dl, n=14). To garner potential mechanistic insight, we performed transcriptomic analyses using quantitative RT- PCR for select angiogenic regulators. We observed no significant differences in pericardial fat gene expression for pro-angiogenic mediators vascular endothelial growth factor-A (VEGF-A), fibroblast growth factor-2 (FGF-2), and angiopoietin-1, or anti-angiogenic factors including soluble fms-like tyrosine kinase-1 (sFlt-1) and endostatin. In contrast, mRNA expression of anti-angiogenic thrombospondin-1 (TSP1) was significantly upregulated (2-fold, p<0.05) in CAD subjects compared to the non-CAD group, which was confirmed by protein western-immunoblot analysis. Plasma concentrations of TSP-1 quantified by ELISA were not significantly different between the two groups. In summary, pericardial fat in subjects with CAD may be associated with an anti-angiogenic transcriptome linked to functional defects in vascularization capacity. Local paracrine actions of TSP1 in adipose depots surrounding the heart may play a role in mechanisms of ischemic heart disease.
Abstract 14823: Atrial Electrical Substrates Associated With Atrial Fibrillation Drivers Analyzed With Real-Time Phase Mapping “ExTRa Mapping” in Patients With Persistent Atrial Fibrillation
Authors: Nakasuka Kosuke , Oishi Yukako , Kato Marina , Mori Kento , Goto Toshihiko , Seo Yoshihiro
Published: June 2023

Introduction:
Elucidation of the mechanism of atrial fibrillation (AF) will lead to improved catheter ablation outcomes. However, the electrical substrates on which AF drivers such as meandering rotors and multiple wavelets are likely to appear are still unclear.

Methods:
Twenty-nine patients (age 68±10 years, eight females) with persistent AF were included in this study. Real-time phase mapping (ExTRa mapping) was performed in the left atrium during AF. After that, electroanatomical mapping such as voltage and activation mapping with HD-grid catheter was performed after conversion to sinus rhythm with cardioversion. According to the nonpassively activated ratio (%NP: the ratio of the form of rotors and/or multiple wavelets to the recording time), the recorded three highest %NP (Active-area) and three lowest %NP areas (Passive-area) were collected in each subject. Electrical property and overlapping with the low-voltage zone (LVZ, voltage amplitude <0.5mV) or mid-voltage zone (MVZ, 0.5-1.0mV) within these areas were assessed and compared between the Active- and the Passive-areas.

Results:
We analyzed a total of 87 Active- and 84 Passive-areas and the mean %NP were 61±8% and 13±8%, respectively. Signals with ≥4 fractionated components (fractionated electrograms) were seen significantly more in the Active-areas than in the Passive-areas (53% vs. 26%, respectively; p<0.001,
Figure A
). However, there was no difference in the conduction velocity (0.70±0.34m/s vs. 0.73±0.30m/s; p=0.577), mean voltage amplitude (1.78±1.54mV vs. 1.71±1.53mV; p=0.794) and coinciding with LVA/MVA (43% vs. 41%; p=0.785) between the Active- and the Passive-areas (
Figure B-D
).

Conclusion:
AF drivers tended to appear in the area with fractionated electrograms. High %NP areas partly overlapped, but not always coincided with LVA/MVA, as much as low %NP areas.
Abstract 14825: Utilizing a Novel Horizontal Approach for Implantable Loop Recorders
Authors: Kazmi Maryam , Viswanathan Rohan , Suthar Kandarp , Shah Kajol , Naranjo Jorge , Jumkhawala Saahil , Hemam Majd , Wengrofsky Perry , Aziz Emad
Published: June 2023

Introduction:
Implantable Loop Recorders (ILR) are used in detecting and monitoring arrhythmias. These subcutaneous devices remain in place for years for continuous cardiac monitoring. There have been few studies on how best to position an ILR for maximum accuracy and comfort. Currently, manufacturers recommend insertion of the ILR at a 45-degree angle from the sternum at the 4th intercostal space and a minimum R wave amplitude of 0.2mV for adequate sensing. We adopted the technique of implanting all ILRs horizontally between the 4th and 5th ribs and examined patient outcomes.

Methods:
Data was obtained through chart review of 288 patients who received a horizontally placed ILR from 2019 to 2021. Patient’s age, sex, BMI, indication for ILR, ILR manufacturer, episodes of artifact and complications were collected. The R wave magnitude (mV) immediately succeeding implantation was recorded from the procedure note.

Results:
Of our patients, 91% received a Medtronic ILR, 6% had a Boston Scientific ILR and 3% had a Biotronik ILR. The mean age was 60 ± 14 years, with 51% of patients being male. Within the sample, 27% had a BMI less than 25 kg/m
2
, 33% were overweight, and 40% were obese. Approximately 271 patients had a documented R wave amplitude at implantation, with the average being 0.44 mV ± 0.41 (95% CI 0.39 to 0.48). Of 240 patients with follow-up, 8% had an arrhythmia recorded that was found to be a false positive episode. There were no major complications.

Conclusions:
Using the horizontal approach, we obtained adequate sensing based on average R wave amplitude. We had very few false positive arrhythmias, as only 8% of our patients were noted to have a false positive reading versus 25% reported in other studies. This approach minimizes involvement of breast tissue and thus reduces risk of peri-procedural bleeding and ILR migration and increases patient comfort. The outcomes of our population indicate that this is a viable approach and may be superior to standard.
Abstract 14826: Single Day Intravenous Sotalol as a Loading Dose to Initiate Oral Sotalol Therapy: Is it Safe and Efficacious?
Authors: Ahmed Adnan , Garg Jalaj , Atkins Donita , Park Peter , Pothineni Naga Venkata K , Koerber Scott , Tummala Rangarao V , Bommana Sudharani , Gopinathannair Rakesh , Natale Andrea , Lakkireddy Dhanunjaya
Published: June 2023

Introduction:
Due to pro-arrhythmic effects associated with Sotalol, inpatient initiation with QTc monitoring for five doses is recommended. An IV loading dose followed by two oral doses has been shown to achieve steady-state concentrations.

Hypothesis:
To evaluate the safety of single day loading of IV sotalol in patients with atrial fibrillation and atrial flutter (AF/AFL).

Methods:
We prospectively evaluated 40 patients at our institution who received IV sotalol as single day loading dose for initiation of oral sotalol therapy for AF/AFL. IV sotalol dose was calculated based on target oral dose as indicated by baseline QTc interval and renal function. Patients' QTc (in sinus) was measured via ECG on 15 minutes intervals and after IV loading completion. Loading was considered complete after second oral dose. All patients were monitored via a mobile cardiac outpatient monitor for 3 days followed by a final 12 ECG.

Results:
A total of 40 patients were included in the study. The mean age was 69
+
8.2 years, 78.9% of patients were men. QTc significantly increased from 435.9
+
26.4 to 462.9
+
31.6 with following IV loading (p<0.001), that stabilized following oral loading completion (450.63
+
44.4; p=0.12). There were no cases of severe bradycardia, sinus node dysfunction, ventricular arrhythmias. reported.

Conclusions:
Our study sheds evidence that rapid IV sotalol loading in AF/AFL is safe and efficacious. This will not only provide patient convenience but will lead to reduced economic burden on patients and health care systems.
Abstract 14846: Reduced Daily Steps Walked and Increased Sedentary Time During Covid 19 Might Have Contributed to Poorer Prognosis in Outpatients With Cardiovascular Disease
Authors: Hirashiki Akihiro , Shimizu Atsuya , Kokubo Manabu , Nomoto Kenichiro , Kondo Izumi , Arai Hidenori
Published: June 2023

Introduction:
The 2019 coronavirus (COVID-19) pandemic has caused high rates of morbidity and mortality worldwide. Rates of physical activity in older adults may have decreased because of the COVID-19 pandemic, but the extent of this decrease and its effect on prognosis in cardiovascular disease (CVD) remain unknown. Our objective was to investigate the change in physical activity between autumn 2019 (before COVID-19) and autumn 2020 (during the third wave of the pandemic) in older Japanese adults with CVD.

Methods:
This was a single-center prospective observational study of CVD patients regularly attending our hospital’s cardiology outpatient clinic. We asked questionnaires regarding physical activity at two time points: autumn 2019 and autumn 2020. Patients were followed for an average of 429 days from autumn 2020. Composite endpoints were defined as hospitalization for heart failure, dehydration, cerebral stroke, fall-related fracture, or pneumonia, or all-cause death.

Results:
The study participants’ (n = 533) mean age was 75.9 years. We found a significant decrease in total steps walked/day in autumn 2020 (4055 steps/day) compared with autumn 2019 (4649 steps/day) (
P
< 0.001). Time spent sedentary was significantly longer in autumn 2020 (5.7 h/day) than in autumn 2019 (5.1 h/day) (
P
< 0.001). Classification of patients according to steps/day (<2000, 2000 to 4999, or ≥5000 steps/day) in autumn 2020 revealed that cumulative event-free survival was significantly lower in the <2000 steps/day group than in the other two groups (P<0.001,
Figure
). Similarly, when patients were classified according to time spent sedentary (˂3, ≥ to ˂6, or ≥6 /day), cumulative event-free survival tended to be lower in the <3 h/day group (
P
=0.075).

Conclusions:
Steps walked/day decreased significantly, and time spent sedentary increased significantly, during COVID-19 in CVD outpatients. Lifestyle changes seem to have affected overall prognosis.
Abstract 14850: Effect of Therapeutic-Dose Heparin on Acute Kidney Injury in Non-Critically Ill Hospitalized Patients With Covid-19: The Activ4a and Attac Randomized Trial
Authors: Smilowitz Nathaniel , Hade Erinn , Kornblith Lucy , Castellucci Lana , Cushman Mary , Farkouh Michael E , Hunt Beverly , Kim Keri , Kindzelski Andrei , Lawler Patrick R , Leifer Eric , McVerry Bryan J , Reynolds Harmony , Hochman Judith , Hochman Judith S , Neal, MD Matthew D , Berger Jeffrey S
Published: June 2023

Background:
Acute kidney injury (AKI) is common in patients with COVID-19 and mediated, in part, by thromboinflammation. In non-critically ill patients with COVID-19, therapeutic-dose anticoagulation with heparin increased the probability of survival to hospital discharge with reduced use of cardiovascular or respiratory organ support. We investigated whether therapeutic-dose heparin reduces the incidence of AKI or death in non-critically ill patients hospitalized for COVID-19.

Methods:
Non-critically ill patients hospitalized for COVID-19 were enrolled in an open-label, multiplatform randomized trial of therapeutic-dose heparin versus usual-care pharmacologic thromboprophylaxis. The primary endpoint of this analysis was in-hospital diagnosis of AKI or death. AKI was defined as Kidney Disease Improving Global Outcomes stage 2 or 3 AKI (≥2-fold increase in serum creatinine or initiation of renal replacement therapy). A Bayesian statistical model estimated the risk of AKI or death between those randomized to therapeutic-dose anticoagulation versus usual-care thromboprophylaxis, adjusted for age, sex, D-dimer, time epoch, country, site, and platform.

Results:
Among 1922 enrolled from ACTIV4a and ATTACC, 23 were excluded due to ESRD at enrollment. Baseline or follow-up creatinine was missing for 205 individuals. Among 1694 participants analyzed, median age was 60, 58% were men, and median baseline creatinine was 0.9 mg/dL. The primary endpoint occurred in 83 participants (4.9%); 4.4% assigned to therapeutic-dose heparin and 5.5% assigned to thromboprophylaxis (adjusted relative risk [aRR] 0.72, 95% CrI 0.47-1.10; posterior probability of superiority [defined as relative risk < 1.0] was 93.6%). Therapeutic-dose anticoagulation was associated with a 97.7% probability of superiority to reduce the composite of stage 3 AKI or death (3.1% vs. 4.6%; aRR 0.64, 95% CrI 0.40-0.99) compared to usual-care thromboprophylaxis.

Conclusions:
Therapeutic-dose anticoagulation with heparin was associated with a high probability of superiority to reduce the incidence of in-hospital stage 3 AKI or death in non-critically ill patients hospitalized for COVID-19, compared with usual-care thromboprophylaxis.
Abstract 14853: Epicardial Adipose Tissue Associates With High Cardiometabolic Risk and Fibro-Fatty Burden Longitudinally in Psoriasis
Authors: OHagan Ross , Hong Christin , Berg Alexander , Hsu Li-Yueh , Bui Vy , Li Haiou , Gonzalez-Cantero Alvaro , Chen Marcus Y , Teague Heather L , Sorokin Alexander , Mehta Nehal N
Published: June 2023

Introduction:
Psoriasis is a systemic inflammatory disease associated with increased cardiometabolic risk and coronary plaque burden. Epicardial adipose tissue volume (EATV) is considered a proinflammatory marker related to atherosclerotic plaque formation. The longitudinal impact of EATV on plaque characteristics, such as fibrofatty burden (FFB), assessed by coronary computed tomography angiography (CCTA), in psoriasis has not been reported.

Hypothesis:
1)
Psoriasis patients with increased EATV have a worse cardiometabolic profile and increased FFB.
2)
Increasing EATV associates with increased FFB over four years.

Methods:
FFB by CCTA was assessed in three-hundred nineteen participants with psoriasis at baseline and one-hundred twenty-five at four years. A previously published automated framework for segmentation of the heart was used to generate EATV from non-contrast computed tomography scans and results were manually reviewed. Coronary characteristics were quantified using QAngio software.

Results:
Quartile analysis of EATV at baseline revealed a stepwise increase in hypertension (P<0.001), waist to hip ratio (P<0.001), visceral adiposity (P<0.001), homeostatic model assessment for insulin resistance (P<0.001), glycoprotein A (P<0.001) psoriasis area severity index (P=0.005) and FFB (P<0.001) with increasing EATV (Table 1). EATV associated with FFB (β=0.251; P <0.001) in models adjusted for Framingham risk score and waist to hip ratio. Longitudinal analysis showed EATV associated with FFB over four years in models adjusted for Framingham risk score and waist to hip ratio in psoriasis (β=0.288; P =0.009).

Conclusion:
Our study supports that EATV correlates with a high cardiometabolic risk profile in psoriasis. Further, we show that as EATV increases, there is a heightened risk of rupture-prone fibrofatty plaque. Further studies are needed to elucidate the role of EATV in predicting cardiovascular disease risk associated with psoriasis.
Abstract 14869: In-Hospital Outcomes and Predictors of Patients With Infective Endocarditis Undergoing Transcatheter Aortic Valve Replacement
Authors: Ebner Bertrand , Kaur Sukhpreet , Inestroza Karla , Martillo Miguel , Ergui Ian , Albosta michael , Vergara-Sanchez Carlos , Hernandez Rafael J , Dangl Michael , Grant Jelani , VINCENT LOUIS , Maning Jennifer , Olarte Neal , Colombo Rosario
Published: June 2023

Background:
Although there is no clear indication on transcatheter aortic valve replacement (TAVR) in patients with infective endocarditis (IE), in some instances, TAVR remains the only possible option in some clinical scenarios.

Methods:
The National Inpatient Sample Database was queried from 2011-2019 for relevant ICD-9 and -10 diagnostic and procedural codes. Baseline characteristics and in-hospital outcomes of patients with a diagnosis of IE undergoing TAVR were queried. The association of baseline comorbidities with in-hospital mortality was determined using a binary logistic regression model to obtain adjusted odds ratios (aOR).

Results:
A total of 750 patients were identified with IE who underwent TAVR (0.3% of patients undergoing TAVR). In this cohort, 60% were male and 85% were white. Mean age was 73 ± 14 years old. At baseline, patients with IE had a prevalence of 80% of heart failure, 74% of hypertension (HTN), 58% of coronary artery disease (CAD), 49% of hyperlipidemia (HLD), 41% of chronic kidney disease (CKD), 39% of atrial fibrillation (AF), 29% of tobacco use, 27% of pulmonary hypertension, 23% of diabetes, 17% of peripheral vascular disease and 15% of history of stroke, amongst the most common ones. In-hospital death was 7.3% with a median length of stay of 8 days [IQ 2-19]. This population had an 85% rate of sepsis, 34% of acute kidney injury with 9% need of renal replacement therapy. Major bleeding was present in 17% with need of blood product transfusion in 17% of the cases. Other complications found were cardiogenic shock (13%), complete heart block (11%), vascular complications (7%), pericardial effusion (7%) with 3% of pericardiocentesis, 4% intraoperative cardiac complications and 5% of cardiac arrest. Mortality was mainly associated with HLD (aOR 11.073 [4.363-28.101]), HTN (aOR 3.863 [2.209-6.755]), HF (aOR 2.491 [1.392-4.456]) and CAD (aOR 2.597 [1.469-4.592], p<0.05 for all).

Conclusion:
We found a higher mortality post-TAVR in patient with IE than the general population undergoing TAVR (~4%). Controlling baseline comorbidities such as HLD, HTN and HF might be an important treatment part to decrease the risk of in-hospital mortality post-TAVR in patient with IE. Further prospective studies are needed to elucidate these findings.
Abstract 14879: Circadian Variation in Pre-Procedural Rupture of Acute Type A Aortic Dissection
Authors: lu chen , HU JIA
Published: June 2023

Introduction:
Acute type A aortic dissection (ATAAD) is a devasting cardiovascular disease. Though it is recommended by guidelines, urgent open surgery was not accessible for all patients. Transferring patients to comprehensive aortic centers, inadequate medical assistance in low-resource health systems or financial issues would delay the timing of surgery. There have been several reports about the connection between circadian variation and cardiovascular disease. The study was conducted to examine the circadian variation in pre-procedural rupture of ATAAD in the hospital.

Methods:
The study enrolled ATAAD patients who died from aortic rupture within 7 days since onset in our center from January 2010 to December 2020. Patients who died within 1 hour after admission were excluded. All patients accepted anti-impulse therapy immediately upon admission. Clinical data were retrospectively collected from medical records.

Results:
In total, 200 ATAAD patients were enrolled in the retrospective observational study. Mean age of recruiters was 55.98 ± 11.82 years and 159 (78.5%) were men. Mean time from onset to admission was 26.78 ± 24.97 hours and mean time from onset to rupture was 48.27 ± 42.01 hours. Distributions of rupture time were visualized through histogram. The peaks of the occurrence of aortic rupture were in 6:00-8:00 (26%) and 18:00-22:00 (36%). Kernel density estimation was consistent with the results.

Conclusions:
Rupture of ATAAD does not seem to be a random phenomenon, while the peak of occurrence was consistent with the circadian rhythm. Even when the hemodynamic state was well controlled, fluctuant blood pressure and heart rate that influenced by the circadian rhythm would increase the risk of aortic rupture. During 6:00-8:00 and 18:00-22:00, more frequent blood pressure measurement and does adjustment of intravenous anti-impulse drugs might improve aortic rupture reduction. What’s more, bedtime hypertension treatment might also help.