bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13784: Impact of the Variation of Aortomitral Positional Anatomy for the Atrioventricular Conduction Disorder in the Mitral Valve Surgery
Authors: Handa Kazuma , Kawamura Masashi , Yoshioka Daisuke , Kawamura Takuji , Kawamura Ai , Misumi Yusuke , Taira Masaki , Shimamura Kazuo , Miyagawa Shigeru
Published: December 2023

Introduction:
Advances in cardiac imaging have provided detailed anatomical information, including the variation of the aortic root rotation. This variation affected the distance between membranous septum and right fibrous trigone, that might be synonymous with variation of the conduction system location. However, clinical significance has been unknown. We aimed to analyze the variation of the aorto-mitral position and its relationship of conduction disorder in the mitral valve surgery.

Methods:
This study included 180 patients underwent simple mitral valve surgery (valve repair: n=159, replacement: n=21). The anatomical variations were classified by preoperative three-dimensional transesophageal echocardiography (3D-TEE), and postoperative occurrence of new conduction disorder was analyzed.

Results:
As in the image, the variations in the aorto-mitral position were classified into
Lateral
(14%) or
Center appearance
(86%) groups, which was further classified to
Center
(83%),
Lateral
(14%), or
Medial rotation
(3%) groups. Atrioventricular conduction disorder was observed as first-degree block (n=24 (13%)) including complete right bundle branch block (n=1 (0.6%)). This disorder newly occurred more in the
Lateral appearance
compared to the
Center
(36% vs 10%, p=0.0003). The prolongation of the PR interval (msec) between the pre and postoperative period (ΔPR) was greater in the
Lateral appearance
than the
Center
(+17 vs +14, p=0.02). Regarding the aortic root rotation, the conduction disorder occurred in 6%, 27% and 20% patients, and each ΔPR was +2, +16 and +22 of the
Center
,
Lateral
, and
Medial rotation
respectively. Conduction disorder occurred more in the
Lateral rotation
than the
Center
(p=0.0017), persisting one year after the surgery (19% vs 2%, p=0.0059).

Conclusion:
The variation of the aorto-mitral position could be classified by 3D-TEE. The
Lateral rotation
would be a risk of atrioventricular conduction disorder in the mitral valve surgery.
Abstract 13912: Insights From a Multi-Center Consortium for HCV-Viremic Donor Heart Transplant: Outcomes Are Excellent Across Regimens Often Without Major Changes to Statin or PPI
Authors: Farsakh Dana , Abdelrehim Ahmad , Salem Mahmoud , Gottlieb Robert L , Ravichandran Ashwin , Kennedy Jamie , Strope Jennifer , Lin Shin , Chow Jennifer , Eckman Peter , Desai Sapna , van Zyl Johanna , Felius Joost , Hall Shelley
Published: December 2023

Introduction:
With the availability of pangenotypic direct-acting antivirals (DAA) for facile, curative treatment of hepatitis C virus (HCV) infections, HCV-viremic donors are utilized regularly to partially address the shortage of suitable organs for heart transplant (HT). This multi-center, retrospective registry characterized HT outcomes from HCV-positive donors.

Methods:
Of 138 isolated HT recipients from 8 sites across the US, the most common DAAs were the pangenotypic antiviral combinations sofosbuvir-velpatasvir (SOF/VEL, n=39) and glecaprevir-pibrentasvir (GLE/PIB, n=76); these 115 cases were analyzed in terms of primary graft dysfunction (PGD), episodes of rejection ≥ pAMR1 and/or Grade 2R, post-transplant infection, sustained virologic response at 12 weeks post-treatment (SVR12), and survival up to 1 year.

Results:
Comparing these two most common pangenotypic regimens, HT recipients differed in their listing status (p<0.001), hospital stay length (p=0.04), time until HCV+ (p=0.01), DAA payor (p=0.01), induction therapy (p=0.03) and statin therapy (p=0.01). A concurrent open-label trial accounted for up to 13/39 SOF/VEL patients, partially accounting for differences in DAA payor. Despite potential interactions, statin and proton pump inhibitor (PPI) therapy typically continued uninterrupted with minimal dose adjustment. Both treatment groups showed 100% cure (SVR12) of donor-derived HCV. Although not powered for comparative effectiveness of DAA agents, there were no significant differences in study outcomes. SOF/VEL and GLE/PIB-treated patients demonstrated 97% and 96% survival at 1 year, respectively.

Conclusions:
As utilized to achieve cure of HT donor-derived HCV, two pangenotypic DAA regimens are safe and feasible, with coverage accessed across a variety of DAA payors. SVR12 can be achieved often without major modifications to PPIs or statins with either pangenotypic DAA regimen (with pravastatin most commonly utilized).
Abstract 13931: Direct Oral Anticoagulants in Atrial Fibrillation Patients With Rheumatic Heart Disease After Mitral Valve Replacement With Bioprosthesis
Authors: Fath Ayman R , Aglan Amro , Eldaly Abdullah S , Kabbani Mahmoud , Nayak Hemal M , Vinas Ariel
Published: December 2023

Background:
We sought to investigate the outcomes of direct oral anticoagulants (DOACs) versus warfarin in patients with atrial fibrillation and bioprosthetic mitral valve replacement (bMVR) due to rheumatic heart disease.

Methods:
We performed a retrospective study using the TriNetX global database to identify patients with atrial fibrillation and bMVR due to rheumatic heart disease from 2010 to 2020. Patients who had mechanical mitral or aortic valve replacement were excluded. Patients were stratified into 2 groups: DOAC group and Warfarin group. 1:1 propensity-score matching to control for baseline differences between the two groups was performed. The primary endpoint was ischemic stroke and secondary endpoints were all-cause mortality, major bleeding, myocardial infarction, and all-cause hospitalization over a mean follow-up of 3 years.

Results:
A total of 2,011 patients were identified and 586 were included after propensity-score matching (293 patients in each group). Patients in the DOAC group, compared to the warfarin group aged 68.9 ± 11.2 vs 68.2 ± 11 years (P=0.41) and 63.4% vs 63.8% were females (P=0.93). There was no significant difference between the two groups in ischemic stroke, all-cause mortality, major bleeding, myocardial infarction, and all-cause hospitalization. (Table 1, figure 1).

Conclusion:
In patients with atrial fibrillation and bMVR due to rheumatic heart disease, DOACs use was associated with similar rates of ischemic stroke, mortality, major bleeding, myocardial infarction, or hospitalization compared to warfarin.
Abstract 13953: A Genome-Wide European Ancestry Study Identifies Coronary Artery Disease-Associated Loci Through Gene-Sex Hormone Interaction
Authors: jain vardhmaan , Dabbs-Brown Amonae , Liu Chang , Hui Qin , Mehta Anurag , Wilson Peter , Quyyumi Arshed A , Sun Yan
Published: December 2023

Background:
Genome-wide association studies (GWAS) have improved our understanding of the genetic basis of coronary artery disease (CAD). While sex-differences in CAD have been observed, little is known about the role of sex hormones in CAD genetics. Accounting for sex hormone levels may help identify CAD-risk loci and extend our knowledge of its genetic architecture.

Methods:
We performed a GWAS to identify CAD risk loci by incorporating gene-sex hormone interactions in 365,662 individuals of European ancestry enrolled in the UK Biobank (UKB). Genetic interactions of total testosterone (TT), bioavailable testosterone (BAT) and sex-hormone binding globulin (SHBG) were evaluated. GEM software was used to conduct sex-stratified genome-wide interaction analysis with prevalent CAD. Enrollment age and principal components 1-10 were model covariates. The online post-GWAS tool FUMA was used to annotate the biological functions of marginal, interaction, and joint effects summary statistics.

Results:
We identified 64 loci in males and 8 loci in females that reached genome-wide significance (p < 5х10
-8
) for CAD (
Table 1
). Among males, 3 significant loci were identified for BAT, one for TT and one for SHBG using joint effect model that did not overlap with those identified with marginal effect. Among females, 5 significant loci were identified, all for TT using joint effect that that did not overlap with those identified with marginal effect. Of these 5 loci, two loci were independently identified with significant SNP-TT interaction. These loci were mapped close to the TRDN and THADA genes that have been implicated in congenital ventricular tachycardia and polycystic ovarian syndrome, respectively.

Conclusion:
This Genome-wide gene-sex hormone interaction study identified genomic-risk loci that may contribute to the differential CAD risk between men and women, which would otherwise not have been discovered in traditional GWAS only including marginal genetic effect.
Abstract 14182: Outcomes From Left Atrial Appendage Occlusion Utilizing the Watchman FLX versus Watchman 2.5: A Systematic Review and Meta-Analysis
Authors: Aldaas Omar M , Barat Masihullah , Aldaas Amer M , Han Frederick , Hoffmayer Kurt S , Krummen David E , Ho Gordon , raissi farshad , Birgersdotter-Green Ulrika , Reeves Ryan , Feld Gregory K , Hsu Jonathan C
Published: December 2023

Introduction:
Left atrial appendage occlusion with the Watchman device has been shown to be noninferior to oral anticoagulation in preventing strokes in patients with atrial fibrillation. The Watchman FLX device was designed to overcome many of the limitations of the Watchman 2.5.

Hypothesis:
The Watchman FLX will have better short- and long-term safety and efficacy relative to the Watchman 2.5.

Methods:
We performed an extensive literature search and systematic review of studies that compared the short- and/or long-term safety and efficacy of the Watchman FLX versus Watchman 2.5. Risk ratio 95% confidence intervals (CI) were measured using the Mantel-Haenszel method for dichotomous variables, where a RR<1.0 favors the FLX group.

Results:
Seven studies with a total of 2315 patients were included, of which 24.0% (n=555) had the FLX and 76.0% (n=1760) had the 2.5 implanted. There were no statistically significant differences in procedural complications or device-related thrombosis, but significantly less peri-device leak at follow-up, as shown in Figure 1. There were no statistically significant differences in pericardial effusion/tamponade (MD 0.54; 95% CI 0.09-3.25) or device embolization (MD 0.44; 95% CI 0.05-4.14). No statistically significant differences were seen in major bleeding (MD 1.06; 95% CI 0.55-2.05), transient ischemic attack, stroke or systemic embolism (MD 0.31; 95% CI 0.08-1.20) or all-cause mortality (MD 1.65; 95% CI 0.76-3.57) at follow-up.

Conclusion:
Based on the results of this meta-analysis, the Watchman FLX appears to be as safe as the Watchman 2.5, but with lower rates of peri-device leak.
Abstract 14195: Right Ventricular Outflow Tract Diameter Increase With the Low-Moderate Workload: A Prospective Simultaneous Exercise Echocardiography and Invasive Cardiopulmonary Exercise Testing Study
Authors: ElShaer Ahmed , Garcia-Arango Mariana , Korcarz Claudia E , Raza Farhan
Published: December 2023

Background:
While cardiac output at rest can be estimated non-invasively with echocardiogram, change in left ventricular or right ventricular outflow tract diameter (RVOTd) with exercise makes the cardiac output estimation inaccurate.

Hypothesis:
RVOTd increases with exercise proportionally with an incremental workload and is determined by stroke volume augmentation.

Aims:
1. Define a workload-based change in RVOTd in subjects undergoing invasive cardiopulmonary exercise test (iCPET). 2. Correlate RVOTd at exercise stages with iCPET metrics.

Methods:
20 subjects undergoing simultaneous echocardiogram and iCPET were enrolled in a prospective study. Exercise datapoints were acquired at 25 W (n=20), 50W (n=16), 75W (n=14), 100W (n=6). Three hemodynamic groups included: HFpEF (n=12), PAH (n=5), controls (n=3). Utilizing iCPET-based direct Fick cardiac output and stroke volume, RVOTd was reverse engineered with RVOT velocity time integral, per ASE guidelines. Pearson correlation was used to assess correlation of RVOTd with hemodynamic metrics. p<0.05*

Results:
In overall cohort, age was 64±12 years, BMI 31.2±4.9 Kg/m
2
, female 60%, peak VO
2
13.7±5.7 mL/Kg.min
-1
and V
E
/VCO
2
37±8. Increase in RVOTd with exercise is represented in the Figure. In comparison to rest, RVOTd increased significantly even at low-25W (+4.1±13.6%*) and moderate-50W (+7.6±17.2%*) workloads. Overall, RVOTd increased by 4-5% every 25W. At high workload (100W), the diameter increased by 24% (n=6). There were no differences in RVOT diameter between subgroups. RVOTd at four exercise stages (25W, 50W, 75W, 100W) correlated significantly with stroke volume index (r=0.68*, 0.80*, 0.23, 0.64) and cardiac output (r=0.50*, 0.80*, 0.08, 0.68), but non-significantly with heart rate (r=-0.15, 0.19, -0.10, 0.68).

Conclusion:
RVOTd increases by 4-5% every 25W on an incremental workload protocol. This behavior is predominantly associated with an increase in stroke volume index with exercise.
Abstract 14256: Examining the Efficacy of Inferior Vena Cava Filters in the Direct Oral Anticoagulant Era
Authors: Takase Toru , Funauchi Yohei , Yamashita Yugo , Kaneda Kazuhisa , Chatani Ryuki , Nishimoto Yuji , Ikeda Nobutaka , Kobayashi Yohei , Ikeda Satoshi , Kim Kitae , Tsuji Shuhei , Oi Maki , Takada Takuma , Otsui Kazunori , Sakamoto Jiro , Ogihara Yoshito , Nishikawa Ryusuke , Nakazawa Gaku
Published: December 2023

Introduction:
No previous reports have adequately demonstrated whether inferior vena cava filters prevent pulmonary embolism, and reports of disadvantages, such as worsening venous thrombosis, have led to a decrease in the frequency of their use. However, in actual clinical practice, patients often encounter situations in which they expect to benefit from inferior vena cava filters; hence, exploratory studies examining their efficacy continue.

Hypothesis & Methods:
We analyzed data from the COMMAND VTE Registry-2, a multi center, retrospective, observational study of symptomatic venous thrombosis in the DOAC era, for cases using inferior vena cava filters.

Results:
A total of 5197 cases of venous thrombosis were enrolled, among whom 483 (9%) had inferior vena cava filters implanted. The inferior vena cava filter was implanted long-term and removed in 6% and 3% of cases, respectively. Inferior vena cava filters tended to be implanted in patients with active cancer patients, with more patients with terminal cancer, on anticancer therapy, and with distant metastases having long-term filter implantation (P = 0.001). After inferior vena cava filter implantation, the inferior vena cava filter implantation group showed a significantly lower incidence of pulmonary embolism within 30 days after the onset of initial venous thrombosis (P = 0.011). However, Kaplan-Meier analysis during a median follow-up of 854 days showed that long-term implantation of inferior vena cava filters significantly increased incidence of deep vein thrombosis (P = 0.001), whereas multivariate analysis found that long-term implantation of inferior vena cava filters was an independent risk factor for deep vein thrombosis (HR: 2.096, 95% CI: 1.254-3.508, P = 0.005).

Conclusions:
Inferior vena cava filters may be effective in preventing pulmonary emboli in the short term; however, even in the DOAC era, long-term filter implantations were associated with an increased incidence of deep vein thrombosis.
Abstract 14284: Anticoagulant Effects of Edoxaban in Cancer and Non-Cancer Patients With Venous Thromboembolism
Authors: Yoshida Masashi , Kuroda Kazuhiro , Tokioka Koji , Hatanaka Kunihiko , Fujimoto Ryohei , Yamaoka Hidenaru , Kajikawa Yutaka , Kazuki Suruga , Sugiyama Hiroki , Miyaji Tsuyoshi , Morimoto Yoshimasa , Okamura Nobuhiro , Matsuo Naoaki , Ito Hiroshi
Published: December 2023

Introduction:
Edoxaban, a direct oral anticoagulant (DOAC), is established as an anticoagulant medication in the treatment of venous thromboembolism (VTE) and suppression of VTE recurrences. While VTE recurrences in patients with cancer is greater than those in patients with non-cancer in spite of DOACs use, the reason is unclear. Anticoagulant effects of DOACs are not monitored because of less individual variability on their pharmacological effects and a short half-time. Although the plasma concentration of edoxaban correlates with prothrombin time (PT) and activated partial thromboplastin time (APTT) in healthy adults. PT and APTT are prolonged up to 5 hours after administration of edoxaban.

Hypothesis:
We hypothesized that anticoagulant effects of edoxaban are inhibited in patients with cancer and measured PT and APTT to assess its anticoagulant effects.

Methods:
This study is prospective observational study conducted in 12 hospitals. Patients with VTE taking edoxaban for treatment were included. PT and APTT were measured at 5-hours after first administration of edoxaban, and also measured at optional time after 7 days and/or 30 days. D-dimer, prothrombin fragment 1+2, and thrombin-antithrombin complex were measured once as coagulation markers.

Results:
Two hundred forty-three patients were included in the study, and 80 patients were with cancer. PT and APTT were measured at 465 points. PT and APTT at 5-hours after first administration of edoxaban were not significantly different between patients with cancer and non-cancer (17.1 ± 0.4 vs. 16.8 ± 0.3 seconds; PT, 35.1 ± 0.6 vs. 34.5 ± 0.5 seconds; APPT). PT values at 5-hours after first administration were prolonged compared with those at before administration in patients with cancer and non-cancer (13.8 ± 0.6 and 13.8 ± 0.4 seconds; before administration). Other coagulant markers were not significantly different between patients with cancer and non-cancer.

Conclusions:
Anticoagulant effects of edoxaban do not differ between patients with cancer and non-cancer, and those effects are sufficient. Greater VTE recurrences in patients with cancer may be due to hypercoagulable state by cancer, but not lowering anticoagulant effects of edoxaban.
Abstract 14475: Intrinsic T Cell Tolerance to the Autoantigen LL-37 is Mediated in Part by Platelets
Authors: Dimayuga Paul C , Zhao Xiaoning , Zhou Jianchang , Lio Nicole W , Chernomordik Fernando , Chyu Kuang-Yuh , Shah Prediman K , Cercek Bojan
Published: December 2023

Introduction:
An autoimmune response to human cathelicidin antimicrobial peptide LL-37, a component of neutrophil extracellular traps (NETs), may play a role in athero-thrombosis. We have reported that acute coronary syndrome (ACS) patients have increased LL-37 auto-reactive CD8+CD69+CD137+ T cells compared to healthy controls suggesting breach of tolerance to LL-37. Platelets present antigens to CD8+ T cells via HLA Class-I but it is unknown if this pathway is involved in maintaining intrinsic tolerance to the autoantigen LL-37. In this study, we investigated the role of platelets in maintaining immune tolerance to LL-37 in healthy subjects.

Methods and Results:
Platelets and autologous peripheral blood mononuclear cells (PBMCs) were isolated from remnant blood of platelet donor Leukocyte Reduction System cones from the institutional blood bank. Platelet enrichment was confirmed by CD41+ flow cytometry and over 95% were HLA Class-I(+). PBMCs were co-cultured with autologous platelets that were either non-primed or primed with LL-37 peptide at a ratio of 25:1 platelet-to-PBMC. Cells were collected after 16 hours and subjected to fluorescent staining for activation markers by flow cytometry. Compared to non-primed platelets, co-culture of LL-37-primed platelets significantly reduced T cell activation in autologous PBMCs including CD8+CD69+CD137+ T cells, CD4+CD134+ T cells and CD4+CD134+CD137+ T cells (Table), supporting platelet-mediated T cell tolerance to LL-37. We then evaluate if the breach in T cell tolerance to LL-37 in ACS is related to platelet counts. CD8+CD69+CD137+ T cell response to LL-37 in PBMCs of ACS patients was negatively correlated with platelet count (N=21; Pearson r = -0.438, P=0.047).

Conclusions:
The results demonstrate that intrinsic immune tolerance to the autoantigen LL-37 in healthy subjects is mediated in part by platelets. Reduced platelet counts are implicated in the breach of immune tolerance to LL-37 in ACS.
Abstract 14577: Electrocardiogram Parameters for Predicting the Severity of Coronary Artery Disease in Non-ST Segment Elevation Acute Coronary Syndrome
Authors: Choudhary Rahul , Goswami Sourabh
Published: December 2023

Background:
Quantitative electrocardiogram (ECG) parameters have been found to correlate with severity of coronary artery disease (CAD). Thus, it may serve the purpose of risk stratifying patients with non-ST segment elevation acute coronary syndrome (NSTEACS). But little is known about the accuracy of each parameter.So, this study was done to assess the correlation of ECG parameters with severity of CAD in patients with NSTEACS and to compare the diagnostic accuracy among them.

Methods:
178 patients with NSTEACS with left ventricular ejection fraction >50% were selected for the study after excluding patients with heart failure, arrhythmia, prior myocardial infarction or revascularisation. P wave peak time (PWPT), corrected QT dispersion (cQTd) and QT dispersion ratio (QTDR) was calculated in all patients. CAD severity was assessed visually by coronary angiography and calculating the syntax score.

Results:
PWPT, cQTd and QTDR were increased significantly in patients with left main (LM) or triple vessel disease (TVD) than others. These parameters also showed a strong positive correlation with the syntax score (
P<.001
). Among these parameters, cQTd showed the best diagnostic accuracy (76% sensitivity and 64% specificity) to detect LM or TVD with a cut-ff value of 74 ms.

Conclusion:
PWPT, cQTd and QTDR may help to identify high risk patients with NSTEACS and early invasive procedure can be done to salvage a large area of myocardium at jeopardy. These may be particularly helpful to the physicians in periphery who have limited resources.
Keywords: coronary artery disease, non-ST segment elevation acute coronary syndrome, P wave peak time, corrected QT dispersion, QT dispersion ratio
Abstract 14588: Comparison of Different Antithrombotic Regimens After Left Atrial Appendage Occlusion: A Systematic Review and Network Meta-Analysis
Authors: Carvalho Pedro P , Mesadri Gewehr Douglas , Miyawaki Isabele A , Nogueira Alleh , GAROT Philippe , Darmon Arthur , Mazzone Patrizio , Preda Alberto , Nascimento Bruno R , Felix Nicole , Kubrusly Luiz F , Cardoso Rhanderson
Published: December 2023

Background:
The optimal antithrombotic therapy following left atrial appendage occlusion (LAAO) in patients with non-valvular atrial fibrillation (AF) remains uncertain, given the high-risk profile of this population. This network meta-analysis aimed to compare the efficacy and safety of various antithrombotic strategies after LAAO.

Methods:
We conducted a comprehensive search of MEDLINE, Cochrane, Embase, Lilacs, and ClinicalTrials.gov databases for studies that reported clinical outcomes after LAAO, categorized by the antithrombotic therapies administered at discharge. Direct oral anticoagulants (DOACs), vitamin-K antagonists (VKAs), single antiplatelet therapy (SAPT), dual antiplatelet therapy (DAPT), DOAC plus SAPT, VKA plus SAPT, and no therapy were analyzed. We performed a frequentist random-effects network meta-analysis to estimate the odds ratio (OR) with 95% confidence intervals (CI) for each strategy. The surface under the cumulative ranking curve (SUCRA) P-scores provided a ranking of treatments. Quality assessment and risk of bias were conducted in accordance with Cochrane recommendations.

Results:
39 observational studies and 1 clinical trial with a total of 11,111 patients with non-valvular AF were included, totaling 540 cardiovascular events. In the network comparison, DAPT (OR 0.35; 95% CI 0.16-0.76), DOAC (OR 0.35; 95% CI 0.13-0.94), DOAC plus SAPT (OR 0.17; 95% CI 0.04-0.74), and VKA (OR 0.34; 95% CI 0.12-0.97) were superior to no therapy to prevent device-related thrombosis (DRT), whereas SAPT (OR 0.46; 95% CI 0.21-1.03) and VKA plus SAPT (OR 0.43; 95% CI 0.10-0.87) were similar to no antithrombotic therapy. DOAC was associated with a significant reduction of all-cause mortality compared with VKA (OR 0.36; 95% CI 0.15-0.85) and a non-significant trend vs. SAPT (OR 0.49; 95% CI 0.22-1.11). Moreover, DAPT (OR 0.49; 95% CI 0.26-0.91) was superior to SAPT in reducing thromboembolic events, but similar to VKA (OR 0.88; 95% CI 0.37-2.37). There was no significant difference between therapies analyzed in the occurrence of major bleeding.

Conclusion:
In patients with nonvalvular AF undergoing LAAO, DOAC monotherapy is safe and reduce DRT, all-cause mortality, and thromboembolic events compared with other therapies.
Abstract 14721: International Chronic Total Occlusion Percutaneous Coronary Intervention Operator Survey
Authors: Simsek Bahadir , Rempakos Athanasios , Kostantinis Spyridon , Alexandrou Michaella , Karacsonyi Judit A , Rangan Bavana V , Mastrodemos Olga , Abi Rafeh, MD, FACC Nidal , Alaswad Khaldoon , AVRAN ALEXANDRE , Azzalini Lorenzo , El Guindy Ahmed , Egred Mohaned , GOKTEKIN OMER , gorgulu sevket , Jaber Wissam , Kearney Kathleen , Kirtane Ajay J , Lombardi William L , Mashayekhi Kambis , McEntegart Margaret , Nicholson William , Rinfret Stephane , Allana Salman S , Sandoval Yader , Burke M Nicholas , Brilakis Emmanouil S
Published: December 2023

Background:
Contemporary chronic total occlusions (CTO) percutaneous coronary intervention (PCI) practice has received limited study.

Methods:
We performed an online, anonymous, international survey of CTO PCI operators.

Results:
104 CTO PCI operators and 12 interventional cardiology fellows with an interest in CTO PCI participated in this survey. Most were from the United States (53%), men (95%), and spent a median of 60 hours/week in the hospital. Median annual case numbers were 250 (150-400) for PCIs and 43 (10-85) for CTO PCIs (Figure). Almost half (42%) entered CTO cases into registries, mainly into PROGRESS-CTO (78%) and EuroCTO (11%). Most worked at academic institutions (55%), 55% trained dedicated CTO fellows, and 43% proctored CTO PCI. Almost half (43%) had dedicated CTO PCI days, and 54% performed dual access >90% of the time. Nearly half (42%) never discharged CTO patients the same day, while 20% discharged CTO patients the same day >50% of the time. After successful guidewire crossing, 51% used intravascular imaging >90% of the time. Most used CTO scores including J-CTO (82%), PROGRESS-CTO (42%), and PROGRESS-CTO complication scores (24%). Coronary artery perforation was encountered within the last month by 31%, and within 1-6 months by 35%. On a scale of 0-10, the median comfort levels were: covered stents 9.7 (8.2-10), coil embolization 8.0 (5.0-9.7), and fat embolization 5.0 (2.0-9.4). The majority (55%) had a complication cart/kit and 22% conducted regular complication drills with catheterization laboratory staff.

Conclusion:
Our survey provides information on the contemporary CTO PCI practices.
Abstract 14735: Fabry's Disease as a Potential Overlapping Diagnosis in Progressive Hypertrophic Cardiomyopathy
Authors: Suppah Mustafa , Narayanasamy Hemalatha , Nelson James , Alsidawi Said
Published: December 2023

Background:
Fabry's disease (FD), an X-linked lysosomal storage disorder, can present with cardiac manifestations similar to HCM. We aim to emphasize considering FD as a differential diagnosis in patients with HCM while highlighting the role of genetic testing in evaluating left ventricular hypertrophy (LVH).
Cases Presentation:
We present a case series of 3 patients with LVH. Despite initial clinical suspicion of primary HCM, genetic testing confirmed the diagnosis of FD.

Patient 1:
A 38-year-old male with no prior medical history presented with presyncope, lightheadedness, and chest tightness. EKG, Echo, and cardiac MRI suggested apical HCM. Genetic testing indicated FD.

Patient 2:
A 62-year-old male sought a second opinion regarding his diffuse HCM. EKG suggested RBBB. Echo showed a binary appearance of the myocardium, concentric LVH. Genetic testing confirmed FD.

Patient 3:
A 64-year-old male with a history of hypertension and renal disease underwent evaluation for kidney transplantation. Echo showed severely increased concentric LVH and Valsalva-induced intracavitary gradient/obstruction. Alpha-galactosidase level returned very low, suggesting FD, which was confirmed by genetic testing.

Discussion:
FD can be challenging to diagnose due to overlapping clinical and imaging features with HCM, leading to misdiagnosis and delayed management. Therefore, Genetic testing should be offered to all patients with suspected HCM to exclude phenocopies. Particularly, those with progressive HCM and atypical clinical features (renal disease and family history predominantly in males) and imaging features (conduction abnormalities on EKG, binary appearance on Echo). Early identification of FD enables appropriate management, including enzyme replacement therapy, potentially improving clinical outcomes.

Conclusions:
FD should be considered as a differential diagnosis in patients with HCM. Genetic testing plays a vital role in evaluating patients with HCM.
Abstract 14769: Peripheral Venous Pressure Measured With a Novel Miniature Pressure Transducer Correlates With Central Venous Pressure in Heart Failure, Heart Transplant, and Left Ventricular Assist Device Patients
Authors: Flint Sarah , Wengrofsky Aaron , Vlismas Peter P , Wiesenfeld Elliot , Rochlani Yogita M , chavez Patricia , Vukelic Sasha , Murthy Sandhya , Madan Shivank , Saeed Omar , Patel Snehal R , Shin Jooyoung , Jorde Ulrich P , Sims Daniel B
Published: December 2023

Introduction:
Peripheral venous pressure (PVP) has been shown to accurately correlate with central venous pressure (CVP) when measured using a conventional manometer and pressure tubing. We investigated the correlation between PVP as measured by a novel pressure transducer and CVP in heart failure (HF), heart transplant (HTx), and left ventricular assist device (LVAD) patients.

Methods:
A prospective, cross-sectional study examining PVP from February 2022 to May 2023 was conducted. The analysis was limited to patients undergoing right heart catheterization (RHC) admitted for HF, post-HTx monitoring, or LVAD hemodynamic testing. PVP was transduced from an antecubital or more distal peripheral intravenous (IV) catheter site using a miniature digital, disposable pressure transducer (Centurion Compass Universal HG, Medline). Pressures were compared using Pearson’s correlation coefficient.

Results:
99 patients were enrolled with a mean age of 62 ± 12 years and a mean ejection fraction (EF) of 41 ± 21%. 74% of the patients had heart failure, 17% were HTx patients, and 9% were LVAD patients. The PVP measured with the novel pressure transducer was found to be highly correlated to CVP measured by RHC (r=0.80, p < 0.0001) (Figure). High correlation was also noted when broken down by HF (r=0.77, p < 0.0001), HTx (r=0.95, p < 0.0001), and LVAD groups (r=0.90, p < 0.0003). There was a high degree of correlation for HF patients with EF < 50% (r=0.74, p < 0.0001) and EF > 50% (r=0.90, p < 0.0001). A high degree of correlation was found for all peripheral IV insertion sites: antecubital (r=0.86, p=0.000071), forearm (r=0.76, p<0.00001), and hand (r=0.84, p<0.00001).

Conclusions:
There is a high degree of correlation between PVP measured by a novel pressure transducer and CVP in HF, HTx, and LVAD patients. PVP measurements using this transducer are a reliable estimate of volume status in these patient populations.
Abstract 14773: Automated Cardiovascular Calcium Burden: Unlocking the Future of TAVR Prognosis With Artificial Intelligence
Authors: Zhang Ding Yi , Arif Saleena Gul , Roberge Maude , Gandhi Rushali , Zarour Yaman , El Malt Farida , Shalmiev Albert , Benzur Jordan , Chalati Mhd Diaa , Benizri Nissim , Bharaj Neetika , Afilalo Marc , Afilalo Jonathan
Published: December 2023

Background:
Calcific valve disease is now understood as a dynamic inflammatory process that alters the tissue’s adaptive response to stress stimuli. Transcatheter aortic valve replacement (TAVR) is a minimally invasive treatment for severe aortic stenosis. Manual analysis of calcifications in pre-TAVR CT scans is time-consuming and subjective.

Hypothesis:
Deep learning (DL) models can accurately quantify cardiovascular calcification and predict post-procedural outcomes in TAVR patients. We aimed to develop such a model and investigate its correlation with long-term all-cause mortality in TAVR patients.

Methods:
This post-hoc analysis examined patients from the FRAILTY-AVR trial and the Royal Victoria Hospital TAVR registry. A 3D UNet-based DL pipeline was developed and trained to detect and quantify coronary artery calcification (CAC), aortic valve calcification (AVC), mitral annular calcification (MAC), and thoracic aorta calcification (TAC) based on pre-procedural CT images. Quantification involved segmentation and CT image analysis techniques. Cox regression analysis, adjusting for various covariates, evaluated the primary endpoint of all-cause mortality one year after TAVR.

Results:
The study included 585 TAVR patients (mean age: 82.5 years; 44% females) with a median follow-up of 506 days. At one year, 27.5%(161) reached the primary endpoint of all-cause mortality. Hazard ratios for MAC, AVC, TAC, and CAC were 1.26 (95% CI: 1.06-1.51, P=0.010), 0.99 (95% CI: 0.83-1.18, P=0.91), 1.07 (95% CI: 0.89-1.29, P=0.46), and 0.89 (95% CI: 0.72-1.09, P=0.26), respectively. Adjustments for covariates did not significantly change these hazard ratios. Mean calcification volumes were 770 mm3 (AVC), 737 mm3 (CAC), 3076 mm3 (TAC), and 629 mm3 (MAC). No substantial correlations were observed between the four calcifications or cardiovascular co-morbidities however, each score may yield meaningful information.

Conclusions:
High mitral annular calcification, quantified by our AI pipeline, was independently associated with increased one-year post-TAVR mortality. AI enables efficiency, objectivity, and improved insights, enhancing clinical decision-making and personalized care.
Abstract 14936: Integrated Text Messaging for Patients Attending Cardiac and Pulmonary Rehabilitation: A Multicentre Randomised Controlled Trial
Authors: Redfern Julie , Singleton Anna C , Raeside Rebecca , Santo Karla , Hafiz Nashid , Spencer Lissa , Leung Regina W , Roberts Mary , King Meredith , Cho Jin-Gun , Carr Bridie , Jenkins Christine , Partridge Stephanie , Hayes Alison , Chow Clara K , HYUN Karice
Published: December 2023

Introduction:
People living with cardiac and respiratory disease require improved post-hospital support that is readily available and efficient.

Hypothesis/Aims:
Support via text message alongside cardiac and pulmonary rehabilitation (rehab) improves clinical, lifestyle and attendance. Aim was to test effectiveness of an automated, semi-personalised text message support program on clinical and lifestyle outcomes among patients attending cardiac and pulmonary rehab and evaluate program acceptability and utility for patients.

Methods:
Multicentre randomised controlled trial (3:1, intervention:control) among patients attending cardiac and pulmonary rehab. Control received usual care. Intervention received a 6-month text message lifestyle and support program. Primary outcome was 6-minute walk distance (6MWD). Secondary outcomes included clinical measures, lifestyle, medication adherence and rehab program attendance.

Results:
Of the 316 participants (mean age±standard deviation, 66.7±10.1years) randomised, 60% were male (190/327), 156 were recruited from cardiac rehab. At 6 months, 6MWD improved in both groups and was significantly greater among intervention than control participants (unadjusted mean difference [95% CI]: 43.4m [4.3 to 82.4];p=0.0296). After adjustment for baseline values, there was no significant difference between intervention and control groups for 6MWD (adjusted mean difference 2.2m [-21.2 to 25.6];p=0·85), medication adherence or cardiovascular risk factors. At 6 months, intervention participants reported significantly lower depression scores (adjusted mean diff [95%CI] -1.3 [-2.2 to -0.3], p=0.012) and anxiety (adjusted mean diff [95%CI] -1.1 [-2.1 to 0.0], p=0.046). Sub-group analysis of cardiac rehab participants found a clinically meaningful increase in 6MWD at 6 months in the intervention compared to control group (mean diff 18.9m, 95% CI -29.2 to 67.1). The majority of participants found the messages easy to understand (99%) and useful (86%).

Conclusion:
An education and support-based text message program for cardiac and pulmonary rehab attendees improved anxiety and depression plus program attendance, was useful for patients and suitable for implementation.
Abstract 14956: Outcomes of Leadless Pacemaker Implantation Following Transvenous Lead Removal of Infected Cardiac Implantable Electronic Device: A Systematic Review
Authors: Tan Min Choon , Tan Jian Liang , Tay Soon Tzeh , Sorajja Dan , Scott Luis , Cha Yong-Mei , Russo Andrea M , Hussein Ayman , Lee Justin
Published: December 2023

Background:
The outcomes of leadless pacemaker (LP) implantation after transvenous lead removal (TLR) of infected cardiac implantable electronic devices (CIED) are not well-established.

Objective:
This study sought to describe the outcomes of LP implantation following TLR of infected CIED.

Method:
We conducted a literature search using PubMed and Embase for a combination of term including
leadless pacemaker implantation,
transvenous lead extraction, transvenous lead removal
,
transvenous lead explant
,
infected cardiac implantable electronic device
. The inclusion criterion was LP implantation after TLR of infected CIED. The exclusion criterion was TLR for non-infectious reason. Study end-points were procedural complications and LP infection.

Result:
Of 132 publications reviewed, 13 studies with a total of 253 patients (74 ± 14 years of age, 69% males) were included. Amongst, 56.8% had systemic CIED infection and 43.2% had isolated pocket infection.
Staphylococcus Aureus
was the most common causative organism in 33% of the reported patients. Of 253 patients included, 105 patients (41.5%) underwent concomitant LP implantation during TLR procedure, and 36 patients (14.2%) had transvenous pacing as a bridge from TLR to LP implantation. During the LP implantation, 1 patient (0.4%) had an intra-procedural complication requiring sternotomy. Post-LP implantation, 2 patients (0.8%) developed groin hematoma, 2 patients (0.8%) developed femoral arteriovenous fistula, and 1 patient (0.4%) developed pericardial effusion requiring pericardiocentesis. During a mean follow-up of 11.3 ±10.6 months, 3 patients (1.2%) developed pacemaker syndrome, 1 patient (0.4%) developed acute on chronic heart failure exacerbation, and only 1 patient (0.4%) developed LP-related infection requiring LP retrieval.

Conclusion:
This study suggests that LP implant is feasible and safe post-removal of infected CIED with cumulative adverse events at 4% and a reinfection rate of 0.4%.
Abstract 14977: Radial Artery Usage Rate Differs in Hospital Types in Coronary Artery Bypass Graft Surgery: An Insight Into National Inpatient Sample
Authors: Luo Qianyun , Li Renxi , Huddleston Stephen
Published: December 2023

Introduction:
In coronary artery bypass grafting (CABG), the left internal mammary artery (LIMA) may not be utilized, and a secondary conduit is chosen to treat coronary artery disease. Radial artery (RA) and greater saphenous vein (GSV) are both viable secondary conduits to, although RA grafting is associated with higher patency and superior long-term survival. This study aimed to compare the rate of RA graft usage in CABG among different hospital types.

Methods:
Patients received CABG between Q4 2015-2020 were extracted from National Inpatient Sample (NIS) based on ICD10-PCS. Patients less than the age of 40 were excluded for congenital heart defects. Preoperative variables included sex, age, race and ethnicity, socioeconomic status (SES), Elixhauser comorbidities, and hospital characteristics. The rate of RA versus GSV usage were compared with respect to hospital location/teaching status and bed sizes, while all preoperative variables besides the variable of interest were adjusted by multivariable analysis.

Results:
There were 56,318 CABG cases identified with 11,708 RA and 44,610 GSV grafting. RA grafting usage was lower in rural hospitals (aOR 0.59, p<0.01), urban private practice (aOR 0.69, p<0.01), and hospitals with large bed sizes (aOR 0.91, p<0.01) while the rate is higher in urban teaching hospitals (aOR 1.50, p<0.01) and hospitals with medium bed sizes (aOR 1.14, p<0.01).

Conclusion:
This study reveals different RA graft usage for CABG among different hospital types. RA harvest can be more time consuming and resource intensive than GSV harvest. Increased familiarity overcoming these obstacles might increase RA graft usage.
Abstract 15011: Recent Trends in Interventional Treatment of Acute Pulmonary Embolism and Their Implications for a National Healthcare System
Authors: Mohr Katharina , Farmakis Ioannis T , Barco Stefano , Channick Richard N , Christodoulou Konstantinos , Giri Jay S , Hobohm Lukas , Keeling Brent , Keller Karsten , Lanno Michelle , Lookstein Robert A , Moriarty John M , Reed Jamie , Rosovsky Rachel P , Rosenfield Kenneth , Secemsky Eric A , Todoran Thomas M , Binder Harald , Konstantinides Stavros V
Published: December 2023

Introduction:
Catheter-directed treatment (CDT) of acute pulmonary embolism (PE) is gaining popularity in Europe, following a trend that originated earlier in the US. For healthcare systems, reimbursement of CDT depends on their clinical benefits along with assessing the impact on hospital costs.

Hypothesis-Aims:
To estimate how increasing use of CDT, as reflected by prospective US data, may affect costs of PE treatment in the German hospital remuneration system (G-DRG).

Methods:
We analyzed data from the German nationwide inpatient sample (Federal Statistical Office), covering all hospitalizations for PE, for the years 2018-2019. For the same period, we analyzed prospective patient-level data from the multicenter US registry of the Pulmonary Embolism Response Team (PERT) Consortium.

Results:
During the study period, 196,167 patients were hospitalized for acute PE in Germany. Of these, 64,056 (33%) had intermediate-risk or high-risk PE, but overall ≤ 1% received CDT. Median reimbursement was є3,572 (IQR, 2,804-5,869), corresponding to є4,088 in inflation-adjusted 2022 currency ($5,678, adjusted for purchase parity power). Of 1,349 patients with intermediate- or high-risk PE included in the US registry in 2018-2019, 284 (21%) received CDT, mostly aspiration thrombectomy (63/1,349; 4.7%), ultrasound-assisted catheter thrombolysis (151; 11.2%), or non-assisted catheter thrombolysis (47; 3.5%). Median length of stay was 4.5 (2.8-8.2) days. Based on current reimbursement rates in the G-DRG, fees for PE treated with aspiration thrombectomy amount to є12,179-15,753, and for catheter-directed thrombolysis (with or without ultrasound) to є9,858-13,829. Considering, (a) the shorter length of stay; (b) the proportion of patients receiving CDT in the elevated-risk US cohort in 2018-19; and (c) that of intermediate- and high-risk PE in the German PE inpatient sample, average remuneration per patient would rise from currently є4,088 to є4,724 ($6,552).

Conclusions:
CDT for PE patients at elevated risk would currently lead to a 16% increase in average per-patient hospital costs in Germany. Together with clinical validation of CDT in ongoing studies, these estimates may inform decision making on reimbursement of interventional treatment options.
Abstract 15056: The Activation of Angiotensin II Type1a Receptors in the SFO and PVN is Necessary to Prime Immunity in Salt Sensitive Hypertension
Authors: Perrotta Marialuisa , Carnevale Lorenzo , Perrotta Sara , Pallante Fabio , Migliaccio Agnese , LEMBO GIUSEPPE , Carnevale Daniela
Published: December 2023

Introduction:
Salt sensitive hypertension (HTN) is associated with increased salt intake and elevated activity of the renin-angiotensin system (RAS) in the brain. We have found that DOCA-salt HTN partly depends on a sympathetic-mediated PlGF release in the spleen.

Hypothesis:
Whether this effect is related to the contribution of RAS signaling in brain nuclei mediating HTN responses is poorly known. We hypothesized that angiotensin type 1a receptors (AT1aR) within the circumventricular organs (CVOs) could mediate DOCA-salt hypertensive responses.

Methods:
To discriminate between CVOs, we used 3 mouse model with deletion of AT1aR in 3 in brain CVOs. AT1aRfloxed mice were 1) stereotaxically injected with an adenovirus encoding a Cre-recombinase (or GFP as control), directly in the subfornical organ (SFO), or 2) crossed with Sim1Cre+ (and Sim1Cre- as control) mice to delete the gene in the paraventricular nucleus of hypothalamus (PVN) or 3) crossed with Phox2bCre+ (and Phox2bCre- as control) mice to delete the gene in the dorsal motor nucleus of the vagus nerve (DMV). T

Results:
We implanted mice with pellets of DOCA or placebo, as control, and salt in drinking water for 3 weeks finding that: AT1aRfloxed mice + Virus encoding Cre Recombinase in the SFO and AT1aRfloxed;Sim1Cre+ mice were protected form HTN-DOCA-salt (SFO-SBP
mmHg
:133±1 vs 106±0,6, ***p>0,0001; PVN-SBP
mmHg
:144±2 vs 112±2,***p>0,0001 respectively to their controls); whereas AT1aRfloxed;Phox2bCre+ mice had increased blood pressure levels (SBP
mmHg
:144±1 vs 144±0,7, respectively to control mice). Additionally, deletion of AT1aR in the SFO and PVN attenuated egression of T cells from the spleen and infiltration on target organ with a reduced disruption of renal glomeruli and reduced accumulation of matrix protein in response to DOCA-salt (SFO-Bowman’s size μm
2
1761±150 vs 821±78, respectively, **p<0,001; PVN-Bowman’s size μm
2
3927±212 vs 2805±252, respectively, **p<0,001). Mice KO for AT1aR in the DMV were not protected from organ damage (Bowman’s size μm
2
776 ± 104 vs 1090 ± 94, respectively).

Conclusions:
ogether, these data indicate that SFO and PVN contribute to blood pressure in the DOCA-salt model of hypertension through AT1aR signaling, while the DMV role was independent from AT1aR.
Abstract 15113: Diastolic Blood Pressure Predicts Mortality Risk in Patients With Cardiogenic Shock
Authors: Adig Sanjana , guglin maya
Published: December 2023

Background:
Cardiogenic shock is a heterogeneous group with poorly defined hemodynamic goals and predictors of mortality. A common target for management has been empirically set at systolic blood pressure of 90 mm Hg or above and a mean arterial pressure value of over 60 mmHg. In this study, we have compared systolic and diastolic blood pressure in survivors and non-survivors with cardiogenic shock, and then in the subsets in heart failure-induced (HF-CS) versus acute myocardial infarction-induced cardiogenic shock (AMI-CS).

Methods:
A cohort of consecutive patients with cardiogenic shock admitted to our institution from 10/30/2019 to 11/11/2022 was analyzed retrospectively. Blood pressure was recorded on admission and then at 24-, 48-, and 72 hours post-admission. Independent t-testing was performed to evaluate the significance.

Results:
A total cohort consisted of 226 patients with cardiogenic shock (mean age 60.2+-14.5 years, 66% male), including 120 (53.1%) HF-CS and 78 (34.51%) AMI-CS. Diastolic blood pressure was higher in survivors than in non-survivors. Among patients with CS who survived, the diastolic BP was statistically higher than the patients who died at 24 and 48 hours from admission (p= 0.007 and 0.01. respectively). In patients with HF-CS, diastolic blood pressure was also higher at the same time points (p= 0.033 and 0.035, respectively). Neither systolic nor diastolic blood pressure differed between survivors and non-survivors in AMI-CS. Systolic blood pressure was similar in survivors and non-survivors in the whole cohort and in both subsets.

Conclusions:
Our data suggest that diastolic BP could be an early, consistent, and more reliable predictor of mortality than Systolic BP for CS patients, especially in the subset of HF-CS.