bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11765: Gender Disparities in Complications Post Atrial Fibrillation Ablation
Authors: Kainat Aleesha , Alhassan Hassan , Akunor Harriet , Donohue Joseph , Saba Samir
Published: June 2023

Introduction:
Catheter ablation therapy (CAT) is recommended for the management of symptomatic atrial fibrillation (AF). Previous real-world studies using the National Inpatient Sample (NIS) have described a disproportionately higher burden of post-CAT complications in women

Hypothesis:
We sought to determine whether the prior gender disparities in complications post-CAT for AF still exist. We hypothesize that with increasing CAT proficiency women would be no more likely to suffer complications compared to men

Methods:
We identified all percutaneous AF CAT hospitalizations in the NIS 2016-2019. We used Inverse-Probability Weighting (IPW) to create a pseudo-population where gender was independent of the following confounders: age, race/ethnicity, primary payor, median income, CHA2DS2VASc and Elixhauser scores, comorbidities including obesity, alcohol use disorder, obstructive sleep apnea, chronic pulmonary disease, and hospital characteristics-region, teaching-status, and bed-size. We compared in-hospital mortality rate, total procedural complications including pericardial (tamponade/effusion/pericarditis); cardiac (heart failure/perioperative MI/shock); respiratory (pneumothorax/respiratory failure); esophageal (perforation/injury); vascular (access-site fistulas/bleeding); and renal (acute kidney injury) between men and women
Results:
Of the 5,835 AF CATs identified (representing 29,175 nationally), 43.2% were performed in women. Before IPW, women were older, and had higher proportions of comorbidities. After applying weights, baseline characters were well-balanced. In the weighted-cohort, there was no difference in mortality (0.48% vs 0.29%, p=0.52) or total complications (8.3% vs 9.6%, p=0.20). Likewise, pericardial (4.5% vs 4.1%, p=0.26); cardiac (0.3% vs 0.4%, p=0.40); vascular (3.6% vs 3.4%, p=0.37); respiratory (0.7% vs 0.8%, p=0.70); esophageal (0.5% vs 0.4%, p=0.31); and renal (1.2% vs 2.3%, p=0.38) complications, were similar across gender

Conclusion:
In this real-world cohort, the burden of complications after CAT for AF was similar across gender. Sustained national efforts at maintaining awareness of gender disparities in complications post-AF CAT are needed to keep this new status quo
Abstract 11770: Cost-Effectiveness Analysis of Coronary Artery Disease Screening in Patients With Breast Cancer
Authors: Velusamy Ragani , Nolan Mark
Published: June 2023

Background:
Association of cardiovascular disease with cancer is caused by an increased risk of coronary artery disease (CAD), in part attributable to the association of standard risk factors with both coronary disease and cancer. In addition to these drivers of accelerated plaque formation, treatment used in breast cancer therapy is associated with CAD.

Purpose:
Cancer patients require an individualised approach for managing CAD and there is an unmet need to define the benefit of CAD screening on outcomes in cancer survivors and the cost-effectiveness of this approach is unknown.

Methods:
A Markov model was assembled using three states; well, myocardial infarction and death. Base case scenario was a 55 year old female treated for breast cancer, followed up 10 years post treatment. Costs, utilities, and transition probabilities were derived from published literature. Costs are in 2021 AUD$ and calculated from a societal perspective. Costs and utilities were discounted at 3% per annum. Sensitivity analyses were performed on key inputs including transition probabilities of well state and MI, costs of CAD and screening test. Willing-to-pay threshold of AUD$50,000 was selected.

Results:
Screening cancer survivors for CAD dominated no screening, providing cost savings of $1916 and QALY savings of 5.9 QALYs per-patient. Major determinants were probabilities of MI, death and costs of screening and MI. There was no change in life expectancy.

Conclusion:
Screening for CAD provided an increase in long-term QALY and reduction in healthcare costs in breast cancer survivors at least 10 years post treatment. ​
Abstract 11801: Glycoprotein Nonmetastatic Melanoma Proteinbbregulates Lysosomal Integrity and Lifespan of Senescent Endothelial Cells
Authors: Hsiao Chien Lun , Suda Masayoshi , Katsuumi Goro , Shimizu Ippei , Yoshida Yohko , Furihata Takaaki , Furuuchi Ryo , Minamino Tohru , HSIAO YUNG TING
Published: June 2023

Introduction:
The accumulation of senescent cells during aging relates to the development of various age-related pathologies including atherosclerosis and heart failure, which can be improved by specific elimination of senescent cells, so called “senolysis”. We have identified glycoprotein nonmetastatic melanoma protein B (GPNMB) as an antigen specifically expressed by senescent endothelial cells, so called “seno-antigen”. Also, we previously developed the vaccine against Gpnmb, eliminated senescent cells in mice, leading to an improvement of age-related pathologies. However, detailed function of GPNMB in senescent cells is still uncertain.
Purpose:
To elucidate the role of GPNMB in senescent cells and cardiovascular-related pathologies.

Methods:
Overexpression or depletion of GPNMB in endothelial cells (ECs) were generated. Cellular senescence was induced in ECs by doxorubicin. Gpnmb-knockout or overexpressed (Gp-KO or Gp-OE) mice were generated and imposed to hind-limb ischemia treatment or high-fat-diet feeding to evaluate vascular functions. Double transgenic mice (ApoE-KO and Gp-KO or Gp-OE) were also generated and imposed to high-fat diet to develop atherosclerosis.

Results:
The depletion of GPNMB in ECs was proved to shorten their replicative lifespan, and increase the expression of negative cell cycle regulators including p53, p21 and p16. Conversely, overexpressed GPNMB protected ECs from senescence stress.
In vivo
studies showed the impairment of vascular function, atherogenesis, and endothelium-dependent vasodilatation were enhanced in Gp-KO mice, but attenuated in Gp-OE mice. Furthermore, GPNMB was found to localize on lysosomal membrane. Cells with depleted GPNMB demonstrated the accumulation of dysfunctional lysosomes, indicated the contribution of GPNMB in maintaining lysosome integrity. Under senescence-associated lysosomal stress, elevated GPNMB expression was detected, contributing to senescent cells survival.

Conclusions:
GPNMB acts as a protective factor to senescent cells. Seno-antigen targeting GPNMB is possibly considered as an efficient strategy against cardiovascular diseases and other age-associated disorders with higher selectivity and fewer off-target effects.
Abstract 11818: Daratumumab Containing Regimens Improved Survival in Patients With Light-Chain Cardiac Amyloidosis
Authors: morikawa kei , Morioka Mami , Takashio Seiji , Kawano Yawara , Tsujita Kenichi
Published: June 2023

Background:
Immunoglobulin light-chain (AL) amyloidosis is a lethal condition resulting from misfolded immunoglobulin ALs produced by clonal CD38-positive plasma cells. Daratumumab, an anti-human CD38 monoclonal antibody, led to higher frequencies of complete hematologic responses and better clinical outcomes compared to conventional treatment. Therefore, daratumumab-containing regimens has become the standard of care in patients with systemic AL amyloidosis and multiple myeloma. This study sought to evaluate the survival benefit of daratumumab-containing regimens in patients with AL cardiac amyloidosis. Methods and Results: We examined 65 consecutive patients with AL cardiac amyloidosis (mean age: 67.2±10.4 years old, male: 69%) who underwent chemotherapy. We divided the patients into two groups, daratumumab group (n=32: treated with daratumumab containing regimens within the first two lines of chemotherapy) and conventional treatment group (n=33). Compared to conventional treatment group, daratumumab group tended to be older (69.2±9.6 vs. 65.2±11.0; p=0.12), while no significant differences in biomarkers and echocardiographic parameters were observed. A total of 26 patients (40%) were deceased (median follow up period: 395 days). Kaplan-Meier survival curves showed that daratumumab group had significantly lower mortality compared to conventional treatment group (p=0.04; log-rank test; Figure). Cox hazard analysis revealed that daratumumab containing regimens were associated with lower mortality after adjustment for revised Mayo staging system for AL amyloidosis (hazard ratio: 0.32; 95% confidence interval: 0.12 to 0.85; p=0.02).

Conclusion:
Daratumumab containing regimens might be associated with improved survival in AL cardiac amyloidosis.
Abstract 11863: Lutembacher Syndrome - Learning From the Left Atrium
Authors: Smith Christopher T , Rentrop Walter , Raper John , Olsen Daga , Sharifi Sasha , PARKER AMY , George Tara , Thang Sophia , Chib Anjula , Menon Vivek
Published: June 2023

Lutembacher syndrome (LS) is a rare cardiac anomaly that was first reported in 1916 by Rene Lutembacher. LS is characterized by an atrial septal defect (ASD) combined with mitral stenosis (MS), both of which can be either congenital or acquired. Without treatment, pulmonary vascular resistance (PVR) steadily increases and can cause right-to-left ASD shunting. This greatly increases the risk of infective endocarditis (IE) and cerebrovascular accidents (CVA).

-

We present a 69-year-old female with past medical history of laryngeal cancer that presented with dyspnea and hemoptysis. The patient had NYHA class II symptoms and had not undergone prior cardiac work-up.

-

Transthoracic echocardiogram demonstrated a reduced ejection fraction 35%, calcifies mitral valve leaflets, and abnormal flow across the interatrial septum. Subsequent transesophageal echocardiogram confirmed the diagnosis of Lutembacher Syndrome with a mean mitral valve gradient of 15 mmHg and evidence of a secundum ASD. There was predominant left-to-right shunting during bubble study with transient right-to-left shunt while coughing. Moderate to severe mitral regurgitation and severe pulmonary hypertension was also observed. Wilkins score was calculated at 7. The patient was ultimately transferred to a Comprehensive Valve Center for surgical mitral valve replacement (MVR).

-

This case highlights the importance of understanding the pathophysiology of LS for efficient diagnosis and appropriate management. Early evaluation at a Comprehensive Valve Center is recommended. Moderate to severe mitral regurgitation is a contraindication to less invasive options such as a percutaneous mitral balloon commissurotomy (PMBC). It is crucial to recognize that after surgical MVR, the secundum ASD is expected to become smaller with predominant left-to-right shunting due to reduced PVR, which decreases the risk of IE and CVA.
Abstract 11873: Association Between Perioperative Hyponatremia and Survival After Left Ventricular Assist Device Implantation: A Systematic Review and Meta-Analysis
Authors: Del Rio-Pertuz Gaspar , Benjanuwattra Juthipong , leelaviwat Natnicha , Abdelnabi Mahmoud , Mekraksakit Poemlarp , Argueta-Sosa Erwin E
Published: June 2023

Background:
Hyponatremia, defined as a serum sodium (Na) level <135 mEq/L, is a common electrolyte disorder in patients with congestive heart failure and cardiac surgical patients, and its presence is associated with increased morbidity and mortality. Few published reports have described if there is an association between perioperative hyponatremia and left ventricular assist device (LVAD) outcomes. The consolidation of these studies could provide information on patient selection for LVAD implantation if hyponatremia is a concern.Hypothesis: The presence of perioperative hyponatremia is associated with mortality after LVAD implantation.

Methods:
We systematically searched PubMed, Embase, and Scopus for abstracts and full-text papers from inception to May 2022. Studies were included if they evaluated the association between perioperative hyponatremia (Serum Na <135 mEq/L) and survival after LVAD implantation. Data were integrated using the random-effects, generic inverse variance method of DerSimonian and Laird. The study was registered in the Prospero CRD42022334062.

Results:
After removing duplicated and applying the inclusion criteria, a total of 4 studies published from 2018 to 2022 were included. Two studies including 527 patients evaluated the association between hyponatremia before LVAD implantation and mortality, no significant association was found (Odds Ratio (OR): 1.30 Confidence interval (CI) 95%: 0.74-2.31 p:0.26, Figure 1). On the other hand, two studies including 313 patients, evaluated the presence of hyponatremia after LVAD implantation, and no significant association to mortality was found (OR:1.46, CI 95%: 0.49-4.37 p:0.02, Figure 2).

Conclusion:
Hyponatremia before or after LVAD implantation is not significantly associated to mortality. These results may suggest that optimization of hyponatremia may not be critical in the perioperative period.
Abstract 11876: The Selenoprotein, Vimp, Selectively Regulates a Newly Defined Non-Canonical Form of Proteasomal Degradation at the ER to Modulate Cardiac Hypertrophy
Authors: Blackwood Erik , MacDonnell Lauren , Thuerauf Donna , Bilal Alina S , Glembotski Christopher C
Published: June 2023

Introduction:
Canonical endoplasmic reticulum (ER) associated degradation (ERAD) adaptively degrades misfolded potentially toxic ER proteins that can accumulate in cells under a variety of stresses. However, roles for ERAD in vivo in potentially pathological conditions have not been well studied.

Hypothesis:
Here, we examined a functional component of ERAD, VCP-interacting membrane protein (VIMP), positing that decreasing VIMP would decrease canonical ERAD, which would be maladaptive in a mouse model of pathological cardiac hypertrophy.

Methods:
Mice were injected with AAV9 to transduce cardiomyocytes with either a shRNA targeting VIMP (shVIMP), or ectopic wild-type or an ERAD-deficient AAV-FLAGVIMP and subjected to pressure overload-induced cardiac hypertrophy. Mice were also injected with a novel AAV expressing a canonical ERAD substrate to monitor the rate of ERAD in vivo for the first time in any organ system.

Results:
Unexpectedly, both VIMP knockdown and overexpression in mouse hearts decreased canonical ERAD while only VIMP knockdown adaptively decreased pathological cardiac hypertrophy. We evaluated the effects of VIMP gain and loss of function on ERAD-mediated degradation of a cytosolic pro-growth kinase, serum/glucocorticoid-regulated kinase 1, SGK1, which we showed here to contribute to pathological cardiac hypertrophy and to be a non-canonical, i.e non-ER localized substrate for ERAD. In contrast to its effect on canonical ERAD, VIMP overexpression decreased noncanonical ERAD-mediated degradation of SGK1, which accounted for the maladaptive effects of increased VIMP in the heart. We found that DERLIN1 was responsible for increasing ERAD-mediated SGK1 degradation, which accounted for the suppression of pathological cardiac hypertrophy when VIMP was knocked down.

Conclusions:
Thus, the relative levels of VIMP and DERLIN1 comprise a molecular switch mechanism that regulates a newly defined non-canonical ERAD-mediated degradation of SGK1, a critical signaling kinase contributing to pathological cardiac hypertrophy. Furthermore, this noncanonical ERAD is of unique importance in cardiomyocytes as these effects of VIMP gain and loss of function were not observed in cardiac fibroblasts from the same mouse hearts.
Abstract 11906: Association Between Neighborhood Environment and Physical Activity in Adults With Cardiovascular Disease in the United States
Authors: Parekh Tarang , Lahan Shubham , Javed Zulqarnain , Patel Kershaw , Cainzos Achirica Miguel , Nasir Khurram
Published: June 2023

Introduction:
Identifying attributes of the built environment that influence an individual’s adherence to recommended physical activity (PA) levels can inform cardiovascular-healthy urban-planning policies. However, no research has examined whether perceived neighborhood environment characteristics are associated with this among adults with CVD.

Methods:
Cross-sectional study using 2020 data from the National Health Interview Survey, which included 3191 adults with CVD. Perceived walkability and safety barriers were captured from 9 questions on participants’ feelings about the neighborhood’s safety and amenities to allow for walking. Meeting PA recommendation was evaluated based on 2012 ACC/AHA guidelines for individuals with stable CVD based on the self-reported measures of activity (Figure). Adjusted logistic models were created to evaluate the association of perceived walkability and safety with the odds of achieving PA goals.

Results:
In the study population, 36.8% met the overall PA guideline, of whom 7% met only strength activity, 19.5% met only aerobic activity, and 10.3% met both. Men were more likely to meet PA guidelines (42.5% vs. 29.2%) than women. In adjusted weighted analysis, having roads for a walk (OR 1.70, 95%CI 1.23-2.36), fun places such as parks, theatres, and libraries to walk near the living area (OR 1.43, 95%CI 1.08-1.89), and places to walk for relaxing and reducing stress (OR 1.46, 95%CI 1.10-1.95) were strongly associated with meeting PA recommendations.

Conclusions:
In adults with CVD, the neighborhood environment characteristics strongly associated with adherence to PA recommendations were the presence of places to walk for fun and relaxation. Although residual confounding is a possibility, our findings suggest that investing in social determinants by developing communities with amenities such as parks might help encourage physical activity for cardiovascular health.
Abstract 11923: High Sensitivity C-Reactive Protein is Associated With Vulnerable Characteristics in Coronary Plaques in Patients With Stable Coronary Disease
Authors: Katamine Masahiro , Minami Yoshiyasu , Asakura Kiyoshi , Nagata Takako , Kinoshita Daisuke , Ako Junya
Published: June 2023

Introduction:
Higher level of high sensitivity C-reactive protein (hsCRP) is associated with an increased risk of cardiovascular events in patients with coronary artery disease (CAD). However, the association between hsCRP and the characteristics of coronary plaques in patients with CAD remains to be elucidated.

Hypothesis:
Higher hsCRP is associated with a higher prevalence of vulnerable characteristics in coronary plaques in patients with CAD.

Methods:
A total of 793 consecutive patients with stable coronary disease (SCD), who underwent optical coherence tomography (OCT) imaging of coronary plaques were included. The characteristics of culprit or non-culprit plaque assessed by OCT were compared between the higher hsCRP group (hsCRP ≥ 0.2 mg/dL, n=247) and the lower hsCRP group (hsCRP < 0.2 mg/dL, n=546).

Results:
In culprit plaques, the prevalence of thin-cap fibroatheroma (TCFA) was significantly higher in the higher hsCRP group than in the lower hsCRP group (23.8% vs. 14.9%, p=0.003) (Panel A). In non-culprit plaques, the prevalence of TCFA (28.6 vs. 18.2%, p=0.014) and plaque with marcophages (56.4 vs. 45.1%, p=0.029) was significantly higher in the higher hsCRP group than in the lower hsCRP group (Panel B).

Conclusions:
Higher level of hsCRP is associated with a higher prevalence of vulnerable characteristics in culprit and non-culprit plaques in patients with CAD. The present results may partly explain the pathogenesis of an increased incidence of ​recurrent cardiovascular events in patients with CAD.
Abstract 11957: Physical Training Augmented With Whole Body Electronic Muscle Stimulation is Superior to Conventional Training Alone in Healthy Subjects, a Pilot Randomized Controlled Trial
Authors: Sara Jaskanwal D , Rajai Nazanin , Breuer Logan , Bjerke Jacob , Olson Thomas P , Nagai Takashi , Schilaty Nathan , Lerman Amir
Published: June 2023

Introduction:
Physical activity is protective against cardiovascular (CV) disease and mortality, yet more than 25% of adults do not perform any regular exercise. Whole body electronic muscle stimulation (WB-EMS) is a novel FDA-approved device used for physical training that simultaneously stimulates all major muscle groups using percutaneous electrical impulse transmission during exercise. Preliminary studies demonstrated increased muscle mass, reduced fat mass, and improved functional capacity in elderly individuals who trained with WB-EMS. We evaluated the effects of training with WB-EMS on measures of CV health.

Methods:
Healthy adults were randomized to physical training with versus without WB-EMS for one 20-minute session each week for 16 weeks. Participants wore a specifically designed vest and arm and leg straps connected to the WB-EMS device (Miha Bodytec, Germany). Biphasic electrical stimulation was delivered through the vest and straps (4 sec on, 4 sec off) at a frequency that elicited a score of 5-6 on the Borg perceived exertion scale when each major muscle group was stimulated. Individuals randomized to no WB-EMS wore the same equipment but received no stimulation. Sessions were provided by trainers certified in WB-EMS training and consisted of a fixed protocol of simple exercises such as squats and lunges. Temporal changes in measures of CV health were compared between groups.

Results:
Forty-one individuals were recruited between 02/2021 and 02/2022 (n=24 WB-EMS, n=17 no WB-EMS; mean age 35.9±11.2 yrs; 61.3% females; median BMI 24.3 (21.8, 28.1) kg/m
2
. After 16 weeks there were significant and favorable differences in the intervention group compared to controls in waist: hip ratio (-1.2 cm vs. 0.9, p=0.05); total cholesterol (-1.1 mg/kg vs. 14.2 mg/kg, p=0.02); anaerobic threshold (68.2% vs. 30.8%, p=0.03); breathing efficiency (VE/VCO2: -10.36 vs -7.38, p=0.01); and peripheral endothelial function, measured with reactive hyperemia peripheral arterial tonometry (-0.009 vs. -0.29, p=0.06).

Conclusions:
Once weekly training with WB-EMS yielded more favorable changes in CV biomarkers compared to conventional training alone in healthy adults, and thus may offer an effective and time-efficient method of physical training.
Abstract 11961: Ductus Arteriosus Oxygen Response is Mediated by Mitochondrial Subunit NDUFS2
Authors: Bentley Rachel E , Hindmarch Charles C , Lima Patricia , Mewburn Jeffrey , Martin Ashley , Dunham-Snary Kimberly J , Archer Stephen L
Published: June 2023

Introduction:
The ductus arteriosus (DA) is a fetal vessel connecting the pulmonary artery (PA) and aorta, diverting oxygenated blood away from the developing lungs to the systemic circulation. The DA rapidly constricts in response to the increase in arterial oxygen (O
2
) following the first breath. Failure of the DA to close in response to O
2
results in persistent ductus arteriosus, one of the most common complications of preterm birth. Mitochondria are known to play an important role in the O
2
response of DA smooth muscle cells (DASMC), however the mechanism is not fully understood. A subunit of mitochondrial Complex I, NDUFS2 (NADH:ubiquinone oxidoreductase core subunit 2) mediates the O
2
response of other specialized O
2
sensing tissues (PA and carotid body); we assess whether NDUFS2 also plays a role in DA O
2
sensing.

Methods:
DASMC were isolated from male term (29 days gestation) fetal New Zealand white rabbits. Cell lines were purified via fluorescence activated cell sorting, excluding CD90
+
and CD31
+
cells (fibroblasts and endothelial cells, respectively). Smooth muscle cell purity was confirmed using flow cytometry for α-smooth muscle actin (α-SMA). Primary cultures were 97.65% ± 0.65% CD90
-
CD31
-
, and were 100% α-SMA
+
post-sorting. We measured the O
2
responsiveness of DASMC using confocal microscopy, measuring changes in intracellular calcium with Cal-520AM. Cells were cultured in hypoxia (2.5% O
2
, pO
2
= 41 mmHg), with O
2
-induced increase in calcium relative to hypoxic baseline serving as a surrogate for constriction. DASMC were treated for 48 hours with 30 pmol siRNA and 90 pmol Lipofectamine® RNAiMAX to knockdown gene expression of NDUFS2 or a negative control. Knockdown was confirmed using qPCR.

Results & Conclusions:
There was a 14.7% (±2.6%, n=33, p<0.0001) increase in intracellular calcium relative to hypoxic baseline in siNC-treated cells. O
2
response was obliterated when treated with siNDUFS2 (0.7% ± 2.1%, n=29, p=0.798), with a 90.9% ± 1.89% knockdown of NDUFS2 mRNA expression. These data suggest a critical role for the mitochondrial electron transport chain, specifically NDUFS2, in DA oxygen responsiveness. While further functional studies will be required, our findings suggest a novel potential therapeutic target to modulate DA patency.
Abstract 11970: True Prediction Model f Clinical Outcome in Tetralogy of Fallot Using Contraction Fraction From the
Single Center Cardiac Magnetic Resonance Outcomes Registry in Tetralogy of Fallot
Authors: Fogel Mark A , Donnelly Elizabeth , Mahmood Abdullah , Reddy Keerthi , Faerber Jen , Zhang Xuemei , Goldmuntz Elizabeth , Harris Matthew A , Biko David , Partington Sara , Paridon Stephen , Mcbride Michael , Ferrari Victor , Whitehead Kevin , Mercer-Rosa Laura M
Published: June 2023

Introduction:
There are no large scale true prediction models (as opposed to association) to determine predictors of clinical outcomes in repaired tetralogy of Fallot (rTOF) which is the purpose of this study. In addition, right ventricular (RV) contraction fraction (CF), a novel parameter indexing stroke volume (SV) by mass reflecting the amount of blood volume displaced for a given mass has not been studied.

Methods:
We retrospectively reviewed data of all rTOF pts undergoing cardiac magnetic resonance (CMR) from 2005-2020. Composite outcome 1 (CO1) included death, transplant, ventricular tachycardia and pacemaker placement & composite outcome 2 (CO2) added cardiovascular hospitalizations (CVH) to CO1. For CF, SV was indexed to BSA
1.4
& RV mass was indexed to height
2.7
. An elastic net was utilized to determine variables of significance to enter a Best Subsets logistic regression model. Data was split into training testing sets.

Results:
761 rTOF pts were studied with a followup period of 5.1
+
4.2 years. 54 events occurred in total (table). Of all CMR variables considered for CO1, RV CF was the most significant predictor (AUC 0.65) yielding an odds ratio of 0.54 (95% CI 0.34-0.85), P=0.0063. Adding CVH for CO2, both RV CF and left ventricular (LV) mass were significant predictors (AUC 0.74) yielding adjusted odd ratios of 0.60 (95% CI 1.02-1.05), P=0.0063 & 1.03 (95% CI 0.41-0.86), P<0.0001 respectively. RV CF between those who met and didn’t meet CO1 and CO2 endpoints were significantly different (2.0
+
0.76 vs 2.48
+
1.1 cc*cm
2.7
/g*m
1.4
, P=0.006). This was similar to LV mass for CO2 (54.37
+
17.7 vs 69.56
+
26.9 g/m
2
, P=0.015).

Conclusion:
With this largest study of a true prediction model in rTOF, RV CF is an important novel predictor and should be incorporated in followup of rTOF patients. Adding CVH to CO1 adds LV mass as another predictor. A measure that incorporates all important RV remodeling parameters such as CF should be followed longitudinally to identify patients at risk.
Abstract 11994: Reduced versus Standard Dose Apixaban in Patients With Atrial Fibrillation and Acute Coronary Syndrome and/or Undergoing Percutaneous Coronary Intervention: Insights From the AUGUSTUS Trial
Authors: Fudim Marat , Lopes Renato D , Wojdyla Daniel M , Mehran Roxana , Khan Mohammad S , Granger Christopher B , Goodman Shaun G , Aronson Ron , Windecker Stephan , Alexander John H
Published: June 2023

Background:
Patients in AUGUSTUS (n=4614) taking apixaban without aspirin had less bleeding and fewer hospitalizations with no significant increase in ischemic events than those taking VKA, aspirin, or both. It is safe and efficacious to reduce apixaban from 5 mg to 2.5 mg twice daily in patients with AF and ≥2 of the following: age ≥80 years, weight ≤60 kg, serum creatinine ≥1.5 mg/dL. Data on reduced versus standard dose apixaban in patients with AF and ACS and/or PCI are limited.

Methods:
We assessed how many patients receiving apixaban 2.5 mg met the dose reduction criteria. We compared major or CRNM bleeding, death or rehospitalization, and death or ischemic events in those who appropriately received 2.5 mg apixaban, inappropriately received 2.5 mg apixaban, and appropriately received 5 mg apixaban. We determined the association of apixaban versus warfarin on bleeding and ischemic events in patients appropriately assigned 2.5 mg apixaban and appropriately assigned 5 mg apixaban.

Results:
Of 2290 patients assigned apixaban, 229 received 2.5 mg and 98 (43%) of those met reduced dose criteria. Rates of major/CRNM bleeding, death or rehospitalization, and death or ischemic events were higher in patients appropriately receiving 2.5 mg apixaban (13.7%, 34.7%, 12.2%) compared with those inappropriately receiving 2.5 mg apixaban (10.5%, 32.5%, 12.3%) and appropriately receiving 5 mg apixaban (11.0%, 23.0%, 5.7%). Compared with VKA, 2.5 mg apixaban, when used appropriately, resulted in similar or greater benefits than 5 mg apixaban for major/CRNM bleeding, death or rehospitalization, and death or ischemic events (Table).

Conclusion:
Of those in AUGUSTUS who received 2.5 mg apixaban, fewer than half met the reduced dose criteria. In patients with AF and recent ACS or PCI, appropriate use of reduced dose apixaban was associated with a lower risk of bleeding and similar rates of rehospitalization and ischemic outcomes compared with VKA, similar to that for standard dose apixaban.
Abstract 12009: Normal Values and Reference Ranges for Left Atrial Coupling Index: The Copenhagen City Heart Study
Authors: Ravnkilde Kirstine , Skaarup Kristoffer G , Lassen Mats H , Johansen Niklas D , Jensen Gorm , Schnohr Peter , Mogelvang Rasmus , Biering-Srensen Tor
Published: June 2023

Introduction:
Left atrial volumetric/mechanical coupling index (LACi) has shown increasing clinical and prognostic utility. LACi is a proposed echocardiographic measurement combining information regarding LA size and function in one measure with no established reference values. The aim of the present study was to establish sex-based normative values and a reference range for LACi in the general population.

Methods:
The present study included healthy participants from the 5th Copenhagen City Heart Study (2011-2015). Participants were considered healthy when free off heart failure, atrial fibrillation, diabetes, hypertension, ischemic heart disease, valvular heart diseases and use of heart medication. All participants were examined with echocardiography. LACi was calculated as the ratio of LA maximal volume index and a’ (peak myocardial velocity of the left ventricle at the septal base in late diastole). Reference values were defined based on prediction intervals (PI) between 2.5% and 97.5%.

Results:
Among 1,939 participants, mean age was 46 ± 16 years, and 61% were female. Median LACi was 2.5 [95% PI (1.16-4.97)]. We observed higher normative values and reference limits of LACi for females than for males (median 2.5 [95% PI (1.19-5.03)] vs 2.4 [95%PI (1.11- 4.73)], p=0.002) (Figure 1). LACi decreased significantly across age categories for all, and when categorized according to sex. In multivariate linear regression models, younger age (beta=-0.230), female sex (b=-0.081), lower BMI (b=-0.067) and high physical activity (reference: no physical activity during leisure time) (b=0.196) were all significantly associated with higher LACi.

Conclusions:
We report normative reference values and ranges for LACi in a healthy general population and stratified by sex. LACi was higher in females and decreased with age.
Abstract 12060: Ventricular Arterial Coupling - A Potential Biomarker in Children With Dilated Cardiomyopathy
Authors: Gajendran Induja , Hsu Daphne T , Agalliu Ilir , Mahgerefteh Joseph , Lamour Jacqueline M , Bansal Neha
Published: June 2023

Introduction:
Ventriculo-arterial coupling (VAC) ratio (normal value: 0.6 - 1.2) is worse in children with dilated cardiomyopathy compared to controls and is associated with poor heart failure (HF) outcomes. It has not been studied in patients on oral HF medications. Our aim was to study VAC ratio as a measure of response to therapy and its ability to predict worse outcomes in this population.

Methods:
A retrospective study of DCM patients < 21 years on oral heart failure medications was conducted between 2010 and 2022 at the Children's Hospital At Montefiore. Medication data, NYHA functional class, and outcomes (mechanical circulatory support, transplantation, or death) were collected. A single observer analyzed the initial and the last echocardiograms on optimal HF therapy to calculate arterial elastance (EA), ventricular elastance (EES), and VAC ratio. Patients with and without outcomes were compared using chi-square & Mann Whitney tests, as appropriate.

Results:
Thirty-one patients (median age at diagnosis 1.25 (IQR 7.7) years) were followed for a median of 4.92 (IQR 11) years. There was a significant improvement in the VAC ratio (mean 1.85 vs 1.46, SEM 0.17, P=0.02) from diagnosis to the last follow-up with a median change of -13.5%. There was a statistically significant association between the percent change in VAC and change in the NYHA class (P=0.0001). Outcome events occurred in 7 patients; one required mechanical circulatory support, two died, and four underwent transplants. Patients with an outcome event had a worse VAC ratio both at diagnosis (P=0.03) and at the last follow-up (P=0.0001) and a worse NYHA class (P=0.001) at the last follow-up (Table).

Conclusion:
VAC is a potential biomarker for response to therapy and is associated with poor outcomes in pediatric DCM. It provides mechanistic insights into HF in this population.
Abstract 12066: Older Age and Higher Number of Comorbidities Are Associated With Therapeutic Inertia for Blood Pressure Control
Authors: Hiura Grant T , Markossian Talar W , Kramer Holly J , Probst Beatrice D , Tootooni Mohammad Samie
Published: June 2023

Introduction:
Therapeutic inertia, defined as failure to initiate or escalate dose of blood pressure (BP) lowering medications when BP goals are not achieved, remains a major barrier to improving BP control rates. This study examines factors associated with therapeutic inertia for hypertensive ambulatory patients receiving care in university-affiliated primary care clinics.

Methods:
This retrospective cohort study included 8,451 hypertensive adults age
>
65 years with
>
1 primary care follow-up visit within one year between January 1, 2017 and January 31, 2021. Sociodemographic and clinical data, including comorbidities of diabetes, obesity, and cardiovascular disease, were extracted from the electronic health record. Generalized linear mixed models with a binomial distribution were used to calculate adjusted odds of therapeutic inertia during a clinic visit when BP was elevated by age group (65-74, ≥ 75 years) and number of comorbidities (0, 1, 2, 3-4,
>
5), after adjustment for covariates. An interaction term of age group * number of comorbidities in the adjusted model was statistically significant (P<0.001), so marginal effects were used to calculate adjusted probabilities of therapeutic inertia at a clinic visit by age group and by number of comorbidities.

Results:
Mean age was 75 ± 8 years old, 42% were male, and race was 72% White, 17% Black, and 11% other. Across 28,585 clinic visits when BP was elevated, mean SBP and DBP were 152 ± 13 and 78 ± 11 mmHg, respectively, and therapeutic inertia occurred in 75% (21,325) of visits. Figure 1 shows that mean adjusted probability of therapeutic inertia among adults with 0 to
>
5 comorbidities ranged from 64 ± 15 % to 81 ± 12% with age 65-74 years, respectively, and 70 ± 15% to 82 ± 11% with age ≥ 75 years.

Conclusions:
Therapeutic inertia is common among older hypertensive adults with multiple comorbidities, and interventions are needed to address lack of medication escalation when BP remains uncontrolled.
Abstract 12089: Right Coronary Artery Aneurysm in Takayasu Arteritis
Authors: Kabbani Mahmoud , Teng Catherine
Published: June 2023

Background:
Takayasu arteritis (TA) is a large vessel vasculitis that affects the aorta and its primary branches. The coronary arteries are uncommonly involved.

Case Presentation:
A 52-year-old man, with a history of TA not on immune suppressants due to recurrent active miliary tuberculosis, was scheduled for open abdominal repair of a multilobulated saccular thoracoabdominal aneurysm. Cardiology was consulted for pre-operative evaluation. His physical exam and EKG were unremarkable. Imaging of his coronaries with CT angiography showed proximal and distal right coronary artery dilation (14 mm) and a intraluminal thrombus. Revascularization surgically or percutaneously was not advised. Additional vascular interventions were postponed until the patient received adequate treatment for his tuberculosis and uncontrolled TA. The patient was started on ASA and warfarin for the intraluminal thrombus and coronary aneurysm.

Discussion:
Coronary artery aneurysms are rare in TA. When coronaries are involved, ostial stenosis or occlusion is the most common lesion. Invasive coronary angiography is difficult due to diffuse vascular disease and involvement of the aorta. The imaging modality of choice remains a debate. CT angiograms remain a reasonable option for the assessment of coronary involvement. There is no established guideline for the treatment of coronary thrombus in patients with TA. Because coronary aneurysms promote thrombus formation by stasis and abnormal flow conditions, it is reasonable to treat with ASA combined with warfarin as they do in Kawasaki disease.

Conclusion:
Although rare in TA, coronary aneurysm formation is possible. A coronary angiogram is technically difficult in this group of patients, and CT angiograms remains a safe option to define coronary anatomy. The treatment guidelines are lacking, and ASA combined with warfarin is a reasonable option to reduce myocardial infarction and death.
Abstract 12098: Contemporary Trends in Utilization and Outcomes of Percutaneous Left Atrial Appendage Occlusion in the United States
Authors: Gupta Mohak , Jain Vardhmaan , Minhas Abdul M
Published: June 2023

Background:
Percutaneous left atrial appendage occlusion (pLAAO) is an alternative stroke prevention strategy in patients with atrial fibrillation who are poor candidates for long-term anticoagulation.

Methods:
We used the National Inpatient Sample to identify adult hospitalizations of patients who underwent pLAAO from 2016 to 2019. Outcomes of interest included peri-procedural complications, in-hospital death, and length of stay (LOS). Major adverse events were defined as a composite of in-hospital mortality, cardiac arrest, new pacemaker implantation, cardiac tamponade, bleeding requiring transfusion, stroke/TIA, AKI requiring dialysis, and systemic embolization. Trends in outcomes were examined using linear regression for continuous variables and binary logistic regression for categorical variables.

Results:
We found a total of 61090 pLAAO procedures (mean age 76.1 years, 41.7% female, 88.3% at urban teaching hospitals)— 5305 procedures in 2016, 11125 in 2017, 17885 in 2018, and 26775 in 2019. As compared to 2016-2017, patients in 2018-2019 were older (75.7 vs 76.3 years; p<0.01) and more comorbid (Elixhauser comorbidity index of ≥5 in 38.4% vs 41.4%; p=0.01). Major adverse events occurred in 2.4%, and decreased from 2.8% in 2016 to 2.1% in 2019 (p=0.04); primarily driven by a decrease in systemic embolization and stroke/TIA. Overall in-hospital mortality was 0.15%, and decreased from 0.28% in 2016 to 0.15% in 2019 but statistical significance was not achieved (p=0.15). Mean LOS decreased from 1.5 days in 2016 to 1.3 days in 2019 (p<0.01) suggesting that more single-day admissions occurred.

Conclusion:
There was a 400% increase in the annual volume of pLAAO from 2016 to 2019 signifying a large eligible patient population and increasing assimilation of pLAAO into clinical practice. Most complications decreased despite an older and more comorbid patient population which might be explained by improving operator technique and procedural protocols.
Abstract 12143: Ventricular Conduction Abnormality and Outcome of Patients With Mild to Moderate Systolic Dysfunction
Authors: Dhande Mehak , Aronis Konstantinos , Thoma Floyd W , Mulukutla Suresh R , Bhonsale Aditya , Kancharla Krishna , Shalaby Alaa , Voigt Andrew , Estes N A Mark , Jain Sandeep , Saba Samir
Published: June 2023

Introduction:
In the context of mild-to-moderate systolic dysfunction (ejection fraction (EF) 36-50%), cardiac resynchronization therapy (CRT) is indicated only in patients with expected high burden of pacing but not in those with intrinsic ventricular conduction abnormalities.

Hypothesis:
Ventricular conduction delay is associated with a higher risk of mortality and HF hospitalization in patients with mild to moderate systolic dysfunction.

Methods:
We analyzed 5,966 patients with mild-to-moderate systolic dysfunction. Of those, 1,741 (29%) had a QRS duration of ≥120 milliseconds (ms). In the latter group, 68 (4%) patients were implanted with a CRT device. Patients were followed to the endpoints of death and the composite outcome of death or heart failure (HF) hospitalization.

Results:
Of the 1,741 patients with mild-to-moderate cardiomyopathy and wide QRS duration, 849 (51%) died and 1,004 (58%) had a HF hospitalization over a median follow-up of 3.35 years. Compared to patients with QRS<120 ms, patients with QRS>120 ms were at a higher risk of all-cause mortality (HR 1.11, CI 1.00-1.23, P=0.046) and of the composite of mortality or HF hospitalization (HR 1.10, CI 1.01-1.20, P=0.037) (Figure 1). Among patients with QRS>120 ms, those who underwent CRT implant, had a lower risk of all-cause mortality (HR 0.44, CI 0.45-0.89, P=0.02) and of mortality or HF hospitalization (HR 0.58, CI 0.39-0.87, P=0.008).

Conclusions:
Among patients with HF and intermediate EF, a wide QRS is associated with higher risk of mortality and heart failure hospitalization. CRT is associated with a reduction in these adverse outcomes. Randomized trials are needed to assess role of CRT in this patient population.
Abstract 12252: Trends of Arrhythmias in Delivery Hospitalizations in the United States
Authors: Thakkar Aarti , Kwapong Yaa A , Patel Harsh P , Blumenthal Roger S , Chrispin Jonathan , Wu Katherine C , Dani Sourbha , Sharma Garima
Published: June 2023

Background:
Cardiac arrhythmias are associated with increased maternal morbidity. Few data exist on trends of delivery-related hospitalizations complicated by arrhythmias.

Methods:
We used the National Inpatient Sample database to identify delivery hospitalizations for women ages 18-49 years between 2009 to 2019 and coding data from the 9
th
and 10
th
editions of the
International Classification of Diseases
to identify supraventricular tachycardias (SVT), atrial fibrillation (AF), atrial flutter, ventricular tachycardia (VT), and ventricular fibrillation (VF). Data were stratified by age, race/ethnicity, maternal comorbidities, hospital size and setting, and type of insurance coverage. Primary outcome was in-hospital mortality, secondary outcome was adverse pregnancy outcomes (APOs), cesarean section, and cardiovascular decompensation. Multivariate logistic regression was used to understand the predictors of arrhythmia during delivery hospitalization.

Results:
Among 41,320,000 delivery hospitalizations, 141,372 were complicated by arrhythmias; SVT (13%), AF (8%), and VT (3%). The incidence of arrhythmia increased between 2009-2014 and again from 2014-2019 (
Fig 1
). Women above 30 years of age, with valvular disease, heart failure, obesity, hypertension, hyperlipidemia, diabetes mellitus, or previous MI had a greater likelihood of arrhythmia during delivery (
Fig 1
, all p <0.0001). Though in-hospital mortality was low, maternal morbidity from cardiogenic shock (0.20 v 0.0%), caesarean section (44.6 v 32%), and APOs such as preeclampsia (9.36 v 3.57%) were increased (p <0.0001) for women with arrhythmia.

Conclusions:
Women with known CV risk factors are more likely to experience arrhythmia during delivery. Those with arrhythmias also have an increased likelihood of cesarean sections, APOs and cardiogenic shock. The data highlight the importance of CVD risk factor modification and better pregnancy care for those at higher risk of morbidity.
Abstract 12256: Symptomatic Supratherapeutic International Normalized Ratio on Rivaroxaban: A Case Report and a Systematic Review
Authors: Khidhir Angela
Published: June 2023

Rivaroxaban is a direct oral anticoagulant that works by inhibiting factor Xa. Direct anticoagulants have largely replaced direct vitamin K inhibitors (VKAs) due to the increased risk of major hemorrhages and the need for regular monitoring and dose adjustments. However, there have been multiple reports of elevated international normalized ratio (INR) and incidents of bleeding in patients on rivaroxaban, which brings into question the potential need for monitoring. The purpose of this review is to differentiate the patients that may benefit from regular monitoring and to propose future directions for implementation of monitoring. Here we report a case of an INR of 4.8 in a patient who presented with a gastrointestinal bleed and a drop of five gm/dL in hemoglobin four days after starting rivaroxaban following right femoral popliteal bypass graft stenting. The patient had no liver or kidney abnormalities and was not taking any medication or consuming any foods that could introduce any significant drug interaction. Additionally, we conducted a systematic review of similar reports in the literature with the goal of identifying the factors that could influence rivaroxaban’s levels in the blood or its influence on the INR. We reviewed PubMed using keywords including; “rivaroxaban”, “anti-Xa”, “DOAC”, “elevated”, “INR”, “bleeding”, “hemorrhage”, “pharmacology”, and “pharmacokinetics”. The literature revealed reports of INRs up to 5.2. Reviewing the pharmacokinetics of rivaroxaban indicated possibly higher drug levels in Caucasians, patients with a low body mass index (BMI), and patients with polymorphisms in the genes coding for CYP3A4, CYP2J2, or p-glycoprotein, assuming no renal or liver disease and no significant drug-drug or drug-food interactions. INR can be falsely normal if the thromboplastin reagent used to monitor the INR on warfarin is not sensitive to the changes in INR due to rivaroxaban. We suggest finding a thromboplastin reagent that is sensitive to INR changes with rivaroxaban, which could yield clinically relevant INRs on rivaroxaban allowing for accurate monitoring. We then suggest conducting studies to evaluate the cost effectiveness of regular monitoring in at-risk patients.