bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13309: Severe Cardiomyopathy as Harbinger of Multisystem Inflammatory Syndrome From Epstein Barr Infection
Authors: Vo Phuong Uyen , Singh Daljeet , Varian Kenneth D , Orasanu Gabriela
Published: December 2023

Introduction:
Multisystem inflammatory syndrome in adults (MIS-A) is a rare condition characterized by multiple organ injury after a viral infection. Features include fever, elevated inflammatory markers, evidence of acute viral infection, and at least three of the following clinical criteria: peri/myocarditis or acute ventricular dysfunction, rash, encephalopathy, shock, and gastrointestinal symptoms. This is a case of nonischemic cardiomyopathy (NICMP) as a MIS-A manifestation after an Epstein-Barr viral (EBV) infection.

Description of Case:
A 38 year-old female, with a recent pneumonia, presented with two weeks of fever, dyspnea, hemoptysis, fatigue, and right leg swelling. Initial ECG showed sinus tachycardia. Laboratory testing showed leukocytosis 15.5k/uL, NT pro BNP 6470 pg/mL, C-reactive protein 234 mg/L, lactic acid 3.7 mmol/L, creatinine 1.5 mg/dL (baseline 0.7 mg/dL), AST 372 U/L, ALT 658 U/L. RSV, influenza, COVID-19, HIV, hepatitis B/C, and urine antigens were undetected. Imaging showed deep vein thrombosis in right leg veins and bilateral pulmonary emboli with infarcts. Heparin infusion was started. A transthoracic echocardiogram showed biventricular systolic failure with an ejection fraction of 20%. Coronary angiography showed no coronary artery disease. Cardiac MRI showed dilated NICMP with minimal late gadolinium enhancement. The nadir of her cardiac index was 1.2 L/min/m 2. She was started on nitroprusside infusion for early-stage cardiogenic shock. Extensive workup for thrombophilia, autoimmune, amyloidosis, infectious causes were all normal except for an elevated EBV early antigen IgG which indicated past infection within a few months, aligning with patient’s reported pneumonia symptoms before presentation. She clinically improved and was bridged to heart failure guideline directed medical therapy and apixaban on discharge.

Discussion:
Though MIS-A has been reportedly associated with COVID-19, EBV can cause MIS, with severe cardiomyopathy, nephropathy, hepatopathy, and pulmonary infarcts requiring intensive cardiac care, in a normal young adult.
Abstract 13334: Safety of Chest Compressions in Patients With a Durable Left Ventricular Assist Device
Authors: Senman Balimkiz , Pierce Jacob , KITTIPIBUL VERAPRAPAS , Barnes Stephanie , Benjamin Bryner , Whitacre Meredith , Katz Jason N
Published: December 2023

Introduction:
The safety of chest compressions (CC) during cardiopulmonary resuscitation (CPR) among pts with a durable left ventricular assist device (LVAD) is an area of controversy. Concerns regarding device malfunction or dislodgment with CC may result in significant delays or the withholding of life-sustaining intervention entirely. Current societal guidelines, based on small case reports, suggest that manual CC are probably not harmful, but offer no additional guidance. Furthermore, they acknowledge that there are no data regarding the use of machine-assisted CC.

Methods:
We retrospectively reviewed medical records of consecutive pts who underwent durable LVAD implantation at Duke University from 2013-2022. Charts were searched for “code”, “arrest”, “compressions”, and “rapid response team” to identify all instances of cardiac arrest (CA). Baseline pt characteristics, details of the arrest (including CC details), in-hospital care processes, and pt outcomes were abstracted.

Results:
Of 750 pts reviewed, 58 (mean age 64 years, 76% male, median LVAD support duration 19 months) had documented CA. Fifteen (26%) pts presented with an out-of-hospital CA. Twenty-four (41%) pts did not receive CC. The most commonly reported reason for avoiding CC was “LVAD in place - contraindicated.” The CPR duration was longer among those who received CC (median 30mins, range: 1-120 mins) than those who did not (median 20 mins, range: 2-79 mins). Two pts had support from a Lund University Cardiac Assist System (LUCAS) device. Among those who survived either manual and machine-assisted CC, 27% had a post-arrest TTE and none showed evidence of LVAD malfunction/dislodgment.

Conclusions:
Among pts with a durable LVAD who underwent CPR for CA we found no evidence of device dislodgment or safety concerns associated with either manual or LUCAS-assisted CPR. Future multicenter and prospective evaluation is necessary to both confirm these findings and to inform the guidelines.
Abstract 13364: Transplantation of Mutant
Clostridium_ASF356
Rescues Aging Gut-Derived Phenylacetate-Mediated Perivascular Adipose Tissue and Endothelial Senescence
Authors: Pugin Benoit , Constancias Florentin , Thomas Aurélien , LeGludic Sylvain , Allemann Meret S , Lee Pratintip , Menni Cristina , Paneni Francesco , RUSCHITZKA FRANK , Beer Juerg H , Saeedi Saravi Seyed Soheil
Published: December 2023

Introduction:
Perivascular adipose tissue (PVAT) may contribute to atherosclerosis by promoting endothelial dysfunction in aging. Gut microbiota can induce PVAT dysfunction; yet, whether it leads to endothelial cell (EC) senescence requires further investigation. Our studies revealed that gut-derived phenylacetate (PAA) and its derivative PAGln age-dependently increase (
TwinsUK Aging Cohort
). Yet, it remains unclear whether and how it contributes to PVAT-EC senescence.

Methods:
To circumvent our limited knowledge of PAA-(peri)vasculature pathway in aging, we performed multi-omics (fecal shotgun metagenomics and targeted metabolomics), and cell-cell (co-culture) interaction and senescence analyses.

Results:
Our human (
TwinsUK
, n=7,303) and mouse (24
vs.
3 months, n=6) studies identified a positive association of plasma PAA and PAGln with higher abundance of
VOR
- and
PPFOR
-harboring bacteria (metabolizing dietary phenylalanine to PAA), particularly

Clostridium_ASF356,

in gut of old humans and mice that exhibited PVAT and vascular dysfunction. PAA aggravated PVAT dysfunction (reduced UCP1 and Prdm16) by generating excess mitochondrial H
2
O
2
and upregulating
Notch1
, leading to reduced energy supply and increased senescence-messaging secretome from PVAT. It induced senescence (increased SA-β-galactosidase, telomere attrition, cell-cycle arrest (

p16
INK4a

and

p21
WAF1/Cip1

), and SASP (IL6 and VCAM1)) in co-cultured aortic ECs and reduced angiogenesis (tube formation). We also showed that transplantation of

genetically-engineered
Δvor, Δppfor C. ASF356
double mutants

to old mice (reduces plasma PAA) decreases VCAM1 secretion from PVAT and thereby inhibits senescence in aortic ECs that exhibited eNOS uncoupling.

Conclusions:
We conclude that age-related increase in microbiota-driven PAA regulates PVAT-mediated EC senescence via
Notch1
signaling. Our bacterial engineering approach may represent a novel (peri)vascular senotherapy.
Abstract 13374: The Intersection of Prenatal Clinical and Demographic Factors in Predicting Fetal Brain Volume and Neurodevelopmental Outcome in Single Ventricle CHD
Authors: Peyvandi Shabnam , Ortinau Cynthia M , Rofeberg Valerie , Vesoulis Zachary , Hart Nicholas , Herrera Pujols Kaysi , Wypij David , Rollins Caitlin K
Published: December 2023

Background:
Fetuses with single ventricle (SV) CHD have small total brain volumes (TBV) which has been linked to neurodevelopmental impairment (NDI). Evidence suggests a prenatal origin of NDI for CHD. Our primary aim was to use machine learning methods to identify prenatal variables that predict fetal brain growth and in turn early NDI.

Methods:
This is a multi-center prospective cohort study of maternal-infant dyads with a fetal diagnosis of SV who underwent fetal brain MRI and in-depth prenatal clinical and sociodemographic data collection (self reported race/ethnicity, income, education, area deprivation index, maternal health, genetics, placental health). Infants had ND testing at 12-30 months with Bayley Scales of Infant and Toddler Development. Machine learning models used recursive partitioning to predict 1) gestational-age (GA) and sex-adjusted fetal TBV and 2) ND outcome while including fetal TBV in the models.

Results:
A total of 67 maternal-infant dyads were enrolled with a mean GA of 33.4 weeks (SD=3.4) at fetal MRI and male predominance (57%); 48 infants had follow-up at median age of 23.5 months (SD=6.3). Key predictors of fetal brain volume were race/ethnicity, maternal age, and cardiac anatomy (Figure 1A). For NDI, fetal brain volume was the strongest predictor of motor outcomes but was not associated with other domains (Figure 1D). Cardiac anatomy was the strongest predictor of cognitive outcome (Figure 1B), while race/ethnicity was the strongest predictor of language (Figure 1C). Cardiac anatomy, maternal age, and cerebral and placental hemodynamics (e.g., middle cerebral or umbilical artery pulsatility) each predicted multiple domains of neurodevelopment.

Conclusions:
In regression tree modeling, sociodemographic variables are the strongest predictors of fetal TBV, which in turn predicts motor outcome. Prenatal factors predicting NDI across all domains span sociodemographic, cardiac, and placental characteristics.
Abstract 13391: The Natural History of Familial Hypercholesterolemia Diagnosis, Treatment, and Outcomes in Patients With Incidental
LDLR
Pathogenic Mutation Found in Population Based Sequencing Study
Authors: Knight Stacey , Walton Nephi A , Le Viet T , Evans Jared M , Christensen G B , Knowlton Kirk U , Nadauld Lincoln , Anderson Jeffrey L
Published: December 2023

Introduction:
The HerediGene Population Study is a collaborative between Intermountain Health and deCODE genetics that seeks to understand the genetics behind diseases to better predict and prevent disease. Here we describe the natural history of familial hypercholesterolemia (FH) diagnosis (dx), treatment, and outcomes in HerediGene patients (pts) with an
LDLR
gene variant.

Methods:
From the first 32,159 sequenced pts, 157 (0.05%) had a pathogenic/likely pathogenic variant in
LDLR.
These LDLR carriers were divided into three groups - pts with no prior FH dx (n=47; 30%), pts with an FH dx made after a major adverse cardiovascular event (including, myocardial infarction, heart failure hospitalization, stroke, peripheral artery disease, and carotid artery disease) (n=41; 26%), and pts with an FH dx made prior to any MACE (n=69, 44%) (this is the referent group). The natural history of FH was examined using pairwise comparisons between the referent group and each of the first two groups.

Results:
The clinical characteristics, LDL-C values, treatments, and outcomes are shown in the Table. The age at last visit or death was similar for all these groups (median=62). Compared to pts without an FH dx, pts with FH dx prior to a MACE had significantly more LDL-C measurements, increased statin and other lipid-lowering medications, and had a large change in LDL-C measurements. They were slightly, but not statistically, less likely to have subsequent MACE (25% vs 28%; p=0.72). The LDL-C measurements and statin use were similar for those pts with FH dx after MACE and pts with FH dx prior to MACE. However, pts with FH dx after a MACE had higher rates of death (36.6% vs 11.6%; p=0.002).

Conclusions:
Aggressive treatment for and subsequent decrease in LDL-C following FH dx in pts with LDLR mutation, highlight the need for early diagnosis. Furthermore, if this dx was made prior to MACE the death rate was lower. Larger sized studies are needed, but these findings provide support for early screening for FH.
Abstract 13395: Dapagliflozin Reduces Myocardial Sodium Content and Correlates With Reverse Cardiac Remodeling in Nondiabetic Patients With Heart Failure and Preserved Ejection Fraction (Dapa-Sodium)
Authors: plata carlos A , Vernaza Armando , Yela-Muñoz Iván E , Casanova-Valderrama Maria E
Published: December 2023

Introduction:
Myocardial sodium overload is a major determinant of adverse cardiac remodeling in heart failure (HF). Sodium tissue content by 23Na magnetic resonance imaging (23Na-MRI) has been validated in human studies. SGLT-2 inhibition blocks sodium reabsorption in renal proximal tubular cells with remarkable cardiovascular outcomes in HF due to mechanisms not yet fully understood.

Hypothesis:
SGLT-2 inhibition will decrease myocardial sodium content and it will correlate with reverse remodeling in HFpEF.

Aim:
To determine whether Dapagliflozin leads to decreased myocardial sodium content and reverses pathological hypertrophy in HFpEF.

Methods:
Prospective, single-center, open-label study of sixty nondiabetic outpatients with HFpEF underwent baseline 23Na-MRI and initiated with dapagliflozin 10 mg once daily according to GDMT. Absolute changes in myocardium relative sodium signal intensity (rSSI) and left ventricular mass index (LVMi) were analyzed from baseline and at 3-month follow-up with 23Na-MRI.

Results:
All patients exhibited significantly high baseline myocardium rSSI [0.32 (0.28, 0.34)]; 66% above median [0.24 (0.20, 0.27), P = 0.004], decreasing -30% to [0.27 (0.22, 0.30), P<0.001] at 3 months with Dapagliflozin therapy. These changes were correlated with a significant reduction in LVMi of -13 g/m
2
[from 84 g/m
2
(72, 120) to 71 g/m
2
(63, 95), P<0.001].

Conclusions:
Dapagliflozin reduces myocardial sodium content and reverses pathological hypertrophy in patients with HFpEF. These findings suggest that SGLT-2 inhibition acts directly on cardiomyocytes and explains the cardioprotective effects demonstrated though large randomized trials.
Abstract 13406: Surveillance Bias: Inpatient Outcomes of Heart Failure in Substance Users as an Example
Authors: Mohamad Alahmad Mohamad Alhoda , Gibson Cheryl A
Published: December 2023

Introduction:
Substance use (SU), including opioid, methamphetamine, and cocaine use, is not infrequent among those with heart failure (HF). We aimed to characterize substance use among patients with heart failure and its association with inpatient outcomes.

Methods:
We used the Nationwide Readmission Database (NRD) for 2019 for our retrospective study. First, we extracted all cases older than 18 years that included a primary diagnosis of HF. Appropriate survey and domain analyses were applied to obtain national estimates using SAS 9.4.

Results:
We identified 1,318,006 discharges with a primary diagnosis of HF. SU was present in 5% of the study cohort (n= 57,395 cases). Patients with SU were younger than those without SU (mean age 55 years vs. 72 years, p<0.001) and fewer women (29% vs. 49%, p<0.001). Patients with SU had a higher prevalence of underlying hypertension, acquired immunodeficiency syndrome, and chronic lung and liver disease, but a lower prevalence of malignancy, dementia, end-stage renal disease, diabetes, and cerebrovascular disease (p<0.001). Substance users had significantly lower inpatient mortality (1.4% vs. 2.9%, p<0.001), but higher leaving against medical advice (AMA) (8% vs. 1%, p<0.001), length of stay (mean 9 days vs. 8 days, p<0.001), and all-cause 30-day readmission rates (58% vs. 46%, p<0.001). Even after adjusting for age, gender, and comorbidities, the presence of SU continued to be associated with lower inpatient mortality compared to those without SU (OR 0.81 [0.73-0.90]). In this case, mortality rates are calculated based on discharge-level records rather than patient-level records. This leads to a dilution of the inpatient mortality rate because drug users who have multiple readmissions contribute more to the denominator. After excluding patients who left AMA or had readmission in the same year, SU was not associated with any favorable outcome (OR 1 [0.90-1.12]).

Conclusions:
While administrative data offers opportunities to study clinical outcomes, understanding how data is created and analyzed is key. Because the NRD database is built based on discharge-level rather than patient-level records, this is an example of how these calculations can introduce bias.
Abstract 13409: Maintaining a High Total Serum Magnesium Level With Intravenous Magnesium Sulfate
Authors: Kwon JooEun , lucas brian
Published: December 2023

Introduction:
Understanding how intravenous magnesium sulfate (MgSO4) administration affects total serum magnesium concentration (TsMg) is important in maintaining a target TsMg level in acute heart failure patients on loop diuretics.

Hypothesis:
Describe how TsMg changes after single dose of MgSO4 and estimate how often MgSO4 should be given to maintain TsMg above 2 mg/dL.

Methods:
We studied hospitalizations of veterans from the Veterans Health Administration (VHA) aged ≥ 65 without severe renal disease (EGFR > 15 cc/min per 1.73 m2) from 2013-2017 with a primary diagnosis of acute heart failure. We constructed linear and logistic mixed-effects models with values of TsMg at level 1, nested within dose, hospitalization, and patient.

Results:
There were 27,474 doses of intravenous MgSO4 administered in 16,139 hospitalizations to 13,439 unique veterans across 145 hospitals in the VHA. Veterans were elderly (mean age 76), 98% male, 72% non-Hispanic white. Mean TsMg was initially high and leveled off 24-48 hours after MgSO4 administration, with an average TsMg increase of 0.2 mg/dL regardless of dose administered
(Figure)
. The probability of maintaining a TsMg above 2.0 mg/dL just one day after MgSO4 ranged from 49-54%
(Table)
.

Conclusions:
TsMg is often targeted above 2.0 gm/dL, especially in the setting of arrhythmias or QT-prolonging medications. As MgSO4 is frequently administered in heart failure patients on diuretics, understanding that TsMg may be misleadingly elevated for the first 48 hours after MgSO4 is important. We recommend administering MgSO4 at least once per day if the goal TsMg level is ≥ 2.0 gm/dL.
Abstract 13411: Effect of Multilevel, Nurse-Led, Mobile Health Enhanced Intervention on Cardiovascular Disease Risk Reduction Among Patients With Uncontrolled Hypertension in Ghana: Evidence From the ADHINCRA Study
Authors: Hinneh Thomas , Ogungbe Oluwabunmi V , Metlock Faith , Appiah Nana Kwasi F , Commodore-Mensah Yvonne , SARFO FRED S , Dennison Himmelfarb Cheryl R , Appiah Lambert T , Carson Kathryn , Cooper Lisa A
Published: December 2023

Introduction:
Although cardiovascular disease (CVD) accounts for over two-thirds of premature mortality in Africa, risk assessments to guide preventive interventions for atherosclerotic CVD are rarely performed in many clinical settings.

Objective:
To investigate the impact of Nurse-led intervention on ASCVD risk reduction in adults with uncontrolled hypertension in Kumasi, Ghana enrolled in the ADHINCRA study.

Methods:
Using a cluster randomized controlled pilot trial design, four hospitals were randomized to the intervention arm and enhanced usual care (UC) arm. Two hundred and forty (240) participants were randomized to intervention (120 participants) or enhanced usual care (120 participants). We estimated the 10-year ASCVD risks for adults older than 40 years using Pooled Cohort Equations (PCE). We employed a mixed-effect linear regression model to predict the mean risk score as a function of the treatment group. ASCVD was first modeled as a continuous outcome, then categorized according to the ACC/AHA cut points: low (<5%), Borderline (5%-<7.5%), Intermediate (≥7.5% <20%), and high-risk (≥20%).
Result:
The mean age (SD) was 53 ± 9.7 years; 117 men [49%]. The mean [SE] ASCVD scores for the intervention and Enhanced Usual group (EUC) arms at baseline were 14.1% (0.93) and 15.4% (1.03) respectively. At Month 12, the mean ASCVD score was 13.8% (0.77) in the intervention group and 15.2% (0.98) in the Enhanced usual group. Using the AAC/AHA risk categorization, 24% of patients in the intervention and 27% in the EUC were in the high-risk category. Relatively, ASCVD risk was 1.27% (95 CI -2.36, -0.17; P = .023) lower in the intervention group compared to the EUC arm at month 12 (
Figure 1
).

Conclusion:
The Nurse-Led Multilevel Mobile Health Intervention led to a reduction in ASCVD risk, however, the reduction was not sustained after month 6, a more robust RCT is required to examine intervention sustainability in Ghana.
Abstract 13423: Magnetocardiography as a Noninvasive Diagnostic Strategy for Ischemia Evaluating Following Coronary Revascularization of Patients With Non-ST Segment Elevation Myocardial Infarction
Authors: Liu Linqi , yang shuwen , Zhang Huan , Zhou Shu , Yang Xueyao , Ma Zhao , Cai Bin , Ding Ming , Tu Chenchen , Song Xiantao , Zhang Hongjia
Published: December 2023

Introduction:
Magnetocardiography (MCG) constitutes a non-invasive and radiation-free procedure that quantifies the heart's magnetic fields and has exhibited sensitive diagnostic capabilities for ischemia. Typically, MCG presents a distinctive pattern in healthy subjects, characterized by a positive and a negative pole that forms an angle of approximately 45-60 degrees within the T peak segment.

Hypothesis:
Our study aims to monitor the significant alterations in MCG patterns among patients with Non-ST Segment Elevation Myocardial Infarction (NSTEMI) undergoing revascularization.

Methods:
Patients were prospectively enrolled and MCG scans were conducted thrice: three days pre-intervention, one week post-intervention, and at a three-month follow-up.

Results:
Four patients underwent anatomical complete revascularization, while one patient had incomplete revascularization. When comparing the MCG patterns of patients with NSTEMI (Figures B-F) to a normal MCG pattern (Figure A), pre-intervention scans showed angular deflection (80%, except for patient 3) and an anomalous distribution of poles (100%). One week post-intervention, patients who underwent complete revascularization (Figures B-D) had myocardial enzymes normalized, along with slight angle recovery and reshaping of the poles (100%). By the three-month follow-up, these patients experienced symptom resolution, and their MCG patterns showed normalized angles with recovered poles (100%). However, the patient who underwent incomplete revascularization (Figure F) exhibited sustained myocardial ischemia symptoms, with no further angle recovery and continued anomalous distribution of positive poles, both post-intervention and during follow-up.

Conclusions:
The distribution of poles and angular deflection could potentially serve as indicators of ischemia. MCG may represent a promising strategy for evaluating myocardial recovery in patients with NSTEMI.
Abstract 13428: Validation of the Tri-Score for Outcome Prediction After Isolated Tricuspid Valve Surgery in Asians
Authors: Kim Dae-Young , Kim Jihoon , Cho Iksung , Kim Eun Kyoung , Hong Geu-Ru , Ha Jong-Won , Park Sung-ji , Shim Chi Young Y
Published: December 2023

Introduction:
TRI-SCORE was recently developed in Europe as a risk model for predicting in-hospital mortality after isolated tricuspid valve surgery (ITVS).

Hypothesis:
This study aimed to validate TRI-SCORE in an Asian population and investigate its value for predicting long-term outcomes.

Methods:
The TRI-SCORE was calculated for 186 patients (65 ± 12 years, 62% female, 88% functional tricuspid regurgitation [TR]) who underwent ITVS for severe TR at two Korean centers and was based on eight parameters: age, New York Heart Association class, right-sided heart failure signs, furosemide daily dose, glomerular filtration rate, bilirubin, left ventricular ejection fraction, and moderate/severe right ventricular dysfunction. The primary outcome was all-cause death during follow-up; the secondary outcome was in-hospital mortality.

Results:
During a median follow-up duration of 50 months after ITVS (interquartile range 22-82), 21 patients (11.3%) experienced the primary outcome, and six patients (3.2%) experienced the secondary outcome. Observed all-cause death and in-hospital mortality increased by up to 50% in those with higher scores. Patients with the primary outcome had a higher TRI-SCORE (4.4 ± 2.5 vs. 2.9 ± 2.1, p = 0.003) than those without. The TRI-SCORE showed a significant association with the primary outcome (concordance index: 0.76, cut-off value: 4) and in-hospital mortality (concordance index 0.84, cut-off value: 5) (Figure). Using the Kaplan-Meier analysis, patients with a high TRI-SCORE exhibited a poor clinical outcome for all-cause death at follow-up (log-rank p = 0.001) and in-hospital mortality (log-rank p = 0.003).

Conclusions:
TRI-SCORE was validated in an Asian population and helped predict long-term outcomes after ITVS.
Abstract 13443: Dead Antegrade Fast Pathway: A Dilemma for Atrioventricular Nodal Re-Entry Tachycardia Ablation
Authors: Nadkarni Ninad , Fohle Emmanuel , Pham Scott
Published: December 2023

Background:
Catheter ablation is the first-line treatment option for symptomatic atrioventricular nodal re-entry tachycardia (AVNRT). Ablation of the slow pathway is preferred over the fast pathway in Typical AVNRT, given that it has a lower risk of heart block. Still, baseline conduction abnormalities and findings on the Electrophysiology (EP) study can alter the ablation strategy.

Case:
We report a case of a 61-year-old male who was referred to EP clinic for symptomatic suspected AVNRT. His baseline electrocardiogram (EKG) showed normal sinus rhythm with PR prolongation, right bundle branch block, and left anterior fascicular block. EP study was performed, which showed prolonged AH interval with normal HV interval (Figure 1). Typical AVNRT was induced with a premature atrial complex; there was no AV nodal jump before the tachycardia, but it had a long AH interval (Figure 2). There was no evidence of pre-excitation.

Discussion:
Since there was no antegrade conduction through the fast pathway, conventional slow pathway ablation was not viable as it would make the patient pacemaker (PM)-dependent. Even ablating the fast pathway, though not PM-dependent, would still put him at risk for complete heart block, especially when his antegrade conduction via the slow pathway was unreliable. Hence PM was discussed with the patient before ablation. The fast pathway was mapped and ablated (Figures 3, 4, and 5) without complication, and PM was implanted.

Conclusion:
This case emphasizes the role of fast pathway ablation in symptomatic AVNRT in patients with conduction abnormalities and the importance of EP study to see the need for PM post-ablation.
Abstract 13452: Clinical Usefulness of Oxygen Uptake Efficiency Slope for Evaluation Functional Capacity of Heart Failure With Preserved Ejection Fraction
Authors: Son ByengJu , Son Jang-Won , Park Jong-Seon , CHOI KANGUN , Nam Jong-Ho , Park Jong Il , Kim Sun-o , Jung Yu-jung , Jeong Jun-Chang , Kim Ung
Published: December 2023

1. Backgrand:
The diagnostic criteria for HFpEF have been established; however, the evaluation criteria for functional capacity, such as LVEF in HFrEF, have not been clearly delineated. Furthermore, exercise intolerance is a prominent manifestation in patients with HFpEF.Considering these factors, the objective of this study was to analyze the results of cardiopulmonary exercise testing (CPET) in the HFpEF patient cohort and utilize them for the assessment of functional capacity.

2. Methods:
Exercise echocardiographic data were retrospectively analyzed in a cohort of 83 patients who underwent exercise echocardiography between September 2021 and October 2022. Among them, 64 patients also underwent cardiopulmonary exercise testing (CPET). The diagnostic criteria for HFpEF were determined based on the ASE/EACVI algorithm, as outlined below.

3. Result:
Notably, only in the case of the oxygen uptake efficiency slope (OUES), the patient group with diastolic dysfunction displayed a statistically significant result that was significantly lower than that of the group with normal diastolic function. Based on these findings, when the ROC curve was generated using OUES as the negative predictive value, the AUC was 0.708, indicating a fair result.

4. Conclusions:
The decrease in OUES was found to be statistically significant in HFpEF patients. As a result, it is anticipated that OUES can serve as a measure for evaluating functional capacity in HFpEF patients, in addition to serving as an objective indicator of improved cardiopulmonary exercise capacity when treating HFpEF patients.
Abstract 13485: Distinction of Characteristics Associated With Successful Venoarterial Extracorporeal Membrane Oxygenation Decannulation in Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest
Authors: Dahiya Garima , Nowariak Meagan , nzemenoh bellony , Gonzalez Daniel , Bartos Jason , Singh Rahul , Jiang Ziou , Gutierrez Alejandra , Yannopoulos Demetris , Elliott Andrea M
Published: December 2023

Introduction:
Assessment for readiness of decannulation from venoarterial extracorporeal membranous oxygenation (VA ECMO) is largely based on anecdotal data and provider experience, with high failure rates of 30-70% reported in literature. Compared to patients cannulated for cardiogenic shock, in-hospital cardiac arrest and post-cardiotomy, patients cannulated for out-of-hospital cardiac arrest (OHCA) extracorporeal cardiopulmonary resuscitation (ECPR) represent a unique population.

Aims:
We sought to identify parameters impacting decannulation success among OHCA patients treated with ECMO-facilitated resuscitation.

Methods:
Consecutive OHCA patients treated with previously described Minnesota Resuscitation Consortium ECPR protocol from 2015 to 2022 were eligible for inclusion. Hemodynamics, patient characteristics, mechanical circulatory support, and echocardiographic data were compared among patients with successful versus failed decannulations, defined as death due to cardiac causes or recannulation on VA ECMO within the same hospitalization.

Results:
Among 390 ECPR protocol patients, 125 (32%) were deemed ready for decannulation with 88% successful (N=110) and 12% failed decannulations (N=15). Feature importance analysis was performed by leveraging multiple models, to identify strength of variables associated with decannulation success. Multivariable logistic regression showed left ventricle ejection fraction (coeff 0.14), pressors (coeff -0.12), pulsatility (coeff 0.08) and VA ECMO flow (coeff 0.05) prior to decannulation played a role in success. The ROC-AUC for LVEF alone was 0.57, however, incorporation of additional variables improved the predictive power with an ROC-AUC of 0.86 (Figure 1).

Conclusions:
Our findings accurately predict decannulation success and emphasize consideration of multiple factors impacting outcomes. Prospective validation of a composite score combining these variables is warranted.
Abstract 13516: Outcomes Among Heart Failure Patients Hospitalized for Infective Endocarditis: A United States National Cohort Study
Authors: Casipit Bruce Adrian , Idowu Abiodun , Al Sudani Hussein , Casipit Carlo , Lo Kevin Bryan , Khraisha Ola , Amanullah Aman M
Published: December 2023

Introduction:
We aim to investigate the impact of heart failure (HF) among hospitalized patients with infective endocarditis (IE) in terms of in-hospital outcomes including the risk for mortality, development of cardiogenic shock (CS) and certain arrythmias, as well as hospital length of stay (LOS).

Methods:
We queried the 2018-2020 United States National Inpatient Sample (NIS) Database in conducting this retrospective cohort study. We identified hospitalized adult patients greater than 18 years of age with HF and IE using appropriate ICD-10 CM codes. Those with HF were subsequently stratified into systolic and diastolic HF. A survey multivariable logistic and linear regression analysis was used to calculate adjusted odds ratios (ORs) for the outcomes of interest.

Results:
A total of 150,059 hospitalized patients with IE were identified in the years 2018-2020, of which 33.58% (50,390/150,059) had HF. The overall in-hospital mortality rate among hospitalized patients with IE is 12.13% (18,185/150,059). Among those with HF, the in-hospital mortality rate was significantly higher at 15.11% (7,614/50,390, p<0.001). Using a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, HF among hospitalized patients with IE increased the risk for adverse in-hospital outcomes. (Table 1)

Conclusions:
Our study showed that concomitant HF among hospitalized patients with IE increased the risk for in-hospital mortality, longer LOS, development of CS and certain arrythmias including atrial fibrillation, ventricular tachycardia, and ventricular fibrillation. This highlights the significant impact of HF as a potential predictor of worse outcomes among hospitalized IE patients.
Abstract 13542: Electrical Delay, LA Electromechanical Delay, and LA Volume Contribute to Increased LA Stiffness in Relatively Elderly Patients With Pulmonary Vein Isolation for Atrial Fibrillation
Authors: Sasaki Takuya , Okuda Shinichi , Nagai Hitoshi , Ueyama Takeshi , Ikeda Yasuhiro
Published: December 2023

Background:
Atrial dysfunction occurs after pulmonary vein isolation (PVI) for atrial fibrillation (AF), and some reports suggest that electrical conduction delay (ECD) via the Bachmann bundle could be a contributing factor. However, the relationship between ECD in the atria and LA function after PVI remains unclear. The LA reservoir strain (LARS) by speckle-tracking echocardiography (STE) is used to assess LA booster function, with a decrease indicating increased LA stiffness.

Purpose:
We aim to investigate ECD, LA electromechanical delay (LAEMD), and LA function in patients after PVI for AF.

Methods:
This single-center retrospective study included 74 patients (Mean age at 70.4 ± 9.1 years, 44 males, left ventricular ejection fraction (LVEF): 62.9 ± 6.8 %, LA volume index: LAVI 39.0 ± 10.8 ml/m
2
) who were in sinus rhythm at the echocardiographic examination. ECD on the ECG was defined as the presence of biphasic P waves, which were classified into those not observed (group A; n=42), those observed only in III lead (group B; n=23), and those observed in all lower wall leads (II, III, aVF) (group C; n=9). LAEMD was defined as the time interval between the top of the R wave on the ECG and the start of the late diastolic wave (a') on the tissue doppler imaging, and the lateral (a' lateral) and septum (a' septum) time differences (a’ sep-lat time) were calculated. To evaluate the LA function, two-dimensional STE was analyzed.

Results:
Mean observation period was 19.2 months after PVI. Groups B and C showed significant differences in a' sep-lat time compared to group A. LARS was markedly reduced in all groups (average: 19.0 ± 6.3). LARS and LAVI showed a significant difference between groups A and C. Multivariate analysis of factors leading to LARS showed correlations with a', E/e'.

Conclusion:
These results suggest that in relatively elderly post-PVI AF patients with preserved LVEF, the ECD and LAEMD as well as LAVI may affect LA function long after PVI and contribute to increased LA stiffness.
Abstract 13552: Prognostic Value of Modified Body Mass Index in Acute Decompensated Heart Failure Patients With Reduced, Mildly-Reduced and Preserved Left Ventricular Ejection Fraction
Authors: Yamada Takahisa , Watanabe Tetsuya , Morita Takashi , Kawasaki Masato , Kikuchi Atsushi , Kondo Takumi , Kawai Tsutomu , Nishimoto Yuji , Nakamura Jun , Fujita Takeshi , Taniichi Masanao , Chang Yongchol , Fukunami Masatake
Published: December 2023

Backgrounds:
Malnutrition is associated with poor outcome in patients with acute decompensated heart failure (ADHF). Although conventional body mass index (cBMI) and serum albumin level are commonly used as indicators of malnutrition, these variables are influenced by fluid balance, and it has been recently reported that the modified BMI (mBMI, serum albumin х cBMI) would be a better prognostic marker than cBMI and serum albumin level in ADHF patients. However, it remains unclear whether mBMI on admission or discharge would have more prognostic information in patients admitted with ADHF after the discharge, and there is no information available on the prognostic impact of mBMI in ADHF patients, relating to reduced (HFrEF), mildly-reduced (HFmrEF), and preserved left ventricular ejection fraction (HFpEF).

Methods and Results:
We studied 263 ADHF patients (HFrEF:n=103, HFmrEF:n=59, HFpEF:n=101) discharged with survival. We calculated mBMI on admission and discharge. During a follow up period of 5.1±4.3 yrs, 67 patients had cardiovascular death (CVD). AUC of mBMI at discharge (0.697[0.625-0.769]) was greater than that on admission (0.661[0.585-0.737], p=0.055). At multivariate Cox analysis, mBMI at discharge (adjusted hazard ratio 0.965[0.948-0.982], p<0.001) was significantly associated with CVD, independently of prior heart failure hospitalization, systolic blood pressure, eGFR and serum sodium level. Patients with lower mBMI (<median value=75.4) had an increased risk of CVD than those with higher mBMI (≥75.4) in all three subgroups (HFrEF: 43% vs 21%, p=0.013, HFmrEF; 32% vs 11%, p=0.025, HFpEF: 41% vs 12%, p=0.008).

Conclusion:
Modified BMI at the discharge might be better prognostic marker than that on admission and provides long-term prognostic information in patients admitted for ADHF, regardless of reduced, mildly-reduced or preserved left ventricular ejection fraction.
Abstract 13567: Comparison of Change in Lipoprotein(a) Mass and Molar Concentrations by Alirocumab and Risk of Subsequent Cardiovascular Events in ODYSSEY OUTCOMES
Authors: Szarek Michael , Reijnders Esther , Steg Philippe G , Jukema J W , Schwertfeger Markus , Bhatt Deepak , Bittner Vera A , Diaz Rafael , fazio Sergio , Garon Genevieve , Goodman Shaun G , Harrington Robert A , White Harvey D , Zeiher Andreas M , Cobbaert Christa , Schwartz Gregory G ,   ODYSSEY OUTCOMES Investigators
Published: December 2023

Background:
Baseline (BL) lipoprotein(a) (Lp(a)) concentration is similarly related to cardiovascular (CV) risk when measured in either mass or molar units by immunoassay (IA). Because of Lp(a) isoform variation in mass, differences may exist between Lp(a) measurement methods in terms of relating change to risk reduction. We determined whether the reduction in major adverse cardiovascular events (MACE) by PCSK9 inhibitor alirocumab (ALI) had a similar relationship to the reduction in Lp(a) concentration as measured by 3 different methods.

Methods:
Lp(a) was measured by IA-mass (Siemens), IA-molar (Roche), and mass spectrometry (MS)-molar assays at BL and month 4 (M4) in a subgroup of patients in the ODYSSEY OUTCOMES trial which compared PCSK9 inhibitor ALI with placebo in patients with recent acute coronary syndrome. Changes in Lp(a) from BL to M4 were related to subsequent risk of MACE (coronary heart disease (CHD) death, nonfatal myocardial infarction (NFMI), fatal + nonfatal ischemic stroke, or unstable angina hospitalization) in the ALI group. Proportional hazards models were adjusted for BL Lp(a), BL LDL-C and its change from BL to M4, and other patient characteristics. Hazard ratios (HR) were calculated for the median change of each Lp(a) assay. All analyses were by intention-to-treat.

Results:
Among 5500 patients randomized to ALI with available data from all 3 Lp(a) assays, 443 experienced a subsequent MACE. Changes in Lp(a) IA-mass and MS-molar concentration were significantly related to reduced MACE risk, while change in IA-molar concentration was marginally significant; associations were more evident with CHD death + NFMI (
Figure
). MACE HRs for median change were similar across tests.

Conclusion:
With caveats of a modest number of MACE for analysis, moderately elevated Lp(a) levels, and intra-patient variability in serial values, 3 Lp(a) assay methods appeared similarly predictive of ALI MACE reduction.
Abstract 13569: Impact of Intense Smartphone Application Based versus Routine Outpatient Follow-Up on Short Term Clinical Outcomes in Acute Decompensated Heart Failure (ADHF)
Authors: Singh Ajit Pratap , sethi rishi , Dwivedi Sudhanshu , Chandra Sharad , Pradhan Akshyaya
Published: December 2023

Introduction:
Heart failure (HF) poses a global health burden, with about 26 million people affected and an estimated health expenditure of US$31 billion worldwide . The outcome of HF patients with reduced ejection fraction (HFrEF) has improved significantly due to the availability of evidence-based therapies. Still, the readmission rates, and subsequent mortality, have remained unchanged in the last two decades. Despite immense positive evidence, < 25% of patients with HFrEF are on the appropriate target doses of medical therapy.

Objectives:
Impact of intense versus routine outpatient follow-up on clinical outcomes and patient satisfaction in Acute decompensated heart failure (ADHF) patients over a 3-month follow-up.METHODS: This is a prospective open-label randomized study analyzing readmission rates and achieving target doses of GDMT.

Results:
A total of 226 subjects (Intense smartphone application-based follow-up -112) (routine outpatient follow-up -114) were enrolled in the study. The mean age was 53 and 54 years in intense follow-up and routine follow up, respectively. Both study arms were well-matched and randomized. There was a significant reduction in rehospitalization rate in the intense follow-up arm (28 vs. 57) p - 0.005. Subjects on smartphone application-based follow-up had better drug compliance and a rapid escalation of GDMT to reach target doses.

Number of patients on target dose of GDMT at three months

Conclusion:
Intense smartphone application based follow-up was feasible and safe for ADHF patients. The incidence of 30-day and three months readmissions improved. They also showed improved BP, HR, and NT Pro-BNP levels. Drug dosages were up-titrated periodically in these subsets of patients based on their cardiac function and laboratory parameters. Newer apps should be designed to incorporate artificial intelligence (AI) with features more likely to improve key patient-reported and clinical outcomes.
Abstract 13657: Cholesterol Content of VLDL Particles and Incident Coronary Artery Calcification Among ELSA-Brasil Participants - A Metabolomic Approach
Authors: Tebar William , Meneghini Vandrize , Generoso Giuliano , Pereira Alexandre , Bittencourt Marcio , Santos Itamar S , Lotufo Paulo A , Bensenor Isabela M
Published: December 2023

Background:
Very-low density lipoproteins (VLDL) are the smallest and most atherogenic particles.

Research question:
The association of cholesterol content in VLDL particles with incident coronary artery calcification (CAC) is unclear.

Aim:
To analyze the association of VLDL cholesterol content with 5-year CAC status among ELSA-Brasil participants.

Methods:
Data from 832 participants (50.3±7.2 years, 50.4% women) free of cardiovascular disease and statin use were analyzed. The cholesterol content of VLDL lipoproteins were assessed by high-throughput proton Nuclear Magnetic Resonance metabolomics platform. CAC score was assessed by computed tomography at baseline and after 5-year follow-up, being classified as absent CAC (baseline and follow-up CAC=0), prevalent CAC (baseline CAC>0) and incident CAC (baseline CAC=0 and follow-up CAC>0). Distribution of cholesterol content were compared by U-Mann Whitney test according to CAC status. Generalized linear models compared cholesterol concentrations according to CAC status, adjusted by sociodemographic (age, sex, race, education, health insurance), lifestyle (physical activity, alcohol and smoking) and comorbidities (hypertension, diabetes, obesity and total cholesterol ≥200mg/dL).

Results:
CAC incident was 6.6% of sample (n=55), whereas 26.2% was CAC prevalent (n=218) and 67.2% was CAC absent (n=559). VLDL cholesterol concentrations in CAC incident participants were higher than those with CAC absent, but similar to those with CAC prevalent - Figure 1. Regression models showed higher concentrations of all lipids in CAC incident than CAC absent, but there was no difference between CAC incident and CAC prevalent. The associations remained beyond adjustment for sociodemographic and lifestyle factors, but lost significance after adjustment for comorbidities.

Conclusions:
This finding suggests a predictive role of VLDL cholesterol content for CAC incidence among ELSA-Brasil participants.
Abstract 13674: AIBP-Mediated Cholesterol Efflux Controls Lymphangiogenesis
Authors: KIM Jun-dae , Chaudhary Surbhi , Fang Longhou
Published: December 2023

Background:
Lymphangiogenesis give rise to lymphatic vessels that are essential for maintenance of tissue fluid homeostasis. Lymphatic vessel formation requires lymphatic endothelial cell (LEC) specification from the venous ECs and subsequent LEC proliferation and migration, all of which are regulated by the VEGFC/VEGFR3 signaling. Cholesterol is essential for cell functions and organ development yet the molecular mechanism by which it controls lymphangiogenesis is unknown.

Hypothesis:
In this study, we hypothesize the role of apoA-I binding protein (AIBP)-regulated cholesterol metabolism in lymphangiogenesis.
Aim:
We aim to dissect the role of AIBP mediated cholesterol efflux on caveolin-1 (CAV-1) disruption and its effect on VEGFC/VEGFR3 signaling and lymphangiogenesis.

Methods:
We utilized the mouse embryonic stem cell differentiation model to assess the role of AIBP-CAV-1-VEGFR3 axis in LEC fate determination. We used AIBP and CAV-1 knockout (KO) to assess the role of this signaling circuit in developmental lymphangiogenesis using zebrafish and in adult lymphangiogenesis using the mouse corneal lymphangiogenesis model. We used CAV-1 KO neonatal mice to study tail lymphangiogenesis.

Results:
We found that AIBP dictates lymphatic vessel formation by accelerating cholesterol efflux. Loss of Aibp2, the zebrafish paralog of human AIBP, impairs lymphangiogenesis. Recombinant AIBP protein induces mouse embryonic stem cell differentiation to LECs. Mechanistically, CAV-1 suppresses VEGFR3 activation, but cholesterol efflux by AIBP disrupts lipid rafts/caveolae and reduces CAV-1 bioavailability, which abolishes the CAV-1 inhibition of VEGFR3 signaling, thereby augmenting VEGFR3 activation in human LECs. Loss of CAV-1 increases LEC progenitor specification in zebrafish, and rescues lymphangiogenesis in Aibp2-deficient animals. CAV-1 KO neonatal mice significantly augmented tail lymphangiogenesis. Further, AIBP expression is reduced in the epidermis of human lymphedema.

Conclusion:
Our study elucidates a novel role of AIBP-mediated cholesterol efflux in lymphatic vessel formation and provides new therapeutic targets for the treatment of lymphatic dysfunctions.
Abstract 13725: Intravascular Ultrasound-Guided versus Angiography-Guided Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis
Authors: Kalsi Jasmeet K , Suffredini John , Koh Stephanie , Khalid Umair , Denktas Ali E , alam mahboob , Kayani Waleed T , Jia Xiaoming
Published: December 2023

Introduction:
Intravascular ultrasound (IVUS) provides intra-procedural guidance in optimizing percutaneous coronary interventions (PCI) and has been shown to improve clinical outcomes in stent implantation. However, current data on the benefit of IVUS during PCI in STEMI patients is mixed.

Research Question:
Whether IVUS is associated with improved outcomes during PCI in STEMI patients is unclear.

Aim:
We performed a systematic review and meta-analysis assessing the utility of IVUS during PCI in the setting of STEMI.

Methods:
We performed a systematic search on PubMed and Embase for studies comparing IVUS versus angiography guided PCI in STEMI. Mantel-Haenszel random effects model was used to calculate risk ratios (RR) with 95% confidence intervals (CI) for outcomes of major cardiovascular adverse events (MACE), death, myocardial infarction (MI), target vessel revascularization (TVR) and stent thrombosis (ST). Analysis was performed using Review Manager version 5.4.1.

Results:
A total of 7 studies including 78,612 individuals presenting with STEMI were included for the meta-analysis. Follow-up ranged from 11 to 60 months. We found a significant association between IVUS-guided PCI with lower risk for MACE (RR 0.82, 95% CI 0.76-0.90) compared with angiography-guided PCI. We also found significant association between IVUS-guided PCI with lower risk for death, MI, and TVR but not ST (Figure 1).

Conclusion:
In our meta-analysis, IVUS-guided compared with angiography-guided PCI was associated with improved clinical outcomes in STEMI patients.