bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12817: Experimental Analysis of Bicuspid Aortic Valve Hemodynamics: Effect of Mild Aortic Dilatation on Systolic Flow Characteristics
Authors: Hattori Kaoru , Nakama Natsuki , Jumpei Takada , Kawasaki Eita , Hamada Kohei , Nagao Michinobu , Goto Yasuhiro , Niinami Hiroshi , Iwasaki Kiyotaka
Published: April 2022

Introduction:
Aortic diameter is a determinant index in deciding surgical intervention for aortic aneurysm with bicuspid aortic valve (BAV). However, the treatment of a mildly dilated ascending aorta remains controversial. We experimentally investigated influence of mild dilatation of the ascending aorta on BAV-related hemodynamics in 3 BAV morphologies.

Methods:
An MRI-compatible pulsatile flow circulation system incorporating an aortic valve model and aortic arch model was developed. Tricuspid aortic valve (TAV) and 3 asymmetric BAV models including RL-, RN-, and LN-BAV were constructed by suturing bovine pericardium as cusps to aorta. The aortic arch models with the ascending diameters of 30 mm (non-dilatation) and 40 mm (mildly dilatation) were compared. Streamlines and the circulations (m
2
/s) of peak systolic flow in non- and mildly dilated ascending aorta were assessed using 4D-flow MRI in each BAV morphology (Fig).

Results:
Streamlines showed eccentric aortic valvular outflow jets impinging on the outer curvature of the ascending aorta, proximal arch, and left-anterior supra-valvular aortic wall in RL-, RN-, and LN-BAV, respectively. Regardless of the non-dilated or mildly dilated aorta, the circulations of peak systolic flow were larger in the BAVs than the TAV model (non-dilated aorta, TAV 0.005; RL- 0.016; RN- 0.026; LN-BAV 0.011 m
2
/s, mildly dilated aorta, TAV 0.009; RL- 0.017; RN- 0.028; LN-BAV 0.025 m
2
/s). Right-handed rotation was observed in RL- and RN-BAV, whereas LN-BAV presented left-handed rotation. In LN-BAV, the circulation markedly increased in the mildly dilated ascending aorta.

Conclusions:
Asymmetric BAV morphology was associated with highly eccentric aortic valvular outflow jet that directly impinged on the aortic wall, and the large circulation of peak systolic flow. The dilatation of the ascending aorta, even mild dilatation, might induce further increase in the circulation of systolic flow, especially in LN-BAV morphology.
Abstract 12824: Culprit Plaque Morphology and Healing Capacity in Patients With and Without Pre-Infarction Angina: An Optical Coherence Tomography Imaging Study
Authors: Vergallo Rocco , Ricchiuto Alfredo , Francesco Ridolfi , Lombardi Marco , Maino Alessandro , Buonpane Angela , Bianchini Emiliano , Galli Mattia , Domenico D'Amario , Montone Rocco , Leone Antonio Maria , aurigemma cristina , Romagnoli Enrico , Buffon Antonino , Burzotta Francesco , Trani Carlo , crea Filippo
Published: April 2022

Introduction:
The relationship between culprit plaque morphology, healed culprit plaques prevalence and clinical presentation of acute myocardial infarction (AMI) remains largely unexplored.

Hypothesis:
We hypothesized that pre-infarction angina (PIA) may reflect a distinct morphologic phenotype of culprit plaques and a different healing capacity.

Methods:
We conducted a retrospective observational study in patients with AMI who underwent intracoronary optical coherence tomography (OCT) imaging of the culprit lesion before PCI at the Fondazione Policlinico Gemelli-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome. Based on the clinical history, patients were classified into 2 groups: i) PIA group, defined as either intermittent chest pain within 6 hours preceding the final episode of chest pain, or unstable angina (or both) in the week preceding AMI; or ii) no-PIA group, defined as a single episode of chest pain without prodromal symptoms in the preceding week. Culprit plaques were classified as plaque rupture (PR) or intact fibrous cap (IFC), and presence of layered appearance (healed plaque, HP) was assessed. Thrombus burden (TB) was estimated, and prevalence of diffuse calcification, neovascularization, and OCT-defined macrophage accumulation were evaluated.

Results:
A total of 102 patients with AMI were included (50 PIA, 52 no-PIA). Patients with PIA showed a higher prevalence of IFC than PR (58% vs 42%, p=0.030). PR in patients with PIA were more frequently associated with macrophage accumulation (71.4% vs 28.6% p=0.001), and TB tended to be lower [22.0 (15.8-30.3) vs. 38.5 (12.8-67.5), p=0.145]. Diffuse calcifications were significantly less frequent in patients with PIA (22.0% vs. 40.4%, p=0.045), while neovascularization tended to be more frequent (58.0% vs. 42.3%, p=0.113). HPs prevalence was significantly higher in the PIA than in the no-PIA group (66.0% vs 25.0%, p<0.001).

Conclusions:
Patients with PIA have a distinct culprit plaque phenotype, more frequently characterized by IFC and a relatively lower TB, with a significantly higher prevalence of plaque healing.
Abstract 12832: Yield From Family Screening in a National Adolescent Cardiac Screening Program
Authors: Abela Mark , Debattista Jessica , Scerri Jeanesse , YAMAGATA KENTARO , Tiziana Felice , Zammit Burg Melanie R , Sammut Mark A , Xuereb Robert G , Grech Victor , Scerri Christian , monserrat lorenzo I , Papadakis Michael
Published: April 2022

Introduction:
Cascade family screening in inherited heart disease is often reserved for probands with a clinical diagnosis. This study assessed the yield of family screening in a national cardiac screening program, comparing a clinical and a clinical/genetic screening algorithm.

Methods:
2708 teens (14-16 years) participated in a national cardiac screening program. Probands with suspected or confirmed inherited cardiac disease were evaluated clinically and genetically (216 cardiac gene panel). Relatives were subjected to a standard clinical screening protocol. Segregation analysis (Sanger sequencing) was performed in families with gene positive (G+) probands (VUS, likely or definite pathogenic mutations as per ACMJ criteria). Cascade screening was limited to a) first degree relatives and/or b) G+ individuals in the presence or absence (not exceeding two generations) of a clinical phenotype. A standard clinical algorithm (family screening in probands with a pre-clinical or clinical diagnosis) was compared with a genetic lead algorithm.

Results:
2(0.1%) probands were diagnosed with a cardiac phenotype (n=1 HCM, n=1 LQTS). Another 17(0.6%) probands had evidence of pre-clinical disease. 81 relatives (60.5% female) underwent evaluation, mean age 41.1±16.7 at first evaluation. 11 families (57.9%) were G+. 54(66.7%) were first degree relatives. 12(14.2%) were screened because of a phenotype in the proband, 57(70.4%) because of a pre-clinical ECG. Another 12(14.8%) were screened because of the family genotype, translating into a 7.4% higher referral rate. The diagnostic yield was higher in the presence of a proband phenotype (41.7% vs 4.3%, p=0.001). Using a standard clinical algorithm, the diagnostic yield of family screening was 10.1% (n=2 HCM, n=5 LQTS). Adding genetics to the algorithm identified another individual (n=1 DCM), equating to a mildly decreased overall yield of 9.9%. The yield between both algorithms was not significantly different (p=0.956).

Conclusion:
The yield of family screening in probands with a pre-clinical phenotype or clinical diagnosis was 10.1%. This was similar (9.9%) when incorporating genetic testing in the algorithm. The added benefit of systematic genetic testing in a family screening program is limited.
Abstract 12845: Use of IABP as a Bridge to Transcatheter Mitral Valve Edge-to-Edge Repair in a Patient With Pre and Post Capillary Pulmonary HTN
Authors: Gaznabi Safwan , Balasubramanian Senthil S , Paz Rios Luis H , Ricciardi Mark J , Gordon Robert
Published: April 2022

An 83 yr old male with history of HLD & prior tobacco use presented with worsening dyspnea for the last 6 month and PND. Physical examination revealed BP 150/100 mmHg, holosystolic murmur in left 2nd intercostal space, diastolic murmur at the apex, decreased bibasilar lung sound & left leg swelling. CXR demonstrated cardiomegaly without evidence of pulmonary edema. ECG showed sinus rhythm with left atrial enlargement. Labs were remarkable for proBNP: 6,886 pg/mL and D dimer: 1.99 mg/L. Echocardiogram showed LV EF of 61%, dilated left atrium, severe mitral regurgitation (MR) with P2 focal cord rupture and moderate pulmonary hypertension (pHTN). He underwent a CT scan of his chest which revealed small right pulmonary embolism. He underwent cardiac catheterization which revealed mild CAD, increased left ventricular filling pressures (20 mmHg) severe pHTN without response to inhaled nitric oxide, PVR: 14 woods units, SVR: 2575 dynes/seconds/cm5, transpulmonary gradient: 41 mmHg & cardiogenic shock with cardiac output (CO) 2.77 and Cardiac Index (CI) 1.4. He was diuresed, started on milrinone, endothelin receptor antagonist (macitentan) and later guanylate cyclase stimulator (riociguat). Days later he underwent insertion of an IABP for afterload optimization & repeat hemodynamics showed normalized intracardiac filling pressures & improvement of cardiac index and SVR. The next day the patient underwent successful transcatheter mitral edge-to-edge repair (TEER). Echocardiogram showed mild MR with mean trans-mitral gradient of 5mmHg & RVSP of 47 mmHg. IABP was removed the next day and he returned home within a week of TEER. There is a paucity of data for the use of IABP in acute MR in the setting of mixed precapillary and post capillary pHTN which necessitates the use of endothelin receptor antagonist and guanylate cyclase stimulator as a bridge to TEER. Our case demonstrates the importance and success of a multidisciplinary strategy in this complex valvular cardiac condition.
Abstract 12846: Sleep Quality and Cardiac Structure and Function in Individuals With Heart Failure With Preserved Ejection Fraction
Authors: Mathews Lena , Yanek Lisa R , Hays Allison G , Sharma Kavita , Shah Sanjiv J , St-Onge Marie-Pierre , Ouyang Pamela
Published: April 2022

Introduction:
Sleep disorders are associated with heart failure. The association of cardiac dysfunction with abnormalities in sleep have not been clearly elucidated. We examined the association of cardiac structure and function on echo with sleep patterns in participants with stable heart failure with preserved ejection fraction (HFpEF).

Hypothesis:
Greater cardiac abnormalities would be associated with greater impairments in sleep quality in HFpEF.

Methods:
We recruited participants with compensated HFpEF. We used 14-day actigraphy to measure night-time sleep quality (latency, efficiency, awake after sleep onset, movement and fragmentation) and quantity (sleep duration). We examined cardiac structure: (left ventricular diastolic diameter [LVDD], volume [LVEDVI], left ventricular mass index [LVMI]); function (ejection fraction, global longitudinal strain [GLS], E/e’ ratio, E/A ratio, left atrial volume index, mitral annular velocity e’, tricuspid regurgitation velocity). Associations between sleep and echo parameters were examined using linear regression adjusted for age, sex, race and body mass index (BMI).

Results:
Among 47 study participants, 40% were Black, 72% were women, with mean age 65(11 SD) years. Cardiac abnormalities and sleep duration were not associated. Higher LVMI was associated with higher night fragmentation (ß coefficient and 95% confidence intervals 0.95 [0.16-1.74]). Higher average E/e’ was associated with higher night movement (2.62 [0.55-4.70]), and sleep fragmentation (2.61 [0.36-4.87]). Measures of systolic function were not associated with sleep abnormalities.

Conclusions:
In HFpEF, greater abnormalities in cardiac structure (LV mass) and diastolic function (higher E/e’) were associated with more restless sleep. Our findings suggest a relationship between sleep quality and cardiac dysfunction in patients with HFpEF. Future research is needed to assess the directionality of this association.
Abstract 12847: Left Atrial Cardiac Angiosarcoma: A Systematic Review of Case Reports
Authors: Sachdeva Sonali , Patel Nirmit , Gupta Sneha , Isufi Mimoza , SAEED TAHA , Dalal Shivani , Manaktala Pritika , NANDWANA VARSHA , Vyas Ankit , Desai Rupak
Published: April 2022

Background:
Primary cardiac angiosarcoma is a rare endothelial cell tumor, most commonly (78-93%) found in the right atrium. However, rare instances of left atrial angiosarcoma have been noted with varied clinical presentation and fatal prognosis.

Methods:
A systematic search using PUBMED, SCOPUS and WEB OF SCIENCE was undertaken to identify case reports on left atrial angiosarcomas through June 2021. The data on patient demographics, presentation, diagnostics imaging, management, and outcomes were analyzed using descriptive statistics.

Results:
Of 19 case reports
(Table 1)
, left atrial angiosarcoma was more prevalent among females (63%, 12/19). The mean age of cases was 59.26± 12.21 years. Progressive exertional dyspnea (11/19, 58%) and chest pain (5/19, 26%) were the most common presenting symptoms. Myocardial ischemia was the initial presentation in 11% of cases (2/19), congestive heart failure in 26%(5/19) while cerebrovascular events were reported in 11% of cases (2/19). Transesophageal echocardiography and transthoracic echocardiography were the mainstay imaging modalities used for diagnoses. Most cases were diagnosed intraoperatively (16/19, 84.2%) with one case being diagnosed through skin biopsy of a cutaneous metastatic nodule
(Table 2)
. Surgical excision followed by chemotherapy was the treatment of choice in most cases. With 26% (5/19) metastatic prevalence, death was reported in 58% of the patients (11/19).

Conclusions:
Primary left atrial cardiac angiosarcoma remains an elusive diagnosis with nonspecific constitutional symptoms. Even with advanced diagnostic modalities, the tumor is mostly detected at an advanced and incurable stage with a grave prognosis and high mortality rate. A deeper understanding of the spectrum of clinical presentation with a high index of suspicion can help clinicians in early diagnosis, which is imperative to prolonged survival.
Abstract 12849: Invasive Assessment of Hemodynamic Effect of Ivabradine in Post ST Segment Elevation Myocardial Infarction Associated Sinus Tachycardia
Authors: Kumar Sharma Akhil , Dwivedi Sudhanshu K , singh amit K , Chaudhary Gaurav K , Chandra Sharad , Sethi Rishi , Pradhan Akshyaya , Vishwakarma Pravesh , Bhandari Monika , Shukla Ayush , Singh Abhishek
Published: April 2022

Introduction:
Post MI tachycardia is associated with increase in cardiac morbidity and mortality. We aimed to assess efficacy and safety of ivabradine to control heart rate in post MI tachycardia patients in whom beta-blockers were intolerant.

Hypothesis:
We hypothesized that ivabradine in post MI tachycardia patients effectively control heart rate without deteriorating effects on hemodynamics.

Methods:
STEMI patients with sinus tachycardia (heart rate >120/min) who had intolerance to beta blocker were enrolled. Important exclusions were cardiogenic shock, second /third-degree atrioventricular block, Killip class III/ IV. Patient’s invasive hemodynamic parameters such as MAP (Mean Arterial Pressure), iSV (indexed Stroke Volume), CVP (Central Venous Pressure), cardiac output and cardiac index were measured with help of Edwards LifeSciences Flotrac monitor. Patients received ivabradine till heart rate control (<100/min.) was achieved. The primary objectives were to study ivabradine efficacy to achieve target heart rate, and its effects on hemodynamic parameters and secondary objectives were to assess any adverse events.

Results:
Mean age was 52.7 ± 9.8 years and 29 (81%) were male. At enrolment, mean heart rate, MAP, iSV and CVP was 128.92±3.3bpm, 87.31±10.46mmHg, 28.19±7.85ml/m
2
, 6.35±2.61 mmHg respectively. At target heart rate ≤1oo/min (mean 96.57±5.29bpm), MAP, iSV and CVP were 82.71±13.70 mmHg (P=0.559), 1.11±6.33ml/m
2
(P=0.087) and 7.7±2.54 mmHg (P=0.122) showed no significant changes. However, cardiac output and cardiac index dropped to 5.22± 1.00 L/min (P=0.005) and 2.96±0.60 L/min/m
2
(P=0.005) but within physiological limits. None of the patient reported hypotension, arrhythmia, heart failure or in-hospital mortality.

Conclusions:
Invasive hemodynamic evaluation showed oral ivabradine is effective and safe alternative to control heart rate in uncomplicated post MI sinus tachycardia patients who had intolerance to beta-blockers.
Abstract 12850: The Effect of Regionalization on End-of-Life Hospitalizations for Adult Congenital Cardiology Patients
Authors: Bui Christine M , Saynina Olga , chamberlain lisa , Wise Paul , Fernandes Susan M
Published: April 2022

Introduction:
Adult congenital heart disease (ACHD) patients may have shortened life expectancy due to complications of interventions and accrued comorbidities. Specialized ACHD care has become standard of care. The effect of regionalization on ACHD patient death is not known.

Methods:
The Office of Statewide Health Planning and Development database identified ACHD patients ≥ 18 years who died in California hospitals from 1995 - 2018. Specialized ACHD centers were self-designated, so high and low ACHD surgical volume centers were also compared.

Results:
Of 3,724 patients, when comparing by volume, more deaths occurred at low (85.2%) than high volume centers (14.8%); when comparing by specialization, more deaths occurred at non-ACHD (78.8%) than ACHD centers (21.2%). Moderate (9.4%) and high complexity (4.4%) lesions were rare. Common causes of death were sepsis (14.6%), myocardial infarction (9.3%), stroke (7.5%), and heart failure (7.1%). High volume centers were more likely the location of death than low volume centers for patients aged 18-64, with private insurance, and who lived >20 miles away (p <0.0001 for all). These held true for ACHD vs non-ACHD centers (p <0.0001 for all). Low volume centers were more likely the location of death than high volume centers for patients from zip codes with relative poverty (p 0.0243). This held true for non-ACHD vs ACHD centers (p 0.0182).

Over 24 years, the proportion of patients dying at ACHD centers increased (Figure 1), while the proportion of patients dying at high volume centers decreased.

Conclusion:
ACHD patients who die at high surgical volume and ACHD self-designated centers are more likely to be young, have private insurance, be referred to centers far from home, and have higher socioeconomic status. These likely reflect disparities in access to specialized ACHD care. Despite regionalization with an increase in specialized ACHD centers over time, the majority of ACHD patients continue to die at non-specialized centers.
Abstract 12856: Novel Four-Dimensional Ultrasound Metric Improves Detection of Heart Failure Progression in Hypertrophic Cardiomyopathy
Authors: Damen Frederick W , Salvas John P , Pereyra Andrea S , Ellis Jessica M , Goergen Craig J
Published: April 2022

Introduction:
Progression to heart failure is a known consequence of longstanding hypertrophic cardiomyopathy (HCM); however, routine function markers such as ejection fraction (EF) are often inadequate to predict dysfunction progression. The objective of this abstract was to create a novel metric, the Hybrid Strain Index (HSI), that can provide better characterization of heart failure progression. We hypothesized that longitudinal changes in a mouse model with known cardiac dysfunction could be more accurately differentiated with HSI than EF.

Methods:
Longitudinal 4D ultrasound (4DUS) data from mice with hypertrophic cardiomyopathy secondary to cardiac deletion of the carnitine palmitoyltransferase 2 enzyme (

Cpt2
M-/-

; n=12) and littermate controls (n=14) were analyzed using a custom MATLAB toolbox that derived both global volumetric (e.g., EF) and regional kinematic (e.g., circumferential and longitudinal strain) measurements. The circumferential and longitudinal regions most sensitive to disease progression were identified as the base (E
θθ
) and posterior-wall (E
LL
), respectively. The HSI metric was then calculated as the L2 norm of those peak-strain values.

Results:
To identify the earliest age of deviation between

Cpt2
M-/-

and controls, 95% confidence intervals from linear regression through HSI values intersected at 5.7 weeks old, compared to 7.1 weeks old using EF, suggesting HSI provides earlier sensitivity to cardiac dysfunction. Additionally, area-under-curve (AUC) measurements from ROC analysis of each metric, regardless of age, showed greater differentiation between cohorts using HSI (AUC = 0.91) than EF (AUC = 0.84). This further suggests enhanced diagnostic value of HSI compared to EF in the setting of cardiac dysfunction.

Conclusions:
The proposed HSI metric demonstrated greater sensitivity to detecting cardiac dysfunction and disease progression, compared to EF, in a mouse model of hypertrophic cardiomyopathy (

Cpt2
M-/-

).
Abstract 12859: Tissue Doppler Derived Biphasic Velocities During the Pre and Post-Ejection Phases: Patterns, Concordance and Hemodynamic Significance in Health and Disease
Authors: Omar Alaa M , Ronderos Botero Diana M , Arreaza Caraballo Javier , Kim GaHee , Khachatoorian Yeraz , Kliewer Jaclyn , Abdel Rahman Mohamed A , Rifaie Osama A , Bella Jonathan N , Argulian Edgar , Contreras Johanna P
Published: April 2022

Introduction:
Pre-(PRE) and post-ejection (POE) velocities by mitral annular tissue Doppler (TD) are biphasic and may be related to myocardial deformations. We investigated the predominance and concordance of TD-PRE and POE velocities and their effect on myocardial functions in controls and in HF patients.

Methods:
Retrospectively, 84 HF patients [57.6±8 years, 28(33%) females, NYHA: 2.3±0.6, EF: 55±15%, 52(62%) preserved EF, and 32(38%) reduced EF], 42 normal young controls [27±4 years, 5(12%) females], and 26 asymptomatic age matched controls without cardiac abnormalities [53±12 years, 28(65%) females] were included.

Results:
While controls had almost always predominantly positive PRE and negative POE, HF had more negative PRE (Controls: 2%, HFpEF: 10%, HFrEF: 35%, p<0.001) and positive POE (Controls: 4%, HFpEF: 33%, HFrEF: 74%, p<0.001). Moreover, almost all controls exhibited normal concordance (positive PRE and negative POE). HF exhibited more abnormal concordance (Figure 1A,C) which was significantly associated with worse NYHA, and parameters of diastolic and systolic functions. Opposite PRE and POE velocities correlated significantly in all groups (PREp vs POEn: young:r=0.52, p<0.001, age controls:r=0.79, p<0.001, HFpEF: r=0.56, p<0.001, HFrEF: r=0.42, p=0.018; PREn vs POEp: young: r=0.25,p=0.1, age controls: r=0.42, p=0.04, HFpEF: r=0.43, p=0.004, HFrEF: r=0.61, p<0.001) and the ratios PRE-P/N and POE-N/P correlated significantly with E/e’ in HF only (Figure 1B).

Conclusions:
In physiological state, TD signals are predominantly positive during PRE and negative during POE. Opposite PRE and POE velocities corelate, representing the PRE-generation and POE-reversal of shortening-stretch relationships, the attenuation of which in HF may be related to elevated LV filling pressures. In HF, partially or completely reversed concordance of PRE and POE is associated with progressive worsening of clinical and hemodynamic profiles.
Abstract 12860: Effects of Marine Omega-3 and Vitamin D Supplementation on Circulating Biomarkers of Glucose-Insulin Homeostasis and Incident Cardiovascular Disease in the Vitamin D and Omega-3 Trial (VITAL)
Authors: Qian Frank , Guo Yanjun , Gibson Heike , Gomelskaya Natalya , Liu Yanyan , Demler Olga , Cook Nancy R , Lee I-min M , Buring Julie E , Larsen Julia A , Boring Jennifer , Mcphaul Michael J , Manson Joann E , Pradhan Aruna D , Mora Samia
Published: April 2022

Introduction:
Dysglycemia and insulin resistance increase cardiovascular disease (CVD) risk. Associations between specific glucose-insulin biomarkers and CVD have been inconsistent.

Hypothesis:
We hypothesized that higher insulin, C-peptide, insulin resistance score (IRS), and HbA1c are associated with incident CVD and coronary heart disease (CHD) events and that both vitamin D and omega-3 fatty acids (n-3 FA) would improve these biomarkers and attenuate their risks with CVD.

Methods:
VITAL (NCT01169259) was a 2x2 factorial design RCT testing vitamin D (cholecalciferol, 2000 IU/d) and n-3 FA (EPA+DHA, 1 g/d) for the primary prevention of CVD. Incident CVD cases [non-fatal myocardial infarction (MI), non-fatal stroke, or CV death] were matched 1:1 on age and sex to healthy controls (n=715 CVD pairs including 423 CHD [MI, revascularization, CHD death] pairs). Conditional logistic regression adjusting for demographics, CV risk factors, and randomized treatment was used to assess the adjusted odds ratio (aOR) and 95% CI between baseline levels of insulin, C-peptide, IRS (Insulinх0.0265+C-peptideх0.00511+Creatinineх-3.2641), and HbA1c with risk of CVD and CHD events. In control participants, we examined the randomized effects of vitamin D or n-3 FA on changes in these biomarkers at 1- or 2-years follow-up.

Results:
Mean age of participants was 71 years, approximately 42% were female, and 12% were African American. Baseline insulin, C-peptide, and IRS were not associated with CVD (
Figure 1
). HbA1c was associated with CVD risk, aOR (95% CI) per SD increment, 1.17 (1.01, 1.38). Of the 4 biomarkers, only IRS was associated with CHD risk, aOR (95% CI): 1.22 (1.01, 1.46). Randomization to vitamin D or n-3 FA did not modify levels of these biomarkers or their associations.

Conclusions:
HbA1c was significantly associated with CVD risk, whereas IRS was associated with CHD risk. Neither vitamin D nor n-3 FA appreciably modified these biomarker levels or their risk associations.
Abstract 12869: Left Atrial Contractile Strain Predicts Recurrence of Atrial Tachyarrhythmia After Catheter Ablation
Authors: Nielsen Anne B , Skaarup Kristoffer G , Djernæs Kasper , Hauser Raphael , Estepar Raul S , Sørensen Samuel K , Ruwald Martin H , Hansen Morten L , Worck René H , Johannesen Arne , Hansen Jim , Biering-Sørensen Tor
Published: April 2022

Background:
Despite improvement in treatment strategies of atrial fibrillation (AF), a considerable number of patients still experience recurrence of atrial tachyarrhythmia (ATA) following catheter ablation (CA). We hypothesized that baseline myocardial impairment of the left atrium (LA) is useful in identifying patients at high risk of ATA recurrence.

Methods:
This retrospective study included 921 patients with AF who underwent CA. Echocardiography including two-dimensional speckle tracking echocardiography (2DSTE) was performed in all patients prior to CA. Logistic regression analysis was used to assess the association between ATA recurrence and peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS), and left atrial conduit strain (LACS).

Results:
During one-year follow-up, 375 (41%) experienced ATA recurrence. The median age of the included study population was 63.5 years (IQR: 55.6, 69.6) and 665 (72%) were male. Patients with recurrence had lower PALS (19.6% vs. 22.0%, p=0.004) and PACS (10.7% vs. 12.4%, p < 0.001). No difference in LACS was observed. After adjusting for potential clinical and echocardiographic confounders PALS (OR = 1.04, CI95% [1.01; 1.06], p = 0.011, per 1% decrease) and PACS (OR = 1.06, CI95% [1.02; 1.11], p = 0.007, per 1% decrease) remained independent predictors of recurrence. However, in patients with a normal-sized LA (LA volume index < 34 mL/m
2
), only PACS remained an independent predictor of recurrence (OR = 1.06, CI95% [1.01; 1.12], p = 0.013, per 1% decrease). Figure 1 displays the increasing risk of recurrence with decreasing PALS, PACS, and LACS.

Conclusion:
In patients undergoing CA for AF, LA deformation analysis by 2DSTE could be of use in risk stratification in clinical practice regarding ATA recurrence, even in patients with a normal-sized LA.
Abstract 12874: Impact of Calcified Nodule in Patients Undergoing Rotablator Atherectomy
Authors: Pengchata Ploy , Wongpraparut Nattawut , Wongsawangkit Namthip , Pongakasira Rungtiwa
Published: April 2022

Introduction:
Impact on clinical outcome of the patient with calcified nodule remain unknown. Calcified nodule may cause suboptimal stent expansion, stent mal-apposition.

Hypothesis:
We hypothesized that the presence of calcified nodule in the heavy calcified lesion undergoing rotablator atherectomy (RA) assisted percutaneous coronary intervention (PCI) increased device-oriented composite endpoint (DoCE).

Methods:
We retrospective reviewed consecutives patient with heavy calcified lesion underwent RA assisted intravascular ultrasound (IVUS) guidance PCI between August 2016-April 2020. Pre-procedural IVUS imaging was mandatory. Calcified nodule was defined as convex shape of luminal surface and luminal side of calcium with protruding in the coronary artery lumen that assessed by IVUS. Primary outcome was cumulative 5-year composite device-oriented composite endpoint (DoCE), define as composite of CV death, myocardial infarction and clinically-driven target lesion revascularization (CDTLR).

Results:
Two-hundred consecutives patient with heavy calcified lesion underwent RA assisted intravascular ultrasound (IVUS) guidance PCI was enrolled. Calcified nodule was found in 87 patients (43.5%) with heavily calcified lesions. Cumulative 5-year DoCE was significantly higher in the presence of calcified nodule group than in the non-calcified nodule group (20.7% vs 8.8%, P=0.02). Calcified nodule group has the higher incidence of under-expansion and asymmetrical expansion of stent. The patient who had calcified nodule with eccentric calcification has significantly higher cumulative 5-year DoCE compared to calcified nodule with concentric calcification (p<0.01).

Conclusions:
The presence of calcified nodule in the heavily calcified lesion underwent RA assisted PCI increased with cumulative 5-year DoCE.
Abstract 12890: Prognostic Value of Relative Flow Reserve by Hybrid
13
N-ammonia Positron Emission Tomography/Magnetic Resonance Imaging in Coronary Artery Disease
Authors: Endo Keiichiro , Kiko Takatoyo , Shimizu Takeshi , Takayoshi Yamaki , Kunii Hiroyuki , Nakazato Kazuhiko , Takeishi Yasuchika
Published: April 2022

Background:
13
N-ammonia PET has been used to evaluate myocardial blood flow (MBF) and coronary flow reserve (CFR) quantitatively. Relative flow reserve (RFR) was defined as the ratio of hyperemic MBF in a stenotic area to hyperemic MBF in a normal perfused area. The aim of this study was to examine the prognostic value of RFR in patients with coronary artery disease (CAD).

Methods:
We enrolled consecutive 66 patients with suspected CAD who underwent hybrid
13
N-ammonia PET/MRI. Under vasodilator stress with intravenous injection of adenosine, MBF and CFR were calculated from dynamic acquisition of
13
N-ammonia PET. RFR was calculated as the ratio of hyperemic MBF of a stenotic myocardial area to hyperemic MBF of a non-stenotic reference vascular territory. MRI images were simultaneously acquired with PET. Left ventricular ejection fraction (LVEF) was calculated from cine mode MRI. The end points were defined as composite of all-cause death, sustained ventricular arrhythmia, hospitalization due to decompensated heart failure and coronary artery revascularization.

Results:
Over the median follow-up of 3.6 ± 1.3 years, there were 22 (33.3%) adverse cardiac events. Kaplan-Meier analysis demonstrated lower event free rates in patients with CFR < 2.0 (P < 0.01, Figure A) and RFR < 0.81 (P = 0.022, Figure B), but not in those with stress MBF < 1.34 (P = 0.295) and stress LVEF < 55% (P = 0.187). Univariate Cox regression analysis showed that abnormal RFR (< 0.81) was significantly associated with adverse events (HR 3.72, 95% CI 1.21-18.01, P = 0.02).

Conclusion:
RFR is a useful marker to predict cardiac adverse events in patients with CAD. It would be an alternative approach to perform only stress scan without rest scan to reduce radiation exposure and scan time.
Abstract 12893: Early- and Delayed-Afterdepolarizations as Cellular Promoter of Ventricular Fibrillation in Hypertrophic Cardiomyopathy
Authors: Santini Lorenzo , Coppini Raffaele , ZOCCHI CHIARA , Ferrantini Cecilia , Olivotto Iacopo , Cerbai Elisabetta
Published: April 2022

Introduction:
Hypertrophic cardiomyopathy (HCM) represents the main cause of sudden cardiac death (SCD) due to ventricular fibrillation in young adults. Recent data suggest that enhanced cellular automaticity as early- and delayed-afterdepolarizations (EADs and DADs) could represent a major trigger of arrhythmogenesis in HCM.

Hypothesis:
To deeper understand the cellular mechanisms of arrhythmogenesis and to establish an arrhythmic rysk stratification in HCM patients, we performed a translational and retrospective study in 61 HCM patients who underwent surgical interventricular-septum myectomy to relieve refractory obstruction-related symptoms, combining a clinical follow-up study with in vitro assessment of ventricular myocyte arrhythmogenicity.

Methods:
At the time of surgery, fresh ventricular tissue was collected and used to isolate single ventricular cardiomyocytes, which were then used to perform patch clamp experiments, to assess the occurrence of EADs and DADs. HCM patients were followed up for a median time of 8 years, monitoring the occurrence of non-sustained ventricular tachycardia (NSVT) or life-threatening arrhytmic events (LAE, including sustained VT and VF).

Results:
Our data show that EADs occurred in 36% of patients (22/61) and were correlated to a prolongation of action potential duration (due to larger I
Nal
and I
CaL
density), while DADs occurred in 27% of patients and were associated to an impairment of Ca
2+
handling. During follow up, NSVT events occurred in 19/62 patients, while LAE occurred in 4/62 patients (combined occurrence 37%). Moreover, patients with NSVT/LAE were more likely to show specific "pro-arrhythmic" ECG-patterns. The occurrence of NSVT/ LAE was strongly associated with the presence of DADs in cells but not with the presence of EADs. Interestingly, the occurrence of DADs in cells was also associated with the presence of "proarrhythmic" ECG-patterns.

Conclusions:
The presence of cellular triggers as DADs, related with changes of ion channels and intracellular calcium homeostasis, appear to be necessary for arrhythmia generation in HCM. Such pro-arrhythmic changes seem to be linked with specific alterations at ECG level, that might be used as clinical arrhythmia predictors in HCM patients.
Abstract 12895: Superior Effectiveness and Safety of Ticagrelor in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A Nationwide Registry-Based Study
Authors: Godtfredsen Sissel Johanne , Pareek Manan , Leutscher Peter , Hylgaard Jørgensen Steen , Butt Jawad , Gislason Gunnar , Kober Lars , Fosbøl Emil , Bhatt Deepak L , Torp-Pedersen Christian , Kragholm Kristian
Published: April 2022

Introduction:
Dual antiplatelet therapy with aspirin and a P2Y
12
inhibitor is recommended following PCI for ACS. The optimal choice of P2Y
12
inhibitor remains debated. We compared effectiveness and safety of clopidogrel, ticagrelor, and prasugrel in a large, nationwide cohort of patients with ACS undergoing PCI.

Methods:
Registry-based study of first-time ACS patients who underwent PCI ≤7 days of admission and redeemed a prescription of a P2Y
12
inhibitor ≤30 days of the index event. The primary outcome was major adverse cardiovascular events (MACE): a composite of cardiovascular death, recurrent myocardial infarction, stroke, or repeat revascularization at 12 months. The safety outcome was bleeding requiring hospitalization at 12 months. Multivariable logistic regression with average treatment effect modeling was used to calculate standardized absolute and relative risks for outcomes across age, sex, comorbidity, bleeding, and concomitant anticoagulant therapy distributions.

Results:
We included 26,997 patients; 6,585 were discharged on clopidogrel, 18,425 on ticagrelor, and 1,987 on prasugrel. Corresponding median ages were 70, 64, and 59 years (p<0.001). Patients in the clopidogrel group were more likely to have had a prior bleeding episode (p<0.001). Adjusted relative risks of MACE were 0.80 for ticagrelor vs clopidogrel (p<0.001), 0.85 for prasugrel vs clopidogrel (p<0.001), and 1.05 for prasugrel vs ticagrelor (p=0.22). Adjusted relative risks of bleeding were 0.82 for ticagrelor vs clopidogrel (p=0.001), 1.07 for prasugrel vs clopidogrel (p=0.56), and 1.30 for prasugrel vs ticagrelor (p=0.03). While statistically significant, the absolute differences in risk of bleeding among groups were modest (Figure).

Conclusion:
Ticagrelor and prasugrel were associated with lower risk of MACE than clopidogrel but did not significantly differ from each other. Ticagrelor was associated with a lower risk of bleeding than both clopidogrel and prasugrel.
Abstract 12898: Eosinophilic Myocarditis Following Osimertinib Treatment for Epidermal Growth Factor Receptor Mutated Lung Adenocarcinoma
Authors: Andersson Charlotte , McCarter Kaitlin , Ruberg Frederick , Meier-Ewert Hans , Tapan Umit , Siddiqi Omar
Published: April 2022

A 60-year-old man with oligometastatic adenocarcinoma of the lung presented with symptoms of heart failure 6 weeks after initiation of treatment with osimertinib, an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor. A transthoracic echocardiography (TTE) showed a moderately sized pericardial effusion, mildly increased left ventricular (LV) wall thickness, and mildly depressed LV ejection fraction (45-50%), without tamponade physiology. His TTE prior to treatment initiation was normal. He endorsed chest pain across the entire chest that had started on the second day after initiation of osimertinib and was worse when laying down. His serum troponin I concentration was elevated to 10.6 ng/mL upon admission and ECG showed sinus tachycardia. He was carefully diuresed with some improvement in symptoms. A peripheral eosinophilia was noted, which raised suspicion for eosinophilic myocarditis. A cardiac magnetic resonance imaging confirmed a mildly reduced LVEF of 51% and mildly increased LV wall thickness. There was diffuse late gadolinium enhancement throughout the entire myocardium, with increased T1 and T2 signals and the extracellular volume was increased to 40%, supporting a diagnosis of perimyocarditis. A left and a right heart catheterization were subsequently undertaken. His coronary arteries were normal and the right heart cathetherization showed unremarkable hemodynamics, including a right atrium pressure of 6 mm Hg, right ventricular pressure of 34/6 mm Hg, pulmonary artery pressure of 33/9 mm Hg, and a pulmonary capillary wedge pressure of 10 mm Hg. A right heart biopsy revealed a dense eosinophilic infiltration of the myocardium, consistent with an eosinophilic hypersensitivity reaction, manifesting as myocarditis. High dose prednisone was initiated and after 2 months of treatment, repeat TTE showed resolution of his pericardial effusion and normalization of the LV wall thickness and LVEF (65%). This case illustrates the value of multi-modality imaging and endomyocardial biopsy to diagnose rare complications of novel, targeted cancer therapeutics.
Abstract 12899: CMR Derived Intraventricular Pressure Gradients Analysis Shows Impaired Left Ventricular Function in Precapillary Pulmonary Hypertension
Authors: Vos Jacqueline L , Leiner Tim , van Dijk Arie P , Pedrizzetti Gianni , Alenezi Fawaz , van der Wegen Constantijn T , Driessen Mieke M , Nijveldt Robin
Published: April 2022

Introduction:
Precapillary pulmonary hypertension (pPH) predominantly harms the right ventricle. Still, due to ventricular interdependence, it also affects left ventricular (LV) function. Since LV ejection fraction (EF) is often preserved, more sensitive techniques may be better suited to detect LV dysfunction, such as LA strain or estimation of LV intraventricular pressure gradients (IVPG). However, the value of these techniques in pPH is still unknown.

Hypothesis:
Cardiovascular magnetic resonance (CMR) derived LA phasic function and LV-IVPG can detect LV dysfunction in pPH patients.

Methods:
pPH patients (n=31) and healthy controls (n=10), age- and sex-matched, underwent CMR imaging. LA phasic function and the LV-IVPG, calculating the pressure gradient between apex and base throughout the cardiac cycle, were analyzed using standard long-axis cines.

Results:
LV systolic function, both LVEF as well as the IVPG positive systolic ejection force, was preserved in pPH patients compared to healthy controls (p=0.90, p=0.08 resp.). However, diastolic function in pPH patients was impaired, depicted by 1. lower LA reservoir (patients vs. controls 26% ±9 vs. 37% ±7, p=0.001) and conduit strain (15% ±8 vs. 26% ±7, p=0.001), and 2. an impaired diastolic suction force, and decreased E-wave decelerative force, indicating a weaker passive filling in early to mid-diastole (
see Table
). Also, 11 pPH patients (35%) showed reversal of IVPG at systolic-diastolic transition, meaning that LV pressure temporarily exceeds LA pressure, whereas none of the healthy controls showed this pattern (p=0.04).

Conclusions:
pPH impacts LV function by altering diastolic function, demonstrated by an impairment of LA phasic function and LV-IVPG analysis. These parameters could therefore potentially be used as early markers for LV functional decline in pPH patients.
Abstract 12914: Predicting Favorable Hemodynamic Response to Intravenous Morphine in ICU Patients With Congenital Heart Disease
Authors: Sperotto Francesca , Emani Sivaram , Zhu Lin , Delgado Marlon , Santillana Mauricio , Kheir John
Published: April 2022

Introduction:
Intravenous morphine is commonly used to treat pain in patients with congenital heart disease (CHD), though response is variable. For a variety of reasons (objective measure in small children, who cannot communicate verbally; intubation; neuromuscular blockade), heart rate (HR) is often used to assess medication response. As a groundwork for decision support, we created a model of predicting a favorable hemodynamic response to intravenous morphine.

Methods:
All doses of intravenous morphine administered to patients in the cardiac ICU between 2011 and 2020 were reviewed, excluding doses given on ECMO support, during pacing, or with missing hemodynamic data. The change in HR Z score from baseline (5 minutes prior to bolus) and putative peak effect (30 minutes post-bolus) was computed. Doses were dichotomized into ‘effective’ doses (HR decrease by ≥1 Z-score) and ‘ineffective’, denoting a particularly noticeable change at the bedside. Generalized mixed linear models (GMLM) and random forest (RF) classifiers were used to model the HR response over time. The dataset was divided (dose level) into training (80%) and validation (20%) cohorts.

Results:
Of 197,242 doses, 117,495 doses among 8,154 patients (median age 0.61 years, 44% post-surgical patients) were included. The median dose of morphine was 0.051 mg/kg (IQR 0.048, 0.099). Concomitant infusions included opioids (45%) and sedatives (53%); 23% of patients received NMB agents. The median HR Z score change was -0.8 (A). HR response category was well predicted by both GMLM (sensitivity = 0.69, PPV 0.90, AUC 0.74) and RF models (sensitivity = 0.73, PPV = 0.90, AUC = 0.76). Predictor variables for GMLM are shown in B.

Conclusions:
A favorable HR response to morphine can be accurately predicted prior to administration using logical patient factors. This tool represents a component of a decision-support tool for sedation and pain management in critically ill patients.
Abstract 12919: Impact of Small Valve Size After Transcatheter Aortic Valve Implantation on 1-year Outcomes in Women: Results From the WIN-TAVI Registry
Authors: Pivato Carlo Andrea , Cao Davide , Sartori Samantha , Snyder Clayton , Nicolas Johny , Chiarito Mauro , Tavennier Annerieke , Nardin Matteo , Sharma Samin K , Mehilli Julinda , Petronio Anna S , Morice Marie c , Chieffo Alaide , Dangas George , Mehran Roxana
Published: April 2022

Introduction:
Women undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis are more likely to have a small aortic annulus compared with men. However, there is lack of data on the prognostic relevance of bioprostheses size in women.

Hypothesis:
To assess the impact of a small valve size on clinical outcomes in women undergoing TAVI.

Methods:
The Women's INternational Transcatheter Aortic Valve Implantation (WIN-TAVI) registry was the first study to investigate the safety and efficacy of TAVI in women with aortic stenosis.Patients were stratified according to the size of aortic valve bioprosthesis, with small valve defined by a size≤23 mm and non-small valve defined by a size>23 mm. The primary outcome of interests was the occurrence of Valve Academic Research Consortium (VARC)-2-efficacy endpoint, a composite of all-cause death, stroke, myocardial infarction, hospitalization for valve-related symptoms or heart failure or valve-related dysfunction at 1-year follow-up.

Results:
Out of 934 patients, 388 (41.5%) received a small valve and had a lower body mass index, lower surgical risk scores and were less likely to suffer from atrial fibrillation as compared with patients receiving a larger valve. The latter were more likely to require post-dilation (18.6% vs. 10.4%, p<0.001) and had a trend for higher rates of residual aortic regurgitation grade ≥2 (8.7% vs. 5.1%, p = 0.051). At 1 year, the risk of the VARC-2 efficacy endpoint was similar between the two groups (16.0% in small valve vs. 16.3% in non-small valve, p = 0.8808; adjusted hazard ratio 1.34, 95% confidence interval 0.90 to 2.00), Figure. No significant differences in the occurrence of the secondary endpoints were noted after multivariable adjustment.

Conclusions:
Among women undergoing TAVI, the valve size was associated with different baseline and procedural characteristics but was not an independent predictor of clinical outcomes.
Abstract 12923: Lack of Concordance Between Parameters Defining Cardiogenic Shock in Patients With ST Elevation Myocardial Infarction
Authors: Eastman Triston , Ragheb Mirna , Thorleifson Mullein , Hiebert Brett , Minhas Kunal , Kass Malek , Ravandi Amir , Shah Ashish
Published: April 2022

Introduction:
In stark contrast to a ~3-5% in-hospital mortality in all comer ST Elevation Myocardial Infarction (STEMI) patients, ~40-50% of STEMI patients complicated by cardiogenic shock (CS) die during their index-hospital admission. None of the pharmaco-mechanical circulatory support therapies have demonstrated survival benefit in CS, likely due to our inability to objectively define and identify CS in the “pre-shock” state. As per the current guidelines, CS is defined as either (1) systolic blood pressure (SBP) ≤ 90mmHg, (2) cardiac-index (CI) <1.8 L/min/m
2
or <2.2 L/min/m
2
with inotropic/vasopressor support in presence of pulmonary capillary wedge pressure ≥15 mmHg, and/or (3) lactate >2 mmol/L. These parameters are used interchangeably. however,

data comparing these parameters is lacking.

Objective:
(1) To identify the

incidence of CS

using the above three parameters, and (2) assess the

concordance between these parameters in STEMI patients

.

Methods:
CI (total body impedance method), SBP and lactate were measured pre- and post-primary percutaneous coronary intervention (PPCI) in consecutive STEMI patients.

Results:
Sixty-eight STEMI patients (32% female) with a mean age of 65.8 years were recruited. Based upon lactate, CI and SBP the incidence of CS pre-PPCI was 47%, 26% and 17% (Panel-A). Poor concordance was seen between all three parameters. SBP and CI (R 0.466, R
2
0.220; Panel-B), CI and lactate (R -0.228, R
2
0.052; Panel-C), as well as SBP and lactate (R -0.314, R
2
0.098; Panel-D) criteria predominantly identified different patient cohorts, with minimal overlap; demonstrating that these parameters cannot be used interchangeably.

Conclusion:
Our study is the first to describe poor congruity between the current parameters defining CS. Such limitations raise the need of objectively defining CS so that these high-risk patients can be identified early in the course of CS (pre-CS state), where timely interventions are likely to improve the outcomes.