bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13019: Differences in Outcomes Among Elderly Patients on Medicare Undergoing Transapical Access and Non-Transapical Access Transcatheter Aortic Valve Replacement
Authors: Dhaliwal Jasninder S , Memon Rahat A , Aggarwal Shruti , Ramphul Kamleshun , Ravalani Abhimanyu , Sombans Shaheen , Sakthivel Hemamalini
Published: December 2023

Introduction:
While a recent study reported a decreasing trend in the use of transapical access (TA) transcatheter aortic valve replacement (TAVR) over non-transapical access (non-TA) TAVR, their burden on Medicare remains considerable. We aim to investigate differences in outcomes among elderly patients covered by Medicare undergoing TA and non-TA-TAVR.

Methods:
Medicare-insured elderly (ages≥ 60 years) undergoing TAVR (TA and non-TA) were recruited from the National Inpatient Sample (2016-2020), and differences in outcomes between the two procedures were evaluated.

Results:
We found 259385 procedures of TAVR involving 256145 (98.8%) cases of non-TA-TAVR and 3240(1.2%) cases of TA-TAVR. Between 2016-2020, a continuous drop in TA-TAVR use was observed (vs. non-TA-TAVR). Mortality rates among non-TA-TAVR patients also decreased from 1.8% in 2016 to 1.1% in 2020. Meanwhile, patients with TA-TAVR experienced a rise in mortality from 3.8% in 2016 to 5.8% in 2018, which decreased in 2019(3.7%) and 2020 (2.2%). TA-TAVR cases had a higher mean Charlson Comorbidity Index (CCI) score (3.65 in TA-TAVR cases vs. 3.02 in non-TA-TAVR patients) and higher odds of major bleeding (aOR 1.554, 95% CI 1.442-1.675, p<0.01), postprocedural pneumothorax (aOR 2.853, 95% CI 1.689-4.820, p<0.01), postprocedural respiratory failure (aOR 5.106, 95% CI 4.149-6.284, p<0.01), use of mechanical ventilation (aOR 3.077, 95% CI 2.653-3.569, p<0.01), or Major Adverse Cardiac Events (MACE) (aOR 1.512, 95% CI 1.325-1.727, p<0.01) vs. non-TA-TAVR cases. No differences in cardiac tamponade (aOR 1.350, 95% CI 0.957-1.904, p=0.087) were seen. Finally, TA-TAVR cases required a longer stay (mean length of stay 7.15 vs. 3.76 days).

Conclusions:
The use of non-TAVR over TA-TAVR continued between 2016-2020 with favorable short-term survival rates and fewer complications such as major bleeding, postprocedural pneumothorax, respiratory failure, MACE, and the need for mechanical ventilation.
Abstract 13022: Myocardial Restoration and Functional Recovery Through Transplantation of Vascularized Cardiac Microtissues Derived From Human Induced Pluripotent Stem Cells in a Rat Model of Myocardial Infarction
Authors: Hakamada Keisuke , Murata Kozue , Minatoya Kenji , Masumoto Hidetoshi
Published: December 2023

Introduction:
Cardiac regenerative therapy is acknowledged as a promising strategy for treating individuals suffering from severe heart failure. To address the current constraints of stem cell therapy, which primarily relies on indirect paracrine effects for functional improvement, the ideal goal would be to restore the damaged myocardium in the diseased heart. To achieve this, the transplantation of biomimetic heart tissues that closely resemble the natural structure of the heart is highly anticipated.

Methods:
We successfully generated 3-dimensional vascularized cardiac microtissues (VCMs) using human induced pluripotent stem cells (hiPSCs) through dynamic culture on thin cardiac tissue sheets (CTSs) composed of hiPSC-derived cardiomyocytes and vascular cells. These VCMs exhibited a robust vascular network comprising human vascular cells. Subsequently, we transplanted CTSs (n=6) or VCMs (n=6) onto an athymic rat model of myocardial infarction (MI), while a sham operation was performed on another group (n=6). To assess cardiac function, we employed cardiac magnetic resonance imaging. The survival of grafts, extension of fibrotic scars, neovascularization in the MI border zone, and the formation of a human vascular network within the engrafted region were evaluated through histopathology and light sheet fluorescence microscopy with tissue clearing techniques.

Results:
Functional analyses demonstrated that the VCM group exhibited the highest left ventricular ejection fraction (Sham: 36.5±0.9%, CTS: 43.5±2.9%, VCM: 55.2±2.5%, p < 0.01). Histopathological evaluation revealed that the VCM group had a larger engraftment area, along with the smallest scar extension and the highest vascular density in the myocardial infarction border zone. Furthermore, LSFM revealed the presence of vascular networks originating from human cells within the engrafted VCMs.

Conclusions:
The transplantation of hiPSC-derived VCMs demonstrated remarkable therapeutic potential in a rat model of MI, leading to the formation of a vascular network by human cells. This approach might hold great promise as an effective strategy for efficiently restoring the damaged myocardium in hearts afflicted with disease.
Abstract 13026: Effects of Dapagliflozin in Heart Failure, Type 2 Diabetes, and Neuropathy - A Patient-Level Meta-Analysis of DAPA-HF and DELIVER
Authors: Butt Jawad H , Jhund Pardeep S , Docherty Kieran , Bachus Erasmus , Claggett Brian , Hernandez Adrian F , Lam Carolyn S , Inzucchi Silvio , Martinez Felipe , de Boer Rudolf A , Kosiborod Mikhail N , Desai Akshay S , Kober Lars , Ponikowski Piotr , Sabatine Marc S , Shah Sanjiv J , Vaduganathan Muthiah , Solomon Scott , McMurray John J
Published: December 2023

Introduction:
Type 2 diabetes (T2D) is a common comorbidity in heart failure (HF), and neuropathy is a serious complication in patients with T2D that is associated with worse outcomes.

Purpose:
To investigate the efficacy and safety of dapagliflozin, compared with placebo, according to neuropathy status in patients with HF and T2D.

Methods:
We conducted a patient-level pooled analysis of the DAPA-HF and DELIVER trials, which evaluated the effects of dapagliflozin, compared with placebo, in patients with HFrEF and HFmrEF/HFpEF, respectively. The primary outcome was a composite of worsening HF or cardiovascular death.

Results:
Of the 5,274 patients with T2D at baseline, 756 (14.3%) had a history of neuropathy. Compared to patients without neuropathy, those with neuropathy more often had a history of hypertension and PAD and were female. They also had a higher BMI, HbA1c, and LVEF, but a lower eGFR and NT-proBNP. Patients with neuropathy had a longer duration of both T2D and HF, worse NYHA functional class and KCCQ scores and a higher incidence of all outcomes. The benefit of dapagliflozin on the primary outcome was consistent irrespective of neuropathy status: no neuropathy, HR: 0.81 (95% CI: 0.72-0.92); neuropathy, HR: 0.63 (0.46-0.84) (P
interaction
=0.11). Dapagliflozin reduced the risk of secondary clinical outcomes and increased (improved) mean KCCQ scores from baseline to 8 months in both patients with and without neuropathy. The effects on secondary outcomes appeared larger in those with neuropathy
(Table)
. Adverse events and treatment discontinuation were not more frequent with dapagliflozin than with placebo irrespective of neuropathy status.

Conclusions:
Dapagliflozin reduced the risk of worsening HF or cardiovascular death and improved symptoms in patients with HF and T2D, with and without neuropathy, possibly with larger effects in individuals with neuropathy. In addition, dapagliflozin was safe and well-tolerated, irrespective of neuropathy status.
Abstract 13038: Predictive Value of Cardiac Function Parameters and NT-proBNP in Patients With Pulmonary Arterial Hypertension (PAH) Treated With Sotatercept in the STELLAR Trial
Authors: McLaughlin Vallerie V , Hoeper Marius M , Badesch David B , Ghofrani Ardeschir H , Gibbs Simon R , Gomberg-Maitland Mardi , Preston Ioana R , Souza Rogerio , Waxman Aaron B , lin jianxin , Levonas Amy O , de Oliveira Pena Janethe , Humbert Marc
Published: December 2023

Background:
Sotatercept is an activin signaling inhibitor under investigation for PAH.

Goal:
Evaluate the prognostic utility of hemodynamic and cardiac function parameters in PAH patients receiving sotatercept vs placebo.

Methods:
Participants in STELLAR, a phase 3 trial (NCT04576988), were randomized 1:1 to sotatercept (0.3 up to 0.7 mg/kg once every 3 weeks) or placebo added to background therapies. Eligible participants had WHO functional class II-III, pulmonary vascular resistance ≥400 dyn·s·cm
-5
, and 6-minute walk distance 150-550 m. This post-hoc analysis assessed clinical worsening events at last measurement by baseline echocardiography (ECHO), right heart catheterization (RHC), and NT-proBNP parameters. Clinical worsening events were assessed up to week 60. Uni-/multivariate-adjusted Cox models identified baseline parameters significantly (p<0.05) associated with events. Parameters with p-values <0.10 were carried forward to multivariate model. Receiver operating characteristic curves assessed discriminatory utility of cutoff values.

Results:
Of the significant univariate predictors, only study treatment and log2 NT-proBNP were significant independent predictors of clinical worsening in multivariate model (Table). Each unit increase in log2 NT-proBNP at baseline was associated with a 61% increase in risk (HR 1.61, 95% CI 1.39, 1.88; p<0.001). The AUC for log2 NT-proBNP (0.76 [95% CI 0.67, 0.85]) showed good performance. The optimal NT-proBNP cutoff value was 322 pg/mL. Sotatercept treatment was associated with an 81% reduction in risk vs placebo (HR 0.19, 95% CI 0.10 to 0.38; p<0.001), even after adjusting for NT-proBNP.

Conclusions:
This post-hoc analysis demonstrated that NT-proBNP is a strong predictor of clinical worsening events in PAH patients. Sotatercept treatment offered protection beyond that achieved with standard therapies alone, even after adjusting for the impact of NT-proBNP.
Abstract 13047: The Modulatory Effects of Perivascular Adipose Tissue on the Renal Arterial Vasorelaxation and Its Relationship With Kidney Function in Metabolic Syndrome
Authors: Kagota Satomi , Maruyama-Fumoto Kana , Shinozuka Kazumasa
Published: December 2023

Metabolic syndrome (MetS) is a cluster condition that increases the risk of cardiovascular diseases and type 2 diabetes. Perivascular adipose tissue (PVAT) regulates the arterial tone. We have demonstrated that the renal arterial PVAT enhances the vasorelaxation response in MetS model strains, SHRSP.Z-

Lepr
fa

/IzmDmcr rats (SPZF) and SHR/NDmcr-cp rats (CP). Furthermore, we have found that overactivation of angiotensin II type 1 receptor (AT1R) signaling and a decrease in apelin levels in PVAT leads to a decline in compensatory PVAT effects. MetS is associated with chronic kidney disease, and the dysfunction of the PVAT favoring the vasorelaxation response could be a reason for kidney disease development. Therefore, we investigated the relationship between PVAT function and kidney function using MetS model rats.Renal arteries were isolated from the male and female SPZF and CP at 23 weeks of age. Vasorelaxation and mRNA transcript levels in PVAT were examined using organ bath methods and quantitative real-time polymerase chain reaction, respectively. Systolic blood pressure (sBP) was measured using a tail-cuff method. Insulin, glucose, and creatinine in the serum and protein in the urine were measured using commercial kits and eGFR, and the HOMA-IR were calculated.sBP was higher in SPZF than CP, but lower in females than males. HOMA-IR and urine protein levels were the lowest, while eGFR and enhancing effects of PVAT on acetylcholine-induced relaxations were the highest in female CP among the groups. eGFR was negatively correlated with sBP, HOMA-IR, and urinary protein levels. The enhancements of relaxations by PVAT were negatively correlated with sBP, HOMA-IR, and AT1R activity in PVAT.This study suggests that the insulin resistance and high blood pressure are associated with PVAT dysfunction, resulting from AT1 activation in PVAT, while it does not support the hypothesis that the disappearance of the effects of PVAT directly leads to kidney dysfunction.
Abstract 13049: Electrophysiological Mechanism of Potassium Channel KCNQ1 p.V162M Mutation Induced Atrial Tachycardia and Epilepsy
Authors: chen zhiqing , Xie jinyan , Liu yang , Hong Kui
Published: December 2023

Objective:
Arrhythmia and epilepsy are the causes of syncope and sudden death. Both of them are associated with abnormal function of potassium ion channels. Delayed rectified potassium current (IKs) is generated by combining the α subunit of potassium ion channel encoded by KCNQ1 gene with the β subunit encoded by KCNE1 gene. It plays an important role in electrical excitation and K+ circulation of nerve cells. In this study, a patient with atrial arrhythmia and epilepsy with a history of syncope was identified by genetic testing as having a mutation in the KCNQ1 p.V162M gene. The purpose of this study was to investigate the effect of KCNQ1 p.V162M mutation on the structure and function of potassium ion channels.

Methods:
The mutant plasmid KCNQ1-p.V162M was constructed for cell transfection. The expression of protein and mRNA were analyzed by western blotting and real-time quantitative PCR. The IKs of the two groups were detected by whole-cell patch clamp technique.

Results:
Whole exon gene sequencing revealed that the patient carried the KCNQ1 p.V162M mutation. The results of molecular biology experiment showed that mRNA, KCNQ1 total protein and membrane protein expressions in mutant group were significantly lower than those in wild group. Whole-cell patch clamp results showed that the peak current density and tail current of IKs in the mutant group were significantly decreased compared with those in the wild group, indicating that the mutation of KCNQ1 p.V162M could lead to decreased function of potassium ion channels.

Conclusions:
KCNQ1 p.V162M mutation can lead to decreased expression of KCNQ1 protein and decreased function of potassium ion channel, which may be the potential mechanism of atrial tachycardia and epilepsy induced by this mutation.
Abstract 13090: Clinical Burden of Transthyretin Amyloid Cardiomyopathy (ATTR-CM) in the USA From 2004 to 2022
Authors: Alexander Kevin M , Ersboell Anne S , Haase Christiane L , Mortensen Julie T , Maurer mathew S
Published: December 2023

Introduction:
Advances in diagnosis and disease awareness have led to increased prevalence and incidence of diagnosed transthyretin amyloid cardiomyopathy (ATTR-CM) worldwide. At the same time, patients are being diagnosed at an older age and with multiple comorbidities. Current data on the clinical burden of ATTR-CM in the USA are lacking.

Aims:
To assess the clinical burden of ATTR-CM in terms of comorbidities, medication use, and healthcare resource utilization in a large US population over time.

Methods:
Data from 2004–2022 were extracted from TriNetX, a US database of electronic medical records covering in- and outpatient data. An algorithm using ICD-9/10 codes and RxNorm codes for clinical drugs (amyloidosis + cardiac manifestation – light chain amyloidosis) was used to identify patients with ATTR-CM. Included were adults ≥ 18 years old at index date (first ATTR-CM diagnosis per the algorithm) with ≥ 1 year of database history. Demographic characteristics at index, medication use and clinical encounters in the year pre-index, and comorbidities at any time pre-index were assessed in cross-sectional cohorts over time.

Results:
Of more than 78 million patients in the database, 12 209 fulfilled all inclusion criteria (2004–2008, n = 332; 2009–2013, n = 913; 2014–2018, n = 3392; 2019–2022, n = 7572). The prevalence of both ATTR-CM-related comorbidities and other comorbidities, as well as associated medication use, generally increased over time (
Table
). In the year before ATTR-CM diagnosis, a considerable proportion of patients had outpatient, inpatient and emergency visits; among patients with one or more clinical encounter, the median number of encounters (any encounter) was ≥ 10 across all cohorts (
Table
).

Conclusion:
In patients with ATTR-CM in this large US population, the clinical burden has become more complex over time, with an increasing proportion of patients having multiple morbidities and clinical encounters in the time before diagnosis.
Abstract 13098: Worsening Tricuspid Regurgitation Associated With Permanent Pacemaker and Implantable Cardioverter-Defibrillator Implantation: A Systematic Review and Meta-Analysis of Over 66,000 Patients
Authors: Alnaimat Saed , Doyle Mark , Krishnan Kousik , Biederman Robert W
Published: December 2023

Introduction:
Worsening TR following either PPM or ICD implantation is an emerging clinical challenge. Early recognition of this entity is essential in guiding treatment.

Hypothesis:
Despite many technological advances in electrophysiology, transvenous lead placement currently remains an integral part of cardiac device implantation procedures. While worsening of TR post-device does not seem to be surprising, it is counter-intuitive and eventually leads to right-sided heart failure symptoms.

Methods:
We searched electronic databases from inception to January 2023 for published studies that reported incidence of TR worsening post-device implantation. Log odds ratio was used to summarize group differences.

Results:
Our analysis included 29 studies with 66,590 participants. Patients with device implantation (n=1,008) were significantly more likely to develop worsening TR as compared to controls (n=58,605) (OR: 3.18, p<0.01). Amongst a total of 7,777 patients, pooled incidence of at least one-degree worsening of TR post-implantation was 23%. Worsening TR significantly increases mortality (HR 1.42, p=0.02). Larger right atrial area (OR 1.11, p<0.01) is significantly associated with an increased risk of worsening TR, while males are less likely to develop this complication as compared to females (OR 0.74, p<0.01). Importantly, there is no statistically significant difference between the type of implanted device (ICD vs PPM) and post-device TR. Further, RV dysfunction, pulmonary artery pressure, baseline mitral regurgitation, LVEF, baseline atrial fibrillation, and age have no association with worsening TR.

Conclusions:
A substantial number of patients undergoing PPM or ICD implantation are at an increased risk of worsening TR. Importantly, in this largest review to date incorporating over 66,000 patients, this significantly increases mortality by greater than 140%, accordingly deserving more recognition and clinical attention in the current era.
Abstract 13113: Associations of Cerebrovascular Regulation and Arterial Stiffness With Cerebral Small Vessel Disease: A Systematic Review and Meta-Analysis
Authors: Scheuermann Britton , Parr Shannon , Kunkel Olivia , Turpin Vanessa-Rose , Liang Jia , Ade Carl J
Published: December 2023

Background:
The global incidence of ischemic stroke is projected to increase ~20% by 2030, with one-fifth of these cases attributed to cerebral small vessel disease (cSVD). Stiffening of central arteries potentiates small vessel injury in the brain, which may precede or develop in parallel with disruption of local regulatory mechanisms such as cerebrovascular reactivity. However, evidence of these vascular etiologies of cSVD remains inconclusive. To address this, we conducted separate systematic meta-analyses to characterize the relationship between cerebrovascular reactivity or arterial stiffness and cSVD.

Methods:
MEDLINE and Web of Science were searched for studies reporting odds ratios (OR) using arterial stiffness or cerebrovascular reactivity as continuous predictors for the presence of cSVD. Data were extracted using predefined tables and random-effects meta-analyses were performed to determine pooled OR and 95% confidence intervals.

Results:
Four cross-sectional studies were included in the analysis between cerebrovascular reactivity and cSVD, including 294 participants (38.1% women). Decrements in cerebrovascular reactivity were associated with a greater cSVD burden (OR = 1.93, 95% CI: 1.15-3.24, p = 0.01, I
2
= 97.4%). For arterial stiffness, 34 cross-sectional studies comprising of 26,541 participants (52.9% women) were included. Increases in indices of arterial stiffness were associated with a greater burden of cSVD (OR = 1.13, 95% CI: 1.07-1.20, p < 0.0001, I
2
= 60.2%).

Conclusion:
Impaired cerebrovascular reactivity and elevated arterial stiffness were both associated with an increased incidence of cSVD. While investigation of a link between cerebrovascular reactivity and arterial stiffness is a growing field, our findings suggest that the two measures have either individual or overlapping relationships with cSVD. This highlights the need for monitoring of both local and global cardiovascular regulation in high-risk individuals.
Abstract 13114: Beyond the Medical Record: An In-Depth Exploration of Takotsubo Syndrome Triggers
Authors: Keirns Natalie G , Rosen Rochelle , Burg Matthew , Ouaddi Sara , Black Emma , Tripolone Janice , Breault Christopher , Abbott Jinnette D , Salmoirago-Blotcher Elena
Published: December 2023

Introduction:
Takotsubo syndrome (TS) is an acute, reversible episode of systolic dysfunction, preceded by emotional/physical triggers in 2/3 of cases and no trigger in 1/3 of cases based on retrospective medical record data.

Research Question:
How do patients with a recent TS episode describe their triggers?
Goals:
To conduct an in-depth investigation of patient narratives concerning the events that triggered their TS episode.

Methods:
We conducted semi-structured interviews in patients with a recent (< 1 month) TS episode (Mayo Clinic criteria). We inquired about (1) type of trigger(s), and (2) trigger timing (< or > 48-96 hours before TS episode). Triggers were coded as emotional, psychosocial, and/or behavioral/physical. Recordings were transcribed, coded, summarized, and analyzed by the first and second authors.

Results:
Over 2/3 of patients (n=30; 97% female, 93% white; age 64 ± 9 yrs old) identified a trigger. Triggers included: a) acute events that occurred <48-96 hours before the TS episode (e.g., death of daughter), b) chronic circumstances that occurred both outside of and within 48-96 hours before the episode (e.g., conflicts with spouse), and c) acute events that occurred >48-96 hours before (e.g., binge drinking). The most prevalent triggers were negative emotions (86%; e.g., stress) and behavioral or physical factors (81%; e.g., atypical exercise/exertion). Nearly all triggers reported (81%) were multi-factorial (e.g., both physical
and
emotional). Of note, among participants who initially did not identify a trigger, 67% described potential triggering factors during the interview (e.g., increased stress).

Conclusions:
Consistent with the literature, 2/3 of patients identified a trigger. Yet, in contrast with current evidence, triggers were most often multifactorial (e.g., both emotional
and
physical) and many were chronic/ongoing. Moreover, for participants who could not identify a trigger, a potential trigger was often identified in the interview. Patients’ narratives around TS triggers are highly complex and likely insufficiently captured in clinical encounters. If these findings are replicated in larger and more diverse samples, they could lead to a re-thinking of the role of triggers in the onset of TS.
Abstract 13124: Better Prognostic Value of Single Time Coronary Artery Calcium Score Over the 30-y Averaged Pooled Cohort Equation in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Mok Yejin , Honda Yasuyuki , Wang Frances , Howard Candace M , Folsom Aaron R , Coresh Josef , Budoff Matthew J , Blaha Michael J , Matsushita Kuni
Published: December 2023

Background:
Cardiovascular disease (CVD) risk prediction in the 75-and-older population is challenging in part because traditional risk factors at older age may not reflect the risk factor profile over the life course. In this regard, coronary artery calcium (CAC) can be considered an integrated biomarker of exposure to CVD risk factors. However, the predictive value of a single time point CAC at older age vs. the cumulative exposure of traditional risk factors over three decades is unknown.

Methods:
In 1,875 ARIC participants (age 75-94 years) without a history of coronary heart disease (CHD), stroke, and heart failure (HF) at Visit 7 (2018-2019), we assessed the association of Visit 7 CAC vs. a weighted average of Pooled Cohort Equation (PCE) calculated 10-year atherosclerotic CVD (ASCVD) risk from Visit 1 (1987-89) to Visit 7 with the risk of ASCVD (CHD or stroke), HF, and all-cause mortality using adjusted Cox models. Risk prediction improvement was assessed using Harrel’s C-statistics.

Results:
The median CAC was 221 (IQI 35-743), and the median averaged PCE score was 15.0% (IQI 10.4%-21.2%). Over a median follow-up of 2.1 (IQI 1.7-2.5) years, there were 48 ASCVD events, 36 HF events, and 85 deaths. A higher CAC score was associated with a higher risk of ASCVD and HF, even after adjusting for averaged PCE (adjusted hazard ratio 3.33 [95% CI 1.53, 7.26] and 5.57 [1.95, 15.89] for CAC 1000+ vs. 0-99, respectively), but not all-cause mortality (
Table
). In contrast, averaged PCE was not associated with ASCVD or HF independent of CAC. However, averaged PCE showed robust associations with all-cause mortality. Notably, the addition of CAC to averaged PCE significantly improved risk prediction of HF, whereas adding averaged PCE to CAC did not significantly improve the risk prediction for any adverse outcome.

Conclusions:
The present study shows that a single time point CAC outperforms 30-y cumulative exposure of PCE for ASCVD and HF prediction in the 75-and-older population.
Abstract 13134: Comparative Analysis of Implantable Loop Recorder Devices
Authors: gupta eisha , Prakash Atul , Hadaya Tarick , srivastava kartikeya , Prakash Tannavi
Published: December 2023

Implantable loop recorders ILR are used for diagnosis and evaluation of Atrial fibrillation and Syncope. The devices mainly utilize RR variability to determine an episode of AF.Diagnosis of bradycardia is based on rate and absence of any R wave. Presence of a P wave is not a prerequisite.In this Retrospective study we used recorded electrogram characteristics obtained with two ILRs. Hypothesis-The R wave amplitude and clarity of P wave facilitates correct diagnosis of AF and any heart block .This would also infuence any undersensing and oversensing Methods-The two ILRs were Medtronic Reveal I & Biomonitor III.The Biomonitor is 77.5x8.6 x4.4 mm whereas LINQ I is 44.8x7.2x4 mm. Main difference in the two is that BioMonitor III has larger sensing area ( 77.5 vs 44.8). Results 106 patients were included in this analysis 53 patients had Medtronic Reveal I and the remaining 53 patients had a BioMonitor III. We compared the amplitude of the R wave, presence of P wave, Undersensing and Oversensing of recorded events. Group I = patients who had Medtronic reveal I, 19 Males, 34 Females, mean age 74+11 BMI=28.83±6.8 Indication was AF in 38 & syncope in 15. Mean R wave was 0.48 mV±0.38, Clear P waves were noted in 16/53. Oversensing noted in 8/53, Undersensing in 4/53. Group I I = patients with BioMonitor III 27 Males, 26 Females,Mean age 73+10 Mean BMI 29.20±5.35. Indication was AF in 37 & syncope in 16.Mean R wave was 0.65 mV±0.37. Clear P waves noted in 33/53. Oversensing noted in 8/53, Undersensing in 0/53. Group II( BM III) had significantly greater R wave amplitude (p=0.02), the presence of a P wave in sinus rhythm was in significanly greater number of patients (p=0.009) There was no significant difference in proportion of patients with oversensing in the two groups ( p=0.09 ) However undersensing was seen in significanly less No of patients in Group II as compared to Group I ( p= 0.04). The two groups are matched for age sex, BMI , indication for implantation. Conclusions 1 In ILRs the recordings obtained with a Biomonitor III ( larger recording area ) had significantly greater amplitude of R wave and a greater proportion of patients with a clear P wave as compared to a Medtronic Reveal 1 ILR 2. Undersensing is also less seen with the Biomonitor ILR which may be related to the R wave amplitude.
Abstract 13141: Max Opposing Wall Delay in Right Atrial Strain Can Be a Prognostic Factor at 30-day Mortality in Submassive Pulmonary Embolism
Authors: Orihara Yoshiyuki , Eguchi Shunsuke , Eguchi Ayumi , Pfeiffer Michael , Peterson Brandon , Ruzieh Mohammed , Gao Zhaohui , Boehmer John , Gorcsan John , Wilson Ryan
Published: December 2023

Background:
Submassive pulmonary embolism (sPE) is common and associated with significant mortality. Right ventricular dyssynchrony caused by sPE were reported previously. However, limited studies have evaluated dyssynchrony of right atrium (RA) strain in the setting of sPE. The purpose of this study was to identify the potential role of RA dyssynchrony in patients with sPE.

Methods:
201 patients with sPE were assessed in this retrospective cohort study. All echocardiograms were completed within 48 hours of diagnosis. RA strain was analyzed retroactively using TOMTEC®. RA dyssynchrony was defined as absolute max opposing wall delay which was time interval between peak lateral and septal wall strain in RA after R-R interval correction (maxOWD) (Figure 1). The primary outcome was 30-day all-cause mortality.

Results:
201 patients included in the study. Mortality rate of 11.4% was seen at 30 days. Median maxOWD in survivors was significantly low compared to that in non-survivors (4.35 vs 16.20, p < 0.001). Univariable and Multivariable analysis showed maxOWD was an independent factor to predict short-term mortality. Receiver operating characteristics (ROC) analysis revealed area under the curve was 0.795 and best cutoff value was 10.43. Using the cutoff value, Kaplan-Meier curves depicted survival rate in patients with maxOWD > 10.43 was significantly lower than those with maxOWD ≤ 10.43. (Hazard Ratio 7.84, p < 0.001) (Figure 2)

Conclusions:
Max opposing wall delay after R-R interval correction in RA strain has significant prognostic value in assessing risk of mortality in patients with submassive PE.
Abstract 13148: Sex Difference and Right Ventricular Global Longitudinal Strain in Prognosis of Malignancy-Related Submassive Pulmonary Embolism
Authors: Eguchi Shunsuke , Orihara Yoshiyuki , Eguchi Ayumi , Pfeiffer Michael , Peterson Brandon , Ruzieh Mohammed , Gao Zhaohui , Boehmer John , Gorcsan John , Wilson Ryan
Published: December 2023

Introduction and Hypothesis:
The risk of pulmonary embolism (PE) increases in patients with malignancy. It was reported that malignancy-related PE had significantly higher mortality compared to PE without malignancy. The aim of this study was to identify predictive factors for mortality in patients with malignancy-related submassive PE.

Methods:
Retrospective cohort study of patients with submassive PE between 2010 and 2018. Echocardiograms were obtained within 48 hours of PE. Strain parameters were retrospectively applied using TomTec®. The primary outcome was all-cause mortality at 30 days. Univariable and multivariable analysis, receiver operator characteristic (ROC) curve and Kaplan-Meier curves were used for evaluation.

Results:
82 patients were analyzed. Among patients (mean age: 65.0 ± 13.3 years, 51.2 % female), mortality at 30 days occurred in 17.1 %. In univariable analysis, sex, left ventricular diastolic diameter, right to left ventricular diastolic diameter ratio, right ventricular global longitudinal strain (RVGLS), RV free wall strain and right atrial strain were associated with 30-day mortality (p < 0.05). Multivariable analysis revealed sex and RVGLS independently associated with 30-day mortality (p = 0.007 and p = 0.036, respectively). ROC curve indicated that the best cutoff value for the absolute RVGLS to predict 30-day mortality was 17.7 % (area under the curve 0.827, sensitivity 0.917, specificity 0.672). Kaplan-Meier curves showed that male patients had higher risk of 30-day mortality compared with female patients (p = 0.029. Figure A). Patients with absolute RVGLS less than 17.7 % had 18 times higher risk compared to the other patients (p = 0.006. Figure B).

Conclusions:
Sex and RVGLS predicted short-term mortality in malignancy-related submassive PE more accurately. Further study is needed to validate these findings and determine the role of sex difference and RVGLS in malignancy-related submassive PE.
Abstract 13153: Non-Rheumatic Streptococcal Myocarditis Manifesting as Acute Non-ST-Elevation Myocardial Infarction
Authors: Benjanuwattra Juthipong , Juarez Michel , Rogers Brandon , Jenkins Leigh A
Published: December 2023

Case presentation:
A 24-year-old healthy man presented with acute, constant, non-radiating, chest pain with pleuritic quality. Three days prior, he had developed fever, sore throat, cervical lymphadenopathy, and tachycardia. Amoxicillin was given for a positive rapid streptococcal test. He was afebrile and bradycardic at 50 bpm. Lab showed leukocytosis (WBC 20,000/μL, neutrophil 80%), elevated ESR 70 mm/hr, CRP 23 mg/dL, and rising hs-cTn from 800 to 1,700 ng/L. Anti-streptolysin O and anti-DNase-B were normal. Tests for adenovirus, EBV, CMV, and other respiratory viruses were negative. Initial EKG showed sinus bradycardia with ST depression and T-wave inversion in V1-V2 and III. CXR and echo were unremarkable. He received intravenous penicillin G and indomethacin. Chest pain resolved on the following day. Repeat EKG showed resolution of bradycardia, ST depression, and T-wave inversion in V2. Indomethacin, colchicine, and amoxicillin were given upon discharge.

Discussion:
In contrast to acute rheumatic fever (ARF), a condition caused by molecular mimicry leading to cross-reactive humoral and cellular immune responses between cardiac and
Streptococcus pyogenes
antigens, the pathophysiology of non-rheumatic streptococcal myocarditis is presumably toxin-mediated. Although the revised Jones criteria were fulfilled in our patient, the temporal relationship between pharyngitis and the onset of carditis must be taken into account to distinguish these two entities. Concurrent myocarditis and pharyngitis suggest non-rheumatic streptococcal myocarditis, as opposed to a delayed presentation in ARF. Latency from pharyngitis to chest pain was reportedly around 3 days. The absence of valvular heart disease and streptococcal antibodies, such as anti-streptolysin O and anti-DNase B, are a clue to diagnosis. A recent case-series also suggested male-predominance. There has been an increase in a diagnosis of non-rheumatic streptococcal myocarditis due to a widespread use of diagnostic modalities such as MRI. Clinicians should consider this condition in a differential diagnosis of acute coronary syndrome, particularly in any young individuals with chest pain, elevated cardiac biomarkers, EKG changes, and simultaneous streptococcal pharyngitis.
Abstract 13175: Association of Heart Rate Variability and Electrolyte Changes During Hemodialysis in Patients With Chronic Kidney Disease
Authors: Im Sung I , Su Hyun BAE
Published: December 2023

Introduction:
Autonomic neuropathy commonly arises as a long-term complication in chronic kidney disease (CKD) and can be diagnosed from heart rate variability (HRV), calculated from electrocardiogram (ECG) recordings.

Hypothesis:
There is limited data about HRV using real-time ECG according to electrolyte levels during hemodialysis (HD) in patients with CKD.

Methods:
Total of 50 patients (62.1±10.7 years) with CKD underwent continuous real-time ECG monitor (237.4±15.3 mins) during HD for HRV using remote monitoring system and checked electrolyte levels before/after HD. And we compared HRV according to electrolyte levels.

Results:
During the monitor, we checked total 2374 times of ECG and electrolyte level simultaneously of all patients. Both time and frequency domain HRV were higher when the patients had lower K
+
level change before/after HD (<0.5mEq/L) as compared with those with higher K
+
level change (>0.5mEq/L) in Table. In addition, there were higher incidence of arrhythmic events including atrial/ventricular premature complexes, even though no difference of mean heart rate in patients with lower K+ level change group (P<0.001).

Conclusions:
Poor controlled K+ level during hemodialysis was independently associated with higher HRV in patients with CKD. This is further substantiated by independent continuous associations between real-time measures of K+ level and higher HRV. These data strongly suggest that cardiac autonomic dysfunction can be caused by lower change before/after hemodialysis alone.
Abstract 13177: The Association Between Insufficient Valve Expansion and Aortic Valve Calcification for Transcatheter Valve Implantation With Self-Expandable Valve
Authors: Isomatsu Daisuke , Sato Akihiko , Muto Yuki , Misaka Tomofumi , Oikawa Masayoshi , Kobayashi Atsushi , Yoshihisa Akiomi , Nakazato Kazuhiko , Ishida Takafumi , Takahashi Katsuhiro , Yamakuni Ryo , Sekino Hirofumi , Fukushima Kenji , Ito Hiroshi , Takeishi Yasuchika
Published: December 2023

Background:
Transcatheter aortic valve implantation (TAVI) has emerged as the preferred treatment for severe aortic stenosis. Nevertheless, severe calcification remains a factor leading to insufficient valve expansion and paravalvular leakage (PVL) after TAVI, mainly when using the self-expandable valve. We aimed to investigate the relationship between calcification and valve expansion using pre- and post-operative computed tomography (CT) scans, by comparing with valve phantoms as a reference standard.

Methods:
We enrolled 62 consecutive patients (mean age: 84.2 ± 4.4 years, 23 male) who underwent TAVI with the Evolut PRO+. We measured the aortic valve's calcium volume (Ca-Vol) by contrast-enhanced CT. The shorter diameter (mm) and the area (cm
2
) of the base of the implanted valve were measured. We performed CT scans of valve phantoms for each size and defined the measured shorter diameter and the base area as the reference standard. We calculated the insufficiency of valve expansion as the ratio of the patient valve's shorter diameter and base area to that of the phantom valve. PVL was defined as more than mild regurgitation by transthoracic echocardiography.

Results:
The base area of valve phantoms was 3.6, 4.1, 6.4, and 8.4 cm
2
for 23, 26, 29, and 34 mm, respectively. The shorter diameter and base area of the implanted valve were 15.7 ± 2.6, 15.2 ± 2.8, 17.3 ± 4.0, 23.9 ± 1.8 mm, and 2.7 ± 0.7, 2.5 ± 0.6, 3.4 ± 1.0, and 6.2 ± 1.6 cm
2
for 23, 26, 29, and 34 mm (n=4, 31, 24, and 3, respectively). Significant inverse correlations were observed between Ca-Vol and shorter diameter ratio (r
2
= 0.1, P = 0.009), area ratio (r
2
= 0.1, P = 0.006), and PVL (r
2
= 0.4, P < 0.001), respectively. On the other hand, there was no significant correlation between area ratio and PVL (r
2
= 0.004, P = 0.6).

Conclusion:
Severe calcification in the aortic valve was associated with insufficient valve expansion and PVL for the Evolut PRO+.
Abstract 13181: Tricuspid Regurgitation Impact on Outcomes (TRIO) Score in Patients With Tricuspid Regurgitation and Severe Pulmonary Hypertension
Authors: Alabdaljabar Mohamad Saleh , Naser Jwan , Kane Conor , Lara-Breitinger Kyla , Anand Vidhu , Pislaru Cristina , Eleid Mackram F , Alkhouli Mohamad , Kane Garvan , Pellikka Patricia A , Lin Grace , Nkomo Vuyisile T , Pislaru Sorin
Published: December 2023

Background:
Clinically significant tricuspid regurgitation (TR) is an important contributor to morbidity and mortality. The Tricuspid Regurgitation Impact on Outcomes (TRIO) score based on 8 parameters (age, gender, chronic heart failure, chronic lung disease, heart rate, creatinine, aspartate transaminase level, and TR severity) is used for risk stratification. The performance of the TRIO score in patients with TR secondary to severe pulmonary hypertension (PH) is unknown.

Research Questions:
To evaluate whether the TRIO score can be applied in patients with TR and pulmonary hypertension (PH), and to identify other predictors of mortality.

Methods:
Retrospective study including patients with TR ≥ moderate. Severe PH was defined as right ventricular systolic pressure (RVSP) ≥50 mmHg. The impact of clinical, echocardiographic and laboratory variables on mortality was evaluated with the Cox proportional hazard method.

Results:
A total of 13,482 patients from the TRIO population were included; severe PH was present in 6,530 (48.4%); mean age 73.4
+
13.3, 55.7% females. TRIO score performance was modest (AUC 0.62) in risk stratification (Figure A). PH patients had significantly higher mortality than those without PH at all levels of TRIO score (Figure B); differences were progressively lower with increasing TRIO scores. At multivariate analysis, only TRIO score [HR = 1.54 (1.35-1.77) per unit change], presence of an elevated NT-proBNP [HR = 1.02 (1.02-1.03) per 1000 pg/ml change], RVSP (HR = 1.08 (1.02-1.16) per 10 mmHg change], presence of RV dysfunction [HR = 1.15, (1.05-1.26)] and pulmonary artery pulsatility index (PAPi) ≤ 4 [HR = 1.34 (1.07-1.67)] were significant predictors of mortality (model AUC 0.65).

Conclusions:
TRIO score allows risk stratification in PH patients, but performance is modest; incorporating additional factors marginally increased model performance. PH patients have higher mortality at all levels of TRIO score, more so at low scores.
Abstract 13182: Comparison of Actual and Theoretical Aortic Valve Calcium Score to Assess TAVR Referral Delay in Patients With Atrial Fibrillation
Authors: Masson Rajeev , Abraham Bishoy , Nkomo Vuyisile T , Holmes David R , Pislaru Sorin , Arsanjani Reza , Chao Chieh-Ju , Klanderman Molly , Morsey Mahmoud , Sell-Dottin Kristen , Baqal Omar , Fortuin Floyd D , Sweeney John , Alsidawi Said
Published: December 2023

Introduction:
Doppler mean gradient (MG) can underestimate the severity of aortic stenosis (AS) in patients with atrial fibrillation (AF) compared to patients in sinus rhythm (SR). Patients with AF and severe AS may experience delayed diagnosis and more advanced disease at time of referral for transcatheter aortic valve replacement (TAVR).

Methods:
Patients who underwent TAVR from 2013 to 2017 for native valve severe AS were identified from an institutional database. MG and aortic valve calcium score (AVCS) at time of referral were compared in patients in AF and SR. Retrospective theoretical AVCS in AF patients were derived assuming an average progression of 152 AU/year (published data).

Results:
There were 820 patients included; mean age was 81.3+/- 8.2 years and 41.6% were female. AF was present in 356 patients at time of referral. Patients in AF were older (82.2 vs. 80.5, p = 0.003), had lower MG compared to SR patients (42.0 vs. 44.9, p = 0.002) and a lower peak velocity (4.1 vs. 4.2, p = 0.010) with a similar indexed aortic valve area (0.4 vs. 0.4, p = 0.17). Stratified by sex, the median calcium score for AF patients was higher (by around 300 AU) among both males (AF 2850.0 vs. SR 2561.0, p = 0.044) and females (AF 1942.0 vs. 1610.5, p = 0.025) (
figure 1
). A density plot of retrospective theoretical AVCS in AF patients (projected assuming referral to TAVR approximately two years prior) resulted in nearly identical median AVCS between the two cohorts (
figure 2
).

Conclusions:
Older age and higher AVCS in patients with AF compared to SR suggests that AS was both underestimated and more advanced at time of referral to TAVR. Patients in AF may have severe AS as early as 2 years prior to TAVR referral.
Abstract 13187: TikTok and Cardiovascular Health: An Analysis of TikTok as a Potential Outlet to Increase Cardiovascular Health Literacy
Authors: Pham Liem , Schneier Ezra , Dafonte Natalia , Posner Kevin , Thiemann Daniel , Vaidya Pranay , Timmapuri Sarah
Published: December 2023

Introduction:
Multidisciplinary approaches promoting continued patient education may improve patient adherence and reduce hospitalizations. The recent emergence of short video applications provides a new avenue for health-related education. Current and future patients can benefit from utilizing this new media resource to expand cardiovascular health literacy and promote positive outcomes.

Methods:
TikTok was queried in #cardiology, #cardiologylife, #interventionalcardiology, #pediatriccardiology, #cardiologynurse between 11/15/22-11/18/22. Inclusion criteria were English videos focused on information, inspiration, or wellness from US healthcare professionals between 2021-2022. Posts that met inclusion criteria (N=218) were statistically analyzed. A linear model was created to estimate a value for views.

Results:
The year 2022 had the highest values of 324,077 views, 14,901 likes, and 1170 downloads, as opposed to 2021 with 305,377 views, 6918 likes, and 508 downloads. Of the 218 videos, 127 (58.3%) involved information, 45 (20.6%) involved inspiration, and 46 (21.1%) involved wellness. The difference in mean views between 2021 and 2022 was 38,937 (p=0.23), suggesting a potential upward trend. The difference in mean likes and downloads between 2021 and 2022 was 2909 (p=0.009) and 276 (p=0.013) respectively. Linear modeling revealed a strong relationship between likes/downloads and views, but could not predict the number of views on a video. While we cannot confidently state that the mean number of views is increasing, we have determined that likes and downloads are certainly increasing with expanding engagement.

Conclusions:
The results of this study highlight the use of social media, specifically TikTok, as an inexpensive and passive way to improve health literacy. The increasing average number of views from 2021 to 2022 illustrates the upward trend among users and how TikTok can be used in a multidisciplinary approach to patient care and patient education. Further research is required to determine the role TikTok may play in patient care and how it may be utilized to inform the care of specific patient populations; however, the opportunities it may provide are promising.
Abstract 13194: Association Between Left Atrial Function and Frailty: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Sun Daokun , Parikh Romil , Wang Wendy , EATON ANNE , Lutsey Pamela L , Windham B Gwen , Inciardi Riccardo M , Solomon Scott , Shah Amil M , Chen Lin Y
Published: December 2023

Background:
Frailty is highly common in people with cardiovascular disease. Worse left atrial (LA) function is an independent risk factor for cardiovascular disease. However, whether worse LA function is independently associated with frailty is unclear.

Aim:
To evaluate the association of LA function with incident frailty in community-dwelling older adults.

Methods:
We included 3,292 older adults from the Atherosclerosis Risk in Communities (ARIC) study who were non-frail at baseline (visit 5, 2011-2013) and had LA function (reservoir strain, conduit strain, and contractile strain) measured from two-dimensional speckle-tracking echocardiography. The validated Fried frailty phenotype, which includes measurements of weight loss, slowness, exhaustion, weakness, and low physical activity, was used to define frailty (≥3 of the 5 components). Incident frailty was assessed between 2016 and 2019 during 2 follow-up visits; all the included participants attended at least 1 of the 2 visits. LA function was assessed continuously (per 1-SD decrement) and categorically in quintiles. Multivariable logistic regression was used for analysis.

Results:
The median (IQR) age was 74 (71-77) years (58% female) and 214 (7%) participants developed frailty during a median (IQR) follow-up of 6.3 (5.6-6.8) years. After adjusting for potential confounders, each 1-SD decrement in LA reservoir strain and LA contractile strain was associated with 35% (95% CI: 11-65%) and 22% (95% CI: 2-45%), respectively, greater odds of developing frailty (
Table 1
). Compared to the highest quintile, participants in the lowest quintile of LA reservoir strain had 2.3-fold greater odds of developing frailty.

Conclusions:
Worse LA function is associated with higher incidence of frailty. Future studies are needed to investigate the mechanism underlying this association.