bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17774: Utilization of Oral Anticoagulants and Antiplatelets in Nursing Home Residents With Atrial Fibrillation
Authors: Ko Darae , Lee Yoojin , Dae Hyun Kim , Zullo Andrew , Berry Sarah
Published: December 2023

Background:
Prior research reported underutilization of oral anticoagulants (OAC) in nursing home (NH) residents with atrial fibrillation (AF), but these studies may not have sufficiently addressed whether utilization was appropriate given the multimorbidity and limited life expectancy, and whether these patients are receiving antiplatelet (APT) as the alternative stroke prophylaxis.

Methods:
We conducted a retrospective cohort study using electronic health records and Minimum Data Set resident clinical assessment from 735 NHs among long-stay NH residents (≥100 days) with a diagnosis of AF. Because there was increased awareness of thrombotic events during the COVID-19 pandemic, we assessed OAC and APT use in 30 days prior to 1/1/2020 and 1/1/2021 was measured from medication order records.

Results:
Our study sample included 8135 long-stay residents with AF (mean age 78, 58% women, 1.6% American Indian/Asian/Native Hawaiian, 14% Black, 2.4% Hispanic, 80% White, 2% Other). Dementia was the most common comorbidity (51%) followed by diabetes (40%), heart failure (36%), chronic kidney disease (32%), and stroke (19%). One in 3 residents had moderately or severely impaired cognitive function. One third of the residents received APT only (mostly aspirin) and half did not receive APT or OAC in either year. The proportion of patients who did not receive OAC increased in 2021 (Figure).

Conclusion:
Only 13% of NH residents with AF received OAC and 37% received APT only. Given APT does not reduce the risk of AF-related stroke but has similar bleeding risk as OAC, there is an urgent need to develop anticoagulant standards for NH residents that address multimorbidity, life expectancy and patient preferences.
Abstract 17780: Trends in Clinical Characteristics and Short-Term Mortality in STEMI Patients in Senegal
Authors: NDAO Serigne Cheikh T , KA Mame Madjiguène , MBOUP Waly N , YASSINE Rabab , DIA Khadidiatou , MBOUP Mouhamed C
Published: December 2023

Introduction:
The prevalence of in-hospital ACS has risen from 4% to 10% in Dakar cardiology departments over the past 15 years.

Hypothesis:
The aim of this study was to describe the epidemiological, clinical profile and short-term prognosis of patients with acute ST Segment Elevation Myocardial Infarction (STEMI) treated by percutaneous coronary intervention (PCI).

Methods:
This was a single-center descriptive study using prospective data collection from September 2020 to July 2022, including all patients with acute STEMI managed by PCI in with Hôpital Principal Dakar (HPD). The latter is the main military hospital of Senegal.

Results:
Among the 1146 patients admitted in HPD cardiology department, 156 (13.61%) had STEMI and 92 (58.97%) of them had undergone PCI. The mean age of the patients was 60.04 ± 11 years, with a male predominance (78.26%). Eighty-three patients (90.2%) were seen within the first 12 hours, with an average of 3.26 ± 3 hours. Regarding clinical presentation, almost all patients (98.9%) were in Killip I or II class. Seventy-eight patients (84.8%) had a diagnostic ECG within the first 12 hours of symptoms initiation, with a mean of 3.95 ± 2.95 hours. Thrombolysis was performed in 10.86% of the patients with a success rate of 70%. The radial approach predominated largely (89%) and primary PCI was performed in 71.73% of patients. Overall, PCI with stent implantation, exclusively drug eluting stent (DES), was done in 95.65% of cases with a success rate of 98.91%. Three non-fatal periprocedural complications were reported and in-hospital mortality rate was 4.34%.

Conclusions:
In Dakar, the prognosis of acute STEMI has been improved since the availability of PCI with routine primary PCI 24/7. However, the intervention delays need to be perfected.
Abstract 17781: Spironolactone Improves Left Atrial Function and Atrioventricular Coupling in Resistant Hypertension
Authors: Girard Andrew A , Denney Thomas S , Sharifov Oleg F , Lloyd Steven G
Published: December 2023

Purpose:
To determine the blood pressure independent effects of spironolactone on left atrial (LA) size and function in patients with resistant hypertension (RHTN).

Methods:
Patients with RHTN (N=36, 55±7 years) were prospectively recruited. Spironolactone was initiated at 25 mg/day and increased to 50 mg/day after four weeks. Other antihypertensives were withdrawn to maintain constant blood pressure. Cardiac magnetic resonance imaging was performed at baseline and after six months of spironolactone treatment and changes in LA functional metrics were assessed (Figure 1). The statistical analysis was conducted using two-sided tests of significance.

Results:
LA size and function parameters improved from baseline to month-six: LA volumes indexed to body surface area (LAVI) were reduced (LAVI
max
41.4±12 vs 33.2±9.7 ml/m
2
; LAVI
pre-A
32.6±9.8 vs 25.6±8.1 ml/m
2
; LAVI
min
18.5 [13.9 - 24.8] vs 14.1 [10.9 - 19.2] ml/m
2
; all p < 0.05); left atrioventricular coupling index was reduced (28.2±11.5 vs 22.7±9.2 %, p < 0.05); LA emptying fractions (LAEF) were increased (total LAEF 52.4 [48.7 - 60.3] vs 55.9 [50.3 - 61.1] %; active LAEF 40.2±8.6 vs 43.1±7.8 %, both p < 0.05). There was a substantial increase in reservoir strain (29.1 ± 8.5 % vs 30.9 ± 5.5 %, p = 0.068) whereas active strain was significantly increased from baseline (16.3 ± 4.1 % vs 17.8 ± 4.2 %, p < 0.05). Changes in passive strain and strain rates were not statistically significant (p > 0.1). The effect of spironolactone was similar in patients with high (N = 18) and normal (N = 18) aldosterone status (defined by plasma renin activity and 24-hour urine aldosterone).

Conclusion:
Treatment of RHTN with spironolactone is associated with improvements in LA size and function regardless of whether aldosterone levels were normal or high. This study suggests the need for larger prospective studies examining effects of mineralocorticoid receptor antagonists on atrial function and atrioventricular coupling.
Abstract 17809: Association of Fatigue Subtype With Echocardiographic Measures of Cardiac Structure and Function in Prevalent HF in the Atherosclerosis Risk in Communities Study
Authors: Pavlovic Noelle , Dennison Himmelfarb Cheryl R , Abshire Saylor Martha , Leoutsakos Jeannie-Marie , Matsushita Kuni , Shah Amil M , Ndumele Chiadi E
Published: December 2023

Background:
Fatigue is prevalent in heart failure (HF) patients and strongly linked to adverse outcomes, but the relationship of cardiac structure and function with fatigue type and severity in HF is unknown.

Methods:
We included 947 individuals with prevalent HF from visit 5 (2011-2013) of the ARIC study with data on general and exertional fatigue, and echocardiographic measures. We previously identified four subtypes of fatigue using latent class analysis: Low/no fatigue, high general/low exertional, moderate general/moderate exertional, and high general/high exertional fatigue. We used multinomial logistic regression to determine the relationship between 1-SD higher echocardiographic parameters and fatigue subtypes, adjusting for age and sex.

Results:
Our sample was 54% female and 38% Black, with mean age of 77 ± 5.5 and LVEF of 61% ± 10. Adjusting for sex and age, worse longitudinal strain (OR = 1.55 [1.13, 2.13]), higher LV mass index (OR = 1.62 [1.23, 2.14]), and multiple measures of impaired diastolic function were associated with higher odds of having the high general/high exertional fatigue subtype compared to the low/no fatigue subtype
(Table)
. LV mass index and impaired diastolic function were also associated with higher odds of having the moderate general/moderate exertional fatigue subtype
(Table)
. Adjustment for additional sociodemographic and clinical characteristics attenuated associations, with only lateral E/e` significantly associated with the high general/high exertional fatigue subtype (OR= 1.81 [1.12, 2.91]), and the moderate general/moderate exertional fatigue subtype (OR=1.44 [1.10, 1.96]).

Conclusions:
Associations of fatigue subtype with cardiac structure and function are largely explained by other sociodemographic and clinical characteristics. Supplementary interventions targeting non-cardiac structural and functional mechanisms of fatigue may contribute to improved fatigue symptomatology in prevalent HF.
Abstract 17815: Effectiveness of Artificial Intelligence in Triaging Transmissions From Cardiac Implantable Electronic Devices
Authors: Bawa Danish , Ahmed Adnan , Kabra Rajesh , bansal shanti l , Olsen Eric , Colombowala Ilyas , Ghazal Rachad , Pothineni Naga Venkata , Darden Douglas J , Gopinathannair Rakesh , Lakkireddy Dhanunjaya R
Published: December 2023

Background:
Monitoring of cardiac implantable electronic devices (CIED) may cause tremendous burden on device clinics. Multiple transmissions for device alerts pose challenges in terms of triaging and clinical action. In this study we compared the effectiveness of artificial Intelligence (AI) as compared to Device technicians (DTs) in triaging the data from CIED.

Methods:
The study included remote transmissions from CIEDs being monitored at 78 clinics across USA from Jan to April 2023. Transmissions were initially processed by AI and were either dismissed, forwarded to the DT for review or forwarded directly to the device clinic. The data forwarded to the DT was analyzed and was either dismissed or forwarded to the device clinic with and without alerts. Transmissions were further classified based on urgency of response needed. About 15% of all transmissions processed by AI and DT were randomly examined by EP for accuracy.

Results:
A total of 42,534 patients with CIEDs generated 273,435 transmissions. Of these, 21% (57,345) transmissions were dismissed by AI - 17.8% (38,530) without alerts and 33.1% (18,815) with alerts. Of the transmissions dismissed, alerts for AT/AF represented the largest proportion in DT group, whereas alerts for pacing percentage was most seen with AI (table 1). Similar trends were seen with transmissions that were forwarded to clinics with pacing percentage dominating in AI group, and AT/AF detection in the DT group (table 2).

Conclusion:
In our study, compared to DT, AI algorithm was found to be more accurate in overall triage of remote transmission data and has the potential to improve the clinical efficiency of device clinics and care of patients with CIEDs.
Abstract 17840: Impact of Age and Sex on Mortality Trends of Infective Endocarditis in High-Income Countries
Authors: Hibino Makoto , Verma Subodh , Bhatt Deepak , Yanagawa bobby
Published: December 2023

Introduction:
Incidence of infective endocarditis may relate to a variety of background conditions which may vary depending on age groups and sex in a country. Its national trends in each age group and sex among high-income countries are still unclear.

Hypothesis:
We hypothesized that mortality from infective endocarditis is without sex differences and has improved in all age groups in both sexes among high-income countries.

Methods:
The WHO mortality database was analyzed to determine trends in mortality from infective endocarditis in the UK, Germany, France, Italy, Japan, Australia, the USA, and Canada from 2000 to 2021. Age-standardized and age-specific (≤49, 50-64, 65-79, ≥80 years) mortality rates per 100,000 persons in either sex were compared by using male-to-female ratio. Trends were analyzed using joinpoint regression.

Results:
Age-standardized mortality rates ranged from 0.40 (95%CI, 0.38, 0.42) in Japan to 1.29 (95%CI, 1.23, 1.35) in France in the most recent year and showed increasing trends in all studied countries except for Japan with decreasing trends and the USA with constant trends. During the studied periods, age-standardized mortality was male-dominant in all countries (p<0.0001). In age-specific analysis, three age groups (≤49, 50-64, 65-79 years) showed male dominancy in all countries while age group ≥80 years showed no sex difference except for France. Different mortality trends were identified between the sexes. In the USA, female mortality rates showed increasing trends in the age group ≤49 years while there were decreasing trends in the other three age groups. Male mortality rates showed constant trends in age groups ≤49 and 50-64 years while there were decreasing trends in the age group 65-79 and ≥80 years.

Conclusions:
Mortality from infective endocarditis was male-dominant in age groups less than 80 years old in all studied high-income countries. The different mortality trends between sexes among age groups need to be contextualized.
Abstract 17844: Association of Left Atrial Appendage Emptying Velocity With Type of Atrial Fibrillation
Authors: Bajaj Matthew , Smith Ross , Baghdadi Sarah , Tabak Carine , Parikh Riya , Enders Robert , Uhlich Cody , Morgan Ethan , Baer Jacob , Jiwani Sania , Harvey Christopher , Noheria Amit
Published: December 2023

Introduction:
Left atrial appendage emptying velocity (LAAev) is a surrogate for propensity of LAA thrombus and cardioembolic stroke. While atrial fibrillation (AF) is a known cause of reduced LAAev, relationship between type of AF and LAAev is unclear.

Hypothesis:
Long-standing persistent/permanent (LSP) AF is associated with reduced LAAev compared to paroxysmal/persistent AF.

Methods:
We searched transesophageal echocardiogram (TEE) reports of unique individuals from 2016-2022 at the University of Kansas Medical Center. LAAev was obtained from Doppler TEE images. Type of AF and other variables were extracted from medical charts. Association of AF type with LAAev was assessed using univariate and multivariate linear regressions. The multivariate model including all significant univariate predictors comprised age, sex, hypertension, coronary artery disease, peripheral arterial disease, history of venous thromboembolism, left atrial size, mitral regurgitation, left ventricular ejection fraction, rhythm during TEE, general anesthesia, eGFR, and platelet count.

Results:
Our study comprised 995 patients (female 38.1%, age 71.3±12.7 yr, white 89.3%) of whom 817 (82.1%) had history of AF (43.6% paroxysmal, 21.7% persistent, 16.8% LSP. Among the 817 patients with AF, history of LSP AF was associated with reduced LAAev both in univariate (β=-8.65±1.70 cm/s, p<0.0001) and multivariate (β=-3.77±1.98 cm/s; p=0.05) analyses.

Conclusion:
Even though CHA
2
DS
2
VASc score does not incorporate type of AF, we found LSP AF to be an independent marker for reduced LAAev. History of LSP AF should be considered in future AF-related stroke risk stratification models.
Abstract 17857: Demographic Disparities and Survival Outcomes in Primary Cardiac Tumors
Authors: Ramesh Nithya , Rajeshkumar Chitra Shanjeev Kumar , Sreemantula Harsha Sai , SHAIK AISHA SULTANA , Basit Jawad , Thirumaran Rajesh , Sundaram Vignesh
Published: December 2023

Introduction:
Secondary cardiac tumors are not uncommon as they are seen in almost 14% of patients with multiple distant metastases, the most common primaries being lung, breast, and hematological malignancies. Whereas, primary cardiac tumors are rare, and only about 10-25% of these are primary malignant cardiac tumors (PMCT). With this study, we aim to analyze the demographic disparities and the determinants of survival in this infrequent group of cardiac neoplasms.

Methods:
We obtained data from the Surveillance, Epidemiology, and End Results (SEER) database, 17 registries, Nov 2022 sub (2000-2020) for PMCT. A total of 713 samples were obtained after excluding patients with unknown age, race, and survival. Cox proportional hazard regression was used for multivariate survival analysis.

Results:
The mean age at diagnosis of PMCT was 55.13 ± 20.47 years, with the standard deviation reflecting a wide range and dispersion. Males accounted for 51.75% of the patients. Racial demographics showed a predominance of White (61%), followed by Hispanic (18.65%), Asian/pacific islander (10.09%), and Black (9.67%) populations. The most predominant types were sarcomas (62.27%) and lymphomas (27.48 %), with the rest 10.23% including tumors like mesothelioma and adenocarcinoma among others. Kaplan-Meier method was used to estimate overall survival (OS) at 1, 3 and 5 years to be 50.8%, 26.6% and 18% respectively. Cox regression demonstrated statistically significant differences in survival only with age and histopathology. Older patients [HR 1.008 (1.004-1.012)] had worse OS. Compared to sarcomas, lymphomas [HR 0.45 (0.36-0.55)] had better OS, while the group comprising the other 10.23% of PMCTs [HR 1.52 (1.17-1.96)] had worse OS. No statistically significant differences in survival were noted between males and females, and also between different racial groups.

Conclusions:
Despite being rare malignancies, PMCTs continue to have a poor prognosis. Though sex and ethnicity do not influence survival, older patients with sarcomas and other rare PMCTs have poorer outcomes. Further investigations aimed at improving survival in these at-risk groups are warranted. This information will also aid providers in advanced care planning.
Abstract 17859: Real World Cardiovascular Events With Next Generation Bruton's Tyrosine Kinase Inhibitors - An Updated Analysis
Authors: Poliner Michael C , Buck Benjamin , Ghazi Sanam , Chen Sunnia , Gambril John A , Sansoterra Stephen , Wiczer Tracy , Bhat Seema , Azali Leylah , Rosen Lindsay , Kalathoor Sujay , Zhao Qiuhong , Rogers Kerry , Kittai Adam , Grever Michael , Awan Farrukh , Ruz Patrick , Palettas Marilly , Ferdousi Mussammat , Kola-Kehinde Onaopepo , Sharma Sneha , Byrd John , Woyach Jennifer , Addison Daniel
Published: December 2023

Introduction:
Acalabrutinib and zanubrutinib are next generation Bruton’s tyrosine kinase inhibitors (BTKIs) associated with dramatic efficacy against B cell malignancies. In early trials, these BTKIs show less cardiac activity than ibrutinib. Yet, whether this is seen in longer term follow up is unknown.

Methods:
Leveraging the US Food and Drug Administration’s Adverse Events Reporting System (FAERS), we identified the relative incidence and predictive factors for atrial fibrillation (AF) after BTKI initiation from 2015-2022. Secondary outcomes were the reporting odds ratios (ROR) of major adverse cardiovascular adverse events (AEs), defined as AF, non-AF atrial arrhythmias, heart failure, conduction blocks, and ventricular arrythymias. In addition, using a registry cohort of 838 hematologic malignancy patients treated with ibrutinib or acalabrutinib from 2012-2020, we assessed the comparative incidence of new AF. Observed incident AF rates were compared with Framingham heart predicted rates, and absolute excess risks of AF were estimated. Multivariable logistic-regression models were used to identify factors associated with AF, other cardiac AEs, and mortality.

Results:
Among 21,435 events reported to FAERS during BTKI use, 3,453 were cardiovascular AEs. AF was the most reported AE (ROR 8.8, 95% CI, 8.3-9.4;
Figure A
). The likelihood (ROR) of cardiac AE reporting in next generation BTKI treated patients was >3.0 (
P
<0.05;
Figure A
) for AF events. Furthermore, in acalabrutinib treated registry patients, 9.7% developed incident AF over a median follow up of 42 months. In those without prior ibrutinib use, the weighted average incidence was 281 per 10,000 person years compared to the Framingham predicted rate of 103 per 10,000 person years (RR 2.73,
P
<0.001; AER 178;
Figure B
).

Conclusions:
These data suggest residual AF risk with next generation BTKIs.
Abstract 17867: Inward Displacement: A Novel CMR Technique for Quantification of Myocardial Wall Motion in Patients With Myocardial Infarction
Authors: De La Pena-Almaguer Erasmo , Ponce Aldo , Guajardo Jaime
Published: December 2023

Introduction:
Inward displacement (InD) is a novel parameter which quantifies myocardial wall motion (WM) by measuring the distance travelled by endocardial tracked points towards their corresponding center of the left ventricle in systole, calculated from 3 LAX views obtained during CMR.

Hypothesis:
InD using CMR is capable of obtaining global quantifiable measurement of WM abnormalities in patients with myocardial infarction (MI) as defined by Late Gadolinium Enhancement (LGE).

Methods:
We compared patients with history of MI documented by LGE CMR.Studies were acquired in a 1.5 T Siemens Aera (Siemens, Erlangen Germany) scanner with an 18-channel body array coil; Multi-planar ECG-gated cine CMR was obtained using a balanced steady-state free precession readout and LGE images were acquired using an IR prepped sequence 10 min after Gadolinium contrast injection. Offline analysis using automated endocardial LV contour detection was conducted for each of the LAX series and manual corrections were performed as required. InD was measured in mm and expressed as a percentage. Values were compared between MI patients and normal subjects, and analyzed using a Medis Suite workstation (Medis Medical Imaging BV, Leiden, The Netherlands).

Results:
We analyzed 646 segments in 38 patients of which 9 had past history of myocardial infarction. Global InD for healthy subjects was 28% vs 19% SEM 0.97, as compared to patients with MI (p:< 0.00001).

Conclusions:
InD is capable of quantification of abnormal motility in subjects with myocardial infarction, therefore producing an objective measure of LV segmental WM abnormalities, further studies are warranted.
Abstract 17871: Heterozygous Carriers of KCNQ1 Variants Associated With the Jervell-Lange-Nielsen Syndrome Have a Better Outcome When Compared to Other Type 1 LQTS Patients
Authors: Morgat Charles , Denjoy Isabelle , Fressart Veronique , Neyroud Nathalie , Messali Anne , Temmar Yassine , Porretta Alessandra Pia , Algalarrondo vincent , Surget Elodie , Leenhardt Antoine , Extramiana Fabrice
Published: December 2023

Background:
KCNQ1 mutations are associated with a risk of life-threatening torsade de Pointes. In the most common presentation, the mutation is heterozygous (type 1 LQTS). The homozygous expression causes type 1 Jervell-Lange-Nielsen syndrome (JLNS) with deafness and higher risk of sudden cardiac death.

Hypothesis:
Heterozygous carriers of JLN mutations would have different phenotype expression than patients carrying other KCNQ1 variants.

Aims:
To evaluate QTc duration and incidence of LQTS-related cardiac events according to genetic presentation.

Methods:
All patients with class 4 or 5 KCNQ1 variants for LQT1 or JLNS followed in our center (September 1993 to January 2023) were included. Lifelong Severe Cardiac events (ACA, SCD, appropriate shocks) and cardiac events (severe event + cardiac syncope) were collected.Quantitative data were compared between groups by ANOVA. Kaplan-Meier survival curves with the log-rank test were used to compare survival between the groups.

Results:
Three groups were identified among 741 LQT1 patients (55.3% female, age at diagnosis 25.2 years); 30 JLNS (group 1), 557 LQT1 carrying heterozygous mutations not found in the JLNS population (group 2), and 154 heterozygous carriers of mutations found in the JLNS population (group 3). QTc interval duration was different between groups (548±60ms, 467±36ms and 450±31ms in group 1, 2, 3 respectively, p<0.001).Patients carrying heterozygous JLN mutations (group 3) had a lower risk for cardiac events than patients with heterozygous non JLN mutations (group2) (HR 0.36 [0.23-0.57]; p<0.01) (Figure). Four parameters were independently associated with cardiac events: QTc (HR 1.01 [1.01-1.01]; p<0.01, haploinsufficiency (HR 0.57 [0.36-0.92]; p<0.05), pore localization (HR 1.63 [1.16-2.30]; p<0.01), and group (HR 0.50 [0.32-0.81]; p<0.01).

Conclusion:
Heterozygous carriers of JLNS variants have a lower risk of cardiac arrhythmic events that other type 1 LQTS patients.
Abstract 17923: Acute Limb Ischemia Due to Dissection and Thrombosis of Anomalous Right Subclavian Artery: A Rare Complication of Trans-Radial PCI
Authors: Farooq Waseem , Khan Raheel , Page Brian
Published: December 2023

Introduction:
Right subclavian artery (RSA) normally originates from brachiocephalic artery, but in 0.4-1.8% of the general population it may arise directly from the aortic arch distal to the left subclavian artery. We present a case of acute limb ischemia due to dissection and thrombosis of anomalous right subclavian artery (ARSA) following transradial PCI.

Case:
A 60-year-old female presented with anterior STEMI. Coronary angiogram was performed via right transradial approach. During the procedure the aortic arch was noted to be exceedingly tortuous and coronary artery catheterization was difficult. Post-procedure, patient reported right arm pain. Her right hand was cold with bluish discoloration, nonpalpable right radial, ulnar and brachial artery pulses which prompted a CTA of the chest and right upper extremity. Imaging revealed ARSA with dissection and thrombosis of the RSA extending to mid-brachial artery and absent opacification of radial/ulnar arteries. The patient underwent right brachial artery cutdown, axillary artery thrombectomy and stenting of ARSA dissection. Post procedure, her pulses were palpable with triphasic doppler signals in the radial and ulnar artery. Four months later, surveillance CTA of chest showed patent stent without additional evidence of dissection (Figure 1).

Discussion:
ARSA is a rare anatomical variation of the origin of the RSA but also the most common abnormality of the aortic arch. ARSA anomaly is often asymptomatic, but approximately 10% is associated with tracheo-esophageal symptoms; the most frequent among them is dysphagia. Only 60% of coronary procedures using transradial approach are successful in the presence of ARSA. This congenital variant makes it difficult to approach the ascending aorta by the right transradial route, as it requires the catheter to curve back to reach the aortic root. Prompt recognition of this anomaly during the procedure and alternate access routes can avoid these severe complications.
Abstract 17924: Machine Learning Analysis of the Atrial ECG in Patients With Persistent Atrial Fibrillation Predicts Long-Term Outcomes
Authors: Bohorquez Jorge , Zaatari Ghaith , Ganzer Patrick , Schwartz Odelia , Prasad Abhishek , Mitrani Raul , Goldberger Jeffrey
Published: December 2023

Background:
The surface Atrial ECG (A-ECG) time and frequency domains features are not currently used clinically in patients with persistent atrial fibrillation (PeAF). Machine Learning (ML) can provide novel insight into various data sources.

Research question:
Can ML analysis of the A-ECG predict the outcome of catheter ablation (CA) of PeAF?

Aim:
To use ML Tools to assess A-ECG prediction of CA outcomes in PeAF patients at 1 and 2 years.

Methods:
Thirty-two patients (age 63±9 years; 71% males) with PeAF underwent two 5-minute epochs of surface ECG; 4 were excluded for significant artifacts and 2 more for unrelated clinical issues. The Pre-CA A-ECG was derived by QRST subtraction and independent component analysis filtering and divided into 50% overlap 10-second windows for spectral analysis. A-ECG mean dominant frequency DF, mean organization index and median amplitude M-AMP were computed for each lead. Freedom from atrial arrhythmia AA (Responders) was assessed at one and two years. The two 5-minute segments per patient were included in the data set. Classification Learner (Mathworks Inc., Natick, MA, USA) was used to train classifiers, looking for the minimum number of features able to explain the outcomes. Once the best (2-3) features were identified, a MATLAB program was used to visualize the decision regions and correlate with ablation outcomes.

Results:
ML identified A-ECG features DF and M-AMP of V
1
to well explain outcome. Specifically, an Artificial Neural Network (ANN) with 1 fully connected hidden layer of size 7 can explain the data with 90.4% accuracy. The figure shows the datasets for year 1 and year 2 CA outcomes, superimposed with ANN decision regions, for Responders and non-Responders. High DF and high M-AMP are predictors of responders and Low DF low M-AMP for non-Responders.

Conclusion:
ML analysis of the A-ECG is a promising tool to predict Responders to PVI CA for treatment of PeAF. This predictive algorithm needs to be tested on a prospective cohort.
Abstract 17927: Acipimox Does Not Improve Endothelial Function and Insulin-Stimulated Vasodilation in Patients With Metabolic Syndrome
Authors: Sullivan Alexander , Shardelow Emily M , Aday Aaron W , Wells Quinn S , Freiberg Matthew S , Beckman Joshua A
Published: December 2023

Introduction:
Insulin resistance increases circulating free fatty acid (FFA) concentrations, which causes the release of inflammatory cytokines and induces endothelial dysfunction. Acipimox reduces FFA efflux and may improve insulin sensitivity and endothelium-dependent microvascular vasodilation.

Hypothesis:
We hypothesize that acipimox treatment will improve insulin-stimulated forearm blood flow (FBF) compared to placebo in volunteers with metabolic syndrome.

Methods:
We conducted a randomized, double-blind, placebo-controlled crossover trial (NCT00759291) evaluating 1-week of acipimox 250 mg QID on insulin-stimulated FBF in patients with and without metabolic syndrome.

Results:
Sixteen patients received acipimox (6 metabolic syndrome and 10 healthy controls). Patients with metabolic syndrome were older (63.8 vs 49.9 years old, p<0.001) with higher baseline insulin levels (15.9 vs 3.5 μU/mL, p=0.002), and trended towards higher BMIs (30.9 vs 24.6 kg/m
2
, p=0.083). Baseline insulin sensitivity by Homeostatic Model Assessment for Insulin Resistance (HOMA IR) differed between controls and those with metabolic syndrome (0.68 vs 3.28, p=0.001) but did not change with acipimox (p=0.540, Panel A). Insulin stimulation increased FBF in patients treated with placebo (p=0.01, Panel B) and acipimox (p=0.03, Panel C) but was not augmented by acipimox in participants with metabolic syndrome or healthy controls (Panel D and E). In multivariable-adjusted regression analysis, acipimox did not increase FBF, even after adjusting for baseline FBF and key baseline differences, including metabolic syndrome.

Conclusion:
Acipimox did not improve insulin sensitivity and had no effect on microvascular endothelial dysfunction assessed by insulin-stimulated FBF. This suggests that FFA modulation does not reverse microvascular dysfunction in patients with metabolic syndrome.
Abstract 17952: Age-Dependent Disparities on Associations of Socioeconomic, Lifestyle, and Metabolic Risk Factors With Major Cardiovascular Diseases and Mortality
Authors: Liu Yunan , xiao zilin , Zong Geng
Published: December 2023

Introduction:
Existing studies that quantified and compared the relative risks (RRs) and population-attributable risks (PARs) of modifiable risk factors for cardiovascular diseases (CVDs) and mortality by age have been limited to conventional factors and moderate PARs.

Methods:
335 540 participants from UK Biobank were stratified into <55 years (n=138 058), 55-65 years (n=140 224), and ≥65 years (n=57 258). The outcomes included incident CVD, coronary heart disease, heart failure (HF), ischaemic stroke, CVD mortality, and all-cause mortality.

Results:
The PARs for CVD cases and deaths were 11-24% for socioeconomic factors, 14-27% for lifestyle factors, and 34-41% for metabolic factors, which collectively measured 58-82%. Younger participants had significantly higher RRs of CVDs associated with socioeconomic, lifestyle, and metabolic risk factors (P
interaction
<0.05), and higher PARs from socioeconomic and lifestyle risk factors (Figure). For socioeconomic factors, area deprivation accounted for 10.5% of CVD deaths, while PARs of low education for CVDs and mortality ranged from 9.1% to 12.8%. Smoking accounted for 4.2-10.9% of PARs for CVDs and mortality, and other lifestyle factors such as unhealthy sleep (i.e. 5.6% for CVD mortality) and poor diet (i.e. 5.5% for IS) also contributed to moderate PARs. Metabolic risk factors accounted for 30.9% (28.6-33.2%) to 44.9% (39.0-50.7%) of CVD cases and deaths in all age groups, with hypertension being the predominant risk factor (22.4-32.5%).

Conclusions:
Socioeconomic and lifestyle risk factors showed stronger associations with CVDs and mortality among relatively younger people, while cases attributed to metabolic risk factors were consistently high in all age groups. This study further supports the role of an integrated CVD prevention strategy that combines social, behavioural, and medical approaches, especially among younger population.
Abstract 17962: Lenalidomide Associated Coronary Thrombosis
Authors: Kondapaneni Varshitha , Muthyala Krithika , Bardia Nikky , Riad Mariam , Omar Bassam , Malozzi Christopher
Published: December 2023

Background:
Immunomodulatory drugs (IMiDs) including lenalidomide, are associated with improved outcomes in multiple myeloma (MM), despite a small risk of vascular thrombosis.

Case:
A 49-year-old male with dyslipidemia, insulin-dependent diabetes and MM presented with chest pain radiating to both shoulders. He was diagnosed with IgA Kappa MM two and half years ago, and received 6-month induction chemotherapy with RVD (lenalidomide, bortezomib and dexamethasone), followed by stem cell transplant; currently maintained on Lenalidomide 10 mg daily. Other medications included Ozempic, Tresiba, atorvastatin and Xarelto for a remote history of deep vein thrombosis. Electrocardiogram (EKG) showed inferoposterior myocardial infarction (Fig. A). Vital signs were stable and physical exam was unremarkable. Labs revealed normal renal function, mild anemia and peak troponin of 117,556 pg/ml.

Decision-making:
He underwent prompt left heart catheterization which revealed proximal occlusion of a dominant left circumflex coronary artery (LCX) with thrombus throughout (Fig. B). Other vessels had mild disease. Decision was to proceed with primary percutaneous coronary intervention (PCI), including clot extraction and addition of eptifibatide for 12 hours given the large thrombus burden, the extensive ischemic changes on EKG and the active chest pain. He underwent successful thrombectomy and deployment of 2 drug-eluting stents in the LCX, resulting in TIMI 3 flow (Fig. 3). He recovered well and was discharged on previous meds in addition to Eliquis (to replace Xarelto), clopidogrel and aspirin.

Conclusion:
IMiDs have improved outcomes in MM patients, at a small expense of increased venous, and less commonly arterial, thrombosis. Patients should be monitored closely, preferably under the care of an experienced cardiooncologist, with strict control of their cardiac risk factors and consideration of antiplatelet therapy to avoid potential coronary thrombosis.
Abstract 17965: Hypertension Cascade and Social Determinants of Health in Women of Reproductive Age
Authors: Metlock Faith E , Teshome Biruk , Ogungbe Oluwabunmi V , Kwapong Yaa A , Hinneh Thomas , Sharma Garima , Commodore-Mensah Yvonne
Published: December 2023

Introduction:
Studies examining hypertension (HTN) among women of reproductive age (18-44 years) are sparse. We sought to evaluate HTN awareness, diagnosis, treatment, and social determinants of health among women aged 18-44 years, in a national registry.

Methods:
We analyzed cross-sectional data from participants enrolled in the American Heart Association Research Goes Red (RGR) Registry, an online platform powered by Verily, who responded to the Project Baseline and RGR enrollment questionnaires. HTN outcomes were examined as self-report awareness of blood pressure (yes/no), HTN diagnosis (yes/no), and current HTN medication use (yes/no). Multinomial logistic regression models were used to assess the association between HTN cascade outcomes and social determinants of health, adjusting for age.

Results:
In a sample of 2,422 adult women (mean age 36 ± 6 years); non-Hispanic Black women were 3-times more likely have HTN (adjusted Odds ratio [aOR] 3.08; 95%CI 1.67-5.66) and be treated (aOR 3.21; 95%CI 1.67-6.03) compared to non-Hispanic White women (
Table
). The odds of HTN prevalence were higher (aOR 1.82; 95%CI 1.11-2.94) and HTN awareness lower (aOR 0.62; 95%CI 0.39-0.98) among Hispanic women compared to non-Hispanic White women. Compared to college graduates, high school graduates had 43% lower odds of HTN awareness, 85% high odds of HTN diagnoses. Persons with lower income were more likely to have HTN diagnoses and treatment and less likely to be aware.

Conclusions:
Social determinants of health including race, education and income were associated with HTN cascade outcomes. Tailored public health interventions and policies for improving HTN outcomes among women of reproductive age must address social needs.
Abstract 17970: Incidence and Impact of Contrast-Associated Acute Kidney Injury in High-Bleeding Risk Patients Undergoing Percutaneous Coronary Intervention
Authors: Nicolas Johny , Sartori Samantha , Spirito Alessandro , Smith Kenneth , Vogel Birgit , Beerkens Frans , Edens Madison , Camaj Anton , Power David , Sharma Samin K , Kini Annapoorna , Dangas George , Mehran Roxana
Published: December 2023

Introduction:
Contrast-associated acute kidney injury (CA-AKI) is associated with increased morbidity and mortality following percutaneous coronary intervention (PCI). The incidence and impact of CA-AKI in high-bleeding risk (HBR) patients undergoing PCI remain unknown.

Methods:
We included patients who underwent PCI at a tertiary care center (Mount Sinai Hospital, NY) between 2012 and 2019. Patients were classified as HBR if they met ≥1 major or ≥2 minor criteria according to the Academic Research Consortium (ARC)-HBR definition. CA-AKI was defined according to the Acute Kidney Injury Network as an increase in serum creatinine by ≥50% or ≥0.3 mg/dL within 48 hours after PCI. The primary outcome was all-cause death within 1 year after PCI. Secondary outcomes included myocardial infarction, stent thrombosis, all-cause stroke, post-discharge and all bleeding.

Results:
Out of 16,966 patients, 7,295 (43.0%) were classified as HBR. CA-AKI occurred in 10.8% of HBR and 3.0% of non-HBR patients (p<0.001). Among HBR patients, those who had CA-AKI were younger and had a higher prevalence of anemia (81.4% vs. 67.7%, p<0.001), diabetes (66.8% vs. 52.8%, p<0.001), and kidney disease (83.8% vs. 50.8%, p<0.001) than those who did not. In contrast, fewer differences in baseline characteristics were observed in non-HBR patients with vs. without CA-AKI. The occurrence of CA-AKI was associated with an increased risk of all-cause death (HBR: HR 3.13, 95% CI [2.39-4.09]; non-HBR: HR 9.11, 95% CI [4.91-16.9]) and other adverse events in both HBR and non-HBR patients (Figure 1). Interestingly, a significant interaction was noted between HBR status and CA-AKI with respect to all-cause death (p-interaction=0.002).

Conclusions:
CA-AKI occurred at a significantly higher rates in HBR vs. non-HBR patients undergoing PCI and was associated with a significant increase in adverse events. Nonetheless, the impact of CA-AKI on all-cause death was lower in HBR vs. non-HBR patients.
Abstract 18023: What is the Relationship Between Summer Ambient Temperatures & Heart Failure Hospitalizations Among Low-Income Older Adults in the US?
Authors: Kuhrt Nathaniel , Bisno Daniel , Gandhi Poonam , Parthasarathi Ashwaghosha , Robinson David , Setoguchi Soko
Published: December 2023

Background:
A trend of warmer nights and higher daily minimum temperatures (T
min
) during summer is a leading indicator of climate change. The impact of increased T
min
on hospitalizations in low-income older adults with heart failure (HF) remains unknown.

Hypothesis:
Higher T
min
increases the risk of HF hospitalization among older adults and low-income patients will be more impacted.

Methods:
We conducted a time-stratified case-crossover study among older adults (age ≥ 66 years) hospitalized for HF during summer months (May-Sept) between 2008-2019 using 20% Medicare data. We employed bidirectional sampling to select controls. Data on daily T
min
from the Parameter-elevation Relationships on Independent Slopes Model were linked using patient zip code. The non-linear effect of T
min
was estimated using conditional logistic regression with a restricted cubic spline in all patients and by Medicaid eligibility.

Results:
Among 460,072 patients hospitalized for HF (mean age 78 years, 62% female, 86% white), the risk of HF hospitalization increased nearly linearly with higher T
min
(OR: 74 °F = 1.09 [1.09 - 1.10], 84 °F = 1.18 [1.16 - 1.20]) relative to the median summer T
min
(64 °F) (Figure 1). Patients with Medicaid dual eligibility experienced greater risk of HF hospitalization than their counterparts (Figure 2).

Conclusions:
Among older US adults, summer days with higher T
min
were associated with increased risk of HF hospitalization. Low-income patients were at greater risk, possibly secondary to behavioral differences. This effect may be mediated through physiological stress from warmer nights; increased ambient temperatures are associated with inflammation and myocyte damage.
Abstract 18042: Induction of Cardiac Reprogramming Following Injury Through Delivery of a Single Factor, PHF7
Authors: Garry Glynnis A , Dos Santos Matthieu , Tan Wei , Chen Kenian , Bezprozvannaya Svetlana , Liu Ning , Bassel-Duby Rhonda S , Olson Eric N
Published: December 2023

Direct reprogramming of resident cardiac fibroblasts into cardiomyocytes is an attractive strategy to restore cardiac function following myocardial infarction (MI). However, canonical and extensively studied reprogramming factors (e.g.
Gata4, Mef2c, Tbx5)
have shown to be ineffective in reprogramming adult human fibroblasts. Furthermore, current human cocktails require an excess of factors, limiting the clinical translation and safety of this technology. Recently, we undertook a large screen of gene regulatory factors and identified the epigenetic factor PHF7 as the most potent activating factor of adult human fibroblast reprogramming, and described its ability to bind and modify chromatin accessibility at cardiac super enhancers. In this manuscript, we describe the ability of PHF7 to activate adult reprogramming
in vitro
in absence of canonical reprogramming factors, with PHF7, MEF2C, and TBX5 (PMT) or PHF7 and TBX5 (PT) alone. These minimalist PHF7 cocktails induced broad and unique cardiac transcriptomes in comparison to canonical cocktails. Importantly, when overexpressed in isolation in fibroblasts, PHF7 strongly activated expression of several cardiac transcription factors, establishing its role as a cardiac master regulator. When delivered to the mouse heart following MI, minimalist PHF7 cocktails were found to significantly recover cardiac function and decrease fibrotic scar formation. Interestingly, delivery of PHF7 alone following MI was sufficient to improve cardiac function and induce remodeling through activation of
bona fide
reprogramming events
in vivo
as determined by genetic tracing of the

Postn
MCM

lineage. Here, we report for the first time the ability of a single reprogramming factor, PHF7, to induce fibroblast to cardiomyocyte reprogramming and recover cardiac function following injury
in vivo.
Abstract 18056: Transhepatic and Trans-Patent Foramen Ovale Ablation of Atrial Fibrillation in the Setting of Chronic Inferior Vena Cava Occlusion: Addressing Complex Anatomic Hurdles and Achieving Therapeutic Success
Authors: Ghanta SaiNikhila , Alotaibi Bader , Alderson Tyler , Amerneni Krishna Chaitanya , Priddy Erin , Vallurupalli Srikanth , ATREYA AURAS R
Published: December 2023

Background:
Rhythm control for atrial fibrillation (AF) is the preferred approach for symptomatic patients, particularly those with reduced ejection fraction. Catheter ablation primarily consists of pulmonary vein isolation via a transseptal approach. In patients with chronic occlusion of inferior vena cava (IVC), surgical ligation of IVC, or congenital venous system abnormalities, conventional femoral venous access may not feasible.

Case Report:
A 78-year-old male with history of Hypertension, diabetes, coronary artery disease, bilateral DVTs s/p thrombectomy, prior IVC stenting, presented with persistent, symptomatic AF on apixaban. Given a moderately reduced EF of 40-45%, amiodarone intolerance, and contraindication to other AADs, he was referred for catheter ablation. CT venogram showed chronically occluded IVC with patent hepatic veins, therefore transhepatic access to the right atrium was obtained. Transesophageal echocardiography (TEE) was planned for transseptal puncture; however, this showed an incidental PFO. This PFO was easily engaged using a manual modification of a VersaCross transseptal sheath and after entering the left atrium, the sheath was exchanged with a bi-directional sheath (Vizigo). Using this single left atrial access, pulmonary vein isolation and posterior wall isolation were performed. The transhepatic access site was closed with coil embolization to prevent track bleeding (figure 1).

Conclusion:
We present a case where successful AF ablation was achieved via percutaneous transhepatic approach, with improvised utilization of a conveniently located PFO. This was guided by pre-operative CT, and intra-operative TEE which allowed us to minimize any transseptal puncture related complications. The utilization of a multidisciplinary team comprising electrophysiologists, advanced imaging cardiologists and interventional radiologists is invaluable in executing complex procedures of this nature.
Abstract 18083: Surgical vs. Endovascular Revascularization for Chronic Limb Threatening Ischemia: A Meta-Analysis of Randomized Controlled Trials
Authors: Mufarrih Syed H , Khan Mohammad Saud , Qureshi Nada Q , Akbar Muhammad , Kazimuddin Mohammed , Aronow Herbert D
Published: December 2023

Background:
Timely revascularization is essential for limb salvage and to reduce mortality in patients with chronic limb threatening ischemia (CLTI). The optimal revascularization strategy, in patients who are candidates for surgical bypass and endovascular therapy, remains uncertain, despite recent publication of 2 randomized controlled trials (RCTs).

Research Question:
Do outcomes differ following surgical and endovascular revascularization for CLTI?

Methods:
PubMed, Web of Science and the Cochrane Library were searched to identify RCTs comparing outcomes of endovascular versus surgical revascularization for CLTI. Data were pooled for major outcomes including mortality, re-intervention, major amputation, and major adverse cardiovascular events (MACE). Aggregate risk ratios with 95% confidence intervals were calculated using a random-effects model.

Results:
Three RCTs with 2,627 patients (1,312 endovascular; 1,315 surgical) were included in the meta-analysis. Of these, 1,864 (70.9%) of patients were male and 347 (13.2%) were older than 80 years of age. When comparing endovascular and surgical revascularization, there was no significant difference in 30-day mortality (RR: 0.74 [0.38,1.48], p=0.40), long- term mortality (RR: 1.02 [0.87, 1.19], p=0.82), re-intervention (RR: 1.24 [0.74, 2.07], p=0.41), major amputation, (RR: 1.16 [0.87, 1.54], p=0.31), therapeutic cross-over (RR: 0.92 [0.37, 2.26], p=0.85), or MACE (RR: 1.07 [0.92, 1.26], p=0.37).

Conclusion:
Current data suggest there is no difference in outcome following endovascular and surgical revascularization for CLTI. A planned patient-level meta-analysis may provide further insight.