bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12873: Arrhythmogenic and Ischemic Cardiopathy Mimics Covid-19 Myocarditis
Authors: Shakhmatova Olga , Balakhonova Tatyana , Mironov Nikolay , Makeev Maxim , Blankova Zoya , Butorova Ekaterina , Mironov Vsevolod , Panchenko Elizaveta P
Published: June 2023

A 63-year-old man with a history of hypertension, hyperlipidemia and severe COVID-19 3 months earlier presented with NYHA class III-IV heart failure (HF) and intermittent claudication. Three months before, patient noted increasing dyspnea. SARS-CoV2 was verified. CT scan showed pneumonia; the severity of disease required dexamethasone and tocilizumab. Atrial fibrillation (AF) and LV EF 30% were first detected. CT scan disclosed left atrial appendage (LAA) thrombosis. Despite anticoagulants, 3 weeks later the patient developed lower limbs ischemia. Ultrasound and CT scan showed multiple thrombosis in the abdominal aorta and lower limbs arteries (Figure A). Surgery for limb ischemia was not performed due to a further decrease of LV EF to 18%. At that point, diagnosis was SARSCoV2-induced myocarditis. Нe visited our hospital for second opinion. ECG showed AF with mean heart rate (HR) of 158/min (B). Careful history collection suggested a longer AF duration which was missed and untreated due to lockdown. CRP, troponin were normal. NT-proBNP was 9326 pg/ml. After strict rate control was achieved, LV EF became 23%. Cardiac MRI with delayed gadolinium contrast revealed no fibrosis or active myocarditis (C). Angiography showed stenosis >70% of the left anterior descending artery (D). After PCI, LV EF became 27%. The patient was discharged on guideline-recommended optimal medical therapy. Three months later LV EF became 30%, six months later - 47%. Thrombus in LAA was dissolved. Pulmonary vein isolation and cardioversion were performed. One week later LV EF was 60%. Currently, the patient has stable sinus rhythm and no signs of HF for > 6 months. Thus, COVID-19 could contribute to the progression of atherosclerosis, modify the substrate and aggravate the severity of AF, but it was not the only cause of a serious illness in the patient. COVID-19 also had an indirect negative impact - delay the detection of cardiac pathology and cause its underdiagnosis under the guise of "post-COVID".
Abstract 12876: Post-Transcriptional Regulation of Cardiac Fatty Acid Metabolism by the Tandem Zinc Finger Mrna Binding Protein Tristetraprolin
Authors: Keykhaei Mohammad , Chang Hsiang-Chun , Sato Tatsuya , Sawicki Konrad , S. Shapiro Jason , Tatekoshi Yuki , Ardehali Hossein
Published: June 2023

Introduction:
Heart failure (HF) is characterized by a switch from predominantly fatty acid (FA) to glucose metabolism, but the molecular pathways involved in this switch are not totally understood. Identification of novel pathways regulating cellular metabolism could facilitate the development of new therapies. Tristetraprolin (TTP) is a tandem zinc finger protein that binds to AU-rich elements (AREs) in the 3’ untranslated region (UTR) of mRNA molecules and causes their degradation. Its expression is regulated by mTOR, a key protein involved in cellular metabolism. Our preliminary data suggested a link between TTP and FA metabolism in the heart. Thus, we hypothesized that TTP regulates cardiac FA metabolism and that its deletion prevents the development of HF by increasing FA uptake and metabolism in the heart.

Results:
TTP downregulation in cultured cardiomyocytes resulted in higher palmitate uptake and oxidation, while its overexpression had the opposite effect. Since TTP regulates its targets at the mRNA level, we studied the mRNA levels of ARE-containing genes involved in lipid metabolism, and found that only PPARα mRNA to be significantly increased with TTP downregulation. Furthermore, we demonstrated that TTP physically interacts with PPARα mRNA, and the activity of a luciferase reporter harboring full-length PPARα 3’UTR is increased with TTP downregulation. Additionally, PPARα mRNA is stabilized with TTP knockdown. We then studied the role of TTP in cardiac FA metabolism using mice with cardiac-specific (cs) TTP knockout (KO). Consistent with our in vitro data, cs-TTP KO mice displayed higher fatty acid utilization compared to littermate controls but maintained normal cardiac function at baseline. We also demonstrated a significantly higher TTP levels in failing human and mouse cardiac samples, suggesting that TTP levels are altered in HF.

Conclusion:
Our results demonstrate that TTP is a novel regulator of cardiac FA metabolism through its effect on PPARα, and that its levels are increased in HF. Thus, modulation of TTP may be a viable therapeutic approach for HF.
Abstract 12899: A Patient-Specific Fluid-Structure Interaction-Based Approach to Improve Surgical Predictability in Bicuspid Aortic Valve Patients
Authors: Wanna Charles , Kolanjiyil Arun , Chandran Krishnan B , Kim Hyunggun , Kitkungvan Danai , Grande Allen Kathryn J , Ramzy Danny , McPherson David D , Prakash Siddharth K , Govindarajan Vijay
Published: June 2023

Introduction:
BAV is the most common congenital heart defect affecting ~1.4% of the population. It also brings with it an increased risk of aortopathy, including coarctation, aneurysm, dissection, and accelerated calcification with either stenosis or aortic insufficiency. Quantifying BAV function, altered blood flow, and corresponding hemodynamic forces and their impact on accelerated BAV deterioration improves BAV diagnosis. Predicting how these parameters improve post-interventions may improve surgical predictability and long-term outcome.

Methods:
A patient-specific modeling protocol based on MRI-based patient data and strongly coupled fluid-structure interaction (FSI) technique was developed to evaluate BAV. Flow via left ventricle, BAV, ascending and descending aorta (Fig A-B) was simulated to obtain biomechanical insights near valve vicinity and study its effects downstream. Diseased anatomy was simulated, and biomechanics compared with virtual interventions that included 1) surgical aortic valve replacement (SAVR), 2) valve sparing root replacement (VSRR) with a sinus graft, and 3) VSRR without sinus graft (Fig C).

Results:
Our model predictions showed that viscous dissipation (or energy loss) was the greatest in the diseased BAV indicating a high energy loss that substantially reduced post-virtual interventions. Specifically, energy loss reduced by 2.55-, 1.65-, 2.52- folds for SAVR, VSRR-sinus, and VSRR+sinus respectively at peak-systole (Fig. E-H). Interestingly, while SAVR produced the largest orifice area (OA), OA of BAV marginally reduced post VSRR during peak-systole (Fig. I)
Conclusions:
These studies provide insights into BAV dynamics and may help determine the optimal interventions for a patient. These insights may help improve diagnosis and surgical predictability, optimize treatment, and help with clinical decision making for BAV patients at risk.
Abstract 12914: Effect of Home-Based versus Center-Based Cardiac Rehabilitation Among Attendees From a Large Healthcare System During the Covid-19 Pandemic
Authors: Chacin Suarez Audry , Hama Tomoaki , Bissen Thomas G , Bonikowske Amanda R , Jallow Haddijatou , Rogers Michael J , Ryskey Abigail L , Salstrand Rosalyn M , Scales Robert , Shultz Adam M , Smith Joshua R , Sweere Kara A , Taylor Bryan J , Wheatley-Guy Courtney , Olson Thomas P
Published: June 2023

Introduction:
The COVID-19 pandemic imposed significant constraints to delivery of cardiac rehabilitation (CR) with many programs relying on delivery of home-based cardiac rehabilitation (HBCR). We sought to compare the effects of HBCR vs conventional center-based CR (CBCR) on clinical metrics, health-related quality of life, and modifiable risk factors in CR patients.

Methods:
Retrospective cohort study comparing 511 HBCR patients (March 2020-April 2021; COVID-19 pandemic) and 765 age and sex matched CBCR patients (Jan 2018-Jan2020; immediately pre-pandemic) from the Mayo Clinic Health System. We assessed changes in clinical outcomes before and after CR. HBCR included 12 sessions (one in-person assessment + weekly education and exercise monitoring phone/video calls). Conventional CBCR included 36 sessions (3 sessions per week for 12 weeks). Continuous data were described as mean±SD, and comparisons of change between groups were assessed with linear regression adjusting for baseline value, in complete cases.

Results:
HBCR and CBCR patients were 65±14 yrs old (68% male) and 65±14 yrs old (67% male) respectively. HBCR patients demonstrated greater improvement in exercise days/week whereas CBCR patients had greater improvement in exercise min/day. HBCR patients had greater improvement in blood glucose with a trend towards greater improvement in non-HDL cholesterol. Both groups demonstrated similar improvement on nutrition, depression, health-related quality of life surveys and total, LDL and HDL cholesterol, as well as HbA1c between the groups.

Conclusions:
Collecting clinical metrics during the COVID-19 pandemic proved challenging due to the initial closure of out-patient services. For patients in whom data was captured, HBCR appears to be similarly effective at improving several intermediate outcomes compared to CBCR. HBCR may be an effective alternative for improving clinical outcomes in patients who are unable to participate in CBCR.
Abstract 12956: Pulmonary Vein Thrombosis: A Rare Complication Following Infection With SARS-CoV-2
Authors: Suresh Mithun R
Published: June 2023

Case Presentation: 49 year old male with past medical history of hypertension who presented with dyspnea and nasal congestion of three days duration. Testing for SARS-CoV-2 was positive. ECG revealed sinus tachycardia with an incomplete right bundle branch block. D-dimer was elevated 3,388 ng/mL and CT pulmonary angiogram revealed thrombosis of a right lower lobe pulmonary vein extending to the posterior aspect of the left atrium along with consolidation in the right lower lobe concerning for pulmonary infarct versus congestion in the setting of pulmonary venous thrombosis. The patient was admitted and started on intravenous unfractionated heparin. Echocardiogram performed later in the day revealed left ventricular segmental wall motion to be globally hypokinetic with mildly reduced ejection fraction of 45%. Left atrium was severely enlarged. No thrombus could be seen in the left atrium or ventricle. Bubble study revealed no evidence of atrial septal defect or patent foramen ovale. The next day after admission, his symptoms had resolved and he was back to his baseline, so he was discharged. No supplemental oxygen was required. Heparin was transitioned to apixaban, and metoprolol succinate and lisinopril were initiated. Cardiac monitoring during the hospitalization did not demonstrate any arrhythmias. Etiology of his pulmonary vein thrombosis was ultimately felt to be due to coagulopathy secondary to COVID-19 given that the patient’s medical history was otherwise unremarkable.

Discussion: This case describes a rare complication due to infection with SARS-CoV-2. Pulmonary artery thrombi are common with SARS-CoV-2 infection, but pulmonary vein thrombi are rare. With thrombus extending to the left atrium, cardiac monitoring was performed and did not reveal evidence of atrial fibrillation or atrial flutter. With no other identifiable cause of the thrombus, the etiology was likely due to SARS-CoV-2 infection.
Abstract 12963: Increased Readmission Rates in Cardiogenic Shock Patients Who Received Temporary Mechanical Circulatory Support: A Call to Targeted Action
Authors: An Crystal , Dewan Krish , Zhou Guangjin , Maigrot Jean-Luc , Koroukian Siran , Xu Samantha , Eid Noha , Soltesz Edward G , Weiss Aaron J
Published: June 2023

Introduction:
Patients hospitalized for cardiogenic shock who survive to discharge are at high risk of readmission. Patients requiring temporary mechanical circulatory support (tMCS) during their index admission reflect a high risk population. Therefore, we aim to quantify and compare the 90-day readmission trends for patients who did and did not receive tMCS at their index hospitalization for cardiogenic shock.

Methods:
From 2016 to 2019, patients with an admission diagnosis for cardiogenic shock were identified in the Florida State Inpatient Database. Patient characteristics, management at index admission, and causes of readmission were analyzed.

Results:
In total, 31,986 patients had an index admission for cardiogenic shock, of which 5,229 (16.3%) were treated with tMCS. In a 90-day cohort analysis of 18,317 patients, 6,119 (33.4%) patients were readmitted. Among patients that received tMCS during their index admission, 1,583 (51.2%) were readmitted compared with 4,536 (29.8%) that did not receive tMCS. Repeat readmissions for cardiogenic shock were present in 490 (15.9%) of patients who received tMCS at index admission compared with 232 (1.5%) of patients who did not have tMCS at index hospitalization. There was no statistically significant difference in the readmission rates across the four years of the study.

Conclusions:
Despite significant improvements in medical therapy and mechanical support in recent years, the rate of readmission after index admission for cardiogenic shock has not

decreased. Trends in 90-day readmission demonstrate that patients who received tMCS at their index hospitalization for cardiogenic shock were not only more likely to be readmitted, but also more likely to be readmitted specifically with a repeat diagnosis of cardiogenic shock. Patients who require tMCS at their index admission for cardiogenic shock should be targeted as a high risk group to prevent readmission.
Abstract 12969: Impact of Race and Ethnicity on Hospital Morbidity and Resource Utilization in Acute Care Pediatric Cardiology Patients
Authors: Hills Brittney K , Gal Dana B , Plummer Sarah T , FIGUEROA MAYTE , Krishnan Anita , Sawyer-Gray Andrea M , Grabinski Johnisha , Pater Colleen , Patel Sonali S , Schiller Amy J , Madsen Nicolas
Published: June 2023

Introduction:
Disparities in healthcare outcomes are well described among patients of different races and ethnicities including pediatric cardiology. Multicenter studies examining these outcomes are lacking in pediatric acute care cardiology. We hypothesize that Black and Hispanic patients admitted to pediatric acute care cardiology units have increased hospital and acute care encounter length of stay (LOS) and complication rates compared to their White and non-Hispanic peers.

Methods:
Utilizing the Pediatric Acute Care Cardiology Collaborative registry, we examined all acute care cardiology unit encounters from 2/1/2019 to 7/30/2021 ending in discharge to home or death. Hospitalizations were categorized by race and ethnicity. In-hospital complications included health-care acquired infections, iatrogenic incidents, pneumonia, sepsis, seizures and stroke. Data were analyzed for differences in LOS and complication rates using chi-square and ANOVA testing. We used Bonferroni correction to establish a significance threshold of 0.007.

Results:
Analysis included 30,404 hospitalizations from 29 centers. There were 16,233 White (70%), 4,533 Black (19%), 919 Asian (4%) and 1,629 other races (7%) encounters. There were 23,592 (78%) non-Hispanic and 4,583 (15%) Hispanic encounters. Black patients had higher rates of premature birth (21.4%) and low birth weight (10.7%), compared to White patients (15.6% and 5.9% respectively, p<0.0001). Both non-Hispanic Black and Hispanic patients had longer total hospital and acute care LOS than non-Hispanic White patients. Complication rates analyzed by race trended towards significance between Black and White patients, and Hispanic patients had a higher complication rate than non-Hispanics. (
Table 1
)

Conclusions:
Despite improved outcomes for patients with congenital and acquired heart disease, significant racial and ethnic disparities continue to exist. Directed efforts are needed to achieve equitable results.
Abstract 12970: Predictors of Stroke and Mortality in Children Who Undergo Ventricular Assist Device Placement: An Evaluation of Pre And Post-Operative Risk Factors Linked From the Advanced Cardiac Therapies Improving Outcomes Network (action) and Pediatric Cardiac Critical Care Consortium (pc4) Registries
Authors: Perry Tanya , Rosenthal David N , Lorts Angela , Zafar Farhan , Zhang Wenying , Vanderpluym Christina J , DeWitt Aaron G , Reichle Garrett , Banerjee Mousumi , Schumacher Kurt
Published: June 2023

Introduction:
Ventricular assist devices (VAD) have improved outcomes in children with advanced heart failure. However, despite improvements in adverse event rates, mortality and early post-VAD stroke remain important consequences. We sought to determine pre and post-operative factors that increase the risk of these outcomes utilizing data linked from the ACTION and PC4 registries.

Methods:
ACTION and PC4 registries are audited, comprehensive, encounter-based registries of patient course and outcomes for pediatric heart failure and pediatric cardiac critical care respectively. Data from patients who underwent initial VAD placement in each registry from 8/2014-7/2020 were linked using indirect patient identifiers. Patient demographics, heart disease, pre and post-operative ICU courses and outcomes were compiled. Appropriate descriptive and univariate statistics assessed association of patient factors with hospital mortality and stroke. Multivariable logistic regression sought independent associations with these outcomes.

Results:
248 ACTION subjects were linked to a matching patient in PC4 with 98% match concordance. Median age was 7.7 years (1.5-15.5), weight 21.3kg (9.1-58) and 56% male. The cohort had 66% LVAD, 23% Single ventricle VAD and 10% BiVAD. Of the devices, 52 (21%) were Berlin EXCOR, 95 (38%) intracorporeal continuous flow, and 30 (12%) temporary continuous flow. The primary diagnosis was congenital heart disease in 35% of patients. Overall, 32 patients (13%) had a stroke and 45 patients (18%) died prior to discharge. Multivariable analysis found risk factors for mortality included only congenital heart disease (OR=3.78 [95%CI: 1.16-12.29], p=0.027), INTERMACS profile 1 (OR=6.51 [95%CI: 1.08-39.26], p=0.041), post-operative hepatic dysfunction (OR=37.35 [95%CI: 4.39-317.76], p<0.01) and stroke (OR=5.33 [95%CI: 1.4-20.31], p=0.014). For stroke, no significant independent predictors were identified.

Conclusion:
Critical care therapies are not independently associated with post-VAD hospital death or stroke. Post-operative liver injury and stroke were associated with mortality.
Abstract 12973:
Ulk1
Inhibition Ameliorates
Ttntv
Cardiomyopathy in Adult Zebrafish via Repairing Dysregulated Autophagy and Cellular Senescence
Authors: Zhu Ping , Li Jiarong , Ding Yonghe , Islam Shahidul , Xu Xiaolei
Published: June 2023

Background:
TITIN truncational variants (TTNtv) is the predominant genetic factor for dilated cardiomyopathy (DCM). Therapeutic development for TTNtv DCM has been confounded by allelic heterogeneity (AH), i.e. while truncations in the C-terminal A-domain (TTNtv-As) are pathogenic, truncations in the N-terminal Z-disc domain (TTNtv-Zs) are largely benign. Molecular mechanisms underlying AH remain elusive, partially because of the lack of an
in vivo
animal model.

Objective:
We enquire whether zebrafish is a faithful vertebrate model for deciphering AH in TTNtv DCM and for therapeutic development.

Methods and Results:
Through comparing phenotypes among a series of
ttntv
-As and
ttntv
-Zs in adult zebrafish, we detected DCM-like phenotypes only in
ttntv
-As but not
ttntv
-Zs. Similar to human TTNtv DCM and corresponding rodent models, zebrafish
ttntv
-As manifest decreased ejection fraction, enlarged heart size, myofibril dys-organization, compromised exercise capacity, and dysregulated autophagy. Moreover, we noted exaggerated cardiac senescence at the later stage of the pathogenesis of
ttntv
DCM. Because AH in autophagy dysregulation was also detected in homozygous
ttntv-A
zebrafish embryos, we screened autophagy genes and identified
ulk1
inhibition that is able to repair the dysregulated autophagy. A similar repairing effect of
ulk1
inhibition on dysregulated autophagy was noted in an adult heterozygous
ttntv-A
model, which is sufficient to attenuate the cardiac senescence and improve cardiac function.

Conclusion:
Our data suggested adult zebrafish as the first vertebrate model that is able to recapitulate AH in TTNtv DCM patients. Conserved phenotypes including autophagy dysregulation are recapitulated in this lower vertebrate model, while cardiac senescence has been suggested as a novel pathological event. Genetic studies in this animal strongly suggest that repairing autophagy dysregulation is a therapeutic avenue for TTNtv DCM, and identified
ulk1
as a candidate therapeutic target gene.
Abstract 12990: A Strange Case of Pericarditis: Pericarditis With Pneumopericardium Caused by a Misplaced G Tube
Authors: Mahesh Ashwin , Padrao Eduardo M , Huh Kangwook , Bustos Brian P , Meng Joyce
Published: June 2023

Introduction:
Most cases of pericarditis are idiopathic, consideration of other differentials remains essential. We present a 53 year-old-male who presented with pericarditis with pneumopericardium caused by a misplaced gastrostomy tube (G-tube).

Case Description:
A 53 year-old-male with autosomal dominant polycystic kidney disease on hemodialysis, encapsulating peritoneal sclerosis with percutaneous G-Tube for decompression, presented to the hospital with an acute sharp left sided chest pain. Vitals were unremarkable except for tachycardia. Physical exam revealed abdominal distension with tenderness elicited in the right upper quadrant and epigastric regions, with a G-tube in place with no erythema or tenderness along skin. A rub or pulsus paradoxus was not appreciated. EKG showed sinus tachycardia with diffuse ST elevations suggestive of acute pericarditis. Blood work including troponins were unremarkable except for BUN of 104 mg/dL. In suspicion of uremia, daily hemodialysis was initiated with prednisone. Patient did not respond to therapy despite improvement in uremia. CT imaging revealed a pneumopericardium [Tan arrow - Figure 1] which was in communication with the G-Tube, dislodged from its initial position [White arrow - Figure 1]. The G-Tube was later clamped and an echocardiogram revealed a small posterior pericardial effusion without tamponade. Patient later underwent surgical removal of the G-Tube followed by endoscopic suture closure of the fistula with symptom resolution.

Conclusion:
Although idiopathic pericarditis encompasses most of the cases, concerns should be raised for those patients that have atypical presentations, comorbidities and who do not respond to initial therapy.
Abstract 13: Myocardial Metabolic And Electrolyte Derangements Linked To PEA Rearrest
Authors: Irish Laken , Abboud Bisan , Akino Lydia , Almahameed Soufian , Ziv Ohad , Poelzing Steven , Piktel Joseph S , Laurita Kenneth R , Wilson Lance D
Published: June 2023

Background:
Cardiac rearrest after return of spontaneous circulation (ROSC) is a significant barrier to successful resuscitation, making it a high priority for emergency care research. Regardless of initial arrest rhythm, rearrest is commonly due to pulseless electrical activity (PEA). However, mechanisms underlying PEA rearrest are poorly understood. Previously, myocardial contractile function during ischemia-reperfusion has been tied to alterations in extracellular sodium (Na+) and calcium (Ca2+) concentrations.

Objective:
To determine physiological predictors and explore potential mechanisms underlying susceptibility to PEA rearrest.

Methods:
Acute myocardial infarction (AMI) induced by left anterior descending artery (LAD) occlusion was followed by 8 min of VF, then pigs were resuscitated (defibrillation, CPR, epinephrine) to ROSC and the LAD was reperfused. Pigs were instrumented to measure metabolic variables from arterial and coronary sinus venous blood gases, electrolytes, and hemodynamics. Subjects that had PEA rearrest (n=7) were compared to those that did not rearrest (n=4).

Results:
Hemodynamic and primary arrest characteristics were similar between PEA and no rearrest groups, including ischemia duration, time to ROSC, CPR events, and epinephrine administration. At ROSC, hemodynamic and metabolic variables including pH, myocardial lactate consumption, myocardial arterial/venous oxygen difference were also similar between groups. Importantly, post-ROSC myocardial lactate consumption was significantly increased in the PEA group (3.9 vs. 0.5 mmol, p<0.03) as was coronary sinus Na+ (147 vs. 135 mEq/L, p<.03); however, coronary sinus Ca2+ was significantly reduced (1.9 vs. 2.3 mEq/L, p<.01 ). Taken together, these data suggest that metabolic substrate depletion may promote local electrolyte shifts contributing to mechanical dysfunction underlying PEA.

Conclusion:
PEA rearrest was associated with increased myocardial lactate consumption and derangements in cardiac Na+ and Ca2+ in a translational model with well controlled arrest characteristics. Improved understanding of mechanisms underlying post-ROSC electrolyte shifts may identify novel mechanisms and therapeutic approaches to prevent and treat PEA.
Abstract 13005: Tips and Tricks for Successful Trans-EVAR TAVR: Buddy Up
Authors: Ghosh Priyanka , Shah Amit , Sporn Daniel , Reitknecht Felice , Kaluski Edo
Published: June 2023

Trans-catheter aortic valve replacement (TAVR) via tortuous iliofemoral access with prior endovascular aneurysm repair (EVAR) is challenging.

83 year old male with severe aortic stenosis and prior EVAR was evaluated for TAVR with 29 mm Edwards Sapien 3 valve. Right femoral access was planned with ipsilateral protection. CT angiogram showed EVAR with tortuosity, rigidity, and graft protrusion concerning for advancement of equipment. The right iliofemoral system was accessed using a 4F radial sheath, Judkins JR4 catheter, and 0.035” angled glide wire exchanged for Amplatz Superstiff wire. A 30 cm 6F sheath was advanced over the wire followed by additional Superstiff buddy wire. Two Proglides were deployed over two separate wires, without rewiring. To overcome friction on removing second Proglide, predilatation of the arteriotomy should have been performed with a 8-9F sheath. An 8F sheath was advanced over one of two Superstiff wires. A V18 0.018” wire was placed in the ipsilateral protect site, exchanged for a third Superstiff wire to ease insertion of the Edwards sheath. The sheath was advanced followed by successful valve deployment. After removing the delivery system, two pre-deployed Proglides closed the arteriotomy site.

Detailed planning enables operators to overcome challenges using the following strategies: 1) avoid unnecessary rewiring of the iliofemoral system by use of a 30 cm 6F sheath, 2) predilate the TAVR arteriotomy with larger sheaths prior to deploying Proglides to avoid limited manipulation space for Proglides and two wires, 3) use buddy wires if TAVR sheath advancement has failed over one wire and consider additional buddy wires from within the TAVR arteriotomy or ipsilateral protection site, and 4) use ipsilateral protection to avoid challenges of crossing over from contralateral iliofemoral. Although trans-EVAR TAVR remains somewhat unpredictable, these strategies may simplify and reduce the inherent failure rate of such procedures.
Abstract 13012: Atrial Fibrillation Symptom Improvement Following De Novo Catheter Ablation: Trajectories and Predictors of Symptom Resolution
Authors: Reading Turchioe Meghan , Volodarskiy Alexander , Guo Winston , Taylor Brittany , Hobensack Mollie , Pathak Jyotishman , Slotwiner David J
Published: June 2023

Introduction:
Atrial fibrillation (AF) symptom relief is a primary indication for catheter ablation, but the impact of ablation on AF symptoms is not well characterized. The objective of this study was to describe AF symptom documentation in electronic health records (EHRs) pre- and post-ablation and identify correlates of post-ablation symptoms.

Methods:
We evaluated EHRs of AF patients (n=1293) in a large, urban health system from 2010-2020 who underwent ablation and had at least one encounter note within 30 days of the ablation. We extracted structured data about patient demographics, medications, diagnoses, and encounters, and symptom data from unstructured clinical notes using natural language processing. We used Cochran’s Q tests with post-hoc McNemar’s tests to determine whether the prevalence of symptoms differed significantly pre- and 3, 6, 9, and 12 months post-ablation. We used bivariate logistic regression models to estimate the unadjusted odds of symptom prevalence by personal or clinical characteristics at 6 and 12 months post-ablation.

Results:
Compared to pre-ablation, the prevalence of any AF symptom decreased but anxiety and weakness increased post-ablation (Table 1). The unadjusted odds of any symptoms 12 months post-ablation were associated with Black/African-American (odds ratio [OR]=0.35; 95% confidence interval [CI]=0.14-0.92) or another race (OR=0.39, 95% CI=0.16-0.95) versus Asian race, Hispanic/Latino ethnicity (OR=2.40, 95% CI=1.28-4.39) versus non-Hispanic/Latino, antiarrhythmic medication (OR=0.62, 95% CI=0.46-0.80) versus no medication, smoking history (OR=0.70, 95% CI=0.53-0.94) versus no history, and heart failure (OR=0.73, 95% CI=0.55-0.97) versus no heart failure.

Conclusion:
Symptom patterns post-ablation are heterogeneous. Findings warrant confirmation with larger, more representative datasets, which may be informative for patients whose primary goal for undergoing an ablation is symptom relief.
Abstract 13042: Circulating Obesity Associated Pro-Fibrotic Protein as a Brown Adipokine Promotes Liver and Heart Fibrosis in Obese Nash Mice
Authors: Hsiao Yung-ting , Shimizu Ippei , Yoshida Yohko , Minamino Tohru
Published: June 2023

Introduction:
Non-alcoholic steatohepatitis (NASH), driven by the obesity epidemic, has become the most common form of liver disease. Excessive calorie intake inflames visceral adipose tissue, and let this organ produce pro-inflammatory adipokines. Brown adipose tissue (BAT) is another type of fat pad equipped with the thermogenic capacity, and the role of BAT-derived adipokines (BATokines) in pathogenesis of NASH remains to be explored.

Hypothesis:
Various kinds of white adipokines are known in obesity. However, BATokines in pathogenesis of NASH still remain to be explored.

Methods:
To identify the function of obesity associated pro-fibrotic protein (OAFP), we generated a murine obese NASH model by imposing a high fat diet in C57BL6/NCr mice, and murine OAFP knockout (KO) model. We also conducted functional in vitro studies with differentiated brown adipocytes.

Results:
Here we identified a secreted type pro-fibrotic protein OAFP, as one of the BATokines contributing for the promotion of liver fibrosis in a murine NASH model. We also found that OAFP increased in circulation of human NASH patients. Genetic models with OAFP suppression ameliorated liver fibrosis, in contrast, OAFP gain of function model enhanced this in our NASH model. In addition, we found that cardiac fibrosis also developed in the NASH model, and this was ameliorated in OAFP-KO model, indicating the pathogenic role of OAFP in heart failure with preserved ejection fraction (HFpEF). Our biobank studies also showed OAFP increased in HFpEF patients. We also found ER stress-mediated signaling enhanced the production of this BATokine.

Conclusions:
Our results testing mice models, and human studies indicate suppression of OAFP becomes therapies for HFpEF and NASH.
Abstract 13052: Clinical Utilization of Natriuretic Peptide Levels Independent of WATCH-DM Score for Heart Failure Prediction in a Large-Scale Asian Diabetic Population - A Multi-Center Cohort Study
Authors: Hung Chung-Lieh M , Lin Jiun-Lu , Wang Chih-Yuan , Wu Yen-Wen
Published: June 2023

Introduction:
Type 2 diabetes is an important co-morbid condition strongly associated with the risk of developing heart failure (HF). Risk scores such as the WATCH-DM score that predict the occurrence of HF among diabetes patients are largely based on data collected from white ethnicities.

Hypothesis
Here, we sought to investigate surrogate markers for predicting HF among type 2 diabetes patients of Asian ethnicities

Methods
Data on baseline characteristics (according to WATCH-DM scoring), laboratory information (mainly sugar profiles, renal function, and Natriuretic Peptide [NP]: N-Terminal Pro-B-Type Natriuretic Peptide [NT-proBNP], and 12-lead surface electrocardiography (ECG) findings were collected among adult Asians (aged ≥ 20 years old) with type 2 diabetes free from HF diagnosis from a multi-center cohort. We analyzed the clinical indicators for incident HF during the entire course of follow-up.

Results:
Among 6,668 study participants (mean age: 62.9±14.3 years, 49.3% male), the overall HF incidence was 13.7% (n=916) during a median of 3.6 years ([25
th
~75
th
]: 1.86~5.57 years) of follow-up period. Using backward multivariate selection, we identified aging (adjusted odd ratio [aOR]: 1.21, per 10-year increment), higher body mass index (aOR: 1.11, per 5 kg/m
2
increment), history of myocardial infarction (aOR: 2.26), atrial fibrillation rhythm (aOR: 1.72), prolonged QRS duration (aOR: 1.08, per 10-ms increment) by ECG (according to WATCH-DM score), higher NT-proBNP level (aOR: 1.47, per 1 log-transformed unit increment), and renal impairment (aOR: 1.06, eGFR per 10 mL/min/1.73m
2
decline) as independent predictors of incident HF. The optimal cutoff of NT-proBNP in predicting HF incidence was 77.3 pg/mL.

Conclusions:
In this large-scale survey, our findings highlighted the baseline clinical indicators and the potential utilization of ECG and NP in HF prediction among diabetic Asians. Additionally, we demonstrated that optimal predictive value of NP to be remarkably lower than contemporary HF cutoff independent of WATCH-DM score.
Abstract 13054: The Novel Galnac-Conjugated Rnai Trigger Downregulates Apoc3 and Triglyceride Levels in Humanized Liver Mouse Model
Authors: Shah Vivek , Molyneaux Michael , Samarsky Dmitry
Published: June 2023

Background:
Hypertriglyceridemia is a critical risk factor for coronary artery disease. Apolipoprotein C-III (APOC3), produced by liver hepatocytes, regulates triglyceride (TG) levels. We studied effect of novel GalNAc-conjugated APOC3 targeting RNAi trigger (STP125G) on APOC3 and TG levels in humanized liver mouse model.

Methods:
In dose response study, female uPA-SCID mice (n=4 mice/group), group 1 received PBS control, group 2 received 10mg/kg and group 3 received 30mg/kg STP125G, subcutaneously on day 0. Liver biopsies, plasma and serum samples were collected at week 2. In duration response study, male uPA-SCID mice (n=4 mice/group/timepoint), group 1 received PBS control and group 2 received 10mg/kg STP125G, subcutaneously on day 0. Liver biopsies, plasma and serum samples were collected for each group at weeks 2, 4, 8 and 12. Human APOC3 mRNA (qPCR) and protein (ELISA) levels were measured in liver biopsies and plasma samples, respectively. TGs and total cholesterol (TC) levels were measured in serum samples.

Results:
In dose response study, animals reported significant suppression of mRNA and reduction of plasma protein levels in 10mg/kg (88% and 91%, respectively) and 30mg/kg (92% and 98%, respectively) dose groups as compared to control group (
p
<0.001). Animals also reported significant reductions in TGs and TC levels at 10mg/kg (25% and 33%, respectively) and 30mg/kg (43% and 44%, respectively) dose groups as compared to control group (
p
<0.05). In duration response study, treated animals reported significant suppression of mRNA levels at week 2 (83%), week 4 (85%) and week 8 (48%) as compared to control group (
p
<0.0001). Treated animals reported significant reduction in plasma protein levels at week 2 (82%;
p
<0.0001), week 4 (89%;
p
<0.0001) and week 8 (70%;
p
=0.0005) as compared to control group. At week 4, treated animals reported significant reduction in TGs (53%; p=0.0079) and TC (36%; p=0.0072).

Conclusions:
The studies demonstrated that a single administration of STP125G, in a humanized liver mouse model, results in significant suppression of human APOC3 mRNA and plasma protein levels that lasts for up to 8 weeks. It also suggests treatment with STP125G results in lowering of triglycerides and total cholesterol in the treated animals.
Abstract 13057: Efficient Diagnosis and Reduced Medical Costs by the 0-hour/1-hour Algorithm for Patients With Suspected Non ST Elevation Acute Myocardial Infarction in the Emergency Department
Authors: Sasaki Shun , Inoue Kenji , Shiozaki Masayuki , Handa Keigo , Watanabe Ryo , Minamino Tohru
Published: June 2023

Background:
European Society Cardiology guidelines recommend that the 0-hour/1-hour (0-1h) algorithm using high sensitivity cardiac troponin T (hs-cTnT) improves the early triage of patients with chest pain. To avoid the unnecessary admission including coronary angiography leads to decrease in medical costs. However, the economic consequences of applying the algorithm are unknown.

Purpose: We compared the medical expenses to be affected by the implementation of this algorithm.

Methods:
We compared two prospective cohort study (one hospital has been implemented the 0-1h algorithm (cohort A), and the other has not (cohort B)) using a de-identified electronic medical record based on the database of health claims in Japan. Eligible patients were measured of hs-cTnT because of chest pain. We excluded patients with STEMI, heart failure or terminal kidney function. The 0-1h algorithm stratified patients into “rule-out,” “rule-in,” and “observation” based on the measurements of hs-cTnT levels at baseline and absolute changes at 1hour. Resource utilization (RU) and predicted diagnostic accuracy of the 0-1h algorithm compared to usual care in the emergency department (ED) were estimated. We then assumed that we implemented the 0-1h algorithm in cohort B by applying the diagnostic accuracy of the 0-1h algorithm to cohort B and compared it with the collected data achieved within 30 days of the index visit.

Results:
Consecutive 472 in cohort A (69.6 +/- 14.1 years old, 59.5% male) and 427 in cohort B (65.8 +/- 14.4 years old, 59.0% male) were followed. The prevalence rates of AMI were 7.4% and 3.3%. The sensitivity and specificity for the 0-1h algorithm in cohort A were 100% (91.1%-100%) and 95.0% (94.3%-95.0%), compared to 92.9% (69.6%-98.7%) and 89.8% (89.0%-90.0%) for usual care in cohort B. Assuming that the 0-1 algorithm is implemented in cohort B with the same diagnostic accuracy, emergency CAG is expected to be reduced by 50%, with a reduction in healthcare costs of approximately $ 1,500 to $ 2,500 per person. As a result, the implementation of the 0-1hr algorithm is expected to reduce medical costs by $ 31,500 to $ 52,500 in cohort B.

Conclusions:
The 0-1h algorithm dose not only efficiently stratifies risks, but can also be expected to reduce medical costs.
Abstract 13087: Right Atrial Adaptation in Pulmonary Hypertension: Pressure-Volume and Histological Analysis
Authors: Wessels Jeroen N , Van Wezenbeek Jessie , de Rover Jari , Smal rowan , Llucia-Valldeperas Aida , Celant Lucas , Marcus J. Tim , meiboom lilian , Groeneveldt Joanne , Niessen Hans , Goumans Marie Jose J , Bogaard Harm J , Vonk Noordegraaf Anton , Strijkers Gustav , Westerhof Berend , De Man Frances S
Published: June 2023

Introduction:
Pulmonary arterial hypertension (PAH) is associated with increased right atrial (RA) pressure and volume. We hypothesized that these patients have RA hypertrophy, increased stroke work, fibrosis and stiffness and that RA adaptation falls short in severe right ventricular (RV) diastolic stiffness (end-diastolic elastance; E
ed
).

Methods:
RA pressure-volume loops were created through a novel method in controls (N=9) and patients (N=27). RA volume was measured on a magnetic resonance transverse stack of slices and pressure with catheterization. In a larger cohort of controls (N=20) and PAH patients with low (N=39) or high E
ed
(N=41), RA volume was measured on a 4-chamber view and stroke work estimated through multiplying active emptying by A-wave pressure. Atriovenous stiffness was measured as the slope from minimal pressure and volume and V-wave. In PAH-patients (N=4) and controls (N=5) that died or underwent heart- and lung-transplantation, we collected RA tissue to study hypertrophy and capillarization (CD31 and wheat germ agglutinin staining) and fibrosis (Masson’s trichrome staining).

Results:
Averaged pressure-volume loops show RA dilatation in patients and elevated pressure, especially during atrial contraction. Atriovenous stiffness was similar in PAH and controls, but higher in high E
ed
when compared to low E
ed
patients. RA stroke work and pressure rise during atrial contraction were higher in PAH. However, when corrected for E
ed
, these parameters were decreased in high E
ed
patients, indicating RA-RV uncoupling. Histological analysis showed increased RA hypertrophy, number of capillaries per cardiomyocyte and perivascular/interstitial fibrosis in PAH patients.

Conclusions:
In PAH patients there is RA hypertrophy and increased stroke work. In severe RV diastolic stiffness, RA adaptation falls short and RA-RV uncoupling occurs. Although there is increased fibrosis, atriovenous stiffness is not different between PAH and controls.
Abstract 13088: Peak Systolic Strain Rate is Associated With Incident Heart Failure in the General Population - The Copenhagen City Heart Study
Authors: Vyff Frederikke A , Johansen Niklas D , Skaarup Kristoffer G , Lassen Mats H , jensen gorm B , Schnohr Peter , Mogelvang Rasmus , Biering-Sørensen Tor
Published: June 2023

Introduction:
Peak systolic strain rate (SrS) reflecting the maximal acceleration of the systolic deformation during systole derived from speckle tracking echocardiography has been demonstrated to be a significant predictor of cardiovascular outcomes in patients with myocardial infarction. However, the prognostic utility of SrS in individuals with low cardiovascular risk is unknown.

Hypothesis:
We hypothesized that SrS was associated with incident heart failure (HF) in the general population.

Methods:
The 5th Copenhagen City Heart Study is a prospective cohort study. All participants had echocardiography performed. Exclusion criteria were prevalent HF and inadequate image quality for SrS assessment. The multivariable Cox model included variables from the Atherosclerosis Risk In Communities (ARIC) HF risk score and left ventricular ejection fraction.

Results:
A total of 4,013 participants were included in the final study sample. The mean age was 56 years and 2,290 (57.1%) were female. The mean SrS was 1.11 s
-1
. During a median follow-up of 5.4 years, 101 participants (3%) developed HF. In multivariable analysis, decreasing SrS was significantly associated with HF (HR 1.32 (95% CI: 1.12; 1.56) p= 0.001) per s
-1
decrease) (Figure). The optimal cutoff value of SrS < 1.028 s
-1
was linked to a 4-fold risk of HF (HR 4.38 (95% CI: 2.92; 6.56). Incidence rate of HF was 2.4 per 1000 person-years (95% CI: 1.77; 3.36) when SrS ≥ 1.028 and 10.7 per 1000 person-years (95% CI: 8.35; 13.63) when SrS < 1.028. The cutoff had a sensitivity of 63.4% (95% CI: 53.2; 72.7), a specificity of 72.1% (95% CI: 70.6; 73.5), and a negative predictive value of 98.7% (95% CI: 98.2; 99.1). Finally, SrS added incremental value to the ARIC HF risk score with a net reclassification index of 0.264 (95% CI: 0.086; 0.415).

Conclusions:
SrS was significantly associated with the development of HF in the general population and provided incremental value to the ARIC HF risk score.
Abstract 13089: Noninvasive Panoramic Mapping of Rotations and Rate With Adenosine Challenge Predicts Ablative Outcomes in Persistent Atrial Fibrillation Patients
Authors: Calvo David , Salinas Lucia , Martinez-Camblor Pablo , Alvarez Rut , Martinez Amaia , Soroa Miguel , García-Iglesias Daniel , Berenfeld Omer
Published: June 2023

Introduction:
Ablation outcomes in persistent atrial fibrillation (AF) are suboptimal.

Hypothesis:
Characterizing the adenosine effects in non-invasive panoramic mapping can guide ablation to increase long-term freedom of arrhythmias.

Methods:
Persistent AF patients (N=25, mean±SD: 15.3±8.4 mo) underwent non-invasive panoramic mapping (CardioInsight, Medtronic) twice at baseline (B1 and B2) and then during 12 mg adenosine (Ado) peak effect. Reproducible rotational domains (≥2 rotations) were thereafter ablated (3.2±1.3 sites/patient). Data were exported to determine dominant frequencies (DFs) using short FFT technique with 0.1 Hz resolution and correlation with simultaneous intracardiac recordings (p<0.001).

Results:
Areas with stable DFs at B1 and B2 (
Abstract 13109: Pacemaker Mediated Contact Allergy to Thiuram and Paraphenylenediamine
Authors: Menon Vivek , Chib Anjula , jaikumar likhitesh , Sharifi Sasha , Thang Sophia , Smith Christopher , Volansky Paul , JAGTAP DO MANDAR , Pidikiti Nanni
Published: June 2023

Introduction:
Allergic contact dermatitis to cardiac rhythm devices (CRD) has been reported sporadically from the early 1980s to present. Most of these cases involve allergic reactions to direct contact agents such as nickel, silicone, titanium, cobalt, epoxy resin, mercury, polysulfone, polyurethane and polychloroparaxylene. Our case is unique in that the strongest allergic reaction was with thiuram and P-phenylenediamine (PPD), which has only been documented once since the advent of permanent pacemakers (PPM)

Case:
58-year old male with history of hypertension and coronary artery disease presented with palpitations and fatigue. Holter monitoring demonstrated tachybrady syndrome and he underwent dual chamber PPM implantation (L331 Accolade
TM
MRI - Boston Scientific Inc). Eight weeks later he presented with new onset rash around his neck and the surgical site. PPM allergy was suspected, as patient did not respond to empiric antibiotics. He underwent PPM and lead extraction. Decision was made to observe patient without immediate re-implantation of PPM. Skin patch testing was strongly positive to thiuram and PPD. Final diagnosis of allergic contact dermatitis was made and patient’s condition improved.

Discussion:
Thiuram and PPD, the raw materials used in the production of silicone rubber, encase pacemaker headers and leads. Individuals typically get sensitized to PPD by using hair dyes or temporary henna tattooing. The device used in our patient contained the same compounds. No studies to date document the true incidence and/or prevalence of allergic reactions to pacemaker components. One non-randomized retrospective trial reported benefits of skin patch testing before CRD implantation in patients who had a history of allergy to metals. Future trials are warranted to further evaluate the efficacy and benefits of pre-implantation skin testing and if it would benefit the population as a whole.