bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 188: Association Between Mean Arterial Pressure and Neurological Outcomes in Comatose Cardiac Arrest Patients: A Multicenter Observational Study
Authors: Lee Byungkook , Lee Dong H
Published: December 2023

Aim:
The target blood pressure has not been determined in comatose cardiac arrest patients. Therefore, we aimed to investigate the association between mean arterial pressure (MAP) and six-month neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors who underwent targeted temperature management (TTM).

Methods:
We analyzed the prospective registry of comatose OHCA survivors who underwent TTM. The arterial blood pressure measured every 1 hr in a 48-hour period after return of spontaneous circulation (ROSC) was recorded between January 2019 and May 2021 in the registry. We calculated the MAP during 48 hr and at every 6 hr. Patients with an MAP < 65 mmHg or missing MAP data for more than 6 hr were excluded. We conducted a multivariable logistic regression analysis to determine the association between MAP and neurological outcomes and conducted a linear mixed models analysis to reveal the interaction between MAP over time and neurological outcomes. The primary outcome was six-month neurological outcomes with Cerebral Performance Category (CPC), which was dichotomized into good (CPC 1 or 2) and poor (CPC 3-5) neurological outcomes.

Results:
Of the 394 included patients, 255 patients (64.7%) had poor neurological outcomes. MAP did not differ between the neurological outcome groups (poor [89 mmHg, 82-97 mmHg] vs. good [89 mmHg, 84-95 mmHg]; p = 0.498). MAP was not independently associated with poor neurological outcomes (odds ratio, 1.010 [95% confidence intervals, 0.978-1.042]) adjusted with age, sex, body mass index, pre-existing illness (coronary artery disease, diabetes, pulmonary disease, renal impairment), witnessed collapse, first-monitored rhythm, cardiac etiology, downtime, lactate level after ROSC, and sequential organ failure assessment score. Repeated MAP measurements every 6 hr did not differ between the neurological outcome groups (p = 0.403), and the interaction between MAP every 6hr and neurological outcomes was not significant (p = 0.136).

Conclusions:
MAP during 48 hr after ROSC was not associated with the six-month neurological outcomes. MAP measurements every 6 hr during 48 hr after ROSC did not differ between neurological outcome groups, and the changes in MAP over time were not associated with neurological outcomes.
Abstract 18810: Mitochondria-Rich Extracellular Vesicles From Stem Cell-Derived Cardiomyocytes Restore Bioenergetic Metabolism of Ischemic Myocardium in a Porcine Chronic Heart Failure Model
Authors: Ikeda Gentaro , Ueyama Tsuyoshi , Tzng Eileen , Takashima Hiroyuki , lyins jennifer , Bayardo Nathan , OBrien Connor G , Yang Phillip C
Published: December 2023

Introduction:
The disruption of mitochondrial energy metabolism underlies the pathophysiology of ischemic heart failure. We previously demonstrated that intramyocardial injection of mitochondria-rich extracellular vesicles (M-EVs) derived from iPSC-derived cardiomyocytes (iCMs) transfers mitochondria and non-mitochondrial biologics into recipient cardiomyocytes. This process stimulates mitochondrial biogenesis and enhances functional capacities in murine and porcine acute myocardial infarction (MI) models. However, the therapeutic potential and underlying mechanism in chronic heart failure models remain to be assessed.

Method:
M-EVs were isolated from the conditioned medium of human iCMs using differential centrifugation. A total of 11 Yorkshire pigs underwent myocardial ischemia for one hour via balloon occlusion of the left anterior descending artery (Week-0). At week-4, 1.0 x 10
11
M-EVs or PBS control were administered transendocardially to the peri-infarct region (PIR) using a percutaneous catheter delivery system (Biocardia, Inc, CA). Cardiac functions and scar size were analyzed by cardiac MRI with gadolinium contrast at week-4 (pre-injection) and -8 (post-injection). Myocardial tissue samples were collected from the PIR and remote non-ischemic areas at week-8. Proteomic analysis and single-nucleus RNA sequencing were performed to investigate comprehensive protein and gene expression profiles of the myocardium.

Results:
Left ventricular (LV) ejection fractions were significantly decreased at Week-4 (32.7±5.4%). M-EV treatment significantly improved absolute LVEF from week-4 to -8 in the treatment vs. non-treatment groups, +3.15% vs. -4.99%, respectively, (p<0.0001). No significant difference was observed in the scar size. Multiomic analysis of proteomes and single-nucleus transcriptomes suggested restoration of dysregulated cardiometabolic protein profile and mitochondrial energy metabolism in the myocardium.

Conclusion:
M-EV-mediated transfer of mitochondria and enriched proteins augmented LV dysfunction in the pig chronic MI model. M-EV therapy may represent a novel biologic approach that directly targets cardiac metabolism by restoring mitochondrial function and cellular bioenergetics.
Abstract 18822: Disparities in Access and Long-Term Survival in St Elevation Myocardial Infarction Patients the Brazilian Public and Private Health Services- Victim Registry
Authors: Lima Ticiane Clair R , Oliveira Jussiely C , Oliveira Jeferson C , Barreto Ikaro D , Martins-Filho Paulo R , Oliveira Laís C , Arcelino Larissa A , silveira Fabio S , Almeida-Santos Marcos A , Prado Luís Flávio A , Moraes Enilson V , FERREIRA EDUARDO , Mendonça José T , Nascimento Thiago A , Barreto Rafael V , Sousa Antonio S , Barreto-Filho José Augusto
Published: December 2023

Introduction:
This study aims to evaluate the impact of disparities in access to specialized services and reperfusion therapies on the long-term survival of patients with ST-elevation myocardial infarction (STEMI) treated under the Unified Health System (SUS) and those covered by Private Healthcare Insurance (PHI). Scarce data exist for regions characterized by significant socioeconomic disparities.

Methods:
The VICTIM registry was utilized to compare disparities among STEMI patients treated under SUS and PHI. The registry involved all Percutaneous Coronary Intervention (PCI) hospitals in Sergipe, the smallest state in Brazil, consisting of one facility for SUS patients and three facilities for private patients. We examined the patient's opportunity to reach a PCI hospital, reperfusion data from 2014 to 2018, and long-term survival through telephone interviews between 2020 and 2021. Long-term outcomes evaluated using the Gehan-Breslow test with Dunn correction, and significance level p<0.05.

Results:
Out of the 1.082 patients evaluated, 893 (82.53%) received treatment under SUS, while 189 (17.47%) covered by PHI. SUS patients had to travel a distance six times greater from the site of pain to the PCI hospital (58.2 km vs. 8.7 km; p<0.001); had lower rates of reperfusion (49.8% vs. 67.2%; p<0.001) and primary PCI (47.2% vs. 66.5%; p<0.001); and often had to pass through at least one institution before reaching the PCI hospital (76.1% vs. 41%; p<0.001). The time from symptom onset to seeking help was similar for both groups, but the overall time from symptom onset to arrival at the PCI hospital was longer for public service patients (10.3h vs. 5.3h; p<0.001). Fibrinolytic therapy was underused (2.5% vs. 1.1%; p=0.411). Long-term survival results displayed in Figure 1.

Conclusions:
SUS patients exhibited higher long-term mortality rates, longer travel distances, and reduced access to reperfusion therapies compared to PHI patients, indicating disparities in care.
Abstract 18827: Emergency Department Threat Perceptions and PTSD Symptoms After Suspected Stroke
Authors: Kumar Sitara P , Wu Clark Adriana , Jerez Victor , Ellis Julia , Keys McKay Charles , Aguirre Jennifer , Murdock Margaret E , Diaz Keith M , Kronish Ian M
Published: December 2023

Introduction:
Stroke is a leading cause of death, physical, and psychological disability in the United States. One in four stroke survivors develop significant PTSD symptoms (PTSS), which can influence disease outcomes. It is important to identify factors that increase early psychological distress and subsequent PTSS development, such as threat perceptions in the emergency department (ED). Understanding the relationship between ED threat and PTSS may help identify areas for improving early stroke care. The purpose of this study was to determine whether ED threat perceptions influence PTSS development at 1-, 6- and 12-months after suspected stroke.

Methods:
The sample consisted of patients (n = 203, 48% female, 59.4 ± 15.5 years) who presented to the ED of an academic medical center for suspected stroke. ED threat was assessed in-hospital using the ED Threat Perceptions questionnaire, and PTSS were assessed at 1-, 6- and 12- months post-stroke using the PCL-5 tool. Linear regression was used to assess the association between ED threat and PTSD symptoms, adjusting for demographics, depression, chronic disease severity (Charlson index), and stroke severity (NIHSS).

Results:
In unadjusted analyses, ED threat perceptions were associated with higher PTSS at 1- (β=0.42, 95% CI [0.16-0.68] p=0.002), 6- (β=0.32, 95% CI [0.07-0.58], p=0.013), and 12-mo (β=0.44, 95% CI [0.15-0.72], p=0.003), independent of demographics, stroke severity, and depressive symptoms when expressed continuously. In nested models, addition of ED threat perceptions to a model including demographics and stroke severity significantly improved the model (Δ-2 log likelihood = 7.15, df=1; p=0.007), indicating independent effects in the association of ED threat perceptions with PTSD symptoms beyond stroke severity.

Conclusions:
ED threat perceptions were associated with higher PTSS at 1-, 6-, and 12-months after suspected stroke even after accounting for clinician-measured stroke severity. This suggests that early threat perceptions contribute to PTSD risk above and beyond the physical impact of the event. These results indicate the importance of the ED environment and provide a target for future interventions to minimize the development of PTSD symptoms post-stroke.
Abstract 18832: Early Leadless Pacemaker Implantation in a Case of Severe Cervical Spinal Cord Injury
Authors: ElSaygh Jude , Bradel Laura , Berman Jeremy
Published: December 2023

Introduction:
Bradycardia is a frequent cause of morbidity and mortality in spinal cord injury (SCI) patients and optimal timing of permanent pacemaker implant is unclear.

Case Summary:
A 67-year-old female with no cardiac history was admitted for fall of uncertain etiology complicated by severe cervical SCI and neurogenic shock. Despite emergent surgical decompression, the injury resulted in quadriplegia. Post-operatively, bradycardic arrest occurred requiring resuscitation and dependence on dopamine infusion. Rhythm strip from showed p-p slowing followed by high grade atrioventricular block with multiple blocked p waves. A decision was made for early intervention with implantation of a Micra leadless pacemaker (LPM) (Medtronic, Minneapolis, MN) for both hemodynamically significant bradycardia and backup to prevent bradycardic arrest. A LPM was successfully implanted without complication on hospital day 8. The pacemaker was set to VVI 60. Post operatively, the patient required intermittent pacing and tolerated dopamine weaning.

Discussion:
Bradycardia in SCI patients, especially those with high cervical and complete SCI, occurs due to unopposed parasympathetic activity, resulting in baseline sinus bradycardia. Even more concerning is the risk for sudden and unpredictable sinus arrest and/or AV block, which is a leading cause of mortality in the first year after SCI. While initial management of bradyarrhythmia in SCI patients may respond to pharmacologic intervention, temporary and/or permanent pacing may be indicated. Acute SCI patients may not be ideal candidates for traditional pacemakers since ICU and infectious complications are common in this cohort, but LPMs have extremely low risk of implant site and infectious complications and can be utilized earlier in the hospital course. Our case showcases this strategy of early leadless pacemaker implantation. Further study is needed to better evaluate the safety and efficacy of this strategy.
Abstract 18844: LncRNA MIR17HG and Peripheral Arterial Disease
Authors: batan sonia , Ganta Vijay C
Published: December 2023

Introduction:
VEGF-A, a potent angiogenic growth factor has been extensively investigated as a therapeutic for Peripheral artery Disease (PAD). Recently, we have shown that increased levels of the anti-angiogenic VEGF-A isoform (VEGF165b) decreases perfusion recovery by inhibiting a truncated miR-17-20a cluster in ischemic endothelial cells and macrophages. Since miR-17-20a cluster is produced from the lncRNA-MIR17HG, we wanted to determine the role of VEGF165b-MIR17HG axis in regulating ischemic angiogenesis and perfusion recovery in PAD

Methods:
Hypoxia serum starvation in Human Umbilical vein endothelial cells (HUVECs) and Human microvascular endothelial cells (HMEC-1) was used as an
in vitro
PAD model.

Results:
Since LncRNAs have multiple transcript variants, we first determined if a specific MIR17HG transcript is present in human chronic limb threatening ischemia (CLTI) vs. normal. Bioinformatics analysis of a recently published bulk RNA-Seq data showed that among 17 annotated transcripts, transcript-1 (MIR17HG-Tr1) is specifically expressed in normal and CLTI muscle biopsies. Analysis of FPKMs showed a numerical increase in MIR17HG-Tr1 in CLTI vs. normal biopsies. qPCR analysis using primers specific for MIR17HG-Tr1 showed significantly higher expression of MIR17HG-Tr1 in HSS-HUVECs and HSS-HMEC-1 vs. their respective controls. VEGF165b inhibition in HSS-HUVECs and HSS-HMECs significantly decreased MIR17HG-Tr1 expression compared to IgG controls. To determine whether MIR17HG functions independent of its miRNA cluster, we silenced MIR17HG-Tr1 and examined miR17-92 cluster expression. Silencing MIR17HG-Tr1 didn’t significantly affect the expression of miR-17-92 cluster members either under normoxic or HSS conditions.
In vitro
tube formation assay showed that silencing MIR17HG-Tr1 significantly increased the angiogenic capacity of HSS-HUVECs vs. control.

Conclusion:
This data indicates VEGF165b inhibits MIR17HG-Tr1 to induce ischemic angiogenesis independently of its miR17-92 cluster. Ongoing studies are aimed at understanding the mechanism by which 1) VEGF165b regulates MIR17HG-Tr1 and 2) MIR17HG-Tr1 regulates revascularization in PAD.
Abstract 18878: Right Heart Valves Affected by Cancer-Related Non-Bacterial Thrombotic Endocarditis as Potential Cause of Pulmonary Embolism
Authors: alladi sai swetha , Klarich Kyle W , Kurmann Reto , Hodge David , Dariusz Patrzalek , Houghton Damon , Wysokinska Ewa , Wysokinski Waldemar E
Published: December 2023

Background:
Ca-NBTE primarily affects the mitral valve (MV) and aortic valve (AV), with rare involvement of the right heart valves. Premortem descriptions of this condition are limited to a few case reports. This study presents an initial clinical series focusing on patients with Ca-NBTE specifically affecting their right heart valves. We describe the underlying cancers, types of valve lesions, and associated embolic complications.

Patients and Methods:
A electronic search of medical records (March 31, 2002, to June 30, 2022) was followed by a manual review to identify adult patients with echocardiographically detected NBTE, active cancer, and no infectious endocarditis or lupus anticoagulant/antiphospholipid antibodies.

Results:
Out of 115 identified patients with Ca-NBTE (mean age 63.2±9.7 years, 66.1% female), there were 8 cases (7.0%) affecting right heart valves (mean age 64.5±12.1 years, 3 females) with underlying cancer: pancreatic (n=3), lung (n= 2), genitourinary (n=1), gastric (n=1) and neck sarcomatoid carcinoma (n=1). TV was affected in 8 patients and PV in one case; 4 patients had Ca-NBTE limited only to PV, 2 patients had MV and TV, 1 patient had mitral, aortic and TV, and 1 patient with pancreatic cancer had all four valves affected by NBTE. 5 patients had embolic complications to the brain with one patient in that group also experiencing emboli to the kidney and spleen. Out of 4 patients with NBTE limited to TV, two still had brain emboli, one had only pulmonary embolism, and one patient had no embolic complications.

Conclusion:
Around 7% of Ca-NBTE cases involve the right heart valves, with half of these cases limited to the TV. The cancer profile in these cases resembles that seen in left heart valve involvement.
Abstract 18895: Myocardial Injury After Non-Cardiac Surgery (MINS) in the High Sensitivity Troponin Era: Current Trends of Preoperative Risk Stratification in a Large Urban Healthcare System
Authors: Deb Brototo , Lawrence Luke , Vargas Jose , Taylor Allen J , Srichai-Parsia Monvadi
Published: December 2023

Introduction:
Myocardial Injury after Non-Cardiac Surgery (MINS) is a significant cause of perioperative morbidity and mortality. Recognizing and understanding the patient characteristics and potential predictors of MINS can contribute to more effective patient risk stratification and management.

Hypothesis:
Certain preoperative risk factors are associated with a higher risk of developing MINS among patients undergoing noncardiac surgery.

Methods:
We retrospectively reviewed the data on 2458 noncardiac surgeries performed within the MedStar System between 2022-2023 in which patients underwent routine pre- and postoperative high sensitivity troponin I (hsTnI) and EKG monitoring over 72 hours. MINS was defined as any elevation in hsTnI >99
th
percentile for gender (>34 ng/L: females, >53 ng/L :males). Multivariable logistic regression models were used to identify the factors associated with MINS which included demographics, surgical details, comorbidities, relevant preoperative labs and vitals.

Results:
Out of the 2,458 patients, 889 (36%) were diagnosed with MINS. Patients with MINS were older, nonsmokers, and females with prior congestive heart failure (CHF), coronary artery disease (CAD), chronic kidney disease (CKD), atrial fibrillation, and preoperatively lower blood pressure and higher creatinine compared to patients without MINS (Table 1). In multivariable adjusted models, CHF [aOR=1.6, 95%CI: (1.1, 2.3)], CAD [aOR=2.1(14, 2.9)], CKD [aOR=1.4(1.2, 1.8)] were associated with higher odds of developing MINS. RCRI score was not associated with postop MINS. Figure 1 shows rates of developing MINS among surgical specialties.

Conclusions:
Our study demonstrates that risk factors including age, gender, pre-existing cardiovascular and renal disease, preoperative blood pressure, and certain surgery types are associated with MINS. Research is needed to further define how to utilize this information to identify and minimize the risk of MINS.
Abstract 18944: Affordability of Insulin for Non-Elderly Adults in the United States Following $35 Monthly Out-of-Pocket Cap
Authors: Ghoreshi Kayvon , Lokesh Nidhish , Patel Lajja Ben , Sumarsono Andrew
Published: December 2023

Introduction:
In March 2023, insulin manufacturers in the United States announced price reductions, with Eli Lilly adding a $35 OOP cap on their unbranded insulin products.

Aims:
To investigate estimated OOP savings of a $35 insulin cap for non-Medicare patients.

Methods:
We used the 2019 Medical Expenditure Panel Survey (MEPS). Non-Medicare adults aged 18-64 who filled at least one insulin prescription were included. We identified insulin prescriptions with OOP spending above $35 and estimated savings using a $35 OOP cap. For each respondent, we calculated annual insulin OOP spending, average OOP spending per prescription, and total estimated OOP savings with a $35 OOP cap. Analyses were done in SAS.

Results:
Over 4.1 million non-elderly civilians filled 32.7 million insulin prescriptions in 2019, totaling $1.7 billion in OOP costs, or $418 per person (Table 1). There were 1.6 million people (39.5%) eligible for reduced OOP spending under a $35 OOP cap. Those eligible were more often male and medium- or high-income. Only 16% of publicly insured patients were eligible for savings with a $35 OOP cap, compared to 53% among privately insured and 52% among uninsured groups. Of those eligible for savings, we estimated a $35 OOP cap would have reduced average annual OOP insulin spending from $984 to $231, saving an estimated $1.2 billion. Uninsured patients would see a 93% reduction in OOP spending. Hispanic patients would see an 87% reduction in OOP spending, compared to 73% among non-Hispanic patients. Near poor and low-income patients would see greater OOP reductions than patients in other income groups.

Conclusions:
Populations most likely to benefit under a $35 OOP insulin cap are those with the highest cost-sharing requirements, such as the uninsured and those just above the threshold for income-based social services. Future work should assess how insulin OOP caps affect patient adherence and outcomes.
Abstract 18970: Sex Differences and In-Hospital Outcomes of Acute Coronary Syndrome Among Patients With Mediastinal Radiation Exposure: Insights From the National Inpatient Sample (2009-2020)
Authors: Ahmed asmaa , Faisaluddin Mohammed , Osama Muhammad , Patel Harsh P , Thakkar Samarthkumar , Alweis Richard , Dani Sourbha , Iqbal Uzma
Published: December 2023

Background
There is a paucity of data about the sex disparities and temporal trends in outcomes of Acute Coronary Syndrome (ACS) patients with prior mediastinal radiation.

Methods:
The National Inpatient Sample database years 2009 to 2020 was queried for ACS hospitalizations of patients with prior mediastinal radiation. The primary outcome was MACCE (major cardiovascular events) and secondary outcomes included other hospital cardiovascular outcomes including hospital resource utilization.

Results:
A total 23385 hospitalizations for ACS with prior mediastinal radiation exposure were identified. Females accounted for 15904 (68.01%) of the cases. Median age was 70 vs 72 and the majority of the cases were whites 82.79% vs 78.22% for females and males respectively. Cases were mostly non-ST elevation MI in both genders 75.98% vs 79.71% while ST-elevation MI represented 24.02% vs 20.29% of them. Female patients with ACS had a higher burden of hypertension, diabetes mellitus, hyperlipidemia and obesity, however, males had a higher burden of Peripheral vascular disease, chronic heart failure and smoking. After propensity matching, primary outcome related to MACCE was higher in males (aOR1.803, 95%CI (1.65-1.96)) along with cardiogenic shock (aOR: 1.77, 95%CI (1.55-2.02)) and Mechanical Circulatory Support (MCS) use (aOR: 1.48, 95%CI (1.29 -1.71)). Similar findings were noted after the subgroup analysis in STEMI and NSTEMI where males had the worst In-hospital outcomes compared to females. Overall, we observed an increasing trend in ACS hospitalizations among females from 2.85% in 2009 to 7.91% in 2020 however, mortality decreased over the years from 8.69% in 2009 to 3.51% in 2020.

Conclusions:
This nationwide observational analysis showed significant disparities and burden of cardiovascular comorbidities among male and female ACS patients with prior mediastinal radiation history, with higher hospitalization rates among females but higher mortality among males.
Abstract 18974: Transcatheter Tricuspid Valve Replacement in a Symptomatic Bioprosthetic Tricuspid Stenosis Patient With Carcinoid Heart Disease: A Case Report
Authors: PUSAPATI SUMA , Kapaganti Sowjanya , Kanmanthareddy Arun R
Published: December 2023

Background:
Patients with carcinoid heart disease are prone to the development of mild to severe tricuspid regurgitation with or without accompanying tricuspid stenosis. We present an interesting case of a patient with bioprosthetic tricuspid valve stenosis secondary to carcinoid heart disease undergoing transcatheter tricuspid valve replacement (TTVR).

Case history:
The patient is a 64-year-old female with metastatic carcinoid syndrome and subsequent tricuspid valve replacement with 25 mm Magna ease bovine pericardial valve. The surgery was complicated by carcinoid crisis, pneumothorax, and complete heart block. She presented with worsening shortness of breath with exertion. Echocardiography revealed severe tricuspid stenosis associated with a severely dilated right atrium, moderate pulmonary stenosis. Transesophageal echocardiography confirmed carcinoid degeneration of the bioprosthetic tricuspid valve. CT chest and abdomen with contrast showed consistent findings of severe tricuspid stenosis, metastatic carcinoid tumor with new foci in liver, lungs. Ischemic evaluation with angiography revealed normal coronaries. Decision making: The patient was evaluated by the heart team and was considered to be a prohibitive risk patient for redo surgery. We then evaluated her suitability for transcatheter valve replacement, and the patient was felt suitable for undergoing valve-in-valve transcatheter tricuspid valve replacement via the right internal jugular vein approach because of the coaxial alignment of the valve through this route. The patient successfully underwent this procedure with a 26 mm balloon-expandable valve without any complications and is currently in NYHA class I functional status.

Conclusion:
Carcinoid syndrome can affect bioprosthetic tricuspid valves and transcatheter valve replacement may be advantageous in replacing the affected bioprosthetic valves by reducing morbidity and mortality.
Abstract 18975: First Reported Case of SLE Associated Recurrent Pericarditis Treated With Rilonacept
Authors: Bhalla Jaideep Singh , Saraswati Ushasi , Karmali Rehan , Majid Muhammad , Arockiam Aro Daniela , Syed Alveena , Klein Allan L
Published: December 2023

Description of case:
A 42 year old female presented with a 1 month history of exertional dyspnea and intermittent pleuritic chest pain. She had a 12-year history of systemic lupus erythematosus (SLE) and non-specific interstitial pneumonitis being managed with mycophenolate mofetil. Labs showed an ESR of 76 mm/hr and CRP of 5.5 mg/dL. CT chest ruled out pulmonary embolism but showed a moderate pericardial effusion, also seen on an echocardiogram. A cardiac MRI (cMRI) showed moderate diffuse circumferential pericardial enhancement. She was diagnosed with lupus pericarditis and initially treated with ibuprofen, colchicine, prednisone, and hydroxychloroquine; however, continued to have persistent symptoms over the next few months. Repeat cMRI showed a transition to effusive constrictive physiology. She was offered pericardiectomy but following shared decision making and multi-disciplinary discussion, she was started on Rilonacept. She experienced significant and sustained relief in symptoms, improvement in inflammatory markers and reduction of pericardial enhancement on cMRI. Discussion To the best of our knowledge, this is the first case of Rilonacept used to successfully treat recurrent pericarditis from SLE. Recurrence in chronic idiopathic pericarditis is thought to be driven by the innate immune system and Interleukin-1 (IL-1), while in autoimmune diseases, it is mediated by the adaptive immune system and Type 1 Interferon, which is associated with a poorer prognosis. The RHAPSODY and AIRTRIP trials demonstrating efficacy of IL-1 blockers in recurrent pericarditis excluded patients with autoimmune diseases. Use of IL-1 blockers to treat Lupus pericarditis has only been reported in 2 cases using Anakinra. Our patient’s positive response to Rilonacept suggests the presence of additional target pathways in autoimmune diseases that may mediate pericarditis recurrence. Future prospective studies are needed to elucidate this further.
Abstract 18987: A 10-Year Contemporary Analysis of Outcomes of Patients With Amyloidosis and VT Underdoing Ventricular Tachycardia (VT) Ablation
Authors: Umrani Rohan , Matsumura Martin , Khalid Yaser , Roy Trinava , Dasu Neethi , Dasu Kirti
Published: December 2023

Introduction:
Cardiac amyloidosis (CA) can lead to heart failure and arrhythmias as a result of electromechanical cardiac remodeling. CA is most associated with atrial fibrillation, however, small studies have shown that the highest risk population is those with ventricular tachycardia (VT). There are limited studies on the clinical implications of patients with cardiac amyloidosis and VT undergoing VT ablation (VTA) versus medical therapy. This study’s aim is to assess mortality and outcomes in patients with CA undergoing VTA vs medical therapy.

Hypothesis:
We anticipate CA patients undergoing VTA will have better outcomes than their medically managed counterparts.

Methods:
The US National Inpatient Sample (NIS) was searched for patients with CA with and without VTA as a secondary diagnosis using ICD-9/10 codes from 2010 to 2020. Primary outcomes were inpatient mortality, hospital length of stay (LOS), and total hospital charges (TOTHC). Data analysis utilized propensity matching via the Kernel Method.

Results:
his study included 357,350 patients with CA, of which 92,750 underwent VT ablation (Group A), which was compared with CA patients receiving medical therapy (Group B). Group A had decreased mortality (5.27% vs 11.33%, p<0.0001), but increased LOS (+6.81 days, p<0.0001, CI: 6.15-7.47), and TOTHC ($240,459.80, p<0.0001, CI: 105,536.40-375,383.30). Secondary analysis is described in Table 1.

Conclusions:
Although LOS and TOTHC were increased in patients with CA with VTA, overall mortality was decreased compared to those with CA managed medically. Numerous risk factors were identified that worsen hospital outcomes in this population. Our study demonstrates that early referral to EP and early VT ablation could be the best management strategy for patients with CA and VT as they had significantly reduced mortality compared to the group which only had medical management.
Abstract 18989: Neonatal Arch Reconstruction via Sternotomy or Thoracotomy: A Propensity Score Matched Analysis
Authors: Chiu Peter , Gearhart Addison , Marathe Supreet , Holland Margaret , Goto Shinichi , Ghelani Sunil J , Kaza Aditya K
Published: December 2023

Introduction:
For neonatal repair of coarctation of the aorta, patients may either undergo thoracotomy or sternotomy with cardiopulmonary bypass. While some guidance exists, the optimal approach remains poorly defined.

Methods:
This is a single center retrospective cohort study from 7/05 through 5/22 including patients who underwent neonatal aortic arch reconstruction for isolated coarctation of the aorta and excluding genetic syndromes, heterotaxy, and right aortic arch. Propensity score was estimated using demographic and anatomic variables and 1:1 optimal matching was performed. Primary outcomes were reintervention, either open or catheter-based, and survival. A hazard spline was constructed in order to assess the effect of varying distal arch size on hazard of reoperation (Figure 1). ICU and Hospital length of stay were secondary outcomes.

Results:
There were 263 patients who underwent isolated coarctation repair during the given time period. Matching yielded 50 patient pairs (n = 100). In the propensity matched population, one patient died and 11 patients underwent reintervention, with 2 of these patients undergoing 2 reinterventions. The interaction between distal transverse arch size and operative approach (sternotomy vs. thoracotomy) was statistically significant, p < 0.05 for interaction. Among patients with a distal arch z-score < -3.5, there appeared to be an advantage to sternotomy. With a distal arch z-score > -3.5, patients undergoing sternotomy appeared to have a disadvantage with respect to risk for reintervention. ICU length of stay was greater for patients undergoing sternotomy, 5.9 days [IQR: 4 to 12.6] vs 2.8 days [IQR: 1.7 to 4.2], p < 0.001, as was hospital length of stay, 14.3 days [IQR: 11 to 23.7] vs 6.5 days [IQR: 5.2 to 9.8], p < 0.001.

Conclusions:
Patients with a distal arch z-score larger than -3.5 may benefit from thoracotomy, and those with a distal arch z-score smaller than -3.5 may benefit from sternotomy.
Abstract 19017: Peri-Operative Bridging Requirement for Patients Chronically Taking Direct Oral Anticoagulants (DOACS) or Vitamin-K Antagonists (VKA) Before Undergoing the Elective Procedure: A Systematic Review and Meta-Analysis
Authors: Malik Saad U , Alagha Zakaria , Akbar Usman , Ghallab Muhammad
Published: December 2023

Introduction:
Many patients undergo elective interventions/surgical procedures while being on direct oral anticoagulants (DOACs) or vitamin-K antagonists (VKA) chronically. There is limited data on peri-procedural management of DOACs in patients undergoing elective procedures. It is also unclear if there is any role of peri-procedural bridging in patients on chronic VKA therapy. We conducted this study to evaluate the efficacy and safety of DOACs (continued vs. interrupted)and VKAs (with vs. without bridging) among patients undergoing elective procedures.

Methods:
This systematic literature review was conducted according to PRISMA guidelines until 10
th
June 2023. The following inclusion criteria were used: adults, chronic use of VKAs or DOACs, elective procedures, and clinical trials. Primary endpoints were major bleeding, stroke, MI, and VTE. A generic variance random effects model was used to estimate odds ratios using CMA III. Heterogeneity and quality of studies were quantified via I
2
statistic and GRADE score, respectively.

Results:
14 clinical trials were included (n=15683). There was no difference in the risk of major bleeding (OR: 1.06, 95% CI: 0.65 -1.7, I2: 46%) or risk of stroke(OR: 1.10, 95% CI: 0.66 - 1.84, I2: 0%) whether DOACs were held or continued respectively. Among patients on VKA, there was no difference in risk of major bleeding in bridging vs. no bridging groups (OR: 2.02, 95% CI: 0.87 - 4.71, I2:75%). There was no difference in the rates of stroke (OR: 0.44, 95% CI: 0.12 -1.58, I2: 0%), MI (OR: 1.64, 95% CI: 0.76 - 3.53, I2: 0%), and VTE (OR: 1.26,95% CI: 0.31 - 5.01, I2: 0%). The quality of included studies was low to moderate.

Conclusion:
Patients undergoing elective procedures and chronically taking DOACs have a similar risk of major bleeding and stroke when DOACs are continued or interrupted peri procedurally. Similarly, among patients on VKA who were bridged or not bridged, there was no difference in risk of bleeding, stroke, MI or VTE.
Abstract 19043: Global Surgical Outcomes for Congenital Heart Disease: A Look at Databases
Authors: Modrego Adriana M , Hasan Babar , Garcia-Canadilla Patricia , Ather Mishaal , Snyder Corey , Jenkins Kathy J , Gauvreau Kimberlee , Subramanyan Ram Kumar , Tobota Zdzislaw , Sandoval Nestor , Zheleva Bistra , Sarris Georgios , Sanchez-De-Toledo Joan , Mayer John E , Shaffer Kenneth , Chowdhury Devyani
Published: December 2023

Introduction:
Congenital heart diseases (CHDs) are the most common congenital anomalies, and almost one-third of patients require an intervention in the neonatal period or first year of life. Unlike low- and middle-income countries (LMICs), the survival of patients with CHD in high income countries is over 90%. The aim of this study was to compare the different congenital heart surgery (CHS) outcomes databases and analyze geographical variations.

Methods:
We analyzed the STS-CHSD (North America), the ECHSA, the ECHSA (Only Europe), and the IQIC for CHD (LMICs) databases between 2016 and 2019. All databases include aggregated data consisting of the 10-benchmark CHS and CHS grouped by mortality risk categories. For each database and condition, we extracted the number of participants, number of operations, postoperative length of stay (LOS), and mortality, comparing regional findings.

Results:
Compared to ECHSA, STS-CHSD database had more operations (32066 vs 14327) despite lower participant numbers. 50% of surgeries in LMIC were VSD closure, while the STS database reported the largest number of complex interventions. Mortality was lowest in North America for all the operations. LMICs had the shortest LOS, while North America had the longest LOS for almost all the benchmark operations. (Figure) However, the relevance of LOS is limited due to lack of data on demographic findings like age at surgery and gestation.

Conclusions:
The analysis of these three databases, accounting for limitations of aggregate data, highlight the differences in the CHS outcomes among world regions, reflecting the geographical difference of the population. Furthermore, it emphasizes the critical need to develop collaborative databases to improve global outcomes.
Abstract 19050: Polysomnography and Sleep Symptom-Based Patient Profiles Associated With Atrial Fibrillation Development
Authors: Heinzinger Catherine M , Lapin Brittany , Thompson Nicolas , Milinovich Alex , Foldvary-Schaefer Nancy , Van Wagoner David R , Chung Mina K , Mehra Reena
Published: December 2023

Introduction:
Although sleep disorders are linked to atrial fibrillation (AF), the complex interplay remains unclear. Investigating sleep-based profiles associated with AF can deepen understanding and identify at-risk patients.

Hypothesis:
We hypothesized discrete phenotypes of symptoms and polysomnography (PSG)-based data differ in relation to incident AF.

Methods:
This retrospective cohort study of Cleveland Clinic patients (age>18) who underwent PSG 11/27/2004-12/30/2015 identified patient clusters using latent class analysis of 23 sleep-related symptoms, Epworth Sleepiness Scale (ESS) score, and 24 PSG measures of sleep disordered breathing and architecture. Cox proportional hazards models with cluster membership as the independent variable and incident AF as the dependent variable were adjusted for age, sex, race, BMI, cardiopulmonary disease and risk factors, anti-arrhythmic medication, and positive airway pressure with follow up 7.6±3.4 years.

Results:
Of the sample (n=43,433, age 52±15, 52% male, 74% White) 9% developed AF. Five clusters were identified: 1) Hypoxic + Sleepy (n=3,245): highest % time SaO
2
below 90%, highest ESS, 2) Apneas + Arousals (n=4,592): highest AHI, highest arousal index, 3) Short sleep + Low %REM (n=6,126): shortest sleep duration, longest REM latency, lowest %REM, 4) Hypopneas (n=2,661): most hypopneas, 5) Long sleep + High %REM (n=26,809): longest sleep duration, shortest REM latency, highest %REM (reference). Compared to reference, Hypoxic + Sleepy had 48% (HR=1.48, 95%CI=1.34-1.64), Apneas + Arousals had 22% (HR=1.22, 95%CI=1.11-1.35), and Short Sleep + Low %REM had 11% (HR=1.11, 95%CI=1.01-1.22) higher risk of AF development. Internal validation indicated reasonable predictive accuracy. Sensitivity analysis excluding split night studies confirmed the associations observed.

Conclusions:
Of 5 patient profiles identified, Hypoxic + Sleepy conferred the strongest AF risk. Consistent with prior evidence of hypoxia as an AF driver and cardiovascular risk of the sleepy phenotype, this constellation of symptoms and physiology illustrates risk in the clinical setting, providing potential value as a risk prediction tool. Future investigation will focus on external validation of these findings.
Abstract 19104: Hemodynamic Analysis of Pulmonary Artery for Congenital Right-Side Heart Disease in Adulthood by 4d-Flow MRI
Authors: Inage Akio , Mizuno Naokazu , Kishiki Kanako
Published: December 2023

Introduction:
Using 4D-flow MRI, we evaluated hemodynamics in the pulmonary artery of congenital right-side heart disease in adulthood.

Hypothesis:
We hypothesize that 4D flow MRI may be used to assess pulmonary artery flow hemodynamics in adults with congenital right heart disease.

Methods:
In 20 adults, we measured energy loss (EL) and helicity of the main pulmonary artery (MPA) by cardiovascular MRI. The maximum value (peak EL) in one heartbeat and the total value were obtained for EL. Helicity was defined as a vector quantity, with clockwise rotation being positive and counterclockwise rotation being negative, and the total value was calculated.

Results:
The mean age was 27.9 years. The cases included 15 cases of postoperative tetralogy of Fallot without pulmonary arterial hypertension (TOF) and 5 cases of congenital heart diseases with pulmonary arterial hypertension (CHD-PAH). Peak EL, time to peak EL, and total helicity were higher in the CHD-PAH group than TOF group. Peak EL values were significantly higher during systole but were observed during diastole in 8 patients (40%). The combined mean value of helicity was positive, with clockwise predominance in 12 cases (60%). A strong correlation was found between peak EL and clockwise helicity (r=0.68) and counterclockwise helicity (r=-0.73). In addition, a correlation was observed between diastolic EL/BSA and diastolic clockwise helicity (r=0.51) and diastolic counterclockwise helicity (r=-0.52). A correlation was also observed with the pulmonary regurgitant fraction (r=0.49).

Conclusions:
In this study, helicity in the MPA was dominant clockwise in congenital right-side heart disease in adulthood. It was suggested that EL was involved in helicity throughout the entire cardiac cycle and that peak EL had a particularly large effect.
Abstract 19210: Interpretation of Deep Learning Model That Identifies Regional Myocardial Dysfunction From the Surface Ecg
Authors: Ansari Rayan A , bhatia neal , Tooley James , Thakkar Vyom , Torres Jessica , Tung Jagteshwar , Alhusseini Mahmood , Clopton Paul L , Sameni Reza , Clifford Gari , Ashley Euan A , Perez Marco V , Zaharia Matei , Narayan Sanjiv M , Rogers Albert J
Published: December 2023

Introduction:
Cardiac wall motion abnormalities (WMA) are key prognostic indicators for major cardiovascular events and mortality, yet they are poorly detected by current ECG screening tools such as Q waves. Deep learning (DL) models have improved analysis of complex data and novel tools may provide interpretation of these models.

Hypothesis:
ECG features beyond the Q wave may be identified by analyzing an ECG-trained DL model to improve WMA detection over standard ECG measurements.

Methods:
We developed a DL neural network using 36,964 unique patients (62.9±16.9 years, 47% female, 58% white) labeled by natural language processing of echocardiography reports within 60 days. To understand how the CNN model identifies WMAs from the ECG input, we implemented Shapley Additive exPlanations (SHAP) and DeepExplainer on R-wave aligned beats over 300ms surrounding the QRS complexes to identify hot-spots across the ECG. We then retrained classifiers on 60mg windows of the ECG to identify which timepoints produced the greatest performance (ablation method).

Results:
Probing the CNN revealed that ECG regions throughout the QRS and T-waves identified WMA. Analysis output shows that such ECG regions arose throughout the QRS and T-waves, and not just at early regions corresponding to Q waves
(Panel A)
. An aggregate view of the ECG reports summarizes the most discriminatory ECG regions for all patients
(Panel B)
. Stepwise analysis of limited windows within aligned ECG beats also confirmed this analysis
(Panel C)
. We found that the highest performance window was 60-120ms (AUC 0.814), containing most of the QRS, with the lowest performance in the window of 0-60 ms (AUC 0.699) and 0.20-0.80ms (AUC 0.707).

Conclusions:
The DL model show promise in accurately detecting WMAs and provides key insights into critical ECG regions for WMA detection beyond the Q wave. Further analysis of WMA detection with these expanded regions is needed.
Abstract 197: Establishing a Novel Pulse Wave Velocity-Guided Mouse Model of Cardiac Arrest With Different Durations
Authors: zhuang zhen W , Liu Fang
Published: December 2023

Background:
Neurological and cardiovascular injuries are the leading causes of death following cardiac arrest (CA). Few rodent models recapitulate these post-resuscitation symptoms.

Aims:
To develop extended ischemic CA models under Pulse Wave Velocity
(
PWV) guidance with consistent post-CA brain injury (PCABI) and coronary dysfunction as potential therapeutic targets and mechanical studies.

Methods:
Forty-eight mice were randomized into four experimental groups (control, 8-, 12-, and 16-min CA). Potassium chloride (KCL) was intravenously injected, resulting in immediate asystole. Mice were resuscitated with an injection of epinephrine and manual chest compressions. PWV was monitored for the left carotid artery velocity and coronary flow reserve (CFR). Resuscitability, synaptic density in the hippocampal CA1 region, blood-brain barrier (BBB), and neurologic deficit scores (NDS) were also evaluated.

Results:
The PWV could monitor rapid asystole after KCL injection, improve cardiopulmonary resuscitation (CPR) success rates, and avoid the pre-matured end of resuscitation. Compared to the standard control, mice with 8-min CA had preserved CFR, mild loss of synaptic density (p>0.05), mild hypothermal, and a normal electrocardiogram. They maintained BBB integrity with no significant change to neurologic function. Compared with a 92% CPR success rate in 8 min-CA mice, 12 min-CA mice had 83%, and 16 min-CA mice had 58% resuscitability. Twelve min-CA mice had significantly impaired CFR at 24 hours and high lethality (40%, P<0.05) within the first three days; 16 min-CA mice worsened (33% survival rate, p<0.01). The 24 hrs electron microscope showed that CA-induced synaptic vesicle densities were ischemic time-dependent [350±60 (control) vs. 289±64 (8 min CA) vs. 269±34 (12 min CA) vs. 181±41/field (16 min CA)], consistent with NDS. The cerebrum and hippocampus were the most valuable regions, indicated by Evans blue evaluation at 48 hrs after CA.

Conclusions:
We established elongated PWV-guided CA models as with successful CPR, post-CA neurological deficits, leaky BBB, loss of synaptic density, coronary endothelial dysfunction, and even death in mice, which closely recapitulated the post-resuscitation symptoms in survived patients after CPR.
Abstract 213: High-Throughput Analysis of Mitochondrial Morphology in Neurons Post-Mitochondrial Transplantation
Authors: Nakamura Eriko , Kuschner Cyrus , Aoki Tomoaki , Endo Yusuke , Becker Lance B , Hayashida Kei
Published: December 2023

Background:
Mitochondrial transplantation (MTx) improves neurological and survival outcomes in rats after cardiac arrest. However, the impact of transferred mitochondria on native mitochondrial features in neurons remains poorly assessed. Evaluating mitochondrial morphology provides insights into post-MTx mitochondrial dynamics in recipient neurons, aiding the understanding of cellular processes and targeted therapy development.
Aim:
To investigate whether increased uptake of donor mitochondria influences the morphology of native mitochondrial networks in neurons.

Methods:
We conducted
in vitro
MTx using the HT-22 neuron cell line. Native mitochondria in neurons were pre-labeled with MitoTracker Green. Extracellular mitochondria were isolated from healthy adult rat muscle tissue, labeled with MitoTracker Deep Red, and co-cultured with neurons. Confocal microscopy captured 2D fluorescence images. MitoHacker, a computational program, facilitated high-throughput analysis of 27 mitochondrial morphometric markers.

Results:
We analyzed 62 images of cells (
Figure
). MitoHacker successfully identified features of native and transferred donor mitochondria. Linear regression analysis revealed that total donor mitochondrial area had positive correlations with native mitochondrial counts, total area, minor axis length of mitochondrion, mitochondrial averaged density, and mitochondrial branch length, and a negative correlation with distance between mitochondrial location and nucleus (all P<0.05). These findings suggest that increased amounts of transferred mitochondria can positively influence native mitochondrial biogenesis, proliferation, accumulation, and activated mitochondrial dynamics and networking in recipient neurons.

Conclusion:
Using the deep learning-based mitochondrial morphology analysis, our study provides evidence that MTx significantly impacts mitochondrial morphology and dynamics in recipient cells.