bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17700: Double Trouble With Identification of Isolated Sub-Segmental Pulmonary Embolism Using ICD-10 Discharge Diagnosis Codes: The PE-EHR+ Study
Authors: Bejjani Antoine , Khairani Candrika D , Lo Ying-Chih , Jimenez David , Barco Stefano , Mahajan Shiwani , Caraballo Cesar , Secemsky Eric A , Klok Erik , Hunsaker Andetta , Aghayev Ayaz , Muriel Alfonso , Hussain Mohamad A , Appah-Sampong Abena , MOJIBIAN HAMID , Lu Yuan , Lin Zhenqiu , Aneja Sanjay , Khera Rohan , Goldhaber Samuel , Zhou Li , Monreal Manuel , Krumholz Harlan M , Piazza Gregory , Bikdeli Behnood ,   PE-EHR+
Published: December 2023

Introduction:
International Classification of Diseases 10
th
revision (ICD-10) discharge diagnosis codes are widely used for research studies that use electronic databases. The accuracy of the codes for identifying patients with isolated sub-segmental pulmonary embolism (issPE) is unknown.

Methods:
We used data from the Mass General Brigham (MGB) health system (01/2016-12/2021) and included 1,734 patients randomly selected from 3 groups: Patients with ICD-10 Principal Discharge Diagnosis codes for PE, patients with secondary Discharge Diagnosis codes for PE, and patients with no ICD-10 codes for PE. Weighted estimates were obtained by considering the total number of hospitalizations in each category at MGB hospitals. Accuracy of the codes was assessed by two independent physicians who reviewed discharge summaries, daily notes, and radiology reports.

Results:
Of 1,734 records reviewed, 1,712 were included (age: 60.6±17.8 years, 52.3% female). Manual chart review found 865 patients with acute PE, including 104 (12.0%) with issPE. Of these 104 patients, 103 (98.3%) had ICD-10 codes for PE. However, only in 15 (14.6%) cases, PE codes were specified as being limited to subsegmental vessels (issPE). In turn, in another 43 cases, Principal-or-secondary ICD-10 codes for issPE were listed but the patients did not have acute issPE during index hospitalization per review of records. The sensitivity and specificity for issPE codes in Principal or secondary discharge position were 14.4% and 97.3% (Table, panel A). Positive predictive value in the weighted sample was only 26.2% (Table, panel B).

Conclusions:
ICD-10 codes are insensitive and have a poor positive predictive value for detection of isolated subsegmental PE and should not be used for case identification for research purposes or quality improvement initiatives.
Abstract 17701: Glucagon-Like Peptide-1 Receptor Agonist Weight Loss Results from an Allied Health-Led Atrial Fibrillation Risk Factor Modification Clinic
Authors: Watkins April K , Collins Jennifer S , Champion Jane D
Published: December 2023

Introduction:
Atrial Fibrillation (AF) is a global health threat associated with embolic stroke, heart failure, and death. Modifiable risk factors play a role in preventing and slowing the progression of AF. Obesity is one such modifiable risk factor with a strong association with AF. Glucagon-like peptide-1 receptor agonists (GLP1-RA), semaglutide and liraglutide, are approved by the Food and Drug Administration for weight loss. Prescribing semaglutide and liraglutide for weight loss in AF patients seen in an allied health professional (AHP) risk factor modification clinic can potentially improve patient outcomes.

Hypothesis:
This study aims to determine weight change, side effects, and comorbidities for patients prescribed GLP1-RA in the AHP AF clinic.

Methods:
Following Institutional Review Board approval and exempt status, a retrospective chart review was conducted using the AF clinical registry for 95 consecutive patients followed over 90 days in the AHP clinic from January 1 to November 30, 2022, who were prescribed GLP1-RA by the AHP or had an existing prescription from a primary care provider or endocrinologist.

Results:
Patients totaled (n=95), aged 26-86 years, (36.8%) women, (80%) identified as white, (51.6%) persistent or (38.9%) paroxysmal AF, and (44.2%) underwent prior ablation. Comorbidity prevalence hyperlipidemia (55.8%), DM (33.7%), CHF (16.8%), and left ventricular ejection fraction >50% (85.3%). Patients receiving a GLP1-RA, either semaglutide (n=78, 82.1%) or liraglutide (n=17, 17.9%), experienced significant reductions in weight (Kg, 116.44 vs. 111.49, p<.001), (BMI, 38.54 vs. 36.68, p<.001), with no significant differences found in the reduction of weight (Kg/BMI) by GLP1-RA prescribed. Patients without DM experienced significantly greater reductions in weight than those with DM (Kg, p<.012, BMI, p<.07). Those without CHF also experienced significantly greater reductions in weight, (Kg, p<.05, BMI, p<.05), than those with CHF. Side effects experienced by 10.5% included nausea, constipation, or diarrhea.

Conclusion:
GLP1-RA has shown significance for weight loss for AF patients seen in the AHP AF lifestyle clinic. The next steps should include evaluating AF burden before and after weight loss on the medication.
Abstract 17708: Cardiac Nut-Cracker: Paroxysmal Left Main Coronary Compression by Inducible Pulmonary Trunk Dilatation in Pulmonary Hypertension
Authors: Suen Andrew O , Beale Anna , Granton John T , Davierwala Piroze , Neethling Elmari , Snyman Adam , Kalra Sanjog
Published: December 2023

Case Presentation:
A 56yo woman with a 12-year history of idiopathic pHTN and severe RV dysfunction presented with worsening exertional angina (CCS III). Perfusion imaging demonstrated a large apical-septal defect, corresponding to an 80% eccentric stenosis of the LMCA on angiography (
Fig 1AB
) due to compression on ostium and shaft by a severely dilated pulmonary trunk (
Fig 1C
). Right heart catheterization revealed pulmonary artery pressures (PAPs) of 90/40/68mmHg. Operative risk for CABG was deemed prohibitive, thus the patient underwent high-risk PCI of the LMCA under IV conscious sedation. Initial angiography confirmed a patent LMCA with minimal longitudinal compression. Opening PAPs (102/37/64mmHg) with supplemental oxygen (FiO
2
/PaO
2
0.76/168mmHg) were similar to preop findings (
Fig 1D
). To replicate her symptomatology, supplemental oxygen was discontinued, resulting in rapid worsening of LMCA compression with severe reduction in LMCA cross-sectional area at room air conditions (FiO
2
/PaO
2
0.21/70mmHg), with corresponding suprasystemic PAP (122/44/73mmHg) (
Fig 1E)
. Under IVUS guidance, a preselected stent was deployed producing complete LMCA patency without evidence of dynamic compression; minimal stent areas were unchanged at supraphysiologic and physiologic conditions: 19 vs 20mm
2
, FiO
2
0.73 vs 0.21 (
Fig 1F
).

Discussion:
LMCA stenosis from extrinsic compression of the vessel by an enlarged pulmonary artery is a rare etiology of acute coronary syndromes. Treatment options include PCI, CABG, reimplantation, or PA reduction plasty. While preop imaging clearly demonstrated LMCA compression by a dilated PA, during PCI true and dynamic severity of LMCA compression was revealed only under “normoxic conditions” (FiO
2
0.21). This paroxysmal “nut-cracker” phenomenon from inadvertent reversal of dynamic LMCA compression highlights the importance of normoxia in making the diagnosis of such anomalies in susceptible individuals with pHTN.
Abstract 17720: The Role of Soluble Guanylyl Cyclase/NLRP3/RHOA/ROCK Axis in Coronary Artery Spasm: A Potential Biomarker and Therapeutic Target
Authors: Hung Ming-Yow , Yeh Chi-tai , Yadav Vijesh Kumar , Fong Iat-Hang
Published: December 2023

Background:
Coronary artery spasm (CAS) can lead to potentially life-threatening acute coronary syndrome. The second messenger cyclic guanosine 3',5'-monophosphate (cGMP), which is regulated by BNP-pGC-cGMP and nitric oxide (NO)-soluble guanylate cyclase (sGC)-cGMP pathways, regulate not only vasodilation but also the functions of immune cells. However, the significance of sGC, as a primary receptor for NO, is unclear in CAS.

Methods:
We investigated sGC and downstream signaling in patient monocyte-derived macrophages (PMDMs) and human coronary artery smooth muscle cells (HCASMCs) using computational biology and bioinformatics to correlate macrophage polarization subsets, Lp(a), and inflammasome signaling axes with CAS.

Results:
Plasma sGC levels were significantly higher in 30 CAS patients compared to 20 non-CAS controls (P<0.001). RNA-sequencing analysis revealed a significant association of sGC expression with NLR Family Pyrin Domain Containing (NLRP)-3 in HCASMCs and induced expression of inflammatory cytokines-specific surface markers. Lp(a) induction promoted the sGC-NLRP3 mediated lipid metabolism axis in PMDMs at both mRNA and protein levels, with elevated M1 polarization. sGC inhibition in HCASMCs reduced RhoA-GTP activity and its downstream effector ROCK, mitigating the Lp(a) effect, while sGC-specific modulator 1-H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-l-one (ODQ) treatment decreased Lp(a)-induced expression of sGC-NLRP3-inflammasome mediators and induced caspase-1, as well as subsequent cleavage of proIL-1β and proIL-18 in VSMCs.

Conclusion:
sGC/GC molecule in conjunction with the RHOA/ROCK pathway is an early biomarker for CAS. The sGC-NLRP3-inflammasome mediators signaling axis plays an important role in Lp(a)-regulated macrophage polarization and CAS development.
Abstract 17723: Non-Contrast Cardiac Magnetic Resonance BOOST Whole Heart Acquisition to Evaluate Coronaries in Children and Young Adults
Authors: Whitehead Kevin K , Harris Matthew A , Vaiyani Danish , Biko David M , Partington Sara L , Sellers Robert T , Kunze Karl P , Botnar Rene , Prieto Claudia , Fogel Mark A
Published: December 2023

Introduction:
Cardiac magnetic resonance (CMR) coronary evaluation remains challenging in teenagers and young adults using conventional respiratory navigation strategies due to irregular respiratory patterns. Motion correction strategies have shown promise in improving efficiency and quality. We sought to evaluate a non-contrast 3D whole-heart sequence with bright-blood (BB) and dark-blood (DB) phase sensitive inversion recovery (BOOST) using image-based navigation (iNAV) and a variable-density cartesian spiral profile order trajectory (VD-CASPR).

Hypothesis:
BOOST acquisitions improves delineation of coronary origins and proximal courses.

Methods:
Pts undergoing clinically indicated CMRs were prospectively enrolled and scanned at 1.5T (AVANTO FIT, Siemens) using 2 different imaging methods: 1) BOOST research sequence employing either T2 or magnetization transfer preparation at 1.0-1.4 mm isotropic resolution. When clinically indicated, 2) a standard navigated inversion recovery gradient echo sequence (IR-FLASH) acquired after gadolinium or ferumoxytol infusion. Both coronary imaging methods were rated on a 1-4 scale: 1=non-diagnostic, 2=coronary origins with significant image degradation, 3=mild image degradation, and 4=sharp delineation of the proximal coronaries. A composite BOOST score (highest score between BB and DB images) was compared to IR-FLASH. Group comparisons used a paired t-test (two-tailed, p<0.05).

Results:
18 pts, mean age 18.8 years (range=10-31) underwent BOOST imaging. 15 had an IR-FLASH for comparison. BOOST acquisition times were 7-12 minutes. Three pts had coronary anomalies (2 with right coronary from the left sinus, 1 single coronary). Coronary origins were delineated on all BOOST exams with a mean score=3.6 for BB BOOST and 2.9 for DB compared to 3.1 for the IR-FLASH, neither of which was significantly different. The composite BOOST mean score was 3.8, which was significantly higher than IR-FLASH.

Conclusions:
In our series in children and young adults, contrast-free BOOST imaging delineated coronary origins in all pts, even in challenging cases of anomalous origins. When utilizing both BB and DB BOOST images, image quality exceeded that of a conventional post-contrast IR-FLASH sequence.
Abstract 17775: Utilization Patterns and Outcomes Associated With Open vs. Endovascular Abdominal Aortic Aneurysm Repair: Findings From the National Inpatient Sample
Authors: Nriagu Bede N , Idowu Abiodun , Evbayekha Endurance O , Adabale Olanrewaju , Bolaji Olayiwola , Ouedraogo Faizal
Published: December 2023

Introduction:
Abdominal aortic aneurysm (AAA) is associated with significant morbidity and mortality. Treatment options include open and endovascular AAA repair. We explored the utilization patterns and outcomes of open and endovascular AAA repair among hospitalized patients in the US.

Hypothesis:
We hypothesized that there would be no difference in the utilization patterns of open and endovascular AAA repair by race and gender.

Methods:
Using the ICD-10 diagnosis and procedure codes, we queried the National Inpatient Sample 2016 to 2019 for hospitalizations among patients ≥18 years old who had an open or endovascular AAA repair. Multivariable logistic regression was used to estimate the odds of death and discharge dispositions comparing open to endovascular AAA repair. Regression models were adjusted for age, sex, median income zip, history of aneurysm of carotid, iliac, and lower extremity artery, co-morbidities including diabetes, hypertension, smoking, obesity, chronic kidney disease, congestive heart failure, myocardial infarction, COPD, and atherosclerosis.

Results:
Our study included 132,775 and 36,010 weighted hospitalizations for endovascular and open AAA repair, respectively. The open AAA repair cohort were younger compared to those of endovascular AAA repair (mean age ± S.D: 65.0 ± 10.4 Vs.73.3 ± 9.0). A higher proportion of female underwent open AAA repair than endovascular AAA repair (33.5% vs. 20.9%). Across all racial/ethnic groups, endovascular repair for AAA was more common than open AAA repair among males, except for black males. A higher proportion of black males underwent open AAA repair than endovascular repair (5.7% vs. 3.9%). Patients who had open AAA repair had higher odds of death compared to those who had endovascular repair (Adjusted odds ratio [aOR], 5.99 [95% CI, 5.22-6.87];
p<.0001
). Conversely, a higher odd of discharge to home/short term facility was noted among patients who had endovascular compared to open AAA repair (aOR, 5.83 [95% CI, 5.38 - 6.32];
p<.0001)
.

Conclusions:
Disparities exist in the utilization of open versus endovascular AAA repair among hospitalized patients. Results could be used to support future research to examine factors driving these disparities.
Abstract 17806: Outcome Prediction Score for Mitral Transcatheter Edge-to-Edge Repair in Patients With Concomitant Significant Tricuspid Regurgitation
Authors: Shechter Alon , Kaewkes Danon , Patel Vivek , Koren Ofir , Koseki Keita , Nagasaka Takashi , Makar Moody , Chakravarty Tarun , Skaf Sabah , Makkar Raj R , Siegel Robert J
Published: December 2023

Introduction:
Tricuspid regurgitation (TR) adversely affects the post-procedural course following mitral transcatheter edge-to-edge repair (TEER). We aimed to derive a clinical risk stratification model for patients undergoing TEER for mitral regurgitation while exhibiting significant TR.

Methods:
This is a single-center, retrospective study of 217 consecutive individuals referred to an isolated mitral TEER who had above-moderate TR at baseline. The primary outcome of interest was the 1-year composite of all-cause mortality or heart failure hospitalizations. The cohort was randomly split in a 75% to 25% ratio, creating train (n=163) and test (n=54) datasets. Model development, discrimination and calibration were based on the train dataset. Internal validation was applied to the test dataset.

Results:
By 1-year, 81 (37.3%) patients died or were hospitalized for heart failure. After multivariable analysis, a score for predicting the primary outcome was constructed that utilized a 0-3 scaling system, in which each point represented one of three baseline variables associated with this combined endpoint: serum B-natriuretic peptide (BNP) level >1,000 pg/mL, qualitative right ventricular (RV) dysfunction on transthoracic echocardiogram, and a cardiac implantable electronic device (CIED). C-statistic of the model for the primary outcome was 0.66 (95% CI, 0.58-0.74, p=0.001) and 0.76 (95% CI, 0.62-0.90, p=0.004) in the train and test datasets, respectively - representing a significantly better discrimination ability than the MitraScore and the Society of Thoracic Surgeons score for mitral valve repair.

Conclusions:
The BNP-RV-CIED (BRC) score is a simple clinical prediction tool that may aid in the triage of mitral TEER candidate with significant pre-existing TR.
Abstract 17807: Rapid Progression of CAD After Stopping Statin and Starting a Ketogenic Diet in a Phenotypic Lean Mass Hyper-Responder
Authors: Kukuc Laura , Proute Matthew , Haynes Tiffany , Fishberg Robert , Ohonba Nosagie , Alam Loba
Published: December 2023

Introduction:
Ketogenic diet (KD) has been a popular diet method for weight loss and described as an alternative to pharmacotherapy on social media. KD is thought to improve some risk factors of ASCVD, such as type 2 DM, obesity, and decrease LDL. Recent studies have described lean mass hyper-responders (LMHR), a specific phenotype with lower BMI, total cholesterol >200 mg/dL, HDL >80, and TG <70. LMHR is thought to be protective against ASCVD. While on carbohydrate restricted diet, LMHR may have significant rise in LDL. We present a patient with known CAD and similar phenotype to LMHR that developed rapid progression of CAD after stopping statin and initiating strict KD.

Hypothesis:
KD may accelerate disease in those with known CAD, despite being LMHR phenotype.

Methods:
51-year-old male with BMI 23, CAD with previous PCI to proximal LAD, HTN, HLD, family history of early CAD, presented with inferior STEMI. He underwent emergent catheterization revealing 95% stenosis of the mid RCA and 99% occlusion of the distal RCA treated with two drug eluting stents. Previous catheterization showed only moderate disease of the distal RCA. He had discontinued atorvastatin about 2 years after his first coronary intervention due to myalgias. Prior to starting it, his total cholesterol was 207, LDL 131, HDL 43, and TG 67 with a normal BMI- similar traits to LMHR phenotype. Atorvastatin 80 mg was started, and his LDL decreased to 44. After he discontinued the statin, he started a KD to try to manage his cholesterol and CAD.

Results:
When he presented with STEMI, his total cholesterol was 388, LDL 301, HDL 73, TG 71, and Lp(a) 155 nmol/L. He resumed atorvastatin 80 mg and started alirocumab at discharge with subsequent LDL of 14.

Conclusions:
Social media has influenced many to try ketogenic diet to manage metabolic health. Some influencers have questioned high-LDL association with ASCVD and have recommended avoiding pharmacotherapy. Despite popular opinion that high-LDL in this phenotype does not have clinical implication, our patient with a similar profile had rapid progression of CAD while on a KD and was untreated for HLD. Patients with known CAD and LMHR should be very cautious when starting popular diets and should discuss the possible implications with their provider.
Abstract 17810: Sustained Natural Heart Regeneration After Myocardial Infarction in One-Week-Old Rats Without Significant Cardiomyocyte Proliferation
Authors: Wang Hanjay , Shin Hye Sook , Elde Stefan , Mullis Danielle , Walsh Sabrina , Lee Seung Hyun , Hironaka Camille , Lucian Haley , Thakore Akshara , Tran Nicholas , Jung Jinsuh , Wu Matthew , Zhu Yuanjia , Woo Y Joe
Published: December 2023

Introduction:
Newborn mammals are capable of natural heart regeneration after cardiac injury during the first week of life, but whether a decline in cardiomyocyte (CM) proliferation directly leads to the loss of regenerative potential is unknown. We hypothesized that, after myocardial infarction (MI) in neonatal rats, the extent of regeneration is directly correlated with the degree of CM proliferation.

Methods:
Neonatal Wistar rats, including both males and females, underwent left coronary artery ligation to induce MI on postnatal day 1 (P1, n=12), day 7 (P7, n=14), day 8 (P8, n=14), or day 9 (P9, n=15). Sham surgery was performed at each age (n=14, 13, 12, 16, respectively). CM proliferation was assessed using Ki67 staining in a subset of each age group, sacrificed 1 week after MI (n=4, 3, 5, 4) or sham surgery (n=4, 3, 3, 5). At 9 weeks post-MI, echocardiography was performed, and the hearts were explanted for Masson’s trichome staining.

Results:
At 9 weeks after surgery, left ventricular (LV) end-diastolic diameter (Fig 1A) and ejection fraction (EF, Fig 1B) were similar for P1 MI vs P1 sham (EF 62.5±5.2% vs 62.4±3.3%, p=0.941), as well as for P7 MI vs P7 sham (EF 61.4±3.3% vs 63.3±3.3%, p=0.210), consistent with robust natural regeneration. Progressive LV remodeling, dysfunction, and scar formation were observed after P8 MI (EF 50.1±2.6% vs 63.5±3.6%, p<0.001) and P9 MI (EF 39.4±3.4% vs 63.1±3.9%, p<0.001), but minimal scar was observed after P1 MI and P7 MI (Fig 1C). While the proportion of Ki67-positive CM was increased after P1 MI vs P1 Sham (4.0±2.0% vs 0.5±0.5%, p=0.013), CM proliferation was not significantly increased after P7 MI (1.0±0.4% vs 0.3±0.4%, p=0.105), or after P8 or P9 MI (Fig 1D).

Conclusions:
In rats, CM proliferation is not significantly stimulated after P7 MI, but the hearts develop with preserved geometry, normal function, and minimal infarct. Further studies are needed to examine non-CM-related mechanisms influencing the extent of natural heart regeneration.
Abstract 17817: Deep Learning-Based Retinal Imaging for Predicting Cardiovascular Disease Events in Prediabetic and Diabetic Patients: A Study Using the UK Biobank
Authors: Lee Chan Joo , Rim Tyler H , Kang Hyun Goo , Kim Sung Soo , Lee Geunyoung , Yu Marco , Tham Yih-Chung , Cheng Ching-Yu , Park Sung Ha
Published: December 2023

Introduction:
Our previous work led to developing a deep learning algorithm for retinal images, Reti-CVD, which effectively predicted cardiovascular disease (CVD) events in individuals without CVD history, leveraging coronary artery calcium (CAC) scores for algorithm training.

Hypothesis:
This study aims to assess the capability of deep learning-assisted retinal imaging to predict CVD events among prediabetic and diabetic patients using the data from the UK Biobank.

Methods:
Our study included prediabetic and diabetic patients from the UK Biobank. Reti-CVD scores were calculated and categorized into three risk groups - low (n=550), moderate (n=276), and high (n=275), based on the 50th and 75th percentiles, following a 2:1:1 ratio. To assess the Reti-CVD's ability in predicting fatal and non-fatal CVD events, we performed a survival analysis on the longitudinal data from the UK Biobank using Cox proportional-hazards models and hazard ratios (HRs).

Results:
Among the 1101 prediabetic or diabetic patients at the onset, 138 (12.5%) experienced CVD events. According to Reti-CVD scores, these events were found as 8.2% (45/550), 15.2% (42/276), and 18.5% (51/275) in the low, moderate, and high-risk groups over a median follow-up period of 11 years, respectively. After adjusting for factors such as age, gender, hypertensive medication use, statin use, and smoking history, a significant association was observed between the Reti-CVD and the incidence of CVD events (HR=1.57, 95% CI, 1.00-2.47 for the moderate-risk group; HR=1.88, 95% CI, 1.19-2.98 for the high-risk group compared to the low-risk group). An increasing HR trend of 1.36 (95% CI, 1.09-1.70) was observed across risk groups in the prediction of CVD events.

Conclusions:
The Reti-CVD offers a valuable tool for risk stratification among prediabetic and diabetic patients, indicating its potential in managing these high-risk groups.
Abstract 17846: Successful Treatment of Recurrent Pericarditis With Rilonacept in the Setting Of ATRA/ATO Use in Acute Promyelocytic Leukemia
Authors: Majid Muhammad , Arockiam Aro Daniela , Agrawal Ankit , Kumar Ashwin , Yaker Zachary , Mudra Sarah , Klein Allan L
Published: December 2023

Case Presentation:
A 40-year-old female was admitted for a 4-day history of recurrent left-sided pleuritic chest pain. Physical examination was pertinent for tachycardia and presence of a pericardial friction rub. Past medical history included recently diagnosed Acute Promyelocytic Leukemia undergoing active chemotherapy. Complete blood count showed leukopenia. Brain natriuretic peptide was slightly elevated at 241 pg/mL. Electrocardiogram demonstrated sinus tachycardia with diffuse ST-segment elevation and PR-segment depression (Figure 1. A). Echocardiogram showed normal biventricular function with a small posterior and lateral pericardial effusion and small pericardial effusion adjacent to the right ventricle (Figure 1. B). Cardiac magnetic resonance (CMR) imaging showed a moderate circumferential pericardial effusion and increased pericardial signal on T2 STIR imaging and late gadolinium enhancement (LGE) (Figure 1. C, D). Given the constellation of symptoms and findings, the patient was diagnosed with acute pericarditis secondary to differentiation syndrome (DS) suspected to be due to her underlying malignancy and anti-cancer treatments. She was started on aspirin and colchicine. Steroids and rilonacept were later added for incomplete treatment response. On follow-up, she was doing well. Repeat CMR demonstrated mild to moderate pericardial delayed enhancement with no edema and no pericardial effusion (Figure 1. E,F).

Discussion:
The presentation of DS can vary, and consensus diagnostic criteria are lacking. Cases of myopericarditis with concurrent pericardial effusions have been reported in the setting of patients undergoing chemotherapeutic treatment with differentiating agents. Management is complicated and requires multi-disciplinary care. Our case illustrates that rilonacept may be considered as an alternative to corticosteroids in the treatment of recurrent pericarditis in a patient with a hematologic malignancy.
Abstract 17847: Typical Right Atrial Flutter Ablation Using Subclavian Venous Access in Patients With Interrupted or Occluded Inferior Vena Cava
Authors: Jakulla Roopesh Sai , Mehta Nikhil , Osei Kofi M , Gupta Sanjaya K
Published: December 2023

Introduction:
Ablation for typical atrial flutter (AFL) traditionally involves vascular access from the femoral vein to facilitate advancing catheters through the Inferior Vena Cava (IVC) to the right atrium (RA). In patients with interrupted or occluded IVC, this procedure is challenging to perform. We report a case series of typical right AFL ablation using subclavian access in interrupted or occluded IVC.

Cases:
A 63-year-old female with typical AFL refractory to medical therapy was referred for radiofrequency ablation (RFA). She had a history of surgically corrected atrial septal defect at age 4 years with known IVC interruption draining into RA via an azygous venous extension. Another case involved a 41-year-old male with quadriplegia and typical AFL who underwent an attempted RFA from femoral access that was aborted due to massive thrombosis of IVC.

Decision making:
In both cases, two sheaths were placed into the left subclavian venous system using ultrasound guidance. A coronary sinus catheter and irrigated tip ablation catheter were advanced into the coronary sinus and RA respectively. Additionally, in the second case, an intracardiac echocardiography probe was inserted via separate venous access. Using the electroanatomic mapping system, entrainment and activation mapping confirmed a tricuspid isthmus-dependent AFL. RFA was performed using an open irrigated RFA catheter in a linear fashion resulting in the termination of the tachycardia to sinus rhythm. In the first case, ablation extended from the tricuspid annulus to the os of the hepatic vein at the 06:00 position. Post ablation, hemostasis was achieved using a suture-mediated closure device. At follow-up, both patients were asymptomatic without evidence of AFL on extended-duration cardiac monitoring.

Conclusion:
In patients with interrupted or occluded IVC, the subclavian veins can be accessed for mapping and ablation of typical AFL when traditional femoral venous access is challenging.
Abstract 17854: Imaging Intravascular Macrophages Using Micro-Sized Superparamagnetic Decoys
Authors: Gauberti Maxime , Navarro-oviedo Manuel , Vivien Denis , Martinez de Lizarrondo Sara
Published: December 2023

Introduction:
During inflammatory processes, intravascular macrophages are capable of phagocytizing circulating debris in the circulation.

Hypothesis:
Intravenous injection of contrast-loaded decoys could be used to label intravascular macrophages and map their distribution by non-invasive imaging.

Methods:
We synthetized superparamagnetic decoys with hydrodynamic diameters from 20 nm to 4.5 μm. Experimental models of neuroinflammation (intrastriatal injection of LPS or TNF) and ischemic stroke (thrombin model and ferric chloride model) were performed in mice. High resolution 3D T2*-weighted MRI sequences were performed after intravenous injection of the superparamagnetic decoys.

Results:
In experimental models of neuroinflammation, intravenous injection of superparamagnetic decoys with a diameter of 1 μm (but neither smaller nor larger particles) reveals intravascular phagocytic cells in the cerebral circulation, in a dose dependent manner. In ischemic stroke, we found that intravenous injection of the decoys leads to numerous signal voids in the vessels in and around the infarct core at 48 hours (Figure 1a-b). Interestingly, the intravascular phagocytic activity appears much higher in permanent rather than transient models of ischemic stroke. Pre-treatment with anti-CD11a blocking antibodies significantly reduced the number of intravascular macrophages in stroke. Histological studies confirmed that injected decoys are phagocytized by intravascular cells which express typical markers of the monocyte/macrophage lineage including CX3CR1 dependent GFP expression and CD68 (Figure 1c).

Conclusions:
Intravenous injection of superparamagnetic decoys in the micrometer size range allows to image intravascular macrophages. This new method allows to study the pathophysiological roles of intravascular macrophages in experimental models and could be easily translated to humans.
Abstract 17863: Analysis of Social Determinants of Health, Burden of Treatment and Quality of Life in Patients With Heart Failure With Preserved and Reduced Ejection Fraction, a Single Center Study With Six Months Follow Up
Authors: Johan Kenneth , Lim Chee Yao , Patel Pinal , Singh Inderpreet , Duran Santibanez Israel , Evans Jeffrey , Gutierrez Jorge , Markson Favour , Sinanova Betina , Vohra Ammar , YIP Laverne , Bhaskaran Aditya , Sura Harsh , menon vidya
Published: December 2023

Introduction:
Heart failure (HF) is a chronic debilitating disease with immense burden on the patient’s life. This study aims to investigate the clinical characteristics, social determinants of health (SDOH), burden of treatment (BoT), and quality of life (QoL) of patients with heart failure with preserved and reduced ejection fraction (HFpEF and HFrEF).

Methods:
Data from 191 patients (63 HFpEF, 128 HFrEF) were collected from February 2022 to March 2023. Validated questionnaires including SDoH, BoT and QoL were filled by the patient on admission and in 6 months as a follow up. Descriptive statistics were used to compare the demographic and clinical characteristics of HFpEF and HFrEF patients. Inferential statistics, including logistic regression, were used to analyze the associations between SDOH, BoT, QoL, and 30-day readmission rates.

Results:
Distribution between both groups is similar to the general population. HFpEF patients experienced more interpersonal challenges and reported greater difficulty with self-care and usual activities. HFrEF patients had higher rates of substances, alcohol, and tobacco use. Regarding readmission, HFpEF patients with medication difficulties and HFrEF patients with difficulty accessing healthcare services were more likely to be readmitted. Both HFrEF and HFpEF patients showed significant improvement in SDOH, QoL and BoT in the follow up data (Table 1).

Conclusions:
The study findings highlight the distinct clinical characteristics, SDOH, BoT, and QoL factors associated with HFpEF and HFrEF. These findings can contribute to targeted interventions and improved patient care. Moreover, the study emphasizes the importance of addressing social and personal factors influencing HF outcomes, aiming to reduce healthcare disparities and improve patient well-being. The results have implications for healthcare providers, policymakers, and researchers in improving the management and outcomes of heart failure patients.
Abstract 17886: Temporal Trends, Healthcare Resource Utilization and In Hospital Outcomes of Infective Endocarditis Following Transcatheter Edge-to-Edge Repair Using Mitraclip Among Elderly Patients With Severe Mitral Regurgitation: A National Perspectives
Authors: Dodoo Sheriff , Apenteng Bettye , Kumi Dennis , Opoku Samuel , Ramadan Ronnie
Published: December 2023

Introduction:
Procedural proficiency combined with the careful selection of patients with severe mitral regurgitation, who are at high or prohibitive risk for cardiac surgery, may have influenced the incidence and outcomes of infective endocarditis (IE) following mitral Transcatheter edge-to-edge repair (TEER).

Objective:
To assess the temporal trends, healthcare resource utilization (HRU), and in-hospital outcomes of IE post-TEER.

Methods:
We used the National inpatient sample registry to identify all patients aged
>
65 with definite IE post-TEER between 2016 and 2020. Temporal incidence trends, in-hospital mortality, length of stay, and discharge disposition were analyzed.

Results:
During the study period, there were an estimated 71 cases of endocarditis among patients 65 years and older following mitral TEER, representing 355 discharges (1.0% of TEER-associated discharges) nationally. The temporal trend of the incidence of IE is shown in Figure 1. Relative to its absence, the occurrence of IE following TEER was associated with a 30.3% increased risk of HRU (Patient Average Treatment effect - PATE estimate = 0.303; 95% confidence interval (CI) =0.214 - 0.391; P<0.001); a 13.2% increased risk of AKI (PATE estimate = 0.132; 95% confidence interval (CI) =0.033 - 0.232; p=0.009) and a 6.2% increased risk of in-hospital mortality (PATE estimate = 0.062; 95% confidence interval (CI) =0.008 - 0.117; p=0.025)

Conclusions:
Among elderly patients with severe symptomatic mitral regurgitation, who are at high or prohibitive risk for cardiac surgery, the incidence of TEER-associated IE appears to be trending downwards. The occurrence of TEER-associated IE confers small but significant high HRU, complication rates, including AKI and in-hospital mortality, compared to those without IE. High-fidelity studies are needed to elucidate these findings.
Abstract 17888: Apixaban versus Vitamin K Antagonists for Left Ventricular Thrombus: A Systematic Review and Meta-Analysis
Authors: Pasqualotto Eric , Mesadri Gewehr Douglas , Oliva Morgado Ferreira Rafael , chavez Matheus , Pessoa Fernando , A de Moraes Francisco Cezar , PEREIRA RAFAEL , Kubrusly Luiz F
Published: December 2023

Introduction:
Left ventricular thrombus (LVT), a major complication following acute myocardial infarction, significantly contributes to the increased risk of stroke and systemic embolism. Although vitamin K antagonists (VKAs) are the first-line treatment for LVT, direct oral anticoagulants (DOACs) have emerged as a potential alternative. However, the comparative effectiveness and safety of DOACs and VKAs for LVT treatment remain uncertain.
Research question:
Is apixaban therapy more effective and safer than VKA therapy for LVT?
Aim:
To assess the efficacy and safety of apixaban compared with VKAs therapy in patients with LVT.

Methods:
We systematically searched PubMed, Embase, and Cochrane databases for studies comparing the efficacy and safety of apixaban versus VKAs. We applied the random-effects model to calculate odds ratios (OR) and the corresponding 95% confidence interval. Heterogeneity was assessed using I
2
statistics. All calculations and graphics were performed using R (version 4.2.3).

Results:
Three randomized clinical trials (RCTs) were included, with 109 patients assigned to either apixaban (56 patients) or VKAs (53 patients). Compared to VKAs, apixaban showed no significant impact on thrombus resolution (OR 0.69; 95% CI 0.11-4.50; p=0.70; I
2
=0%), stroke reduction (OR 0.91; 95% CI 0.09-9.38; p=0.93; I
2
=1%), clinically relevant bleeding (OR 0.21; 95% CI 0.02-1.99; p=0.17; I
2
=0%), or all-cause mortality (OR 0.65; 95% CI 0.11-3.78; p=0.63; I
2
=8%).

Conclusions:
Apixaban therapy showed similar efficacy and safety to VKAs for LVT. These findings support the use of apixaban as an alternative to VKAs in LVT treatment.
Abstract 17889: Impact of Continuous Positive Airway Pressure for Severe Sleep Apnea on Very Late Recurrence in Patients Receiving Catheter Ablation of Atrial Fibrillation
Authors: Tanaka Nobuaki , Okada Masato , Tanaka Koji , Hirao Yuko , Harada Shinichi , Miyazaki Naoko , Kawahira Masatsugu , Iwasa Kohei , Koyama Yasushi , Fujii Kenshi , Heitaro Watanabe , Iwanaga Yoshitaka , OKAMURA ATSUNORI , Iwakura Katsuomi
Published: December 2023

Background:
Sleep apnea (SA) represents a risk for arrhythmia recurrence following catheter ablation (CA) of atrial fibrillation (AF). Continuous positive airway pressure therapy (CPAP) is the established standard treatment for moderate to severe SA. While CPAP exhibits promise in reducing AF recurrences post-CA, the evidence is not entirely consistent. The impact of CPAP for severe SA on very late recurrence post-CA of AF has not been elucidated.

Methods:
This study employed a retrospective, single-center, observational design. Data were derived from SA screening tests routinely performed in patients scheduled for CA of AF in our facility. We defined severe SA as an apnea-hypopnea index (AHI)≥30 by a home sleep apnea test or polysomnography. After excluding patients already diagnosed with sleep apnea before CA, we enrolled 461 consecutive severe SA patients. We divided them into two groups according to whether they had more than 1-year usage of continuous positive airway pressure after CA (CPAP group) or not (non-CPAP group). CPAP usage was monitored through telemonitoring and regular follow-up visits at our outpatient clinic every three months. Very late AF recurrence was defined as AF recurrence more than 1-year after the index CA.

Results:
The age was 65±10 years, 17.6% were females, and 60.1% had non-paroxysmal AF. The mean AHI was 37.4±15.3. The CPAP group included 32.8% (n=151) and non-CPAP group 67.2% (n=310). The AF recurrence rates within 1-year post-CA were similar between the two groups (CPAP group vs. non-CPAP group, 17.2% vs. 15.8%, log-rank p=0.88). However, the very late AF recurrence rate was lower in the CPAP group than non-CPAP group (CPAP group vs. non-CPAP group, 5.6% vs. 15.4%, log-rank p=0.0089).

Conclusion:
Among the untreated severe sleep apnea patients at the time of the catheter ablation of AF, CPAP treatment during 1-year post-CA was associated with fewer AF recurrences beyond 1-year post-CA.
Abstract 17900: Target Trial Emulation: Evaluating Cardiac Rehabilitation After TAVR
Authors: Varghese Merilyn , Dahabreh Issa , Song Yang , Xu Jiaman , Beatty Alexis L , McConeghy Kevin , Yeh Robert W , Sperling Laurence , Fonarow Gregg C , Keteyian Steven J , Wu Wen-Chih H , Kazi Dhruv S
Published: December 2023

Introduction:
Effectiveness of cardiac rehabilitation (CR) after transcatheter aortic valve replacement (TAVR) has not been examined in randomized trials. We used a novel causal inference approach called target trial emulation to evaluate whether participation in CR after TAVR reduces all-cause mortality.

Methods:
We emulated a target trial among Medicare beneficiaries age≥ 65 years who had undergone a TAVR from October 2016 through September 2019. The intervention was starting CR within 90 days of discharge (time 0) and the outcome was death from any cause. We created two exact copies of each patient’s data (“clones”) and assigned one clone to the control arm and the other to the intervention arm. This eliminated baseline confounding and immortal time bias. Each clone was censored when not consistent with the assigned treatment strategy (e.g., when a control clone initiated CR). Inverse probability weights accounted for potentially informative censoring. Falsification endpoints examined residual confounding.

Results:
Among 62,628 Medicare beneficiaries eligible for CR after TAVR, mean age was 80 years, and 43% were women. Of these, 28% initiated CR within the 90-day grace period. After adjusting for demographic, clinical, social, and economic differences, all-cause mortality at 2 years was lower in the CR arm than in the no CR arm (HR 0.74, 95% CI 0.63-0.87, p<0.01) (Figure). Falsification endpoints suggested some residual confounding but absolute differences between the two groups were small.

Conclusion
Fewer than 1 in 3 eligible patients receive CR after TAVR. In the first-ever target trial emulation of CR in patients undergoing TAVR, patients who initiate CR had lower rates of all-cause death. Ongoing work will examine additional approaches to account for residual confounding and use alternative quasi-experimental study designs. If replicated, our findings suggest that innovation in CR access and delivery is needed to enhance uptake after TAVR.
Abstract 17940: Effects of Continuous Accelerated Pacing on Clinical Outcomes in Patients With Heart Failure With Preserved Ejection Fraction: Three Year Follow Up of the myPACE Randomized Clinical Trial
Authors: Infeld Margaret , Cyr Jamie , Novelli Alexandra , Wahlberg Kramer J , Rawlings Rebecca , Plante Tim B , Meyer Markus
Published: December 2023

Background:
Heart failure with a preserved ejection fraction (HFpEF) is prevalent and has few evidence-based therapies. In a trial of HFpEF patients with specialized pacemakers, an accelerated personalized pacing rate averaging 75 bpm (myPACE) improved quality of life, NT-proBNP, physical activity, and atrial fibrillation burden compared with the standard lower rate setting of 60bpm (usual care). The one-year myPACE trial was not powered for clinical outcomes, but most patients elected to remain on their assigned treatment.

Methods:
The myPACE study was a single-center, blinded, randomized controlled trial that enrolled patients from June 2019 to November 2020. In this per-protocol analysis of clinical events over a 3-year follow-up, we included trial participants who remained on their assigned heart rate after study completion. The outcome of this analysis is a composite of the first clinical event (urgent visit or hospitalization for heart failure or atrial fibrillation, unstable angina or myocardial infarction, stroke, and death). Events were obtained by chart review and adjudicated by two blinded investigators. A Kaplan-Meier event-free survival plot and a log-rank test evaluated differences between the two treatment arms.

Results:
Of the 100 myPACE trial participants, most (40/48 myPACE and 48/52 usual care) remained on their assigned heart rate over a median (IQR) of 3.3 (2.6, 3.7) years after enrollment. The median (IQR) age was 75(69-80), and 45% were female. Accelerated personalized pacing was associated with reduced adverse clinical outcomes by about 60 percent. The Kaplan-Meier event-free survival plot for the composite of clinical events is shown in the Figure.

Conclusions:
In a per-protocol clinical event analysis of the extended myPACE study, those who continued the myPACE accelerated pacing protocol had fewer adverse clinical events than those with a lower rate setting of 60 bpm.
Abstract 17944: Process Mapping Care of Patients With Lower Extremity Wounds Due to Chronic Limb Threatening Ischemia
Authors: Cralle Lauren , Humphries Misty
Published: December 2023

Background:
The care experience for patients with wounds due to chronic limb threatening ischemia (CLTI) is rarely understood. Quality improvement programs frequently fail to recognize the entire process involved in accessing care. We developed a process map for stakeholders to guide quality improvement for CLTI patients.

Methods:
We recruited a team of stakeholders, including nurses, providers, coordinators, and patients, and met through iterative meetings to create a process map. We categorized barriers, identified actors, and estimated wait times. Based on information gathered, targeted solutions to improve care were developed.

Results:
We mapped 2 pathways, inpatient hospitalization and outpatient evaluation, for CLTI patients seeking care. Within these 2 paths, we identified 25 action steps with 15 decision points. We identified a total of 105 barriers to patients accessing care in each pathway. These were mapped into 9 categories grouped into multiple patient factors, health systems resources, insurance, communications, and waiting. We also identified 40 actors whose role in the process could create barriers within the process, including family, translators, social services, insurance. Finally, we grouped solutions into 4 categories. Overall, the shortest time to treatment was mapped as 8 weeks with expedited care to over 1 year with care provided solely in clinic.

Conclusion:
Process mapping highlights the great lengths patients endure to get treatment as well as specific opportunities for improving care between systems, providers, patients, and families. This work should serve as the foundation for quality improvement programs for patients with CLTI.
Abstract 17951: Infective Endocarditis of an Amplatzer PFO Occluder: A Rare and Devastating Complication
Authors: Salehin Salman , Ahmad Shahzad , Harmouch Wissam , Yaqub Maha , Abdou Claudine , Shalaby Mostafa , Abdulla Amer
Published: December 2023

Introduction:
Patent foramen ovale (PFO) closure is indicated for secondary prevention of ischemic strokes in select patients. PFO closure devices are rarely complicated by infective endocarditis (IE). We present the case of a patient with a closure device infected by Methicillin-sensitive Staphylococcus Aureus (MSSA).

Case:
A 60-year-old woman with a history of ischemic stroke status post transcatheter PFO closure with a 25 mm Amplatzer occluder eight months prior to presentation was admitted for a two week history of lower back pain, bilateral lower extremity weakness, and urinary incontinence. She denied dental procedures following device implantation. MRI of the spine revealed L3-L4 osteomyelitis with an adjacent epidural abscess which was immediately drained. Blood and intra-operative cultures revealed MSSA. There was no evidence of endocarditis on transthoracic echocardiogram (TTE). Given persistent bacteremia, a transesophageal echocardiogram (TEE) was performed, revealing large, highly mobile vegetations measuring up to 3 cm in length, attached to both the left and right atrial surfaces of the Amplatzer occluder. Urgent surgical removal of the Amplatzer occluder and PFO closure was performed. She received a 4-week course of Cefazolin.

Discussion:
Despite periprocedural antibiotics and prophylaxis for dental procedures for six months after implantation, IE of PFO occluders can rarely occur days to years after implantation. In patients with PFO occluders and persistent bacteremia or fevers, TEE is the diagnostic modality of choice as TTE are often negative. Management consists of urgent surgical excision and long-term antibiotics.