bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13431: Safety and Efficacy of Pulmonary Artery Denervation Therapy for the Treatment of Pulmonary Artery Hypertension
Authors: Vorla Mounica , Akbar Usman , Rallabhandi Sai Sri Harsha , Shastri Dipsa , Chitteti Aditi , Yandrapalli Srikanth
Published: December 2023

Background:
Despite recent advances in the treatment of pulmonary arterial hypertension (PAH), the survival rate remains poor in severe PAH. Pulmonary artery denervation (PADN) therapy for PAH is gaining popularity, although the safety and efficacy of PADN were not fully evaluated. Therefore, we conducted an updated systematic review and meta-analysis of the safety and efficacy of PADN in the treatment of patients with PAH.

Methods:
Using PRISMA guidelines, we searched PubMed, Embase, Cochrane, and the Clinical Trials.gov databases from inception till May 2023 for placebo-controlled outcome studies that compared PADN therapy to placebo in patients with moderate-severe PAH. The literature was screened for appropriate randomized clinical trials (RCT) and prospective studies, and data were extracted and analyzed. Comprehensive meta-analysis software (CMA v3, Biostat Inc. Englewood, NJ, USA) was utilized to perform statistical analyses.

Results:
The metanalysis included 8 studies (7 RCTs and 1 prospective) with 577 patients (PADN group = 270, placebo = 307). PADN treatment was associated with a significant reduction in mean pulmonary artery pressure [weighted mean difference (WMD) = -6.9 mmHg; 95% CI = -9.7, -4.1; P < 0.01; I
2
= 61] and pulmonary vascular resistance [WMD = -3.2 dyne.s.cm
-5
; 95% CI = -5.4, -0.9; P = 0.005; I
2
= 95]. There was a statistically significant improvement in the cardiac output [WMD = 0.3 l/min; 95% CI = 0.07, 0.6; P=0.012; I
2
= 76] and numerical improvement in 6-minute walking distance [WMD = 67.7m; 95% CI = -3.73, 139.2; P = 0.06; I
2
= 95] in the PADN group. There were fewer side effects in the PADN group as compared to the placebo group.

Conclusion:
This updated metanalysis supports PADN as a safe and efficacious therapy for moderate-severe PAH. Findings are limited by small sample size, medium-quality literature, and large data heterogeneity, necessitating larger RCT with clinical endpoints comparing PADN therapy with optimal medical treatment.
Abstract 13433: Outcomes of Chest Pain Discharge Decisions Following Launch of a Heart Score Clinical Decision Support Alert
Authors: Vaskas Adrianna , Garg Ria , Hussain Muzna , Marshall Kyle , Matsumura Martin E
Published: December 2023

Background:
The use of a bioclinical risk score such as the HEART score is recommended for the evaluation of pts presenting to the ED with chest pain (CP). Prior studies have demonstrated that CP pts with HEART score
<
3 and “ruled out” with cardiac troponin series are low risk for 30d death/MI (MACE). There is limited data regarding whether the addition of the HEART score to a validated high sensitivity troponin accelerated diagnostic protocol (ADP) has beneficial effects on CP patient discharge decisions in the ED.

Research Question:
Did the addition of an EHR-embedded automated HEART score clinical decision support alert (CDSA) have a beneficial effect on discharge decision making of ED CP pts in Geisinger Health System?

Methods:
Retrospective analysis of 30day MACE following ED visit for CP for the 6mo period prior to and 10mo following the launch of a HEART score CDSA (11/2021-3/2023). Discharges were stratified using a previously validated accelerated hsTnT ADP into those that ruled in (ADP+) or ruled out (ADP-). Comparison of MACE in pre- vs. post-CDSA periods was performed using chi square analysis.

Results:
MACE stratified by study period and ADP results are summarized in the Table. There were no significant differences in 30-day MACE pre- vs. post-CDSA, both overall and in ADP+ and ADP- subgroups. In contrast, the presence or absence of a high risk (>3) HEART score in isolation did significantly predict the risk of MACE [11/2360 (0.47%) for HEART score
<
3 vs 36/966 (4.04%) for HEART score >3, p<0.001].

Conclusions:
Addition of an EHR-embedded HEART Score CDSA did not have a significant effect on 30d outcomes following ED provider discharge decisions. While the HEART score by itself did stratify risk of 30d MACE, our study suggests the additive benefit of the HS CDSA to clinical decision making based on an established hsTnT ADP unclear.
Abstract 13461: Early Vascular Aging is Associated With Early Cardiac Aging, Upregulation of Left Ventricle Pro-Fibrotic and Inflammatory Genes and Memory Decline in Aged Dahl Salt-Sensitive Rats
Authors: Grigorova Yulia N , Juhasz Ondrej , Long Jeffrey M , McDevitt Ross A , Zernetkina Valentina I , Morrell Christopher H , Wei Wen , Rapp Peter R , Bagrov Alexei Y , Lakatta Edward G , Fedorova Olga V
Published: December 2023

Introduction:
Blood pressure (BP) begins to increase early in life in Dahl salt-sensitive rats (DSS) that consume a normal salt (NS) diet. Epidemiologic studies have shown that early vascular aging (EVA) is associated with central arterial stiffening (CAS) and hypertension, which develop earlier in life than expected in general population and contribute to cognitive impairment later in life.

Hypotheses:
(i) DSS rats will develop EVA earlier in life on NS diet, and with advancing age will exhibit early CV aging; (ii) In DSS, CV remodeling and CAS are implicated in memory decline. We tested these hypotheses using a longitudinal repeated measure design in DSS and their parental breed Sprague-Dawley rats (SD) at 3- & 12-mo of age.

Methods:
Male SD and DSS were kept on NS diet (0.5% NaCl; n=8/group) for entire experiment. Repeated measures of systolic BP (SBP), pulse wave velocity (PWV; an index of CAS), echocardiography, and non-repeated measures of Morris water maze (MWM) to test spatial memory, aortic collagen, elastin (histochemistry), and left ventricle (LV) mRNA expression (qPCR) were assessed at 3- & 12-mo. Data analyses: linear mixed-effect 2-way ANOVA, t-test & linear regression (LR) modeling. A 2-sided p<0.05 was considered significant.

Results:
SBP, PWV, aortic weight, wall thickness and collagen/elastin ratio were higher in DSS-3 vs. SD-3, and in DSS-12 vs. DSS-3. RWT and LV expression of pro-fibrotic, inflammatory and senescence genes were higher in DSS-12 vs. DSS-3 and vs. SD-12 (Table). DSS-12 spent more time to find a hidden platform in MWM vs. SD-12; their impaired spatial hippocampal memory was positively associated with PWV and LV mass by LR analysis.

Conclusions:
EVA, indexed as higher BP, PWV and aortic remodeling was associated with early CV aging, manifested by activation of LV senescence, inflammatory and pro-fibrotic genes and by higher rates of age-associated changes in BP, RWT and LV mass in DSS vs. SD. In DSS, early CV aging was associated with memory decline.
Abstract 13464: Considering Race and Ethnicity in Cardiovascular Risk Assessment
Authors: Wesley Shaun R , Guerrero Kerly , Mishiyeva Medina , Xiao Weirui , Patel Krishna K , Bernstein Peter S , Wolfe Diana S , Thornburg Loralei L
Published: December 2023

Background:
Cardiovascular disease (CVD) remains one of the leading causes of mortality in American adults, with disparities among racial and ethnic groups due to differential healthcare access and systemic racism. To better characterize the validity and generalizability of the AHA/ACC’s 2019 guidelines for primary prevention of CVD and 2018 special report on the use of the risk assessment tool for ASCVD, we examined the racial and ethnic composition of the study populations used in the underlying cited works.

Methods:
We reviewed all the references cited in the guidelines for our primary outcome, inclusion of race and ethnicity information. In addition, data were collected on study design, location (international, US, or both), reported sex/gender of participants, and total participants. We further assessed discussion of race and ethnicity within the articles as: cursory (1-2 sentences), moderate (3-5 sentences), or extensive (>5 sentences). Finally, we pooled the racial distributions for all study populations and compared it to national rates in the US population of 76% White, 14% Black, 6 % Asian, 19% Hispanic.

Results:
Of the 58 cited articles, 12 (20.6%) reported racial and/or ethnic backgrounds of participants. Of those 12 articles, 7 (12% of total) included cursory discussions of race and ethnicity, while the remaining 5 included no such discussion. Only 3 (5%) reported both race and sex distributions, none of which allowed calculation of race by sex. The pooled racial averages were 20% Black, 1% Asian and 9% other, with 11% identifying ethnicity as Hispanic.

Conclusion:
The majority of the guideline source data provides no information regarding the racial and ethnic backgrounds of study participants. Studies that do address race and ethnicity show an overrepresentation of white individuals compared to the general US population and provide no data specifically addressing the risk to people who are neither white nor male. This leads to potential underestimation of risks and imprecise risk calculations for non-white populations due to small sample sizes in the original studies. It is crucial to include diverse participant groups in studies at population rates to ensure precise risk calculations, improve CVD prevention, and reduce mortality rates.
Abstract 13469: A Comprehensive Echocardiographic Assessment of Patients With Chronic Myeloid Leukemia on Dasatinib
Authors: Chen Chen , Hernandez Maria P , Altman Jessica , Appadurai Vinesh , Akhter Nausheen
Published: December 2023

Background:
Dasatinib, a tyrosine kinase inhibitor used in the treatment of chronic myeloid leukemia (CML), is known to cause cardiotoxicities; however, little is known about the echocardiographic changes associated with this drug. Here we present a comprehensive echocardiographic assessment of patients with CML on dasatinib receiving care at a quaternary facility.

Methods:
We performed a retrospective cohort analysis on consecutive adult patients with CML receiving dasatinib between 2017-2022 who had a baseline and follow-up echocardiogram. Comprehensive clinical, laboratory and advanced echocardiographic data with speckle-tracking analyses (Tomtec Arena, Germany) were included.

Results:
Among 41 adult patients with CML (average age 64±16 years old, 39% female) who were prescribed with dasatinib (initial dose 100mg once daily), at baseline, 7 (17%) patients had heart failure with preserved ejection fraction (HFpEF), 11 (27%) coronary artery disease, and 3 (7%) pulmonary hypertension. There was a statistically significant increase in the indexed LV end-diastolic diameter and LV mass in pre- vs post-dasatinib echocardiograms; however, there was no significant change in ejection fraction or global longitudinal strain. There was no significant change in RV structure or function measures. There was a significant increase in LA volume index and decrease in lateral e’ velocity in pre- vs post-dasatinib echocardiograms. A trend towards declining LA reservoir strain post-dasatinib was noted. Ten (24%) patients had a progression in diastology grading after the initiation of dasatinib. Five out of 7 patients with HFpEF at baseline had progression in diastolic function post-dasatinib.

Conclusions:
Dasatinib was associated with significant changes in LV end-diastolic diameter, LV mass, LA volume, and diastolic parameters in patients with CML. These findings require further corroboration with a larger patient cohort and correlation with clinical outcomes.
Abstract 13474: The Efficacy of Istaroxime for Patients With Acute Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Abuelazm Mohamed T , Mahmoud Abdelrahman , Tanashat Mohammad , M. AlBarakat Majd , Abusuilik Husam , Ali Shafaqat , Abdelazeem Basel
Published: December 2023

Introduction:
Acute heart failure (AHF) exacerbation is the leading cause of morbidity and mortality associated with HF. The current AHF management strategies are inotropic and vasoactive agents. Despite the transient improvement in hemodynamic status with these agents, they have not shown survival benefits. Istaroxime is a novel IV inotropic agent with a dual mechanism, increasing both cardiomyocyte contractility as well as relaxation.

Methods:
We conducted a systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), which were retrieved by systematically searching: PubMed, Web of Science, SCOPUS, and Cochrane through April 24th, 2023. We used the fixed-effect or random-effects model, according to heterogeneity, to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD), with a 95% confidence interval (CI).

Results:
We included three RCTs with a total of 300 patients. Istaroxime was significantly associated with increased LV ejection fraction (MD: 1.06, CI [0.29, 1.82], P = 0.007), stroke volume index (MD: 3.04, CI [2.41, 3.67], P = 0.00001), and cardiac index (L/min/m2) (MD: 0.18, CI [0.11, 0.25], P = 0.00001). Also, istaroxime was significantly associated with decreased E/A ratio (MD: -0.39, CI [-0.58, -0.19], P = 0.0001) and pulmonary artery systolic pressure (MD: -2.30, CI [-3.20, -1.40], P = 0.00001). Istaroxime was significantly associated with increased systolic blood pressure (MD: 5.32, CI [2.28, 8.37], P = 0.0006) and decreased heart rate (MD: -3.05, CI [-5.27, -0.82], P = 0.007).

Conclusions:
Istaroxime improved blood pressure and some echocardiographic parameters, forming a promising strategy for AHF management. However, the current is limited to a small number of RCTs, warranting further large-scale phase III trials before clinical endorsement.
Abstract 13493: Autoimmune Myopericarditis: A Rare Presentation of Acute Myeloid Leukemia
Authors: Gaston Farrah , Sachdeva Amitoj , Manley-Casco Dario , Syed Anwaruddin , Ghadiam Harshavardhan
Published: December 2023

Description of Case:
A 51-year-old female with a past medical history of hypertension and type II diabetes mellitus presented with chest pain for 2 days that improved with sitting up and leaning forward. This was associated with exertional dyspnea and dizziness. EKG showed diffuse ST-T elevations with PR depression. The patient had a WBC Count of 1.37 X 10
9
/L, Troponin (normal 0.028 ng/ml) was 1.466>1.539>1.105>1.105, CRP 27.35 mg/ml, ESR was 77 mm/h. The patient’s symptoms were concerning for acute pericarditis versus acute coronary syndrome. Echocardiogram showed no regional wall motion abnormality and a small pericardial effusion. Cardiac magnetic resonance imaging demonstrated myopericarditis. The infectious workup was negative. Further workup showed positive antinuclear antibody and positive smooth muscle antibody/ribonucleoprotein. Flow cytometry indicated 1% blast with immunophenotypic atypia and neutropenia. Bone marrow aspiration and biopsy confirmed 6-7% myeloblast and pathology revealed high-grade myeloid neoplasm transforming into acute myeloid leukemia (AML). The patient was initiated on ibuprofen and colchicine for myopericarditis and is currently undergoing chemotherapy.

Discussion:
The etiology of pericarditis includes infection, malignancy, autoimmune disease, myocardial infarction, and cardiac surgery. In one study involving 784 patients, the etiology of pericarditis was only identified among 17% of cases, with 5% of those being autoimmune and 5% of those being neoplastic. Our patient had a rare presentation of AML and this case serves as a reminder to clinicians about the importance of thorough investigation when patients present with pericarditis without a clear attributable cause to identify an underlying disease and prevent treatment delay.
Abstract 13555: Effect of Calcium Channel Blockers on Clinical Outcomes in Patients After Percutaneous Coronary Intervention With Left Ventricular Dysfunction
Authors: Uematsu Manabu , Nakamura Takamitsu , Horikoshi Takeo , Kobayashi Tsuyoshi , Yoshizaki Toru , Nakamura Jun , Makino Aritaka , Saito Yukio , Obata Jun-ei , Sawanobori Takao , Takano Hajime , umetani ken , Asakawa Tetsuya , Sato Akira
Published: December 2023

Although calcium channel blockers (CCBs) are effective in hypertension and IHD, short-acting CCBs are not recommended for heart failure due to have negative inotropic effects. On the other hand, long-acting CCBs have been reported to be safe for use in patients with cardiac dysfunction, but details are still unclear. In this study, we investigated the relationship between the effects of CCBs on CAD patients and left LV function.

Methods:
We enrolled 7173 consecutive CAD patients (Age; 69 [61-76] years and male; 78%) who underwent successful PCI for AP or ACS between April 2008 and March 2020 from prospective, multicenter registry (FUJISUN registry). Of the enrolled patients, 5307 analyzable patients were divided by LVEF <40 or ≥40%. Patients were prospectively followed for a maximum of 8 years or until the occurrence of the cardiac events (CEs): cardiac death, nonfatal MI.

Results:
During the follow-up period (3.6 [1.4-6.7] years), 230 (4%) CEs occurred (109 Cardiac death, 121 MI). Both patients with LVEF <40% and ≥40% had higher prevalence of HT and lower levels of BNP in CCB group than in non-CCB group. Propensity match analysis was performed to reduced selection bias for CCB use in each group. In patients with LVEF <40%, Kaplan-Meier analysis showed that CCB group had significantly lower probability of CEs than non-CCB group, whereas in those with LVEF ≥40%, the probability of CE was similar in both groups. Multivariate Cox proportional hazards analysis showed that CCB group had significantly lower probabilities of CEs compared with non-CCB group in patients with LVEF<40%, (HR 0.25; 95% CI 0.09-0.71, p <0.01), but not in those with LVEF≥40% (HR 1.13; 95% CI 0.80-1.60, p = 0.50).

Conclusions:
Long-acting CCBs may improve clinical outcomes in post-PCI CAD patients with LV dysfunction.
Abstract 13562: Calcium Supplementation to Prevent Pre-Eclampsia and Hypertensive Disorders of Pregnancy: A Meta-Analysis of Randomized Controlled Trials
Authors: Jaiswal Vikash , Jaiswal Akash , Medina Jillian Reeze , Kalra Kriti
Published: December 2023

Background:
Pre-eclampsia and eclampsia are common causes of morbidity and mortality, especially in low-income countries. Reducing adverse outcomes associated with hypertensive disorders of pregnancy has been the ultimate priority in recent years.

Objective:
We aim to evaluate the association between calcium supplements and the risk of preeclampsia and gestational hypertension among pregnant women.

Methods:
A systematic literature search was performed in electronic databases from inception to 15th May 2023, including only randomized controlled trials involving pregnant women, with one group on calcium supplements and another with a placebo. Pooled odds ratios (OR) were calculated using a random effect model, and a p-value of <0.05 was considered statistically significant.

Results:
A total of 27 studies with 28,660 patients (14319 patients with calcium supplements and 14341 patients with placebo group) were included in the analysis. The Pooled analysis shows that calcium supplements reduce the risk of preeclampsia by 44% (OR, 0.56(95%CI: 0.45-0.70), P<0.001) compared to placebo. Similarly, calcium supplements were found to significantly reduce the risk of gestational hypertension by 20% (OR, 0.80(95%CI: 0.70-0.91), P<0.001).

Conclusion:
Our study shows that calcium supplements are associated with a significant reduction in preeclampsia and gestational hypertension which can lead to a reduction in associated morbidity and mortality.
Abstract 13565: Long-Term Prognostic Value of the Combination of Systemic Immune-Inflammation Index and AHEAD Score and in Patients Admitted for Acute Decompensated Heart Failure
Authors: Yamada Takahisa , Watanabe Tetsuya , Morita Takashi , Kawasaki Masato , Kikuchi Atsushi , Kondo Takumi , Kawai Tsutomu , Nishimoto Yuji , Seo Masahiro , Nakamura Jun , Fujita Takeshi , Taniichi Masanao , Chang Yongchol , Fukunami Masatake
Published: December 2023

Backgrounds:
Systemic inflammation plays a critical role in the outcomes of heart failure patients. A newly defined index, which is named as systemic immune-inflammation index (SII), had been reported to have prognostic value in patients with cardiovascular disease. On the other hand, comorbidities are strongly associated with poor clinical outcome in heart failure patients (pts). AHEAD (A: atrial fibrillation; H: hemoglobin; E: elderly; A: abnormal renal parameters; D: diabetes mellitus) score was known to be related to clinical outcomes in acute decompensated heart failure (ADHF) patients. We sought to investigate the prognostic value of the combination of SII and AHEAD in patients admitted for ADHF.

Methods and Results:
We studied 263 patients admitted for ADHF and discharged with survival. At the discharge, we obtained SII, which is computed as neutrophils x platelets / lymphocytes, and AHEAD score (range 0-5, atrial fibrillation, hemoglobin <13 mg/dL for men and 12 mg/dL for women, age >70 years, creatinine >130 μmol/L, and diabetes mellitus). During a follow-up period of 5.0±4.2 yrs, 67 patients had cardiovascular death (CVD). At multivariate Cox analysis, SII and AHEAD score were significantly independently associated with CVD, independently of prior heart failure hospitalization, systolic blood pressure and left ventricular dimension index. The patients with both greater SII (≥571 determined by ROC analysis: AUC 0.632[0.553-0.712]) and AHEAD score (≥3: AUC 0.635[0.562-0.707]) had a significantly increased risk of CVD than those with either and none of them (51% vs 28% vs 16%, p<0.0001, respectively).

Conclusion:
The combination of SII and AHEAD score would be useful for stratifying patients at risk for cardiovascular-renal poor outcome in ADHF patients.
Abstract 13574: A 5-Year Nationwide Analysis: Management & In-Hospital Outcomes of Acute ST-Elevation Myocardial Infarction in the ≥90-Year-Old
Authors: Desai Spandan , Roma Nicholas , Shah Kashyap , Shirani Jamshid
Published: December 2023

Introduction:
The number of individuals living at or beyond age 90 is increasing and many have ischemic heart disease (IHD). There is limited data for management and in-hospital outcomes of acute ST-segment elevation myocardial infarction (STEMI) in this age group.

Methods:
National Inpatient Sample 2016-2020 was used to query 1,003,305 hospitalizations for adults with STEMI that were divided into two groups: adults ≥90 years and adults between ages 18 and <90.

Results:
33,515 (3.3%) cases with acute STEMI were observed in ≥90-year-old population group (67% females, 84% Caucasians, p<0.001). There was a decline in annual admissions for acute STEMI in the ≥90-year-old group as listed in Table 1. This group had lower rates of diagnostic and reperfusion therapies (coronary angiography (CA) 41% -vs- 86%, P<0.001, PCI 34.5% -vs- 73.2%, p<0.001, CABG 0.3% -vs- 5.50%, p=0.090, Fibrinolysis 0.2% -vs- 0.8%, p=0.061). Smoking history was observed less often in the ≥90-year-old group (21.5% -vs- 49.6%, p<0.001). Hospital mortality in this group was significantly higher (27.6% -vs- 9.1%, p<0.001) and there were higher rates of complications including AKI (32.6% -vs- 18.9%, p<0.001), CHF (53.6% -vs- 38.5%, p<0.001), ventricular arrhythmias (11.1% -vs- 19.2%, p=0.003), and cardiogenic shock (15.1% -vs- 14.1%, p=0.753). In the ≥90-year-old group that died as compared to ≥90-year-old group that survived, there were lower rates of CA (25% -vs- 44%) and PCI (18% -vs- 36%), all p<0.001. In this same comparison group, there were higher rates of development of AKI- 43.2% -vs- 28.5%, need for ICU- 25.7% -vs- 4.3%, need for vasopressors- 6.7% -vs- 1.6%, and need for mechanical ventilation- 23.0% -vs- 3.2%, all p<0.001.

Conclusions:
In the ≥90-year-old population admitted with acute STEMI, there were lower rates of reperfusion therapy while In-hospital mortality and complications rates remain high.
Abstract 13576: Long-Term Serial Changes in Echocardiographic Parameters in Patients With Heart Failure With Preserved Ejection Fraction After Catheter Ablation for Atrial Fibrillation
Authors: Okada Taiji , Kobori Atsushi , Sano Madoka , Ooka Junichi , Ryousuke Murai , Sasaki Yasuhiro , Toyota Toshiaki , Taniguchi Tomohiko , Kim Kitae , Ehara Natsuhiko , Kinoshita Makoto , Tani Tomoko , Furukawa Yutaka
Published: December 2023

Background:
Heart failure with preserved ejection fraction (HFpEF) is frequently complicated by atrial fibrillation (AF). Catheter ablation for AF is an effective method for restoring and maintaining sinus rhythm (SR). However, there is limited data on the serial changes in echocardiographic parameters in patients with HFpEF after ablation.

Hypothesis:
The serial changes in echocardiographic parameters after ablation for AF depend not only on baseline rhythm but also on the presence of HFpEF.

Methods:
A retrospectively review was conducted on 1109 out of 2123 patients who had serial echocardiographic data available before the ablation procedure and at 1-year, 2-year, and 3-year follow-ups. The changes in echocardiographic parameters were assessed using repeated measures ANOVA with a Greenhouse-Geisser correction and Bonferroni tests in four groups, which were divided according to baseline rhythm and HFpEF. HFpEF was defined as an HFA-PEFF score ≥ 5 or 2-4 and left atrial pressure ≥ 15 mmHg at the time of catheter ablation.

Results:
The prevalence of HFpEF was 51.9%, and paroxysmal AF was present in 65%. Left atrial volume index (LAVI) was larger at baseline in patients with AF and significant decreased after ablation in all groups. The trend of left atrial emptying fraction (LAEF) increased in patients with baseline AF until 1year later, while in patients with baseline SR and HFpEF, LAEF gradually declined even after catheter ablation. The trend of left ventricular ejection fraction increased in patients with baseline AF. The trend of mean E/E’ mildly increased after ablation in all groups. There were significant differences between HFpEF and non-HFpEF. (Figure)

Conclusions:
Catheter ablation was associated with changes of LA size, function and left ventricular function. Baseline rhythm and the presence of HFpEF play a complex role in the course of cardiac function after ablation.
Abstract 13581: Effect of Lipoprotein(a) on Long-Term Outcomes at Different LDL-C and hs-CRP Status in Patients With Percutaneous Coronary Intervention
Authors: Li Jiawen , Yan Kailun , Li Yulong , Yang Yuejin , Yuan Jinqing , Zhao Xueyan
Published: December 2023

Background:
Although some studies have shown that the risk of adverse events associated with lipoprotein (a) [Lp(a)] are influenced by low-density lipoprotein cholesterol (LDL-C) or high-sensitivity C-reactive protein (hs-CRP) levels, results on whether hs-CRP and LDL-C jointly mediate the effect of Lp(a) on long-term outcomes are unknown.

Aim:
To investigate the effect of Lp(a) on long-term clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) according to LDL-C levels and further hs-CRP levels.

Methods:
This prospective study consecutively enrolled 10,724 patients with PCI in the year 2013. The primary endpoint was all-cause death. The secondary endpoint was cardiac death.

Results:
There were 10,000 patients with available baseline data included in final analysis (Age 58.33±10.26 years, 77.27% Male). During a median follow-up of 5.1 years, 358 patients developed all-cause death and 217 cardiac death. After the multi-variable Cox analysis, in the overall population, Lp(a) ≥ 30 mg/dL was an independent risk factor of all-cause death and cardiac death. Further analysis showed that, in patients with LDL-C < 70 mg/dL, Lp(a) ≥ 30 mg/dL was not an independent risk factor of all-cause death and cardiac death regardless of hs-CRP < 2 or ≥ 2 mg/L. However, when LDL-C ≥ 70 mg/dL, in the setting of hs-CRP ≥ 2 mg/L, Lp(a) ≥ 30 mg/dL was an independent risk factor of all-cause death and cardiac death; in the setting of hs-CRP < 2 mg/L, Lp(a) ≥ 30 mg/dL was only the independent risk factor of cardiac death.

Conclusions:
The current study first reported that LDL-C and hs-CRP jointly affected the long-term outcomes associated with Lp(a) in PCI patients. When LDL-C < 70 mg/dL, Lp(a) ≥ 30 mg/dL was not associated with the risk of all-cause death and cardiac death irrespective of hs-CRP levels. Our finding may be instructive for the management and treatment of Lp(a) in the future.
Abstract 13584: Prognostic Value of Combined Assessment of Cardiac Magnetic Resonance and Fluorodeoxyglucose Positron Emission Tomography in Patients With Cardiac Sarcoidosis
Authors: Kazui Sho , Takenaka Sakae , Nagai Toshiyuki , Tsuneta Satonori , Yoshiya Kato , Komoriyama Hirokazu , Kobayashi Yuta , Takahashi Akinori , Kamiya Kiwamu , Temma Taro , Sato Takuma , Tada Atsushi , Yasui Yutaro , Nakai Michikazu , Sato Takahiro , Tsujino Ichizo , Kudo Kohsuke , Konno Satoshi , Anzai Toshihisa
Published: December 2023

Background:
Although the combined assessment of late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) and
18
F-fluorodeoxyglucose positron emission tomography (FDG-PET) was useful for the detection of cardiac sarcoidosis (CS), its prognostic value remains unclear.

Methods:
We examined 90 consecutive CS patients diagnosed by both CMR and FDG-PET before prednisolone (PSL) therapy between September 2008 and April 2023 in our hospital. We calculated the overlap rate of FDG uptake area in the LGE-positive area to evaluate the association between concordance of FDG/LGE areas and adverse events. Patients were divided into two groups according to the median concordance ratio (overlap rate) between FDG and LGE areas (70 %). The primary outcome was a composite of sustained ventricular tachycardia/fibrillation (VT/VF), worsening heart failure, and sudden cardiac death.

Results:
Median interval between CMR and FDG-PET was 6.5 (IQR 3.0-24.0) days. There are no significant differences on age, sex, left ventricular ejection fraction (LVEF), brain natriuretic peptide (BNP) level, and extent of LGE between the groups. During a median follow-up period of 3.2 (IQR 1.0-6.2) years, the primary outcome occurred in 25 (28%) patients. Patients with lower concordance showed a higher incidence of the primary outcome (Figure A), and lower improvement in LVEF after PSL therapy (Figure B) compared to those with higher concordance. In multivariable Cox regressions, lower concordance was significantly associated with the primary outcome adjusted for history of VT/VF (HR 7.37,
P
= 0.001), LVEF (HR 7.75,
P
= 0.001), log BNP (HR 5.62,
P
= 0.006), and extent of LGE (HR 11.75,
P
= 0.017).

Conclusions:
Lower concordance ratio of FDG/LGE before PSL therapy was associated with higher incidence of adverse events and lower improvement of LVEF. Assessment of active inflammation in the extent of LGE might be useful for risk stratification and prediction of the response to PSL in patients with CS.
Abstract 13588: A Generalizable Deep Learning System for Cardiac MRI
Authors: Shad Rohan , Zakka Cyril R , Kaur Dhamanpreet , MONGAN JOHN , Kallianos Kimberly G , Filice Ross , Khandwala Nishith , Eng David , Langlotz Curtis , Hiesinger William
Published: December 2023

Introduction:
Our goal was to create a generalizable Cardiac MRI (CMR) deep learning system capable of understanding the breadth of human disease and health. With traditional supervised approaches, parameters learned for one clinical problem rarely generalize to others. Models must be re-trained from scratch for each new clinical task of interest, requiring thousands of training examples every time. Unlike human clinicians, deep learning models lack a baseline fund of clinical knowledge over which learning specific tasks can be accelerated.

Methods:
We use self-supervised contrastive learning to train a video transformer system that learns complex pathophysiological visual representations guided by natural language supervision from text reports accompanying each CMRI study. Two parallel deep learning systems - one processing text, and the other processing CMR cine sequences learn from each other, allowing the vision system to learn from radiologist reports as training progresses. Training was performed on a multicenter clinical dataset of 17000 patients. We subsequently freeze the vision network, and apply it to the task of calculating left ventricular ejection fraction (LVEF%) from the UK BioBank (45,6323 participants)

Results:
On a hold-out test subset of UK BioBank participants, we report a mean absolute error (mae) of 3.344 (sd 3.615), with Bland Altman limits of agreement -9.91% to +9.61%. Using this network to screen for HFrEF (Heart Failure with reduced ejection fraction < 40%), the AUC is 0.880 (95%CI: 0.835-0.925; n=4259). This is significantly more performant compared to our baseline, where we finetune the exact same network architecture using traditional supervised approaches (AUC 0.751 (95% CI: 0.692-0.811; p < 0.001)). Finally, our network achieves superior results with 1/100
th
the data.

Conclusions:
We show that contrastive text-video pre-training can be used to train powerful and generalizable deep learning systems for CMR.
Abstract 13591: Utilization and Spending on Fixed-Dose Combination Treatment for Hypertension in Medicare and Medicaid, 2016-2020
Authors: Essa Mohammed , Ross Joseph S , Dhruva Sanket , Desai Nihar R , Spatz Erica S , Faridi Kamil
Published: December 2023

Introduction:
ACC/AHA hypertension guidelines recommend fixed-dose combination (FDC) medications for Stage 2 hypertension to improve adherence and blood pressure control. However, utilization, total spending, and generic availability of FDC antihypertensives among U.S. adults are unknown.

Methods:
We evaluated total claims in millions (M) and inflation-adjusted spending for all first-line single and FDC antihypertensive medications consisting of ACEi/ARBs, calcium channel blockers, and/or thiazide diuretics in Medicare Part D and Medicaid from 2016 to 2020. We also evaluated use of generic vs. brand-name first-line antihypertensives.

Results:
Though total antihypertensive claims increased from 2016 to 2020 in Medicare and Medicaid, use of FDC antihypertensives decreased from 20.6M to 16.9M claims in Medicare (12.6% to 9.4% of all first-line hypertension treatment claims), and from 4.6M to 3.4M claims in Medicaid (12.3% to 8.8%), respectively (
Figure
). Total spending on FDC antihypertensives decreased from $823.3M to $670.9M in Medicare and from $58.9M to $46.9M in Medicaid over this time period. Generically available medications constituted >96% of all Medicare and Medicaid claims in 2016 and >99% of all Medicare and Medicaid claims in 2020 for both single and FDC antihypertensives. Spending on FDC brand-name medications decreased by 87.6% in Medicare ($385.5M to $47.7M) and by 94.1% ($24.9M to $1.5M) in Medicaid.

Conclusions:
Though FDC medications are widely recommended for treatment of hypertension and almost exclusively generic, use of these agents in Medicare and Medicaid has decreased from 2016 to 2020. Further efforts are needed to understand the decrease in FDC use and to increase adoption of FDC antihypertensives in clinical practice.
Abstract 13600: LDL Levels and Lipid Lowering Management Across Age Groups in Mexican Population. Analysis From the Mexican Registry of Cardiovascular Diseases (REMECAR)
Authors: De Los Rios Manuel O , Leiva-Pons Jose L , Alcocer Gamba Marco A , Cortes Lawrenz Jorge , Alejandro Ricalde , Virgen-Carrillo Luis R , Pavia-Lopez Abel A , Lugo-Gavidia Leslie M
Published: December 2023

Background and Aims:
Age is a major determinant of cardiovascular (CV) risk. While younger people are more likely to have lower CV risk they may have other risk factors that can impact the long-term development of cardiovascular disease. Among them, dyslipidemia has a crucial role in the development of atherosclerotic disease (ASCVD).

Objective:
This analysis aimed to compare LDL levels and lipid lowering management in patients with dyslipidemia across different age groups

Methods:
The REMECAR registry is a prospective, multicentre, observational study of patients attending to outpatient cardiovascular clinics for diagnostic, and clinical management of cardiometabolic diseases. Patients were classified according to their age group.

Results:
A total of 6,138 patients with a previous diagnosis of dyslipidemia were included in the analysis. The prevalence of ASCVD and comorbidities progressively increased with older age, while younger patients presented higher proportions of modifiable risk factors (Alcohol consumption, Smoking). Younger patients had significantly higher cholesterol, LDL-c, and triglycerides levels compared with groups >60 years (Figure 1A). Most of the patients <40 did not have any established lipid-lowering therapy (73.4%). This same group also showed higher proportions of patients with LDL>190mg/dL (6.3%) and with triglycerides>500mg/dL (4.8%). Low/Moderate Statin was the most frequent treatment, high-intensity statins were used in less than 20% of all groups despite the increasing prevalence of ASCVD (Figure 1B).

Conclusions:
A stepwise therapy escalation is reasonable in young patients, as the risk of CV events is not immediately perceived. However, this also prolongs long-term exposure if proper management is not established on time, leading to the progression of the disease. Our results underline the urgent need to improve population awareness, proper follow-up, and optimization of lipid-lowering management.
Abstract 13609: Racial Disparities and In-Hospital Outcomes of Atrial Fibrillation Ablations in Hypertrophic Cardiomyopathy: A 5-year Nationwide Inpatient Sample Analysis
Authors: Desai Spandan , Roma Nicholas , Shah Kashyap , Dixit Shiv , Durkin Michael
Published: December 2023

Introduction:
Atrial fibrillation (AF) is a common supraventricular arrhythmia observed in patients with hypertrophic cardiomyopathy (HCM). However, there is a dearth of data regarding racial disparities and in-hospital outcomes specifically among HCM patients undergoing AF ablation.

Methods:
National Inpatient Sample database from 2016 to 2020 was queried for patients with HCM undergoing AF ablation using appropriate diagnostic and procedural ICD codes. These were further divided into African American (AA) and non-African American (non-AA) groups. Logistic regression was used to compare baseline characteristics and in-hospital outcomes.

Results:
A total of 610 HCM patients underwent AF ablation between 2016-2020. Out of these, 45 (7.4%) were AA. Compared to non-AA patients, AA patients undergoing AF ablation were younger (mean age: 61-vs-64 years), more often female (56%-vs-54%, p=0.28) and had a higher burden of comorbidities (Table 1). AA patients had lower length of stay (4.1-vs-4.7 days, p=0.008) and total hospital cost ($113,564-vs-158,904, p<0.001). The AA group had a higher prevalence of hypertension (44.4% -vs- 36.3%, p<0.001), obstructive sleep apnea (55.6% -vs- 21.2%, p<0.001), heart failure with reduced ejection fraction (22.2% -vs- 3.5%, p<0.001), alcohol use (11.1% -vs- 0.9%, p<0.001) and class I obesity (11.1% -vs- % 6.2%, p<0.001). This group also had higher in-hospital mortality (11.0% -vs- 0.9%, p<0.001) and worse in-hospital outcomes including acute pericarditis, cardiogenic shock, and requiring mechanical ventilation (Table 1).

Conclusions:
Despite lower length of stay and hospital cost, AA patients with HCM that underwent AF ablation had higher in-hospital mortality and complications compared to non-AA patients. These observed disparities warrant further research to gain a deeper understanding of the underlying factors contributing to these outcomes.
Abstract 13611: Right Ventricular Perforation and Subsequent Tamponade Due to Fractured Inferior Vena Cava Filter Strut
Authors: Minciunescu Andrei , Gattani Raghav , kiernan Joseph M , Saeed Ibrahim , Haddad Tariq M , Ryan Liam , Howard Edward
Published: December 2023

Description of Case:
A 39-year-old woman with a remote history of unprovoked pulmonary embolism (PE) treated with a retrievable inferior vena cava (IVC) filter presented with chest pain and syncope. Initial vital signs and examination were unremarkable. ECG showed diffuse ST elevations with PR depression consistent with acute pericarditis (Figure 1A). Given her history, CT angiogram (CTA) was performed and revealed complex pericardial effusion without PE. Echocardiogram confirmed large pericardial effusion with evidence of right ventricular diastolic collapse, raising concern for impending cardiac tamponade (Figure 1B). Urgent pericardiocentesis yielded 500 mL of sanguineous fluid, with resolution of effusion. A pericardial drain was left in place. Overnight she became hypotensive, tachycardic, diaphoretic, with muffled heart sounds on exam. Rapid re-accumulation of blood was noted from the drain, confirmed by repeat echo showing enlargement of the pericardial effusion. She was diagnosed with recurrent hemorrhagic pericardial effusion (HPE) of unclear etiology and was emergently taken for mediastinal exploration, where a metal shard measuring 2.2 cm was seen protruding though the RV (Figure 1C), confirmed on intraoperative TEE (Figure 1D). It was determined that a fractured IVC filter strut had migrated into the RV causing perforation and recurrent HPE. The strut was removed and RV defect patched. The patient did well post-operatively without effusion recurrence. Follow up CTA confirmed fractured IVC filter strut, with another filter strut also seen extending through the IVC wall (Figure E).

Discussion:
Rapid reaccumulation of a hemorrhagic, hemodynamically significant pericardial effusion without clear etiology, as in this case, should prompt consideration of surgical exploration to assess for bleeding source. As strut fractures are a known complication of retrievable IVC filters, these filters should be removed when no longer indicated.
Abstract 13620: Highlights From National Inpatient Sample 2016-2020: Temporal Trends in Septal Reduction Therapy in Hypertrophic Cardiomyopathy
Authors: Desai Spandan , Roma Nicholas , Shah Kashyap , Gasimli-Gamache Leyla , Shirani Jamshid
Published: December 2023

Introduction:
Surgical myectomy (SM) and Alcohol septal ablation (ASA) are used for septal reduction therapy (SRT) in obstructive hypertrophic cardiomyopathy (oHCM). Selection criteria, local expertise, and reported outcomes for choice of SM versus ASA have evolved in recent years. We aimed to compare recent temporal trends of SM and ASA.

Methods:
National Inpatient Sample 2016-2020 was queried to identify adults with oHCM using appropriate ICD codes along with procedure codes for ASA and SM. oHCM patients were divided into two groups- SM and ASA. Logistic regression was used to compare in-hospital outcomes.

Results:
Between 2016 and 2020, there were 5445 cases of SM and 1955 cases with ASA. Cases with ASA were older (67.5 -vs- 59.7 years), more likely to be females (67.3% -vs- 56.3%, p<0.001), and had higher proportion of African Americans (12% -vs- 7%, p<0.001). An overall downward trend in number of SM procedures and an increase in ASA procedures from 2016 to 2020 was observed as listed in Table 1. There were lower number of SM procedures compared to ASA in 2020. While total number of SRT remained relatively stable, proportion of ASA increased in all regions (West, South, Northeast) except Midwest. Urban teaching hospitals continued to perform >90% of SRTs each year and mortality was significantly higher in non-teaching compared to urban teaching hospitals for both SM (8.9% -vs- 2.3%, p<0.01) and ASA (5.6%-vs-1.9%, p<0.01). Major complications were uncommon and did not change during the study period for both procedures.

Conclusions:
This retrospective database of hospital admissions for SRT indicates that there was a decline in proportion of patients that underwent SM for oHCM between 2016 and 2020 in most regions of the United States. Further studies are needed to determine the impact of this trend on long-term outcomes of patients with oHCM.
Abstract 13628: Methicillin-Resistant Staphylococcus Aureus Associated Pericardial Empyema: A Lethal Threat to the Heart
Authors: Hazique Mohammad , Ahmed Sara
Published: December 2023

Introduction:
A highly uncommon but potentially life-threatening condition called Pericardial empyema is a rare but rapidly fatal condition, and in more than half the cases, the diagnosis is postmortem. The most common causal microorganism is Staphylococcus aureus.

Case Presentation:
A 73-year-old male with a past medical history of type 2 diabetes mellitus and hypothyroidism presented with chills, fever, and a non-healing skin infection on his arm for the last two weeks. Wound and blood cultures were positive for Methicillin-resistant Staphylococcus aureus (MRSA). He was started on intravenous Vancomycin. On day 3 of admission, he suddenly developed chest pain. On examination, he had muffled heart sounds with jugular venous distension. Electrocardiogram showed sinus tachycardia with diffuse ST elevation. Laboratory investigations were significant for marked leukocytosis of 28,000/ul, Troponin was 0.056 ng/ml. Bedside transthoracic echocardiography (TTE) showed a large pericardial effusion (Figure 1A). An emergent pericardiocentesis was performed, yielding 250 ml of cloudy serosanguinous fluid. A pericardial window with 28 F drain placement was carried out. A right radial arterial line was placed for further hemodynamic monitoring. The next day, there was a clot in the drain, which after removal, yielded 1000 ml of bloody fluid. Immediate bedside TTE showed no significant effusion or rupture of the myocardium (Figure 1B). The patient suddenly became dyspneic and developed pulseless electrical activity. Code blue was initiated. The patient passed away from cardiopulmonary collapse. Later, the pericardial fluid was positive for MRSA.

Conclusions:
This case illustrates the importance of timely diagnosis and management of pericardial empyema. Due to its high mortality rate, we encourage professionals to be more aware of this phenomenon's presence as well as its ambiguous clinical outcome.