bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15148: How Reassuring is an Initial Echocardiogram With Normal Coronary Arteries for Patients Presenting With Acute Kawasaki Disease?
Authors: Khoury Michael , Nelson Jennifer A , Lee Simon , Portman Michael A , Yetman Angela T , Dahdah Nagib , Misra Nilanjana , Nowlen Todd , Jone Pei-Ni , Fabi Marianna , Tierney Seda S , Fernandez-Cooke Elisa , Elias Matthew , Mauriello Daniel , Dallaire Frederic , Norozi Kambiz , Dancey Paul , Farid Pedrom , Manlhiot Cedric , McCrindle Brian W
Published: December 2023

Background:
We sought to determine the utility of current echocardiography surveillance recommendations for coronary artery (CA) involvement for children with Kawasaki disease (KD) with normal baseline studies.

Methods:
The International KD Registry enrolled 1200 patients (36 sites, 7 countries) with a site diagnosis of KD from 01/2020 to 01/2023; 139 with positive/possible COVID-19 infection/exposure and 174 with no echo within 10 days of admission were excluded, leaving 887 patients for analysis of results of serial echos and associated factors.

Results:
An initial echo was performed within 5 days of admission for 96% and within 10 days of symptom onset for 83% of patients; the max Z score in any CA branch at initial echo was normal (Z <2) 78.9%, dilation (Z 2-<2.5) 6.6%, small aneurysm (CAA; Z 2.5-<5) 10.5%, medium CAA (Z 5-<10) 2.9% and large CAA (Z ≥10) for 1.2% of patients. Higher CA Z score/Z score category were both significantly related to greater time from symptom onset to echo (p<0.001). For those with initial normal CAs, a second echo (median of 16 days after admission) was normal for 94.2%, dilation 1.9%, small CAA 2.7%, medium CAA 0.6%, and large CAA for 0.6%. For those with 2 normal echos, a third echo (median of 44 days after admission) was normal for 97.6%, dilation 1.4%, small CAA 0.5%, and 1 patient each with medium and large CAA. Additionally, after up to 6 normal echos, 3 patients had developed small CAA, 1 medium and 1 large CAA. Overall, a total of 24 (2.8%) patients had large CAA (13 admitted >10 days after symptom onset). Of these, 10 had large CAA evident at initial echo performed at day 0-3 after admission, 9 had lesser involvement at initial echo that then progressed to large CAA, and 5 had normal initial and subsequent echos and then were noted to have large CAA at an echo performed 14, 17, 21, 23 and 53 days after admission (the patient with a large CAA first detected at 53 days had no interim echos performed since their first normal echo).

Conclusions:
Current recommendations for serial echo assessment are effective in detecting all patients with large CAA. For rare patients, despite a normal initial echo large CAA may nonetheless develop. Additionally, important CA involvement may be evident at presentation (often delayed presentation), precluding prevention.
Abstract 15152: One-Year Evolution of Patients With Pulmonary Embolism During the Highest Epidemic Peak of COVID-19: COVID-EP Study
Authors: Rosario Roger , ELIAS Antoine , Bouvaist Hélène , Dreyfus Julien , Ludivine Saby , Fard Damien , Bonomini Justine , BIELMANN Cecile , Ahamada Rahamia , PENARANDA Guillaume , bonello laurent , Lapébie François-Xavier , Seemann Aurélien , Perret Thibault , Range Gregoire , Meneveau Nicolas
Published: December 2023

Introduction:
During the first COVID peak, among patients admitted to intensive care unit, pulmonary embolism (PE) diagnosis frequency was high. In April 2020 (highest epidemic peak of COVID), no PE management guidelines were effective, and PE evolution in this context was uncertain. Although several studies had explored a potential link between COVID and PE, none had focused on PE evolution according to COVID status excepted for death and short-term complications.

Hypothesis:
Our aim was to investigate whether COVID status and/or treatments used at the time of PE could affect PE evolution in longer-term.

Aims:
The main objectives were: (1) To assess the occurrence at 6 and 12 months after PE diagnosis of one of the following complications of interest: interstitial pathology, recurrence of PE, pulmonary arterial hypertension (PAH) or death, (2) to investigate the impact of the treatment dispensed on PE evolution.

Methods:
A National multicenter prospective cohort study was conducted in patients diagnosed with PE in April 2020. Patients were divided into two groups according to their COVID viral status (COVID-positive and COVID-negative) and were followed up to 12 months.

Results:
A total of 87 patients were included into 12 centers. No difference in global complication rates was observed between the groups at 6 and 12 months (p=0.4682 and p=0.5045 respectively). However, we observed that COVID-Positive patients had more interstitial pathology at 3, 6 and 12 months than COVID-Negative patients (p=0.0075, p=0.0088 and p=0.0033 respectively). Furthermore, the PE complication rate was significantly higher in patients treated with heparin-alone in COVID-negative patients (p=0.0002).

Conclusions:
COVID status did not appear to influence PE evolution, in accordance with the literature. Interstitial pathology has recently been shown to be a complication of COVID, which may explain its higher incidence in the COVID-positive group. Because of the exceptional context of the COVID pandemic in which this study was conducted and the short duration of inclusion, it might be interesting to confirm these results with a study on a larger population and over a longer period, in order to possibly update the management of patients with PE.
Abstract 15170: Prognostic Implication of Left Atrial Reservoir Strain in Severe Mitral Stenosis With Low Transmitral Diastolic Pressure Gradient: Result From Long-Term Follow-Up Registry
Authors: Lim Ha Jeong , Cho Iksung , Kim Dae-Young , Kim Kyu , Gwak Seo-Yeon , Lee Hyun-Jung , Lee Hee Jeong , Shim Chi Young Y , Ha Jong-Won , Lee Seonhwa , Kim In-Cheol , CHOI KANGUN , Son Jang-Won , Hong Geu-Ru
Published: December 2023

Background:
Prognosis of severe mitral stenosis (MS) with low transmitral mean diastolic pressure gradient (MDPG) has not been fully understood with lack of long-term follow-up study.

Aims:
We investigated the prognostic implication in severe MS with low MDPG.

Methods:
We included patients with severe rheumatic MS (mitral valve area [MVA] < 1.5 cm
2
) from the Multicenter mitrAl STEnosis with Rheumatic etiology (MASTER) registry. Patients with severe MS were categorized into high (≥ 5 mmHg) or low (< 5 mmHg) MDPG groups. The primary outcome was a composite of all-cause mortality and stroke. Among 1,248 patients with severe MS, 322 (25.8%) had low and 926 (74.2%) had high MDPG.

Results:
Their mean age was 59±13 years, 25% were men, and 74% had atrial fibrillation. Patients with low MDPG were older and had a higher prevalence of atrial fibrillation. During a mean follow-up of 6.8±5.9 years, 194 patients (15.5%) experienced composite events. Patients with severe MS and low MDPG had a higher risk of experiencing composite events compared to those with high MDPG (hazard ratio [HR]: 1.56, 95% CI: 1.15-2.12; p=0.004). Subgroup analysis with low MDPG revealed that decreased left atrial reservoir strain (LARs) was independently associated with poorer outcome (HR, 2.58, 95% CI: 1.08-6.20; p=0.034).

Conclusion:
Severe MS patients with low MDPG are at higher risk of adverse events compared to those with high MDPG. The assessment of LARs can be useful in identifying subgroups of low MDPG severe MS patients with poor prognosis.
Abstract 15182: Evaluation of an Electronic Clinical Decision Support Tool for Incident Elevated Blood Pressure in Adolescents
Authors: Benziger Catherine P , Allen Clayton I , Freitag Laura A , Suess Madison , Asche Stephen E , Ekstrom Heidi L , Essien Inih J , Muthineni Abhilash , Thirumalai Vijayakumar , Vo Phuong H , Kromrey Kay A , Ronkainen Elizabeth A , Saman Daniel , Oconnor Patrick J , Kharbanda Elyse O
Published: December 2023

Introduction:
The PedsBP Clinical Decision Support (CDS) is an electronic health record-linked tool developed in an urban health system that aims to improve the quality of blood pressure (BP) measurement and recognition of hypertension in children.

Aims:
To describe the feasibility of implementing the PedsBP tool for use in a rural health system, and to describe repeat BP measurement among patients 6-17 years with an incident hypertensive BP at high-intensity clinics using the PedsBP CDS.

Methods:
This is a 3-arm, parallel group, cluster randomized controlled pragmatic trial in 40 community-based primary care clinics in a rural Midwestern health system (Essentia Health). Clinics were randomized 1:1:1 to usual care, low-intensity implementation (PedsBP CDS only), or high-intensity implementation (Peds BP CDS plus in-person training, monitoring CDS use, and feedback). The PedsBP CDS includes an alert to re-measure a hypertensive BP at that visit, an alert that a hypertensive BP should be repeated in 1-3 weeks, and patient-specific order sets. Study outcomes include repeat BP measurement at an index visit and diagnosis of hypertension within 6 months of meeting clinical criteria. Safety outcomes include stroke, transient ischemic attack, acute renal failure, uncontrolled hypertension within 6 months of index visit.

Results:
Among 22,238 (50.9% female, mean age 11.7 years, SD=3.5 years) patients with visits between 8/1/22-1/31/23 at participating clinics, 4008 (18.0%) had an incident hypertensive BP and 239 (1.1%) met clinical criteria for hypertension. Among those who met clinical criteria for hypertension, there were no cases of uncontrolled hypertension or other safety outcomes. Of 7974 patients with encounters at 13 high-intensity clinics and with a BP measured, the initial BP was elevated for 1307 (16.4%) and remeasured in 628 (48.1%). Among 1265 patients at high-intensity clinics with a BP elevated and with body mass index (BMI) information, 482 (38.1%) were obese (BMI percentile ≥95%), 209 (16.5%) were overweight (BMI percentile 85% to <95%), and 574 (45.4%) were not overweight or obese (BMI percentile <85%).

Conclusions:
The PedsBP CDS is feasible to implement in a new health system and has the potential to improve the quality of pediatric BP care.
Abstract 15201: Obicetrapib as an Adjunct to Stable Statin Therapy Significantly Lowers LDL-C, Non-HDL-C, and Apolipoprotein B in Japanese Patients: Results From the Japan Phase 2 Study
Authors: Harada-Shiba Mariko , Kling Douglas , Kastelein John J , Ditmarsch Marc , Wuerdeman Erin , Hsieh Andrew , Nicholls Stephen , Davidson Michael
Published: December 2023

Background:
Obicetrapib is a selective CETP inhibitor that has been shown to reduce LDL-C, non-HDL-C, lipoprotein particles, and apolipoproteins when used as monotherapy, and in combination with ezetimibe, on background high-intensity statins. Previous studies of obicetrapib were conducted in predominantly Caucasian participants. There is a lack of clinical experience with obicetrapib when used in combination with stable statin therapy among Asian population.
Objectives:
This study was designed to fill the gap in clinical experience and to characterize the safety, efficacy profile of obicetrapib within the Asian population.

Methods:
The Phase 2 study is a trial of Japanese participants who had not achieved treatment goal in accordance with the 2022 Japan Atherosclerosis Society Guidelines and with LDL-C >70 mg/dL or non-HDL-C > 100 mg/dL and TG < 400 mg/dL, while receiving stable statin background therapy. Participants were randomized 1:1:1:1 to obicetrapib 2.5 mg (n=25), obicetrapib 5 mg (n=25), obicetrapib 10 mg (n=26), or placebo (n=26). The primary endpoint was percent change in LDL-C from baseline to week 8. Key secondary endpoints included changes in ApoB, non-HDL-C, and HDL-C. Standard safety assessments were conducted.

Results:
Obicetrapib produced significant lowering of median LDL-C (45.8%, P<0.0001), ApoB (29.7%, P<0.0001), non-HDL-C (37.0%, P<0.0001) and raising of HDL-C (158.9%, P<0.0001). Placebo demonstrated median change of -0.9%, -0.4%, -0.4% and +5.2% for these parameters respectively. Obicetrapib was well tolerated with similar treatment emergent adverse events compared to placebo. There were no clinically significant changes in laboratory parameters, vital signs, or physical examinations in any treatment group.

Conclusions:
Similar to previous studies, obicetrapib 2.5 mg, 5 mg, and 10 mg resulted in significant reductions in LDL-C, ApoB, and non-HDL-C in the Asian population. All doses of obicetrapib were safe and well tolerated.
Abstract 15211: Age and Improvement in Health- Related Quality of Life After Percutaneous Coronary Intervention
Authors: Lappalainen Laura , Lavikainen Piia , Roine Risto , Sintonen Harri , Martikainen Janne , Tolppanen Anna-Maija , Hartikainen Juha
Published: December 2023

Background:
The purpose of percutaneous coronary intervention (PCI) is to relieve chest pain, improve health-related quality of life (HRQoL), or reduce the risk of cardiac adverse events and death among patients with coronary artery disease. The aim of this study was to investigate whether age is related to HRQoL improvement in patients undergoing PCI and which clinical characteristics explain the changes in HRQoL during 12 months.

Methods:
Altogether 301 patients undergoing PCI were divided into three age groups: ≤65 (n=94), 66-74 (n=117), and ≥75 (n=90). Patients responded to the generic 15D and disease-specific SAQ-7 HRQoL instruments at baseline and 1 and 12 months after PCI.

Results:
The median ages in groups were 60, 69, and 79 years, and the proportions of women were 19.1%, 32.5%, and 35.6%, respectively. Baseline instrument scores were lower in the oldest group compared to the youngest groups (15D
p
<0.001, SAQ-7
p
=0.006). 15D and SAQ-7 improved statistically (
p
<0.001 for all) and clinically significantly in all groups at 1 month. At 12 months, the 15D score decreased in all groups but remained statistically and clinically higher compared to baseline in the two youngest groups, and in the oldest group, it was statistically (
p
=0.005) and nearly clinically higher (threshold 0.015, Δ score 0.013, 95% CI -0.003-0.030). In the oldest group, deterioration in the 15D between 1 and 12 months was due to dimensions “mobility”, “vision”, and “excretion” but not in “cardiac-related” dimensions. Significant improvement in SAQ-7 score at one-year follow-up was observed in all groups (
p
<0.001 for all). The improvements in 15D and SAQ-7 scores at 12 months showed no difference between the age groups (
p
=0.381).

Conclusions:
There was no difference in the improvement of generic or disease-specific HRQoL after PCI between the age groups. Importantly, both 15D and SAQ-7 improved equally in the oldest groups as in the younger patients.
Abstract 15220: The Thermal Characteristics to Phrenic and Esophageal Injuries During Ablation of QDOTMICRO (50w-Qmode and 90w/4sec-Qmode+) vs 50w-TactiCath SE vs 50w-Thermocool Smart Touch: Findings From an
In-Vivo
Porcine Study
Authors: Otsuka Naoto , Okumura Yasuo , Nagashima Koichi , Kurokawa Sayaka , Watanabe Ryuta , yuji wakamatsu , Hirata Shu , Hirata Moyuru , Sawada Masanaru , Nakai Toshiko
Published: December 2023

Introduction:
Recently, there have been numerous strategies for treating atrial fibrillation, including the choice of catheters However, the thermal characteristics of each catheter, particularly in terms of safety, have not been fully understood.

Hypothesis:
Our aim was to characterize the thermal damage to collateral tissues during 50W-HPSD ablation and 90W/4sec-vHPSD ablation using three different ablation catheters.

Methods:
In 28 pigs, we implanted thermocouples on the superior vena cava, close to the phrenic nerve, and on the esophageal, close to the inferior vena cava. We performed endocardial ablation near the fiducial markers of the thermocouples using three different RF catheters: ablation index (AI)-guided HPSD (Qmode) and vHPSD ablation (Qmode+) with QDOTMICRO, lesion size index-guided HPSD ablation (targeting 5.0) with TactiCath Sensor Enabled (Tacti), and AI-guided HPSD ablation (targeting 400) with Thermocool Smart Touch (STSF). We measured tissue temperatures during ablation, including maximum tissue temperature (Tmax), time to maximum tissue temperature (t-Tmax), time to achieve a lethal temperature of 50°C (t-50°C), and time to return to baseline from Tmax (t-Tbase).

Results:
In terms of the frequency of esophageal injury, there were no significant differences among the different catheters. However, the depth of esophageal injury from the adventitia showed a significant difference. In terms of phrenic nerve injury, Tacti had the highest frequency compared to the other catheters (100%, p=0.0012). Tmax, t-Tmax, t-50°C, and t-Tbase showed significant differences, as shown in figure.

Conclusions:
The thermal effects on collateral tissues differ among the three different catheters and settings. STSF and Qmode result in a gradual increase in tissue temperature, while Tacti and Qmode+ lead to a rapid temperature increase. These distinct thermal distributions may contribute to the risk of phrenic nerve and esophageal injuries.
Abstract 15226: Premature Ventricular Complexes Were Not Associated With an Increased Risk of Atrial Fibrillation in Patients Without Structural Heart Disease
Authors: Bouleau Robin , Glaser Natalie , Jonsson Martin , Scorza Raffaele
Published: December 2023

Background:
Recent studies have suggested that patients with premature ventricular complexes (PVCs) may have a higher risk for atrial fibrillation. However, the study bases are heterogenous, and it is currently unclear whether frequent PVCs are linked to an increased risk in patients where underlying structural heart disease has been thoroughly excluded.

Research question:
Do PVCs increase the risk of atrial fibrillation in patients without structural heart disease?

Aim:
To analyze the risk of new-onset atrial fibrillation in PVC patients without structural heart disease.

Methods:
We included PVC patients from three secondary centers in Stockholm, Sweden. The patients had no history of heart disease, normal results at exercise stress test and echocardiography, and no previous diagnosis of atrial fibrillation. For each case, four age- and sex-matched controls were obtained from the general population. Controls with previous heart disease or atrial fibrillation were excluded. We used inverse probability of treatment weighting (IPTW) to control for differences in baseline characteristics between the groups. An IPTW cause-specific hazards model was fitted using the cmprskcoxmsm package in R. Data are presented as hazard ratios (HR) with 95% confidence intervals (CI).

Results:
A total of 773 PVC patients and 3128 controls were included. The median age was 59 years, and 2285 (59%) were women. Patients with PVCs had a higher incidence of malignant diseases, hypertension, and hyperlipidemia. After inverse probability of treatment weighting, baseline characteristics were well-balanced between the groups. The median follow-up time was 5.2 years (maximum 6.5 years). The risk for atrial fibrillation was higher for patients with PVCs in the crude cohort (4.3% versus 2.0%), but there was no difference between the groups in the IPTW cohort after adjusting for death as competing risk (HR 1.50, 95% CI 0.88-2.57, p=0.14).

Conclusion:
PVC patients without structural heart disease did not have a higher risk of incident atrial fibrillation than age- and sex-matched controls from the general population. These results could argue against a causal relationship between PVCs and atrial fibrillation. However, more studies are needed to confirm the results.
Abstract 15228: Impact of Gender and Left Ventricular Ejection Fraction on Health-Related Quality of Life and Its Change in Patients With Heart Failure
Authors: Jang Ji-Hun , Kim Dae-Young , Shin Sung-Hee
Published: December 2023

Introduction:
Health-related quality of life (HRQoL) is an important part in managing patients with heart failure (HF). However, the influence of clinical factors on HRQoL in HF remains limited.

Hypothesis:
This study aimed to examine HRQoL changes based on gender and left ventricular ejection fraction (LVEF) among patients with HF.

Methods:
A total of 199 patients hospitalized for acute HF (mean age, 71±14 years; men:women=119:80; mean LVEF=42±16) were enrolled in a prospective way from Jan 2022 to Jan 2023. Baseline and 4-month follow-up Kansas City Cardiomyopathy Questionnaire (KCCQ) scores were assessed. Patients were categorized into 4 subgroups: Group 1, women with LVEF≥50% (n=37); Group 2, men with LVEF≥50% (n=26); Group 3, women with LVEF<50% (n=43); Group 4, and men with LVEF<50% (n=93).

Results:
Women demonstrated lower KCCQ clinical and overall summary scores than men at baseline (p=0.003, 0.004, respectively) and 4-month follow-up (p=0.029, 0.038, respectively) after adjusting for age and body mass index. In addition, these scores tended to be lower in patients with LVEF ≥50% than those with LVEF <50% at both baseline and follow-up (all p<0.05). When we assessed KCCQ scores according to group, group 1 showed the lowest KCCQ overall summary score (KCCQ-OS: 36.9 [IQR 22.9-49.8], p=0.004) and clinical summary score (KCCQ-CS: 37.8 [IQR: 24.5-51.1], p=0.001). Also, the scores for physical limitation, symptom frequency, symptom burden, social limitation, self-efficacy scale, and total symptom score were lowest in Group 1 (all p<0.05). Although HRQoL improved across all groups, the follow-up KCCQ-OS and KCCQ-CS scores remained lowest in Group 1 (KCCQ-OS: 54.0 [IQR 44.3-64.4], p=0.026; KCCQ-CS: 56.5 [IQR: 45.0-63.9], p=0.031).

Conclusions:
Among patients with HF, women with LVEF≥50% reported significantly worst HRQoL even after HF treatment, suggesting more attention should be paid to HRQoL in managing this specific population during HF treatment.
Abstract 15237: Feasibility and Diagnostic Accuracy of Handheld Echocardiography in Patients Hospitalized With Acute Coronary Syndrome
Authors: Geers Jolien , Molek Patrycja , Balfour Amy , Botezatu Simona , Joshi Shruti S , White Audrey , McCarley Joanne , Everett Russell , Martin Gillian , Cusack David , Cosyns Bernard , Newby David E , dweck marc R
Published: December 2023

Introduction:
Transthoracic echocardiography (TTE) is recommended in every acute coronary syndrome (ACS) patient, but is time-consuming and not always deliverable. Development of handheld echocardiography (HHE) devices provide a fast, low-cost method to facilitate rapid bedside clinical assessment of those patients.

Hypothesis:
We hypothesized that evaluation of hospitalized ACS patients using HHE is feasible and provide similar information to standard TTE in detecting important cardiac pathology.

Methods:
Patients admitted with ACS were prospectively enrolled, and underwent both bedside HHE (Philips Lumify) and clinical TTE evaluation. Independent analysis of HHE and TTE images was performed by a blinded expert team to determine key predetermined imaging findings that might alter management of ACS patients (Table 1). The TTE analysis was repeated for these variables after 1 month. Agreement of HHE vs TTE was assessed with kappa statistics and compared to agreement of TTE vs TTE as reference standard.

Results:
The analysis included 108 patients (mean age 65y, 78% male). Duration of HHE was a third faster than targeted clinical TTE (8.2±1.8min vs 12.1±5.0min; p<0.001). Agreement in detecting the following variables was good (>0.60) and similar for HHE vs TTE compared to TTE vs TTE: left ventricle (LV) dilatation, LV hypertrophy, LV ejection fraction <40%, anterior and inferior wall motion abnormalities, right ventricle (RV) dilatation, pericardial effusion, aortic stenosis, ventricle septum defect, and takotsubo cardiomyopathy. Agreement between HHE vs TTE was less good than TTE vs TTE for detection of lateral wall motion abnormalities, RV dysfunction, and LV thrombus.

Conclusions:
In ACS patients, bedside HHE is faster and provides similar diagnostic information to TTE for the majority of key echo findings. However, important exceptions exist, in particular HHE is less good at detecting lateral wall motion abnormalities, RV dysfunction and LV thrombus.
Abstract 15254: Temporal Assessment of Clinical Outcomes in Patients With ST-Elevation Myocardial Infarction and Non-ST-Elevation Myocardial Infarction
Authors: Cho Kyung Hoon , Oh Seok , Lim Yongwhan , Ahn Joon Ho , Lee Seung Hun , Hyun Dae Young , Kim Min Chul , Sim Doo Sun , Hong Young Joon , kim Juhan , Ahn Young Keun , Lee Jang Hoon , Yoon Chang-hwan , Lee Sang Rok , Hahn Joo-Yong , Jeong Jin-Ok , Kim Weon , Hwang Jinyong , Jeong Myung Ho H
Published: December 2023

Background:
Limited data exist regarding the temporal progression of outcomes in patients with ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI).
Research Questions:
Are there any significant differences in the occurrence of cardiovascular events over time between patients with STEMI and NSTEMI in the modern era of percutaneous coronary intervention?

Aims:
We aimed to compare the incidence rates of major cardiovascular events over time between patients with STEMI and NSTEMI using the Korea Acute Myocardial Infarction Registry-National Institutes of Health database.

Methods:
We analysed the data of 13,056 patients diagnosed with STEMI or NSTEMI between 2011 and 2015 (median age, 65 years [interquartile range {IQR}, 54-74]). We calculated yearly, monthly, weekly, and daily time-point event rates after admission, considering the number of events during the specific periods divided by the number of event-free patients just before those periods. The primary outcome measure was all-cause mortality.

Results:
During the 3-year follow-up (median, 1095 [IQR, 1044-1095] days), 12.4% of patients (1589/12,836) died from any cause. Patients with STEMI had a significantly higher mortality rate in the first week of admission than that of patients with NSTEMI (4.54% [283/6235] vs 1.76% [120/6823],
P
< 0.001), but this difference was not observed in the second week (0.59% [35/5952] vs 0.67% [45/6703],
P
= 0.635). Subsequently, higher mortality rates were observed in patients with NSTEMI than in those with STEMI for all time points. Daily outcome analysis revealed a gradual decrease in the difference in mortality rates in patients with STEMI versus NSTEMI from the first to the ninth day, followed by an inversion on the tenth day: STEMI: 2.39% (149/6235) vs NSTEMI: 0.59% (40/6823) on the first day; 0.13% (8/5942) vs 0.10% (7/6694) on the ninth day; and 0.03% (2/5934) vs 0.13% (9/6687) on the tenth day.

Conclusions:
This analysis of temporal outcomes from a nationwide Korean registry demonstrated that patients with STEMI initially had higher mortality than patients with NSTEMI, but this difference gradually decreased and subsequently inverted during the second week, specifically after the ninth day.
Abstract 15264: Impact of 2018 Change in UNOS Heart Transplant Policy on Wait List Outcomes
Authors: Patel Het
Published: December 2023

Introduction:
In October 2018, the updated Heart transplant (HT) policy by United network of Organ Sharing (UNOS) gave priority to critically ill heart failure patients. It has made significant improvement in long term survival of ECMO bridged HT recipients. However, there are limited reports on wait list mortality following change in this policy.

Hypothesis:
Review of waitlist mortality following 2018 change in guideline

Methods:
This is a retrospective cohort study including all adult heart failure patients listed for HT alone between 2015 and 2022 in the UNOS data. Cohort was stratified on the basis of year of listing, those who listed between 2015 & 2018 and those who listed between 2019 & 2022. The categorical and continuous variables were compared using chi2 and Kruskal Wallis test, respectively. Time to death analysis between both the group was evaluated using Kaplan Meier curve and log rank test.

Results:
Total 33,908 patients were included, of them 16,281 were listed between 2015 & 2018 and remaining 17,627 were listed between 2019 & 2022. The rate of HT did not change between both the time period (10,660 (65.5%) & 11,660 (66.1%), p=0.19)), respectively. There was no difference in age, gender and BMI between both the groups. The use of Intra-aortic balloon pump, ventilator, Inotropes and other parameters indicating severity of illness were frequently noted among patients listed between 2019 & 2022. The overall wait list mortality has reduced from 1250/16,281(7.7%) to 764/17,627 (4.0%) during later time period, p<0.001 (Figure 1). Similarly, patients’ dropouts due to illness severity has reduced from 1321/16821 (8.1%) to 764/17,627 (4.3%), p<0.001, respectively. There is significant reduction in disease etiology specific mortality following 2018 change.

Conclusions:
The change in HT policy in 2018 has significantly reduced the wait list mortality and dropouts during study periods. In addition, sicker patients were listed for transplant following 2018 change.
Abstract 15265: Rilonacept for Refractory Pericarditis Following Immune Checkpoint Inhibitor Therapy: A Case Report
Authors: Hamandi Mohanad , Gooch Janelle , Levenson Joshua E
Published: December 2023

Background:
Immune checkpoint inhibitor (ICI)-mediated cardiotoxicities are rare but potentially fatal. Myocarditis, with clinical presentations ranging from asymptomatic to cardiogenic shock, and pericarditis, have been reported in clinical trials and as post-marketing experience with immunotherapy. It is estimated to occur in less than 1% of individuals receiving single immune checkpoint inhibitor therapy, with a median time to onset of 30 days. Herein, we report a case of late-onset ICI-mediated myopericarditis presenting with cardiogenic shock, followed by recurrent pericarditis refractory to steroid taper.

Case Presentation:
A 44-year-old woman with triple-negative breast cancer underwent chemotherapy, immune checkpoint inhibitor therapy with Pembrolizumab, lumpectomy, and radiation therapy. After the treatment, the patient developed symptoms consistent with myopericarditis, complicated by pericardial effusion with tamponade and cardiogenic shock. The patient underwent emergent pericardiocentesis and, due to refractory shock, was initiated on high-dose steroid therapy with complete resolution. However, during the tapering of steroids, the patient experienced a recurrence of pericarditis, characterized by chest pain, recurrent pericardial effusion, and elevated inflammatory markers. NSAIDs and colchicine were initiated early in the management but failed to achieve symptom control. Given the refractory nature of the recurrent pericarditis, the decision was made to reintroduce prednisone therapy, which led to substantial symptomatic improvement. To avoid further flares with steroid taper, the patient was started on rilonacept. It led to sustained pain control, and steroids were successfully tapered.

Conclusion:
Pericarditis is a rare complication of pembrolizumab. There are no specific guidelines on the management of ICI-related recurrent pericarditis. Rilonacept was added due to the refractory nature of her symptoms with steroid taper. It led to sustained improvement in pain, and steroids were successfully tapered.
Abstract 15267: Differential Effect of Calcium Score on Major Adverse Cardiac Events in Men and Women
Authors: Naseer Usman , FOHLE EMMANUEL , Hajek Catherine , Petrasko Marian S , Stys Adam , Rajpurohit Naveen , Larson Eric , Weaver Max , Bartaria Shubhi , GU SHAOPENG , Stys Tom
Published: December 2023

Introduction:
Coronary artery calcium (CAC) is well-validated for cardiovascular risk stratification. There are well-known gender differences in the presentation, diagnosis, and management of cardiac diseases that have been extensively studied in the past. To date, there have not been extensive studies to look at the differential effect of CAC score on major adverse cardiac events (MACE; defined as death, MI, stroke, or coronary revascularization) amongst men and women. The objective of our study is to look at this aspect.

Methods/Results:
Data were analyzed on a group of 1,380 patients who had participated in both the Sanford Health Heart Screen Program and the Sanford Health Preemptive Genomic Screening Program. These patients had their heart screen between 2011 and 2021 and their genetic testing between 2018-2022. Patients consented to both forms of screening independently, and the results were analyzed by means of a retrospective review. While other genetic factors were excluded from this study, we separated patients by sex. This sample had 64% female and 36% male. 10% of males had a MACE event and 4.9% of females had a MACE event. Males had higher levels of CAC (M=249.55, SD=550.41) compared to that of females (M=57.97, SD=190.5). The correlation between CAC and MACE was higher for males (r=0.33, p<0.01) than it was for females (r=0.17, p<0.05), Zou’s CI [.06, .26].

Conclusion:
Males, overall had a higher level of CAC score compared to females. The correlation between the CAC score and MACE was also higher for males, as compared to females.
Abstract 15268: Abnormal Single-Lead Electrocardiograms Predict Future Atrial Fibrillation Risk: The VITAL-AF Trial
Authors: Pipilas Daniel , Khurshid Shaan , Al-Alusi Mostafa , Atlas Steven , Ashburner Jeffrey M , Borowsky Leila H , McManus David D , Singer Daniel E , Lubitz Steven A , Chang Yuchiao , Ellinor Patrick T
Published: December 2023

Introduction:
The use of single-lead electrocardiograms (1L ECG) is increasing due to the proliferation of devices available to consumers. Automated software algorithms provide real time analyses using the 1L ECG signal, yet it is unclear whether these interpretations confer a future risk of AF.

Aim:
Investigate the risk of future AF by automated 1L ECG interpretation in patients who did not receive an AF diagnosis within 60 days of screening 1L ECG

Methods:
Patients enrolled in the VITAL-AF trial were categorized based on automated interpretation of 1L ECGs by the AliveCor KardiaMobile device:
Normal =
all 1L ECGs were interpreted as “Normal”,
Possible AF
= at least one “Possible AF”,
Other
= at least one “No Analysis” or “Unclassified” but no “Possible AF”. Time to incident AF was calculated with the beginning of the at-risk period defined as 60 days after the latest 1L ECG. Confirmatory testing was not required by the trial protocol, so the at-risk period was designed to exclude delayed AF diagnoses. Cox proportional hazard regression models were used to compare groups adjusting for age, body mass index, hypertension, myocardial infarction, diabetes mellitus, congestive heart failure and smoking status.

Results:
The study included 14,181 patients (
Normal
n = 10,930,
Other
n=2,689,
Possible AF
n= 562). As expected, a report of
Possible AF
had the highest AF incidence (5.75% per year, 95% Confidence Interval [CI] 4.12-8.00) and was associated with greater risk of incident AF compared to
Normal
(adjusted Hazard Ratio [aHR] 2.73, 95% CI 1.87-3.98). Interestingly, a diagnosis of
Other
was also associated with a marked increased risk of incident AF (2.37, 95% CI 1.88-2.99) (
Figure)
.

Conclusions:
Abnormal 1L ECGs with incident AF not confirmed within 60 days were still predictive of future AF compared to “Normal” tracings. Further monitoring may be warranted following abnormal 1L ECGs.
Abstract 15269: Effect of a Systemic Right Ventricle With A Biventricular Circulation on Cardiorespiratory Fitness
Authors: Desrosiers-Gagnon Charles , Mahdi Naima-Ayane , White Michel , Khairy Paul , Mongeon Francois P , Mondésert Blandine , Dore Annie , Gagnon Daniel , CHAIX Marie-Alexandre
Published: December 2023

Background:
The clinical care of adults with a systemic right ventricle with biventricular circulation (sRV-biV) is influenced by cardiorespiratory fitness (CRF) evaluation. However, prognostic markers for CRF are derived from analyses of adults with a systemic left ventricle (sLV). While some studies suggest that CRF is lower in adults with sRV-biV compared to those with a sLV, they have not controlled for key clinical characteristics and ventricular function of the systemic ventricle.

Research Question:
Is CRF lower in adults with a sRV-biV compared to adults with sLV matched for clinical characteristics and systemic ventricular function?

Methods:
A retrospective cross-sectional comparison of exercise stress test results was performed comparing 24 adults with sRV-biV to 24 adults with a sLV matched for sex (4 females), age (sRV-biV: 46 ± 9 years, sLV: 46 ± 11 years), body mass index (sRV-biV: 28 ± 4 kg/m
2
, sLV: 27 ± 4 kg/m
2
), ejection fraction of the systemic ventricle (normal: 2, mild: 4, moderate: 11, severe: 7), NYHA class (I: 6, II: 17, III: 1), and doses of diuretics (spironolactone ≤ 25 mg: 24, furosemide ≤ 80 mg: 24 ). Peak VO
2
was compared between groups with Wilcoxon signed-rank tests. Effect sizes are reported as Cohen’s
d
.

Results:
Peak VO
2
did not differ significantly between groups (sRV-biV: 20.3 ± 4.2 vs. sLV: 20.9 ± 6.0 mL/kg/min, p=0.43,
d
=0.18). When patients were dichotomized according to the Weber criterion for optimal versus suboptimal CRF (sLV peak VO
2
> or ≤ 20 mL/kg/min), peak VO
2
was lower in sRV-biV in those with optimal CRF (sRV-biV: 21.0 ± 4.8 vs sLV: 26.6 ± 5.1 mL/kg/min, p=0.006,
d
=0.72). In contrast, peak VO
2
was greater in sRV-biV in those with suboptimal CRF (sRV-biV: 19.3 ± 3.5 vs. sLV: 16.9 ± 2.0 mL/kg/min, p=0.12,
d
=NA).

Conclusion:
Although peak VO
2
values are similar among patients with a sRV-biV and matched controls with a sLV, differences are observed when stratified according to the Weber criteria for optimal CRF. These results may reflect different pathophysiological adaptive mechanisms of a sRV vs sLV. Further studies are required to establish specific prognostic thresholds for patients with sRV-biV.
Abstract 15275: Cardiac Magnetic Resonance Ventricular Function and Hemodynamic Multivariable Model Predictors of Exercise Performance in Tetralogy of Fallot Using Machine Learning and Multivariable Modelling: A Substudy of the
Single Center Cardiac Magnetic Resonance Outcomes Registry-Tetralogy of Fallot
Authors: Fogel Mark A , Reddy Keerthi , Mahmood Abdullah , Zhang Xuemi , Ampah Steve , Faerber Jen , Goldmuntz Elizabeth , Harris Matthew , Biko David , Partington Sara , Paridon Stephen , Mcbride Michael , Ferrari Victor , Whitehead Kevin K , Mercer-Rosa Laura M
Published: December 2023

Background:
There are no robust predictors of exercise performance in repaired tetralogy of Fallot (rTOF) using both ventricular function and hemodynamics.

Aim:
To utilize machine learning and multivariable modeling to determine cardiac magnetic resonance (CMR) and other metrics predictive of exercise performance.

Methods:
We retrospectively reviewed data of all rTOF pts undergoing CMR from 2005-2020. Those who had cardiopulmonary exercising testing (CPET) within 6 months of CMR were analyzed using the machine learning technique LASSO to choose candidate variables for subsequent testing with multivariable modeling. CMR parameters included right (RV) and left ventricular (LV) function and hemodynamics. Significance P<0.05.

Results:
266 of 761 pts with rTOF met the inclusion criteria (age at CMR 16.1
+
9.7 years old, age at repair 0.36 years old, 56% male). Higher RV mass, RV global function index and lower pulmonary regurgitant fraction (PR) were independently associated with higher % predicted (%P) maximum oxygen consumption (VO
2
max). In addition, females and non-syndromic pts were also associated with higher %P VO
2
max (table). Those with a higher LV end-diastolic volume (EDV), females and pts without pulmonary atresia performed better at %P work. Those with a higher RV mass/volume demonstrated a worse ventilatory equivalent of carbon dioxide (VE/VCO
2
). See table.

Conclusion:
RV ventricular functional parameters, PR (hemodynamics), gender and syndromic status are all independently associated with %P VO
2
max. Those with larger LV volumes were able to perform more work and those with a higher RV mass/volume had a worse VE/VCO
2
. Our findings shed some light into the etiology of poor rTOF exercise performance.
Abstract 15309: Prevalence of Dependent Cannabis Use in Patients Hospitalized With Peripheral Vascular Disease and Concomitant Tobacco Use Disorder and Associated Major Adverse Cardiac Events: National Inpatient Sample Analysis 2019
Authors: Jitta Sahas Reddy , Chigurupati Himaja Dutt , Neppala Sivaram , Lekkala Sai Prasanna , Mellacheruvu Sai Priyanka , Pamreddy Hrushikesh Reddy , Kannekanti Lavanya chowdary , Singh Gurjot , Khela Puneeteshwar , Patel Manali , Hingora Mohmed Junaid , Gill Karanvir Singh , Desai Rupak
Published: December 2023

Introduction:
Cannabis use disorder (CUD) and tobacco use disorder (TUD) are independent risk factors for patients hospitalized with peripheral vascular disease (PVD) and major adverse cardiac and cerebrovascular events (MACCE). However, the impact of CUD on PVD with concomitant TUD and associated MACCE remains unexplored, despite the increasing prevalence of cannabis use in the USA.

Methods:
Using the 2019 National Inpatient Sample and relevant ICD-10-CM codes, we identified hospitalizations in patients with PVD and TUD. Baseline demographics, comorbidities, and major adverse cardiac events were compared between CUD+ vs CUD- cohorts. A multivariable regression analysis was conducted, adjusting for confounders to assess the odds of MACCE.

Results:
Among 363,795 patients admitted with PVD and TUD, 13,440 (3.7%) had CUD+ [median age 57 (48-64)], with a higher proportion of males (70.5% vs 60.8%) and black patients (27.8% vs 14.7%) compared to the CUD-cohort (all p<0.001). The CUD+ cohort exhibited higher rates of alcohol abuse (21.4% vs 11.1%), drug abuse (47% vs 6%), depression (19.2% vs 16.2%), and prior VTE (11% vs 9.2%) (all p<0.001). Overall, MACCE was reported to be high in the CUD+ cohort (18.1% vs. 16.4%). After adjusting for covariates, the CUD+ cohort had significantly higher odds of developing MACCE in the middle-aged (45-64 years) (OR:1.20, 95%CI: 1.04-1.38, p=0.014) and the male subpopulation (OR:1.20, 95%CI: 1.01-1.42, p=0.039). Subgroup analysis revealed that complicated hypertension (OR:1.80, 95%CI:1.28-2.53), hyperlipidemia (OR:1.59, 95%CI: 1.20-2.13), and prior TIA (OR:1.48, 95% CI:1.02-2.16) were significant predictors for the MACCE middle-aged cohort (all p< 0.05) (Table 1).

Conclusion:
In CUD+TUD cohorts with PAD, men and middle-aged individuals had greater odds of MACCE. Therefore, clinicians should be aware of this high-risk population, and further prospective studies are required for a significant association.
Abstract 15314: Rhythm Outcome of Persistent Atrial Fibrillation Ablation Depending on the Timing of the First Electrocardiographic Documentation
Authors: Kim Hongju , Kim Kipoong , Kim Daehoon , Choi Sung Hwa , Kim Moon-Hyun , Park Je W , Yu Hee Tae , Uhm Jae-Sun , JOUNG BOYOUNG , LEE Moon Hyoung , Pak Hui-Nam
Published: December 2023

Introduction:
Recently, delaying atrial fibrillation (AF) catheter ablation (AFCA) by 12 months for antiarrhythmic drug (AAD) management didn't result in reduced ablation efficacy. In this study, we explored AFCA rhythm outcomes based on the diagnosis-to-ablation time (DAT) in AAD-resistant persistent AF (PeAF).

Methods:
We included 1,038 AAD-resistant PeAF patients with clear DAT (male 79.8%, 61.0 [54.0-68.0]) who underwent AFCA followed by guidelines-based regular rhythm follow-up. Before AFCA, all patients underwent optimal medial therapy (AAD) with or without cardioversion. Patients on AADs, who experienced paroxysmal type recurrence, were classified as AAD-partial-responders, while those maintaining PeAF were categorized as AAD-non-responders. We determined the DAT cut-off for rhythm outcome using a maximum likelihood approach in a Cox regression model.

Results:
AAD-partial-responders showed higher body mass index (p=0.007), larger left atrial diameter (p<0.001), lower eGFR (p=0.039). AAD non-responder showed higher recurrence after AFCA (Log-rank p<0.001; aHR 1.75, 95% CI 1.33-2.30, p<0.001). The maximum likelihood estimation from Cox analysis showed bimodal peaks at 22 and 40 months. In contrast, DAT 12 months didn't show discrimination power for post-AFCA recurrence (Log-rank p=0.290, HR1.13[0.91-1.41], p=0.281), while DAT>22 months (Log-rank p=0.001, HR1.34[1.09-1.64], p=0.005) and DAT>40 months (Log-rank p=0.001, HR1.34[1.09-1.64], p=0.006) significantly indicated poor rhythm outcome. DAT>22 months among AAD-partial-responders (Log-rank p=0.012, HR 1.96 [1.16-3.31], p=0.012) and DAT>40 months among AAD-non-responders (Log-rank p=0.009, HR 1.28 [1.02-1.60], p=0.031) were a poor prognostic factor for rhythm control after AFCA.

Conclusions:
DAT and AAD responsiveness affected the rhythm outcome of AFCA. Delaying AFCA over 22 months of DAT is not desirable in PeAF patients even under optimal medical therapy with AADs.
Abstract 15324: Biodegradable Polymer Ultrathin Sirolimus-Eluting Stent is Associated With Better Outcomes Compared With Polymer-Free Ultrathin Sirulimus-Eluting Stent in Complex Percutaneous Coronary Intervention: A Post Hoc Analysis of the HOST-IDEA Randomized Clinical Trial
Authors: Han Jung-Kyu , Park Sang-Hyeon , Hwang Doyeon , Yang Seokhun , Kang Jeehoon , Yang Han-Mo , Park Kyung W , Kang Hyun-jae , Koo Bon-Kwon , Kim Hyo-Soo
Published: December 2023

Introduction:
Third generation drug-eluting stents with ultrathin struts and advanced polymer technology have been introduced. However, their safety and efficacy have not been fully elucidated, particularly in complex percutaneous intervention (PCI).
Aim
To investigate the clinical outcomes of complex PCI using the Coroflex ISAR polymer-free sirolimus-eluting stent (SES) or Orsiro biodegradable polymer SES.

Methods:
This study was a post-hoc analysis of the HOST-IDEA trial that randomly assigned 2,013 patients undergoing PCI with Orsiro or Coroflex ISAR into either 3-month dual antiplatelet therapy (DAPT) or 12-month DAPT arms from January 2016 to May 2021 at 37 centers in South Korea. We compared a 1:1 propensity score (PS)–matched cohort balanced by patient and procedural characteristics. The primary endpoint was target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction, and clinically-driven target lesion revascularization at 1 year. Complex PCI was defined as any of the following features: ≥3 stents implanted, ≥3 lesions treated, bifurcation PCI, total stent length ≥ 60 mm, left main PCI, or heavy calcification.

Results:
After PS matching, baseline patient and procedural characteristics were balanced between Coroflex ISAR and Orsiro groups (n=542 in each). Complex PCI was significantly associated with a higher rate of TLF compared with non-complex PCI (5.3% vs. 1.1%, hazard ratio (HR) 5.12 [95% confidence interval (CI) 2.21-11.86], P<0.001). Compared with the Coroflex ISAR SES, the better outcomes of TLF associated with the Orsiro SES was more pronounced in the complex PCI group (HR 0.14 [95% CI 0.03-0.60],
P
=0.008 in complex PCI; HR 0.99 [95% CI 0.25-3.98],
P
=0.993 in non-complex PCI; P for interaction 0.054).

Conclusion
In patients undergoing complex PCI with third-generation DES, the Orsiro SES was associated with significantly better outcomes in terms of TLF than the Coroflex ISAR SES.