bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 18098: Prolonged Filtered QRS Duration on Signal Averaged Electrocardiogram is Associated With Structural Remodeling in Hypertrophic Cardiomyopathy
Authors: Vera Sarmiento Hernan L , Tanriverdi Talha , Hurtado-de-Mendoza David , Sivalokanathan Sanjay , Dolores Cerna Ketty , Lu Daiyin , Zimmerman Stefan , Sinha Sunil K , Corona-Villalobos Celia P P , Abraham M Roselle
Published: December 2023

Background:
Hypertrophic cardiomyopathy (HCM) is characterized by myocyte hypertrophy, electrical remodeling and fibrosis that lead to inhomogeneous ventricular depolarization and arrhythmias. Signal averaged ECG (SAECG) is useful for non-invasive risk stratification in ischemic cardiomyopathy. However, the association between SAECG and structural remodeling in HCM has not been investigated.

Methods:
We retrospectively studied 594 HCM patients from the Johns Hopkins HCM Registry, who underwent echocardiography and cardiac magnetic resonance (CMR) imaging within 12 months of SAECG or 12-lead ECG. Seventy-three patients underwent SAECG and were divided into 2 groups (Normal-SAECG, Abnormal-SAECG) based on filtered QRS duration and/or presence of late potentials
.

Results:
Abnormal SAECG was seen in 50% of HCM patients (37/73). Of the 37 HCM patients with abnormal SAECG, 29 patients only had prolonged filtered QRS duration (
fQRS>
114ms
),
and 8 patients had prolonged
fQRS
duration as well as late potentials (
LAS40
>38ms;
RMS40
<20μV). Mean
fQRS
and
LAS40
were significantly higher in the Abnormal-SAECG group (
fQRS
: 125.7 vs 107msec, p<0.0001;
LAS40
: 31.2 vs 22.9msec; p=0.002;
RMS40
: 40 vs 54μV; p=0.07). HCM patients with abnormal SAECG also had
1)
larger left atrial size (p=0.03), lower global LV peak systolic strain (p=0.04), systolic strain rate (p=0.008), early diastolic strain rate (p=0.01) by ECHO;
2)
greater LV mass index (p=0.004)
3)
Higher prevalence and amount of late gadolinium enhancement (LGE) reflecting LV-scar (p=0.045 and 0.01) by CMR;
4)
higher prevalence of repolarization abnormalities on 12-lead ECG (p=0.02). Adverse outcomes (sustained-VT/VF, heart failure, death) were similar in the 2 groups. Filtered QRS duration (SAECG) was positively correlated with LV mass index (r=0.43, p=0.0002), QRS duration on 12-lead ECG (r=0.67, p=0.000), and negatively correlated with global LV early diastolic strain rate (r= -0.34, p=0.009) in our HCM cohort.

Conclusion:
In HCM, prolonged filtered QRS on SAECG reflects a greater degree of structural remodeling characterized by more LV hypertrophy, larger LA size, worse cardiac mechanics, and higher prevalence and amount of fibrosis.
Abstract 18106: Keeping up With the Newest Guideline Directed Medical Therapy for Heart Failure With Reduced Ejection Fraction, Resident-Driven Quality Improvement Project
Authors: Sharma Gautam Seema , Golubykh Konstantin , Rajak Kripa , Amirian Aslan , Kovalenko Iuliia , Halder Anupam , Mirza Taaha M , Vargas Jesus , Hodara Roberto , Wert Yijin , Taneja Kriti , Atrash Anas
Published: December 2023

Introduction:
Chronic Heart Failure (CHF) is an epidemic associated with high morbidity and mortality. As per 2022 AHA/ACC/HFSA guidelines, the management of Heart Failure with reduced Ejection Fraction (HFrEF) includes Angiotensin Receptor-Neprilysin Inhibitors (ARNIs), Angiotensin-Converting Enzyme Inhibitors (ACEIs)/Angiotensin Receptor Blockers (ARBs), Beta-Blockers (BB), Mineralocorticoid Receptor Antagonists (MRA) and Sodium-Glucose co-transporter 2 Inhibitors (SGLT2I) as class 1 recommendations. Considering the new guidelines for HFrEF we decided to perform a quality improvement project to improve the GDMT prescription rate in patients with HFrEF.

Methods:
Our project included: dot phrase creation for all physicians through electronic medical records (EMR) system, educational sessions, monthly emails and weekly EMR chat messages regarding GDMT and CHF order set to physicians, A4 sized posters distributed on all hospital floors. We then performed retrospective review and analysis of patient charts who were admitted to three UPMC Central PA hospitals with diagnosis of HFrEF exacerbation during December 2019 to January 2021 (pre-intervention) and March 2022 to September 2022 (post-intervention).

Results:
Total 615 patients were included. There were no significant differences in demographics between pre intervention (357) and post intervention (258) groups including age, sex, race. There were no differences in prescription rate and target dose at discharge between BB groups (92.72% vs 91.86%%, p=0.693 and 7.25% vs 7.17%, p=0.978). The intervention helped in increasing prescription of ARNIs from 6.2% to 30.62%, p< 0.0001 and 13.92% were discharged on target dosages. The prescription of MRA was increased (47.62%vs 51.55%). Furthermore, initiation of SGLT2I was achieved in 41.47% in post-intervention from 0% in the pre-intervention group.

Conclusions:
Despite higher awareness of GDMT and the trend towards having more patients discharged on therapeutic dosages of GDMT, it is evident that GDMT is still underused among patients with HFrEF. Our results indicate that more emphasis should be placed on rapid up-titration of GDMT.
Abstract 18110: Assessing the Impact of a Multidisciplinary Cardio-Kidney Care Team on the Overall Care Satisfaction in Patients With Heart Failure With Reduced Ejection Fraction And Chronic Kidney Disease
Authors: Vellanki Shaitalya , Muhanji Priscilla , Patel Hina , Evans Elizabeth , Swamy Sowmya , Lee Maximillian , Egers Max , Turley Jeffery , Govi Ashley , Huang Jessica , De Guzman Eison , Lo Kevin , Panjrath Gurusher S , Rangaswami Janani
Published: December 2023

Background:
Patients with heart failure with reduced ejection fraction (HFrEF) and chronic kidney disease (CKD) experience fragmented care in the usual referral-based model given poor care coordination between subspecialists and primary care clinicians (PCCs). Multidisciplinary specialty care teams can improve care coordination, increase use of guideline-directed medical therapies (GDMT), and potentially increase patient satisfaction.

Methods:
We conducted a randomized controlled trial in a single-center tertiary care institution, enrolling patients with both HFrEF (ejection fraction <50%) and CKD (stages 2-5, not on hemodialysis) over 6 months. The patients’ PCCs were randomized to either the control arm in which usual care was continued, or to the treatment arm where PCCs were supported by a virtually organized cardio-kidney team with a heart failure specialist and nephrologist. Treatment arm PCCs received recommendations from the cardio-kidney team via electronic medical record secure messaging sharing guidance on GDMT use, necessary lab tests, etc. Patients’ quality of life and symptoms were assessed at both baseline and 3 months via the Kidney Disease Quality of Life (KDQoL) survey and Kansas City Cardiomyopathy Questionnaire (KCCQ), respectively.

Results:
95 patients had 3 month follow-up data (treatment n=47, control=48). The mean patient age was 67.4±10.8, and 61% were male. The majority (76%) were African American with mean EF of 35.5 ±11.0. The treatment group had higher reported and clinically significant (>at least a 5-point change) improvement of KCCQ scores from baseline to 3 months (52%) compared to the control group (38%), however, this was not statistically significantly different (p=0.15). Meanwhile, the proportion of deterioration was 39% and 40% in the treatment and control groups, respectively. There were no significant differences in KDQOL scores between or within both groups when comparing the baseline to 3 month data.

Conclusion:
Implementing a multidisciplinary care team to support PCCs is a feasible intervention and at 3 months, there was an increase (although statistically insignificant) in KCCQ scores. A longer duration of follow-up may be better able to assess the effects of multidisciplinary care team models.
Abstract 18126: A Rare Case of a Left Ventricular Papillary Fibroelastoma With an Initial Presentation of Unilateral Vision Loss
Authors: Brown Bernard , john sabu
Published: December 2023

A 59-year-old female with hypertension presented with acute onset of decreased vision in the right eye. She reported waking up 3 days prior to admission with sudden onset of shadow in the right eye appearing like a falling curtain which eventually progressed to total visual loss. She also complained of headaches and palpitations. The patient denied pain, nausea, vomiting, photophobia, changes in speech, aphasia, facial weakness, arm or leg weakness or numbness. She states that this is her first experience of vision loss. At the time of admission, she was hypertensive to 170/100s and started on amlodipine 5mg and losartan 25mg. Neurology and ophthalmology were consulted for concerns of stroke and new vision loss. She was started on heparin drip, aspirin 81mg, atorvastatin 80mg, and methylprednisolone 1g. Ocular examination revealed right brachial retinal artery occlusion. MRI brain showed chronic microvascular changes, but no acute intracranial hemorrhage or infarction. CT angiogram of the neck showed mild soft plaque in right carotid bifurcation. Transthoracic echocardiogram revealed a 1.6cm x 1.6cm left ventricular mobile mass which appeared to be attached to the posteromedial papillary muscle and left ventricle ejection fraction of 60%. The patient underwent open heart surgery for removal of the mass. The mass was confirmed to be a papillary fibroelastoma attached to the left ventricular trabeculum. The mitral valve and subvalvular apparatus were not involved. New onset of stroke or acute vision loss is generally a result of thromboembolism. Most times it can be caused by a clot formed in a patient with atrial fibrillation. In other cases, it can be due to a ruptured cholesterol plaque. However, primary cardiac tumors are rare, especially ones on the papillary muscle. We presented a rare case of papillary fibroelastoma that possibly embolized causing acute unilateral vison loss. This case reinforces the importance of cardiac imaging in new stroke or acute vision loss.
Abstract 18131: Outcomes of Catheter-Based Thrombectomy versus Surgical Embolectomy Among Patients With Massive Pulmonary Embolism: A Nationwide Analysis From the United States
Authors: Ismayl Mahmoud , Ahmed Hasaan , May Joshua , Hashem Anas , Hamadi Omar , Goldsweig Andrew M
Published: December 2023

Background:
Clinical outcomes of catheter-based thrombectomy (CBT) compared with surgical embolectomy (SE) in patients with massive pulmonary embolism (mPE) have not been previously examined.

Methods:
We conducted a retrospective cohort study using the 2016-2020 National Inpatient Sample database to compare the outcomes of CBT versus SE in patients with mPE. Outcomes of interest included risk-adjusted in-hospital mortality, major bleeding, stroke, acute kidney injury (AKI), hospital length of stay (LOS), and total cost.

Results:
The total cohort included 5,845 patients with mPE, of which 5,490 (93.9%) underwent CBT and 215 (3.7%) underwent SE. After risk-adjustment, CBT had similar odds of in-hospital mortality (adjusted odds ratio [aOR] 1.49, 95% confidence interval [CI] 0.60-3.66, p=0.37) and stroke (aOR 1.49, 95% CI 0.30-7.38, p=0.62), lower odds of major bleeding (aOR 0.28, 95% CI 0.13-0.63, p<0.01), and higher odds of AKI (aOR 2.40, 95% CI 1.11-5.17, p=0.02) compared with SE. CBT had a similar LOS (p=0.58) and total cost (p=0.23) compared with SE. Between 2016 and 2020, there was a temporal increase in the performance of CBT in patients with mPE (p
trend
<0.01).

Conclusions:
In patients with massive PE, CBT was associated with similar in-hospital mortality, stroke, LOS, and total cost, lower major bleeding, and higher AKI compared with SE. Randomized controlled trials are indicated to confirm our findings.
Abstract 18140: Is Socioeconomic Status Associated With a Novel Clinical Risk Prediction Score for Sudden Cardiac Death?
Authors: Reinier Kyndaron , Chugh Harpriya , Uy-Evanado Audrey , Chugh Sumeet S
Published: December 2023

Introduction:
Lower socioeconomic status (SES) is associated with higher risk of sudden cardiac death (SCD), but SES has not been used for SCD risk stratification. We have recently developed a novel risk score (VFRisk) for avertable SCD (8 clinical factors, 4 ECG markers, and 1 echocardiographic marker). We evaluated the association of the clinical components of the VFRisk score with SES.

Hypothesis:
Higher VFRisk scores will associate with lower SES.

Methods:
Individuals with SCD (2002-2019), were identified from a large ongoing study in a northwest US metro area (pop ~1 million). For each SCD case, a partial VFRisk score was calculated limited to the 8 clinical components (VFRisk-clinical; diabetes, HF, stroke, atrial fibrillation, COPD, history of MI, seizure, and syncope). The VFRisk-clinical score was categorized as low (<25
th
percentile), moderate (25
th
-75
th
), and high (>75
th
percentile). SES was defined for each SCD case by residential census tract median household income and categorized into quintiles.

Results:
Among 4,412 SCD cases, data for SES and VFRisk-clinical was available for 3,606 (82%) with a median VFRisk of 2.8 (min 0 - max 13.4). There was a weak negative linear correlation between median household income quintile and VFRisk-clinical score (r = -0.05, p=0.002) and mean VFRisk-clinical score was slightly lower with higher SES quintile (Figure). However, there was no significant trend in the proportion of SCD cases with a high VFRisk-clinical score (>75
th
percentile) by median income quintile (p=0.13). In a logistic regression model, income quintile was not significantly associated with a high VFRisk-clinical score (p=0.60).

Conclusions:
No clear association was observed between the VFRisk-clinical score and SES, possibly due to involvement of SES early in the causal pathway of these clinical conditions, or due to effects of SES on risk pathways for SCD separate from the components of the VFRisk score.
Abstract 18145: Meta-Analysis Comparing Immediate and Staged Complete Revascularization for Multivessel Disease in Acute Coronary Syndrome Patients
Authors: Mufarrih Syed H , Qureshi Nada , Khan Mohammad Saud , Haider Sajjad , Foley Jeffrey , Akbar Muhammad , Kazimuddin Mohammed , Hyder Omar N , Abbott Jinnette D
Published: December 2023

Background:
Acute coronary syndrome (ACS) patients undergoing PCI often have severe non-culprit vessel involvement known as multivessel disease (MVD), which is linked to worse outcomes. While guidelines recommend complete revascularization, the optimal timing is unclear. Comparing immediate vs. staged approaches is crucial to identify the optimal approach to revascularization.

Research question:
Do outcomes differ between immediate complete revascularization (ICRV) and staged complete revascularization (SCRV) in patients with ACS and MVD?

Methods:
PubMed, Cochrane library and Web of Science were searched for studies comparing immediate vs. staged complete revascularization for ACS and MVD. Randomized controlled trials (RCTs) and prospective studies reporting all-cause mortality, major adverse cardiac events (MACE), myocardial infarction (MI), and revascularization were included. Thirty-day and extended-term outcomes were evaluated, and risk ratios (RR) with 95% confidence intervals (CIs) were calculated using a random-effects model.

Results:
The meta-analysis comprised 6 RCTs and 5 prospective studies, involving 3,631 patients (ICRV: 1,728; SCRV: 1,903) presenting with ACS (ST-elevation MI (STEMI)=9, NSTEMI=1; Mixed=2). The mean age was 62.4 ± 9.4 years, with 79.5% male. The ICRV group exhibited significantly higher 30-day mortality (RR: 2.19 [1.31-4.06], p=0.004), while the SCRV group had higher revascularization rates at 30 days and extended term (RR: 0.27 [0.10-0.69], p=0.007 and RR: 0.68 [0.48-0.96], p=0.03, respectively). No significant difference was found in 30-day and extended-term MACE and MI between the ICRV and SCRV groups.

Conclusion:
Although there was no significant difference in overall MACE between the two complete revascularization strategies for patients with ACS and MVD, the SCRV group showed lower 30-day all-cause mortality, while the ICRV group demonstrated a lower incidence of revascularization rates.
Abstract 18151: Impact of Socioeconomic Disparities in Women With Peripartum Cardiomyopathy
Authors: Lee Somin , Ali Nisha , Bhandari Sachin , Chilimuri Sridhar , Bella Jonathan N , Jadhav Preeti
Published: December 2023

BACKGROUND
Peripartum cardiomyopathy(PPCM) is a rare cardiomyopathy associated with pregnancy. Recently there is increased awareness of social determinants and health impact on cardiovascular disease.

Hypothesis:
We aim to investigate incidence, complication, and prognosis of PPCM in socioeconomically vulnerable South Bronx community and compare it with contemporary data.

METHOD
A retrospective cohort study was performed from 2009 to 2023 at a single center, BronxCare Health System in United States. A community hospital is located in South Bronx, a low socioeconomic neighborhood where median income is 57th percentile($15,398). South Bronx ethnicity was reported as 34% Black, 60% Hispanic. Statistics for numerical variables were presented as mean±SD and categorical variables were presented as count. Total subjects 52 were identified. After adopting criteria of systolic dysfunction with left ventricular ejection fraction(EF)<45%, 27 patients were included in PPCM group in our study consisting of 14 Black and 13 Hispanic women.

RESULT
The incidence of PPCM in our study was 1 in 622 live births compared to the incidence of PPCM in the United States 1 in 3,186 live births.(RR=5.12) MAE defined as mortality, heart transplant, mechanical circulatory support, pulmonary edema, thromboembolism, implantable cardioverter defibrillator implantation and cardiogenic shock, occurred in 29.6% compared to 13.5% of patients in a nationwide population-based study.(RR= 6.985) Follow-up echocardiogram in 5 years, 5 patients(18%) recovered their ejection fraction>45%, 11 patients (40%) did not recover, and the other 11(40%) were lost to follow-up, and repeat EF is unknown. 17 patients (62.9%) were counseled contraception. 4 patients had subsequent pregnancy, only 2 had recovered EF prior to subsequent pregnancy.

CONCLUSION
We observed the significant burden of PPCM in low-socioeconomic South Bronx community, higher incidence, and greater risk of adverse events compared to the nationwide population-based study. Healthcare professionals should be alert and emphasize the importance of close follow-up, patient education, and social support for PPCM patients to prevent complications and improve prognosis to decrease socioeconomic disparity impact on PPCM.
Abstract 18152: Clinical Impact and Mechanism of De Novo Aortic Insufficiency During Percutaneous Ventricular Assist Device Support for Cardiogenic Shock
Authors: Domae Keitaro , Hata Masatoshi , Sakamoto Tomohiko , Kodani Noriko , Yokota Junki , Matsuda Masaru , Tsuji Hiromi , Mike Asako , Hao Hiroyuki , Nakamoto Kei , Ichibori Yasuhiro , Higuchi Yoshiharu , Masai Takafumi , Sawa Yoshiki
Published: December 2023

Introduction:
Recently, percutaneous ventricular assist device (p-LVAD) has been widely applicable for cardiogenic shock. Clinically significant aortic insufficiency (AI) is contraindication for p-LVAD, nevertheless p-LVAD itself can cause de novo AI (dAI) during the support. However the detail of dAI during p-LVAD support was not fully investigated. The aim of this study was to evaluate the clinical impact of AI during p-LVAD support and also investigate the mechanism and risk factor of dAI.

Methods:
Seventy-seven consecutive patients who underwent p-LVAD support (average age 66.7 years, Impella CP/2.5 in 65 and 5.5/5.0 in 12 cases) from 2018 to 2022 were retrospectively evaluated. The average support periods was 8.0±6.9 days. dAI was defined as development of AI ≥ moderate during p-LVAD support. Aortic valve pathology was examined using autopsy specimens in eight patients.

Results:
Three patients had AI ≥ moderate before p-LVAD support and underwent surgical intervention (AVR in 2 and AV repair in 1) during p-LVAD support. dAI was observed in 8 patients (10.3%, moderate in 7 and severe in 1). Moderate dAI in four of these patients improved after cardiac recovery and weaning of p-LVAD support. However, in 3 other patients with dAI ≥ moderate developed hemodynamic instability and deceased due to heart failure. In only a patient, moderate dAI remained after p-LVAD weaning with stable hemodynamics. Progression of AI after p-LVAD removal was not observed in all patients. In-hospital mortality was higher in the patient with dAI (75.0 vs. 47.8%, p=0.14). Pathological evaluation revealed hemorrhagic change at LV side of aortic valve with hemosiderin-laden macrophages in 3 autopsy specimens, which suggested contact of p-LVAD catheter. The univariate analysis identified mild AI before p-LVAD support as independent risk factor for dAI (Odd ratio 5.5, 95%CI 0.074-0.45, p<0.001).

Conclusions:
Our study demonstrated that de novo AI frequently occurred during p-LVAD support and had a negative impact on hemodynamics and prognosis. Interference with aortic valve by the p-LVAD catheter may cause and exacerbate AI, even in the cases with pre-existing mild AI. Surgical intervention is essential to improve hemodynamics for severe and permanent AI during p-LVAD support.
Abstract 18182: Inappropriate Shocks After Mitraclip™ Placement: Should Reassessment of Post-Procedural ICD Sensitivity Be Routine Practice?
Authors: Bhatia Unnati , Hanson Ivan D , Mehta Nishaki M
Published: December 2023

Case Description:
A 53 year old African American woman with non-ischemic cardiomyopathy (EF 10%) with intolerance to GDMT (allergies) and severe secondary MR. An ICD was placed years ago. Given LBBB and QRS 146ms, she underwent a BiV(biventricular pacing)-ICD upgrade with symptomatic improvement, but persisting exertional intolerance. TEE showed a favorable anatomic profile for transcatheter edge-to-edge MV repair and a MitraClip™ was placed. Post-procedure, the severity of MR decreased significantly (from severe to mild), however there was no sizable improvement in LV EF. Also, there were no significant EKG changes. Three months later, she experienced multiple inappropriate shocks (IAS). Device interrogation revealed T-wave oversensing (TWOS). TWOS was noted on multiple vectors with LV only pacing, but was solely associated with fusion complexes on BiV pacing. R wave sensing threshold was increased. Patient was switched to BiV only pacing and AV delay(paced and sensed) was decreased to avoid fusion beats. Patient did well and no further IAS were noted at 4 months follow-up.

Discussion:
ICDs (+/- CRT) are vital in preventing SCD in advanced CHF. Currently, transvenous technology is excellent at avoiding TWOS, however our case represents a challenging dilemma where repolarization may have changed post-operatively after MitraClip™ placement. T wave amplitude is dynamic and real time monitoring of sensing threshold is needed. This becomes especially important after structural heart procedures like MV TEER that can induce subclinical electroanatomic changes. While MitraClip™ can reduce ventricular arrhythmias with favorable remodeling, inappropriate sensing of devices is a small but real risk. Consequently, there are no established guidelines on routine post-procedural device interrogation. Preemptive reassessment of T wave safety margin and monitoring of sensing thresholds and lead placement may be useful following structural heart interventions.
Abstract 18186: Four Chambers Strain Analysis in Patients Admitted With Acute Heart Failure: A New Characterization of Heart Involvement?
Authors: Soulat-Dufour Laurie , Bourai Ania , Lang Sylvie , Capderou Elodie , EDERHY Stephane , ADAVANE Saroumadi , Chauvet-Droit Marion , Arnaud Camille , Issaurat Pauline , Jullien Stéphanie , Cardoso Chloé , Gerard Manon , Cherif Ghassen , Addetia Karima , Boccara Franck , Assyag Patrick , Lang Roberto , Cohen Ariel
Published: December 2023

Introduction:
In heart failure (HF), most of the data available on myocardial strain focused on the left ventricle (LV). Very few data concern the other cavities.

Hypothesis:
We hypothesized that all cardiac cavities are involved in HF and thus we evaluated all chambers strain profiles in patients admitted with acute HF.

Methods:
We prospectively evaluated 95 patients hospitalized for HF. Patients were divided into preserved left ventricle ejection fraction (LVEF) (LVEF ≥50%, HFpEF n=24), mildly reduced LVEF ((LVEF 41-49%, HFmrEF n=17), and reduced left ventricular ejection fraction (LVEF) (LVEF ≤40%, HFrEF n=54). In addition to the usual two-dimensional echocardiographic parameters, LV global longitudinal strain, left and right atrial strain (reservoir, conduit, contractile strain), right ventricular free wall strain were determined using speckle tracking transthoracic echocardiography at admission.

Results:
Patients with HFrEF were younger in comparison with patients with HFmrEF and HFpEF, (respectively 66.3 ± 14.2, 78.3.0 ±8.7, 75.6 ± 10.2 years p<0.001). Table 1 summarizes the main Doppler and echocardiographic comparisons. Myocardial strain analyses demonstrated that patients with HFrEF had significant lower LV global, right ventricular strain, left atrial reservoir strain, left and right atrial conduit strain (Figure 1).

Conclusions:
Beyond the alteration of LV function, HFrEF involves alteration of right ventricle, left and right atrial functions. Strain analysis is an interesting tool in addition to conventional echocardiographic parameters to assess heart function in heart failure. The prognostic impact of these finding remains to be studied.
Abstract 18201: Intracoronary Optical Coherence Tomography versus Intravascular Ultrasound in ST and Non-ST Elevation Myocardial Infarction: A Nation-Wide Analysis
Authors: Mathew Kalathil Ruth ann , Pusapati Suma , Machanahalli Balakrishna Akshay , Dutt Dua Noor , Aboeata Ahmed
Published: December 2023

Introduction:
Intravascular ultrasound (IVUS) and intracoronary optical coherence tomography (OCT) are the 2 techniques of intracoronary imaging that are currently accessible modalities to precisely measure coronary diameters and characterize morphology of lesions. We aimed to compare the impact of IVUS and OCT on outcomes and 30-day readmission rates following STEMI and NSTEMI.

Methods:
We queried the National Readmission database (2010-2019) to identify patients with STEMI and NSTEMI, undergoing PCI and compared outcomes and 30-day readmission rates between patients undergoing IVUS-guided PCI and OCT-guided PCI. Multivariable logistic regression was performed to evaluate the odds ratios (OR) of adverse outcomes in the 2 groups

Results:
Of 67,479 STEMI admissions undergoing ICI-guided PCI, 65,137 underwent IVUS and 2,342 underwent OCT. Patients undergoing OCT compared to IVUS had lower Length of stay (LOS) (OR 0.98 [0.96-0.99], P<0.05). However, there was no significant difference in in-hospital mortality, 30-day readmission rate and 90-day readmission rate. Of 103,901 NSTEMI admissions undergoing ICI-guided PCI, 100,127 underwent IVUS and 3774 underwent OCT. Patients undergoing OCT compared to IVUS had lower LOS (OR 0.95 [0.93-0.98], P<0.001) and 30-day readmission rates (OR 0.84 [0.71-0.99], P<0.05), but no significant differences were found in in-hospital mortality and 90-day readmission rates

Conclusions:
In acute MI patients undergoing ICI-guided PCI, OCT-guided PCI during index hospitalization is associated with similar outcomes compared to IVUS-guided PCI (except better LOS and 30-day readmission rates in NSTEMI).
Abstract 18222: FAM210A Regulates Mitochondrial Translation and Maintains Cardiac Mitochondrial Homeostasis
Authors: Yao Peng , Wu Jiangbin , Subbaiah Kadiam C
Published: December 2023

Introduction:
Mitochondria play a vital role in cellular metabolism and energetics and support cardiac function. FAM210A (family with sequence similarity 210 member A) is a novel hub gene in mouse cardiac remodeling. Human FAM210A mutations are associated with sarcopenia. However, the physiological and molecular function of FAM210A remain elusive in the heart.

Hypothesis:
We aim to determine the biological and molecular mechanism of FAM210A in regulating mitochondrial function and cardiac health.

Methods and Results:
Tamoxifen-induced conditional knockout of
Fam210a
in mouse cardiomyocytes (CMs) induced progressive dilated cardiomyopathy and heart failure (HF), ultimately causing mortality. Fam210a deficient CMs exhibit severe mitochondrial morphological disruption and functional decline accompanied by myofilament disarray at the late stage of cardiomyopathy. Moreover, we observed increased mitochondrial reactive oxygen species production, disturbed mitochondrial membrane potential, and reduced respiratory activity in CMs at the early stage before contractile dysfunction and HF. Multi-omics analyses indicate that FAM210A deficiency persistently activates integrated stress response (ISR), resulting in transcriptomic, translatomic, proteomic, and metabolomic reprogramming, ultimately leading to pathogenic progression of HF. Mechanistically, mitochondrial polysome profiling analysis shows that FAM210A loss of function compromises mitochondrial mRNA translation and leads to reduced mitochondrial encoded proteins, followed by disrupted proteostasis. We observed decreased FAM210A protein expression in human ischemic heart failure and mouse myocardial infarction tissue samples. To further corroborate FAM210A function in the heart, AAV9-mediated overexpression of FAM210A promotes mitochondrial-encoded protein expression, improves cardiac mitochondrial function, and partially rescues murine hearts from cardiac remodeling and damage in ischemia-induced HF.

Conclusions:
These results suggest that FAM210A is a mitochondrial translation regulator to maintain mitochondrial homeostasis and normal CM contractile function. This study also offers a new therapeutic target for treating ischemic heart disease.
Abstract 18234: The Fast and the Furious, A Rare Case of RCA Dissection Following a Car Accident in a Male Patient
Authors: Saracino Valentina N , Kelly Catherine , Mitchell Michael
Published: December 2023

Introduction:
Coronary artery dissection is a rare, but potentially lethal, etiology of chest pain in the emergency department. Dissection is defined as a spontaneous, traumatic, or iatrogenic disruption of the tunica intima, causing blood to accumulate in a false lumen. Coronary artery dissection reportedly has a 0.1% incidence in the general population, occurring most commonly in the LAD, and less commonly in the RCA. Acute myocardial infarction (AMI) following blunt chest trauma has an age predominance of 82% being less than 45 years of age. With a low incidence and abnormal age presentation, an electrocardiogram must be included in the work-up of blunt chest trauma to assess for coronary artery dissection.

Case:
A 44-year-old male with a history of polysubstance abuse, obesity, and hypertension presented with left hip pain following a motor vehicle accident. The patient had been operating a small motorcycle when he struck a stationary vehicle. He was wearing a helmet but was ejected from the motorcycle, landing on his back. The patient eventually began to experience both right-sided chest pain as well as right-sided neck pain while in the. An electrocardiogram was performed that showed inferior ST-segment elevation with reciprocal ST-segment depression in the lateral leads. Troponins were 42ng/L, 1,465ng/L and 8,170ng/L. Cardiac catheterization revealed a spiral dissection of the RCA extending from the ostium to the mid-segment with TIMI 1 flow. The patient remained on medical management of aspirin, clopidogrel, and heparin and was monitored in intensive care for 48 hours prior to home discharge.

Conclusion:
Blunt force cardiac injury is an uncommon cause of chest pain and myocardial infarction, and rarer still is RCA dissection. This case highlights the distinct importance of electrocardiograms as a pivotal part of the trauma and chest pain diagnostic reasoning process.
Abstract 18242: Mitral Valve Repair vs. Mitral Valve Replacement in Rheumatic Heart Disease Patients: A Systematic Review and Meta-Analysis
Authors: Hassan Omer Ul , Yasmin Farah , Moeed Abdul , Rahman Saad Ur U , Jawed Shizra
Published: December 2023

Background
Mitral valve repair (MVP) is recommended over mitral valve replacement (MVR) for mitral valve disease. However, its benefits in rheumatic heart disease (RHD) patients are unclear. We conducted this meta-analysis to compare perioperative and long-term clinical and safety outcomes of MVP vs. MVR.

Methods:
MEDLINE, Google Scholar, and Scopus were searched from inception till June 2023 comparing clinical outcomes with MVP vs. MVR in RHD patients. Primary outcomes were early mortality and long-term survival. Secondary outcomes were freedom from reoperation, freedom from valve related adverse events, postoperative infective endocarditis (IE), thromboembolic events (TEE), and hemorrhagic events. The outcome measures were summary random effects risk ratio (RR) and hazard ratios (HR) with 95% confidence intervals.

Results:
A total of 19 studies with 10,724 RHD patients (3,495 MVP vs. 7,229 MVR; mean age: 38.3 years for MVP vs. 43.5 years for MVR) were included. MVP was associated with significantly lower early mortality (RR 0.62 [0.45, 0.85]; p=0.003), and long-term mortality (HR 0.53 [0.37, 0.76]; p=0.0006). Upon meta-regression analysis, only increasing age was associated with early mortality (Coeff: 0.0194, p=0.037). However, MVP was associated with significantly lower freedom from reoperation at both 5- (RR 0.88 [0.83, 0.93]; p<0.0001) and 10-year (RR 0.90 [0.83, 0.98]; p=0.01) follow-ups. Freedom from valve related adverse events was higher in the MVP group at 10-year follow-up (RR 1.15 [1.06, 1.24]; p=0.0006) with no significant difference at 5-year follow-up (RR 1.03 [0.94, 1.14]; p=0.50). No significant difference was seen for IE (RR 1.03, p=0.91) and hemorrhagic events (RR 0.70, p=0.05). TEE were significantly lower in the MVP group (RR 0.59 [0.44, 0.78]; p=0.0003).

Conclusion:
In RHD, MVP reduced early- and long-term mortality and achieved greater freedom from valve related adverse events. However, there was a higher risk of reoperation in MVP.
Abstract 18259: Overestimation of Major Amputation Risk in Patients Undergoing Peripheral Vascular Intervention for Peripheral Artery Disease When Not Accounting for Mortality Risk
Authors: Romain Gaelle , Smolderen Kim G , Cleman Jacob , Mena-Hurtado Carlos
Published: December 2023

Background:
Endovascular peripheral vascular intervention (PVI) is intended to improve symptoms and functioning, and avoid limb amputation in patients with chronic limb threatening ischemia (CLTI). CLTI is associated with high mortality risk, which differs across age groups. We aimed to offset mortality vs. amputation risks by age groups in patients with CLTI using competing risk modeling.

Methods:
Patients with CLTI underwent PVI in 2017-2018 in the Vascular Quality Initiative registry were included. Mortality and major amputation outcomes over 3 years were derived from Medicare data. The cumulative incidence (CIF) of both outcomes in age groups <65 and ≥65 years, was calculated by Aalen-Johansen (AJ), taking mortality into account, and compared with corresponding CIF calculated by Kaplan-Meier (KM). The major amputation risk in <65 vs ≥65 years was estimated using a Fine and Gray competing risk model (sHR) and Cox regression (HR) adjusted for patients’ baseline characteristics.

Results:
A total of 10,114 patients were included: 22% <65 years; 59% male and 19% Black. The cumulative incidence of death without major amputation increased with age (32% in <65 vs. 46% ≥65 years) and was higher than that of major amputation (26% in <65 vs. 15% in ≥65 years). By ignoring competing risk, both death without major amputation and major amputation was overestimated by a relative difference of 25.4% and 14.3% in <65 years and by 13.8% and 21.2% in ≥65 years. The adjusted major amputation risk in <65 vs. ≥65 years estimated by Cox regression was HR 1.30 95%CI 1.16-1.56 vs. FG model sHR = 1.75 95%CI 1.57-1.95. (Table)

Conclusions:
Longer term mortality following PVI is high, especially among elderly with CLTI. To derive accurate risk estimates for amputation across age groups, advanced methods that can accommodate the competing risk of mortality are needed to better inform clinicians and patients as they face CLTI treatment decisions.
Abstract 18288: Mice Harboring a Novel De Novo Missense
RBFOX2
Variant Display Abnormal Heart Development
Authors: Choudhury Talita , Manivannan Sathiyanarayanan , Gordon David , Cameron Emily , Girard Holly , Myers Katherine , White Peter , Garg Vidu
Published: December 2023

Hypoplastic Left Heart Syndrome (HLHS) is a complex form of congenital heart disease, characterized by severe underdevelopment of the left ventricle, stenosis or atresia of the mitral and aortic valves, and hypoplasia of the ascending aorta and aortic arch. Despite advances in surgical and palliative strategies leading to improved neonatal survival outcomes, HLHS is still associated with early mortality and long-term morbidity. Elucidation of HLHS etiology is compounded by its complex inheritance mechanism and heterogenous genetic landscape, with studies indicating a multigenic etiology. We performed exome sequencing on a parent-offspring trio in which the proband was affected with HLHS and identified a novel
de novo
missense variant in the gene,
RBFOX2,
that was bioinformatically predicted to be pathogenic. RBFOX2 belongs to a family of RNA-binding proteins that is broadly expressed in all tissues and regulates splicing and transcription of many targets, including those involved in heart development. In order to determine the in vivo pathogenicity of the
RBFOX2
variant, we generated a knock-in mouse model harboring orthologous missense RBFOX2 variant using CRISPR/Cas9 technology.
RBFOX2
KI/KI
mice were found to be embryonic lethal. Morphological analysis revealed 100% of homozygous mutants exhibit gross developmental defects. Normal Mendelian ratios are found at E9.5 but homozygous mutants display severe growth retardation from E9.5 to E11.5. Histologic analysis demonstrated underdevelopment of the ventricular chambers starting at E9.5. Overall, these mutant mice, harboring a clinically relevant human HLHS variant in
RBFOX2
, display highly penetrant hypoplastic hearts with significant growth retardation. The use of this new murine model will pave the way for better cellular and molecular characterization of the deficits in RBFOX2 function that contribute to HLHS.
Abstract 18312: Is the Presence of Multiple Valvular Heart Disease or Mitral Annular Calcification in Cancer Patients Exposed to Chest Radiotherapy or Chemotherapy That Underwent Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis Associated With MACE?
Authors: Santos Patarroyo Sebastian , Ricaurte Carolina , Collantes Diana , Daryanani Andres , Toro-Manotas Rafael , Eleid Mackram F , Pislaru Sorin , Michelena Hector I , Greason Kevin , Nkomo Vuyisile T , Villarraga Hector R
Published: December 2023

Introduction:
Multiple Valvular Heart Disease (VHD), defined as at least moderate stenotic or regurgitant lesions in ≥2 valves, mixed VHD as combination of lesions in the same valve and mitral annular calcification (MAC) are common conditions. Association between multiple-mixed VHD (MMVHD), MAC and MACE in patients exposed to Radiation Therapy (RT) and/or chemotherapy (CT) who underwent Transcatheter Aortic Valve Replacement (TAVR) has not been studied.

Aim:
Assess the presence of MMVHD and MAC in cancer patients with prior RT and/or CT and their correlation with MACE (cardiovascular death, myocardial infarction, revascularization, stroke and hospitalization for heart failure) after TAVR.

Methods:
544 patients were included and divided into 3 groups: 187 with prior chest RT and CT (RT/CT), 155 CT only, and 202 without CT/RT as controls (Table 1). Data was obtained from the pre-procedure echocardiogram and quantified in a 1-6 scale (none, mild, mild/moderate, moderate, moderate/severe and severe). Fisher’s exact test or chi-square were used to compare categorical. Multiple VHD-MACE correlation was evaluated through multivariable Cox analysis using a proportional hazards model.

Results:
The prevalence of Multiple VHD was 37.4% in RT/CT, 23.2% in CT, and 13.9% in controls p<0.001(Figure 1). The RT/CT group had a significantly higher prevalence of severe MAC. Multiple VHD predicted MACE at 18 months after TAVR in RT/CT (HR 3.42, CI 1.93-6.08, p<0.001) and in CT (HR 2.55, CI 1.39-4.66, p=0.002) (Table 2). In RT/CT, severe MAC also predicted MACE (HR 3.68, CI 2.13-6.37, p<0.001), while it was not a predictor in the other groups. Stenotic or regurgitant VHD was more prevalent in the RT/CT group (Figure 2).

Conclusions:
Multiple VHD was found higher in RT/CT and predicted MACE at 18 months post-TAVR, including CT only patients. Severe MAC was also a strong predictor of the outcome in RT/CT patients. Pre-TAVR evaluation of MMVHD lesions is crucial for optimal patient management.
Abstract 18326: The Association of s Shockable Rhythm and Automated External Defibrillator Use With Outcomes in Infants With Out of Hospital Cardiac Arrest: A Study From the Cardiac Arrest Registry to Enhance Survival
Authors: Naim Maryam Y , Griffis Heather M , McNally Bryan F , Al-Araji Rabab , Berg Robert , chung sarita , Nadkarni Vinay M , Tobin Joshua M , Vetter Victoria L , Rossano Joseph
Published: December 2023

Introduction:
Defibrillation with an automated external defibrillator (AED) is critical in the chain of survival following a cardiac arrest caused by pulseless ventricular tachycardia and ventricular fibrillation. However, in 2022 the International Liaison Committee on Resuscitation could not make a recommendation for or against the use of AEDs in infants.

Hypothesis:
We aimed to describe the association of a shockable rhythm with outcomes in infants with out of hospital cardiac arrest (OHCA) and test the hypothesis that a shockable rhythm and AED use with defibrillation would be associated with improved neurologically favorable survival at hospital discharge by analyzing data from a large cardiac arrest registry in the United States

Methods:
We conducted an analysis of the Cardiac Arrest Registry to Enhance Survival database. Inclusion criteria were age < 1 year of age and non-traumatic OHCA from January 1, 2013 through December 31, 2021. The primary outcome was neurologically favorable survival defined as a Cerebral Performance Category Scale of 1 or 2.

Results:
A total of 10,108 infants with OHCA were evaluated of which 308 (3%) had a shockable rhythm and 9,800 (97%) had a non-shockable rhythm. Compared to infants with non-shockable rhythms infants with shockable rhythms were more likely to be white (37.7% white, 25.6% black, 7.5% Hispanic), have a witnessed arrest (44.5% vs. 16%), a non-home/public arrest (16.9% vs. 6.7%), and bystander AED application with defibrillation (19.4% vs. 0.18%) (p<0.05 for all). Neurologically favorable survival (19.2% shockable vs. 4.2% non-shockable was higher in arrests with a shockable rhythm compared to non-shockable arrests, p<0.001). AEDs were applied by bystanders in 1479 (14.5%) arrests and were associated with neurologically favorable survival (11% AED with defibrillation vs. 3.5% AED without defibrillation, p=0.002)

Conclusions:
Although infants infrequently had an OHCA with a shockable rhythm survival outcomes were superior in arrests with a shockable rhythm and in arrests where there was bystander AED use with defibrillation. These results emphasize the importance of AED use in infants with shockable rhythms following an OHCA.
Abstract 18334: Altered in-vivo Placental Microstructure Predicts Adverse Neurodevelopmental Outcomes in Toddlers With Congenital Heart Disease
Authors: Wu Yao , Andescavage Nickie , Kapse Kushal , Donofrio Mary T , Liggett Melissa , Kapse Anushree , Myers Madison , du Plessis Adré J , Limperopoulos Catherine
Published: December 2023

Introduction:
Pregnancies complicated by fetal congenital heart disease (CHD) are at risk for disrupted placenta function; placental insufficiency, in turn, is a risk factor that may adversely impact offspring neurodevelopment. However, the relationship between altered in-vivo placenta function and infant neurobehavioral outcomes in CHD is unknown.

Hypothesis:
We hypothesized that altered in-vivo placenta microstructural diffusion in CHD would be associated with impaired infant neurodevelopment.

Methods:
We prospectively recruited women with pregnancies complicated by CHD diagnosis and low-risk pregnancies. Women underwent an MRI on a GE 1.5T scanner at 20-39 gestational weeks. T2w sequence and pulsed gradient spin echo were acquired for placenta volume and diffusion kurtosis measures. Bayley-III and Infant-Toddler Social and Emotional Assessment were completed at around 18 months. Generalized estimating equation was used to examine the association between placenta measures and infant outcomes, adjusting for potential confounders.

Results:
We enrolled 236 mother/baby dyads (111 CHD; 125 controls) who underwent 394 MRIs (175 CHD; 219 controls). Forty-seven had single-ventricle (SV) CHD and 64 had two-ventricle (2V) CHD. In CHD, 32 subjects died, and 71 infants had neurodevelopment testing at a mean age of 20 months. Placenta diffusion coefficient (dki_d), reflecting tissue cellularity, was higher in CHD vs controls (p=0.009). In CHD, placenta diffusional kurtosis (dki_k), reflecting tissue heterogeneity, was lower in neonates who died pre-operatively vs those who survived (p=0.05). Compared to 2V CHD, pregnancies with SV fetuses had lower placenta dki_k and trending higher placenta dki_d. In CHD, higher placenta dki_d was associated with poorer language skills (p=0.05) while lower placenta dki_k was associated with higher behavioral dysregulation (p=0.03).

Conclusions:
We report for the first time disturbances in placenta microstructural diffusion in CHD. We also demonstrate that altered placenta diffusion was associated with impaired language and behavioral dysregulation in CHD toddlers. These data suggest that altered placenta microstructure may be an important biomarker for later neurodevelopmental dysfunction in CHD.
Abstract 18340: Several De-Regulated Chemokine Pathways Characterize Long COVID Syndrome
Authors: Gyongyosi Mariann , Han Emilie , Lukovic Dominika , Hamzaraj Kevin , Bergler-Klein Jutta K , Hasimbegovic Ena
Published: December 2023

Introduction:
The diagnosis of the Long COVID multi-organ syndrome is impeded by lack of circulating biomarkers.
Hypothesis:
We hypothesized, that post-COVID syndrome is associated with circulating protein de-regulation, enabling diagnosis of long COVID syndrome.

Methods:
Consecutive patients (70% female, 55±8y) with long COVID syndrome (n=70, 64.3% female, 49±6y) and non-diseased, non-vaccinated healthy controls (n=23, 70% female, 55±8y) of the Vienna POSTCOV Registry (EC 1008/2021) were included, and blood samples were collected. Proteomics was performed by using the Olink proteomics technology (Olink Proteomics, Uppsala, Sweden), by using cardiovascular, Immunologic, inflammation and neurologic protein (3x96 protein) panels. Protein-protein interaction network were built by selecting the significantly dysregulated proteins from the 4 panels, and were classified into functional groups.

Results:
Multiplex protein panel revealed 34 significantly de-regulated proteins as compared to controls. Gene ontology categorized the 29 upregulated proteins into several pathways with significant (false discovery rate <0.05) functional enrichment in biological processes (eg. death-inducing signaling complex assembly or positive regulation of tumor necrosis factor-mediated signaling pathway), and in molecular function (catalytic activity). Downregulated proteins were in association with chemokine-mediated signaling pathway and chemokine activity (Figure). KEGG pathway analyses revealed upregulated apoptosis, TNF- and NF-κB signaling pathways, but unchanged ACE2 receptors in patients with long COVID syndrome.

Conclusions:
Several de-regulated chemokine pathways characterize long COVID syndrome and may serve as a combined biomarker panel for long COVOD diagnosis and target drug prediction.