bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14734: Circulating Sulfhydryl Oxidase and Risk of Cardiovascular Disease
Authors: Qian Juying , Chen Ao , Chen Zhangwei , Ge Junbo
Published: December 2023

Introduction:
Whether circulating quiescin sulfhydryl oxidase (QSOX) family enzymes level is causally associated with an increased risk of cardiovascular disease remains unestablished. In this study, we applied Mendelian randomization (MR) analysis to investigate the potential causal relationship between circulating QSOX family enzymes and a wide range of cardiovascular disease outcomes in European ancestry.

Methods:
Independent single nucleotide polymorphisms associated with QSOX1 and QSOX2 at the genome-wide significance level were selected as instrumental variables. Summary-level data for 9 cardiovascular endpoints were obtained from genetic consortia, the UK Biobank study, the FinnGen consortium, HERMES and MEGASTROKE.

Results:
Higher genetically predicted circulating QSOX2 levels were associated with an increased risk of coronary artery disease. For each standard deviation increase in genetically predicted QSOX2 levels, the odds ratio was 1.05 (95% confidence interval, 1.02, 1.07; p = 0.0001) for coronary artery disease. Significant causal association of genetically determined QSOX2 level with heart failure, ischemic stroke and peripheral artery disease was also found with the inverse-variance weighted MR method. However, no potential causal relationships between circulating QSOX2 and atrial fibrillation, intracerebral hemorrhage, pulmonary embolism, transient ischemic attack and venous thromboembolism were observed. There was no association between genetically predicted QSOX1 and cardiovascular disease.

Conclusions:
This study reveals suggestive evidence that lowering circulating QSOX2 levels may reduce the risk of coronary artery disease, heart failure, ischemic stroke and peripheral artery disease.
Abstract 14737: A Case of an Intracardiac Sarcoma Arising From Metastatic Spread of a Primary Phyllodes Tumor of the Breast
Authors: Allen Donovon , Morton Kara , Ahmed Mustafa , Clarkson Stephen , May Jori , Litovsky Silvio
Published: December 2023

Background:
Malignant phyllodes tumors with cardiac involvement are rare, presenting diagnostic and management challenges. The benefits of medical and surgical therapies remain unclear. Large-bore aspiration devices are currently only approved for retrieval of venous thromboemboli but may present a valid option for diagnosis and treatment of intracardiac masses in high risk patients.

Case Summary:
We present the case of a 57-year-old female with a malignant phyllodes tumor of the breast and bilateral pulmonary emboli who presented with an incidental complex intracardiac mass on transthoracic echocardiography (1). A follow-up transesophageal echocardiogram demonstrated masses within the superior vena cava, right atrium, and right ventricle (2a-2b). Aspiration thrombectomy was performed given clinical stability and concern for thrombi with high risk of worsening clot burden. A large-bore aspiration device was used to retrieve the masses in multiple passes (3), which were pathologically consistent with spindle cell sarcoma. A cardiac MRI was completed following aspiration, and multiple mobile masses persisted in the right ventricle (4). The patient was discharged on day nine of hospitalization with therapeutic chemotherapy planned. She had one session of chemotherapy before a fatal cardiac arrest from unknown cause three months after discharge.

Discussion:
Phyllodes tumors rarely metastasize to the heart, and effective modalities for their diagnosis and management are unclear. Treatment strategies include wide surgical resection of the primary tumor, however mortality remains high in the setting of metastatic spread. Current guidelines recommend following principles of soft tissue sarcomas with chemotherapy. Large-bore aspiration devices may be an effective way to resect intracardiac tumors for both diagnostic and therapeutic purposes as an alternative to invasive surgical intervention for high-risk patients.
Abstract 14752: FGF-23, Cardiovascular Events, and the Benefit of Canagliflozin in the CANVAS Trial
Authors: Punithan Aranya , Ghamarian Ehsan , Grothe Daniela , Maclean macy , Connelly Kim , Neal Bruce C , Weisman Alanna , Cherney David , Billia Filio , Udell Jacob A
Published: December 2023

Background:
The incremental prognostic value of FGF-23 with cardiovascular (CV) risk, composite kidney outcomes (KO) and treatment response was assessed in the CANVAS trial, which studied the efficacy of the sodium glucose co-transporter 2 inhibitor canagliflozin (cana) versus placebo in patients with type 2 diabetes (T2D) and high CV risk.

Methods:
3188 patients with available baseline FGF-23 samples were studied. The association between FGF-23 and the composite of time to CV death or hospitalization for heart failure (HHF) (primary endpoint), HHF, CV death, major adverse CV events (MACE) and KO were assessed using multivariable Cox proportional hazard regression models adjusted for clinical risk factors. Events rates by randomized treatment assignment were calculated for FGF-23 after assignment to a ‘low risk’ (Quartiles 1-3) or ‘high risk’ (Q4) group.

Results:
The median level of FGF-23 was 64.1 RU/mL (IQR 48.3-94.1). A doubling of FGF-23 was significantly associated with the primary endpoint (HR, 1.32; 95% CI, 1.19-1.46;
P
<0.001) as well as HHF (HR, 1.53; 95% CI, 1.31-1.79,
P
<0.001), CV death (HR, 1.18; 95% CI, 1.03-1.35,
P
=0.014), and KO (HR, 1.11; 95% CI, 1.02-1.21,
P
=0.014) but not MACE (HR, 1.05; 0.95-1.15,
P
=0.3) in the fully adjusted model (Table 1). Cana yielded consistent risk reduction for the primary endpoint, HHF and KO regardless of whether patients were categorized in the high or low risk group (all
P
heterogeneity>0.30) (Table 2).

Conclusion:
High levels of FGF-23 are associated with an increased risk of CV death and HHF, HHF, CV death, and KO in patients with T2D and high CV risk. Treatment with cana provides consistent benefit across higher and lower levels of FGF-23.
Abstract 14776: Myopericarditis Mimicking Myocardial Infarction With Non-Obstructive Coronary Arteries
Authors: Akhtar Mohammad M , Bashir Hanad , Menon Santosh
Published: December 2023

This is a case of a 76-year-old female with a past medical history of recurrent paroxysmal symptomatic supraventricular tachycardia (SVT), atherosclerotic heart disease, mild aortic and mitral valve regurgitation, mild-moderate tricuspid regurgitation, right bundle branch block, hypothyroidism and bronchiectasis who presented to her dermatology appointment with palpitations and dizziness. She visited the cardiologist's office and was found to have SVT on electrocardiogram which did not terminate with Valsalva maneuvers. She arrived at the emergency department with chest pain and converted to sinus rhythm after 6 mg of intravenous adenosine was administered. Her troponin peaked to 0.21 and she was admitted with concerns for non-ST segment elevation myocardial infarction. Transthoracic echocardiogram showed left ventricular ejection fractions of 61 percent with no wall motion abnormalities and left atrial and inferior vena cava dilation. She underwent left heart catheterization which only showed mild calcification and minimal luminal irregularities of the left anterior descending artery. Cardiac MRI showed myopericarditis and she was discharged with 0.6 mg of colchicine twice daily with plans for outpatient follow up.

Discussion

Patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) are discovered to have myocarditis on cardiac MRI 25-30% of time. However, this case uniquely demonstrates myopericarditis as the cause for MINOCA which may not have been previously specified. In addition, it is important to emphasize the utility of Cardiac MRI as a non-invasive modality to diagnose MINOCA “mimics”, especially in the female population.
Abstract 14792: Predisposing Risk Factors Affecting Reversibility of Left Ventricular Diastolic Dysfunction in Patients With Moderate Diastolic Dysfunction and Preserved Ejection Fraction
Authors: Cho Sung Woo , Ko Kyu-Yong , Hwang Ji-Won , Kwon Sung Uk , Kwak Jae-Jin , Namgung June , Doh Joon Hyung , Kim Sung Eun , Kim Girim , Kim Dong-Gil
Published: December 2023

Introduction:
Few data exist on factors affecting the reversibility of diastolic dysfunction (DD) especially in patients with preserved left ventricular ejection fraction (LVEF).

Hypothesis:
In the present study, we investigated the predisposing risk factors affecting the reversibility of DD in patients with moderate DD and preserved LVEF.

Methods:
A total of 600 patients with moderate DD and preserved LVEF who underwent follow-up echocardiography were enrolled between 2011 and 2020. We compared their index and follow-up echocardiography findings and determined the predisposing factor affecting the reversibility of DD.

Results:
Comparing the index and follow-up echocardiography findings showed that 379 (63%) patients had improved to normal or mild DD (improved group) and 221 (37%) patients had maintained or worsened DD (unimproved group). Among the clinical risk factors, the incidence of paroxysmal atrial fibrillation (PAF) was significantly higher in the unimproved group than in the improved group (11 vs. 18, p=0.007). After adjustment for other clinical factors, PAF was determined to be an independent predisposing risk factor for the unimproved group (odds ratio, 2.76; 95% CI: 1.28-6.21, p=0.01). At follow-up echocardiography, the mean E/A ratio and E/e' were significantly improved in patients without PAF but remained in patients with PAF.

Conclusions:
We identified that PAF was an independent predisposing risk factor for the unimproved group in patients with moderate DD and preserved LVEF. Therefore, further management of PAF might be required in patients with moderate DD and preserved LVEF to prevent adverse cardiovascular events.
Abstract 14798: NAMPT Inhibition Restores Coronary Microvascular Dysfunction in Diabetes
Authors: Ramirez Francisco J , Gao Lei , Cabrera Jody , Razan Rahatullah , Yang Mingya , Garcia Joe G , Makino Ayako
Published: December 2023

Introduction:
Nicotinamide phosphoribosyltransferase (NAMPT) is a multitask peptide; extracellular NAMPT acts as a proinflammatory cytokine, and intracellular NAMPT participates in energy metabolism through NAD
+
production. Serum NAMPT level is increased in diabetic patients; however, the pathophysiological role of NAMPT in diabetic cardiovascular complications is poorly understood. This study aims to investigate the effect of NAMPT inhibition on coronary microvascular function in diabetes.

Materials and Methods:
We used two diabetic mouse models: inducible type 2 diabetic (T2D) mice generated by a single injection of low-dose STZ (75 mg/kg, i.p.) with a high-fat diet feeding, and spontaneous T2D mice, TALLYHO/JngJ. Cardiac endothelial cells (CECs) were isolated for molecular biological experiments. Coronary flow velocity reserve (CFVR) was used to determine coronary microvascular function.

Results:
T2D mice exhibited elevated NAMPT expression in CECs. There was no difference in glucose tolerance and body weight in diabetic NAMPT hetero knockout mice and FK866 (NAMPT inhibitor)-administered diabetic mice compared to their controls. However, CFVR was significantly increased by NAMPT inhibition in T2D mice, accompanied by increased capillary density and augmented endothelium-dependent relaxation (EDR). Chronic administration of neutralizing NAMPT antibody (Ab) also improved CFVR in T2D mice toward the level in control mice. RNA sequencing data in CECs revealed that NAMPT-Ab administration in T2D mice significantly restored the levels of genes related to angiogenesis. NAMPT (100 ng/ml) or NAD
+
(100 nM) treatment attenuated cell migration in control CECs and reduced EDR in control CAs. Furthermore, NAMPT or NAD
+
treatment increased mitochondrial ROS formation and decreased Gap junction activity in control CECs.

Conclusion:
Our data suggest that NAMPT inhibition increases capillary density via enhancing endothelial migration, arguments EDR through reducing mitochondrial ROS production and increasing gap junction activity, and results in restoration of coronary microvascular function in diabetic mice. Therefore, NAMPT inhibition could be a new therapeutic strategy for coronary microvascular disease in diabetes.
Abstract 14848: Interplay of Cardiovascular Risk Factors, Comorbidities, Demographics, and Social Determinants of Health on Adherence to Guideline Directed Medical Therapies in Heart Failure With Preserved Ejection Fraction: The All of Us Research Program
Authors: Do Trinh , Grace Kyrillos , Gong Yufan , Devineni Divya , Lombardo Dawn , Wong Nathan D , Lee Andy
Published: December 2023

Background:
Despite its high prevalence, HFpEF is difficult to diagnose and treat due to its complex pathophysiology. Unlike HFrEF, treatments are limited for HFpEF. A combination of SGLT2i, angiotensin receptor neprilysin inhibitor (ARNi), and mineralocorticoid antagonist (MRA) has been shown to improve cardiovascular outcomes; however, acceptance of GDMT remains an obstacle in clinical practice. We sought to investigate the relationship of social determinants of health (SDOH), demographics, comorbidities, and risk factors with prescription patterns to GDMT for HFpEF.

Methods:
The All of Us Research Program, which began in May 2018, is a diverse database that prioritizes historically marginalized populations. Demographics, risk factors, and SDOH measurements were compared with use of GDMT for HFpEF adults aged 18 years and over. Multiple logistic regression analysis was used to examine the association among demographics, comorbidities, risk factors and SDOH with use of at least two of the recommended GDMT therapies for HFpEF (SGLT2 inhibitor, angiotensin receptor/ARNi, and MRA).

Result:
The study found that 38.4% (3773) of the 9823 adults with chronic heart failure had HFpEF. 51% of those with HFpEF do not take any GDMT, 11% take 2/3 of the GDMT, and only 1% take all three. Furthermore, a multiple logistic regression analysis revealed a greater odds of being on at least 2 GDMT for HFpEF among participants with known ASCVD (1.96 [1.41, 2.78]), diabetes (2.15 [1.56, 3.01]), and BMI ≥ 35 kg/m2 (1.02 [1.01, 1.04]). In addition, female sex is also associated with increased odds of being on at least two agents (1.46 [1.08, 2.00]). The likelihood of being prescribed GDMT for HFpEF was not predicted by race, education, income, or health insurance type.

Conclusion:
Risk factors such as ASCVD, diabetes and obesity were shown to be associated with an increased rate of GDMT use, while sex differences are also present.
Abstract 14849: Impact of Intravenous Heparin Bolus on Outcomes of Leadless Pacemaker Implantation
Authors: Huang Jingwen , bhatia neal , Lloyd Michael S , Westerman Stacy , Shah Anand , Leal Miguel A , Delurgio David B , Patel Anshul , Tompkins Christine , Leon Angel R , El-Chami Mikhael F , Merchant Faisal M
Published: December 2023

Background:
During Micra leadless pacemaker (LP) implantation, continuous heparin is infused to prevent thrombus within the sheath and on the device. Early guidance from the manufacturer (Medtronic) recommended an initial systemic heparin bolus to further prevent thrombus formation. However, systemic heparin may increase the risk of implant complications. Thus, many operators have moved away from routine boluses. However, there is a paucity of data on the impact of heparin bolus on outcomes.

Methods:
We reviewed all Medtronic Micra LP implants at our institution from 9/2014 to 9/2022. The decision to bolus with heparin was at the operator discretion.

Results:
Among 621 LP implants, 326 received a heparin bolus, 243 did not, and 52 patients had unknown bolus status. In the cohort, 50.4% were men. Mean age at implant was 76.8 ± 14.9 years. Mean follow up was 1.7 ± 1.4 years. There were no significant differences in device electrical parameters (R wave sensing, impedance, and capture thresholds), right ventricular pacing burden (RVP), or left ventricular ejection fraction (LVEF) comparing heparin bolus vs. no bolus at both initial interrogation and long-term follow up (Figure). There was no difference between groups in the number of attempted device deployments per implant procedure (1.42 ± 0.81 vs 1.31 ± 0.66, p=0.15). Implant-related adverse events were also similar between bolus and no-bolus groups: access-site hematoma (5 vs 7, p=0.99), pseudoaneurysm (1 vs 1, p=0.99), cardiac perforation (1 vs 1, p=0.99), 30-day re-hospitalization (15 vs 21, p=0.98) and 30-day all-cause mortality (14 vs 16, p=0.57). There was 1 additional non-fatal cardiac perforation in a patient with unknown bolus status.

Conclusion:
Routine systemic bolus of heparin can be safely omitted in appropriately selected patients undergoing LP implant. Heparin bolus may still be considered in long cases requiring multiple device deployments or in patients with high risk for thrombotic complications.
Abstract 14855: Noninvasive Prediction of Pulmonary Capillary Wedge Pressure in Patients With Normal LV EF: Comparison of CMR With Echocardiography
Authors: Rahi Wissam , Hussain Imad , Quinones Miguel A , Shah Dipan J , Nagueh Sherif F
Published: December 2023

Background:
Cardiac magnetic resonance (CMR) was recently reported to predict mean pulmonary capillary wedge pressure (PCWP) with the best accuracy in mid-rage or reduced left ventricular (LV) ejection fraction (EF). . There is a paucity of data on the accuracy of CMR estimation of PCWP in patients with normal left ventricular (LV) ejection fraction (EF) or on how CMR compares with echocardiography in these patients.

Methods:
Stable patients with EF of ≥50%, who underwent right heart catheterization (RHC), CMR, and echocardiographic imaging within one week were included. PCWP was estimated by CMR using a previously validated equation where PCWP is estimated based on the left atrial maximum volume (LAV) and left ventricular mass (LVM) as PCWP=6.1352+ (0.07204*LAV) + (0.02256*LVM). Echocardiographic estimation of PCWP was based on 2016 ASE/EACVI guidelines taking into account the presence of myocardial disease and pulmonary vein atrial velocity.

Results:
Mean age was (54.6 ± 15.2), 58.2% females. There were 33 patients with PCWP > 15 mmHg by RHC and 46 with a normal PCWP by right heart catheterization. The table shows sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the two imaging modalities. CMR prediction of PCWP had an AUC=0.72. In comparison, echocardiographic prediction of PCWP had significantly higher accuracy (AUC=0.87 vs. AUC=0.72;
P-
value=0.008).

Conclusion:
In patients with normal LV EF, CMR estimation of mean PCWP has an acceptable accuracy for detecting patients with mean PCWP>15 mmHg. Echocardiography predicts elevated PCWP with a significantly higher sensitivity, specificity, and overall accuracy in comparison with CMR.
Abstract 14877: Spike Protein of SARS-CoV-2 Virus Induces Mitochondrial Dysfunction in Swine Heart via Redox Impairment of Heme Proteins and Increasing Superoxide Generation
Authors: Chen Yeong-Renn , Chen Chwen-lih , Kolz Chris , Kang Patrick T , Lynch William , DeLucia Angelo L , Chilian William M
Published: December 2023

The cellular entry of the SARS-CoV-2 virus depends on the binding of spike (S) protein to its biological ligand, ACE2. Although the virus commonly causes respiratory distress, cardiac injury can occur in COVID-19 patients, which is consistent with the expression of ACE2 in myocytes. Previous reports indicate SARS-CoV-2 proteins can target cardiac mitochondria and suppress mitochondrial function via enhancing MPTP pore opening and perturbing cardiac bioenergetics. To explore the underlying mechanism of the effect of SARS-CoV-2 on cardiac mitochondria, we measured the interactions of SARS-CoV-2 proteins with swine heart mitochondria in vitro. Incubation of recombinant S protein with isolated mitochondria significantly decreased state-3 oxygen consumption rate (OCR, 95.10 vs 65.68 nmol/min/mg) and FCCP uncoupling OCR (82.94 vs 66.95 nmol/min/mg). We further detected that S protein impaired the enzymatic activities of electron transport chain (ETC) (by 15.62% to 34.44%). However, S protein had no effect on TCA cycle enzymes, indicating the involvement of mitochondrial membrane components in decreased OCR by S proteins. Recombinant nucleocapsid (N) protein of SAR-CoV-2 had no effect on the OCR and ETC activities of swine mitochondria. S proteins decreased the intensity of mitochondrial heme spectrum determined by dithionite reduction with UV/VIS spectroscopy (by 17.52% heme
a
, 15.82% heme
c
1
). The results were further assessed using isolated complex III (Cx3) and complex IV (Cx4). Treatment of isolated Cx3 and Cx4 with S protein decreased the spectral intensities of heme
a

and heme
c
1
. The spectra of both Cx3 and Cx4 were not affected by N protein. The results suggested S protein downregulates redox potentials of ETC in swine mitochondria. Treatment of swine mitochondria with S proteins enhanced superoxide (

.

O
2
–
) generation by Cx1 (by 43.7%) and by Cx3 (by 10.9-fold) assessed by EPR and cytochrome
c
reduction assays. However, we detected S proteins modestly decreased

.

O
2
–
generation by swine mitochondria under state-2 condition (by 9.52%), indicating impairing pH gradient by S protein. In conclusion, the spike protein of SARS-CoV-2 virus mediates mitochondrial dysfunction of swine heart via impairing the redox function and increasing

.

O
2
–
generation.
Abstract 14880: Optimizing Percutaneous Mitral Valvuloplasty for Rheumatic Mitral Stenosis: Clinical Significance of Mitral Valve Area Changes
Authors: Ko Kyu-Yong , Cho Iksung , Hong Geu-Ru , Kim Dae-Young , lee seonhwa , CHOI KANGUN , Lee Hee Jeong , Kim Incheol , Son Jang-Won , Ha Jong-Won , Shim Chi Young Y , Gwak Seo-Yeon , Kim Kyu , Kim William D , Seo Jiwon , Ha Kyungeun , Kim Hojeong
Published: December 2023

Introduction:
Percutaneous mitral valvuloplasty (PMV) is an established treatment for severe rheumatic mitral stenosis (RMS). However, there is limited data on the clinical significance of mitral valve area change (ΔMVA) during PMV on prognosis. Hypothesis: The prognosis improves with greater post-procedure ΔMVA.

Methods:
Data from the Multicenter mitrAl STEnosis with Rheumatic etiology (MASTER) registry, which included 3,140 patients with at least moderate RMS were analyzed. Out of those, patients with severe RMS (MVA < 1.5 cm
2
) who underwent their first PMV were included for analysis. Changes in echocardiographic parameters before and after PMV were calculated, and composite outcomes including all-cause death, heart failure admission, stroke, and mitral valve re-intervention were evaluated.

Results:
A total of 295 patients were included, and during the median follow-up of 91.1 months, composite outcomes occurred in 76 patients (16.5% in optimal and ΔMVA > 0.5 cm2 group vs. 27.7% in optimal but ΔMVA ≤ 0.5 cm2 group vs. 35.7% in suboptimal group, respectively). Patients who achieved optimal results with ΔMVA > 0.5 cm
2
had a better prognosis compared to other groups. (log-rank p=0.002). The group with optimal result but ΔMVA ≤ 0.5 cm2 had a higher risk for composite outcomes compared to the group with ΔMVA > 0.5 cm2 (Hazard’s Ratio: 2.29, 95% confidence interval: 1.11-4.72, p=0.024).

Conclusions:
Achieving a significant increase in ΔMVA of at least 0.5 cm
2
can improve prognosis, and this could be recommended as an additional objective during PMV, in addition to the traditional optimal targets.
Abstract 14887: Sleep Disorders Increase the Risk for Calcific Aortic Stenosis
Authors: El Jamal Nadim , Brooks Thomas , Skarke Carsten , Fitzgerald Garret A
Published: December 2023

Introduction:
Circadian disruption has been implicated in the development of various cardiovascular diseases in several epidemiological studies. The role of molecular clocks in heart failure and vascular disease has also been extensively studied in animal and human models. However, studies assessing circadian rhythms in aortic valve disorders are lacking. We hypothesize that circadian disruption due to sleep disorders increases the risk for a diagnosis of calcific aortic stenosis (AS).

Methods:
We requested electronic health record (EHR) data from 8.8 million patients with ICD9 and ICD10 codes for sleep disorders and from 8.8 million patients without these diagnosis codes from the TriNetX Diamond network. We then ran cox proportional hazards models for the incidence of non-rheumatic aortic stenosis (ICD10 codes I35.0 and I35.2) after age 60 for patients diagnosed with sleep disorders (ICD10 G47-, ICD9 327-) before age 60 compared to patients with no sleep disorder diagnosis before age 60. We adjusted the models to include sex, BMI, and ICD codes for hypertension, hyperlipidemia, diabetes, and chronic kidney disease. We excluded patients with congenital aortic valve disorders, and patients with aortic valve procedures but no AS.

Results:
In our adjusted models, patients with any sleep disorder were at a significantly higher risk for being diagnosed with AS after age 60 (Figure). Analysing each individual sleep disorder we find that sleep apnea, hypersomnia, and narcolepsy are the main drivers for the association compared to other sleep disorders. The differences in adjusted and un-adjusted models indicate that a portion of the effect may be driven by cardiometabolic and renal risk factors.

Conclusions:
Circadian disruption due to a diagnosis of a sleep disorder increases the risk for developing AS. While some disorders are independent risk factors, in others the higher risk might be driven by the presence of known cardiometabolic and renal risk factors.
Abstract 14894: The Impact of Coronary Artery Disease on Cardiovascular Events Differs Between Men and Women in the PARTNER Trials
Authors: Daubert Melissa A , Xu Ke , Brown Kayla , Hahn Rebecca T , Pibarot Philippe , Leipsic Jonathon , Clavel Marie-Annick A , Elmariah Sammy , Weissman Neil J , Asch Federico M , Khalique Omar , Leon Martin B , Cremer Paul C , Lindman Brian R , Alu Maria , Douglas Pamela S
Published: December 2023

Introduction:
Among individuals with severe aortic stenosis (AS), there is significant heterogeneity in the burden of coronary artery disease (CAD).

Hypothesis:
We hypothesize that a greater CAD burden will be associated with increased adverse events after AS treatment.

Methods:
Patients with severe AS in the PARTNER (Placement of Aortic Transcatheter Valves) 1, 2 and 3 trials and registries were categorized by CAD burden. Clinical characteristics, imaging, treatment, and outcomes were compared between those with obstructive CAD [defined invasively as coronary stenosis ≥50%, prior myocardial infarction (MI) or revascularization] and patients with no or non-obstructive CAD (all stenoses <50% and no prior MI or revascularization). The primary endpoint was cardiovascular (CV) death or heart failure (HF) hospitalization at 2 years.

Results:
Among 8058 patients with severe AS, 2200 (27.3%) had non-obstructive or no CAD and were more likely to be female (61.2%) with fewer CAD risk factors. Left ventricular (LV) mass index and LV dimensions were smaller and LV ejection fraction was higher among those with non-obstructive or no CAD. TAVR was performed in 72.0% of non-obstructive or no CAD patients and in 81.3% of patients with obstructive CAD (p<0.0001); the remaining patients received SAVR. After adjustment for clinical, imaging, and AS treatment differences, the rate of CV death or HF hospitalization was higher among those with obstructive CAD (HR 1.16, 95% CI: 1.03-1.30, p=0.01). However, there was a significant sex-related difference in the primary outcome particularly between males and females with non-obstructive or no CAD,
p
interaction
=0.003 (Figure).

Conclusions:
Patients with a greater burden of CAD had worse clinical outcomes after treatment for severe AS. However, there was a significant interaction by sex. Further study is needed to understand the increased CV risk among females compared to males with non-obstructive or no CAD.
Abstract 149: The Effect of Lumbar Cerebrospinal Fluid Drainage on Mortality Reduction and Neuro-Prognostic Improvement in Out of Hospital Cardiac Arrest Patients Underwent Targeted Temperature Management
Authors: You Yeonho , Kang Changshin , Ahn Hong Joon , Park Jung Soo , Jeong Won-joon , Min Jinhong , In Yong Nam , Jeon So Young Y
Published: December 2023

Cerebral edema and increased ICP in post OHCA patients can be harmful due to the brain’s rigid encasement, although the increase is small. Lumbar CSF drainage (LD) may be a valuable treatment for refractory increased ICP in patients with discernible basal cisterns. Furthermore, much of the CSF volume is located in the subarachnoid spaces, which are not accessible for drainage by ventriculostomies. However, there has been no study on the effect of LD in OHCA patients. Therefore, we investigaed whether LD reduces mortality and improves neurological prognosis in OHCA patients who underwent TTM. This was a prospective single-center study conducted from July 2021 to April 2020 (CNUH IRB201907033003, NCT04328974). The target temperature of 33°C was maintained for 24 h, and LD was initiated when ICP exceeded 15 mmHg at the rate of 10 ml per hour via a LD catheter until ICP was less than 15 mmHg. We performed propensity score matching with the CAHP score variables between the group with and without LD. We used the binary logistic regression and the Cox proportional hazard regression with the NULL PLEASE score variables. After propensity score matching, 50 patients were selected in each group (Fig.1, Table 1). Serum levels of NSE and the percentage of brain tissue with ADC value < 650 X 10
-6
mm
2
/s (PV
650
) obtained 72 h after ROSC were lower in the group with LD (Table 2). The analysis revealed that LD was associated with good neurological prognosis and increased the probability of survival (Table 3, Fig. 2). The subgroup analysis, focusing on OHCA patients with moderate severity based on the rCAST score, yieded consistent results (Table 4, Fig. 2).This study demonstrated that LD significantly improved neurological prognosis and reduced mortality in OHCA patients with moderate severity.
Abstract 14907: Trends in Management Practices of Cardiovascular Implantable Electronic Device Infections in Patients With End-Stage Kidney Disease
Authors: Jiwani Sania , Chan Wan-Chi , Pothuru Suveenkrishna , Reddy Madhu , Pimentel Rhea C , gupta Kamal
Published: December 2023

Introduction:
End-stage kidney disease (ESKD) patients with cardiovascular implantable electronic devices (CIEDs) are at higher risk of bloodstream infection. While prior studies have shown high procedural success rates of lead extraction and improved outcomes, the rates of lead extraction in these patients at the national level are not known.

Aim:
To evaluate trends in management practices of CIED infections in ESKD patients.

Methods:
Utilizing the United States Renal Data System and ICD 9 codes, we identified patients aged >18 years with ESKD on hemodialysis who underwent first CIED implant from January 2006-September 2014. For study purposes we studied management strategy in those who developed CIED infection within 1 year of device implant. We excluded patients with a prosthetic valve as the ICD 9 code for CIED infection also includes prosthetic valve infection. We restricted the study population to those with CIED implanted until September 2014 as ICD 10 codes were implemented in September 2015 and the ICD 10 code is not specific code for CIED infection (it also includes vascular device infections). After identifying patients diagnosed with CIED infection, we utilized procedure codes for lead extraction within 60 days of the infection diagnosis to determine the mode of management. In the absence of procedure codes for extraction, patients were presumed to have been managed medically.

Results:
A total of 380 ESKD patients undergoing CIED implant from 2006-2014 were diagnosed with CIED infections within 1 year of device implant. Of these, 183 (48.16%) patients underwent lead extraction within 60 days. When analyzed by year, the rates of utilization of lead extraction in these patients have not changed significantly from 2006 to 2015 (Table).

Conclusions:
The utilization of lead extraction for management of CIED infections in ESKD patients remains low (~50%). This data calls for a reassessment of management strategy for device infections in ESKD patients.
Abstract 14922: Cardiovascular Genetic Testing: Insights Into Patient Demographics, Provider Characteristics, and Indications
Authors: Bui Quan M , Ding Jeffrey , Silva Jorge , Urey Marcus A , Chi Neil , Adler Eric , Hong Kimberly
Published: December 2023

Introduction:
Genetic testing offers the opportunity for early diagnosis of cardiovascular disease (CVD). Despite guideline recommendations, genetic testing is vastly underutilized in CVD.

Methods:
This single-center, retrospective study included CVD patients who underwent outpatient genetic testing, using Invitae kits, at UCSD Sulpizio Cardiovascular Center from September 2018 to February 2023. Patient demographics, provider characteristics, indications for testing, genetic testing data, and genetic counselor referrals were collected.

Results:
A total of 374 patients were included with a median age of 57 years. Patients were predominantly male (58.6%) and Caucasian (64.7%). Prevalence of genetic testing increased yearly from 2019 (n = 51) to 2022 (n = 142). The most common indication for genetic testing was cardiomyopathy (76.7%) followed by aortopathy (13.6%) and hyperlipidemia (5.3%). Heart failure (71.3%) providers were most likely to order genetic testing followed by adult congenital (14.4%) providers (Figure 1). There were 79 (21.1%) patients who had either a pathogenic (P) or likely pathogenic (LP) mutation, 166 (44.4%) patients who had a variant of uncertain significance, and 44 (55.7%) patients who had more than one gene mutation present. The most common genes implicated were those that cause cardiomyopathy, MYBC3 (n = 9) and TTR (n= 9). For patients who had either a P or LP mutation, 59.5% of them were referred to a genetic counselor and only 36.7% were actually seen by one.

Conclusion:
In this study, the prevalence of outpatient genetic testing for CVD is increasing with a significant proportion ordered by heart failure physicians for cardiomyopathy. Of the patients who tested positive, less than half received genetic counseling. These data suggest an opportunity for research focused on improving access to and patient acceptance of genetic counseling. As genetic testing becomes more prevalent, genetic counseling should increase in parallel.
Abstract 14927: Transcatheter Aortic Valve Implantation Bailout for Severe Aortic Insufficiency Due to Aortic Root Dissection Following Ascending Aortic Aneurysm Repair
Authors: Sanchez-Nadales Alejandro , iddrisu muftawu deen , Alonso Mileydis , Sarkar Abdullah , Lopez David , Asher Craig R , Hakemi Emad
Published: December 2023

Case Presentation:
75-year-old female with history of conservatively managed ascending aortic aneurysm with mild Aortic Insufficiency (AI) and a chronic Type B aortic dissection. Due to rapid aneurysmal expansion she underwent surgical ascending aortic aneurysm repair with a 32-mm Gelweave graft, aortic valve commissuroplasty, and 1-vessel aorta-to-right coronary artery bypass graft. She was discharged 15 days post-op in stable condition. However presented 2 weeks later with new onset dyspnea with minimal exertion, orthopnea, peripheral edema, wide arterial pulse pressure (150/50 mmHg), jugular venous distention. Transthoracic and transesophageal echocardiography showed a new and severe AI, with preserved left ventricular ejection fraction. A computed tomography angiogram (CTA) of the chest showed an acute aortic dissection at the proximal and distal segments of the aortic graft (Figure 1). She underwent a transcatheter aortic valve implantation (TAVI) with a self-expanding bioprosthesis: 27 mm Portico
TM
valve (St. Jude Medical, St. Paul, MN, USA) anchored at the annular level (annular area 370 mm
2
, perimeter 69 mm with calculated over sizing of 30%) and at the 32 mm Gelweave graft level (42 mm bioprosthesis aortic outflow dimension) without acute complications (Figure 2). She was discharged and remained clinically well without recent readmission for CHF exacerbation.

Conclusions:
Patient was deemed a poor surgical candidate due to frailty and recent sternotomy. This case demonstrates TAVI as off-label treatment option for severe AI due to aortic root dissection in poor surgical candidates.
Abstract 14932: Prediction of Pulmonary Embolism Using Random Forest Algorithm: A Study on 917 Patients Over a Period of 1 Year in a New York City Public Hospital
Authors: Kharawala Amrin M , Varrias Dimitrios , Nagraj Sanjana , Karamanis Dimitrios , Seo Jiyoung , Vegivinti Charan Thej Reddy , Barzallo Diego , Hernandez Romero Gabriel , Demirhan Yunus Emre , Balasubramanian Prasanth , Duarte Gustavo , Hache-Marliere Manuel , Tavares Santos Heitor , Alhuarrat Majd Al Deen , SAFIRIYU ISRAEL , Kokkinidis Damianos , Spanos Michail , Palaiodimos Leonidas
Published: December 2023

Introduction:
Pulmonary Embolism (PE) can be challenging to diagnose. Artificial intelligence (AI)-generated models can help improve the diagnostic accuracy of detecting PE.

Aim:
Establish the diagnostic accuracy of AI-generated models in predicting PE as compared to routinely used diagnostic predictive tools (Well’s score, YEARS score, and revised Geneva score).

Methods:
We conducted a single-center retrospective review of patients who underwent computed tomography pulmonary angiography (CTPA) for diagnosing PE over a one-year period. Twenty-five parameters including age, sex, race, BMI, history of deep vein thrombosis or PE, malignancy, hypertension, COPD, CKD, presenting symptoms like chest pain, dyspnea, cough, palpitations, dizziness, lightheadedness/syncope, hemoptysis, fever, pain on palpation of the lower extremity, vitals including heart rate, respiratory rate, oxygen saturation, findings of lower extremity venous duplex, presence of right ventricular dysfunction on echocardiogram, elevated troponin and pro-brain natriuretic peptide were utilized to train the AI model. Random forest algorithms were trained for predicting PE in 80% of the dataset, while the remaining 20% was used to test the AI model. Subsequently, the accuracy of the model was matched with the accuracy of four alternative modalities: clinical judgment of PE being equally or more likely, Well’s score >4, YEARS score ≥1, and revised Geneva score ≥11. CTPA results were used as the gold standard. Analysis was performed using STATA BE/17 and Python 3.8.

Results:
917 patients were included in the analysis (median age: 57 years (IQR: 41-68); female: 59%). The AI model correctly classified patients with 84.6% diagnostic accuracy, outperforming every other modality (Figure 1).

Conclusion:
AI-generated prediction models can be useful in predicting PE with considerable accuracy. Further, large-scale studies are required to validate these results externally.
Abstract 14942: Austrian Syndrome Complicated by Purulent Pericarditis
Authors: Umrani Rohan , Mason Nicholas , Amin Hiral
Published: December 2023

Introduction:
Austrian syndrome is a triad of pneumonia, endocarditis, and meningitis due to
S. pneumoniae
. First characterized by Robert Austrian in 1956, it is a rare condition with an unknown incidence since the advent of the antibiotic age and introduction of the pneumococcal vaccine.

Case Presentation:
A 69-year-old female with a history significant for alcohol abuse presented with shortness of breath, productive cough and encephalopathy. The patient was septic with concurrent NSTEMI. She was emergently intubated for hypoxia and CT chest revealed multifocal pneumonia with a pericardial effusion. Echocardiogram (TTE) demonstrated a mitral annular calcification extending into the ventricle and confirmed a small fibrinous effusion without tamponade physiology. Infectious workup revealed
S. pneumoniae
bacteremia and pneumonia and he was initiated on ceftriaxone. The patient remained encephalopathic despite antibiotic treatment. Lumbar puncture revealed
S. pneumoniae
meningitis. The patient’s mentation continued to decline. MRI brain revealed an embolic shower. Repeat echocardiogram showed worsening pericardial effusion and the patient suffered a cardiac arrest due to pericardial tamponade resolved with emergent pericardiocentesis. Pericardial fluid was noted to be serofibrinous with predominance of leukocytes albeit culture negative. Unfortunately the patient succumbed to her illness and passed.

Conclusions:
Males, alcoholics, the immunocompromised, or those with a history of heart valve surgery are at risk for Austrian Syndrome. Mortality is as high as 60%-75%. This patient was at risk due to her history of alcoholism. Her presentation is unique in that she had concurrent purulent pericarditis, which is rarely attributed to S. pneumoniae. The condition is fatal if untreated and mortality ranges from 15%-40%. Treatment entails prompt drainage and appropriate antibiotic coverage. The advent of pneumococcal vaccination has significantly reduced the incidence of
S. pneumoniae
infection. This case represents the widespread effects of this organism if left unrecognized and untreated. Clinicians should have a high index of suspicion in any patient with pneumococcal infection and underlying predisposing factors.
Abstract 14945: Left Bundle Branch Area Pacing Improves Right Ventricular Function in Heart Failure With Preserved Ejection Fraction: Evidence From PROPHET Trial
Authors: Su Yang , Zhao Dongdong
Published: December 2023

Introduction:
Left bundle branch area pacing (LBBAP) has emerged as a promising pacing strategy, especially for patients with heart failure. However, the impact of LBBAP on hemodynamics and cardiac function in heart failure with preserved ejection fraction (HFpEF) has not been investigated yet.

Hypothesis:
LBBAP could improve cardiac function of patients with HFpEF.

Methods:
This prospective cohort study enrolled patients with preserved left ventricular ejection fraction who were receiving LBBAP, and two cohorts (non-HFpEF cohort and HFpEF cohort) were built based on diagnosis of HFpEF. Hemodynamics before and after LBBAP were measured using right heart catheterization (RHC). And the changes of cardiac function were evaluated by transthoracic speckle tracking echocardiography (STE)

Results:
30 consecutive patients were included in the study, with 17 patients in the non-HFpEF group and 13 patients in the HFpEF group. Preprocedural STE showed worsened right ventricular function in the HFpEF group indicated by global longitudinal strain rate, free-wall strain rate, fractional area change, Tricuspid annular plane systolic excursion and Tei index. And RHC showed elevated right ventricular stroke work index (RVSWI, 8.6±4.1 non-HFpEF vs 15.0±5.6 HFpEF, P=0.170). While post-LBBAP evaluation showed a more significant reduction in RVSWI in the HFpEF group (6.7±2.5 (reduction 22.1%) non-HFpEF vs 8.0±1.0 (reduction 46.7%) HFpEF, P=0.043). Besides, post-LBBAP STE showed improvement of right ventricular function, despite no significant difference in the extent of improvement was found between groups.

Conclusions:
LBBAP might be more beneficial to patients with HFpEF as it could improve right ventricular function by alleviating the workload of right ventricle. Long-term benefit of LBBAP in HFpEF requires further investigation.
Abstract 14964: Unsupervised Machine Learning of Imaging-Based Sub-Phenotypes of Aortic Stenosis With Differential Risks of Conduction Disturbances After Transcatheter Aortic Valve Replacement
Authors: El Zeini Mustapha , Tran Matthew , Badarabandi Umarani , Liu Chun , Chang Andrew Y , Malik Sachin , Kang Guson , Sayed Nazish , Sallam Karim , Tsao Philip S , Wu Joseph C , Chen Ian Y
Published: December 2023

Background:
It is currently unclear whether various measurements of the aortic valvular complex routinely performed on pre-operative computed tomography angiograms (CTA) can collectively predict the risk of conduction disturbances after transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS). Here, we aimed to use unsupervised machine learning to analyze a multitude of CTA features and identify distinct patient sub-phenotypes with different risks for TAVR-related conduction disturbances.

Methods:
The pre-TAVR CTAs of 660 AS patients (330 males, 330 females) were analyzed using TeraRecon to extract 21 features that included aortic valve leaflet calcification loads, dimensions of the aortic root (annulus, sinus of Valsalva, sinotubular junction) and the ascending aorta, coronary ostial heights, and aortic angle. Agglomerative hierarchical clustering was performed separately on male and female datasets using R, with assessment of clusterability based on Hopkins statistics and agglomerative coefficient and the optimal number of clusters based on 30 previously validated indices (NbClust package). Multivariable logistic regression was conducted to assess the dependence of significant conduction disturbances (new left bundle branch block, advanced atrioventricular block) on cluster type.

Results:
Both male and female datasets were fairly clusterable (Hopkins statistics, 0.70 vs 0.68; agglomerative coefficient, 0.93 vs 0.93), with 3 and 2 as the optimal number of clusters, respectively. Of the 3 male clusters identified, the cluster with intermediate median values of aortic valve leaflet calcification loads and aortic root dimensions (M2) was associated with the greatest risk of conduction disturbances, compared to clusters with low (M1) and high (M3) median values of these variables (OR
M2/M1
=9.24,
p
=0.03; OR
M2/M3
=1.33,
p
=0.40; OR
M3/M1
=6.97,
p
=0.07). The risk of the M1 cluster was not statistically different from those of the female clusters (F1, F2; OR
M1/F1
=0.31,
p
=0.27; OR
M1/F2
=0.25,
p
=0.21), which were not different from each other (OR
F1/F2
=0.82,
p
=0.68).

Conclusion:
Machine learning of pre-TAVR CTAs can help identify subgroups of patients with similar or varying risks of TAVR-related conduction disturbances.