bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14359: A Hybrid Finite Element and Smoothed-Particle Hydrodynamics Method Can Simulate Peri-Procedural Complications of Thrombectomy
Authors: M. J. Sarayi S. Mostafa , Faghihi Danial , Waqas Muhammad , Siddiqui Adnan H , Tutino Vincent M
Published: April 2024

Introduction:
Ischemic stroke is a major cause of mortality and morbidity worldwide. Stent retriever thrombectomy (SRT) is a preeminent treatment for large vessel stroke. While effective, SRT only attains first pass success in 30% of cases, and can cause complications, like embolus formation.
In silico
modeling of SRT facilitates understanding the cause of such complications.

Hypothesis:
A combination of finite element analysis (FEA) and smoothed-particle hydrodynamics (SPH) can accurately simulate SRT.

Methods:
We developed a workflow to simulate key SRT steps including stent packaging, delivery, deployment, and clot extraction. The Solitaire X stent was reconstructed from microCT, and FEA with Timoshenko beam elements was used to simulate the superelasticity of the Nitinol wires. Inspired by their structure and components, clots were modeled with a hybrid FEA-SPH method: initially represented in FEA, but as the clot is deformed by the stent, the elements convert to SPH particles, allowing integration of the stent and clot. These methods were used to model SRT of 3 clots with increasing stiffness in a rigid, straight vessel under flow arrest. For validation, the results were compared to
in vitro
experiments matching the simulations.

Results:
Our SRT simulations were similar to in vitro tests. In 3 tests, the softest clot was retrieved, but a portion of the tissue was cleaved, creating an embolus, the moderately stiff clot was retrieved successfully, while the stiffest clot was unable to be retrieved. The stress-strain curve of the stent in moderately stiff case showed typical superelastic behavior, and the clot’s curve showed hyperelastic behavior.

Conclusions:
This study shows the capability of a hybrid FEA-SPH to model SRT and several related clinically-important complications with high accuracy. In the future, this workflow could be used to study mechanisms of peri-procedural complications, or to develop safer, more effective thrombectomy devices.
Abstract 14390: Regional Variations in Atrial Fibrillation Hospitalizations
Authors: Busari Olukayode A , Akuna Emmanuel , Fatuyi Michael , Asotibe Jennifer
Published: April 2024

Introduction:
Atrial fibrillation is a common diagnosis that affects several millions of Americans yearly. Our goal is to criticize if and why geographical location could affect the outcome of a-fib management. We hope to determine if a region holds superiority in the management and outcome of A-fib patients and to understand why. Analysis with the National Inpatient Sample divided the United States into four groups the Northwest, Mid-west, South, and West. We analyzed and compared the regions in terms of the overall outcome.

Methods:
Data obtained from the Nationwide Inpatient Sample database from 2016 and 2017. We included data on all adult patients (aged 18 and above) hospitalized with a principal diagnosis of A-fib using ICD-10 codes. The primary outcome was inpatient mortality. Secondary outcomes had total death, length of hospital stay, total hospital charges, cost of hospitalization. Multivariate regression analysis was used to adjust for patients’ sociodemographic factors, Charleston comorbidity index, and hospital characteristics as confounders.

Results:
A total of 821,629.5 hospitalizations were for Atrial fibrillation. The Northeast (NE) region had 165,695 patients, the Midwest (MW) had 198,324.9, the South had 333,849.8, and the West had 123,759.8 of the total Atrial fibrillation hospitalizations. A-fib was higher in females overall (51.06%). There was significant racial variation across regions, with the South having the highest proportion of Blacks (10.36%) while the West had the highest proportion of Hispanics (12,84%). Inpatient mortality for A-fib was 0.09%. There was no significant difference in the adjusted odds ratio for mortality across the regions. Compared to the NE, the MW and W had decreased mean LOS (-0.29, 95% CI: -0.35 - [-0.22], p=0.000 and -0.42, 95% CI: -0.51 - [-0.33], p=0.000 respectively) in days.

Conclusions:
In conclusion, although A-fib outcomes across all US regions are relatively uniform, local regional differing effects may play a role in the delivery of care to patients. For example, we noticed that the mortality rate was much more significant in the West when compared to the other three regions. This study aims to identify and explain the varying outcomes in management to decrease all round mortality in all regions.
Abstract 14452: Echocardiographic Evaluation of Donor Cardiac Structure and Function Following Reanimation Using Normothermic Regional Perfusion in Donation After Circulatory Death
Authors: Markin Nicholas W , Chacon M. M , Castleberry Anthony , Fristoe Lance , Lowes Brian D , Um John , Urban Marian
Published: April 2024

Introduction:
As heart transplantation from donation after circulatory death (DCD) continues to increase, preliminary results suggest outcomes comparable to donation after brain death. It is unknown if the obligatory period of warm ischemia experienced during DCD withdrawal process causes immediate changes in cardiac allograft function.

Methods:
We retrospectively reviewed and compared pre-donation with post reanimation echocardiographic findings in all DCD donors at our institution from Jan to March 2021. All DCD donor organs were reanimated with in-situ thoracoabdominal normothermic regional perfusion (NRP) after circulatory death. Echocardiographic assessment included: a) 2-dimensional and speckle-tracking measures of chamber size and function; b) ejection fraction (EF); c) fractional area change (FAC); and d) global longitudinal strain (GLS).

Results:
Altogether 3 DCD heart donations were performed during the study period. Basic demographics and withdrawal ischemic time periods are depicted in Table 1. There were no changes in LV EF and RV FAC when comparing the pre-donation and the post-reanimation echocardiogram. There was a minimal decrease in LV GLS and RV free-wall systolic strain in 2 of the 3 donors following reanimation (Table 2).

Conclusions:
DCD cardiac allografts reanimated with NRP demonstrated no change in echocardiographic parameters used for a standard donor heart evaluation and were successfully transplanted. Findings suggest donor cardiac function is not clinically different from the pre-donation in DCD hearts reanimated after a relatively short functional ischemic time and without need for inotropic support.
Abstract 14453: Risk of Atrial Fibrillation (AF) With Radiation Therapy Compared to Known Drugs Causing AF: Data From the FDA Adverse Event Reporting System, a Pharmacovigilance Database
Authors: Modi Malak , Thotamgari Sahith Reddy , Dominic Paari
Published: April 2024

Introduction:
Even though some studies have implicated radiation therapy (RT) as a risk factor for atrial fibrillation (AF), the association between RT and AF remains controversial.

Hypothesis:
To estimate the risk of AF associated with RT and compare it with dobutamine, flecainide, propafenone, ibrutinib and adenosine - the most common drugs causing AF.

Methods:
The US Food and Drug Administration’s Adverse Event Reporting System (FAERS) was queried for “Atrial fibrillation (AF)” secondary to “radiation therapy”, “Dobutamine”, “dobutamine hydrochloride”, “dobutamine hydrochloride in dextrose”, “flecainide”, “flecainide acetate”, “propafenone”, “propafenone hcl”, “propafenone hydrochloride”, “propafenone hydrochloride sr”, “ibrutinib” and “adenosine” and all other drugs on May 25, 2021. Disproportionality signal analysis was performed by calculating the reporting odds ratio (ROR) with its 95% confidence interval (CI). The ROR was considered significant when the lower limit of the 95% CI was >1.0.

Results:
FAERS database has a total of 22,002,078 AE reported till May 25, 2021. The ROR (95% CI) for AF due to RT versus all other drugs in FAERS was 3.9 (2.9 to 5.3) signifying disproportionately increased reporting. ROR (95%CI) for AF due to dobutamine, flecainide, propafenone, ibrutinib and adenosine was 18.2 (15.6 to 21.3), 19.0 (17.0 to 21.2), 35.9 (32.5 to 39.7), 16.6 (15.9 to 17.4) and 10.0 (7.4 to 13.6) respectively.

Conclusions:
While there is significantly higher reporting of AF with RT, this risk is lower when compared to the most common causes of drug induced AF.
Abstract 14484: Spatial Electrical Synchronization in Patients With Atrial Fibrillation and Atrial Tachycardia
Authors: Ganesan Prasanth , Deb Brototo , Rodrigo Miguel , Feng Ruibin , bhatia neal , Rogers Albert J , Krummen David , Wang Paul J , Clopton Paul L , Rappel Wouter-Jan , Narayan Sanjiv M
Published: April 2024

Introduction:
Atrial fibrillation (AF) shows regional organization in multiple studies, but it is undefined how such regions are similar to or differ from, organization characteristic of atrial tachycardia (AT, spontaneous or paced).

Hypothesis:
Spatiotemporal analysis of AF will show spatial islands in which electrograms (EGMs) show 1:1 synchronization and other characteristics, similar to but smaller in size than in AT.

Methods:
We recruited N=70 patients (age 64±10yrs, 72%male) in group (I) N=10 patients with AT, (II) N=30 patients with AF that terminated by ablation, and (III) N=30 AF patients without termination. All patients had 64-pole unipolar recordings (basket catheter) during AF. We quantified spatial organization by correlating electrogram shape and timing in simultaneous overlapping electrode grids throughout the atria, indicating 1:1 synchronization over time (Fig A-D, red boxes). We related results to acute success of ablation (at organized sites, then pulmonary vein isolation).

Results:
Organized electrogram islands were seen in all patient groups. REACT values globally showed a spectrum from groups (I) to (III) (0.82±0.02, 0.60±0.10, 0.44±0.22 p=0.034, ANOVA). Fig B-D illustrate organized islands (B) in entire atrium in AT; (C) near site of AF termination by ablation; (D) near a site that did not terminate AF. There was no difference in organization value for AT globally (group I) and near the site of termination in AF patients (group II) (0.82±0.02 vs 0.78±0.04, p=NS).

Conclusions:
Spatial atrial synchronization is present across a spectrum of atrial arrhythmias, and is higher for AF patients with acutely successful ablation versus those without. Mechanistically, organization was similar at AF termination sites and to patients with atrial tachycardia.
Abstract 6901: Effect of a Virtual Patient Simulation at Improving VTE Prevention Strategies in Acutely Ill Medical Patients
Authors: Harris Margaret , Spyropoulos Jelena , Lacouture Michael , Blevins, MD Doug , Capparelli Catherine , Zec Bonomo, MBA, CHCP Mahira
Published: April 2024

Introduction:
Despite evidence and guidelines for VTE prophylaxis in the hospital setting, cardiologists are challenged to implement the latest evidence-based strategies to prevent VTE in clinical care. We sought to determine if an online, virtual patient simulation (VPS)-based continuing medical education intervention could improve performance of cardiologists related to individualized strategies to prevent VTE in these patients.

Methods:
The intervention comprised two patients presenting in a VPS platform that allows learners to order lab tests, make diagnoses, and prescribe treatments in a manner matching the scope and depth of actual practice. Tailored clinical guidance (CG), based on current evidence and expert recommendation, was provided following each decision, followed by the opportunity for the learner to modify their decisions. Decisions were collected post-CG and compared with each user’s baseline (pre-CG) decisions using a McNemar’s test to determine
P
values. Data were collected from March 27, 2020 through June 10, 2020.

Results:
Significant absolute improvements were observed after CG for the following: Case 1 (n= 123) • Diagnose high risk for VTE:44% improvement (15% pre-CG vs 59% post-CG; P<.001) • Order/Initiate o Rivaroxaban: 46% improvement (13% pre-CG vs 59% post-CG; P<.001) o Enoxaparin: 13% improvement (7% pre-CG vs 20% post-CG; P<.001) o Post-discharge VTE assessment risk and counseling: 22% improvement (50% pre-CG vs 72% post-CG; P<.001) o Patient education: 20% improvement (50% pre-CG vs 70% post-CG; P<.001) o Follow-up visits: 20% improvement (48% pre-CG vs 68% post-CG; P<.001) Case 2 (n= 80) • Order/Initiate o Rivaroxaban: 28% improvement (35% pre-CG vs 63% post-CG; P<.001) o Enoxaparin: 10% improvement (4% pre-CG vs 14% post-CG; P<.05) o Post-discharge VTE assessment risk and counseling: 12% improvement (63% pre-CG vs 75% post-CG; P<.01) o Patient education: 11% improvement (60% pre-CG vs 71% post-CG; P<.01) o Follow-up visits: 11% improvement (63% pre-CG vs 74% post-CG; P<.01)

Conclusions:
VPS that immerses specialists in an authentic, patient-based, practical learning environment can significantly improve evidence-based clinical decision making for the prevention of VTE in acutely ill medical patients.
Abstract 6931: Epigenetic Modification of the Von Willebrand Factor Promotor Drives
in situ
Thrombosis in Chronic Thromboembolic Pulmonary Hypertension
Authors: Manz Xue D , Szulcek Robert , Pan Xiaoke , Symersky Petr , Dickhoff Chris , Majolée Jisca , Kremer Veerle , Michielon Elisabetta , Jordanova Ekatarina S , Radonic Teodora , Bijnsdorp Irene V , Piersma Sander R , Pham Thang V , Jimenez Connie , De Man Frances S , Boon Reinier A , Voorberg Jan , Hordijk Peter L , Aman Jurjan , Bogaard Harm
Published: April 2024

Background:
Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by thromboembolic obstructions of the pulmonary circulation; disease progression may involve
in situ
thrombosis. CTEPH patients have elevated Von Willebrand Factor (VWF) plasma levels and we hypothesized that endothelial secretion of VWF in CTEPH recruits platelets to the pulmonary vascular wall, thereby driving
in situ
thrombosis.

Methods:
CTEPH specific primary pulmonary artery endothelial cells (PAEC) were isolated from pulmonary endarterectomy material and control PAECs from patients undergoing lobectomy. Endothelial-platelet interaction was studied by an human
in vitro
model of thrombosis. We used an antibody and knockdown mediated approach to inhibit VWF and validate its functional relevance. Cell culture findings were validated in human tissue with immunofluorescence
in situ
hybridization, and proteomics and chromatin immunoprecipitation were used to investigate the underlying mechanism of CTEPH.

Results:
CTEPH-PAEC showed increased platelet adhesion compared to control. This was mediated by a 5-fold enhanced VWF gene expression, resulting in higher release of VWF protein upon endothelial activation. The increase in VWF mRNA was confirmed in human pulmonary artery tissue and was associated with elevated Nuclear Factor κB 2 (NFκB2) protein expression. Epigenetic histone modifications of reduced histone tri-methylation (H3K27Me3) and increased histone acetylation (H3K27Ac) of the VWF promotor in CTEPH-PAEC, support NFκB2 binding that drives VWF transcription. Knockdown of NFκB2 normalized VWF RNA expression levels and reversed the pro-thrombotic phenotype observed in CTEPH-PAEC.

Conclusions:
We show experimental evidence of VWF-mediated
in situ
thrombosis in CTEPH. Epigenetic modifications of the VWF promotor in CTEPH-PAEC, enhances NFκB2 binding and subsequently VWF transcription and platelet adhesion. We demonstrate a direct molecular link between inflammatory pathways and thrombosis in the pulmonary vascular wall that emphasizes the central role of
in situ
thrombosis in CTEPH.
Abstract 6985: Real-World Incidence and Factors That Contributes to the Development of Acute Kidney Injury in Patients Receiving Impella for Hemodynamic Support in a Community Based Health Care System
Authors: Kalyan Sundaram Arvind , Voyce Stephen J , Crissinger Samantha , Vanenkevort Erin , Kandadai Srilakshmi
Published: April 2024

Introduction:
Impella is a peripherally inserted ventricular assist device used for providing hemodynamic support in patients with cardiogenic shock and/or high risk percutaneous coronary interventions (PCI). The aim of the study was to examine the incidence and factors that can impact acute kidney injury (AKI) in a real world, community-based patient population.

Methods:
A retrospective observational study was conducted on patients with an Impella placed between January 2015- March 2020 at three hospitals within the Geisinger Health Care System.

Results:
Of the ninety-nine patients identified, 58 patients (58.3%) developed AKI. In those who had Impella placed electively (n=15), 3 patients (20%) developed AKI. In the urgent group (n=35), 9 patients (25.8%) developed AKI. In the emergent group (n=28), 12 patients (42.9%) developed AKI and in the salvage group (n=20), 8 patients (40%) had AKI. The acuity of the procedure did not significantly impact the subsequent development of AKI (p = 0.38). Chronic kidney (CKD) was present in 35 patients (35.4%) in the group and 15 (42.9%) developed AKI. In the 64 patients without CKD, 17 patients (26.6%) had AKI. The difference among the two group was not significant (p = .097). Patients with higher BMI had a lower likelihood of developing AKI compared to the lower BMI patients (p = .001). Patients with a longer duration of Impella implantation had a lower incidence of AKI (p = .001).

Conclusions:
AKI is a common complication associated with Impella placement, but its development does not appear to be related to the acuity of the procedure. 2. In the current study, the presence of CKD was not a risk factor for developing AKI. 3. Patient with higher BMI and longer duration of Impella had lower likelihood to develop AKI.
Abstract 6994: Impact of Urine Osmolality at Discharge on Prognosis in Heart Failure Patients
Authors: FUJITA MOTOHIRO , Kikuchi Noriko ,   Atsushi Suzuki, Shiga Tsuyoshi , Suzuki Tsuyoshi , Hagiwara Nobuhisa
Published: April 2024

Introduction:
Urine osmolality (U-OSM) is determined by the balance of water and solutes, antidiuretic hormone, and renal function. U-OSM can be altered in heart failure (HF) patients, and is influenced by multiple factors, including volume status, diuretics, and so on. However, it is not known whether U-OSM is a predictive factor of prognosis among symptomatic HF patients.

Hypothesis:
The aim of the study is to clarify the impact of U-OSM at discharge according to baseline renal dysfunction on prognosis among symptomatic HF patients.

Methods:
This study is a sub-analysis from HIJ-HF-III, which is a single center registry that collected prospectively consecutive 1,408 HF patients hospitalized at Tokyo Women’s Medical University from 2015 to 2019. 745 HF patients who were discharged alive and had available data of U-OSM at discharge were included in this study. The primary endpoint is all cause death after discharge.

Results:
Mean age was 69 +/- 14.8 years old, 60.1 % of the patients were male. 36.3 % of the patients had renal dysfunction. Median U-OSM at discharge was 465 mOsm/l. During the median follow-up period of 20.1 months after discharge, 108 (14.5 %) patients were died. Kaplan-Meier survival analysis showed that low U-OSM at discharge was associated with high mortality among HF patients with renal dysfunction (p=0.049). On the other hand, there was not associated between U-OSM and mortality after discharge among HF patients without renal dysfunction (p=0.944). Multivariate logistic regression showed that low U-OSM at discharge was independently associated with increased the risk of death (hazard ratio [per 1 mOSM/l]: 1003, 95%CI 1.000-1.005, p=0.041) among HF patients with renal dysfunction.

Conclusion:
Among HF patients with renal dysfunction, low U-OSM at discharge was significantly associated with poor outcome after discharge.
Abstract 8858: Reduced Left Ventricular Ejection Fraction is Associated with Higher Long-Term Mortality in Patients with Electrical Storm
Authors: Incognito Cameron , Parker Joshua , Hedley Jeffrey , Menon Venu , Wazni Oussama M , Rickard John , Tang Wai Hong
Published: April 2024

Introduction:
Little is known about the relationship between LV ejection fraction (EF) and mortality in contemporary patients with electrical storm (ES).

Objective:
EF at the time of admission for ES was organized into subgroups: EF ≤ 22% (A), 23-32% (B), 33-42% (C), 43-52% (D), and >52% (E). EF subgroups were compared to determine differences in 1-year all-cause mortality. Secondary outcomes included cardiogenic shock (CS), multiorgan system failure, acute tubular necrosis (ATN), and cardiac arrest. We hypothesize that patients with reduced EF will have poorer short-term prognosis and more in-hospital complications.

Methods:
Single center, retrospective study including consecutive patients admitted to the coronary ICU with ES between April 2014 - 2020. ES was defined as ≥ 3 isolated sustained ventricular arrhythmias or ICD therapies within 24 hours.

Results:
Of 214 patients admitted with ES, 203 had an echocardiogram on admission. 70 (34.5%) were group A, 58 (28.6%) group B, 36 (17.7%) group C, 23 (11.3%) group D, and 16 (7.9%) group E. The mean EF was 30 +/- 13% (Figure 1). The mean age was 64 +/- 13 years, 83.3% male. 1-year all-cause mortality between subgroups was significant by Kaplan-Meier survival estimate and Mantel-Cox log rank (χ
2
11.2; p 0.023; Figure 2). By Cox Regression using Group E as a reference, only Group A had a statistically significant difference in 1-year all-cause mortality (HR A/E 3.71 [95% CI 1.14 - 12.07]; p 0.029). Analysis of in-hospital complications showed a difference only in cardiogenic shock (p < 0.0001) with higher incidence in those with lower EF (Figure 3).

Conclusions:
In patients with ES, LVEF is significantly associated with all-cause 1-year mortality. Those with significantly impaired LVEF (≤ 22%) had higher 1-year all-cause mortality compared to those with preserved EF (> 52%).
Abstract 8872: Comparative Effectiveness of Dosing of Medical Therapy for Heart Failure: From the CHAMP-HF Registry
Authors: Greene Stephen J , Butler Javed , Hellkamp Anne , Spertus John , Vaduganathan Muthiah , Devore Adam D , Albert Nancy M , Patterson J Herbert , Thomas Laine E , Williams Fredonia , Hernandez Adrian F , Fonarow Gregg C
Published: April 2024

Introduction:
The comparative effectiveness of differing doses of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) on clinical and patient-reported outcomes in US clinical practice is unknown.

Methods:
This analysis included 4,832 US outpatients with chronic HFrEF in the CHAMP-HF registry with available medication data and no contraindications at baseline. Baseline dosing of ACE inhibitor (ACEI)/ angiotensin II receptor blocker (ARB)/ angiotensin receptor-neprilysin inhibitor (ARNI), beta-blocker, and mineralocorticoid receptor antagonist (MRA) therapies were examined. Multivariable models assessed associations between medication dosing and clinical outcomes over 24 months (all-cause mortality, HF hospitalization) and patient-reported outcomes at 12 months (change in Kansas City Cardiomyopathy Questionnaire Overall Summary Score [KCCQ-OS]).

Results:
After adjustment, compared with target dosing, lower dosing was independently associated with higher all-cause mortality for ACEI/ARB/ARNI (overall p<0.001) and beta-blocker therapies (overall p=0.042)
(Table)
. Lower dosing of ACEI/ARB/ARNI was independently associated with higher risk of HF hospitalization (overall p=0.046), but beta-blocker dosing was not. Target dosing of MRA was not associated with risk of mortality or HF hospitalization. For each GDMT, compared with target dosing, lower dosing was not associated with change in KCCQ-OS at 12 months, with potential exception of worsening KCCQ-OS with lower dosing of ACEI/ARB/ARNI.

Conclusions:
In this contemporary US outpatient HFrEF registry, target dosing of ACEI/ARB/ARNI and beta-blocker was associated with reduced mortality, and variably associated with other outcomes. MRA dosing was not associated with outcomes. Unmeasured differences between patients receiving differing dosages may explain differences between results seen here compared with randomized trials.
Abstract 9008: Echocardiographic Markers in Early Postnatal Life to Predict Intervention in Coarctation of Aorta
Authors: Wutthigate Punnanee , Simoneau Jessica , Renaud Claudia , Altit Gabriel
Published: April 2024

Background:
Coarctation of the aorta (CoA) is challenging to diagnose in the early neonatal life due to the patent ductus arteriosus (PDA). We aimed to describe the resource utilization, early post-natal cardiac profile and predictors for need of cardiac surgery.

Methods:
Retrospective study of infants with an antenatal suspicion of CoA, without major associated cardiac anomalies, born at ≥37 weeks during 2014 to 2020. The analyzed echocardiography (ECHO) was performed within 48 hours after birth. Those not requiring post-natal intervention (normal group) were compared to those that required post-natal cardiac surgery (CoA). Strain was measured using speckle-tracking ECHO (STE).

Results:
A total of 51 newborns were included, of which 40 (78%) were normal and 11 (22%) underwent intervention. In the normal group, median hospitalization was 4 [2-6] days, 6 (15%) were exposed to prostaglandin E (PGE) infusion, 38 (95%) were on intravenous fluids, 9 (23%) required gavage and age at full feeds was 3 days (IQR: 2-5). Ductus was patent in all newborns and aortic arch measurements were significantly smaller in the CoA (ascending [p=0.01], proximal, distal, isthmus [
p
<0.001]). Right ventricular (RV) predominance was higher in the CoA group, as demonstrated by the left ventricular (LV) end-systolic eccentricity index (EI) (1.60 [0.28]
vs
2.16 [0.45];
p
<0.001) and by a larger end-diastolic area (EDA) of the RV in apical 4 chamber (A4C) relative to the LV-EDA - with a ratio of 1.02 [0.2]
vs
1.56 [0.23];
p
<0.001. Isthmus and EI were predictive for intervention (OR 26, 95%CI (-42 to -9);
p
=0.002, OR 4.5, 95%CI (1.5-7.5);
p
=0.003). A RV to LV EDA ratio in A4C greater than 1.3 demonstrated a high probability for intervention (AUC = 0.97). CoA newborns had a lower RV deformation by STE (peak systolic strain rate (SR); -0.98 [0.17]
vs
-0.83 [0.2];
p
=0.02, early diastolic SR; 1.05 [0.2]
vs
0.85 [0.26];
p
=0.01).

Conclusions:
Most infants with antenatal suspicion of CoA did not require intervention but were high consumers of resources. Despite PDA patency, isthmus and RV predominance on first post-natal ECHO were predictors for surgery. The novel markers of strain by STE and ventricular EDA ratio in A4C may help predicting those with true CoA requiring intervention.
Abstract 9023: Post-Operative Ectopic Atrial Tachycardia in Congenital Heart Disease
Authors: Uniat Jonathan , Hill Allison , James Mark , Shwayder Mark , Silka Michael J , Bar-cohen Yaniv
Published: April 2024

Introduction:
Ectopic atrial tachycardia (EAT) is relatively common in infants following surgery for congenital heart disease (CHD). There is limited data regarding this arrhythmia.

Hypothesis:
Operative factors, including CHD diagnosis, can identify risk factors for post-operative EAT.

Methods:
This was a retrospective analysis of patients undergoing CHD surgery in the first year of life between January 2007 and July 2020. Patients and surgeries with EAT were compared to those without EAT.

Results:
Out of 5,792 infant CHD surgeries, 129 (2.2%) developed postoperative EAT. The onset of EAT occurred at a median of 9 days (IQR 5-14 days) after CHD surgery. Compared to controls, the EAT cohort was younger (median 7 vs 85 days, p <0.01) and had lower weight (3.3 vs 4.3 kg, p <0.01) with no gender difference. EAT occurred following 24/265 (9%) total anomalous pulmonary venous connection (TAPVC) repairs (relative risk of 4.7, p<0.001), 22/351 (6%) arterial switch operations (RR 3.2, p<0.001), 6/90 (7%) interrupted arch repair (RR 3.1, p=0.004), and 23/460 (5%) Norwood operations (RR 2.5, p<0.001). EAT patients had longer cardiopulmonary bypass (median 64 vs 58 min, p=0.008) and deep hypothermic circulatory arrest times (15 vs 0 min, p<0.001) but no statistically significant difference in cross clamp times (25 vs 31 min). Antiarrhythmics were given to 109 patients (84%), but treated patients were more likely to be identified for study inclusion potentially biasing this percent-treated value. Propranolol (60%), amiodarone (22%), and flecainide (4%) were the most frequently used antiarrhythmics during hospitalization. On discharge, 60% of EAT patients were on antiarrhythmics, most commonly propranolol (55%), amiodarone (4%), and flecainide (4%). Although 15 patients did not survive to hospital discharge, EAT was not directly implicated in any deaths.

Conclusions:
In this study of a large cohort of postoperative EAT patients, the arrhythmia occurred in 2.2% of cases with a median onset of 9 days after surgery. TAPVC repair carried the highest risk of postoperative EAT, followed by arterial switch, interrupted aortic arch repair, and Norwood operations. Patients with EAT were younger, smaller, and had longer bypass and circulatory arrest times than controls.
Abstract 9033: Effectiveness of a Virtual Patient Simulation at Improving Management of Complex Patients with Arterial Disease
Authors: Harris Margaret , Spyropoulos Jelena , Lacouture Michael , Armagan Allison , Capparelli Catherine , Bonomo Mahira
Published: April 2024

Introduction:
Despite evidence and guidelines for management of patients with arterial disease, including CAD and PAD, patients remain at high risk for adverse cardiac events. Cardiologists are challenged to implement the latest evidence-based strategies to reduce risk for adverse cardiovascular events in these patients. We sought to determine if an online, virtual patient simulation (VPS)-based continuing medical education intervention could improve performance of cardiologists related to implementation of effective antithrombotic strategies to improvement management of patients with CAD and PAD.

Methods:
The intervention comprised two patients presenting in a VPS platform that allows learners to order lab tests, make diagnoses, and prescribe treatments in a manner matching the scope and depth of actual practice. Tailored clinical guidance (CG), based on current evidence and expert recommendation, was provided following each decision, followed by the opportunity for the learner to modify their decisions. Decisions were collected post-CG and compared with each user’s baseline (pre-CG) decisions using a McNemar’s test to determine
P
values. Data were collected July 30-November 10, 2020.

Results:
Significant absolute improvements were observed after CG for the following: Case 1 (n= 152) Order/Initiate: Screening for high-risk categorization using modified REACH score: 15% improvement (24% pre-CG vs 39% post-CG; P<.001); Evaluate for bleeding risk: 20% improvement (25% pre-CG vs 46% post-CG; P<.001); Rivaroxaban: 55% improvement (0% pre-CG vs 55% post-CG; P<.001); Continue aspirin: 1% improvement (86% pre-CG vs 87% post-CG, P=ns); Follow-up visits: 14% improvement (41% pre-CG vs 55% post-CG; P<.001) Case 2 (n= 113) Order/Initiate: ABI: 44% improvement (1% pre-CG vs 45% post-CG; P<.001); Rivaroxaban: 55% improvement (0% pre-CG vs 55% post-CG; P<.001); Continue aspirin: 7% improvement (81% pre-CG vs 88% post-CG, P<.05); Follow-up visits: 17% improvement (50% pre-CG vs 67% post-CG; P<.001)

Conclusions:
VPS that immerses and engages specialists in an authentic, patient-based, practical learning environment can significantly improve evidence-based clinical decision making for the management of complex arterial disease.
Abstract 9064: The Increase of Tissue Echogenicity as the Pre-State of Steam Pops During Radiofrequency Catheter Ablation
Authors: Satoshi Takahashi , Mine Takanao , Yoshikawa Fumitsugu , Takai Kenji , Takada Masanori , Fujita Koichi , Nishibori Yoshiharu , Maruyama Takao
Published: April 2024

Introduction:
Steam pops (SPs) during radiofrequency catheter ablation (RFA) using force sensing catheters are infrequent but represent a potential severe complication such as embolic stroke, cardiac perforation. SPs remains unpredictable, and unclear in detailed phenomenon.

Methods:
In an ex vivo, we set the bovine myocardium to 36 °C in a constant temperature bath and performed an experiment in a water tank that generated a non-pulsatile flow. RFA using irrigation catheter was applied at catheter-tissue contact force (CF) 5, 10, 20g, 30g, 40g, and 50g for 30sec. The increase of tissue echogenicity (increased echo brightness) observed by intracardiac echocardiographic images using ViewFlex™ Xtra and impedance during RFA were evaluated with and without SPs.

Results:
SPs phenomenon appeared in 48 out of 137 sites (35%), and the increased echo brightness during RFA was observed in 89 lesions (65%). All lesions with SPs showed increased echo brightness before SPs (6.4±6.1sec before SPs). Sites with SPs showed stronger CF (30.8±14.8g vs. 22.9±15.9g, p=0.0047), higher initial impedance (78±12Ω vs. 73±9Ω, p=0.0063), greater impedance drops in 5 seconds after the beginning of RFA (13±7Ω, vs. 6±5Ω, p<0.0001), and earlier appearance of increased echo brightness (9.7±6.2 vs 17.4±6.3 sec, p<0.0001). Among 89 lesions with increased echo brightness, sites with SPs showed greater impedance drops in 5 seconds after the beginning of RFA (13±7Ω, vs. 7±6Ω, P<0.0001). In ROC curve analysis of the impedance drops in 5 seconds after the beginning of RFA (AUC, 0.81; sensitivity, 85%; specificity, 71%), optimal cut-off value of SPs was 7.6Ω, and SPs were not observed in lesions with the impedance drops of 3Ω or less. (Figure)

Conclusions:
The increase of tissue echogenicity observed by ICE images show the pre-state of all steam pops during RFA. Steam pops could be avoided by checking the impedance drop at the initial stage of RFA under ICE monitoring.
Abstract 9073: Profiling of Metabolic Remodeling in Rat Model of Pressure Overload Induced Early Systolic Dysfunction and in Progression to Overt Systolic Heart Failure
Authors: Chaanine Antoine H , Delafontaine Patrice , Busija David W
Published: April 2024

Introduction:
We have previously shown left ventricular (LV) structural and hemodynamic differences in two models of rat pressure overload induced moderate remodeling and early systolic dysfunction (MOD) and overt systolic heart failure (SHF). The MOD and SHF phenotypes develop 8 weeks post ascending aortic banding via a vascular clip, area of 2 mm
2
and 1.5 mm
2
, respectively.

Hypothesis:
Metabolic remodeling play significant role in the development of MOD and SHF phenotypes, but is more evident in SHF than MOD.

Methods:
Shotgun proteomics and phospho-(p)-proteomics and non-targeted metabolomics analysis was performed in LV myocardium tissue from Sham, MOD and SHF using liquid chromatography mass spectrometry (LC-MS); n=3 biological samples per group. Raw proteomics, p-proteomics and metabolomics MS data were uploaded into Qlucore bioinformatics software for statistical analysis and data visualization. Statistically analyzed data were then uploaded into Ingenuity Pathway Analysis bioinformatics software for data validation and assessment of highly enriched canonical pathways related to metabolism that were up or down-regulated in MOD and SHF relative to Sham. Some of the proteomics and p-proteomics data were validated by immunoblotting.

Results:
Canonical pathways of oxidative phosphorylation, fatty acid β-oxidation, Kreb’s cycle, branched-chain amino acid and amino acid (Glutamine and Tryptophan) degradation were downregulated in MOD vs Sham and were further downregulated in SHF vs MOD. Whilst glycogen degradation and glucose degradation were upregulated in MOD and SHF vs Sham, but more so in MOD than SHF. Metabolomics data revealed that long chain and very long chain acyl-carnitines were decreased in abundance in MOD and SHF relative to Sham, while short and medium chain acyl-carnitines were decreased in abundance in SHF only. Moreover, Isoleucine degradation and glycolysis decreased and Taurine biosynthesis increased in SHF vs MOD. p-Proteomics data showed mild decrease in protein kinase A (PKA) and AMPK signaling in MOD vs Sham, which were more profoundly decreased in SHF than MOD.

Conclusion:
The interplay between PKA and AMPK signaling play an important role in metabolic remodeling and transitioning from MOD to SHF phenotype.
Abstract 9084: Selective Beta3-Adrenergic Receptor Antagonist Therapy Causes Regression of Cardiac Dysfunction in a Rat Model of Progressive Heart Failure: Insights into Molecular and Cellular Mechanisms
Authors: Sun Xiaoqiang , Cheng Che Ping , Cao Jing , Chen Zhe , Zhang Zhi , Li Tiankai , Zhang Xiaowei , Herrington David M , Zhao David , Cheng Heng
Published: April 2024

Background:
Heart failure (CHF) causes cardiac β
3
-adrenergic receptor (AR) upregulation with resultant enhanced β
3
-AR-stimulated-G
i
-coupled negative modulation on cardiac function. This suggests a direct and contributing role of β
3
-AR activation on CHF progression. However, its precise role is unclear. We hypothesize that up-regulation of cardiac β
3
-AR promotes CHF progression. Chronic β
3
-AR antagonist (ANT) may improve Left ventricular (LV) myocyte function, and β-adrenergic reserve, thus preventing the progression of CHF.

Methods:
LV and myocyte functional response and β
1
- and β
3
-AR expression were compared in 3 groups of SD male rats (8 each) during 3 months: 1) CHF, 3 months after receiving Isoproterenol (ISO, 170 mg/kg, sq, for 2 days); 2) CHF/β
3
-ANT, 2 months after receiving ISO, L-748,337, a selective β
3
-AR antagonist (β
3
-ANT) (10
-7
M/kg/day, mini pump) was initiated and was given for 1 month; and 3) sham controls.

Results:
Versus controls, ISO-treated rats had CHF onset at 1 month after ISO and progressed to severe CHF at 3 months. Plasma norepinephrine (NE, 1298 vs 261 pg/ml) increased 4-fold; whereas, stroke volume (SV) and ejection fraction (EF, 34 vs 62%) decreased more than 45%. These changes were parallel with significant reductions in cell contraction (dL/dt
max
, 95 vs 189 μm/s), relaxation (dR/dt
max
,75 vs 158 μm/s) and [Ca
2+
]
i
transient ([Ca
2+
]
iT
) (0.17 vs 0.26). Acute superfusion of ISO (10
-8
M) caused much less increases in dL/dt
max
(34 vs 74%), dR/dt
max
and [Ca
2+
]
IT
(14 vs 28%). These changes were associated with significantly decreased β
1
-AR mRNA (52%, 0.30 vs 0.62), but increased β
3
-AR mRNA (119%, 1.25 vs 0.57) expression. CHF with β
3
-ANT treatment, significantly decreased plasma NE (197 pg/ml). EF (59%) and SV returned to normal control values. The signal ratios of β
1
-AR mRNA (0.59) and β
3
-AR mRNA (0.66) recovered to control levels. ISO-induced increases in dL/dt
max
(75%), dR/dt
max
and [Ca
2+
]
iT
were also significantly augmented.

Conclusion:
Chronic β
3
-ANT leads to normalization of LV myocyte β
1
- and β
3
-AR gene expression, restores normal LV myocyte β-AR reserve, and leads to regression of LV and myocyte dysfunction in a rat model of progressive CHF. Thus, β
3
-AR blocker may provide a new therapeutic strategy for the treatment of CHF.
Abstract 9098: The Relationship Between Linoleic Acid (LA) and Dihomo-Gamma-Linolenic Acid (DGLA) as Indicator of Delta-6-Desaturase Activity
Authors: Nilsen Dennis W , Myhre Peder L , Kalstad Are Annesoenn , Schmidt Erik Berg , Arnesen Harald , Seljeflot Ingebjorg
Published: April 2024

Introduction:
Low levels of dihomo-gamma-linolenic acid (DGLA) have been shown to predict total death in patients hospitalized with an acute coronary syndrome. DGLA is converted from gamma-linolenic acid (GLA) by the enzyme elongase, following a slower and rate-limiting conversion from linoleic acid (LA) to GLA by the action of delta-6-desaturase. This would suggest that DGLA levels are (strongly) associated with delta-6-desaturase activity. Furthermore, a high ratio of LA to DGLA (LA:DGLA) has been claimed to reflect reduced delta-6-desaturase activity.

Hypothesis/Aim:
To evaluate the relationship between LA:DGLA ratio and DGLA levels in patients with a recent myocardial infarction (MI).

Methods:
Baseline samples from the OMEMI (Omega-3 Fatty acids in Elderly with Myocardial Infarction) trial* in which a total of 1027 patients, aged 70 to 82 years, were included 2-8 weeks after an MI, were obtained. The total fatty acid profile was determined in serum phospholipids and relative concentrations (wt%) of LA, GLA and the LA:DGLA ratio (used as a surrogate for delta-6-desaturase activity) were evaluated across quartiles of concentrations of DGLA.

Results:
Levels of GLA were low compared to other n-6 fatty acids and followed the same trend as DGLA, consistent with a rapid turnover from GLA (Table 1). Furthermore, there was a steady decrease in the LA:DGLA ratio across the quartiles of DGLA, with approximately 50% lower levels in the highest compared to the lowest quartile of DGLA.

Conclusion:
We found a strong inverse relationship between DGLA and the LA:DGLA ratio in patients with a recent MI, indicating that the LA:DGLA ratio may serve as a measure of delta-6-desaturase activity. * Circulation 2021; 143(6): 528-39.
Abstract 9169: A Non-Invasive Virtual Heart Approach Predicts Reentrant Ventricular Arrythmia (VA) Circuits in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): A Proof-of-Concept Study
Authors: Zhang Yingnan , Prakosa Adityo , Pandey Pallavi , Zimmerman Stefan L , Tandri Harikrishna , James Cynthia A , Tichnell Crystal , Murray Brittney , Calkins Hugh , Trayanova Natalia
Published: April 2024

Introduction:
ARVC is a leading inherited cause of VA in young adults. Progressive and extensive structural and electrical remodeling in the right ventricle (RV) serves as a complex substrate for reentrant VA circuits in ARVC. Non-invasive prediction of ARVC reentrant VA circuits could provide a thorough pre-ablation evaluation of the arrhythmogenic substrate and identify specific region(s) to target during the ablation procedure. Here we developed a non-invasive personalized virtual heart approach that accurately predicts reentrant VA circuits in ARVC patients.

Methods:
As a proof-of-concept retrospective study, we constructed 3D computational models of ARVC patients’ hearts from LGE-CMR scans with observed RV hyperenhancements representing arrhythmogenic substrates (Fig A). 3 patients were included in this study: patient 1 (P1) had clinical VA and inducibility in electrophysiologic study (EPS); patient 2 (P2) had negative EPS despite previous evidence of VA; patient 3 had no VA. We generated a computational model for each heart incorporating personalized diffuse and dense (scar) fibrosis distribution. ARVC-specific ionic and conduction properties were represented in different regions. The VA inducibility of each model was assessed by rapid pacing from 9 RV sites.

Results:
For all cases, model outcomes correlated with clinical observations. In P1 model, VA was induced from the inferior basal region, as observed in EPS. Reentrant wavefronts occurred endocardially near the patient’s scar region, matching the EPS (Fig C1). Clinical ablation at this location terminated VA. In P2, VA was induced by pacing from the inferior lateral wall, a pacing location not part of the EPS protocol; reentry occurred on the basal lateral wall (Fig C2), a common location for VA circuits in ARVC. No VA was induced in P3.

Conclusions:
The novel ARVC virtual heart approach accurately predicts reentrant VA circuits and can potentially become a tool in assisting ablation in ARVC patients.
Abstract 9343: Dietary Fat Intake and the Risk of Stroke: Results from Two Prospective Cohort Studies
Authors: Wang Fenglei , Baden Megu Y , Rexrode Kathryn M , Hu Frank B
Published: April 2024

Background:
The association between specific types of fat intake and the risk of stroke remains inconclusive. Prospective data examining the relation of fat from different food sources to stroke risk are sparse. We aimed to investigate the association between total fat, various types of fat, and fat from different sources and the risk of stroke.

Methods:
We followed 73,867 women (Nurses’ Health Study, 1984-2016) and 43,269 men (Health Professionals Follow-up Study, 1986-2016) free of cardiovascular disease and cancer at baseline. Dietary fat intake was collected by food-frequency questionnaires and categorized by sources and types. Cox proportional hazards models were used to assess the association between fat intake and stroke risk.

Results:
During 3,168,151 person-years of follow-up, we documented 6,189 incident stroke events (including 2,967 ischemic and 814 hemorrhagic). A high intake of vegetable fat (HR comparing extreme quintiles=0.88; 95% CI: 0.81, 0.96; P-trend<0.001) or polyunsaturated fat (HR=0.88; 95% CI: 0.80, 0.96; P-trend=0.002) was associated with lower total stroke risk, whereas high non-dairy animal fat was associated with an increased risk (HR=1.16; 95% CI: 1.05, 1.29; P-trend<0.001). We observed similar associations for the ischemic stroke, but only the positive association of non-dairy animal fat was observed for the hemorrhagic stroke. For food groups contributing to fat intake, vegetable oil (HR per 1 serving/day=0.91; 95% CI: 0.84, 0.98) was associated with lower total stroke risk, while total red meat (HR=1.08; 95% CI: 1.02, 1.13) and processed red meat (HR=1.12; 95% CI: 1.03, 1.23) were associated with a higher risk. The association for vegetable oil was attenuated after adjusting for vegetable fat or polyunsaturated fat, while adjusting for non-dairy animal fat rendered total red meat and processed red meat nonsignificant.

Conclusions:
A higher intake of vegetable fat, polyunsaturated fat, and vegetable oil was associated with a reduced risk of stroke, but a high intake of non-dairy animal fat, total red meat, and processed red meat was associated with increased stroke risk. These findings indicate the importance of considering the fat sources when examining the association between fat and stroke.
Abstract 9367: Predictors of Renal Function Improvement After Left Ventricular Assist Device Implantation in Moderate to Severe Chronic Kidney Disease
Authors: Saiani Rayhan , Unlu Ozan , Sepulveda Alemany Hector , Pabon Maria , Goyal Parag , Sobol Irina , Krishnan Udhay , Horn Evelyn M , Srivatana Vesh , Saal Stuart , Liu Frank , Karas Maria G
Published: April 2024

Introduction:
Renal dysfunction remains a relative contraindication to left ventricular assist device (LVAD) implantation due to postoperative morbidity and mortality in advanced stages of chronic kidney disease (CKD). However, correlates of early improvement and long-term durability of renal function have not been well elucidated in this population.

Methods:
We evaluated 113 consecutive patients who underwent LVAD implantation in our center from 2008 - 2019. Patients with pre-LVAD glomerular filtration rate (GFR) < 60 mL/min (defined as the highest GFR reported within 30 days prior to implantation) were included. Demographic, clinical, echocardiographic, and hemodynamic data were collected during the index admission and up to two years after implantation.

Results:
Seventy-two patients met inclusion criteria (mean age 61 ± 12 years, male 88%, white 39%, nonischemic cardiomyopathy 60%, hypertension 61%, diabetes 47%, destination therapy 72%, HeartMate [HM] II 76%, HM3 24%). Forty-three patients (60%) had an increase and 26 (36%) had a >25% improvement in GFR 3 months after implantation. The absence of proteinuria, defined as >150 mg/day per a spot urine protein:creatinine ratio, was associated with >25% improvement in GFR 3 months postoperatively (OR 3.85, 95% CI 1.24- 12.0, p = 0.02). No history of coronary artery disease, higher pre-implant albumin and hemoglobin levels, and shorter intra-operative bypass times were also associated with >25% improvement in renal function at 3 months (all p <0.05). Average GFR improved one month after LVAD implantation and remained stably improved for up to two years in patients with moderate to severe CKD (Figure).

Conclusion:
Early improvement in renal function appears to be durable for at least two years after LVAD implantation in patients with moderate to severe CKD. The absence of proteinuria, potentially reflecting a lack of intrinsic renal disease, may predict early improvement in renal function after LVAD implantation.