bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13274: The Safety of Early Discharge After Tavi in Northern and Rural Ontario Canada
Authors: Hanna George , MacDonald Derek , Bittira Bindu , Horlick Eric , Ali Noman , Atoui Rony , Fam Neil , Shurrab Mohammed , Spadafore Joanne , Allen Julie , Cheema Asim , Nalla Bhanu , Pulkkinen Carly , Cote Sylvain , Hennessey Hooman , Stringer Melissa , Collin Joanne , Fenton John , Lauck Sandra , Sathananthan Janarthanan , WOOD DAVID , Al-Nasser Sami
Published: June 2023

Introduction:
Early hospital (<48hrs) discharge following transcatheter aortic valve implantation (TAVI) is an increasingly adopted practice. However, the safety of such an approach among patients residing in rural areas in Northern Ontario, including remote and medically underserved areas is lacking.

Methods:
After adapting the Vancouver 3M clinical pathway, all patients who underwent TAVI in Sudbury, Ontario were included in the analysis. The primary endpoint was all-cause mortality within 30 days. Secondary endpoints included procedural complications, post-TAVI length of hospital stay (LOS) and 30-day re-hospitalizations.

Results:
165 patients underwent TAVI after adapting the Vancouver 3M clinical pathway. Mean age was 81 years (SD ± 8). Median STS-mortality score was 2.5% (IQR, 1.9-3.5). There was one in-hospital death (0.6%) with no 30 day mortality observed beyond hospital discharge. 11 patients (6.7%) required rehospitalization within 30 days, 3 of them for cardiac complaints. More over, after adoption of the 3M clinical pathway, the need for procedural mechanical ventilation and surgical vascular cut-down declined from 100% and 97% at baseline, to 6% and 2% respectively. Similarly, after adapting the 3M clinical pathway, the number of patients receiving TAVI on a given procedural day increased from two to three patients. Median post TAVI-LOS declined from 5 days (2-6 days) to 1 day (1-3 days).

Conclusions:
By transitioning to a 3M approach, our study has shown that early discharge after TAVI in Northern Ontario at a single lower-volume TAVI centre is feasible and safe, with favorable outcomes and improved hospital LOS. Furthermore, resource utilization improved with fewer patients requiring mechanical ventilation and surgical cut-down, leading to a downstream increase in the number of patients receiving TAVI on a given procedural day. This experience can potentially improve TAVI equity for underserved and vulnerable populations, reduce TAVI wait times and bridge variations in TAVI funding.
Abstract 13279: Effects of SBT-255 on Myocardial Infarct Size and No Reflow in a Rat Myocardial Ischemia/Reperfusion Model
Authors: Dai Wangde , Brown David A , Kloner Robert A
Published: June 2023

Background:
We determined whether mitochondrial protective agents, elamipretide and SBT-255, could limit myocardial infarct (MI) size and the no reflow phenomenon in a standardized rat model.

Methods and Results:
Anesthetized rats were randomized into 3 groups (n = 15 in each group): (1) Saline control group; (2) Bolus dose of elamipretide (1 mg/kg body weight); (3) Bolus dose of SBT-255 (1 mg/kg body weight). The treatment was administered at 10 minutes after coronary artery occlusion. The coronary occlusion was maintained for 30 minutes followed by 3 hours of reperfusion. MI size (triphenyl tetrazolium chloride staining technique), expressed as a percentage of the ischemic risk zone (blue dye technique) was significantly lower in the SBT-255 treated group at 30.2 ± 5.0% versus 53.1 ± 4.0% in the saline group and 48.1 ± 5.1% in the elamipretide group (p=0.001). Area of no-reflow (thioflavin S technique) as a percentage of the risk zone was significantly smaller in the SBT-255 treated group (22.2 ± 5.4%) compared to the saline (38.0 ± 3.4%) and elamipretide groups (36.4 ± 5.0%; p=0.024). The Figure demonstrates the association between myocardial ischemic risk area and infarct size (panel A) as well as no-reflow size (panel B) among the 3 groups. The regression lines in both infarct size and no-reflow size shift downward in SBT-255 group compared to the saline and elamipretide group, indicating that, for the same size of risk area, the infarct size and no-reflow were smaller in the SBT-255 group than the other groups.

Conclusions:
SBT-255 treatment significantly reduced infarct size and no-reflow size compared to either saline or elamipretide treatment in an acute rat myocardial ischemia/reperfusion model.
Abstract 13319: Cryoaballoon Ablation in Patients With Atrial Fibrillation and Heart Failure - Insights From Ongoing POLAR-HF Trial
Authors: Boehmer Andreas A , Rothe Moritz , Nussbaum Elena , Soether Christina M , Zezyk Celine , Dobre Bianca C , Kaess Bernhard M , Ehrlich Joachim R
Published: June 2023

Background

Atrial Fibrillation (AF) and heart failure (HF) often co-exist and increase cardiovascular mortality. Radiofrequency ablation is safe and effective in patients with AF and HF. There is evidence for a reduction in mortality in treated patients (CASTLE, NEJM 2019), and the European Society of Cardiology recommends catheter ablation (class 1A), particularly in patients with tachycardiomyopathy. However, there is no large-scale prospective study evaluating efficacy and safety of cryoballoon pulmonary vein isolation (cryoPVI) in patients with AF and HF.

Objective

Prospective comparison of cryoPVI in patients with and without HF (defined as LVEF ≤ 40%) regarding efficacy and safety.

Methods
POLAR-HF trial is an investigator-initiated, single-center, prospective, non-inferiority, interventional study. Follow-up was performed at 3, 6 and 12, 18 and 24 months after ablation. Endpoints were: symptomatic AF recurrence for efficacy and bleeding, stroke or death for safety. Periprocedural parameters were observed.

Results:
We analyzed 668 consecutive patients who underwent cryoPVI. Of these 581 had normal LVEF (age 69±10 years, CHA2DS2-VASc Score 2.7±1.5, 54% male) while 87 patients (13%) suffered from HF (age 70±10 years, CHA2DS2-VASc Score 3.3±1.4, 70% male). After 24 months primary efficacy endpoint occurrence was similar in normal LVEF and HF group (34.1 % vs. 35.6%, P=0.66, Figure). Safety endpoint occurred in form of pericardial effusion or transient phrenic nerve injury in six patients with normal LVEF (1.2%) and none in HF group. No deaths or strokes were observed in either group.

Conclusion

The interim results of the POLAR-HF study suggest that cryoPVI is a safe and effective ablation method for patients with atrial fibrillation and heart failure.
Abstract 13350: Accelerating the Diagnosis of Familial Hypercholesterolemia: A Mixed Methods Analysis of Physician-Patient Communication Needs
Authors: Cheung Brian , Block Robert , Wong Nathan D , Eapen Danny J , Sperling Laurence , McIntosh Scott
Published: June 2023

Introduction:
Familial hypercholesterolemia (FH) is a common genetic disorder, but fewer than 10% are appropriately diagnosed. Use of electronic health records (EHRs) can potentially improve diagnosis and treatment.

Hypothesis

Systemwide strategies using the EHR can identify patients who may have FH with the goal of improving communication and preventive treatment.

Methods:
Our analysis included patients identified as having possible FH utilizing an LDL-C ≥190 mg/dL screen in the EHR. Patients were followed for 6 months, and lipid levels were measured at baseline, 6 weeks, 4 months, and 6 months. Changes in lipid levels were analyzed using paired sample t-tests for normalized data or Wilcoxon Rank Sum Test for skewed data. Our previously reported qualitative data were collected from 5 focus groups, 34 semi-structured key informant interviews, and open-ended survey items from patients and primary care clinicians before and after EHR messages about FH were sent.

Results:
In 12 patients, the LDL-C (25.3 ± 39.4 mg/dL, 18.7 ± 29.1%; p = 0.029) and total cholesterol/HDL-C (3.8 ± 1.0, 3.2 ± 0.9; p = 0.040) decreased at 4 months after lipid lower therapy initiation. In our previous work, which provides context to these findings, key themes identified were that patients trusted FH resources from the EHR and sought outside resources to educate themselves and their family, empower themselves, and improve their health. Yet, patients did not feel empowered due to the perceived lack of educational resources. Patients concluded that the physician-patient relationship via an EHR facilitates sustainable behavioral changes and treatment adherence. They also found that using the EHR to communicate with clinicians and to get laboratory results was helpful.

Conclusion

Leveraging the EHR to identify patients with FH can lead to better lipid management. Patients and clinicians can identify methods to improve diagnostic processes and communication channels in the EHR.
Abstract 13352: Differential Response of Healthy Endocardial Cells versus Endocardial Fibroelastosis-Derived Cells to Flow Alterations and Statins
Authors: Silva-Gomez Natalia , Diaz-Gil Daniel , Winkler Aimee , Emani Sitaram , Piekarski Breanna L , Del Nido Pedro J , Friehs Ingeborg
Published: June 2023

Introduction:
Endocardial Fibroelastosis (EFE) is a subendocardial thickening of organized collagen and elastin layers restricting the ventricle. It has been linked to flow disturbances in congenital heart defects. Endothelial-to-mesenchymal transition (EndMT) has been identified as the underlying mechanism for EFE and also plays a central role in other diseases such as atherosclerosis where statins (e. g. atorvastatin) have been successfully used as EndMT-inhibitors. This study sought to establish a causal relationship between flow and EndMT, and to determine the protective effects of atorvastatin.

Methods:
Healthy endocardial endothelial cells (EECs) and EFE-derived EECs were exposed to either flow stagnation (≤5dynes/cm
2
) with and without atorvastatin (0.5μmol/l) or physiological flow (~10dynes/cm
2
) using a flow pump system (ibidi). Active EndMT (double staining with αSMA and CD31/VE-Cadherin) and collagen production was determined by immunohistochemical staining.

Results:
In healthy EECs (n=4), flow stagnation induced EndMT and collagen production which was significantly ameliorated by physiological flow (n=3, p<0.001, Fig. 1A+C). In contrast, physiological flow resulted in an increase in collagen production by 89% (n=8, p<0.001, Fig. 1D) in EFE-derived EECs. Under flow stagnation, atorvastatin inhibited EndMT (reduction by 39%, p<0.001, Fig. 1A) and collagen production in healthy EECs (reduction by 9%, p<0.001, Fig. 1C). This effect was blunted in EFE-derived EECs regarding EndMT reduction (17%, p<0.001, Fig. 1B), with no effect on collagen.

Conclusion:
Physiological flow and atorvastatin protect healthy EECs from EndMT but only the latter is beneficial for EFE-derived EECs. Thus, statins potentially offer a preventative treatment for EFE patients with flow stagnation. This study revealed a profound difference in the response to flow of healthy and EFE-derived EECs, indicating an intrinsic predisposition to EndMT in these patients.
Abstract 13360: Impact of Goal Setting in a Digital Health Coaching Program for Participants With Type 2 Diabetes
Authors: Moore Jasmine , Patel Dhiren , Tran Vanessia , Burton B Stephen
Published: June 2023

Introduction:
Cardiovascular disease remains one of the most common causes of death in people with diabetes. We retrospectively explored how a digital health coaching (DHC) program with goal-driven engagement for individuals with type 2 diabetes mellitus (T2DM) influenced outcomes at 3 months.

Methods:
This retrospective analysis included de-identified results from overweight/obese individuals who participated in a 3-month DHC program tailored for people with diabetes, whose main goal was medication adherence. Participants were referred through employer programs, payor programs, or physicians. Changes in biometric variables and diabetes-related quality of life were assessed at 3 months.

Results:
Over one year (January 1, 2021, to December 31, 2021), 182 participants engaged and completed the DHC program. Participants were predominantly women (79%), with an average age of 50, and racially/ethnically diverse (51% white, 49% non-white). Of this cohort, 24% lived in rural areas, and 44 participants had low medication adherence scores at baseline. At 3 months, there were significant decreases in diabetes distress score (27.14% reduction in diabetes distress; 2.91 to 2.12, p<0.001) and HbA1c (6.44% improvement; 7.61 to 7.12, p-0.0017). In addition, members with low medication adherence scores had a larger improvement than all members, with the main cohort improving the medication adherence score by 5.4% (10.34 to 10.90, p=0.058) and the low medication adherence group improving by 18.07% (7.55 to 8.91, p=0.007). Members with low medication adherence scores at baseline had significantly larger improvement than all other members, with 12.67% more improvement than members overall.

Conclusions:
Participants in the program showed improved outcomes for HbA1c and diabetes-related quality of life measures at 3 months. Engaging patients in DHC can help improve outcomes in populations at-risk of low adherence.
Abstract 13363: Incidence, Management, and Outcomes of Pediatric Pulmonary Embolism in the United States:
An Observational Study Using Data From the Pediatric Health Information Systems Database
Authors: Rastogi Radhika , Okunowo Oluwatimilehin , Faerber Jennifer , Mavroudis Constantine D , Giglia Therese M , Witmer Char , Raffini Leslie , O'Byrne Michael
Published: June 2023

Introduction:
Pulmonary embolism (PE) is a rare but potentially severe disease. Strategies for treatment in adults are evolving to increasingly include local thrombolysis and thrombectomy, in addition to mainstay treatment of anticoagulation (AC). Neither the incidence of pediatric PE nor contemporary evidence on treatment have been well studied, so this study addresses these knowledge gaps by describing PE patients and their treatment outcomes.

Methods:
A retrospective multicenter cohort study was performed using patients ≤18 years with PE at US hospitals contributing data to the Pediatric Health Information Systems Database from 1/1/2015-9/1/2021. This study 1) described the clinical characteristics of PE patients, 2) examined trends in treatment strategies, and 3) used multivariable models to examine the relationship between treatment and outcomes (in-hospital mortality, length of stay (LOS), and adjusted costs of hospitalization).

Results:
In total, 3148 unique patients with PE were studied (54% female, median age 15 years). Most patients (63%) had at least one comorbid condition, the most common being congenital heart disease (25%). Most patients received anticoagulation only (88%), 7% underwent systemic thrombolysis, and 5% underwent local thrombolysis and/or thrombectomy. In-hospital mortality was 7.5%, with 62% of patients requiring ICU admission, and 7.4% receiving extracorporeal membrane oxygenation. Median (IQR) LOS was 10 days (21) and median cost was $54,026 (145,231). Use of thrombectomy and thrombolysis did not increase over time (p=0.98). In multivariable analysis, receipt of local thrombolysis and/or thrombectomy was associated with lower mortality (adjusted OR: 0.54, p=0.03). Systemic thrombolysis (β=1.73, p<0.001) and local thrombolysis and/or thrombectomy (β=1.35, p=0.003) were associated with higher costs than AC alone, without significant associations between treatment and LOS.

Conclusion:
Pediatric PE is associated with high mortality and healthcare utilization, reflecting the medical complexity of the patients. Rates of local thrombolysis and thrombectomy remain low, and further study is required to elucidate which patients may benefit from such procedural management.
Abstract 13371: Beneficial Effects of Growth Hormone Releasing Hormone Agonist in a Murine Model of Cardiometabolic Heart Failure With Preserved Ejection Fraction
Authors: Kanashiro-Takeuchi Rosemeire M , Takeuchi Lauro M , Dulce Raul A , Kazmierczak Katarzyna , Balkan Wayne , Cai Renzhi , Schally Andrew , Hare Joshua M
Published: June 2023

Introduction:
Heart failure (HF) with preserved ejection fraction (HFpEF) represents a major unmet medical need due to its complex pathophysiology and lack of effective therapies. We previously showed that growth hormone-releasing hormone (GHRH)-agonists improve the phenotype of models of HF with reduced EF (HFrEF) and cardiorenal models of HFpEF.

Hypothesis:
We tested the hypothesis that the GHRH-agonist, MR-356 mitigates/reverses the cardio-metabolic HFpEF phenotype.

Methods:
C57BL6N mice received a high-fat diet (HFD) plus the nitric oxide synthase inhibitor (L-NAME) for 9 weeks. After 5 weeks of the HFD+L-NAME diet, animals were randomized to receive daily injections of MR-356 or placebo for 4-weeks. Control animals received no HFD+L-NAME or agonist treatment. Cardiac performance was assessed by echocardiography and hemodynamic measurements. Blood pressure, glucose tolerance, and exercise capacity, as well as cardiac hypertrophy, fibrosis, capillary density, and lung congestion were evaluated.

Results:
After 5 weeks of HFD+L-NAME diet, the placebo group showed impaired diastolic function (increased E/E’ratio, EDPVR, end-diastolic pressure), glucose intolerance and reduced global longitudinal strain and exercise capacity (p<0.05). MR-356 treatment improved all of these parameters (p<0.05). Cardiac hypertrophy, fibrosis, and capillary rarefaction in the placebo group (p<0.05) were completely restored by MR-356 (p<0.05). The increased expression of cardiac pro-BNP, and inducible nitric oxide synthase (iNOS) in the placebo group (p<0.05) was brought to normal levels by MR-356 (p<0.05). Hypophosphorylation of the titin isoforms in the placebo group (p<0.05) was attenuated in the MR-356 group.

Conclusions:
Our data show the unique potential of MR-356 to treat several HFpEF-like features including diastolic dysfunction, cardiac hypertrophy, fibrosis, and exercise intolerance, suggesting that MR-356 reduces myocardial stress associated with metabolic inflammation in HFpEF. Thus, GHRH-agonists may be an effective therapeutic strategy for the treatment of the cardiometabolic HFpEF phenotype.
Abstract 13385: Long Term Outcomes in Catheter Ablation of Atrial Fibrillation Compared to Medical Therapy
Authors: Kim Yong Giun , Islam Sunjidatul , Dover Doug , Deyell Marc , Hawkins Nathaniel , Sandhu Roopinder , Sapp Jon , Andrade Jason , Kaul Padma , Parkash Ratika
Published: June 2023

Introduction:
The long-term effects of catheter ablation (CA) compared to medical therapy on cardiovascular outcomes for atrial fibrillation (AF) remain undetermined. We examined the outcomes associated with CA compared to rate or rhythm control therapy in a population cohort with AF.

Methods:
Using Alberta administrative data, patients with AF as the primary diagnosis during hospitalization or emergency department/physician visit were included between 2008-2018. Based on therapy received, patients were assigned to CA, rate (digoxin, calcium channel or beta blocker) or rhythm control (amiodarone, sotalol, flecainide, propafenone, dronedarone). If treatment changed over time, the patient was censored in the prior treatment arm and assigned to the new arm. The association of treatment (included as time-varying covariate) with the primary composite outcome of death, hospitalization for heart failure or stroke was examined using multivariable Cox models after adjusting for age, sex, comorbidities and baseline medications. Secondary outcomes included cardiovascular hospitalizations, and individual components of the composite.

Results:
There were 2,149 (4.0%) patients treated with CA and 51,315 with medical treatment (rate : 41,948, (81.5%) rhythm: 9,367 (18.2%). During a median follow-up of 4.2 years, CA for AF was associated with a lower crude incidence of the composite outcome (rate per 100 person-years was 3.3 for CA, 9.5 for rate control, and 6.3 for rhythm control). In multivariate analysis, compared to CA, both rate (adjusted hazard ratio (aHR) 1.55, 95% confidence interval (CI), 1.44 to 1.68) and rhythm control (aHR 1.37; 95% CI 1.27 to 1.49) were associated with a higher risk of the primary composite outcome.(Figure) Secondary outcomes are shown in the Figure.

Conclusions:
Only a small percentage of patients with AF undergo CA. Patients selected for CA have a lower risk of long-term adverse outcomes compared to medical therapy in patients with AF.
Abstract 13408: Vaping Realities: Views From Youth
Authors: walker kandi L , McLeish Alison C , Agbonlahor Osayande , Tomlinson Madeline M , Wood Lindsey A , Vincent Kolbie , Kerstiens Savanna , Clarke Julianna , Garfinkle Plymesser Eowyn , hart joy L
Published: June 2023

Introduction:

Youth e-cigarette use is a pressing public health issue. To better understand the landscape of youth e-cigarette use, we engaged middle and high schoolers (N=37) in a photovoice project and focus group interviews.

Methods:
Members of the VAPERACE Center’s Youth Advisory Council documented experiences with vaping through photographs from October 2021-April 2022. A question was posted each month (e.g. Where do you see vaping?), and participants recorded responses through photographs and then discussed these with the group, focusing on how the photographs conveyed the reality of vaping in their lives. They also participated in focus groups with open-ended questions designed to spur conversation about direct experiences with vaping and their related perceptions, attitudes, and beliefs. Using the constant comparative method, participant responses were analyzed for key themes.

Results:
Overwhelmingly, the photographs and focus group responses indicate that these youth have considerable exposure to vaping. Their photos documented that vaping pervades many aspects of their lives (e.g. in cars and school bathrooms, at parties and sporting events). Comments such as, “It’s everywhere. Everywhere you go. Everywhere you look.” underscore the degree to which youth confront vaping. Additionally, participants said that promotion of vape products was common, from the stores they entered to their social media feeds, and agreed on the power of social media influencers, which were paid more attention than PSAs. Because one “can’t hide from vapes,” one needs strategies to resist use, and these youth emphasized that “exit strategies” and face-saving approaches (e.g. “Thanks, but I’ve got a tennis match.”) worked better than strong, direct messages (e.g. ”No!”). They also expressed concerns about health effects, including CVD, and negative environmental impacts from trash produced by disposable e-cigarettes.

Conclusions:
The photovoice and focus groups revealed considerable exposure to vaping. Because these youth perceive that exposure cannot be avoided, they emphasized strategies to decline use. Thus, health advocates should consider strengthening educational programming to assist youth in honing refusal skills, especially indirect ones.
Abstract 13412: Updated Meta-Analysis on Safety and Efficacy of Cerebral Embolic Protection Devices Among Patients Undergoing Transcatheter Aortic Valve Replacement
Authors: Shrestha Dhan B , Shtembari Jurgen , Lamichhane Sandesh , Baniya Abinash , Shahi Manoj , Sutton Nadia R , Villablanca Pedro A
Published: June 2023

Introduction:
Cerebral embolic protection devices (CEP) have been introduced to capture embolic debris and reduce the risk of stroke during Transcatheter Aortic Valve Replacement (TAVR). Available evidence regarding the safety and efficacy of CEP is inconclusive. Therefore, we aimed to determine the safety and efficacy of CEP use during TAVR.

Methods:
Major electronic databases were searched for the relevant articles with appropriate search terms. All relevant data from 17 studies were extracted into a standardized form. Statistical analyses were performed using Revman 5.4. Odds Ratio (OR) or mean differences (MD) were used to estimate the desired outcome with a 95% confidence interval (CI).

Results:
A total of 17 studies involving 204,875 patients (15,880 in the CEP arm and 188,995 in the non-CEP arm) were included. No significant difference in 30-day stroke was observed with the use of CEP between the two groups (OR 0.75, 95% CI 0.55 to 1.03). The use of CEP was associated with a lower odds of 30-day mortality by 39% (OR 0.61, 95% CI 0.53 to 0.70). Based on diffusion weighted-magnetic resonance imaging (DW-MRI), there were no differences in the occurrence of new lesions, the total volume of lesions, and the number of new lesions. In addition, the use of CEP in patients undergoing TAVR was associated with a reduction in major or life-threatening bleeding events (OR 0.89, 95% CI 0.81 to 0.98). No differences were observed in the outcomes of acute kidney injury and major vascular complications between both arms.

Conclusion:
No significant difference in 30-day stroke was observed with the use of CEP in TAVR patients. The use of CEP was associated with significantly lower odds of 30-day mortality and lower rates of major or life-threatening bleeding compared with no CEP in patients undergoing TAVR. Further studies are needed to confirm current findings
Abstract 13416: Evaluation of Risk Factors for Pacemaker After Tavr Among Patients With a Pre-Existing Right Bundle Branch Block
Authors: Vitter Sophie , Black George , Kim Joshua , Lisko John , Gleason Patrick T , Grubb Kendra J , Greenbaum Adam , Devireddy Chandan , GUYTON Robert A , Leshnower Bradley G , Merchant Faisal M , El-Chami Mikhael F , Westerman Stacy , Shah Anand , Leon Angel R , Lloyd Michael S , Babaliaros Vasilis , Kiani Soroosh
Published: June 2023

Background
:

Pacemaker implantation (PMI) remains a common complication after TAVR. While a pre-existing right bundle branch block (RBBB) is consistently the strongest reported risk factor for PMI, most patients with a RBBB will not require PMI after TAVR.

Objective
:

To identify factors associated with a higher risk of PMI after TAVR among patients with pre-existing RBBB.

Methods
:

We identified all patients at a single institution undergoing first-time TAVR with a balloon-expandable prosthesis without a pre-existing pacemaker or ICD, and pre-existing RBBB (defined as RBBB morphology with QRS >=110ms) from December 2013 to December 2020 (n=219). We evaluated the univariate association for numerous clinical, EKG, imaging, and procedural characteristics with PMI. We included all factors with p=<0.10 in a logistic regression model to assess for independent associations with PMI in the original cohort and 1000 bootstrapped samples.

Results
:

A history of syncope, body mass index, calcium channel blocker use, baseline PR interval, and prosthesis oversizing >16% were associated with PMI on univariate analysis. When included in a logistic regression model, syncope (OR 3.2, 95%CI: 1.1-8.8, p=0.027) and oversizing (OR 3.1, 95% CI: 1.4-6.8, p=0.005) remained independently associated with PMI. These findings were consistent in the bootstrapped samples. Those with both factors (n=4) had a PMI rate of 75% which was higher compared to those with one or neither (43% and 22%, respectively; p<0.001).

Conclusion
:

Among those with pre-existing RBBB, a history of syncope and prosthesis oversizing >16% were independently associated with a higher risk of PMI. These findings warrant external validation.
Abstract 13426: Efficacy and Safety of Hypothermia as Adjuvant Therapy for Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis
Authors: Mir Ali , Rahman Mohammed , Ragab Khaled , Elsayed Sarah , Fathallah Ahmed H , Hagrass Abdulrahman , Kamal Ibrahim , Bahuva Ronak , Farooq Waseem , Khan Hassan
Published: June 2023

Objective:
Randomized control trials (RCT) conducted on myocardial infarction (MI) patients regarding the efficacy of therapeutic hypothermia (TH) as an adjunct to percutaneous coronary intervention (PCI) have shown inconsistent results. This study aims to compare the use of TH in patients with MI undergoing PCI with control groups.

Methods:
We systematically searched four databases; PubMed, Scopus, Web of Science, and Cochrane for studies conducted until March 2022. The inclusion criteria were any study design that compared TH in patients with MI undergoing PCI with a control group. Infarct size percentage and recurrent MI were primary efficacy outcomes. Mortality, major adverse cardiovascular events (MACE), and overall bleeding complications were primary safety outcomes. The risk of bias assessment of the included RCTs was conducted through Cochrane tool, while the quality of the included cohort studies was assessed by the NIH tool. The meta-analysis was performed on RevMan.

Results:
A total of 19 studies were included; 15 RCTs, one case-control, and three cohort studies. Infarct size percentage was significantly reduced in TH group as compared to control (MD= -1.76, 95% CI [-3.04, -0.47), p=0.007), but the TH group had a higher incidence of bleeding complications (OR= 1.88, 95% CI [1.11, 3.18), p=0.02). There were no significant differences between TH and control groups in mortality (OR= 1.06, 95% CI [0.75, 1.50), p=0.73) or recurrent MI (OR= 1.21, 95% CI [0.64, 2.30), p=0.56).

Conclusion:
In patients with MI, TH reduces infarct size while increasing bleeding complications. Mortality and recurrent MI outcomes are not significantly reduced.
Abstract 13448: Time Course and Predictors of Renal Function Decline After Pediatric Heart Transplantation: A PHTS Multi-Institutional Analysis
Authors: Varma Manu R , Richmond Marc E , Koehl Devin A , Aljohani Othman A , Exil Vernat J , Morrison Adam K , Sheybani Aryaz , White Shelby , Cantor Ryan S , Kirklin James K , Eghtesady Pirooz
Published: June 2023

Introduction:
Decline in renal function can impact both the management and outcomes of pediatric heart transplantation (HTx). Initial renal function decline may be subclinical and underappreciated. We sought to identify the time course and predictors of decline in renal function and the impact of these changes on HTx outcomes.

Methods:
The Pediatric Heart Transplant Society (PHTS) database was queried to identify HTx recipients at participating centers from 1996 to 2019 with at least 1 year of follow-up. Patients with simultaneous or previous kidney transplant were excluded. Renal function was measured by modified Schwartz formula eGFR on annual follow-up forms and stratified into eGFR groups by National Kidney Foundation chronic kidney disease staging guidelines. “Initial renal function decline” was defined as the initial drop by at least one eGFR group relative to stage at 1 year post transplant (“baseline”).

Results:
Of the 5,250 patients who met inclusion criteria, initial renal function decline occurred, relative to baseline, in 7.4%, 18.7%, and 55.7%, by 1, 5, and 10 years of follow up, respectively (Figure A). eGFR group distribution for the cohort progressively worsened over the follow up period (Figure B). On multivariate Cox modeling, risk factors for renal function decline were increased BSA at 1 year post-transplant (HR 1.24 [1.02, 1.52]), acute rejection with hemodynamic compromise (HR 1.24 [1.10, 1.39]), and Black race (HR 1.21 [1.08, 1.36]) with the use of tacrolimus (vs cyclosporine) being protective (HR 0.77 [0.69, 0.85]). Patients whose eGFR was < 30 mL/min at 1 year follow up had an increased risk of graft loss (P < 0.0001 compared to all other groups).

Conclusions:
Decline in renal function occurs progressively, affecting over 50% of HTx recipients in long term follow up, independent of renal condition at the time of HTx. Avoidance of potentially nephrotoxic events and medications must be considered at all times in the long term management of pediatric HTx.
Abstract 13465: Digital Health and Multifaceted Interventions to Help Manage Cardiovascular Patients in a Resource-Constrained Area in Brazil Before and During COVID-19 Pandemic
Authors: Marcolino Milena S , Cimini Christiane C , Maia Junia X , Almeida Pinto Vania , Schulthais Chagas Victor S , Batchelor James , Ribeiro Antonio Luiz P
Published: June 2023

Introduction:
During the COVID-19 pandemic, social isolation led to a reduction in the number of consultations of patients with hypertension and diabetes mellitus (DM) , which may cause serious complications.

Objective:
To assess the effect of the pandemic on the control of hypertension and DM in primary care. Additionally, to develop and assess usability of a digital solution to improve patient monitoring.

Methods:
Quasi-experimental study. Patients ≽30 years-old with diagnosis of hypertension or DM from 34 primary health care centers from 10 Brazilian municipalities were assessed from Jun/2017 to Dec/2020. Data on the number of consultations, systolic, diastolic blood pressure (SBP, DBP) and glycohemoglobin levels were collected. A decision support system (DSS) was developed, to be used by community health workers (CHW), to identify patients with uncontrolled diseases during household visits. Software usability was assessed by a panel of experts.

Results:
From 5,070 patients (mean age 56.0 [IQR 48.0-62.0], 66.4% women), 94.9% had hypertension and 27.0% DM. There was a significant reduction in the weekly number of consultations before vs. after social restriction, (107 [IQR 60, 153] vs (20 [IQR 7, 29]), p<0.001). Only 772 patients (15.2%) returned for consultation since the beginning of the pandemic. They had lower SBP (120.0, IQR 120.0-140.0 mmHg) and DBP (80.0, IQR 80.0-80.0 mmHg), comparing to individuals who did not return (SBP: 130.0, IQR 120.0-140.0 mmHg; DBP: 80.0, IQR 80.0-90.0 mmHg; p<0.001). There was no difference in glycohemoglobin levels. The expert panel agreed the DSS may identify patients at risk, and can be incorporated into the CHW routine. Up to March 2021, over 17,000 registries were performed using the app.

Conclusion:
COVID-19 pandemic caused a significant reduction in the number of consultations of patients with hypertension and DM in PHC. The DSS was considered useful, and it was well accepted by the CHW.
Abstract 13485: Sunitinib and Changes in Right Ventricular Function: Insights From a Prospective Cohort of Patients With Metastatic Renal Cell Carcinoma
Authors: Rethy Leah , Demissei Biniyam , Narayan Vivek , Haas Naomi , Ky Bonnie
Published: June 2023

Introduction:
Tyrosine kinase inhibitors (TKI) have established cardiotoxic effects including hypertension and declines in left ventricular ejection fraction (LVEF). However, the effects on right ventricular (RV) function remain unknown.

Methods:
Patients with metastatic renal cell carcinoma (mRCC) initiating sunitinib therapy were prospectively enrolled and echocardiography was performed at baseline and at 3.5, 15 and 33 weeks. All participants with ≥ 1 echocardiographic metric of RV function (FAC, TAPSE, RV S’) from ≥2 time points were included. Estimates of mean (95% CI) absolute change in RV function and associations between clinical characteristics and changes in RV function were calculated using generalized estimating equations.

Results:
Of the 84 patients included, 55% had prevalent hypertension, 51% had hypercholesterolemia, 5% had heart failure and 8% had coronary heart disease. Estimates for changes in RV function after 3.5 weeks were: -0.5% (-1.5, 0.5) for FAC, p=0.32; -0.05 cm (-0.08, -0.02) for TAPSE, p=0.002; and -0.8 cm/s (-1.2, -0.5) for RV S’, p<0.001 (Figure). At 33 weeks, the decline in RV S’ remained significant (-1.8 cm/s [-2.6, -1.0], p<0.001). Higher doses of sunitinib were associated with a decline in TAPSE (50mg vs. 25mg [reference]: -0.20cm [-0.33.-0.07]). TAPSE and RV S’ were associated with concurrent declines in LVEF (-2.2% [-3.5, -0.9]; -2.1% [-3.4, -0.8] for each interquartile decline in TAPSE and RV S’ respectively, p=0.001). There were no associations between changes in FAC and LVEF, and no clinical characteristics were associated with declines in FAC.

Conclusions:
In patients with mRCC, sunitinib treatment was associated with a modest worsening of RV function. Further study is needed to determine the longer term consequences of these changes.
Abstract 13503: Assessment of Automatic Measurement of Short-Term Variability of Repolarization for Arrhythmic Risk Monitoring in a Porcine Model of Ischemic Ventricular Fibrillation
Authors: Loen Vera , Aranda Alfonso , Beekman Jet , Jansen Marlijn S , Cervera-Barea Aina , Meine Mathias , Vos Marc A
Published: June 2023

Background:
Short-term variability of repolarization derived from the QT-interval (STV-QT) has previously been demonstrated to increase prior to arrhythmias in both humans and animals. To continuously monitor the arrhythmic risk by a cardiovascular implantable electronic device (CIED), a fully automatic method to determine STV on intracardiac electrograms (STV-EGM
auto
) has been developed. This method demonstrated high effectiveness in monitoring and predicting Torsade de Pointes arrhythmias in the CAVB dog model. However, this technique has not been evaluated in arrhythmias related to ischemia yet.

Purpose:
To assess the novel automatic method of arrhythmic risk monitoring by CIEDs through STV-EGM
auto
measurements in a porcine model of ischemia-induced ventricular fibrillation (VF).

Methods:
Myocardial infarction was induced in 8 anesthetized pigs by balloon occlusion of the left anterior descending coronary artery for 75 minutes, followed by reperfusion. Monitoring included a 12-lead ECG and a duodecapolar EGM catheter in the right ventricle. STV-EGM
auto
and STV-QT, our gold standard calculated by the method of fiducial segment averaging, were assessed at baseline, occlusion, one minute before VF and just before VF. The STV values and the percentual changes from baseline to the successive three timepoints were compared between STV-EGM
auto
and STV-QT.

Results:
VF occurred 21±8.8 minutes after occlusion. Both STV-EGM
auto
and STV-QT increased significantly from baseline to VF (1.1±0.8 ms
vs
2.4±1.5 ms, p<0.05; 1.0±0.5 ms
vs
2.2±0.9 ms, p<0.05, respectively). The percentual change in STV-EGM
auto
from baseline to occlusion, one minute before VF and VF showed an excellent correlation with the changes in STV-QT from baseline to the successive timepoints (r
2
= 0.94; p<0.001). Bland-Altman analysis of the values showed a small bias of 0.26 ms and 95% limits of agreement between -1.1 and 1.6 ms.

Conclusion:
The STV values derived from the fully-automatic method for continuous STV measurements on intracardiac EGM signals (STV-EGM
auto
) show values and trends similar to the clinically validated STV-QT in a porcine model of ischemia-related VF. Future integration of this technique in CIEDs can furnish continuous monitoring of arrhythmic risk.
Abstract 13506: Three-Dimensional Transoesophageal Echocardiography Characterization of Left Atrial Appendage Dimensions in Patients With Spontaneous Cardioversion of Atrial Fibrillation
Authors: Soulat-Dufour Laurie , SIMON Theo , Lang Sylvie , EDERHY Stephane , ADAVANE Saroumadi , Chauvet-Droit Marion , Nhan Pascal , Capderou Elodie , Kamami Iris , Arnaud Camille , Lebos Pierre-Antoine , Issaurat Pauline , Boccara Franck , COHEN Ariel A
Published: June 2023

Introduction:
Few studies have described the clinical profile and natural history of patients with spontaneous cardioversion (SpCV) in atrial fibrillation (AF).

Hypothesis:
We hypothesized that patients with SpCV have a distinct morphological pattern in AF.

Methods:
We prospectively evaluated 262 patients hospitalized for AF using two-dimensional (2D) transthoracic (TTE) and three-dimensional (3D) transoesophageal echocardiography (TEE). 3D parameters were off-line analysed using Tomtec software (4D Cardio-View, Philips). Patients were divided into two groups according to the cardiac rhythm within 24 hours after admission: spontaneous cardioversion (SpCV group, 59 patients) and non-spontaneous cardioversion (noSpCV group, 203 patients).

Results:
Mean age of the population was 66±12 years and 166 (63%) patients were male. SpCV group had in comparison with noSpCV group lower CRP levels (respectively 3.3(3-5.5) versus 4(3-10) mg/L, p=0.0394), lower BNP levels (151(67-200) versus 269(129-424) pg/mL, p<0.001) and lower HBA1c levels (5.5(5.3-5.7) versus 5.9(5.6-6.3) %, p<0.0001). Using 2D TTE, SpCV group had in comparison with noSpCV group lower indexed left atrial end-systolic volume, lower indexed right atrial end-systolic volume, lower E velocity, and higher left ventricle ejection fraction (Table 1). Based on 2D and 3D TEE, SpCv group had in comparison with noSpCV group higher LAA emptying flow velocity and higher LAA filling flow velocity, lower 3D end-systolic and end-diastolic LAA volumes (both non-indexed and indexed) and lower 3D LAA ostium in comparison with noSpCV group (Table 1).

Conclusions:
Although SpCv of AF is a frequent situation incompletely studied, clinical and echocardiographic characteristics could be described. Further investigations are needed to determine the impact of such abnormalities on the prognosis in the SpCV group.
Abstract 13520: Impaired Prenatal Brain Development Predicts Adverse Neurodevelopmental Outcomes in Infants With Congenital Heart Disease
Authors: Wu Yao , Andescavage Nickie , Kapse Kushal , Kapse Anushree , Sharker Yushuf , Lopez Catherine , Donofrio Mary T , Vezina Gilbert , Wessel David , du Plessis Adré J , Limperopoulos Catherine
Published: June 2023

Introduction:
Fetuses with complex congenital heart disease (CHD) are at high risk for impaired brain development. However, the relationship between altered fetal brain development and infant neurobehavioral outcomes in CHD remains largely unknown.

Hypothesis:
We hypothesized that impaired fetal brain volumetric growth and cortical folding in CHD would predict impaired infant neurodevelopment.

Methods:
We prospectively recruited women with pregnancies complicated by a fetal CHD diagnosis. Women underwent a fetal MRI on a GE 1.5T scanner. Volumes of fetal total brain, cortical gray matter, white matter, deep gray matter, cerebellum, and brainstem were quantified. Cortical folding included local gyrification index, sulcal depth, and surface area. We completed Bayley Scales of Infant and Toddler Development III and Infant-Toddler Social and Emotional Assessment at 18 months. Generalized estimating equations were used to measure associations between fetal brain measures and infant neurodevelopment outcomes.

Results:
We enrolled 186 mother/baby dyads who underwent 250 MRIs between 20-39 gestational weeks. Seventy-seven had single-ventricle (SV) CHD and 109 had two-ventricle (2V) CHD. Forty-nine subjects died and 133 infants underwent neurodevelopment testing at a mean age of 19.6 months. Decreased fetal brain volumes and delayed cortical folding (all p<0.05) were associated with poorer infant cognitive outcomes. Impairments in fetal cerebellum (p=0.004), cortical (p=0.05) and deep gray matter (p=0.03) volumes, and cortical folding measures (all p<0.01) were associated with language delays. Reduced prenatal cortical gray matter volume (p=0.008), gyrification (p=0.02), and surface area (p=0.05) were associated with motor delays. Infants with SV CHD had lower competence scores compared to 2V CHD.

Conclusions:
We report that impairments in fetal brain growth and cortical folding predict adverse cognitive, language and motor outcomes in CHD. Infants with SV CHD showed greater susceptibility to social-emotional problems compared to those with 2V CHD. These data suggest that impaired prenatal regional brain growth disturbances and delayed cerebral cortical development are important biomarkers for later neurobehavioral dysfunction.
Abstract 13525: The Mitraclip System Improves Cardiovascular Outcomes Compared to Medical Management in the Setting of Cardiogenic Shock
Authors: Chiang Caleb , Kerolos Mina , Eid Joseph , Ritz Ethan , Derbas Laith , Suboc Tisha , Collado Fareed M , Kavinsky Clifford J , Suradi Hussam S
Published: June 2023

Introduction:
Cardiogenic shock (CS) is associated with high mortality and morbidity. Severe mitral regurgitation (MR) in the setting of CS is associated with poor outcomes. Transcatheter Edge-to-Edge Repair (TEER) with the Mitraclip system is commonly used to treat MR, though its use in CS is less defined.

Hypothesis:
TEER with Mitraclip in patients with moderate to severe MR and CS improves cardiovascular outcomes compared to medical management alone.

Methods:
A single-center, retrospective study included adult patients with moderate to severe MR and CS between 2012 and 2021. Moderate to severe MR was defined by grades 3+ and 4+ MR. CS was defined as a sustained systolic blood pressure <90mmHg for at least 1 hour, use of inotropes, vasopressors, or mechanical circulatory support, and clinical and laboratory findings of end-organ damage. The primary outcome was major adverse cardiovascular events (MACE) defined as cardiovascular death, heart failure admission, stroke, and myocardial infarction at 30 days and 6 months. The secondary outcome was change in New York Heart Association (NYHA) classification.

Results:
There were 28 patients included in the medical management and 33 in the Mitraclip groups. Table 1 includes this study’s outcomes. There were no significant differences in patients with a MACE at 30 days (13 vs. 8, p=0.069), though there were significant differences at 6 months (12 vs. 7, p=0.002). There were no differences in cardiovascular death. Patients in the Mitraclip group had fewer heart failure admissions at 6 months (p=<0.001), though not at 30 days. At 30 days, more patients in the Mitraclip group improved to NYHA classes I/II compared to medical management alone (10 [35.7%] vs. 16 [50%], p=0.043). There were no differences in NYHA classes I/II at 6 months (7 [43.7%] vs. 13 [54.2%], p=0.63).

Conclusions:
TEER using the Mitraclip system improves mid-term cardiovascular outcomes in patients with CS compared to medical management alone.
Abstract 13561: Sex-Based Differences in Outcomes for Transcatheter Based Intervention: Insight From the National Inpatient Sample
Authors: ASEMOTA IRIAGBONSE , Sana Muhammad Khawar , Yilmaz Mahir , Hammo Hasan , DeAngelo Sean , Sharma Bharosa , Almani Muhammad Usman , Usman Muhammad , Akuna Emmanuel , Shaka Hafeez
Published: June 2023

Introduction:
Transcatheter aortic valve replacement (TAVR) is now firmly established as an alternative to surgical aortic valve replacement in the treatment of aortic stenosis in all risk groups. Sex differences may influence procedural outcomes. Our study aims to contribute further data on the impact of sex differences on patients who underwent TAVR using a nationally representative sample.

Methods:
Data were obtained from the combined National Inpatient Sample (NIS) 2016 and 2018. The NIS was searched for hospitalization for TAVR procedure using the ICD-10 PCS codes. Patients undergoing the TAVR procedure were then stratified by sex into male and female sex. Outcomes of interest include in-patient mortality, length of stay (LOS), Total hospital charge (THC), Post procedural complication, pacemaker implantation, cardiogenic shock, ischemic stroke, intra-aortic balloon pump insertion, post-procedural infection, and post-procedural kidney disease. Multivariate logistic and linear regression analysis was used accordingly to adjust for possible confounders.

Results:
There were over 105 million discharges in the combined 2016-2018 NIS database. The database contained hospitalizations for adult patients (aged ≥ 18 years) who were hospitalized for the TAVR procedure. Females had more TAVR procedures compared to men (54.1% vs 45.9%, P<0.0001 and were older than men who underwent TAVR. There was similar in-patient mortality in both group (1.7% vs 1.2%, AOR: 1.21, P=0.072, 95% CI 0.98- 1.51). Women had lower rate of cardiogenic shock (AOR: 0.78, P=0.009, 95% CI 0.65-0.94), pacemaker implantation (AOR: 0.84, P=0.001, 95% CI 0.76-0.93) compared to men. Women had higher odds of post-procedural complications compared to men (AOR: 1.18, P=0.001, 95% CI: 1.07-1.29. There were similar rates of ischemic stroke (AOR: 1.23, P=0.502, 95% CI 0.66-2.31), postprocedural kidney injury (AOR: 1.65, P=0.278, 95% CI 0.66-4.12) in women compared to men. In addition, there was no difference in total charge and length of hospital stay.

Conclusions:
Women had increased post-procedural complications compared to men in regard to TAVR, however, mortality is similar in both groups. There was no difference in resource utilization and length of stay between both sexes.