bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14959: Mitochondrial Transplantation in Pediatric and Neonatal Porcine Hearts in a Model of DCD Heart Transplantation
Authors: Sanchez Alemany Victor , Nomoto Rio , Saeed Mossab , Celik Aybuke , Regan William , Matte Greg , Emani Sitaram , Del Nido Pedro J , MCCULLY James D
Published: June 2023

Introduction:
Heart transplantation in pediatric and neonatal patients is limited by the donor pool. Donation after circulatory death (DCD) could potentially expand the donor pool by offering an additional source of cardiac allografts. In this study, we investigated the efficacy of mitochondrial transplantation to enhance myocardial function in pediatric and neonatal DCD hearts.

Hypothesis:
Autologous mitochondrial transplantation enhances the viability and function of pediatric and neonatal DCD donor hearts.

Methods:
Circulatory death was induced by extubation in neonatal (25 - 50g heart weight, representing 4-16 month human) and pediatric (68 - 98g heart weight, representing 4-6 year human) swine model. Hearts were subjected to 20 min of warm ischemia and 10 min of cold cardioplegic arrest and then harvested. The aorta and pulmonary artery were cannulated, inferior and superior venae cavae ligated and a balloon was inserted in the left ventricle. The hearts were then mounted on the ex situ perfusion device. After 15 minutes of reperfusion, hearts received either vehicle alone ([VEH], 10 mL n = 6) or vehicle containing autologous mitochondria ([MT] 5x10
9
in 10 mL; n = 6). A Sham non-ischemic group (n = 4) did not undergo warm ischemia, mimicking donor after brain death (DBD). Hearts were machine perfused for 2 hours unloaded and 2 hours of loaded conditions.

Results:
Following 4 hours of reperfusion, neonatal and pediatric DCD hearts receiving VEH showed significantly decreased myocardial function and viability as compared to Sham non-ischemic control hearts. In contrast, in both neonatal and pediatric DCD hearts receiving MT, LVDP, dP/dt max, and fractional shortening were significantly increased (p < 0.001 for each) and were equal or better than that observed in Sham non-ischemic hearts. Infarct size was significantly decreased in both neonatal and pediatric DCD hearts receiving MT as compared to VEH (p < 0.001).

Conclusions:
Mitochondrial transplantation provides for significantly enhanced preservation of myocardial function and viability in neonatal and pediatric DCD hearts that is equivalent to or better than that observed in DBD hearts. Mitochondrial transplantation provides a possible option to expand the pediatric and neonatal heart donor pool.
Abstract 15294: Right Atrial Thrombus Extraction Through Angiovac - A Challenge Based on Chronicity
Authors: Sadaf Murrium I , Tarun Tushar
Published: June 2023

Case Presentation:
23-year-old woman with right ovarian dysgerminoma, treated with debulking surgery and bleomycin, etoposide, and platinum, found to have a right atrial (RA) mass on post-chemotherapy surveillance CT and referred to the cardiology clinic. Her vitals were stable, lungs were clear to auscultation, RRR without murmurs, no JVD or LE edema. On labs, hgb:11g/dL and LDH:283 units/L(135 to 214 units/L). A transthoracic echocardiogram (TTE) and a cardiac MRI revealed a mass of RA at the junction of inferior vena cava (IVC) entry into RA, measuring 3x1.3 cm in the 2-chamber view and 2.4x1.8 cm in the 4-chamber view (Fig A,B) with prolapse into the right ventricle (RV) in diastole. Based on cardiac MRI’s short and long inversion time imaging characteristics, thrombus was the most likely diagnosis (Fig C). Shared decision-making with the patient included options: 1) open heart surgery for removal; 2) interventional aspiration thrombectomy; or 3) conservative treatment with anticoagulation (AC). After six weeks of AC with enoxaparin, TTE revealed a RA thrombus of the same size as previously (2.8x1.2 cm). Given the lack of improvement, she agreed to an invasive procedure to remove the mass using an AngioVac aspiration system (AngioDynamics, Latham, NY). The AngioVac cannula maneuvered in the RA under fluoroscopic and TEE guidance to capture the RA mass. However, the mass broke into two pieces, one piece still attached to the RA and the other piece lodged in the AngioVac cannula (Fig D,E). She remained hemodynamically stable after the procedure. The pathology of the RA mass revealed an organized thrombus (Fig F). She had no complaints on follow-up in the clinic and continued on AC for 6 months.

Discussion:
Percutaneous aspiration thrombectomy using the AngioVac system has become a novel option for removing commonly encountered intravascular material, such as fresh thrombi or emboli in the RA, RV, SVA, IVC, and the iliofemoral vein, but may be complicated in old thrombi.
Abstract 154: Limitation of Troponin T In Identifying the Cause of Out-of-hospital Cardiac Arrest
Authors: Verkaik Bas J , Dekkers Paul , Slagboom Ton , van der Werf Christian , Lemkes Jorrit , Koster Rudolph W
Published: June 2023

Introduction:
High Sense-Troponin T (HS-TnT) is a key determinant for presence or absence of acute MI in chest pain patients (pts). Its value for acute MI diagnosis in pts with out-of-hospital cardiac arrest (OHCA) needs assessment because myocardial ischemia may be the cause but also a consequence of cardiac arrest causing global ischemia during no and low flow periods.

Methods:
Data were prospectively collected. From pts included in the ARREST registry who survived OHCA to discharge with VF as initial rhythm, the cause of OHCA and peak HS-TnT were analyzed. Cause of OHCA was determined independently by researchers, from history, admission and serial ECG, coronary angiography (CAG), cardiac imaging and genetics as available and indicated, without using HS-TnT information. MI diagnosis was made according to the 4
th
universal definition of MI: type 1 MI (thrombotic STEMI/NSTEMI), type 2 MI (supply/demand imbalance) and no MI (short transient ECG changes and all non-ischemic causes).

Results:
From 2012 till 2018 in the study region 373 OHCA pts met the inclusion criteria and had a known peak HS-TnT. Of these, Type 1 MI was present in 109 STEMI and 39 NSTEMI pts, type 2 MI in 116 pts and no MI in 109 pts. No significant coronary stenosis or normal CAG was present in 81 pts: 11/106 (10%) with type 2 MI and 70/109 (64%) without MI. HS-TnT exceeded the conventional diagnostic threshold of 4 times upper limit of normal (4x14ng/L = 56 ng/L) in 99%, 95%, 95% and 89% of pts, respectively. Median peak HS-TnT levels in STEMI, NSTEMI, Type 2 and no AMI pts was 1890 ng/L, 480 ng/L, 300 ng/L and 261 ng/L, respectively. (Figure) Area Under the ROC-Curve of HS-TnT values to differentiate between type 1 NSTEMI and type 2 AMI was 0.649, between type 1 NSTEMI and no MI 0.684 and between type 2 MI and no AMI 0.555.

Conclusion:
Exclusion of diagnosis of MI in OHCA pts cannot be made with HS-TnT, nor a distinction between NSTEMI, type 2 MI and no AMI. Based on HS-TnT many OHCA pts without ischemic cause would classify as NSTEMI.
Abstract 15499: Adjunctive Papillary Muscle Approximation With Undersizing Mitral Annuloplasty Improves Mitral Valve Mobility and Biomechanics to Repair Functional Mitral Regurgitation
Authors: Gaidulis Gediminas , Padala Muralidhar
Published: June 2023

Introduction:
Undersizing mitral annuloplasty (UMA) to repair functional mitral regurgitation (FMR) has failed to achieve durable results. Though FMR recurrence rates of 60% at 2 years are often cited, even at 30 days, nearly 30% of the patients had moderate or greater FMR in the CTSN trial. We previously demonstrated experimentally that adjunctive papillary muscle approximation (PMA) can improve valve function, with or without UMA. In this modeling study, we used patient specific mitral valve geometries to investigate the effects of UMA and UMA+PMA on mitral valve biomechanics.

Methods:
3D ultrasound was obtained in 3 pigs with chronic heart failure and moderate or severe FMR. Each 3D echo was segmented, and computational valve models were developed. UMA was mimicked with ring sizes of 36, 32, and 28 mm (
Fig A
). PMA was then added to each ring size, and the outcomes were reassessed (
Fig B
). In each simulation, leaflet stresses and chordal forces, coaptation area, and tenting parameters were computed.

Results:
Compared to pre-repair, UMA increased coaptation area by 178.3% with 36 mm, 279.1% with 32 mm, and 356.7% with 28 mm ring (
Fig C
). With 36 mm ring, leaflet stresses increased by 4.3%, while smaller rings reduced stresses by 24.3% (32 mm) and 33.8% (28 mm) (
Fig D
). Chordal forces after UMA decreased by 37.6%, 50.6%, and 55.2% (
Fig E
). Leaflet mobility was improved, as tenting area decreased by 46.1%, 57.9%, and 67.5% (
Fig F
). Adding PMA, achieved better valve closure and coaptation without the need for excessive annular downsizing: tenting area decreased by 76.5%, 85.2%, and 92%, and coaptation area increased by 190.6%, 309.8%, and 386.4%. In addition, leaflet stresses were reduced by 17.4%, 38.5%, and 44.9%, and chordal forces by 48.1%, 63.7%, and 72.9%.

Conclusions:
Adjunctive addition of PMA repaired FMR and restored physiological mitral valve mobility even at 36 mm annular size, reducing the need for excessive annular undersizing and potentially resulting in a durable repair.
Abstract 15511: Sex-Specific Trends in Obesity-Attributable Atrial Fibrillation in the United States
Authors: Wass Sojin Y , Al-Kindi Sadeer
Published: June 2023

Introduction:
The prevalence of atrial fibrillation (AF) has significantly increased in the United States over the past 2 decades. Obesity is a major risk factor for AF, and the association between obesity and AF may vary by sex. We sought to investigate sex-specific trends in obesity-attributable AF in the US

Methods:
We used data from the 2019 Global Burden of Disease Study to determine changes in age-standardized AF disability-adjusted life years (DALYs) and mortality in the US between 1990 and 2019. We examined the trends in the contribution of obesity to AF mortality and DALYs by sex.

Results:
Between 1990 and 2019, age-standardized AF DALYs increased by 13% in males (181 to 205 per 100K) and by 15% in females (110 to 126 per 100K). Age-adjusted AF mortality increased by 22% in males (4.9 to 6.0 per 100K) and by 26% in females (3.5 to 4.4 per 100K). Overall, obesity contributed to higher percentage of AF in females compared with males. Between 1990 and 2019, the percentage of obesity-attributed AF DALYs increased in females (27% to 34%) and males (21% to 31%). The percentage of obesity-attributed AF deaths increased both in females (25% to 32%) and males (18% to 28%) between 1990 and 2019, figure.

Conclusion:
AF morbidity and mortality showed a disproportionate increase among females compared with males in the US over the past 3 decades. Obesity disproportionately contributes to AF morbidity and mortality among females compared with males.
Abstract 15516: A Nationally Representative Evaluation of Patients With Established Cardiovascular Disease and Cardiovascular Risk Factors Achieving Health Goals With Electronic Devices in the United States
Authors: Aminorroaya Arya , Dhingra Lovedeep S , Oikonomou Evangelos , Aghajani Nargesi Arash , Khera Rohan
Published: June 2023

Background:
Electronic devices, like tablets and smartphones, may help users track and manage cardiovascular (CV) risk factors. However, data on their effectiveness and equitable distribution are scarce. We aimed to investigate the patterns and predictors of achieving health goals using tablets/smartphones among patients with CVD or with CV risk factors.

Methods:
We used data from the nationally representative Health Information National Trends Survey 5 (HINTS5) from 2017 to 2020. In a validated questionnaire, tracking a health-related goal (quitting smoking, losing weight, or increasing physical activity) using tablets/smartphones was assessed in patients with CVD (ischemic heart disease and congestive heart failure) or CV risk factors (smoking, obesity, hypertension, and diabetes), for magnitude and demographic predictors of success.

Results:
Among 16,092 participants of HINTS5, 1,606 had CVD (68±14 years, 47% women), and 8,984 were at risk of CVD (59±15 years, 59% women). During 2017-2020, compared with an estimated 46% (95% CI: 44-47%) of the US adult population, 33% (95% CI: 28-38%) of patients with CVD and 43% (95%CI: 41-45%) of patients at-risk of CVD successfully reported tracking their progress to achieve a CV health goal using tablets/smartphones. Younger age, female sex, non-Hispanic Black race, and higher income were significantly associated with higher proportion reporting improving their CV health, among patients with and at-risk of CVD.

Discussion:
Nearly half of patients with CV risk factors successfully manage health habits using electronic devices, but given large underuse among demographic groups with frequent adverse cardiovascular outcomes, a systematic approach to their use in clinical care may help improve patient outcomes.
Abstract 15525: Resolving Human Sinoatrial Node Leading Pacemaker vs Atrial Early Activation Sites by 3D High Resolution Imaging to Guide Ablation Treatment of Atrial Arrhythmia
Authors: Li Ning , Hansen Brian , Kalyanasundaram Anuradha , Kennelly James , Mohler Peter J , Simonetti Orlando , Zhao Jichao , Hummel John , Fedorov Vadim V
Published: June 2023

Introduction:
Surgical/ablation treatment for atrial arrhythmias such as anatomic sinoatrial node (SAN) tachycardia and atrial fibrillation either target or preserve the SAN. However, defining SAN is challenging because clinical electrophysiological (EP) mapping can visualize only exits of SAN activation as early activation sites (EAS) and not the leading pacemaker (LP) within the 3D intramural SAN.

Methods:
High resolution (300-900μm
2
) including epi/endocardial (Epi/Endo) dual sided near infrared optical mapping (NIOM) was conducted on coronary perfused explanted human atria (n=26, 19-69 y.o.). SAN was defined by optical action potential morphologies as the region of slow diastolic depolarization (slow upstroke) preceding atrial excitation. Serial histology and contrast enhanced MRI (CE-MRI, 100μm
3
resolution) were used to define the 3D fibrotic structure of the SAN pacemaker complex.

Results:
During sinus rhythm (SR) (83±22 bpm), the LP was primarily located in the SAN center. Electrical impulses exit from SAN to atria through 1-2 sinoatrial conduction pathways (SACP), leading to discrete EAS along crista terminalis (CT), preferentially from lateral superior/middle SACPs. The distance between SAN LP and EAS varied from 3.5-23 mm. Heterogeneous atrial wall thickness, fibrosis content and myofiber orientation along the SAN and CT (5-15mm thick) regions led to complex intramural conduction from SAN LP to EAS and substantial Epi-Endo activation dyssynchrony.

Conclusions:
EAS visualized on both Epi/Endo mapping mainly distributed along thick CT, but not on the surface projection of SAN, due to intramural fiber orientation of preferential SACPs. The higher fibrotic content in the human SAN than CT detected by CE-MRI, integrated with EP mapping can be helpful to accurately define SAN structure and pathways for reentrant SAN arrhythmias ablations.
Abstract 15539: Echocardiographic Predictors of Early Myocardial Dysfunction in Duchenne Muscular Dystrophy
Authors: Sanchez Jessica , Kaufman Beth , Maskatia Shiraz A , Punn Rajesh
Published: June 2023

Introduction:
Cardiomyopathy, a well described complication of Duchenne Muscular Dystrophy (DMD), typically presents in adolescence or early adulthood. Transthoracic echocardiography (TTE) is a widely utilized and cost-effective tool to diagnose and monitor its progression. To our knowledge, there is no standardized, echocardiography-based risk stratification to predict progression to DMD cardiomyopathy. We aim to identify markers associated with eventual left ventricular (LV) dysfunction in patients with DMD cardiomyopathy, while they still demonstrate preserved normal LV ejection fraction (LVEF).

Methods:
We reviewed TTEs of patients with DMD from a single institution and identified their first instance of reduced LVEF (<55%), as well as two preceding TTEs occurring 6-24 months prior. At each time point, we assessed LVEF, LV diastolic parameters, LV global longitudinal strain (LVGLS), LV and atrial volumes. We compared these parameters to 26 age-matched control DMD patients without evidence of LV dysfunction.

Results:
We identified 28 pediatric DMD patients with LVEF <55%. At each time point preceding reduced LVEF, the average LVGLS and average LVEF were lower, compared to controls. Study patients also demonstrated increased LV end systolic volume, and diminished LVEF and LVGLS over the course of the 3 time points (p<0.05 for all). Logistical regression showed EF and LVGLS one year prior were independently associated with ventricular dysfunction (p = 0.029 and 0.028); age did not correspond with diminished EF.

Conclusions:
Patients with DMD demonstrate reduced LVGLS, as well as sequentially increasing LV systolic volume and decreasing LVEF prior to the onset of LVEF <55%. These findings suggest a decline in myocardial mechanics >1 year prior to a diagnosis of DMD cardiomyopathy. Recognizing changes in LV strain and volumes while patients are still in a compensated state of cardiac output, may lead to earlier detection of subclinical LV dysfunction.
Abstract 15544: Electrographic Flow Mapping Improves Outcome of Catheter Ablation Procedures for Persistent Atrial Fibrillation
Authors: Gagyi Rita B , Bhagwandien Rohit E , Wijchers Sip , Yap Sing-Chien , Szili-Torok Tamas
Published: June 2023

Introduction:
Catheter ablation (CA) has been proven to be the most effective treatment strategy in paroxysmal atrial fibrillation (AF), however, it remains challenging due to suboptimal success rates in persistent AF. Existing mapping technologies cannot reliably distinguish active sources in this patient population. Recently, a novel mapping system (electrographic flow mapping, EGF) was developed, using computer vision and optical flow smoothing algorithms to detect and quantify patterns of electrical wavefront propagation in the atria.

Hypothesis:
We hypothesised that EGF mapping is superior to classical three-dimensional electroanatomic mapping (CARTO) in one-year outcomes of CA for persistent AF. We assessed procedural safety and efficiency too.

Methods:
The study group included patients with persistent AF undergoing CA using EGF combined with CARTO (group1). Data of group 1 patients were compared with data from pulmonary vein isolation (PVI)-only procedures (group 2) and PVI plus additional empiric substrate ablation procedures (group 3) using CARTO. 12-months outcome as freedom from AF and atrial tachycardia/atrial flutter (AT/AFL), procedural safety and efficiency were analysed too.

Results:
A total number of 70 consecutive patients were included (mean age 63.9±7.8 years). Thirty-nine patients were included in group 1, 16 patients in group 2) and 15 patients in group 3). Patients in group 1 had fewer AF recurrences compared to group 2 and group 3 at 12 months (23.1% vs. 62.5% vs. 46.7%, p=0.01). There were no differences in AT/AFL recurrence between the study groups (12.8% vs. 18.8% vs. 16.7%, p=0.84). Procedure-related complications were documented in none of the study groups. Procedure times were longer in group 1 (187.2±51.6 vs. 136.3±55.4 vs. 139.6±48.6 min, p<0.01). There were no differences in fluoroscopy use (275.8±172.8 vs. 321.4±254.8 vs. 212.3±127.8 mGy, p=0.27), RF application number (p=0.24) and application duration (p=0.77) between the study groups.

Conclusions:
Our data suggest that patients treated with combined EGF and CARTO mapping-based CA have less AF recurrences at one-year. The procedure is safe and seems to be a promising treatment alternative for this complex group of patients.
Abstract 15611: Impact of Amyloidosis in Patients Undergoing Transcatheter Aortic Valve Replacement: Insights From National Inpatient Sample 2016- 2019
Authors: Watts Abi , Patel Kunal N , Vohra Shekhar , Majmundar Monil , Toquica Gahona Christian , Raj Kavin , jalal ayesha , Patel, MD Keval V , Patel Pratik
Published: June 2023

Introduction:
Aortic Stenosis (AS) is increasingly recognized as one of the underdiagnosed manifestations of cardiac amyloidosis (CA) and existing literature shows conflicting evidence on the impact of CA on AS.

Methods:
A retrospective analysis of 2016-2019 NIS was conducted to identify hospitalizations (Age≥18) who underwent TAVR using ICD-10 codes. Existing literature was reviewed to select variables before conducting a univariate screen and balancing between groups with CA vs without CA. Propensity score weights were generated using Doubly robust estimation, and IPTW matching was done. The ATET was calculated by extrapolating propensity weights and using weighted multivariate analysis.

Results:
Out of 227,200 TAVR, only 245 (1.1%) had a concomitant diagnosis of CA. Hospitalizations with CA had a mean age of 80.49, 71.43% males, 82.98% white, 12.77% black, and others. Analysis total of 3,205 deaths, CA was associated with lower odds of mortality (OR 0.25, p 0.00). Factors associated with increased mortality in TAVR were age, HTN, low household income, elixhauser comorbidity index, mechanical vent >24 hrs, Shock on pressors/device, Pericardial effusion/tamponade, AKI, ESRD on HD, and Acute stroke. Out of 17,590 pacemakers (PPM) implantations, CA was associated with lower odds of getting a PPM (OR 0.13, P 0.00). Factors increasing the risk of getting a PPM were high degree AV block, age, male sex, DM, and ventricular arrhythmias. A total of 4280 acute strokes occurred, and CA was not associated with increased risk following TAVR (OR 0.46, p 0.38). Factors increasing the acute stroke risk after TAVR were age, mechanical vent >24hrs, and anemia. 3460 valve complications occurred, and CA was not associated with increased risk (paravalvular leak, displacement, infection, breakdown, and others) (OR 10.20, p 0.16). A significant risk factor for valve complications after TAVR was the presence of pericardial effusion/tamponade.

Conclusions:
The presence of CA does not result in poor outcomes in TAVR. Limitations of our study are a small sample, retrospective analysis, and lack of cardiac imaging data. Further studies that eliminate our study's limitations are required to conclusively evaluate the impact of CA in patients who undergo TAVR.
Abstract 15652: Insurance Status Alone Does Not Explain Increasing HF Mortality Among Young Adults
Authors: Shirey Tracy , Patel Shivani A , Morris Alanna A
Published: June 2023

Introduction:
Heart failure (HF) mortality among young adults has been increasing since 2012. It is unknown if insurance status contributes to these trends.

Hypothesis:
Uninsured status contributes to rising HF mortality rates in young adults across US states over the last decade.

Methods:
State-level age-adjusted mortality rates for HF and all cardiovascular disease (CVD) in adults aged 25-64 from 2010-2020 were obtained from the National Center for Health Statistics. All deaths across fifty states and the District of Columbia (DC) were included, averaging 3.3 million individuals per year. Annual estimates of the percentage of uninsured adults ages 25-64 (% uninsured) from the US Census were merged with mortality data by state and year. We examined cross-sectional associations of % uninsured with HF and CVD mortality in each year. We further examined the longitudinal association of % uninsured and mortality outcomes across years using linear regression models with generalized estimating equations to account for the longitudinal design.

Results:
Across n=51 US states and DC, the age-adjusted HF mortality rate increased from a mean of 6.48 in 2010 to 7.54 in 2020 (p<0.001), while the age-adjusted all-cause CVD mortality rate increased from 78.71 in 2010 to 88.91 in 2020 (p<0.001). Over the same period, the % uninsured decreased from 19% in 2010 to 11% in 2020 (p<0.001). In 3 of 10 years, there was a significant association between % uninsured and HF mortality (β ranging from 15.94 to 25.01 deaths per 100,000 in 2010, 2015, and 2020; p<0.01,) and CVD mortality (β ranging from 166.48 to 258.48 deaths per 100,000 in 2010, 2015, and 2020; p<0.01). The longitudinal association between % uninsured and HF mortality was not significant (β=1.81 deaths per 100,000; p=0.44).

Conclusion:
Uninsured status is associated with HF and overall CVD mortality across US states in certain years, however, there is no association between uninsured status and HF and CVD mortality rates from 2010-2020.
Abstract 15656: Genotype-Specific Natural History of Catecholaminergic Polymorphic Ventricular Tachycardia
Authors: Mazzanti Andrea , Kukavica Deni , Trancuccio Alessandro , Giannini Gala , Memmi Mirella , Gambelli Patrick , Bloise Raffaella , Marino Maira , Morini Massimo , Ortiz Martin F , Napolitano Carlo , Priori Silvia G
Published: June 2023

Background:
Based on the genetic background, Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT) has been recently classified in “typical” (RYR2 and CASQ2) and “atypical” (TRDN, TECRL, CALM1-3, RYR2 loss-of-function [RYR2-LoF]), but genotype-specific outcome is unknown.Hypothesis. We aimed to describe genotype-specific outcomes of patients with “typical” and “atypical” CPVT before treatment.

Methods:
Patients were classified in: 1) “Typical” CPVT (RYR2, CASQ2); 2) “Atypical” CPVT (TRDN, TECRL, CALM1-3 and RYR2-LoF). We assessed the occurrence of a first life-threatening arrhythmic event (LAE; sudden cardiac death, aborted cardiac arrest or hemodynamically non-tolerated ventricular tachycardia) before the initiation of therapy. We used the Kaplan-Meier life-table method and the log-rank test to compare the cumulative probability of experiencing a first LAE by the age of 40 years in the absence of treatment.

Results:
We included 238 patients (56% females, median age 14 years [IQR: 9-28 years]): 226/238 (95%) patients with “typical” CPVT (216 RYR2, 10 CASQ2), and 12/238 (5%) patients with “atypical” CPVT (5 RYR2-LoF, 4 TRDN, 3 TECRL). Interestingly, in 47% of probands the RYR2 variant was likely de novo. No patients experienced an LAE in the first year of age, but patients with atypical CPVT had an increased probability to experience a LAE by the age of 5 years (3/5, 60%), as compared with patients with typical CPVT (2/43, 5%; OR 30.8; p=0.003). In half of patients with LAE (23/48; 48%), the occurrence of LAE was the first clinical manifestation of CPVT. Overall, the probability to experience an LAE by the age of 40 years in the absence of treatment was higher in patients with atypical CPVT (100%), as compared to patients with typical CPVT (39%; p=0.003, Figure).

Conclusions:
Patients with atypical variants of CPVT are at increased risk to experience an LAE before treatment, especially during early childhood.
Abstract 15663: Trasapical Mitral Valve and Left Ventricular Reshaping to Repair Functional Mitral Regurgitation in a Dilated Ventricle
Authors: King Chase L , Silverman Michael , Wong Keawepono , Kikuchi Yuta , Lopez Alejandra , Maddamma Amanda , Onohara Daisuke , Padala Muralidhar
Published: June 2023

Background:
The COAPT trial demonstrated that repair of functional mitral regurgitation (FMR) in heart failure (HF) improves prognosis, only when the LV end diastolic diameter is <65mm. A significant need exists for a new therapy that can address both FMR and the LV in patients with LV EDD>65mm. In this study, we report a novel beating heart transapical device that can address FMR by beating heart papillary muscle approximation (PMA), and reduces the LV size and sphericity as well. Preclinical efficacy of this novel device in a swine HF/FMR model is reported.

Methods:
The device was prototyped using biocompatible 3D printed parts (Fig A), and a delivery catheter was custom designed for beating heart deployment (Fig B). In 7 healthy pigs, and 4 pigs induced with chronic post-myocardial infarction HF, with moderate or greater FMR, the device was implanted via a transapical access. The device was adjusted in steps - (step 1) reduce the inter-PM distance to an extent that FMR is mild or less; and (step 2) reshape the LV to achieve a 30% reduction in LV EDV and 25% reduction in sphericity index (SI). Echocardiography was used to assess mitral valve function and LV geometry, and LV function was assessed with invasive hemodynamics. Pigs were survived thereafter.

Results:
With this new device, MR was consistently reduced from moderate levels to none/mild. Mitral valve coaptation length increased from 3.49 ± 0.42 to 6.45± 1.13 mm (p=.019) and tenting area decreased from 158.09± 33 to 116.4± 16.7mm
2
(p=.05). LV EDV was reduced from 142.8± 29.6 to 97.5± 19.6ml (p=.025), SI was decreased from 0.67± 0.04 to 0.49± 0.07 (p=.0497) and IPMD was reduced from 23.5± 5.7 to 12.76± 3.0mm (p=.032). The device did not adversely impact cardiac output (6.59± 1.3 to 4.83± 1.6 LPM, p=.067) or E/A wave ratio (1.40± 0.23 to 1.35±0.29, p=.60).

Conclusion:
This novel transapical beating heart MV and LV reshaping device, significantly reduced FMR and reshaped the LV in this swine model.
Abstract 15668: Concurrent ST Elevation Myocardial Infarction and Gastric Perforation: A Management Dilemma
Authors: Fashanu Oluwaseun E , Babayale Omofolarin , Shamaki Garba Rimamskep , Lee Elizabeth
Published: June 2023

Case Presentation:
A 62-year-old male with RBBB, hypertension, diabetes, and former tobacco use presented with nausea, vomiting, abdominal and chest pain which responded to Pepto-Bismol. Examination revealed tachycardia, hypertension, a rigid, tender abdomen with guarding and rebound. His ECG showed anterolateral STEMI with dynamic changes. Chest and abdomen CT revealed a perforated ulcer with free air and also noted a hypodense region of the LV in the vascular distribution of the LAD suggestive of an acute infarct. Echo revealed LAD territory wall motion abnormalities with an estimated LVEF of 35%. It was decided to proceed with coronary angiography first based a multidisciplinary team discussion between the patient, surgical, and cardiology team. This showed a totally occluded proximal LAD, felt to be the culprit lesion, 90% proximal stenosis of LCx, and diffuse disease of RCA (figure). Right heart catheterization showed mixed shock. Plain old balloon angioplasty of LAD was done, IABP placed, and pressors started. He then had an exploratory laparotomy with lysis of adhesions and Graham patch repair of perforated gastric ulcer. He ultimately had a DES to his LAD 15 days after tolerating DAPT. Repeat Echo done after 2 months of GDMT revealed a recovered LVEF of 55%.

Discussion:
STEMI and perforated viscus are two clinical emergencies with high mortality. Few case reports of simultaneous occurrence are documented in the literature with no guideline-directed management given the rarity of its presentation. In our patient, we preceded with coronary angiogram to attain moderate hemodynamic stability with POBA aiding in revascularization and IABP providing mechanical support. Furthermore, early revascularization in STEMI is known to have mortality benefits. Our approach led to a favorable outcome with resultant recovery in cardiac performance and can be considered as a strategy to tackle similar presentations with expert deliberation.
Abstract 15680: Impact of Heart Failure on Peri-Procedural Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement
Authors: Atluri Ramtej , Kodali Mouna , Yalamanchili Sreeram , Vallabhaneni Meghana , Shoura Sami , Murthi Mukunthan , Velagapudi Sujitha , Shrestha Prajwal
Published: June 2023

Introduction:
Transcatheter aortic valve replacement (TAVR) is rapidly becoming commonplace for hemodynamically significant aortic stenosis (AS). Heart failure (HF) is a common comorbidity in aortic stenosis patients. Prolonged elevated left ventricular pressures result in progressive left ventricular hypertrophy and remodeling which in turn predisposes to the HF. Since many who undergo TAVR for AS could have HF, we aimed to assess periprocedural outcomes in this population.

Methods:
We utilized the National Inpatient Sample from 2016-2019 to identify 217,575 hospitalized adults who underwent TAVR for AS. These hospitalizations were further stratified based on the presence of HF. A multivariate regression model was used to adjust for confounders and analyze the variables.

Results:
Of those who underwent TAVR for AS, 146,770 (67.4%) had HF. Those with HF had a higher proportion of males (47.3% vs 41.6%; p<0.001).
Figure 1
shows the Forrest plot for multivariate analysis of peri-procedural complications when adjusted for patient demographics, comorbidities, and hospital characteristics. When adjusted similarly, patients with HF who underwent TAVR had longer length of stay (LOS) by 0.89 days (p<0.001) and had additional hospital costs (HC) of $13,297 (p<0.001).

Conclusions:
Patients undergoing TAVR with co-existing HF had significantly worse outcomes in terms of LOS, HC, atrial flutter, AKI, sepsis, pneumonia, and endotracheal intubation. Patients with severe AS may have altered myocardial contractility and periprocedural hemodynamic shifts may be poorly tolerated due to structural and functional impairments that persist even after correction of afterload. Despite the risk of periprocedural outcomes, the benefit of ventricular unloading particularly in those with preserved or mildly reduced ejection fraction should not be overlooked.
Abstract 15740: Association Between Intimate Partner Violence and Major Adverse Cardiovascular Events: Findings From the Coronary Artery Risk Development in Young Adults (Cardia) Study
Authors: Recto Kathryn , Colangelo Laura A , Kershaw Kiarri N , Lloyd-Jones Donald M
Published: June 2023

Background:
Data are limited on the associations between intimate partner violence (IPV) in young adulthood with the incidence of cardiovascular (CV) events in middle age, and it is unclear how these associations may be affected by other CV risk factors.

Methods:
We included up to 4357 CARDIA participants (ppts). Exposure variables measured at baseline (1987-1988) included how often in the past year ppts became involved in a violent argument 1) with a spouse/lover (IPV), 2) with family other than spouse, 3) with someone else they knew, 4) with someone they did not know, and 5) whether the ppts kept a gun at home for protection. Over 28 years of follow up, we assessed incident CV events (defined as non-fatal myocardial infarction, non-fatal stroke, heart failure hospitalization, and other CV death) and total mortality. We used Cox models to examine associations between violence exposure status and incidence of CV events or total mortality, with additional adjustment for baseline risk factors.

Results:
At baseline, mean age was 27 years with 54% female ppts. Ppts exposed to IPV in the last year were more likely to be Black (62% vs. 42% of those unexposed to IPV). Ppts with at least one violence exposure in the past year also had higher rates of alcohol use, smoking, and depression. With adjustment for age/sex/race, exposure to IPV, family violence, and keeping a gun were associated with incident CV events and total mortality (Table). While these associations were attenuated with adjustment for CV risk factors, most of those for total mortality remained statistically significant with hazard ratios for “more than 1 time” ranging from 1.26 to 1.59.

Conclusions:
Among young adults, having at least one violent episode in the past year with a spouse/lover or family member was significantly associated with incident CV events and total mortality. These associations were attenuated after adjusting for additional variables, such as smoking, as this high-risk behavior may lie in the causal pathway.
Abstract 15782: A Rare Case of Septal Atrial Flutter
Authors: Hashmath Zeba , Naniwadekar Aditi
Published: June 2023

Background:
Isthmus-dependent counterclockwise or clockwise flutter is well defined and responsive to radiofrequency ablation (RFA) of the cavotricuspidisthmus (CTI). However, inter-atrial septal (IAS) flutter is rare and occurs with IAS substrate abnormalities and prior cardiac surgery.

Case:
A 62-year-old female with paroxysmal AF on rivaroxaban, hypertension and diabetes mellitus presented with palpitations refractory to propafenone and metoprolol. She underwent successful isolation of all four pulmonary veins (PVs) and RFA of the CTI with demonstration of bidirectional block. A year later, she presented with atypical AFL (Fig 1A) failing cardioversion. During redo ablation, bipolar voltage map of the left atrium (LA) demonstrated durable isolation of all four PVs. Burst pacing (BP) from the coronary sinus (CS) up to 220ms did not induce AFL. The LA posterior box was isolated by creating a roof line and a line connecting the inferior veins (Fig 1B). No extra-PV triggers were noted on high dose isoproterenol. However, during the washout period, BP from the CS induced AFL with a tachycardia cycle length of 237ms, concentric CS activation and almost simultaneous activation along the crista in the right atrium (RA). High-density activation and coherent mapping of LA and RA suggested a micro-reentrant circuit over the posterior IAS with wavefront collision across the CTI (Fig 1C, D). Concealed entrainment was observed over the LA posterior septum near the transseptal puncture site. RFA successfully terminated the AFL. RFA was performed in a sequential unipolar fashion on both sides of the septum over areas of fractionation. No atrial arrhythmias were inducible with BP on or off isoproterenol. Patient remained in sinus rhythm at 9 month follow up.

Conclusion:
IAS flutter post AF ablation or cardiac surgery is rare, and management is challenging. While RFA has a 93% success rate, larger studies are required to further delineate this condition.
Abstract 15790: Severe Renal Impairment on Admission is Associated With Early Cardiac Readmission in Patients With Heart Failure With Preserved Ejection Fraction
Authors: Kahn Alexa B , Al-zakhari Rana , Jangda Umair , Chkhikvadze, MD tamta , Every Hannah , Basit Hajira , Kemp Kevin , Raina Jilmil , Chuquin Jose , Khorolsky Ciril , trikha anuragh , Ha Jung Eun , Jusakos Panayotis , Saith Sunil
Published: June 2023

Introduction:
Acute Decompensated Heart Failure is one of the most common reasons for hospitalization in the United States. Heart failure with preserved ejection fraction (HFpEF) accounts for nearly half of all heart failure admissions, significant contribution owing to various co-morbidities. The role of kidney impairment on admission and prognostic association with early HFpEF readmission is unclear.

Methods:
We conducted a retrospective analysis of patients admitted with decompensated HFpEF at a hospital in New York City. Clinical demographics & admission laboratory values collected to classify kidney function, according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula to calculate glomerular filtration rate (GFR). Severe renal impairment (SRI), defined as a GFR less than 15 mL/min/1.73 m
2
. Patients followed for one-year to assess all-cause & cardiac-specific readmission within 30 days & all-cause mortality within one year.

Results:
A total of 358 patients with HFpEF were studied, 218 (60.8%) were female, 196 (54.6%) with diabetes. There were 82 readmissions (22.9%) within 30 days, 37 (10.3%) due to cardiac-specific causes, 69 (19.3%) who died within one year of hospitalization. There were 47 (13.1%) who met criteria of SRI on admission. No difference in one-year mortality with SRI, compare to normal renal function (38.2% vs. 23.1%, p = 0.416). Patients with SRI were more likely to be readmitted within 30-days for cardiac specific reasons than normal renal function (27.6% vs. 8.5%, p = 0.034), while a borderline significant increase in all-cause readmission (38.2% vs. 23.1%, p = 0.066).

Conclusions:
Patients with HFpEF & SRI, were more likely to experience readmission within 30 days due to cardiac-specific reasons than patients with normal renal function. These findings may assist in enhancing cardiac-specific prevention strategies in discharge planning.
Abstract 15813: Comparative Case Series of Biventricular Support Between Heartmate-3 Ventricular Assist Devices and the Total Artificial Heart: A Single-Center Experience
Authors: Satish Mohan , Roldan Julie , Moss Noah , Anyanwu Ani , Mancini Donna M
Published: June 2023

Introduction:
Currently, only the Syncardia Total Artificial Heart (TAH) is approved for biventricular support as a bridge-to-transplant (BTT). The off-label use of continuous flow ventricular assist devices (VAD) in a biventricular configuration (BiVAD) has been used with variable results, emphasizing the need for patient selection. We report our single-center BiVAD experience in patients supported with two HeartMate-3 (HM-3) VADs in a biventricular configuration in comparison with TAH support.

Methods:
All patients receiving durable biventricular mechanical support at The Mount Sinai Hospital (New York, New York) were considered. Baseline clinical, echocardiographic, hemodynamic and outcome data were extracted. Outcomes of interest were postoperative survival and adverse events, and compared using non-parametric statistics. Successful BTT and post-transplant survival were descriptively evaluated.

Results:
From November 2018 through May 2022, a total of 6 (37.5%) patients received two HM-3 VAD pumps in a BiVAD configuration and 10 (62.5%) patients received a TAH. Overall, TAH patients had significantly higher median INTERMACS profiles (p < 0.05) at baseline compared to those on HM-3 BiVAD support but lower 30-day and 6-month survival and with a significantly higher rate of renal failure (Table 1). However, survival declined to the same rate at 1-year with both forms of support and was largely due to extracardiac adverse events related to underlying comorbidities (particularly, CKD/ESRD and diabetes, p < 0.05). Successful BTT has thus far been achieved in 2 (33%) HM-3 BiVAD compared to 5 (50%) TAH patients, and had similar post-transplant survival at 1-year.

Conclusions:
HM-3 BiVAD demonstrated lower short-term and similar long-term mortality compared to TAH support among patients in extremis. However, larger studies are needed to optimize patient selection and pursuit of mechanical support in biventricular failure.
Abstract 15839: Complication and Readmission Outcome of Atrial Fibrillation Catheter Ablation Among Cancer Patients
Authors: Wu Lingling , Narasimhan Bharat , Yang Zhuoran , Bhatia Kirtipal , Li Pengyang , Shah Arti , Kantharia Bharat K
Published: June 2023

Introduction:
Catheter ablation (CA) has been increasingly utilized among patients with atrial fibrillation (AF) as a guideline-supported treatment. However, limited data is available regarding its safety among cancer patients.

Hypothesis:
Patients with a cancer diagnosis has worse outcome following AF CA

Methods:
We queried the 2016 to 2019 United State Nationwide Readmission database to identify all patients with (active cancer or a history of cancer) or without cancer diagnosis who underwent AF CA. Hospital outcome and 30 days readmission rate were analyzed. Multivariate logistic regression or Cox proportional hazards regression analysis was employed when appropriate adjusting for comorbidities as well as patient and hospital-level factors.

Results:
A total of 46,461 AF CAs were included in the analysis, among which 800 (1.72%) patients were diagnosed with active cancer and 5,133 (11.04%) patients had a history of cancer. Compared to non-cancer patients, patients with a cancer diagnosis were older and more likely to be female (Table 1). Patient with cancer diagnosis also has a higher burden of comorbidities, stroke risk, and bleeding risk as evidenced by Charlson Comorbidity Index, CHA
2
DS
2
-VASc score, and ATRIA score (Table1). As a result, patient with active cancer has higher inpatient hospital mortality, procedural complication rate, and all-cause readmission rate. After adjusting for confounders, active cancer diagnosis but not a history of cancer was associated with increased hospital mortality (Odds ratio: 2.72[1.18-6.24] p=0.018 vs noncancer) In contrast, only a history of cancer was associated with a small increased risk of 30 days readmission following CA (Hazard ratio: 1.19 [1.04-1.37) p=0.009 vs noncancer). There was no difference in procedural risk between cancer and non-cancer patients.

Conclusions:
Active cancer but not a history of cancer was associated with increased in-hospital mortality among AF patients who underwent CA.
Abstract 15841: Echocardiographic Parameters Are Correlated With Initial Infection Severity in Long-Term Post Covid-19 Patients
Authors: Grigorov Mladen , Huang Jiapeng , Ghafghazi Shahab , Arnold Forest , Ali T'shura , Xu Qian , Kong Maiying , Cavallazzi Rodrigo , Chen James
Published: June 2023

Introduction:
COVID-19 acutely affects the cardiovascular system leading to various cardiac complications. Major concerns are on the less understood long-term cardiovascular consequences of COVID-19.

Hypothesis: Post COVID-19 cardiac dysfunctions could be long lasting and vary by severity of initial infection.

Methods:
This is an on-going prospective observational study from a multidisciplinary Post COVID-19 Research Clinic. Inclusion criteria included both RT-PCR confirmed and recovered COVID-19 patients and control subjects. After IRB approval and informed consents, 83 participants received serial transthoracic echocardiography at 3, 6 or >12 months after initial infection. Pearson’s correlation coefficients, Fisher's exact test and one-way ANOVA was conducted to examine the association between variables, across follow-up time and severity of initial infection.

Results:
Proximal RVOT diastolic diameter was significantly larger at >12 months’ compared to earlier time points post COVID-19 (2.92±0.55 cm at 3 months, 2.81±0.57 cm at 6 months and 3.15±0.52 cm at >12 months). The posterior wall was significantly thicker in post COVID-19 patients with moderate or severe infection compared to patients with mild infection. The left atrium diameter was significantly larger as the initial infection severity increased. Pulmonary artery acceleration time was significantly shorter as initial infection severity increased indicating higher pulmonary arterial pressure although no significant relationship was found with follow-up time. There were no left ventricular ejection fraction, E/E’ (index of diastolic function) or valvular abnormality differences by either follow-up time or severity. Furthermore, 77% patients with severe infection had grade 1 diastolic dysfunction compared to mild (28.57%) or moderate (33.33%) patients.

Conclusions:
Long-term echocardiographic follow-up showed increased RV size after COVID-19 over time. Posterior wall thickness, left atrium size and pulmonary artery acceleration time, and diastolic dysfunction were correlated with initial infection severity in long-term post COVID-19 patients suggestive of possible structural changes in recovered patients from COVID-19.