bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17931: Auxotonic MyoPod® Engineered Heart Tissues Enable Longitudinal Tracking of in vitro Development of Hypertrophic Cardiomyopathy
Authors: Rupert Cassady , Archer Benjamin , Dau Viet , Cirilli Shannon , li xia , Campbell Stuart G
Published: December 2023

Introduction:
Engineered heart tissues (EHTs) formed from human induced pluripotent stem cell (hiPSC)-derived cardiomyocytes carrying relevant mutations are a valuable tool for in vitro disease modeling and therapeutic testing. Tracking the emergence of a phenotype in vitro is key to targeting the optimal window to test therapeutic intervention. We hypothesized that auxotonic MyoPod® EHTs would enable longitudinal characterization with video analysis.

Methods:
Four auxotonic MyoPod® scaffold designs of decellularized porcine ventricular myocardium were seeded with wild type (WT) hiPSC-cardiomyocytes and human cardiac fibroblasts and cultured for 3 weeks. Mechanical testing was then performed on a MyoLab® instrument to obtain the contractile phenotype. One auxotonic MyoPod® design was then selected to form EHTs with WT or MYH7 R403Q
+/-
hiPSC-cardiomyocytes and fibroblasts. Videos of spontaneous contractions were obtained every 2-3 days.

Results:
All auxotonic MyoPod® scaffold designs tested (A-D) formed spontaneously contracting EHTs. In optimization studies, design C auxotonic MyoPod® EHTs were not significantly different from isometric control in any of the contractile metrics measured including twitch force (256.2 ± 25.8 μN vs 214.7 ± 78.1 μN) and time from peak force to 50% relaxation (103.8 ± 6.6 ms vs 111.2 ± 7.6 ms; control vs C, n=3 EHTs/group). When design C MyoPod® EHTs were seeded with WT and MYH7 R403Q
+/-
cardiomyocytes, video analysis showed slower relaxation time in MYH7 R403Q
+/-
EHTs that was significantly longer compared to WT control by one week of culture. Time to 90% relaxation (RT90) was lengthened by 38.8% ± 2.2% in MYH7 R403Q
+/-
(WT: n=7, MYH7 R403Q
+/-
: n=6; p<0.01). These video analysis results agree with MyoLab® testing data of isometric WT and MYH7 R403Q
+/-
EHTs where RT90 was slowed by 36.8% ± 0.1% in MYH7 R403Q
+/-
(WT: n=8, MYH7 R403Q
+/-
: n=5; p<0.01).

Conclusion:
In these studies, an auxotonic MyoPod® scaffold design was identified that does not alter the baseline contractile phenotype of EHTs, and it was used to track the development of relaxation deficit in MYH7 R403Q
+/-
EHTs over one week in culture. This technology can be used to track both the development of a disease phenotype and its response to therapies delivered in vitro.
Abstract 17932: Smoking History is Associated With Worse Outcomes in Patients With Sarcopenia Admitted for Acute Decompensated Heart Failure
Authors: Mirzai Saeid , Persits Ian , Volk Maximilian C , Sarnaik Kunaal , Martens Pieter , Estep Jerry , Chen Po-Hao , Tang Wai Hong W
Published: December 2023

Background:
Sarcopenia and smoking are independently associated with worse heart failure (HF) outcomes; therefore, their combined effect is likely even more detrimental.

Research Questions:
We studied the impact of sarcopenia and smoking on outcomes in patients admitted for acute decompensated HF (ADHF).

Methods:
We conducted a retrospective cohort study of 406 consecutive patients hospitalized at our tertiary care center for ADHF from 2017 to 2020 with computed tomography of the chest one month before the discharge date. Semi-automatic measurements were made at T12 (Figure 1A) and adjusted for height squared to obtain skeletal muscle index (SMI). To compare survival, patients were divided into four groups: nonsarcopenic nonsmokers (controls, 22.4%), sarcopenic nonsmokers (10.6%), nonsarcopenic smokers (44.3%), and sarcopenic smokers (22.7%). Sarcopenia was the lowest sex-stratified SMI tertile (cutoffs of 29.6 cm
2
/m
2
in males and 25.7 cm
2
/m
2
in females), and smokers were those who had ever smoked.

Results:
The mean admission age of our cohort was 70±14 years, 44.3% were female, and 67.0% had a smoking history (191 former and 81 active). Compared to nonsmokers, patients with a smoking history had more COPD (53.3% vs. 18.7%, p<0.001) and higher all-cause mortality (HR 1.41, 95%CI 1.05-1.90, p=0.021), but did not differ in SMI. When further stratified by sarcopenia, during a median 22.9 (3.0-33.5) months of follow-up, all groups had higher all-cause mortality when compared to controls (figure 1B); the highest rate was seen in sarcopenic smokers, which remained significant when adjusted for age, male sex, Caucasian race, CAD, and COPD (HR 1.71, 95%CI 1.12-2.60, p=0.013). Sarcopenic smokers also had the highest rate of ICU admissions (50.0%).

Conclusions:
Sarcopenia and smoking portend worse prognoses in patients admitted for ADHF, with sarcopenic smokers having the worst outcomes, independent of COPD history.
Abstract 17945: Characterization and Treatment of Primary Cardiac Rhabdomyosarcoma in the Last Three Decades
Authors: Ahmed Sanya
Published: December 2023

Introduction:
Cardiac rhabdomyosarcomas are rare, aggressive neoplasms comprising 5% of cardiac sarcomas overall. Due to the low prevalence, there is little consensus on the appropriate identification and treatment of this condition. This research aims to characterize trends in the clinical presentation of the disease and identify improvements for therapeutic management.

Methods:
A literature review was conducted by identifying cases of primary cardiac rhabdomyosarcoma published in English to PubMed between 1993 and 2023 and available via the SUNY Downstate Library. Studies were analyzed for patient demographics, clinical course, treatment, and recovery.

Results:
The analysis included 31 identified cases. Most cases were reported in male (52%) adults (87%) with an average age of 44 (STD: 21). Patients frequently presented with dyspnea (59%) and cardiac issues (52%), including chest pain (19%) and conduction disorders (19%). Tumors were detected via echocardiogram (79%) and CT (18%) and frequently left-sided (60%), with the most cases arising in the left atrium (47%). There was valvular involvement in 43% of cases. Surgery was performed in 86% of patients, of which 33% were fully resected via sternotomy and 13% were cardiac transplants for unresectable tumors. 56% of patients survived at 12 months follow-up. Surgical management was combined with chemotherapy (46%), such as the VAC regimen (40%), and radiation (14%), which improved patient 1-year mortality by 26%. 26% of patients developed recurrence of the primary tumor and 42% of patients developed metastatic disease; osseous metastases (38%) were the most common. 13% of patients had a prior history of cancer.

Conclusions:
The rare rhabdomyosarcoma may present as a middle-aged patient with dyspnea and cardiac concerns refractive to standard management. A left atrial mass mimicking a benign lesion such as a myxoma may be seen on echocardiogram, and suspicious lesions should undergo surgical resection to relieve symptoms and confirm the diagnosis. Supplementation of surgical management using chemotherapy and radiation may improve outcomes in patients. Clinicians should closely monitor the patient for osseous and lung metastases. A prior history of cancer may be a risk factor for the disease.
Abstract 17959: Cardiovascular Outcomes and Readmissions of Atrial Fibrillation Among Patent Foramen Ovale Occluder Device Recipients : A Propensity Matched National Readmission Study
Authors: Taha Amro , Ali Shafaqat , Duhan Sanchit , Atti Lalitsiri , Aziz Sundal , Elseidy Sheref , Khir Fadi , Victor Varun , Boshkovska Spaseski Maja , Erdem Saliha , ElJack Ammar , Almas Talal , Ali Shehzad , Alraies M Chadi C
Published: December 2023

Introduction:
Patent foramen ovale (PFO) occluder devices are increasingly utilized minimally invasive procedures used to treat cryptogenic stroke. Data on the impact of Atrial Fibrillation (AF) among PFO occluder device recipients are limited.

Methods:
The Nationwide Readmissions Database was queried between 2016 to 2019 to identify PFO patients with and without AF. The two groups were compared using propensity score matching (PSM) and multivariate regression models. The outcomes included in-hospital mortality, acute kidney injury (AKI), Mechanical circulatory support use (MCS), Cardiogenic shock (CS) acute ischemic stroke, bleeding and other cardiovascular outcomes. Statistical analysis was performed using STATA v. 17.

Results:
Out of 6,508 Weighted hospitalizations for PFO occluder device procedure over the study period, 877 (13.4%) had AF compared to 5,631 (86.6%) who did not. On adjusted analysis, PFO with AF group had higher rates of MCS (PSM, 4.5% vs. 2.2 %, p value=0.011) and SCA (PSM, 7.6% vs. 4.6 %, p value=0.015) compared to PFO with no AF. There was no statistically significant difference in the rate of in hospital mortality (PSM, 5.4% vs. 6.4 %, p value=0.39), CS (PSM, 8.3% vs. 5.9 %, p value=0.075), AKI (PSM, 32.4% vs. 32.3 %, p value=0.96), bleeding (PSM, 2.08% vs. 1.3 %, p value=0.235) or the readmission rates among both cohorts. Additionally, AF was associated with higher hospital length of stay (9.5 +/-13.2 vs. 8.2 +/-24.3 days, p value =0.012 ) and total cost ($66,513+/-$80,922 vs. $52,013+/-$125,136, 0.025, p value = 0.025) compared to PFO without AF.

Conclusions:
The presence of AF among PFO occluder device recipients is associated with increased adverse outcomes including MCS use and SCA with no difference in mortality and the readmission rates among both cohorts. Long term follow up needs further studies.
Abstract 17978: Validation of Contemporary Administrative Codes for Identifying Pulmonary Vein Isolation Procedures
Authors: Ferro Enrico G , Reynolds Matthew R , Xu Jiaman , Song Yang , d'Avila Andre , zimetbaum peter , Cohen David J , Yeh Robert W , Kramer Daniel B
Published: December 2023

Introduction:
Use of pulmonary vein isolation (PVI) to treat atrial fibrillation continues to grow. Despite great interest in leveraging administrative data for real-world analyses, contemporary procedural codes for identifying PVI have not been validated.

Methods:
Inpatient PVIs were identified among US Medicare fee-for-service beneficiaries using Current Procedural Terminology (CPT) code 93656 in the Carrier Line Files. Each patient was cross-matched by procedure date with claims from Medicare Provider Analysis and Review Files (MedPAR), in order to compare CPT claims with International Classification of Diseases-10
th
Revision Procedure Coding System (ICD-10 PCS) claims submitted by healthcare facilities to bill for each PVI. We performed the reverse for commonly matched ICD-10-PCS codes, to identify their corresponding CPT-billed procedures.

Results:
We identified 20,388 inpatient PVIs from 1/2017 to 12/2020, of which 14,468 (71%) were linked to MedPAR by same-day procedure date. Of these, 13,156 (91%) were billed as ICD-10 02583ZZ “
Destruction of Conduction Mechanism, Percutaneous Approach
”, with lower use of other codes. However, the reverse process yielded heterogeneous results: among 75,003 procedures billed as ICD-10 02583ZZ, only 15,691 (21%) matched with CPT 93656 (PVI), as several other procedures were interchangeably billed under this same ICD-10 code (Figure).

Conclusions:
Compared with CPT codes as a gold standard, the ICD-10-PCS code most commonly associated with CPT-billed PVI procedures actually refers to ablation of the atrio-ventricular junction. Yet this same ICD-10-PCS code also matches with a wide range of other procedures distinct from PVI. We conclude that ICD-10-PCS codes alone are not sensitive or specific for identifying PVI in claims, and cannot be reliably used in isolation for health services research on this important procedure.
Abstract 17979: Cardiogenic Shock - The Index Presentation of Cardiac Sarcoidosis; Challenges in Diagnosis and Management
Authors: Bakst Bradley , Chima Noor
Published: December 2023

Cardiac sarcoidosis often presents with ventricular dysrhythmias but can manifest as cardiogenic shock. We discuss a patient who presented with the latter requiring escalating support serving multiple challenges including making a definitive diagnosis & its management.

59 year-old male presented in cardiogenic shock requiring inotropic assisted diuresis. Due to continued clinical decline, he underwent Impella 5.5 placement for mechanical circulatory support (MCS). Echocardiogram showed ejection fraction of 25-30% with global hypokinesis. Reviewing his prior medical records, revealed a lymph node biopsy with non-caseating granulomas 5 years ago concerning for sarcoidosis. Due to his dependence on temporary MCS, we were unable to confirm with a cardiac MRI. Knowing that FDG-PET can only elucidate the site of active sarcoidosis, it was pursued as the only viable imaging modality. His FDG-PET scan was positive for involvement of the inferior wall & right atrium. He was placed on immunosuppression with mycophenolate mofetil & prednisone. During his hospitalization, serial FDG-PET scans were performed showing resolution of active inflammation which allowed for weaning of immunosuppressants.

Despite treating his active disease, his course was complicated by worsening renal failure requiring hemodialysis, MCS-dependent heart failure, placement of a left ventricular assist device (LVAD) and fungemia. Following treatment, he was placed on lifelong suppression with fluconazole. Given his renal failure and infection, he was not a candidate for heart transplant. His infection also precluded our ability for long-term immunosuppression.

There are no guidelines or detailed pathways on managing cardiogenic shock in patients with cardiac sarcoidosis. Our case highlights the challenges faced when shock is the index presentation as it increases the risk of end organ damage which therefore requires expedited work up for destination therapy. Though LVAD is a viable option for patients with cardiac sarcoidosis, duration of immunosuppression, long term follow up for scar, risk and treatment of infection in patients that are not transplant candidates is largely unexplored. More studies are needed to help guide management of shock in this patient population.
Abstract 17982: Impact of Obstructive Sleep Apnea on Bradyarrhythmia Hospitalizations: Analysis of the National Inpatient Sample 2016-2020
Authors: Vardar Ufuk , Battikh Naim , Shrestha Prajwal , Gajjar Rohan , Yilmaz Mahir , Kumi Dennis , Jamshed Aneeza , Vij Aviral
Published: December 2023

Background:
Obstructive sleep apnea (OSA) has been associated with many forms of heart rhythm disorders, including bradycardia and cardiac conduction delay. Here, we aimed to investigate the relationship between OSA and bradyarrhythmias.

Methods:
A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2016 to 2020. 1,685,704 hospitalizations with a primary diagnosis of bradyarrhythmias (including sinus node dysfunction, atrioventricular block and cardiac conduction disorder with 1:1 AV conduction) were identified and stratified based on the presence of OSA using ICD-10 codes. Multivariate regression analysis was used to adjust for confounders and analyze the variables.

Results:
Out of the 1,685,704 hospitalizations with bradyarrhythmias, 204,307 (%12.1) had OSA. In-hospital mortality in patients with OSA was significantly lower (3.51% vs 5.64%; p<0.001). When adjusted to patient demographics, comorbidities, and hospital characteristics, independent risk factors for inpatient mortality included congestive heart failure (aOR 1.22, 95% CI 1.17 - 1.27, p-value<0.001), atrial fibrillation (aOR 1.14, 95% CI 1.10 - 1.18, p-value <0.001); however conditions associated with a lower risk for inpatient mortality included previous CABG (aOR 0.91, 95% CI 0.85 - 0.97, p-value 0.004) and previous pacemaker (aOR 0.61, 95% CI 0.58 - 0.65, p-value <0.001). Mean length of stay (LOS) and mean hospital charges (HC) were also lower in the presence of obstructive sleep apnea compared to those without (5.28 vs 6.01 days, p-value 0.002 & $90,549 vs $103,450, p-value < 0.001 respectively).

Conclusion:
Amongst hospitalizations with a primary diagnosis of bradyarrhythmias, patients with OSA had better outcomes in terms of in-hospital mortality, length of stay and total mean hospitalization charges. This likely suggests that OSA-related bradyarrhythmias are a more benign and modifiable when compared to non-OSA-related bradyarrhythmias.
Abstract 18025: Does Co-Morbid Depression Predict Worse In-Hospital Outcomes in Elderly Patients Primarily Hospitalized With Atrial Fibrillation?: A Nationwide Sex and Race Stratified Analysis
Authors: Garg Vibhor , Verma Jyoti , Sharma Hansika , Vasireddy Nikhil Sai , Klair Harroop Singh , Kavathia Shrenil , Bodhankar Shruti , Anmol Kumar , Kolli Dhanush , Hashmi Sobya , Kolli Jithin Teja , Desai Rupak
Published: December 2023

Introduction:
Depression is an established risk factor for major adverse cardiac and cerebrovascular events (MACCE). However, the association between depression (DP) and all-cause mortality, as well as stroke in atrial fibrillation (AF) patients, remains understudied. We aim to establish a relationship between depression and MACCE in AF patients.

Methods:
Using the National Inpatient Sample (2019) and relevant international classification of disease (ICD-10) codes, we identified hospitalizations with AF among elderly patients (age >65) and categorized them into groups with and without depression (DP vs nDP). The primary outcome was all-cause inpatient mortality and stroke in AF-related hospitalizations.

Results:
The overall prevalence of depression (DP) among elderly patients hospitalized for AF was 10.6% (32810/310,005). The DP cohort contained less number of males (30.4% vs 44.38%), Blacks ( 2.91% vs 5.77%), Hispanics (4.11% vs 4.68%) while more females (69.59% vs 55.62%) and Whites ( 88.7% vs 83.82%). Stroke prevalence was not significantly different (0.8% vs 0.8% OR:0.97, CI:0.85-1.1 p=0.701) whereas all-cause mortality prevalence was lower in the DP cohort (0.9% vs 1%, OR: 0.85, CI:0.75-0.97 p=0.015). Surprisingly, the subgroup analysis revealed that depressed males exhibited significantly higher odds of stroke, and this association persisted even after multivariable analysis (aOR 1.184, CI: 1.12-3.02, p= 0.016)[Fig 1]. All-cause mortality was higher in depressed blacks(2.6% vs 1.4%, OR:1.84, CI:1.21-2.79, p=0.004) and lower in depressed females (0.8% vs 1.1%, OR:0.78 CI:0.67-0.91, p=0.001). Adjusted multivariable analysis revealed no significant all-cause mortality and stroke in depressed vs non-depressed except for subgroup analysis for elderly depressed males.

Conclusion:
Depression independently associated with stroke in elderly males hospitalized for AF.
Abstract 18058: Dorsal Root Ganglion Nerve Block Causing Reverse Takotsubo Cardiomyopathy
Authors: Li Jiwen , Tuzovic Mirela , Cheng Evaline
Published: December 2023

A 65-years-old female presents to the emergency room after C2 dorsal root ganglion nerve block for cervicogenic headaches, where intraoperatively she became hypotensive and unresponsive with sinus tachycardia to the 140s. She required brief intubation and intravenous vasopressors for resuscitation and was quickly extubated with complete neurologic recovery within hours of presentation. Her vital signs were within normal limits. She had no clinical signs of heart failure on exam. Laboratory values were within normal limits except for elevated hs- troponin which peaked at 1136ng/L. Her EKG showed nonspecific ST changes and T-wave inversion in the high lateral leads. She underwent transthoracic echocardiogram and was found to have basal to mid inferior wall and inferoseptum akinesis with reduced left ventricular ejection fraction of 35-40%. She was initially asymptomatic, but six hours after presentation developed radiating left arm pain then crushing chest and throat pain, with an uptrend in her troponins to 6539, without dynamic EKG changes. She was urgently taken to the cath lab and was found to have clean coronaries, and ventriculography was performed with findings consistent with reverse takotsubo. She was started on low dose beta blockers and ARBs with complete resolution of symptoms. Reverse takotsubo is a rare variant of takotsubo cardiomyopathy, where basal and midventricular segments of the left ventricle are akinetic, with the majority of patients recovering systolic function within months. This condition is frequently triggered by an intense trigger. To our knowledge, this is the first described case of a high-cervical nerve block precipitating takotsubo.
Abstract 18076: MicroRNA-342-3p Rescues Post-Ischemic Cardiac Function in Diabetic Mice via HGF-MET Pathway Activation
Authors: Jamaiyar Anurag , Chen Jingshu , Wu Winona , Assa Carmel , Cheng Henry , Perez-Cremades Daniel , Feinberg Mark W
Published: December 2023

Introduction:
- Patients with diabetes have a poorer prognosis following myocardial infarction compared to healthy controls. This is partly due to impaired post-ischemic angiogenesis in the diabetic heart. The role of microRNAs (miRs) in angiogenesis is relatively unexplored. miR expression is responsive to stimuli such as hypoxia, metabolic environment, growth factors, etc. Here, we describe how miR-342-3p, a hypoxia-responsive miR, regulates angiogenesis under physiologic and diabetic conditions.

Methods:
- miR-342-3p or control mimic was injected into the border zone of hearts post-ischemia/reperfusion in male Ldlr
-/-
mice on a high fat and high sucrose (HFSC) diet. Echocardiography, histology, immunofluorescence, RNA FISH and in vitro assays were used to elucidate the mechanism of action of this miR.

Results:
- Ejection fraction (EF) and fractional shortening (FS) of miR-342-3p injected hearts were significantly higher by 145% and 173%, respectively, at day 14 compared to controls (p = 0.0204 and p = 0.0095). Capillary density as well as ki67+ endothelial cells were more abundant by 107% and 154%, respectively (p = 0.0371 and p = 0.0242) vs control. RNA sequencing of miR-342-3p overexpressing endothelial cells implicated HGF-MET signaling as one of the top upregulated pathways. Western blots (WB) revealed an increase in MET expression (p = 0.0255) in miR-342-3p overexpressing cells vs control. Decorin (DCN) was identified as a direct target of miR-342-3p and validated by WB and luciferase reporter assays. Hypoxia (2% O
2
) induced miR-342-3p expression (p = 0.0023) while suppressing DCN levels. However, both high glucose (25 mM) and palmitate (100 μM) treatments blunted the miR-342-3p induction while increasing Decorin levels. Co-IP and microscopy were used to show Decorin-MET co-localization. Lastly, miR-342-3p and DCN were inversely expressed (p = 0.0188 and p = 0.0015 respectively) in diabetic and healthy ECs obtained from patients.
Conclusion:
- These findings establish a critical role for miR-342-3p in regulating cardiac angiogenesis post-ischemic injury in diabetic mice. Under diabetic conditions, the hypoxia induced expression of miR-342-3p is blunted, leading to Decorin mediated degradation of MET receptors, which impairs angiogenesis.
Abstract 18104: The Unexpected Disaster: Unusual Form of Left Ventricular Rupture
Authors: Aburumman Huthaifah , Abdallah Ahmed , Alshami Mohammad , patel jeetendra
Published: December 2023

Description:
We present a 73-year-old female, who presented with NSTEMI. EKG showed ST depression in the inferior and anterior leads. Initial Troponin I was high (0.17 ng/mL). She received nitroglycerine with no relief of her pain, so she underwent an emergent left heart catheterization (LHC). The LHC showed two tandem 90% stenosis in the right coronary artery (RCA) and mild disease in the left anterior descending (LAD) and left circumflex (LCx) arteries. PCI to the RCA was successful. She was started on a high-intensity statin, carvedilol, dual antiplatelet therapy, and losartan. On the day after PCI, an echocardiogram showed preserved ejection fraction with no evidence of pericardial effusion. The patient was doing well until 2 days after the PCI when she was found obtunded and hypotensive. She received normal saline bolus, epinephrine, and norepinephrine, after which she improved. A bedside echocardiogram revealed evidence of pericardial effusion with tamponade physiology and a pericardial clot. The patient and her family declined further interventions and elected to proceed with comfort measures.

Discussion:
Mechanical complications of acute myocardial ischemia (AMI) have substantially decreased in numbers after the implication of early reperfusion therapies, but they remain fatal if not recognized early and treated. Free wall rupture (FWR) usually occurs in the first 7 days following an AMI, with an average of 2.6 days. FWR mostly happens after infarction of the LAD or LCx territories. In our case, there was no delay in reperfusion therapy and there was no evidence of infarction on the echocardiogram however the patient developed FWR as a complication and in a timeline earlier than average making this case unique.
Abstract 18125: Disparities in HFrEF Patients Excluded From Guideline Directed Medical Therapy at an NYC Safety Net Hospital
Authors: Mehta Adhya , Huang Anna , Chen Yi-Yun , Faillace Robert
Published: December 2023

Introduction:
Prescription of GDMT in heart failure with HFrEF patients is an important performance measure. However, little has been explored into the populations that are purposely excluded from the prescription of GDMT because of medical contraindications, patient refusal, cost, etc. We explored the disparities for the non-prescription of GDMT at an NYC hospital. This is essential to understand the gaps in the treatment of HFrEF patients.

Hypothesis:
No clinical or demographic disparities exist in the exclusion of patients from the prescription of GDMT.

Methods:
Data were collected retrospectively through the Get With The Guidelines™- Heart Failure registry for HFrEF (LVEF =<40%) patients admitted at NYC Health+Hospital/Jacobi Medical Center from 1/1/2017-5/31/2022. Only records without missing data for each medication class were included, resulting in 869 records for ACEI/ARB/ARNI, 373 for SGLT2i, 830 for beta-blocker, and 865 for MRA. Logistic regression including both demographic and clinical factors was used to analyze the exclusion outcome from each GDMT. Results were presented as adjusted odds ratios at 0.05 level of significance.

Results:
50.29% had documented exclusion (e.g. contraindication, patient refusal, etc.) from the prescription of ACEI/ARB/ARNI, 46.65% from SGLT2i, 7.5% from beta-blockers, 42% from MRAs. Of these patients, 56.85%, 48.39%, 53.33% and 41.76% of patients had a “patient reason” for not being prescribed ACEI/ARB/ARNI, beta-blockers, SGLT2i, and MRAs at discharge, respectively. Results are summarized in the Table.

Conclusions:
Both clinical and demographic factors had significant associations with the nonprescription of GDMT. There is a sizable population of patients with non-medical reasons for nonprescription of GDMT. A more granular analysis of patient-related reasons (such as cost, patient education, etc.) should be explored to improve the prognosis of this vulnerable population with HFrEF.
Abstract 18141: Outcomes of Prospective Computational 12-Lead ECG Mapping to Guide Ablation of Unstable Ventricular Tachycardia
Authors: Ho Gordon , Sung Kevin , Han Frederick , Hsu Jonathan , Hoffmayer Kurt , raissi farshad , Feld Gregory K , Krummen David E
Published: December 2023

Background:
Unstable ventricular tachycardia is difficult to map and ablate, with high recurrence rates. We developed a 12-lead ECG mapping algorithm based on computational models to localize VT to help guide ablation of unstable VT.

Hypothesis:
We hypothesized that prospective ECG-mapping can facilitate invasive activation mapping and improve the success of unstable VT ablation.

Aims:
To compare the time to ICD shock + death in patients undergoing ECG-mapping guided ablation of unstable VT compared to standard ablation controls.

Methods:
Consecutive patients from 2 centers with unstable VT undergoing ECG-mapping guided VT ablation were prospectively enrolled. Using the ECG, computational mapping localized the VT onto a 3D model. A multielectrode catheter was placed at the predicted site and activation mapping was performed during VT reinduction. Ablation was performed per standard protocol. Time to ICD shock or death was compared using Cox regression (adjusting for age, EF and ICM) between ECG-mapping guided ablation vs standard VT ablation controls with a minimum 3 month f/u. Accuracy of ECG mapping was compared with activation mapping.

Results:
Out of 32 consecutive patients who underwent ECG-mapping guided VT ablation, 26 had unstable VT (age 66±10 yr, EF 34±17%). All 26 (100%) patients with unstable VT (median VT CL: 326±81ms) underwent successful activation mapping, Fig 1A. Using Cox regression adjusting for covariates, ECG-mapping guided VT ablation had a significant reduction in ICD shock or death compared to standard ablation controls (p=0.01, HR=0.23 [CI 0.07-0.70], Fig 1B). There was a 99% reduction in total ICD shocks during mean 7.5 month f/u. For all 32 patients, the mean accuracy of ECG mapping was 1.3±0.7cm when compared to invasive activation±entrainment mapping.

Conclusions:
Use of computational 12-lead ECG mapping to guide ablation of unstable VT significantly improved freedom from ICD shocks and death resulting in excellent accuracy.
Abstract 18146: Deactivation Status of Defibrillation at the End of Life in Patients With Implantable Cardioverter Defibrillators
Authors: narumi shoko , Kondo Yusuke , Nakano Masahiro , Kajiyama Takatsugu , Ito Ryo , Chiba Toshinori , RYUZAKI SATOKO , Yoshino Yutaka , Komai Yuya , Takanashi Yukiko , Kobayashi Yoshio
Published: December 2023

Background:
Implantable cardioverter-defibrillators (ICDs) are effective in preventing sudden cardiac death due to fatal arrhythmias. However, defibrillation is also known to cause physical and emotional distress to the patients. When patients with an ICD are approaching the end of life, the guidelines on palliative care in cardiovascular diseases recommend that the benefits and burdens of ICDs are fully explained to the patients and that a policy regarding the deactivation of defibrillation function is discussed. However, there are few reports on the therapy status of ICD patients in the end-stage of life.Aim: To investigate the deactivation status of defibrillation in patients with an ICD.

Methods:
We retrospectively analyzed ICD database at our hospital and studied 143 ICD patients who died from 2006 to June 2023. The frequency of ICD therapy delivered before death and information about the discussion of deactivation and do not attempt resuscitation (DNAR) decisions were reviewed using medical charts.

Results:
Of 143 patients, 45 (31%) patients in the end-stage of life were assigned to DNAR and 24 (17%) patients was explained deactivation of ICD therapies at the time of DNAR order. Fifteen (10%) patients, including 11 patients in the end-stage heart failure, underwent deactivation and 2 patients received ICD therapies after DNAR order. Nine (6.2%) patients did not undergo deactivation. Of those, 4 patients received ICD shock therapies. Twenty-one patients (15%) were not given the explanation for the deactivation after DNAR order. Of those, 4 patients received ICD shock therapies.

Conclusion:
Our study shows that only 10% of Japanese ICD patients in the end-stage of life underwent deactivation of ICD therapies. Discussions regarding ICD deactivation in palliative care are necessary to reduce the risk of painful shocks and distress during the end of life.
Abstract 18178: Should We Screen for S-ICD Vectors in Hypertrophic Cardiomyopathy Post-Myectomy?
Authors: Bhatia Unnati , Mehta Nishaki M
Published: December 2023

Case Description:
We describe a 40 year old Asian male with hypertrophic cardiomyopathy (HCM) who presented after an inappropriate shock from his subcutaneous ICD (S-ICD) but was otherwise asymptomatic. The device was placed 4 months ago for secondary prevention of sudden cardiac death (SCD). He underwent a septal myectomy 2 months prior to presentation for severe LVOT obstruction. EKG showed sinus rhythm with new post-myectomy LBBB. Troponins were normal. Device interrogation revealed a wide complex rhythm consistent with sinus tachycardia with LBBB and evidence of T-wave oversensing (TWOS). The S-ICD was turned off and no further arrythmias were seen on continuous telemetry. Subsequent vector rescreening reflected ineligibility for S-ICD, most likely due to altered QRS morphology post-myectomy. Accordingly, the S-ICD system was extracted and a dual chamber transvenous ICD was placed. Patient noted to be doing well at 3 months follow up.

Discussion:
S-ICD is a safe and effective alternate to transvenous ICDs to prevent SCD in patients with HCM, especially those with a long life-expectancy. The pre-implant automated screening tool generates 3 sensing vectors. Screening is done to ensure at least 1 vector with suitable EKG morphology as low amplitude vectors and low R:T ratios increase risk of oversensing. However, post-surgical changes can alter the QRS morphology as seen above. This can significantly impact the screening process. Currently, there are no guidelines for rescreening. We propose rescreening in the setting of significant QRS changes (especially post-operatively) to reduce the risk of oversensing and undersensing in high risk populations.
Abstract 18179: Metabolic Biomarker Signatures for Incident Heart Failure Hospitalisation Compared to Different Types of Cardiovascular Events: Evidence From NMR Metabolomics in 250,000 Individuals
Authors: Wurtz Peter , Julkunen Heli , Lundgren Sara , Schut Kirsten , Kerminen Sini , Barrett Jeffrey
Published: December 2023

Introduction:
Metabolomic biomarker profiling by Nuclear Magnetic Resonance (NMR) is a powerful technique to examine molecular signatures for heart failure risk and clarify pathological differences to cardiovascular outcomes.

Hypothesis:
Blood lipids and metabolite biomarkers may differ in how they relate to prediction of heart failure vs coronary and stroke outcomes.

Methods:
We measured detailed plasma lipids and metabolites by NMR metabolomics in ~250,000 individuals from UK Biobank. We assessed shared and discordant biomarkers for heart failure hospitalisation in relation to myocardial infarction, ischemic stroke, peripheral artery disease, cardiac arrest and cardiovascular death. During 10 years of follow-up, 7.800 incident heart failure hospitalisation events occurred and 5-10.000 incident events for cardiovascular outcomes.

Results:
The overall pattern of biomarker associations differed for heart failure compared to for example, myocardial infarction, with biomarkers of LDL metabolism and apolipoprotein being especially discordant (Figure). In contrast, biomarkers of chronic inflammation and circulating fatty acids were concordant for the risk of heart failure and myocardial infarction. There were also prominent differences in the metabolic biomarker signatures for the risk of different types of cardiovascular diseases, such as between chronic ischemic heart disease, and different types of stroke. The biomarker association magnitudes were strongest for cardiovascular mortality and especially strong for short time to event onset.

Conclusions:
Heart failure and different cardiovascular endpoints have partly different metabolic biomarkers signatures. These may represent pathophysiological differences and have relevance for cardiovascular risk prediction, especially if using the five-point major adverse cardiovascular event definition.
Abstract 18197: Relationship Between Donor Ejection Fraction and Left Ventricular Wall Thickness With Mortality Among Heart Transplants Recipients
Authors: Zoni Cesar R , Dean Matthew , Copeland Laurel , Silverman Julia , Lemoine Christopher D , Mahajan Aviral , Sai Sudhakar Chittoor , Ravi Yazhini
Published: December 2023

Introduction:
Limited availability of donor hearts contributes to significant mortality in patients waitlisted for heart transplantation (HTx). Donor hearts with reduced ejection fraction (EF) and left ventricular hypertrophy are considered to adversely affect long term HTX outcomes and are rejected.

Objective:
To determine the relationship of donor’s EF and left ventricular wall thickness (LVWT) with mortality in HTx recipients.

Method:
Retrospective analysis from The United Network for Organ Sharing (UNOS) registry. Adult HTx recipients with donor's EF and LVWT recorded from 2006 to 2022 were included. Study sample was grouped into four groups (Group 1 EF>50% & LVWT<1.4cm, group 2 EF≤50% & LVWT<1.4cm, group 3 EF>50% & LVWT≥1.4cm, and group 4 EF≤50% & LVWT≥1.4cm) according to donor characteristics. Primary end point: mortality (30 days, 1 year, and 5 years).

Results:
21,012 patients were included, in which 19,205(91.4%) were in group 1, 898(4.3%) in group 2, 867(4.1%) in group 3, and 42(0.2%) in group 4. There were significant differences in baseline characteristics between the groups (Table 1). Unadjusted mortality was 6.3%, 6.0%, 6.0%, and 2.4% (p=0.86) at 30 days; 16.2%, 13.5%, 16.8%, and 7.3% (p=0.08) at 1 year; and 32.2%, 29.2%, 35.4%, and 29.0% (p=0.18) at 5 years, respectively (Table 1 and Figure 1). Neither adjusted mortality was different across the groups (Table 2).

Conclusion:
There were no significant differences in recipient mortality in different groups based on donor EF and LVWT. Expanding the donor selection criteria would allow for increase in the donor pool and assist in decreasing the mortality, while on the wait list for HTx.
Abstract 18200: Prognostic Importance of Serial NT-proBNP Measurements Following High-Risk Mi: The PARADISE-MI Trial
Authors: Jering Karola , Claggett Brian , Pfeffer Marc A , Granger Christopher , Kober Lars , Lewis Eldrin F , Maggioni Aldo Pietro , Mann Douglas , McMurray John J , PRESCOTT Margaret , Rouleau Jean L , Solomon Scott , Steg Philippe G , von Lewinski Dirk , Braunwald Eugene
Published: December 2023

Introduction:
N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a potent predictor of heart failure (HF) and death following myocardial infarction (MI). NT-proBNP levels change post MI.

Hypothesis:
Serial measurements of NT-proBNP add prognostic information.

Aims:
To investigate the prognostic importance of NT-proBNP two weeks after MI in PARADISE-MI and to identify predictors of week 2 NT-proBNP.

Methods:
Patients with MI and LVEF ≤40% and/or pulmonary congestion (n=5661) were randomized to sacubitril/valsartan or ramipril. Patients with NT-proBNP measured at week 2 (n=1057) were analyzed. Associations of week 2 NT-proBNP with subsequent clinical outcomes were evaluated with Cox models adjusted for baseline NT-proBNP, age, sex, atrial fibrillation (AF), LVEF, STEMI presentation, BMI, eGFR, high-sensitivity troponin T (hs-cTnT), time from presentation to randomization and treatment assignment.

Results:
Median NT-proBNP was 1425 [685, 2598] ng/L at week 2, declining 23% (95% CI, 20-26%) from baseline. Patients in the highest NT-proBNP quartile at week 2 (≥2616 ng/L) were older, had lower LVEF and eGFR, higher Killip class, more AF, and higher baseline NT-proBNP (all p≤0.05). Higher NT-proBNP at week 2 was independently associated with greater risk of CV death or incident HF (adjusted HR [aHR] 1.62 per log2; 95% CI, 1.30-2.03), HF hospitalization (aHR 1.96; 95% CI, 1.46-2.62) and all-cause death (aHR 1.86; 95% CI, 1.40-2.47). Higher baseline NT-proBNP and hs-cTnT, longer interval between presentation and randomization and female sex were associated with higher week 2 NT-proBNP levels while sacubitril/valsartan was associated with lower levels (Table).

Conclusions:
Patients with elevated NT-proBNP two weeks after high-risk MI are at greater risk of subsequent death or incident HF, even after adjusting for baseline level. Higher baseline NT-proBNP and hs-cTnT are predictive of higher week 2 NT-proBNP while sacubitril/valsartan decreases levels.
Abstract 18202: Sex Differences in Transthyretin Amyloid Cardiomyopathy
Authors: Jefferson Artrish , Vaishnav Joban , Sharma Kavita , Gilotra Nisha A , Polydefkis Michael , Ranek Mark J , Hubbard Abby , Yanek Lisa , Shankar Bairavi
Published: December 2023

Introduction:
Transthyretin amyloid cardiomyopathy (ATTR-CM) predominantly affects men. It is unknown if women are underdiagnosed or if female sex is protective. We investigated sex differences in clinical presentation and disease outcomes in ATTR-CM.

Methods:
Patients seen with ATTR-CM at our institution were included for analysis. Chi-squared or Fisher’s exact tests, and Wilcoxon tests were used to assess associations between clinical variables and sex in the overall cohort as well as by genotype (wtATTR and V122I). Hazard ratios with 95% confidence intervals were used to assess outcomes.

Results:
Of 293 subjects, 235 (80%) were men and 58 (20%) were women. Women vs men were more likely Black in the entire cohort (65% v 39%) and in the wtATTR group (70% v 8.7%, p<0.05). Women were significantly older in wtATTR (84 [6.6] v 79 [7.2] yrs) and V122I (75 [6] v 71 [8.3] yrs), had higher HR (83 v 75 bpm), lower eGFR (54 v 62 mL/min/1.73 m2), and thinner intraventricular septum diameter (1.54 [0.3] v 1.71 [0.3] cm) than men at time of diagnosis (p<0.05). Women with wtATTR had significantly higher mean RAP (14.8 [6.9] v 8.69 [4.8] v mmHg, p<0.05) and a trend toward higher PASP (55.5 [17.0] v 42.9 [12.8] and PCWP (22.5 [6.7] v 17.3 [6.4] mmHg, p=0.06) vs men. There was no difference in HF hospitalization or death at 5 years (HR 0.93 [0.59-1.45], p=0.70) and no significant increase in proportion of women diagnosed over disease eras (pre-2013, 2013-2018, and 2019-2023).

Conclusions:
In a well characterized cohort with ATTR-CM, women were diagnosed less frequently and at an older age with markers of more advanced disease including higher HR, worse renal function, and higher filling pressures compared to men. Disease recognition in women did not increase over time. While this may be due to the nature of the disease, the characteristics we identified at diagnosis support that women with ATTR-CM are under detected. Future sex-based screening studies are needed to increase detection of ATTR-CM in women.
Abstract 18209: The Association Between Lp(a) and Low-Density Plaque Volume is Not Modified by CRP
Authors: Fisher Rebecca , Nurmohamed Nick , Malick Waqas A , Aquino Melissa , Min James K , Earls James P , Goonewardena Sascha N , Fisher Edward A , Rosenson Robert S
Published: December 2023

BACKGROUND:
Inconsistent data have suggested an interaction between Lp(a) and hs-CRP levels, putting patients with concomitant elevation at the greatest risk for atherosclerotic cardiovascular events. To date, the association between Lp(a), systemic inflammation as measured by hs-CRP, and coronary plaque phenotype has not been unraveled.

METHODS:
Among consecutive asymptomatic patients evaluated for primary prevention of coronary artery disease, we explored the associations between Lp(a), hs-CRP and coronary atherosclerosis using atherosclerosis imaging-quantitative coronary CT angiography (AI-QCT; Cleerly Labs, Cleerly Inc., Denver,CO). The associations between Lp(a), hs-CRP and the AI-QCT outcomes defined as percent atheroma volume (PAV) as well as percent low-density non-calcified plaque volume (LD-NCPV) were assessed using multivariable linear regression adjusted for clinical risk factors.

RESULTS:
The mean age of the 373 included patients was 56.2 ± 8.9 years, 71.6% were male, and 54.2% was on statin therapy. Mean±SD LDL-C was 106 ± 41 mg/dl, median (IQR) Lp(a) was 31 (11, 89) nmol/L, while median hs-CRP levels were 0.8 (0.4, 1.8) mg/L. In the multivariable-adjusted analysis, Lp(a) levels were significantly associated with an increase in PAV (0.367 increase in PAV per 100 nmol/l increase in Lp(a), p=0.026) and percent LD-NCPV (0.018 increase in PAV per 100 nmol/l increase in Lp(a), p=0.031). However, there was no effect of adding hs-CRP to the models (p=0.446), and we observed no direct relationship between hs-CRP and PAV (p=0.446) or percent LD-NCPV (0.871). Table 1.

CONCLUSIONS:
Lp(a) is associated with low-density non-calcified plaque and total coronary plaque burden. The current study found no impact of hs-CRP on these associations, nor were hs-CRP levels associated with plaque burden.
Abstract 18210: Renal Denervation in Management of Heart Failure: A Systematic Review and Meta-Analysis
Authors: Mai Steven L , mushtaq muhammad , Patel Chandani , Rasmussen Peter , Dang Alexander , Tomcho Jeremy C , Khalife Wissam
Published: December 2023

Introduction:
Renal denervation (RDN) is a novel intervention targeting sympathetic nerves along the renal artery. Ablation of this neurohormonal pathway alters the pathophysiology of heart failure (HF) and can lead to improvements in clinical outcomes. We conducted a systematic review and meta-analysis to review the outcome of heart failure patients undergoing RDN.

Methods:
We performed a comprehensive search on PubMed, Cochrane, and Embase from inceptions through June 2023 using the string “(“renal denervation” OR “renal sympathetic denervation “) AND (“heart failure” OR “congestive heart failure”)”. Exclusion criteria include non-human trials, studies without a baseline and control, and studies without outcomes of interest. We collected the number of patients with HF and the resulting outcomes. Outcomes of interest include left ventricular ejection fraction (LVEF), six minute walk distance (SMWD), NT- proBNP, and systolic and diastolic pressures. The random-effects model was used to calculate the odds ratios (OR), mean differences (MD), and confidence intervals (CI). A p value <0.05 was considered statistically significant. Heterogeneity was assessed using the Higgins I2 index.

Results:
Nine randomized control trials involving a total of 513 patients were included in our analysis. We found a significant difference when comparing the RDN group to the control groups for LVEF (MD 1.39, 95% CI [0.03,2.75]), SMWD (MD 200.13 m, 95% CI [187.32,212.95]), NT-proBNP (MD -397.16 pg/ml, 95% CI [-438.90, -355.42]), SBP (MD -3.69 mmHg, 95% CI [-7.24, -0.14]) within 12 months. Interestingly, difference in DBP was insignificant (MD -1.13 mmHg, 95% CI [-3.33,1.07]). Our RDN group had a significant decrease in hospital admissions (OR 0.83, 95% CI [0.25,2.77]) for HF exacerbation within 12 month following denervation. When comparing RND to baseline, we found a significant difference in LVEF (MD 1.90, 95% CI [0.64,3.16]) and SMWD (MD 106.56 m, 95% CI [88.72,124.40]).

Conclusions:
Our analysis demonstrates RDN results in a significant difference in LVEF, SMWD, NT-proBNP, and SBP in patients with HF when compared to control and baseline. However, further research is needed with larger samples to establish the safety and effectiveness of RDN as a viable therapy in HF.