bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17475: Intravascular Ultrasound versus Angiography in Percutaneous Coronary Interventions: A Meta-Analysis Unveiling Compelling Evidence of Ultrasound's Superiority
Authors: Abouzid Mohamed R , Ali Karim , Ali Ahmed , Ali Khaled , El-Helw Mohamed
Published: December 2023

Objective:
This meta-analysis aims to compare the effectiveness of intravascular ultrasound (IVUS) versus angiography alone in percutaneous coronary intervention (PCI) procedures.

Methods:
A comprehensive literature search was conducted to identify relevant studies comparing IVUS-guided PCI with angiography-guided PCI. The primary outcome measure was major adverse cardiac events (MACE) including cardiac death, myocardial infarction, and target vessel revascularization. Secondary outcomes included all-cause mortality, stent thrombosis, and angiographic outcomes.

Results:
A total of 41 eligible studies involving 712635 patients were included in the meta-analysis. IVUS-guided PCI was associated with a significantly lower risk of MACE compared to angiography-guided PCI (pooled odds ratio [OR] 1.38, 95% confidence interval [CI] 1.24-1.53, p<0.00001). The use of IVUS also resulted in a lower risk of all-cause mortality (pooled OR 1.61, 95% CI 1.41-1.83, p<0.00001) and reduced rates of stent thrombosis (pooled OR 2.28, 95% CI 1.82-2.86, p<0.00001) and TVR (pooled OR 1.31, 95% CI 1.21-1.42, p<0.00001).

Conclusion:
This meta-analysis provides evidence supporting the use of IVUS-guided PCI over angiography-guided PCI. IVUS-guided procedures were associated with reduced MACE rates, improved procedural success, decreased stent thrombosis, and superior angiographic outcomes. The findings suggest that incorporating IVUS into PCI procedures may lead to improved clinical outcomes and more optimal stent deployment. However, further studies are warranted to explore potential subgroup differences and to evaluate the cost-effectiveness of IVUS-guided PCI.
Abstract 17479: Angiographic Factors Influencing Treatment Decisions in Pediatric Brain Arteriovenous Malformation (pAVM): Insights From Cart Analysis
Authors: Tusa Lavieri Miguel , Aguilera-Pena Maria Paula , Quintero Consuegra Miguel D , Joseph Benson , Chang Daniel , Nisson Peyton , Danielpour Moise , Gonzalez Nestor R
Published: December 2023

Introduction:
Pediatric cerebral AVM (pAVM) are the most common cause of hemorrhagic stroke in children. Their optimal management approach remains controversial. Determining the angiographic factors that impact outcomes for the various treatment strategies is crucial.

Hypothesis:
To identify angiographic factors for modality-treatment decision-making

Methods:
Cross-sectional study of patients diagnosed with pAVM at a pediatric stroke center between 2016 and 2021. Patients’ demographics, angiographic characteristics (volume, location, nidal aneurysms, non-plexiform rapid fistulas, venous drainage, and nidus diffuseness), treatment, and clinical outcomes were collected. Classification and Regression Tree Analysis (CART) was used to identify impactful angiographic factors, multivariate regression was applied to evaluate their significance in treatment decision-making.

Results:
Thirty-seven consecutive patients were included, 25 were male, with a median age of 10.3 years (IQR 7.9-13.3). Median follow-up was 30.3 months (IQR 8.6-53.8). Twenty patients presented with a ruptured pAVM. Endovascular embolization was the most common treatment (19, 51.4%), followed by radiosurgery (14, 37.8%), and observation (8, 21.6%). Twenty-seven patients (81.8%) had improved or stable functional neurologic status at last follow-up, and six (18.2%) declined (none of them by more than one point on the mRS). Only one patient had post-treatment hemorrhage during follow-up.The angiographic features associated with specific treatments were: the presence of non-plexiform rapid fistulas (endovascular in 94.0% of patients p=0.01), basal ganglia or pons location (excluded from endovascular in 86% of patients p=0.30), absence of a nidal aneurysm (radiation in 98% p=0.03). CART did not identify other potentially impactful angiographic factors.

Conclusions:
Our study shows generally favorable outcomes and low complication rates in pAVM patients who underwent multimodal treatment. The presence of non-plexiform rapid fistulas and nidal aneurysms should be considered when determining the appropriate treatment approach. Further prospective confirmatory analyses are warranted.
Abstract 17527: Plasma Proteomic Representations of Central Hemodynamics Over Time in Heart Failure
Authors: Egerstedt Anna , Czuba Tomasz , Lundgren Jacob , Lejonberg Carl , Braun Oscar O , Radegran Goran , Gidlof Olof , Gerszten Robert E , Smith Gustav
Published: December 2023

Introduction:
Perturbation of central hemodynamic parameters are defining features in heart failure (HF) and strong prognostic factors, including increased filling pressures, reduced cardiac output (CI), extended blood circulation times and increased peripheral oxygen extraction (ΔAVO2). Invasive catheterization is used for precise assessment of central hemodynamics.

Hypothesis:
We postulated that plasma proteins may serve as non-invasive representations of central hemodynamics in HF patients.

Methods:
Affinity-based plasma proteomic profiling of 1305 proteins was applied to a cohort of patients with advanced HF undergoing invasive cardiac catheterization before and 6 months after heart transplantation. A total of 30 central hemodynamic parameters were measured and calculated. Protein profiles associated with central hemodynamics over time were identified from repeated-measures models.

Results:
We identified 1304 associations for 201 unique proteins meeting our Bonferroni-adjusted significance threshold (p<1x10-6) for at least one hemodynamic parameter. Most of the 201 proteins were associated with more than one parameter. Most proteins (70%) associated with parameters in more than one of five domains (filling pressures, left ventricular (LV) function, right ventricular (RV) function, systemic arterial function, pulmonary arterial function). No proteins were associated with 6 of the 30 hemodynamic parameters, which changed little after transplantation and related to arterial function or RV function. The largest number of protein associations were observed for RAP, cardiac power index, left ventricular stroke work index, and ΔAVO2 followed by systolic blood pressure, CI, and PAWP (>80). These include expected associations of natriuretic peptides, ST2 with LV function, filling pressures and of angiotensinogen with vascular function parameters. We further describe the discriminatory ability of identified proteins for clinically relevant differences in key hemodynamic parameters.

Conclusions:
We have identified circulating biomarkers to non-invasively monitor central hemodynamics in HF over time. Our findings may also inform understanding of pathways involved in HF pathophysiology and circulatory regulation.
Abstract 17542: Impact of New-Onset Atrial Fibrillation Detected by Cardiac Implantable Electronic Devices on Embolic Stroke Events
Authors: Nakano Miyo , Kondo Yusuke , Nakano Masahiro , Kajiyama Takatsugu , Ito Ryo , Chiba Toshinori , Sugawara Masafumi , Yoshino Yutaka , RYUZAKI SATOKO , Komai Yuya , Takanashi Yukiko , Kobayashi Yoshio
Published: December 2023

Background:
The association between atrial fibrillation (AF) detected by implanted cardiac implantable electronic devices (CIEDs) and the incidence of embolic stroke has been reported. However, the cut-off value of new-onset AF duration detected by CIEDs for embolic stroke is still unknown. In previous studies regarding the cut-off value of AF duration, patients who had a history of AF or had received anticoagulant therapies were also included. Therefore, the solo effect of AF on the risk of embolic stroke cannot be reliably evaluated on these studies. The aim of this study is to identify the incidence of embolic stroke in Japanese patients with a CIED and examine the cut-off value of AF duration detected by CIEDs as a risk factor for embolic stroke.

Methods:
We retrospectively analyzed the database of our CIEDs clinic. Every 6 months, AF events were checked by CIEDs. Patients who had a history of AF or had received anticoagulant therapies before and after a CIED implantation were excluded. We examined the characteristics and incidence of embolic stroke and investigated the relationship between new-onset AF detected by CIEDs and the incidence of embolic stroke.

Results:
We enrolled 710 consecutive patients who were followed-up at our CIED clinic. We excluded 360 patients who had a history of AF or had received anticoagulant therapies. Finally, 350 patients (follow-up period, 75±58 months; age, 70±16 years) were included in this study. During the follow-up period, 24 patients (6.9%) had embolic stroke. Receiver-operating characteristic curve analysis confirmed that 30 seconds was the best cut-off value of AF duration detected by CIEDs for embolic stroke (AUC = 0.72). Multivariate analysis demonstrated that independent predictors for embolic stroke were left atrial diameter ≥40mm (p=0.019), new-onset AF ≥ 30 seconds (p = 0.0016).

Conclusion:
AF episodes lasting for ≥ 30 seconds was the risk factor of embolic stroke. We should evaluate AF burden carefully in this population.
Abstract 17555: Are Intermittent BP Control and Patient Complexity Barriers to Antihypertensive Treatment Intensification for Uncontrolled BP?
Authors: Egan Brent M , Martin Ben , Wagner Shaun , Ramsey David , Davis Rob , Myftari Klodiana , Sutherland Susan E , Rakotz Michael
Published: December 2023

Background:
Antihypertensive (AH) therapeutic intensification (TI) is the exception even when systolic blood pressure (SBP, mmHg) is ≥160. Adults with hypertension (HTN) often have multiple chronic conditions (CCs) and wide intra-individual BP variability. Patient complexity and intermittent control to <140/<90 may contribute to low rates of AH TI.

Methods:
The study included 119,260 adults 18-85 years with a HTN diagnosis and ≥3 encounters with BP values in the past 2 years (01/01/20-12/31/22). SBP on the last recent visit, number (n) and percent (%) of patients by SBP group on the last visit, number of Elixhauser chronic conditions (ECC), % of visit in the past 2 years with BP <140/<90, and % of last visits with AH TI (addition of a new BP med class) are provided in the Table.

Results:
The main results are shown in the Table. The rate of TI correlated with the % of visits with uncontrolled BP in the past 2 years when controlling for number of CC (partial r=0.046, p<0.0001) and inversely with CC when controlling for SBP (partial r = -0.039, p<0.0001). Adjusted odds ratios (OR) for percent of visits controlled and TI was 1.697 (95% CI [1.577, 1.826]) when controlling for age, SBP, and number of chronic conditions. OR was 0.933 (95% CI [0.925, 0.942]) for number of chronic conditions and TI, controlling for SBP and % visits controlled.

Conclusion:
Hypertension control varies, even among groups with last SBP <120 or ≥160. In fact, BP in adults with last SBP ≥160, BP was <140/<90 on nearly one third of visits in the prior two years, which may contribute to the fact that TI occurred on only one in four visits in this group. However, patient complexity (ECC) was not a barrier to TI in this patient cohort.
Abstract 17568: Myocardial Infarction Modifies the Effect of Food Insecurity on Diabetes-Related Mortality
Authors: Banerjee Sri , Radak Tim , Dunn Patrick , Gonzales-Lagos Rafael
Published: December 2023

Introduction:
Food Insecurity continues to be a public health problem that requires attention. A quarter of households have experienced food insecurity in their lifetime.

Hypothesis:
In this study, we will determine how myocardial infarction increases the effect of food insecurity among diabetes-related mortality.

Methods:
The National Health and Nutrition Examination Survey (NHANES) is a survey completed by non-institutionalized population of the U.S. All respondents from the NHANES survey, who were 20 years or older between the years 1999-2010 were included in the analysis with follow-up through 2019. Self-reported information was used for USDA Food Security Survey. Analysis was performed using complex samples Cox regression to determine the relationship of food insecurity on diabetes-related mortality and how myocardial infarction influences this.

Results:
Percent mortality among individuals with diabetes was 6.11% among males and 5.67% among females with mean follow-up of 13.7 years. For diabetes-related mortality, the crude hazard ratio (HR) for food insecurity was 1.42 (95% confidence interval [CI], 1.03-1.95 p = 0.03). The adjusted HR was elevated, 2.66 (CI 1.05-6.78, p = 0.04), among food insecure individuals who had myocardial infarction (MI) but close to 1.0 (1.33 CI 0.99-1.79, p = 0.06) among food insecure individuals who had no MI infarction, after adjusting for medical (tobacco use) and demographic risk factors (poverty-income-ratio, age, gender, ethnicity).

Conclusions:
We found that not only food insecurity leads to higher diabetes-related mortality, but also MI occurrence affects this relationship. Prevention programs for food insecurity are especially important with comorbidities to implement social change.
Abstract 17569: Changes in Adherence to “Life’s Essential 8” and Subsequent Risk of Cardiovascular Disease
Authors: Chen Zhangling , Li Wenjuan , Zhou Shenghua , Xing Aijun , Wu Shouling
Published: December 2023

Introduction:
The American Heart Association recently released an updated algorithm for evaluating cardiovascular health (CVH)—Life’s Essential 8 (LE8). However, very few studies have evaluated associations between changes in LE8 score over time and risk of cardiovascular disease (CVD).

Hypothesis:
We hypothesized that improving adherence to LE8 score over time was associated with lower CVD risk.

Methods:
We examined associations between 6-year changes (from 2006 to 2012) in LE8 score (score range, 0-100) and risk of CVD, including heart disease and stroke (from 2012 to 2020). Participants were 53328 Chinese adults from the Kailuan Study who were free from CVD in 2012. Diet, lifestyle and health conditions were repeatedly assessed every 2 years. The LE8 score was calculated based on scores for 8 components: diet quality, physical activity, smoking status, sleep health, BMI, blood lipids, blood glucose, and blood pressure. We used Cox proportional-hazard models to estimate hazard ratios (HRs) with adjustment for age, sex, alcohol intake, education, income, and family history of CVD.

Results:
We documented 4264 incident CVD cases (2159 heart disease and 2311 stroke) (some individuals had both heart disease and stroke) during a median of 7.7 years of follow-up. Compared with participants whose LE8 scores remained stable, those with the largest increase of LE8 score had a 30% lower CVD risk, 30% lower heart disease risk, and 28% lower stroke risk (HR and 95%CI: 0.70 (0.63, 0.78) for CVD, 0.70 (0.61, 0.82) for heart disease, 0.72 (0.63, 0.83) for stroke); while participants with the largest decrease had a 47%, 57%, and 35% higher risk for CVD, heart disease, and stroke, respectively. Each 10 points increase of LE8 score was associated with 27%-29% lower risk for these diseases. Similar results were observed in secondary analyses of 4-year changes (2006 - 2010) and 8-year changes (2006 - 2014) in LE8 score with CVD risk. These associations persisted in subgroup analysis stratified by risk factors of CVD.

Conclusions:
Improving adherence to LE8 score over a 6-year period was associated with lower risk of CVD, heart disease, and stroke, whereas decreased adherence to LE8 score was associated with higher risk. These findings support greater adherence to LE8 for improving CVH.
Abstract 17589: Efficacy of Sacubitril-Valsartan Compared With Angiotensin-Converting Enzyme Inhibitor or Angiotensin-Receptor Blocker for Preventing Atrial Fibrillation Recurrence After Catheter Ablation: A Systematic Review and Meta-Analysis
Authors: Lucena Larissa A , Freitas Marcos , Guida Camila , Souza Ana C , de Sousa Júlio César V , Saraiva da Silva Maia Ferdinand Gilbert
Published: December 2023

Introduction:
Among patients with atrial fibrillation (AF) who underwent catheter ablation, it is unclear whether AF recurrence is lower in those who receive Sacubitril-Valsartan (SV) than in those who receive ACEi (angiotensin-converting enzyme inhibitor) or ARB (angiotensin-receptor blocker).

Hypothesis:
Is SV more effective than ACEi/ARB in decreasing AF recurrence after catheter ablation?

Methods:
We systematically searched PubMed, Embase, and Cochrane Library for randomized controlled trials (RCTs) and propensity-matched cohorts (PMC), evaluating the efficacy of SV for preventing AF recurrence in patients who underwent catheter ablation. The outcomes of interest were AF recurrence and structural remodeling, assessed by Left Ventricular Ejection Fraction (LVEF) and Left Atrial Volume Index (LAVi). Statistical analysis was performed using RevMan 5.1.7. Heterogeneity was assessed with I
2
statistics.

Results:
We included 2 RCTs and 1 PMC, comprising 517 patients, of whom 256 were treated with SV, 101 received ARB, and 155 ACEis. AF recurrence was significantly lower in the SV group (RR 0.50; 95% CI 0.37-0.68; p<0.00001; I
2
=0%; Figure 1A), even considering only RCTs (RR 0.55; 95% CI 0.34-0.91; p=0.03; I
2
=0%). Also, SV was associated with a significant decrease in LAVi (MD -5.34 mL/m
2
; 95% CI -8.77 to -1.91; p=0.002; I
2
=57%; Figure 1B) compared to ARB. LVEF was similar between groups (MD 1.24 %; 95% CI -0.12 to 2.60; p=0.07; I
2
=0%).

Conclusions:
SV therapy was associated with a decreased risk of AF recurrence compared to ACEi or ARB, and was superior to ARB in attenuating atrial structural remodeling in patients submitted to catheter ablation.
Abstract 17598: Low Socioeconomic Status Leads to Higher Cardiovascular Mortality in the United States
Authors: Banerjee Sri , Gonzales-Lagos Rafael , Dunn Patrick
Published: December 2023

Introduction:
Lower socioeconomic status can lead to chronic disease. However, there is a dearth of information as to how it pertains to organ-specific mortality.

Hypothesis:
In this study, we determined if there was a connection longitudinally between poverty-income-ratio (PIR) and cardiovascular mortality

Methods:
We conducted a study which assessed for all adult (≥ 20 years) individuals from the 1999-2010 National Health and Nutrition Examination Survey, which is a population-based survey conducted with cardiovascular mortality data obtained through December 2019. All individuals from this were living in the United States. Socioeconomic status was determined using total family income divided by the poverty threshold (≤1 versus >1). Comparisons were analyzed using Complex Samples Cox regression to determine the relationship of poverty-income-ratio and cardiovascular mortality.

Results:
Data was available for 13,680 adults in the United States population. Mean time period of males (8.3 years (CI 8.0-8.5) who experienced death was higher than the mean time period among females 8.8 years (CI 8.6-9.0). The overall age-adjusted, sex-adjusted hazard ratio for high PIR to low PIR is 1.73 (1.39-2.16, p < 0.01). The adjusted HR remained strong at 1.98 (CI 1.18-3.33, p < 0.01) among adults after the results were controlled for medical (obesity, depression) and demographic (gender, age, and ethnicity) risk factors.

Conclusions:
There is a significant relationship between low socioeconomic status and cardiovascular mortality among all adults. Consequently, individuals with cardiovascular disease need to be better screened for social determinants of health.
Abstract 17602: Cardiac Structure and Function and Renal Outcomes in Patients With Heart Failure With Preserved Ejection Fraction: Insights From the PARAGON-HF Trial
Authors: Lu Henri , Chatur Safia , Inciardi Riccardo M , Abanda Martin , Mc Causland Finnian R , Shah Amil M , Cikes Maja , Claggett Brian , Prasad Narayana , Lam Carolyn S , OMeara Eileen , McMurray John J , Hegde Sheila , Solomon Scott , Skali Hicham
Published: December 2023

Introduction:
Chronic kidney disease is common and associated with a worse prognosis in patients with heart failure (HF). However, the association of cardiac structure and function with renal outcomes in patients with HF with preserved ejection fraction (HFpEF) is not known.

Goal:
Identify cardiac structural and functional correlates of renal outcomes in HFpEF.

Methods:
Patients enrolled in the echocardiographic sub-study of the PARAGON-HF trial were included. The endpoint of interest was a composite renal endpoint: a ≥50% decline in estimated glomerular filtration rate (eGFR) relative to baseline, development of end-stage renal disease, or death attributable to renal causes. Multivariable Cox proportional hazards models were used to identify measures of cardiac structural and functional parameters associated with the composite renal endpoint, adjusting for baseline eGFR, systolic blood pressure, NT-proBNP, treatment arm (sacubitril-valsartan or valsartan) and diabetes.

Results:
In 1,097 patients (53% women, mean age 74±8 years), over a median follow-up of 2.9 years (IQR 2.6-3.4 years) there were 28 composite renal events (0.9 per 100 patient-years). After multivariable adjustment, higher left ventricular (LV) posterior wall thickness and mass index, right ventricular (RV) end-diastolic and end-systolic areas as well as impaired RV function (lower fractional area change and lower absolute RV free wall longitudinal strain), but not LV systolic function (LVEF and global longitudinal strain) were each associated with a significantly higher risk for the composite renal endpoint (
Figure
).

Conclusions:
In the PARAGON-HF echocardiographic sub-study, evidence of cardiac biventricular remodeling and deterioration of RV function were associated with an increased risk of renal events. These results underscore the close relationship between the heart and kidneys in patients with HF even when LVEF is preserved.
Abstract 17603: Novel Cardiac Dynamics Modeling of Clinical Cardiac MRIs Can Identify Who Has Clonal Hematopoiesis of Indeterminate Potential With High Accuracy
Authors: Zappala Emanuele , Cross James , Christofides Anthos , Matute Martinez Carlos , Jayakrishnan Ritujith , Im Yunju , Ferrigno Guajardo Ana , Ahn Shawn , Jha Alokkumar , Halene Stephanie , VanOudenhove Jennifer , Van Dijk David , Kwan Jennifer M
Published: December 2023

Background:
Clonal hematopoiesis of indeterminate potential (CHIP) has been shown to be an independent risk factor for heart disease, heart failure and is associated with aging. CHIP is diagnosed by DNA sequencing of blood. It is unclear whether imaging can help predict who has CHIP, which would then be able to help stratify patients at risk for adverse cardiovascular events.

Hypothesis:
We investigated whether use of cardiac dynamics modeling on routine cardiac MRI (CMR) would be able to help 1) predict who has CHIP and 2) predict age of the patient

Methods:
Whole exome sequencing of peripheral blood DNA and subequent analysis on our somatic variant pipeline using MUTECT2 was used to identify those who had CHIP. Using dynamical modeling based on neural integral equations, dynamic imaging assessment of the cine images of the CMRs were used to identify CHIP and age of the myocardium using both supervised and unsupervised approaches.

Results:
We identified 98 unique patients with both CMR and CHIP status and found that 40 (41%) had CHIP. Majority were female 65 (66%) and there was no significant difference in median age between CHIP vs no CHIP patients (69, IQR 62-78 vs 65, IQR 54-72). There were no significant differences in co-morbidities between those with CHIP or no CHIP, including CAD, diabetes, hypertension, heart failure. Dynamic imaging was able to predict CHIP with 74% accuracy (Figure) with an unsupervised approach and above 90% accuracy with a supervised approach. In addition, this technique was able to accurately predict the age of the patient with accuracy within 1 year of the patient’s age (standard deviation of 0.0012 years) at the time of the MRI, using a supervised approach.

Conclusions:
Cardiac dynamics modeling is a promising deep learning technique that can both accurately classify CHIP and age. Ongoing work shows promise in predicting the outcome of cardiomyopathy using similar techniques. Ongoing validation is underway using a large cohort from UK Biobank.
Abstract 17612: Are There Changes in Cardiac Valve Morphology or Valve Disease Progression After CD19 CAR T-cell Therapy-Induced Cytokine Release Syndrome? An Echocardiographic Study
Authors: Daryanani Andres E , Santos Patarroyo Sebastian , Abbasi Muhannad , Collantes Diana , Ricaurte Carolina , Toro-Manotas Rafael , Paludo Jonas , Lin Yi , Villarraga Hector R
Published: December 2023

Background:
CD19 CAR T-cell therapy is a novel cancer treatment for B-cell malignancies. Systemic inflammation due to Cytokine Release Syndrome (CRS) can occur. Elevated levels of cytokines have been linked to valve damage.

Hypothesis:
Evaluate changes in valve morphology or progression of valvular heart disease in adult patients after CD19 CAR T-cell therapy and by clinical CRS grade.

Methods:
Patients that underwent CD19 CAR T-cell therapy with both a baseline and a post-treatment transthoracic echocardiogram (TTE) were included. Patient characteristics and outcomes were abstracted from the electronic medical record. CRS was categorized as CRS<2 and CRS ≥2 for all patients using the ASTCT 2019 criteria. Valve thickening was graded as a dichotomous variable. Valve disease (regurgitation or stenosis) was ranked on a 1-to-6-point numeric scale (none, mild, mild-moderate, moderate, moderate-severe, severe) and grade point value difference was calculated. Variables were compared by Chi Squared and Student’s t tests.

Results:
114 patients were included with a median TTE follow-up of 44 days, 54% developed CRS ≥2 (Table 1a). Overall, no statistically significant changes in valve morphology and valve disease progression were observed in the cohort (Figure 1a, 1b). Among CRS groups, valve morphology changes and valve disease progression were similarly distributed (21% in CRS <2 vs 19% in CRS ≥2, p=0.623 and 28% in CRS <2 vs 24% in CRS ≥2, p=0.62 respectively) (Fig. 1a). In the cases that progression was observed, it was mostly mild, and regurgitation was the most common pattern (Fig. 1c).

Conclusions:
This is the first study to evaluate the incidence of cardiac valve disease progression or thickening in patients treated with CD19 CAR T therapies. We can conclude that no progression of valve disease or changes in valve morphology were observed in its entirety or by CRS groups. Longer follow up is needed to validate these findings.
Abstract 17617: Toward Improving Diagnosis and Interventional Predictability in Aortic Valve Stenosis Using Computational Modeling
Authors: Govindarajan Vijay , Johnson Nils , Chandran Krishnan B , McPherson David D
Published: December 2023

Introduction:
Watchful waiting for symptoms or critical hemodynamics to intervene on aortic stenosis (AS) may delay too long. While stress tests can detect symptoms in allegedly asymptomatic AS patients, image-based computations based on advanced modeling techniques can provide critical biomechanical insights.

Hypothesis:
Advanced computational modeling techniques utilizing patient data backed by high-performance computing can inform a personalized understanding of disease progression, diagnosis, and anticipated post-op hemodynamics to predict interventional efficacy.

Methods:
A validated in-house Fluid-structure Interaction (FSI) algorithm that allows easy translation of patient-specific anatomies was utilized to perform "virtual stress test" on a moderate AS with increasing LV contraction to predict systolic ejection dynamics under stress. TAVR was virtually implanted and post-op aortic hemodynamics were quantitatively compared with pre-op (diseased) data.

Results:
Predictions demonstrated that that aortic flow turbulence in moderate AS (Re = 11,700) during exercise (115 bpm) can be similar to severe AS (Re=10,000) at rest (70 bpm) resulting in a greater dissipation losses rising linearly with heart rates. As LV contraction rose, each valve cusp underwent a distinct non-linear rise (>100%) in mechanical stresses that can accelerate calcification. Interestingly, our evaluation revealed that the heterogenous ΔP vs. Q relationship in AS observed clinically can be attributed to a non-linear rise in aortic valve area occurring during mid-systole. Aortic hemodynamics improved post-TAVR by reducing dissipation losses by ~11 fold and restoring near-normal peak-systolic velocity (1.7 m/s) in the ascending aorta.

Conclusions:
High-performance based multi-physics algorithms incorporating patient data might offer comprehensive biomechanical insights into diagnosis and interventional suitability for aortic valve stenosis.
Abstract 17620: Progressive Volume Retention Requiring an Increase in Loop Diuretic Use After Watchman Implant: A Retrospective Case Control Study
Authors: Parrott Clifton , Patel Nisha , Hicklin Harry , Hodges Edward , Bhave Prashant , Whalen S. Patrick , Zhao David X , richardson karl
Published: December 2023

Introduction:
Some patients with atrial fibrillation and high stroke risk cannot be anticoagulated. Percutaneous left atrial appendage occlusion (LAAO) is a potential alternative stroke risk reduction strategy. The LAA secretes ANP which has neurohormonal effects on fluid balance, but the effects of LAAO on clinical volume status remains uncertain.

Goals:
We expanded upon our prior data reporting a rise in diuretic use after LAAO by including a control cohort of patients without LAAO.

Methods:
Retrospective clinical data from patients who underwent LAAO at our institution from 2015-2020 with Watchman 2.5 (n=151, 38% female) and Watchman FLX patients from 2020-2022 (n=80, 31% female) were analyzed. A control group consisting of patients with atrial fibrillation who have not had LAAO were included (n=186, 38% female). Data extracted included demographics, loop diuretic dose, LVEF, and presence of HTN, CAD, PAD, DM, CKD, TIA/CVA. Progressive volume retention was defined as initiation or increase in loop diuretic dose within 12 months of LAAO, or within last 12 months from most recent cardiology visit for controls.

Results:
There was no significant difference in clinical variables between the two groups except for a significantly high proportion of TIA/CVA in LAAO group (p=0.003) and CKD and HF in the control group (p=0.031 and 0.004, respectively). Specifically, 49/231 (21.2%) of the LAAO cohort showed a rise in loop diuretic requirements compared to 27/186 (14.5%) of the controls (p = 0.078). There were 17/231 (7.4%) new loop diuretic prescriptions in the LAAO group compared to 6/186 (3.2%) for the controls (p = 0.066). In multivariable analyses controlling for age, sex, BMI, preimplant LVEF, prior HF, CKD, and LAAO, only age, prior HF, and LAAO predicted a rise in loop diuretic in subsequent year after implant. The strongest predictors were the presence of prior HF, OR 2.32 (95% CI 1.28-4.21, p = 0.005) and LAAO, OR 1.9 (95% CI 1.09-3.27, p = 0.023).

Conclusions:
These results suggest that LAAO is associated with an almost two-fold increased risk of clinically relevant volume retention. This risk appears to be highest among patients with a clinical history of HF. These findings may inform preimplantation discussions and post-LAAO expectations and clinical management.
Abstract 17625: Comparative Analysis of Mortality and Amputation Rates in Patients Undergoing Atherectomy for Infra-Popliteal Peripheral Arterial Disease: Insight From the VQI
Authors: Jamil Yasser , Nanna Michael , Ochoa Cassius I , Mena-Hurtado Carlos , Attaran Robert R
Published: December 2023

Introduction:
Infra-popliteal peripheral arterial disease (IPPAD) poses challenges due to complex vasculature. The BASIL-2 trial demonstrated superiority in endovascular treatment compared with surgical bypass in patients with IPPAD. However, the choice of endovascular modality has not been conclusive.

Hypothesis:
Combining plain balloon angioplasty (POBA)+atherectomy is associated with improved clinical outcomes compared to POBA.

Methods:
Patients that underwent POBA vs POBA+Atherectomy for IPPAD from the Vascular Quality Initiative database were identified. Propensity score matching (PSM) was employed to balance the distribution of confounding variables for mortality identified on multivariable logistic regression. Patient characteristics and long-term outcomes between the two treatment groups were compared.

Results:
A total of 10,494 individuals (74.6%) were treated with POBA, while 3,569 (25.4%) were treated with POBA+atherectomy. PSM ensured minimal differences in baseline characteristics, such as indication for procedure and prior revascularization. The atherectomy group was associated with higher technical success and lower perioperative complications, such as renal complications and hematoma, at the expense of higher rates of distal embolization. During long term follow up, patients who underwent atherectomy had lower rates of major amputation but lower freedom from reintervention. There were no differences in major adverse limb events and mortality.

Conclusion:
Combining POBA with atherectomy appears to be a safe approach in IPPAD, with lower rates of long-term amputation at the cost of higher risk for future re-intervention.
Abstract 17651: Long-Term Outcomes of Prosthesis-Patient Mismatch After Surgical Aortic Valve Replacement: Meta-Analysis of Kaplan-Meier-Derived Individual Patient Data
Authors: Pompeu Sa Michel , Jacquemyn Xander , Van den Eynde Jef , Chu Danny , Serna-Gallegos Derek , Ebels Tjark , Clavel Marie-Annick , Pibarot Philippe , Sultan Ibrahim
Published: December 2023

Introduction -
It remains controversial whether prosthesis-patient mismatch (PPM) impacts long-term outcomes after surgical aortic valve replacement (SAVR).

Hypothesis -
PPM is associated with poor outcomes after SAVR.

Methods -
Study-level meta-analysis of reconstructed time-to-event data from Kaplan-Meier curves of studies published by March 2023.

Results -
Sixty-five studies met our eligibility criteria and included 122,989 patients (any PPM: 68,332 patients, 55.6%). At 25 years of follow-up, the survival rates were 11.8% and 20.6% in patients with and without any PPM, respectively (HR 1.16; 95%CI 1.13-1.18, p<0.001). At 20 years of follow-up, the survival rates were 19.5%, 12.1 and 8.8% in patients with no, moderate and severe, respectively (moderate vs no PPM: HR 1.09; 95%CI 1.06-1.11; p<0.001; severe vs no PPM: HR 1.29; 95%CI 1.24-1.35; p<0.001). RMST was 0.8 years shorter in patients with moderate PPM, and 2.1 years shorter in patients with severe PPM in comparison with patients without PPM (10.2 years and 8.9 years vs. 11.0 years respectively, p<0.001). PPM was associated with higher risk of cardiac death, HF-related hospitalizations and aortic valves reinterventions over time (p<0.001). Statistically significant associations between PPM and worse survival were observed regardless of type of valves (bioprosthetic vs mechanical valves), contemporary PPM definitions unadjusted and adjusted to body mass index and PPM quantification method (in vitro, in vivo, Doppler echocardiography). Our meta-regression analysis revealed that populations with more women tend to have higher HRs for all-cause death associated with PPM.

Conclusions -
The results of the present study suggest that any degree of PPM is associated with poorer long-term outcomes following SAVR and provide support for implementation of preventive strategies to avoid PPM after SAVR.
Abstract 17668: Association of Female Sex With Outcomes in Older Patients With STEMI
Authors: Seok Minji , Muhyieddeen Amer
Published: December 2023

Introduction:
Acute coronary syndrome is increasingly affecting the aging population. Despite this, we have observed that older patients presenting with acute coronary syndromes often experience poorer outcomes in the setting of age-related comorbidities and undergo decreased rates of reperfusion therapy. In this analysis, we aimed to uncover any sex differences in outcomes amongst older female patients admitted with ST-Elevation Myocardial Infarction (STEMI).

Methods:
We utilized the National Inpatient Sample data from 2020 to isolate cases where patients were primarily admitted for STEMI. From this pool, we then identified two subsets: individuals who were aged 65 and over and females. We implemented both logistic and linear regression analyses and accounted for any potential confounding factors. We considered our findings to be statistically significant if the 2-tailed p-value was <0.05.

Results:
During 2020, there were a total of 159,890 hospitalizations for STEMI. Among these cases, 46.3% or 74,013 involved patients over 65 years old. After adjusting for various factors such as race, hospital characteristics (including bed size, location, and teaching status), insurance coverage, income level, and Elixhauser comorbidities, we noted a number of significant findings for women over the age of 65 admitted due to STEMI. These included a heightened in-hospital mortality rate (aOR 1.36, 95% CI 1.23- 1.52), reduced usage of mechanical ventilation (aOR 0.86, 95% CI 0.78 - 0.96), less likelihood to receive mechanical circulatory support (aOR 0.64, 95% CI 0.53 - 0.78), and a decreased probability to undergo PCI (aOR 0.87, 95% CI 0.81 - 0.94).

Conclusion:
In hospital admissions for STEMI, we observed that older female patients experienced increased complications during hospitalization and were less likely to undergo invasive reperfusion therapy. Additional research would be required to identify if these sex differences can be attributed to variations in initial presentation before STEMI or if changes in clinical management by sex are contributing to adverse outcomes.
Abstract 17671: Comparative Analysis of Warfarin and Direct Oral Anticoagulants for the Treatment of Left Ventricular Thrombus
Authors: Pakhchanian Haig , Carbone Spencer , Ganju Nakul , Raiker Rahul , Balhara Aseem
Published: December 2023

Introduction:
This study aims to evaluate the efficacy and safety of direct oral anticoagulants (DOACs) in the treatment of left ventricular thrombus (LVT). Warfarin has been shown to be an effective treatment in mitigating thrombotic events; however, numerous limitations exist, including the need for frequent monitoring and increased risk of side effects. Despite this, insight into DOAC use for the treatment of LVT remains limited. Thus, this study seeks to investigate the safety and efficacy of DOACs as a potential alternative to warfarin for the treatment of LVT.

Hypothesis:
DOACs decreases the risk of adverse events compared to Warfarin in patients with LVT.

Methods:
A retrospective cohort study was conducted using a federated realtime database called TriNetX which is comprised of over 100 million patient records. ICD-10 diagnostic codes and national drug codes were used to stratify adults by warfarin or DOAC treatment within 3 months of an initial LVT diagnosis. A 1:1 matched propensity score analysis was conducted, adjusting for comorbidities and demographics, to calculate adjusted Risk Ratios (aRR) with 95% CI. 90-day risk for mortality, stroke, need for blood transfusion, hemorrhage, and arterial embolism & thrombosis were examined.

Results:
In a matched sample of 11,206 patients in each cohort, patients with LVT who took warfarin within 3 months of initial diagnosis is at higher risk for stroke (aRR[95%CI]=1.44(1.34,1.55)], need for blood transfusion [1.29(1.11,1.51)], hemorrhage [1.56(1.35,1.8)], and arterial thromboembolism [1.28(1.13,1.45)] than LVT patients who took a DOAC. Risk for death was non-significant between cohorts.

Conclusions:
The findings from this large electronic medical record patient cohort establish higher rates of adverse events for patients with LVT treated with warfarin versus DOAC, with no statistically significant difference in therapeutic efficacy.
Abstract 17672: Implications of Pcsk9 on Abdominal Aortic Aneurysm
Authors: Rhee Yae Hyun , Deng Alicia , Spin Joshua M , Headley Colwyn , Tsao Philip S
Published: December 2023

Objective:
Recent genome-wide association studies revealed a potential role of proprotein convertase subtilisin/kexin type9(Pcsk9) in the human abdominal aortic aneurysm(AAA) disease.Altered Pcsk9 gene expression and smaller AAA diameter were observed in murine AAA using the porcine pancreatic elastase(PPE) model in our lab. Pcsk9 increases plasma LDL-cholesterol,enhances tissue inflammation and induces vascular smooth muscle cell (VSMC) senescence, hallmarks in AAA.However, the exact cellular mechanisms of Pcsk9 in AAA disease remain unclear.Despite the absence of a pharmacological treatment for AAA, monoclonal Pcsk9 antibody therapies have proven effective against statin-resistant hypercholesterolemia.This study aimed to explore the impacts of Pcsk9 on aortic vascular inflammation and VSMC dedifferentiation with a view to better understanding AAA pathophysiology and providing a basis for future investigations into Pcsk9 inhibitors.

Hypothesis:
We hypothesized that local vascular injury escalates Pcsk9 expression,amplifying vascular inflammation and driving VSMC towards dedifferentiation that further advances AAA. Conversely,Pcsk9 inhibition will mitigate these processes.

Methods:
AAA was induced by PPE model in wildtype C57Bl/6 mice and Pcsk9 knock-out (KO)mice.Sonography was used to evaluate the aneurysm growth. Single-cell RNA sequencing was employed to examine local changes in the aortic wall. Local vascular Pcsk9,pro-inflammatory and VSMC marker gene/protein expression were quantified using qPCR and immunohistochemistry.VSMCs were treated with exogenous Pcsk9 in vitro to assess metabolism via Seahorse.

Results:
Reduced AAA diameters were observed in Pcsk9 KO mice compared to wildtype controls. Significant upregulation of local Pcsk9 expression accompanied AAA induction. Single-cell RNA sequencing revealed altered gene expression profiles across vascular cell populations. In vitro,VSMCs displayed changes in marker gene/protein expression after treatment with exogenous Pcsk9, alongside metabolic changes (Mann-Whitney Test).

Conclusions:
The findings suggest a significant role of Pcsk9 in AAA pathogenesis. Its inhibition appears to mitigate AAA growth,indicating a promising treatment target for AAA.
Abstract 17680: MIBG Myocardial Scintigraphy is Useful for Predicting CTRCD Caused by Trastuzumab
Authors: Noma Takahisa , Tobiume Atsushi , kawaguchi keigo , moriya seiji , Ishihara Yu , Ohara Minako , Ishizawa Makoto , ISHIKAWA KAORI , Murakami Kazushi , Minamino Tetsuo
Published: December 2023

Introduction:
Trastuzumab is known to reduce the mortality rate, recurrence rate, and metastasis rate in Human epidermal growth factor receptor type 2 (HER2)-positive breast cancer patients, and it is recommended to administer it for 12 months to all early-stage HER2-positive breast cancer patients. However, trastuzumab administration can lead to Cancer Therapeutics-Related Cardiac Dysfunction (CTRCD). The guidelines suggest that regular echocardiography every 3 months is useful for early detection of CTRCD, but there are no tests available to predict it before its onset.The purpose of this study is to determine whether cardiac sympathetic nerve evaluation using MIBG myocardial scintigraphy before trastuzumab administration can predict the development of CTRCD three months after administration.

Methods:
MIBG myocardial scintigraphy was performed before trastuzumab administration in 35 HER2-positive breast cancer patients, and cardiac function assessment was conducted using echocardiography before administration, at 1 month, and at 3 months. Simultaneously, NT-proBNP and troponin levels were measured. CTRCD was defined as a decrease in global longitudinal strain (GLS) of 10% or more from before administration at the 3-month follow-up.

Results:
Anthracycline and trastuzumab regimens were used in 21 patients (60%). CTRCD occurred in 17 patients at the 3-month follow-up. There were no significant differences in age or previous medication between the CTRCD group and the non-CTRCD group, but the early H/M ratio in MIBG myocardial scintigraphy was significantly lower in the CTRCD group (2.77±0.36) compared to the non-CTRCD group (3.10±0.36) (p<0.01). There were no significant differences in the delay H/M ratio or washout rate. None of the echocardiographic parameters, NT-proBNP levels, or troponin levels showed significant differences and did not become predictive factors.

Conclusions:
MIBG myocardial scintigraphy is useful for predicting CTRCD caused by trastuzumab. Preclinical studies have suggested that HER2 transactivation from β-adrenergic receptors in the myocardium confers cardioprotection. Suppression of HER2 signaling during cardiac sympathetic nerve dysfunction potentially contributes to the development of CTRCD.
Abstract 17686: Safety and Efficacy of Drug-Eluting Stents for Patients at High Risk of Bleedings: A Network Meta-Analysis
Authors: Giacobbe Federico , Valente Eduardo , Nebiolo Marco , morena arianna , Giannino Giuseppe , Falorni Lucrezia , Troncone Mattia , Carmagnola Ludovica , Ravetti Emanuele , di vita umberto , De Filippo Ovidio , Bruno Francesco , D'Ascenzo Fabrizio , De Ferrari Gaetano Maria
Published: December 2023

Introduction:
Among different coronary stents implanted in High Bleeding Risk (HBR) patients with an indication for short antiplatelet therapy, no comparisons in terms of efficacy have been provided.

Methods:
A Network Meta Analysis was performed including all Randomized Controlled Trials comparing different coronary stents evaluated in HBR patients. Major Adverse Cardiovascular Events (MACEs) as defined by each included trial were the primary end point, whereas TLR (target lesion revascularization), TVR (target vessel revascularization), stent thrombosis and total and major (BARC3-5) bleedings were the secondary ones.

Results:
A total of 4 studies (ONYX ONE, LEADERS FREE, SENIOR and HBR in BIO-RESORT) including 6637 patients were analyzed with different kind of stents and DAPT length (1 or 6 months) on 12 months follow-up. About one third of these patients were defined HBR due to indication for oral anticoagulation. All Drug Eluting Stents (DESs) reduced risk of MACE compared to Bare Metal Stents (BMSs) when followed by a 1-month DAPT. At SUCRA analysis, Orsiro was the device with the highest probability of performing best. Rates of TLR and TVR were significantly lower when using Resolute Onyx, Synergy and BioFreedom stents in comparison to BMS when followed by 1-month DAPT, with Synergy ranking best. Synergy also showed a significantly lower number of stent thrombosis compared to BMS (RR 0.28, 95%CI 0.06-0.93), while Orsiro and Resolute Integrity showed the highest probability of performing best.

Conclusion:
In HBRs patients, all DESs were superior to BMSs in terms of efficacy and safety. Among DESs, Orsiro was the one with the highest ranking in terms of MACE, mainly driven by a reduced incidence of repeated revascularization and stent thrombosis