bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11704: Conduction Abnormalities Among Chronic Chagas’ Disease Patients With Heart Involvement and Events of Cardiogenic Shock
Authors: Akkaramani Sudhamai , Ramphul Kamleshun , Ahmed Raheel , Memon Rahat A , Aggarwal Shruti , Dhaliwal Jasninder S , Ahmad Hasan , Farhan Muzammil , Hasan Ali , Hassan Azeem , Ponna Pramod Kumar , Sombans Shaheen , Sakthivel Hemamalini
Published: December 2023

Introduction:
Chronic Chagas Cardiomyopathy can disrupt various conduction pathways, triggering arrhythmias and cardiogenic shock (CS). The American Heart Association recently advocated for better global awareness in endemic regions. We aim to provide a perspective on cardiac arrhythmias seen in Chronic Chagas disease with heart involvement in the United States.

Methods:
Cases of “Chagas' disease (chronic) with heart involvement” were used via the 2016-2020 National Inpatient Sample. The presence of several cardiac arrhythmias was analyzed.

Results:
Between 1st January 2016 to 31st December 2020, around 1920 patients were hospitalized with Chronic Chagas’ disease with heart involvement in the United States. The cases were predominantly Males (61.2%) who were also younger compared to Females (mean age of Males: 55.83 years vs. mean age of Females 58.86 years, p<0.01). The mean age of all patients was estimated at 57.0 years. The patients were primarily covered by Medicaid (40.4%), followed by Medicare (26.0%), and Private insurance (21.9%). Moreover, 90.9% of hospitalizations took place in Urban-teaching centers. Several arrhythmias such as atrial fibrillation (37.2%, 715 cases), supraventricular tachycardia (4.7%, 90 cases), ventricular tachycardia (29.2%, 560 cases), ventricular fibrillation (4.2%, 80 cases), and atrial flutter (6.8%, 130 cases), as well as conduction defects such as first-degree Atrioventricular block (1.6%, 30 cases), complete atrioventricular block (3.9%, 75 cases), and sick sinus syndrome (2.9%, 55 cases), were observed. The mean Charlson Comorbidity Index (CCI) score among these patients was 2.66. Around 185 patients (9.6%) developed CS during their hospitalization. While no statistical significance was seen in the mean ages of patients with and without CS (58.57 vs. 56.84 years, p=0.062), those with CS had a higher mean CCI score (3.73 vs. 2.55, p<0.01; 14.6% of patients with CCI≥4 vs. 8.0% with CCI <4, p<0.01), with a longer hospitalization (22.97 days vs. 6.49 days, p<0.01).

Conclusions:
Patients with Chagas disease with heart involvement can experience various conduction abnormalities. CS was more common in patients with a higher CCI score, resulting in a longer stay.
Abstract 11705: Events of Device Failure in Elderly Patients Undergoing Watchman Device Insertion in the United States
Authors: Dhaliwal Jasninder , Memon Rahat A , Aggarwal Shruti , Ramphul Kamleshun , Sombans Shaheen , Sakthivel Hemamalini
Published: December 2023

Introduction:
Watchman device implant reduces various cardio-cerebral events in patients with left atrial appendage. As there is a lack of data on device failure among the elderly undergoing this procedure, we aim to provide a perspective via the 2016-2020 National Inpatient Sample(NIS).

Methods:
Watchman procedures in patients ages ≥60 years, with a history of atrial fibrillation or flutter, were examined for our study from the NIS. Events of device failure were considered, and variables that may influence such events were studied via logistic regression models.

Results:
We found 85190 procedures for Watchman device insertion conducted in the United States, and 510 (0.6%) cases reported an event of device failure. Procedures at rural centers reported higher odds of device failure than urban teaching centers (1.3% of rural center procedures vs. 0.6% of urban teaching hospital procedures, aOR 2.970, 95% CI 1.965 -4.488, p<0.01). Meanwhile, patients with a history of CKD (aOR 0.565, p<0.01), hypertension (aOR 0.500, p<0.01), and peripheral vascular diseases (aOR 0.513, p=0.012) showed reduced odds. Several complications were also noted among those with device failure, as 20 cases (3.9% ) had acute kidney injury, 45 patients (8.8%) developed cardiac tamponade, 70 cases (13.7%) had pericardial effusion, and 20 cases (3.9%) necessitated mechanical ventilation. The mean CHA
2
DS
2
-VASc score among patients with device failure was 4.65 (vs. 4.68, p=0.029), and the mean Charlson Comorbidity Index score was 1.42 (vs 1.65, p<0.01). Patients with device failure had a more expensive stay (mean hospital charge $144936 vs. $122504).

Conclusions:
Device failure was a rare but severe complication involving 0.6% of procedures in our analysis. Many comorbidities influenced events of device failure. As our study found a higher incidence among procedures done in rural centers, further studies to screen and assess the patients and monitor their condition may help improve the outcomes.
Abstract 11723: Predictors of Post-Operative Atrial Fibrillation in Patients Undergoing Stress Echocardiography Prior to Noncardiac Surgery
Authors: Stanko Kevin M , Weingarten Toby , Kane Garvan , McCully Robert B , Pellikka Patricia A , Mauck Karen , Cullen Michael W
Published: December 2023

Background:
Atrial fibrillation (a-fib) occurs in up to 40% of patients after noncardiac surgery and is associated with increased risk of adverse outcomes. Practice guidelines recommend stress testing, including stress echocardiography (SE) to assess for coronary artery disease in selected high-risk patients prior to noncardiac surgery. The utility of using SE findings for predicting postoperative a-fib is unknown.

Hypothesis:
Myocardial ischemia can contribute to arrhythmogenic potential; other echocardiographic variables are likely associated with a-fib. Findings on SE may identify patients at risk for a-fib after noncardiac surgery.

Aims:
To determine if certain SE findings predict a-fib following noncardiac surgery.

Methods:
The study included patients undergoing pharmacological and exercise SE before noncardiac surgery. The primary outcome was a-fib/flutter within 30 days after surgery. Multivariate analysis was adjusted for age, cardiovascular comorbidities, and markers of surgical risk.

Results:
This analysis included 2,376 patients (mean age 68 +/- 7 years; 60% male); 1,986 patients had no known history of a-fib/flutter. Of these, 48 (2.4%) developed postoperative a-fib/flutter. In multivariate analysis, SE variables associated with development of new a-fib/flutter included left ventricular dilation (OR 2.11, p=0.049), increased left atrial volume (OR 1.19, p=0.045), and increased left ventricular mass index (OR 1.13, p=0.043) on rest images. The presence of ischemia or infarct on stress echocardiogram was not associated with postoperative a-fib/flutter. A total of 390 patients had a history of paroxysmal a-fib/flutter and were in sinus rhythm at the time of surgery. Of these, 90 (23%) experienced recurrent a-fib/flutter within 30 days of surgery. Multivariate analysis did not reveal any SE variables significantly associated with recurrence, including presence of myocardial ischemia or infarct at the time of SE.

Conclusions:
All SE variables associated with postoperative a-fib following noncardiac surgery are available from resting images alone. Therefore, SE that includes comprehensive resting images may offer benefit in the pre-operative evaluation of selected patients.
Abstract 11734: Allopurinol & Plaque Stabilization in Patients With Acute Coronary Syndrome: A Randomized Clinical Trial
Authors: Yu Miao , Gu Jin , heshui shi , Zhu Zheng-Feng , Yang Fen , Yuan Yuan-Fan , Zhou You-Cai , cheng xiang
Published: December 2023

Background:
Allopurinol, a xanthine inhibitor that lowers uric acid (UA) concentration, has been proven to reduce inflammation and oxidative stress in patients with cardiovascular disease. However, it is unknown whether these beneficial effects translate into favorable plaque modification in acute coronary syndromes (ACS).

Aims:
This study aimed to investigate whether allopurinol therapy could improve plaque stabilization in ACS patients using coronary computed tomography angiography (CCTA).

Methods:
This was a prospective, single-center, randomized, double-blind clinical trial began in March 2019 (clinical trial.gov identifier NCT03745729). A total of 162 acute coronary syndromes (ACS) patients aged 18-80 years with a blood level of high-sensitivity C-reactive protein (hsCRP) > 2 mg/L were included. The subjects were randomly assigned in a 1:1 ratio to receive either allopurinol sustained-release capsules (at a dose of 0.25 g once daily) or placebo for 12 months. The primary efficacy endpoint was the change in low-attenuation plaque volume (LAPV) from baseline to the 12-month follow-up.

Results:
Among 162 patients, 54 in allopurinol group and 51 in placebo group completed the study. There were no significant differences between the allopurinol and placebo groups in terms of baseline data for age (58.5±10.2 years vs. 56.8±10.0 years, P=0.392) and sex (male/female, 40/14 vs. 40/11, P=0.600). The median follow-up duration was 14 months in both groups. Compared with placebo, allopurinol therapy did not significantly alter LAPV (-13.4±3.7% vs. -17.8±3.6%, P=0.390), intermediate attenuation plaque volume (-16.1±3.0% vs. -16.2±2.9%, P=0.992), dense calcified plaque volume (12.2±13.7% vs. 9.7±13.0%, P=0.894), total atheroma volume (-15.2±3.2% vs. -16.4±3.1%, P=0.785), remodeling index (2.0±3.9% vs. 5.4±3.8%, P=0.536) or hsCRP levels (-73.6 [17.9-91.6] % vs. -81.2 [47.7-95.4] %, P=0.286).

Conclusions:
Our findings suggest, for the first time, that allopurinol therapy does not improve atherosclerotic plaque instability or inflammation in ACS.
Abstract 11737: Clinical Background and Outcomes of Super-Elderly Patients With Hemodynamically Stable Acute Myocardial Infarction
Authors: Okamoto Hiroshi , Nishi Takeshi , Ishii Masanobu , Tsujita Kenichi , Koto Satoshi , Uemura Shiro
Published: December 2023

Background and hypothesis:
An increasing proportion of the population is living into their nineties and beyond, as are the number of super-elderly patients (over the age of 90 years) who present with acute myocardial infarction (AMI). The decision to perform emergency revascularization in these patients is difficult because they commonly have multiple comorbidities and are at high risk for invasive procedures.

Aims:
In order to help stratifying decision-making, this study was planned to clarify the clinical background, in-hospital outcome, and effect of primary percutaneous coronary intervention (PPCI) in super-elderly AMI patients with stable hemodynamics on admission.

Methods:
Between April 2012 and March 2018, 6,427 hemodynamically stable AMI patients over 90 years of age were identified in a nationwide Japanese administrative database (the JROAD-DPC registry). clinical characteristics, in-hospital occurrence of in-hospital adverse outcomes, and the effect of PPCI were examined.

Results:
The AMI patients included 4,242 females (66.2%) with a mean BMI of 20.7±4.0 and 2,828 patients (44.0%) with Killip class 1 on admission. The rate of 30-day all-cause mortality was 14.0% and full-score Barthel index, an ordinal scale used to measure performance in activities of daily living (ADL), at discharge was 20.8%. In-hospital complications occurred in 38.2% of patients, which consisted of heart failure after admission (16.0%), life-threatening arrhythmia (3.5%), the use of IABP (3.8%), ECMO (0.2%), mechanical respiration (12.8%), dialysis (1.5%), major bleeding (3.6%), sepsis (1.6%), and pneumonia (10.3%). PPCI was performed in 36,79 patients (57.2%). Patients who underwent PPCI had significantly lower 30-day all-cause mortality (9.4% vs 20.2%, p<0.05) and significantly lower major non-cardiac events (14.9% vs 17.1%, p<0.05).

Conclusions:
Super-elderly AMI patients (≥90 years of age) were at high-risk for in-hospital mortality rates and In-hospital complications, even if they were hemodynamically stable on admission. PPCI is associated with improved in-hospital outcomes. Therefore, PPCI may provide acceptable outcomes even in these super-elderly AMI patients.
Abstract 11774: Right Ventricular Function and Myocardial Blood Volume Analyses by Convolutional Neural Network in Experimental Pulmonary Hypertension
Authors: Wang Sailun , Kremer Nils , Bibli Sofia-Iris , Belenkov Alexander , Hu Jiong , Henneke Ingrid , Mukhametshina Regina , Ghofrani Ardeschir H , Weissmann Norbert , Pullamsetti Soni Savai , Seeger Werner , Schermuly Ralph T , Tello Khodr , Kojonazarov Baktybek
Published: December 2023

Introduction:
Survival of patients with pulmonary hypertension (PH) is highly dependent on the right ventricular (RV) function. Despite the association of various factors with adaptive or maladaptive RV phenotypes, the contribution of microvascular density to RV adaptation to pressure overload remains unclear.

Hypothesis:
This study aimed to evaluate the RV myocardial blood volume and its role in the RV adaptation to pressure overload.

Methods:
Both the University Animal Care Committee and the federal authorities for animal research of the Regierungsprasidium Giessen (Hessen, Germany) approved the study protocol. The study used adult Wistar-Kyoto rats and Sprague-Dawley rats to induce PH using SuHx and monocrotaline (MCT), respectively. Echocardiography, in vivo contrast-μCT, and invasive hemodynamic measurements were performed. The researchers used an artificial intelligence (AI)-based convolutional neural network (CNN) approach to reconstruct, segment, and analyze the cardiac μCT images. The RV functional reserve was evaluated during mCT acquisition and dobutamine stress test, and metabolomics analysis was performed.

Results:
The data showed that SuHx rats developed maladaptive cardiac function and RV-PA uncoupling. MCT rats exhibited adaptive RV function at days 14 and 21, but maladaptive function at day 35, which was associated with RV-PA uncoupling and reduced RV functional reserve. Impaired PKA-CREB signaling pathway was also found to be associated with the reduced RV functional reserve in the MCT rats. In both PH models, the absolute RV blood volume significantly increased with the development of RV hypertrophy, but the relative blood volume decreased, which was associated with maladaptive RV function

Conclusions:
This study is the first to demonstrate the use of AI CNN in post-processing of μCT-derived cardiac images from experimental PH models. Additionally, a single-beat PV loop was established for the first time in a rat model of PH by combining non-invasive and invasive techniques. The findings suggest that RV maladaptive function in rat models of PH is characterized by capillary rarefaction, impaired RV reserve in response to dobutamine infusion, which is associated with impaired PKA-CREB signaling pathway in the RV.
Abstract 11804: Implementing a Digitally-Enabled Community Health Worker Intervention for Patients With Heart Failure: A Randomized Controlled Trial
Authors: Carter Jocelyn A , Isselbacher Eric , Donelan Karen , Thorndike Anne N
Published: December 2023

Introduction:
Heart failure (HF) readmissions are a leading cause of US 30-day hospital readmissions. Factors related to clinical complexity and unmet social needs are among the key drivers associated with HF negative clinical outcomes. Digital platforms have shown promise in improving HF outcomes but limitations like patient lack of familiarity with technology and unmet social needs continue to limit implementation and adoption.

Hypothesis:
An intervention pairing HF patients with a digital platform and a community health worker (CHW) for 30 days post-hospital discharge is (a) feasible, (b) acceptable, and (c) can demonstrate preliminary effectiveness in reducing 30-day hospital readmissions, emergency department (ED) visits, and missed clinic appointments compared to control (CHW only).

Methods:
Participants (n=50; enrolled 9/2022-6/2023) were randomized to intervention (CHW + digital platform) or control (CHW only). Intervention participants received a digital platform within a mobile phone application (daily symptoms questionnaire, educational videos) connected to a biometric sensor (tracking heart rate, oxygenation, steps taken), a digital weight scale, and a digital blood pressure monitor. Feasibility (use of the platform and engagement with the CHW), acceptability (willingness to use the intervention again), and clinical outcomes (30-day readmissions, ED visits, and missed appointments) were tracked.

Results:
As of June 1, 2023 (n=42), preliminary analysis demonstrates intervention feasibility (participant use of the sensor (avr 11.1 hrs/day), digital blood pressure (1.3 times/day; SD=0.22) and weight scale (1.1 times/day (SD=0.18) on 81-86% of study days; symptom questionnaire completion on 75% of study days; >3 CHW interactions occurred for 71% of participants) and acceptability (84% of participants indicated willingness to use the intervention again). Clinical outcome data analysis completion is forthcoming September 2023.

Conclusions:
A novel intervention combining a digital platform with CHW social needs care in HF was feasible and acceptable. Clinical outcome data analysis completion is forthcoming September 2023. A larger future clinical trial is needed to determine the intervention’s true effectiveness.
Abstract 11893: Efficacy and Safety of Ongericimab in Chinese Patients With Primary Hypercholesterolemia and Mixed Dyslipidemia
Authors: Wang Xiaozeng , Miaohan Qiu , Cheng Zhifeng , Ji Xianyou , Chen Jiyan , Zhu Hong , Tang Yida , Huang Zhouqing , Su Guohai , Wang Gaopin , Huang Zhijun , Yao Zhuhua , Lin Jinxiu , Sun Yihong , Li Shunhui , Shao Cong , Yan Hui , Zhao Yi , Bai Xuelian , wang shi , Yaling Han
Published: December 2023

Background:
Ongericimab, a monoclonal antibody that inhibits proprotein convertase subtilisin/kexin type 9 (PCSK9), significantly reduced low-density lipoprotein cholesterol (LDL-C) levels in the phase 2 trial. A phase 3 trial was conducted to evaluate the efficacy and safety of ongericimab in Chinese patients with primary hypercholesterolemia and mixed dyslipidemia on background lipid-lowering therapy (LLT).

Methods:
This was a randomized, double-blind, placebo-controlled, 52-week trial conducted in China (NCT02662569). Eligible patients receiving stable statin (±ezetimibe) therapy but not achieving LDL-C goals were enrolled. Patients were randomly assigned in a 2:1:2:1 ratio to receive either ongericimab 150 mg or placebo subcutaneously every 2 weeks (Q2W), or ongericimab 300 mg or placebo subcutaneously every 4 weeks (Q4W) for 52 weeks. The primary endpoint was percent change in LDL-C from baseline to week 24.

Results:
A total of 806 patients were randomized, 802 patients received at least one dose of ongericimab or placebo. The least-squares (LS) mean difference between ongericimab and placebo in LDL-C from baseline to week 24 was -67.7% (95% CI: -72.49%, -62.99%; p < 0.0001) in Q2W group and -61.2% (95% CI: -67.09%, -55.21%; p < 0.0001) in Q4W group. LDL-C reductions were maintained to Week 52. Ongericimab also favorably altered other lipid parameters (Table 1). The overall incidence of adverse events was similar between ongericimab and placebo.

Conclusion:
Ongericimab on stable background LLT significantly reduced LDL-C and was well tolerated in Chinese patients with primary hypercholesterolemia and mixed dyslipidemia.
Abstract 11914: Diagnostic and Prognostic Role of Left Ventricular Strain Imaging in Adults With Coarctation of Aorta
Authors: Kandlakunta Sriharsha , Ahmed Marwan , Karnakoti Snigdha , Abozied Omar , Younis Ahmed , Egbe Alexander C
Published: December 2023

Introduction:
The relative diagnostic and prognostic performance of left ventricular global longitudinal strain (LVGLS) as compared to LV ejection fraction (LVEF), and the role of LVGLS for detecting early stages of LV systolic dysfunction in adults with repaired coarctation of aorta (COA) is unknown.

Objective:
The purpose of this study was to address these knowledge gaps.

Methods:
Retrospective cohort study of adults with repaired COA that underwent transthoracic echocardiogram (2003-2020). LV systolic function was assessed using LVEF (derived from volumetric analysis) and LVGLS (derived from speckle-tracking echocardiography).

Results:
Of the 795 patients (age 36±14 years), mean LVEF and LVGLS were 62±11%, and 21±4%, respectively. The prevalence of LV systolic dysfunction was higher when assessed using LVGLS as compared to LVEF (20% versus 6%, p<0.001). Of 795 patients, 94 (12%) patients died, of which 75 (9%) died from cardiovascular causes. LVGLS provided more robust prognostic power in predicting all-cause mortality as compared to LVEF as evidenced by a higher
C
-statistic (0.743, 95%CI 0.730-0.755 versus 0.782, 95% CI 0.771-0.792, p<0.001). Furthermore, patients with normal LVEF in the setting of reduced LVGLS had a higher risk of all-cause mortality (as compared to patients with normal LVGLS and LVEF) and were at risk for temporal decline in LVEF during follow-up.

Conclusions:
These findings suggest that the use of LVGLS for risk stratification can help identify high-risk patients, and provide opportunities for interventions, which would, in turn, improve clinical outcomes. Further studies are required to empirically test these postulates.
Abstract 11944: Atherosclerotic Cardiovascular Disease Among Insured Adults by Gender Identity
Authors: Streed Carl G , Swabe Gretchen , Sisson Emily , Reisner Sari , Jasuja Guneet , Poteat Tonia , Mukherjee Monica , Cabral Howard , Tangpricha Vin , Paasche-Orlow Michael , Benjamin Emelia J , Magnani Jared W
Published: December 2023

Background:
Atherosclerotic cardiovascular disease (ASCVD) risk is significantly affected by sex; however, the increasing impact of gender identify is unclear.

Hypothesis:
We hypothesized that transgender and gender diverse (TGD) adults had higher prevalence of ASCVD risk factors and higher incidence of ASCVD outcomes compared to cisgender persons.

Methods:
We used a large claims-based dataset (Optum’s de-identified Clinformatics® Data Mart Database) to conduct a cohort study of ASCVD risk and morbidity. We used a validated algorithm to identify TGD persons. Covariates included age, sex, race and ethnicity; ASCVD risk factors (e.g., hypertension); socioeconomic factors (e.g., education). We examined incidence and hazard ratios (HRs) of ischemic stroke (IS), myocardial infarction (MI), and coronary revascularization by gender identity in multivariable models.

Results:
We identified 85,282 TGD adults from 2010-2022 and frequency matched them to 414,590 cisgender referents (1:5 ratio). Incidence of MI, IS, and revascularization (
Table 1
) for TGD persons assigned male at birth over 50 years of age were 18.90, 32.16, and 9.88 per 1000 persons-years, respectively. For TGD persons assigned female at birth over 50 years of age, incidence of MI, IS, and revascularization was 8.37, 15.21, and 4.61 per 1000 persons-years, respectively. Accounting for demographic characteristics, ASCVD risk factors, and socioeconomic status, the HRs for TGD persons assigned male at birth compared to cisgender women for MI, IS, and revascularization were 2.02, 0.93, and 4.30, respectively. HRs for TGD persons assigned female at birth compared to cisgender men for MI, IS, and revascularization were 0.89, 0.70, 1.64, respectively.

Conclusion:
We identified significant differences in ASCVD risk and morbidity by gender identity. Further research is needed to identify intervenable targets to improve the cardiovascular health of TGD populations.
Abstract 11965: Impact of Atherothrombotic Risk Stratification in Patients With Heavily Calcified Lesions Following Rotational Atherectomy
Authors: Yoshizaki Toru , Nakamura Takamitsu , Horikoshi Takeo , Watanabe Yousuke , Kobayashi Tsuyoshi , saito yukio , Obata Jun-ei , Sawanobori Takao , Takano Hajime , umetani ken , Asakawa Tetsuya , Sato Akira
Published: December 2023

Background:
Patients who undergo percutaneous coronary intervention (PCI) with rotational atherectomy (RA) are at high risk of adverse clinical outcomes, and there are few clinical risk stratification tools for these patients. The Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention (TRS 2°P) is a simple 9-point risk stratification tool. A previous study reported that TRS 2°P was useful in predicting adverse clinical events in patients with acute coronary syndrome. However, it is unclear whether TRS 2°P predicts adverse clinical events in patients with heavily calcified lesions, requiring RA.

Hypothesis:
This study aimed to investigate whether TRS 2°P is useful for the prediction of adverse clinical events in patients undergoing PCI with RA from the Japanese multicenter PCI registry.

Methods:
We conducted a study with 196 patients who underwent PCI with RA out of 7,391 patients who underwent PCI in a multicenter, prospective cohort registry. Patients were divided into 3 groups according to the tertiles of the TRS 2°P: 65 patients in the T1 group (TRS 2°P<3), 66 patients in the T2 group (TRS 2°P=3), and 65 patients in the T3 group (TRS 2°P>3). The primary endpoint was the cumulative 2-year incidence of major adverse cardiovascular and cerebrovascular events (MACCE), defined as a composite of cardiac death, acute coronary syndrome, and ischemic stroke.

Results:
A cumulative 2-year MACCE occurred in 41 (24%) patients during the follow-up period. The cumulative incidence of MACCE was significantly higher in the T3 group than in T1 group (log-rank p=0.02). Multivariate Cox analyses revealed that the T3 group was associated with an increased risk of MACCE compared to T1 group (adjusted hazard ratio, 2.66; 95% confidence interval, 1.04–6.77; p=0.04). The addition of TRS 2°P to conventional risk factors, including male sex, number of diseased vessels, and low-density lipoprotein cholesterol levels, improved the net reclassification improvement (NRI) and integrated discrimination improvement (IDI) (NRI 0.39, p=0.027; IDI 0.072, p<0.001).

Conclusions:
Atherothrombotic risk stratification using TRS 2°P is useful for identifying high-risk patients with heavily calcified lesions following RA.
Abstract 12011: A Case of Emphysematous Pyelonephritis With Use of Empagliflozin
Authors: MAKNOJIA ARISH
Published: December 2023

Background:
SGLT2i improve cardiovascular (CV) outcome in patients with HFrEF with or without diabetes (DM). Although recent trials and metanalysis have showed improve renal outcomes with SGLT-2i, one should be aware of the potential serious adverse effects with this group of medications including life threatening UTI.

Case:
50-year-old female with history of type 2 DM presented with septic shock due to bilateral (B/L) pyelonephritis, with no associated renal calculi. CT of the abdomen also revealed emphysematous pyelonephritis of the left kidney. Few days later, patient went into PEA requiring intubation with return of spontaneous circulation within 4 minutes of advanced cardiac life support. Patient was extubated subsequently later on during her hospitalization. Work up for PEA revealed depressed left ventricular systolic function with an EF of 25-29% with no wall motion abnormality. Patient also developed decompensated HFrEF with development of b/l pleural effusion and generalized anasarca. Cardiology was consulted for management of her cardiomyopathy. She was recommended coronary angiography but she declined. Therefore, Patient was started on guideline direct medical therapy for HF with metoprolol succinate, lisinopril and spironolactone. Due to recent evidence of SGLT-2i improving CV outcomes in patients with HFrEF, it was also recommended to start SGLT-2i.

Discussion:
On further reviewing regarding use of SGLT-2i and association with UTI, we found a case report causing emphysematous pyelonephritis with use of canagliflozin. Medication reconciliation done at the time of discharge revealed that patient was recently initiated on empagliflozin three months prior to her admission. Therefore, it was speculated that her emphysematous pyelonephritis could be one of the rare complications of SGLT-2i since no other etiologies was noted per urological workup and we decided not to continue SGLT-2i. A search of FAERS from March 2013 through October 2014 identified 19 cases of urosepsis reported with the SGLT2 inhibitors (canagliflozin [n=10] and dapagliflozin [n=9]). All cases resulted in hospitalization. No deaths were reported. Clinicians should be aware of potential life-threatening UTI which may occur with SGLT-2i use.
Abstract 12014: Macrophage-Specific DNaseII Deficiency Plays a Critical Role in Vascular Inflammation and Atherosclerosis in Apolipoprotein E-Deficient Mice
Authors: Suto Kumiko , Hara Tomoya , Nishimoto Sachiko , Kaneyama Shuri , Sata Masataka , Fukuda Daiju
Published: December 2023

Background:
Atherosclerosis is a chronic inflammatory disease of the walls of blood vessels. Macrophage activated by endogenous ligands plays an important role in chronic inflammation of blood vessels. Deoxyribonuclease (DNase) II in macrophages digests the endogenous DNA derived from apoptotic cells. Recent studies show that Toll-like receptor 9 (TLR9), one of the major receptors of endogenous DNA, activates macrophages, suggesting that DNA degradation by DNase II may contribute to the pathogenesis of inflammatory disease. We investigated whether DNase II in macrophages contributes to the development of vascular inflammation and atherogenesis using apolipoprotein E-deficient (ApoE-/-) mice.

Methods:
Macrophage specific DNase II deleted ApoE-/- (DNase2flox LysMCre ApoE-/-) mice and its control (DNase2flox ApoE-/-) mice were generated. For in vivo TLR9 inhibition, DNase2flox LysMCre ApoE-/- mice received TLR9 antagonist (iODN2088) or genetically lacked TLR9 (DNase2flox LysMCre ApoE-/- TLR9-/-) mice were also evaluated. All mice were fed a western-type diet and received subcutaneous angiotensin II infusion (1000 ng/kg per minute) for 8 weeks. Atherosclerotic lesions were investigated by en face Sudan IV staining and quantitative reverse transcription polymerase chain reaction. In vitro experiments using peritoneal macrophages were performed to confirm the proinflammatory roles of mitochondrial DNA (mtDNA) in the absence of DNase II.

Results:
Expression of DNase II and TLR9 increased in the atherosclerotic plaques. Macrophage-specific DNase II deletion significantly atherogenesis in the aortic arch in ApoE-/- mice (P<0.05) and increased RNA expression of inflammatory molecules in the aorta. In vitro experiments demonstrated that mtDNA or TLR9 agonist significantly increased the expression of inflammatory molecules in DNase II deficient peritoneal macrophages. Activation of NF-κB signaling was involved in DNase II deficient vascular inflammation and macrophage activation.

Conclusions:
Macrophage-specific DNase II deletion accelerated vascular inflammation and atherogenesis, which are attenuated by genetic deletion or pharmacological blockade of TLR9. DNase II may be a potential therapeutic target for atherosclerosis.
Abstract 12040: Acute-to-Chronic Assessment of Trajectory of Left Ventricular Ejection Fraction is Useful to Predict Long-Term Clinical Outcomes After Acute Myocardial Infarction
Authors: Yoshioka Goro , Tanaka Atsushi , Node Koichi
Published: December 2023

Aims:
To determine the prognostic impact of left ventricular ejection fraction (LVEF) trajectories from acute to chronic phase of acute myocardial infarction (AMI).

Materials and methods:
Among 2,266 consecutive patients admitted for AMI from February 2008 to January 2016, 1,330 survivors with LV ejection fraction (LVEF) ≥40% during hospitalization who had LVEF data at 6 months after AMI were analyzed. Patients were divided into three subgroups based on LVEF at 6 months: reduced-LVEF (<40%), mildly-reduced-LVEF (≥40% and <50%) and preserved-LVEF (≥50%). Occurrence of a composite of hospitalization for heart failure or cardiovascular death after 6 months of AMI was the primary endpoint. The prognostic impact of LVEF at 6 months on primary endpoint was analyzed with a multivariate-adjusted Cox proportional hazards regression model.

Results:
Overall, the mean age was 67.5 ± 11.9 years, and LVEF during index hospitalization was 59.4 ± 9.1%. The individual trajectories of LVEF from index hospitalization to 6 months was dynamically changed. The median (interquartile range) duration of follow-up was 3.0 (1.5-4.8) years, and the primary endpoint occurred in 35/1,330 (2.6%) patients (13/69 [18.8%] in the reduced-LVEF, 9/265 [3.4%] in the mildly-reduced-LVEF, and 13/996 [1.3%] in the preserved-LVEF categories). The adjusted hazard ratio for the primary endpoint in the reduced-LVEF vs. mildly-reduced-LVEF categories and in the reduced-LVEF vs. preserved-LVEF categories was 4.71 (95% confidence interval [CI], 1.83 to 12.13; p <0.001) and 14.37 (95% CI, 5.38 to 38.36; p <0.001), respectively (Figure).

Conclusion:
Late-onset LV systolic dysfunction was significantly associated with long-term outcomes after AMI. Our findings suggest that, even in AMI survivors without LV systolic dysfunction at the acute phase of AMI, reassessment of LVEF and careful monitoring of its trajectories is useful to predict long-term clinical outcomes.
Abstract 12044: Sex-Related Differences in Long-Term Outcomes Across the Spectrum of Left Ventricular Ejection Fraction in Acute Decompensated Heart Failure Patients
Authors: Kawai Akane , Nagatomo Yuji , Iwashita Midori , Ikegami Yukinori , Takei Makoto , Goda Ayumi , Kohno Takashi , Mizuno Atsushi , Kitamura Mitsunobu , Nakano Shintaro , Sakamoto Munehisa , Shiraishi Yasuyuki , Kohsaka Shun , Adachi Takeshi K , Yoshikawa Tsutomu ,   WET-HF Investigators
Published: December 2023

Background:
An important knowledge gap remains on sex-related differences in heart failure (HF) management. Recently, it has been recognized that patients, particularly women, with supra-normal left ventricular ejection fraction (snLVEF) are at high risk of adverse outcomes.

Aims:
We sought to evaluate the sex related differences of long-term outcomes across the spectrum of LVEF in acute decompensated HF (ADHF) patients.

Methods:
We analyzed 3943 ADHF patients (age 77 years; 59.8% male) who were enrolled in WET-HF multicenter registry in Japan from 2006 to 2017. The association of long-term outcomes across the spectrum of LVEF were compared between men and women.

Results:
In both HF with reduced EF (HFrEF; LVEF < 50%) and preserved EF (HFpEF), female patients were older and had lower body mass index, lower prevalence of ischemic etiology, and smaller LV chamber size. In HFrEF, implementation of guideline-directed medical therapy such as the combination of renin-angiotensin-system inhibitor (RASi), β-blocker and mineralocorticoid receptor antagonist (MRA) was significantly lower in women at discharge, even after adjustment for covariates (RASi + β-blocker : odds ratio [OR], 0.80, p=0.049; RASi + β-blocker + MRA: OR, 0.73, p=0.016). Female patients showed higher incidence of the primary endpoint, defined as the composite of cardiac death and ADHF readmission during 1,000 days after discharge (
p
= 0.009, log-rank test). However, female sex did not remain significant after adjustment for covariates. Restricted cubic spline analysis demonstrated a U-shaped relationship with a nadir at LVEF 60% between LVEF and the hazard ratio of the primary endpoint in women, but this relationship was not observed in men (
p
for interaction = 0.048,
Figure A, B
). This trend was more evident after excluding patients with valvular heart disease (
p
for interaction = 0.014,
Figure C, D
).

Conclusions:
In women, not only low LVEF but also snLVEF were associated with worse long-term outcomes.
Abstract 12048: Aortic Vulnerable Plaques Including Cholesterol Crystals: Non-Obstructive General Angioscopy and Pathological Study
Authors: Tanaka Yudai , Kojima Keisuke , Hotsubo Yuta , Takahashi Kurara , Nakajima Yuki , MIGITA SHOHEI , Mizobuchi Saki , Miyagawa Masatsugu , Fukumoto Katsunori , Arai Riku , Morikawa Tomoyuki , Takashi Mineki , Kitano Daisuke , Murata Nobuhiro , Sudo Mitsumasa , Okumura Yasuo
Published: December 2023

Introduction:
Severe atherosclerosis of the aorta is known to be a risk of embolism to peripheral organs such as cerebral infarction and acute lower limb ischemia. Non-obstructive general angioscopy (NOGA) has high spatial and temporal resolution, and it is possible to dynamically observe various atherosclerosis in the aorta. Cholesterol crystals (CCs) which could be observed by NOGA scattered into the blood from ruptured plaques and caused inflammation. However, which NOGA-derived aortic plaques are high risk has not fully investigated yet.

Aims:
The purpose of our study was to evaluate aortic vulnerable plaques based on their frequency of scattering CCs.

Methods:
We investigated 52 consecutive patients with coronary artery disease who underwent NOGA between September 2021 and May 2023. Blood specimens were taken from a total of 118 NOGA-derived atheromatous plaques in the infrarenal abdominal aorta. Then, presence of CCs at each plaque was evaluated with polarized light microscopy using the filter paper rinse method.

Results:
The mean age of 52 patients in this study was 67.4 years, 82.7% were male, 36.5% had diabetes, 76.9% had dyslipidemia, and 82.7% had hypertension. CCs were detected in 28.8% (n=34/118) of the samples. The frequency of detection of CCs in aortic plaques was 52.5% for Puff Chandelier Rupture (PCR), 15.4% for Puff Rupture (PR), 4.5% for yellow plaques (YP), 0% for thrombi, and 0% for ulcer and fissure. P < 0.0001).

Conclusions:
Among aortic atherosclerotic plaques, many CCs were detected from PCR. PCR may be a vulnerable plaque that has a high impact on peripheral organs.
Abstract 12054: Activated Clotting Time and Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry
Authors: Simsek Bahadir , Rempakos Athanasios , Kostantinis Spyridon , Alexandrou Michaella , gorgulu sevket , Alaswad Khaldoon , Frizzell Jarrod D , Yildirim Ufuk , Poommipanit Paul , Aygul Nazif , Abi Rafeh, MD, FACC Nidal , Bagur Rodrigo , Davies Rhian , GOKTEKIN OMER , Choi James W , Reddy Niranjan , Haddad Elias , Kerrigan Jimmy , Mutlu Deniz , Mastrodemos Olga , Rangan Bavana V , Karacsonyi Judit , Allana Salman S , Kearney Kathleen E , Sandoval Yader , Burke M Nicholas , Brilakis Emmanouil S , Azzalini Lorenzo
Published: December 2023

Introduction:
The optimal range of activated clotting time (ACT) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study.

Methods:
We examined the association between ACT and in-hospital ischemic and bleeding outcomes in patients who underwent CTO PCI in the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO, NCT02061436).

Results:
ACT values were available for 4,377 patients who underwent CTO PCI between 2012 and 2023 at 29 centers. Mean ACT distribution was: <250 seconds (19%), 250-349 seconds (50%), and ≥350 seconds (31%). The incidence of ischemic events was 0.8%, bleeding events 3.0%, and net adverse cardiovascular events (NACE, composite of in-hospital all-cause mortality, myocardial infarction, stroke, urgent repeat revascularization, pericardiocentesis, and bleeding) 3.8%. In multiple logistic regression analysis, increasing nadir ACT was associated with decreasing ischemic events: adjusted odds ratio (aOR) per 50-second increments: 0.69 (95% confidence interval [CI] 0.50-0.94, p=0.017); and increasing peak ACT was associated with increasing bleeding events: aOR per 50-second increments 1.17 (95% CI 1.01-1.36, p=0.032). A U-shaped association was seen between mean ACT and NACE, where restricted cubic spline analysis demonstrated that patients with low (<200 seconds) or high (>400 seconds) ACT had increasing NACE risk, compared with ACT 200-400 seconds (aOR 2.06, 95% CI 1.18-3.62, p=0.012) (Figure).

Conclusions:
Among patients who underwent CTO PCI, mean ACT had a U-shaped relationship with NACE, where patients with low (<200 seconds) ACT (driven by ischemic events) or high (>400 seconds) ACT (driven by bleeding) had higher NACE compared with ACT of 200-400 seconds.
Abstract 12069: Impact of Atrial Fibrillation on Outcomes in Patients With Heart Failure With Reduced, Mildly Reduced and Preserved Ejection Fraction. A Systematic Review and Meta-Analysis of Published Studies
Authors: Kroshian Garen , Joseph Jacob , KINLAY SCOTT , Peralta Adelqui , hoffmeister peter , Singh Jagmeet , Yuyun Matthew
Published: December 2023

Background:
Atrial fibrillation (AF) is highly prevalent in patients with heart failure (HF), however the difference in outcomes between the HF sub-types is not well known. Contemporary classification of HF categorizes it into HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF). With the new designation of HFmrEF, there have been studies researching the risk profile of AF in the three HF categories, however there is not yet a unifying statement on these data.

Aim:
Systematic review and meta-analysis aimed to determine if there are any significant differences in AF-associated all-cause mortality (primary endpoint), heart failure hospitalizations, cardiovascular mortality, and stroke (secondary endpoints) between HFrEF, HFmrEF, and HFpEF.

Methods:
A systematic search of PubMed, EMBASE, and Cochrane Library databases until February 28
th
, 2023, identified studies reporting clinical outcomes linked to AF by HF category status. Data were combined using D+L random effects model.

Results:
The review included 21 studies comprising 238,107 patients. Pooled AF prevalence: 32% in HFrEF, 38% in HFmrEF, and 43% in HFpEF. AF was associated with a higher risk of all-cause mortality in HFmrEF and HFpEF only (Figure for pooled hazard ratio (HR) and 95% CI). AF associated with a higher risk of HF hospitalizations, in the total population (HR=1.29, 95% CI=1.14-1.46), HFmrEF (HR=1.64, 95% CI=1.20-2.24), and HFpEF (HR=1.46, 95% CI=1.17-1.83), but not HFrEF (HR=1.01, 95% CI=0.87-1.18). AF was only associated with cardiovascular mortality in the HFpEF subcategory but was associated with stroke in all three HF subtypes.

Conclusion:
AF was associated with a higher risk of all-cause mortality and heart failure hospitalization in HFmrEF and HFpEF only. As treatment guidelines for AF in HFmrEF are limited, the benefit of treatments to control AF in this subgroup should be further investigated.
Abstract 12093: Bi-Ventricular Cardiac Adaptations to 20 Weeks of High-Intensity Resistance Training in Healthy Untrained Men: A 3D Echocardiography Longitudinal Study
Authors: Pamart Nicolas , Drigny Joffrey , Azambourg Helene , Remily Marion , Macquart Maxime , Lefevre Alexandre , Lahjaily Kamal , Parienti Jean-Jacques , Rocamora Amelia , Guermont Henri , Desvergee Antoine , Ollitrault Pierre , Tournoux Francois , Saloux Eric , Normand Hervé , Reboursiere Emmanuel , Gauthier Antoine , Hodzic Amir
Published: December 2023

Introduction:
The historical description of cardiac remodelling between strength and endurance athletes, made by Morganroth in the 1970s, has been challenged with the advancements in our understanding of the protective effect of Valsalva manoeuvres and the emergence of sophisticated imaging techniques for cardiac function assessment.

Objective:
We aimed to analyze the kinetics of muscular and cardiac responses to 20 weeks of high-intensity resistance training in healthy untrained volunteers.

Methods:
A total of 27 young and healthy men with an average age of 22.8±3.2 years participated in a 20-week strength training program. The training program intensity was guided by 1-Repetition Maximum (RM) testing. Before and after 12 and 20 weeks of training, participants were assessed using body composition analysis, electrocardiogram, 3D transthoracic echocardiography, cardiopulmonary exercise testing (
V
O
2peak
), and muscle isokinetic dynamometry. Anova was utilized to analyse time effect.

Results:
Among the initial cohort, 22 subjects completed the study protocol. Arterial blood pressure significantly decreased at both time points. Isokinetic evaluation confirmed increases in maximal strength for quadriceps (Δ
0-20wk
=+46.8Nm, P<0.001), hamstrings (Δ
0-20wk
=+25.3Nm, P=0.025), triceps (Δ
0-20wk
=+11.6Nm, P=0.005), and biceps (Δ
0-20wk
=+9.2Nm, P=0.023). Regarding cardiac analysis, after 20 weeks of training 3D left ventricular (LV) mass increased (120.1±15.4 to 133.7±16.3 g, P=0.018), with an augmentation in both septal wall (6.1±1.1 to 7.2±1.4 mm, P=0.027) and posterior wall thickness (5.5±1.3 to 7.1±1.3 mm, P<0.001). 3D LV end-diastolic volume increased by 7.28% without reaching a significant difference. Right ventricular (RV) wall thickness also increased (3.33±0.73 to 3.89±0.8 mm, P=0.04), with a slight non-significant augmentation of 3D RV end-diastolic volume by 7.89%. No significant changes were found in LV and RV systolic or diastolic function.

Conclusions:
This study demonstrated that our 20-week high-intensity strength training program resulted in a rapid and significant increase in muscular strength. The cardiac response to strength training showed a moderate biventricular response like that of endurance athlete
Abstract 12099: The Racial Disparity Among the Clinical Outcomes Post Stroke and Its Intervention Outcomes: A Systematic Review and Meta-Analysis
Authors: Jaiswal Vikash , Hanif Muhammad , Suresh Vinay , Evbayekha Endurance O , Ruchika FNU , Momi Navroop , Chia Jia Ee E , Jaiswal Akash
Published: December 2023

Background:
The Racial disparity between the clinical outcomes post-stroke has not been well studied, with limited literature available.Objective: We conducted a meta-analysis to evaluate the post-stroke outcomes among White and Black patients.

Methods:
We systematically searched all electronic databases from inception until 1st March 2023. The primary endpoint was post-stroke in-hospital mortality and all-cause mortality. Secondary endpoints were post-stroke intervention in-hospital mortality, intracerebral hemorrhage, and all-cause mortality (ACM).

Result:
1250397 patients were included in the analysis, with 1018892 (81.48%) patients of the White race and 231505 (18.51%) patients of the Black race. The mean age of the patients in each group was (73.55 vs 66.28). The most common comorbidity among White and Black patients was HTN (73.92% vs 81.00%) and DM (29.37% vs 43.36%). The odds of in-hospital mortality post-stroke (OR, 1.45(95%CI:1.35-1.55), P<0.001), and all-cause mortality (OR, 1.40(95%CI:1.28-1.54), P<0.001) were significantly higher among White patients compared with Black patients. Among patients with post-stroke intervention, the odds of in-hospital mortality (OR, 1.29 (95% CI: 1.05-1.59, P=0.02), and intracerebral hemorrhage(ICH) (OR, 1.15, (95%CI:1.06-1.26), P<0.01) were significantly higher among White patients compared with Black patients post-intervention. However, all-cause mortality (OR,1.21(95%CI: 0.87-1.68, P=0.25) was comparable between both groups.

Conclusion:
Our study is the most comprehensive and first meta-analysis with the largest sample size thus far, highlighting that White patients are at increased risk of mortality and post-intervention intracerebral hemorrhage compared with Black patients.