bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11037: Inappropriate Sinus Tachycardia and
18
FDG PET Scan
Authors: Chaaban Nourhan , Chaaban Said , Kshatriya Shilpa
Published: June 2023

Introduction:
Inappropriate sinus tachycardia is a clinical syndrome characterized by an elevated heart rate at baseline with associated symptoms including palpitations. This entity can be quite disabling with no identifiable etiology in most cases. However, secondary causes need to be evaluated. This case highlights the utility of 18 F-Fluorodeoxyglucose PET in identifying myocarditis in a patient with systemic lupus erythematosus and in therapy changing management.

Case:
A 30-year-old female presented to the cardiology clinic with symptoms of palpitations for the past year with associated dizziness and fatigue, impairing her quality of life. Past medical history includes SLE, maintained on Hydroxychloroquine, and antiphospholipid antibody syndrome on warfarin. A resting EKG showed sinus tachycardia. Medical workup for sinus tachycardia was unremarkable. The patient had a normal echocardiogram. A 24-hour Holter monitor showed occasional PACs, a maximum HR of 167 with an average HR of 102 bpm, with symptoms of lightheadedness and palpitations correlating with sinus tachycardia (rates of 106 to 134 bpm). A treadmill exercise test was negative for ischemia with a peak HR of 196 bpm. Given suspicion for autoimmune myocarditis, an FDG PET using F18 was ordered showing abnormal di!use FDG myocardial uptake consistent with inflammation.

The patient was started initially on metoprolol tartrate. She developed side e!ects, so she was switched to ivabradine and diltiazem. These findings were also communicated to her rheumatologist with a decision to aggressively treat her lupus disease. Methotrexate and a prednisone course were added. After 2 months, the patient reported improvement to near resolution of her symptoms.

Conclusion:
In this case, we aim to introduce the importance of cardiac PET nuclear imaging in addressing the relationship between inappropriate sinus tachycardia and autoimmune disease.
Abstract 11040: Disparities in Inpatient Intensity of End-of-Life Care for Children With Advanced Heart Disease
Authors: Chen Spenser Y , chamberlain lisa , Saynina Olga , Fernandes Susan M , Johnston Emily E
Published: June 2023

Introduction:
Children dying of advanced heart disease experience high intensity end-of-life care (EOLC). However, little is known about disparities in EOLC intensity, which is critical for EOLC equity.

Methods:
We conducted a population-based retrospective analysis using the California Office of Statewide Health Planning and Development private inpatient discharge database to assess disparities in inpatient EOLC intensity by examining the terminal admission for children (0-21y) with cardiomyopathy and moderate/complex congenital heart disease (CHD) who died in 2005-2018. We examined rates of medical intensity (intubation, CPR, etc.) and cardiac intensity (ECMO, ventricular assist device interventions, other cardiac surgeries, or ≥ 2 cardiac catheterization, biopsy, or electrophysiology procedures). Clinical and sociodemographic factors, including death at a California Children’s Services designated cardiac special care center, associated with medical intensity and cardiac intensity were examined.

Results:
The 2,794 children died and 76% were < 1 year old. Of them, 26% had cardiomyopathy, 44% moderate CHD, and 46% complex CHD. The majority were male (55%) and publicly insured (64%). The largest racial/ethnic group was Hispanic (50%) followed by non-Hispanic white (26%). Mean length of terminal admission was 31±50d, and 82% died at a cardiac special care center. During the terminal admission, the majority (79%) were intubated, 39% had cardiac surgery, 30% received ECMO, 28% received CPR, and 42% had a cardiac intensity marker. Black children and children with cardiomyopathy were less likely to have a cardiac intensity marker (aOR=0.6 [95% CI: 0.39-0.91]; reference, non-Hispanic white, aOR=0.46 [95% CI: 0.34-0.61]; reference, moderate CHD, respectively). Children who died at a cardiac special care center were more likely to have a cardiac intensity marker (aOR=6.79 [95% CI: 4.95-9.32]; reference, non-specialty center).

Conclusion:
Children with advanced heart disease in California exhibited high intensity EOLC with significant sociodemographic variation. It is critical to determine if this variation represents patient preferences, provider biases, or systemic factors such as resource availability.
Abstract 11067: Off-Heparin Implantation of Leadless Pacemaker, a Single Center Study
Authors: Mendoza Ivan , Tran Dan , Gonzalez Carta Karina A , Mendoza Ivan
Published: June 2023

Introduction:
Leadless pacing(LP) technology has been expanding in recent practice as an alternative to traditional pacing This technology is associated with reduce complications such as infection, dislodgment, and hardware burden. There has been recent reports on effusions with its implantation .Historically the manufacturer has recommend bolus of heparin or infusions We present the results and operative outcomes of patients who received a LP without initial heparinization or infusion from 2016 to 2021 at a single center.

Objective
We sought to describe the outcomes of LP implantation without the need of heparin administration.

Methods:
We report the clinical outcomes and operative findings of 200 patients who underwent LP implantation without initial heparin loading or infusions . An aggressive flushing strategy of the sheaths before and during the procedures was performed Data recorded include indication, ejection fraction (EF) R waves, capture thresholds, ventricular ectopy on deployment,recaptures, procedure times, and complications. Patients on chronic anticoagulation were excluded

Results:
A total of 200 patients were included , average age was 77 years and 20 (10%) had a reduced EF (<40%) pre-procedure. The most common indications included complete AV block (97, 48.5%) and atrial fibrillation with slow ventricular response (76, 38%). All patients (100%) had successful establishment of ventricular pacing with no short-term complications postoperatively. Average R waves after deployment were 9.7 with average capture thresholds of 0.84 @ 0.24 Ventricular ectopy was seen for 134 (67%) of patients upon deployment with 62 (31%) patients requiring recaptures, and 29 (14.5%) requiring more than one recapture. There was no evidence of thrombus in the sheaths or implanting instruments . There were no embolic or thrombotic complications.

Conclusions: LP
implantation is highly effective and efficacious in establishing single-chamber ventricular pacing for a variety of conduction pathologies with minimal complications postoperatively. It appears that an aggressive flushing strategy of the implanting equipment & sheaths is safe & effective without the need of heparinization. Further studies will be require to validate this strategy
Abstract 11088: Childbirth Related Complications in Women With Hypertrophic Cardiomyopathy
Authors: Yellapu Vikas , Gasimli-Gamache Leyla , Singh Amitoj , Shirani Jamshid
Published: June 2023

Background.
Women with hypertrophic cardiomyopathy (HCM) have higher risk of adverse cardiac events and obstetrics complications with labor and delivery (L&D). Data on HCM and peripartum complications are still scarce. We aimed to examine the maternal cardiovascular and obstetric outcomes of L&D in women with HCM in the United States. Methods. We identified 1,1655 mothers with HCM (age 29.5±6.2 years, 48% Caucasians) admitted to a hospital for childbirth from 2003-2018 according to Nationwide Inpatient Sample database.

Results.
Mode of delivery was Cesarean section (CS) in [702 (61%)] and mean length of stay was 5.5±6 days. There were two maternal deaths and a low rate of major adverse cardiac events (MACE) including cardiac arrest [n=11 (0.9%)], cardiogenic shock [n=10 (0.8%)], and ventricular tachycardia [n=35 (3%)]. Cardiopulmonary resuscitation, mechanical circulatory support, and temporary venous pacemaker rates were low at 0.75%, 0.4%, and 0.4% respectively. There was an increased rate of ARDS [n=45 (3.9%)], deep veins thrombosis [n=8 (0.7%)] and acute renal failure [n=14 (1.2%)]. Obstetric complications included abruption placenta [n=36 (3.14%)], preterm labor [n=193 (16.8%)], premature rupture of membranes [n=32 (2.8%)], pre-eclampsia/eclampsia [n=166 (14.37%)] and gestational hypertension [n=57 (4.9%)]. Post-partum hemorrhage occurred in [n=26 (2.2%)] of deliveries and maternal blood transfusion was needed in [n=77(6.7%)] of patients. Fetal distress, abnormal fetal heart rate and fetal growth retardation occurred in 5.5%, 9.8% and 1.3%, respectively.

Conclusions.
We were able to identify that there has been an increase in the number HCM over the past decade, however, there has been a decrease in maternal and fetal complications.
Abstract 11095: Abdominal Paraganglioma: A Rare but Non-Negligible Etiology of Severe Dyspnea in Late Gestation
Authors: Zhao Hong-Jin , Li Yan , Yang Le , Yuan Hai-Tao
Published: June 2023

With a history of cesarean delivery of a dead baby at 36 weeks of pregnancy due to severe dyspnea two years ago, a 25-year-old woman with 32 weeks of pregnancy complained severe dyspnea again and was transferred to our emergency department. Her serum test showed extremely elevated NT-proBNP. Her echocardiography exhibited normal left ventricular ejection fraction (LVEF) but diffused myocardial hypertrophy/edema, resulting in decreased inner diameters in the left ventricle and left atrium, which is quite different from other diastolic heart dysfunctions usually showing an enlarged left atrium. After emergency cesarean delivery, her cardiac walls became thinner, and the left ventricle and atrium inner diameters increased correspondingly on echocardiography along with the relieved dyspnea, but the baby did not survive either. The prominent elevation in serum norepinephrine as well as the abdominal vascular ultrasound indicated the probability of a paraganglioma below the abdominal aorta bifurcation, which was finally confirmed by pathology. However, whole exome sequencing did not exhibit the usual gene mutation reported but exhibited the
RYR2
heterozygous mutation in c.2642T>G, which was likely pathogenic according to bioinformatic analysis. Therefore, the severe dyspnea in her late gestation was due to the occupancy of the enlarged uterus on the paraganglioma below the abdominal aorta bifurcation, thus inducing considerable catecholamine excretion and the incidence of catecholamine cardiomyopathy (Takotsubo syndrome). To the best of our knowledge, this is the first report showing the special location of a paraganglioma exacerbated by pregnancy. The adverse pregnancy outcome emphasized the importance of the early diagnosis of paraganglioma-induced cardiomyopathy, which is rare and easily neglected by clinical obstetricians. Our case implicates that for pregnant patients with diastolic dysfunction who are contraindicated for cardiac MRI, the diffused myocardial hypertrophy/edema, especially the decreased left atrium inner diameter displayed in echocardiography, could suggest the incidence of paraganglioma-induced cardiomyopathy rather than other diastolic heart dysfunctions, such as hypertensive heart failure of pregnancy.
Abstract 11119: Racial and Ethnic Disparities in Preoperative Characteristics and Outcomes Following Mitral and Tricuspid Valve Surgery
Authors: Winicki Nolan M , Florissi Isabella S , Zaheer Salman , Holmes Sari D , Alejo Diane E , Fonner Clifford E , Gammie James S
Published: June 2023

Introduction:
Prior investigations assessing the impact of race and ethnicity on outcomes after mitral valve surgery have reported conflicting findings. The aim of this analysis was to examine the association of race with characteristics and outcomes for patients undergoing mitral and tricuspid valve (MV; TV) surgery using a representative statewide database.

Methods:
We performed retrospective analyses on 5,929 patients (2,707 female, median age 63 yrs) who underwent MV (
n
=4,490, 76%), TV (
n
=473, 8%), or both MV and TV (
n
=966, 16%) surgery in a statewide collaborative of 10 centers from 2012-2020. The influence of race/ethnicity on preoperative characteristics, MV and TV repair rates, and postoperative outcomes was assessed for White (
n
=4,208, 71%), Black (
n
=1,261, 21%), Hispanic (
n
=140, 2%), Asian (
n
=169, 3%), and mixed/other race (
n
=151, 3%) patients.

Results:
Black patients, compared to White patients, had a higher Society of Thoracic Surgeons predicted risk of morbidity or mortality (24.5% vs 13.1%
P
<0.001) with a higher incidence of previous valve operations, myocardial infarction, stroke, hypertension, diabetes, and chronic lung disease. Compared to White patients, Black and Hispanic patients were less likely to undergo an elective procedure (White 71%, Black 55%, Hispanic 58%,
P
<0.001). Degenerative MV disease was more prevalent in White patients (White 62%, Black 41%, Hispanic 43%, Asian 51%, mixed/other 45%, all
P
<0.05) while rheumatic disease was more prevalent in non-White patients (Asian 28%, Hispanic 26%, mixed/other 25%, Black 17%, White 10%, all
P
<0.05). Repair for degenerative MV disease was more prevalent in White vs Black patients (84% vs 74%,
P
<0.001), but after multivariable adjustment race was no longer associated with MV repair (
P
=0.073). In multivariable analyses, adverse postoperative outcome incidences were not different by race groups, including mortality.

Conclusions:
Patient race/ethnicity affects the burden of comorbidities at the time of presentation for operation and MV disease etiology. Strategies to improve early detection and referral for surgery and to decrease rates of rheumatic disease for racial and ethnic minority patients with MV and TV disease may enhance outcomes.
Abstract 11161: Thymic Hemorrhage – A Cause for Cardiac Arrest?
Authors: Riaz Sana , Thompson Paul
Published: June 2023

Introduction:
Thymic hemorrhage is a rare cause of sudden cardiac death, particularly in adults. We present a 35- year- old with sudden “cardiac” death secondary to thymic hemorrhage.

Case:
A 35-year-old healthy man presented following witnessed cardiac arrest. CPR was initiated immediately. The initial rhythm was shockable, he was defibrillated, and ROSC was achieved. He was intubated on site and transferred to the hospital. Initial labs were negative for electrolyte derangements and drugs of abuse. His high-sensitivity troponin T was 238 ng/L (nl<23 ng/L) and subsequently trended downward. His electrocardiogram showed non-specific ST-T abnormalities. His echocardiogram showed an ejection fraction of 25 to 29% with global hypokinesis. He was extubated on day 4 and scheduled for coronary angiography. On day 5, when he attempted to get out of bed, he lost consciousness and became pulseless. His initial rhythm was PEA, but with episodes of ventricular fibrillation during CPR, he was shocked accordingly. He had prolonged CPR, therefore, obviating advanced therapies. His autopsy showed only thymic hemorrhage. His coronary arteries were normal, with no signs of myocardial injury or myocarditis.

Conclusion:
Massive acute thymic hemorrhage is extremely rare in adults but is a rare but recognized cause of sudden death in utero and infants. There are only two reported cases of thymic hemorrhage in adults in the literature. Both the patients were nearly 40-year-old men who presented with chest pain. Initial imaging was consistent with mediastinal widening requiring thoracotomy that demonstrated hemorrhagic thymus. Similar to our patient, the reported cases were young men with no prior history of trauma. In contrast, our patient presented with cardiac arrest, and initial imaging was negative for mediastinal widening. The underlying etiology of cardiac arrest from thymic hemorrhage is poorly understood. Right atrial compression from acute hemorrhage of a benign thymic tumor was postulated as the cause of sudden death in a previously healthy 15-year-old boy. Our patient is a rare case since there are, to our knowledge, no reported cases in the literature of thymic hemorrhage as the cause of death in adults.
Abstract 11172: Heterogeneity in the Association Between the Presence of Coronary Artery Calcium and Cardiovascular Events: Multi-Ethnic Study of Atherosclerosis
Authors: Inoue Kosuke , Seeman Teresa , Horwich Tamara B , Budoff Matthew , Watson Karol E
Published: June 2023

Introduction:
Coronary artery calcium (CAC) has been widely recognized as an important predictor of cardiovascular disease (CVD). Given the finite resources, it is important to identify individuals who would receive the most benefit from detecting positive CAC by screening. However, the evidence is limited as to whether the burden of positive CAC on CVD differs by multi-dimensional individual characteristics. We aimed to investigate the heterogeneity in the association between positive CAC and incident CVD.

Methods:
This longitudinal cohort study included adults aged ≥45 years free of cardiovascular disease from the Multi-Ethnic Study of Atherosclerosis (MESA). After propensity score matching in a 1:1 ratio, we applied a machine-learning causal forest model to (i) evaluate the heterogeneity in the association between positive CAC and incident CVD and (ii) predict the increase in CVD risk at 10-year when CAC>0 (vs. CAC=0) at the individual level. We then compared the estimated increase in CVD risk when CAC>0 to the 10-year atherosclerotic CVD (ASCVD) risk calculated by the 2013 ACC/AHA pooled cohort equations.

Results:
Across 3,348 adults in our propensity score-matched analysis, our causal forest model showed heterogeneity in the association between CAC>0 and incident CVD. We found a dose-response relationship of the estimated increase in CVD risk when CAC>0 with higher calculated 10-year ASCVD risk (
Figure
). Even among 1,413 adults with low/borderline ASCVD risk, 689 (49.4%) showed ≥7.5% increase in CVD risk when CAC>0; these individuals were more likely to be male, non-Hispanic Black or Hispanic, less educated, never smokers, and have unfavorable CVD risk factors than others.

Conclusion:
The increases in CVD risk when CAC>0 were heterogeneous across individuals, and nearly half of people with low/borderline calculated ASCVD risk showed a large increase in CVD risk when CAC>0, highlighting the need for CAC screening among such low-risk individuals.
Abstract 11191: Early Surgery versus Conservative Management Among Patients With Asymptomatic Aortic Stenosis: A Meta-Analysis
Authors: Jaiswal Vikash , Kalra Kriti , Attia Abdelrahman , Khan Nida , Joshi Amey , Baburaj Abiram , BUTEY SWATIKA , Patel Nirmit , Jaiswal Akash , Naz Sidra , Ishak Angela , Ang Song Peng , Chia Jia Ee , Pasam Chetana , Mudwari Richa
Published: June 2023

Introduction:
With the increasing prevalence of asymptomatic severe AS and its progression to the symptomatic stage the early surgical aortic valve repair is emerging as a popular option but with limited evidence of its efficacy and safety.

Objective:
We aimed to conduct a meta-analysis to evaluate the efficacy and safety to early surgical aortic valve repair as compared to conservative management.

Methods:
A systematic literature search was performed in PubMed, Scopus, Embase and Cochrane databases for studies comparing the early surgery versus conservative management among asymptomatic aortic stenosis patients. The primary outcome was all-cause mortality. Secondary endpoints were cardiovascular mortality (CVM), sudden cardiac death (SCD), hospitalisation due to heart failure, the composite of mortality and MACCE, Clinical thromboembolic events, major bleeding, myocardial infarction (MI), and stroke.

Results:
A total of 5 articles (3 observational studies and 2 randomized controlled trials) were included. We found that there were significantly lower odds of all-cause mortality [OR, 0.33; (95%CI:0.25-0.42); p<0.000001], cardiovascular mortality [OR, 0.34 (95%CI:0.25-0.47); p<0.00001] and composite of mortality and MACE (OR:0.32(95%CI:0.24,0.42;p<0.00001), sudden cardiac death (OR:0.32; CI: 0.16-0.64; p=0.001) and hospitalization due to heart failure (OR:0.27, CI: 0.16-0.44; p<0.00001) with early surgical aortic valve repair compared to conservative management. There was no significant difference between the incidence of major bleeding, clinical thromboembolic events, stroke and myocardial infarction between the conservative care groups and early surgery. We also found a reduced risk of

Conclusion:
Among asymptomatic patients with AS, SAVR shows better outcomes in reducing mortality and other complications compared with the conservative management approach.
Abstract 11198: Intra-Myocardial Dissecting Haematoma Presented as a Ventricular Tachycardia in a Patient With Remote Silent Myocardial Infarction
Authors: Iqbal Noreena , Kamel Yasmin , Kardos Attila
Published: June 2023

Intramyocardial dissecting haematoma (IMDH), a rare form of myocardial rupture, is recognised as a complication of acute myocardial infarction (MI) but can also occur as a result of a thoracic trauma or spontaneous rupture of intramural coronary vessels. Before the advent of advanced multi-modality cardiac imaging, IMDH was an autopsy diagnosis. In this report, we present a patient with recent onset of palpitation due to non-compromising ventricular tachycardia (VT). Post cardioversion ECG showed anterior-apical deep Q waves in keeping with prior silent MI. Transthoracic echocardiography showed severely reduced left ventricular ejection fraction due to extensive apical aneurysm and raised the possibility of protruding apical thrombus. Subsequent contrast echocardiography showed features compatible with extensive LV apical thrombus and raised the differential diagnosis of contained myocardial rupture and IMDH. During the two years follow-up guideline directed medical therapy for heart failure and antiarrhythmic medication stabilised patient at NYHA class I-II with no recurrence of VT. Multimodality imaging including cardiac CT and MRI confirmed the suspicion of IMDH. With this case we are highlighting the difficulties in the diagnosis and the controversies of the management of IMDH.

Figure: A: ECG shows monomorphic VT. B: after chemical cardioversion, ECG shows sinus rhythm with old transmural extensive anterior MI. C: Transthoracic echocardiography, apical 4 chamber view shows aneurysmatic left ventricular apex with echo lucent space with mobile intraventricular membrane separating the true LV lumen and the dissecting hematoma (Asterix). D: Contrast enhanced echocardiography delineating the true LV cavity from the IMDH. E,F: Contrast enhanced CT showing the low attenuation hematoma located in the anterior LV apex. Note the calcification in the LV apical myocardium indication of prior transmural MI.
Abstract 11205: Pharmacological and Non-Pharmacological Parasympathomimetic Interventions Prevent Trastuzumab-Induced Cardiotoxicity Through Attenuating Impaired Mitochondrial Function
Authors: Khuanjing Thawatchai , Maneechote Chayodom , Ongnok Benjamin , Prathumsap Nanthip , Arinno Apiwan , Chunchai Titikorn , Arunsak Busarin , Chattipakorn Siriporn , Chattipakorn Nipon
Published: June 2023

Introduction:
Although the use of trastuzumab (Trz) has effectively reduced the mortality rate in breast cancer patients, Trz-induced cardiotoxicity (TIC) has become a serious complication. Parasympathetic activations via either electrical vagus nerve stimulation (VNS) device or acetylcholinesterase inhibitor donepezil (DPZ), have been shown to exert cardioprotection in various heart diseases. However, the cardioprotective effects of VNS and DPZ on left ventricular (LV) function, autonomic function, and mitochondrial function in TIC rats are unknown.

Hypothesis:
Both VNS and DPZ protect the heart against TIC by reducing LV dysfunction, sympathovagal imbalance, and mitochondrial dysfunction. A combination of VNS and DPZ treatment exerts a better benefit than either single intervention.

Methods:
Adult male Wistar rats (N=25) were subjected to VNS device implantation. Then, rats were assigned into five groups (N=5/group), including (i) control without VNS (C), (ii) Trz (4 mg/kg/day, I.P., 7 days), (iii) Trz+DPZ (5 mg/kg/day, P.O., 7 days) (TrzD), (iv) Trz with VNS (TrzV), and (v) Trz+DPZ with VNS (TrzVD). LV function and heart rate variability (HRV) were performed. All hearts were collected to determine mitochondrial reactive oxygen species (ROS) levels and mitochondrial morphology.

Results:
Trz rats had a reduced LV ejection fraction, impaired HRV as shown by increased LF/HF ratio, and mitochondrial dysfunction shown by increased ROS levels and dysmorphology (Figures 1A-D). Treatment with either DPZ, VNS, or the combined treatment exerted similar cardioprotection via reducing sympathovagal imbalance and mitochondrial injury, leading to improved LV function, (Figures 1A-D).

Conclusions:
Promoting parasympathetic activity using VNS, DPZ, or the combined treatment similarly protected the heart against TIC via improving HRV, mitochondrial function, and mitochondrial morphology, suggesting a novel potential strategy for patients receiving Trz.
Abstract 11211: Kawasaki Disease Like Vasculitis Facilitate Atherosclerosis and Statin Shows Significant Antiatherosclerosis and Antiinflammatory Effect in Kawasaki Disease Model Mouse
Authors: Motoji Yusuke , Fukazawa Ryuji , Yasuo Miyagi , Itoh Yasuhiko , Ishii Yosuke
Published: June 2023

Introduction:
Kawasaki disease (KD) is an acute form of systemic vasculitis that may promote atherosclerosis in adulthood. We reported last year that CAWS vasculitis, a KD-like vasculitis, induces atherosclerosis in ApoE -/- mice and that statin suppress atherosclerosis and vasculitis. For further validation, we focused on macrophage cells and its fractionations.

Hypothesis:
Statins have a therapeutic effect by affecting the macrophage cell infiltration and fractionation.

Methods:
CAWS was injected intraperitoneally in 5-week-old male ApoE-/- mice, and they were divided into 4 groups: the control, CAWS, CAWS+statin, and Late-statin groups. They were sacrificed at 6 or 10 weeks after CAWS injection and blood samples, aorta and heart were taken. Statin was started after CAWS injection, except for the late-statin group, which was administrated statin internally 6 weeks after injection. The serum was assayed for LDL/VLDL cholesterol. The aortic root and abdominal aorta were evaluated with HE staining and immunostaining (Macrophage fractionation; M1+M2(anti-Mac2), M1 (anti-CD80), M2 (anti-CD206)).

Results:
These serum LDL/VLDL cholesterol levels were elevated in all groups. CAWS significantly accumulated inflammatory cells, including macrophage cells, in both the aorta and abdominal aorta(Macrophage at aortic root: 6wks; Control 0.34±0.08% vs. CAWS 10.22±2.17 (p=0.030), 10wks; 0.67±0.39 vs. 6.48±1.07 (p=0.052)).Statins significantly inhibited macrophage cell infiltration at the aortic root. The M2/M1 ratio was significantly increased in the statin group(6wks; CAWS 0.10±0.05% vs. CAWS+statin 1.10±0.27 (p=0.030), 10wks; 0.17±0.10 vs. 0.96±0.15 (p=0.030)). The Late-statin group was also found to have about the same above therapeutic effects.

Conclusions:
It was suggested that statins might suppress CAWS vasculitis and atherosclerosis by inhibiting the accumulation or differentiation of macrophage cells (mainly M1) and increasing M2 cells, which have tissue repair effects. Statin was effective for prevention of atherosclerosis even when in the late phase. In the future, this study would be expected to contribute to expanding the indications of statin therapy for patients with KD who have cardiovascular sequelae.
Abstract 11247: Impact of Pre-Existing Heart Failure on Non-St Segment Elevation Myocardial Infarction Outcomes
Authors: Gill Ahmad , Al-Taweel Omar , Al-Tarawneh Saba , Jaradat Mohammad , HAWWASS DALIA , Ahsan Chowdhury
Published: June 2023

Introduction:
There is limited data examining how pre-existing heart failure impacts patients with a non-ST segment elevation myocardial infarction (NSTEMI). In this study, we compare the in-hospital outcomes of NSTEMI patients with chronic heart failure with reduced ejection fraction (HFrEF) against NSTEMI patients with chronic heart failure with preserved ejection fraction (HFpEF).

Methods:
We queried the National Inpatient Sample database (2016-2019) to identify patients admitted with a principal diagnosis of NSTEMI and a secondary diagnosis of chronic heart failure. We conducted propensity score matching using a greedy nearest neighbor 1:1 model. Multivariable logistic regression was used to compare mortality.

Results:
51,564 patients met our inclusion criteria. Patients with a NSTEMI and chronic HFrEF had 1.71 times higher odds of suffering in-hospital mortality compared to NSTEMI patients with chronic HFpEF (aOR 1.71, 95% CI: 1.55-1.90; p < 0.001). When separated by race, NSTEMI patients with HFrEF had a higher mortality rate amongst White patients (5.7% vs 4.4%, p < 0.001, Figure 1). These patients also had higher rates of coronary artery disease, hypertension and prior myocardial infarction (Table 1). There was no difference in percutaneous coronary intervention (21.7% vs 21.5%, p = 0.60, Table 1) or postoperative cardiac arrest, cerebral infarction and hemorrhage between our two cohorts.

Conclusions:
Patients with a NSTEMI and chronic HFrEF had higher odds of suffering in-hospital mortality compared to NSTEMI patients with chronic HFpEF. Further studies should explore the interventions providers may undertake to better support this vulnerable population.
Abstract 11257: Septal Ischemia in Acute Coronary Syndromes and the Risk of Cardiac Arrest
Authors: Sundaram Kavin , Sabzwari Syed Rafay Ali , Aleong Ryan G , Tumolo Alexis , Rosenberg Michael , Zipse Matthew , Tzou Wendy , Garg Lohit
Published: June 2023

Introduction:
The interventricular septum may play an important role in circuits that lead to ventricular tachycardia and ventricular fibrillation.

Hypothesis:
Among patients with ST-segment myocardial infarction elevation (STEMI), those presenting with cardiac arrest are more likely to have septal ischemia, defined as ST-elevation > 1 mm in V1, than those with other clinical presentations.

Methods:
A single-center retrospective review was conducted for all patients presenting with a STEMI from January 1, 2016-December 31, 2021. This identified a total of 60 consecutive patients with pre-intervention cardiac arrest and the first 60 patients in this time frame who presented without cardiac arrest. Both groups had had similar baseline characteristics. (
Table 1).

Results:
A higher proportion of patients presenting with cardiac arrest had evidence of septal ischemia (
Figure 1,
29/60 versus 17/60, p<0.02). These findings remained statistically significant in a sub-group analysis of patients drawn from the same series with lesions of the right coronary artery (RCA) and left circumflex (LCx) without proximal left anterior descending (LAD) lesions
(
7/23 versus 2/32, p<0.02
)
.

Conclusions:
Patients presenting with cardiac arrest in the setting of ACS were more likely to have evidence of septal ischemia.
Abstract 11288: Conduction Velocity is Slower in Corridors Traversing Lipomatous Metaplasia Than in Corridors Traversing Scar in Chronic Infarcts
Authors: Xu Lingyu , Zahid Sohail , Pourmousavi Khoshknab MirMilad , Moss Juwann , Berger Ronald D , Chrispin Jonathan , Callans David J , Marchlinski Francis E , Zimmerman Stefan , Han Yuchi , Desjardins Benoit , Trayanova Natalia , Nazarian Saman
Published: June 2023

Introduction:
We sought to examine the association of infarct scar versus lipomatous metaplasia (LM) with impulse conduction velocity (CV) in putative ventricular tachycardia (VT) corridors that traverse the infarct zone in patients with prior myocardial infarction (MI).

Methods:
The cohort included 31 patients from the prospective
In
tra-Myocardial
F
at Deposition and Ventricular Tachycardia
in
Ischemic Card
i
omyopa
t
h
y
(INFINITY) study. CV was calculated as the mean CV between that point and five adjacent points along the activation wavefront using an automated Python script in myocardial scar, border zone (BZ), and potential viable corridors defined by late gadolinium enhancement (LGE)-cardiac magnetic resonance (CMR), and LM identified by computed tomography (CT). Both image sets were registered with electroanatomic maps (EAM).

Results:
Regions with LM exhibited lower myocardial CV than scar (median 12.0 vs. 13.5 cm/s,
P
<0.001). Of 96 corridors computed from LGE-CMR and electrophysiologically confirmed to participate in VT reentry, 95 traversed through or near LM identified on CT. These critical corridors displayed slower CV {median 8.8 [interquartile range (IQR) 6.0, 15.4] vs. 39.0 (IQR 27.8, 56.5) cm/s, P <0.001, Figure 1}, and demonstrated low-peripheral-high-center (mountain-shaped, 25%), or mean low level (45.7%) CV patterns, when compared to 122 non-critical corridors distant from LM that displayed high-peripheral-low-center (valley-shaped, 20.5%) or mean high level (59%) CV patterns.

Conclusion:
Myocardial LM is a crucial contributor to VT propensity. Corridors traversing through or near LM exhibit significantly slower CV, which likely facilitate the presence and stability of the VT circuit reentry.
Abstract 11298: Bioenergetics-Independent Stress Response to Mitochondrial Protein Import Clogging in the Heart
Authors: Mishra Gargi , Rana Arnav , Coyne Liam , Wang Xiaowen , Chen Xin Jie
Published: June 2023

Mitochondria are double-membraned organelles indispensable in metabolically active organs such as the heart. Much of the mitochondrial proteome is encoded by the nuclear genome and requires import into mitochondria via channels present on the outer and inner mitochondrial membranes. If protein import goes awry at any step, it can cause unimported mitochondrial proteins to accumulate in the cytosol, leading to mitochondrial Precursor Overaccumulation Stress (mPOS). Defects in mitochondrial protein import have been linked to many forms of heart disease such as Senger’s syndrome, cardiac arrhythmia, and chronic atrial fibrillation. The A123D mutation in adenine nucleotide translocase 1 (Ant1), an ATP/ADP antiporter present on the mitochondrial inner membrane, has been shown to cause hypertrophic cardiomyopathy, while other mutations in
Ant1
(A114P, A90D, V289M, L98P) have been shown to cause Autosomal Dominant Progressive External Ophthalmoplegia. Our studies suggested that the mutant ANT1 can cause mitochondrial protein import clogging. To characterize the pathophysiology induced by mitochondrial protein import clogging, we developed a mouse model (the “clogger mouse”) expressing two clinically relevant mutations in
Ant1
, namely
A114P
and
A123D
. While prior work on this model revealed a low-penetrant neurodegenerative and mild myopathic phenotype, the impact of this mutation on the heart has not been studied. In the current study, we show that expression of Ant1
A114P, A123D
has little effect on mitochondrial respiration and heart function. This is consistent with the rapid degradation of Ant1
A114P, A123D
in the heart. Interestingly, transcriptomic analysis revealed an altered expression of circadian regulator and output genes such as
Clock,
Ciart, Per1-3, Cebpb
and
Hlf
in the clogger mouse relative to wild type. These data suggest that mitochondrial protein import clogging can induce a stress response independent of bioenergetics. It also led us to hypothesize that the circadian pathway plays a role in adapting to mitochondria-induced proteostatic stress in the heart. Our current experiments focused on testing this hypothesis are anticipated to help us understand how the heart can uniquely adapt to mitochondrial protein import clogging.
Abstract 11327: De Novo Heart Failure in a Young Adult: A Case of Severe Aortic Regurgitation Secondary to an Aortic Root Aneurysm in a Patient With Marfan's Syndrome
Authors: Orozco -Sepulveda Dayana , Mencia-Amador Dario , SANTALO RAMON E , Hernandez del Rio Jorge Eduardo , Miranda - Aquino Tomas
Published: June 2023

A 24-year-old male, with no past medical history, presented to the ER with a 15-day history of insidious abdominal pain and distention, associated with progressive dyspnea on exertion and bilateral lower extremity pitting edema. In the previous 48 hours before his hospital admission, patient began presenting orthopnea and paroxysmal nocturnal dyspnea.On presentation patient was normotensive and tachycardic, with low oxygen saturation on pulse oximetry. On auscultation a loud early diastolic decrescendo murmur was heard at the parasternal border, with and audible S3 gallop. Characteristic Marfanoid habitus was observed. Patient underwent TTE were there was a notable aortic root dilation, mainly at the level of the sinuses of Valsalva, which had a diameter of 85 mm and 62 mm at the sinotubular junction. Ascending and descending aorta had a normal diameter. An eccentric jet of severe aortic regurgitation was also noted, which collided with the anterior mitral valve leaflet causing an Austin Flint phenomenon. Left ventricular ejection fraction was estimated at 24%, severe dilation was noted on all chambers. There were no echocardiographic signs of aortic dissection. Patient underwent genetic testing and ophthalmic evaluation, confirming the diagnosis of Marfan’s syndrome. A contrast enhanced CT angiogram confirmed the presence of severe aortic root dilation without dissection. Patient underwent Bentall procedure and began treatment for HFrEF at discharge. Marfan Syndrome is an autosomal dominant connective tissue disorder, due to mutations mostly in the
FBN1
gene. Most cardiovascular symptoms are related to dilation of the aortic root and subsequent aortic regurgitation due to aortic annulus dilation. In patients with Marfan’s syndrome, all aortic root aneurysms ≥5.0 mm should undergo surgical repair regardless of symptoms.
Abstract 11421: Intervention With Cerebral Embolic Protection in Transcatheter Aortic Valve Implantation (INTERCEPTavi): Does Carbon-Dioxide Flushing Reduce Vascular Brain Injury?
Authors: Khawaja Saud , hanna lydia , Singh Abhinav , Crockett Stephen , Malik Iqbal , Sen Sayan , Ruparelia Neil , Hadjiloizou Nearchos , Farag Mohamed , Khamis Ramzi Y , Gibbs Richard , Mikhail Ghada W
Published: June 2023

Background:
Transcatheter Aortic Valve Implantation (TAVI) is associated with 2-3% clinical stroke rate and much higher incidence of silent cerebral infarction. This study investigated the neuroprotective benefits of minimising air emboli in TAVI. It aimed to demonstrate a reduction in vascular brain injury by flushing TAVI valves with CO
2
and saline compared to saline only as per standard practise.

Methods:
Patients undergoing transfemoral TAVI for aortic stenosis were enrolled. Patients were randomised to CO
2
and saline (TAVI-CO
2
) versus saline only (TAVI-S) flushing of TAVI valves during preparation. Patients underwent MRI brain following TAVI to identify new cerebral infarcts and any reduction in vascular brain injury by reducing air emboli.

Results:
Twenty-Two patients were enrolled in the study with a mean age of 79±10 years. Fifteen (68%) were males. Nine patients (41%) had history of hypertension, 5 (23%) had previous cerebrovascular disease and 5 (23%) had diabetes. Two (9%) patients did not have their TAVI valve implanted and hence were excluded. No patients had any procedural related complications. Three (14%) patients required permanent pacemaker insertion post procedure and could not have their MRI. Fifteen patients (68%) had MRI brain post-TAVI, 7 patients in the TAVI-CO
2
group and 8 patients in the TAVI-S group. TAVI-CO
2
group had a total of 41 new cerebral lesions compared to 66 lesions in TAVI-S group. TAVI-CO
2
had on average 6.80 new lesions/patient compared to 8.25 lesions/patients in TAVI-S (p=0.34) Cerebral infarcts were also analysed according to valve type. In self-expanding valves (n=7), TAVI-CO
2
had 8 lesions/patient compared to 10 lesions/patient in TAVI-S (p=0.46). In balloon-expanding valves (n=8), TAVI-CO
2
had 4.25 lesions/patient compared to 6.25 lesions/patient in TAVI-S (p=0.25).

Conclusion:
There is a trend in the reduction in the number of new cerebral lesions in the TAVI-CO
2
arm compared to the TAVI-S patients. This is the first study that identifies the importance of air emboli in TAVI and the associated potential vascular brain injury. As brain injury remains a significant concern during TAVI, a larger randomised trial is required to further investigate the neuroprotective benefit of flushing TAVI valves with CO
2
.
Abstract 11471: Engineered Bacterial Sodium Channel Gene Therapy Prevents Contractile Deficit and Reduces Ventricular Arrhythmias in a Non-Human Primate Model of Myocardial Infarction
Authors: Wu Tianyu , Loo Sze-Jie , Gao Yu , Luo Jun-Hua , Su liping , Tee Nicole Gee-Zhi , Ye Lei , Bursac Nenad
Published: June 2023

Introduction:
Current therapies for myocardial infarction (MI) and sudden cardiac death are limited. The ability to enhance amplitudes of sodium current and calcium transient in cardiomyocytes could improve electrical synchrony and contractions of infarcted heart tissue to both prevent arrhythmias and improve pumping function. We hypothesized that adeno-associated virus (AAV) delivery of prokaryotic sodium channel (BacNa
v
) can improve electrical and contractile function of infarcted hearts.

Methods:
MI in non-human primates (NHPs) was induced by 60-min ischemia / reperfusion injury. Animals were randomized to sham surgery (n=6) or MI followed by intramyocardial injection of AAV-BacNa
v
(n=6) or AAV-GFP (n=6) into the infarct area and border zone. Left ventricular (LV) function was assessed by echocardiogram at baseline, 1- and 4-week post-MI. Spontaneous arrhythmias were tracked by a subcutaneously implanted loop recorder during the 4-week study period.

Results:
At 4 weeks post-MI, BacNa
v
and GFP expression were detected in all treated animals (Fig. 1). Compared to sham animals, GFP-treated animals showed lower LV ejection fraction (LVEF, 37.4±3.4% vs 58.2±1.2%, p<0.0001) and increased LV end-systolic volume (3.8±0.57mL vs 2.1±0.25mL, p<0.05). BacNa
v
-treated animals showed significant increase in LVEF compared to the GFP group (48.3±3.4% vs 37.4±3.4%, p<0.05) and did not differ from the sham group. Compared to the GFP group, fewer BacNa
v
-treated animals displayed spontaneous arrhythmias (16.7% vs 100%, p<0.05) and had less arrhythmia episodes per animal (0.17±0.17 vs 2.17±0.6, p<0.01), while not differing in any measured electrophysiological parameters from the sham group.

Conclusion:
The AAV-mediated BacNa
v
expression in cardiomyocytes can alleviate cardiac contractile deficit and reduce ventricular arrhythmias in the setting of MI in an NHP model. BacNa
v
gene delivery may represent a promising therapeutic strategy for the treatment of MI.
Abstract 11482: The PCSK9-Targeted Antisense Oligonucleotide AZD8233 Reduces LDL-C, ApoB, and Lp(a) in Patients With Dyslipidemia on Statin Treatment - Data From the Phase 2b ETESIAN Study
Authors: Hofherr Alexis , Schumi Jennifer , Rudvik Anna , Vega Rick , Ryden-Bergsten Tina , Hurt-Camejo Eva , Johanson Per , Carlsson Bjorn C
Published: June 2023

Introduction:
Elevated blood levels of lipoprotein(a) [Lp(a)] are an independent causal risk factor for atherosclerotic cardiovascular disease. Lp(a) particles are formed by a lipid domain and an apolipoprotein B (apoB) protein that is bound to apolipoprotein(a). Standard low-density lipoprotein cholesterol (LDL-C) and ApoB lowering treatments have minimal Lp(a)-lowering efficacy. We have previously shown that AZD8233 inhibits hepatic PCSK9 synthesis and causes substantial reductions in LDL-C. Here we report the significant effects of AZD8233 on Lp(a) and ApoB.

Methods:
ETESIAN was a multicenter phase 2b, randomized, double-blind, placebo-controlled, dose-ranging study (NCT04641299). Eligible participants were 18-75 years old, on statin therapy, with LDL-C of ≥ 70 to < 190 mg/dL, and with fasting triglycerides of < 400 mg/dL. Participants were randomized 1:1:1:1 to subcutaneous injections (days 1, 8, 29, and 57) of either 15, 50, or 90 mg AZD8233, or placebo. The primary objective was to evaluate the effect of AZD8233 versus placebo on LDL-C at week 12. Secondary objectives were to assess Lp(a) levels and other lipid parameters.

Results:
A total of 119 patients were enrolled in ETESIAN. AZD8233 was well tolerated and demonstrated dose-dependent and clinically meaningful reductions in LDL-C, Lp(a), and ApoB (
Table
). The relative distribution of these effects across participant subgroups and the interaction of effects on Lp(a), ApoB, and LDL-C will be presented.

Conclusion:
In patients with dyslipidemia on statins, AZD8233 caused substantial reductions in LDL-C and Lp(a), two independent risk factors for major adverse cardiovascular events. The broad lipid-modifying effect of AZD8233 may, hence, provide an opportunity to reduce cardiovascular risk in patients with ASCVD beyond currently available medications.
Abstract 11483: Rationale and Design of Randomized Controlled Trial Evaluating an Atrial Appendage Micrograft Transplantation in Conjunction With Coronary Artery Bypass Surgery
Authors: Sikorski Vilbert T , Nummi Annu , Mulari Severi , Kankuri Esko M , Vento Antti E
Published: June 2023

Introduction:
In addition to the revascularization therapies for ischemic heart disease (IHD), such as coronary artery bypass grafting (CABG), tissue-engineered cell therapies can help further improve myocardial repair. First clinical results on autologous right atrial appendage-derived micrograft (AAM) transplantation have demonstrated excellent safety and feasibility profiles and suggested a therapeutic effect on myocardial viability. This randomized clinical trial aims to extend the evaluation of efficacy of AAMs transplantation when combined with CABG surgery.

Methods and objectives:
This double-blinded randomized controlled AAMS2 trial will assess the benefits, safety, and feasibility of the perioperatively assembled and epicardially transplanted AAMs-patch in conjunction with CABG. The trial recruits a total of 50 patients, half of which are randomized to receive the AAMs-patch (CABG+AAMs) and the other half to undergo a standard CABG. Prior to surgery, cardiac structure and function are assessed with late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMRI), electrocardiogram, and transthoracic echocardiography (TTE). LGE-CMRI, electrocardiogram, and TTE are repeated at 6-month follow-up for structural and functional comparisons to baseline. The primary endpoints focus on the efficacy of the AAMs patch as evaluated by LGE-CMRI and TTE as well as changes in health-related quality of life assessments, 6-minute walk test or N-terminal-pro-BNP levels. The secondary endpoints centre on feasibility and safety. For molecular and especially RNA-level analysis of the response to therapy in blood, RNA-stabilized whole blood and plasma samples are collected.

Conclusions:
The AAMS2 trial is expected to provide further feasibility and safety data as well as insights for efficacy of epicardial AAMs-patch transplantation when administered during CABG surgery.