bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12998: Preoperative Venous Variability Index Predicts the Need for Pulmonary Venous Reintervention in Total Anomalous Pulmonary Venous Return
Authors: Stanley Helen M , Cohen Meryl S , Faerber Jen , Callahan Ryan M , Fuller Stephanie M , White Brian R
Published: December 2023

Background:
Postoperative obstruction in total anomalous pulmonary venous connection (TAPVC) is variable. Clinical risk factors are described but the role for preoperative echocardiographic markers in prognostication is unclear. Pulmonary venous variability index (PVVI), a novel metric developed at our center, is shown to better correlate to preoperative catheterization gradient and clinical markers of obstruction than standard echocardiographic measures. We hypothesized that preoperative PVVI is superior to maximum and mean velocity for prediction of outcome in TAPVC.

Methods:
We performed a retrospective review of TAPVC patients born 1/1/2006-9/30/2022 and repaired at our center. The medical record was reviewed for clinical and surgical risk factors. Preoperative echocardiograms were reviewed for clinical read and PVVI ((maximum velocity - minimum velocity) / mean velocity) was calculated from spectral Doppler of the pulmonary venous pathway. The outcome was time to surgical or catheter-based pulmonary vein reintervention or death.

Results:
In total, 162 patients were repaired. The outcome was met in 52 (32%). A univariate Cox proportional hazards model was performed for possible predictors (Table). Clinical predictors were single ventricle, heterotaxy, and a vertical vein not ligated during repair. Of echocardiographic metrics, PVVI and minimum velocity had strong associations with outcome (Figure).

Conclusion:
Preoperative PVVI predicts postoperative obstruction in TAPVC or death, while maximum and mean velocity and qualitative assessment of obstruction do not. Use of this quantitative metric may decrease practice variation and be valuable in prognosis.
Abstract 13021: Double-Peaked Trajectory of the Corrected QT Interval and Its Sex Differences During the Clinical Course of Takotsubo Syndrome
Authors: Kitagawa Mari , Kato Ken , Kondo Yusuke , Kobayashi Yoshio
Published: December 2023

Background:
In the general population, the normal value of the corrected QT (QTc) interval for women is under 450 ms, which is longer than that of men (under 430 ms). There have been reported several sex differences in characteristics of takotsubo syndrome (TTS). Prolonged QTc interval is a relatively common electrocardiographic finding in TTS.

Research Question:
Little is known about the sex differences in the trajectory of QTc interval during the clinical course of TTS.

Aim:
The aim of this study was to determine the change in the QTc interval from the acute onset to one year later by sex.

Methods:
This study retrospectively included 85 consecutive patients with TTS admitted to our hospital from 2015 to 2023. A total of 848 twelve-lead electrocardiograms (ECG) performed from the date of diagnosis (day 0) within one year were analyzed. Mean QTc intervals were calculated by the day from day 0 to day 16, and after day 17, by defined periods (day 17-30, 31-60, 61-90, 91-180, 181-360).

Results:
Fifty-eight (68%) patients were women. There were no significant differences between women and men in age (71 ± 13 years vs. 67 ± 10 years, P =0.13), preceding physical trigger (55% vs. 70%, P =0.24), and all-cause mortality within one year (17% vs. 19%, P >0.99). On day 0, the QTc intervals within the normal range were observed both in women and men. The first peak of the QTc interval was observed on day 2 with the mean QTc interval of 475 ± 70 ms in women, and 474 ± 60 ms in men. Once the QTc interval shortened after the first peak, it prolonged again and the second peak was observed around the second week from the onset. In the second peak, the QTc interval was found to be longer in men (503 ± 32 ms) compared to women (471 ± 56 ms). After the second peak, the QTc interval gradually normalized, and never prolonged again until one year.

Conclusions:
The double-peaked trajectory of the QTc interval was clearly observed during the clinical course of TTS. The variability of the QTc interval was greater in men than in women.
Abstract 13027: Hospital Outcomes and Predictors of Spontaneous Coronary Artery Dissection With Concurrent Ventricular Arrhythmias
Authors: Tan Min Choon , Yeo Yong Hao , Ang Qi Xuan , Yang Eric , Mazzarelli Joanne , Lee Justin , Su Wilber , Lee Kwan S
Published: December 2023

Background:
While spontaneous coronary artery dissection (SCAD) patients can present with ventricular arrhythmias (VAs), the in-hospital outcomes among these patients are not well-established.

Objective:
This study aimed to analyze the in-hospital outcomes of patients with SCAD and concurrent VAs, and to determine the predictors of VAs occurrence in this population.

Methods:
Using the Nationwide Readmissions Database, our study included patients aged 18 years or older who had SCAD between 2017 and 2020. We categorized the cohort into two groups depending on the presence of VAs during hospitalization. The in-hospital outcomes were assessed between two groups. Through multivariable analysis, we further analyzed the predictors of VAs occurrence among SCAD patients.

Results:
Our study included 160 (13.45%) SCAD patients with concurrent VAs and 1,030 (86.55%) SCAD patients without concurrent VAs between 2017 and 2020. SCAD patients with concurrent VA were associated with higher rates of early mortality (11.88% vs. 2.04%, p<0.01), prolonged index hospital stay (≥7 days) (31.25% vs. 12.82%, p<0.01), and non-home discharge (21.88% vs. 6.50%, p<0.01). The length of hospital stay was longer in the SCAD with concurrent VAs group (6.93 days vs. 3.73 days, p<0.01), and the median cumulative cost of hospitalization was also higher in this group ($31,450 vs. $14,664, p<0.01). SCAD with concurrent VAs patients also had poorer in-hospital adverse events. In multivariable analysis, the independent predictors for VAs occurrence among SCAD patients were chronic liver disease (aOR: 2.18; 95% CI: 1.15- 4.12, p=0.02) and heart failure (aOR: 3.40; 95%CI: 2.30- 5.02, p<0.01).

Conclusion:
Ventricular arrhythmias among SCAD patients were associated with poorer in-hospital outcomes. Heart failure and chronic liver disease were the predictors of VAs in SCAD patients. This highlights the importance of closely monitor and aggressive VAs management among these high-risk patients.
Abstract 13045: Myofibroblasts Revert to an Inactive Phenotype During Regression of Heart Failure
Authors: Yang Chao , Chen Yuxing , Zhu Lianlian , Zhang Lan , Kong Xiangmin , Chen Qiyu , Liu Xue , Wu Yue , Hu Xinyang , Zhu Wei , Wang Jian'an
Published: December 2023

Introduction:
The therapy of left ventricular mechanical unloading, such as transcatheter aortic valve replacement(TAVR)and left ventricular assist devices(LVAD)has significantly improved prognosis for patients with heart failure. However, the detailed cellular and/or molecular mechanisms of recovery of cardiac function remain unknown.

Objective:
We aimed to build a cellular atlas of the heart that experienced stress and de-stress process, with a focus on myofibroblasts, specifically its cell fate of differentiation and function.

Methods:
We conducted single-cell and ATAC sequencing on non-myocardial cells from mouse heart samples of pressure overload-induced heart failure and recovery, using TAC (transverse aortic arch constriction)/deTAC (with suture for the constriction removed 2 weeks after TAC) model to identify the dynamic changes. Lineage tracing technique was also used to gain further insight into cell fate and reciprocal interactions. Macrophage subgroup was cleared using various approaches to investigate the cross-talk between myofibroblast and macrophage.

Results:
We generated a TAC/deTAC mouse model which can faithfully simulate a reversal process of functioning for the heart that underwent a pressure overload stress. Multi-omics sequencing reveals the genetic changes and transcriptional regulation of cell populations at different stages. Among the different cell types, significant changes in the gene expression pattern were observed in fibroblasts. Aided by myofibroblast lineage tracing, flow cytometry examinations suggested that remaining in a quiescent state rather than showing a decrease in its number appeared as the main fate of myofibroblasts. Surprisingly, however, simultaneous pressure unloading and macrophage clearance resulted in a significant reduction in the number of myofibroblasts.

Conclusions:
With a reliable TAC/deTAC mouse model, our multi-omics data revealed dynamic changes in cell populations of the heart that underwent pressure overload followed by unloading, our data demonstrated a quiescent state rather than a reduction in number was the major fate for the activated myofibroblasts for which macrophages were involved. These findings provide a theoretical basis for further treatment.
Abstract 13069: Submitting ACC-NCDR CathPCI Data Are Not Enough
Authors: Weiner Bonnie H , Cigarroa Joaquin E , Cowley Michael J , Marshall J. Jeffrey
Published: December 2023

Introduction:
The majority of facilities performing PCI in the US report data to the ACC-NCDR CathPCI Registry. The large number of records included in this dataset provide benchmark comparisons for facilities to consider however it is of concern that this may not result in the development of meaningful actions for improvement. The current analysis was undertaken to understand changes in Registry findings over time in facilities undergoing accreditation reviews.

Methods:
A component of site visits for accreditation, executive summaries or dashboards for each facility are reviewed and findings are categorized as being ≤ 50
th
percentile or ≤ 10
th
percentile when compared to the registry benchmark data at the time they are reported.

Results:
Twenty-one facilities underwent 32 reviews. (Figure 1). Although there is a trend in decreasing percentage of variables ≤ 50
th
percentile with subsequent reviews, these differences were not statistically significant. No such trend was observed for variables ≤ 10
th
percentile. In general, facilities deferred have higher rates of both findings, but these differences also are not statistically significant overall or at each review point.(Figure 2)

Conclusions:
Facilities undergoing accreditation reviews, irrespective of the accreditation decision have high rates of NCDR registry variables that are ≤50th and ≤10th percentile. These do not change significantly over time and suggest that insufficient attention is paid to these variables, corrective action is not identified or is not effectively implemented. Ongoing support is necessary to achieve these changes.
Abstract 13070: Interleukin-19 Regulates Lymphatic Permeability and Induces Prox1-Dependent Lymphangiogenesis
Authors: Peluzzo Amanda , Corbett Cali , St. Paul Amanda , Kelemen Sheri E , Autieri Michael
Published: December 2023

Introduction:
Increased lymphangiogenesis is associated with atherosclerosis, but whether it is disease-causative or a compensatory attempt to attenuate disease is currently unresolved. Recent studies suggest lymphatic permeability plays a role in reverse cholesterol transport (RCT) as a possible mechanism for attenuating atherosclerosis. We previously reported that that Interleukin-19 (IL-19), an immunomodulatory cytokine, is unique by inducing angiogenesis while reducing atherosclerosis. The purpose of this study was to test the hypothesis that IL-19 could be atheroprotective by inducing functional lymphangiogenesis and promoting lymphatic flux.

Methods & Results:
RNA sequencing of IL-19-treated human Lymphatic Endothelial Cells (hLEC) identified induction of chemokines, pro-lymphangiogenic, and permeability-associated genes. Prox1, the master regulator of lymphatic formation, was increased by six-fold, validated by qPCR and western blot. Cellular assays further demonstrated IL-19-associated lymphangiogenesis through hLEC proliferation, migration, and tube formation, each mitigated by Prox1 siRNA knockdown. Angpt2, a regulator of permeability through VE-cadherin, is also upregulated by IL-19 and mitigated by Prox1 siRNA knockdown. Electric Cell-substrate Impedance Sensing (ECIS) showed that IL-19 mitigates oxLDL-associated decreases in permeability, suggestive of preventing lymphatic barrier malfunction during atherosclerosis. Preliminary
in vivo
lymphatic permeability assays suggest injection of rmIL-19 improves lymphatic function in conditional lymphatic-specific Prox1 heterozygous mice. Conversely, similar experiments show that
Il19
/
LDLR
double knockout mice, which are known to have exacerbated atherosclerosis, also have significantly decreased lymphatic permeability compared to

LDLR
-/-

mice after 16-weeks of high fat diet.

Conclusion:
These data suggest that IL-19 is a previously unrecognized regulator of lymphatic function as it increases lymphangiogenesis and permeability, with the potential to improve RCT. Together, these effects may regulate atherosclerosis, and influence our understanding of the association between the lymphatic system and atherosclerosis.
Abstract 13078: Prognostic Significance of Reticulocyte Production Ability in Patients With Chronic Heart Failure
Authors: Nakao Motoki , Nagai Toshiyuki , Tada Atsushi , Koya Taro , Ishizaka Suguru , Mizuguchi Yoshifumi , Aoyagi Hiroyuki , Imagawa Shogo , Tokuda Yusuke , Kato Yoshiya , Takahashi Masashige , Sakai Hiroto , Machida Masaharu , Matsutani Kenichi , Saito Takahiko , Okamoto Hiroshi , Anzai Toshihisa
Published: December 2023

Background:
Anemia is frequently observed in patients with chronic heart failure (CHF), and many studies have evaluated the association between anemia and mortality in CHF. The quality of erythropoiesis is an intrinsic aspect of pathophysiology of anemia, and the ability of reticulocyte production would be one of the pivotal factors in the quality of erythropoiesis. However, it remains unclear whether reticulocyte production ability is associated with clinical outcomes in patients with CHF.

Methods:
We prospectively examined 1,274 symptomatic CHF patients (mean age 71.9±13.4 years, median LVEF 50 [IQR 36-63]%) in a multicenter registry (25 sites). The reticulocyte production ability was evaluated by calculating the reticulocyte production index (RPI) using reticulocyte counts and serum hematocrit. Patients were divided into four groups according to the presence of WHO defined anemia and the median value of RPI. The primary outcome was composite of all-cause death and hospitalization for worsening HF.

Results:
During a median follow-up period of 427 (IQR 273-642) days, the primary outcome occurred in 222 (17%) patients. The group with anemia and high RPI (≥0.982, the median) showed the highest incidence of the primary outcome among the groups (
P
< 0.001) (Figure A). In an anemic subgroup (n = 611), higher RPI was independently associated with increased adverse events (HR 1.67, 95% CI 1.31-2.13) adjusted for age, sex, estimated glomerular filtration rate, NT-pro BNP, hemoglobin, serum sodium and iron parameters. In this subgroup, erythrocyte counts were not significantly increased in patients with higher RPI compared to lower RPI (Figure B). Moreover, there were no significant differences on transferrin saturation and serum iron between the groups (Figure B).

Conclusions:
Higher reticulocyte production ability, which might reflect the impaired process of erythropoiesis, was associated with worse clinical outcomes in patients with CHF, especially with anemia.
Abstract 13086: National Trends in Timely Ambulatory Follow-Up After Acute Myocardial Infarction and Congestive Heart Failure Cospitalizations Among Medicare Beneficiaries
Authors: Anderson Timothy S , Yeh Robert W , Herzig Shoshana , Marcantonio Edward R , Landon Bruce
Published: December 2023

Introduction:
Following hospitalization for acute myocardial infarction (AMI) or congestive heart failure (CHF), close outpatient follow-up is warranted for symptom monitoring and initiation or titration of evidence-based therapies.

Objective:
To describe temporal trends in ambulatory care following CHF and AMI hospitalizations, between 2010 and 2019.

Methods:
We examined a 100% sample of Medicare fee-for-service beneficiaries discharged to the community after an AMI or CHF hospitalization. We assessed quarterly rates of timely post-discharge cardiology and primary care follow-up, defined as receipt of an ambulatory visit within 14 days of discharge. We assessed trends for five subgroups based upon known disparities in cardiovascular outcomes: sex, race/ethnicity, Medicaid dual-eligibility, county-level social deprivation index, and rurality.

Results:
The AMI cohort included 1,680,916 hospitalizations (54.9% male, 9.4% Black, 81.7% White) and the CHF cohort included 4,256,405 hospitalizations (47.7% male, 16.2% Black, 75.0% White). Timely cardiology follow-up after AMI increased from 26.8% in 2010 to 39.4% in 2019 (absolute change 12.6%) while follow-up after CHF increased from 22.0% to 33.4% (absolute change 11.5%). The proportion of patients without cardiology or primary care follow-up after AMI decreased to 36.1% in 2019 and to 41.6% for CHF. Though rates of timely follow-up increased for all demographic groups, female, Black, Hispanic, Medicaid dual-eligible patients, patients residing in rural areas, and patients residing in counties with high social deprivation were less likely to receive follow-up throughout the study.

Conclusions:
Rates of timely ambulatory care after AMI and CHF hospitalization have improved, but the majority of patients do not receive follow-up within 14 days of discharge. Efforts to improve post-hospital cardiology and primary care follow-up have the potential to improve clinical outcomes and reduce disparities.
Abstract 13093: Impact of Digital Health Coaching on Older Individuals With Cardiometabolic Conditions
Authors: Moore Jasmine , Rutland Sarah , Tran Vanessia , Murphy Jane
Published: December 2023

Introduction:
Cardiometabolic conditions are top contributors to low health-related quality of life and early mortality. The multi-faceted care needed to manage these conditions can become more challenging as patients age. This analysis aimed to identify if a digital health coaching (DHC) program can improve how older adults manage their cardiometabolic conditions.

Methods:
This retrospective analysis included adults 55 or older who participated in a DHC program for at least 3 months. Participants were referred by an employer/payor program or physician. Participants enrolled in 1 of 4 cardiometabolic condition-specific programs: Weight Management, Type 2 Diabetes, Hypertension, or Dyslipidemia. To assess outcomes and impact of participation in DHC, changes in psychosocial and cardiovascular-related quality of life measures collected at baseline and month 3 were evaluated.

Results:
Of 1,290 adults enrolled in a cardiometabolic DHC program, 639 remained engaged and completed outcome measure surveys. Most participants were female (80%), and the study population was racially diverse: 52% white, 48% nonwhite. At 3 months, self-reported diabetes distress scores (2.36 to 1.9, P<0.05) and weight (206.5 to 201.765, P<0.05) improved. Depression (2.36 to 1.9, P<0.05), stress (3.97 to 3.27, P<0.05), and anxiety (0.86 to 0.73, P<0.05) scores also improved.

Conclusions:
DHC participants improved clinical and psychosocial outcomes in 3 months in this outcome analysis. Engaging in DHC may help patients manage their cardiometabolic conditions and help improve their health-related quality of life.
Abstract 13106: Two-Year Clinical Outcomes of Staged Transcatheter Mitral Edge-to-Edge Repair After Transcatheter Aortic Valve Replacement
Authors: Nagasaka Takashi , Nakamura Mamoo
Published: December 2023

Introduction:
Residual significant MR has been linked to an increased risk of adverse clinical events in patients undergoing TAVR. However, the effectiveness of staged TEER after TAVR has been poorly assessed.

Hypothesis:
To investigate clinical outcomes of staged transcatheter edge-to-edge repair (TEER) for residual significant mitral regurgitation (MR) after transcatheter aortic valve replacement (TAVR).

Methods:
This observational study included consecutive patients with residual grade 3+ or 4+ MR after TAVR performed at our institution between April 2016 and November 2020. The primary composite outcomes were all-cause mortality and heart failure (HF) hospitalization at 2 years, with HF hospitalization assessed as a secondary outcome for all-cause mortality. Additional analyses, including changes in MR grade and New York Heart Association (NYHA) functional classification, were performed.

Results:
Among 314 patients, 104 (33.1%) treated with staged TEER and 210 (66.9%) treated with medical therapy alone were enrolled. Patients who underwent staged TEER had a lower rate of primary composite outcomes than those who received medical therapy alone (33.7% vs. 48.1%, p=0.027) (Figure1). However, there was no significant difference in all-cause mortality (11.5% vs. 13.8%, p=0.46) or HF hospitalization (31.7% vs. 42.9%, p=0.061). Staged TEER was associated with a marked improvement in the MR grade and NYHA class from baseline to 2 years.

Conclusions:
Staged TEER following TAVR was associated with improved clinical outcomes and a reduced MR grade. The findings suggest that TEER should be considered a potential treatment option for significant residual MR in patients who have previously undergone TAVR.
Abstract 13128: IGFBP8 as a Novel Biomarker for Hemodynamics and Functional Status in Pulmonary Arterial Hypertension
Authors: Blatt Carly , Schramm Jennifer , Yang Jun , Griffiths Megan , Brandal Stephanie , Damico Rachel L , Vaidya Dhananjay , Simpson Catherine , Kolb Todd , Pauciulo Michael , Nichols Bill , Ivy Dunbar D , Austin Eric D , Hassoun Paul , Everett Allen D
Published: December 2023

Background:
Previous studies have shown that insulin-like growth factor binding proteins (IGFBPs) are correlated with pulmonary artery hypertension (PAH) disease severity. IGFBP8 has been shown in- vitro to be associated with pulmonary vessel remodeling and PAH in gene deletion experiments. However, no studies have evaluated IGFBP8 levels in adults with PAH.

Research Question:
This study sought to assess if IGFBP8 concentrations are elevated in patients with PAH and if levels are associated with survival, hemodynamic, and clinical PAH measurements.

Methods:
Serum IGFBP8 was measured in 2,763 adults with PAH and 92 adult controls. Two PAH cohorts and two control cohorts were used for analysis. A Mann-Whitney U test was used to compare IGFBP8 levels in PAH and controls. Samples were adjusted for age and sex using linear and logistic regression for continuous and categorical variables, respectively. IGFBP8 levels in the PAH cohort were compared to mean right atrial (mRAP), mean pulmonary artery pressures (mPAP), pulmonary vascular resistance (PVR) and functional measures such as six-minute walk distance (6-MWD), and New York Heart Association Functional Class (NYHA FC). Analysis of composite outcome (death or transplant) was conducted using a Cox proportional hazard model.

Results:
IGFBP8 levels were higher in PAH vs controls patients (Figure 1B, p<0.0001). Among PAH patients, for every natural log unit higher, IGFBP8 was associated with death or transplant with Cox proportional hazard ratio of 1.313 (95% CI 1.034-1.666; p=0.025). Higher IGFBP8 levels were associated with lower 6-MWD (p=0.035) and increased NYHA FC (p=0.026). Hemodynamically, increased IGFBP8 levels were associated with lower cardiac index (p=0.014), increased mRAP (p=0.012) and lower stroke volume (p=0.002) but not mPAP or PVR (Figure 1A).

Conclusions:
IGFBP8 is a novel biomarker in PAH. Higher levels are associated with worse survival, worse hemodynamics, and poor functional status.
Abstract 13138: Outcomes of Surgical Repair for Sinus Venosus Atrial Septal Defect
Authors: Moolla Muhammad , EL-Andari Ryaan , John Kevin , Slingerland Ashley , Campbell Sandra , Mathew Anoop
Published: December 2023

Introduction:
Sinus venosus atrial septal defect (SVASD) is a rare congenital cardiac anomaly comprising 5-10% of all atrial septal defects. Although surgical closure is the standard treatment for SVASD, data on outcomes have been confined to small cohorts. Thus, we conducted a systematic review and meta-analysis of outcomes of SVASD repair.

Methods:
A comprehensive search of PROSPERO, MEDLINE, EMBASE, and Cochrane Library databases was conducted. The primary outcome was mortality. Secondary outcomes encompassed atrial fibrillation, sinus node dysfunction, pacemaker insertion, cerebrovascular accident (CVA), reoperation, residual septal defect, superior vena cava (SVC) obstruction, and reimplanted pulmonary vein obstruction. Pooled incidences of outcomes were calculated using a random effects model.

Results:
Forty studies involving 1,292 patients who underwent SVASD repair were included. The majority were male (59.4%), with 92.9% presenting with associated pulmonary anomalous venous connection. The weighted mean ages were 18.6 ± 12.5 years, and the overall weighted mean follow-up period was 8.6 ± 10.4 years. In-hospital mortality rate was 0.24%, with a 30-day mortality of 0.56% reported in 720 patients. Incidences of atrial fibrillation, sinus node dysfunction, pacemaker insertion, and CVA over the long-term follow-up were 2% (1-3%), 4% (2-6%), 2% (1-2%), respectively. Reoperation, residual septal defect, SVC obstruction, and reimplanted pulmonary vein obstruction occurred in 1% (0-2%), 2% (2-2%), 1% (1-1%), and 2% (2-2%) surgeries, respectively.

Conclusions:
This is the first comprehensive analysis of outcomes following surgical repair of SVASD. The findings affirm the safety and effectiveness of surgical intervention, establishing a reference point for evaluating emerging transcatheter therapies. Comparable safety and efficacy profiles to surgical repair are essential for widespread adoption of transcatheter treatments.
Abstract 13147: Monitoring Central Arterial Pressure on the Chest Surface: Initial Results From Two Pilot Studies in Human Subjects
Authors: Arustamyan Michael , nagarajan nagalakshmi , Gutmann Rebecca A , Girotra Saket , El Accaoui Ramzi N , Hoffman Stacy , West Alan , Strollo Patrick J , London Barry , Mansour Shareef , Shusterman Vladimir
Published: December 2023

Central arterial pressure (AP) monitoring is essential for personalized patient management but requires direct arterial line (Aline) access. We report the first results from two pilot studies tracking central AP in humans using a noninvasive, high-fidelity MEMS array (APEX, PinMed, Inc., Pittsburgh, PA) versus an Aline (
Study 1
) and a brachial cuff (
Study 2
).

Methods:
The APEX array was designed and optimized for the chest surface using a realistic, full-scale physical model (Fig. 1A) and a validated, large-scale computational model of circulation.
Study 1:
AP was recorded in 7 CVICU patients (age: 73±7y, 43% female; pressure ranges for systolic, diastolic, and mean: 91-198, 46-83, and 61-121 mm Hg, respectively).
Study 2:
AP was recorded during moderate physical activity (handgrip followed by leg lifts) in 30 subjects (age: 46±10y, 53% female; pressure ranges for systolic, diastolic, and mean: 90-210, 49-116, and 67-147 mm Hg, respectively).

Results:
Study 1:
AP was recorded over 2.7±1.7hr with no adverse events. Individual changes in AP recorded by APEX and Aline were similar (mean pressure [MP] range for individual changes >10 mm; Fig. 1B, r: 0.4-0.8); the differences were small (RMSE for MP: 4.8 mm, r
2
: 0.93, Fig. 1C).
Study 2:
Individual AP changes recorded by APEX and brachial cuff were similar (Fig. 2A). The accuracy was similar for the entire group (N=30) and for the subgroup of subjects with high BMI (n=15); there were no significant differences between the subgroups of female and male subjects (Fig. 2B, 2C).

Conclusions:
If confirmed in larger studies, the surface MEMS array has the potential to enable noninvasive central-AP monitoring in clinical and ambulatory settings.
Abstract 13202: Efficacy and Safety of Combining a Thiazide Diuretic With a Loop Diuretic in Decompensated Heart Failure: A Systematic Review and Meta-Analysis
Authors: Silveira Filho Rodrigo B , Antonio Pinheiro Braga Marcelo , Mamede Isadora , Martins Otavio C , Oliveira Franchini Anne Estefane , Catao Marcel
Published: December 2023

Background:
Acute decompensated heart failure (ADHF) has several presentations, one of the most common being congestion which is treated by intravenous loop diuretics. However, prolonged use of this therapy may lead to resistance that can be overcome with a sequential nephron blockade by adding a thiazide diuretic. Less is known about the safety of that combination.

Research question:
Is the combination of a thiazide diuretic and a loop diuretic safe and effective?

Goal:
To perform a meta-analysis of the association between the combination of loop and thiazide diuretics, their efficacy, and potential adverse effects.

Methods:
We systematically searched PubMed, Embase, and Cochrane for randomized controlled trials that compared patients with ADHF using only a loop diuretic and patients using a thiazide adjuvant therapy, and reported the outcomes of (1) weight change; (2) hypokalemia (potassium ≤ 3.5 mmol/L or potassium ≤ 3.5 mEq/L); (3) 30-day rehospitalization; and (4) length of stay. Heterogeneity was examined with I2 statistics. A random-effects model was employed. Review manager 5.4 was used for statistical analyses.

Results:
In 4 studies, among 424 patients with ADHF, 212 (50%) were treated with a combination of loop and thiazide diuretics and 212 (50%) had a loop monotherapy treatment. Overall, individuals receiving the diuretic combination experienced greater weight loss (MD -0.73; 95% CI -1.23, -0.24; p=0.004; Fig. 1A), but had higher incidence of hypokalemia (RR 2.36; 95% CI 1.56, 3.58; p<0.0001; Fig. 1B) compared to those who were not receiving. There was no significant difference between both groups in all-cause 30-day rehospitalization (RR 1.26; 95% CI 0.81, 1.96; p=0.30; Fig. 1C) or length of hospital stay (MD 0.26; 95% CI -1.03, 1.54; p=0.70; Fig. 1D).

Conclusions:
These findings suggest that the combination of a loop and a thiazide diuretic may lower body weight in patients with ADHF. However, its role in improving clinical outcomes remains unclear.
Abstract 13211: Racial Disparities in the Association Between Early Repolarization Pattern and Cardiovascular Mortality
Authors: Dhaliwal Simrat , AlSadawi Mohammed , Aslam Faisal , Kim Paul , Gier Chad , Henriques Matthew , Mann Noelle
Published: December 2023

Introduction:
The early repolarization (ER) ECG pattern has been associated with increased cardiovascular (CV) mortality, but it is unclear if there are racial differences in risk.

Objectives:
To evaluate racial differences in East Asian and Caucasian decent and the prognostic significance of ER.

Methods:
A literature search was conducted for studies reporting the association between ER and CV mortality endpoints. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. The minimum follow up duration was one year. Analysis was performed using odd ratios (OR).

Results:
A total of 16 studies and 189,422 participants (16,307 with ER vs 173,115 without ER) were included; mean follow-up was one year. ER was associated with increased CV mortality (OR 1.68, 95% CI 1.28-2.20; P<0.01). East Asian patients with ER had higher CV mortality compared to Caucasians (OR 3.94, 95% CI 2.2-7.04 vs. OR 1.32, 95% CI 1.03-1.70; P<0.01). (Figure 1-3)

Conclusions:
ER pattern is associated with increased CV mortality, particularly in East Asian patients.
Abstract 13214: Arrhythmic Burden After Bruton's Tyrosine Kinase Inhibitor Initiation and Major Cardiovascular Events
Authors: Gambril John A , Ghazi Sanam , Sansoterra Stephen , Ferdousi Mussammat , Kola-Kehinde Onaopepo , Ruz Patrick , Kittai Adam , Rogers Kerry , Grever Michael , Bhat Seema , Wiczer Tracy , Byrd John , Woyach Jennifer , Addison Daniel
Published: December 2023

Background:
Bruton’s tyrosine kinase inhibitors (BTKi) have dramatic efficacy against B cell malignancies. BTKi’s also cause cardiotoxic arrhythmias, including atrial fibrillation (AF) and ventricular arrhythmias (VA). Yet, the true burden and long term effects of arrhythmias after BTKi therapy are unknown.

Research Question:
In patients with suspected BTKi related arrhythmias, what is the relative AF burden? Does it prognosticate future events?

Methods:
Leveraging a cohort of consecutive B cell malignancy patients initiated on BTKi from 2009-2020, we identified patients with available ambulatory rhythm monitors. The primary outcome was AF burden after BTKi initiation. Secondary outcomes included VA burden, conduction blocks, and other arrhythmias of probable or definite BTKi association. Observed incident AF rates and burden with next generation BTKi’s were compared to ibrutinib. Multivariable regression and survival analysis were used to define factors associated with AF related hospitalizations and major adverse cardiac events (MACE), as well as the relationship between AF burden and mortality. Outcomes were stratified by high (≥5%) vs low (<5%) AF burden.

Results:
Of 890 BTKi treated patients, 98 wore ambulatory rhythm monitors, including 38 on next generation BTKi’s [age 67.7 years, 24.2% prior AF]. Median duration BTKi use was 34 months. Among next generation BTKi treated patients, 8.7% developed incident AF compared to 25.5% with ibrutinib (
P
=0.048). Ten patients (26.3%) developed symptomatic or >1% PVCs, at a mean burden of 7.1% compared to eight patients (13.3%) with mean burden 9.4% on ibrutinib. In a multivariable model accounting for traditional CV risk factors, prior AF associated with increased post BTKi AF burden. In follow up, high AF burden associated with increased MACE (HR 3.49,
P
=0.001) and mortality (HR 3.2,
P
=0.002);
Figure
.

Conclusions:
In BTKi treated patients, cardiotoxic AF burden prognosticates future MACE and mortality.
Abstract 13226: Young Infants With Symptomatic Tetralogy of Fallot: Superior Survival With Staged Repair
Authors: Ye Xin Tao , Henmi Soichiro , Buratto Edward , Haverty Mitchell , Yerebakan Can , Brizard Christian , d'Udekem Yves , Konstantinov Igor
Published: December 2023

Background:
The optimal strategy to treat symptomatic young infants with tetralogy of Fallot (TOF) is unclear.

Objective:
We performed a balanced comparison of staged repair (SR) vs. primary repair (PR) at two institutions that have exclusively adopted each strategy.

Methods:
Between 1993 and 2021, 143 consecutive infants under 4 months of age underwent systemic-to-pulmonary shunt at the Royal Children’s Hospital, Melbourne, Australia. These were compared with 122 consecutive infants in the same age group who underwent PR between 2004 and 2018 at the Children’s National Hospital, Washington, D.C. The primary outcome was mortality. Secondary outcomes were component and cumulative hospital stay, durations of perioperative support, hospital complications, and early and late reinterventions. Propensity-score matching was performed for risk adjustment. Mean follow-up was 9.3 years.

Results:
In the unmatched comparison, the SR cohort was younger, more commonly on prostaglandin infusion and mechanical ventilation, more likely to require urgent procedures, and had lower weight and smaller pulmonary annulus size. Hospital mortality after initial procedure (SR: 2.8% [4/143] vs. PR: 2.5% [3/122]; p = 0.86) and 10-year survival (SR: 95% [95% confidence interval (CI): 90 - 98%] vs. PR: 90% [95% CI: 81 - 95%]; p = 0.65) were similar. Hazard of reinterventions favored the PR group during early (<6 months) follow-up (hazard ratio: 0.22; 95% CI: 0.11 - 0.48; p < 0.001) but was similar at late follow-up. Most secondary outcomes cumulatively favored the PR group. Among 57 propensity-score matched pairs, the SR group had superior survival at 10 years (98% [95% CI: 88 - 99.8%] vs. 85% [95% CI: 69 - 93%]; p = 0.02).

Conclusions:
In this two-institutional, propensity-score matched comparison of SR vs. PR in symptomatic young infants with TOF, the SR strategy was associated with superior long-term survival and equivalent late reinterventions, at a cost of increased early reinterventions.
Abstract 13230: Prediction of Coronary Artery Lesions Caused by Treatment-Resistant Kawasaki Disease Before Initial Treatment
Authors: Yoshikane Yukako , Miyamoto Tatsuki , Nagamitsu Shinichiro
Published: December 2023

Introduction:
Kawasaki disease (KD), which is the most common multisystem vasculitis with unknown causes in childhood, causes coronary artery lesions (CALs). Especially in the case of treatment resistance, CALs occur at a high rate. To prevent CALs, it is important to identify risks as early as possible and establish aggressive treatment strategies.

Hypothesis:
CALs caused by treatment-resistant KD cases can be predicted before initial treatment.

Methods:
Fifty-five KD patients who scored high in all three Japanese Intravenous immunoglobulin (IVIG) non-response prediction scoring systems were included. We detected independent risk factors that contribute to the prediction of CALs due to treatment-resistant KD by multivariate analysis, determined the cut-off value for identifying subjects at risk of CALs by receiver operating characteristic analysis, and developed a new model for predicting CALs (including transient dilatation) due to treatment-resistant KD.

Results:
Neutrophils and Total bilirubin (T-bil) before initial treatment were detected as independent risk factors. When both neutrophils >20,000 and T-bil >2.5 were present (high-risk group), CALs occurred with a sensitivity of 100%, a specificity of 96%, a positive predictive value of 71%, and a negative predictive value of 100%. There were five patients out of seven who had coronary artery dilation greater than z-score >2.5 by treatment resistance, compared to zero patients out of forty-eight in low-risk group (p<0.01).

Conclusions:
It may be possible to predict CALs caused by treatment-resistant KD cases with high sensitivity and specificity before initial treatment with a new model using neutrophils and T-bil. If the occurrence of CALs due to treatment-resistant KD is expected, it is possible to consider an aggressive treatment strategy from the initial treatment.
Abstract 13237: The Combined Effect of Triglyceride-Glucose Index and High Sensitivity C-reactive Protein on Cardiovascular Outcomes in Patients With Chronic Coronary Syndrome: A Multicenter Cohort Study
Authors: Li Qinxue , Yuan Jinqing
Published: December 2023

Background:
Triglyceride-glucose (TyG) index is a proven non-invasive alternative indicator of insulin resistance. There is an interconnection between insulin resistance and inflammation, and high sensitivity C-reactive protein (hsCRP) is one of the most commonly used biomarkers of systemic inflammation. We aimed to investigate the combined association of TyG and hsCRP with adverse outcomes in patients with chronic coronary syndrome (CCS).

Methods:
A total of 9421 patients with CCS were finally included in this study. The primary endpoint was defined as a composite of the major adverse cardiovascular events (MACE) covering all-cause death, non-fatal myocardial infarction, and revascularization. Kaplan-Meier analysis and Cox regression models were used to evaluate the relationship between TyG, hsCRP, and cardiovascular events.

Results:
During the 2-year follow-up period, 660 (7.0%) cases of MACE were recorded. Participants were divided equally into 3 groups according to TyG levels. Compared to the TyG T1 group, the risk of MACE was significantly higher in the TyG T3 group (adjusted HR 1.283, 95% CI 1.037-1.587, P=0.022). In addition, there was a significantly higher risk of MACE in the TyG T3 group with a higher level of hsCRP (> 3 mg/l) (adjusted HR 1.735,95% CI 1.126-2.674, P=0.012). However, the association between TyG and MACE events was attenuated with hsCRP ≤ 3 mg/l (adjusted HR 1.077,95% CI 0.834-1.391, P=0.568). When patients were divided into 6 groups according to hsCRP and TyG, the Cox regression analysis showed that patients in the TyG T3&hsCRP>3 mg/l group had a significantly higher risk of MACE than those in the TyG T1&hsCRP≤3 mg/l group (adjusted HR: 1.577, 95%CI: 1.180-2.108, P=0.002). The Cox regression analysis of secondary endpoints showed that all-cause mortality and myocardial infarction appeared to be the main contributors to the increased risk of MACE.

Conclusion:
Elevated TyG index serves as a strong predictor of poor prognosis in patients with CCS. Additionally, participants with concurrently elevated hsCRP and TyG had worse clinical outcomes. The concurrent assessment of TyG and hsCRP may be valuable in identifying high-risk groups among CCS patients.
Abstract 13281: The Combined Effect of Omecamtiv Mecarbil and Low-Dose Dobutamine for Post-Arrest Myocardial Dysfunction in a Rat Model of Cardiac Arrest
Authors: LEE HSIN YU , Tsai Min-Shan , Chen Wen-Jone , HUANG CHIEN-HUA , Chiang Wen-Chu , Lu Kuan-Ting , Ma Matthew
Published: December 2023

Introduction:
Post-arrest myocardial dysfunction attributes unstable hemodynamic and mortality in successfully resuscitated cardiac arrest victims. Studies demonstrated that low-dose dobutamine (LDb) and Omecamtiv Mecarbil (OM) improved post-arrest myocardial dysfunction and neurological recovery, respectively.

Hypothesis:
Whether the combination of LDb and OM synergistically improves post-arrest myocardial dysfunction?

Methods:
Asphyxial cardiac arrest was induced in adult male wistar rats and left untreated for 9.5 minutes followed by cardiopulmonary resuscitation. Successfully resuscitated animal were randomized into control group (without medication), OM group(0.25 mg/kg/h), LDb group (5 micrograms/Kg/min), and OM+LDb group, in which drugs or normal saline were continuously intravenously infused for 4 hours. Hemodynamic were monitored for 4 h after return of spontaneous circulation. Survival status and neurological recovery were observed for 72 h. The difference of biomarkers, histological examinations and mitochondrial function of myocardium between groups were evaluated.

Results:
As compared with the control group, the OM, LDb, and OM+LDb groups all demonstrated improved left ventricular systolic function (dp/dt40), better cardiac output, lower Troponin-I, higher 72-h survival, and more favorable neurological recovery. The LDb group showed a higher dp/dt40 and cardiac output than the OM group, whereas OM+LDb group did not demonstrated significant benefit when compared to OM and LDb, respectively. The OM, LDb, and OM+LDb mitigated post-arrest myocardial damage and cardiac mitochondrial injury, and ameliorated myocardial and hippocampus apoptosis. However, the OM+LDb group showed no superiority to the OM group or LDb group.

Conclusions:
Both OM and LDb improved post-arrest myocardial dysfunction, cardiac mitochondrial injury, survival, neurological recovery following cardiac arrest. However, OM+LDb group did not exert synergistic effect in ameliorate post-arrest myocardial dysfunction.
Abstract 13289: Medicaid Patients in Cardiac Rehabilitation: Underrepresented, High Risk, High Need
Authors: Khadanga Sherrie , Savage Patrick , Yant Blair , Anair Bradley , Ades Phillip , Gaalema Diann
Published: December 2023

Purpose:
Patients with lower-socioeconomic status (SES) have higher rates of cardiovascular (CV) events and therefore, have the most to gain from cardiac rehabilitation (CR). Unfortunately, those with lower-SES are much less likely to engage in CR which has made characterization of this population quite difficult. Our CR program specifically increased recruitment of lower-SES patients, allowing for careful comparison of medical, psychosocial, and behavioral risk factors between lower and higher-SES patients eligible for secondary prevention.

Methods:
Demographic and clinical characteristics were prospectively gathered on consecutive individuals entering Phase 2 CR from 1/2014-12/2022. Patients were classified as lower-SES if they had Medicaid insurance. Statistical methods included chi-square and non-paired t-tests. A
p
value of <0.01 was used to determine significance.

Results:
The entire cohort consisted of 3131 individuals. Compared to higher-SES patients, lower-SES individuals (n=405, 13%) were a decade younger, almost 6 times more likely to be current smokers, nearly 3 times more likely to have elevated depressive symptoms, and had significantly higher body mass index, waist circumference, and hemoglobin A1c, with more abnormal lipid profiles (all p<0.001). Despite being a decade younger, lower-SES patients had lower measures of peak VO
2
and self-reported lower levels of physical function (both p<0.001).

Conclusion:
Lower-SES patients have a remarkably prominent high-risk CV profile resulting in a substantially higher risk for a recurrent coronary event than higher-SES patients. Accordingly, strong efforts must be placed to engage this high-risk population in CR. It is imperative for CR programs to ensure that they are appropriately equipped to intervene on risk factors such as low fitness, depression, and smoking.
Abstract 13296: Cardiovascular Determinants of Exercise Capacity in Patients With Cancer
Authors: Evertz Ruben , Anker Markus , Diehl Christine , Braulke Friederike , Overbeck Tobias R , Garfias-Veitl Tania , Hasenfuss Gerd P , Schuster Andreas , von Haehling Stephan
Published: December 2023

Introduction:
Maintaining cancer patients′ exercise capacity and therefore patients′ self-determined life is of huge importance, but little is known about major determinants. We sought to identify determinants of exercise capacity in patients with a broad spectrum of cancer types, who were already receiving cancer treatment or about to commence such therapy.

Methods:
Exercise capacity was assessed in 253 consecutive patients mostly suffering from advanced cancer using the 6-minute walk test (6-MWT). All patients underwent echocardiography, physical examination, resting electrocardiogram (ECG), hand grip strength (HGS) measurement, and laboratory assessments.

Results:
Patients were divided into two groups according to the median distance in the 6-MWT (459 meters). Patients with lower exercise capacity were older, had significantly lower HGS and haemoglobin and higher values of high sensitive (hs) Troponin T and NT-proBNP (all p <0.05). Whilst the co-morbidity burden was significantly higher in this group, no differences were detected for sex, body mass index, tumour type, or cachexia (all p > 0.2). Using multivariable logistic regression, we found that the presence of anaemia (odds ratio (OR) 6.172, 95% confidence interval (CI) 1.401-27.201, p=0.016) as well as an increase in hs Troponin T (OR 3.077, 95% CI 1.202-5.301, p=0.019) remained independent predictors of impaired exercise capacity. Increasing HGS was associated with a reduced risk of a lower exercise capacity (OR 0.896, 95% CI 0.813 - 0.987, p=0.026).

Conclusions:
Screening patients for elevated hs troponin levels as well as reduced HGS may help to identify patients at risk of lower exercise capacity during cancer treatment.