bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 10984: Alert-Based Computerized Decision Support for High-Risk Ambulatory Clinic Patients With Atrial Fibrillation Not Prescribed Anticoagulation: A Randomized, Controlled Trial (AF-Alert2)
Authors: Piazza Gregory , Hurwitz Shelley , Campia Umberto , Bikdeli Behnood , Lou Junyang , Khairani Candrika D , Bejjani Antoine , Snyder Julia , Pfeferman Mariana , Barns Briana , Rizzo Samantha , Glezer Alexandra , Goldhaber Samuel Z
Published: June 2023

Introduction:
Despite widely available risk stratification tools, safe and effective anticoagulants, and guideline recommendations, antithrombotic therapy for stroke prevention in atrial fibrillation (AF) is under-prescribed in ambulatory clinic patients.

Hypothesis:
We hypothesized that alert-based computerized decision support (CDS) would increase anticoagulation prescription in ambulatory clinic patients with AF and high-risk for stroke.

Methods:
We enrolled 798 patients (CHA
2
DS
2-
VASc score≥2) with AF who were not prescribed anticoagulant therapy and had an ambulatory clinic visit at Brigham and Women’s Hospital. Patients were randomly allocated, according to Attending Physician of record, to intervention (alert-based CDS) versus control (no notification). The primary efficacy outcome was the frequency of anticoagulant prescription.

Results:
The CDS tool assigned 395 and 403 patients to the alert and control groups, respectively. Patients in the alert group were more likely to be prescribed anticoagulation within 48 hours of the clinic visit (15.4% vs. 7.7%, p<0.001) and at 90 days (17.2% vs. 9.9%, p<0.01). Direct oral anticoagulants (DOACs) comprised the majority of increased prescriptions of anticoagulation at 48 hours and 90 days. No differences in stroke, TIA, or systemic embolic events (0% vs. 0.8%, p=0.09), symptomatic VTE (0.5% vs. 1%, p=0.43), CV mortality (0.5% vs. 0.7%, p=0.99), or a composite of major adverse cardiovascular events (2.8% vs. 2.5%, p=0.79) were observed at 90 days (
Figure
).

Conclusions:
An alert-based CDS strategy increased anticoagulation in ambulatory clinic patients with AF and high-risk for stroke who were not receiving anticoagulation at the time of the office visit. ClinicalTrials.gov Identifier: NCT02958943
Abstract 10999: Long-Term Outcomes of Atrioventricular Valve Regurgitation and Repair in Patients With Single Ventricle Physiology
Authors: Smerling Jennifer L , Goldstone Andrew B , Bacha Emile , Liberman Leonardo
Published: June 2023

Introduction:
In single ventricle patients, AV valve regurgitation increases the risk of adverse outcomes, and staged palliation with concomitant AV valve intervention further increases that risk in the post-operative period. Long-term outcomes of valve intervention during stage 2 palliation, however, have not been established. The purpose of this study is to evaluate long-term outcomes after AV valve intervention during stage 2 palliation in patients with RV dominant circulation in a multicenter study utilizing a national public-use database.

Methods:
The study was performed using the SVR and SVR II public use datasets. From the original cohort of 549 patients, 102 (19%) with moderate or severe tricuspid valve regurgitation as measured by their stage 2 pre-operative core lab echocardiogram were included. Kaplan-Meier curves were performed to describe the association between valve regurgitation and intervention and long-term survival up to 6 years post Fontan. Multivariable Cox proportional-hazards models were used to assess the relationship between valve intervention and survival adjusting for confounding covariates.

Results:
Patients with moderate or severe valve regurgitation at either stage 1 or 2 had worse long-term survival defined as death or transplant up to 6 years post-Fontan operation (
p
< 0.001,
p
< 0.01). There were 34 patients (33%) of the 102 with significant regurgitation who underwent valve intervention at the time of stage 2 repair. Those who underwent valve intervention at stage 2 surgery were significantly more likely to die or undergo heart transplantation (HR 3.49, CI 1.53-7.94). Of the patients who underwent valve intervention, those who survived were more likely to have none or mild valve regurgitation by the time of stage 3 (78% vs 46%,
p
= 0.025). Patients with moderate to severe AV valve regurgitation at the time of the Fontan had favorable outcomes regardless of valve intervention with 100% survival.

Conclusions:
The risks associated with AV valve regurgitation in single ventricle patients are not mitigated by valve intervention at the time of stage 2 palliation. In fact, patients who underwent valve intervention at stage 2 had significantly worse survival as compared to patients with AV valve regurgitation who did not.
Abstract 11015: Pacemaker Lead Insertion Sites Contribute to Regional and Global Ventricular Dysfunction
Authors: Castellanos Daniel A , Prakash Ashwin , Sanders Stephen , Carreon Chrystalle Katte , Sigler Matthias , Oleary Edward , Baird Chris , Fynn-Thompson Francis , Gauvreau Kimberlee , Ghelani Sunil J , Mah Douglas
Published: June 2023

Introduction:
Ventricular pacing can cause dysfunction but how the lead is anchored to the myocardium has not been studied. We evaluated patterns of regional and global ventricular function in patients with a ventricular pacemaker or defibrillator using cine cardiac CT (CCT).

Methods:
This was a single center retrospective study of patients with a ventricular pacemaker or defibrillator who underwent a cine CCT from September 2020 to June 2021. Regional wall motion abnormalities (RWMAs) were assessed in relation to lead insertion site (sew-on vs screw-in) and pacing activity (active vs. inactive).

Results:
A total of 122 ventricular lead insertion sites were analyzed in 43 patients (53% male, median age 20 years, range 3-57 years). Thirteen patients (30%) had palliated single ventricle physiology, twenty-nine patients had congenital heart disease with biventricular circulation (67%), and one patient had a structurally normal heart (2%). RWMAs were present in 51/122 (42%) lead insertion sites among 23/43 (53%) patients. The prevalence of a lead insertion site associated RWMA was higher with active pacing (54% vs 19%; p < 0.001) and highest for active epicardial sew-on sites (
Figure 1
). RWMAs were not associated with position of the insertion site relative to the chest wall (p = 0.85) or the distance between the two heads of a bipolar lead (p = 0.23). Patients with lead insertion site associated RWMAs had a lower systemic ventricular ejection fraction (mean of 37.5% vs 52.5%, p < 0.001) compared to those without a RWMA.

Conclusions:
Pacemaker lead insertion site RWMAs are common and associated with systemic ventricular dysfunction. The mechanism and clinical significance of this regional and global dysfunction warrant further study.
Abstract 11053: Is the Abnormal Rise in Both Systolic and Diastolic Blood Pressure Post-Mild Exercise Protocol Associated With More Cardiovascular Structural and Functional Abnormalities Than Isolated Systolic or Diastolic Rise Alone?
Authors: El Shahawy Mahfouz , Izadi Lillee , Sabatini Antonella
Published: June 2023

Background:
An isolated abnormal rise in systolic or diastolic BP post-mild exercise protocol (PMEP) is a major CVD risk factor.
Purpose:
To assess whether a combined abnormal rise in systolic and diastolic BP PMEP is associated with more cardiovascular structural and functional abnormalities (CVSFA) than an abnormal rise in either isolated systolic or diastolic BP PMEP.

Methods:
We screened 2,924 asymptomatic subjects, ages 20-79, for CVD risk using the Early Cardiovascular Disease Risk Scoring System, also known as the Rasmussen Risk Score, which was published previously. This consists of 10 tests: 7 vascular and 3 cardiac. The vascular tests are large (C1) and small (C2) artery stiffness, BP at rest, and after PMEP, CIMT, abdominal aorta ultrasound, and retinal photography. The 3 cardiac tests are Pro-BNP, ECG, and LV ultrasound. Out of the total subjects, 1106 (38%) were on no medications. These were divided into four BP subcategories according to the current ACC/AHA guidelines, shown in the table.

Results:
As shown in the table, combined systolic and diastolic BP rise PMEP is more common than either one alone. Systolic and diastolic BP rise PMEP is associated with more CVSFA, particularly in those with Stage 1 and 2 hypertensions compared to those who are normotensive. The CVSFA in combined systolic and diastolic BP PMEP is not statistically significant when compared to isolated abnormal rise in systolic or diastolic BP.

Conclusions:
Abnormal rise in BP PMEP is associated with significant CVSFA, regardless of whether isolated or combined. Hence, we recommend exercise stress testing protocol for risk stratification and optimal treatment in hypertensive patients.
Abstract 11083: Post-Infarction Cardiac Protection by Gut Butyrate-Producers
Authors: Chen Hung-Chih , Hsieh Patrick C
Published: June 2023

Background
The gut microbiota and their metabolites have been shown to contribute to the development of coronary artery diseases. However, little is known about their roles in post-injury cardiac repair. Here, we investigated the gut microbiota and plasma metabolomes distinct in patients with ST-elevation myocardial infarction (STEMI), and explored their roles on adaptive responses, using germ-free (GF) mice and nonhuman primate models.

Methods
We recruited 70 controls and 77 coronary angiogram-confirmed STEMI patients, and collected their stool and plasma. The stool and plasma of STEMI patients were collected immediately following percutaneous coronary intervention (PCI, STEMIT1) and again at 28 days after PCI (STEMIT2). We used 16S V3-V4 rRNA NGS and shotgun metagenomics to map the gut microbiota and both NMR and LC-MS metabolomics to profile the plasma metabolites. To determine the

role of the gut microbiota and their metabolites on post-injury cardiac repair, we inoculated identified bacteria in GF mice and treated specific pathogen free mice with candidate metabolites. Moreover, we validated the microbiome and metabolomics findings in a nonhuman primate coronary ischemia-reperfusion (IR) injury model.

Results
The 16S V3-V4 rRNA NGS and shotgun metagenomic analysis revealed an enrichment of butyrate-producing bacteria in STEMIT1, as compared to STEMIT2 or to control cases. Fecal microbiome transplantation of STEMI samples in GF mice deteriorated host post-injury cardiac function, showing reduced left ventricle ejection fraction and cardiac mechanics. Moreover, plasma ketogenesis increased in the STEMI patients using NMR and LC-MS metabolomics. The protective effect of butyrate was more profound with intact commensal gut flora. Furthermore, inoculation of butyrate-producers in GF mice elevated plasma ketone body and better preserved post-injury cardiac function. Agreed with the clinical finding, we observed injury-induced elevation of gut butyrate-producers and plasma ketone bodies in the nonhuman primate IR model.

Conclusion
This study demonstrates the pivotal role of gut butyrate-producers and the derived ketogenesis in post-injury cardiac repair, which may lead to new prevention strategies and treatment for heart failure.
Abstract 11089: Comparison of Long-Term Cardiovascular Events of Influenza Patients With versus Without Pre-Existing Cardiovascular Disease in the Infection Treated With Antiviral Agents
Authors: Park Kyung Teak , KANG KI-WOON , Shin Seung Yong , Won Ho Yeon , Kim Hyue Mee , Lee Wang Soo , Kim Sang Wook
Published: June 2023

Introduction:
The antiviral agents are highly recommended to prevent cardiovascular mortality in patients with pre-existing cardiovascular disease in the pandemic era, but the long-term cardiovascular mortality have not yet been comprehensively characterized in the influenza infection treated with antiviral agents.

Hypothesis:
This study aimed to compare long-term cardiovascular mortality of influenza patients with versus without pre-existing cardiovascular disease in patients with anti-viral agents.

Methods:
The data were extracted from the National HealthDatabase from 2001 to 2010, which covers nearly the entire population of South Korea. 865,522 influenza patients treated with anti-viral agents were selected and cardiovascular disease was classified as atrial fibrillation (AF), heart failure (HF), ischemic heart disease (IHD) and 5-year mortality were analyzed using Cox proportional hazard regression model.

Results:
Of these, 96,433 patients (11.1%, mean age 46) had IHD (86.4%), HF (23.1%) and AF (12.5%) in the influenza infection treated with anti-viral agents. The incidence of IHD was 0.25 per 100-person year in the pre-existing IHD, 0.25 per 100-person year in the pre-existing HF and 0.20 per 100-person year in the pre-existing AF. The incidence of myocarditis was 0.008 per 100-person year in the pre-existing IHD, 0.006 per 100-person year in the pre-existing HF and 0.01 per 100-person year in the pre-existing AF. The incidence of cardiovascular death was 0.49 per 100-person year in the pre-existing IHD, 0.47 per 100-person year in the pre-existing HF and 0.47 per 100-person year in the pre-existing AF.

Conclusions:
Long-term cardiovascular mortality in influenza patients with pre-existing cardiovascular disease treated with antiviral agents were not significantly different from those without pre-existing cardiovascular disease.
Abstract 111: Ischemic Post Conditioning After Asphyxial Arrest In A Diabetic Rat Model
Authors: Barajas Matthew , Oyama Takuro , Shiota Masakazu , Li Zhu , Zaylskie Lauren , Walter Miriam , Riess Matthias L
Published: June 2023

Diabetes (DM) is a pervasive disease associated with increased risk of cardiac arrest (CA) and worse survival. Diabetics display abrogation of post arrest therapies. Ischemic post-conditioning (IPoC) has been shown to improve outcomes in young healthy swine, but never in a DM model. We hypothesized that IPoC would be beneficial for survival of non-DM rats after asphyxial CA and that this benefit would be abrogated in DM. Male Wistar rats were utilized, 12 of 23 underwent induction of DM with injection of streptozotocin (30mg/kg) IP and feeding of western diet for 12 weeks. Rats were intubated, mechanically ventilated, and anesthetized with isoflurane. A non-invasive flow probe was placed on a carotid artery. An internal jugular vein and femoral artery and vein were cannulated. Electrocardiogram, echocardiogram, and arterial blood gas were analyzed. Asphyxial CA, induced by rocuronium and cessation of ventilation, proceeded for 7 min. CPR was initiated utilizing an automated chest compressor at a rate of 200/min. Animals were randomly assigned to standard CPR (S-CPR) or IPoC. IPoC was initiated 40 seconds into CPR with a 20 sec pause followed by 20 sec of compressions, 1 cycle. This cycling was performed 4 total times after which S-CPR was continued. Defibrillation and epinephrine were given, as necessary. Data were collected every 40 sec during CPR and at 15 min, 1 and 2 hr after return of spontaneous circulation (ROSC). Data were analyzed using ANOVA with pairwise comparisons. Significance set at p <.05. Non-DM rats displayed high rates of ROSC in both S-CPR, and IPoC groups, 100% (5 of 5) and 83% (5 of 6) respectively. DM S-CPR rats had a reduced ROSC rate at 14% (1 of 7) which improved to 80% (4 of 5) with IPoC. There were no significant differences between DM S-CPR and IPoC groups during CPR. Only DM rats required defibrillations. DM rats had a significantly longer time to ROSC, higher epinephrine requirement, lower nadir pH, and lower carotid blood flow at end experiment. There was no difference in any marker between non-DM S-CPR and IPoC groups after ROSC. DM was associated with increased injury from CA. IPoC was not harmful to non-DMs but improved ROSC rate and thus survival in DM rats. This is a novel demonstration of IPoC utility in a historically conditioning resistant group.
Abstract 11149: Pretreatment With P2Y12 Inhibitors in ST-Elevation Myocardial Infarction & Systematic Review and Meta-Analysis
Authors: Mesadri Gewehr Douglas , Dagostin Caroline , Cardoso Rhanderson , kubrusly Taiane B , Kubrusly Fernando B , Kubrusly Luiz F
Published: June 2023

Background:
the practice of pretreatment with oral P
2
Y
12
inhibitors in ST-Elevation Myocardial Infarction (STEMI) remains common; however, its association with improved cardiovascular outcomes is unclear, since no large RCT has addressed this issue.

Hypothesis:
We aimed to evaluate the association of oral P2Y12 inhibitor pretreatment in STEMI patients with cardiovascular and bleeding outcomes.

Methods:
PubMed, MEDLINE, Embase, Cochrane, Scopus, Web of Science were systematically searched for studies that compared pretreatment with P
2
Y
12
versus no pretreatment in STEMI, and reported efficacy and safety outcomes. A meta-analysis using a fixed and random effects model was used to calculated outcomes of interest. Heterogeneity was assessed with I
2
statistics.

Results:
A total of 3 RCTs and 14 observational studies assigning 91,771 patients to either pretreatment (65,598 patients) or no pretreatment (26,171 patients) were included. Follow-up ranged from 7 days to 19 months. The P
2
Y
12
inhibitors included clopidogrel, prasugrel and ticagrelor. At 30 days, P
2
Y
12
pretreatment was associate with lower 30-day mortality (risk ratio [RR], 0.71; 95% CI, 0.56-0.91; p=0.006; I
2
=75%), stent thrombosis (RR, 0.33; 95% CI, 0.12-0.95; p=0.04; I
2
=83%), and major bleeding (RR, 0.81; 95% CI, 0.74-0.90; p<0.0001; I
2
=0%). No difference in the incidence of 30-day myocardial infarction (MI), target vessel revascularization (TVR), MACE (death/MI/TVR), stroke, pre-PCI TIMI 0 flow, and post-PCI TIMI 0-2 flow was observed. Subgroup analysis including only randomized studies indicated no difference in all-cause mortality between groups (RR, 1.49; 95% CI, 0.89-2.52; p=0.13; I
2
=38%).

Conclusion:
In this study, pretreatment with oral P2Y12 inhibitors among patients with STEMI before cath lab, compared with treatment once coronary anatomy is known, was associated with decreased all-cause mortality and bleeding risk.
Abstract 11151: Pre-Operative Malnutrition Increases Risk of Major Infection and Death in Hospital After Ventricular Septal Defect Closure in Low-Resource Settings
Authors: Wittenberg Rachel E , Gauvreau Kimberlee , Duggan Christopher , Du Xinwei , Giang Do , JAYANTHI VENKATA KRISHNA KISHORE , Sandoval Nestor , Jenkins Kathy J
Published: June 2023

Introduction:
High energy requirements and poor feeding due to left-to-right shunting can lead to growth failure in patients with ventricular septal defect (VSD) but the effect of malnutrition on surgical outcomes is not well known, especially in low-resource settings. More data would inform decisions on whether nutritional repletion should occur pre-operatively or be deferred until after surgery.

Methods:
We analyzed cases of isolated VSD +/- ASD or PDA closure in children < 5 years old from 19 centers in 10 low- and middle-income countries with complete audited data collected as part of the International Quality Improvement Collaborative for Congenital Heart Disease from 2016 - 2020. Premature infants and those with known genetic/non-cardiac structural anomalies were excluded. We examined inter-center variation in weight-for-height z score (WHZ) and adjusted for age and major medical illness to calculate odds ratios (OR) of death and major infection (surgical site infection or bacterial sepsis) during hospitalization for changes in WHZ, and for patients with moderate acute malnutrition (-3 < WHZ ≤ -2; MAM) or severe acute malnutrition (WHZ ≤ -3; SAM) versus those without malnutrition (WHZ > -2).

Results:
Among 6441 VSD closures (5023 membranous, 160 muscular, 73 AV canal, 1046 infundibular, 139 DORV), median age was 8 months (1 day - 4.4 years). Median WHZ at time of surgery was -1.1 (-8.0 - 7.4); 949 patients (15%) had MAM and 1026 (16%) had SAM. Median WHZ (-3.52 - 0.35) and rates of MAM (19 - 80%) and SAM (6 - 63%) varied among centers. Overall, 0.5% died in hospital and 1.2% had major post-operative infection. Odds of major infection (OR 1.07, 95% CI 0.89-1.29) and mortality (OR 1.18, 0.93-1.49) increased for each one unit decrease in WHZ. For the MAM group, odds of major infection (OR 1.50, 0.67-3.37) and mortality (OR 1.32, 0.50-3.49) were increased compared to those without malnutrition. For SAM, odds were higher, and were significant for major infection (OR 2.15, 1.01-4.56) and nearly so for mortality (OR 1.93, 0.98-3.77).

Conclusions:
Malnutrition is common in children undergoing VSD closure in low-resource settings and increases risk of major infection and death, especially in cases of SAM. Pre-operative nutritional repletion may be considered to reduce risk.
Abstract 11152: Complications Associated With Transesophageal Echocardiography in Transcatheter Structural Cardiac Interventions in the United States: 2012-2022
Authors: Hasnie Ammar A , Parcha Vibhu , HAWI RIEM , Trump Michael L , Shetty Naman , Ahmed Mustafa I , Booker Oscar J , Arora Pankaj , Arora Garima
Published: June 2023

Introduction:
Transesophageal echocardiograms (TEEs) performed during structural cardiac interventions may have higher complications than those performed in the non-operative setting. However, there is limited data on complications associated with TEE in these procedures. The objective of this study was to evaluate the prevalence of major complications among these patients in the United States (US).

Methods:
A retrospective cohort study was conducted using an electronic health record database from large academic medical centers across the US for patients undergoing TEE during structural interventions from January 2012 to January 2022. Using the American Society of Echocardiography endorsed ICD-10 codes, patients undergoing TEE during a structural cardiac intervention, including transaortic, mitral or tricuspid valve repair, left atrial appendage occlusion, and paravalvular leak replacement were identified. The primary outcome was major complications within 72 hours of the procedure (composite of bleeding, esophageal and upper respiratory tract injury).

Results:
A total of 9,482 adult patients undergoing TEE for transcatheter structural cardiac interventions were identified. The median age was 71 years (IQR: 61 - 80 years), including 43% females and 19% non-white individuals. Of those, 7,158 (75%) of patients were on anticoagulation, and 6,272 (66%) were on antiplatelet therapy. In the study cohort, 246 (2.6%) patients had a major complication. Complication rates were higher in patients on anticoagulation or antiplatelet therapy compared to those who were not (2.9% vs. 0.84%, p<0.001, OR: 3.57 [95% CI: 1.89- 6.74]). Patients aged ≥65 had higher rates of major complications compared with those <65 (2.95% vs. 1.16%, p<0.001). Complication rates were similar among males and females (2.7% vs 2.5%, p=0.50).

Conclusions:
Nearly 2.6% of patients undergoing TEE during transcatheter structural cardiac interventions have a major complication. Major complications are relatively more common among older patients and those on anticoagulant and antiplatelet therapy. With a shift of poor surgical candidates to less invasive procedures, the future of TEE-guided procedures relies on a heart team approach and a comprehensive risk discussion.
Abstract 11155: Recovery of Tricuspid Valve Function After Resection of a Primary Ovarian Carcinoid Tumor
Authors: Wong Jeffrey D , Finlayson Sarah D , Loree Jonathan D , Straatman Lynn P , Nair Parvathy , Tsang Michael Y , Luong Christina , Tsang Teresa , Gin Ken , Jue John , Yeung Darwin
Published: June 2023

Case Presentation:
A 51-year-old woman presented with a >1-year history of bilateral leg edema, diarrhea, and facial flushing. Examination revealed a large abdominal mass, which CT scan confirmed to be a 15x11x13 cm ovarian mass with solid and cystic components. She underwent hysterectomy and bilateral salpingo-oophorectomy. Histopathology revealed a 17 cm ovarian dermoid cyst containing an insular carcinoid tumor. Her post-operative urinary 5-hydroxyindoleacetate (HIAA) level was 23 umol/d (normal 10-40 umol/d) and chromogranin-A level was 95 ug/L (normal <94 ug/L), but positron emission tomography (PET) scan showed lymph node metastasis, prompting initiation of lanreotide, a somatostatin analogue. A perioperative echocardiogram revealed thickened, fixed, and retracted tricuspid and pulmonic valves with severe tricuspid and pulmonary regurgitation consistent with carcinoid heart disease. The right ventricle was dilated but showed preserved systolic function. Valve intervention was considered but deferred as right heart catheterization 15 weeks after surgery showed normal right-sided pressures. A follow-up echo 8 months post resection showed unchanged pulmonary regurgitation but significant improvement in tricuspid valve mobility with a corresponding reduction in tricuspid regurgitation to a mild-to-moderate level.

Discussion:
Thickened and fixed tricuspid valve leaflets with significant regurgitation represents a hallmark of carcinoid heart disease that can lead to progressive right heart failure, often necessitating surgical intervention. This is a rare case of carcinoid heart disease where there was marked improvement in tricuspid valve function after surgical resection of a primary carcinoid tumor and initiation of somatostatin analog therapy. It highlights the potential for timely treatment to reverse the deleterious effects of carcinoid tumors on cardiac valves, which may ultimately spare the need for cardiac surgery.
Abstract 11156: Over Time, Heart Failure Symptoms Worsen Depression
Authors: Abbott Laurie , Graven Lucinda J , Schluck Glenna
Published: June 2023

Introduction:
Heart failure (HF) is a global health problem, contributing to increases in hospital readmission rates, high health care costs, and increased morbidity and mortality. HF symptoms can be difficult to manage and lead to depression.

Purpose:
To examine the impact of a nurse-led, telephone, coping intervention and HF symptoms on depression in patients with HF.

Methods:
A 3-group randomized controlled pilot study was conducted with 107 HF patients to test the effectiveness of a 12-week telephone-based coping intervention for HF symptoms. The intervention group (n = 34) received 1 home visit, weekly (1st month), and biweekly (months 2-3) telephone calls. The attention group (n = 38) received sham calls on a similar pattern as the intervention group. All groups received usual care, with the control group (n = 35) receiving usual care only. HF patients were 61 years old, on average; 54.2% male; 54.2% African American; and 43.9% NYHA II. Data were collected at baseline, 5, 9, and 13 weeks on social support (Interpersonal Support Evaluation List), problem-solving (Social Problem-Solving Inventory Revised-Short), HF symptoms (Heart Failure Symptom Survey), and depression (Center for Epidemiological Studies-Depression scale). Linear mixed modeling was implemented to examine the effect of the intervention and HF symptoms on depression over time, controlling for social support and problem-solving.

Results:
Sixty-four patients completed the study (18 intervention; 24 attention; 22 control). No significant between-group differences in sociodemographic characteristics, HF symptoms, or depression was noted at baseline. There was no significant intervention effect over time on depression. However, experiencing HF symptoms over time contributed to worse depression across all groups.

Conclusions:
Experiencing HF symptoms can lead to worsened depression over time. Interventions that improve self-management of HF symptoms can potentially be effective in reducing depression in HF patients.
Abstract 11162: Low Left Atrial Appendage Flow Velocity Predicts Treatment Failure in Patients With Left Atrial Thrombi: Insight From the LAT Trial
Authors: Okada Masato , Tanaka Nobuaki , Tanaka Koji , Hirao Yuko , OKAMURA ATSUNORI , Iwakura Katsuomi , Egami Yasuyuki , masuda masaharu , Sunaga Akihiro , Hikoso Shungo , Inoue Koichi , Sakata Yasushi ,   the OCVC-Arrhythmia Investigators
Published: June 2023

Background:
Blood stasis is one of the important pathogeneses in the formation of left atrial (LA) thrombi. The LA appendage peak flow velocity (LAAV) is an established quantitative parameter for estimating the thromboembolic risk. However, it remains unknown whether the LAAV affects the successful resolution of LA thrombi even after prescribing an appropriate oral-anticoagulation treatment.

Purpose:
To evaluate whether the LAAV is associated with successful resolution of LA thrombi.

Methods:
The analysis was performed from the LAT trial, a multicenter observational study investigating the outcomes of silent LA thrombi detected by trans-esophageal echocardiography (TEE) or computed tomography. Management of oral anticoagulants was at the physician’s discretion, and resolution of LA thrombi was checked by follow-up TEE. Of 297 patients registered in the trial, we enrolled 236 patients (median age, 69 years; 28% female; 100% atrial fibrillation) whose baseline LAAV data was available in this study.

Results:
The prescription rates of oral-anticoagulants at baseline and the final follow-up were 83.5% and 93.6%, respectively (p = 0.002). During a median follow-up of 387 (interquartile range, 367-414) days after the thrombi detection, LA thrombi successfully resolved in 145 (61.4%) patients by altering the oral anticoagulants. Patients with resolved LA thrombi had a higher baseline LAAV than those without (28.4 ± 18.5 vs. 19.8 ± 9.3 cm/s, p < 0.001). A receiver operating curve analysis revealed that the best cut-off value for predicting treatment success or failure was 25 cm/s (area under the curve: 0.651, p < 0.001). After adjusting for age, gender, body mass index, heart failure, and warfarin use, an LAAV ≤ 25 cm/s was a significant predictor of failed resolution of LA thrombi (hazard ratio, 1.54; 95% confidence interval, 1.09-2.18; p = 0.015).

Conclusions:
In the LAT trial, one third of patients failed thrombolysis even 1 year after identifying silent LA thrombi. An LAAV ≤ 25 cm/s at baseline independently predicted treatment failure with oral anticoagulants.
Abstract 11179: Changes in Cardiomyocyte Structure on Endomyocardial Biopsy Following COVID-19 Infection
Authors: Saxon Cara E , Berning Amber A , Bristow Michael R , Altman Natasha
Published: June 2023

Case Presentation:
A 24-year-old unvaccinated male with a history of NYHA Class II heart failure and morbid obesity presented with 4 days of chest pain and shortness of breath, and was found to have COVID-19 pneumonia. History included non-ischemic cardiomyopathy (NICM) with an LVEF of 33%. Troponin was 40 ng/L (ref <=53 ng/L) and NT pro-BNP 1915 pg/mL (ref <125 pg/mL). TTE showed LVEF 18.5% with severe global hypokinesis. As a participant in a clinical trial investigating heart rate modulation in NICM, 106 days prior to his positive COVID-19 PCR he had an endomyocardial biopsy (EmBx) revealing unremarkable myocytes (Figure 1A & B). His end-of-study EmBx (118 days after COVID-19 infection) showed scattered hypertrophic cardiomyocytes with enlarged hyperchromatic nuclei and T-tubule dilation (Figure 1 C & D).

Discussion:
Recent studies have described several types of myocardial injury related to COVID-19 infection. This is the first report to compare myocardial histopathological findings pre- and post-infection. The post-infection EmBx demonstrating cardiomyocyte hypertrophy and T-tubule dilation along with worsening LVEF on TTE were associated with progressive myocardial dysfunction following a recent COVID-19 infection. T-tubule changes have been correlated with abnormal cardiomyocyte contractile mechanics in animal models, although not previously described in relation to COVID-induced myocardial dysfunction. Limitations include the duration between his infection and biopsy as well as receipt of a study drug (ivabradine or placebo), though unlikely to impact the histopathology results.

Figure 1:
Endomyocardial histology and electron microscopy (EM) findings
A,
Pre-COVID with minimal pathologic findings (100x, H&E);
B,
Pre-COVID EM with normal intercalated disc (arrow) and mitochondria (arrowhead);
C,
Post-COVID with scattered hypertrophic cardiomyocytes (100x, H&E);
D,
Post-COVID EM with t-tubule dilation (arrows)
Abstract 112: A Transcriptomic Evaluation Of Brain And Cardiac Tissues After Cardiac Arrest In Rabbits
Authors: Abi Zeid Daou Yara , Hocini Hakim , Boissady Emilie , Faucher Estelle , Kohlhauer Matthias , lidouren fanny , Lefebre Cécile , Ghaleh Bijan , Tissier Renaud
Published: June 2023

Introduction:
A sepsis-like syndrome is known to occur rapidly after cardiac arrest.

Hypothesis:
A comprehensive investigation of immune signaling pathways could allow a better understanding or brain and heart disorders after cardiac arrest in rabbits.

Methods:
Anesthetized rabbits underwent 10 min of ventricular fibrillation. After resuscitation, they were followed during 2 or 6 h before brain and heart withdrawal (n=6 in each condition). Additional animals were submitted to a Sham procedure (n=6). The transcriptome was sequenced in cerebral and cardiac samples. Long mRNA expression was quantified vs Sham (fold-change > 1.5; p<0.05) before functional enrichment for pathways analysis using Reactome ID (R-HSA-9014325).

Results:
403 and 1561 genes were differentially expressed at 2 and 6 h in the brain of rabbits submitted to cardiac arrest vs Sham, respectively. Those genes related to 233 and 104 signaling pathways at 2 and 6 h, among which 15 and 1 concerned innate immunity or inflammation pathways, respectively (Table). This included several pathways related to interleukins (IL-1, 4&13 and 17) and toll-like receptors (TLR-1, 2, 6 and 9). In the heart, 1786 and 1457 genes were differentially expressed at 2 and 6 after cardiac arrest vs Sham. These genes were related to 68 and 58 signaling pathways at 2 and 6 h, among which only 1 and 3 concerned immunity or inflammation, respectively.

Conclusion:
Immuno-inflammatory events appears rapidly after cardiac arrest in the brain, supporting the need for early intervention to prevent neuro-inflammatory events. Conversely, the immuno-inflammatory response do not seem critical in the heart in the early phase after cardiac arrest.

Table 1:
p values of immune pathways significantly altered in either brain or heart after 2 or 6 hours after cardiac arrest, as compared to Sham animals.
Abstract 11202: A Biomarker of Stress and Self-Reported Stress Related to Caregiving Predict Poor Quality of Life in Caregivers of Patients With Heart Failure
Authors: Huang Tsuey-yuan , Tsai Ming-Fen , Lin Chin-Yen , Chung Misook L
Published: June 2023

Introduction:
Caregivers of patients with heart failure (HF) are at high risk of low quality of life due to stress-related to caregiving. Self-reported measures are commonly used to assess relatively long-term stress related to caregiving. Still, biological markers of stress, a short-term stress measure, are rarely used. There is limited knowledge on whether both can predict the quality of life in caregivers of patients with HF.

Hypothesis:
The stress biomarker (serum cortisol) and subjective distress related to caregiving (Caregiver Burden Inventory) predict the quality of life in caregivers of patients with HF.

Methods:
In this cross-sectional study, Taiwanese caregivers of patients with HF completed surveys including stress-related caregiving and quality of life measured by the Caregiving Burden Inventory and the Short Form-36, respectively. A blood sample for serum cortisol was collected between 9 and 12 AM. Independent t-test and multivariable linear regression analysis were conducted adjusting for age, gender, education, marital status, relationship with care-recipient and depressive symptoms (Patient Health Questionnaire).

Results:
Of the 113 caregivers (mean age 54.5 years, 70.8% female, 78% married/cohabitated), 59% cared for patients with NYHA class III/V. Single caregivers had higher serum cortisol levels than married caregivers (11.4 vs. 8.5, p =.002). Males had a significantly higher serum cortisol level than females (10.7 vs. 8.5, p =.010), but males reported a lower caregiver burden than females (1.3 vs. 1.6, p =.049). Both serum cortisol (β =-.36, P=.012) and caregiver burden (β = -.29, P= .018) were significant predictors of physical well-being. Serum cortisol (β= -.28, p=.026) and caregiver burden (β =-.25, p =.027) also significantly predicted mental well-being.

Conclusions:
Although stress levels are different by caregivers’ characteristics, both cortisol level and self-report caregiver burden have similar predictability of quality of life in caregivers of patients with HF. Reducing stress and caregiver burden is necessary to improve the quality of life in this population.
Abstract 11217: Pregnancy Outcomes in Unrepaired Congenital Heart Disease a Multicenter Experience From 1272 Patients
Authors: Zhang Qian , Fang Zhu , shi guocheng , chen huiwen
Published: June 2023

Introduction:
The prevalence of unrepaired congenital heart disease (CHD) before pregnancy is tremendously high, especially in developing countries. And their maternal outcomes haven’t been investigated at scale in a contemporaneous population. This study describes the maternal outcomes among pregnancies with unrepaired CHD.

Methods:
From 1993 to 2019, we nationally enrolled 2,220 CHD pregnancies from 7 tertiary centers. Patients were subdivided into two groups: pregnancies with unrepaired CHD and with repaired CHD. Maternal and offspring outcomes of completed pregnancies and their demographics, antenatal cardiac situation, and comorbidities were collected. To identify the risk factors for cardiac outcomes, univariate and multivariate analyses were performed through logistic regression.

Results:
Of 2,220 completed pregnancies with CHD, 1,272 women had unrepaired CHD. The main CHD diagnosis of unrepaired CHD patients was shunt lesion (64.54%). In parturients with unrepaired CHD, the incidence of mortality and heart failure were 1.73% and 14.94%, respectively. Pregnancies with unrepaired CHD had a significantly higher incidence of adverse maternal and offspring events than pregnancies with repaired CHD. Preterm delivery (22.56%) and low birth weight (21.15%) were the most common obstetric and offspring complications. Independent risk factors for maternal cardiac events included having a New York Heart Association functional class III-IV, elevated brain natriuretic peptide level, pulmonary hypertension, delayed first antenatal care visit, absence of strict antenatal supervision, and lack of multidisciplinary team management.

Conclusions:
In conclusion, pregnant women with unrepaired CHD were associated with significant morbidity and mortality. And they had significantly worse maternal and offspring outcomes than pregnant women with repaired CHD.
Abstract 11224: Anatomical Characteristics of Myocardial Bridging and Its Impact on Myocardial Ischemia in Patients With Nonobstructive Coronary Artery Disease
Authors: Toya Takumi , Tsukasa Naganuma , Hara Suzue , Ichishima Miyuzu , Nagatomo Yuji , Adachi Takeshi
Published: June 2023

Introduction.
Epicardial coronary arteries running through the myocardium (myocardial bridges: MBs) are compressed during myocardial contraction and may be involved in myocardial ischemia. However, the anatomical characteristics of MBs and their impact on myocardial ischemia have not been well characterized.

Methods.
We included 626 patients who underwent coronary artery computed tomography to evaluate ischemic signs and/or symptoms (mean age 66±13 years, 32% males). Curved multiplanar reformation images were used to assess MBs' presence, length, and thickness. In patients with positive noninvasive stress testing (NST), we compared the frequency and anatomical characteristics of MBs between patients with obstructive coronary arteries (OCA defined as >50% stenosis in main branches) and those with nonobstructive coronary arteries (INOCA).

Results.
MBs were found in 176 patients (28%), of which 45% were superficial (≤2 mm), 54% were deep (2-5 mm), and 1% were very deep (>5 mm) MBs (mean MB thickness 2.2±0.9 mm). The mean MB length was 18.2±5.7 mm with 14% long MBs (≥25 mm). Ninety-four out of 202 patients undergoing NST presented positive results, 62 of whom had OCA and 32 had INOCA. MBs were more frequently observed in patients with INOCA than in those with OCA (63% vs. 39%, P=0.03) (Figure A). Interestingly, INOCA patients tended to have longer MBs than those with OCA (20.7±6.0 mm vs. 17.6±5.4 mm, P=0.08), whereas MB thickness was not different between the two groups (2.3±0.7 vs. 2.0±0.6, P=0.19) (Figure B).

Conclusion.
Longer MBs may significantly impact myocardial perfusion, potentially producing positive results on stress tests in patients with INOCA.
Abstract 11227: A Rare Case of Echo Contrast Anaphylaxis Complicated by Acute Coronary Syndrome
Authors: Steinhauer Rachael , Miyashita Satoshi , Maslon Luisa , Chweich Haval , Downey Brian
Published: June 2023

Introduction:
Contrast agents in echocardiography are used frequently to enhance endocardial border visualization and assessment of structural heart disease. Sulfur hexafluoride lipid type A injectable suspension is a generally well-tolerated class of contrast. Anaphylaxis to these agents is exceedingly rare. We now report the first case of acute coronary syndrome in the setting of echo contrast anaphylactic shock.

Case:
A 49-year-old woman was hospitalized for an ST-elevation myocardial infarction (STEMI) for which a drug-eluting stent had been placed in the left anterior descending artery (LAD). An echocardiogram was performed to evaluate for structural heart disease. Shortly after administration of echo contrast the patient developed sudden-onset tachypnea and suffered a pulseless electrical activity cardiac arrest. She was treated for anaphylactic shock with epinephrine and high-dose steroids and achieved return of spontaneous circulation. Following the arrest an electrocardiogram revealed an anterolateral STEMI. The patient immediately underwent repeat angiography which revealed a 100% in-stent thrombosis of the LAD. The occlusion was successfully revascularized with a drug eluting stent with an Impella CP (Abiomed, Danvers MA) support. Subsequent laboratory exam demonstrated an elevated blood tryptase level consistent with an anaphylactic event.

Discussion:
We present a unique case of anaphylactic shock with acute coronary syndrome following administration of sulfur hexafluoride echo contrast. The incidence of anaphylaxis to echo contrast is less than one per million, and therefore it may not be immediately recognized as a mechanism of shock. Any prior reactions to polyethylene glycol should be noted before using these agents as this ingredient is thought to be the cause of anaphylaxis. In our case, diagnosis of anaphylaxis was confirmed by measuring the serum tryptase level. Tryptase is released from mast cells during allergic events, so this laboratory test with high specificity for anaphylaxis can be a useful tool in challenging cases such as this. Additionally, mast cell and platelet activation secondary to anaphylaxis may be an important mechanism of acute coronary syndrome with in-stent thrombosis.
Abstract 11239: Gender Disparities in the Utilization of Catheter-Directed Thrombolytic Therapy vs. Systemic Thrombolytic Therapy in Patients With Acute Pulmonary Embolism
Authors: Jalid Ayeshah , Ashraf Muddasir
Published: June 2023

Introduction:
Gender disparities in the utilization of catheter-directed thrombolytic (CDT) therapy vs. systemic thrombolytic (ST) therapy in patients with acute pulmonary embolism (PE) have not been studied before.

Methods:
Using the National Inpatient Sample database from 2012 to 2018, we identified all adult patients with acute PE who received any thrombolytic therapy. The primary outcome was the utilization of CDT vs. ST therapy in females compared to males. The secondary outcome was the mortality in females compared to males in all patients of acute PE who received any thrombolytic therapy.

Results:
We identified 45,950 patients who received CDT or ST therapy. The mean age was 59.7 years in females vs. 59 in males (p-value - .03). Males were more likely to have saddle PE (33% vs. 29%, p-value < .01) and less likely to have vasopressor use (3% vs. 5%, p-value < .01). Baseline characteristics are shown in
Table 1.
Females were less likely to have CDT vs. ST therapy on adjusted analysis (AOR - 0.85, p-value < .01), as shown in
Table 2.
Females also had 27% higher in-hospital mortality than males in the entire cohort who received any thrombolytic therapy even after adjustment for age, race, comorbidities, and hospital factors (AOR - 1.27, p-value < .01). CDT was associated with a 58% lower risk of in-hospital mortality than systemic thrombolytic therapy in the adjusted model (AOR - 0.42, p-value < .01).

Conclusion:
Gender disparities exist in the utilization of CDT in patients of acute PE who receive thrombolytic therapy, with lower utilization in females than males, despite significantly reduced in-hospital mortality associated with CDT vs. ST therapy.
Abstract 11244: Active Decompression During Device Assisted Elevation of the Head and Thorax, an Impedance Threshold Device, and Active Compression Decompression Cardiopulmonary Resuscitation is Needed for Sustained Hemodynamic Benefit in a Porcine Model of Prolonged Cardiac Arrest
Authors: Arango Susana , Kshatriya Shilpa , Metzger Anja , Salverda Bayert , Lick Michael , Moore Johanna C , Lurie Keith G
Published: June 2023

Introduction:
Active compression decompression cardiopulmonary resuscitation (CPR), an impedance threshold device (ITD), and automated device-assisted controlled head up positioning, collectively termed AHUP CPR, work synergistically to lower intracranial pressure, augment venous return to the heart and significantly improve neurological survival versus conventional (C)-CPR in animals and patients in cardiac arrest. The current study focused on the role of active decompression (AD) during prolonged AHUP CPR, since AD can be difficult to perform manually for an extended period.

Hypothesis:
Full AD is needed to optimize hemodynamics during prolonged AHUP CPR

Methods:
Six female and male farm pigs (~40 kg) were sedated, intubated, anesthetized, and monitored. After 8 min of untreated ventricular fibrillation followed by ≥ 30 min of AHUP CPR with an automated device, AHUP CPR was continued except that AD was intentionally reduced from an average of 3.33 ± 0.37 cm of lift to 0 cm lift above the resting neutral position as this is the amount of decompression that occurs with C-CPR and passive chest wall recoil. After 1 min of AHUP CPR with 0 cm lift, AD was progressively increased back to 3 cm of lift over 3 min. Hemodynamics (mean ± SD) were compared using Student’s t test, where p<0.05 was considered statistically significant.

Results
Coronary perfusion pressure (CorPP) (p<0.005), cerebral perfusion pressure (CerPP) (p<0.001), and ETCO2 (p<0.0001) significantly decreased after AD was discontinued (Fig.1). With restoration of AD to 3 cm, CorPP (p<0.009) and ETCO2 (p<0.001) significantly improved and CerPP trended higher (p=0.084).

Conclusion
During prolonged (≥ 30 min) AHUP CPR in pigs, active lift of the chest wall is essential to maintain stable hemodynamics. Hemodynamics deteriorated rapidly with intentional loss of AD, but could be partially restored with resumption of AD.