bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13662: Novel Morphological Classification of Left Atrial Appendage Using 3-Dimensional Printer -Rock, Paper and Scissors-
Authors: RYUZAKI SATOKO , Kondo Yusuke , Nakano Miyo , Nakano Masahiro , Kajiyama Takatsugu , Ito Ryo , Chiba Toshinori , Yoshino Yutaka , Komai Yuya , Takanashi Yukiko , Kobayashi Yoshio
Published: December 2023

Background:
Left atrial appendage (LAA) of Asians is generally larger and more complicated than that of non-Asians. Whereas the four classifications from previous reports are widely used in the world, different physicians have different point of views in the real-world practice.

Purpose:
To identify the relationship between morphological features of LAA and cardioembolic stroke in Japanese patients.

Methods:
All left atrial appendage closure (LAAC) cases in our institution performed between February 2020 and April 2023 were retrospectively analyzed. The three-dimensional printing of LAA was generated from cardiovascular computed tomography imaging data. The shapes of the LAA were classified into 3 morphological types: (1) The LAA with bi lobe was defined as “Scissors” type; (2) The one with complicated peripheral branches was “Paper” type; (3) The simple one was “Rock” type. We examined the relationship between the risk of cardioembolic stroke and the morphological features of the LAA.

Results:
The cohort consisted of 93 consecutive patients (age, 75±1 years; male gender, 72%; the size of WATCHMAN device, 29±0 mm). There were 41 (44%) patients who had a history of cardioembolic stroke (27% vs. 41% vs. 58%; Rock vs. Scissors vs. Paper types, p-value = 0.0466). In the multivariate analysis, the Paper type is the potential risk factor of cardioembolic stroke (p-value < 0.01) (Table1.2).

Conclusions:
The morphological features of LAA by three-dimensional printing was significantly related to cardioembolic stroke in this population. Physicians should pay attention to anticoagulant therapy management and proactively consider LAAC in LAA with complicated peripheral branches.
Abstract 13663: 90-day Safety and Performance Outcomes With a Novel Extravascular ICD Lead
Authors: Saini Karan S , Paluri Sarin N , Pandravada Abhishek , Philip Nicholas , Burke Martin C
Published: December 2023

Introduction:
Long-term transvenous implantable cardioverter defibrillator (ICD) leads have many pitfalls. There is in development a novel extravascular (EV) ICD lead for sensing and defibrillation of ventricular tachyarrhythmias (VT/VF) utilizing commercially available DF-4 ICD pulse generators. We evaluate here 90-day safety and performance outcomes for delivery, stability, sensing, and defibrillation using this prototype EV lead.

Methods:
18 patients scheduled to undergo de novo or replacement ICD were enrolled in a prospective, nonrandomized study (SECURE-EV STUDY). Each subject was simultaneously implanted with EV ICD lead (AtaCor, SanClemente, CA) attached to a commercially available ICD pulse generator. Study lead was delivered with a designed tool into left parasternal anterior mediastinum via a selected 4th, 5th or 6th intercostal space. Over 90 days pts were evaluated intermittently for defibrillation energy requirements, matched sensing events between both devices, stability of lead position and adverse events.

Results:
16/18 of enrolled subjects received study device. Lead failed implant in 2 due to (1) intercostal ossification and (1) mediastinal adhesions. Prior to 30-days, 4 subjects were withdrawn from study due to pneumothorax, wound dehiscence, death unrelated to IV-ICD implantation and early elective lead removal. Over 90-days of simultaneous sensing, 4 events of VT/VF in 3 pts were detected by both devices. There was 1 AF discrimination error & 1 atrial oversensing event detected by both devices. There were 4 events of non-cardiac noise in 4 pts detected by EV-ICD only. 1 event of Twave oversensing was detected by TV-ICD. 23 conversion tests in 13 subjects were performed at energy (26 to 30 J delivered, 1 tested with 35J) at 30- and 90-day visits, with successful conversion in all 23. Mean time between fibrillation detection and shock delivery was 10.7 seconds.

Conclusion:
This study showed feasibility of sensing and defibrillating induced VT/VF with intercostal placed prototype extravascular ICD lead. Findings with ICD lead was consistent across 4 commercially available ICDs. Simultaneous sensing of VT/VF in ambulatory pts was matched. Non-cardiac inappropriate sensing with EV-ICD lead is being addressed in new prototype.
Abstract 13669: Hypertension Subtypes as Predictors of Cardiovascular and All-Cause Mortality
Authors: Tang Kevin S , Jones Jeffrey , Fan Wenjun , Wong Nathan D
Published: December 2023

Background:
While hypertensive subtypes have been examined in relation to cardiovascular disease (CVD) outcomes in selected earlier cohorts, noting poorer outcomes in those with isolated systolic hypertension (ISH) in particular, contemporary data utilizing newer definitions of hypertension are lacking among US population-representative adults. We evaluated the association between hypertension subtypes with CVD and all-cause mortality.

Methods:
We included data from the National Health and Nutrition Examination Survey (NHANES) dataset 1999-2008 with follow-up through 2018. Hypertensive subtypes were based on systolic and diastolic blood pressure cut points of 130 and 80 mmHg, respectively. The incidence of CVD and all-cause mortality was examined and compared between hypertension subtypes (isolated systolic hypertension [ISH], isolated diastolic hypertension [IDH], and systolic-diastolic hypertension [SDH]) against patients with normal blood pressure using Cox regression analysis, adjusted for age, ethnicity, gender, tobacco use, use of antihypertensive agents, and comorbidities including diabetes mellitus and dyslipidemia.

Results:
A total of 23,206 subjects (projected to 194 million US adults) were included at baseline, of which 58% were normotensive, 21% had ISH, 8% had IDH, and 13% had SDH. In the adjusted analysis, ISH and SDH (but not IDH) were significantly associated with increased CVD. Subgroup analyses excluding those not on antihypertensive therapy (26.8%) showed these relationships to persist, except for ISH in relation to CVD mortality.

Conclusions:
Compared to normotension, ISH and SDH were independently associated with higher risk of cardiovascular and all-cause mortality. This has important implications for the continued necessity of managing systolic hypertension.
Abstract 13724: Multiparameter Right Ventricular Dysfunction Predicts Worse Prognosis in Heart Failure With Preserved Ejection Fraction - Lessons From the PARAGON-HF Trial
Authors: Lu Henri , Inciardi Riccardo M , Abanda Martin , Shah Amil M , Cikes Maja , Claggett Brian , Prasad Narayana , Lam Carolyn S , Redfield Margaret M , McMurray John J , Solomon Scott , Hegde Sheila , Skali Hicham
Published: December 2023

Introduction:
Impaired tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC) and right ventricular free wall longitudinal strain (RVFWLS) have been individually associated with a worse prognosis in patients with heart failure with preserved ejection fraction (HFpEF). However, these parameters measure different aspects of RV function and understanding their cumulative effect may provide insights into the overall impact of RV dysfunction (RVD) in HFpEF patients.

Goal:
Assess the association between the number of echocardiographic RVD parameters and clinical outcomes.

Methods:
Patients from the echocardiographic sub-study of the PARAGON-HF trial with adequate image quality (N=809, 53% women, mean age 74±8 years) were categorized based on the number of measures of RVD, which included TAPSE <1.7 cm, FAC <35% or RVFWLS <20% (absolute value). Associations with total HF hospitalizations (HFH) and CV death, total HFH alone, first HFH or CV death, all-cause death and CV death were assessed by Groups, after accounting for confounders.

Results:
A total of 348 patients (43%) in Group 0 (no abnormal parameter), 355 (44%) in Group 1 (one abnormal parameter) and 106 (13%) in Group 2 (two or more abnormal parameters) were identified. After multivariable adjustment (
Table
), Group 2 was significantly associated with an increased risk of total HFH and CV death (RR 2.13, 95%CI 1.13-4.01), first HFH or CV death (RR 2.07, 95%CI 1.15-3.73), all-cause death (RR 2.61, 95%CI 1.19-5.74) and CV death (RR 3.08, 95%CI 1.14-8.31). The treatment effect of sacubitril/valsartan for total HFH and CV death was not modified by RVD Group (p-value for interaction=0.94).

Conclusions:
The presence of two or more RVD parameters was associated with a significantly worse prognosis, while an isolated RVD measure was not. These findings suggest that a more comprehensive approach to assessment of RV function may have better prognostic value in HFpEF.
Abstract 13728: Generation of a Patient-Reported Outcome Measure of Quality of Life in Heart Valve Disease
Authors: Pons Ariel , Whalley Gillian , Sneddon Kate , Jenkinson Crispin , Morley David , Coffey Sean
Published: December 2023

Introduction:
Heart valve disease (HVD) is common globally, yet there is no questionnaire measuring quality of life (QOL) across the lifespan of HVD. This limits assessment of changes in QOL in response to intervention in HVD.

Research Question:
What are all features of QOL in lived HVD, and how may these be best selected between to create a well-performing questionnaire?

Goal:
We aimed to generate a patient-reported outcome measure of QOL in common and significant types of HVD: aortic stenosis, mitral regurgitation, mitral valve disease in rheumatic heart disease, and valve repair/replacement.

Methods:
Participants were recruited from echocardiographic databases in two tertiary surgical centres in three phases. Phase One described QOL in interviews; Phase Two pilot-tested the questionnaire; and Phase Three selected between items using item distributions, exploratory factor analysis (EFA), and item response theory (IRT) to create the final questionnaire, called the Valve Quality of life (VALVQ).

Results:
In Phase One, 34 people with HVD, three family members, and five clinical experts were interviewed. Key features of QOL were physical capacity relative to ‘normal’, symptom interpretation causing reduced activity, and fatigue. In Phase Two, we showed in 62 participants that the resulting questionnaire - and its semantic differential item format - was functional. In Phase Three, 290 participants returned questionnaires. Items were removed for poor distributions, then EFA identified ‘physical capacity’ and ‘disease perception’ as key factors. A two-parameter Graded Response Model was used to generate the final 12-item VALVQ, which is shown in the attached table.

Conclusion:
Through application of sequential analyses across three phases, we generated the final 12-item VALVQ. It has two factors - physical capacity and disease perception - and can be deployed for future research on QOL in HVD, whether before or after intervention and across multiple forms of HVD.
Abstract 13743: Validity and Reliability of a Palliative Care Needs Assessment Tool in Japanese Patients With Heart Failure
Authors: Tatsuta Daishiro , Sato Takuma , Nagai Toshiyuki , Koya Jiro , Nishino Kotaro , Naito Seiichiro , Mizuguchi Yoshifumi , Temma Taro , Kamiya Kiwamu , Narita Hisashi , Tsuruga Kenkichi , Anzai Toshihisa
Published: December 2023

Backgrounds:
Although patients with heart failure (HF) frequently experience considerable symptom burden and require significant care similar to those with cancer, most HF patients do not receive timely intervention due to the absence of standardized method for identifying those in need of palliative care. Several tools have been employed to assess palliative care needs and identify eligible patients. However, their validity and reliability have yet to be fully examined worldwide. We sought to assess the validity and reliability of The Needs Assessment Tool: Progressive Disease-Heart Failure (NAT: PD-HF) in Japanese HF population.

Methods:
We enrolled consecutive HF patients admitted in our university hospital between February and May 2023 and their caregivers were also included. The NAT: PD-HF were translated into Japanese by our professional multidisciplinary team in accordance with cultural and medical background. We assessed the internal consistency of the NAT: PD-HF with Cronbach`s alpha, and the inter-rater and test-retest reliability with Cohen`s kappa. After using this tool, patients, caregivers, and health care providers were asked whether the tool adequately identify their burden and care needs.

Results:
During the study period, 75 patients, 67 caregivers, and 17 health care providers agreed to participate. Cronbach's alpha was 0.80 and the minimum Kappa coefficient was 0.73 for inter-rater reliability and 0.83 for test-retest reliability. Seventy-one patients (94%) and 64 caregivers (95%) found this tool useful to identify their burden and care needs. Seventy patients (93%) and 63 caregivers (94%) felt that the tool will improve the quality of care. Sixteen health care providers (94%) also believed this tool was helpful to understand the burden and care needs of both patients and caregivers. However, 7 of them (41%) considered they may not have enough time to use the tool in their daily clinical practice.

Conclusions:
The NAT: PD-HF was suggested to be a reliable and potentially valid tool even among Japanese HF patients. This tool was very well accepted by patients, caregivers, and health care providers to identify burden and care needs. Further follow-up studies are needed to examine the prognostic impact of using this tool.
Abstract 13748: Safety and Efficacy of Extended Endovascular Treatment for Acute Type B Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection
Authors: Allievi Sara , Trimarchi Santi , Coselli Joseph S , Sultan Ibrahim , Brinster Derek R , Bavaria Joseph E , Leshnower Bradley G , Kachroo Puja , Jassar Arminder , Bekeredjian Raffi , pai Chih Wen , Pacini Davide , Myrmel Truls , Eagle Kim A , Patel Himanshu J , Schermerhorn Marc
Published: December 2023

Introduction:
Prior studies reported that extended TEVAR could improve false lumen remodeling in acute type B aortic dissection (TBAAD). However, extended aortic coverage is also a risk factor for spinal cord ischemia (SCI). This study aimed to evaluate the safety and efficacy of extended TEVAR for TBAAD.

Methods:
Patients who underwent TEVAR for TBAAD between 01/2002-01/2023 in the IRAD Interventional Cohort were analyzed and stratified based on treatment extent: “extended” if aortic coverage > 200 mm, “not-extended” if ≤ 200 mm. Patients with prior aortic repair were excluded. We assessed postoperative SCI and mortality with univariate analysis. Secondly, we compared mid-term outcomes with cumulative incidence function (Gray's test) and Kaplan-Meier estimate (log-rank test).

Results:
Of 4,146 TBAADs, 350 met inclusion criteria. Compared with not-extended patients (173, 50.3%), patients with extended TEVAR (171, 49.7%) were more frequently Black (29.9% vs. 16.6%; p=.006) and less frequently had aortic valve disease (1.4% vs. 6.5%; p=.03). The indication for extended TEVAR was more frequently extension of incident dissection (15.5% vs. 5.5%; p=.02). Extended TEVAR more frequently had proximal seal in the arch (60.6% vs. 48.2%; p=.03), and distal seal in the thoraco-abdominal (22.1% vs. 7.6%; p=.002), or infrarenal aorta (10.8% vs. 3.5%; p=.02). Extended TEVAR had higher rates of postoperative SCI (6.7% vs. 3.8%; p=.31) and mortality (9.9% vs. 6.4%; p=.24), although the difference was small and not significant. Moreover, after median follow-up of 23.8 months, extended TEVAR had different estimates (albeit not significant) for 3-year complete false lumen thrombosis (48.9% vs. 40.2%; p=.79), 4-year reoperation (13.3% vs. 7.7%; p=.35), and aortic growth (74.6% vs. 47.0%; p=.70), but similar survival (84.7% vs. 83.0%; p=.84).

Conclusions:
Extension of incident dissection was more common in the extended TEVAR patients.. Although these patients had almost double the rate of SCI, this wasn’t significant. Our findings suggest that extended and not extended treatment for TBAAD may have similar postoperative and mid-term outcomes. Further studies with bigger sample size, and longer follow-up are needed to confirm these results.
Abstract 13752: Current Management and Outcomes of Acute Intramural Hematoma
Authors: Evangelista Arturo , Harris Kevin M , Taylor Bradley , Ouzounian Maral , Braverman Alan C , Brinkman William T , Van Kimmenade Roland R , Levack Melissa , Eidt John , Brinster Derek R , pai Chih Wen , Arnaoutakis George , di eusanio marco , Gilon Dan , Isselbacher Eric M , Eagle Kim A
Published: December 2023

Background:
Optimal management of intramural hematoma (IMH) remains controversial. Previous studies offer conflicting information on how outcomes differ between patients with acute aortic dissection (AAD) and IMH.

Methods:
Patients enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and 2023 were stratified by AAD and IMH. True IMH, defined as the presence of intramural hematoma in the absence of both double lumen and intimal flap, was noted in 605 patients (7.7%).

Results:
IMH was more common in Type B patients (12.7% IMH versus 5.1% with Type A). In both groups, IMH patients were older (mean age 70.4 vs. 61.3 years, p<0.001) and less frequently male (51.4% vs. 67.2%, p<0.001). Marfan Syndrome was less common with IMH (1.1% vs. 4.0%, p<0.001).For both dissection types, IMH patients less frequently demonstrated presenting mesenteric ischemia (Type A: 0.8% vs. 4.3%, p=0.003; Type B: 0.7% vs. 6.3%, p<0.001) or limb ischemia (Type A: 3.2% vs. 12.3%, p<0.001; Type B: 2.7% vs. 9.3%, p<0.001). Tamponade at presentation was more common in Type A IMH (17.9% vs. 11.6%, p=0.005). Type B IMH patients had less presenting renal failure (7.5% vs. 16.9%, p<0.001).

Medical management alone was more commonly employed as a treatment strategy for IMH versus AAD, both in Type A (18.8% vs. 8.7%, p<0.001) and Type B (78.7% vs. 56.9%, p<0.0001). Correspondingly, Type B IMH patients had less endovascular management (15.6% vs. 29.3%, p<0.001). Surgery was delayed beyond 48 hours of diagnosis in almost twice as many surgical Type A IMH patients (14.9% vs. 8.4%, p=0.009). Additionally, medically managed type A IMH patients had lower mortality than those with AAD (33.3% vs. 58.0%, p=0.001), although medical mortality was still higher than that of surgical patients with IMH (33.3% vs. 12.0%, p<0.001). Kaplan-Meier analyses of 1-year post-discharge death, late intervention, and aortic growth were similar between groups.

Conclusions:
Intervention was less common among patients with IMH for both Type A and Type B. While a select subset of non-operative IMH patients had more favorable in-hospital outcomes compared to those with AAD, this mortality was still higher than for those IMH patients receiving surgery.
Abstract 13754: Bone Marrow Mesenchymal Stem Cell Derived Extracellular Vesicles Alleviate Fibrosis by Reducing Energy Production of Cardiac Fibroblast via Glutamate Metabolism Regulation
Authors: chen yongjian , Wang Jingyi , Ni Cheng , Hu Xin Yang
Published: December 2023

Background:
Extracellular vesicles derived from bone marrow mesenchymal stem cells (MSC-EVs) have been validated for certain therapeutic effects on cardiac diseases, however, the underlying mechanism and precise bioactive components towards myocardial fibrosis remain unknown.

Aim:
The current research endeavors to investigate the utilization of MSC-EVs in pressure overload induced fibrosis and unravel the mechanisms of MSC-EVs mediated fibrosis regulation.

Methods and Results:
Compare to the control group, mice underwent intramyocardial injection of MSC-EVs showed remarkable improvement of cardiac function, as well as cardiac fibrosis post transverse aortic constriction (TAC) surgery. Seahorse XFe Extracellular Flux Analyzer unveiled decreased ATP production in fibroblasts after MSC-EVs administration
in vitro
. Targeted metabolomics and KEGG pathway analysis revealed glutamate metabolism as the predominantly metabolism process that regulated by MSC-EVs in cardiac fibroblasts. Meanwhile, cell metabolism assays indicated dysregulated α-ketoglutaric level in MSC-EVs treated fibroblasts, which directly lead to an activation of AMPK. Further screening identified glutamic pyruvate transaminase (GPT2) ,which catalyzes glutamic acid to α-ketoglutaric, to be pivotally suppressed by MSC-EVs treatment. Moreover, miR-30c-5p in MSC-EVs was uncovered to inhibit GPT2 expression. In the
in vivo
TAC model, MSC-EVs pretreated with the miR-30c-5p oligonucleotide did not recapitulated the same results as MSC-EVs do, while MSC-EVs with miR-30c-5p overexpression exerted better therapeutic effect than MSC-EVs alone.

Conclusions:
MSC-EVs ameliorate cardiac fibrosis via reducing the synthesis of ATP from cardiac fibroblast, which in turn improve cardiac function in mice under pressure overload condition. This effect is mediated by miR-30c-5p in MSC-EVs through the inhibition of GPT2 expression and subsequent AMPK activation in cardiac fibroblasts.
Abstract 13779: J Wave Augmentation During CAG is Related to VF in the Acute Phase of STEMI
Authors: Sakaguchi Yuta , Hasegawa Yuki , Suzuki Naomasa , Otsuki Sou , Chinushi Masaomi , Inomata Takayuki
Published: December 2023

Introductions and Hypothesis:
Myocardial ischemia induced by contrast medium during coronary angiography (CAG) is associated with local conduction delay and J wave manifestation. However, whether J wave manifestation during CAG can predict ventricular fibrillation (VF) in the acute phase of ST-elevation myocardial infarction (STEMI) is unclear.

Methods:
Among 420 consecutive patients with STEMI who underwent emergent percutaneous coronary intervention, 141 patients (male, n=116; age, 65±10 years) who underwent CAG in the absence of significant coronary artery stenosis were included in this study. Patients were divided into two groups based on the development (n=17) or non-development (n=124) of VF within 48 hours after STEMI. Electrocardiograms recorded during CAG in the absence of significant coronary artery stenosis were analyzed in all subjects.

Results:
The frequency of J wave (≥0.1 mV) at baseline was similar between the VF (18%) and non-VF (8%) groups. However, the frequency of J wave augmentation >0.1 mV above baseline during CAG was higher in the VF group than in the non-VF-group (47% vs. 8%; P<0.01). The percentage of Killip class ≥3 was higher in the VF group than in the non-VF group, but there were no significant differences between the two groups in coronary risk factors, time from onset to transport to the hospital, or peak CK/CK-MB values. In a multivariate analysis, J wave augmentation during CAG was an independent factor in the occurrence of VF in the acute phase of STEMI.

Conclusions:
J wave augmentation during CAG was associated with VF within 48 hours after the onset of STEMI and may be useful for risk stratification of STEMI.
Abstract 13783: Tissue Thickness is an Essential Factor of Higher Risk of Steam Pop During Bipolar Ablation - Ex-Vivo Assessment
Authors: Okuyama Takafumi , Makimoto Hisaki , Kamioka Masashi , Watanabe Tomonori , Watanabe Hiroaki , Yokota Ayako , Komori Takahiro , Kabutoya Tomoyuki , Imai Yasushi , Kario Kazuomi
Published: December 2023

Introduction/Backgrounds:
For ventricular arrhythmias originating deep within the myocardium, bipolar ablation can be employed. However, there is currently no standardized strategy for bipolar ablation settings such as energy and ablation time.

Hypothesis and Aims:
We intended to test a hypothesis that the target tissue thickness may determine the optimal bipolar ablation settings of power and duration.

Methods:
Using porcine cardiac tissues ex-vivo ablation experiments were conducted. Each radiofrequency (RF) ablation catheter was placed on both sides of the myocardial slice at an angle of 45 degrees and 10g contact. We investigated the depth of ablation lesions and the occurrence of steam-pop under the multiple settings of myocardial tissue thickness, energy and ablation duration.

Results:
We analyzed in total 194 bipolar RF applications. For myocardial slices of 10-, 15- and 20-mm thickness, we performed 60-second RF ablation of 20, 30, 40 and 50W energy settings. No transmural lesion creation was noted on the 20-mm thickness tissues even by 50W RF energy (
Figure 1
). Transmural lesion was observed with RF energy of 30W or more on the most of the 10-mm thickness tissues. Prolonged duration of 180 seconds with 30W or more accomplished the transmural lesion on the 15-mm thickness tissues. We observed steam-pop in 11 out of 194 applications (5.7%). Steam-pops were exclusively observed on the 10mm tissue with 30W or more.

Conclusion:
Our data showed that (1) transmural lesion creation for 10-mm tissue is feasible under 30W or more and 60 seconds bipolar ablation, (2) for thicker tissue even 50W application of 60 seconds may not generate transmural lesion, (3) prolonged RF duration enables transmural lesion for thicker tissues, (4) steam-pop can occur on thinner tissues under higher wattage. These results suggest that we should adapt the bipolar RF settings, particularly the power and duration depending on the target tissue thickness.
Abstract 13788: Association Between Floroquinolones and Cardiovascular Outcomes: A Systematic Review and Meta-Analysis
Authors: VERMA NEHA , Jaiswal Vikash , Mohamed Taha Amira , Deb Novonil , Evbayekha Endurance O , Gupta Shiva , CASTILLO ROMARIE JOY , Shrestha Abhigan Babu , Sharma Vagisha , Sharma Akanksha , Ramadan Alaa , Rajak Kripa , Song David , Attia Abdelrahman , Sharma Prachi
Published: December 2023

Background:
The administration of Fluoroquinolones (FQ) has raised concerns regarding potential adverse cardiovascular outcomes, including severe arrhythmias, myocardial infarction, and even mortality. Nevertheless, a comprehensive evaluation of these outcomes and their real impact on patients receiving these antibiotics is lacking.

Objective:
We aim to evaluate the association between fluoroquinolones and cardiovascular outcomes.Methods: We systematically searched all electronic databases from inception until 27th May 2023. Odds ratios (OR) with corresponding 95% confidence intervals (CI) were calculated, with a p-value <0.05 considered statistically significant.

Results:
The final analysis included a total of 11 studies, encompassing a sample size of 6,579,936 individuals (FQ: 2,005,466 and control: 4,574,470). The pooled analysis shows that the FQ group was associated with significantly higher risk arrhythmia (OR: 1.87 (95% CI: 1.22, 2.87), P<0.01, cardiovascular mortality (OR: 1.72 (95% CI: 1.38, 2.14), P<0.0001), and myocardial infarction (OR: 1.33 (95% CI: 1.26, 1.39), P<0.0001).

Conclusion:
Fluoroquinolones exhibit a significant cardiotoxic effect, contributing to the development of arrhythmias, myocardial infarction, and even mortality. Consequently, caution must be exercised when prescribing this class of antibiotics, with regular follow-up recommended to monitor potential cardiovascular complications.
Abstract 13903: Pacemaker Mediated Arrhythmia Following AV Synchronous Leadless Pacemaker Implantation
Authors: Vrtikapa Dejan , Chong Luke , Modaff Daniel , Kipp Ryan T
Published: December 2023

Background:
Leadless pacemakers have gained popularity in providing permanent pacing in select patient populations. Pacemaker mediated tachycardia and arrhythmias have been well described in patients with dual chamber pacemakers, but up to this point not in leadless pacing.

Case Description:
A 91-year-old female with symptomatic bradycardia and 2:1 AV block underwent implantation of a Micra AV pacemaker programmed VDD 60-100 bpm. Five months later, she presented with decompensated heart failure with a heart rate of 88 bpm and a newly reduced left ventricular ejection fraction of 30%. Device interrogation showed 95% ventricular pacing, with 91% AV synchrony. The Micra was found to be tracking an atrial rhythm between 80-100 bpm more than 80% of the time (Figure 1A). RV pacing induced cardiomyopathy was suspected and she underwent placement of a bi-ventricular pacemaker. During implant, a short VA time was noted and changes in the V-V cycle length predicted changes in the A-A cycle length (Figure 1B). Micra ventricular pacing was held resulting in an AV paced rhythm from the CRT system and a drop in rate to 60 bpm (Figure 1C). These results indicate that the Micra pacemaker was tracking the atrial mechanical contraction (AM) from a retrograde conducted P-wave resulting in elevated heart rates from a pacemaker-driven arrhythmia.

Discussion:
In patients with poor AV conduction, intact VA conduction, and SA node dysfunction, Micra AV may create pacemaker mediated arrhythmia by tracking the AM of the retrograde conducted P-wave. Careful patient selection to avoid Micra AV placement in patients with SA node dysfunction, and close attention to the rate histogram on device interrogation may prevent development and facilitate recognition of this unique cause of pacemaker-mediated arrhythmia.
Abstract 13914: Development of a High School Mentorship and Scholarship Program to Promote Interest in Healthcare Among Students Underrepresented in Medicine
Authors: Shaw Kirsten , Schmidt Christine , Richards-May Kate , Tierney David M
Published: December 2023

Introduction:
Despite the rising demand, positive career outlooks, and promising salary in healthcare professions, youth from underrepresented backgrounds continue to be poorly represented in these careers. Mentorship has emerged as a strategy to enhance the involvement of underrepresented youth in healthcare careers, serving as one of the few effective approaches to address this disparity.

Aims:
The aim of this study was to develop practical recommendations for founding, growing, and sustaining a mentorship and scholarship program between a physician group and a racially, ethnically, and socioeconomically diverse local high school.

Methods:
Each year, six events were hosted for high school students interested in healthcare. Events included hands-on activities, networking events, career panel discussions, and field trips to our simulation center. Following 2 years of successful program execution, a modified mini-Delphi approach was used to develop formal recommendations for founding, growing, and sustaining such a program.

Results:
On an observational basis, the mentorship program appeared effective at growing high school student interest in healthcare careers. Utilizing a modified mini-Delphi method, we created recommendations for the development of a healthcare mentorship and scholarship program. These recommendations are shown in Figure 1.

Conclusions:
These recommendations may serve as a guide for other programs that wish to establish similar programs. All our self-developed curricula, grant proposals, and marketing materials will be freely shared with any group wishing to develop a similar program.
Abstract 13915: Comparison of Proteomic CV Risk to Established ASCVD 10-year Risk Decision Points
Authors: Hinterberg Michael , Trujillo Nelson P , Gill Rosalynn , Paterson Clare , Chadwick Jessica , Simpson Missy , Kuzma Jessica , Williams Stephen A
Published: December 2023

Introduction:
The ASCVD pooled cohort equation (PCE) is well-established for CV risk assessment. Decision points for determining treatment plans are low, intermediate and high risk over 10 years, however this approach over and underestimates risk in certain subgroups. The validated CV Risk SomaSignal® Test (SST) provides 4-year risk probability of MACE allowing for timely assessment of risk, but the shorter timescale makes comparison to 10-year PCE risk less intuitive.

Hypothesis:
Using a previously described metacohort (n=5,575) of patients with increased CV risk, we hypothesized that PCE would stratify patients differently than the CV Risk SST, and that CV Risk score scaled to 10 years would yield an improved net reclassification index (NRI).

Methods:
CV Risk SST and PCE scores were calculated on metacohort plasma samples. CV risk score was scaled to 10 years by parameterizing the model for a 10-year score, and then calculating a quadratic equation for the conversion. CV risk score was stratified by four established risk bins, whereas the PCE was stratified similarly using <7.5%, 7.5%-15%, 15%-20%, and > 20% risks based on literature and practice-derived cutoffs. Event rates were compared between scores, and NRI was calculated.

Results:
We observed total NRI of 11.4% for the 10-year CV Risk SST vs. PCE, with up-classification (positive NRI=83.7%) mitigating down-classification (negative NRI=-0.723). Event rates for the high-risk group in the CV Risk test were higher than the PCE, and lower in the low-risk group (p < 0.05).

Conclusions:
The CV Risk SST stratifies patients by identifying low- and high-risk groups using thresholds that are more discriminatory than low-risk and high-risk thresholds in the PCE. For comparison, the CV risk SST can be scaled to 10-year risk, with CV risk SST having a positive NRI for identifying MACE. This reclassification can allow targeted therapies in patients at greater risk and use of non-pharmacological therapies in the low-risk patients.
Abstract 13943: Comparison of the Frequency and Time to True Ventricular Tachycardia Among Patients in the Cardiac, Medical/Surgical and Neurologic Intensive Care Units
Authors: Prasad Priya A , Zegre-Hemsey Jessica K , Carey Mary , Al-Zaiti Salah S , Sommargren Claire E , Isola Lamberto , Mortara David , Badilini Fabio , Pelter Michele M
Published: December 2023

Introduction:
Continuous ECG monitoring is the non-invasive gold standard used to identify ventricular tachycardia (VT), yet 87% of current bedside monitor VTs could be false. Therefore, knowing the burden of true VT is essential to guide treatment to those at greatest risk of poor outcomes.

Hypothesis:
When stratifying by intensive care unit (ICU) (cardiac, medical/surgical, neurological), there will be differences in: 1) demographic and clinical characteristics of patients with true VT; and 2) frequency and time to first true VT.

Methods:
Retrospective cohort study of adults admitted to an academic medical center ICU, 9/13-4/15. Potential VTs among 5,679 consecutive ICU patients were manually annotated by clinicians as true/false. Patient-level data were extracted from the health record. We used Kaplan-Meier and Cox proportional hazards methods to calculate time to first true VT and 60-day VT rate by ICU type.

Results:
There were differences in all characteristics examined (p<0.0001)(Table) and frequency of true VT, stratified by ICU type (log-rank p<0.0001)(Figure). After adjustment for age, gender, and risk factors (Table), CICU patients had a 42% increased rate (HR 1.42, 95% CI 1.16-1.74) and NICU patients had a 28% decreased rate of VT (HR 0.72, 95% CI 0.59-0.89) compared to M/SICU patients.

Conclusion:
Patients in the CICU experienced true VT much earlier (1.5 days) after admission than patients in the M/SICU and NICU. In addition, CICU patients had a higher rate of true VT and associated VT risk factors as compared to M/SICU and NICU patients. As expected, known cardiac risk factors are associated with true VT, but may be hidden among false alarms during bedside monitoring.
Abstract 13963: Redefining the Assessment of “Therapeutic” Platelet Response to Acetylsalicylic Acid
Authors: Tantry Udaya , Bliden Kevin , Kundan Parshotam , Kraft Danielle , Parekh Rueshil , Singh Sahib , Dilli Babu Aravind , Shah Anika , Gurbel Paul A , Chaudhary Rahul
Published: December 2023

Background:
Despite extensive investigations, the optimal assessment of the “therapeutic response” to acetylsalicylic acid (ASA) remains unclear. Limited information is available on the relation between serum thromboxane (Tx)B
2
; arachidonic acid (AA)-induced platelet aggregation (PA) by light transmittance aggregometry (LTA); aspirin reaction units (ARU) by VerifyNow aspirin test (VN), and pharmacokinetics (PK).

Methods:
Serial PD and PK analyses were performed immediately after a single 162 or 650 mg dose of chewed and swallowed ASA in ten healthy volunteers. ASA response was defined as >95% inhibition of serum TxB
2,
<550 ARU by VN test and ≤20% AA-induced PA. Correlation analyses between PK and PD measurements and receiver operating characteristic (ROC) curve analyses were performed.

Results:
ASA Response measured by VN, and AA-induced PA was achieved within 30 minutes of ASA administration. A good correlation was observed between VN ARU and 1 mM AA-induced maximum PA (r=0.80, p<0.001), serum TxB
2
(r=0.76, p<0.001), and inhibition of serum TxB
2
(r=0.87, p<0.001). The relation between platelet aggregation and TxB
2
inhibition appears to be dichotomous, with only modest inhibition of TxB
2
(~50% inhibition) associated with marked inhibition of platelet aggregation. ROC curve analyses indicated that ≤558 ARU and ≤7% AA-induced PA were associated with >95% inhibition of TxB
2
. A plasma ASA 686 ng/mL cut-off was associated with >95% inhibition of serum TxB
2
, ≤7% 1 mM AA-induced PA by LTA, and ≤585 ARU.

Conclusion:
Our study demonstrated an important relationship between PD and PK parameters measured immediately following oral ASA and cutoff values for VN assay and LTA that is associated with >95% inhibition of serum TxB
2
. We demonstrated that ~50% inhibition of TxB
2
is required to reach high levels of platelet function inhibition.
Abstract 13969: Etiology-Specific Prevalence of Heart Failure: A Systematic Analysis of the Global Burden of Disease Study 2021
Authors: Johnson Catherine O , Dorsey Henry , DeCleene Nikki , Razo Garcia Christian A , Wong Renee , Mensah George A , Roth Gregory A
Published: December 2023

Background:
While heart failure (HF) is a common disease worldwide with high health care costs and disease burden, the underlying causes vary widely by location. Estimates of how etiologies of HF vary globally will support clinical and public health practice, research, and related capacity building.

Research Question and Goals:
To provide, current, consistent and comparable estimates of etiology-specific HF prevalence as part of the Global Burden of Disease (GBD) Study 2021.

Methods:
We included all available population-representative data on prevalence, incidence, and mortality to estimate HF prevalence using DisMod-MR, a Bayesian geospatial model. We then estimated the proportion of HF due to each of 27 underlying etiologies using cause-specific mortality estimates, individual-level vital registration records with multiple cause of death information, and linked hospital-mortality data. These proportions were then multiplied by the estimates of HF prevalence to generate estimates of etiology-specific HF burden for all countries.

Results:
HF etiologies varied widely across the the seven GBD super-regions. Ischemic heart disease (IHD) was the most common underlying cause in all super regions except for Sub-Saharan Africa where hypertensive heart disease was the most common (Figure). Age-standardized prevalence of HF due to IHD ranged from 77.51 to 306.25 per 100,000 (Table).

Conclusion:
While IHD was the most common underlying cause of HF for most locations in 2021, there was substantial variability by location. Improved understanding of HF etiologies could guide tailored clinical and public health practice and research.
Abstract 13983: Reproductive Health Counseling and Experiences Among Females With Congenital Heart Defects: Results From the Congenital Heart Survey to Recognize Outcomes, Needs, and Well-Being
Authors: Galindo Maureen K , Klewer Scott E , Downing Karrie F , Takamatsu Chelsea L , Seckeler Michael D , Oster Matthew E , Collins R. Thomas , Nembhard Wendy N , Bolin Elijah H , Farr Sherry L
Published: December 2023

Introduction:
The American Heart Association (AHA) recommends clinicians discuss reproductive health with women with congenital heart defects (CHD) beginning in adolescence due to their unique pregnancy and contraceptive needs. Therefore, we assessed reproductive health counseling and experiences among women with CHD, and differences by CHD severity.

Methods:
Women with CHD ages 19 to 38 years, identified in active, population-based birth defects registries from Arkansas, Arizona, and Atlanta, GA, completed the Congenital Heart Survey To Recognize Outcomes, Needs, and well-beinG (CH STRONG) from 2016 to 2019, including questions about reproductive health counseling, concerns and experiences. Prevalence estimates standardized to all CH STRONG-eligible women and adjusted prevalence ratios (aPR), calculated with multivariable Poisson regression, assessed differences by CHD severity.

Results:
Of 765 female respondents, 40.7% were 19-24 years, 66.7% were non-Hispanic white, and 67.7% had > high school education. Overall, 21.3% received CHD-specific contraceptive counseling, 28.3% pregnancy counseling, and 12.8% advice to avoid pregnancy (Fig). Women with severe, compared to non-severe CHD, were more likely to receive clinician counseling about safe contraception (aPR=3.0, 95% confidence interval [CI]: 2.2-4.0), pregnancy (aPR=3.5, 95% CI: 2.7-4.6), and advice to avoid pregnancy (aPR=4.3, 95% CI: 2.9-6.5), and they were more likely to be concerned about their ability to have children (aPR=1.4, 95% CI: 1.1-1.8) and delay/avoid pregnancy (aPR=2.2, 95% CI: 1.5-3.2). No differences were seen in ever being pregnant (aPR=0.83, 95% CI: 0.6-1.1).

Conclusions:
Results suggest most women with CHD are not receiving AHA-recommended reproductive health counseling. Almost one in three women with severe CHD received clinician advice to avoid pregnancy, although AHA guidelines state pregnancy is contraindicated for few women with CHD.
Abstract 13984: Obstructive Sleep Apnea and Quality of Life in Patients With Heart Failure or Coronary Heart Disease
Authors: Wu Jia Rong , Lin Chin-Yen , Kang JungHee , Chung Misook L , Miller Jennifer , Mudd Martin Gia , Biddle Martha , Rayens Mary Kay , Lennie Terry A , Okoli Chizimuzo C , Fisher Mary Beth , Feltner Frances J , Moser Debra K
Published: December 2023

Background:
Obstructive sleep apnea (OSA), prevalent in patients with heart failure (HF) and those with coronary heart disease (CHD), is associated with poor quality of life (QoL) but underlying mechanisms are not well understood. Depressive symptoms and low perceived control, also common in these patients, may explain associations between OSA and QoL.

Objective:
To determine whether depressive symptoms and perceived control mediate the association of OSA with QoL among patients with HF or CHD.

Method:
We performed a serial mediation analysis using baseline data from an ongoing randomized comparative effectiveness trial from 222 adults with HF or CHD (male: 55%, age: 59±13 years, married: 65%). Obstructive sleep apnea was measured using the STOP-BANG that included information on
s
noring,
t
iredness,
o
bserved apnea, high blood
p
ressure,
b
ody mass index,
a
ge,
n
eck circumference, and
g
ender. Depressive symptoms were measured using the Patient Health Questionnaire-9. Perceived control was measured using the Control Attitude Scale-Revised (CASR). Quality of life was measured using the Functional Outcomes of Sleep Questionnaire. The analysis was conducted using PROCESS (Model 6) for SPSS.

Results:
Ninety-nine (45%) of participants had OSA. Obstructive sleep apnea was
indirectly
associated with QoL through the following paths: 1) depressive symptoms; 2) perceived control; 3) serially through both depressive symptoms and perceived control (Figure), indicating a mediating role for depressive symptoms and perceived control in the association of OSA with QoL.

Conclusion:
Because the relationship between OSA and poor QoL is mediated by depressive symptoms and perceived control, it is critical to screen patients for these conditions. As important, interventions need to be developed to reduce depressive symptoms and improve perceived control in order to improve patients’ QoL.
Abstract 13990: ECG Interpretation Proficiency of Healthcare Professionals
Authors: Kashou Anthony H , Noseworthy Peter A , Beckman Thomas , Anavekar Nandan S , Cullen Michael W , Angstman Kurt B , Sandefur Benjamin J , Shapiro Brian P , Wiley Brandon W , Kates Andrew , Huneycutt david , Braisted Andrew , Smith Stephen W , Baranchuk Adrian , Grauer Ken , O'Brien Kevin , Kaul Viren , Gambhir Harvir S , Knohl Stephen J , Albert David E , KLIGFIELD Paul , Macfarlane Peter W , May Adam
Published: December 2023

Background:
ECG interpretation is crucial in medical practice, but professionals struggle with achieving and maintaining competency. Identifying proficiency gaps aids in designing educational interventions.

Methods:
Medical professionals from various disciplines interpreted 30 12-lead ECGs containing commonly taught urgent and non-urgent findings. Performance metrics evaluated were overall adjusted score (% of correctly identified findings using a point-value score based on clinical relevance), unadjusted score (% of correctly identified findings), interpretation time per ECG, and self-reported confidence (rated on an ordinal scale of 0 [not confident], 1 [somewhat confident], or 2 [confident]).

Results:
Among 1206 participants, there were 72 (6%) primary care physicians (PCPs), 146 (12%) cardiology fellows-in-training (FIT), 353 (29%) resident physicians, 182 (15%) medical students, 84 (7%) advanced practice providers (APPs), 120 (10%) nurses, 249 (21%) allied health professionals, 571 (47%) physicians, and 453 (38%) non-physicians. Participants had a mean adjusted score of 46.9% (± 15.9%), unadjusted score of 56.4% (± 17.2%), interpretation time of 142 seconds (± 67 seconds), and confidence of 0.83 (± 0.53)
(Table 1)
. Performance varied across groups; cardiology FIT had superior performance in all metrics. Physicians generally outperformed non-physicians, with higher overall adjusted score (52% vs. 43%; p<0.01), unadjusted score (62% vs. 52%; p<0.01), and confidence (0.91 vs. 0.80; p<0.01). Unadjusted score for PCPs was higher than nurses and APPs (58% vs. 47% and 51%; p<0.01) but lower than resident physicians (58% vs. 60%; p<0.01). Allied health professionals outperformed nurses and APPs and closely matched resident physicians and PCPs.

Conclusions:
Significant gaps in ECG interpretation proficiency exist, emphasizing the need for comprehensive, scalable, and accessible educational tools.