bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14124: Acute Mitral Regurgitation With Chronic Endocarditis in Type I Osteogenesis Imperfecta
Authors: Sam Riya , Vulisha Abhinav K , Bhardwaj Neharika , Ogdon Charles , Pati Prateeth
Published: June 2023

Case Presentation:
A 45-year-old man with history of Type I osteogenesis imperfecta (OI) presented with severe shortness of breath and worsening bilateral lower extremity edema for 6 weeks. Paternal family history was significant for Type I OI with early deaths in affected females. Physical examination revealed a distressed man with blue - gray sclerae and jugular venous distention. Cardiopulmonary examination was remarkable for tachycardia, grade IV holosystolic murmur radiating to the axilla, bilateral lung crackles with decreased air entry on the lower lung fields and pitting pedal edema up to mid thighs. TTE and TEE were significant for severe eccentric posterior MR with multiple vegetations versus ruptured chordae and normal systolic function. He underwent an emergency mitral valve replacement complicated by post-operative severe AR requiring redo sternotomy with aortic valve replacement. Histologically, aortic valve leaflets were suggestive of chronic endocarditis with dual negative sets of blood cultures drawn since admission. He was eventually discharged home after an intense cardiac rehabilitation with appropriate follow ups.

Discussion:
OI is a rare hereditary connective tissue disorder affecting the production of Type I collagen due to mutations in COL1A1 and COL1A2 genes. Although lesser known, OI valvulopathy is typically limited to the left sided structures, for unknown reasons, with the most common valvular anomaly being AR followed by MR. Despite the dramatic cardiac involvement in our patient and known mortality risk associated with surgical intervention, prompt evaluation and early intervention led to a successful outcome.
Abstract 14132: Comparison of Right Anterior Mini-Thoracotomy versus Partial Upper Sternotomy in Aortic Valve Replacement
Authors: Salamate Saad
Published: June 2023

Introduction:
Propensity score analysis of midterm outcomes after isolated aortic valve replacement through right anterior mini-thoracotomy and partial upper sternotomy could provide information about the most beneficial minimally invasive technique for the patient based on the preoperative risk factors.

Hypothesis:
Can the right anterior mini-thoracotomy be used as first line surgical access for aortic valve replacement?

Methods:
Between March 2015 and February 2021, 694 minimally invasive isolated aortic valve surgery were performed at our institution. Among these, 441 right anterior mini-thoracotomies and 253 partial upper sternotomies were performed. A propensity score analysis was performed in 202 matched pairs.

Results:
Cardiopulmonary bypass time and cross clamp time were significantly shorter in right anterior mini-thoracotomy group than in the partial upper sternotomy group (
p
=0.001 and
p
<0.001, respectively). Time to first mobilization and hospital stay were significantly shorter in the right anterior mini-thoracotomy group than in the partial upper sternotomy group (
p
=0.005,
p
=0.001, respectively). A significantly lower incidence of revision surgery was noted in the right anterior mini-thoracotomy group than in the partial upper sternotomy group (
p
=0.046). No significant differences in 30-day mortality (
p
=1.000) and 1-year mortality (
p
=0.543) were noted. Kaplan-Meier survival estimates were 96.3 % in right anterior mini-thoracotomy group and 92.7 % in the partial upper sternotomy group after 4 years (log rank 0.169), respectively.

Conclusions:
Despite the technical challenges, right anterior mini-thoracotomy can be chosen as first-line strategy for the isolated aortic valve replacement. For patients unsuitable for this technique, the partial upper sternotomy remains a safe method that can be performed by a wide range of surgeons.
Abstract 14136: Diagnosis and Prognosis of Type 2 Myocardial Infarction Using Objective Evidence of Myocardial Ischemia
Authors: Knott Jonathan D , Ola Olatunde , De Michieli Laura , Akula Ashok , Mehta Ramila , Hodge David , Gulati Rajiv , Jaffe Allan S , Sandoval Yader
Published: June 2023

Introduction:
Differentiating type 2 myocardial infarction (T2MI) from myocardial injury can be difficult. The presence of objective evidence of acute myocardial ischemia may facilitate the identification of high-risk T2MI patients.

Methods:
Retrospective, observational cohort post-hoc analysis of adult emergency department patients undergoing hs-cTnT measurement. Patients with ≥1 hs-cTnT>99th percentile were adjudicated following the Fourth Universal Definition of MI. Patients were categorized as “subjective T2MI” when ischemic symptoms were the lone criteria supporting T2MI, or “objective T2MI” when there was ≥1 objective clinical feature (electrocardiography, imaging, angiography) of acute myocardial ischemia. The primary outcome was mortality.

Results:
A total of 857 patients were included, amongst which 55 (6.4%) were classified as subjective T2MI, 36 (4.2%) as objective T2MI, and 702 (82%) as myocardial injury. Among objective T2MIs, the most common criteria were ischemic electrocardiographic changes (n=29). Median (IQR) maximum hs-cTnT were 24 (18, 43) ng/L in myocardial injury, 34 (19, 80) in subjective T2MI, and 74 (35, 237) in objective T2MI. Those with objective T2MI had a higher risk of mortality during the index presentation (17% vs. 1.7%, p<0.0001; HR 11.1 95% CI 3.7-33.4) and at 2-year follow-up (47% vs. 31%, p=0.04; HR 1.92, 95% CI 1.17-3.14) than those with myocardial injury (Figure). Objective T2MI had a higher mortality than subjective T2MI at index presentation (17% vs. 2.0%, p=0.01) and at 1- (25% vs. 9.1%, p=0.04) and 3-months (31% vs. 13%, p=0.04) follow-up. There were no mortality differences between subjective T2MI and myocardial injury.

Conclusions:
In patients diagnosed with T2MI, those with objective evidence of myocardial ischemia have significantly worse outcomes compared to those with myocardial injury and subjective T2MI. A more rigorous definition of T2MI might be a more effective way to define this important entity.
Abstract 14158: Impact of Gender Differences on Changes in Myocardial Perfusion Following Percutaneous Coronary Intervention of Chronic Total Coronary Occlusions
Authors: Somsen Yvemarie , de Winter Ruben , van Veelen Anna , Schumacher Stefan , van Diemen Pepijn , Jukema Ruurt , Hoek Roel , Stuijfzand Wynand , Danad Ibrahim , Verouden Niels , Alexander Nap , Henriques Jose P , Knaapen Paul
Published: June 2023

Introduction.
Data on gender differences in chronic total coronary occlusion (CTO) percutaneous coronary intervention (PCI) are scarce. Prior studies have demonstrated CTO PCI to reduce ischemia, however female patients are less likely to undergo revascularization. This study sought to investigate the impact of gender on myocardial perfusion changes following CTO PCI as measured by [
15
O]H
2
O positon-emission tomography (PET) perfusion imaging.
Methods.
A total of 212 patients were prospectively enrolled in a single-center CTO registry and underwent single-vessel CTO PCI, combined with [
15
O]H
2
O PET imaging at baseline and three months follow-up. Baseline and follow-up resting myocardial blood flow (MBF), hyperemic MBF and coronary flow reserve (CFR) allocated to the CTO territory were quantitatively assessed. The presence of residual ischemia was defined as hMBF ≤2.3 mL·min
-1
·g
-1
in the CTO area at follow-up.
Results.
This study comprised 34 (16%) females and (84%) males. Mean age in females was higher compared to males (68 ± 9 vs. 61 ± 10 years, p<0.01). In women, resting MBF at baseline was more elevated than in men (1.02 ± 0.24 vs. 0.84 ± 0.21 mL·min
-1
·g
-1
, p<0.01). Similarly, baseline hMBF was found to be higher in females (1.81 ± 0.53 vs. 1.64 ± 0.53 mL·min
-1
·g
-1
, p=0.03), and showed a higher increase after CTO PCI (Δ1.06 ± 0.71 vs. Δ0.71 ± 0.66 mL·min
-1
·g
-1
, p=0.01). Improvement in CFR after CTO PCI was more evident in female patients (Δ1.17 ± 1.04 vs. Δ0.82 ± 0.89, p=0.04). At three months follow-up, the proportion of patients with residual ischemia was lower in women versus men (9 (27%) vs. 91 (51%), p=0.01).
Conclusions.
We found a higher increase in hyperemic MBF and CFR following CTO PCI in women compared to men, as measured by serial [
15
O]H
2
O PET imaging. In addition, lower rates of residual ischemia were observed in women. This study suggests the potential benefit of a lower threshold for CTO PCI in female patients.
Abstract 14185: Higher Rates of Heart Failure Hospitalizations for V142I ATTR-CM Patients With Atrial Arrhythmias and Conduction Disease
Authors: Rim Austin , Steinberg Rebecca , Yalamanchili Sreeram , Patel Rahul , Rangaswamy Nandakumar Dhanish Revanth , Brown Matthew T , Bhatt Kunal
Published: June 2023

Introduction:
TTR cardiac amyloidosis (ATTR-CM) is a progressive, infiltrative cardiomyopathy that is characterized by the deposition of amyloid fibril extracellularly in the myocardium. Patients with ATTR-CM are known to be at higher risk for arrhythmias and conduction disease, likely due to changes in the cardiac anatomy and disruption of the conduction system by amyloid fibrils. Our study aims to determine whether presence of an arrhythmia or conduction disease is associated with mortality and heart failure hospitalizations in patients with ATTR-CM and V142I mutation.

Hypothesis:
Patients with arrhythmia or conduction disease will have higher rates of heart failure hospitalizations (HFH) and mortality than those without it.

Methods:
We conducted a retrospective chart review of patients diagnosed with ATTR-CM with V142I mutations enrolled in Emory University's Cardiac Amyloidosis Clinic between January 2014 and April 2022. Kaplan-Meier (KM) curves stratified by presence of atrial arrhythmia, ventricular arrhythmia, or conduction disease were generated for mortality and first HFH within 2 years of initial diagnosis. Log-rank test was used to compare KM curves. A p-value < 0.05 was considered significant.

Results:
111 patients were identified to have ATTR-CM with V142I mutation. 51.4% (57) of the patients had an atrial arrhythmia (fibrillation or flutter), 46.8% (52) had conduction abnormalities (defined as second or third degree heart block). 44.1% (49) had ventricular arrhythmias (including NSVT, sustained VT, and/or VF). Patients who had atrial arrhythmia and conduction disease were more likely to have HFH within 2 years compared to those who did not (p = 0.0011, p = 0.044 respectively). Patients with atrial arrhythmia, ventricular arrhythmia, or conduction disease were not at higher risk of mortality within 2 years (p=0.21, p=0.71, p=0.66 respectively).

Conclusions:
For patients with ATTR-CM with V142I mutation, atrial arrhythmia and conduction disease were risk factors for HFH within 2 years. Atrial and ventricular arrhythmia and conduction disease were not associated with higher mortality within 2 years.
Abstract 14191: Text Message Reminders Are Feasible in Haiti and May Increase Clinic Attendance for Non-Communicable Diseases: A Pilot Study
Authors: M Morris Sarah , Banigbe Bolanle , Toussaint Evyrna , Léopold Fénelon Darius , Dawson Calixte , Kwan Gene
Published: June 2023

Introduction:
Chronic non-communicable disease (NCD) care requires long-term compliance with clinic appointments. In rural Haiti, remembering appointments is a barrier to visit adherence. While short message service (SMS) text reminders can improve attendance in other settings, this has not been assessed Haiti. This quality improvement study assesses the feasibility and acceptability of using SMS reminders to promote clinic attendance in rural Haiti.

Methods:
We included patients at the NCD and type 1 diabetes clinics of Hôpital Universitaire de Mirebalais, Haiti. Patients with upcoming visits were sent 2 SMS reminders 3 days and 1 day before their visit. Patients who attended their clinic visit completed a survey regarding the feasibility, acceptability, and usefulness of the SMS reminders. The primary study outcome was the proportion of patients who received SMS messages. Secondary outcomes included the proportion of patients who found SMS reminders acceptable, missed clinic appointments, and could not be reached by phone.

Results:
Of the 96 patients with scheduled visits during the study period, we sent SMS reminders to 88 (91.2%) patients; 8 did not have recorded phone numbers. 25% of patients missed their visit and 9% were unable to be reached by phone. The 72 patients that attended their visit had a mean age of 49.5 years and 58.2% were female. Half of those who attended their visit (36) received the SMS. Of the 36 patients that received the SMS, 100% liked the reminder, 97.2% wanted to receive future messages, and 22.2% reported they would not have attended their visit without the reminder. Of the 36 patients who did not receive the SMS, 14 (38.9%) had a new phone number while 12 (33.3%) did not have access to a phone. The biggest patient-reported barriers to receiving SMS were inconsistent cellular signal (25%) and lack of access to a phone (22%).

Conclusion:
Sending SMS reminders was feasible and acceptable to NCD patients in rural Haiti. The messages were universally liked by the patients who received them and influenced the decision to attend their visit. For some patients, inconsistent signal and lack of phone access will need to be addressed. If implemented at full scale, SMS reminders could significantly improve appointment attendance in rural Haiti.
Abstract 14195: The Effects of Pulmonary Capillary Wedge Pressure (PCWP) Reduction on Starling Mechanisms in Heart Failure With Preserved Ejection Fraction (HFpEF): Potential for Harm?
Authors: Hughes Seamus B , Wakeham Denis J , Bagga Joetsaroop S , Macnamara James P , Balmain Bryce N , Hearon Christopher M , Babb Tony G , Levine Benjamin D , Sarma Satyam
Published: June 2023

Introduction:
Elevated left ventricular (LV) filling pressure during exercise is a pathognomonic characteristic of HFpEF. Multiple therapies aiming to reduce filling pressures in HFpEF patients have failed to improve exercise capacity and in some studies, decreased activity levels. The Dynamic Starling Mechanism (DSM) quantifies beat-by-beat modulation of stroke volume (SV) by respiratory-mediated changes in LV filling and provides insight into the efficiency with which changes in LV filling pressure are converted to SV. Low DSM gain reflects inefficient conversion of LV pressures (input) into stroke volume (output). In this study, we examined the effect of sublingual nitroglycerin (NTG; 400μg given q15 minutes) to lower PCWP compared to placebo on DSM.

Methods:
HFpEF patients (n=11, 7 women; age 73 ± 7 years) were studied seated upright at rest following sublingual administration of placebo or NTG. DSM was quantified by transfer function analyses of beat-by-beat changes in pulmonary artery diastolic pressure (PAD, right heart catheterization as index for PCWP) and SV (Modelflow from radial arterial line waveform, normalized to direct Fick-derived SV) at the prevailing respiratory frequency. Direct Fick SV was calculated as VO2/a-vO2 difference divided by heart rate.

Results:
Compared to placebo, NTG decreased both SV (Placebo: 53 ml vs NTG: 43 ml, p=0.004) and PAD (Placebo: 15.0 mmHg vs NTG: 13.9 mmHg, p=0.026). The DSM gain was decreased with NTG compared to placebo (0.57 vs 0.82 ml/mmHg, p<0.0001) suggesting a smaller change in SV for a change in filling pressure.

Conclusions:
Lowering cardiac filling pressures in the seated upright position decreased efficiency of the beat-by-beat Starling mechanism. The results may provide insight into how reducing LV filling pressures impacts stroke volume regulation, potentially leading to decreased exercise tolerance in HFpEF patients.
Abstract 14202: Prenatal Diagnosis Influences Birth Characteristics and Subsequent Postoperative Outcomes in Transposition of Great Arteries
Authors: Namachivayam Siva P , Butt warwick w , Brizard Christian P , Millar Johnny , Thompson Jenny , Walker Sue P , Cheung Michael
Published: June 2023

Background:
Prenatal diagnosis of transposition of great arteries (TGA) is expected to improve postoperative outcomes after neonatal arterial switch operation (ASO); however published reports give conflicting results. We aimed to determine the association between prenatal diagnosis and postoperative outcomes after neonatal ASO.

Methods:
Cohort study conducted among 243 newborns with TGA (70 % prenatally diagnosed) born mainly in 3 Australian states (Victoria, South Australia and Western Australia) between 2010 and 2019. Robust multivariable modelling was used to determine the influence of prenatal diagnosis on (a) birth characteristics and (b) post-operative outcomes. Mediation analysis estimated the extent to which prenatal diagnosis mediated its effects through gestational age.

Results:
Gestational age and birthweight centile were lower and small-for-gestational-age (birthweight <10th centile) more common (11.8% vs 1.4%) in those diagnosed prenatally. Among births which followed labour induction or prelabour caesarean, prenatal diagnosis was associated with earlier gestational age at birth [mean (SD), 38.5(1.6) vs 39.2(1.4), P=0.01]. Among births which followed spontaneous onset of labour, prenatal diagnosis was associated with earlier gestational age at labour onset [38.2 (1.8) vs 39.2 (1.4), P = 0.01]. Prenatal diagnosis was associated with longer mechanical ventilation (incidence rate ratio: 1.74, 95% CI, 1.37 to 2.21), intensive care unit (1.70, 1.31 to 2.20) and hospital stay (1.37, 1.14 to 1.66) and also a greater need for postoperative extracorporeal membrane oxygenation. Gestational age at birth mediated up to 60% of the effect of prenatal diagnosis on postoperative outcomes.

Conclusion:
In this Australian study, prenatal diagnosis for TGA is associated with poorer postoperative performance after neonatal ASO and a large proportion of this effect is mediated by gestational age at birth. A higher proportion of newborns with a prenatal diagnosis were also small-for-their gestational age. Addressing factors associated with earlier gestational age at birth is likely to improve postoperative outcomes.
Abstract 14204: Impact of Concomitant Tobacco Use on Major Adverse Cardiovascular Events in Young Adults Hospitalized With Known Cannabis Use Disorder
Authors: Yarrarapu Siva Naga S , Abrishami Shabnam , Narula Harshit , Singh Monika , Mahadevaiah Ashwini , Niaz Rabiya , Aqeel Mariam , Saeed Memoona , Thota Anjani Kumar , Desai Rupak
Published: June 2023

Introduction:
Cannabis use disorder (CUD) and tobacco use disorder (TUD) are both independent CVD risk factors. However, with the increasing use of recreational cannabis use, the impact of concomitant TUD on major adverse cardiovascular/cerebrovascular events (MACCE) remains unexplored.

Hypothesis:
Evaluating the impact of concomitant CUD & TUD on MACCE.

Methods:
We queried 2019's National Inpatient Sample to identify young adults hospitalized with CUD, with vs. without TUD. Baseline demographics, comorbidities, major adverse cardiac events, and the need for revascularization were compared. Multivariable regression analysis was performed, adjusting for confounders to assess the odds of MACCE.

Results:
Of 539125 patients with CUD, 288260 (53.5%) were TUD+ [median age 31 (25-37)]. TUD+ cohort often had males (60% vs 51.6%), white (58.1% vs 46.8%) patients than TUD- cohort (all p<0.001). The TUD+ cohort showed higher rates of uncomplicated hypertension (15.0% vs 11.6%), alcohol abuse (21.0% vs 12.9%) but lower rates of obesity (9.2% vs. 11.6%), diabetes with chronic complications (4.5% vs. 5.4%), complicated hypertension (3.7% vs 4.4%) and metastatic cancer (0.2% vs. 0.5%) (all p<0.001). After adjusting for covariates, the TUD+ arm had significantly higher odds of acute MI (OR:1.37), Acute PE (OR:1.46), Type 1-DM (OR:1.66), PCI (OR:1.78), CABG (OR:2.62) but lower odds of all-cause mortality (OR:0.55), cardiac arrest including VF (OR:0.59), AF (OR:0.67) and dysrhythmia (OR:0.75) (all p<0.001)
[Fig. 1].
The TUD+ cohort incurred lower hospital charges than TUD- cohort (p<0.001). No statistical significance was observed in the odds of stroke and MACCE.

Conclusions:
Concomitant tobacco & cannabis use had higher odds of Acute MI, PE, PCI and CABG but, interestingly, lower odds of all-cause mortality, dysrhythmia, AF and cardiac arrest including VF. The association between cannabis use and concomitant tobacco use on MACCE needs to be further studied.
Abstract 14213: The Polyamine Spermidine Enhances the Contractile Force of μ-Patterned Single-Cell Stem-Cell-Derived Cardiomyocytes Post Doxorubicin Treatment
Authors: Blair Cheavar A , Pruitt Beth
Published: June 2023

Doxorubicin (DOX) is a chemotherapy used to treat childhood and adult malignancies, including pediatric leukemia and breast cancer. However, despite being a cornerstone for oncological care, the use of DOX is limited due to dose-dependent cardiotoxicity, which can lead to contractile dysfunction and heart failure. Yet, Dox is still widely used due to the lack of suitable replacements. The exact mechanism of Dox-induced cardiotoxicity is not fully understood. However, proposed mechanisms include sarcomere degradation and impairment of autophagy. To determine whether enhancing autophagy can restore contractile function, we treated μ-patterned single-cell human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs), displaying sarcomere disarray and reduced contractile force post-Dox treatment with spermidine, an autophagy activator. The contractile force was quantified using traction force microscopy. There were five conditions (untreated control, Dox, maintenance medium post-Dox, spermidine post-Dox, and spermidine-only). We found that hiPSC-CMs treated with spermidine post-Dox produce 67% of the contractile force generated by control cells (.22 μN vs. .33 μN, not significant) and significantly (.22 μN vs. .11 μN, p < .0001) higher contractile force compared to cells in maintenance medium post-Dox. In the spermidine-only group, our results demonstrate that spermidine significantly (.57 μN vs. .33 μN, p < .0001) increases contractile force compared to control. Spermidine-only treated cells were also bigger (spread area = ~1716 μm
2
vs. ~1353 μm
2
, p < .00001) than the control and had a more robust and organized sarcomere network. Preliminary qPCR results suggest that spermidine upregulates genes that control sarcomere function (e.g., MYH7) and organization (e.g., ANKD1). These data demonstrate that spermidine can enhance contractile force post-Dox treatment and increase cellular size and sarcomere network in hiPSC-CMs. The data further suggests that sarcomere homeostasis is one of the cellular mechanisms spermidine regulates in hiPSC-CMs. This work opens the door for developing therapies that target autophagy and sarcomere proteostasis to treat cardiac dysfunction.
Abstract 14220: Incidence of Delirium After Transcatheter Aortic Valve Replacement
Authors: Martillo Miguel A , Ebner Bertrand , Ergui Ian , Albosta michael , Dangl Michael , Inestroza Karla , Grant Jelani , Vincent Louis T , Maning Jennifer , Colombo Rosario
Published: June 2023

Introduction:
Patients who undergo transcatheter aortic valve replacement (TAVR) often are elderly, frail and with comorbid conditions. Delirium is frequently encountered in older adults and is associated with increased morbidity and mortality.

Hypothesis:
The purpose of this study is to determine the clinical significance of postoperative delirium in patients with aortic stenosis undergoing TAVR.

Methods:
The National Inpatient Sample was queried from 2011-2019 for relevant ICD-9 and ICD-10 codes to identify patients who underwent TAVR. Baseline characteristics and in-hospital outcomes between patients with and without delirium were compared. Logistic regression was performed to adjust for pre-specified co-variates for mortality and other in-hospital outcomes. p-value was considered significant when <0.001.

Results:
We identified a weighted sample of 270,178 patients who underwent TAVR, of which 5,059 (1.9%) had a diagnosis of delirium. Baseline characteristics are shown in Table 1. Patients who had delirium after TAVR had a higher mortality risk (3% vs 1.8%), had a longer LOS (median 7 vs 3 days) and higher expenditures (median $220,046 vs $179,166, p<0.001 for all). When adjusted for significant comorbidities, the odds ratio (OR) for mortality was 1.303 (CI [1.1-1.5]) with a LOS OR of 1.065 (CI [1.062-1.068], p<0.001 for both.

Conclusions:
Delirium after TAVR is associated with higher in-hospital mortality, prolonged hospital stay and higher hospital expenditures. A structured approach focused on prevention and early recognition of delirium may be warranted.
Abstract 14221: External Validation of Transthyretin Cardiac Amyloid Score Supports Use as Low-Cost Screening Tool
Authors: Cavalier Joanna S , Goldstein Benjamin , Khouri Michel G
Published: June 2023

Introduction:
Cardiac amyloidosis (CA) is an increasingly recognized cause of heart failure. Novel therapies for transthyretin (TTR) CA elevate the need for early identification when treatment has the greatest efficacy. The TTR CA score (TCAS) was recently developed to predict the likelihood of TTR CA in patients undergoing 99mTc-pyrophosphate scintigraphy (PYP) scanning. Its simple inputs could be easily extracted from the electronic health record (EHR), suggesting possible use as a quick, EHR-based screening tool. We perform the first external validation of the TCAS using only EHR-extracted data. We hypothesized that a screening algorithm like TCAS could be generalizable and feasible to implement using our EHR.

Methods:
EHR data were extracted on all patients at a large academic medical center who underwent PYP scans between 2017 and 2022. PYP scan was considered positive if the patient was part of our institution’s registry of patients with confirmed CA. Inputs - age, sex, echocardiogram wall thickness and ejection fraction, and hypertension diagnosis codes - were converted to TCAS scores. Area under the receiver operating characteristic curve (AUROC) was calculated to analyze predictive performance. Using a TCAS ≥6 as the threshold for high-risk, performance characteristics were calculated.

Results:
Of 365 patients who underwent PYP scan, 335 had sufficient records to calculate a TCAS. Of these 335 patients, 69 (20.6%) had positive PYP scans. Median TCAS was 5 (interquartile range 4,7). The AUROC was 0.826, with a sensitivity of 87.0%, specificity of 63.9%, positive predictive value of 38.5%, and negative predictive value (NPV) of 95.0%.

Conclusions:
External validation of the TCAS supports its strong predictive performance with comparable AUROCs to the initial study (0.84-0.89). Clinically, with its high NPV, the TCAS has potential to serve as a simple, low-cost screen to avoid costly PYP scans. We demonstrate the ability to extract all inputs from the EHR, without need for manual chart review or calculation, suggesting that the TCAS could function as an EHR-based screening tool. Low-cost screening tools are needed to identify patients who would benefit from TTR CA workup with PYP scanning, facilitating treatment at earlier disease stages.
Abstract 14230: Comparing Stress Echocardiography Parameters of Transgender Women With Their Cisgender Counterparts: The Mayo Clinic Women’s Heart Clinic
Authors: Walsh Connor D , Adel Fadi , Bretzman John , Sang Philip , Pellikka Patricia A , Mankad Rekha
Published: June 2023

Introduction:
Stress echocardiography (SE) is a common functional imaging modality used for the detection of symptomatic coronary artery disease (CAD). Currently, the interpretation of SE relies on sex-based comparators for reporting parameters, including exercise time and functional aerobic capacity. These parameters are based on the cisgender male and female populations but have not been studied among transgender (TG) patients. Thus, we sought to characterize the SE parameters among a group of TG women.

Methods:
We designed a case-control study of TG women who underwent a SE at the Mayo Clinic. Each TG patient was age-matched with 2 cis-males and 2 cis-females. Demographics, medical history, and SE data were extracted. Conditional logistic regression analysis was performed to compare the TG cohort with each cisgender cohort separately.

Results:
Among the 43 TG females (age 57.7±9 years, 94.9% white), the prevalence of CAD was less than in cis-males (p=0.013) but similar to cis-females. For SE parameters, TG females had higher resting heart rates than cis-males (median [Q1, Q3]: 80 [71,93] vs 70 [64, 77]; p=0.002). Double product (24816 [21156, 27864] vs 26864 [22444, 30660]; p=0.016), exercise time (7.3 minutes [6,9] vs 8.5 [7.2, 9.5]; p=0.041), and metabolic equivalents (8.2 [7, 10] vs 9.5 [8.2, 10.5]; p=0.018), were all lower in TG females than cis-males. Exercise ejection fraction was higher in the transgender cohort than in cis-females (70 [70, 75] vs 70 [65, 70]; p=0.007). There was no difference in functional aerobic capacity or in the rest or stress wall motion score indices among the groups. Finally, there was no difference in the prevalence of positive electrocardiogram or SE studies.

Conclusion:
In conclusion, we report for the first time SE profiles for TG females which display an overall distinct phenotype compared to cis-males and cis-females. Larger prospective studies are warranted to further define these parameters for the TG population.
Abstract 14237: Left Atrial Dynamics Predict Incident Atrial Fibrillation in Hypertrophic Cardiomyopathy
Authors: Andrews Erik , Cuddy Sarah , Ho Carolyn , Lakdawala Neal K
Published: June 2023

Introduction:
Atrial fibrillation (AF) is the most common arrhythmia in patients with hypertrophic cardiomyopathy (HCM) and is associated with an 8-fold increased risk of stroke. However, the ability to predict incident AF remains limited.

Methods:
At a single referral center, we identified HCM patients with paired transthoracic echocardiograms (TTEs) performed at least 12-months apart and both prior to a diagnosis of AF. Baseline clinical characteristics and the occurrence of incident AF was obtained from a clinical registry and the electronic medical record. Comprehensive analysis of TTEs was performed by an experienced reader who was blinded to clinical events and included total atrial emptying fraction (LA EF) and its individual components, including LA volume at end-systole. Changes in parameters over time were determined by comparing results between each TTE. Univariate and multivariate regression, Cox proportional hazard, and Kaplan-Meier methods were used to analyze factors associated with the subsequent incidence of AF.

Results:
We studied 202 patients (mean age 45 years, 42% female, 27% hypertensive, 39% with sarcomere mutation, 37% NYHA II or greater). Of all factors examined, the initial LA EF, as well as the rate of LA remodeling as defined by the change in LA end-systolic volume over time, were most significantly predictive of AF development (Figure 1). These results were robust to multivariate regression with other factors significant in HCM (Figure 1C), including baseline LA diameter.

Conclusions:
Reduced LA function (the LA EF) and increased rate of LA dilation predict incident AF in HCM. Future studies are needed to identity factors associated with adverse LA dynamics in HCM and whether these can be mitigated with pharmacotherapy.
Abstract 14243: Machine Learning-Based Prediction for Functional Recovery After Coronary Artery Bypass Grafting
Authors: Inoue Koichi , Masuda Hirotada , Yoshioka Daisuke , Saito Tetsuya , Kawamura Takuji , Miyagawa Shigeru
Published: June 2023

Background:
Patients with improved left ventricular ejection fraction (LVEF) after coronary artery bypass grafting (CABG) are known to have a better prognosis. In patients whose LVEF does not improved, the next alternative is cardiac regenerative therapy. However, surgeons cannot establish an appropriate surgical strategy because it is unpredictable what improvement will be achieved for the patient before CABG. Recently, it has been reported that high-quality medical data and machine learning (ML) can be used to predict diseases.Hypothesis:A ML model with preoperative values of patients could predict functional recovery of LVEF after CABG.Patients and Methods:Three hundred forty-two patients with reduced LVEF who underwent isolated CABG in Osaka University Medical Hospital were included. Reduced LVEF was defined as less than 50% by preoperative echocardiography.
Functional recovery
of LVEF was defined as the condition with a 5% improvement of LVEF after CABG. Seventy percent of the patients’ data was used as a training dataset, and the other 30 percent was used as a test dataset for ML. Eighty preoperative features, such as creatinine level, were used for ML model construction.Results:Two hundred fifteen patients got functional recovery after CABG. Our unique ML model found five important preoperative features; histories of hypertension, chronic obstructive pulmonary disease, diabetes mellitus, cerebrovascular disease, and hemodialysis. The trained Extra Trees Classification model with these five features could predict the patients’ functional recovery with 70.7% accuracy in the test data. The predictive model had the area under the curve was 60.9 in the receiver operating characteristic curve.Conclusion:Machine learning-based prediction could work to sort patients with ischemic heart disease into recovery or non-recovery groups after CABG. This algorism may contribute to future precision medicine.
Abstract 14246: Right Atrial Dilation and Conduit Dysfunction is Associated With Significant Pulmonary Insufficiency in Tetralogy of Fallot: Assessment of a New Normative Dataset
Authors: Haughian Brendan T , Colen Timothy M , Khoo Nee Scze , Youssef David E , Eckersley Luke
Published: June 2023

Background:
Right atrial (RA) size and dysfunction predicts adverse clinical outcomes in adult Tetralogy of Fallot (TOF); however limited normative or TOF data are published in children. We aimed to develop and validate 2-dimensional echocardiography normal values for RA size and function in children, by comparison with the RA of children with TOF and to determine the RA size and functional trajectory in TOF after initial repair.

Methods:
We prospectively imaged 156 healthy children, 13 days to 18 years, and measured RA area at end systole (RAAs), onset of ECG p wave (RAAp) and at end diastole (RAAd), to calculate total RA emptying fraction (EF) (RAAs - RAAd / RAAs), conduit EF (RAAs - RAAp / RAAs), and active EF (RAAp - RAAd /RAAs). Z-scores were developed using BSA indexing. We analysed studies at <1, 3-4 and 6-7 years of age in 22 patients with TOF with sub-analysis according to degree of pulmonic regurgitation: none to mild (G1 n=7) vs. moderate or greater (G2 n=15).

Results:
RA area indexed to a best-fit power of BSA was homoscedastic. Normal RA conduit EF increased, and RA active EF decreased until a BSA ~1 m
2
before stabilizing, and was best fit by a linear spline function, node at BSA 1 m
2
(Figure 1). TOF RA was dilated early after repair and normalized by 4 years in G1 but not G2. Total RA EF and conduit EF, but not active EF were persistently reduced (Table 1).

Conclusion:
Using new z-score formulas for indexed RA size and EF, we demonstrate persistent RA dilation and conduit dysfunction in TOF is associated with significant pulmonary regurgitation. Future work will explore the potential utility of RA size and function in prediction of right heart normalization post-pulmonary valve replacement.
Abstract 14248: The Impact of Trastuzumab on the Pulmonary Artery Systolic Pressure in Patients With HER-2 Positive Breast Cancer
Authors: Abdulelah Zaid A , Khrais Mohammad Z , Ghalayni Ruba A , Al-Khalili Faris , Alqaisieh Mohammad , AbuAlSha'r Mu'taz F , Abdulelah Ahmed A , Abandeh Yazan S , Al-Rimawi Dalia , Hamam Ismail R
Published: June 2023

Introduction:
Despite that trastuzumab (TZB) improves life expectancy and prognosis in patients with HER-2 positive breast cancer (BC), cardiotoxicity is a well-established complication. However, other potential cardiac complications of TZB such as pulmonary hypertension (PHTN) are poorly investigated.

Aim:
Evaluate the effect of TZB on pulmonary artery systolic pressure (PASP) and measure the predictors of developing elevated PASP.

Methods:
The medical records for all females who received TZB treatment for confirmed HER-2 positive BC at King Hussein Cancer Centre in Jordan between 2014 - 2019 who had a documented normal PASP of ≤35 mmHg before treatment were evaluated.

Results:
A total of 436 patients with a mean age of 53±11 years were included. The leading comorbidities were hypertension and diabetes mellitus affecting 26.2% and 15.4% of the patients, respectively. 15.6% of the study’s population were active smokers. Prior to initiating TZB, 22.3% had left ventricular hypertrophy (LVH), 14.3% had mild tricuspid valve regurgitation (TR), 11.5% had pericardial effusion, and 4.8% had mild aortic valve regurgitation (AR).Of alarming significance, 24.8% of the patients had their PASP increased after one year. Patients who developed elevated PASP tend to be older (56.9 vs 51.3, P<0.001), had baseline mild TR (26.3% vs 10.3%, P<0.001), LVH (39.4% vs 17.6%, P<0.001), and mild AR (9.1% vs 3.7%, P=0.031).Multivariate analysis showed that the only predictors of elevated PASP are TR at baseline (OR 3.9; 95% CI 1.58-6.17, P=0.001), and age (OR 1.04; 95% CI 1.01-1.06, P=0.005). However, baseline LVH (OR 1.79; 95% CI 0.98-3.26, P=0.057), number of the TZB cycles (OR 0.93; 95% 0.85-1.02, P=0.152), and the total dose of TZB (OR 1; 95% CI 1-1, P=0.284) were non-significant predictors.

At 1 year follow up, the mean total cumulative dose of TZB was 6.8±1.8 grams that were given at a mean of 15±3 cycles. Moreover, major events (heart failure exacerbation, pulmonary embolism, and acute coronary syndrome) were recorded in 3.9% of the patients and death occurred in 4.1%.

Conclusions:
Trastuzumab demonstrated an increase in the PASP in a considerable portion of the patients at 1-year interval with this elevation being substantially concerning due to being highly indicative of PHTN.
Abstract 14252: Cumulative Apolipoprotein B Blood Concentrations During Early Adulthood and Incident Atherosclerotic Cardiovascular Disease Risk After Age 40 Years: The Coronary Artery Risk Development in Young Adults Study
Authors: Wilkins John T , Ning Hongyan , Sniderman Allan D , Stone Neil J , Otvos James D , Jacobs David R , Sawicki Konrad , Sawicki Konrad T , Murthy Venkatesh L , Shah Ravi V , Allen Norrina B , Lloyd-Jones Donald
Published: June 2023

Introduction:
The associations between cumulative exposure to apolipoprotein B (apoB) containing lipoproteins across early adult life and incident ASCVD in later life have not been quantified.

Methods:
Of 4945 eligible Coronary Artery Risk Development in Young Adults (CARDIA) cohort participants we used NMR to measure apoB in 3110 participants who had samples available from the years 2, 7, 15, and 30 exams. To mitigate biases from missingness of data we conducted multiple imputation for apoB levels for the residual 1,835 participants without NMR measures of apoB. We estimated the participant-specific apoB throughout the exposure period (ages 19 to 40y) using nonparametric spline models. The area under the apoB/age curve was calculated as cumulative exposure and expressed in mg/dL*years. To quantify the association between cumulative apoB exposure during early life with incident ASCVD after age 40y we used demographic- and risk factor-adjusted* Cox regression models (see table). We used a restricted cubic spline to examine the pattern of association across the range of cumulative apoB exposure.

Results:
4945 CARDIA participants were followed for a total of 88664 person*years; 255 incident ASCVD events occurred after age 40y. Participants with higher cumulative apoB levels were more likely to be men; and have higher BMI, BP, glucose, and tobacco use. In demographic and risk factor adjusted models a 100mg/dL*yr difference in cumulative apoB from ages 19 to 40y (representing a mean yearly difference of about +5mg/dL) was associated with HR 1.15 (95% CI:1.10-1.19) and HR 1.10 (95%CI:1.06-1.15) for ASCVD events, respectively. At apoB exposures >1700mg/dL*y (>80mg/dL/y) there was a strong, direct association with incident ASCVD after age 40y.

Conclusion:
Prevention strategies that reduce apoB exposures in early adult life will likely attenuate ASCVD risks later in life; targeting a usual apoB level < 80mg/dL may provide maximal benefit.
Abstract 14292: Association of Technetium Pyrophosphate Scan Grade With Adverse Remodeling and Burden in Cardiac Amyloidosis
Authors: Scheetz Seth , Alvi Nazia , Zareba Karolina , Amit Patel , Goyal Akash , de Carhalho Singulane Cristiane , Sarswat Nitasha , Addetia Karima , Vallakati Ajay , Slivnick Jeremy
Published: June 2023

Introduction:
While technetium pyrophosphate (Tc-PyP) is known to be highly accurate for identifying transthyretin cardiac amyloidosis (ATTR-CA), it is currently unclear whether the grade of uptake observed on Tc-PyP correlates with either amyloid burden or adverse cardiac remodeling.

Methods:
At three academic medical centers, we retrospectively identified patients with confirmed ATTR-CA—defined in accordance with guidelines using either tissue biopsy or grade ≥2 Tc-PyP uptake—who underwent Tc-PyP and cardiac magnetic resonance (CMR) at 1.5T (Phillips, Siemens or GE). Left (LV) and right (RV) ventricular size, mass, and systolic function were quantified. T1 mapping including extracellular volume (ECV)—a surrogate for amyloid burden—was quantified according to guidelines. 3-hour Tc-PyP grade was assessed in accordance with guidelines. CMR markers were correlated with Tc-PyP grade using ANOVA with pair-wise comparisons made using t-test, Wilcoxon rank, or chi-squared as appropriate with p<0.01 used to denote significance.

Results:
45 patients were included (mean age 75.4 years, 75.6% male). Within the cohort, grade 0, 1, 2, and 3 uptake were present in 1(2%), 3(7%), 6(13%), and 35(78%) patients respectively. All patients with Tc-PyP grade <2 were confirmed to have ATTR-CA by endomyocardial biopsy. Neither age, gender, or comorbidities differed significantly based on Tc-PyP uptake (Panel A). In univariate analysis, both indexed LV mass and ECV were significantly associated with Tc-PyP grade (Panel B). As compared to those with grade 2, patients with grade 3 Tc-PyP uptake had significantly higher ECV (p<0.001) and indexed LV mass (p=0.003).

Conclusions:
The presence of higher Tc-PyP grade is associated with increasing amyloid burden and a greater degree of adverse LV remodeling. Higher Tc-PyP grade appears to be indicative of more advanced disease stage in this patient population.
Abstract 143: Does Bystander Gender Make Difference In Outcomes Of Out Of Hospital Cardiac Arrest?
Authors: Lee Gyeongmin , Yoon Hanna , Song Kyoung J , Hong Kijeong , Kim Ki Hong , Park YongJoo , LEE Stephen Gyung Won , Choi Seul Ki , Hong Wonpyo , Lim Hyouk Jae , Lee Kang bin
Published: June 2023

Objective:
We hypothesize that there is difference in outcomes of out-of-hospital cardiac arrest according to bystander gender.

Methods:
We used a nationwide, out-of-hospital cardiac arrest cohort database during 2006-2020. We extracted cases involving patient older than 18 years with presumed cardiac etiology and witnessed arrest, but not by EMS or nursing home worker or medical personnel. The primary outcome was the good neurologic outcome. Secondary outcomes were successful bystander cardiopulmonary resuscitation rate which defined that starting bystander CPR and keep going until by EMS arrival and survival outcome.

Results:
The total number of populations was 24919 patients. Of these, 10413 patients (41.8%) were resuscitated by female bystander. When cardiopulmonary resuscitation by female bystander, patient more likely to achieve good neurological outcome (206(2.0%) vs 235(1.6%), p=0.344), and survival (352(3.4%) vs 400(2.8%), p=0.0046). However, female bystander less likely to do successful cardiopulmonary resuscitation (5730(55.0%) vs 9405(64.8%), p<0.0001). Adjusted odds ratios for good neurologic outcomes, survival and successful bystander cardiopulmonary resuscitation rate resuscitated by female bystander, when compared with male bystander, were 1.46 (1.18-1.80), 1.44 (1.23-1.69) and 0.68 (0.64-0.71), respectively. In the interaction model, adjusted odd ratio (95% Confidence interval) for good neurological outcome of patient resuscitated by female bystander was 1.53 (1.21-1.94) in patients who arrested at private place and 1.18 (0.71-1.98) in patients who arrested in public place.

Conclusion:
Patient who resuscitated by female bystander were more likely to have good neurologic outcome and achieve survival discharge. Effect of bystander gender was increased when patient arrested in private place.
Abstract 14306: Development of Sleep-Disordered Breathing Destabilizes Ventricular Repolarization
Authors: Solhjoo Soroosh , Haigney Mark C , Crainiceanu Ciprian M , Koch Abigail , Siddharthan Trishul , Punjabi Naresh
Published: June 2023

Introduction:
Sleep-disordered breathing (SDB) is a prevalent condition associated with adverse cardiovascular events, including nocturnal arrhythmias and sudden cardiac death, but the underlying mechanism is unclear.

Hypothesis:
Ventricular repolarization instability increases in those who develop SDB.

Methods:
For the participants of the Sleep Heart Health Study (SHHS), the percentage of sleep time with oxygen saturation levels < 90% (T90) was measured. We identified participants who did not have SDB (T90 < 0.22% = median of the SHHS cohort) during the initial study but developed SDB (T90 > 10%) by the time of the 5-year follow-up. A comparator group was identified as those who matched the first group on age, sex, BMI, and race but had T90 < 0.22% during both the initial and the follow-up sleep studies. Each group consisted of 25 (8 M and 17 F) participants, none of whom had any diagnosed comorbidities or prescriptions that could affect cardiac repolarization. Heart rate (HR), heart rate variability (SDNN), and QT variability index (QTVI, a measure of ventricular repolarization instability) were calculated from one-lead ECG recordings. Paired sample
t-
test was used to assess statistical associations.

Results:
The respiratory disturbance index (RDI) for the study group increased from 2.57 ± 0.74 events/hr at baseline to 14.8 ± 3.72 events/hr at follow-up (P = 0.001), while the RDI was not different for the comparators (3.08 ± 0.71 events/hr at baseline, 3.65 ± 0.68 events/hr at follow-up, P = 0.599). In those who developed SDB, HR and SDNN did not change between baseline and follow-up, but QTVI increased from -1.25 ± 0.15 to -0.85 ± 0.15 (P = 0.013). None of the measured electrocardiographic parameters differed between baseline and follow-up in comparators.

Conclusion:
Over a five-year follow-up, the development of SDB was associated with an increase in QT variability comparable to symptomatic heart failure. Hypoxemia appears to be the main underlying mechanism.