bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14283: Influence of the HEAR Score for 30-day Risk-Stratification in Emergency Department Patients Evaluated With High-Sensitivity Cardiac Troponin T
Authors: Ola Olatunde , Akula Ashok , De Michieli Laura , Knott Jonathan D , Mehta Ramila A , Hodge David O , Gulati Rajiv , Jaffe Allan S , Sandoval Yader
Published: June 2023

Background:
The 2021 ACC/AHA chest pain guidelines recommend risk scores such as HEAR (History, Electrocardiogram, Age, Risk Factors) for short term risk-stratification yet limited data exists integrating them with high-sensitivity cardiac troponin T (hs-cTnT).

Methods:
Retrospective, multicenter (n=2), observational, U.S. cohort study of consecutive ED patients without ST-elevation myocardial infarction (MI) who had at least one hs-cTnT (limit of quantitation, LoQ, <6 ng/L, and sex-specific 99
th
percentiles of 10 ng/L for women and 15 ng/L for men) measurement on clinical indication in whom HEAR scores (0-8) were calculated. The composite major adverse cardiovascular (MACE) outcome was 30-day MI and death.

Results:
Among 1,979 ED patients undergoing hs-cTnT measurement, 1045 (53%) were classified as low-risk (0-3), 914 (46%) as intermediate-risk (4-6), and 20 (1%) as high-risk (7-8) based on HEAR scores. HEAR scores were not associated with an increased risk of 30-day MACE after adjusted analyses. Outcomes according to risk-strata based on HEAR scores and baseline hs-cTnT are shown in Table 1. Patients with quantifiable hs-cTnT (LoQ-99
th
) had an increased risk for 30-day MACE (3.4%) despite being estimated to be low-risk (0-3) per HEAR scores. Conversely, those with serial hs-cTnT<99
th
percentile remained at low-risk (range 0% to 1.2%) for 30-day MACE across HEAR score strata.

Conclusions:
HEAR scores are of limited value in those with baseline hs-cTnT99
th
percentile where hs-cTnT identifies very low and high-risk patients irrespective of HEAR scores. In those with baseline quantifiable hs-cTnT within the reference range (<99
th
percentile), a higher risk (>1%) for 30-day MACE exists even in those with low HEAR scores. With serial hs-cTnT measurements, HEAR scores overestimate risk when hs-cTnT remains <99
th
percentile.
Abstract 14309: Does Obesity Affect the Long-Term Results of Catheter Ablation of Atrial Fibrillation?
Authors: Vasilottos Nektarios , Kumar Awaneesh , McCoy Cody , Tanawuttiwat Tanyanan , Miller John M , Das Mithilesh
Published: June 2023

Background:
The presence of obesity in patients who underwent catheter ablation (CA) of atrial fibrillation (AF) is thought to be a predictor of poor outcomes.

Methods:
We studied the long-term success of CA of AF in patients with mild to severe obesity and followed them for recurrence of AF/atrial flutter (FL).

Results:
Of 185 patients (mean age: 60.3 ± 10.7 years, male: 75%), 24 (13%) patients had a normal body mass index (BMI < 25.0 kg/m
2
), 53 (28.6%) patients were overweight (BMI 25.0-29.9 kg/m
2
), 78 (42.2%) patients were obese (BMI 30.0-39.9 kg/m
2
) and 30 (16.2%) had severe obesity (BMI > 40 kg/m
2
). There were no significant differences in baseline characteristics including age, gender, race, left ventricular ejection fraction, and presence of hypertension, diabetes, and valvular disease. Number of ablations performed in the normal, overweight, obese, and severe obesity groups were 1.3 ± 0.5, 1.4 ± 0.6, 1.5 ± 0.6, and 1.5 ± 0.7, respectively. During a median (±1SE) follow-up of 5.23 ± 0.17 years, 79% in the normal BMI, 70% in overweight, 41% in obese, and 80% in severe obesity group were in sinus rhythm. There was no significant difference among all four groups regarding recurrence of AF/AFL (p=NS). Kaplan-Meier survival analysis showed no significant difference in time to recurrence of AF/AFL based on BMI.

Conclusion:
Severity of obesity does not predict recurrence of AF/AFL after CA during long-term follow-up.
Abstract 14316: Prognostic Utility of Left Atrial Strain to Predict Thromboembolic Events and Mortality in Patients With Amyloid Cardiomyopathy
Authors: Akintoye Emmanuel O , Majid Muhammad , Hanna Mazen A , Klein Allan L
Published: June 2023

Introduction:
There is no risk stratification tool to identify patients with amyloid cardiomyopathy (ACM) that will benefit from prophylactic anticoagulation and the available survival staging systems have only modest discriminatory ability

Methods:
Using the prospective Amyloid Heart Disease database of Cleveland Clinic, we identified patients with light chain (AL) or transthyretin (ATTR) ACM but no history of atrial fibrillation. LA strain was measured in accordance with guidelines and its association with incident thromboembolic event (TE) and mortality was evaluated. In addition, we determined the incremental utility of LA strain to current ACM prognostic staging systems

Results:
In 448 patients (mean age 68 years, 72% male), there were 64 (14.3%) TE and 234 deaths (52.2%) after a median follow up of 3.8 years. LA reservoir (LAr) and contractile (LAc) strain significantly predict both events (
Fig 1
). The hazard ratio (HR) for TE was 2.22 (95% CI=1.27-3.85, p=0.006) and 2.63 (1.25-5.00, p=0.01) per standard deviation decrease in LAr and LAc, respectively. The respective HR for mortality was 1.32 (1.09-1.59, p<0.001) and 1.49 (1.22-1.75, p<0.001). The addition of either LAr or LAc to prognostic staging systems resulted in significant increase in discriminatory ability e.g., C-statistics of the revised Mayo staging for AL increased from 0.65 to 0.68 and 0.70 (p≤0.02) after the addition of the LAr and LAc, respectively (
Fig 2
)

Conclusions:
Patients with ACM experience high rate of TE and mortality, even in the absence of atrial fibrillation. LA strain can help to identify those that will benefit from prophylactic anticoagulation and provides incremental risk stratification
Abstract 14332: Syncope, Storm, and Shock: Fulminant Myocarditis
Authors: Gandhi Nikhil , Swisher Jordan , Alkehef Yazan , Yamasaki Hiroshi
Published: June 2023

A 46-year-old female with prediabetes and recent hysterectomy three weeks prior presented to the hospital for syncope. Patient reported no chest pain or dyspnea but complained of intermittent palpitations. The patient developed runs of non-sustained ventricular tachycardia which quickly escalated into incessant ventricular tachycardia (VT). Unresponsive to maximal medical therapy, the patient was cardioverted, intubated and sedated. Electrocardiogram was obtained which showed ST segment elevation in V1 and V2 without reciprocal changes. Bedside point-of-care ultrasound was negative for wall motion abnormalities. Laboratory results were significant for normal electrolytes, elevated troponins peaking at 7.14 ng/mL the following morning, and lactic acid of 3.2 mmol/L. Patient was initiated on vasopressor and ionotropic support for suspected shock. Left heart catheterization was negative for obstructive coronary artery disease. Right heart catheterization revealed mild pulmonary hypertension and biventricular failure. Formal echocardiogram revealed mid-range ejection fraction with a small pericardial effusion. The patient’s clinical status was deteriorating and revealed multiorgan failure. In conjunction with advanced heart failure and mechanical circulatory support teams, veno-arterial extracorporeal membrane oxygenation was initiated with subsequent implantation of intra-aortic balloon pump. High-dose steroids were given while awaiting transfer to a quaternary center. The patient is currently being evaluated for endomyocardial biopsy and evaluation of left ventricular assist device or heart transplantation due to fulminant myocarditis (FM). FM requires early recognition, intensive support, and further investigation for optimal management.
Abstract 14335: Vascular Complications and Outcomes Following Transcatheter Aortic Valve Replacement in Patients on Chronic Steroids Therapy. A Meta-Analysis
Authors: Ang Song Peng , Chia Tong Hong , Jaiswal Vikash , Song David , Chia Jia Ee
Published: June 2023

Introduction:
Chronic steroids therapy was reportedly linked to increased vascular complications (VC) following invasive vascular procedures. However, its association with VC after transcatheter aortic valve replacement (TAVR) remained uncertain, with conflicting results being reported. We aimed to compare the rate of vascular complications and outcomes between patients with and without chronic steroid use after TAVR.

Methods:
We conducted a comprehensive literature search in PubMed, Embase and Cochrane databases for relevant studies. Endpoints were described according to Valve Academic Research Consortium-2 definitions and were assessed within 30 days of TAVR. Effect sizes were pooled using the DerSimonian and Laird random-effects model as risk ratio (RR) with 95% confidence intervals (CI).

Results:
5 studies with 6136 patients undergoing TAVR (328 steroids, 5808 non-steroids) were included in the analysis. Patients on chronic steroids were younger (mean age 80.2 vs 82.3 years) and were more likely to be female (56% vs 54%). Patients on chronic steroids had a higher risk of major vascular complications (RR 2.32, 95% CI 1.73-3.11, p<0.001), major bleeding (RR 1.61, 95% CI 1.27-2.05, p<0.001) and aortic annulus rupture (RR 4.66, 95% CI 1.67-13.01, p<0.001). There was no significant difference in terms of minor vascular complications (RR 1.43, 95% CI 1.00-2.04, p=0.05), in-hospital mortality (RR 1.86, 95% CI 0.74-4.70, p=0.19) and 30-day mortality (RR 1.14, 95% CI 0.53-2.46, p=0.74) between both groups.

Conclusion:
Chronic steroid therapy is associated with increased rate of major VCs, major bleeding and aortic annulus rupture following TAVR. Further randomized controlled trials were encouraged to confirm these findings.
Abstract 14347: Rapid Calculation of Cardiology Risk Scores by Natural Language Processing of Unstructured Medical Record
Authors: Huang Andy , Liu George C , Lee Paul C
Published: June 2023

Introduction:
Risk score calculators such as ASCVD (for coronary artery disease), CHA2DS2-VASc (for atrial fibrillation), and H2FPEF (for diastolic heart failure) optimize outpatient cardiology care, but may not be routinely performed because calculation is time consuming. Natural Language Processing (NLP) methods can rapidly capture clinical data from unstructured medical records. Our aim was to create an algorithm that can rapidly calculate these scores using NLP methods.

Methods:
In the algorithm we created (named MYTH), demographic, history and physical, ICD10 diagnostic codes, laboratory, EKG, echocardiography data were captured by analysis of textual syntax, domain-specific knowledge graph, and regular expressions. The data captured are then fed into various risk score calculators. We compared the speed of the algorithm with manual calculation using a commonly used online calculator. Twenty outpatient cardiology unstructured medical records were used for each of the three risk scores.

Results:
NLP is faster than manual calculation. See attached table.

Conclusions:
NLP-based algorithm increases the speed of risk score calculation. The improvement is especially dramatic in complex risk scores, such as diastolic heart failure risk scores. NLP method can optimize cardiology care in time-constrained settings.
Abstract 14379: The Association of Triglyceride-Rich Lipoproteins With Cognitive Function: ELSA-Brazil (the Brazilian Longitudinal Study of Adult Health)
Authors: Hamandi Mohanad , Generoso Giuliano , Suemoto Claudia K , Bensanor Isabela M , Kulkarni Krishnaji , Santos Raul , Jones Steven R , Blaha Michael J , Toth Peter P , Andrade Lotufo Paulo A , Bittencourt Marcio S
Published: June 2023

Background:
Plasma triglyceride levels correspond to the sum of the triglyceride (TG) content in triglyceride-rich lipoproteins (TRL) and their remnants. Experimental studies have shown TRL adverse effects in the brain, but there is limited data about their role in cognitive function. We investigated the cross-sectional association of TG and TRL-cholesterol with domain-specific cognitive tests.

Methods:
A total of 4,443 participants (51±9 years, 54,2% women) without previous cerebrovascular disease and not on lipid-lowering drugs were evaluated using the delayed word recall test, the category fluency test and the trail making test. TRL were measured by the Vertical Auto Profile (VAP) test, an ultracentrifugation method, and TG by the conventional method. Then, we constructed multiple linear regression models to analyze these associations.

Results:
The mean TRL level was 32.1±12.2 mg/dl, and the median (IQR) TG was 109 (79-153) mg/dl. There was a negative association between TRL and global cognitive z-score after adjustment for age, sex, ethnicity, education, smoking status, physical activity, alcohol use, depression, systolic blood pressure, diabetes, thyrotropic hormone, LDL, HDL, TG and waist circumference (p=0.009), due to the inverse association with trail making test (p=0.009). We found no association between TG with any cognition tests after adjustment.

Conclusion:
TRL levels measured by VAP are independently associated with the global cognitive and executive function. TG was not associated with cognitive performance.
Abstract 14412: Statin Use and Incident Heart Failure by Race and Cardiovascular Disease Risk in a Real World Primary Prevention Cohort
Authors: Hay Eli J , Zhu Jianhui , Thoma Floyd W , MARROQUIN Oscar C , Muluk Pallavi , Johnson Amber E , Countouris Malamo E , Smith Anson J , Saeed Gul J , Al Rifai Mahmoud , Saeed Anum , Mulukutla Suresh R
Published: June 2023

Background:
Statins are indicated for primary prevention in patients with elevated risk of atherosclerotic CVD (ASCVD). However, statin associated risk reduction in heart failure (HF) is uncertain. There remain racial disparities in statin prescription and associated ASCVD outcomes. We evaluated the association of statin therapy and incident HF stratified by race and estimated ASCVD risk in a primary prevention cohort.

Methods:
Statin use in Black and White patients without ASCVD and HF was evaluated (2013-2019) based on the ACC/AHA 10y risk groups (
Borderline
[5%-7.4%],
Intermediate
[7.5-19.9%], or
High
[≥20%]). Guideline Directed Statin Intensity (GDSI) was defined as “at least moderate” for
intermediate and high
risk patients. Statin use and HF outcome was assessed via electronic health care record and ICD-10 codes. Cox regression models, fully adjusted for CVD risk factors, were used to calculate HRs for the association between statin use and incident HF.

Results:
In 270,079 patients, 39% Black and 32% White patients were categorized as intermediate or high ASCVD risk. Proportionally fewer Black patients in intermediate (22% vs. 31%) and high (40% vs. 44%) risk groups received "any statin" (all p<0.001). At 6y follow up, incident rate of HF was 12.9 per 1000-person-y in those with highest ASCVD risk. Black patients had higher risk of HF events [(HR
HF
1.11 (1.05-1.17), p<0.001)]. In both populations, high risk patients not on any statin had significantly higher risk of HF [(HR
HF
1.42 (1.04-1.93) in Black and 1.22(1.08-1.37) in White] (
Table
). The interaction between race and statin use was not a significant predictor of incident HF.

Conclusion:
In a large healthcare system, statin use was low among White and Black patients. Lack of statin therapy was associated with a higher risk of incident HF amongst those at highest ASCVD risk. Further research is needed to study the role of statins in primary prevention of HF, especially in higher risk populations.
Abstract 14468: Which Measure of Right Ventricle Assessment Should Be Used in COVID19 to Predict In-Hospital Mortality?
Authors: Mahmood Riaz , Asreb Abdullah , Joy Parijat S , Kumar Gagan
Published: June 2023

Introduction:
Right ventricle failure is one of the features of severe COVID19 which is associated with poor outcomes. Measurement of failing right ventricle (RV) is difficult, and the few measures that have been used to study RV include tricuspid annular plane systolic excursion (TAPSE), right ventricle systolic pressure (RVSP) and RV dilation. There is limited data with regards to which of these parameters should be used to predict mortality in COVID19.

Hypothesis:
low TAPSE, high RVSP, and higher dilation are associated with higher in-hospital mortality.

Methods:
We performed a retrospective chart review of patient hospitalized with COVID-19 infection and underwent echocardiography (ECHO) within the Northeast Georgia Health System from March 2020 to December 2021. The primary outcome was in hospital mortality. RV dilation was classified as none, mild, moderate, and severe. TAPSE and RVSP were used as continuous variable in univariate analysis. We used multivariable cox regression model and adjusted for demographical characteristics and underlying co-morbidities, along with the three RV failure parameters. We used interaction terms between the parameters to identify which parameter correlated with mortality. For interaction, we classified TAPSE into 4 group - <1.2; 1.2 to 1.5; 1.5-1.8 and >1.8.

Results:
In total 7939 patients were identified with COVID-19 infection and of these, 3,109 underwent ECHO. Of these 56% were males and mean age was 65.6 years (SD 15.1 years). In hospital mortality was 25.9%. On univariate analysis, TAPSE (HR 0.71, 95%CI 0.61-0.84), RV dilation (HR 1.11, 95%CI 1.04-1.19) were strongly associated while RVSP (HR 1.01, 95%CI 1.00-1.01) was poorly associated with in-hospital mortality. On multivariable cox regression model with interaction, TAPSE < 1.2 along with moderate to severe RV dilation was associated with in hospital mortality (HR 1.88, 95%CI 1.25-2.8, p=0.002). Dilated RV was still associated with in-hospital mortality even when TAPSE was higher than 1.2 (HR 1.56, 95%CI 1.01-2.4, p=0.04).

Conclusions:
Moderate to severe Dilation of RV and TAPSE < 1.2 were strongly associated with an increase in mortality. Moderate to severe dilation of RV was also associated with increased mortality with TAPSE between 1.2 to 1.8.
Abstract 14473: The Impact of Dietary Patterns on Cardiovascular Death Comparing Populations of United States and Great Britain: An Analysis of the Global Burden of Disease Study 2019
Authors: Titus Anoop , Saji Anu , Arun Kumar Pramukh , Dasari Mahati , Avinashsingh Eswarsingh FNU , Baburaj Abiram , Sherif Akil A , sattar yasar , Mathews Koshy Rohan , Gaikwad Pramod , hadley Michelle
Published: June 2023

Introduction:
Dietary risk factors contribute to cardiovascular mortality. To the best of our knowledge, there are no studies comparing two first world countries with respect to cardiovascular deaths (CVD) and the impact of dietary risk factors. We sought to compare these parameters in Great Britain (GBR) and the United States of America (USA)

Methods:
A total of 33,041,416 patients with dietary risk factors and CVD from GBR and USA was obtained from the Global Burden of Disease Study between 1990 and 2016.The 30-year mean CVD was compared for all risk factors with the Welch Two sample t-test. Trends of CVD proportions of 30-years is as shown (Fig 1 and 2).

Results:
30-year mean cardiovascular death for all variables between GBR and USA was statistically significant (p< 0.05) with the exception of diet low in whole grains. Cardiovascular death with risk factors of diet low in PUFA, fruits, vegetable, nuts and seeds were measures where GBR had a higher 30-year mean CVD than the USA. Remaining factors contributed to higher CVD proportion in USA.

Conclusions:
A higher proportion of CVD was seen in the USA with dietary risk factors including low PUFA, processed meat, sweetened beverages, low legumes, high sodium and high trans-fatty acids when compared to GBR. Our study proves that there exists significant disparity in CVD proportions between two first world countries despite similar dietary risk factors.
Abstract 14480: Importance of the Characteristics of Aortic Valve Calcification for Identifying Patients at a High Risk for Permanent Pacemaker Implantation After Different Types of Transcatheter Aortic Valve Replacement
Authors: Dong Zhifeng , Ardura-Fabregat Alberto , Zhao David X , Zhou Li , Garcia Mario J , Pu Min
Published: June 2023

Background:
Aortic valve calcification is a known risk factor for permanent pacemaker implantation (PPMI) following transcatheter aortic valve replacement (TAVR). However, the impact of characteristics of the calcium deposit on the aortic valve and annulus on post-TAVR PPMI has not been well defined.

Hypothesis:
Analysis of the characteristics of aortic valve calcification and its interactions with different types of TAVR could identify patients at a high risk for PPMI.

Methods:
This single-center retrospective study included 352 patients treated with TAVR for severe symptomatic aortic stenosis. One hundred ninety-three patients received self-expanding (SE) valves and 159 patients received balloon-expandable (BE) valves. Aortic valve calcification was evaluated using multi-slice computed tomography (MSCT) and 3mensio™ software prior to the TAVR. Total calcium volume (TCV) in the aortic valve was measured in the space ±10 mm of the aortic annulus. In addition, the largest calcium nodule diameter (LCND) was measured at the non-coronary cusp - right coronary cusp commissure, which is anatomically adjacent to the His bundle. TCV and LCND were compared among patients who required PPMI vs. those who did not.

Results:
PPMI was required post-TAVR in 69 subjects (25.9% in SE and 11.9% in BE, p<0.05). TCV was not associated with an increased risk of post-TAVR PPMI. However, the risk of PPMI increased incrementally in patients who received SE valves from LCND measured 1mm, 1-5 mm, 5-10 mm >10mm (
Figure
). There was no significant association between either TCV or LCND and PPMI in BE TAVR.

Conclusions:
PPMI was more common in SE than in BE. The size of LCND was associated an increased risk for SE. The preprocedural assessment of LCND may help the selection of appropriate types of TAVR (SE vs. BE) to reduce the risk for PPMI.
Abstract 14484: Shockwave Lithotripsy as a Non Surgical Modality for Calcified Carotid Stenosis
Authors: Varma Yash K , Dixit Aatrey , Jena Nihar , Patel Kirit
Published: June 2023

An 80-year-old gentleman with significant bilateral carotid artery stenosis and previous right carotid endarterectomy underwent a CT Angiogram of the Head and Neck due to multiple episodes of syncope. The study revealed heavily calcified atherosclerotic disease at the left carotid bulb and bifurcation, causing high-grade luminal stenosis of 80 to 82% at the origin of the internal carotid artery. Hence, a decision was made to obtain a cerebral angiogram. Aortic arch angiogram revealed a type III arch, following which a cerebral catheter wire was engaged in the left carotid artery. A selective angiogram showed 80% calcified stenosis at the level of bifurcation, with the left external carotid artery being 100% occluded. Given the heavily calcified lesion, supra core guidewire was crossed across the lesion, followed by advancement of protection device into the distal segment of the left internal carotid artery. Balloon angioplasty was performed twice from the ostial to the proximal segment of the left internal carotid artery. An attempt was made to place a stent without any success. Subsequently, a decision was made to proceed with shockwave lithoplasty. We inserted a transvenous pacemaker with a backup rate of 40 bpm. A Shockwave catheter was inserted and shockwaves were delivered with multiple inflation techniques at 4 atmospheric pressure for 15 seconds each. Periodic neuro assessments were normal. This was followed by the placement of stents in the distal left common carotid and ostial to proximal left internal carotid artery reducing the calcified 80% stenosed lesion to 10% with excellent angiographic results. Subsequently, the filter and the catheter were removed and the femoral artery access site was secured. The patient tolerated the procedure very well without any immediate or delayed complications. The intracerebral vasculature remained intact as confirmed by a cerebral angiogram. TVP was removed and the patient was discharged in a stable condition after 2 days. Hence, Shockwave lithotripsy can be successfully used for critical carotid artery stenosis in patients that pose a high surgical risk. It helps soften the lesion for better dilatation of the vessel and achieve improved luminal gain for appropriate stent expansion.
Abstract 14493: Strength- and Aerobic-Based Cardiac Rehabilitation Improves Intermediate Outcomes and Functional Capacity in Patients With Diabetes
Authors: Liu Nina , Khong Anthony , Cortez-Toledo Elizabeth , Andrade Humberto , Gonzalez Tinoco Jose , junker margaret , Lopez Javier E
Published: June 2023

Background:
Improvement in cardiorespiratory fitness during comprehensive cardiac rehabilitation (CR) is associated with improved cardiovascular prognosis. However, data on the improvement of intermediate outcomes (IOs) also associated with improved prognosis, i.e., low density lipoprotein (LDL) cholesterol and systolic blood pressure (SBP), in patients living with diabetes (DM) has been conflicting. The aim of this study is to characterize the integrated effects of combining strength and aerobic training on these IOs and functional capacity for patients living with and without DM.

Methods:
We retrospectively reviewed 377 CR program enrollments from 333 individual patients from 12/2019 - 3/2022. Paired functional capacity was assessed by the metabolic equivalent of task (METs) in a 6-minute walk test (6-MWT), arm curl reps, chair-to-stand reps, and timed up and go test. Demographics and IOs were obtained from the electronic records. P-values were determined by the Chi-square test for categorical variables and Mann-Whitney U test for continuous variables.

Results:
Baseline demographics and comorbidities of our cohort are described in Table 1. Patients with DM had more CAD and CKD. All patients undergoing CR showed integrated improvements in LDL with functional capacity in this paired analysis. However, patients without DM demonstrated a more significant reduction in SBP (Table 2).

Conclusions:
Combining strength and aerobic training resulted in integrated improvements in lipids and functional outcomes between patients with and without DM. Our results highlight the efficacy of this combined training for all CR patients, and the need for closer monitoring and management of SBP, a critical disease driver in patients with DM, CAD, and CKD.
Abstract 14503: Cardiac Arrest Secondary to Inferior ST-Segment Elevation Myocardial Infarction in Patient With Paroxysmal Nocturnal Hemoglobinuria and COVID 19 Infection
Authors: Mohamed Mohamed Salah , Salama Amr , Hashem Anas , Hussein Ahmed , Balmer-Swain Mallory
Published: June 2023

Background:
Patients with Paroxysmal Nocturnal Hemoglobinuria (PNH) have attacks of complement-mediated hemolysis that can be spontaneous or secondary to precipitating factors such as infections. During these episodes, these patients have an increased risk of thrombosis, typically venous and rarely arterial. We present a rare case of cardiac arrest due to ventricular fibrillation (VF) and inferior STEMI in a patient with PNH and a recent COVID infection.

Case: 63 years old male patient with a medical history of PNH presented with typical chest pain, fever, cough, jaundice, and dark-colored urine. On examination, he was hemodynamically stable with jaundiced eyes. A few minutes later, he had cardiac arrest due to VF. He achieved return of spontaneous circulation (ROSC) after two defibrillation shocks. EKG showed inferior STEMI. Labs showed hemoglobin of 6.4 g/dl, elevated cardiac markers, serum LDH, and indirect bilirubin. Serum haptoglobin was < 1 mg/dl. His COVID 19 PCR test was positive.

Decision making: He received 2 units of packed RBCs and underwent a coronary angiogram (CA) which revealed total proximal occlusion of the right coronary artery (Figure A). He underwent successful PCI by two drug-eluting stents (figure B). His peripheral blood immunophenotyping and flow cytometry was positive for loss of glycosylphosphatidylinositol-linked antigens and decreased expression of CD 59/14/24. He was started on Ravulizumab, a humanized monoclonal antibody complement five inhibitor.

Conclusion:
PNH and COVID increase the risk of thrombosis. Thrombosis mechanism in PNH includes platelets and coagulation system activation via complement cascade and impairment of the fibrinolytic system. COVID infection increases the risk of thrombosis by endothelial cell dysfunction and release of cytokines. Due to the patient’s acute presentation, he needed to undergo immediate CA and lifesaving PCI regardless of his hematological disorder or active COVID-19 infection.
Abstract 14508: Association of Multi-Ethnic Genome-Wide Blood Pressure Polygenic Risk Score With Adverse Cardiovascular Events
Authors: Parcha Vibhu , Pampana Akhil , Shetty Naman , Irvin Marguerite M , Natarajan Pradeep , Lin Henry , Guo Xiuqing , Rich Stephen S , Rotter Jerome I , Li Peng , Oparil Suzanne , Arora Garima , Arora Pankaj
Published: June 2023

Background:
Traditional cardiovascular (CV) risk factors and the underlying genetic risk of elevated blood pressure (BP) determine an individual’s composite risk of developing adverse CV events. We evaluated the relative contributions of the traditional CV risk factors to the development of adverse CV events in the context of varying BP polygenic risk score (PRS) profiles among multiethnic population-based cohorts (ARIC, MESA, JHS, FHS, CARDIA, and CHS cohort).

Methods:
Multiethnic genome-wide BP PRS was constructed among participants with WGS data through TOPMed program and were stratified into high, intermediate, and low genetic risk (>80
th
, 20-80
th
, <20
th
centile). Based on the ACC/AHA Pooled Cohorts Equation (PCE), participants were stratified into low and high (10y-ASCVD risk: <10% or ≥10%) CV risk factor profile groups. Cox regression was used to assess the risk of adverse CV events (incident HF, CHD, and stroke) and its components.

Results:
Among 21,899 American adults (mean age: 56 years; 56% women; 36% non-White race), 1 SD increase in the BP PRS computed using 1.1 million variants was associated with systolic BP (β: 4.7, 95% CI: 4.5-5.0) and HTN (OR: 1.09, 95% CI: 1.09-1.10), respectively. This association was robustly seen across racial/ethnic groups. Each SD increase in BP PRS was associated with a higher risk of the primary outcome (HR: 1.08 [1.05-1.11]) after controlling for ACC/AHA PCE risk score. Among individuals with a high BP PRS, low ASCVD risk was associated with a 69% lower hazard for the primary outcome (HR: 0.31, [0.27-0.35]) compared with those with high ASCVD risk. A similar pattern was noted in intermediate and low BP PRS groups. Comparable results were noted for all the secondary outcomes.

Conclusions:
In a multiethnic cohort of >21,000 US adults, genome-wide BP PRS was associated with BP traits and adverse CV events. Adequate CV risk factor control may reduce this increased predisposition to adverse CV events by 69% in those with high BP PRS.
Abstract 14518: Social Determinants of Health Impact Cardiac Rehabilitation Referral and Participation Patterns Among Patients With Coronary Heart Disease
Authors: Torres Barba David , Ramirez Nuno Santiago , Dang David , Gallegos Armando , Maloof Zapata Alexandra , Castellanos Luis R
Published: June 2023

Introduction:
Cardiac Rehabilitation (CR) is a medically supervised preventative cardiovascular program recommended following cardiovascular illnesses. Although the benefits of CR are well-studied and participation considered a Class Ia recommendation, referral and participation rates are low.

Hypothesis:
We hypothesized socioeconomic factors negatively impact participation and referral patterns among individuals with CHD.

Methods:
Our prospective study included 561 patients hospitalized with ACS to University of California San Diego Medical Centers in Southern California. Participants included adult patients 18 years or older from rural and urban communities admitted for percutaneous coronary intervention, coronary artery bypass grafting, or acute myocardial infarction. Baseline characteristics were compared by paired t-tests and chi-square analysis for continuous and categorical variables, respectively. Univariable and multivariable logistic regression models were utilized to assess the impact socioeconomic factors have on CR referral and participation patterns.

Results:
Of the 561 enrolled participants, 317 were referred to CR. Income, language, and urban/rural setting were found to be statistically significant in the univariate and multivariate analysis with those with incomes above 60 K/year being 1.73 times more likely to be referred than those with income <30K/year (95% CI 1.00-2.99), English speakers 3.53 times more likely to be referred than Spanish speakers (95% CI 1.83-6.94), and those in urban settings 2.12 times more likely to be referred than those in rural settings (95% CI 1.29-3.50). Among the 317 referred patients, 75.4% participated in at least one CR session. In those referred, after adjusting for cofounding factors, language and city setting were the most significant factors impacting participation, with English speakers being 3.8 times more likely to participate than Spanish speakers (95% CI 1.28-11.99), and those living in urban setting being 2.33 times more likely to participate than those living in rural areas (95% CI 1.00-5.37).

Conclusions:
The identification of significant socioeconomic factors can help implement institutional initiatives that eliminate the disparities identified.
Abstract 14560: Prevalence and Correlates of Echocardiographic Abnormalities in Type 2 Diabetes: Insights From iCaReMe Global Registry
Authors: Kosiborod Mikhail N , Lam Carolyn S , Khunti Kamlesh , Lambers Heerspink Hiddo , Nicolucci Antonio , Joshi Shashank , Fenici Peter , Surmont Filip , Goncalves Susana , Vasnawala Hardik , Vazquez Estefania , HADAOUI Ahmed
Published: June 2023

Background:
T2D is a major risk factor for cardiovascular (CV) burden. Opportunities for early prevention are often missed due to lack of detection of preclinical end- organ damage. To gain insights on cardiac structural disorders in T2D, we assessed the prevalence of echocardiography (echo) abnormalities and correlates in individuals with T2D enrolled in iCaReMe Registry (NCT03549754)

Methods:
The iCaReMe is a multinational, observational registry which aims to provide real world data on patient characteristics, disease management, and outcomes in type 2 diabetes, chronic kidney disease and heart failure. We report data of adults (>18 years) with T2D but no known cardiorenal complications at index visit enrolled between December 2020 and December 2021 from 5 countries – Egypt, India, Mexico, Malaysia, and the Philippines.

Results:
Among 11415 enrolled subjects (mean± SD age, 54.4±11.21years; 59.4% women), the mean±SD glycated hemoglobin (HbA1c) was 8.5±2.17%. Mean±SD systolic and diastolic blood pressure (mm/Hg) were 127.5±15.39 and 75.0±11.77, respectively. Mean duration of T2D was 10.2±8.03 years, 36.3% had history of hypertension (HTN). 43.7% were obese, 39% had high/very high CV risk according to 2019 ESC risk estimation and 29.4% had A2/A3 albuminuria. Of individuals with documented echo data (1506 [13.2%]), 450 (29.9%) had at least one abnormality— 260 (17.3%) left ventricular hypertrophy (LVH), 253 (16.8%) left atrial enlargement (LAE), 65 (4.3%) diastolic dysfunction, 62 (4.1%) pulmonary hypertension, and 57 (3.8%) valvular disease. In multivariate analysis, age and history of HTN were associated with LVH, while age, obesity, history of HTN, T2D duration, and A3 albuminuria category were associated with LAE (Table).

Conclusion:
Among patients with T2D in real world settings, there was a high burden of preclinical structural heart disease. Older patients with obesity, HTN, longer duration of T2D and proteinuria should be considered for screening.
Abstract 14591: Incidence of High-Risk Patients After Percutaneous Coronary Intervention for Coronary Stent Thrombosis Without Neointima Formation on Coronary Artery Stent Evaluated by Coronary Angioscopy and With High Whole Blood Platelet Aggregation
Authors: Funabashi Nobusada , Akaza Shin , Misumi Kazuo
Published: June 2023

Introduction:
The risk of coronary thrombosis after percutaneous coronary intervention (PCI) is high in the absence of neointima formation on coronary artery stents, evaluated by coronary angioscopy, and high whole blood platelet aggregation.

Hypothesis:
For high risk patients, despite dual antiplatelet therapy, coronary angioscopy should be used to check for neointima formation and/or whole platelet aggregation measured.

Methods:
This is a retrospective analysis of 2757 stents from 2757 patients (2024 male, mean 71±10 years) who underwent coronary angioscopy (timing determined by physicians) 3-12 months after PCI. The whole blood platelet aggregatory threshold index (PATI; WBA-Neo, ISK, Osaka, Japan) was calculated. For coronary angioscopy, we categorized neointima formation on stents: Grade 0) no neointima; 1) strut surrounded by neointima but not completely buried; 2) strut completely buried by neointima but still observable through neointima; 3) strut completely buried by neointima and not observable. PATI (μM) measured the minimum concentration of adenosine 5'-diphosphate causing non-reversible platelet aggregation and indicated platelet aggregation (range 0-8). The higher the PATI, the lower the platelet aggregation.

Results:
On coronary angioscopy, 689, 1341, 543, and 144 stents were Grade 0, 1, 2, and 3, respectively. The 689 stents in Grade 0 from 689 patients consisted of 207 (of 824=25%) Xience, 189 (of 579=33%) Combo, 117 (of 583=20%) Synergy, 91 (of 382=24%) Ultimaster, 26 (of 118=22%) BMX-J, 23 (of 94=24%) Orsiro, 18 (of 108=17%) Resolute, 3/10 (30%) NOBORI, and 1/6 MULTI LINK8 stents. Of 689 patients with Grade 0 stents, 14 had PATI <2 (high platelet aggregation); eight 2-2.99; 29 3-3.99; nine PATI ranged 4-4.99; 10 5-5.99; 13 6-6.99; 17 7-7.99; and 589 >8.00 (low platelet aggregation). Of 14 patients with Grade 0 stents and PATI<2, two underwent single and 12 double antiplatelet drug therapies.

Conclusions:
14 of 2757 patients (0.5%) simultaneously showed Grade 0 stents on coronary angioscopy and PATI <2; we speculated such patients required additional antiplatelet drug therapy. The incidence of such high-risk patients after PCI was very low. Whole platelet aggregation should be checked despite dual antiplatelet therapy results.
Abstract 14604: Arrhythmia Burden With Right-Heart Catheterization: A Systematic Review and Meta-Analysis
Authors: Vallabhajosyula Saarwaani , Hafez Nada , Babayale Omofolarin , Elkhapery Ahmed , Boppana Hemanth Krishna , Balmer-Swain Mallory
Published: June 2023

Background:
Current guidelines cite complete heart block as a complication of invasive hemodynamic monitoring. This was described to be higher in those with existing intraventricular conduction delays. The objective of this meta-analysis was to evaluate the true risk of arrhythmias and pacemaker implantation rates in patients undergoing right-heart catheterization or with pulmonary artery catheter use.

Methods:
A literature search was performed from inception until May 2022. Studies that reported incidence rates of arrhythmias in those undergoing right-heart catherization or with pulmonary catheter use, including right- (RBBB) and left-bundle branch (LBBB), were included. Some studies described the development of complete heart block (CHB) and need for pacing.

Results:
Six single-center studies were included in our analysis with a total of 8, 077 right-heart catheter insertions. All patients had continuous ECG monitoring. Most frequently reported arrhythmia was premature ventricular ectopy (56.4%). No fatal ventricular arrhythmias were described and when noted, RBBB was transient in nature (0.2%, n=12/7577). The risk of CHB was 12.8% (n=24) in those with pre-existing LBBB (n=187). Pacing needs were infrequently described, but when reported was 6.3% (n=10) of concordant CHB and LBBB (n=160), and this was 0.2% of all described LBBB patients (n=6292) (
Figure
).

Conclusion:
Most arrhythmias were benign and transient in nature. The risk of CHB requiring pacing needs was only 0.2%. This begs the question of true burden of the theoretical complication of CHB with invasive hemodynamic monitoring, and most evidence is from decades ago.
Abstract 14607: Discharge Education Based on Teach-Back Method Improves Outcomes in Patients With Heart Failure
Authors: Oh Sunyoung , Lee Ji Yea , LEE HYUN JOO , Oh Eui Geum
Published: June 2023

Introduction:
Heart failure (HF) is one of the most common causes of hospital readmission. Self-care is essential but challenging task in patients with HF, and self-care deficit is closely related to unplanned readmission and unnecessary health expenditure. Patient centered education using teach-back method (TBM) emerged as a key strategy to prevent patients’ adverse events by improving self-care. This study aims to evaluate the effects of TBM in patients with HF.

Hypothesis:
HEART program
®
, a TBM-based discharge education, will significantly improve self-care, symptom experience, caregiver dependency, and unplanned healthcare utilization.

Methods:
This was a randomized controlled trial in HF patients with left ventricular ejection fraction ≤50%. Before discharge, the experimental group (EG) received HEART program
®
by a trained nurse, while the control group (CG) received usual discharge education. Measures were self-care (self-care maintenance; symptom-perception; self-care management), symptom experience, caregiver dependency at 7-days after discharge, and healthcare utilization (readmission; emergency room visit; hospital contact, etc.) at 1-month after discharge. Outcomes were analyzed with ANCOVA and Chi-squared test using SPSS program 25.

Results:
A total of 86 patients (EG = 40, CG = 46) completed the study (mean age 61±12 years; mean left ventricular ejection fraction 30±9%; mean duration of illness 4 years; mean hospitalization day 8±7). Self-care (self-care maintenance,
F
=12.3; symptom perception,
F
=15.4; self-care management,
F
=6.0) in the EG significantly improved compared with the CG (all
P
s<.01). On the other hand, there were no significant differences in symptom experience and caregiver dependency between the two groups (all
P
s>.05). For healthcare utilization, only hospital contact via telephone was significantly different between the EG and CG (N=1 vs. 8;
P
=.032).

Conclusions:
This result indicates that discharge education based on TBM is an effective strategy to improve self-care ability, which could lead to reducing unplanned health expenditure in patients with HF. We suggest that healthcare providers implement TBM education for patients with chronic HF.
Abstract 14613: Amyloidosis-Related Orthopedic Events, Low Plasma Transthyretin, and Risk of Cardiac Events
Authors: Greve Anders M , Christoffersen Mette , Hornstrup Louise S , Frikke-Schmidt Ruth , Nordestgaard Borge G , Tybjaerg-hansen Anne
Published: June 2023

Introduction:
Carpal tunnel syndrome, spinal stenosis, and biceps tendon rupture may precede cardiac transthyretin amyloidosis (ATTR-CA).

Hypothesis:
We tested the hypothesis that amyloidosis-related orthopedic events herald amyloidosis and cardiac events consistent with ATTR-CA through transthyretin destabilization.

Methods:
In observational analysis in the Copenhagen General Population Study (CGPS; n=93,637), we first tested whether amyloidosis-related orthopedic events at baseline were associated with amyloidosis and incident cardiac events consistent with ATTR-CA (heart failure, atrial fibrillation, myocardial infarction, or death), and whether a low plasma transthyretin was associated with a higher risk. In genetic analysis, in CGPS and the Copenhagen City Heart Study(CCHS) combined (n=102,496), we tested whether
TTR
genotypes associated with stepwise lower plasma transthyretin, marking lower transthyretin tetramer stability and higher amyloidogenic potential, was associated with both orthopedic and incident cardiac events, implying a common mechanistic background through transthyretin destabilization.

Results:
In individuals with versus without orthopedic events at baseline, hazard ratios (HRs) were 10.7 (95% CI: 3.9-29.3) for amyloidosis, and 1.3(1.1-1.4) for cardiac events. Furthermore, in individuals with orthopedic events at baseline, HRs for cardiac events were 3.8(1.9-7.6) in those with transthyretin <20 mg/dL versus ≥20 mg/dL (Figure 1). Finally, HRs as a function of
TTR
genotype increased with lower transthyretin and lower transthyretin tetramer stability up to 3.0(1.4-6.6) for orthopedic events and 1.6(95% CI: 1.0-2.6) for cardiac events.

Conclusion:
Amyloidosis-related orthopedic events are associated with increased risk of incident cardiac events, with the highest risk in those with low transthyretin levels. Orthopedic and cardiac events are linked through transthyretin tetramer destabilization.
Abstract 14622: Macrophage Dectin-1 Targeted Photoactivation Promotes Inflammation Resolution With Stabilization of the High-Risk Atheroma as Serially Assessed by Intravascular OCT-NIRF Imaging
Authors: Kim Jin Hyuk , Kim Yeon Hoon , Ahn Jae Won , Kim Hyun Jung , Kim Ryeong Hyun , Song Joon Woo , Park Ye Hee , Nam Hyeong Soo , Kang Dong Oh , Yoo Hongki , Park Kyeongsoon , Kim Jin W
Published: June 2023

Backgrounds:
Atherosclerosis is a chronic inflammatory disease causing a fatal plaque rupture and its key aspect is a failure to resolve inflammation. We hypothesized that macrophage targeted near-infrared fluorescence (NIRF) emitting photoactivation could simultaneously
in vivo
assess the inflamed high-risk plaques and facilitate the inflammation resolution.

Method and results:
We newly synthesized a Dectin-1 targeted photoactivatable theranostic agent by the chemical conjugation of photosensitizer chlorin e6 (Ce6) and Dectin-1 ligand laminarin (LAM-Ce6). Intravascular photoactivation through a customized fiber-based diffuser effectively reduced inflammation in the targeted plaques 4 weeks after LAM-Ce6 administration as serially assessed by dual-modal optical coherence tomography (OCT)-NIRF catheter imaging. The number of TUNEL-positive apoptotic macrophages peaked at 1 day after laser irradiation, and then resolved until 4 weeks. One hour after the light therapy, autophagy was strongly augmented with the formation of autophagolysosomes revealed by co-localization of enhanced microtubule-associated protein light-chain 3 (LC3) and lysosome-associated membrane protein 2 (LAMP2) expressions in the plaques (Figure). LAM-Ce6 photoactivation increased the TUNEL/RAM11- and MerTK-positive cells in the plaques, suggestive of enhanced efferocytosis. In line with inflammation resolution, photoactivation reduced the plaque burden with collagen-rich fibrotic replacement via TGF-β pathway confirmed by corroborative immunostainings (
p
<0.01).

Conclusions:
OCT-NIRF imaging-guided macrophage Dectin-1 targetable photoactivation could stabilize the inflamed high-risk plaques by autophagy-mediated inflammation resolution and TGF-β dependent fibrotic replacement. This novel targeted photoactivation will offer new opportunity for the catheter based theranostic strategy.