bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13847: The Ross Procedure versus Mechanical versus Bioprosthetic Aortic Valve Replacement: A Network Meta-Analysis
Authors: Yokoyama Yujiro , Kuno Toshiki , Toyoda Nana , Fujisaki Tomohiro , Takagi Hisato , Itagaki Shinobu , Ibrahim Michael , Ouzounian Maral , El-Hamamsy Ismail , Fukuhara Shinichi
Published: June 2023

Background:
The Ross operation appears to restore normal survival in young and middle-aged adults with aortic valve disease. However, there is limited data comparing it to conventional aortic valve replacement options. Objectives: To compare outcomes of the Ross procedure, mechanical and bioprosthetic aortic valve replacement (M-AVR, B-AVR).

Methods:
MEDLINE and EMBASE were searched through March 2022 to identifyrandomized controlled trials (RCTs) and propensity-score matched studies (PSMs) that investigated outcomes of patients ≥16-year-old undergoing the Ross procedure, M-AVR or B-AVR.

Result:
The systematic literature search identified 2 RCTs and 8 PSMs involving a total of 4,812 patients (Ross: n=1,991; M-AVR: n=2,019; B-AVR: n=802). All-cause mortality was significantly lower in the Ross procedure group compared with M-AVR (hazard rate (HR) [95% confidence interval (CI)]=0.58 [0.35-0.97], P=0.035) and BAVR (HR [95% CI]=0.32 [0.18-0.59], P <0.001) groups. The reintervention rate was lower in the Ross and M-AVR groups compared with B-AVR (HR [95% CI] =0.31 [0.15-0.65], P=0.002, HR [95% 272 CI] =0.15 [0.05-0.41], P< 0.001, respectively), while it was higher after the Ross procedure compared with M-AVR group (HR [95% CI] =2.12 [1.04-4.33], P=0.039). However, post-Ross reinterventions included both autograft and right ventricular outflow tract. Major bleeding rate was lower after the Ross procedure compared with M-AVR. Long-term stroke rate was lower following the Ross procedure compared with M-AVR and B-AVR. The rate of endocarditis was also lower after the Ross procedure compared with B-AVR.

Conclusion:
Improved long-term outcomes of the Ross procedure are demonstrated compared with conventional M-AVR and B-AVR options. These results highlight a need to enhance the recognition of the Ross procedure and revisit current guidelines regarding the optimal valve substitute for young and middle-aged patients.
Abstract 13866: Interventional Heart Failure: Current State of the Field
Authors: Alvarez Miguel , Diakos Nikolaos , Larson Ian , Mustehsan Mohammad Hashim , Kapur Navin K
Published: June 2023

Introduction:

The expanding intersection between interventional cardiology (IC) and advanced heart failure (AHF) has raised interest in an Interventional Heart Failure (IHF) specialty.

Methods:
We conducted a survey among cardiologists trained in AHF and IC to investigate the state of this new field. This was distributed by the Society of Cardiovascular Angiography and Interventions (SCAI) via their newsletter and publicized via Twitter.

Results:
Data from 55 respondents in 47 medical centers (22% outside the United States) was acquired. In the US, these centers are concentrated in the South (43%) and Northeast (23%), and commonly host advanced therapies programs: 89% ECMO, 69% durable LVAD and 56% heart transplant. Respondents were 94% men; 47% were 35-45 y. and 41% were >45y. old. Foreign physicians accounted for 13%. In the US, 56% of respondents were international medical graduates (IMGs) and 31% were American medical graduates (AMGs). Most completed training after 2013 (69%). IC fellowship was completed first by 47% of AMGs, 50% of IMGs (Figure). Only 23% trained beyond AHF and IC. Area of clinical focus is coronary artery disease (CAD) 42%, cardiogenic shock (CS) 40%, structural procedures 13%. Respondents regularly implant IABP (95%), Impella (83%) and VA-ECMO (69%). Time devoted to IC is 50-80% in 49% (Figure). Most take STEMI call (84%) and do CCU rounds (95%) while only 21% take donor call. Only 32% feel their training was excessive and 82% would repeat it. Most (84%) support the creation of integrated 2-year AHF and IC fellowships.

Conclusions:
We report the first survey assessing the IHF specialty. We observed a growing workforce focused on CAD, mechanical circulatory support and CS. Development of integrated training pathways is viewed favorably by the IHF community.
Abstract 13869: Outcomes of Right Heart Catheterization in Patients With ST-Elevation Myocardial Infarction and Cardiogenic Shock: A Nationwide Analysis From the United States
Authors: Ismayl Mahmoud , Goldsweig Andrew M , Altin Elissa
Published: June 2023

Introduction:
The role of continuous hemodynamic assessment with right heart catheterization (RHC) in the management of cardiogenic shock (CS) continues to be debated. There are limited data exploring the outcomes of RHC in patients with ST-elevation myocardial infarction (STEMI) and CS. This study aims to assess the outcomes of RHC in patients with CS secondary to STEMI.

Methods:
This is a retrospective study of the Nationwide Inpatients Sample database that identified patients hospitalized with STEMI and CS on mechanical circulatory support with percutaneous left ventricular assist device to compare outcomes in those treated with RHC versus no RHC. Our primary outcome was in-hospital mortality. Secondary outcomes included cardiac, renal, neurologic, and pulmonary complications, need for blood transfusion, hospital length of stay (LOS), and total cost. The trends of RHC utilization were also evaluated.

Results:
The total cohort included 11,235 patients hospitalized for STEMI and CS between 2016-2019, of which 4,180 (37.2%) underwent RHC. Despite the higher comorbidity burden in the RHC group, there was a trend towards improved in-hospital mortality with RHC compared to no RHC (42% vs. 46%, p=0.07). However, RHC was associated with significantly higher renal (61% vs. 55%, p=0.01) and pulmonary complications (67% vs. 59%, p<0.001) and more blood transfusions (18% vs. 14%, p=0.005). There were no significant differences in cardiac (58% vs. 56%, p=0.19) and neurologic complications (6% vs. 5%, p=0.15) between both groups. The LOS was longer and the cost was higher with RHC. There was a trend towards increased RHC utilization from 2016-2019 (p<0.001).

Conclusions:
Although non-significant, RHC in STEMI patients with CS is associated with reduced in-hospital mortality. Given the possible mortality benefit with RHC, further research is necessary to optimize utilization of RHC while reducing complications in STEMI patients with CS.
Abstract 13878: A Case of Severe Tricuspid Regurgitation, Recurrent Ascites, Worsening Renal Function Leading to Hemodialysis Secondary to RV Lead Impingement, Resolved Completely With Lead Extraction
Authors: jaikumar likhitesh , Priyadarshini Anju , Menon Vivek , Chib Anjula , Sharifi Sasha , Volansky Paul , Charlton Sandra , JAGTAP DO MANDAR , McGrew Frank A
Published: June 2023

Introduction:
1. In contemporary practice, implantation of Cardiovascular Implantable Electronic Devices (CIED) is associated with low complication rate peri-procedurally. 2. However, in some patients these complications can have high morbidity and mortality; namely pneumothorax, pericardial tamponade, pacemaker syndrome, and rarely tricuspid regurgitation (TR) secondary to lead impingement. 3. TR secondary to RV lead impingement is not uncommon but infrequently lead to severe TR and worsening heart failure symptoms. 4. We present a case of severe TR secondary to RV lead impingement leading to splanchnic congestion and recurrent ascites, worsening renal failure leading to hemodialysis (HD), all of which resolved with lead extraction.

Case:
A 77-year-old woman with known CAD with prior PTCA, paroxysmal AF, and prior watchman implantation, evaluated in our clinic for severe TR. She had recurrent admissions for ascites needing paracentesis. Her liver function and ultrasound was normal. Her renal function worsened and HD was initiated. ECHO showed normal LVEF, severe TR with RVSP of 74mmHg, and mild RV dysfunction. Pericardial physiology was normal. The lead was noted to be impinging on the septal leaflet, and adherent. Normal pulmonary valve function.

Follow up:
We proceeded to perform RV lead extraction and implanted a new leadless pacemaker [MICRA-AV, Medtronic Inc]. Her follow up ECHO in 2 weeks showed mild TR and normal RV function. RVSP had dropped significantly to 34mmHg. Surprisingly, her needs for paracentesis came down and by 3 months follow up she did not need paracentesis anymore. Her renal function improved, and her HD needs stopped.

Conclusions:
1. CIED implantations are associated with low complication rate (less than 5% in total) in most patient cohorts but in some patients it can be associated with significant complications increasing their morbidity and sometimes mortality. 2. Severe TR is a well-recognized complication of pacemaker implantation. It led to recurrent ascites needing paracentesis, ESRD requiring HD and multiple hospital admissions and thus increasing the morbidity. 3. It is important to recognize the uncommon complications of such commonly used intracardiac devices for electrophysiologists, cardiologists and PCPs.
Abstract 13882: Impact of Dementia on Inpatient Outcomes and Readmission Risks After Transcatheter Aortic Valve Replacement
Authors: Park Dae Yong , Sana Muhammad Khawar , Shoura Sami , Hammo Hasan , Hu Jiun-Ruey , Lowenstern Angela , Ahmad Yousif , Nanna Michael
Published: June 2023

Introduction:
The prevalence of both aortic stenosis (AS) and dementia increases with age, but studies evaluating in-hospital outcomes and readmission risk after transcatheter aortic valve replacement (TAVR) in patients with dementia are scarce.

Hypothesis:
The presence of dementia is associated with higher rates of adverse in-hospital outcomes and readmissions following TAVR.

Methods:
Using the National Readmissions Database 2017-2018, we identified all admissions for TAVR in patients with AS and stratified them to those with and without dementia. We assessed delirium and falls in hospital using multivariable logistic regression, and 90-day readmissions using multivariable Cox proportional-hazard modeling, adjusted for demographics, comorbidities, hospital characteristics, primary payer, median income, and elective admission status.

Results:
Among 48,923 TAVR procedures, 2,192 (4.5%) were performed in patients with dementia. Patients with dementia experienced higher odds of delirium (adjusted odds ratio [aOR] 4.50, 95% confidence interval [CI] 3.35-6.05, p<0.01) and fall in hospital (aOR 2.34, 95% CI 1.39-3.95, p<0.01) during hospitalization for TAVR. Patients with dementia also experienced an increased hazard of 90-day readmission (adjusted hazard ratio 1.14, 95% CI 1.04-1.25, p<0.01) (Figure 1). Causes of 90-day readmission were mostly non-cardiovascular.

Conclusions:
Patients with dementia undergoing TAVR suffered from increased odds of delirium and falls, with a higher hazard of 90-day readmission after discharge. These findings should be integrated into shared decision-making before elective TAVR.
Abstract 13884: Cardiopulmonary Exercise Testing Delineates Underlying Mechanisms of “Good” and “Poor” Exercise Performance in Post-Fontan Patients
Authors: Tsuda Takeshi , Kernizan Daphney , D Aloisio Gina
Published: June 2023

Background:
Fontan patients have limited exercise capacity primarily due to an absence of subpulmonary ventricle by which ventricular filling is hindered in response to incremental exercise. Little is understood as to how to improve exercise performance in Fontan patients.

Methods:
Cardiopulmonary exercise testing (CPET) in Fontan patients were studied retrospectively. The patients were divided into “Good” and “Poor” performance by peak oxygen consumption (pVO2) at 35 and 30 ml/kg/min for males and females, respectively. Data are shown as mean ± standard deviation.

Results:
Table 1 presents demographic data and CPET results of males and females with “Good” and “Poor” exercise performance (total 36 patients). Ventilatory anaerobic threshold (VAT) and peak work rate (pWR) were significantly lower in male “Poor” group than in male “Good” group whereas no significant difference was noted in female groups other than pVO2. A specific trend of each group emerged when weight (kg)-pVO2 (L/min) and maximum minute ventilation (maxVE: L/min)-pVO2 (L/min) relationship were assessed, which indicated that “Good” Fontan had higher skeletal muscle mass effects in given weight and better ventilatory efficiency for oxygenation, respectively, than “Poor” group (Figure 1).

Conclusions:
Under the same single ventricle physiology which mitigates ventricular filling, some Fontan patients showed better exercise performance than others due to higher skeletal muscle mass effects and better ventilatory efficiency for oxygenation. A simple method of plotting of 2 CPET parameters may be useful in assessing improvement in exercise performance by muscle and breathing training in Fontan patients.
Abstract 13924: Impact of a Pandemic on Women Diagnosed With Peripartum Cardiomyopathy
Authors: Shahin Omar K , Shahin Hania N , Hyunju Heineke S , Biswas Mimi S
Published: June 2023

Background:
Peripartum cardiomyopathy (PPCM) is a dilated form of cardiomyopathy that occurs during the last month of pregnancy or up to five months postpartum. Approximately 1,100 women develop PPCM in the United States each year. The aim of our study is to compare the incidence of PPCM prior to the start of the Coronavirus Disease 2019 (COVID) pandemic to afterwards and to determine the impact of COVID on hospitalized patients with PPCM.

Methods:
This was a retrospective study of 2,286 patients with a diagnosis of PPCM who were admitted to a private hospital system across the United States between the year 2017 and year 2021. There was 1,790 patients in the pre-COVID cohort, and 496 patients in the COVID era cohort. Demographics of patients were collected, with t-test and chi square p-values utilization for statistical description.

Results:
The mean age of women was 32.13 years. In the COVID era cohort, the percentage of Hispanic patients was significantly higher than the pre-COVID era (16.84% vs. 12.34%, p=0.012). In the COVID era, patients were more likely to have preeclampsia (20.16% vs. 13.52%, p<0.001), HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome (2.62% vs. 0.61%, p<0.001), respiratory failure (19.56% vs. 10.57%, p<0.001), and myocardial infarction (3.63% vs. 1.90%, p=0.022). There was no significant difference in troponin and d-dimer values between the two era cohorts. The average length of stay, percentage of patients admitted to the intensive care unit (ICU), and death did not significantly differ between the pre-COVID and COVID era cohorts.

Conclusion:
In our study, although there was no significant difference in length of stay, ICU admission, or death in the COVID era cohort, myocardial infarction, preeclampsia, HELLP syndrome, and respiratory failure were each more prevalent in women with PPCM during the COVID era. These findings might indicate suboptimal access to outpatient and inpatient medical care during the COVID pandemic, which could have led to these more serious diagnoses.
Abstract 13932: Association of Heparin Exposure With 5-year Mortality and Heart Failure in Patients With End-Stage Kidney Disease on Hemodialysis
Authors: Miller Alec , Jacobs Mark , Khan Sobia , Mallipattu Sandeep , Kalogeropoulos Andreas P
Published: June 2023

Introduction:
Fibroblast growth factor (FGF) 23 is strongly upregulated in end-stage renal disease (ESRD) on dialysis and induces left ventricular hypertrophy (LVH) through activation of cardiac FGF receptor 4. Recent experimental animal data suggest that heparin acts as a co-receptor for FGF23, promoting binding to cardiac cells and LVH.

Hypothesis

We hypothesized that mortality and HF risk would be higher among patients with ESRD on hemodialysis who are regularly exposed to heparin during dialysis sessions.

Methods:
Using data from the TriNetX Research Network, we identified patients with ESRD (ICD-10 code N18.6) who received dialysis services (Z49.X) or were dependent on dialysis (Z99.2), for ≥5 instances 1 month apart, during years 2011-2017. Patients were stratified by heparin exposure during dialysis (≥5 instances vs. no exposure). Patients on peritoneal dialysis were excluded. We examined 5-year mortality and HF risk, after matching for demographics, background conditions, laboratory values, and vital signs at baseline. We used Kaplan-Meier estimates for incidence and Cox proportional hazards models for hazard ratios.

Results:
We matched 2131 patients who were exposed to heparin (≥5 instances) during dialysis and 2131 who were not. The two cohorts were balanced for characteristics, as evident from standardize mean differences <0.1,
Table 1.
Kaplan-Meier mortality at 5 years was 44.4% in the heparin-exposed cohort vs. 31.4% in the non-exposed cohort (HR 1.39, 95%CI 1.24-1.55; P<0.001). Incidence of HF at 5 years was also higher with heparin exposure: 44.3% vs. 34.0% in the non-exposed cohort (HR 1.35, 95% CI 1.17-1.5; P<0.001).

Conclusion

In this comparative retrospective study of propensity score matched patients with ESRD on dialysis, regular exposure to heparin was associated with higher mortality and HF risk at 5 years. Despite the shortcomings of a retrospective study, these hypothesis-generating findings merit investigation in prospective studies.
Abstract 13949: Age-Dependent Detection of Atrial Fibrillation With Implantable Cardiac Monitors in Patients With Cryptogenic Stroke
Authors: Uhe Tobias , Keilitz Janina , Berrouschot Jörg , Wachter Rolf
Published: June 2023

Introduction:
Prolonged and intensified rhythm monitoring is recommended to detect atrial fibrillation (AF) in patients with cryptogenic stroke (CS). Continuous monitoring using implantable cardiac monitors (ICM) results in AF detection rates of up to 30%. Although higher age has been identified as an independent risk factor for AF after CS, there are no specific recommendations for the implantation of ICM in younger patients.

Hypothesis:
AF dectection in young patients (< 60 years) with CS and continuous rhythm monitoring is low.

Methods:
From 02/2014 to 11/2021, 186 patients (mean age 65 ± 12 years) with cryptogenic stroke were included in this analysis. All patients underwent 72-h ECG monitoring, transcranial Doppler Ultrasound and transthoracic echocardiography according to current guidelines. Follow-up was performed by means of a regular outpatient presentation every three months and included medical history, physical examination, and interrogation of the ICM. AF was defined as any episode of absolute arrhythmia >30 seconds.

Results:
AF was detected in 62 patients (33 %) during a mean follow-up of 36 ± 23 months. AF was found in 6 % (3/52), 27 % (17/62), 56 % (31/55) and 65 % (11/17) (p < 0.001) in patients aged < 60 years, 60-69 years, 70-79 years and ≥ 80 years, respectively (see Figure 1). All patients with AF under 60 years had an impaired systolic left ventricular function (left ventricular ejection fraction < 50 %).

Conclusions:
In cryptogenic stroke patients, detection of Atrial Fibrillation by implantable cardiac monitors increases with advanced age. In patients younger than 60 years, Atrial Fibrillation was only detected in patients with impaired systolic left ventricular function. The diagnostic benefit of ICM implantation in young patients with cryptogenic stroke and preserved LV function is limited. Possibly positive predictors for AF detection should be identified and considered in the decision to implant cardiac monitors.
Abstract 13950: Dynamic Myocardial Systolic and Diastolic Response to Exercise in Patients After the Fontan Operation
Authors: Borhanuddin Boekhren Karyostyko , Dragulescu Andreea , Slorach Cameron , Hui Wei , Fan Chun-po S , Mueller brigitte , Cifra Barbara , Mertens Luc L
Published: June 2023

Background:
Exercise capacity is one of the predictors of morbidity and mortality in patients after the Fontan circulation. The influence of myocardial systolic and diastolic functional reserve on exercise performance has not been well established in this population. This study aimed at studying the myocardial response to exercise in Fontan patients using exercise echocardiography.

Methods:
Twenty-three Fontan patients with baseline ejection fraction >55% and 23 age and gender matched controls were included. A stepwise exercise stress echocardiography protocol was used. Tissue Doppler imaging (TDI) systolic (s’), and early diastolic (e’) velocities and myocardial acceleration during isovolumic contraction (IVA) were measured in the free wall of the dominant ventricle and interventricular septum and in the left ventricular free wall and septum of controls. Measurement was taken at rest and at incremental heart rate (HR). Changes in tissue Doppler velocities versus heart rate were studies and compared between patients and controls.

Results:
Resting HR was not significantly different between patients and controls but peak HR was lower in the Fontan group vs controls (
p
<0.001). At rest patients had significantly lower lateral and septal e’ and s’ compared to controls (lateral s’: 6.35±1.05 vs. 14.41± 1.88 cm/s; lateral e’: 9.38±1.71 vs.20.66±2.55 cm/s; septal s’: 5.30±2.46 vs. 11.58±2.26 cm/s; septal e’: 10.45±2.46 vs. 17.80±1.58 cm/s
P
<0.001) except for IVA. At peak exercise, all variables were significantly lower in the patient group. During exercise, the slopes of lateral and septal s’ and IVA were significantly different between patients and controls except for e’.

Conclusion:
Our data suggest that patients with Fontan physiology have blunted systolic contractile response to exercise. Surprisingly our data suggest that the dynamic early diastolic myocardial reserve is preserved which suggest that early myocardial relaxation is not a limiting factor.
Abstract 13962: Anemia Correction Improves Mortality and Other Outcomes in Patients With Incident Atrial Fibrillation: A Nationwide Cohort Study
Authors: Byun Jee Hyuk , Lim Ha Jeong , Yang Pil-sung , Sung Jung-Hoon , JOUNG BOYOUNG
Published: June 2023

Background:
Emerging evidence has suggested that anemia in patients with atrial fibrillation (AF) may lead to poor outcomes. We investigated the association of anemia after AF diagnosis with mortality and cardiovascular (CV) events.

Methods:
Using the database of Korean National Health Insurance Service and health examination, a total of 102,801 patients newly diagnosed with AF (2005-2015) were categorized into four groups according to the status of anemia before and after AF diagnosis. The primary outcomes were all-cause mortality and composite of CV death, ischemic stroke, heart failure hospitalization, or acute myocardial infarction.

Results:
The median follow-up duration was 5.3 years. Among AF patients with anticoagulation, the non-anemia to anemia and consistent anemia groups were associated with a higher risk of mortality (hazard ratio [95% CI]: 1.56 [1.34-1.80] and 1.59 [1.30-1.95]) and CV composite outcome (1.30 [1.15-1.47] and 1.28 [1.09-1.51]) compared to the consistent non-anemia group, respectively. Correction of anemia after diagnosis of AF (anemia to non-anemia group, HR [95%CI]: 1.38 [1.13-1.69]) showed a lower risk of mortality compared to the patients with persistent uncorrected anemia (consistent anemia group, 1.59 [1.30-1.95]). These results were consistently observed in AF patients without anticoagulation.

Conclusions:
Anemia was associated with an increased risk of mortality and CV outcomes in patients with newly diagnosed AF. Anemia correction after AF diagnosis could reduce the risk of subsequent CV events and mortality. Correction of anemia should be encouraged as part of a comprehensive approach to AF management to improve outcomes.
Abstract 13978: Biologic versus Imaging Markers Predicting Readmission and Death in Heart Failure With Preserved Ejection Fraction
Authors: Wengrofsky Aaron J , Majmudar Ushma V , Atienza Matthew , Castagna Francesco , Hanif Waqas , Garcia Mario J
Published: June 2023

Introduction:
Increased B-type Natriuretic Peptide (NT-proBNP) levels have been associated with adverse outcomes in patients with heart failure with preserved ejection fraction (HFpEF). Global longitudinal strain (GLS) and wall stress (WS) are frequently reported to be abnormal in these patients as well, but studies examining how structural changes in those with HFpEF affect morbidity and mortality have been scarce.

Hypothesis:
NT-proBNP is a stronger predictor of death and heart failure readmissions in HFpEF patients when compared to GLS and WS.

Methods:
We conducted a retrospective study of 237 patients admitted with acute decompensated heart failure, all with EF
>
50. Average age was 78
+
11, 69% of patients were female, and average BMI was 29
+
13. GLS was measured using speckled tracing echocardiography and WS was calculated from systolic blood pressure, end-systolic left ventricular (LV) dimension, and end-systolic posterior wall thickness.

Results:
During a follow-up period of 2 years, 55 patients died and 55 were readmitted with the diagnosis of acute decompensated heart failure. Mean NT-proBNP among all patients was 9982
+
16268, mean GLS -17.84
+
4.52, and mean WS was 52.27
+
25.23. 129 patients had an abnormal or borderline GLS of >-18, whereas nearly all patients (230) had an abnormal WS of <109. (See table for results.)

Conclusion:
GLS and WS are reduced in a significant proportion of HFpEF patients. However, our data suggests that compared to echocardiographic indices of LV systolic function, biomarkers have a stronger short-term prognostic value.
Abstract 13988: A Devastating Case of Clostridial Infective Endocarditis
Authors: Alhasan Faysal , Biondi Nicholas , Akbarshahi Nataly , Suter Blair , Beauti Wisam , Walker Jackson , Hendrix Andrew , Kakroo Mashhood
Published: June 2023

Introduction:
Cardiac necrotizing soft tissue infections (NSTI) have been scarcely reported in the literature. We present a rare case of a disseminated NSTI with myocardial involvement secondary to embolic phenomena from emphysematous infective endocarditis (IE).

Case presentation:
73-year-old female on dialysis with atrial fibrillation and diabetes mellitus was transferred for multifocal strokes evidenced on magnetic resonance imaging. Presented with leukocytosis, lactic acidosis, acute liver failure, and right upper extremity (RUE) NSTI. She was started on antibiotics and vasopressors and taken emergently to the operating room for RUE amputation. Following surgery, an electrocardiogram revealed anterior STEMI. Bedside transthoracic echocardiogram noted a severely reduced ejection fraction and a mitral valve vegetation. Computed tomography of head and chest revealed pneumomyocardium, portal venous gas, and pneumocephalus. Blood cultures revealed growth of Clostridium perfringens. With severe multi-organ failure and a poor prognosis, comfort care was elected, and the patient expired.
Figures: A:
RUQ subcutaneous gas.
B:
Chest wall gas.
C:
pneumocephalus.
D:
pneumomyocardium.
E:
MV vegetation.

Discussion:
Septic embolization is a devastating sequela of IE. Vegetations > 1cm have increased embolic potential and all-cause mortality. The most common site of embolization is the central nervous system; however, coronary embolization can also occur. Clostridial endocarditis is rare, despite being documented as the first cause of anaerobic IE. Mortality rate of clostridial NSTI and shock exceeds 50%. Source control and rapid identification of infection are paramount for treatment success. A multidisciplinary approach should be employed when treating Clostridial infections, specifically endocarditis. Our case highlights the need for prompt recognition of IE and the interplay of multimodal imaging in the diagnosis of disseminated infection.
Abstract 13989: Glutaredoxin-1: A Redox Regulator of Metalloproteases in Vascular Endothelial Cells
Authors: Han Jingyan , Liu Hanxiao , Tsukahara Yuko , wan xuping , Sulser Ponce De Leon Sandra , Budbazar Enkhjargal , Seta Francesca
Published: June 2023

Background:
Endothelial dysfunction is a common mediator of aneurysmal remodeling regardless of etiology and the vascular bed that occur (e.g., genetic mutations, hypertension, aging, smoking, abdominal or thoracic artery or aortic root), but the underlying mechanisms remain unknown. This work aims to test the hypothesis that perturbing thiol redox signaling in endothelial cells triggers aberrant activation of matrix metalloproteinase-2 and -9, thereby precipitating aneurysmal remodeling.

Methods and Results:
In human aortic aneurysm (AA) samples from individuals with Marfan syndrome, levels of MMP-2/-9 were increased drastically that coincided with elevated oxidative stress markers: tyrosine nitrated proteins and lipid peroxidation product 4-hydroxynonenal . In mouse model of AA: fibrillin-1 mutant(

Fbn1
mgR/mgR

) mice, reversible oxidation of cysteine residues—S-glutathionylation (PrS-SG) that mediate thiol redox signaling by modulating target proteins’ functions—were markedly elevated as an early redox event. Endothelial specific deletion of glutaredoxin-1(Grx1), a specific de-glutathionylation enzyme was found to massively increase gelatinase activity of MMP-2/-9 in whole aortas, and worsen vessel wall integrity. Using primary human aortic ECs, we showed that Grx1 can directly prevent pro-MMP-2/-9 from glutathionylation of their cysteine switch and consequent activation. Furthermore, the medium collected from HAECs that lack functional Grx1 stimulated MMP-2 activity in smooth muscle cells, thus setting up an amplifying mechanism of MMP activation.

Conclusions:
this study is the first to provide experiment evidence for a pathogenic role of dysregulated thiol redox signaling in vascular endothelial cells in aneurysmal remodeling.
Abstract 13993: Sex Differences in Cardiac Structure and Function Following Acute Myocardial Infarction: Insights From the PARADISE-MI Echocardiographic Sub-Study
Authors: Wang Xiaowen , Cikes Maja , Claggett Brian , Jering Karola , Mullens Wilfried , Kober Lars , Jhund Pardeep S , Kovacs Attila , Zhou Yinong , Shah Amil M , Pfeffer Marc A , Solomon Scott
Published: June 2023

Introduction:
Women have a higher incidence of heart failure (HF) hospitalizations than men following acute myocardial infarction (AMI). The extent to which differential cardiac remodeling between men and women might account for this higher risk in women is poorly understood.

Hypothesis:
Women and men have differences in cardiac remodeling after AMI that are predictive of clinical outcomes.

Methods:
The Prospective ARNI versus ACE inhibitor trial to Determine Superiority in reducing heart failure Events after Myocardial Infarction (PARADISE-MI) trial randomized patients within 0.5 to 7 days of AMI complicated by left ventricular (LV) dysfunction, pulmonary congestion, or both to sacubitril/valsartan or ramipril. In the pre-specified echocardiographic sub-study, 544 participants were enrolled to undergo protocol echocardiography at the time of randomization and after 8 months.

Results:
At baseline, women (n=142, 26%) were older, more likely to have a history of hypertension, and less likely to have a history of MI. Women had a higher LV ejection fraction (LVEF), lower LV end-diastolic index (LVEDVi) and end-systolic volume index (LVESVi), and LV mass index, but no difference in left atrium (LA) volume index compared with men (Table). Women had better diastolic function compared with men. The absolute and relative changes in these echocardiographic parameters from baseline to 8 months were not significantly different between women and men. In univariate analyses, baseline LVEF, LVEDVi, LVESVi, LA dimensions and diastolic measurements are associated with primary outcome (Table).

Conclusion:
In PARADISE-MI, women have higher LVEF and lower indexed LV and LA chamber sizes compared to men following high-risk MI. The changes between baseline and 8-month in LVEF, LV and LA dimensions did not differ significantly between men and women, suggesting that differential cardiac remodeling post-MI may not account for the increased HF risk in women compared with men.
Abstract 14006: Circulating microRNAs Predict Recovery in Pediatric Dilated Cardiomyopathy Patients
Authors: Miyamoto Shelley D , Lipshultz Steven E , Neltner Bonnie , Hamza Taye , Wilkinson James D , Karimpour-Fard Anis , Colan Steven , Sucharov Carmen C ,   Pediatric Cardiomyopathy Registry Investigators
Published: June 2023

Introduction:
microRNAs (miRs) are small single stranded RNAs capable of targeting expression of several genes. Circulating miRs are stable and can be important biomarkers of disease progression and diagnosis.

Hypothesis:
We hypothesized circulating miRs could be a reliable prognostic biomarker of recovery for pediatric dilated cardiomyopathy (DCM).

Methods:
TaqMan Open Array miR panel (ThermoFisher Scientific) was used to investigate expression of 381 circulating miRs. Samples originated from the Pediatric Cardiomyopathy Registry (PCMR) and were collected within 3 months of a new diagnosis of DCM. Inclusion criteria included <18 years of age at diagnosis of idiopathic or familial DCM (EF<50% or left ventricular end-diastolic dimension [LVEDd] z-score ≥+2). Patients with DCM secondary to musculoskeletal diseases or anthracycline toxicity were excluded. Primary outcomes, occurring within 1 year of enrollment, were defined as: [1] Death, transplant (tx) listing or initiation of mechanical circulatory support; [2] Recovered- normalization of ventricular size and function (EF≥50% and LVEDd z-score <+2) or [3] Stable- persistent DCM with EF<50% or LVEDd z-score ≥+2. Statistical analysis included random forest, hierarchical clustering and area under the receiver operator curve (AUC).

Results:
N=10 subjects were included in Group 1, of which 70% were female, 6 were white, 2 Hispanic and 3 of other/unknown races, median age 9.5y. N=5 samples were included in Group 2, of which 60% were female, 3 were white, 1 black and 1 native American, median age 1.9y. N=20 samples were included in Group 3, of which 40% were female, 10 were white, 5 black, 1 Pacific islander, 2 Hispanic and 4 of other/unknown races, median age 2.1y. The top 3 miRs differentiating Group 2 (Recovered) from Group 1 (Death/Tx) (AUC of 0.92) were hsa-miR-655, -410 and -636. The top 3 miRs differentiating Group 2 (Recovered) from Group 3 (Stable) were hsa-miR-17, -410 and -345 (AUC of 0.76).

Conclusions:
These results indicate circulating miRs can predict recovery in the pediatric DCM population. A unique biomarker signature of miRs specific to patients who have the potential to recover would improve risk stratification of this population.
Abstract 14011: Rare Variants in GUCY1A3 Gene Contribute to Hypertension via NO/cGMP Pathway
Authors: Li Chen , Wang Jing , Chao Xing , Lu MInjie , Zhu Yuming , Wu Xueyi , Shao Yibing , Zou Yubao , song lei , Wang Jizheng
Published: June 2023

Hypertension is a leading risk factor for cardiovascular events and considered as a complex genetic disease. Previous studies have revealed many common variants relevant to hypertension. However, the contributions of rare variants and the underlying mechanisms are still poorly understood. Through a case-control study with whole-exome sequencing, we found that rare nonsynonymous variants in
GUCY1A3
gene were enriched in the patients with early-onset hypertension. To assess the effects of rare variants of
GUCY1A3
, a knock-in mouse model carrying a variant corresponding to Pro637His in human
GUCY1A3
was generated, and the blood pressure (BP) was measured by telemetry.The baseline systolic BP of both homozygous (P637H
+/+
) and heterozygous (P637H
+
)mice were higher than their wide-type (WT) littermate controls. After administration of eNOS inhibitor, BP elevated in all genotypes, and the P637H
+/+
and P637H
+
mice had profoundly higher BP than WT. The vascular dysfunction in mutated mice was determined as contraction curves of aorta ring elevated earlier and higher, and relaxation curves decreased later than WT rings. Furthermore, compared to WT mice, the protein levels of sGCα1 and sGC in both P637H
+/+
and P637H
+
mice were decreased both at baseline and after NO inhibitor treatment, and the cGMP levels were also significantly decreased. Consistenly, the activity of cGMP-dependent protein kinase1 (cGK-1) was supressed and the phosphorylation of its downstream substrate, myosin light chain, was increased in knock-in mice. Finally, the inhibitory effect on sGC proteins expression and NO/cGMP pathway activity were also observed in vitro on other 5 rare nonsynonymous variants of
GUCY1A3
. In conclusion, our results demonstrate that
GUCY1A3
defects contribute to hypertension by reducing the activity of NO/cGMP pathway, and support that rare varaints are important components of the genetic architecture of hypertension.
Abstract 14016: Marked Geographic Variation in Atrial Fibrillation Ablation Rates in a Universal Single Payer Health Care System
Authors: Seo Christina , Kushwaha Sameer , Dorian Paul , Chan Timothy , Allan Katherine S , Gozdyra Peter , Abdel Qadir Husam , Angaran Paul
Published: June 2023

Introduction:
Atrial fibrillation (AF) ablation is increasingly commonly performed for patients with symptomatic AF. In Canada, AF ablation occurs at specialized electrophysiology centers (“EP centers”), which are clustered in major urban centers.

Hypothesis:
People with AF who live closer to an EP center are more likely to undergo an AF ablation.

Methods:
Data was compiled from Ontario Health datasets (e.g. emergency department (ED) visits, hospital discharges, physician billing) and Canadian census data for people presenting to an ED in Ontario, Canada with a new diagnosis of AF between 2007-16. The primary outcome was ablation within one year of the index ED visit. Secondary outcomes include ablation at two years. Multivariate logistic regression was conducted to assess the relationship between distance to EP centers and likelihood of ablation. We also studied ablation frequency in relation to material deprivation (e.g. income, housing quality and education). Geospatial analyses were performed using QGIS.

Results:
Of the 135,681 people with newly diagnosed AF, 3911 (2.9%) had an ablation within one year of AF diagnosis and 5827 (4.3%) within two. There was a significant inverse relationship between a doubling of distance to the closest EP center and ablation within one year (OR: 0.93, 95% CI: 0.91-0.94), and two years (OR: 0.95, 95% CI: 0.94-0.97). Higher deprivation (measured in standard deviations from the mean) was associated with significantly less ablation at one year (OR: 0.89, 95% CI: 0.85-0.92). There was wide regional variation with relatively low rates near the largest urban center (Figure 1).

Conclusions:
Living further from an EP center and greater material deprivation are associated with lower AF ablation rates. Ablation rates vary by region, with the highest rates not consistently observed in areas most concentrated with EP centers.

Figure 1.
Age and sex adjusted AF ablation rates per 100,000 patients within a year of AF diagnosis in Ontario, Canada
Abstract 14024: Role of Endothelial CXCR4 on the Development of Aortic Valve Stenosis
Authors: Winnicki Anna , Gadd James , Ohanyan Vahagn A , Hernandez Gilbert , Wang Yang , Enrick Molly , McKillen Hannah , Kiedrowski Matthew , Kegecik Karlina , Penn Marc S , Chilian William M , Yin Liya , Dong Feng
Published: June 2023

Background.
CXCL12/CXCR4 signaling is essential in cardiac development and repair, however, its contribution to the Aortic valve stenosis (AVS) remains unclear. In this study, we tested the role of endothelial CXCR4 on the development of AVS.
Methods.
We generated CXCR4 endothelial cell-specific knockout mice (EC CXCR4 KO) by crossing CXCR4
fl/fl
mouse with Tie2-Cre mouse to study the role of endothelial cell CXCR4 in AVS. CXCR4
fl/fl
mice with no Tie2-Cre gene present were used as control. Echocardiography was used to assess the aortic valve and cardiac function. Heart samples containing the aortic valve were stained using Alizarin Red for detection of calcification. Masson’s Trichrome staining was used for the detection of fibrosis. Apex samples were stained with wheat germ agglutinin to visualize ventricular hypertrophy.
Results.
Compared with the control group, the deletion of CXCR4 in endothelial cells led to significantly increased aortic valve peak velocity and aortic valve peak pressure gradient, and decreased aortic valve area and ejection fraction. EC CXCR4 KO mice also developed cardiac hypertrophy evidenced by increased left ventricular mass, diastolic and systolic left ventricle posterior wall (LVPW), cardiac myocyte size, and heart weight (HW) to body weight (BW) ratio. Our data also confirmed increased microcalcifications, interstitial fibrosis, and thickened valvular leaflets of the EC CXCR4 KO mice.
Conclusions.
We found that the deletion of CXCR4 in endothelial cells leads to aortic valve stenosis and left ventricular hypertrophy. This indicates endothelial cell CXCR4 plays a protective role against AVS, and EC CXCR4 KO mice can be used as a novel model for AVS study.
Abstract 14026: Intermittent Occlusion of the Superior Vena Cava Reduces Estimated Stressed Blood Volume in Patients With Acutely Decompensated Heart Failure
Authors: Yousefzai Rayan , Abraham Jacob , Kiernan Michael S , Tedford Ryan J , Benzuly Keith , Karas Richard H , Burkhoff Daniel , Kapur Navin K
Published: June 2023

BACKGROUND:
Stressed blood volume (SBV) refers to intravascular volume that produces hydrostatic pressure and contributes to congestion in acutely decompensated heart failure (ADHF). The VENUS HF Early Feasibility Study (EFS) is the first clinical trial testing intermittent occlusion of the superior vena cava (SVC) with the preCARDIA system, a catheter mounted balloon and pump console, to improve decongestion in ADHF. We hypothesized that preCARDIA therapy reduces SBV in ADHF.

Methods:
In a multicenter, prospective, single-arm exploratory safety and feasibility trial, 32 patients with ADHF were assigned to preCARDIA therapy for 24 hours. Invasive hemodynamics were measured before, immediately after, and for 3 hours after preCARDIA treatment. SBV was estimated (eSBV) using the hemodynamic simulator, Harvi, with heart rate (HR), cardiac output (CO), central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), systolic and diastolic systemic arterial and pulmonary artery (PA) pressures, and left ventricular ejection fraction (LVEF) from 27 enrolled subjects.

Results:
Mean LVEF was 28±13%. Freedom from device or procedure related major adverse events was observed in 96% (n=26/27) of patients. Compared to pre-treatment values, CVP, PCWP, and PA pressures were significantly reduced, while systemic mean arterial pressures, HR and CO remained unchanged (Table 1). Daily urine output (2.6±1.9 vs 5.2±3.8 L, p=0.0072) and net fluid balance (-1.7±1.4 vs -3.4±2.6 L/24hr, p=0.0098) improved with 24-hours of treatment. Compared to pre-treatment values, eSBV decreased by 22% or -709±551 mL/70kg from baseline to 3 hours after treatment completion (3217±426 vs 2507±694 mL/70kg, p<0.000001).

Conclusions:
We report for the first time that intermittent SVC occlusion using the preCARDIA system reduced estimated stressed blood volume in patients with ADHF. These results support future studies characterizing the clinical utility of the preCARDIA system.
Abstract 14031: Sacubitril-Valsartan Effects on Atherosclerotic Outcomes: A Meta-Analysis of Randomized Trials
Authors: CARVALHO LIS VICTORIA RAVANI , Abi-Kair Borges Calomeni Pedro , de Miranda Gauza Mateus , Pereira Jussara , Cardoso Rhanderson
Published: June 2023

Introduction:
Sacubitril-Valsartan is an angiotensin receptor neprilysin inhibitor (ARNI) associated with a decreased risk of death and of hospitalization for heart failure. However, its effects on atherosclerotic disease outcomes are not definitively known.

Methods:
We performed a systematic review and meta-analysis comparing the effects of ARNI with angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) on acute coronary syndrome (ACS), myocardial infarction (MI), stroke, angina pectoris and peripheral artery disease (PAD). PubMed, Scopus and Cochrane Central were searched for randomized studies until June 2022.

Results:
Thirteen randomized controlled trials, with 20,981 patients were included; 10,483 (50%) patients received ARNI and 10,498 were treated with ACEI or ARB (50%). The incidence of MI (OR 0.96; 95% CI 0.79-1.16; p=0.62; Fig. 1A), ACS (OR 0.98; 95% CI 0.61-1.59; p=0.97; Fig. 1B), angina pectoris (OR 0.95; 95% CI 0.78-1.15; p=0.58) and stroke (OR 1.00; 95% CI 0.85-1.17; p=0.96) were not statistically different between groups. However, ARNI was associated with higher incidence of PAD (OR 1.60; 95% CI 1.03-2.47; p=0.04; Fig. 2).

Conclusions:
There was no significant difference between ARNI and ACEI or ARB in terms of ACS, MI, angina pectoris, or stroke, although there was a slightly higher incidence of PAD in patients treated with ARNI.
Abstract 14040: Mechanical Aortic Strain Promotes Expression of Proteolytic Matrix Markers in Abdominal Aortic Aneurysm
Authors: Patel Raj , Figueroa Mario , Mattia Victoria , xiong Ying , Mukherjee Rupak , Jones Jeffrey A , Ruddy Jean M
Published: June 2023

Introduction:
Serum biomarkers for abdominal aortic aneurysms (AAA) have been identified, but the prognostic relevance has remained unclear. Mechanical activation of aortic VSMCs can elicit production of interleukin-6 (IL-6), a cytokine consistently elevated in AAA. Expecting that stressed native aortic cells may drive degenerative remodeling, we hypothesize that biomarkers focused on matrix proteolysis may be elaborated directly from the aortic wall and assessed as an indicator of aortic strain.

Methods:
AAA was induced in C57Bl/6 mice with peri-adventitial CaCl
2
(n=5). Terminal procedure at 21 days quantified aortic diameter (AoD) by digital microscopy, obtained blood sampling, and collected aortic tissue. Aortic ultrasound (Vevo3100 with VevoVasc Software) was conducted on Days 0 and 21 to assess AoD and aortic strain parameters. Tissue and serum were analyzed to quantify IL-6 and the proteolytic matrix markers: matrix metalloproteinase-9 (MMP-9), Cathepsin S (CtsS), Cystatin C (CysC), and osteoprotegerin (OPG). Aortic VSMCs underwent mechanical stimulation with 12% Stretch and subsequent QPCR for expression of proteolytic matrix markers (n=4). Groups were analyzed by T-test and ANOVA.

Results:
At 21 days, all mice in AAA group developed true aneurysms by digital microscopy (>50% dilation compared to internal baseline), and this correlated to measurements from transabdominal ultrasound. Aortic strain assessment indicated increased stiffness parameters in AAA (elevated Pulse Wave Velocity, decreased Distensibility, and decreased Global Radial Strain). The AAA group also had significantly elevated levels of IL-6, MMP-9, and OPG (p<0.05 versus Control for each), with a trend toward increased CtsS and CysC. Alternatively, Stretch VSMCs demonstrated upregulated expression of IL-6, CysC, and OPG (p<0.05 vs Static), while the proteases MMP-9 and CtsS remained unchanged.

Conclusion:
Mechanical activation of aortic VSMCs can stimulate expression of biomarker proteins associated with AAA, but protease production may rely on the inflammatory infiltrate to promote degenerative matrix remodeling. Further investigation into the source of common AAA biomarkers will provide insight for effective integration into patient care.