bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13191: Effectiveness of a Telemedicine Intervention in Reducing Heart Failure Hospitalizations in Brazil: A Randomized Clinical Trial
Authors: RIBEIRO EDMAR G , Brant Luisa C , Bernal Regina T , Rezende Lilian C , Chequer Graziela , Temponi Barbara V , Vilela Daniel B , Buback Julia B , Franco Tulio B , Ribeiro Antonio L , Malta Deborah
Published: December 2023

Introduction:
Telemedicine interventions (TMI) for heart failure (HF) can reduce hospitalizations and deaths. It is unknown if lower literacy and access to technology in low- and middle-income countries could hamper these positive results. We evaluated if a TMI could reduce HF-related rehospitalizations in HF patients discharged from public hospitals in Brazil compared to usual care.

Methods:
In a randomized clinical trial (UTN: U1111-1263-9802), patients >30 years, hospitalized due to HF in 6 public hospitals (09/2021 to 06/2022) were randomized before discharge to usual care (n=57) or to a multi-component TMI (n=70). The TMI included a weekly structured telephone support from a nurse to evaluate the daily monitoring of weight, blood pressure and heart rate collected by the patient, assess decompensation signs and treatment adherence barriers, and promote self-care education - including flexible diuretics dosing. The nurse was linked to a cardiologist for teleconsultations, according to pre-defined clinical decision trees. An educational program was also available, including unidirectional messages and two-way messaging in working hours. The primary outcome was HF-related rehospitalizations after 180 days, analyzed by intention-to-treat.

Results:
Of 127 patients, mean age was 64±11 years, 48% were female, 71% were black/“pardo”, 33% had <4 years of education, and 68% had reduced ejection fraction. At 180 days, HF-related hospitalizations occurred in 18 (26%) patients from the TMI vs. 26 (46%) from the usual care group (RR=0.56, 95%CI 0.34-0.91, p<0.01). Kaplan-Meier curves for the primary outcome are shown in
Figure 1
. All-cause death or rehospitalizations (secondary outcome) occurred in 30% of patients in the TMI vs 47% in the usual care group (RR=0.63, CI95% 0.40-0.99, p=0.04).

Conclusions:
In HF patients discharged from hospitals in Brazil, a TMI reduced HF-related rehospitalizations compared to usual care.
Abstract 13200: Changes in Thrombi-Inflammatory Biomarkers Associated With Therapeutic Heparin in Non-Critically Ill Patients Hospitalized With COVID-19: A Pre-Specified Secondary Analysis of the ACTIV4a and ATTACC Randomized Clinical Trial
Authors: Wahid, MD Lana , Froess Joshua , Ortel Thomas L , Zarychanski Ryan , Gong Michelle N , Cushman Mary , Kornblith Lucy , Castellucci Lana , Farkouh Michael E , Gologher Ewan , McVerry Bryan J , Bochicchio Grant V , Duggal Abhijit , Greenstein Yonatan , Hanna Nicholas , Hudock Kristin , Huang David T , Hyzy Robert , Khan Akram , Krishnan Vidya , Kutcher Matthew , Lim George , Lopez-Sendon Moreno Jose Luis , Matthay Michael A , Pandey Ambarish , Quigley John , Satterwhite Lewis , Widmer Robert J , Jenny Wilson Jenny , Hochman Judith S , Berger Jeffrey S , Neal Matthew D , Lawler Patrick R
Published: December 2023

Background:
SARS-CoV-2 infection potentiates thromboinflammation contributing to poor outcomes in COVID-19. In non-critically ill patients hospitalized for COVID-19, therapeutic-dose heparin improves clinical outcomes. We hypothesized therapeutic-dose heparin impacts thromboinflammatory biomarkers in patients hospitalized for COVID-19 infection.

Methods:
We conducted a pre-specified secondary analysis of a multi-platform open-label, randomized trial comparing therapeutic-dose versus usual-care thromboprophylaxis-dose heparin in non-critically ill patients hospitalized for COVID-19. Inflammatory markers were analyzed using Wilcoxon rank-sum test and compared based on treatment. Ordinal logistic regression models evaluated for relative D-Dimer change (measured at baseline, day 1, day 3). Odds ratio of a 3-level ordinal outcome (death, survival with organ support, or survival without organ support through 21 days) was determined for relative change.

Results:
Of 1510 patients, 528 had a D-Dimer on baseline and day 1, and 432 on baseline and day 3. Median age was 60 years (IQR: 50-69) with 41% female and 66% under-represented minorities. Compared to usual-care, therapeutic-dose heparin was associated with a greater drop in D-Dimer at days 1 and 3; other biomarkers were unaffected by treatment (Table 1). D-Dimer at baseline and day 1 had an OR 0.93 (95% CI: 0.88, 0.98) whereas baseline and day 3 had an OR 0.86 (95% CI: 0.78, 0.94) of the ordinal outcome translating in a higher odds of surviving without the need for organ support (adjusted for treatment, gender, and age).

Conclusion:
In this randomized controlled trial therapeutic-dose heparin was associated with an early reduction in D-Dimer and clinical improvement, suggesting thromboinflammatory mechanisms whereby treatment conferred a clinical benefit. Temporal changes in D-dimer could predict treatment response or may signal need for alternative therapies.
Abstract 13210: A Hidden Right Atrial Lipoma in a Patient With Recurrent Sustained Supraventricular Tachycardias
Authors: Song DaYoung , Khazoum Elias , Viswanathan Swati , Mikhail Maha B
Published: December 2023

Introduction:
Cardiac lipomas, known for their benign nature, compose 8 percent of primary cardiac tumors. Advanced imaging modalities allow improved diagnosis, yet little of their potential complications involving the heart's conduction system is known.

Case:
A 65-year-old male presented to the Emergency Department with palpitations. History was significant for recurrent sustained orthodromic atrioventricular reentrant tachycardia using a concealed left posterior accessory pathway from a prior EP study. He was treated with ablation twice in the past. The patient was hemodynamically stable on evaluation. ECG showed supraventricular tachycardia (SVT) involving orthodromic re-entry with a ventricular rate of 227 bpm. Computer tomography (CT) of the chest revealed a large, low-attenuated lesion with -102 Hounsfield unit (HU) attached to the right atrial roof, extending to both SVC and IVC. No sparing of foramen ovale was seen. Findings suggest right atrial lipoma. A transthoracic echocardiogram (TTE) visualized the same echo-dense structure without increased vascularity. The patient responded to intravenous Adenosine. We discussed the case with the Cardiothoracic surgery team. Outpatient cardiac MRI and elective surgery were planned.

Discussion:
The case presented clinically significant atrial arrhythmia in a patient with a massive right atrial lipoma. Although most cardiac lipomas remain asymptomatic, arrhythmias coinciding with the location of involved chambers have been reported. In addition, the recurrence of orthodromic tachycardia despite previous ablation suggests the potential benefit of surgical intervention.
Abstract 13223: Assessing Cardiomediastinal Abnormalities Through Quantitative Evaluation of Chest X-rays: A Multicenter Validation in Various Clinical Cohorts
Authors: Lee June-Goo , Jun Tae Joon , Kim Cherry , Suh Young Joo , Van Assen Marly , De Carlo N , Cho Iksung , Kim Young-Hak , Yang Dong Hyun
Published: December 2023

Objective:
The ADC study, entitled 'Quantitative

A

nalysis of Chest X-ray for

D

iagnosing

C

ardiomediastinal Abnormality,' is aiming to establish the normal reference values for cardiovascular borders (CB) using Chest X-ray (CXR) and to investigate its clinical application.

Methods:
The normal reference values of CBs, including right upper/lower, aortic knob, pulmonary conus, left atrial appendage [LAA], and, left lower were determined by pre-validated deep learning from 71,494 'normal' CXRs, as defined by echocardiography. All CBs were standardized into age-and gender specific z-score and underwent validation using three distinct normal external datasets (n=25,429). Subsequently, the clinical relevance was investigated across different disease cohorts - coronary artery disease (CAD, n=34,251), valvular heart diseases (VHD, n=9,893), and mediastinal mass (Mass, n=109).

Results:
External normal cohorts aligned with the normal CBs established by this study, with a low range of z-scores (-0.49 - 0.40). After adjusting for cardiovascular risks in CAD cohorts, an increased pulmonary conus (z-score > 2.5) on CXR was found to be independently linked to adverse outcomes (HR 1.56 - 3.76, p < 0.001). The pattern of cardiomegaly varies depending on the type of VHDs. In mitral stenosis (MS), the LAA are broader than in aortic stenosis (AS) (1.73 vs. 0.55), while the ascending aorta is more expansive in AS (1.20 vs. 0.47). The subgroup of MS with significant TR demonstrated worse CXR measurements as opposed to MS in isolation (LAA diameter 62.2mm vs. 57.4mm). Among 109 mediastinal masses, the borders of 66 tumors (60.6%) were merged with the CBs and consequently detected via CB analysis.

Conclusion:
This fully automated, deep learning-guided chest X-ray analysis may contribute to various clinical tasks such as detection, classification, and risk stratification of cardiomediastinal abnormalities.
Abstract 13241: Long-Term Clinical Outcome After Transcoronary Cardiosphere-Derived Cell Infusion in Patients With Single Ventricle Congenital Heart Disease
Authors: Hirai Kenta , Oh Hidemasa
Published: December 2023

Introduction:
Although transcoronary infusion of cardiosphere-derived cells (CDCs) in patients with single ventricles provides short-term improvement in cardiac function, the long-term efficacy is still unknown.

Hypothesis:
We tested the hypothesis that CDC infusion is associated with improved long-term clinical outcome in patients with single ventricles and heart failure.

Methods:
Patients were enrolled in the TICAP phase 1 (Transcoronary Infusion of Cardiac Progenitor Cells in Patients With Single Ventricle Physiology) and PERSEUS phase 2 (Cardiac Progenitor Cell Infusion to Treat Univentricular Heart Disease) trials between January 5, 2011, and January 30, 2015. The inclusion criteria were that patients were aged <6 years who were diagnosed with single ventricle lesions undergoing stage 2 (bidirectional Glenn) or stage 3 (total cavopulmonary connection) palliation. Medical records of patients with single ventricles were obtained and analyzed as a control group who were eligible but were treated by staged palliation alone. We evaluated the effectiveness of CDCs using an integrated cohort study in 93 patients with single ventricles, including 40 patients who received CDC infusion and 53 controls.

Results:
At the time of this study, 35 patients with CDC infusion and 43 controls were alive without cardiac transplantation, with mean follow-up of 10.0±1.2 years. The absolute changes in brain natriuretic peptide (
P
= 0.015), atrioventricular regurgitation grade (
P
= 0.018), and weight for age (
P
< 0.001) from baseline to last follow-up showed significant improvements in CDC-treated patients compared with controls. Survival rate did not differ between the 2 groups (log-rank
P
= 0.351), whereas overall patients treated by CDCs had lower incidents of late failure (
P
= 0.043) and adverse events (
P
= 0.036) compared with controls. Multivariate proportional hazard regression analyses showed that CDC infusion was associated with lower risks of late failure (
P
= 0.003) and adverse events (
P
= 0.013).

Conclusions:
Intracoronary delivery of CDCs in patients with single ventricles did not improve all-cause mortality rate but significantly reduced the incidence of late failure and adverse events at 8 years of follow-up.
Abstract 13250: Establishing Partition Values and Clinical Phenotype for Heart Failure Patients With Abnormal Left Atrial Function Index: A Cross-Sectional Analytical Study
Authors: Kweki Anthony , Aiwuyo Henry , Evbayekha Endurance O , Oladimeji Oluwaseye , Iloeje Ugoeze , Akinti Oluwasegun , John Osarenkhoe , Fatuyi Michael , Umuerri Ejiroghene , Aigbe Fredrick , Obasohan Austine
Published: December 2023

Introduction:
Left atrial function index (LAFI) has recently been validated for global estimation of left atrial (LA) function. LA dysfunction is critical to developing overt heart failure (HF), and getting the best tool for assessing its function is critical to HF prevention. This study attempts to establish cut-off values for LAFI among HF patients and identify which HF phenotype is associated with abnormal LAFI.

Hypothesis:
Is there any association between abnormal LAFI and changes in LV function?

Methods:
This cross-sectional study was conducted at the Delta State University Teaching Hospital, Nigeria. We recruited 80 hypertensive HF patients and 40 healthy normotensive controls. LAFI = (LAEF x LVOT-VTI)/LAESVI. (LAEF = left atrial emptying fraction; LAESVI = left atrial end-systolic volume index; LVOT-VTI = left ventricular outflow tract velocity time integral). Relationships between variables were determined using an independent student’s t-test, and a P-value of <0.05 was significant.

Results:
In the control arm, the LAFI reference range was estimated to be 24.07-76.24. Abnormal LAFI was defined as LAFI < 24 and 77.5% of the individuals with HF were found to have abnormal LAFI. There was no difference in age (61.83±7.48 vs. 63.22±6.75, p=0.46), BMI (28.27±4.47 vs. 29.52±5.91, p=0.33) and systolic BP (127.34±19.28 vs. 120.94±19.94, p=0.22) of hypertensive HF patients with LAFI <24 and LAFI ≥24. Those with abnormal LAFI had lower EF (45.04±11.06 vs. 63.73±14.73, p<0.0001), FS (25.75±8.26 vs 32.49±8.64, p=0.003) and SV (57.16±13.30 vs. 64.99±16.94, p=0.02). However, E/E’ (15.62±5.61 vs. 9.2±3.22, p<0.0001) and LAVI (37.22±5.80 vs. 16.48±5.65, p<0.0001) were higher among patients with lower LAFI. Contrarily, E/A (1.87±0.97 vs. 1.87±0.83, p=0.98) and TAPSE (17.87±3.67 vs. 19.54±2.47, p=0.06) did not show any difference among the groups.

Conclusions:
This study shows that abnormal LAFI was associated with impaired LV function and it is crucial to deploy this non-invasive modality of cardiac assessment in hypertensive patients. Early identification of abnormal left atrial mechanics is pertinent to preventing overt HF, especially in parts of the world where access to advanced cardiovascular care is limited.
Abstract 13256: Efficient and Precise Phenotyping of Murine Fetal Hearts by Means of Synchrotron-Based Phase-Contrast Micro-Computed Tomography
Authors: Peruzzi Niccolo , Gawlik Kinga I. , Mead Timothy , Dreier Till , Lampei Elna , Romell Jenny , Apte Suneel S , Bech Martin , Bonnin Anne , Tran-Lundmark Karin
Published: December 2023

Mouse models are routinely utilized to investigate the role of genes in congenital heart disease. Cardiovascular phenotyping is, however, quite challenging because of the small size of fetal mouse hearts. The most used method is histological assessment, which typically provides only two-dimensional information and thus might overlook important structural defects. Three-dimensional (3D) methods with sufficient resolution are either time-consuming, require specific sample preparation and/or selective staining, or cause destruction of the sample.

Here, synchrotron radiation-based phase-contrast micro-computed tomography (SRμCT) was evaluated for fast and precise phenotyping of unstained, intact murine fetal hearts in a non-destructive way.

Embryonic day (E) 18.5 hearts from control mice and mice that lack the secreted protease ADAMTS6 were formalin-fixed, paraffin-embedded and then scanned with SRμCT at the TOMCAT beamline (Swiss Light Source) with a 1.63 μm effective pixel size. Following SRμCT, the hearts were sectioned and processed for standard hematoxylin and eosin staining (H&E), and for specific immunofluorescence staining.

SRμCT enabled evaluation of the hearts with a high level of detail. A full E18.5 mouse heart was scanned in less than 3 minutes, followed by virtual sectioning along arbitrary slicing planes and 3D rendering for morphological assessment. The resolution proved sufficient to trace minute features like the coronary arteries. In the
Adamts6
knockouts, malformations such as a ventricular septal defect and double outlet right ventricle could be readily diagnosed. We also explored the potential of merging stained sections with SRμCT.

In summary, SRμCT has the potential to become a powerful tool for fast phenotyping of mutant mouse models. The combination of 3D imaging with subsequent sectioning and methods like histology, immunohistochemistry and in situ hybridization will uncover pathophysiological mechanisms in 3D space.
Abstract 13261: Global T Wave Inversion: Incidence and Implications in Critically Ill Patients
Authors: Kroshian Garen , Phelan Christopher , tighe dennis , Tighe Elizabeth
Published: December 2023

Background:
Symmetric global T-wave inversion (GTWI) occurs in 0.3% of general hospital admits. As reported by Walder and Spodick, GTWI exhibited a 4:1 female preponderance and was often associated with ACS or central nervous system (CNS) disorders; in-hospital mortality was not affected. Anecdotally we have observed this ECG pattern in critically-ill medical ICU (MICU) patients. We hypothesized that GTWI is more prevalent among MICU patients and may be associated with adverse outcomes.

Methods:
We reviewed the ECGs, demographic, clinical, and physiological data of 1652 consecutive patients admitted to 2 medical ICUs. Those admitted to CCU and Neuro ICU were excluded as were MICU patients with a primary diagnosis of ACS, acute CNS syndrome, LBBB, ventricular pacing, pre-excitation, and uninterpretable ECG. ECGs performed within 48 hours of ICU admit were reviewed by 2 blinded readers. GTWI was defined by the criteria of Walder and Spodick. The GTWI group was compared to 95 matched patients without GTWI.

Results:
See Table. GTWI occurred in 75 patients (4.5%); 56% of whom were female. Significant differences between GTWI vs control included history of CAD (p=0.03), cardiomyopathy (p=0.035), CKD (p=0.046), and prior EP procedure (p=0.023). In addition, QT-interval (p<0.0001), QTc (p<0.0001) and BNP (1433±1725 vs 750±978 pg/mL; p=0.032) were greater in the GTWI group. LVEF (52.7±16.2% vs 55.6±14.1%) and cTnI (1.35±2.52 vs 1.25±4.15 pg/mL) were similar. MICU days and APACHE II score were greater in those with GTWI. Total length of stay and in-hospital mortality were similar.

Conclusions:
In this critically-ill MICU cohort, GTWI was more prevalent compared to previously reported general hospital admits. A distinct female preponderance was not found. This ECG pattern was associated with underlying cardiac disease, greater length of MICU stay and higher illness severity, but was not associated with higher in-hospital morality.
Abstract 13267: Early Predictors of High-Risk Lymphatic Subtypes on T2-Weighted MRI in Patients After Superior Cavopulmonary Connection
Authors: Joyce Jeremiah , Rastogi Radhika , Pinto Erin , Smith Christopher , Dori Yoav , DeWitt Aaron G , Ravishankar Chitra , Biko David , Vaiyani Danish , David Goldberg
Published: December 2023

Introduction:
Lymphatic subtype as determined by T2-weighted MRI (T2-CMR) after superior cavopulmonary connection (SCPC) is known to predict clinical outcome after Fontan. Factors related to lymphatic subtype development are not well understood. This study aims to identify early predictors of high-risk lymphatic subtypes.

Methods:
Retrospective cohort study of consecutive patients with pre-Fontan T2-CMR from 2017 to 2021. Patients divided into two groups based on lymphatic subtype: Group 1 - subtypes 1, 2, and 3; Group 2 - subtypes 3+ (defined as type 3 with history of chylothorax) and 4. Pearson’s chi square, Fisher’s exact, Wilcoxon rank sum, univariate and multivariate logistic regression analysis were performed.

Results:
We identified 171 patients. The groups differed significantly in total hospital, ICU, and chest tube days, number of catheterizations and number of cardiac surgeries (Table 1). Moderate or greater atrioventricular valve regurgitation (Mod+ AVVR), increased catheterizations and increased chest tube days were associated with high-risk lymphatic subtype. Maintenance of antegrade pulmonary blood flow at the time of SCPC was not significant (Table 2). In multivariate analysis, Mod+ AVVR and number of chest tube days remained in the model after adjusting for other covariates. Overall model significance was 0.007 with an area under the curve of 0.777.

Conclusions:
Mod+ AVVR and increased chest tube days are predictive of high-risk lymphatic subtype. Further study is needed to determine if lymphatic subtype is acquired via clinical exposure or whether native lymphatic subtype may be predictive of clinical course even prior to cavopulmonary connection.
Abstract 13292: Vacuum Cleaning a Four-Chamber House: A Case of Using Percutaneous Aspiration Thrombectomy for an Infected Right Heart Clot
Authors: Vo Phuong Uyen , Rea Mark , Matriano-Lim Charles
Published: December 2023

Introduction:
Infected SVC thrombi are rare serious complications of indwelling catheters and usually require cardiothoracic surgery. However, there is limited literature regarding the use of aspiration thrombectomy in treating endocarditis.

Description of Case:
A 40 year-old male with end-stage renal on hemodialysis through left internal jugular (IJ) tunneled dialysis catheter (TDC), due to failed AV fistula attempt, and recent parietotemporal-intraparenchymal hemorrhage s/p craniotomy presented with altered mental status and subjective fever. Labs showed leukocytosis with bandemia, elevated procalcitonin, and metabolic acidosis. Mental status change was primarily attributed to acute metabolic encephalopathy. Patient was started on broad antibiotics before found in sepsis from MRSA bacteremia, which likely came from his TDC and required vancomycin monotherapy. Transthoracic echocardiogram found a pedunculated mass along the atrial septum. TDC was removed for source control with tip’s culture growing MRSA. Transesophageal echocardiogram (TEE) confirmed a right atrial-SVC junction thrombus. Heparin infusion was started. A temporary femoral central line was placed for dialysis. Patient underwent a TEE-guided percutaneous aspiration thrombectomy with the Inari FlowTriever® catheter that significantly debulked the thrombus, which culture also grew MRSA. Patient clinically defervesced and downtrended leukocytosis but blood cultures sterilized after antibiotics were escalated to daptomycin and ceftaroline. A new right IJ TDC was safely placed. He was discharged on six-week daptomycin and remained infection-free upon follow up.

Discussion:
FlowTriever® catheter effectively aspirated the infected right heart clot for source control, expediting the bacteremia resolution - an imperative criterion for new TDC reinsertion. The technology is promising for inoperable patients as adjunct therapy to antibiotics when treating endocarditis.
Abstract 13301: TRIM29 Causes Pathogenesis of Viral Myocarditis by Inducing PERK-Mediated Endoplasmic Reticulum Stress and Reactive Oxygen Species Responses
Authors: Lu Wenting , Wang Junying , Zhang Jerry , Du Yong , Fang Mingli , Zhang Ao , Sungcad Gabriel , Chon Samantha , Xing Junji
Published: December 2023

Introduction:
Viral myocarditis is an inflammatory disease of the myocardium which contributes to a significant fraction of sudden death in children and young adults. The ongoing coronavirus disease 19 pandemic emphasizes the need for understanding the pathogenesis mechanisms and potential treatment strategies for viral myocarditis.

Methods:
To understand the role of the novel E3 ligase TRIM29 in controlling viral myocarditis, wild-type and TRIM29 knockout mice were infected with coxsackievirus B3 (CVB3) for inducing viral myocarditis. Mice survival and heart function were monitored by transthoracic echocardiography, and hearts were harvested for histology and immunohistochemistry analysis. Real-time PCR, western blotting, co-immunoprecipitation, enzyme-linked immunoassay, flow cytometry, over-expression and knockdown techniques were used to understand the pathogenic mechanisms of TRIM29 in regulating endoplasmic reticulum stress response after virus infection in this study.

Results:
We found that TRIM29 was highly induced by cardiotropic viruses, including CVB3 and encephalomyocarditis (EMCV), and promoted protein kinase RNA-like endoplasmic reticulum kinase (PERK) mediated endoplasmic reticulum (ER) stress, apoptosis, and reactive oxygen species (ROS) responses that restrict viral replication in cardiomyocytes
in vitro
. TRIM29 deficiency protected mice from viral myocarditis by promoting cardiac antiviral functions and reducing PERK-mediated inflammation and immunosuppressive cells
in vivo
. Mechanistically, TRIM29 interacted with PERK to catalyze SUMOylation of PERK for maintaining its stability, thereby promoting PERK-mediated signaling pathways.

Conclusions:
Our data provide the first evidence that TRIM29-mediated PERK signaling pathways cause pathogenesis of viral myocarditis and identify the TRIM29-PERK axis as a potential therapeutic target for treating viral induced cardiovascular diseases.
Abstract 13319: The Barostim Baroreflex Activation Therapy System: Safety Insights From FDA MAUDE Database
Authors: Bawa Danish , Ahmed Adnan , Ghazal Rachad , Pham Nicholas , Sheth Aakash , Darden Douglas J , Kabra Rajesh , Gopinathannair Rakesh , Pothineni Naga Venkata , Lakkireddy Dhanunjaya R
Published: December 2023

Introduction:
BAROSTIM NEO® is a Baroreflex activation therapy (BAT) system which has been approved recently by FDA for patients with refractory heart failure. Post market experience of BAT related complications and performance issues have not been reported.

Objective:
To analyze the post-approval device failures and patient related adverse events (AE) associated with Barostim NEO® system using Manufacturer and User Facility Device Experience (MAUDE) database.

Methods:
A MAUDE database search was conducted on December 7, 2022, for reports received between Jan 1, 2019, to November 30, 2022. Manual search of the MAUDE database conducted using the term “Barostim” in the brand name section. The AE were adjudicated to various categories based on the review of the event description for each medical device report (MDR).

Results:
A total of 22 events were reported which included MDRs reported by physicians or manufacturer or both. Device related malfunction was reported in 45.5% (n=10) whereas patient related AE reported in 77.3% (n=17) cases. Of total device related AE, material split, cut or torn was most commonly reported problem (32%, n=7), followed by high impedance (13.6%, n=3) and low impedance (9.1%, n=2). Of the patient related AE, 32% (n=7) were related to clinical or subclinical infection, 18.2% (n=4) hematoma, 13.6% (n=3) heart failure or myocardial injury, 9.1% (n=2) stroke/CVA, 9.1% and 9.1% (n=2) twiddler’s syndrome. No carotid artery or jugular injury and procedure related death reported in the study period. The report is limited by the lack of information on the total number of BAT devices implanted across the country.

Conclusions:
This study provides a wide range of device malfunction and patient related post-approval adverse events for Barostim device which have not been reported in any clinical trial/study before. The reported complications seem to be in line with other cardiac implantable electronic devices and no BAT specific complications were noted.
Abstract 13325: Novel Heterozygous
EFEMP2
Variant Detected in a Patient With Bilateral Internal Carotid Artery Dissection and Oligodontia
Authors: Millay Olivia , Sheppard Mary B , Bergmann Liisa , Hartsfield James
Published: December 2023

Cutis laxa is a rare connective tissue disorder characterized by sagging or inelastic skin. This phenotype is caused by multiple genotype variants. Biallelic variants in the
EFEMP2
gene cause cutis laxa subtype IB characterized by aortic aneurysm, arterial tortuosity, arterial stenosis, joint laxity, arachnodactyly, emphysema, and retrognathia.
EFEMP2
encodes fibulin-4, an extracellular matrix protein involved in elastogenesis and modulation of TGF-beta signaling. To date, monoallelic variants in
EFEMP2
have not been described as pathogenic. Furthermore, oligodontia has not been associated previously with variants in
EFEMP2
. We describe a 67-year-old male with a past medical history of left distal internal carotid artery (ICA) pseudoaneurysm and dissection, right distal ICA dissection, arterial tortuosity, and oligodontia who was found to have a heterozygous variant of uncertain significance in EFEMP2: c.1279_1289del11, p.Arg427CysfsX27. The variant has not been observed previously in large population cohorts and causes a shift in reading frame that substitutes the carboxyl terminal 17 amino acids with 26 alternative amino acids. This carboxyl terminal variant of
EFEMP2
has been predicted to interact with PITX2 in yeast two-hybrid analyses. Furthermore, variants in
PITX2
have been associated with dental agenesis, including oligodontia. We hypothesize that heterozygous variants in
EFEMP2
represent a new syndrome characterized by arteriopathy and dental agenesis.
Abstract 13330: Swimming Exercise in Youth Athletes is Associated With Reduced Cardiovascular Risk Factors: An Analysis of the HeartBytes Dataset
Authors: Farhan Saaniya , Dikdan Sean , Johnson Drew , Shipon David
Published: December 2023

Background:
The American Heart Association has defined cardiovascular health using eight components related to cardiovascular disease (CVD) risk, including BMI, blood pressure, and physical activity. Swimming exercise has been widely promoted for the prevention of CVD; however, its relationship with CVD risk factors has rarely been examined in adolescents and compared to that of land-based exercise.

Methods:
Data was obtained from in-person surveys and physical examinations conducted by the nonprofit Simon’s Heart organization. Multivariate logistic regression models adjusting for age, sex, BMI, participation in sports, and activity level per week were performed to assess the relationship between swimming exercise and each outcome. Chi-square tests between swimmer and non-swimmer athletes were run to compare outcomes by exercise modality.

Results:
Among 7,154 adolescents ranging from ages 12 to 20, 686 (9.6%) were swimmers (52% male, age = 14.6 ± 1.85, BMI = 20.8 ± 3.65, mean arterial pressure (MAP) > 100 = 1.7%); 5,642 (78.9%) were involved in non-swimming sports (55.4% male, age = 15.1 ± 1.82, BMI = 21.6 ± 5.77, MAP > 100 = 3.42%), and 813 (11.4%) did not play sports. Swimmers were less likely than all non-swimmers to have an obese BMI or BMI greater than 30 (OR: 0.49, CI: 0.26-0.85,
p
= .018) and a high MAP or MAP greater than 100 (OR: 0.44, CI: 0.20-0.84,
p
= .025). Similarly, tests of differences between swimmer and non-swimmer athletes were significant for obese BMI (
p
= .002) and high MAP (
p
= .002). A significantly higher proportion of swimmers (53.1%) versus non-swimmer athletes (38.8%) performed more than 10 hours of physical activity per week (
p
< 0.001), and swimmers were more likely to be highly active (OR: 1.59, CI: 1.35-1.87,
p
< .001). A lower percentage of swimmers reported abnormal cardiac symptoms such as chest pain compared to non-swimmer athletes, but these differences were non-significant.

Conclusions:
This study identified a lower likelihood of two CVD risk factors among swimmers, which is consistent with existing literature suggesting a cardiovascular benefit to swimming exercise. This may be explained by higher levels of physical activity per week among swimmers. More studies are needed to further elucidate the effects of swimming on CVD risk.
Abstract 13333: Review of Simultaneous Kidney and Heart Transplant After 2018: UNOS Data
Authors: Patel Het , Pawa Arpita , Maheshwari Surabhi , Gayle Kathryn
Published: December 2023

Introduction:
In October 2018, the Organ Procurement and Transplant Network (OPTN) adopted a 6-tier system for organ allocation where priority was given to critically ill patients, especially those on Extra Corporeal Membrane Oxygenation (ECMO) support. The guideline lacks information about multiorgan transplant due to weak evidence on Simultaneous Kidney and Heart transplant (SKHT) data. Hence with this study, we aim to review outcomes of patients on ECMO at the time of SKHT.

Method:
This was a retrospective study of adult SKHT recipients between 2018-2022 from the OPTN database. The study excluded individuals who underwent simultaneous multiple organ transplants, isolated heart transplants, as well as those with incomplete outcome information. The cohort was stratified by ECMO need at the time of transplant. Univariate cox regression analysis was performed for predictors of worse outcomes. Patient survival was compared using Kaplan Meier (KM) curve and log rank test.

Results:
A total of 1383 patients were included in this study, of which 72 (5.2%) were on ECMO bridge. On review of baseline characteristics, patients on ECMO had mean wait time of 65 (± 190) days with higher mortality rate post-transplant and a lower mean survival time as compared to the non-ECMO counterparts (398 (± 404) vs 545 (± 462) days, p= 0.008). On analysis of KM curve, SKHT recipients on ECMO bridge had higher mortality within the first 10 months of transplant and plateaued after that. The only predictors associated with worst outcomes among ECMO recipients were dialysis requirement and development of stroke post-transplant. On the contrary, Left Ventricular assisted device (LVAD) use prior to transplant was associated with 70% reduction in mortality in non-ECMO group (HR: 0.30 (95% CI: 0.11 - 0.83, p=0.02)) in this cohort.

Conclusion:
Following the change in guidelines, around 5.2% of the total SKHT recipients were on the ECMO bridge. Dialysis requirement and development of stroke post-transplant was independently associated with higher mortality compared to non ECMO group. On the contrary, patients on LVAD support at the time of transplant have had better outcomes.Figure 1:
Abstract 13349: The Effect of Chronic Standard Cigarette Smoke Exposure Compared to Chronic Electronic Cigarette Exposure With or Without Nicotine on Blood Pressure
Authors: Dai Wangde , Shi Jianru , Carreno Juan , Kleinman Michael T , Herman David , Johnson Rebecca , Renusch Samantha , Hasen Irene A , Ting Amanda , Kloner Robert A
Published: December 2023

Background:
While the acute exposure to electronic cigarette (e-C) vapor has been associated with an increase in blood pressure, the chronic effect of e-C vapor on blood pressure compared to standard cigarette smoke has not been extensively studied. We determined the effect of chronic e-C exposure versus standard cigarette smoke on blood pressure and other cardiac functional measures.

Methods:
Sprague Dawley rats (both sexes) were randomly exposed to air (n=34), e-C with nicotine (e-Cn; n=30), e-C without nicotine (e-C; n= 28) or standard cigarette smoke (SCS; n=27) for 12 weeks. After 12 weeks of exposure hemodynamics were determined by Millar catheter, echocardiography, and thermodilution catheter, a few days after their last exposure.

Results:
As shown in the Table, SCS was associated with higher systolic, diastolic and mean blood pressures and peak LV systolic pressure compared to air or e-Cn or e-C groups. Neither fractional shortening or cardiac output differed among the groups. dp/dt min, a measure of diastolic LV function, was lowest in the e-C group. Tau, a measure of LV relaxation was worse in this group as well.

Conclusions:
Standard cigarette smoke exposure was associated with an increase in blood pressure when blood pressure was tested at 12 weeks. Neither electronic cigarette smoke with or without nicotine caused an increase in blood pressure compared to air. However, e-C was associated with worse diastolic function. Standard cigarettes may be associated with a greater sympathetic surge causing elevated blood pressure compared to electronic cigarettes.
Abstract 13389: Outcomes of Transcatheter Aortic Valve Replacement in Patients With Prior Mediastinal Radiation in the United States
Authors: Agarwal Siddharth , Sharma Vagisha , Bansal Agam , Akhtar Khawaja , Khalid Umair , Baber Usman
Published: December 2023

Introduction:
Although prior mediastinal radiation is associated with significantly worse clinical outcomes after SAVR, it is unknown if the same holds true for patients undergoing transcatheter aortic valve replacement (TAVR).

Hypothesis:
We hypothesized that the presence of prior mediastinal radiation may affect the outcomes of patients undergoing TAVR and tested this hypothesis using data from a nationally representative sample of the US population.

Methods:
The National Readmissions Database was analyzed from 2016-2019 to identify patients ≥ 18 years old undergoing TAVR. Patients with prior mediastinal radiation were then identified by using ICD-10 CM codes. Propensity score matching was used to adjust for confounders.

Results:
Our cohort included 173,743 patients undergoing TAVR, of which 2,780 (1.6%) had prior mediastinal radiation. Patients with prior mediastinal radiation undergoing TAVR were younger, had a higher proportion of females, and had a lower burden of comorbidities including hypertension, diabetes, and renal failure. Crude percentages are reported in Figure 1. On propensity score-matched analysis, the presence of prior mediastinal radiation was associated with similar odds of in-hospital mortality and peri-procedural complications including cardiovascular complications, peripheral vascular complications, pulmonary complications, neurological complications, major bleeding, and new pacemaker implantation along with similar odds of 30-day and 180-day all-cause, stroke-related, bleeding-related, and heart failure-related readmissions compared to those without prior mediastinal radiation.

Conclusion:
In conclusion, our data suggest that patients with prior mediastinal radiation undergoing TAVR have similar outcomes compared to those who have no history of mediastinal radiation.
Abstract 13405: Cardiac Computed Tomography Variables for Prediction of New-Onset Heart Failure: Multi-Ethnic Study of Atherosclerosis
Authors: de la Rosa Angelo L , Mehta Aditya , Hansen Spencer L , McClelland Robyn L , Bertoni Alain G , Budoff Matthew J
Published: December 2023

Introduction:
Heart failure (HF) prediction models utilize clinical variables. The purpose of this study was to determine if addition of cardiac computed tomography (CT) variables could improve discrimination of HF prediction scores.

Methods:
Participants of the Multi-Ethnic Study of Atherosclerosis (MESA), a cohort between 45 to 84 years old and free of clinical cardiovascular disease at baseline, with complete clinical data and cardiac CT were included to evaluate new-onset HF during the follow-up period. Cardiac CT variables analyzed included left ventricular size index (LVSi) and calcification of the coronary arteries (CAC), aortic valve (AVC), mitral valve (MVC), and thoracic aorta (TAC). We evaluated if CT variables improved the Pooled Cohort equations to Prevent HF (PCP-HF) score (an internally and externally validated model of 33,010 patients predicting 10-year risk of new-onset HF).

Results:
Among 6,667 MESA participants (52.7% female), 426 events of new-onset HF occurred during the follow-up period. After the Cox model was adjusted for cardiac CT and PCP-HF score variables, CAC (HR 1.10; 95% CI 1.05-1.15; p<0.001), AVC (HR 1.08; 95% CI 1.03-1.13; p=0.002), MVC (HR 1.06; 95% CI 1.01-1.12; p=0.015), and LVSi (HR 1.14; 95% CI 1.10-1.18; p<0.001) were all significantly associated with new-onset HF. After using time-dependent ROC and stratifying by sex, AUC discrimination of new-onset HF with the PCP-HF score was improved by the inclusion of cardiac CT variables. In females, the AUC for 10-year risk of new-onset HF improved from 0.80 to 0.86 with the addition of cardiac CT variables. In males, the AUC for 10-year risk of new-onset HF improved from 0.77 to 0.84 with the addition of cardiac CT variables.

Conclusions:
In addition to traditional clinical risk factors, cardiac CT variables provide anatomic risk factors that improve the prediction of new-onset HF. Coronary and valvular calcification may signal poorly controlled clinical risk factors that are often associated with HF. LVSi may reflect left ventricular remodeling associated with HF. More studies are needed to further elucidate the relationship between cardiac CT anatomic risk factors and HF.
Abstract 13420: Nicorandil Suppresses Mitochondria-Associated Ferroptosis to Attenuates Cardiac Microvascular Disorder in Diabetes: Role of Mitochondria-Localized AMPKα1
Authors: Qian Juying , Li Su , Liu Muyin , chen zhangwei , Ge Junbo
Published: December 2023

Backgrounds:
Common metabolic risk factors, including diabetes, promote cardiac microvascular disorder (CMD), which contributes to ischemia with no obstructive coronary artery disease (INOCA). Recently, our group demonstrated the inhibition of mitochondria-associated ferroptosis in CMD alleviates diabetic cardiomyopathy. Nicorandil (Nic) is recommended as an anti-angina drug for INOCA, whether Nic could inhibit ferroptosis in CMD is not discussed.

Aims:
To explore the benefits of Nic on diabetes-induced CMD and ferroptosis.

Methods:
Nic was orally administered to db/db mice for 6 months. Mitochondria-localized AMPKα1 (mitoAMPKα1) was overexpressed in endothelial cells. Ferroptosis and related signaling pathways were assessed by mRNA sequencing assays, fluorescence staining and western blot.

Results:
Nic significantly alleviated CMD and diabetic cardiomyopathy as evidenced by improved cardiac microvascular perfusion and anatomical structure. mRNA sequencing assays revealed significant enriched pathways related to ferroptosis, mitophagy and AMPK signaling pathway after Nic treatment. Moreover, Nic reversed genes expression involved in ferroptosis and reduced mitochondrial and cellular lipid peroxidation (LPO) formation. Nic increased AMPKα1 phosphorylation and promoted its translocation to mitochondria, in where the phosphorylated AMPKα1 stimulated Parkin-dependent mitophagy and reduced mitochondrial translocation of ACSL4 to inhibit ferroptosis. Endothelium-specific overexpression of an active form of mitoAMPKα1 showed similar benefits as Nic to inhibit cardiac microvascular ferroptosis and improved myocardial dysfunction and pathological remodeling.

Conclusions:
The present work identified mitoAMPKα1 as the potential target for Nic to alleviate mitochondria-associated ferroptosis in diabetes-induced CMD.
Abstract 13421: Meta-Analysis of Penetrance in Genetic Hypertrophic Cardiomyopathy
Authors: Topriceanu Constantin-Cristian , Pereira Alexandre C , Moon James C , Captur Gabriella , Ho Carolyn Y
Published: December 2023

Introduction:
Hypertrophic cardiomyopathy (HCM) is clasically caused by pathogenic or likely pathogenic (P/LP) variants in genes encoding sarcomeric proteins (G+) leading to left ventricular hypertrophy (LVH).

Aim:
To contrast cross-sectional penetrance in clinical and population studies, and to determine the phenotypic conversion (% of G+ developing LVH during follow-up) in longitudinal studies (
Figure 1
).

Methods:
A systematic literature search was performed. Pooled penetrance (with 95% confidence intervals [CIs]) and phenotypic conversion were calculated with random effects generalized linear mixed model meta-analyses. Calculations were made for each gene and across all genes. Meta-regression was employed to explore sex-related differences.

Results:
In cross-sectional clinical studies, after excluding probands, penetrance across all genes in relatives carrying P/LP variants identified during cascade screening was 58% (95% CI [53,64]). Penetrance varied from ~32% for myosin light chain 3 to ~65% for myosin heavy chain 7 (
MYH7
) and troponin T (
TNNT2
). The mean age of HCM onset was 38 years (95% CI [36, 40]) across all genes, but studies including a higher % of males reported a later age of onset. In contrast, penetrance in population studies was ~10-15%, ranging from 0% in Atherosclerosis Risk in Communities to 18% in the UK Biobank. In longitudinal clinical studies, the pooled phenotypic conversion was 15% (95% CI [8,27]) over an average of ~7 years of follow up, starting from a mean age of ~16 years across all genes. However, it varied from ~12% for myosin binding protein C to ~23% for
MYH7
.

Conclusions:
The penetrance is 5-7-fold higher in a clinical context compared to incidental identification in population studies, suggesting important but currently undefined factors that modify disease expression. More longitudinal studies are needed to improve understanding of penetrance and identify drivers of the transition from genetic susceptibility to overt HCM
Abstract 13429: Association of Periprocedural Opiate Exposure During Cardiac Catheterization and Long-Term Opiate Dependence
Authors: Ebrahimi Ramin , Alvarez Carlos , dennis paul , Shroyer A. Laurie
Published: December 2023

Introduction:
Recent data suggest that a brief exposure to opiates during medical encounters may lead to their higher use long-term. In this study we investigated the association of peri-procedural opiate exposure with incident opiate dependence disorder (ODD) for patients undergoing invasive cardiac catheterization (ICC)

Methods:
The Veterans Affairs national electronic medical records for patients undergoing an ICC between 01/01/2010 and 01/01/2018 were extracted. Patients with ODD prior to the ICC date were excluded from analysis. Peri-procedural opiate use was defined as receiving morphine or fentanyl within 24 hours before or after the ICC. ODD was diagnosed using international classification of disease (ICD) 9
th
and 10
th
version codes. Opiates evaluated included morphine, fentanyl, or other opiates (e.g., codeine, hydrocodone, and methadone). Follow up period extended to 01/01/2020.

Results:
From 01/01/2010 to 01/01/2018, 223,436 patients underwent ICC; of these, 215,841 had no prior ODD. New ODD was identified in 2710 (5.80%) of the 46,624 patients who received opiates peri-procedurally compared to 3,666 (2.16%) of the 169,217 patients who did not receive opiates peri-procedurally, p-value < 0.01.

Conclusions:
Brief peri-procedural use of opiates in patients undergoing ICC may lead to long-term opiate dependence disorder. Further research to validate these results are warranted. Potential alternatives to opiates must be considered for such patients.