bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14676: Susceptibility to Cardiac-Targeted Irradiation in Wild-Type and Nos1 Haploinsufficient Mice
Authors: Dierdorff Jason M , Mehdi Haider , Elmonzer Mohamed , Greiner Alexander , Current Kyle , Yoon Jin-Young , Prathivadhi-Bhayankaram Sruti , Morgan Gina , Kutschke William J , Wipf Peter , Epperly Michael , Allen Bryan G , Spitz Douglas R , Greenberger Joel , London Barry
Published: December 2023

Introduction:
Cardiac irradiation causes heart failure and arrhythmias. We reported that cardiac-targeted irradiation (CTI) led to cardiac dilation with increased end diastolic volume (EDV) by echocardiogram (echo) after 9 months in wild-type C57Bl6/J (WT) male (M) but not female (F) mice. Both sexes developed cardiac fibrosis and evidence of lung congestion, and the radiation mitigator MMS350 did not protect either sex. Here, we studied the effect of CTI on Nitric Oxide Synthase 1 haploinsufficient (Nos
+/-
) mice treated with/without MMS350.

Methods:
10 week-old Nos
+/-
and WT mice were exposed to 20 Gy CTI (R) with or without MMS350 (D) and followed for 9 months (Nos
+/-
: +R+D, n = 9M, 6F; +R-D, n = 6M, 7F; WT: +R+D, n = 12M, 14F; +R-D, n = 13M, 14F), with parallel unirradiated controls (Nos
+/-
: -R+D, n = 8M, 6F; -R-D, n = 10M, 7F; WT: -R+D, n = 8M, 12F; -R-D, n = 7M, 8F)). Echos and EKGs were performed at baseline and every 3 months. Heart weight (HW), lung weight (LW), and body weight (BW) were measured.

Results:
Unlike irradiated male WT mice where EDV was increased (p=0.001), EDV was smaller in male (p=0.04) and EF was decreased in both male (p=0.01) and female (p=0.05) Nos
+/-
irradiated mice compared to unirradiated controls, independent of MMS350 treatment (Figure). In addition, the PR interval was shorter in irradiated Nos
+/-
male (p=0.008) and female (p=0.003) mice compared to unirradiated controls. HW/BW was not significantly changed in any group, while LW/BW was significantly increased only in WT male (p=0.04) and female (p=0.001) irradiated mice.

Conclusions:
In long term follow-up of CTI-treated mice, Nos1 deficiency prevents sex-specific cardiac dilation in males, promotes left ventricular systolic dysfunction and alters cardiac conduction system properties. Further investigation into the role of nitric oxide in radiation-induced cardiac damage and the mechanisms underlying sex differences in the response to radiation are warranted.
Abstract 14695: Artificial Intelligence Applied to the Electrocardiogram Predicts Outcomes in Patients With Severe Aortic Stenosis and Potential Cardiac Amyloidosis Undergoing Transcatheter Aortic Valve Replacement
Authors: Pereyra Milagros , FARINA JUAN , Mahmoud Ahmed K. , Scalia Isabel G , Galasso Francesca , Killian Michael E , Suppah Mustafa , Chao Chieh-Ju , Sweeney John P , Fortuin Floyd D , Rosenthal Julie , Arsanjani Reza , Ayoub Chadi
Published: December 2023

Introduction:
Cardiac amyloidosis (CA) has been suggested to be common (up to 16%) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). CA has poorer outcomes and its assessment in all TAVR patients may be costly and challenging.

Hypothesis:
CA may be screened for with an artificial intelligence (AI) clinical predictive model applied to pre-TAVR ECGs, and high probability (>50%) for CA may be associated with worse clinical outcomes.

Methods:
In this retrospective analysis of the Mayo institutional National Cardiovascular Disease Registry (NCDR)-TAVR, patients undergoing a TAVR between Jan-2012 and Dec-2017 were included. Pre-TAVR ECGs were analyzed by the AI predictive model for CA embedded in the EMR. EMRs were reviewed to assess for a clinical diagnosis of CA in those identified as high probability (>50%) by the AI tool. Clinical outcomes on 1 year follow-up were extracted from the NCDR-TAVR database and Kaplan-Meier curves were created to compare patients with high CA probability (≥50%) versus those with low probability (<50%).

Results:
Of 1070 patients who underwent TAVR (mean age 81.1± 8.5 years, 58.2% male), 263 (24.6%) had ≥50% probability for CA on pre-procedure ECG. Only 18 (1.7%) of these had clinical diagnosis of CA. In the survival analysis, high probability of CA by AI tool was associated with higher all-cause mortality (HR 1.60, 95%CI 1.09-2.34, p=0.01) and greater HF admissions (HR 1.59, 95%CI 1.08-2.35, p<0.01). Neither TIA/stroke nor myocardial infarction were statistically significant. MACE (TIA/stroke, myocardial infarction, heart failure admissions) was higher in the ≥50% CA probability group (HR 1.68, 95%CI 1.17-2.40, p<0.01),
(Figure)
.

Conclusion:
CA is clinically underdiagnosed in patients undergoing TAVR. AI applied to pre-TAVR ECGs suggesting higher probability for CA identifies a subgroup at higher risk of clinical events, who may benefit from further diagnostic evaluation for CA.
Abstract 14710: The Landscape of Pharmacological Interventional Trials for the Treatment or Prevention of Coronary Artery Disease: Analysis of clinicaltrials.gov Listings From 2008 to 2022
Authors: Chi Gerald , Bahit Cecilia , Korjian Serge , Allaham Laith , Kazmi Syed Hassan A. , Nara Paul , Shaunik Alka , Gibson Charles
Published: December 2023

Background:
Coronary artery disease (CAD) has been the leading cause of death and disability over the past two decades.

Aims:
To systematically assess the characteristics and trends of clinical trials pertaining to the treatment or prevention of CAD.

Methods:
The analysis included studies that (1) were registered in the ClinicalTrials.gov database from 2008 to 2022; (2) involved ≥1 pharmacological intervention; and (3) were designed to treat or prevent CAD or its complications. Study records were downloaded on December 27, 2022 for screening and analysis. Pharmacological interventions were classified according to the World Health Organization Anatomical Therapeutic Chemical Classification System. Annual trends by the year of study registration were assessed with a two-sided Cochran-Armitage test.

Results:
A total of 1,619 trials were identified from a pool of 437,319 studies. There was a declining trend in the number of CAD trials (Figure A). The majority of trials (47.5%) were targeted to enroll ≤100 participants, while 39.4% targeted 101-1000 participants, 10.5% targeted 1001-5000 participants, and 2.6% were mega-trials (>5000 participants). The distribution of study duration was as follows: ≤12 months (25.3%), 13-60 months (67.3%), and >60 months (7.5%). Of note, the open-label design was more commonly employed in treatment trials (41.8% vs. 31.6%; p=0.02), while the parallel assignment was more frequently utilized in prevention trials (88.8% vs. 82.0%; p=0.03). In addition, declining trends in the proportions of phase 3 trials (p=0.0008; Figure B) and trials of lipid-modifying (p=0.0043) or anti-thrombotic agents (p=0.03; Figure C) were observed.

Conclusion:
Between 2008 and 2022, the clinical trial landscape of CAD diminished and was mainly shaped by studies with small to moderate sample sizes and short to intermediate follow-up duration. Research focus trended toward study interventions other than anti-thrombotic or lipid-modifying agents.
Abstract 14740: Identifying Predictors of Timing to Guideline-Directed Medical Therapy for Medical Beneficiaries With Heart Failure
Authors: Chiang Melody , Kim Dennie , Cascino Thomas , Hou Hechuan , Hawkins Robert , Funk Kylee , Aaronson Keith D , Cabrera Lourdes , Likosky Donald S , McCullough Jeffrey
Published: December 2023

Introduction:
Despite substantial evidence supporting the timely initiation and optimization of guideline-directed medical therapy (GDMT) for patients with heart failure, its utilization remains low.

Hypothesis:
Variation in GDMT prescribing will be explained by patient-, clinician-, and hospital-level determinants that can serve as targets for future interventions.

Methods:
This study included 793,319 fee-for-service Medicare beneficiaries admitted with heart failure (incident or acute-on-chronic) between 2009-17. The GDMT outcome was the receipt of 1 from each of 3 medication classes within 120 days of discharge: beta blockers, ACE inhibitors/ARBs, or MRAs. Candidate predictors included patient demographics, pre-admission medication, community distress (social determinants), and Charlson comorbidities. Models, estimated via logistic regression and marginal effects, considered unobserved changes in practice patterns over time and, in some specifications, provider differences (fixed effects). Other specifications controlled for observed hospital characteristics.

Results:
The cohort was 49% female (n=390,765), 16% Black (n=123,238), 6% Hispanic (n=50,138) with a median (IQR) of 78 years (69-86). The median number of comorbidities was 3 (IQR 2-4). The overall 120-day use of beta blockers was 55%, ACE inhibitors/ARBs 47%, MRAs 21%, and all three medications 11%. After adjustment, the largest predictors of GDMT were pre-admission medication use and comorbidities (eg, renal disease). Women achieved 0.9% lower GDMT (Figure). Community distress was associated with lower GDMT; yet, the magnitude of effect was small (-0.01%). Academic hospitals achieved 0.3% better GDMT despite having a more severe patient population.

Conclusions:
GDMT use was low (and lowest for MRAs). Targeted interventions to address these identified predictors may advance the prescribing and use of guideline-directed, evidence-based care for heart failure patients.
Abstract 14764: Underuse of Preventive Care Among Female Sudden Death Victims
Authors: Bain Schuyler , Keen Susan , Day Gabriella , Shartle Kaitlin , Senter Elizabeth , Bourgeois Camille , Daniels Michael , Simpson Ross J
Published: December 2023

Background:
Sudden death accounts for approximately 10% of deaths among working age adults. The rate of sudden death among females is one third lower than males, although the burden of chronic medical conditions are similar in victims of both sexes. The reasons for this difference are unclear and may be important in addressing preventive screening underutilization, as preventive screenings have been shown to reduce morbidity and mortality.

Research Questions:
Does utilization of preventive services differ among sudden death victims and living controls? Do these differences vary by sex?

Aims:
We aim to describe receipt of preventive screenings and influenza vaccination in sudden death victims and to compare these rates to those of a living control population.

Methods:
Clinical records from 267 out-of-hospital sudden death victims aged 18-64 in Wake County, North Carolina from 2013-2015 and 1112 demographically matched living controls from the same county and time were compared. Victims were identified by screening Emergency Medical Service records and adjudicated to exclude expected deaths from chronic disease, trauma, suicide, and overdose. Records were systematically reviewed for evidence of influenza vaccination and receipt of colon, cervical, and breast cancer screenings within the past five years, according to USPSTF criteria. Percentage of individuals who received each preventive screening were compared using means difference tests. Binomial regression was performed to investigate the effect of insurance status on preventive care receipt

Results:
Rates of colonoscopy and influenza vaccination were similar between cases and controls among both sexes. Female victims had low utilization of preventive services and were less likely to have received Pap smears (24.1% vs 50.9%; p<0.001) and mammography (44.0% vs 65.2%; p<0.001) compared to controls. While these differences can be partially explained by insurance status, with both private and public insurance being protective, screening differences remained significant.

Conclusion:
Significant differences in preventive screenings are present among female sudden death victims and may represent an important behavioral pattern to identify and intervene upon in these vulnerable patients.
Abstract 14780: Characterization of HFrEF and HFpEF According to Three Categories of Risk Factors: Modifiable, Non-Modifiable, and the Social Determinants
Authors: Dhani Mohamed Angelina , Elfert Khaled , Zaremski Lynn
Published: December 2023

Background:
The prevalence of HF is expected to rise in the next decade. In this cross-sectional study, we aim to explore HF according to three categories of risk factors involved in its development: modifiable, non-modifiable, and social determinants.

Methods:
We conducted a cross-sectional study using the National Inpatient Sample(NIS) Database. The variables in NIS were defined using the ICD-10-CM. The study population was from 2016 to 2020, aged 18 years and above. We included patients admitted to the hospital with a principal diagnosis of HFrEF or HFpEF. Exclusion criteria included patients with isolated right heart failure and uncategorized HF. We analyzed the hospital location and baseline patient characteristics, including, race, age, income, smoking, alcohol and drug abuse, and comorbidities. The primary outcome was inpatient mortality. The data were analyzed with STATA software.

Results:
A total of 951,714 patients were included; 502,490 had HFrEF and 449,225 HFpEF with a mean age of 67.4 and 74.4 respectively. The HFrEF group had more men (63%) and the HFpEF group had more women (62%) (A). Patients in the 1
st
income (lowest) quartile constituted the largest proportion of HFrEF and HFpEF compared to the other quartiles (B). We noted a statistically higher proportion of patients with HFrEF compared to HFpEF in the 1st income quartile (35 vs. 29% respectively). In the 4th quartile, HFpEF was more common than HFrEF (20 vs. 17% respectively ) (B). HTN (64%), DM (41%), renal failure (39%), and COPD (41%) were the most common comorbidities in both groups. Smoking, alcohol abuse, and drug use were more frequent in patients with HFrEF than HFpEF being 20 vs. 11%, 6 vs. 3%, and 8 vs. 2% respectively. Mortality was 3% in HFrEF and 2% in HFpEF (p <0.0001).

Conclusion:
This analysis presents data that emphasizes the importance of all three categories of risk factors, including the social determinants. It could help to develop effective interventions to reduce the future burden of HF.
Abstract 14790: Association of Neighborhood Socioeconomic Disadvantage in Early Pregnancy and 30-Year Predicted Probability of Cardiovascular Disease 2-7 Years Postpartum
Authors: venkatesh kartik K , Khan Sadiya S , Catov Janet M , wu jiqang , McNeil Rebecca , Pemberton Victoria L , Greenland Philip , Chung Judith , Levine Lisa , Yee Lynn , Simhan Hyagriv , Haas David , Saade George , Bairey Merz C Noel N , Grobman William
Published: December 2023

Introduction:
To determine whether neighborhood socioeconomic disadvantage as measured by the Area Deprivation Index (ADI) in early pregnancy is associated with higher 30-year predicted risk of cardiovascular disease (CVD) by the Framingham Risk Score.

Methods:
A secondary analysis of data from the prospective Nulliparous Pregnancy Outcomes Study-Monitoring Mothers-to-Be (nuMoM2b) Heart Health Study (HHS) longitudinal cohort. Participant home addresses in the first trimester were geocoded at the census-tract level. The exposure was neighborhood socioeconomic disadvantage using the 2015 ADI by tertile (least deprived [T1], reference; most deprived [T3]). The primary outcome was the predicted 30-year risk of hard CVD using the Framingham Risk Score (composite of fatal and non-fatal coronary heart disease and stroke). The secondary outcome was predicted 30-year risk of total CVD (composite of “hard” CVD plus coronary insufficiency and angina pectoris, stroke, transient ischemic attack, intermittent claudication and heart failure). Outcomes were assessed categorically as high-risk defined as a predicted probability of CVD
>
10%, and secondarily as a continuous measure of absolute risk (%). Modified Poisson and linear regression models adjusted for age, insurance, education, and income.

Results:
Among 4,310 nulliparous individuals, the median age was 27 years (IQR: 23-31), and the median ADI was 43 (IQR: 22-74). At 2-7 years postpartum (median: 4 years), the median 30-year risk of hard CVD was 2.3% (IQR: 1.5-3.5), and total CVD was 5.5% (IQR: 3.7-7.9). Individuals living in neighborhoods in the highest tertile of socioeconomic disadvantage were more likely to have a high 30-year predicted risk of hard CVD (≥10%) compared with those in the lowest tertile (aRR: 2.25; 95% CI: 1.23, 4.11), with similar results for high 30-year predicted risk of total CVD (aRR: 1.36; 95% CI: 1.09, 1.69). Living in the highest ADI tertile was associated with a higher absolute risk of 30-year hard (adj. ß: 0.41; 95% CI: 0.19, 0.63) and total CVD (adj. ß: 0.76; 95% CI: 0.38, 1.14) when analyzed as a continuous outcome.

Conclusions:
Neighborhood socioeconomic disadvantage in early pregnancy is associated with higher predicted risk of 30-year CVD 2-7 years after delivery.
Abstract 14793: Relationship Between Self-Rated Health and Clinical Outcomes in Hypertension: A Secondary Analysis of the Systolic Blood Pressure Intervention Trial (SPRINT)
Authors: Kazibwe Richard , Ahmad Muhammad , Chevli Parag A , Namutebi Juliana H , Kazibwe Joseph , Epiu Isabella , Shapiro Michael D , Yeboah Joseph
Published: December 2023

Background:
Self-rated health (SRH) is a well-known independent predictor of mortality. However, the association of SRH with clinical outcomes in patients with hypertension remains uncertain. SPRINT investigated the benefit of intensive (vs. standard) blood pressure treatment in patients with high-risk hypertension.

Objective:
To examine the association between SRH and the primary SPRINT outcome, which was defined as the composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, and cardiovascular death.

Methods:
A trained study personnel administered a questionnaire to assess SRH. Each participant rated their overall health as excellent, very good, good, fair, or poor (E, VG, G, F, P). We categorized SRH into excellent, very good, good and fair/poor. Multivariate Cox regression was used to examine the association of SRH and clinical outcomes in SPRINT.

Results:
We included 9,319 participants (aged 67.9±9 years, 35.6% women, 57.6% White) who had available data on SRH. After a median follow-up of 3.8 years, 724 and 500 primary outcome and all-cause mortality events occurred, respectively. Relative to SRH of excellent, the risk of the primary outcome (HR 95% CI) associated with very good, good, and poor/fair SRH was 1.11 (0.78-1.56; p=0.555), 1.45 (1.03-2.05; p=0.036) and 1.87 (1.28-2.75; p=0.001), respectively. Similarly, relative to excellent, the risk of all-cause mortality (HR 95% CI) associated with very good, good, and poor/fair SRH was 1.13 (0.73-1.76; p=0.581), 1.72 (1.12-2.64; p=0.014) and 2.11 (1.32-3.38; p=0.002), respectively. Poorer SRH was also associated with a higher risk of each component of the primary outcome and adverse events (
Table).

Conclusion:
In the SPRINT cohort, SRH was independently associated with the risk of cardiovascular outcomes, mortality, and adverse events. Further studies are needed to explore the utility of incorporating SRH in the assessment of risk in patients with hypertension.
Abstract 14794: Relationship Between Cerebral Infarction Incidence and Humidity in a Super-Aging Society
Authors: Yoneyama Kihei , Doi Shunichi , Yoshida Toshiya , Kawagoe Yasuhito , Ishibashi Yuki , Izumo Masaki , Tanabe Yasuhiro , Harada Tomoo , Akashi Yoshihiro J
Published: December 2023

Introduction:
Cerebral infarction is one of the major causes of physical disability among the elderly worldwide. Weather temperature and humidity are rarely reported as predictors of cerebral infarction in our super-aging society.

Hypothesis:
Temperature and humidity are associate with cerebral infarction admission in super aging society.

Methods:
The Japanese registry of all cardiac and vascular diseases database includes patients with cardio-cerebrovascular disease who required admission and constitutes a nationwide dataset in Japan. This study included 606,807 consecutive patients with cerebrovascular disease requiring admission were admitted between 2015 and 2019. We investigated the relationship between cerebral infarction admission and temperature, or humidity.

Results:
Data were collected from 422,759 admitted patients with cerebral infarction. In the population with cerebrovascular disease admission, the median age was 75.0 (66.0-83.0) years and 55.8% of subjects were male. The mean temperature and humidity 1 day before cerebral infarction hospitalization were 17.2 °C and 69%, respectively. Multilevel mixed-effects linear regression models showed non-linear relationship of temperature and humidity with cerebral infarction admissions after adjusting for air pollution, hospital, and patient demographics. A negative linear association was found between mean temperature and humidity with cerebral infarction admission at mean temperature <7°C and mean humidity <40% (coefficient, -2.098 [-2.220 to -1.976] per °C, coefficient, 0.165 [0.151 to 0.179] per %, respectively).However, a positive linear association was found at mean temperature ≥7°C, at mean humidity ≥40% (coefficient, 0.190 [0.161 to 0.219]per °C, coefficient, 0.136 [0.103 to 0.168] per %, respectively).

Conclusions:
Extremely lower or higher temperature and humidity are both associated with an increased incidence of cerebral infarction admission in Japan.
Abstract 14824: Reduced Endothelial ADAR1-Dependent RNA Editing Induces NOCT-Driven Immunoactivation and Promotes Pulmonary Hypertension
Authors: Woodcock Chen-Shan J , Maroli Giovanni , Kim Hyunbum , Tang Ying , Tai Yi Yin , Okawa Satoshi , Cho Shu-Ting , Lafyatis Robert , Chauvet Caroline , Kudryashova Tatiana , Goncharova Elena A , Bertero Thomas , Yuan Ke , Pullamsetti Soni , Chan Stephen Y
Published: December 2023

Introduction:
Early apoptosis of pulmonary artery endothelial cells (PAECs) is a key driver of vascular remodeling and pulmonary hypertension (PH), but its regulation is poorly defined. Adenosine deaminase acting on RNA 1 (ADAR1) is an RNA editing enzyme that converts adenosine to inosine (A-to-I) in RNA transcripts. We found that ADAR1 expression was reduced in PH endothelium. While reduced RNA editing stimulates aberrant cytosolic innate immunity and can drive apoptosis, the exact RNA editing targets and downstream mechanisms regulating pulmonary endothelial survival are unknown.

Hypothesis:
Deficiency in ADAR1-mediated RNA editing promotes pulmonary endothelial pathophenotypes and drives PH.

Methods & Results:
ADAR1 expression was downregulated in the pulmonary vascular endothelium and in lung tissues of human and mouse PH. Global A-to-I editing was decreased in the whole lungs and PBMCs from PAH patients.
In vitro
, hypoxia, a known PH trigger, downregulated ADAR1 in PAECs via upregulation of the ADAR1-targeting microRNA, miR-17. By RNA sequencing of PAECs after ADAR1 knockdown, we identified the circadian gene
Nocturnin
(
NOCT
) as a direct ADAR1 target that carries two active A-to-I RNA editing sites in the 3’UTR. By single cell RNA sequencing of human PAH lungs,
NOCT
editing levels were reduced, while
NOCT
transcript levels increased. Correspondingly,
in vitro
,
ADAR1
silencing increased
NOCT
mRNA levels, thus activating an innate immune response and PAEC apoptosis. Forced NOCT expression phenocopied the effect of ADAR1 deficiency, inducing RNA sensing innate immunity signaling pathway and increasing apoptosis.
In vivo
, in mice chronically exposed to hypoxia, administration of the ADAR1 inhibitor 8-Azaadenosine (Aza) resulted in worsened indices of PH. Notably, genetic deletion of
NOCT
mitigated PH induced by Aza in hypoxic IL6 transgenic mice, emphasizing the crucial role of NOCT in ADAR1-mediated pathogenesis.

Conclusions:
Hypoxia-induced ADAR1 deficiency promotes
NOCT
mRNA dysregulation to induce PAEC innate immunity, PAEC apoptosis, and PH. This study provides impetus to target the ADAR1-NOCT axis for more effective diagnostics and therapeutics for PH.
Abstract 14832: Comparative Effectiveness of Intravascular Ultrasound versus Angiography in Abdominal and Thoracic Endovascular Aortic Repair: Systematic Review and Meta-Analysis
Authors: Shimoda Tomonari , D'Oria Mario , Kuno Toshiki , Takagi Hisato , Heindel Patrick , Hussain Mohamad , Secemsky Eric A
Published: December 2023

Introduction:
The effectiveness of intravascular ultrasound (IVUS) with angiography compared with angiography guidance alone in the treatment of aortic conditions remains unclear.

Objective:
This systematic review and meta-analysis evaluates the evidence for IVUS use during thoracic (TEVAR) and abdominal (EVAR) endovascular aortic repair.

Methods:
A comprehensive search of MEDLINE, EMBASE, and Cochrane CENTRAL databases was conducted to identify studies comparing outcomes of patients undergoing TEVAR/EVAR with and without IVUS. The primary outcome was all-cause mortality during follow-up. Secondary outcomes included contrast volume, fluoroscopy time, perioperative mortality, and reinterventions during follow-up. Continuous variables, risk ratios (RRs), and hazard ratios (HRs) with 95% confidence intervals (CIs) were extracted from each study. Pooled analysis was performed using a random-effects model.

Results:
A total of 6,888 patients (n=4,226 IVUS and n=2,662 non-IVUS) from nine observational studies were included in the meta-analysis. The follow-up period ranged from 9 months to 25 months. The IVUS group exhibited a reduction in contrast agent volume (weighted mean difference (WMD) [95% CI] = -34.65 mL [-54.73, -14.57]) and fluoroscopy time (WMD [95% CI] = -6.13 min [-11.10, -1.15]) (
Figure 1A&B
). Perioperative mortality was comparable between both groups (RR [95% CI] = 0.67 [0.40-1.12], respectively). Reintervention rates and all-cause mortality during the follow-up period were similar between the two groups (HR [95% CI] = 0.80 [0.33-1.97], HR [95% CI] = 0.75 [0.47-1.18], respectively) (
Figure 1C
).

Conclusions:
This systematic review and meta-analysis provides evidence that the use of IVUS enables safe and effective deployment of TEVAR and EVAR with reduced contrast agent usage and shorter fluoroscopy duration. These findings support the potential of IVUS as a valuable tool in endovascular aortic interventions.
Abstract 14835: A Rare Case of Left Atrial Thrombus Post Extensive Ablation Despite Therapeutic Anticoagulation
Authors: Naveed Shahmir , Mehta Samir P , Azizi Abdul , Chandra Avinash
Published: December 2023

Introduction:
Persistent Atrial Fibrillation (AF) is often treated with radiofrequency catheter ablations to the pulmonary veins as well as linear ablations of the left atrium. Extensive ablations can increase the risk of clotting at the ablation site.

Case:
A 47-year-old male with a history of Shone Syndrome, AF on Warfarin with prior ablations presented for acute monocular vision loss found to be due to central retinal artery occlusion. Symptoms were three weeks after repeat PVI and posterior wall isolation. Transesophageal echocardiogram (TEE) showed multiple mobile echodensities suspicious for thrombi in the left atrium but no LAA thrombus. With elevation of INR goal range to 3 to 3.5 and addition of aspirin there was resolution of the left atrial thrombi on repeat TEE 2 months later.

Discussion:
Visual loss was suspected to be cardioembolic. The cause of thrombi, despite being anticoagulated with an INR of 2.6, was multifactorial from chronic fibrosis, repeated ablation-induced injury yielding endothelial damage, elevated LA pressures due to mitral stenosis, and persistent atrial flutter. Multiple small thrombi visualized adherent to left atrial wall without any thrombus in LAA. Advanced imaging cannot guide anticoagulation strategy directly but can assess fibrotic burden. It is important to consider increasing the INR goal or adding aspirin to high-risk patients.

Conclusion:
Patients should be risk stratified when extensively ablated and with elevated atrial pressures with multimodal imaging to determine risk and management when undergoing extensive ablation. Further investigation needs to be done to determine if heightened anticoagulation goals are needed based on risk stratification.
Abstract 14837: Increase in Left Atrial Pressure After Cryoballoon Ablation Indicates Worse Atrial Function: Evidence From APPEARANCE-AF Trial
Authors: Ren Zhongyuan , wu Shubin , Wu Jiayu , Zhong Yuan , Xu Jun , Sun Hui , Zhao Dongdong , Xu Yawei
Published: December 2023

Introduction:
Left atrial pressure (LAP) is a direct reflection of left atrial function, while LAP could fluctuate following left atrial procedure. The pattern of LAP change in response to pulmonary vein isolation (PVI) and its significance remain to be explored.

Hypothesis:
The change of LAP before and after PVI could indicate atrial function and predict adverse events.

Methods:
28 patients from APPEARANCE-AF trial underwent PVI using cryoballoon ablation were included. Pre-ablation and post-ablation LAP were directly measured via catheter. The correlation of LAP change with demographics, biochemical measurements, and speckle traced echocardiographic indexes of left atrium (LA) were investigated.

Results:
The included cohort has a mean age of 73.8±8.4 years old, with 12 male (42.9%). Instant PVI was achieved in all patients without complications. The average mean LAP (mLAP) measured before and after PVI was 8.2±4.5 mmHg (pre mLAP) and 14.0±6.5 mmHg (post mLAP), with a significant increment (ΔmLAP: 5.8±4.5 mmHg, P<0.001). In the evaluation of the association of LAP with LA function, the change in LAP significantly correlated with LA strain rate in reservoir (LASr, r=-0.58, P=0.001) and conduit phase (LAScd, r=0.63, P<0.001) and LA ejection fraction (r=-0.48, P=0.014). Furthermore, we divided the cohort into group with significant increment of LAP (inc-mLAP, increment of mLAP > 5 mmHg, n=14) and group with non-significant increment of LAP (ninc-mLAP, mLAP ≤ 5 mmHg, n=14). Correspondingly, patients with larger LAP increment presented significant worse atrial function indicated by LASr (17.3%±5.6% ninc-mLAP vs 11.5%±7.3% inc-mLAP, P=0.030), LAScd (-9.6%±2.2% ninc-mLAP vs -5.7%±3.6% inc-mLAP, P=0.003).

Conclusions:
PVI could significantly increase LAP, and a higher change of LAP could indicate worse atrial function. Measuring the change of LAP might be valuable in predicting the prognosis of PVI.
Abstract 14871: Mitral Valve Involvement in Systemic Sclerosis, Post COVID-19 Infection
Authors: Xu Lu , Avany Albert , Munetsi Magrian , Khanna Ashok
Published: December 2023

Introduction:
We report a case of mitral valve regurgitation as cardiac involvement of systemic sclerosis (SSc) in a 52-year-old woman post COVID-19 infection.

Case Description:
52-year-old female presented with new-onset, progressive dyspnea, dryness and thickness of the skin, intermittent palpitations, and weight loss 3 months after recovered from COVID-19. Initial laboratory studies showed low hemoglobin levels and elevated pro-BNP, troponin-T, hs-CRP and ESR. An autoimmune panel was ordered and revealed positive antinuclear antibodies (ANA) and positive scleroderma related antibodies (anti-RNA polymerase III). Chest radiography and Chest CT without contrast both showed septal and bronchial wall thickening. A transthoracic echocardiogram was performed and showed a severely dilated left atrium and mildly thickened mitral valve leaflets with severe mitral regurgitation. A transesophageal echocardiogram revealed a thickened anterior mitral leaflet and restricted mobility of the posterior leaflet with mitral regurgitation being moderate in severity. These findings were consistent with the reported changes seen on echocardiogram and in autopsies in patients with SSc. The diagnosis of SSc in this patient was made and the patient was started on mycophenolate.

Conclusions:
This case highlights the possible mechanisms through which COVID-19 may trigger the development of autoimmune and inflammatory reactions which, in our case, lead to the development of mitral regurgitation as a sequela of SSc. Imagine 1.

Imagine 2.
Abstract 14891: Time to Therapeutic Range for Patients With Acute Pulmonary Embolism Undergoing Mechanical Thrombectomy
Authors: Zhang Robert S , Ho Alvin M , Elbaum Lindsay , Grossman Kelsey , Singh Arushi , Greco Allison A , Hall Sylvie , Ahuja Tania , Postelnicu Radu , MUKHERJEE VIKRAMJIT , Keller Norma , Alviar Carlos L , Bangalore Sripal
Published: December 2023

Introduction:
Anticoagulation therapy is the mainstay for the management of patients with acute pulmonary embolism (PE) and achieving a timely time to therapeutic range (TTR) is important. We sought to determine the TTR in patients with acute PE referred for mechanical thrombectomy (MT) and the proportion of patients with therapeutic activated clotting time (ACT) at the time of MT.

Methods:
This single center retrospective study included all patients who underwent percutaneous MT at a large academic public hospital from January 2020 through April 2023. Therapeutic anticoagulation was defined as an ACT >200 seconds or if the patient received enoxaparin within 6 hours prior to MT.

Results:
A total of 63 patients (average age 58 years, 43% female) with intermediate or high-risk PE were included in the analysis. The median time from the diagnosis of PE or clot-in-transit (CIT) to MT was 15 (IQR 6.1-23.2) hours. Fifteen patients (23.8%) were initiated on enoxaparin at the diagnosis of acute PE or CIT. Among these patients, 5 (7.9%) were on enoxaparin only and 10 (15.9%) patients were initiated on enoxaparin and then transitioned to a heparin infusion prior to MT. One patient was initiated on argatroban, while the remaining 47 patients were initiated on a heparin infusion at time of diagnosis (77.6% received heparin bolus). In patients who received a heparin infusion, the median ACT in the cath lab was 134 (IQR 118-159) seconds. Only a total of 9/63 (14.3%) were therapeutic by ACT at the time of MT or received therapeutic enoxaparin within 6 hours of MT. Excluding patients who received enoxaparin initially, 34/48 (70.8%) patients reached a therapeutic anti-Xa or partial thromboplastin time (PTT) levels. The median time to reach a therapeutic anti-Xa or aPTT was 5.6 (IQR 3.3-8.2) hours (Figure).

Conclusion:
In patients with acute PE referred for MT, only a minority of patients had therapeutic ACT prior to mechanical thrombectomy.
Abstract 14909: Door-to-Diuretic Time and Mortality in Patients With Acute Heart Failure: A Meta-Analysis
Authors: Sampaio Rodrigues Thalys , Garcia Quarto Levindo Jose , Nogueira Savio , Theuerle James D , Farouque Omar , Burrell Louise M , Koshy Anoop N
Published: December 2023

Background:
Recent studies have highlighted potential benefit with time-to-therapy of intravenous (IV) diuretics in patients with acute heart failure (AHF), although the data is conflicting. We sought to evaluate the impact of door-to-IV diuretic time on mortality in patients with AHF presenting to hospital.

Methods:
Electronic databases were searched for prospectively registered (PROSPERO CRD42023394255) studies published up to February 2023 that evaluated the effect of door-to-IV diuretic time on clinical outcomes in AHF. The primary outcome was in-hospital mortality and the secondary outcome 30-day all-cause mortality. Three reviewers independently appraised the data, with summary odds ratios (OR) and 95% confidence intervals (CIs) pooled using a random-effects model.

Results:
Seven observational studies comprising 29,102 patients were included. Three studies were prospective in design. Diuretics of choice were furosemide or bumetanide. Early IV diuretic administration was defined as a reference range from 30 to 105 minutes. Early IV diuresis was not associated with any difference in in-hospital mortality (OR 0.84, 95% CI 0.57-1.24) with high heterogeneity (I
2
=74%). However, pooled data from 4 studies evaluating 30-day outcomes demonstrated reduced 30-day mortality (OR 0.77, 95% CI 0.64-0.93).

Conclusion:
Door-to-IV diuretic time was not associated with reduced in-hospital death but was associated with significantly improved 30-day mortality. Prospective trials are warranted to evaluate the effect of early IV diuresis across heart failure phenotypes and disease severities.
Abstract 14916: Clinical and Socioeconomic Factors Associated With Time to Surgery and Preoperative Mortality in Surgery-Eligible Patients With Rheumatic Valvular Heart Disease in Uganda
Authors: Doh Chang Yoon , An Crystal , Chang Andrew Y , Rwebembera Joselyn , Mwambu Tom P , Beaton Andrea Z , Nakagaayi Doreen , Ruda Vega Pablo , Sable Craig A , Lwabi Peter , Longenecker Chris T
Published: December 2023

Background:
There is a considerable gap between those needing and receiving surgery among people with rheumatic heart disease (RHD) in Uganda. Nevertheless, risk factors associated with time to surgery and preoperative mortality among those in need of surgery remain poorly understood.

Methods:
A cohort of patients with RHD who met criteria for valve surgery was assembled using the Uganda National RHD Registry (Jan. 2009- Aug. 2022). Kaplan-Meier estimates and multivariable Cox proportional hazards models were constructed to estimate time to surgery and death for those awaiting surgery.

Results:
1,452 patients met surgical indication for valvular RHD. Median age was 20 years (interquartile range [IQR] 13-36), and 30.4% were male. 29.4% had multiple concurrent valve indications. During a median follow-up of 357 days (IQR 21-1029), 30.6% died while awaiting surgery and 13.5% obtained surgery. Median time to surgery was 9.3 years. Multivariable time to surgery model adjusted for age, socioeconomic factors, and HIV status revealed significantly increased likelihood of surgery in men vs. women (hazard ratio [HR] 1.78; 95% CI 1.21-2.64), college/university vs. none/primary school education (HR 3.60; 95% CI 1.88-6.89), and history of atrial fibrillation (HR 2.78; 95% CI 1.63-4.76), but decreased likelihood of surgery in age ≥18 years (HR 0.49; 95% CI 0.32-0.77) and NYHA class III/IV vs. I/II (HR 0.51; 95% CI 0.32-0.83). Median preoperative time to death was 4.6 years. Following stratification by NYHA class I/II and III/IV and adjustment for age, sex, and socioeconomic class, the following predictors were associated with increased mortality in both models: history of infective endocarditis (HR 2.38; 95% CI 1.05-5.39), RV dysfunction (HR 2.44; 95% CI 1.13-5.27), pericardial effusion (HR 1.68; 95% CI 1.27-2.21), surgical indication for multiple valves (HR 1.77; 95% CI 1.41-2.21), and atrial fibrillation (HR 1.47; 95% CI 1.03-2.10).

Conclusions:
Our analysis revealed a low rate of surgical intervention and high mortality rate in a high-risk population of Ugandans living with advanced RHD and operative indication. Unsurprisingly, sex and socioeconomic status remain barriers to receipt of surgery that must be addressed to achieve equity in this neglected disease.
Abstract 14918: Apical Cardiomyopathy in a Transplanted Heart
Authors: Killian Michael , Barry Timothy , Alsidawi Said
Published: December 2023

Case description:
A 67 year old female presented for annual review to the transplant clinic 4 years post orthotopic heart transplant for nonischemic dilated cardiomyopathy. She was asymptomatic. Her medical history included hypothyroidism, hypertension, osteoporosis, restless leg syndrome and calcineurin inhibitor related complications - CKD 3b, impaired glucose tolerance and a left partial glossectomy with neck dissection for stage 3 SCC of the left lateral tongue. Medications included aspirin, atorvastatin, prednisolone, tacrolimus, septrin and ropinirole. Family history was significant for heart failure in her father. She was a nonsmoker and did not consume alcohol. Physical examination was unremarkable. Diagnostic tests are shown below.

Discussion:
Apical hypertrophic cardiomyopathy (ApHCM) has rarely been described in post cardiac transplant populations. Characterized by increased left ventricular apical wall thickness, it results in a ‘spade-like’ appearance on imaging and is associated with marked T wave inversion on ECG. ApHCM is associated with progression to heart failure, apical aneurysm, ventricular arrhythmias and increased mortality rates. Patients may be asymptomatic at diagnosis. Regarding screening, criteria exist for the selection of donor hearts pre transplant with caution exercised if LVH >13mm. Causes of non HCM hypertrophy in this population include calcineurin inhibitors, hypertension, obesity and graft versus host disease. Data for treatment for ApHCM is lacking however it follows the path of classical HCM, involving the use of beta and calcium channel blockers to reduce demand ischemia and management of sequelae.
Abstract 14919: Speckle Tracking Based Echocardiographic Evaluation of COVID-19 Recovered Patients: A One Year Follow-Up Study
Authors: Kunal Shekhar , Faiz Md , Palleda Girish , Batra Vishal , BANSAL ANKIT , Gupta Mohit
Published: December 2023

Introduction:
The occurrence of myocardial injury during acute COVID-19 is well known however, its persistence and impact over a longer period of time is unclear.

Hypothesis:
We assessed left ventricle (LV) global longitudinal strain (GLS) and right ventricle (RV) longitudinal and free wall strain using speckle tracking echocardiography (STE) in COVID-19 recovered patients.

Methods:
A total of 189 subjects following recovery from COVID-19 infection and with a normal LV ejection fraction were enrolled. Routine blood investigations, inflammatory markers and detailed echocardiographic evaluation including STE were done for all. All these patients were followed-up for a period of one year with repeat echocardiography done at six months and one-year.

Results:
Of the 189 subjects, 176 (93.1%) were symptomatic and categorized as mild [n = 91 (51.8%)], moderate [n = 65 (36.9%)] or severe [n = 20 (11.3%)] illness. Subclinical LV and right ventricle (RV) dysfunction were seen in 58 (30.7%) and 25 (13.2%) patients respectively. LVGLS was significantly lower in patients recovered from severe illness (mild: -21.4 ± 3.1 %; moderate: -18.8 ± 4.8%; severe: -16.3 ± 2.7%; P < 0.0001). RV longitudinal strain was significantly lower in patients recovered from severe COVID (mild: -22.9 ± 1.7, moderate: -21.8 ± 1.5, severe: -17.9 ± 1.6; P < 0.0001). There was a significant improvement in LVGLS (baseline: -19.1± 5.7, one-year: -19.9±4.6; P < 0.0001) and RVFWS (baseline: -23.5±6.3; one-year: -23.7 ± 5.8; P=0.03) however, RVLS improved though not significant (baseline: -21.4±5.7; one-year: -21.6 ± 5.2; P=.156) over a one-year follow-up period. Of the 58 subjects with baseline reduced LVGLS, over a one-year follow-up, 22 (11.6%) had persistently reduced LVGLS.

Conclusions:
Subclinical LV dysfunction was seen in one third of recovered COVID-19 patients which improved over a one-year follow-up. A fraction of subjects had persistently reduced LVGLS even at one year which suggests need for closer follow-up among them to elucidate long-term cardiovascular outcomes.
Abstract 14961: Revitalizing Graft Patency: Intravascular Lithotripsy in Calcified Saphenous Vein Graft to Left Anterior Descending Artery Stenosis
Authors: Singh Chetan , Pandya Dishita , Raza Mohammad , Shah Neeraj
Published: December 2023

A 73-year-old man with coronary artery disease (CAD), coronary artery bypass graft, heart failure [EF 25%] & hypertension presented with Non-ST Segment Myocardial Infarction. Angiography revealed multivessel CAD with chronic total occlusion (CTO) of mid-left anterior descending (LAD) after a large first diagonal branch, CTO of mid-left circumflex & distal right coronary artery. Saphenous vein graft (SVG) to obtuse marginal was patent. SVG-diagonal & SVG-ramus intermedius were occluded. Mid SVG-LAD showed severe calcified stenosis (Fig. 1A). Native LAD beyond the SVG provided left to right collaterals to right posterior descending artery. Complex high-risk coronary intervention was performed on the SVG-LAD with mechanical circulatory support (MCS; Impella CP). SVG-LAD had a balloon undilatable lesion despite high pressure inflation with 4.0 mm cutting balloon (Fig. 1B). Intravascular ultrasound (IVUS) revealed severe stenosis with extensive circumferential calcification (Fig. 1C). Subsequently, intravascular lithotripsy (IVL) with 4.0 mm Shockwave balloon followed by high pressure balloon angioplasty with 4.5 mm noncompliant (NC) balloon was performed with significant luminal gain and fractures in calcium (Fig. 1D). The lesion was treated with 5.0 mm drug eluting stents that were post dilated with 5.0 mm NC balloon with excellent angiographic and IVUS result (Figs. 1E & F). MCS was successfully removed at the end of the case.SVG grafts are associated with poor long-term patency compared to arterial grafts. PCI to SVG has a high failure rate and PCI of native vessel is often preferable. High risk SVG interventions with atherectomy have been recently reported, though data is limited. IVL has been safely used in heavily calcified native coronary arteries, however, its use in SVG disease is rare. We report the first off-label use IVL of SVG-LAD with MCS for treatment of a last-remaining conduit. Additional studies to assess IVL efficacy in vein grafts are warranted.
Abstract 14970: Left Ventricular Assist Device Outcomes 5 Years From Heart Transplant Allocation Score Change
Authors: Agronin Jacob , Brown Meredith , Rakita Val , Toyoda Yoshiya , Kashem Mohammed
Published: December 2023

Background:
The United Network for Organ Sharing (UNOS) adopted new criteria for the heart allocation score on 10/18/2018 to reflect changing trends of candidates’ mortality while awaiting transplant. We examined the impact of these policy changes on rates of left ventricular assist device (LVAD) implantation and outcomes posttransplant from a relatively newer UNOS database.

Methods:
The UNOS registry was used to identify first-time adult heart recipients with LVAD at listing or transplant who underwent transplantation between 1/1/2016 and 3/10/2020. Survival data was collected through 3/30/2023. Those listed prior to 10/18/2018 but transplanted after were excluded. Patients were divided into before or after change groups. Demographics and clinical parameters were compared. Survival was analyzed with Kaplan-Meier curves and log-rank tests. A p<0.05 was considered significant.

Results:
We identified 4599 heart recipients with LVAD in the before (n=3767) and after (n=832) score change eras. The after group had a lower rate of LVAD implantation while listed compared to the before group (19.4% vs 34.5%, p<0.0001), younger average age (53.1 ± 12.2 vs 54.1 ± 11.9, p=0.0350) and more likely to be female (24.9% vs 19.6%, p=0.0007); in both groups, most recipients (62%) were white. There was significantly farther distance from the donor hospital to transplant center in the after group (259.5 ± 246.8 NM vs 143.2 ± 182.1 NM, p<0.0001) and decreased waitlist days (83.5 ± 103.5 vs 369.0 ± 458.5, p<0.0001). Recipients in the after group were more likely to receive a CDC increased-risk donor organ (37.5% vs 30.2%, p=0.0002). Survival at 5-years was significantly reduced in the after group (60.5% vs 78.9%, p<0.0001).

Conclusions:
The allocation score change in 2018 yielded considerable changes in MCSD implantation strategy and survival. The rate of LVAD implantation decreased with profoundly worse 5-year survival, showing further divergence from prior short term posttransplant data.