bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 18105: Lean Six Sigma Approach to Improve Post Percutaneous Coronary Intervention Cardiac Rehab Referral Rates
Authors: Andre Veronica , Shapiro Timothy A , Ooi Shaung , Bengaluru Jayanna Manju
Published: December 2023

Background:
Cardiac rehabilitation referral rates remain low despite known benefits including decreased mortality and improved quality of life. Studies have identified factors tied to both positive and negative predictors of referral rates, however, overall, it appears to be due to site-specific variation demonstrating the need for hospital-level intervention.

Aims:
This quality improvement study aimed to improve cardiac rehabilitation referral rates after PCI at our institution utilizing the Lean Sigma Six (LSS) approach, which has been described as a means to improving the quality of healthcare delivery.

Methods:
An interdisciplinary team used the Define-Measure-Analyze-Improve-Control (DMAIC) framework to implement this study. A GEMBA walk i.e., personal observation of workflow was performed. We

Define

d

and

Measure
d

process of cardiac rehabilitation and the referral rates. We

Analyzed

to identify that the orders were being placed by multiple team members including residents, general and interventional cardiology fellows, attendings, and nurse practitioners. Process maps were created, and our

Intervention

was to involve interventional cardiology fellows as stakeholders best suited to place orders since they are involved in all PCIs at our institution. Education was provided specifically to them beginning in July 2022. Statistical Process Control charts were used to analyze data trends from 2019 - 2022 where a total of 3046 PCIs were performed.

Control

process involved reinforcing the effect of intervention in quarterly meetings.

Results:
Baseline referral rates ranged from 10-60%. A significant increase in cardiac rehabilitation referral rate achieving a target referral greater than 90% was observed and maintained through the subsequent quarters.

Conclusion:
LSS is a powerful methodology to examine causes of delay in care. Intervention using LSS principles and tools, may help improve system processes to achieve desired quality outcomes.
Abstract 18108: Statin Biotransformation and 5-Year Cardiovascular Outcomes in the SAPhIRE Multicentre Observational Trial
Authors: goh Eugene C , Wu Lik Hang , Pakkiri Leroy sivappiragasam , Ng Mei Li , Yang Jielin , George Maya , Aminkeng Folefac , Liu Jianjun , Tai E Shyong , Tan Jack W , Drum Chester L
Published: December 2023

Importance:
Individual variation in statin biotransformation may explain differences in clinical outcomes but remains poorly understood.

Objectives:
To quantify statin biotransformation phenotypes in cardiology patients and validate predictors of 5-year clinical outcomes in two independent cohorts.

Design:
SAPhIRE is a multicentre, prospective, observational trial of 1363 general cardiology patients taking atorvastatin or simvastatin. The study was initiated in 2014. Sample collection was completed in 2016, and outcomes of participants were followed-up to June 2020 via the Singapore National Registry of Diseases Office (NRDO).

Setting:
Participants were enrolled across the National University Hospital of Singapore (NUH) and Singapore General Hospital (SGH). Pharmacologic, genotypic, and mechanistic predictors of 5-year clinical outcomes were determined using clinical data, quantitative mass spectrometry and GWAS.

Main Outcome(s):
Major Adverse Cardiovascular Events (MACE) via linkage with NRDO. Risk analysis (multivariable Cox hazards modelling, univariable Kaplan Meier) was used to assess association of metabolism, genomics, and co-prescriptions on 5-year outcomes.

Results:
In both independent cohorts, increased statin lactone production of the upper tertile (ATVLAC≥3.9ng/ml) predicted MACE (HR=2.45, CI=1.60-3.44, P<0.001) and all-cause mortality (HR=3.18, CI=1.96-5.16, P<0.001), independently of LDL and drug dose. UGT1A, a lactone-producing gene, associated with ATVLAC at genome-wide significance. In a candidate gene analysis of UGT1A, UGT1A1*80-associated GOF mutations (rs887829, rs11891311, rs6742078, rs4148324, rs4148325 and rs10929302) predicted 1.34-fold higher ATVLAC compared to major allele homozygotes, and after controlling for clinical variables, exhibited higher rates of MACE (average HR=1.40, p<0.05). Among 51 co-prescriptions, omeprazole was the strongest predictor of increased ATVLAC (1.41-fold, P<10-8) and MACE (HR=1.46, CI=1.06-2.00, P=0.020).

Conclusion:
A phenotype of low statin lactone production predicts preferential cardiac outcomes in two-thirds of statin takers and is influenced by both UGT1A variation and omeprazole co-prescription.
Abstract 18114: Generating Human Artery and Vein Cells From Pluripotent Stem Cells Highlights the Arterial Tropism of Nipah and Hendra Viruses
Authors: Ang Lay Teng
Published: December 2023

Introduction:
biology research endeavors to generate specific subtypes of endothelial ‘‘cell types’’ such as artery and vein cells. Despite substantial progress, incomplete knowledge of artery and vein development challenges efforts to generate artery and vein cells from human pluripotent stem cells (hPSCs).

Hypothesis:
We hypothesize that TGFb and PI3K are artery and vein-specifying signals, respectively. We can efficiently specify artery cells by inhibiting vein-specifying signals and vice versa in chemically defined media.

Methods:
To generate artery cells, we activated TGFb and inhibited PI3K signaling (amongst other signals). Conversely, to generate vein cells, we inhibited TGFb and activated PI3K signaling.

Results:
We generate >90% pure artery and >80% pure vein endothelial cells from hPSCs within 3-4 days of differentiation, respectively. Both artery and vein cells could form 3D blood vessel networks
in vitro
and
in vivo
, sense and respond to shear stress, and uptake low-density lipoproteins. These cells modeled viral infection of human vasculature by Nipah and Hendra viruses, which are extraordinarily deadly and require biosafety-level-4 containment. Generating pure populations of artery and vein cells showed that Nipah and Hendra viruses preferentially infected arteries; arteries expressed higher levels of their viral-entry receptor. Virally-infected artery cells fused into syncytia containing up to 23 nuclei, which rapidly died. Despite infecting arteries and occupying 6%-17% of their transcriptome, Nipah and Hendra largely eluded innate immune detection, minimally eliciting interferon signaling.

Conclusions:
In conclusion, we efficiently generate artery and vein cells, introduce stem-cell-based toolkits for biosafety-level-4 virology, and explore the arterial tropism and cellular effects of Nipah and Hendra viruses. This large-scale supply of human endothelial cells could also enable applications, including vascular disease modeling and tissue engineering synthetic blood vessels.
Abstract 18136: Efficacy and Safety of Catheter Ablation for Atrial Arrhythmias in Patients With Cardiac Amyloidosis - A Systematic Review and Proportional Meta-Analysis
Authors: Basit Jawad , Zaheer Zaofashan , Yasmin Farah , Akbar Usman A , Hamza Mohammad , Abbas Khawar , Irshad Umer , dhama kuldeep , Rajeshkumar Chitra Shanjeev Kumar K , Al Ahmad Majd , Rehman Mohammad E , Saeed Sajeel , sattar yasar , Tse Gary , Alraies M Chadi C
Published: December 2023

Background
Cardiac amyloidosis (CA) is a restrictive cardiomyopathy characterised by amylin deposits in the heart muscle. While the prevalence of atrial arrhythmias in CA is high, the data regarding the outcomes of catheter ablation in these patients is limited. Our current study aims to elucidate the safety & efficacy of catheter ablation for treating atrial arrhythmias in patients with CA.

Methods:
We conducted a comprehensive literature search across MEDLINE & Scopus from inception till May 2023 for randomized control trials & observational studies reporting catheter ablation (cryoablation or radiofrequency ablation) for the treatment of atrial arrhythmias (AAs) (atrial flutter, atrial fibrillation, atrial tachycardia) in patients with cardiac amyloidosis (transthyretin or light-chain). The primary outcomes of interest were pooled recurrence & re-ablation rates. The secondary outcome was all-cause mortality. All data was analyzed using the Hedges-Olkin random-effects model & presented as percentage proportions.

Results:
A total of 6 cohort studies with 154 cardiac amyloidosis patients with atrial fibrillation were included. The pooled incidence of repeat ablation was 16.4% [(6.2%, 26.7%), p=0.002)] & recurrence rate was 47.9% [(25.2%, 70.5%), p<0.001)]. The pooled incidence of all-cause mortality in these patients was 37.1% [(25.1%, 49.1%), p<0.001)].

Conclusion
High rate of recurrence & need for re-ablation coupled with high mortality demands better patient selection. Prospective & randomized controlled data is needed to better study the outcomes of catheter ablation in these patients.
Abstract 18155: A Rare Case of Acute Purulent Pericarditis Secondary to Invasive Streptococcal Infection (S. Pyogenes) With Cardiac Tamponade in an Immunocompetent 37-Year Old Female: A Case Report
Authors: BANQUIRIGO RAYMOND
Published: December 2023

BACKGROUND:
Purulent pericarditis is a rare occurrence in the era of modern antibiotics. It is most often caused by organisms such as Staphylococcus aureus, Streptococcus pneumoniae, viridans streptococci, Haemophilus influenzae, and anaerobic bacteria with
Streptococcus pyogenes (S. pyogenes)
being a possible, though very uncommon etiology. It is usually associated with an underlying infection or compromised immune system. Purulent bacterial pericarditis is a high mortality entity and represents only 1% of the causes of pericarditis, among these only a few cases have been reported of
Streptococcus pyogenes
pericarditis. This is an extremely rare case of acute purulent bacterial pericarditis caused by S. pyogenes in an immunocompetent adult patient with no underlying chronic medical conditions.

CASE PRESENTATION:
A 37-year-old healthy female with no known comorbidities came in for chills, dyspnea, chest pain radiating to the upper back aggravated by deep breathing and relieved with leaning forward. She initially presented with unstable vital signs (hypotension and tachycardia). Electrocardiography demonstrated diffuse ST-segment elevation and PR segment depression, while chest Xray and CT scan showed lobar pneumonia. Blood tests showed leukocytosis with neutrophilic predominance indication infection and workup for autoimmune disease was done which was negative. 2D echo showed large pericardial effusion with tamponade physiology. An urgent pericardiocentesis was done with drainage of 350cc nonclotting purulent serous fluid. Cultures grew
Streptococcus pyogenes (S. pyogenes)
confirming the diagnosis of acute purulent bacterial pericarditis. Management for pericarditis including daily drainage of pericardial effusion, colchicine, ibuprofen was initiated together with antibiotics for the pneumonia and the patient had resolution of the pericardial effusion as documented by repeat 2DED upon follow up.
Abstract 18159: Cardiac Resynchronization Therapy Response Predicted by Tissue Characterization Using Cardiac Magnetic Resonance Imaging in Non-Ischemic Dilated Cardiomyopathy
Authors: Oh Jaewon , Kim Se-Eun , Kim Daehoon , Yu Hee Tae , Lee Chan Joo , Kim Tae-Hoon , Uhm Jae-sun , Pak Hui-Nam , LEE Moon Hyoung , JOUNG BOYOUNG , Kang Seok-min
Published: December 2023

Introduction:
Tissue characterization using cardiac magnetic resonance (CMR) is helpful for risk stratification in non-ischemic dilated cardiomyopathy (NIDCM).

Hypothesis:
This study aimed to investigate the predictive role of tissue characterization identified by CMR on cardiac resynchronization therapy (CRT) response.

Methods:
We retrospectively reviewed the patients who underwent CMR within 1 year before CRT implantation in NIDCM patients at a single tertiary center from January 2018 to September 2022. Late gadolinium enhancement (LGE), native T1, T2 and extracellular volume (ECV) were analyzed. CRT response was defined as a decrease in left ventricular end-systolic volume (LVESV) > 15% or an increase in left ventricular ejection fraction > 5% on TTE after at least 3 months after CRT implantation.

Results:
Among a total of 101 patients (mean age 66 years, 52.5% of male), 76 (75.2%) patients were defined as CRT responders. CRT responders had more LBBB (96.1% vs. 60.0%, p<0.001) and longer QRS duration (156.0±178.5 vs. 167.0±176.5ms, p=0.005) compared with CRT non-responders. However, LGE burden (34.3 vs. 13.3%, p<0.001), native T1 (1371.6 vs. 1336.8ms, p=0.033), T2 (45.9 vs. 42.1ms, p<0.001), and extracellular volume (ECV, 36.8 vs. 31.0%, p<0.001) were significantly higher in CRT non-responders. The area under the curve (AUC) to predict CRT response is the highest in LGE burden (0.817, 95% confidence interval [CI]: 0.710-0.925), followed by ECV (0.808, 95% CI: 0.711-0.905), T2 (0.779, 95% CI: 0.663-0.895), and native T1 (0.643, 95% CI: 0.520-0.766). After adjustment, LGE burden>20% (odds ratio [OR]: 0.15, 95% CI: 0.02-0.71, p=0.024) and ECV > 34% (OR: 0.13, 95% CI: 0.01-0.78, p=0.037) were independently poor CRT response predictors.

Conclusions:
The tissue characterization by using CMR is helpful to predict CRT response and clinical outcomes in patients with NIDCM, independently of conventional CRT response predictors.
Abstract 18177: Novel Pre-Operative Non-Invasive Computational 12-Lead ECG Mapping to Facilitate Surgical Ablation of Ventricular Arrhythmias
Authors: Ho Gordon , Pretorius Victor , Coletta Joelle M , Artrip Jonathan , Madani Michael M , Feld Gregory K , Krummen David E
Published: December 2023

Background:
In patients undergoing cardiac surgery who have ventricular arrhythmias (VAs) such as VT, VF, or PVCs, concurrent surgical ablation is an attractive therapeutic strategy. However, electrophysiologic mapping systems are not routinely available in the OR and it may be difficult to localize the VA origin. We developed a workflow incorporating novel 12-lead ECG computational model-based mapping to localize VAs.

Hypothesis:
We hypothesized that use of pre-operative computational ECG mapping can help guide surgical ablation of VAs in patients undergoing cardiac surgery.

Methods:
Patients undergoing cardiac surgery with pre-existing VT, VF or PVCs were enrolled with informed consent. A standard 12-lead ECG of the VA was recorded in the clinic or during non-invasive programmed stimulation in the EP lab. ECG mapping localized the VA and visualized on a 3D model. During circulatory arrest, surgical ablation was performed using either cryoablation or irrigated RF ablation probe. Follow-up was performed with event monitors or ICD monitoring.

Results:
A total of 7 patients (mean age 55±15 years, female 29%, EF 31%±20%) were enrolled (Table). Surgical indications included mitral annuloplasty (Pt 1), pulmonary thromboendoarterectomy + CABG (Pt 2), coronary artery unroofing (Pt 3), left ventricular assist device (Pt 4-6, Fig 1), and CABG (Pt 7). In this cohort, 5 PVCs, 3 monomorphic VT and 1 VF morphologies were localized using ECG mapping and surgically ablated at time of cardiac surgery. There was a 100% (18 to 0) decrease in VT/VF episodes and 97.2 ± 0.03% reduction in PVC burden at median 9.5 month (IQR 3.7-29.5) follow-up. No intra- or post-operative complications occurred.

Conclusions:
This case series illustrates feasibility and excellent efficacy of a novel preoperative ECG mapping workflow using a forward-solution algorithm to guide successful and safe concomitant ventricular arrhythmia ablation during cardiac surgery.
Abstract 18180: Contemporary Nationwide Trends in Major Adverse Cardiac and Cerebrovascular Events in Young Hospitalized Adults With Dependent Cannabis Use in Absence of Concomitant Tobacco, Alcohol or Cocaine Use Disorder, 2016-2019
Authors: Gurram Priyatham , Mohammed Adil S , Guntuku Sandeep , Yadav Vikas , Medarametla Ravi Venkata Sai Krishna , Lingamsetty Shanmukh sai pavan , Baskara Salian Rishabh , Nawab Shariq , Mohammed Zaki Ur Rahman , SAEED ERUM , SAEED IRFAN , Jahan Rawnak , Jain Akhil , Desai Rupak
Published: December 2023

Introduction:
Recreational cannabis use has been on the rise among young adults in recent years. Dependent cannabis use disorder (CUD) has been linked to various cardiac events, but its impact on young adults in the absence of concomitant substance abuse remains unclear. We aim to analyze the nationwide trends in hospitalizations for major adverse cardiac and cerebrovascular events (MACCE) in this specific population.

Methods:
We identified hospitalized young adults (18-44 years) using National Inpatient Sample (2016 -2019), excluding those with concomitant substance abuse (tobacco, alcohol, and cocaine). They were divided into CUD+ and CUD- groups. We assessed the trends in hospitalizations for MACCE, including all-cause mortality (ACM), acute myocardial infarction (AMI), cardiac arrest (CA), and acute ischemic stroke (AIS), using ICD 10 codes.

Results:
Of 27.4 million hospitalizations among young adults without other substance abuse, 4.2% (1.1 million) had CUD. The rates of hospitalizations for MACCE (1.71% vs. 1.35%), AMI (0.86% vs. 0.54%), CA (0.27% vs. 0.24%), and AIS (0.27 vs. 0.24%), were higher in the CUD+ group compared to the CUD- group (P < 0.001). However, the rate of ACM hospitalizations (0.30% vs. 0.44%) were lower in the CUD+ group. From 2016 to 2019, the CUD+ group exhibited a relative increase of 5% in MACCE and 20% in AMI hospitalizations, which were lower compared to the respective increases of 22% and 36% in the CUD- group (Ptrend<0.05). Additionally, there was a relative decrease of 13% in ACM hospitalizations among the CUD+ group, whereas the CUD- group experienced a relative increase of 10% (Ptrend<0.05).

Conclusion:
The CUD+ group had higher rates of MACCE admissions, but the growing trends were more pronounced in the CUD- group through the years. Interestingly, the CUD+ group exhibited lower rates of ACM compared to the CUD- group. Further research is needed to better understand this complex relationship.
Abstract 18184: Association Between Impaired Global Longitudinal Strain and Long-Term Mortality in Patients With Moderate Aortic Stenosis: A Meta-Analysis
Authors: Raval Maharshi , Katukuri Nishanth , Venugopalan Sruthi , Vadiyala Mounika Reddy , Majmundar Vidit , Jain Akhil , Siddiq Sajid , Desai Rupak
Published: December 2023

Background:
Impaired left ventricular (LV) global longitudinal strain (GLS) is associated with worse outcomes in patients with severe aortic stenosis (AS). However, its prognostic value in patients with moderate AS is still unknown. The aim of this study is to investigate the impact of LV GLS on outcomes of patients with moderate AS.

Methods:
PubMed/Medline, Scopus, and Google Scholar databases were systematically reviewed to find relevant studies through June 2023 reporting data on the relationship between the LV GLS and long-term mortality in patients with moderate AS. Binary random effects models were used to estimate pooled odds ratios (OR) and 95% confidence intervals (CI). I2 statistics were used to interpret heterogeneity, with I2>75% indicating substantial inter-study variation. Leave-one-out meta-analysis was performed to evaluate the effect of each study on the overall estimate. A p<0.05 was considered statistically significant.

Results:
A total of 172 studies were reviewed, and 4 studies between 2000-2023 were included in our meta-analysis with a median follow-up of 48.5 months and GLS cut-off varying from 11% to 16%. The pooled univariate analysis revealed a significant association between LV GLS and long-term mortality in patients with moderate AS with a pooled OR of 2.02 (95CI 1.04-3.93) p=0.04, I2=94.25%. The multivariate analysis, after adjusting for overall modifiable risk factors, yielded significant results, with an adjusted odds ratio (aOR) of 1.56 (95CI 1.21-2.01) p<0.01, I2=89.48%. Sensitivity analysis, using leave-one-out method, demonstrated robustness and stability of the results with aOR 1.56 (95CI 1.21-2.01) p<0.01.

Conclusions:
In patients with moderate AS, impaired LV GLS is associated with an increased risk for all-cause mortality. If further randomized studies confirm the prognostic ability of impaired GLS, moderate AS can be redefined, and GLS can be considered in determining the optimal timing for aortic valve intervention.
Abstract 18190: Role of Specialised Heart Failure Unit in Optimisation of Guideline-Directed Medical Therapy With Focus on Renal Function - Real World Data
Authors: Macken Elizabeth L , Ferrari Marco , Pol Salia Virxinia , Mandanrano Lilly , Ghazal Heba , Ali Omar , Ray Robin , Shanmugam Nesan , Anderson Lisa , Rosano Giuseppe , Metra Marco , Banerjee Debasish , Jouhra Fadi
Published: December 2023

Introduction:
Guideline-directed medical therapy (GDMT) has proven to significantly reduce morbidity and mortality in Heart Failure. We highlighted the differences in renal function among HF patients managed on GDMT, comparing those within a dedicated HF unit (HFU) to those under General Medical (GM) and Geriatrics (GER).

Aim:
The purpose of this single-centre cohort study is to highlight differences in renal function outcome between these groups.

Methods:
Our database consists of 540 patients with AHF admitted to HFU or GM/GER from 01/08/2021 to 31/07/2022. We divided this group as follows:
Group A
: 267 patients from GM/GER.
Group B
: 273 patients in HFU.Groups were classified by ejection fraction(HFrEF/HFmrEF/HFpEF). We analyzed eGFR, K+ and Creatinine(Cr) on admission(adm) and discharge(dc).

Results:
Group A(GM/GER)
: HFrEF patients had average eGFR of 45.70(mL/min) on adm and 43.58 on dc. HFmrEF subgroups had eGFR of 48.60 on adm and 46.54 on dc. HFpEF subgroups had eGFR of 50.16 on adm and 47.75 on dc.
Group B(HFU):
Patients with HFrEF had eGFR of 53.50 on adm and 50.74 on dc. HFmrEF subgroup had adm eGFR of 49.48 and 47.01 on dc. HFpEF subgroups had eGFR of 45.95 on adm and 41.72 on dc.
Group A and B comparison
: We have previously demonstrated (Fig.1) that among patients with AHF managed in HFU, there is better optimisation of GDMT. Within the HFrEF cohort, eGFR decreased -2.76 in Group B, with reduction of -2.12 in Group A. Group B HFmrEF showed reduced eGFR of -2.47; Group A decreased -2.06. In HFpEF, eGFR reduced -4.23 in Group B. In Group A, eGFR decreased -2.41. An inpatient mortality of 15.73% was calculated in Group A, contrasting significantly with 6.23% among the HFU cohort.

Conclusion:
This study highlights differences in renal function outcome between these two groups. It demonstrates that despite optimisation and initiation of GDMT in Group B - which may lead to concern for its impact on renal function - eGFR, Cr and K+ levels were not markedly different between both cohorts.
Abstract 18212: The Fat Embolism Enigma: Unveiling the Intricate Complications of Breast Reconstructive Surgery
Authors: Khalil Muhammad Hasib H , Haider Mobeen , Rahman Saad Ur , Khalid Yousra , Alsara Osama , Bodine Christopher
Published: December 2023

Background:
Fat embolism can occur after plastic surgery, especially when injecting fat into subcutaneous tissue. It can be asymptomatic or can have hypoxia, mental status changes, and petechiae rash. Diagnosis is challenging but the workup includes imaging to exclude other differentials including pulmonary thromboembolism. Echocardiography assists in identifying fat emboli. Case Presentation: A middle-aged female with no prior cardiac history was undergoing right-sided breast reconstructive surgery with liposuction from the abdomen and fat grafting. Intraoperatively, the patient became hypoxic and hypotensive. The patient was started on vasopressors. A CT-Angiogram Chest revealed multiple bilateral pulmonary emboli, with some emboli having negative Hounsfield units (HU). Anticoagulation was started. Fat emboli could not be excluded. The patient was ultimately transitioned to venoarterial extracorporeal membrane oxygenation. Transthoracic echocardiogram showed right ventricular (RV) hypokinesis with preserved apical function and multiple, mobile, irregular masses in the RV. Figure 1 With the patient’s history, this was concerning for fat emboli. A transesophageal echocardiogram (TEE) showed multiple (4 visualized) masses seen in the RV, caught into the subvalvular tricuspid apparatus on the chordae and the RV trabeculation. (Largest mass: 1 cm in diameter). Figure 2 A bilateral lower extremity venous duplex was negative. The patient was diagnosed with obstructive shock secondary to fat embolism. She was eventually weaned off of mechanical support and discharged in stable condition.

Discussion:
Autologous fat grafting (AFG) has gained popularity in reconstructive and aesthetic surgery. It is important to remain vigilant about fat embolism as a complication that presents as sudden hypoxia and obstructive shock in the appropriate setting. DVT should be ruled out. Echocardiography can assist in diagnosis. Treatment is supportive.
Abstract 18216: NT-proBNP After Discharge in Patients With Decompensated Heart Failure and Preserved Left Ventricle Ejection Fraction: The NICE Study
Authors: Pascual Figal Domingo , Gallego Navarro Adrián , Blanco Pacheco Javier E. , Martinez-Tovar Maria , Hernández Vicente Álvaro , Martínez Selle Manuel , Solé González Eduard , Sánchez Fernández Pedro Luis , García Pavía Pablo , Varela Román Alfonso , Delgado Jiménez Juan Fco. , Riquelme Perez Alejandro , Noguera Velasco José A , Ordóñez Llanos Jordi , Bayés Genís Antoni
Published: December 2023

Introduction:
In hospitalized patients with heart failure (HF), the transition period after discharge is associated with high risk of adverse events. The impact of monitoring natriuretic peptides (NP) in patients with preserved LVEF (HFpEF) has not specifically studied.

Methods:
NICE trial (NCT02807168) is a randomized, open-label, blinded for events and multicenter study. The study population included hospitalized patients with HFpEF (LVEF>50% and at least one additional criteria of diastolic dysfunction). Patients were randomized at discharge into intervention (NP group) or control group. Both groups received optimal therapy and scheduled clinical visits at 14 and 30 days, 3 and 6 months, and NT-proBNP results were available for the clinician only in the intervention group.

Results:
157 patients (76±8 years, 61% female, LVEF 61±7%) were randomized into NP group (n=79) and control group (n=78). Baseline characteristics did not differ between groups. At 6 months, no differences were found in HF readmission in NP vs. control group (12.8% vs. 11.4%, HR 1.15, CI95% 0.47-2.81), or any episode of worsening HF (20.5% vs. 24.1%, HR 0.89, CI95% 0.44-1.82). NP group had a significantly lower mortality than the control group (1.3% vs. 10.1%, HR 0.12, IC95% 0.02-0.98, p=0.048), as well as a trend to lower risk of hospitalization for non-HF related causes (12.8% vs. 19.0%, HR 0.68, IC95% 0.39-1.18). Considering the composite end-point (death or worsening HF), the intervention with NT-proBNP was associated with a lower risk trend (20.5% vs. 30.4%, HR 0.65, IC95% 0.34-1.22, p=0.181). Regarding the use of medical therapies, diuretic and ACEI doses were higher in the intervention group during the follow-up.

Conclusions:
In hospitalized patients with HFpEF, NT-proBNP availability during the transition period did not reduce the risk of HF readmissions. Nevertheless, it was associated with a lower mortality. These results suggest a global impact in the disease, beyond readmissions.
Abstract 18238: ChatGPT Has the Potential to Increase Accessibility to Cardiology Research
Authors: Atmar Aorzala , Andalib Saman , Spina Aidin , Dylewski John , Haspil-Corgan Tessa
Published: December 2023

Introduction:
Generative language models like ChatGPT have experienced a novel rise in their implementation. This study explored ChatGPT’s potential in simplifying cardiology research abstracts published in specific journals within the family of Journals of American College of Medicine (JACC). If successful, this can expand the understanding of cardiology research among the public and those with low health literacy.

Research Question:
Can ChatGPT transform abstracts to be understandable by patient populations who cannot understand medical text without including extraneous or false information?

Goals:
We quantified the readability of abstracts published in JACC with clinically verified metrics. We assessed the readability of these same abstracts post-ChatGPT transformation.

Methods:
Review article abstracts published in the JACC from January to June 2023 were simplified using ChatGPT. The following prompt was used in ChatGPT to transform abstracts: “Please rewrite the following text to be readable at a 5th-grade level. Do not include information not contained in the original text, and do not exclude information contained within the original text.” Readability was quantified using Flesch-Kincaid Grade Level (FKGL) and Reading Ease (FKRE) scores. A board-certified cardiologist assessed content validity and ensured accuracy.

Results:
All 24 abstracts had significantly lower FKGL and higher FKRE scores (P<0.001) after transformation by ChatGPT, indicating improved readability. No extraneous information was found in 24/24 transformed abstracts.

Conclusion:
Medical literature exceeds the average reading and comprehension level of US adults, especially among those with low socioeconomic status. Our results indicate that ChatGPT effectively simplifies complex cardiology literature, maintaining information accuracy. This opens the door for further exploration of ChatGPT's role in improving accessibility to various cardiology topics.
Abstract 18247: Society for Cardiovascular Angiography and Intervention Shock Staging is Associated With Outcomes in Patients With an Impella 5.5 Temporary Left Ventricular Assist Device
Authors: Maigrot Jean-Luc A , Starling Randall C , Soltesz Edward G , Smedira Nicholas G , Tong Michael , Unai Shinya , Bhat Pavan , Moros David , Blackstone Eugene H , Weiss Aaron J
Published: December 2023

Introduction:
Surgically implanted microaxial ventricular assist devices (VAD) such as Impella 5.5 are increasingly used as temporary mechanical circulatory support (tMCS) in patients at risk for and with cardiogenic shock (CS). Understanding the associations between CS severity and outcomes in patients supported with Impella 5.5 may optimize patient selection and prevent futile interventions.

Hypothesis:
Increasingly severe Society for Cardiovascular Angiography and Intervention (SCAI) SHOCK stages in patients supported with Impella 5.5 are associated with worse outcomes.

Methods:
From 2019-2022, retrospective review of perioperative characteristics, SCAI SHOCK stage and outcomes in patients supported with an Impella 5.5.

Results:
In total, 228 Impella 5.5s were implanted in 226 patients; 28% (63) SCAI SHOCK stage A, 4% (10) stage B, 14% (31) stage C, 46% (104) stage D and 9% (20) stage E. Stage A and B patients more often had elective Impella 5.5s for tMCS-assisted interventions (cardiac surgery, PCI, VT ablation) (30%, 69/228) while stage C-E patients primarily had Impella 5.5 placement for acute MI (AMI), chronic cardiomyopathy and postcardiotomy CS (60%, 136/228) (p<0.01). Death on Impella support by SCAI SHOCK stage was: A 3.2%, B 10%, C 13%, D 27%, E 37% (p<0.01). The transition to durable VAD or heart transplant by SCAI SHOCK stage was: A 1.6%, B 0%, C 48%, D 35%, E 16% (p<0.01).

Conclusions:
Patients supported with Impella 5.5s presented in varying degrees of CS as defined by SCAI SHOCK stage. Patients with AMI, chronic cardiomyopathy, and postcardiotomy CS more commonly presented in higher SCAI SHOCK stages than those who underwent planned Impella 5.5-assisted cardiac interventions. Patients in stage E at implant had the highest mortality while patients in stage C and D were more likely to be bridged to durable VAD or heart transplant.
Abstract 18248: Physical Activity and Nutrition Self-Efficacy Associates With Perceived Everyday Discrimination in African American Women: The Step It Up Physical Activity Intervention
Authors: Osei Baah Foster , Baumer Yvonne , Tarfa Hannatu , Dave Ayushi , Pita Mario , Cintron Manuel A. , Ortiz-Whittingham Lola , Reynolds Sandy , Abhinav Saurabh Fnu , Kameswari Potharaju , Baez Andrew , Thompson Keitra , Ayers Colby , Neally Sam , Curlin Kaveri , Vijayakumar Nithya , Mitchell Valerie , Wells Ayanna , Marah Marie , Collins Billy , Dodge Tonya , Wallen Gwenyth , Powell-Wiley Tiffany M
Published: December 2023

Background:
Increased self-efficacy facilitates health promoting behaviors such as physical activity (PA). Perceived discrimination may limit PA among minoritized populations, but little is known about the relationship between PA and nutrition self-efficacy (PANSE) and perceived discrimination (PD) among African American (AA) women with overweight/obesity.

Methods:
We examined the associations between PANSE and PD in 106 AA women in the Step It Up, a community-engaged, digital health intervention. All completed the PANSE (higher scores = higher self-efficacy), the everyday discrimination scale (higher scores = higher frequency of everyday discrimination), and a sociodemographic survey. We used linear regression to assess the associations between PANSE and PD adjusting for covariates and the interaction effects of discrimination and income.

Results:
The participants had a mean age of 55.9 (SD±12.7) years with mean BMI 36.3 (SD±6.9) kg/m2. PD was negative and significantly associated with PANSE in both our unadjusted model and after adjusting for age and educational level (Table 1). The association trended marginally significant in the third model when we adjusted for income. We found no interaction effect between PD and income.

Conclusion:
PD is associated with PANSE among this AA women cohort. This suggests an urgent need for future research to better extricate the relationship between PD and PANSE to inform interventions that addresses everyday discrimination among diverse population groups; particularly in AA women with overweight/obesity.
Abstract 18255: Ventricular Fibrillation and Cardiac Arrest as Initial Presentation in Arrhythmogenic Cardiomyopathy
Authors: Ahsan Muhammad Junaid , Yousaf Amman , Veer Manik , MANOLA AKRIVI , Goerbig-campbell Jennifer
Published: December 2023

Background:
Arrhythmogenic cardiomyopathy (ACM) is a rare inherited condition, characterized by fibro-fatty remodeling, leading to ventricular dilation, dysfunction, and arrhythmogenesis.

Case Summary:
Herein, we present a 22-year-old male admitted with ventricular fibrillation and out-of-hospital cardiac arrest. He received 120 minutes of CPR and received six defibrillator shocks. EKG showed diffuse T-wave inversions in anterolateral leads and prolonged QT interval. Vasopressors and anti-arrhythmic were initiated. VA-ECMO was cannulated. Echocardiogram showed biventricular systolic dysfunction with LVEF of 20%. Next day he was extubated and ECMO was decannulated. His extensive workup including a viral panel was negative. cMRI showed recovery of biventricular function with imaging characteristics consistent with myocarditis. Genetic testing revealed a pathogenic variant of the desmoplakin (DSP) gene. DSP was positive in the sister and mother. For secondary prevention, a subcutaneous ICD was placed. He was discharged on Losartan and metoprolol succinate. The patient continues to do well on subsequent follow-ups.

Decision-making:
cMRI showed myocardial edema, pericardial enhancement and mid-myocardial late gadolinium enhancement pattern consistent with modified lake louise criteria. As cMRI was performed post-cardiac arrest, and his presentation included V.fib with clinical and biventricular function recovery, 48 hours post-presentation, the presentation was not consistent with myocarditis. Genetic testing was pursued which was positive for DSP.

Discussion:
Ventricular arrhythmias can be the initial presentation of ACM in young patients, predominantly involving left ventricle. Although cMRI presentations can be similar acutely, they should be differentiated from viral myocarditis. In young patients presenting with ventricular arrhythmias, ACM should be considered regardless of family history of arrhythmias or sudden deaths.
Abstract 18273: Mitral Annular Calcification is Associated With Higher Operative Risks and Worse Survival in Hypertrophic Cardiomyopathy
Authors: Nie Changrong , Wu Zining , Zhu Changsheng , Lu Zhengyang , Wang Shuiyun
Published: December 2023

Background:
Mitral annular calcification (MAC) is common in hypertrophic cardiomyopathy (HCM), usually accompanied by mitral leaflet calcification, subvalvular apparatus calcification, and mitral valve dysfunction. However, the impact of MAC on surgical strategy and clinical outcomes in HCM is not fully understood.

Methods:
This cohort enrolled 1035 consecutively recruited patients diagnosed with HCM between January 2016 and December 2021. All patients received a computed tomographic scan prior to surgery.

Results:
Of the 1035 patients, 112 (10.8%) had MAC, including 39 patients with moderate or severe MAC (calcification area greater than one-third of the annulus). Patients with MAC were significantly older (59.6±8.2 years vs. 47.5±12.3 years, p<0.001) and more likely to be female (61.8% vs. 35.4%, p<0.001). Echocardiography showed a higher proportion of mitral leaflet thickening (17.9% vs. 6.0%, p<0.001) in patients with MAC. Moreover, patients with MAC had a higher rate of annular reconstruction (1.79% vs 0.11%, p=0.002), plastic ring implantation (5.36% vs 1.84%, p=0.017), chordae release (12.50% vs 5.09%, p=0.002), artificial neochordoplasty (2.68% vs 0.54%, p=0.015), and fibrous membrane removal (8.93% vs 4.12%, p=0.022), as well as longer ventilation time [19 hours, interquartile range (IQR) 17.0-26.0 vs. 18 hours, IQR 14.0-20.5, p<0.001], intensive care unit stay [61 hours, IQR 36.5-96.0 hours vs. 48 hours IQR 24.0-72.0 hours, p<0.001] and postoperative hospital stay [8days, IQR 7-11 days vs. 7 days, IQR 6-8 days, p<0.001]. During a median follow-up time of 26.2 months (IQR, 17.0 to 39.5 months), 5 death and 158 major adverse cardiovascular events (MACE) were observed. Kaplan-Meier survival curves showed that patients with MAC had a higher cumulative rate of all-cause mortality (p=0.026) and MACE (p=0.003) compared to their counterparts. On multivariable Cox regression analysis, moderate or severe MAC was an independent risk factor for MACE (Hazard ratio =2.38, 95% confidence interval: 1.31-4.32).

Conclusions:
The prevalence of MAC was 10.8% in this study. The presence of MAC was associated with a higher rate of concomitant operations, longer hospital stays, and worse survival.
Abstract 18294: The Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients With Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Abdelazeem Basel , Soliman Youssef , Seri Amith Reddy R , Mahmoud Abdelrahman , Ali Shafaqat , Abuelazm Mohamed T
Published: December 2023

Introduction:
The effect of intensive blood pressure (BP) lowering on cardiac remodeling remains uncertain, with emerging evidence suggesting that it can prevent the development of left ventricular hypertrophy (LVH) in patients with hypertension (HTN). We aim to investigate the effect of intensive BP lowering on LVH and cardiovascular disease (CVD) incidence in HTN patients.

Methods:
A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), which were retrieved by systematically searching: PubMed, Web of Science, SCOPUS, and Cochrane through June 8
th
, 2023. We used the random-effect model to pool dichotomous data using risk ratio (RR) and hazard ratio (HR), with a 95% confidence interval (CI). Trial sequential analysis (TSA) was performed to weigh type I and II errors, estimating if the effect is large enough to be unaffected by further studies.

Results:
We included four RCTs with a total of 20,747 patients. Two RCTs investigated an intensive target of < 120 mmHg, and another two investigated <130 mmHg. Intensive BP lowering was associated with a decreased risk of LVH incidence (RR: 0.66, with 95% CI [0.56 - 0.77]). Our TSA revealed that the cumulative Z-curve consistently crossed the TSA boundary, indicating a statistically significant effect, signifying that the available evidence has reached a predefined threshold for statistical significance, providing robust evidence. Also, intensive BP lowering was associated with a decreased risk of CVD (HR: 0.71, with 95% CI [0.60 - 0.85]).

Conclusion:
Intensive BP lowering protects against LVH in HTN patients. TSA suggests that additional RCTs may not be necessary to establish the efficacy of intensive BP lowering on LVH. Also, intensive BP lowering was associated with decreased CVD incidence; however, LVH did not explain this effect in the included RCTs. Therefore, further research is warranted to explore possible mechanisms of decreasing CVD with intensive BP lowering in HTN patients.
Abstract 18297: Association Of Maximum Daily Mobility After Open Cardiac Surgery And Clinical Outcomes
Authors: Albert Nancy M , Phillips Cristin , Hoffman Julie , Levay Michelle , Bena James F , Morrison Shannon L , Barley Gina , Collins Mary C , Soltesz Edward G , Bober Kenneth J
Published: December 2023

Introduction:
Hospital-based mobility after coronary artery bypass graft (CABG) and valve surgery using a mid-sternal incision is valuable and facilitated by use of Phase 1 cardiac rehabilitation. However, rehabilitation services may be limited and patients may not receive the full benefits of early mobility. Further, factors associated with maximum daily mobility and clinical outcomes need to be better understood.

Research Questions:
What is the degree of maximum daily mobility variability during hospitalization and what factors are associated with higher maximum daily mobility?

Methods:
This prospective, correlational design used a daily mobility form, surveys and medical records data from 5 hospitals in 5 states. Nurses collected mobility (daily) and psychological status (one time, post intensive care unit [ICU] stay) using valid and reliable tools. Medical record data were retrieved by analysts. Maximum daily mobility scores were categorized into 4 groups; higher levels represented greater mobility. Relationships between mobility category scores and patient factors were described using Spearman correlations (95% confidence intervals.

Results:
Of 650 participants with a median [25th, 75th percentile] of 4.0 [3.0, 5.0] days of post-ICU daily mobility data, lowest to highest category rates were 9.5% (n=62), 9.8% (n=63), 16.2% (n=105) and 64.5% (n=419). Higher maximum daily mobility was associated with hospital site, younger age, male gender, commercial insurance, lower body mass index, no history of prior myocardial infarction, heart failure, aortic or pulmonic valve disease, cerebrovascular disease or diabetes, higher hemoglobin/hematocrit, lower serum creatinine and lower rates of prolonged ventilation (all p <0.05). Higher maximum daily mobility was associated with higher general health perception scores (rho 0.12 (0.04, 0.19), p=0.003, shorter hospital length of stay and an increased likelihood of discharge to home (both p <0.01).

Conclusions:
After CABG/valve surgery, maximal daily mobility varied by multiple factors, many of which were not directly associated with patient’s ability to ambulate. Attention to achieving higher post-ICU daily mobility levels are warranted.
Abstract 18300: Do Current Cardiovascular Risk Models Predict the Development of Cardiotoxicity in Lymphoma Patients Treated With Anthracycline?
Authors: Ricaurte Carolina , Santos Patarroyo Sebastian , Daryanani Andres , Collantes Diana , Toro-Manotas Rafael , Nhola Barros Lara , Cerhan James , Herrmann Joerg , Thompson Carrie , Villarraga Hector R
Published: December 2023

Introduction:
Assessing baseline cardiovascular (CV) risk factors is crucial for identifying cancer patients at higher risk of cardiotoxicity (CT). While both CT specific scores, including Heart Failure Association-International Cardio Oncology Society (HFA-ICOS) and our institutional score, as well as general CV scores like Atherosclerotic cardiovascular disease (ASCVD), have been used to assess CT risk; in lymphoma patients undergoing anthracycline therapy, their utility remains unknown.

Aim:
Evaluate the performance of each risk score to predict CT in a cohort of newly diagnosed lymphoma patients undergoing anthracycline treatment, followed for a median of 5.4 years.

Methods:
326 Hodgkin and non-Hodgkin lymphoma patients treated and followed from 2013 to 2021 were prospectively assessed. Baseline measurements of the three risk scores were obtained. ASCVD score was not assessed in patients >80 or <40 years old or without baseline cholesterol. CT was defined during or after one year of chemotherapy as severe, moderate, or mild according to 2022 ESC guidelines. Logistic regression and AUC were used to assess the association of each score and compare the models.

Results:
Among 326 patients, 78 developed CT (8 severe, 21 moderate, 49 mild). A high-risk score from HFA-ICOS was significantly associated with severe and moderate CT(OR: 6.1, p=0.001), sensitivity 37%, and specificity 88%. A very high-risk classification of the institutional score was associated with severe and moderate CT (OR: 8.4, p=0.006), sensitivity 44%, and specificity 81%. No association was found between the ASCVD score stratification and CT. When mild CT was included in the analysis, the AUC values were lower (see Table 1).

Conclusions:
Cardio-oncology risk scores were associated with severe and moderate CT, outperforming ASCVD, but their predictive capacity was weak. Incorporating other serum or imaging biomarkers into the models may improve the predictive accuracy of CT risk assessment.
Abstract 18303: Characteristics of Clinical Studies Evaluating Thrombolysis and Novel Catheter-Based Interventions for Pulmonary Embolism
Authors: Bertot John H , Abdelrahman Khaled , Unlu Ozan , Watson Ryan , Kochar Ajar
Published: December 2023

Introduction:
Novel treatment approaches for pulmonary embolism (PE) including catheter directed thrombolysis (CDT), percutaneous thrombectomy (PT), and systemic thrombolysis (ST) are under investigation. However, characteristics of studies of these interventions are not well described. We sought to evaluate the state of studies pertaining to advanced PE therapies.

Methods:
The ClinicalTrials.gov (CTG) database was queried using search terms specific to advanced therapies and PE between January 1, 2000, and June 30, 2022, with unrelated, withdrawn, and terminated studies excluded. Advanced therapies were defined as studies evaluating either systemic thrombolysis, CDT, and/or PT. Geographic data from enrollment was gathered using zip codes of study sites. Descriptive characteristics related to studies were explored, and ANOVA was used to compare mean trial enrollment between interventions.

Results:
Of 700 total results, our search yielded 56 eligible studies (8.0%) investigating advanced PE therapies, among which 39.3% studies evaluated CDT, 32.1% evaluated ST, and 28.6% evaluated MT. Most studies were interventional (76.7%) rather than observational (23.3%). The primary study endpoint was most commonly a surrogate endpoint (60.7%), with mortality (5.4%) or a composite including mortality (21.4%), or other endpoints (12.5%) were less frequent (Figure). Mean enrollment was 206.4 in ST, 101.5 in CDT, and 103.7 in PT studies, with no significant difference in study size between intervention type (p=0.207). The USA was the most frequent trial sponsor (41.1%), and within the USA, trial sites were most commonly in large, urban areas and demonstrated geographic variation.

Conclusion
In conclusion, there is a paucity of studies evaluating advanced therapies for PE with substantial heterogeneity in design and geography. These data highlight the need for further high-quality studies to inform clinical decision making for the treatment of PE.