bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13298: Impact of Finerenone on Cardiac Biomarkers in Patients With T2D and Chronic Kidney Disease
Authors: Berger Mario , Scalise Andrea , Kramer Frank M , Paraschin Karen , Goea Laura , Kolkhof Peter , Rohwedder Katja , Skubala Adam , Voss Sebastian , ZANNAD Faiez , Rossing Peter
Published: December 2023

Introduction:
Finerenone is a non-steroidal, selective antagonist of the mineralocorticoid receptor (MR), which blocks MR-mediated sodium reabsorption and MR overactivation. In this biomarker substudy to FIDELITY, a pooled, pre-specified analysis of FIGARO-DKD and FIDELIO-DKD, NT-proBNP and cardiac troponin T (cTnT) levels were assessed to explore the effect of finerenone on cardiac markers. FIGARO-DKD and FIDELIO-DKD were two phase III trials investigating efficacy and safety of finerenone vs. placebo (PLC) on cardiorenal outcomes, in patients with T2D and CKD.

Hypothesis:
Finerenone impacts the levels of major cardiac biomarkers.

Methods:
Samples were collected prospectively from non-selected patients who consented to the biomarker study. At baseline (BL), this study included 1037 subjects with cTnT data and 1592 subjects with NT-proBNP data from 13 and 24 countries, respectively. Samples were analyzed at BL, 4, 12, 24, 36 and 48 months follow-up on treatment with finerenone or PLC. Treatment effects on biomarkers were computed by a linear mixed model, adjusted for age, gender, screening eGFR and UACR, history of CVD, BL biomarker levels and geographical region.

Results:
Both, NT-proBNP and cTnT increased over time in both arms, yet, the increase was significantly lower in the active arm compared to PLC, even though finerenone temporarily reduces eGFR. The maximum ratio (finerenone to PLC) was 0.82 (95% CI: 0.76 to 0.90) at month 4 for NT-proBNP, and 0.94 (95% CI: 0.892 to 0.995) for cTnT at month 36. Median levels of biomarkers at BL were 177 pg/mL (NT-proBNP, IQR: 74-426) or 18 pg/mL (cTnI, IQR: 7-27).

Conclusions:
In patients with T2D and CKD, finerenone, on top of maximum tolerated labelled RAS inhibition and standard of care co-medication, reduced plasma NT-proBNP and cTnT, biomarkers usually associated with cardiac stress and injury, and indicative of poor prognosis. Our findings are in line with outcome data from FIDELITY showing a 22% risk reduction for HF hospitalization1 and other findings suggestive of reduced adverse cardiac remodeling. This data provides supportive mechanistic insights for benefits on cardiorenal outcomes in FIDELITY, confirming preclinical findings as well as clinical data on short-term treatment effects on NT-proBNP.
Abstract 13299: Are There Differences in Left Ventricular and Aortic Pressures Measured With Fluid-Filled and Solid-State Pressure Catheters
Authors: Machado Priscilla , Cohen Ira S , Osler Brian , McDonald Maureen , Esposito Cara , Davis Marguerite , Fischman David L , Savage Michael P , Mehrotra Praveen , Forsberg Flemming , Dave Jaydev K
Published: December 2023

Purpose:
To compare left-ventricular and aortic pressures obtained using fluid-filled and high-fidelity solid-state pressure catheters in subjects undergoing left heart catheterization.

Methods:
Twenty subjects scheduled for a left heart catheterization were enrolled and 18 subjects completed this IRB-approved study. During catheterization, left-ventricular (LV) and aortic (AO) pressures were obtained using a fluid-filled pressure catheter (standard-of-care) and a high-fidelity solid-state pressure catheter synchronously. The pressure tracings were analyzed by two independent readers to measure LV systolic (LVSP), LV minimum diastolic (LVMDP), LV end diastolic (LVEDP), AO systolic (AOSP), and AO diastolic (AODP) pressures. Derivatives of the pressure waveforms were computed to estimate the isovolumic contraction and relaxation rates (peak ± dp/dt). The measurements were made over multiple cardiac cycles and averaged results were used for comparisons using repeated measures analysis of variance, post-hoc tests with Bonferroni corrections and Bland-Altman plots.

Results:
A significant main effect of the pressure catheter was noted for LVSP, LVMDP and AOSP (p < 0.025). The LVSP and AOSP measured with fluid-filled pressure catheters were higher by 6.6 ± 6.9 mmHg and 4.6 ± 5.2 mmHg in comparison to the high-fidelity solid-state pressure catheter assessments. In contrast, the LVMDP measurements were 3.5 ± 5.7 mmHg lower than the solid-state pressure catheter measurements. When evaluating the differences between readers, the maximum difference was noted for LVEDP measurements (3.1 ± 2.4 mmHg; p ≤ 0.001). The differences in isovolumic contraction rate (66.4 ± 116.0 mmHg/s) and relaxation rate (60.5 ± 113.5 mmHg/s) were not significantly different between the two catheter systems after Bonferroni corrections for multiple comparisons (p > 0.06). Bland-Altman analysis revealed a bias ranging from 0.8 to 6.6 mmHg for all the pressure measurements.

Conclusions:
There are differences in LVSP, LVMDP, and AOSP measured using fluid-filled and high-fidelity solid-state pressure catheters. Clinicians should be aware that the fluid-filled catheters commonly overestimate the true systolic pressures in the left ventricle and aorta.
Abstract 13315: Recurrent Cardiac Tamponade Due to Minoxidil Associated Drug Induced Lupus Erythematosus
Authors: Juarez Michel , Benjanuwattra Juthipong , Herrera Ramos Alejandro , Iskandir Marina , Ansari Mohammad , Shurmur Scott W
Published: December 2023

Case description A 59 year old man with history of MGUS, CKD stage 2, DM, HTN, and OSA presented with gradual worsening of dyspnea and intermittent dizziness over the past few days. Echocardiography showed diastolic collapse of the RV, RA collapse, IVC plethora, marked tricuspid in-flow velocities, and pericardial effusion suggestive of cardiac tamponade (CT). Subxiphoid pericardial window was emergently performed. Serosanguineous fluid 900 mL was drained, and fluid analysis was negative for malignancy or infection. Pericardial biopsy revealed fibro-connective tissue with mild peri-vascular chronic inflammation. He significantly improved and was discharged after 5 days.

One month later, he presented again with 1 day symptom of severe dyspnea due to recurrent pericardial effusion with CT physiology. Emergent pericardiocentesis was performed to remove 1,800 ml of serous fluid. Serologic workup for autoimmune disease was strongly positive for anti-histone antibody. ESR (124 mm/hr) and c-reactive protein (5.8 mg/dL) were elevated. Upon review of prescription list, he had been treated for HTN in the past 5 years with minoxidil, amlodipine, lisinopril, and carvedilol.

Discussion The use of topical minoxidil, a potent peripheral arterial vasodilator, has been approved for androgenetic alopecia in both men and women for decades, whereas oral minoxidil is limited to refractory hypertension due to side effects such as reflex tachycardia, fluid retention, hypertrichosis, and, rarely, idiosyncratic pericardial effusion.

Pericardial effusion was reported in approximately 3-5% of patients receiving minoxidil therapy, which could be attributed to volume overload associated with underlying renal insufficiency. Besides hydralazine, another direct arterial vasodilator commonly implicated in drug-induced lupus erythematosus (DILE), minoxidil also carries a trivial risk of DILE, as suggested by a positive anti-histone antibody and biopsy-proven serositis.

Although the association between topical minoxidil and pericardial effusion has never been reported, receding hairline has become a major cosmetic concern and the clinicians should be aware of this rare, but serious, complication associated with minoxidil due to its widespread use.
Abstract 13321: Novel Regional Analysis of Left Atrial Strain From Computed Tomography Separates Patients With Persistent versus Paroxysmal Atrial Fibrillation
Authors: Sillett Charles , Razeghi Orod , Lee Angela , Solis Lemus Jose Alonso , Roney Caroline , Ganesan Prasanth , Feng Ruibin , Chubb Henry , NIEMAN Koen , Rogers Albert J , Rajani Ronak , Narayan Sanjiv M , Niederer Steven A
Published: December 2023

Introduction:
It is difficult to quantify progression of atrial fibrillation (AF). Atrial fibrosis is a hallmark of the AF substrate, increasing from paroxysmal to persistent AF, but is difficult to assess by voltage mapping or magnetic resonance imaging. It remains unclear if fibrosis could be revealed by atrial stiffness, which increases with regional fibrosis burden and can be measured by analysis of retrospective gated computed tomography (CT).

Hypothesis:
Differences in regional CT-derived atrial strain enable the identification and characterization of persistent versus paroxysmal AF.

Methods:
Fifty patients with paroxysmal (60%) and persistent (40%) AF (age 59.8 ± 12.8, 34% female) underwent CT coronary angiography which included a retrospective gated CT protocol prior to AF ablation. LA reservoir area strain was measured globally and regionally on the LA endocardium using an optimised feature tracking algorithm. The LA body was classified into five regions using Universal Atrial Coordinates (Fig A).

Results:
Global strain was significantly lower in patients with persistent versus paroxysmal AF (13.6 ± 8.2 % vs 24.5 ± 12.0 %, p = 0.0008). The posterior, septal, anterior and inferior wall strains were significantly lower in persistent AF patients (posterior: 16.6 ± 9.5 % vs 30.3 ± 15.9 %, p = 0.007; septum: 20.8 ± 11.8 % vs 39.6 ± 15.8 %, p = 0.00004; anterior: 17.5 ± 10.6 % vs 28.7 ± 15.7 %, p = 0.008, inferior: 16.6 ± 9.5 % vs 30.3 ± 15.9 %, p = 0.001, Fig B). Receiver operator curve analysis showed septal wall strain outperformed CHA2DS2-VASc score, LA volume and global strain for binary classification between groups (AUC: CHA2DS2-VASc: 0.67; LA volume: 0.79; global strain: 0.78; septal strain: 0.84, Fig C).

Conclusions:
Novel feature tracking of retrospective gated CT reveals abnormal atrial strain in patients with persistent versus paroxysmal AF. Future work could incorporate this tool into patient phenotyping or the identification of AF substrates to target ablation.
Abstract 13353: Sleep Health Phenotypes Predict Symptoms, Cognitive Function, and Adverse Events in Patients With Heart Failure
Authors: Jeon Sangchoon , Conley Samantha , Hollenbeak Christopher , O'Connell Meghan , Tocchi Christine , Yaggi Henry K , Wang Zequan , Redeker Nancy S
Published: December 2023

Introduction:
Poor sleep contributes to outcomes in heart failure (HF). Phenotypes reflecting multi-dimensional sleep health may better predict outcomes and support more precise interventions than single measures, but few studies have used this approach.

Aims:
1) Describe phenotypes of sleep health and 2) Evaluate whether sleep health phenotypes predict symptoms, cognitive function, and time to first hospitalization and emergency department (ED) visits among HF patients.

Methods:
We performed secondary analysis of a randomized controlled trial of cognitive behavioral therapy for insomnia compared with HF self-management education with HF patients. We measured sleep [rest-activity rhythms, sleep duration, and efficiency (2-week wrist actigraphy/follow-ups); insomnia; CPAP use; and daytime sleepiness (Epworth Scale)]; perceived stress; fatigue; anxiety; depression; pain; and cognitive ability (Patient-Reported Outcomes Measurement System: PROMIS) at baseline and 3, 6, and 12 months post-intervention and tracked hospitalizations and ED visits. We used K-means clustering to identify sleep phenotypes and generalized linear mixed models and Cox models to predict outcomes, adjusted for demographic factors.

Results:
Among 166 participants (M age = 63.2 (SD = 12.8) years; 57% female; 23% NYHA Class 3/4 HF; 35% EF less than 45%), there were 4 phenotypes [poor sleep (14%); short sleep/high sleep efficiency (39%); long sleep/low sleep efficiency (25%); and healthy sleep (21%)] at baseline. The healthy sleep group was older and had lower BMIs and less comorbidity and had better outcomes compared to all other phenotypes. In particular, this group had better fatigue (-2.43±0.87), pain (-1.86±1.05), anxiety (-1.50±0.89), stress (-1.46±0.69), and cognitive ability (1.76±0.80) than the poor sleep group. The poor sleep group had shorter time to adverse events compared to the other phenotypes (Hazard ratios of 0.41 to 0.56 for hospitalizations and 0.35 to 0.60 for ED visits).

Conclusions:
Multidimensional aspects of sleep predict HF outcomes and may improve on prediction with single measures. Future tailored sleep interventions focused on phenotypes may more precisely improve outcomes among HF patients than traditional approaches.
Abstract 13363: Echocardiographic Coronary Flow Velocity Parameters in Assessing Sub-Clinical Atherosclerosis in Inflammatory Bowel Disease Patients: A Meta-Analysis
Authors: Sharma Vagisha , Shrestha abhigan babu , Malhotra Anureet , Agarwal Siddharth , Kumar Harendra , Singh Mansunderbir , Grover Tanvi , Dang Sana , Dash Chandan K , Goyal Rohit , Yadav Abhishek , Koirala Samrat , BHATIA HITESH , Jaiswal Vikash , Hussain Sayed T
Published: December 2023

Introduction:
Chronic inflammatory diseases are linked to atherosclerosis and cardiovascular events. However, there are conflicting results in the literature regarding differences in echocardiographic Coronary Flow velocity parameters, which serve as markers of subclinical atherosclerosis, between inflammatory bowel disease (IBD) patients and healthy controls.

Hypothesis:
We aim to assess the Coronary Flow Velocity Reserve (CFVR), baseline Diastolic Peak Flow Velocity (DPFV), and hyperemic DPFV in IBD patients.

Methods:
We conducted a systematic search of databases, from January 1, 2014, to June 1, 2023, to gather relevant studies. The pooled mean differences in various parameters between IBD patients and controls were calculated using the standard mean difference with 95% confidence interval (CI), and random effect model was used when heterogeneity (I
2
) crossed 50%.

Results:
4 studies with 342 participants were included. The mean age of the IBD group was 39.25 years and of the control group was 41.25 years. Male comprised 51.46% of the study participants. IBD patients had a significantly lower CFVR (SMD; -1.12 95%CI; [-1.62, -0.61], p-value<0.01) and hyperemic DPFV (SMD; -0.68, 95%CI [-1.09, -0.27], p-value<0.01) than healthy controls. Whereas, Healthy controls had a lower baseline DPFV (SMD; 0.69 95%CI; [0.35, 1.04], p-value<0.01) than the IBD group.

Conclusions:
IBD was associated with Coronary Microvascular Disease assessed as impaired CFVR and hyperemic DPFV. This suggests reduced myocardial perfusion in IBD patients and the need for regular cardiovascular risk assessment and targeted interventions to mitigate the increased risk of cardiovascular events.
Abstract 13407: Long-Term Outcomes of Chronic Thromboembolic Pulmonary Hypertension Treated With Pulmonary Endarterectomy and Balloon Pulmonary Angioplasty: Results From the Japanese Prospective CTEPH Registry (CTEPH AC Registry)
Authors: Masaki Kohei , Hosokawa Kazuya , Funakoshi Kouta , TANIGUCHI Yu , Adachi Shiro , inami takumi , Yamashita Jun , Ogino Hitoshi , Tsujino Ichizo , Hatano Masaru , Yaoita Nobuhiro , Ikeda Nobutaka , Shimokawahara Hiroto , Tanabe Nobuhiro , Kubota Kayoko , Shigeta Ayako , Ogihara Yoshito , Horimoto Koshin , Dohi Yoshihiro , Kawakami Takashi , Tamura Yuichi , Tatsumi Koichiro , Abe Kohtaro
Published: December 2023

Introduction:
In Japan, balloon pulmonary angioplasty (BPA) is more commonly adopted in patients with chronic thromboembolic pulmonary hypertension (CTEPH) compared to European countries or US due to their expertise. However, there are no reports from regions where BPA is extensively practiced.

Aims:
This study aims to explore the treatment outcomes in Japan.

Methods:
The study involved a nationwide, prospective, observational registry that included all patients diagnosed with CTEPH from August 2018 to February 2023 in Japan. Patients were categorized as naïve or prevalent cases based on their previous reperfusion therapy (pulmonary endarterectomy and/or BPA) at the time of enrollment. Each case was further classified as operable or BPA group. The primary outcome measure was morbidity and mortality (MM) events since enrollment, which comprised all-cause death, CTEPH-related hospitalization, rescue reperfusion therapy, initiation of parenteral pulmonary vasodilators, and worsening of CTEPH characterized by a decrease in 6-minute walk distance greater than 15% and deterioration of the WHO functional class.

Results:
A total of 1194 patients, including naïve cases (operable: n = 54, BPA: n = 293) and prevalent cases (operable: n=125, BPA: n = 532), were identified. Among the naïve cases, there were no significant differences in age or disease severity between the operable and BPA groups. Among the prevalent cases, the BPA group was older (63 ± 13 vs. 58 ± 14 years old, p < 0.0001) and had higher pulmonary vascular resistance (364 ± 279 vs. 293 ± 206 dyne*sec/cm5, p = 0.001) compared to the operable group. The results of primary outcome measures were comparable between both the groups (Figure).

Conclusions:
BPA as well as pulmonary endarterectomy is considered as safety and effective therapeutic option in CTEPH patients.
Abstract 13410: Severe Brain White Matter Hyperintensity is Associated With Local Brain Atrophy of Parahippocampal Gyrus and Predicts Prognosis in Heart Failure Patients Without Dementia
Authors: Meguro Tomomi , Meguro Yuko , Funabashi Nobusada
Published: December 2023

Introduction:
Aged heart failure (HF) patients without dementia may have a risk of cognitive impairment (CI) that attenuates the effect of treatment for HF. White Matter Hyperintensity (WMH) is a potential risk of CI through a disconnection of subcortical brain network. On the other hand, patients with CI have severe brain atrophy in parahippocampal gyrus (PHG). However, it is not clear whether WMH is associated with atrophy in PHG and predicts prognosis of HF patients.

Hypothesis:
In HF patients without dementia, WMH is associated with brain atrophy of PHG, a potential risk of CI, and predicts prognosis.

Methods:
Sixty-five HF patients (age 76±11 years, NYHA class II, EF47±17 %) were enrolled. We excluded patients with dementia using mini-mental state examination. We took 3D-T1 weighted images and Fluid Attenuated Inversion Recovery (FLAIR) images of whole brain using 1.5T magnetic resonance imaging. Image analysis was performed to evaluate the severity of atrophy of PHG and volume of WMH using 2mm voxel-based morphometry by the statistical parametric mapping software. The Z-score value was calculated to evaluate the severity of atrophy in PHG. A Kaplan-Meier Curve adjusted with age, sex, presence of atrial fibrillation, and blood pressure was constructed using inverse probability weighting method.

Results:
We determined the cut-off point of the volume of WMH for estimating cardiac death using a receiver operating characteristic curve. Patients were divided into High-WMH group (n=37, volume of WMH 30±13 mL) and Low-WMH group (n=28, volume of WMH 8±5 mL) according to the cut-off value (15mL). As shown in representative cases (Figure1), the Z-score value in PHG (pink circle) was higher in High-WMH group (1.45±0.78, white arrow) compared to Low-WMH group (0.94±0.57, P=0.006). Adjusted Kaplan-Meier curves showed poor prognosis of High-WMH group (Figure 2).

Conclusions:
In HF patients without dementia, severe WMH is a potential risk of CI and predicts poor prognosis.
Abstract 13441: Outcomes of Percutaneous Atrial Septal Defect Closure Following Mitraclip and Transcatheter Mitral Valve Replacement
Authors: Hashem Anas , Khalouf Amani , Mohamed Mohamed Salah , Ismayl Mahmoud , Kashou Anthony H , Bou Chaaya Rody G , Nayfeh Tarek , Rai Devesh , Sulaiman Samian , balla Sudarshan
Published: December 2023

Introduction:
Data on clinical outcomes of percutaneous closure of iatrogenic atrial septal defect (PC-ASD) in patients undergoing transcatheter edge-to-edge repair (TEER) or mitral valve replacement (TMVR) remains limited. We used a real-world USA database to evaluate the differences in the in-hospital outcomes between both groups.

Hypothesis:
Is there a clinical significance for PC-ASD in patients undergoing TEER or TMVR?

Methods:
We used the National Inpatient Sample (2015-2020) by utilizing ICD-10 codes to identify all patients who underwent TEER or TMVR with or without PC-ASD. Multivariate logistic regression was used for adjusted outcomes (adjusted odds ratio [aOR]).

Results:
A total of 44,065 eligible weighted hospitalizations were included: 39,625 (89.9%) of the patients underwent TEER and 4,440 (10.1%) underwent TMVR. Rates of PC-ASD were higher in TMVR group compared to TEER group (10.7% vs. 2.0%, p<0.01). In patients who underwent TEER without PC-ASD, PC-ASD was more associated with acute heart failure (AHF) (aOR 1.42 [1.19-1.68], p<0.01) and longer hospitalizations (aOR 1.64 [1.41-1.89], p<0.01), without significant difference in inpatient mortality (aOR 0.97 [0.61-1.54], p<0.01), cardiogenic shock (aOR 1.13 [0.85-1.51], p=0.21), need for mechanical circulatory support (MCS) (aOR 0.98 [0.61-1.54], p=0.18), and stroke. Compared to patients who underwent TMVR without PC-ASD, PC-ASD was associated with higher inpatient morality (aOR 1.65 [1.13-2.4], p<0.01), need for MCS (aOR 1.91 [1.33-2.73], p<0.01) without significant difference in AHF (aOR 1.19 [0.94-1.51], p=0.18] and cardiogenic shock (aOR 0.83 [0.56-1.22], p=0.43). Remarkably, PC-ASD was less associated with stroke (aOR 0.27 [0.10-0.72], p<0.01).

Conclusions:
Rates of PC-ASD after TEER were lower than after TMVR and were associated with worse in-hospital mortality and need for MCS in TMVR but not in TEER. Also, PC-ASD was less associated with stroke after TMVR.
Abstract 13454: Safe Large Bore Access via the Third Part of the Axillary Artery for Mechanical Circulatory Support Implantation
Authors: Singh Swaiman , KANWAR ARDAAS S , Gonzalez Bonilla Hilda M , Rizzo Skylar , Rosenbaum Andrew , Frantz Robert , Behfar Atta
Published: December 2023

For patients in cardiogenic shock, percutaneous mechanical circulatory support devices (MCSD) have emerged as critical tool to improve hemodynamics and optimize end-organ perfusion; successfully bridging patients to recovery, decision or transplantation. The most commonly utilized MCSD is the femoral intra-aortic balloon pump (IABP). However, femoral access hampers the patient's mobility, quality of life, and capacity to participate in rehabilitation. The advent of the axillary artery approach has served to circumvent limitations associated with the femoral artery approach. However, optimum anatomical placement of IABP within the axillary artery (axIABP) is a topic of debate considering its proximity to the brachial plexus. Here, we report our experince with percutaneous access of the third poriton of the axillary artery which showed promising results with minimal device related complications or adverse events.

Methods/Results:
Between 2017-2023, a total of 89 patients in cardiogenic shock underwent percutaneous axIABP placement at the Mayo Clinic, MN. All demographic, clinical, and periprocedural data were obtained from hospital chart review and recorded in a database under IRB approval. Indications for axIABP support was determined by multidisciplinary assessment. Complications encountered in the cohort included infection at site 6.7% (n=6), device malfunction [rupture, fracture, leak] 8.98%(n=8), and balloon migration 5.61% (n=5). One patient developed local erythema, 4 (4.49%) patients developed significant vascular complications, including access site bleeding in two patients 2.24%, arterial thrombosis in three patients 3.37%, and self-limited intracranial bleeding in one patient 1.12%. Of note, no nerve injury or damage was observed in the entire patient cohort.

Conclusion:
Our study highlights the feasibility of percutaneous axIABP in the third portion of the axillary artery, while assessing safety profile and ease of removal. Notably in our review, we did not encounter any brachial nerve damage. Ultrasound was pivotal in identifying and avoiding nerves and nerve bundles during initial access. In conclusion, this approach of axIABP insertion is feasible and can be leveraged for delivery of future innovation in MCSD
Abstract 13479: Impact of ST-Elevation Myocardial Infarction Among Hospitalized Patients With Coronary Artery Dissection: A United States Population-Based Cohort Study
Authors: Casipit Bruce Adrian , Idowu Abiodun , Al Sudani Hussein , Casipit Carlo , Nguyen Matthew , Lo Kevin Bryan U , Khraisha Ola , Amanullah Aman M
Published: December 2023

Introduction:
ST-Elevation myocardial infarction (STEMI) is a rare but serious complication of coronary artery dissection (CADi). There is paucity of data on the in-hospital outcomes of hospitalized patients with CADi complicated by STEMI.

Methods:
We queried the National Inpatient Sample to identify patients with CADi who developed STEMI during the index hospitalization using appropriate ICD-10 codes between 2018-2020. We aim to investigate the impact of STEMI among CADi patients based on in-hospital mortality, risk for cardiogenic shock and arrythmias, utilization of coronary intervention, mechanical circulatory support, and mechanical ventilation. A multivariable logistic regression analysis was used to calculate adjusted odds ratios (ORs) for the outcomes of interest.

Results:
A total of 20,941 hospitalized patients with CADi were identified, of which 5.42% (1135/20,941) had concomitant STEMI during the index hospitalization. The overall in-hospital mortality rate among hospitalized patients with CADi was 6.45% (1,351/20,930). Among those with concomitant STEMI, the in-hospital mortality was significantly elevated to 18.5% (210/1,135, p= 0.00) compared to those who did not have STEMI. After adjusting for possible confounders, concomitant STEMI in CADi patients was found to be an independent significant predictor of increased risk for cardiogenic shock, development of ventricular tachycardia, ventricular fibrillation, utilization of percutaneous coronary interventions, coronary artery bypass graft, mechanical ventilation, and in-hospital mortality (Table 1).

Conclusions:
STEMI among CADi patients was independently associated with poorer cardiovascular and in-hospital mortality outcomes. Therefore, prompt recognition and treatment of underlying STEMI in CADi patients is necessary to prevent adverse outcomes.
Abstract 13487: Amazon Pharmacy's RxPass to Achieve Modest Out-of-Pocket Savings on Generic Prescription Medications
Authors: Oddleifson David A , Zheng ZhaoNian , Wadhera Rishi K
Published: December 2023

Introduction:
In January 2023, Amazon introduced a $5/month medication subscription service called RxPass for its Amazon Prime members. The service covers over 80 generic medications, including 12 for cardiovascular conditions. We evaluated how much US adults could save by using RxPass and determined the characteristics of those most likely to benefit.

Method:
In this observational study of adults aged 18-64 years who were prescribed at least one medication in the RxPass formulary, we used the 2019 Medical Expenditure Panel Survey (MEPS) to estimate the number of adults who spent more than the $199 annual cost of Amazon Prime & RxPass on eligible medications. A multivariable logistic regression model was then fitted to assess individual characteristics associated with saving under RxPass.

Results:
If the weighted study population of 50,845,777 adults (standard error [SE] ±1,711,996) obtained eligible medications from Amazon’s RxPass, only 5.1% (2,602,310 [±119,628]) would achieve savings. The estimated average out-of-pocket spending on eligible medications for those who would save by using RxPass was $354 (SE ±$16.1) per year. The estimated average out-of-pocket savings from using RxPass was $155 (SE ±$16.1) per year (Figure), resulting in a total savings of $404,482,986 (SE ±$49,831,316) per year.

Lack of insurance coverage and being prescribed a greater number of RxPass-eligible medications were each associated with a higher likelihood of achieving savings under RxPass. Being from a racial or ethnic minority background was associated with a lower likelihood of savings.

Conclusion:
These findings suggest that Amazon RxPass will achieve only modest out-of-pocket savings for a limited number of working-age adults. The observed racial and ethnic disparities reflect well-documented barriers in medication access. Adjustment of the RxPass pricing structure is necessary for the program to improve access and adherence to common generic medications.
Abstract 13515: Continuous Optimization of Atrioventricular Pacing Timing of Cardiac Resynchronization Therapy in Heart Failure Patients With Pacemaker Dependency
Authors: Nakamura Toshihiro , ishibashi kohei , Ueda Nobuhiko , Oka Satoshi , Miyazaki Yuichiro , Wakamiya Akinori , Nakajima Kenzaburo , Kamakura Tsukasa , Wada Mitsuru , Inoue Yuko , Miyamoto Koji , Nagase Satoshi , Aiba Takeshi , Kusano Kengo
Published: December 2023

Background:
BLOCK HF study demonstrated that biventricular pacing was superior to conventional right ventricular pacing in heart failure (HF) patients with atrioventricular (AV) block. An adaptive cardiac resynchronization therapy algorithm (aCRT) provides continuous pacing timings of AV delays based on periodic automatic evaluation of electrical conduction even in the patients with AV block, and is effective in patients with CRT devices. However, it is uncertain whether this algorithm has better benefits even in patients with pacemaker dependency.

Methods:
Between Jan/2016-Dec/2022, a total of 359 patients were implanted CRT devices. Pacemaker-dependent CRT patients with aCRT algorithm function were selected from them. Sixty-five patients with pacemaker dependency (31 patients using the aCRT algorithm [adaptive group] and 34 patients not using the aCRT algorithm [non-adaptive group]) were included in the analysis. Pacemaker dependency was defined as absence of spontaneous ventricular activity during sensing test at VVI 30 bpm or long atrioventricular delay (>300ms). The primary endpoint was a composite clinical outcome of all cause death and/or HF hospitalization.

Results:
There were no significant differences in baseline characteristics between two groups. During a median follow-up of 1,067 days (interquartile range 553-1,776 days), the aCRT reduced the risk of the composite clinical outcome in patients with pacemaker dependency (log-rank P=0.0187, Figure). In addition, use of the aCRT algorithm was an independent predictor of the composite clinical outcomes in the multivariate analysis (hazard ratio 0.32, 95% confidence interval: 0.12-0.88, P=0.028).

Conclusions:
The aCRT algorithm was useful and significantly reduced the risk of the clinical outcome, even in patients with pacemaker dependency.
Abstract 13526: Palliative Care Service Utilization in End-Stage Heart Failure: A Propensity Matched Nationwide Analysis
Authors: SAFIRIYU ISRAEL , Nagraj Sanjana , Adefuye Mayowa , Fatuyi Michael , Kharawala Amrin , Alhuarrat Majd Al Deen , Varrias Dimitrios , Naser Ahmad , Thachil Rosy
Published: December 2023

Background:
Palliative care services (PCS) is crucial in the care of end-stage heart failure (ESHF) patients. However, there is limited data on the utilization rates and the predictors PCS in ESHF patients.

Research question:
What is the frequency of PCS utilization, and what are the predictors of PCS use in ESHF patients?

Methods:
ESHF admissions were identified from the National Inpatient Sample database from 2018 – 2020. The identified admissions were stratified based on the use of PCS. The primary outcomes were the rate of utilization, and the predictors of PCS use in ESHF patients. Multivariate logistic regression and propensity matching were used to adjust for confounders.

Results:
In total, 147,140 ESHF admissions were identified, of which only 6.2% (9170) had PCS use. Patients with PCS were older(71.66 years vs 63.78 years; p<0.001), and were less likely to be of African American race (13.7% vs 17%; p<0.001). They were more likely to have a do-not-resuscitate (DNR) status (66.1% vs 10.2%; p<0.001), be frail (42.4% vs 18.3%), and have had a cardiac arrest event(2.5% vs 0.8%;p<0.001). The major predictors of PCS use were DNR status (adjusted odds ratio[aOR]:13.38, 95%CI: 11.73 – 15.27; p<0.001), cardiogenic shock (aOR: 3.54, 95%CI: 3.02 – 4.15; p<0.001), cardiac arrest during the current admission (aOR: 1.57, 95%CI: 1.01 – 2.44; p<0.001), & urban teaching hospital status (aOR: 1.69, 95%CI: 1.36 – 2.09; p<0.001)
Fig 1
. A matched pair of 8255 patients were identified in both groups. The ESHF patients with PCS had a higher in-hospital mortality (aOR: 3.30; 95%CI: 2.73 – 3.99; p<0.001), and were less likely to receive a heart transplant (aOR: 0.25; 95%CI: 0.12 – 0.50; p<0.001) Tab 1.

Conclusion:
Palliative care services are significant underutilized in the United States. DNR status, cardiogenic shock, respiratory failure, cardiac arrest, and admission to an urban teaching hospital were the major predictors of PCS use in ESHF.
Abstract 13532: Long-Term Survival of Different Heart Failure Categories in Patients Discharged Owing to Coronary Artery Disease With/Without Acute Coronary Syndrome
Authors: Lai Chao-Lun , Ko Tsung-Yu , Lin Jesse Chih-Wei , Wang Ting-Chuan , Liao Min-Tsun , Pan Heng-Yu , Liu Sheng-Fu , Kao Hsien-Li , Chan K. Arnold , Ho Yi-Lwun
Published: December 2023

Background:
Heart failure (HF) has been classified into distinct phenotypes based on left ventricular ejection fraction (LVEF). We conducted this retrospective cohort study to explore the long-term survival prognosis of different types of HF especially the HF with improved ejection fraction (HFimpEF) group.

Methods:
We collected patients who had ever been hospitalized owing to coronary artery disease or acute coronary syndrome between July 2006 and June 2017 at National Taiwan University Hospital (NTUH) and NTUH Hsin-Chu Branch. Patients were classified as (1) HF with reduced ejection fraction (HFrEF); (2) HFimpEF; (3) HF with mildly reduced ejection fraction (HFmrEF); (4) HF with preserved ejection fraction (HFpEF); according to echocardiography-derived LVEF during or after the index hospitalization. The date of the first echocardiography during or after the index hospitalization was defined as the index date. All patients were followed from their index date until death or the end of the study (December 31 2017), whichever occurred first.

Results:
Totally, 11549 patients were categorized into 4 groups (HFrEF group, n = 986; HFimpEF group, n = 461; HFmrEF group, n = 1454; and HFpEF group, n = 8648). The crude mortality rate during follow-up in HFrEF group, HFimpEF group, HFmrEF group, and HFpEF group was 60.4%, 28.0%, 36.6%, and 18.3%, respectively. Patients in HFimpEF group, HFmrEF group, and HFpEF group all possessed a significantly reduced risk of all-cause mortality compared with HFrEF group (adjusted hazard ratio [HR] 0.241, 95% confidence interval [CI] 0.199-0.292 for HFimpEF group; 0.443, 95% CI 0.393-0.500 for HFmrEF group; and 0.292, 95% CI 0.262-0.324 for HFpEF group). Using the time-varying Cox regression model to deal with the immortal time bias, we found a persistent lower risk of all-cause mortality in patients in HFimpEF group compared with patients in HFrEF group (adjusted HR 0.579, 95% CI 0.467-0.718).

Conclusion:
Patients in HFrEF group had the worst long-term survival prognosis and patient in HFpEF group had the best long-term survival prognosis. Patients in HFimpEF group represented a distinctive population with good survival prognosis than HFrEF group and HFmrEF group.
Abstract 13543: Novel Genes That Regulate QT Interval in Taiwanese Cohort
Authors: Chen Jien-jiun , Tsai Chia-Ti
Published: December 2023

Introduction:
QT interval denoted repolarization of the ventricule. QT intervals prolongation or shortening would lead patients prone to sudden cardiac death, i.e. Long QT or Short QT syndrome. There are many genes that have been reported to be related to QT interval changes. In this study, we used Genome wide association study(GWAS) to search for genes that regulate QT interval in a large Taiwanese cohort.

Methods:
We collected 13020 samples and did GWAS study. We collect ECG and analyze QTc interval by standard method. We search for genes and SNP have correlation with QT interval and used Taiwan Biobank as control. The QTc was measured as continuous variables. A P<10
-8
was considered significant variants.

Results:
In this study, we found many variants that regulate QT interval. (Figure 1). The variants included rs36092684 encoding C1orf132 which was long none coding RNA (never reported before), rs846111 that influences QT interval, 1:162021296:A:ATTG (a novel variants non reported yet), rs12143965, encoding NME7 (
ATP1B1
was a strong functional candidate, although
NME7 could not be excluded without functional validation),
rs10490255 encoding SLC8A1 Na
+
-Ca
++
exchanger that wound prolonged QT, rs16862199, encoded SLC19A2 genes that was associated with Thiamine-responsive megaloblastic anemia (TRMA), in such patients, their QT prolonged, rs2277923, encoding NKS2-5 that would cause dilated cardiomyopathy, conduction disorder, long QT, tetralogy of Fallot, rs144500919 (a novel SNP), rs12665409 encoding SLC35F1 that affects QT interval, and rs3778873(KCNH2), rs2074239 (KCNQ1).

Conclusion:
In this large Taiwanese QT study, we identified variants that would regulate QT interval. Some were reported before, such in QTGEN or QTSCD studies, and others were novel. The novel variants warrant further functional studies.
Abstract 13553: Traumatic Right Atrium Perforation Causing Pneumopericardium and Pneumothorax, Treated Conservatively
Authors: Maraj Diva , Othman Hussein
Published: December 2023

Background:
Pneumopericardium after pacemaker implantation is an extremely rare complication. Patients can present with symptoms such as chest pain, shortness of breath, or be completely asymptomatic. We present a case of a 68-year-old male who underwent dual chamber pacemaker implantation complicated by a pneumopericardium and contralateral pneumothorax.

Case Report:
A 68-year-old male with a past medical history of coronary artery disease status post percutaneous coronary intervention to the obtuse marginal artery and left circumflex, hypertension and benign prostatic hyperplasia presented with syncope while driving. Telemetry showed symptomatic long pauses up to 6.2 seconds and a dual chamber pacemaker implantation was recommended via the left subclavian vein approach. It was noted that the patient had multiple attempts to place the right atrium lead. Two days after the procedure, the patient developed severe right-sided chest pain and an electrocardiogram showed diffuse ST segment elevations consistent with pericarditis. A chest computed tomography (CT) showed a large right-sided pneumothorax and pneumopericardium and a chest tube was placed. The pacemaker was interrogated and showed a stable function and the patient was managed conservatively. A repeat CT chest showed significant improvement in both the pneumopericardium and the pneumothorax and the patient did well on follow up.

Discussion:
Ipsilateral pneumothorax and cardiac perforation are not uncommon following pacemaker implantation; however, contralateral pneumothorax and pneumopericardium are extremely rare. In our patient, it appears that the right atrium lead perforated through the right atrium into the right pleural space creating a fistula between the pericardial and pleural spaces. This was not detected on the initial chest x-ray and was only seen on subsequent CT chest imaging. Treatment of pneumopericardium usually involves lead revision or extraction; however, conservative therapy can be successfully attempted with close monitoring, as in our case.
Abstract 13582: Interferon Regulatory Factor 8 Promotes Abdominal Aortic Aneurysm via Inducing Type I Conventional Dendritic Cell Differentiation
Authors: Yuan Zhen , Shu Li , Wang Yidong , Cai Zhejun
Published: December 2023

Introduction:
Abdominal aortic aneurysm (AAA) remains to be the most common true aneurysm worldwide. Previous studies identified the participation of dendritic cells (DC) in the pathogenesis of AAA. However, the detailed subtypes involved and mechanisms remain unknown. Our previous RNA-Seq data determined dramatically increased
Irf8
in AAA samples, which drives DC differentiating to Type I conventional dendritic cells (cDC1).

Aim:
The aim of the work is to determine the role of interferon regulatory factor 8 (IRF8) in the development of AAA.

Methods and Results:
Murine AAA were induced via elastase infusion. The single-cell transcriptomic sequencing of CD45+ cells in murine AAA samples identified the dramatically increased cDC1. By flow cytometry, we found that the ratio of CD103
+
cDC1s reached maximum at day 7. Compared with the control group,
Irf8
CAG-LSL
Itgax
Cre
mice (
Irf8
overexpression in DC) suffered significantly more severe aneurysm expansion, elastin degradation and apoptosis of smooth muscle cells, while the AAA development in
Irf8
flox/flox
Itgax
Cre
mice (
Irf8
deletion in DC) was less sharp.
Batf3
-/-
mice which were cDC1 depleted, showed similar characteristic in AAA expansion with
Irf8
flox/flox
Itgax
Cre
mice. The effective CD8
+
T cells increased significantly in
Irf8
CAG-LSL
Itgax
Cre
mice than the control group, while decreased in
Irf8
flox/flox
Itgax
Cre
ones. Deletion of
Clec9a
which blocks cross-present dead-cell-associated antigens to the CD8
+
T cells, also attenuated AAA development, in accordance with
Irf8
flox/flox
Itgax
Cre
mice in gross anatomy and pathology changes.

Conclusion:
Our findings suggest that the activation of IRF8 promotes cDC1 differentiation, which subsequently activate CD8
+
T cells and contribute to destruction of the aortic-wall and AAA formation.
Abstract 13589: Prophylactic Anticoagulation to Prevent Left Ventricular Thrombus Following Myocardial Infarction: A Systematic Review and Meta-Analysis
Authors: Sacoransky Ethan , Ke Danny Yu Jia , Alexander Bryce , Abuzeid Wael
Published: December 2023

Introduction:
Left ventricular thrombus (LVT) complicates an estimated 12% of anterior STEMI. The current standard of care for STEMI patients includes primary PCI and dual antiplatelet therapy (DAPT). Guidelines from the American Heart Association recommend consideration of prophylactic anticoagulation to prevent LVT in select high-risk patients following STEMI. These guidelines have a low certainty of evidence (level C), with most studies published prior to the current era of primary PCI and DAPT. Therefore, an updated review is needed in this area.

Methods:
Electronic databases, including EMBASE, MEDLINE and CENTRAL were systematically searched from January 2012 to June 2022. We included primary studies that used PCI as the lone revascularization strategy for STEMI. Studies were included if they compared the incidence of LVT in patients receiving prophylactic anticoagulation and DAPT with those receiving DAPT alone.

Results:
7,378 studies were screened, with 4 studies eventually included in this review. One study was a randomized control trial and three were retrospective cohort studies. Pooled analysis using a fixed-effects model showed LVT was significantly less common in the triple therapy (TT) group compared to the DAPT group (OR = 0.38; 95% CI = 0.17-0.86; p = 0.02). However, using a random-effects model, there was no significant difference in LVT between the TT and DAPT group (OR = 0.42; 95% CI = 0.04-4.67; p = 0.33).

Conclusions:
Based on the current state of knowledge, there is no compelling evidence to either support or oppose prophylactic anticoagulation in STEMI. An appropriately powered clinical trial is warranted due to the need for more robust data in this area.
Abstract 13592: Addition of the Heart Score to a hsTnT Accelerated Diagnostic Protocol: Effect on Negative Predictive Value at Different hsTnT Thresholds
Authors: Hussain Muzna , Garg Ria , Marshall Kyle , Matsumura Martin E
Published: December 2023

Background:
The majority of pts with CP and low to modest elevations of high sensitivity troponin (hsTn) are safe for discharge from the ED; thus improvement of the negative predictive value (NPV) of the CP accelerated diagnostic protocol (ADP) can have significant impact on ED throughput. Prior studies have examined the role of adding bioclinical risk scores such as the HEART score (HS) to a hsTn ADP. In general these studies suggest the HS does not add to prediction of 30d MACE for pts with low peak troponin levels, i.e. less that the 99
th
percentile. Little is known about the effect of the HS on hsTn ADP for higher values of troponin.

Research question:
How would the addition of the HS affect the NPV of a hsTnT ADP across a range of modest hsTnT elevations?

Methods:
Retrospective analysis of pts presenting with CP and assessed with a validated hsTnT ADP as well as an EHR-embedded HS decision tool from 5/2022-3/2023. The hsTnT ADP was derived from the ESC guidelines and pts were excluded if peak hsTnT was
>
52ng/l (the cutoff for “rule-in”). For calculation of NPV for MACE at 30 days post-discharge pts were grouped by peak hsTnT as <6ng/l, <12ng/l, and <52ng/l. HS was grouped as
<
3 (low risk) or >3 (intermediate-high risk). Comparison of NPV results was performed using chi square analysis.

Results:
Summarized in the Table. The addition of the HS did not significantly change the NPV for 30d MACE for CP pts with peak hsTnT <6ng/l or <12ng/l. In contrast, NPV in pts with peak hsTnT <52ng/l was improved significantly by addition of the HS.

Conclusion:
The additive value of the HS to a hsTnT ADP for identifying pts safe for ED discharge depends on the range of troponin measurement- HS did not change NPV at very low levels (ie from < limit of quantitation – approx. 99
th
percentile) but did improve the NPV at modest elevations between the 99
th
percentile and the cutoff for “rule-in” by our ADP. This findings should be considered when designing hsTn CP evaluation protocols that incorporate HS into the algorithm.
Abstract 13610: Examining Stroke in Metabolically Healthy Hospitalized Young Tobacco Users With Prediabetes: A Population-Based Analysis in the United States, 2019
Authors: Desai Rupak , Mahadevan Arankesh , Dhavapalani Dhayashri , Rajarajan Srinishant , Babu Kalaivani , Thompson-Edwards Ashley , Reyaz Nafisa , Garikipati Sushmitha , Jain Manisha , Meenashi Sundaram Dakshin , Vanani Samir , Prem Anand Dharshana , Vasavada Advait
Published: December 2023

Introduction:
Correlation between prediabetes and stroke risk among young, metabolically healthy tobacco users is unknown. Our research aims to explore this association.

Methods:
We did a retrospective study and extracted data from the 2019 National Inpatient Sample (NIS). Focusing on metabolically healthy (defined as absence of known cardiovascular disease risk factors, hypertension, diabetes mellitus, hyperlipidemia, and obesity) young adults aged 18-44 with tobacco use and prediabetes.

Results:
Our study of 1,017,540 hospital admissions of young, tobacco-using metabolically healthy individuals, identified 2,390 (0.2%) prediabetic cases. Compared to non-prediabetics, prediabetic patients were older, more often male, less frequently white, and had higher rates of comorbidities such as chronic obstructive pulmonary disease (19.2% vs. 11.7%), previous myocardial infarction (1.5% vs. 0.4%), and chronic kidney disease (2.5% vs. 0.9%). Clinical outcomes showed prediabetes was associated with higher rates of major adverse cardiac and cerebrovascular outcomes (MACE) (2.9% vs. 1.4%, p<0.001) and stroke (1.9% vs. 0.5%, p<0.001). After adjusting for confounders, prediabetes was still associated with increased stroke (aOR: 3.31, 95% CI: 1.67 - 6.55, p<0.001). The odds of MACE were higher but not significant (p=0.078). Stratifying by demographics, both sexes and all races except blacks for MACE (p=0.172) showed statistically significant higher rates of MACE and stroke in prediabetic patients. Those in lower household income with prediabetes also had higher rates of MACE and stroke (p=0.015 and p=0.001, respectively).

Conclusion:
There is almost a 3-fold escalation in stroke risk among prediabetic young, metabolically healthy tobacco users. These findings highlight the necessity of acknowledging prediabetes as a potent risk factor despite absent metabolic risk factors and prevailing income disparities.