bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15402: Anatomic and Physiologic Classification of Adults With Congenital Heart Disease Using International Classification of Diseases (ICD) Coding
Authors: Ivey Lindsey C , Chen Joy , Ahmad Attila , Raskind-Hood Cheryl L , Rodriguez Fred H , Book Wendy M
Published: December 2023

Background:
The 2018 Adult Congenital Heart Disease (ACHD) Anatomic Physiologic (AP) classification scheme encompasses both anatomy and physiology to guide care management. To utilize the ACHD AP classification system in population-based research, an International Classification of Diseases (ICD) code-based classification is needed.

Methods:
AP classification of 240 cases, 18-65 years, with an encounter between 1/1/2010 - 12/31/2019 identified by at least one of 90 CHD codes (41 ICD-9-CM, 49 ICD-10-CM) in a tertiary adult healthcare system was performed by two methods - medical record review and a novel code-based AP classification. Cases were assigned one of four mutually exclusive AP classification categories based on complex vs. non-complex (simple plus moderate) anatomy and combined AB physiology (no/mild physiologic comorbidities) vs. CD physiology (moderate/severe physiologic comorbidities). A composite outcome of death, emergency department visit and/or hospitalization at 1-year after AP classification was evaluated.

Results:
Both record review and ICD code-based physiology classification methods demonstrated significant differences in 1-year outcomes between AB and CD physiology regardless of anatomic classification (Table 1), with CD physiology experiencing more adverse outcomes. Performance of AP classification by record review [PPV: 85.1% (97/114)] and ICD code-based classification [PPV: 80.7% (92/114)] (p=0.38) was similar. No differences were revealed by comparing outcome prediction within physiologic group by method, (AB by record review vs. AB by ICD codes: p=0.98; CD record review vs. CD by ICD codes: p=0.16).

Conclusion:
An ICD code-based classification of the ACHD AP guidelines is feasible, predictive of future adverse outcomes, and a reliable tool to use in administrative data. ICD code-based AB and CD physiology classifications are a good differentiator of outcomes for both complex and non-complex anatomic groups.
Abstract 15409: Analysis of Discrimination and Calibration of Two Cardiovascular Risk Scores in Patients With Non-Alcoholic Steatohepatitis Shows a Need for Improved Accuracy of These Models
Authors: Fishman Jesse , Mospan Andrea R , Morris Heather L , Gazis Derek , Sanyal Arun , Newsome Philip , Loomba Rohit ,   TARGET-NASH Investigators
Published: December 2023

Background:
CV risk can be estimated by risk scores such as the Framingham and the Pooled Cohort Equations (PCE). The applicability of these tools in present day NASH (non-alcoholic steatohepatitis) cohorts, individuals with increased morbidity and mortality from CVD, was evaluated to assess their relevance.

Hypothesis:
The Null Hypothesis is that there is no difference between the predicted CV risk as estimated by the Framingham or PCE risk scores, and the actual CV events that occur in a NAFLD (non-alcoholic fatty liver disease)/ NASH cohort.
Aim:
To assess the prognostic performance of the Framingham and PCE risk scores in a NAFLD/NASH cohort.

Methods:
The study population were US patients in the observational TARGET-NASH study with NAFLD/NASH aged 18 years or older. Patients with any CV history at or prior to index were excluded. Patients’ five-year CV risk was estimated using recalibrated Framingham and PCE models and compared with observed CV events. Model discrimination and calibration were assessed using the area under the receiver operator curve (AUROC) and Hosmer-Lemeshow test statistic, respectively.

Results:
980 and 587 patients in the Framingham and PCE cohorts, respectively, had all data needed for calculation of CV risk, of which 274 and 169 had at least five years of follow-up. Framingham five-year predicted CV risk was significantly greater among patients who did vs did not experience a CV event (13.7% [SD 9.0] vs 10.5% [SD 8.8]; p=0.02). No statistically significant difference was observed in the PCE analysis. The AUROC was 0.62 (95% CI 0.51, 0.73) for Framingham and 0.58 (95% CI 0.44, 0.72) for PCE at five years, with worst predictive performance among the subgroup of cirrhotic NASH patients for both risk equations. Analyses of model calibration revealed a statistically significant lack of calibration for both tools at five years (Framingham: χ
2
=25.58, p=0.001; PCE: χ
2
=33.86, p<0.001).

Conclusion:
Framingham and PCE may have poor predictive accuracy for CVD risk in NAFLD/NASH cohorts. This tended to be most apparent among the upper decile of predicted risk, with predicted values far exceeding the observed. Lack of ten-year follow-up and unmeasured risk factors may also explain some of the residual overestimation not accounted for in our models.
Abstract 15422: Diffuse Myocardial Fibrosis Predicts Outcome in Moderate and Asymptomatic Severe Aortic Stenosis
Authors: Lee Hyun-Jung , Singh Anvesha , Lim Jaehyun , Bing Rong , Tastet Lionel , Park Jun-bean , Kim Hyung-kwan , Kim Yong-Jin , Clavel Marie-Annick A , Gerber Bernhard L , McCann Gerry , DWECK MARC , Pibarot Philippe , Lee Seung-Pyo
Published: December 2023

Introduction:
Patients with moderate or asymptomatic severe aortic stenosis (AS) are at increased risk of cardiovascular events, but markers to guide intervention are lacking. We investigated the use of cardiovascular magnetic resonance (CMR) to identify drivers of outcome.

Methods:
Moderate (aortic valve area [AVA] 1.0-1.5 cm2) or asymptomatic severe AS patients (AVA≤1.0 cm2 and NYHA functional class I-II) (n=457) were prospectively enrolled from five international sites and parameters including extracellular volume fraction (ECV%) and late gadolinium enhancement were analyzed on CMR. Clinical events were defined as all-cause mortality and admission for heart failure.

Results:
Moderate AS patients had smaller left ventricular (LV) mass and less diastolic dysfunction compared to asymptomatic severe AS patients, but showed no difference in the extent of myocardial fibrosis and scar. During median 5.7-years follow-up, 83 clinical events occurred. Patients with clinical events had smaller AVA, greater diastolic dysfunction, and higher ECV% (median [interquartile range] ECV% 26.3% [24.3-29.8] vs 28.2% [25.5-30.8], P=0.003). There was a stepwise increase of clinical events across ECV tertiles. ECV% was associated with clinical outcome (adjusted HR 1.05, 95% CI 1.00–1.09, P=0.035), independent of AVA and aortic valve replacement as a time-dependent covariate. The prognostic significance of ECV% was consistent when AS severity was alternatively defined using aortic peak velocity and mean pressure gradient, and also across subgroups by AS severity and symptoms, AVA, aortic peak velocity, mean pressure gradient, and left ventricular ejection fraction (Figure).

Conclusions:
Increased diffuse myocardial fibrosis is associated with poor outcomes in moderate and asymptomatic severe AS patients and can help identify those who require closer surveillance and possibly earlier intervention.
Abstract 15437: Use of Artificial Intelligence to Decrease Data Deluge From Remote Monitoring of Cardiac Implantable Electronic Devices
Authors: Bawa Danish , Kabra Rajesh , Ahmed Adnan , bansal shanti l , Ghazal Rachad , Pham Nicholas , Colombowala Ilyas , Olsen Eric , Darden Douglas J , Pothineni Naga Venkata , Gopinathannair Rakesh , Lakkireddy Dhanunjaya R
Published: December 2023

Background
Remote monitoring (RM) has become the standard of care for follow up of patients with cardiac implantable electronic devices (CIED). Data deluge from RM of CIEDs is one of the major challenges faced by the cardiac device clinics. This study explores the role of a novel artificial intelligence (AI) algorithm in reducing the data deluge from CIED.

Methods:
The study included remote transmissions from CIEDs being monitored at 78 clinics across USA from Jan 2023 to April 2023. De-identified data was obtained from the data repository of Octagos Health. The transmissions were initially processed by AI algorithm and were either dismissed, forwarded to the device technician (DT) for review or forwarded directly to the device clinics. The main reasons for dismissals were redundant data or clinically non-actionable and non billable information. After initial triage by AI algorithm, the DT served as the second checkpoint who either dismissed or forwarded the transmissions to the device clinic with and without alerts.

Results:
A total of 42,534 patients with CIEDs were included in this study. There were 19,895 (46.8%) patients with pacemakers, 8,858 (20.8%) with ILRs, 7,012 (16.5%) with ICDs, 5,028 (11.8%) with CRT-D and 1,741 (4.1%) with CRT-P. Over a period of 4 months of RM, 273,435 transmissions were received. Of these, 57,345 (21%) transmissions were dismissed by AI and 118,546 (43.4%) were dismissed by the device technician team. As such only 97,544 (35.7%) transmissions were sent to the clinicians, of which 37,627 (13.8%) had alerts while 59,917 (21.9%) were routine transmissions. For quality control, about 15% (11,324) transmissions were randomly verified by EP for accuracy and were found to be 99% (11,193/11,324) accurate.

Conclusion
In our study, the use of AI algorithm significantly decreased data deluge by appropriate triaging of RM data from CIEDs. This has a potential to streamline the workflow of cardiac device clinics and improving efficiency and patient care.
Abstract 15441: Impact of the COVID-19 Pandemic on Cardiac Implantable Electronic Device Procedures and Complications in the United States
Authors: Carver Caleb , Ramphul Kamleshun , Deshpande Saurabh , Khan Hassan , Ahmed Raheel , Obeng-Gyimah Edmond , Schuler Brian , Khanji Mohammed , Sawatari Hiroyuki , Wafa Syed Emir Irfan , Somers Virend K , Padmanabhan Deepak , Providencia Rui , Chahal Anwar
Published: December 2023

Introduction:
The impact of COVID-19 was felt across cardiology as resources were redirected to critical care, delaying elective cardiology procedures.

Hypothesis:
To evaluate differences in outcomes of cardiac implantable electronic device (CIED) procedures in 2020 (height of COVID) vs. 2016-2019 (pre-COVID).

Methods:
Adults >= 18 years undergoing CIED procedures were identified from National Inpatient Sample Databases (NIS) 2016-2020. Complications and mortality were assessed based on the type of device: Permanent Pacemaker (PPM); Implantable Cardioverter Defibrillator (ICD); Cardiac Resynchronization Therapy with Pacemaker (CRT-P) or defibrillator (CRT-D): Leadless PPM; Generator explant (GE), and Lead extraction (LE).

Results:
A 13.8% drop in CIED admissions was recorded between 2019 and 2020 (p<0.01). Fewer procedures involving PPM, ICD, CRT-P, CRT-D, LE, and GE were observed between 2019 and 2020. Leadless PPM utilization rose consistently between 2016-2020 (47.6% increase during 2020 vs 2019)(Figure). In 2020, a higher proportion of patients were classified with a Charlson Comorbidity Index score of ≥3 (severe) (47.4% in 2020 vs. 42.9% in 2016-2019, p<0.01). The table shows significantly higher complications during CIED implants with no changes in mortality related to procedures.

Conclusions:
Patients admitted for CIED implants in 2020 had more severe comorbidities and expressed considerable differences in complications than pre-COVID era (2016-2019), but mortality remained unchanged. Leadless PPM use increased during pandemic, as against a decrease in the use of other CIEDs.
Abstract 15442: Street Gang Territories and Hypertension in Chicago
Authors: Mekonen Bruk , Agha Al Kola Mustafa , Tabit Corey
Published: December 2023

Hypertension is a major cardiovascular risk factor. Gang violence is an unfortunately common reality in urban communities and violence is associated with worse cardiovascular outcomes. However, the relationship between street gang territories and cardiovascular risk is unknown. We conducted a retrospective cohort study to determine if residence within a street gang territory is associated with higher blood pressure compared with demographically similar patients who resided outside of gang territories within Chicago.

A balanced dataset of 1,016 unique-but-demographically-similar patients with at least 3 available pre-pandemic ambulatory blood pressure measurements at our urban, academic tertiary-care center were sampled from over 70,561 available patients. Patients were matched for the number of BP measurements, age, race, sex, and other sociodemographic variables. Patients were geo-coded and mapped, and known street gang territories were similarly geo-coded and mapped using publicly available data from the Chicago Police Department data portal. Out of 66 known street gangs in Chicago, our institution served patients from 28 unique gang territories.

Patients residing within a known street gang territory had on average 6.2 mmHg higher BP than those living outside any known street gang territory (median = 133.2 vs 127.0, respectively,p<0.001). SBP control in each unique street gang territory was highly variable with medians ranging between 108.8 to 165.0 mmHg (Figure).

In conclusion, we find that residence within a street gang territory is associated with significantly higher systolic blood pressure compared with demographically similar patients who do not live in a gang territory. While poverty and other social determinants of health are known to affect hypertension and cardiovascular risk, residence within a gang territory may represent a new social risk factor for cardiovascular disease.
Abstract 15443: An Economic Modeling Analysis of an Intensive GDMT Optimization Program in Hospitalized Heart Failure Patients
Authors: Dixit Neal , Parikh Neil , Ziaeian Boback , Fonarow Gregg C
Published: December 2023

Background
For patients with heart failure with reduced ejection fraction (HFrEF), suboptimal initiation and titration of guideline-directed medical therapy (GDMT) has resulted in preventable loss of life and function. The STRONG-HF trial reinforced this finding by demonstrating substantial reductions in the composite of mortality and morbidity over 6 months among hospitalized heart failure (HF) patients who were randomized to intensive GDMT optimization compared to usual care.
Research Question
Whether an intensive GDMT optimization program would be cost-effective in HFrEF has yet to explored.
Aim
We performed an economic analysis of a hypothetical intensive GDMT optimization program over 6 months in patients hospitalized with HFrEF compared to usual care.

Methods:
Using a 2-state Markov model we evaluated the effect of an intensive GDMT optimization program on patients hospitalized with HFrEF. Two population models were created to simulate this intervention, the first, a “clinical trial” model, based off the participants in the STRONG-HF trial and the second, a “real world” model, based off the Get With The Guidelines-HF Registry of patients admitted with worsening HF. We then modeled the effect of a 6-month intensive GDMT optimization program comprised of a HF physician, clinical pharmacists, and registered nurses. Hazard ratios from the intervention arm of the STRONG-HF trial were applied to both populations models to simulate clinical and financial outcomes of an intensive GDMT optimization program from a United States healthcare perspective with a lifetime time horizon.

Results:
An intensive GDMT optimization program, resulted in an additional 1.04 and 0.59 life years in the clinical trial and real-world models, respectively. Both models showed the program would be highly cost-effective with incremental cost-effectiveness ratios <$5000 and reductions in healthcare spending due to reduced hospitalizations in the 6 months after discharge.

Conclusions:
An intensive GDMT optimization program for patients hospitalized with HFrEF would be highly cost-effective and result in substantial gains in clinical outcomes. Clinicians, payers, and policy makers should prioritize creation of such programs.
Abstract 15446: Impact of Patient Demographics on Optimal Beta-Blocker Use After New-Onset Heart Failure: Analysis of the HF-OPT Study (Heart Failure Optimization Study)
Authors: Jungbauer Carsten G , Colley Byron , Döring Michael , Duncker David , Gummadi Siva , Jonsson Orvar , Maier Lars S , Perings Christian , Robertson Michael , Wittlinger Thomas , Veltmann Christian
Published: December 2023

Background:
While beta-blockers (BB) have helped to improved outcomes in patients with heart failure and a low ejection fraction (HFrEF), the titration to target doses has been suboptimal and it is not clearly understood why. The Heart Failure Optimization Study (HF-OPT) study in newly diagnosed HF patients (pts) collected baseline data, arrhythmias during wearable cardioverter defibrillator (WCD), as well as medications and dosing.

Purpose:
The objective was to assess which factors were associated with receiving BB at target doses by day 180.

Methods:
Data from pts with newly diagnosed HFrEF during WCD use was collected from 487 pts (54% from US, 72% male, age 59±13) in the HF-OPT study. Target dose of BB were defined as the lowest maximum dose from either the ESC or ACC/AHA/HFSA guidelines. Supraventricular tachycardia (SVT) was used to label all dysrhythmias originating at or above the atrioventricular node and captured by the WCD. Association between BB and other variables were assessed using logistic regression.

Results:
6 months after a new diagnosis of HFrEF, 97% of pts were prescribed BB, but only 25% were on target doses. Univariate analysis showed that only BMI, age, sex, black race, a history of hypertension, and no history of PCI or angina, were associated with receiving target doses of BBs by 180 days. Having episodes of SVT during the first 180 days were also associated with receiving target BB doses (Table). In multivariate analysis, all were significantly associated with target BB dose except BMI, SVT during WCD use and history of PCI.

Conclusions:
The full beneficial effects of BB may not be achieved in patients with HFrEF if the patients are not recieving target doses. In the HF-OPT study, factors positively associated with reaching target BB doses included younger age, black race, being male, and a history of hypertension. Having a history of angina was associated with not achieving target BB doses. The significance of these differences should be further explored.
Abstract 15449:
Cardiopulmonary Best Abstract Award
: Pausing Reveals Exercise-Induced Uncoupling: Exploring the Dynamics of RV-PA Coupling in the Six-Minute Walking Test
Authors: Kremer Nils , Richter Manuel J , Yogeswaran Athiththan , Rako Zvonimir , Maggio Enrico , Seeger Werner , Tello Khodr
Published: December 2023

Background:
The six-minute walking test (6MWT) is a commonly used test for assessing the functional capacity of patients with pulmonary hypertension (PH), providing functional and prognostic information. Functional capacity depends on RV-PA coupling, the matching of right ventricular contractility to afterload. However, the dynamics of RV-PA coupling during the 6MWT have never been studied.

Methods:
We used a wireless hemodynamic monitoring system (CorLog, emka-medical, Germany) to continuously measure right ventricular pressure in 10 patients with PH (8 = group I, 1 = III, 1 = IV) during a 6MWT. We calculated right ventricular ejection fraction (RVEF) and Ees/Ea based on the pressure signal as shown in the figure (panel a). Dyspnea was evaluated using the Borg scale.

Results:
By analyzing the hemodynamic response during the 6MWT, we identified two patterns: 1) Improved/preserved coupling: Five patients exhibited an initial improvement in Ees/Ea and maintained coupling at least at the baseline level throughout the test, without requiring pauses. 2) Uncoupling associated with pauses: Five patients experienced a slight increase in Ees/Ea at the beginning, followed by a progressive loss of coupling and ejection fraction, necessitating pauses. During pauses, Ees/Ea values restored, enabling patients to resume walking. Patients of the second phenotype reported higher levels of dyspnea. The highest reported Borg score was 8 ± 0.9 vs. 4.6 ± 1.2 in the first group. Also, the covered distance was shorter in the second group (159 ± 64m vs. 288 ± 88m, p=0.03). Both groups showed differences in Ees/Ea (0.47 [0.46 - 0.57] vs. 0.34 [0.30 - 0.43], P=0.05) and RVEF (34 ± 4.1% vs. 28.5 ± 2.6%, P=0.03) at baseline, with Group One exhibiting superior values.

Conclusion:
This is the first investigation into the significance of RV-PA coupling in real-life exercise limitation and dyspnea during the 6MWT. Pauses observed during the 6MWT can serve as indicators of exercise-induced uncoupling.
Abstract 15461: Proteomic Profiling Identifies Metabolic and Extracellular Matrix Markers That Predict MACE in Individuals With Type 2 Diabetes: An EXSCEL Substudy
Authors: Corey Kristin M , Nguyen Maggie , Ramaker Megan E , Sourij Harald , Felker Michael , Sattar Naveed , Mentz Robert J , Hernandez Adrian F , Green Jennifer , Holman Rury , Shah Svati H
Published: December 2023

Background:
Patients (pts) with type 2 diabetes mellitus (T2DM) are at greater risk for major adverse cardiovascular events (MACE; e.g. stroke, myocardial infarction, and cardiovascular death). Given marked heterogeneity of risk, better multi-marker models are required to improve risk prediction.

Methods:
We evaluated 5473 pts with T2DM in the EXSCEL trial of exenatide, a GLP1-RA, vs. placebo by profiling ~5000 proteins at baseline and 12 months. Multivariable Cox proportional hazards models (adjusted for age, race, sex, study treatment, BMI, eGFR, BP, HbA1c, CHF and CV disease) were used to test for association between individual proteins with MACE. Pathway analysis using gene set enrichment (GSEA) was performed and LASSO, elastic net, random forest, and gradient boosted decision tree models were used to predict MACE on a held-out test set (N=1094). Protein importance scores and coefficients were analyzed to determine proteins predicting MACE. Linear mixed models (LMM) were performed to assess treatment effect on protein levels.

Results:
Over a median of 3.2 (IQR 2.2-4.4) years, 813 (6.72%) pts experienced MACE. A total of 1278 individual proteins were associated with MACE (FDR adjusted p <0.05). GSEA identified 8 pathways enriched in these proteins including fatty acid metabolism (p=0.01) and cardiac muscle contraction (p=0.04). LASSO outperformed other models in discrimination for MACE (AUC = 0.75) and prioritized tetranectin (an adipocyte secretory protein associated with insulin resistance and fibrinolysis) and fibulin-1 (a regulator of extracellular matrix) as highly predictive of MACE. Both proteins were highly associated with MACE in Cox proportional hazards models (tetranectin: FDR adjusted p=8.86e-26, HR = 0.11 (95%CI 0.07-0.16), fibulin-1: FDR adjusted p=6.72e-14, HR = 6.49 (95%CI 4.13- 10.19). LMM showed treatment modification in tetranectin levels (p=0.0018) with exenatide.

Conclusions:
Leveraging a large trial of a GLP1-RA in pts with T2DM, we identified proteomic models highly discriminative of MACE. Models using proteins involved in molecular pathways of fatty acid metabolism and cardiac contraction may have clinical utility in identifying higher risk pts and for understanding beneficial molecular mechanisms of GLP1-RA.
Abstract 15470: Increased Risk of Major Adverse Cardiac and Cerebrovascular Events in Elderly Non-Smokers With Cannabis Use Disorder: A Population-Based Analysis
Authors: Mondal Avilash , Dong Qiming , Bollu Bhaswanth , Shafi Nimra , Mylavarapu Maneeth , Parmar Poojan , DADANA SRIHARSHA , Kali Abeera , Khan Muhammad Hassan , Shanker Srija , butt Samia , Desai Rupak
Published: December 2023

Background:
Tobacco smoking confounds CVD risk studies. No large-scale investigation has been performed yet to examine cannabis use disorder (CUD) in elderly non-smokers with established CVD risk and major adverse cardiac and cerebrovascular events (MACCE).

Methods:
The National Inpatient Sample (2019) was queried using relevant ICD-10 codes to identify elderly (>65 years) admissions with established CVD risk without known tobacco use disorder and stratified into CUD and non-CUD cohorts. Logistic regression evaluated MACCE odds as primary outcomes and secondary outcomes as predictors of MACCE incidents in CUD users. P< 0.05 was considered significant.

Results:
Of 28,535 elderly cannabis users with CVD risk and no tobacco use disorder, 13.9% reported MACCE episodes. CUD patients were more likely to be male, black, and non-electively admitted from urban teaching and Western region hospitals. AIDS, alcohol abuse, depression, uncomplicated hypertension, and drug abuse were greater in the CUD cohort, while the non-CUD group had more complicated hypertension, diabetes with and without chronic comorbidities, hyperlipidemia, obesity, thyroid issues, previous strokes, VTE, cancer. The CUD cohort reported higher MACCE (OR 1.20; 95% CI 1.11-1.29). ACM (3.3% vs. 1.7%), dysrhythmia (34.9% vs. 24.9), acute myocardial infarction (7.6% vs. 6.0%, p 0.001), transfer to other facilities (28.9% vs. 19.0%), and home health care (22.4%) compared to non-CUD cohort (p 0.001). Chronic lung disease, renal disease, hypertension, and hyperlipidemia were predictors of MACCE episodes in CUD users.

Conclusion:
Even after controlling for smoking, elderly cannabis users having CVD risk had 20% more MACCE events encountered than non-users. Cannabis use in older non-smokers deserves investigation into CVD. risks
Abstract 15472: The IRIS™ Valve: A Growth Accommodating Transcatheter Pulmonary Valve for Pediatric Patients
Authors: Agwu Nnaoma , Nguyen Daryl , Kelley Gregory S , Burney Tanya , Perminov Ekaterina , Alcantara Christopher , recto michael , Kheradvar Arash
Published: December 2023

Introduction:
It is estimated that at least 1 million children are living with a congenital heart defect (CHD) in the U.S. Most of these patients are born with some degree of right ventricular outflow tract (RVOT) abnormalities that at some point require pulmonary valve replacement to mitigate the detrimental effects of pulmonary valve regurgitation (PVR) on the right ventricle (RV). Due to their size, available solutions, e.g., the Melody™ valve (Medtronic Inc., Minneapolis, MN) cannot be implanted in small children under 20 Kg. Those must wait until they grow to a suitable weight to receive the valve, which may lead to RV dysfunction.

Hypothesis:
To mitiagte the detrminental effects to the RV, the IRIS™ valve is implantable at 12 mm with a 12-Fr delivery catheter. As the valve annulus grows, the valve would be balloon expanded up to 20 mm.

Methods:
The IRIS™ valve has been designed according to origami concepts such that its three leaflets would retain a fully-coapted form as it is expanded to a larger size. Here we report our methods and results of implantation in 9-17Kg Yucatan pigs.

Results:
The IRIS™ valve is made of thin porcine pericardial leaflets sewn into a laser-cut stainless-steel stent. The stented valve is covered with an ePTFE skirt to mitigate paravalvular leak. The IRIS™ valve is fully crimped over a 12-Fr delivery catheter for transfemoral implantation. We have successfully implanted the valve at the native pulmonary valve position with minimal regurgitation in three pigs ranging from 9 to 17kg with varying pulmonary annulus sizes.

Conclusions:
The IRIS™ transcatheter pulmonary valve has been successfully developed according to proprietary origami concepts. Using the 12Fr delivery catheter, the smallest delivery profile reported, we successfully implanted the IRIS™ valve within the pulmonary annulus of mini pigs with encouraging results.
Abstract 15486: In-Hospital Outcomes After Cardiac Transplantation in Patients With Autism Spectrum Disorders: Insights From the National Inpatient Sample 2011-2019
Authors: Ergui Ian , Sheth Rahul , Dangl Michael , Ebner Bertrand , Inestroza Karla , Albosta Michael , Vergara Carlos , Grant Jelani K , VINCENT LOUIS , Maning Jennifer , Colombo Rosario , Grazette Luanda
Published: December 2023

Introduction:
Many governing bodies and major international societies recommend against heart transplantation (HTx) in patients with severe cognitive-behavioral disabilities, however no clear criteria are offered to define severity. Patients with Autism Spectrum Disorders (ASD) may face systematic discrimination when being evaluated for HTx. There is a lack of data regarding outcomes after HTx in patients with ASD.

Methods:
The NIS was queried from 2011-2019 for relevant ICD-9 and ICD-10 codes to identify patients with and without ASD who underwent HTx. Baseline characteristics and in-hospital outcomes between patients were compared. Binary logistic regression was used to adjust outcomes for significantly different baseline characteristics (p<0.05).

Results:
We identified a weighted sample of 25,456 patients who underwent HTx, of which 80 had a concurrent diagnosis of ASD. Because less than .05% of the adult HTx population had ASD, the outcome analysis was restricted to the pediatric population. After restriction there were 3,769 pediatric patients who underwent HTx, of which 70 had a diagnosis of ASD. There were no significant differences in mortality, transplant related complications (acute graft rejection, acute graft failure, acute cardiac allograft vasculopathy and unspecified complications), cardiac arrest, periprocedural sepsis, mechanical circulatory support, stroke and bleeding/vascular complications between groups. While unadjusted values signaled a difference in the rate of complete heart block (CHB), there was no significant difference after application to a binary logistic regression model (CHB aOR: 1.83, 95% CI .70 to 4.77, p=0.22) Total cost of stay was significantly higher in the ASD group ($2,017,389±$2,136,742 versus $1,675,459±$1,604,926, p<0.05) while total length of stay was higher in the non ASD group (79.6±72 days versus 64.8±53.7 days, p<0.05).

Conclusion:
There are no significant differences in outcomes after HTx between pediatric patients with and without ASD. The exclusion of patients with ASD from some transplant programs represents a major disparity in healthcare and transplant teams should consider a multidisciplinary approach to evaluating ASD patients for Htx.
Abstract 15489: Clinical Characteristics and Outcome of Patients With Acute Myocardial Infarction and Pre-Existing Left Heart Valvular Disease
Authors: Muzafarova Tamilla , Motovska Zuzana , HLINOMAZ Ota , Hromadka Milan , Kala Petr , Vichova Teodora , Mrozek Jan , Kettner Jiri , Hutyra Martin , Petr Robert , Tomasov Pavol , Ionita Oana , Jarkovsky Jiri
Published: December 2023

Introduction.
With the aging population and rising prevalence of cardiovascular risk (CV) factors, the global number of patients with acute myocardial infarction (AMI) and left valvular heart disease (VHD) is expected to increase substantially.

Aims:
To analyze the impact of pre-existing significant mitral regurgitation (MR) and aortic stenosis (AS) on clinical characteristics and outcome of AMI.

Methods:
The analysis is based on national all-comers’ registry of AMI enriched by information from the National Registry of Reimbursed Health Services.

Results:
Among 47,436 AMI-patients admitted during 2017-2021 selected VHD was documented in 1,445 (3.0%) patients; 510 (35.3%) with MR, 869 (60.1%) with AS. Patients with VHD (compared to without) had worse CVrisk profile - older (mean(SD)) age 73.9(10.6) vs. 65.6(12.5)ys, more previous PCI 23.5% (vs. 14.9%), CABG 23.4% (vs. 5.3%), higher comorbidity (diabetes 27.6% vs. 20%, CKD 11.9% vs. 5%); p<0.001 for all comparisons. NSTEMI was the most frequent manifestation in 58.9% of VHD patients (vs. 41.3% without, p<0.001). Patients with VHD had a wider extent of coronary artery disease with multivessel- 61.5% (vs. 53.6%) and left main disease 10.9% (vs. 5.5%), a higher proportion of TIMI 3 before PCI in 48.8% (vs. 38.0%), and with more frequent ≤80% IRA-stenosis in 20.0% (vs. 13.1%); p<0.001 for all comparisons. The presence of VHD fundamentally affects the short- and long-term prognosis (Fig). The AS patients had the highest prevalence of diabetes (30.1%), the highest risk of Killip ≥3 (OR 1.78; 95%CI 1.48-2.15) and need of mechanical ventilation (OR 1.29; 95%CI 1.04-1.59), and the highest risk of death.

Conclusion:
Preexisitng significant VHD modifies the risk profile, presentation, and prognosis of AMI patients. AS patients have the worst prognosis, which may point to the need for earlier planning of valvular intervention, especially in those with current coronary disease.
Abstract 15493: Coronary Artery Revascularization Strategies for Angiographically Inconclusive Lesions: A Network Meta-Analysis of Randomized Controlled Trials
Authors: Suebsaicharoen Thanakit , Dejprasert Wiphut , Numthavaj Pawin , Tansawet Amarit , Sasiprapha Thinnakrit , Thakkinstian Ammarin
Published: December 2023

Background:
There has been no head-to-head comparison among coronary artery revascularization strategies including different guiding modalities for percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG).

Aim:
To compare the cardiovascular outcome of all available coronary artery revascularization strategies

Method:
Systematic search of randomized controlled trials and study selection were performed in accordance with PRISMA guidelines. Coronary artery disease with angiographically inconclusive lesions was the domain of interest. Trials were excluded if they involved patients with left main disease, chronic total occlusion, or primary PCI for acute myocardial infarction (MI). The outcome of interest was a primary endpoint of all-cause death, non-fatal MI, or unplanned revascularization. Patient-level data was constructed from Kaplan-Meier (KM)-extracted data and combined across studies. A mixed-effect Weibull regression with accelerated failure time was used, and hazard ratios (HR) with 95% confidence intervals (CI) were then estimated.

Result:
A network map of 7 interventions including 15 trials of 17286 patients and cumulative probability curves are shown in Figure 1A and 1B respectively. CABG is the most effective strategy with 42% risk reduction in primary endpoint compared to angiography-guided PCI (HR 0.58, 95% CI 0.50-0.67), followed by quantitative flow ratio (QFR)-guided PCI (HR 0.64, 95% CI 0.50-0.82), intravascular ultrasound (IVUS)-guided PCI (HR 0.70, 95% CI 0.53-0.93) and fractional flow reserve (FFR)-guided PCI (HR 0.79, 95% CI 0.66-0.96). PCI guided by instantaneous flow ratio (iFR) and optical coherence tomography (OCT) is also superior to angiography but not statistically significant as shown in Figure 1C.

Conclusion:
CABG remains the most effective strategy in reducing the primary endpoint while QFR is superior to OCT, IVUS, FFR, iFR, and angiography in guiding PCI accordingly.
Abstract 15506: Pattern of Use of Anakinra for Patients With Kawasaki Disease versus Multisystem Inflammatory Syndrome in Children Associated With COVID-19
Authors: Portman Michael A , Harahsheh Ashraf S , Raghuveer Geetha , Sundraram Balasubramanian , Venkataraman Aishwarya , Yamazaki-Naksahimada Marco , Park Susan , El Ganzoury Mona , Dionne Audrey , Thacker Deepika , Chang Arthur J , Choueiter Nadine , Braunlin Elizabeth A , Orr William , McHugh Kimberly E , Farid Pedrom , Manlhiot Cedric , McCrindle Brian W
Published: December 2023

Background/Aims:
Anakinra (interleukin-1 blocker) has emerged as a potential adjunctive therapy for treating resistant acute Kawasaki disease (KD) and those with evolving aneurysms, and has been used as both primary and adjunct therapy for treating Multisystem Inflammatory Syndrome in Children (MIS-C), both in the absence of randomized trials. We sought to determine patterns of use, adverse events and evidence of benefit.

Methods:
The International KD Registry contemporaneously enrolled 727 patients with KD (site diagnosis confirmed by AHA criteria) and 1476 with MIS-C (site diagnosis confirmed by CDC criteria) from 39 sites in 7 countries from 01/2020 to 01/2023. Data collected included demographics, clinical features and presentation, management, laboratory values, and outcomes.

Results:
Anakinra was used at 22 (56%) sites for 11 (1.5%) KD patients (median duration 21 days) and 257 (17.4%) MIS-C patients (8 days; 11% discharged on anakinra). For KD, anakinra was used for treatment resistance for 5 sites, evolving aneurysms 3, macrophage activation syndrome (MAS) 1 and not-specified for 2. For MIS-C, anakinra use was determined by protocol for 3 sites, on a case-by-case basis for 10, reserved for treatment failure for 3 and not-specified for 6 sites. Reported indications for use (may be multiple) included routine use for ICU patients for 34% of treated MIS-C patients, worsening/persistent lab abnormalities 28%, critical decompensation (primarily cardiac) 21%, persistent/recurrent fever 21%, treatment failure 9%, coronary artery abnormalities 8%, and cytokine storm/MAS for 4%. Adverse events in treated MIS-C patients were noted for 23 (9%) and included neutropenia in 9, transaminitis 8, injection site pain/rash 4 and one each with anemia and thrombocytopenia. Extreme patient heterogeneity and confounding by indication precluded a formal analysis of impact on outcomes, although sites reported evidence of clinical improvement relevant to reported indications for all but one patient.

Conclusions:
Greater anakinra use for MIS-C vs KD likely reflects greater perceived indication, primarily greater clinical and inflammatory severity. Subjective evidence of benefit and a low prevalence of adverse events suggest an ongoing role for anakinra.
Abstract 15518: What Monitoring Duration is Needed to Rule Out High Atrial Fibrillation Burden?
Authors: Johnson Linda S , McIntyre William F , Brandes Axel , Healey Jeff S , Svennberg Emma
Published: December 2023

Introduction:
Atrial fibrillation (AF) burden contributes to stroke risk. AF detection rates increase with monitoring duration, but the relationship between time to the first AF episode and AF burden has not been described. We aimed to identify AF free monitoring durations after which a given AF burden can be ruled out.

Methods:
We included all subjects without permanent AF (n=13,106, median age 65 years (IQR 51-74 years), 40.1% male) monitored for ≥14 days in 2021 in the USA with PocketECG (MEDICALgorithmics), a full disclosure mobile cardiac telemetry device. We graphed 14-day AF burden (% time in AF/total time) by time in days before detection of prespecified AF durations (<30s (micro-AF), ≥30s-6 minutes, ≥6 minutes-1 hour and ≥1 hour in mutually exclusive strata) and calculated the 95th percentile of 14-day AF burden by time to first AF episode of different durations. Confidence intervals were estimated using bootstrapping with 1000 replications.

Results:
There were 5,605 patients with micro-AF episodes, 1,788 patients with 30s-6min AF episodes, 748 patients with 6 min-1 hour AF episodes and 227 patients with ≥1 hour AF episodes (Fig 1 a-d). The overall AF burden was higher in subjects with longer episodes, but decreased by time to first episode for all episode durations, Figure 1e-h. After 3 days of monitoring the 95th percentile for overall AF burden was 0.03% (95%CI 0.02-0.03%) in patients without micro-AF, 0.1% (95%CI 0.08-0.11% in patients without ≥30s AF, 0.4% (95%CI 0.3-0.4%) without ≥6-minute AF episodes, and 1.5% (95%CI 1.2-1.8%) without ≥1 hour episodes of AF.

Conclusions:
The probability of a high AF burden decreases as AF-free monitoring time increases, and AF free monitoring time can be used to inform the need for longer monitoring. When no AF episodes lasting ≥1 hour have been detected after 3 days of monitoring the probability of an AF burden >2% can be effectively ruled out.
Abstract 15536: Impact of Social Determinants of Health on Atherosclerotic Cardiovascular Diseases Incidence
Authors: Paulin Audrey , Manikpurage Hasanga D , Theriault Sebastien , Arsenault Benoit
Published: December 2023

INTRODUCTION:
Individuals with an unfavorable socioeconomic status have a higher risk of developing chronic diseases such as atherosclerotic cardiovascular disease (ASCVD). However, the shared contribution of socioeconomic status, psychosocial factors and living environment on ASCVD risk remains unknown. We investigated the contribution of these social determinants of health on the incidence of ASCVD.

METHODS:
We developed a polysocial risk score (PsRS) using latent class analysis based on socioeconomic factors (household income, level/quality of education and employment status), psychosocial factors (living alone, social support, social activities, social isolation, emotional distress, and diagnosis of psychiatric disorders), and living environment (social deprivation score, crime rate, housing quality, housing stability, proximity to green/blue spaces and proximity to nature). The study sample included 319 842 participants of the UK Biobank, free of ASCVD recruited between 2006 and 2010. As of August 2021, 23 840 of them had incident ASCVD (fatal or nonfatal myocardial infarction, ischemic stroke, or cardiac revascularization procedures). Participants were divided into three groups based on latent class analysis adjusted for age. The impact of the PsRS on incident ASCVD was assessed using Cox proportional hazards for all participants, women and men adjusted for age, sex, and ethnicity.

RESULTS:
Compared to participants with a low PsRS, those with an intermediate score had a slightly higher risk of ASCVD (hazard ratio [HR]=1.05 [95% CI, 1.01-1.09], p=0.024) while those with a high PsRS had a higher risk of ASCVD (HR=1.46 [95% CI, 1.40-1.52], p<0.001). The effect of the PsRS on ASCVD incidence appeared to be more pronounced in women (HR=1,59 [95% CI, 1.48-1.71], p<0.001 and HR=1.39 [95% IC, 1.32-1.46], p<0.001, respectively, for women and men with a high PsRS compared to individuals with a low PsRS within the same sex).

CONCLUSION:
A PsRS based on the living environment as well as socioeconomic and psychosocial factors was associated with incident ASCVD in participants of the UK Biobank. Multifactor approaches targeting both social determinants of health and traditional risk factors could reduce the burden of ASCVD in the general population.
Abstract 15539: Outcomes of a Multidisciplinary Approach to Management of Mavacamten in Obstructive Hypertrophic Cardiomyopathy
Authors: Willeford Andrew , Huynh Trina , Kraushaar Megan , Silva Enciso Jorge
Published: December 2023

Background:
Mavacamten treats obstructive hypertrophic cardiomyopathy in adults, improving symptoms and functional capacity. Its complex management process involves frequent echocardiograms, dose adjustments based on Valsalva left ventricular outflow tract (VLVOT) gradient changes, and screening for drug interactions. The high cost of mavacamten poses a financial burden to patients, and the management process lacks adequate simplification. Real-world workflow descriptions are needed for successful patient outcomes.

Methods:
We retrospectively analyzed patients prescribed mavacamten from May 2022 to May 2023 through a multidisciplinary workflow. Patients were referred to a pharmacist after an initial clinic visit with a cardiologist. Pharmacists counseled patients, enrolled them in the online Risk Evaluation and Mitigation Strategies program, and facilitated enrollment in the manufacturer's patient support program for cost reduction options and prior authorization. Echocardiogram dates were determined using a calculator created by the authors and coordinated with the echocardiography staff. Pharmacists adjusted doses based on finalized echocardiogram reports. Outcomes included ejection fraction (EF), LVOT, and VLVOT which were analyzed using a generalized linear mixed model controlling for time. Additional outcomes were out-of-pocket cost, time to approval, and time to first dispense.

Results:
Among 34 patients considered, 21 received mavacamten. Reasons for non-receipt included cost (6 patients), unwillingness to follow-up (4 patients), drug interactions (1 patient), absence of mavacamten on insurance formulary (1 patient), and awaiting insurance approval (1 patient). Patients on mavacamten received therapy for 2-48 weeks. They experienced significant decreases in average LVOT (P<0.001) and VLVOT (P<0.001) over time. Average EF showed a non-significant decrease (P=0.097), with one patient recovering from a decline below 50% upon discontinuing mavacamten.

Conclusion:
Mavacamten faces barriers such as echocardiogram follow-up, complex dosing, drug interaction screening, and cost. However, the described workflow effectively addresses many of these barriers, serving as a template for mavacamten management.
Abstract 15557: A Retrospective Study of Clinical Pathways and Outcomes of Andexanet Alfa Administration for Reversal of Critical Bleeding or Urgent Surgery in Patients on Oral Direct Factor Xa Inhibitors
Authors: Goldin Mark , Smith Kolton , Koulas Ioannis , Leung Tung Ming , Ravi Mayuri , Parhar Sanjit , Shah Sejal , Floyd Kayla , Ohanesian Lori , Bain Rachel , Defonte Daniella , Ochani Kanta , Spyropoulos Alex
Published: December 2023

Introduction:
Andexanet is FDA approved for reversal of life-threatening bleeding from factor Xa (FXa) inhibitors rivaroxaban and apixaban and off-label for urgent surgical reversal. Data are lacking on processes to ensure prompt andexanet dosing.

Hypothesis:
Presentation-to-andexanet time depends on clinical, demographic, and hospital factors.
Goals:
To identify factors impacting presentation-to-andexanet time and post-andexanet adverse outcomes.

Methods:
We retrospectively studied patients at a 23-hospital system who received andexanet from November 3, 2019, to March 4, 2023. Abstractors manually coded demographics, comorbidities, anticoagulant use, andexanet indication, and clinical pathway time stamps. The primary outcome was presentation-to-andexanet time. Secondary outcomes were post-andexanet major thromboembolism or bleeding, and in-hospital mortality.

Results:
110 patients were analyzed (mean age 77.4 years, 71.3% White). Most patients were on lower dose FXa inhibitors without antiplatelets; 77% had at least 2 vascular comorbidities. Andexanet was used most for intracranial hemorrhage (ICH) (80%); 7% of doses were for urgent surgery (Table 1). Median presentation-to-andexanet time was 219 minutes. Linear regression showed non-ICH bleeding was associated with greater time to andexanet dose. More post-treatment thromboembolism or bleeding occurred at tertiary academic hospitals (p = 0.02). In-hospital mortality did not differ among hospital types (Table 2).

Conclusions:
In a retrospective study, a non-ICH site was associated with greater median time to andexanet dose. More post-andexanet adverse events occurred at tertiary hospitals.