bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14535: Association Between Lower Extremity Revascularization Reinterventions and Treating Facility on Limb Preservation
Authors: Alabi Olamide , Duwayri Yazan , Zheng Xinyan , Mao Jialin , MASSARWEH NADER
Published: June 2023

Introduction:
Lower extremity revascularization (LER) improves quality of life and limb preservation rates. However, LER is complicated by the frequent need for short-term reintervention (re-LER). It is unclear if re-LER at a facility that did not perform the initial revascularization is associated with subsequent amputation.

Hypothesis:
Re-LER at a non-index procedural site is associated with 90-day major amputation.

Methods:
This was a national cohort study of older adults who underwent endovascular LER for PAD with subsequent re-LER (January 1, 2010 - December 31, 2018) in the Vascular Quality Initiative dataset linked to CMS claims and American Hospital Association facility-level data. We excluded acute limb ischemia and aneurysm procedural indications. The primary outcome was 90-day amputation. The primary exposure was site of first re-LER (same or different than index site). Multivariable logistic regression was used to determine the association between patient and facility characteristics and the likelihood of 90-day amputation.

Results:
Among 4,473 patients, 60.6% were male and 82.5% were White. One-fifth of patients had their re-LER at a non-index procedural site. Chronic limb threatening ischemia (CLTI) was the operative indication in 52.9%, 44.2% were on the femoropopliteal segment, and 64.8% of index LER procedures were completed in the outpatient setting. Comparing those who had re-LER at a non-index versus index procedural site, there were no differences in age or sex. However, a higher proportion of Black patients had their first re-LER at a non-index site (16.0% vs 13.7%, p=0.01). After adjusting for patient characteristics, re-LER at a non-index facility was associated with a 34% increase in the odds of amputation (odds ratio [OR] 1.34 [95% CI 1.02-1.75]). Additionally, non-White race was also associated with increased odds of amputation (OR 1.40 [95% CI 1.06-1.84]). After adjusting for facility characteristics, these differences were no longer significant.

Conclusions:
Disease-specific factors appear to be associated with the likelihood of amputation after re-LER while sociodemographic and facility-level factors do not. Quality improvement efforts should focus on early identification and management of patients with PAD.
Abstract 14539: Interhospital Differences in the Use of Critical Care Therapies in Coronary Intensive Care Units and Its Association With In-Hospital Mortality: Insights From the Critical Care Cardiology Trials Network
Authors: Donnelly Sarah J , Katz Jason N , tymchak wayne J , Bohula Erin A , Guo Jianping , Berg David , Morrow David , Van Diepen Sean ,   CCCTN Investigators
Published: June 2023

Background:
Previous studies have shown wide interhospital variation in cardiovascular intensive care unit (CICU) admission practices and use of critical care restricted therapies and monitoring (CCRx), but little is known about practice differences among tertiary and academic CICUs.

Methods:
The Critical Care Cardiology Trials Network (CCCTN) is a multicenter registry of tertiary and academic CICUs in the USA and Canada that contributed consecutive patient data in annual 2-month periods from 2017 to 2021. The analysis included 13,318 admissions across 28 sites and compared interhospital variability in CCRx and its association with in-hospital survival.

Results:
CCRx was provided to 61.4% (interhospital range 28.3 - 86.7%) of CICU patients. Admissions to CICUs in the highest tertile of CCRx utilization, compared with the lower tertile, had a greater burden of comorbidities; less frequently admitted patients with ACS (18.7% vs 35.8%); more frequently admitted cardiac arrest (4.9% vs 2.6%) or cardiogenic shock (5.8% vs 1.9%); and had higher median admission Sequential Organ Failure Assessment (SOFA) scores (5.0 vs 2.0), lactate (1.9 vs 1.8 mmol/L), and creatinine (1.3 vs 1.1 mg/dL) levels. Unadjusted in-hospital mortality varied widely between CICUs (median 12.6%; range 4.0-23.5%; p<0.001). After adjustment for patient differences, the correlation between CICU provision of CCRx and in-hospital mortality was weak (r=0.287, p<0.001).

Conclusions:
In a large registry of tertiary and academic CICUs, there was large interhospital variability in the provision of CCRx. The weak adjusted correlation with in-hospital mortality suggests that standardized CICU admission criteria could reduce disparities in admission practices and improve health-resource allocation.

Figure 1: Unadjusted correlation between individual CICU utilization of critical care restricted therapies and in-hospital all-cause mortality
Abstract 14545: Extramedullary Plasmacytoma of Tonsil Presenting as Cardiac Amyloidosis
Authors: Memon Rahat Ahmed A , Haas Donald , Janga Chaitra , Muhammadzai Hamza , Ginnaram Shravya , Checchio Lucy
Published: June 2023

Introduction:
AL amyloidosis is a systemic disease characterized by the deposition of misfolded immunoglobulin light chains produced from clonal plasma cells in multiple organs of the body causing its dysfunction. We present you an unusual case of AL cardiac amyloidosis in a patient with extramedullary plasmacytoma of the tonsils.

Case Presentation
61-year-old female presented with dyspnea on exertion with NT-proBNP elevated to 1439 pg/ml. CXR showed increased pulmonary vascular congestion. The patient was started on IV furosemide 40 mg BID with good urine output. Transthoracic echocardiogram revealed left ventricular hypertrophy with an ejection fraction of 60-65% with a global longitudinal strain of -9.0% and regional longitudinal strain reduced in the basal and mid-left ventricular segment but preserved in apical segment consistent with infiltrative cardiomyopathy. The patient underwent a nuclear (nuclear technetium pyrophosphate) scan of the heart consistent with cardiac amyloid deposition. She also was noted to have increased tonsillar mass which was biopsied. In the hospital, the patient had a cardiac arrest with the initial rhythm being ventricular fibrillation. The patient received 6 rounds of shock, and multiple injections of epinephrine, amiodarone, and bicarbonate push. The patient died despite all efforts of resuscitation. Histopathology results of tonsillar mass were consistent with plasmacytoma with amyloid deposition on Congo-red stain. Lambda: Kappa ratio was 70:1.

Discussion:
In cardiac amyloidosis, light chain deposits between cardiac myocytes disrupt cell-cell interaction. It can present as restrictive cardiomyopathy, conduction system abnormalities, or sudden cardiac death. It is essential to diagnose cardiac amyloidosis earlier. If untreated, the median survival of patients with cardiac AL amyloidosis is 6 months from the onset of heart failure.

Conclusion:
Our case was unusual in which a rare tumor of tonsils had plasma cell tumor which led to cardiac amyloidosis
Abstract 14592: Impact of Sodium Abnormalities: Hypernatremia vs Hyponatremia on Inpatient Hospital Congestive Heart Failure Outcomes: A National Inpatient Sample Data Analysis
Authors: Devarakonda Pradeep kumar , Singh Sohrab , karki monika , Gopalakrishnan Akshaya , Dhulipala Vishal , Atti Lalitsiri , Manoharan Suganya , Yoe Linus , Bandaru Praneeth , Reddy Sarath
Published: June 2023

Introduction
Sodium abnormalities are commonly associated with congestive heart failure (CHF). The main objective of this study is to analyze the impact of hyponatremia vs. hypernatremia on in-hospital outcomes in patients admitted with CHF
Methods

The National inpatient sample (NIS) data from 2017 to 2018 were queried using International Classification of Diseases 10 (ICD-10-CM) codes E871 and E870. Demographics and hospital characteristics were compared along with In-hospital mortality, length of stay (LOS), and total charge. The outcomes were measured using linear and logistic regression models to adjust the odds ratio for confounders.

Results:
A total of 350,144 patients with heart failure as a primary diagnosis (42% systolic and 32% diastolic HF) were included in the study. Among them, 37,129 (10.7%) had hyponatremia while 5839 (1.8%) had hypernatremia. In-hospital mortality rates were significantly higher with an adjusted odds ratio (OR) of 2.78 (p<0.001) among hypernatremia patients. Mean length of stay (LOS) was also high among hypernatremia patients (12.3 vs 8 days), with an adjusted odds ratio of 4.89 (p-value <0.001). Similarly, mean total charges were higher in the hypernatremia group (175,632$ vs 91,022 $). Notably, hypernatremia was associated with more hemorrhage complications (OR-6.35, p <0.001).

Conclusions:
Even though hypernatremia is less frequent than hyponatremia among CHF patients, it is associated with significantly higher mortality, LOS, and total charges than hyponatremia.
Abstract 14599: Survival From Sudden Cardiac Arrest During the COVID-19 Pandemic: Two-Year Prospective Evaluation in a Large US Community
Authors: Chugh Harpriya , Sargsyan Arayik S , Nakamura Kotoka , Uy-Evanado Audrey , Shepherd Daniel , Salvucci Angelo , Chugh Sumeet S , Reinier Kyndaron
Published: June 2023

Background:
Early experience in the COVID-19 pandemic indicated higher rates of out-of-hospital sudden cardiac arrest (SCA) and worse outcomes. There is little data from subsequent surges of Delta and Omicron variants.

Hypothesis:
All surges in the COVID-19 pandemic affected SCA incidence and outcomes.

Methods:
In Ventura County CA (pop. 848,112), all SCA cases with likely cardiac etiology and resuscitation attempted by emergency medical services (EMS) were prospectively identified (2015-). Comparisons were conducted between two years of the pandemic period (Feb 1, 2020-Jan 31, 2022) and the corresponding 2y pre-pandemic period (2018-2020) and during COVID surges (>3000 COVID cases / month in the county) vs. non-surge times during the pandemic (<3000 cases / month). COVID monthly incidence was obtained from US CDC data (Fig. red curve).

Results:
Pre-pandemic there were 671 SCA cases (40/100,000, mean age 70.9 yrs, 63% male) with an increase in the pandemic period (p<0.001) to 894 cases (53/100,000, mean age 69.6 yrs, 65% male). During the pandemic there was significant reduction in SCA survival (16.4% to 9.1%, p <0.001). Survival decreased consistently with each COVID surge. The mean SCA survival during surges (Fig. blue curve) was significantly lower than pre-pandemic (6.3% vs 16.4% dotted blue curve, p <0.001) as well as during non-surge periods (6.3% vs 11.4%, p=0.008). Comparing pre-pandemic to COVID surge periods, the proportion of SCA calls with ambulance response time < 4 min declined from 27.1% to 9.4% (p<0.001) as did the proportion of SCAs with shockable rhythm (26.2% to 18.6%, p=0.004), and bystander CPR (56.9% to 47.9%, p=0.004).

Conclusion:
SCA rates continue to be higher during the COVID-19 pandemic with persisting significant reductions in survival outcomes at 2y, that are exaggerated during each surge. These findings have implications for ongoing community public health and EMS response planning during the pandemic.
Abstract 14615: Genome-Wide Association Study and Gene-Lifestyle Interaction of Dyslipidemia in Korean Population: Based on Gender Differences
Authors: LEE GYEONG HEE , Yoo Hae , JEON HYEKYUNG
Published: June 2023

Introduction:
Dyslipidemia is caused by the interaction between genetic variation and health-related lifestyle factors, and the incidences varies according to gender. The purpose of this study is to investigate the association between dyslipidemia-related single nucleotide polymorphisms(SNP) and health-related lifestyle factors in Korean cohorts.

Hypothesis:
We hypothesized that some SNPs affect the effects of lifestyle factors on the risk of dyslipidemia and analyzed gene-environment interactions to search interactive SNPs.

Methods:
Genotyping was conducted to determine genotypes of 72,298 people and investigate genotypes for 7,079,946 SNPs from Korean Genome and Epidemiology Study. We analyzed the effects of lifestyle factors such as diet, stress, physical activity, alcohol consumption, and smoking on dyslipidemia. After discovering SNPs with GWAS, the interaction between the SNPs and health-related lifestyle factors was confirmed.

Results:
Five SNPs were found to be associated with dyslipidemia in the entire cohort: rs117026536(LPL), rs651821(APOA5), rs9804646(APOA5), rs9926440(CETP), rs429358(APOE). In men, four SNPs were found to be associated with dyslipidemia, of which two were found only in men: rs662799(APOA5), rs56156922(CETP). Coffee intake and smoking experience had significant interaction with five SNPs in the entire cohort (p<0.05; p<0.05). SNPs of the LPL and the APOA5 showed significant interaction with drinking and exercising (p<0.05; p<0.05). Interestingly, there was a specific association between the risk of dyslipidemia and stress in men. rs662799(APOA5) showed significant interaction with stress (OR: 1.081, p=0.016). In addition, rs662799(APOA5) and rs56456922(CETP) had a significant interaction with the drinking period(p<0.05).

Conclusion:
These results revealed a substantial interaction between lifestyle factors and the SNPs of APOA5 and LPL genes in hyperlipidemia in Korean population. Moreover, a specific association was found between rs662799(APOA5) and stress in Korean men. Since there is a significant interaction between genetic variation and lifestyle factors according to gender, further studies considering these characteristics are needed.
Abstract 14627: Angiotensin-Neprilysin Inhibition in Cardiac Sarcoidosis
Authors: Ahmed Raheel , Shi Rui , Qadeer Abdul , Ballo Gerald , Okafor Joseph , Azzu Alessia , Pennell Dudley , Baksi John , Wechalekar Kshama , Wells Athol , Khattar Rajdeep , Collins Peter , Kouranos Vasilis , Sharma Rakesh
Published: June 2023

Introduction:
Sacubitril/Valsartan is an established treatment for heart failure patients with reduced ejection fraction (HFrEF). However, there is a paucity of data on its use in patients with cardiac sarcoidosis (CS).

Hypothesis
To establish the beneficial role of Sacubitril/Valsartan in cardiac sarcoidosis.

Methods
All consecutive CS patients taking Sacubitril/Valsartan were identified from our database from 2016 to 2022. They were followed up for at least 6 months with serial echocardiography. Data regarding symptoms and echocardiographic parameters were compared using Wilcoxon signed rank test.

Results
A total of 30 CS patients taking Sacubitril/Valsartan were identified (mean age: 56.73±11.63 years old). The diagnosis of CS was determined in all patients by a multi-disciplinary team. Patients were male predominant (73.3%). The prevalence of smoking, diabetes, hypertension and ischaemic heart disease was 20%, 10%, 10% and 3.3% respectively. Beta-blockers, mineralocorticoid receptor antagonists, prednisolone, implantable cardioverter defibrillator and cardiac resynchronisation therapy (defibrillator) were present in 93.3%, 96.7%, 53.3%, 16.7% and 56.7% patients respectively. At the time of diagnosis, 24 (80%) patients were found to have active cardiac sarcoidosis on cardiac PET. At 6-months following the commencement of Sacubitril/Valsartan, there was a significant improvement in LV ejection fraction (38.77±10.26% vs 32.87±9.30%, p<0.001), LV end-systolic diameter (4.89±1.06cm vs 5.14±1.07cm, p=0.013) and New York Heart Association class (1.6±0.55 vs 2.0±0.52, p=0.001). During the median follow up of 24.9 months, the composite end-point of death and cardiac transplantation was reached in 3 (10%) patients (3 deaths and 0 cardiac transplantation). The patients experiencing at least one sustained ventricular arrhythmia (or aborted sudden cardiac death) decreased from 9 to 7 (p=0.21), the mean prednisolone dose was also comparable (11.56±4.42 vs 10.28±3.71, p=0.50) and none of the patients stopped Sacubitril/Valsartan.

Conclusions
Sacubitril/Valsartan in cardiac sarcoidosis patients with HFrEF is associated with at least short-term improvements in LV remodelling and functional status.
Abstract 14638: Survival Outcomes in Hospitalized COVID19 Patients With New Onset Cardiomyopathy
Authors: Kumar Sachin , Rikabi Sarah , Ghimire Bindesh , Nair Raunak , Reed Grant W , Khot Umesh N , Shah Gautam
Published: June 2023

Introduction:
Cardiac injury is known to occur in patients with COVID19 infection and is associated with a poor prognosis. However, there is limited data assessing the survival outcomes in hospitalized COVID19 patients with new-onset cardiomyopathy (NOC). We studied the impact of NOC on short and long term mortality in hospitalized COVID19 patients.

Methods:
We reviewed all cases of hospitalized COVID19 patients from the Cleveland Clinic COVID19 registry from 18
th
March, 2020 to 18
th
May, 2021 who received an in-hospital echocardiogram and had any prior echocardiogram to compare. The mean interval between the in-hospital and prior echocardiogram was 2.8 years. NOC was defined as a reduction in left ventricular ejection fraction (LVEF) of
>
10% with a new LVEF of
<
53%. The 30-day and 1-year mortality of patients with NOC were analyzed.

Results:
Of the 1537 hospitalized COVID19 patients receiving echocardiogram, 907 with a prior echocardiogram were included, of which 77 (8.5%) had NOC. Out of the 907 patients, 229 (25.2%) died within 30-days and 519 (57.2%) died within one year. It was found that patients with NOC had higher 30-day mortality than those without NOC (24.2% vs 36.4%, p=0.0078). However, the 1-year mortality was similar in the two groups (41.4% vs 45.3%, p=0.21).

Conclusions:
We found that NOC in hospitalized COVID19 patients was associated with higher 30-day mortality, however, it did not adversely impact the 1-year survival. Our findings suggest that although NOC is associated with worse short-term outcomes, long-term survival was primarily driven by the underlying disease process rather than the NOC.
Abstract 14677: Therapeutic Outcomes in Concomitant Cardiogenic Shock and Severe Aortic Stenosis: Insights From the National Inpatient Sample
Authors: Ergui Ian , Dangl Michael , Ebner Bertrand , Hernandez Rafael J , Inestroza Karla , Albosta michael , Vergara-Sanchez Carlos , Grant Jelani , Vincent Louis T , Maning Jennifer , Colombo Rosario
Published: June 2023

Introduction:
Cardiogenic shock (CS) in patients with concomitant severe aortic stenosis (AS) is a critical combination of pathologies that has been associated with a 43% to 77% in-hospital mortality. There is scant data regarding outcomes after medical management (MM), transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in this high risk population.

Methods:
The National Inpatient Sample was queried from 2011-2019 for relevant ICD-9 and ICD-10 codes to identify patients with AS and CS who underwent MM, TAVR or SAVR. Binary logistic regression was used to adjust outcomes for significantly different baseline characteristics.

Results:
We identified a weighted sample of 4,663,000 patients with AS, of which 26,101 had a concurrent diagnosis of CS and did not meet exclusion criteria. Medical management was associated with increased mortality compared to treatment with TAVR or SAVR (aOR 2.231, 95% CI 2.032-2.448, p<0.001). SAVR was associated with decreased mortality when compared to TAVR, although the difference was not statistically significant. Patients that underwent intervention, and specifically SAVR, had lower odds of cardiac arrest than patients that underwent medical management (SAVR aOR 0.514, 95% CI 0.386- 0.685, p<0.001, TAVR aOR 1.946, 95% CI 1.461-2.592, p<0.001). Medical management was associated with decreased risk of complete heart block (aOR 0.402, 95% CI 0.341-0.473, p<0.001), length of stay (8.4±9.9 days versus 9.6±8.5 for TAVR and 11.4±9.7 for SAVR, p<0.001) and cost of stay ($151,605±200,268 versus $352,936 ±297,495 for TAVR and $325,485 ±281,422 for SAVR, p<0.001).

Conclusions:
Patients with concomitant CS and severe AS have increased mortality with MM as compared to patients that undergo TAVR or SAVR, however there is no significant difference between TAVR and SAVR mortality despite SAVR patients generally having a lower incidence of comorbidities. These patients may benefit from AVR as opposed to MM.
Abstract 14679: Electrocardiogram Findings From Athletic Adaptation and COVID-19 Infection in Collegiate Football Players
Authors: Noe McKenna C , Parisi Erika , Conway Darryl , Navitskis Lenny , Rifat Sami , Chung Eugene H
Published: June 2023

Introduction:
Improved criteria have enhanced the sensitivity and specificity of the 12-lead ECG to identify underlying cardiovascular conditions predisposing to sudden cardiac death or morbidity. However, the impacts of chronic high-intensity exercise and especially ethnicity on changes in longitudinal ECG remain unknown. Furthermore, given the ongoing pandemic, we must consider how COVID19 infection may impact ECG findings. We analyzed collegiate student athlete ECGs over time to determine whether longitudinal training, race, and post-COVID19 status impact the ECG findings with the goal of informing future interpretation criteria.

Methods:
We included twenty-two NCAA Division I football players from January 2018 to January 2021. Ten athletes contracted COVID19 during this period. We compared pre-season ECGs prior to the first and third years of athletic participation as well as any within 34 days after confirmed COVID19 infection. Heart rate, QRS duration, QT interval, and any International Criteria findings were identified. The ECGs acquired prior to the athlete’s first-year of participation served as the baseline for comparison for the third-year and post-COVID19 ECG. T-tests and two-sample z-tests were used as appropriate for statistical analysis.

Results:
Compared to matched first-year baseline, the QRS duration of post-COVID19 ECGs was significantly longer (102 ± 26 ms vs 100 ± 31 ms, p = 0.01, 95% CI 0.62-3.77), which was not seen when compared to matched third-year ECGs. There were no other significant differences between white and black athletes, or those of third-year ECGs compared to the matched first-year baseline.

Conclusions:
In this small cohort of 22 athletes, there was no significant change in heart rate, QRS duration, QT interval, or International Criteria classifications, including early repolarization and voltage, between first- and third-year ECGs of white and black athletes. Although the post-COVID19 QRS duration was significantly increased compared to first-year ECGs, the range was still within normal; there was no increase with respect to third-year ECGs. Further analysis of a larger sampling of athletes of different sexes and sports that also considers the impact of training on the post-COVID ECG is ongoing.
Abstract 14680: Outcomes of Coronary Artery Bypass Graft in Patients With Atrial Fibrillation - A Study From National Inpatient Database 2016-2019
Authors: Adhikari Govinda , Baral Nischit , Seri Amith Reddy , Kambalapalli Soumya , Ghimire Calvin , Patel Neej , Kunadi Arvind
Published: June 2023

Introduction:
Atrial fibrillation (AF) is a common arrhythmia after Coronary artery bypass graft (CABG). There is a paucity of data on the outcomes of CABG either On-pump CABG (ONCABG) or Off-pump CABG (OFCABG) in patients with underlying AF.

Methods:
We queried the National Inpatient Sample (NIS) from 2016-2019 to identify adult patients who underwent CABG (On and Off-pump) using ICD 10 codes. Patients were divided into two groups based on history of AF. Primary outcomes of interest were in-hospital mortality and mean length of stay. Other covariates of interest included sex, age, race, insurance, income quartile by zip code, comorbidities, hospital location, and size. We used the Charlson Comorbidity Index (CCI) categories to account for comorbidities. We ran multivariate regression models to investigate the possible association.

Results:
There were 100,715 unweighted index hospitalizations identified for ONCABG and 25,956 for OFCABG. Patients were predominantly male and white race with a mean age of 65.7 years. A total of 34,333 (34.1%) patients had underlying AF in ONCABG group and 8369 (32.24%) in the OFCABG group. Multivariate regression analysis showed that in ONCABG, AF gorup had significantly higher odds of in-hospital mortality (aOR: 1.22; 95% CI: 1.10, 1.36; p = <0.001) compared to those without AF. Similarly, in OFCABG group, AF group had significantly higher odds of in-hospital mortality (aOR: 1.26; 95% CI: 1.04, 1.52; p = 0.019) compared to those without AF after controlling for the covariates of interest and comorbidities. The mean LOS was higher in the AF group in both ONCABG (10.6 vs 8.59 days, p<0.001) and OFCABG (10.78 vs 8.77 days, p<0.001). The number of ONCABG performed each year increased from 24,761 in 2016 to 25,683 in 2019, however, the number of OFCABG decreased from 7008 in 2016 to 6179 in 2019.

Conclusions:
AF was associated with increased in-hospital mortality and mean LOS among the patients who underwent CABG. The number of ONCABG performed each year increased whereas the number for OFCABG decreased.
Abstract 14682: Gender Disparities in Hypertrophic Cardiomyopathy After Septal Myectomy - Insights From the National Inpatient Sample 2011-2019
Authors: Inestroza Karla , Matute-Martinez Carlos , Mijares Rojas Ivan , Dangl Michael , Ergui Ian , Vergara-Sanchez Carlos , Albosta michael , Hernandez Rafael J , Ebner Bertrand , Grant Jelani , Alfonso Carlos , Colombo Rosario
Published: June 2023

Introduction:
Data suggests that women with hypertrophic cardiomyopathy (HCM) have worse clinical outcomes than men. However, data from large multi-center studies on gender differences in patients who undergo septal myectomy (SM) is scarce.

Methods:
The National Inpatient Database was queried from 2011- 2019 for relevant ICD-9 and -10 diagnostic and procedural codes. We compared baseline characteristics and in-hospital outcomes of patients with HCM who underwent SM stratified according to male vs. female gender. A p-value <0.001 was considered statistically significant.

Results:
We identified 10,805 patients with HCM who underwent SM, of which 55.4% were female. Women were significantly older (60.9 vs. 56.3 years), had more obesity (31% vs. 26.8%), heart failure (44.6% vs. 40%), chronic obstructive pulmonary disease (12.2% vs. 9.2%) and pulmonary hypertension (16.2% vs. 11.5%) (p<0.001 for all) compared to men. Men had more hypertension (75.4% vs. 69.7%), tobacco use (41.5% vs. 34%), alcohol use (3.5% vs. 1.4%), hyperlipidemia (59.3% vs. 55.6%), obstructive sleep apnea (25.9% vs. 15%), coronary artery disease 41% vs. 32%), chronic kidney disease (12.6% vs. 8.7%), atrial fibrillation (46% vs. 40.9%), and atrial flutter (8.5% vs. 4.7%) (p<0.001 for all) compared to women. In-hospital outcomes demonstrate women had higher all-cause mortality (3.3% vs. 1.6%, OR: 2.4 [1.5-4]) and more frequently required intra-aortic balloon pump placement (OR: 6.9 [2.7-19]) compared to men. Men had more intraoperative cardiac complications (OR: 1.4 [1.1-1.6]), pneumothorax (OR: 1.7 [1.25-2.5]), and pericardial complications (OR: 10 [3-33]) (p<0.001 for all) compared to women.

Conclusions:
In patients with HCM who underwent SM, women had higher all-cause mortality despite having less comorbidities than men. These highlights potential gender differences in outcomes in patients referred for SM. Whether biases exist in referral patterns needs to be further elucidated.
Abstract 14685: Predictors of Prognosis in Cardiogenic Shock Complicating Initially Acute Myocardial Infarction
Authors: Muzafarova Tamilla , Motovska Zuzana J , HLINOMAZ Ota , Kala Petr , Hromadka Milan , Precek Jan , Mrozek Jan , Matejka Jan , Kettner Jiri , Bis Josef , Jarkovsky Jiri
Published: June 2023

Introduction:
Despite modern treatment methods, cardiogenic shock mortality complicates acute myocardial infarction (CS-AMI) remains high.

Hypothesis:
The study of factors affecting CS-AMI outcomes is essential.

Methods:
Data from the all-comers' National Registry of Coronary Interventions from 2016 to 2020 were evaluated. Of 50,745 patients with AMI (STEMI/NSTEMI) 2,822 patients (5.6%) had initially CS (72.6% men, mean age 67.6 (12) yrs). The study analyzed the predictive value of such traditional cardiovascular risk factors related to the MI (sex, age, previous PCI or CABG, renal failure, localization of MI, time delay to reperfusion), comorbidities (expressed by the Deyo modification of Charlson comorbidity index), the severity of the condition on admission (mechanical ventilation, resuscitation), the extent of coronary artery disease and procedural success (the number of affected vessels, TIMI flow before and after PCI, LM disease), and such untraditional factors as season, weekday and day time. Multivariable analysis was used to identify independent predictors of prognosis in patients with CS-AMI.

Results:
The 30days mortality was 50.7%. As independent predictors of prognosis were identified age (older 80yrs, OR 4.97;95% CI 3.73-6.61), resuscitation (1.34; 1.07-1.67), mechanical ventilation (1.39;1.10-1.75), 3-vessel disease 1.39;1.12-1.72), left main disease (1.26; 1.01-1.57), and post-procedural TIMI flow lower 3 (1.14; 0.79-1.66). The independent predictive value of the comorbidity index was not confirmed (1.062;0.796-1.417). The numerically higher mortality rate was shown during a) autumn time (54.2%) and winter (51.8%), b) weekend (51.45%) (vs. working week (50.03%)), c) working hours (49.3%) (vs. the after-working hours (47.6%)). The multivariate analysis did not confirm the independent predictive value of these variables.

Conclusions:
Mortality of CS-AMI patients is significantly and independently influenced by factors confounding their circulatory instability, such as resuscitation and respiratory failure, the extent of coronary disease, and the success of reperfusion therapy. The independent impact of comorbidity and non-traditional factors on the prognosis of these patients has not been confirmed.
Abstract 14695: Prevalence of Extracoronary Vascular Abnormalities Among Patients With Spontaneous Coronary Artery Dissection: A Look at Scad Across the Lifespan
Authors: Visina Jacqueline , Haque Nowrin , Huang Shi , Kim Esther S
Published: June 2023

Introduction:
Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction in young women; however, SCAD has also been described in older patients. Differences in SCAD presentation, cardiovascular risk factors, presence of extracoronary vascular abnormalities (EVAs), and management across the lifespan have been understudied.

Methods:
Single-center cohort study of consecutive patients seen in a dedicated SCAD clinic. Medical history, radiographic, and angiographic data were collected. All patients underwent brain to pelvis CTA imaging to evaluate for EVAs. Patients were stratified into three age groups: 20-40, 40-60, and ≥60 years. Differences among age groups were evaluated using Kruskal-Wallis tests for continuous variables and Pearson Chi-squared tests or Fisher’s exact tests for categorical variables.

Results:
193 patients met inclusion criteria, 94.3% women. Prevalence of hypertension (14.8%, 42.6%, and 60%, p<0.001) and dyslipidemia (11.1%, 37.4%, and 53.3%, p<0.001) increased with age. Precipitating factors were significantly different among age groups (p<0.001) with usual exertion more commonly seen in the older cohort (25.5%, 39%, 73.3%). Peripartum SCAD (40%, 2.5%, 0%) and female sex (94.5%, 95.9%, 80%) were more commonly seen in the younger cohort (p<0.001). Younger patients were more frequently discharged on anticoagulation (10.9%, 0.8%, 0%, p<0.004). There were no significant differences in SCAD presentation, vessel involvement, SCAD management, and EVA prevalence. Procedural complications were not different.

Conclusions:
Older women who develop SCAD have more typical risk factors for ACS including hypertension, and dyslipidemia. Clinical presentation, vessel distribution, and management of SCAD do not vary across age groups. The prevalence of arteriopathies is high and similar across age groups, underscoring the importance of the evaluation for EVAs following SCAD in patients of all ages.
Abstract 14697: Chronic Medication Burden for Patients After Congenital Heart Surgery: A 14-Year Statewide Analysis of Publicly Insured Patients
Authors: Woo Joyce L , Nash Katherine A , Dragan Kacie , Crook Sarah , Neidell Matthew , Cook Stephen , Hannan Edward L , Newburger Jane W , Jacobs Marshall L , Bacha Emile A , Vincent Robert , Walsh-Spoonhower Kathleen , Mosca Ralph S , Kumar TK , Devejian Neil , Kamenir Steven A , Alfieris George M , Swartz Michael F , Meyer David , Paul Erin A , Billings John , Anderson Brett R
Published: June 2023

Introduction:
Data on the longitudinal health experience after pediatric cardiac surgery are limited. We examined chronic medication use by cardiac disease severity amongst publicly insured children in New York State over the course of childhood.

Methods:
We identified Medicaid-enrolled youth <18 years with a history of cardiac surgery in the NYS CHS-COLOUR database, which links clinical registry data to 14 years of New York State Medicaid data (2006-2019). We report total expenditures and prevalence of outpatient chronic medication use, defined as
>
90 days of a filled prescription.

Results:
Of 4.5 million children enrolled in Medicaid, 5,459 underwent cardiac surgery. Chronic medication expenditures were $4.1K/person-year for those with critical single ventricle disease (SV), $2.4K/person-year for critical biventricular disease (BV), $2.4K/person-year for non-critical cardiac disease (non-critical), and $0.3K/person-year for enrollees without a history of cardiac surgery (non-cardiac). Prevalence of chronic medication use was 0.65 (SV), 0.38 (BV), 0.37 (non-critical), and 0.15 (non-cardiac) enrollees/person-year. Prevalence of chronic medication use was higher for enrollees with cardiac surgery compared to non-cardiac enrollees: 16 times higher for cardiac/renal medications, 1.9 times higher for respiratory/allergy, 7.4 times higher for gastrointestinal, and 0.8 times higher for central nervous system medications (primarily driven by antiepileptics in enrollees <1 year and by psychotropics in adolescents). For enrollees with a history of cardiac surgery, patterns of medication use differed by age, medication type and disease severity (higher for SV compared to similar patterns of use for BV and non-critical,
Figure
).

Conclusion:
Chronic medication use is common and costly even years after pediatric cardiac surgery. Understanding longitudinal medication burden helps clinicians and families plan for future healthcare needs.
Abstract 14701: Angiographic and Prognostic Difference of Acute Myocardial Infarction Patients With and Without Out of Hospital Cardiac Arrest Stratified by Killip Classification
Authors: Kurita Tairo , Ito Hiromasa , Izumi Daisuke , Hoshino Kozo , Seko Tetsuya , Tanigawa Takashi , Kitamura Tetsuya , Yamada Norikazu , Kakimoto Hitoshi , Dohi Kaoru
Published: June 2023

Backgrounds:
Although the mortality rates for AMI have declined, the mortality rate for AMI with out-of-hospital cardiac arrest (OHCA) remains high. It has been supposed that CTO (chronic total occlusion) in non-infarct related artery is associated with OHCA patients. However, the detailed angiographic and prognostic comparison between OHCA patients and non-OHCA patients stratified by Killip classification has not been well evaluated.

Methods:
Among 5662 AMI patients (5420 non-OHCA patients and 242 OHCA patient) who underwent emergency coronary angiography between 2013 and 2020 were enrolled from Mie ACS registry. Difference of culprit lesion and non-infarct related CTO lesion were analyzed between with and without OHCA. They were further stratified using Killip classification.

Results:
In-hospital mortality for AMI patients with OHCA was 31.4%, significantly higher than the 5.5% for AMI patients with non-OHCA (p<0.001), and mortality rates tended to be increased with increasing Killip class in each group(P<0.001). AMI patients with OHCA also had a significantly higher frequency of culprit artery with LMT and LAD and a higher frequency of CTO lesion in non-infarct related artery compared to the AMI patients with non-OHCA.(See Table) Multivariate analysis revealed that LAD CTO in non-infarct related artery(Odds ratio 2.3) culprit artery of LMT and LAD (Odds ratio 3.2 and 1.6), lower BMI(Odds ratio 0.96), younger age(Odds ratio 0.98) and male gender (Odds ratio 1.7)was significantly associated with OHCA(P<0.05, respectively). However, non-LAD CTO lesion in non-infarct related artery was not associated with OHCA

Conclusions:
Patients with OHCA had a higher incidence of culprit artery with LMT and LAD, and non-infarct-related LAD CTO lesion, suggesting that extensive myocardial ischemia with LAD lesion was strongly associated with OHCA.
Abstract 14704: Comparison of Anticoagulation Strategies for Epicardial Access in Ventricular Tachycardia Catheter Ablation
Authors: Romero Jorge , Alviz Isabella , Velasco Alejandro , Gabr Mohamed , Rodriguez-Taveras Joan , Rodriguez Daniel , Lorente Ros Marta , Cerna Luis , Marin Jorge , Duque Mauricio , Dave Kartikeya P , DAVE KARTIKEYA P , MATIAS JOSE , Matias Jose , Matias Jose , Della Rocca Domenico G , Natale Andrea , Mohanty Sanghamitra , Diaz Juan C , Di Biase Luigi
Published: June 2023

Introduction:
Percutaneous epicardial access (EpiAcc) is frequently required for endo-epicardial ablation of ventricular tachycardia (VT), especially in ischemic cardiomyopathy, where it has been demonstrated to increase success rate. For patients who have indications for chronic oral anticoagulation (OAC), this often poses a challenge due to potential risks of procedural complications. We sought to assess the safety and outcomes of epicardial VT ablation on uninterrupted OAC compared to off anticoagulation.

Methods:
In this multicenter study, we retrospectively analyzed patients with ischemic cardiomyopathy and VT who underwent endo-epicardial ablation with EpiAcc. The study group included patients who underwent ablation either under uninterrupted OAC or off anticoagulation. Procedural data, outcomes, and complication rates were analyzed for comparison of both groups.

Results:
Overall, we analyzed 135 patients who underwent VT ablation via EpiAcc; 55 under full-dose uninterrupted AC and 80 off AC. There was no difference in procedure-related complications between both groups (1.8% vs 2.5%, p=0.09). There was no major bleeding requiring transfusion in any group. There was no difference in risk of cardiac tamponade between both groups (0% vs 0%, p=1). The rate of groin hematoma was 1.8% vs 1.3%, p=0.087). No thromboembolic events were reported.

Conclusion:
Epicardial VT ablation on uninterrupted OAC is a safe alternative to off AC, with no additional risk of life-threatening complications, thus preventing the possibility of thromboembolic events in patients who have an indication for chronic AC.

1
Abstract 14710: Social Determinants of Sleep Disturbances Among Adults With Multiple Cardiovascular Disease Risk Factors
Authors: Liu Xiaoyue , Commodore-Mensah Yvonne
Published: June 2023

Background:
Social determinants of health (SDoH) play a critical role in sleep. Patients with multiple cardiovascular disease (CVD) risk factors are vulnerable to poor sleep. Few studies have examined SDoH related to poor sleep in this vulnerable group. Therefore, we focused on adults with all three CVD risk factors - hypertension, diabetes, and obesity- and examined the relationships between SDoH and sleep outcomes.

Methods:
We analyzed data from the 2013-2018 National Health Interview Survey among adults with hypertension, obesity and diabetes. Sleep outcomes included sleep duration (categorized as <7, 7-9, >9 hours), days having trouble falling asleep, and days having trouble staying asleep (both categorized as no trouble, 1-3, 4-7 days). We used multivariable logistic regression to examine the relationship between SDoH (race, sex, education, income, marital status, employment status, and neighborhood cohesion) and sleep outcomes.

Results:
The sample included 9,695 adults aged 62 (±12) years. Over half slept either < 7 or > 9 hours, and 44.2% and 51.2% reported having trouble falling and staying asleep, respectively. Black adults were more likely to sleep < 7 hours compared to white adults (OR=1.32, 95% CI: 1.00-1.74). Income > $100,000 was significantly related to having trouble staying asleep (OR=1.87, 1.01-3.46) in comparison to income < $35,000. Compared to adults who lived in neighboordhood with higher social cohesion, those in neighborhoods with lower social cohesion were more likely to sleep < 7 hours (OR=1.57, 1.24-1.99) and have trouble staying asleep (OR=1.36, 1.07-1.74). Unemployed adults were less likely to sleep > 9 hours and experience trouble falling or staying asleep.

Conclusions:
Race, income, employment status, and neighborhood cohesion were related to sleep among adults with hypertension, diabetes, and obesity. Targeted sleep interventions should be implemented for high-risk patients who experience specific characteristics of SDoH.
Abstract 14737: Right Heart Remodeling After Pulmonary Valve Replacement in Patients With Pulmonary Atresia With Intact Ventricular Septum and Critical Pulmonary Stenosis
Authors: Irwin Margaret M , Reynolds Lindsey , Binney Geoffrey , Lipsitz Stuart , Ghelani Sunil J , Harrild David M , Baird Chris , Geva Tal , Brown David W
Published: June 2023

Background:
Patients with pulmonary atresia with intact ventricular septum (PA/IVS) and critical pulmonary stenosis (CPS) managed to a biventricular circulation may eventually require pulmonary valve replacement (PVR) for pulmonary regurgitation (PR). Right ventricular (RV) remodeling after PVR has been well described in tetralogy of Fallot (TOF); we sought to investigate RV volumetric and functional changes in PA/IVS using CMR.

Methods:
A retrospective cohort of PA/IVS and CPS patients who underwent PVR at Boston Children’s Hospital from 1995-2021 with CMR before and after PVR was matched 1:3 with TOF patients by age at PVR. Patients with initial intervention >2 weeks of age or 1.5 ventricle circulation were excluded. Median regression modeling accounting for matching was performed with reduction in indexed right ventricular end diastolic volume (RVEDVi) post PVR as the primary outcome, adjusting for covariates including tricuspid regurgitation (TR) and PVR valve size.

Results:
Twenty PA/IVS or CPS patients (cases) were matched with 60 TOF (controls), with median age at PVR 14 years; at median follow-up 8 years post PVR, 95% were NYHA Class I. Pre-PVR RVEDVi was similar between groups (165 vs 167 ml/m
2
, p=0.7), although cases had higher RV EF (51.4 vs 48.6%, p=0.03), TR fraction (23 vs 9%, p=0.008), and a trend toward lower RV mass; PR fraction, LV volumes and EF were similar. Pre-PVR RV free wall and LV longitudinal strain were similar, although LV circumferential strain was worse in cases (-15.6 vs -17.1, p=0.01). At median 2 years after PVR, RVEDVi was similarly reduced from 166 to 118 ml/m
2
(p=0.73), although cases had higher RV EF (52.3% vs 46.9%, p=0.007) with less reduction in indexed RV mass (Δ4.5 vs 9.6 g/m
2
, p=0.02); LV volumes and EF were similar. Post PVR, RV and LV longitudinal strain remained unchanged both within and between groups; LV circumferential strain was similar post PVR and remained lower in cases vs controls.

Conclusion:
Patients with PA/IVS after PVR demonstrate similar RV remodeling to TOF patients, with lesser reduction in RV mass and comparatively better post RV EF. CMR strain imaging found no significant pre-post differences in RV or LV systolic parameters. Further investigation is needed to evaluate for changes in diastolic parameters.
Abstract 14749: Assessment for Neurocognitive Change After Catheter Ablation for Atrial Fibrillation
Authors: Clark Kevin , Amara Richard S , Singh Jasmine , Shah Keneil , Haq Muhammad , Kagan Calvin , Shorofsky Stephen , Rottman Jeff , See Vincent Y , Dickfeld Timm
Published: June 2023

Introduction:
Several studies have been conducted to evaluate the neurocognitive effects of catheter ablation for atrial fibrillation. However, these studies have found mixed results. Theoretically, silent peri-procedural stroke might yield a worsening of neurocognitive function, though normalization of heart rhythms might yield improvement. The purpose of this study was to prospectively follow patients after catheter-ablation for paroxysmal or persistent atrial fibrillation with serial telephone-based Montreal Cognitive Assessments (t-MoCA) over 6 months to evaluate for changes in neurocognitive function.

Hypothesis:
No change in t-MoCA scores between baseline and 1-month, 3-months, and 6-months after catheter ablation for atrial fibrillation.

Methods:
All consenting patients who underwent first time or redo catheter ablation for atrial fibrillation (with either radiofrequency- or cryo-ablation) between January 2021 and May 2022 were enrolled in the study. A t-MoCA was conducted to measure cognitive function at baseline, 1 month, 3 months, and 6 months from the date of catheter ablation. Only patients who completed at least 1 month of follow-up were included for analysis. Paired t-tests and one-way ANOVA were used to assess for significant differences in t-MoCA scores.

Results:
42 patients met criteria for analysis. Paired two-tailed t-test values at 1-month, 3-months, and 6-months demonstrated an increase in t-MoCA score by 2.17 (n=42, p = 0.036), 3.08 (n=27, p = 0.005), and 3.06 (n=24, p = 0.006) respectively when compared to baseline. One-way ANOVA testing showed no significant differences between the 1-month, 3-month, and 6-month scores (p = 0.73).

Conclusions:
Patients undergoing first time or redo catheter ablation for atrial fibrillation had significant improvement in t-MoCA scores at 1-month, 3-months, and 6-months post-ablation. The improvement seen at 1-month was sustained throughout the 6-months of follow-up. Further long-term assessment is needed to determine if this effect persists over a longer period of time and to potentially correlate these findings with post-ablation atrial fibrillation recurrence.