bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 10891: Artificial Intelligence Echocardiographic Detection of Right Ventricular Dysfunction in Patients With High-Risk Pulmonary Embolism
Authors: Hsia Brian C , Subramaniam Varsha , Singh Supreet , Lai Ashton , Samtani Rajeev , Bienstock Solomon , Liao Steve , Stern Eric , LaRocca Gina , Sanz Javier , lerakis stamatios , Croft Lori , Stone Gregg , Goldman Martin E
Published: June 2023

Introduction:
Patients (pts) with pulmonary embolism (PE) and right ventricular (RV) dysfunction have a worse prognosis. We previously validated a real-time artificial intelligence software (AI, LVivoRV®) which calculates RV fractional area changes (FAC), free wall strain (FWS), and tricuspid annular planar systolic excursion (TAPSE) from a single unedited, non-ultrasound agent-enhanced apical 4-chamber (A4C) TTE view.

Hypothesis:
AI-calculated TTE parameters of RV function will accurately identify pts with intermediate-high and high-risk PE that would otherwise have been identified by comprehensive physician assessment of all TTE parameters, physical exam and biomarkers (“physician assessment”).

Methods:
We retrospectively identified pts in whom both a TTE (60.7% with ultrasound contrast) and chest CTA were performed for PE evaluation (median 1 day between studies). Based on comprehensive physician assessments, pts were stratified by the 2019 ESC guidelines from low-risk to high-risk for PE mortality. The accuracy of AI-TTE thresholds for RV dysfunction (previously defined) to identify physician-assessed high-risk PE was examined.

Results:
Of the 107 pts, 66 (61.7%) had confirmed PE on CTA. By physician assessment, 28 of these 66 cases were classified as intermediate-high/high-risk PE. Across all AI-TTE parameters, the sensitivities and negative predictive values for intermediate-high/high-risk PE (n=28) ranged from 79-86% and 83-87% respectively (Table). In contrast, the specificities and positive predictive values ranged from 30-56% and 29-38%.

Conclusions:
A simple to use, fully automated, AI-based TTE assessment of RV dysfunction at the bedside identified ~85% of all cases that would otherwise have been identified as intermediate-high and high-risk PE by comprehensive physician assessment (although the false positive rate was high). Further studies are warranted to examine how best to integrate this AI into clinical care pathways.
Abstract 10899: Excessive Right Ventricular Afterload in Pulmonary Arterial Hypertension: Effects on Diastolic Function and the Left Ventricle
Authors: Cubero Salazar Ilton M , Lancaster Andrew , Kauffman Matthew , Weller Alexandra , Simpson Catherine , Kolb Todd M , Damico Rachel L , Mathai Stephen , Kass David A , Tedford Ryan J , Hassoun Paul , Hsu Steven
Published: June 2023

Introduction:
Right ventricular (RV) diastolic dysfunction in pulmonary arterial hypertension (PAH) remains poorly understood. In this study, we used RV pressure-volume (PV) loops to assess RV diastology as a function of afterload in PAH.

Methods:
RV PV loops were prospectively measured in control (n=9) and PAH (n=39) patients at rest and during supine bike exercise. PAH patients were stratified by effective arterial elastance (Ea), a lumped measure of total afterload, into two groups: high afterload (HA, n=20) and severe afterload (SA, n=19).

Results:
PAH groups were matched with respect to age, sex, and PAH medication usage. Ea at rest and exercise was higher in SA PAH (1.8 vs. 0.6 mmHg/ml, P <0.0001 at rest; 2.3 vs 0.8 mmHg/ml, P < 0.0001 with exercise). In the SA group, RV end-diastolic pressure (RVEDP) was higher at rest (13.3 vs 7.6 mmHg, P = 0.0017) and rose markedly with exertion (23.4 vs 13.1 mmHg, P=0.0001). Because RV volumes changed similarly in both groups, SA patients exhibited stiffer RVs (dP/dV 0.30 vs 0.11 mmHg/mL, P=.024). To understand pericardial-interventricular interactions, we calculated the RVEDP-to-pulmonary capillary wedge pressure (PCWP) ratio and the left ventricular (LV) transmural filling pressure (LVTMFP). RVEDP/PCWP was substantially higher in SA (2.1 vs 1.0, P=.005). Therefore, even though PCWP rose considerably in SA (mean 16 mmHg), exercise LVTMFP was significantly reduced in SA vs HA PAH (-7.5 vs 2.55 mmHg, P=0.002). Along with reduced LV size seen by concomitant echo, we thus revealed blunted LV filling specifically in SA PAH. Accordingly, exercise cardiac index, stroke volume index, and LV stroke work index were all markedly reduced in SA PAH.

Conclusions:
Severe afterload in PAH results in high RV diastolic pressures and RV stiffening, which in turn blunt LV filling and LV output with exertion. Due to ventricular interactions, exercise PCWP may rise considerably in PAH, thus reducing its ability to differentiate from left heart disease.
Abstract 10902: The Association of Public-Access Defibrillation Rate With Mortality and Neurological Outcomes in Out-of-Hospital Cardiac Arrest Patients With Bystander-Witnessed and Initial Shockable Rhythm During Covid-19 Pandemic in Japan
Authors: Katasako Aya , Tahara Yoshio , Tsujita Kenichi , Noguchi Teruo , Kusano Kengo , Yonemoto Naohiro W , Nonogi Hiroshi , Nagao Ken , Ikeda Takanori , Sato Naoki , Kobayashi Yoshio ,   The Japanese Circulation Society Resuscitation Science Study (JCS-ReSS) Group
Published: June 2023

Introduction:
On January 16, 2020, the first COVID-19 infectious patient was reported in Japan. Since then, we have faced on the unprecedented COVID-19 pandemic. Initially, the direct mortality caused by COVID-19 had been focused on. However, recently, the pandemic’s indirect negative effects, stagnation of chain of survival, has been seen as a problem.

Hypothesis:
The negative impact would be particularly large on out-of-hospital cardiac arrest (OHCA) patients with initial shockable rhythm.

Methods:
This is a retrospective cohort study from the All-Japan Utstein Registry, which is a population-based and nationwide registry. Primary outcome are survival rate and favorable neurological outcome (Cerebral Performance Category of 1 or 2) at 30 days. We identified the association of the use of AED with survival and neurological outcome in patients who had OHCA events, bystander-witnessed and initial shockable rhythm before and after COVID-19 pandemic.

Results:
We compared the 5,240 OHCA patients with bystander-witnessed and initial shockable rhythm in pandemic period (2020) to the 16,628 of those in non-pandemic period (2017-19). The use of AED was decreased, (22.5 vs 20.3 %, respectively, p<0.001) and the survival rate and the proportion of favorable neurological outcome at 30 days was decreased. (39.3 vs 37.7 %, respectively, p=0.04; 28.7 vs 26.1 %, respectively, p<0.001) In addition, we compared by the regions. In regions of infection spread, the use of AED was decreased (25.9 vs 22.5 %, respectively, p=0.001), and the survival rate and the proportion of favorable neurological outcome at 30 days was decreased. (40.8 vs 36.8%, respectively, p<0.001; 29.5 vs 24.5 %, respectively, p<0.001) However, in regions of infection non-spread, there are no significantly differences in these points.

Conclusion:
The delay of prehospital intervention may have negatively effected in the survival rate and favorable neurological outcome at 30 days during COVID-19 pandemic.
Abstract 10908: The Association of Duration of Resuscitation and Long-Term Survival and Functional Outcomes After Out-of-Hospital Cardiac Arrest
Authors: Chai Jocelyn , Fordyce Christopher B , Guan Meijiao , Humphries Karin , Hutton Jacob , Christenson Jim , Grunau Brian
Published: June 2023

Introduction:
Longer emergency medical system (EMS) CPR-to-ROSC interval has been shown to be linearly associated with worse hospital discharge outcomes for out-of-hospital cardiac arrest (OHCA). We hypothesized that this association extends post-discharge in hospital survivors. We investigated whether pre-arrest co-morbidities influence the duration of resuscitation.

Methods:
We included EMS-treated adult OHCA (Jan 2009 - Dec 2016) from British Columbia Cardiac Arrest Registry and provincial databases. Pre-OHCA characteristics were compared by ≤ 10, 10-20, and >20 min CPR-to-ROSC interval categories. Outcomes included survival and functional outcomes at hospital discharge and 1-year, as well as 3-year post-discharge survival. We examined the relationship between CPR-to-ROSC interval categories and 1 and 3-year survival using Kaplan-Meier (KM). We examined the relationship between the CPR-to-ROSC interval (continuous variable) with all outcomes using regression models.

Results:
Among 10,241 OHCA, 4604 (45%) achieved ROSC, with a median CPR-to-ROSC interval of 15.5 (IQR 9.0- 22.9) min. Diabetes, chronic kidney disease, and prior MI were associated with longer CPR-to-ROSC intervals. 1245 (12.2%) survived to hospital discharge. Among hospital survivors, KM survival at 1- and 3- years were 92% [95% CI 90-93%] and 84% [95% CI 82-86%] respectively; survival curves stratified by CPR-to-ROSC intervals were not statistically different (Figure). Longer CPR-to-ROSC interval was non-linearly associated with lower survival and functional outcomes at hospital discharge but not with post-discharge outcomes.

Conclusion:
Longer CPR-to-ROSC interval was associated with lower survival at hospital discharge and is influenced by pre-arrest co-morbidities. However, these intervals were not associated with long-term survival or functional outcome among hospital survivors, suggesting that the early risk of longer CPR-to-ROSC intervals does not persist.
Abstract 10914: Acute Heart Failure Due to Rupture of an Aortic Pseudoaneurysm Into the Right Atrium
Authors: Tomura Nobunari , Nakagami Takuo , Kikai Masakazu , Hamaoka Tetsuro , Fukai Kuniyoshi , YAMAGUCHI Shinichiro , Matsubayashi Keiji , Matoba Satoaki
Published: June 2023

Introduction:
Rupture of an aortic aneurysm into the right atrium (RA) is extremely rare, while rupture into the thoracic cavity or pericardial sac is a common fatal complication. We describe a case of acute heart failure due to rupture of an aortic pseudoaneurysm with aorta-right atrial fistula.

Case Summary:
A 73-year-old man presented to the emergency department with dyspnea and abdominal distention. He had a history of ascending aortic replacement for type A aortic dissection 18 years ago. On arrival, physical examination revealed diminished breath sounds, leg edema but no cardiac murmurs. Investigations demonstrated abnormality of hepatic and kidney function, elevated BNP (490.9 pg/ml) in blood exam, and enlargement of ascending aortic aneurysm at the proximal anastomotic site with ascites/pleural effusion on computed tomography (CT), while left ventricular function was normal on transthoracic echocardiogram. We diagnosed acute heart failure with preserved ejection fraction and started to reduce fluid using diuretics. However, the response to diuretics was not good and the progression of lactic acidosis was observed regardless of using cardiotonic agent. Since it was becoming difficult to maintain systemic circulation, we performed further investigations before introducing mechanical support. The pulmonary artery catheterization revealed elevated RA pressure with wide pulse pressure (38/12 mmHg) and Oxygen step up in RA. An aortic root angiogram, contrast-enhanced CT and transesophageal echocardiogram showed a rupture of aortic pseudoaneurysm complicated with aorta-right atrial fistula (Figure). Although emergent surgery was performed, he unfortunately died the following day.

Conclusions:
This is a rare case of intracardiac perforation of aortic aneurysm diagnosed by various modalities. We should consider the possibility of developing shunt disease when we meet patients with rapidly progressive circulatory failure unresponsive to drugs.
Abstract 10917: Bone Mineral Density for Stratification and Prediction of Risk for Cardiovascular Outcomes in Women
Authors: Mannumbeth renjithlal Sarath lal , Eid Mohamed , Zaalouk Mostafa , Nand Nikita , Malik Muhammad Ahmed , Shaukat Fahd , Ritter Nathan , Makaryus Amgad , NISHA PILLAI
Published: June 2023

Introduction:
Atherosclerotic Cardiovascular disease
(
ASCVD) in women remains understudied, under-diagnosed, and under-treated. It is known that traditional risk factors have varied effects on men's vs. women's hearts. However, the current risk stratification tools tend to underestimate or not consider such sex-specific factors. We aimed to investigate the utility of bone mineral density (BMD) with DEXA scoring as a predictor of ASCVD in women.

Methods:
Patients who underwent DEXA scanning from 2012 to 2014 at multiple centers within our health system were collected and categorized using International Classification of Diseases (ICD) diagnosis codes to identify comorbidities and outcomes. Age, Sex, Race, history of hypertension (HTN), hyperlipidemia (HLD), diabetes mellitus (DM), body mass index (BMI), and smoking status were noted.

Results:
Of the 2,254 patients who underwent DEXA scanning, 1,995 participants were female (88.5%), and 1,929 were white (85.6%) with an average age of 72.8 years. The primary outcome was any ASCVD event (stroke, MI and cardiac death). During the mean follow-up of 9 years, 245 patients (10.8%) experienced ASCVD events. Patients with osteoporosis defined by a T score <-2.5 had higher odds of ASCVD events (OR - 3.82 [2.370-6.172], P<0.0001). Osteopenia was defined by a T score between -1 and -2.5 and was not associated with an increased risk of ASCVD events (OR 1.2 [0.782-1.957] P <0.36).

Conclusions:
BMD measurement with DEXA scanning may be useful for the stratification and prediction of risk for ASCVD events in women, with no additional economic strain on the healthcare system. Further wide-scale studies are needed to utilize this potentially promising predictor and commonly used diagnostic test.

.
Abstract 10923: CD51 Positive-bMSCs Exosomes Coated With Macrophage Membrane Migrated to Infarct Myocardium and Reconstructed Coronary Micro-Circulation via Sox17-Vegfr Signaling Pathway
Authors: Xie Dongmei , li yuanlong
Published: June 2023

Bone marrow-derived CD51-positive cells (CD51+bMSCs) were candidate progenitor cells for transplantation into acute myocardial infarction (AMI) mice, which could reduce death of cardiomyocytes and promote recovery of cardiac function. However, practical applications were limited by short survival time of resident cells in the injured myocardium and ball-like proliferation potential. Considering exosomes can mimic the biological effects of mother cells, we have discovered that the transplantation of exosomes secreted by CD51+bMSCs (abbreviation: CD51+bMSCs-Exo) to mice with AMI avoided the above problems, and effectively improved heart function via intramyocardial injection but not intravenous injection. The unequal effects were contributed to the different number of exosomes that attached to the injured tissues. Based on the chemotactic characteristics of macrophages to inflammatory tissues, we supposed that the chemotactic capacity of CD51+bMSCs-Exo could be improved when they encapsulated with macrophage membrane expressing multiple receptors (abbreviation: ME complex). The experimental results show that: 1) ME complex migrated to the injured myocardium after intravenous delivery and promoted the recovery of infarcted myocardium.2) Plenty of new blood vessels were emerged in the injured myocardium, which reconstructed coronary microcirculation. 3)Single-cell sequencing data found that sox17 may be an important factor to reconstruct coronary microcirculation in myocardial infarction tissue. We assessed the hypothesis that sox17 can form a positive feedback loop with VEGFR on endothelial cells. +bMSCs-Exo promotes angiogenesis. In conclusion, ME complex activates SOX17/VEGFR of endothelial cells to promote angiogenesis in AMI mice.
Abstract 10926: Warfarin Dosing Algorithms With the Information on Genotype and Amiodarone for Patients Without Extracorporeal Circulation Devices Could Be Beneficial for Those With Left Ventricular Assist Devices
Authors: Makiguchi Misaki , Maeda Makiko , Saito Marika , Ito Yoshito , Sera Fusako , Samura Takaaki , Kawamura Takuji , Kawamura Ai , Kubota Kaoru , Maeda Shinichiro , Kashiyama Noriyuki , Kainuma Satoshi , Ohtani Tomohito , Yoshioka Daisuke , Takeda Toshihiro , Sawa Yoshiki , Miyagawa Shigeru , Sakata Yasushi , Fujio Yasushi
Published: June 2023

Introduction:
Many prediction algorithms for warfarin maintenance dose (WD) were constructed based on the clinical and genetic information of the patients without extracorporeal circulation devices (ECDs). However, it is unclear whether might be useful for the patients with ECD, such as left ventricular assist devices (LVAD), who still require warfarin.

Hypothesis:
The WD algorithms constructed using non-ECD patients could be useful for LVAD patients.

Methods:
An observational study, the Human Genome Research Ethics Committee of OU approved (#756), was conducted at the Osaka University (OU) Hospital on 108 LVAD patients receiving warfarin therapy. Genetic polymorphisms of CYP2C9*1, *3, and VKORC1-1639G>A were tested using TaqMan genotyping assay kits. WD was defined as the administered dose during the periods when the PT-INR value was within its target range. We investigated the difference between the actual warfarin dose (AWD) and the calculated warfarin dose (CWD) using an algorithm proposed by the International Warfarin Pharmacogenetics Consortium (IWPC), which we verified with 125 Japanese non-ECD patients previously (Eur J Clin Pharmacol, 75:901).

Results:
The percentage of patients whose difference between CWD and AWD was within 20% of AWD showed no significant difference between the LVAD and the non-ECD (%; I, LVAD, 41.7, non-ECD, 49.6, p=0.23). The root mean squared percentage error (RMSPE) to the AWD was similar between the groups (%; LVAD, 42, non-ECD, 37). As the algorithm requires if amiodarone is concomitant with warfarin, we probed the effect of the amiodarone dose on the CWD. Interestingly, RMSPE of the LVAD with ≥ 200 mg/day of amiodarone (≥ 200A) was higher compared to those with < 200 mg/day (<200A) and without amiodarone (%; 85.5, 25.9, 36.8). The difference between AWD and CWD of ≥ 200A was significantly higher than <200A (mg/day; 0.87, -0.07; p=0.012). We verified similar tendencies using other algorithms published before.

Conclusions:
The WD algorithm with the information on genotype and concomitant use of amiodarone for the non-ECD could be beneficial for the LVAD. Besides them, extra careful attention should be required for patients with ≥ 200 mg/day of amiodarone not to have warfarin overdosed.
Abstract 10938: Concomitant Latent Pulmonary Vascular Disease Leads to Impaired Global Cardiac Performance in Heart Failure With Preserved Ejection Fraction
Authors: Schuster Andreas , Schulz Alexander , Lange Torben , Evertz Ruben , Hartmann Finn , Kowallick Johannes , Hellenkamp Kristian , Uecker Martin , Seidler Tim , Hasenfuss Gerd , Backhaus Soeren J
Published: June 2023

Introduction:
The REDUCE-LAP II trial demonstrated adverse outcomes after interatrial shunt device (IASD) placement in heart failure with preserved ejection fraction (HFpEF) attributed to latent pulmonary vascular disease (PVD). We hypothesized that exercise-stress cardiovascular magnetic resonance (CMR) imaging could provide non-invasive characterisation of cardiac and pulmonary physiology for improved patient selection.

Methods:
The HFpEF-Stress Trial prospectively enrolled 75 patients with exertional dyspnoea and diastolic dysfunction. Patients underwent rest and exercise-stress right heart catheterisation (RHC), echocardiography and CMR imaging. Pulmonary artery and capillary wedge pressures, cardiac index (CI) and vascular resistance (PVR) were calculated. Latent PVD was defined as increased PVR≥1.74 Wood-Units during exercise-stress. CMR assessed long axis strains (LAS) and filling volumes of all cardiac chambers. Right ventricular (RV) function was further quantified by stroke and peak flow volumes.

Results:
Patients with latent PVD (n=24) showed higher HFA-PEFF scores and lower RV function (rest TAPSE, p=0.010; stress RV LAS, p<0.001) compared to patients without (n=43). RV filling (p=0.007), stroke and peak flow volumes (p<0.001) were reduced and led to impaired left atrial (p≤0.010) and ventricular (LV) filling (p≤0.008) and LV-CI (p<0.001) despite normal LV contractility (LV LAS p≥0.255). The degree of RV dysfunction during exercise-stress best predicted latent PVD (RV peak flow, AUC rest 0.81 vs. stress 0.91, p=0.005).

Conclusions:
Latent PVD is a feature of advanced HFpEF and associated with impaired RV functional reserve, global diastolic filling and LV-CI. This can be quantified by CMR and used to identify patients likely to benefit from IASD implantation.
Abstract 10944: Cardiac Magnetic Resonance Derived Left Atrioventricular Coupling Index and Major Adverse Cardiac Events in Patients Following Myocardial Infarction
Authors: Lange Torben , Backhaus Soeren J , Schulz Alexander , Evertz Ruben , Kowallick Johannes , Bigalke Boris , Hasenfuss Gerd , Thiele Holger , Stiermaier Thomas , Eitel Ingo , Schuster Andreas
Published: June 2023

Introduction:
Recently a novel left atrioventricular coupling index (LACI) has been introduced providing prognostic value to predict cardiovascular events beyond common risk factors in patients without cardiovascular disease. Since data on cardiovascular magnetic resonance (CMR)-derived LACI in patients following acute myocardial infarction (AMI) are scare we aimed to assess and validate the diagnostic and prognostic implications of LACI in a large AMI patient cohort.

Methods:
1044 patients following AMI were included. After primary percutaneous coronary intervention CMR imaging and subsequent functional analyses were performed in median 3 days after AMI. LACI was defined by the ratio of the left atrial end-diastolic volume divided by the left ventricular end-diastolic volume. Major adverse cardiac events (MACE) including death, reinfarction or congestive heart failure within 12 months after the index event were defined as primary clinical endpoint.

Results:
LACI was significantly higher in patients with MACE compared to those without MACE (p < 0.001). Youden Index identified an optimal LACI cut-off of 34.7% to classify patients at high-risk (p < 0.001 on log-rank testing). Greater LACI was independently associated with MACE on univariate regression modeling (HR 8.1, 95% CI 3.4% - 14.9 %, p < 0.001) and maintained independence after adjusting for baseline confounders and left ventricular ejection fraction (LVEF) on multivariate regression analyses (HR 3.1 95% CI 1.0 - 9., p = 0.049). Furthermore, LACI assessment enabled further risk stratification in high-risk patients according to traditionally utilized reduced LVEF ≤ 35 % (p < 0.001 on log-rank testing).

Conclusions:
Atrial-ventricular interaction using CMR-derived LACI is a superior measure of outcome beyond sole LA or LV volume analyses and EF especially in high-risk patients following AMI.
Abstract 10954: Average Annual Out-of-Pocket Cost of Guideline Directed Medical Therapy for Heart Failure
Authors: Alhassan Hassan A , Akunor Harriet , Aryan Aiyer , Rollman Bruce L , Luo Jing , Hickey Gavin W
Published: June 2023

Introduction:
The 2022 multi-society heart failure guidelines underscore the importance of initiating and maintaining patients on Guideline Directed Medical Therapy (GDMT). Cost transparency plays a key role in the shared-decision making process, however, national estimates of out-of-pocket (OOP) cost for GDMT for Heart Failure (HF) are lacking

Methods:
Using data from the Medical Expenditure Panel Survey (MEPS) 2019, we estimated the average annual OOP cost for each GDMT drug class: cardio-selective Beta-Blockers (BB), Angiotensin-converting enzyme inhibitors (ACEi)/Angiotensin II receptor blockers (ARB)/Angiotensin Receptor-Neprilysin Inhibitor (ARNi), Mineralocorticoid Receptor Antagonists (MRA), and Sodium-glucose cotransporter-2 inhibitors (SGLT2i). We also estimated average annual OOP costs for recommended GDMT combinations: Quadruple therapy, quadruple with ARNI alone, and various combinations of triple therapy. Cost estimates were also stratified by insurance status.

Results:
Of 28,512 MEPS participants, we found 1,954 with a prescription for a BB, 3,642 with at least 1 script for an ACEi/ARB, 42 participants on ARNI, 280 with at least 1 script for an MRA, and 140 with at least 1 script for an SGLT2i. Average annual OOP costs for each GDMT drug class was: $41 (95%CI $34-$48) for BB, $29 (95%CI $26-$32) for ACEi/ARB, ARNi alone estimated at $192 (95%CI $111-$274), $32 (95%CI $25-$39) for MRA, and $151 (95%CI $110-$191) for SGLT2i. The average annual OOP cost for quadruple therapy in 2019 was $253, $292 for privately insured, $159 for those on public insurance, and $975 for the uninsured. Quadruple therapy with ARNI alone on average added ~$200 to the annual OOP cost. For triple therapies, a combination of MRA, BB, and ACEi/ARB was $282 less compared to a combination of BB, ARNI, and SGLT2i.

Conclusions:
The average annual OOP for GDMT was substantially mitigated by insurance coverage. Including estimates of GDMT cost and the protective role of health insurance coverage in the shared decision-making process might increase the proportion of heart failure patients initiated and maintained on GDMT.
Abstract 10960: The Thoracic Duct is Well-Visualized on 3D-BSSFP Imaging in Patients With Fontan Circulation and Its Size and Tortuosity Are Associated With Worse Outcomes
Authors: Castellanos Daniel A , Ahmad Sidra , St. Clair Nicole , Sleeper Lynn A , Lu Minmin , Schidlow David N , Rathod Rahul , Yin Suellen M , Esch Jesse , Annese David , Powell Andrew J , Quinonez Luis , Shaikh Raja , Ghelani Sunil J
Published: June 2023

Introduction:
Lymphatic complications are common in patients with Fontan circulation. 3D balanced steady-state free precession (3D-bSSFP) angiography by cardiovascular magnetic resonance (CMR) is widely adopted for cardiovascular anatomical assessment. We sought to determine the frequency of thoracic duct visualization using 3D bSSFP images and assess whether thoracic duct characteristics are markers of poor clinical outcomes.

Methods:
This was a retrospective, single-center study of patients with Fontan circulation who underwent CMR. Patients with repaired tetralogy of Fallot (rTOF) were included as a comparison. Thoracic duct characteristics included maximum diameter and a qualitative assessment of tortuosity (Figure). Clinical outcomes included protein-losing enteropathy (PLE), plastic bronchitis, listing for heart transplant, or death. A composite outcome was defined as presence of any of the above.

Results:
The study group was comprised of 189 Fontan patients and 36 rTOF patients (median age at CMR 16 years, IQR: 11-23 years). The thoracic duct diameter was larger (median 2.50 vs 1.95 mm, p<0.01) and more often well-visualized (65% vs 22%, p<0.01) in Fontan patients vs the rTOF group. The thoracic duct diameter was larger in Fontan patients with PLE (median 4.0 vs 2.5 mm, p=0.02) vs Fontan patients without PLE, and was more tortuous in Fontan patients with congestive heart failure (CHF) vs Fontan patients without CHF (moderate or greater tortuosity in 75% vs 28.5%, p=0.02). Larger thoracic duct diameter was associated with a lower ejection fraction (R= -0.24, p<0.01). The composite outcome was present in 6% of Fontan patients and was not associated with thoracic duct diameter (p=0.72) or tortuosity (p=0.09).

Conclusions:
The thoracic duct can be well visualized in 2/3 of patients with Fontan circulation on 3D-bSSFP images. Larger thoracic duct dimension and increased tortuosity are associated with co-morbidities experienced by Fontan patients.
Abstract 10977: Shared Decision-Making in Athletes Diagnosed With a Cardiovascular Condition: A Scoping Review
Authors: Corneil Heidi , Liblik Kiera , Varghese Sonu , Masotti Bruce , Moulson Nathaniel , McKinney Jimmy , Allan Katherine S , Johri Amer , Grubic Nicholas
Published: June 2023

Introduction:
Exercise restriction following the identification of a cardiovascular condition can profoundly impact the identity, career, and well-being of athletes. Shared decision-making (SDM) is emerging as the standard of care to guide recommendations for athletes at risk of cardiovascular events. This scoping review summarizes existing approaches, barriers, and facilitators to SDM in sports cardiology.

Methods:
A literature search of the MEDLINE, Embase, Cochrane Library, PubMed, CINAHL, SPORTDiscus, and PsycInfo databases was conducted in January 2022. Abstract screening and full-text review were completed in duplicate by independent reviewers. The PCC (Participants, Concepts, Context) framework was used to assess study eligibility. Included articles discussed the use of SDM (C/C) following the diagnosis of a cardiovascular condition in an athlete (P).

Results:
A total of 6,049 records were screened, of which 38 were included in this review. Article classifications included theoretical papers (31), such as editorials and guidelines, and research studies (7). Main findings of the research studies are shown in Table 1. All selected articles defined SDM as an open dialogue between the athlete, healthcare team, and other stakeholders (e.g., parents, coaches). The benefits and risks of management strategies, treatment options, and return-to-play were the focus of this dialogue. Common themes among SDM approaches emerged, such as emphasizing patient values, considering non-physical factors (e.g., emotional, psychological, financial), and informed consent. Barriers to SDM included pressure from institutions and liability of healthcare providers in the case of adverse events.

Conclusions:
SDM is the recommended paradigm for providing care to athletes diagnosed with cardiovascular conditions. Further education for healthcare providers regarding the SDM approach, as well as future research assessing SDM in a clinical setting, is needed.
Abstract 10982: A Novel Index of Coronary Artery Calcium Derived From Preoperative Non-Gated Chest Computed Tomography Correlates With Traditional Estimates of Perioperative Risk
Authors: Maidman Samuel D , Choi Daniel , Hayes Dena , Dhaduk Nehal , Donnino Robert , Smilowitz Nathaniel R
Published: June 2023

Introduction:
Cardiovascular events are feared complications of non-cardiac surgery. Prior studies demonstrate associations between coronary artery calcium (CAC) from ECG-gated computed tomography (CT) imaging and perioperative major adverse cardiac events. We sought to evaluate correlations between an index of CAC severity from preoperative non-gated CT imaging and traditional estimates of perioperative risk.

Methods
We identified consecutive adults age ≥45 years who underwent in-hospital, major non-cardiac surgery across a large urban health system between 2016 and 2020 and had non-gated (contrast or non-contrast) chest CT imaging performed within 1 year prior to surgery. Patients with prior coronary revascularization or heart valve surgery were excluded. CAC severity in each coronary artery was assessed and graded from absent to severe using a 0-3 scale by physicians blinded to clinical data. An index of CAC was computed as the sum of the scores for each coronary artery. The Revised Cardiac Risk Index (RCRI) was determined for each patient. Correlations between the CAC index and RCRI were assessed using Spearman Correlation Coefficient (𝜌;).

Results
A total of 2,560 patients met inclusion criteria - mean age 68.1 ± 12.3 years, 49.8% female, 60% white (Figure 1A). The median pre-operative RCRI score was 1 [IQR 0-1, range 0-6] (Figure 1B). A majority of patients (64.3%) had non-contrast chest CT imaging. The median CAC index was 1 [IQR 0-3, range 0-9] (Figure 1C). A correlation between the CAC index and RCRI (Coefficient (𝜌;): 0.209, p<0.001) was observed, with stepwise increases in the CAC index when stratified by pre-operative RCRI (Figure 1D).

Conclusions
A pragmatic, novel index of CAC derived from existing non-gated chest CT imaging correlates with pre-operative RCRI. As the RCRI is a validated preoperative risk stratification tool, this finding demonstrates the potential to leverage pre-existing, non-gated CT imaging to inform preoperative risk assessment.
Abstract 10985: Cardiopulmonary Assessment of COVID-19 Survivors Stratified by Acute Disease Severity and Post-Acute Symptoms
Authors: Szekely Yishay , Ghantous Ehab , SAdon Sapir , De Marzo Vincenzo , Clavario Piero , Porto Italo , Crisafulli Ernesto , Vannini Luca , Quijada-Fumero Alejandro , Laynez-Carnicero Ana , Cassar Mark Philip , Neubauer Stefan , Raman Betty , Banai Shmuel , Topilsky Yan
Published: June 2023

Introduction:
Studies have demonstrated a reduction in peak oxygen consumption (VO
2
) post-acute COVID-19. We sought to determine the association between acute COVID-19 severity, post-acute symptoms and peak VO
2
after recovery.

Methods:
This study analyzed data from patients who recovered from COVID-19 and underwent cardiopulmonary exercise testing (CPET) as part of prospective studies in 5 centers across UK and Europe. Patients were asked to report current symptoms. Peak VO
2
, lung volumes, gas exchange, ventilatory efficiency, heart rate and O
2
pulse were measured in a standard symptom-limited incremental cycle ergometer CPET.

Results:
Among 417 patients examined 136±63 days after recovery from COVID-19, 164 (39%) were female. Mean age was 56.9±13.3 years. The spectrum of acute COVID-19 severity included critical (N=47; 11.3%), severe (180; 43.2%), moderate (75; 18.0%) and mild (115; 27.5%) illness. The most common post-acute symptom was dyspnea (200; 48%), followed by muscle pain (173; 41%). Mean peak respiratory exchange ratio was 1.13±0.1, and did not vary across acute disease severity or post-acute symptom status. There was no significant difference in peak VO
2
as % from predicted in mild to critical acute disease: 84.0±2.1%, 91.4±2.6%, 82.9±1.7% and 83.7±3.2%, respectively (p=0.06). Patients with dyspnea or muscle pain had each lower peak VO
2
as % from predicted, compared to patients free of the specific symptom (81.3±21.2% vs. 88.1±22.9%, p=0.002 and 78.6±19.1% vs. 88.2±22.0%, p<0.0001, respectively). Both dyspnea and muscle pain were each associated with significantly lower peak heart rate and peak O
2
pulse, as well as lower lung volumes and gas exchange capacity, compared to patients free of the specific symptom.

Conclusions:
Common post-acute COVID-19 symptoms, and not acute disease severity, are associated with lower peak VO2 in CPET. Parameters related to both cardiac and pulmonary function seem to play a role in this reduced physical performance.
Abstract 10996: Clinical Characteristics and Outcomes of Infective Endocarditis Among Intravenous Drug Abusers - A Single-Center Experience
Authors: Almaghraby Abdallah , Abdelnabi Mahmoud , Abdelgawad Hoda , Azab Sahar , Ayman Abdel-Hay Mohmaed
Published: June 2023

Introduction:
There are limited data regarding intravenous drug abuse (IVDA) associated with infective endocarditis (IE). The study aimed to compare IVDA to non-IVDA-associated IE regarding the differences in clinical profile, microbiology, echocardiography, and clinical outcomes among patients admitted with IE.

Methods:
90 patients from January 2019 to December 2021 who met the Modified Duke ‘‘definitive’’ criteria for IE were included. Demographic, clinical, and laboratory data were collected. All patients underwent transthoracic echocardiography and transesophageal echocardiogram whenever indicated. In-hospital morbidity and mortality were reported.

Results:
Among the 90 patients included, 24 (26.7%) had a history of IVDA. IVDA-group were younger (27 vs 40 years, P<0.0001), males (95.8% vs 69.7%, P=0.01), and more likely to have concomitant HCV and HIV infections compared to non-IVDA-group (50% vs 3%, P<0.0001). Methicillin-resistant staphylococcus aureus (MRSA) percentage was higher in IVDA-group (54.2% vs 16.7%, P= 0.0004). Tricuspid value was the most common valve (79.2%) affected in IVDA-group whereas mitral followed by aortic valves were most commonly involved in non-IVDA-group (43.9% and 31.8% respectively). Embolic events at admission were more frequent in IVDA-group (83.3% vs 15.2%, P<0.0001). Septic shock and embolic events (58.3%, 37.5% consecutively) are the most common causes of in-hospital morbidity among IVDA-group. In-hospital mortality was significantly higher among IVDA-group compared to non-IVDA-group (58.3% vs 25.8%, P=0.04).

Conclusion:
The demographic, microbiological, and echocardiographic profile is quite different in IVDA and non-IVDA-group. Larger studies are required to confirm these data, especially in low- and middle-income countries.
Abstract 10997: Reduction in Dietary Saturated Fat Intake Lowers LDL-C but Increases Lp(a) Levels in African Americans: Findings From the GET-READI Randomized Controlled Crossover Feeding Trial
Authors: Byambaa Enkhmaa , Zhang Wei , Bang Heejung , Khan Muhammad , Khazaei Sina , Most Marlene M , Rood Jennifer , Lefevre Michael , Berglund Lars
Published: June 2023

Reduction in dietary saturated fatty acids (SFA) intake results in a significant clinically meaningful lowering of LDL-C across ethnicities. In contrast, the role of dietary SFA reduction in modulating emerging risk factors for cardiovascular disease (CVD) in different ethnic groups remains poorly understood. An elevated level of lipoprotein(a) [Lp(a)], an independent casual risk factor for CVD, disproportionally affects African Americans. In this study, we assessed the responses in Lp(a) to dietary SFA reduction specifically in African Americans (N=166) enrolled in GET-READI (The Gene-Environment Trial on Response in African Americans to Dietary Intervention), a randomized controlled feeding trial. Men and women with above optimal LDL-C were fed two diets in a random order for five weeks each: (1) the average American diet (AAD) (37% total fat: 16% SFA), and (2) a diet similar to the Dietary Approaches to Stop Hypertension (DASH) combination diet (25% total fat: 6% SFA). The mean age of participants was 33 years (range: 18-64 years), 70% were women, the mean BMI was 28.4 kg/m
2
and LDL-C was 116 mg/dL. At the end the 5-week intervention period with the DASH diet, compared with the end of the AAD diet, LDL-C was significantly reduced (mean change: -12.4 mg/dL,
p
<0.0001), as were the levels of total cholesterol (-16.6 mg/dL,
p
<0.0001), HDL-C (-5 mg/dL,
p
<0.0001), apoA-1 (-8.7 mg/dL,
p
<0.0001) and apoB-100 (-5.7 mg/dL,
p
<0.0001). In contrast, Lp(a) levels were significantly increased following the DASH diet compared to AAD (from a median value of 44 mg/dL with AAD to 58 mg/dL with DASH; mean change: +11.2 mg/dL,
p
<0.0001). As LDL-C measurements typically include Lp(a)-cholesterol, the “true” LDL-C decrease is estimated at -16 mg/dL, i.e., an underestimation by about 30%. In conclusion, in a large cohort of African Americans, an ethnic group with a high burden of elevated Lp(a), reductions in SFA intake significantly increased Lp(a) while reducing LDL-C. These findings suggest that dietary SFA reduction exerted an opposing effect on the circulating levels of two highly-atherogenic lipoproteins. Future studies are warranted to elucidate mechanism(s) underlying the SFA reduction-induced increase in Lp(a) and its role in CVD risk across population groups.
Abstract 11021: Chest Symptoms and Subsequent Risk of Incident Cardiovascular Disease: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Ejiri Kentaro , Mok Yejin , Ding Ning , Chang Patricia , Rosamond Wayne D , Shah Amil M , Lutsey Pamela L , Chen Lin Y , Blaha Michael J , Mathews Lena , Matsushita Kuni
Published: June 2023

Introduction:
The 2021 AHA/ACC Chest Pain Guideline classifies the likelihood of ischemia according to chest symptom characteristics. However, the associations of various chest symptoms with long-term risk of different cardiovascular disease (CVD) have not been fully investigated.

Aim:
To quantify the associations of chest pain and dyspnea with incident major CVD.

Methods:
In 13,200 ARIC participants (mean age 54 [SD 6] years, 56% female, 25% Blacks) without prior CVD at visit 1 (1987-89), we categorized chest pain into definite angina, possible angina, non-anginal chest pain, and no chest pain based on the WHO Rose questionnaire, and dyspnea into grade 0, 1, 2, and 3-4 based on the Medical Research Council scale. CVD outcomes included myocardial infarction (MI), heart failure (HF), atrial fibrillation (AF), and ischemic stroke (median follow-up, 26-28 years). We estimated 30-year cumulative incidence accounting for competing risk of deaths and ran multivariable Cox models.

Results:
Definite angina and possible angina were robustly associated with incident MI (Table), with adjusted HR 1.83 (95%CI 1.51-2.22) and 1.64 (1.26-2.13), respectively. These two chest pain types were also related to HF, AF, and ischemic stroke, although possible angina did not reach statistical significance for stroke. Even non-anginal chest pain was associated with MI, HF, and AF. Dyspnea showed graded association with all CVD outcomes, but particularly with MI and HF (bottom half of Table). For example, grade 3-4 and 2 showed HR of 2.13 (1.71-2.65) and 1.41 (1.13-1.76), respectively, for MI. When chest pain and dyspnea were modeled simultaneously, their associations were independent.

Conclusions:
In persons without prior CVD, chest pain and dyspnea were independently associated with different CVD events over 30 years. Our findings suggest broad prognostic implications of chest pain beyond coronary disease and emphasize the importance of recognizing dyspnea for CVD risk management.
Abstract 11044: Neither Peak Donor Troponin Nor Donor Troponin Trends Adversely Impact Post-Transplant Outcomes in Pediatric Heart Transplantation
Authors: Amdani Shahnawaz , Toll Alice , Noreen Samantha
Published: June 2023

Introduction:
Cardiac troponin is utilized in decision making when considering a suitable donor for heart transplant (HT). To date, no pediatric study has assessed the impact of peak donor troponin or donor troponin trends on post-HT survival.

Methods:
All children in the Organ Procurement and Transplantation Network database undergoing HT in the U.S. from 2007 - 2020 and with donor troponin I levels recorded were included. Donors were divided into groups based on peak troponin value:

Low

(0-<25%ile),

Medium

(25-<75%ile), and

High

(>75%ile); and on differences between first and last troponin:

Increasing
:

>20% increase,

Persistently high
:

initial and final troponin high;

Persistently
low
:

initial and final troponin normal;

Decreasing
:

>20% decrease. Donor characteristics were compared and effects of donor troponin on graft survival were evaluated both unadjusted and after multivariable adjustment using Cox proportional hazards model.

Results:
Of 5569 HT, troponin levels were available for 4572 (82%) recipients. Compared to donors with

Low

and

Medium

troponin values, donors with

High

troponin values were older (median age 3 vs. 7 vs. 13 years), male (59.2 vs. 59.5 vs. 64.7%), White (50.3 vs. 52.4 vs. 55.5%), died from anoxia (33.5 vs. 41.1 vs. 48.9%), with ejection fraction ≤55% (4.2 vs. 6.4 vs. 8.7%) and receive cardiopulmonary resuscitation [CPR] (44.3 vs. 53.7 vs. 63.3%) (p<.05 for all). Donors with

Increasing

and

Persistently high

troponin values were older, had lower ejection fraction and were more likely to receive CPR than those with

Persistently
low

and

Decreasing

troponin (p<.05 for all). Neither unadjusted
(Figures A, B)
, nor multivariable adjusted outcomes revealed any differences in graft survival post-HT based on peak troponin or troponin trends
(Figure C, Table A)

Conclusions:
Donor troponin values do not predict post-transplant survival in children undergoing HT. Our study will allow for safe expansion of donor heart utilization in pediatric HT.
Abstract 11057: Glycosylation Profile of Immunoglobulin G and Incident Cardiovascular Events: Secondary Analysis of Two Randomized Clinical Trials
Authors: Hoshi Rosangela , Plava Branimir , Liu Yanyan , Trbojevic-Akmacic Irena , Glynn Robert J , Ridker Paul , Cummings Richard , Lauc Gordan , Demler Olga , Mora Samia
Published: June 2023

Introduction:
Alterations in the glycosylation pattern of immunoglobulin G (IgG) play a key role in the transition from healthy to diseased tissue, and have been related to inflammation, immune function, and cardiovascular disease (CVD) risk factors.

Hypothesis:
We hypothesized that IgG glycosylation patterns are associated with the risk of developing CVD events.

Methods:
IgG glycosylation profiles were measured using ultra-performance liquid chromatography on baseline plasma samples from two nested CVD case-control studies within the JUPITER (NCT00239681; Npairs=162; discovery) and the TNT (Npairs=367, validation) randomized trials. In both cohorts, we used conditional logistic regression adjusted for age, sex, statin, race, LDLC, smoking, hypertension, BMI, HDLC, triglycerides, and
hs
-CRP to examine the association of 24 IgG glycan peaks (IgG-GPs) with incident CVD events. In the controls sample, we performed Spearman correlation between IgG-GPs and
hs
-CRP, a biomarker of inflammation.

Results:
After adjusting for CVD risk factors and correcting for multiple testing (overall FDR<.05), one agalactosylated fucosylated glycan (IgG-GP4) was positively associated with CVD risk (odds ratio [OR]=1.4, 95%CI= 1.1; 1.9), while three digalactosylated (IgG-GPs 12, 13, and 14), and one monosialylated glycan (IgG-GP 16) were negatively associated with CVD risk in JUPITER (OR ranging from 0.7 to 0.8, 95%CI=0.5; 1.0). The results replicated in TNT (Figure 1). IGG-GP4 positively correlated with
hs
-CRP, while an inverse non-significant correlation, was observed for IGG-GPs 12, 13, and 14 with hsCRP (Figure 1).

Conclusions:
Certain glycosylation traits were associated with risk of incident CVD independent of clinical risk factors and statin therapy. Specifically, one agalactosylated fucosylated glycan was positively associated with CVD risk, while digalactosylated and sialylated glycans were inversely associated with CVD risk in two independent cohorts.
Abstract 11063: Inequities in Modifiable Cardiovascular Risk Factors Among Women of Childbearing Age With Hypertension Using Life's Simple 7
Authors: Meyerovitz Claire , Cook Philip M , Juraschek Stephen , Ayturk Didem , PERSON Sharina , Moore Simas Tiffany , Lemon Stephenie , Kovell Lara
Published: June 2023

Introduction:
Cardiovascular disease (CVD) is the leading cause of maternal morbidity and mortality. The American Heart Association’s “Life’s Simple 7” (LS7) highlights seven modifiable factors for promoting cardiovascular health - managing blood pressure (BP), controlling cholesterol, reducing blood sugar, getting active, eating better, maintaining a healthy weight, and not smoking.

Hypothesis:
We hypothesized there would be racial differences in LS7 factors among women of childbearing age with hypertension (HTN).

Methods:
Using National Health and Nutrition Examination Surveys from 2001-18, we evaluated LS7 factors among women aged 20-50 years with HTN. HTN was defined as BP ≥140/90 mmHg or anti-hypertensive medication use. LS7 scores reflect one point per guideline met. DASH adherence was calculated from 24-hour dietary recalls, with one point per nine nutrient goals.

Results:
In 1293 women, the mean (SE) age was 36.4 (0.25) years. Black and Hispanic women with HTN were less likely than White women to have total cholesterol <200 mg/dL (39% and 38% vs 47%, both p <0.05), hemoglobin A1c <6.5% (83% and 84% vs 92%, both p <0.05), and BMI <25 (13% and 16% vs 25%, p <0.001 and p <0.05), while Asian women had higher DASH adherence than White women (16% vs 6.5%, p <0.05) (Table). The mean LS7 score was higher in Asian women (3.89 (0.09), p <0.05), lower in Black women (3.16 (0.05), p <0.05), and similar in Hispanic women (3.34 (0.05)) compared to White women (3.40 (0.06)).

Conclusions:
We found frequent comorbidities in women of childbearing age with HTN along with racial/ethnic differences in LS7 scores. Interventions to increase LS7 scores may promote health equity and reduce pregnancy-related complications.