bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17921: Diastolic Dysfunction Might Predict Outcomes in Acute Coronary Syndrome Patients Undergoing Primary Percutaneous Coronary Intervention
Authors: Upreti Prakash , Saad Muhammad , Pandey Neelanjana , Krim Nassim R , Vittorio Timothy
Published: December 2023

Introduction:
Acute coronary syndrome (ACS) leads to diastolic dysfunction which might cause unfavorable long-term clinical outcomes. We aim to evaluate the association between diastolic parameters in patients with an ACS and event rates including 30-day mortality and 6-month readmission rates.

Methodology:
We studied 1579 patients with ACS who underwent primary percutaneous coronary intervention (PCI) from January 1, 2010 through December 31, 2020. Clinical, laboratory, transthoracic echocardiographic (TTE) and coronary angiographic parameters were retrospectively reviewed. Diastolic parameters (E/A ratio, TR velocity, LVEF and LAVI) in patients with left anterior descending artery (LAD) PCI (n=879) were compared with those who underwent PCI to non-LAD artery (n=700). Percentage of 6-month all-cause readmission, cardiogenic shock as well as mortality rates were calculated in both cohorts.

Results:
The mean age of 1579 ACS patients was 65
+
12 years, BMI 29
+
5 kg/m
2
, peak high sensitivity troponin 624 ng/L, E/A ratio 1.065, TR velocity 3.2 m/s, LAVI 34.26 mL/m
2
and LVEF 50.1%. The percentage of hospital readmission within 6 months was higher in patients with diastolic dysfunction and LAD PCI compared to those with non-LAD PCI (19% versus 16%,
p
- value=0.004). Although patients with diastolic dysfunction and LAD PCI had higher percentage of cardiogenic shock compared to non-LAD PCI group (6.0% versus 3.7%,
p
-value<0.001), 1-year mortality did not differ between the 2 groups (
p
-value=0.84).

Conclusion:
Diastolic dysfunction is associated with worse clinical outcomes in patients undergoing LAD PCI which warrants a larger prospective clinical study.
Abstract 17938: Identifying the Prevalence of Coronary Artery Disease Among Patients With Non-Alcoholic Fatty Liver Disease in the Adult US Population
Authors: Pleshkova Yelena , Sawyer Alexia , Brands Chad , Patel Urvish , Barve Nishad , Kavarthapu Anusha , Desai Darshi , Desai Aditya , Shah Parth , siripuram chandu , Mehta Deep , Parvez Mohammad
Published: December 2023

Introduction/Background:
In the twenty-first century, new findings have helped unravel the outstanding significance of contributory roles of the different pathologies in the proper regulation of physiologic and metabolic homeostasis. NAFLD is presently considered one of the emerging gastroenterological pathologies in the world. In our research study, we describe the contributory potential of NAFLD to cardiovascular disease. We also examined the patterns of NAFLD and identified specific emerging subgroups to improve our understanding of intertwined mechanisms between NAFLD and the pathogenesis of systemic atherosclerotic diseases.

Aims and Objective:
The primary outcome of the study was to identify the prevalence of NAFLD. The secondary outcome was to evaluate the prevalence of CAD in people with NAFLD and to describe the association between these two processes.

Methods:
We performed a retrospective cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) database from 2015 to 2018. Adults with a secondary diagnosis of NAFLD were identified. Univariate analysis was performed using Mann Whitney U test and chi-square test. A multivariable logistic regression analysis was performed to describe the association between NAFLD and CAD.

Results:
Among a total of 275,968 people in this selected NHANES cohort, 0.26 were identified to have NAFLD. In the cohort, NAFLD was more prevalent in older (median: 62 years), males, Mexican Americans and Hispanics, and people with median household income >$100,000. People with NAFLD had an early onset of CAD (47 vs 60 years) with higher prevalence of CAD in NAFLD compared to the group without NAFLD (15.90% vs 4.64%). People with NAFLD had a significantly higher association of having CAD (prevalence odds: 9.78 [95% CI: 9.76-9.80]).

Conclusion:
In a select NHANES cohort, positive correlations were identified between groups with NAFLD and the early onset of CAD. Additional findings include positive correlations for ethnicity, social economic status, and gender. Prospective studies and long-term clinical follow-up will be required to further characterize specific populations with NAFLD in an attempt to mitigate the burden of CAD within the population of NAFLD patients.
Abstract 17939: Predictors of Time in Target Range in a Comprehensive Self-Measured Blood Pressure Program in a Socially and Economically Disadvantaged Primary Care Population
Authors: Shah Samir , Hartley Maria , Rodriguez Jordan , Cantu Martinez Omar , Chacin Suarez Audry , Behme Matthew , Copeland Joshua A
Published: December 2023

Introduction:
The Community Practice Center (CPC) in North Philadelphia serves a community with significant socioeconomic barriers leading to inability to access care necessary for management of hypertension (HTN). Prior studies have shown the efficacy of SMBP programs in improving blood pressure (BP) control.

Methods:
All sequential patients presenting to the CPC with stage 2 HTN were screened for eligibility. Upon enrollment, patients received a Bluetooth-enabled BP cuff connected to a mobile health app and HTN education. Patients completed validated social and behavioral assessments including social determinants of health (SD)H) assessment via WellRx screen, depression screening (PHQ-9), and self-efficacy screening (
Self-Efficacy to Manage Chronic Disease Scale
). A behavior change plan was created using Brief Problem Solving Therapy based on the aforementioned assessments. Staff continuously monitored usage, BP, and provided individualized interventions. We conducted a cross-sectional quality improvement study using daily BP data from June 2022 - April 2023 to assess the correlation between baseline sociodemographic characteristics and Time in Target Range (TTR) through multivariable linear regression. We calculated TTR, defined as the percentage of time with systolic BP within 100-130 mmHg, through linear interpolation.

Results:
A total of 133 patients were enrolled in the program. We analyzed data from 78 patients with ≥3 days of readings (average 33; SD 49) and complete baseline characteristics (Table 1). Female sex and non-smoking status were associated with TTR, while diabetes, positive depression screening, positive SDOH screening, and self-efficacy were not (Table 2).

Conclusions:
In a socioeconomically disadvantaged population participating in a comprehensive SMBP program, depression, SDOH, and self-efficacy screening at time of enrollment did not predict TTR. Participation in a SMBP program may be valuable in these populations.
Abstract 17943: Biomechanical Finite Element Analysis of Asymmetric Bicuspid Aortic Valve With Different Commissure Positionings for Repair
Authors: Park Matthew H , Zhu Yuanjia , Elde Stefan , Yajima Shin , Woo Y Joe J
Published: December 2023

Introduction:
While bicuspid aortic valves (BAVs) exist with a wide variety of phenotypes, type 1 valves that require surgery often present with varying levels of cusp fusion, raphe geometry, and commissure positioning angles. Regarding central coaptation angle, BAVs commonly present with asymmetry between fused and non-fused cusps, and surgical debate focuses on whether BAV repair should aim to minimize or accommodate for this asymmetry. We aimed to compare the hemostatic structural integrity of different commissure positionings for repair based on a BAV with an original 150° central angle.

Methods:
BAV models were designed based on literature of asymmetric valve geometry. The central angle of the pathological valve was 150°, which is common (Fig A). Two subsequent valve geometries were modeled to represent the repair conditions where commissure positioning forces result in central angles of 165° (Fig B) and 180° (Fig C). These models were matched with leaflet surface area and implemented with mechanical parameters of aortic leaflet tissues. Coaptation planes were modeled as encastre boundaries. A hemostatic pressure gradient was applied at 90 mmHg to mimic peak diastolic pressures, and Fusion360 was used for finite element simulations.

Results:
All three models showed maximum von Mises stresses in the belly regions of the fused leaflet (Fig A-C). Upon running the simulations, the 150° model showed maximum Von Mises stresses of 8103 Pa, the 165° model showed maximum stresses of 5405 Pa, and the 180° model showed stresses of 6116 Pa.

Conclusions:
By leveraging finite element models and computational biomechanics analyses, we were able to identify differences in BAV leaflet stresses based on alternate commissural positioning of an asymmetric BAV phenotype. Our finding suggests that peak diastolic leaflet forces may be minimized by focusing surgical BAV repair on a moderate reduction of leaflet asymmetry (i.e., 150° to 165°), without imposing perfect symmetry.
Abstract 17955: Cost-Effectiveness of a Shock Team Approach in Refractory Cardiogenic Shock
Authors: Taleb Joseph , Giannouchos Theodoros , Kyriakopoulos Christos , Clawson Antoine , Davis Erin , Sideris Konstantinos , Shah Kevin S , Tonna Joseph , Dranow Elizabeth , Jones Tara , Carter Spencer , Fang James C , Stehlik Josef , Ohsfeldt Robert , Selzman Craig , Hanff Thomas , Drakos Stavros G
Published: December 2023

Background:
Multidisciplinary Shock Teams have improved clinical outcomes for cardiogenic shock (CS), but their implementation costs have not been studied.

Objectives:
To compare costs between patients treated with and without a Shock Team and determine if the team's implementation is cost-effective compared to standard of care (SoC).

Methods:
We examined patients with refractory CS, treated with or without a Shock Team at a tertiary academic hospital from 2009-2018. Real-world hospital data was used to compare costs and outcomes, including survival at discharge, 1-year survival, and quality adjusted life years (QALYs) gained at 1 year. Incremental cost-effectiveness ratios (ICER) were calculated over a 1-year time horizon, with parameter uncertainty evaluated through probabilistic sensitivity analysis using (PSA) 1000 second-order Monte Carlo simulations.

Results:
The study involved 244 patients, with 123 treated by the Shock Team and 121 receiving SoC. Patients were predominantly male (77.5%), with a mean age of 58 years (18-92). The Shock Team approach improved survival rates at hospital discharge and 1-year follow-up (61.0% vs 47.9%; p=0.04 & 55.0% vs 40.5%; p=0.03, respectively). The ICER for increases in survival probability at discharge for the multidisciplinary Shock Team compared to SoC was $102,088. The ICER for increases in survival probability at 1-year was estimated at $96,152 and at $127,862 per one QALY gained. PSA estimates showed that the Shock Team was cost-effective in the majority of simulations using a willingness-to-pay threshold of $150,000, while it was also dominant in almost one-third of the simulations.

Conclusion:
The Shock Team approach for treating refractory CS may be a cost-effective alternative to traditional SoC. These findings can help prioritize the implementation of Shock Team initiatives to further improve cardiogenic shock outcomes.
Abstract 17956: In Hospital Outcomes of Patients With Acute Coronary Syndrome With Underlying Immune Thrombocytopenia Purpura
Authors: Lukan Abdulkareem , Gwira-Tamattey Edwin , Ahmad Muhammad , Ishfaq Hama , Alagbo Habib , Otulana Rukayat , Iddrisu Muftawu-Deen , Nduka Tagbo C , Barriga Guzman Rocio
Published: December 2023

Introduction:
Acute coronary syndrome (ACS) represents a significant health burden worldwide. Immune thrombocytopenia (ITP), a condition characterized by low platelet due to immune-mediated destruction, has been associated with increased bleeding risk and altered hemostatic balance. This abstract aims to summarize a research study investigating the in-hospital outcomes of patients diagnosed with both ACS and underlying ITP, shedding light on the unique challenges posed by this comorbidity

Methods:
We queried the National Inpatient Sample (NIS) database from 2016 to 2020. The NIS was searched for hospitalization of adult patients with Acute Coronary Syndrome as a principal diagnosis with and without ITP as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality .The secondary results were sepsis, acute kidney injury (AKI), Cardiogenic shock (CS), Cardiac arrest (CA), Total hospital charge (THC), pulmonary embolism (PE), and length of stay (LOS). Multivariate logistic and linear regression analysis were used accordingly to adjust for confounders.

Results:
About 1200515 patients were admitted for ACS, 0.19% (2225) had underlying ITP, Compared with those with ITP, there is statistically significant increase in LOS (8.85 vs 6.26, p<0.004, IRR=1.16,), THC (161275.7 vs 116208.7, p<0.003, IRR=31221.23,) and statistically significant decrease in cardiogenic shock (4.94% vs 5.94%,p<0.039, OR=0.62, 95%CI 0.4-0.98). But there were no statistical significance in Death (13.93% vs 9.8%, p<0.405, OR=1.13, 95%CI 0.84-1.51), sepsis (23.15% vs 18.0%, p<0.728, OR=0.96, 95%CI 0.75-1.22), AKI (35.5% vs 46.52%, p<0.395, OR=1.09, 95%CI 0.89-1.35), PE (2.7% vs 2.49%, p<0.448, OR=0.78, 95%CI 0.41-1.47), and All_CA (13.03% vs 9.87%, p<0.375, OR=1.29, 95%CI 0.73-2.3).

Conclusions:
These findings suggest that while ACS patients with underlying ITP may have certain differences in LOS, healthcare charges, and cardiogenic shock rates, they do not appear to be at significantly increased risk for mortality or other major complications. Additionally, the lower incidence of cardiogenic shock in the ITP group may indicate potential protective effects or differences in underlying pathophysiology, warranting further investigation
Abstract 17996: One-Year Outcomes of Patients With ST-Segment Elevation Myocardial Infarction According to Eosinophil Blood Count
Authors: Golino Michele , Corna Giuliana , Moroni Francesco , Talasaz Azita , West Josh , Thomas Georgia , Carbone Salvatore , MARKLEY ROSHANAK , Turlington Jeremy , Canada Justin M , Abbate Antonio , Van Tassel Benjamin
Published: December 2023

Background:
ST-segment elevation myocardial infarction (STEMI) elicits an intense inflammatory response but the relation between eosinophil blood count and outcomes in this setting is not clear.

Hypothesis:
A difference in eosinophil blood count in patients with STEMI is associated with a different incidence of death or hospitalization for heart failure (HF).

Methods:
In this retrospective study using the US cohort of 49 healthcare organizations in the TriNetX database, we included 41,945 patients with STEMI (identified by ICD-10-CM code) between January 1, 2012, and June 2, 2022. Patients were divided into two groups according to the median of eosinophil blood count measured 2-3 days after the acute event in our previous study (0.2x103/μL). The Kaplan-Meier method was used to compare the risks of the composite outcome of death or HF hospitalization within the two cohorts.

Results:
We included 15,725 and 26,220 patients with median eosinophil blood count equal/above and below 0.2x103/μL, respectively. At 1-year follow-up, the risk of death or HF hospitalization was lower in patients with eosinophil blood count above/equal to the median, 0.2x103/μL (13.6% vs 18.9%; Hazard Ratio 0.68, 95% CI [0.64-0.71]; p<0.001). The incidence of the composite outcome at 1 year was 15.3% and 21.5% for patients with median eosinophil blood count equal/above and below 0.2x103/μL, respectively (p<0.001 for the log-rank test). Figure 1. Secondary analysis suggested that this result was driven mainly by lower mortality in the cohort with higher eosinophil count (10.1% vs 14.9%; HR 0.63, 95% CI [0.59-0.67]; p<0.001).

Conclusions:
In our large 'real world' analysis, a higher eosinophil blood count within the normal range during the acute phase post-STEMI is associated with a better outcome of death or hospitalization for heart failure.
Abstract 18015: Cardiopulmonary Exercise Testing Parameters-Based Phenogroups of Patients With Heart Failure With Reduced Ejection Fraction Using an Unsupervised Machine Learning Algorithm
Authors: Chaikijurajai Thanat , Augusto Silvio N , Engelman Timothy , Van Iterson Erik H , Finet J. Emanuel , Tang Wai Hong W
Published: December 2023

Introduction:
Although cardiopulmonary exercise testing (CPET) is the standard test for functional capacity and risk stratification in patients with HFrEF, the integrative use of different CPET parameters for prognostication is warranted.

Hypothesis:
A differential prognostication of HFrEF phenogroups can be achieved by means of an unsupervised machine learning algorithm of CPET parameters.

Methods:
We reviewed medical records of 1,067 patients with HFrEF (EF ≤ 40%) undergoing CPET from 12/2012 to 9/2020. Patients with hypotensive or bradycardic response during exercise were excluded. Unsupervised machine learning using partition around medoids (PAM) algorithm was used to create clusters based on CPET parameters. Primary outcome was LVAD/heart transplant-free survival. Kaplan-Meier plots along with log-rank test and multivariable Cox regression analysis with adjustment for co-morbidities, age, smoking, and LVEF were used to compare prognosis across clusters.

Results:
Among 935 patients with HFrEF included in the algorithm (mean age 56±12 years, EF 24±8%, 73% men, and 73% with RER > 1.05), 329 (35 %) patients had adverse events (median follow up time 964 days). Using the PAM algorithm, we created 3 clusters using CPET parameters. Median (IQR) of age (53 [43-62], 58 [50-64] and 61 [54-68] years for cluster 1,2, and 3, respectively) and LVEF (30 [22-25], 25 [19-30] and 21 [16-26] % for cluster 1,2, and 3, respectively) were significantly different (
P
<0.001). No differences in sex of BMI were observed. Co-morbidities burden was higher in cluster 2 and 3, compared to cluster 1 (
Figure 1A)
. Compared to cluster 1, cluster 2 and 3 had worse LVAD/heart transplant-free survival (adjusted HR 2.15 [95% CI 1.46-3.17] and 5.68 [95% CI 3.89-8.30], respectively;
Figure 1B
).

Conclusions:
Patients with HFrEF could be risk-stratified into low-, medium- and high-risk using PAM algorithm solely based on CPET parameters that tracked with increasing comorbidity burden.
Abstract 18017: Sex Based Disparities in Cardiac Arrest Related Outcomes: The National Inpatient Sample Analysis
Authors: Schulze Goni Thatiana , Taha Amro , Dabbara Sagar , Atti Lalitsiri , Duhan Sanchit , Khir Fadi , Ali Shafaqat , Victor Varun , Hussein Mohammed H , Hussein Sami , Almas Talal , Ali Shehzad , Alraies M Chadi C
Published: December 2023

Introduction:
Despite the lower incidence of cardiac arrest in women, their rates of survival to hospital discharge are poorer compared to men. To further examine this disparity in outcomes following cardiac arrest, we assessed the differences in outcomes among patients hospitalized after successful resuscitation. We utilized data from the National Inpatient Sample Database (NIS) for this evaluation.

Methods:
We conducted a query of the NIS spanning the years 2015 to 2019 to identify patients who experienced cardiac arrest. Subsequently, we categorized the sample based on gender. The primary outcome measured was in-hospital mortality. To calculate the adjusted odds ratios (aOR) of in-hospital outcomes, we employed multi-logistic regression analysis using STATA v.17.

Results:
Among the 874,745 weighted hospitalizations related to cardiac arrest, 56.91% were men and 43.09% were women. After adjusting for confounding factors, we observed that women who were successfully resuscitated from cardiac arrest had significantly higher rates of adverse outcomes compared to men. These outcomes included in-hospital mortality (aOR 1.092, 95% CI 1.07-1.10, p<0.001), stroke (aOR 1.19, 95% CI 1.14-1.24, p<0.001), pericardial effusion (aOR 1.14, 95% CI 1.09-1.18, p<0.001), and pacemaker placement (aOR 1.20, 95% CI 1.15-1.25, p<0.001). However, major bleeding occurred less frequently in women (aOR 0.93, 95% CI 0.90-0.96, p<0.001). Although the total cost of hospitalization was higher for men ($172,021 ± 267,161 vs $149,718 ± 241,244), the length of stay was similar for both groups.

Conclusions:
Our study highlights significant gender-based disparities in post-cardiac arrest patients, with women experiencing poorer overall outcomes. Future qualitative studies should focus on identifying risk factors and improving post-resuscitation care specifically for women, with the aim of reducing gender-based differences in clinical outcomes.
Abstract 18019: Gender Differences Among Elderly Patients Hospitalized With Acute Coronary Syndrome in the United States Between 2011-2019
Authors: Lecompte Paola A , Mijares-Rojas Ivan , Kaur Sukhpreet , Dangl Michael , Grant Jelani , Sancassani Rhea , Colombo Rosario
Published: December 2023

Introduction:
Acute coronary syndrome (ACS) is one of the main causes of morbidity and mortality in the elderly. Women in general are less likely to be referred for coronary catheterization, percutaneous coronary intervention, and fibrinolysis.

Hypothesis:
We tested the hypothesis that elderly females were less likely to undergo catheterization and revascularization for ACS as compared to elderly men.

Methods:
We identified hospitalizations for patients aged 75 years old or older admitted with a primary admitting diagnosis of NSTEMI or STEMI between 2016 and 2019 using the National Inpatient Sample Database. Baseline characteristics, in-hospital complications, mortality, and length of stay were compared between male and female patients. A p-value <0.001 was considered significant.

Results:
We identified a total of 776,485 hospitalizations. See Table 1 for baseline characteristics and in-hospital outcomes. Male patients exhibited a higher prevalence of comorbidities. Furthermore, female patients were more prone to conditions such as hypertension, obesity, dementia, and stroke. In terms of in-hospital complications, male patients had the highest percentage of all complications. Male patients had a statistically significantly higher number of interventions compared to females, including cardiac catheterization (59.7 vs 51.4, p <0.001), percutaneous coronary intervention (39.7 vs 32.8, p <0.001), and CABG (0.8 vs 0.4, p <0.001). Male patients also had the highest length of stay compared to females (4.9 vs 4.6 days, p <0.001). Alternatively, Females were found to have the highest mortality compared to males (7.8 vs 7.5, p <0.001).

Conclusions:
Our results on ACS outcomes in elderly females are consistent with literature demonstrating that females are less likely to undergo catheterization or revascularization and have higher mortality. More research is needed to address these gender disparities.
Abstract 18030: Periprocedural Outcomes of Percutaneous Coronary Interventions in Patients Admitted for Acute Myocardial Infarction and Concomitant COVID-19 Pneumonia: Insight From the National Inpatient Sample
Authors: Vardar Ufuk , Gajjar Rohan , AZIZ IMRAN , Battikh Naim , Jamshed Aneeza , Shrestha Prajwal , Shoura Sami J. , Vij Aviral
Published: December 2023

Background:
Percutaneous coronary intervention (PCI) with drug-eluting stent (DES) placement for acute myocardial infarction (MI) is considered standard of care where a culprit lesion is identified. Coronavirus disease - 19 (COVID-19) pneumonia has been associated with a prothrombotic state, however its effects on periprocedural outcomes after PCI are unclear. We analyzed the peri-procedural outcomes in these patients who had concomitant COVID-19 pneumonia in the same hospitalization. Methods: A retrospective cohort study was conducted using the National Inpatient Sample from 2020. 300,840 hospitalizations were identified who underwent PCI and DES for acute MI. These were further stratified based on the presence of COVID-19 using ICD-10 codes. Multivariate regression analysis was used to adjust for confounders and analyze the variables. Results: Out of the 300,840 hospitalized patients who underwent PCI for acute MI, 3260 (1.1%) had COVID-19 pneumonia. In-hospital mortality was significantly higher in those with COVID-19 pneumonia (19.1% vs 3.4%; p<0.001). Mean length of stay (LOS) and mean hospital charges (HC) were higher in the presence of COVID-19 (7.83 vs 3.81 days, p<0.001 & $188,533 vs $129,570, p<0.001, respectively). Patients with COVID-19 pneumonia had higher rates of GI bleed (1.53% vs 0.07%, p=0.01), postoperative bleeds (7.0% vs 3.9%, p< 0.001), intracranial hemorrhage (ICH) (0.77% vs 0.12%, p<0.001), cardiac arrest (9.3% vs 3.7%, p<0.001) and cardiogenic shock (12.5% vs 7.3%, p<0.001). Conclusions: Patients who underwent PCI for acute MI and had COVID-19 pneumonia in the same hospitalization had significantly worse outcomes such as mortality, cardiogenic shock, cardiac arrest, postoperative bleeds, intracranial hemorrhage. While severity of COVID pneumonia likely accounts for these worse outcomes, the higher incidence of bleeding (GI, post procedure and intracranial) is concerning and needs further studies to evaluate further.
Abstract 18043: Massive Right Coronary Artery Aneurysm With a Massive Thrombus Presenting as ST Elevation Myocardial Infarction
Authors: Shabbir Muhammad Asim , Ehtesham Moiz , Sharma Tushar , Nickol Jennifer , Malik Shahbaz
Published: December 2023

Introduction:
Coronary artery aneurysm (CAA) is a vessel dilation exceeding 1.5 times adjacent normal segments. We present a case of massive right coronary artery (RCA) aneurysm complicated by ST elevation (STE) myocardial infarction.

Case Summary:
An 87-year-old female with no significant medical history presented with chest pain. Vitals signs and physical exam were normal. A 12 lead EKG demonstrated STE in inferior leads. Coronary angiography revealed a large aneurysm of the RCA throughout its course (max diameter 20 mm) with TIMI I flow. In the mid RCA, there was a long filling defect with irregular borders consistent with a congealed, organized layered thrombus causing 90% stenosis. Percutaneous coronary intervention (PCI) was not pursued due severe aneurysmal dilation and risk for embolization. The proximal to mid left anterior descending artery (LAD) and abdominal aorta were also aneurysmal. The patient was deemed not to be a surgical candidate after a heart team discussion (STS risk of morbidity or mortality = 12.6%). Left ventricular ejection fraction was 60%. Chest pain resolved and patient was discharged on indefinite anticoagulation and antiplatelet therapy.

Discussion:
Giant CAAs are rare, with an incidence of 0.02%. Causes include atherosclerosis, Takayasu arteritis, Kawasaki disease, or congenital defects. Although mostly incidental, CAA can be complicated by thrombosis, embolization, fistulation, rupture, arrhythmia, or sudden death. Our patient had an acute RCA thrombus due to stasis and turbulent blood flow in the aneurysm. Localized CAA are treated with surgery or percutaneous coiling or stenting. However, PCI was not feasible in our patient due to risk of embolization and difficultly with stent apposition in the setting of a diffuse, giant-sized aneurysm.

Conclusion:
CAAs are rare but may cause grave complications. A heart team discussion is essential to guide appropriate medical, percutaneous, or surgical treatment based on vessel anatomy.
Abstract 18054: Contemporary In-Hospital Outcomes of Congestive Heart Failure With Multiple Myeloma; a Regression Matched Analysis
Authors: Taha Amro , Badu Irisha , Victor Varun , Atti Lalitsiri , Duhan Sanchit , Khir Fadi , Schulze Goni Thatiana , Ali Shafaqat , Boshkovska Spaseski Maja , Almas Talal , Ali Shehzad , Alraies M Chadi C
Published: December 2023

Introduction:
Multiple myeloma (MM) is a disease commonly found in elderly individuals and is associated with a high burden of cardiovascular comorbidity. Various disease manifestations in MM, including amyloidosis, anemia, hyperviscosity, hypercalcemia, intramedullary arteriovenous fistula formations, and chemotherapy-related complications, contribute to an increased risk of congestive heart failure (CHF). The objective of this study was to examine the clinical outcomes of MM patients admitted with CHF.

Methods:
The National Inpatient Sample database from 2016-2020 was queried to identify patients with a primary diagnosis of CHF and stratified based on the presence of MM. The primary outcome measured was in- hospital mortality. The adjusted odds ratio (aOR) of in-hospital outcomes were calculated using software STAT v.17.

Results:
Of the 536,700 primary hospitalizations with CHF, 1,965 (0.36%) had MM. On adjusted analysis, the CHF-MM cohort had a higher odds of cardiac arrest (aOR 2.5, 95% CI 1.2-5.5), need for new hemodialysis (aOR 2.4, 95% CI 1.6-3.6) and GI bleeding (aOR 2.1, 95% CI 1.1-3.8) However, there was no statistically significant difference in the odds of in-hospital mortality, stroke, AMI or major bleeding. Furthermore, the presence of MM in CHF related hospitalizations was not associated with higher length of stay and adjusted total cost.

Conclusion:
Our study reveals that MM patients admitted with CHF have an increased risk of cardiac arrest, new hemodialysis, and GI bleeding. To optimize cardiovascular outcomes in this high-risk patient population, a multidisciplinary approach involving hemato-oncologists and cardiologists is necessary.
Abstract 18068: Isometric Handgrip Exercise Myocardial Perfusion Reserve Correlates With Coronary Microvascular Dysfunction and Abnormal Left Ventricular Strain: A Report From the Women’s Ischemia Syndrome Evaluation Pre-Heart Failure With Preserved Ejection Fraction Study
Authors: Muhyieddeen Amer , Nelson Michael , Lauzon Marie , Kwan Alan C , Sharif Behzad , Berman Daniel , Li Debiao , Handberg Eileen M , Pepine Carl , Bairey Merz C Noel N , Wei Janet
Published: December 2023

Background:
Impaired coronary artery response to isometric handgrip exercise (IHE) has previously been demonstrated to reflect endothelial dysfunction, an important contributor to ischemia with no obstructive coronary arteries (INOCA) and coronary microvascular dysfunction (CMD). Stress perfusion cardiac magnetic resonance (CMR) imaging is typically performed with pharmacologic stress using myocardial perfusion reserve index (MPRI) as a measure of CMD. IHE-MPRI has not been comprehensively studied in patients with INOCA, who are at risk for heart failure with preserved ejection fraction (HFpEF).

Hypothesis:
IHE-MPRI is related to CMD measured by pharm-MPRI and left ventricular (LV) structural and functional abnormalities in INOCA patients at risk for HFpEF.

Methods:
Participants with INOCA underwent comprehensive CMR with first-pass perfusion with adenosine or regadenoson, rest, and IHE. MPRI was adjusted to rest rate-pressure product (RPP). Lack of a satisfactory IHE response (defined as increase in heart rate≥10 bpm or systolic blood pressure ≥10 mmHg) was excluded. CMR measures of LV structure, function, MPRI, T1 and T2 mapping were analyzed using commercial software, blinded to clinical data. Pearson correlations were performed.

Results:
Of the participants (n=44) with IHE-MPRI, mean age was 55±11 years, body mass index 27±7 kg/m
2
, and 98% female, 31% hypertension, 12.5% diabetes, 19% hyperlipidemia. IHE-MPRI adjusted for rest RPP significantly correlated positively with pharm-MPRI and inversely with time to peak strain, diastolic strain measures and myocardial T2 (
Figure
). IHE-MPRI was not related to resting or IHE heart rate, systolic strain, LV mass, volumes, mass-volume ratio, native T1 or extracellular volume.

Conclusion:
IHE-MPRI relates to CMD and LV strain among patients with INOCA. Measurement of IHE-MPRI may improve understanding of CMD and LV structural and functional abnormalities that may contribute to development of HFpEF.
Abstract 18072: Multiple Sclerosis and Covid-19-Related Myocarditis: A Brain and Heart Affectation
Authors: VAELI ZADEH ALI , Redondo Andres , Criado Carrero Ricardo , Dixon Britony , Marcano Claudia , Hsu Vincent , Collado Elias , Larned Joshua
Published: December 2023

Introduction:
Myocarditis (MC) and multiple sclerosis (MS) are inflammatory affectations of the myocardium and the central nervous system, respectively. It has been suggested that MS and MC share similar immunological dysfunctions. MS and MC also have associations with viral infection, and SARS-CoV-2 specifically has been associated with MC, indicating that a viral infection may induce or enhance a dysfunctional immune response favored by individuals' genetic susceptibility.

Hypothesis:
We hypothesized that patients with preexisting MS may be more susceptible to COVID-19-related MC.

Methods:
A retrospective study was conducted using the PearlDiver database (PearlDiver Technologies, Fort Wayne, IN). Using ICD codes, a cohort of patients admitted for COVID-19 as the primary diagnosis (index event) was identified. The cohort then was divided into two groups based on the presence of MS upon admission. The records of both groups were compared by demographics and a panel of 16 comorbidities. Pearson's chi-square and t-test were used to compare the group's characteristics when appropriate. A Kaplan-Meier analysis was then used to compare the probability of the outcome (MC) 90 days following the index event. A p-value of <0.05 was considered significant.

Results:
We found a total of 2,782,278 patients admitted for COVID-19, with 24,515 (0.88%) having a history of MS. Patients with MS were younger (mean age 58 vs. 60, p<0.0001), predominantly female (73%), and had more comorbidities (Elixhauser Comorbidity Index 8.8 vs. 6.3, p<0.0001). A history of hypertension, heart failure, obesity, cerebrovascular accident, drug abuse, smoking, asthma, cancer, diabetes, MC, and MI were significantly more prevalent in the MS group. No differences in rheumatoid arthritis, CKD, and HIV were identified. COVID-19 patients with pre-existing MS were significantly at higher risk of MC, 90 days after admission (Log-Rank p=0.04).

Conclusions:
Despite its striking analogies to MS, the precise mechanism by which SARS-CoV-2 induces MC is unknown. Our findings highlight the likelihood that SARS-CoV-2 can induce myocardial inflammation in patients with a dysfunctional immune response. Moreover, MS patients were more exposed to established cardiovascular disease risk factors.
Abstract 18079: Forecasting Inpatient Cardiology Consultation and Transthoracic Echocardiogram Volumes
Authors: Wang Catherine , Tattersall Matthew C , Bavafa Hessam , Batt Bob , Kalscheur Matthew M
Published: December 2023

Introduction:
The demand for inpatient cardiology consultation and transthoracic echocardiography (TTE) places a significant strain on hospital resources. There is limited understanding of the frequency and predictors of cardiology consultations and TTE in a real-world inpatient setting which hinders efforts to optimize staffing and workload expectations. Forecasting methods may shed light on these critical aspects of healthcare delivery.

Hypothesis:
Forecasting methods may predict the daily volumes of inpatient cardiology consultations and TTEs in an academic medical center.

Methods:
Our study examines the daily consultation and TTE ordering patterns using a dataset of over 26000 adult patients admitted to a teaching hospital in 2019 under “observation” or “inpatient” status. Using individual patient characteristics and clinical data, we sought to forecast the probability of a cardiology consult or TTE being ordered at the patient level and then aggregated these probabilities to predict daily volumes. The dataset was partitioned into a training cohort (80%) and a testing cohort (20%). Models tested included logistic regression, random forest, support vector machine, neural networks, gradient boosting machines, and hybrid models. Model performance was assessed using mean absolute error (MAE).

Results:
In 2019, the average daily cardiology consult and TTE volumes were 2.8 (SD = 1.5) and 13 (SD = 4.5), respectively, in the hospital studied. No strong seasonal pattern was observed in the consultation and TTE orders. Utilizing individual-level forecasting followed by aggregation at a daily level resulted in reasonable daily estimates. Preliminary results indicate that the best-performing machine learning-based models for individual predictions yield MAE values ranging from 1.06 to 1.19 for consultations and from 3.18 to 3.62 for TTEs. These findings suggest that, on average, the predictions deviate by approximately 1 unit in absolute value for consultations and around 3 units in absolute value for TTEs from the true values.

Conclusion:
Our findings suggest the feasibility of utilizing machine learning models for individual predictions to forecast and facilitate planning for hospital inpatient cardiology consultations and TTE volumes.
Abstract 18084: Coagulopathy and Hospital Outcome in Patients With Covid-19: An Insight From National Inpatient Sample
Authors: Al Ahmad Majd , Alhuneafat Laith , Al-Ahmad Anas , Hamza Mohammad , Satyavolu Bharadwaj , Waqar Hafiza Hareem , jabri ahmad , Al-Abdouh Ahmad
Published: December 2023

Introduction:
SARS-CoV-2 infection has been linked to thrombosis and bleeding. In this study we aim to investigate coagulopathy rates, predictors and in-hospital outcomes in a nationally representative sample of COVID-19 patients.

Methods:
Using the 2020 National Inpatient Sample. We identified adult patients who were admitted with a principal diagnosis of COVID-19. Mortality difference, LOS, and COC were evaluated as indicators of healthcare resource usage. Regression analysis adjusted for baseline variables and comorbidities compared individuals who developed coagulopathy to those who did not. Logistic regression analysis was used to identify COVID-19 coagulopathy facrtors. p-value <0.05 indicated statistical significance.

Results:
Among 1,050,045 COVID-19 admissions, 12% (126,225 patients) developed coagulopathy. Those with coagulopathy group had higher rates of in-hospital mortality (aOR 1.31, CI 1.23-1.39, p <0.001), prolonged LOS (aMD 2.29 days, 95% CI 2.12-2.46, p<0.001), and increased COC (aMD 142615$, 95% CI 32905-41299, p<0.001) compared to those that did not develop coagulopathy. Factors associated with coagulopathy included male gender, black race, higher Charleston comorbidity index, and lowest income quartile

Conclusion:
Approximately 12% of patients developed coagulopathy, which was associated with increased in-hospital mortality, longer length of stay, and higher cost of care. These findings emphasize the importance of identifying and managing coagulation disorders in COVID-19 patients to improve outcomes and allocate healthcare resources effectively. Further research is needed to explore interventions and strategies for mitigating the impact of coagulopathy in this population
Abstract 18093: History of Stroke as a Predictor of High Left Atrial Fibrosis in Patients With Persistent Atrial Fibrillation
Authors: El Hajjar Abdel Hadi , Dagher Lilas , Mekhael Mario , Noujaim Charbel , Chouman Nour , Younes Hadi , Assaf Ala' , huang chao , Marrouche Nassir
Published: December 2023

Introduction:
The relationship between left atrial (LA) remodeling and ischemic stroke (IS) risk in patients with atrial fibrillation (AF) is well-established. The DECAAF II trial is the largest MRI-based, multicenter, randomized study conducted on persistent AF patients.

Hypothesis:
Our research investigates whether a history of stroke correlates with the extent of atrial fibrosis, as determined by late gadolinium enhancement magnetic resonance imaging (LGE-MRI), among the DECAAF II trial population.

Methods:
Patients with persistent AF who underwent LGE-MRI were enrolled and categorized into two cohorts: those with a history of stroke and those without. Covariates were adjusted using propensity score matching, and atrial fibrosis was compared between groups. Participants were then subdivided according to three baseline atrial fibrosis cut-off values: ≥ 15%, ≥ 20%, ≥ 25%. Univariate logistic regression and adjusted multivariate analyses were applied to evaluate the impact of clinical characteristics and risk factors on baseline fibrosis.

Results:
From the 843 patients involved in the DECAAF II trial, 70 (8.3%) had a stroke history. Those with stroke history had higher rates of hypertension, diabetes, and hyperlipidemia. Seventy patients without a stroke history were matched to stroke patients using propensity score analysis, revealing a significantly higher fibrosis in the stroke group (20.2% vs. 8.1%, p = 0.017). Increasing age significantly predicted all three baseline fibrosis categories (≥15%, ≥20%, ≥25%). Notably, stroke history was as a predictor of baseline fibrosis ≥25%, even after adjusting for other risk factors and clinical characteristics (OR = 1.98 [1.14-3.43], p = 0.01).

Conclusions:
There is a significant correlation between high left atrial fibrosis level and an increased risk of ischemic stroke in patients with persistent atrial fibrillation. This suggests that atrial fibrosis may provide insights into stroke risk classification.
Abstract 18094: Supersaturated Oxygen Therapy Benefits Late Presenters With Anterior ST-Segment Elevation Myocardial Infarction
Authors: Traverse Jay H , Burke M Nicholas , Sandoval Yader , Wang Yale , Chavez Ivan , Brilakis Emmanouil S , Cavalcante Joao
Published: December 2023

Introduction:
Patients with late-presentation ST-Segment Elevation Myocardial Infarction (STEMI) are at increased risk of mortality and development of heart failure and have limited therapeutic options besides percutaneous coronary intervention (PCI).

Hypothesis:
Intracoronary supersaturated oxygen therapy (SSO2) (Zoll / Therox) is approved as an adjunctive therapy to PCI in STEMI patients and may reduce infarct size in patients with less than 6 hours of ischemia. However, in pre-clinical studies, the delivery of SSO2 reduces infarct size even when delivered 24 hours following coronary occlusion. We hypothesized that late-presenting anterior STEMI patients may benefit from SSO2 therapy following PCI.

Methods:
We studied 12 patients (7M, 5F; 60 ± 9 years) with ongoing anterior STEMIs and prolonged ischemic times (12.2 ± 7.6 hrs). Ten of the 12 patients had an occluded LAD on presentation with TIMI 0 flow and 11 patients had anterior q-waves in at least 2 consecutive leads on the presenting EKG. All patients underwent successful PCI of the LAD with DES followed by 60 minutes of SSO2 therapy delivered through a catheter placed in the left main coronary artery. Cardiac MRI measurement of LV function and infarct size was performed in all patients 1 to 3 days later.

Results:
Mean infarct size was 32 ± 10 % of LV mass. Baseline left-ventricular ejection fraction (LVEF) measured within 24 hours of PCI was 37.8 ± 10.0 %. LVEF improved to 50.2 ± 11.2 % on follow-up imaging performed at a mean of 2 months following PCI (p < 0.01). To date, all patients remain alive and no patients have been admitted for heart failure. One patient underwent LVAD placement during his baseline hospitalization for persistent cardiac shock and another patient underwent bypass surgery 7 months later after having developed in-stent restenosis and progressive CAD.

Conclusions:
SSO2 therapy can be safely performed in high-risk STEMI patients with prolonged ischemic times who undergo successful PCI and is associated with a significant recovery of LV function when measured several months later.
Abstract 18097: The Burden of Ischemic Heart Disease in North Africa and Middle East Region From 1990-2019: Results From the GBD Study
Authors: Aminorroaya Arya , Saeedi Moghaddam Sahar , Tavolinejad Hamed , Aryan Zahra , Heidari Behnam , Ebrahimi Hedyeh , Naderian Mohammadreza , Shobeiri Parnian , Ghanbari Ali , Rezaei Nazila , Malekpour Mohammad-Reza , Haghshenas Rosa , Rezaei Negar , Larijani Bagher , Farzadfar Farshad
Published: December 2023

BACKGROUND:
Despite the substantial burden of IHD in North Africa and Middle East (NAME) region, temporal trends of the burden of IHD were not systematically evaluated in this region and its countries previously.

Methods:
We reported deaths, premature mortality, YLLs, YLDs, and DALYs of IHD in NAME region and its 21 countries during 1990-2019 using the results of the Global Burden of Disease Study 2019. Premature IHD mortality was defined as IHD death in males <55 and females <65 years of age.

Results:
IHD accounted for 0.8 million deaths and 18 million DALYs in NAME in 2019. From 1990-2019, the age-standardized death rate of IHD significantly decreased by 29% (-37 to -22) and reached 219 (194 to 247) per 100,000 in NAME in 2019 (Fig A) compared with the global estimates of -31% (-35 to -27) and 118 (108 to 126), respectively. From 1990-2019, the age-standardized DALY rate of IHD significantly decreased by 33% (95% CI: -41 to -25) and reached 4159 (3651 to 4752) per 100,000 population in NAME in 2019 (Fig B) compared with the global estimates of -29% (-33 to -24) and 2243 (2099 to 2385), respectively. The reduction in age-standardized DALY was mostly derived from the reduction in YLL (-34%) rather than YLD (-4%) compared with worldwide estimates of -29% and -6%. While the decreasing pattern in the age-standardized DALY and death rate of IHD was consistently observed across all 21 NAME countries, it was not statistically significant for Egypt, Libya, Saudi Arabia, Syria, Tunisia, and Yemen (Fig C, D). In 2019, 27% of IHD deaths in females and 18% of IHD deaths in males were premature in NAME, which was higher than the worldwide estimates of 17% and 15%, respectively. Turkey, Iran, and Lebanon showed the greatest reduction in IHD premature mortality during 1990-2019.

CONCLUSIONS:
Despite the improvements, IHD still remains the leading cause of lost death and DALYs in NAME. People are more likely to die prematurely due to IHD with more pronounced sex disparities in NAME compared with the global average.
Abstract 18102: Impact of Regional Cardiac Wall Motion Abnormalities on Ejection Fraction and Mortality: Large Data Enabled by Natural Language Processing
Authors: Rogers Albert J , Bhatia Neal K , Tooley James , Thakkar Vyom , XU JUSTIN , Ansari Rayan , Torres Jessica , Tung Jagteshwar , Alhusseini Mahmood , Clopton Paul L , Sameni Reza , Clifford Gari , Ashley Euan A , Perez Marco V , Zaharia Matei , Narayan Sanjiv M
Published: December 2023

Background:
Cardiac wall motion abnormalities (WMA) independently predict mortality and other adverse events beyond ejection fraction. The impact on mortality and ejection fraction has not been studied in large cohorts with long term follow up.

Aim:
We aimed to describe the relationship of specific regional cardiac WMAs with ejection fraction and mortality in a large referral academic center.

Methods:
We collected echocardiograms, demographics, and follow-up data from 35,210 patients from Stanford University. Specific regional abnormalities were determined by natural language processing (NLP) of clinical reports. WMAs were stratified across 5 anatomic regions and compared. Ejection fraction effect were compared by the Mann-Whitney U test and visualized with violin plots. Mortality between regions was assessed with Cox proportional hazards model and visualized with Kaplan-Meier plot.

Results:
In the Stanford University cohort, (62.9±16.9 years, 47% female, 58% white), regional WMAs were associated variable reductions in EF with apical, anterior, and septal WMAs resulting in an EF 41.6-42.8 +/- 12.8%, which was greater than lateral (45.4 +/- 10.2%) and inferior/posterior (46.3 +/- 12.1) (p< .01 for all comparisons). Distributions for inferior/posterior and lateral were more left-skewed and apex/septal were more bimodal (
Panel A
). In follow-up, having at least one WMA increased the risk of overall mortality with a hazard ratio of 1.8 (CI: 1.61-2.00) over a > 4 year period (
Panel B
).

Conclusion:
In a very large population of echocardiograms performed in an academic referral center, wall motion abnormalities in different areas were associated with variable effects on ejection fraction and long-term mortality. Natural language processing enabled analysis of a large database of echocardiogram reports.