bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14769: Reproductive Duration, Number of Live Births, and Incidence of Heart Failure in the Women's Health Initiative Study
Authors: Hall Philip S , Nah Gregory , Howard Barbara , Lewis Cora E , Allison Matthew A , Sarto Gloria E , Waring Molly E , Jacobson Lisette T , Manson JoAnn E , Klein Liviu , Parikh Nisha I
Published: April 2024

Introduction:
Reproductive factors that are reflective of endogenous sex hormone exposure may have an impact on cardiac remodeling and the development of heart failure. We sought to identify the association between key reproductive factors, including number of live births, age at first pregnancy, and reproductive duration (age at menopause - age at menarche) with the subsequent incidence of heart failure.

Methods:
We studied women in the University of North Carolina heart failure adjudication cohort of the Women's Health Initiative who were systematically evaluated for the presence of heart failure hospitalization from enrollment through 2010. We employed Cox Proportional Hazards Regression analysis in age and multivariable-adjusted models to relate the number of live births, age at first pregnancy, and reproductive period to incident hospitalized heart failure. Multivariable models were adjusted for age, income, education level, ethnicity, region, body mass index, hypertension, diabetes, hyperlipidemia, breastfeeding, pregnancy loss, hysterectomy, oral contraception, and hormone replacement.

Results:
Among n=28,516 who completed menopause at enrollment and who had non-missing reproductive history data, there were n=1,494 cases of adjudicated heart failure with mean follow up of 13.1 years. The mean age was 63 years, mean reproductive duration was 34 years, mean age at first pregnancy was 22 years, and mean number of live births was 3. Reproductive duration was inversely associated with heart failure even after adjustment for covariates (see Table 1). Early age at first pregnancy and nulliparity were significantly associated with incident heart failure in age-adjusted models, but not in multivariable-adjusted models.

Conclusions:
Shorter reproductive period is associated with incident heart failure in postmenopausal women. Whether or not exposure to endogenous sex hormones underlies this relationship should be investigated in future studies.
Abstract 14770: Myocardial Scar Predicts Mortality in Patients With Ischemic and Non-ischemic Cardiomyopathy Who Have Undergone Cardiac Resynchronization Therapy (CRT)
Authors: Harb Serge C , Chareonsri Nisarat , Popovic Zoran , Aman Wahaj , Varma Niraj , Flamm Scott , Kwon Deborah
Published: April 2024

Introduction:
Mortality in patients (pts) with cardiomyopathy (CM) remains high despite advances CRT. We sought to determine the effect of myocardial scar, as depicted by cardiac MRI (CMR), on overall mortality in patients with both ischemic (ICM) and non-ischemic cardiomyopathies (NICM) who underwent CRT placement.

Methods:
We studied 101 pts (48% NICM, age 62 +/- 11, 33% women) who had a CMR pre-CRT. Total scar % was measured and patients were categorized into tertiles: No scar = 0 % scar (43% of pts); moderate scar: >0 but ≤19% scar (25% of pts) and extensive scar: >19% (32% of patients). CRT placement occurred on average 1 year after CMR. Ejection fraction (EF) pre-CRT and more than 6 months post CRT were assessed. Pts were followed up to 14 years for the occurrence of death. Means were compared using T-test and Cox regression survival analysis was used to compare survival among groups.

Results:
Mean EF pre-CRT was 22.8% (SD=8) and significantly increased post CRT to 31.5% (SD=15); p<0.01. There were 26 deaths over a mean of 5 years (SD +/- 3 years) from time of CRT implant. Patients with ICM had more % scar (mean=24+/-15%) compared to non-ICM (mean=2+/-5%; p<0.01). On univariate survival analysis, EF pre-CRT (HR=0.9, CI=0.87-0.98, p=0.01) and EF post-CRT (HR=0.9,CI=0.93-0.99,p=0.03) were both significantly associated with survival . Death occurred significantly more in patients with ICM (HR=4.8; CI=1.4-16.3; p=0.01) and in those with any % scar compared to no scar (HR = 4.0 CI=1.2-13.5, p=0.02). Compared to those with extensive scar, pts with no scar (HR=0.2; CI=0.1-0.6, p<0.01) and those with moderate scar (HR=0.3; CI=0.1-0.9; p=0.04) had better survival - figure 1. Even after controlling for the etiology of the CM (ICM vs. NICM), total scar % remained predictive of survival (p=0.02).

Conclusion:
In a population of patients with ICM and NICM who have undergone CRT, patients with more extensive scar had lower survival, even after adjusting for the etiology of the cardiomyopathy.
Abstract 14842: Half of the Implantable Cardioverter Defibrillator-Eligible Patients That Undergo Coronary Artery Bypass Graft Surgery Improve Their Ejection Fraction to Above 35% Post-operatively
Authors: Koene Ryan J , Voight Jessica , Florea Viorel G , Vakil Kairav , Adabag Selcuk
Published: April 2024

Background:
In patients with preoperative ejection fraction (EF) ≤35%, a 90-day waiting period after coronary artery bypass grafting (CABG) is recommended to assess the impact of revascularization on left ventricular (LV) EF, prior to considering implantable cardioverter-defibrillator (ICD) therapy for primary prevention of sudden cardiac death. However, there is very little data to show whether EF improves to >35% after CABG, rendering these patients ICD-ineligible postoperatively. We sought to determine the incidence and predictors of EF improvement to >35% in ICD-eligible patients undergoing CABG.

Methods:
Of the 2,838 patients who underwent isolated CABG between 2001 and 2014 at the Minneapolis Veterans Affairs Medical Center, 375 had echocardiographic assessment of LV EF before (within 6 months) and after (3-24 months) CABG. Of these 375 patients, 74 (20%) had an LV EF ≤35% prior to CABG and were examined in this analysis. Logistic regression was used to examine the variables associated with perioperative improvement in LV EF.

Results:
Mean age of the 74 patients was 65±9 years. Mean preoperative EF was 28±6%, and improved to 36±12% postoperatively (p< 0.001). In 38 (51%) patients, EF improved to >35% after CABG (mean EF in this subgroup increased from 29±5% to 46±8% postoperatively, p< 0.001). Improvement in EF to >35% was 5 times more likely in patients with a preoperative EF of 26-35% than those with preoperative EF ≤25% (odds ratio 4.95, 95% confidence interval 1.73 to 14.1; p=0.003). Other baseline clinical characteristics were similar between patients with vs. without an improvement in EF to >35%.

Conclusion:
More than 50% of the ICD-eligible patients who underwent CABG with a preoperative EF ≤35% improved their EF to >35% after CABG and became disqualified for primary prevention ICD therapy. Preoperative EF was a strong determinant of EF improvement postoperatively. These results provide evidence for the current practice guideline recommendation of reassessing EF 90 days after CABG in ICD-eligible patients. They also suggest that it is less likely for patients with a preoperative EF ≤25% to become ineligible for primary-prevention ICD after CABG.
Abstract 14851: Inflammation in the Perivascular Adipose Tissue is Associated With Coronary Artery Disease: An Autopsy Study
Authors: Farias Daniela S , Pasqualucci Carlos A , Nishizawa Aline , Silva Luiz F , Campos Fernanda M , Silva Karen C , Cuelho Anderson , Leite Renata E , Ferretti-Rebustini Renata E , Grinberg Lea T , Farfel José M , Jacob-Filho Wilson , Suemoto Claudia K
Published: April 2024

Introduction:
Inflammation of the perivascular adipose tissue (PAT) has been associated with coronary artery disease (CAD); however, lymphocyte B in PAT has not been previously investigated, neither the presence of inflammation in acute CAD.

Hypothesis:
The number of macrophages, T and B lymphocytes in PAT are greater in CAD than in controls.

Methods:
We collected whole hearts and abdominal subcutaneous adipose tissue (SAT) from individuals ≥ 30 years-old. Coronary artery atherosclerosis were evaluated using morphometric methods to determine the level of obstruction and the presence of unstable plaques (e.g. ulceration, hemorrhage, or thrombotic occlusion). Samples of PAT next to the atheromatous plaque and SAT were stained using immunochemistry: macrophages (CD68), T lymphocytes (CD3) and B lymphocytes (CD20) and quantified in 20 random fields. The number of inflammatory cells was compared among controls, chronic CAD, and acute CAD in PAT and in SAT.

Results:
We evaluated 49 participants (controls n=12; chronic CAD n=27, and acute CAD n=10). Compared to controls, the number of B lymphocytes was greater in participants with CAD in PAT [acute CAD: 7.7 (IQR 3.8-17.3); chronic CAD: 5.8 (IQR 1.9-9.6); controls: 1.9 (IQR 0-4.8); p=0.01]. In SAT, macrophages was greater in CAD groups [chronic CAD: 175 (IQR 94-326); and acute CAD: 138 (IQR 15-277)] than in controls [65 (ITQ 28-110); p=0.02]; and also for T lymphocytes [chronic CAD: 45 (IQR 25-75); acute CAD: 40 (IQR 25-56)]; controls [13 (IQR 8-38) p=0.03]. In paired analysis, we found more macrophages in the PAT than in the SAT in all groups [controls:PAT-288 (IQR 98-597); SAT-65 (IQR 28-110) p=0.02]; [chronic CAD: PAT-505 (IQR 434-987); SAT-175 (IQR 94-326) p<0.0001]; [acute CAD: PAT-496 (IQR 200-743); SAT-104 (IQR 15-277) p=0.007]. B lymphocytes in CAD were larger in the PAT than in the SAT, respectively [chronic: 5,8 (IQR 1,9-9,6) vs. 1,9 (IQR 1,9-7,2) p=0.04]; [acute: 7,7 (IQR 1,9-17,3) vs. 1,0 (IQR 0-2,9) p=0.03].

Conclusions:
We found an association between inflammation in the PAT and CAD mediated by humoral response. Besides, we detected inflammation in SAT in CAD groups mediated through T lymphocytes and macrophages, suggesting a systemic response in individuals with CAD that is more intense in PAT than in SAT.
Abstract 14865: Comparative Analysis of Radial Versus Femoral Diagnostic Cardiac Catheterization Procedures in a Cardiology Training Program
Authors: Singh Gurpreet , Campos Enrique P , Kavinsky Clifford J , Snell R. J , Schaer Gary L , Jolly Neeraj
Published: April 2024

Background:
The use of radial access for cardiac catheterization has been increasing for both diagnostic coronary angiography and percutaneous coronary interventions. In comparison with femoral access, radial approach decreases access site complications and prolonged bed rest, which leads to patient preference. Comparison between these two techniques however, is limited with cardiology fellowship trainees as primary operators.

Methods:
We conducted a retrospective study of 163 consecutive radial and 180 consecutive femoral access diagnostic cardiac catheterization procedures, with cardiology fellowship trainees as primary operators. Variables including procedure time, fluoroscopy time, dose area product (DAP), and contrast volume used were recorded for all procedures. Mann-Whitney and rank Anova tests were used for statistical analysis.

Results:
The radial approach was associated with significantly higher fluoroscopy time (8.0±6.97 vs 4.25±3.01 minutes, p<0.001), DAP (10775±6724 vs 7952±4236 micoGy/m
2
, p<0.001), procedure time (38.31±12.25 versus 27±17.56 minutes, p<0.001), procedure start to vascular access time (8.24±6.31 versus 5.31±4.59 minutes, p<0.001), and vascular access to procedure end time (30±15.34 versus 21.2±9.57 minutes, p<0.001). These differences persisted after adjusting for patients with bypass grafts and additional imaging (p<0.001). The use of contrast amount was not significantly different between two groups (p=0.115).

Procedure start to vascular access time improved significantly with fellowship training year in both the radial (9.57±6.96 vs 8.23±6.08 vs 5.57±4.82 minutes) and femoral groups (6.17±5.07 vs 5.47±4.75 vs 4.01±3.31 minutes). Fluoroscopy time showed significant difference only in femoral access group (p<0.07). DAP did not improve with training in either access group.

Conclusion:
Radial procedures were associated with more radiation dose and procedure time. Despite decrease in total procedural time for radial cases with the level of training, total radiation dose did not decrease.
Abstract 14867: Duration of Dual Antiplatelet Therapy After Various Drug Eluting Stent Implantation
Authors: Sharma Abhishek , Sharma Samin K , Garg Akash , Vallakati Ajay , Stone Gregg , Mukherjee Debabrata , Lavie Carl , Marmur Jonathan D
Published: April 2024

Objective:
To evaluate efficacy and safety of long duration DAPT i.e., > 12 months (L-DAPT) and short duration DAPT i.e., ≤ 12 months (S-DAPT) after various drug eluting stent (DES) implantation.

Methods:
We searched Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) to identify randomized controlled trials (RCTs) assessing the effect of L-DAPT versus S-DAPT after sirolimus-eluting (Cypher®); paclitaxel-eluting stents (Taxus®); zotarolimus-eluting (Endeavor®) and everolimus-eluting stents (Xience V®) implantation. Primary efficacy end points were stent thrombosis, target vessel revascularization (TVR), all cause mortality and cardiac mortality. Primary safety end points were major bleeding and stroke. Event rates were compared using a Forest plot of relative risk using a random effects model.

Results:
We included six RCTs that randomized 19,012 patients to S-DAPT versus L- DAPT (4638 first generation DES; 14,374 in second generation DES; 8099 EES; 4876 in ZES). Outcomes with S-DAPT and L-DAPT in various generations of DES stents are summarized in table below:

Conclusion:
Compared with L-DAPT, S-DAPT was associated with higher rate of myocardial infarction and stent thrombosis without any significant difference in the rate of all cause mortality, cardiac mortality and stroke after first and second generation DES. However, on subgroup analysis of second generation stent there was no significant difference in the rate of all cause mortality, cardiac mortality, myocardial infarction, stent thrombosis and stroke with S-DAPT and L-DAPT after ZES implantation. Shorter duration DAPT may be optimum for newer generation stents particularly ZES.
Abstract 14870: Progression of Paroxysmal to Persistent Af in Patients Awaiting AF Ablation
Authors: Kochhaeuser Simon , Dechering Dirk , Trought Kathleen , Hache Philip , Haig-Carter Tanjah , Khaykin Yaariv , Wulffhart Zaev , Pantano Alfredo , Tsang Bernice , Tsang Bernice , Eckardt Lars , Verma Atul
Published: April 2024

Objective:
Atrial fibrillation (AF) is a progressive disease for which ablation has become an important treatment option. Success rates have been shown to be significantly higher while AF has not yet progressed to persistent. In a general AF-population the HATCH-score has been proposed to predict the risk of progression to persistent AF. However, little is known about predictors of progression in patients awaiting AF ablation.

Methods/Results:
We performed a retrospective, single centre investigation of patients with paroxysmal AF at the time they were placed onto our AF ablation waiting list and evaluated possible risk factors for the progression of AF until the time of the actual ablation.

Of 564 patients (median age 60.4 (±15.1) years, 194 (34.4%) female) 60 (11%) progressed from paroxysmal to persistent AF during a median waiting time of 291 (±244.3) days. In patients that progressed to persistent AF, ablation took significantly longer (180±99 min vs. 157±85min; p 0.009), had a tendency to require longer RF-energy delivery (68.9±40 min vs. 61.8±44 min; p 0.052) and was associated with a higher rate of recurrence (53.3% vs. 39.1%; p<0.001). Patients that did progress to persistent AF had tied significantly more antiarrhythmic drugs (1 (±2) vs. 1(±1); p 0,048) and more frequently had a history of amiodaron treatment (21.7% vs. 11.9%; p 0.03).

The previously proposed HATCH-score was only a poor predictor of AF progression (AUC 0.54). Furthermore, none of the individual HATCH-score parameters was a significantly predicted the progression of AF in our population. However, a left atrial (LA) diameter of more than 45mm (OR 3.46, p< 0.001) and heart failure (OR 3.11, p 0.036) were strong and independent predictors of AF progression in multivariable analysis.

Conclusion:
Patients with an increased LA-diameter or heart failure have a significantly increased risk to progress to persistent AF. If ablation is considered in such a patient it should be conducted as soon as possible to prevent progression to persistent AF.
Abstract 14926: Uninterrupted Novel Oral Anticoagulants vs Uninterrupted Warfarin Peri-Ablation of Atrial Fibrillation: A Meta-Analysis of Embolic and Bleeding Complications
Authors: Musat Dan L , Garikipati Naga V , Preminger Mark W , Sichrovsky Tina , Mittal Suneet , Steinberg Jonathan S
Published: April 2024

Introduction:
Novel oral anticoagulants (NOACs) like dabigatran (D), rivaroxaban (R) or apixaban (A), are being used much more commonly pre and post-atrial fibrillation (AF) ablation. Many prior reports have included patients with NOACs held for varying periods before, after or both relative to ablation. It is unclear if uninterrupted (U) NOACs increase procedural risk vs the preferred peri-ablation regimen, uninterrupted warfarin (UW). Because individual studies may be too small given low complication rates, we conducted a meta-analysis to provide more robust data to guide current practice

Methods:
All published papers (n=4) and abstracts (n=5) to date that compared complication rates for peri-AF ablation use of U-NOACs vs. UW were included. Bleeding complications included pericardial effusion and vascular bleeding, and embolic complications included stroke/TIA or systemic embolism. The Mantel-Haenszel fixed effect model for pooling the study results was used, with a random effects model for heterogeneous samples/results.

Results:
The 1404 pts on a U-NOACs (15% D, 59% R, 26% A) were similar to the 1528 pts on UW. There was no difference in composite total complication rates between the 2 groups (6.4% U-NOACs vs 7.7% UW), (OR 0.78, 95% CI 0.58 - 1.05; I2 = 0%). Composite embolic and bleeding rates were similar in both groups (0.14% in U-NOACs vs 0.20% in UW, OR 0.99, 95% CI 0.25 - 4.06; I2 = 0%; and 6.3% in U-NOACs vs 7.5% in UW, OR 0.78, 95% CI 0.58 - 1.06; I2 = 0%, respectively, Figure).

Conclusions:
This meta-analysis demonstrates that U-NOACs are a legitimate alternative for peri-AF ablation anticoagulation with no significant difference in bleeding or embolic events compared to UW.
Abstract 14943: Significance of Improvement of Advanced Heart Block in Response to Corticosteroid Therapy in Patients With Cardiac Sarcoidosis
Authors: Segawa Masato , Fukuda Koji , Nakano Makoto , Kondo Masateru , Hirano Michinori , Shimokawa Hiroaki
Published: April 2024

Introduction:
Advanced heart block (AHB) is one of the major manifestations in patients with cardiac sarcoidosis (CS) and is regarded as a prognostic factor of poor prognosis. Although it has been reported that AHB is improved in response to corticosteroid therapy in some cases, the significance of the improvement remains to be examined.

Methods and Result:
We examined 68 consecutive patients with CS who admitted to Tohoku University Hospital from October 1998 to September 2014 (57±11 years-old, M/F 18/50, mean follow-up 5.5-year). CS was diagnosed based on the original guidelines for diagnosis of CS from the Japanese Ministry of Health and Welfare. Corticosteroid therapy was performed in all CS patients. Among the 68 patients, 29 (43%) had AHB at admission (AHB group). The AHB group tended to have higher BNP level as compared with those without AHB (no-AHB group) (358±92 vs 200±35 pg/ml, P=0.086), whereas there was no difference in left ventricular ejection fraction between the two groups (50.0±18.9 vs 51.0±14.6%, P=0.801). Kaplan-Meier estimate of freedom from heart failure hospitalization, but not that from all-cause death or VT/VF, showed that the AHB group had more events than the no-AHB group (log-rank P=0.032) (Figure A). Importantly, among the 20 AHB patients after excluding 9 patients with CRT therapy at admission, AHB was improved in 6 in response to corticosteroid therapy but was sustained in the remaining 14, where event-free survival was significantly better in the former than in the latter (log-rank P=0.014) (Figure B). Although BNP levels were comparable between the two groups at admission (242±52 vs. 213±74 pg/ml, P=0.761), there was a significantly greater improvement in the BNP levels in patients with improvement of AHB (125±26 vs 22±7 pg/ml, P=0.022).

Conclusions:
These results indicate that improvement of AHB in response to corticosteroid therapy may be an important prognostic factor of better prognosis associated with improved cardiac function.
Abstract 14956: Out-of-hospital Cardiac Arrest and Bystander CPR in Kent County, Michigan: A Geospatial Analysis
Authors: Uber Amy , Chassee Todd , Sadler Rick C , Reynolds Joshua C
Published: April 2024

Introduction:
Geographic clustering of OHCA & bystander CPR (bCPR) has been demonstrated in some US cities. We assessed for geospatial distribution patterns within our county.

Objectives:
1) Characterize bCPR performance; 2) Test for geographic clustering of OHCA & bCPR; 3) Identify hot spots & cold spots, defined as areas with disproportionately greater and lesser chance of bystander intervention within a concentration of OHCA.

Hypothesis:
OHCA & bCPR is geographically clustered within our region, resulting in hot and cold spots of bystander intervention.

Methods:
Retrospective, observational, population-based, cohort study using the CARES dataset for Kent County, Michigan. We included adult, non-traumatic, EMS-treated OHCA from 2010-14, excluding cases with on-site medical care. We abstracted EMS dispatch addresses, bCPR, & patient characteristics, then geocoded street addresses (ArcGIS) to create a population-adjusted density map of OHCA annual incidence. Moran’s I test assessed for spatial autocorrelation of population-weighted cardiac arrest rate by census block. Difference mapping identified relative differences between cases with/without bCPR, & Getis-Ord Gi statistic assessed for spatial clustering of bCPR, identifying hot and cold spots.

Results:
Of 1,632 eligible subjects, 1,167 met inclusion criteria. bCPR occurred in 436 (37%), & was performed by family members (58%), lay persons (34%), & off-duty medical providers (8%). Specific techniques included compressions/ventilations (28%), compression only (35%), ventilation only (1%), & unknown (36%). Geospatial analysis revealed significant clustering of OHCA ranging from 0 to >60 annual cases per 100,000 population (p<0.001). Relative difference in bCPR ranged from -11.2 to 0.9 across geographic locales, with a paucity of bCPR (-11.2 to -2.0) in urban and suburban areas. We identified central Grand Rapids & southern suburbs as primary cold spots (99% confidence), whereas eastern & northeastern suburbs contained hot spots (99% confidence).

Conclusion:
The minority of OHCA received bCPR. OHCA & bCPR are geographically clustered, & bCPR is more/less likely to occur in certain areas. Distinguishing hot & cold spots affords opportunity for targeted public health initiatives.
Abstract 15002: Pulse Oximetry Plethysmographic Waveform: A New Method to Identify ROSC During CPR
Authors: Li Chen , Xu Jun , Zhu Huadong , Yu Xuezhong
Published: April 2024

Introduction:
Chest compressions might not benifit the circulation in CPR when the patient got ROSC. It has been reported that pulse oximetry plethysmographic waveform (POP) reflected the peripheral tissue perfusion. We noticed that POP disappeared when the patient suffered cardiac arrest, and changed during CPR. Hypothesis: We assessed the hypothesis that the changes of POP could be utilised as a new method to identify ROSC during CPR.

Methods:
617 cardiac arrest patients from 14 hospital in 10 cities were enrolled in the study. Investigate the feasibility of POP in the recognition of ROSC during CPR using time domain method and frequency domain method retrospectively. Single blind method was used in POP analysis.

Results:
During chest compression in cardiac arrested patients, POP in time domain showed relatively regular compression wave (Figure 1A), while frequency domain waveforms showed a single peak, with the harmonic (Figure 1B). When ROSC achieved during chest compression, POP appeared fluctuation (Figure 2A), while frequency domain waveform showed fluctuation hybrid. Integration showed a single peak spectrum (Figure 2B), while separation showed a double peak spectrum (Figure 2C). Diagnostic tests of fluctuation hybrid using frequency domain method showed Se 0.461, Sp 0.972, PV+ 0.810, PV- 0.876. Conclusions: In conclusion, POP could be used to identify ROSC during CPR.
Abstract 15003: Spatiotemporal Stability of Public Cardiac Arrests
Authors: Demirtas Derya , Brooks Steven C , Morrison Laurie J , Chan Timothy C
Published: April 2024

Background:
Public access automated external defibrillator (AED) deployment and community cardiopulmonary resuscitation (CPR) programs should target geographical areas with high risk of out-of-hospital cardiac arrest (OHCA). Although these long-term, location-based interventions implicitly assume that the geographical OHCA risk remains stable over time, there is a paucity of evidence to support this assumption.

Objective:
To determine whether geographic OHCA risk is stable over time in a Canadian urban setting.

Methods:
We identified all atraumatic public-location OHCAs in Toronto, Canada from Jan. 2006 – Dec. 2014 and allocated each of them to one of the 140 neighborhoods defined by the City of Toronto. We then calculated the intra-class correlation (ICC) to measure the relative variability of OHCA counts within and between neighbourhoods over time.

Results:
We identified 2506 atraumatic public OHCAs. The figure shows that the average number of public OHCAs in Toronto was 278.4 (±41.4) per year. The highest-risk neighborhood had an average number of 12.9 OHCAs per year and remained the highest-risk neighborhood during six of the nine years. The four lowest-risk neighborhoods each had a rate of 0.1 OHCA per year. The ICC value was 0.67 [95% CI, 0.61 to 0.73], indicating that there was less year-to-year variation within the same neighborhood (i.e., more temporal stability) and more variation between neighborhoods.

Conclusion:
The OHCA rate in Toronto is stable at the neighborhood level over time. High-risk neighborhoods tend to remain high-risk, which supports focusing public health resources in those areas to increase the efficiency of these scarce resources and improve long-term impact.
Abstract 15044: Cardiac Explant-derived Cells From Aged Donors With Ischemic Cardiomyopathy Demonstrate Impaired Cell Survival and Therapeutic Regeneration
Authors: Rafatian Ghazaleh , Kamkar Maryam , Seymour Richard , Burgon Patrick G , Suuronen Erik J , Davis Darryl R
Published: April 2024

Background:
While cardiac stem cells are emerging as a promising therapy for ischemic cardiomyopathy (ICM), the influence of advanced donor age and ICM on the regenerative performance of these cells are unknown.

Hypothesis:
Advanced donor age and a history of ICM combine to limit the regenerative performance of explant-derived cells (EDCs) through altered cell functions which reflects fundamental changes in the molecular signature of aged ischemic EDCs.

Methods and Results:
EDCs were cultured from myocardial biopsies of young (8 weeks; n=40) and old (52 weeks; n=36) C57/BL6 mice 4 weeks after randomization to sham or experimental myocardial infraction (MI; ejection fraction 28±2%, p=0.24 effect of donor age). Although advanced donor age was associated with reduced telomere length, aging alone had negligible effects on EDCs. In contrast, EDCs sourced from aged ICM donors showed reduced cardiomyogenic differentiation (i.e., greater propensity to adopt an endothelial or smooth muscle lineage), cytokine production (reduced angiogenin, angiopoietin-1 and VEGF), pro-angiogenic capacity (1.2±0.03 fold less tubules formed; p=0.02), reactive oxygen species metabolism (1.8±0.3 fold greater reactive oxygen species, p=0.04; 1.9±0.1 fold less superoxide dismutase activity, p<0.01; 2.4±0.3 fold less glutathione peroxidase activity, p<0.01), and apoptosis resistance (1.5±0.1 fold greater; p=0.02) as compared to young ICM EDCs. With the exception of 1.6±0.1 fold greater production of IL-6 (p=0.04), ICM did not influence young EDCs. Transplantation of EDCs from aged ICM donors into aged recipients 1 week after MI provided lesser degrees of cell-mediated cardiac repair (3±1 vs. 8±1% change in LVEF from baseline to 21 days post CSC transplant after transplant of young ICM EDCs; p<0.01). Finally, transcriptome comparison of ICM EDCs showed aging promoted the differential expression of 145 genes (≥2 fold change; false discovery rate ≤0.05) which modify many of the pathways responsible for effective cell cycle control and DNA damage/repair.

Conclusions:
EDCs from aged donors with a history of ICM demonstrate an attenuated capacity for cardiac repair that reflects differential expression of transcripts suggestive of impaired cell cycle control and repair.
Abstract 15431: Impact of Malnutrition as a Key Prognostic Factor in Patients With Heart Failure With Preserved Ejection Fraction
Authors: Takahashi Tetsuya , Watanabe Tetsu , Narumi Taro , Sugai Takayuki , Toshima Taku , Yokoyama Miyuki , Kinoshita Daisuke , Nishiyama Satoshi , Takahashi Hiroki , Arimoto Takanori , Shishido Tetsuro , Miyamoto Takuya , Kubota Isao
Published: April 2024

Background:
Malnutrition is one of the unfavorable prognostic factors in patients with heart failure (HF). Prevalence of HF with preserved ejection fraction (PEF) (defined as left ventricular ejection fraction >50%) has been increased and there is an obvious association between HF-PEF and hypertension, diabetes mellitus, and insulin resistance. However, association between malnutrition and clinical outcomes in patients with HFPEF remains to be elucidated.

Methods and Results:
We evaluated controlling nutritional status score (CONUT), prognostic nutritional index (PNI), and geriatric nutritional risk index (GNRI) in 190 patients with HFPEF (mean 69.9 ± 11.6 years) admitted to our hospital. Patients were prospectively followed with the endpoints being cardiovascular death or rehospitalization. There were 56 events including 14 deaths and 42 rehospitalizations during a median follow-up of 14.0 months. Patients with cardiac events showed more severe New York Heart Association (NYHA) functional class and lower left ventricular ejection fraction (LVEF) compared with those without. Total lymphocyte count, serum albumin, and total cholesterol level were lower in patients with cardiac events. Patients with cardiac events showed higher CONUT score (6 vs 2, P<0.001), lower PNI (30.4 vs 38.9, P<0.001), and lower GNRI (84.9 vs 96.3, P<0.001) compared with those who without. The correlations between each nutritional index and clinical parameters were examined. CONUT score, PNI, and GNRI correlated with age, LVEF, and serum brain natriuretic peptide (BNP) level. In Cox proportional hazards analysis, higher CONUT score (adjusted hazard ratio 9.0, 95% confidence interval (CI) 3.2-25.2), lower PNI (3.6, 1.7-7.7), and lower GNRI (6.3, 2.7-14.9) were independently associated with cardiac events after adjustment of age, gender, NYHA functional class, and serum BNP level. Kaplan-Meier analysis revealed that significantly higher cardiac event rate was observed in the patients with malnutrition (log-rank test, P<0.001).

Conclusion:
Malnutrition was associated with unfavorable outcomes in patients with HFPEF. Evaluating nutritional status may provide valuable prognostic information in patients with HFPEF.
Abstract 15435: Myocardial Deformation at Rest Predicts Exercise-induced Elevation in Left Ventricular Filling Pressure in Patients With Exertional Dyspnea
Authors: Biering-Sørensen Tor , Santos Mário , Rivero Jose , McCullough Shane D , West Erin , Opotowsky Alexander R , Waxman Aaron B , Systrom David M , Shah Amil M
Published: April 2024

Background:
An exaggerated rise in the pulmonary arterial wedge pressure (PAWP) with exercise is a hallmark of heart failure. However, conventional resting-state measures of cardiac structure and function poorly predict exercise hemodynamics. We determined whether LV longitudinal strain (LS) and circumferential strain (CS) predict exercise-induced rise in PAWP.

Methods:
We studied 85 patients referred for cardiopulmonary exercise testing with invasive hemodynamic monitoring for evaluation of dyspnea. Patients with an LVEF<50% or moderate or greater valvular disease were excluded. All patients underwent rest echocardiography followed by exercise testing with invasive hemodynamic monitoring. Global longitudinal strain (LS), global circumferential strain (CS) and the CS/LS-ratio were measured by 2D speckle-tracking echocardiography.

Results:
Mean age was 53±18 years, 25% were male, 41% had hypertension, and 9% had diabetes mellitus. Lower absolute LS at rest was associated with greater increase in PAWP during exercise (r=0.23, p=0.033). In contrast, higher absolute CS at rest predicted a greater increase in PAWP (r=-0.27, p=0.025) and greater increase in stroke volume with exercise (r=-0.26, p=0.044). Higher CS/LS-ratio was most predictive of elevation in PAWP with exercise (r=0.27, p=0.023; Figure).

Conclusion:
Myocardial deformation at rest predicts exercise-induced rise in PAWP among patients with dyspnea and a preserved LVEF. A pattern of rest deformation characterized by worse LS and exaggerated CS is most strongly associated with exercise-induced rise in PAWP.
Abstract 15456: Computer-assisted Diagnosis of Coronary Angiography
Authors: Soroushmehr S.M.Reza , Bafna Abhishek , Shashank Sinha , Brahmajee Nallamothu , Ward Kevin , Najarian Kayvan
Published: April 2024

Introduction:
Current analysis of coronary angiograms (CAs) relies on visual estimation by human operators with several limitations. Techniques like quantitative coronary angiography are available but require significant user input. A fully-automated system would be useful in guiding diagnosis and quality assurance of CAs.

Methods:
We obtained 56 CAs from a random cohort at the University of Michigan from 2010-2012. Studies were limited to nonobstructive coronary disease to facilitate early development of programming. Image processing techniques were employed in 20 test cases to fully-automate interpretation and was compared to visual estimation by a physician annotating images. Programming was done in MATLAB.

Results:
In 56 CAs with annotation, the algorithm was able to correctly identify 133/146 lesions, yielding an accuracy of 91%. The figure shows an example where a right coronary artery lesion was correctly identified. Major challenges were surmounted, including vessel identification, motion and extrinsic artifacts (e.g, catheters), morphological operations using a branch-point vessel skeleton, and vessel tracking and thickness estimation through edge detection.

Conclusions:
We demonstrate proof-of-concept for a fully-automated system for analyzing CAs that showed excellent correlation with annotated data. Future studies will need to develop the system for more complex cases and to explore its clinical and quality implications.
Abstract 15502: Thrombus Aspiration in Primary Percutaneous Coronary Intervention: An Updated Meta-analysis
Authors: Carmo João , Costa Francisco M , Ferreira Jorge , Mendes Miguel
Published: April 2024

Background:
During primary percutaneous coronary intervention (PPCI), routine thrombus aspiration has been proposed based on small trials that suggested improved clinical outcomes, but last trials had reported conflicting results. We aimed to access whether thrombus aspiration and PPCI is superior to PPCI alone on clinical outcomes in patients with ST-elevation myocardial infarction, based on last clinical data.

Methods:
PubMed, Embase and Cochrane databases were searched. We included studies that randomized patients with ST-elevation myocardial infarction to thrombus aspiration and PPCI versus PPCI alone, and excluded studies that did not have clinical outcomes and those in which mechanical thrombectomy was used. We calculated risk ratio with 95% confidence interval (CI) for all-cause mortality, reinfarction, target vessel revascularization, stent thrombosis and stroke.

Results:
Twenty randomized trials enrolling 21,368 patients were included. Of these, 10,661 were randomized to thrombus aspiration and PPCI, and the remaining 10,707 to PPCI only. The all-cause mortality was similar between the two groups (risk ratio [RR] = 0.88; 95% CI 0.77-1.01, p=0.07). Although reinfarction (RR = 0.96; 0.80-1.15, p=0.64), target vessel revascularization (RR 0.93; 0.83-1.07; p=0.26) and stent thrombosis (RR = 0.83; 0.65-1.07, p=0.15) were also similar between the two groups, there was an increase in rate of stroke in patients randomized to thrombus aspiration (RR = 1.52; 1.08-2.14; p=0.02).

Conclusion:
This meta-analysis that includes the largest trial to date showed that thrombus aspiration did not reduce mortality, reinfarction, target vessel revascularization or stent thrombosis, but was associated with a higher rate of stroke.
Abstract 15537: Ezetimibe in Combination With Simvastatin Reduces Remnant-cholesterol Without Affecting Biliary Lipid Concentrations in Gallstone Patients
Authors: Parini Paolo , Ahmed Osman , Gustafsson Ulf , Sahlin Staffan , Pramfalk Camilla , Eriksson Mats
Published: April 2024

Introduction:
Large genetic studies have recently recognized remnant-cholesterol, defined as cholesterol in triglyceride (TG)-rich lipoproteins, as a causal risk factor for ischemic heart disease and low grade inflammation, independently of HDL-cholesterol. NPC1L1 in the intestine is the target of ezetimibe, but its function in the liver is still unknown.

Hypothesis:
To clarify the function of hepatic NPC1L1 in humans we performed a randomized, single-blind, placebo-controlled study and investigated molecular changes in lipoprotein, lipid and carbohydrate metabolism secondary to combined inhibition of cholesterol synthesis and intestinal cholesterol absorption.

Methods:
Forty cholesterol gallstone patients (13 men and 27 women) received 80 mg/day simvastatin, 10 mg/day ezetimibe, or a combination of simvastatin and ezetimibe, or placebo for four weeks. Plasma, bile and liver biopsies were collected.

Results:
The first results showed that ezetimibe treatment alone or in combination with simvastatin did not increase the % molar concentration of cholesterol in bile nor blunted the decrease due to cholesterol synthesis inhibition. Combination therapy led to a 70% decrease in cholesteryl esters (p<0.001) and a 50% decrease in TG (p<0.01) in the core of TG-rich lipoproteins. Negative changes in fasting insulin, c-peptide, or glucose concentrations were not observed. The dramatic changes in the core of TG-rich lipoprotein were not seen in subjects treated with simvastatin or ezetimibe alone, and were not paralleled by changes in HDL-cholesterol.

Conclusions:
The expected increase in biliary cholesterol following treatment with ezetimibe does not occur in humans, suggesting different functions of NPC1L1 (or ezetimibe action) in the liver and intestine. The results also help to explain why ezetimibe associated to simvastatin was more effective in reducing CVD events in the diabetic patients (IMPROVE-IT), known to have increased levels of TG-rich lipoproteins.
Abstract 15550: Impact of PET Imaging to Visualize Activated Macrophages in Immune Rejection of Allogenic iPS Derived Cardiac Myocytes in Mice
Authors: Kashiyama Noriyuki , Miyagawa Shigeru , Fukushima Satsuki , Saito Atsuhiro , Masuda Shigeo , Kawamura Takuji , Kawamura Ai , Yoshida Shohei , Harada Akima , Ueno Takayoshi , Toda Koichi , Kuratani Toru , Sawa Yoshiki
Published: April 2024

Introduction:
Transplantation of allogeneic cells inevitably induce activated macrophage-related host immune response, which would limit therapeutic effects. Importantly, monitoring magnitude of the immune response is poorly established in the allogeneic cell transplantation therapy for the heart.

Hypothesis:
In this study, we hypothesized that [18F]-DPA-714-PET imaging may visualize activated macrophages accumulated to the host heart after transplantation of allogeneic induced pluripotent stem cell (iPSC)-derived cardiomyocytes (CM).

Methods:
iPSC-CM cell-sheets of C57BL/6 mice origin were generated by the thermoresponsive dish and transplanted over the surface of the left ventricle (LV) of C57BL/6 mice as a syngeneic cell-transplant model (Group sTx), or Balb/c mice as an allogeneic one (Group aTx). The mice were examined by [18F]-DPA-714-PET to assess maximum standardized uptake value (SUVmax) ratio (A/S ratio) calculated by SUVmax in the anterior and septal wall of the LV. In addition, expression of factors associated with immune rejection was assessed by RT-PCR and the significance of immune rejection was evaluated by Immunochemical staining of CD3 or CD68 positive cell.

Results:
A/S ratio was comparable in all groups at 1 day (aTx: 1.19±0.05, sTx: 1.16±0.03, sham: 1.20±0.03, p=0.34), though higher in the aTx group than the other groups at 7 day (aTx: 1.38±0.03, p<0.01, sTx: 1.18±0.04, sham: 1.25±0.09) after the cell transplantation. In addition, the expression of IL-2 and MCP-1 of the heart tissue were higher in the aTx group than the other groups at 7 day (aTx: 31.4±3.8, p<0.01, sTx: 1.5±1.2, sham: 2.3±0.9 and aTx: 30.8±12.7, p<0.01, sTx: 4.0±3.4, sham: 5.5±2.0). Furthermore, in the immunochemical histology, the percentages of CD3 and CD68 positive cells were also higher in the aTx group than the other groups at 7day.

Conclusions:
Accumulation of activated macrophages were identified in the LV surface more intensely after the allogeneic iPSC-CM transplantation than the syngeneic or sham one by the [18F]-DPA-714-PET imaging, warranting that PET imaging may be applicable in clinical setting of the allogeneic cell transplantation therapy to monitor magnitude of host immune response.
Abstract 15613: Change in Cardiorespiratory Fitness is Inversely Related to Mortality Among Men and Women: Data From the Henry Ford Exercise Testing (FIT) Project
Authors: Brawner Clinton A , Al-Mallah Mouaz H , Ehrman Jonathan K , Qureshi Waqas T , Schairer John R , Blaha Michael J , Keteyian Steven J
Published: April 2024

Background:
Cardiorespiratory fitness (CRF) is inversely related to all-cause mortality and cardiovascular-related morbidity and mortality. However, there is limited data describing whether change in CRF is associated with improved outcomes.

Hypothesis:
Change in CRF between two clinical exercise stress tests is related to risk of all-cause mortality.

Methods:
In this retrospective, observational study, we identified 14,305 patients (age = 55 ± 11 y; 39% women; 30% non-white) who completed two clinically-indicated exercise tests that were at least 12 mo apart between 1991 and 2009 within the Henry Ford Health System. CRF was quantified in metabolic equivalents of task (METs) estimated from peak treadmill speed and grade. All-cause mortality was identified through April 2013 using the Social Security Death Index. Cox regression analysis was used to evaluate the risk of mortality associated with change in CRF between tests 1 and 2. Change in CRF was analyzed as the change in categorization between Poor Fitness (<7 METs) and Fit (≥ 7 METs) and as an absolute change in peak METs. Based on data at test 1, covariates included age; sex; race; cardiovascular risk factors; medications; and history of coronary artery disease, heart failure, and atrial fibrillation; as well as year of test 1 and time between tests 1 and 2.

Results:
The mean time between test 1 and 2 was 4.3 ± 2.8 y. During 9.4 ± 3.9 y of follow-up after test 2, there were 1,980 (14%) deaths. Adjusted Cox regression results are shown in the Table. Among all patients, each 1 MET increase in CRF at test 2 was associated with a 5% lower risk of mortality (hazard ratio 95% confidence interval 0.94, 0.97; p < 0.001).

Conclusions:
Among men and women referred for a clinical exercise test, change in CRF from Poor Fitness to Fit is associated with a 38% lower risk of all-cause mortality relative to patients who remain Poor Fit. These data support the importance of improving CRF and the clinical utility of serial assessments of CRF in risk assessment.
Abstract 15661: Clinical Predictors and Financial Implications of Permanent Pacemaker Implantation in Patients Undergoing TAVR: A Nationwide study
Authors: Deshmukh Abhishek , Patel Samir V , Pant Sadip , Patel Nileshkumar J , Savani Chirag , Arora Shilpkumar , Patel Nilay , Desai Maheshkumar , Bhimani Ronak , Badheka Apurva O , Padmanabhan Deepak , Friedman Paul , Turakhia Minang , Cha Yong Mei , Asirvatham Samuel , Rihal Charanjit , Noseworthy Peter
Published: April 2024

Introduction:
The treatment options for high and extreme-risk patients with severe symptomatic aortic stenosis have changed significantly over the past decade because of advances in transcatheter aortic valve replacement (TAVR). However new permanent pacemaker implant (PPI) remains an impending concern after TAVR.

Hypothesis:
We sought to determine the frequency, predictors and outcomes of patients requiring PPI after TAVR.

Methods:
We queried the National Inpatient Sample (NIS) database using the ICD-9-CM procedure code of 35.05 for transfemoral/transaortic and 35.06 for transapical replacement of aortic valve .We identified TAVR procedures associated with new permanent pacemaker implants using appropriate validated ICD-9-CM codes. Using multivariate analysis we further identified predictors of PPM implants

Results:
An estimated 8828 TAVR procedures were performed in United States between 2011-2012. 773 (8.7%) TAVR procedures were associated with PPIs. PPI were higher in older (age>80 years), White race, diabetics, left bundle branch block (LBBB), right bundle branch block (RBBB), transfemoral approach. The inhospital mortality ( 5.2% vs.4.6% ) , mean length of stay ( 9.8 vs. 8.3 days ) disposition to short term nursing facility was higher (38.2% vs. 32.1%) and mean total costs (82217$ vs. 52283$) was higher in TAVR + PPI group . On multivariate analysis, Age in 5 year increment [Odds ratio (OR) 1.11; Confidence interval (CI) 1.05-1.17, p<0.001], diabetes [OR 1.26; CI 1.07-1.49, p<0.001], LBBB [OR 1.99; CI 1.55-2.56, p<0.001], RBBB [OR 5.36; CI 3.80-7.55, p<0.001] were independent predictors of PPI. Transfemoral approach was associated with more PPI implants [OR 1.41; CI 1.12 -1.78, p<0.001]

Conclusion:
Age, baseline conduction system disturbances, diabetes, transfemoral approach emerged as independent predictors of PPI after TAVR. This study provides useful tools to identify high-risk patients for PPI after TAVR.