bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14176: Cardiac Structure and Function in Relation to Health-Related Quality of Life in Heart Failure Patients With Preserved Ejection Fraction: Results From the PARAGON-HF Study
Authors: Lee Sahmin , Claggett Brian , Shah Amil M , Chandra Alvin , Lewis Eldrin F , Inciardi Riccardo M , Planinc Ivo , Cikes Maja , Prasad Narayana , Martinez Felipe , Lam Carolyn S , McMurray John J , Solomon Scott , Skali Hicham , Hegde Sheila
Published: December 2023

Background:
Health-related quality of life (HRQL) is reduced in patients with heart failure with preserved ejection fraction (HFpEF). However, the extent to which HRQL outcomes are related to cardiac structure and function in patients with HFpEF is not well understood.

Methods:
We examined the association between baseline echocardiographic measures and longitudinal Kansas City Cardiomyopathy Questionnaire (KCCQ) measures in patients with HFpEF in the PARAGON-HF trial using longitudinal regression models adjusted for age, sex, baseline KCCQ score, randomization, and other important clinical confounders.

Results:
Among 1,094 patients with baseline KCCQ data at randomization and a baseline echocardiogram within 6 months of enrollment, the mean age was 74 years and 53% were women. Over 3 years, 78% completed KCCQ measures at baseline, 12, 24, and 36 months. Missing values for non-survivors (n=116) were imputed as zero to avoid survival bias. Posterior wall thickness, septal E/e’, and right ventricular (RV) end diastolic area were negatively associated with the KCCQ Overall Summary Score, and a similar pattern of associations was observed for the KCCQ Clinical Summary Score (Table). Pulmonary artery systolic pressure was additionally negatively associated with the KCCQ Total Symptom Score. Notably, left ventricular (LV) size, septal wall thickness, LV ejection fraction, LV strain, and left atrial size were not significantly associated with longitudinal changes in KCCQ.

Conclusion:
In patients with HFpEF, increased LV posterior wall thickness, elevated LV filling pressure, elevated pulmonary pressure, and RV enlargement - together suggestive of more advanced diastolic dysfunction - are associated with a decline in KCCQ scores and may influence future worsening of quality of life.
Abstract 14224: Cryoballoon Ablation of Atrial Fibrillation in Octogenarian
Authors: Bai Rong , Montoya Alexis , Liao Yu , Lam Truc Vy , lockhart carla , Dai Yi , Katrapati Praneeth , Martinez Jake , Stempihar Jaime , Rodriguez Joy , Jones Camelle , Paveglio Katie , Zawaneh Michael , Weiss J Peter P , Tung Roderick , Su Wilber
Published: December 2023

Introduction:
While the safety and efficacy of AF ablation using radiofrequency (RF) have been demonstrated in the very elderly, data on the application of cryoballoon ablation in this population is limited.

Hypothesis:
Cryoballoon ablation of AF in the very elderly is feasible and safe.

Methods:
Consecutive patients who was 80 years or older and underwent de novo cryoablation of AF from June 2015 to September 2021 were included. All procedures were performed under general anesthesia and with ICE guidance. Following single transseptal puncture, a 28 Cryoballoon was used for all cases; procedural endpoint was isolation of all PVs. Extra-PV ablation including CTI, linear ablation or substrate modification was performed when deemed necessary. At the end of procedure, figure-of-8 suture was applied at the groin(s) to achieve hemostasis which was removed after 4-hour bed resting if no bleeding.

Results:
70 patients were included mean age of whom was 83 (median 82, range 80-94). Baseline demographics and clinical characteristics of the patients were summarized in

Table 1

. PVI was achieved in all but one patient in one PV, this vein was isolated by RF touch-up ablation. CTI ablation was performed in 26 cases but none of the patients required additional ablation. No major complication including tamponade, stroke/TIA, heart failure/fluid overload, phrenic nerve injury or death was associated to the procedure. Iliac vein bleeding developed in one case (1.43%) which required transfusion and stent placement. 11 (15.7%) patients were discharged at the same day of procedure. Overall, all patients were discharged from hospital within 25.2 hours after the procedure. Of 45 patients who completed12-month follow-up, 22 (48.9%) remained in sinus rhythm. 10 patients were reported deceased during follow-up.

Conclusions:
Cryoablation of AF in the very elderly is a feasible and safe procedure. Most patients can be discharged within one day or even on the same day of procedure.
Abstract 14226: Prognostic Impact of Hyperkyphosis in Patients Undergoing Transcatheter Aortic Valve Replacement
Authors: Iwaya Takuma , Kanzaki Hideaki , Irie Yuki , Kawamoto Naonori , Okada Atsushi , Masashi Amano , Amaki Makoto , Takagi Kensuke , Kitai Takeshi , Kusano Kengo , Noguchi Teruo , Fukushima Satsuki , Izumi Chisato
Published: December 2023

Introduction:
Hyperkyphosis, an excessive forward curvature of the upper spine seen in older people, can lead to pulmonary function decline, decreased physical performance, and frailty. However, there are no data on the prognostic impact of hyperkyphosis in transcatheter aortic valve replacement (TAVR).

Hypothesis:
Hyperkyphosis may be associated with poor clinical outcomes of TAVR.

Methods:
This study included 244 patients (age, 83.7 ± 5.4 years; 73.4% female) who underwent transfemoral TAVR at our institution between January 2016 and April 2020. Hyperkyphosis was defined as a Cobb angle of greater than 40°.

Results:
Hyperkyphosis was present in 47 patients (19.3%), and all had marked descending aortic tortuosity. Vascular and access-related complications were more frequent in the hyperkyphosis group (10.6% vs. 2.5%; P = 0.025). The event-free rate of clinical efficacy, which was a composite of death, stroke, and hospitalization for procedure- or valve-related causes, was lower in the hyperkyphosis group (Log-rank test, P = 0.001). Multivariate Cox regression analysis revealed that hyperkyphosis was an independent determinant of lower clinical efficacy (hazard ratio 2.24, 95% confidence interval 1.05-4.77; P = 0.037).

Conclusions:
Hyperkyphosis, present in approximately 20% of patients undergoing trans-femoral TAVR, is associated with more perioperative vascular complications and poor clinical outcomes.
Abstract 14246: Impact of Coronavirus Disease 2019 Infection on Non-ST Elevation Myocardial Infarction Outcomes
Authors: Gill Ahmad , Al-Taweel Omar , Massey Blaine , Ahsan Chowdhury H
Published: December 2023

Introduction:
In this study, we explore the in-hospital outcomes of non-ST elevation myocardial infarction (NSTEMI) patients with and without concurrent coronavirus disease 2019 (COVID-19) infection.

Methods:
We utilized the National Inpatient Sample database (2016-2020) to identify patients who were admitted with a principal diagnosis of NSTEMI and a secondary diagnosis of COVID-19 infection. We conducted propensity score matching. Multivariable logistic regression, adjusted for age, sex and comorbidities, was used to compare mortality.

Results:
1340 patients met our inclusion criteria. NSTEMI patients with concomitant COVID-19 infection had 3.24 times higher odds of suffering in-hospital mortality compared to NSTEMI admissions without COVID-19 (aOR 3.24, 95% CI: 1.93-5.43; p < 0.001). When separated by race, NSTEMI patients with COVID-19 had higher mortality rates amongst White (8.2% vs 4.7%, p = 0.04) and Black patients (14.2% vs 0.9%, p < 0.001, Figure 1). NSTEMI patients with COVID-19 infection were more likely to have acute respiratory distress syndrome (1.6% vs 0.1%, p = 0.004), myocarditis (1.3% vs 0%, p = 0.003) and severe sepsis (2.8% vs 0.9%, p = 0.01, Table 1). These patients were less likely to undergo percutaneous coronary intervention (PCI) (22.7% vs 28.4%, p = 0.02), but there was no significant difference in mean time to PCI (1.7 days vs 1.3 days, p = 0.12).

Conclusion:
Patients with NSTEMI and concurrent COVID-19 infection had higher odds of suffering in-hospital mortality compared to NSTEMI patients without COVID-19 infection. Further research should examine the impact of COVID-19 vaccination on the outcomes of this high-risk patient population.
Abstract 14255: Roles of Mitochondrial Ca
2+
in Contractile Properties in Diabetic Rat Myocardium
Authors: Koyama Sana , Okumura Tsuyoshi , Akazawa Shiori , Takeda Kao , Shindoh Chiyohiko , Sato Haruka , Miura Masahito
Published: December 2023

Introduction:
Diabetes mellitus is an important risk factor for heart failure with reduced relaxation. It has not yet been established how mitochondrial Ca
2+
is involved in the reduced relaxation in diabetic myocardium. Thus, using trabeculae from diabetic hearts, we examined whether mitochondrial Ca
2+
affects contractile properties in diabetic myocardium.

Methods:
Rats were given a subcutaneous injection of 55 mg/kg streptozotocin (STZ-rats) or solvent (Ctr-rats). Eight weeks after the injection, trabeculae were dissected from rat hearts. Force was measured with a strain gauge, intracellular Ca
2+
(Ca
i
) with fura-2, mitochondrial Ca
2+
with rhod-2, and mitochondrial ROS with MitoSox Red (24°C). To evaluate contractile properties of cardiac muscle, the velocities of contraction (dF/dt) and relaxation (-dF/dt) were calculated at 0.7 and 2.0 mM extracellular Ca
2+
. To eliminate the effect of developed force (F
dev
), the dF/dt and -dF/dt were normalized by dividing them by their F
dev
.

Results:
Blood glucose of STZ-rats was higher than that of Ctr-rats (p<0.01). STZ-rats showed smaller F
dev
, smaller dF/dt
max
/F
dev
, and smaller -dF/dt
min
/F
dev
(n=9, p<0.05), suggesting that muscle contraction and relaxation are impaired in STZ-rats. STZ-rats showed lower peak and slower decline of Ca
i
transients compared to Ctr-rats (n=9, p<0.01). In addition, Ru360 (5 μM), a mitochondrial calcium uniporter (MCU) inhibitor, decreased rhod-2 fluorescence and increased dF/dt
max
/F
dev
and -dF/dt
min
/F
dev
in STZ-rats (n=7, p<0.05), suggesting that a decrease in mitochondrial Ca
2+
improves muscle contraction and relaxation. On the contrary, spermine (150 μM), a MCU activator, increased rhod-2 fluorescence and decreased dF/dt
max
/F
dev
and -dF/dt
min
/F
dev
(n=5, p<0.05). In STZ-rats, Ru360 increased MitoSox Red fluorescence (n=5, p<0.05). The spatial distribution of rhod-2 and MitoSox Red imaged with confocal microscopy was similar to that of MitoTracker Green within trabeculae, meaning that rhod-2 and MitoSoxRed are loaded within mitochondria.

Conclusions:
These results suggest that in diabetic hearts, mitochondrial Ca
2+
is involved in the improvement of muscle contraction and relaxation, probably through changes in ROS production.
Abstract 14258: Are Anticoagulants Necessary for Isolated Distal Deep Vein Thrombosis? From COMMAND VTE Registry 1 and 2
Authors: Funauchi Yohei , Takase Toru , Yamashita Yugo , Kaneda Kazuhisa , Chatani Ryuki , Nishimoto Yuji , Ikeda Nobutaka , Kobayashi Yohei , Ikeda Satoshi , Kim Kitae , Tsuji Shuhei , Oi Maki , Takada Takuma , Otsui Kazunori , Sakamoto Jiro , Ogihara Yoshito , Nishikawa Ryusuke , Nakazawa Gaku
Published: December 2023

Background:
Anticoagulation for isolated distal deep vein thrombosis (DVT) remains controversial and is rarely recommended; however, all available data are from the warfarin era, and the effects of DOACs remain unknown.

Objective and Methods:
A large cohort of patients with acute venous thrombosis in the Contemporary Management and Outcomes in Patients with Venous Thromboembolism Registry (COMMAND VTE Registry 1 and 2) in Japan were included for analysis. We then evaluated the patient characteristics, clinical outcomes of symptomatic isolated distal DVT, and the risk-benefit of anticoagulation therapy by comparing direct oral anticoagulant (DOAC) and warfarin.

Results:
From a total of 8224 patients in the COMMAND registry, we excluded those with isolated distal DVT who had an event within 30 days of the initial venous thrombosis, leaving 1054 patients for the study. Among the 1054 patients included, 599, 312 and 143 were on DOACs, warfarin and no anticoagulant respectively. Overall, Kaplan-Meier analysis during a median follow-up of 988 days showed that anticoagulation significantly prevented recurrent VTE (P = 0.011), with no difference between warfarin and DOACs (P = 0.862). No clear increase in bleeding events were observed regardless of anticoagulation status (P = 0.327). Subsequent analysis stratified entries into transient (N = 318), Persistent (N = 353), and Unprovoked (N = 383) groups according to risk of venous thrombosis. In the persistent group, anticoagulation significantly prevented recurrent VTE (P = 0.025), with no difference between DOAC and warfarin (P = 0.939). In the transient group, anticoagulation was not effective in preventing recurrent VTE, with warfarin use significantly increasing bleeding events compared to those with DOAC or no anticoagulation (P = 0.030). Multivariate analysis showed that anticoagulation was independently associated with decreased incidence of venous thrombosis in the persistent group [HR: 0.262 (0.094-0.727), P = 0.010].

Conclusion:
In symptomatic isolated distal DVT, anticoagulation is effective in preventing exacerbation of venous thrombosis; however, warfarin may increase bleeding events among the patients with transient DVT risk.
Abstract 14274: Management of Severe Asymptomatic Carotid Stenosis, Best Medical versus Stenting versus Endarterectomy, a Network Meta Analysis of Randomized Controlled Trials
Authors: K. Awad Ahmed , Abuelazm Mohamed T , Elzeftawy Mohamed , Gowaily Ibrahim , Abdalshafy Hassen , Mouffokes Adel , Ali Shafaqat , Abdelazeem Basel
Published: December 2023

Background:
We conducted a network meta-analysis to investigate the efficacy and safety of best medical therapy (BMT) versus carotid artery stenting (CAS) versus carotid endarterectomy (CEA) in patients with severe asymptomatic carotid stenosis.

Methods:
We systematically searched Web of Science, SCOPUS, EMBASE, PubMed, and Cochrane Central till March 1
st
, 2023, to include any randomized control trial (RCT) that assesses the efficacy of BMT, CAS, or CEA in the management of severe asymptomatic carotid stenosis. A network meta-analysis was conducted using R software pooling dichotomous outcomes using risk ratio (RR) and 95% confidence interval (CI).

Results:
Eight RCTs with 10,094 patients were included. Compared to BMT, both CAS and CEA showed a statistically significant higher risk of the 30 days composite (stroke, myocardial infarction (MI), and mortality) (RR: 4.37 [95% CI 2.35 - 8.11]) (RR: 4.04 [95% CI 2.08 - 7.85]), respectively; mortality (RR: 6.93 [95% CI 1.60 - 29.98]) (RR: 8.12 [95% CI 1.88 - 35.16]), respectively; MI with (RR: 16.03 [95% CI 1.96 - 26.14]) (RR: 27.51 [95% CI 1.65 - 45.46]), respectively; and stroke (RR: 3.42 [95% CI 1.70 - 6.88]) (RR: 2.48 [95% CI 1.23 - 4.99]), respectively. However, both CAS and CEA did not show statistically significant differences between BMT five-year mortality and MI. Finally, CEA showed a statistically significant lower risk of 5-year restenosis with (RR: 0.38 [95% CI 0.12 - 0.88]) and stroke (RR: 0.27 [95% CI 0.22 - 0.98]) compared to BMT.

Conclusion:
BMT for severe asymptomatic carotid stenosis holds an equal efficacy compared to CSA and CEA, yet an even lower risk regarding short-term outcomes. However, CEA shows a lower risk compared to BMT and CSA in terms of long-term (five-year) stroke and restenosis. Further research is still warranted to clarify which patients can benefit most from invasive strategies and to furtherly investigate BMT due to the currently limited evidence.
Abstract 14278: 14 Days of Severe, Sustained Normobaric Hypoxic Enhances Left Ventricular Contractility in Patients After Myocardial Infarction
Authors: Hoenemann Jan , Hoffmann Fabian , Weis Henning , Gerlach Darius , Zaha Vlad G , Sadek Hesham A , Reuter Hannes , Baldus Stephan , Drzezga Alexander , Splettstoesser Frank , Frede Stilla , Levine Benjamin D , Jordan Jens , Limper Ulrich , Tank Jens
Published: December 2023

Studies in mice with experimental myocardial infarction revealed, that sustained severe normobaric hypoxia (FiO2=0.07) reactivates cardiomyocyte proliferation and improves left ventricular ejection fraction. Our study aimed to test safety and feasibility in humans and to assess whether hypoxia improves left ventricular contractility in selected patients with myocardial scars following myocardial infarction.Three males, who suffered myocardial infarction 49-126 months prior to study entry, whose capability for hypoxia acclimatization was validated previously and one healthy male control participated in this proof-of-concept study. After preacclimatization we induced severe hypoxia by adding nitrogen until alveolar oxygen partial pressure reached about 35 mmHg. Hypoxia was maintained for 14 consecutive days (FiO2=0.095) and nights (FiO2=0.105). We assessed ventricular function by echocardiographic-derived global longitudinal strain (LVGLS), serum NTproBNP, high-sensitive Troponin I levels, and marker of myocardial repair. Cardiac 18F-FDG-PET-MRI was done at baseline, end of hypoxia exposure, and at 30 days follow-up. LVGLS increased in prior viable myocardium, but also in areas adjacent to the myocardial scar (baseline: -12.57±2.4 %, end of hypoxia: -14.37±2.62% recovery day 3: -14.33±2.72%, 30 days follow-up: -15.2±3.11%, p=0.0182). NTproBNP tended to decrease (baseline: 189±134 pg/ml, end of hypoxia: 127±28 pg/ml, recovery day 3: 114±18 pg/ml, 30 days follow-up: 108±65 pg/ml). These parameters were not affected in the control. MRI-derived left ventricular enddiastolic volume remained unchanged, but end-systolic left ventricular volume decreased in patients (baseline: 108±49 ml, recovery day 3: 92±50 ml, 30 days follow-up: 101±47 ml, p=0.0068). Troponin I remained in the reference range in all participants. The patient with the most pronounced increase in LVGLS revealed a relevant increase in FDG-uptake at the follow-up, which was also observed in areas adjacent to the myocardial scar.Given the small sample size and the selection of patients, our results have to be interpreted with caution. However, the data indicate potentially beneficial hypoxia-mediated effects in selected patients with ischemic heart disease.
Abstract 14297: The Portfolio Dietary Pattern and Risk of Cardiovascular Disease Mortality During 1988-2019 in US Adults: Findings From the Third National Health and Nutrition Examination Survey
Authors: Kavanagh Meaghan E , Zhang Zefeng , Glenn Andrea J , Zurbau Andreea , Oguntala Julianah O , Malik Vasanti S , Josse Robert G , Kendall Cyril W , Jenkins David J , Sievenpiper John L
Published: December 2023

Introduction:
The Portfolio Diet, a dietary pattern that combines cholesterol-lowering plant foods, reduces several cardiovascular disease (CVD) risk factors in clinical trials and has been associated with reduced CVD risk predominately in White populations. As NHANES III (1988-1994) purposely over-sampled non-Hispanic Blacks and Mexican Americans, undertaking an analysis of the Portfolio Dietary Pattern in NHANES III will expand the generalizability of previous findings.

Objective:
To examine the relation of the Portfolio Dietary Pattern with CVD and all-cause mortality in NHANES III.

Methods:
We included 14,035 adults (76% non-Hispanic White, 11% non-Hispanic Blacks, 5% Mexican Americans, 8% other) without reported CVD. Diet was assessed by a 24-hour recall and supplemented with a food frequency questionnaire using the Portfolio Diet Score (PDS), with positive points given to nuts, plant protein, viscous fibre, phytosterols and plant monosaturated fat sources, and negative points given to foods high in saturated fat and cholesterol. To identify cause of death we used the NHANES III Linked Morality File (2019). SAS PROC SURVEYPHREG was used to run Cox proportional hazards models to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) by tertiles of PDS for CVD and all-cause mortality with adjustment for behavioral, sociodemographic, family history, and baseline clinical and dietary characteristics.

Results:
During a median follow-up of 23 years, a total of 1,809 CVD deaths were documented over 321,950 person-years. After multivariable adjustment, higher PDS was associated with a lower risk of CVD mortality (HR 0.85; 95% CI: 0.73-0.99) and all-cause mortality (HR 0.86; 95% CI: 0.77-0.95) when comparing the highest to lowest tertiles of intake. A 25-percentile increase in PDS (6 points) tended towards an association with a lower risk of CVD mortality (HR: 0.88; 95% CI: 0.76-1.01) and was associated with lower risk of all-cause mortality (HR: 0.90; 95% CI: 0.85-0.96).

Conclusion:
Among US adults greater adherence to the Portfolio Dietary Pattern was inversely associated with CVD and all-cause mortality. These findings improve the generalizability of the Portfolio Dietary Pattern for CVD prevention in diverse populations.
Abstract 14299: Low Left Atrial Motion Automatically Calculated is Indicator of Atrial Cardiomyopathy and High Risk of Cardioembolic Stroke
Authors: RYUZAKI SATOKO , Kondo Yusuke , Nakano Miyo , Nakano Masahiro , Kajiyama Takatsugu , Ito Ryo , Chiba Toshinori , Yoshino Yutaka , Komai Yuya , Takanashi Yukiko , Kobayashi Yoshio
Published: December 2023

Background:
Atrial cardiomyopathy is considered to be an important risk factor for cardioembolic stroke. However, little is known how to evaluate the degree of atrial cardiomyopathy.

Hypothesis:
Left atrial ejection fractions (LAEF) are useful and more sensitive predictors of cardioembolic stroke. Aim; To identify the relationship between LAEF and clinical events such as cardioembolic stroke.

Methods:
The left atrial appendage closure (LAAC) database of our institution from February 2020 to April 2023 was retrospectively analyzed. The LAEF was calculated from cardiovascular computed tomography (CT) imaging data using the automatic 3-dimensional chamber analysis software. We examined the relationship between the risk of cardioembolic stroke and LAEF.

Results:
We enrolled 52 consecutive patients who underwent cardiovascular CT before LAAC (age, 75.3±1.1 years; female gender, 26.9%; BMI, 23.3±0.5 kg/m
2
; CHA
2
DS
2
-VASc score, 4.8±0.2; HAS-BLED score, 3.3±0.1). Of those, 22 (42.3%) patients had histories of cardioembolic stroke. Comparison between patients with and without cardioembolic stroke were shown in Table1. Receiver-operating characteristic curve analysis confirmed that 16.32% was the best cut-off value of LAEF for the history of cardioembolic stroke (AUC = 0.81). In the multivariate analysis, LAEF ≤ 16.32% is the independent predictor for cardioembolic stroke (p-value = 0.0362, respectively) (Table2).

Conclusions:
Low left atrial motion was potential risk factor for cardioembolic stroke in this population. This result could have a relevant impact on the antithrombotic management of patients and, moreover, LAAC could be the best option for these patients.
Abstract 14326: Temporal Trends in Renal Artery Stenting Among Older Patients in the United States
Authors: Earle William B , Li Siling , Song Yang , Krawisz Anna , Cluett Jennifer , Aronow Herbert D , Parikh Sahil A , Carroll Brett , Secemsky Eric A
Published: December 2023

Introduction:
There is mixed evidence to support renal artery (RA) stenting for improvement in blood pressure control or reduction in cardiovascular and renal events, yet it remains a treatment option in specific clinical scenarios. Contemporary procedural rates and outcomes have been incompletely evaluated.

Objective
This study aims to describe temporal trends in RA stenting and outcomes among older US patients.

Methods:
Fee-for-service Medicare beneficiaries age over 65 years, with >1 year of enrollment in Medicare, who underwent RA stenting between January 1, 2016 and December 31, 2020 were included. Outcomes included: (i) a composite of hospitalization for hypertensive urgency, stroke, or myocardial infarction (MI), (ii) new initiation of dialysis, and (iii) need for repeat RA stenting. The cumulative incidence function was used to estimate the incidence of outcomes, accounting for the competing risk of death.

Results:
A total of 31,359 were included: 55.7% female, average age 75.7 ±6.4 years, 88.9% white and 6.6% black. Among the study sample, 75.9% had chronic kidney disease (CKD), 98.2% had hypertension, and 80.9% had ischemic heart disease. Between 2016-2020, the incidence of RA stenting decreased annually from 27.3 to 15.9 per 100,000 Medicare beneficiaries. The 1-year post-procedure incidence of MI was 4.0%, stroke 2.6%, hypertensive urgency 4.6%, dialysis initiation 2.1% and repeat RA stenting 4.6%. Adverse events occurred more frequently among older patients, Black patients, those whom the indication for RA stenting was cardiovascular disease or CKD, and patients enrolled in both Medicare and Medicaid. (
Fig. 1
)

Conclusion:
RA stenting rates in the US are declining, yet it is still frequently used in clinical practice. Post-procedure cardiovascular and renal events are infrequent, but their incidence varies by patient population. Further investigation is warranted to evaluate the risks and benefits of this procedure in specific patient populations.
Abstract 14338: The Impact of Medication-Assisted Treatment for Opioid Use Disorder on Congestive Heart Failure Outcomes
Authors: Rasmussen Peter , Kuo Yong-Fang , Dominique Elmir Digbeu Biai , Harmouch Wissam , Mai Steven , Raji Mukaila
Published: December 2023

Introduction:
Congestive heart failure (CHF) and opioid use disorder (OUD) are leading contributors to healthcare utilization in the United States. Little is known about how OUD treatment impacts clinical outcomes in patients with both CHF and OUD. We examined the impact of medication assisted treatment (MAT—buprenorphine and methadone) on outcomes for patients diagnosed with OUD and CHF, and which MAT medication is associated with the fewest cardiac toxicities.

Hypothesis:
The use of MAT in patients with both CHF and OUD will improve clinical outcomes related to CHF including hospitalizations, emergency room (ER) visits, and mortality.

Methods:
A retrospective cohort study of patients 18 years or older diagnosed with both CHF and OUD was conducted using Optum’s de-identified Clinformatics® Data Mart Database. Using a multivariate logistic regression model, patients who were prescribed MAT were compared to those who were not. The primary outcomes were CHF hospitalizations, CHF ER visits, all-cause hospitalizations, and mortality.

Results:
No significant differences in the primary outcomes between the MAT and non-MAT cohorts were observed. A subgroup analysis demonstrated that buprenorphine had a lower risk of mortality compared to methadone (HR 0.72, 95% CI 0.52-1.00, p=0.0482).

Conclusions:
No significant differences in CHF hospitalizations, CHF ER visits, and all-cause hospitalizations were observed between the MAT and non-MAT cohorts. Buprenorphine was associated with a lower risk of mortality when compared to methadone.
Abstract 14347: Albuminuria, N-Terminal Pro-Brain Natriuretic Peptide and Incident Congestive Heart Failure in High-Risk Adults With Hypertension: A Post Hoc Analysis of the Systolic Blood Pressure Intervention Trial
Authors: Kazibwe Richard , Ahmad Muhammad , Soliman Elsayed Z , Chen Lin Y , Shapiro Michael D , Yeboah Joseph
Published: December 2023

Introduction:
Abnormal levels of urinary albumin concentration (UAC) and N-terminal pro-Brain Natriuretic Peptide (NT-proBNP) have each been independently associated with an increased risk of congestive heart failure (CHF). It remains unknown whether the concomitant presence of abnormal UAC and NT-proBNP increases an individual’s risk for future CHF beyond that contributed by each biomarker.

Objective:
To examine the joint association between abnormal UAC and NT-ProBNP with incident CHF in participants from the SPRINT (Systolic Blood Pressure Intervention Trial) study.

Methods:
This analysis included 8,176 participants from SPRINT with available data on baseline UAC and NT-proBNP. UAC was measured by urine albumin-creatinine ratio (UACR). Albuminuria was defined as UACR ≥30 mg/g. Abnormal NT-proBNP was defined as levels ≥125 pg/ml. Cox proportional hazard models were used to examine the association of UAC and NT-proBNP, as well as albuminuria and abnormal NT-proBNP, with incident CHF.

Results:
Over a median follow-up of 3.2 years, 179 incident cases of CHF were observed. In adjusted models, the risk of incident CHF (HR 95% CI) associated with each 1 (one) unit standard deviation increase in the levels of UAC and NT-proBNP was 1.10 (1.04-1.16; p <0.001) and 1.13 (1.10-1.16; p <0.0001), respectively. A statistically significant multiplicative interaction between UAC*NT-proBNP was observed in the fully adjusted model (p <0.0001). The risk associated with the presence of abnormal UAC +/- abnormal NT-proBNP in the SPRINT cohort is depicted in the figure.

Conclusions:
Among SPRINT participants, we found a significant multiplicative interaction between UAC and NT-proBNP as predictors of incident CHF. Also, the risk of future CHF was over six times higher in individuals with abnormal UAC and NT-proBNP, compared with those with normal levels of both biomarkers. More studies are needed to further explore this interaction and the implications on CHF prevention.
Abstract 14350: Prognostic Impact of Right Ventricular Free Wall Longitudinal Strain in Tricuspid Regurgitation: A Systematic Review and Meta-Analysis
Authors: Guida Camila M , Almeida Camila P , Perego Andresa F , dos Santos Camila D , leite igor H , Nogueira Paula C , Vilela Andrea d
Published: December 2023

Introduction:
Traditional echocardiography is limited in the early assessment of right ventricular (RV) dysfunction, especially in cases of tricuspid regurgitation (TR). In this context, right ventricular free wall longitudinal strain (RVFWLS) has emerged as a promising tool to enhance this evaluation.

Hypothesis:
We aimed to conduct a systematic review and meta-analysis to investigate whether impaired RVFWLS in patients with moderate to severe TR is associated with an increased risk of all-cause mortality and heart failure (HF) hospitalization.

Methods:
We searched Pubmed, Embase and Cochrane for studies that examined our clinical question. Two reviewers performed study selection, data extraction and assessment of bias. RVFWLS was evaluated as a binary variable: normal/near-normal vs. impaired. The latter was defined as a RVFWLS > -17%. Statistical analysis was performed using Review Manager 5.4.1. We calculated pooled hazard ratios (HR) with 95% confidence intervals (CI) under a random effects model. We also performed a subgroup analysis of multivariable analyses to minimize the effect of confounding variables.

Results:
We included 1,523 patients from 5 cohort studies. The mean follow-up ranged from 2.2 to 3.9 years. Mean age ranged to 62 to 84 years and 1,462 (96%) had functional TR. All-cause mortality (HR 1.06; 95% CI 1.02-1.10; p=0.002) and the composite of all-cause mortality or HF hospitalizations (HR 1.10; 95% CI 1.03-1.18; p=0.006) were significantly higher in patients with impaired RVFWLS compared with normal or near-normal RVFWLS. When considering only the multivariable analyses, patients with reduced RVFWLS also had a higher adjusted risk of all-cause mortality (HR 1.05; 95% CI 1.02-1.08; p=0.003).

Conclusions:
Our findings indicate that RVFWLS is an independent prognostic factor for all-cause mortality among patients with moderate to severe TR. The use of RVFWLS to guide management of this population warrants further investigation.
Abstract 14356: Higher Burdon of Premature Ventricular Complexes is Not Uncommon in Stable Well Treated Heart Failure Patients and Relate to Poorer Outcomes
Authors: Kramarenko Daria , Shukr Batool , Stephan Johnathan , LIU BIN , peterson edward , Amin A.S. , Lanfear David E , Pinto Yigal
Published: December 2023

Introduction:
While premature ventricular contractions (PVCs) are generally considered benign, recent evidence suggests that even the contractions preceding PVCs are inefficient so that even a moderate burden of PVCs may be associated with loss of contractile efficiency and increased risk of events. It is however unclear what proportion of stable heart failure (HF) patients have a moderate to high burden of PVCs, despite being well-treated.

Aim:
The aim of this study was to assess the proportion of HF patients that have more than 5% PVCs and whether this higher number is related to worse outcomes.

Methods:
We retrospectively analyzed electronic medical records from 676 adult patients with either an ejection fraction < 40% or NTproBNP more than 600 pg/ml at the Amsterdam UMC (AMC) who received Holter monitoring between 2014 and 2022. In a second independent cohort from a heart failure registry at Henry Ford Hospital (HFH) in Detroit, Michigan, we retrospectively reviewed all participants with ejection fraction < 40% that had a Holter monitor at any point (n=180).

Results:
The median baseline age of the Amsterdam UMC patients was 62 and 40% were female. The HFH cohort had a median age of 64 years and 50% were female. Results are summarized in the table. During the follow-up period, significantly more patients died in the group with more than 5% PVCs (p < 0.05 in the Amsterdam UMC cohort).

Conclusions:
We show in two independent cohorts that around 8-10% of HF patients have a significant burden of PVCs (i.e. >5% of all heartbeats), despite adequate use of beta-blocker therapy. This proportion of PVCs is associated with an increased risk of death over one year. This suggests that in HFrEF patients, PVCs burden more than 5% of heartbeats may not be as harmless as often thought.
Abstract 14417: Regional 4D Cardiac Magnetic Resonance Strain Associates With Late Gadolinium Enhancement in Duchenne Muscular Dystrophy Associated Cardiomyopathy
Authors: Earl Conner C , Markham Larry W , Soslow Jonathan H , Goergen Craig J
Published: December 2023

Introduction:
Cardiomyopathy (CM) is the leading cause of death in Duchenne muscular dystrophy (DMD). Onset and clinical progression are varied. Cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE) can detect fibrofatty replacement prior to
decreased left ventricular ejection fraction (LVEF) but requires administration of gadolinium contrast agents. Non-contrast
methods to characterize CM onset and progression could decrease scan time and exposure to gadolinium. Using a novel 4D (3D+time) regional strain analysis method,

we hypothesized that the regional magnitude of surface area strain (E
a
) would be significantly decreased in DMD patients with LGE and that E
a
would correlate with decreased LVEF

.

Methods:
Short-axis cine CMR images for 43 pediatric DMD patients (13.6 ± 4.2 years) were compiled into 4D sequences for regional strain analysis (Fig. 1A). For all 4D sequences, epi- and endocardial borders were segmented across one cardiac cycle for kinematic analysis using a custom-built MATLAB graphical user interface (MathWorks, Natick, MA). Regional E
a
was measured by determining the relative change in the localized 4D endocardial surface mesh compared to end-diastole. Unpaired t-test and Spearman’s
rho
were used to determine statistical significance and correlation.

Results:
DMD patients had a range of CM severity: 13 with reduced LVEF of <55% (30% of total) and 28 with LGE (65% of total). Peak E
a
was significantly different between patients with and without LGE in the basal inferior (
p
=0.022), basal inferolateral (
p
<0.001), basal anterolateral (
p
=0.002), mid inferolateral (
p
=0.004), mid anterolateral (
p
=0.018), and apical anterior (
p
<0.032), regions (Fig.1B). Basal E
a
also correlated significantly with LVEF (
rho
=-0.45,
p<
0.001; Fig. 1C).

Conclusion:
Regional E
a
from 4D CMR in DMD was reduced in patients with LGE compared to those without LGE particularly in the basolateral regions. Peak basal E
a
correlated with a reduction in LVEF.

LVEF.
Abstract 14480: Safety and Efficacy of Direct Oral Anticoagulants vs Low Molecular Weight Heparin for Treatment of Venous Thromboembolism in Patients With Cancer
Authors: Singh Sahib , Tantry Udaya , Bliden Kevin , Gurbel Paul
Published: December 2023

Introduction:
Direct oral anticoagulants (DOACs) have been studied for treatment of venous thromboembolism (VTE) in patients with cancer. However, the trials have shown conflicting results when compared with low molecular weight heparin (LMWH). Therefore, we aimed to conduct an updated meta-analysis of the available studies.

Methods:
Randomized controlled trials (RCTs) comparing DOAC vs LMWH for VTE treatment in cancer patients were searched from multiple online databases. The primary endpoints of interest were recurrent VTE, major bleeding, clinically relevant non major bleeding (CRNB) and mortality at the longest available follow up. A random-effects model was used to estimate risk ratios (RR) with 95% confidence intervals (CI).

Results:
Six RCTs, with a total of 3,703 patients - 1,855 in the DOAC group and 1,848 in the LMWH group were included. Around 49% of patients were men and the mean age was 66 years. The follow up duration varied from 3 to 24 months. Patients treated with DOAC, when compared with the LMWH group, had lower risk of recurrent VTE (RR 0.66, 95% CI 0.52-0.83, p = 0.0005) (Figure 1), but a higher risk of CRNB (RR 1.63, 95% CI 1.19-2.23, p = 0.002). No significant differences were found between the two groups with regards to major bleeding (RR 1.19, 95% CI 0.82-1.71, p = 0.36) (Figure 2) or overall mortality (RR 1.02, 95% CI 0.90-1.14, p = 0.78).

Conclusions:
For treatment of VTE, DOACs as compared with LMWH are associated with significant reduction of recurrent VTE events but with a higher risk of CRNB.
Abstract 14494: National Trends in Emergency Department Discharges for Acute Pulmonary Embolism, 2006-2015
Authors: Watson Nathan W , Carroll Brett , Krawisz Anna , Schmaier Alec A , Secemsky Eric A
Published: December 2023

Introduction:
Outpatient management for selected low-risk patients with acute pulmonary embolism (PE) has emerged as a safe and feasible approach that is currently supported by clinical practice guidelines. However, recent evidence suggests that many patients are still managed with hospital admission. Few studies have assessed recent real-world, national trends in discharge rates for acute PE from the emergency department (ED).

Methods:
We conducted an observational study leveraging data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) between the years 2006-2020. NHAMCS is a nationally representative probability sample which reflects ED visits within the US. All patients with a primary diagnosis of acute PE were included. Subgroup analysis was performed on patients who were hemodynamically stable (heart rate<110 and systolic blood pressure>100) and those with a PESI risk class I or II.

Results:
Between 2006-2020, there were an estimated 2,519,606 ED visits for acute PE. Among the whole cohort, the mean age was 58.2 (SE: 1.53) and 59.1% were female. Overall, 22.1% of patients with acute PE were discharged from the ED, which increased from 7.8% between 2006-2008 to 32.1% between 2018-2020. A total of 67.9% of patients were hospitalized, which decreased from 83.7% between 2006-2008 to 61.9% between 2018-2020. When stratified by hemodynamic stability or low PESI risk class, similar trends were observed (Figure). Since 2012, 33.0% of patients with PESI class I or II were discharged and 57.8% were hospitalized.

Conclusion:
In a representative nationwide sample, rates of discharge from the ED for acute PE have increased over the past fifteen years with the largest increase occurring between 2009-2014. However, since 2012, only one-third of low-risk patients presenting to the ED were discharged for outpatient management and rates appear to have stabilized. We speculate that outpatient management for low-risk acute PE is still underutilized in the US.
Abstract 14503: Chemokine Ligand 18 (CCL18) is a Long-Term Predictor of All-Cause Mortality, but Did Not Predict CVD Events
Authors: Nilsen Dennis W , Aarsetoey Reidun , Ueland Thor , Aukrust Pal , Michelsen Annika , Poenitz Volker , Brugger-Andersen Trygve , Staines Harry , Grundt Heidi
Published: December 2023

Introduction:
Chemokines mediate leukocyte recruitment and activation. Chemokine ligand 18 (CCL18) is mainly expressed by a broad range of cells such as monocytes/macrophages and dendritic cells. It is highly expressed in chronic inflammatory diseases, and locally in atherosclerotic plaques, particularly at sites of reduced stability. Circulating CCL18 levels are transiently elevated in patients admitted with unstable angina pectoris, but data on myocardial infarction (MI) are scarce.

Aim:
To assess the utility of CCL18 as a prognostic marker of CVD in patients hospitalized for chest pain of suspected coronary origin.

Methods:
The population consisted of 871 consecutive patients (ClinicalTrials.gov Identifier: NCT00521976). Stepwise Cox regression models, applying continuous log
e
-transformed values, were fitted for each of the biomarkers with all-cause mortality and cardiac death within 24-months and all-cause mortality within median 7 years (y) as the dependent variables, adding an analysis of 1) all-cause mortality or MI, and 2) all-cause mortality or MI or stroke at 7 y follow up (FU). The hazard ratio (HR) (95% CI) was assessed in a univariate and multivariable model, adjusting for traditional clinical cardiovascular risk factors, adding BNP, hsCRP, and TnT.

Results:
Plasma samples from 849 patients were available. By 24 months FU, 138 (15.8%) patients had died; 86 were cardiac deaths. The univariate analysis showed a positive, significant association between CCL18 and total death [HR 1.55 (95% 1.30-1.83), p=0.000], and for cardiac death [HR 1.32 (95% 1.06-1.64), p=0.013]. Applying multivariable analysis, the associations were no longer significant.

At 7 y FU, a total of 332 (38.1%) patients had died. After multivariable adjustment, CLL18 was independently associated with all-cause mortality [HR 1.14 (95% CI, 1.01-1.29), p=0.030], but not for MI (n=203) or stroke (n=55). The positive association between CCL18 and all-cause mortality was lost when combined with CVD events; all-cause mortality or MI (n=404, p=0.75), and all-cause mortality or MI or stroke (n=422, p=0.79).

Conclusions:
CCL18 predicts long-term all-cause mortality, but had no independent prognostic bearing on short-term cardiac death and CVD events during long-term FU.
Abstract 14513: A Bayesian Analysis of Circadian Variation in Sudden Death in Wake County, North Carolina
Authors: Siddiqui Sydra , Elzinga David C , Pearcy Leigh B , James Connor , Keen Susan , Simpson Ross J
Published: December 2023

Introduction:
Sudden death is often attributed to coronary artery disease. Demonstrating that sudden death exhibits a different circadian profile than coronary artery disease would support the emerging concept that sudden death is a syndrome, with multiple etiologies.

Hypothesis:
Sudden death will demonstrate a circadian peak with deaths more frequent in the morning hours.

Methods:
The study analyzed 399 sudden death victims aged 18-64 attended by Wake County Emergency Medical Services (EMS) from 2013 to 2015. Time of death was determined using EMS records and medical examiner reports. When time of death could not be reliably determined for a victim, the victim was removed from the study. Only 169 deaths (42.3%) where time of death was reliably known to within one hour were included in the final analysis. Bayesian hierarchical modeling identified the location and/or absence of peak times for sudden death victims overall and subgroups with heart failure (19), coronary artery disease (40), hypertension (89), and respiratory disorders (48).

Results:
Time of death for all-cause sudden death victims spanned from 6:30 AM to noon, with no evidence of a specific, circadian peak. However, sudden death victims with underlying chronic heart failure displayed a strong circadian peak around 7:00 AM, while respiratory disorder cases showed a limited peak in the mid to late morning. Victims with coronary artery disease and hypertension exhibited no peak (Figure 1).

Conclusions:
Sudden death victims lack a distinct overall pattern for time of death. However, individuals with underlying heart failure and possibly respiratory diseases demonstrate a circadian pattern. These findings support the notion that sudden death has multiple causes beyond coronary artery disease. Future preventive interventions should consider the diverse etiologies of sudden death.
Abstract 14515: Distinct Genetic Mechanisms for Bradyarrhythmias From Multi-Center Multi-Ancestry Meta-Analyses
Authors: Weng Lu-Chen C , Ramo Joel , Jurgens Sean J , Chaffin Mark , Khurshid Shaan ,   AGENT investigators,   FinnGen,   Million Veteran Program,   Regeneron Genetics Cntr, Haggerty Christopher M , Cho Kelly , Palotie Aarno , Wilson Peter , Ellinor Patrick T , Lubitz Steven A
Published: December 2023

Background:
With an increasing prevalence in older adults, bradyarrhythmias pose a major public health problem.

Hypothesis:
Genetics can inform on disease pathophysiology and implicate targets for therapeutic development for bradyarrhythmias.

Methods:
We first performed ancestry-specific genome-wide association studies (GWAS) and combined the results in meta-analyses of up to 1.3 million individuals including 9,511 sinus node dysfunction (SND) cases, 34,086 distal conduction disease (DCD) cases, and 28,899 pacemaker implantation (PM) cases. We evaluated the biological relevance of bradyarrhythmia loci by analyses of transcriptomes, pleiotropy, and partitioned heritability based on cardiac single cell RNA sequencing data. Finally, we performed rare variant burden testing in 460,000 whole exome sequenced individuals (cases: 1,766 SND, 12,422 DCD & 5,646 PM) from UK Biobank and Mass General Brigham Biobank.

Results:
Common variant analyses identified 13, 28, and 21 loci for SND, DCD, and PM, respectively. SND and DCD were moderately genetically correlated (r
g
= 0.64). Common variant loci included genes underlying familial forms of bradyarrhythmias (HCN4 and SCN5A) and genes regulating population-level variation in electrocardiographic traits. Four well-known common variant arrhythmia loci (
SCN5A
/
SCN10A
,
CCDC141
,
TBX20
, and
CAMK2D
) were shared for SND and DCD, while other loci were more specific for SND (
PITX2
,
HCN4
,
ZFHX3
) or DCD (
CAV1
and
NKX2
-
5
). We observed an inverse association between predicted cardiac expression of
SCN10A
and risk of SND and DCD, and positive associations of predicted cardiac expression of
CEP68
and
STRN
with risk of SND and DCD, respectively. Among 9 cardiac cell types, cardiomyocyte-expressed genes were enriched for contributions to DCD heritability. Rare variant analyses implicated
LMNA
for all bradyarrhythmia subtypes;
SMAD6
and
SCN5A
for DCD; and
TTN
,
MYBPC3
, and
SCN5A
for PM.

Conclusions:
We identify novel genes and loci associated with bradyarrhythmias. The genetic architectures of SND and DCD are both overlapping and distinct. Multiple genetic mechanisms involving ion channels, sarcomeric components, cellular homeostasis, and cardiac development may influence the development of bradyarrhythmias.