bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11607: In-Hospital and Readmission Outcomes With Percutaneous Balloon Mitral Valvuloplasty
Authors: Chahine Nicole , Malhotra Akshay , Hussain Fizza , Elkaryoni Ahmed , Mentias Amgad , Alkhouli Mohamad , Gordon Paul , Sharaf Barry , Aronow Herbert D , Lopez John J , Abbott Jinnette D , Saad Marwan S
Published: June 2023

Introduction:
Percutaneous balloon mitral valvuloplasty (PBMV) is primarily performed for rheumatic mitral stenosis (MS). Therefore, limited data exist on PBMV in countries with a low incidence of rheumatic disease. We sought to examine in-hospital and readmission outcomes for PBMV in the U.S.

Methods:
Using the Nationwide Readmission Database, hospitalizations in which patients received PBMV for rheumatic and non-rheumatic MS were identified. In-hospital mortality and 30-day readmission rate were examined, and multivariable logistic regression was performed for risk adjustment. Additionally, McNemar's test was used to examine the change in 90-day hospitalization rate before vs. after PBMV.

Results:
Between 2016-2019 there were 1109 hospitalizations in which patients received PBMV for rheumatic (n= 955, 86.1%) vs non-rheumatic MS (n=154, 13.9%) (Figure). In-hospital mortality (odds ratio (OR) 0.67, 95% confidence interval (CI): 0.19-2.25; p=0.52) and 30-day all-cause readmission rate (OR 1.05, 95% CI: 0.54-2.04; p=0.88) were similar with rheumatic vs non-rheumatic MS, respectively. There was no change in 90-day all-cause hospitalization rate after PBMV for rheumatic and non-rheumatic MS (25.5% to 21.8%; p=0.14, and 24.0% to 33.7%; p=0.19, respectively), and similarly among key subgroups except for male and patients <65 years old; (27.7% to 18.1%, p=0.05) and (26.4% to 20.8%, p=0.05) respectively (Figure). Notably the 90-day heart failure-hospitalization rate significantly decreased after PBMV (16.9% to 12.0% [relative reduction 28.9%], p=0.01).

Conclusions:
Patients who received PBMV for rheumatic and non-rheumatic MS had similar in-hospital mortality and 30-day all-cause readmission rates. There was no change in the 90-day all cause hospitalization rate before and after PBMV however the 90-day heart failure-hospitalizations were significantly reduced. Future studies are needed to examine the role of PBMV in patients without rheumatic MS.
Abstract 11621: Risk Factors for Cardiovascular (CV) Outcomes in Patients With Essential Thrombocythemia: An Analysis of the National Inpatient Sample (NIS)
Authors: Tafur Guillermo , Sandefur Hardy , Durante Marisa , Golemi Lolita , Kandula Pranav , Tafur Alfonso J
Published: June 2023

Introduction:
Essential Thrombocythemia (ET) is a myeloproliferative neoplasm characterized by an overproduction of platelets in the bone marrow. Patients suffering from this condition are at a higher risk for CV complications. Studies have demonstrated a prothrombotic state in ET patients and a significant mortality rate stemming from thrombotic complications. However, data regarding the risk of hospitalization for CV events in patients with ET are scarce. Therefore, our objective was to identify risk factors for CV outcomes among patients with ET.

Methods:
We performed a retrospective analysis of the National Inpatient Sample (NIS) from 2016 to 2017. Patients included were at least 18 years of age and had an ICD-10 diagnosis of ET. To identify CV outcomes, an ICD-10 code for VTE, Stroke, ACS, or a Major Adverse Limb Event had to be present in the top three discharge diagnoses. We identified common chronic comorbidities and performed binary logistic regression to identify risk factors for hospitalizations due to CV outcomes. Those factors were then validated with the 2018 and 2019 NIS databases.

Results:
We identified a total of 234,225 (weighted) NIS patients with ET. The mean age was 59.72 years (SD = 18.679), and patients were predominantly female (57%). CV outcomes were present in 18,955 cases (8.10%). Significant predictors for CV outcomes among patients with ET included valvular disease (VHD) (odds ratio, 1.33 [95% CI, 1.23-1.43]; P<0.0001), peripheral vascular disease (PVD) (odds ratio, 1.97 [95% CI, 1.87-2.07]; P<0.0001), paralysis (odds ratio, 1.63 [95% CI, 1.54-1.73]; P<0.0001), and hypertension (HTN) (odds ratio, 1.36 [95% CI, 1.32-1.41]; P<0.0001). Upon re-testing with 237,345 (weighted) ET patients from the 2018 and 2019 NIS cohorts, significant risk factors included VHD (odds ratio, 1.99 [95% CI, 1.90-2.08]; P<0.001), PVD (odds ratio, 2.07 [95% CI, 1.98-2.16]; P<0.001), paralysis (odds ratio, 3.35 [95% CI, 3.21-3.49]; P<0.0001), and HTN (odds ratio, 1.68 [95% CI, 1.62-1.74]; P<0.001).

Conclusion:
Among patients with ET in the 2016-2019 NIS cohorts, VHD, PVD, HTN, and paralysis were associated with the greatest risk of CV outcomes. Patients hospitalized with ET may benefit from increased risk management in the setting of these comorbidities.
Abstract 11623: Retrograde Facilitated Antegrade Dissection and Re-Entry
Authors: Karacsonyi Judit , Simsek Bahadir , Kostantinis Spyridon , Brilakis Emmanouil S
Published: June 2023

History:
A 69-year-old man presented with severe medically refractory stable angina and was referred for revascularization of a right coronary artery (RCA) chronic total occlusion (CTO
Figure 1.A
). The patient had undergone coronary artery bypass surgery 16 years prior as well as numerous percutaneous coronary intervention. Echocardiography demonstrated normal left ventricular systolic function.

Procedure:
Antegrade wiring was attempted first with a Fielder XT guidewire (GW) and a Turnpike Spiral microcatheter (MC
Figure 1.B
). Due to the ambiguous proximal cap and long occlusion length, retrograde crossing was attempted next. After attempting to cross multiple collaterals a Sion Black crossed a proximal septal collateral (
Figure 1.C
), but several MCs could not follow the GW, despite ballooning the collateral with a 1.5 mm balloon and GuideLiner support. We switched to antegrade dissection and re-entry with a knuckled Gladius Mongo that reached the distal RCA (
Figure 1.D
). With the Stingray balloon and ‘double blind stick and swap’ technique we crossed into the distal true lumen, but the GW position was lost after removal of the balloon. We crossed with the retrograde GW to the antegrade guide catheter
(Figure 1.E)
, but ‘tip in’ technique as well as passing the retrograde MC was not successful. Using a new Stingray balloon and the retrograde GW as true lumen marker (
Figure 1.F
) we crossed into the distal true lumen. After drug-eluting stent implantation (
Figure 1.G
) the distal bifurcation was recanalized with kissing balloon dilation (
Figure 1.H
) and implantation of another stent with a nice final result (
Figure 1.I
).

Conclusion:
Persistence is key in CTO PCI in patients with severe medically refractory stable angina and limited revascularization options. Crossing the collaterals with MC can be challenging: possible solutions are smaller MC, predilation in septal collateral, ‘tip in’ or switching to another crossing strategy such as ADR with retrograde facilitation.
Abstract 11625: To Cool or Not to Cool for Brugada Syndrome
Authors: Ahuja Tania , Kiefer Nicholas J , Caballero Alex , Pashun Raymond
Published: June 2023

Brugada syndrome (BrS) is an autosomal dominant genetic disorder, characterized by abnormal findings on the electrocardiogram (ECG) in conjunction with an increased risk of ventricular tachycardia (VT) and sudden cardiac death. Triggers of the ECG pattern and VT in BrS include fevers, drugs, and electrolyte abnormalities. This case reports a unique treatment approach of targeted temperature management (TTM) to treat persistent fevers and VT secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a patient with BrS. We report the case of a 23 year old male with history of BrS with an intracardiac defibrillator (ICD) who presented to the hospital with chest pain and a runny nose. Vital signs upon admission were notable for temperature of 38.2
o
C, heart rate of 155 beats/minute and blood pressure of 134/110 mmHG. Laboratory values on admission revealed a normal complete blood count, a normal basic metabolic panel, an elevated c-reactive protein (CRP) of 19.1, and PCR confirmed SARS-CoV-2 infection, with a cycle threshold value of 16.4. ECG revealed a type 2 Brugada pattern. Interrogation of his ICD revealed 28 device shocks on the morning of admission, with each episode beginning with a premature ventricular contraction inciting polymorphic VT. His transthoracic echocardiogram (TTE) discovered a newly reduced ejection fraction of 25% with global hypokinesis. Persistent VT prompted intubation and sedation with propofol. Repeat SARS-CoV-2 inflammatory markers revealed a rising CRP of 244. Therapies included acetaminophen around the clock and remdesivir and dexamethasone to target COVID-19. During the first two days in the cardiac intensive care unit (CICU), fevers persisted with Brugada pattern on ECG. Given the potential for recurrent VT, targeted TTM was initiated using the Arctic Sun external cooling device to maintain normothermia to 37
o
C. After 5 days of no VT, fever curve, Brugada pattern, and inflammatory markers improved. TTM was discontinued, COVID-19 therapies were completed, and he was extubated. His cardiac function normalized on repeat TTE and he was discharged home. We report a unique case of TTM use in a patient with BrS with VT secondary to infection with COVID-19, as a way to decrease fevers and prevent further triggering of VT.
Abstract 11629: Multicenter Development and Validation of a Machine Learning Risk Model to Predict Right Ventricular Failure Following Mechanical Circulatory Support: The STOP-RVF Score
Authors: Kyriakopoulos Christos P , Taleb Iosif , Ijaz Naila , Demertzis Zachary , Peruri Adithya , Wever-Pinzon Omar , Koliopoulou Antigone G , Bonios Michael J , Hanff Thomas C , Dranow Elizabeth , Giannouchos Theodoros V , Sideris Konstantinos , Nelson Marisca , Elmer Ashley , Tang Daniel , Nemeh Hassan , Stehlik Josef , Fang James C , Selzman Craig H , Alharethi Rami , Caine William , Cowger Jennifer , Shah Palak , Drakos Stavros G
Published: June 2023

Introduction:
Existing models predicting right ventricular failure (RVF) after durable left ventricular assist device (LVAD) support are limited due to lack of multicenter validation, absence of intraoperative characteristics, and marginal predictive power. We sought to derive and validate a risk model to predict post-LVAD RVF.

Methods:
Advanced heart failure (HF) patients (N=798) requiring continuous-flow LVAD were enrolled at the Utah Transplant Affiliated Hospitals (n=477), Inova Heart & Vascular Institute (n=183), and Henry Ford Medical Center (n=138). Baseline clinical and intraoperative characteristics were recorded. The primary outcome was RVF incidence, defined as the need for right VAD (RVAD) or intravenous inotropes for >14 days. Bootstrap imputation and lasso variable selection were used to derive a predictive model which was then validated. A risk calculator was developed classifying patients into risk groups, and survival was compared.

Results:
Patients were predominantly white (72%), males (84%), aged 56±13 years. Patients in the RVF and non-RVF groups were comparable in terms of sex, age, and LVAD indication, while RVF patients more commonly had a history of systemic hypertension, non-ischemic cardiomyopathy, lower INTERMACS profiles, and more commonly required inotropic or temporary circulatory support pre-LVAD. Overall, 193 (24.2%) patients developed RVF with 109 (56.5%) requiring inotropes and 84 (43.5%) an RVAD. Multivariable predictors for RVF are shown in the
Figure
and achieved a c-statistic of 0.74 (95% CI: 0.70-0.78). Inclusion of intraoperative characteristics did not improve model performance. Cumulative survival was higher in the minimal risk group compared to low, moderate, and high.

Conclusions:
The STOP-RVF calculator effectively stratifies the risk for RVF after LVAD support by implementing routinely collected clinical data. It could impact patient selection and peri-operative management of advanced HF patients.
Abstract 11646: Impact of Fetal Hypoxia on Myocardial Molecular Profile in the Lamb Extra-Uterine Environment for Neonatal Development
Authors: Edwards Jonathan J , Hunt Mallory , Yang Yifan , Williams Spencer , Bowman-Cornelius Caitlyn , Landell Matthew , Gunder Meredith , Buchanan Jamuna , Davey Marcus , Flake Alan , Gaynor James W , Arany Zoltan
Published: June 2023

Background:
Using the EXTrauterine Environment for Neonatal Development (EXTEND) system to chronically reduce myocardial oxygen delivery (DO
2
) to levels mimicking human congenital heart disease caused increased myocardial capillarity and cardiomyocyte hypotrophy. However, molecular mechanisms for this have not been evaluated.

Methods:
Preterm fetal lambs were isolated by cesarean section and supported by EXTEND for 7 days in normoxia (n=5) or hypoxia (n=4) and compared to in utero gestational age matched controls (n=3). Right and left ventricle (RV, LV) molecular profiles were assessed by RNAseq, qPCR, and western blot. Differentially expressed genes (DEGs) were identified with limma/edgeR. BioPlanet enrichment analysis was performed with Enrichr.

Results:
DO
2
was lower in hypoxic lambs (15.5 vs 23.8 ml/kg/min, p<0.0001). RNAseq revealed no significant DEGs between normoxia and control, while hypoxia significantly altered myocardial gene expression. The directionality was similar for LV and RV (r=0.82, p<0.0001), but more statistically significant in LV (97 vs 7 DEGs, adj p<0.05). Enrichment analysis revealed Hif1-target upregulation. qPCR confirmed upregulation of Hif1 targets and apoptosis activators
Bnip3
(RV log
2
fold change (FC) 0.8) and
Bnip3l
(LV log
2
FC 1.6) and downregulation of the antiapoptotic
Angpt1
(RV log
2
FC -1.5; all p<0.05). However, by protein, Bnip3 and Bnip3l were reduced (RV FC 0.6, p<0.0001) and (LV FC 0.8, p=0.0001), Bax was equally reduced (RV and LV FC 0.65, p<0.05), and the proangiogenic/antiapoptotic hormone Angptl4 was increased (FC 1.9 RV and 2.3 LV, p<0.05). In contrast, the proangiogenic/antiapoptotic cadherin receptor Cdh13 was reduced (RV and LV FC 0.5, p<0.05). Finally,
Fblim1
, a driver of cardiomyocyte hypertrophy, was decreased in LV and RV by RNAseq (logFC -0.75 and -0.63, adj p<0.05) but increased by protein (LV FC 1.9, p=0.006).

Conclusions:
The normoxic EXTEND system faithfully recapitulates the myocardial molecular profile of normal lamb gestation. The molecular impact of fetal myocardial hypoxia is heterogeneous and suggests negative feedback loops with alterations in angiogenesis and cell survival/size. Future studies will dissect if these changes are sufficient to alter myocardial structure.
Abstract 11650: Cardiometabolic Disease Protein Signatures and Response to GLP-1 Receptor Agonist in the EXSCEL Clinical Trial
Authors: Ostroff Rachel , Green Jennifer , Mentz Robert J , Chadwick Jessica , Hinterberg Michael , Kureshi Natasha , Simpson Missy , Williams Stephen A , Hernandez Adrian F , Holman Rury , Sattar Naveed , Shah Svati H
Published: June 2023

Introduction:
Recent type 2 diabetes (T2D) therapeutics have pleiotropic benefits. High throughput proteomic assays offer opportunities to systematically analyze T2D-related cardiometabolic traits and drug-related effects.

Methods:
The Exenatide Study of Cardiovascular Event Lowering (EXSCEL) trial randomized patients with T2D to once-weekly exenatide (EQW) versus placebo. This biomarker substudy of 5205 participants performed plasma proteomic profiling on baseline and 1-year samples using an aptamer-based platform. Changes in nine protein-imputed cardiometabolic traits were compared between treatment groups. In exploratory analyses, proteomic cardiovascular (CV) risk was stratified in individuals based on use of open label “drop-in” SGLT-2 inhibitors during follow-up.

Results:
Proteomic signatures for impaired glucose tolerance, body fat, and visceral fat decreased more in the EQW group compared with placebo (adjusted p<0.05), partially consistent with EQW-induced weight loss (
Figure
). Protein-imputed resting energy rate, cardiorespiratory fitness, and lean body mass also decreased to a greater extent in the EQW group. Proteomic CV risk increased in both groups over one year but increased less in the EQW group (0.8% vs. 2.3%, adjusted p<0.01). Individuals predicted at baseline to be at high CV risk had significantly lower observed CV event rates if they received “drop-in” SGLT-2 inhibitors (p<0.05).

Conclusion:
Leveraging EXSCEL, a large-scale clinical trial of a GLP1-receptor agonist, this biomarker substudy uses proteomic signatures to demonstrate pleiotropic drug effects related to cardiometabolic traits. Further, proteomic CV risk increased to a lesser extent in individuals randomized to EQW, suggesting that EQW has beneficial effects influencing cardiovascular risk directly or indirectly through these proteomic pathways.
Abstract 11660: Case Report: Stymied by the Stemi, an Un-Emblematic Pulmonary Embolism
Authors: Tamizharasu Jothika T , English Carter W , Atreja Surabhi M
Published: June 2023

Introduction:
Diagnosing a pulmonary embolism (PE) can be challenging, especially when it presents as another “can’t miss” diagnosis like acute coronary syndrome. Although electrocardiogram (EKG) abnormalities can be seen in many PE presentations, rarely are ST elevations noted. We describe a case report of PE presenting as STEMI.

Case presentation:
A 71-year-old woman with hypertension, hyperlipidemia, type 2 diabetes mellitus, and morbid obesity presented to the emergency department with chest pain radiating to the jaw along with shortness of breath. On initial presentation her heart rate was 110 bpm, respiratory rate 40, 84% SpO2 on room air, and blood pressure 150/84 mmHg. EKG showed ST elevation in anterior leads V1-V2 and reciprocal changes of ST depression in lateral leads I, aVL, V5-V6. Serial troponins were elevated and she underwent left heart catheterization which showed non-obstructive coronary artery disease and hyperdynamic left ventricular function. Right heart catheterization (RHC) showed an elevated mean pulmonary artery pressure of 49 mmHg, and pulmonary artery pulsatility index was 2.2, suggestive of right ventricular dysfunction which prompted an urgent CT pulmonary angiogram and transthoracic echocardiogram. The CT revealed extensive pulmonary embolism and echocardiogram demonstrated dilated right ventricle with hypokinesis and akinetic right ventricular free wall. A left lower extremity ultrasound revealed deep vein thrombosis.

Discussion:
This patient depicts an uncommon presentation of acute PE masquerading as acute coronary syndrome. Her case was diagnostically challenging as her EKG findings were not consistent with those typically seen in acute PE. Review of the literature reveals only a handful of case reports of a PE appearing to be a STEMI. Although rare, clinicians should entertain the idea of PE when presented with ST elevation and no culprit lesion and a careful RHC may be useful in establishing diagnosis.
Abstract 11674: Acute Effects of Nicotine-Containing Product Challenges on Cardiovascular and Autonomic Function Among Electronic Cigarette Vapers, Combustible Cigarette Smokers, and Controls: The CLUES Study
Authors: Tattersall Matthew C , Hughey Christina M , Piasecki Thomas M , Korcarz Claudia E , Hansen Kristin , Fiore Michael C , Baker Timothy B , Stein James H
Published: June 2023

Background:
The acute cardiovascular effects of electronic nicotine delivery devices (ENDs) have not been well-characterized. We hypothesized differences in acute cardiovascular and autonomic function responses to use of ENDS by chronic ENDs users (“vapers”), use of combustible cigarettes by chronic “smokers,” and no product use among non-smoking/non-vaping controls.

Methods:
CLUES (HL1393301) was a cross-sectional study of 395 individuals: 164 exclusive vapers (exhaled carbon monoxide [CO] <5 ppm, positive urine NicCheck I test), 117 exclusive smokers (CO >5 ppm, positive urine NicCheck), and 114 non-vaping/non-smoking controls (CO <5 ppm, negative urine NicCheck). We measured systolic and diastolic blood pressure (BP), heart rate (HR), brachial artery diameter, and time domain HR variability (root mean square differences in successive normal intervals [RMSSD]; % adjacent normal intervals >50 ms [PNN50]) before and 15’ after a product use challenge. Linear mixed models were created to predict outcome measures from group, time, and group*time with age, sex, and race as covariates, followed by group contrasts via
post-hoc
t-tests with Bonferroni-corrected p values.

Results:
Vapers were a mean (SD) 27.4 (10.6) years old (39% female, 86% white) and had vaped for 4.1 (2.7) years. Smokers were 42.8 (13.8) years old (44% female, 56% white) and had smoked for 23.0 (13.0) years. Controls were 30.8 (11.9) years old (50% female, 69% white). Model-adjusted mean (95% CIs) outcomes and p values for between group differences in challenge responses are in the Figure. Compared to controls, vapers had greater increases in systolic BP, diastolic BP, and HR (all p
<
0.002) and greater reductions in brachial artery diameter, RMSSD, and PNN50 (all p
<
0.003) than controls, with values similar to smokers.

Conclusion:
Chronic vapers showed acute increases in BP and HR, vasoconstriction, and reductions in time domain HR variability after using ENDS, similar to cigarette use by smokers.
Abstract 11679: Simple Text-Messaging and Social Support to Increase Hypertension Medication Adherence in Non-Hispanic Black Adults in New Orleans, LA
Authors: Reddy Tina K , FERDINAND Daphne P , Wegener Madeline , Guduri Pavan , Nedunchezhian Saihariharan , Lefante John , Ferdinand Keith C
Published: June 2023

Introduction:
Non-Hispanic Black adults (NHB) have the highest US CVD risk, the leading cause of mortality. Medication nonadherence predicts suboptimal HTN control. Self-measured blood pressure (SMBP) effectively tracks BP changes and medication response.

Purpose:
This New Orleans, LA predominantly NHB single cohort pilot study examined uncontrolled HTN utilizing bidirectional electronic messaging (BEM) with an interdisciplinary healthcare team assessing medication adherence, quality of life (QOL), and BP, without pharmacotherapeutic change.

Methods:
Participants were screened from Tulane Cardiology Clinic and community sources. Eligibility criteria included: uncontrolled HTN (BP >130/80 mmHg), low Krousel-Wood (KW) adherence score, and smartphone access. Participants (n=36) were provided validated bluetooth-enabled BP devices synced to smartphones via a cloud-based BP recording app. Demographic information included: age, self-identified race (91.7% NHB), and sex. Pre- and post-study KW adherence scores, CDC Health Related QOL surveys, BMI and BP were obtained. Participants were followed with BEM for 8 weeks with SMBP and daily text reminders.

Results:
Mean age was 58.7±12.8 years; mean BMI was 34.8±7.8; 63.9% were female; 25.7 % with previous diabetes diagnosis; 72% with obesity. Nonadherence significantly improved with mean KW adherence composite score change from 2.19 to 1.58 (p = 0.0001). Mean baseline SBP/DBP was 142.19/81.19; SBP decreased significantly by mean 10.5±20.0 mmHg (p = 0.0027) with no significant change in DBP. There was a non-significant decline in the average summary index of unhealthy days during the previous 30 days from 9.1 days to 6.8 days, change -2.3 ± 10.7 (p = 0.21).

Conclusions:
A novel approach combining cloud-based bluetooth SMBP transmission with BEM health communication significantly improved medication adherence and systolic BP in a predominantly NHB urban cohort without modifying existing pharmacotherapy.

“Supported in part by U54 GM104940 from the National Institute of General Medical Sciences of NIH, which funds the LA Clinical and Translational Science Center. Content is solely the responsibility of the authors and does not necessarily represent official views of the NIH.”
Abstract 11707: How Age Affects the Association of Breast Arterial Calcification With Clinical Outcomes and Mortality
Authors: Sykes Alexandra V , Bui Quan M , Allen Tara S , Belrose Nora , Nerlekar Nitesh , Mantey Richard , Wang Junhao , Eghtedari Mohammad , Daniels Lori
Published: June 2023

Background
Cardiovascular disease (CVD) remains the number one cause of death in women. Current screening tools in this population do not identify all women who are at risk. Screening for breast artery calcification (BAC) via routine mammography is emerging as a risk enhancing tool; however, how risk prediction varies by age is unknown.

Methods
This single-center, retrospective study included 14,544 women who had a digital mammogram from 2008-2016. BAC was quantified with the Bradley score derived from an automated algorithm developed by CureMetrix; presence of BAC was defined as a Bradley score ≥10. Mortality data were collected after index mammogram by review of medical records. Adjusted hazard rations (aHR) were calculated using Cox regression models with interaction terms to evaluate the influence of age on the association between presence of BAC and mortality, after adjusting for age, diabetes, medications, race, current smoking, systolic blood pressure, total and HDL cholesterol, plus prior CVD.

Results
In the overall study population 8% had diabetes, 30% hypertension, 30% hyperlipidemia and 5% were current smokers. BAC was detectable in 522 of 9,027 (6%) of women age 40-59 years, 657 of 2,865 (23%) 60-69 years, and 702 of 1,358 (52%) 70+. Over mean follow-up of 4.2 years, there were 328 deaths (15.1%) among women with BAC. When subjects were separated by age, presence of BAC was associated with mortality among younger women (40-59 years: aHR 1.50 [95% CI 1.06-2.12]; 60-69 years: aHR 1.59 [95% CI 1.19-2.12],
Figure
). Among women ages 70+, BAC was not a significant predictor of mortality (aHR 1.11 [95% CI 0.86-1.43]). There was a significant negative interaction effect of age with BAC for prediction of mortality (p < 0.001).

Conclusions:
BAC is predictive of mortality, especially in younger women. BAC may be a useful screening adjunct to traditional CVD risk factors, to help identify women at an early age who may benefit from more targeted preventive measures.

Figure
Abstract 11712: Transcatheter Reconstruction of Right Ventricular Outflow Tract After Severe External Compression by a Pseudoaneurysm in an Adult With Tetralogy of Fallot
Authors: Takamatsu Chelsea , Ibrahim Ramzi , Corban Michel T , Klewer Scott E , Seckeler Michael D
Published: June 2023

Introduction:
Increased survival of adults with tetralogy of Fallot (TOF) has led to the recognition of unanticipated complications. A rare complication after TOF repair is a right ventricle pseudoaneurysm (RV PSA). Often asymptomatic and incidentally found on imaging, the few reports of clinically significant RV PSA were mostly treated surgically. We present an adult with RV PSA after TOF repair treated by a novel transcatheter approach.

Case Presentation:
A 41 year old male with TOF and a valved right ventricle to pulmonary artery conduit presented with right ventricular failure due to right ventricular outflow tract obstruction (RVOTO) from an anterior RV PSA compressing the conduit (Figure 1). His case was further complicated by HFrEF, severe pulmonary regurgitation, and refractory atrial fibrillation requiring anticoagulation. Surgical intervention was not offered due to five prior sternotomies; he was not a transplant candidate due to substance abuse. CT imaging was used to create a virtual 3D model for interventional planning (Figure 1). A Covered CP Stent™ (B. Braun, Bethlehem, PA) on top of a Palmaz™ XL 5010 stent (Cordis Corp, Miami Lakes, FL) was anchored in the pulmonary valve ring and extended proximally to seal the PSA leak in the RVOTO, followed by Sapien S3 valve (Edwards, Irvine, CA) implantation in the proximal end of the stents (Figure 2). Right ventricular systolic pressure acutely decreased with improved systolic function.

Conclusion:
Adults with congenital heart disease often require unique approaches to intervention for managing the unnatural history of their conditions. 3D modeling of complex structures is a vital tool to plan these interventions.
Abstract 11722: Trends and Outcomes of Mechanical Circulatory Support in Pregnancy
Authors: Alharbi Anas A , Al Hajji Mohamed , AlYami Bandar , sattar yasar , balla sudarshan
Published: June 2023

Introduction:
Although cardiogenic shock is a rare presentation in pregnant patients, recent advances in advanced heart failure improved the survival in this particular group. In this abstract, we will present the trend of mechanical circulatory support (MCS) use in pregnancy and its inpatient outcomes.

Methods:
We used the national inpatient sample database between 2016 and 2019 to select all pregnancy admissions who underwent mechanical circulatory support using the tenth revision international classification of diseases.

Results:
The trend of MCS use did not change significantly during the study period (Figure 1). Around 23.9% of patients died during the same admission. Patients who survived had a mean of 16 days of hospital stay. About 31% of patients were discharged home, 15.5% were discharged to skilled nursing facilities and 15.5% were discharged to short-term hospitals or rehab (Table 1 and 2)
Conclusions:
The trend of mechanical circulatory support use in pregnant patients did not change significantly during the study period. Around one fourth of patients died during the same admission.
Abstract 11734: Myocardial Perfusion Reserve Quantified by Stress Cardiovascular Magnetic Resonance Imaging is Reduced in Long COVID Patients Presenting With Chest Pain
Authors: Culver Austin , Ju Peter , Kim Daniel , Benefield Brandon , Hsu Li-Yueh , Gunasekaran Suvai , Ison Michael , Kalhan Ravi , Allen Bradley D , Markl Michael , Yancy Clyde , Lee Daniel C
Published: June 2023

Introduction:
Chest pain is common in patients with Post-acute Sequelae of SARS-CoV-2 (PASC), also known as long COVID, but the mechanism is unknown.

Hypothesis:
We hypothesized that PASC patients with chest pain have impaired myocardial perfusion reserve (MPR) measured by stress perfusion cardiovascular magnetic resonance (CMR) imaging.

Methods:
We retrospectively identified the first 30 consecutive patients who underwent clinically ordered adenosine stress perfusion CMR for chest pain persisting >4 weeks after SARS-CoV-2 infection (PASC). Patients with a history of coronary artery disease (CAD) or left ventricular ejection fraction (LVEF) <50% were excluded. Patients without a history of SARS-CoV-2 infection who had a normal clinically ordered perfusion CMR served as controls. A previously-described automated pixel-wise quantitative perfusion tool was used to calculate stress and rest myocardial blood flow (MBF) in mL/min/g, and MPR as the ratio of stress MBF/rest MBF. The cutoff for reduced MPR was >2 SD below mean MPR for controls.

Results:
In 30 PASC (67% female, age 43±13) and 13 controls (54% female, age 50±12), with LVEF (61±6% vs 59±8%), native T1 (1001±49 vs 992±57 ms), T2 (49.5±3.7 vs 48.0±3.3 ms), and ECV (24.6±2.9 vs 24.6±2.6%) were similar (p>0.2 for all). Prior pericarditis (n=2) or prior myocarditis (n=3) were infrequent, with no acute disease by CMR. PASC patients had significantly lower global MPR than controls (1.54±0.25 vs. 2.20±0.36, p<0.001), and 16/30 (53%) PASC patients had reduced MPR (<1.49). Clinical ischemia evaluation revealed obstructive CAD in only 2 PASC patients.

Conclusions:
In PASC patients with chest pain undergoing stress perfusion CMR, global MPR is frequently reduced and is significantly lower than in patients with normal clinical perfusion CMR and no history of SARS-CoV-2 infection. This study raises the possibility that microvascular dysfunction is an important cause of chest pain in patients with long COVID.
Abstract 11738: Epicardial Connections as an Etiology in Recalcitrant Tachyarrhythmias After Left Atrial Ablations in Patients With Persistent Atrial Fibrillation
Authors: Carcora Yaser , Zhi Emily , Murthy Smitha , Li Stephanie , Adabag Selcuk , Tholakanahalli Venkatakrishna N
Published: June 2023

Introduction:
Left atrial radio frequency ablation(RFA) for persistent atrial fibrillation(AF) and left atrial tachycardias(LAT) are often challenging due to the presence of epicardial connections(EC).

Hypothesis:
Mapping and subsequent ablation of epicardial connections using high density(HD) mapping and activation patterns leads to successful termination of persistent AF and LAT.

Methods:
We studied 40 patients who were found to have epicardial connections as determined by HD mapping, missing isochrones and activation patterns. All patients underwent antral ablation for pulmonary vein isolation (PVI). LAT were remapped using Advisor HD Grid catheter.

Results:
At baseline, the mean age and BMI was 74±6.4 and 33.5±5.8 respectively. Out of 40 patients with EC, 21 were associated with the Vein of Marshall (Figure 1), 4 were associated with Septo-pulmonary bundles(figure 2), 6 were associated with the Bachman Bundle(Figure 3) and 9 were associated with Septo-atrial bundles. Acutely, endocardial ablation opposite to the epicardial connection sites achieved success with PVI, Posterior Wall Isolation(PWI) and termination of LAT.

Conclusions:
EC significantly contributes to the failure of PVI, PWI and the reorganization of LAT. Rigorous mapping of the connecting bundles using HD mapping helps target the ablation sites for successful outcomes.
Abstract 11746: Decellularized Dermis Extracellular Matrix Alloderm Mechanically Strengthens Biological Engineered Tunica Adventitia-Based Blood Vessels
Authors: Patel Bijal , Wonski Bryan , Dan Saliganan , Rteil Ali , Kabbani Loay , Lam Mai T
Published: June 2023

Introduction:
Of the three layers of a mammalian artery, the tunica adventitia provides the most strength to prevent rupture of blood vessels under high pressures. The structural network of this outermost layer mainly consists of fibroblasts and collagen. Many groups have improved strength of their tissue engineered (TE) vessels by conditioning with pulsatile flow in bioreactors. Conditioning stimulates cellular collagen production; however, it is time-consuming ranging from 3-8 weeks. Dermis is comprised primarily of collagen providing skin with considerable strength.

Hypothesis:
We hypothesized inclusion of decellularized dermis, Alloderm, into TE vessels can increase the strength and thus decrease production time.

Methods:
To generate a TE adventitia vessel, we adapted our lab’s ring stacking method which creates tissue rings that are stacked to form a tubular, vascular constructs. Human dermal fibroblasts (HDFs) were used to form a cellular fibrin hydrogel in a petri dished with a central post. Alloderm was cut into a donut shape and placed on top of the hydrogel around the central post (Figure 1). Additional HDFs were placed on top of the hydrogel and Alloderm. Over 14 days the HDF monolayer rolled around the post into a ring. These Alloderm rings were stacked and adhered using fibrin glue to create a TE vessel.

Results:
TE vessel tensile strength was significantly higher with Alloderm than without: 1500 ± 262 kPa (n = 5) versus 67.9 ± 9.78 kPa (n = 5). Histology indicated Alloderm significantly increased total collagen content and fiber maturity compared to TE vessels without. Mechanical integrity of Alloderm rings was maintained for 4 weeks: tensile strength 2760 ± 1130 kPa. In comparison, native adventitia strength is 1430 ± 604 kPa.

Conclusions:
This work shows that decellularized dermis can successfully be incorporated into TE vessels. Additionally, inclusion of Alloderm significantly increases tissue strength and collagen content that is maintained over time.
Abstract 11761: Increasing Trend in All-Cause Mortality Among Elderly Black Patients Hospitalized With Acute Myocardial Infarction With Prior Coronary Artery Bypass Grafting - A Nationwide Inpatient Analysis 2016-2019
Authors: Prem Anand Dharshana , Shahnawaz Warda , Raja Sager Avinaash , Pannala Sai Shanmukha Sreeram , Rahman Aleen , Miguel April Kristine , Nathani Pratiksha Shankarlal , Lekkala Sai Prasanna , Srikanth Sashwath , Desai Rupak
Published: June 2023

Background:
Acute myocardial infarction (AMI) in elderly patients who have previously undergone coronary artery bypass grafting (CABG) poses a diagnostic and therapeutic complexity. There is limited data on cardiovascular and mortality outcomes for this population.

Methods:
Using the National Inpatient Sample (NIS) from 2016-2019, we identified patients over 65 years with a prior CABG presenting with AMI, excluding those with a history of percutaneous coronary intervention. After assessing baseline characteristics, we analyzed trends in cardiovascular disease (CVD) risk and all-cause in hospital mortality (ACM) while stratifying for gender and race. Pearson’s chi-squared test was utilized to compare the CVD variables.

Results:
There were 266,365 hospitalizations included in the study with a median age of 77 years. They were predominantly males(69.5%), of Caucasian origin (81.7%), Medicare enrollees (91.4%) and were admitted in urban teaching hospitals (67.2%) located in the South of the US (39.5%) as non-elective cases (93.8%). Between 2016-19, Hyperlipidemia (HLD), smoking(Sm), and obesity(Ob) showed an increasing trend in males (2.8%, 1.3%, and 2% respectively) and females (2.1%, 2.4%, and 2% respectively), whereas hypertension (HTN) decreased by 4.5% in males and 6.3% in females.The length of stay remained constant at 4 days and the average cost of stay was 58963.5 USD. HTN among all races decreased from 2016 to 2019 except for Native Americans. HLD and obesity exhibited an upward trend among all races. Hispanics and Asians/Pacific Islanders(PI) had a consistent downtrend in mortality rates, with Native Americans showing the biggest drop in mortality rate (6.9%). All-cause mortality decreased from 2016 to 2019 by 1.4% except for Blacks which has increased by 2.6%, overtaking Asian/PI. All p<0.001.

Conclusion:
More research is needed to determine the factors contributing to the increased all-cause mortality trend in Black patients admitted with AMI.
Abstract 11764: A Novel Approach for Pre-Implant Endothelialization of Xenogeneic Decellularized Vascular Tissues by Human Endothelial Cells Utilizing Tissue Surface Modification and Dynamic Culture
Authors: Ho WenJin , Masumoto Hidetoshi , Kobayashi Mako , Murata Kozue , Ikeda Tadashi , Hashimoto Yoshihide , Kimura Tsuyoshi , Minatoya Kenji , Kishida AKIO
Published: June 2023

Introduction:
Autologous grafts for revascularization might be limited due to the quality of vessels. Decellularized xenogeneic vascular grafts potentially substitute for autologous grafts. We have been developing a decellularization method based on high hydrostatic pressure (HHP) which confers highly preserved extracellular structure. For broader application of the HHP-decellularized vascular graft, pre-implant endothelialization of the grafts by human endothelial cells would be anticipated which may prevent clot formation and graft occlusion.

Hypothesis:
We hypothesized to achieve sufficient
ex vivo
endothelialization of HHP-decellularized tissues by virtue of chemical endothelial surface modification and dynamic culture recapitulating blood flow.

Methods:
Thin slices of bovine aortic endothelium were decellularized by HHP. We divided the tissues in 2 groups: coated with E8 fragment of human laminin 411 (hL411) holding high affinity with endothelial cells and coated with gelatin (Gel). We directly seeded human umbilical vein endothelial cells (HUVECs) with a density of 2 х10
6
cells/cm
2
, then divided the tissues in 2 subgroups: dynamic culture (20 cm/s) and static culture. We kept the culture for up to 2 weeks and evaluated the area coverage by staining of live cells by Calcein-AM, histological analysis, and scanning electron microscopy (SEM). We tested clot formation using human whole blood.

Results:
hL411/dynamic group exhibited significantly higher area coverage compared to those of other groups which almost reached 100% [coverage at 2 weeks: Gel/static vs hL411/static vs Gel/dynamic vs hL411/dynamic: 57.3±4.1 vs 61.3±2.7 vs 74.7±19.9 vs 99.3±0.7 %, p<0.001(vs NC/static), n=6]. Immunostaining for CD31 and SEM revealed sufficient coverage with endothelial cells in hL411/dynamic. Clot formation assay showed lower clot formation in hL411/dynamic group than in hL411/static (p=0.014) and mock without hL411 coating (p=0.006) (n=3).

Conclusions:
Surface modification of HHP-decellularized xenogeneic endothelial tissues combined with dynamic culture achieved sufficient
ex vivo
endothelialization accompanied with the prevention of clot formation which would promote the clinical use of endothelialized vascular grafts in the future.
Abstract 11773: Burden, Trends, Odds and Predictors of Acute Cardiac Events in Geriatric Patients Admitted With Comorbid Chronic Kidney Disease With vs. Without Cannabis Use - An Age Matched Nationwide Analysis, 2016-2019
Authors: Desai Rupak , Raza Syed Mohammad Moosi , guddeti ananth vallabh , Mahajan Kshitij , Vasavada Advait , Surpur Swapnil , Patlolla Mani Chandan Reddy , Fatima Ehrima , Bambhroliya Zarna , Gbemudu Paul , Jain Akhil
Published: June 2023

Background:
The impact of recreational marijuana use/cannabis use disorder (CUD) in elderly chronic kideney disease (CKD) patients remains unknown amidst the rising use of cannabis in the USA. We conducted a nationwide study to assess the impact of CUD on cardiovascular outcomes in these patients.

Methods:
We used National Inpatient Sample (2016-2019) and geriatric (≥65 years) admissions with CKD. We compared baseline characteristics, comorbidities and composite in-hospital outcomes [MACCE- all-cause mortality, acute myocardial infarction-AMI, cardiac arrest and acute ischemic stroke-AIS] between the age-matched (1:1 propensity score matching) CUD+ vs. CUD- cohorts.

Results:
Age-matched (median 70 years, p=0.998) geriatric CKD-CUD+ (n=34255) and CUD- (n=34225) cohorts were compared. CUD+ cohort often consisted of males (75.0 vs. 53.8%), blacks (35.9 vs 20.8%) and patients from lowermost income quartile (38.7 vs. 33.5%) (p<0.001). CUD+ cohort had a higher burden of smoking, depression, PVD, and hypertension (p<0.05). Multivariate analysis did not find association between CUD and overall MACCE in CKD patients (aOR 1.05, 95CI 0.93-1.18, p=0.433). Odds of AMI was 1.24 times higher in CUD+ cohort [aOR 1.24, 95CI 1.07-1.43, p=0.005], however, no significant association was found for AIS, cardiac arrest. Inpatient mortality was significantly lower in CUD+ cohort [aOR 0.59, 95CI 0.46-0.75, p<0.001]. Males [aOR 1.20], HTN [aOR=1.31], hyperlipidemia [aOR 1.48], diabetes [aOR=1.01], alcohol abuse [aOR 1.01], PVD [aOR=1.26], cancer [aOR=1.01], South region admissions [aOR=1.31] were significant positive predictors of MACCE in the geriatric-CKD-CUD+ cohort. Smoking (OR=0.79), depression (OR=0.72) and obesity (OR=0.74) demonstrated paradox effect on MACCE with CUD.

Conclusions:
Recreational cannabis use in the geriatric population with comorbid CKD was not associated with increased composite MACCE, however, increased the risk of AMI.
Abstract 11780: Machine Learning Models to Predict Development of CKD and/or HF in Early Stages of Type 2 Diabetes Patients
Authors: Tsubota Hiroo , Yajima Toshitaka , Kanda Eiichiro , Kanemata Satomi , Suzuki Atsushi , Shirakawa Koichi , Makino Masaki
Published: June 2023

Chronic kidney disease and/or heart failure (CKD/HF) are the first and most frequent comorbidities that are associated with adverse prognosis in early stages of type 2 diabetes (T2DM) patients. However, efficient screening and risk assessment strategies for the development of CKD/HF remain to be established. We aimed to develop novel machine learning models that can predict the risk of CKD/HF manifestation as well as prognosis in early stages of T2DM patients without a history of CKD or cardiovascular diseases (CVDs). Prediction models were developed with extreme gradient boosting machine (XGB), neural network, logistic regression (LR), and Cox proportional hazards using real-world data of T2DM patients aged ≥18 years without a history of CKD or CVDs (n=217,054) extracted from a Japanese hospital-based administrative claim database. A separate dataset of 16,822 patients from another Japanese database was used for external validation. The outcomes used to construct the models were diagnosis of CKD/HF, hospitalization for CKD/HF and all-cause death during a 5 -year follow-up period. AUROC of XGB and LR for each outcome were as follows. Diagnosis of CKD/HF: 0.777 (XGB); 0.732 (LR), Hospitalization for CKD/HF: 0.785 (XGB); 0.767 (LR), All-cause death: 0.918(XGB) and 0.903(LR). The best-performing XGB models were externally validated; AUROC for diagnosis of CKD/HF , hospitalization for CKD/HF and all-cause death were 0.718 , 0.837 and 0.869 respectively. Furthermore, the Kaplan-Meier curves showed that for both outcomes, the hazard ratio of event-free survival in the group predicted as high-risk and low-risk in the XGB model was statistically significant (Figure). These results demonstrated successful construction of prediction model and using an administrative hospital database and suggest that our model may contribute to early diagnosis and intervention of CKD/HF among early stages of T2DM patients and ultimately improving prognosis of the patients.
Abstract 11805: Giant Cardiac Lymphangioleiomyomatosis: A Previously Unreported Primary Cardiac Tumor
Authors: Xiang Kun , Fan Chengming
Published: June 2023

Lymphoangioleiomyoma is a benign lymphatic tumor characterized by proliferation of perivascular epithelioid cells and is commonly known as part of the lymphangioleiomyomatosis (LAM). LAM is a rare, slowly progressive systemic disease and is considered as a low-grade, metastatic neoplasm, almost exclusively affects women of child-bearing age. LAM generally presents with features of cystic lung destruction. Independent onset of extrapulmonary LAM without typical cystic lung destruction is very rare. Herein, for the first time, we present a giant primary cardiac lymphangioleiomyoma of a 24-year old man with exertional dyspnea and intermittent chest pain. A giant mass (52 mm х 65 mm) and multiple irregular dark purple cauliflower-like nodules were found with irregular margins and firm texture involving the right atrium, right ventricle, inferior vena cava, superior vena cava and sinus node (Attached figure). Given the large size and wide involvement of the heart tumors, radical surgery was not performed except for a tissue biopsy. The final diagnosis of cardiac lymphangioleiomyoma was defined after pathological reexamination of the tumoral tissue sample. After comprehensive communication, the patient refused further surgical treatment and discharged with waiting for heart transplant. To our knowledge, the presented cardiac lymphangioleiomyoma is the first to be reported in the literature.