bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 16558: Revascularization in Patients With Ischemic Cardiomyopathy and Viability: A Meta-Analysis of Randomized Controlled Trials
Authors: Truong Vien T , Ngo Tam , Duong Hoang N , Patel Vivek , Dai Phan Q , Ahmad Mansoor , Patel Krunalkumar , Dutta Abhishek , Khan Amna , Jaiswal Jay , Usama Syed Muhammad , Vo Minh A , Tripathi Devendra , Skenderi Sonela , Metkus Thomas , Dhar Sunil
Published: December 2023

Introduction:
Observational studies have suggested that revascularization improves survival in patients with ischemic cardiomyopathy (ICM) with left ventricular ejection fraction less than less than or equal to 35% and demonstrable myocardial viability compared to medical therapy alone. However, the recent Revascularization for Ischemic Ventricular Dysfunction (REVIVED) trial revealed that among patients with severe ischemic left ventricular systolic dysfunction receiving optimal medical therapy, percutaneous coronary intervention did not reduce the incidence of major adverse cardiac events.

Hypothesis:
This meta-analysis aims to evaluate the impact of revascularization on patients with ICM and demonstrable myocardial viability, specifically focusing on randomized controlled trials (RCTs).

Methods:
We conducted a systematic search of MEDLINE, Embase, and the Cochrane Database of Systematic Reviews from inception to February 8th, 2023. The primary outcome assessed in this study was mortality. A random-effects models were applied to pool effect sizes.

Results:
Four RCTs involving 1365 patients with ICM and viability met the inclusion criteria. Among them, 684 patients were included in the revascularization group, while 681 patients received optimal medical therapy. In the revascularization group, 232 patients (34%) died, compared to 266 patients (39%) in the medical therapy group. The meta-analysis revealed that revascularization in this patient population was not associated with a significant improvement in survival (pooled odds ratio [OR]: 0.82; 95% CI: 0.59-1.14; p = 0.24). Furthermore, revascularization did not show a significant reduction in major adverse cardiac events (pooled odds ratio [OR]: 0.56; 95% CI: 0.27-1.16; p = 0.12).

Conclusions:
This meta-analysis of randomized controlled trials does not provide evidence supporting the effectiveness of revascularization in patients with ICM and demonstrable myocardial viability
Abstract 16566: A Lifestyle-Integrated Resistance-Based Exercise Intervention for Sarcopenic Patients With Coronary Artery Disease: A Pilot Randomized Controlled Trial
Authors: Li Polly Wai Chi , yu Doris S
Published: December 2023

Introduction:
Sarcopenia is an important prognostic indicator for patients with coronary artery disease (CAD). No study has explored the effects of resistance-based exercise on sarcopenic patients with CAD.

Hypothesis:
Patients who receive the lifestyle-integrated resistance-based exercise intervention would have better physical performance, skeletal muscle mass, muscle strength, cardiac-related functional status, health-related quality of life (HRQoL) and psychological distress after the intervention than those who receive usual care.

Aims:
To examine the feasibility and preliminary effects of the strength-building lifestyle-integrated intervention among sarcopenic CAD patients on physical performance, skeletal muscle mass, muscle strength, cardiac-related functional status, HRQoL and psychological distress.

Methods:
This two-arm pilot randomized controlled trial recruited community-dwelling older CAD patients with sarcopenia. Patients in the intervention group received the 12-week individualized, progressive, low-to-moderate intensity resistance-based exercise intervention delivered through in-person and online supervised approach. The control group received usual care.

Results:
Thirty-eight participants (mean age: 69.0 ± 4.9 years) were randomized into the intervention (n = 21) or control (n = 17) group. The intervention was feasible and acceptable. The lost to follow-up rate was 7.9%, and the overall attendance was 92%. No adverse events were recorded. The intervention group showed significantly greater improvement in HRQoL (β = 0.417, 95%CI: 0.036 - 0.798, p = 0.032) and functional status (β = -1.342, 95%CI: -2.808 - -0.124, p = 0.043) than the control group at the immediate post-intervention. No significant between-group changes in physical performance, muscle mass and strength, and psychological distress were detected.

Conclusions:
The intervention is feasible and acceptable for CAD patients. It improves patients HRQoL and functional status. A full-scale randomized controlled trial is warranted to investigate its effects.
Abstract 16587: Sodium Glucose Cotransporter-2 Inhibitors Post Acute Coronary Syndrome Induced New Heart Failure
Authors: Rahhal Alaa , Hamamyh Tahseen , Chapra Ammar , Najim Mostafa , hemadneh mohammad , Faraj Hazem , Yasin Ahmed , Toba Haneen , Mohammed Wafa , Hamad Mohammad Khair , Kanjo Wael , Al-Tikrety Nawras , Mahfouz Ahmed , Alyafei Sumaya , Al-Hijji Mohammed , Arabi Abdulrahman , Patel Ashfaq
Published: December 2023

Introduction:
Patients with acute coronary syndrome (ACS) have an unmet need for further risk reduction in major adverse cardiovascular events (MACE) and heart failure (HF) development despite guideline-directed medical therapy. As sodium glucose cotransporter-2 inhibitors (SGLT2i) are cardioprotective, in this study, we assessed the effectiveness of SGLT2i post-ACS with new onset HF.

Hypothesis:
SGLT2i use improves the effectiveness outcomes post-ACS induced new HF.

Methods:
We conducted a retrospective observational cohort study that included all diabetic patients admitted to the main tertiary cardiology center in Qatar between 1/06/2017 and 1/06/2021 with ACS complicated by new HF defined as new clinical HF requiring diuretics during the index admission, or ejection fraction (EF) <40%. We divided the study population in two groups; (1) SGLT2i users; (2) non-SGLT2i users. Primary outcomes were evaluated at 30 and 360 days, including a composite of ACS, HF hospitalization, and all-cause mortality. A propensity score-matched model (1:1) was used to adjust for baseline characteristics between the study groups. Cox proportional hazard regression analysis was used to evaluate the outcomes. P-value <0.05 indicated statistical significance.

Results:
We included 465 ACS patients who met the eligibility criteria (93% male, mean age 55±10 years, and 72% Asian). Using 1:1 propensity score matching, 78 patients were included per arm with an absolute standardized difference <0.1 for all baseline characteristics. The use of SGLT2i post ischemia-induced new HF resulted in lower composite outcomes at 30 and 360 days [
30-day:
2.6% vs. 11.5%, HR= 0.20 (0.04-0.94), P =0.041;
360-Day:
14.1% vs. 23.1, HR= 0.46 (0.22-0.99), P= 0.046].

Conclusions:
Our findings suggest cardioprotective effects of SGLT2i post-ACS induced new HF, which widens the SGLT2i spectrum of indications and may encourage cardiologists to prescribe SGLT2i for this population.
Abstract 16602: The PlGF-Nrp1 Interaction Promotes the Splenic Immune Response in Hypertension After Neuroimmune Activation
Authors: Perrotta Sara , Carnevale Lorenzo , Pallante Fabio , Perrotta Marialuisa , Mastroiacovo Francesco , Migliaccio Agnese , Lembo Giuseppe , Carnevale Daniela
Published: December 2023

Introduction:
We previously discovered that Placental Growth Factor (PlGF) is released in the spleen by a sympathetic discharge to elicit hypertension. Neuropilin1 (Nrp1) is one of PlGF receptors and, interestingly, is a transmembrane protein expressed on precursors of Dendritic cells (DCs).

Hypothesis:
Here we investigated the involvement of Nrp1 as the PlGF receptor mediating the neuroimmune activation of immune response during hypertension.

Methods:
We used flow cytometry and tail cuff to evaluate the involvement of PlGF-Nrp1 pathway in neuroimmune activation of splenic immune response in hypertension.

Results:
To define Nrp1 role in transducing PlGF effect during hypertension, we evaluate its expression by flow cytometry finding that monocyte-derived DCs (MoDCs) increased Nrp1 expression in response to AngII (12.7±1.3 vs 28.8±3 % Nrp1 Veh vs AngII; p<0.01). This effect was blocked by splenic sympathetic denervation obtained by celiac ganglionectomy (CGX) (28.8±3 vs 14±1.5 % Nrp1 Sham AngII vs CGX AngII; p<0.01). To test the relevance of PlGF-Nrp1 pathway in hypertension, we generated a transgenic mouse model with a selective deletion of Nrp1 in myeloid lineage utilizing the LysMcre (Nrp1
myeKO
mice). By using an in vitro standard differentiation protocol of maturation of monocytes in DCs, we observed that CD86 and MHCII expression was up-regulated in MoDCs from the spleen of WT mice cultured in the standard medium plus rmPlGF (0.014±0.001 vs 0.035±0.005 CD86+ DCs/total cells count respectively, p<0.05; 0.010±0.003 vs 0.030±0.003 MHCII+ DCs/total cells count respectively, p<0.01). On the contrary, CD86 and MHCII were similarly expressed on MoDCs from Nrp1
myeKO
mice cultured with and without rmPlGF indicating that PlGF is involved in the maturation of MoDCs through its interaction with Nrp1. To confirm the involvement of Nrp1 in blood pressure (BP) increase, we infused AngII to Nrp1
myeKO
mice, finding that they were protected from hypertension as compared to WT control mice (Systolic BP 106±1 vs 126±2 mmHg respectively, p<0.001).

Conclusions:
These data demonstrate that PlGF-Nrp1 pathway is a key mechanism that promote the immune response involved in hypertension and blocking the splenic innervation, hampered this response and BP increase.
Abstract 16604: Systemic Lupus Erythematosus and Pregnancy: An Analytical Review of Cardiovascular Disease and Obstetric Complications
Authors: Hussain Bilal , Mahmood Ahmed M , Alalawi Luay , cuevas christel , Khan Sohail , Waqar Fahad , Alexander Thomas , Ansari Mohammad M
Published: December 2023

Background
Cardiovascular disease in pregnant patients with Systemic Lupus Erythematosus (SLE) is not well studied. Our objective is to study the prognostic implications of SLE in pregnancy in terms of cardiovascular disease (CVD) and obstetric complications.

Methods
A retrospective cohort analysis was conducted using National Inpatient Sample 2016-2020. Cohorts of patients hospitalized for SLE, pregnancy and CVD were identified using respective ICD-10 codes. Multivariate logistic regression analysis was used to assess prognostic outcomes.

Results
Among 898825 patients hospitalized for SLE, 30845 patients were pregnant. Out of these patients with SLE and pregnancy, 1710 patients had cardiovascular disease (prevalence 5.5%). Mean age for SLE patients with pregnancy and cardiovascular disease was 30 years, 36.7% were white, and 36.4% were African-American. SLE in pregnancy is associated with five folds higher odds of cardiovascular disease (OR 4.8, CI 4.3-5.5, p<0.001). The strongest association of SLE in pregnancy is with pericarditis (OR 77, CI 34.4-172, p<0.001), followed by myocarditis (OR 35, CI 3.9-312, p=0.001), pulmonary hypertension (OR 12.9, CI 8.6-17.5, p<0.001), ischemic heart disease (OR 9.3, CI 6.7-12.8, p<0.001), stroke (OR 9.3, CI 4.8-18, p<0.001) and congestive heart failure (OR 7.7, CI 5.16-11.5, p<0.001). Table 2 outlines the pregnancy outcomes and complications in SLE. SLE is associated with significantly lower odds of live birth (OR 0.35, CI 0.32-0.37, p<0.001). SLE is associated with significantly higher odds of pregnancy complications (Table 2).

Conclusion
5.5% of SLE patients with pregnancy have CVD. SLE in pregnancy is associated with five folds higher odds of cardiovascular disease with strongest association to pericarditis, followed by myocarditis, pulmonary hypertension, ischemic heart disease, and stroke. SLE in pregnancy is associated with lower odds of live birth and higher odds of obstetric complications.
Abstract 16621: Factors Influencing the Difficulty of Guidewire Passage in Duplex-Guided Endovascular Treatment for Femoropopliteal Chronic Total Occlusions
Authors: Kanichi Otowa , Matsuura Shintaro , Dotani Naoki , Miya Yusuke , USUDA KEISUKE , Chikata Akio , Maruyama Michiro , Usuda Kazuo
Published: December 2023

Introduction:
Previous studies have shown the effectiveness of duplex-guided endovascular treatment (EVT) for femoropopliteal chronic total occlusions (FP-CTO). However, the factors that contribute to the difficulty of guidewire passage during duplex-guided EVT have not been clearly understood. Therefore, this study aimed to examine the factors associated with prolonged guidewire passage in the CTO segment using this method.

Methods:
In this single-center, retrospective analysis, data from patients who underwent duplex-guided EVT for FP-CTO from April 2018 to March 2023 were collected. The guidewire passage index (GPI), defined as the time required for guidewires to pass the CTO segment divided by the length of the CTO segment, was used. The study aimed to explore the correlation between the GPI and the personal backgrounds and lesion characteristics of the patients.

Results:
A total of 40 lesions in 35 patients (28 males, mean age: 75.8 ± 6.5 years) with consecutive de novo lesions were treated using duplex-guided EVT. The patients had a mean height of 162.0 ± 7.8 cm, weight of 58.9 ± 10.9 kg, body mass index (BMI) of 22.4 ± 3.4 kg/m
2
, and pre-EVT ankle brachial index (ABI) of 0.50 ± 0.19. The mean lesion length was 218.2 ± 67.8 mm, and the CTO length was 159.4 ± 85.0 mm. All procedures were successful, with an average time of 44 ± 48.2 min required for guidewires to pass the CTO segment and a GPI of 2.9 ± 2.7 min/cm. There was a negative correlation (–0.46) between the time required for guidewires to pass the CTO segment and age, while positive correlations were found between the time required for guidewires to pass the CTO segment and weight, BMI, lesion length, and CTO length (0.32, 0.44, 0.48, and 0.58, respectively). However, no associations were found between GPI and factors such as gender, hypertension, diabetes, dyslipidemia, renal insufficiency, smoking status, CTO length of 150 mm or more, Rutherford classification, Fontaine classification, or puncture site. Additionally, no correlations were found between GPI and age, height, weight, BMI, preoperative ABI values, lesion length, or CTO length.

Conclusions:
The patient background does not appear to have an impact on the difficulty of guidewire passage in duplex-guided EVT for FP-CTO.
Abstract 16625: Frameshift Mutation in
LMNA
Gene Causes Atrial Arrhythmogenesis via Epigenetic Inhibition of
KCNA5
Expression
Authors: ZHU YUE , LIN ZHIQIAO , Lin Yongping , ZHENG BINGYU , ZHANG YIKE , Liu Hailei , JU WEIZHU , Cui Chang , Chen Minglong
Published: December 2023

Introduction:
Cardiolaminopathy is a genetic heart disease caused by
LMNA
mutations, often leading to atrial tachycardia, AV block, ventricular arrhythmia and eventually dilated cardiomyopathy. While performing WES on pedigrees with primary atrial myopathy, we identified that nearly half of them possess mutations on the
LMNA
gene. However, previous studies on laminopathy have mainly focused on ventricular lesions, leaving the mechanism of how
LMNA
mutation leads to the atrial myopathy yet to be elucidated.

Methods:
To better understand the role of the
LMNA
gene in atrial cardiomyopathy, we employed the CRISPR/Cas9 to establish a heterozygous KI mouse model with a frameshift mutation (
lmna
c.1249delA, p.K418Sfs) identified from a pedigree of atrial cardiomyopathy.

Results:
The heterozygous mice displayed progressive and spontaneous atrial arrhythmia, along with increased fibrosis, without any involvement of the ventricles, which was consistent with the affected individuals in the pedigree. Electrophysiological measurements showed prolonged APD90, an increased occurrence of EAD events, and augmented atrial conduction heterogeneity compared to the control mice. Bioinformatics analysis of mouse atrium indicated
KCNA5
, which specifically expressed in the atrium, was significantly down-regulated. This reduction was further corroborated through Western blotting and immunofluorescence. Additionally, ChIP qPCR analysis revealed an enhanced binding of
KCNA5
with lamin A/C and reduced binding with the promoting histone H3K4me3 in the mutant atrium. Notably, the presence of atrial arrhythmia and the downregulation of
KCNA5
were also observed in another
lmna
frameshift mutation mouse model, suggesting that these mechanisms may be universal in
LMNA
-related atrial cardiomyopathy.

Conclusions:
Laminopathy causing atrial cardiomyopathy has long been underestimated. Our study validates the pathogenicity of
LMNA
frameshift mutation for the atrium and highlights epigenetic changes leading to
KCNA5
expression downregulation and consequential phenotypic alterations. These results broaden the current knowledge of laminopathy beyond its previous emphasis on ventricular lesions, offering potential therapeutic targets for the disease.
Abstract 16630: Economic Impact of Frailty in Patients Undergoing Elective Percutaneous Left Atrial Appendage Closure (LAAC) With WATCHMAN Device
Authors: Patil Shivaraj , Tito Sahana , Rojulpote Chaitanya , Atri Viha , Atri Avica , Bhattaru Abhijit , Khraisha Ola
Published: December 2023

Introduction:
Frailty is associated with significant morbidity and mortality in older adults. Currently, standard practice after percutaneous left atrial appendage closure involves monitoring patients overnight and discharging them the following day.

Hypothesis:
Frailty predicts increased hospital cost and length of stay (LOS) in patients undergoing elective LAAC with WATCHMAN device.

Methods:
Patients aged ≥65 years who underwent elective LAAC with WATCHMAN device were identified using ICD-10 procedure code 02L73DK from 2016-2018 HCUP-NIS Database. In-hospital major adverse event (MAE) was defined as the composite of mortality, stroke (ischemic or hemorrhagic) or TIA, bleeding or transfusion, vascular complications, myocardial infarction, systemic embolization, and pericardial effusion or tamponade requiring pericardiocentesis or surgery. Hospital Frailty Risk Score (HFRS) was calculated for each patient based on 109 ICD-10 diagnosis codes and classified into non-frail (HFRS < 5) and frail (HFRS score ≥ 5) groups. Multivariate regression analysis was used to assess the relationship between the HFRS and hospital cost hospitalization (≥90 centile) and prolonged LOS (>72 hours).

Results:
28,050 patients (Age = 77.3 ± 6.4 years; Female = 42.6%) were included. Median hospitalization cost was $24,500 (inter-decile range: $14,000-37,100) and median LOS was 1 day (inter-decile range: 1-2 days) and 4.7% experienced in-hospital MAE. Frail patients (HFRS score ≥ 5) constituted 12.5% of the cohort. Increasing Hospital Frailty Risk Score was associated with a greater risk of high-cost hospitalization and LOS > 72 hours (Figure).

Conclusions:
Increasing frailty is a significant predictor of increased hospital cost and LOS in elective LAAC. This effect is independent of age and in-hospital MAE.
Abstract 16656: Association of Mean Arterial Pressure Variability With Kidney Function in Living Kidney Donors
Authors: Tantisattamo Ekamol , Rochanaroon Voramol , Noree Wanprapit , Tribuddharat Narisara , Wanichwecharungruang Nisha , Kulthamrongsri Narathorn , Suenghataiphorn Thanathip , Naunsilp Piengpitch , Srikulmontri Thitiphan , Chuenchaem Urairat , Puchongmart Chanokporn , Thiravetyan Ben , Vutthikraivit Possawat , Tanariyakul Manasawee , Leesutipornchai Thiratest , Lalitnithi Pakin , Wattanachayakul Phuuwadith
Published: December 2023

Introduction:
While mean arterial pressure (MAP) is associated with poor kidney function, the association of MAP variability with kidney function in living kidney donors (LKD) is unknown. We aim to evaluate the association between MAP variability and kidney function post-donation.

Hypothesis:
Wide MAP variability is associated with worsening kidney function post-donation.

Methods:
A retrospective cohort study utilizing OPTN/SRTR included adult LKD undergoing donation between 6/1972 and 9/2022. MAP variability is assessed by the average real variability of MAP (ARV-MAP) defined byan average of absolute difference in consecutive MAP at 6, 12, and 24 months post-donation. The risk of ≥35% decrease in post-donation eGFR from pre-donation eGFR among quartiles (Q) for AVR-MAP was examined by multivariable Cox regression.

Results:
Of 136,984 LKD, mean±SD age was 42±12 years and 61% were female. Mean pre-donation SBP, DBP, and MAP were 122±13, 74±9, and 90±10 mmHg, respectively. Mean post-donation BP at 6, 12, and 24 months were 120±13 / 75±9, 120±13 / 75±9, and 120±12 / 75±9 mmHg, respectively and corresponding mean post-donation MAP were 89.7±9.1, 89.8±9.0, and 90.2±9.0, respectively. Median (IQR) ARV-MAP was 6 (3, 10) mmHg. Mean pre-donation eGFR was 102.1±29.1 ml/min/1.73 m
2
and eGFR at 6-, 12-, and 24-months post-donation were 60.7±42.6, 62.4±43.9, and 64.4±44.9 ml/min/1.73 m
2
, respectively. The incidence rate of the event was 8.21 per 100 person-months. Compared to Q1 of the ARV-MAP, only Q3 had a 3.8% higher risk for declined eGFR (HR
Q3
(95%CI) 1.04 (1.00, 1.08)). After adjusting for age, gender, race/ethnicity, U.S. citizenship status, level of education, history of hypertension, pre-donation BMI, pre-donation MAP, eGFR, and post-donation proteinuria, Q2, Q3, and Q4 have a 6.3%, 8.3%, and 6.9% significantly greater risk of the event, respectively (HR
Q2
1.06 (1.00, 1.12); HR
Q3
1.08 (1.02, 1.14); HR
Q4
1.07 (1.01, 1.13)). There is no effect modification of the covariates for the ARV-PP - post-donation eGFR association.

Conclusions:
The risk for a 35% decline in post-donation kidney function is associated with ARV-MAP. DBP and PP may involve in kidney function after unilateral nephrectomy in LKD who develop post-donation glomerular hyperfiltration.
Abstract 16659: Neo LVOT Prediction With the Innovalve TMVR System - CT Preliminary Results
Authors: Goitein Orly , Meerkin David , Guetta Victor , Avner Avi , Rihal Charanjit , Raanani Ehud
Published: December 2023

Introduction:
The Innovalve TMVR is a novel self-expandable trans-catheter mitral valve prosthesis, delivered trans-septally using femoral venous access. It is deployed in an intra-valvular posterior position after sub-valvular anchoring by rotation of 6 circumferential arms. LV outflow tract (LVOT) compromise is of great concern in TMVR. A predicted Neo LVOT area of 170 mm
2
is the currently accepted cut-off for LVOT obstruction.

Hypothesis:
CT can accurately predict the Neo LVOT area prior to Innovalve TMVR procedure.

Methods:
CT was performed as a screening tool to evaluate the Neo LVOT area prior to Innovalve TMVR procedure. CT protocol: Retrospectively ECG gated with full cardiac cycle coverage. CT was performed before and after the procedure. Predicted Neo LVOT (pNLVOT) was calculated using a dedicated simulation valve prior to TMVR, actual Neo LVOT (aNLVOT) was calculated with the inserted valve in place following TMVR. The native LVOT (nLVOT) area, the predicted % LVOT reduction (nLVOT area-pNLVOT area /nLVOT area), the actual % LVOT reduction (nLVOT area-aNLVOT area /nLVOT area) and the difference between them (pNLVOT%-aNLVOT%) were calculated.

Results:
One hundred patients were screened for Innovalve TMVR procedure based on Neo LVOT criteria. pNLVOT≥ 170 mm
2
was found in 11 patients (11%), (7 males) average age 68±10 years, these patients underwent Innovalve TMVR procedure. The median calculated LVOT was 647.8+/-260 mm
2
(range 373-1312), the median pNLVOT reduction was 16% ±15 (range 3-53), the median aNLVOT reduction was 5%±14 (range -5-40) and the median difference between the pNLVOT and aNLVOT was 8±12 (range -4-31). In 8/11 patients (73%), the aNLVOT was larger than the pNLVOT (range difference 1 to 31%). In 3/11 patients (27%), the aNLVOT was smaller than the pNLVOT (range difference -1 to -4%).

Conclusions:
Underestimation of neoLVOT reduction, was uncommon and documented only minor and clinically insignificant difference between the pNLVOT and aNLVOT. As overestimation of NLVOT reduction allows a margin of safety for MTVR, we conclude that CT can serve as reliable NLVOT screening tool.
Abstract 16671: Supraventricular Ectopic Activity Predicts Postoperative Atrial Fibrillation, New-Onset Atrial Fibrillation, and Worse Survival in Hypertrophic Cardiomyopathy
Authors: Nie Changrong , Zhu Changsheng , Lu Zhengyang , Wang Shuiyun
Published: December 2023

Introduction:
Supraventricular ectopic activity (SEA), in the form of frequent premature atrial contractions (PACs) and runs of PACs, has been considered a marker of foci that are capable of firing rapidly to initiate atrial fibrillation (AF), but the cut-off value has not been determined. Therefore, we aimed to examine the association between SEA and postoperative AF (POAF) and clinical outcomes and to investigate the cut-off value in patients with hypertrophic cardiomyopathy.

Methods:
This cohort included 1491 consecutively recruited patients, of which 530 were excluded for various reasons, leaving 961 patients for final analysis. All patients received 24-hour Holter ECG monitoring 2-5 days before surgery.

Results:
The mean age of the study population was 48.4 (SD,12.3) years and 397 patients (41.3%) were female. The incidence of POAF was 20.7% and increased with PACs severity. Multivariable logistic regression analysis showed that supraventricular tachycardia (SVT) was independently associated with higher incidence of POAF and the model including SVT had the largest area under the curve (AUC) [AUC=0.710] among all the multivariable models. Furthermore, Kaplan-Meier survival curves demonstrated that patients in the tertile 3 (upper tertile of the total numbers of PACs), PACs>100, PACs >200, ESVEA (top decile of PACs plus top decile length of short atrial runs), and ESVEA3 (PACs>100 plus top decile length of short atrial runs) group had significantly higher cumulative rates of new-onset AF and composite endpoints compared to their counterparts. On multivariable Cox regression analysis, PACs> 100, PACs>200, ESVEA, and ESVEA3 were independent indicators for higher incidence of new-onset AF and composite endpoints. Among those multivariate models, PACs >200 had the higher effect size for predicting new-onset AF [Hazard ratio (HR) 3.13, 95% confidence interval (CI) 1.74-5.62] and composite endpoints [HR =2.00, 95%CI 1.30-3.06].

Conclusions:
The incidence of POAF was 20.7% increasing with the severity of the PACs burden. Moreover, among supraventricular arrhythmias, SVT was the best indicator for predicting POAF. Likewise, PACs>200 may consider as the best candidate for predicting a higher incidence of new-onset AF and composite endpoints.
Abstract 16681: Echocardiogram-Based Screening and Prevalence of Rheumatic Heart Disease in Children and Adolescents From Endemic Areas: A Systematic Review and Updated Meta-Analysis
Authors: Mutarelli Antonio , Negrao Pantaleao Alexandre , Nogueira Wilson , Smiderle Gelain Marco Antônio , Pinton Fábio Augusto , Melo Pedro , Nunes Maria C
Published: December 2023

Background:
Rheumatic heart disease (RHD) is the leading cause of cardiac death in children, posing a significant burden to health systems, particularly in developing countries. Echocardiogram is a sensitive tool to identify early RHD patients, who may benefit from secondary prevention. Therefore, we performed an updated meta-analysis to determine the prevalence of latent RHD using echocardiogram-based screening performed in endemic regions across the globe.

Methods:
PubMed, Embase, Cochrane, and Lilacs databases were searched for cross-sectional studies reporting the prevalence of RHD in individuals aged 5-20 years, through echocardiogram-based screening programs in endemic areas. Studies with screening based on auscultation were excluded. Echocardiography-detected RHD was considered as borderline or definite by World Heart Federation (WHF) criteria and possible, probable or definite by World Heart Organization (WHO) criteria. We used random-effects models to assess the prevalence of RHD according to the geographic distribution.

Results:
A total of 57 studies were included, with a total of 224,100 screened subjects. WHF criteria for RHD echocardiographic diagnosis were used in 46 studies, WHO criteria in 6, and others in 3. The overall prevalence of echocardiography detected RHD was 23 per 1,000 individuals (95% CI 18 to 29 per 1,000), with a pooled prevalence of definitive RHD of 9 per 1,000 individuals (95% CI 7 to 12 per 1,000). Analysis of the prevalence of echocardiography detected RHD in different continents yielded an overall prevalence of 21 per 1,000 (95% CI 14 to 31 per 1,000) in Africa, 28 per 1,000 (95% CI 18 to 42 per 1,000) in Oceania, 21 per 1,000 (95% CI 15 to 30 per 1,000) in Asia, and 22 per 1,000 (95% CI 6 to 76 per 1,000) in Latin America.

Conclusion:
Screening programs incorporating echocardiography found a significant prevalence of RHD, in the range of 20 to 30 per 1,000 children and adolescents screened in endemic areas across different continents.
Abstract 16692: Early Life Stress Elicits Heart Failure Traits Across Generations in Mice
Authors: Costantino Sarah , Manuella Francesca , Mohammed Shafeeq , Ambrosini Samuele , Boscardin Chiara , Ruschitzka Frank , Hamdani Nazha , Mansuy Isabelle M , Paneni Francesco
Published: December 2023

Introduction:
Adverse childhood experiences, particularly early life stress (ELS), are associated with cardiovascular disease later in life but the underlying mechanisms remain elusive. Parental life experiences can have effects that are transmitted to the offspring suggesting a possible trans-generational transmission of ELS phenotypic traits.

Hypothesis:
ELS can impair cardiac function in exposed parents and their offspring.

Methods:
We used an ELS mouse model based on unpredictable separation of mouse pups (F1) from their mother (F0) each day for 3 hours from postnatal day 1 (PND1) to PND14 combined with dams exposure to an additional unpredictable stressor (forced swim in 18°C water for 5 minutes or 20-minute physical restraint in a tube) during separation. Control litters were raised normally. Echocardiography (Vevo 3100, Visualsonics) was performed at 6, 12 and 18 months in exposed animals (F0), their unexposed offspring (F1) and grand-offspring (F2). Both male and female mice were studied. Heart weight/tibia length was used to assess cardiac mass while Masson's Trichrome was employed to detect fibrosis. Lung congestion was assessed as lung wet/dry weight ratio. Single-cell RNA sequencing (scRNAseq) was performed in MSUS and control hearts. A 6-week environmental enrichment (EE) program (cages containing running wheels, maze) was employed to test the possible rescue of ELS effects in adult males and their offspring.

Results:
Male and female MSUS mice (F1) displayed a time-dependent deterioration (from 6 to 18 months) of LV hypertrophy, diastolic function, myocardial fibrosis and lung congestion when compared to controls. ScRNAseq revealed dysregulation of genes controlling inflammation and metabolism (Cav1, Fabp4) in cardiomyocyte and endothelial cell clusters. MSUS F1 and F2 females and males had diastolic dysfunction and lung congestion at 12 and 18 months (no change at 6 months). Notably, EE improved diastolic function and lung congestion in MSUS mice.

Conclusions:
ELS induces heritable cardiac alterations which can be rescued by EE in fathers. These results shed light on the causal role of ELS on heart failure development and potential mitigation strategies.
Abstract 16707: Clinical Validation of a Chest-Worn Personal ECG Device for the Detection of Atrial Fibrillation
Authors: Reddy Satish , Kennedy Alan , Vidyasagar Kirthi , Doggart Peter , Joseph Peter , Funston Rebecca C , Bhushan Manav
Published: December 2023

Introduction:
Novel consumer-focused personal ECG devices have the potential to revolutionise the way that cardiac arrhythmias are diagnosed and managed. These devices can be used remotely to monitor patients for arrhythmias, which could lead to earlier detection and treatment. In this study, we aimed to compare the cardiologist's interpretation of clinical 12-lead ECG recordings to a consumer-focused dry-electrode ECG chest strap device (Fourth Frontier FX+).

Methods:
We included patients seen in an outpatient cardiology clinic at the Sri Jayadeva Institute of Cardiovascular Science and Research, Bangalore, India. A total of 163 paired ECG recordings were captured from 85 adult patients (50% female, median age 54 years, AF present at the time of recording in 38%). Patients with critical cardiac problems or life support systems were excluded. ECG data from the Fourth Frontier FX+ (Fourth Frontier, Bangalore, India) and a standard 12-lead ECG were obtained simultaneously in the supine position. PDF reports for both devices were then generated, and the cardiologist's interpretation of the Fourth Frontier FX+ ECG was compared to the cardiologist's interpreted 12L ECG.

Results:
The cardiologist's interpretation of the Fourth Frontier FX+ data matched the cardiologist-interpreted 12L data for all patients. One FX+ ECG was excluded from the analysis due to not enough data being captured by the device. A total of 33 patients were correctly identified as having atrial fibrillation.

Conclusion:
The results of this study demonstrate that the Fourth Frontier FX+ ECG monitor is comparable to a 12-lead ECG for cardiac rhythm monitoring and that it can be used remotely to monitor patients for cardiac arrhythmias. This has the potential to change the way that arrhythmias are diagnosed and managed and lead to earlier detection and treatment at scale.
Abstract 16715: Rare or Disregarded; A Case of Autoimmune Myopathy
Authors: Barkhordarian Maryam , Grijalva Mark , Jarri Amer , Belyayeva Anna , Weissman Simcha
Published: December 2023

Introduction:
Statin-induced myopathy can present with symptoms ranging from mild myalgia to significant muscle weakness. This case report highlights how statin-induced autoimmune myopathy often goes undiagnosed.

Case Presentation:
We present a 69 year old male with a past medical history of coronary artery disease who presented with myalgia and progressive proximal muscle weakness for 2 months. On admission, creatinine kinase (CK) level was noted to be elevated at 8323 u/L. Atorvastatin was held on admission and the patient received intravenous (IV) fluid as treatment for presumed rhabdomyolysis. Although CK was trending down, the patient did not show any significant improvement in muscle weakness or myalgia. At this point, myositis was suspected, so a myositis panel including anti-HMG Co-A Reductase antibody was ordered and the patient was started on IV steroids. Anti-HMG Co-A Reductase antibody was positive and the rest of myopathy workup was negative; meanwhile, the patient's muscle weakness significantly improved. The patient was discharged on a methylprednisolone with close outpatient rheumatology follow-up.

Discussion:
Drug-induced rhabdomyolysis is one of many causes of myalgia. It is crucial to review a patient’s medication list and discontinue any possible medications that are possible offenders. Statin-induced myopathy should also be suspected when typical treatment for rhabdomyolysis is failing. Statin induced autoimmune myopathy is associated with muscle weakness, elevated CK and a positive anti-HMG Co-A Reductase antibody, which requires discontinuation of Statin and initiation of immunosuppressive therapy.

Conclusions:
This case report highlights the importance of early identification and management of statin-induced autoimmune myopathy as a possible differential diagnosis in patients with muscle weakness, elevated CK levels while on statin therapy who do not respond to IV fluid alone.
Abstract 16749: Influence of Dual-Specificity Protein Phosphatase 5 on Structural and Mechanical Properties of Rat Middle Cerebral Artery
Authors: Tang Chengyun , Zhang Huawei , Border Jane J , Fang Xing , Roman Richard J , Fan Fan
Published: December 2023

Dual-specificity protein phosphatase 5 (DUSP5) is a multifunctional phosphatase that modulates signaling cascades by catalyzing the dephosphorylation of both threonine and tyrosine residues. We recently reported that KO of
Dusp5
enhances cerebral and renal hemodynamics and cognitive function. This effect is associated with increased pPKC and pERK1/2 levels in arteries and arterioles of the brain and kidneys. Further, we found that KO of
Dusp5
contributes to the regulation of arteriolar passive mechanical properties with higher myogenic tones, better distensibility, greater compliance, and less stiffness. The present study focuses on the structural and mechanical properties of rat middle cerebral artery (MCA) to evaluate whether it contributes to enhanced vascular and cognitive function in
Dusp5
KO rats. Vascular smooth muscle cell layer numbers and collagen content in the wall of the MCA are similar in
Dusp5
KO and control rats. While external elastic lamina was absent in the MCA in both strains, internal elastic lamina was thicker in the MCA of
Dusp5
KO vs. control rats (2.33 ± 0.02 vs. 1.85 ± 0.03 μm) and associated with higher autofluorescence intensity (953.76 ± 10.03 vs. 737.31 ± 64.88 au), smaller fenestrae areas (51.31 ± 3.62 vs. 70.46 ± 2.24), and fewer number of fenestrations (138.19 ± 8.86 vs. 374.73 ± 17.02 μm
2
). Even though the myogenic tone is enhanced in
Dusp5
KO vs. control rats (52.37 ± 1.65 vs. 44.87 ± 2.00%), other passive mechanical properties (wall thickness, cross-sectional area, wall-to-lumen ratio, wall tension, distensibility, incremental distensibility, circumferential wall strain, circumferential wall stress, and elastin modulus) of the MCA of
Dusp5
KO rats do not exhibit significant changes. The findings suggest that while
Dusp5
KO has a limited impact on changing the structural and mechanical properties of the MCA, its role in enhancing hemodynamics and cognitive function is primarily attributed to its enzymatic function.
Abstract 16753: Effectiveness of Guideline-Endorsed Low-Density Lipoprotein Cholesterol Reduction Rates in Patients With Prior Percutaneous Coronary Intervention
Authors: Jung Yu Jung , Park Jong Il , Son Byung-ju , Kim Hong-ju , CHOI KANGUN , Nam Jong-Ho , Son Jang-Won , Park Jong-Seon , Shin Dong Gu , Kim Ung , Jeong Jun-Chang , Cho Yu-Hyum , Bae Yeong-Hui , Ji-Hyun Song , Kim Sun Oh
Published: December 2023

Background/Objective:
Low-density lipoprotein cholesterol (LCL-C) should be treated by guideline directed management which is more than 50% reduction of initial LDL-C and less than 55mg/dL LDL-C level in patients with prior percutaneous coronary intervention (PCI). However, there is no direct comparative evidence on target reduction rate and target goal LDL-C level. Therefore, we investigated the clinical influence of >50% reduction from baseline LDL-C in patients with prior PCI.

Methods:
A total of 3,104 patients with prior PCI were retrospectively enrolled from 2014 to 2020 at Yeungnam University Medical Center. The primary endpoint was 3-year major adverse cardiovascular events (MACE which was defined as a composite of cardiovascular death, nonfatal myocardial infarction, target-lesion revascularization, hospitalization for heart failure, or non-fatal stroke. And the secondary endpoints were individual components of the primary endpoint.

Results:
Among all patients, the achievement rate of target LDL-C < 55 mg/dL and more than 50% reduction from baseline was 17.2%. There was no significant difference between the LDL < 55 mg/dL group and the LDL ≥ 55 mg/dL group in the risk for MACE (hazard ratio [HR], 1.09; 95% confidence interval [CI], 0.84-1.43; P = 0.502) after propensity score matching. However, the group that achieved ≥ 50% reduction of LDL-C from baseline LDL-C level showed a significant reduction in the occurrence of MACE in the subgroup of LDL-C level ≥ 55 mg/dL (HR, 0.34; 95% CI, 0.16-0.74; P= 0.004), compared to the group with < 50% reduction of LDL-C.

Conclusion:
More than 50% reduction from the baseline LDL-C reduced the incidence of MACE in the LDL-C ≥ 55 mg/dL
Abstract 16761: Preprocedural Frailty is Associated With Lower Cardiac Rehabilitation Use Despite Greater Benefit
Authors: Bauer Tyler M , Hou Hechuan , Likosky Donald S , Pagani Francis D , Keteyian Steven J , Sukul Devraj , Thompson Mike P
Published: December 2023

Introduction:
Increased frailty before cardiovascular procedures is associated with poorer outcomes. While underutilized, cardiac rehabilitation (CR) is guideline-recommended for patients undergoing cardiovascular procedures and may help mitigate frailty through individualized, monitored exercise and risk factor reduction.

Research Question/Hypothesis:
Evaluate the relationship between preprocedural frailty, CR use, and one-year mortality.

Methods:
Medicare fee-for-service claims data were queried for patients who underwent inpatient percutaneous or surgical revascularization or aortic valve replacement between July 2016 and December 2018. Patients were stratified into quartiles (Q1 through Q4) using the validated claims-based frailty index. CR use was defined as attending any CR session within one year of discharge. Unadjusted and adjusted logistic regression was used to compare CR use across increasing frailty quartiles, and inverse probability treatment weighting was used to evaluate the effect of CR on one-year mortality across frailty quartiles.

Results:
Overall CR enrollment among the 570,851 beneficiaries was 35.3%; increasing frailty was associated with decreased CR use (unadjusted: frailty Q1: 48.3% vs Q4: 20.6%, p<0.001; adjusted OR: 0.61, p<0.001). Unadjusted one-year mortality was lower among CR users as opposed to non-users (2.7% vs 14.6%). After weighted adjustment, the absolute reduction in mortality associated with CR use was greater among frailer patients (Q4: -12.2%) relative to less frail patients (Q1: -2.9%) (Figure). Significant interaction effects between CR use and frailty quartiles indicated stronger associations of CR on mortality among more frail patients.

Conclusions:
Preprocedural frailty was associated with lower CR use despite greater absolute benefits on one-year mortality. Increasing CR enrollment in frail patients may enhance outcomes after cardiac interventions.
Abstract 16763: Complete Heart Block as a Complication of Diffuse Large B Cell Lymphoma
Authors: Luna Alvarez Amezquita Jose A , Becerra Victor G , Vazquez Moises A , PEREZ TAGLE TEJEDA ALFREDO , Palatianos de Araujo Yoana , Mijares Ivan A , Calfa Marian
Published: December 2023

Abbreviations: DLBCL (diffuse large B cell lymphoma), CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone).

Description of case

We present the case of a 78-year-old female who presented initially with a right neck mass, abdominal pain, diarrhea, and recurrent pericardial effusions requiring pericardial window procedure.

Biopsy of the neck mass demonstrated a DLBCL. Involvement of a right atrial mass attached to the septum in close relation to the tricuspid valve was seen on TEE. Metastatic disease to the lungs and liver was demonstrated on CT chest and abdomen respectively.

The patient posteriorly developed symptomatic bradycardia that on electrocardiogram and telemetry monitoring was shown to be due to a complete heart block with junctional and ventricular escape beats with a rate of 30-40 beats per minute. Due to the anatomical characteristics of the right atrial mass, placement of a right ventricle leadless pacemaker (micra) was decided. The patient was started on mini-CHOP chemotherapy shortly afterwards.

Discussion

Primary cardiac lymphomas are a rare presentation accounting for less than 1% of all cardiac malignancies. Although rare, secondary involvement of the heart is more frequent than primary involvement and represents 20-25% of the cases. From all the broad subtypes of lymphomas, DLBCL is the most commonly found to affect the cardiac system, often being represented by alterations in the conduction system and causing congestive heart failure.

The exact mechanism of the conduction abnormalities in the setting of cardiac lymphoma has not yet been well elucidated but is presumed to be either caused by an infiltration of the conduction system, direct mass burden effect, or a combination of both.

It has been seen in similar cases that initiation of chemotherapy can help decrease the pacing requirements or even resolve completely the conduction abnormalities. In a few cases, permanent pacing is required. Metastatic disease to the heart is a marker for poor outcome and median survival with therapy after diagnosis is between 7 to 18 months.
Abstract 16768: Blood Pressure Responses to Exercise in Patients With Heart Failure With Preserved Ejection Fraction: The Importance of Normalizing Blood Pressure to Workload
Authors: De Oliveira Gomes Diana , Wakeham Denis J , Brazile Tiffany M , Bagga Joetsaroop , Howrey Matthew M , Macnamara James P , Levine Benjamin D , Hearon Christopher , Sarma Satyam
Published: December 2023

Background:
Exaggerated exercise blood pressure (EEBP) is assessed using systolic blood pressure (SBP) thresholds at peak exercise (>210 [men], >190 [women] mmHg), which is confounded by the presence of hypertension. However, SBP-workload slopes are independent of resting SBP and predict future cardiovascular events in those at high-risk for and those diagnosed with heart failure and preserved ejection fraction (HFpEF). Thus, we compared the two methods of EEBP assessment between normotensive high-risk individuals and hypertensive patients with HFpEF.

Methods:
We studied 71 individuals at high-risk for HFpEF (obesity and elevated cardiac biomarkers; 58% Female; age: 49±6 years, BMI: 39.0±5.7 kg/m
2
) and 42 patients with HFpEF (67% Female; age: 71±6 years, BMI: 40.0±6.4 kg/m
2
) during cycle ergometry. Blood pressure was measured via Brachial electrosphygmomanometry. SBP/Watts slopes were constructed using data from rest, 2 sub-maximal, and peak exercise workloads. To index central arterial stiffness we calculated the SBP/cardiac output (Q˙c; acetylene rebreathing) slope and systemic arterial compliance (SAC; stroke volume / pulse pressure).

Results:
Resting SBP was higher in HFpEF compared to high-risk (132±23 vs 120±19 mmHg,
P
=0.001). Peak workload (
P
<0.001), oxygen uptake (1.284±0.420 vs 2.016±0.453 L/min; 11.7±3.3 vs 18.2±4.1 mL/min/kg, both,
P
<0.001), and Q˙c (
P
<0.001) were lower in HFpEF. Peak exercise SBP was not different between HFpEF (189±28) and high-risk groups (180±33 mmHg,
P
=0.104), but the SBP/Watts slope was higher in HFpEF (0.9±0.7 vs 0.4±0.2 mmHg/Watt,
P
<0.001). In patients with HFpEF the SBP/Q˙c slope was higher (9.8±6.7 vs 5.6±2.8 mmHg/L/min,
P
<0.001) and SAC was lower (1.2±0.4 vs 1.7±0.5 mmHg/ml
, P
<0.001).

Conclusion:
Only reporting peak SBP masks the greater SBP response to exercise in HFpEF when compared to younger high-risk individuals; a difference likely mediated by higher arterial stiffness. Thus, the slope method may be more appropriate for quantifying BP responses to exercise as it more accurately reflects the physiology of EEBP in patients with HFpEF.