bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13682: Not All Apical Left Ventricular Masses Are Thrombi: An Unusual Case of an Apical Left Ventricular Lipoma Presenting as Chest Pain and Palpitations
Authors: Nguyen Ryan T , MANDANIA ROSHNI A , Khan Safi U , Arshad Hassaan , Raza Zohair
Published: June 2023

Introduction:

Cardiac lipomas are rare primary cardiac tumors. Depending on the location, they can present with vague symptoms such as chest pain, palpitations, dizziness, or arrhythmias.

Case Presentation:
A 58 y.o. female with a PMH of HLD and HTN presents for evaluation of chest pain and palpitations. An initial CvCTA was negative for significant CAD. A TTE showed a 1.6cm x 1.42 cm echolucent mobile mass attached to the lateral wall of the LV (Figure 1.A). Initially, there was a reasonable concern for an LV thrombus. However, it was unusual since the TTE revealed a normal EF and overall wall motion. Due to suspicions of a non-thrombus LV mass, a cardiac MRI was performed which showed a highly mobile mass attached to the mid anterior/anterolateral wall and a chordae within the LV cavity (Figure 1.B, Figure 1.C). The lesion was T2-hyperintense with loss of signal during fat suppression, highly suspicious for a lipoma. Given the mass mobility and strong patient preference, an elective robotic surgical resection was performed with a surgical biopsy confirming a lipoma (Figure 1.D).

Discussion:
Cardiac lipomas are often silent; however, symptoms can range from benign palpitations to life-threatening arrhythmias and outlet obstruction. TTE is typically the first-line imaging choice, followed by either cardiac CT or MRI imaging used for further diagnostic evaluation. Treatment options include conservative observation or prophylactic resection for asymptomatic patients, and therapeutic resection for symptomatic patients.

Conclusion:
Cardiac lipomas should be considered in the differential for any cardiac mass. TTE is the first-line imaging choice followed by a cardiac CT or MRI. Treatment remains a discussion between the patient and physician, varying from conservative management of symptoms to definitive treatment with surgical resection.
Abstract 13684: Comparison Between Men and Women With Severe Obesity for Risk of Adverse Outcomes of Myocardial Ischemia: An Exercise Stress Echocardiographic Study
Authors: Moras Errol , Gandhi Kruti , Elias Joseph , Meister David , Pena Maria , Perez Lizardo Christopher , Mancero Brissete , kim GaHee , Zipf Elizabeth , Alam Loba , Konje Swiri , Omar Alaa M , Argulian Edgar
Published: June 2023

Background:
Obesity and sex have a complex relationship with myocardial ischemia. We explored the association of sex and severe obesity with adverse cardiovascular outcomes in patients with ischemic exercise stress echocardiography (EXE).

Methods:
We retrospectively studied 142 patients with ischemic ExE [Age: 65±11 years, 70(49%) women, EF: 57±8%, body mass index (BMI): 28±6 kg/m
2
]. Severe obesity (BMI>35 kg/m
2
) occured in 48 (34%) patients. Patients were stratified based on obesity and sex (4 groups, women, and men with and without severe obesity), followed for median of 1.5 years, and compared for clinical, exercise variables and occurrence of composite outcomes (death, acute coronary syndrome, cardiac hospitalization and repeat ischemia testing).

Results:
In our study, 28(20%) women and 20(14%) men had severe obesity, and 42(29%) women and 52(37%) men had no severe obesity. Groups were not different for age, risk factors, exercise characteristics, and resting LV function. Outcomes occurred in 85(60%) patients and were more prevalent in women with severe obesity compared to women without or men with or without severe obesity [21(75%), 17(40%), 11(55%), and 35(67%), p=0.014]. Sex and severe obesity did not predict outcomes in isolation [HR: 1.13 (95%CI:0.74 to 1.73), 1.48 (95%CI:0.95 to 2.3), respectively, figure 1A, B]. Survival analysis showed that women without severe obesity were at lowest risk, men were at similarly elevated risk irrespective of severe obesity, and women with severe obesity were at highest risk for composite outcomes [p=0.037, figure 1C, HR: 2.5 (95% CI: 1.3 to 4.8)]. After adjusting for clinical, exercise, and echocardiographic variables, women with severe obesity remained at high-risk [HR: 2.2, (95% CI: 1.06 to 4.36)].

Conclusion:
In patients with ischemic ExE, women with severe obesity are at higher risk for adverse cardiac outcomes. Future studies are needed to understand the pathophysiologic mechanisms underlying this association.
Abstract 13689: A Case of Myopericarditis Caused by Salmonella
Authors: Fu Danni , Yuen Brian
Published: June 2023

Introduction:

Salmonella is a gram-negative bacteria that usually causes self-limiting diarrhea. It is a rare infectious etiology of myopericarditis. Here we present a case of a young healthy male with Salmonella diarrhea who developed myopericarditis.

Case:

26 year-old male with no medical history presented with chest pain for several hours, improved by sitting upright. He also endorsed fevers, watery diarrhea, nausea, and body aches for the past 5 days. Vital signs and physical exam were within normal limits. Complete blood count and comprehensive metabolic panel were unremarkable but high sensitivity troponin T was 125 and peaked at 434. ESR and CRP were elevated. EKG showed minimal up-sloping ST-elevations diffusely with PR-elevation in lead aVR. Chest X-ray was clear. Patient was started on aspirin, clopidogrel, heparin drip, and low dose beta-blocker for empiric treatment of acute coronary syndrome as well colchicine for pericarditis. Transthoracic echocardiogram showed normal ventricular functions and no pericardial effusion. Cardiac MRI showed myocardial late gadolinium enhancement involving the outer wall of the lateral, inferolateral, and inferior walls of the basal left ventricle corresponding to myocarditis. At this point heparin was stopped and patient was transitioned to high dose aspirin with resolution of chest pain. He was continued on the beta-blocker for arrhythmia prevention in the setting of myocarditis. All infectious work up including respiratory viral panel, COVID PCR and antibodies, and blood cultures were unremarkable except stool PCR that was positive for Salmonella species. Infectious disease was consulted and he was given one dose of ceftriaxone and 7 days of azithromycin. Patient was discharged with close follow-up.

Conclusions:
Salmonella myopericarditis is rare and more often described in immunocompromised patients. Our case highlights this condition in an immunocompetent male. Cardiac treatment is supportive with volume optimization and arrhythmia prevention. Early liaison with infectious specialists in treatment of the infection is important given various region-dependent antibiotic susceptibilities.
Abstract 137: Effect Of Chest Compression Release Velocity On Cerebral Perfusion Pressure In A Porcine Experimental Model Of Cardiac Arrest.
Authors: Lim Hyouk Jae , Song Kyoung Jun , Hong Ki Jeong , Kim Ki Hong , Yoon Hanna , LEE Stephen Gyung Won , Choi Seul Ki , Lee Gyeongmin , Park YongJoo , Hong Wonpyo , Lee Kang bin
Published: June 2023

Background:
Previous studies have shown that chest compression release velocity (CCRV) of over 400mm/s is associated with improved survival and favorable neurologic outcome after cardiac arrest. However, it is uncertain whether CCRV during CPR is related to cerebral perfusion pressure (CePP). The purpose of this study was to evaluate the association between CCRV and CePP in a porcine cardiac arrest model.

Methods:
After 6 minutes of untreated ventricular fibrillation, 2 cycles of basic life support (BLS) and 12 cycles of advanced cardiovascular life support (ACLS) were conducted. During ACLS phase, CCRV was accelerated from 250mm/s to 450mm/s by 50mm/s (accelerating group) or decelerated from 450mm/s to 250mm/s by 50mm/s (decelerating group). Both groups performed BLS with the self-set value of the mechanical CPR device (LUCAS 2 chest compression system, CCRV of 170mm/s). Twenty-four pigs were randomly assigned to each group. Macrovascular circulation (CePP) and microvascular circulation using laser doppler flowmetry presented as a fraction of the baseline flow (f-LDF) were measured. We excluded the last 2 cycles of ACLS phase from the analysis due to time-dependent deterioration effects of hemodynamic outcomes. Linear mixed model was used to measure the median difference in CePP and f-LDF according to CCRV.

Results:
A total of 24 pigs were analyzed. Decelerating group of CCRV of 400mm/s showed significantly higher CePP values compared to the group of 170mm/s. Effect of changes in CCRV on CePP, stratified by groups, are as follows (median, [95% confidence intervals]): 1. Accelerating group: CCRV of 170mm/s; reference, 250mm/s; -1.98 [-10.78 - 11.79] mmHg, 300mm/s; -1.88 [-11.15 - 12.55] mmHg, 350mm/s; -2.55 [-11.46 - 12.24], 400mm/s; -6.05 [-5.59 - 16.86], and 2. Decelerating group: CCRV of 170mm/s; reference, 250mm/s; 5.71 [-16.27 - 27.11] mmHg, 300mm/s; 6.01 [-16.28 - 27.90] mmHg, 350mm/s; 6.96 [6.36 - 47.70], 400mm/s; 26.96 [6.36 - 47.70]. However, there was no significant CCRV effects on f-LDF (Accelerating CCRV of 400mm/s; 1.54 [ -0.03 - 3.10] and decelerating CCRV of 400mm/s; -2 [-4.42 - 0.34]).

Conclusion:
In a VF cardiac arrest porcine study, CCRV of 400mm/s at early phase of CPR has positive effects on CePP.
Abstract 13701: The Lumen Diameter Enlargement of the Carotid Arteries Increased the Risk of Stroke Incidence in a Japanese Urban Population: The Suita Study
Authors: Teramoto Masayuki , Kokubo Yoshihiro , Arafa Ahmed , Kashima Rena , Shimamoto Keiko , Kataoka Hiroharu , Iihara Koji
Published: June 2023

Introduction:
We aimed to examine the impact of increased LD of common carotid arteries (CCA), external carotid arteries (ECA), and internal carotid arteries (ICA) on the risk of incident stroke in a general population.

Methods:
We studied 3,356 Japanese men and women without cardiovascular disease whose CCA, ECA, and ICA were measured by carotid ultrasonography on both sides at baseline (October 2001 to March 2005). We confirmed the near and far walls intima-media interfaces by Doppler and calculated the lumen diameter as the distance between the intima-to-lumen interface of the near-wall to the lumen-to-intima interface of the far wall. The Cox proportional hazard model was used to calculate the multivariable-adjusted hazard ratios (HRs) with 95% conﬁdence intervals (CIs) of stroke incidence according to the CCA, ECA, and ICA LD.

Results:
During 30,818 person-years of follow-up, we observed 105 incident stroke cases. The higher CCA and ECA LD were associated with increased risks of incident stroke. The associations were attenuated by additional adjustment for blood pressure levels and antihypertensive drugs use, but remained statistically significant. Further adjustment of other traditional cardiovascular risk factors and carotid plaque did not alter the association materially; the multivariable-adjusted HR per standard deviation increase of CCA LD was 1.30 (95% CI, 1.05 to 1.61). Compared with participants in the first quartile (< 4.8 mm) of ECA LD, the multivariable-adjusted HRs of incident stroke were 1.71 (95% CI, 0.86 to 3.38) for those in the second quartile (4.8 - 5.3 mm), 2.18 (95% CI, 1.13 to 4.23) for the third quartile (5.4 - 6.0 mm), and 1.62 (95% CI, 0.79 to 3.29) for the fourth quartile (≥ 6.0 mm) of ECA LD. Such associations were not observed for ICA LD.

Conclusions:
In addition to the traditional risk factors and carotid plaque, CCA and ECA LD can improve risk reclassification of incident stroke in a general urban population.
Abstract 13705: Catheter Ablation for Atrial Fibrillation in Patients With Heart Failure: An Update Meta-Analysis
Authors: Gabr Mohamed , Romero Jorge , Alviz Isabella , Briceno Gomez David F , Diaz Juan C , Rodriguez Daniel , Patel Kavisha , POLANCO DALVERT , Trivedi Chintan G , Mohanty Sanghamitra , Della Rocca Domenico G , Lakkireddy Dhanunjaya R , Natale Andrea , Di Biase Luigi
Published: June 2023

Introduction:
Increasing evidence has suggested improved outcomes in atrial fibrillation (AF) patients with heart failure (HF) undergoing catheter ablation (CA) as compared to medical therapy. We sought to investigate the benefit of CA on outcomes of patients with AF and HF as compared to medical therapy.

Methods:
A systematic review of PubMed, Embase, and Cochrane Central Register of Clinical Trials was performed for clinical studies evaluating the benefit of CA for patients with AF and HF. Primary endpoint was all-cause mortality. Secondary endpoints included atrial-arrhythmia recurrence and improvement in left ventricular ejection fraction (LVEF).

Results:
Eight randomized controlled trials were included with a total of 2121 patients (mean age: 65 ± 5 years; 72% male). Mean follow-up duration was 32.9 ± 14.5 months. All-cause mortality in patients who underwent CA was significantly lower than in the medical treatment group (8.8% vs. 13.5%, RR 0.65, 95% CI 0.51-0.83, P=0.0005). A 35% relative risk reduction and 4.7% absolute risk reduction in all-cause mortality was observed with CA. Rates of atrial-arrhythmia recurrence were significantly lower in the CA group (39.9% vs 69.6%, RR 0.55, 95% CI 0.40-0.76, P=0.0003). Improvement in LVEF was significantly higher in patients undergoing CA (+9.4 ±7.6%) as compared to conventional treatment (+3.3±8%) (Mean difference 6.2, 95% CI 3.6-8.8, P<0.00001).

Conclusion:
CA for AF in patients with HF decreases all-cause mortality, improves atrial-arrhythmia recurrence rate and LVEF when compared to medical management. CA should be considered the treatment of choice to improve survival in this select group of patients.

Central Illustration summarizing study outcomes.
A) All-cause mortality; B) Change in left ventricular ejection fraction; C) Atrial-arrhythmia recurrence

1
Abstract 13706: Late Presentation Right Ventricular Failure in Patients With Left Ventricular Assist Device
Authors: Navarro Andrew G , Olivas-Martinez Antonio , Braghieri Lorenzo , Li Song , Mahr Claudius , Tian Rong , O'Brien Kevin D , Bravo Claudio A
Published: June 2023

Introduction:
Right Ventricular Failure (RVF) is an incompletely characterized complication seen in patients following durable left ventricular assist device (LVAD) implantation. Previous research focused on early post-implantation RVF, and its definitions are inconsistent. This study aims to characterize the incidence and clinical features of late presentation RVF in LVAD patients.

Methods:
This retrospective cohort study included all subjects who underwent LVAD implantation at the University of Washington between 2005 and 2021 and were on support for at least 90 days. Late RVF was defined as meeting Mechanical Circulatory Support Academic Research Consortium criteria and late RVF onset >30 days post-implantation. The outcomes of interest were late RVF incidence and mortality while on LVAD support. Using Cox regression models, baseline factors were assessed as potential predictors for late RFV, with the time-varying exposure of developing late RVF after LVAD implantation as a risk factor for death.

Results:
The cohort included 430 LVAD recipients, median age 56 years (IQR 43-64), 17% women and 75% Caucasian. A total of 115 subjects met criteria for late RVF with a median time to RVF of 48 months (95% CI 43-63) and an incidence rate of 18.3 events per 100 person-years. Multivariable analysis showed that albumin, destination therapy (DT) LVAD, use of inotropes longer than 2 weeks post LVAD implantation, and device type were associated with development of late RVF. DT as treatment intention was the predictor with the highest hazard ratio (HR= 2.82, 95% CI 1.75-4.55, p<0.001). After controlling for several covariates, RVF was associated with an increased hazard of death (HR 1.87, 95% CI 1.22 - 2.86, p = 0.004) (Figure).

Conclusions:
Late RVF while on LVAD support was a relatively common complication in this cohort and was associated with significantly higher mortality. LVAD implantation as DT was the predictor most strongly associated with late RVF.
Abstract 13730: Genotype-Phenotype Correlates in Recent-Onset Dilated Cardiomyopathy and Their Prognostic Implications
Authors: Kubanek Milos , Piherova Lenka , Krebsova Alice , Binova Jana , Kotrc Martin , Hartmanova Hana , Stranecky Viktor , Palecek Tomas , Chaloupka Anna , Grochova Ilga , Krejci Jan , Petrkova Jana , Melenovsky Vojtech , Kmoch Stanislav , Kautzner Josef
Published: June 2023

Introduction:
Recent-onset dilated cardiomyopathy (RODCM) is a disease of heterogeneous etiology and diverse clinical outcomes.

Hypothesis:
We hypothesized that the genotype of RODCM might correlate with left ventricular reverse remodeling (LVRR) and long-term clinical outcomes.

Methods:
A total of 386 RODCM patients (pts) [age 44±12 years, 277 males (72%), familial in 98 pts (25%)] with a history of symptoms less than six months underwent whole-exome sequencing (WES) where likely-pathogenic and pathogenic (class 4-5) disease-causing variants were identified. LVRR was defined as an improvement in left ventricular ejection fraction to >50% or ≥10% absolute increase, with left ventricular end-diastolic diameter ≤33 mm/m2 or ≥10% relative decrease. In this prospective study, the primary outcome was the first event of all-cause death, heart transplantation or ventricular assist device. The secondary outcome included sudden cardiac death, resuscitated cardiac arrest or treated ventricular tachyarrhythmias.

Results:
WES detected class 4-5 titin truncated variants (
TTNtv
) in 69 pts (19%), class 4-5 non-titin variants (non-
TTN
)
(Figure)
in 56 pts (14%), variants of unknown significance only in 103 pts (27%) and a negative result in 158 pts (40%). At 12 months, LVRR was assessed in 359 pts and was present in 171 pts (48%). Carriers of class 4-5 non-
TTN
variants developed LVRR less frequently than subjects with other genetic testing results (28% vs. 51%, p˂0.01). During a median follow-up of 55 months, the primary and secondary outcomes occurred in 79 pts (20%) and 50 pts (13%), respectively. Carriers of class 4-5 non-
TTN
variants had an increased risk of both primary [HR 2.36 (95% CI 1.32-4.20), p˂0.01] and secondary [HR 3.08 (95% CI 1.42-6.67), p˂0.01] outcomes as compared with genotype-negative pts. In multivariable models, genotype remained a strong predictor of both types of outcome.

Conclusions:
Among RODCM patients, carriers of class 4-5 non-
TTN
variants have an increased risk of death and progressive heart failure, and a higher long-term burden of life-threatening ventricular arrhythmias compared to genotype-negative subjects.

Funding:
Supported by the research grant of the Ministry of Health, Czech Republic: [NV19-08-00122] and IPO 00023001.
Abstract 13748: The Relationship Between Anxiety, Cumulative Social Risk, and Adherence to Antihypertensive Medications
Authors: Kesiena Onoriode , Rizvi Mehdi , Hagan Kobina , Singireddy Shreyas , Seffah Kofi D , Allahverdiyeva Aysha , Braunstein Jacob , Kumar Navin , Olokunlade Temitope , Sharma Garima , Mossialos Elias , Nasir Khurram
Published: June 2023

Introduction:
Psychiatric disorders and social determinants of health impact the management of medical conditions. We examined the relationship between anxiety, cumulative social risk, and adherence to antihypertensive medications.

Methods:
We used data from the 2020 national health interview survey to evaluate antihypertensive medication use. Anxiety and use of anxiolytics were the independent variables. Cumulative social risk (CSR) was made up of a composite of economic stability, education, food insecurity, neighborhood, and health care system. Four quartiles were created, with the highest (4
th
) CSR quartile denoting the least social risk. Logistic regression was used for the analysis.

Results:
Of the 10,499 participants with hypertension, 8772 (80.2%) of were taking hypertensive medications. The mean (SE) age of the sample was 60.4 (0.23) years and 50% were females. Among those on antihypertensives, 16.2% reported anxiety and 68.0% reported using anxiolytic medications. Distribution of CSR is as shown in figure 1. Among those with anxiety, the odds of taking antihypertensive medications reduced as the CSR quartile increase from 2
nd
[AOR 0.42; 95% CI 0.18, 0.96. p=0.039], 3
rd
[AOR 0.38; 95% CI 0.18, 0.83. p=0.016] to 4
th
quartile [AOR 0.34; 95% CI 0.13, 0.88. p=0.026] as compared to 1
st
quartile. Among those on anxiolytic medications, belonging to CSR 4 quartile had a reduced [AOR 0.21; 95% CI 0.08, 0.58. p=0.003] as compared to the CSR 1 quartile.

Conclusions:
Individuals with anxiety with the least CSR are less likely to be taking antihypertensive medications. This may be related to an increased likelihood of a healthier lifestyle.
Abstract 13758: Distension of the Upright Ultrasound Jugular Venous Pulse is Predictive of All-Cause Mortality in Patients Referred for Right Heart Catheterization
Authors: George Thomas , Herner Maranda , Dranow Elizabeth , KHOR Lillian , Anderson McHale , Zheutlin Alexander , Harrison Jonathan D , Wendl Elizabeth , Wang Libo
Published: June 2023

Introduction:
Bedside central venous pressure assessment is integral to diagnosing and managing heart failure (HF). A noninvasive point of care ultrasound (POCUS) assessment of the jugular venous pressure (uJVP) was validated as accurate in predicting elevated right atrial pressure (RAP) on right heart catheterization (RHC) in HF patients. A qualitative assessment of uJVP in the upright position (uuJVP) was found to be highly specific for detecting elevated RAP. We compared the prognostic value of the distended uuJVP and elevated RAP in predicting one-year mortality.

Hypothesis:
We hypothesized that a distended uuJVP was predictive of all-cause mortality.

Methods:
Adult patients undergoing RHC underwent uuJVP assessment with POCUS. A distended uuJVP was defined as internal jugular venous distention to at least the same size as the adjacent common carotid artery during resting inspiration and expiration (Figure 1c). Patients were examined upright at 90 degrees with their back/neck supported, and followed for one year after undergoing same day uuJVP assessment and RHC. Elevated RAP was defined as ≥10 mmHg on RHC. Kaplan Maier analysis of all-cause mortality was performed.

Results:
100 patients had a uuJVP assessment prior to RHC. The distended uuJVP correlated with a mean RAP of 15 mmhg (8.3-17.1 mmHg) (Figure 1d) with a specificity of 94.6% for predicting RAP of ≥10 mmHg. Multivariate cox regression analysis showed that patients with a distended uuJVP had an increased one-year mortality (HR 3.20, 95% [CI 1.24- 8.20], p=.02) similar to those with RAP ≥10 mmHg by RHC (HR 3.21, 95% CI [1.20-8.64], p=.02) (Figure 1a/1b). Of 27 deaths, 11 (40.7%) had positive uuJVP with a specificity of 79.7%, 95% CI (69.2%-88%).

Conclusions:
The bedside distended uuJVP was similarly predictive of all-cause one-year mortality as elevated RAP by RHC. The clinical application of this simple, qualitative ultrasound estimate of RAP warrants further investigation.
Abstract 13763: Institutional Variation of Transcatheter Edge to Edge Repair for Mitral Regurgitation and Short-Term Outcome: A Report From National Readmission Database
Authors: Shoji Satoshi , Kuno Toshiki , Briasoulis Alexandros , Inohara Taku , Kohsaka Shun , Malik Aaqib H
Published: June 2023

Introduction:
Transcatheter edge-to-edge repair (TEER) of the mitral valve has become an established therapy for patients with severe mitral regurgitation; however, the impact of institutional variations in the number of edge-to-edge TEER for readmission rates with large-scale data is not well investigated.

Objectives:
Our study aimed to describe the institutional variations of TEER, and also the association between the institutional volume and readmission rates after the procedure across the US institutions.

Methods:
We conducted a retrospective cohort study of TEER performed in the US between 2019 using the Nationwide Readmission Database. We divided the patients according to the tertiles based on site-specific case of TEER (Q1 [lowest]-Q3 [highest]) and evaluated its association with 30-day readmission rates using Cox proportional hazard model.

Results:
Overall, 4,922 patients who underwent TEER (mean age 76.8 ± 11.5 years, and 54.5% male) at 250 institutions were included in the analyses. Patients in Q3 (highest tertile) were more likely to be older, and have comorbidities, albeit risk adjusted 30-day readmission rates were similar in each group (Q1: 13.5%; Q2: 13.6%; Q3: 13.7%). Rather than the volume of the procedure, institutional characteristics, such as teaching hospitals located in metropolitan area (hazard ratio [HR 1.92, confidence interval [CI] 1.41-2.61) and institutions with predominantly non-elective (e.g. urgent or emergent) TEER cases (HR 1.75 95% CI 1.39-2.22), or patient characteristics such as chronic heart failure (HR 1.91 95%CI 1.33-2.73), cancer (HR 1.87 95%CI 1.15-3.06), chronic kidney disease (HR 1.45 95% CI 1.20-1.75), chronic pulmonary disease (HR 1.40 95% CI 1.13-1.72), diabetes mellitus (HR 1.39 95% CI 1.12-1.72), and history of percutaneous coronary intervention (HR 1.37 95% CI 1.07-1.76) were associated with a higher incidence of 30-day readmission.

Conclusions:
Among patients undergoing TEER in a contemporary representative US cohort, procedure volume variation was not associated with the 30-day readmission rate.
Abstract 13764: Renalase Peptide Agonist Therapy Normalizes the Cardiac Response to Pressure Overload in Chronic Kidney Disease
Authors: Krishna Kumar Nair Govind , Zhang Jiasheng , Guo Xiaojia , guerrera nicole , Wu Xiaohong , Hu Xiaoyue , Gorelick Fred S , Safirstein Robert , Giordano Frank J , Young Lawrence H , Desir Gary V
Published: June 2023

Introduction:
Chronic kidney disease (CKD) increases susceptibility to heart disease. The mechanisms remain unclear and may include dysregulation of autocrine, paracrine or circulating factors. Renalase (RNLS) is a secreted protein expressed in the kidney and heart with potent pro-survival and anti-inflammatory properties. Cardiac pressure overload by transverse aortic constriction (TAC) is associated with increased cardiac RNLS expression in normal mice, while mice with CKD have decreased cardiac RNLS. We hypothesized that CKD would alter the hypertrophic response to TAC, and that therapy with exogenous mouse-specific RNLS agonist peptide (mRNLS-ap) would normalize the response.

Methods:
In wild-type male C57BL/6J mice, CKD was induced by two doses of cisplatin (15mg/kg SQ), two weeks apart (validated and published CKD model). Non-CKD mice received 0.9% saline. TAC was induced 8 weeks after first cisplatin dose. Control mice (sham) had aortic arch exposure without constriction. mRNLS-ap (20 mg/kg SQ) was injected twice daily for 14 days, starting one day before surgery. Serial echocardiograms were performed.

Results:
CKD groups had similar degrees of renal failure. Mean aortic gradients were comparable after TAC. Kidney RNLS protein expression was 44% less in CKD (n=8) than non-CKD (n=4) mice at sacrifice (12 weeks after surgery) (p<0.001). One-week post-surgery, untreated CKD-TAC mice showed impaired hypertrophy with smaller increase (over baseline pre-TAC values) in LV wall thickness than non-CKD-TAC mice (15 ± 5% vs. 35 ± 4%, n=12 each; p<0.001). Four weeks post-surgery, the response normalized with similar LV wall thickness increases in CKD-TAC and non-CKD-TAC mice (31 ± 8% vs. 29 ± 3%, n=11-12 each; p>0.99). Sham groups did not change. One-week post-surgery with exogenous mRNLS-ap therapy, the difference in LV wall thickness increase between the CKD-TAC and non-CKD-TAC hearts was eliminated (28 ± 6%, n=9 vs. 24 ± 8%, n=4; p>0.95). Sham groups did not change.

Conclusions:
RNLS expression is reduced in cisplatin-induced CKD, and associated with a delayed LV hypertrophic response to TAC. RNLS agonist therapy corrects this delay. Plasma and/or cardiac RNLS are important early mediators of cardiac adaptation to pressure overload stress in CKD.
Abstract 13772: The Cardiac Autonomic Reactivity in Long-Term Female Yoga Practitioners: A Comparison With Runners and Sedentary Individuals
Authors: Lin Jia-Ru , Wu Pei-Tzu , Wu Wen-Lan , Chang Yu-Kai , Chu I-Hua
Published: June 2023

Introduction:
Yoga practice, a means of stress management, has been reported to optimize psychophysiological health; however, its underlying mechanisms remain unclear. The purpose of the present study was to examine the cardiac autonomic reactivity in long-term yoga practitioners and compared that to runners and sedentary individuals.

Hypothesis:
The level of cardiac autonomic reactivity in yoga practitioners would be greater than that in the sedentary individuals but similar to that in the runners.

Methods:
Female individuals aged 20-50 years old with BMI 18.5-30 kg/m
2
were recruited. Participants in the yoga (or running) group regularly performed yoga (or running) for ≥ 90 minutes/week, for at least 2 years. Participants who did not regularly perform any type of physical activity were assigned to the sedentary group. Blood pressure (BP), heart rate (HR), respiration rate (RR) and heart rate variability (HRV) parameters (e.g., high frequency normalized unit (HFnu), the square root of the mean squared differences of successive normal-to-normal intervals (RMSSD), total power (TP) and standard deviation of normal-to-normal (SDNN)) were recorded at rest, during and following psychological stress, which was elicited by the Stroop color-and-word test (SCWT) and the mental arithmetic task (MAT). Outcome variables in the 3 groups were compared at multiple phases using Group x Time mixed design ANOVA and Bonferroni post-hoc comparison.

Results:
Yoga group demonstrated a lower RR (10.4±2.1 bpm) as compared to the other 2 groups, and a lower HR (66.6±7.6 bpm) and diastolic BP (67.8±8.4 mmHg) at rest as compared to the sedentary group (all p<0.05). HFnu following mental stress returned to the baseline in yoga (35.7±16.0 vs. 43.5±20.5) and running groups (44.7±17.1 vs. 52.0±18.0), but not in the sedentary group (29.9±22.0 vs. 43.1±18.3, p< 0.05). Similar results were observed in RMSSD and TP, where the level of outcome variables at the recovery phase returned to baseline in the yoga and running group, but not in the sedentary group.

Conclusions:
Yoga practitioners may have a greater homeostatic capacity and autonomic resilience than do sedentary individuals. The level of autonomic reactivity in long-term yoga practitioners was similar to that in the runners.
Abstract 13783: Near-Real Time Extended Ambulatory ECG Monitoring in Patients With Syncope Unveils a Spectrum of Arrhythmias and High Incidence of Atrial Fibrillation
Authors: Hoppe Bobbi L , Reynolds Matthew , Hsu Mike , Crosson Lori , Wilk Alan , langan marie-noelle
Published: June 2023

Introduction:
Patients (pts) with a history of syncope are at high risk for sudden death with a reported 1-year mortality rate of 30%. Triaging relevant arrhythmias (ars) in a timely manner in this population is critical to allow for potential life-saving interventions. For example screening atrial fibrillation (AF) studies of pts with no known AF, reported an AF detection of 4.5% to 5.3%. It is unknown if these findings extend to a syncope population. A recent syncope study reported most significant ars occurred outside the typical window of a hospital stay. Therefore, this study aims to analyze a proprietary Zio AT database containing arrhythmia findings of pts monitored for the diagnosis of syncope.

Methods:
Data retrospectively analyzed 10,643 pts from US institutions with a syncope indication for monitoring. Pts with recordings between July 2017 to December 2021 were analyzed. All ars transmitted via cellular gateway during the wear period and full ECG download at end of wear were analyzed with a validated proprietary AI algorithm, then followed by a certified cardiographic technician review. Ars were defined as: AF, ≥30 seconds at any heart rate; SVT, ≥90 bpm for ≥4 S beats; Pause, ≥3 second; AV Block, any 3rd or 2nd degree AV Block (Mobitz I or II); VT, ≥100 bpm for ≥4 V beats or PVT, TdP, VF. Detected ars were characterized by duration, episode counts, rates, and/or burden (where applicable).

Results:
Of the 10,643 pts studied (49% female, mean age 65.4 years, mean wear 11.9 ± 3.6 days), 8,442 (79%) had at least 1 arrhythmia detected, with 3,107 (29%) having 2 or more arrhythmia types. Most common ars detected in this patient population were SVT (69%; 7365/10643), VT (26%; 2716/10643), and AF (9.5%; 1015/10643). AV Blocks (3.6%; 382/10643) and Pauses (6.2%; 662/10643) were not uncommon. Surprisingly, the most common arrhythmia to trigger a notification alert was AF/AFL (8.5%). Average time until first AF detection was 1.4 ± 2.8 days for all AF subjects and 2.8 ± 3.5 days for paroxysmal AF subjects.

Conclusions:
In this large retrospective study, ambulatory ECG monitoring with ZIO AT in syncope indicated pts revealed an unexpectedly high incidence of AF and SVT. Further analysis of this group may help clinicians focus a heightened awareness of atrial ars in this population.
Abstract 13786: Effectiveness of Ambulatory Pulmonary Artery Pressure-Guided Therapy in Reducing Readmissions in Patients With Heart Failure With Reduced Ejection Fraction versus Heart Failure With Preserved Ejection Fraction
Authors: Goel Akshay , Malik Aaqib H , Bandyopadhyay Dhrubajyoti , Gupta Rahul , Hajra Adrija , Briasoulis Alexandros , Aronow Wilbert S , Panza Julio A , Lanier Gregg
Published: June 2023

Introduction:
The cardio-microelectromechanical system (CardioMEMS) is an implantable pulmonary artery pressure monitoring device that aims to avoid decompensated heart failure (HF) admissions through hemodynamic-guided care. The aim of our study was to compare the impact of CardioMEMS implantation on hospital readmissions between HFrEF and HFpEF patients.

Methods:
Data from the National Readmission Database 2015 to 2019 were analyzed. International Classification of Diseases codes were used to identify patients hospitalized for HF and those with CardioMEMS implantation. The outcome of interest was the 30-day readmission rate. Multivariate logistic regression analysis was done to account for possible confounders.

Results:
We identified 3,801,661 admissions with a primary diagnosis of HF. Of these, 2,279,203 (59.95%) patients carried a diagnosis of HFrEF, while 1,522,458 (40.05%) had HFpEF. Patient characteristics are shown in the table. CardioMEMS was implanted in 1100 patients with HFrEF, and 297 patients with HFpEF. Among patients with HFrEF, those who received CardioMEMS implantation during the index admission had a significantly lower 30-day readmission rate compared to those who did not (16.4% vs 21.0%, adjusted odds ratio [OR] 0.74, 95% confidence interval [CI] 0.63-0.87, p <0.01) (Figure). However, among HFpEF patients, there was no significant reduction in 30-day readmissions after CardioMEMS implantation (19.8% vs 20.7%, adjusted OR 0.95, 95% CI 0.72-1.27, p = 0.37) (Figure). CardioMEMS implantation was not associated with a higher rate of complications such as major bleeding, acute kidney injury, or stroke, in both HFrEF and HFpEF groups.

Conclusions:
Our findings suggest that ambulatory pulmonary artery pressure-guided therapy may be more effective in reducing HF readmissions in patients with HFrEF than in those with HFpEF. This may have significant clinical implication in appropriate patient selection for CardioMEMS implantation.
Abstract 13804: Effect of Cardiac Catheterization Timing on In-Hospital Outcomes for Patients Presenting With Non ST Elevation Myocardial Infarction on the Weekend
Authors: Lecompte Osorio Paola A , Dangl Michael , Albosta michael , Hernandez Rafael , Vergara-Sanchez Carlos , Inestroza Karla , Ergui Ian , Colombo Rosario
Published: June 2023

Introduction:
Patients admitted to hospital for non-ST elevation myocardial infarction (NSTEMI) on a weekend have higher rates of mortality. Delayed catheterization and revascularization have been hypothesized as a potential etiology. Few studies have evaluated the timing of catheterization and outcomes for NSTEMIs occurring on the weekend.

Hypothesis:
Delayed catheterization in patients with NSTEMI on a weekend is associated with higher mortality.

Methods:
The National Inpatient Sample Database was queried from 2016-2019. Baseline characteristics and in-hospital outcomes of NSTEMI were compared in patients who presented on the weekend based on timing of diagnostic cardiac catheterization. Multivariate logistic-regression was performed for the effect of cardiac catheterization timing on mortality. A p-value was considered significant when <0.001.

Results:
We found a total of 275,545 hospital admissions occurring on the weekend for patients with a primary diagnosis of NSTEMI. Patients were classified in 3 categories. Early catheterization 98,005 (36%) defined as catheterization on or before hospital day 1, delayed catheterization 102,850 (37%) defined as catheterization on or after hospital day 2, and patients that were not catheterized 74,690 (27%). Among patients who received catheterization, mortality was significantly higher in patients who received delayed catheterization 2.9% vs 1.3%, p<0.001. Patients who underwent delayed catheterization had higher odds of mortality compared to early catheterization (adjOR 1.83 95% CI [1.69-1.98]). Highest mortality presented in patients who did not receive catheterization 10.4%, p<0.001 (adjOR 3.39 [3.23-3.56]). Among patients who died without receiving catheterization (n=7,770), 51.6% died within 2 days of hospitalization.

Conclusion:
For patients presenting with a NSTEMI on the weekend, delayed catheterization is associated with higher mortality.
Abstract 13810: Development and Validation of the Peripheral Artery Questionnaire for Critical Limb Ischemia-(PAQ-CLI) Instrument
Authors: Smolderen Kim G , Spertus John , Romain Gaelle , Pacheco Christina , Scott Kate , Stone Nancy , Scierka Lindsey , Fuss Christine , van Roij Evy , Mena-Hurtado Carlos
Published: June 2023

Background:
Patients with critical limb ischemia (CLI) experience pain, non-healing wounds, and amputation, which impacts their health status. There are no CLI-specific health status instruments that meet FDA standards. We sought to develop and validate a CLI-specific health status instrument to supplement the Peripheral Artery Questionnaire (PAQ).

Methods:
Using the PAQ conceptual framework, the PAQ-CLI was created in 3 phases: (1) construct validity was established through qualitative input from patients and vascular specialists; (2) items were elicited for CLI clinical phenotypes (rest pain; wound; post-amputation) and tested with cognitive interviewing; (3) psychometric testing in the prospective SCOPE-CLI registry was completed to confirm factor structure, convergent validity (against the EQ-5D, maximum walking distance, and Wifi), internal consistency, and 1-month test-retest reliability (against 46 stable patients determined by global assessment of functioning change).

Results:
The original domain structure of the PAQ captured the full range of health status experiences, including physical function, symptom stability, symptoms, treatment satisfaction, quality of life, and social limitations, confirmed by eigenvalues >1.77. After item-reduction (30 items for all clinical phenotype modules combined), the correlation with the PAQ-CLI summary score, EQ-5D Index, maximum walking distance, and Wifi wound and Ischemia score was 0.67, 0.38, -0.23 and -0.28, respectively. Cronbach’s alphas ranged from 0.85-0.88 and one-month test-retest reliability for the summary score was r=0.67. Baseline PAQ-CLI summary scores were lowest for rest pain (39.7±17.2), followed by wounds (49.0± 20.2), and highest for post amputation status (52.2±21.4) (
Figure)
.

Conclusion:
The PAQ-CLI is a novel, validated instrument for patients with CLI meeting quality benchmarks for instrument development as defined by classical test theory.
Abstract 13818: Health System Integrated Measurement-Based Care Using Patient-Reported Outcomes Assessment in Lower-Extremity Peripheral Artery Disease
Authors: Smolderen Kim G , Scierka Lindsey , Rahman Mufti , van Roij Evy , Bradley Brooklyn , Nagpal Sameer , Spertus John , Bascombe Alexandria , Siddiqui Waleed Tariq , Provance Jeremy A , Romain Gaelle , Lynch Shannon , Bogra Pragati , Velazquez Eric J , Churchwell Keith , Lorusso Francine , Mena-Hurtado Carlos
Published: June 2023

Introduction:
Peripheral artery disease (PAD) is a chronic disease that requires continuous and individualized disease-management to optimize patients’ symptoms, function and quality of life. Directly capturing patient-reported outcomes (PROs) in routine practice has the potential to increase the patient-centeredness of PAD care. We designed and implemented a system to measure health status within the workflow of a vascular specialty clinic.

Methods:
In a large academic center, from February 2020 until March 2022, an in-person patient navigation system (Yale PRO-QI) supported by a online data collection workbench was implemented to collect the EQ-5D, Peripheral Artery Questionnaire (PAQ), and VascuQol-6 as part of the outpatient consultations for lower-extremity PAD. Completion rates by month, and domain and summary scores for each PRO were derived per clinical phenotype: new patient/pre-procedural patient, post-procedural/follow-up patient.

Results:
Of 1071 eligible patient visits, 841 PRO assessments (n=446 unique patients) were completed, for an overall completion rate of 78.5% (monthly completion range 56.4%-100.0%). Patients had a mean age of 70.5±10.2 years, 39.4% were female, 9.6% Hispanics, 14.6% blacks, and 74.7% whites. Of the PROs administered, only the Symptom Stability, Treatment Satisfaction, and Quality of Life subscales of the PAQ were able to discriminate between the clinical phenotypes with differences that reached the minimal clinically important difference threshold of ~10 points (
Figure
).

Conclusions:
In anticipation of measurement-based care metrics that assess quality of care benchmarks for patient-centered PAD care, our health system integrated PRO workflow had a high response rate, and was able to successfully discriminate between highly symptomatic vs. stable patients as measured by validated disease-specific PRO benchmarks for PAD treatment success.
Abstract 13825: Clinical and Echocardiographic Outcomes Associated With Early Initiation of Beta Blockers Use Among Patients With Recently Diagnosed Non-Ischemic Cardiomyopathy Treated With a Wearable Cardioverter Defibrillator
Authors: Goldenberg Ido , Mohammed Moghniuddin , Aktas Mehmet K , Zareba Wojciech , McNitt Scott , Kutyifa Valentina
Published: June 2023

Introduction:
Beta-blocker (BB) therapy was shown to improve clinical outcomes among heart failure patients with reduced ejection fraction. However, there are limited data on the efficacy of BB use among patients with recently diagnosed non-ischemic heart cardiomyopathy (NICM) who are treated with the wearable cardioverter defibrillator (WCD) until a decision on the need for an ICD is made.

Aim:
Determine if BB use is associated with improved outcomes in patients with NICM treated with the WCD.

Methods:
The study population comprised 1195 patients with recently diagnosed NICM enrolled in the prospective WEARIT-II Registry. Clinical data, arrhythmia events, ICD implantation, and improvement in left ventricular ejection fraction (LVEF) were captured. Multivariate logistic regression was used to estimate the odds ratio (OR) of LVEF improvement to >35% by BB usage. The risk of death at 1-year by BB use was assessed using a multivariate cox-proportional hazards modeling.

Results:
Patients treated with BBs at baseline were more likely to experience an improvement in LVEF to >35% that patients who did not receive treatment with BB (43% vs 29%, respectively; adjusted OR=1.67 95% CI [1.15-2.41] p=0.007; Figure: panel A and were less likely to receive an ICD at the end of the WCD use (37% vs 47%; adjusted OR=0.64 95% CI [0.46-0.90] p=0.024; Figure: panel B). At 12 months of follow-up the probability of death was significantly lower among patients who received BB therapy during WCD use vs. those who did not.,(p=0.007 Figure: panel C), corresponding to a significant 59% lower risk of death at one year associated with early BB use (adjusted HR=0.41 95% CI [0.21-0.80] p<0.01).

Conclusions:
Among patients newly diagnosed NICM who are treated with a WCD until a decision on the need for an ICD is made, early initiation of BB is independently associated with a greater likelihood of improvement in EF, a lower probability of needing an ICD at end of WCD use, and a lower risk of death at 1-year.
Abstract 13844: Comprehensive Proteomics Profiling of Myocardium Identifies Dysregulated Signaling Pathways in Hypertrophic Cardiomyopathy
Authors: Lumish Heidi S , Liang Lusha , Hasegawa Kohei , Adlestein Elizabeth , Swistel Daniel , Maurer Mathew S , Reilly Muredach P , Sherrid Mark , Shimada Yuichi J
Published: June 2023

Background:
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disease. The signaling pathways that link gene mutations to the manifestation of clinically-overt HCM remain unknown.

Hypothesis:
Comprehensive proteomics profiling of myocardium identifies signaling pathways that are differentially regulated in HCM.

Methods:
We conducted a multicenter case-control study. Cases were patients with HCM who underwent septal myectomy. Controls were donors without cardiac disease whose heart was excised but could not be transplanted due to size mismatch. We performed proteomics profiling of 7289 proteins from myocardium and excluded 1222 proteins significantly correlated with age. We performed a univariable analysis of the remaining 6067 proteins to determine the association between protein concentration and disease status using the Wilcoxon rank sum test. We executed pathway analysis of proteins significantly dysregulated (i.e., univariable p <0.05) in cases with HCM compared to controls. Pathways with false discovery rate [FDR] <0.01 were considered to be dysregulated.

Results:
There were 121 patients included in the study, with 106 HCM cases and 15 controls. Among the 6067 proteins analyzed, 986 were differentially regulated between HCM cases and controls. Pathway analysis of these proteins revealed dysregulation of the Ras-MAPK pathway (FDR < 0.0001) and multiple metabolic pathways, mainly related to amino acid metabolism (
Figure
). Pathways that are known to be dysregulated in HCM, such as the TNF pathway and those related with inflammation, were also dysregulated.

Conclusions:
The present study represents the largest-scale (n >100) and most comprehensive proteomics profiling (>7000 proteins) of human HCM myocardium to date, elucidating dysregulation of both novel (e.g., Ras-MAPK, amino acid metabolism) and known (e.g., TNF, inflammation) pathways in patients with HCM.