bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17216: Limited Concordance of Core Lab Left Ventricular Ejection Fraction With Automated Assessments: A Sub-Study From VALOR-HCM
Authors: Parizher Gary , Jaber Wael A , Owens Anjali T , Wolski Kathy E , Geske Jeffrey B , Saberi Sara , Wang Andrew , Sherrid Mark , Lakdawala Neal K , Fifer Michael A , Fermin David R , Naidu Srihari S , Smedira Nicholas G , Schaff Hartzell , McErlean Ellen , Sewell Christina M , Lampl Kathy L , Sehnert Amy J , Nissen Steven E , Desai Milind Y , Cremer Paul C
Published: December 2023

Introduction:
The performance of automated left ventricular ejection fraction (LVEF) assessment in patients with altered cardiac chamber geometry, such as those with obstructive hypertrophic cardiomyopathy (HCM), is not well described.

Aims:
Accurate assessment of LVEF is required for dose titration and continuation of myosin inhibitors in obstructive HCM. From the VALOR-HCM trial (NCT04349072), the agreement of two commercially available software packages was compared with blinded core lab assessment of LVEF.

Methods:
From baseline and week 16, among 112 patients randomized to either mavacamten or placebo, 178 echocardiograms were analyzed. Representative clips were manually selected, and automated LVEFs were calculated. Comparisons of LVEFs were made using Pearson’s correlation coefficients and Bland-Altman analysis.

Results:
With core lab assessment, the overall median LVEF was 68% (Q1 66%, Q3 70%). The correlation with vendor 1 was moderate (r = 0.47, 95% CI 0.35-0.58,
p
<0.001) and weak with vendor 2 (r =0.21, 95% CI 0.07-0.35,
p
=0.004). Correlation was also weak between vendor 1 and 2 (r = 0.14, 95% CI 0.00-0.28,
p
= 0.06). Vendors 1 and 2 had an underestimation bias of LVEF of 8% (95% CI 6-9%) and 8% (95% CI 7-9%), respectively, compared to core lab LVEF (Figure 1).

Conclusions:
In VALOR-HCM, the concordance of LVEF between different commercially available software packages with each other and with a core lab assessment was limited. Further study is needed to evaluate and improve the performance of automated LVEF tools in obstructive HCM patients who have altered cardiac chamber geometry.
Abstract 17222: Warriors Takotsubo Syndrome
Authors: Druml Lauren E , Hu Xinge
Published: December 2023

Background:
Takotsubo syndrome (TTS), also known as stress-induced cardiomyopathy or "broken heart syndrome," is characterized by transient left ventricular dysfunction, typically triggered by negative emotions or physical stressors. It presents with symptoms similar to acute coronary syndrome, but with no associated coronary artery stenosis. “Happy Takotsubo” syndrome, triggered by intense positive emotions, is an uncommon variant and presents a unique challenge in clinical diagnosis.

Case Presentation:
An 86-year-old woman who was an avid Golden State Warriors fan developed sudden-onset pressure-like chest pain following intense excitement over the Golden State Warriors winning a critical basketball game. In the emergency department, the patient was found to have a high sensitivity troponin greater than 4,000 and ST elevations in leads V3 to V6, meeting STEMI criteria. Emergent cardiac catheterization revealed no coronary artery stenosis. Echocardiography was significant for apical ballooning of the left ventricle, consistent with TTS (Figure 1). Symptoms resolved following low-dose beta-blocker therapy, and the patient was discharged after 24 hours of observation. Repeat echocardiography eleven days later demonstrated near-resolution of the apical ballooning (Figure 2).

Discussion:
This case highlights "happy Takotsubo" syndrome as a unique presentation of TTS triggered by intense positive emotions. In this case, the patient developed TTS after experiencing excitement over a Golden State Warriors victory. By sharing this case, we aim to contribute to the existing literature and enhance knowledge about this uncommon presentation.
Abstract 17225: Association Between Moderate and Vigorous Physical Activity on Long-Term Heart Failure Risk: The Cooper Center Longitudinal Study
Authors: West Julianna , Dalmacy Djhenne , Leonard David , Defina Laura , Berry Jarett D
Published: December 2023

Introduction:
Regular physical activity (PA) is associated with a lower risk of heart failure (HF). However, the relative contributions of moderate and vigorous intensity exercise on HF risk is still unclear. We characterized the association between moderate (MPA) and vigorous physical activity (VPA) on the long-term risk for HF.

Methods:
We included participants free from baseline coronary disease in the Cooper Center Longitudinal Study (CCLS) who were Medicare eligible at age 65 years. PA was measured from a self-report instrument that included duration (minutes/week) and intensity of exercise (METs), with moderate intensity as 3-6 METs and vigorous intensity as 6 METs. Incident HF was defined as a HF hospitalization event (primary diagnosis) from Medicare claims files. MPA and VPA were considered separately as continuous variables. The association between baseline PA and incident HF was evaluated by Cox proportional hazards models adjusted for standard HF risk factors.

Results:
Of 32,322 individuals (mean age 50.9, 74.2% men), the mean number of hours/week of MPA and VPA was 1.2 and 1.4, respectively. 56.42% reported zero MPA and 42.6% reported zero VPA. Higher levels of VPA, but not MPA, were associated with a lower burden of HF risk factors. After 275,373 person-years of follow-up, we observed 954 incident HF hospitalizations. MPA was not significantly associated with HF risk in either model. VPA was inversely associated with HF risk in age-adjusted models. After multivariable adjustment, VPA was not associated with HF risk (see table).

Conclusions:
Midlife VPA, but not MPA, was associated with a lower risk for HF. However, after additional adjustment for traditional HF risk factors, the association between higher VPA and HF risk was no longer significant. These findings suggest that the inverse association between midlife VPA and long-term HF risk may be mediated by a more favorable risk factor profile.
Abstract 17227: An Artificial Intelligence Based Model for Heart Failure With Preserved Ejection Fraction Predicts Cardiac Mortality
Authors: Cassianni Claire E , Huntley Geoffrey D , Akerman Ashley P , Porumb Mihaela , Scott Christopher G , Chartsias Agisilaos , Ryu Alexander J , Hawkes William , Arystan Ayana Z , Kane Garvan C , Pislaru Sorin V , Lopez-Jimenez Francisco , Sarwar Rizwan , O'Driscoll Jamie , Leeson Paul , Upton Ross , woodward gary , Pellikka Patricia A
Published: December 2023

Background:
Diagnosis of heart failure with preserved ejection fraction (HFpEF) is challenging due to non-diagnostic imaging outputs and discordant clinical features. Using only a single videoclip from a standard transthoracic echocardiogram (TTE), we developed an artificial intelligence (AI) model to differentiate patients with HFpEF from those without HFpEF. In a separate test population, we assessed the model’s ability to predict cardiac mortality.

Methods:
A 3-dimensional convolutional neural network was developed and trained on apical 4-chamber videoclips to classify patients with HFpEF (cases) versus without HFpEF (controls). Overall and cardiac mortality were obtained from the National Death Index.

Results:
The model was independently tested in 646 cases and 638 controls from 8 centers in 4 states. Sensitivity (87.8%; 84.5-90.9%) and specificity (81.9%; 78.2-85.6%) were high and sustained in various subgroups, including increased left atrial volume index, average E/e’ ≥15, and pulmonary artery systolic pressure >35 mm Hg. During follow-up (median [IQR] 3.4 [1.7-6.5] years), 540 patients died. There were 135 cardiac deaths attributable to heart failure (47%), coronary artery disease (41%), valve disease (4%), arrhythmia (4%), and others (5%). Compared to a negative output, all-cause mortality was higher in patients with a positive (HR 2.9 [2.4-3.5]) or uncertain output (HR 1.8 [1.2-2.5]), and cardiac mortality (Figure) was also higher in patients with a positive (HR 7.7 [4.5-13.3]) or uncertain output (HR 3.4 [1.4-8.1]). Cardiac mortality differences according to AI model prediction remained after age adjustment (positive: HR 5.9 [3.3-10.4], p<0.001; uncertain: HR 2.8 [1.2-6.8], p=0.02).

Conclusion:
A novel AI model to detect HFpEF based on a single routinely acquired TTE videoclip also identifies those at increased risk of cardiac mortality.
Abstract 17250: It's the Journey, Not the Destination: Demonstration of an Uncommon Variation of Para-Hisian Pacing
Authors: Vedage Natasha A , Perucki William H , Basil Anuj , Cooper Joshua M , Whitman Isaac R
Published: December 2023

A 21 year-old college athlete presented with palpitations during exercise. ECG and transthoracic echo were normal. He underwent electrophysiology study. With catheter placement, the patient had atrial fibrillation without preexcitation. On isoproterenol, spontaneous salvos of supraventricular tachycardia (SVT) occurred. Coronary sinus activation was concentric. SVT never sustained, limiting diagnostic maneuvers. In SVT, the ventriculoatrial (VA) time was 145 msec, and there was no decrement of VA conduction with ventricular extrastimuli. Para-Hisian pacing (PHP) was performed. At high output, local myocardial + Purkinje (LM+P) capture was observed, with a VA time of 130 msec; at lower output, selective Purkinje (SP) capture was observed, with a narrower QRS (Figure 1A), and paradoxically
longer
VA time (160 msec) (Figure 1B). The diagnosis of a retrograde conducting-only accessory pathway (AP) was made, mapped with ventricular pacing, and ablated on the posteroseptum. SVT was no longer inducible.

Discussion:
PHP is employed to identify presence of a septal retrograde conducting AP based on findings of
equal
VA times with LM and LM+P capture. Here, the traditional findings of PHP (LM and LM+P capture) were absent because LM capture did not occur, and a third, distinct manner of activating the ventricle (via SP capture) produced unexpected results. In the presence of a retrograde conducting AP, the VA time with narrow-QRS by way of SP capture (sequential activation of the Purkinje system then myocardial conduction) was paradoxically longer than that of wider-QRS LM+P capture (concurrent Purkinje and myocardial conduction), because the path of VA conduction via the AP is “closer” to the site of first ventricular activation. The comparison of SP to LM+P capture may in and of itself declare the presence of an AP; however, LM, LM+P, and SP capture together may be useful to identify a second concealed AP providing incremental diagnostic information to conventional PHP.
Abstract 17264: PFO Cover Index by 3D-TEE Predicts Residual Shunting After Transcatheter Closure
Authors: Datta Tanuka , Ruggiero Nicholas J , Peters Andrew C , Pender Ashley , Marcantuono Rebecca , Vishnevsky Alec , Mehrotra Praveen
Published: December 2023

Introduction:
Proper defect sizing and device size selection are imperative for ensuring successful clinical outcomes after transcatheter patent foramen ovale (PFO) closure. However, with current sizing techniques, residual shunting remains as high as 25% and is associated with an increased risk of recurrent neurologic events. Since 2017, we adopted a PFO sizing strategy based on right atrial (RA) tunnel “width” oversizing utilizing three-dimensional transesophageal echocardiography (3D-TEE).

Hypothesis:
We hypothesized that the PFO tunnel width at the RA opening and a cover index based on this dimension would predict residual shunting at long term follow-up.

Methods:
Sixty-four patients underwent transcatheter PFO closure (60 patients utilizing a 3D-TEE based oversizing strategy) at our institution between 2015 and 2022. PFO tunnel length, tunnel width at RA opening, and tunnel width at left atrial opening were determined by 3D-TEE either before or at the time of closure. We determined an absolute PFO “cover index” for each patient as follows: RA disc diameter - RA tunnel width. Receiver operating characteristic (ROC) curve analysis was used to determine the predictive ability of 3D-TEE derived PFO dimensions and the PFO cover index to predict residual shunting at follow-up.

Results:
Fifty-one of sixty-four patients had a long-term follow-up bubble study (mean follow-up time 8.0±3.7 months). Of the 47 patients closed utilizing a 3D-TEE based sizing strategy and with a follow-up bubble study, only 5 patients (10.6%) had residual shunting at follow-up. Of the three 3D-TEE based PFO dimensions, only the RA tunnel width was predictive of residual shunting at follow-up (AUC 0.84, p=0.004). A cutoff of 15.5 mm or greater for RA tunnel width had the best combination of sensitivity (86%) and specificity (73%). The PFO cover index was also strongly predictive of residual shunting at follow-up (AUC 0.87, p=0.002). A cutoff of 9.5 mm or less had the best combination of sensitivity (86%) and specificity (82%).

Conclusions:
A larger PFO tunnel width at the right atrial opening and a lower cover index based on this dimension predict residual shunting at follow-up. Our findings have important implications for improving sizing strategies for transcatheter PFO closure.
Abstract 17275: Clinical Outcomes Following Maze and Left Atrial Appendage Occlusion Procedures for Patients With Atrial Fibrillation Undergoing Mitral Valve Surgeries: Insights From the National Readmission Database
Authors: Mkhaimer Yaman , Mehta Nikhil , kennedy kevin , Shatla Islam , Wimmer Alan P
Published: December 2023

Background:
Maze procedure and left atrial appendage occlusion (LAAO) are often done as adjunctive procedures during mitral valve surgery in patients with atrial fibrillation (AF). We examined the effect of the Maze procedure and LAAO on AF-related clinical outcomes.

Methods:
We identified patients with AF from the Nationwide Readmission Database who underwent mitral valve surgery in the years 2016-2019 using ICD 10 codes. Patients were grouped by procedure type (Maze+/LAAO+, Maze+/LAAO-, Maze-/LAAO+, Maze-/LAAO- (control)). Outcomes were in-hospital and 180-day readmission rate for stroke and mortality, and 180-day AF/atrial flutter readmission. Multivariate regression analysis was conducted adjusting for demographics, hospital characteristics, comorbidities, and cardiac surgery type.

Results:
Of 14,979 patients with AF who underwent mitral valve surgery, adjunctive procedures were performed as follows: 2427 Maze+/LAAO+, 997 Maze+/LAAO-, 4052 Maze-/LAAO+, and 7503 Maze-/LAAO-. Stroke during the index admission and within 180 days occurred less frequently in the adjunctive procedure groups than in control group (2.5%, 2.3%, 3.4%, and 4.9% respectively, P<0.001). Similar results were observed for in-hospital and 180-day mortality (3.9%, 7.6%, 4.8%, and 6.8% respectively, P<0.001). However, readmission within 180 days for AF/atrial flutter was higher in the adjunctive procedure groups than the control group (5.6% vs 4.2% vs 5.4% vs 3.8%, P<0.001). On multivariate analysis, patients who had either Maze or LAAO procedures (Maze+/LAAO+, Maze+/LAAO-, Maze-/LAAO+) had a lower 180-day stroke risk when compared to the control group (hazard ratio (HR) 0.7, P=0.01; HR 0.66, P=0.55; and HR 0.79, P=0.01 respectively). Similarly, 180-day mortality was lower in patients who underwent LAAO compared to the control group (HR 0.71, P=0.002; HR 1.27, P=0.05; and HR 0.78, P=0.004 respectively).

Conclusion:
Patients with AF who underwent Maze and/or LAAO procedures during mitral valve surgery had lower 180-day stroke and mortality rates. There was a higher rate of readmission for AF/atrial flutter, which may be a short-term proarrhythmic effect of these procedures or may reflect differences in AF type and rhythm control goals in the control group.
Abstract 17294: Dynamic Change Patterns of Visceral Adiposity Index and Risk of Cardiovascular Disease: A Chinese Nationwide Cohort Study
Authors: Hu Xiangming , Ou Yanqiu , Dong Haojian , Zhou Yingling , Jin Junguo , Liu Jieliang , Jiang Lujing , Liu Mingqin
Published: December 2023

Introduction:
Visceral adiposity index (VAI), as a reliable marker for visceral adiposity accumulation and dysfunction, is an independent risk factor for cardiovascular disease (CVD). However, the influence of VAI transition on CVD has never been revealed.

Hypothesis:
Different VAI dynamic change patterns have different impacts on the risk of CVD.

Methods:
There were 5,395 participants aged equal or more than 45 years recruited in 2011 and followed up until 2018, with VAI information and free of a diagnosis of CVD at baseline. New-onset CVD including heart disease and stroke was defined by medical diagnosis. A receiver-operating characteristic curve was employed to divide individuals into high and low VAI categories. Participants were divided into four groups based on VAI change patterns during follow-up period (2011—2015): low-low group, low-high group, high-low group, and high-high group. The probabilities of CVD-free survival were estimated by Kaplan-Meier analysis. A Cox proportional hazards model was used to evaluate the association between different change patterns of VAI and CVD.

Results:
During a median follow-up period of 7 years, 969 participants (17.9%) developed CVD. The high-high group (hazard ratio (HR): 1.65, 95% confidence interval (CI): 1.39—1.97) and the low-high group (HR: 1.29, 95% CI:1.04—1.61) were associated with a higher risk of CVD after adjusting for demographic characteristics and traditional risk factors compared to the low-low group, while the effect in high-low group was not significant.

Conclusions:
Changes in VAI were significantly associated with CVD risk. Monitoring the dynamics of the VAI in public health practice would help prevent CVD.
Abstract 17313: Evaluating the Predictive Accuracy of Viscoelastic Blood Coagulation Measurements for Postoperative Bleeding in Cardiac Surgery: A Diagnostic Accuracy Meta-Analysis
Authors: Elfaituri Muhammed K , Khaled Ala , Faraj Hazem Abdelkarem A , BenGhatnsh Ahmed , Msherghi Ahmed
Published: December 2023

Introduction:
Postoperative bleeding in cardiac surgery significantly impacts patient morbidity and mortality. Viscoelastic blood coagulation measurements, such as point-of-care (POC) viscoelastic hemostatic assays (VHAs), are proposed tools for predicting this complication and enabling proactive management. However, thoroughly evaluating existing evidence is essential to confirm their effectiveness.

Hypothesis:
This study aims to evaluate the diagnostic accuracy of viscoelastic blood coagulation measurements in predicting postoperative bleeding following cardiac surgery.

Methods:
A systematic search of studies published up to May 2022 was conducted, employing databases such as PubMed, EMBASE, and the Cochrane Library. Included studies implemented viscoelastic blood coagulation measurements in cardiac surgery settings, providing data on diagnostic accuracy for predicting postoperative bleeding. Major postoperative blood loss, as defined within each study setting, was used as the reference standard. Statistical analysis was performed using R software (version 4.0.3) with mada package. This analysis enabled various diagnostic accuracy metrics pooling, all presented with a 95% Confidence Interval (CI).

Results:
This analysis incorporated 10 studies comprising 2048 patients, 374 of them experienced confirmed postoperative bleeding after cardiac surgery. The pooled sensitivity and specificity of viscoelastic blood coagulation measurements for predicting postoperative bleeding were found to be 65% (95% CI: 42.9-82%, I2=89.4%) and 85% (95% CI: 69.7-93.3%, I2=95.1%) respectively. The false-positive rate was identified as 15% (95% CI: 6.7-30.3%). The diagnostic odds ratio was 10.50 (95% CI: 2.93-37.57). The positive and negative Likelihood Ratios were 4.34 (95% CI: 1.89-9.95) and 0.42 (95% CI: 0.23-0.75), respectively.

Conclusions:
Despite moderate sensitivity, viscoelastic blood coagulation measurements exhibit high specificity in predicting postoperative bleeding in cardiac surgery, potentially enhancing patient management through early intervention. However, due to the observed heterogeneity, further large-scale studies are required to confirm these results and assess their impact on patient outcomes.
Abstract 17329: Histone Modifications Regulate Hypertrophy Pathways in Obstructive Hypertrophic Cardiomyopathy
Authors: Garmany Ramin , Dasari Surendra , Bos Johan M , Tester David J , Dos Remedios Cristobal , Maleszewski Joseph J , Robertson Keith , Dearani Joseph A , Ommen Steve R , Giudicessi John , Ackerman Michael J
Published: December 2023

Introduction:
Recently, we demonstrated transcriptional down-regulation of hypertrophy pathways in myectomy tissue derived from patients with obstructive hypertrophic cardiomyopathy (HCM) despite translational activation of associated hypertrophy pathways. Previous studies of other forms of cardiac hypertrophy demonstrate hypertrophy pathways are activated via histone acetylation and histone deacetylase (HDAC) inhibitors prevented development of hypertrophy. Whether histone modifications regulate hypertrophy pathways in HCM remains unexplored.

Methods:
Chromatin immunoprecipitation sequencing (ChIP-seq) was performed on myectomy tissues from 40 patients with HCM and 23 controls to characterize differential histone marks for H3K4me3 (active promoter), H3K9ac (active promoter), H3K9me3 (heterochromatin), H3K27ac (active enhancer), H3K27me3 (repression) across the genome. The differential histone marks were integrated with RNA-sequencing (RNA-seq) data derived from the same patients.

Results:
Overall, we identified 2,912 (7%) differential H3K4me3 peaks impacting 5 pathways, 23,339 (21%) differential H3K9ac peaks impacting 87 pathways, 33 (0.05%) differential H3K9me3 peaks, and 58,837 (42%) differential H3K27ac peaks impacting 50 pathways. There was increased H3K27ac (q-value = 0.002) and H3K9ac (q-value = 0.009) at RAS-MAPK loci. Univariate analysis of concordance between H3K9ac with RNA-seq data showed activation of cardiac hypertrophy signaling (z-score=4.5; -log [BH p-value] = 3.1), while H3K27me showed down-regulation of cardiac hypertrophy signaling (z-score=-2.4; -log [BH p-value] = 2.4). Multivariate integration of the ChIP-seq data with RNA-seq data identified 3,189 transcripts concordant with all five histone marks impacting 254 pathways, 18 (7%) of which are involved in cardiac hypertrophy.

Conclusions:
Myectomy tissue from patients with obstructive HCM shows enrichment of histone modifications at cardiac hypertrophy loci with activation via H3K27 and H3K9 acetylation and repression via H3K27 methylation. Further studies are needed to understand the balance and temporal relationship between these competing regulators in HCM pathobiology and the potential for epigenetic therapies.
Abstract 17362: Left Atrial Stiffness is Increased in Pediatric Hypertrophic Cardiomyopathy and May Be of Incremental Value in Predicting Major Adverse Cardiac Events in This Group
Authors: Numata Ryusuke , Matsubara Daisuke , Anvekar Priyanka , Kauffman Hunter , Wang Yan , Anyosa Renzo C , Banerjee Anirban
Published: December 2023

Background:
Determining risk factors by echocardiography to prevent major adverse cardiac events (MACE) is crucial in pediatric patients with hypertrophic cardiomyopathy (HCM). Recent studies have shown that LA stiffness and strain may serve as surrogate markers in children, to differentiate elevated pulmonary capillary wedge pressure from normal and predict COVID-19 related myocardial injury.

Hypothesis:
LA stiffness may predict MACE in pediatric patients with HCM.

Methods:
We retrospectively enrolled 201 pediatric patients with HCM diagnosed by echocardiography. They were divided into two groups: MACE (n=61) and non-MACE (n=140) groups. LV systolic function, and LA strain were evaluated by conventional 2D and speckle tracking echocardiography. Noninvasive LA stiffness was calculated as the ratio of E/e’ to LA strain as depicted in the following equation:
LA Stiffness=
E/e
'
ratio
/ LA Peak Strain
(%
-1
). The primary outcome was a composite endpoint of MACE (including ICD placement, myomectomy, heart transplant or death) during follow-up.

Results:
The MACE group showed significantly decreased LV global longitudinal strain (GLS) compared to non-MACE group (GLS - 16.76 ± 5.05% vs. - 20.25 ± 3.40%, p < 0.001), even though LV ejection fraction showed no significant difference between the two groups. LA peak strain was significantly reduced (21.96 ± 7.24% vs. 30.80 ± 7.10%, p < 0.001), whereas, noninvasive LA stiffness was significantly increased (0.72 ± 0.48 %
-1
vs. 0.34 ± 0.16 %
-1
, p < 0.001) in the MACE group. Among the LV diastolic indices, LA stiffness was the superior-most index for predicting MACE (see Table 1, Figure 1) (AUC: 0.814, cut off value: 0.49%
-1
). Also, LA stiffness was independently associated with increased risk of the composite endpoint of MACE (HR: 3.26 [95% CI: 1.77 -5.99]; P < 0.001, see Table 2).

Conclusion:
LA stiffness is a newly described index in children, that may be of incremental value in predicting risk of MACE in pediatric HCM patients.
Abstract 17366: Effects of Acute Maternal Supplemental Oxygen on the Fetal Circulation in Transposition of the Great Arteries
Authors: Sun Liqun , Lee Fu-Tsuen , Szabo Adrienn , Saito Mika , Barber Nathaniel , van Ameron Joshua , Portnoy Sharon , Marini Davide , Saini Brahmdeep , Balmer-Minnes Diana , Guerra Vitor , Thakur Varsha , Macgowan Christopher , Miller Steven , Jaeggi Edgar T , Seed Mike
Published: December 2023

Introduction:
The presence of a restrictive atrial septum in the setting of transposition of the great arteries (TGA) is associated with a high risk of hypoxic ischemic injury upon transition to postnatal circulation. Fetal cardiovascular magnetic resonance (CMR) measures of vessel flow and oxygen saturation provide a unique opportunity to study fetal TGA hemodynamics at baseline and during acute maternal hyperoxygenation.

Methods:
Thirty-one pregnant mothers with fetuses diagnosed with TGA and an intact ventricular septum (n=23) or small ventricular septal defect (n=8) were recruited and underwent fetal CMR in room air and during administration of 10L/min of oxygen by face mask for up to 45 minutes. Blood flow and oxygen saturations were measured in the major fetal vessels using cine phase contrast MRI and MR relaxometry at baseline and during hyperoxygenation.

Results:
Two patients exhibited severe restriction at the atrial septum, one undergoing fetal atrial septostomy at 37 weeks and one requiring cannulation onto ECMO shortly after birth. Both revealed reversal of the usual relationship of oxygen saturation between the aorta and the main pulmonary artery at baseline and during hyperoxygenation, i.e. in TGA with restrictive atrial septum the saturations are higher in the aorta than pulmonary. Acute maternal supplemental oxygen was associated with increased pulmonary blood flow (p=0.008) and reduced foramen ovale (p=0.01) and ductus arteriosus shunting (p=0.01). There were no significant changes in umbilical vein, descending aorta and superior vena cava flow. Fetal oxygen saturations increased throughout fetal circulation (p<0.0001) with an associated increase in fetal oxygen delivery (p=0.007), but no increase in fetal cerebral oxygen delivery (p=0.58).

Conclusions:
This study characterized the effects of acute maternal supplemental oxygen on the fetal circulation in patients with TGA and confirmed the redistribution of flow toward the fetal pulmonary circulation. We observed higher oxygen saturations in the aorta than main pulmonary artery in fetuses with TGA with an intact or highly restrictive atrial septal communication. This finding could be helpful in selecting patients for prenatal or emergency neonatal balloon atrial septostomy.
Abstract 17367: Impact of Cardiac MRI on Myocarditis Management and Patient Outcomes: A Big Data Study
Authors: Narendrula Aparna , Issa Rochell , Chen David , Nguyen Christopher , Tang Wai Hong W , Kaelber David , Kwon Deborah H
Published: December 2023

Introduction:
The lack of consensus regarding the role of cardiac magnetic resonance (CMR), an essential myocarditis imaging modality, leads to patient care inconsistencies. We investigated the impact of CMR on resource utilization and patient outcomes in myocarditis patients.

Methods:
Using TriNetX, we conducted a large, retrospective analysis between 1/01/2010 and 6/02/2023. We compared myocarditis patients with and without CMR within 3 months of diagnosis. Matching cohorts (n=7,488 per cohort) were created based on demographic variables and comorbidities including lipidemias, hypertension, diabetes, sarcoidosis, and select heart diseases within 1 month of diagnosis. The analysis yielded risks to compare outcomes, resource utilization, and medication and procedure usage.

Results:
Patients without CMR had higher mortality rates compared to those who received CMR in the context of higher mortality between 2017-2022 compared to 2010-2016 (Risk 2.728% vs 2.314%, p<0.05). Mortality risk was higher in the non-CMR cohort at 3 months, 1 year and 5 years. Risks of developing cardiomyopathy and heart failure were higher in the non-CMR group. Between 1 and 5 years, the CMR group experienced fewer hospitalizations (Risk 11.6% vs 14.9%, p<0.05). CMR recipients had a higher chance of receiving all GDMT categories within 30 days, and most GDMT categories within 1 year.

Conclusions:
Myocarditis patients referred for CMR experienced lower hospitalization and mortality rates over 5 years, and were less likely to develop complications and more likely to receive early GDMT. These findings imply potential downstream impacts of CMR on optimal therapeutic management and risk reduction.
Abstract 17390: The Impact of The Covid-19 Pandemic on Perceived Stress in Rural Caregivers Participating in a Cardiovascular Risk Reduction Intervention
Authors: Smith Jennifer L , Kang JungHee , Miller Jennifer , Chung Misook L , Moser Debra K
Published: December 2023

Introduction:
Interventions to reduce cardiovascular disease (CVD) risk factors are key for improving the health and well-being of rural caregivers who are often referred to as invisible patients. The Rural Intervention for Caregivers’ Heart Health (RICHH), a CVD risk reduction intervention (2017-2022) included a stress management module. The COVID-19 pandemic (2020-2021) had an unknown impact on this intervention on perceived stress. The aim of this study was to determine whether the COVID-19 pandemic moderated the effects of RICHH on perceived stress for rural caregivers.

Methods:
This was a randomized controlled trial of a CVD risk reduction intervention that promoted self-care. Caregivers were randomized to usual care or the RICHH intervention. Data were collected at baseline, 4 and 12 months. Participants were grouped into two groups by COVID-19 timing: 1) the pre-pandemic group (n=145) completed the study before the pandemic; and 2) the pandemic group (n=114) completed the study during the pandemic. A piecewise linear mixed-effect model was used to evaluate the impact of the intervention and COVID-19 timing on perceived stress (Cohen’s Perceived Stress Scale).

Results:
The effect of the intervention on perceived stress in 259 participants (mean age = 55 ± 13 years, 78% female, 95% white, and 73 % married) was significant in the pandemic group (β= -.59, SE = .14, P < .001) but not in the pre-pandemic group (β = -.10, SE = .13, P = .45 [Figure1). The differences in perceived stress changes between the pre-COVID and during-COVID groups was significant, indicating a moderating effect of COVID (β = -.50, SE = .19, P = .009).

Conclusion:
The RICHH intervention helped to mitigate stress during the COVID-19 pandemic among those in the intervention group at the 4 months, however this effect was not sustained at 12 months. It remains unclear if the reduction in perceived stress during the pandemic was due to participation in the intervention or weekly contact with an interventionist.
Abstract 17404: Heart Failure Hospitalization Readmissions and Mortality on Cardiology versus Non-Cardiology Services in a U.S. Hospital System
Authors: Hammonds Racquel , Seals Austin , Kitzman Dalane W , Gilbert Olivia
Published: December 2023

Introduction:
With the number of patients diagnosed with heart failure (HF) in the U.S. exceeding the number of cardiologists specialized to care for them, there is increasing reliance on non-cardiologists for treatment of acute decompensated heart failure (ADHF). Based on prior studies, there is concern that outcomes may be inferior under this circumstance.

Hypothesis:
Patients admitted with ADHF have lower 30-day readmissions when admitted to cardiology versus non-cardiology services.

Methods:
This was an observational, retrospective cohort study of 6885 patients with a primary diagnosis of ADHF based on ICD diagnosis-codes from 2015 to 2020. Data were retrieved from an EPIC-based registry with patients admitted to any of five network hospitals in a single health system. The registries were constructed through Clarity. Logistic regression adjusted for age, race, and gender was employed to distinguish differences in 30-day readmissions in those admitted with ADHF to cardiology vs. non-cardiology services.

Results:
Of the 6885 patients, 14% were admitted to cardiology, and 86% under non-cardiology services. The total cohort’s mean age was 69 (±15). The majority were White (71%) and male (54%). There was a statistically significant difference in mean age between cardiology services (68 [±14]) and non-cardiology services (69 [±15]) (p= 0.013). Black patients represented 15% of patients on cardiology services and 28% on non-cardiology services (p <0.0001). There were more male patients on the cardiology services (64%) than the non-cardiology services (52%) (p <0.0001). Unadjusted 30-day readmissions were lower for those admitted to cardiology vs. non-cardiology services (odds ratio 0.82 [95%CI: 0.67, 0.99, p=0.041]). Adjusted 30-day readmissions for those admitted to cardiology vs non-cardiology services were also lower (odds ratio 0.79 [95%CI: 0.65, 0.97, p=0.022).

Conclusion:
In this institutional electronic health record-based study, 30-day HF readmissions were found to be significantly lower in those admitted to cardiology vs. non-cardiology services. A future study to explore the variables contributing to these outcomes and to validate this data in a larger population is required.
Abstract 17427: Smaller Hospital Bed Size is Associated With Higher Mortality in Stanford Type A Aortic Dissection
Authors: Li Renxi , Luo Qianyun , Green Derrick L , Huddleston Stephen
Published: December 2023

Introduction:
The National Inpatient Sample (NIS) database stratifies hospital bedsize according to the number of hospital beds, urban or rural, and teaching or non-teaching hospital. Larger hospital bed size stratified by these criteria has been associated with better patient care and surgical outcomes in some instances. This study aimed to examine the effect of hospital bed size on perioperative outcomes in Type A Aortic Dissection (TAAD).

Methods:
Patients who underwent TAAD repair were identified in the NIS from Q4 2015-2020 by ICD10-CM/PCS. NIS stratifies hospital bed size into small, medium, and large, rural vs urban, and teaching status. Patients were stratified into two cohorts: small/medium and large. Significant preoperative differences were present between groups; thus, multivariable logistic regressions were performed to compare the surgical outcomes (in-hospital). Adjusted preoperative variables included sex, age, race, socioeconomic status, comorbidity, primary payer status, hospital characteristics, length of stay (LOS), days from admission to operation, and total hospital charge were compared.

Result:
There were 1,106 and 3,752 cases with small/medium and large bed sizes, respectively, identified in the NIS database. Among patients admitted to small/medium bed size hospitals, there was higher mortality (17.27% vs 14.37%, aOR=1.32, 95% CI 1.09-1.60, p<0.01), but shorter LOS and lower cost compared to larger hospitals (Table). There was no difference in morbidities (Table).

Conclusion:
Marked higher mortality is associated with admission to smaller hospital bed sizes among patients with TAAD, which may in turn decrease the average LOS and cost. Given that a significant percentage of patient are already being transferred out of the initial hospital and small/medium hospital size is associated with higher mortality, centralization of care in centers of excellence may decrease the high mortality associated with TAAD.
Abstract 17428: Severity of Diastolic Dysfunction Predicts Risk of Myocardial Infarction
Authors: Gokhale Tanmay A , Dhande Mehak , Mulukutla Suresh R , Thoma Floyd W , Bhonsale Aditya , Kancharla Krishna , Voigt Andrew , Shalaby Alaa , Estes Nathan A , Jain Sandeep , Saba Samir
Published: December 2023

Background:
Diastolic dysfunction (DD) is known to be a predictor of mortality. However, the impact of DD on the risk for myocardial infarction (MI) is not well defined.

Research Question:
We sought to examine whether DD is an independent predictor of risk of MI in patients with a preserved ejection fraction.

Methods:
This was a retrospective study of consecutive patients who underwent an echocardiogram that showed normal systolic function and had ≥3 months of follow-up. DD was graded using the contemporaneous guidelines at the time of the echocardiogram. Subsequent MI was determined by the presence of an inpatient encounter with a primary diagnosis of MI.

Results/Data:
136,455 patients were included (mean age 56 years; 58% women). DD was present in 18.3% of patients (14.1% Grade 1, 3.8% Grade 2, 0.4% Grade 3). Patients with DD were more likely to be older (71 vs 53 years) and have coronary artery disease (27% vs 12%), diabetes (27% vs 14%), hypertension (69% vs 47%) and hyperlipidemia (64% vs 41%), among other comorbidities. Survival free from MI was significantly lower as diastolic dysfunction severity increased (Figure 1). Multivariate Cox proportional hazards modeling demonstrated that DD was an independent predictor of MI (hazard ratios [CI]: Grade 1: 1.51 [1.35-1.69]; Grade 2: 1.92 [1.64-2.25]; Grade 3: 2.82 [1.94-4.09]).

Conclusions:
Our data demonstrate that the risk of MI is significantly increased in the presence of DD, with higher risk at higher grades of DD. The increased risk associated with grade 3 DD is comparable to that from a prior history of coronary artery disease. These findings suggest that the severity of DD may be a useful tool in risk stratifying patients for risk of MI.
Abstract 17436: A Diagnostic Copycat: Culture Negative Endocarditis of A Bioprosthetic Valve Presenting as ANCA Vasculitis
Authors: Hamilton David E , Fell Katherine , Brummel Kent , Eagle Kim
Published: December 2023

A 59-year-old female with a history of bicuspid aortic valve (AV) complicated by aortic stenosis and ascending aortic aneurysm s/p bioprosthetic AV and ascending aorta replacement presented with a 6-month history of weight loss, fatigue, and lower extremity rash. Initial laboratory workup identified anemia, leukopenia, and acute kidney injury with proteinuria and microscopic hematuria. Further workup included negative blood cultures, elevated inflammatory markers, elevated rheumatoid factor, hypocomplimentemia, and ANCA positivity (PR3 Ab positive). Biopsy of her palpable purpuric rash demonstrated vascular immune deposition pattern consistent with leukocytoclastic vasculitis. Renal biopsy revealed focal and crescentic glomerulonephritis with immune complex deposition. CT abdomen noted mesenteric lymphadenopathy with fluid surrounding the thoracic aortic graft. Surface echocardiogram showed bioprosthetic AV replacement with diffuse cusp thickening without stenosis or regurgitation. At this point, a multidisciplinary team offered a broad differential diagnosis of inflammatory vasculitis versus culture-negative endocarditis with plan for further testing. Follow-up whole-body and cardiac PET scan identified FDG-avid abnormalities involving the aortic graft and AV with hypermetabolic soft tissue thickening surrounding the aortic root. Transesophageal echocardiogram confirmed AV thickening with a 1 cm mobile echodensity. Additional serologic testing identified positive Bartonella henselae IgG (1:8192) and IgM (>1:20) titers. The final diagnosis was B. henselae prosthetic AV endocarditis and ascending aortic graft infection. She underwent repeat AV and ascending aortic graft replacement, with graft material positive for B. henselae PCR and was treated with a course of doxycycline and rifampin. B. henselae is a fastidious gram-negative bacterium that can cause culture negative endocarditis but is very rarely associated with aortic graft infection. This case highlights (1) a rare example of B. henselae aortic graft infection, (2) the difficulty in differentiating B. henselae endocarditis from inflammatory vasculitis, and (3) the importance of engaging multidisciplinary teams to solve difficult diagnostic cases.
Abstract 17454: Development and Validation of an Artificial Intelligence 12-Lead Electrocardiogram-Based Mutation Detector for Congenital Long QT Syndrome
Authors: Bos Johan M , Liu Kan , Attia Zachi , Noseworthy Peter A , Friedman Paul , Ackerman Michael J
Published: December 2023

Introduction:
Over 100 FDA-approved medications, electrolyte perturbations, and many disease states can prolong the QT interval in up to 10% of patients. In contrast, approximately 1 in 2,000 people have congenital long QT syndrome (LQTS) hallmarked by pathological QT prolongation secondary to LQTS-causative mutations.

Hypothesis:
an artificial intelligence (AI) deep neural network (DNN) analysis of the 12-lead ECG can distinguish patients with LQTS from those with acquired QT prolongation.

Methods:
The study cohort included 1599 patients with genetically confirmed LQTS and over 2.5 million controls from Mayo Clinic’s ECG data vault. Every patient/control with ≥ 1 ECG above age- and sex- specific 99
th
percentile values for QTc [> 460 ms for all patients (male/female) < 13 years of age, or > 470 ms for men and > 480 ms for women above this age] was included. An AI-DNN involving a multi-layer convolutional neural network was developed. To simulate screening conditions, patients were matched at a ratio of 1:2,000 (incidence of LQTS) or 1:200 (balance of LQTS vs acquired QT prolongation in a tertiary referral center).

Results:
Among the 1,599 patients with LQTS, 808 (> 50%) had ≥ 1 ECG with QTc above the aforementioned QTc thresholds (2,987 ECGs) compared to 361,069/2.5M controls (14% of Mayo Clinic patients getting an ECG, 989,313 ECGs). Following age- and sex- matching and splitting, the model successfully distinguished LQTS from those with acquired QT prolongation at 1:2,000 matching with an AUC of 0.937 (accuracy 89%, sensitivity 81%, specificity 90%, PPV 0.05, NPV 0.99). Furthermore, when matching at a rate that genetically-mediated QT prolongation would be encountered in clinic (1:200), the model still successfully separated the two groups (AUC 0.912, accuracy 88%, sensitivity 78%, specificity 89%, PPV 0.1, NPV 0.99).

Conclusion:
For patients with a QTc exceeding its 99
th
percentile values seen in health, this novel AI-DNN 12-lead ECG distinguishes abnormal QT prolongation stemming from LQTS versus acquired QT prolongation with high performance characteristics (AUC > 0.93). Even when scaled to referral center and LQTS incidence ratios, a negative AI-DNN signal rules out the presence of a LQTS disease-causative mutation with 99% negative predictive value.
Abstract 17470: Comparison of Outcomes for Adult Patients With Subaortic Stenosis by Surgical or Medical Management: Single-Center Cohort Study
Authors: Agrawal Ankit , Arockiam Aro Daniela , Saraswati Ushasi , Chandna Sanya , Majid Muhammad , Kassab Joseph , Chedid El Helou Michel , Atar Mustafa , El Dahdah Joseph , Zakhour Samer , Rodriguez L L , Popovic Zoran B , Griffin Brian P , Wang Tom Kai Ming K
Published: December 2023

Introduction:
Surgery is recommended subaortic stenosis (SAS) patients with severe left ventricular outflow tract obstruction and symptoms, left ventricular dysfunction and sometimes aortic regurgitation, although how surgery modifies patient prognosis is not well understood. We compared the outcomes of SAS based on past and follow-up treatment disposition.

Methods:
This is a retrospective observation study of adult patients (≥ 18 years) evaluated for SAS on transthoracic echocardiography at our institution during 1/1/2001 to 6/30/2022. Patients were divided into three groups: 1. Patients with prior SAS surgery at index visit; 2. Patients who underwent surgery during follow-up without prior SAS surgery; and 3. Patients managed medically. Primary follow-up endpoint all-cause mortality and secondary endpoint heart failure (HF) hospitalization were compared between groups.

Results:
There were a total of 115, 106, and 263 patients in group 1, 2, and 3 respectively. The mean age was 45.7±20 years and 67.1% were females. Over median follow-up of 5.5 years, there were 8, 6 and 42 deaths, 3, 9 and 21 heart failure hospitalization, and 20, 15, and 25 SAS recurrences in groups 1, 2, and 3, respectively. Multivariate analysis showed that patients with shortness of breath (odds ratio 3.64, 95% confidence interval 1.20-11.05, P=0.02) and those who are treated medically (1.77 (1.03-3.05), P=0.03) are associated with higher rates of composite death and HF hospitalization. The figure illustrates the Kaplan-Meier survival curves for the primary and secondary endpoint. Group 3 had significantly worse all-cause mortality (P=0.04) and heart failure hospitalization (P=0.03) rates during follow-up.

Conclusions:
The cohort of adult SAS patients that were managed medically were associated with worse prognosis.
Abstract 17471: Adjunctive Hypothermia for Patients With ST-Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention: A Controversy With Disheartening Results!
Authors: Abouzid Mohamed R , Ali Karim , Ali Ahmed , Ghanim Mohammed
Published: December 2023

Objective:
This meta-analysis aims to assess the effectiveness of hypothermia as an adjunctive therapy in percutaneous coronary intervention (PCI) for patients with ST-segment elevation myocardial infarction (STEMI).

Methods:
A comprehensive literature search was conducted using electronic databases to identify relevant studies published up until May 2023. Studies investigating the use of adjunctive hypothermia in STEMI patients undergoing PCI were included. Data on clinical outcomes, including mortality, infarct size, left ventricular function, major adverse cardiac events (MACE), and microvascular obstruction, were extracted and analyzed.

Results:
A total of 8 studies involving 488 patients were included in this meta-analysis. The pooled analysis revealed no significant difference in all-cause mortality between the adjunctive hypothermia group and the control group (risk ratio [RR] = 0.65; 95% confidence interval [CI] 0.30-1.43). There was no significant difference in MACE rates between the two groups (RR = 1.53; 95% confidence interval [CI] 0.66-3.53). Additionally, no significant differences were observed in infarct size, left ventricular function, or microvascular obstruction.

Conclusion:
While previously believed to show promise, hypothermia as an adjunctive therapy in PCI fails to achieve any significant superiority over standard interventions according to our analysis. Nevertheless, our findings should be interpreted with caution, taking into account the limitations we faced in our analysis such as the small number of studies available in the literature. Continued research efforts on bigger sample sizes are essential to either refine or refute the current findings.