bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14249: COVID-19 and Complete Heart Block in a Vaccinated Adult
Authors: Lawrence Luke , Brahier Mark , Srichai-Parsia Monvadi B , Thomaides Athanasios
Published: June 2023

Introduction:
Complete heart block (CHB) in association with Covid-19 is uncommon and has been described primarily in the pre-vaccine time period. In the setting of acute Covid-19 infection, decision to treat CHB with permanent pacemaker (PPM) is often uncertain as the CHB may resolve or persist. We present a case of reversible CHB and Covid-19 infection in a vaccinated healthy 28-year-old.

Case:
A healthy 28-year-old female presented after syncope. She had been vaccinated three times against Covid-19 with Pfizer-BioNTech mRNA vaccine with her third dose four months prior. She had known Covid-19 exposure and developed sore throat three days prior to presenting with syncope. She had no other symptoms.

Physical exam was remarkable only for bradycardia. Labs showed positive Covid-19 PCR test and elevated troponin of 0.396 ng/mL. Complete blood counts, metabolic panel, ESR and CRP were normal. Lyme IgM and IgG were negative by Western blot. ECG showed CHB with a rate of 35 beats per minute (Figure 1A). Echocardiogram showed no abnormalities.

The patient remained in CHB for 24 hours, at which point PPM was implanted after shared-decision making. Post-PPM ECG showed AV-paced rhythm (Figure 1B). At follow up, PPM interrogation showed that she transitioned to sinus rhythm with right bundle branch block (RBBB) followed by a return to normal sinus rhythm without RBBB 5 days after implantation (Figure 1C). Cardiac MRI two months after PPM implantation showed no abnormalities.

Discussion:
This was a case of Covid-19 associated myocardial injury with CHB in a fully-vaccinated, healthy adult treated with PPM. Despite vaccination, this patient experienced myocardial and conduction system involvement during acute Covid-19 infection. Myocardial injury along with this ECG progression suggested that there was transient inflammation of the myocardial septum resulting in CHB. It may be reasonable to delay PPM implantation in cases of CHB and Covid-19 infection as the CHB may be transient.
Abstract 14258: Left Bundle Branch Pacing for Cardiac Resynchronization Therapy in Heart Failure: A Systematic Review and Meta-Analysis
Authors: El Iskandarani Mahmoud , Shatla Islam , Kassab Mohamad , Refaat Marwan M , Paul Timir K
Published: June 2023

Introduction:
: Cardiac resynchronization therapy (CRT) using a biventricular pacemaker (BVP) reduced mortality and rehospitalizations in patients with symptomatic heart failure (HF) with a left ventricular ejection fraction (LVEF) of less than 35% and concomitant left bundle branch block. However, 10-30% of BVP patients fail to show a clinical or echocardiographic response. Recently left bundle branch pacing (LBBP) has been studied as a more physiological alternative to BVP. The aim of this study is to summarize the available evidence on LBBP.

Hypothesis:
LBBP is an effective and feasible alternative option for CRT.

Methods:
Unrestricted searches of the PubMed, EMBASE, and Cochrane databases from inception till June 1, 2022, for studies examining the role of LBBP for CRT in HF patients. Data were analyzed using Revman 5.3 software. Mean Difference (MD), Odds Ratio (OR), and 95% Confidence interval (CI) were calculated using the random-effects model.

Results:
A total of 8 observational studies (3 single-armed, and 5 comparative studies) examined 756 HF patients who underwent CRT (551 LBBP vs 205 BVP). LBBP was successful in 87% of patients. Compared to baseline, LBBP was associated with a reduction in QRS duration (MD -53.5, 95%CI -69.77, -37.24), an increase in LVEF (MD 17%, 95%CI 13.38, 20.6), and a reduction in NYHA class (MD -1.4, 95%CI -1.56, -1.05). Compared to BVP, LBBP was associated with a significant reduction in QRS duration (MD -22.68, 95%CI -31, -14.35), improvement in LVEF (MD 7.58, 95%CI 5.21, 9.95), and a decrease in NYHA class (MD -0.55, 95% CI -0.73, -0.37) during a mean follow-up of 9.2 months. The super response rate, which is defined as an increase in LVEF of more than 20% or LVEF at or above 50% after CRT, was higher in LBBP compared to BVP (OR 2.98, 95%CI 1.65, 5.32).

Conclusions:
LBBP is a feasible and effective alternative for CRT. LBBP was associated with better electrical ventricular synchrony than BVP which was also translated into better echocardiographic and clinical outcomes in the short term. Our findings need to be further validated in larger randomized controlled trials with a long-term follow-up.
Abstract 14285: Comparison of Percutaneous Coronary Intervention-Related Adverse Cardiac Outcomes in Patients With In-Stent versus De Novo Chronic Total Occlusion: A Systematic Review and Meta-Analysis
Authors: Lyonga Ngonge Anthony , Nso Nso , Mbome Yolanda , Brgdar Ahmed , Tabot Tabot Mpey , Ahmad Basharat , TAHA Mohamed , Alebna Prince , Munawar Muhammad , Asangmbeng Nformbuh , Effoe Valery , Mehrotra Prafulla P , UROOJ FATIMA
Published: June 2023

Introduction:
Contemporary literature reveals a range of cardiac complications in patients who receive the percutaneous coronary intervention (PCI) for chronic total occlusion (CTO).

Hypothesis:
This study compared the adverse cardiac outcomes and procedural/technical success rates between the patients groups of in-stent (IS) CTO PCI and de novo CTO PCI.

Methods:
This systematic review and meta-analysis compared odds for primary (all-cause mortality, MACE, cardiac death post PCI, stroke) and secondary (bleeding requiring blood transfusion, ischemia-driven target-vessel revascularization, PCI procedural success, PCI technical success, and target-vessel MI) endpoints between 2,734 patients who received PCI for IS CTO and 17,808 for de novo CTO. Odds ratios for outcome variables were calculated within 95% confidence intervals (CIs) via the Mantel-Haenszel method. The pooled analysis was undertaken for observational (retrospective/prospective) single- and multi-centered studies published between January 2005 and December 2021.

Results:
We found 57% higher, 166% higher, 129% higher, and 57% lower odds for MACE (OR: 1.57, 95% CI 1.31, 1.89,
p
<0.001), ischemia-driven target-vessel revascularization (OR: 2.66, 95% CI 2.01, 3.53,
p
<0.001), target-vessel myocardial infarction (MI) (OR: 2.29, 95% CI 1.70, 3.10,
p
<0.001), and bleeding requiring blood transfusion (OR: 0.43, 95% CI 0.19, 1.00,
p
= 0.05), respectively, in patients with IS CTO PCI as compared to that of the de novo CTO PCI. No statistically significant differences between the study groups were recorded for the other primary/secondary outcome variables.

Conclusions:
The findings from this study indicated a high predisposition for MACE, ischemia-driven target-vessel revascularization, target vessel MI, and a lower incidence of bleeding episodes among IS CTO PCI patients as compared to those with de novo CTO PCI. The prognostic outcomes in CTO PCI cases require further investigation with randomized controlled trials.
Abstract 14287: Development of an Innovated Heart Failure Hospitalist Program Drives Best Practice and Exceptional Outcomes From 2018-2021
Authors: Vargas Jesus
Published: June 2023

Introduction:
Heart Failure (HF) is an important health care issue given its high prevalence, mortality, and cost of care. Despite numerous evidence-based strategies in the literature aiming at reducing HF readmissions, patients with HF remain at high risk for subsequent hospitalization with 20 to 25% readmitted within 30 days.

Hypothesis:
The UPMC Hospitalist and Cardiology leadership recognized the need to foster consistent inpatient hospitalist providers, which was lacking in the current model. The concept of a dedicated Heart Failure Hospitalist service line emerged.

Methods:
Patients with both primary HF: UPMC Hospitalist, Cardiologist, teaching service N= 4192 (70%); CHF hospitalist Team N=1785 (30%). Heart failure order set usage, length of stay, all-cause 30-day readmission rates, readmission with HF, cost per case were assessed between these two groups from 2018-2021.

Results:
All-cause 30-day HF readmission rates at UPMC (Harrisburg, West Shore, Community General Hospitals) for all providers is 21% from 2018-2021, matching the national average. HF Hospitalist team (only at Harrisburg Hospital) has consistently lower readmission rates: 9% (2018), 8.34% (2019), 8.6% (2020), 6.95% (2021). HF hospitalist length of stay was also consistently lower, by 0.5 to 0.9 days. Potential cost savings to UPMC hospitals is $1.5 million dollars since start of HF Hospitalist service line.

Conclusions:
Heart failure is a major health care issue. The HF Hospitalist service line was created to support an environment of patient-centered care by providing continuity of care for HF admissions and HF patients admitted for non-HF medical issues. The HF Hospitalists provide quality care with frequent daily rounding, optimization of HF medications, providing education to the patient and family to improve treatment plan adherence, as well as engaging in early discussion of palliative and hospice transition. At this community-based healthcare system, HF Hospitalist outcomes include decreasing length of stay; decreased 30 day all-cause readmission to an impressive 8.2%, and reduced 30 day HF readmissions 4.12%. This was done while reducing healthcare costs during the 4yrs of the HF Hospitalist service line at UPMC.
Abstract 14328: The Impact of Peripheral Arterial Disease in Major Bleeding and Major Cardiac and Cerebrovascular Events in Patient Undergoing Percutaneous Coronary Intervention: A Contemporary Assessment
Authors: Bhuiyan Md R , Bimal Tia , Fishbein Joanna , Selim Samy , Gandotra Puneet , Ong Lawrence , Gruberg Luis
Published: June 2023

Introduction:
Peripheral arterial disease (PAD) has been associated with adverse outcomes in patients undergoing percutaneous coronary intervention (PCI). However, there are controversial reports regarding its impact in the current era of radial interventions.

Hypothesis:
We assessed the hypothesis that patients with PAD and patients without PAD undergoing PCI have similar major bleeding complications and major adverse cardiac and cerebrovascular events (MACCE).

Methods:
This was a retrospective analysis of data collected from 6 New York metropolitan area tertiary care hospitals and submitted to the NCDR between 2010 and 2018. Major bleeding events were classified using Bleeding Academic Research Consortium (BARC) classification. Severe bleeding was defined as a BARC ≥3. Hierarchical logistic regression was utilized to assess the association of PAD with post-PCI adverse outcomes, as appropriate.

Results:
A total of 2,933 PAD patients (9.4%) underwent PCI (without PAD, n = 28,172). Results are shown in the Table. PAD patients had a significantly higher odds of MACCE and major bleeding complications, including blood transfusions and in-hospital mortality. Access site bleeding and the need for post PCI dialysis did not reach statistical significance. A multivariable analysis will be presented.

Conclusions:
In conclusion, PAD continues to be a major risk factor for patients undergoing PCI. When compared with patients without PAD, these patients are at an increased risk of major adverse outcomes, including a 67% increase in mortality risk and a 44% in major bleeding complications risk.
Abstract 14358: A Rare Case of Refractory Ventricular Arrhythmias Caused by Subacute Aortic Root Thrombosis Following Left Ventricular Assist Device
Authors: Buttar Rupinder , Salama Amr A , Khosa Gurveer , Goldenberg Ido , baibhav bipul , Shah Abrar H
Published: June 2023

Introduction:
Aortic Root thrombus (ART) is relatively uncommon complication following left ventricular assist device (LVAD) therapy with significant morbidity and mortality.

Case:
A 51-year-old male with coronary artery disease with CABG (LIMA to LAD and sequential SVG) presented with acute cardiogenic shock. EKG showed right bundle branch block with diffuse T wave inversions. Coronary angiogram showed severe three vessel disease with occlusion of all vein grafts except LIMA-LAD. Patient subsequently underwent LVAD with HM3 implant placement as a destination therapy. He was started on warfarin with heparin drip as a bridge. Post op course was complicated by recurrent VF storm. Patient was started on amiodarone and lidocaine. A transthoracic echocardiogram showed LVAD inflow cannula in place and aortic valve was noted to be closed with every beat. HM3 speed was decreased to 5500 rpm. Patient continued to have recurrent episodes of VF, refractory to cardioversion and anti-arrhythmic agents. CT angiogram showed aortic root filling defect consistent with thrombosis extending from the leaflets towards the Sino tubular junction, along the left coronary cusp leaflets. Patient eventually required VT ablation for refractory ventricular arrhythmia. Patient underwent median sternotomy for surgical removal of aortic root thrombus which showed parts of the thrombus intimately connected to the aortic root wall including the left main and right coronary ostia. Post op patient was continued on systematic anticoagulation with noted clinical improvement.

Conclusion:
ART after LVAD placement is a rare complication and can be associated with myocardial infarction and thromboembolic events. It can compromise coronary perfusion and result in ischemic ventricular arrhythmias as seen in our case. Management includes surgical removal of the pump or orthoptic heart transplantation. VT ablation should be considered if no ischemic culprit identified
Abstract 14362: A Case of a Primary Malignant Pericardial Myxoid Sarcoma in a Young Adult
Authors: Agarwal Apurv , Desai Viral K , Stoddard Marcus F
Published: June 2023

Introduction:
Primary pericardial malignant tumors are rare clinical entities with an incidence of 0.001%. The symptoms depend on the location and size of the mass, typically causing chest pain, dyspnea, or syncope. We present the case of a young man with atypical chest pain, rapidly progressing to cardiac arrest from a primary pericardial myxoid chondrosarcoma.
Case Presentation:
A 31-year-old man presented with atypical chest pain. Subsequently, he had a cardiac arrest with pulseless electrical activity. CT chest revealed a 9.5 x 10 cm epicardial mass (Figure 1a, 1b) found to be a myxoid sarcoma on CT-guided biopsy. The morphology was suggestive of a high-grade extra-skeletal myxoid chondrosarcoma. Cardiac MRI had normal function and no myocardial invasion. The staging MRI did not show any other primary source. Due to the large size of the mass, a decision was made to perform surgical resection. Most of the tumor was excised but had positive margins from the part adherent to the inferior vena cava. In the absence of clear guidelines, multiple chemotherapy regimens including doxorubicin, ifosfamide, and etoposide were tried. The initial response was complicated by eventual recurrence and metastasis to the chest wall and mediastinum (Figure 1c, 1d). Further, genetic testing with next-generation sequencing demonstrated MAP3K1 gene mutation. As MAP3K1 mutations have shown sensitivity to MEK inhibition, targeted chemotherapy with trametinib was initiated in combination with pazopanib, a multikinase inhibitor. With the progression of metastatic disease despite treatment, the patient decided to pursue palliative care.

Discussion:
Malignant pericardial myxoid chondrosarcoma is a rare tumor that may lead to fatal outcomes in young adults. Despite numerous surgical and chemotherapeutic interventions, they have a guarded prognosis. Increased clinician awareness and a wide differential while evaluating cardiac masses are key for early detection and timely treatment.
Abstract 14372: Case Series: Non-Lipid Plaque Formation as the Mechanism for Ponatinib-Induced Vascular Toxicity Using Operator-Assisted Virtual Histology Optical Coherence Tomography
Authors: Aziz Moez , Koutroumpakis Efstratios , Deswal Anita M , Monlezun Dominique , Thomason Nicole , Abe Junichi , Otchere Prince , Palaskas Nicolas L , Jabbour Elias , Kim Peter , Lopez-Mattei Juan , Cilingiroglu Mehmet , Marmagkiolis Konstantinos , Feldman Marc D , Iliescu Cezar
Published: June 2023

Introduction:
The third-generation tyrosine kinase inhibitor ponatinib approved for treating chronic myeloid leukemia (CML) rendered drug resistant with a threonine-315-isoleucine (T315I) mutation is associated with increased incidence of vascular adverse events (VAEs). This case series sought to elucidate the mechanism of these VAEs.

Methods:
Two patients with CML and two patients with Philadelphia chromosome positive acute lymphocytic leukemia (Ph+ ALL) on at least one year of ponatinib therapy were imaged with optical coherence tomography (OCT) after presenting with angina. An additional four patients from an institutional OCT database were matched across clinical parameters (age, sex, diabetes, prior coronary artery disease (CAD) history, prior congestive heart failure (CHF) history, hypertension, and family history of CAD) to serve as controls. Plaque composition was assessed using operator-assisted virtual histology OCT (vOCT).

Results:
Clinical presentations included 2 cases of NSTEMI, 1 case of unstable angina, and 1 case of stable angina pectoris among the 4 ponatinib patients. Atherosclerosis was composed primarily of calcium and fibrous tissue with minimal lipid presence (0 ± 0°) compared to the matched controls. The matched controls had a mean non-zero lipid content of 48.43 ± 18.36°, (
P
< 0.05) (Table 1). Three of the four patients had cardiovascular risk factors.

Conclusions:
Ponatinib causes VAEs through non-lipid plaque formation driving a symptomatology consistent with an oxygen supply-demand mismatch. This mechanism is distinct from traditional pathways of excess lipid and plaque instability causing coronary artery disease and merits further investigation.
Abstract 14399: Novel Mechanisms of Diastolic Dysfunction in Cardiac Aging
Authors: Daneshgar Nastaran , Dai Dao-Fu
Published: June 2023

Aging is associated with a progressive decline in cardiac diastolic function. Membranous α-klotho, predominantly produced by the kidney, can be cleaved and form circulating α-klotho, which acts as an anti-aging hormone. Echocardiography showed klotho deficiency in 20-24-month-old heterozygous klotho (KL
+/-
) mice aggravates left ventricular hypertrophy (LVH) and diastolic dysfunction (DD) compared with old wild type (OWT) littermates. Supplementation with α-Klotho (0.1mg/kg/day. i.p) for 10 weeks significantly reduced LV mass and ameliorated DD in both OWT and OKL. The improvement in DD was confirmed by Millar catheter measurement of -dP/dt. To gain mechanistic insights, we performed unbiased acetylomics using Acetyl-lysine antibody enrichment, followed by Tandem mass tag proteomics analysis. We identified 1215 lysine acetylation sites (K-Ac) on >1000 cardiac proteins, of which 220 K-Ac sites were significantly hyperacetylated in OWT hearts. There were 63 Ac-K sites >2-fold hyperacetylated in aged hearts (OWT vs. YWT). The comparison of OKL to YWT augmented the number of Ac-K sites to 82. These sites include redox proteins, several metabolic and mitochondrial proteins involved in fatty acid and amino acid metabolism, and the TCA cycle. Several isoforms of myosin heavy chains (MHC) were also hyperacetylated at multiple sites. Some hyperacetylated MHC (e.g. K941) are predicted to alter the molecular structure and relaxation kinetics by Molecular Dynamic Simulation. In addition to delayed Ca
2+
reuptake by myocardial sarcoplasmic reticulum ATPase (SERCA2a), decreased SERCA2a expression and increased acetylated SERCA2 in aged hearts, which was all corrected upon klotho supplementation, we found potential novel mechanisms of DD with hyperacetylation of MHC, concomitant with a decrease in Sirt1 deacetylase, in OWT mice that was aggravated in OKL, which was replenished upon klotho supplementation. Collectively, we demonstrated klotho deficiency aggravates cardiac aging phenotypes, associated with hyperacetylation of several cardiac proteins due to diminished Sirt1. Klotho supplementation rejuvenates several cardiac aging phenotypes, including regression of LVH and improvement of DD, in parallel with reversal of protein acetylation.
Abstract 144: Impact Of Gender On Outcomes In The Extracorporeal Cardiopulmonary Resuscitation Population For Out-of-hospital Cardiac Arrest
Authors: Chahine Johnny , Kosmopoulos Marinos , Raveendran Ganesh , Yannopoulos Demetris , Bartos Jason
Published: June 2023

Introduction:
Extracorporeal Cardiopulmonary Resuscitation
(
ECPR) is associated with improved neurologically favorable survival for refractory ventricular tachycardia/ventricular fibrillation (VT/VF) arrests. Women are known to have less coronary artery disease, and it is unknown if the lack of a reversible cause would be associated with worse outcomes after ECPR.

Hypothesis:
We hypothesize that female gender may be associated with worse outcomes after ECPR.

Methods:
Patients who presented for refractory VT/VF arrest between 2015 and 2021 were included. The primary outcomes included overall survival at 36 months and neurologically favorable survival on discharge (Cerebral Performance Categories scales of 1 or 2). Secondary outcomes included cardiopulmonary resuscitation (CPR) time, median lactate level on presentation, and bystander CPR.

Results:
Out of 357 patients who presented for out-of-hospital cardiac arrest, 68 patients (19%) were female. The median age for females was 57 years (IQR 57-52) and for males was 59 years (IQR 50-66). Women were more likely to receive ECPR and not to be excluded (5.9% of women were excluded vs. 14.9%, p=0.048) and were less likely to have obstructive coronary disease on coronary angiogram at presentation (39.5% vs. 62.9%, p=0.005). There was no difference in neurologically favorable survival based on gender (39.1% in women vs. 33.7%, p=0.42) nor 36 months survival (p= 0.58, figure). There was also no difference in median CPR time (62 minutes (IQR 51-76) in women vs. 59 minutes (IQR 45-70), p=0.16), median lactate levels (11.5 mmol/L (IQR 8-14.8) in women vs. 11.6 mmol/L (IQR 8.7-14.7), p=0.95), and in receiving bystander CPR (65.6% in women vs. 70.1%, p=0.49).

Conclusion:
There is no difference in neurologically favorable survival or overall survival based on gender in ECPR patients who had an out-of-hospital cardiac arrest, despite the difference in the prevalence of obstructive coronary artery disease on presentation.
Abstract 14407: Clinical Outcomes of Transcatheter Aortic Valve Replacement in Patients With Bicuspid versus Tricuspid Aortic Valve Stenosis
Authors: Radwan Yasser , Wang Enhua , Salam Mohammad F , Saeed Al-Asad Khalid , Halboni Adnan , Al-abcha Abdullah , Saleh Yehia , Abela george
Published: June 2023

Introduction:
Transcatheter aortic valve replacement (TAVR) has proven to be safe and efficacious in patients with tricuspid aortic valve (TAV) stenosis. However, due to its anatomic complexity, bicuspid aortic valve (BAV) stenosis has been excluded from previous trials, and data remain limited regarding TAVR in this group of patients.

Methods:
We searched the databases systematically for relevant studies from inception to March 2022. The primary focus was all-cause mortality at 1-year. Additional outcomes included 30-day mortality, 30-day stroke, and 30-day major vascular complications.

Results:
We included 28 studies with a total of 346,033 patients who underwent TAVR, of which 17,835 patients had BAV stenosis. The risks of 1-year mortality and 30-day major vascular complications were similar between the 2 groups. However, patients with BAV who underwent TAVR had a higher risk of 30-days mortality (BAV 2.3% vs TAV 2.2%, p=0.02) and 30-day stroke (BAV 2.2% vs TAV 1.8%, p=0.01). A subgroup analysis of 23,623 matched patients of whom 49.5% had BAV stenosis was performed. The risk of 1-year mortality was lower in patients with BAV compared to TAV (BAV 5.8% vs TAV 6.8%, p=0.009). Risks of 30-day mortality, and 30-day major vascular complication were similar between the two groups. However, the risk of 30-day stroke was higher in the BAV group (BAV 2.2% vs TAV 1.7%, p=0.02).

Conclusions:
In our meta-analysis, among patients who underwent TAVR for aortic stenosis, there was no significant difference between BAV vs TAV in outcomes, except for higher risk of 30-days mortality and stroke. Among matched groups, patients with BAV stenosis undergoing TAVR had comparable outcomes to patients with TAV stenosis except for higher risk of stroke and lower risk of 1-year mortality in BAV group.More studies, specifically randomized trials, are still warranted to further assess efficacy, safety and reassure the long-term outcomes in this group of patients.
Abstract 14413: Possible Antibody Mediated Cardiac Rejection After Combined Heart-Kidney Transplant in a Sensitized Patient Associated to COVID-19 Pneumonia
Authors: Castillo Josefina , Ortiz Ana Mireya , Jalil Jorge , Greig Douglas , Córdova Samuel , Fernández Rodrigo , Castro Pablo
Published: June 2023

Background:
Antibody mediated rejection (AMR) starts with the appearance of donor-specific antibodies (DSA), followed by graft injury that may be subclinical and can progress to cardiac allograft vasculopathy (CAV) and chronic graft dysfunction.

Case report
A 48-year-old man with a past medical history of right nephrectomy due to congenital renal atrophy and dilated cardiomyopathy required heart transplantation at age 31, presented an episode of AMR grade 2 ten years post-transplant developing CAV with graft loss and end-stage renal disease. He was listed for a combined heart-kidney transplant. His panel reactive antibody (PRA) level was 40%, requiring desensitization therapy (plasmapheresis, intravenous gamma globulin and rituximab). At age 44, he received a heart-kidney transplant. Methylprednisolone and rabbit antithymocyte globulin were used for induction and desensitization therapy with plasmapheresis and intravenous gamma globulin at months 0-3-6-12 was continued. Maintenance immunosuppression therapy continued with tacrolimus, mycophenolic acid and prednisone. During follow-up persistent circulating DSA anti-class II HLA were detected and PRA reached 80%.

He was admitted with a multifocal COVID-19 pneumonia. He had received 4 doses of the messenger RNA vaccine BNT162b2. Dexamethasone was started and mycophenolic acid was discontinued for 14 days. He did not need mechanical ventilation.

Echocardiogram revealed marked concentric LVH, LVEF = 60%, grade II diastolic dysfunction and reduced global longitudinal strain (-7,6%). Pro-BNP was 962 pg/ml, and Troponin T 100 pg/ml. Endomyocardial biopsy showed no signs of cellular rejection nor capillary injury. Immunopathologic findings were negative. Coronary angiogram showed no significant lesions. AMR was suspected, the patient was treated with methylprednisolone, plasmapheresis and intravenous gamma globulin. Clinical response was satisfactory, and he was discharged in functional class I (NYHA).

Conclusions
Although both histological and immunopathologic studies were negative, clinical suspicion for AMR in a highly sensitized patient prevailed in the context of a recent infectious intercurrence. Other diagnosis cannot be completely ruled out in this clinical scenario.
Abstract 14415: Clinical Characteristics and Predictors of the “Good Fontan”: A Multi-Institutional Study
Authors: elder robert W , Valente Anne M , Davey Brooke , Wu Fred , Drucker Nancy A , Lombardi Kristin , Lee Seohyuk , St. Clair Nicole , Toro-salazar Olga H , Rathod Rahul
Published: June 2023

Introduction:
Fifteen-year survival after Fontan operation approaches 95%, but morbidities are increasingly prevalent. It is unknown how well cardiologists can predict which pts are at risk for major adverse events (MAE), but awareness is critical to enable appropriate counseling. We asked cardiologists the “surprise” question: would you be surprised if your patient has a MAE in the next year?

Methods:
We performed a prospective, multi-center study across New England. The attending cardiologist was asked the yes/no “surprise” question. Inclusion criteria included lateral tunnel or extracardiac Fontan and age >10 yrs; individuals were excluded for current transplant evaluation, history of Fontan conversion, or pregnancy. Baseline clinical data were collected. After 12 months, cardiologists were surveyed to assess for MAE (see Table) and multivariate analysis (MVA) was performed for those deemed to be at risk and those with MAE.

Results:
From 2018-19, 146 pts and 40 cardiologists were enrolled at 9 sites. 99/146 pts (68%) were predicted to be a “Good Fontan.” After 1 yr, 17 (12%) patients experienced a MAE (Table). The simple kappa coefficient of ability to predict MAE was 0.17 (95% CI 0.02-0.32), suggesting ability to predict MAE was only 17% better than random chance. In MVA of those at risk (47/146), diuretic/beta blocker use (p=<0.0001) and systolic dysfunction (p=0.0046) were associated with identified risk. MVA of pts who experienced MAE (n=17) found prior unplanned cardiac admission (p=0.0062), diuretic/beta blocker use (p=0.028) and significant AV valve regurgitation (p=0.049) to be associated with MAE.

Conclusions:
Cardiologists are only marginally able to identify which Fontan pts are at risk for MAE in the next year. There was overlap between factors associated with prediction of “at risk” group and MAE, namely use of diuretic/blocker and the linked systolic dysfunction/AV valve regurgitation, which merits close attention in follow-up and further study.
Abstract 14437: Safety of Fluoroless Radiofrequency Ablation for Atrial Fibrillation in Patients With Pre-Existing Cardiac Implantable Electronic Device
Authors: Iqbal Arshad , Li Kai Yu , Gautam Sandeep
Published: June 2023

Introduction:
Radiofrequency catheter ablation (RFA) for atrial fibrillation (AF) is being increasingly performed without fluoroscopy. There is limited experience in flouroless RFA for AF in patients with pre-existing cardiac implantable electronic devices (CIED).

Hypothesis:
The safety of Fluoroless RFA for AF in patients with pre-existing CIED is uncertain.

Methods:
In this single-center study, we retrospectively evaluated patients undergoing fluoroless RFA for AF with pre-existing CIED in situ. A total of two hundred and sixty-four (264) consecutive fluoroless RFA procedures for AF from 6/1/2019 to 5/2/2022 were evaluated. All procedures were performed with intracardiac echocardiography (ICE) support. We assessed rates of CIED-related complications and changes in lead parameters over 30 days of follow-up. Pre and post-ablation device interrogations were reviewed for interval changes and compared for any change in the device or lead parameters. Patients were tracked for any subsequent device malfunction.

Results:
Among 264 fluoroless AF ablations patients, 25 (9.5%) had pre-existing CIED (13 dual-chamber pacemakers, 4 dual-chamber defibrillators, 4 single-chamber defibrillators/pacemakers, and 4 biventricular devices). Mean age was 71.2 ± 6.0 years with mean duration of indwelling CIED was 1821.1 ± 1586.8 days (see Table). Two (0.07%) patients had lead-related fibrin on ICE imaging. There was no significant difference in lead(s) threshold, impedance, or sensing post-procedure or at 30-days follow-up compared to pre-procedure (see Table). There were no intra- or post-op thromboembolic events or subsequent device infection over 30 days of follow-up. None of the patients required lead revision. One patient underwent CIED extraction after 11 months for an unrelated secondary device infection.

Conclusion:
Radiofrequency catheter ablation for AF can be safely performed without fluoroscopy in patients with CIED.
Abstract 14452: Do Patient-Reported Symptoms on Ambulatory Electrocardiogram Correlate With Atrial Arrhythmia Episodes?
Authors: Abedin Zameer , Herner Maranda , Torre Michael , Zhang yue , Orton Cody , Lyons Ann , Butcher Ryan , Steinberg Benjamin A
Published: June 2023

Introduction:
Guidelines regarding rhythm control for atrial arrhythmias (AT/AF) are primarily based on symptom burden. Ambulatory electrocardiogram (AECG) monitoring is often performed to evaluate AT/AF burden and guide clinical decision-making. Yet, to date, little is known about the correlation of symptoms reported during AECG with recorded AT/AF.

Methods:
University of Utah patient AECGs with at least one AT/AF event over 7 or more days of monitoring were retrospectively reviewed - only events with symptoms or with AT/AF were included (other arrhythmias were rare and excluded). Patient triggered symptoms included reported shortness of breath, tiredness, palpitations, dizziness, or passing out. Tetrachoric correlation analysis was performed to evaluate the correlation between symptoms and AT/AF episodes.

Results:
We identified 742 patients with a mean age of 64 years, 50% female, 22% with chronic heart failure, overall mean CHA
2
DS
2
-VASc score of 2.5 and 67% with scores ≥2. There were 6,289 symptomatic events and 6,900 AT/AF episodes. Among these were 1,025 (16%) episodes of shortness of breath, 854 (14%) of tiredness, 2,660 (42%) of palpitations, 794 (13%) of dizziness, and 95 (2%) of passing out. Symptomatic events were less likely to predict simultaneous AT/AF compared to sinus rhythm on AECG, with a moderate inverse tetrachoric correlation of -0.66 (range -1 to 1, with 1 representing perfect positive correlation).

Conclusion:
Patient-triggered symptomatic events were inversely correlated with recorded AT/AF events and represented an unacceptable marker of actual arrhythmia. A more holistic approach to assessment of ATAF symptoms is needed to improve patient selection for rhythm control therapy.
Abstract 14461: Post Transcatheter Aortic Valve Replacement (TAVR) Mortality Outcomes in Patients With and Without Severe LV Dysfunction (LVEF<35%): A Pooled Analysis
Authors: Shrivastava Sanskriti , Pandya Krutarth K , Saqib Najam , SETHI NISHANT
Published: June 2023

Background:
Transcatheter aortic valve replacement (TAVR) is indicated in patients with severely reduced left ventricular ejection fraction (LVEF) and can restore left ventricular (LV) function. However, mortality outcomes in this unique subset of patients has been studied only in limited cohorts.

Methods:
Extensive search on PubMed and Google Scholar yielded 1069 reports meeting inclusion criteria. These studies were independently evaluated by 2 physicians. Nine studies comparing all-cause mortality in patients undergoing TAVR with and without severely reduced LVEF (<35%) were included with a total of 31,952 patients. A study-level analysis was done using Review manager 5.3. As a guide, an I2 >30% was considered an indicator of statistical heterogeneity among the studies. A Mantel-Haenszel Random effects model was used to calculate the Odds Ratio for homogeneous endpoints. A p value <0.05 was considered significant.

Results:
30-day and 1-year all-cause mortality was significantly higher among patients with severely reduced LVEF yielding Odds Ratios of 1.80[CI 1.33-2.87; p=0.01; I
2
= 77%] (A) and 1.81 [1.65-1.99 p<0.001; I
2
= 26%] (B). respectively.

Conclusion:
There is a staggering 80% increased risk of short- and long-term mortality in patients with severely reduced LV function following TAVR. These findings are concerning despite lack of randomized data. Interdisciplinary management with advanced heart failure teams should be undertaken pre-emptively in these patients for close monitoring and early intervention.
Abstract 14475: Use of Extracorporeal Membrane Oxygenation in Neonates With Pulmonary Atresia and Intact Ventricular Septum - A Multicenter Study
Authors: Allen Kiona Y , Flores Saul , Loomba Rohit , Mastropietro Christopher , Cheung Eva , Amula Venu , Radman Monique R , Kwiatkowski David M , Puente Bao , Buckley Jason , Karki Karan , chiwane saurabh , Cashen katherine , Piggott Kurt , Kapileshwarkar Yamini , Narayana Gowda Keshava M , Badheka Aditya , Raman Rahul , Costello John M , iliopoulos ilias
Published: June 2023

Introduction:
Data are limited on use of extracorporeal membrane oxygenation (ECMO) in neonates with pulmonary atresia intact ventricular septum (PAIVS). We aimed to describe ECMO use, risk factors, and associated outcomes in this population.

Methods:
This is a retrospective analysis of neonates with PAIVS who received ECMO between 2009-2019 in 19 US hospitals affiliated with the Collaborative Research for the Pediatric Cardiac Intensive Care Society (CoRe-PCICS). Patient demographics and clinical, procedural, and imaging data were collected from the medical record. Variables significant on univariate analysis were entered into a logistic regression and a model built to calculate estimated risk of ECMO. A similar analysis compared patients who received ECMO and experienced inpatient mortality to those who did not. A receiver operator curve analysis was conducted to determine the accuracy of this risk score in predicting inpatient mortality. A p-value <0.05 was statistically significant.

Results:
Of 295 neonates with PAIVS, 32 (11%) were supported with ECMO. By multivariable analyses, a higher left pulmonary artery z-score (OR 2.0; p-value <0.01) and the presence of ventriculocoronary connections by cardiac catheterization (OR 3.4; p-value 0.03) was associated with an increased risk of receiving ECMO. The resulting risk score had an area under the curve of 0.71 for prediction of need for ECMO. Of these 32 ECMO patients, 15 (46%) experienced mortality. By univariate analyses, those who were supported with ECMO, and experienced inpatient mortality had a higher gestational age (p-value 0.04). No significant associations were identified in those supported with ECMO and any independent variable.

Conclusions:
In a multicenter cohort of patients with pulmonary atresia with intact ventricular septum, 11% received ECMO. Of those supported with ECMO, 46% experienced inpatient mortality. There are risk factors that can help in identifying those who may require ECMO.
Abstract 14476: Automatic Radiomics-Based Assessment of Myocardial Texture in Transthyretin Cardiac Amyloidosis: A 2D Echocardiographic Study
Authors: Datar Yesh , Cuddy Sarah , Ovsak Gavin , Saith Sunil , Giblin Gerard , Bay Camden , Maurer Mathew S , Ruberg Frederick , Falk Rodney H , Arnaout Rima , Dorbala Sharmila
Published: June 2023

Introduction:
Myocardial
i
nfiltration with amyloid fibrils increases myocardial echogenicity on echocardiography (echo). Increased echogenicity has been challenging to quantify. Radiomics methods may better detect changes in echogenicity than the human eye. Our objectives were (1) to detect an altered myocardial echogenicity in transthyretin cardiac amyloidosis (ATTR-CM) using radiomics analysis and (2) to compare myocardial echogenicity by radiomics to human interpretation.

Methods:
We evaluated echo images of 515 patients with suspected ATTR-CM referred for an 99m-technetium pyrophosphate scan at 3 major amyloidosis centers. Myocardial echogenicity was assessed at the basal interventricular septum using an open-source radiomics platform (LIFEx) to extract 41 texture-based features. The texture features were processed using a cloud platform (BigML), which performed automated model selection and hyperparameter tuning (Figure). The studies were randomly split into training (80%) and evaluation (20%) sets. Two echo and amyloidosis experts visually evaluated myocardial echogencity on 80 random studies and classified them into ATTR-CM or non- ATTR-CM.

Results:
In this cohort, 57% of patients were diagnosed with ATTR-CM. The best radiomics model was a decision forest with bootstrapping, with an AUC of 0.79 (95% CI: 0.70-0.88) for diagnosing ATTR-CM. By contrast, visual classification of echo texture as ATTR-CM or not was poor; the interobserver agreement for assessing a septal ROI for altered myocardial echogenicity consistent with ATTR-CM was a kappa of 0.29 and using the entire apical 4 chamber view 0.44. Given the poor agreement an AUC could not be calculated.

Conclusions:
We have validated the use of a radiomics approach to evaluate myocardial echogenicity in ATTR-CMP. This work lays the foundation to evaluate changes in myocardial texture using echo to raise the suspicion of cardiac amyloidosis and assess changes following targeted TTR therapies.
Abstract 14486: Short-Term Outcomes After Transcatheter Aortic Valve Implantation in Patients With or Without Active Cancer
Authors: Aikawa Tadao , Kuno Toshiki , Briasoulis Alexandros , Malik Aaqib H
Published: June 2023

Introduction:
The clinical management of aortic stenosis in patients with concomitant cancer is gaining increasing interest. This study aimed to investigate the effect of concomitant cancer on short-term outcomes after transcatheter aortic valve implantation (TAVI) using a nationally representative database.

Methods:
All data were extracted from the Nationwide Readmissions Database (NRD) in the US. The NRD was queried to identify all patients ≥18 years who underwent TAVI between 2012 to 2019 using the ICD-10-CM codes: 02RF37H, 02RF37Z, 02RF38H, 02RF38Z, 02RF3JH, 02RF3JZ, 02RF3KH, and 02RF3KZ. Concomitant active cancer was also identified based on ICD-10-CM codes. The primary outcome in this study was 30-day readmission rates. A mulitilevel logistic regression analysis accounting for strata and hospital clustering was performed to examine the association between active cancer status and 30-day readmission rates.

Results:
During the study period, 123,339 patients underwent TAVI, of whom 8,050 (6.5%) had active cancer. Patients with active cancer were less likely to have hypertension, diabetes, obesity, and history of coronary artery disease than those without. Crude 30-day readmission rates after TAVI were higher in patients with active cancer (23.8% in colon, 15.0% in lung, 15.2% in prostate, and 16.4% for all cancers) than 13.0% among those without. Crude in-hospital mortality (2.6% vs. 1.8%, P<0.001) and the incidence of permanent pacemaker implantation (11.0% vs. 9.9%, P=0.003), bleeding requiring transfusion (14.1% vs. 8.2%, P<0.001), and acute kidney injury (16.6% vs. 12.2%, P<0.001) after TAVI were higher in patients with active cancer than those without. After adjustment for baseline characteristics, adjusted odds ratio of 30-day readmission rates after TAVI was significantly higher in patients with active cancer than those without. (odds ratio, 1.27; 95% confidence interval, 1.18-1.37; P<0.001).

Conclusions:
Active cancer status was significantly associated with a higher rate of 30-day readmission rates after TAVI.
Abstract 14498: Cardiogenic Shock Intravascular Cooling Trial (CHILL-SHOCK)
Authors: Gupta Nikhil , Singh Nikhil , Bandealy Nadeem , Emami Neyestanak Maryam , Besser Stephanie , Arevalo Cynthia , Friant Janet , Blair John , Nathan Sandeep , Shah Atman , Kalathiya Rohan , Paul Jonathan D
Published: June 2023

Introduction:
Despite advances in revascularization and mechanical support, cardiogenic shock (CS) remains a highly morbid clinical state with 30-day mortality approaching 50%. Therapeutic hypothermia (TH) has been demonstrated to improve hemodynamics and reduce inflammation in small studies, but prospective randomized data is limited. We aimed to assess the safety and hemodynamic effects of TH (33 °C for 24 hours) in patients with CS.

Methods:
A total of 20 patients in CS were randomized to either TH plus standard therapy or standard therapy alone in this pilot study. Patients randomized to TH were cooled and rewarmed via intravenous cooling catheter. The primary safety endpoint was a composite of bradycardia requiring treatment, bleeding requiring transfusion as a result of catheter placement or secondary to resulting coagulopathy, shivering, hyperglycemia requiring insulin for non-diabetic patients, electrolyte derangement unexplained by other therapies, and complications from cooling catheter insertion. Secondary endpoints included hemodynamic parameters (cardiac output, pulmonary artery pressure, systemic vascular resistance, and cardiac power index).

Results:
There were no statistically significant differences in the composite analysis of prespecified safety outcomes (3 events in TH group vs 0 events in control group, p = 0.24). Patients randomized to TH demonstrated a statistically significant increase in cardiac index (3.6 [3.1, 3.9] L/min/m
2
vs 2.6 [2.5, 3.2] L/min/m
2
, p = 0.03) and cardiac power index (0.61 [0.55, 0.70] W/m
2
vs 0.53 [0.44, 0.57] W/m
2
, p = 0.03) compared to the control group at 48-96 hours after randomization. There were no statistically significant differences between the two groups for other collected hemodynamic variables.

Conclusions:
TH is a safe adjunct therapy for patients presenting with CS and may yield improvement in specific hemodynamic parameters. Larger studies are necessary to better understand the clinical benefits of TH in patients presenting with CS.
Abstract 14500: Association Between the Arrival Time of Paramedics and the Neurological Outcome at Discharge of Cardiac Arrest Patients
Authors: Han Kichan , Park Seung Min
Published: June 2023

Introduction:
Improving survival rate and neurological outcome of out-of-hospital cardiac arrest (OHCA) patients is a global public health challenge. Prompt and appropriate management by emergency medical service at the prehospital stage is essential to achieve a good outcome in OHCA patients.

Hypothesis
We hypothesized that the arrival time of the second ambulance may affect the prognosis of patients with cardiac arrest, and this study aimed to investigate the relationship between the arrival time of last-arrival ambulance and the neurological outcome at discharge.

Methods
This study was a retrospective analysis of a prospectively collected registry of OHCA patients. Adult non-traumatic OHCA patients from Jan 2017 to Dec 2018 were included. ROC analysis was performed for good neurological outcomes, according to the arrival time of the last-arrival ambulance. Comparing the early arrival team (response time of last-arrival ambulance less than 14 minutes) and the late arrival team (response time of last-arrival ambulance 14 minutes or longer) with propensity score matching.

Results
A total 3,289 OHCA patients from 12 cities of Gyeonggi province, metropolitan area located in the suburbs of the capital of Republic of Korea was included. optimal cut off was 14 minutes. After propensity score matching, Survival to admission, survival discharge and good neurological outcome were higher in the early arrival team than the late arrival team [26.1% versus 21.3, 12.6% versus 6.3% and 7.1% versus 3.2%]. The response time of last-arrival team 14-minute or longer group showed a significant association with poor neurological outcomes at discharge compared to the group with less than 14 minutes [Odds ratio 2.87, 95% confidence interval 1.65-5.11, P value < 0.001].

Conclusion
In two-tier ambulance system, response time of last-arrival team 14-minute or longer was associated with poor neurological outcomes upon discharge in out-of-hospital cardiac arrest patients.