bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 15996: Pre-Operative Predictors of Permanent Pacemaker Implantation Post Aortic Valve Replacement: A Retrospective Cohort Evaluation
Authors: Tsang Bernice , Pirbaglou Meysam , Azizi Zahra , Alipour Pouria , Gao-Kang Jenny , Yang Jaejoon , Pantano Alfredo , Sadek Mouhannad , Khaykin Yaariv
Published: December 2023

Introduction:
Permanent pacemaker (PPM) implantation following Aortic Valve Replacement (AVR) is common. While AVR modality choice (i.e. surgical vs. transcatheter) affects PPM risk, identifying pre-operative factors associated with increased PPM risk can benefit enhanced risk assessment and care decisions.

Methods:
This study is a retrospective evaluation of pre-operative factors associated with PPM risk within 1-month post-AVR at a tertiary care centre (2014-2020). Pre-AVR conduction abnormalities were classified as left bundle (LBBB), right bundle branch blocks (RBBB), and other abnormalities (left anterior/posterior fascicular block, intraventricular conduction delay) in combination with RBBB, LBBB, or alone.

Results:
Of the 776 (mean age= 74, 66% male) patients, 89 (11.5%) subsequently received PPM. As per pre-AVR electrocardiogram, 76 (9.8) were not in sinus rhythm and 214 (27.6%) had conduction abnormalities, including: 81 (10.4%) LBBB and LBBB + other, 91 (11.7%) RBBB and RBBB + other, and 42 (5.4%) other abnormalities. Pre-AVR rhythm (18.4 vs. 10.7%, p=0.05) and conduction abnormalities (19.2 vs. 8.5%, p<0.0001) were significantly associated with the need for post-AVR PPM. No statistically significant differences were observed in other demographic-clinical characteristics. Logistic regression, adjusted for age and sex, indicated significantly higher post-AVR PPM risk for patients with RBBB and RBBB + other (OR= 3.84, 95%CI: 2.21-6.66, p<0.0001) and other miscellaneous (OR= 2.58, 95%CI: 1.13-5.93, p<0.03) abnormalities, but not for LBBB and LBBB + other (OR= 1.14, 95%CI: 0.52-2.50, p<0.75) compared to participants with no pre-AVR conduction abnormalities. Females experienced significantly lower need for PPM (OR= 0.60, 95%CI: 0.35-1.00, p= 0.05).

Conclusions:
Pre-AVR RBBB and other conduction abnormalities alone or together, but not LBBB are associated with significantly higher need for post-AVR PPM.
Abstract 16030: Efficacy and Safety of Catheter Directed Thrombolysis in Intermediate to High-Risk Pulmonary Embolism: A Meta-Analysis of Randomized Trials
Authors: khan Muhammad Aslam , Rahman Hammad , Khan Syed Zamrak , Khan Bilal
Published: December 2023

Background:
Systemic anticoagulation (SA) is the standard treatment for acute pulmonary embolism (PE). The role of catheter directed thrombolysis (CDT) in addition to SA in intermediate-high risk PE remains unclear.

Methods:
Three randomized controlled trials comparing CDT+SA versus SA alone in intermediate-high risk PE were included in the analysis using databases including Embase, PubMed and Cochrane databases (inception June 01, 2023). The primary outcome was 90-day all-cause mortality. The secondary outcomes were major bleeding, number of patients with RV/LV ratio >0.9 at 3 months, and vascular access complication. The outcomes were reported as relative risk (RR) with a 95% confidence interval (CI) using random effects model.

Results:
The analysis comprised of 179 patients with 88 in the CDT group and 79 in the SA group. There was no significant difference in 90-day all-cause mortality (RR: 0.19, 95% CI, 0.02-1.64, p=0.30) among both the groups. Similarly there was no significant difference in major bleeding (RR: 1.20, 95% CI, 0.03-46.18 p= 0.92), RV/LV ratio >0.9 at 3 months (RR: 0.70, 95% CI, 0.41-1.21p=0.2) and vascular access complications (RR: 2.51, 95% CI, 0.44-14.35 p= 0.30).

Conclusions:
Our study found no significant advantage of CDT+SA versus SA alone in patients with intermediate-high risk PE. Given the scarcity of randomized data, we emphasize the need for a large-scale randomized trial to investigate the long-term effects of CDT in this population.
Abstract 16037: Vaping Associated Sudden Cardiac Arrest in a Young Healthy Patient
Authors: Ahmed Hasaan , Ismayl Mahmoud , Palicherla Anirudh , May Joshua , Thirumalareddy Joseph
Published: December 2023

Introduction and Importance:
While the use of vaping has increased significantly among young individuals, the effects of the various vape aerosol chemical contents on cardiac electrophysiological dynamics remain unknown.

Case Presentation:
A 22-year-old female with a history of energy vaping but no significant past medical history presented with cardiac arrest. Found to have no pulse, CPR was started and initial rhythm of ventricular tachycardia was obtained. Shock was administered with follow-up rhythm of ventricular fibrillation. Patient was shocked again and entered atrial fibrillation with rapid ventricular response. She later cardioverted into sinus tachycardia and was intubated. Transthoracic echocardiogram showed normal ejection fraction but was otherwise unremarkable. Patient was extubated on day four of hospitalization. Left heart catheterization and cardiac MRI were completely unremarkable. Toxicology, urine analysis, and troponins were all negative. Patient was discharged with metoprolol tartrate, and a life-vest with outpatient follow-ups for possible implantable cardioverter-defibrillator placement in the setting of negative work up for sudden cardiac arrest.

Clinical Discussion:
Vaping-induced sudden cardiac arrest may be attributed to a reduction in cardiac repolarization reserve. Exposure to vegetable glycerin and propylene glycol, substances present in nearly all vape products, have been found to incite arrhythmias and disrupt cardiac conduction in animals. Acrolein,a byproduct of glycerin, has also been found to induce arrhythmias due to autonomic dysfunction. Increased prevalence of ventricular arrhythmias have also been noted with exposure to aerosols containing nicotine-free propylene glycol (PG).This likely stems from the impact of PG aerosols on the transient outward potassium current, which plays a significant role in early cardiac repolarization.

Conclusion:
The effects of inhaling vape aerosols remain not fully understood. While there is a perceived notion that nicotine-free aerosols may not be harmful, that remains unclear.Further studies should be conducted to evaluate for pro-arrhythmogenic effects and autonomic dysfunction from the various chemical substances present in vape aerosols.
Abstract 16049: Hydrogen Sulfide Attenuates Duchenne Cardiomyopathy via Suppression of Sterile Inflammation
Authors: Roy Taylor I , Cain Chad , Mauro Adolfo G , Raucci Frank J , Salloum Fadi N
Published: December 2023

Background:
Duchenne muscular dystrophy (DMD) is a lethal, X-linked recessive disease caused by mutations in dystrophin. There is currently no cure for DMD, and the main cause of death is dilated cardiomyopathy. Hydrogen sulfide (H
2
S) is a gaseous molecule produced endogenously, and disruptions in basal H
2
S levels have been associated with various pathophysiological conditions, including heart failure. In this study, we investigated whether H
2
S could prevent cardiac dysfunction in a mouse model of DMD.

Methods:
Male mdx
4cv
/mTR
KO
mice received early treatment (ET) with the H
2
S donor, SG1002 (40 mg/kg/day in chow starting at the time of weaning) or no treatment (NT), and wildtype C57BL (WT) mice were used as control. Left ventricular ejection fraction (LVEF) was assessed by transthoracic echocardiography. Skeletal and cardiac fibrosis was determined by picrosirius red staining. NLRP3 inflammasome activity was measured through apoptosis speck like protein (ASC) staining in cardiac muscle tissue.

Results:
NT mice exhibited significant LVEF decline by 4 months compared to ET and WT mice and declined further by 12 months (n=15-17, NT: 45.2% ± 7.9 vs ET: 57.1% ± 8.9% and WT: 56.5% ± 7.0%, P<0.001). In addition, ET mice showed significantly reduced fibrosis compared to NT mice in the myocardium (n=5-8, 2.62% ± 0.87% vs 11.32% ± 4.70%, respectively, P=0.002), diaphragm (n=11-14, 15.84% ± 9.0% vs 31.14% ± 7.1%, respectively, P<0.001), and gastrocnemius (n=12-17, 7.60% ± 3.14% vs 13.48% ± 5.97%, respectively, P=0.004) at 12 months. ASC aggregation score was significantly higher in cardiac tissue samples (Fig 1) from NT mice at 12 months compared with WT mice. ET attenuated the increase in cardiac ASC aggregation at 12 months compared with NT mice (P<0.001).

Conclusions:
Our results demonstrate that early treatment with SG1002 preserves cardiac function in a mouse model of DMD and suggest a potential therapeutic role of NLRP3 inflammasome suppression as a protective strategy in DMD.
Abstract 16108: Impact of Early Intervention on Quality of Life Outcomes in Peripheral Artery Disease Patients With Chronic Total Occlusion Lesions: Results From the PORTRAIT Registry
Authors: Hussain Yasin , Mena-Hurtado Carlos , Smolderen Kim G , Romain Gaelle
Published: December 2023

Background:
Peripheral artery disease (PAD) is associated with functional impairment, decreased quality of life, and increased risk of cardiovascular events and mortality. Chronic total occlusion (CTO) lesions occur in up to 40% of PAD patients and pose a challenge for successful endovascular revascularization. We aim to evaluate the baseline characteristics, presentations, procedural outcomes, and quality of life (QOL) outcomes of CTO lesions in PAD compared to non-CTO lesions and the interaction with invasive therapy.

Methods:
The PORTRAIT registry is a prospective, multicenter, international study that enrolled patients with new or worsening claudication symptoms and an abnormal resting or post-exercise ankle brachial index. Patients with CTO lesions were compared to those without CTO lesions and divided into those who received early invasive treatment (revascularization within three months of enrollment) or noninvasive treatment with medical management. Quality of life outcomes were evaluated using the Peripheral Artery Questionnaire (PAQ) at baseline and during follow-up at 3, 6, and 12 months.

Results:
A total of 581 matched patients were identified, of which 39% had CTOs and 61% did not. Of the patients with CTOs, 31% underwent early invasive treatment and 69% were noninvasively managed. Patients with CTOs were more likely to present with higher Rutherford classification. The PAQ Summary Score was similar at baseline in patients with CTOs compared to those without CTOs. At 12-month follow-up, early invasive treatment resulted in higher PAQ summary scores in the non CTO arm (82.48 ± 22.79 vs. 67.83 ± 27.00, P<0.001). In the CTO arm, while PAQ summary score was higher at 3 and 6 months in the early invasive arm, the difference was not significant at 12 months (76.18 ± 25.16 vs. 70.60 ± 24.24, P=0.14)

Conclusions:
Patients with CTO lesions present with higher Rutherford classification than their non-CTO counterparts and both have similar PAQ summary scores at presentation. Early invasive treatment for CTO and non-CTO lesions in PAD patients is associated with significant improvements in quality-of-life outcomes.
Abstract 16169: Use of Ramen in Heart Failure: Correction of Severe Hyponatremia With Salt Intake
Authors: Narowska Gabriela , Graham Brianna , Davis Hugh , Oliveros Estefania , Lee Jean
Published: December 2023

Background
Hyponatremia (Na<136mmol) is the most common electrolyte imbalance in patients with heart failure (HF) and is associated with increased mortality, morbidity and rehospitalizations. The mechanisms of hyponatremia in heart failure are multifold and include an increased sympathetic tone and renin-angiotensin-aldosterone-system, salt and water retention in the proximal and distal tubules, high antidiuretic hormone coupled low glomerular filtration rate and diuretic use. We present a case highlighting the complexity of sodium balance in acute decompensated heart failure.

Case Presentation
A 65-year-old female with a medical history of heart failure with preserved ejection fraction (EF 60-65%), pulmonary hypertension, atrial fibrillation, and CKD presented to the Emergency Department with volume overload. We began diuresis with bumetanide on hospital day 1 (HD#), however given inadequate urine output chlorthalidone was added on HD #5 and metolazone on HD #7. On admission, her sodium was 134 and down trended to a low of 121 on HD#13. She had worsening BUN/Cr from 62/2.14 at admission to a peak 135/2.66. She developed oral intake intolerance, asterixis and encephalopathy. The management changed to halting diuretics, fluid restriction, and hypertonic saline without improvement. Urine electrolytes were used to tailor treatment, leading to cessation of hypertonic saline stopped and introducing Ramen (875 mg of Na) and salt tablets (394 mg of Na). While maintaining euvolemia, there was resolution of symptoms and improvement in Na=134, BUN 49, Cr 1.16.

Discussion
Treatment options for hyponatremia in HF, such as water restriction or the use of hypertonic saline with loop diuretics, have limited efficacy. The use of high oral salt intake with close monitoring of jugular vein pressure, weight, symptoms, and urine electrolytes can help a select group of patients with hyponatremia and advance heart failure despite traditional knowledge.
Abstract 16179: Psychiatric Status in Young Adults With Surgically Corrected D-Transposition of the Great Arteries (d-TGA) -The Boston Circulatory Arrest Study
Authors: Gurvitz Michelle Z , Roseman Alexandra , Kovacs Adrienne , Sahakian Lori , Hobson Clare , Dawkins-Henry Onella , Wypij David , Newburger Jane W , Ibeziako Patricia
Published: December 2023

Background:
The Boston Circulatory Arrest Study (BCAS) is a longitudinal investigation of neurodevelopmental and mental health (MH) outcomes of newborns with d-TGA who underwent the arterial switch operation. Goal: We describe current and lifetime MH outcomes in this now adult cohort.

Methods:
We enrolled 88/149 surviving and eligible infant BCAS study participants (29±1.3 yrs; 73% male) between 2017 and 2021; 77 were evaluated prior to the COVID-19 pandemic. The Structured Clinical Interview for DSM-5 Disorders - Research Version, which includes modules exploring anxiety, mood, externalizing, trauma and stress-related, and substance use disorders, as well as suicidality, was administered and captured lifetime (any point in life) and current (within the last 1-12 months) diagnoses.

Results:
One participant was not interviewed and was referred for further care after endorsing current suicidal ideation. Of 87 interviewees, 62 (71%) met criteria for ≥1 lifetime psychiatric disorder, with 41% diagnosed with lifetime mood disorder and 25% with lifetime anxiety disorder. In addition, 37% noted lifetime substance use disorders, most commonly with alcohol use. Four (5%) had a lifetime history of post-traumatic stress disorder. For comparison, general US similar age population prevalence of lifetime mood, anxiety, and substance use disorders were 21-24%, 30-35% and 17-18% respectively. Forty (46%) participants met criteria for ≥1 current disorder, with 11% diagnosed with mood disorders and 16% with anxiety disorders and 22% with substance use disorders. Further, 31% of participants had a history of suicidal ideation, 10% of non-suicidal self-injury, and 6% of suicide attempt compared to 5%, 1% and 0.4% respectively in a similar age general US population.

Conclusions:
MH disorders are common in young adults with d-TGA, with almost three-quarters meeting criteria for a psychiatric disorder by age 35. Mood and anxiety disorders are particularly common, and almost one-third endorse a history of suicidal ideation. Substance use is also common and warrants inclusion in history-taking of adolescent and adult CHD patients. Ongoing surveillance to identify patients with MH disorders in order to initiate treatment is vital for young adults with CHD.
Abstract 16204: Scaling Hearts: Exploring the Link Between Psoriasis and Infective Endocarditis in Pacemaker Patients
Authors: Mustafa Ahmad , Wei chapman , Khan Shahkar , Rizvi Taqi A , Afif John , Mustafa Nawal , Grovu Radu , Elsayegh Suzanne , Weinberg Mitchell
Published: December 2023

Introduction:
Device related infective endocarditis (IE) is associated with high morbidity and mortality resulting in a growing emphasis on identifying and managing comorbidities that increase the risk of IE in these patients. Psoriasis, a chronic inflammatory skin disorder with multifactorial etiology, is increasingly being identified as having multiple cardiovascular manifestations. However, little is known about the impact of psoriasis on IE risk in patients with permanent pacemaker (PPM).

Hypothesis:
Psoriasis patients with PPM have an increased risk of developing IE.

Methods:
Patients with a history of PPM implantation were sampled from the National Inpatient Sample Database (2016 - 2018). Comorbidities were identified using ICD-10 codes. Individuals with age < 18, history of endocarditis, immunosuppression, central line associated infections, intravenous drug use, and implantable cardiac defibrillators were excluded. Patients were stratified into two groups based on the presence of psoriasis. A univariate analysis followed by a multivariate analysis adjusting for age, gender valvular disease, dental infections, coronary artery disease, and sixteen other comorbidities was performed. Furthermore, 1:10000 propensity score matching was performed between the psoriasis and non-psoriasis groups and rates of IE were calculated.

Results:
Out of the 437,728 patients included in the study, 45 (4.4%) had psoriasis. Psoriasis patients were older and had more coronary artery disease. Psoriasis patients had significantly higher rates of endocarditis (4.4% vs 0.6%; p<0.001). On multivariate analysis, psoriasis was linked to a 7.2-fold higher IE risk compared to patients without psoriasis (OR: 7.2 [1.7-30.2]; p=0.007). Post-match analysis showed similar results with 8.3-fold higher rates of IE in psoriasis patients (OR: 8.3 [2.0-34.4]; p<0.001).

Conclusions:
Psoriasis was independently associated with elevated risk of IE in patients with PPM. The chronic inflammatory state associated with psoriasis likely contributed to this risk. Further large-scale studies are required to corroborate these findings as this will have implications on consideration of IE prophylaxis for these patients.
Abstract 16217: Characteristics and Short-Term Outcomes of Patients With Cardiogenic Shock Secondary to Myocarditis
Authors: Nair Raunak M , Giri Abhishek Ramgir R , Chawla Sanchit , Agrawal Ankit , Shekhar Shashank , Higgins Andrew , Lee Ran , Jaber Wael A , Rampersad Penelope , Cremer Paul C , Menon Venu
Published: December 2023

Background:
The clinical profile and short-term prognosis of patients with cardiogenic shock (CS) secondary to myocarditis remains poorly defined.

Methods:
All patients admitted to Cleveland Clinic Cardiac Intensive Care Unit (CICU) between Jan 1
st
, 2010, to Dec 31
st
, 2021, with a diagnosis of cardiogenic shock (CS) were retrospectively identified through electronic medical records. Patients were further categorized into those with CS secondary to myocarditis (myocarditis-CS) or other etiologies (non-myocarditis-CS). Only patients with confirmed myocarditis with an endomyocardial biopsy or cardiac MRI were included. Descriptive characteristics and short-term outcomes of this group were explored.

Results:
A total of 2775 patients were admitted to our CICU with CS of which, 26 patients (1%) had CS secondary to confirmed myocarditis. Compared to patients with non-myocarditis CS, patients with myocarditis-CS were significantly younger (median age of 49 vs 65, p<0.001), had lower prevalence of known coronary artery disease (23% vs 62%, p<0.001), and significantly lower prevalence of other comorbidities (diabetes- 12% vs 42%, dyslipidemia- 23% vs 49%, and hypertension- 31% vs 62, all p<0.05). Amongst patients with myocarditis-CS, 23% (n=6) patients received a heart transplant during the same admission whereas 8% (n=2) were discharged on an LVAD. Viral myocarditis was the most common etiology (35%, n=9), followed by idiopathic myocarditis (23%, n=6), and lymphocytic (15%, n=4). The 30-day all-cause mortality of patients with CS-myocarditis was 8% compared to 22% for those with non-myocarditis CS (p=0.1).

Conclusion:
Myocarditis continues to remain an infrequent cause of CS in the contemporary era accounting for around 1% of all CS admissions. A third of these patients would require advanced therapies and so early consideration of a destination mechanical therapy or transplant is vital to ensure optimal care of these patients.
Abstract 16224: Efficacy of Torsemide versus Furosemide in Heart Failure. A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Eid Mohamed , Barssoum Kirolos , Mostafa Mostafa R , Takla Andrew , Najim Mostafa , Mohamed Sarah , Diab Mohamed , Mannumbeth Renjithlal Sarath Lal , Jneid Hani
Published: December 2023

There is conflicting evidence regarding how torsemide and furosemide differ in their effects on heart failure outcomes. Therefore, we conducted a meta-analysis of randomized controlled trials to compare the therapeutic efficacy of furosemide versus torsemide in the management of heart failure.

Methods:
MEDLINE/PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were queried for studies comparing furosemide to torsemide in heart failure from inception through January 2023. Outcomes of interest included all-cause mortality, hospitalization due to heart failure, and weight change.

Results:
Our analysis included 10 RCTs comprising 4011 patients, of whom 2019 were treated with furosemide and 1992 patients were treated with torsemide. There was no significant difference between the groups in terms of all-cause mortality (OR 0.99; 95% CI, 0.97-1.02; p = 0.66; I2 = 0.03%); heart failure hospitalization (OR 0.96; 95% CI, 0.87- 1.06; p = 0.38; I2 = 89%) and weight change (mean difference -0.15; 95% CI, -0.82-0.52; p = 0.66; I2 = 94%).

Conclusion:
Furosemide and torsemide have a similar impact on mortality, hospitalization due to heart failure, and weight change in patients with congestive heart failure
Abstract 16233: Paradoxical Coronary Embolus Associated With Right Atrial Thrombus in Cardiac Amyloidosis
Authors: O'Gorman Brendan P , Pathangey Girish , DeLago Augustin J , Shah Kajal P , Amin Sheena N , Min David B
Published: December 2023

Introduction:
This case highlights amyloidosis’ risk for intracardiac thrombosis with an atypical presentation of paradoxical coronary embolism due to right atrial thrombus.

Clinical Presentation:
An 87-year-old male with atrial fibrillation not on anticoagulation, HFrEF, severe mitral regurgitation, CKD3B, and recent medically managed NSTEMI, presented with shortness of breath. Labs showed elevated Troponin-T HS (174 ng/L) and proBNP (11,955 pg/mL). Echocardiogram revealed EF 25-30% with new lateral and anterior wall akinesis, concerning for NSTEMI I. Coronary catheterization revealed possible thrombus in the left circumflex artery (Figure 1A), but distal perfusion was intact. CT angiogram was negative for coronary artery dissection, providing clearance to initiate treatment with Eliquis. Intriguingly, cardiac MRI suggested intracardiac thrombus within the right atrial appendage and patent foramen ovale (Figure 1B), and possible amyloidosis from delayed gadolinium uptake. Despite negative serologic amyloid workup, pyrophosphate scan confirmed transthyretin amyloidosis. The patient was diuresed for decompensated heart failure but hypotension and acute-on-chronic kidney disease limited Guidelines-Directed Medical Therapy at discharge.

Discussion:
This case elucidates the importance of recognizing the thromboembolic risk in cardiac amyloidosis patients. Studies indicate up to 30% of cardiac amyloidosis patients have intracardiac thrombi, particularly those with primary amyloidosis subtype. Notably, no correlation exists between the CHA2DS2-VASc score and the presence of left atrial appendage thrombus in patients with cardiac amyloidosis and atrial fibrillation. Despite the left atrial appendage being twice more susceptible to thrombus formation, the right atrial appendage requires attention. Timely screening in high-risk patients could enable early thrombus detection, potentially improving prognosis.
Abstract 16259: Sex Related Differences in Clinical Presentation and Outcomes in Left Ventricular Thrombus
Authors: Russell Adam J , Sadaf Murrium I , Misch Jonathan , Kaur Jagdeep , Tarun Tushar , KUMAR SENTHIL , Vallurupalli Srikanth
Published: December 2023

Introduction:
Sex related differences in the etiology, clinical characteristics and outcomes in patients with left ventricular thrombus (LVT) are not well understood.

Methods:
We developed a multi-center registry of patients diagnosed with LV thrombus by echocardiography between 1/1/2014-12/30/2020. Cases were retrospectively identified and baseline clinical characteristics, thrombus features, treatment, resolution and long-term outcomes were studied.

Results:
Women constituted 27% of all patients (n=271, 29% African American). Compared to men, there were no significant differences in age at presentation (median age 60 years) or median LVEF at presentation (25%). Women were more likely to have nonischemic cardiomyopathy (52.6% vs 32.2%, p=0.02) and presented with thromboembolic event at time of diagnosis of LVT (27.3% vs 13.6%, p=0.008). There was no difference in use of vitamin K antagonists during the study period. During a median follow-up of 72 months, there was no significant difference in all-cause mortality or risk of stroke or arterial thromboembolism (figure 1A-B). In Cox regression analysis, age and LVEF at presentation, chronic kidney disease, malignancy and LVEF at presentation were significant predictors of long-term mortality.

Conclusions:
There was no significant difference in all-cause mortality or risk of stroke or thromboembolism between men and women after diagnosis of LV thrombus.
Abstract 16261: Pharmacy-Led Optimization of Guideline-Directed Medical Therapy in Heart Failure With Reduced Ejection Fraction Program Improves Heart Failure Metrics in a Safety-Net Hospital
Authors: Barbera Gabrielle , Norman Kelsey , Lee Meissane , Jones Kyle , Pipilas Alexandra , Wulff Kelly , Surjanhata Alana , Paul Ludwine , Ahluwalia Monica , Nayor Matthew G , Gopal Deepa M
Published: December 2023

Introduction:
Quad-therapy with guideline-directed medical therapy (GDMT) improves HFrEF outcomes but is challenging to implement in safety-net centers. We expanded an outpatient pharmacy-led medication titration program (OPTIMAL-HF) to improve HF care.

Research Question:
Does a safety-net pharmacy-led program lead to significant change in medication rates, all-cause/HF admissions, and HF metrics?

Methods:
From a Boston Medical Center HF hospital discharge or ambulatory visit, 122 patients were referred. A cardiology clinical pharmacist conducted either in-person/telemedicine visits. Scales and blood pressure monitors were provided for remote monitoring. HF GDMT was titrated based on an algorithm until goal doses/maximally tolerated doses of GDMT were achieved signaling OPTIMAL-HF graduation. Chart review was performed with an approved IRB.

Results:
Of the 28 graduates of the program, 76% were Black/Hispanic, 71% resided in an area deprivation index ≥ 5 (scale, 1-10, higher score signifying greater neighborhood disadvantage). The median time to complete the program was 22 weeks (interquartile range (IQR) 8, 29 weeks) with median of 6 visits (IQR 3, 8 visits). In the 3 months prior to program enrollment, there were 13 hospitalizations (8 due to HF); in the 3 months after OPTIMAL-HF graduation (n=20), only 3 hospitalizations (0 due to HF) were noted. At graduation, 64% were on quad-therapy with 100% on beta-blockers, 96% on ace-inhibitors/angiotensin-receptor blocker/angiotensin-receptor-neprilysin inhibitor, 71% on mineralocorticoid receptor antagonist, and 89% on sodium-glucose cotransporter-2 inhibitors. An increased number of OPTIMAL-HF graduates reached maximum-tolerated/goal doses of GDMT with significant improvements in LVEF (
Figure)

Conclusions:
OPTIMAL-HF improved HF metrics including medication rates, all-cause/HF hospitalizations, and LVEF in graduates of this program supporting an effective model in a safety-net center.
Abstract 16273: Contemporary Risk Prediction Model for In-Hospital or 30-day Mortality After Percutaneous Coronary Interventions: An NCDR CathPCI Registry Model
Authors: Castro Dominguez Yulanka , Wang Yongfei , Minges Karl E , Spertus John , Dehmer Gregory J , Mercado Nestor , Clary Julie , Osborne Anwar D , Pereira Lucy , Curtis Jeptha P , Cavender Matthew
Published: December 2023

Introduction:
While the ACC NCDR CathPCI registry has long provided risk-adjusted benchmarking of in-hospital mortality after percutaneous coronary intervention (PCI), extending follow-up to 30 days in those who are discharged can provide a more comprehensive assessment of post-PCI outcomes.

Aims:
We sought to develop a new model for predicting in-hospital or 30-day mortality after PCI with excellent discrimination to be used for quality improvement efforts.

Methods:
Data from 472,594 PCIs performed in 2019 at 1,369 sites from the CathPCI registry linked to National Death Index data were used to identify pre-procedural and angiographic predictors of mortality and develop a predictive model of in-hospital or 30-day mortality. A thousand bootstrapped samples of the development cohort were created, and stepwise logistic regression was performed on each sample. The final model included variables that were selected in at least 70% of the bootstrapped samples.

Results:
The overall in-hospital or 30-day mortality rate after PCI in the entire cohort was 2.8%. In those undergoing elective PCI without shock or clinical instability, mortality was 0.5%, while in those undergoing salvage PCI or for refractory shock it was 60.3% . Cardiovascular instability, level of consciousness after cardiac arrest, frailty, and chronic kidney disease stage were the factors most predictive of mortality (Table 1). The full model performed well with good discrimination in the overall population (C-index= 0.907), and in the cohorts of patients with STEMI (c-index=0.899), and cardiac arrest or shock (c-index=0.828), as well as across the spectrum of procedural risk.

Conclusions:
This risk model can accurately predict in-hospital or 30-day mortality in those undergoing PCI by incorporating variables that capture cardiovascular instability and clinical status. Extending the mortality follow-up period should enable for a more standardized evaluation of outcomes across hospitals.
Abstract 16281: Right Ventricular Systolic Strain Normal Ranges and Comparisons by Contemporary Vendor-Neutral Echocardiography Software: A Prospective Healthy Cohort Study
Authors: Wang Tom Kai Ming , Agrawal Ankit , Dong Tiffany , Arockiam Aro Daniela , El Dahdah Joseph , Majid Muhammad , Haroun Elio , Rodriguez L L , Grimm Richard A , Griffin Brian P , Popovic Zoran B
Published: December 2023

Background:
Right ventricle longitudinal strain (global: RVGLS and free-wall: RVFWLS) by speckle-tracking echocardiography is increasingly utilized to assess right ventricle systolic function with prognostic value demonstrated in several cardiovascular conditions. Contemporary strain software have addressed past limitations to be able to analyze scans from different vendor scanners, however few studies have validated them externally. We prospectively evaluated the reference ranges and correlations of RVGLS and RVFWLS by the latest strain software in healthy patients.

Methods:
We prospectively studied 100 healthy subjects undergoing echocardiography during January-April 2023 at our institution, 20 each in age groups 18-29, 30-39, 40-49, 50-59, 60+ years; half were men and half women; and half with GE and half with Philips scans. RVGLS and RVFWLS were quantified using TomTec version 51.02 (Autostrain RV), EchoPAC version 206 (AFI-RV) and VVI software for comparative analyses

Results:
RVGLS and RVFWLS means (lower limits of normal LLN defined as 95
th
percentile)±standard errors were -20.6%±0.3% (-16.9±0.5%) and -24.1±0.4% (-18.6±0.6%) by TomTec; -17.1±0.3% (-14.0±0.5%) and -19.6±0.4% (-15.8±0.7%) by EchoPAC; and -17.3±0.3% (-12.5±0.6%) and -19.2±0.4% (-13.6±0.8%) by VVI respectively, with significant differences between mean RVGLS and RVFWLS of TomTec and EchoPAC or TomTEC and VVI only (P<0.001). Factors with beta-coefficients and 95%CI significantly associated with RVGLS in multivariable linear regression analyses were male sex 1.35 (0.18-2.53) for TomTec; age (per 1 year) 0.06 (0.01-0.10), Philips versus GE scan 1.38 (0.17-2.58) for EchoPAC and 1.54 (0.31-2.78) for VVI. Factors with beta-coefficients and 95%CI significantly associated with RVFWLS in multivariable linear regression analyses were Philips versus GE scan 2.11 (0.67-3.56) for EchoPAC and 2.07 (0.38-3.76) for VVI, and none for TomTec.

Conclusion:
RVGLS and RVFWLS measurements were feasible for all strain software on both GE and Philips scans, with means and LLN identified. Factors associated with RV strain values varied by strain software, in particular, Philips scans had less negative RVGLS and RVFWLS than GE scans when measured using EchoPAC and VVI but not TomTec.
Abstract 16284: Atypical Cause of Embolic Stroke; Intracardiac Metastasis of Mixed Germ Cell Tumor
Authors: Kal Sarala , Garg Vinisha
Published: December 2023

Testicular neoplasm constitutes the most common solid organ malignancy in males between the ages of 15 and 35. Metastatic disease to the heart is a rare entity. In most cardiac cases, metastasis is by direct hematogenous spread via the inferior vena cava to the right heart. Metastatic disease to the left heart is even more infrequent. We present the case of intracardiac metastasis of mixed germ cell tumor presenting with an embolic stroke. A 47-year-old Latinx male with a history of stage IV testicular cancer s/p left radical orchiectomy with multiple bilateral pulmonary masses (largest 6x9 cm), atrial fibrillation s/p ablation, left lower extremity iliac thrombus s/p thrombectomy, HTN, and diabetes who presented with sudden onset expressive aphasia and dysarthria. CT head showed a 3x5 cm left occipital intraparenchymal hemorrhage suspected to be an embolic stroke with hemorrhagic conversion. Further evaluation with TTE and TEE revealed a highly mobile and friable multi-lobar mass attached to the anterior mitral leaflet occupying most of the left atrial cavity (4.2x4.9 cm), a small mass attached to the right ventricular aspect of the tricuspid valve, an echo-dense mass in the left lower pulmonary vein at the left atrial junction, and a large mass abutting the rim of the superior vena cava. Definitive surgical management was considered; however, patient was deemed a high-risk candidate given high burden of cardiac metastases. After multidisciplinary discussion, it was decided to pursue systemic chemotherapy. This case illustrates an exceptionally rare presentation of advanced stage testicular cancer metastasizing to the heart with large intracardiac tumor burden resulting in embolic stroke. Early cardiac screening may be beneficial in individuals with history of cancer who present with stroke symptoms. Embolization of cardiac metastasis to other organs poses a great clinical challenge and multidisciplinary decision-making is crucial to clinical management.
Abstract 16287: Predictive Value of High Sensitivity Troponin T for Patients With Suspected Acute Coronary Syndromes Undergoing Invasive Coronary Angiography
Authors: Khokhar Arshjot , Ambrosini Alexander , Li Fangyong , Sangal Rohit , Possick Stephen , Cigarroa Natasha , Kim Nancy , Shah Samit
Published: December 2023

Introduction:
High sensitivity troponin T (hs-cTnT) assays are used to risk stratify patients with suspected acute coronary syndromes(ACS), but the predictive value of hs-cTnT in patients undergoing invasive coronary angiography (ICA) has not been well described.

Hypothesis:
Hs-cTnT levels at baseline and the delta change with serial sampling will correlate with the findings of ICA, and the diagnostic performance of hs-cTnT may be affected by patient specific variables.

Methods:
This is a retrospective study of 1,037 patients that presented to the emergency department with suspected ACS who had hs-cTnT measured and underwent ICA. We collected patient demographics, medical history and results of cardiac testing. Our primary endpoint was a diagnosis of obstructive coronary artery disease (CAD) defined as a stenosis > 70% or > 50% in the left main. We excluded cases of arrhythmias, cardiac arrests, or STEMI. Data analyzed using multivariate regression models.

Results:
We analyzed data from 728 patients with a mean age of 68 years old, 62.5% were male and 37.5% female. 312 patients were diagnosed with no obstructive CAD and 413 with obstructive CAD, of which 286 underwent PCI, 43 underwent CABG and 84 were medically managed. There were significant (p<0.001) differences in average baseline hs-cTnT levels between no obstructive CAD (78.8 ng/L) and obstructive CAD (201.1 ng/L) patients, but no significant difference in the 1 hour hs-cTnT delta (30.4 ng/L vs 33.3ng/L) or the 3 hour delta (56.4ng/L vs 66.6ng/L). Being male, White race, or having diabetes were independent predictors of obstructive CAD with odd ratios of 2.42 (95% CI 1.75-3.34), 1.64 (95% CI 1.12-2.41), and 1.47 (95% CI 1.05-2.06) respectively.

Conclusion:
In this study, elevated baseline hs-cTnT was predictive of obstructive CAD but trending hs-cTnT had no additionalpredictive value. Average baseline hs-cTnT for no obstructive CAD was higher than the manufacture suggested cutoff (52 ng/L) to identify myocardial injury. Baseline variables of sex, race and history of diabetes were predictive of obstructive CAD regardless of the hs-cTnT. Future analysis will determine whether specific hs-cTnT thresholds in these populations could improve hs-cTnT performance for the identification of obstructive CAD.
Abstract 16300: Genetic Influences on Cardiovascular Deaths During Various Follow-Up Lengths in the 45-Year Longitudinal Twin Study
Authors: Dai Jun
Published: December 2023

Background:
Genetic factors are known to affect cardiovascular and coronary heart death. The more deaths occur during the longer follow-up period in a longitudinal study. However, it is unclear whether follow-up lengths affect genetic influences on the mortality from total cardiovascular (CVD) and coronary heart diseases (CHD).

Objective:
To determine genetic influences on the mortality from CVD and CHD over various years of follow-up in the 45-year longitudinal National Heart, Lung, and Blood Institute (NHLBI) Twin Study.
Method:
A total of 1024 middle-aged, white male, veteran twins (512 pairs), including 253 monozygotic and 261 dizygotic twin pairs, were initially enrolled during 1969-1973 and then followed up on vital status and causes of death through December 31, 2015. Tetrachoric correlation coefficients were estimated for CHD and CVD death at 20, 30, and 45 years of follow-up, respectively. Genetic and environmental influences on the death were quantified using the best-fitting structural equation model selected with the smallest Akaike's Information Criterion value and the parsimony rule.

Results:
The age at death ranged from 43.9 to 97.3 years over a 45-year follow-up. Tetrachoric correlation coefficients in dizygotic twins were less than half of that in monozygotic twins over 20, 30, and 45 years of follow-up for CVD but over 20 and 30 years for CHD, respectively. Dominant genetic factors explained 40% (95% CI 5% ~ 68%), 39 % (16% ~ 59%), and 24% (4% ~ 43%) of variation in CVD death over 20, 30, and 45 years of follow-up, respectively, while the remaining variation in CVD death was explained by unique environmental factors during each follow-up period. For CHD death, unique environmental factors explained all variation over 20 and 45 years of follow-up. By contrast, dominant genetic factors explained 26% (95% CI -6% ~ 53%) variation in CHD death over 30 years of follow-up while the remaining variation was explained by unique environmental factors.

Conclusion:
Dominant genetic factors consistently influence cardiovascular mortality over 20 to 45 years of follow-up, implying a twin study of cardiovascular death can control for genetic confounding during this period.
Abstract 16308: Comparison of Myocardial Mechanics Post Mitral Valve Repair With Leaflet Preservation vs. Leaflet Resection: A Sub-Analysis of the Randomized CAMRA CardioLink-2 Trial
Authors: Rumman Rawan K , Verma Subodh , Chan Vincent , Fottinger Alexandra , Quan Adrian , Hibino Makoto , de Varennes Benoit E , Chu Michael W , Teoh Hwee , Yanagawa bobby , Bisleri Gianluigi , Leong-Poi Howard , Mazer David , Connelly Kim
Published: December 2023

Introduction:
Prior studies comparing leaflet resection vs. leaflet preservation for surgical repair of mitral regurgitation (MR) caused by prolapse focus predominantly on measurement of left ventricular ejection fraction. This study aims to evaluate subclinical differences in myocardial mechanics pre- mitral valve (MV) repair, immediately after, and 1-year post-repair, as well as compare differences between leaflet resection and preservation strategies.

Methods:
104 patients were randomly assigned to the resection or preservation group for surgical treatment of posterior leaflet prolapse in the Canadian Mitral Research Alliance CardioLink-2 study. Speckle-tracking echocardiography was performed at baseline (pre-repair), immediately post-repair, and 1 year post-repair. Global longitudinal strain (GLS) was compared at the three timepoints, as well as between leaflet preservation and resection groups using descriptive statistics.

Results:
The mean age of the participants was 65 ± 10 years, and 83% were male. The mean GLS pre-MV repair was -19.6 ± 5.4, and did not differ between the leaflet resection and leaflet preservation groups. The mean GLS dropped to -12.8 ± 4.7 immediately post-repair (p= 0.001 compared to pre-repair). The GLS immediately post-repair was slightly lower in the leaflet resection vs. preservation group (-11.8 ± 4.9 vs. -14.2 ± 3.3, p=0.04). At 1 year post-repair, the mean GLS improved to -16 ± 4, but remained below pre-repair values (p=0.001 compared to immediate post-repair, p=0.03 compared to pre-repair values). At 1-year follow-up, there were no differences in GLS between the leaflet resection and preservation groups.

Conclusion:
The leaflet preservation and resection techniques for surgical repair of MR have similar effects on myocardial mechanics 1-year post-repair. MV repair is associated with an immediate reduction in myocardial strain, with only partial recovery in the first year post-MV repair. Further studies are needed to determine whether myocardial strain continues to improve beyond the first year post-repair to baseline levels.
Abstract 16338: Outcomes in Patients With High-Risk Pulmonary Embolism Undergoing Extracorporeal Membrane Oxygenation and Adjunctive Treatment Strategy, Including Percutaneous and Surgical Management- A Retrospective Study at a Tertiary Care Center
Authors: Park Joseph H , Schurr James W , Pugliese Steven
Published: December 2023

Introduction:
The management of high-risk PE has remained challenging with high mortality rates. Several first-line treatments have been utilized, including percutaneous, surgical, and medical therapies. Extracorporeal membrane oxygenation (ECMO) has been utilized as a bridge toward definitive treatment in patients with persistent hemodynamic instability. Data on the use of combined ECMO and percutaneous management in high-risk PE are limited.

Hypothesis:
The goal of this study is to examine outcomes in patients with high-risk PE undergoing ECMO by their adjunctive treatment strategy (catheter-directed thrombolysis, percutaneous mechanical thrombectomy, surgical thrombectomy, systemic thrombolysis, or anticoagulation alone).

Methods:
Retrospective chart review at a tertiary care center of patients with high-risk PE undergoing ECMO between 2016-2023 was performed. Patients were classified into six groups by their adjunctive treatment strategy (see figure 1). Baseline clinical factors, predisposing factors for venous thromboembolism, cardiac arrest data, echocardiography, hospital course, and mortality were compared by ANOVA and chi-squared tests. Primary outcome of 30-day all-cause mortality was compared with Kaplan-Meier curve with log-rank test.

Results:
A total of 55 patients were included. Of these patients, 36/55 (67.3%) had a cardiac arrest. The overall all-cause 30-day mortality was 25/55 (45%). Patients receiving multiple therapies were younger compared to other groups (p value = 0.003). All-cause mortality was lower amongst patients who received interventional procedures compared with those who received medical management only (see figure).

Conclusions:
Our findings favor the use of combined ECMO and adjunctive procedural approaches rather than adjunctive medical therapies in patients with high-risk PE.
Abstract 16362: Does Extra-Pulmonary Triggers or Autonomic Neural Activity Affect the Rhythm Control by Anti-Arrhythmic Drugs in Patients With Post-Ablation Atrial Fibrillation Recurrence?
Authors: Park Hanjin , Kim Daehoon , Park Je-Wook , Yu Hee Tae , Kim Tae-Hoon , Uhm Jae-sun , JOUNG BOYOUNG , LEE Moon Hyoung , Hwang Chun , Pak Hui-Nam
Published: December 2023

Introduction:
Although the EAST-AFNET trial demonstrated the usefulness of atrial fibrillation (AF) rhythm control, including antiarrhythmic drugs (AADs), little is known about their effect on recurred AF after catheter ablation (CA).

Hypothesis:
We explored the effect of AADs depending on the presence of extra-pulmonary vein triggers (ExPVT) or post-ablation heart rate variability (HRV) in patients who recurred after AFCA.

Methods:
In this retrospective analysis of a single-center cohort, we analyzed 2,036 patients who underwent de-novo AFCA, and 486 of them had recurrent AF and subsequently underwent rhythm control with AADs. We investigated the effects of the extra-pulmonary vein (PV) triggers and post-procedural 3
rd
month HRV (rMSSD; cut-off determined by Youden index) on the AAD responsiveness.

Results:
The post-AFCA recurrence was significantly higher in patients with ExPVT (Log-rank p<0.001, HR 1.45 [1.16-1.83], p=0.001) or higher 3
rd
month post procedure HRV-rMSSD (Log-rank p<0.001, HR 1.36 [1.11-1.65], p=0.003) than their counterparts. Patients with ExPVT at de novo procedure had significantly higher 3
rd
month rMSSD (15.0 [11.0-23.0] vs. 17.0 [11.0-28.0], p=0.022) and patients with high 3
rd
month rMSSD showed a higher rate of ExPVT identified at the 2
nd
repeat procedure (n=160, 41.0% vs. 22.2%, p=0.019). Among those patients how recurred AF after AFCA, post-AAD recurrence did not differ depending on ExPVT (Log-rank p=0.455, HR 1.12 [0.78-1.69], p=0.436) or rMSSD (Log-rank p=0.457, HR 1.16 [0.87-1.55], p=0.300). Post-AAD recurrence did not differ between class IC and III AADs (p for interaction = 0.311).

Conclusion:
ExPVT and post-procedural high rMSSD are independent risk factors for post-AFCA recurrences but not for AAD response in recurred AF patients. Whether AADs may suppress ExPVT and modulate cardiac autonomic activity after post-AFCA recurrences need further investigation.