bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17605: Multidisciplinary Team Approach in the Management of Pregnant Women With Complex Congenital Heart Disease: A Case Series
Authors: Nguyen Andrew H , Mehta Aditya , sahu anurag
Published: December 2023

Introduction:
Women with congenital heart disease (CHD) now live well into adulthood and consider pregnancy. A multidisciplinary team approach is crucial to the management of complex pregnant cardio-obstetrics patients. Here, we present a case series of three patients where careful team-based care resulted in successful delivery and without significant postpartum complications.

Case series:
Baseline patient characteristics and delivery details are summarized in Table 1. Patient 1, with history of repaired bicuspid aortic valve (AV) and subsequent severe bioprosthetic aortic stenosis, presented with incalcitrant supraventricular tachycardia leading to an urgent c-section. Patient 2, with history of complete Shone complex, underwent emergent c-section in the cardiac OR with extracorporeal membrane oxygenation on standby after developing rapid atrial tachycardia. Patient 3 fortunately did not suffer difficulties during her pre-planned c-section. She had a history of partial AV canal defect and subaortic membrane causing severe left ventricular outflow tract obstruction. Despite the differences between their hospitalizations and pregnancy course, utilizing a multidisciplinary approach led to no long-term postpartum complications and delivery of healthy neonates for all three patients.

Discussion:
Cardiovascular (CV) disease is the leading cause of maternal mortality accounting for greater than 25% of deaths. CHD is the most common CV condition encountered in pregnant women. Consistent with the Presidential Advisory from the AHA and ACOG, development of a cardio-obstetrics team is vital to managing complex maternal CV disease and minimizing CV morbidity and mortality.

Conclusion:
Integrating the expertise and collaboration among a multidisciplinary cardio-obstetrics team from preconception through the postpartum period allows for individualized care necessary to optimize maternal and fetal outcomes for women with complex CHD.
Abstract 17616: The Association Between Hypokinetic Left Ventricle And Pulmonary Embolism
Authors: Naeem Azka , Sciandra Casey , Seitllari Armando , Achuthanandan Supraja , Rivera Boadla Marlon E , Zadushlivy Dmitriy
Published: December 2023

Case Description:
A 49-year-old male patient working as a public transport driver presented with syncope lasting a few minutes, followed by non-exertional substernal discomfort. He was hemodynamically stable with a normal physical examination. Laboratory tests revealed an elevated D-dimer of 1146 mg/L and troponin peaking at 1.38 ng/mL. CT Pulmonary angiography was performed, revealing a saddle embolus with signs of right heart strain (Figure 1). A transthoracic echocardiogram revealed a left ventricular (LV) ejection fraction (EF) of 31-35%, and moderately decreased left ventricular systolic function. A venous duplex and hypercoagulability workup yielded negative results. Left-heart catheterization showed normal coronary arteries. A repeat transthoracic echocardiogram three days later showed improvement in LV systolic function with an EF of 41-45% and normal LV function. He was discharged on apixaban with appropriate follow-up.

Discussion:
Saddle embolism is one of the rare but life-threatening forms of pulmonary embolism. It causes RV dilatation and flattening of the interventricular septum towards the left side, decreasing cardiac output via the “Reverse Bernheim Effect". Rarely, it affects LV contractility and LV ejection fraction. Together, this can lead to severe hemodynamic instability and increase the risk of complications like pulmonary infarction, cardiac arrhythmias, and cardiogenic shock. Therefore, clinicians must be aware of this possibility, as early detection and timely treatment improve patient outcomes.
Abstract 17621: Acute Coronary Syndrome Due to Septic Emboli From Infective Endocarditis
Authors: Alla Raviteja , Lopez Jonathan , Dutta Mudit , Patel Neil , TAHA YASMEEN
Published: December 2023

Case Description:
A 34-year-old female with a history of IV drug use and valvular infective endocarditis requiring multiple valve replacements presented with weakness and abdominal pain. She was found to be in septic shock requiring vasopressors and antibiotics. EKG was initially without ischemic changes. Imaging revealed multiorgan infarction including the spleen, left kidney, and parietal and temporal lobes of the brain with concomitant subarachnoid hemorrhage. TTE showed multiple masses on the mitral valve and new stenosis of the recently replaced tricuspid valve, concerning for multi-valvular involvement. LV systolic function was normal. Blood cultures were positive for MRSA and Strep agalactiae. Severe troponin elevation along with diffuse ST elevations in V3-6 prompted cardiology consultation, however intervention was deemed inappropriate due to presence of subarachnoid hemorrhage, thrombocytopenia and multiorgan failure. The patient was soon transitioned to comfort care after a discussion with family.

Discussion:
Acute coronary syndrome (ACS) secondary to infective endocarditis is a rarely cited phenomenon. Standardized management and treatment for ACS is difficult in the setting of co-existing multiorgan failure. In this case, our patient with infective endocarditis subsequently developed ACS secondary to septic emboli from large perivalvular vegetations. We emphasize vigilance for acute coronary events during infective endocarditis without source control.
Abstract 17637: Lacking MicroRNA-1’s Biophysical Action Causes Heart Failure Revealed by a Newly Developed Biplane Echocardiography of Mouse Heart
Authors: Kacira Ege , Pittman Mitchell , Yang Dandan , Sturgill Sarah L , Ziolo Mark T , Han Yuchi , Deschenes Isabelle , Fu Jidong
Published: December 2023

MicroRNA-1 (miR1) is the most abundant microRNA in the heart and plays a key role in maintaining cardiac homeostasis through a well-known RNAi mechanism. Recently, we found a novel biophysical function of miR1 to physically bind to and modulate cardiac ion channels. A human single nucleotide polymorphism-hSNP14A/G (rs776480338) of miR1, in which the 14th nucleotide “A” is mutated to “G”, specifically abolishes the biophysical modulation while maintaining the RNAi. However, the physiological significance of microRNA’s biophysical action remains unknown. To study this, we created a single-nucleotide 14A/G mutation on miR1-1 and miR1-2 genes by using CRISPR/Cas9 and developed 14G-mutated homozygous (14G-Homo, miR1-1 14G/G:miR1-2 14G/G) transgenic mice. In addition, we also developed a new echocardiography methodology that can consistently record clear 4-chamber views of mouse hearts, allowing integration of 4-chamber and long axis views for the clinically recommended Biplane Simpson’s assessment of left ventricular (LV) function. Validation via Cardiac Magnetic Resonance (CMR) revealed that the Biplane method is more accurate than M-mode analysis for precise assessments of mouse LV functional parameters. These findings were highlighted in practice by monitoring both Wild Type (WT) and 14G-Homo mice at 2, 3, and 4 months of age, in which M-mode consistently overestimated LV parameters. Moreover, the clarity of the 4 chamber images enables many cardiac analyses that were previously not feasible for the mouse heart, such as the mitral valve color doppler that revealed turbulent blood flow into the LV of 14G-Homo mice. With the 4-chamber view methodology, we also studied the right ventricular (RV) function by assessing fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE) and found that cardiac functional deterioration of 14G-Homo mice most likely originated in the LV, followed by RV deteriorations and development of heart failure. In conclusion, our study demonstrated that the biophysical action of miR1 is essential to cardiac homeostasis. Additionally, our new imaging methodology enables more clinically comparable analyses which significantly improve translational implications of mouse cardiac research.
Abstract 17639: Association of Retinal Microvascular Changes With Incidence and Progression of Coronary Artery Calcium Score in Individuals With vs Without Diabetes Mellitus; Data From the Multi-Ethnic Study of Atherosclerosis
Authors: khazai bahram , Adabifirouzjaei Fatemeh , Guo Mengye , Ipp Eli , Klein Ronald , Klein Barbara , Cotch Mary Frances , Wong Tien Y , Swerdloff Ronald , Wang Christina , Surampudi Prasanth , Kaufman Joel D , Park Claire , Hendel Robert C. C , Budoff Matthew J
Published: December 2023

Introduction:
Retinopathy (RP) is a microvascular complication of diabetes mellitus (DM); however, it is also increasingly recognized in persons without DM. Microvascular disease may play a prominent role in coronary heart disease (CHD) development. We performed this study to evaluate the association of grades of RP with incidence of CAC (Coronary Artery Calcium) among those with zero CAC at baseline.

Hypothesis:
We performed this study to evaluate the association of grades of RP with incidence of CAC among those with zero CAC at baseline and to Identify the association of grades of MA and RP with progression of CAC among those with positive CAC at baseline.

Methods:
We included 5709 subjects with and without DM from the Multi-Ethnic Study of Atherosclerosis (MESA), who had retinal photos and CAC score available. We analyzed the association of grades of RP with incidence and progression of CAC among subjects with and without DM with zero CAC and positive CAC at baseline from robust regression models. The grades of RP were defined as: no retinopathy, minimal non-proliferative R (NPR) (level 14 -20), early to moderate NPR (level 31-41) and severe NPR or proliferative RP (level 51-80).

Results:
Among those with zero CAC, in the diabetic group, early to moderate (95% CI [1.2, 2]) and severe (95% CI [1.3, 3]) NPR had significantly higher incident CAC risk than the non-retinopathy group. Among those with positive CAC at baseline, in the diabetic group, the early to moderate NPR group had higher CAC progression than the non-retinopathy group. (95% CI [-146, 228]). In the non-diabetic group, the minimal NPR group had significantly higher CAC progression than the non-retinopathy group (95% CI [1.8, 52.7]).

Conclusions:
In conclusion, after adjustment for major CHD risk factors, RP with any severity was associated with incident CAC in DM individuals, however only early to moderate NPDR was associated with CAC progression in them.
Abstract 17665: School Electrocardiography Screening Program Prompts the Detection of Otherwise Unrecognized Atrial Septal Defect in Children in Japan
Authors: Yodoya Noriko , Sawada Hirofumi , Mitani Yoshihide , Ohashi Hiroyuki , TSUBOYA NAOKI , Ohya Kazunobu , Takeoka Mami , Hirayama Masahiro
Published: December 2023

Background:
Atrial septal defect (ASD) is a congenital heart disease that often presents without symptoms or murmurs. If left untreated, children with ASD can develop comorbidities in adulthood. In Japan, school electrocardiography (ECG) screening has been implemented for all 1st, 7th, and 10th graders. However, the impact of this program in detecting children with ASD is unknown.

Hypothesis:
School ECG screening program prompts the detection of otherwise unrecognized ASD in children in Japan.

Methods:
This is a retrospective study that analyzed consecutive patients with ASD who underwent catheterization for surgical or catheter closure at ≤18 years of age during 2009-2019 at a tertiary referral center in Japan.

Results:
Of the overall 116 patients with ASD (median age of 3.0 years at diagnosis and 8.9 years at catheterization), 43 (37%) were prompted by the ECG screening (Screening group), while the remaining 73 (63%) were by other findings (Non-screening group). Of the 49 patients diagnosed at ≥6 years of age, 43 (88%) were prompted by the ECG screening, with the 3 corresponding peaks of the number of patients at diagnosis. Compared with the non-screening group, the screening group exhibited similar levels of hemodynamic parameters but had a lower proportion of audible heart murmur (Levine 2/6 or higher) and coexisting diseases at catheterizarion (p=0.016), which were mainly prompted by the health care and health checkups in infancy or preschool period. Patients positive for a composite parameter (iRBBB, inverted T in V4, or ST depression in the aVF lead) accounted for 79% of the screening group at catheterization, each of which was correlated with hemodynamic parameters in the overall patients (p<.05).

Conclusions:
The present study showed that school ECG screening detected otherwise unrecognized ASD, which prompted the diagnosis of the majority of patients at school age and > one-third of overall patients in Japan. These findings suggest that ECG screening program could be valuable for detecting hemodynamically significant ASD in students, who are asymptomatic and murmurless.
Abstract 17682: Recurrent Corynebacterium Striatum Infective Endocarditis: A Case Series and Patient-Specific Risk Factors
Authors: Diab Mohamed , Nand Nikita , Eid Mohamed M , Osama Muhammad , Jain Deeptanshu , Pendela Venkata Satish , Corteville David , Alweis Richard
Published: December 2023

Introduction:
Corynebacterium species traditionally classified as culture contaminant is now emerging as a cause of recurrent bacteremia and infective endocarditis (IE) especially in patients with cardiac devices. The ability to form biofilms and propensity for antibiotic resistance causes recurrent infections making treatment very challenging. Current literature about Corynebacterium IE, the risk factors and predictors of recurrence is very limited.

Methods:
We report 2 cases with recurrent Corynebacterium bacteremia and endocarditis and describe their individual risk factors and management.

Results:
The first patient, a 52-year-old female with chronic tracheostomy due to bilateral vocal fold paresis and prior pseudomonas aortic valve endocarditis s/p aortic valve replacement with 2 episodes of recurrent Corynebacterium bacteremia. Her risk factors for recurrence being prosthetic valve and chronic tracheostomy. Was initially bacteremic with Corynebacterium striatum and positive TEE showing 1cm aortic valve vegetation treated with vancomycin for 6 weeks. She represented 3 months later with recurrent Corynebacterium bacteremia. In addition to antibiotics required tracheostomy decannulation and right cordotomy as definitive therapy.

The second patient, a 76 year old male with history of ESRD on HD, heart failure with BiV ICD with 3 prior episodes of recurrent Corynebacterium bacteremia. His risk factors being chronic hemodialysis and presence of ICD. Initial 3 episodes were thought to be secondary to infected permcath which was replaced and then substituted by AV fistula. TEE at all times was negative. Device removal was recommended but patient refused and was treated with 6 weeks of vancomycin each time. Was readmitted for the fourth time with recurrent Corynebacterium striatum bacteremia. TEE remained negative. ICD was deemed as the nidus of recurrent infection and eventually underwent ICD lead extraction.

Conclusion:
We illustrate the variability in patient characteristics and risk factors for recurrent Corynebacterium endocarditis. Presence of tracheostomy, chronic HD and cardiac devices are possible risk factors. Surgical intervention seems to be the only curative option in these cases.
Abstract 17712: The Discrimination Ability of the CHA2DS2-VASc Score for Predicting Ischemic Stroke in Patients With and Without Atrial Fibrillation: An Updated Meta-Analysis
Authors: Basit Jawad , Zaheer Zaofashan , Yasmin Farah , Ahmed Aleena , Hamza Mohammad , Cheema Huzaifa Ahmad , Akbar Usman A , Aamir Muhammad , dhama kuldeep , Saeed Sajeel , Rehman Mohammad E , Malik Jahanzeb , Alamzaib Sardar Muhammad , sattar yasar , Tse Gary , Alraies M Chadi C
Published: December 2023

BACKGROUND:
The CHA2DS2-VASc score guides anticoagulation therapy for stroke prevention in non-valvular atrial fibrillation (NVAF) patients. A previous meta-analysis showed a moderate discrimination ability of CHA2DS2-VASc score to detect stroke in patients with & without NVAF. In the presence of newly published data over the past three years, there is a need to recalibrate the existing statistical evidence.

METHODS:
A comprehensive literature search was conducted across PubMed, Embase, CENTRAL (the Cochrane Library), & Google Scholar from inception till May 2023. All studies evaluating the discrimination ability of the CHA2DS2-VASc score, as measured by the C statistic, for short (<2 years), intermediate (2-5 years), & long-term (>5 years) follow-ups in patients with & without NVAF were included. The generic inverse variance weighted random effects method was used to pool C-statistic & corresponding standard errors (SEs) from each study.

RESULTS:
A total of 28 studies with a population of 639450 patients were included. Seventeen studies (n=500555) reported the discrimination ability of CHA2DS2-VASc score for NVAF patients, & 11 studies (n=138895) for patients without NVAF. The summary C statistic for short-term follow up was 0.66 (0.62-0.70) for NVAF subgroup. For mid-term follow-up, the pooled C statistic was 0.65 (0.63-0.67), while being 0.63 (0.60-0.66) & 0.68 (0.66-0.70) for the subgroup with NVAF & without NVAF respectively. The CHA2DS2-VASC score showed moderate discrimination [0.66 (0.62-0.70)] at long-term follow up (NVAF [0.58 (0.55-0.61)]; without NVAF [0.67 (0.64-0.70]).

CONCLUSION:
CHA2DS2-VASc score has moderate & similar discrimination ability for detecting stroke in both NVAF & non-NVAF patients.
Abstract 17725: Prognostic Implications and the Impact of Empagliflozin on Bone Morphogenetic Protein-10 in Heart Failure: Results from the EMPEROR Program
Authors: Butler Javed , Siddiqi Tariq J
Published: December 2023

Background:
Bone morphogenetic protein (BMP)-10 is upregulated in response to cardiac injury and exerts a protective role via activating transforming growth factor β/Smad and STAT3-pathways preserving normal cardiac function by inhibiting cell death and fibrosis.

Aim:
To assess association of baseline characteristics and prognostic significance of BMP-10 in patients with heart failure (HF) with reduced or preserved ejection fraction, and the effect of empagliflozin on BMP-10 level.

Methods:
Serum BMP-10 (Elecsys®, Roche Diagnostics) was assessed in 1127 patients from the EMPEROR-Reduced and Preserved trials, categorized by tertiles of baseline BMP-10 (<2.35; ≥2.35-<3.11; ≥3.11 ng/mL).

Results:
Median baseline BMP-10 was 2.71 ng/mL. Patients in higher tertiles tended to be older, women, NYHA class III-IV, with obesity, atrial fibrillation, and worse renal function (all P<0.05). Baseline BMP-10 level correlated with N-terminal pro B-type natriuretic peptides and high-sensitivity troponin T levels (Spearman rho=0.41, 0.26 respectively). Higher baseline BMP-10 was associated with increased risk for adverse outcomes (
Table 1
). For each 2-fold increase in BMP-10, the adjusted hazard ratio (HR) for cardiovascular death (CV) or HF hospitalization was 2.85 (95% CI 1.99, 4.09, P<0.0001). Empagliflozin treatment was associated with reduction in BMP-10 at week 12 (adjusted gMean ratio 0.94 [0.91-0.97], P<0.001) but not week 52 (1.00 [0.96-1.04], P=0.86). Empagliflozin reduced the risk of CV death or HF hospitalization, particularly for patients at highest baseline BMP-10 level (<1
st
tertile HR 1.03 [0.56-1.88]; ≥1
st
and <2
nd
tertile HR 0.74 [0.40-1.35]; ≥2
nd
tertile HR 0.61 [0.40-0.92], P-trend=0.15).

Conclusion:
BMP-10 levels were associated with worse disease severity and outcomes in patients with HF. Empagliflozin was associated with reduction of BMP-10 at week 12. The benefit of empagliflozin on outcomes was more pronounced with higher BMP-10 levels.
Abstract 17728: Distribution and Predictors of Left Atrial Low Voltage Areas in Patients With Atrial Fibrillation Undergoing Catheter Ablation
Authors: Oraii Alireza , Thind Munveer , Sekigawa Masahiro , Zado Erica , Deo Rajat , Epstein Andrew , Frankel David S , Nazarian Saman , Marchlinski Francis E
Published: December 2023

Background:
Low voltage areas (LVAs) in the left atrium (LA) are associated with a higher likelihood of non-pulmonary vein triggers for atrial fibrillation (AF), and ablation of LVAs has been shown to reduce AF recurrence. This study aimed to assess the distribution and predictors of LVAs in a large cohort of patients undergoing AF ablation.

Methods:
This study included patients who underwent first AF ablation at the Hospital of the University of Pennsylvania between November 2020 and December 2022. Patients with prior LA ablation, cardiac surgery, sarcoidosis, or amyloidosis were excluded. All patients underwent voltage mapping with multipolar mapping catheters and pulmonary vein isolation. LVAs were defined as contiguous areas with a bipolar voltage <0.5mV. The associations between preprocedure risk factors, echocardiographic findings, and LVAs were assessed using univariable logistic regression. All variables with a p value <0.1 were entered in a stepwise, backward, multivariable model.

Results:
A total of 857 consecutive patients (mean age: 64.7 years, 34% women, 33% non-paroxysmal AF) were included. LVAs were identified in 132 (15.4%) patients, of whom 72% had LVAs in posterior wall, 47.7% in roof/anterior, 43.9% in septum, 24.2% in floor/inferior, and 16.7% in lateral wall. The multivariable model showed that age (OR per 1 year increase 1.05, 95% CI 1.03-1.08), heart failure/left ventricular cardiomyopathy (OR 2.1, 95% CI 1.4-3.3), sinus node dysfunction (OR 3.7, 95% CI 1.8-7.3), persistent/permanent AF (OR 3.2, 95% CI 2.1-4.9), and severe LA enlargement on echocardiography (OR 1.9, 95% CI 1.1-3.5) were independent predictors of LVAs.

Conclusion:
LVAs are identified in 15% of patients undergoing first AF ablation and are typically located along the posterior and anteroseptal LA. Presence of LVAs can be anticipated using a readily available preprocedure risk assessment. This information may influence preprocedure planning and choice of ablation strategy.
Abstract 17745: Impact of Acute Limb Ischemia Caused by Femoropopliteal Stent Thrombosis on Clinical Outcomes in Patients With Lower Extremity Artery Disease
Authors: NAKAO SHO , Iida Osamu , Takahara Mitsuyoshi , Suematsu Nobuhiro , Yamaoka Terutoshi , Matsuda Daisuke , Nakama Tatsuya , Fujihara Masahiko , Tobita Kazuki , Haraguchi Takuya , Ogata Kenji , Mano Toshiaki
Published: December 2023

Introduction:
Although contemporary femoropopliteal (FP)-specific stents have shown durable patency in endovascular therapy (EVT), acute limb ischemia (ALI) caused by stent thrombosis (ST) are substantially experienced in clinical setting. The current study investigated that impact of ALI caused by FP-ST on clinical outcomes in patients with lower extremity artery disease (LEAD).

Methods:
The current study was multicenter and retrospective study enrolling 498 ALI patients (mean age: 76 years, male: 59%, diabetes mellitus [DM]: 34%, hemodialysis [HD]: 19%). We compared clinical outcomes of 105 ALI caused by FP-ST (ST-ALI) with 347 ALI caused by de novo thrombosis or embolus (de novo-ALI) presenting Rutherford category I or II. Outcome measure was 12-month amputation free survival (AFS), and predictors of AFS were also investigated using multivariate Cox proportional hazard analysis.

Results:
Frequency of DM (63% vs. 26%) and HD (51% vs. 10%) was higher in ST-ALI, while average age was older (74 years vs. 77 years) and frequency of atrial fibrillation (Af) (18% vs. 49%) was higher in de novo-ALI. In patients presenting with Rutherford category I or II ALI, The 12-month AFS was significantly lower in ST-ALI than in de novo-ALI (52.2±5.1% vs. 75.6±2.5%, p<0.001). Multivariate analysis revealed that ST-ALI (hazard ratio [HR]: 1.77, 95% confidential interval [CI] 1.18-2.65, p=0.006) as well as age (HR: 1.03, 95%CI 1.01-1.05, p=0.008), HD (HR: 2.58, 95%CI 1.64-4.04, p<0.001), Af (HR: 1.77, 95%CI 1.18-2.65, p=0.006), presence of wound (HR: 1.78, 95%CI 1.10-2.88, p=0.018), peak CRP value (HR: 1.05, 95%CI 1.03-1.07, p<0.001) and non-ambulatory status (HR: 2.17, 95%CI 1.41-3.31, p<0.001) were significantly associated with low 12-month AFS.

Conclusions:
In patients presenting with Rutherford category I or II ALI, ST-ALI, age, hemodialysis, presence of wound, atrial fibrillation, peak CRP value and non-ambulatory status adversely impact on 12-month AFS.
Abstract 17747: Gynecological Manifestations in a Patient With Arrhythmogenic Right Ventricular Cardiomyopathy: A Desmosomal Link?
Authors: Khidhir Angela , Sherpa Mingma
Published: December 2023

Introduction:
Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is inherited cardiomyopathy which is caused by desmosomal protein gene mutations, primarily in the desmoplakin (DSP), plakophilin-2 (PKP2), and desmoglein-2 (DSG2) genes. It is characterized pathologically by myocardial atrophy, fibrofatty replacement, and fibrosis, precipitating ventricular arrhythmias (VA). Desmosomal mutations have been linked to impaired follicular development and leiomyoma formation. However, there is little information about the association of their expression in myocardial with ovarian or uterine tissues. As incidences of ARVC/D in women increase, it is crucial to determine if women with the gynecological manifestations of these mutations are at a higher risk of developing ARCV/D.

Case:
We report a case of a 32-year-old female who presented with exercise-induced palpitations and syncopal episodes. She has a history of severe dysmenorrhea but has no medical conditions otherwise. On monitoring, she was found to have a high burden of ventricular premature complexes (VPCs). VAs were thought to have precipitated her syncopal episodes. She was started on antiarrhythmics. Echocardiogram demonstrated right ventricular dilatation and wall thinning. The patient later underwent genetic testing, which confirmed ARVC-associated mutations. Her dysmenorrhea was managed with combined oral contraceptives and nonsteroidal anti-inflammatory drugs. Pelvic ultrasound revealed leiomyomas, which were surgically removed.

Discussion:
This case supports the possible complex interplay between cardiovascular and gynecological conditions in patients with desmosomal mutations. Desmosomes are specialized protein complexes crucial in maintaining tissue's structural and mechanical stability. Mutations in desmosome genes disrupt the normal functioning of these protein complexes, leading to impaired cell-cell adhesion and increased vulnerability to tissue damage. The next step is to conduct studies to better understand the risk of developing cardiovascular disease in patients presenting with these gynecological conditions and vice versa to provide early monitoring and treatment.
Abstract 17749: Regionalization of Non-Pulmonary Vein Triggers for Atrial Fibrillation When the P Wave is Obscured Using Non-Invasive Electrocardiographic Imaging QRS-T Subtraction Algorithm
Authors: Thind Munveer , Oraii Alireza , Sekigawa Masahiro , Lou Qing , Arceluz Martin , Ciaverelli Sara , Zado Erica , Guandalini Gustavo , Markman Timothy , Deo Rajat , Schaller Robert , Nazarian Saman , Dixit Sanjay , Supple Gregory E , Frankel David S , Santangeli Pasquale , Epstein Andrew , Callans David , Hyman Matthew C , Tschabrunn Cory M , Marchlinski Francis E
Published: December 2023

Introduction:
Ablation of non-pulmonary vein triggers (NPVTs) after pulmonary vein isolation (PVI) may reduce atrial fibrillation (AF) recurrence. Localizing a trigger which initiates AF after a single atrial ectopic beat is challenging, especially in the scenario when the trigger P wave is obscured by preceding QRS-T complex.

Aim:
To evaluate the potential for noninvasive electrocardiographic imaging (ECGi) to localize NPVTs when the P wave morphology is superimposed on the T wave of the previous beat.

Methods:
We developed an algorithm which overlays and subtracts the preceding QRS-T wave complex from the QRS-T wave complex which is obscuring the P wave of interest, thus revealing the P wave morphology (Figure 1A). Resultant unobscured P waves (from multiple body surface electrodes) are then used for ECGi computation. In five patients undergoing AF ablation, after PVI, we paced from 15 atrial sites where NPVTs commonly arise, and evaluated the epicardial activation maps generated by ECGi both when pacing was timed to ensure an unobscured P wave and when timed to coincide with preceding QRS-T complex. Co-registration of CT-based ECGi activation maps with invasive electroanatomic map (EAM) allowed comparison of the earliest activation site on ECGi map from both the obscured P waves after QRS-T subtraction and unobscured P waves with true pacing locations on EAM (Figure 1B).

Results:
From 146 pacing sites in our patient cohort, for the unobscured P waves, median distance between earliest site on ECGi map and EAM pacing location was 16 mm (10-21 mm), and for obscured P waves after QRS-T subtraction, median distance was also 16 mm (12-23 mm) (Figure 1C).

Conclusion:
Using a QRS-T subtraction algorithm, ECGi can approximate origin of paced P waves whether P wave is unobscured or obscured by the preceding QRS-T complex. Spontaneous NPVT P waves are commonly obscured by the QRS-T wave and the ability to rapidly localize an early coupled P wave may facilitate NPVT mapping and ablation.
Abstract 17750: Impact of Ventricular Assist Device Use on Pediatric Heart Transplant Outcomes in a Linked Cohort of the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) and Pediatric Heart Transplant Society (PHTS) Databases
Authors: Auerbach Scott R , Anton Kristin , Bansal Neha , Bogle Carmel , Boucek Katerina , Cantor Ryan S , Kirklin James K , Rosenthal David N , Shezad Muhammad Farrukh , Urschel Simon , Watanabe Kae , Zhao Hong , O'Connor Matthew J
Published: December 2023

Purpose:
Pediatric ventricular assist devices (VAD) improve waitlist mortality. We aimed to compare outcomes after heart transplant (HT) based on pre-HT support in patients (pt) <18 years (yr) at listing.

Methods:
Prospectively collected VAD and post-HT data were linked between ACTION and PHTS databases, respectively (4/1/2018-6/30/2022). Support groups were defined as medical (MG) and VAD (VG), device groups as paracorporeal pulsatile (PP), paracorporeal continuous (PC), and intracorporeal continuous (IC), and device types as LVAD, BiVAD, RVAD, and systemic VAD (SVAD). Standard descriptive statistical methods were used. The Kaplan Meier Method and log rank test analyzed for univariable graft loss post-HT.

Results:
The 1360 pt included VG=405 and MG=955. At HT, VG pt were younger (6.7 ± 6.2 vs 7.7 ± 6.4 yr; p=0.008) and waited less time for HT 0.35 +/- 0.9 vs 0.5 +/- 0.82 yr (p=0.0036). More VG pt required mechanical ventilation (15.3% vs 11.0% (p=0.03) and intensive care (67% vs 51% p<0.0001). Proportions of congenital heart disease (CHD) and cardiomyopathy (CM) were different between groups (MG: 64.8% CHD and 32.6% CM vs VG: 35.1%CHD and 65.2% CM; p<0.0001). VG device group and type were PP n=184 (LVAD 62.0%, SVAD 22.3%, BiVAD 15.2%), IC n=154 (LVAD 77.3%, SVAD 12.3%, BiVAD 10.4%), PC n=50 (LVAD 26.0%, SVAD 38%, BiVAD 12%), and other n= 17 (41.2% LVAD, 47.0% unknown, 11.8% BiVAD). Overall, graft survival was similar between MG vs VG (p=0.17). There were significant differences in graft survival when stratified by device group (
Figure 1A,
IC 95.5%, PP 78.8%, and PC 65.9% p<0.0001), support group and diagnosis (
Figure 1B
MG-CM 95.7%, VG-CM 88.0%, MG-CHD 86.5%, and VG-CHD 82.7% at 3 yr, p=<0.0001), and by device type (LVAD 90.3% vs SVAD 80.0, and BiVAD 70.7% at 3yr; p=0.014).

Conclusion:
Graft survival varies by pre-HT dx and device type and group. CHD, PC, and BiVAD pt may be at higher risk of graft loss. These may be risk factors to consider for risk stratification in post-HT management.
Abstract 17765: Stress Myocardial Blood Flow is Abnormal During Acute Takotsubo Syndrome
Authors: Saxena Retu , Cavalcante Joao , Witt Dawn R , Garberich Ross , Bae Aaron , Benson Gretchen A , Schwager Sarah , Kellman Peter , Xue Hui , Sharkey Scott W
Published: December 2023

Introduction:
Coronary microvascular dysfunction (CMD) is a proposed mechanism for takotsubo syndrome (TS). Therefore, we performed cardiac magnetic resonance imaging (CMR) with quantitative stress/rest perfusion and T2 mapping during acute TS and at 6-month post recovery. AIM: Quantitate stress/rest myocardial blood flow (MBF) in acute/recovery TS and compare basal with apical MBF.

Methods:
TS diagnosed by internationally accepted criteria. Each patient underwent acute and 6-month recovery CMR with automated in-line quantification of global/regional MBF, cine imaging, T2-mapping, and late gadolinium enhancement (LGE) imaging. Normal rest and stress MBF are 0.8-1.0 and > 2.0 ml/min/g, normal myocardial perfusion reserve (MPR) is > 2.4.

Results:
Acute and recovery studies were performed on 7 patients, all women, average age 63
+
8.5 years. CMR was performed within 72 hours of TS diagnosis. Initial versus (vs) follow-up EF: 40.3% vs 67.1%, left ventricular (LV) mass: 108.7 grams vs 86.3 grams. Acute studies demonstrated hypokinesis in the mid-apical segments with corresponding myocardial edema, LGE was absent in all patients. Myocardial edema and wall motion abnormality normalized at recovery.

During acute TS, rest and stress MBF were 1.14 and 2.58 ml/min/g (base) vs 0.96 and 1.73 ml/min/g (apex). While at recovery, rest-stress MBF were 1.14 and 3.12 ml/min/g at base versus 1.09 and 2.76 ml/min/g at apex (Figure). MPR improved from acute to recovery: 2.14 vs 2.74 (global), 2.25 vs 2.84 (base), and 1.85 vs 2.64 (apex); p = 0.126; 0.035; 0.012 respectively (Figure).

Conclusion points:
Resting MBF is normal during acute TS in both basal and apical LV segments despite typical apical ballooning consistent with stunned myocardium. MPR is more abnormal in apical than base segments during acute TS, returning to normal at recovery. Myocardial edema might contribute to apical CMD during acute TS.
Abstract 17794: Rheumatoid Arthritis is Associated With Hypertension in Mendelian Randomization Analysis
Authors: Samson Mackenzie N , Wells Quinn , Alexander Matthew R
Published: December 2023

Introduction:
Epidemiologic studies have identified associations between multiple autoimmune diseases and hypertension. However, these studies can be biased by reverse causality and unmeasured confounding. Mendelian randomization (MR) is less susceptible to these biases and can provide insights into the etiological relationship between risk factors and outcomes.

Question:
Using MR, is there supportive evidence to suggest a causal relationship between autoimmune diseases and hypertension?

Methods:
Single nucleotide polymorphism (SNP)-based instrumental variables for type 1 diabetes mellitus, Crohn’s disease, ulcerative colitis, systemic lupus erythematosus, and rheumatoid arthritis were obtained from the NGHRI-EBI GWAS catalog of individuals of European ancestry using MR-Base, a database of instrumental variables derived from previously performed GWAS. The outcome was self-reported hypertension among UK Biobank participants with genome-wide genotyping of European ancestry. Two sample MR was performed using the TwoSampleMR R package, using the inverse variance weighted method with correction for linkage disequilibrium.

Results:
After correction for multiple comparisons using the false discovery rate, rheumatoid arthritis was associated with significantly higher odds of hypertension (beta= 0.0034, SE=0.0013, p=0.045). No significant associations were observed for type 1 diabetes mellitus (beta = 0.0046, SE=0.0023, p=0.103), Crohn’s disease (beta= 0.0023, SE= 0.0017, p= 0.267), ulcerative colitis (beta= -0.0014, SE=0.0011, p=0.267) and systemic lupus erythematosus (beta= -1.6x10
-8
, SE=0.0014, p=0.999). Sensitivity analysis using MR Egger revealed no significant confounding horizontal pleiotropy for the relationship between rheumatoid arthritis and hypertension (Egger-intercept= -0.0001, SE=0.0003, p=0.677).

Conclusion:
Using MR, a causal association was suggested between rheumatoid arthritis and hypertension. There was no evidence for an etiologic relationship observed with other autoimmune disease exposures tested. These findings suggest a role for rheumatoid arthritis in promoting hypertension development, which we theorize may be through enhanced immune activation.
Abstract 17795: Increased Long-Term Odds of Atrial Fibrillation in Overweight or Obese Young Men: A Systematic Review and Meta-Analysis
Authors: Doshi Preet , Saenz Ancira Santiago , Patel Yash , Higuera Ornelas Javier , Geddada Sunitha , Chiluveru Sricharan , Shanthosh kumar Sandhya , Tera Chenna reddy , Chalasani Vardhan , Bansal Prerna , Chintalapalli Patta Harika Varma , Vyas Ankit , Desai Rupak
Published: December 2023

Aim:
Studies in the past have linked obesity as a risk factor for atrial fibrillation (AF). However, there is a paucity of data on this influence in young adult males. This meta-analysis aims to evaluate and stratify the association between BMI and AF among young men.

Methods:
PubMed, Scopus, and Google Scholar databases were systematically reviewed for studies reporting long term-incidence of atrial fibrillation in young male adults (18-49 years) with obesity (BMI>30 kg/m
2
), and overweight BMI (BMI 20-25 kg/m
2
). Random effects models were used for the meta-analyses and subgroup analyses. I
2
statistics were used to identify (>50%) heterogeneity. A sensitivity analysis was performed using leave-one-out method.

Results:
Six studies with a total of 21,856,538 individuals were screened, out of which 6,732,531 young males with higher BMI and obesity were evaluated for the risk of Atrial fibrillation for a median follow-up duration of 6.3 years (3.3 - 29 years range). South Korean and Japanese studies together constituted 99.86% of the study population. Most commonly associated comorbidities were hypertension, diabetes mellitus type 2, dyslipidemia and smoking. The unadjusted HR showed a significant association between overweight (BMI 25-30) [OR:1.42, (95%CI:1.28-1.58, I
2
: 75.86%; p< 0.01] and obesity (BMI >30) and AF [OR: 2.02, (95%CI: 1.77-2.29, I
2
:64.3%; p=0.02] in young adult males. After multivariable analysis, the association remained significant for overweight [OR:1.22, 95%CI: 1.14-1.32, I
2
: 82.74%; p< 0.01] and obesity [OR:1.48, 95%CI: 1.29-1.71, I
2
: 90.43%; p< 0.01]. Sensitivity analysis indicated that no single study unduly influenced the pooled estimates.

Conclusion:
This meta-analysis revealed that higher BMI (overweight and obese) in young males is associated with an increased long-term risk of AF over a median follow-up duration of 6.3 years.
Abstract 17798: Plasma Cardiac miRNA Expression During ST Elevation Myocardial Infarction
Authors: Barringhaus Kurt , Prousi George , Samani Stephanie , Freeberg Lisa , Churillo Amelia , Slone Sarah , Spinale Francis G
Published: December 2023

Introduction:
MicroRNAs (miRs), short sequences of RNA that silence gene expression, have been proposed as biomarkers potentially capable of detecting myocardial infarction earlier and more accurately than troponin. Few studies have assessed expression patterns of cardiac-relevant miRs at the time of ST elevation myocardial infarction (STEMI).

Hypothesis:
Plasma levels of miRs known to regulate myocardial processes are altered in the plasma of patients early after STEMI onset.

Aim:
To establish a signature of miRs differentially expressed in plasma of patients with STEMI at the time of presentation.

Methods:
10cc blood was obtained at the time of coronary angiography for patients presenting with STEMI(n=9), and plasma was recovered after centrifugation. Patients without coronary heart disease who had undergone coronary angiography served as referent normals(n=5). Following RNA extraction, RT-qPCR was performed to quantify levels of 84 cardiac miRs (Qiagen, Germany) with fold change calculated by the 2
-
ΔΔCt
method.

Results:
The mean age was similar between STEMI and referent normal control patients (59±9 vs 60±8), and the mean troponin was numerically higher in the STEMI group (15.4±21 vs 0.00±0; p=0.13). As shown in the table, the expression levels of 25 miRs were significantly increased, and 2 were decreased as compared with control patients (p<0.10). Seven miRs were not detected, and the remaining 47 detectable miRs were not different between the groups(p≥0.10). Cardiac-specific miR-499a-5p and miR-208b-3p demonstrated the greatest fold-change relative to referent normal patients.

Conclusions:
Cardiac-specific miRs, most notably miR-499a-5p and 208b-3p, as well as many other miRs are differentially expressed early after STEMI onset. Further work is needed to determine whether miRs can detect STEMI earlier or more accurately than troponin or provide incremental diagnostic value for patients presenting with acute coronary syndromes.
Abstract 17808: Neuroprotective Effects of 4,4'-Diisothiocyanostilbene-2,2'-Disulfonic Acid Inhibition on Voltage-Dependent Anion Channel 1 or Ruthenium Red Inhibition on Mitochondrial Calcium Uniporter After Cardiac Arrest
Authors: Sui Xin , Yin Chengke , He Zhaoyi , Xu Wenjia , Zhang Lei , Han Fei
Published: December 2023

Introduction:
Mitochondrial dysfunction is associated with poor neurological outcomes after resuscitation. Over the past decade, identification of the mitochondrial outer membrane voltage-dependent anion channel 1 (VDAC1) and inner membrane mitochondrial calcium uniporter (MCU) has provided insight into the roles that mitochondrial Ca2+ regulation plays in neuronal function after cardiac arrest (CA).

Hypothesis:
The neuroprotective effects of 4,4'-Diisothiocyanostilbene-2,2'-disulfonic Acid (DIDS) inhibition on VDAC1 or Ruthenium red (RUR) inhibition on MCU after asphyxial CA in rats were investigated.

Methods:
Male SD rats, 240-340 g, were subjected to 8 min asphyxial CA and followed by manual cardiopulmonary resuscitation. Sham, Control, DIDS, RUR, DIDS+RUR groups were included. The rats in the DIDS, RUR, DIDS+RUR groups received 7 mg/kg DIDS, 3 mg/kg RUR or 7 mg/kg DIDS combined with 3 mg/kg RUR immediately after return of spontaneous circulation (ROSC). Survival and Neurologic Deficit Score were assessed at 24 h after ROSC. Neurological outcome was assessed. Hippocampal mitochondrial apoptosis was measured.

Results:
Survival was significantly higher in the RUR group compared to the Control group (85% vs. 40%, P < 0.05). NDS in the DIDS and RUR groups were significantly better than in the Control group (P < 0.05). Neurons were less damaged in the DIDS, RUR, DIDS+RUR groups than in the Control group (Figure). Cyt.C was lower in the DIDS, RUR, DIDS+RUR groups than in the Control group (P < 0.05). Bax was lower in the RUR, DIDS+RUR groups than in the Control group (P < 0.05). Bcl-2 was highly expressed in the RUR group than in the Control group (P < 0.05). Cleaved caspase-3 was lower in the DIDS+RUR group (P < 0.05). AIF was higher in the DIDS and RUR groups compared to the Control group (P < 0.05).

Conclusions:
Inhibiting VDAC1 or MCU significantly improved survival, neurological outcome and inhibited hippocampal mitochondrial apoptosis after CA.
Abstract 17814: Naltrindole Mitigates Rigor During Myocardial Ischemia by a Novel Mechanism and Shows Translational Cardioprotection in Myocardial Ischemia-Reperfusion Injury Models
Authors: Clair Logan , Ramsarran James , Boakye Tanoh Desmond , Humayun Annam , Melnik Juliet , Dean Tameka , CHEN Qian , Barsotti Robert , Young Lindon , Dai Wangde , Kloner Robert A
Published: December 2023

Introduction:
Naltrindole (NTI) was cardioprotective in both ex-vivo (5μM) and in-vivo (7.5mg/kg) rat myocardial ischemia-reperfusion (MIR) models. Recently, we showed that NTI 50-200μM (~2-7.5mg/kg, in-vivo) attenuated phorbol ester-induced PMN superoxide release by a novel mechanism devoid of opioid receptors. We hypothesize that NTI exerts its cardioprotective effects (and therefore, its effects on the infarct size) in a dose-dependent manner.

Methods:
Ex-vivo
studies were done with Sprague Dawley male rats using a Langendorff apparatus. Excised hearts were pretreated with Krebs buffer (controls), NTI 1.25μM, NTI 2.5μM, or NTI 5μM for 5 min, followed by 30 min of global ischemia (I) and a 45 min reperfusion (R) period.
In-vivo
studies were performed with Sprague Dawley female rats which received infusions (NTI 0.2-1.0 mg/kg, 3.75 mg/kg, or 7.5 mg/kg) through the jugular vein (0.4mL/min) over 5 mins before regional I was induced by occluding the LAD artery for 30 min followed by a 3 hr R period. Cardiac function was measured in both studies through a pressure transducer placed into the left ventricle.

Results:
Ex-vivo: NTI 5μM, 2.5μM and 1.25μM reduced infarct size by 66% (4.8±1%, n=5, p<0.05), 52% (6.8±0.8%, n=6, p<0.05), and 13% (12.2±3%, n=5) respectively compared to control (14.1±1%, n=7). NTI 5μM (1358±300 mmHg) had significantly improved dP/dt max at the end of R compared to untreated controls (576±163, p<0.05).
In-vivo:
High Dose (7.5 mg/kg x 5 min = 37.5 mg/kg [total dose]), Intermediate Dose (3.75 mg/kg x 5 min = 18.75 mg/kg [total dose]), and Low Dose (0.2-1.0 mg/kg x 5 min = 1.0-5.0 mg/kg [total dose]) NTI reduced infarct size by 81% (11±4%, n=5, p<0.05), 55% (26±7%, n=5, p<0.05), and 4% (55±4%, n=18) respectively compared to untreated controls (57±2%, n=15). DP/dt max was similar among all study groups at the end of R.

Conclusions:
Both ex-vivo and in-vivo MIR models showed a dose-dependent effect on reducing infarct size. This effect is most likely correlated with a reduction in rigor during myocardial ischemia. Future in-vivo studies will test 2 mg/kg and 7.5 mg/kg in rat and porcine MIR respectively. The infarct reducing effect of NTI might benefit patients who will opt for elective PCI, CABG, and transplant.
Abstract 17825: Heart Rate Fragmentation Analysis May Suggest Non-Autonomic Markers of Sudden Cardiac Death Risk in Adults With Williams-Beuren Syndrome
Authors: Cathey Brianna , levin mark D , Fu Yi-Ping , Smith Kevin , Osgood Sharon , Raja Neelam , Kozel Beth
Published: December 2023

Background:
Williams-Beuren syndrome (WBS) is a rare genetic disorder caused by a chromosomal microdeletion (7q11.23). It confers increased arrhythmia and sudden cardiac death (SCD) risk. Mechanisms underlying this risk remain obscure. We recently found HRV abnormalities in individuals with WBS that are known to correlate with sudden death risk in diabetes and following MI and stroke. Heart rate fragmentation (HRF) correlated with adverse CV events in some studies where HRV failed to identify high-risk subjects. Some argue that HRF quantifies non-autonomic CV modulators. We, therefore, sought to further explore non-autonomic modulators of cardiovascular disease by performing HRF analysis in a cohort of adults with WBS.

Hypothesis:
We hypothesize that those with WBS may exhibit increased sudden death risk from mechanisms not detected by conventional HRV measures.

Aims:
We aim to 1) Identify biomarkers that are predictive of SCD risk in WBS, and 2) Determine if HRF quantifies non-autonomic CV modulators.

Methods:
We performed HRF analyses on 24hr ECGs in subjects with WBS (n=18) and age- and sex-matched controls (n=18) enrolled in a prospective NIH study. HRF analyses include the percentage of inflection points (PIP), percentages of hard (PIP
H
) and soft (PIP
S
) inflection points, and the distribution of “words”, where W
0
,W
1
,W
2
, W
3
represent sequences of 4 beats with 0, 1, 2, or 3 inflection points. Inflection points were defined as a change in NN by more than 1/s, where ‘s’ is the sampling frequency. Mann-Whitney tests were used to compare HRF in subjects vs. controls. Spearman’s correlation was used to compare HRF to traditional HRV.

Results:
HRF markers (PIP, PIP
S
, and W
3
) were significantly elevated in WBS subjects (P<0.003)(Fig 1A-C). PIP
S
and W
3
were negatively correlated with parasympathetic markers HF power and SD1 among WBS subjects (Fig 1D).

Conclusion:
HRF may quantify some non-autonomic modulators of sudden death risk in those with WBS.