bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14765: Long-Term Outcomes of Second-Generation Drug-Eluting Stents versus Coronary Artery Bypass Graft: A Sistematic Review and Meta-Analysis
Authors: Carvalho Ferreira Andre , Lacalle Almir , Prado Saad Gabriel , Lima Ana , Benitez Gonzalez Maria E , Guida Camila
Published: December 2023

Introduction:
Long-term data is limited on the comparative outcomes of percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (S-DES) versus coronary artery bypass grafting (CABG) in patients with coronary artery disease (CAD).

Hypothesis:
Our aim was to conduct a systematic review and meta-analysis comparing mortality and cardiovascular outcomes in patients with left main or multivessel CAD who underwent PCI with an S-DES versus CABG with a minimum mean follow-up period of 3 years.

Methods:
We searched PubMed, Embase, and Cochrane for studies that examined our clinical question. Three reviewers independently performed study selection and data extraction. Statistical analysis was performed using Review Manager 5.4.1. We calculated pooled hazard ratios (HR) with 95% confidence intervals (CI) under a random effects model. The data from observational studies were extracted and pooled as multivariable-adjusted HR or propensity score matching to minimize confounding.

Results:
We included 10 studies, 2 of which were randomized controlled trials (RCT), with a total of 25,866 patients, of whom 11,482 (44.3%) underwent PCI. The mean follow-up ranged from 3.0 to 11.8 years. S-DES had a significantly higher risk than CABG for all-cause mortality (HR 1.36; 95% CI 1.10-1.68; p=0.005) and myocardial infarction (MI) (HR 1.89; 95% CI 1.12-3.18; p=0.02). No significant difference between the groups was found for major cardiovascular events (HR 1.10; 95% CI 0.98-1.23; p=0.11) and stroke (HR 0.83; CI: 0.60-1.15; p=0.27). In a subgroup analysis of RCTs, there was no significant difference between patients who underwent S-DES or CABG.

Conclusion:
In this meta-analysis of RCTs and multivariable or propensity-matched observational studies, our findings suggest that PCI with S-DES is associated with an increased risk of mortality and MI events compared with CABG in patients with left main or multivessel CAD.
Abstract 14817: Influence of Timing of Mechanical Thrombectomy in Treatment of Intermediate-Risk Pulmonary Embolism
Authors: Chiang Caleb J , Bartos Jason , Gutierrez Alejandra
Published: December 2023

Background:
Acute pulmonary embolism (PE) is associated with significant morality. Patients with signs of right ventricular (RV) dysfunction are at a high risk of adverse events. Mechanical thrombectomy reduces RV strain and therefore is often performed in intermediate-risk PE. The optimal timing of the procedure is uncertain. We aimed to assess the influence of timing of mechanical thrombectomy on outcomes in patients with intermediate-risk PE.

Methods:
A single-center, retrospective study collected patient data between 7/2020 and 1/2023. Adults presenting with an intermediate-risk PE who were treated with mechanical thrombectomy were included. Patients with high risk PE were excluded. We compared patient outcomes between individuals receiving intervention within 12 hours of diagnosis (early treatment; ET) to those receiving intervention after 12 hours of diagnosis (delayed treatment, DT). Our primary outcome was change in pulmonary artery pressures. Secondary outcomes included length of stay, intubation rates, vasopressor need and mortality.

Results:
69 patients (52% male) were included for analysis. Of these, 37 were included in the ET group and 32 in the DT group. Presenting WHO class was higher in the ET group. Other baseline demographics, presenting vital signs, and echocardiographic parameters were similar between groups (Table). Patients in the ET group had a greater reduction in their pulmonary artery systolic pressure (PASP) after intervention compared to the DT group (-14.8 mm Hg vs. -8.3 mm Hg, p = 0.05; Fig). There were no differences in mortality, intubation rate, vasopressor or inotrope use between groups. There was no significant difference in overall hospital length of stay (LOS), though there was a trend towards shorter ICU LOS in the ET group (1.92 d vs. 4.2 d, p = 0.056).

Conclusions:
When performed for intermediate-risk PE ET is associated with greater reductions in PASP compared to DT.
Abstract 14878: Be Aware of False Negative Bubble Study in Diagnosis of Patent Foramen Ovale!
Authors: Elgwairi Emadeldeen , Dickson Stephen , Friedman Brian
Published: December 2023

Introduction:
Echocardiography plays an important role in diagnosis of Patent Foramen Ovale (PFO). However, there are some anatomic variations which may result in a false negative study.

Case presentation:
A 55-year-old male was hospitalized for acute right-hemiplegia. The EKG revealed normal sinus rhythm. Brain imaging revealed acute bilateral infarcts. The transthoracic echocardiogram (TTE) showed a normal ejection fraction without significant valve disease and a negative agitated saline Bubble study. A Trans-esophageal echocardiogram (TEE) revealed a negative Bubble study using intravenous access via the left arm. The TEE also revealed an atrial septal aneurysm and large eustachian valve (EV). The Bubble study was then repeated with agitated saline injected from lower extremity. This demonstrated a significant right to left shunt through a PFO.

Discussion:
EV is a remnant of the valve of the inferior vena cava that directs blood flow through the fossa ovalis during embryonic life. A large or prominent EV may be a risk factor for paradoxical embolism by preventing spontaneous foramen closure. Agitated saline originating from the superior vena cava (SVC) may result in a false-negative study due to the prominent EV preventing microbubbles from the SVC from crossing the interatrial septum. In this case, the patient’s age, clinical presentation and the finding of EV and atrial septal aneurysm raised the suspicion of PFO. Repeating the bubble study using a lower extremity peripheral access was positive. This step played a crucial role in the diagnosis of PFO in this patient and his subsequent management.

Conclusion:
Cardiologists should be aware that the presence of a prominent EV may result in a false negative bubble study result when the injection is performed via upper limb intravenous access.
Abstract 14879: Stroll in Style: Rocking the MCS Catwalk!
Authors: Bhardwaj Anju , saatee siavosh
Published: December 2023

Introduction:
Patients who present with cardiogenic shock may require temporary mechanical circulatory support (tMCS) devices in the ICU.

Hypothesis:
Physical therapy (PT) and rehabilitation is associated with improved outcomes. But literature investigating the feasibility and safety of mobilization in patients on tMCS is limited.

Methods:
In this survey-based study, we examined various practice patterns in ambulating patients supported on tMCS globally. We received 93 responses of which 73 (80.22%) were from United States.

Results:
82 programs believed that mobilization improved outcomes in these patients. Of these 81 programs (87.1%) ambulate patients supported on tMCS, but only 61 programs (65.59%) have an MCS trained physical therapist ambulating patients on tMCS. 72 programs (77.42%) reported staffing issues as a limiting factor in mobilizing these patients. (Figure 1) 82 programs (88.17%) would change the cannulation site for more convenient patient mobilization. 59 (63.44%) programs reported complications associated with mobilization which included device/cannula dislodgement, pump malfunction, bleeding, hemolysis, etc. (Figure 2) Only 41 programs (44.1%) have a guideline or protocol to ambulate these patients.

Conclusions:
We conclude that current state of PT in patients on tMCS is suboptimal and needs a uniform standardized protocol. Most programs need an experienced physical therapist to facilitate mobilization of these patients. We also outlined various patient and device related factors which can improve mobilization and outcomes in these patients. More studies are needed to assess impact of mobilization on outcomes and length of stay.
Abstract 14892: Sex Difference in the Prognostic Power of Growth Differentiation Factor 15 for Cardiovascular Event: The Japan Morning Surge-Home Blood Pressure Study
Authors: Hoshide Satoshi , Kario Kazuomi
Published: December 2023

Introduction:
Growth differentiation factor 15 (GDF-15), a cytokine secreted in response to cellular stress and inflammation, has been associated with cardiovascular event. Although previous studies have reported that there was a close association between sex hormones and GDF-15, data are sparse about sex difference in the prognostic power of GDF-15 for cardiovascular event.

Hypothesis:
We hypothesized that there is the differential prognostic power of GDF-15 for cardiovascular outcome according to gender.

Methods:
This prospective practitioner-based cohort study was conducted between 2005 and 2012 and included participants in the Japan Morning Surge-Home Blood Pressure Study with a history of at least one cardiovascular event who had GDF-15 measurements at baseline.

Results:
The study included 4066 participants (mean age 64.8 years; men, n=1897; women, n=2169). During an average 6.2 years follow-up, 249 cardiovascular events (coronary artery disease, stroke and heart failure) occurred. GDF-15 levels were significantly higher in the male vs. the female group (median [interquartile], 1014 [741.3-1432] ng/L vs. 909.9 [671.6-1257] ng/L; P<0.001). In women, multivariate Cox analysis revealed that after adjusting other potential predictors, log-transformed GDF-15 was independently associated with cardiovascular events (Hazard ratio [HR], 2.09; 95% confidence interval [CI], 1.31-3.35; P=0.002), whereas this association was not found in men. In women, higher GDF-15 (≥1200 ng/L) was independently associated with cardiovascular event (HR, 2.23; 95%CI, 1.41-3.53; P=0.001), whereas this association was not found in men. The interaction between higher GDF-15 and cardiovascular event according to sex tended to be significant (P=0.087).

Conclusions:
There is a sex difference in the prognostic power of GDF-15 for cardiovascular event.
Abstract 14906: Incidence and Impact of Takotsubo Syndrome in Hospitalized COVID-19 Patients
Authors: Li Pengyang , Shi Ao , Lu Xiaojia , Li Chenlin , CAI Peng , Teng Catherine , Wu Lingling , Liu Qi
Published: December 2023

Background:
Takotsubo syndrome (TTS) has been reported in coronavirus disease-2019 (COVID-19) patients, although minimal data are available. Objectives: We assessed the incidence and impact of TTS on hospitalized COVID-19 patients.

Methods:
We conducted a retrospective cohort study using ICD-10 to identify patients with a primary diagnosis of COVID-19 with or without TTS in the National Inpatient Sample 2020 database. We compared outcomes between both groups after propensity score matching for patient and hospital demographics and comorbidities.

Results:
A total of 211,448 patients with a primary diagnosis of COVID-19 were identified. Of these, 171 (0.08%) had a secondary diagnosis of TTS. Before matching, COVID-19 patients with TTS, compared with those without TTS, were older (68.95 vs 64.26 years) and more likely to be female (64.3% vs 47.2%) and to have anxiety (24.6% vs 12.8), depression (17.5% vs 11.4%), and COPD (24.6% vs 14.7%) (all p<0.05). The TTS group had worse outcomes in death (30.4% vs 11.1%), cardiac arrest (7.6% vs 2.1%), cardiogenic shock (12.9% vs 0.4%), length of stay (LOS, 10.7 vs 7.5 days), and total charges ($152,685 vs $78,468), respectively (all p< 0.001). After matching, the TTS group (n=170), compared with the non-TTS group (n=508), had a higher incidence of inpatient mortality (30% vs 14%, p<0.001), cardiac arrest (7.6% vs 2.8%, p=0.009), and cardiogenic shock (12.4% vs 0.4%, p<0.001), a longer LOS (10.7 vs 7.6 days, p<0.001), and higher total charges ($152,943 vs $79,523, p<0.001).

Conclusions:
TTS is a rare but severe in-hospital complication in COVID-19 patients.
Abstract 14928: Coronary Artery Disease Impacts Cardiac Remodeling in Patients Treated for Severe Aortic Stenosis in the PARTNER Trials
Authors: Daubert Melissa A , Xu Ke , Hahn Rebecca T , Pibarot Philippe , Leipsic Jonathon , Clavel Marie-Annick A , Elmariah Sammy , Weissman Neil J , Asch Federico M , Khalique Omar , Leon Martin B , Cremer Paul C , Lindman Brian R , Alu Maria , Douglas Pamela S
Published: December 2023

Introduction:
Coronary artery disease (CAD) is common in patients with severe aortic stenosis (AS), but the impact on cardiac remodeling and outcomes after AS treatment is unknown.

Hypothesis:
We hypothesize that greater CAD burden will be associated with less beneficial remodeling and increased adverse events.

Methods:
Patients with severe AS in the PARTNER (Placement of Aortic Transcatheter Valves) 1, 2 or 3 trials, with baseline and 1 year echoes, were categorized as: 1. Obstructive CAD (coronary stenosis ≥50% on invasive angiography, prior myocardial infarction (MI) or previous revascularization); or 2. Non-obstructive or no CAD (all stenosis <50% and no prior MI or revasc). Clinical and imaging characteristics were compared and changes in cardiac structure and function were assessed at 1 year. Associations between CAD, cardiac remodeling and cardiovascular (CV) events at 2 years were examined.

Results:
Among 5552 patients with severe AS, 1598 (28.8%) had non-obstructive or no CAD and were more likely to be female (67.1%), have fewer CAD risk factors, and receive SAVR (28% vs. 19%) compared to those with obstructive CAD (all p<0.0001). Despite lower LV mass index (LVMi), patients with non-obstructive or no CAD had higher aortic valve velocities, gradients, ejection fraction (EF) and stroke volume index compared to those with obstructive CAD. After 1 year, the decrease in LVMi was similar between groups (p=0.91), but patients with obstructive CAD were more likely to increase EF by ≥5% (p=0.006), reduce LV dimensions (p=0.04), or decrease mitral regurgitation (p=0.01). After adjustment for baseline factors and AS treatment, CV death or heart failure (HF) hospitalization was higher among patients with obstructive CAD (HR 1.16, 95% CI: 1.03-1.30, p=0.01). When LV remodeling at 1 year was also adjusted for, the point estimate was similar but there was no significant difference in the landmarked rate of CV death or HF hospitalization between year 1 and 2 (HR 1.22, 95% CI: 0.95-1.56, p=0.12).

Conclusions:
Nearly a third of patients with severe AS did not have obstructive CAD and had a better prognosis after treatment for AS. However, patients with obstructive CAD and LV remodeling were not at greater risk for CV events compared to those with non-obstructive or no CAD.
Abstract 14966: Happy Heart Syndrome: The Mid-Ventricular Variant of Takotsubo Cardiomyopathy Triggered by Pleasant Experiences
Authors: Hasan Md Rockyb , Alhussain Eman , Abdelsalam Mohammed , Vo Thien
Published: December 2023

Introduction:
A joyful event triggered chest pain in an elderly woman, leading to the diagnosis of a mid-ventricular variant of Takotsubo cardiomyopathy (TC).

Case presentation:
A 65-year-old woman experienced chest pain during a surprise retirement party. The initial electrocardiogram revealed T-wave inversions in leads V1 and V2, and her troponin I level was 6700 ng/ml. A coronary angiogram did not reveal any occlusion in the coronary arteries. However, the left ventriculogram exhibited findings consistent with the mid-ventricular variant of TC. The patient was treated with a diuretic, a beta-blocker, and an ACE inhibitor. A follow-up echocardiogram was scheduled after four weeks. Discussion: TC typically manifests with abnormal apical wall motion on the left ventriculogram, causing "apical ballooning" at end-systole and basal hyperkinesis, unrelated to specific major epicardial coronary artery distribution. Among patients presenting with symptoms resembling acute coronary syndrome (ACS), a study reported that 1.2% showed TC, with 60% exhibiting regional dysfunction in both apical and midventricular regions. In comparison, 40% had isolated dysfunction in the midventricular area. Other rare variants of TC have also been documented, including the inverted Takotsubo or basal variant, biventricular apical dysfunction, and isolated right ventricular Takotsubo syndrome. In a recent study, TC triggered by positive experiences ("happy heart syndrome"), the mid-ventricular variant was found to occur more frequently, representing 35% of the cases. The treatment for TC includes standard management of heart failure and regular follow-up echocardiography is recommended for surveillance.

Conclusion:
In cardiology, the often-overlooked atypical patterns of left ventricular dysfunction in Takotsubo cardiomyopathy (TC) and the challenges of diagnosing TC in patients with diverse emotional triggers pose difficulties.
Abstract 14968: Clonal Hematopoiesis and Cardiotoxic Risk After Hematopoietic Stem Cell Transplantation
Authors: Quartermaine Cooper J , Braunstein Zachary , Ruiz Miguel , Shaaban Adnan , Habib Alma , Kola-Kehinde Onaopepo , McLaughlin Eric , Sughra Sana , Ghazi Sanam , Ferdousi Mussammat , Ruz Patrick , Sansoterra Stephen , Byun Woo Yul , Byrd John C , Brammer Jonathan , Addison Daniel
Published: December 2023

Background:
Clonal hematopoiesis (CH) occurs as part of normal hematopoietic stem cell senescence and prior chemotherapy administration. As such, CH is frequent for patients undergoing allogeneic stem cell transplants (ASCT). CH has been identified as a driver of inflammation. In animals, inflammation plays a role in atrial fibrillation (AF) development, the most common cardiotoxicity after ASCT treatment. Yet, whether the presence of post-ASCT CH associates with AF risk is unknown.

Methods:
We analyzed bone marrow derived mononuclear cells from 201 cancer patients treated with ASCT by deep targeted amplicon sequencing (next generation sequencing) to detect the presence of select CH (defined as DNMT3A, TET2, ASXL1, IDH1, FLT3, JAK2 at VAF of ≥ 2%), irrespective of relapse status; at median 4 months post ASCT. Observed incident AF rates were compared to Framingham heart predicted rates. Cox regression and survival analysis were used to define factors associated with incident AF and MACE, as well as the relationship between the presence of post-transplant CH mutations and MACE risk. Further, we also assessed the effect of CH on post-ASCT survival outcomes. The presence of mutations was analyzed for an association with post-ASCT incident AF and overall survival.

Results:
Overall, the prevalence of CH in post-ASCT patients was 42.3% (85), including 29.5% with ≥2 mutations. Over a median follow-up of 33 months, 11.5% of patients developed incident AF and 29.9% experienced MACE. In those without prior AF, the weighted average incidence was 407/10,000 person-years compared to the Framingham-predicted 63/10,000 person-years (RR 6.4,
P
<0.001; AER 344). In follow-up, increased CH burden associated with increased risk of incident AF (HR 3.6,
P
=0.04), cancer-progression (HR 2.6,
P
=0.006), and mortality (HR 2.09,
P
=0.047);
Figure
. There was no difference in non-AF MACE.

Conclusions:
The presence of CH in ASCT treated cancer patients appears to associate with increased AF risk.
Abstract 14972: Association Between CEC Measured by Immobilized Liposome-Bound Gel Beads Method and the Size of Lipid-Rich Coronary Artery Plaque
Authors: Miyakoshi Tsunehiro , Horiuchi Yuna , Araki Makoto , Yonetsu Taishi , Watanabe Mei , Nakamura Motoki , Kameda Takahiro , Yoshimoto Akira , Ichimura Naoya , Tohda Shuji , Tozuka Minoru , Sasano Tetsuo , Ohkawa Ryunosuke
Published: December 2023

Introduction/Background:
High-density lipoprotein (HDL) exerts cholesterol efflux capacity (CEC), and it ameliorates cardiovascular disease (CVD). CEC had been expected as a surrogate biomarker in addition to HDL cholesterol (HDL-C), which has been found not always to reflect the CVD risk. However, the procedures of the conventional CEC assays were too complex to be introduced into clinical practice because of cell-based assay. Given this situation, we invented novel cell-free CEC assay named immobilized liposome-bound gel beads (ILG) method. ILG method utilizes liposomes which contain fluorescence labeled cholesterol instead of lipid loaded foam cells, and has advantage of simplicity of procedure and accuracy.

Reserch Question/Hypothesis:
Does ILG method show some associations between CEC and HDL subclass, and also reflect the condition of coronary artery plaque?

Goals/Aim:
We aim to demonstrate CEC by ILG method has clinical significance for assessment of the CVD risk.

Methods/Approach:
Patients who underwent diagnostic catheterization or percutaneous coronary intervention were enrolled, and 61 patients were examined through CEC analysis by ILG method and assessment of coronary artery plaque by optical coherence tomography (OCT) imaging. Large lipid-rich plaque was defined as a lipid plaque with a lipid arc ≥180°and lipid length ≥5 mm. Serum HDL subclass was analyzed by enzymatic assay (Denka). We defined the ratio apolipoprotein E(apoE)-containing HDL-C to HDL-C as %apoE, and we also calculated the value of HDL
3
-C/HDL
2
-C, and classified HDL
3
- or HDL
2
-rich group.

Results/Data:
HDL-C was positively associated with %apoE, and CEC of apoE-rich patients was higher than that of apoE-poor patients. This correlation was maintained after classified based on size of HDL. CEC and %apoE in patients with large lipid-rich plaque were significantly lower than in those in without. In contrast, there was no significant difference in HDL-C and LDL-C.

Conclusion:
In present study, ILG method showed that apoE has some influence on CEC, and CEC was inversely correlated with size of lipid-rich plaque. These results implied that ILG method, suitable CEC assay for clinical site, might be useful to assess the CVD risk.
Abstract 14978: Using a Machine Learning Risk Score to Predict Outcomes in Patients Undergoing LVAD Implantation: An Analysis of the INTERMACS Database
Authors: John Sonya , Park Jin Joo , Yagil Avi , Campagnari Claudio , Greenberg Barry , Adler Eric
Published: December 2023

Background:
Left ventricular assist device (LVAD) implantation is a viable treatment option for end-stage heart failure patients. Despite its benefits, outcomes of LVAD surgery can vary significantly, underscoring the importance of accurately assessing patients' risk prior to the procedure. MARKER-HF is a mortality risk model that utilizes machine learning algorithms to predict outcomes in HF patients.

Aim:
We assessed the predictive accuracy of MARKER-HF in patients undergoing LVAD implantation and determined whether it offered prognostic information beyond the INTERMACS profile.

Methods:
We calculated the MARKER-HF score in 25,365 patients from the INTERMACS database who underwent LVAD implantation between 2006 and 2020 and divided the population into 4 risk groups based on their score (low <-0.2; moderate: -0.2 - 0; high: >0 - 0.2; very high: >0.2). The outcomes of interest were in-hospital and post-discharge 1-year mortality.

Results:
There was a negative correlation between the MARKER-HF score and INTERMACS profile (Pearson r = -0.348). MARKER-HF score exhibited a wide distribution within each INTERMACS profile. During the index hospitalization, 1383 (5.5%) patients died. The in-hospital mortality increased steadily with a higher MARKER-HF score, ranging from 2.9% in low to 13.8% in very high-risk groups, while it decreased with a higher INTERMACS profile. When combining the MARKER-HF and INTERMACS profile, we identified both patients with the lowest (2.6%) and the highest in-hospital mortality (16.1%). In a Cox-proportional hazard regression analysis adjusting for both MARKER-HF and INTERMACS profile, only the MARKER-HF score was significantly associated with increased post-discharge mortality (hazard ratio: 1.25, P<0.001), but not INTERMACS profile (P=0.847).

Conclusion:
The MARKER-HF score is a simple non-invasive tool that can assist with optimal decision-making and can add additional information beyond the INTERMACS classification.
Abstract 14988: Clinical Impact of Biventricular vs. Isolated Left Ventricular Involvement Among Patients With Takotsubo Cardiomyopathy- An Updated Meta-Analysis
Authors: Erdem Saliha , Hamza Mohammad , Patel Dhruvil , kanwar Amrit , Taha Amro , Dayco John , Afonso Luis
Published: December 2023

Introduction:
Takotsubo Cardiomyopathy (TC) is a form of acute nonischemic cardiomyopathy manifesting as a transient state of cardiac dysfunction. Isolated left ventricular TC (ILVTC) is most commonly observed, less frequently, superimposed right ventricular involvement is apparent - referred to as biventricular TC (BVTC). Few analyses have been done to characterize the implications of biventricular TC on hospital courses and outcomes.

Methods:
A literature search was conducted on PubMed and Google Scholar to identify qualifying studies. Inclusion criteria were adult patients with TC, and studies reporting comparison of outcomes (cardiogenic shock, use of inotropes, all causes of mortality, and length of hospital stay) between patients with BVTC and ILVTC. Exclusion criteria were any studies that reported on patients younger than 18 years or did not report all the outcomes for BVTC vs ILVTC.

Results:
A total of 1,156 patients with TC were analyzed from 6 included studies, of which 15% had BVTC (n=175), and 85% had ILVTC (n=981). Patients with BVTC were found to have a higher incidence of cardiogenic shock patients (OR:3.3; 95% CI=1.40-7.77) and use of inotropes (OR:3.66; 95% CI =1.60-8.35). All-cause mortality did not reach statistical significance between the two groups (OR:2.05; 95% CI=0.81 - 5.22; p <0.13). There was also no significant difference in length of hospital stay (Hedges’ g = 0.22; 95% CI = -0.01 to +0.45; p = 0.0593).

Conclusions:
In comparison to ILVTC, BVTC increasingly predisposes to cardiogenic shock development. Yet, the presence of biventricular involvement does not impact the risk of mortality or hospital length of stay when compared to ILVTC.
Abstract 15036: Identification of Fabry Disease Cardiac Phenotype in Hypertrophic Cardiomyopathy With Cardiac Magnetic Resonance Imaging Technology
Authors: li jialin
Published: December 2023

Introduction:
Cardiac magnetic resonance(CMR), especially T1 mapping, has an important role in the diagnosis of Fabry disease, but the differential value in myocardial diseases with hypertrophic phenotype needs further study. More importantly, there has been no systematic study of the difference between different CMR techniques indistinguishing Fabry cardiomyopathy from hypertrophic cardiomyopathy (HCM).

Hypothesis:
Myomapping technology can be a parameter in distinguishing Fabry cardiomyopathy from HCM.

Methods:
We continuously included patients with clinically diagnosed hypertrophic cardiomyopathy, completed systematic magnetic resonance imaging, and used genetic testing as the diagnostic criteria. We reported the prevalence rate in the population of HCM, and deeply conducted comparative studies on the differences in magnetic resonance characteristics between Fabry disease and HCM. We also analyzed the diagnostic value of magnetic resonance imaging in distinguishing Fabry cardiomyopathy from HCM.

Results:
We continuously included patients diagnosed with hypertrophic cardiomyopathy at West China Hospital from 2012 to 2022 and completed systematic magnetic resonance imaging examinations. We reported the prevalence of Fabry cardiomyopathy in the population using genetic testing as the diagnostic criteria, and deeply conducted comparative studies on the differences in CMR features between Fabry disease and HCM. We also analyzed the diagnostic value of CMR in distinguishing Fabry cardiomyopathy from HCM.

Conclusions:
We found a prevalence of 13 (2.6%) cases of Fabry disease in the hypertrophic cardiomyopathy cohort (494 cases). Our further analysis found that there were no significant differences in the degree of hypertrophy, overall cardiac function and size of Fabry patients compared with patients with HCM, as well as strain analysis. NativeT1 was significantly reduced in Fabry disease, and segmental analysis found that the basal and middle ventricular septum and anterior wall were the most obvious. ECV differed significantly between the two groups. There was no difference in T2 between the two groups. ROC analysis showed that T1 had the most discriminating value
Abstract 15053: Distinct Effects of Sacubitril/Valsartan on Left Atrial Function Between Heart Failure With Preserved and Reduced Ejection Fraction
Authors: Hashimoto Takaaki , Hashimoto Kaho , Iijima Aika , Karasawa Yuka , Amano Kazushige , Hama Tomoaki , Fujii Toshiharu , Kawamura Youta , Ushijima Akiko , Yoshimachi Fuminobu , Morita Norishige , Murata Mitsushige
Published: December 2023

Background:
Although Sacubitril/Valsartan(S/V) could ameliorate left ventricular (LV) function, it was recently reported that S/V worsened the left atrial (LA) remodeling in pre-heart failure with preserved ejection fraction (pre-HFpEF). However, the effects of S/V on LA function remains controversial in heart failure. Accordingly, this study investigated the effects of S/V on LA function and remodeling in both HFpEF and HFrEF.

Methods:
This was a single-center retrospective study of patients with HF hospitalized at our hospital. Patients with HF underwent clinical evaluation and echocardiography at baseline and after administration with S/V. LA volume index (LAVI) , LA emptying fraction (LAEF), transmitral peak E wave velocity (E), pulsed-wave TDI e’ velocity (e’), and E/e` were measured by echocardiography.

Results:
A total of 71 consecutive patients (71 ± 13 years, 70% male) were enrolled in this study. Among them, 29 were patients with HFpEF (LVEF 55 ± 7%), and 42 were HFrEF (LVEF 28 ± 7%). S/V administration significantly reduced the serum brain natriuretic protein level in HFpEF and HFrEF (279 ± 343 to 155 ± 214 pg/ml, 638 ± 642 to. 218 ± 288 pg/ml, p<0.05, respectively). LAVI was also significantly decreased after S/V administration in HFpEF and HFrEF (41 ± 11 to 38 ± 12 ml/m
2
, 50 ± 19 to. 41 ± 21 ml/m
2
, p<0.05, respectively), implicating its effects on LA reverse remodeling. Furthermore, the significant decrease in the velocity of E wave and E/e’ were observed in HFpEF and HFrEF. However, LAEF were significantly improved in HFrEF, but not in HFpEF, while e’ were improved in HFpEF, but not in HFrEF. These results indicated that the effects of S/V might be attributable to LV relaxation in HFpEF and to LA reservoir function in HFrEF.

Conclusions:
This study demonstrated that treatment with Sacubitril/Valsartan could lead to LA reverse remodeling in both HFpEF and HFrEF, possibly due to the distinct mechanisms of Sacubitril/Valsartan for improving the LA function. Further studies should be needed to be clarified.
Abstract 151: The PRINCESS 2 Trial: A Randomized Study to Assess the Impact of Ultrafast Hypothermia on Neurologic Function in Out-of-Hospital Cardiac Arrest With Initial Shockable Rhythm
Authors: Dillenbeck Emelie , Hollenberg Jacob , Holzer Michael , Busch Hans-Joerg , Nichol Graham , Radsel Peter , Belohavek Jan , Forsberg Sune , Annoni Filippo , Svensson Leif , Jonsson Martin , Bäckström Denise , Gellerfors Mikael , Awad Akil , Taccone Fabio S , Nordberg Per
Published: December 2023

Background:
The impact of ultrafast hypothermia, i.e. delivered intra-arrest or immediately after return of spontaneous circulation (ROSC), on functional neurologic outcome after out-of-hospital cardiac arrest (OHCA) is unclear. In two prior trials, prehospital transnasal evaporative intra-arrest cooling was safe, feasible and reduced time to target temperature. Both studies showed trends towards improved neurologic recovery in patients with shockable rhythms. The aim of the PRINCESS2-study is to assess whether cooling, initiated either intra-arrest or immediately after ROSC, followed by in-hospital hypothermia, significantly increases survival with complete neurologic recovery as compared to standard normothermia care, in OHCA patients with shockable rhythms.

Methods/Design:
This investigator-initiated, randomized, controlled trial will randomize patients at the scene of cardiac arrest to either transnasal cooling within 20 minutes from Emergency Medical System arrival with subsequent hypothermia at 33°C for 24 hours after hospital admission (intervention), or to standard of care with no prehospital or in-hospital cooling (control). Fever (>37,7
o
C) will be avoided for the first 72 hours in both groups. All patients will receive post resuscitation care and withdrawal of life support procedures according to current guidelines. Primary outcome is survival with complete neurologic recovery at 90 days, defined as modified Rankin scale (mRS) 0-1. Key secondary outcomes include survival to hospital discharge, survival at 90 days and mRS 0-3 at 90 days. In total, 970 patients are required to detect an absolute difference of 9 % (from 45 to 54 %) in survival with neurologic recovery (80 % power and 2-sided α=0,5). Recruitment starts in Q3 2023 and we expect maximum enrolment to be achieved during 2024 at 20-25 European and US sites.

Discussion:
This trial will assess the impact of ultrafast hypothermia applied on the scene of cardiac arrest on survival with complete neurologic recovery in patients with OHCA and shockable rhythm
Abstract 15114: Enhanced External Counter Pulsation for Treatment of Angina With No Obstructive Coronary Artery Disease (ANOCA)
Authors: Ashokprabhu Namrita D , Fox Jessie , Shah Sachin , Roca Alvarez Yulith , Schmidt Christian , TIERNEY DARLENE , Thompson Lauren , Henry Timothy D , Quesada Odayme
Published: December 2023

Background:
Angina and no obstructive coronary artery disease (ANOCA) is associated with poor outcomes and limited treatment options. Enhanced external counterpulsation (EECP) is a non-invasive treatment that involves applying external inflatable cuffs to the lower extremities to increase blood flow during diastole (diastolic augmentation and increased preload), followed by deflation during systole (decreased afterload). Although EECP is indicated in refractory angina patients, its effectiveness in treating refractory angina in ANOCA patients is relatively unknown and limited to small case series.

Objective:
Assess the efficacy of EECP treatment in ANOCA patients using Canadian Cardiovascular Society (CCS) angina class, 6-minute walk test (6MWT), Duke Activity Status Index (DASI), Seattle Angina Questionnaire (SAQ), and weekly anginal episodes.

Methods:
We examined ANOCA patients (defined as £50% stenosis in any major epicardial vessels) with CCS class 3 or 4 angina that completed EECP treatment at 2 large centers. CCS class, 6MWT, DASI, SAQ, and weekly anginal episodes were evaluated pre- and post- EECP treatment, as data was available. A paired Student’s t-test, Wilcoxon signed-rank test, and McNemar’s test were utilized as appropriate.

Results:
65 ANOCA patients (63% female; 60±11 years) that completed 35±2 EECP sessions were included. Patients were on 4±2 cardiac medications pre-EECP (78% statin, 52% ACEI/ARB, 62% BBs, 34% CCBs, 48% nitrates, and 53% ranolazine). Post-EECP, 42 patients (65%) had an improvement of
3
1 CCS angina class with 16 (25%) improving by
3
2 classes. Significant improvements in CCS angina severity, 6MWT, DASI, SAQ, and weekly anginal episodes were evident post-EECP (
Table
).

Conclusion:
In ANOCA patients, EECP therapy reduces CCS angina class and improves exercise tolerance. EECP should be considered in ANOCA patients with refractory angina CCS class 3 or 4 as a part of optimal medical therapy.
Abstract 15132: Proteomic Signatures of Human Immunodeficiency Virus-Associated Subclinical Left Atrial Dilation
Authors: Peterson Tess E , Hahn Virginia S , Haberlen Sabina , Plankey Michael , Palella Frank , Bader Joel , Margolick Joseph , Kirk Gregory , Piggott Damani , Brown Todd T , Post Wendy S , Wu Katherine C
Published: December 2023

Introduction:
Persons living with HIV (PLWH) receiving combination antiretroviral therapy (cART) are at higher risk of heart failure (HF) and preceding cardiac abnormalities, including left atrial (LA) dilation, compared to persons without HIV (PWOH). Mechanisms of this excess risk are unclear. We assessed whether plasma proteomic signatures of immune activation are cross-sectionally associated with LA volume index (LAVi) and augmented among PLWH.

Methods:
We performed Olink proteomics on plasma obtained concurrently with cardiac magnetic resonance among PLWH and PWOH. Proteins were analyzed individually and as clusters agnostically defined using weighted gene co-expression network analysis. Associations with HIV serostatus and LAVi were estimated using multivariable linear regression with robust variance. We explored protein relationships using annotated enrichment analysis.

Results:
Among 352 participants (age 55±6 years; 25% female; 70% Black), mean LAVi was 29±9 mL/m
2
and 60% were PLWH (88% on cART; 73% with undetectable plasma HIV RNA). Of 2594 proteins, 104 were independently associated with LAVi (false discovery rate, FDR<0.05). We identified 49 of these as candidate contributors to the association between HIV seropositivity and higher LAVi (36 when excluding PLWH with detectable HIV RNA), enriched in T-cell activation and leukocyte cell adhesion regulators. We identified one protein cluster positively associated with LAVi and HIV seropositivity regardless of HIV suppression status, enriched in TNF signaling, ephrin signaling and extracellular matrix (ECM) organization.

Conclusion:
Proteomic signatures that may in part account for HIV-associated elevation in LAVi are enriched in pathways of immune activation, cytokine signaling and ECM organization, even among virally suppressed PLWH on cART. These findings support a link between persistent immune activation and subclinical LA dilation which may portend future risk for HF among PLWH.
Abstract 15137: microRNA-132 Inhibition Improves Cardiac Function and Reduces Remodeling in Patients With Heart Failure With Reduced Ejection Fraction (HFrEF): An Exploratory Subgroup Analysis of the CDR132L First-in-Human Study
Authors: Taubel Jorg , Hauke Wilfried , Rump Steffen , Viereck Janika , Bauersachs Johann K , Solomon Scott , Thum Thomas
Published: December 2023

Background:
The CDR132L first-in-human (FiH) study examined safety, tolerability, pharmacokinetic, and exploratory pharmacodynamic effects of different ascending doses of the novel antisense oligonucleotide CDR132L targeting microRNA-132-3p (miR-132) in patients with stable heart failure (HF) of ischemic origin receiving standard-of-care (n=28). The study population was not stratified according to their left-ventricular ejection fraction (LVEF), and therefore heterogenous, but equally distributed among heart failure with reduced or preserved ejection fraction (HFrEF or HFpEF).

Research question:
In an exploratory post-hoc analysis of pharmacodynamic parameters we specifically focused on patients with HFrEF (with a LVEF<45% at baseline, n=14) and, based on our predictive PK/PD modeling, categorized patients into ‘non-pharmacodynamically active’ (non-PD active; placebo and 0.32 mg/kg CDR132L group) and 'pharmacodynamically active' (PD active; patients receiving 1, 3, or 10 mg/kg CDR132L).

Results:
The PD active group showed a significant median reduction in NT-proBNP by 37.1% between baseline and study endpoint (day 112) while this HF biomarker was increased by 17.7% in the non-PD active group (p=0.0152, Mann-Whitney U test). CDR132L treatment provoked a trend towards 6.1% improvement in LVEF. For the non-PD active group only +1.4% were noted. An additional biomarker related to HF and cardiac fibrosis, lipocalin-2 (NGAL), tended to decrease in the PD active, but not in the non-PD active group.

Conclusion:
Analysis of the HFrEF subgroup in this FiH trial, although limited by the small patient numbers, indicatively underlines the encouraging benefits of CDR132L, a novel antisense drug, on LV function and cardiac remodeling as established in previous large animal HF models.
Abstract 15176: Artificial Intelligence Model Detecting Acute Myocardial Infarction Requiring Revascularization
Authors: Cho Kyung Hoon , Han Donghoon , Chang Mineok , Oh Seok , Lim Yongwhan , Ahn Joon Ho , Lee Seung Hun , Hyun Dae Young , Lee Namho , Choi Seonghoon , Cho Jung Rae , Kang Min-Kyung , Shin Dong-Geum , Ji Younghoon , Joo Sunghoon , Lee Yeha , Kim Min Chul , Sim Doo Sun , Hong Young Joon , kim Juhan , Ahn Young Keun , Jeong Myung Ho H
Published: December 2023

Background:
Rapid myocardial revascularization in patients with acute myocardial infarction (AMI) is essential for increasing the chances and extent of myocardial salvage and better clinical outcomes. There still have been largely missed opportunities in the timely diagnosis of AMI.
Research Questions:
Can artificial intelligence (AI) be helpful in timely diagnosing AMI?

Aims:
We aimed to develop an AI algorithm for detecting AMI requiring revascularization using electrocardiograms (ECGs).

Methods:
We developed an AI model detecting myocardial infarction requiring revascularization from a 12-lead ECG. This retrospective cohort study included 17,907 ECGs from 5,872 coronary angiography-validated AMI patients and 705,482 ECGs from 294,755 non-AMI patients at Chonnam National University Hospital between May 2013 and December 2020. External validation was performed at Hallym University Kangnam Sacred Heart Hospital using 357,072 ECGs from 163,870 patients between January 2006 and December 2020.

Results:
The prevalence rates of AMI-ECGs were 5.29% (1356/25,627) and 0.87% (3089/357,072) in the internal test and external validation set, respectively. The areas under the receiver operating characteristic curves (AUROC) were 0.958 (95% CI, 0.955 to 0.962), 0.988 (95% CI, 0.986 to 0.991), and 0.930 (95% CI, 0.923 to 0.936) in total, ST-elevation myocardial infarction, and non-ST-elevation myocardial infarction in the external validation, respectively (Figure 1A). Subgroup analysis assessing the efficacy of subsets of 12-lead ECG revealed that the AUROC were 0.926 (95% CI, 0.920 to 0.931), 0.921 (95% CI, 0.915 to 0.926), and 0.846 (95% CI, 0.839 to 0.854) in 6 limb-lead, lead combining I and II, and lead I, respectively (Figure 1B).

Conclusion:
Our AI model detecting myocardial infarction can be beneficial in identifying patients with acute myocardial infarction requiring revascularization timely.
Abstract 15189: Association of Serum Albumin Levels and Post Stroke Outcomes in Acute Ischemic Stroke. Analysis of the Norfolk and Norwich Stroke Registry
Authors: Thuemmler Rosa J , Pana Tiberiu A , Carter Ben , Bettencourt Joao H , Metcalf Anthony K , potter john , Myint Phyo K
Published: December 2023

Introduction:
Low serum albumin levels have been associated with poor acute ischemic stroke (AIS) outcomes. We hypothesised this relationship may be non-linear and aimed to assess it in a large cohort of unselected AIS patients with long term follow-up.

Method:
This retrospective cohort study included patients from the Norfolk and Norwich Stroke and TIA Register: consecutive AIS patients aged ≥40 years from Dec 2003-Dec 2016 with complete follow-up data. The primary exposure of interest was admission serum albumin. Assessed outcomes were in-hospital mortality, poor functional outcome at discharge (modified Rankin score of 3-6), length of stay (LoS) >4 days and long-term mortality. Poisson and Cox regressions were used to investigate the relationship between albumin and in-hospital and long-term outcomes, respectively. Restricted cubic splines modelled these relationships flexibly. All models were adjusted for confounders, including inflammatory markers on admission and stroke severity.

Results:
A total of 9,979 patients were included (mean age (standard deviation) = 78.3 (11.2) years, 57% female). The mean serum albumin was 36.69g/L (5.38); the median (IQR) was 37g/L (34-40). Lower-than-median albumin (<37g/L) was significantly associated with up to 2-fold higher long-term mortality risk (HR
max
; 95% confidence interval = 2.01; 1.61-2.49) and in-hospital mortality (RR
max
; 95% confidence interval = 1.48; 1.21-1.80). Higher-than-median albumin (>44g/L) was associated with higher long-term mortality (HR
max
1.12; 1.06-1.19), but not in-hospital mortality. There were no significant associations between admission albumin and LoS or poor functional outcome (
Figure
).

Conclusion:
Albumin <37g/L was associated with higher in-hospital and long-term mortality whilst levels >44g/L were associated with higher long-term mortality. Future studies should explore nutritional interventions for better stroke outcomes.
Abstract 15195: Utility of a Polygenic Risk Score for Dilated Cardiomyopathy in the General Population
Authors: Paldino Alessia , Figueiral Marta , Vyas Hridyanshu , Jenkins Gregory , Scott Christopher , Klee Eric , Rodeheffer Richard J , Medina-Inojosa Jose R , Redfield Margaret M , Burnett John C , Lopez-Jimenez Francisco , sinagra Gianfranco , Merlo Marco , Pereira Naveen L
Published: December 2023

Introduction:
Common genetic variation has been linked to an increased risk of developing dilated cardiomyopathy (DCM). However, the phenotypic profile, outcomes, and biological mechanisms by which such genetic background may predispose individuals to DCM are still unknown.

Hypothesis:
The primary objectives of this study were to develop a DCM polygenic risk score (PRS) based on prior case control-DCM GWAS and to apply this PRS to a well clinical characterized general population.

Methods:
The DCM-PRS was derived from 13 DCM risk alleles that were assayed in an unselected cohort (n=1897) of unrelated Olmsted County residents age >45 years who did not have a history of heart failure (HF) or CM and underwent physical examination, echocardiography, and blood analyses.

Results:
The entire population was equally divided into quartiles based on the DCM-PRS. No significant differences were present in terms of age (median 62 years) and sex (48% male). However, a significant correlation was detected between the DCM-PRS and left ventricle ejection fraction (LVEF) (Beta: -2.68, p<0.001), LV end-systolic diameter (Beta: 0.22, p<0.001), and LV end-diastolic diameter (Beta: 0.14, p=0.01). During a follow-up of 16 years (IQR: 15-17), 47 subjects developed DCM. Using a 3:1 non-DCM vs DCM matched cohort, a logistic regression analysis, found a significant correlation between median DCM-PRS and DCM development [OR=2.27 (1.06, 4.85), p=0.03]. However, there was no association between the DCM-PRS and HF biomarkers (aldosterone, natriuretic peptides, ST2, Galectin-3).

Conclusions:
DCM-PRS correlates with decreased LVEF, increased LV dimensions, and DCM development in a general population without significant differences in baseline clinical features. The absence of correlation between the DCM-PRS and available HF biomarkers suggests that this genetic background affects LV traits and DCM development independent of these biological mechanisms.